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HomeMy WebLinkAboutFORELAND VIEW BLK 3 LT 1Foreland View Block 3 Lot 1 #017-401-49 Municipality of Anchorage Page / 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 9/ 03/f PID Number: D/%—#O/ �Af Name: L Wastewater System: XNew ❑ Upgrade Address: ;ZO4 016kZZ.41V,0 A - O/ 41V(_# ABSORPTION FIELD Phone: ,L /- 11 No. of Bedrooms: ❑ Deep Trench XShallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: D. Total Depth from original grade: G GPD/S . Ft. L� U Lot: Block: Subdivision: 0A1'E1_4AIP Depth to pipe bottom from original grade: Gravel depth beneath pipe W /'0 Ft. 3 d Ft, Township: Range: Section: FIII added above original grade: Gravel length: , c2•5 -Ft. 7r "A Ft. WELL: XNew ❑ Upgrade Gravel dept},' W,, Number of lines: Dis encs between lines: Classification (Private,A,B,C): Total Depth: Cased To: 7107 Ft 140 FL Total absorption area: I O Ft. Pipe material: Ft. %fid SG. Ft. 317.314 /16 7M Driller: Date rilled: Static Water Level: 41 P//k/6 Law(o 9 14 5 Ft. Install r:/ M� Ja Date installs : / Yield:0ev Pump Set at: Casing Height Above Ground: GPMOAlkhOW Ft. Z Ft. TANK SEPARATION DISTANCES Xseptic ❑Holding ❑S.T.E.P. To Septic Absorption Lift Holding cul WPrivate Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines L,vc�.-= T -Nr fDOO Well /D6 13v a///] �S Material: S+e Number of Co partments: Surface Water N/� JU A NIA q J1J%A LIFT STATION Lot Line 6a2 ' /0 14 I ,{ / ,4 /'� j'/0 / Size In gallons: Manufacturer: Foundation IN14 /t7 ,r /�{^'/A/APumpae f� "Pump on" level at: m evel at: High water alarm at: Curtain Drain 11An' /7 /`r A A & Electrical Inspections performed by: Remarks: BENCH MARK rZ r MOU110ED L! D Location antl Description: -Z 35 P51 ORIAL FOs3 Nt 01/6,e_ rr Assumed Elevation: A510149 ENGINEER'S SEAL r V. n Inspections performed b : Dates: lst//A /9/ feeee.ao 2nd Z/ZQ0/ aacn Department of HealM and Human Services approval Tg selams .4. Rut®ra t.%' 1 CE -673a �f® Reviewed and approved by: Date: Permit No. SW 910347 94.4' Page Z 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 Inspection Report uescription: rucciana view. Lot L. block PID No.At7_401_49 S 0°03'58" E 100.00 (NOT TO TANK 12-013 A(2/91)MOA 25 FIELD SCALE 1' = 60' UI U ASSUMED ELEV - 100.00' FILL y 91 q2 8].67.6i1"f LEACHFIELD ENGINEER'S SEAL-.. i, WATER SOL aSfZ (TH p2) ( ba x0 x SWING TIES A -C 27' B -C 14' A -D 60' B -D 18' A-E 59' B-E "G'4'— 21 - TEST HOL •- - MONITOR o - SEWER C 4 - WELL ,TT.i,T.Tr. - PROPOSE = 180.00' - - - - EASEMENT. = 34.33' ASSUMED ELEV - 100.00' FILL y 91 q2 8].67.6i1"f LEACHFIELD ENGINEER'S SEAL-.. i, WATER SOL aSfZ (TH p2) ( ba x0 x JUN -17-1.31.2 WED S : 09 A - P . 04 . -. STATE OF ALASKA STATIC WATER LSVOL: 41S ft. Date material type ana Color DZPA.RTMENT OF NATURAL. RESOURCES .. METHOD OF DRILLING: fesair rotary ©cable tool other: ._.._.__ DIVISION OS GEOLOGICAL AND GEOPHYSICAL SURVEYS ` WATER WELL RECORD LOCATION OF WELL USE OF WELL:j3domestio Dirrigatioll []monitor ❑ public supply []other: BOROUGH iUUDIVISION LOT BLOCK SECTION QTRS TOWNSHIP RANGEAN MERIDI �0 `g I-1 �y.,-y�- ��•.r4d2xD._,�"• /"" IS �L� .P I WELL OWNER:..T._ MEASURING POINT: /atop of caning © graumt surface other. BOREHOLE DATA: Depth WELL DEPTH:ft Depth of hole: Depth of Caging:'11ft DATE OF COMPLETION / STATIC WATER LSVOL: 41S ft. Date material type ana Color From I To .. METHOD OF DRILLING: fesair rotary ©cable tool other: ._.._.