Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
GREAT LAND ESTATES #3 BLK 5 LT 4
Greatland Estates #3 Block 5 Lot 4 #051-133-07 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221337 Work Type: SepticTank Upgrade Tax Code Number: 05113307000 Site Legal Address: GREAT LANDESTATES #3 BLK 5 LT 4 G:1260 Site Mailing Address: 19725 HARDROCK DR, Chugiak Owner: HENDERSON BRANDON SCOTT & KALY Design Engineer: EKLUTNA ENGINEERING, LLC* This permit is for the construction of: Effective Date Expiration Date ��cnt G a'( f ; ufi p llepartment Lot Size in Sq Ft: Total Bedrooms: 8/31/2022 8/31/2023 81457 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: • Prior to a future COSA, a ROW Encroachment Permit will be required for the seepage pit in the utility easement. Received By: /, / Issued By: _&!�I Date: Date: g�3 1h7 3 MUNICIPALITY OF ANCHORAGE Development Services, Department Uu*Phone: 04 907-343-79 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTICIWELL PERMIT APPLICATION Parcel I.D. 051-133-07 Property owner(s) HENDERSON BRANDON & KALYN Day phone Mailing address 19725 HARDROCK DRIVE CHUGIAK, AK 99567 Site address 19725 HARDROCK DRIVE CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) GREAT LANDESTATES #3 BLK 5 LT 4 Legal description (Township, Range & Section) Lot Size 81,457 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) El(w Single Family (SF) Absorption Field ❑ Initial o A ) Septic Tank E] Upgrade 0 Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Murpyipal Codes. (Signature of property owner or authorized agent) ?, 31 'ZozZ Permit/Rush Fees: tY2 Z 535 Waiver Fees: Date of Payment: ��z'1�22 g�31�22 Date of Payment: Receipt Number: 012061) 02150D Receipt Number: Permit No. OS !O % Z 1337 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221337, Deb Wockenfuss, 08/31/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221337, Deb Wockenfuss, 08/31/22 MUNICIPALITY OF ANCHORAGE —, { 0 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION �Y ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 pfE L ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME �// !� ��-{�G='-� >'Ll,�/�/L1`L_r /' { PHONE ��E [ilji/� EW E] UPGRADE MAILING ADDRESS //Q/ LEGAL DESCRIPTION LOCATION '��1' NO. OF BEDROOMS 'N'{/E�i7 TFC f='f-R✓�OY`�GY��', �ic�/ �- Uy DISTANCE TO: Well / Absorption area Dwelling p PERMIT NO.� F Z W Manufacturer c� Material No. of compartments in Liq. capacity in gallons %O�� IF HOMEMADE: Inside length Width Liquid depth O z DISTANCE TO: Well Dwelling PERMIT NO. 2 Z FManufacturer Material Liquid capacity in gallons O Well Foundation Nearest lot line PERMIT NO. w= DISTANCE TO: Distance between lines J u. Z No. of lines Length of each line Total length of lines Trench width Z w inches —2 f Top of tile to finish grade Material beneath tile Total effective absorption area 0 inches W Length it { Width �� { Depth �C� p CJ PER-ULT NO. _ % CJ .� % 2 C7 I F IL — W °. Type of crib �. ,.p,. � .�,�- mzl' -� Crib diam�ter Crib depth , / / /f Total effective absorption area �7 7 W ur DISTANCE TO: Well / 1�� � Building fo tion Nearest lot line p h! / ( ) � Class Depth Driller Distance to lot line PERMIT NO. W W Z. Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE MATERIALS SOI L TEST RATI NG- ��' SQ • / r! lr� , qq INSTALLER REMARKS {4 {u 4 _ cpDeT'_ / _ N � 0 70 �(, r .r J APPROV DATE LEGAL, 1� 72-1013 (Rev. 3/78) THE REQUIRED SIZE OF THE SOIL HBSORPTI0N SYSTEM IS: PIT WA 171 1 n Is c2s 171 MM E,n THIS ~V -THE ` ,DEF�l�TMENT'\^��'EHLTH co 71E TRENCH HND ENVlRONME�THL��'`�ECTION DIM-wSION I'�THE (IN FEE�) 825 'L' STREET. HNCHORHGE. HK 99501 / " / | �1~r/�^ ~°�"�"` , THE SURFHCE OF THE GROUND HND 264-4720 OF THE EXCHV�TION (IN FEET) PERMIT^N0� ( 780]1] ) SET WIF,TH AS Piz 1 1 1H 170 ro"HYMM X^1 HPPLICHNT GREG FE��ETTE DEPTH IS THE MINIMUM DEPTH 1101 N7T� HVE ��~~--- 274 4518 LOCHTION CHUGIHK HK EXCHVHTION (IN FEET). BETWEEN LEGHL L4 B5 GREHT LHND EST DISPOSHL SYSTEM IS LOT , SIZE 0 SQUHRE FEET TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH WELL/ OR MAXIMUM NUMBER OF BEDROOHS = ] H PUBLIC WELL SOIL RHTING (SQ FT/BR)- 85 THE REQUIRED SIZE OF THE SOIL HBSORPTI0N SYSTEM IS: FW FEE: E-3 "IE lffw��111� !! --:: . -. ;:-�: ����...... ��� PERMIT HPPLICHNT HHS PIT WA 171 1 n Is c2s 171 MM E,n THIS ~V -THE OF HNY WELLS �EN�TH co 71E TRENCH UR DRHINFIELD. i� DIM-wSION I'�THE (IN FEE�) THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFHCE OF THE GROUND HND THE BOTTOM OF THE EXCHV�TION (IN FEET) Q F�n M Npin K? THERE IS NO SET WIF,TH FOR TRENCHES. INSPECTION HND HPPROVHL BY THIS THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFHLL PIPE HND THE BOTTOM OF THE EXCHVHTION (IN FEET). FW FEE: E-3 "IE lffw��111� !! --:: . -. ;:-�: ����...... ��� PERMIT HPPLICHNT HHS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURING THE OF HNY WELLS HDJHCENT TO THIS PROPERTY HND THE INSTALLATION INSPECTIONS NUMBER OF RESIDENCES THHT THE WELL NILL SERVE �:1--. G! Do ���F:-m'! �,Ei � it.,.� ��- - 1- 1 oil P41 50 TQ Q F�n M Npin K? —__ SYSTEM WITHOUT FINAL. INSPECTION HND HPPROVHL BY THIS BHCKFILLING OF HNY DEPHRTMENT WILL BE SUBJECT TO PROSECUTION. BETWEEN H WELL HND HNY GN~SITE SEWHGE DISPOSHL SYSTEM IS MINIMUM DISTHNCE 100 FEET FOR H PRIVHTE WELL/ OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC NELL OTHER REQUIREMENTS MHY HPPLY. SPECIFICHTlONS HND CONSTRUCTION DIHGRHMS FREE HVHILHBLE TO INSURE PROPER INSTHLLHTION �0MANW! :1 -V 01-112:,2 -11,[ E> K cl EHA-1 hill 11Z lot �:::�i ...' ���� I CERTIFY THHT 1� I HM FHMILIHR WITH THE REQUIREMENTS FOR ONIT1E SEWERS HND WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE. -�� 0 Et..E GEG_., CHNICAS DEVEL�,,�MENT CO. Box 90, Davis St., EacIle River, Alaska 99577 G 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG',688-22BO Soils Er Foundations Land Development Performed for: Name: Ai;E! <9YO-iF9 � - Tel. No. -2E/- Mailing Address: //©/ 7 6A, - Legal Description: fGK �.er7 �,nrP�u c� Depth (feet) Soil Characteristics 0 2 3 7 8 9. 10 11 12 Aitl.a L- eve, -E 13 rte. - 15 16 2 Ves /2 �1 6 -,k,:7 1 iV1 L 4/ ,v Ground Water Encountered: Yes No L If yes, what depth Proposed Installation: Seepage Pit Drain Field --L Comments: Performed by: Date:_ A411 /Om r Y c k i� old k en-Iuw � -- -- 9)bu �oP-Nk, f, AN""" ' P d Tat tft rb BrIffing. by A & L DRILLING COMPANY ` BOX 97, EAGLE RIVER, ALASKA 99577 • TELEPHONE 694-2588 OWNER OF LAND ( (`r ' % ( r' yEJ ! DEPTH OF WELL �. STATIC LEVEL OF WATER FT. r J ADDRESS' LEGAL DESCRIPTION Sf / 7 F�1-'tI1�1 %Od�1fi L // �.� DRAW DOWN FT. 7G} `f' � ` .i /j 1/71 Ended `I '� GALS. PER HR DATE -Started % KIND OF CASING PERMIT NUMBER KIND OF FORMATION: MISCL. INFORMATION:jo ) DRILLER'S NAME 9 ' c.) Ft. Ft. ()( rh& I- rrom 1 L. From to Ft. 1 C) Ft. � Fi'V Q �i��l From Ft. to Ft. From to t to !,J ;i" Ft. / l74AN f•<i1>6)`f 1Jt/t%J�d�J' From Ft. to Ft. From Ft. From ::? G'� Ft. to � 7c) Ft. `'l A)y ie<��Jhal v�� 3(�[lJrom relil Ft. to Ft %'.1 ,1 =� 7�f'I%�l''J �n rom � Ft. to Ft From Ft. to=y Ft. ;<s =��'-� �"' Ft. ,iJ % Jgd'r)4 tali % �: � From Ft. to Ft. From Ft. to 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. Ft. From -Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to From Ft. to Ft. From Ft. to Ft. Ft. From Ft. to Ft. From Ft. to From Ft. to Ft. From Ft. to Ft. Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft From Ft. to MISCL. INFORMATION:jo ) DRILLER'S NAME 9 x"nI—A who .5 H,.uU~ `1U.~.A. u ^ ��, " ""`~^" ". .. ,-1__~ ^ DEPARTMENT 0`�/EHLTH HND ENYIRONMENTHL K~'JECTION STREET/ HNCHQRHGE/ HK99501 279~2511 #4 EE PL__ 9 F�:, EH: h, --H 1—I PERMIT NO. ( 77841 ) HPPLICANT 1101 W 7TH HNCH 274 4518 LOCHTION HHR�H�[K DM/Y� LEGAL LOT 4 BL 5 GREHT LAND ESTHTES LOT SIZE 81457 SQUHRE FEET MINIMUM DISTHNCE BETWEEN H WELL AND ANY ON --SITE SEWAGE DISPOSHL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 200 FEET FOR H PUBLIC WELL WELL LOGS HRE REQUIRED HND MUST BE RETURNED TO THE DEPARTMENT WITHIN ]0 DHYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MHY HPPLY� SPECIFICHTIONS AND CONSTRUCTION DIHGRHMS HRE AVAILABLE TO INSURE PROPER lNSTHLLHTION ������ �������� ��� ���� I CERTIFY THAT' 1:I HM FHMILIHR WITH THE REQUIREMENTS FOR ON-SITE SEWERS HND WELLS HS SET FORTH BY THE MUNICIPALITY OF HNCHORHGE. 2� DHNCE WITH THE CODES. �PPLICHNT CRHIG DERNETT k, MUHMPAUTY Ofd AmCHORAGIE o�� 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. 051-133-07 1. GENERAL INFORMATION Expiration Date: L E a C Complete legal description GREAT LAND ESTATES #3 BLK 5 LT 4 Location (site address) 19725 Hardrock Drive Chugiak AK 99567 Currentr0 ert s PRESSMAN-SCHNEIDER NICOLE & SCHNEIDER BEN p p Y owner(s) Day phone Mailing address 19725 Hardrock Drive Chugiak AK 99567 Real estate agent Day phone 2. TYPE OF DWELLING: Q Single Family (w woAD T, ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic ED Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ Waiver Fee $ _ Date of Payment 12-2 Date of Payment Receipt Number 0e�'3610 Receipt Number, COSA # OSG Z21 OD 1 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Eklutna Engineering, LLC Address 19162 Mountain Rd Chugiak AK 99567 Engineer's Printed Name Curtis Townsend, PE 6. DSD/SIGNATURE System #1 Approved for 3 bedrooms By: System #2 Approved for _ _ bedrooms Disapproved Phone 907.406.1058 Date 49 . " 0'404 eras %' 0 Flo. El 9iM , PROFesSt- Conditional approval for bedrooms, with the following stipulations: Original Certificate Date:I 1,Z-0 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Ghecklist Legal Description:GREAT LAND ESTATES #3 BLK 5 LT 4 Parcel lD:051-133-07 lf more than 1 septic system on lot: COSA Checklist # _of - Structure served by this system - A. WELL DATA E Wett log is filed with Onsite (or attached) Date driled 1977 Totaldepth 226 x Cased b 226 ft I Sanitary seal is functioning correctly E Wires are properly protected Casing height (above ground) t1B in. Date of flow test for COSA 1ot3ot21 Static water level at beginning of test lre n Well production at time of ,"t1 4'5 gpm Water storage tank volume 0 gallons Welldisinfected for coliform test? n yes E tto E Cotiform bacteria is Negative Nitrate 2'09 6971 E Nitrate less than MRL (ND) Arsenic - ug/L E Arsenic less than MRL (ND) Collected by Curtis Townsend Date of Samole 't2t2812'l Comments B. TANKDATA Age of tank(s) ;\y"^r" Tank type/material sePtic ASS Measured operatin gffiu"r in septic tank 51' I Standpipes/foundation cleanout per record drawing Date of pumping Bl5l21 D. ABSORPTION FIELD DATA Which system tested (date installeOl 1979 E nt-l standpipes present per record drawing Total measured depth from grade 7'75 ft 16sx; Measured depth to pipe invert from grade 1Lft trin)I run - pressurized field E Monitor tubes go to bottom of effective. lf not, state depth into effective ! Code-required soil cover over field fl System presoaked (Required if vacant for greater than 30 days prior to Adequacy test date Results @ eass For 3 bedrooms Fluid depth prior to test 0 in Water added 753 gal New depth 17 in Elapsed time jfl min Finalfluid depth 0 in Absorption rate > 450 gpd Any rejuvenation treatment (past 12 months) date of test) Gallons introduced -gailons lf yes, enter date COmmgntS/DefiCienCigS: code required soil cover is not present, but no reports of crib freezing and very little water is present in crib C. LIFT STATION n Required maintenance Age of lift station COSA Checklist yellow sheet E. SEPARATIONDISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot : 100' @ Yes Neighboring Tank > 100' p Yes Absorption Field on Lot > 100' E Yes Neighboring Absorption Fields > 100' E Yes Community Sewer Main > 75' E Yes From Septic/Holding Tank on Lot to: Building Foundations 2 10' E Yes E Yes E Yes E Yes E ves Community Sewer Manhole/Cleanout > 100' @Yes ifNo-ft Private Sewer/Septic Line > 25' E Yes if No - ft Holding Tank > 100' ElYes if No - ft Animal Containment > 50' E Yes if No - ft Manure/Animal Excreta Storage : 1 00' flYes ifNo-ft if No if No if No ft ft ft ft ft (Please enter distances if less than required) ifNo_ft ifNo_ft ifNo_ft ifNo_ft ifNo ft Property Line > 5' Absorption Field > 5' Water Main > 10' Water Service Line > 10' From Absorption Field on Building Foundation 2 10' Property Line > 10' Water Main > 10' Water Service Line > 10' Surface Water > 100' Lot to: (Please enter distances if less than required) EYes ifNo-ft @Yes ifNo_ft EYes ifNo-ft EYes ifNo_ft EYes ifNo_ft lf absorption field is under driveway comment below Wells on Adjacent Lots: Surface Water > 100' Wells on Adjacent Lots: Private Wells > 100' EYes if No - ft @Yes ifNo_ Community Wells > 200' [l Yes if No -lf septic tank is under driveway comment below ft ft Private Wells > 100' Community Wells > 200' EYes ifNo_ft EYes ifNo_ft F. ENGINEER'S GOMMENTS w&aye ng 'r# COSA Checklist yellow sheet 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 Parcel I.D. o5z-133-o7 COSA # MbO_�Et OU, Expiration Date: 13 — %2 1. GENERAL INFORMATION Complete legal description Great Land Estates #3 Block 5, Lot 4 Location (site address) 29725 Hardrock Drive, Chugiak Current Property owner(s) Jennifer& Wade Allred Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address P.O. Box 671275 Chugiak AK a9567 Unless otherwise requested, COSA will be held by DSD for pickup. 2.- NUMBER OF BEDROOMS: � 3 ,,,3. TYPE OF WATER SUPPLY: Individual Wel(- - - I idiv0ual Water Storage ❑ Community Glass Well ❑ Public WaterSystem ❑ Day phone Day phone 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 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. 