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HomeMy WebLinkAboutGATEWAY TO THE PARK BLK 1 LT 23Gateway to the Park Block 1 Lot 23 #067-611-05 �� MUNICIPALITY OF ANCHORAGE '• f 7.'0.7.'0.DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street -Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME /� /{-�J • 6 l API C/-� / /I% /- 13 C //+, D 6- l� C -'k-' (, PHONE PHONE /KNEW E UPGRADE MAILING ADD SS .)) " p?'% [7 j / AL'f-',.:5-6'') LEGAL DESCRIPTION L c. 3 5 / 6 /47 -7---t--(..../ a7 7: -7--/-7-i.=2 / z LC LOCATION -_5-- T/3 ci 2/ SGt/r O. OF BEDROOMS 3 SEPTIC TANK DISTANCE TO: VVell c c T AbsorptyQn ar�a Dwelling, � / PER�11T,f�0�/`�2 oJUof Manufacturer /?_ C Y /o C. M eria .g / � No. compartments(jaY2_ Liq.Fap�ciyx iry�allons C/ IF HOMEMADE: Inside length Width Liquid depth Z O Q 2 F - DISTANCE TO: Well /Dyvellin PERMIT NO. Manufacturer / ./ / Material Liquid capacity in gallons TI LE D*AINr D TRENCH DISTANCE TO: Well / / / L^ Foundo?/ Nearest t line7'4 /0 PERJ�A,JT 0.11 //;; �+` g Z S No. of lines j Length ci,ea h inp 9 � L Total len th o n 6s Trench w 1/ inches Distance b twee f li s /V %�- Top of tile to finish grade / Material ben ath the r, inches Total effecf;We ation a [�f SEEPAGE PIT Length Width Depth PERMIT NO. Type of crib Crib diameter/Jrib / depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line W CIrxls r,/ -L Depth,z!!/lti 7v Driller Distance to lot line PERMIT NO. DISTANCE TO: ilding foundation � Sewer line Septic tank Absorption areals) OTHER e tli e i' PIPE MATERIALS r ri SOIL TEST RAT 1G /� /2-) / 8iz 0 7? I NSTALLEF3 / /V0(/11Gf it (C`',„ f dfd-P ' REMARKS pp ri �j 6 74 /V / VH A .ekriecti/`. +NI- s . //sar) 6 o� t - /'1u lila z Gam/ 6Pi r A1.4%1 ° 1 in t �L" „co0ti C' / e �4� i.tivrf A. S�":ier •• / ..• Ne 1'57 E 4� �� to � •r §3 4124/1‘(V r 61`; PRQFE!S\QN��� 1 IAA �( �1\\moi APPROVED „tit. E:i'31 Qr..n.i t? DATE LEGAL SRB186K T /Z-9% 0(_:2- / //i/g# ,a1:= R;V=R, AL=+ ',� 4... r, �, /��� c ./1' MUPATC:=IF7-fAH_I-11-V DF.7 ��CA-ADP:ir7ACET.E1- DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 225 L STREET, ANCHORAGE, AK 99501 264-4720 PERMIT NO: 840P75 DATE ISSUED: 09/26/84 APPLICANT: IDAHO PINE BLDG CONT AC��ESS: P O BOX 872252 WASILLA, AK 99587 CONTACT PHONE: 376-7046 LEGAL DESCRIP: SUBDIVISION: GATEWAY TO THE PARK LOT; 23 SECTION: 9 TOWNSHIP: 13N RANGE: 1E LOT SIZE: 1A (SQ.FT. OR ACRES) MAX PEDPOOMS: 3 BLOCK: 1 Licted below ore the options available to you in designing your septic system. Choose the option that test fits your site. �.EP,7rErN117!--! 4.70_, E7YF;:-J.f71-,,g DEPTH |C ,!PE SOTTOM (F!.) 4.VL ��4.0 CRAVE! DEPTH (FT.) ��.��' 3.5 TOTAL DEPTH (FT.) ��f'7/1"~ -' 7.5 SRAVEL WIDTH (FT) 2.5 '/ 5.0 3RAVEL LENGTH (FT.) 38.r1--l'i / 41.0 GRAVEL VOLUME (CU.YDS.) 19.4 30.4 TANK SIZE (GALS) 1,000.0 ** 1,000.0 SOIL RATING (�Q.FT./BR) 125 125 TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of 4n7horage (MCA) and the State of Alaska. 2. I will install the system i: accordance with all MOA codes and regulations, and in complia:ce with the desio: criteria of this permit. 3 I will adhere to all MOA and State of Alaska requirements for the set back dista:ces f/.om any. existing well, wastewater disposal system or public sewerage system or this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 3 Hedrooms and any enlargement will require a: additional permit. IF A LIFT STATIRN INSTALLED IN AN AREA COVERED BY MOA BUILDIND; CODES, THEN (1) AN ELECITPICAL PERMIT AND MUST BE OBTAINED1 (2) AS-BUILTS WILL NOT 3E APPROVED /4ITHCUT AN ELECTRICAL INSPECTION P[PORT; AND (3) THE ELECTRICAL WORK MUST BE DCNE BY A LICENSED ELECTRICIAN. ' '---------- :-)PFLICANT: IDAHO PINE BL�G CONT \SSUEn BY �ATE: __________ PERFORMED FOR XSOILS LOG G.Sys' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST /cam/ road A7» L 2 3 8 / o-4 7frSLOP£ 7J SITETEPLAN LEGAL DESCRIPTION: 1 2- 3- 4- 5 6- 7 - 8- 9 10- �%E�PTr ('EEC DATE PERFORMED: ❑ PERCOLATION TEST UV9cc{li c si�ry s/lNi ' F2AC7-f€i O "7C G�- /23 A34 (r - /2f 71/8 L/61-/7 S/L i 19- 20 - COMMENTS PERFORMED 8 '/h me -to ,Cf7fll 0.