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HomeMy WebLinkAboutMCGOWAN LT 5McGowen Lot 051-091 -28 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211194 Work Type: Septic Upgrade Tax Code Number: 05109128000 Site Legal Address: MCGOWAN LT 5 G:1357 Site Mailing Address: 21237 WEEPING BIRCH AVE, Chugiak Owner: DELLA CROCE JOHN Design Engineer: VEI CONSULTANTS This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date f Deparrment 6/14/2021 6/14/2022 Lot Size in Sq Ft: 20770 Total Bedrooms: X 4 — C041 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: "*The� `,y -bedroom reserve field shall be shown on the record drawings. Please note, the field shall be within the 30 ft radius of a test hole. c_nci Shall 64?_ o to ''V' M m 4 he- etc i 5-H r -s W T S Cftd4oL^TeX) U� S; 7 v%�s n'o I to r�jr A e 0-A e- d . _ PC 9/2x{/21 AcwLZ-rs Received By: Date: y 2 7 Issued By: Date: / �� P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Department On -Site Water and Wastewater Section �rcnr S ,ry I) I1J i'f I71 L`ilf *XxX VARIAMCAUWAIVER REVIEW xxXX Waiver#: OSV211030 COSA#: PID#: 051-091-28 Legal Description: McGowan Lot 5 Engineer: VEI Consultants Applicant: John Delia Croce Permit#: OSP211194 Your request for a waiver of the required 100 feet horizontal separation from the septic tank to the private well has been approved. The approved separation distance is 90.0 feet. This is a re - issuance of WR980042; the proposed tank will be an improvement over the existing steel tank. In addition, your requests for a waiver of the required horizontal separation from the absorption field to a steep slope and to the septic tank have been approved. The approved separation distances are 8.5 feet and 2.0 feet, respectively. See engineer's waiver request for justifications. This waiver approval applies to the proposed septic tank and absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. a a a a a a a a avavaaIII vaamaaaaamamaaaaaammaaaaaaavaammmaaaaaaaaaaaaaeaaaaaaavaaaaaaaaI Waiver is Granted: X Waiver is not Granted: Date: .�Z 0.2 ] Approved by: ���'. &A Name of Reviewer amaavaamaaevacaacaaaaacmaaaaaeaaaaaaaaaaaaacaaaaaaaaaaaaaaaaaaaaomaaaaaavaaaa01 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-091-28-000 Property owner(s) John Delia Croce Mailing address PO Box 772274, Eagle River, AK 99577 Site address 21237 Weeping Birch Ave Day phone 907-529-2529 Legal description (Sub'd., Block & Lot) Lot 5, McGowan Subdivision Legal description (Township, Range & Section) Lot Size 20,770 Sq. Ft. Number of Bedrooms cv 1 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field E] Initial ❑ Single Family (SF) [x] Septic Tank ElUpgrade ❑ (w/wo ADU) Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: 15.65.210 B.1.e. Disposal Field within 20' of 25% slope <10 ft Distance: 8.5 1 certify that the above information is correct. I further certify that this is in accordance with applicable unicipa€ Cod (Sign ture of property owner or authorized agent) Permit/Rush Fees: 5 Waiver Fees: -$ 9-rJ Date of Payment:. 1I )'0 � 1 Date of Payment: _ -1 / ao 2 1 Receipt Number: 9 ' A'5 �6 Receipt Number: °� 2-05 7 61 Permit No. 0 SP 'a 11 1 9 Waiver No. OS \ V10 3 U GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc Civil Engineering and Surveying Consultants 1345 Rudakof Circle, Suite 201 Serving All of Alaska Anchorage, Alaska 99508 FAX: (907) 338-5386 Phone: (907) 337-3330 September 20, 2021 Becca Carroll Municipality of Anchorage Development Services On -Site Water and Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Re: On -Site Sewer for Lot 5, McGowan Sub'd Revised Narrative, Waiver Request, and Permit Application Ms. Carroll, Earlier this summer, VEI Consultants was contracted to design a replacement onsite wastewater disposal system at the above referenced property. The existing single family residence on the property is three (3) bedroom. In the near future, the homeowner plans to renovate the home and add additional bedrooms. In June 2021 we completed the design and obtained a permit (OSP211194) to construct a system accommodating a five (5) bedroom single family residence. In late July, JR's Septic began construction of the system and installed the new 1500 gallon HDPE tank. However, when they started excavating in the northwest corner of the proposed leachfield, they found an unforeseen tight silt layer (about 5 ft thick) at a depth of approximately 7 ft. With this area unusable for a new drainfield, the homeowner and I decided to have JR's connect the new tank to the existing drainfield and give us time to consider other options. At this time we would like to revise our permit to allow construction of a system accommodating a four (4) bedroom single family residence. We proposed to retrofit the new 1500 gallon HDPE tank with an AWWTS Category 3 Advantex system, which will discharge into the existing drainfield. A satisfactory adequacy test was performed on the existing drainfield (see System Design). The house, well, and septic system locations are shown on the attached Site Plan, Sheet 1. We request that you approve the attached permit application for construction of the wastewater disposal system. M On -Site 6i'asteivater Disposal System — Revised Narrative, Lot .5, McGowan Sub 'd September 20, 2021 Page 2 of '3 Soils VEI conducted field investigations including surveying, boring and logging a test hole and installation of monitoring tube, digging a test pit, performing percolation tests and groundwater monitoring. The Soils Log—Percolation Test for Test Hole #1 is attached; this data provides the basis for design. Groundwater was detected in the test hole at a depth of 21.0 ft (monitored several times in October 2020, November 2020, and May 2021). An impermeable layer was detected at a depth of 25.0 ft. A monitoring tube for the test hole is in place. Percolation tests were performed using the procedure outlined in AMC Chapter 15.65.210. We chose an application rate of 1.2 gpd/sf in the previous trench design based on using a percolation rate of 3 minutes per inch. This is comparable to the existing drainfield design that assumed a soil rating of 100 SF/bedroom (1.5 gpd/sf). Surface Water & Topography There are no surface waters within 100 feet of the proposed system. Additionally, no seasonal surface water has been observed collecting anywhere on the property. The general slope of the lot is from South to North at a gentle grade. However, an embankment with a height of approximately 6' and a slope of 50%, is located on the northeast corner of the property. The existing absorption trench is located 10.5 feet from the top of the embankment. Svstem Design See the attached design drawings and specifications for the proposed system design. The proposed system will not alter the existing site topography or drainage patterns. The ground surface will be graded to ensure positive drainage across the absorption trench and prevent surface water from collecting. The existing septic tank is 90 feet from the well on the property; a waiver for this reduced separation distance has been granted. The existing absorption trench is greater than 100 feet from the well. There are no adjacent private wells within 100 feet or community wells within 200 feet of the proposed system. We do not expect there to be any adverse effect on adjacent lots by the construction of this system. Coy 1 Ors -Site Yt'asteivater Disposal System — Revised Narrative, Lot 5, McGowan Sub'd September 20, 2021 Page 3 of 3 On September 18th and 19" I performed an adequacy test on the existing absorption trench. The system has been actively used and did not require a pre-soak. Using the onsite well, I added 3 gpm to the cleanout upstream of the tank for 200 minutes (a total of 600 gallons). The water depth in the existing trench was monitored using the existing tube at the east end of the field. Test log is as follows: TIME WATER DEPTH IN TUBE NOTES 10:00 AM 10.5 inches Start of Test / Water On 1:30 PM 15.25 