__ .,..14 USE OF WELL:j3domestio Dirrigatioll []monitor ❑ public supply []other: CASING: Stiok-up ==.-w t: DSam: in WELL INTAKE: Aa open end Q :screened El perforated amen hole Depths of openings: to ft �0 `g �y.,-y�- ��•.r4d2xD._,�"• /"" !SO SCREEN`,YPE; Diem: in Slat/Me ahllzes,.r�Length _eft Set Between and `'ft- r GRAVEL PA PE: _ Volume used: Depth t0 .top:--.r.�..,. .. GROUT TYEVolume:._....... Depth: fxom t,toft DEVELOPMENT METPIOD:�� �- Duration R E C E 1 E REMARKS. JUL 91992 Munlcipallty of Anchorage Dept Health & Human Services CONTRACTOR INFO t TIONf — _ w j �� i A A I — PUMPING LEVEL ANA IELD: -� �--ft after hra pumping-Ypm PUMP INTAKE DEPTH .-£t HOxgepower:`� Date Pump Installed �- WATER CHEMISTRY SAMPLE TAKEN? Q yds an .. .. . , . . . . .. 0 Date PLEASE MARL WHITE COPY OF 1,06 WITHIN .45 DAYS TO: DGGS PO BOX'77-2116 EAGLE RI'V'ER, AX. 99577 PERMIT NUMBER:SW910347 DATE ISSUED:10/28/91 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES EXPIRATION DATE:10/28/92 OWNER NAME:SINES MARK OWNER ADDRESS:P.O.BOX 112876 ANCHORAGE, AK 99511 PARCEL ID:01740149 LEGAL DESCRIPTION: FORELAND VIEW BLK 3 LT 1 LOT SIZE: 76063 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY ISSUED BY: DATE: zezo I/ 9/ DATE: PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE s� i usp� roc DEPARTMENT OF HEALTH AND P.O. BOX 196650, 825 "L" HUMAN SERVICES STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW910347 DATE ISSUED:10/28/91 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES EXPIRATION DATE:10/28/92 OWNER NAME:SINES MARK OWNER ADDRESS:P.O.BOX 112876 ANCHORAGE, AK 99511 PARCEL ID:01740149 LEGAL DESCRIPTION: FORELAND VIEW BLK 3 LT 1 LOT SIZE: 76063 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY ISSUED BY: DATE: zezo I/ 9/ DATE: Male RAT(ti' ��1�Il�QQpIl�1� 3QpA710M Louis Butera, P.E. Registered Civil Engineer R E C E I V E October 23, 1991 John Smith, P.E. Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Foreland View, Lot 1, Block 3 Narrative Dear Mr. Smith, OGT 2 3 1991 PPiunicipallty of Anchorage Depi. Health & Hurnan Services The proposed septic upgrade will have very limited impact on adjacent properties for the following reasons: 1. The area has large lots allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance if installed. 3. Reserve space is adequate. Well is sited appropriately. 4. Drainage will not be effected and is not a major consideration in our design. 5. The installation of the leachfield will require the leachfield be installed on a 33 % slope. This will require a variance from the MOA 25 %- limit. The soil has an adequate percolation rate to prevent effluent seepage from the hillside and there is sufficient separation to the road grade break. Neighboring septic leachfields are installed on this slope, and there are no alternatives for this lot. The system is designed 7' off suspected bedrock layer. Bedrock depth is conservative at 12'; we have a test hole at 30' distance showing bedrock at 14' depth. System is also conservatively designed at 0.6 GPD/ft2 based on worst of three test holes. This will allow greater effluent dispersal. Over 85.5' of trench or a maximum of 5.3 gallons per foot per day. A distribution box will be utilized to maintain equal distribution, an effluent pumping system would be prohibitively expensive. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. P.O. Box 773294 • Eagle River, Alaska 99577 • Telephone (907) 694-5195 • Fax (907) 694-3297 SPECIFICATIONS FOR ON-STTE SEPTIC SYSTEM Revised 10/23/91 LEGAL: LOT 1, BLOCK 3, FORELAND VIEW A. GENERAL 1. 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 or modified 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. 8. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. B. DRAINFIELD 1. The drainfield is to follow the natural land contour to maintain uniform total depth of the drainfield bottom. 2. The bottom of the drainfield shall be level, plus or minus 1.5". 3. The total depth of the drainfield excavation is not to exceed 4' at any point. 4. The drainfield gravel is to be covered with typar fabric material. 5. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. 6. The area over the drainfield is to be finish graded to prevent ponding of surface water runoff. 7. 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 = 4' GRAVEL DEPTH = 3.0' DRAINFIELD LENGTH = 85.5' DRAINFIELD WIDTH = 5' SOIL RATING = 0.6 GPD/ftz BEDROOM CAPACITY = 3 SEPTIC TANK SIZE = 1,000 gallons (minimum) NOTE: 2' mounded soil cover 2" 35 PSI burial foam over trench, tank and all flow lines Install level tee fitting to distribute effluent evenly to each trench. Twenty-four (24) hours notice required for all inspections. EAGLE RIVER ENGINEERING SERVICES P. 0. Box 773294 EAGLE RIVER, ALASKA 99577 Phone 694.5195 3 JOB L-O'r/ dl"Il 3 �o"�.7mro� (//B�✓ SHEET OF CALCULATED BY L '-ff DATE /"/1 3/11 CHECKED PRIVATE WELL AND SEPTIC + 100' NO COMMUNITY WELL _ F--10' I _ _ _ — 10' TELE. ESMT. — — — — — — — — — — — — — — — I I q I� I w JG NI w I w u NO DEVELOPMENT �- �t y W VELL\SEPTIC I o W I = /- I VEPJ a( z ! w o. LOT 1 I I BLOCK 3 PWEOSLO 3 OMN00 I I ' 0�1 I !` M v 100' R 2 j ! 160 .X, TANK 0* REPL. 0 4 a ! AREA 2 j �/ �33 y /! Dor t. ti O DEVELOPMENT 'li3Y, W / h R = 30' AV L = 34.33' 34. I ® — TEST HOLE • — MONITOR TUBE SCALE 1' = 60' 0 — SEWER CLEANOUT + — WELL — PROPOSED LEACHFIELD NO KNOWN CURTAIN DRAINS - — - - EASEMENT WELL AND LEGAL: FORELAND VIEW OWNER: MARK SINES CONTRACTOR: HAGMEIER JOB # 91 -1421 DATE: SEPTIC PLAN LOT 1, BLOCK 3 10/22/91 SCALE 1" = 60' EAGLE RIVER ENGINEERING P.O. Box 773294 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) SER VICES 694-3297 4%1- OF A4s10 * :49TH* I c LOUIS A. BUTERA CE -6736 OCT -11-91 F= P- 1 1 2: 32 A �, "•�' �� j 'Munlcipbllly'at,AAehor�ge , ' DEPARTMENT OF HEALTH A HUMAN `68RVIC&S'' , A25:"L" Street, ApchoragevAlaska 99502-oeSo =0 LOG ,,: P'EpOOLATION TEST ' _ P _ 0 1. y�.,(�IvQiweEq•59 •}�• . e; r ^�.,� 04 PERFORMED DATE PERFORMED I 'J "'•V . LEGAL OF.$CAIPTION• L-,1 $ Townshlp, gange, 5oction: ocPTii AjRI LAua5 V I6KJ sLOPs SITE PLAN _..._ IFEtrI 3 p a elZl.y Cwt fte:D 3N4 6 , OOMMENIS WAE6F OVNQ WATa . y Ft 'IFY98. AT WHAT NTH? PBACOLIjT10N RAT! ' B • 8 VENOM=' to 11 �.rO _ 12 13 14 is ,18 " q t8 19 Zd OOMMENIS WAE6F OVNQ WATa . y Ft 'IFY98. AT WHAT NTH? PBACOLIjT10N RAT! ' VENOM=' �.rO no A0 HQLZ DIA6)1ITER TEST ALIN BETWEEN ... PT AND FT k. Q Arm.-. Ate" I eA 4" ✓ 9P 1% D AAAA PERFORMED BY; K U: 'Kat3r:= r=M 1 0-1-016 TH, AT 1'HISMST .WhAI PERFORMED IN J OCORDANCE WITH ALL STATE AND MUNICIPAL OUIDECINES IN EFFEOT ON THI$ OATS, DATE; -- ,12•004 IR4v.4"951 G a: 4o �03 0t4g-- kat a oo �• ^ '• ranrt faX transmittal memo 7871 P E � ,. JOB Lo t / /f/tf 3 /—ore 1A . of EAGLE RIVER SHEET NO. / OF ENGINEERING SERVICES P.O. Box 773294 CALCULATED BY L'� DATE EAGLE RIVER, AK 99577 694.5195 CHECKED BY DATE Kai BH Ism a.ml msi lrnew� ®. n�: sam w.. m n i. to s�a� BWM rou rsB immmm 1 L SOILS LOG MUNICIPALITY OF ANCHORAGE Jk rI/rlo +.r DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: ���-+� 49 �'+-�e/ B DATE PERFORMED:w/�/`J/ LEGAL DESCRIPTION: �i'� / /-'thy-7 fie. /4.. a( (/ieN Tf/ -I- -r/4 Od I-T«Oa SPT SLOPE SITE PLAN E /v/n ta/ L+lye s- 1 2- 3- 4- 5d3 45 t O 12 13 66 m) c,.�t Ro�ir /,�rev✓r✓ o ry 14 Date Gross Time Net Time 15 Net Drop 16 3'-� his` 1 i6 17 18 PnCFF= 19- TS3\ 20 COMMENTS rH WAS GROUND WATER S ENCOUNTERED? tiV LO 3a P IF YES, AT WHAT E DEPTH? 7 c(. yr Reading Date Gross Time Net Time Depth to Water Net Drop 3'-� his` 1 i6 PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN 3 FT AND ' FT Eagle River Engineering Services PERFORMED BY: P. n. Rnr 773P94 CERTIFIED BY: �DATE: Eagle River, AK 99577 6945195 72-008 (6/79) 1 SOILS LOG 'r MUNICIPALITY OF ANCHORAGE g PERCOLATION 1 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION resr 925 L. Street, Anchorage, Alaska 99501 284-0720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: -TVA /74 P',,'e"C— DATE PERFORMED: LEGAL DESCRIPTION: ��'� / /�/L!3 f e/ vi//e`- Ty #/ SLOPE SITE PLAN EPT 1 Toru/ / L +•ye i 2 G ' 3- 4 6 5 U 6- CG m) ,S/%f4) 6+�r�� Gra•+-f. 9 /3ru.✓../ O+J A, fir. r WAS 13- Date Gross Time Net Time Depth to Water Net Drop 4- /•/is-�5I t "r" a.13 ti 15 T Via^ 3r'i'iE:F ,A 16 '�' 3 8 VDy9v¢am'gonv 17 �V � q. Louis .n. Fulcra 8 T CE -6736 so De• 0 8 18- 2: 3q 3, g FI/6 3 �6 19- 19 20 WAS GROUND WATER ENCOUNTERED? No zil■ IF YES, AT WHAT DEPTH? Tor ;N rAP n Reading Date Gross Time Net Time Depth to Water Net Drop SOq /•/is-�5I /It3��try6w T 3 /. �; • Y 3 8 3 7%c 3 2: 3q 3, g FI/6 3 �6 3 . F./6 PERCOLATION RATE E-' 3 (minutes/inch) TEST RUN BETWEEN 3 FT AND y FT PERFORMED 8V: Eagle River Engineering Services CERTIFIED BY: DATE: /o d "t5 Eagle River, AK 99577 6945195 72009 (6/79) MUNICIPALITY OF ANCHORAGE Development Services Department �`= Phone: 907-343-7904 On -Site Water & Wastewater Section `'- Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 017-401-49 1. GENERAL INFORMATION Expiration Date: 2- - Z 02 Q Complete legal description Foreland View, Block 3, Lot 1 Location (site address) 8521 Spendlove Drive Anchorage, AK Current property owner(s) Mailing address Real estate agent Raymond Kaufman Day phone 907-349-3821 8521 Spendlove Drive, Anchorage; AK 99516 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: _ Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Q Private Septic` Water Storage ❑ Holding Tank I ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer i ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: I' COSA Fee $ 556- Waiver Fee $ Date of Payment 3"1 Q -&I amts Date of Payment Receipt Number Receipt Number COSA # USC 0-6 D Waiver # COVID-19 257o DISCOUNT APPLIED 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone 907-522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage AK 99503 Engineer's Printed Name Michael E. Anderson, P.E. Date 5/24/2020 6. DSD SIGNATURE �/ /` System #1 Approved for 3_ bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: '-11J/[I)))dol. By.,_� Original Certificate; Date: �-0--20Zb The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. i` 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Adviso Well Flow Advisory Other0WV'ke COSA Checklist blue sheet Legal Description: Foreland View, Block 3, Lot 1 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA OR Well log is filed with Onsite (or attached) Date drilled 1/6/92 Total depth 208 ft Cased to 10 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) '18 in. Date of flow test for COSA 5/15/19 Static water level at beginning of test 130 ft. Comments B. TANK DATA Age of tank(s) 28 years Tank type/material Septic/Steel Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping 5/16/20 - A Plus Home Services D. ABSORPTION FIELD DATA 5' Wide Shallow Trench Which system tested (date installed) 11/7/91 ❑ ALL standpipes present per record drawing Total measured depth from grade 5.8 ft (max) Measured depth to pipe invert from grade 2.8 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced NA gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 017-401-49 Structure served by this system Well production at time of test 4.4 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ❑ Nc ❑ Coliform bacteria is Negative Nitrate 1.53 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Forge Engineering Date of Sample 5/7/20-,-- C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: N/A Adequacy test date 5/15/19 Results ❑✓ Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 801 gal New depth 0 in Elapsed time 0 min Final fluid depth 0 in Absorption rate '600 gpd Any rejuvenation treatment (past 12 months) NA If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' P/ Yes Community Sewer Manhole/Cleanout > 100' ❑✓ Yes if No ft [ Yes if No ft Neighboring Tank > 100' E✓ Yes if No ft Private Sewer/Septic Line > 25' 7 Yes if No ft Absorption Field on Lot > 100' ❑v Yes if No ft Holding Tank > 100' Q✓ Yes if No ft Neighboring Absorption Fields > 100' Yes if No ft Water Main > 10' Animal Containment > 50' Yes if No ft 0✓ Yes if No ft F✓ Yes if No ft Water Service Line > 10' ❑✓ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' Yes if No ft M Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' P/ Yes if No ft Surface Water > 100' Q✓ Yes if No ft Property Line > 5' 0✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ED Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' ✓Q Yes if No ft Community Wells > 200' F✓ Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 21 Yes if No ft If absorption field is under driveway comment below Property Line > 10' F71 Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓® Yes if No ft Private Wells > 100' ®✓ Yes if No ft Water Service Line > 10' Fv Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100'✓� Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet 5/26/20 'ORO F F1,1; P® �� { Z > �b e � / O• / � BSl I ^p C Ln m wo _I n ! _m 4 -i O o a. A ' u n o w I ! �,�, � I ! I 6p• r / m om \ z a= I r p f r N \ m \C; r �. m .�: smova 1%0310)3d 001 I ( ro � N O 00 N C Z / m ----------- --- ---------- ,ZL•t'6Z 3„89,£0.00 S I— — — — — — — — — — I I i PLOT PLAN _ AS BUILT X_ SCALE GRID —SK2841 Project No. 20-1411R7_ 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates inc. (907) 522-6476 Phone ooppp O (907) 522-4625 Fox o� Q Professional Land Surveyors kenolongsurvey.com o Y F.............!' jonalhanOlongsurvey.com S�QO 1 hereby certify that I have surveyed the following described property: Q LOT 1, BLOCK 3, FORELAND VIEW SUBDIVISION (PLAT No. 83-203) Q �:` 49?H GV •"�.,�� Anchorage Recording District, Alaska, and that the Improvements situated thereon are ........ within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed : KENN ti• •. •�•m-� remises and that there are no roadwa s, transmission lines or other visible00"o _ easements on sold properly except as indicated hereon. do �} '. (IQ�go' .. 5-520. •' ��Q Dated this the i�� Day of _ hlb_F --_,�° at Anchorage, Alaska Q4f n �'••• 2 goo ' �QRO�SStON%y �o It Is the responsibility of the owner to determine the existence of any easements, �04ppoQa covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 Septic 'Tank Advisory Certificate of On -Site Systems Approval #OSC201210 Subdivision: Foreland View Block 3 lot 1 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 28 years old. Typical replacement costs range from $8,000 to $11,000. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. Mailing Address P O Box 196650 * Ancliorage,jAlas�Ca 99519 6650 *www MuhEiorg Municipality of Anchorage ° Development Services Department Building Safety Division Onsite 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 n Parcel I.D. 017-401-49 HAA# 14 A o fy// D 1. GENERAL INFORMATION Expiration Date: tri —Z 9-O f Complete legal description FORELAND VIEW SUBDIVISION; LOT 1, BLOCK 3 Location (site address or directions) 8521 SPENDLOVE DRIVE * ANCHORAGE AK 99516 Current Property owner(s) MARK SINES Day phone 345-1931 ® Individual On-site Mailing address 8521 SPENDLOVE DRIVE * ANCHORAGE, AK 99516 Lending agency Mailing address Real Estate Agent Mailing address Day phone BONNIE MEHNER w/ JACK WHITE Day phone 563-5500 3201 "C° STREET SUITE 200 * ANCHORAGE AK 99503 Unless otherwise requested, HAA will be hold 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 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 $9,000.00 at 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 AuthorityApproval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system islare) safe, functional and adequate for the number of bedrooms and We of structure indicated herein. I further verify that based on the information obtained from the Municipalily of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system !slate) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone Address 6901 DEBARR ROAD, SUITE 26 * 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 theyguarantse 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 w111 it confer any legal right whatsoever. 