•OO••11. ••00 . Robert A. Shafer :�� -'! , N.. 1457.E ; 6 \Li '°ROFESSOI.; U A/A3,,„ /4ERCOLATION RATE kAl WAS GROUND WATER A%n L ENCOUNTERED? /�'C/ 0 P IF YES, AT WHAT DEPTH? E 1,) S 2 Reading Date Gross Time Net Time Depth to Water Net Drop ////74- ,- • TEST RUN BETWEEN F' FT AND SRB 190X PH 9 7� V577 CERTIFIE (minutes/inch) FT WELL LOG Box 871218 - Wasilla, Alaska 99687 - 376-2041 DEPTH OF WELL U_ H 1— c/) N N cc w w cc Z 0 � D 0 < WELL - SITE SCREENED PERFORATED SIZE OF CASING LL LL LL LL LL LL LL i I MUNICIPALITY OF ANMORAGE DEPT' OF HEALTH & ENVIRONSENT9d PRSTECQ1.0 0 KIND OF FORMATION: MAR 198 .LL LL LL LL REC IVE 2 2 2 5 5 2 0 0 0 0 0 0 Crrc cc CC LL LL LL LL LL LL LL LL LL LL LL LL LL LL 0 0 0 0 0 0 0 <Sit LL LL LL LL LL LL ▪ LL ^I a 1— 0 Lu Q ( 0 0 0 0 0 0 0 0J CO 0 LL LL LL LL U. LL LL CC w J J Fc 0 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 067-611-05 1. GENERAL INFORMATION Complete legal description GATEWAY TO THE PARK B1, L23 Expiration Date: g Location (site address) 1825 MOUNT YUKLA CIRCLE, EAGLE RIVER, AK 99577 Current Property owner(s) WILLIAM & ROBIN BULLOCK Day phone Mailing address PO BOX 772981, EAGLE RIVER AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: Z Single Family (w/wo ADU) Duplex Multiple Dwellings (Single Family and/or Duplex) I1 II 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Individual Well ® Individual Individual Water Storage I I Holding Tank ❑ nommi inity Class wall it Community Public Water System ❑ Public Sewer ❑ SUS1iTMe MAY 132014 TYPE OF WASTEWATER DISPOSAL: WaiverNariance request for: Distance: Received by: COSA to be released to the engineer, unless o,,tlie e requested by the engineer. Date: COSA Fee $ S2 -(o P Waiver Fee $ Date of Payment 5/13) )'4 C�, Date of Payment Receipt Number 53)50 Receipt Number COSA# OS Gy Lt '3 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 ARCTERRA CONSULTING, INC. Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Phone 868-3791 Date 5112/14 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 occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. 6. DSD SIGNATURE System #1 Approved for 3 bedrooms. System #2 Approved for bedrooms.S ;'�n 27tJ '_ Disapproved. Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: 1St/ The(ytdnicrpal;- of A `orage 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 If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: GATEWAY TO THE PARK B1, L23 Parcel ID: 067-611-05 A. WELL DATA Well type PRVT If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 10/2211984 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 202 ft. Cased to 202 ft. Casing height (above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test 10/2211984 4/28114 Static water level 90 ft. 96 ft. Well production 20 g.p.m. 6.6 g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 0.847 mg/L Arsenic: ND ug/L B. SEPTIC/HOLDING TANK DATA Date of sample: 4/2812014 Collected by: ARCTERRA Tank Type/Material SEPTIC I STEEL Date installed 10120/1984 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 412812014 Pumper JR's C. ABSORPTION FIELD DATA Date installed 10/2011984 Soil rating (g.p.d./ft2 or ft2/bdrm) 125 System type DEEP TRENCH Length 24 ft. Width 4 ft. Gravel below pipe 8 ft. Total depth 11_1* ft. (Measured 4/28/14) Eff. absorption area 384 ftZ Monitoring tube Y Depression over field N Date of adequacy test 4/28/2014 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 460 gal. New