inches Water Off 3:30 PM 12 inches 5:30 PM 11.25 inches 8:30 PM 11 inches 7:30 AM (NEXT DAY) 9.75 inches 10:00 AM 9.75 inches End of Test The existing trench showed no issues handling the 600 gpm required of a 4 -bedroom system. This test, along with the knowledge that the effluent quality will be greatly improved with the advanced treatment system, leads me to conclude that the existing trench will be adequate for this new 4 -bedroom system. If you have any questions, please contact me at 337-3330. Sincerely, VEI CONSULTANTS Scott T. Roelfs, Attachments: OveraTFSite Plan Proposed Septic System Plan Construction and Material Specifications 'onsultants Civil Engineering and Surveying Consultants 1345 Rudakof Circle, Suite 201 Serving All of Alaska Anchorage, Alaska 99508 FAX: (907) 338-5386 Phone: (907) 337-3330 June 11, 2021 Municipality of Anchorage Development Services On -Site Water and Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Re: On -Site Sewer for Lot 5, McGowan Sub'd Narrative, Waiver Request, and Permit Application To whom it may concern, VEI Consultants was contracted to design a replacement onsite wastewater disposal system at the above referenced property. The existing single family residence on the property is three (3) bedroom. In the near future, the homeowner plans to renovate the home and add additional bedrooms. Therefore, this system has been designed to accommodate a five (5) bedroom single family residence. The house, well, and septic system locations are shown on the attached Site Plan, Sheet 1. We request that you approve the attached permit application for construction of the wastewater disposal system. Soils VEI conducted field investigations including surveying, boring and logging a test hole and installation of monitoring tube, digging a test pit, performing percolation tests and groundwater monitoring. The Soils Log—Percolation Test for Test Hole #1 is attached; this data provides the basis for design. Groundwater was detected in the test hole at a depth of 21.0 ft (monitored several times in October 2020, November 2020, and May 2021). An impermeable layer was detected at a depth of 25.0 ft. A monitoring tube for the test hole is in place. Percolation tests were performed using the procedure outlined in AMC Chapter 15.65.210. We have chosen an application rate of 1.2 gpd/sf in the design of the trench based on using a percolation rate of 3 minutes per inch. Surface Water & Topography There are no surface waters within 100 feet of the proposed system. Additionally, no seasonal surface water has been observed collecting anywhere on the property. The general slope of the lot is from South to North at a gentle grade. However, an embankment with a height of approximately 6' and a slope of 50%, is located on the northeast corner of On -Site Wastewater Disposal System — Narrative, Lot S, McGowan Sub 'd June 11, 2021 Page 2 of 3 the property. The proposed absorption trench is located 8.5 feet from the top of the embankment. • Waiver Request - Disposal field within 20' of 25% slope with height less than 10 feet below invert elevation of horizontal drainpipe (15.65.210 B.Le) The existing well locations severely limit the area available for the absorption trench (see Sheet 1). We found the only reasonable approach to be widening, lengthening, and deepening the existing absorption trench. With this approach, it is not possible to achieve a 20 -foot horizontal separation from the embankment in the northeast corner of the property. To determine the acceptable height of the drainpipe in this location, I referred to a memorandum by James Cross (a former manager of the Onsite program) dated 4/7/2004. In the memo he describes a method using a point 2.5 feet above the distribution piping and an imaginary line at a 25% grade. I went through the method he describes and drew this imaginary line on the Section view (see Sheet 3). As you can see, this imaginary line does not intersect the existing ground. Therefore, the elevation of the drainpipe is acceptable for the reduced horizontal distance to the slope. This, in combination with the well percolating gravel soils and my site observations, makes me believe there will be no adverse impacts associated with granting this waiver. System Design See the attached design drawings and specifications for the proposed wide trench absorption system design. The proposed system will not alter the existing site topography or drainage patterns. The ground surface above the disposal field will be graded to ensure positive drainage across the absorption trench and prevent surface water from collecting. The existing septic tank is 90 feet from the well on the property; a waiver for this reduced separation distance has been granted. The proposed septic tank will also utilize this waiver. • Waiver Request - Disposal field within 5' of septic tank (15.65.210 B.Lk) With the location of the tank determined by the existing well waiver, and the location of the disposal field determined by the required separation to the slope, it was not possible to achieve a 5 -foot separation from the tank to the disposal field. The concerns with this reduced separation distance would be: The excavation around the tank could cause a "short-circuit" pathway for the effluent to reach the groundwater - In this case, the elevation of the bottom of the tank is 0.7' lower than the bottom of the trench. The separation from the bottom of tank to the high groundwater is 10.5 feet, still well above the required 4 feet. On -Site Wastewater Disposal System — Narrative, Lot 5, McGowan Sub 'd June 11, 2021 Page 3 of 3 2. The installation of the tank could compromise the stability of the disposal field — In this case, the contractor will be installing both the tank and the disposal field. This concern can be addressed with the phasing of the construction. For these reasons, I believe these will be no adverse impacts associated with granting this waiver. The absorption trench is greater than 100 feet from the well. There are no adjacent private wells within 100 feet or community wells within 200 feet of the proposed system. We do not expect there to be any adverse effect on adjacent lots by the construction of this system. If you have any questions, please contact me at 337-3330. Sincerely, VEI CONSULTANTS Scott T. Roelfs, PE Attachments: Overall Site Plan Proposed Septic System Plan Construction and Material Specifications LOT 1A LOT 2`5��. WELL RADIUS O LOT 3 POINT "A" FOR SWING TIES SEPTIC SYSTEM PLAN - Pg 2 SECTION - Pg 3 EX.STING - DPAINFIE_D ®®®� OF EXISTING POINT "B" 3—BEDROOM FOR SWING TIES HOUSE LOT 5 �o¢tPN A%P\��� SWING 71E DISTANCES (FT) COMPONENT FROM POINT "A' FROM POINT 'B" FOUNDATION CLEANOUT TBD TBD TANK MANWAY (1ST) TBD TBD TANK MANWAY (2ND) IBD IBD ADVANTEX POD TBD TBD DOUBLE CLEANOUT TBD TBD EAST MONITORING TUBE TBD TBD 49th ........... .. >� .... .... ..............�,, ......... .... SCOTT T. ELFS : wAV Air CE— 18 AIV ®® PROFESSOW 4® IJ No. OF BEDROOMS: 4 WIDTH: 5' GALLONS PER DAY: 600 GPD DEPTH OF SEWER ROCK: 4' PERCOLATION RATE: 3 MIN/INCH REQUIRED LENGTH (W/O REDUCTION FACTOR): 40' ALLOWABLE APPLICATION RATE: 3 GPD/SF REDUCTION FACTOR (W+2)/(W+1+2D): 0.5 MINIMUM EFFECTIVE ABSORPTION AREA: 200 SF REQUIRED LENGTH: 20' \ yzEXISTING DEEP TRENCH WIDTH: 3' DEPTH OF SEWER ROCK: 5' \\ LENGTH: 34' -�_ EFFECTIVE AREA: 340 SF � I / I srnada .y— G '1"13M .001 — I REMOVE EXISTING SEPTIC TANK. REMOVE OR ABANDON EXISTING PIPING I I SEE NOTE 2 — — _ 90' WELL RADIUS (EXISTING i WAIVER FOR TANK) y� BENCHMARK w NE PROPERY CORNER TOP 3/4" ROD ELEVATION = 93.1 X CONNECT TO EXISTING 4" PERFORATED PIPING r \ \ \ DOUBLE 1\CO \ \RFp \ I \ 4 \ \ \mss �pR\\ f SEE NOTE 1\ \ \k\pq�\�eC� \ nixi 0 o I POTENTIAL REPLACEMENT TRENCH c (USING AWWTS CAT III) v� a L---- 7----� \ Z \ CONNECT TO EXISTING 4" PIPING \ ■ REPLACE FOUNDATION CLEANOUT \ E ISTING 3 -BEDROOM HOUSE 1 TO 4 FEET FROM FOUNDATION 0� NOTES: � � I � 1. 