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BROOKS VANDERWOOD LT 48A
brooks Vanderwood Lot 48A #051-104-68 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 1 ON -SITE WASTEWATER INSPECTION REPORT Permit Number: OSP 251234 PID Number: 0511046800 Dwelling: RN Single Family (SF) R with ADU F1 Duplex (D) 0 Two Single Family Project: F-1 New ME Upgrade Name VOLDEN ABSORPTION FIELD R Deep Trench El Wide Trench R Bed El Mound Site Address 20838 HELLUVA EJ Other Phone Number of Bedrooms Soil Rating depth from original grade -3 GPD/SF ITotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot BROOKS VANDERWOOD LOT 48A Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 t. F Well +100 +50 TANK 9 Septic ❑ S.T.E.P. El Holding El Other Manufacturer GREER Capacity 1000 Gal, Surface Water +100 Material Number of compartments Lot Line +10 NA POLY 2 Foundation + 10 LIFT STATION Manufacturer Capacity Remarks OLD TANK DISPOSED OFF SITE Gal. Tank Replacement Only Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 drainfield Tank to 3034 Installer NORTHERN LIGHTS CONSTRUCTION Drainfield EXIST CO/MT 3034 Inspector C.BALZARINI BENCH MARK (Assumed elevation) 100 ft Inspection 7/22/25 7/23/25 Location and description dates: 2 �d TOP OF TANK MANHOLE LID 3'd 4111 ON -SITE WATER AND WASTEWATER SECTION APPROVAL Engineers Stamp IF Akl k�l Conditional Approval: Date Asw --------- 49 TH Septic System Approved Date CHARLES G BALZARINI CE-13854 Note: this approval does not include well permit requireme S. PR OFESVO 1 44 18/4/25 (Kev ubmwit3) CHARLES G BALZARINI CE-13854R E GI S TEREDPROFE S S I O N A L E N GINEER 8/5/25 §401 E° ■ RO ! © o d \) ) - \ M. \ � \\ �ƒ 00 §/!0 ) g)E ` \ \(0 ° 2 \ ; )®*® ; \ \ \ 0 g0 §§ w G Cn w/ fLn ! v < �. »#L NL.6 Li! \ \ r ƒO k� 00 .� , .: � \\ \ s HEL UVA STREET I ` - \ / « \ , / \ «+oE,s« + �4 2 \ E � 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: OSP251234 Work Type: SepticTank Upgrade Tax Code Number: 05110468000 Site Legal Address: BROOKS VANDERWOOD LT 48A G:1358 Site Mailing Address: 20838 HELLUVA ST, Chugiak Owner: VOLDEN LORA L & TORGOR Design Engineer: C&M ENGINEERING SERVICES This permit is for the construction of: ❑ Disposal Field R1 Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: 7/15/2025 7/15/2026 49520 ❑ 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 Received B) Issued By: Date: 7/15/2025 3 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 05110468000 Property owner(s) Volden Mailing address Site address 20838 Helluva Street Legal description BROOKS VANDERWOOD LT 48A Number of Bedrooms 3 Engineering Firm C&M Engineering Building Permit Number Day phone Not Applicable F-1 APPLICATION IS FOR: APPLICATION IS AN: (Z all that apply) Disposal Field ❑ Initial ❑ Septic Tank Q Upgrade Holding Tank ❑ Renewal El Privy ❑ Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: Permit/Rush Fees:. Waiver Fees: Date of Payment: 7- Date of Payment: Permit No. ri 5 P;�] Waiver No. May 2025 C&M ENGINEERING SERVICES Ph: 907-854-5558 Municipality of Anchorage Onsite Water & Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 RE: Proposed Septic System for Brooks Vanderwood Lot 48A Dear Reviewer, The above referenced property is currently served by an older septic system with a failing tank. Our review of available documentation and field investigation show that this project will not adversely impact any nearby Wells, Wastewater disposal systems, replacement disposal sites, or drainage flowing onto and off of the subject property. As shown on the plan, the tank and field will be greater than 10’ from the house foundation. The tank will be of MOA approved construction. The tank shall be covered with a minimum of 2” moa approved insulation and 3’ of cover or a minimum of 4’ of cover without insulation. Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854- 5558 or by email cgbalzarini@gmail.com with any questions or concerns. Sincerely, Charles Balzarini, PE 7/1/25 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251234, Ben Cogger, 07/15/25 CHARLES G BALZARINI CE-13854REGISTEREDPROFESSION A L E N GINEER 7/1/25 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251234, Ben Cogger, 07/15/25 ' O Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Waste~ter Program, 4700 S. Bmgaw St. P.O. Box 196650 Anchorage, AK 99519~650 Page ~ of~ ~.ci.anchorage.ak. us (907) 343-79~ ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: 5 ~ O I ~ i 3~' PID Num~. "~m':'~rO/~n Lee WastewaterSystem: ~New DUpgrade ~dress: ;~0~ Ht//~gaS?re~ ~'~/~ ?~Ed7-dl~, ABSORPTION FIELD LEGAL DESCRIPTION ~"""""~: 0.~.o,.,. Fl. Ft. Drillen s.,.: ICasi~ Height .,. ~ TANK Septic Abso~tion Lift Holding Publi~dvat~ ~a%~, ~ Capac~ ~ ~0' · an~ .~e. S~a~on Ta.~ S.we, U.e ~;~b;.4 ~ ..,. Material: ~ 5~'lO'~X ~,z.: ~ . LOl Line ~1. ~ .u~.,,o~ ~' 5~' "~-"'-"- ~ ~ in.J ~ in. Pu~ CunainDrain / ~ ~'1'' ~ ~ M~ El~llnspe~onspe*~edb~ Remarks: [~,sr~ L,~,~ ~,,~ 7~c~ BENCH MARK En ' : ~%~ ,.,,-' .',.,?~-,~ S & ~ ENGINEERING Inspections pedormed by: 17034 Eagle Rl~e~Lo~...~...~,...="g~es: ~" 6--12-01 ., ~.,,..,.r..,..-, 2"~ ~--JO--O/ Development Se~ices Depadment Approval Reviewed and approved by / Da,e: ~ -~O/ (R~. I=~) 'it. / c ;~o' ~- PER~[T NO. SW01 01,34 PAGE 2 OF 5 DEPARTMENT OF HEALTH ANIJ HUM:AN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. ]~ox 196650 I_Anchoro§e, ALosko 99519-6650 ·Tel. e~hone~ :::]43-4744 ON-SITE VVASTEWATER IJISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 48A, BROOKS-VANDERWOOD S/D P.I.D. No. 051-104-68 I LOT 1 LOT 2 ///2/co,./ / \ \ ~ ~_ ~///// /¢'/ X ~ ', · I . 100' WELL RADIUS · " I ~i~...~ .. :......,.~:~. ~7' ~":.~'*. LOT 4~B '~//~,~ :~..~:~.,~ ..... ~ ..... PERMIT NO. SW01 01,34 PAGE ,3 OF 3 · Mu_ni_cip.a_[i~y_o.F Anchoraae DEPARTMENT uP HI---ALTH AND HUIVFAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.D. Box 196650 eAnchoro, ge, Ato~sko, 99519-6650eTetephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 48A, BROOKS-VANDERWOOD S/D P.I.D. NO. 051-104-68 FINAL GRADE y2" INSULATION FINAL GRADE GRADE A B FCO 29.0' 28.5' ST1 41.0' ,38.5' ST2 47.5' 45.0' DBL1 51.5' 49.5' DBL2 5,3.0' 50.5' C01 67.5' 89.0' MT1 77.5' 99.0' C02 90.5' 80.5' MT2 90.0' 75.5' WATER FOUND ® 86.8' 84.3' B.O.H. Munlcipalily oi Anchorage DEPARTMENT OF HEALT~ & HUMAN SERVICES 825 "L" Slreet. Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORME 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS .T.~$ WAS GROUND WATER ENCOUNTERED? IF .YES, AT WHAT DEPTH? Deplh to Waler After Monllorlng? Dale: Re~ding I Date --I I / / I PERCOLATION RATE TEST RUN BETWEEN Gross Net Depth to Time Time Water Net Drop 10' V'4- (0 0 (minutes/inch) PERC IIOLE DIAMETER , FTAND ·4 FT · ..'/ 1..~ // PEnFORMED BY: ~;v~r L~p Roa~ ~o. ~ . - . ~ CEnTIFY THAT T~IS TEST WAS PERFORMED IN 72-~8 (Rev. a/85} MUNICIPALITY OF ANCHORA GE 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 Date Issued: May 29, 2001 Expiration Date: May 29, 2002 Permit Number: SW010134 Legal Description:~ BROOKS VANDERWOOD LT. 48A Design Engineer: 0003 S & S Engineering Owner Name: CAROLYN LEE Owner Address: 20838 HELLUVA STREET CHUGIAK, AK 99567-6128 Parcel ID: 051-104-68 Site Address: 020838 HELLUVA ST Lot Size: 49520 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: r~ Disposal Field [--] Septic Tank [] Holding Tank [--] Privy r-~ 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. 5. The following special provisions. SEPTIC TANK SHALL BE EXPOSED AT THE TIME OF CONSTRUCTION AND VERIFIED FOR INTEGRITY. Received By: Issued By: Date: ~'-~ ~ -a ( Date: 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 SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Permit Number ,SWO I 0134 Property owner(s) Mailing address (1) ~address (2)~-08~8 ~-.Z/UlJ~ Legal description (Lot, Block & Sub'd.) ~.o'~ Legal description (Section, Township & Range) Lot Size ~,~-~ ~ 4':/, 'ZO THIS APPLICATION IS FOR: Sewer Only Sewer and Well Day phone ~7~- &J--O 5 Zip Code ~ 7-~ / 28 Sewer Upgrade Number of Bedrooms "~ Well Only [] '[] Water Storage [] THIS PROPERTY CONTAINS: Hot Tub r'-I Jacuzzi Swimming Pool r"'] Water Softening Unit Ther';'py Pool r-I I certify that the above information is correct. I fudher certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. _ 17034 Eafll~ River Loop Road, No. 2~ (Signature of properly owner or authorized agent) Eagle River, Alaska 995~ Permit Fees: '"1~ Date of Payment: Receipt Number: o 0 (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: ~-~ May 8, 2001 SEWER &WATEn MAIN EXrENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PtAN~ $OILTEST PERCOLATION TEST STRUCTURAL& MEcHANIC, N. ~N~PECTIONS ON SITE W~TEWATER ExSPOSAL SYSTEM DESIGN ROBERT C. COWAN, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 48A, Brooks-Vanderwood S/D It is requested that you issue a permit to upgrade a septic system to serve the existing three bedroom dwelling on the referenced property. A test hole was excavated and a percolation test was performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation 3/20/01 water was found at eleven feet indicating a drainfield bed design was necessary. An additional test hole is proposed at the time of excavation. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. 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, RCCOhm Enclosure 7034 NORTH EAGLE RIVER LOOP ~ SUITE 204 4 EAGLE RIVER. ALASKA 99577 [~'~!~___~) DEPARTMENT OF HEALTH & HUMAN SERVICES ¢"'~ ""' '~'~'~ ~,-~-' '"' ~' ;{,! ~ · 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG m PERCOLATION TEST .,. -_ ................... LEGAL DESCRIPT,ON: ~ Townsh,p. Range. Sect,on: ' / 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 SLOPE SITE PLAN 19 20 WAS GROUND WATER ENCOUNTERED? ,F yes. ATW.AT / / / DEPTH? pO Depth to Water klter I; MonitorinD? Dale: Reading Date Gross Net Depth to Net ~/~1/~ Time Time Water Drop ~o ~ o ~/4.. ~,, PERCOLATION RATE . ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN '-~ FT AND 4 FT COMMENTS PERFORMED BY: ~7~dw :=,~.c~ .~.;'.'~." ---r ~ ........ CERTIFY ~HAT THI~TEST WAS PERFORMED IN 72-~8 {Rev. 4/~) sEwEn J, W,(T En L~u~ EXtENSions SEWER&WATER IN~PEC110~ SOl 1EST 1ESt ~PECTt~ W~T~ATER ~SIGN ROBERT C. COWAN, P.E. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL sPECIFICATIONS CIVIL ENGINEERS (907) 694-297g FAX (907) 694-12t t REFERENCE: Lot 48A, Brooks-Vanderwood Subdivision May 8, 2001 , GENERAL: The scope of this project includes the verification and / or installation of a 1250 gallon septic tank and an absorption bed to serve the existing three bedroom residence located on the referenced property. Construction shall be in accordance with tile approved site plan and design drawings, Municipal permit or ADEC Authority to Construct with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. · Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department or ADEC if required, for system installations. Owners installing their own systems must also receive prior approval from the Municipal ttealth Department. sEPTIC TANK iNSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction Shall include two 4" cleanouts for pumping access. The septic tank shall be stifficiently bedded to prevent settling or shifting of the tank. 17034 t~ORTH I~GLE RIVER LOOP ~ SUITE 204 ~ EAGLE nIVEIq. ALASKA 99577 Page 2 Lot 48A, Brood-Vanderwood S/D May 8, 2001 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 fi. of cover shall be insulated. Se 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. 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. Final grading over tile septic tank shall be such that a positive slope exists away from the septic tank. LEACItFIELD BED INSTALLATION: o ' Excavate the proposed Bed Area to the depth shown on the design. The bottom of the excavation shall be within 2 inches of level. If the bottom of the excavation becomes smeared, it must be raked or scratched (ruffed-up) before gravel or sand placement. If a sand layer is required, place sand over entire excavation to the required depth sl~0wn on the design. The top of the sand layer must be within 2 inches of level. Sewer rock shall be placed Uniformly throughout the entire bed. Perforated distribution pipe must be installed level with perforations down. Gravel depth below the perforated pipe shall be a minimum of six (6) inches. Gravel depth above the perforated pipe shall be a minimum of two (2) inches. The,total gravel depth throughout the entire bed shall be a minimum of twelve (12) inches. The perforated distribUtion pipes must be no more than six :feet apart. The distance between the outermost perforated distribution pipes and the sidewall of the absorption bed must be no more than three feet. o Silt barrier material must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed at tile locations shown on tile design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel depth shall be perforated six (6) inches below the bottom of the horizontal distribution lines. The monitoring tube should not extend below the bottom of the gravel surface. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed When the backfill depth is less than thirty-six (36) inches. The finished grade over tile bed must be mounded to prevent the formation of a depression after settling. Page 3 Lot 48A, BroodoVanderwood S/D May 8, 2001 8. A mound system is to have the upper six inches oftop soil and be seeded for vegetation. MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality &Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes o Use of a type of pipe other than listed above must be approved by tile inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Doxy Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). o A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the//200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current MOA or ADEC requirements. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of tile wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation ofditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. Page 4 Lot48A, Brood-VanderwoodS/D May 8, 2001 The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulatiOn, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, 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 MOA permit or ADEC Authority to Construct. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shaft 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. 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 carry out the ~vork 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 ~f e~-'~ ~'~e- ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ~ ~[~.E']] ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL DESCRIPTION LOCATION NO, O~DROOMS ~. DISTANCE TO: ~ ~ J Abso:~n~rea Dwel,~O~ ,, ~ Manufacturer G~~ Material ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. ~ ~ ~ Manufacturer Material Liquid capacity in gallons ~ ~ DISTANCE TO: ~ No. of liTs line , Totallings Trench w~ ~ ~of tile to fjnish grade ~ MaterJal beneath tile ~ ~'~ ~ inches Total~~sorption area m Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ DISTANCE TO: Well Building foundation Nearest lot line ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER SOl L TEST RATING APP~E~ ~ DATE LEGAL 3 'PERMIT NO. l"lUli'-,! T r: 'r,,~',~RL T T'T' F,F [:EPIRRTMENT , HEFlLTH IRND EN, IRONr,IENTIRL' .(OTECTION 825 /L¢ STREET, IRNCHORIRGE, FlK. 99501 264-4720 I.--IELL R1"-.IE:', 01"-4--5 T TE ',' 828642: ) i~:'PLICIRNT NILLIIRM E. SF'URI...'. E:OX 4-1,.-"66 IRNCH. !OCIRT 101'-4 iEGFlL LOT/48 SEC 9 T15N' ~:114 LOT SIZE ,FYPE OF SOIL IRBSORF'TI01'.4 S'T'STEH I5' DRIRINFIELD ~'IRX]'MUH NUMBER OF BEDROOMS = ~: SOIL RIRTING <SQ FT?BR>= /THE REOUIRED S~E.~THE SOIL IRBSO::ON SYSTEM IS' ' / E:"EF'T .tF-I= ~ "-[--EI'-~GTH= .:, -=. 20000 SQUARE FEET ~3 F.,:' Fi "..,' E L [:-'EPTH= 2 THE LENGTH DII'dENSIOr.4 IS THE LENGTH ,,'IN FEET) OF THE TRENCH CIA DRRINFIELD. THE [:.,EF'TH OF R TRENCH OR PIT IS THE [:,ISTIRIqCE E:ETI.,4EEr.,I THE SURFACE OF THE GROUND FIND THE E:OTTOM OF THE EXC:AVRTIOI'.4 ,.'IN FE~ THE TF-:EI"-.~L--:H !...-! T E':,TH T S ',,-':.. E'~OLZ~..~ FEET. THE 6RIRVEL E:,EF'TH IS THE I'dINIMLII'd DEPTH OF GRFlVEL BETI,IEEr.,I THE OUTFALL PIPE FIND THE BOTTOM OF THE EXC:FI',/FITICd'~ ,:.'IN FEET). . REL::..,IJ I F-:ED SEPT T C: T IR !'-,I I-:-'. S I ZE= :2. E~ r"~ ~--'~ 1-3F:tLLC~I'-.IS F'ERHIT IRPF'LIC:IRNT HAS THE RESPONSIBILITY TO INFORI"I THIS DEF'RRTMENT DURING THE INSTIRLLIRTION IN=,FE_.TiUNS'- ' r' - OF FtNY 14ELLS FID._TIRCENT TO THIS F'F.:OPERTY FIND THE NUI'dBER OF RESIDENCES THFtT THE P.!ELL I:IILL SERVE. TI..-I C~ ,' 2-" ;, T 1"-.~SF"ECT T 6~1"-,1'; F-IF~E REr2..LI T REr'.'. E;IRCI-(FILLII'..IG OF FINY c ,,- , -,~r--,TEI'I 14ITHOUT FINAL INSPECTION AND IRPPROVAL E:Y THIS [:'EPIRRTt'dEI'-4T 14ILL BE SUE:JECT TO PROSECUT!ON. I"IlNIML/r,1 DISTANCE BETI,IEEN A ;4ELL IRI'.~C, ANY ON-SITE SENFtGE DISF'OSRL SYSTErt IS 100 FEET FOR IR F'RI',/ATE NELL OR 150 TO 200 FEET FROM A F'I_IE:LIC P-tELL DEPENDING UPON THE TYF'E OF F'UBLIC NELL HINIMUM DISTIRI'..ICE FROM Fi F'RIVIRTE HELL TO R F'RIYIRTE SENER LINE IS 25 FEET AND TO IR COr,1MUNITY SENER LINE IS .75 FEET. NELL LOG__.'; ARE REg!UIRE[:, IRND MUST E:E RETURNED TO THE DEPIRRTI',IENT 1.4ITHIN ~0 DRYS OF THE NELL COMPLETION. OTHER REC..!UIREMENTS I"IIRY FIF'F'LY. SF'ECIFICIRTIONS IRIqD CON~TRUCTInN DIIRGRRMS ARE RVRILIRBLE TO INSURE PROF'ER INSTIRLLFITION. F'EF:I--1 I T E::-::I=' 'ir RE'---'; E:.E~3EI'-IE:EF.: _~--: :.1_.. -1'_=_ :=.---: I CERTIFY THAT ±' I RH FIRMILIRR P~ITH THE RE~!UIRE[.~ENTS FOP, ON-SITE SEL4ERS AND NELLS RS SET FORTH BY THE MUNIr:IF'RLITY OF RNCHOF.:RGE. 2' I NILL INSTALL THE SYSTEM IN RCCORDRNCE NITH THE CODEC:. _'2:: I UNDERSTAND THAT THE OH-SITE SEI,.IER rS'T'STEI',I MAY RE.qUIF.:E EIqLAF.:GEf,IENT IF THE RESIDENCE IS REMODELE[:, TO INCLU[:,E I','IARE THAN _.3: E:EDROOMS. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCR,PT~ON: ~/ 77. /~'~/ SLOPE 4 6L,~Y ........ 5 10 11 12 13 14 15- 16 17 18 19 20 No. DATE PERFORMED: "~['/~'-~'~ -s I~E PLAN was GROUND WATER ENOOUNTERED, O IF YES, AT WHAT ,...,/ / E DEPTH? ' .,. PERCOLATION RATE //y-~ ""' (minutes/inch) Reading Date Gross Net ' Depth to Net ....... Time /~ Water Drop ~. FT DATE: MUNICIPALITY OF ANCHORAGE Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Parcel ID 051-104-68 Certificate of On -Site Systems Approval OSC251344 Expiration Date: Legal description BROOKS VANDERWOOD LT 48A Site address 20838 HELLUVA ST Current property owner(s) VOLDEN LORA L & TORGOR X The On -site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or conditions: By: E r..g 1 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 Service 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 submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other MUNICIPALITY OF ANCHORAGE *A" fv"ll Development Services Department 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. 05110468000 Complete legal description BROOKS VANDERWOOD LT 48A Location (site address) 20838 HELLUVA ST Current property owner(s) Volden Day phone 2. ON -SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: X Private Well E] Private Well serving 2 dwelling units El Private Well serving 3+ dwelling units Al Community Well or Public F71 Water Storage 4. TYPE OF WASTEWATER DISPOSAL: 01 Private Septic F] Private Septic serving 2 dwelling units El Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: El Steel ME Plastic R Concrete Fl Fiberglass Age 0 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: EJ AWWTS F1 Bed [0-1 Deep Trench r_1 Wide Trench R Seepage Pit Waiver request for: Expedited review requested: r_1 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 $ Date of Payment COSA # 05( 2VP3 5� Waiver Fee $ Date of Payment Waiver # COSA Application —June 2022 COSA Checklist Legal Description: BROOKS VANDERWOOD LOT 48A Parcel 1D: 0511046800 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 A. WELL DATA ❑O Well log is filed with Onsite (or attached) Date drilled 1984 Total depth 63* Cased to 63* ft Al Sanitary seal is functioning correctly FE-1 Wires are properly protected Casing height (above ground) +18 in. Well production at time of test 1.5 gpm ft Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes n Nc X Coliform bacteria is Negative Nitrate 4.60 mg/L ❑ Nitrate less than MRL (ND) Arsenic 1.359 ug/L ❑ Arsenic less than MRL (ND) Date of flow test for COSA 7/25/25 Collected by C.Balzanni Static water level at beginning of test 30 ft. Date 8/3/25 Comments * PER WELL LOG. PUMP INTAKE LEVEL MEASURED AT 68' BELOW TOP OF CASING USING ACOUSTIC WELL PROBE. B. TANK DATA Measured operating fluid level in septic tank _ Date of pumping ❑ Required maintenance completed, if AWWTS Comments: NEW TANK D. DISPOSAL FIELD DATA Which system tested (date installed) 2001 A ALL standpipes present per record drawing Total measured depth from grade 5.5 ft (max) Measured depth to pipe invert from grade 5 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. A Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 7/25/25 Results Q✓ Pass Fluid depth prior to test Water added 450 gal 0 in New fluid depth 0 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate 450 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 Effective depth used 0 in Effective depth remaining 6 in in COSA Checklist_May2025.docx E. SEPARATION DISTANCES From Well on Lot to: (Please enter distances if less than required) Septic Tank/Lift Station on Lot > 100' Z Yes if No ft Neighboring Tank > 100' Q Yes if No ft Disposal Field on Lot > 100' Yes if No ft Neighboring Disposal Fields > 100' Q Yes if No ft Sewer Line/Main > 100' Q Yes if No ft Sewer Manhole/Cleanout > 100' M Yes if No Sewer Service/Septic Line > 25'F71 Yes if No Holding Tank > 100' 2 Yes if No Animal Containment > 50' F/I Yes if No Manure/Animal Excreta Storage > 100' ✓� Yes if No N/A — Served by Community Well (not on lot) or Public Water ft ft ft ft ft From Septic/Holding Tank and Disposal Field(s) on Lot to: (Please enter distances if less than required) Tank to Foundation > 10' M Yes if No ft Surface Water > 100' Q✓ Yes if No ft Field to Foundation > 10' Z✓ Yes Tank to Property Line > 5' Z Yes Field to Property Line > 10' EYes Water Main/Service Line > 10' 0 Yes if No ft Wells on Adjacent Lots: if No ft Wells > 100' if No ft if No ft Community Wells > 200' 0 Yes if No ft Q Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS THE WELL PRODUCTION EXCEEDS THE MINIMUM REQUIREMENTS FOR A 3-BEDROOM HOME, HOWEVER THERE IS LITTLE STORAGE CAPACITY IN THE WELL CASING. ADDITIONAL WATERS TORAGE WOULD IMPROVE THE PERFORMANCE OF THE SYSTEM. THE WELL IS EQUIPED WITH A PUMP PROTECTOR G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on -site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm C&M Engineering Engineer's Printed Name Charles Balzarini COSA Check5st_May2025.docx Phone 907-854-5558 Date 8/5/2025 OF A�,AW * .49 TM ..., C HARLES G BALZARINI Fc •. GE-13854 • �`� / ��?��O PROFESSt4NP;�,., Municipality of Anchorage DeVelopment Services ,,Department" Building Safety Division On-Site Water and Wastewater Program .4700 S6uth Bragaw St. 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. 051-104-68 GENERAL INFORMATION Complete legal description T.n ~- Location (site address or directions) Expiration Date: ~ -~. ~, _ ~) z_~ ARA · ~,~nnt'~-V~nd~-~nnR q~4.1,~.l e~[OIl 20838 'Relluva St. Chugiak Current Property owner(s) Joseph Mailing address ,Juneau, & Rachelle LawendowskDay phone ., 907-364-4664 AK e Lending agency Mailing address Real Estate Agent .Kathi Olmstead Day phone Day phone 6q&-/,2nn Mailing Address 16600 Centerft~lrl Br. ti?.~ll Rna1. ~ver, AW' 99577 TYPE OF WASTEWATER DISPOSAL: 'Individual Omsite ~ Individual Holding tank E] Community On-site [-I Public Sewer [] NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: ' -Individual Well ~ Individual Water Storage " [-'1 Community Class ~ Well [--I Public Water System [] I 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 pedod 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. e STATEMENT OF INSPECTION BY 'ENGINEER As certified by my seal affixed hereto and as &f the validation date shown below, I verify that my investigation, beset 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 vedfy 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 En~ineer~nR Address 17034 N. Eagle River Loop Engineer's Printed Name. Robert C. 5. DSD SIGNATURE ' l/ Approved'for ..~' Disapproved. . Conditional approval for bedrooms. Phone 694-2979 Ste. 204 Ea~le River, AK 99577 Date fj ~ % ROBERT bedrooms, ~th the follo~ng stipulations: ' Additional Comments Attachments: HAA Checklist X Septic System AdviSory , Well Flow Advisory. Maintenance Agreements Supplemental Engineer's Report' Other Original Certificate Date: ,~-'-.2_.,Q. ~ '-0/7/-- (Rev. 0t/02) AD Bo Municipalit), or AnChorage Development Services Department Building Safety Division ' "On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Legal Description: WELL DATA Well type Date c mpleted ~/~ ;Sanitary (Y/N) Total depth ft. HEALTH At,ITHORITY APPROVAL CHECKLIST Lori4~/~,, ,' ~,¢¢:s V/4¢~6~o¢ ParcellD: '" ' ' ' ' ' ' ~{9 ' If'A, B, or C provide PWSID # --- :Well Log (Y/N) i Y FROM WELL LOG Static water level Well production WATER SAMPLE RESULTS: Coliform O) colonies/100 mi. SEPTIC/HOLDING TANK DATA ft. ~ g.p.m. Wires properly protected (Y/N) , i' Casing height (above ground) AT INSPECTION g.p.m. Nitrate O, I mg./I. Other bacteria.~_O -colonies/100 mi. Date installed ~"J Cleanouts (Y/N) High water alarm (Y/N) Tank Type/Material, ,~r'l ~,. / ~ Tank size t~-"~gal. Number of Compartments Foundation cleanout (Y/N) "~/ Depression over tank (Y/N) Date ,f pumping ~. I "?.--,~./O 4 Pumper, ~'~ ABSORPTION FIELD DATA Date installed ~ ] J~l O I Soil rating (g.p.d./f¢ or ft'/bdrm) O, ¢ Length ~1 ft. Width J ¢ ft. Total depth ~ ft; Eft. absorption area~ / ~t~ Monitoring tube, Fluid depth in absorption field before test ~. in. Water added ~gal. Elapsed Time: ~Omin. Final fluid depth ~ in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (YIN & type) ~¢~ ~d ~ ~ If yes, give date System type ~ Gravel below pipe ! ~)o ~" ft. Depression over field For :2~ bedrooms D..LIFT STATION · :; Date installed "Pump on" level' ;I Datum .f E;: ~SEPARATION DISTANCES Size in gallons :I: "Pump off" level at' in. Cycles tested :: '. Manhole/Access Y/N) High water alarm 'level' M~ets alarm & circuit requirements? :.'SEPARATION DISTANCES FROM WELL ON LOT TO: "" : [' '-:.ii ·~! .... lJlot:..:" 0 I':o;if.;.il ;. ; . ,' i: Septic tank/h on I O_, 1- '+;;i.. . i On ad' acent, lois . ;~bsorption field or~ I(~t !'i'l / . atn . Public sewer main /t~ Publi( 'sewer manholelcl~ 5ut ~septic s?~,c, lin ':' "~' . ' H°Iding ,a~ SEPA~TION DISTANCES FROM SEPTIO/H~ TANK oN LOT TO: , ~uilding foundation ~ Prope'dy line, ~ . ~ Abso~ti~n fiel~'' water main [ ~ "i , .... ' e e~i line /:0 ~ Sufiacewater- ~O + On ad acentlots ::! O o. !,-r- Wel s on adjacent ors / ~EPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: ' Property line ' Water Sermce hne I Watermain ' ' . , ./:,~" t I,; : : .,i:i Driveway, parking/vehicle storage '~urtain drain ~1~):~,.1'¢- J/~fJ~'~ Wells On id COMMENTS ' I~i[ ', ' ENGINEER'S CERTIFICatION '. . . ' ' I 'cedify that I have determined through fie/d inspebtions and rewew of Mun/c/pa/ records ~hat the above systems are m, ~onformance with MOA H,4A:gbideh'nes in'effec't c;n' this date.' ' e II 0,o,~,~- L-. I'LOf"-;/J,'J Engineers Printed Nam ~ _ , --.'..:,_ _ . Date ,: t '!f' ;'~-/~ Y'/O ¢. ;: HAA Fee $ '/i/ Date of Payment i: ',Recleipt Number .Waive~ Fee::$ Date 0'f Payment Rec~eil~t Number l.herd~y ce~ify th~t I have su~cycd ~he '. ~,- v~,.l~.,.,,,~' ~ ~,':..'.'" .' ..." '". ....... on the ~per~ ly~ ~ ?pmv~em! on pmpe~ lV~ adia~nl t ' . e'. ez~p~sma~c~e~..' . . . .i, ;.., , . :.~ .:- D~led ~t F~$~ ~iv~, Alaska "..' .... I ~':~ '~.~.~,,Lz,~y' "-'-: ..... ~.-~. '.-. , · .so~r ~.~o~' ~~:'"'-I I ~*~ · ':- ~,S~,~d [,,~ S~, or ~,.~ ... 1 ~ . · .' : ". :: ' r~one (~)_ 69~3. ~':~',.c._ ~." 7"' Municipality of Anchorage Development Services DePartment Building Safety. DMsion On-Site Water and Wastewater Pro,ram .~470OSohth Bragaw St. P.O. BOX 196650 Anchorage, AK 99519-6650 W~w.~:i.anchorage.ak.us . (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A :SINGLE FA il"YDWELLI'NG Parcel I.D. 05'/-Io¥-6~ , COi:nplete leg~i d~s'cription Expiration Date: · Lot 48A, Brooks Vanderwood Subdivision , 20838 Helluva Street Location (site address or directions) Current Propertyowner(s) Carolyn T.ee · .Mailinga~ldress ?0 Box 670372, Lending agency Day pho.ne 777- 8105 Chugiak., AK 99567:...:.... .... '. Day phOne Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] BI Individual Holding tank . E] BI. Community On-site [] r-] 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 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for propedies 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 propedies served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) 'Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER ' " "As:(~edified by my seal affixed hereto and as of 'the validation'date shown below, I verify that my inveStig'ation, based (~n procedures outlined in the Health 'Authority Approval Guidelines for this application, 'show~ ~that the on-site water supply and/or wastewater dispo'§~l system is(am) safe, functional and adequate for the nt~mber of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation ...... · ~ S & S ENGINEERING" ' Phone Name of Firm 1707. E*_~!s ~!'.'--r L~cF ~,,.,,4 Ne. Address E.',gle River, AlasEa 9,577 G/~).. Engineer's Pi'irited Name RobeZ:t C. Co.an, ?.E. Date' r .~ ...... "-'/ ...... : ..... 5. DsD SIGNATURE ~ ' -' '~.,~'.... ..-'.'.~ Approved f°r'i ~ bedrooms. · ~.'~,:~,~' ..... ,.','.,~:" -¢ .. DisapproVed. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory 'Maintenance'Agreements Supplemental Engineer's Report Other Original Certificate Date: {Re,/. 12J00} . MUniciPality Anchorage ' r : !' Develop;ment serVices Department :~ ~ ' : i BUildin{] Safety Division" . ~ ~ ~ ! ;:: On-siie Water & WasteWater. Program ' I I · ~ !: 4700 South Bragaw St. "' : -P.O. Box 196650 Anchorage, AK 99519-6650 [ 'i" "i ;www.ci.anchorage.ak/us i (907) 343-7904 '[, ~r H LTH A THORITY:APpROvAL CHECKLI,;T Wel'l type .~__~VA~ ~ If A, B, or'C provide PWSID # ~'- Well Log (Y/N) 4'- Dat~ ~;o e'i ' ' ' sahi s~]al i Wires prOperly ~rotected~)N) , t , '~,3 fl: Casing height (above ground)' ·l~ in. Total depth ~"~ f ft. '-,, Cased to :I ' '" '!~" FROM WELLLOG 'AT INSPECTION static watbr ie,~el ft. W~li Prod g.p.m. orion .... -~ §.p.m. s REsuLT-: ~' . . "[: · , WATER SAMPLE C~31iform ~i Colonies/100 mi. :Nitr~te l~,·'"~"~::~ng./i, i Other bacter!a -~colomes/100 mi. - -::' ~ TANK' "DATA .' i 17034 Easle River Loop ~oad No, 204 B SE.P[TICIHOLDING - = --,, .~. ~, · . ~ . , .... ~' :' [ . :a2~e ,~v.r Alaska 99577 . 'rank ,umber o Compartments ,--' C eanouts , Z High water alarm (Y/N) '~/ Foundation'oleanou~,) ': ~'6' Depress,o? over tank (Y/N) /~ 0 : Date Installed ~/= ! Soil rating (g.p.d;/ft~ or ft~/bdrrn) ~/~ ~-. System type , . [}!' ':~" '*~ ' - ~ ' ' ' ' ~ Length . ~ ~/,~ . ff., ~. , Width ~ : ' /~ __--fl. G[avelbelowp~pe ~.~ fl. Total depth ' ~- i~ff. Eft. absorption'area'-//~fl: Monitoring t~be .~ 'Depression over field Date ofadeauacv;test . ~ ~ I) . .. ' , ,~ For ,bedrooms Fluid depth in'absorption field __ in. write? added .gal. i New depth in. Elapsed Time:i rain...' pth in. * Absorption r,,e >= g.p.d. An~,~?ejuvenaQ6n treatment, )'(YIN type) L: If yes, I~, ' : t ED Date installed ~.( .in gallons "Pump on" level at ~. -PUm'p off- level at Datum : Cycles tested SEPARATION DISTANCES' SEPARATION DISTANCES ~R~)M WELL ON LOT TO: r Septic tank/~on on lot Absorption field on lot Public sewer main ¢'J' '~ '- eptic service line in, Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? ..On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank I SEPARATION DISTANCES FROM SEPTIC/~L-DIR~TANK !ON LOT TO: Building foundation Z:~ '/.4--. : Property line ~ / -f- Absorption field ~ '~' Water main /~' i~ ! ~ Water service line ,/O ,/'/- Surface water / OO I,+' Wells on adjacent lots /OO t,(_ .. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~ O I ~ Building foundation. Water Servic'e line ! O ~ ,!-- · ~Surface water ! ~ Curtain drain ~f~J/)N~.- ~/~ Wells on adjacent lots ('(20 fr--- COMMENTS ENGINEER'S CERTIFICATION - : ~'certify that I have determined through field inspections and review of Municipal records that the above systems are i.n conformance with MOA HAA. guidel{nes in effect on th!s date. /1-- Engineer's Printed Name )/~Jo,~'~7' Date ::., :. ° / HAA Fee $' - Date of Payment Receipt Number (Rev. 12/00) o o 61"-/t, ,Waiver Fee $ Date of Payment Receipt Number 6' C/L FENCE 0 90.8 4" PVC SEPTIC th w STD -PIPES (TYP) U io '6 m 3 v Cr zi 0 83.8 1 2 �v c S 89054'36"E 1 300.12 \ 6' CIL FENCE h- cs 2sO •r\ . EXISTING b, \ GARAGE 1 150,0 /L FENCE CONC. C \�x 6XC v 4 8H 0�2 Ji owe � � e �23• GRAVEL DRIVE DECk 174.0 N EXISTING HOUSE ro x w t n; � 2D C. o �c4,• lily C� ai well 0 Well 0 N 89057' 18"W 300.09 WELL PROPOSED FOR ABANDONMENT 30 I I I I I 1 u 4 I 1 q I 3 I 1 W x TW 1 I W N:.0 1 I > O I � � 8 J J Z = 0 30 3i15/01 1 AS BUILT 50-31 DATE FLD. BK. A.`�''*'<t►t! t�C•, OF•��`�r AV ff 'W..tz" #.. *. 0 7 * 0, ...0. m V, Will'i$ D. Fleming c 1 �4~0ap•'•••r..�•''•ti54V "afessiono\ ° 1r1 111 %tt►ra►t'►*• NOTES: Easements not appearing on record subdivision plat are not shown unless description of easement is provided by client. It is the responsibility of the owner or builder, prior to construction, to verify proposed buiiding grade relative to finish grade and utilities connections, and to oetermine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. Elevations based on assumed datum unless otherwise indicated, and beoring5 and distances are record data. 3' 8S Engineering S8S 17034 EAGLE RIVER LOOP ROAD Engineering EAGLE RIVER, ALASKA 99577 (907)694-2979 LEGAL. DESCRIPTION LOT 48A BROOKS-VANDERW00D SUBDIVISION PLAT NO. SCALE GRID 84-506 1"=40' NW 1358 LOCA710N OF WELL (Please complete either to, lb or to.) s i Ia. Borough 9 Subdivision Lot +Block Ib. 1/4gtrs• 3a 4A—of—of—of� Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS Street Address and Area of Well Location 2. WELL LOG Feet Below Material Type Surface Top Bottom DUX 16. WATER WELL CONTRACTORS CERTIFICATION: WATER WELL RECORD STATE OFALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological a Geophysical Surveys Drilling Permit No.��� A.D.L. No. N xange Meridian 15' 30 wOSeward 3. OWNER OF WELL: _ — Address: 4. WELL.�DEP�TH: ( final) I 5. DATE OF CONtPLET10.N �ieiu 1 6. ❑ Coble tool Oitotary Driven 0Dug Auger 0 Jetted Bored Other: 7, USE4`Q,Domestic D Public supply O Industry Irrigation L_1 Rechargo El Commerical Test Well Other: 8. CASING: 0 Threaded Welded diam. U in, to ft. Depth Weight tbs./ ft. diam. in. to ft, Depth Stickup ft. 9. FINISH OF WELL: Type' Diameter: ' Slot/Mesh Size: Length: Set between ft. and ft Backfilling _ Gravel pack 10. STATIC WATER LEVEL ft. / EjAbove or ❑ Below land surface — —Date Equipment used: I I . PUMPING LEVEL below land surface and YIELD it, after hrs, pumping 9-P.m. ft, after hrs. pumping g.p.m. 12.GROUTING Well Grouted: 0Yes No Material: ED Neat Cement Other: 13,PUMP: (if available) HP Length of Drop Pipe ft. capacity g.p.m. 0 Subm. Jet 0 Centrifical Other 14. REMARKS: H ., � jai `' ..'' � �11 L 15. Water Temperature 0 F cj C This well was drilled under my jurisdiction and this report is true to the,best of my knowledge and belief; Registered Business Name Contract License Number Address: « < i c'' Signed: Authorized Representotivo Date: ._ ? C N G1 (n r R a z 0 02-WWR 0181) Copy Distribution: WHITE -State DGGS, PINK -Driller, CANARY -Customer i