depth 0 in. Elapsed Time: 1 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at Datum Cycles tested Meets alarm & circuit requirements? in. E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 1001+ Absorption field on lot 100'+ On adjacent lots 1001+ 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'+ Water main 10'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Water Service line 10'+ Property line 5'+ Absorption field 5'+ Water service line 10'+ Surface water 100'+ Building foundation 10'+ Water main 10'+ Surface water 100'+ Driveway, parking/vehicle storage 101+ Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name KENNETH M. DUFFUS Date 5112114 COSA brown sheet_10-10-12.doc UNSUBDIVIDED 50' BLM SECTION LINE EASEMENT ( LOT 17A ANCHORAGE RECORDING DISTRICT MT YUKLA CIR ASBUILT OF: GATEWAY TO THE PARK SUBDIVISION LOT 23 BLOCK 31 PLAT 82-251 = FND 5/8" REBAR LOT 20A SURVEY CERTIFICATION: I, John L. Schuller, have conducted a physical survey of this property as shown on this drawing and that the improvements situated thereon are within the property lines and no enchroachments exist other that 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. Under no circumstance should any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. WORK ORDER NUMBER: 14— 014 DAZE: MAY 2, 2014 SCALE: 1"=30' E-MAIL: DRAWN BY: CHECKED BY JLS GRID NUMBER: SE1005 BODK/PAGE: 140123 OFAL�1 :' 49TH i� ` * 0 �, •9 JOHN L. SCHULLER.: i,/ LS -10408 ..,0A \ rOfessionG\ L_ v� ADL NDRjt Ai r CA1 0r L -1 C) 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax 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 RtmtwA1- CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 069-611-05 1. GENERAL INFORMATION Complete legal description COSA # 5' 0 9I Expiration Date: 5(3/0(.b Lot 23; Blork 17 Gateway to the Park Location(siteaddress) 1825 Mt. Yukla Circle Current Property owner(s) Mailing address Ray MATT-RES'S Day phone 696-7481 Lending agency Day phone Mailing address Real Estate Agent Dave windsor ! Remax Day phone 727-3300 Mailing Address 110 W. 38th Ste. 100 Anchor arAK 44503 Unless otherwise requested, COSA will be held by DSD for pickup. %�Tnf 2 .7_/, 7 i06 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 0 ❑ Community On-site ❑ ❑ Public Sewer ❑ 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 fn 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. 1 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 S & S Engineering Phone 694-2979 Address 17034 N. Eagle River Loon Ste. 204 Eagle River, AK 99577 Engineer's Printed Name Re Bear c . Co , p,✓ Date 3 79 C 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for By: OF Al •y;` • gf ?t ROBERT C. COWANe.. C` CE -8801 ..a.•$ Os 1111 � 1ZatJ' — 46 ; bedrooms, with the following stipulations: (ANCHp'r,. el• . w! 0�5! Pr =i• esu. M Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory { Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other (Rev. 11/05) Original Certificate Date: z/'1/S(. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.clanchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROV�ALL CHECKLIST ' Legal Description: LOT 23; FBOO( .1-; &4 tc� / t Parcel ID: OC 7 - CH -o5 A. WELL DA Well type f tvRTtc- If A, 8, or C provide PWSID # — Well Log did) 1E5 Date completed ID 114t+ Sanitary seal 4 N) 165 Wires properly protected (N) Ifs Total depth 202-' ft. . Cased to 7�Zr ft. Casing height (above ground) a..