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HomeMy WebLinkAboutBERNARD BLK 2 LT 15AOnsite File F Aw On -Site Water System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP151348 Tax Code Number: 06032111000 Work Type: Well Renewal Permit Effective Dates: October 26, 2015 to October 25, 2016 Design Engineer: Subdivision: BERNARD Site Legal Address: BERNARD BLK 2 LT 15A G:0254 Owner/Address: SECRETARY OF HOUSING & URBAN DEVELOPMENT 34 CIVIC CENTER PLAZA RD 7015 SANTA ANA CA 927014003 Site Mailing Address: 8011 STEWART MOUNTAIN DR, Eagle River Lot Size in Sq Ft: 34000 Total Bedrooms: 4 This permit is for the construction of: N Disposal Field N Septic Tank N Holding Tank N Privy Y Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. eLs."7"---------eitgi Received By: Date Date Issued By: MUNICIPALITY OF ANCHORAGE Community Development Department Development Services Division On -Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel1.D. d Ga 21 --/I 2. Property owner(s) P_.-4 e I( Lv # , e. Day phone207 752e )o t Mailing address SOI I fie -we -e f MC PTJ Eed. t2,:c/ At t t 9 577 Site address Se.. Legal description (Sub'd., Block & Lot) I "ea"( C401. j I 6 1*AC, 2 Lo/- / S 44 Legal description (Township, Range & Section) Lot Size 7 / 6°0 Sq. Ft. Number of Bedrooms L( APPLICATION IS FOR: ( all that apply) Absorption Field ❑ Septic Tank ❑ Holding Tank ❑ Privy E< Private Well Water Storage APPLICATION IS AN: Initial Upgrade Renewal TYPE OF DWELLING: Single Family (SF) (w/wo ADU) Duplex (D) Multiple Dwellings (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: 0 0 I certify that the above information is correct. [further certify that this is in accordance with applicable Municipal Codes. (S gnature of property owner or authorized agent) Permit/Rush Fees: NC Date of Payment: Receipt Number: Permit No. Permit App_9-1-12.doc csj°icr3 Waiver Fees: Date of Payment: Receipt Number: Waiver No. Y r� tV r iffir a1 w 0 cc` z\ R l AF wi roZ h it Ser- "%w 20ga OD �yVk�p 4N '11411 gggi .t E' •2rf a.x titisi 40 34s 24u .pes 0 vias< a fy 5 4 te3u fir -o< gig Oa' Wag 0 FV�f 1.11 3 J 4 a •• ix 4S e tzl Eno ado U FNM z„�I� WN m-0 oMha w W y a 01444„444 L! W U awao Z tau- vs'6'13_ r N Ir.nclM 0 v Sac SZ on x Per 4 inta `j W r~ lD TRACT K -t NJIS30 1 NV1d MIS I .OS = M A L A s A Filed for Record at Request of: Fidelity Title Agency Of Alaska, LLC AFTER RECORDING MAIL TO: Name Russell Brian Helminen 1 2015-044806-0 Recording Dist: 301 - Anchorage 9/28/2015 1 :42 AM Pages: 1 of 2 II IIII II 1111 11 II Address 1911 Lake Otis Parkway City, State Zip Anchorage, AK 99508 Escrow Number: F-54785 fri L II VIII II III 111 FTAA 111 1 111 Special Limited Warranty Deed THE GRANTOR The Secretary of Housing and Urban Development, his/her successors and assigns, whose address is 501 Marquette Avenue, Suite 1200, Minneapolis, MN 55402, for and in consideration of TEN DOLLARS ($10.00) AND OTHER GOOD AND VALUABLE CONSIDERATION in hand paid, conveys and warrants to Russell Brian Helminen and Katrina Lynn Helminen, husband and wife, whose mailing address is: 1911 Lake Otis Parkway Anchorage, AK 99508, the following described real estate, situated in the Anchorage Recording District of Third Judicial District, State of Alaska: Lot 15A, Block 2, BERNARD SUBDIVISION, according to the official plat thereof, filed under Plat Number 72-80, in the records of the Anchorage Recording District, Third Judicial District, State of Alaska. SUBJECT TO all taxes and homeowner dues not yet due; easements, exceptions, plat notes, by-laws, rights- of-way, covenants, conditions and restrictions of record, if any; and subject to the following: This conveyance is subject to covenants, conditions, restrictions and easements, if any, affecting title, which may appear in the public record, including those shown on any recorded plat or survey. The Secretary of Housing and Urban Development (Seller) agrees to sell the property at the price and terms set forth herein, and to prepare a deed containing a covenant which warrants against the acts of the Seller and all claiming by, through or under him. eRecorded Document II 111 11 111 GRANTOR: Date: By:Authorized Signer SecretaFav- .nment Jason Tobin ng Resan at Authorized Agent STATE OF m ss. County of p,,ea.$tot ��__ --^_ THIS IS TO CERTIFY that on this aC day of September , 2015 , before me 2q : ¶1%0Q VALL€ 7-0.. personally appeared r Sc ^( i�Y ttiI who proved t0 me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. nd and official seal. ot. Public in and for My commission expires: 1431 r I< Special Limited Warranty Deed —Page 2 eRecorded Document rev" i R06ERTTHOvALLEJ J COMMISSION #/965274. - Nota1?ANGEC Public - California Co COMCr tvImmission Excirea ECEMQ_g 31 2615 10111111110111111111111111 2 of 2 2015-044806-0 MUNICIPALITY OF ANCHORAGE Development Services Department Onsite Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WATER SUPPLY PERMIT Initial Date Issued: Sep 11, 2007 Expiration Date: Sep 10, 2008 Permit Number: SW070241 Parcel ID: 060-321-11 Legal Description: BERNARD BLK 2 LT 15A Design Engineer: 0000 ZZ - NONE NEEDED Site Address: Owner Name: TERRY VAKALIS Lot Size: 34000 SO. FT. Owner Address: 8011 STEWART MOUNTAIN DRIVE Total Bedrooms:,82/ Permit Bedrooms: Y'q EAGLE RIVER , AK 99577 - This permit Is for the construction of: ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified In Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By:a:S2.— Issued By. Date: Date: 9 -/3 7/117 Municipality of Anchorage Development Services Department - ... . Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907) 343-7904 ON-SITE SEPTIC/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. n(i'O - a I- 11 ff ll Property owner(s) $CAKA 11 SDay phone hone Z23-0167 1`e✓I4 , �i1 / t� Mailing address_ R6� • 1 1 'rM 2),C £C, 4t Zip Code p/ S 7-7 Site address 5q Zip Code Legal description (Sub'd, Block & Lot) UFRAMRP SURD, B1 0C2 2 LOT /54 Legal description (Township, Section & Range) Lot Size 5v-600 Sq. Ft. Number of Bedrooms 3 THIS APPLICATION IS FOR (®all that apply): Absorption Field 0 Septic Tank Holding Tank Privy Private Well Water Storage 0 0 0 THIS APPLICATION IS AN: Initial Upgrade Renewal 0 0 0 certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees:/75 41) �7 Date of Paym�}/ /ent: !��/07 Date of Payment: Receipt Number. 09 91-% Receipt Number: (Rev. 11/05) Waiver Fees: 1" = 50' SITE PLAN DESIGN 1,4 r VNUV .-j O • -i n ri o til mm m Z zm�-I x Rim v re- O C `�' t — HN 1 ;o r NT -0 til L2-3 FirZ g WI, y Z O X 0 D r r /l 1 • l" I• o g:1 in o > o r > Zm4 go 9-4-41 Zi ca 0 _11 Ht 74H N gr n rIo. DPo zm - 4n mr�... nYO aa5i —I i "X12ntPO ,. r.z ori \Z -• 5.) x.or QNmn -_ _ IIC o r ► 2� 1 Nt:C Aa7 ;oc. 1 m %i a �9001zo+� { .` I and =g -i= ,. o b• AAi=zmm O Ci rnnOOKinn �NO S9Zz N xz? s Rt.] ell; 9 z Iz °x o O ty si LrurnS+i V Al vonevt/0 r Net ,- r- 0 i > >---y— - o 2 Fill n Fir n W r LI i4#1/ 0 . •yet xi cotn N 5 1 Municipality of Anchorage Page I of DEPARTMENT OF HEALTH 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 Permit Number: S 970016-4 PID Number 060 -'5a1 - 1 Nam!: KATNLE,E'1J 1"1:� C"n^ mIsS>zY Wastewater System: 0 New Upgrade Address: 99577 Nr. Rte, Q 9500 `c. esv e e , Ak ABSORPTION FIELD 3313 -Phone: D I 7 No. of Bedrooms: XDeep Trench 0 Shallow Trench 0 Bed 0 Mound 0 Other LEGAL DESCRIPTION Soil Rating: ) (' GPD/So. Ft. Total Depth from origin,) grade: 7 Lot: C, Block: S division": 15A A lv`�_eIv Acgo Depth to pipe bottom from original grade: a 1 Ft. Gravel depth beneath pipe J Ft. Township: Range: Section: Fill added above original grade: . Gravel length: 3 7.5 Ft. CD - off, Ft. WELL: 0 New ❑ Upgrade Gravel width: ^ s / Ft. Number o,f lines: Distance between lines: Ft. Classification (Private, A,B,C): OMMu.1 i i Total D &fr Ft. Cased To: Ft. Total absorption area: —7 I5 SQ. Ft. Pipe material. > _ ASTM 0 - c� U.1 i �-"$I0 Driller: Date Drilled: Static Water Level: Installer,--• Dateinstaller Yield: GPM Pump Set at: Ft. Casing Height Above Ground: Ft. TANK SEPARATION DISTANCES b Septic 0 Holding )(S.T.E.P. To From Septic Tank Absorption Field Lift Station Holding Tank Public/Private Sewer Lines Manuf cturer: `� A f�L,N . 4 ,4 %�\< Capacity in gallons: I.25 0 Well- Ifpocit, xit Material: S-rc Number of Compartments: Water loo'F cool- LIFT STATION Lot/ Line !0f # bit Size in gallons: lasv Manufacturer: �uecfoQM, TSN Foundation 5 If. "Pump on" leev�l�at: "Pump off"at: (High wateralarm at: Curtain Drain %� . 1 1�! �� ^'!- Pump Make & Model Elec rical Inspections OSI 0.5/1/YNeAuegLY performed by: Lre.tos I c. Com. _ Remarks: I )4s7 hA( S*,ter, C -7-4,J k. BENCH MARK PuwrAt4 CR() 04(1.-.x..9 4- Location and Description: 1 o or COVCRPre SLAB. A-64,,,An,./‘ 0. Case' To po-9Jr "Q/' i,,,i4gumed Elevation: 100 ..;',1 r. = tr •'ND9 '1.'1* >, •1••M ••• Inspections by: S & S ENGINEERING Dates' 1St s "a�(' 9. • 1NNN•••4••••• ., ,.', „..„....j, -ERT performed 17034 EaglRiver Loop Rood, No0. 2nd S •o�tr `7 C. 7s,,,,k ROBERT COWAN ,,, i Ea, • ver, Department of He: and Reviewed and approved by: .. a Alaska 995 Hum Services �1 . �+%� 3r•9 S -poi --`)-7 appr val`���<<�K�-V�,�Ct Date ci, • CE - 8801 : r'ti, ,p'j i Q>.\y �..t�` do \y Aw:z:r:::'�'. / elk 72-013 (Rev. 9/91) MOA 25 PERMIT NO SW970010 PAGE 2 OF 2 Municipality of Anchorage DEPARTMENT OF HEALTH 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 15A, BLOCK 2, BERNARD SUBDIVISION P.I.D. NO. 060-321-11 EXISTING CRIB INSTALLED FLOW DIVERTER(FD) BULL RUN (BULL RUN VALVE COMPANY) NEW 1250 GAL. S.T.E.P. TANK NOTE: MAINTAINED 10' SEPERATION DISTANCE TO ALL WATER LINES FD CEMENT WALKWAY NEW TRENCH a'PROX. OCAT/0N OF WATER EWE IIILAND ROAD ST1 ST2 INSTALLED DRIVEWAY BARRIER A 81G ROCK 3.5' X 2.5' X 3.0' W"W—W—W— 100.00' 99.40' _ FINAL GRADE MT CO C01 = 100.90' 1. CO2 = 101.70' z -i SCALE 1" = 40' CO1 = 98.45' CO2 = 98.65' MT1 = 93.40' A MT2 = 93.30' NO WATER FOUND 87.30' B.O.H. ROBERT C. COWAN CE - 880141, rr i+• + <.0 .. ti A B C D FCO 17.0' 15.0' — — ST1 19.0' 16.0' — — ST2 23.0' 19.5' — — MH 24.0' 21.0' — — FD 32.0' 27.5' — — C01 — 26.0' 16.0' — MT1 — 25.5' 14.0' — CO2 — — 41.0' 45.5' MT2 — — 33.5' 38.5' MT3 45.5' 28.5' — — FD CEMENT WALKWAY NEW TRENCH a'PROX. OCAT/0N OF WATER EWE IIILAND ROAD ST1 ST2 INSTALLED DRIVEWAY BARRIER A 81G ROCK 3.5' X 2.5' X 3.0' W"W—W—W— 100.00' 99.40' _ FINAL GRADE MT CO C01 = 100.90' 1. CO2 = 101.70' z -i SCALE 1" = 40' CO1 = 98.45' CO2 = 98.65' MT1 = 93.40' A MT2 = 93.30' NO WATER FOUND 87.30' B.O.H. ROBERT C. COWAN CE - 880141, rr i+• + <.0 .. ti JUN -02-97 MON 14:33 HEAVLNLY LIGHTS ELECT CO 6b 6061 F.v1 (.11-- -.. ,-Peer ( Leet c �onswwactiii 491 Willow Street • Wasilla, Alaska 99654 Pllune# (907) 373-3893 • Fax# 373-3894 70 ik owe t 1 w c*..y Co crry ) Tit t ! F i- s 1 `r,)4 to Lo k4 fAry a it k,,e(01.6c d 7ec-ev1c.cc tn- ei°cS r inn ce r all Gu v Y' cam► 7 N � (-- p Yh u v4 c. Tex / ;cm Coe. c. 61-etvtivia V ctS t vi S C V $ A) 0 &Ae:::) 6S - M14%4 i I,.48c evt 6r Aide 108$ -/12/97-�,4 7 iJ&f;3a-eo, Ipli//7.41' _,, PAGE 1 OF 1 44,_0],-7:-cIQUOt MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970010 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:DAVID RICHARD M & M KATHLEEN OWNER ADDRESS:HC 85, BOX 9500 EAGLE RIVER, AK. 99577 PARCEL ID:06032111 LEGAL DESCRIPTION: BERNARD BLK 2 LT 15A LOT SIZE: 34000 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 1/27/97 EXPIRATION DATE: 1/27/98 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 DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: 1.) CONFIRM 10 FT. MIN. SEPARATION BETWEEN ABSORPTION FIELD AND ALL WATER LINES. 2.) INSTALL BARRIERS AROUND/OVER ABSORPTION TRENCH SUCH THAT DRIVING OR PARKING OVER THE TRENCH CANNOT OCCUR. RECEIVED BY: ISSUED BY: DATE: i(1/6/ DATE: Q/�r�-"W< or„,�AwS&S Engineeiinq EAGLE AIASIfA HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN ROBERT C. COWAN, P.E. ROBERT A. SHAFER, P.E. January 16, 1997 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 15A; Block 2; Bernard Subdivision CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 Request you issue a permit to upgrade the septic system serving the existing three bedroom house on the referenced property. Also request you issue a Conditional Health Authority Approval. The septic system will be upgraded no later than 15 June, 1997. A test hole was excavated and percolation test performed in the area of the proposed upgrade. The approximate location of the test hole is located on the attached site plan. At the time of excavation no water was encountered in the test hole. The monitoring tube in the test hole has been checked and was found to be dry. Attached is the proposed upgrade design. This property is served by a Community Water System. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, please conctact us. Sincerely, /4/ Robert C. Cowan, P.E. Enclosures 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Ak 4` ,0lV S & S DESIGN CRITERIA: 41._____ nC3IneCR1nC3 3 BDRM = 450 GPD ALASKA SOILS = 1.2 GPD/SQ.FT. 450/1.2 = 375 SQ.FT. REQ'D. LEGAL LOT 15A, BLOCK 2, BERNARD S/D DRAWN J.L.M. CKD. R.C.C. SITE PLAN O Ln ii DATE 1 _9_96 SHT. 1 OF 1 G/ �SEMETta 70 EN STRUCTURES,ENCROACHMENTS L1! EN SHOWN ON THIS SITE PLAN ARE AS SHOWN ON AN AS -BUILT SURVEY DRAWN BY: ROBERT C. JOHNSON IT IS THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY EASEMENTS, REQUIRED SEPARATION DISTANCES, AND PROPERTY LINES PRIOR TO CONSTRUCTION. NOTE: IF SEPTIC TANK IS OF GOOD INTEGRITY, INSTALL A 500 GAL. LIFT STATION AS SHOWN. IF SEPTIC TANK IS OF POOR INTEGRITY, IT IS TO BE EXCAVATED, PUMPED, CRUSHED, AND ABANDONED COMPLETELY; AND REPLACED WITH A NEW 1250 GALLON S.T.E.P. SYSTEM. 20' ALLEY TRENCH CRITERIA: 7' DEEP 5' EFFECTIVE 2.5' WIDE 37.5' LONG EXISTING 1000 GAL. SEPTIC TANK LOT 16 fA,t, V RIFY (SEE NOTE) ITY/ (APPROX. LOC.) INSTALL DBL CO INSTALL FLOW DIVERTER—\ EXISTING CRIB ABANDON SUCH THAT IT MAY BE USED IN THE FUTURE. LOT 15A PROPOSED 500 GAL. IiILAND LIFT STATION WATER LINE _ROAD ROAD (APPROX. LOC.) KEY BOY. (APPROX. ._OC.) (/)0".7 TRACT E-1 —CUTBANK `-PROPOSED TRENCH Co ti -n" MTpCO DRIVEWAY GARAGE INS7,11„ vEKa1 ►3AR 2��2 TRACT K-1 ALL PORTIONS OF SYSTEM WITH LESS THAN 3.5' OF COVER REQUIRE INSULATION. CONTRACTOR IS REQUIRED TO OBTAIN UTILITY LOCATES PRIOR TO ANY EXCAVATION WORK. 0 i01 In —44 ivenrffeald 7.0 -a ! ROBERT C. COWAN `." CE -8801 ea tR `\`',�` 20, ALLEY (APPROX. LOC.) LOT 14A ALL PROPERTIES SfOWN ARE SERVED BY A COMMUNITY WATER SYSTEM. NO NO WELLS WITHIN 200' OF SEPTIC SYSTEM. ELN ORA- LANE_ CLIENT THE ENGINEER MA" VARY THE EXACT CNENSIONS AND DESIGN PAFAMMRS IN THE FIELD, IF NECESSARY. TO MEET SITE ccr:DmON0. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: T f ° t 1_4-61/.1 P.Og-g-1 SS .Aj LEGAL DESCRIPTION: L- i A 1._tc- Z Township, Range, Section: ©p-- 3 -,J A-9_9 SID SLOPE tt ROBERT C. COWAN � V ,; F . RRo1 DATE PERFORMEb': ;. 2 3 4 5 6 7 8 9 10 0 0 0 r- 12 14 15 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water Atterr Monitoring? 2 N0 kA Date: -1-57 SITE PLAN T N �4- S Reading Date Gross Time Net Time Depth to Water Net Drop 2 -- 9fL—j oa. ( ,-3_e-, _ 4I‘..z.: — .( c 1.t:' AA t A 0... )..) PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) PERC HOLE DIAMETER FT AND FT COMMENTS PERFORMED BY $ &S ENGINEERING I�`�'.� CERTIFY THAT T IS TEST WAS PERFORMED IN 17034 Eagle River Loop Road No. 204 ACCORDANCE WEag%IRii4Uerjt 114g9157AL GUIDELINES IN EFFECT ON THIS DATE. DATE 72-008 (Rev. 4/85) S&S Encineentnc EAGLE A HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN ROBERT C. COWAN, P.E. ROBERT A. SHAFER, P.E. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 15A, Block 2, Bernard Subdivision January 9, 1997 GENERAL: CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 1. The scope of this project includes the installation of a leachfield trench to serve the three bedroom residence located on the referenced property. The existing 1000 gallon septic is to be excavated to verify its integrity . If of good integrity, install a 500 gallon lift station as shown on site plan. If of poor integrity, abandoned completely and replace with a new 1250 gallon S.T.E.P. System. The existing crib is to be abandoned such that it may be used in the future. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Page Two Lot 15A, Block 2, Bernard January 9, 1997 Subdivision 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Page Three Lot 15A, Block 2, Bernard January 9, 1997 Subdivision 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Lot 15A, Block 2, Bernard January 9, 1997 INSPECTIONS: Subdivision Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. Page Five Lot 15A, Block 2, Bernara January 9, 1997 Subdivision S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER GREA1 ER ANCHORAGE AREA BOR,.. JGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE ��Sy/EWAGE DISPOSAL SYSTEM MAILIIJGADDRESS J('/GJ NAME OA` M% PHONE `-3."7-- LOCATION C LEGAL DESCRIPTION 'i /� 2-- SEPTIC TANK: DISTANCE FROM WELL NUMBER OF MANUFACTURER MATERIAL COMPARTMENTS '-.1--- INSIDE Z INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY / °°6 GALLONS. SEEPAGE PIT: NUMBER OF PITS --r DIAMETER OR WIDTHJ( LENGTH 4f, DEPTH `v LINING MATERIAL BUILDING FOUNDATION ADDITIONAL ABSORPTION 7/ 7 .BMJ CRIB SIZE: DIAMETER DEPTH DISTANCE FROM: WELL TOTAL EFFECTIVE , NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT. WELL: TYPE CONSTRUCTION DEPTH DISTANCE FROM: BUILDING FOUNDATION NEAREST , LOT LINE NEAREST , SEWER LINE SEPTIC SEEPAGE , TANK SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES• DIAGRAM OF SYST INSTALLED BY: PIPE MATERIAL:Ceftj LOT SLOPE: REMARKS• Form No. EQ -031 Q DATE 9J (C APPROVED G.A.A.B. DIF7 Fir -411-231-E: DEPARTMENT i HEALTH AND ENVIRONMENTAL . )TECTIQN 2510 E. TUDOR RD., ANCHORAGE, HK. 99507 276-2221 r,4 -r�� PERMIT Na ( 76434 ) APPLICANT nM. DAVIS 5619 SHELLTIE LOCATION MI 2 SO FORKNEAR ICE PALACE LEGAL LISA 62 BERNARD SUB TYPE OF SOIL HBSORBTION SYSTEM IS: PIT MAXIMUM NUMBER OF BEDROOMS = LOT SIZE ]]3-2082 -7:7984 CQUARE FEET SOIL RATING (SQ FT/BR)= 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: LE:r4M-Ei= OF:FiviaL_ ICAIRTF-1= � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF EACH 51DE FOR A SEEPAGE PIT. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN_ THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). ORDEIDILIIIIRarm TAFIUNIK AJOI��Q-HCAFCLAL_CINE; BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTI0N. MINIMUM DISTANCE BETWEEN A WELL AND -ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS -100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETIM SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATIM Nvni_AE IE!:77,uE: I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. ° SIGNED:_ ��c� ."��ICHNT M. M. DHYIS •ISSUED BY_ 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 Parcel I.D. 06032111 Expiration Date: 0-2q '2-D2 1. GENERAL INFORMATION Complete legal description BERNARD B2 Ll 5A Location (site address) 8011 STEWART MOUNTAIN DR Current property owner(s) HELMINEN RUSSELL Day phone 752-3012 Mailing address Real estate agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: . Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment �/ 17> ZQ i Z i Receipt Number OZZ 1 Z COSA # _ CJS Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER -_As-certified_by-my-seal_affixed_hereto-and-as-of-the -validation-date-shown-below,—I-verify-that my-investigation,—based on procedures out fined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 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 State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm NorthRim Eng. Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 4/30/22 r, � �y♦ si * :49IJ3.� f� * 4� 6. DSD SIGNATURE System #1 Approved for bedrooms ♦4i CE -MIN System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: if �o pROGA q TER By: t`^- (�9�( Original Certificate Date: S "z V-202 z The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other 'er-1 talc pG U1Y COSA Checklist blur Sheet • Legal Descri tion: --BERNARD B2 L15A - =_ 06032111 - 9 p ParcellD: If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 11/11/15 Total depth 300 ft Cased to 44 ft ❑ Sanitary seal is functioning correctly Al Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 5/5/22 Static water level at beginning of test 18 ft. Comments B. TANK DATA Age of tank(s) 25 years Tank type/material StpStl Measured operating fluid level in septic tank na ❑ Standpipes/foundation cleanout per record drawing Date of pumping 5/10/22 D. ABSORPTION FIELD DATA 5/24/97 Which system tested (date installed) same ❑ ALL standpipes present per record drawing Total measured depth from grade 9 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A — pressurized field OR Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Structure served by this system Well production at time of test 5+ gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes FOR No ❑ Coliform bacteria is Negative Nitrate mg/L FOR Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by NRim Eng. Date of Sample 5/5/22 C. LIFT STATION ❑ Required maintenance completed Age of lift station 25 years Lift station material Stl Comments: Adequacy test date 5/5/22 Results ED Pass For 3 bedrooms Fluid depth prior to test 9 in Water added 450 gal New depth 15 in Elapsed time 30 min Final fluid depth 9 in Absorption rate 450 gpd Any rejuvenation treatment (past 12 months) no If yes, enter date E. SEPARATION DISTANCES -------From - Private -Well on-Lot-to,-(Please6hter-dist6fice�- if less-thanirequired or if -community -well) LiJYea ifNuft SeoUnT8Mk/Lift Station onLot 1DQ |fabsorption field isunder driveway comment below Wells unAdjacent Lots: Community Sewer �> 100 Yeo M,, Yes ifNoft Wells onAdjacent Lots: M., Yes ifNoM Yea Neighboring Tank >1QO^ Yes ifNoft Private Wells >1OO' Yes ifNoft Private Sewer/Septic Line > 25'Yea ifNoft Absorption Field onLot >10O' Yea ifNoO Community Wells >2O0' Yes iyNoft Holding Tank >1OO' Yes ifNoh Yen Neighboring Absorption Fields a 100^ Animal Containment ��5O' Yeo ifNoM RYeo ifNoD K4onuve04nirnol Excreta Storage >1U0' Comnnuni�yGevverN4min��75' [E] Yes i[NoD — Yea ifNoft From Septic/Holding TmnkonLottm:(PleaueanterdistanoeeifbooQhammquked) Building Foundations 1O' 4�0«ea KNnC�+ M Surface VVab*r>1O0' Yes ifNoft Property Line >b' LiJYea ifNuft ifNoft |fabsorption field isunder driveway comment below Wells unAdjacent Lots: Absorption Field >E/ Yeo Yes ifNoM Wells onAdjacent Lots: Private Wells >1UO' Yee ifNoft Water Main >1O' Yea Yes M`No- __ft Private Wells >1OO' Yes ifNoft Community Wells >2O0^ 0Yes if NO ft Water Service Line �>1O' Yes ifNoM Community Wells >2O0' Yes iyNoft {fseptic tank isunder driveway comment below From Absorption Field onLot to: (Please enter distances if less than required) Building Foundation >1[y Yes ifNuft |fabsorption field isunder driveway comment below Property Line >10' Yeo ifNoM Wells onAdjacent Lots: Water Main >1U' Yea ifNoft Private Wells >1OO' Yes ifNoft Water Service Line >�1O' Yes iyNoM Community Wells >2O0' Yes iyNoft Surface Water >100' Yen ifNuft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION / certffil that / have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet ,< � � �. 3 v� e �`� sem., s "'� •� � � ,�"•�' 2 u�w �.� Elam Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax. 907-343-7997 Lift Station/Pump Vault Owner 1 ;:S % i Street Address Septic Tank: -Sludge level inches -Pumping: required y es no-Pumpin .completed s e no 1-iftLift s_ gi6jz -Pump basket cleaned GDL no -Effluent filter cleaned es no -Control floats cleaned a no -Proper float settings confirmed e no -Operation satisfactoryno Alarm System: -Dedicated electrical alarm circui no -Audible and visual alarm inside dwelling no -Alarm system operatio satisfact oaatto Manhole Riser -Ground water intrusion at riser to tank connection es no -Ground water intrusion around pipe penetrations ves Fo -Weep hole functional aL no -Manhole lid: Functional es no Insulatedes no Properly Secured a no Other -All manufacturer required inspections and maintenance completed (Zno Comments.. Qualified Maintenance Provider: Technician Nllcm Date of maintenance5M 7 Company s a,,t&-Jt oq 9umkgS Signatures Q Date)iI 2--2— 157,68' 2 t 0 rD 0 O Q o ID .o G7 @ 23 r- o W 9 T, td 9 S D X 'a m . �. :3;uCD Q (a o � m nr r,�n a' � � O '-� < a U. t S� 11 Q (O T1 m D CD to Z '10 v_) N '�Ao e -r t • 2 QfD rrCO .-�• 0 On n �•n ^? 0 C,m o X30 co �J �. % < O cS N vs C' G v C < ¢ O ': a"� p•� O O•�• o Cn CL C) CD o o n p v cn o z w N G- }<_.. N_Q..�..... 157,68' m V1 =,8 CO S C O CD A O m N N a) ED C n m _ c O� C m m m I CJ1 p m Ui p N < / h,0 vro m ,88'TLI 3 .O'V,9I-2 S Cp J Ro W~' L3 GO ir1 z d 2 t 0 rD 0 O Q o ID .o G7 @ 23 r- o W 9 T, td 9 S D X 'a m . �. :3;uCD Q �«� t\tt}ff o U) n' _ S�'� �`7: • i t t 0 '17 fSi a _ .�,`�' ' • . t S� 11 Q (O T1 m D ll// to Z z v_) Ci7 '�Ao w QfD .-�• 0 tD % L4 N co N` � N ': ftf �ti� D m V1 =,8 CO S C O CD A O m N N a) ED C n m _ c O� C m m m I CJ1 p m Ui p N < / h,0 vro m ,88'TLI 3 .O'V,9I-2 S Cp J Ro W~' L3 GO ir1 z d 2 t 0 rD 0 O Q O Q n — n '— n 9 T, td 9 S D T co Ul C3 Co z m O •S a F ty c p 3a nm N °' ��- � N O 3 N n 4, 1 m� 9 3 � { t p Q a Q (O T1 m td a �p t z IE s Q 3 i w QfD tD N r N` � N T co Ul C3 Co z m O •S a F ty c p U1 3 N (D DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval #OSC 221215 Subdivision: Bernard Block 2 Lot 15A 907-343-7904 Fax: 343-7997 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks The septic tank for this COSH / property is 25 years old. A leaking septic tank may be a source of contamination to the aquifer. Typical replacement costs range from $10,000 to $15,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of a 16 -year-old septic tank. Certified Drilling Log R_ DOC CO dba BILL S. COLE 41�►ULLIVAN WATER WELLS ef-P.O. Box 670269, Chugiak, AK 99567 688-2759 OWNER OF LAND: Russell Helminen ADDRESS: 8011 Stewart Mountain Dr. ER 99577 LEGAL DESCRIPTION