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Home My WebLink AboutGATEWAY TO THE PARK BLK 1 LT 5Gateway To The Park Block 1 Lot 5 #067-601-02 Municipality of Anchorage,Building Safety Divisiontr 01>Development Services Department �tYy On -Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page www. ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SW D G Q /J Z PID Number. 067- .. of 60I-02, Name Dick Stiefken _ Wastewater System: 0 New ® Upgrade Aeele•F 32461 Mt Korohusk Eagle River, AK ABSORPTION FIELD Ptxne ar 696-8902 Nro. 3Bedrooms°® Deep Trench a shallow Trench a end o Mand o Other LEGAL DESCRIPTION SodRating 2.0 GPD/FT Total Depth from angered grgraba 7.0 7.D FI. Block La Subdivision: 1 5 Gateway to the Park Depth to ppe baton horn anginal grade 3 n. Gravel depth beneath ppe- 4.0 FI Township Range Seem Fa added above original gine 0.94-1.9 FI. Gravel Length 24 FI. Well: ■ New 0 Upgrade Gravel wan 5.0 FI. Number of Ines 1 Distance between Ines NA FI Classification (Pmale, A B. CL Private Taal Dep h FI. Can to. Ft Taal absorption area 240 Fr Pipe Melena D3034 & F810 Dew cc 0 Dae Doled Stan war Level FI Installer RPC Dae Installed 6/9/2006 meld GPM Pump SM at FI. Casing Height Above Grand FL TANK SEPARATION DISTANCES ® Septic 0 Holding 0 S.T.E.P. • Other. To From Septic Tank Absorption Field Lift Station Holding Tank ubhUPnvate Sewer line Maanadaer Anchorage Tank Capacity 1500 Gal Well 100'+ 100'+ NA NA 25'+ Mann Steel Number al Compartments 2 surtac.war "50'+ ••50'+ NA NA LIFT STATION Lot Line 5'+ 10'+ NA NA sue 1500 Ga Min4acwnr Orenco Foundation 5'+ 10'+ NA NA .P-.snp n• level a Timer In 'Pump •Pp afr level Activated In High wane( alarm a. 46 I, Goan Oran NA •50'+ NA NA Pump Mae & Model Franklin 244504,3117-1/2hp ENNicw Inspections performed by Rising Son Stamina Tank insulated, except for under Advantex pod, old BENCH MARK tank removed and field abandoned. • none know n `Back door socatron and ill door "WR # 060023 Assumed Elevakn 100 FL Engineer's Stamp �� OF L. ' i +4:4".0' ".. pts, . I * 49� e••• 91� • ••' " ''"";,1;17•41 •••e• ••• •• :•4 Inspections performed by: KND Engineering, Inc.Dates: 1st6/9/2006 r 2nd/ 3rd 6/10/06 — 6112106 % Development Services Department Approval Reviewed ed and approved by ey/ `V/� Date: %-28 -06 rvw% Kennepn lit .• CEJ 4.. ��gto•' •.3�'-e 7/`�J AS -BUILT SYSTEM DETAILS/SITE PLAN GATEWAY TO THE PARK S/D, BLOCK 1, LOT 5 L01 6p?�, 1 0 PID 067-601-02 PERMIT#: SW060117 N AD,ANIEX SYSTEaf FP CANT! . . ABANDONS TANK AND DRAIN FIELD FALL IWO —FLOWING Le SURFACE SURFACE WATER / // u / 0' .•••• / CN .••••• ckr ,O GRAPHICS SCALE SCALE: 1:40 / 40' A -C=40.8' B -C=67.0' A -D=46.0' B -D=71.0' §w A -E=57.8' ° B -E=73.8' t4 A -F=64.0' e,± B -F=78.7' 84.03 84.03 1500 GAL =1 11 ADVANTEX LI TANK 11R -R -R-0-101 HOUSE TANK arc, OF AZ 11,4 m • KENNETH CE- , .V1ESS10t�V s \.`N..."4—. %1.76 FINAL GRADE IIL.. .-1111— — — — FILTER FABRIC & INSULATION 75 a x0. SCALE: NTS a,.•�1i,.e~�. TRENCH ' ••:•-• . ....:e1 `Ii (..72.81 ,'' VARIES 05' 4.0' 1 24' SCALE: NTS BOHC 66.50 ) 'REPARED FOR: DICK STIEFKEN 32461 MT. KORIIUSK CIR. EAGLE RIVER, AK 99577 696.8902 ABBREVIATIONS PAGE 1 OF I 6011 = BOTTOM OF TESTHOLE CO — CLEANOUT MT = MONITORING TUBE FIELD 800K5 WARDED: BOUNDARY: ORA Me KMD ST.n.0 maxim KMD Air KNDENG DATE 6/19/06 DRG FW d"' 5E905 ADHD flLO60IJW&S.DWG 4e"" 06-013 END ENGINEERING, INC. 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)666-e1l 1/FAX (907)090-6111 wN.INDRngIn..rtng.eom/knd.nAB.k.n.t Jun 19 2006 2:07PM Rising Son Electric, Inc. 622-6777 June 19, 2006 KND Engineering, Inc. FAX #868-3793 Rising bon Electric. Inc. 14916 Woodland Drive Eagle River. AIC 99577 (907) 622-67// p.l Re: Lot 5 Block 1 Gateway To The Park Dear Dee: The lift station at the above referenced property has been wired In accordance with NEC and State/Local codes. Thank you. Sincerely, 51.2,242,-;c. AO. Qot rlac h.Qc. ciao CiutAuc-M. Kevin S. Hombuckle, Owner Administrator License Number 1284 Specialty Contractor License Number 27285 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW060117 Legal Description: GATEWAY TO THE PARK BLK 1 LT 5 Design Engineer: 0070 KND ENGINEERING Owner Name: DICK STIEFKEN Owner Address: 32461 MT. KOROHUSK EAGLE RIVER , AK 99577-0000 Date Issued: May 26, 2006 Expiration Date: May 26, 2007 Parcel ID: 067-601-02 Site Address: 032461 MT KOROHUSK CIR Lot Size: 43560 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. Please submit a signed, notorized copy of the AWWTS Maintenence agreement with the COSA form. Received By / e Date' S 26— � Issued By: �,� t 00--ri n_ Date: 5-2.6-04. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel 1.0. 067-601-02 Property owner(s) Dick Stiefken Day phone 696-8902 Mailing address32461 Mt. Korohusk, Eagle River, AK Zip Code 99577 Site address same Zip Code Legal description (Sub'd., Block & Lot) Gateway to the Park Block 1, Lot 5 Legal description (Township, Range & Section) Lot Size C13, 5jc0 Sq. Ft. Number of Bedrooms 3 THIS APPLICATION IS FOR (® all that apply): THIS APPLICATION IS AN: Absorption Field ® Initial Septic Tank ® Upgrade Holding Tank 0 Renewal Privy 0 Private Well 0 Water Storage 0 certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. i of property owner or authorized agent) Permit/Rush Fees: $460.00 Waiver Fees: $1,150.00 Date of Payment: Receipt Number: (Rev. 11/05) Sizzle(, Ragg2. Date of Payment: 5/2 LA L Receipt Number: F1049,9— JK D ENGINEERING, INC 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 It _W_ (907) 696-6111/FAX (907) 696-8111 May 22, 2006 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Septic Upgrade — Gateway to the Park, Block 1, Lot 5 Gentlemen: The owner has requested we proceed forward to obtain a septic permit on the subject lot to upgrade the existing failed system. Per our discussion with you previously we are requesting a 50' surface water to wastewater system waiver at this time. Due to natural drainage patterns, topography and adjacent wastewater systems —rerouting existing drainage is not feasible. A holding tank would also require a waiver. The requested separation reduction requested with this waiver is also based on the effluent wastewater treatment provided by the AdvanTex system. The effluent treatment of the AdvanTex system creates raw household waste that is 95-99% cleaner than the typical septic tank effluent. For example, comparing the BOD (Biochemical Oxygen Demand) and TSS (Total Suspended Solids) make up of the effluent between AdvanTex effluent and the effluent found in a typical septic system are as follows: Type of Effluent BOD TSS Typical Household Raw Waste 450 mg/ L 500 mg/ L Typical Septic Tank Effluent 130 mg/ L 30 mg/ L Typical AdvanTex Effluent <15mg/L <15mg/L The AdvanTex system is also continuooulsy monitored 24 hours a day, 7 days a week remotely via the VeriComm Monitoring System. This ensures that the system is operating appropriately and if not, the