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HomeMy WebLinkAboutGATEWAY TO THE PARK BLK 2 LT 1Gateway to the Park Lot 1 Block 2 #067-611-18 Municipality of Anchorage, Department of Health and Human Services�,, Division of Environmental Services �.ti, `' On-Site Services Section 825 "L" Street Room 502 �����L P.O. Box 196650 Anchorage, AK 99519-6650 Page www.ci.anchorage.ak.us (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: 5V400001D6 PID Number: D(o i -. Ion l - /8 of Name: Co (i I n # Kat hc 0710,4„s Wastewater System: ❑ New 0 Upgrade Address: 3254/o 5 River ed 5 e ever; AK ABSORPTION FIELD Phone: 00 mbez of Bedrooms: 3 .,( 0 Deep Trench W Shallow Trench 0 Bed 0 Mound 0 Other. LEGAL DESCRIPTION Soil Rating: Orb GPD/FF Total Depth from original grade:: 5.4 5 Ft. Block: Lot: Subdivision: nn 2. 1 Ga.-e wa j 415- 6 Par k Depth ep to pipe bottom from original grade tle: FI' Gravel depth beneath pipe: 2.7 FI. 7 Township:`� Range: Section: Fill added above original grade: /• Ft. Gravel Length: /D4/ Ft. Well ❑New U ra • p/ Gravel width: r. FI. Numbest lines: / Distance between lines: Classification (Private, A, B, C): I(/Total Depth: FI Cased to: FI Total absorption area: 7504-,(/Flr Pipe Material: Pa/0 3 034/ •L Driller. h S'j t Y. Date Drilled: Static Water Level: FL Installer Na. in ani /ndeAns/. Date Installed: /D [O-/-5-D0 Yield: IPump Set al: GPM FI. Casing Height Above Ground: Ft. TANK SEPARATION DISTANCES [yj septic ❑ Holding • S.T.E.P. 0 Other. To From Septic Tank Absorption Field -- Lift Station- . Holding Tank Public/Private Sewer Line Manufacturer: _ Ane-A, /0-4A Capacity: /Z.50 Gal. Well I /Do - ( 'Doi- /DO I t Material: / 6 ice./ Number of Compartments: 2 Surface Water /001 r !00 — LIFT STATION / Lot line ID {' IDI -' -- Size: Gal. Manufacturer: IFoundation * Di I lo k _.. r+ 'Pump on- level al: Pump off' l eYal in. High water alarm at: n. Curtain Drain Pone. /inotdv) Pump Make 8 Electrical Inspections performed by: R 7c- /roid 6i:41/a-tan- Ano.ie-,-ca-f BENCH MARK ends ax/ s4rn e,„7/rte /eh Li Location and Description: $earn o C sic%Adq many 4ireslio%. el /.amu and e��oxs/a/w.tJ 012 JAssumed Elevation: /op Ft. is/%ak eed/a 4., Sham on TI/ Do-/. Exira 4-- /e. A, ,, , tr.,- re,,-- ����\ 40 �� OF ALS Inspections performed by: NO • s' Dates: 1st /v l3 Du / * 49TH /\ * �/ /,�// - , ,l i ../ If 2nd 6 3 / l . I{EN•`__ S:- Department of Health and Human Services approv• ` `, CE- Ts wa , Reviewed and approved by: / Gil./ —Q-e Date: 6 -P-7- o a �S�`A' (Bcv. IIl99) / / Q 1��� \�Q _....._•" `V' ' Kir AS -BUILT SYSTEM DETAILS/SITE PLAN GATEWAY TO THE PARK \ T NEW '250 DIV ERTER S/D, LOT 1, BLOCK. 2 c T A Existing Field M CO Permit SW000105 PID#067-611-18 SCALD 1' = 50' WELL ic* A—C=14.5' B—C=52.3' A—D=22.3' B—D=53.8' A—E=25.1' B—E=54.5' A—F=58.9' B—F=56.2' A—G=153.2' B—G=110.0' C._98.22,) 4SOLID FROM HOUSE 1 41250 GAL SEPTIC TANK 97,69)g 1 II li, ..Q._36.2t FINISHED GRADE C95.59)\ FILTER FANaGNN 93.99) 411CaNk‘ ............. Jr V *-C49TH AN ‘V *7, ?METH M. D CE -7116 • s ........ - tftwEsst00' NC91.35.) SEWER ROCK C91.36> C88.6X 104' PREPARED FOR: CDLLIN MATHEWS 32540 EAGLE RIVER RD, EAGLR RIVER, AK 99577 (907) 694-3776 SCALD NTS (-81.11-) FIELD BOOKS GOMPUlED: BOUNDARY' R.JOHNSON DRAWN: VBG STAXIM R.JOHNSON CHECK KMD Ant R.JOHNSON DAM 6 /21/00 ND ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 DWG. RLE c'm 8E1005 ACAD FILE' 99095.DWG 99095 (907)696-6111/FAX (907)696-6111 • MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW000105 Legal Description: GATEWAY TO THE PARK BLK 2 LT 1 Design Engineer: 0070 KND Engineering Owner Name: KND Engineering Owner Address: 20441 Ptarmigan Blvd. Eagle River , AK 99577-2083 This permit is for the construction of: Disposal Field ✓ Septic Tank I Holding Tank Ch,o fiaTh-, (I 3l ao @ Coli3/bo83phr Date Issued: Jun 02, 2000 Expiration Date: Jun 02, 2001 Parcel ID: 067-611-18 Site Address: 032540 EAGLE RIVER RD Lot Size: 43560 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 Privy Private Well Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 (24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Date: — Credo Issued By: Cessat- Date: — 2 -0 KND ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 May 25, 2000 Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: Sewer Upgrade — Gateway to the Park Block 2, Lot 1 Gentlemen: On May 16, 2000 DHHS issued a permit (SW000105) to upgrade the referenced property's septic tank. Subsequently, the system has been determined to be in failure and the owner has now requested that we proceed forward to modify the previous issued septic permit to upgrade the disposal field on the subject lot. On May 17, 2000 we dug one testhole for the proposed system. The results of the test are attached. The general slope of this lot is from east to west at a grade of approximately 10 - 15%. We have designed our system utilizing the testhole we excavated for the existing 3 - bedroom house. The lot is served by an individual well. We propose to install a 5' wide shallow trench. Water was not encountered during the excavation or monitoring. There are no public or private wells within 200' of our proposed system location except as noted. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, SND Engineering Kenneth M. Duffus, P.E. attachments: On -Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test WELL & WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLAN GATEWAY TO THE PARK S/D, LOT 1, BLOCK 2 KND VACANT NO PUBLIC YELLS VITHIN 200' OF PROPOSED SYSTEM. NO PRIVATE YELLS WITHIN 200' OF PROPOSED SYSTEM EXCEPT AS NOTED. NO SEPTIC SYSTEMS WITHIN 200' OF PROPOSED WELL EXCEPT AS NOTED. DESIGN DETAILS 4 BDRM X 150 GPD = 600 GPD 600 GPD/.8 GPD PER SQ, FT. (4.9 MIN/IN.)= 750 SQ. FT (750/5'(W)) X 0.64(RF) (2.5 GRAVEL) = 96 FT. TRENCH USE 1 TRENCH — 96 (L) X 5' (W) X 2.5'(B) Total depth of system Is 5.5' from original grade. Total depth of' gravel below distribution pipe Is 2.5'. NOTES: 1. CONNECT TO EXISTING DIVERTER. 2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM IF LESS THAN 2' OF COVER. 3. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE MIN. 3' COVER IF REQUIRED. PREPARED FOR: COLLIN & KATHY MATHEWS 32540 EAGLE RIVER ROAD EAGLE RIVER, AK 99577 Scale: 1'= 100' PAGE 1 OF 2 FIELD BOOKS COMPUTED: BONNDAWn R. JOHNSO NDRANN' KMD STAKING R. JOHNSON CHECKED: KMD ASBUILD R. JOHNSO DWG. FILE N DAIS/i/nn rnv 5/24/1) GRID: SE1005 ACRD FILE: 00001 .JOB No.: 00001 END J D ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 WASTEWATER DISP❑SAL SYSTEM DETAILS GATEWAY TO THE PARK S/D, LOT 1, BLOCK 2 250 S. ERTER—I CO Proposed Field ssI0" ' S PREPARED FOR: CDLLIN & KATHY MATHEWS 32540 EAGLE RIVER ROAD EAGLE RIVER, AK 99577 Scale: 1"= 20' PAGE 2 OF 2 FIELD BOOKS cOMPUim: BOUNDARY: R. JOHNSON DRAWN: KMD STARING: R.JOHNSON aBa m: KMD AssmiT: R. JOHNSO N °AEE 5/1/00 Jr ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-6736 DWG. FILE GRID: SE1005 ACRD FIRE 00001 'DB No.: 00001 (907)696-6111/FAX (907)696-8111 ICND ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 SOILS PERCOLATION TEST Performed for: Collin Mathews Project: Depth (Feet) a:'t of 4Zgsyee ®���e•'••e...e. 'y' SOS : •°e'•, � +0i ®*^ , Tea %* %°.°° •e..•e.•.ev aeon -'-.•. 9 �, f•„fi 2 e�.,. a �q. Q mqL Kennein M. Duf;V �� fFJ� 4 cP•° CE 7116 ft, »;;ROF Snetinttl nlianalgir Date Performed: 5/17/00 Gateway to the Park B2, L1 ORG - black rootmat GM—fill w/ gravel ORG—black rootmat GM - loose w/cobbles to 8" very moist - wet @ 8 - 8.5' 16 - HOLE PRESOAKED 17- PRIOR TO TEST 18- 19- 20 - TEST HOLE # 00-1 SEE ATTACHED SITE PLAN FOR HOLE LOCATION Was Ground water encountered? NO Depth to water after monitoring? NO What depth? NA Date? 5/25/00 Reading Date Gross Time Net Time Depth to Water Net Drop 1 5/18/00 1:00 - 9" - 2 1:10 10 min 6 6/16" 2 10/16" 3 1:11 - 6 6/16" - 4 P21 10 min 3 15/16" 27/16" 5 * 1:22 - 9" - 6 1:32 10 min 613/16" 23/16" 7 1:33 - 613/16" - 8 1:43 10 min 412/16" 21/16" 9 * 1:44 - 9" - 10 1:54 10 min 615/16" 21/16" 11 1:55 - 6 15/16" - 12 2:05 10 min 414/16" 21/16" * Water Added Percolation Rate 4.85 (min/in) Perc Hole Diameter Test Run Between 3 feet and 4 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. • i -� MUNICIPALITY OF ANCHORAGE 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 iNkillGetsr *9E5 PHONE 3413-6SLr XNEW ❑ UPGRADE MAILING ADDRESS �C .,i� A � 1 R/�„ 9,51C T C ir��! S/ LEGAL DESCRIPTION w; / &46e Z #fl V 4/ T K sea- 7-i3 g, —f -E6 , LOCATION el/04F /rte gb. NO. OF BEDROOMS 3 Uy. DISTANCE TO: Well/ / Absorption area 6, Dwelling USED •1T�!`7`n. PERMIT NO.f can SLIJ w2Q Manufacturer LEZ `-/ Material��CL G�- No. of compartments NI- Liq. capacity in gallons den, IF HOMEMADE: Inside length Width Liquid depth Z DISTANCE TO: Well Dwelling PERMIT NO. O _ Q Manufacturer Material Liquid capacity in gallons TILE DRAINFIELD TRENCH DISTANCE TO: Wello/ //7 /- Fou dauo Nearest lot line / 3Z PERMIT NO. SIS 39 / No. of lines/ Length of eaccje/ Total lengthyf�irf�s J� Trench width i S iwekes Distance between lineA s Top of tile to finish grade / Material beneath tile / inches Total effective arptio arnea I� ui Length Width Depth PERMIT NO. H a L.1.1 Type of crib Crib diameter Crib depth Total effective absorption area w w - DISTANCE TO: Well Building foundation Nearest lot line J Class?boir Depth Driller Distance to lot line PERMIT NO. Lu DISTANCE TO: Building foundation Sewer line Septic tank /O 1 1 Y' Absorption areals) /i / �/7 OTHER PIPE MATERIALS eAl /fel SOIL TEST RATING /3: BPM f INSTALLER /ONS j (� O4 / l 3) 9/j 11 Os ,. REMARKS ///S d 61 TI1i1 k ilk i N r %Slit �` C� ti ai aEil 6102/4,5 / J m✓i / au72 1716/1( �X `l . ,els A. 1'11E11 _ rit lar -71 I APPROVED DATE LEGAL ,-'. ,j/./ RAF sEt 9 - i ,... _ / L. . Imo/ /,_ .�.•• r✓M a di l' . . _.-- . /SF n6 j"Eing bN DOC Co. dba TMUISIR TIElIL23 P.O. BOX 670272, CHUGIAK, ALASKA 99567 o TELEPHONE 688.2759 OWNER OF LAND ADDRESS LEGAL DESCRIPTION DATE - Started PERMIT NUMBER Ended DEPTH OF WELL STATIC LEVEL OF WATER FT. DRAWDOWN FT. GALS. PER HR KIND OF CASING KIND OF FORMATION: From Ft. to Ft. From . Ft. to Ft. From Ft. to Ft. From. Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. Ci From Ft. to Ft. From / Ft R� o From Ft. to Ft. _ 111 F�Ng4gjcCFAt/. b From_ Ft. to Ft. From F to T q0<. From Ft. to Ft. From Ft. `fc �j��F091, From Ft. to Ft. FromX77 Ft. From Ft. to Ft. From Ft. to�_aFt. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. _ From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft MISCL. INFORMATION: DRILLER'S NAME 10. P.113 VA I C I F° Y CSF d k !ADP):AEE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION szn L STREET, ANCHORAGE, AK 99501 264-470 19—E I TE BEL.JEFF f L. -J L_ L_ PERI-' I T 850791 Z: )U0+ o��+35 i i ; _ILANi: WOODCREST HOMES 9260 ROY ST. #A ANCHORAGE, AK 99515 ,_ IN - -._ PHONE: DESCFiIF': SUBDIVISION: GATEWAY TO THE PARK LOT: 1 SECTION: 9 TOWNSHIP: 13N RANGE: ti 4.=560 (SO.FT. OR ACRES) .*11S MS: BLOCK: 2 _i_t_-d 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.) _l; SAL DEPTH (FT. GRAVEL WIDTH (FT.) RAVEL. LENGTH (FT.) GRAVEL VOLUME (CU. `r'DS. ) TANK 'SIZE (GALS) ..__ RH1 1N 8., 0. F T. W - 1 F2F4IN 7.0 1.0 8.0 5.0 7 .. 1,(,0C.0 ** 178 TANK MUST HAVE AT LEAST TWO COMPARTMENTS certify that: 1. I am familiar- with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 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 _._werage system on this or any adjacent or nearby lot. I understand that this permit is valid for a maximum of t bedrooms ano any enlaroement will require an additional permit. IFiALIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, .HEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS -! LL. NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (.7) THE :_-E'CTRICAL WORE. MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED rl?'f L1_r'ANT: WOODCREST HOMES -1ULU L) E) f DATE: DATE: r_ r_r- PERFORMED FOR: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST SOILS LOG PERCOLATION TEST LSTEI/C P/ U/A DATE PERFORMED: -7 -a LEGAL DESCRIPTION: L-0 / / bitlek Z- �'��(f✓�7' YT 1 -0 2- 3- 4 -� 5- N 1 w 1 1 1 1 0 19 6:i 7 ll OL ZED ot6/hi t5 5/LT F1/X 7 774•017- 401i 8 - 8- 9 -0 10 - 11 10- 11 - 12 13- 14- 15 16- 1 M w r 1 1 N erg sa:—/- 5/6 -DV- 4 M l - M 11C/$7 • r 17 EA/1) 18 - -re i 19- 20 - ✓ekY 7/r 71-Ae SLOPE (10 WAS GROUND WATER S ENCOUNTERED? L 0 P E IF YES, AT WHAT --15EPTH? .i 7.-//1/4) t/& See-? SITE PLAN s7A/[e _ Itz gEN)Rk ?ROW E/1 -440- ,,_ A 40- ,�L,✓ef L Reading Date Gross Time Net Time Depth to Water Net Drop 't 16,0 G - /G/G3.O (cZ-r / Z-6 /o .-s�� z, o / • G /61-e3.O /C 3C �_s� r�> 0 UL /GC /6 521 j /6 SQ 3.0 3 PERCOLATION RATE /7 /7/0 SJ�S Iminutenink t \ TESTI RUN BETWEEN 5CO•� COMMENTS /L_5 1C Ate) / /.3�' 75/sek PERFORMED BY: Arab V'ffrW CERTIFIED BY. FT AND g.S FT DATE: /"2/! J — MUNICIPALITY OF ANCHORAGE ®f Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 067-611-18 Certificate of On -Site Systems Approval Expiration Date: 11/2/23 Legal description GATEWAY TOTHE PARK BLK 2 LT 1 Site address 32540 EAGLE RIVER RD Current property owner(s) HERCZEG BRYAN A &STINNETT-HERCZEG TERRI L X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By:. & / Original Certificate Date: 8/2/23 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory x Arsenic Advisory Other COSA Approval—June 2022 MUHM A UTA OF ANCHORAGE 'r Development Services Department Y� 9- -04 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 067-611-18 Complete legal description GATEWAY TO THE PARK BLOCK 2 LOT 1 Location (site address) 32540 EAGLE RIVER ROAD EAGLE RIVER AK 99577 Current property owner(s) BRYAN & TERRI HERCZEG Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 23 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ® Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $_ 5-5-0 Date of Payment T t a -L COSA # 0.5 G 2-7j 12y Waiver Fee $ Date of Payment Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: GATEWAY TO THE PARK BLOCK 2 LOT 1 Parcel ID: 067-611-18 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 1985 Total depth 120.2 ft Cased to 40+ ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 36 in. Date of flow test for COSA 7/7/23 Static water level at beginning of test 15 ft. Well production at time of test 4+ gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 0.409 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 7/7/23 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank 49” Date of pumping 7/6/23 Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 1985 ALL standpipes present per record drawing. Total measured depth from grade 10.2 ft (max) Measured depth to pipe invert from grade 3.7ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 7/7/23 Results Pass Fluid depth prior to test 0 in Water added 450 gal New fluid depth 4 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 12 in (MOA 1’ ED) Effective depth used 0 in Effective depth (ED) remaining 12 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots, MOA data and appears that the 1985 trench is deep. Owner switched diverter to 1985 field in 4/2023. The 2000 field was dry & tested on 6/1/2022. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 7/14/23 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 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 evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 7/14/23 www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval # OSC231241 Subdivision: Gateway To The Park Block:2, Lot: 1 The septic tank for this property is 23 years old. The average life of an asphalt coated steel septic tank is 20 years. Typical replacement costs are $10,000 or more, not including engineering, surveying or MOA permitting fees. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. ;Mailing Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org MUNICIPALITY OF ANCHORAGE Development Services Department's Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel -I. -D. 067-611-18 - Expiration -Date: (� Z © Z Z -- 1. GENERAL INFORMATION Complete legal description GATEWAY TOTHE PARK BLK 2 LT 1 Location (site address) 32540 EAGLE RIVER RD Current property owner(s) HERCZEG BRYAN & STINNETT-HERCZEG TERRI Day phone Mailing address 32540 EAGLE RIVER RD Real estate agent Day phone 2. TYPE OF DWELLING: 0 Single Family ( o DU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well [] Private Septic R Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 55 0 Waiver Fee $ Date of Payment (�" 13 --Z2. Date of Payment Receipt Number (9-5:_2 13 Receipt Number COSA # 03 c a 21 a 7 y 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 Eklutna Engineering, LLC Address 1-9162-Mountain-Rd-Chugiak-AK-995 Engineer's Printed Name Curtis Townsend, PE 6. DSD SIGNATURE System #1 Approved for_ bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms Phone 907.406.1058 Date Z 2 Z - r ........ q ,. � •moi x'.49 R � ..s• . .,..........• J ENGV JVLL�R'S tags �T na r pate L ! s UZ ct ¢ .No. CE 11 v e ��\ipROFESS1flta"�'-+ �. bedrooms, with the following stipulations: By: _ �- Original Certificate Date: 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Advisory -- Other op_4a4ltt 0�� � S i 011 d Legal Description: GATEWAY TO THE PARK BLK 2 LT 1 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1985 Total depth .1.27 ft Cased to 40+ ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) > 24 in. Date of flow test for COSA 6/1/2022 Static water level at beginning of test 15 ft Comments B. TANK DATA Age of tank(s) 22 years Tank type/material septic Steel Measured operating fluid level in septic tank 5 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 6/2/2022 D. ABSORPTION FIELD DATA Which system tested (date installed) 2000 On ALL standpipes present per record drawing Total measured depth from grade 7.4 ft (max) Measured depth to pipe invert from grade 5.1 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 2.3 Parcel ID: 06761118000 Structure served by this system Well production at time of test 4.7 gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 0.311 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Curtis Townsend Date of Sample C. LIFT STATION ❑ Required maintenance c Age of lift stationy Lift station materia Adequacy test date 6/112022 Results [D Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 490 gal New depth 0 in Elapsed time 105 min NO Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate '400 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test) If yes, enter date Gallons introduced gallons ----- Comments/Deficiencies: 1985 field had 0" of water in monitor tube, only tested 2000 field for adequacy COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Q Septic Tank/Lift Station on Lot > 100' if No ft Community Sewer Manhole/Cleanout > 100' Q Yes if No ft M Yes if No ft Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25'M Yes if No ft Absorption Field on Lot > 100' ❑✓ Yes if No ft Holding Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' ft If septic tank is under driveway comment below Animal Containment > 50' Q Yes if No ft �✓ Yes if No ft ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75'[j✓ Yes if No ft Q Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10'0 Yes if No ft Surface Water > 100' [✓ Yes if No ft Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Q Yes if No ft Private Wells > 100' �✓` Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' M✓ 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' Q Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' 0 Yes if No ft Water Service Line > 10' Q Yes if No ft Community Wells > 200' El Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that / 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 FRICOSA Checklist yellow sheet ��y Z� www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval #OSC 221274 Subdivision: Gateway to the Park Block 2 lot 1 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks The septic tank for this COSA / property is 22 years old. A leaking septic tank may be a source of contamination to the aquifer. Typical replacement costs range from $10,000 to $15,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of a 16 -year-old septic tank in failure and should be replaced. Mailing Address P D Box 196650 *Anchorage, Alaska 99519 6650 *www muni org Parcel I.D. 1. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING MR' loll N COSA # Na 0151 Expiration Date: 8 ' SS — 8 G GENERAL INFORMATION Complete legal description -4//. d/., -/c."2. 4.r/etvwy /a the 6diY.'siion Location (site address) 3.9 syn d-', /c give/. Road, e-„q/e ,9.'ve-, „'.e Current Property owner(s) f 9thy hails Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 3 Day phone 6707)19/7-377 �,Tyo st-9q%.giver /ed., .F.v1/e �ve.A[ 99.577 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 0 ❑ Community On-site 0 ❑ Public Sewer 0 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined In the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. 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 atthetime of installation. Name of Firm Deal/n:1 7 gen /e7 Phone 607»116 "nn ',tee G E..l'orMh 5f,4 e -c/e. Engineer's Printed Name Daai9 /,9e p f/ n Ie ,. Date 1� ak�� pkv° ?,'t{• 0.•• Address 5. DSD SIGNATURE f/ Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: .•••0 1 T. ICENLEY CE 8175 4••t. WATER AND : fi _ WFRO� AtMR • gt •••. _ •• Q\\\\ JJO.A Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report . Other BYO ,,c2 RA / P'VI, (Rev. Hq5) Original Certificate Date: . - 8 ' 0 4 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: /O z`/ Siete:, de leaw9 tc Parcel ID: (.2C7- 6 1/ - /8 A. WELL DATA Well type /7.1/2/49z. Date completed M'S. Total depth /P ft. If A, B, or C provide PWSID # Sanitary seal (Y/N) y Cased to //O>' ft. FROM WELL LOG Date of test 745 Static water level o ft. Well production /o g.p.m. Well Log (Y/N) v Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION <dig/o6 a 9• / ft. y 5- g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate e; 72 mg/L Other bacteria 0 colonies/100 mL Arsenic: 5 iigR Date of sample: 9k/o6 Collected by: Fred /44,)/e// B. SEPTIC/HOLDING TANK DATA Tank Type/Material Sep / c/S7ee / Date installed G//3/o0 Tank size /pie gal. Number of Compartments -& Cleanouts (YIN) Y Foundation cleanout (Y/N) y Depression over tank (Y/N) N High water alarm (YIN) N/A Date of pumping /olfS'/o5 Pumper ,IPPanip ers C. ABSORPTION FIELD DATA nein old 7/f/s5 o.8/30 Date installed ox/ s/ec Soil rating (g.p.d./ft2 or ft2/bdrm) System type a»/e 1; -enc It Length fliioy ft. Width o%' ft. Gravel below pipe /f-7 ft. a, el Total depth _9 ft. Eff. absorption area 7s00ft2 Monitoring tube / Depression over field 4-- Date YDate of adequacy test dS3JO6 Results (Pass/Fail) ,Ass For '9 bedrooms 9 -fly c Fluid depth in absorption field before test o in. Water added 7T7 gal. Elapsed Time: 30 min. Final fluid depth o in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) /1'c 9 - New depth o in. Absorption rate >= 6 DO g.p.d. If yes, give date D. LIFT STATION Date installed Size in gallons _ Manhole/Access (Y/N) 'Pump on' level at _ in. 