5. DSD SIGNATURE ✓ Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the filowing Attachments: HAA Checklist r/ Septic System Advisory Well Flow Advisory Date 337-6179 v 01 Manitenance Agreements Supplemental Engineer's Reort Other a "uAll e � ON-SITE WATER AND WASTEWATER PROGRAM e A By:— i �, D�_ Original Certificate Date: (Rev. 11100) Municipality of Anchorage R, Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: FORELAND VIEW S/D LOT 1 BLOCK 3 Parcel ID: 017-401-49 A. WELL DATA *PER 1991 INSPECTION REPORT Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed *1/06/92 Sanitary seal (YIN) YES Total depth *208 ft. Cased to *16 ft. FROM WELL LOG Date of test *1/6/92 Static water level * 145 ft. Well production *115 g.p.m. WATER SAMPLE RESULTS Coliform 0 colonies/100 ml. Nitrate 0.6 mg./L. Date of sample: 3/9/01 Collected by: B. SEPTIC/HOLDING TANK DATA Well Log (Y/N) sp i6S Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 3/9/01 154 ft. 5.0+ — 9 -p.m -Other bacteria 0 colonies/100 ml. AWWC. INC. Tank Type/Material STEEL Date installed 11/07/91 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 4/28/2001 Pumper C. ABSORPTION FIELD DATA "BELOW FINAL GRADE " CALCULATED Date installed 11/08/91 Soil rating 6p.d./ orft2/bdrm) 0_6 HOME SERVICES MT1/MT2 System type TRENCH Length 85.5 ft. Width 5 ft. Gravel below pipe 3 ft. Total depth*6 5 - 9 75 ft. Eff. absorption area ***?37 fe Monitoring tube YES Depression over field NO Date of adequacy test 3/9/01 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test0�'in. Water added 983 gal. New depth4"/5 1n. Elapsed Time: 30 min. Final fluid depth07fin. Absorption rate >= 450+ g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - D. LIFT STATION Date installed "Pump on" level atin. E. SEPARATION DISTANCES Size in gallons High water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5' Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line P 10'+ Building foundation 10,+ Water main N/A Water service line 10'+ Surface water 1001+ Driveway, parking/vehicle storage 50'+ 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 Q -. review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. QO • • • .. , .... • • . of r y A. —7953 Gorness: JEFFREY A. GARNESS Q P .•:� Engineer's Printed Name dos '•. .• 4�fPrP .........•• `hod Date '? Z�f7f 4O dP"f essio"ON HAA Fee $ 3 SOO • Oc-�, Date of Payment C) Receipt Number 3 (Rev. 12100) Waiver Fee $ Date of Payment Receipt Number Gat -21-98 04:31P Bonnie Mehner• &. Associate. (907)762-1858 P.02 "L Mol it r4; 12;33 Ivn.c!;3 rut �L�-ANU vjtw )UODIVISION .oT I , BLOCK 3 r .soa 03' s-s"r 10$ 5' `7p.0' S 4Sn ,�6 O'47° wCL 1. V !' 6YI%T" b 0, bbPc,blk5 � x'P fr ti 4t e ya t{d v as brr 4 v a� P P i d" gyp' AS "UILT a hereby certify that � s tho pj'�rty depicted ahpvAnd rth9�P wlA[1)I LAtYD ,SURt7TNC no entc:oac/mnenta exist axcppt a5 iPidi- at! A. Gaatald[,�, cat,Cd. It 720 T'"t 88t}, Atie. S® tlsa ras�ioeaRibilit.y of kha Pcwrage, Alaska 99501 eee er ko det�smi�g vhhee exl�tehce of an! (P f I.M PI^1 .( a OF At%4h� �' ddTM 1.47 a. �/2-31�Z i f3� y T f I.M PI^1 .( a OF At%4h� �' ddTM 1.47 a. �/2-31�Z MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES M e Division of Environmental Services M} 1 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. It 017-401-49 HAA # 1. GENERAL INFORMATION Complete legal description Foreland View, Lot 1, Block 3 Location (site address or directions) 8521 Jeanne Drive, Anchorage, AK cr,Dj.2 Suer, � Property owner Re - Ha Day phone 248-6789 Mailing address 2204 Cleveland #201, Anchorage, AKK 99517 Lending agency NSA Day phone Mailing address Agent NSA Day phone Address Unless otherwise requested, NAA will be held for pickup. F 2. NUMBER OF BEDROOMS: 3 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 421 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 yaglP Riyer Eng;nPer;ng Se=ices Phone 694-5195 Address P.O. Box 773294, Eagle River, Ak 99577 Engineers signature / Date 7 ,f S 6. ' DHHS SIGNATURE X Approved for Disapproved. 1n I Conditional approval for _ Additional Comments yFii �a oav as o�na�=aaea, o..e—�c-r> •S�?] `d c�' - Luuis lk8u!era bedrooms. bedrooms, with the following stipulations: By: Date 7— 20 -92 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(Rev.1/91) Beck MOA#21 I Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST (A Legal Description: F-0r41A1Vp 11/ENJ Parcell.D. 01*7-4t0l-- 9 Lof /v &06k 3 A. WELL DATA Well type RX1447E If A, B, or C, attach ADEC letter. ADEC water system number IV/A Log present (Y/N) %/ Date completed U/10&19 2 Driller 4Lp/1V6 i Total depth 207 Cased to Casing height Sanitary seal (Y/N) YC5 Wires properly protected (Y/N) YE 5 Date of test Static water level Well flow Pump level FROM WELL LOG /O& /92 /# 5' /5 g.p.m. ONkNOWN SEPARATION DISTANCES FROM WELL TO: AT INSPECTION i 5 i� 3 R7 c r- z rn ; N m g.p.m. rn CO m N N o N_ O Z Septic/hakfizzqtank on lot /0& ; On adjacent lots _J_/0,0 Absorption field on lot 130 ; On adjacent lots f / 00 Public sewer main N% Public sewer manhole/cleanout NIA Sewer service line f /00 i Petroleum tank MW6 ARPAi2C'1yT WATER SAMPLE RESULTS: Coliform Nitrate 0 79 Other bacteria Date of sample: Ol��/1/92 Collected by: <N6/N !Q B. SEPTIC/HGL9tNG TANK DATA Date installed ZZ 16 Z9 / Tank size 2000 Compartments Z Cleanouts (Y/N) yE5 Foundation cleanout (Y/N) Y65 Depression (Y/N) NO High water alarm (Y/N) NSA Alarm tested (Y/N) /V 1A Date of pumping Pumper N /,4 SEPARATION DISTANCES FROM SEPTIC/1 lei E)I dG TANK TO: Well(s)onlot lob—on adjacent lots f //00J Foundation 6/ To property line CD2 Absorptionfield 0 r Watermatin/service line f/DD� Surface water/drainage 4i LA 72-026 (Rev. 7/91) Front - CONTINUED ON BACK PAGE 0 C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level Meets MOA electrical SEPARATION Al Well o t "Pump on" level FROM LIFT STATION TO: D. ABSORPTION FIELD DATA On adjacent lots •/Access (Y/N) "Pump off" level at Cycles tested Surface water _ Date installed ��D �9 / Soil rating 0,10 68011F7 Z System type A Length gs' S v Width 5 y Gravel thickness 3 v Total depth T4ENC' l! Total absorption area 75D lie Cleanouts present (Y/N) 1165 Depression over field (Y/N) NO Date of adequacy test IIIA " NEG1J r Results(pass/fail) %SASS for bedrooms Peroxide treatment (past 12 months) (Y/N) If yes, give date N�A SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /301 On adjacent lots 71_/00 � Property line To building foundation To existing or abandoned system on lot 6e 1A On adjacent lots 71 -sol, Cutbank NIA WaterwA+F'service line f X 61 v Surface water - N/A Driveway, parking/vehicle storage area 70 v Curtain drain E. ENGINEER'S CERTIFICATION I certify that t have checked, verified, or conformed to all MOA and HAA guidelines in effect on the'date of this inspection. Signature Engineer's Name Date Z.l6 i HAA Fee $ / 70 t1rL19 Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number