-114 in. FROM WELL LOG AT INSPECTION Date of test f0istleg p,/41(06 ' Static water level 101 ft. 9 t ft. Well production 20 g.p.m. 14 .6 g.p.m. WATER SAMPLE RESULTS: O ' 0 O Coliform 0colonies/100 ml. Nitrate 0•� m� /06 c�Other, bacteria 0 colonies/100 ml. CIO Arsenic: _ mg./I. Date of sample: OS Collected by: .Sas Bo4/,i e tK9X B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPile_ 1 STt C Date installed ft' /7-0 /91 Tank size 1000 gal. Number of Compartments Z Cleanouts est) It% Foundation cleanout4l) YEt, Depression over tank (Y/g2 PO High water alarm (Yap PO Date of pumping 1 Pumper 5 -Q'S rr1t-tir! K, 4 C. ABSORPTION FIELD DATA Date installed 1toivie Soil rating (g.p.d./ft Length 241 I ft. Width ItS4 ' System type 1 et -CCH ft. Gravel below pipe TpiJ t ft. Total depth 12-. ft. EH. absorption area ft2 Monitoring tube `kS Depression over field 1.90 Date of adequacy test 5/1 /0 5 Results ail) For 3 bedrooms Fluid depth in absorption field before test in. Water addedj3jgal. New depth 1" in. Elapsed Time: 1D min. Final fluid depth ba1(r in. Absorption rate >= 14504- - g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/011 type) ?CO If yes, give date D. LIFT STATION Date installed Size in gallons 'Pump on- level at _ in. -Pump off" level Datum Cycles tested E. EPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT Septic tank/lift station on lot I t O f 104_ Absorption field on lot Public sewer main N f} Sewer /septic service line 26 1+. TO: i - TO: Manhole/Access High water alarm level at Meets alarm & circuit requirements? On adjacent lots On adjacent lots top r -1 - in. Public sewer manhole/cleanout N4 Holding tank pit SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 104 - Water main 0;- Watermain Nth Property line 10 LI - Water Water service line Absorption field 101+ Surface water tbo I� Wells on adjacent lots I Ob SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r Property line (0 4- Building foundation (0 r + Water main o Water Service line 101 4- Surface water (00 Driveway, parking!vehicle storage /01t Curtain drain pol)& K &) Wells on adjacent lots ( (90 + F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA✓ guidelines in effect on this date. Engineer's Printed Name �d�6E/t r COc✓9 Date /// �OS s�tp��F�t S:t ;� t A/, / 114 of r^ w " A ` ROHR( C. COWAN i z be le is• CE -8801 ;.ter,! y%, ` .'? -- t.' , r l‘k HAA Fee $ (.1. Date of Payment £'/22/65 Receipt Number (Rev. 12/01) 7(9844 " Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cianchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel1.D. ILL q -Len 'OS 1. GENERAL INFORMATION Complete legal description Lot 23. Binrle 1., Location (site address or directions) 1825 _1L. Ynkla 8-A CLQ. HAA # b6.04lq Expiration Date: ( - ,X5 O S r.sinsy 1:.0 the Part Current Property owner(s) Rov Nattregs Mailing address Lending agency Mailing address Day phone A96 -7&R1 Day phone Real Estate Agent Barbjrittendnn / Prudential Mailing Address Day phone X89-1 Unless otherwise requested, HAA will be held by DSD for pickup. 3 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑ 0 ❑ ❑ ❑ ❑ Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSO) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil enoineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S & S Fnyinnering Phone 694—?979 Address 17034 Eagle River,Lp. Rd.— Eagle River, Ak. 99577 Engineer's Printed Name Robert C. Cowan Date g/1/ Jor 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Arc,/ ., . 4 If :..W 4..x..a.psr- - — of A -�- ROBERT C COWAN %a /VI 3'.\ Cb. -8801 •, _et ,, Conditional approval for bedrooms, with the following stipulations: Additional Comments • . ON-SITE • G -Z• WATER AND m= WASTEWATER-- PROGRAM • Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory By: (Rev 01102) Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: 8 - oZ 5- 5 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 1I HEALTH AUTHORITY nAPPROVAAL�CHECKLIST ' Legal Description: ICT o23 BLOCK- � •1 &4TE(D$ 7R1 -let Parcel ID: OC 7 - g //-OS A. WELL lDATA ) `, Well type '11...-t Vi`tTl- If A, 8, or C provide PWSIfDD #= Well Log�l) -/ES Date completed 1011491 Sanitary seal ON) TSS Wires properly protected (fIN) 'IE -s Total depth 202: ft. Cased to 2OZ1 ft. Casing height (above ground) /Z24 in. FROM WELL LOG AT INSPECTION Date of test (o f rz eg egq(O S Static water level 901 ft. L9' 7 ' ft. 'T Well production 20 g.p.m. • i, g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate o.-7itmg./I. Other bacteria 0 colonies/100 ml. .. Arsenic: = mg./I. Date of sample: %'b f OS Collected by: 'Si-' E,4 /iitetsX 8. SEPTIC/HOLDING TANK DATA Tank Type/Material SE-FrJC. / STEL- Date installed /0 (ZA /9 q Tank size 1000 gal. Number of Compartments 2- , Cleanouts $94) 'FS Foundation cleanouteIN), S Depression over tank (Y/Jli-)00 High water alarm (Ygp Apo Date of pumping 11Nql°S Pumper Z2.JS f vtvt(>tiuG{, C. ABSORPTION FIELD DATA Date installed e1 Soil rating (g.p.d./ft2 IZS� r ft /bdrm System type I etk)C-H t Length 24' ft. Width - t i ft. Gravel below pipe i0 ft. Total depth I2- ft. Eff. absorption area ft2 Monitoring tube *"..> Depression over field 00 Date of adequacy test 8/9/0 5 Results !, ail) PA S For _a bedrooms Fluid depth in absorption field before test in. Water added j al. New depth 1" in. Absorption rate >_ 150'f' g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/0 type) KY!) If yes, give date '— Elapsed Time: ID min. Final fluid depth Dqin. D. LIFT STATION Date installed Size in gallons "Pump on" level at _ in. "Pump off" level Datum Cycles tested E. EPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: t Septic tank/lift station on lot /CO f ' Absorption field on lot j 00 4_ Public sewer main P Sewer /septic service line 25 't-- Manhole/Access High water alarm level at Meets alarm & circuit requirements? On adjacent lots On adjacent lots tO©14- in. Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10 Water main p Wells on adjacent lots 0'14 - Property line 10 11- 1 Water service line (0 'F Absorption field Surface water /60 14 - SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /0f+ Building foundation (0 I-4- Water main t I t Water Service line (O 4 Surface water (00 '- Driveway, parking/vehicle storage /0 { t Curtain drain )CE ' LC/t.'tstv,V Wells on adjacent lots QUO + F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. %dieEAi C • Ldc✓9,1 Engineer's Printed Name % Date / r/ /03— HAA 0S HAA Fee $ y� •a)Date of Payment 22/D5 Receipt Number (Rev. 12/01) �aB�W KI, Waiver Fee $ Date of Payment Receipt Number 171,Z.4 - C -t. a.(1 MIR 0- f tr= 0' Ni' -reit.. >r E(ac• ashit 01::1! •`a • ':;�• :.>•,� •ti ••v C t { ft RJ. tt. Jar,-jr: f •,, •6 1 hereby certify that I have surveyed the following described property. L c T 2.3 > t I ccc.kj , •-- , 6-.`F:t.WM1 1 e, 1 Nr A.. 1 -.N}( 'Jubp,1 Syr- •-r.cA.-4"T(-"Ji a 1F3CH, .. Anchorage Recording Precinct, Alaska, and that the improve-• ments situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that • no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways,' transmission lines or other visible easements on said property except as indicated hereon. - - . . Dated at Eagle River, Alaska . - • ' this 11:5 - nay of It t2CU 5 D 20cY • ROBERT C. JOHNSON 'Z'C,cer' SCALE: - Registered Land Surveyor No. 880 -LS Z" - (Fe" • •_ - Box 77-0456, Eagle River, Alaska 99577 Phone (907) 694-2543 . . • MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date May 29, 1986 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 23; B.eoch 1; Gateway to the Pahfz Subdivision Location (address or directions) (b) Applicant Name Jehome Montague Telephone: Home 694-8434 Business 261-4624 Applicant Address 2440 Eaq.ee Riven Road, Eaq!e Rivet, A.eaulza 99577 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ; Buyer ❑ ; Other 0 (explain); (d) Lending Institution Home Say.ingb and Loan Address Telephone ATTENTION: VJctoh.ia/Anchohage, A.eablza 276-1451 Ext. 207 (e) Real Estate Company and Agent none/het(.inaneing Address Telephone VNtd (f) M the HAA to the following address: S K S Engineering SRB 196X Eagle Rivet, A/a61za 99577 2. TYPE OF RESIDENCE Single -Family J7 Multi -Family 0 Other Number of Bedrooms 3 o.dehed by V.Lctonia/Home Savings and Loan • 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 ® Public 0 Community 0 Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11:84) Done 1 of 0 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 Address Date S & S ENGINEERING Telephone 9'44— 2 SR 6 196X EAGLE RIVER, AK 99577 6. DHEP APPROVAL_ / Pp o , y _ri 4-t T2� A Date C ,. Approved for L% bedrooms b Approved Disapprove Conditional Terms of Conditional Approval JI IN d 1986_ shift 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. Dann 9 of 9 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) MUNICIPALITY OF ANCHORACHECKLIST - FEBRUARY 1984 DEPT. OF HEALTH & 264-4720 ENVIRONMENTAL PROTECTION A. WELL DATA Well Classification N 0 51986 RECEIVED Well Log Present&N) Total Depth -0-1:?Z Cased to Static Water Level Casing Height Above Ground Legal Description L-cvr �3 'PLS- ( Cab-S+Ga�6�l 1 -Tk4� i�a¢.1L If A, B, C, D.E.C. Approved (Y/N) 14/A Date Completed (C)— Zs -6+ Yield 2-0 UFA -1 7. --ca.' Depth of Grouting u. 310 N Pump Set At Sanitary Seal on Casing PY N) Electrical Wiring in Conduit ON) Depression Around Wellhead (YiASP Separation Distances from Well: To Septic/He14irrg•Tank on Lot t tip On On Adjoining Lots To Nearest Edge of Absorption Field on tot apt ; On Adjoining Lots To Nearest Public Sewer To Nearest Public Sewer Line Cleanout/Manhole )-11t, 1pot-4 To Nearest Sewer Service Line on Lot 2 I5 k Water Sample Collected by lJ 4 6 3 ' t l a 61 Date Water Sample Test Results ,b-f't Comments /l 6 B. SEPTIC/1101- 4NCTANK DATA Date Installed to'2o-$4' Size 1 No. of Compartments Standpipese7N) Air -tight CapsaN) Depression over Tank (Y/Sii? Date Last Pumped Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) 1 Temporary Holding Tank Permit (Y/N) A Separation Distances from SepticLH Tank: To Water -Supply Well i crc>1 + To Building Foundation To Property Line l c) t 4- To Disposal Field e , To Water Main/Service Line 1 tr, To Stream, Pond, Lake, or Major Drainage Course Comments 2 - Foundation Foundation CleanoutON) S -yq -Sb � f A for 1 aIA Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata _7-647 113(L- Type of System Design " +-) Date Installed 10--Zo — 04' Width of Field 45,1 Length of Field 2- 1.1- Square 4 Square Feet of Absorption Area 313 Q Depression over Field (YST) Depth of Field 12 Gravel Bed Thickness Results of Last Adequacy Test ad Separation Distance from Absorption Field: //49'4 To Water -Supply Well To Building Foundation Lot i3 r Standpipes PresentC/N) Date of Last Adequacy Test A./S/ 1-65S -7740.) 2/43. 31/24 To Property Line On Adjoining Lots / 0 j-/- To t To Existing or Abandoned System on To Water Main/Service Line /? ,- To Cutbank (if present) AZ& To Stream/Pond/Lake/or Major Drainage Course a 4t i - To Driveway, Parking Area, or Vehicle Storage Area Za Comments D. LIFT STATION Date Installed Dimensions Size in Gallons 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 11�3yescJiiCitithie jiigd,gr conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Qe6196X Date es --0___q 4 1986 Company Jp i OA No s-- 2 Y Receipt No. %6561� Date of Payment Amount. $ Page 2 of 2 72-026 (11/84) `'►'`lrfiM .'.N• f•aZ -./�.s,.•! ,iff4( fr/ ,ot :Awe A. Silltier .w.t401 No- 1457-i ai0v- ,�. FW a,10FfSSo�'! 