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Home My WebLink AboutGATEWAY TO THE PARK BLK 1 LT 16 Onsite File Gateway to the Park Block 1 Lot 16 #067 - 611 - OS Dec 3 i ' 8 03:48r Anc{ uage'Are.1 & �•,_nip Ssr 907:2430742 ?.1 ---� Development Servirps Department Building ,Safety Division -Site 'dater A WOStewater, Prtrgram c _ r 4700 Fimcre Road ` Mark s R.O Box 196650 tr B 9g!Ch Anchorage, Ak K 99507 Mayor r,vw.mun .ntr, !9'07? 343-7904! Pump Installation Log W(41 Drillittg Perunit Nurnb�r: SVS' Parcel Identification Number: OG'1— L 1 OS Legal Description � w - C -,`i a� +Z_� +',)e pal-�2 N Lf P!snmp installation Date: J —' Pump intake Depth Fiel,1►j, Tcjp of N4'e11 Casing: r � �j feet PUMP ManUfacturer's Name; `Fl�9) mc-, k 4 Pump Tvlodel. Pump Size ltlj Pitless .A,drapte,�- $urii!I D4cpt!i: /0 feet Date of Issue: .PR'o MY Owner `vats; 8; Address. _W�- Aw'�.'r PideSS Adapter kfanufacturer's Name: � � -L„��o : ,Nj-- Pitless Adapter Inst:,*(ler: WI -11 Disinfeeted Upon Completion'' }'es '-' No A-fethod of Disinfectic!!: Comments: Pump Installer Vane: as^��,c v��•�r (,ti'_LZz :�, Attention: The pu;n installer sha4: p ev!cie a ouIllp nista ; ttion log to the DSD within 330 day-, of f!t rrp ins4�11aiio,l. Municipality of Anchorage Community Development Department Page 1 of 2 On-Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite• (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP171055 PID Number: 067-611-08 ❑ New ❑,, Upgrade Name ROBERT&TONYA KENNEDY ABSORPTION FIELD Address ❑ Deep Trench ❑ Shallow Trench El Bed ID Mound 1921 MT KILIAK CIR, EAGLE RIVER,AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 2 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot Ft. Ft. GATEWAY TO THE PARK 1 16 Fill added above original grade Gravel length Township Range Section Ft. Ft Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Tank Line Ft2 Ft. Well 109.1 100+ N/A ' N/A 25+ TANK 0 Septic 0 S.T.E.P. ❑ Holding 0 Other Manufacturer Capacity Surface Water 100+ 100+ N/A N/A • Anchorage Tank 1000Gal. I Material Number of compartments Lot Line 24.6 10+ N/A N/A STEEL 2 NA Foundation 11.9 10+ N/A j N/A LIFT STATION Manufacturer Capacity Curtain Drain 50+ 50+ N/A N/A Gal. Pump on level at Pump off level at High water alarm at Remarks in. in. in. Pump make and model Electrical Inspections performed by -PIPE MATERIAL House to tankTank to �� Installer AUp3rainfield .410/3 DEAN CONSTRUCTION Drainfield 40.1;0%. CO/MT qp4 9L Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 100.0ft Inspectiont Location and description dates: 1• 4/19/17 2°" 4/20/17 3rd Ott, SW BOTTOM TRIM COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineers Stamt. Conditional Approval: Date �GOF A ( .. '7.1%9,LA 41oe ;� 9 � . , *i ..._-f r' lsyen1f'• none 1 76*. 8149 . RA)-tuA. i1 ('� i s �Approved CA, Date Li(2 8/ i i tl\ meq, Inspection Report_1-1-12.doc • I1l17I---- '.'..\''---\----T--n---"- lII''\\' ....''''"- s e . '' \ 1 ' -*, .40- "' 'Alt- \ _ lit... . *1 if, ** ///\ L _ . 44.! N 1 \ 7 . __--- ____-- TRUE NORTH 0, SCALE : 1•-50 r � a f \---WELL (E)/ A B FC 24.9 12.9 DRIVtWA T1 27.6 18.7 T2 30.5 23.5 h ()IC) 16 DCO 32.2 25.9 ��Q M1 34.9 32.8 V� � I /..---------- M —� M NIAZ M -_______ ,,IN 9A I 41 �_ W ABANDON°000G SEPTIC TANK IAW MOA CODE ' 14. i _ INSTALLII000G SEPTIC a 'f W/ DCO AFTER TANK c.n , J 24j Nit 6 -109.1 f j / J U 1 U' •C I3 =' 1 7A K 0 0 5 z z Wo \ U U U ) EL.99.3 - /`(" / W `N f/ CO 9.4 �� \ / g -3 1 1000 g SEPTIC ran TANK(N) ,9.� I NOTES: 1PANNONE ENG SVC, LLC �OF Date RECORD DRAWING P.O. BOX 102954 ANCHORAGE, AK 99510 oa/2s TANK REPLACEMENT _ PHONE (907) 272-8218 FAX (907) 272-8211 4,_••. Scale — Ir *�, ��` . .01,0 : DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Andlorl~e, Almkl g~501 TIIIi~ 264-4729 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT I .AME// /-/ ~ // IPH°NE /'T~x/,~, ~b?O ~..'t / I o/ _~' Z~~/ LEGAI/OESCRIPTION _ / J / · O AT,O. / / - I NO. Manufacturer ~. ~ j~ ~_~x~ ~ II ~.~..~F~.~ II No. of comperlment~ Well Dwelling : PERMIT NO. DISTANCE TO: DISTANCE TO: Well No. of lines Length of each Top of tile to finish grade line length of lin~ K~ial beneath tile Crib diamete~ Crib depth ~Netl Typ,~ cr~ DISTANCE TO: DISTANCE TO: OTHER PIPE MATERI~;,~C IINSTALLER REMARKS PERMIT NO. Trench width inches Dis'mr, ce between line~ To~l effecti,~'~ .,~tio~ area Distance to lot line PERMIT NO. Septic tank Absoq)~mt area(s) ~t~ICt~ALITY O~ ANO~4tA6~ . ~i ~ Departmen~f Health ~d ~v~~t~ot~tlon~.. ~-~-~ 825~ Strut, ~or~e, ~.~9501 - ~ ~ ~ ' 264-4720 ~ - ' . ~ * *" HAdRIaN PERHIT * * * Pe~zt f~/~' ~ WE~ ~D/OR ON-SITE S~ER PE~IT ~ of Soil ~so~tion Syst~ Is: ~ch: Dra~fi~: Seepage ~ ~ Hold~g T~ J ~e ~~ Size of the Soil ~sorption Sys~ Is: ? { L~'TH ~' GRAVEL ~P~~ WID~ D~TH ~e length d~si~ is ~e l~gth(~ feet) of ~e trench or ~a~field. ~e d:~ o~ a t~ch or pit is ~e dist~ce ~twe~ the s~face of ~e gro~ ~e bott~ of the ~cavation(~ feet). ~e is no set width for tre-ches. ~e ~av~ de~ is ~e m~4m~ de~h of ~avel betwe~ the outfall pi~ ~d ~e ~tt~ of the ~cavation(~ feet). · * = * * ~t applic~t ~s ~e re~ns~ility to ~fo~a t~s de~nt ~stallation ~p~ti~s of ~y wells adjac~t to this pro~y ~d the n~ of~ ~id~ces that ~e ~11 w~l s~e. e e e ~0~) INSPECTIONS ARE REgUlR~ ~c~ill~g of ~y syst~ without f~al ~spection .~ approval by ~is dep~t will. ~ s~j~t to prosecution. ~4w~ dist=e betwe~ a well ~d ~y on-site sewage dis~l syst~ is 100 for: a private well or 150 to 200 feet fr~ a p~lic well dep~d~g u~n ~e t~ of: p~lic well. ~i~ dist~ce from a private well to a private sewer l~e is: ~ feet ~ to a co--miry s~ l~e is 75 feet. Well logs are r~~ ~~t be r~~ to this de~~t with~ 30 days of the well c~pleti~. O~er ~~ents ~y apply. Sp~ifications ~d c~s~uction ~ia~s a~l~le to ~s~e proof installation. e e e PERMIT ~PIRES DECE~ER ~1, i 9 I c~tify that: (1) I ~ f~iliar with ~e re~~n~ for on-site sewers ~d ~lls as set forth by the M~icipality of ~bhorage. (2) I wil~s~ll the~st~m ~ accord~ce wi~ c~es. . . (3) I ~~ ~at ~ o~site sewer syst~ may re,ire ~l~g~= if ~plic~t Date: ~ SWP/024 (1/81) MI.IMICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3" 4' 5' 6' 7' 8 g SLOPE SITE PLAN 10- 11 12 13 14 15 16 17 18 19- 2O COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT ® Municipality ®f Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 067-611-08 1. GENERAL INFORMATION: Expiration Date: _U o—n 1 � , � D a Complete legal description GATEWAY TO THE PARK: BLOCK 1 LOT 16 KILIM< Location (site address) 1921 MOUNT IAC CIRCLE, EAGLE RIVER, AK 99577 Current Property owner(s) ALEXANDER DEYOUNG Day phone 795-5054 KILT NK Mailing address 1921 MOUNTK CIRCLE, EAGLE RIVER, AK 99577 Real Estate Agent NICOLE LEE Day phone 223-7597 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 2 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Distance Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $_L1 12. 50 Co 111 D Waiver Fee $ Date of Payment (p —R' W) Date of Payment Receipt Number OzVg 7(; Receipt Number COSA # OSC ZD 1558 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: O €3 o In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and `� :•.• �a'/t •.•%�, r industry practices. The reported results describe the condition of the systemis on the date/s of the r?, a/� v�f a evaluation. Separation distances were measured to readily identifiable features. Hidden defects or J'N,� ,{ encroachments may exist that were not identified during the evaluation. The operational life of all wells �� I� �`` �• yWr and septic systems depend upon a variety of variables, including but not limited to, soil conditions, /e%• •. • • •; • .JJ. • • • • • • • • • • groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the systems. These conditions can vary, and .", :.; are outside the control of GEG. Satisfactory test results do not guarantee future performance of the��, lWeifrey,�A Gor� ss. System/s; therefore, GEG makes no warranty (express or implied) regarding the future performance Qf �; c; )� , the well or septic system. GEG makes no representation whether an alternative well or septic system Vis can be installed on the property in the event either of the current systems fail to perform adequately in ;t,"o the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE e� •/ System #1 Approved for bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the fol #AECC884 ,G�pp�,li,.ITY O/V,,S o ; R /VZ) m ti 11 tipula i q44 By: J( 6 9\9Original Certificate Date- .1 D 1 3 b 0 �QC The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist _ Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc Legal Description: GATEWAY TO THE PARK; BLOCK 1, LOT 16 Parcel ID: 067-611-08 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 9/12/83 Total depth 120 ft Cased to UNK ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 9/1/20 Static water level at beginning of test 10.1 ft Comments B. TANK DATA Age of tank(s) 3.5 years Tank type/material STEEL Measured operating fluid level in septic tank 49.75° ❑ Standpipes/foundation cleanout per record drawing Date of pumping 5/11/2020 D. ABSORPTION FIELD DATA BED Well production at time of test 5.1 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 0.68 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by GEG,LTD. Date of Sample 9/1/20 STATION ❑ Requir aintenance completed Age of lift station yea Lift station materi/al' Comments/ Which system tested (date installed) 8/25/�M 1983-P6 V_6 Adequacy test date 9/1/20 ❑ ALL standpipes present per record drawing (-t Mk1_) Results F71 Pass For 2 bedrooms Total measured depth from grade *9.9 ft (max) Fluid depth prior to test *0 in Measured depth to pipe invert from grade *7.9 ft (min) Water added 533 gal ❑ N/A — pressurized field New depth *7.25 in * ❑ Monitor tubes go to bottom of effective. If not, state sed time 128 min Ela depth into effective p ❑ Code -required soil cover over field Final fluid depth *0 in ❑ System presoaked Absorption rate 300+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: 'A NEW CLEANOUT WAS INSTALLED ON THE DISTRBUTION LINE AND NEW MONITROING TUBE WAS ALSO INSTALLED BY JR'S EXCAVATION ON 10/2/2020 NEARBY THE OLD MONITORING TUBE. THE OLD MONITRING TUBE EXTENDS APPROXIMATELY 2 FEET BELOW THE INVERT ELEVATION OF THE DISTRIBUTION LINE IN THE CLEANOUT AND THE NEW MONITORING TUBE EXTENDS 0.48' BELOW THE INVERT OF THE DISTRIBUTION ELVEATION IN THE CLEANOUT. 7.9' TO INVERT OF PIPE AT OLD MONITORING TUBE BASED UPON ELEVATIONS TAKEN BY GEG. LIQUID DEPTH FOR SEPTIC ADEQUACY TEST SHOWN IS IN OLD MONITROING TUBE. DRAINFIELD IS APPROXIMATELY 10-15 FEET AWAY FROM A STEEP SLOPE (<46%) WEST OF THE DRAINFIELD NO INIDCATION OF DAYLIGHTING ALONG THIS STEEP SLOPE OBSERVED COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' 0 Yes if No Community Sewer Manhole/Cleanout > 100' E✓ Yes if No ft Q Yes if No ft Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25' M Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No *UNK ft Holding Tank > 100' R� Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' El Yes if No ft ✓j7 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑✓ Yes if No ft Q Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' M Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' Q Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' []✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' [J✓ Yes if No ft Community Wells > 200' Yes if No Surface Water > 100' ❑ Yes if No *UNK ft F. ENGINEER'S COMMENTS `PER 2017 COSA, DRAINFIELD IS 100+ FEET FROM WELL ON PROPERTY OR SURFACE WATER. EXACT CONFIGURATION AND ORIENTATION OF DRAINFIELD IS UNKNOWN. THERE IS A SMALL CREEK RUNNING ALONG THE NORTH SIDE OF THE PROPERTY (NORTH OF THE WELL). 4od600 G. ENGINEER'S CERTIFICATION `�� 1 certify that 1 have determined through field inspections and review �� •' S�0 of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. t..it ' ..........�.......I QQ j g4ey A `earn ; € '•1/ CE 7955" ,• \c ° COSA Checklist yellow sheet dprofess*'o� #AECC884O��lz= ft ft • • '1 9 70%Gi- &( Municipality of Anchorage ti w X6��8 9 �, On-Site Water and Wastewater Program 1 .t' al �� (907) 343-7904 a APR 2 7 Lei s Ai„ r Certificate of On-Site Systems Approv. *VAIN ti Parcel I.D. 067-611-08 Expiration Date: !` �� 6 g L g��d 8, i2p1-1 a 1. GENERAL INFORMATION Complete legal description Gateway to the Park Block 1 Lot 16 Location (site address) 1921 Mount Kiliak Circle Current Property owner(s) Kennedy, Robert & Tony Day phone Mailing address 1921 Mount Kiliak Circle Eagle River, AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: O Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 2 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual E Individual Water Storage ❑ Holding Tank I 1 Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: IiiDate: 2,11APrL t-7 COSA to be released t• .1' -'7", eer,unless otherwise requested by the engineer. COSA Fee $ */`L [ Waiver Fee $ Date of Payment 16 9//9' Date of Payment Receipt Number o f tt sReceipt Number COSA# e�(_,17-1/6-2- Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances m ured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition,ground wtet may fluctuate during the year,and the water usage of the family being served by the system.These conditions are outside the tl4e evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the s , nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 4/27/2017 *: iil •.* 6. DSD SIGNATURE .4..,\11. • '• '+r X System #1 Approved for a bedrooms SIeireri It •annone . fi (i 1,•. CE-8149 System #2 Approved for bedrooms �� 4s,•. •• �� Disapproved ��1 .% S`_4 - ANN.NConditional approval for bedrooms, with the following stip. ulatio ns: Q0\1`i Or,yAc-y �V Jam' ON-SITE %Gy. WA WASTEWATER U PROGRAM65. ! � Q �'? Ar-- r�itt^F O By: pt � 19,{1 0, CQ.%x,.-'8) Original Certificate Date: ) 8 f ' The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory . Septic System Advisory Arsenic Advisory Well Flow Advisory Other .. COSA bice sheet f - . c If more than 1 septic system is on the lot: COSA Checklist # ' of Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description Gateway to the Park Block 1 Lot 16 Parcel ID 067-611-08 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (YIN) Y Date completed 9/13/1983 Sanitary seal (YIN) Y Wires properly protected (YIN) Y Total depth 120 ft Cased to 120 ft Casing height (above ground) 1 8 in FROM WELL LOG AT INSPECTION Date of test 9/13/1983 4/11/2017 Static water level 9.5 ft. 12.0 ft Well production 50 g.p.m 4.2 g p m WATER SAMPLE RESULTS Coliform NEG colonies/100 mL Nitrate 0.803 mg/L Arsenic ND ug/L Date of sample_ 4/11/2017 Collected by PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 4/20/2017 Tank size 1 000 gal. Number of Compartments 2 •Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (YIN) N Date of pumping NEW Pumper N/A C. ABSORPTION FIELD DATA 9/Z5/INe13 Date installed 4120/201 Soil rating (g.p.d./ft2 or ft2/bdrm) 150 SFIBDRM System type B0D Length 22.5 ft. Width 20 ft. Gravel below pipe 0.5 ft. Total depth 9.6 ft. Eff. absorption area 450 ft2 Monitoring tube Y Depression over field N Date of adequacy test 4/11/2017 Results (Pass/Fail) PASS For 3 bedrooms X15°` Fluid depth in absorption field before test 0 in. Water added gal. New depth 6 in Elapsed Time: 20 min. Final fluid depth 0 in. Absorption rate >= 450 g.p d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes. give date D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES 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+ Public sewer manhole/cleanout 100+ Sewer/septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ _ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 00+ F. COMMENTS G. ENGINEER'S CERTIFICATION s`'F 1 certify that I have determined through field inspections and r....A'N.. 1 .'�•,9�� review of Municipal records that the above systems are in r*;-1�Q -1 . I\ ...*94� conformance with MOA COSA guidelines in effect on this date. Steven Pannone `/! •• . Engineer's Printed Name r :Steven fit.•rannone 4/27/2017 6 CE-8149 A/ Date 4} ti r �%tiiPRO ss40— ma COSA canary sheet_2-6-15.doc 1 )s ,a- g-vi `‘9 7 :t:_ k ------\-- % ka b -1-_--• \----- N ti\ \ vt \ \ y Id't\iri I 44 to ik ys�a • o A/fir • • MSI otts Ii .• IA �► ,yams ,' lib �/� �� ,7 oSS $4a !_ »yam -UILT SEWARD & ASSOCIATES LAND SURVEYING 694-0829 _______I� SCALE I HEREBY CERTIFY THAT I HAVE SURVEYED THE � �o��mi q FOLLOWING DESCRIBED PROPERTY: " _3O +{, 4F qi 14.. FOLLOWING s.9%a-4r.Gy- rU 9 { .�G07`ar�6 'a/ DATE- .......... Q�,'� AND THAT NO ENCROACHMENTS EXIST EXCEPT AS y / �► .:.1.5:42t, '!`' '� INDICATED. IT IS THE RESPONSIBILITY OF THE � i:" M d )WNER TO DETERMINE THE EXISTENCE OF ANY GRID: s'•' '�• 4 EASEMENTS, COVENANTS, OR RESTRICTIONS f / -� �v� • .,.g WHICH DO NOT APPEAR ON THE RECORDED SUBDI.- • Won* Mar Seward k 1 r1S1ON PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' /yam`��, 15•••,64./.y1 r0 .NY DATA HEREON BE USED FOR CONSTRUCTION �' 7F FENCE LINES, OR FOR ESTABLISHING BOUND- — ' 't,1''pti, 1...*• XRY LINES. DF7A � N.4-111106"?. MUNICIPAUTY OF ANCHORAGE Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL II~ORMATION (M~I be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) · Location (address or directions) (b) Property owner L-,~¢~- '=~t~~ Telephone: (home)~'~r/~ Bu~i -ne~-- Mailing Address (c) Lending Institution Telephone Mailing Add. _re~__ (d) (e) Real Estate Company and Agent . · Add _re~__ ! ~ ~'I'"Z"~' ~;~__.~ I~ "~% ~L--~-q~ '~. Telephone Mail the I-IAA to the following adding___: (or check here~if hold for pick up.) List contact parson end day phone number ~ 2. 'n'PE OF RESIDENCE Single-Fa~ily]~- '~-WATER SUPPLY Individual Well ~. Number of bedrooms Community [] Public [] ~ If 'community well system, must have written confirmation ;~om the State Depamnem of Environmental Conservation attesting fo th legality end 4. SEWAGE DISPOSAL On-site ~ Public [] Community n Holding Tank n Note: If community well system, muet have wi;[~ confirmatio~ from tho St:ate Department of EnvironmMltM Conservation attesting to the legality and s(atus. ~m,..tM) Pege 1of 2 $. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH,. DATA AND INFORMATION * As certified by my seal affixed hereto and sa of the validation cl~ta shown below. I verify that my inva~tigation of this Health Authority Approval shows th~ the ~ ~ supply and/or wistewater ~ system is eaf~ functionaland adequate for the number of bedrooms and type of structure indicated herein. I fu~her verify that based on the information obtained from the Municipality of Anchorage files and ;,~,m my inv~ and inspection, the on-site water supply and/or westewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this irmpection. Name of Firm Address Date s & s EHGI~RING Telephone Approved for ~' bedrooms by Date /~' Disapproved Conditional Approved ~. -. Terms of Conditional Approval The Municipality of Anchorage Dapartment of Health and Human Services (DHHS) issues Health Authority Approval cMi;icated based only upon the representations given in pmagraph S al)ova 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 slate requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for e~or~.or in the professional engineer's work. 72~soq,,.;mm B.* Page 2 of 2 ~PAUTY OF AN.C .HORAGE (MOA) ~ _,.'( ~lW P'- Well Log PresentatiON) ___~(____ Date Gomplet~:l To~l~p~ ~ ~to ~' ~thofGr~ting ............. PumP~ E~ri~l Wid~ ~nd~i~ '~: :-,: -71- ~ion ~TION DIST~ FRO~ ' -' ' ~ ~~nk ~ Lot ~ To ~ E~ ~ A~m,o, Fi~. Lot / T0 ~r~ublic ~r Li~ ~d To N~ ~blic To N~ ~r ~ Line ~ Lot Water~leT~R.ul~ ~~~ / ~ ~ ~ Comm~m, R~ ~~- . ~--~--~ -- . B~.~ TANK DATA Date ;,,~,;a;;=d !1~/4r'~ Size ~ No: of Compartment~ Standpipes ~]PN) :~_~Air-t.i~ht ~----apsd::~) y Foundation Clean~) y Depression Over Tank (Y~I~ /'~ -- _ Elate Last pumped pumping/l~a.., in_ten .a~eConta...ct.oq File (_Y_/N) ~ ;:fo~ ~ H01dJng Tank High-Water Alarm (~/N) ~ Temporary Holding Tank Perm';t (Y/N) SEPARATION DISTANCES -'- FROM SEPTIC/H~L-I~4NG TANK: ' "' ' '*' ~. ~, ~ To Disposal Field "'~]~.~/am., p°mll;:~,~'or'Major Drainage Course ! ~:~ ~ Page I ~2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ ~'~ ~'~'~ Width of Field ~ ~:;~ Type of System Design Length of Field Depth of Field Gravel Bed Thickness To Water-Supply Well TOLotBUilding Fou n d~t~ To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Square Feet of Absortion Area '~1~C~'=~ Statndpipes Present~Si)/N) Depression over Field (Y,~ : ~ Date of Last Adequacy Test Results of Last Adequacy Test ~ SEPARATION DISTANCE FROM ABSORPTION FIELD: [ ~;:?C:;' ~ TO Property Line ?(~ ~' -- To Existing or Abandoned System on ; On Adjoining Lots ~ ~4 / ~ !4- TO Cutback (if present) Comments / D. LIFT STATION /-,- Date Installed "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) ~"Pump Off" Level at Test **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 $ & 17034 Eagle River Loop Ro~d No. Company Date MOA No. __ Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 ~ , Drinking Water Analysis Report for Total Coliform Bacteria PUBLIC WATER SYSTE~ LD.# ~ Analy~ shows this Water SAMPLE to..be:* : .... [] UnSatisfactory ~ ': n~ sampl~ via special clellve~' mail with lab tel. no. ) ri Treated Water * No ~)f colonies/100 mi. ~1 I I ~*IFil BACTERIOLOGICAL WATER ANALYSIS RECORD 51 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Tlql C = "c.o Numberous To Count ~ FEDERAC TAX ID · g~ iliATSI$ H Fl ~ fox lbek hte blurt l~lntd: OCT 5 # t ~$:0~ Client Sample ID:LX&. IX. ~LT~Ii! TO Tut tiM[ LPMSID PEesezvod with :~ Cltamt b : S t S ~ BIB _ueC'D LaboEate~y W :SIJ~B! C. sm t~s s s us~Bms~ Cbmlab lef J: 2S35 Lab httl I):. 7 lq~ammt~ Te~ted I Toet~ ferfo~md ' Soe Si)octal ImtEuettoM lbovu Ui-~mvatlable I~- Bono btoctod ** be S~t, le lemmb lbev. ua= Mot Analyzed LT-LMs Than. ~-eremtex Thn Nat~ Sampl~ ~st I~sul~s Crmm_nt~ [Fag~ 1 cfi[ 2] 2-15-84 LIFT ~TI(~ Date Installed Sims in Gallo~s · Pum~ On" Leal at High W~te= Alarm Iavel at~ ~.l~tzi~ai "Pum~ Off" Level at , Vent (¥/~) ,, WATER AND SEWER INSPECTION WEI.L IN~J,.-t~l WiNS AND FLOW 'l~ST · TE F~NS RO~) DESIGN ~OJLTEST ON 811~E WASTE WA~ER i)~'0e, AL SYSTEM DEIGN EXGAVA~ON WOrK ROBERT A. SHAFER Februa~-y 27, 1984 CIVIL ENGINEER 694-2979 MuNtCtPA, LITY OF A~4C)R'A~ Orr.?T. OF H=,=,=,=,=,=,=,=,=,=~ALTH & RECEWED ~unicipality of Anchorage ' ~- · Department of Health and Environmental Protection 825 L Street Anchorage, Alaska 99501 REFERENCE: Lot 16t Block 1~ Gateway to the Park Subdivision~ S~t Section 4t NE~4~ Section 9t T13N~ Request a Health Authority Approval be provided for the residence located on the referenced property. The following documents are provided for your information. A. Application for Health Auth~ity Approval. Certificate. Bo Health Auth~ity Al~roval Checklist February 1984 C. A well log D. Drinking water analysis report for total coliform b~acteria A well yield production test was performed and it was determined that the well can provide the minimum susta/ned yield in excess of 0.104 gallons per minute per bedroom. ~owever this well cannot be guard-teed against subsequent reduction in yield or failure. The current well is an artesian well and is being relieved by two i~ galvanized pipe extend/ng from the well casing below the pitless to a nearby strea~. The relief pipe outlet is covered by a screen. If we may be of f~kh~rservice or provide additional infor~ation for your use, please ~o not he~tate to contact us. ? . cc: Kelly Stovall ~ tM¥ KAt'tl I: RIVFR A~A~KA