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Home My WebLink AboutT14N, R1W, Section 17 (8)T14N RIW Sec. 17 E2 SE4 NW4 (Whitestone Estates Unit#1) #067-311-01-001 Municipality of Anchorage Page __L of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: Sw 18ba3__1 PID Number: Name, }�S� ��t5 Wastewater S New ❑ stem: � Y Upgrade .� � Address �,L -1734-11 ABSORPTION FIELD Phone: i - J - lv No. of Bed oms: ❑ Deep Trench Shallow Trench ❑ Bed ❑ Mound []Other .1 LEGAL DESCRIPTION Soil Rating: rr-- ()' W GPD/S. Ft. Total Depth from original grade: 2 r" Bock: 1 1 t Subdivision: �l �W Depth to pipe bottom from original grade: I Gravel depth Qneath pipe I JYi Ft. Ft. Township: 1' Range: Section: Fill added above original grade: Gravel length: 1`[ Ft. Jv.S Ft. WELL: , New ❑ Upgrade Gravel width: Numberpflines: % Distance between lines: I Ft. Ft. C ification (Private, A,B,C): TotalDepth: Cased To: Total absorption area: Pipe matterill: 7J 1 bJ Ft. 1. FL .5 SC. Ft. '7 30 D, r�ille"r:� Dat Dri led: �II°I$ Static Water Level: I Installer. Date installed: {L li( 6 Ft. 1IQ Yield: Pump Setat: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES ❑ Septic ❑ Holding ❑ S.T.E.P. TO Septic AbsorptionHolding _ Public/Private Manufacturer: Capacity in gallons: From Tank Field Tank Sewer Lines WeIFN4 o" , 1 im —i l f /1 I" f1 qZ 3 J Material: Number of Compartments: Surface Water ` r �r�Sr-AT1AN ; iX& Lot11 Line ulk pp 1 / 2i lO�eJ •v7�t� Sizeingalions: �y Manufacturer: DD ��// ��v &U_Ct /ISL (go Foundation O/A 0!1UU4 )5-5' `' p 1"-1"' "Pump on" level at: "Pump off' level at: High water alarm at: Curtain _ — — Pump Make B Model Electri� I, I_ns�pections performed by: Drain �117. &MVIL Remarks: BENCH MARK Location and Description: /1 _ i-lr,J wt� 7wwogboff7aj Assumed Elevation: /a) 7 Ft ENGINEER'S SEAL ro�®®V%%,h j OF 444ttll � e' ... 3 or .j � }� ��rn1 A I�0 Inspections performed by: Dates: 1s `a gQUB 2nd Il IIO P8 e4•Q. •ea s.e.. a es a 94' Department of Health and Human Services approval °�, :@ Dean A. Karcze t Reviewed and approved by: Date: e s E-8303 a°°• �� aq�FEss.o'�� 72-013 (Rev. gal) MOA 25 Permit No. _SW RgaM Page -2- of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspeotion Report UI-ilj I Legal Description: NE -IL sr'114 do`14 'TI111.1 PiyV 5Ec 17 5M PID No.: \I f Q "UNIT � __ l V RESERVE TRENCH X 0' NIT 1 PRIMARY TRENCH Te 9 5' X 50.5' t• C TH D TH 4 E �\TH e \\ BIOCYCLE MO EL 6000 y `� UNIT 1 'WELL i DISTANCES ( TEST P BY OTHERS A -C 68.4 a PIT BY PTS A—D 28.4 A-E 15.5 , CLEANOUT B—C 103.5 e -D 53.O.T.52.11 MONITORING TUBE B—E SCALE 1' = 50' 100.9 TH O.G. AT TRENCH g 100.9 V, O ' evv..ec..vvm or *' e „'d� s9 95.2jHe s� a •a.ev .pw..•e..m A 4.6 94. 93.7 93.7 e�.ms vv •..• •e •... BIOCYCL 89.7 , cn� a Dean A. Karcz�Ls # 61 CE-8303>�r® NO GW 6®'F•o, • .....• F'_m B.M. — NW CORNER HOUSE, TOP FOUNDATION �O® D"ROFESS��,�® — (ASSUMED ELEV. = 100.0) ®��"vz'®�'�� 02/02/1999 09:02 9077453072 ARCHIBALD DRILLING PAGE 02 Municipality of Anchorage Iepsrtment of Hsslth and Human 8orvloss Ivoe �ryeeoni i!s IV Obrst �� fr.0. (ifos 1NM0 Aneherpe, AIeMA Mf3eS•�Ns Oso -361- O6 fhmW Number r9gn, ��. _Dsm Of IMusZ 3.L`WL TO IdsnlfllOdlorl Nwrbpr Ow staled Orae F, p* " , 29 .1$ to uW data 0 op a so pens! Iuwbnt a Y« a No L"d T1 4N R1 SEC 17 NE4 SE4 NW4 UNIT -1 • A Adffts* MASTERPIECE HOMES,INC. PO Box 773471 EAGLE RIVERO AX 99577-3471 Sall Type A ThkkMM A Weller Strde rr«n a aaJr Mary esple enol pill 0 20 al�nteat d�011d Bi -1sM Clesllp MWtlsOMW relns: ClgX Gravel AQ Cl fro pbelshtq Le ..