1500 GALLON POLYETHYLENE SEPTIC TANK (GREER) WITH MANWAY RISER (20"0 MIN) SERVING BOTH COMPARTMENTS. LOT 5 2" INSULATION IMMEDIATELY OVERTOP TANK. + MCOOWEN SUB 'D 2. RESIDENTIAL ADVANTEX TREATMENT USING AN EXISTING TANK I AND SIZED FOR 4—BEDROOMS. SYSTEM CONSISTS OF: SPLICE BOX, FLOAT SWITCH ASSEMBLY, HOSE AND VALVE ASSEMBLY, PF SERIES EFFLUENT PUMP, CONTROL PANEL, BIOTUBE PUMPING PACKAGE, AX20 FILTER POD, SEPTIC SYSTEM REPLACEME RECIRCULATING SPLITTER VALVE, AND VERICOMM MONITORING 21237 WEEPING BIRCF SYSTEM. HDPE TANK WILL ACT AS PROCESSING TANK. LOT 5 EFFLUENT DISCHARGE SHALL BE ORIENTATED TO THE NORTH McGOWEN SUBDIVISI TO GRAVITY FLOW TO EXISTING DRAINFIELD. 3. NO SURFACE WATER OBSERVED WITHIN 100 FEET OF SYSTEM. lz 5' \ • .tr�wm�Rm% �.� OF q i-� �; \ •• 49th .....--r ..........................ter... . :.��.. ...... ..... ...... • SCOTT OELF :' .w 1 OFF�SIO�P���� Lr) o o 0 n o 0 m m LJ i �Q\/ j ...... ., .�. ... .�/.. W \J :... ... -. i W h p w C) LIJLr0 .....o./ ..........:..... z j...:...:.........i.... I LLI w .......... .:... :........ `,.... N I... (n ..; ..:. ..:... F X... ....... W .. ........ w ..I...... 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J O® LD W J.. o - w a¢ �� � m moi: ("0 o AV V) 'SOF x w. . 0 0 `7) p m m VEIConsultants Civil Engineering and Surveying Consultants Serving All of Alaska 1345 Rudakof Circle, Suite 201 Anchorage, Alaska 99508 FAX: (907) 338-5386 Phone: (907) 337-3330 SOILS LOG - PERCOLATION TEST PERFORMED FOR: John Della Croce DATE PERFORMED: 10/28/20 LEGAL DESCRIPTION: Lot 5, McGowan Subdivision TOWNSHIP, RANGE, SECTION: PERFORMED BY: Scott Roelfs, P.E. TEST HOLE No. TH #1 DEPTH (FEET) Elevation = 101.7' 0-_ 1_ = Overburden 2- ❑ Net Drop (inches) 3 NO YES GM 21.5, r GROUNDWATER ENCOUNTERED: Silty Sandy 4 - _E gravel 5 - - 21.0, 6- .+ 5 1/4 2 3 8- -9-•.. 3 1/4 4 9-... r 5 3/16 10- 5 16:52 3 1/2 GW 12- '..o -q., Well Graded 1 7/8 :'d v Gravel 16:58 3 1/8 -•e0., n 8 14- 5 5 1/16 15- 5-16- a` 16 b', 18 ° 21.0 - ae :" "': . 7 25- ' Tight Silt 0 -■ F '. 49th t . • cE- � a • z � �a." .FI-SSI� s♦� SLOPE W W TOTAL DEPTH OF TESTHOLE. 25.0' Gross Time GROUNDWATER ENCOUNTERED: ❑ Net Drop (inches) 10/28/20 NO YES DEPTH TO GROUNDWATER: 21.5, ao GROUNDWATER ENCOUNTERED: ❑ ® m (After Monitoring) NO YES DEPTH TO GROUNDWATER: 21.0, 16:45 MONITORING DATE 5/18/21 CITE' DI AAI SEE SITE PLAN Date Reading Gross Time Net Time (min.) Depth to Water (inches) Net Drop (inches) 10/28/20 Presoak 16:00 1 16:40 3 1/4 2 16:45 5 5 1/4 2 3 16:46 3 1/4 4 16:51 5 5 3/16 1 15/16 5 16:52 3 1/2 6 16:57 5 5 3/8 1 7/8 7 16:58 3 1/8 8 17:03 5 5 1/16 1 15/16 PERCOLATION RATE 3 (minutes/linch) PERC HOLE DIAMETER 6" TEST RUN BETWEEN 7.0 FT AND 8.0 FT COMMENTS: PERFORMED BY VEI CONSULTANTS. I, SCOTT T. ROELFS , CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: Co#� 1 Civil Engineering and Surveying Consultants 1345 Rudakof Circle, Suite 201 Serving All of Alaska Anchorage, Alaska 99508 FAX: (907) 338-5386 Phone: (907) 337-3330 September 20, 2021 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES AND MATERIAL SPECIFICATIONS LEGAL DESCRIPTION: Lot 5, McGowan Subdivision, Anchorage Recording District GENERAL: 1. The scope of this project includes the installation of a new onsite advanced wastewater treatment and disposal system to serve an existing 3 -bedroom single family residence on the referenced property. The homeowner has plans in the near future to renovate the home; therefore, the system has been designed to accommodate a 4 -bedroom residence. 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 Municipal Wastewater Disposal Regulations. Any deviation from the site plan and design drawings requires engineer approval. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Groundwater monitoring test pipes shall remain in place and functional until. construction has begun. After construction has begun, test -hole excavations shall be filled and the monitoring tubes removed. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Onsite Water and Wastewater Section for systems installations. Owners installing their own systems must also receive prior approval from the Municipal Onsite Water and Wastewater Section. 6. Components of the existing onsite disposal system, such as the septic tank, shall be properly disposed of, or properly abandoned. ADVANCED WASTEWATER TREATMENT AND EFFLUENT PUMPING SYSTEM The Advanced Wastewater Treatment System (AWWTS) shall meet or exceed the Category III requirements listed in the Municipality of Anchorage Wastewater Disposal Regulations. The system shall be a standard AdvanTex Treatment System, including a Biotube pump vault, recirculating pump and a 56 cu. Ft. AX20 fiberglass filter pod. The unit shall be capable of treating a domestic wastewater flow of at least 600 gpd. The system will utilize a new 1500 gallon HDPE septic tank. The effluent will gravity flow to the existing absorption trench. CCP1 On -Site [Nastetivater Treatment and Disposal System — Specifications, Got S, ddcGowan Sub'd September 20, 2021 Page 2 of 3 2. The filter pod shall be insulated with 2" of spray -on urethane insulation down to a depth of 48" below the pod lid. The spray -on urethane shall be of a MOA approved type suitable for below grade applications. Exposed insulation above grade shall be protected from UV. 3. The AWWTS shall be installed in accordance with the manufacturer's recommendations 4. The effluent piping from the pod to the existing absorption trench shall be uniformly graded to the existing absorption trench. If cover is less than 3 feet, insulate with 2 inches insulation. Always maintain 2 feet of cover. 5. In the line between the tank and the absorption system there shall be two opposing cleanouts (double cleanout). The cleanouts shall be located on undisturbed soil not more than ten feet from the tank. The first cleanout in the line shall be to clean the line toward the absorption system and the second cleanout will be oriented to allow cleaning toward the septic tank. Cleanouts shall extend to a minimum of 12 inches above final grade. 6. Insulation shall be placed over any wastewater line or pipe over which a driveway, parking, or vehicle storage area may be constructed. 7. Control panels for the AWWTS shall be UL listed and suitable for interior and exterior mounting. The AWWTS shall be fitted with a high-level alarms, with these alarms shall be on a separate electrical circuit from the rest of the equipment. SEPTIC TANK INSTALLATION 8. Septic Tank shall be a minimum of 1,500 gallons. The tank shall be constructed of polyethylene and shall be pre -approved by MOA for installation. The contractor shall ensure that the fill over the tank does not exceed the burial depth rating. 9. Septic Tanks installed with less than 4 feet of cover shall be insulated. Minimum cover with insulation shall be 2 feet. Insultation shall be placed immediately above the top of the tank. 10. Construction shall include a 20 inch (minimum) diameter watertight manway riser serving both compartments of the tank. The risers, including the covers, shall be insulated with 4 inches (minimum) insulation extending to 48 inches below grade, or to the tank insulation. The insultation shall be of a MOA approved type suitable for below grade applications. Exposed insulation above grade shall be protected from UV damage. The riser lids shall be secured (lockable) to prevent unintended access. The riser lids shall match the final grade. 11. All septic tanks shall be fitted with watertight couplings, approved by MOA, at the pump out attachments and on the inlet of tank. A watertight cap shall be installed on the outlet. 12. The septic tank shall be sufficiently bedded with proper material and compacting to prevent settling or shifting of the tank. 13. The sewer piping from the foundation cleanout to the septic tank shall be 4 inches laid at a minimum 2% slope. If cover is less than 3 feet, insulate with 2 inches insulation. Always maintain 2 feet of cover. On -Site bi"astewater Treatment and Disposal System — Specifications, Lot 5, McGowan SOW September 20, 2021 Page 3 of 3 14. Insulation shall be placed over any wastewater line or pipe over which a driveway, parking, or vehicle storage area may be constructed. MINIMUM MATERIAL SPECIFICATIONS: 1. A MOA approved septic tank manufacturer must construct any septic tank proposed for installation. 