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date - Zv - 9S 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) L- 2 3 /2 / -f9 TF Gu 74- Tv /-%/ /? - Location (address or directions) _ p / / ' L ,/� /lot. -d 4 /1-= f Of'41{zo�+ �/� L�1� /u (� (b) Applicant Name�CiQ%0P/NZ• Telephone: Home Business 376 —"7° ! v Applicant Address P a g�I 7 Z-2- S 2. %t1 S i L�— a , 9rr'6 k7 (c) Applicant is (check one): Lending Institution 0 ; Owner/builder; Buyer 0 ; Other 0 (explain): (d) Lending institution e.9 , r Telephone Address � l %� (e) Real Estate Company and Agent (x-. �y l . Address Gt./ c..- _ u cz G,L. / (f) Telephone 444441 -the HAA to the following address: -, � 2. TYPE OF RESIDENCE Single -Family Multi -Family 0 Other Number of Bedrooms 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 Public 0 Community 0 Holding Tank 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. -ops 11 64 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 Address Date -8 & i E.:G1tvE=Hill a ST -18 196X Lti>: RIVER. ALA..KA T7 PH. 694-37D Telephone <� OF 141 w r i n �.] E.9 $` .L.- rg .. �� • 2.bai A_ Shafer No. 1:.57-E • ,f 6. DHEP APPROVAL\ i/ \ o Approved for Brooms by . 'tom-��'�-'L-� ate �� h� Approved _1-- Disapproved Conditiona Terms of Conditional 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. A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF AtaIg DEPT. OF HEAL AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECIMCKLIST - FEBRUARY 1984 264-4720 RECEIVED Legal Description L17c,JB/,2/ Well Classification 7) ((/9 -Ti If A, B, C, D.E.C. Approved/Pl) Well Log Present6,1.N) Date Completed /v`, J'7g4 Yield >213/p/4--' Total Depth C of 1 Cased to 2-t-'-- / Depth of Grouting ,-...) K4 Static Water Level %/ Pump Set At i,(1-4/CA(a1")a Casing Height Above Ground .?C-' Electrical Wiring in Conduit y -s Sanitary Seal on Casin ,y e -- Depression Around Wellhead (Y/N) 4 O Separation Distances from Well: To Septic, Holding Tank on Lot /O r • On Adjoining Lots Ada r � rd- To Nearest Edge of Absorption Field on Lot //6 On Adjoining Lots 10 0 To Nearest Public Sewer Line CleanoutiManhole Water Sample Collected by //4- /Li/4- To Nearest Public Sewer To Nearest Sewer Service Line on Lot cz.)J_ 02 /g/p® -S— ; Date Water Sample Test Results �L�Ta �'E'c.ry Comments B. SEPTIC/HOLDING TANK DATA Date Installed 0 Size /vd u No. of Compartments Standpipes (9/Ft) Air -tight Caps0/41) Foundation CleanoutOtt) Depression over Tank (Y N) "�"' Date Last Pumped AfEw Pumping/Maintenance Contract on File (Y/N) .0 ! for Holding Tank High -Water Alarm (;71d' A/A+ Temporary Holding Tank Permit 44471t) A-(1 Separation Distances from Septic/Holding Tank: To Water -Supply Well %O To Building Foundation t-16 I To Property Line 10 z To Disposal Field 8 f To Water Main/Service Line 7'0 74- To Stream, Pond, Lake, or Major Drainage Course iv `o N Comments Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ID/14 Jrfe Width of Field L/r Square Feet of Absorption Area 3AKI Depression over Field (le/ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well ,%/ep To Building Foundation C/ Type of System Design Length of Field i Depth of Field f Gravel Bed Thickness Standpipes Presen Date of Last Adequacy Test ti e E^/ p✓ / To Property Line la.t To Existing or Abandoned System on Lot /J--0 ^-) r= • On Adjoining Lots To Water Main./Service Line /0 f To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course /"--"-t9 N ez To Driveway, Parking Area, or Vehicle Storage Area Comments 3� f /v®N� /V4:4 eft- D. Q D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at /Vent (Y/N) Tested for Electrical Codes (Y/N) Comments PPping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed $ & g 1EVOIWEELIINQ Date L - 2-3- CS Compa6 ,aIEEtAER, ALM% VOW MOA No. S 7- PH. 694-2977 Receipt Nom« Date of Payment 3- 1 - es - Amount. $ 4-4 S • U_) Page 2 of 2 72-026 (1 84)