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FOX HILL BLK 1 LT 8
Fox Hill Lot 8 Block #051-073-26 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231058 PID Number: 051-073-26 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name JASON & SERENA OUTHIER ABSORPTION FIELD - IDSF ❑ Deep Trench ❑ Wide Trench ❑ Bed ® Mound Site Address 22232 WOODCLIFF COURT,. CHUGIAK *IDSF ® Other - REBUILD & MATCHED EXISTING ELEVATIONS Phone Number of Bedrooms Soil Rating Total depth from original grade 3 2 GPD/SF *0.5 TO 1 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade *(ABOVE GRADE) +1.5 TO 3 Ft. Gravel depth beneath pipe PEA GRAVEL 0.55 Ft. Subdivision Block Lot FOX HILL 1 8 Fill added above original grade VARIES — SEE DRAWING 4+/- Ft. Gravel length 20 Ft. Township Range Section Gravel width 18 Ft. Beds: Number of Lines 8 Distance between lines 2.0 Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 360 Ft2 -- -- Ft. Well __ 100'+ 25'+ TANK ® Septic ® S.T.E.P. ❑ Holding ❑ Other Manufacturer NEW— ANCH. TANK Capacity 1500 Gal. Surface water -- 100'+ Material EPDXY STEEL Number of compartments 2 Lot Line -- *8'+ NA Foundation __ 101+ LIFT STATION Manufacturer NEW— ANCH. TANK Capacity 1500 Gal. Remarks IDSF REBUILD WITH INSULATION. NEW AIR COMPRESSOR / ALARM & NEW ANCHORED EPDXY COATED STEEL STEP TANK INSTALLED. Alarm location BACK ROOM / WALL Electrical installed by DRS Installer JRS PIPE MATERIAL House to tank Tank to 3034 drainfield Drainfield 3034 Co/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspdection 15` 4/20/2023 2nd 4/21/23 Location and description 3`d 4/24/23 4d' 4/25/23 BOTTOM OF SIDING ON-SITE WATER AND WASTEWATER SECTION APPROVAL _"001»r1 -'=:tQ,�i� Conditional Approval: Date �'�� • vim.. " • ' " " • .. • • • • Septic Syste Approved - , ; Curtis Huffman r� �•,. �� Date / Z� z� z •.����� ,�IF 4/26/2023. • �lkiF�PROFESSICAV Note: this approval does not include well permit requirements. 1�,�`Z��. trcev uoiUu its/ PID:051-073-26 PERMIT:OSP231058FOX HILL BLOCK 1, LOT 8 FIRST WATER CONSULTING FOX HILL BLOCK 1, LOT 8 Municipality of Anchorage 11; 0-1)"1", P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 i Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV231018 COSA#:OSC231107 Permit#: PID#: 051-073-26 Legal Description: FOX HILL BILK 1 LT 8 Engineer: Curtis Huffman Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 8 feet. This waiver approval applies to the absorption field. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: I Date: Z ZOZ Approved by: Name of Reviewer .............................................. ■ ............................. ■ 1 **** VARIANCE/WAIVER REVIEW **** 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com April 27, 2023 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: FOX HILL BLOCK 1, LOT 8 – FIELD TO LOT LINE WAIVER We respectively request continuation of the MOA waiver #WR000097 for the field to lot line waiver of 8’ be granted and continued at this time. Granting of this waiver is justified since the new IDSF field was rebuilt in the exact location of the previous existing field and there have been no known issues or ill effects to the adjacent property since this IDSF has been in operation since 2000 and it is anticipated that the field will not impact the neighboring property. Furthermore, continuing this waiver is justified since this is the best septic absorption site location for the field per lot and area characteristics, existing data of soils / groundwater shallower elsewhere, remote monitoring could be added and would allow a reduced 5’ separation and the adjacent septic field is 50’+ away and does not interfere. We therefore request the waiver fee be waived and a waiver issued. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. ZZ Z w a �w �uq ow w U J = LU F- F- F U In W w F t'+ � i O 0 CO Cb LLJ L_. O O O CV II 01 F- 0 O J M CD � azo �$ m M i 4'j 3',Ot7.60 ::---90N m F- D D Z w o F o ' Z ¢ U T- 0- p J F Z O LL ¢ U vwi� F D .� z w X, J X _ I a ti0 Z6Z M,.00 LO o90S LU O Z w 0 LU J Z F Q o O U LU ui LU Z w= Q w Q F Q Z w F Vl W Lu OC Lj O = J F- Z J ¢ 2¢w �¢p �Z}� J F -LA0 ¢ a� o LL¢FJF JwU ZNQ} ZmF-Z •� N O O W �O}`nZ in DLu ixwpw O ZZ� a m V not LLLLming maw OLLOF� v=i QwpZ� Z ..n c, o m ¢LU LLI ¢InwUlwF-lUil} ZOwwpQ •¢ U N m Z w m F- vZ -J=iUwF- Cn QUQ�iUiiLL O w m _j LUm0FQ�U"p5<LALnZ �_=w FO � 0 V m Jinpw JZvwi�mHinN D �U)i in ZLU0 Ln > ONO V1 ZS V)= 0�Lu 1VI zm ZF-��Z O p '� QOLLorZ0U0Z-ZF-Q� FOwowY U = 1 F a w_j 0 0 o� Lu F �� w O 0} Z Z U g r w l¢- w� eCo p g m ix mZmJF0�Fp�>D �ZQawQFmLL O C''o Qj a l7 LL D o U D Z LL' O' D Lu W Q W LL' Z F� F= Q J J w Z U w} m ¢¢ 3: m O o J= m ,3: O ZZ p� W LL0JO=a Qt7i1 ZLL0"'zFz}'¢' U W or O LL' W LU O W= U LL >¢> Z F¢.. O O} Vl w Ln J N U>Fl¢O�LL WLLLL Z LU U�p}�¢ ZOJF-wd'OwD l9 0>ZZWZwopL!)0>mUFi F-LL0F-F— -M o � � II (D :U:i 0- z00¢�ww InJJLL Ln ZFw < ©� o ¢ l7 FFFUF-FJ�LLFF V1FU a'Z�a W OZLL- Ow�QDJmOMOw=FLL'vWiQpmaZFQlI'� x } 2 c Z O¢ 2 2 �^ F F O Z w¢ Z aC Z¢ Z ¢> m w 0 m w v _ •. p m Ln m a 0 2> w w N O w Z U V w LU N 0 LL_¢ o Z Z 2���F¢22 2w�0¢`nM:Lu M: O> a Y ui I� W F � in F- UZ�FmI-OOOr ul3: Z Z rr w a� Q u J W Ix 2LU ¢ 0^ N m V in kp `amu 3 a LL 0 0 V Ln � Z � 00 0 1J W N O 11 O O Co ONM r ID Y v C? 1O m L j rn Ln coo o ire>O . Q N M O :> N N N m C14to Z J .N Ln ri Ln C N t0 W IN T _ pN O u i o '� o U N Ln ¢ VI LL LL ¢ Iw r a V - U 44��tZZi'' zm _ �- w A •' F- in 060 LL H w� Q 3 H o LU OD 4 F- LL, Z Z • Q� r m 1,y �Q� O 1 --• o 0 O J 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: OSP231058 Work Type: Septic Upgrade Tax Code Number: 05107326000 Site Legal Address: FOX HILL BILK 1 LT 8 G:1458 Site Mailing Address: 22232 WOODCLIFF CT, Chugiak Owner: OUTHIER JASON J & SERENA G Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: cnt 'S, l�elrirtment 4/14/2023 4/13/2024 39999 Q Disposal Field Q 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 Received By: .5U �� Issued By: �- c'� Date: Date: l/v 20 Z 3 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-073-26 Property owner(s) JASON & SERENA OUTHIER Day phone Mailing address 22232 WOODCLIFF COURT, CHUGIAK, AK 99567 Site address 22232 WOODCLIFF COURT, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) FOX HILL BLOCK 1, LOT 8 Legal description (Township, Range & Section) Lot Size 39,999 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: ([D