--JMR tlR�r— Jl�s• ou ro---�^, Clay & Sand 120 160TteaAMMa Gravel Water 160 185 won tromand czXWQW o sernnea; ftut�ftvt ft*W taM D 111411000 •limn ,,,- _ lm 9Wppsd knt to Ono: fe 2n errl Mi •ds ,,,_�..� Nems �MA�/ t4e ONYMtaalMat X Yell No RECEIVED FEB 2 1999 was orlN Mow, DAVE ARCHIBALD Q ARCI TAQTa DRTT LTNr: cggyTe,� �Adommm HC04 BOX 7386 ptiy PAL ER � AK lrQ06�S Murric:paliiy of Dept. HAnchorage a I Attention: The well driller shall proMda a waM 110111111* t*e propsRy awr*r wkNn 30 days of oompiewn. r. C. CARCEL ELECTRIC INC. 10410 FINLEY CIR. • ANCHORAGE, AK. 99516 907-346-4030 • 907-346.4032 fax Master Piece Homes P.O- Box 773471 Eagle river, Ak 99577-3471 To Whom It May Concern: Feb. 25, 1999 Carcel Electric, wired the Bio -cycle located at White Stone Estates Unit 1, Eagle River, Ak This Bio -cycle was wired per the 1996 National Electrical Code. If you have any questions please give me a call. Thank Y Steve Cloud RECEIVED APR 6 1999 Municipalay ul A11Cnora96 Dept. Health & Human Services 13.16 Profession1118070TOCRINewsemees me. 4155 Tudor Centre Drive, Suite 103, Anchorage Alaska 99508 (907) 561-6237 fax: (907) 563-3813 December 10, 1998 Daniel Roth, Civil Engineer On -Site Services Section Health & Human Services 825 L Street, Suite 502 Anchorage, AK 99501 Re: White Stone Estates Condominiums Unit 1- Inspection Report Transmittal Permit # SW980237 Dear Mr. Roth: RECEIVED DEC 11 1998 Municipality of Anchorage Dept. Health & Human Services Transmitted with this letter is a completed On -Site Wastewater Disposal System and/or Well Inspection Report for Unit 1 of Whitestone Estates. If you have any questions, please call me at 561-6266. Sincerely, Professional and Technical Services, Inc. Dean A. Karcz, PE Vice President DAK:dak Attachments 04 cosi, MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ONSITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Permit Number: SW980237 Date Issued: Jul 15, 1998 Expiration Date: Jul 15, 1999 Parcel ID: 050-362-06 Legal Description: T1 4N R1 W SEC 17 NE4SE4NW4 Design Engineer: PTS, INC. - Dean Karcz, P.E. GNtr Site Address: Owner Name: MASTERPIECE HOMES, INC. Lot Size: 435600 SQ. FT. Owner Address: PO BOX 773471 Total Bedrooms: 4 Permit Bedrooms: 4 EAGLE RIVER, AK 99577-3471 This permit is for the construction of: ❑✓ Disposal Field[?] Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Z%;;� Date: Z :d Date: 7'141,7W_ F. P�olessionaialloreeasiewsemen i g. 4155 Tudor Centre Drive, Suite 103, Anchorage Alaska 99508 (907) 561-6237 fax: (907) 563 813 June 30, 1998 Daniel Roth, Civil Engineer On -Site Services Section Health & Human Services 825 L Street, Suite 502 Anchorage, AK 99501 Re: White Stone Estates Condominiums ltt 1- Additional information Dear Mr.. t This letter is a supplement to information previously submitted to your office dated June 11" and June 17' of 1998 for unit one (1) of White Stone Estates Condominiums. Specifically this letter transmits the calculations for the wastewater disposal field and a narrative description of probable impacts to adjacent properties. Additionally, the site plan and typical sections sheets have been revised showing the disposal field being located on the north side of the lot adjacent to the Ptarmigan Blvd right-of-way. The proposed disposal field for unit one (1) is not anticipated to have negative impacts on any of the adjacent properties. Properties in the vicinity of unit one (1) include Lots 11 & 12, Block 2 and Lot 8, Block 3 of Eagle Park Subdivision. The existing wells are located greater than one hundred feet (100') from the proposed disposal field. Site drainage flows to the east and then south in the general vicinity of unit one (1), away from the existing home sites, wells and septic systems on the afore mentioned lots. ALASKA PROPERTYDEVELOPMENT SPECIALISTS Pre%ssionaiandTeessiesiseivi a inc. 4155 Tudor Centre Drive, Suite 103, Anchorage Alaska 99508 (907) 561-6237 fax: (907) 563-3813 July 9, 1998 Daniel Roth, Civil Engineer On -Site Services Section Health & Human Services 825 L Street, Suite 502 Anchorage, AK 99501 Re: White Stone Estates Condominiums Unit 1 -Additional information MUM 7U MIR 111 This letter is in response to comments discussed in our telephone conversation on July 8, 1998 regarding the septic disposal field locations relative to the existing soil information. In our conversation you expressed concern from the Health Department about placing the disposal fields in previously placed fill material. Based on the telephone conversation, the septic fields have been redesigned and relocated to areas where they will be placed in native material. The primary trench is proposed to be located north of the house, immediately south of what would be the Ptarmigan Boulevard right-of-way, if it were ever dedicated for this property, providing the necessary set backs from the property line and building. A five foot (5') wide by fifty foot (50') long trench is proposed, with four feet (4') of gravel beneath the perforated pipe. Test Pit 9 encountered fill to seven feet (7') and the native material had a percolation rate of twenty-two (22) minutes per inch. The top of the leach field will be at a depth of seven feet (7') and extend to a depth of eleven and a half feet (11 ''/z') deep. Calculations for the disposal field are provided in the table below: UNT MAY PERCOLATION FLOW RATE (GPD) (MIN/IN.) APPLICATION RATE (GPD/SF) ABSORPTION AREA (SF) 50% RED, OF AREA FOR BIOCYCLE (SF) LENGTH OFF WIDE TRENCH (FT) GRAVEL RF FOR DEPTH GRAVEL BENEATH PERF. PIPE DEPTH (FT) REVISED LENGTH OFFWIDE 1 600 22 0.6 1000 500 100 4 0.5 50 ALASKA PROPERTYLIEVELOPMENT SPECIALISTS White Stone Estates Condominiums Unit 1 -Additional information 07/09/98 P.T.S., Inc. Page 2 The reserve trench has a proposed area of five feet (5') by eighty-five feet (85') based on the percolation rate of fifty-five (55) minutes per inch from Test Pit 5B. Note that corrected soils logs for Test Pits 5, 5A and 5B are included with this letter. An original soils log for Test Pit 9 has previously been submitted to your office. Test Pits 5A and 5B encountered fill of approximately ten and a half feet (10 %z') and the reserve trench, if necessary, will also be located in the native material. I hope the information provided will be adequate for you to issue the well and septic permits for this unit. If you have any questions, please call me at 561-6266. Sincerely, Professional & Technical Services, Inc. 4-b_ Dean A. Karcz, P.E. Vice President Enclosures ALASKA PROPERTY DEVELOPMENT SPECL9LISTS 6UN/7 PRIMARY TRENCH' 5"X 50'- DEAN 0' DEAN A. KARCZ NO, CE -8303 u 1 9Q pmm m g a mma mom m ae� � nam ease vme�raveorimrr �awals USCOD o TEST PIT BY OTHERS • TEST PIT BY PTS °c" CLEANOUT *", MONITORING TUBE 4" DIA. PVC FROM HOUSE, S = 2% DEAN A. KARCZ NO, CE -8303 MANHOLE COVER; 3" INSULATION ON LID 1-1/4" DIA. PVC FROM BIOCYCLE BIOCYCLE MODEL 6000 MONITORING MOUND SURFACE TUBE FOR DRAINAGE NA � SOIL BACKFILL 4.5' 4" PERF. PIPE NOTES 1. GROUNDWATER DEPTH GREATER THAN 17' BELOW GROUND SURFACE. 2. BEDROCK GREATER THAN 17' BELOW GROUND SURFACE. J. LENGTH OF BED = 50'. p I r �.y mtrffzwg Ac u"e r�rmarmvorimr �vverms SECTIONS UNIT 1 WHITE STONE ESTATES nGURE 31 SCALE 1'=50' 16/30/98 Municipality of Anchorage . DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: _ /'7-1071es Pi CCP DATE LEGAL DESCRIPTION: ,erVz SE V¢- IvAl 11¢ Township, Range, Section: Sec /7 7-/4/✓ I IW DEPTH 1 SLOPE SITE PLAN (FEET) 1 0 �OWH Si /¢y Sgntly C+iR ✓el 2 Wife/ c 0.6,41e5 a� t/ cdao� de bri s y 3 / 4 `1\ 5 "l U 7r 6"4y Si/�y Scn% $ Cdi�h codh/es 9 10- 11 12- 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS 2 13141516n is1s20COMMENTS 1 n s dal/ed WASGROUNDWATER ENCOUNTERED? NO S IF YES, AT WHAT L DEPTH? — O P E DePM to Waw Al`I r mimbr)ng1 T— Date 3(� PERCOLATION RATE (mmutewmh) PERC HOLE DIAMETER G �� TEST RUN BETWEEN FT AND _LL FT PERFORMED BY: 1;!5, cn7a") 'Ae/` I A XusfiD A;ari f/.1/fIzCERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE 3 /2 / %9'B 72-008 (Rev. 4/85) 17jIN Pmiessienaiawrecamewservices inc. 4155 Tudor Centre Drive, Suite 103, Anchorage Alaska 99508 (907) 561-6237 fax., (907) 563-3813 July 14, 1998 Daniel Roth, Civil Engineer On -Site Services Section Health & Human Services 825 L Street, Suite 502 Anchorage, AK 99501 Re: White Stone Estates Condominiums Unit 1 and 2 -Additional information Dear Mr. Roth: RECEIVED JUL 14 1998 Municipality of Anchorage Dept. Health & Human Services Per our telephone conversation yesterday, please find the enclosed soils log for Test Pit 5C for the subject project. This test pit was excavated to twenty-one feet (21') below ground surface and no bedrock was encountered. The test pit was located on the midpoint between Test Pit 5A and 513, which have been used to design the primary septic system for Unit 2 and reserve area for Unit 1. Based on our telephone conversation, this is the last piece of information you need in order to issue permits for the two (2) units. If you have any questions, please call me at 561-6266. Sincerely, Professional & Technical Services, Inc. Dean A. Karcz, P.E. Vice President Enclosures ALASKA PROPERTY DEVELOPMENT SPECIALISTS ® Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 �SOILS LOG — PERCOLATION TEST PERFORMED FOR:n_ _�/V 61 fP 5740//e X17 P6; DATE PER LEGAL DESCRIPTION:_ Z' �'L SF/4 NV✓X4 Township, Range, Section: SP,. (FEETI 1 2 3 Gr 4- 6- 7 s7 s s 10 11 12 13- 14- 15- 16- 17 3 14151617 18- 19- 20- at 81920at COMMENTS — bray S!/ o / l<m Nf GJ!'n _r 06v1 �i dnZ! Tff 5G i &,nvel qhs t,rl/e'�l L' $Ofd!% %; WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L DEPTH? O P E Depth to Water After Monitoring? Datc OF G, SCOTT CROWTHER %- CE -6491_ _.- /7 r, SITE PLAN PERCOLATION RATE (minutewimh) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT PERFORMED BY: 6 J Crac.11-ACr I ERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7 14 (?9 72-008 (Rev. 4185) PROPERTY OWNER AGREEMENT y FOR THE MAINTENANCE OF AN ON-SITE WASTEWATER DISPOSAL SYSTEM This agreement, dated July 1 6th 199 S , is made between the Municipality of Anchorage Department of Health and Human Services (DHHS) and the property owner(s)of- White Stone Estates Condominiums Unit`1 located at: East 1/2 of the Southeast 1/ of the T +k + 1/ Township 1� North, Range 1 West, Seward Meridian of �oction 17, This agreement is made for the purpose of maintaining an on-site wastewater disposal system on the subject property. The property owners agree to the following: Submit to the Municipality of Anchorage, on an annual basis, an inspection and operation statement from a registered professional engineer. This inspection and _ operation statement shall verify that the engineer has inspected all effluent and air Pumps, timers, and alarms, and that any deficiencies have been repaired and that the system is functioning as designed. (Signature) (Signature) (Printed Name) (Printed Name) -------------------- ----------Notarize Here _ _ __ --------- ---------------------- StatffJ/ of 4' On this day of // personally appeared be ore mi, X who is personally known to me proved on the basis of proved on the bath/affirmation of whose identity I whose identity I to be the signer he/she a credible witness acknow d that he signed it. N ar lic commission expires Municipality of Anchorage t �` Development Services Department e Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING CSD— 3&2- uC Parcel I.D. Via- HAA# Expiration Date: __ O 1. GENERAL INFORMATION Ex P 1 141`4 Vt� SSG 17 E 5ty N1Wz/ Complete legal description WHITE STONE ESTATES; UNIT #1 / NF4F4;� Location (site address or directions) 20620 PTARMIGAN BOULEVARD Current Property owner(s) CLARENCE & SUSAN GRAVES Day phone Mailing address Lending agency Mailing address 20620 PTARMIGAN BOULEVARD * EAGLE RIVER, AK 99577 Day phone Real Estate Agent HAL JACKSON w/ COLDWELL BANKER Day phone 696-9312 Mailing address 10928 EAGLE RIVER ROAD * EAGLE RIVER, AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 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 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results 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 wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Note. Alaska Water and Wastewater Consultants, Inc, shall be paid $468'x3Bat, or prior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Address ALASKA WATER & WASTEWATER CONSULTANTS, INC. 6901 DEBARR ROAD, SUITE 213 * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. 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 performance 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. Satisfactory test results do not guarantee future performance of the system, nor do theyguarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty or future 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 person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for _ 4 bedrooms. Disapproved. Phone 337-6179 Date Z D z Conditional approval for bedrooms, with the fllowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory LIZ Manitenance Agreements Supplemental Engineers Reort Other OF AIVO�' ,Z: WATER AND ; . nrr�rtLA2GR PROGRAM By. //, / J Original Certificate Date: 5 — 3' (Rev. 12100) Municipality of Anchorage c DEPARTMENT OF HEALTH & HUMAN SERVICESR E C E I v C Environmental Services Division 0A 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 34OW446 1999 Health Authority Approval Checklist Municipality of Anchorage Dept. Health & Human Services Legal Description: NE 1 /4 SE 1 /4 NW 1 /4, T1 4N R1 W Parcel Sec. 17 Unit 1 A. WELL DATA Well type Private If A, B, or C, attach ADEC letter. ADEC water system number Log present(Y/N) Total depth 185 Sanitary seal (Y/N) Date of test _ Static water level Well production _ Y Date completed 9/9/98 Cased to 185' Y FROM WELL LOG 9/9/98 25' 10 WATER SAMPLE RESULTS: Coliform 0 Nitrate Date of sample: 3/30/99 B. SEPTIC/HOLDING TANK DATA Date installed N / A Tank size Foundation cleanout (Y/N) Date of Pumping C. ABSORPTION FIELD DATA Casing height (above ground) 31 Wires properly protected (Y/N) _ g.p.m. 0.10 Collected by: AT INSPECTION Other bacteria Bruce Brown Y Number of Compartments Cleanouts (Y/N) Depression (Y/N) High water alarm (Y/N) Pumper 9 - p.m - Date installed 11/16/98 Soil rating (g.p.d./ft'orft2/bdrm) n - (h System type S he 1 1 aw Tr nch Length 50.5' Width 5 1 Gravel thickness below pipe 41 Total depth 121 Effective absorption area h 56. 5 s f Monitoring Tube present (Y/N) Y Depression over field (Y/N) N Date of adequacy test N / A Results (Pass/Fail) N / A For N / A bedrooms Fluid depth in absorption field before test (in.); Immediately after_ gal. water added (in.): Fluid depth (ins) Minutes later: Absorption rate = g.p.c Peroxide treatment (past 12 months) (YM) If yes, give date 72-026 (Rev. 3/96)' a Biocycle Date installed /16/98 Size in gallons Manhole/Access(Y/N) Y High water alarm level at* Cycles tested E. SEPARATION DISTANCES "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main 103.01 N/A Sewer /septic service line go -81 "Pump off" level at* On adjacent lots + 1 1 0 1 On adjacent lots + 1 1 0 f Public sewer manhole/cleanout Biocycle a 10q_7i Biocycle SEPARATION DISTANCES FROM griPTIGM91=911SIGTANK ON LOTTO: N/A Foundation 1 5. 5 1 Property line 68-31 Absorption field 15. 4 1 Water main/service line - Surface water/drainage - Wells on adjacent lots + 3 00 t SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 3 3 . 9 Building foundation 28.41 Water main/service line N /A Surface water 7 Driveway, parking/vehicle storage area 6Z., Curtain drain Wells on adjacent lots + 3001 F. ENGINEER'S CERTIFICATION 1 certify that I have determined thru field inspections and review of Municipal recoi in conformz0ce with MOA HAA guidelines in effect on this date. �. Signature Engineer's Name A C 'i -L- Date I HAA Fee $ S nr� n ) Waiver Fee $ Date of Payment t -1-h `lel Receipt Number rg-)/-n 1/wo 72-026 (Rev. 3/96)* Date of Payment Receipt Number are PROPERTY OWNER AGREEMENT FOR THE MAINTENANCE OF AN ON-SITE WASTEWATER DISPOSAL C4 SYSTEM This agreement, dated 199 , is made between the Municipality of Anchorage Department ofealth and Human Services (DHHS) and the property owner(s) of: Uw.i 1 :� ci G. �.L, c. �/ ,n, This agreement is made for the purpose of maintaining anon -site wastewater disposal system on the subject property. The property owners agree to the following: Submit to the Municipality of Anchorage, on an annual basis, an inspection and operation statement from a registered professional engineer. This inspection and operation statement shall verify that the engineer has inspected all effluent and air Pumps, timers, and alarms, and that any deficiencies have been repaired and that the System is functioning as designed. l (Signature) (Signature) C' vt..� Cm's (Printed Name) (Printed Name) ------------------------------Notarize Here ------- State of ALA -6,(-4- On this :2,_ day of Apt) IL_ r l ci �Kjt,6,6 personally appeared before me, who is personally known to me x whose identity I proved on the basis of i>11Gf7i( r-US(o32�5 €xdc6. whose identity I provdd on the bath/affirmation of u to be the signer of � as , a credible witness and he/she acknowledged ----that he/she signed it. J � N tare My commission expires My Commission Expires MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services -- �-- On-Site Services Section y'CMdGr1 P.O. Box 196650 Anchorage, Alaska 99519-6650 G uzv 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # U)/ -c- `'�z - � \ �' HAA # _ � ��1!�� 1. 1. GENERAL INFORMATION Complete legal description NE 1/4 SE 1/4 Nig' 1/4, T1 LN R1 W Sec. 17 Location (site address or directions) Unit 1, Whitestone Estates Property owner Masterpiece Homes Dayphone 694-7320 Mailing address PO Box 773471 Lending agency Mailing Agent - Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 - 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest - Ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site X 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)Nev.1/91) Front MOAe21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverifythat 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 PTS, Inc. Phone 561-6237 Address 4155 Tud T Centre Dr., Suite 103 Engineer's signature Date )n 6. DHHS SIGNATURE J Approved for ;oz bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments M C UITIC Date .) Z. 99 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a cou rtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025MOV.1i91) Back MOAa21 Municipality of Anchorage A Development Services Department xa Building Safety Division Onsite Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorege.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST 7'i,1.r/1 R1v✓, sic 4-71 GYz, SEV', AiWi�- us D -36x Ho Legal Description: WHITE STONE ESTATES; UNIT #1 Parcel ID: -050�36i-e6- A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N A Date completed 9/9/1998 Sanitary seal (Y/N) YES Total depth 185 ft. Cased to 185 ft. FROM WELL LOG Date of test 9/9/1998 Static water level UNK ft, Well production 10 g p -m - WATER SAMPLE RESULTS Coliform 0 colonies/100 ml. Nitrate 0.2 mg./L. Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 18'+ in. AT INSPECTION 6/28/2001 iG'b'1 5.0+/- g.p.m. Other bacteria 0 colonies/100 ml. Date of sample: 5/7/2002 Collected by: AKWWC, INC. B. SEPTIC/HOLDING TANK DATA Tank Type/Material BIOCYCLE Date installed 11/16/1998 Tank size 1500 gal. Number of Compartments MULTIPLE Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) YES Date of pumping 7/23/2001 Pumper J.R.'S PUMPING C. ABSORPTION FIELD DATA *SYSTEM WAS PRE-SOAKED ON 6 28 2001 Date installed 11/16/98 Soil rating OE/ 50r ft'/bdrm) 0_6 System type TRENCH Length 50.5 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth 12 ft. Eff. absorption area 505 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 6/28/2001 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 10_75in. Water added 894 gal. New depth24_7�n. Elapsed Time: 439 min. Final fluid depth19_25in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date D. LIFT STATION BIOCYCLE MODEL 6000 Date installed 11/16/98 Size in gallons 1500 Manhole/Access (Y/N) YES "Pump on" level at in. "Pump off' level at — in. High water alarm level at — Datum E. SEPARATION DISTANCES Cycles tested N/A Meets alarm & circuit requirements? YES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankllift station on lot 100'+ Absorption field on lot 100 On adjacent lots 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer/septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: BIOCYCLE UNIT 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: Absorption field 5'+ Surface water 100'+ Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date "Zz— 2 !J HAA Fee $ 375 ,p Waiver Fee $ Date of Pavment 5 " ,)a .0 � Date of Payment Receipt Number O'go /`"l`/ Receipt Number (Rev. 12100) OF -7953 ASBUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCA `2� o FOLLOWING DESCRIBED PROPERTY: �� Of AL A GiiTF,sTay�Ej�3"l/.Y/r�(�/. DATE:.. ,; ��.. ,.96, MC AND THAT NO ENCROACHMENTS F`XIST EXCEPT AS .S�� . •..f- A INDICATED. IT IS THE RESPONSIBILITY OF THE �'� /j M T H OWNER TO DETERMINE THE EXISTENCE OF ANY GRID, "• .. d EASEMENTS, COVENANTS, OR RESTRICTIONS fr�SG r •..• WHICH DO NOT APPEAR ON THE RECORDED SUBDI- o„e,e Mak sw..a• VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD PB' ANY DATA HEREON BE USED FOR CONSTRUCTION _ '•civ OFFENCE LINES, OR FOR ESTABLISHING BOUND-}>'�`. •"'• ; ARY LINES. DRAWN: