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HomeMy WebLinkAboutCOTTONWOOD HEIGHTS BLK 1 LT 1Cottonwood Heights Block 1 Lot 1 #051-431-27 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 hftp://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241372 Work Type: Septic Upgrade Tax Code Number: 05143127000 Site Legal Address: COTTONWOOD HEIGHTS BLK 1 LT 1 G:0756 Site Mailing Address: 16239 DIVISION ST, Chugiak Owner: MORRISON PROPERTY OF ALASKA Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: 11 /6/2024 11 /6/2025 44550 Q Disposal Field 2 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing 3 TO F Received By: Date: Issued By: Date: ANCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 ON -SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-431-27 Property owner(s) MORRISON PROPERTY OF ALASKA LLC Day phone Mailinq address 130 WILDWOOD DRIVE, MADISON, MS 39110 Site address 16239 DIVISION STREET, CHUGIAK, ALASKA 99567 Legal description (Sub'd., Block & Lot) COTTONWOOD HEIGHTS BLOCK 1 LOT 1 Legal description (Township, Range & Section) Lot Size 44,550 Sq. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (Z all that apply) Absorption Field Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature: of. property -owner or authorized agent) Permit/Rush Fees: 4595 Waiver Fees: Date of Payment: ///-z q Date of Payment: Receipt Number: 2 110q lj Receipt Number: Permit No. C, /JZ Lj 1-3 72- Waiver No. GAIDevelopment Services\Building Safety\On Site Water and WastewaterTormsUient FormsTermit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / FirstWaterAK@gmail.com ! !! October 31, 2024 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: COTTONWOOD HEIGHTS BLOCK 1, LOT 1 The property owner has requested we obtain a permit to upgrade the failed septic system of the above referenced lot. We propose to install one deep trench and 1250-gallon STEP tank to serve the existing 2-bedroom residence. The design is based on the recent test hole conducted on October 22, 2024. Seeps were encountered at excavation, but no groundwater was observed at test hole monitoring. In any case, the field is designed to maintain 4’+ to these observed seeps. The slopes are moderate at 7-12% at the proposed upgrade location. The lot and area are served by private water. The area was searched for wells, but none could be found that would impact this installation. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241372, Curtis Townsend, 11/06/24 24 . 1 ' 5.0' 5.8' 24.3' 24.3' 24.3' 10.3' 5.5' 24.0' 8.0' 16.2' 34 . 3 ' 16.3' 2. 0' 32.0' OVERHANG ROOF RESIDENCE GARAGE SHED 8'x16' ELEC. GA S DR I V E W A Y FIRST WATER CONSULTING COTTONWOOD HEIGHTS BLOCK 1, LOT 1 DESIGN CALCS: NO WELLS WITHIN 100' OF PROPOSED SEPTIC SYSTEM. NO SLOPES >25% WITHIN 50' OF PROPOSED FIELD. SEARCHED AREA (N, E & S) & NO WELLS COULD BE FOUND. NO WELLS WITHIN 100' OF PROPOSED SEPTIC SYSTEM. VACANT Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241372, Curtis Townsend, 11/06/24 2 4 . 1 ' 5. 0' 5.8' 24 .3' 24.3' 24 .3' 10.3' 5. 5 ' 24.0' 8 .0' 16.2' 3 4. 3 ' 16.3' 2. 0' 3 2.0' OV E RH A NG RO OF RESIDENCE GARAGE SHED 8'x16' EL E C. GA S DR I V E W A Y FIRST WATER CONSULTING DESIGN DETAILS: COTTONWOOD HEIGHTS BLOCK 1, LOT 1 DI VI SI O N S T R E E T NO WELLS WITHIN 100' OF PROPOSED SEPTIC SYSTEM. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241372, Curtis Townsend, 11/06/24 3030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 FirstWaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL : COTTONWOOD HEIGHTS B1, L1 PERFORMED BY: FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 10/31/2024 DEPTH FEET OG SOILS 1 ORG/OL 2 3 4 5 SP/sm-gp 6 7 8 9 10 11 12 SEEPS 13 14 15 16 BOH 17 18 19 20 Reading Date Gross Time Net Time Depth to Water Net Drop 10/25/24 10 min 6” 4 2/16” “ 6” 4 1/16” “ 6” 3 14/16” “ 6” 3 13 /16” “ 6” 3 13 /16” “ 6” 3 13 /16” PERCOLATION RATE 2.6 (MIN / INCH) TEST RUN BETWEEN 4 & 5 FT PERC HOLE DIAMETER 6” PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH. GROUND WATER ENCOUNTERED: NO (11’ seeps) IF YES, AT WHAT DEPTH: NA DEPTH TO WATER AT MONITORING: DRY DATE: 10/30/2024 TESTHOLE # 24-1 DATE PERFORMED: 10/22/24 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION PERFORMED FOR: MORRISON PROPERTY OF AK 10/31/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241372, Curtis Townsend, 11/06/24 Municipality of Anchorage Page I e1 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 * Anchorage. Alaska 99519-6650 at Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number. Sui000 wale PID Number. 0 st - 't3l - 27 Nems Wastewater System: O New la Upgrade R ; a Address: ABSORPTION FIELD ' P.0 20132 Phone No. of BiOroaa Deep Trench Shailow Trench a Bed a Mound D other 4/F-1 It LEGAL DESCRIPTION Sail Rating: TOWoaptnfrom orig"algredr. it, O. GPo .a. Lot awls: subdivision: Dafen to less Hotta" freta argrW tpedc Grewal d.Otn aenesth pi W 71 I I Cofi0nw.e4'rtS. H' Ft. Ft. Township:llangr Sscuor: Fin ad sddab(we Mlgmal oreds•. GrevM 1"tn: 1 T SN Iw 1VEf 0..sn/.Sd IV. r'"Ft. .7 n. WELL, FxtiTwo-p New. 0 Upgrade Gnwa Oip"" 71 Number of lined: Distance aw..es roc Ft clasuttution tPmate. A,&C):roW =L GasW To: aorption area: Towbe pips materiae /i SI 0 rG2 t ✓w TE AFL — Fl. 41.24) so. Ft. 57th 303YF Drilla: Data Drilled: Sues Water lase InsWlw. Data "stalled: 9-30-00 -� Ft. M la' Sun jC1rC4Vqt;hA Tlsid: Pump Set at a.ro aoo1. Moana TANK GPM FL Ft. FX�Ir..wG SEPARATION DISTANCES C§Septic aHolding 0S.T.E.P. To $.+1141 _ UR Iterae9 Manufacturer. Capacity to gallons: As.arasrt Fran Tana View tilall.n T.na s.wtLr was los' 1031 Wterat Number of Compartments Surface LIFT STATION Water r,,, rro, Lot I Sita in gubns uanufsctur . Line /.1' -p on' level at Punto atr' lawel sc Nigh water,alarm at Foundation fta" Curtain f _ Nrmp uaa Electrical Inapaenons penom+w t+Y. Orrin T BENCH MARK Remarks: .pew ce4CNFIEcd A4o o TO Loa~ aid Description: fX. Tr..rs. L E.•rFT r�.rgfo Te 3• 7v w r I cos ; n Assumed Elavatiorl: rf >•i.� mrd New G.�/I DSO �.�/ 100. ENGINEERS SEAL OF4,'C�16. g0 Inspections performed by: xr-6A"?'"""Dates: lst 6'3r" •»� •�•�•�'• 2nd 5 3v we �...f�...........»»:.».#�.t« `a l Loth A.Si brit :R1 Department of Health and Human Se ce approval � ;'`.� CUM � •� QA'••......••••�r� Date: Reviewed and approved by: T2O13 (1/111 MCA 23 Permit No. SW000407 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LOT 1 BLOCK 1. COTTONWOOD HIGHTS PID No.: 051-431-27 SCALE 1"-50' S89'59038"E 297.00' C�arog o 6 27�_Ci o _ House A EXISTING FIELD EXPANDED. mo b �+': iii •in��r Z�.4� .;. •rte � ,>VI a• c-: �;;;•7A: '•+ � -ti•;r,. ,;.,;., I �i 30' NEW FIELD R100.00 II F S89'59'38"E 297.00' s.ay nn ti Not® - TEST HOLE • - MONITOR TUBE o - SEWER CLEAN OUT - WELL - EXISTING LEACH FIELD ©— Driveway ® — Decks 10/20/00 ENCINEER'S SEAL ELEVATIONS WELL CASM CNOT TO SCALE) Zs°o0000pp OF A��Sp� DRIGRML D��Q^`• ��0 LEVEL °Ar. o°�: 49TH , 00 TRI 10°R O.................................O •• nL u scum D° TN »s IIMII a' w Gvr a"��............. P rnu•• ' se• O '.LOUIS A. BUTERA i oiv..•. rn xa OQ cJJ'•.. CE -6736 QO 0 \TRI •.1°o��roFE$s�� 4000E Permit Number: SW000407 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 PERMIT Upgrade 0-'Z•00 a l;Z:0-0 .1- *X : o a t4 --- Date Issued: Sep 29, 2000 Expiration Date: Sep 29, 2001 Parcel ID: 051-431-27 Legal Description: COTTONWOOD HEIGHTS BLK 1 LT 1 Design Engineer. 0024 Eagle River Engineering Services Site Address: Owner Name: RICK OLSEN Lot Size: 44550 SQ. FT. Owner Address: PO BOX 241632 Total Bedrooms: 2 Permit Bedrooms: 2 ANCHORAGE. AK 99524-1632 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: Date: 1-29-06 Date: 7) Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Fame River. AK 99577-3294 (907) 694-3297 fax September 26, 2000 Jim Cross, P.E. Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Lot 1 Block 1, Cottonwood Heights Narrative & Permit Application Dear Mr. Cross: We are applying for an upgrade permit on the above referenced lot. The existing system is a 2 Bedroom capacity installed in 1984. The system has failed due to plugging of the gravel/soil interface. The existing effluent pipe system has been flushed and camera inspected. We propose to install an additional 20' of leach trench at the end of the existing system keeping the existing system online. This is due to the limited practical area available due to topography and well location on the lot. I believe the initial system failed due to the shallow gravel depth. We are proposing to keep the existing 1984 tank in place without inspection, however if this is not acceptable then indicate on the permit and we will replace the tank. The proposed septic upgrade will have very limited impact on adjacent properties for the following reasons: The surrounding lots are large, allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance, wells are in excess of 200'. The lot to the south is vacant. 3. Reserve space is adequate, due to absorption capacity. 4. Drainage will not be affected and is not a major consideration in our design. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. 0000k00-061 NAR i NO WELL OR SEPTIC COWLICT WT" UPGRADE .100' 589'59038"E 297.00' S89'59'38 -E 297.00 VACANT LOT NO WELL OR SEPTIC ® - TEST HOLE •- MONITOR TUBE 0 - SEWER CLEAN OUT + - WELL - EASEMENT PROPOSED LEACH FIELD EXISTING LEACH FIELD NO SURFACE WATER ©_ OAveway NO KNOWN CURTAIN DRAINS ®- Decks WELL SEPTIC SITE PLAN LEGAL: Lot 1, Block 1, Cottonwood Hi hts OWNER: Rick Olsen : c--) CONTRACTOR: MIDNIGHT SUN EXC. s * :49TH .. JOB 00-061ws DATE: 9-22-001 SCALE l' = 50' � — ,..........; EACLE RIVER ENGINEERING SERVICES j c LOUIS A. BUTERA w; AP.O. Boz 773294 //�J}� CE -6736 EACLE RIVER, AK. 99577/"I'll 8CFESSIMAOL (907) 694-5195 FAX: (907) 694-3297 ��� Garog Ci ;A NO WELL OR SEPTIC 4100' House OSx o .