all that apply) Absorption Field E] Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank 0 Upgrade El Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well El Water Storage R 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. nature of property owner or authorized agent) Permit/Rush Fees: '$ _S" --_q -5- Waiver Fees: Date of Payment: 11 h07 3 Date of Payment: Receipt Number: 111 1'i / Receipt Number: Permit No. C)S P z, 310 S7& Waiver No. GAIDevelopment Services\Building Safety\On Site Water and Wastewatefforms\Client FormsTermit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com ! !! April 6, 2023 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: IDSF SEPTIC SYSTEM UPGRADE PERMIT LEGAL: FOX HILL BLOCK 1, LOT 8 The septic field has failed and on behalf of the owner we request a septic permit to upgrade the system on the above referenced lot. The current owners bought the property a couple of years ago and now are planning on selling. It appears that the bottomless sand filter (IDSF) absorption field has developed a biomat in the top 3-4 of the sand and pea gravel and is not operating properly. We propose to rebuild the IDSF as it currently exists by removing any contaminated sand and all the pea gravel in the IDSF and then installing new sand with pea gravel to the same existing or higher elevations and layout of the IDSF. The existing components (STEP tank, pressure line and air line, alarm, air compressor, flushing valves,…) will be inspected and continue to be used unless deemed needing to be replaced. The lot and area are served by private water. The design will not impact any of the neighboring properties and is proposed to be installed 10 from property line replacing the need for the MOA 8 waiver. 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 OSP231058, Curtis Townsend, 04/14/23 FIRST WATER CONSULTING FOX HILL BLOCK 1, LOT 8 DESIGN CALCS: NO SLOPES >25% WITHIN 50' OF PROPOSED FIELD. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231058, Curtis Townsend, 04/14/23 FIRST WATER CONSULTING FOX HILL BLOCK 1, LOT 8 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231058, Curtis Townsend, 04/14/23 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage. Alaska 99519-6650 Telephone: 545-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Numbem SW000118 PID Number:. 051 --07,3--26 ~ame:GORDON MOENCH Wastewater System: [] New · Upgrade P.O. BOX 671195 CHUGIAK. AK 99567 ABSORPTION FIELD NO. of Bedrooms: Ph°"":(907) 688-4576 ,3 DDeep Trench nShollow Trench IBed nMound lathere* LEGAL DESCRIPTION **2.0 8 1 FOXHILL 1.5 - ,3.0 (ABOVE) - - - 4.0 - 5.5 WELL: [] New [] Upgrade 18 ~ Ft n. ,360 s~. Ft. ASTM D-,3054/F'-810/SCH 40 PVC r~ EAGLE MTN. EXC. 10/24-25/2000 SEPARATION DISTANCES =s.,uc a.o~,, · S.T.~,. r~om Tank Reld StaUon Tank S.,., U~. ANCHORAGE TANK 1250 we, 10o'+ 100'+ 100'+ - 25'+ STEEL 2 s.,o=o ~oo'+ ~oo', ~oo', - - LIFT STATION Water Lot S'+ *S'+ '~'+ - - 1250I ANCHORAGE T'~I~'~/"'~RENCO SYSTEMS Foundation .5'+ 10'+ 5'+ -- - TIMER TIMER 45" Curta;n ' 20 OSI 0,5 HHF ALCAN ELECTR C Drain NONE KNOW~ P~"" ~ · ~: ~ Remarks: 'LOT LINE WAIVER REOUESTED (SEE ATTACHED BENCH MARK LETTER). TOP OF HOSE BIB IN BACK OF HOUSE. · *THIS IS A INNOVATIVE: BOTI'OMLESS INTERMIT/ENT SAND FILTER. 2.0' TO 2,95' OF M.O,~. APPROVED SAND FILTER ADDED. 3 P.S.I. ON GAUGE FOR NR BLOWER (10/50/200). 6th 10/50/2000 Department of Health and Human Services approval R~vlewed and approved by:_~~_~,~:~-Daf, e: //- ~- O° AS-BUILT DRAWING SWO00118 051-075-26 I L j I ~ ~ ~ ', WOODcLipp C ~1I~"'~ N ~.~ ~o ~. I ~ ~0~ ~1 W~ D~ ON 10/24/2~. ~ ~ 8EU~D A ~ ~T ~[ ORIOI~ GR~NDWA~ R~IN~ WERE: FCO 14.94 30,05 ~ , dT2 68.97 ~ NO~: ~I~NG D~N~E~ ~D S~CJ ~T3 92.63 109.5~ I T~K WERE COMPL~LY ~DONED I dT4 ~6.06 96.58 '~ ..... .4,.~ ~:r: .............. ,,, CONSULTANTS, INC. GORDON MOENCH (907) 688-4576 2 OF ~ , ~d~ffley A. G---orne~s~ FOXHILL SUBDIVISION; LOT 8, BLOCK 1, ~ ~ ~, ......... ~E OF WORK: AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE ,'*,,..UM*,, AS--BUILT DRAWING SWO00118 051-073-26 511 ~0~., I,N/~, fil~ /- IO~ .2404.16 O 5 4,0 · Mf IIqStl. AflON ~ l~2ffO/~ Of: . / /- ~: _ : ,,"..,':-:..':..'d.': ;:;'.' ',,'., ,-;-7,;:.'?.;" .;~};,..:,.,'? .'?,,';;L.:.;;,,':-'-:. : ?: :.' '-.'.-'.::'.;:"'~,'~', .... ',"P "'5'~' '/"h '°".''''' .' ......... (l'"~l~Sf PO~13 -' 9~1 1HAl41~2ffOM Of' 1 ~/1/2.00D J.L.M. ALASI~, WATER & WASTEWATER ~,~.. f~}' ~]/~ ~k-~ '"~'4,: ~o.~;^.~. ~.o. ..T.S.,L~" 'gl tA/':'"'I 2) · REP/~REO FOR: PHON~' NUMBER: PAGE NUMBER: GORDON MOENCH (907) 688-4576 $ OF ~ FOXHILL SUBDIVISION; LOT 8, BLOCK 1, ~.,." ............. '~.,.,~',~ PROFILE AS-BUILT OF SEPTIC SYSTEM UPGRADE ALASIC WATER & WASTEWATER CONSULTANTS, INC. November 2, 2000 Municipality of Anchorage Department of Health and ttuman Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 RECEIVED NOV 09 2000 ~,tumc~pahly ot Anchorago Oept, Health & Human Services Reft Lot Line Waiver for Lot 8, Block 1, Foxhill Subdivision To whom it may concern: We request that your department issue a 8 foot lot line waiver from the west property line to the new Bottomless Intermittent Sand Filter (ISF) drainfield. On 10/25/200, we contacted your department and received verbal approval for the waiver prior to the installation of the new drainfield. I am unaware of any adverse impacts this waiver would have on adjacent wells or septic systems. If you have any quf~tions, please contact us at 337-6179. Thank you for your assistance. Jeffe~ [X{G:imess, P.E., M.S. Presi :fit ' 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com Alcan Electrical Engineering, Inc. 6~70 A~cfic $1~g Rd. Anchorage, A~ska 99518 Fax Cover Sheet DATE: November 2, 2000 TIME: 1222 PM TO: AWWC PHONE: 337-6179 Jeff FAX: 336~246 FROM: AJcml Elec~c PHONE: ~3-3787 SkJpp I~ingmann FAX: 58'24~286 RE: Lot 6, Block 1, Foxhill Sub REC IV[D NOV 09 2000 *Vlumc~pal,ly ~1 Ar ChOrago UepL Hea th & Human Services In regards to thc scwagc ~ station tl~t Alcan connected at the above mentioned location. All ¢leci,"s:al work performed by Alcan was done to 1999 National Electrical Code, (NEC) standards. If you have any questions please contact mc. Thank you! Number of I~ges Including cover sheet: 1 ~ 'd O~'ON OIH3313 NVOlV ~dtl:l 000['~ 'AON MUNICIPALITY OF ANCHORAGE Department of Health and Hurnar~ Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: May 22, 2000 Expiration Date: May 22, 2001 Permit Number: SW000118 Legal Description: FOX HILL BLK 1 LT 8 Design Engineer: 0041 AK Water & Wastewater Consultant Owner Name: Gordon Moench Owner Address: PO Box 671195 Chugiak, AK 99567-1195 Parcel ID: 051-073-26 Site Address: 022232 WOODCLIFF CT Lot Size: 39999 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit Is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Pdvate Well [] Water Storage Ail construction must be in accordance with: 1. The attached approved design. 