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 Pannone Engineering Services LLC Phone 272-8218 Address P.O. Box ioozgz Anchorage, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date ihi/aoia Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guide/ ines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encro achments. PES can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of Phis report by any other person or party is not authorized nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for �— bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: /1LWA 1111C11Lb. COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: �� r Original Certificate Date: % 3 (Rev. 77/05) - Municipality of Anchorage s Development Services Department t- 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: Great Land Estates #3 Block c Lot y Parcel ID: o52 -i:4 -o7 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed Q/2111q77 Sanitary seal (YIN) v_ Total depth a26 ft. Cased to a ft. FROM WELL LOG Date of test 0/2-1/2977 Static water level 27c ft. Well production 8 g.p.m. WATER SAMPLE RESULTS: Coliform Ngec_colonies/100mL Nitrate a.36 mg/L Well Log (Y/N) Wires properly protected (YIN) Y Casing height (above ground) 28 in. AT INSPECTION 2/;/2022 280 ft. Arsenic: ND ug/I Date of sample: 3./,4/=t2 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/ Fiberglass Date installed 613oh978 Tank size 2000 gal. Number of Compartments 2 Cleanouts (Y/N) Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping _5/4/2o22 Pumper JR's Pumping C. ABSORPTION FIELD DATA Date installed 613o/2978 Soil rating (g.p.d./ff or fe/bdrm) 8 S5 F/BR System type Crib Length 22 ft. Width 22 ft. Gravel below pipe 6 ft. Total depth zo ft. Eff. absorption area azz _ftz Monitoring tube Y Depression over field N Date of adequacy test 2/112022 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 33 in. Water addedr5o gal. New depth34 in. Elapsed Time: 20o min. Final fluid depth 33 in. Absorption rate >= 45o+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at _ in. Datum Size in gallons "Pump off' level at —in. Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot io7 Absorption field on lot 120 Public sewer main _7s+ Sewer /septic service line 21;+ Manhole/Access (YIN) High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Animal containment areas So+ Manure/animal excrete storage areas 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation c+ Property line io+ Absorption field s+ Water main io+ Water service line 25+ Surface water ioo+ Wells on adjacent lots loo+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 75+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain So+ Wells on adjacent lots zoo+ F. COMMENTS G. ENGINEER'S CERTIFICATION I 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. Engineer's Printed Name Steven R. Pannone. P.E. Date 1/11/2012 COSA Fee $ V � Waiver Fee $ _ Date of Payment )2 % Date of Payment Receipt Number i )Rgc0-0Cq Receipt Number, (Rev. 11/05) 0 /en R. Panni No. CE 8149 0 in. Municipality of Anchorage • -- Development Services Department �' " :11 Building Safety Division . On -Site Water and Wastewater Program 3 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-0650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 051-133-07 COSA# UP01$2 Expiration Date: 9-18-06 GENERAL INFORMATION Complete legal description Lot 4 Block 5 Greatiand Es+ates No. 3 Location (site address) 19725 Hardmek Drive. Chugiak, AK 99567 Current Property owner(s) Richard & Cori Cook Day phone 562-5522x113 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 19725 Hardrock Drive, Chuoiak, AK 99567 Day phone _Hank Gramr/Ancoraoe Realty Day phone 7484464 3340 Arctic Blvd., Anchorage. AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite 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 seat affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of Onsite Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services, LLC Phone 272-8218 Address P.O. Box 102954 Anchorage AK 99510 / Engineer's Printed Name Steven R. Pannone, P.E. Date S -As- O 6 Engineers Comments: In conducting an adequacy test. I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water •���� OF eV aa'4 levels that may fluctuate during the year, and the water usage of the family being served by the system. .