Bernard Blk 2 Lt 15 A DATE: 11/11/15 PERMIT OSP151348 DATE OF ISSUE: 10/26/15 NUMBER: TAX IDENTIFICATION 06032111000 NUMBER Is well located at approved permit location: ®Yes ❑No Method of Drilling: ®air rotary ❑cable tool Depth of Well: 300' Casing Type: --steel - wall thickness _250 inches Diameter: 6 inches, depth 44 feet Liner type 260'4 1/2" PVC Static Water Level: 21 feet Recovery Rate 5 ® gpm ❑ gph Method of Testing air Well Intake Opening Type: ❑ open end Eopen hole ❑ Screened Start. feet Stopped ❑ Perforations Start feet Stopped Grout Type: Bentonite chips Volume: 100 lbs Depth: from 2 feet, to 42 feet Well Disinfected Upon Completion: ®yes ❑ no Method of Disinfection: Chlorine 50 ppm Comments: Bore Hole Data Depth From To 0 2 2 4 4 43 43 108 108 212 212 285 285 289 123= I KITI, Casing stickup Overburden Hardpan & boulders Bedrock gray Bedrock green Bedrock gray Bedrock broken - 5 gpm Bedrock gray WATER BU ITY TESTING Collfform o m Nitrates N WL Arsenic tg/L Drillers Name: Cole Sullivan ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. Municipality tit Aiichotage Development Setvlces be�iiiment ' Building Safely Division On -Site Water and Wastewater Program 4700 SoUth Bragaw St. P.O. Box '196650 Anchorage, Ak 99519-6650 wIlek.ci.anchorage.ak.Us (907) 34$-7904 • CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 060-321r11 HAA#P O 03O/83 2- R-03 Expiration Date: 1. GENERAL INFORMATION Complete legal. description 1.or 151%;_..31 nrk 2•..; Hej-nnri s„ha;trisio*i Location (site address or directions) 8011 Stewart Mountain Dr. Current Propertyowner(s) Terry Vakalis Day phone 694-9856 Mailing address same Eagle River, AK 995/7 Lending agency: Residential Mortgage. Day phone 222-8837 .. •, :« 1 -. t t. 1: err ,r., t••' ,..:. .,:. i >X , :r:.. a . .:..... • Mailing address . 1.400' West ' Bensnn 'Blvd. Sto 2_0 "Anchorage; AK 99503 • Real Estate Agent • •Day phone Mailing Address • Unless otherwise requested, HAA will be held by DSD for pickup. 2. 'NUMBER OF BEDROOMS:_ 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 0 ❑ El Z._ 5'�Ss/coj TYPE OF WASTEWATER DISPOSAL: 0 0 Individual On-site IndividUal Holding tank • Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for 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 Tess than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) CertificNas are valid tot one year tor 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 systerrl is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further berify that based on the information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes; ordinances, and regulations in effect at the time of installation. Name of Firm Address 17034 N. EaPle River Lunn SrP_ 704 Engle_ River, AK 99577 Engineer's Printed Name Robert C. Cowan Date S—/ 6'/0 3 S & S Engineering Phone 694-2979 5. DSD SIGNATURE • Approved for 3 bedrooms. B Disapproved. • Conditional approval for bedrooms, with the following stipulations: OF •••.• ;7.!: ENGINEER II ROBERT C. COWAN f ,v �1�`c'•.� CE -8601 ;4-7;� J�{ :',c " t •'1)P^;-•' . :;•" lee • ON-SITE . ► Additional Comments WATER AND WASTEWATER PROGRAM • J • Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other (Re.. 12100) Original Certificate Date: - " 0 3 Legal Description: A. WELL DATAf1 Well type Y"nl c 4 Date completed _ Total depth Date of test Static water level Well production WATER SAMPLE RESU Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST 47/54 //od dj / A/t 4 Vp Parcel ID: 0 6U - 30)1-4 ft. If A, B, or C provide PWSID # Sanitary seal (Y/N) Cased to ft. FROM WELL LOG Coliform g.p.m. olonies/100 ml. Nitrate mg./I. Arsenic: - mg./I. Date of sample: B. SEPTIC/HOLDING TANK DATA P Tank Type/Material Se(YPk „stet (- ^^�� Tank size IAD gal. Number of Compartments P' Foundation cleanout (JN) Depression over tank (Y/N) NO Date of pumping �vvi t� d 003 Pumper R. S PLc4vwn 1%� C. ABSORPTION FIELD DATA 1 U Date installed Slay -419 Soil rating g.p.d orft2/bdrm) I. Well Log (YIN Wires prope rotected (Y/N) C • height (above ground) AT INSPECTION ft. g.p.m. in. Other bacteria colonies/100 mi. Collected by: Date installed Cleanoutsl(Y7J) f.5 High water alarmEaN) YDS Length ft. Width a.5 ft. System type -tRo,.0-5 Gravel below pipe Jr ft. Total depth ft. Eff. absorption area 7rft2 Monitoring tube ypS Depression over field NO Date of adequacy test 9-07)- a 3 Results Fluid depth in absorption field before test ay in. Fail) P4 -S5 Water added SIZ gal. Elapsed Time: 6_ min. Final fluid depth 36 in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) AM For 3 bedrooms New depth 613 in. Absorption rate >= -5(93 g.p.d. If yes, give date D. LIFT STATION Date installed S ^ R 7 Size in gallons ID 50 Manhole/Acces >_ YPs "Pump on" level at `1_ / in. "Pump off' level at 3? in. High water alarm level at 5/4f in. Datum et) tOh eF'09.uk Cycles tested d Meets alarm & circuit requirements? >4's E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: N/A Septic tank/lift station on lot - . Absorption field on lot Public sewer main Sewer /septic eine -- Ona - - nt lots On adjacent Tots Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5 # Property line /0fi Water main ds-4-- Wells am'}' Wells on adjacent Tots ?OU f Absorption field /0 f Water service line /0 f Surface water / dd t SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /v'f' Building foundation /0 t Water main /0 r` / Water Service line /0 f' Surface water /0e.1 I- Driveway, parking/vehicle storage d Curtain drain N/4 Wells on adjacent Tots acxi 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. R013t-R.- C , Cp L.,,,,J Engineer's Printed Name Date .' • r• J, • Ro3ERT C. COWAN ; - #0 c0 CE -SECI • HAA Fee $ 37_67 0,0 Waiver Fee $ Date of Payment _ _5-- % - 0 3 Date of Payment Receipt Number ,l7 © ©:C Receipt Number (Rev. 12/01) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# 002- Sal - it 1. GENERAL INFORMATION HAA # y4 97 ()ca./ Complete legal description Lot 15A; Block 2; Bernard Subdivision Location (site address or directions) Mile 2 Hiland Road Eagle River, AK Property owner M. Kathleen Morrissey Day phone 696-0312 Mailing address HC85 Box 9500 Eagle River, AK 99577 Lending agency Clty Mortgage Day phone 263-0700 Mailing address 121 W. Fireweed Lane Anchorage, AK 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 Community well Public water xxx 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 Holding tank Community on-site Public sewer xxx NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. S& S ENGINEERING C n 7 y_ c Name of Firm 17034 Cagle R;ver Loop Road o. 204 Phone Address Eagle River, Alaska 99577 Engineer's signature Date /l q 7 REQUEST YOU ISSUE A FULL HEALTH AUTHORITY APPROVAL AT THIS TIME. ALL WDRK; REQUIRED ON THE CONDITIONAL H.A.A. DATED 1/27/97 HAS BEEN SATISFACTORILY COMPLETED. OWAN 6. DHHS S ATURE ate ; ROBERT C. 01 �,•• CE -8801 •,+ ic's:''..., ..' ,� Approved for3 bedrooms. 'it. %y ........... '? Ar " Disapproved. Conditional approval for bedrooms, with the following stipulations: By. Additional Comments Date CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERU1f P C E. I / E I'1 Environmental Services Division ,` 1. C V IJ 825 L Street, Room 502 • Anchorage, Alaska 99501 • {907 3- UN -Ng Health AUthority Approval CheCklistolunIcipality of Anchorage Dept. Health & Human Services Legal Description: LOT ISI Qaocic a F.n eN4kb LID Parcel I.D.; ©GCa - 3 A. WELL DATA /I Well type I�oMMuA 1.. If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed Total depth Cased to Casing height (above gro Sanitary seal (Y/N) Wires properly p • ted (Y/N) FROM WELL LOG NSPECTION RI 2'79/ Date of test Static water level Well production WATER SAMPLE R S: Coliform Nitrate g.p.m. g.p.m. Other bacteria e of samjlle: Collected by: B. SEPTIC/HOLDING TANK DATA 5:7.e. P ,. Date installed S---24-1/ Tank size I;50 Number of Compartments Foundation cleanou (i) I e,5 Depression (Y L High water alar Date of famping� Pumper ./v/ C. ABS(RPTION' FIELD DATA Date installed 6."24' S 1 Soil rating (g.p.d./ft2 or ft2/bdrm) '•g System type _ —11);--)0c 14 Length 37 S 1 Width2•'5 Gravel thickness below pipe Total depth Effective absorption area 37 Ste onitoring Tube present( V) Ye $ Depression over field (YY ("d Date of adequacy test esults (Pass/Fail) For Fluid depth in absorption field before test (in.); Fluid depth (ins) Minutes later: / Absorption rate g.p.d. Peroxide treatment (past 12 months) (Y/N) w/� If yes, give date 72-026 (Rev. 3/96)* bedrooms Immediately after --gal. water added (in.): D. LIFT STATION Date installed Manhole/Access 61) 'P S High water alarm level at* 6/1 Cycles tested Size in gallons IP 5C-' "Pump on" level at* E. SEPARATION DIS NCES *Datum OGG A TTh M SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot On adjacen Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer /s . ' service line Lift station SEPARATION DISTANCES FROM/SEPTIOHOLDING TANK ON LOT TO: / Foundation S' Property line to / f" Absorption field /0 Water main/service line 10 4 Surface water/drainage lOd Wells on adjacent lots 4 //- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 10 /1 Building foundation /O / 1- Water main/service line /0 /4- fI Surface water /0011- Driveway, parking/vehicle storage area / "Pump off" level at* Curtain drain ,/j%/4 Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal in conformance witlines in effect on this date. Signature Engineer's Name C. Bt I C. Caw dna Date G / ` / 7 HAA Fee $ 3 n O Date of Payment 017/97 Receipt Number r s C 1 r6 72-026 (Rev. 3/96)* records ms are y.... , ... �, ...�, .... ROBERT c COWAN #;f .� CE - 8801 4( Waiver Fee $ Date of Payment Receipt Number J., '."="il!/tel, sx' ifO) EngineeRinq EAGLE MKA HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN ROBERT C. COWAN, P.E. ROBERT A. SHAFER, P.E. June 6, 1997 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 15A; Block 2; Bernard Subdivision CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 RECEIVED JUN 9 i997 Municipality of Anchorage Dept. Health & Human Services A Conditional Health Authority Approval (HAA) was issued on 1/27/97 for the referenced property. All work required for the Conditional HAA has been satisfactorily completed. Please issue a full Health Authority Approval at this time. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/gk 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 /30 1 I 0 0 1' m ^ y N 5 4 r 93,9 rn N 03°31140.E 157.68' (REC) V • 0 0 •0. A 0i s 8 iIJ O mu mA arc x O� 01 1N3113SV3 30vw1v80 '1.4 01 N 02.16'40.W 172.08' (M) BASIS 171.88 (R) OZ 20 ' k T N 0 0 r r 0 0 41. 0 0 N 0 r r m 0 0 m O r 2 O • ` c c m O z N N 2 NOI1dI2lOS34 70931 nw so co LP z A c n^ D n c c.' m � 3 .4 0 -..to m s n „n 0.„ • • 43 O= O O Q 4. 1° - M a n: O 3 O O D w 0 t' y 0 D O n N o u A o 0 m o n w 3 ao < o Q o ^f g o G c o u - 3 CI 0 M 0 q �" O O O+ n O °' O A O- w M O 0 3 c ' + c ° n 0 n M g' -j 2 0 ma n 0 .• Q G0 o-.-^.-3�o •a -.o IA �30no .o .0u xo o < V.Y. om w ?QO 0-n • o • w v-- O no. v .c o00 nM an o o 0 s=c= 0 37 :3Et g O O w O N p G{ O. u 0 O r< O M .( * _.. O . 1° O 2 0 1 •�/►`: � •1 icW •., • : •00 • �• r � a. e1 T r c 0 m A ID ID Y N c W 0 0 Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING \ HAA # 6��,`\C nal 040-32-1-11 1. GENERAL INFORMATION Complete legal description Lot 15A; -Block 2; Bernard Subdivision Location (site address or directions) Mile 2 Hiland Road Eagle River, AK • Propertyowner M. Kathleen Morrissey Day phone 696-0312 Mailing address/ HC 85 Box 9500 Eagle River, AK 99577 .Lending agency :c i ry Day phone a- 6 3`o.° o Mailing address 1a i w s r ,tciQi w b 2-4 C4/4.2 4 -at Ak `1'is-oj Agent Dan Wolfe/ Remax Properties Day phone 276-2761 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 xxx 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 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. XXX 72-025 (Rev. 1/91) Front MOA *21 5. STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown' below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING agle River Loop Road No. 204 Phone G d-41 Address Eagle Rive, Alaska 99577 Date i //c /9 7 Engineer's signature REQUEST YOU ISSUE A CONDITIONAL HEALTH AUTHORITY APPROVAL AT THIS TIME. SEPTIC `SYSTEM TO BE UPGRADED NO LATER THAN 15 JUNE,_1997. ROBERT C. COWAN }FAQ 6. DHHS SIGNATUREo. Approved for bedrooms. Disapproved. Conditional approval for 7711Z—E- (-) bedrooms, with the following stipulations: EScRow MONIES 7V PERt=ol2r& /4U_ WORK /VECESSAoz. To aPUfWE TC SEPTIC SySTE (AS PER # SW`i001U > - NU LATEX (f1,4N 15 , rri? , (SEE Azmc w 1 ,7 $ N ) Additional Comments Mau/Es /14f/sr k2E A// J /N 5SC/acA J/ J77 7INet L /4PPR3U/ L /S 621-/vTEf) /10 A. TA//S DETi2TMEJJT • Date 0/4 CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev.1/91) Back MOA #21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist ,�o r- 1 S 4 C3 ;LOCK U6 a Rev4RQ Legal Description: Parcel LD.: 640 "'3c)-/"1 A. WELL DATA Well type 4 If A, B, or C, attach ADEC letter: ADEC water system number e / '7 S" Log present (Y/N) Date completed Total depth Cased to Casin• • =`• t (above ground) Sanitary seal (Y/N) ires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well production g.p.m. g.p.m. WATER SAMP ' ESULTS Colifor Nitrate Other bacteria e of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed q /13 /7 4 Tank size / 00 0 Number of Compartments Cleanouts 9N) )'E 3 Foundation cl , eth . N 0 Depression (Ye W 0 High water alarm (Y9 N Date of tPgrnp ng 7 1''-1:41,4:•.77,- Pumper S . R. P vMp,,/4 C. ABSO PTION FIELD/ DATA Date it ! tallpd 33q / 3 / 7 ,Soil rating (g.p.d./ft2 o ft2/bdr - 00 Length I`w Width 1 7 � Gravel thickness below pipe (0 Total depth CcA&c Effective absorption area ;'i 6 rr Monitoting Tube present MN) '-S Depression System type C �c ' '3 Date of adequacy test 1?