2. Ail requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of AJaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours pdor 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: ,/(~F.,~'z/'"~ (~'~ Date: Date: ALAsir. A w^TER'' WASTEWATER CONSULTANTS, INC. April 24, 2000 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic System Upgrade for Lot 8, Block 1, Fox Hill Subdivision (Bottomless Intermittent Sand Filter - ISF) To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. The existing septic system consists of a 1000 gallon septic tank and a bed type drainfield. The existing bed is grossly surcharged and must be upgraded. We are proposing that a 1250 gallon S.T.E.P. tank and a innovative Bottomless Intermittent Sand Filter (ISF) system be installed. Comments regarding the proposed upgrade are summarized as follows: 1. GENERAL: Several test holes were excavated south of the existing septic system to determine an area suitable for a septic system upgrade. Due to the high groundwater in the area, only one test hole was found to be suitable for an on-site septic system. Given the limited area around the test hole and the setbacks from the existing septic system, it is our opinion that a Bottomless ISF system is the most viable option. 2. SOILS: Attached are logs which shows the soil classifications, groundwater monitoring, and the percolation test results. In test hole #1, the soils below the organic layers are a SM/ML material to a depth of 9 feet (bottom of test hole). In test hole #2, the soils below the organic layers are a GM/SM material to a depth of 5.5 feet and then transitions to a SM/ML material to a depth of 7.5 feet (bottom of test hole). Groundwater was encoufitered during the excavation of both test holes; at 7 feet in TH#1 and at 5.5 feet in TH#2. After 8 days, the monitoring tubes were checked and groundwater was found to be at 2 feet in TH#1 and at 5 feet in TH#2. A percolation test for TH#1 was performed between the depth of 1.5 feet to 2.0 feet which had a percolation rate of 120 minute/inch. A percolation test for TH#2 was performed between the depth of 1.5 feet to 2.5 feet which had a percolation rate of 1.67 minute/inch. It is our opinion that the area around TH#1 is not suitable for on-site septic and the proposed upgrade should be designed around the 30 radius of TH#2 and that a application rate of 2.0 gallons/day/ft2 should be used. 6901 Debarr Road, Suite 2B ~ Anchorage, AK 99504 ~ Ph: (907)337-6179 ~ Fax: (907)338-3246 3. DRAINFIELD DESIGN: Bottomless Intermittent Sand Filter (ISF) a. Percolation Rate: 1.67 minutes/inch b. Allowable Application Rate for ISF: 2.0 gallons/day/ft2 c. NumberofBedrooms: 3 d. Des!gn Flow: 450 gallons per day e. Mimmum Absorption Area: 225 ft2 f. Effective Depth below pressure pipes: 2.5+ inches g. Width: 18 feet h. Length: 20 feet. i. Effective absorption area -- 360 fl2 j. Air Supply: Thomas Industries, Model 5070, "Anchorage Tank". k. Air Supply Line: "Wasteflow" emitterline, 1/2 inch I.D, "Anchorage Tank". I. Sand Material: In accordance with M.O.A. latest standards m. Pea Gravel: 100% passing 3/8" sieve, less than 20% passing the 1/4" sieve, and less than I% passing the/18 sieve. We are proposing to excavate doxvn to a depth of 1 feet (maximum - remove all organics), place a minimum of 6 inches of sand, install the air supply line, and cover it with 1.5 feet of sand. On top of the sand, we will place 6 inches of 3/8 inch pea gravel, with the pressure laterals midway in the layer. We will use a conventional lift station (Anchorage Tank), equipped with a programmable timer so that flow can be intermittently dosed to the ISF. 4. SURFACE WATERS: There is a drainage easement with a ditch line approximately 100 feet away from the proposed septic system upgrade. The ditch is believed to divert runoff water from breakup on the adjacent property. No surface water was visible on April 14, 2000. 5. TOPOGRAPIIY: As can be seen on the attached design, there are no slope concerns. 6. MATERIALS AND CONSTRUCTION PRACTICES: The materials Used, and the construction practices will comply with DHHS' "Intermittent Sand Filter Design, Installation & Maintenance Manual". The contractor should read this document prior to construction. Copies are available at the Municipal Onsite Services office (Sth floor, 9th & L St.). 7. CLOSING: I am open to any suggestions from your department, which would be an improvement to the proposed design. I am unaxvare of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank ~o]~or your assistance. Presid~n{ ~} NOTE: Attached is a site plan drawing, a design drawing, a detail drawing, two soils logs, and a 7 page constnwtion specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B ~ Anchorage, AK 99504 ~ Ph: (907)337-6179 ~ Fax: (907)338-3246 N I ~T 5, B~K 1 I KIM~N SUBDMSION ~T NO ~NC~NS I ~T 2 NO ~NC~NS ~ KIM~" SUBDMSION NO CONCERNS I A~S~ ~'I'ER & ~S'FE~TER CONSULTANTS, INC. GORDON MOEN~H (907) 688-4576 1 OF SITE P~N FOR SEPTIC SYSTEM UPGRADE (BO~OMLESS ISF) . ' "-'UURT ~\\ I( \, I t.~..:.~_.~_ ~ . , I~(ISTINO SEPTIC T~I( TO ~ \ // / -- / ~ ~' ~/ ~ 5.r~P. ~K i ~ ~D RL~R (]S~. ~VA~ A B~ ~T / ~]E~ ~Y ~ T~ T~ ~ ~NG. ~E D~L ~D PROR~ (P~E 3 OF 3), J ~ r~ P[~ ~m3 v~ NO~: ~E CO~OR S~ ~ ~E W~ PROPE~ D~E ~ UNE ~D ~E 100 FOOT WE~ ~IUS ~GGED ~ A ~/~ ~/2ooo o~wN ........... AI~S~ WATER & ~STEWATER OO.DO..o~.c. (.07) FOX HILL SUBDIVISION; LOT 8, BLOCK 1, DESIGN OF SEPTIC SYSTE~ UPGRADE (BO~O~L[SS · 20' LONC ' ~HINO V~ _ ~OU S.T.E.P. ~ COMPR~OR P~ G~P OF ~O. ~HING~D c~V~, I ~O~ORING ~BE ~' G~EMON~ORING ~BE~ · ~2x4 & PL~D BOX (REM~ ~ OR~I~) 2 FEE1 MINIMUM OF OF ~O RL~. ~.e... PR~ FOR: ~ON[ NUMBS: GORDON MOENCH (907) 688-4576 ~ ~,~: ~% '-....J.. .... .