system will be serviced immediately. On April 24, 2006 one testhole was performed for the proposed system. The results of this test are attached. The general slope of this lot is from east to west at a grade of approximately 17-22%. We have designed our system utilizing the RE: Gateway to the Park 131,15 May 22, 2006 Page 2 of 2 recent testhole (TH06-1) and previous testhole (TH83) that were excavated for the existing 3 -bedroom house. Water was not encountered during the excavation or during monitoring. The lot is served by an individual well, located on the north portion of the lot. We propose to install one 5' wide shallow trench with an AdvanTex Orenco Package System. This system will be manufactured by Anchorage Tank Sr Welding to meet Orenco Systems, Inc. latest design criteria and in accordance to MOA requirements. The Drainfield Design is bal. on the following: • 3 -Bedroom Design Flow: .: i gpd �- • Percolation Rate: 22.8 min/inch • Category III Allowable Application Rate: 4 gpd/sf • Designed Application Rate: 2 gpd/sf • Minimum Absorption Area. 225 sf • Effective Absorption Area: 225 sf (5' wide by 23' long) • Effective Depth Below Distribution Pipes: 4' There are no public or private wells within 200' of our proposed system location except as noted. There is no surface water within 100' of the proposed system, except as noted and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, END Engineering, Inc. Attachments: On -Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test Contractor Specs WELL & WASTEWATER DISPOSAL SYSTEM DETAILS/SITE PLAN GATEWAY TO THE PARK S/D, BLOCK 1, LOT 5 NO P:RtJC W ELLS WTfIIN 2000f PROPOSED SYSTEM. NO PRIVATE WELLS WmNIN 2000F PROPOSED SYSTl4 EXCEPT AS NOTED. ND SEPTIC SYSTEMS WITHIN 200 OF PROPOSED WELL EXCEPT AS NOTED. CE -71110 �� a ry 11'/24 4 • ceaarlif -"Ess1001 DESIGN DETAILS 3 BDRM X 150 GPD - 450 CPD 450 GPD/2 GPD PER SQ. FT. (ADVANTEX SYSTEM) 225 SQ. FT (225/5'(W)) X .5(RF) (4.0' GRAVEL) - 23 FT. TRENCII USE 1 TRENCIIES - 23 (L) X 5' (W) X 4.0'(D) Total depth of system is 7' from original grade. Total depth of gravel below distribution pipe is 4.0'. NOTES: 1. CONTRACTOR TO ABANDON EXISTING SEPTIC TANK AND DRAIN FIELD. 2. INSULATE TRENCHES WITH 2" HD BURIAL FOAM. 3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INTO SEPTIC TANK. 4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACIIIEVE MIN. 3' COVER IF REQUIRED. 5. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT WELLS & SEPTICS. EASEMENTS, & OTIIER SETBACK REQUIREMENTS. PREPARED FOR: DICK STIEFKEN 32461 MT. KORI IUSK CIR. EAGLE RIVER, AK 99577 696-8902 Scale: 1"= 100' PAGE 1 OF 4 FIELD BOOKS COYPUTCR B01"1D11"° BOUNDARY DRAIN: VBG STAInitl STAKING ccTxm: KMD AAET' SCHULLER DAt 5/18/06 DRG. DIE r 111 5E905 ACAO Fa FILE '0B "W` 06013 ]1 ID ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)898-6111/FAX (907)696-8111 WASTEWATER DISPOSAL SYSTEM DETAILS GATEWAY TO TIIE PARK S/D, BLOCK I, LOT 5 1 LOT 6 BLK 1 9 ct oact LOT 5 BLK 1 CONNECT TO 4) V / � 47. EXISTING DISCHARG pc"_P LINE 44Ec4/c'� CP / r O R (4/47 N. b el//co- CO A} .,/ , 46.3' ED ADVA T1183 P OPOSED 0.'TFALL (STING ELD Fb2 MOVE EXI DRAT INE INTO EA EMENT 66.8' TH06-I FLOWING SURFACE WATER SUR f Pc, F of ALs i Fkst S Zt/ • t/ PREPARED FOR: DICK STIEFKEN 32461 MT. KORIIUSK CIR. EAGLE RIVER, AK 99577 696-8902 P` �G� i tct \0 O�P\NPGC' \0 Scale: I"= 30' PAGE 2 OF 4 FIELD BOOKS oaFU,m: "len" BOUNDARY DAVM: VBG STMGa STAKING °Calk KMD Assam SCHULI ER DA16 5/18/06 END ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 DMC. OLE: fl 5E905 ADAD PoL FILE 06013 (907)696-8111/FAX (907)696-8111 AdvanTex Treatment System AX 20 Scric"s - Mode la Inlet Riser/Lid 2 Dia. Vent Inlet 00' 38. Inlet — MvanTex Filter Filtrate Return Line a --Discharge Filtrate a1 —MvanTex Filter Side View Biotube® Pump Package Top View 30' Dia. Riser/Lid Discharge Filtrate lope (min. 1/87IL) Alin. 23' Dia. Tank Opening ORENCO PACKAGE SYSTEM: 1. INSTALL 1500 GAL SEPTIC TANK W/ INTEGRATED ADVANTEX SYSTEM - OR TANK WILL BE SIZED PER ANCIIORAGE TANK FOR A 3 BDRM RESIDENCE. 2. INSULATE TANK, EXCEPT BELOW ADVANTEX PADS TO ALLOW I TEAT TRANSFER. 3. NO AIR LINE REQUIRED. -"w'ESSIO1U3' Apr PREPARED FOR: DICK STIEFKEN 32461 MT. KOROIIUSK CIR. EAGLE RIVER, AK 99517 696.8902 End View Recirculating Splitter Valve (RSV) with Quick Disconnect Scale: NTS PAGE 3 OF 4 FIELD 6001(5 ao"ru7rtt °01MDr'^r BOUNDARY aura VBG Spa.* STAKING a*a`co: KMD a" SCHULLER DATE 5/18/06 END ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 DC nu:: qtl° 5E905 ACID FILL FILE '10e No.: 06013 (907)696-6111/FAX (907)696-8111 WASTEWATER DISPOSAL SYSTEM DETAILS GATEWAY TO THE PARK S/D, BLOCK 1, LOT 5 4" MONITORING TUBE /// ///////!/l///////////l///r-zrzi //!J///////// rzn.eJ///////, // FROM ADVANTEX --/ 4" CLEANOUT O" 4" DISTRIBUTION LINE. 4" CLEANOUT �/ j 4" MONITORING TBE ^'iiwzrti iro zrziiinrri/////remzizmnrrnzi//i///i///i///i mdr, 17-22%ORIGINAL GRADE e1_\h arakS• 9T. 44 - r— - /i •• 1 0, +aa•• . W 2! °.er'// tssl0tA' i PLAN VIEW LEACIIFIELD DETAILS 1 4" MONITORING TUBE INSULATION 4^ CLEANOUT FILTER FABRIC 2' M N COVER W/ INSULATION v,.; zmoi. "..r.. J �-1%.'^r �+= � ate.• ?. ^ ^•M4`N•Y f1�„i`�jTY/. YtI.nVw PROFILF, VIEW LEACIIFIELD DETAILS X7.2?' ORIGIN AL GRADE 4' SEWER ROCK EXISTING STRATA OF ACCEPTING SOIL NOTE: BOTTOM OF SEWER DRAINROCK MUST BE 4+ FEET ABOVE GROUNDWATER AND 6+ FEET ABOVE BEDROCK. PREPARED FOR: DICK STIEFKEN 32461 MT. KOROIIUSK CIR. EAGLE RIVER, AK 99577 696-8902 Scale: NTS PAGE 4 OF 4 GELD BOOKS ca�wrtn B0ull.” BOUNDARY DRAIN VBG nAJCPC4 STAKING CHECKER KMD i S8 tt SCHULLER DAt 5/18/06 DWG RF: aeo: SE905 "GD MIL FILE "DD "" 06013 END ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 ]K V ID ENGINEERING, INC. 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 SOILS PERCOLATION TEST Performed for. Dick Stiefken Project: Depth (Feet) Gateway to the Park, Block 1, Lot 5 4- 5- 7- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- CM B.O.11. IIOLE PRESOAKED 20- PRIOR TO TEST TEST HOLE # 06-1 SEE ATTACHED SITE PLAN FOR HOLE LOCATION Was Ground water encountered? NO Depth to water after monitoring? NO What depth? NA Date? 5/10/06 Reading Date Gross Time Net Time Depth to Water Net Drop 1 5/1/06 1:00 - 6" - 2 1:30 30 min 411/16" 15/16" 3 • 1:31 - 6" - 4 2:01 30 min 412/16" 14/16" 52:02 - 6"• - 6 2:32 30 min 411/16" 15/16" • Water Added Percolation Rate 22.8 (min/in) Perc }Tole Diameter 6" Test Run Between 4 feet and 5 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. Municipality of Anchorage Mayor Mark Beyich P.b. Box 100650 • Anchorage, Alaska 91519-CC8O • Telephone (007) 3436301 • Fax (907)34.3-8200 4700 Bmgaw Street • Aiuhomgc, Alaska 90i07 www..muni.org Building Safety Division May 26, 2006 Kenneth M. Duffus, P.E. KQVD Engineering, Inc 20441 Ptarmigan Blvd. Eagle River , AK 99577 Subject: Waiver Request for Gateway to the Park, Block 1 Lot 5 Waiver Request WR#: 060023 Parcel