- 1171“. Results (Pas 94 Tait ofT Fluid depth in absorption field before test (in.); Immediat er gal. water added (in.):, Fluid depth (ins) Minutes later: Absorption rate = g.p.d. Peroxide treatment (past 12 mont ) If yes, give date 72-026 (Rev. 3/96)* P.4it_ For over field (Ye "o bedrooms D. LIFT STATION Date installed Size in gallon Manhole/Access (Y/N) "P = . evel at* "Pump off" level at* High water alarm level at* Cycles t E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot On adjace Absorption field on lot On adjacent Tots Public sewer main Public sewer manhole/cleanout Sewer /septic se me Lift station *Datum SEPARATION DISTANCES FROM HOLDING TANK ON LOT TO: Foundation Property line /0 4 Absorption field Water main/service line / o Surface water/drainage /0 0 -� SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Wells on adjacent lots a 00 Property line ) 0 �f" TO 1 TJ Building foundation 1 0 - Water main/service line / O /4 - Surface water / b 0 Driveway, parking/vehicle storage area O Curtain drain °`r 0 k NO w Wells on adjacent Tots a o 0 F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal re fjerC'ihe _ : ms are in conformance with OA HAA guid lines in effect on this date. Signature Engineer's Name /e d ,St47- 47- C a 7✓i1n/ Date / /P. 3 /97 ROBERT :C. COWAN n,\ CE - 0801 ��►\r��==a• te o HAA Fee $ 3 O ©, Oa Waiver Fee $ Date of Payment / 6-7 "7 /q 7 Receipt Number a. 5—Fr 9 (4' 7 5-6 ) Receipt Number 72-026 (Rev. 3/96)* Date of Payment f4 :.pvS&S 4�. Engi nf eiz1nq RIVER ALASKA HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN ROBERT C. COWAN, P.E. ROBERT A. SHAFER, P.E. January 23, 1997 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 15A; Block 2; Bernard Subdivision CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 Request you issue a Conditional Health Authority Approval on the referenced property due to winter conditions. Upon completion of our site evaluation, we found the septic system to be saturated. There is no eminent health hazard and there will be no adverse effects as a result of granting the conditional approval. The septic system will be upgraded no later than 15 June, 1997. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/Igk 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # Thio(") — Sal "l\ 1. GENERAL INFORMATION Complete legal description HAA # Wl1-1(y. Dor /5731 &P.,IJA-P-o xc g Location (site address or directions) S- -wA-n-Ft. tn: C 141 7" i iZei) marY'is (Y\ Property owner ��1AI K. ��tj Day phone fiy-/3/� Mailing address /7 I3 1&)X 9S) G710 icy- 1 3�7 Day phone Lending agency Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 4121 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. David R. Dayton P.E. Name of Firm 20410 D.nalar Sc. Phone 696-.2fi%7 Chugiak, Alaska 99567 Address Engineer's signature Date 6. DH)IS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: By. OF At4 oelpiro ..«7 . # David R. Dayton ,4644 •., NO. 2203.E fro, "r"+A•qv- ... •. o•./ Additional Comments Date CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA a21 Legal Description: Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST tar /54 8 1)4f 4 5:43 Parcel I.D. SO -5 A. Well Data Well type C P45 A Log present (Y/) Date completed Driller If A, B, or C, attach ADEC letter. ADEC water system number ,21v2 75.1 Total depth Cased to Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) m FROM WELL LOG AT INSPECTION r 70 c oz Date of test 70 --nirri r, ri 7. Static water level D Well flow g.p.m. g.p.m. r" < y Pump levell ril D rn SEPARATION DISTANCES FROM WELL TO: v; m O z Septic/holding tank on lot . - O' -t— ; On adjacent Tots v` - Absorption field on lot -0-}- ; On adjacent lots 2.0-0,4-, Public o -u,4 - Public sewer main Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed c)l / '5/74" Tank size 1 000 Compartments Cleanouts (Y/N) Y Foundation cleanout (Y/N) Si Depression (Y/N) Alf High water alarm (Y/N) N!//} Alarm tested (Y�/N)/4 Date of pumping 113/'7 I- Pumper --Ss 1` 5 Paztp SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ,J/4 On adjacent lots 2-4-4- Foundation To property line WI-- Absorption field 1_.;" Water main/service line iso - Surface water/drainage /cot - 72 -026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed /4" Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pump off" Level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM Well on lot D. ABSORPTION FIELD DATA LIFT STATION TO: On adjacent lots Date installed 7// ,/ 76' Soil rating (GPD/Ft2) Length / Width P7L Total absorption area 3 *Lo Cleanout present (Y/N) Surface water /D g�/L- System type 536"- - Pii— Gravel thickness 4 Total depth / L Depression over field (Y/N) Date of adequacy test //u/9 Results (pass/fail) for 5 Bedrooms Water level in absorption field before test 0 After test Peroxide treatment (past 12 months) (Y/N) A) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot "1/4_ To building foundation On adjacent lots 4)/4 Property line /o, - 3O To existing or abandoned system on lot A)0*hr On adjacent lots -Q ,r-- Cutbank Ai/hi Water main/service line 2,5'9' Surface water Driveway, parking/vehicle storage area Curtain drain 1VoVa- �,)1L%. i E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. OF 44. r •.M•..y David R. Dayton P.E. 20210 Donalar St. Signature Chugiak, Alaska 99567 Engineer's Name Date //1-4-/9,e' er,§. °avid h. rayiaii NO. 2&05-E o .. • `'110FEGiV) Win'11 HAA Fee $ FOO ` 00 Date of Payment Receipt Number 72-026 (3/93)' Back 69_„5--e/r) Waiver Fee $ Date of Payment Receipt Number D. R. DAYTON, P.E., R.L.S. .