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CHALET TERRACE LT 2
Chalet Terrace Lot 2 #015-163-39 -Jun -19-02 03:57P Permit Counter 907 343 8250 P•02 Municipality of Anchorage ;•.� 33��, Development Services Department T"' Bl ift Safety Drdmn On -She Water and Wulewatet Proprarn, 4700 S. eragaw St P.O. Box 19WW Arltdlo". AK 99510 -WW Pagel of 4 w .d.anchoragcakus (907) 343.7901 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Fermit Number. SW020142 PID Number: 015-163-39 N.T. Robin & Karen Erickson WastewaterSystem: l] New ® Upgrade . "'•"" 1/.01 IIills a ABSORPTION FIELD Pte. (907) 346-1550 POO117a.'.Y•\ D. TwO0DO. T.9hCNOW Dane oar. LEGAL DESCRIPTION aanaic 1.2 i�0•°« 1 + rprAA a Chale' errace DOW 0 me •.a\w eYn e.yw oeaa 2.5+ IL+M apN lrn.Mlle«' 10 r, TM W' Ilenpa a.m'. I4 Y'e a. N7; C,"L«ph 19 r,, Well: ❑ New ❑ Upgrade aYw Yo« 3 "°^•"0 • �e 1 a.. up...w. rt Caueuuen iPrYYaa. a. C; Te'i D.fe. G..e': Tw ..Yp..n r.a r•.Y.'n.Perf F810 I �. n 80 �+ orw.� °"iD'•" """"'"""` ToNelson Grp i%15 & 16/02 n c*""""" o".. TANK NM PL el SEPARATION DISTANCES M Septic ❑ Hcldin3 ❑ S.T.E.P. ❑ Other. To rmm Septic Tana Abso•pcon F na un Statbn He1T09 Tank Pytrepnot S. Lie Anchorage Tank �-j 1000 Co. MYr r. 'inrewr d Cemow•+N. w.+ NA NA NA NA NA Steel 2 p.•...w.'Y 1001 1001 N/A N/A LIFT STATION — N/A L"w' 301 301 N/A N/A 1uw cY .wrY F'MYY• 51 211 N/A NIA Yyy Yf IFn.I Yl•p Jr Y.' Y I.�aYY \YA M « 7L\ ruq W.. \ \beM ewar.l npgfA. e.�'IMe LY Cow a•" NIA _N/A INIA N/A EXTO xistin ST was Inspected & f BENCH MARK UGMT W a.pl to be corroded. It was removed Top of concrete deck sup ort at A.ww.e ....vs replaced with a w tank north corner of house. 100.01' same location, .n r 01 Irspectons performed by: Pinard EneineerinQates: 1' 6 1 02 r 2'• 6/15/02 �... .... .... Develomen So 'ccs Departure t p roval PCE J'c�• Paul E. Pinard • -4793 '�� •'•\•••••••e9110`t� Reviewed and approved by: Date: -� len I: M11 �Q/� FSS\ HILLSIDE DRIVE ©10� M _0 LU k � yJ >r / I EzLtfng SAS(is*e Abandoned) —Teatl,.la � 2 Sdback From 251/.+ Slope x •lR9i+968B WWDS UPCRADL LSec Ru -4 N x ' 1 200'+ To Community (publk) We0 L D ;0 M n 0 W W d M 0 n y �nZ-4 p .4 J? 0 W a r �I a G b M w 4-A 3 < 0� a`3 0m d ,6 ir L y9 ,. N > ir cn co "1 rTl 1\\ CtN S aZ c i .riTl°s pcn m ........"" ^0Z�� N N $ J> Nip �c� n V z GZi �• N ash p ... .n `..�. ,'37 nL d o �d m N y rn '� dry w z Her A Q'a CA ►.! ����"'� a a `�' .. q�� � � GYM � � � N �• N '��ry, H � ��� r e� 0 V CD PJ "�f1 ' y.'1Gx] R 20 b •"'.fl N 3 �C e M 9 a 1 S leo` r r h 2 I "N g I dl � 1 PINARD ENGINEERING c P.O. Box 871347 Wasllla. AK 99887 (907) 357• ENGR (3847) TEST HOLE LOG / PERCOLATION TEST s TEST HOLE92— DATE: 6/16/02 JOB NUMBER' 0 LOCATION: Lot 2, Chalet Terrace FIELD STAFF: A. Wien Topsoil 1 OL 2 3 4 5- 6- 7- 10- 11 67 1011 12- 13— SW 213 SW - Gravelly Sand, clean & loose SLOPE Level SITE PLAN AE—TB #1 Ne -t-1 —New SAS 14r f—TH 4 Was Ground Water Encountered? Yes /©o If YES, Depth to Ground Water. PERCOLATION TEST' DATA A Time Measurement Drop In Leel Pere Rate 14 PERCOLATION RATE minAnch IIry PERC HOLE DIAMETER ,N 49 4i 15 TEST RUN BETWEEN FT and FT in DEPTH >t PALEP6MAM r�•, CEA793 16 COMMENTS' eP`O �eo,Ess�a" 21 r BOH 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 WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW020142 Legal Description: CHALET TERRACE LT 2 Design Engineer: 0811 Pinard Engineering Date Issued: Jun 04, 2002 Expiration Date: Jun 04, 2003 Parcel ID: 015-163-39 Site Address: 013101 HILLSIDE DR Owner Name: Robin & Karen Erickson Lot Size: 15969 SQ. FT. Owner Address: 11401 HILLSIDE DRIVE Total Bedrooms: 3 Permit Bedrooms: 3 ANCHORAGE. AK 99516-1175 This permit Is for the construction of. ❑v 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. S. The following special provisions. AT THE TIME OF CONSTRUCTION THE ENGINEER SHALL PLACE A BEDROCK)GROUND WATER TEST HOLE IN PROXIMITY OF THE PROPOSED ABSORPTION FIELD TO A MINIMUM DEPTH OF 6 FEET BELOW THE ABSORPTION FIELD FROM ORIGINAL GROUND SURFACE OR 20.5 FEET FROM ORIGINAL GROUND SURFACE, WHICHEVER IS DEEPER. Received By: Issued By: Date: O Date: Y Municipality of Anchorage -� Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907) 343-7904 Parcell.D. ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING 015-163-39 Rosy Permit Number SWO?0/42 Property owner(s) Robin & Karen Erickson Day phone 346-1550 Mailing address (1)11401 Hillside Drive Mailing address (2 Anchorage, Alaska Zip Code 99516 Legal description (Lot, Block & Sub'd.) Lot 2, Chalet Terrace Subdivision Legal description (Section, Township & Range) Lot Size 15,970± XX=Sq.Ft. /S -f 9G9 THIS APPLICATION IS FOR: Number of Bedrooms 3 Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade FLI THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwellin and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: V OJ /5 O RusZ-Waiver Fees: Date of Payment: to - S-02— Date of Payment: Receipt Number: 2 0 6 410 Receipt Number: (Rev. 12100) PINARD ENGINEERING Paul E. Pinard Z Registered Engineer/AK & ID P.O. Box 871347, Wasilla, Ak 99687 (907) 357-ENGR(3647) Dan Roth June 1, 2001 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw Street Anchorage, Alaska 99519-6650 RE: Lot 2, Chalet Terrace Subdivision; Wastewater Disposal System Upgrade, Plan Submittal Dear Mr. Roth: In preparation for the sale of the above referenced property, the owners, Robin & Karen Erickson, had this firm conduct an "Adequacy" test on the wastewater disposal (WWDS) that serves the three (3) bedroom, single family residence on the property. The system failed the test and now requires an upgrade. Based on my research of records on your web site, it appears that the existing system was installed in 1973 and consists of a 1000 gallon septic tank and a crib seepage pit for the soil absorption system. The owners have a sale