ID # 067-601-02 SW060117 Dear Kenneth M. Duffus, P.E.: Your request for a waiver of the required 100 feet horizontal separation from the absorption field and septic tank to surface water has been approved. The approved separation distance is 50 feet. This waiver approval applies to the proposed absorption field and septic tank to surface water separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Deb Wockenfuss Civil Engineer On -Site Water & Wastewater Program Community, Security, Prosperity Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Waiver Review Worksheet WR#: 060023 Pak 067-601-02 HA/Permit# SWO60117 Date Received: May 26, 2006 Legal Description: Gateway to the Park, Block 1 Lot 5 Engineer Kenneth M. Duffus, P.E. KND Engineering, Inc 20441 Ptarmigan Blvd. Eagle River , AK 99577 Applicant: Dick Stiefken Waiver Requested: 50' from surface water to wastewater system Criteria: Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Points: Waiver is Granted: X Waiver Is not Granted: List Conditions or Reasons for above: The Category III advanced wastewater system, AdvanTex, will be the replacement system. AdvanTex provides a 95% cleaner effluent than a standard system and the AdvanTex also provides continuous monitoring so that any problems will be addressed immediately. Date: 5126106 By: Deb Wockenfuss Name of Reviewer Rec#: 80492 Amount: $1150.00 Date Paid: 5/26/2006 KND ENGINEERING, INC. 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907) 696-6111/FAX (907) 696-8111 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES AND MATERIAL SPECIFICATIONS LEGAL DESCRIPTION: Gateway to the Park, Block 1, Lot 5 GENERAL: 1. The scope of this project includes the installation of a septic tank and/or drainfield to serve a single-family residence on the referenced property as delineated on the attached Municipality of Anchorage (MOA) permit and site plan. 2. Construction shall be in accordance with the approved site plan and design drawings; MOA permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. KND Engineering, Inc (KND) assumes no responsibility of the accuracy of the as -built survey provided by the owner or owner's representative. 4. The owner or contractor is responsible to notify the engineer of any discrepancies noted on the design plans or drawings prior to commencing work. These discrepancies could be, but not limited to, possible encroachments, surface water, varying soils, unplatted easements, types or use of dwellings on or adjacent to property, nearby public wells, etc. 5. The contractor shall be responsible for locating any necessary underground utilities, easements, property lines and surface water. The owner and/or contractor shall ensure, if deemed appropriate, that a registered land surveyor prior to construction flags all setbacks. 6. The contractor shall be responsible for verifying all pertinent separation distances and component layout. 7. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 8. The MOA Development Services Department On -Site Water & Wastewater Program must certify contractors installing wastewater disposal systems. Owners installing their own systems must also receive prior approval from said MOA Department. SEPTIC TANK / HOLDING TANK / LIFT STATION INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded with proper material and compacting to prevent damaging, settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above the final grade. 4. Septic tanks installed with less than 4 foot of cover shall be insulated. The contractor will ensure that the fill over the tank does not exceed the burial depth rating. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 feet from the tank. The second cleanout, in line, shall be to dean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. Page 1 of 3 Reference: Gateway to the Park 61, IS Date: 05/22/06 Page: 2 of 3 7. All H.D.P.E. tanks shall have a vertical length of 4 -inch perforated drainpipe besides the tank extending to the bottom of the tank to above grade to monitor ground water. 8. All tanks shall be anchored when there is not enough adequate soil cover to resist buoyancy forces in high -groundwater areas. 9. All holding tanks and lift stations shall have an audible and visual alarm inside the residence. 10. All lift stations shall be wired in compliance with the Uniform Electrical Code and all MOA guidelines. 11. The contractor shall remove the old tank, or abandon it in compliance with the Uniform Plumbing Code. The contractor is solely responsible for the abandonment procedure. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavaction become smeared, they must be raked or scratched (roughed -up) before gravel (sewer rock) placement. 2. Once the sewer rock is installed, the distribution pipe is installed level with the perforations facing downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitoring tubes shall be four- (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backfill over the final gravel layer must not be less than twenty-four inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. 6. All advanced technology waste water disposal systems (Advantex, Biocycle, Intermittent Dosing Sand Filter, etc...) shall be constructed, installed, maintained and monitored per manufacturer's specifications and MOA requirements. MINIMUM MATERIAL SPECIFICATIONS: 1. A MOA approved septic tank manufacturer must construct any septic tank proposed for installation. 2. The following pipe materials are MOA approved for use in septic system installations: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. If deemed necessary, a sieve analysis should be performed. 7. When sand is being used as a filter material, its gradation specification must conform to current MOA or DEC requirements. Reference: Gateway to the Park B1, 13 Date: 05/22/06 Page: 3 of 3 INSPECTIONS: Typically there will be three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the sewer rock, distribution lines, standpipes, and cleanouts, but before the placement of the silt barrier, insulation, or any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required, especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. The inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractor's activities. The owner shall contract with the contractor to perform the work outlined in these specifications and attached plans and in accordance with the attached MOA permit. All materials, components, and construction practices shall comply with the MOA's and the State of Alaska's latest ordinances, regulations, or policies regarding wells and septic systems. The failure of the inspecting engineer to notice a material or construction non-compliance does not relieve the contractor of his/her responsibility to correct such deficiency. There will be no contractual arrangement existing between the contractor and KND Engineering, Inc. KND shall be the owner's representative and will inspect the work as stated above to document the contractor's activities. Final acceptance of the contractor's work rests with the owner and the MOA. KND shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. KND's inspecting engineer will not be responsible for the construction means, methods, and techniques, sequence, procedures or the safety precautions incident to this project. BY PROCEEDING FORWARD WITH THE INSTALLATION OF THE WATER AND/OR WASTEWATER SYSTEM (S), THE PROPERTY OWNER, CONTRACTOR, AND WELL DRILLER ACKNOWLEDGES HAVING READ AND ACCEPTED THESE SPECIFICATIONS. • MUNICIPALITY OF ANCHORAGE + T, _ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION II ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAM _ ivr- � �,.f'7 /S�� PHONE .NEW ❑ UPGRADE MAILING RE ,(09/i/'/A / j2� re / - €e/ f* sett /f / ,E:: 7c LEGA D�SCRIPJON / %� �//jj,,,, �'/��/J,r1/C/�/ /-r- �/KJ -7 70 f W'1% / '/QIF LOCATION LOCATION / SEPTIC TANK DISTANCE TO: Wel `0 /74. / Absor " n fy L Dwellipt 70 /it / PERMIT N ,� d54/ z3 �e D Manufactufer• / e-e ✓ MSi/1(aL,e / No. of �rypartments Liq, sa iIlons / IF HOMEMADE: Inside length WidthWi Liquid depth D Y J 0 Z O Z Q 2 - (- DISTANCE TO: Well Dlling PERMIT NO. Manufacturer // Material Liquid capacity in gallons TILE TRENCH DISTANCE TO: Wely3, j 74 Foundait, 0 j t Nearest t ie 1 /h l.Jh PERM PERF NAS /0 a3 J / No. of lines / Length �.`h (rat D V — TotalnyfYj oft* ((��J r�jj Trenc !.T c7�/ inches riaLbeneat e 4 /� . ( �� ' Z�L S � ��nches Total effectiv a• •do area � sZ Top of4e tdfin grade // SEEPAGE NT Length Width Oepth PERMIT Ne Type of crib Crib diamet/ / ,1Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line w � Class C A. I $13e.__1 L Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption areals) OTHER F---f- 4 — L ( (/' PIPE MATERIALS �vc 46 r `' SOIL TEST RATIN 22 5 /,� t\4 1NSTA REMARKS i S o t -6, 1 S /OD D ru-! / 15' 7 k3c - 1 rJ41 ^a- � fs � (fLE` (0 .. :. pvrar- ,e.t../ `',r ..r", .jj l 2 Y k, :A-- -".'4.v..,,_:-.om- P ElGINEERING APOVE D�JATE LEGAL $�I$ $E( .7/M// /�15 rjvl- RIVER, ALLS ''t. £YST. PFI. S9�'r297�J 3 i^U� P- ��Fs�� DEPARTMENT u. HEALTH AND ENVIRONMENTAL ,..OTECTI8N ~^ ' 825 'L' STREET, ANCHORAGE, AK 99501 264-4720 : ANCHORAGE 694-2131 : EAGLE RIVER ��R:1-1 I-- PERM IT NO. 831023 . HPPLICANT : SO FORK CONSTRUCTION PHQNE: 694-2979 n ADDRESS: %S&S 5RB 156X EAGLE RIVER, AK 39577 Jr --LEGAL �E��rTION - SUBDIVISION: GATEWAY TO THE PARK BLOCK: 1 LOT: � ~ LOT SIZE 0 FAD. FT. TOWNSHIP: 0 RANGE: 0 SECTION: 0 MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING = 225 213 225 (SQ.FT./BR) LISTED BELOW ARE THE DFTIONS AVAILABLE TO YOU IN DESIGNING YOUR SEPTIC SYSTEM. CHOOSE THE OPTION THAT BEST FITS YOUR SITE 17F:EEt-JC:1-1 £:.�� WIDTH = 2.5 FT� LENGTH = 57 0 FT r � v�+'r~-`,~`�'�� TOTHL DEPTH = 10� 0 FT. GRAVEL DEPTH = 6 0 FT� �"~4�~ GRAYEL VOLUME = ]4� � CU� YDS ' TANK SIZE = 1,000. 0 GALLONS (TWO COMPARTMENT TANK) � (( EE;EEE. E.1 ---7'=7;.1C31-4 WIDTH = 22. CI FT. � =LENGTH = 44. 0 FT � TOTAL DEPTH = 5.0 FT � - �� GRAVEL DEPTH = 0. 5 FT. � �, ~' ~T GRAVEL VOLUME = 8 CUYDS. TANK SIZE = i. 000. 0 GALLONS (TWO COMPARTMENT THNK) �I EE FE: Fi U-4 F- I E E)E�I ci� WIDTH = FT. LENGTH = 79. 0 FT. ! NOTE ! - >75 FT. REQUIRES TWO TRENCHES TOTAL DEPTH = 7. 0 FT. GRAVEL DEPTH = 3. 0 FT. GRAVEL VOLUME = 51.2 CU. YDS. TANK SIZE = 1,000. 0 GALLONS (TWO COMPARTMENT TANK) I CERTIFY THAT: i. I Ai1 FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE AND THE STATE OF ALASKA. 2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES AND HAVE RECEIVED A COPY OF THE CODE SUMMARY AND DIAGRAM ATTACHMENTS WHICH IS PART OF THIS PERMIT. I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDR0OMa PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM PERSONNEL DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. IF A LIFT STATION IS INSTALLED, AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED. HS-BUILTS CANNOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT. THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIHN. SIGNED: APPLICANT: ISSUED BY: � DHTE: 11/14/83 PERFORMED FOR: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST LEGAL DESCRIPTION. 1 2- 3- 4- 5 L -3 �.19Ten tPE rd SL E TH Or y7 2 nl G. 44‘'. Gm- s/LTcsttiloy /P 4'/ 6-2 /9017Z- 6- 7- 8- 9- 10 Fl 225 /'" V SU7y JOy 11 - 12 - 13- 14- 15 16- 17- 18- 19- 20 - DATE PERFORMED tvta ii. 7.L, `y /' �,J�J T IF YES, AT WHAT E 1/4 C Ili/— S/L `N DEPTH? .oy/.S i/G-2f '' COMMENTS CD • • Rubert A. s!,ofet : , • ':: • • ._.z. Ivo. 1457-E •.• eE �FOFROFESSI`3N.V\± WAS GROUND WATER ENCOUNTERED? ❑ SOILS LOG ❑ PERCOLATION TEST ///2/7 /42� SITE PLAN rt= FO 4 - C7� Reading Date Gross Time Net Time Depth to Water Net Drop I fplri /I Pm 7'2" VZ Li 1/ 3a 5o /0 7" 2-7 3 1/ (r, 14o /0 Io y ti 103-b i to /I IA 71- S A 11 lj /0 //1 l f , PERCOLATION RATE TEST RUN BETWEEN s 8. r E'IC'IfdEERING PERFORMED BY: SSB 196X CERTIFIED s„47LE RIVER:�1J S:L 77 FT AND es/inch) FT DATE: 213 r OWNER OF LAND ADDRESS ' Q1rrtthrb iriLtiiijj log by DOC Co. dba SULLIVAN WATER WELLS P. O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759 LEGAL DESCRIPTION_ DATE - Started - / BCPTIi OF WCLL • STATIC LEVEL OF WATER FT ,'e_ C f rT_ r'.� 7 i ,r c` r;;IC/C" DRAW DOWN FT - Ended / PERMIT NUMBER GALS. PER HR KIND OF CASING ? d k KIND OF FORMATION: From Ft. to Ft °J F4'Sat'Ot- ..� From Ft to Ft From Ft. to -) Ft- �3 1 (--,.< 4 '-"ZZ From Ft to Ft From Ft. to Ft. " s•-" t'r ‹ j From Ft. to Ft From - Ft. to=/ Ft _S - * 6 ‹,,,,_,&-C From Ft. to Ft From Ft. to -- -.-Ft. "' e---- C c .4 7 From Ft to Ft From Ft to / C Ft. 4:4- 04 ✓ 1 C co -/d --e- From Ft. to Ft. From , Ft. to Di Ft. 4 --) /j l t'.+ -'x- a From Ft. to Ft. From Ft. to Ft. -c -M re....‹ From Ft. to Ft. From Ft. to Ft From Ft. to Ft. From Ft. to Ft From Ft. to Ft. From Ft. to Ft. From Ft. to Ft From Ft. to Ft. From Ft to Ft From Ft. to Ft. From Ft. to Ft From Ft. to Ft. From Ft to Ft From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft to Ft MISCL. INFORMATION: • 110111 FR'C NAMF Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FORA SINGLE FAMILY DWELLING COSA# a0144 Expiration Date: — 0 Parcel I.D. 067-601-02 1. GENERAL INFORMATION Complete legal description GATEWAY TO THE PARK. BLOCK 1. LOT 5 Location (site address) 32461 MT, KOROHUSK CIRCLE, EAGLE RIVER, AK 99577 Current Property owner(s) RICHARD ALLEN Day phone Mailing address 21323 LOWLAND AVENUE. EAGLE RIVER. AK 99577 Lending agency Mailing address Day phone Real Estate Agent BONNIE MEHNER Mailing Address Day phone 762-3110 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑ Individual Holding Tank ❑ Community On-site ❑ Public Sewer z The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ArcTerra Engineering & Surveying, Inc. Address 20441 PTARMIGAN BLVD.. EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Phone 868-3792 Date 0511612008 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 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 Ars OF 414 hi occupants or can ArcTerra guarantee that no unseen • encroachments, deficiencies or discrepancies exist. 