-':~-~ FOX HILL SUBDIVISION; LOT 8, BLOCK 1 DETAIL OF BO~OMLESS INTERMI~ENT SAND FILTER (ISF) ALASKA WATER & WASTEWATER CONSULTANTS, INC. PHON£ (907) 357-6179 * tAX (907) 358-3246 ISOIL LOG - PERCOLATION TEST I LEGAL DESCRIPTION: FOX HILL SUBDIVISION; LOT 8, BLOCK 1 ~'.~?..-~ ~ ~ PERFORMED FOR: COROON UOENCH ...... DA~ PERFORMED: 4/~/2000 V~ V//.~ J TEST HOLE ~ 1 J qh(,.~,~ ............. 1 ~ OR~ICS GC OL ~N~ I J~ ~ ~ . ~ROUNDWATER 7' 4/6/2000 10 11 DATE READING CLOCK NET TIME WATER LEVEL NET DROP TIME (MIN~ES) RE.lNG (INCHES) 12 4/7/2000 -PERC. HO~ W~ PR~OAKED 4+ HOURS PRIOR TO 13 1 3:20 -- 6" 2 3:50 30 1/4' 5 1/4' 14 3 3:50 6' 4 4:20 30 1/4' 5 1/4' 15 16 17 18 19 PERCO~TION ~TE 120 (HIN./INCH) PERC, HOLE DIA. 6 (INCHES) 2 TEST R~ BETWEEN 1,5 FT, ~D 2.0 COHHENTS: PERFORMED BY A~ WATER · W~ATER, I, JE~R~ K C~NESS, CER~ THAT THIS W~ PERFORMED IN ACCORD~CE WITH ~L ~ATE ~D MUNICIPAL GUIDEUNES IN E~E~ ON OA~: ~/~ ~/~0 DEPTH TO DATE ~ROUNDWATER 7' 4/6/2000 2' 4/14/2000 ALASKA WATER & WASTEWATEP, CONSULTANTS, INC. ISOIL LOG - PERCO~TION TEST] _ LEGAL DESCRIPTION: FOX HILL SUBD~SION: LOT B . BLOCK 1 "''" ' ITEST HOLE ~2] GH ' ~CL GC SW HH aSEOR~U t ~ ~ [ I / DEPTH TO $ROUNDWATEE ~ DATE . , 5.~' ~/s/eooo 5.o' ~/~ ~/~ooo ~0 I1 DATE RE.lNG CLOCK NET TINE WATER LEVEL NET DROP TINE (HIN~ES) READING (INCHES) 12 4/7/2000 1 5:20 -- 2 ~:30 10 O' 6" 13 3 3:30 ~ 6" 4 3:40 10 14 5 5:40 ~ 6' 6 5:50 10 O' 6' 15 7 5:50 ~ 6' 16 8 4:00 10 O' 6' 9 4:00 ~ 6' 17 10 4:10 10 O' 6' 11 4:10 ~ 6' 18 12 4:20 10 O" 6' 19 PERCO~TION RATE 1.67 (HIN./INCH) PERC. HOLE DIA. 6 .(INCHES) 2 TEST R~ BETWEEN 1.5 ~. ~D 2.5 FT. COHHENTS: PERC. HO~ W~ PRESO~ED 4+ HOURS PRIOR TO TEEING PERFORMED BY A~ WATER & W~A~ER. I, JE~R~ ~ G~NESS, CERH~ T~T THIS DEPTH TO DATE GROUNDWATER 5.5' 4/6/2000 5.0' 4/14/2000 PROPERTY OWNER AGREEMENT FOR TIlE MAINTENANCE OF AN ON-SITE WASTEWATER DISPOSAL SYSTEaM This a~eement, dated O '1:~, is made between the Municipality of Anchorage Dep-~, tment of Health and Human Services (DHHS) and the property o,,mer(s)or: gO/- g £1odc I for./ /ll This a~eement is made for the purpose of maintaining an on-site wastewater disposal system on the subject property. The property owner~ a~ee to th, e follo~ng: Submit to the Municipality of Anchorage, on an ~.nual 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. (Si~aamre) (Printed Name) (Signature) (Printed Name) i 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 I N~A N~-~-- . ^~, ~,~..) ¢ PHONE LEGAL DE~ 18TFON [] UPGRADE LOCATION NO. OF BEDROOM,~,.--~ Well ,.~ / ,,/-. Absorption area /,~/.. Dwelling.,~ , /.~ PERMIT NO I F-~ IManufactu~ ..... Ma ' No of compartments I ILiq~a~i~n~°ns I IF HOMEMADE [ Inside length Width Liquid depth , .....L_ -- ~ / ~ I Well ~undation Nearest lot line ~ / DISTANCE TO' I ~z / No. of Hnes I L.~9¢ ~ .a¢i,~ Total length of lines Trench width i Distaece between lines ~ ~ / Top ct ti~e to finish grade Material beneath tile I Total effective absorption area ~ ~ength .4 ~'~ 7~ Widtb _, .-,~ ¢ ,F. depth~ t % Ct_~ ..... ~ ' PERMITNO ~ { ~v,~ of ~ib Crib di~ Crib dep~ Tota~ ~f¢..~i~. ~b~omtio. ~re¢ ~2 L ~ ~ M ICI~. , De~th Drille¢ Distance to lot line ~ ~ DISTANCE TO Building foundation Sewer line Septic tank ~tion area(s~ OTHER PIPE MATERIALS ::1...:t: FII"! FFIi'I]:L.:I;F!I:;i: H:I:'I"H "i"l..illi!: I:;;:I;:i:[:i:!!...I]:F;:E:HE:t'.,I"I"i5 I'::'()F;'. Ol",l...-.:i!i;]:"l"E] :!51~:l.,.IE:l';~:~i; FINE:, ~-,.IEL. 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MUNICIPALITY OF ANCHORAGE Department ~ Health and Environmenta' ~rotection 825 ~ Street, Anchorage, AK. 79501 264-4720 * * * HANDWRITTEN PERMIT * * * Permit ~ W'~'~OR ON-SITE SEWER PERMIT Location: ]Legal Description: ~- ¢ ~it~l~ ~ Type of Soil Absorption System Is: Trench: Drainfield: Maximum Number of Bedrooms: ~-~,_~ Phone Number: I~/'~.Z- ~-~ LOt Size: Seepage Bed: ~' Holding Tank: Soil Rating(sq.ft/br) //6~ ' The Required Size of the Soil Absorption ,~ystem Is: GRAVEL DEPTH WIDTH/~/.. Z The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE =----/~J(~d9 GALLONS Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that ~bedrooms. Date: ~--1_3 ( -- o'/~ SWP/024 (1/81) SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST LEGAL DESCR PTION: ~ ~ /~"'"<~ ~ /~7' / DATE PERFORMED: 1 2 3 4 6 7 8 9 10 .11 12 13 14 16 17 18 19 [] PERCOLATION TEST {OUND WATER ED? SLOPE -j SITE PLAN EPTH,?AT Will / / /',' / Gross Net Depth to Net Reading Date Time Time Water Drop 20 .j' PERCOLATION RATE ~ ~ EJ (minutas/inch} / ~' ////. : .~. ~., ~.,,,, ,~ : ~ ~/ ~- . 72-008 (6/79) by Co. SULLIVAN WATER WELLS P.O. BOX272, CHUGIAK, ALASKA 99567 · TELEPHONE688-2759 OWNER OF LAND ,.V<./~d ~'._/-/ /vg,~tO ~)/0.~ 7'"' ADOgESS / ,~- 7 c l-t t c ~ /0 ~.o o,o ER LEGAL DESCRIPTION PERMIT NUMBER / ! DEPTH OF WELL /t ¢~ O __ (~ ~:~ / / STATIC LEVEL OF WATER FT. ~L~/~ / ~/~ ~/iZ/~ DRAW DOWN FT. Ended _C~/~'/~_~ GALS. PER HR KIND OF CASING /~o~ KIND OF FORMATION: From~--- Ft. From ~' Ft. From __ Fl. From ~ _Ft. From-~:2-~---- Ft. From/O ~ Ft. From, __Ft. From //al__Ft. From Ft. From __Fl. From ,__Ft. to From .... Ft. to From . Ft. to__ From Ft. to From FI, to From__Ft. to From , Ft. to Ft. Ft. Ft. .Ft, Ft.. Ft. Ft.. From---- From From__ From__ From__ Frmn From From From From From From From From From From__ From__ Ft. to Ft, to_ Ft. to___ Ft. to___ Ft. to-- Ft. to Ft. to___ __Ft. to___ __Ft. to_ Ft. to_ Ft. to Ft, to Ft. to_ Ft. to __Ft. to__ .Ft. to___ Ft. to Fl. _Ft. Ft. Ft _Ft. Ft Ft. Ft _Ft. Ft. _Ft. Ft, Ft. Ft, Ft. Ft, Ft. MISCL. INFORMATION: t .L It ::i.. 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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. 051-073-26-000 Legal description FOX HILL BLK 1 LT 8 Site address 22232 WOODCLIFF CT Expiration Date: 2 z Current property owner(s) JASON & SERENA OUTHIER X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or advisories: bedrooms, with the following stipulations: GBy: Original Certificate Date: 4/27/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY OF Development Services Department On -Site Water & Wastewater Section Ro-sh ANCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051-073-26 Complete legal description FOX HILL BLOCK 1, LOT 8 Location (site address) 22232 WOODCLIFF COURT, CHUGIAK, AK 99567 Current property owner(s) JASON & SERENA OUTHIER Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age NEW - See advisory if steel older than 20 years — EPDXY COATED 1500 -GAL STEP TO IDSF 6. ABSORPTION FIELD: ® AWWTS ❑ Bed ❑ Deep Trench ® Wide Trench ❑ Seepage Pit Waiver request for: F ( IS -L0 %y LO 7— L t Distance:_7 r Expedited review requested: P1 By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Waiver Fee $ / fl F-1�__1_ P oqrz-vi Date of Payment COSA # O sG 23 1 107 Date of Payment Waiver # 05 Z 3 0 COSA Application 2022.doc Legal Description: FOX HILL BLOCK 1 LOT 8 Parcel ID: 051-073-26 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ® Well log is filed with Onsite (or attached) Well production at time of test 4gpm Date drilled 1984 Total depth 121 ft Water storage tank volume NA gallons Cased to 121 ft Well disinfected for coliform test? ❑ Yes No ® Sanitary seal is functioning correctly ® Coliform bacteria is Negative ® Wires are properly protected Nitrate 4.23 mg/L ❑ Nitrate less than MRL (ND) Casing height (above ground) 18+ in. Arsenic ug/L ® Arsenic less than MRL (ND) Date of flow test for COSA 3/27/2023 Collected by FORGE ENGINEERING INC. Static water level at beginning of test 100 ft. Date 3/28/2023 Comments FORGE ENGINEERING INC TESTED WELL & TOOK CAN WATER SAMPLES. B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NA — NEW ® Required maintenance completed, if AWWTS Comments: NEW COMPRESSOR & STEP D. ABSORPTION FIELD DATA — IDSF REBUILD Which system tested (date installed) NEW FIELD ® ALL standpipes present per record drawing Total measured depth from grade 3.2 ft (max) Measured depth to pipe invert from grade NA ft (min) ® NIA — pressurized field. ® Per record drawings, field is insulated. ® Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date C. LIFT STATION ® Required maintenance completed Age of lift station NEW years Lift station material EPDXY STEEL Comments: IDSF W/ STEP REBUILD Adequacy test date NA — NEW Results ❑ Pass Fluid depth prior to test _ in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) _ in Effective depth used _ in Effective depth remaining _in Comments/Deficiencies: NEW SEPTIC IDSF SYSTEM TANK & ABSORPTION FIELD INSTALLED PER PREVIOUS EXISTING ELEVATIONS & SLIGHLTY HIGHER WITH 1+ INCHES OF MOA SAND. COSA Checklist 2022.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' various and dynamic characteristics and are outside the control of the evaluator of the Animal Containment > 50' ® Yes if No ft ® Yes if No ft occupants or guarantee no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & �� • • • • • • . Manure/Animal Excreta Storage > 100' • • Curtis Huffman Community Sewer Main > 75' ®Yes _ if No ft ®Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No ft Tank to Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑ Yes if No *8 ft Private Wells > 100' ® Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ® Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS * CSV 2-3 101 MOA LOT LINE WAIVER. IDSF ABSORPTION MOUND / BED WAS REBUILT IN THE SAME LOCATION G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer's Printed Name _CURTIS HUFFMAN, PE Date 4126/2023 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic ,��� applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use,/ local soil characteristics, groundwater levels that may fluctuate during the of . • ' ' • • . • `t] Q'• • I� year, quality �r construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to g�•• •;���j *�TM •� * rr% these ' various and dynamic characteristics and are outside the control of the evaluator of the / , , • . , , , , • • • , , // well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future that occupants or guarantee no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & �� • • • • • • . FWI $ • • Curtis Huffman �� ?'F'•• CE 128991 c,�lF�• . 4/26/23 . • •����� ••..... PROFESSION ~ COSA Checklist 2022.docx MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this Day of API 1— of 20 2'22, by and between G%1Y��s}roP+tE -yt(- b� awY" ire f -lo+ W, X)NE --b s c- , herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as IDSF or "Innovative Bottomless Intermittent Sand Filter" qer MOA IR located at (legal description) FOXHILL BLOCK 1, LOT 8 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) l� Throughout the term of this Agreement, the Owner shall enter into a service agreement a 6y �� N'z-F with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. t;, It shall be the responsibility of the Owner during the term of this Agreement to pay for all C"r bv� ll� N--T—r repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). lL� Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Y;�,- Owner acknowledges that regular maintenance of an AWWTS reduces the potential C� la� 1Li K .1.F. failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 �L- Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. L Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be Ut �90Y-q T assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. l(� Owner agrees that any sale or transfer of title of the property will not occur without a new C� 1G1 Certificate of On -Site Systems Approval. �l. Owner agrees that the AWWTS installation and maintenance requirements as provided cq' by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNER: By: (signature) V4A$—xN M& q,�(— (print name) STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT ) Date: The foregoing instrument was acknowledged before me this — day of 20___, by NOTARY PUBLIC FOR ALASKA My Commission expires: MUNICIPALITY: r By: (signature) VU iM`1 S T'D`✓'-5,cvc, (print name) Date: Title: C i vi AI /• n I -A1 n\ bnnn i rX Z Acknowledgment by Individual State of R �a5l�ct County of ?�� � ud in a� d�'� c+ - On this da of ,^�-fN \ 1` `' D,, _ Y 1� 1J , 20 . Before me, V"` `Qelc Name of Notary Public the undersigned Notary Public, personally appeared I� I VfiS�Ivv2 L, ZaIC"C , PO Name of Signer(s) ❑ Proved to me on the oath of ❑ Personally known to me ® Proved to me on the basis of satisfactory evidence A-e-p�- (Description of ID) to be the person(s) whose name(s) is/are subscribed to the within instrument, and acknowledged that he/she/they executed it. ..��:r,trrrrrr WITNESS my NOT.q 9 •3 A N� VBLIG tO ; A; Notary Seal For Bank Purposes Only Description of Attached Document Type or Title of Document MUCL �AC.ed VjRr-hUA4 C Document Date Signer(s) Other Than Named Above Account Number (if applicable) I N/\l0'- (Signature of Notary Public) My commission expires od-i aaI 1�10-6 Number of Pages U C('A� CQ��(T CK01 e Y Q Optional: A thumbprint is only needed if state stat- utes require a thumbprint. DIII�IN�IIIINIIIIIII�I�IIIIIoil 1111111111111111 1 111141111111111 DSG5350/595575 (Rev 05 - 05/21) Top of thumb here UNIUPALITY OF ANCHORAGE Development Services Department= r Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 051-073-26 1 Certificate of On -Site Systems Approval GENERAL INFORMATION Expiration Date: %Q `20Z( Complete legal description FOX HILL BLK 1 LT 8 Location (site address) 22232 Woodcliff Ct Chugiak Current property owner(s) LEWELLYN JOHN & GLORIA Day phone Mailing address Real estate agent PO Box 576 Willow AK 99688 Pete Carpenter 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 907-854-8404 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic Fil Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSAFee$ y1a.5�(CDVI�-� Date of Payment t 0' Zj — 2.0 Receipt Number e q2_ 35 COSA # OSC a 015 '6_� 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Eklutna Engineering, LLC Phone 907.406.1058 Address 19162 Mountain Rd Chugiak AK 99567 Engineer's Printed Name Curtis Townsend, PE Date / n 202b 6. DSD SIGNATURE System #1 Approved for 3 bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms ���K� of ALq�y��0 >��.•'4 TM P Curtis �� FG/,S• • p119 o late CNo.E ,se 04 �. 1111Z'PROFESS0't_ bedrooms, with the following stipulations: By v►�-c Original Certificate Date: -2 0 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. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Advisory Othe� ,ti VC ckur sa dY`1/ pit-Vube Legal Description: FOX HILL BLK 1 LT 8 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1984 Total depth 121 ft Cased to 121 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) > 18 in. Date of flow test for COSA 100/2020 Static water level at beginning of test 106 ft. Comments B. TANK DATA Age of tank(s) 20 years Tank type/material STEP steel Measured operating fluid level in septic tank 49 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 10/7/2020 r D. ABSORPTION FIELD DATA Which system tested (date installed) 1012000 ❑ ALL standpipes present per record drawing Total measured depth from grade 2.9 ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field X Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 051-073-26 Structure served by this system Well production at time of test 3.0 gpm Water storage tank volume 121 gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 3.28 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Curtis Townsend Date of Sample 10012020 ; _ C. LIFT STATION ❑ Required maintenance completed Age of lift station 20 years Lift station material steel Comments: Adequacy test date 10110120 Results M Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 450 gal New depth 3 in Elapsed time 1440 min © Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate ' 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: bed is insulated according to inspection report COSA Checklist yellow sheet 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' a Yes Community Sewer Manhole/Cleanout > 100' M Yes if No ft Q Yes if No ft Neighboring Tank > 100' I/ Yes if No ft Private Sewer/Septic Line > 25' 177� Yes if No ft Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' ❑✓ Yes if No ft Water Main > 10' Animal Containment > 50' ❑✓ Yes if No ft M Yes if No ft ❑✓ Yes if No ft Water Service Line > 10' ❑✓ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' Q 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' a Yes if No ft Surface Water > 100' 0 Yes if No ft Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' ❑✓ 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' ✓❑ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No 8 ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' Q Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS WR000097 lot line waiver G. ENGINEER'S CERTIFICATION 1 certify that 1 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. _ o A �s4AV— S' `49 .....e. ' COSA Checklist yellow sheet o ee000^" 6 •.i30.�11 •�Ci�s� MUNICIPALITY OF ANCHORA(M 0 CoinMUnitv Development Department I On -Site Water & Wastewater Program P: 907-343-7904 - F: 907-343-7997 - P.O. Box 196650 Anchorage, AK 99519-6650 - hitp:i/www.muni.org/bttildiiit,1 Intermittent Dosing Sand Filter LRYfilaintenance Log Ownerj-o�� Street Address Phone 'TO'7 7Z.2-- 711 �. Legal Desc. 10 2C )1\\ Septic Tank: -Sludge level inches -Pumping: required Les no -Pumping completed es no Absorption Field- -Liquid level Field: -Flushing valves per approved design es no -All flushing valves opened, distribution lines flushed, and flushing valves closed Lift station: -Pump basket cleaned(X!Is�n 0 -Biotube effluent filter cleaned (ge�� no -Timer float settingz±inches -High level float setting 13 inches -Reference poin s -Pump on 50 seconds -Pump off 30 minutes -Cumulative lifetime cycles I Al 1. 7 *36 *Cumulative run time ),;ZF52� hou -Operation satisfactory ,,'Yes no Air System: -Air pump filter cleaned es no -Air pressure psi -Date of latest install or rebuild0-,/ec,,c5iAir system operationKs_a_�fisfaci®ry not Alarm System: -Dedicated electrical circuit es no -Float setting 36 inches � �7 Comments: �_ e -C) 0 1,1_, �C' 11� -Audible and visual alarm in OAI,@rm system operation dwelling P . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . jl ................................................. . . . ) . . . . . . . . . . . . . . . . . . . . YY\ ..... V. Z!.........e, .... ........................................................................................................................................................... ................................................................................................................................................................ Maintenance Provider: Technician M`\Q)0r'.A Date of maintenance Company SignatureDate/' IDSF Maintenance Log_040313.doc Septic Tank Advisory Certificate of On -Site Systems Approval #OSC 201580 Subdivision: Fox Hill Block 1 Lot 8 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 20 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. MaiUng Address P"O Box 196650'* Anchorage, Alaska 99519 6650 *www muni org K4 J F % x � z ' p N J c O Z I IOC.• � •• O `C 6 15�- ti ,0 0�' LE, - lhcMmlw---.'�;;--M���� O) I- 0 J '--gCz -___ `CR 60D80N LO =•L > 0 Z/ s` X—X— z O b' Q 0 ~ U) t - w J k O �k n mak, �o zsz--M,— '00— to.- 90S n t- 0 J 00 O In h () L.L.) O Ln co z 0 J 0411h, F x � z x Z I 0 .� V) O a \ V V I Y wa) ¢•�w 0V �W J N= W J O O N "�_Ua�7N3 W Q Q O -,L C E W O= N V V Z O v cOaV V O Z N C.V V � O O n - r� U :3c�ov C U) �'-- ° N a N 0 V 0.0. Ouj t•N C V I oo r Q U ;n Z5. � m o c c w N N o c via .c c v = T V N E a, J O o - .o NO 41 O.0 Z O.O ... J d C O U O Q D O. O J Q E ` C O M av Tn. V C O a Z N 0 O O c T� OC f YW► E M r LU -i Ty w O 0 0 C NN O -00 .5-, W)- tO EO p OO Q• O o (/Q F-0 0 .- NOJ 'i O O V / zonav`oE 'W' O •V C CN Q 0 ONO 0 N cn •- U ` W (D N �axit v WtO In N z I I In ii 5tOi W� 3c _ z(p w��tMO LLJ _�m� 10 0 (n Wit\ Of Lj a Q- 0mro 11 Ln 0r) a g >-- 0 0 > rn > Dern ow O x U) j N W x z J d- u O_ m Q m E" `i � U Z(n >a ZD O Q a0 a �' ol(1J CZ �zQ� z m LL.i m LO O I- ¢ z N r- 0 0 o J of O Qo O r�lI Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Se~on P.O. Box 196650 Anchorage, AJaska 99519-6650 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING 1. GENERAL INFORMATION Completelegaldescription FOXHILL SUBDIVISION: LOT 8. BLOCK 1. Location (site address or directions) 2:23'32 WOODCLIFF COURT CHUGIAK. AK 99567 Property owner Mailing address Lending agency Mailing address GORDON MOENCH P.O. EOX 671195 CHUOIAK. AK 99567 Day phone (907~ 688-4576 Day phone Agent JILL HOELTING W/ DYNAMIC PROPERTIES Day phone (907~ 261-7600 Address 3111 "C" ~TRE-~T ANCHORACE. AK 99503 Unless othenvise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well xxx Community well Public water NOTE: If cemmunity we/I system, provide wfitten confirmation from State ADEC at~est- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding Tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide wdtten confirmation from State ADEC lng to the legality and status of system. 72-~25 (Rev. 1/~1 ) Front .MOA//21 Computer Version Note: Alaska. Water. and Wastewater Consultants, Inc.. shall be paid $1,950. O0 at, or prior to, closing for the engineering sen/ices providea. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affbxed 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 further redly 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 a!l Munic?paL~and State codes, ordinances, and regulations in effect on the date of this inspection.,'~//~ ,~ /~/[ . Name of Firm ALASKA WATER &.WASTEWATER CONSULTANTS, INC, Phone f907) 337-6179 Address 6901 DEBARR ROAD. SUITI~.2B ANCHORAGE, ALASKA 99504 ,, / Engineer's S,gnature" ~, ' ,~,!,~/._,, ~'---1 Date "/~./c~ In system in accordance ~th ADEC and MOA DHFIS Guidelines & Recjulations. The reported results described the performance of the system under the conditions encountered at the b'me of the test, and separa#on distances measured to readity identifiable features. The operational life of all wells and septic systems depend on the local soils cond!tlon, ground water levels that may fluctuate dudng the year, and the water the evaluator of the system. SatisfactoG, test results do not guarantee future performance -~=,~,~ _ AB/V/C, Inc. can therefore not provfde any warran~y for future estimate of how long the ~.~_~." /.41~.r,/, ~'~-~ system wfll continue to meet the operational requlrements of the ADEC or MOA DHHS. ~ * : Thecontsnto, th,sreport,s,orth.o,e ene,,,o, the e,,s,eda ., ........ reliance upon or use of this report ~ ~ny o~er peraon or ,ean7 ~ not ,~utho#zed, ~-. ~1~. nor will lt confer any legal rlght whatseever. '~.p ~ s. .Hs SIG.*TURE ,. ....' __ Disapproved ' Conditional approval for bedrooms, with the following stipulations: Additional Comments Date .//° ,~7-~ 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 ) eac~ MCA ~21 Computer Veto[on Municipality of Anchorage R E C E I V E D DEPARTMENT OF HEALTH & HUMAN SERVICES ~ EnvlronmentelSen~sOIvlslon (907)343.4/l~V 0 9 Z{}001 825 't.' Slmet, Rm 502 Anchorage, Ateska 99501 MUNICIPALITY OF ANCHORAGE Health Authority Approval Checldis~R0m~rrAL SER~CF.S 0Ma0N FOXHILL SUBDMSION; LOT 8m BLOCK I f Parcel I.D.: 051-073-26 If A, B, or C, altech ADEC latter. ADEC water system number Y~ Date completed 1Z1' Cased to 121' WELL DATA Well Type PRNATE Log present (Y/N) Total deplh YES 2/7/84 Casing height (above ground) 18"+ W~es propedy protected (Y/N) YE;S FROM ~ I LOG Date of test 2/7/84 Static water level 90' Well I:m:XlUCtlon 20 WATER SAMPLE RESULTS: Coliform O Date of ~ample: 10/50/00 B. SEPTIC/HOLDING TANK DATA AT INSPECTION lO/ O/OO 10)' g.p.m. ;~.6 g.p.m. Nltmte~Other bacte~te Collected by:. A.W.W.C. INC. Foundation claansut (Y/N) Date of Pumping NI~'W C. ABSORPTION FIELD DATA Date Installed Dateinstelled 10/24-25/00 Tankelze 1250 YES Depression (Y/N) NO High water elarm (Y/N) Pumper - (INTERMll'FENT SAND FILTER) 10/24-25/00 Soil rating (g.p.dJ112 or~--'~_ Number of Comperlmente ;~ Claanouts (Y/N) YES *BELOW FINAL GRADES TO TOP OF SAND. ;2.0 Systemtype BOTTOMLESS ISF Length 20' Width 1~' Gravel thickness below pipe 0.29' Total depth '2.6'+ Effectlveabsorpfionama 560 sq. FT. MonltorlngTubepmsent(Y/N) YES Dapresslonoverfield(Y/N) NO Date of edeCluacy test NEW Results (Pass/Fell) - For 3 Bedrooms Ruld deplh in eb~:~Uon field before test (in.); Ruld depth - (ins) Minutes late~. Peroxkle tmalment (past 12 months) (Y/N) - Immedtetely alter - gal. water added (in.): - - Absorption rate = - - If yes. give date - D. UFT 8TATIOH Date Installed I~n~le/~ (Y/N) High ~ter elam level at* Cyclse ~tsd 10/'24-25/2000 Size in gal]ons 1250 YES "Pump on" level at' TIMER 'Pump off' level at* 45" *Datum BOTTOM OF TANK NEW '~MER Septic/holding tenk on lot Absorption field on lot Public sewer main Sewer/septic service line E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 100'+ 100'+ N/^ 25'+ SEPARATION OISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Water main/service line 10'+ Surface waterldralnege 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line ,8'+ Building foundation 10'+ On ad]asent lots On adjacent lots Public sewer manhole/cloanout ~ Lift station ~rptlon field Wel~ on adjacent Io~ 100'+ 100'+ N//A 10o'+ 100'+ *SEE LOT'LINE WAIVER REQUEST. Water main/sen4ce line. 10'+ Sur[ace water 1 oo'+ Driveway, parldng/Vehlcle stemge area 10'+ Curtsln drain NONE KNOWN Wells on adjacent ints 100'+ / sat t ha de l ¢ in pec uns ond ,,v ew of Municipal m(~prds ~all/t~ I~b~j~e s~/~ems ere in conformance Enginse¢$ Na~e_I I' ~0EFFREY A. C_,ARN~S Date MUNICIPALITY OF ANCHORAGE Department of Health & Human Services On-Site Services Waiver Review Wmkaheet WR#: WR00009? P]D~: 051.073-26 Date Received: November 9~ 2000 Legal Description: Foxhill~ Lot 8~ Block I HA#: HA000574 Engineer:. Alaska Water & Westewater Conaultants~ Inc. 6901 Debarr Road~ Suite 2-b~ Anchorage~ AK 99504 Applicant: Gordon Moench Waiver Requested: 8 foot lot-line waiver Permit~: SW000110 Criteria: 1. Geology A. Watar Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation 2. Special Conditions: 3. Other:. Points: Waiver is Granted: List Conditions or Reasons for above: Waiver is not Granted: Date: Rec~: 06446 Amount: $115.00 Date Paid: 1119100 AK Water & Wastewater Consultants, Inc. ATTN': Seffrey Garness, PE 6901 De Barr Road, Suite 2B Anchorage, AK 99504- November 27, 2000 Subject: Waiver Request forFOX HILL BLK I LT 8 Waiver # WR000097 Lot Line Request for Parcel ID 051-073-26 Dear Engineer: Your request for a waiver of the required 10 feet horizontal separation of the on-site wastewater disposal system to the lot line has been approved. The approved separation distance is $ feet. Tiffs waiver approval applies to the current on-site wastewater disposal system and lot line separation only. Any future upgrade to the on-site wastewater disposal system and lot line will require all separation distances to be met or another waiver approval from tiffs department. Ifthere are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely~~,~~ JeffPoet Engineering Technician III On-Site Water Quality Program I1-05-D0 17:24 FROM.-CTE ENVIRONhEflTAL ,~K CT&E Environmental Services Inc. CT&E Ref.~ Client Name Project Name/~ Client Sample ID Matrlz Ordered By PWSID 100679200~L~' ~) i~.g,r~'~& Wastewater Consultants Inc. /n..ot~lk 1 Foxhill ~ti~lk I Foxhill ~ Water Sample Remarks: 5515~0I To346 P.02/0~ Fo622 Clknl POrt Print ed Date/Time 11/06/2000 16:16 Collected Date/Time 10/30/2000 16:45 Recelved Date/Time 10/31/2000 11:04 Technical Director Stephen C. Ede ~a~era Dmp&re.m~n~ Nin'ate-N Results PQL Allowable Prep Ana~is Units Melhod Limits Dnte Date Init 1.42 0.500 mg/L EPA 300.0 10 tnax 10/31/00 SCL Microbiology ~',aborat orlr Total Coliform co[/lOOmL SMI8 922213 10/31/00 KAP MUNICIPALITY Of' ANCHORAGE DIVISION OP ENVIRONMENTgL DEP,~RTMENT OF ~,TH AND ~YI~iNTAL PR~ECTION APPLIC~JPI~ ~R H~,~I ~UTHORITY APPROV~ (~]~IFI~TE / 1, ~r~,~_~._i~,ti~' Application Date (a) lega%gh:!s~'ipt~.on (J. nc~.kL~ lot, block, suod~vision, section, to,,mship, range) Location (~d~kess or directions) ~ ...... Applicants Ad~'es.L 2~L..,~ (c) Appzl.ant is (check o~,) r~ndin9 Institution [-2T~[ ~ ~.rner/bui.l~r~ Buyer ~[, Other, ~t (e~lain), (d) Lending Institution Telephone Address (e) ~a:]. Estate Co. & Auent Address Other _{ ~de :~kc~_i!p }__ ............................... Individual ~ 11. L~2__~?:{ Con~ranity Iii! Note: If cen~mit:y ~e].]l system, must have wzgitten oonf:[r~tion fron ~e State ~pa~r!t of [~vJ. roni~ntal Conservation attestir:g to tl~a legality ald status. Is t~e ml.l adequate fo~ the numar of ~dr~s s~c'.ified in this ~ ._ Is the ,~stewater disposal s~stem adequate for the rttunt;er off ~dr~ N) [Pa{~ 1 of 2] 2-15-.84 5~ .~.~nj~neerin_____~g. Finn Providinq~In~ctio_ns,_ :T~.~ts, ~ta and Information I ~rtify th~t~:~'~ve c~cked, ~rified, or ~nfor~d to all ~A H~A Gui~lir:es in effect onsigne~~~tffe da ~/~ ~h ~s~ct ion.~/ ..... Date ~~~~' ' ~ Signed by )Date ENGINEER SEAL) 6. DHEP A~proval Approved for Approved' ~_.--~. Disapproved Te~mts of Conditional Approval 1'ne Municipality of Ancho~a.cD Department o:f ~a].th and Environme..ntal Protection dces not guarantee the continued satisfactory perfornmnce of t2m water supply and/or the wastewater disposal systemo This approval indicates that::, as of the. validation date sh~.rn above, ~used on t~m data and inforn~tion furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and fun<~ tiop, al for the num~r of bedrocms and type. of structure indicated° (DHEP SEAJb ) 7, ~:nil the HAA to the foJ.l~4ing ad¢%,ess: KB2/d5/s [Page 2 of 2] 2-15~84 Be MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - ]FEBRUARY 1984 MUNICIPALITY OF ANCHOP, AGI~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION APR ,'~ 0 Total Depth /~(~ Cased to .RE C IVED i~~'~~-,Appr ovid (Y~) ~te ~pleted ~~ ~/ Yiel~ /~ ' ~pth o'~ ~outin~ Static Water ~l ~ ~ ~ ~t At ~ ~ Casing ~ight ~ Gl-~nd ~" Sanitary ~al on Casing~) Elec~ical Wiring in ~nduit~ ~p~essi~ ~ound ~l~ead~~ ~p~ation Distan~s f~ To ~ptic~.Ta~ ~ ~" .<.~ ~ ..Z~.~ ,; ~ ~joining not~ To ~a~est ~ge of ~so~tion F~31d o~ncL. /~)/~,~/~-; ~ Adjoining ~ts ~ ~ .~ To Newest Public ~ Li~e.: ~._ ~ / To ~est Public ~ s~t/Ma~o~ W/~-'~ ~o ~t ~ ~v~ ~ o~ ~ ~/~ , "/ ,_~-~ . . . , ~'/ ' Wate~ S~le Collected By_~J ~ ~ ~c ~ ~., ~; ~te ~.~)' '~'~~ ~ Wate~ S le Test ~sults ~ c~~ ~ ~ .... ~ / / ' SEPTIC/~, TANK DATA Date Instal~ 2~/~/~ Size No. of C~,~a~tmsnts Foundation C~Leanou~/W9 To Water Me~/Service Line Course Comments Depression ove~ Tank (~) Date Last Pumped /%3_~ Pumping/Maintenance Contract c~ File (~Y~//~ ; fo~ /{J Holding Tank High-Wate~ Alarm (Y/~//m' Temporary Holding Tank Permit Separation Distances f~om Septic/Holding Tank: To Water-Supply Well /~ ~'7Z TJ Building Foundation To Property Line /~) ~ To Disposal Field_ /O /~. . To Stream, Pond, Take, c~ Major D~ainage [Page 1 of 2] 2~15-84 ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 2--_~ --F y idth of Field /8 Length of Field ~ ! Depth of Field ~-~' Gravel Bed Thickness Square Feet of Absorption~ea ~ ~ Standpipes P~esent~N~ Depression over Field (~ /~te of last Adequacy Test Results of last Adequacy Test ~"/ Separation Distance from Absorption Field~ To ~at. er-Supply ~ll /~O ~ To ~operty Line /~ To Building Fo~dation ~ To Existing or Abandoned System on T ter ' ' Line ,~i) ~f To Cutbank(if present) To Stream/Pond/Lake/o~ Majo~ D~ainage Course To D~iveway, Parking Area, o~ Vehicle St°~age Ar~ea ~ Co]~ents D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) C~tut~nts Dim~ ns ions / . Manhole/Access (Y/N) ~ / / "~Pt~mp Off" Level at /['/ ./~/Z~/__ Vent (Y/N) Pumpi~hg Cycles du~ing Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify t.h~ ~ave chec~ed, verified, or confornmd to all MOA ~..~ ~ !..~..e.s in effect on the da~ of ~j ~>j~gdtz~n. / Signe _. Date ' [Pa~ 2 of 2] 2-15-84