•�P��� " ^' •♦a These conditions arc outside the control of the evaluator of this system All systems eventually fail and G7 �i� satisfactory test results do not guarantee future performance of the system• nor do they guarantee that '� i� a ,0 there arc no bidden defects or encroachments. PES can therefore not provide any warranty for future�• "-0 performance nor give any estimate of how long the system will continue to meet the operational w requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed io -tA StevenR. PonnoA"d above. Any reliance upon or use of this report by any other person or party is not authorized nor will it 0. , No. CEe t a9 C c5fcrany legal right whatsoev.DSD SI NATUREen •♦a'aia E55 - 0, 1✓ Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory WATER AND PROGRAM _: Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Ilp By:���� Original Certificate Date: �' — 06 tR" 11,05) Municipality of Anchorage • Development Services Department ° Building Safety Division On -Site Water & Wastewater Program 4700 Bragsw Street P.O. Box 196550 Anchorage, AK 9951943550 www.muni.org/onsfte (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST ... , . ,-Lc ..1, 7IT1,7 . A. WELL DATA Well type P If A, B, or C provide PWSID # Date completed 101111977 Sanitary seal (Y/N) y total depth 225.2 ft Cased to _49—t—ft FROM WELL LOG Date of test 01n977 Static water level 175 ft. Well production 8 g.p.m. WATER SAMPLE RESULTS: Coliform 'fir colones/100 mL Nitrate of , a'Img/L Arsenic: tjo mgA Date of sample:¢ B. SEPTIC/HOLDING TANK DATA Tank Type/Material Sunset Plastics Fibemlass Tank size _1000 gal. Number of Compartments j Well Log (Y/N) Wires properly protected (Y/N) V V Casing height (above ground) 24*in. AT INSPECTION 177.8 ft. Other bacteriacolonies/100 mL Cleanouts(Y/N) Foundation cleanout (Y/N) X Depression over tank (Y/N) High water alarm (YIN) NIA Date of pumping 4/27H008 Pumper Ars Pumolno C. ABSORPTION FIELD DATA Date installed 6=978 Soil rating (g.p.d.A1e or fe/bdrm) 83 System type lsesoaoe Pit Length 11 ft Width -11 ft. Gravel below pipe 6 ft Total depth JA ft. Eft. absorption area jKfe Monitoring tube Y Depression over field N Date of adequacy test 40005 Results (Pass/Fail) Pass For j bedrooms Fluid depth in absorption field before test ga in. Water addedjlj gal. New depth2j. in. Elapsed Time: jQ min. Final fluid depth )M in. Absorption rete >= 450* 9.p -d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give data D. LIFT STATION Date installed 'Pump on' level at _ in. Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 100+ Absorption field on lot 100+ Public sewer main 100+ Sewer /septic service line 25+ anhoie/Aocess(Y/N) ah water alarm level at tats alarm b circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Animal containment areas 100+ Manure/animal excrete storage areas 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10+ Property line 10+ in. Water main 100+ Water service fine 25+ Surface water _ 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 0 Ar Building foundation 10+ Water main 100+ Water Service fine 25+ Surface water 100+ Driveway, parkingivehide storage 20+ Curtain drain None Observed Wells on adjacent lots 1100+_ F. COMMENTS 301 IV G. ENGINEER'S CERTIFICATION I car* that I have determined through field inspections and 71 review of Municipal records that the above systems are in conformance wiM MOA COSA guidelines in effect on this date. .. ».. Engineers Printed Name Stevan R Pannone. P.E i `%Sle,en R. �1 CC 8143 e Date COSA Fee E 6 O w Date of Payment Receipt Number $ G Z o Co (Raw. 11/05) Waiver Fee $ Date of Payment Receipt Number 9MI SGS Ref.N 1062125001 Client Name Pannone Eng. Srv. Project Nome/IV Lt 4 Bk 5 Creatland Est No 3 Client Sample ID Lt 4 Bk 5 Creatland Est No 3 Matrix Drinking Water PN'SID 0 Sample Remarks: All Doles/Times are Alaska Standard Time Printed Daterflme 05/12/2006 16:49 Collected DatefTime 04/28/2006 14:15 Received Date/time 04/28/2006 15:09 Technical Director Stephen C. Ede Allowable Prep Analysis Panuneter Results POL Units Mc&W Container ID Limits Date Date ]nit Nitrite -N ND 0.100 mg/L EPA 353.2 B 0428/06 ALR Nitrate -N 2.29 0.100 mg/L EPA 353.2 B 0428/06 ALR Metals Department I lardness as C%CO3 Private Individual Analvaia Aluminum Antimony Arsenic Barium Cadmium Calcium Chromium Copper Iron Lead Magnesium Manganese Phosphorus Fluoride Chloride Potassium Selenium Sodium Silicon Silver Sulfate Thallium 108 5.00 mg/L SM202340D C 05/01/0605/11/06 SCL ND 20.0 ug/L EP200.8 C 05/01/06 05/11/06 SCL ND 1.00 ug/L EP200.8 C (<=6) 05/01/06 05/11/06 SCL ND 5.00 ug/L EP200.8 C (<=10) 05/01/06 05/11/06 SCL 5.09 3.00 ug/L EP200.8 C (<=2000) 05/01/06 05/11/06 SCL ND 0.500 ug/L EP200.8 C (<=5) 05/01/06 05/11/06 SCL 30100 500 ug/L EP200.8 C 05/01/06 05/11/06 SCL ND 1.00 ug/L EP200.8 C (<-100) 05/01/06 05/11/06 SCL 13.8 1.00 ug/L EP200.8 C (<=1300) 05/01/06 05/11/06 SCL 251 250 ug/L EP200.8 C (<-300) 05/01/06 05/11/06 SCL 0.783 0.200 ug/L EP200.8 C (<=15) 05/01/06 05/11/06 SCL 7940 50.0 ug/L EP200.8 C 05/01/06 05/11/06 SCL 3.37 1.00 ug/L EP200.8 C (<=50) 05/01/06 05/11/06 SCL ND 200 ug/L EP200.8 C 05/01/06 05/11/06 SCL ND 0.100 mg/L EPA 300.0 B (<=2) 05/02/06 05/02/06 JEM 1.92 0.100 mg/L EPA 300.0 B (x_250) 05/02106 05/02/06 JEM 573 500 ug/L EP200.8 C 05/01/06 05/11/06 SCL ND 5.00 ug/L EP200.8 C (<=50) 05/01/06 05/11/06 SCL 2740 500 ug/L EP200.8 C (<-250000) 05/01/06 05/11/06 SCL 5260 200 ug/L EP200.8 C 05/01/06 05/11/06 SCL ND 1.00 ug/L EP200.8 C (<-100) 05/01/06 05/11/06 SCL 12.1 0.100 mg(L EPA 300.0 B (<=250) 05/02/06 05/02/06 JEM ND 1.00 ug/L EP200.8 C (<=2) 05/01/06 05/11/06 SCL WMI SGS ReLM 1062125001 Client Name Pannone Eng. Srv. Project Name/M Lt 4 Dk 5 Greatland Est No 3 Client Sample ID Lt 4 Dk 5 Greutland Est No 3 51strix Drinking Water PWSID 0 All Dates/rimes are Alaska Standard Time Printed Date/rime 05/12/2006 16:49 Collected Date/time 04/28/2006 14:15 Received Date/time 04282006 15:09 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Private Individual Analvaia Total Dissolved Solids Zinc Nickel HCO3 Alkalinity CO3 Alkalinity OI I Alkalinity Conductivity pit Alkalinity Total Coliform 116 10.0 mg/L SM20 2540C D (<=500) 0428/06 AZS 89.6 5.00 ug/L EP200.8 C (<=5000) 05/01/06 05/11/06 SCL ND 2.00 ug/L EP200.8 C (100) 05/01/06 05/11/06 SCL 100 10.0 mg/L SM20 23206 D 0428/06 PLW ND 10.0 mg(L SM20 23200 D 0428/06 PLW ND 10.0 mg/L SM20 2320B D 0428/06 PLW 220 1.00 umbos/cm SM20 25100 D 0428/06 ALR 8.10 0.100 pH units EPA 150.1 D (6.5-8.5) 0428/06 ALR 100 10.0 mg(L SM20 2320B D 0428/06 PLW 0 col/100mL SM20 9222B A (<=1) 0428/06 TLF AS -BUILT 1 hereby certify that 1 have surveyed the following described propcTty. Le, T- 4 1 B io cF: S, ii-rv'f" �-�r rc r� Es •r4,'{.• z}yn i �- lll4: 3r T f Anchorage Recording precinct, Alaska, and that the improve- ments situated thereon are within the property lines and do not 1 overlap or encroach on the property lying adjacent thereto, that no improvements on property lying adlscent thereto encroach on the premises tn-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 t `� day of Me.V 200 •. ROBERT C. JOHNSON.•y� SCALE: Registered Land Surveyor No. &Q -LS rj p Box 77-0A56, Eagle River, Alaska 99577 phone (907) 691-2543 '- ' -• \ \wh 3- f t t: t `:o n \ AS -BUILT 1 hereby certify that 1 have surveyed the following described propcTty. Le, T- 4 1 B io cF: S, ii-rv'f" �-�r rc r� Es •r4,'{.• z}yn i �- lll4: 3r T f Anchorage Recording precinct, Alaska, and that the improve- ments situated thereon are within the property lines and do not 1 overlap or encroach on the property lying adjacent thereto, that no improvements on property lying adlscent thereto encroach on the premises tn-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 t `� day of Me.V 200 •. ROBERT C. JOHNSON.•y� SCALE: Registered Land Surveyor No. &Q -LS rj p Box 77-0A56, Eagle River, Alaska 99577 phone (907) 691-2543 '- ' -• 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 Parcel 1. D. # ��� _ I _5 7 HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 4; Block 5• Greatland Estates Subdivision n2 Location (address or directions) 19725 Hard Rock Drive, Eagle River, Alaska (b) Property owner Casarta Telephone: (home) 688-3617 Business Mailing Address (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent FORTUNE ROPFRTTF$/Mary Ann gaCkwith Address 3000 A Street, Anchorage, Alaska 99503 Telephone 562-7653 (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/694-2979 17034 Eagle River Loop Road, Suit Eagle River, Alaska_ 99577 2. TYPE OF RESIDENCE Single -Family KI Number of bedrooms 3 3. WATER SUPPLY Individual Well 12f 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 IN Public ❑ Community ❑ Holding Tank ❑ 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. 7/88) Page 1 of 2 Z }o Z abed 10e9 (89/L 'ABU) 9ZO-ZL •�aoM s,aaauibue peuoissa}oid a4l ul suoissiwo ao saoaaa aol apsuodsaj lou si a6eao4ouy to AllledioiunW a41 •panssi sl aleoilllaao a aaolaq elep azo leue ao suoiloadsui Ion puoo lou op SHH0 to saaAojdw3 'sluawaiinbaj alels pue peaapal uleliao (lsiles oliapao ui suoilnlllsui 6uipua� aia4l pue sawo4 to sjasegoind o} (salinoo a se si4l saop SHHO a41 'e�sely }o alelS a4l ui paaalsi6aa aaaui6ua leuoisseloid luepuedepul ue Aq anoge g gdej6eied ul uanl6 suolleluasaidaa eql uodn Aluo paseq poleoiliaao 1enoaddy Alijoglny 4lleaH sanssi (SH HO) saoinaaS uewnH pue 4l1e9H to luawlaeda4 a6eao4ouy }o (llledioiunlnl a41 N011nyoi leuoilipuoO auogdalal jenoaddy leuoilipuoo }o swam panoiddesla ---7— panoaddy Aq swooape -L ao} panoaddy -lVAOHddV SHHO '9 alea .Oz 'oal pecu dool ,:a:y a tA. SSaaPPV waif }o aweN •uolloadsui s1gl to alep ayl uo loal}a ui suoileln6aa pue 'saoueupo 'sapoo alelS pue ledloiunw Ile 4j!m eouelldwoo ui sl walsAs jesodsip jaleMalseM ao/pue Ajddns aalem alis-uo a4l 'uoiloadsui pue uoile6ilsanui Aw wojl pue sail a6eao4ouy to �(lilediolunW 9141 woa} pauielgo uoilewaolui a4l uo paseq le4l Aluan aa4lin} I •ulaaa4 paleoipui ainlonils }o ad (l pue swooapaq }o aagwnu a41 aol alenbape pue jeuoilounl 'ales si walsAs lesodsip aalemalsenn jo/pue Alddns aalem alis-uo ayl le41 SmOgs lenoaddy Aluoglny 411e81-1 sigl to u011e61lsanui Aw le4l A}laan I 'Molaq umogs alep uoilepijen a4l }o se pue olaaa4 paxille leas Aw Aq palliljao sy NOI1VWHOdN1 ONV V1VO 'HOHV3S 3-114 `S1S31 `SNOIlO3dSN1 !DNIOIAOHd MIA ONIH33NION3 '9 MUNICIPALITY OF ANCHORAGE (MOA) ��` Spy • Health Authority Approval (HAA) i <: G� CHECKLIST - FEBRUARY 1984 343-4744 G\�N `Y 00��� Legal Description: .L.ot 15F Ale a A. WELL Well CI ssification —Si —Si"]P, to ry\i u If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N)Ll (Date Completed —.2 — �j Yield :S--. Q 10 AA \ Total Depth 225 Cased to t Depth of Grouting — C Static Water Level Pump Set At Z U 5 - Casing Casing Height Above Ground e �t Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) _ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot 1s? a ; On Adjoining Lots r (Da �f i To Nearest Edge of Absorption Field on Lot (Z O ; On Adjoining Lots ( C)D + To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole ti A To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed O -'maize 1000oVdNo.of Compartments Z Standpipes (Y/N) Air -tight Caps (Y/N) LIFoundationCleanout (Y/N) Depression over Tank (Y/N) LV Date Last Pumped 11, _ I — I Pumping/Maintenance Contact on File (Y/N) ) lA;for tj IA Holding Tank High -Water Alarm (Y/N) ",1 Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: I I To Water -Supply Well To Building Foundation J A f To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Tome posal Field 5 Comments 72-026 (Rev. 7/88) Front Page 1 of 2 I C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ���� Type of System Design Date Installed () '—�� 8 Length of Field Width of Field i Depth of Field / O A Gravel Bed Thickness Square Feet of Absortion Area -2 Statndpipes Present (Y/N) q Depression over Field (Y/N) /I1 _ Date of Last Adequacy Test a Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: i To Water -Supply Well ZC7 To Property Line To Building Foundation To Existing or Abandoned System on i Lot AA ; On Adjoining Lots O To Water Main/Service Line &J IA To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course (A)/)A To Driveway, Parking Area, or Vehicle Storage Area o Comments D. LIFT STATION Date Installed \ Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. "Check Permitted Bedroom Rating Against HAA Request's I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in at is inspection. << 5 Pvt,lidELCdI�IO MUNICIPALITY OF ANCHORAGE (jCl t � ,yE RONMENTAL SERVICES DIVISIOt�a Signed f , �9, . V. Company 12,Pto�j99577 ,Inv 131990 9(t1&erg Sial Date G1 Z �G� �, "..r ws: ` J,�,: A. n [ S MOA No. O _� E C L 't,ii•i- JC }� 1� Receipt No. �a.�% � v �� Date of Payment Amount: $ 1 % �•- C�C� Receipt No Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 I MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date _ 1/ Z' ' (a) Legal Description zt (include lot, block, subdivision, Location (address or direc •ions) ,C//inn Kf,/ ,/ lin ��un! S! , township, range) (b) Applicants Name //2t--- - 6'1-n/l= Telephone - Home Business Applicants Address �`// '- Lr�tl (c) Applicant is (check one) Lending Institution ; Owner/builder ; Buyer Other (explain); (d) Lending Institution �L`�/1 S.�rtiy� L'�� Telephone Address fUC7/-4y7 F� x1an ii A)UC« ol'i !14 Ale (e) Real Estate Co. & Agent Address C L/a CRUX 711:7 Telephone I (f) Mail the HAA to the following address: CLAZ LAC L_ 7 2. Type of Residence Single-FamilyMulti-Family. Number of Bedrooms 3. Water Supply - Individual Well 125 Community El Other (describe Public M 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 ;�2 Public E:] Community = 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 21 5• Engineering Firm Providing Inspections, Tests, File Search, Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on --site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm Address to C.3, Date zzy 41, (ENGINEER SEAL) Telephone -A. loakwr No. 1437-E 6. DHEP Approval r�o •' :/ Approved for bedrooms By Approved I/ Disapproved Conditional Terms of Conditional Approval CAUTION THE 14UNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA CERTIFICATE IS ISSUED. THE MUidICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 PROTECTION REPRESENT - REGISTERED HOMES AND REQUIRE - BEFORE A FOR ERRORS [Page 2 of 21 7-19-84 A. WELL IATA C: ANUI(A."AC;'. MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 A U h ' J, Well Classification '-sr r' If A, B, or C. D.E.C. Approved(Y/N) Well Log Present �) Date Completed Zi "7'7 Yield Total Depth Cased to 04 Depth of Grouting Static Water Level L 7�E Pump Set At Z C� Casing Height Above Grounds Sanitary Seal on Casingl&—) Electrical Wiring in Conduit ) Depression Around Wellhead (Y Separation Distances from Wille To Septic/993j Tank on Lot on Adjoining Lots To Nearest Edge of Absorption Field on Lotfl i; On Adjoining Lots To Nearest Public Sewer Lie To Nearest Public Sewer Cleanout/Manhole N� To Nearest Sewer Service Line on Lot o st Water Sample Collected By ` "•`r f Date Water Sample Test Results' Comments B. SEPTIC/Fl@id&-TANK DATA Date Installed Cp':-3o Size/� c�Ca� No. of Compartments Standpipes T I) Air -tight Caps (WN) Foundation Cleanout Y ) Depression over Tank (Y Date Last P rped a--Z-2_—a5L Pumping/Maintenance Contract on File (Y/N) for Holding Tank High -Water Alarm (Y ) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Noiding Tank: i To Water -Supply Well �(� '� To Building Foundation 27 To Property Line To Disposal Field j To Water Main/ServAc'p Line a To Stream, Pond, Lake, or Major Drainage Course Comments [Page 1 of 21 b2 27 , �-V 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ELL Type of System Design Date Installed (o- 30•- % Length of Field (a Width of Field (p Depth of Field Gravel Bed Thickness Square Feet of Absorption Area z Standpipes Present KY ?N) Depression over Field (Y ] Date of Last Adequacy Test Z3 Lpi`' Results of Last Adequacy lbst S 77 - Separation Distance from Absorption Field: i To Water -Supply Wb11 / Z_C) To Property Line To Building Fou dation go To Existing oar /Abandoned System on., Lot On Ad'oining Lots f To Water Main/Service Line 4- To Cutbank if resent) To Stream/Pond/Lake/or Major Drainage Course Y.4 To Driveway, Parking Area, or Vehicle Storage Area 2") Ccnnants D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y Comments Dimensions Manhole/Access (YM) ';Pulp C�ff" Level at Vent (Y/N) during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guryilines in effect on the date of this inspection. - '"-- Signed C lE, l{, !h't Date�W4 410"Z4 �i�I �� *` •'' s1 °ve Y� {tra y 171v Yio �i \.�!r n MOA No. Company J - '�.�11g,11-1211" KBl/d5/s (Page 2 of 21 �^ A*b*0 A. SfieWr Na 1d57•E . „ ®ell itrirs 2-15--84 P'3 W MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE & I�ARTMENT OF HEALTH & ENVIRONMENTAL PROT C ,(�,FrPT. OF IEALTH FEN�111��C��jNMENTAL i. LION 825 LStreet -Anchorage, Alaska 99501 / • JAN 2 3 1979 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 �EE pp 4111ILITIES INDIVIDUAL WATER AND SU REQUEST FOR APPROVAL OF DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER PHONE Greg & Jami Paul Fernette 276-5004 MAILING ADDRESS 1101 W. 7th Street PROPERTY RESIDENT If different from above) PHONE NHN Hardrock Drive * ATTACH WELL LOG. A well log is required for all wells drilled 2. BUYER PHONE Greg & Jami Paul Fernette depth (attach log if available.) MAILING ADDRESS NHN Hardrock Drive 3. LENDING INSTITUTION PHONE ALASKA STATEBANK 279-7637 MAILING ADDRESS 310 E. Northern Lights Boulevard, Anchorage, AK 99503 4. REALTOR/AGENT PHONE N/A Owner/Builder MAI LING ADDRESS 5. LEGAL DESCRIPTION Lots 3 & 4, Block 5, Great Land Estates STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS E] One ❑ Four El Other RR SINGLE FAMILY K7 Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY RR 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** **If individual/on-site, give installation date 7/78 If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) fit/ J� v✓ i� THIS SIDE FOR OFFICIAL USE ONLY J DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ SINGLE FAMILY ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ MULTIPLE FAMILY 0 TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY PERMIT NUMBER ❑ INDIVIDUAL DEPTH OF WELL ❑ COMMUNITY DATE DRILLED ❑ PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER ❑INDIVIDUAL/ON -SITE DATE INSTALLED ❑PUBLIC UTILITY Connection Verified INSTALLER �c.1.r-� Vii'- ED Septic Tank or ❑ Holding Tank Size: IC900 If Tank is homemade SOILS RATING give dimensions: 4' TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL r .�Le.-t_ -(_ 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line WELL T0: Absorption Area to nearest Lot Line 5. COMMENTS J Lim APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) C17L--6ISAPPROVED DATt�{S p y BY (Ti ell % ,1 LEGAL DESCRIPTION 72-010 (Rev. 3/78)