2. Insulation shall be at least 2 inch thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI, Insulfoam R -Tech IV, or equal) 3. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 4. A permeable nontoxic geotextile silt barrier (Typar 3401, Mirafi 140N, or equal) shall be installed between the final sewer rock layer and the native soil backfill. 5. All leachfield gravel (sewer rock) shall be 0.5"-2.0" screened gravel with less than 1% passing the #200 sieve. 6. The following pipe materials are MOA approved for use in septic system installations: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 or F789 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes ASTM D2751 (ABS) Yes No **Use of a type of pipe other than listed above must be approved by the inspecting engineer. INSPECTIONS: Typically, there will be several inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. A preconstruction site meeting. 2. An inspection must be conducted after the tank and pod has been set in place with distribution piping and cleanouts installed, but prior to backfill. 3. The final inspection is to occur upon backfill and final grading of the property. The inspecting engineer is to be contacted at least 24 hours prior to the start of construction. The engineer shall be notified %2 day prior to a required inspection. .'� �� - . . co 49 TH ¢�. Scots T, Ro' Is C 11$ OFESS�ON��� 0 FOUND 1/2" RBR 3 22I 7, 12 1' ! 0= 1 :i m 0' UTILITY EASEMENT FOUND 3/4" ROD --- x 40.4' IA S 89'55'50" E 155.01' (R) S 89°39'44" E 154.77' (M) 21 6' 4� <<cr' 43.6' GQ . FOUND 3/4" ROD ci .n `i° Ln N O tMn O Z 48.5' 47.7' 44.7' S 89'56'10" E 154.99' (R) 154.29' (M) FOUND 3/4" ROD DISTURBED RESET 0 Lo 0 t5 30 SCALL; 1,. WEEPING BIRCH AVE I HEREBY CERTIFY THAT I HAVE SURVEYED THE DESCRIBED PROPERTY AND NO ENCROACHMENT EXISTS EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF p THE OWNER TO DETERMINE THE EXISTENCE OF ANY rl) EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. LEGEND 1 t ALL DfMENa1pNS 1N FEEPUNLESS HF NOTO .. P� OFROPERTYLINE —x— CHAIN LINK FENCE = BOLDING f/j 0 SURVEY MONUMENT 74 : 4 TH UTILITY POLE EXISTING WELL 6 4 �j f,. M MEASURED / ` ---- ........ ( ) '.VERNON L. ROELF = , (R) RECORD KpEHLER L_ D. 7617 AS -BUILT !,' I�1� £SSIowF 'L� _ McGOWEN SUBDIVISION _VEConsultants -f 1345 RUDAKOF CIRCLE SUITE 201 LOT 5 ANCHORAGE, ALASKA 99508 NEI/4, SEC 8, T15N, RIW, S.M .M • o Lo o Ln 6.3 1 "=30' /4/2017 w» ar EVR NW 1357 NO'. 1702  MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTI=CTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 9950'1 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAM E..~ , IPHONE I ~}-N-E~ MAI LING AD.SS LEGAL DE~IPTION LOCATION NO, OF BEDROOMS E ~ Manufacturer~¢.(~ . .. Ma~r~-. ..... ,. No, of compartments ILiq,?~)~i3. gallons IF "OMEMA.E: Inside length Width Liq~ d~th ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O Manufacturer Material Liquid capacity in gallons Nd, of lines/ Ledgth ~e~ch line Total leith of I>nes4''~ Tronc~lOth Distan2lbotT~n lines --; ~ ~ Top of tile to finish grade i~ ~ Material benbath tile ~0 inches Total eff O~O~e absorption area Length Width Depth PERMIT NO. ~--~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank ~ Absorption area(s) OTHER ...... PIPE M~T ¢~IA LS SOIL TEST RATING INS~LLER : REMARKS % .'~ ~PP -- DAT[ ~EGAL 72-01 ~ev. 3/78) F EF..fll T I,I HF F L i _.HNT L 0 C FI T I 0 N LEGFIL EVERETTE L5 MCGI:IWEN C R L K I N S TYF'E F~F :,UIL HE,:,_F. FTION SYS'rEM IS: TRENCH I',IR.'..=:IMIJH NIJMBER OF BEE,F.':ZMS = ]: 9'9999':9 '=;QUFIRE FEET =,UIL F..HFINa ,::S6! I-T,..BF...)= :L00 THE F.'E=.~ ....... lIRE[ c';IZE OF THE SOIL RE,_,OF...FTIUI'i _,Y_,TErl : E:, E: P"T' ~-t = E: L. E I'..,! IEi-F H = _~=-: ~.ZI ~.3 F-.: F! "-,," E L_ [:, E F' T FI == :' THE LENGTH DIHENSION IS THE LENGTH (IN FEET) OF ]'FIE TRENCH OR D:,RRINFIELD. 'THE DEPTH OF FI TRENCFI OR PIT I'E; THE DISTRNCE BETHEEN THE SURFFICE OF'.' THE GROUN[:, RND THE BOTTOM OF THE EXCR'¢FITION (IN FEET). THERE IS NO SET NI[:,TH FGF.: TRENCHES. THE GRFIVEL DEPTH IS THE MINIMIJM DEPTH OF' GRR',,,'EL BETWEEN THE OUTFFILL PIPE RND THE BOTTOM OF: THE E'?=;CFI',,,'FITION (IN FEET). F-:E],;.]LI :[ F-:E[:, E;EF"'I- ][ C: 'T"FII'-,II<C '-'~; ]: ZE= .-J.. £~.~.t~.:~ PERMIT RF'F'LICFtNT HRS THE RE:,F_N:,IE, ILI- ~3 ""' " TY "FO INFOF.:M THIS DEF'RRTMENT [:,URING THE INSTFILLRTION IN_,FEbTInNq~ _ F~F_ RNY WELLS RDJRCENT TF~ THIS r'r*_r'r=~.:~'r] .......... RND THE NUME:ER OF RES I [:'ENCEE; THRT THE NELL NILL SERVE. ......... "T' i-,l,], .:; 2 ::. I P-,I S; F" E C: ]- Z C~ I"-,! S Et IF;.'.'. E DRCKFILLING OF RNY '-'"-' ", ~,~=,¥EI1 WITHOUT FINFIL INSPE]TION RND FIF'F'F.'.OVRL E!?T' ]'HIS DEF'RRTMENT NILL E:E .... c;IIE:.TEF:T TO FF._=,EL. JTION.'"'-"- ~-' MINIMUM DISTANCE BETWEEN Ft NELL RND RNY ON-SITE SENRGE [."ISF'OSFIL SYSTEM IS J_00 FEET FOR R PF.:I',,,'RTE 14ELL OR t50 TO 200 FEET FROM R PUBLIC NELL [:,EPEN[:,ING UF'ON THE TYPE OF F'UE:LIC NELL MINIMUM [."ISTRNCE FROM R PRI'v'RTE 14ELL TO FI PRIVRTE SEI.4ER LINE IS 25 FEET RND TO A COMMUNITY SENEF.: LINE IS 75 FEEZT. WELL. LOGS RRE RE[:.!UIF.~ED FIND MUST BE RETURNED TO THE [:,EPRRTMENT HITHIN Z::O DRYS GF ]"FIE NELL COMPL. ETION. GTHE:R REL.]UIREMENTS MR'-? FtPPLY. ':-]F'ECIFICRTIONS Ri,iD CONSTRUCTION [.',IRGRFtMS ARE A',.,'RILRBLE TO INSURE F'ROPER INSTFtLLRTION. F E F. t I ]: "F E ,---, F ][ F-: E _, [::, E C: E I'"1 E: E2 R 31 .. ;1 ....... :. I CERTIFY TFIRT :L: I RM FRMILIFIF.: klITH THE REQUIREMENTS FOR ON-SITE SEWERS RND HELLS RS SET FORTFI BY THE MUNICIPFtLITY OF RNCFIOF.:RGE. 2: I WILL INSTRLL THE SYSTEM IN RCCOR[:,RNCE NITH THE CODES. .7: I UNDEF.'.STRN[:, THRT THE ON-SITE SEHER E;Y'Z;TEM MRY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODEl_ED TO INCLUDE MORE THRN ~: BE[:,ROOMS. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20- COMMENTS SLOPE SOI LS LOG [] PERCOLATION TEST SITE PLAN WAS GROUND WATER S ENCOUNTERED? ~ P IF YES, AT WHAT E DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT 0 0 0 0 0 0 0 0 0 0 0 0 : ~ :: ,','n i ~ ~'l ~] ~t ,-,,] ~'t ~ ,--1 :--I ,'""] ~t :--'l ~'I 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 OWNER OF KIND OF FORMATIO~I: FROM ..,,..0,.,,.,;..,,. FT. TO .... ,'(,, ........... lc'T, ~RO~ 0 FROM ,,.,.,....~; ...... FT. TO .... ,,~,,.. Fr ................ '.'"!~! FROM .~ FROM ....... FROM .~.,L,~ ....... 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.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-091-28 f GENERAL INFORMATION Complete legal description MCGOWEN LOT 5 COSA # ~1~'¢ Expiration Date: Location (site address) 21237 WEEPING BIRCH AVE, CHUGIAK, AK 99567 Gurrent Property owner(s) FRANK & LINDA MONEYMAKER Day phone Mailing address 11030 KASKANAK DRIVE, EAGLE RIVER, AK 99577 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Un/ess otherwise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] Individual Holding Tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems 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 COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As 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 ARCTERRA CONSULTING, INC. Phone 868-3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 10/18/2010 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the.conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be Observed .from the surface, changes inland use, local soil characteristiCs, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. DSD SIGNATURE ~ Approved for .