4:15::: o *� Wf� 5. DSD SIGNATURE _V-- Approved for 3 bedrooms. Disapproved. . • WFES`'LOt Conditional approval for bedrooms, with the following stipulations: 1N • ••M r c Kenneth M 6.4 CE' i p 11 ; 6 4r ct.o.,.,:(: y�, ..• t y OF lir - .n : ON-SITE .s -gI WATER AND : t^= WASTEWATER : : PROGRAM : .,• : ..� Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory ..11»l)111} Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: ' Z 1 " 0 p Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: CATEWAYTOTHEPARKBLOC 1.LOT5 Parcel ID: 067-601-02 A. WELL DATA Well type FRIVATF If A, B, or C provide PWSID # _ Well Log (Y/N) y Date completed 5/14/1984 Sanitary seal (YIN)y Wires properly protected (Y/N) y Total depth 100.4 ft. Cased to 100.4 ft. Casing height (above ground) 124 -.in FROM WELL LOG AT INSPECTION Date of test 5/14/84 5/7/08 Static water level flowing ft. 8 ft. Well production 50 g.p.m. 4.5 g.p.m. WATER SAMPLE RESULTS: Coliform Qcolonies/100mL Nitrate 0.142 mg/L Other bacteria colonies/100 mL Arsenic: ND mg/1 Date of sample: 5/5/08 Qollected by: ArcTerra B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 6/9/06 Tank size .1500 gal. Number of Compartments 2 Cteanouts (Y/N) yFoundation cleanout (Y/N) y Depression over tank (Y/N) r], High water alarm (YIN) y_Date of pumping 5/7/08 Pumper Sanitary C. ABSORPTION FIELD DATA Date installed 6/9/06 Soil rating (g.p.d./ft2 or ft2/bdrm) y& System type Advantex•Shallow Trench Length _aft. Width _2 ft. Gravel below pipe Aft. Total depth 7 ft. Eff. absorption area 240 ft2 Monitoring tube y Depression over field N Date of adequacy test 5/7/2008 Results (Pass/Fail) Pass For g bedrooms Fluid depth in absorption field before test Q in. Water added 450 gal. New depth 0 5 in. Elapsed Time: j min. Final fluid depth Q in. Absorption rate >= 450g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) )_If yes, give date D. LIFT STATION Date installed 6/9/06 Size in gallonsl500 Manhole/Access (Y/N) Y 'Pump on level at TIMER in. "Pump off" level at ACTIVATED in. High water alarm level at 46in. Datum BOTTOM OF TANK Cycles tested 2 Meets alarm & circuit requirements? Y E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Sewer /septic service line 25'+ Animal containment areas 50'+ Public sewer manhole/cleanout 100'+ Holding tank 100'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main 10'+ Water service line 10'+ Wells on adjacent Tots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Absorption field 5'+ Surface water 50'+ • Building foundation _ 1IY+ Water main 10'+ Water Service line 10'+ Surface water 50'+ • Curtain drain 50'+ (None Known) F. COMMENTS t /Luis. t: .d 0 Driveway, parkingNehicle storage 10'+ Wells on adjacent Tots 1001+ 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 COSA guidelines in effect on this date. Engineer's Printed Name KENNETH M. DUFFUS Date 05/16/2008 or ... .., d: ...CI.•q,4_NI �.h,•.�i * ' 9f ♦s49TH04 e •••• 0 Tit wit: err •.. p ��i. FE s COSA Fee $430.00 /� Date of Payment J7,t/ �,(.-' 5 Receipt Number /(9�6( (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT MEMORANDUM OF UNDERSTANDING BETWEEN MUNICIPALIT1Y OF ANCHORAGE AND Ltirx;ntt. Attict he" MA THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this ZSTDay of Mal of20CE, by and between i)pirttit:GI Arida ha-04AP- herein r dahPa+4tP- herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Memorandum of Understanding agree as follows: 1. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality grants permission to Owner to utilize and operate A. Advanced Wastewater Treatment �System (AWWTS), described as A 4. l/a h tG je located at Cr'!., /c- w Q y 1 f z ec, fits. , Anchorage, Alaska. 2. Definitions. 6/oc - I A o t .S A. Alteration. Any change to the design or function of an AWWTS that Includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Prior to performing any alterations to an AWWTS the owner must obtain a Wastewater Disposal System Construction Permit from the Municipality pursuant to Anchorage Municipal Code (hereinafter, "AMC") 15.65. B. Certificate of On -Site Systems Approval. An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with AMC 15.65. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. C. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. D. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AWWTS that were included in the original design which would allow the AWWTS to continue to perform as designed. E. Permit (Construction) An On-Site Wastewater Disposal System Construction Permit as defined by AMC 15.65. F. Permit (Operating) An Advanced Wastewater Treatment System Operating Permit.- An annual permit, issued by the Municipality, that allows the Owner to operate an AWWTS, upon meeting all the requirements of this agreement, the conditions of Operating Permit, the requirements of the On-Site Wastewater System Construction Permit and all relevant provisions of AMC 15.65 3. Fee. Owner shall pay to Municipality an annual fee of ? t vo ($ Q .00), payable on or before the issuance of the operating permit and annually thereafter. The annual fee is due on or before the anniversary date of the approval by the Municipality of installed system. 4. Term. The term of this Memorandum of Understanding shall be for the life of the AWWTS. The term begins on the date of approval by the Municipality of the installed system and shall continue while the AWWTS system is in use or operational or until the property is sold or title is transferred by owner and a new certificate of On -Site approval is issued to the new owner or transferee of the property. 5. Alterations, Installation and Removal of Additional Equipment. Owner agrees not to make any alterations, removal of parts or additions to the AWWTS without a Construction Permit from the Municipality. 6. Maintenance and Repairs. A. Throughout the term of this Memorandum of Understanding, the Owner shall maintain AWWTS in good repair. In addition, it shall be the responsibility of the Owner during the term of this Memorandum of Understanding, and any extensions or renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs. Further, Owner agrees to comply will all applicable ordinance, laws, regulations, rules and orders for the AWWTS. 13. Owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system pursuant to the terms and conditions contained in the Owner's AWWTS Operating Permit. This schedule shall be submitted to the Municipality annually upon the renewal of the permit. The schedule of maintenance and repair contained in the Owner's AWWTS Operating Permit is: 3I —�Nhuet4 C. Owner acknowledges that the fine schedule for failing to maintain and repair an AWWTS are codified in AMC 14.60. D. Owner agrees that only maintenance, repair personnel certified by the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system. E. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS upon 24 hours written notice. F. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. G. Owner agrees that the relevant provisions of the standard specification guidebook for AWWTS is the governing professional guidelines for the construction, maintenance and repair of the Owner's AWWTS. 7. Nonwaiver. The failure of either party at any time to enforce a provision of this Memorandum of Understanding shall in no way constitute a waiver of the provisions, nor in any way effect the validity of the Memorandum of Understanding or any part hereof, or the right of such party thereafter to enforce each and every provision hereof. 8. Amendment. A. This Memorandum of Understanding shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality of this Memorandum of Understanding was executed and such writing shall be attached to this Memorandum of Understanding as an amendment. • B. For the purposes of any amendment modification or change to the terms and conditions of this contract, the only authorized representatives of the parties are: Owner: Anchorage: Purchasing Officer C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 9. Jurisdiction: Choice of Law. Any civil action arising from this Memorandum of Understanding shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Memorandum of Understanding. 10. Severahility. Any provisions of this Memorandum of Understanding decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Memorandum of Understanding. OWNER:, / MUNICIPALITY: By: ej%V/J Picea-if By: Title: Date: Date: 512e / ay STATE OF ALASKA THIRD JUDICIAL DISTRICT ) ss. The foregoing instru ent was acknowledged before me this2' day of 20 08 . by la e 2 Pi i i, (1 . J L ii is the OUJfl .1)11,4 Ag..4 o TARY % UBLIC OR LASKA N Commission expires: 8.2 S' /O OFFICIAL SEAL State of Alaska NOTARY PUBLIC JINNY ROSE DAY My Cmisissilee Capin": Aw 28,1010 /eC2c:c", Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 067-601-02 1. GENERAL INFORMATION COSA # 0,01/7 Expiration Date: 9 - 2 g- O Complete legal description Gateway to the Park - :.. .. _ Wee. /c — / , L0 7t' - S Location (site address) 32461 Mt. Korohusk Circle Eagle River AK Current Property owner(s) Dick Stiefken Day phone 696-8902 Mailing address 32461 Mt. Korohusk Circle Eagle River AK Lending agency . Day phone Mailing address Real Estate Agent Bonnie King Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 3 TYPE OF WASTEWATER DISPOSAL: ® Individual On-site ❑ Individual Holding Tank 0 ❑ Community On-site 0 ❑ Public Sewer 0 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered In the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm KND ENGINEERING, INC Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Phone 696-6111 Date 6/22/2006 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 systems are subject to these various and dynamic characteristics and are outside the control of the '``` evaluator of the well and septic system. Therefore, + OFA44‘1 A KND can not give any estimate of how long a : <C. •1 system will function satisfactory for current or future j'4 ' .•........... • . Of' 1 occupants or can KND guarantee that no unseen • I. �, V l� encroachments, deficiencies or discrepancies exist. / ; 49L - 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. x Conditional approval for 3 bedrooms, with the following stipulations: At the time of title transfer the new property owner shall sign the attached maintenance agreement which shall be returned to this office before an unconditional approval is issued. Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: 6 - 2 0 Co Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 198850 Anchorage, AK 995196850 www.muntorg/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Gateway to the Park ' `'' " 6 /S] • k -1/ L s#i(Parcei ID: 06740142 A. WELL DATA Well type private If A, B, or C provide PWSID # Weil Log (Y/N) Y Date completed 05.14-1984 Sanitary seal (Y/N) Y Wires properly protected (YM) 11 Total depth 100'5" ft. Cased to 100.5" ft. Casing height (above ground) Sin. FROM WEU.. LOG AT INSPECTION Date of test 05/14/1984 3/9/2006 Static water level Flowinn ft. 7 ft. Well production 50 WATER SAMPLE RESULTS: g.p.m. 5.27 g.p.m. Conform 0 colonies/100mL Nitrate 0.185 mg/L Other bacteria —Q„ colonies/100 mL Arsenic: .lip. mgA Date of sample: 3/9/08 — 619/06 Collected by:)CND Enalneerinq B. SEPTIC/HOLDING TANK DATA Tank Type/Material Footle/Steel Date installed 6/9/06 Tank size 1500 gal. Number of Compartments $ Cleanouts (Y/N) X Foundation cleanout (Y/N) X Depression over tank (Y/N) JV High water alar (YM) X Date of pumping NA -New Tank Pumper fit C. ABSORPTION FIELD DATA Date installed 6/912006 Soil rating (g.p.d./ft2 or ft2/bdrm) a/ System type Advantex-Shallow Trench Length 24 ft. Width ¢ ft. Gravel below pipe 4 ft. Total depth Lft. Eff. absorption area �,ft2 Monitoring tube Y Depression over field Date of adequacy test NA -New System Results (Pass/Fail) _ For_ bedrooms Fluid depth in absorption field before test_ in. Water added_gal. New depth In. Elapsed Time: _ min. Final fluid depth _ in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) 4l lf yes, give date D. LIFT STATION - ADVANTEX Date installed 619/06 Size in gallons 1500 Manhole/Access (WN) Y "Pump on level at TIMER in. "Pump off- level at ACTIVATED in. High water alarm level at 46 in. Datum BOTTOM OF TANK Cycles tested a Meets alarm & circuit requirements? X E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanklhft station on lot 100'. On adjacent Tots 1001+ Absorption field on lot 100'. Public sewer main 75'. Sewer /septic service line 25'+ On adjacent lots 1001+ Public sewer manhole/cleanout 1001+ Holding tank 100'+ Animal containment areas NA Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main 101+ Water service line 10'+ Wells on adjacent Tots 1001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation10'+ Water main 101+ Water Service line 101+ Surface water 1001+ Curtain drain 50'. Wells on adjacent lots 0'+• F. COMMENTS WR # 060023 — Surface water Absorption field 5'+ Surface water 50'. • Driveway, parking/vehicle storage 10'+ I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name KENNETH M. DUFFUS Date612212006 ;We S s ix�49lli 9/. 1� G. ENGINEER'S CERTIFICATION• COSA Fee $430.00 WakerFee $ Date of Payment 4i2iO4, Date of Payment Receipt Number 22.1116, 2iO4, Number (Rev. 11/05) Con oil /3- - yl-o6 3- -y.K-o' «Z3 SGS SCS Refit Client Name Project Name/# Client Sample ID Matrix PWSID 1061172001 KND Engineering Gateway to the Park 131 L5 Gateway to the Park 131 L5 Drinking Water 0 All Dates/Times are Alaska Standard Time Printed Date/Time Collected Date/Time Received Date/Time Technical Director 03/152006 17:01 03/092006 14:45 03/09/2006 15:34 Stephen C. Ede Sample Remarks: Parameter Results PQL Units Method Allowable Prep Analysis Container ID Limits Date Date Init Metals by ICP/MS Arsenic Waters Department Nitratc-N Microbiology Laboratory Total Coliform ND 0.181 0 5.00 ug/L EP200.8 0.100 mg/L EPA 353.2 co1/100mL SM20922213 C (<-10) 03/13/06 03/13/06 TK 13 (<-10) 03/09/06 1C A (o-1) 03/09/06 TLF Page 2 of 4 LOT 6 BLx 1 <06 MT. KOROHUSK CIRCLE ele A 4, LOT 4 BLK 1 K Paso co' 4' 2.0' P CANT 0. SW LOT 12 BLI[ 1 ANCIIORACE RECORDING DISTRICT ..\` •A LOT 11 i 4>3T % �i1 i. f" BLK 1 IOHN c LS-10C4HULLER08 . .,°/ 11 °aa • 6•.15:.Oto167 ,X t1°astonot Vg- ELEVATIONS OF: GATEWAY TO THE PARK SUBDIVISION LOT 5 BLK 1 PLAT 82-251 SURVEY CERTIFICATION: 1, John L. Schuller, have conducted a physicalsurvey of this property as shown on this drawing and that the improvements situated thereon are within the property lines and no encroachments exist other than noted. EXCLUSION NOTES:It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: 06-013 wm JUNE 15, 2006 wake 1050. ctiw ImMn,OoM.Mt IN It oto BY JL5 cot Nat SE905 0601/39 Jr ID ENGINEERING, INC. 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)868-3791/FAX (907)868-3793 f MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I D # - f. i`,1 HAA # na a 1. GENERAL INFORMATION Complete legal description Lot 5; Block 1; Gateway To The Park Subdivision Location (site address or directions) 32461 Mt. Korohusk Cr. Eagle River, AK Property owner - Kenneth & Rachel Moll Day phone 264-1775 Mailing address 32461 Mt. Korohusk Eagle River, AK Lending agency Day phone Mailing address Agent Day phone Address xxX . 3 'Fti4ryoF (494/ SF. �t� o410 'AAe 1_s,p Oe (,ccc/,Fo Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer XXX NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA m 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. l 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 Address Engineer's signature S & S ENGINEERING 17034 Eagle River Loop Road No. z Eagle River, Alaska 99577 Phone G y 7 6. DHHS S NATURE Approved for bedrooms. By. Date � Y // 7 OP.744‘s ~off � .,�S�• ROBERT C. COWAN JCC 1 vf�.� CE -8801 r�."I if , . `Aor� Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 411, . iP.i .I Date )_ 91 - CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA e21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-47?fr VE p Health Authority Approval Checklist CC V C Legal Description. - &th- 1 t iPre AP To Parcel I.D.: A. WELL DATA Well type 1•404J, i )RI- If A, B, or C, attach ADEC letter. Log presentOY N) •I Total depth / o a / S Sanitary seal ON) Date of test Static water level Well production so, l� WATER SAMPLE RESULTS: Coliform 0 Nitrate Date completed ADEC water system number C-141 -YV / r --// Cased to ' Casing height (above ground) /2 Wires properly protected 5) FROM WELL LOG AT INSPECTION Fi..0u10.1 y Date of sample: L -/Rt -57 ' g.p.m. L.,Z g.p.m. a/00 Other bacteria 0 5 7 Collected by: B. SEPTIC/HOLDING TANK DATA Date installed 11- ir3 Foundation cleanout ) .STS <4,2 Tank size 10 00 Number of Compartments Z Cleanouts PN) �i Depression (Y44 "3 High water alarm (Y/N) ^3'A / Date of Ppniping 6'It-`77 C. ABSORPTION FIELD DATA Date installed / 1 (F3 Length 190 � Effective absorption area ' 5 (ep<M<onitoring Tube present ill) ,/ Depression over field (Yt ,3 Date of adequacy test (o -/'t -$7 Results( ail) PA -SS �,c/For 3 bedrooms`/ Fluid depth in absorption field before test (in.); too a Immediately afters" !gal. water added (in.): 8 7 a `i O H��( Absorption rate = �v q.p.d. Fluid depth !i (ins) Minutes later: p Pumper -TR Puoito.,)/7 Soil rating (g.p.d./ft2 or ft2/bdrm) ch) -2.5- ion System type Width a•S Gravel thickness below pipe 7 Total depth // "vex. Peroxide treatment (past 12 months) (Y/40 "id''/6 i'4"142 If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* - • . - level at* High water alarm level at* •atum sted E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Iva 14- On adjacent lots i oc 13r- Absorption field on lot 10 On adjacent Tots be l^k Public sewer main rJI A Public sewer manhole/cleanout la Ik Sewer /septic service line 'lJy Lift station "� !‘ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: = 14- Foundation rFoundation Property line )0 14 Absorption field -r r Water main/service line /9 0 Surface water/drainage /00 l ~ Wells on adjacent Tots /aO 4 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: 14- Property line /v r Building foundation /0 l Water main/service line /4 /IL Surface water /o o If' , parking/vehicle/� Driveway, storage area sa Curtain drain �° 14-%�°6�^� Wells on adjacent lots °f' t— F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal reco in conformance' th/WO,4 'defines in effect on this date. ZL Signature Engineer's Name /t d L et; C. Co w9.✓ Date ‘//e/0/7 HAA Fee $ . ei ' Y?) - Waiver Fee $ Date of Payment (/ (1 //: Date of Payment Receipt Number o7 - -09o') Receipt Number 72-026 (Rev. 3/96)* ms are ROBERT. C., eoWA, Q CE - 8801 r . �I MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH 22 GG CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL VR0- 1 OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date December 10, 1986 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 5; Block 1; Gateway to the Park Subdivision Location (address or directions) (b) Applicant Name Kenneth Moll Telephone: Home 694-7238Bus1 264-1133 Applicant Address 2436 Eagle River Road, Eagle River, Alaska 99577 (c) Applicant is (check one): Lending Institution 0 ; Owner/builder IN ; Buyer 0 ; Other 0 (explain). (d) Lending Institution Telephone Address (e) Real Estate Company and Agent none/refinancing Address Telephone__l� (f) ]Gt'the HAA to the following address: S & S EICTNEERING SRB 196X FaglP River Road Faglp Rivar, Alaaka 99577 2. TYPE OF RESIDENCE Single -Family igg Multi -Family❑ Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well ® Community 0 Public 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite jJ Public 0 Community 0 Holding Tank 0 Note: 11 community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/04) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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 S & S ENGINEERING Telephone C9' `f' 17 Address SR B 196X Date EAGLE RIVER, AK 99577 "4.04,.k� -- 11 • * 49..r /4•1-..... N F • 4i1;'`':::1,: ..e16.bellpliko....41:47977.-6...e.:J1,22,,F1 9 1 41k vivb.PvItakOz.6.5,41.6.°...aff- 6. DHEP APPROVAL �Ctla /'?r7 ?7' Approved for bedrooms by Date O Approved -' Disapproved Conditional Terms of Conditiohal Approval • \\\ CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 A. WELL DATA r-. ,, CIPALITY OF ANCHORAGE (MOw) cg IEA TH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 p� BIet°Z 264-4720 Legal Description- L 0/ S l��x � / i;CC�' VO :sM?i4„MY To 77-/c 1).4R-44. etX\i Well Classification s.F Well Log PresenttN) Total Depth too' S " Static Water Level Cased to �,r Casing Height Above Ground Electrical Wiring in Conduit (SYN) Separation Distances from Well: To Septic/Holding Tank on Lot If A, B, C, D.E.C. Approved (Y/N) Date Completed too' r" > -/c-/ Depth of Grouting Yield Co. s e.?,'t Pump Set At Sanitary Seal on Casing ON) Depression Around Wellhead (YEI? � 6t) >F ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot /00 Lf ; On Adjoining Lots /CxJ rf' / cx, To Nearest Public Sewer Line PYA}' To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot 25 /4 Water Sample Collected by S 4-S ,Nc=c �.JA/C.s ; Date /2.