pending and are anxious to resolve the problem with the failed system and wish to immediately proceed with an upgrade to the system. A testhole was dug on the property in the area immediately southwest of the existing seepage pit, within twenty-five (25) feet of where the new soil absorption system (SAS) is proposed to be sited. To help determine the soil characteristics, a percolation test was conducted in this testhole. The testhole log and percolation test data are enclosed (Encl. 1). . The testhole revealed satisfactory soil conditions that were subsequently confirmed by the results of the percolation test. At the time of excavation of the eighteen (18) foot deep testhole, a watertable was not found. Before the testhole was backfilled, a perforated pipe was installed as a monitor tube (MT) for measurement of the watertable at a later date. Examination of the MT eight (8) days later did not reveal any evidence of a watertable. A design for the proposed upgrade to the WWDS is enclosed (Encl. 2). The design specifies a "Deep Trench" type SAS, with an Effective Depth of ten (10) feet (sewer rock under the perforated pipe). The SAS would consist of one (1) trench with a length of nineteen (19) feet, providing 380 sf of absorption area. Flow from the existing septic tank will be directed at a one percent or greater slope to the distribution pipe (leach line) in the Deep Trench, where the piping is to be installed level, for equal distribution of the effluent throughout the length of the drainfield. The ground slopes in the immediate area of the WWDS are slight to moderate, presenting no problems to the installation of the system. The adjacent properties were inspected for possible impacts or conflicts with the proposed system. None were found. The proposed, upgraded system is located outside the minimum protective radius of any existing drinking water well. This property and the other lots in this subdivision are served by a community (public) water system. Because of the nature of the problem, i.e. a failed system that needs to be immediately replaced, and the pending sale/transfer of this property, your prompt review of these plans would be appreciated. The owners have authorized payment of the MOA fee (enclosed) for an expedited review and are prepared to immediately commence with the upgrade of this system once a permit is issued. A permit application has been completed and is also enclosed, along with a check for the sewer permit fee. Please contact me as soon as a permit is issued so that I can coordinate with the owner on this upgrade. If you have any questions, please give me a call at the telephone number above or on my cell phone (232- 1347). Thank you 1 'ncere� Paul E. Pinard, P.E. 5 Encl. (as) cc Robin & Karen Erickson, w/encl. # 1,2 & 4 N HILLSIDE DRIVE h A M 1 � y _ r P / _ 8 \ x x._x-x�,� 1 / x � t Existing SAS (To Be Abandoned) X 1 f— SO' Setback From 25%+ Slope x tr m PROPOSED WWDS UPGRADE % Via• (See Design, Sht 22) +g W x r y � j �r � I % well J, CxJ ` %O`t a r ro ca e ra x a CC p: yl'� • 4 1+ � Z m��oya a� c-. it Z M p1A� 1aO.O T x ,Q'. dei 'gyp i y2e y34:S • i Y e` I z st P ; w 70 Q L' 6.� • � 'p 3� O '� N w O $ y a 11u gd P > a y (n 'S3 0 O k o Z `p o p M M I N sxZ� 1dN wap �c'D ri CN (.n ? z ='\,c �-4m d _. 1 et r► v z G' Z y�/� T r+ - iii .\oar _ N�ii N< G)III^1 VO O > •\j. 1 II�Y C O � [� f/� (>� qq n 1 vO H a' w �. 0) � � 1'1 rl I� .-0 i f � t•1 n Y Y Y OE A o� -4� �c oaf O N Q3 �Molv MB"r do `z�wo;O P " Y G 1� PINARD ENGINEERING c P.O. Box 871347 Wasllla. AK 99687 (907) 357• ENGR (3647) ° TEST HOLE LOG / PERCOLATION TEST s TEST HOLE # 1 DATE: 5/21/02 JOB NUMBER' 02-069 SLOPE LOCATION: Lot 2. Chalet Terrace Level FIELD STAFF: A. Wien r%zoTY CFFT ROIL TYPE N Topsoil m 1 OL 2 3-1 1 ci W 5 SW - Gravelly Sand, Clean, Loose 6 but walls stat OK for Trench 7 8 9 10 11 12 13 SITE PLA y#1E—TH _ I 36' r i LJ s �0' s Exist. Seepage Pit Was Ground Water Encountered? Yes No If YES, Depth to Ground Water. Dry 5/21 & 5/29/02 PERCOLATION TEST DATA PM A Time Measurement Drop in Leel Perc Rate Time (minute) (inches) (intoes) min. / Inch Comments 8: 8.00 Fill Pere Hole :0 10 2.50 0 Refill Perc Hol 9:1 10 2.6 7 Refill Pere Hol :2 10 .62 8 Refill Pere Hol 9: 10 0 .50 Refill Pere Hol 10 .62 . 8 Refill Pere Hol 10 3.62 4.38 Stop Test 14 PERCOLATION RATE 2.3 min/inch ter.`'` CI 11i PERC HOLE DIAMETER 6" *' 49 R - 15 TEST RUN BETWEEN 5 Pr m` and 6 FT in DEPTH PAULE HARD CEA793 COMMENTS- Pere Hole pre-soaked. 16- 18 6 18 BOH GRE:R ANCHORAGE AREA BOf �)'GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME �f�'��s ��-��' MAILING ADDRESS // "I PHONE `- LOCATION / S'' f l�i�'�Ut LEGAL DESCRIPTION / " C SEPTIC TANK: DISTANCE FROM WELL e1y1 �' MANUFACTURER INSIDE LENGTH INSIDE WIDTH SEEPAGE PIT: _ NUMBER OF MATERIAL E COMPARTMENTS LIQUID DEPTH LIQUID CAPACITY/r(e' GALLONS. ADDITIONAL ABSORPTION WELL: / TYPE BUILDING FOUNDATION CESSPOOL APPROVED DISTANCES: CONSTRUCTION DEPTH _ NEAREST r���''` NEAREST SEPTIC LOT LINE I,"�` "`; SEWER LINE -,TANK_ OTHER SOURCES DISAPPROVED _ REMARKS INSTALLED BY: PIPE MATERIAL: LOT SLOPE: Cts REMARKS:P Form No. EQ -031 DIAGRAM OF SYSTEM DISTANCE FROM: SEEPAGE SYSTEM h ----- 40 DATE 1(k 9_0 APPROVED G.A.A.B. L�f NUMBER OF PITS DIAMETER OR WIDTH, LENGTH DEPTH LINING MATERIAL C'l�C�1 CRIB SIZE: DIAMETER DEPTH DISTANCE FROM: WELL + ` //��,�, TOTAL EFFECTIVE )�� BUILDING FOUNDATIONZ( NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT. ADDITIONAL ABSORPTION WELL: / TYPE BUILDING FOUNDATION CESSPOOL APPROVED DISTANCES: CONSTRUCTION DEPTH _ NEAREST r���''` NEAREST SEPTIC LOT LINE I,"�` "`; SEWER LINE -,TANK_ OTHER SOURCES DISAPPROVED _ REMARKS INSTALLED BY: PIPE MATERIAL: LOT SLOPE: Cts REMARKS:P Form No. EQ -031 DIAGRAM OF SYSTEM DISTANCE FROM: SEEPAGE SYSTEM h ----- 40 DATE 1(k 9_0 APPROVED G.A.A.B. /73 y�,, f. GREATER ANCHORAGE AREA BOROUGH gv b DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 330 "C" STREET ANCHORAGE, ALASKA 99503 I. TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT NAME OF APPLICANT '� -KA/ / INSTALLATION LOCATION LEGAL DESCRIPTION LL INSTALLATION OF: SEPTIC TANK '/U C J7 L--- et 14 Z ;7 3 TYPE AND SIZE OF FACILITY TO BE SERVED �) I�� ter, MAILING ADDRESS -S/ ' ` SEEPAGE PIT DI r PHONE N FIELD , OTHER FINANCED THROUGH TO BE INSTALLED BY SOIL TEST RESULTS �Gsf- .rr NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED A V� FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. Te SEPTIC TANK SIZE" �, C.j 'L TYPE -�/ SEEPAGE AREA SIZE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT / DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK SEEPAGE PIT DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TAf�{1� SEEPAGE PIT -. DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT ! DRAIN FIELD SEPTIC TANK, SEEPAGE PIT DRAIN FIELD , TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. i . OR LICENSED DESIGNER TYPE DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 26-68 AND THAT THE ABOVE DESCRIBE SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE���'"3 �- PPLICANT'S SIGNATURE FOR NO. EQ -016 • r. _. HI:ALTti ?I.'_'AI.T'';W!i r CASE. ;! ANCHORAGE, ALA`,KA 99501 79 Performed for `J' m !- r ^. Date Performed LE,Pal Descriptan: Lat Bleck Subc I- Description: This Fcrm Repox•ts a So is Lon v Percolation Tes Depth Feet Soil Chavacteristics Location Sketch F Was Ground 'slater Encountered?�rJ' If Yes, At What Depth Reading DateGross Time Net Time Depth To H2O Net Drop Proposed Installation; Seepage Pit Drain i ield Deco; Of Inlet _1)ept , 'J'oott� om Of Pa.t Or r± enc'i , COMMr..iTi: 2 2 5 S w .-b.�„ 2 .a -j L Test Performed B%:: Data Certified By;.,i-ZIC), Date: GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVTRONMFNTAL QUALITY 3330 "C" Street ANCHORAGE, ALASKA 99503 Case # Performed For ,UQ (; / .ue1-< Dated Performed 16 -a7-? 3 Legal Description: Lot_Block _Subdivision l' L"S-7 This Form Reports Soils Log X Percolation Test- - Soil Test Must Be Logged To 4' Below Proposed Seepage System - Depth Feet Soil Characteristics 1-- 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14— Was Ground Water Encountered? ;%'c) If Yes, At What Depth? S� 010 Reading Date Gross Time Net Time Depth to H2O Net Drop Percolation Rate Minute Proposed Installation: Seepage Pit Drain Field Depth of Inlet — Depth to Bottom of—Pit or Trench— COMMENTS: Test Performed BY���� ��w�� Date Certified BY: Date: MUNICIPALITY OF ANCHORAGE c,� Development Services Department -r Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-163-39-000 Expiration Date: Legal description CHALET TERRACE LT 2 Site address 7425 CHALET CT Anchorage AK 99507 Current property owner(s) ST CLAIR LEN E & KARIN T 1/18/2025 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: 2/9/2024 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 X Arsenic Advisory Other COSA ApprovaLJune 2022 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-163-39 Complete legal description CHALET TERRACE LOT 2 Location (site address) 7425 CHALET COURT, ANCHORAGE, AK 99507 Current property owner(s) LEN & KARIN ST CLAIR Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units ® Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 22 - 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 $ .J 50 Date of Payment /Z A COSA # OC LI 1021 Waiver Fee $ Date of Payment Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: CHALET TERRACE LOT 2 Parcel ID: 015-163-39 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA - CLASS “C” WATER - #211106 Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 4.90 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 1/18/2024 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank 49” Date of pumping 1/22/2024 Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 6/15/2002 ALL standpipes present per record drawing Total measured depth from grade 14.2 ft (max) Measured depth to pipe invert from grade 3.8 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective (ED). 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 2000 gallons 1/22/24 date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 1/23/2024 Results Pass Fluid depth prior to test 6 in Water added 540 gal New fluid depth 26 in Elapsed time 1145 min Final fluid depth 6 in Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 120 in (MOA 10’ ED) Effective depth used 6 in (Final Fluid Depth) Effective depth remaining 114 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots & appears approximate w/ 6” of sludge/fluid at bottom of monitoring tube. Per MOA request, record drawing hand note shows 2” of BB (Blue Board) insulation. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) - NA Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No *5 ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS *PER INSPECTION REPORT -- INSTALLED PER CODE IN 2002 WITH ELEVATED DECK SUPPORTS OUTSIDE EXISITING 2002 SEPTIC TANK AS MOA PERMITTED & SUBSEQUENT COSAS. 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 FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 1/25/2024 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 1/30/24 DEVELOPMENT SERVICES DEPARTMENT o On -Site Water and Wastewater Section _> www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval # OSC241021 Subdivision: Chalet Terrace Block: , Lot: 2 907-343-7904 Fax: 343-7997 The septic tank for this property is 22 years old. The average life of an asphalt coated steel septic tank is 20 years. Typical replacement costs are $10,000 or more, not including engineering, surveying or MOA permitting fees. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. r r v M v C M NOTES: GROUND LEVEL IMPROVEMENTS LOCATIONS ARE APPROXIMATE DUE TO SNOW COVER. A VARIANCE FOR THE BUILDING ENCROACHMENT INTO THE 10' SECONDARY FRONT YARD SETBACK ALONG CHALET COURT WAS GRANTED BY RESOLUTION #94-077. UMALL r COURT 4 1 PLOT PLAN AS BUILT X SCALE 1" = 30' GRID SW 2640 Project No. _ 24-024/R1 _ 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone 4��0000p (907) 522-4625 Fax a� F A C p04 Professional Land Surveyors kenOlongsurvey.com ...... • ,� d jonathanOlangsurvey.com �dP •.• .s �a I hereby certify that I have surveyed the following described property: LOT 2, CHALET TERRACE (Plat No. 70-265) Anchorage Recording District, Alaska, and that the Improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements an the property lying adjacent thereto encroach on the surveyed premises and that then: are no roadways, transmission lines or other visible easements on said property except as Indicated hereon. A�� Dated this the Day ofFL , t� - a ,i°-' Z 4 at Anchorage, Alaska It Is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. AECC063 Parcel I.D. 015-163-39 Municipality of Anchorage s �� On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Chalet Terrace Lt2 Expiration Date: to - oz 2"1 J Location (site address) 7425 Chalet Ct., Anchorage Ak. 99507 Current Property owner(s) Gina LapekaS Day phone Mailing address 7425 Chalet Ct., Anchorage Ak. 99507 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: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class C Well WaiverNariance request 3 Received by: I � COSA to be released to the en0eer, unless otherwise requested by the engineer. COSA Fee Date of Payment Receipt Number COSA#�� 4 Date: j ! ) Put Waiver Fee $ Date of Payment Receipt Number Waiver # TYPE OF WASTEWATER DISPOSAL: ❑ Individual El ❑ Holding Tank ❑ Q Community ❑ Received by: I � COSA to be released to the en0eer, unless otherwise requested by the engineer. COSA Fee Date of Payment Receipt Number COSA#�� 4 Date: j ! ) Put Waiver Fee $ 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 outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Alk. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE k-SSystem #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Date l 3r5`,3`Z-17 Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: 3 `-2) 7— 13 Theunici i rage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r c If more than 1 septic system is on the lot: COSA Checklist # + of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Chalet Terrace U2 A. WELL DATA Well type Class 'C' Date completed _ Total depth ft. Date of test Static water level Well production If A. B, or C provide PWSID # 211106 Sanitary seal (YIN) Cased to ft. FROM WELL LOG ft. WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate 3.88 mg/L Arsenic N D ug/L Date of sample: 3/12/12 B. SEPTICIHOLDING TANK DATA Tank Type/Material Steel Tank size 1000 gal. Number of Compartments 2 Parcel ID: 015-163-39 Well Log (YIN) Wires properly protected (YIN) Casing height (above ground) in. AT INSPECTION ft. g.p.m. Collected by: P.E.S. Date installed 6/15/02 Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (YIN) NA Date of pumping 5/23/12 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed 6/15/02 Soil rating (g.p.d./f:2 or ftz/bdrm) 1.2 sVbd System type Trench Length 19 ft. Width 3 ft. Gravel below pipe 10 ft. Total depth 14.8 ft. Eff. absorption area 380 ft2 Monitoring tube Y Depression over Feld N Date of adequacy test 11/27/12 Results (PassIFail)'aSs For 3 bedrooms Fluid depth in absorption field before test 7 in. Water added 456 gal. New depth 18 in. Elapsed Time: 90 min. Final fluid depth 7 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons in. "Pump off' level at in. E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line Cycles tested Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots _ On adjacent lots _ Public sewer manhole/cleanout Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION l certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R Pannone Date /Zo t� COSA brown sheet 10-10-12.doc Water main 10+ Driveway, parking/vehicle storage 110+ Municipality of Anchorag -• Development Services Departm Building Safety Division % On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-163-39 HAA # 114 hQL M_�& q Expiration Date: - a4, O 3 1. GENERAL INFORMATION Complete legal description Lot 2, Chalet Terrace Subdivision Location (site address or directions) 013101 Hillside Drive Current Property owner(s)Robin & Karen Erickson Day phone (907) 346-1550 Mailing address Lending agency Mailing address Real Estate Agent 11401 Hillside Drive Anchorage, Ak 99516 Day phone Terri Davis Dayphone (907) 727-5130 Mailing Address Next Estate Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class C Well Public Water System ❑ Rd. #5 chorage, Ak 99503 TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of 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 sincle 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.) Certificates are valid for one year for properties served by Class A or B we!ls 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, 1 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. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pinard Engineering Phone(907) 357-3647 Address PO Boz 871347 %snla. Alaska 99687 Engineer's Printed Name 5. DSD SIGNATURE Paul E. Pinard - Ll"' Approved for �3_ bedrooms. Disapproved. Date 6/19/02 Paul E. PinarJ� '),c�1j.•°•• CE -4793 °: �c.J We- ROFESS1.0 Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: i 1'• / -rrc� Oriainal Certificate Date: (R".1ua) Municipality of Anchorage • Development Services Department Building Safety Division On-site Water 8 Wastewater Program 4700 South Bragew St. . P.O. Box 196650 Anchorage, AK 995196650 www.ci.enchorage.ak.us (907) 343-79W HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 2, Chalet Terrace Subdivision_ Parcel ID: 015-163-39 A. WELL DATA Well type Community If A, B, or C provide PWSID #211106 Well Log (Y/N) N/A Date completed N/A Sanitary seal (YIN) Wires properly protected (Y/N) N/A Total depth N/A ft. Cased to N/A ft. Casing height (above ground) N/A In. FROM WELL LOG Date of test N/A Static water level NIA ft. Well production N/A g.p.m. WATER SAMPLE RESULTS: N/A Coliform colonies/100 ml. Date of sample: Nitrate mg.A. Collected by: AT INSPECTION B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping N/A Pumper N/A N/A N/A ft. N/A g.p.m. Other bacteria colonies/100 ml. Date installed 6/15/02 Cleanouts (Y/N) Y High water alarm (Y/N) N/A C. ABSORPTION FIELD DATA Date installed 6/15/ 02 Soil rating (g.p.d.1W or ft Abdrm) � of/bdsystem type Deep Trench Length 19 ft. Width 3 ft. Gravel below pipe 10 ft. Total depth 12.5 ft. + Eft. absorption area 380 ft' Monitoring tube Y Depression over field IN Date of adequacy test N/A Results (Pass/Fail) N/A For N/A bedrooms Fluid depth in absorption field before testqLA in. Water addedNLA gal. New depthN/A in. Elapsed Time: t/ min. Final fluid depthN/A in. Absorption rate >= N/A g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) N/A If yes, give date D. LIFT STATION N/A Date installed Size in gallons "Pump on" level at _ in. "Pump ofP leve a Datum Cycles tested E. SEPARATION DISTANCES SEPARATIONS LACES FROM WELL ON LOT TO: Manhole/Access (Y/N) _ High water alarm level at Meeh alarm 3�aranE7r}eole N/A in. Septic tank/lift station on lot On adjacent lots Absorption field on lot cent l:manho Public sewer main Public sewer ut Sewer /septic service line Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 51 Property line 301+ Absorption field 81 Water main SO 1 + Water service line 101 + Surface water 1001 + Weiss on adjacent lots N/A SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 301+ Building foundation 21 1 Water main 501+ Water Service line 101 + Surface water 11001+ Driveway, parkinglvehide storage 201 + Curtain drain N/A Wells on adjacent lots N A F. COMMENTS G. ENGINEER'S CERTIFICATION ••s'f�+( r y�P�• 1 certify that I have determined through field inspections and *.• LU • • review of Municipal records that the above systems are in �4 • • • • • • • conformance with MOA HAA guidelines in effect on this date. ERA • ••• • • • • • • • / ul E Pinard Engineer's Printed Name Paul E. Pinard 11 •. CIE -479 1111 Date 6/19/02 .• �.{',. •••AgQFESSid"® a_ HAA Fee $ 3 7s Date of Payment %a - 20— 02Receipt Number Z- b .•� (Rev. 12100) Waiver Fee $ Date of Payment Receipt Number 0 50' (NTS) 111=20' 00 rn N 3 0 O 0 O O 7 P70-265 CHALET TERRACE SUBDIVISION LOT 2 15,969 S.F. ALPS AVENUE 0 N R9°55'3n"F 139.50' AS—BU I LT I hereby certify that I have surveyed the property depicted above and that no GASTALDI LAND SURVEYING encroachments exist except as indicated. Jeff A. Gaatoldl, R.L.S. It is the responsibility of the owner to 4726 West 88th Ave. determine the existence of any easements, Anchorage,.. Alaska 99502 covenants or restrictions which do not PHONE -248-5454 appear on the recorded subdivision plot. Under no circumstances should any data GRID DATE hereon be used for construction or for 2640 g/lg/gq establishing boundary or fence lines. F.B. JOB NO. ANCHORAGE RECORDING DISTRICT, ALASKA 94-13 CTER2 PINARD ENGINEERING Paul E. Pinard Registered Engineer/AK & ID P.O. Box 871347, Wasilla, Ak 99687 (907) 357-ENGR(3647) Dan Roth Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw Street Anchorage, Alaska 99519-6650 June 19, 2001 RE: Lot 2, Chalet Terrace Subdivision; Wastewater Disposal System Upgrade, Record Drawing Submittal Dear Mr. Roth: 1�1 Attached is the Inspection Report, Record Drawings and the Health Authority Certificate Application for the recently installed Wastewater Disposal System (WWDS) on the referenced property. You had previously approved the plans and issued the permit on June 4, 2002 for this upgrade of an existing system. Installation of this upgrade began on Saturday morning; June 15`}' and was finished with the final grading on Monday morning, June 17'x'. As specified in the permit, calls were made to your office to advise you of the installation and the two (2) required inspections. Calls were made to your office Friday evening, Saturday morning, Saturday afternoon and Sunday afternoon, however your recorder must have turned off because there was no answer to any of these calls. Another testhole was dug on the property, as required by the permit, near one end of the new soil absorption system (Deep Trench). The testhole was dug to a depth of 21', more than six (6) feet below the bottom of the new absorption system and revealed the same soil conditions as originally encountered. There was no watertable or seeps revealed in the new testhole. A testhole log is included with the Record Drawings. A check in the amount of $ 375.00 for the Health Authority Certificate is also enclosed. Please contact me as soon as an approval is issued so that I can coordinate with the owners and their Realtor on the pending sale/transfer of this property. If you have any questions, please give me a call at the telephone number above or on my cell phone (232- 1347). Thank you! ' cerely, Paul E. Pinard, P.E. 4 Encl. (as) cc Robin & Karen Erickson, w/encl. 1-3 Vdl MUNICIPALITY OF ANCHORAGE ,> DEPARTMENT OF OF HEALTH & HUMAN SERVICES ..Division of Environmental Services _. On-Site Services Section x=<" P.O. Box 196650 _ Anchorage, Alaska 99519-6650 343-4744 , ._t w b :a`t-,�.._ .... ••,!. '. i': ,i ' n = CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING u .. -zw "nt tri{ ••{ r_4; ©l g- _16 —39 Parcel I.D. # HAA # _ f I = 4GENERAL INFORMATION r Y Complete legal description Lot 2; Cha ee t• Te4Aace Subdiv" ion Location (site address or directions) 11401 H.c.P ide au've Anchorage, AK - Jau SuthenPand - y(hfi Property owner - Day phone 277 9636 Mailing address 2320 Be&on# Anchorage, AK 99516 562-7275 (w) Lending agency Day phone Mailing «address - Agent Day phone. p- Unless otherwise requested, HAA will be held for pickup ger } i 2 NUMBER OFBEDROOMS• r' 3 3. TYPE OF .WATER SUPPLY: s rt- Individual well Community well .� . 'L Xxx Oil Publicwater ax ,ty y _ �y11, ADEC attest Ing to the It alt and status of system., j, ��!' r NOTE If commun► wells stem, provide written confirmation from State 99 tY ys 4. TYPE OF WASTEWATER DISPOSAL: S r Individual on-site - s Mf Holding tank k , , ��V�iP*"*1.13''<'r�. 't94�� ., , `,..'.. . aJ�' tib. �t'�k ,�,—;��.�-�,�(f �.d �,+.•'t Community on site it A. n, .,Y ,i .t... °^.6..'exaar Public sewerJjf]� `�- i ." '.`,... -' - .:• ,,_.,.`. ,.�_.-:i .s ,. f.. ". ' r s,:�k` ;7c, =; ,>..,�{, ,.{1y!'h•�ci+'tt! NOTE. If community wastewater system, provide written- confirmation from Stat eADEC - attesting to the legality and status of system. syr r2 72-M (Rwv.1/91) froM MOA N21 x 5. STATEMENT OF INSPECTION BY ENGINEER ' As certified by my seal affixed hereto and as of the validation date shown below, I verify thatmy 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 investi!c ation 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& 5 ENGINEERING Phone /"103,9( e River Loop Reed Ift Address �' R Engineer's signature Date 02- l 9,S .. ....,...,.... ...... ,. ..._. {r ;7 RCZERT C. COWAN [ �! C. r_ sF 6... DHHS SIGNATURE ./, Et .,........ ... , _ Approved for . bedrooms. - Disapproved. Conditional approval for �` bedrooms, with the following stipulations 1.iK L Additional Comments . . Date B 1 • c, A �•� the �uldniipality of chorage Department of Health and Human Services (DHHS) issues Health Authority E Approval FCertificates• based only upon the representations given, in paragraph 5 above by an independent .�s pl ofessional enKiri er, registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes rd t t' rta'n federal and state ' uirements Employees of DHHS do not and t vir. lending institutions m o e, o sa isfy %, i req 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_()25(Rw. 1/91) Back MOA N21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LT �2� Parcel I.D. A. Well Data J Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump levell (D)S"-/63_317 B, or C, attach ADEC letter. ADEC water system number %l1 U4 Date completed Driller Cased to 1l� Casing height Wires properly protected (Y/N) FROM WE ph L LOG / / H 1,J g.p.m. AJ4 SEPARATION DISTANCES FROM WELL TO: Septictholding tank on lot o` 06 4 ; On adjacent lots Absorption field on lot �36'4 ; On adjacent lots Public sewer main I J)A Public sewer manhole/cleanout Sewer service line Petroleum tank r � � c OZ rtl � 9 n q C T .p.m. ® eD z N C ® N G 0 z WATER SAMPLE RESULTS: Coliform N4 Nitrate i� Other bacteria Date of sample: Collected by: A B. SEPTIC/HOLDING TANK DATA Date installed III/ Z33 Tank size /000 G. -c- Compartments Cleanouts (YIN) I z� Foundation cleanout (Y/10 No Depression (Y/1 High water alarm (Y h) Alarm tested (Y/gyp 1/11��� rp Date of pumping Pumper 4 f AJ AE ELw- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: 1 Well(s) on lot ti -h- On adjacent lots a oo Foundation 8 1 r To property line IU Absorption field 1010 Water main/service line Surface water/drainage 72-026 (3193)' Front 10 6, �- CONTINUED ON BACK PAGE C. LIFT STATION '"IA Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DI,STAt4I E FROM LIFT STATION TO: on lot On adjacent lots Manufacturer Manhole/Access (Y/N) tested off" Level at Surface water D. ABSORPTION FIELD DATA J Date installed �� ! I �3 Soil rating (Ftz) 6� 5182 System type clr-lL� Length 1y' Width 11� I Gravel thickness 6 Total depth /6 Total absorption area 336 EF Cleanout present 101) Yds Depression over field (Y/M �d Date of adequacy test a ? t 9S Results (passifail) /9Z z for 3 Bedrooms Water level in absorption field before test 3 -$ After test 3 - 0 Peroxide treatment (past 12 months) (Y/6 /U67 If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot L4 _On adjacent lots dao '-J Property line To building foundation /o � To existing or abandoned system on lot _ On adjacent lots /U a Cutbank 14 Water main/service line Surface water /Ub Driveway, parking/vehicle storage area Curtain drain No"* I� rv6wti E. ENGINEER'S CERTIFICATION 10 �-A I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ..........., , SignaturecY' .. Engineer's Name [ :....: ....... ..a�,;. t� -+ ROBERT C. COWAN ,^ Date �/ f !/ `7 S''�:,� CE - aso 1 HAA Fee $ / Waiver Fee $ Date of Payment ll S( Date of Payment Receipt Number L� �%� Receipt Number 72-026 (3193)' Back ' MUNICIPALITY OF ANCHORAGE O DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVALQ� OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name , '�'""� Telephone: Home Business `Applicant Address (c) -Applicant is (check one): Lending Institution ❑ ;.Ow er/builder); Buyer ❑ ; Other ❑ (explain); - A (d) Lending Institution elep one A, Address P" (e) :., Real Estate Company and Agent - ,. Address Telephone r (f) Mail the HAA to the f low i address: 5'G! - Sv yid x G 2. TYPE OF RESIDENCE Single Family Multi -Family ❑ Other Number ' of Bedrooms 3.`WATER SUPPLY Individual Well ❑ Community'19 Public ❑ xa �r 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. :r.. Pagel of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDING. .SPECTIONS, TESTS, FILE SEARCH, DA). 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 FirmGS Telephone Address 12000 �.% 33— /�� SuiT1' JS 44, /< %^5a3 Date 2 �awwv►ti�` A.Q�,� ��� 00001". 4 *CO �'�� ♦ + i ROY C R D, ,!R . Otte ���..Ar #�� ftp•••....•••'• *Ar B s♦ 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) IJACIPALITY OF ANCHORAGE (MOA) or i�'�GNM✓�yalti4 AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 oN �N .� 264-4720 =J1g� Legal Description: _q VV A. WELL DATA Q �co 1� Well Classification � y. If A, B, C, D.E.C. Approved(�� N) og Present (Y/N) Date Completed ��-'' Yield Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Grou Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot djoining Lots To Nearest Public Sewer Line To Nearest Pub ewer Cleanout/Manhole To Nearest Sewer Service . e on Lot Water Sample Collected by ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed �/-73 Size 1000 No. of Compartments Standpipes 6)N) Air -tight Caps) Foundation CI Ping f:A►D Y 4 r Depression over Tank (YQ Date Last Pumped _ A. �• r -Z t -t7 Pumping/Maintenance Contract on File (Y/N) �-% ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) AA Separation Distances from Septic/Holding Tank: r To Water -Supply Well Z&V f To Building Foundation r r To Property Line 0 'A- To Disposal Field r To Water MairVSefvice Line 7 To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �S Type of System Design eve 40 Date Installed �� j. %j Length of Field r � Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area _ -334- Standpipes Present) Depression over Field (Y/ Date of Last Adequacy Test Results of Last Adequacy TestotfT� Separation Distance from Absorption Field: r r To Water -Supply Well Z� �" To Property Line IX r To Building Foundation ze To Existing or Abandoned System on Lot 4 ; On Adjoining Lots /© _10- To 1`To Water Main/Service Line f4 7" To Cutbank (if present) I!IA To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION ad Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) — "Pump Off" Level at Vent (Y/N) ** Check Permitted Bedroom Rating Against HAA Request ** PumpiRg,Cycles during Adequacy Test. Meets MOA I certify that I ha clicked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed �� Date +•�F�'` Company �e-5 MOA No 9-7 0 �'�GG Q A4��• Receipt No. �/ vVd 7 �!""el �•.'/ � Date of Payment O j9�0 o,Amount_ $ �� Q 4 �•• ••••• .•mo , ` i Y C. REID, JR. i J*Ci?s*2251, Page 2 of 2 72-026 (11/84) STEVE COWPER, GOVERNOR 0 Q 0 0 0 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 563-6775 3601 "C" STREET, SUITE 1334 ANCHORAGE, ALASKA 99503 DATE: August 24, 1987--- PWSID #: 211106 ------------------ To Whom It May Concern: According to the records on file in this office, the - CHALET --_-- TERRACE ------------- Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, Ronald S. Klein Environmental Field Officer PINARD ENGINEERING Paul E. Pinard Registered Engineer/AK & ID P.O. Box 871347, Wasilla, Ak 99687 (907) 357-ENGR(3647) Dan Roth Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bmgaw Street Anchorage, Alaska 99519-6650 June 19, 2001 RE: Lot 2, Chalet Terrace Subdivision; Wastewater Disposal System Upgrade, Record Drawing Submittal Dear Mr. Roth: Attached is the Inspection Report, Record Drawings and the Health Authority Certificate Application for the recently installed Wastewater Disposal System (WWDS) on the referenced property. You had previously approved the plans and issued the permit on June 4, 2002 for this upgrade of an existing system. Installation of this upgrade began on Saturday morning, June 15'' and was finished with the final grading on Monday morning, June 17i°. As specified in the permit, calls were made to your office to advise you of the installation and the two (2) required inspections. Calls were made to your office Friday evening, Saturday morning, Saturday afternoon and Sunday afternoon, however your recorder must have turned off because there was no answer to any of these calls. Another testhole was dug on the property, as required by the permit, near one end of the new soil absorption system (Deep Trench). The testhole was dug to a depth of 21', more than six (6) feet below the bottom of the new absorption system and revealed the same soil conditions as originally encountered. There was no watertable or seeps revealed in the new testhole. A testhole log is included with the Record Drawings. A check in the amount of $ 375.00 for the Health Authority Certificate is also enclosed. Please contact me as soon as an approval is issued so that I can coordinate with the owners and their Realtor on the pending sale/transfer of this property. If you have any questions, please give me a call at the telephone number above or on my cell phone (232- 1347). Thank you ! erely, \Paul E. Pinard, P.E. 4 Encl. (as) cc Robin & Karen Erickson, w/encl. 1-3 MUNICIPALITY OF ANCHORAGE DIVISION OF &WIROWENTAL HEALTH DEPARIMENT OF HEALTH AND aMRON MD4TAL PRMC"TION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information (a) Legal Desc ripti ( include lot, block, / --? / .h .,7 -, r �,00,O lJlr,- Location (adc�e ss or directions) Applicaticn Date y 3r-gq vision, section, township, range) (b) Applicants Name e., ///1 -S telephone .341r f % 4 - Applicants Applicants Address (c) Applicant is (check one) Lending Institution ; Owner/builder ; Buyer r:::l ; Other f:::j (explaln); s t L Te la hone / • �_�, i '.S` (d) Ianding Institution ; 1 la s �u I, r r s crC. P Address t h��- i�i T51 /7 (e) Real Estate Co. a Agent Z�^R q f & L C57-.-4T"e Address Te lephone 2. TyLe of Residence Single -Family Number of Bedrocxns 3. Water Supply Multi -Family 1 Other (describe) Individual Well F::� Community rx-7 Public Note: If cotmunity well system, must have written confirmaticn from the State Department of Ervirormental Conservation attesting to the legality and status. Is the well adequate for the number of 5tidrocros specified0in this HAA (Y/N) Y 4. Sewage Disposal Onsite Public Cornunity Holding Tark Is the wastewater disposal system adequate for the number of bedrocans (Y/N) y [Page 1 of 2 J Information to all MOA HAA Guidelines ir, 'f f I,,- i ., Fpr a f, • s! q r �n � rec'T Date Name of Firm /Jqa * � e r k' e Telephone .3+4- - f-70 1 Address S igned by AJL . i Date, .-.� (ENGINEER SEAL) 6.DHEP Approval ®®m0® 40 1- At ®�® AP'�'� • . 0 >� 4� ...4 ....`J .:: ................ NEIL HAl"JThIORYE + �� �.' CE - 4369 .` c; 1 ��v�l! f ••. •.•• �.S'.J t tk Approved for --� bedrooms By TDate � Approved Disapproved Conditional Terms of ConditLional Approval The Municipality of Anchorage Department of Health and Environmental Protection does not guarantee the continued satisfactory performance of the water supply and/or tre wastewater disposal system. This approval indicates that, as of the validation date shown above, based on the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and furc- tional for the number of bedrocus and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the following address: RB2/d5/s (Page 2 of 21 2 -15-x•1 r w a7 a M, 6k 2 -15-x•1 MUNICIPALITY OF ANCHO MC#i DEPT. OF HEALTH & ENVIRONMENTAL PIiOtECtI©Pl MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL ( HAA) AY a 1 4 CHECKLIST - FEBRUARY 1984 p E C E J v E D 1� Legal Description: 6-5)r /J,'_� A. WELL DATA - '7 ��F S:2 '?T, ti Well Classification { o ,.�c�� �; r,o If A, B, cr C, D.E.C. Approvved(Y/N) Well Log Present (Y/N) Al Date Completed 1JYield M Total Depth �,`,� Cased to Depth of Grouting f�1, Static Water Level'/, Pump Set At Casing Height Above Ground / <.,°115� Sanitary Seal on Casing (Y )4i ��; Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N)1:' .� Separation Distances fron Well: To Septic/Holding Tank on Lot ;; ' ' ; On Adjoining Lots tZ To Nearest Edge of Absorption Field on Lot e• t'a° ; On Adjoining Lots ll,,, To Nearest Public Sewer Line A'4. To Nearest Public Sewer Cleanout/Manhole/ To Nearest Sewer Service Line on Lots Water Sample Collected By /%,.`'ry' ; Date Water Sample Test Results Come nts B. SEPTIC/HOLDING TANK DATA Date Installed Aetl i 13 Size /DOD a' 4L No. of Ccmpartments / Standpipes (Y/N) %/@5 Air -tight Caps (Y/N) yeS Foundation Cleanout (Y/N),� Depression over Tank (Y/N) �j p Date Last Pumped -el 3C0 - e?el Pumping/Maintenance Contract on File (Y ) _; for _ /Nll/ Holding Tank High -Water Alarm (Y/N)h Temporary Holding Tank Permit (Y/N) /J44 Separation Distances from Septic/Holding Tank: To Water -Supply TAJell (;pro To Building Foundation G1 To Property Line To Disposal Field rj To Water Main/Service Line /�' '` To Stream, Pond, Lake, cr Major Drainage Course �-'----- Comments (Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA �� K ` fi T of System Design Sells Rating in Absorption Strata �_ A L'xr Type Y 9 G �3 Date Installed /Vou. 6 -?3 Length of Field Iq Width of Field �� t Depth of Field tl Gravel Bed Thickness ///�- Square Feet of Absorption Area 336 Standpipes Present (Y/N) Ve f Depression over Field (Y/N) Alp Date of Last Adequacy Test Results of Last Adequacy Zest Vim, Separation Distance from Absorption Field: To Water -Supply Nie 11 4 ° '` To Property Line /S � 46- To `To Building Foundation �' To Existing or Abandoned System on Lott!/ On Adjoining Lots ••gyp' To Water Main/Service Line /5-- To Cutbank(if present) A] 114 To Stream/pond/Lake/or Major Drainage Course ItJ-,4 To Driveway, Parking Area, or Vehicle Storage Area /Q° s' Comments D. LIFT STATION �&) 1A Date Installed Dimensions J Size in Gallons Manhole/Access (Y/N) "Pump on" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Vest. Meets MDA Electrical Codes(YM) Cements * Check Permitted Bedroam Rating Against T•IAA Request ** I certify that I have checked, verified, or, conformed to all MOA HAA NAO! in effect on the date o,f, this ipact' on. ' ' •� S i e d � Dated 7 .• MOA No.1�} -L E�1GI a Company /f 9-(a-. "i-G.Ar� e c°..'. KBl /d5/s t' i pPr �Fc" 8 [Page 2 of 21 2-15-84 �. F. ,, :� '! :� -�� GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality Street, Anchorage, Alaska 99503 274-4561 Date Received 7 0/, - Time Time of Inspection --T Date of Inspection OZ-,;,' 317.1 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested br.tr L -- Mailing Address: Phone: 7,;2 - /V -r/ 2. Property Qlv� % Co Phone: -R-7S- 3"/ Mailing Address: 4LS- �. 3. Legal Description: &:L -� @-c,Qe &-c,c_._ 4. Location: 4'u- Aq TV - T 5. Type of facility to be inspected 5 F D No. of bedrooms 6. Well Data: A. Type B. Depth C. Construction D. Bacterial Analysis 7. Sewage Disposal System: A. Installed /q 7 3 B. Installer 4.4 C. Septic Tank: 1. Size `! 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank Absorption area Sewer Lines , Nearest lot line Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages s GREATER ANCHORAGE ARLi, BOROUC;H Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 - 274-456 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: CMRO VA FHA CORV 2. Property Owner: Mailing Address: ���.1 Day Phone 3. name of Buyer: Mailing Address: Day Phone 4. Na -.Is of Lending Institution: Mailing Address: 5-- Phone�- 5. Name of Realtor or Agents �� ,��,�✓,�� 4 Mailing Address: ,� f �,�%� Phone 6. Legal Description: _ _-77Z Locati o . 7. Type of Facility to be inspected: No. Bdrms. 3 S. Muter Supply Type of Supply: Publ i c Utility tt��Ind i vi dual If Individual, number of dwellings presently served if Individual, depth of well 9. Sewage Disposal System Type .of System: Publ i c Ut i i i ty Individual (on-site) If Individual , date of i nstai 1 ati on q A(/ r j Page -2 of two pages - RecV z for Approval of Individual S & Water Facilities Legal Description Approv ; Disapproved Date A/al ,Valid for one year from date signed Greater Anchor, a Area Borough, Department of EnvironmPntal Qud1,_'.ty DIAGRAM OF SYSTEM i certl Ty LnaL Lne i nrorrnaLI on contra 1 neu IN U1 I S Vt!gUCJ L lug- aPPI Uva i L'u uc a i.r ua anu accurate representation of the subject sewer and water f c ities and these facilities are operating ,satisfactorily. SIGNED L,`�G c T �'� 11Date �� Z EQ -034 (1/74)