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GREAT LAND ESTATES #3 BLK 7 LT 1
Greatiand Estates #3 Block 7 Lot 1 #051-133-29 . Municipality of Anchorage 'J •,• Development Services Department - Vff Building Safety Division On -Site Water and Wastewater Program, 4700 S. Bragaw St, P.O. Box 196650 Anchorage, AK 99519-6650 Page of 3 www.ci.anchorage.ok.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: PID Number: 051— 133—oZ Name ; r t/'1 / Grq w't r Wastewater System: ❑ New ❑ Upgrade Address� L /(� bis ABSORPTION FIELD Phone ^1 _ I Number of Bedrooms Ll O Deep Trench O Shallow Trench O Bed ❑ M p ptly,; LEGAL DESCRIPTION Soil Rating Total Depth ban original grade; P FIt Ft Block: Lot iia / r<� .�} n G "1r Depth to pipe bottom ham mal grade Gravel de42 th pipe a q F% FI Township Range section: Fill added a aiginal grade G< vel Length: Ft. Ft. Well: New ❑Upgrade ❑ Gravel width; Number of lines. Dsstaroe between Mer Ft. FL class,Rca ion (Private, h B, Total Depth: Cased o' ;_5/'7 -4, Tote) tion area, Pipe M nal /•Ilya FI Fit Driller. Dele Sialic Water Levet Instaner .}.`/,�s &X- d. Datelnetanael // /0 Fl. J W ZZQ " 1 3 Ykldump Set al: " M Above Grand TANK GPM Ft. FL SEPARATION DISTANCES p Septic Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption Lift Holding Public/Privale M dCh1Qf v r capac: . From Tank Field Station Tank Sewer Line f e t 5 OGaI. Well O 51-119, —• T— I J Material. n t-- 1(J CLIFT Number of Compartments: Surface water 11 101� -t. /� 1 r y f t STATION Lot Line �� \ 5'7 \ sas. Manufacturer Gal Foundalron Imo}/, 7 '3 ' 1 �•' ) 1 JJ ��3!!! "Pu^P o^" level al level Wgh water alarm at. In In. Detain Grain onC noc� Pump Maks 6 M Eledrical Inspections performed by Remarks F S,3— If V(I •st.a rr 4L BENCH MARK IouM/isej C/4✓f/!64 Ad9..•ao^� 'O. Locatton and Desrnpt.m.(J r PO OM -C 5/ O /rr7 400 �7(t h �( O (✓isl e �1aNS� R i s Assumed Elslboon. Q `©© Ft E �r...„ As, �� ' ••:fid '. 17034 Eagle River Loop Road, No. 204 Inspections performed by: l Dates: tat '�� A !, l/ J Pj "•9• .. •• w • • ••••••• ••°•• '//'� F;'ral 9-30-03 RcinvT C t2wAN T� ' Development Se ices Department Approval P �j�o� f�1 CE -8801 /' Reviewed and approved by: Date: tz t5 +t `'c �" • »• "' ��•= +, I] (Rev IT.'tlo) fr'v-- +,,n` •'►' �,♦ FUJI �� PERMIT No. SW030364 PAGE 2 OF 3 Municipalit of Anchoraqe DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 aAnchorage, Ataska 99519-6650 • Teol�ephone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 1, BLOCK 7, GREATLAND ESTATES #3 P.I.D. NO. 051-133-29 � I LOT 2 I , I I I LOT 12 ' I I I I I � I � I I � I 1 1 I I I , I I � I I I I Iz I Ia I ,W 41 / 100' WELL RADIUS I I o ;JI 10 I I I I I I I �•Olp,TBM I U O W I /Yf��1 WmS T • DBLI t DBL2 1 C ST . I TUI x � I SCALE: 1' - DO' 1 I, _ • I 0 f Y, 33' t t .M• • »• .N»»»�•IM•»I 33' SECTION LINE EASEMENT M••• . v 1 ROBERT C. CQWAIq Q ----------------------- 10' UTILITY EASEMENT G, CE•SS01 f\T% LOT 1+'ti''' ":: PERMIT No. SW030364 PAGE 3 of 3 Municipalit of Anchora e DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.D. Box 196650 0Anchorage, Alaska 99519-6650 • Tele hone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WpELL INSPECTION REPORT LEGAL LOT 1, BLOCK 7, GREATLAND ESTATES #3 P.I.D. No. 051-133-29 ST1 ST2 98.9' FINAL GRADE 2" INSULATION NEW 93.6' 1300 GALLON POLYETHYLENE 1793.3' SEPTIC TANK N. T. S. �,C�qsy �YN .NM-MMMMM IawOEERT C COWA CE -8801 IN I h cf ti A B ST1 49.0 56.0 ST2 52.0 56.0' DBL1 54.5' 56.5 DBL2 55.0 56.5 TMT 53.5 55.071 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW030364 Legal Description: GREAT LAND ESTATES #3 BLK 7 LT 1 Design Engineer: 0003 S & S Engineering Owner Name: Virginia Crawford Owner Address: PO BOX 672254 CHUGIAK , AK 99567-2254 G ) I(Ici-s—q r►^. -1 Date Issued: Sep 08, 2003 Expiration Date: Sep 07, 2004 Parcel ID: 051-133-29 Site Address: 019619 CHUGACH PARK DR Lot Size: 115434 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By:,F-t- �,,, ,,j _ /"W G—. 47,�X_ Date: q,/5$/0_7 ,Z Date: 03 Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWERIWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 6 S / — ) 3 3 9 Permit Number SW 0 0364 Property owner(s) Vie -Quoin K 1^Q WT Y-01 Day phone ao23 `g�3� Mailing address (1) RoBox 67.:�a 54 Mailing address (2) Cta1VZip Cde - S6 7 Legal description (Lot, Block & Sub'd.) O+ 6&7, �pec E&4e5 Legal description (Section, Township & Range) Vq (p di v G N ( kL 1 Y ) ce 1�S�c174Ft 1 T Lot Sizeg.Ft. Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade K THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. % 8 5 ENGINEERING 1 17034 Eagle River Loop Road No. 404 E-gie RiMer, Alaska 49577 (Signature of property owner or authorized agent) Permit Fees: y q00 Waiver Fees: Date of Payment: el iS- X03 Date of Payment: Receipt Number: 0 1l )I `7-3 Receipt Number: (Rev. 12100) 4 •r S& HEALTH ALIT HORITY APPROVALS SEWER& WATER kWNEX7ENSIONS SEWER & WATER INSPECTION ENGINEERINGSTUOIES ANOREPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SM TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER OSPOSALSYSTEM DESIGN ROBERTC. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 September 4, 2003 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 1, Block 7, Greatland Estates Subdivision #3 It is requested that you issue an emergency permit to,replace, with a new 1300 gallon HDPE septic tank, the existing collapsed septic tank currently serving the existing four bedroom dwelling on the referenced property. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic tank. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/bj j Enclosure 17034 NORTH EAGLE RIVER LOOP 0 SURE 204 • EAGLE RIVER ALASKA 99577 1 " = 60' DESIGN SITE—PLAN ;AI r ^_F KZ^ ��I Arlan �yj y ObA qp t0 ippNa so�-- y � o b I I � I alba I I I i I 1 � I w I >< I N I m I s I O I -zoo Fk! C7 - Z I o^'ol 4 6FpRN0 (7 I C I a G^o HODS 004 O I C rZi I m 9.-'_o yI. I s I "^ ^ h m N m EZ s I c Vco N -1 M ✓ y I r c $ "'3 -1 I N ` I ' I V„c 0 I I �p> zmo � I I mi> -Tm op z i g OCO vt I I _10 I I Z - ' I j - 0 V1 1 I XrM T1 I m Onm y m ---J i------------------------- -------------------- -ONO._ 10• UTILITY EASEMENTEMENT= _-1------------------ ------------ --------------- - I I 1 ���• rn .�t1 ffl y co T7� .�� •i oFg”f I T,��I I I � ��� � �♦ Z � f�.� _ o 0 PERFORMED LEGAL 1 2 3 4 5 6 7 8 91 10• 11 - 12- 13- 14- 15- 16- 17 18- :19 20 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 ••L•• Street. Anchorage. Alaska 99502-0650 SOILS LOG — PERCOLATION TEST �- DATF PEnFORMEU:},�•'Rx}}�' Js rt-� IN: r/ T��'l�!/!;� Township Flange Section• SLOPE SITE PLAN _ s WAS GROUND WATER ENCOUNTEFIED7 S IF YES. AT WHAT L DEPTIV O P EL Depth to Water At Monitorinp7 _/ Dale:% o N—-il I neading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION nAIE---r�mnunesrutelU FERC HOLE DIAMETER TEST nUN BETWEEN/�T AND A0— UT COMMENTS a 45 ENGINEERING 17034 17034 Eagle River L d No. 204 PERFORMED BY: 8tple-RiVN,Alaska-94@77 §ECTZ0:N111lSDAIF CEnIIf Y THAT TI TESIWAS PERFORMED it) ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIUEL :. DATF:: 72"008 (Rev. 4/85) 7 A U9 HEALTH AUTHORITY APPROVALS SEWER& WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERINGSTUDIES AND REPORTS WELL INSPECTION &PLOWTEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANCAL INSPECTIONS ONSITE WASTEWATER DSPOSALSYSTEM DESIGN ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVILENGINEERS (907) 694-2979 FAX(907)694-1211 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 1, Block 7, Greatland Estates Subdivision #3 September 4, 2003 GENERAL: 1. The scope of this project includes the installation of a new 1300 gallon HDPE septic tank to serve the existing four bedroom residence located on the referenced property. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping.access. 17034 NORTH EAGLE RIVER LOOP 0 SURE 204 • EAGLE RIVER, ALASKA 99577 Page 2 Lot 1, Block 7, Greatland Estates Subdivision #3 September 4, 2003 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pine Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). Page 3 Lot 1, Block T, Greatiand Estates Subdivision #3 September 4, 2003 INSPECTIONS: Typically there will be a minimum of two (2) inspections required during the installation of the septic tank. These inspections will occur as follows: The first inspection must be conducted after the septic tank is set in place, but may not be backfilled until after this inspection. 