- /c/ -A(' Water SampleTestResults �� '1"-t SFr�Yt Gy Watt-- a`� Yrcw /177 a)c*R,=c i P. rib' UN /2 -/ 3 'H4 ,Fe+ - '/ries_ B. SEPTIC/HOLDING TANK DATA Date Installed //-/9-a3 Size / 1::›00 No. of Compartments Standpipes Air -tight Caps &N) Depression over Tank (Y9 Pumping/Maintenance Contract on File (Y/N) Foundation Cleanout6/N) Date Last Pumped /2'/ 3'-1,6 ;for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well /00/"f- To Building Foundation `7'0 r f To Property Line /o' -f To Disposal Field 6 To Water Main/Service Line /o 'f Course toe / 1' Comments To Stream, Pond, Lake, or Major Drainage Page 1 of 2 7n n06,11,51A1 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata c:. Z-' Date Installed / / - / 9-6 3 Width of Field 301` Square Feet of Absorption Area Depression over Field (YA) Results of Last Adequacy Test Type of System Design /eitzTx-5G/ Length of Field lv3 Depth of Field // Gravel Bed Thickness 9 5 2. 0 Standpipes Present 0/N) Date of Last Adequacy Test S A -T -t S P.}c zvtz-Y Fast /L - -8 to Separation Distance from Absorption Field: To Water -Supply Well /50/t To Property Linein 7° To Building Foundation ?'07 To Existing or Abandoned System on Lot iLt(1,1 • On Adjoining Lots 30 /f To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Cutbank (if present) %pc,'f SOr D. LIFT STATION Date Installed Dimensions Size in Gallons /f Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed $ t c ENGINEERING Date /2//%/e Company Sit B 196X MOA No --s-e --est> Receipt No EAGLE RIVER, AK 99577 400/-0001-f fc7— .E6 Date of Payment Amount $ Page 2 of 2 72-026 (11/84) S • • _. MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIROMEN1AL HEALTH DEPART/4MT OF IEALTH AND ENVIRONMENTAL PROTECTION APPLICATION EOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date 5' 2 4'- 'S y (a) Legal Description (include lot, block, subdivision, section, township, range) GST S Bt -,k. / h ava-y 7Z) 77-Px1r-e Location (address or directions) / /� (b) Applicants Nene di - n41p-¢_ PP/1 Fp #fQ Phone Q/ / >L� ;4.7t7 Applicants Address (c) Applicant is (check one) Lending Institution n ; 6wee,/builder Buyer!+I ; Other (explain); (d) Lending institution (telephone Address (e) Real Estate Co. & Agenti 2C1 /) Address ✓ Telephone /11 / k•e 2. Type of 1esidence Single-Famil Multi -Family n Other (describe) Number of Bedracus -� 3. Water Supply Individual Well 1-75i- Conminity $1 Public Note: If community well system, must have written confirmatim frau the State Department of Environmental Conservation attesting to the legality and status. Is the well adequate for the number of bedrooms specified in this HAA +I) 4. Sewage Disposal Onsite Public' 1 Community' 1 Holding Tank 1 1 Is the wastewater disposal system adequate for the number of bedroans .e�i/i3) [Page 1 of 2] 2-15-84 5. Engineering Firm Providing Inspections, tests, Data and Information rified, or conformed to all MOA HAA Guidelines in Address Date 317:-///(1( Telephone $ & fi E ICIMEERIN. Signed by : CRs 13cx ( rata EWER, ALAS:1A 7 Date f,i. Q 4? (ENGINEER SEAL) 6.DHEP Approval Approved for bedrooms Approved 1 Disapproved 1 of Conditional Approval (WA, --r / J A L he d, i 49, , �,iri► !r.6. L4° ID. 14172 I F :o Date Conditional !�c ..'res5/a 3 '� /- • c 17 ,? T/ SH u 't e <( o "F'houJ c' et c_ic_ The Municipality of Anchorage Department of Health and Environmental Protection does not guarantee the continued satisfactory performance of the water supply and/or the wastewater disposal system. This approval indicates that, as of the validation date shown above, based on the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional for the number of tedroa►s and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the following address: KB2/d5/s [Page 2 of 2] 2-15-84 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 GlAI3)321 178610 NO11J31O21d Td1N3WNO21IAN3 '8 Id11d3H d0 1d34 , v�DINI1W Legal Description��p C7,4r 1 -r-716 Pio/ i Well Classification S, If A, B, cr C, D.E.C. Approved(Y/N) Well Log Present Cal)_ ---------Date Completed �- / �} -8 - Yield / p/' /-1"* Total Depth /00/5-1f( Cased to /400!S" De • of Grouting �— Static Water Level S / • t At (/ni/CA/'WAI Casing Height Above Ground 2-4/ Electrical Wiring in Conduit ON] Separation Distances frau Well: To Septic/Holding Tank cn Lot 1/0 -.- ' Adjoining Lots Sanitary Seal on Casing) Depression Arcund Wellhead ,(Y,) To Nearest Edge of Absorption Fiel$on On Adjoining Lots To Nearest Public Sewer ine 4 To Nearest Public Sewer Cleancut/Manhole To Nearest Sewer Service Line on Lot "//a Water Sample Colle -- - S 'SrzK il-etJ Date .� S- 30 - 8 SC Water Comments Test Re AST/ sem/ /PI -I ,4Q OWiA/6i LATS Ai p4061/g-1-6P(91) B. SEPTIC/HA 'TANK DATA Date Installed /1-0.-83 Size /000 641- No. of Compartments 17 - Standpipes Standpipes WN) Air -tight Caps (17N) Foundation Cleanout('l) Depressicn over Tank maIP Date Last Pumped Ne -14/ AA Pumping/Maintenance Contract on File (Y ) rt ; for Holding Tank High -Water Alarm (Y/N) A/`Y Temporary Holding Tank Permit (Y/N) #'/4'1 Separation Distances from Septic/Holding Tank: /71To Water -Supply Well //Oft To Building Foundation Zt. To Property Line /0/4" To Disposal Field S / L)-� To Water Main/Service Line CO To Stream, Pond, Lake, or Major Drainage Course Comments t/ [Page 1 of 2] (/ ¶4t K3 /� 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field l/—/7-6'3 2Z S� Type of System Design •yam{nc( Length of Field (7.5? 3o " Square Feet of Absorpti Depression over Field Results of Last Depth of Field // Gravel Bed Thickness % / 952_0 Standpipes Present WN) Date of Last Adequacy Test NEVI/ A/ Al Separation Distance frau Abs ption--Field: - To Property Line To Water -Supply Well To Building F°� ndation Lot /(id To Water Main/Service Line /0 174 To Existing Abandoned System an joining Lots j'6 To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course / To Driveway, Parking Area, or Vehicle Storage Area /00 /t Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level Tested for Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Electrical Codes(Y/N) Catments ing Cycles during Adequacy Test. Meets MOA ** ** Check Permitted Bedroan Rating Against HAA Request I certify th I ve checked, verified, cr conformed to all MOA HAA Guidelines in effect on the da ion. Signe Camp BRBQ�RINQ oex KB1/d5/s ' RNER, AIASKA -g§-p PH. 694-27:,) 1 / **62-1-2,444,-e-27, [Page 2 of 2] Datef-3 3 MOA X. FESSmek 11. +. 2-15-84