'Pump off' level - a =r alarm level at Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot /0-9 Absorption field on lot ii91'7,/y7 rt Public sewer main 4//4' On adjacent lots /oo t f r On adjacent lots /0 o f Pr in. Public sewer manhole/cleanout 4/lf/ Sewer /septic service line over fr Holding tank /V/iI Animal containment areas ro t t Manure/animal excrete storage areas /00 t/'t SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation // /rr Property line .V.9." tit Absorption field /o t it/3i- f /t Water main 4//67 Water service line C2 Ct /r Surface water /o0 t �/ Wells on adjacent lots 'nor, fit SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /0 t /t Building foundation ail q6 fit Water main Water Service line aSt /t eone Knoevn Curtain drain re r r%sf r719 Surface water /o0 f /f Driveway, parking/vehicle storage -79%77/6 � tet Wells on adjacent lots /0o r /t F. COMMENTS ?gcrec p .tlr. d .>; ✓srst .t !dr -s c4OC,% 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 COSA guidelines in effect on this date. Engineer's Printed Name Oou o /' s 7`. /7' -en 417 Date Hsi— 7i Zoete -r�NrAttt 49M ; COSA Fee $ 4130 — Waiver Fee $ Date of Payment 373/ ijy Receipt Number //ei S3 (Rev. 11/05) Date of Payment Receipt Number Pa. .Vets.el 4 UpciarY�-d If. 3—�'� f'Cr--h .. V:-At,ti'6 *•`• •s,..0 ;• F,,.2; ..�,•). it 4 .»i S.M Ma r...... Y t., -' ti4X;t C. eurr.on. • 4ji AS -BUILT 1 hereby certify that I have surveyed the following described property• Loi- /, rfec j! ?&, r/• raeyTn : ; ... r., -4c .rflin.l tit~ !.s<416ti?, T13f;J, RfF_,S • 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 un 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 le t` day ofNS U1G1 1 19 S7 ROBERT C. JOHNSON 1'< Registered Land Surveyor No. 8A0 -LS Box 77-0456, Eagle River, Alaska 99577..• Phone (907) 694-2543 SCALE: 1„ aro' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA #1<< Parcel I D # - \s 1. GENERAL INFORMATION Complete legal description 0 / 11.- £ d../e )" 7—W Location (site address or directions) L L �iJE� �G 4' 6-47‘6&-- -"" Z. .46c��LAS�Cr%96-7/ Property owner -77g-1./.1.-)-- zz-167 '- ()O Day phone L- 96 —cJ Mailing address 'L• vE'y 77.LrE3 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: ' 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 7911/5 Mai 1 /011 F.nnt une »i 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 Z7e',/��-5T'�E''i/ Address '9 Phone (9c 7) 756 - io 7,1 Engineer's signature Date 11. b .19 6. DHHS, SIGNATURE Approved for `J bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By. Date I /) 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) Beck MOA 1021 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES E C E � V E p Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744_ 8 1998 Munic,pality of Anchorage Dept. Health & Human Services Health Authority Approval Checklist Legal Description: A. WELL DATA Welt type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) v Date completed Total depth / -z Cased to Casing height (above ground) A Sanitary seal (Y/N) Y Wires properly protected (Y/N) >' FROM WELL LOG AT INSPECTION Date of test ✓ �� v ��a �`' �y�, Static water level c 3c A--71- Well production G g p m G���� '� °" 6 g.p.m. WATER SAMPLE RESULTS: Coliform 't" Nitrate D. -/4 6 Other bacteria 6- T Parcel I.D.: Date of sample: ^/4 - 9Yd Collected by: ,c-r•i7 '" _Fy B. SEPTIC/HOLDING TANK DATA Date installed 'E'' tank size /4cO Number of Compartments Cleanouts (Y/N) i Foundation cleanout (Y/N) V Depression (Y/N) High water alarm (Y/N) "'l-4 Date of Pumping s/' X198 Pumper ,/ms's/ C. ABSORPTION FIELD DATA Date installed �' ' '�, '' Soil rating (g.p.dJft2 or ft2/bdrm) '3' System type Length 73 / Width Gravel thickness below pipe '- Total depth 6« Effective absorption area y' off Monitoring Tube present (Y/N) % Depression over field (Y/N) Date of adequacy test Ai(' : ' 99-c Results (Pass/Fail)' 5 For 3 bedrooms 72c Fluid depth in absorption field before test (in.); >- Immediately after gal. water added (in.): 74' Fluid depth (ins) Minutes later. ' Absorption rate = 7--J 5'sc g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date Ria 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" levet, at* "' • o ' level at* q High water alarm level at* *Datum Cycles Tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ./a6 F7 On adjacent lots ' ' `..e;f Absorption field on lot 7, 9 ,-t Public sewer main JlH Sewer /septic service line On adjacent Tots c o v`.r7/ Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 2.'14 • Property line Absorption field 6 F� Water main/service line -&f."