�i•��i � i moi. i,`i�i}i�i�•�� • 20210 Donalar January 26,1994 Chugiak, Alaska 99567 (907) ' 696-2417 ADEQUACY TEST Legal, Description: Lot 5A, Block 2, Bernard Subdivision Date of Test: January 2 , !994 Septic Tank: 1000 gallo, 2 compartment, Fiberglass tank (DHHS Records) Absorption System: 14' 14' x 6' seepage pit (DHHS Records) (DHHS Records) Soils Rating: 100 sq. ft. per bedroom Requirements: 3 BR - 450 gallons per day Test: Water was pumped into the seepage pit while measuring volume, time and water level rise. After the daily requirement of 450 gallons were pumped into the pit, the water level drop was measured at regular intervals. Results: The seepage pit is currently functioning adequately for a 3 Br home. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION April 1, 1986 (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 15A; Block 2; Bernard Subdivision; Section 19; T14N; R1W; SM Location (address or directions) Hiland Road 2 miles (b) Applicant Name Mike Davis Telephone: Home 694-3083 Business 248-5178 Applicant Address SR 2, Box 9500, Eagle River, Alaska 99577 (c) Applicant is (check one): Lending Institution 0 ; Owner/builder 12i ; Buyer 0 ; Other 0 (explain); (d) Lending Institution Alaska Pacific Bank Telephone Address (e) Real Estate Company and Agent Address Telephoneel�ll Had AVM the HAA to the following address: S & S Engineering SRB 196X Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family E7 Multi -Family 0 Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well ® Community 0 Public 0 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 0 Community 0 Holding Tank 0 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 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm s & S Engineering Telephone Address SRB 196x Eagle River, Alaska 995f1 175-/g 6 Date 6. DHEP APPROVAL( �� Approved forpg-12 O ' bedrooms by Approved Disapproved Terms of Condition I Approval dh CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional 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 (11/84) A. WELL DATA Well Classification Well Log Present (Y/N) Total Depth Static Water Level Cased to MUNICIPALITY OF ANCHORAGE (MV..) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 CNORp'C'E OF AN N,plylclottY NEA�'� & pEp1. 0 of QROIEC[ION RN�IRONMEN HVR Legal Description. 40T `r4 Bur ? �+ \NAV/Li-A.4 If A, B, C, D.E.C. Approved OR< Date Completed / .it of Grouting Yield /.-Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: 1-- To Septic/Holding Tank on Lot Z-00; On Adjoining Lots To Nearest Edge of Absorption Field on Lot Z''� ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample Test Results Comments -?lS 11)' Z, ti—i rt t B. SEPTIC/HOLDING TANK DATA Date Installed c (3 (' Size t ©c>o No. of Compartments z Standpipes Oi.Der Air -tight Caps64P4). Foundation Cleanout Depression over TankA'(/44 Date Last Pumped 'V - G ;for , Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (YIN) Separation Distances from Septic/Holding Tank: To Water -Supply Well 10 L � "--PLA-a 4.1 C. - To To Property Line To Water Main/6erviee Line Course Comments To Building Foundation To Disposal Field 1* - To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed %-13- 76 Width of Field / 1 Type of System Design —C7.6 g P'� `i7 - Length of Field /411 Square Feet of Absorption Area Depression over Field ('' Results of Last Adequacy Test Depth of Field /Z'� Gravel Bed Thickness Standpipes Present�Y�N') /_ 3 -436, Date of Last Adequacy Test SA'T/sr-71-e T_T ‘— Separation Distance from Absorption Field: To Water -Supply Well 20n r � �BL iL J-- To Property Line 16 To Building Foundation -3a To Existing or Abandoned System on Lot 1.4— ; On Adjoining Lots To Water Main/aiee Line Z t �To Cutbank (if present, To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Sof 4. - 20 pa/ D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at // "Pump Off" Level at High Water Alarm Level at/4— //4— Vent (Y/N) Tested for Pumping Cycles during Adequacy Test, Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to allM A an HAA guidelines in effect on the date of this inspection. Signed S & S Engineering Date /8 6 SRB 196x CompanyE B.s I off, ei �� MOA No J age as a Receipt No 3-1 Date of Payment Amount: $ C� J Page 2 of 2 72-026 (11/84) DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 DATE: PWS I,.n.r 2/ -)_ .� ./. To Whom it May Concern: According to records on file in this office the i`/J Water Regulations Bill SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 47 c: i'L'L �� ; ' 7 - Water System is in compliance with the State Drinking Sincerely, C I PAt1 TY CF ANCHORAGE � l L0 %2WtJ1 EALTht AND E JRONM N ROTECTION reet, Anchorage,: AIas.a 99501 -251.1, ext. 224 or 2=25 ZEQtJEST FOR APP-RO 7AL OF INDnriDuAL SEWER AND WA `ER FACILITIES Lending Institution Request Alae Pacific Bank Mailing Address: - I#os t Off.oe Box >420 99510 Phone: 2 Property Owner :orris Mailing Address: Star ROU dingle Family Residence: (x) Number of Bedrooms: Multiple Family Residence: (_) Number of Bedrooms: c)nstrudtion ewage Disposal System: inn -site System i t.°" Public Utility permit # Installed �4/?nstaiier eptic Tank Size - ManufacturerZe..e24-12 ►bsorption Area Foil_s Rate /60 Material ist nc s: Wel to Septic Tank__to Abaorp on Area o S -ewer- Line Nearest Lot .line Absorption Area o Ne-arest Lot Line "(. ""MUNICIPALITY t,<cE-";t7E:k"-.4 MUNICIPALITY OF ANCHORAGE D:PT. 01= ; DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 1VI ONMEN \L + 825 L Street, Anchorage, Alaska 99501 279-2511, ext. 224, 225 hf,NY 77 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES RECEIVED 1. Type of Inspection: VA 2. Property Owner: Morris M. Davis FHA CONV xx Mailing Address: STar Rt. 2 Box 9500 Eagle RiverDay Phone: 243 3320 3. Name of Buyer: same Mailing Address: same Day Phone: 4. Name of Lending Institution: Alaska Pacific Bank Mailing Address: P. 0. box 420 Anch. 9951kone: 276 3110 ext. 40 5. Name of Realtor or Agent: none Mailing Address:_ Phone: 6. Legal Description: L15A B2 Bernard SD Location: NHN Hiland Rd., Eagle River (see attached map & photo) 7. Type of Facility to be Inspected: sf No. Bdrms 3 8. Water Supply Type of Supply: Public Utility_ Individual x If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) xx If Individual, date of installation unknown unknown Sue Benson 276 3110 x40 72-003(3/76) Departmen-t. of Health and Envirohmental Protection Request for Approval of Individual Sewer and Water Facilities al Description: -, ffadavit Attached: (;) Letter Attached: ( rProve_ d � - isapproved: r Date: epartment Worksheet: