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GATEWAY TO THE PARK BLK 1 LT 17A
Gateway to the Park Lot 17A Block 1 #067-611-21 Municipality of Anchorage O� On -Site Water and Wastewater Program - (907) 343-7904 Page: of ON-SITE WASTEWATER INSPECTION REPORT C7c���© Permit Number: OSP131393 PID Number067-611-21 Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade Name: Charles & Rebecca Knapp ABSORPTION FIELD - EXISTING E] Deep Trench E] Shallow Trench E] Bed ❑ Mound Address 1835 Mount Kiliak Drive, Eagle River ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Gateway to the Park 1 17A Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines -- Distance between lines -- Ft. SEPARATION DISTANCES To Septic Absorption Lift S Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz -- -- Ft. Well 100+ -- -- NA -- TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1 1000 Gal. Surface Water 100'+ -- -- NA Material Steel Number of compartments 2 Lot Line 5'+ -- -- NA NA Foundation 10'+ -- -- NA LIFT STATION Manufacturer Capacity Gal. Curtain Drain NA -- NA NA RemarksOrig. ST decommissioned per code. Pump on level at in. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Installer Mike Anderson Drainfield CO/MT 3034 Inspector ARCTERRA BENCHMARK (Assumed elevation) 100 ft Inspeecct sn 1514/28/14 4/28/14 Location and description 2nd dat:3`d 41h Bottom of Siding COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engin OF AZ Conditional Approval: Date 4g Trl 9,. # LF I{ENNE M.US L 7116 Approveda QJvt� Date D 31 i \ \RoFy,; Io',, .i eer's Stamp Inspection Repo rt_9-1-12.doc I i3 f— V) LL1 Lu � I 4' A -C=26.1' B -C=25.4' m A -D=30.0' B -D=31.0' AS—BUILT TANK DETAILS/SITE PLAN GATEWAY TO THE PARK S/D BLOCK 1, LOT 17A u LOT 17A o. ^° ��J� A 4"� / ^5 M OFC, B S. T. GRAVEL D/W w y�2 CLEANOUT aEAIII>t1T f O COMPUTED: BOUNDARY: BOUNDARY � W W 0_ QO STAKING: STAKING INSLLATIMN j V) DATE: 10/15/18 000 GAL N:7�T ACRD FILE: FILE SEPTIC , ANK OFA4\' TH *� IKENNE M. D S CE -7116 V \ 1'ftFESSIO��'y N�6�0 63"E 615 � �• _ ani i SCALE: NTS , 23'—B AR> 23� .39 EXISTING TRENCH PREPARED FOR: CHARLES & REBECCA KNAPP 1835 MOUNT KILIAK CIR. EAGLE RIVER, AK 99577 FIELD BOOKS COMPUTED: BOUNDARY: BOUNDARY DRAWN: BMW STAKING: STAKING CHECKED: KMD ASSUILT: ,JLS DATE: 10/15/18 DWG. PIIS: GRID: SE1005 ACRD FILE: FILE JOB No.: 13-166 Permit: ❑SP131393 PID# 067-611-21 59.4 rpt �, Drn9j SUMP On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP131393 Tax Code Number: 06761121000 Work Type: Septic Permit Effective Dates: October 25, 2013 to October 25, 2014 Design Engineer: ARC TERRA CONSULTING INC Subdivision: GATEWAY TO THE PARK Site Legal Address: GATEWAY TO THE PARK BLK 1 LT 17A G:1005 Owner/Address: KNAPP REBECCA & CHARLES 1835 MOUNT KILIAK CIR EAGLE RIVER AK 995779727 Site Mailing Address: 1835 MOUNT KILIAK CIR, Eagle River Lot Size in Sq Ft: 41025 Total Bedrooms: 3 This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: The asbuilt drawings shall be scalable. Received By: Issued By: OVVAD MUNICIPALITY OF ANCHORAGE Community Development Department Development Services Division On -Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I. p. 067-611-21 Property owner(s) CHARLES & REBECCA KNAPP Day phone Mailing address 1835 MOUNT KILIAK CIR., EAGLE RIVER, AK 99577 Site address 1835 MOUNT KILIAK CIR., EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) GATEWAY TO THE PARK B1, L17A Legal description (Township, Range & Section) Lot Size 41,025 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: (® all that apply) Absorption Field ❑ Septic Tank Holding Tank Privy Private Well Water Storage APPLICATION IS AN: Initial Upgrade Renewal 121 TYPE OF DWELLING: Single Family (SF) (w/wo ADU) Duplex (D) Multiple Dwellings (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: 121 I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (SignatuJs ijf gF6perty owner or authorized agent) Permit/Rush Fees:�2OO Date of Payment: 10/11/16 Receipt Number: /&3•937 Permit No. £5/°/31.393 Permit App_9-1-12.doc Waiver Fees: Date of Payment: Receipt Number: Waiver No. October 15, 2013 ARC TERRA CONSULTING, INC 212 E. 518t Ave, Anchorage, AK. 99503 Office (907) 868-3791, Fax (907) 868-3793 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Septic Tank Upgrade Permit — Gateway to the Park B1, L17A The owner has requested we proceed forward to obtain a septic permit to upgrade the failed septic tank on the subject lot. The proposed upgrade will serve the existing 3 -bedroom house. The adjacent lots are served by private water as noted on the design. There is no surface water within 100' of the proposed tank. We do not expect there to be any adverse effect on adjacent lots by the development of this tank. If you have any questions, please contact me at 868-3792/FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. Kenneth M. Duffus, Attachments: On -Site Sewer Application Wastewater Absorption System Details/Site Plan 20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793 WASTEWATER DISPOSAL SYSTEM DETAILS/SITE PLAN GATEWAY TO THE PARK S/D BLOCK 1, LOT 17A 16 APPROX. LOC. APMU%. LOC. : SEPTIC 21 10. Orn. Esp. 23 FLAG ALL WELL RADII, EASEMENTS & LOT LINES PRIOR TO CONSTRUCTION N 15 NO POSEIC WELLS WITHIN 200' OF 0- NDPROPOSED EYSTEM. WELL 5 ND PRIVATESEWELLS 200'NOF PROPOSED SYSTEM EXCEPT AS NOTED. 140 POSEIC SYSTEMS WITHIN 200'OF FG- PROPOSED WELL EXCEPTPTAS NOTED. s Y i � `S.� OF 444S 4,ca Tg / I / _ (` w N KENNETH M. iz CE -7116 4c Ale iv FEBS10t�' A \`__111r DESIGN DETAILS DECOMMISSION EXISTING SEPTIC TANK PER CODE INSTALL NEW 1000 -GALLON SEPTIC TANK INSTALL POST TANK CDs - CONNECT TO EXISTING SYSTEM 24 Scale: 1'= 100' NOTES: 1. INSULATE TANK IF <4' COVER. 2. CONTRACTOR WILL ENSURE MINIMUM 2X SLOPE INTO SEPTIC TANK. 3. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT WELLS & SEPTICS. PAGE 1 OF 2 PREPARED FOR: CHARLES & REBECCA KNAPP 1835 MOUNT KILIAK CIR. EAGLE RIVER, AK 99577 FIELD BOOKS COMPUTED: BOUNDARY: BOUNDARY ORA BMW STAKING STAKING CHECKED: KMD ASBUILT: JLS DAm, 10/16/13 ONG FILE: GRID: 5E1005 ACRD FILE: FILE JOB N°" 13-166 CTER d/A11111a • ll'iorriirt WITLIEW N my 1 % LILTING .16�� Pq Ak. 99577' WASTEWATER DISP❑SAL SYSTEM DETAILS GATEWAY TO THE PARK S/D BLOCK 1, LOT 17A GRAVEL D/W LOT 17A BLOCK 1 DECOMMISSION EXISTING INSTALL 1000—GAL S.T. POST TANK COs & MAI '+ FROM FOUNDATION/Si 0 TU:ES & EXISTING SEPTIC N CO UMP �0 --REMOVE POS 59.4 „E 23139' Ri 2O' • rng 3 *.+THAN i Lki 0 KENNETH M. D 7, `' CE -7116 _ . 5�'qy 3 k 1� ..?6/i`/fs. "i/ o N 1 ftxs'SSTOK' Amr FLAG ALL WELL RADII, EASEMENTS & LOT LINES PRIOR TO CONSTRUCTION Scale: 1"= 30' PAGE 2 OF 2 PREPARED FOR' CHARLES & REBECCA KNAPP 1835 MOUNT KILIAK CIR. EAGLE RIVER, AK 99577 FIELD BOOKS COMPUTED: aaM)ARw BOUNDARY D RAM: BMW STAKING: STAKING CHECKED: KMD A$8UILT: JLS D ATE: 10/16/13 DWG FILE GRID: SE1005 ACRD FILE: FILE JOB No.: 13-166 //AMA N 1/` 7••Th Fq AK 99571 by 1 / '� 0 MUNICIPALITY OF ANCHORAGE 0 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE SYSTEM AND/OR WELL INSPECTION /DISPOSAL NAME ,8�� D D / 4 k-Ey 1jR�EPOORRT �J 94 / `3 ? ■ RADE MAILING ADDRESS S' /Z /6 /3 i k? 79Lr 77 LEGAL DESCRIPTION L- 17 8 1 A7r v./ A y ro p"thepl LOCATION 4 7-- 13 cC, 3 Ai 2 / C lAbsorption NO. OF BEDROOMS_ [SEPTIC TANK J DISTANCE TO: WeI�O 7 / A ares. / f Y Dwelling / ` / 7 PEgIT O i / iv Manufacturer /L ,G 7/, Me r� ee / No. of tf 2 Liq. i3 iryQal�Ioons (� (J IF HOMEMADE: Inside length WidthidT Liquid depth OJ D Z =Zet0 DISTANCE TO: Well Dwelling PERMIT NO. .-- Manufacturer / — Material Li Liquid capacity in gallons TILE DRAINFIELD IGNINIMI DISTANCE TO: Na T / f, Foundatig F2 ! Nearest / PE�IIIrjy/6 i j'L� j0 �!! No. of}i�jl ( r Gi Length42, lige L�lf Total IaryjhY iris �f- Tr �L / t P. Distance li Top of le to fi¢' 2 t ¢Z /ink Total • 407°07° MittbrAtijSSC SEEPAGE PIT Length Width PERMITNO. Type of crib Crib diameter i % N gib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Buiitling foundation Sewer line Septic tank Absorption arealsl OTHER PIPE MATERIALS Pji j / /3/ SOIL TEST RATING Z� �� ,C T ii i s INSTALLER ( 6141A -TE , — S REMARKS /YS5 CO via' FIPOrt flO(4` At. our Trs ur A r7 c. // 4o../ -ice iA iiiM•19 CO 411 • r^ maw A. - ash,rt '%, •V wsO,i pR iS10N0.\- ... APP ED DATE LEGAL -- - , . PERMIT NO: DATE ISSUED: n E-) FIL_It-1 I G I PRL I TY OF Rt4GF4C3RF9GE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 IDt-.1-E• i TE SEWER S. WELL PERM I T 840160 04/10/84 APPLICANT: BRAD DICKEY ADDRESS: SR 1613 EAGLE RIVER, AK 99577 CONTACT PHONE: 694-9239 LEGAL DESCRIP: SUBDIVISION: GATEWAY TO THE PARK LOT: 17 SECTION: 4 TOWNSHIP: 13N RANGE: 1E LOT SIZE: 43592 (SQ. FT. OR ACRES) LOT LOCATION: MT. KILIAK CIRCLE MAX BEDROOMS: 3 LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOU IN DESIGNING YOUR SEPTIC SYSTEM. CHOOSE THE OPTION THAT BEST FITS YOUR SITE. DEPTH TO PIPE BOTTOM (FT. GRAVEL DEPTH (FT.) TOTAL DEPTH (FT.) GRAVEL WIDTH (FT) GRAVEL LENGTH (FT.) GRAVEL VOLUME (CL 1. YDS TANK SIZE (GALS) SOIL RATING (SQ. FT. /E:R) IC I-1 4. 5 :. 5 8. 0 2 54. 0 20. 0 1, 000. 0 125 ** ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS BEE} 5. 0 0. 5 5. 5 17. -0 34. 0 21. 4 1, 000. 0 125 ** 1A1_ IR 1=1 I 1� 4. 5 3. 5 8. 0 5. 0 41. 0 30. 3 1, 000. 0 125 ** I CERTIFY THAT: 1. I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOR) AND THE STATE OF ALASKA. 2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOR CODES AND REGULATIONS, AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT. 3. I WILL ADHERE TO ALL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK DISTANCES FROM ANY EXISTING WELL, WASTEWATER DISPOSAL SYSTEM OR PUBLIC SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT. 4. I UNDERSTAND THAT THIS PERMIT IS VALID FOR A MAXIMUM OF 3 BEDROOMS AND ANY ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE, APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. " SIGNED APPLICANT: BRAD DICKEY ISSUED BY ( DATE: DATE: PERFORMED FOR: LEGAL DESCRIPTION: 9 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST gcia/6o soJLS LOG ❑ PERCOLATION TEST DATE PERFORMED: 4-7— 6' 41 L /7 8 /&,,/l 7V 049/2( SLOPE S1TE PLAN Gp- /sz) �B,r Otto ,4 iv<. — 61.#4ck 10 11 12 13 14 6 p - LI6N7 SYLT CO8.9 GeS 771/gni,/141 WAS GROUND WATER ) s 0 P l 15 OF •A�q��, 16 19 PA • 18 . Robert A. Shafer • 4sC a, fL'•� No. 1457-E Zi �1t-ROFESS\OH�+ �%�%��� 17 COMMENTS ENCOUNTERED? IF YES, AT WHAT DEPTH? r fi N 1 E 1 ti —r Reading Date Gross Time Net Time Depth to Water Net Drop 7/, 1 PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN tuandscatin PERFORMED BRIVER. AIASKA eS 77 PH. 694-27/0 CERTIFIED FT AND FT ,S DATE: 9--7-61L1 Well Owner DICKEY, BRAD • M -W mum hie. P.O. Box 10.378 • 10300 OM Seward Hig wvay (407) 318469.5 ANCHORAGE. ALASKA 99511 DRILLING LOG 814-185 Use of Wen, Dourest ic Location (address of: Township, Range, Section, if known; or distance main road Lot 17A Block 1 Gatevay To The Park 3u>`• j»Niee Size of casing 6" Depth of Hole 1141 feet Cased to_ 141 feet Static water level 124 ft. (Rib) (below) land surface. Finish of well (check one) open end (x ry ) ; Screen ( ); Perforated ( ). Describe screen or perforation Lone Well pumping test at 10 gallons per ( (minute) for 1 hours with of drawdown from static leveL Date of completion May 16. 1984 WELL LOG 1007 ler Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness GTO 2 TO 4 1.To 6 Casing Stis:kup Fill Organics 6 To 12 Gravel - Loose 12 To 21 Silty Gravel 21 To 22 Sandi Gravel - wet 22 To 40 Silty Har pan - weeping 40 TO 56 Hardpan - veeping 56 TO 78 Silty hardpan - weeping 7� TO 1.11: Gravelly Hardpan 111 To 121 Gravel - Loose 121 TO 135 Hardpan - Weeping 135 To 141 TO TO (44;-‘ Waterbearing{ravel NWWA Cartifiad Contractor Certificate No 814 & 1173 3 —CONTRACTOR MUNICIPALITY OF ANCHORAGE Development Services Department f: Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 067-611 1. GENERAL INFORMATION Expiration Date: I /_ —ZV ZZ Complete legal description GATEWAY TO THE PARK BLOCK 1, LOT 17A Location (site address) 1835 MOUNT KILIAK CIRCLE, EAGLE RIVER AK 99577 Current property owner(s) KNAPP FAMILY TRUST CHARLES & REBECCA Day phone Mailing address Real estate agent 1835 MOUNT KILIAK CIRCLE, EAGLE RIVER AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 55c) 1 Waiver Fee $ Date of Payment 7 020"'4 Date of Payment Receipt Number (100 1�1 Receipt Number COSA # O S C �2 213 3 (5, 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 716122 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the X11\\\� ♦ system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluators well and septic system. Therefore, any estimate of how long a system will funct- 10Z d ' c for current or future occupants or guarantee that no unseen encroachments, ir` c (o `tir� • • • • '.� �� discrepancies exist can be given by First Water Consulting & FWCS ��� lli •'* �� 6. DSD SIGNATURE _ '" y PEER Pis Huffman :RE V, System #1 Approved for bedroomg t" v!P�itn 128991 •.•���.� O W PS�s�ROFESS System #2 Approved for bedroomsJ;�(> p\_11OG0G Disapproved J�/�J�010, l �l Conditional approval for bedrooms, wi)fmYI ing stipulations: B Original Certificate Date � __J The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: GATEWAY TO THE PARK 131 L17A Parcel: ID: 067-611-21 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ® Well log is filed with Onsite (or attached) Well production at time of test 1.2 gpm Date drilled 5/16/1984 Water storage tank volume NA gallons Total depth 141 ft Well disinfected for coliform test? ❑ Yes ® No Cased to 141 ft ® Coliform bacteria is Negative ® Sanitary seal is functioning correctly Nitrate 0.362 mg/L ❑ Nitrate less than MRL (ND) ® Wires are properly protected Arsenic ug/L ® Arsenic less than MRL (ND) Casing height (above ground) 18+ in. Date of flow test for COSA 2/25/2022 Collected by F� W Static water level at beginning of test 128 ft. Date of Sample 7/14/2022 Comments WELL PUMP SET AT 139'— SHALLOW WELL B. TANK DATA Age of tank(s) 4/2014 years Tank type/material SEPTIC / STEEL Measured operating fluid level in septic tank 50" ® Standpipes/foundation cleanout per record drawing Date of pumping AK QUALITY 3/3/2022 el D. ABSORPTION FIELD DATA C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Which system tested (date installed) 4/1984 Adequacy test date 2/25/22 ® ALL standpipes present per record drawing* Results f] Pass For 3 bedrooms Total measured depth from grade 5_2 ft (max) Fluid depth prior to test <1 in (WET <1 ") Measured depth to pipe invert from grade 3.8 ft (min) Water added 600 gal ❑ N/A — pressurized field New depth 3 in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time <5 min depth into effective 1.4' OF THE 3.5' ED IR ® Code -required soil cover over field Final fluid depth <1 in (WET <1 ") ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: MT/CO AT GRADE. SHOTS OF LOWER MT/CO SHOWS 1.41ED & 5.271). SIMILAR TO PAST MOA COSA WPIPES FOUND AS DESCRIBED IN COSA/ASBS. SITE HAS SLOPES TESTED IN WINTER CONDTIONS & REINSPECTED 7/22/22 IN HEAVY VEGETATION. NES E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No ft Wells on Adjacent Lots: Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Surface Water > 100' ® Yes Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No. Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No. Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No _ ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS -zOF Aq G. ENGINEER'S CERTIFICATION r'g'�4'- • '.f-y►�l �1r; •4$ 7H •,'Ar I certify that 1 have determined through field inspections and review ' ' ' ' ' ' ' ' of Municipal records that the above systems are in conformance with .. .. .... ... MOA COSAguidelines in effect on this date. Curtis Huffman CE 128991 4r Aw, Rio ft ft ILV VRNIIVHbC CAJCIVICIV 1 \/ j I PLOT PLAN AS BUILT _X_ SCALE _ 1__= 50' _ GRID _ SE 1005 Project No. _22-0331A1 Lang & Associates inc. 11500 Daryl Avenue, Anchorage, Alaska (907) 522-6476 Phone 99515-3049 Professional Land Surveyors (907) 522-4625 Fax kenOlangsurvey.com 4csc'pOOpO� o F A jonothanOlongsurvey.com I hereby certify that I have surveyed the following described property: LOT 17A, BLOCK 1, GATEWAY TO THE PARK SUBDIVISION (PLAT No. 83-526) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the 2N`—aN Day of� G+ ==_, at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 49TH* KENj G. LA o 04�Fa' .LS -520.• ' �G AECC963 „Tri Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 067-611-21 1. GENERAL INFORMATION Complete legal description GATEWAY TO THE PARK BLOCK 1, LOT 17A Expiration Date: /0-02-13 Location (site address) 1835 MOUNT KILIAK CIRCLE, EAGLE RIVER, AK 99577 Current Property owner(s) JOSEPH & SHANNA RADOSEVICH Day phone Mailing address 1835 MOUNT KILIAK CIRCLE, EAGLE RIVER, AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Individual Well ® Individual El Individual Water Storage ❑ Holding Tank ❑ Community Class _ Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ TYPE OF WASTEWATER DISPOSAL: WaiverNariance request for. '''z” " ' �r �;`` �; .=d Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ LkCib' 1-4 EAAsh Waiver Fee $ Date of Payment 1 1 i ) 1 Date of Payment Receipt Number CD 5LI �J c7. c1 Receipt Number COSA # 05G l 31 a -q (1 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. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 6/28/13 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 OT �r occupants or can ArcTerra guarantee that no unseen v L encroachments, deficiencies or discrepancies exist. 7 ` 6. DSD SIGNATURE c } A+,n KEIVKETH M. 0 p / 1/ System #1 Approved for 3 bedrooms. / �`$, System #2 Approved for bedrooms. ` \ ; s,ior‘`' .ar- Disapproved. NO.Ns Conditional approval for bedrooms, with the following stipulations: By: Az\)•\5“ (OF 1 7i/r7i �= ON-SITE WATER AND WASTEWATFR oz \{� PROGRAM J• � 5���5,�>,° 11- Original Certificate Date: 7-;1-13 The uni • horage 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 blue sheet 10-10-12.dac 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 BLOCK 1, LOT 17A Parcel ID: 067-611-21 A. WELL DATA Well type PRVT If A, B, or C provide PWSID # _ Well Log (Y/N) Y Date completed 511611984 Sanitary seal (YIN) Y Wires properly protected (Y/N) Y Total depth 141 ft. Cased to 141 ft. Casing height (above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test 511611984 611912013 Static water level 124 ft. 127 ft. Well production 10 g.p.m. 1.3 g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 0.215 mg/L Arsenic: ND ug/L Date of sample: 6/14/2013 Collected by: ARCTERRA B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC /STEEL Date installed 411411984 Tank size 1000 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping / 13 /3 Pumper JRs C. ABSORPTION FIELD DATA Date installed 4114/1984 Soil rating (g.p.d./ft2 or ft2/bdrm) 125 System type SHALLOW TRENCH Length 44 ft. Width 5 ft. Gravel below pipe 3.5 ft. Total depth 5` ft. (See osC10132o Comments) Eff. absorption area 407 ft2Monitoring tube Y Depression over field N Date of adequacy test 6/19113 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 600 gal. New depth 1 in. Elapsed Time: 10 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? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main 75'+ Sewer /septic service line 25'+ Animal containment areas 50'+ SEPTIC/HOLDING TANK ON LOT TO: On adjacent lots 100'+ in. On adjacent lots 1001+ Public sewer manhole/cleanout 100'+ Holding tank 100'+ Manure/animal excrete storage areas 1001+ Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Water Service line 10'+ Water service line 10'+ Surface water 100'+ Building foundation 10'+ Water main 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 100'+ F. COMMENTS *Per MOA docs (MOA approvals HM 2000 & COSA 1010) G. ENGINEER'S CERTIFICATION I certify that t have determined through field inspections and review of determined through field inspections and review of Municipal records that inspections and review of Municipal records that the above systems are in Municipal records that the above systems are in conformance with MOA above systems are in conformance with MOA COSA guidelines in effect on conformance with MOA COSA guidelines in effect on this date. COSA guidelines in effect on this date. on this date. Engineer's Printed Name KENNETH M. DUFFUS Date 6128113 COSA brown sheet_10-10-12.doc 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 FOR A SINGLE FAMILY DWELLING Parcel I.D. 067-611-21 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address COSH# c7 -SC 1062-0 Expiration Date: 3 /f7//( GATEWAY TO THE PARK S/D; LOT 17A, BLOCK 1 1835 KILIAK CIRCLE EAGLE RIVER, ALASKA 99577 BENJAMIN UFFENBECK Day phone 622-2079 1835 KILIAK CIRCLE EAGLE RIVER, ALASKA 99577 Day phone Day phone 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 SewerEl • El 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 samples. (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 GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 11 13 0 lc? Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. .1.00° 0 ness: • ..1.1 3o•Pa. co dProf essi000�o 5. DSD,SIGNATURE !/ Approved for _3 bedrooms. Disapproved. Conditional approval forbedrooms, with the following stip :9! ON-SITE WATER AND WASTEWATER .. PROGRAM Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory By: U (Rev. 11/05) 1r NT c� Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: /217/%0 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: GATEWAY TO THE PARK S/D; LOT 17A, BLOCK 1 Parcel ID: 067-611-21 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 5/16/84 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 141' ft. Cased to 141ft. Casing height (above ground) 18"+ in. FROM WELL LOG AT INSPECTION Date of test 5/16/84 10/5/2010 Static water level 124' ft. 128 ft. Well production 10 g.p.m. 1.66 g.p.m. WATER SAMPLE RESULTS: Coliform 2/ colonies/100 ml. NitrateO SOmg./L. Other bacteria colonies/100 ml. Arsenic: A) 0 ug./L. Date of sample: 10/4/2010 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 4/14/84 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 9/21 /2010 Pumper ROYAL FLUSH C. ABSORPTION FIELD DATA Date installed 4/14/84 Soil rating (g.p.d./ft2orr�t2/bdrrr 125 System type SHALLOW TRENCH Length 44' ft. Width 5' ft. Gravel below pipe 3.5' ft. Total depth *5 ft. Eff. absorption area 407 ft2 Monitoring tube YES Date of adequacy test 10/5/2010 Results (Pass/Fail) PASS Fluid depth in absorption field before test DRY in. Water added 450 gal. Elapsed Time: 0 min. Final fluid depth DRY in. Depression over field NO For 3 bedrooms Absorption rate >= New depth DRY in. 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — *MEASUREMENT TO BOTTOM OF MT. A 2" STEEL MONITORING TUBE HAS PREVIOUSLY BEEN INSTALLED. THE MONITORING TUBE WAS FOUND TO BE 2.15' BELOW THE INVERT OF THE DISTRIBUTION LINE. D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off' level Datu Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 100'+ 100'+ Septic tank/lift station on lot Absorption field on lot Public sewer main N/A Sewer /septic service line 25'+ Animal containment areas 50'+ Manhole/Access (Y/N High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line Water main N/A Water service line Wells on adjacent lots 100'+ 5'+ Absorption field 5'+ 10'+ Surface water 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Water service line 10'+ Curtain drain NONE KNOWN Building foundation 10'+ Water main N/A Surface water 100'+ Driveway, parking/vehicle storage *0'+ Wells on adjacent lots 100'+ F. COMMENTS *HM APPROVED IN 2000 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 JEFFREY A. GARNESS Date a/6/6> vA ss: yc0�© Q a�°rofie'ss• 14 COSA Fee $ 1.4 0 Date of Payment 11/39/g Receipt Number 077506 (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Community Development Department Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # OSC101322 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 4, Lot 9 of Rockhill subdivision. This inspection revealed a nitrate concentration of 7.17 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. GARNESS ENGINEERING GROUP, Ltd. �, ;, CONSULTANTS & GENERAL CONTRACTORS December 6, 2010 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Ref: Comment Sheet about Cover Issues regarding Gateway to the Park SM; Lot 17A, Block 1, Ms. Wockenfuss: There is 3.1 feet of cover over the cleanout and 2.4 feet of cover by the monitoring tube. It is unclear if the drainfield has insulation. However, based upon information supplied by the homeowner, there has been no issue with freezing of the septic system. A portion of the drainfield is also under the driveway. This issue was addressed in the Health Authority Approval in 2000. Again, we are unaware of any adverse effects with the drainfield with these to issues. If you have any questions, please contact us at 337-6179. Thank you for your assistance. Sin erely, Jeffre arness, P.E., M.S. Presi I 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com 14.3 /�/� °OS f1?