~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: By: (Rev. 11/05) Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: M cipality of Anchorage Development Services Department Building Safety ,Division On-Site water & wastewater Program 4700 Bragaw Street P.O. Box 196650 ' Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: MCGO~EN LOT 5 WELL DATA We!l~~A,-~l[..ff.A;~;D, or C provide: PWSID # Date completed I0/~.2/1982 Sanitary seal (Y/N) ~ Total depth ~ ff. Cased to ~ ff. FROM WELL LOG Date of test Static water level 60 ft. Well production 4 g.p.m. WATER SAMPLE RESULTS: Coliform NF.G colonies/100mL Nitrate 3.10 mg/L Well Log (Y/N)~¥ Wires propedy protected (Y/N) _Y Casing height (above ground) 24 in. AT INSPECTION 10/ /2oto 35 ff. 3.48 g.p.m; Tank Type/Material Se~c/Steel Date installed 10/26/82 Tank size I000 gal. Number of Compartments ~_2 Cleanouts (Y/N)Y Foundation cleanout (Y/N) *~'_' Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 5/22/10 Pumper Sanitat3r C. ABSORPTION FIELD DATA Date ir~stalted 10/'26/82 Soil rating (g.p.d./ft2 or ft2/bdrm) 100 System type Trench Length 34 ff. Width 3ft. Gravel below pipe 5__ft. Total depth 7.25 ff, (Measured t0111110) B~ SEPTIC/HOLDiNG T~IK DATA Eft. absorption area 300 ft2 Monitoring tube Y Date of adequaCy test 10/1:1/2010 Fluid depth in absorption field before test 0 in. (Sump -1.$' below invert) Depression over field N Results (Pass/Fail) Pass For 3__ bedrooms Water added 505 gal. New depth 13 in. Elapsed Time: I250 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N__lf yes, give date -- Parcel ID: 051-091-28 Arsenic: ND mg/I Date of sample: 10/1:1/1_0 Collected by: ArcTerra D. LIFT STATION Date installed "Pump on" level at Datum E. SEPARATION DISTANCES Size in gallons "Pump off" level at Cycles tested Manhole/Access (Y/N). High water alarm level at ........... in. Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanldliftstation on lot 90' #WR980042 On adjacent lots 100'+ Absorption.field On lot ;t00'+ On adjacent lots I00'+ 75'+ Public sewermar~hole/Cleanout ~+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM 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 ;tOO'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation ;to'+ Water Service line ;tO'+ Surface water ;tOO'+ Curtain drain 50'+ (None Know~) COUNTS Water main 10'+ Driveway. parking/vehicle storage .......;t0'+ Wells on adjacent lots 100'+ *FCO located in crawl space. Vacant system presna~ked by _or.~o_oerty owner prior to testing,. Per owner, S&:~ Enr, lnee~i,~g recently tested; and passed system in May, 2010, but Were waiHng on fairing wa[=r sami~les until .. buy~ was under coii[~act. With S&S no longer in existence, we werecontacted to retest ~t~s. ' Engineer's Printed Name KENNETH M. DUFFUS Date -- COSA Fee $490,00 Waiver Fee $ Date of Payment / ~~ Date of Payment Receipt NUm~r ~/~ 7 ~ Receipt Number (Rev. 11/05) SGS SGS ReL# 1105484001 Client Name ArcTerra Engineering and Surveying Printed Date/Time 10/14/2010 16:16 Project Name/# McGowen Lot 5 Collected Date/Time 10/I 1/2010 13:30 Client Sample ID McGowen Lot 5 Received Date/Time I 0/11/2010 15:30 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks: 4500NO3-F - Total Nitrate/Nitrite - MS recovery is outside of QC criteria. Refer to LCS for accuracy requirements. Allowable Prep Analysis Parametcr Results LOQ Units Method Container ID I.imits Date Date hilt Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 10/12/10 10/13/10 NRB Waters Department Total Nitrate/Nitrite-N 3.10 0.100 mg/L SM20 4500NO3-F B (<10) 10/12/10 AYC Microbiology Laboratory E. Coli Neeative 1 100mL SM20 9223B A 10/I 1/10 DIsC Total Coliform Negative 1 100mL SM20 9223B A 10/11/10 DI~C Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St, P,O, Box 196650 A~chorage, AK 99519-6650 www.ci.anchorag e,ak,us (907) 343-7904 051-091-28 Parcel I.D. 1, GENERAL INFORMATION CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAHILY DWELLING Expiration Date: ~ Completelegaldescription McGOWEN SUBDIVISION; LOT 5~ Location (site address or directions) 21237 WEEPING BIRCH AVENUE Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address * CHUGIAK, AK 99567 MANDY MONEYMAKER Day phone 257-3248 P.O. BOX 773445 * EAGLE RIVER, AK 99577 Day phone Day phone Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: ;3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well [] Individual On-site Individual Water Storage [] Individual Holding tank Community Class Well [] Community On-site Public Water System [] 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 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or cmissicns in the professional engineer's work. P~tO ~ Note:Alaska Water and Wastewater Consultants, Inc. shall be paid $-~'~ at, or pdor I to closing for the engineering services provided. I 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal alT~xed hereto and as of the validation date shown below, I vedfy that my investigation, based on procedures outlined in the Health Authodty Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(am) safe, functional and adequate for the number of bedrooms and type of strocture indicated herein. I furfher vedfy that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(am) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER &: WASTE'WATER CONSULTANTS, INC. Phone Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE. AK 99504 Engineer's Printed Name JEFFREY A. CARNESS, P.E. Date 337-6179 Engineer's Comments: In conducting this evaluation, AWWC. Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the pedormance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfacto/y test results do not guarantee futura performance of the system, nor do they guarantee that there are no hidden defects or encroachments. A WWC, Inc. can therafora not provide any warranty or futura estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other pereon or parfy is not authorized, nor will it confer any legal tight whatsoever. 5. DSD SIGNATURE ~ Approved for .-~ bedrooms. Disapproved. Conditional approval for __ Attachments: HAA Checklist Septic System Advisory Well Flow Advisory bedrooms, with the lllowing stipulations: Manitenance Agreements Supplemental Engineers Reo~ Other Original Certificate Date: Legal Description: A.* WELL DATA Weti type PRIVAIE Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wasfewster Program 4700 Souffi Bmgaw SL P.O. Box 196650 Anc~e, AK 99519-6650 www.ci,anchorags,ak, us (e07) 343-7~0~ HEALTH ,UTHORITY ,PPROVAL CHECKLIST McGOWEN SUBDMSION; LOT 5, Parcel ID: 051-091-28 If A, B, or C provide PWSID# N/A, Dale completed 10/22/1982 Sanitary seal (Y/N) YES Total depth 79 ft. Cased to. 40+ FROM WELL LOG 10/22/1982 60 It. 4`.0 ,g.p.m. Date of test Static water level Well production WATER SAMPLE RESULTS: Well Log (Y/N) YES Wires propedy pmtactad (Y/N) YES Casing height (above ground) 18+ in. AT INSPECTION 4,/26/2002 28 Colifonm Arsenic: N/A mg./L. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size 1000 ,gal. 0 colonias/100 mi. Nitrate 2.88 mgJL Data of sample: 5/8/2002 STEEL 4,.4 ft. .g.p.m. Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date of pumping 4,/26/2002 Pumper C. ABSORPTION FIELD DATA Date installed 10/28/t 882 Length 54 .It. High water alarm (Y/N) N/A JR'S PUMPING *SUMP EXTENDS ONLY 18" BELOW INVERT Soil rating (g,p.d./ff=on~.?~n~) 100 System bjpe TRENCH Width 3 fl. Gravel below pipe 5 ff. Total depth 7.6 ,It. Eft. absorption area ,,300 It= Monitoring tube *YES Depression over field, NO Data of adequacy test 4./26/2002 Results (Pass/Fall) PASS For 3 bedrooms Fluid depth in absorption field before test *18~in.'-- ~=~ -----'-"~;r-~a~ded 486 gal. New depth'~z3.$ in. Elapsed Time: 1225 min. Final fluid depth 14, in. Absorption rate >=. 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - *'FILLED 1.5" OVER TOP OF LATERAL H20 WAS 3" BELOW INVERT ON 5/8/02 Number of Campadments 2 Date installed 10/26/1982 Cfeanouts (Y/N) YES Other baCteria 0 colonias/100 mi. Collected by: AKWWCt INC. D. LIFT STATION Date installed Size in gallons "Pump on" level at in. 'Pump~j~_Je~e~t~-----T~, Datum ~ Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot'90' Absorption field on lot 100'.4- Public sewer main N/A Sewer/septic service line 25'+ High water alarm level at .in. Meets alarm & circuit requirements?. *WR980042 On adjacent lots 100'~ On adjacent lots 100'+ Public sewer manhote/deanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water service line 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1 (~'+ Waler service line 10'~ Curtain drain NONE KNOWN F. COMMENTS Building foundation 10'+ Surface water 100'+ Wells on adjacent lots. 100'+ Absorption field 5'+ Surface water. 1 G. ENGINEER'S CERTIFICATION I certify that I have detenwined through field inspections and review of Municipal records that the above systems ere in conformance with MOA HAA guidelines in effect on this date. Water main N/A Driveway, perking/vehicle storage Engineer's Prin/~ed ~ame Date JEFFREY A. CAt{NESS H~ Fee $ Date of Payment Receipt Number (Rev. 1~01) Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE M E M 0 R A N D U M SEPTIC SYSTEM ADVISORY Prior to a recent adequacy test on the septic system for this lot, /~ inches of standing water was observed in the absorption field. This indicates that approximately ~ % of the absorption area is inundated. Although this system passed the adequacy test, the remaining life expectancy may be limited. This advisory must be attached to all copies of the subject Health Authcrity Approval. Sent By: A).aska Water and Wastewater Con; 907 338 3246; I~Y-]5-2002 Ii'ED 05:16 PI'I NELLS F~ ~K ~EA~ 117~ ~ GLENN HIG~AY ~ R~, ~ 99577 TO TERMS: QTY. May-16-02 9:21; Page 1/I 9072573258 P. 0l 56167 DAY WORK** r'l co~cr ri E~ DESCRIPTION OFWORK OTHER CHARGES LABOR TOTAL OTHER TOTAL LAD. OR TOTAL MATT~R~LS TOTAL O1'1 ~E fl TAX TOTAL ~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 Parce!l.D.# © $''/ -<2~)/ - 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING NAA # ~1 ~E/.'~ L~,L-~ _~.~,¢L-) Location (site address or directions) .... ' "~"' ..... (.LI.f~/¢~/I/< /)4' P'roperty owner · >; P~ ~:) o ~, ,,_ Day phone -.,.Mailing address. ~'i ?/. "~" ~b ~'¢ Address ? '% ~ 30 i~.,g¢..t,.,..cy i),~,., ~/~:~-'~ Unless otherwise requested, HAA will be held for pickup. NUI~iBER OF BEDROOt~IS: Day phone 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 #21 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 adec uate 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 Phone,. 6 TTO3~Eagie ~Jver Loop F, oad'No. Eagle River, Alaska 99577 Address . ~, Engineer's signature ' .-~/j d/~ ~,r,.__~ Date DHHS SIGNATURE __~.__ Approved for 3 D!sapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date Tt~e lvlunicipality of A~chorage 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 DH HS does this as a courtesy to purchasers of homes ~nd their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze date before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-O25 (Rov. 1/91) B~ck MOA ~F21 Municipality of Anchorage AUg 0 3 1998 DEPARTMENT OF HEALTH & HUMAN SERVICES- Environmental Services Division ,~,,,,r~<:~AU'fY OF ANCHORAGE 825 L Street, Room 502 · Anchorage, Alaska 99501 ~"(},g'01~l;~/'5--~4¢s DIVlSIO Health Authority Approval Checklist Legal Description: ~--od- d' ~6 (~10t'J~q~ °"o ~) Parcel I.D.: A. WELL DATA Well type Log present ~N) Total depth 06'i 091Z sanitary seal Y~) If A, B, or C, attach ADEC letter. ADEC water system number L1 ~'_<., Date completed Cased to ~F0 ~ Casing height (above ground) Wires properly protected Date of test Static water level Well production WATER SAMPLE RESULTS: FROM WELL LOG AT INSPECTION 4' g.p.m. 4', ~ Nitrate 4, 3 t Collected by: ~'; '~ g.p.m. Other bacteria 0 I ~00 Number of ComPartments Depression (YO I~0 High water alarm (Y'O I~0 Pumper Coliform Date of sample'. B. SEPTIC/HOLDING TANK DATA Date installed I01 C-Jo le6~ Tank size Foundation cleanout Date of Pumpin~. C. ABSORPTION FIELD DATA Date in'Stalled \~?/ · Soil rating (g.p.d./ft2 o If. YO . System type _ Length. ,~1 Width .. ~". Gravel thickness below pipe (00" _Total depth Effective absorption area ,~¢,Dj.R -,L Monitoring Tube present (~N) ~'[6% Depression over field (YO 'h)0 ' Date of adequacy test_ ~/~0/,~¢ Results~Fail) *~ For_ ~HP-~fb bedrooms Fluid depth in absorption field before test (in.); 17~~ Immediately affer¢'~gal, water added (in.): Fluid depth (I'" (ins) Minutes later: ~ ~*'¢ Absorption rate ~' = g.p.d. Peroxide treatment (past 12 months) (Y/N) ~o~ ~0~ If yes, give date 72-026 (Rev. 3/96)* LIFT STATION ' Date installed ~"'~,,. Size in gallons Manhole/Access (Y/N) '~'"~P~_mp on" level at* "Pump off" level at* High water alarm level at* %tum~ CycleS tested SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot cfc' Absorption field on lot ! O 0 fA. Public sewer main ~ ~6 (.~ ¢ ,~z¢:4:;jn adjacent lots On adjacent lots Sewer/septic service line Public sewer manhole/cleanout Lift station / I co q- / co SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ) o +- Property line / ~ ¢~ Absorption field Water main/service line /o ,~- Surface water/drainage / 00 -~ Wells on adjacent lots / 0 O -¢ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water Curtain drain ! / Building foundation /0 -/-- Water main/service line / Driveway, parking/vehicle storage area $*'-d t '*' ~ ~ ,~ Wells on adjacent lots / O O -~- F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records that the above s S ignatureinC°nf°rmancewi~t70~?~Iguide/~'~sineffect°nthisdate' Date HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number ¢stems are 72-026 (Rev. 3/96)* Matanuska Electric Association, Inc. Pax: (~07) 74~-9311~ August 25, 1998 To WI~Oro it May Cof~cem: Re: Lot 5 Mc Oowen Subdivision, according to Pl~t 67-45, A~ehoeage R,~eord~ng Dts~rmt We have revtewa~l the request fo: a let~r of non-objection :('or ~he e~istenoe of a well in ~e 10' u611W e~emcnt on ~c sou~ side of Lot 5, Me ~wen su'~visi~ PI~ be ad~ ~t at tMs t~e we ~v~ no obje~ion to ~e e~s~ne~ of ~e well in ~e ea~meng ~is non~bjeotion is coedi~on~ on ~ we~ ~ moved by the l~o~r if MBA pu~ ~ ove~ ~w~ linc in ~e e~emcat ~t ~om~ time ia ~e ~t~e, Sincerely, Keith Q~intav~ll, SR/WA Right-of-Way Administrator August 19, 1998 ENSTAR Natural Gas Company 401 E. Intornational Airport Rd. P O Box 190288 Anchorago, Alaska 99519-0288 Engia¢oring Dept. Fax (907) 563.4085 May Boone 21237 Weeping Birch. Chugaeh, Alaska 995 Re: Water Well Lot 5 McGowen Subdivision To whom it may concern: ENSTAR Natural Gas Company has no objection to the placement of a water well in the platted 10' utility easement on the south side of said property. ENSTAR's 2" gas pipeline is located in the street R/W on the south side of said lot. The house is also served by a S/L from the south along the west property line. These encroachments may hinder ENSTAR's future excavations during maintenance or future ir~stallations. Therefore, the following stipulations apply. 1. ENSTAR will be held harmless, now and forever for any damages or injury to any person or property as a result of these encroachments. 2. Any ENSTAR facility damaged or destroyed, as a result of this encroachment will be repaired at no cost to ENSTAR. 3. Any costs incurred by ENSTAR for special construction necessitated by these eucroaohments will be borne by the property owner. 4. All applicable safety code regulations will be observed and ~naintained. 