�m �'=LS AT ENO, INSTALL CO . .:.� TIE w TO pleTNG TRENCH O 'i • • 1 o71D TEST HOLE b Z •..LIE mX az clElAODEO NEW TRENCH TO SOOT" p' 100' R ' S89'59'38 -E 297.00 VACANT LOT NO WELL OR SEPTIC ® - TEST HOLE •- MONITOR TUBE 0 - SEWER CLEAN OUT + - WELL - EASEMENT PROPOSED LEACH FIELD EXISTING LEACH FIELD NO SURFACE WATER ©_ OAveway NO KNOWN CURTAIN DRAINS ®- Decks WELL SEPTIC SITE PLAN LEGAL: Lot 1, Block 1, Cottonwood Hi hts OWNER: Rick Olsen : c--) CONTRACTOR: MIDNIGHT SUN EXC. s * :49TH .. JOB 00-061ws DATE: 9-22-001 SCALE l' = 50' � — ,..........; EACLE RIVER ENGINEERING SERVICES j c LOUIS A. BUTERA w; AP.O. Boz 773294 //�J}� CE -6736 EACLE RIVER, AK. 99577/"I'll 8CFESSIMAOL (907) 694-5195 FAX: (907) 694-3297 ��� Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 " L" Street. Anchorage. Alaska 99502-0650 SOILS LOG:— PERCOLATION TEST Louis A.Buteta CE4M PERFORMED FOR: �+ c k O/S' DATE PERFORMED: 7—/,F-00 NTf LEGAL DESCRIPTION: Lo* 'l� �en'a'/"'� Township. Range. Section: SLOPE SITE PLAN 00.41 2 3- 4- 6- 7 467 ' + 9 v 10- 11 12- 13-- 14 213 14 15 ' 16 �/ 17 ' is- 19- 20- COMMENTS 81920COMMENTS (sP/SM) �,ye�e•i� Q/e,lr IC%w ae.- WAS GROUND WATER I ENCOUNTERED? NO IF YES. AT WHAT DEPTH) Depth to Water Ater 9 alemftanne? _�Y_ Oatt M Reading Dan Gross Time to Water Na[ Droo SOAR ON.tDepth 1 .. 7 I, f 5 + //•s7 S�—rl'//c PERCOLATION RATE —/ Im.nutes..ntni PERC HOLE DIAMETER TEST RUN BETWEEN . S FT AND 04, f FT PERFORMED BY. EAr<f .O/✓Eir Ener^�a.�o/^� ICERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUICEWNES IN EFFECT ON THIS CATE DATE. ,2-(481Per 4.85, _ Eagle River Engineering Services Louis Butera, P.E. P.O. Bos 773294 Faele River. AK 99577-3294 (907) 694-5195 tel (907) 693-3297 fax SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: Lot 1, Blk 1 Cottonwood Heights subdivision September 25, 2000 A. GENERAL I. The well and septic plan are for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health and State Department of Environmental Conservation requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. S. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. B. SEPTIC TANK Existing 1984 Septic tank shall be inspected if required by the municipality on the permit. If new tank is required then tank is to be placed on original ground or a compacted base of NFS material and existing tank to be pumped, removed and disposed of. C. TRENCH 1. The trench is to be located as shown on the site plan drawing. 2. The bottom of the trench shall be level, plus or minus 1.5" at an elevation of 1 I' below the ground surface at test hole location. 3. The total depth of the trench excavation is not to exceed I I' at any point. 4. The existing effluent line from the septic tank is to be utilized and the new trench added to the existing 30' trench system. The effluent line within the trench shall be laid level within 0.03'. 5. The trench gravel is to be covered with typar fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of Y or equivalent is to be placed over the leachfield. 7. The area over the trench is to be finish graded to prevent ponding of surface water runoff. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFiELD DIMENSIONS: TOTAL DEPTH = 1 l' GRAVEL DEPTH = 7' under pipe, 2" over pipe TRENCH LENGTH = 20' TRENCH WIDTH= 3' SOIL RATING= 0.8 GPD/ft'- BEDROOM CAPACITY = 2 (upgrade of existing 2 BR) SEPTIC TANK = 1000 existing Twenty-four (24) hours notice required for all inspections. 1997,00-061 spec EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 694-5195 ERES Project No.: 00-061 Calculated By: LB Date: 9/25/00 Legal: Cottonwood Heights L1, 81 Single Family 2 Bedroom Dwelling Deep Trench Subsurface Wastewater Disposal Field 00.061cal Water use at 150 gallons per bedroom = Percolation rate = Wastewater application rate = Required absorption area = Trench width (W) _ Gravel depth (D) _ TEST HOLE 1 300 gallons 3.5 minutes per inch 1.2 gallons per day per square foot 250 square feet 3 feet 7 feet Required length = Required absorption area / 2 / D Required length = 250 / 2 / 7 Required length = 18 feet Total Excavation Depth = 11.0 feet .. TFi i'r 'tea v .• ?^:LOUIS A. BUTERA: Q Ut',� 1 -1, •• CE -6736 c ' G 10:05 AM9/25/00 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME / PHONE ❑ UPGRADE MAILING A RE LEGAL DESCRIPTION / L--K % w tw D LOCATION NO. OF BEDROOMS 21 D DISTANCE TO: Well Absorption are Dwelling "&— PERMIT _Y ~a Q Manufacturer Mate' No. of compartm nts� W y Liq.ca aci inns IF HOMEMADE: Insidelenuth _ Width .�— Liquid depth —�..._ Y Jaz DISTANCE TO: Well Dwelling PERMIT NO. _ F Manufacturer lo4 Material Liquid capacity in gallons M DISTANCE TO: Well �C90 / Foundation/,,g / Nearest lot li It PERMI'Tr�lOf / Z7 i � , � J LL F. LL No. of lines Length of eaglylipe s Total length f lines/ Trench wi h,rr 0 inches Distance between lines' Top of the to finish grade Material ben ath the Total effective absor do a D 49 inches Length Width pth PERMIT NO. W a F W °L Type of crib Crib diameter rib depth Total effective absorption area ti DISTANCE TO: Well'Building foundation Nearest lot line J Class De th Driller Distance to lot line PERMIT NO. J DISTANCE TO: 'ITIlit ng foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS �� SOIL TEST RATING INSTALLER 1 ` REMARKSjr �oil .�5 • •- • IZ: R�T_ APPROVED $ AGI RING ATE L SRO LE SIVER, ALASKA 'U37,r /z-ui-j IHev.3//u) ._..__.__..._ .-... i/ "- - ,111 1 Wig AR WELL DR I LLI NG LOG Drilling Co. -� r s -'`L��_._._.____._._.___._.__...__-_ Driller Well owner—' �'–�---- '` '` _ Use of well --- Location (address of, Township, Range, & section, if known, or distance from main road " T T,r, ov u u "/ 117-,,`' 6 , /r / Date completed ld­� Size of casing 41 Depth of hole '� �' feet. Cased to--, feet. Static rater level feet (above) (below) land surface. Ftnish of well ( check one) Open end ('1. Screen ( ) , Perforated ted ( ) . Describe screen or perforations Well pumping test at .gals. per () (minute) for hours . with. _ reet of drawdown from static level. ReMrks . fJu.v, �- V S, L 1 A, 1- Well Loa Depth in feet from Give details of formations penetrated, ground surface size of materiel, colorend hardenss. �t0 _Vry to G G to to U to . to . .. to to t o -- ---i-- to ---•�— to --to — trey N011D3102d.�••— '$ HiIV3H 30 ld�3 3 M ..: N I �C : I F'' 1=�I L. I T' V Q F= SII N IC: H 0I� t�I �C 1F DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 Nit -4--"—=; I TE: E EL4EFR -1?c L4E:LL. P FFZM I T PERMIT NO: 840.54 DATE ISSUED: 05/18/84 APPLICANT: MIKE UHEF: ADDRESS: P O BOX 770537 EAGLE RIVER., AK 9957 CONTACT PHONE: 654--3981 LEGAL DESCRIP SUBDIVISION: COTTONWOODS HEIGHTS LOT: 1 BLOCK: 1 SECTION: 29 TOWNSHIP: 15N RANGE: 1W LOT SIZE: 1. 02A t SQ. FT. OR ACRES) LOT LOCATION: VISION ST MAX BEDROOMS: LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOU IN DESIGNING YOUR SEPTIC SYSTEM. CHOOSE THE OPTION THAT BEST FITS YOUR SITE. ' I w_— 179 ti E= � [� 4� 1. 9_ DEPTH TO PIPE BOTTOM ( FT.) 6. 0 4.0 0 m GRAVEL DEPTH C FT.) 2. 0.5 1.5- ..5TOTAL TOTALDEPTH <FT.) B. 0 4.-5 4.5 GRAVEL WIDTH (FT.) .5 14. 0 5. GRAVEL LENGTH (FT.) .0 27.0 39.0 GRAVEL VOLUME ( CU. YDS.) 17. 14. 0 14. 4 TANK SIZE C GALS) 1 000.0 ** 1'000.0 SOIL RATING CSQ. FT. /BR) 150 125 125 DEPTH TO PIPE BOTTOM C 3.5 FT. REQUIRES INSULATION DEPTH TO PIPE BOTTOM ti 4.0 FT. MAY REQUIRE A LIFT STATION TANK MUST HAVE AT LEAST TWO COMPARTMENTS I CERTIFY THAT :1. I AM FAMILIAR WITH THE REQUIREMENTS FOR ON—SITE SEWERS AND WELLS AS SET FORTH BY THE MUNIiCIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASKA: 2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS, AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT I WILL ADHERE TO ALL MOA AND 'STATE OF ALASKA REQUIREMENTS FOR THE SET BACK DISTANCES FROM ANY EXISTING WELL, WASTEWATER DISPOSAL SYSTEM OR PUBLIC SEWERAGE SYSTEM ON THIS OR ANY.ADJACENT OR NEARBY LOT. 4. I UNDERSTAND THAT THIS PERMIT IS 'VALID FOR A MAXIMUM OF 2 BEDROOMS AND ANY ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT: IF . A LIFT STATION I S 'INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN . ELECTR I CAL PERMIT AND INSPECTION MUST BE , OBTAINED. ( 2) ASW -BU I L'T'S ,WILL NOT BE .APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND C3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED DATE: APPLICANT: MIKE UHER ISSUED BY DATE I'/—. SOILS LOG �" �� ck MUNICIPALITY OF ANCHORAGE U'T -/- DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 1:1 PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR:M lee uweli— DATE PERFORMED: 4�- LEGAL DESCRIPTION: L-07 ' !1O<', ( rF E ) DIZ� iiM`I l '(� SLOPE 1 2 3 4 5 6 7 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS 2- 5-4"L C L A\/ SKI S tF of 14� WAS GROUND WATERS ENCOUNTERED? _� L P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT I:�dlfJl=1~t#iNf �" v (/r��%�' l✓ DAT PERFORMED BY: SR 19BX CERTIFI BY '• "f ["La Kum ALASKA O Pit. 604 -?^7; 72-008 (6/79) • '� Municipality of Anchorage On -Site Water and Wastewater Program � (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcell.D. 051-431-27 1. GENERAL INFORMATION Expiration Date: Complete legal description COTTONWOOD HEIGHTS BLOCK 1, LOT 1 Location (site address) 16239 DIVISION STREET CHUG IAK, AK 99567 Current Property owner(s) CHERYL A. ELDRIDGE Day phone Mailing address Real Estate Agent 16239 DIVISION STREET, CHUGIAK AK 99567 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 2 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class _Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: - - .. ��!%1�/IOAF l �W1 F .. - COSA to be released to the engineer, unless other4ge r/juested by the engineer. COSA Fee $ 449o— Date 490—Date of Payment _a1d5113 CI + Receipt Number OP!! tip{ 1 COSA # 050131 CG 3 Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 2119113 Engineers 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. JW x 6. DSD SIGNATURE`y" System #1 Approved forabedrooms. System #2 Approved for. bedrooms._.mr� �rrz,tr,,*. Disapproved. Conditional approval for bedrooms, with the followirfg s�t+it6dd (n7j/j// By: Q� Original Certificate Date: I a �5 � Th icipalily of Anchorage Development Services Division (DSD) issues Certificates of, On-SRe Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory; -. Septic System Advisory Arsenic Advisoy Well Flow Advisory COSAbluesheei_10-10-12. o. Other If more than 1 septic system is on the lot: COSA Checklist # _of _ Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: COTTONWOOD HEIGHTS BLOCK 1, LOT 1 Parcel ID: 051.431.27 A. WELL DATA Well type PRVT If A, B. or C provide PWSID # _ Date completed 8/1511983 Sanitary seal (Y/N) Y Total depth 80 ft. Cased to 80 ft. FROM WELL LOG Date of test 8.15.1983 Static water level 71 ft. Well production 15 g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 2.42 mg/L Arsenic: ND ug/L Date of sample: 218113 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC 1 STEEL Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping 8117112 Pumper JRs C. ABSORPTION FIELD DATA Date installed 913012000 Soil rating (g.p.d./ft or fe/bdrm) 0.8 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 24+ in. AT INSPECTION 2.8.2013 ft. 6.6+ 9 - p.m - Collected by: ARCTERRA Date installed 613011984 Cleanouts(Y/N) High water alarm (YIN) N System type DEEP TRENCH Length 30 ft. Width 3.4 ft. Gravel below pipe 7 ft. Total depth 11_85 ft. (Measured 218/13) Eff. absorption area 420 fe Monitoring tube Y Depression over field N Date of adequacy test 21812013 Results (Pass/Fail) PASS For 2 bedrooms Fluid depth in absorption field before test 53.4 in. Elapsed Time: 35 min. Final fluid depth 54.6 in. Water added 430 gal. New depth 66.6 in. Absorption rate >= 300+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at _ in. Datum Size in gallons "Pump off' level at _ in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main 75'+ Sewer /septic service line 25'+ Animal containment areas 50'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout 100'+ Holding tank Manure/animal excrete storage areas 100'+ Absorption field 5'+ Water main 104 Water service line 101+ Surface water 1004 Wells on adjacent lots 1004 ABSORPTION FIELD ON LOT TO: Property line 104 Building foundation 104 Water main 104 Water Service line 104 Surface water. 1004 Driveway, parking/vehicle storage 10'+ Curtain drain 504(NONE KNOWN) Wells on adjacent lots 1004 F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of determined through field inspections and review of Municipal records that inspections and review of Municipal records that the above systems are in Municipal records that the above systems are in conformance with MOA above systems are in conformance with MOA COSA guidelines in effect on conformance with MOA COSA guidelines in effect on this date. COSA guidelines in effect on this date. on this date. Engineer's Printed Name KENNETH M. DUFFUS Date COSA brown sheet 10-10-12.doc in. 07/05/01 THU 10:11 FAX 8898499 v- 6�0.:i9:ae.4Al Sastilc mn'tpnea AK VISTA REAL ESTATE ER 1@002 :907 942 TT96 M 2/ 2 � II4•Y 11tl aIX. Y - q. mM blaai 1aa11 Aar6 01R . ii aLN tOQ RN Ysd�a{�maw �3, 589 r9'3B"E pa _297 O � I 6FRA6E 24: L7 I - 7. :. ..: .• 1P: 1,2 1 p `vVk �; 0 ti �. .... I WELL c.aa dd Q) I { n N 69 A LP7'3B" W X 97 00' 014FR No �fSNgTMIR7 sRaueo AN R°R ObISALf0710N OR P74 La a UMW S = W C W raR AIL 006T d 'n+L IIYtNCY. FM l TIS >n1R44YCR tA14! ! P7R AIC ILAAL AGR4AOp1 OIL.T''AW A7AORam � m am= MOW4 mm N=M VAY m WAX tm rlMct 1°fAY90N a@4= AWL SUWO% t AO. W a urma wAvx ••••"•" AIPPA'I KOI"... *am. UMRT... 1lOOMINY r O M IA7D � ALM�IM9oA5B at-rI-•Ir IIRAI. ROCt P r R 10 rmc11lAPONCIOyMp.R�YyOF AFR CII POW4 PRBC TO ONLY rAM � MW.6APOW gMo A" NIX" L a•- TO RM9/m To ML! p�paxaN�mn TO MIA" THE L1MiLT7CL CF CAOCYD77S OOY'SIAl1A iR 060" room -vmua wnm P.L mwm i ppmu � mvI r' A 0 O1116H11p1i PNO 00 A WeAlaswtv". OP- r TMC .iA SLIR46Y CLHIPIf7AilOM o� y Robert E. Johns, Jr. & Assoc,. MAN t w" a�.l'�I:a M �:.�I Pt Pratw3lanal Land Survayare Mw 1wY rr.a r.1 Ma1 MO L, tL AW MM=AIAM WN .+. fMll V. Raa. Plat N��, FOUNDA O feWON110i Af-/JL7 a - . ...� a 4r+..a►.r M OJI rww r . r `wa U 1 �ITMACRK AP"T 4121—S I � 6 .Mrr WT Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchcrage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FORA SINGLE FAMILY DWELLING:; Parcel I.D. OS 1- 'q3 I - 2' 1 HAA# 14P 010297 - Expiration Date: 9 - ;z O - 0 1 1. GENERAL INFORMATION „ Complete legal description l /1 Cr440h W 0cd u C41ts Lof 1, B) ocl< L ` Locatipnjsite'address or directions) --• - • " a3o- a�3a Current Property owners)- P (S<� t� Day phone P:15 - aCo73 D�� (�� Mailing address r �� -)Dx . n r r ii �Sa / L1V1Cll(�l_ _� ,(! . I gS'7f— ! � Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: 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. 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. 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 -badle Kiver hniLmeering Services Phone &W- S 195 Address P.O. Box 773294, Eagle River, AK 995773294 Engineer's Printed Name Lou rs A R,t -herek, s)(? Date_ 5. DSD SIGNATURE Louis A6utxra @a �,b CU73G _(C Approved for bedrooms. `o,T�.,, Disapproved. Conditional approval for bedrooms, with the following stipulations: \\��,,- ?,-•,....••-,.A I `J ON-SITE Additional Comments WASTEWATER n Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: / Gxl . /� a-�I Original Certificate Date:_ �o 02 [� - D f xRty. tato) Municipality of Anchorage • Development Services Department ° Building Safety Division , , • .. On-SRe Water & Wastewater Program 4700 South Bragaw St. P.O. Box 1!36650 Anchorage, AK 89519-6650 www.cl.anchorage.ek.us (907) 343-79W HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: P r to 1 U 36M 0-4�L 1, �1 Parcel ID: % A. WELL DATA Well type &Ukf v If A, B. or C provide PWSID # �G Date completed Q�P"f 10G Sanitary seat (YIN) Total depth f ft. Cased to FROM WELL LOG Date of test Static water level 71 ft. Well production g•p•m- WATER SAMPLE RESULTS: Coliform 4-9oloniesl100 ml. Date of sample: Wn -1e-21 Cdleaed by: C- R !a�S B. SEPTICIHOLDING TANK DATA Nitrate Q5— mgA- Tank Type/Material DCIS-( c 1 Well Log (Y/N) ---Y - Wires property protected (YM) r Casing height (above ground) 247A AT INSPECTION 7 D ft. g.p.m. Other bacteria —0— colonies/100 ml. Date Installed 1'?" Tank size bo o gat. Number of Compartments -,2 - Cleanouts (YIN) V Foundation cleanout (YM) Y Depression over tank (YM) /� High water alarm (Y/N) NY4 Date of pumping _& Lb t Pumper T AS C. ABSORPTION FIELD DATA dlo�P r1� Date installed q -� Sollrating (g.p.d./f? or ftzlbdrm) . $ System type �YLIlC� Length '3 o ft. Width 3- y ft. Gravel below pipe -7_ ft. c Total depth ft. Eff. absorption area a0 fir Monitoring tube Depression over field Date of adequacy test ocl Results (Pass/Fail) AA5-r For _c2_ bedrooms Fluid depth in absorption field before testA* in. Water added �/4 gal. New depth '��d in. Elapsed Time: 111s min. Final fluid depth NyJ in. Absorption rate >= '4P 3 uo g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) If yes, give date D. LIFT STATION Date installed _NR "Pump on" level at _ in. Datum E. SEPARATION DISTANCES Size gallons 'Pump o level at _ in. Cycles tes SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAlft station on lot IDS r Absorption field on lot 103, Public sewer main )VA Manhole/Access (Y/N) High water alarm level at in. Meets alarm b dncuit requirements? On adjacent lots_t io e' On adjacent lots _y icw ,' Public sewer manhole/deanout Sewer /septic service line -)k /0.) Holding tank ^1A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Jc- I Property line 5_10 Absorption field 5"r Water main Water service line It/,01 Surface water 4 It70 i Wells on adjacent lots. rf taJ ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line la I Building foundation Iq1_ Water main t iu r Water Service line 4 /40 Surface water -} l00 Driveway, parkinghrehide storage /40' Curtain drain At /A Wells on adjacent lots trd0 F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field Inspections and 4•-49� review of Municipal records that the above systems are in • •• •••• •• ••••••• •• conformance with MOA HAA guidelines in effect on this date.. Engineer's Printed Name t bGt.iSA • I� cze ta�v.(r2 A t Date 112-t5-01 HAA Fee $ Im. 00 Date of Payment /.(b of 0 Receipt Number. 00(1jp/ (Rev. 12/00) Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 051-431-27 HAA # k i 111oA Y'1S 1. GENERAL INFORMATION Complete legal description Cottonwood heights Lot 1, Block 1 Location (site address or directions) 16239 Division Street Property owner John P• Hester Day phone Mailing address 16239 Division Street, C11ugiak, AK 99567 Lending agency City Mortgage Day phone 263-0700 Mailing address P-0- Box 92810, Anchorage, AK 99509 Agent. RP /May of Rag1P River/v- Ko lfield Day phone 694-4200 Address , �tinrLE a ie=d L1 i=le,- n, � -.s ; - K as:7_ Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 2 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site 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 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify 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 Eagle River Engineering Services Phone 694-5195 Address P.O. Box 773294 Eagle River AK 99577 Engineer's signature ��. �� —�y —� Date 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments Cry` •' ���+,�r� a e Yr ►'�iy, • .4� � S S ! Vl v i ,y.. �rsA••ca •. ��.y n•��.. �+ Lovis A. ?,.-,era f,; bedrooms, with the following stipulations: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 D. LIFT STATION HIA Date installed Manhole/Access (Y/N) "Pump on" High water alarm level at* E. SEPARATION DISTANCES Size in gallons *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: "Pump off' level at* Septic/heldimg tank on lot 105 " ; On adjacent lots -/- /Ud Absorption field on lot /00, ; On adjacent lots f /00 / Public sewer main IVIA Public sewer manhole/cleanout AlJ A Sewer /septic service line f i Z s Lift station NSA SEPARATION DISTANCES FROM SEPTIC/HOEBtM TANK ON LOT TO: Building foundation S Property line f- /D " Absorption field S Water service line 74-/0 Surface water/drainage f" /DD Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation �;" / D , Water service line Surface water 71-/00 / Driveway, parking/vehicle storage area S /ONE Curtain drain AA0A/ZCN7 Wells on adjacent lots t / ey Property line /p F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal;reco �t @Fa Y toms are in conformance with A10�1 HAA guidelines in effect on this date. rf®�•�.°°' ° ooh° ��C1i i /�� /jrrnt rx4 Signature ? •'9TH ilk —� •ai° r Engineer's Name Louis A. Butera yJ Date /��7�?i�9' itN,,•.° CE -6736 tt'�D,'• *r` ------------------ — - — -- — -- — --------------------------------- — — ------ — — ----------- -----$ .P ..... [t--------- HAA Fee $ 'Zcup, pU Waiver Fee $ Date of Payment C)CIt) 29. Date of Payment Receipt Number O k S bq' 44 7—// Receipt Number Rev. 8/95 OSS: haa.wk.doc 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 Time 19, 1986 ...... 1. 9� 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) T nt 1 Blnnk 1 Cnttnnwood Heights T15N R1W SPS 29 Location (address or directions) (b) Applicant Name John Hester Telephone: Home 688-9846 Business 276-5055 Applicant Address S R 1 Box 10-19 AA Division Chugiak, Alaska (c) Applicant is (check one): Lending Institution ® ; Owner/builder ❑ ; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Alaska Pacific Mortgage Telephone 563-2100 Address 880 N St., Suite 111 Anchorage, Alaska 99501 (e) Real Estate Company and Agent N/A Address Telephone (f) Mail the HAA to the following address: Pi cku}) hy engineer 2. TYPE OF RESIDENCE Single -Family$] Multi -Family ❑ Other Number of Bedrooms 2 3. WATER SUPPLY Individual Well ® Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ® Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDINu INSPECTIONS, TESTS, FILE S.:ARCH, DA,A AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ES Telephone Address FAGLERW_ER, AKg-9-5-77 Date 7194 P. 0. BOX 773294 694-5195 J I �•F Lzub A. Lufi 9 CE -6736 � �� ..✓ gfdeer's Seal 6. DHEP APPROVAL Approved for no -W- bedrooms by Date Approved Disapproved Conditio 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 (11/84) MUNICIPALITYOF ANCHORAGE ` MUNICIPALITY OF ANCHORAGE (MON, DEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION: CHECKLIST FEBRUARY 1984 J iU N 30 19W 264-4720 Legal Description: /6/0,i A t r T' / S trJ < w .e c 2 y A. WELL DATA Well Classification 7,_�E If A, B. C, D.E.C.Approved (Y/N) 16 Well Log Present (Y/N) Date Completed -/5 -3 Yield Total Depth S4) " Cased to sF"U r Depth of Grouting 111.4 Static Water Level ?o ✓�rw �ao EG r��s Pump Set At Casing Height Above Ground 3 Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot 11, On ; On Adjoining Lots1av To Nearest Edge of Absorption Field on Lot Zoo ;, On Adjoining Lots To Nearest Public Sewer Line /y� To Nearest Public Sewer Cleanout/Manhole ��/f To Nearest Sewer Service Line on Lot Water Sample Collected by���i""� �^'f"'� 7 Date Water Sample Test Results S•�s�'`;j "' Comments B. SEPTIC/HOLDING TANK DATA y v Date Installed .Size. ,fGoo �i4 � No. of Compartments: -Z Standpipes (Y/N) i Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) Depression over Tank (Y/N) >'� Date Last Pumped .0 Pumping/Maintenance Contract on File (Y/N) s!/1� ; for Holding Tank High -Water Alarm (Y/N) `ovlam Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well ti. To Building Foundation To Property Line s To Disposal Field _5 To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA ,r tlir Soils Rating in Absorption Strata �� r �� Type of System Design Ere 4 Date InstalledLength of Field yD v Width of Field �� Depth of Field Gravel Bed Thickness Square Feet of Absorption Area X5'6 Standpipes Present (Y/N) „ Depression over Field (Y/N) Date of Last Adequacy Test 45�42 S � e Results of Last Adequacy Test f'is�fiY y ��s�T6t��, OE'�4e Separation Distance from Absorption Field: i To Water -Supply Well 11:5v-) To Property Line i -le, I To Building Foundation To Existing or Abandoned System on Lot On Adjoining Lots °'-_?c) " To Water Main/Service Line �� To Cutbank (if present) A1' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION k114 Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) _ Comments "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have chec ed, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed � � Date KZa 7/Sr'd CompanyMOA No. Receipt No. _390-789 Date of. Payment "-% Amount: $ I- !; 41� Page 2 of 2 72-026 (11/84) �^1 I t goe0 Engineer's Seal rp c �y omaoe e s e. e•eaeaoem�m;� •a tt�` Louis A. Butera ��J� d'> °•e CE -6736 T4 pROFESSO MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMEN`I OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date 3/Lgi (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) 1VI"t � ►`� moi/ (b) Applicants Name Telephone L,/ Telephone - Home Business Applicants Address (c) Applicant is (check one) Lending Institution ; Owner/builder Buyer E:1 ; Other [� (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent( _/y)/SL✓Ea 7 •— Address P o .77762-4Lel, i x Telephone 4' Y - CJ 4 (f) Mail the HAA to the following address: ya_�O 1 2. Type of Residence Single -Family Multi -Family F -::j Other (describe) Number of Bedrooms - 3. Water Supply Individual Well �z Community = Public = Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite Public Community E::1 Holding Tank El Note: If community well system, must have written confirmation from the State Department of Environmental Conservation -attesting to the legality and status. [Page 1 of 2] 5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm Telephone Address �~ u RIVER, !ALASK,A .£»577 Date U 8 or C:) 6. DHEP Approval $� J (ENGINEER S Robert A. Shoior `n•��e�� No. 1437-E j *00 Approved for bedrooms By Approved �, Disapproved Terms of Conditional Approval CAUTION Conditional t e THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE- 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 THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) a3 �13�3� HEALTH AUTHORITY APPROVAL (HAA) j786G Q(l� CHECKLIST FEBRUARY 1984 1q0i.o3lMd 1vJN3WN0S1AN3 ("y3H40 U3 da A. WELL DATA C> Well ClassificationF If A, B, cr C. D.E.C. Approved(Y/N) Well Log Present �Y N) Date Cc, npleted I4 �,3 Yield &ECZ#PM Total Depth 180 Cased to r Depth of Grouting Static Water Level TZ/'Je (c2 )11 Pump Set At Casing Height Above Ground .5~b Sanitary Seal on Casing�/N) r Electrical Wiring in Conduit 4T) Depression Around Wellhead (YAM Separation Distances from Wells To Septic/96M+M `Tank on Lot f DS� On Adjoining Lots -zoo f To Nearest :Edge of Absorption Field on/Lot /170 r On Adjoining Lots loo j To Nearest Public Sewer'Line- �/ To Nearest Public Sewer Cleanout/Manhols'f/ To Nearest Sewer Serv' ce ine on Lot D Water Sample Collected' By t S E�F4 ; Date 3 8 Water Sample Test Results Ccmmnts /4 LJ61-4- 51-1154.13( 5w P&1 / AJ cue cis er G. i B. SEPTIgAR H ; TANK DATA Date installed flZ8J Size 20,90 No. of ' Ccnpartments Standpipes 6?N) Air -tight Caps ) Foundation Cleanout( M) Depression over Tank (Y4D Date Last P ed Pumping/Maintenance Contract on File (Y/V) /1-; for Holding Tank -High -Water Alarm (Y,/N) Temporary Holding Tank Permit (Y,/N) Separation Distances from SepticjftTl%mg Tank: To Water -Supply Mll To BuildingFoundation To Property Line —T— To Disposal Field To Water Main/Sery ca Line To Stream, Pond, Lake, cr Major Drainage Course Comments &2 [Page 1 of 21 2-15-84 C. -ABSORPTION FIELD DATA Soils Rating in Absorptign S ata Type of System Design�iN/ Date Installed 3D Length of Field Width of Field (gyp y Depth of Field Z ' Gravel Bed Thickness 4 Square Feet of Absorption Area 2-5�` ' Standpipes PresenteoN) Depression over Field (YM)-) Date of Last Adequacy Test IVO L % Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well / aD To Property Line /0 � To Building Foto dation �� To Existing of Abandoned System m Lot N On Ad' * ning Lots To Water Main/Service Line ''v To Cutbarr ifesent) To Stream/Pond/Lake/cr Major Drainage Course ,4 To Driveway, Parking Area, or Vehicle Storage Areab Comments' D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (YM) "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(YM) Comments ff" Level at Vent (YY -N) during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA on the date of this insppeection.: $40 NGRS XERING Signed r Date 0`` 9 `/ .Company MOA . KBl /d5/s (Page 2 of 21 in effect 2-15-84