_ •'tit% (56,8 \Q LEGAL UESCRIPTTON c 4 0 N ti 11 d N 6 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Mchorage, AK 99519-6650 www.cl.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D.—6il —al HAM! 1-1R 030/7q Expiration Date: 8 - .. 0 3 1. GENERAL INFORMATION Complete legal description Lot 1 7A — Bi, Gateway to Hip Park Svhdi vi ai on Location (site address or directions) • Current Property owner(s) 1835 Mt. Kiliak Circle Matt Patrias. Day phone 694-3381 Mailing address Lending agency Day phone Mailing address 1 Real Estate Agent Jed Winegarten / Dynamic Prop, Day phone Mailing 'Address Unless otherwise requested, HAA 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 _ . The Municipality, of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA)'based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) 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 less than 30 days old. (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 to the professional engineer's work. TYPE OF WASTEWATER DISPOSAL:. a • Individual On-site ill ❑ Individual Holding tank 0 ❑ Community On-site ❑ ' ❑ Public Sewer . . • . • • 0 3 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verity 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 Systeril 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. S & S ENGINEERING 17034 Eagle Pi...4. Lee? Brad Nn—g04 Eagle River, Alaska 99577 Name of Firm Address Engineer's Printed Name ROB i.¢ T C. Cow.fa0 S. DSD SIGNATURE 1"--- Approved for 3 bedrooms. • Disapproved. Conditional approval for Phone 6 - air -7"7 Date `t/30/03 bedrooms, with the f'otlowing stipulations: Additional Comments • ©pt -VP WATER AND WASTEWATER : • PROGRAM..:. • •\•.*..• S�;$' J EN f iwrv- "/./ Attachments: - HAA Checklist Septic Systerri Advisory By: Well Flow Advisory' Maintenance Agreements . Supplemental Engineer's Report Other (Rev. 17/00) Original Certificate Date: 5— 0 3 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 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L-cT /9.4j �ol„4 /) 674f >4/ ?Iv T4, A Parcel ID: 0 G •(-;//-d A. WELL DATA Well type PhiA'+q If A, B, or C provide PWSID # — Well Log 6'N) / v PS Date completed 5- /6- 41. Sanitary seal (9N)''5 Wires properly protected ON) -'04'S Total depth /y/ ft. Cased to / y/ I ft. Casing height (above ground) /61- / in. FROM WELL LOG AT INSPECTION Date of test Pi4y /[ /qt./ Static water level aN ft. Well production //) g.p.m. WATER SAMPLE RESULTS: Coliform O colonies/100 ml. NitrateO-)-6mg/I. Arseni mg./l. Date of sample: Ji/a4do 3 B. SEPTIC/HOLDING TANK DATA Tank Type/Material 5 Ppb t Tank size /OM gal. Number of Compartments o7 Foundation cleanout (YIN) 74'5 Depression over tank ("Y NO Date of pumping SY+ 41, Zw) Pumper JRS Stir'P / 4f-; 9-o3 /I7� ft. g.p.m. Other bacteria 0 colonies/100 ml. Collected byb & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 9957Z Date installed 4' iy, a y Cleanouts 6)N) ?1,"5 High water alarm (Y6 ` /"' C. ABSORPTION FIELD DATA Date installed C/ -/H- $y Soil rating (g.p.d./ftZ or ftZ/bdr 1. f System type /De '/'O"mac <i Length 419 ft. Width ft. Gravel below pipe 3. S ft. Total depth o ft. Eff. absorption area 3,5- ftZ Monitoring tube __ Depression over field D Date of adequacy test c, 3 Results ( ail) PAss For 3 bedrooms Fluid depth in absorption field before tester in. Water added 9.)', gal. New depthPRI in. Elapsed Time: 6o min. Final fluid depth f 7 in. Any rejuvenation treatment (past 12 mo.) (Y/4 & type) UA-C1/44.x., ,.) Absorption rate >= 4150 4 - If If yes, give date g.p.d. D. LI ATION Date installed Size in gallons "Pump on" level at Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot /CO 4" Absorption field on lot 1c 0 t Public sewer main NV/9 Sewer /septic service line a 371. anhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? in. On adjacent Tots /00 + On adjacent lots /00 + Public sewer manhole/cleanout /449 Holding tank NAL SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation S4' Property line C¢ - Water main %Cad jos} Absorption field Water service line /O 1` Surface water /06 /- Wells Wells on adjacent lots /DO F. - SEPARATION SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: %U Building foundation /Olt Water main 41/4 Property line Water Service line Of Surface water 1 O d +' Curtain drain F. COMMENTS �A Weiss on adjacent Tots /04).1- Driveway, 0 J1 - Driveway, parking/vehicle storage 0 ao b Is 7/(.4 ago Dtr,. G. ENGINEER'S CERTIFICATION I certify that 1 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. Ror3eA.7- C. Cowa.4 Engineer's Printed Name Date y /36 / 03 ,�mreeK_L� -fC'. 9.r. LIN, M RO3ERT C. COWAN / ex- ':� CE -8801 ,ra4%�'� t , t.'n_ y HAA Fee $ 37C, e " Date of Payment s' "O 3 Receipt Number 0 341 6 7 / (Rev. 12/01) �.Z Waiver Fee $ Date of Payment Receipt Number Parcel I D # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING 067-611-21 HAA # ALfi(:)726 6 ? / 1. GENERAL INFORMATION Complete legal description GATEWAY TO THE PARK S/D: LOT 17A, BLOCK 1 Location (site address or directions) 1835 KILIAK CIRCLE EAGLE RIVER, ALASKA 99577 Property owner RODNEY DUFF Mailing address 1835 KILIAK CIRCLE EAGLE RIVER. ALASKA 99577 Lending agency Mailing address Agent CAROLYN GREINER W/ REMAX OF EAGLE RIVERDay phone 696-0592/242-4282 Address 16600 C NT RFIELD DRIV EAGLE RIVER ALASKA 99577 Unless otherwise requested, HAA will be held for pickup. Day phone 694-2395 Day phone 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. 3 XXX 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding Tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC ing to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 Computer Version Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1,205.00 at, or prior to, closing for the engineering services provided. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Munici0I and State codes, ordinances, and regulations in effect on the date of this inspection. 1. i/i.� /7; Name of Firm ALASKA WATER at WASTEWATER CONSULTANTS, INC. Phone (907) 337-6 i79 Address 6901 DEBARR ROAD, SiJI$E 2W ANItHORAGE, ALASKA 99504 ii Engineer's Signature \ / Date In conducting this evaluation, AVVWC, Ing. ifter�r ted to ovide a thorough, conscientious engineering analysis of the system in accordance with ADEC and WAD JS Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the water o�opp lI usage of the family being served by the system. These conditions are outside the control of F 4p' the evaluator of the system. Satisfactory test results do not guarantee future performance A.> .' gS,Oo of the system, nor do they guarantee that there are no hidden defects or encroachments. �p •'/' • , ,r h� AWWC, Inc. can therefore not provide any warranty for future estimate of how long the p e/j ; system will continue to meet the operational requirements of the ADEC or MOA DHHS. / % * • / The content of this report is for the sole benefit of the owner listed above. Any l 0 ' I I V& reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DHHS SIGNATURE r ----A effr y A. Ga'rness, 0 9,;t / CE -7953 O� /S GG _1 Op . •.• ;oc Approved for 3 bedrooms b4pProreesiono�o Disapproved Conditional approval for bedrooms, with the following stipulations: Additional Comments By: ,e/rt U/. Date 8 " g • 0 o 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 #21 Computer Version 11 RECEIVED Municipality of Anchorage AUG 15 2000 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division MUNICIPALITY OF ANCH 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 3439411JtENTALsERVICEs Health Authority Approval Checklist Legal Description: GATEWAY TO THE PARK S/D; LOT 17A, BLOCK 1 Parcel I.D.: 067-611-21 A. WELL DATA Well Type PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number N/A Log present (Y/N) YES Date completed 5/16/84 Total depth 141' Cased to 141' Casing height (above ground) 18"+ Sanitary seal (YIN) YES Wires properly protected (Y/N) YES FROM WELL LOG AT INSPECTION Date of test 5/16/84 8/11/2000 Static water level 124' 128' Well production 10 g.p.m. 1.5+ g.p.m. WATER SAMPLE RESTS: Coliform Nitrate D' g{' MLr (ed Other bacteria Date of sample: 8/11/2000 Collected by: A.W.W.C., INC. B. SEPTIC/HOLDING TANK DATA Date installed 4/14/84 Tank size 1000 Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression (Y/N) NO High water alarm (WN) N/A Date of Pumping 5/2000 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA Date installed 4/14/84 Length 44' Width 5' Gravel thickness below pipe 3.5' Total depth *PER INSPECTION REPORT. A 2 INCH STEEL MONITORING TUBE HAS BEEN PREVIOUSLY INSTALLED. ELEVATION SHOTS HAVE BEEN TAKEN AND THE BOTTOM. OF THE MONITORING TUBE WAS FOUND TO BE 2.15 FEET BELOW THE INVERT OF THE DISTRBUTION LINE. Soil rating (g.p.d./ft2 o42/bdri 125 System type SHALLOW TRENCH *7, Effective absorption area 407 SQ.FT. Monitoring Tube present (Y/N) YES Depression over field (Y/N) NO Date of adequacy test 8/11/00 Results (Pass/Fail) PASS For 3 Bedrooms Fluid depth in absorption field before test (in.); 0" Immediately after 513 gal water added (in )• 12" Fluid depth 11" (ins) Minutes later: 10 Absorption rate = 450 Peroxide treatment (past 12 months) (Y/N) NONE KNOWN If yes, give date — 72-026 (Rev. 3/96)' Computer Version ter WA( an) 8/14./00. firr D lvor eamii PwtPCO. i'IDuSE occuPtits D. LIFT STATION Date installed Size in Manhole/Access (Y/N) on" level at* "Pump off level High water alarm level . * *Datum sted E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line 100'+ 100'+ N/A 25'+ On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station 100'+ 100'+ N/A N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Absorption field 511 Water main/service line 10'+ Surface water/drainage 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Wells on adjacent lots 100'+ *BELIEVED TO BE UNDER DRIVEWAY Property line 10'+ Building foundation 1o'+ Water main/service line _1.01+____ Surface water 1001+ Driveway, parking/vehicle storage area `01 Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. ENGINEER'S CERT 1 10 I certify that 1 ha of Municipal re with MOA 11 Signature field Inspections and review systems are in conformance on this date. Engineer's Name a Date 4477" 4 '\ Ilh li It D ffrm A. � ess: • �E-7953• el&- 1°*i' ••. E°4,5 1�apro f es slehooc op000a HAA Fee $ 3 ` 0--c7 Date of Payment Receipt Number q/SJl1V 62-04 (9q- b8 ) 72-029 (Rev. 3/96)' Computer Version Waiver Fee $ Date of Payment Receipt Number � 41, N :Nor 08zz`friff`/5 d¥+. ?,6 IC:e. w � EO'd IS -CV -1769 LO6 - z ... • .*, 2 s, g2Jj�y>V7Z.2ww .AeuL 9 U LO uo d6Z:3! 00-Z0rOnV MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DMsion of Environmental Services On -Site &WANs Section P.O. Box 196659 Anchorage.JUu:ka 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILYLING Parcel I.D. # O 6 7 - 6 i i — I HAA # IF -VA`\ -1 1. GENERAL INFORMATION Complete legal description f2-` Lot 17A; Block 1; Gateway To Park Location (site address or directions) 1835 Riliak Circle �.� ,w'!'� _ -. Eagle River, AR owners' Zoanne Solchani Day phone (206) 528-6015 {Mail address "•"4747 10th.Avo N_R_ 017140 Spattla. WA 98105 s ."'ung agency -•-- Day phone Mailing address •' Agent John Levy/ Realty Executive AR Address Day phone 244-3722 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. . TYPE OF WATER SUPPLY: Individual well Community well Public water 3 XXX NOTE: If community well system, provide written confirmation from State ADEC attest- ing ttesting to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank - Community o gtank- Community on-site Public sewer NOTE If community wastewater system, provide written confintion from State ADEC attesting to the legally and status of system. 72-025 (RM. Vit) Fiord MOA 121 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & $ ENGINEERING Phone 61 y ` )1 7 17034 Eagle River Loop Road No. 204 Address Eagle River, Engineer's signature (/ ' Date ci/ 6. DHHS SIGNATURE Approved for -S bedrooms. Disapproved. By. ROBERT C. COWAN gz� CE -8801 , • Conditional approval for bedrooms, with the following stipulations: Additional Comments ?ase' Date 2 9-17 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 521 Municipality of Anchorage RECEIVE DEPARTMENT OF HEALTH & HUMAN SERVICES S EP 2 1997 Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (9&�a9�4,a �►, wr).age Health 8 Human Services Health Auttfority Approval Chec fc ist Legal Description: 1 v - 8tot:.K ( (/2fl[Ewmi ID VIE Parcel I.D.: 0 G 7 - 61 I - } A. WELL DATA Well type Pgyvare. 1f A, B, or C, attach ADEC letter. ADEC water system number Log present 4) ILS Date completed Prli lb, IgS1 Total depth 14 l' Cased to . 141 1 Casing height (above ground) 17. -aa } Sanitary seal ON) 46S Wires properly protected ON) 4 f 5 FROM WELL LOG AT INSPECTION Date of test NM lb) i984 9 ( t l ell - Static water level 1241 Well production 113 g.p.m. WATER SAMPLE RESULTS: Coliform 0 Nitrate . 070 7 Date of sample: gift o J' 3 B. TANK DATA I Z(o r Collected by: Other bacteria evi g.p.m. . Eagle River, Alaska 9997 Date installed Tank size 1ao[1 Number of Compartments Cteanoutsep1)4dS_ Foundation cleanout 1Y® 140 Depression (1A J Ilrb High water alarm (V 01A Date of P iping 9 ((o (q1 Pumper v f.,4 C. ABSOFIP'AON F DATA Date hi—railed Ita�[ *oil - ring (g.p.dJfF or ft'lbdam)1im&li. System type 7G1u1:+fe-fl Length :12, 4''1' Width - � Gravel thickness below pipe ?i.5 Total depth �l— Effective a6eorption area 17-64 f Monitoring Tube present `, - Depression over field (Y®�`sL Date of adequacy test q11191, Results lamhek6 For 71104.6bedrooms Fluid depth in field before test (in.) a 2_ Immediately atterObgal. water added (in.): 2- N Fluid depth 0 (ms) Minutes lir: 1 5- Absorption rhe = 'i6i'�� g.p.d. --Perodde treatment (past 12 months) (YM) A 6 Knt9uisi If yes, give date 72-026 (Rev. 3196)` D. LIFT STA Dat-inatalled Size In gallons Manhole/Access (Y/N) High water alarm Level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: on" level at* "Pump off" level at* Septic/holding tank on lot Absorption field on lot Public sewer main aJh - Sewer /septic service line as On adjacent Tots loa /_71' On adjacent Tots Apry Public sewer manhole/oleanout 4/ka Lift station /'4051 f SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation t0'+ Property line Absorption field i o Water main/service line Io' t. Surface water/drainage Mc l+ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORP'T'ION FIELD ON LOT TO: Property MIS ° 'A .. Building foundation /O' y' Water main/service line Surface -Water - fes!+ Curtain drain 1+10r3b eb,tan,uw-.J Po 14 10,} Driveway, parkingNshicle storm area Y 51A7151144"1- Tiis Dpi F. ENGINEER'S CERTWICATION Wells on adjacent lots J O _y' I certify that I have determined thru field Inspections and review of Municipal M conformance with /NOA HAA guidelines In effect on this date. Signature Engineers Name Date 1106f4r C. Cowl.✓ cI6a-iw "7 HAA Fee $ J n- • D Date of Payment 7/2---2---"? Receipt Number > 2-3 1 / f7 72-026 (Rev. 3/86)* Waiver Fee $ Date of Payment Receipt Number 111.911OFAU1 Y OF ANCHORAGE OF PEALTH & NUBIAN SERVICES Division of Erni Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-9650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I D. # ()I n1 - let t 1 - ; HAA# ).1Q991(iw 1. GB4ERAL INFORMATION Complete legal description Lot 17X1 Block 1; Gateway To The Park Subdivision Location (site address or directions) 2496 Eagle River Road Property owner Joe Sacconi Day phone 696-2546 (h) Mailing address 14721 Fire Lake Drive Eagle River, AR 99 Lending agency Day phone Mailing address Agent Day phone 244-6547 (car) ta Address Unless otherwise requested, HAA will be held for pickup. 2. NUMMI OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 XXX NOTE If community well system, provide written confirmation from State ADEC attest- ing ttesting 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. 794151ttw. 1!1) Fant YOA I 5. STATEMENT OF INSPECTION BY As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Sit S ' 3 : /1 Phone (494/-7-f-79 _ 17034 90i{ Address 4 ._Road Noy Engineer's signature "rimer (lief - DHHS SIGNATURE XApproved for Disapproved. Conditional approval for bedrooms, with the following stipulations: illr Date ,/q7s APE, e At :t'- Ns. t 457-E ; loe 0p `••.fe•+•• t_ . 111i, Additional Comments Date 1-/a- ' 93 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 • ing institutions in onierto satisfy certain federal and state requirements. Employees of DHHS do not coni pct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the profession: engineer's work Municipality of Anchorage Department of Health and Human Services HEAL—TH AUTHORITY APPROVAL -CHECKLIST 6f!- azi - lJ Legal Dsscription:14 A. .4-1 T 4- Parcel LD. 06/- 6/F- z / A. Well Data Well type ?t-t•l ►r f.- If A, B. or C. attach ADEC letter. ADEC water system -number 6.. Log presei4)N) Date completed 4- - 1 - $k Drier 1.1-.4 Tatat depth IA Sanitary seal6N) ‘1 Cased to 14 t‘ Casing height 172\1- FROM WELL LOG Date of teat --•=• 11' - SLeewater level 124 Wei flow 1 O. O Pump levell U IL - SEPARATION DISTANCES FROM WELL TO: Septi holding tank on lot 1 o o Absorption GM on lot 1 t o' A p, flrblic sewer thein Sewer service line "2.-S Wires 2\1 - Wires properly protected ei/N) ATS 1-1-4:13 11-1' g.p.m. 041mm Iotb On adjacent lots 1 0- O ao w On adjacent lots 1 0 0 �} Public sewer menholekleanout Petroleum tank WATER SAMPLE RESULTS: Collorm D Nitrate Date of sample: 1-1-6117 0.22 Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ll - 14 - 9 4 Collected by: S Nit S lieGINIIIIRM Tank size / b a O Compartments 2 Cleanouls y Foundation cleanout )N) y Depression (Y& Pi High water alarm (Y,i 1,-1 Alarm tested(YlN) ).14 Date of pumping - 1...,7•.)-'217 Punhper T -,t . L6 S5 /b • 1- 0'.tk3=tiI 43 2 8 a SEPARATION DISTANCES FROM SEPTIC/HOLDW �" ., ..:'-'3J-117 `'.3 rEG t rte f. :'r e _S-= Wetl(s) on lot / as ' -- On Ascent lots /D' Foundation 1 % ' To propevty line / 0 r Absorptionfield / o rn Water airVservice line / 0 ill-r'r Surface watendrainage / D a I rt -02613 • Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons = Manhole/Access (Y/N) Vent (YIN) "Pump on" level at - o " Level at High water alarm level Cycles tested Meets MOA electrical codes (Y/ Manufacturer SEPARATIO ANCE FROM LIFT STATION TO: W= on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date Installed 4 - 1 4 -S4 Soil rating (GPD/Ft2) /2S 9'4/B< System type DeA-(1/I/ Et - Length 44-' Width S I Gravel thickness 2 S ' Total depth 8 / Total absorption area /0 2 4 4 -Ai -2- • Cleanout present am Depression over field (Y4 Date of adequacy test 1- / -13 Results fail) I:4 -s s for 3 Bedrooms Water level in absorption field before test b N After test 2 ,//i Peroxide treatment (past 12 months) NS) /do Ali- i4 -J' J J If yes, give date .-1-61 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: r4- 1L Well on lot 1 / c r On adjacent lots / 0 d Property line / ° To building foundation 42-1 To existing or abandoned system on lot 0,1 On adjacent lots 3o r d- Cutbank 3-7:. Water main/service line / b r 4 - Surface water k, c> ' 4- Driveway, parking/vehicle storage area 2 0 9. _ 0 nape -c vx, vE Curtain drain \ A E. ENGINEERS CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HM guidelines in effect onthh date of This inspection. OF Signature Engineer's Na Date 7034 Eagle River Loop Road No. 2 r 0009 .A !. Shg'�r• p • No.. 1457..f: HAA Fee $ / 70 Date of Payment 7- Receipt Number3 C 1 / Waiver Fee $ Date of Payment Receipt Number LniFk i mucinum of mamas • DIMES MALTS D AND MELTE APROINCT1ON APDL ICAS'ION FORMER= AUTHORITT APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (inch lot, block, subdivision, section, township, range) 4/7A B/ G A 7w, 7-0 tire-, Location (addles. or directions) (b) Applicants Nana ./J AC-L{t 7 Telephone Applicants Address (c) Applicant is (check ane) Landing Instituticn ;.Awner/builder ; Buyer J ; Other l (explain); �'` (d) Lending Institution Address � / (e) Real Estate Co. i Agent J4 G 4 a�2 /' r Address �i , y Mad ! K 1bLphone Telephone 2. Type of Residence Single-Family4 Multi -Family 1=1 Other (describe) Number of Bedroom J 3. Water Suva Individual We11J Community 1=1 Public Note: If aaaxnity till system, suet have written confirsaticn frac the State Department of Environmental Om asrvatian attesting to the legality and status. Is the well adequate far the number of bedrooms specified in this HAAIMR) 4. Sewage Disposal Onsittp4r__Public1=1 Ommunityn Holding Tank Is the wastewater disposal syste adequate for the number cf bedroaesON) [Page 1 of 2) 2-15-84 • • 5. &isamrii- Tian Prcvidina Inasmottins, lbsb, Data and Information • I c artilf that I drdosd, verified, or conformod to all !OB HAA GUiblinms in offset an the v/r-Arit# (SIMMER SEAL.) • 6.DREP Approval Approved for bedrooms Approved _X Disapproved 11 Conditional 1 Teres of Conditional Approval � ,11, .k. A. .-. T By A-4- ----te l- Date 1- 04114 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 shorn 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 urytional for the number of bedrooms and type of structure indicated. (DHEP SEAL) 7. Mail the HM to the following address: f4 -.Sea-v 1032/ds/s [Page 2 of 21 L /7* 2-15-84 • n A. FELL DATA mullicIPAt rrr OF ANCHORAGE OM) HEALTH pommy APPAL (HM) CHDxIU.IST - FEBRUARY 1984 NIUNICIPAUTY OF ANCHORME OF HEALTH & ENVIRONMENTAL `JUL 61984 RECEIVED 14e11 Classification S. r, If A, B, or C, D.E.C. Approued(Y/N) ^----" Well Log Present (Y N) _ Date CaipLeted 57/4./61-Yield/0 6,//i Total Depth J(// / Cased to- / (71/� 'Depth of Grouting Static water Level /VI i Pimp Set At Ofe Casing Height Above Ground . 36 4 Sanitary Seal an Casing(rag �Y Electrical Wiring in ConduitDepression Around wellheadOW) Separation Distances fro Fbll: / To Septic/aBlabmg Tank on Lot /OP / ; CrAdjoining Lots /&t) - To Nearest 'Edge of Absorption Field Lot //n ; On Adjoining Lots /6 D i� To Nearest Public Sevier /�0 To Nearest Public Sewer o / Cleanaut/Nanhcle,Q To Nearest Sewer Service Line on Lot /C Water SadpleCollected By SDS . ; Date 7 -/ - water Sample Tbst Results Cants B. SYk'rLC7E TANK DATA Date Installed 4/10-5tSime / iii» No. cf Compartsents Standpipe/'N) Air -tight Caps) Foundation Clean u Depression over Tank (YY Date Last •_• N) Pumping/Maintenance Contract an File (Yg ; for Holding Tarek High -Water Alarm (Y ) ''4 Thsporary Holding Tank Permit (Y/N) Af Separation Distances from Septic/Holding Tank: / F311 DO / To Building Foundation� 7 To Water-Supply To Property Line I/0 /711 -- To Disposal Field Z4r) 1't To Water MaiLire A!'' To Stream, Pond, Lake, cr Major Drainage Course cents [Page 1 of 2] 2-15-84 C. ASSONFTICW FIZW DATA Soils Resting in Date Installed Width of Field Strata z Type of System Design Lemegmargie (4f 'S Length of Field <AV Depth of Field f loDr Gravel -Bad Thickness 4A2.14 Square Peet of Absorption Area 375-r Standpipes-Present.(a7N) Depression over Field (Y/N) to of Last Adequacy Test 11t1' .c7 Results of Last Adequacy Most " Separation Distance from Absorption Fields To Water -Supply Well /49 / To Property Line ' At2 Ori . To Building� ndatian YZ t To Existing 7 Abandoned System on Lot "/ A" .. f On rd ning Lots T To Plater Wein/Service Line To•Cutbank(f present) 3D To /ca Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area _/b Comments D. LIFT 1311TI0N Date Installed Dimensions Size in Gallons /Access (Y/N) "Pump On" Leval at Off" Level at His, Water Alarm Level at Vent (Y/N) Tested for Pumping -s during Adequacy Test. Meets MDA Electrical Codes(11N) Cceaaenta ** Check Permitted Bedroom, Against HAA Request ** m, I certify - checked, verified, or conformed to all MDA HAA Guidelines in effect on the Signed i/ice/rte/ Date MDA KB1/d5/s [Page 2 of 2] 2-15-84