2. The final inspection is to occur upon final grading of the property. The inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to cant' out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER IVI UIV II�l dill I 1 vl niwr ivi r�u� DE`., iTMENT OF HEALTH AND HUMAN SER._..,Es Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT -�- Name�y /� C✓�� "/E' DISTANCES TO FROM SEPTIC TANK ABSORPTION FIELD WELL Address c fl [ L , , WELL Phone(s) Permit No. No. edr oms ✓ 4e 72 LEGAL DESCRIPTION LOT LINE Lot Block % Su pivision f��'G l G�i�ds FOUNDATION �/ Township, Range, Section /d v AS -BUILT DIAGRAM driveway. water bodies, (Show location of well, etc.) septic system, property hoes, foundation, TANKS , , 16 NE SEPTIC ❑ HOLD �U Manufacturer C -P in gallons Material No. of Compartments • r� ir TYPE OF SYSTEM ❑ TRENCH l BED [IW. DRAIN ❑ OTHER Depth to pipe bottom from original grade / / FT Total depth from original grade FT f'b L' Fill added above original grade (�'i 15- FT Gravel depth beneath pipe r (_�2. Is- FT Gravel length FT Gravel width Z FT Total absorption area 8 SQ FT Distance between lines C6 �O/� X . FT Number of fines `/�f/' Soil rating 12 J— SQ FT Pipe material J _g0941 4/C' Intal Date Installed rc� WELLS�I�SI���� o '0 i�7�7 /jJ3 /// 1 PRIVATE ❑ OTHER (Identifv) Clasvhcaton (A,B.C) otal Depth FTJ o FT�� Installei Date Installed: ,r^ t7 REMARKS: nI L /e'/ %f/ arm / 0 ne / ` �/ Scale: '� Inspections prm d by: /V`v' . EN�7 r SEAL tet•-V� i p 'i• ae s•ti•-FK Lr^. r -9 N 9 •t{>i.'.1a1MY1`a. pt { ' •• .a ,�9a A. �+••0 . N& It6!{+- ,. ij> l .0 . b% WOFE S Aa' ��0.�,1.9�i"►-� d L -C L' Date. �' (f V' V '•s (�!/! — �G�/� ENGINEERING certify that [his 1fi034 Eagle Ri%wobbi ver Loop RoadNa. 204 �• /%� Munici Val ka d I�§IA Iq�19 is date: Health Department Approval: - — inspection was performed according to all Date: 72-013 (3/85) r`' ~ ' / MUNICIPALITY OF ANCHORAGE Department Health & Human Services 825 L Street, Anchorage, Alaska 99501 343�4720 ON -- SITE SEWER PERMIT Permit Number: 880072 Upgrade Date Igsued: 06/03/88 Engineer Designed Owner Name: RICH OGAR / S&S ENG" Day Phone: Owner Address: 17034 EAGLE RIVER LP" 694-2979 EAGLE RIVER9 Al-.:: 99577 Parcel Id. 051 133 ---- 29 Lot Legal: Subdivision: {9REATLAND EST. #3 Lot: 1 Block: 7 Section: 10 Township: 151\1 Range: 11W Lot Size 2,65 A (sq.Ift" or acres) Max Bedrooms: This Permit: 4 Total Capacity: 4 SEPTIC TANK: Minimum total septic tank.. capacity: 1,250 gallons" Each septic tank must have at least 2 compartments" Depth to top of septic taAk(s) < 4"0 Wet requires insUlation over tank(s)" INSTALL PER DESIGN BED: 24/ X 32/: MAXIMUM DEPTH 6'. WITH 2/ SAND FILTER" ABANDON EXISTING CRIB" NOTIFY DHHS BEFORE 13T & 2ND INSPECTIONS. THIS PERMIT EXPIRES 12/31/88, I 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. to. I will install the system in accordance with all MOA codes and regulationsr and in compliance with the demign criteria of this permit" 3" I will adhere to all MOA and State of Alaska requirements for tbe set back distances from any existing well, wastewater disposal system or public sewerage system qn this or any adjacent or nearby lot" 4. I understand that this permii is valid for a maximum of' 4 bedrooms, I also understand that the capacity of the total system is 4 bedrooms and any enlargement will rmquire an additional permit. Signed: (Owner) Issued By: DATE: DATE: S & S ENGlNEERING 17034 E. R" LOOP #204 EAGLE RlVER, AK 99577 PHONE #694�2979 *****************... DN~SIlE SEWER PERMlT APPLICATION***************** DATE: 6\1\88 APPLICANT: Rich Ugar ADDRESS: 17O34 Eagle River Loop Rd CONTACT PHONE: 6(38~3755 LE8AL DESCRIPTION: L1 87 Greatland Est #3 SEC 10 �T15N�R1W LOT SlZCi: : 2.65 (SQ FT OR ACRES) MAX. NUMSER OF BEURUOMS: 4 SOIL RATING: 125 SQ FT/BR SQlL lEST UEPTH: 13 FT NO WATER PRESENT lN TEST HOLE. T�IS 1 AN UPGRADE OF 4 BEDROOM TO THE EXISTING SEPTlC SYSTEM �..... ... .... .... ..... ..... �.... �... ... .... . ... .... .... ..... ... .... ..... ..... ��.... ..... ..... .... ..... .... ���... ��.... .. .... ..... TRENCH BED W. DRAlNO" MU) EFFECTIVE DEPTH 0 1 0 CUVEH DEPTH 0 5 0 ROlAL DEPM 0 6 0 LENGTH 0 32 0 WlUTH 0 24 0 SQ F|. 0 768 0 ������... ... ..... �.... ..... .... �������������.... .... ..... �����..... ..... �..... .... .��������������������������������������� SPEClAL CLAW DlTILAW S OR I14S7R1.1CTIDNS: Uver Excavate t�ed By 2 feet To Allow For a 2 foot Sand Filter"Existing Soil Is 8 5 SF per BR Design l s B a s e d O n 125 SF BR From Sand Filter. -�c e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: /t_/ uqa 6 COMMENTS LEGAL DESCRIPTION: DEPTH cl to —� EET) C� 1 �r 2 0 11 <Q r� 3 12 0� Y 4 13 ---- 4- 14- 4151617181920 15- 5 5 <r v 17- 6 COMMENTS 8 ( ro �C g —� 10- 0 11 r� 12 0� Y 13 ---- 14- 4151617181920 15- 16- 17- 18- 19- 20- COMMENTS DATEPERFORMED �r rf�� Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? s IF YES, AT WHAT L O DEPTH? P E Depth to Water Monitoring? Date: Oate: MA.■■■Njim Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN -^NAND —*FT & 5 ENGINEERING 17034 Eagle Rrver L.09p Koad No. PERFORMED BY: –River-, Alaska 99577 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDEL t4 72-008 (Rev. 4/85) C— CERTIFY THAT TH TEST WAS PERFORMED IN ON THIS DATE. DATE: `�– O � GKtl :I( ANl.t1UKAUt AKtA bUr JUH �I��I�JJ�tl�I Department of Environmental Quality �— 3330 C Street Anchorage, Alaska 99503 q INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME 60 -FAMCt-16iC MAILING ADDRESS 1P 00 'J� Nt a AU& PHONE S33 {67117 ("LOCATION LEGAL DESCRIPTION I 6100< 7 (vf'Pkl (.ZINC( �$fArEs SEPTIC TANK: DISTANCE FROM WELL — INSIDE LENGTH SEEPAGE PIT: NUMBER OF PITS LINING MATERIAL wt )75400 —MANUFACTURER— INSIDE ANUFACTURERINSIDE WIDTH_ DIAMETER CRIB SIZE: NUMBER OF MATERIAL 4r��� COMPARTMENTS Z LIQUID DEPTH LIQUID CAPACITY 1250 GALLONS. OR WIDTH_, LENGTH_, DEPTH DIAMETER_DEPTH DISTANCE FROM: WELL TOTAL EFFECTIVE BUILDING FOUNDATION_, NEAREST LOT LINE ABSORPTION AREA (WALL AREA) ADDITIONAL ABSORPTION FT. WELL: Vor i4s(L1lC0( at tL�i2 s' intiS�lechati. TYPE 6*11 CONSTRUCTION DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION—,LOT LINE—,SEWER LINE—,TANK—,SYSTEM CESSPOOL APPROVED DISTANCES: INSTALLED BY: PIPEMATERIAL: COL Q 112.x-0 LOT SLOPE: Le REMARKS: OCL �Y Form No. EQ -031 OTHER SOURCES DISAPPROVED REMA DATE DIAGRAM OF SYSTEM ...a 07o- s � FP 1 APPROVED G.A.A.B. ril o„oE GREATER ANCHORAGE AREA BOROUGH b�✓- ,._ ovnT O V o Ma DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO 3330 "C” STREET ANCHORAGE, ALASKA 99503 Uf TELEPHONE 274-4561 9p.,...o,...e. SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT NAME OF APPLICANT Lev L. FA N NEle MAILING ADDRESS 'WO ge"e2 pate A0 PHONE?.T?-(o-7 70 INSTALLATION LOCATION LEGAL DESCRIPTION (,.-r I INSTALLATION OF; SEPTIC TANK TYPE AND SIZE OF FA FINANCED THROUGH SOIL TEST RESULTS DRAIN FIELD OTHER COMPLETION DATE ANTICIPATED NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE /2-0 TYPE ,1 ""- 0-1 MINIMUM DISTANCES, REQUIREMENTS le 1 FOUNDATION TO SEPTIC TANK s FOUNDATION TO SEEPAGE PIT -20 DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL SEEPAGE AREA SIZE 1-71 `1 ^ /7 ( TYPE 56 SEPTIC TANK SEEPAGE PIT 2,0' DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK mor SEEPAGE PIT- 0.-- 0 DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD n r SEPTIC TANK, 0 ` SEEPAGE PIT to DRAIN FIELD , TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH_REGULATIONS REGARDING INSTALLATION. )� G.A.A.B. OR LICENSED DESIGNER DIAGRAM OF SYSTEM 1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BO GHO�INANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. ,//) DATE 21(/ APPLICANT'S SIGNATURE - �eoniftuction gz;it .L'a ' "One test is worth a thousand opinions" ' 0829 TUDOR ROAD. ANCHORAGE, ALASKA 00307 • TELEPHONE 333-8472 Performed For Leo L. Fancher Date Performed 20 Feb 1974 Legal Descrintion: Lot 1 Block 7 Subdivision Greatland Estates ## 3 This Form Renorts Soils Loq yes Percolation Test_ Denth Feet Soil Characteristics 1 — Organic Overburden 2 — 3 — 4 — 5 — 6 — 7 — 9 — 10 — Brown Silt Slightly Silty Sandy Gravel (100 ) Was Ground Water Encountered? no If Yes, At what Depth? Readinq Date Gross Time Net Time Depth to H2O Net Dron' r-- r— Percolation Rate riinuze Proposed Installation: Seenaae Pit yes Drain Field _ Deoth of Inlet Depth To Bottom Of Pit Or Trench CnmVENTS: 100 sq. rainage area required per bedroom No bedrock or water table anticipated Test Performed By Neal A. Hausam P.E. _ Data Certified By: Construction Testlal Date: 2-20-74 _ MMHMPAUTY OF ° HCHORQOE 1. Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-133-29-000 Expiration Date: Leqal description GREAT LAND ESTATES #3 BLK 7 LT 1 Site address 19619 CHUGACH PARK DR Chugiak AK 99567 Current property owner(s) PROVOST MELISSA R & JOHNNY JR 11/9/2023 X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: $/9/2023 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 MUMUPAUTY OF AHCHORAGE © Development Services Department z " Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051-133-29 Complete legal description Greatland Estates #3 Block 7 Lot 1 Location (site address) 19619 Chugach Park Drive, Chugiak, AK 99567 Current property owner(s) ,Johnny & Melissa Provost Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: 0 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: X Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel 0 Plastic ❑ Concrete ❑ Fiberglass Age 20 - 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: 0 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 $ Waiver Fee $ Date of Paymentc� /�� Date of Payment COSA # �S C 13 g Z Waiver # COSA Application—June 2022 Greatland Estates #3 Block 7 Lot 1 051-133-29 3.8 6/13/74 302 N/A 118 8/2/23 Forge Engineering 132 7/27/23 49" 6/6/23 JR's 6/10/88 8.5 7.7 N/A N/A N/A 8/2/23 0 536 0 120 0 > 600 6 0 6 Benjamin Schiller, P.E.8/3/23 (907) 522-7773 hAUHMP L UTY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT o �( On -Site Water and Wastewater Section www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval # OSC231282 Subdivision: Great Land Estates #3 Block:7, Lot: 1 907-343-7904 Fax: 343-7997 The septic tank for this property is 20 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. 40AWANS MUNICIPALITY OF ,ANCHORAGE Ae Development Services Department 1 Phone: 907-343-7904 On -Site Water & Wastewater Section �'` Fax: 907-343-7997 Parcel I.D. 051-133-29 Certificate of On -Site Systems Approval Expiration Date: 1 - 7 - 28 Z D 1. GENERAL INFORMATION GREAT LAND ESTATES #3 BLK 7 LT 1 Complete legal description . Location (site address) 19619 Chugach Park Dr Chugiak AK . Current property owner(s) LINDQUIST DAVID L & SUSAN R Day phone (907) 250-7714 Mailing address PO Box 670016 Chugiak AK Real estate agent Arleen Myers Day phone 907.250.4077 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well F Private Septic F 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 $ `J� Waiver Fee $ Date of Payment l a/a 1 / 9 Date of Payment Receipt. Number Receipt Number COSA # `J l 4 /u r �' 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 Phone 907,355.9820 Address 19162 Mountain Rd Chugiak AK 99567 Engineer's Printed Name Curtis Townsend, PE Date / 0 l Original Certificate Date: V 7'l 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 Septic System Advisory Well Flow Advisory COSA Checklist blue sheet X Nitrate Advisory Arsenic Advisory Other ....... 6. DSD SIGNATURE " System #1 Approved for , bedrooms ��¢ o FGj System #2 Approved for • No. bedrooms srfgF�P oFESStZN. Disapproved Conditional approval for bedrooms, with the following stipulations: Original Certificate Date: V 7'l 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 Septic System Advisory Well Flow Advisory COSA Checklist blue sheet X Nitrate Advisory Arsenic Advisory Other Legal Description: GREAT LAND ESTATES#3 BLK 7 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 1974 Total depth 302 ft Cased to 118 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) ' 12 in. Date of flow test for COSA 9125/19 Static water level at beginning of test 139 ft. Comments B. TANK DATA Age of tank(s) 16 years Tank type/material septic plaStiC Measured operating fluid level in septic tank 49 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 01 -May -2019 D. ABSORPTION FIELD DATA Which system tested (date installed) 1988 ON ALL standpipes present per record drawing Total measured depth from grade 8.3 ft (max) Measured depth to pipe invert from grade 7.8 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 051-133-29 Structure served by this system _ Well production at time of test 4.9 gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes Q No ❑ Coliform bacteria is Negative Nitrate mg/L MR Nitrate less than MRL (ND) i Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Curtis Townsend Date of Sample 9/25/19 C. L � STATION ❑ Require -maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 9125/19 Results ❑✓ Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 450 gal New depth 0 in Elapsed time 92 min Final fluid depth 0 in Absorption rate 450 gpd Any rejuvenation treatment (past 12 months) no If yes, enter date 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' M✓ Yes if No Community Sewer Manhole/Cleanout > 100' Q Yes if No ft r✓ Yes if No ft Neighboring Tank > 100' Yes if No fit Private Sewer/Septic Line > 25'[Z] Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' 21 Yes if No ft R( Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' M✓ Yes if No ft Surface Water > 100' Q✓ Yes if No ft Property Line,? 5' [✓ Yes if No ft Wells on Adjacent Lots: Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells > 100' M Yes if No ft Water Main > 10' M Yes if No ft Community Wells > 200' M 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' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' Yes if No ft Surface Water> 100' [Z] Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that l 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. COSA Checklist yellow sheet Aft�r OF ALA A ; 7H idsL. Towpsero yam. Date%' w C�s� CE i1�4' ENGINEER'S S 3i � R013k4, C- CW6. Municipality of Anchorage • Development Services Department Building Safety Division r On -Site Water and Wastewater Program 4700 South Bragaw St. S A F E T Y P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-133-29 _ HAAdJ- »r; Expiration Date: 1-a?S -Ok�j� 1. GENERAL INFORMATION Complete legal description Lot 1 -Block 7; crPariand Rstatps #1 Location (site address or directions) _19619 rhngarh Park Dr Current Property owner(s) Virginia Crawford Day phone 273-4022 Mailing address PO Box 4646 Pal -mer, AK 99645 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 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. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and.State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S & S Engineering Address 17034 N. Eagle River Loop Ste. 204 Eagle Phone -694-2979 River, AK 99577 Engineer's Printed Name Robert C. Cowan Date 5. DSD SIGNATURE J,ff Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By. A O_ Original Certificate Date: o-6 ul (Rev. 01102) MunidpaYrtofAncha�-age pl6 ��r B�4 Development Services [Separtment Building Safety Division i. Ort Siie V',iaCer & Wa"stevuater Program ` ° S�r �ci anchorage ak us 1 EAL7H AUTHORI7yAPPROMAL CHECKLt8T" If7� i3, or C provide I Ila WeII Log (V) `l�5 1e�rzsx f �' t'�l "f San yIi���tt6ryry.s.CC�6.p.a�yyy�l.., CN) `rsy.Wires properlyproteoted( N `/�Z � 2 p.. ':F'�bRm'G¢A"bY KFR£4'ii3vS::y' `�Po ft% }I^ Si �L�%dIVWrF'f' +k+J R4L Fk .w v A Y eft Cased to A&—ft Casing height (above ground) in. AT INS`PEG !r Level ft /� ft coon e d g p l e Sg m colonies/100 ml NdratD. Ci'� mgt/I Other acterra � co orries1100 ml. �1� mg /I � � Date of sample: �!3/a(� Collected by. IV l .. ��,.f'�.,"{:a/ss mr` S s z�+" xtA.'vn^�va„ .ae s^ q, iY' ;. v� 1., "'x a a ...+✓e', a,.n&s,e.^u.:xa r„,..,.+..i:; haterialj-�I`%PE Date installed °%�13Jp--s gal Number of Compartments Cleanouts (l) `lc—S W +e:KkFk"'s7.WGu§Y4k'4rt” .r, P .. ...._.a.. —... eanout (1) tteuss Depres��s��ion over tank (Y�1 tib_ High water alarm n'Q� K30p" CQ�/ptamer A d Soil rating (g p d fft2 orft2/bdrm) 2� Ahern System type 5 �� r w ft Width"""'�u ft Gra lel belowe i O. S pipe ft. ft Eff. absorptron area ftp Monitoring tube `� `Dep`ression"over field ' Y.= O uacytest ��3/ O Results ail) �/43S For bedrooms i absorptwnfiefd be ore test in Water added 000 gal. New depth �" in: urs^"s4a„y^x: r..vn.,da�rsc.,2 ae .. in Finaluffuid�depfn' I'll in Absorption rate > C� f 9 p d "`'"`"� Lion treatment (past 12 mo) (Y If ves: sive date k) F1 ... .,a1, ooem YdIlullb in.Highvvabaralarm level cd in. ! ` i n\o? Cycles tested | — --`~—'-~^—~`---^-----`^—``~----`-- On adjacent lots + '~~~°~~^~�`°~� / ��a��|o� too '+ Ve systems are in records that the abo FOA HAA guidelines in effect on this date'— 't 06YVAN ame Waiver Fee $ Date of Payment UNI SGS Ref.# 1046009002 Client Name S & S Engineering Project Name/# Various Client Sample ID Lot I Block 7 Greatland Est 42 Matrix Drinking Water PWSiD 0 Sample Remarks: All Dates/Times are Alaska Standard Time Printed Date/Time 09/21/2004 14:17 Collected Daterrime 09/13/2004 14:13 Received Date/Time 09/13/2004 17:12 Technical _Director �l.�^Ste C,. Ede Releasedi)tg J Pazameler Results PQL Units Method Container ID Allowable Prep Analysis ]nit Limits Date Date Waters Department Nitrate -N 0.100 U 0.100 mg/L EPA 300.0 B (<=10) 09/13/04 1JB Microbiology Laboratory Total Coliform 0 coU100mL SM209222B A (<=1) 09/13/04 DKC St,!._ yI ry•.aw,.npsc newrarng_-1;[eUIIRr nta8Kl,;.apd.'4hat.the ,im�ot�t-' ,t��;S: ripe tts sitlie[ed thereoit aitn if3?in tiie ' topertY.lines incl dFi A C .,.. w .; i overlap dr encroach. oh the prope!<Y JAB adjacent thezela; rf}a! Fij. r .� .7 ur no. iarprodetnents on•:property.f ad�acept thereto etrcroach; , on the premises in estign and at t�1er#' tco,ToadWays, ,..tratismiasidb lir(esootkiei visible epeeinetita'onesidpivpetty .,,. except as bidicated'h�eon. Dated at fia a Rfyer Ataaka Yi "!Rot:ert E gT:dejn 0a. Bl. ..'' . iV(i. $Hy7•S ,°''4 i this Z-�ay of p� $0qH- '::1�SVv SCALE::' ^�}�� .FWt 3 �:-YC r'`Y �.: 'S:• �q^+Y ay�f}y1 y'h`V�'I r iI, �i r/ �:� I W+...9%()p�y�Ir� ,M`.� a• OOJI'},7 +1 Pie i Municipality of Anchorage Development Services Department *A. Building Safety DivisionOnsite Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: 5 & 5 Engineering Legal description: Greatland Estates #3 Block 7 Lot i The attached paperwork has been reviewed and is being returned for the following reasons: Original signature or stamp missing on _ Calculation error in design. _ Additional soils information needed. _ Water monitoring results inadequate. _ Discrepancy in information submitted. _ Topographic information missing or inadequate. _ Incomplete; missing _ Incomplete; missing _ Additional adequacy test information needed. _ Water sample unacceptable. _ Measured/proposed distances/dimensions missing. Locations of all soils, percolation and water monitoring tests not shown. _ Proposed system too deep for soils information submitted. Well log required. _ Omission in narrative. _ Insufficient fill over tank or field._ n11'jjw Other. Well stickup less than 12 inches above ground surface � � M �* tolbAICR Date: 10/19/2004 Name of reviewer: Julie Makela. P.E. Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES i Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel LD.# 051-133-29 HAA# HA930422 1. GENERAL INFORMATION Complete legal description Lot 1 Block 7 Greatland Estates S/D #3 Location (site address or directions) 19619 Chugach Park Drive Property owner Richard Ogar Day phone 688-3755 Mailing address 19619 Chugach Park Drive Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: Four (4) 3. TYPE OF WATER SUPPLY: Individual well xxxxx 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 xxxxx 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. 72-025 (Rev. 1/91) Front MOA #21 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 & S Engineering Phone 694-2979 Address 17034 Eagle River Loop Road, Suite 204 Engineer's signature 6. DHHS SIGNATURE xxx Approved for Four (4) bedrooms. Disapproved. Conditional approval for M Date Eagle River 99577 3 a i bedrooms, with the following stipulations: Additional Comments This document is a retype of the original HAA. DHHS has a copy on file with signature of engineer and engineer stamp. If there are any questions, please call 343-4744. 1IITIC Date July 29, 1993 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 MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services Ak On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel 1. D. # 'c�� - 12)1-)-,_�f_\ HAA # 14fi�nl-ka;a 1. GENERAL INFORMATION Complete legal description Lot 1; Btock 7; Gn.eatEand E4;tates #3 Location (site address or directions) 19619 Chugach Patk Drive Property owner R.ichaxd Ugan. Day phone 688-3755 Mailing address 19619 Chugach Pakk Dn..ive Chug.iah, AK 99567 Lending agency Day phone Mailing address Agent _ Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: I- N 3. TYPE OF WATER SUPPLY: Individual well XXX 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 XXX 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. 72-025 (Rev. 1/91) Front MOA #21 / 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 Address Engineer's signature 17034 Eagle 6. DHF,�S SIGNATURE � s Approved for `L bedrooms. Disapproved. Conditional approval for Additional Comments Phone 2-I 7 y Date bedrooms, with the following stipulations: By:��,.��,� amu£ c l Date 7— -z E -- 43 4tlTlr 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 orderto 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. 7M25 (Rev. 1/81) Back MOA 421 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LaT l 6wy--1 L�q"-b.< LP,,Sr, 3 Parcel I.D. psi "l 3,;3- Z-? A. Well Data k Well type V +2-�\(-ADZ- If A, B, or C, attach ADEC letter. ADEC water system number `` P Log present OYN) V -_Date completed --1 4 Driller N Total depth 3 � Cased to \ Casing height 1. -Lo r Sanitary seal O/N) -Q Wires properly protected &N) V FROM WELL LOG AT INSPECTION Date of test l� - "3 --7 4 Static water level r r Well flow �.� g.p.m. �. n g.p.m. Pump levell � m SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot \ r> D ' ; On adjacent lots Absorption field on lot �e `h ; On adjacent lots -�1� Public sewer main Public sewer manhole/cleanout Sewer service line k r Petroleum tank zS WATER SAMPLE RESULTS: �it e v• dr�LN Coliform 6 Nitrate ° I (D 4 Other bacteria _ Collected by: t ACI (/� / q $ ae, 0 Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed kc1'I- Tank size 125 Compartments Z Cleanouts Y'N) `Foundation cleanout (1 Depressio ()ojN, High water alarm (Y& t' Alarm tested (YIN) Date of pumping -�I , o� - `1 2 Pumper SQ-, ( SS Pa a SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: �d- Well(s) on lot On adjacent lots Foundation To property line . 10 �� Absorption field S Water main/service line t o `� Surface water/drainage l 72.026(3193)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DI 511 D. ABSORPTION FIELD DATA LIFT STATION TO: "Pump off" On adjacent lots Surface water Date installed In - n o Soil rating (GPD/Ft2) System type 75fL0 Length 3-1- Width 2`r 1 Gravel thicknessy 5 Total depth 7 Total absorption area I L•$ � Cleanout presentON) Depression over field (Y�1 Date of adequacy test 2 -12 -93 Results as fail) Porss for 4 Bedrooms Water level in absorption field before test b After test b U Peroxide treatment (past 12 months) (Y&r\o �� 1e- So �eJ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot � o 0- On adjacent lots \ b d Property line 1 b 1 To building foundation 1 0 On adjacent lots a � + To existing or abandoned system on lot ^f�4 Cutbank IJ (", Water main/service line Surface water 1 0 C> %k Driveway, parking/vehicle storage area Curtain drain SIA E. ENGINEER'S CERTIFICATION / certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect q. S::, ti.Nt�fidt���Ctl'rJCy Signature ;;03'1 ),caan Road No, Eat& ktt°oct, F11_,sko 99577 Engineer's Name Date HAA Fee $ / �P -- d7 Date of Payment 7` �b/ Receipt Number 70 -AOR 11/0W Rork Waiver Fee $ Date of Payment Receipt Number S� tk / auca( COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES Chemlab Ref.# :93.3364-3 Client Sample ILD :1/7 GREATLAND EST. Matrix :WATER Client Name :MOA*HEALTH & HUMAN SRV -x-]20 QUALITY Ordered By :SUSAN OSWALT Project Name. :MOA WATER QUALITY MONITORING PROGRA Project# PWSID :UA C//'dt Py 5633 8 STREET /t\{J13:. JJ/j/j}ANCHORAGE, AK 99516 TEL: (907) 562.2343 FAX: (907) 561.5301 WORK Order :68254 Report Completed :07/16/93 Collected :07/13/93 @ 09:36 hrs. Received :07/13/93 @ 10:55 hrs. Technical Director: S EP C. EDE Released By : Sample Remarks: ROUTINE SAMPLE COLLECTED BY: S. OSWALT. MOA WATER QUALITY MONITORING PROGRAM. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits. Date Date Init --------------------------------- --------------------------------------------------------- Nitrate-N 0.10 U mg/L EPA 353.2/300.0 10 07/15 LLH x See Special Instructions Above UA = Unavailable *'k See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. G': = Greater Than rte" S13S Member of the SGS Group (Societ6 Generale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA - - DATE RECEIVED o INSPECTION APPOINTMENTS 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ❑ One ❑ Four ❑ Other TIME TIME t✓ TIME Three ❑ Six C� * ATTACH WELL LOG. A well log is required for all wells drilled DATE DATES DATE depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM�� INSPECTOR INSPE OR INSPECTOR c� MUNICIPALITY OF ANCHORAGE IpgLITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEL i�DEFT. 825 LStreet -Anchorage, Alaska 99501 • OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL SANITATION DIVISION �� Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEII ijL`1�"_EB DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERJTYOWNER I--O'CDptu✓' �Lk�L�ez�S✓ PHONE /� (JK.—D-9i r MAILING ADDRESS X 1'�1_."-�3— C,{',utiCTL.cVt�- C''toia�� Pv 'J��Y(h� PROPERTY RESIDENT (If different from above) PHONE 2• BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS - 5. LEGAL DESCRIPTION JSC� LL�7 1 ��. -! STREET LOCATION (2_�c 0����t 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ❑ One ❑ Four ❑ Other SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM�� INDIVIDUAL/ON-SITE** 9 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ TWO ❑ FOUR ❑ SIX ❑ OTHER 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE E] PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: (-'1- If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL_T 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY 72-010 (Rev. 6/79) DAVID A. SLENKAMP MECHANICAL ENGINEER - 694-9055 May 12, 1981 Polar Realty ATTENTION: Woody Smyers 101 East International Airport Road Anchorage, Alaska 99502 Dear Mr. Smyers, ROBERT A. SHAFER MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL %OT-CTION �!,A' 1 5 1981 RECEIVED Reference: Lot 1; Block 7; Greatland Estates #3; Loydale Fancher Property CIVIL ENGINEER 694-2979 A sewer system adequacy test was performed on the system located on the referenced property as you requested. The septic tank was pumped and verified to have a capacity of 1250 gallons. The seepage pit was charged with 1000 gallons and after a period of 24 hours all the water which had been added had percolated out of the crib. It can be concluded from the above test that the on—site waste water disposal system is currently functioning adequately for the three bedroom residence located on this property. The system cannot be guaranteed, however, against subsequent failures. If we may be of further assistance, please do not hesitate to call. Sincerely, E. cc:- Alaska State Bank Municipality of Anchorage Department of Health and Enviornmental Protection SRB 196X EAGLE RIVER, ALASKA