‘•`-'4/ Surface water/drainage /co.'Wells on adjacent Tots /00 V/ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line .2-4,67-74 Building foundation - ' " Water main/service line Surface water / eve'" % Driveway, parking/vehicle storage area ,20 -r• Curtain drain Al,,' -'E F. ENGINEER'S CERTIFICATION Exist Wells on adjacent lots L 0' I certify that I have determined thru field inspections and review of Municipal recor bOt tI abb a Ors are in conformanctwith MOA H4A guidAl'nes in effect on this date. _ p "•; . rt Signature (C Il : ti: , Engineer's Name Date 16.16 HAA Fee $ isnJLL�/ Date of Payment j/ 1 I l g Waiver Fee $ L -7 Date of Payment ' Receipt Number "7 3 S -2-C l t 72-) Receipt Number 72-026 (Rev. 3/96)* Parcel I D # MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING HAA # 1;1-� V,9L✓QG 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) LOT 1; Block 2; Gateway to the Panlz= S(1bd Aiil�ion Location (address or directions) 2450 Eagle. Riven Road (b) Property owner Michael. Fneeman Mailing Address (c) Lending Institution Mailing Address Telephone : (homefi94-6482 Business 2450 EaLe Raven Road, Eagte Riven, AK. 99577 City Mca,tonge Telephone 563-0700 405 West 36th Avenue Suite 100, Anchonage, AK. 99503 (d) Real Estate Company and Agent Tang et Realty ATTR R41.cb Bhown Address P.O.Box 774627 Eagle Riven, AK. 99577-4627 Telephone G94 93kk (e) Mail the HAA to the following address: (or check here if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 Eagle River Loop Read Nei, 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family Tx Number of bedrooms 3 3. WATER SUPPLY Individual Well Z( Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site V( Public ❑ Community ❑ Holding Tank 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/881 Page 1 of 2 Z}olabed )0E8 (BB/L nae) SZO-ZL •)IJOM s,Jaau!6ue leuo!ssa}oJd ay} u! suo!ss!woJOsJOJJaJo}aiqlsuodsailousia6eJoyouy}o/l!!edp!un iayl•panss!s!aieolmJaoaejo}agelepaz/leueJo suogoadsu! lonpuo3lou op SHHQ }o saaL(oldwS •sluawaJ!nbaJ alels pue I Japa} ulelJaO i(}sites of JapJo u! suoiiniiisui 6ulpual Jlayl pue sawoy }o sJesegoJnd of Asalinoo a se s14l s80p SHHO ayl }o eielS 8113 u! paJals!b9J Jaaul6ua leuoissaloid luepuadapu! ue Aq anoge g ydeJ6eied u! uan!6 suo!3eluasaJdeJ oqi uodn thio paseq paieol}lJao lenoJddy Aiuoylny yileaH sanss! 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Aw 1e111 iS}lJan 1 'MOIaq umoys else uoIlep!!en eq }o Se pus olaJay pax!}}e leas AW Aq pat}33183 sy NOIIVINliOdNI aNV V.Va 110HV3S 311d'SIS31 `SNOI103dSNI ONIaIAOIid MIA JNId33NIDN3 'S aMUNICIPALITY OF ANCHORAGE (MOA) Alealth Authority Approval (HAA) 1>tHECKLIST - FEBRUARY 1984 " 343-4744 Legal Description- /4_; £ kAt/AAA-Li the n -Lr 5. A. WELL DATA If A, B, C, D.E.C. Approved (YIN) /P Well Classification 5 Well Log Present (Y/N) _ Date Completed '118 5- /J/P9- Static /Jll9-Static Water Level 3-2 Pump Set At Al Or Casing Height Above Ground -3 •/ Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) I Depression Around Wellhead (Y/N) Total Depth /ab.1 t' Cased to /20. Depth of Grouting Yield y P ✓"^ t J,)I,1 SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot I 0 to r To Nearest Edge of Absorption Field on Lot / (c( To Nearest Public Sewer Line A01 To Nearest Sewer Service Line on Lot ; On Adjoining Lots /00 ; On Adjoining Lots i 00 To Nearest Public Sewer Cleanout/Manhole Water Sample Collected by -' ¶F��� e(-� ; Date � vl S � Water Sample Test Results + 1 r .S L Ac f o/ 1 �r4�.1 PX v4 N1 tt2W-I e s Comments B. SEPTIC/HOLDING TANK DATA Date Installed `f SST -Size /000v1/ No. of Compartments Standpipes (Y/N) 1 Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) N Date Last Pumped -3 f i i -l1 gY Pumping/Maintenance Contact on File (Y/N) N/vt ; for Holding Tank High -Water Alarm (Y/N) N70 Temporary Holding Tank Permit (Y/N) N/ifi SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well To Property Line To Water Main/Service Line /0(9' 3r To Building Foundation N/4 / 1( To Disposal Field To Stream, Pond, Lake or Major Drainage Course Comments N/lr L kJ &NV. 5 . 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata • r Type of System Design 1 L2-PifN 1 I (-(Ci Date Installed /( z/gam Length of Field '7-3 Width of Field S Depth of Field e i rr Gravel Bed Thickness / , Square Feet of Absortion Area `�7 1q Statndpipes Present (Y/N) Depression over Field (Y/N){ Date of Last AdequacyIt Test / , �L4 6 Results of Last Adequacy Test ,` ATI 5 flrr:�I Qry C,<C'o0,1-) SEPARATION DISTANCE FROM ABSORPTION FIELD: 1 To Water -Supply Well / / `7To Property Line 3 Z I To Building Foundation 2 D To Existing or Abandoned System on Lot /J /Or ; On Adjoining Lots / 0C i t To Water Main/Service Line W/R To Cutback (if present) i1l/{�t To Stream, Pond, Lake, or Major Drainage Course N/inr r To Driveway, Parking Area, or Vehicle Storage Area ,,2E- 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 I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed S & S ENGINEERING Company 17034 Eagle River Loop Road No. 204 Eagle River, Apkis 3777Date / MOA No C r Receipt No. c/3/ (7� y3 Date of Payment 4 Amount $ 72-026 (Rev_ 7/88) Beck Receipt No Waiver Fee. $ -S c3. e �y 1 s Seal Date of Payment Page 2 of 2 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date 9-j 'sr5 (a) Legal Description (include lot, block, subdivision, section, township, range) L07-1 BLOCK L 64.72-4W ?z 74" )-ve . i /1 ✓ P / E 5 ?? Location (address or directions) (b) Applicants Namei�� '(RE5 / 57Eva Ian -kiwi Applicants Address 17v'0 ,fc'?1 57._ Telephone — Home Business 2-3 -8017 %is / j (c) Applicant"is(-check one) Lending Institution 1 1 ; Owner/builder\; Buyer 71 ; Other! 1 (explain); (d) Lending Institution Address - Telephone (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the folloy4ng address: 2. Type of Residence Single—Family Number of Bedrooms . � 5 /**�CA Multi—Family! 1 3 3. Water Supply Individual Wel11>. Community 1-1 Other (describe) Public 1 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! Community 1 1 Holding Tank! Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] ,cu /•/C //2L A 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 eater 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 M nicipality 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 regula- tions in effect on the date of this inspection. Mame of Firmft cz'v t '�f-ca%� fi�i�Ct .i Address /Z-: = .33 - 5; /2' Date `- 3 ` (ENGINEER SEAL) DEEP Approval -� Approved for �,�t,Lq bedrooms Approved \� Disapproved Terms of Conditional Approval Telephone G /-0570 Conditional CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DEEP) ISSUES EEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN LN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DEEP DOES THIS AS A COURTESY TO PURCHASERS OF HODS AND THEIR. LENDING LNSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. ^4?LOYEES OF DHEP DO NOT CONDUCT IN2FECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE S ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR ( TSSIO*.;.5 IN TEE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RE4/ej/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description 4C/ / /jkc`K I— 6'/YT�i�/ /` 7/t ?4( x'&. j i5A/ KfL. Sce A. WELL DATA Well Classification 'b�9'lo If A, B, C, D.Q.C. Approved (Y/N) �/� Well Log Present (Y N) Date Completed 7/'5 Yield /6 6,/1Total Depth /4-.)--2-1 Cased to /0-4" Z Depth of Grouting '� Static Water Level 60 Pump Set At N�/9 Casing Height Above Ground 3 . L Sanitary Seal on CasingN) Electrical Wiring in Conduit Y ) Depression Around Wellhead (ye Separation Distances from Well: / / To Septic Holding Tank on Lot lG 6; On Adjoining Lots /�' + c / /' / -r To Nearest Edge of Absorption Field on Lot // % ; On Adjoining Lots To Nearest Public Sewer Line /1/4- To Nearest Public Sewer CleanoutiManhole 'OM- To Nearest Sewer Service Line on Lot /J/4 Water Sample Collected by /�-tG5 /4 Date Water Sample Test Results S7'fit e /'%/'S J Comments B. SEPTIC/HOLDING TANK DATA Date Installed 7-/Z -ems Size /e.i6/ft- Standpipe Air -tight Caps No. of Compartments Foundation Cleanout Z Depression over Tank (YO Date Last Pumped t)/ ; for A.14- Temporary Holding Tank Permit (Y/N) PumpingiMaintenance Contract on File (Y/N) Holding Tank High -Water Alarm (YiN) Separation Distances from Septic/Holding Tank: To Water -Supply Well /b '' / To Property Line 3 7 To Water Main/Service Line /// Course Hifi' Comments ` ;€ To Building Foundation To Disposal Field (o To Stream, Pond, Lake, or Major Drainage Page 1 of 2 [7/7 (r-166,/ 7 /4 //70 /',A.'S C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /3� ��DRri Type of System Design A✓f/tLb Date Installed 7-/Z- 's" Length of Field 73 / Width of Field S i Depth of Field S Gravel Bed Thickness `71/ Square Feet of Absorption Area 9 Standpipes Presen ) ' Depression over Field ( Date of Last Adequacy Test Results of Last Adequacy Test A/A Separation Distance from Absorption Field: To Water -Supply Well // To Property Line 32 - To Building Foundation LCA To Existing or Abandoned System on / • On Adjoining Lots /0- f To Water Main/Service Line /1/4 To Cutbank (if present) /t//e4 To Stream/Pond/Lake/or Major Drainage Course %//4 To Driveway, Parking Area, or Vehicle Storage Area y5 / Comments Lot D. LIFT STATION / r 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 ing Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have he ed, v rified, or conformed to call MOA and HAA guidelines in effect on the date of this inspection. Signed L�%�—E . z-- Date / —3 ��S/ Company Ak-G, MOA No $S 0�` Receipt No '35'5736 Date of Payment 9 - 6 - D J� Amount' $ Li5-S Page 2 of 2 72-026 (11/64) C•� OF A� ,l1 % .JrViir Engineer's Seal