HomeMy WebLinkAboutT15N R1W SEC 5 LT 94TtSN, RtW, Section § Lot 94 #'051-082-04 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: _OSP221350 PID Number: 051-082-04 Dwelling: FE] Single Family (SF) El with ADU n Duplex (D) n Two Single Family Project: n New X Upgrade Name Aaron Butikofer ABSORPTION FIELD El Deep Trench W Wide Trench [:3 Bed F] Mound Site Address 21528 Scenic Dr Chugiak El Other Phone Number of Bedrooms Soil Rating - Total ldepth from original grade 5 1.0 GPD/SF 3.1-4.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2.6-3.5 Ft. Gravel depth beneath pipe 0.5 Ft, Subdivision Block Lot 94 Fill added above original grade 1.4-2.5 Ft, Gravel length 150 Ft. Township Range Section T1 5N R1 5 Gravel width 5 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 Ta Field Tank E Line 750 Ft;? 2 6 Ft, Well >1 00. >100'1 NA 1 NA I TANK N Septic El S,T.E.P. 171 Holding El Other Manufacturer Infiltrator Capacity 1500 Gal, Surface Water >1 00' > 100" NA NA 'I Material Number of compartments Lodine >51 >10 NA NA NA plastic 2 FoundationLIFT >10' > 10' NA NA I STATION Manufacturer Capacity Remarks 2' FILTER SAND BELOW SEWER Gal, ROCK Alarm location Electrical installed by Installer PIPE MATERIAL House to tank 3034 drainfield Tankto 3034 homeowner Drainfield 3034 CO/MT 3034 Inspector Eklutna Engineering BENCH MARK (Assumed elevation) 100 ft Inspection 2 nd 1$t 9/26/2022 9/28/2022 dates: Location and description - 9/330/20,I 411110/8/2 3°06 bottom of siding at point B ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date ... .......... Septic System L T .moi Approved Da te 10-210-2-i Note: this approval does not include well permit requirements. dma� S Record prePared for Aaron Butikofer 21528 Scenic Dr Chugiak, Alaska 99567 T1 5N R1 W SEC 5 LOT 94 EKLUTNA ENGINEERING, LLC DATE: 1 "', I 6-2 M" ' �,N'T',-4HN Rr-),` DRAWN: Hlj-!a� i"Qv SCALE: PID: 051-082-04 S1 0;P NE), C-ONCJJ"u-11- ... ............ X Aw L0i'l "NO - ...0 .t 1 P'AP T Mt,-. -F 'T- N BC,'�C, p r) Tj S F, C 0 0............................ G 0 .......... Xv CLT ---- ------- WAS Ar 1" = 30' Z At?p i� SHEET 2 OF 3 p 5 HO Hplic EL "D ( 71 v 50* x, 5' x 6" S Record prePared for Aaron Butikofer 21528 Scenic Dr Chugiak, Alaska 99567 T1 5N R1 W SEC 5 LOT 94 EKLUTNA ENGINEERING, LLC DATE: 1 "', I 6-2 M" ' �,N'T',-4HN Rr-),` DRAWN: Hlj-!a� i"Qv SCALE: PID: 051-082-04 S1 0;P ... ............ X Aw AW AV 0 OSP221350 ....... ..... #0 0 0............................ 10/17/2022 0 .......... Xv CLT ---- ------- Ar 1" = 30' TFI'�N PAIVE: < SHEET 2 OF 3 p A 5 0 ( 71 v 50* x, 5' x 6" S Record prePared for Aaron Butikofer 21528 Scenic Dr Chugiak, Alaska 99567 T1 5N R1 W SEC 5 LOT 94 EKLUTNA ENGINEERING, LLC DATE: 1 "', I 6-2 M" ' �,N'T',-4HN Rr-),` DRAWN: Hlj-!a� i"Qv SCALE: PID: 051-082-04 7 r -'F- It ... ............ X Aw AW AV 0 OSP221350 ....... ..... #0 0 0............................ 10/17/2022 0 .......... Xv CLT # Ar # AV Ar 1" = 30' ............. . 4k 41� SHEET 2 OF 3 M I BLM LOT 85 8333H ALLUVIAQ STREET N89057'08"W 330.15 CY7 (o W BLM LOT 95 0 M SCALE: V= 60' _____1, 30.5 30.5 50' BLM ROAD shed --"Q i r Q RESERVATION y O � 0 m o ,0 Cs reenhouse c c0 c — —C) -- m — — -- — ---se U' C7 i I 30.5 30.5 I y00.0-- od fence(typ) ReLvmn(cyp Gtave��S� z 0 d Of 177.82.00 f 2 1 m W a S a> d v N..N i -gyp' co W P P ' 6 3P 252 o�eU 1 s W`ndo,,selll�1P1 : °c N 9 'oP .o off t (Y) 2p0, o 0 of 112.3.......... I � W Se > Septic vent ( i L) O opOra) i i i O ' o Manhofe I U 0 BLM LOT 94 z Ia W la � E I I I I EAST 330.15 BLM LOT 101 �� of •q�q'9 • • A00 ® �c"•C -,W tier ® Ut 00�,'. Elizabeth L. Walatka : �`� 00 �' • 8036 - LS • • ek,® O �0FESS1014m- EASEMENTS OF RECORD, OTHER THAN I P ` L4t- - /-G;2--rZ" THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON FB 22-3, pg 69-70 UNLESS OTHERWISE NOTED. FB 08-8, pg 51-52 1 I RECERTIFIED 10-10-22 r`'� ' AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection in accordance with ASPLS Standards of the following described property: BLM LOT 94, SECTION 5, TI 5N, R1 W, Seward Meridian, AK Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 24th day of September , 2008. FRED WALATKA & ASSOCIATES, L.L.C. BE907-248-1666 Engineers and Surveyors This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. 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: OSP221350 Work Type: Septic Upgrade Tax Code Number: 05108204000 Site Legal Address: T15N R1 W SEC 5 LT 94 G:1457 Site Mailing Address: 21528 SCENIC DR, Chugiak Owner: EKLUTNA ENGINEERING, LLC* Design Engineer: EKLUTNA ENGINEERING, LLC* This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: ��»ent �o� C,. `'.• k f llepartment 9/22/2022 9/22/2023 1:•11 Q 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 Received B) Issued By: Date:) /Z Z 2 Z Z Date: qh,-Z_/-Z_ 5 M U HMPAU Y OF AHCHORA E r'~ Development Services Department 1\\ = Phone: 907-343-7904 On -Site Water & Wastewater Section — Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 05108204000 Property owner(s) BUTIKOFER AARON Day phone Mailing address 21528 SCENIC DR CHUGIAK, AK 99567 0000 Site address 21528 SCENIC DR CHUGIAK, AK 99567 0000 Legal description (Sub'd., Block & Lot) T1 5N R1 W SEC 5 LT 94 Legal description (Township, Range & Section) Lot Size 108,900 Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field E] Initial ❑ Single Family (SF) 0 Septic Tank ElUpgrade 0 (w/wo ADU) Tank E] Renewal EJ Duplex (D) El 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 Municipal Qpdps. (Signature of pro authorized agent) Z Permit/Rush Fees: S6)5- "' Waiver Fees: _ Date of Payment: 91,-�%2-a Date of Payment: Receipt Number: —003_ 12) D Receipt Number: Permit No. 1360 Waiver No. GADevelopment Services\Building Safety\On Site Water and WastewaterTorms\Client FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221350, Deb Wockenfuss, 09/22/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221350, Deb Wockenfuss, 09/22/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221350, Deb Wockenfuss, 09/22/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221350, Deb Wockenfuss, 09/22/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221350, Deb Wockenfuss, 09/22/22 MUNICIPALITY OF ANCHORAGE Development Services Department Phone. 907-343-7904 On -Site Water & Wastewater Section Fax. 907-343"7997 Septic System Owner -installer Agreement The On-site Water and Wastewater Section (On-site) may issue an approval for a homeowner to perform work on an on-site wastewater disposal system to serve that individual's owner - occupied, single-family or duplex home if the homeowner meets and agrees to the following requirements. 1. The property owner and excavation equipment operator may perform work on no more than one owner -installation project in a 12 -month period. 2 Owner's projected active involve ent with the installation: J /� cc. V",4 a(� �% n� <Ca��^ , 3. The name of the excavation equipment operator: /,�- row 4. 1 agree that there will be no monetary compensation for installation services rendered 5 The name of the inspecting engineer: Cvi� `Io�� 6. 1 agree to discuss the following items with the inspecting engineer a. Permit design criteria and specifications. b. Inspection requirements set forth in AMC 15.65.070. c. Advance notice given to the On-site Water & Wastewater Section for all required municipal inspections (AMC 15.65.070A). 7 1 agree to have the project -specific On-site Wastewater Disposal System Permit available at the construction site for the duration of all related work. 8 1 agree that if the system is an advanced wastewater treatment system (AWWTS), I will obtain additional installation instructions and approval from the equipment distributor /V'4_ As owner of (legal description) 'L'S 9" �,i C Dom_ C -Cu , k AJC 4J I agree that the information above is true and accurate. Owner's printed name: /4 6r, 'yfl, o Owner's signature / v L--- _ Z Date: MUNICIPALITY OF ANCHORAGE ' DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ~ PHONE ~]A~ LA NG ADDRESS LEGAL DESCRIPTION l /--o7- T/SA/ !cu ee_ [] NEW ,~UPGRADE 5 75-77 LOCATION Well Absorption area ~ L q, capac ty n ga ons Inside ength ~ 0 ~ DISTANCE TO: ~ell ~-~l° ~ ~ I Manufacturer ~ ~ Well - Foundation DISTANCE TO: ~ No. oflin~s Le fcachline To II ~thoflines  Top of tile to finish ~rade M~tedal beneath tile Length I Width Depth ~ Typeofcrib Cribdiameter ~/ ,Cribdepth I // ~ J DISTANCE TO: ~ f~n~i~ /' S~wer~ IDwelling .~(..) Material Nearest lot line Trench width NO. OF BEDRO~/~, PERMIT NO. , No, of compartments ~ Liquid depth PERMIT NO. Liquid.capacity in gallons PERMIT NO. Distance between lines inches Total effective absorption area inches PERMIT NO. Total effective absorption area Nearest lot line Distance to lot line Septic tank OTHER PIPE MATERIALS SOIL TEST RATING ~/! INSTALLER REMARKS APPROVED ~ 72-013 (Rev, 3/78) Permit ~ Applicant: Location: MUNICIPALITY OF ANCHORAGE Departme~bf Health and Environment~Protection 825 L Street, Anchorage, AK. 264-4720 * * * HANDWRITTEN PERMIT * * WELL AND/OR ON-SITE SEWER PER/~~-'~q"''O Phone Number: Legal Description: Z~'~f ~/~/~~'-- LOt Size: Type of Soil Absorption System Is: Trench: Drainfiel~: Seepage Bed: __ Holding Tank: Maximum Number of Bedrooms: ~ Soil Rating(sq. ft/br) The Required Size of the Soil Absorption System Is: DEPTH LENGTH ~ RAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(I~8~cTXI-NG) TANK SIZE = ~"c~ C) GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31~ 1 9 $ 3 * * * Z certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the M~icipality of Anchorage. (2) I wi~ install ~t~system in accordance with codes. (3) I ~d~r~and ~ the on-site sewer system may re.~uire enlargement if S igne~'~/J/~///- t~e ~enc~///~ remodeled to inc~edm~r~I e y' ~.~ ,~ that~ ~bedroo~s/. ~/ /-' Date: ~--3/- ~'-~..~ SWP/024(1/81) GRF- 'e ANCHORAGE AREA Department ~3Eon~irs~E~ntal Quality Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME J0~/A~ ~/~1<'~-~ MAILING ADDRESS PHONE LOCATION SEPTIC TANK: DISTANCE ~ql FROM WELL INSIDE LENGTH MANUFACTURER INSIDE WIDTH NUMBER OF COMPARTMENTS / LIQUID DEPTH LIQUID CAPACITY /00~ GALLONS. SEEPAGE PIT: NUMBER OF PITS // DIAMETER --OR WIDTH ~ , LINING MATERIAL(~/C,~P~g Y~,CRIB SIZE: DIAMETER BUILDING FOUNDATION NEAREST LOT LINE DEPTH ,3 DISTANCE FROM: WELL /001 TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. WELL: TYPE CONSTRUCTION BUILDING NEAREST FOUNDATION LOT LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED NEAREST SEWER LINE REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK SYSTEM DISTANCES: INSTALLED BY: '~-Jl ]~'I~'/]/O~-C~2~' PiPE MATERIAL: LOT SLOPE: Form No. EQ~031 DIAGRAM OF SYSTEM August, 1~73 Newtom Drillin Driller, Zen 0ummlngs Use of well -- Home On smd of Scenic Drive off Birchwood Zoep North Size of casimg ....6" , p®pth ~f Holet 149'5" ,Eeet cased to Static water level .artesia~ . Pumped well at 10 gal a minute. 149'5". Ei~ish of well ..open end. ~$* ~ O' te 8t ... 8' to 23'8" --- 23'8" to 46'10" .-. 46'10" tO 67'10" 67'10 tc 82'6" --. 82'6" tc ~23'4" *-. 123'4" te 13R'5" --- 139'5" 13~'5" ts 14~'5" e-- 149'5" ... Dirt Gravel and 01ay (23'8" Blue 01ay Blue 01ay and Gravel (67'10" water at 2 g~l per min. Blue olay Soft Olay 01ay & Gravel ~ater& Sand Olay & Gravel Surface water) sealed) (unoontrolable s~nd & clay heaving) Water & course Sand (Hole open with course sand. Drilled ahead of casing into olay & gravel. No large gravel). MUNICIPALITY OF ANCHORAGE o Development Services Department I Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 05108204 Legal description T1 5N R1 W Sec 5 lot 94 Site address 21528Scenic Dr. Chugiak AK Current property owner(s) Butikofer Expiration Date: 1-26-2023 X The On-site system(s) is/are approved for 5 bedrooms Conditional approval for Comments or advisories: bedrooms, with the following stipulations: BY: Original Certificate Date: This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory , r / Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY OF ANCHORAGE 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. 051-082-04 Complete legal description T15N R1 W SEC 5 LOT 94 Location (site address) 21528 SCENIC DRIVE, CHUGIAK, AK 99567 Current property owner(s) AARON AB BUTIKOFER Day phone 2. ON-SITE SYSTEMS SIZED FOR 5 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ® Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Date of Payment 111I(1Zz -7 piny COSA # �SG�� 15U:�5 Waiver Fee $ Date of Payment Waiver # COSA Application 2022,doc Legal Description: T1 5N RI SEC 5 LOT 94 Parcel ID: 051-082-04 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ® Well log is filed with Onsite (or attached) Water storage tank volume 200 gallons Date drilled 8/1973 Total depth 149.5 ft Well disinfected for coliform test? ❑ Yes ® No Cased to 149.5 ft ® Coliform bacteria is Negative ® Sanitary seal is functioning correctly Nitrate mg/L ® Nitrate less than MRL (ND) ® Wires are properly protected Arsenic 12.1 ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) 12 in. FWIC5 Date of flow test for COSA 10/06/22 Collected by . Static water level at beginning of test 34 ft. Date 10/05/2022 Well production at time of test 2.15gpm Comments STORAGE TANK WITH PUMP. APPROXIMATE 150 GALLONS OF WATER IN WELL CASING AT TESTING SEVERAL WATER CISTERNS CONNECTED TO ROOF SPOUTS FOR OUTSIDE GARDEN WATERING B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NA – NEW PLASTIC S.T. ❑ Required maintenance completed, if AWWTS Comments: 1,500 GALLON INFILTRATOR TANK D. ABSORPTION FIELD DATA Which system tested (date installed) NEW SYSTEM ® ALL standpipes present per record drawing Total measured depth from grade 6_6 ft (max) Measured depth to pipe invert from grade 5 ft (min) ❑ N/A – pressurized field. ❑ Per record drawings, field is insulated. ® 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) N If yes, enter date C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date NEW SYSTEM Results ❑ Pass Fluid depth prior to test _ in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate _ god FIELD STATUS – POST RECOVERY Effective depth (per record drawings) _ in Effective depth used —in Effective depth remaining in Comments/Deficiencies: THIS IS A NEW OWNER INSTALLED SEPTIC SYSTEM 1501L X 51W X 0.51ED – 4' OG MAX DEPTH + FILL WITH 2' OF MOA SAND BELOW SEWER ROCK. COSA Checklist 2022.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' Z Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No ft Tank to Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ® Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS OLD SEPTIC SYSTEM DECOMMISSIONED 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 Finn FIRST WATER CONSULTING Phone 907-350-9566 Engineer's Printed Name CURTIS HUFFMAN, PE Date 10/20/2022 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FW(S 1_ COSA Checklist 2022.docx _49 TH r • Curtis Huffman ��'c�`•• CE 128991 ••`v��� r}���sfFRF • • 10/20/22 ttl �pROFESSIONPANew Arsenic Advisory Certificate of On -Site Systems Approval # OSC221500 Subdivision: T15N R1W Sec 5 Lot 94 A water sample revealed an arsenic concentration of 12.1 micrograms per liter (ug/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Mailing Address � O Box 196650 *Anchorage, Alaska zO 99519 6650 *www muni org _. Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 RO. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907} 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. ~ 1. GENERAL INFORMATION Complete legal description Lo t 94 HAA# /Q//<)(~'~'~// Expiration Date: T15N, R1W, Section 5 Location (site address or directions) 21528 Scenic Current Property owner(s) Penny Blngman Mailing address?C Lending agency Drive Greatland/Kathy Dayphone 694-9125 Day phone Mailing address Real Estate Agent Greatland/Kathv Geraci Dayphone 694-9125 Mailing Address 11411 Old Glen Hwy., Eagle River, AK 99577 Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] Individual Holding Tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Department of Health and Human Services (DHHS) 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) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Cedificates 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. 72-025 cRev. 01 'OOY 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 Health Authority Approval Guidelines for the Health Authority Approval application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S & $ ENGINEERING ilu,~,~ Eagie River Loop Road No. 2U4 Address Fagle~i~-~'~ Alaska 99~77 Engineer's Printed Name Eobe~-t C. Co~,~an DHHS SIGNATURE [../" Approved for ~ bedrooms. Disapproved. Conditional approval for Phone Date /0/' ~/ T bedrooms, with the following stipulations. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Expiration Date: / -' / ~ - CO ~ Original Certificate [)ate: J 0 - / (¢ - dP 0 Reissue Date: 72 025 ire,/ 01 00V Legal Description: /-eT' ~ ~-// A. WELL DATA Well type ~R ~v~'~ ~- Date completed ~' / 7] Total depth I ~/q '3-" ft "- Municipality of Anchorage Department of Health and Human Servicel~ E C E ! V E Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 OCT 1 0 2000 www. ci.anchorage.ak.us (907) 343-4744 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION HEALTH AUTHORITY APPROVAL CHECKLIST 5'~ c71 a,-J ~ T I ~'hJ ~i~J Parcel I.D.: If A, B, or C provide PWSID # -- Sanitary seal y~..r Cased to I ~ ~-" ft Well Log. T ~ Wires properly protected, Casing height (above ground) 1;~ -/- in. FROM WELL LOG Date of test Static water level ~,~'r¢- s,,~,v ft Well production / O g.p.m WATER SAMPLE RESULTS: Coliform O colonies/100 mi Date of sample: /O B. SEPTIC/HOLD!NG.~rANK DATA Nitrate O. 6-- mg/I Collected by: Tank Type/Material $"~ ¢ ~ c /c~,.~c. ~ ~. r,~.// a~4,~ c~ Date installed (; ? //$ ~ Tank size ..~o o gal Cleanou~t~. Yf~ Date of pumping AT INSPECTION J, 5- g.p.m Other bacteria O colonies/100 mi $ & $ ENGINEERING 17034 Eagle River Loop Read Ne. 204 Eagle River, Alaska 99577 I Number of Compartments. I __Foundation cleanout ),~i Depression over tank ~0 High water alarm <~ /0 O Pumper S~,~ ~0 C. ABSORPTION FIELD DATA Date installed c//~o/'73 Soil rating (g.p.d./ft2 or ft2/bdrm) u/~< System type Length i.~ ¢l ft Width (~ ft Gravel below pipe --~ ft Total depth '7 ft Effective absorption area~~-3-- fl~ Monitoring tube ~/~'J Depression over field__ Date of adequacy test /o/,.¢joo Results(~Fail) /o~¢~j, For ~ bedrooms ~vo Fluid depth in abSorption field before test ! 7~/'{'in Wateradded (;co gal. Newdepth ~ ¢' in. Elapsed Time: ~-O min Final fluid depth 2. ~ ~, in Absorption rate >= (o o O g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N ~ '"~-- ~4,,, o~ ,v If yes, give date - 72-026 (Rev. 01/00)* D. LIFT STATION Date installed Size in gallons ~.~.~4¢al"Ch~e/Access "Pump on" level at __ in "Pump.~¢f~te, ceTat in High water alarm level at __ in Datum .~'~ycles tested Meets alarm & circuit requirements__ SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot /0 o $'~/ On adjacent lots Absorption field on lot Public sewer main Sewer/septic service line ) 0 ¢ --~ On adjacent lots Public sewer manhole/cleanout x~/,~ 0%,¢' ~ Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Building foundation o~ o ~ Property line / 0 o /--z- Water main /u/4- Water service line ? o Drainage ~v //'/- Wells on adjacent lots ,) 0 o SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~' o -k Building foundation ~"0 -+ Water main Water Service line /0 '-/- · Curtain drain Absorption field Surface water Surface water ) o o 4-- Wells on adjacent lots /0o '+ Driveway, parking/vehicle storage (/') o ~¥- F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records 'that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name 78,8~4~- C. C 8~d,-J Date /O / ¢')/oo HAAFee $ Date of Payment 72-026 (Rev. Waiver Fee $ Date of Payment Receipt Number .,~?~,v~ ~.g,~.,~,-'~ ~ MUNICIPALITY OF ANCHORAGE ,x~© o (~ k~/ DIVISION O ~" > ~ 4744 AUTHORITY ~ C t~~C~RTIFICATE OF INSPECTION FOR HEALTH APPROVAL OF ~ ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcell. D.~ ~ /- ~- ~ HAA~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address or directions) NHN Scenic Drive (b) Property owner AHFC ff47609 .Telephone: (home) Business (c) (d) Mailing Address 520 E. 34th, Anchorage, Ak. Lending Institution '- .... Telephone Mailing Address Real Estate Company and Agent Jack White Co.- Barbara Crittenden Address 10928 Eaqle River Rd., Eaqle River, Ak. Telephone 694-5500 / (e) Mail the HAA to the following address: (or check here~, if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, A aska 99577 2. TYPE OF RESIDENCE Single-FamilyK] Number Of bedrooms 3. WATER SUPPLY Individual Well [] 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 ~ Public [] 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. 72 025 (Rev. 7/88) Page 1 of 2 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 [s safe, functional and adequate for the number of bedrooms and type of structure indicated herein, I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Date ENGINEERING River~ Alaska 99577 Telephone 6. DHHS APPROVAL Approved for //' bedrooms by Approved ? Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. · ~ MUNICIPALITY OF ANCHORAGE (MOA) · .b~;(~'~,/ Health Authority Approval (HAA) ~'~'~,~,~ ~o ~ CHECKLIST- FEBRUARY 1984 ~'~ ~.'~ ,~ Legal Description: ~ Well C ass~hcahon~ X¢~ k~&~ If A, B, C, D.E.C. Approved (Y/N) Well Log Present.IN) ~ Date Completed'~ '~:~/'7'~ ~ Yield Total Depth I~1 ' Cased to ~ Depth of Grouting ' - Static Water Level I ~ Pump Set At Casing Height Above Ground I,"~..?-J¢ Sanitary Seal on Casing~_~N) Electrical Wiring in Conduit (~N) y Depression Around Wellhead (Y/(~ SEPARATION DISTANCES FROM WELL:- '~"~'~ To Septic/Holding Tank on Lot ; On Adjoining Lots To Nearest Edge of Absorption Field//~ Lot ~1~' ;On Adjoining Lots A ~::~ To Nearest Public Sewer Line //~' To Nearest Public Sewer Cleanout/Manhole ' 14 To Nearest Sewer Service Line on Lot "~-'~ Water Sample Collected by ~.~-~ ~¢..~l~--~:::~::;~"z~t~ ;Date ,¢~.-~Z~y--~<~ Water Sample Test Results ~~~ ~~ '~ ~'~\~ Comments'~ \,/~'~',t~, ~;;~-~...~ '~--~:;:~'~1~-~:;:A[~:~ ~ ·-'""~'~'--'~_..~ B. SEPTIC/HOLDING TANK DATA Date Installed ~/~-~,/~ Size ~oc~'~) No. of Compartments ~.- Standpipes(_J~'~ ',,/ Air-tight Caps(~N) ¥ Foundation Cleanout~2~i~N) j Date Last Pumped Depression over Tank (Y~ ~ Pumping/Maintenance Contact on File,(Y/~/ ;for Holding Tank High-Water Alarm (Y/N) (P' Temporary Holding Tank Permit sEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well / ~ To Building Foundation \ To Property Line /~::~ L..~. To Disposal Field To Water Main/Service Line ~ ~ To Stream, Pond, Lake or Major Drainage Course Cornments"~ ,.~.~,~,1--~ "'~ {~ ~JN-.~.~, ~-~~ 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~_. Date Installed '~r ~ Width of Field Square Feet of Absortion Area '")/¢"-~F~.-~'~ Statndpipes Present (Y/N) Depression over Field (Y~ ~ Date of Last Adequacy Test Results of Last Adequacy Test ~ ~- -~-'~------, C- SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation/ Lot Type of System Design Length of Field Depth of Field Gravel Bed Thickness To Property Line To Existing or Abandoned System on ;On Adjoining Lots To Water Main/Service Line ~ ~ ).4~- To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments_'2~,/~'¢-¢~~ ~ ~-¢~q~d-~u)~ D. L,FT STAT,O. Date Installed Size~Gallons "Pump ~ High Water Alarm Level ~ 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** ~. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ~, . Signed $ & S ENGINEERING Company Date MOA No. 17034 Eagle Rive~ Loop Road No. 204 F. aglu Riye/r~/~_'i~,sku .y-/7__ ¢ / ¢¢ ReceiptNo. c~'///c~O ~/'/~"~/-'~) Date of Payment Amount: $ / ~_.) ~-~O Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 ~,~'~t . A MUNICIPALITY OF ANCIIORAG~.~ /~-7~'~.'*~,~,~ DEPARTM[ ' OF HEALTH AND ENViRONMEN~ ~. ;~OTECTION ~O ~ - / November~4, Time 10:0~ Ammz_ ~2: Time 10_~a. ~ ~3: Time Y/ Date 11~7-77 Thursday Da~e _~ 7 Friday Date 3977 REQUEST FOR APPROVAL OF INDiVIDUAI SEWER AND WATER FACILITIES Lending Institution Request: Mailing Address: 2. Property Owner: Carlson Mailing Address: % Great Land Realty~,~ L___ola Phone: Phone: 694-9125 3. Legal Description: T15N R1W Section 5 Lot 94 4: Single Family Residence: (x) Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: Three Well System: Permit # Construction Individual well (x) Community/Public System ( ) ]Depth of Well Well Log on File Bacterial Analysis ( ) Sewage Disposal System: Permit # Septic Tank Size Absorption Area On-site Installed System (xk Public Installer Manufacturer Soils Rate Material uti].ity ( ) Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Linc, Department of ~Request f©r Approval Health and Environmental Protection of Individual Sewer and Water Facilihies Legal Description: T15N R1W Section 5 Lot 94 Letter Attached: ( Date: Disapproved: Da te: Department Worksheet: ~MUNICIPALITY OF ANCHORAG[~-~ ~ Department of Health and Environmental Protection~ ' 825 L Street, ~chorage, Alaska 99501 264-4720 ~equest for Approval of Individual Sewer and Water Facilities e Mailing Address: Realtor/Agent: Mailing Address: Property Owner: Mailing Address: Name Buyer: Mailing Address: Lending Institution: Phone: Legal Description: Single Family Residence: ~Number of Bedrooms: --3 Multiple Family Residence:' ( ) Number of Bedrooms: Water Supply: *Individual Well If Individual Well, well depth (~ Public/Community System If Co~mmunity System, name of system ( ) Sewage Disposal System: On-site System ( ) Public System ( ) If On-site System, date of installation: *NOTE: A well log is required on ALL wells drilled since 6/75. If on-site sewer system is over two(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77