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HomeMy WebLinkAboutMCKINLEY HEIGHTS #1 BLK 3 LT 5McKinley Heights #1 Block 3 Lot 5 #051-212-23 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211486 PID Number: 051-212-23 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑✓ Upgrade Name A ORPTION FIELD Existing Kevin Carter ❑ D Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 18688 Amonson Rd. Other Phone Number of Bedrooms Soil RatingTotal depth from original grade 3 D/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original de Gravel depth beneath pipe Ft. Subdivision Block Lot McKinley Heights #1 3 5 Fill added above original grade Ft. Gr el length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dist a between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between t ches From Tank Field Lift Station Tank I Line Ft2 Well 1001+ 25'+ TANK ❑ Septic P1 S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1250 Gal. Surface Water Material Plastic Number of compartments 2 1100'+ Lot Line 10'r I NA Foundation 101+ LIFT STATION Manufacturer Capacity Gal. Remarks *Field verified 10'separation. Alarm location Electrical installed by to PIPE MATERIAL House to tank D3034 dTankrainfield Installer Deen Construction Drainfield CO/MT Inspector Arcterra Consulting BENCH MARK (Assumed elevation) 100ft Inspection in Location and description dates: 5/22/23 2ntl 5/22/23 3'd 5/25/23 4'h Garage slab ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineers Stamp .•' OF !+� Conditional Approval: Date��''� * �` i 49111 KENNETH ou US 4r r CE i Septic Syste Approved C (.��_ Da ♦+,%��ti��+•� No :this approval does not include well permit requirem nt . (Rev 05102/18) AS -BUILT SYSTEM DETAILS/SITE PLAN MCKINLEY HEIGHTS #1 BLOCK 3 LOT 5 c I - 75U W x A -C=30.4' 100.50 10 B -C=72.3' p A -D=34.3' w B -o=76.0' W z Q r rn � O a 2 o d LL C Y p INSULATION J ° 1250 GAL STEP T97 M 80 TANK d SCALE: NTS 98.31 B 0�5 ft-obb."411hI.~Vk rfi aF, 1 PREPARED FOR: KEVIN CARTER 18688 AMONSON ROAD * 419 Tx CHLIGIAK, AK 310-467-0158 } ' D 5 FlELD BOOKS COMPUTED: ;?.2 is � BOUNDARY: A DRAWN:KSD � iSTAKING A CIIECI�D: KMd -w ASBUILT. SLS DATE 7 6 i 1c)�� DWG. FILE: GRID: NW10E ■ rACAD FIs` FILE JOB IN 20158 Permit OSP211486 PID# 051-212-23 '4a WELL SCALE: 1" = 30' SCALE: NTS MUNICIPALITY OF ANCHORAGE �»cnt On -Site Water & Wastewater Program X04 S� PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite 4 ' Della rtin ell t On -Site Wastewater Disposal System Permit Permit Number: OSP221482 Effective Date: 12/8/2022 Work Type: Septic Renewal Expiration Date: 12/8/2023 Tax Code Number: 05121223000 Site Legal Address: MCKINLEY HEIGHTS #1 BLK 3 LT 5 G:1058 Site Mailing Address: 18688 AMONSON RD, Chugiak Owner: CARTER KEVIN R 50% & Lot Size in Sq Ft: 42689 Design Engineer: ARC TERRA CONSULTING INC Total Bedrooms: 3 This permit is for the construction of: ❑ 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 By: C 5 S VIE- () TO/712G� (2 ova Issued By: Date: Date: /Z Zg Z L HUMMP UTV OF '-` HC HO'v„O Development Services Department Phone:907-343-7904 On -Site Water & Wastewater Section - Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-212-23 Property owner(s) Kevin Carter Mailing address 18688 Amonson Rd, Chugiak Site address 18688 Amonson Rd Day phone Legal description (Sub'd., Block & Lot) McKinley Heights #1 Blk 3 Lot 5 Legal description (Township, Range & Section) Lot Size 42689 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field F-1 InitialEl Single Family (SF) IN (w/wo ADU) Septic Tank ® Upgrade ❑ 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 Municipal Codes. Dea Duffus (Signature of property owner or authorized agent) Permit/Rush Fees: I Y 5 Date of Payment: Receipt Number: ® �'31�°(� Permit No. OSN 2 Z W Waiver Fees: Date of Payment: Receipt Number: 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 OSP221482, Curtis Townsend, 12/08/22 1 $1 = 50' ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: McKINLEY HEIGHTS SUBD ADD N01 LOT 5 BLOCK 3 PLAT P-629 SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shoul4 any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER. DATE: SCALE. E -MAIL - JUNE 3, 2023 1 =503 schulierftk.net 23-052 DRAWN BY. CHECKED BY: GRID NUMBER: B66K-P I JAS NW1058 230166 * = FND 5/8" REBAR S fjj? L Ago 0 F 4 N\ A10W -t4 N 100, 49TH �.,....... .... ........ ��� LA � XIA ?A :� ..: ........ ............. OHM L. SCHULLER: It 10' LS -10408 .,Aar 1.881 Talkeetna Street a Anchorage, Alaska 99508 ,eSSiono\\_(907) 227 O A8W —1455 office (907) 274-4992 fax 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: OSP211486 Work Type: SepticTank Renewal Tax Code Number: 05121223000 Site Legal Address: MCKINLEY HEIGHTS #1 BLK 3 LT 5 G:1058 Site Mailing Address: 18688 AMONSON RD, Chugiak Owner: CARTER KEVIN R 50% & Design Engineer: ARC TERRA CONSULTING INC This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: nlcnr w.: S � Wil• r. u. Depai,t rnent 12/6/2021 12/6/2022 42689 ❑ Disposal Field 2 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 By: Date: Issued By: Date: �/? b •��� 3 MUNICIPALITY OF ANCHORAGE rr� Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-212-23 Property owner(s) Kevin & Erma Carter Day phone Mailing address 18688 Amonson Rd, Chugiak, AK 99567 Site address 18688 Amonson Rd, Chugiak, AK 99567 Legal description (Sub'd., Block & Lot) McKinley Hts. #1 Blk 3 Lot 5 Legal description (Township, Range & Section) Lot Size -42,689 - Sq. Ft. Number of Bedrooms 3 - APPLICATION IS FOR: APPLICATION IS AN: (N all that apply) Absorption Field ❑ Initial ❑ Septic Tank 3 Upgrade ❑'` Holding Tank ❑ Renewal ❑ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: TYPE OF DWELLING: Single Family (SF) ❑'` (w/wo AD U) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Dea Duffus (Signature of property owner or authorized agent) Permit/Rush Fees: 4/`i5 Date of Payment: / 2 3 Z 0 21 Receipt Number: Q 3 � Z'2-, Cc; Permit No. OSP Z 114 8 6 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc izcTI,311ZA CONSULTING, INC F 20441 Ptarmigan Bld, Eagle River, AK 99577 ay Office (907) 696-6111, Fax (907) 868-3793 December 1, 2021 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: OSP201305 Permit RENEWAL — McKinley Hts. # 1 Blk 3 Lot 5 The owner has requested we proceed forward to obtain a renewal permit to _ upgrade the aged STEP septic tank on the subject lot. The proposed upgrade will serve the existing 3 -bedroom house. The existing perameters on site have not changed from the original application and permit. The adjacent lots are both developed and un -developed served by private wells more than 100 feet from the septic system on this lot. There is no surface water within 100' of the proposed tank. The new tank will be outside all protective well radii. We do not expect there to be any adverse effect on adjacent lots by the development of this tank. if you have any questions, please contact me at 696- 6111 /FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. "72 Kenneth M. D f s, P. E. Attachments: On -Site Sewer Application 20441 PTARMIGAN BLVD - EAGLE RIVER, AK 99577-8736 - PH (907) 868-3791 - FAX (907) 868-3793 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201305, Rebecca Carroll, 12/18/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201305, Rebecca Carroll, 12/18/20 From:Brannan, Thomas W (DEC)thomas.brannan@alaska.gov Subject:RE: Well classifications - McKinley Hts #1 Blk 3 Lot 5 Date:December 17, 2020 at 11:19 AM To :Dea Duffus dea@arcterra.net Cc:Wockenfuss, Deborah M.deborah.wockenfuss@anchorageak.gov,Rieth, William R (DEC)bill.rieth@alaska.gov, Palmer, Charley (DEC)charley.palmer@alaska.gov Morning Dea, Thanks for your call and email about public water system classifica<on and regulatory coverage. In order for a well to be subject to the DEC’s 200’ separa<on distance requirements, the encroached upon well must be classified as part of a Public Water System (PWS). As I men<oned on the phone, the threshold for coverage under Federal / State Regs is ≥25 persons for ≥60 days of the year. I’m unable to formally classify water systems without Classifica<on Documents from the water system owners and this becomes more unusual with the reported issues with contamina<on and how they are indicated as not in use. However with that, I did some research on our State Drinking Water Records; and it does not appear that we have a PWS within 200’ of the subject lot; this matches with your descrip<on of the land usage in the area, the wells, and DWP Records. As shown in the Figure below, the nearest PWS wells that are in the area serve the Chugiak Benefit Associa<on (PWSID 214586) at ≈725’. With that, it’s my understanding that the Drinking Water Program (DWP) does not have coverage nor is a Separa<on Distance Waiver required from the DWP for the sep<c tank replacement for MCKINLEY HEIGHTS #1 BLK 6 LT 4. As an aside, let’s recall that groundwater wells must be either maintained in a sanitary condi<on or properly decommissioned. Please let me know if you have any ques<ons. Thanks, T.W. Brannan, P.E. Engineer I, DEC Alaska Department of Environmental Conservation EH | Drinking Water Program | Engineering OFFICE 907.269.3076 | FAX 907.269.7650 555 CORDOVA ST. | ANCHORAGE, AK 99501 dec.alaska.gov/eh/dw Chat with me on Teams From: Dea Duffus [mailto:dea@arcterra.net] Sent: Thursday, December 3, 2020 2:39 PM To: Brannan, Thomas W (DEC) <thomas.brannan@alaska.gov> Cc: Wockenfuss, Deborah M. <deborah.wockenfuss@anchorageak.gov> Subject: Well classifica<ons TW We are working on getting a new septic tank permit from the MOA for McKinley Hts #1 Blk 3 Lot 5. The MOA files show there is a partial report that is referenced as “2000 ADEC spill” that shows water sampling from wells on the following lots: Swanee Slopes (SS) Lot 6 Swanee Slopes (SS) Lot 8 McKinley Hts Blk 3 Lot 1 We visited the site and found the area is used as commercial storage for Golden Wheel Amusements carnival ride equipment. A document search of both the MOA on-site system and the state WELTS files did not produce any information on any of these wells. The well on Lot 3 SS is capped at grade and speaking with the owners they stated it is not in use as it may be contaminated. The well on SS Lot 8 could not be found and again the owners they stated it is not in use as it may be contaminated. The well on Lot 1 McKinley Hts. is cut off and capped about 12” above grade and again the owners they stated it is not in use as it may be contaminated. The MOA is requesting something from ADEC stating that these wells do not need the 200 foot protective well radius from our proposed septic tank location. The existing tank was installed in 1984 and we are replacing it with a new plastic tank in the same location. The current location of the tank is more than 140 feet from either well. I have attached our proposed tank replacement design and the referenced well sampling report noted above. Your prompt attention to this matter is greatly appreciated as our client needs to replace the tank as soon as possible. Dea Duffus ArcTerra Consulting, Inc 907-696-6111 dea@arcterra.net Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201305, Rebecca Carroll, 12/18/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201305, Rebecca Carroll, 12/18/20 Municipality of Anchorage :•_�� ' „ Development Services Department -, Building Safety Division •L , , " On -Site Water and Wastewater Program, 4700 S. Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 Page I of p� www.ci.anchorage.ak.us (907)3417904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. W0a6y3 PIDNumber. os -ata-a3 Na",Kc wood Wastewater System: ❑ New ❑ Upgrade MA171193 L<)N a ABSORPTION FIELD �Q` I ^ wme•ra9etreem, � pr.One O 03-6619 o `� ODMT� Os,uuor L«rtl Oeea D OOmer LEGAL DESCRIPTION sod Rada Tatm Depen tdn r. p " F t. 3 Lot: S.E' ( elcdc }5 CNhfA •/t n D"thWp"10" irov"I grade: an Ga "h aal pip•: J i \ FI Ta n,hiP: Range: Sada n FA added d pee grade:Gael Lenrh o F. Ft. Well: New Upgrade Garel niQk \ N.mGr a e•: Dutanca eerween pna: Fl. FL , A, 9.J� TD•pc 1'90F CM m: Tiawn • x P alanatC•aaai!¢ticn TI Tilt C Ft Ft' DNler SL, 11; fey D e 0 Static Watd levet Yea"ner. Dale hare¢ a F, Y:•id:P 1 u Dairy wqd Amro Gana a K GPhI f /i 0 W YJ FL FL SEPARATION DISTANCES DSepr Holding 0S.7.E.P. ❑other. To Septic Absorptionj Lift Holding Pubriciprivat 1 From Tank Field Station Tank Sewer Line Gal. Yle9 ' d L I o L 1 Di — a 5 Wtariat Mmita cl CanFrreda' Sugd,Water Io-. too" foo'+ L N La Lira 61 S e MxMacue It R , Gd. C , L Pnq df l,re 'Poop Wx l sh ver alam at. Fanddsn I ft I.e / L� in N. Pare Na1a d a•M :Y.kv hapecLdnf pedcm Ca in Drain NO *I e, Villa — R•na:a BENCH MARK Loam and Deaanium Aawr.,a E.ew:¢a R Egir ^' Oi C; S L S ENGINEERING Eagle River Loo Road, No. 204 P.e�• ,. r 17034 Dates: 1" Inspections performed by: 9 Eigta River,Atnk"957� Lh « •••• ✓,••• 2nd j ... ............. t7,�t.•n+..... at Development Services Department Approval �jpt��. ROBERT G COWAN CE i Reviewed ✓, "*-�-7 Date:L 1 L%- LV2 -880V tt and approved by: . PERMIT No.;M020432 PACE 2 OF 2 Municipalit of Anchorage DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 *Anchorage, Alaska 99519-6650 • Telephone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 5, BLOCK 3, MCKINLEY HEIGHTS #1 P,1.0. No. 051-212-23 4" STANDPIPES (EXISTING SEPTIC SYSTEM) EXISTING � OaR/�n ANG _ i/ �ONs0At ;.I ` AD 55 1NEW WELL APPROXIMATE LOCATION ��' OF EXISTING ORAINFIELO LOT 6 SCALE: V - 40' y � ROBERT C. COWAN ycy;:� CE -8801 Catifteb )3rittilly log y DOC CO eb• SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2750 OWNER OF LAND: K IFJ L -J a 9 p ADDRESS: LEGAL DESCRIPTION: -d At -k. 3 .%•- DATE: —.jMrCoZy PERMIT NUMBER: fQ ,,�Datte of issued—>— �-42 v TAX IDENTIFICATION NUMBER: / Is well located at approved permit location? 4 -Ws- ,.j No Method of Drilling: r rotary U cable too[ Depth of well: tk Z% Casing Type -EL-Wall Thickness J 4W0 inches Diameter to inches, depth 3&- feet Liner Type: A) t t4-Jc Casing Stickup Above Ground: feet Static Water Level: /4 feet Recover Rate: tow Method of Testing: J�6 n - Well Intake Opening Type: J open end 4'Spen hole :J Screened; Start feet Stopped feet U Perforations - Start feet SlDpped feet Grout Type:,L—•J ia'J TE cV•oluume S'� �j asZ Depth: from D feet, to 2 C feet t Well Disinfected Upon Completion? u Yes No Method of Disinfection: Comments: ne HULt UAIA r-! -L-WC ST/L4c� P V FCr3 JQ� w &J /�eNl,�1GC �jcQn`�w c j1z'A »z Driller's Name t" x" 4 ATTENTION: It Is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health 8 Human Services and/or Department of Environmental Conservation. Matsu Borough: Department of Environmental Conservation. TO/TO 39vd NdAI-IYIS 65LL889 TO:00 6661/10/10 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WATER SUPPLY PERMIT Upgrade Permit Number: SW020432 Legal Description: MCKINLEY HEIGHTS 111 BLK 3 LT 5 Design Engineer: 0003 S & S Engineering Owner Name: Kevin Wood Owner Address: PO Box 671193 CHUGIAK , AK 99567-1193 Date Issued: Oct 22, 2002 Expiration Date: Oct 22, 2003 Parcel ID: 051-212-23 Site Address: Lot Size: 42689 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: (__] Disposal Field ❑ Septic Tank ❑Holding Tank ❑Privy ❑✓ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by catling (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. /0/23/02 Q/4' S140u'q/t/ wwNT1 ro movE rue, wea Smrro ApFRosttMNrE`r., 0 r r0 rkrz- S owri/ 1 E-tsr ox rHE 6x/Jr/et,& WELL, HE Sri rcr TNAr TKE 5/Tr- WE t.Ea- ()PI0PO19-0) wqS ro OE Alm-LEp c4owl4gT BE R ccISSr-p, Received By: Issued By: 2. Date: /a/1Z�Oz �f • Date: IoI2 2 t� Municipality of Anchorage . _ -• beVelopmeht $etVices bepattmeht building Safely Division On -Site Water and WasWialer Program 4700 South bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchotage.ak.us (907) 343-7904 ON-SITE SEWERMELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 6's1 - Zt z— Z3 Permit Number SW 0204.32 Properly owner(s) K V 1 SbQ OD Day phone Vont– 0�019 Mailing address (1) e.0 , box. 4 Mailing address (2) C41 AY. � Zip Code (o �+ Legal description (Lot, Block & Sub'd.) _"k Legal description (Section, Township & Range) Lo[Size- A -4 4-'h u f54•F • Number of Bedrooms 3 11 THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Not Tub Swimming Pool Therapy Pool 0 Well Only 0 Water Storage ❑ ❑ Jacuzzi ❑ ❑ Water Softening Unit ❑ El I certify that the above information is correct. I further certify that this application Is being made for a Single Family bwelling and Is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: 1 S` 0• `' Date of Payment receipt Number: (Rev. 12100) 10 /;- -z- 0 O g -7 Si— Waiver Fees: _ Date of Payment receipt Number: S & S ENGINEERING Eagle River, Alaska 99577 S& IEALTHAUTMONTY APPROVALS SEWER ILWATER TAAINMENSIONS SEWERS WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELLNSPECTION 6 FLOW TEST SITE PLANS ROADDESIGN SOIL TEST PERCOLATION TEST STAL CTURAI S AECHANIM INSPECTIONS ONSITE WASTEWATER 06POSALSYSTEM DESIGN e)zl?IG ROBERT C. COWAN, P.E. CML ENGINEERS (907)694-2979 October 18, 2002 FAX(907)694.1211 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 5, Block 3, McKinley Heights SID #1 It is requested that you issue a permit to install a well to serve the existing three bedroom dwelling on the referenced property. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed well. The construction of this well will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/jhm Enclosure 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER. ALASKA 99577 SITE PLAN DESIGN t" _ 0 w a M —11 G! e�' o b "i \\ ;� Q \ \ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I' ENVIRONMENTAL ENGINEERING DIVISION 825 L Street. Anchorage, Alaska 99501 Telephone 264-4720 \ ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME - PHONE W A "LIZ 2694 UPGRADE MAILING ADDRESS 0, O 14,3 , LEGAL DESCRIPTION �T S13Le. ,7 .V'ila, r/f73r -'14-/ LOCATION r c NO. OF BEDROOM DISTANCE T0: Wellsorption area f Dwelling l 7r PER O _Y E2 Manufacturerc M. r' y No. of compartments H ' ' Liq. c p n in allons IF HOMEMADE: Inside length Width Liquid depth d Y DISTANCE TO: Well Dwell in PERMIT NO. JZZ _— F Manufacturer Material Liquid capacity in gallons a W {a DISTANCE TO: WellFoundati �" y Nearest lot 1 ne PE HM ) NAL U. No. of lines Length of a Total length o % Trench w. hmM Distance, betwe es F. V inche 1. Q Top of tilg/o finish grade ! Material beneath lila Total effegLi 3 bsorpyAn area a /J.SL'L, n inches S Length Width PERMIT NO. W tpepth Qa F- W 1 Type of crib Crib diameter Crib depth Total effective absorption area Q) DISTANCE TO: Well Building foundation Nearest lot line J Class Dpth o0riller Distance to lot line PERMIT NO. J DISTANCE TO: uilding foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS YG _ E SOIL TEST RATINCi._��/�� INSTALLER 1ni ' REMARKS 1,9f33G7t� r 4k . LI:TTA-r1 a,1 N u ar- J*.�j 51 i ....r � z' floor 11572 -/I APPHOVED fofto�HT 'DATE 71 72-01 (Rev. 3/78) ,PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: r-. MUM I C I F='AL I TY OF ANC"CIFtiACGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, A); 99501 264-4720 O N— S I T E 840549 07/06/84 GERALD E (GARY) MOON P O BOX 670430 CHUGIAK, AF; 99567 694-2885 E3EWF=Fi F}EF:M I T LEGAL DESCRIP: SUBDIVISION: MCKINLEY HEIGHTS #1 LOT: 5 SECTION: 16 TOWNSHIP: 15N RANGE: 1W LOT SIZE: 44756 (SQ.FT. OR ACRES) LOT LOCATION: AMONSON ROAD MAX BEDROOMS: 2 Listed below are the options available to you system. Choose the option that best fits your - - - - - - - - - - - - - - - - - - - - - - - T R E N C H DEPTH TO PIPE BOTTOM (FT.) 4.0 GRAVEL DEPTH (FT.) 5.0 TOTAL DEPTH (FT.) 9.0 GRAVEL WIDTH (FT.) 2.5 GRAVEL LENGTH (FT.) 17.0 GRAVEL VOLUME (CU.YDS.) 8.6 TANK SIZE (GALS) 19000.0 ** SOIL RATING (SQ.FT./BR) 85 � .�^ ef^" BLOCK: 3 in designing your septic site. X�1. W. DF:;AIN - - 4.0 �Z 3.5- 7.5. 5_0 19.U 14.0 1,000.0 85 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set, forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 2 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND ELECTRICAL WORE: MUST BE DONE BYALICENSED ELECTRICIAN. SIGNED �- -Ld�__ ��-----DATE:------------ APPLICANT: GERALD X (GARY) MOON ISSUED BY -------- DATE: / -------------- -- /� CODES, AS-BUILTS (3) THE MUt•.I :_ Ir'�IL I TY :JF t=it.e�1-'_"`=:i�:_,C ' DEPARTMENT L. HEALTH AND ENVIRONMENTAL + ..!TECTION gk IL Cf 025 'L` TTREET n"o" i^FGE AI' 99ci+1 264-4720 ANCHORAGE 694-2131 EAGLE RIVER C:t. -=ITC =•CY tCr: ^: WELL ( C=RY7 I T PERMIT NO. 02iOG3 APPLICANT: GREY MOON PHONE: 694-28= ADDRESS: PO BOK GIGA CHUGIAh, AK 99577 LEGAL DESCRIPTION - SUBDIVISION: MCKINLEY HTS CLOCK: 3 LOT: LOT SIZE 0 SQ. FT. TOWNSHIP: - RANGE: - -SECTION: - HAIX,1HUM NIJMDEF: OF BCG^OOH'Y-S = 2 SOIL EATING = 35 35 05 (S!:. FT. /BF,') LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOU IN DESIGNING YOUR SEPTIC S STCH. CHOOSE THE OPTION THAT BEST FITS YOUR SITE. T(__EY-.1:_ 1-1 LSC-. I 1=-1 t•J - - - - - - - - - - - - - - - WIDTH = 2.5 FT. LENGTH = 17.0 FT. TOTAL DEPTH = 9.0 FT. GRAVEL DEPTH 5.0 FT. GRAVEL VOLUME = 0. 6 CU. YDS. TANK SIZE = 1, 000. 0 GALLONS (TWO COMPARTMENT TANK) E: C- C- !E: I :fit. WIDTH = 12.0 FT. LENGTH = 24.0 FT. TOTAL DEPTH - 5.0 FT. GRAVEL DEPTH - 0. J FT. GRAVEL VOLUME = 10.6 CU.YDS. TANK 'SIZE = 11000.0 GALLONS (TWO COMPARTMENT TANK) 1,11 I C, C I t-4 I- I CLC? E> E — I :=i t-. WIDTH 5. 0 FT. LENGTH = 20. 0 FT. TOTAL DEPTH = 7.0 FT. GRAVEL DEPTH 1.0 FT. GRAVEL VOLUME = 12. 9 CU. YDS. TANK SIZE = 1,000.0 GALLONS (TWO COMPARTMENT TANK) I CERTIFY THAT: 1. I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THC MUNICIPALITY OF ANCHORAGE AND THE STATE OF ALASKA. 2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES AND HAVE RECEIVED A COPY OF THC CODE SUMMARY AND DIAGRAM ATTACHMENTS WHICH IS PART OF THIS PERMIT. _. I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF.THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 2 BEDROOMS. PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM PERSONNEL DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE HUMOER OF RESIDENCES THAT THE WELL WILL SERVE. IF A LIFT STATION IS INSTALLED. AN ELECTRICAL PERMIT AND INSPECTION MUST CC OBTAINED. RS-CUILTS CANNOT CE APPROVED WITHOUT AN ELECTRICAL INSPECTIOJ REPORT. THE ELECTRICAL WORE; MUST CC DONE BY A LICENSED ELECTRICIAN. SIGNED APPLICANT: GAF": MOON ISSUED C+': --- DATE: 12,'12133 �.a Permit MUNICIPALITY OF ANCHORAGE Department,`` Health and Environmental-rotection L� 825 _ Street, Anchorage, AK. .j501 310 264-4720 #� fig * * * HANDWRITTEN PERMIT * ` WELL AND/OR ON-SITE SEWER PERMIT Applicant: (r yy //we, Mailing Location: Legal Description: %o % S 13/- 3 Type of Soil Absorption System Is: Trench: X Drainfield: _ Maximum Number of Bedrooms:, The Required Size of DEPTH _ LENGTH G' Address: j',(� /3x �/V/7 . Phone Number: Lot Size: Seepage Bed: Holding Tank: Soil Rating(sq.ft/br) (8.S the Soil Absorption System Is: GRAVEL DEPTH S 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(HOtDtNG) TANK SIZE _ 10C' O 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 M INSPECTIONS ARE REQUIRED Backfilling of any system without final inspection and approval by this departmen will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fee 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 3 I certify that: (1) I am familiar with the requirements for on-site sewers set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I underst nd that the on-site sewer system may require the resi nce is modeled to include more that 3 edri Signea: X , ,Issued by: Applicant � � Date: [5j" SWP/024(1/81) CIL, J, ,L2r•(�lt SD (,lird�r S rr and wells as if SOILS LOG MUNICIPALITY OF ANCHORAGE • ++1 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ! PERCOLATION 'f\ TEST 1 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: C h AaR Y / I tbn rsl DATE PERFORMED: b — I LEGAL DESCRIPTION:_ Le7-r S I;LK. /77 CK/A/LEV NTS, DEPTH bk SLOPE SITE PLAN (FEET) O 0P-6 aN IC 1 G}� � CL/4YEY 2 SNNOY (0 2:f ✓�L 3 Date or gt qal . Net Time o 1P Net Drop 4- a h;�d10 5- 5 ,v a % W 17 o es/R4R 6 O % • 7- i �i Robert A. Shafer 'c1% . NO. No. 1457-E �',e 8- 8 e�p ez,pROtcc�O��'�'�e►� 9- 910 10- r vZ� 11 , o 12 U 13 Berm, . aF vbt.0 14 15 Date or gt qal . Net Time Depth to Water Net Drop is a h;�d10 17 ij ... :... O % • 18 i �i Robert A. Shafer 'c1% . NO. No. 1457-E �',e 19 e�p ez,pROtcc�O��'�'�e►� WAS GROUND -. I ■■■■■■..•� ENCOUNTERED?■■.'�i�■■■ ■■■Epp IF YES, AT WHAT �Fw--NNEENN Edo ■■■■■■■ Reading Date Gross Time Net Time Depth to Water Net Drop 20 lul PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS PERFORMED BY:="t�tti��'r CERTIFI 72-008 (6/79) /-. TO IAT SUBJECT LL. \ (lr3 , u DATE 0 Ch65o�F5�o>•J AREA i csc4a`. �6P't�l q , D- `s , PLEASE REPLY TO SIGNED i 1-4 P P 2oyEQ \ o [Inn' DATE T[ 01 \ Q `1—i I SIGNEj Reddprm e 4S 4169 SEND PARTS 1 AND 7 WITH CA"ON INTACT. Pd' r,, 150...u.<, PART 7 WILL RE RETURNED WITH REPLY. r February 71 1980 Leanore Smith -Miller Box 333 Chugiak, Alaska 99567 Subject: Lot 5 Block, 3 He Finley Heights Subdivision Dear Ms. Smith -fuller: A representative from this department wrote some sever upgrade specifications for the above subject property. A permit was not issued and as far as we know, an upgrade was not performed. On December 19, 1977, an excavator working on the problem called this department and advised us there was not a tank on location. If there are any further questions, please contact this office at 26444720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw AT SUBJECT /l, v/V DATE 1;211417 ....... _-.. .. SIGNED ._I_:%�il �_/.�jOT.-.'... J. ✓ 1 zco - ._ �1 - J�"-� - DATE H Ad,11 rm 6 aS 469 SIGNED SEND PARTS I AND S WTTII CARBON INTACT. PART S WILL RE RETURNED WITH REPLY DETACH AND FILE FOR FOLLOW UP S 'pop-- g' S 2.1 1 • "�. � r,�onsEzucElon �L1E ..Lkv F` � n (O • "Ou u,r b ronb � �houaed oprnlon�' 2204 Cleveland Anchorage, Alaska 99503 Performed For h'.'//%n nom, Date Performed /.Z— /3-7 Lenal Oescrintion: Lot_ cLBlock_3 Subdivision 1/4 This Form Renorts Soils Lon lid s Percolatio Tes _ Denth Feet 2 — r" 4- 6- 8- - 6- 8- 10- 12- 14- 16- 18- 20— 10- 12- 14-16- 18- 20— �ztvy;y C: !�c •�� /)C% -1;z: k /_5- 6011 - tics tics Was Srounl Water Encountered? 4 c If Yes, At what Denth? Readinq I Date I Grnss Time MMMM fit• Net Time I Depth to H2O I Net Oro Percolation Rate Minute Prnrosed Insta at on: Seenaae Pit Drain Field Depth of Inlet Dept o ottom Of Pit 0 C t H N E N T S : `%C' 5': f-4 7i-7'777 of f,: ,-rte " 11 � e x., ice-. Test Performed By !<- �/� + _ Data Certified By: Date: MUHNUPDAUTY OF A HCHO QGE 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. 051-212-23-000 Expiration Date: Legal description MCKINLEY HEIGHTS #1 BLK 3 LT 5 Site address 18688 AMONSON RD Chugiak AK 99567 12/1/2023 Current property owner(s) CARTER KEVIN R 50% &CARTER ERMA REA 50% X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 8/31/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA ApprovaLJune 2022 MUMUPAUTY OF ANCHORAGE AI '(. 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. 051-212-23 Complete legal description McKinley Heights #1 Block 3 Lot 5 Location (site address) 18688 Amonson Rd. Chugiak, AK Current property owner(s) Kevin & Erma Carter 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 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 V Plastic ❑ Concrete ❑ Fiberglass Age 0 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench © Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ _5 50 Date of Payment COSA # /-ZS-7 Waiver Fee $ Date of Payment Waiver # COSA Application—June 2022 Legal Description: McKinley Heights #1 Block 3 Lot 5 Parcel ID: 051-212-23 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ✓❑ Well log is filed with Onsite (or attached) Date drilled 10/22/02 Total depth 180 ft Cased to 38 ft ❑✓ Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 20 in. Date of flow test for COSA 8/4/23 Static water level at beginning of test 27 ft. Comments B. TANK DATA Measured operating fluid level in septic tank New Date of pumping New Tank 5/22/23 ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 7/14/84 F ALL standpipes present per record drawing Total measured depth from grade 9 ft (max) Measured depth to pipe invert from grade ft (min) FV1 N/A — pressurized field. ❑ Per record drawings, field is insulated - W/ 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/Deficienc COSA Checklist June 2022 Well production at time of test 1.8 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ❑✓ No © Coliform bacteria is Negative Nitrate 3.46 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L 0 Arsenic less than MRL (ND) Collected by Arcterra Consulting Date 7/28/23 C. LIFT STATION ✓❑ Required maintenance completed Age of lift station 0 years Lift station material Plastic Comments: Adequacy test date 8/8/23 Results ❑✓ Pass Fluid depth prior to test 0 in Water added 550 gal New fluid depth 0 in Elapsed time 10 min Final fluid depth 0 in Absorption rate 450+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 24 in Effective depth used 0 in Effective depth remaining 2.4 in 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' J❑ Yes if No Community Sewer Manhole/Cleanout > 100' ✓❑ Yes if No ft ] Yes if No Neighboring Tank > 100' © Yes if No ft Private Sewer/Septic Line > 25'�/❑ Yes if No Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100'✓❑ Yes if No Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ❑./ Yes if No Yes if No ft ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ✓❑ Yes if No ft ❑✓ Yes if No ❑ 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' J❑ Yes if No ft Surface Water > 100'❑ Yes if No Tank to Property Line > 5' 7 Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ✓❑ Yes if No ft Private Wells > 100' © Yes if No Water Main > 10' V/ Yes if No ft Community Wells > 200' ❑✓ Yes if No Water Service Line > 10' Q Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS ft ft ft ft ft ft ft ft 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 Arcterra Consulting Phone (907)-696-6111 Engineer's Printed Name Kenneth Duffus Date 8,/.e/`3 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. 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, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. COSA Checklist June 2022 Municipality of Anchorage Development Services Department Building Safely Division i On -Site Water and Wastewater Program 4700 South Br9951 St. Anchorage, Box 196650 chorage, AK 99519-6650 www.cf.anchorage.ok.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-212-23 1. GENERAL INFORMATION HAA # RA o 2 o S 7 1i Expiration Date: 2 - - O 3 Complete legal description T,n f 5 - 111 rick 4 - MclU ril ey Nei ht, g 61 Location (site address or directions) 18688 Amonson Chuoiak Current Propertyowner(s)Kevin Flood Day phone 688-0619 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address PO Box 671193 Chuoiak. AK 99567 Day phone Gary rParhnrdr Day phone )42-4?44 Unless otherwise requested, HAA will be held by DSO for pickup. —AW2 LrZn_ M If f / d -t- 2. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Q{ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Individual On-site a Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Cerliricates of Health Authority Approval (HAA) based only upon the representatlons given in paragraph 5 by an Independent professional civil engineer registered in the Stale 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 less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certifieales are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and Slate codes, ordinances, and regulations in effect at the time of installation. NameofFirm S 5 S Fripineerino Phone 6Q4-2g7Q '-Address 17034 N. Eagle River Loon Ste 204 Eagle River, AK 99577 Engineer's Printed Narne Robert C Cowan Date )f /as-/UZ OF 5. DSD SIGNATURE ` �p ROBERT G COWAN Approved for _bedrooms. f+± c,;CE-88oi Disapproved. tt141%r.... 1` �4�7 �� ►�Y1 Conditional approval for bedrooms, with the following stipulations: Additional Comments this property meets existing State and Municipal Codes. There are nitrates present. It is suggested that periodic testing be performed to insure the we s con rnue sura r ) Carmnt-nitmteeeneentr-ationis5Omg.4 NInre information on nitrates is available from the On -Site Services Program, at 343-7964. Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory _x Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: 0 a -- )fie+ 1.^MM) �^ Municipality of Anchorage Development Services Department Building Safety Division �- Onsite Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 9951M650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ZPT!57- a&y- Parcel A. WELL DATA Well typel,- If A, B, or C provide PWSID # = Date completed' 'f oz- Sanitary sea! (YIN) Total depth 191ft. Cased to -,!'0 ft. FROM WELL LOG Date of test 0 kii O Z 10 Static water level /"5( ft. Well production o, g.p M. WATER SAMPLE RESULTS: Coliform _("�colonies/100 ml. Arsenic: •'? mg./I. B. SEPTICIHOLDING TANK DATA Well Log (YIN) Y Wires properly protected (Y/N) Casing height (above ground) In AT INSPECTION /O _L 0. tio0 _ 9 P,m. Nitrate- 0 mg.A. Other bacteria _47 colonies/100 ml. Date of sample:WoZ ,Collected by: ��iwiliv G/N(�f�i✓G- Tank Type/Material e4�prle,-71w Date installed 8� Tank size 14W - gal. , Number of Compartments y Cleanouts (Y/N) y Foundation cleanout (Y/N) Y Depression over tank (YIN) High water alarm (Y/N) Date of pumping _ 11410Z Pumper �T2' S C. ABSORPTION FIELD DfTA Date installed -`-t= Soil rating (g.p.d.lft2 or ft'/bdrm) System type 5 %V 77Z,( -v L rt Length 4 7?- ft. Width S ft. Gravel below pipe ft. Total depth 5 ft. Eff. absorption area �` ft' Monitoring tube y Depression over field 111 Date of adequacy test 164492, Results (Pass/reit) J9L For 3 bedrooms Fluid depth in absorption field before test _L in. Water added�al. New, deepthL in. Elapsed Time:�o min. Final fluid depth Q in. Absorption rate >= 4L D g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed % 4 Size in gallons 3V<::1 "It Manhole/Access (YIN) 'Pump on' level at E4 in. 'Pump off" level at,,/4f in. High water alarm level at S -Z- In. Datum /04 Oc /`?ter! h/ , Cycles tested Meets alar & circuit requirements? Y E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot lop t On adjacent lots /00 r Absorption field on lot �t70 r �` On adjacent lots /4r) -e> fi Public sewer main ^J Aq Public sewer manholelcleanout ice_ i S4- .er/septic service line Z .F Holding tank N SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation S /�- Property line :: S Absorption field /U Water main '" Water service line /O 4- Surface water /[7l�p r Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /O r� Building foundation /0 Water main ^A Water Service line r -L4- Surface water. l� /y Driveway, parking/vehicle storage �'/O_fi Curtain drain ' �L1�EN/ Wells on adjacent lots /00 r �` F. COMMENTS al all, � �� r AWL 57211V11W� G. ENGINEER'S CERTIFICATION .� �(c OF q( I certify that I have determined through field inspections and T :: review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. 'r •• .:.. y��' Engineer's Printed Name 1Q6136,0 -;-C- J wA.J i ROBERT C. COWAN Jti / CE -8801 Date IfJ •},,,, HAA Fee $ _ 37S - Date 7S - Date of Payment t /ro. •- s H 11/17/DZ- Receipt /l7loZ Receipt Number C a tr 100 n� (Rev. 12/01) l v Waiver Fee $ Date of Payment i/ h'Y /a -2- Receipt Receipt Number r7 :IS IS -C, 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.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Health Authority Approval # 020574 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block 3, Lot 5 of McKinley Heights #1 subdivision, the well's productivity was determined to be 0.60 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. ROBERTC. COWAN, P.E. ROBERTA. SHAFER P.E. CIVIL ENGINEERS (907)694-2979 FAX(907)694.1211 November 13, 2002 MUNICIPALITY OF ANCHORAGE 10"" Development Services Department APPROVALS P.O. Box 196650 Anchorage, Alaska 99519 SEWERAWATER MINE%TENSIIM8 REFERENCE: Lot 5, Block 3, McKinley Heights (# 1) Subdivision Request you grant the following waiver for the existing 3 bedroom house on the referenced property: a waiver to 1 foot for the separation distance from the SEWERS WATER NSPECnON existing lift station and the northwest lot line for the above referenced property. The lift station was installed in 1984. We request a waiver for the separation distance between the existing lift station and the northwest lot line at 1 foot. ENDNEERM6STUDIES ANDREPORTS We do not anticipate any adverse effects on the neighboring properties by the granting of this waiver. WELLINSPECTION S ROW TEST If you have any questions, please contact us. Sincerely, SIZE PLANS l Robert C. Cowan, P.E. RCC/mjc TOADDEMN SOIL TEST PERCOLATION TEST STTRNCTUTALS WOWACAL NSPECnONS ONSITE WASTEWATER OtSPOEALSYSTEN DESIGN 17034 NORTH EAGLE RIVER LOOP 4 SURE 204 • EAGLE RIVER ALASKA 99577 Anchorage �o 1N1U11iei alit NT of Ane1101Mge !sem A ., All -America City I3uilditig Sufety Division George IC 115rcrch. Mayor 2002 11/14/2002 S & S Engineering 17034 Eagle River Loop Rd. #204 Eagle River, Ak. 99577 Subject: Waiver Request for 1 foot separation lift station to lot line Waiver Request # WR02C OF 7 Parcel ID #051-212-23 McKinley Heights #1 Block 3 Lot 5 Dear Engineer: Your request for a waiver of the required 10 feet horizontal separation from the lift station to property line has been approved. The approved separation distance is 1.0 feet. This waiver approval applies to the existing lift station to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Jeffrey W. Poet Engineering Technician On -Site Water & Wastewater Program P.O. Nix 1 iG50 • Anchorage, Alaska !1`).519-6650 • Telephone: (917) 343-8301 • I .-M (!X)7) 343-82(X1 47(X) Smith Iiragaw Slrecl • Anclioragc, Alaslut 10507 it I p://�����r.ci.andurcal;c.alc.us Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program • J� 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchomge.ak.us (907)343-7904 WR#:20 0087 PID#:051-212.23 Date Received: 11-13-02 Waiver Review Worksheet HA#:020574 Permit#: 020432 Legal Description: McKinley Heights #1 Block 3 Lot 6 Engineer. S & S Engineering 17034 Eagle River Loop Rd. #204 Eagle River Ak. 99577 Applicant: Kevin Wood Waiver Requested: 1 foot separation lift station to lot line Criteria: Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Points: .............................................................•................I Waiver Is Granted: t✓ Waiver is not Granted: List Conditions or Reasons for above: Date: / / N - O 2 By: ! a of Revie er .......................................i .... ................................1 Rec#: 1143-02 Amount: $150 Date Paid: 11114/2002 I AMONSON ROAD 4 L- m. F!w tt�GZL LOC. i¢onr� eY s f s C lIl rZ/OZ p SWANEE COURT T 01 S A A mm can 0 U O 4 p N CP Me a g c�0n rn z V� 10 A -ad t-,3 r3 y U� cJs E r4 f111210 21 m 1 A n N m C r :4 to s m m z S/F� MOA f A -ad t-,3 r3 y U� cJs E r4 f111210 21 m 1 A n N m C r :4 to s m m R r RTn! 8— C—!ns `-4 nn:nn 3'11 nn•TT'!n .-ate a� 3�m 'nnm "vwnn'w- ?Rv— sr91 R9:. !nfi n+? ac:9n ?i.i. nn •••._� . .; 7 •: `: _ NO ins 0 | ; Ul s s e. 0� e IS #k@ ��| k e/ cli � \ � ; • _ kk ` � §| � •' MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services I AL SLR"kl O)v)!)U" On -Site Services Section 04 P.O. Box 196650 Anchorage, Alaska 99519-6650 OCT 2 41996 343-4744 CERTIFICATE OF HEALTH AUTHORITY jZECE�V.E� APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # �S�- a \;�l -'q,� HAA # 1. GENERAL INFORMATION Complete legal description Lotf; Bloch 3; MaKin.PeN Heights Of Location (site address or directions) NHN Amoneon Chugiah AK _Property owner Gaty (loon Day phone 694-2885 Mailing address P.O. Box 770429 Eagee RiveA, AK 99577 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest - Ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(RW.1/91) From MOA 121 S.- STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below investigation of this Health Authority Approval application shows that the on -sl and/orwastewater disposal system is safe, functional and adequate for the number of bedrooffl/ and type of structure indicated herein. If urther verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations In effect on the date of this inspection. Name of Firm S 8 S ENGINEERING-7'pPhone ��' y 3` 17034 Eagle River Loop Road No. 204 Address Engineer's signature Date 6. DHHS SIGNATURE Approved for T bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Addltiorial Commer&te: The well for this property meets existing State and Municipal Codes. There are nitrates present. It is au2vpsrpd that a perindip r cring+ hg performed to insure the wells Conti d suitabil47. Nitrate concentration is 7.56 mg/1. EPA By:. 1`� %l''�2 ��C'<"'�—' Date./O 0 g CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority R A� Certificates based only upon the representations given in paragraph 5 above by an Independent P!.0Wonnl engineer registered In the State of Alaska. The DHHS does this as a courtesy to purchasers of homes tltol�br!ding lnstihrtfons in orderto satisfy certain fed' eral and state requirements. Employees of DHHS do not kspeet{orrs or analyze data before a certificate is issued. The Municipality of Anchorage is not *errors oromissions In the professional engineers work. LMW*&V a, i Municipality of Anchorage -�, DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 9 (907)-M'S4"aY Of ANCHUXAUt: ENVIRONMENTAL SERVICES DIVISION Health Authority Approval Checklist OCT 2 4 1996 Legal Description: Lor 51 6 aco , 3, IncKdLeY Parcel I.D.: Ncifwrs S/o u RECEIVED A. WELL DATA Well type Pq rJATC It A, B, or C, attach ADEC letter. ADEC water system number r//A Log present (Y/M tjo Date completed Avaae,c I417Z Total depth U• k . Cased to y o'+ Casing height (above ground) Sanitary seal (YM) Wires properly protected (YIN) A- vleKX la FaacArs FROM WELL LOG AT INSPECTION Date of test iQPPRoX 1972 10/1' AG Static water level V • k • 15, Well production V. k . g.p.m. 3.3 g.p.m. WATER SAMPLE RESULTS: Coliform C7 Nitrate 7•6L Other bacteria Date of sample: Collected by: S i- s E4Gi0eaadG B. SEPTIC/HOLDINGTANK DATA Date installed ?-/`I-84 Tank size 1 006 Number of Compartments Z Cleanouts (9/N) Yc-s Foundation cleanout CVN) YES Depression (Y/6) fro High water alarm (1Q WO Date of Pumping to-2.-qb Pumper JK 90MP)rJC. C. ABSORPTION FIELD DATA Date installed -7- I Y --S4 Soil rating (g.p.d./ft` or tz/bdrm S57 System type 04Al0FjeL0 Length %17 � Width 5 Gravel thickness below pipe - r Total depth 5'— L Effective absorption area 335 Monitoring Tube present (2/N) SEs Depression over field (Y4 &b Date of adequacy test 10-11-11 Results (Pass/Fail) QAu For 3 bedrooms Fluid depth in absorption field before test (in.); */Y p Immediately after yso gal. water added (in.): 20�r Fluid depth 6 t (ins) Minutes later: 15 en J. Absorption rate = HS + g.p.d. Peroxide treatment (past 12 months) (Y/0) d o oa KN,✓r1 If yes, give date 72.026 (Rev. 3/96)' 4 $Ys -mm c-HAavG PR%eC TO Tyr 6Y JS C- eF QESIOENCE. D. LIFT STATION Date installed Manhole/Access (Qt'N) -7-IN-8y Size In gallons "Pump on" level at* 54' "Pump ott"level at* G4't High water alarm level at* Sz" •Datum Tar . at Am 11..a: Cycles tested 2 E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: e ti olding tank on lot I o S t On adjacent lots Absorption field on lot t �� On adjacent lots loot -1, Public sewer main Public sewer manhole/cleanout Sewer/septic service line ZS rt Lift station Ieott SEPARATION DISTANCES FROMISEPTOHOLDING TANK ON LOTTO: Foundation is 1+ Property line tot Absorption field Sst+ Water main/service line to t+ Surface water/drainage t oo1 - Wells on adjacent lots toot•+-' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line to Building foundation 45t+ Water main/servico line I o'+ Surface water Icat Driveway, parking/vehiclestorage area I35t± Curtain drain r4 /A Wells on adjacent lots 70014 F. ENGINEER'S CERTIFICATION _„MWEX„A� . I certify that I have determined thru field inspections and review of Municipal in conformance with MOAHAA uidelines in effect on this date. Signature Engineer's Name / /ac Date HAA Fee Date of Pa Receipt Nt 72-026 (Rev. 3/96)' Waiver Fee $ Date of Payment Receipt Number ROBERT C COWAN CE•8f301 @' Y.._. are +� MUNICIPALITY OF ANCHORAGE' DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL+ a "o OF ON-SITE SEWER AND WATER FACILITY 264-4720 + �Applieation Date June 27,' 1986 t. GENERAL INFORMATION (a) Legal Description (include IoL block, subdivision, section, township, range) Lot 5: Bloch 3; McK.LnEeu He,ighta Subd.Lv.i.64on ) Location (address or directions) i ' Amon6on Road behind Chevaon (b) Applicant Name Gant; Moon Telephone: Home 688-4265Business 694-2885 Applicant Address P.O. Box 670430, Chug.iak,' Alaska 99567 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder M ;Buyer ❑ ;Other ❑ (explain); (d) Lending Institution ' $ectniiy Pacijjr Moo#gage"' Telephone Address ATTENTION: Bob Ness/2550 Denali Meet, Suite 615, Anchou';e '99503 (e) Real Estate Company and Agent none/nebinanci.no Address Telephone M Whe HAA to the following address: S d S EnglneeAing SRB 196X a Eagle R.i.veA, Alaska 99577 2. TYPE OF RESIDENCE Single -Family n ' Multi -Family ❑ ,. Other ^ Number of Bedrooms 3 1 f t 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 the legality and status. s .. •. T •, ,r. 7 { •.� - 4'' SEWAGE DISPOSAL ,.,..•. Onsite Q Public ❑ Community ❑ Holding Tank ❑ Note: It community well system, must have written confirmation Ifom the State Department of Environmental Conservation attesting to the legality and status. r 1 , ' • t . 't I •fin: ', Page 1 of 2 t2-025pIM) . .. . ,, - . lI ; ENGINEERING FIRM PROVIDINt—ASPECTIONS, TESTS, FILE SEARCH lDA' k.. AND INFORMATION",";': Ps 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 regulations In effect on the date of this inspet ng giENGINEERING'... Name of Firm 'Telephone 121 Address ' - 99577 I: �. '-: Date -7 Approved bedrooms by Date 7 Ft A op 6,bwi A. Shs'm,fA,� Conditional III ASIA 1 f jP k% FE Terms of Conditional Approval 0I 4 CAUTION ;,j C,�!t The Muncipality of Anchorage Department of Health and Environmental. Protection ,(OHEP)iisues Health Authonty I .1. �Approval certificates based solely upon the representations given In paragraph 5 above by an )ndependent professional ;I engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending Institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 72-025 (111") 121 6. DHEP APPROVAL-' Approved bedrooms by Date 7 Ft Approved Disapproved Conditional Terms of Conditional Approval 0I 4 CAUTION ;,j C,�!t The Muncipality of Anchorage Department of Health and Environmental. Protection ,(OHEP)iisues Health Authonty I .1. �Approval certificates based solely upon the representations given In paragraph 5 above by an )ndependent professional ;I engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending Institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 72-025 (111") r^ r-- N,tvctP�t ooN� p H &VdNICIPALITY OF ANCHORAGE (MOA) p1"MeALTH AUTHORITY APPROVAL (HAA) oE'rLpttP� CHECKLIST - FEBRUARY 1984 .Vvxvo' 2644720 03 A. WELL DATA LegalDescription �S $1 i� • �J u1�-1L„�t�, Well Classification S C• If A, B. C, D.EC. Approved (Y/N) ^�JA Well Log Present f= t'J Date Completed Ae?QoX, 1'171- Yield DSS 4201/ _ Total Depth V. C. Cased to qD Depth of Grouting Static Water Level 1 S r Pump Set At 01A_ Casing Height Above Ground _ r Electrical Wiring in Conduit (ON) Separation Distances from Well: To Septic/Holding Tank on Lot - Sanitary Seal on Casing (S)N) Depression Around Wellhead (Y®y ; On Adjoining Lots /02> 4 r r To Nearest Edge of Absorption Field onof ALD ; On Adjoining Lots To Nearest Public Sewer Line Ia To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by S; S %JGrtnS L.(rJe- ; Date x-30- 8� Water Sample Test Results Comments B. SEPTIC�HGTANK DATA Date Installed -Q - 8LSize / coo No. of Compartments Z Standpipes©/N) Air -tight Caps (1154) Foundation Cleanout JqN) Depression over Tank (Yo pate Last Pumped Pumping/Maintenance Contract on File (Y/N) N ; for Holding Tank High -Water Alarm (Y/N) 'i'3 Temporary Holding Tank Permit (Y/N) '01A Separation Distances from Septic/Heldirtg•Tank: To Water -Supply Well ( o j To Building Foundation 157 To Property Line To Disposal Field S.S . r. To Water Main/Service Line Course Comments Page 1 of 2 72-026(1(:84) a To Stream. Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata BS gQ Type of System Design D 7sL t &ml ft_D Date Installed 7 �� 9� Length of Field qi i Width of Field "Oil Oir Depth of Field S Gravel Bed Thickness Z , Square Feet of Absorption Area 33 S Standpipes Present 6)N) Depression over Field (Y4 Date of Last Adequacy Test 00 9N Results of Last Adequacy Test 01— Separation Distance from Absorption Field: To Water -Supply Well 146 � + To Property Line 10 � To Building Foundations To Existing or Abandoned System on Lot N�A ; On Adjoining Lots 30 ) To Water Main/Service Line ,LA �'� To Cutbank (if present) A To Stream/Pond/Lake/or Major Drainage Course A 1.4 To Driveway, Parking Area, or Vehicle Storage Area 135 �+ Comments D. LIFT STATION Date Installed 7 -L4 -13q Dimensions SbO 6rA,1-. 'TIbJIL Size in Gallons -s-OD 4AL , Manhole/Access &) "Pump On" Level at 5-, !ZO2 or N1. ii. "Pump Off' Level at �`1 ' b P cv- 1-4-14. High Water Alarm 4evel at ' •5 Z- "moo Vie L4,4. Tested for N p Electrical Codes C/N) Comments VentOIN) Pumping Cycles during Adequacy Test. Meets MOA •' Check Permitted Bedroom Rating Against HAA Request •• I certify that I have checked, verified, or conf ormed to all MOA and HAA guidelines in effect on the date of this inspection. Signed S & S ENGINEERING Date SRB 196X Compary. IVER,AK995777 MOA No. to Receipt No.,3 '� i•C�: .,�.f Date of Payment • 11 Amount: $ G�y / � eaI • ' x shot" No. W74 - Page 2 of 2 72-026 111,84) r� W MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIROIC4EENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date g % (a) Legal De cription (include lot, block, ubcc��;;vision, section, to ship, range) a Rwx 3 M �PI.c/[- Ec, N7S t / Location (address or dire cttb ns) AmtXjft) J OX / SCG 7/t -n/. P/Z.) 2.&ELI (b) Applicants Name rq-r.t.j Telephone - dome Business Applicants Addresses U. (c) Applicant is (check one) Lending Institution ; Owner/builder ; Buyer E:::l ; Other [-::I (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. d Agent Address Telephone (f) Mail the HAA to the following address: �U 1.I�iA 2. Type of Residence Single -Family Multi -Family Other (describe) Number of Bedrooms 3 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 the legality and status. 4. Sewage Disposal Onsite- 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. [Page 1 of 21 ,r { 5. Engineering Firm Providing Inspections, Testa, 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 S & : E.101WEER1Ilii 4LE (t1VER. ALf Address NH. C.:•2117U Date 6. DHEP Approval Approved for Approved \� (ENGINEER SEAL) bedrooms By (/ Disapproved Terms of Conditional Approval CAUTION 11 Telephone 4%. 4j Na 7{ Conditional i THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONZ1ZNTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT— ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONNL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQU=E— MEhTS. EIPLOYEES OF DHEP 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. (DIIEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) ti1L'NICIPALITY OF ANC E HEALTH AUTHORITY APPROVAL (HAA) CEM. N TAL TIROHE PROT. '• CHECKLIST — FEBRUARY 1984 'AUG 1019G' RECEIVED Well Classification S+/ If A, B, or C, D.E.C. Approved(Y/N) Well Log Present (Y,® Date Completed /9 %Z Yield , S'eyoa7f Total Depth 1) /l Cased to 1{0 /-f Depth of Grouting Static Water Level /S i Pump Set At tl Casing Height Above Ground /Z cr Sanitary Seal on Casing OVN) Electrical Wiring in Conduit (frN) Depression Around TAbllhead.(YtM Separation Distances fran Wall: To Septic/H&Idi-g-Tank On Lot 165- On Adjoining Lots /60 'f - To Nearest Edge of Absorption Field on Lot IVO On Adjoining Lots /pt) 1f - To Nearest Public Sewer Lire '��A To Nearest Public Sewer Cleanout/Manhole 'N /F To Nearest Saver Service Line on Lot % =:+u+ry water Sample Collected y saETJig tERwn Date G '44, Water Sample Test Results PH. C7 !.., sjq 7/ S F� c 7-0,r ►/ B. SEPTIC/HetDTNG-TANK DATA Date Installed / 6 ' size C2 No. of CarTwtmerts Z Standpipes (ZN) Air -tight Caps K4M) Foundation Clearwte( M) Depression over Tank (Yt49D Date Last d 1C/:✓ �' Pumping/Nairterance Contract or. File WN), n for Holding Tank High -Water Alarm (Y ) it Temporary Holding Tank Permit (YIN)-" Separation Distances fran SepticA;e_L4trg Tank: To Water -Supply Well s / To Building Foundation /5 - To To Property Line /D �� To Dispcsal Field SS t To Water Mair/8e vice Line /1 To Stream, Pond, Lake, or Major Drainage Course Y7_ Comments (Page 1 of 21 2 -IS -aa C. ABSORPTION FIELD DATA Soils Rating in Absorpti S at/a Type of System Design LjQ,¢�N�it'LD Date Installed r7l g7 Length of Field 47� Width of Field �O Depth of Field s Gravel Bed!Thickness Z� Square Feet of Absorption Area 335 Standpipes Present CYIN) Depression over Field (Y Date of Last Adequacy Test Results of Last Adequacy Test A Separation Distance from Absorption Field: To Water -Supply Will f To Property Line To Building Fndation To Existing',cr Abandoned System on Lot N�b ; On N ininj Lots ..30 /�4- To Water Main/Service Line N/ r� To Cutbark(ifpresent) 7A To Stream/Pond/Lake% Major Drainage Course A To Driveway, Parking Area, or Vehicle Storage Area Connnents D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Dinensicns Manhole/Access (YM) "Pum Off".Level at Vent (YM) c 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 Guidelines in effect on the date of this inspection. Signed $&: C Icllw Ernn Date C/or/-/i�F c �•'•,Sf : Ccrrpan`y" „ LE RIvcA nl c s;.a t:7T MOA No. t* f KBl/d5/s [Page 2 of 21 2-15-84 0' 5. LEGAL DESCRIPTION L DATE RECEIVED INSPECTION APPOINTMENTS C17 STREET LOCATIONPd '6 1S1r"I TIME rK NUMBER OF,BEDROOMS TIME r TIME bt SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY QQ Three ❑ Six DATE DATE /�� DATE i ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY -\0I.-8 -C% INSPECTOR , X44 c_n.YS�R ON-SITE SYSTEM WAS INSTALLED. INS FE _CT OR INSPECTOR 1 1 lE Oct In WALS i NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. MUNICIPALITY OF ANCHORAGEDEPT. OP HLALGI & 110NMENTAL PrOT CTION `\ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIp��ON 825 L Street - Anchorage, Alaska 99501 • 1 1 i°82 JA 1982 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPER DW PHONE IEP, 1� MAI ING ADDRS ( Z l��12 1 PROPERTY RESIDENT (It different fr love) PHONE 1 2. BUYER PHONE J Y MAILING ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS 2- 4. 0. REALTOR/AGENT - PHONE p c O M IN ADOR�SS /. O s s C �a '\ C^ e 7 \..il 0' 5. LEGAL DESCRIPTION L / al k L C17 STREET LOCATIONPd '6 1S1r"I 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ❑ One ❑ Four ❑ Other bt SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY QQ Three ❑ Six 7. WATER SUPPLY INDIVIDUAL' ' ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM V- INDIVIDUAL/ON-SITE**— , X44 c_n.YS�R ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY 4 C 1 1 lE Oct In WALS NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. i 72010 (Rev. 6/79) 62.E ,r7 /amu_>c i79 THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE O SINGLE FAMILY % ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS O ONE O THREE O ,FIVE ❑ OTHER O TWO •-_ O FOUR O SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLICUTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM OINDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or 0Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELLTO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS y /.l ❑ APPROVED FOR BEDROOMS O CONDITIONAL APPROVAL )letter must accom any certificate) I-�IDISAPPROVED DATE / .a ` cif BY i 72010 (Rev. 6/79) 62.E ,r7 /amu_>c i79 unicipc" a �Olt _ Of o Anchorage P(, H 6-650 ANCHORAGE, ALASKA 99502-0650 (907)264-4111 , TONY KNONL IS. MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION JOY 22, 1982 Ardith Young c/o Darlene Nicolaysen P.O. Box 1201 Eagle River AK 99567 Subject: Lot 5 Block 3 McKinley Heights The construction of the well on the subject property is approved. The bacterial analysis is satisfactory. Robert C. Pratt, R.S. Associate Specialist RCP/mag r