5. This letter of non-objection will in no way preclude ENSTAR from full use and enjoyment of its rights within any portion the right-of-way or utility easement. If you plan on any type of excavation on or near this property please contact the Locate Call Center at 278-3121 for an undergrotmd locate of the gas facilities. You may contact me at 264-3744 if you have any further questions concerning this encroachment. Sincerely yours, Drew W. Smith Senior Engineer 20,98 ~2;27 No.O0~ P,O1 By this do~umant Matan~aka Telephone Association Ine, SubdlvMon ~ To.ship 1:~ No~h, ~nge 1 W~a~ 8~ 8,M. . . ~%'~ ' ' oft~ ~oa dtd, ~n tho oxe~ of the~o ti$1~t~ ~A will, ifn~e~d ,,~-~ , , , ~ -rO,-~v~ aI~IU~ ~pMr, ~a/or replace enero~ent aa a reault of utili~ co~a~on will be borne b~ ~e propo~ does not au~i~ ~e pl~ment of <y addttion~ eneronchmenta within ~e that it h~ no objection to tile Easement uporl Lot $, McGowen Issu~l for Mattumska Telephone Aasociation, Inc. this 20th day of August, 1998 by, THIS 18 ~ OgRTIFY, that on flfla 20th day of August, 1998 ~foro me ~e un~r$tgnod, a No~ Public h~ and for the State of Al~ka, duly ~mmiasionod and sworn ~ such, ~rsonally app~r~ Boe~ Obnn ~own ~ me ~d ~ me ~own W b, th¢ tndividu~ n~m~ in aud who ~xoe~ the foregoing tns~oat ~d acknowledged to me ~1 he signed ~d ~ed lhe 8~0 as a volun~ aot ~d deed t:b~' ~e ~s and pu~oscs · oretn menttond. IN WITNESS WHBILEOF, I have hereunto set my l~atd and official seal the d~y and year first above w~.'itton. _= .... ~r...~,. .. ~--7 ..... -. -~ ~-.:,c..,~.,~aaa~._.~. .............. ... LVly 001~1.1'111S810I!. expires: ~-~,~¢?., · '-.': 2~ "..'..::!: Matanu~ Telephone Association, Real E~tale ~nd Properties $~tlon ;~;., ....- P. O/Box 3550 Palmer, Al~ka '9~645: Rick Mystrom, Mayor Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 I~ltp://www.ci.anchorage.ak.us 343-4744 August 25, 1998 Robert C. Cowan, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 5 Mc Gowan Subdivision Waiver Request #WR980042, PID #051-091-28, HA980205 Dear Mr. Cowan: Your request for waiver(s) of the required 100 foot horizontal separation of an on-site wastewater disposal system to a private well has been approved. The approved separation distance(s) are a private well to the on lot septic tank of 90 feet. This waiver approval applies to the existing on--site wastewater disposal system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, Civil Engineer On-site Services Program ljm:#6 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet Date Received: August 5, 1998 Legal Description: Lot 5 Mc Gowan Subdivision Engineer: Robert G. Cowan, P.E., S & S Engineering 17034 Easle River Loop Road~ Suite 204, Eagle River, Alaska Applicant: Max Boone Permit #~c%~[ >~C]~_ 99577 Waiver Requested: On-site well to the septic tank of 90 feet; Criteria: PointS: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: Special Conditions: 3. Other: Waiver is Granted: ~ Waiver is NOT Granted: List Conditions or Reasons for above: ~ ~f~ Date: ~--~-~B By: _pN~ Name of Reviewer Rec ~: 04005/3835 Amount: $ 625.00 Date Paid: 8-3-98 ~r IOa ~. F~O. ~. THU TyPe 4 ~o7 Anchorage Well & Pump Service, Inc. 6901 Tanaina Drive Anchorage .Alaska 99502 Pending Invoice Invoice ~: 00012794 Dill To: MAX BOON C/O JACK SMITH 12130 REGENCY DRIVE EAGLE RIVER, AK 99577 Ship To: MAX BOON 12130 REGENCY DRIVE SALESPERSON YOUR NO. SHIP VIA 0 P SHIP DATE TERMS DATE PG. MARK 974122 Net 10 8/19/98 1 QTY. I ITEM NO. DESCRIPTION ! PRICE UNIT DISC EXTENDED TX. liZ0101 ~Service $80.00 Hour I $80.00 i Tech+Service i Truok:8/18 98--MOB TO JOBSITE, PULL ~ IWELL SEAL; STATIC LEVEL 26'~ START I PUMP; PUMP TO 60'; ! IDOES NOT APPEAR TO ! BE PERFORATED DOWN .4 TO 60' 0 Z0407 Travel: 8/18/98 $60.00 Hour $24.00 Thank youl SALE $104.00 FREIGHT $0.00 SALES TAX $0.00 TOTAL $104.00 PAID $0.00 BALA/~CE $104.00 HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERINGSTUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN July 31, 1998 Municipalib' of Anchorage Department of Health and Human Services P.O. Box 196650 Anchorage, AK 99519 ROBERT C. COWAN, R E. ROBERT A. SHAFER, RE. RECEIVED (907) 694-2979 FAX (907) 694-1211 AUG 51998 Mutfici ) t: alit Health ~Y,o, f Anohn.~ -_ ~ ~uman .~%yge REFERENCE: Lot 5; McGowen Request you grant a waiver for the horizontal separation distance between the well and septic taltk on the referenced property. The mitigation factors ilwolved which support the issuance of the waiver are as follows: i. The horizontal separation distance from the well to the septic taltk is 90 feet. 10% of the required separation distance is requested to be waived. 2. Tile nitrate sample taken from tile well located on the referenced property indicated 4.31 mg/L and bacteria was 0 colonies per 100 ml. 3. The referenced lot is relatively flat. At tile same time the house is located between the well and the septic tank. This would prevent any surfacing effluent from reaching the well head. 4. The water table ill the area appears to be aronnd 40 feet deep with an approximate 0% water table gradient. A cotffining layer at 30 to 35 feet would prevent any efflueut fi'om contaminating the aquifer (see attached surrounding well logs). 5. The soils arc stratified ranging in types between gravel near the ground snrface to clays near the aquifer. The gravel layers make up roughly 75% of the soils that separate the ground surface and the aquifer while the clay layers make up 25%. 6. A septic tank is not normally a continuous source of contanfination and therefore would not be expected to allow septic effluent to reach the well. The granting of this separation distauce would not have an adverse on tile surrounding properties. If you require additional inforlnation, please contact tls. Sincerely, Robert C. Cowan, P.E. RCC/jsf. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 ° EAGLE RIVER, ALASKA 99577 ,ii 3 37 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 ~~7~_~ __ GENERAL INFORMATION (a) Legal~,escription (include lot, block, subdivisio~n, section, township, range) Location (address or directions) (b) Applicant Name~c./<n?2 ,'./~~ Telephone: Home .~2~'¢,C0/-2/¢, Business ~ ApplicantAddress ~ ~ ¢~ 7/ ~ ~~~~ (c) Applicant is (check one): Lending Institution ~; Owner/builder~; ~u ~; Other ~ (explain); (d) Lending Institution /~~ ~~ Telephone Address . ~~/ ~~ - (e) Real Estate Company and Agent Address Telephone (f)/'~the HAA to the following address: TYPE OF RESIDENCE Single-Family ~ Multi-Family Number of Bedrooms Other WATER SUPPLY Individual Well,~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite'~' Public [] Community [] Holding Tank [] Note: I1 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) ENGINEERING FIRM PROVIDIN~ INSPECTIONS, TESTS, FILE SEARCH, DAI~.~ 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 bedroorns and type of structure indicated herein. I further verity that based on theinlormation 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 &~_L~r.~rte~jrr~.~ ~;."t ~ 196x Address ~[U ~{Ver, ~l~ska 995~!' Date Telephone Approved for '~--¢ ~, bedrooms by ~ ' . Conditiona~'J Approved "V Disapproved Terms of Conditional Approval 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 (11/64) MUNICIPALITY OF ANCHORAGE (MOr.~ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: WELL DATA Well Classification Well Log Present~/,~Jkt'~. Total Depth r~,~ Static Water Level Casing Height Above Ground Electrical Wiring in Conduit,t~/N') Separation Distances from Welt: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field or', To Nearest Public Sewer Line Cleanout/Manhole Water Sampie Collected by Water Sample Test Results If A, B, C, D.E.C. Approved (Y/N!: Date Completed /~) ¢/~, - ~Z~ Yield Depth of Grouting Pump Set At Sanitary Seal on Casing Depression Around Wellhead,,(-Y~ Comments ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot . Date B. SEPTIC/HOLDING TANK DATA Date Installed _[,C:)''~(.--~>"~,~"Z-- Size Standpipes ~)N~ Air-tight Caps Depression over Tank.,{,'Y,4~) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well //_2~ To Property Line ]o ~ W- To Water ~¢4~'rr/Service Line ,~ Course No. of Compartments ' · '~¢ Foundation Clean o u t..(.-Y¢~ Date Last Pumped _ _;for Temporary Holding Tank Permit (Y/N) To Building Foundation _ To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed '~C::~ ~ Width of Field ~(..~ Square Feet of Absorption Area ~'"-.~:~-- Depression over Field ,(-Y',~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Mch~/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Length of Field Depth of Field Gravel Bed Thickness Standpipes Present ~AN~ Date of Last Adequacy Test Type of System Design To Property Line /. O I ~- To Existing or Abandoned System on ; On Adjoining Lots /.J / To Cutbank (if present) ~o~ ~ Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Man/~ole/Access (Y/N) / ')Pump Off" Level at //~ //.,1 Vent (Y/N) ///'~__ Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certi'fy that I have checked, verified, or conformed to all .M/.~A~ an,d HAA guidelines in effect on the date of this inspection. Signed $ & $ E'ngir~eering Date SRB 196x MOA No ,::~0.~ ~ . Company Ec-,~le ~;v,~r, ,Alaska ,r,~,~,--~ ' D te of aym.nt Amount: $ ~%¢~00 Page 2 of 2 ~.~ 72-026 (11t84) ' MUNICIPALITY OF ANCHORAGE., DIVISION OF ENVIRONME~FfAL HEALTH DEPARTMENT OF [{EALTH AND EN-qIRONMENT-a-L PROTECTION APPLICATION FOR HEALTH AUTHOR%TY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (~.n(:lude~.log, block~, subdivision, section, township, range) Location (address or directions)f~ ~ ~?,~,.,+:?~:~ Name .5~'~.~?c/ ~.-~-;6~"r~c'~-~ ¢~' Telephone ~ Home Business (b) Applicants .~;~_~ Applicants Address Z~ .... t~ (C) Applic. ant~is (check one)Lendin§ %nstitugion.]~l ; Owner/builder (d) Lending Institueion /;..,½ !-~;~,~ Telephone Address Address Telephone (f) ~M~il the IDJt to the following address: ~ of Residence Single-Family.,~ Number of Bedrooms Multi-Family ~ Other (describe) 3, Water Su_~ Individual Well ~. Community ~ Public ~ Mote: If community well system, must have written coro?irmation from the State Department of Environmental Conservation attesting to the legality and status. Note: If community well system, must have ~itten confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 3, of 2] 5. .En~ineerin Fi~ovi__~j~n~.p~e_.c_~ions, Te~s_t~t?~jtl_~_Se~a_rc_~h_ Data and Information ® As certified by my seal affixed hereto and as of the validation date shows below, I verify that my investigation of. this Health Authority Approval shows that the on~sit'e water supply and/or wastewater disposal system is safe~ f~ctional and adequate for the number of bedrooms and type of structure indicated herein°, i further verify that, based on the information obtained from the Mmnicipail~y of Anchorage files and from my investigation and inspeetion~ the on=site water supply and/or wastewager disposal system is in compliance wl~h all bkmi¢ipal and State codes, ordinances, and regula~ tions in effect on the date of this inspection. Name of Firm Telephone Approved fobedrooms Approved ~ Disapproved Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTME~ OF HY~kLTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIObI4L ENGINEER REGISTE~D YN THE STATE OF ALASKA° THE DHEP DOES %'~HIS AS A COURTESY TO P~JRCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE P. EQUIRE- MENTS, 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 %~lE PROFESSIONAL ENGINEER'S WORK° (DHEP SF~iL) RR4/eJ/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: /vic' MUNICIPALIIY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MAY 2 g I985 ,F RFCFIVFD WELL DATA Well Classification _ Well Log Present(~:C/N) _ Total Depth r-/o"/ ' Cased to '~"(~ '¥' Static Water Level _ ~:.'£> Casing Height Above Ground Electrical Wiring in Conduit ~¢~N) Separation Distances from Well: To Septic/He4~'~;rTank on Lot To Nearest Edge of Absorption Field on Lot ~. ~-~=~ To Nearest Public Sewer Line If A, B, C, D.E.C, Approved (Y/N) Date Completed /¢.o ~/;7_ - ,.~ Yield Depth of Grouting Pump Set At Sanitary Seal on Casing~j~'N) Depression Around Wellhead (Y/~'""J.~L ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments /A~ ~/-- To Nearest Sewer Service Line on Lot L~.~C~ LI,~ B. SEPTIC/H~LDiNGTANK DATA Date Installed Standpipes ~/N) Air-tight Caps((~N) Depression over Tank (Y/~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Ne~+rrgrTank: £ To Water-Supply Well / E) C) To Property Line I~ ~ 4- To Water Main/Service Line L¢~E--~' Course No. of Compartments Foundation Cleanout (Y¢._~ /- Date Last Pumped .--~--~o -~ (~'~" '~ ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026{11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /'g-~ '~ ~-/-¢ '~ Width of Field '~(._c' ~ Square Feet of Absorption Area Depression over Field (Y~) 'Results of Last Adequacy Test Type of System Design Length of Field ~ I Depth of Field ~ ? Gravel Bed Thickness (.~' ~ Standpipes Presen Yt4~_/.N) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line ~'~¢'~ ~--~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on ; On Adjoining Lots '~'~'a ~ ,,.2/~, Cut ban k (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent(Y/N). Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HA~A guidelines in effect on the date of this inspection. Cornpan_gL~ ~-:tIV[,4R, ALASKA 'PH, Receipt No. Date of Payment .~- Amount: Page 2 of 2 72-026 (11/84) MOA No. r-tyOwner APPLI( NT FILLS OUT UPPER HAL ONLY Address Zip Code Type of Resi~nce  2lngle Family Multiple Family No. of Bedroo~ ~ Other Water Supply ~_~ndivldual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ~Community For wells drilled prior to that date, give well depth (altach log il available). D Public Utility Sewer Disposal ~divldual Year Individual Installed: ~ Public Ulility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. c 7-- Time Time Time Time Dale Date Date Date Insp~tor Inspirer Insp~lor Insp~tor / .6'" ~'~'1";'-' / ( ¢"'~'APPROVED BEDfi6OMS~ *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' BY: ~ Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received / Well to Tank Septic T~k Size 72-023 ~'-~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PR~ECTION ~ '~.~.~,_~% S25LStr,,t.Anchora,,, Ala,ka 99501 ~U~ CiPAL ~ OF A~GE ~ ~// ENVIRONMENTAL ENGINEERING DIVI~ONME,;'/_L ,,_ ~ Telephone 264-4720 APR R I980 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS; Complete aH parts on page 1. Incomplete requests will .ot be processed. Please a,lo~ ~a~&r~r~essing. PHONE MA~'I NG AbD~ESS ' ~ , 2. BUY~ PHONE MAV)ING ADDRESS / z 3, L~NG INSTITUTION ' ~ ¢ MAILING ADDRESS ~ , . 4, ~LTOR/AGE~ ~ ~ PHONE c 5, LEGAL DESCRIPTI(~N STR t-' ET LOCATION 6, TYPEOF RESIDENCE [~ SINGLE FAMILY [] MULTIPLE FAMILY 7, WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY NUMBER OF BEDROOMS [] One [] Four [] Other BI Two [] Five ~ Three E] Six *ATTACH WELL LOG. A well :)g is required for all wells drilled since June 1975, For wells drilled prior to '[hat date, g~ve well depth (attach log if available ) J 8, SEWAGE DISPOSAl. SYSTEM '*If individua[/omsite, give installation date ~Z2 '~ ¢ ~ INDIVIDUAL/ON-SITE** If system is over two (2) years old an adequacy test is reauired [] PUBLIC UTI LITY by this Department, NOTE= THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY / / INSPECTION APPOINTMENTS DATE RECEIVED 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVl DUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED Connection Verified INSTALLER [~]Septic Tank or [] Holding Tank Size: t.~:?-~ If Tank is homemade SOILS RATING give dimensions: ] (~ 0 TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS [~'/~PPROVED FOR 3 BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY (Title) LEGAL C2T 72-010 (Rev. 3/78) i~uv Juno 24, 1970 UBJEL~f. Sower and ....... ' ' ' ' for tk)~se (~a~:d by [~rmont C~ark, {~t 5, ~c(;owen St~di. vision In response to a request from Davis & Associates, ~m insf~;ction ;.;a~ ~a~de of th~ s~vor m~d water facilities for thc ~ubject house., Tho :mw¢;r ~yst~m consists of an approved .%'ptic t~u~k ~md drain field, ;m-c~r iu suppi£¢~d by a 65' drillod well, the top of tho being located in a pit. In order to {;~:et this l:~purtr~nt's proval of the wall, the well casing will have to bo oxtea~d at least 12" above tt,o gmuad surfac~ m~d the pit backfilled ~ith tim ~oll ~ill be ~cl~edulod, huwaro N. L:astaugh Sanitarian cc: Davis t, Associates 37 56 G5 $4 36 35 5S TmO_S 63 59 62 C.E t% )) B.L.M~ 'MON, 87 MON. NOTES NOTARY'S ACKNOWLEDGMENT SUBSCRIBED ,AND SWORN SE'FORE ME THIS ~/~7. PLAT APPROVAL ~U3'~OR I~ ~O OFFI~IAL · DTI000996 :i i