HomeMy WebLinkAboutFOX HILL BLK 3 LT 2Fox Hill Block 3 Lot 2 #051-073-03 Municipality of Anchorage :' :• Development Services Department \ Building Safety Division — On -Site Water and Wastewater Program, 4700 S. Bragaw SL P.O. Box 196650 Anchorage, AK 99519.6650 Page ( Of 3 www.ci.anchoroge.akus (907) 343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. , SW000q73 PID Number, 051-073-03 Rrn° James� k Wastewater System: New tZ Upgrade ❑ r0lfoY 1 Esher % a PO B ABSORPTION FIELD Payr: N73w Betroomc ODaap T..d1 OSIWIo.Trr h I[B.d t]Mynd 0o0w. LEGAL DESCRIPTION Sw Raung Taal Depdn fora ononal pada: ( P ,F Ft Block Lm;? S'bei `e Fy..' a // Depm m P" baddrrl aern o gY eredr Grant a"'M W"M P"! CSFI Tyvnaltip' Rage: secure Fa nailed acme a 0nal gr rr J_ 1 GraM LygtR -"7 J / / Ft. Ft. Well: ❑ New ❑ Upgrade GraM.wa I Ft. * 3.: "*m D•etrg. 5 lw': `� clrTu--adraoon ((PmMe, 6 B, Ck Total Depda Cana Io: GX ST:^i 1 , liQ i e. Ft. Ft Taal ab'WPom area asF12 P Matennal } X5 /"I D3oi F /O Orar: Dau Drabd: uo Watr Levet Mtaier %/ 1 a dZxCRV4rF/1 Dals kutaoaa {/e U O 6- Ft w,t F TWa. P Green TANK PM FI. FL FL SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other, To Septic Absorption Lift HoldingPubliUPnrat Mr"V. p l �L Rre capaoty. 000". From Tank Field Station Tank SewttrLine m / 1 �l 7 wse O3L Q3q' 11"T1 -- r IJ Meteor: D 1L/^E Rumouracomprmaru.: swlace Watr 004- 1 OQtf- 100tt I LIFT STATION La line W% a, Z� 8' Sul. Z gF 0 Gal. Mmvlaawr. e 5 — RVC, O rr f A Faurldatgn 13L I $51 7\ ,1 Pwry_7 jy't F —o Cc imna -PL-o' Itpn wear Mrm at In. cwtain Dran orte V Knew '� Pump Make a Modal f Elecoto aapa000m pr antra ar - LL/Flo ,Lee -LL G R° l BENCH MARK d ti / Z and DeaaWh= Laaoan Bjoln � OF Cot-r7er FL r I10C a Engineer's Stamp OF -`AC ''� �,tQ .••a _�~ elil1 S 3 S ENGINEERING 17034 Eagle River Loop Road, No at 1 ���" l B� `� Inspections performed by: a es: 2!„ da 1 — O y '6 1 a7 t ''}'/»�v Development Services Department Approval �• t .•» .e. —ew ac; A�t4ttir j dy Reviewed and approved by: �t/L Date: law. l:mol • ., i n~•••....+•°aAb`.a`',� PERMIT No. SW000473 PAGE 2 OF 3 Municipalit of Anchorage DEPARTMENT OF HEAUH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone- 343-4744 ON—SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 2, BLOCK 3, FOX HILL S/D P.I.D. NO. 051-073-03 •MT2 I I j 0E0 I MT1• I I I I I I I I I I +' I E 1 N I W I u 1 D. I w I LOT 3 I LOT 1 I Q PUMP BASIN Ol ~I MN NEW 1000 GALLON COI HOPE SEPTIC TANK N I!i ST2 •� ^ 1 ST I I I � 0. OBL2 I I I I DELI 4- TOM EXISTING SCALE: V 50' 1 EOR'10 S HOUSE M yo „ F AL p�...•••ti ••' •9 +� o N� 1 to it 00 E ASEMENT .............«•�.M .1 �� .... b•A A. tbeM r,j _ EEEGTRIC — TEIEGOM ;D• ft ••. ______-- F COjJR ref i. _ 1J ,�"� PERMIT No. SW000473 PAGE 3 OF 3 Municipalit of Anchorage DEPARTMENT OF HEAUH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 •Anchorage, Alaska 99519-6650 • Telephone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 2, BLOCK 3, FOX HILL S/D P.I.D. NO. 051-073-03 FINAL GRADE S ST2 C01 TOP 2' 90.5' INsuurco 2" INSULATION 87.5' GALLON NEW SEPTIC TANK 95.9' 95.5' z' SEWER ROCK 1 `-93.0' 93.0' 5' WATER FOUND @ 87.2' 81.0' B.O.H. 87.2' E/ELUENT OUTLET FROM PUMP BASIN N. T. S. JUN -22-01 FRI 08:31 HEAVENLY LIGHTS ELECT CO 373 3894 P.Ot OP 0! ON RAG%NG June 22, 2001 7'0 whom it may concern: The lift station at Jot 2. block 3 at the Fox hilt sub -division was wired by a licensed cicctric'im in acenrdance with the current National Electrical Code. Under penalty of perjury. I certify this information to be true and correct. Sincerely, ALLIED ALASKA ELECTRIC, LLC 37a�, Janette f,. Brown, Sccretaryff'reazurer A0.. Box 876310, Warilla, Alaska 99687 007oe (907) 373,3893/ Cell232-8687/F'er 373-3891 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Nov 08, 2000 Expiration Date: Nov 08, 2001 Permit Number: SW000473 Parcel ID: 051-073-03 Legal Description: FOX HILL BLK 3 LT 2 Design Engineer: 0024 Eagle River Engineering Services Site Address: 022319 WOODCLIFF CT Owner Name: JAMES KNOPKE Lot Size: 41000 SQ. FT. Owner Address: PO BOX 17 Total Bedrooms: 3 Permit Bedrooms: 3 ESTER. AK 99725 - This permit is for the construction of. Q Disposal Field Q Septic Tank Ej Holding Tank ❑ Privy Private Well Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-4744 (24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: //—go � QD Date: — M --00 IST 6�y�O1 3p"^ •" MUNICIPALITY OFANCHORAGE p Department of Heafth and Human Services On -Site Services Program 825 L Street, Room 502 L% L�5/� ( t �. p VA P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Nov 08, 2000 Expiration Date: Nov 08, 2001 Permit Number: SW000473 Parcel ID: 051-073-03 Legal Description: FOX HILL BLK 3 LT 2 Design Engineer: 0024 Eagle River Engineering Services Site Address: 022319 WOODCLIFF CT Owner Name: JAMES KNOPKE Lot Size: 41000 SQ. FT. Owner Address: PO BOX 17 Total Bedrooms: 3 Permit Bedrooms: 3 ESTER. AK 99725 - This permit is for the construction of. Q Disposal Field Q Septic Tank Ej Holding Tank ❑ Privy Private Well Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-4744 (24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: //—go � QD Date: — M --00 Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 Eagle River, AK 99577-3294 November 8, 2000 Jim Cross, P.E. Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Lot 2, Block 3, Foxhill Subdivision Narrative R Permit Application Dear Mr. Cross: (907)694-5195 tel (907)694-3297 fax The proposed septic system upgrade will have very limited impact on adjacent properties for the following reasons: 1. The surrounding lots are large parcels, allowing sufficient room for septic sites if septic systems are placed in the North portion of the lots. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, due to absorption capacity of the gravel soil in this area. 4. While drainage is a consideration the bed system will not affect existing drainage patterns. This septic system is the replacement for a system that was installed in 1984 and has been operation in the water table for years. The new septic system will incorporate a bed with pressurized distribution, similar to the system installed on adjacent lot 4. There is a record in the DHHS files of a curtain drain, we did not see any physical evidence however we are staying 20' down gradient of this location. If you have any questions please call our office at 694-5195. Sincerely, v Louis Butera, P.E. X2000\00 -064 -NAR EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 694-5195 ERES Project No.: 00-064 Calculated By: LB Date: 11/8/00 Legal: FOXHILL LOT 2 BLOCK 3 Single Family 3 Bedroom Dwelling Bed Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = Percolation rate = Wastewater application rate = Required absorption area = Bed width (W) = Bed Gravel depth (D) = TEST HOLE 4 450 gallons 19 minutes per inch 0.4 gallons per day per square foot 1125 square feet 15 feet 1 feet Required length = Required absorption area / Bed width Required length = 1125 / Required length = 75 feet Total Excavation Depth = 1-1.5' ft ADD FILTER SAND TO BED GRADE AS REQUIRED BY ENGINEER 15 (to remove topsoil) 0 -01 0 A� op PCl) 49 TH O ............... Ooa �?h.LOUICEA.6736ERA:� { 00.064cal 4:22 PM11/8/00 Prepared by EAGLE RIVER ENGINEERING 11/8/00 Page 1 PUMP Flow (GPM) ELEV. Head (ft) PIPE Head Loss•(FT) ORIFICE HEAD (FT) FITTING (LOSS (FT) Total HEAD LOSS (FT) ORIFICE RATE" NUMBER OF ORIFICE I ORIFICES SPACING FT 28.0 10 17.87 1 5 5 1 37.87 0.42 67 3.11 I Constants: I Pipe Length (ft) tank to field 113 Volume of effluent in pipe (gal.) Pipe ID (inch) SDR 1601.25 7.20 Pipe Friction Coeff. (m) 150 I ORIFICE SIZE IN. 1 0._13 TOTAL LATERAL LENGTH IN LEACHFIELD 1 207 •IIAZEN AND WILLIAMS FORMULMurlaia^i eswEv^t 85Y(Tnvw)•Emy1row431 ...ORIFICE EQUATION Louts A. Buten CE -0735 PAGE 1 OF 1 APR H FIELD 14010 WELLS. PUBLIC WATER SUPPLY LOT 2. BLOCK 1 NEIGHBORS SEPTIC AO 1S »'L\ 01 R2 RIOO.t If / R100.001 I \ NO SURFACE WATER NO KNOWN CURTAIN DRAINS APR H FIELD LOT 1, BLOCK 1 RECORD CURTAIN DUN 1981 THS 15'X75' BED N t EXISTING BED SYSTEM • Z /i�s��viou ABANDON _ _ TANK Of \,� i ,Of � 1 2q 46 / N*N000 Cl1FF COURT Nf��BORS SEPTIC 12' 2 Cl — TEST HOLE • — MONITOR TUBE — 0 — SEWER CLEAN OUT O — WELL — EASEMENT — PROPOSED LEACH FIELD — EXISTING LEACH FIELD WELL/SEPTIC SITE PLAN LEGAL: LOT2, BLOCK3, FOXHILL OWNER: JIM KNOPKE CONTRACTOR: N A JOB# 00-064 1 DATE: 11/8/00 SCALE 1 " = 60' EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) 694-3297 1 S' TYP 4.5' 1 1/4' PVC CAPPED 1/8' DRAIN HOLE ON BOTTOM ORIGINAL GROUND SURFACE O TH2 60' 1-1/4' TO 2- Reduce to 1-1/4' 3.1' spacing typ. 1/4' Vent hate of lop of cop this end only. 1 1/4' PVC Lateral 2" Manifold (PVC) 2' Min. Earth Cover 1 2. FIL 1 1/4' Latero) 6' saner rock J p Approx. 2-1/2 sand fill placed Water table +4' Impermeable layer +6' LEACHFIELD PROFILE AND LATERAL DETAIL LEGAL: LOT 2, BLOCK 3, FOXHILL OWNER: JIM KNOPKE CONTRACTOR: N A JOB #00-064D DATE: 11/8/00 1 NOT TO SCALE EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX. (907) 694-3295 From lift slaUon 1 1/4' HDPE E Louis A. Buten CUM Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: Lot 2, Block 3, FOXHILL Subdivision November 8, 2000 A. GENERAL 1. The well and septic plan arc for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health and State Department of Environmental Conservation requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. B. SEPTIC TANK/LIFT STATION I. Septic tank / lift station shall be 1250 gallon minimum, MOA approved tank with lift station OSI-05- 20-II1-I17 or equivalent. Existing tank to be abandoned onsite by pumping and crushing. 2. A receipt from a licensed electrician shall be provided to the engineer verifying lift station wiring to all applicable codes. 3. Effluent line from tank to Icachfield is to be 1 %." polyethylene pipe SDR 160 with welded joints and king nipples at each end connection. C. LEACHBED I. .The bed is to be located as shown on the site plan drawing. The initial excavation is to remove the topsoil and organic layer down to sandy gravel. This layer is to be scarified with backhoe teeth. 2. The bottom of the bed shall be brought to a level, t 1.5" of F above grade at test hole 4 with approved filter sand. 3. A gravel bed is to be placed over the sand leveling layer with 1 '/4" pipe laterals buried in the gravel. 4. The effluent line within the bed is 1 %." PVC pipe with 1/8" drilled orifice holes placed holes down at 3.1' spacing on center. 5. The bed gravel is to be covered with typar fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of Y or equivalent is to be placed over the leachfield. 7. The area over the trench is to be finish graded to prevent ponding of surface water runoff. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = +1' (above grade) GRAVEL DEPTH = 0.5' under pipe, 4" over pipe BED LENGTH = 75' BED WIDTII = 15' SAND THICKNESS = 2.5' (estimated) SOIL RATING = .4 GPD/fi2 BEDROOM CAPACITY = 3 TANK SIZE = 1250 (incl lift sta) Twenty-four (24) hours notice required for all inspections. \2000\00-064spec a Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L•• Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST Louis A. Butera CE -6736 PERFORMED FOR: /T�%o to Ke DATE PERFORMED: LEGAL DESCRIPTION: �ta B/k3 fu x �, // Township, Range, Section: SLOPE SITE PLAN 2- 3- 4- 5- 6- 7 3456 7 -.. 8 0 0 ' 10- 11 —O 12 �.. 13 14 15 16 17 18 19 /-/// :( jfiq�.{N.C. O/c/ Ter,. i/ Veey Oe, -re_ /o-/9 r $me. rl� P/+fr5�a WAS GROUND WATER ENCOUNTERED? Ny S IF YES, AT WHAT L DEPTH? p E Dep h to Water After Monitoring? 6s Batt //- /'•" &(A 20 IL JI PERCOLATION RATE (mmuteLmcn) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS %� S7��ATs_- /-'E.Pe /PATE 7 6o r.+.••+//.ve �. /VMS A,fe o /,r 1Jir'.e V PERFORMED BY: CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. 72-008 (Rev. 4,85) . � f`v�� Ct't•w ,tom, NOe••!•w w„•••. r Munletpsllty of AnchorageiIL DEPARTMENT OF HEALTH & HUMAN SERVICESButem ������ �•��•t 825'L” Street, Anchorage, Alaska 99502-0650 , it, c Lou CEaEi :.� F SOILS LOG — PERCOLATION TEST d��.'a __ ..•��{'� PERFORMED FOR: /T A%O PH e DATE PERFORMED: LEGAL DESCRIPTtnN• Lots B/k3 Fux.4•// Township. Range. Section: 1 z 3 Op 4 V 5 6 O 7 8 9 10 11 12 13 14 15 16 17 16 19 20 Tap tv%% /'ca GP f.P-crf Gra c//C/V.7 f A-77+'ea 7.6p WAS GROUND WATER ENCOUNTERED] S IF YES. AT WHATL DEPTH] 2' p E Beptll o W" AW I I I I I Maliwulq]A+.-� WI[ Raadiny pan Gro" Not Depth to Net Time Tim* Water Drop PERCOLATION RATE 111 A (minut*sincn) PERC HOLE DIAMETER 6 TEST RUN BETWEEN FT AND FT COMMENTS l/t/!//Gr %F 6/C Sea fly/ 'N'S /'�.t• �G 1`r�1� LJ./G 4 7't .Z• $�/ rv';O/'rip / 07' V/I i.:! PERFORMED BY: E R•Gr• 1 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. 71J ..O ? Municipality ofAnchorag•'••_� �•����•� DEPARTMENT OF HEALTH & HUMAN SERVICES «»•�••� `•j » 625 `L•• Street, Anchorage, Alaska 99502-0650 t? LOUIS k Buten SOILS LOG — PERCOLATION TEST CaE�•._ CE47>s PERFORMEO FOR: XAlo pHe DATE PERFORMED: LEGAL DESCRIPTION: Ll .7 Fux A, %l Township, Range, Section: OE►TM SLOPE SITE PLAN 7H3 IFEETI ITT—T—I 1 6 7 ^d 8 9 10 11 12 13 14 15 16 17 18 19 Grr/ G.cy � sa fr� co,s 6 /er WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? OW to Waw Ma yFr S L O P E SCG I ih: //+-d r£^ O•i ^•• Reading Data Grou Time Net Time Depth to Water Net OMP 1. r• �2 OG 0//4 :0 A, 5213/ O f -// "'/� 13$40/ /0 //c" r01 o a' -/%ate /'%. •• 20 PERCOLATION RATE /8 •1 (mmutosmchl PERC HOLE DIAMETER G TEST RUN BETWEEN f' FT AND 02 FT COMMENTS PERFORMED 8)e: E R G•r• I �'�— CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. // -•O 'o `t p Q 14FAN EMS EALT. ¢. . r Munlelpallty of Anchorage '•��' « DEPARTMENT OF HEALTH 6 HUMAN SERVICES 1y�utea 825 "L" Street. Anchorage. Alaska 99502-0650 � 'oj���. CE8T36 ,� ,a SOILS LOG — PERCOLATION TEST �Q"`ji�'`•'-b""``a PERFORMED FOR: H /✓o ro K e- DATE PERFORMED: LEGAL DESCRIPTION: I.otei B/k3 Fix A.%/ Township. Range. Section: pTH SLOPE SITE PLAN w J I o 2- 3- 4-- 5 3a5 6 _i v� 7 s 9 10 11 12 13 14 15 16 17 18 19 SGP) -'�.te Cr....+ SA" oy G/es �Ec (d -M ) ,lire y .f. %/s Se. rc/y 4 -awl S47`a. a 0—ma WAS GROUND WATER ENCOUNTERED? IF VES, AT WHAT DEPTH? YEf S L yi O P E w�B`After ag Water M *3.0 Batt //-/o -o o KA Reading Dat. Grou Time Net Time Depth to Water Net Drop S sA+ //—H neo / & i?to 1 .'a* D /=L"4a 3 tl .2t/p /'_6'y/�6 'A Y o .w .,.i S 107//6 �. w 20 -{ I , Ill PERCOLATION RATE 2'r. (minutesnnen) PERC HOLE DIAMETER G TEST RUN BETWEEN I'rFT AND oZ FT COMMENTS PERFORMED BY: E R C -•f• I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. -�. PERFORMED FOR: �/f A.)O AN a DATE PERFORMED: //— 7-00 LEGAL DESCRIPTION: Let.7 B/k3 Fu A A. %/ Township. Range. Section: P/T fl T iSLOPE SITE PLAN F! E ��-1 1 ' 2- 3- 4- 5- 6- 7. 3 4 5 67 8- 10 10 11 12 13 14 15 16 17 18 19 SASNoy 6-a•srEc WAS GROUND WATER ENCOUNTERED? VV 6; IF YES. AT WHAT DEPTH? Boo to WSW A Mooiwag? d,7 S L O P E Ir., ■moi■■���� 20 6 , PERCOLATION RATE (minutes,mcn( PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS - -��"GA ra /LI✓ /6 i/C/••4ji Sym% i,Ae/4,!Z PERFORMED BY. E'P•r'f. ICERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS CATE. DATE. OT 41.4I�� r, Municipality of Anchorage �S DEPARTMENT OF HEALTH & HUMAN SERVICES t'`+ .. •..•• ��; �� LouC A. Butera 825 "L" Street. Anchorage. Alaska 99502-0650 I%k SOILS LOG — PERCOLATION TEST ��-�._ .•���.: PERFORMED FOR: �/f A.)O AN a DATE PERFORMED: //— 7-00 LEGAL DESCRIPTION: Let.7 B/k3 Fu A A. %/ Township. Range. Section: P/T fl T iSLOPE SITE PLAN F! E ��-1 1 ' 2- 3- 4- 5- 6- 7. 3 4 5 67 8- 10 10 11 12 13 14 15 16 17 18 19 SASNoy 6-a•srEc WAS GROUND WATER ENCOUNTERED? VV 6; IF YES. AT WHAT DEPTH? Boo to WSW A Mooiwag? d,7 S L O P E Ir., ■moi■■���� 20 6 , PERCOLATION RATE (minutes,mcn( PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS - -��"GA ra /LI✓ /6 i/C/••4ji Sym% i,Ae/4,!Z PERFORMED BY. E'P•r'f. ICERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS CATE. DATE. MUNICIPALITY OF ANCHORAGE ® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME /'► PfHONEAI�W C-!�/C_%-/ 6}�Jli L.--C>�1JrS'i ^ !vC%�"'L,�% �� ❑ UPGRADE fM MAI LING AC'/ -C> S lt,-S'. 6..__.^%en,),o%/ LEGAL DESCRIPTION !_c>7- Z�-���a�� LOCATION . 0-,C>r NO. OF OOHS __3 U ._ x STANCE T0: Well / � �— Absorption area / � Dwelling .9 % PERMIT M< ZQ facturer r 1 ,� iZs f-� Lq Mate No, of compartments at F- aq c�}J� allons � IF HOMEMADE: Inside la e h _ Width -,� _ Liquid depth DISTANCE TO: Well welling PERMIT NO. _j0Z 2 Z ti Manufacturer Material Liquid capacity in gallons 0 LU S DISTANCE TO: Well Foun ation Nearest lot line PERMIT NO. � n. z z No. of lines Length of each line lfrjlfallangth of lines Trench width Distance between lines h W inches I- Top of tile to finish grade terial beneath tile Total effective absorption area 0 inches W 0n. Length, Width �� / D ,pjh/ Cr` �X Z ,} PERMIT �4� `I r J 1 .< CL Type of crib Crib diameter Crib depth Total effectivejbcey pUt a ku LU Well l , ;M y DISTANCE T0: �° Buildin foundaf n i Nearest lot line 3c / Class Depth Driller Distance to lot linePERMIT NO. J o W DI 1 E 0. a ' it ng f n Sewer line Septic tank Absorption area(s) OTHER FT / r PIPE MATERIALS SOIL TESTRATING INSTALLER G-%LtJ A4.4 F t� _ _y�W REMARKS I LJ[ -4-76— 1 T- �0 Lq � I Of AC ••��y �9'� � G pdf 1 9 .. •• or �� R� prEggl �Aw APPROVED -- -- � DATE20E., � / 17 rl"�1LiN+En�-lilf0 f/t �1 l iiia 7, idti �� •// % OWNER OF LAND ADDRESS LEGAL DESCRIPTI DATE • Started — PERMIT NUMBER Tisr.tiftrb l5ritting lwg by DOC Co. dba SULLMN WATER WELLS P.O. BOX 272, CHUG IAK, ALASKA 99567 • TELEPHONE 688-2759 DEPTH OF WELL STATIC LEVEL OF WATER FT -DRAW DOWN FT. _ GALS. PER HR KIND OF CASING KIND OF FORMATION: From Ft. to Ft. From Ft. to Ft. From Ft. to : Ft.- From Ft. to- --Ft.-From Ft. to Ft.- From Ft. to Ft. From Ft. to - Ft. From _Ft. to Ft From Ft. to Ft. From Ft. to--Ft- o— FtFromFt. From-Ft. to - -.Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to--Ft.--- oFt.Frorn From—Ft. Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. _ From Ft. to Ft. From Ft. to Ft. From —Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From__Ft. to Ft. From Ft. to_ Ft. From Ft. to Ft. From Ft. to -Ft MISCL. INFORMATION: DRILLER'S NAME kY�^� g., 1.'`�­"CAV 7- -,- R TA W W 191 P-4 IC,_*.- 11-11 KD P!! U.31 EE, DEPARTMENT OF" HEHLTH HND ENVlPONMENTRL PROTECTION 825 L STREET, RNCHORHGE/ HK 99501 264~4720 ����YES I _T_ EWE YES Q 14 BEE lot 021 ��.A.. �ENE FT, H -1 1: 'T PERMIT NT 840MAY HRND WRITTEN HPPLICANT C/O S & S ENG/GSCHUCHMHN CUNSTR HDDRAB 196X EHGLE RIYER/ HK 99577 CO@THCT PHONE694~2979 [EGf`lL DESCRIPSUBDIVISION: FOXHILL LOT2 BLOCK� ] SECTION: 4 TOWNSHIP: 15N RHNGE� 1W LOT SIZE� 41000 Q. F-1 OR HCRES) I CERTIFY THHT: 1. I HM FHMILIHR WITH THE REQUIREMENTS FOR ON~SITE SEWERS HND WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE (MOH) AND THE STRTE OF HLHSKH. 2 I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH FILL MOH CODES HND REGUHTIclNS, HND IN COMPLIHNCE WITH THE DESIGN CRITERIR OF THIS PERMIT ]I WILL RDH�RE TO HLL MOH HND OF FOR THE SET BHCK DISTH�CES FROM HNY EXISTING WELL/ WHSTEWHTER DISPOSRL SYSTEM OR PUBLIC SEWERHGE SYSTEM ON THIS OR ANY HDJHCENT UR NERRBY LOT. IF R LIFT IS INSTHLLED IN HN HRER COVERED BY MOA BUILDING THEN (J_) 1:­lN ELECTRICHL PERMIT AND INSPECTION MUST BE C)BTTINED/ (2) HS~BUILTS WILL NOT BE APPROVED WITHOUT HN ELECTRICHL INSPECTION REPORT/ HND (]) THE E037117H1_ WORK MUST BE DONE BY H LICENSED ELECTRICIHN SIGNED DHTE� IHPPLTCRNT� C/O ��& S ��NG'G� SCHUCH��N CONS ISSUED BYDHTE: yale .... ..... .. /.t5~�_~~~�..... .... _*_��', � � v ����,������ +�~ �\���� �� ` �����w�' ���� ������*�'�° ���������� l . ' A�_ «\/ MUIV1U1 AL1 1 Y Uh AIV(HUKAUt Department Health and Environmental "rotection 825 Street, Anchorage, AK. 501 264-4720 Permit # qo 11 i # # # HANDWRITTEN PERMIT WELL AND/OR ON-SITE SEWER PERMIT Applicant: (c 14 L. c_p /n ! Ti Mailing Address: Location: Legal Description: o T 2 Type of Soil Absorption System Is: Trench:. Drainfield: _ Maximum Number of Bedrooms: Phone Number: Lot Size: Z//oG�' Seepage Bed: � Holding Tank: Soil Rating(sq.ft/br) 5!VZ The Required Size of the Soil Absorption System Is: -3 .el _ DEPTH > LENGTH 55 GRAVEL DEPTH WIDTH 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 _ �� _ 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 tha bedrooms. Signed: _ Issued by: Applicant Com,/ Date: SWP/024(1/81) ❑ T SOILS LOG 1 i=� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 " (\� SOILS LOG — PERCOLATION TEST PERFORMED FOR: �JLj//(2 �!'/ /�/`Lw ��LYi/�^ DATEPERFORMED LEGAL DESCRIPTION: Z. EPT}I SLOPE SITE PLAN �E`r�%ljC/9d c 1 2 u -.3 G 4 c 5 � G 6 8 9- 10 10 11 12 13 14 C `V `.- f7 •DJ L. .,.__,__..ENE WAS GSR UND WATER UNTERED? Net Time Depth to Water IF YES, AT WHAT DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop 2- 3 el, to 7 h)ti A) /o , /.3 yy / b Reading Date Gross Time Net Time Depth to Water Net Drop 2- 3 el, to 7 h)ti A) /o , /.3 yy / PERCOLATION RATE % ��L/ (minutes/inch) 3/k TEST RUN BETWEEN 0� FT AND e2— FT 17/f� /A/ S `SCC 619 i •�.-. nV•.i:y:7111.`:' CERTIFIED PERFORMED BY. Iit71t?e it �tFt.,t 72-008 (6/79) DATE:, /��/ Municipality of Anchorage On -Site Water and Wastewater Program - (907) 343-7904 S a F e T r CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-073-03 Expiration Date: cj'1 77Z 1. GENERAL INFORMATION Complete legal description Foxhill Block 3 Lot 2 _ Location (site address) 22319 Woodcliff Ct. Chugiak, AK____ Current Property owner(s) Timothy Hull Day phone Mailing address P.O.__Box_672326 Chugiak, AK 99567 Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class _ Well ❑ Public Water System ❑ WaiverNariance request for: 3' Day phone TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ Received by: _ Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ _ _550 Waiver Fee $ Date of Payment _6/j�/2 1 Date of Payment Receipt Numberct-2 Receipt Number COSA # OS C 2 1 1 3 0 Z Waiver # Distance: 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. _._ Phone 696-6111_ Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577_ Engineer's Printed Name KENNETH M. DUFFUS _ Date Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future \ occupants or can ArcTerra guarantee that no unseen s .. UI' z,11 encroachments, deficiencies or discrepancies exist. /r4,9 , 6. DSD SIGNATURE r System #1 Approved for bedrooms. + rr•.nnETH M. lll5}I1' System #2 Approved for bedrooms. l �?� q 7/L"47 � Disapproved. Conditional approval for bedrooms, with the following stipulations: ON-SITE �y JAi - -- RAND rn -- - PROGRAM o� — 0, l By- � _. _ Original Certificate Date:Z( 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other 'e2 ./� (�d vcSru1 e COSA blue sheet -10-10-12 doc / Legal Description: Fox hill Block 3 Lot 2 Parcel ID: 051-073-03 If more than 1 septic system on lot: COSA Checklist # __of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 4/84 Total depth 141 ft Cased to 140.7 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 31 in. Date of flow test for COSA 5/12/21 Static water level at beginning of test 116 ft. Comments B. TANK DATA Age of tank(s) 20 years Tank type/material STEP/Steel Measured operating fluid level in septic tank 52 Standpipes/foundation cleanout per record drawing Date of pumping 5/24/21 D. ABSORPTION FIELD DATA Which system tested (date installed) 6/4/01 11 ALL standpipes present per record drawing Total measured depth from grade 3.3 ft (max) Measured depth to pipe invert from grade ft (min) N/A — pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Well production at time of test 5.6 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes No Coliform bacteria is Negative Nitrate 4.40 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L 11 Arsenic less than MRL (ND) Collected by Arcterra Consulting Date of Sample 5/10/21 C. LIFT STATION Required maintenance completed Age of lift station 20 years Lift station material Steel Comments: Adequacy test date 5/12/21 Results D Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 450 gal New depth 7 in Elapsed time 120 min Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 450+ and (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: 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' JZ Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft [O Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25'Z Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No ft ® Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' JZ Yes if No ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: ft Community Wells > 200' ® Yes if No ft Absorption Field > 5' ® Yes if No 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 septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® 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' ® 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 / 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 MUNICIPALITY OF ANCHORAGE Development Services Department- Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Lift Station/Pump Vault MS. Owner Street Address woalLa, Septic Tank: -Sludge level �ches -Pumping: requiredes o -Pumping completed yes no Lift station: A)A j -Pump basket cleaned ves no -Effluent filter cleanedey s no -Control floats cleaned es no0 •Properfloat settings confirmedesno -Operation satisfactory es no Alarm Svstem: -Dedicated electrical alarm circuit es no -Audible and visual alarm inside dwelling 60 no -Alarm system operation satisfactor not satisfactory Manhole Riser -Ground water intrusion at riser to tank connection es no -Ground water intrusion around pipe penetrations es o -Manhole lid: Functional Qg no Insulated es no Other -Weep hole functional Qes no Properly Secured es no -All manufacturer required inspections and maintenance completed es no Comments: Qualified Maintenance Provider: Technician Company C G S Signature Date of maintenancea2`'IG ilk Date�� Septic Tank Advisory Certificate of On -Site Systems Approval #OSC 211302 Subdivision: Foxhill Block 3 Lot 2 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 $11,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 -year-old steel tank MAY look like. �� ��� ,� ; ? VMai�i'ng Address � �O Box 196650 *Anchorage, Alaska 99519 6650 *www mum orgrv" k z_' fl�'.�,�. a,,."�.,r�s.<�,Fas^.•'�-+ v"„��.-,..�'a�., �,�*.x.,��.,.e:; �'�.�,�.z�'� w�..�=k,.�,�r_�,s�.'w,.z�..'>aw^'�wws.�..�#.,Pi,.-.5>"-„�:ux �s";�"-5:�a.:�`, �a �. ,�s .�r�ew.u�e. S�va�.. t'. cabs t-� Municipality of Anchorage --1 Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.O$I'D73 — 03 GENERAL INFORMATION. Complete legal description. _'• HAA # 645U Expiration Date: —Z 05 - Fox S Fox 14;11 5Khd1'Vl510A Location (site address or dir ec(ions) as 319 wood,CI iff CI. CuiteritProperty owner(s) Gar(j gndl LIE -AI IIC/` Mailing address a a 3 cl W OOa Cl 1 ff u. C kL9 Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, NAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well 19 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ ogle 3 Day phone 746 'O 7aa Iv Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm E0.91e R;ver En91neer(,r9 Address Io4aI VFW RJ,5N,'P_ a.V E-,qj NVer',Ak 89577 Engineer's Printed Name Ckrr 5foPfier R. LAJ(90CL 5. DSD SIGNATURE _j,L Approved for bedrooms. Disapproved. Phone Date 61171a0o5 Conditional approval for bedrooms, with the following Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory r r . • a. . u: ON•SIIE- ms WATER AND WASTfWATER PROGRAM ; Maintenance Agreements Supplemental Engineer's Report Other By:�Lr Original Certificate Date: (0 `%%- - �✓� (Roy 0IM2( Municipality of Anchorage • 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' r Legal Description: O -A ill C 4,W;Vijr0A. [(9fAf81OCK3 Parcel lD:O51-073-03 A. WELL DATA Well type r"yq to If A. B. or C provide PWSID # _ Well Log ((a/N) ye S Date completed 410 t Sanitary seal ()9/N) �ffls Wires properly protected ®/N) (JE5 Total depth I `� ft. Cased to L40.7 ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test _L4160 5 / I y 105 Static water level 1 10 ft. 11 y ft. Well production 30 g.p.m. 5 g.p.m. WATER SAMPLE RESULTS: Coliform O colonies/100 ml. Nitrate (,-73 mg./I. Other bacteria O colonies/100 ml. Arsenic: IVILO.1— mg./I. Date of sample:51(et i05 Collected by: Ck1 016 & 1zaP,'n: B. SEPTIC/HOtb1M6 TANK DATA TankTypelMaterial Ray/S 5erVtt_e5 Qlagf1 Date installed 6 X01 Tank size 1) 000 gal. Number of Compartments ot Cleanouts (51N) yes Foundation cleanout ('N) V e3 Depression over tank (YA9)) N High water alarm (Ya 0 Date of pumping (9I I a�0 $ Pumper J-05 &mp i n� C. ABSORPTION FIELD DATA Q Date installed 10MI0I Soil rating (g.p.d./W or 2 )0• Ll System type Uej, Length -76 ft. Width 15 ft. Gravel below piped 5 ft. Total depth 31 ft. Eft. absorption area (� 4Lft2 Monitoring tube Vf,% Depression over field Na Date of adequacy test _ 51 (.q I0 5 Results Fail) Po .SS For B bedrooms Fluid depth in absorption field before lest O in. Water added45Q gal. New depth O in. Elapsed Time: O min. Final fluid depth 0 in. Absorption rate >= Lf 50 g.p.d. Any rejuvenation treatment (past 12 mo.) (YA®& type) NO If yes, give date W/0. D. LIFT STATION Date installed 6/ O Size in gallons a80 'Pump on' level at 63 in.W 'Pump off" level at fz5 _ in.b (F Datum foPof /clanhof& Cycles tested 3 E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/ktr-station on lot 10 5 Absorption field on lot at D Public sewer main + -75' Sewer /septic service line f a5 Manhole/Access OYN) High water alarm level at 60 in. W Meets alarm & circuit requirements? ; e0 s On adjacent lots (00' On adjacent lots 10 0 Public sewer manhole/cleanout -1 00 Holding tank -k 100 SEPARATION DISTANCES FROM SEPTICIDOL* NG TANK �b� Building foundation -� Property line -t ON LOT TO: Absorption field J o $ Water main + to Water service line t i0 Surface water Wells on adjacent lots 1d0 +(00 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 0 Building foundation [ by Water main Water Service line 4 t 01 Surface water 11490� Driveway, parking/vehicle storage Curtain drain *'5,0 Wells on adjacent lots t (010, F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engine7&er's Printed Name Chr;5toPher Or W(4ed Date -6 l ( 40 S HAA Fee $ gm.to Waiver Fee $ _ Date of Payment 1)/1-7 )AM- Date of Payment Receipt Number 'f%°il� 1�1) 9MY\_ Receipt Number (Rev. 12/01) MJ ASBUILT 1 h 1� Y �v Y• - ✓ w�a `�� Cou�7 I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY= '-�nr .0/LG _fz2e AND THAT NO EPfCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. SCALE, DATE, GRID= F& DRAWN, ;,Z -V -r ��qkqk%% � •� pF AAC�P4 y ;� •THtlfyj D."* M6,k Svwvrd ����•. LS -6918 ar t'2�' *'of •.,wTviA G-24-06; 9:39AM; ;907 6816301 0 B - SCS ReLM 1052814001 CUent Nome Eagle River Engineering Project Name/0 Fonhills 1.2 B3 Clknt Sample lD Foxhills L2 B3 Matrix Drinking Water Sample Remarks: All DateaMmes are Alaska Standard Time Printed Date/Time 05/23/2005 16:17 Collected Date/time 05/19/2005 12:45 Received DateMme 05/19/2005 15:52 Technical Director Stephen C. Ede Allowablo Prep Analysis Parameter Results PQL Units Method Com ainer m Limits Date Date [nit Waters Dopartment Nitrate•N 1.73 0.100 mg/L EPA 300.0 B (<-10) 05/19/05 Dn Microbiology Laboratory Total Coliform 0 col/100ml. SM2092229 A (o-1) 05/19/03 TLF h (;.¢f'ne,I r - Municipality of Anchorage re"i f (I rd- , Development Services Department " Building Safety Division � On -Site Water and Wastewater Program 4700 South Bragaw St. lP �4-9 CJS S A , r; P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.D5i!- D -73-o3 GENERAL INFORMATION HAA# NI; 0I03a-0 Expiration Date: jX 19-a-7-01 Complete legal description T --OX .. -H I LL L;a - IS 3 Location (site address or directions) 19 lti br)d CI 'PC 0,00. v t 1-46cO -4-7 a Current Propertyowner(s)1//JAmeS lenoj2Le- Dayphone X 3�3tc Mailing address t ) lox I s �2Y1 i� �c �I q -7 a S Lending agency Mailing address Real Estate Agent Mailing Address Day phone k,.rAy ser..: cz Dayphone G5v-5i�s- f ee ,e, ,i, ysr» Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site N Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Is(are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Eagle River Address P.O. Boz 773294, Erle River, Phone &6N- S 195 Engineer's Printed Name -/-,3 ti'y f?,. /,- -, Date (';-- G-- o r A M 5. DSD SIGNATURE v i Loins -V36 ra I� Approved for _: bedrooms. k$�` h'•ef�;� Disapproved. SPL• tt itx Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Q!�Zl Oricinal Certificate Date: O (Pe.. 12C) Municipality of Anchorage • ~' Development Services Department •f Building Safety Division On-Stte 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: (-0X 14, c L, La 63 Parcel ID: A. WELL DATA. la Well type �nkf!e. If A, B. or C provide PWSID _ Well Log (YIN) Date coropieted 4'gW Sanitary seal (YM) Y Wires property protected (YIN) i Total depth 8&—ft. Cased to Iv°. ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION 'Date of test ' 8 `/ t3 -Do Static water level / ° ft. //57 ft. Well production 3o g.p.m. S. a g.p.m. WATER SAMPLE RESULTS: Coliform __*b_colontes/100 ml. Nitrate JjAl mg./l. Other bacteria cotonies/100 mi Date of sample: –dz/IZ9001 Collected by: E*51' 1'9-wuf le;vf`011"'r B. SEPTIC/HOLDING TANK DATA Tank Type/Material N D Pt: Date installed 6� " Tank size I XW gal. Number of Compartments _91 Cieanouts (YIN) , Foundation cleanout (YM) Depression over tank (Y/N) /a High water alarm (YM) Y Date of pumping ^VA./ Pumper C. ABSORPTION FIELD DATA Date installed ID D 1 Sod rating (g•p•dafe or ft'/bdrmJJ_q_ System type I�P� Length -In ft. Width 15 ft. Gravel below pipe 0. S _ ft. Total depth I ft. Eff. absorption area /13S ft= Monitoring tube V Depression over field Nc Date of adequacy test "V /A _,Vo&d Results (Pass/Fad) Adt For 3 bedrooms Fluid depth In absorption field before test — In. Water added= gal. New depth —in. Elapsed Time: =min. Final fluid depth _ in. Absorption rate >= + Ora g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed (a - N - CSI Size in gallons a'30 Manhole/Access (Y/N) Y "Pump on" level at, in. `Pump oft level at 9-4- in. High water alarm level at y 9 In. Datum Oo n..., a N 14 u.0 Cycles tested !� � Meets alarm b circuit requirementsT E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankllfft station on lot 103 r Absorption field on lot �� r Public sewer main ev /g Sewer /septic service line as On adjacent lots t-/oo' On adjacent lots t /0,9' Public sewer manhole/cleanout 1Vh Holding tank Nowe SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation '� / Property linea�b /r Absorption field �a ° Water main /✓AIve Wells on adjacent lots 4 /°v' Water service line -A2L-' fA r" Surface water t/°•' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: � t Property line I a Building foundation 1$5 Water main * /o t -f- Water Service line t 110' Surface water Driveway. parking/vehicle storage Curtain drain *-10' F. COMMENTS G. ENGINEER'S CERTIFICATION Wells on adjacent lots t �• I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name L.Du i5 A - _P,)ufey4 Date 10 - a o - O 1 HAA Fee $ so 0"Y I t Waiver Fee $ _ Date of Payment I Date of Payment Receipt Number Receipt Number (Rev. 12/00) Loins A &bra CEAM f/e/ Or A 49TH....•,. ;9s�ol TH LOUIS A. BUTERA .;"I Y• J� •. LS -9338 co' RT — �W000 C1JFF POLE 3x :NO: SET FOUND REBAR QQ • ALMON.O HUB AND TACK 0 FENCE{-/.f.{�-{-f• WALKWAYS WOOD DECKS GRAVEL DRIVE '•" SEPTIC STANDPIPES WATER WELL + EAGLE RIVER SCALE 10AT-- 18'11. sNEET: ENGINEERING SERVICES ASBUILT SURVEY r -so' 6/12/0 1 XMS 1 .� P.O. Box 773294 10421 VFW Drive OWNER: JIM KNOPKE ERES Project Number. 00-064 Eagle River, Alaska 99577 DESCRIPTION: FOX HILL (907) 694-5195 FAX. • (907) 694-3297 LOT 2, BLOCK 3 CADD File Name: 00-064AB I hereby certify that I hove surveyed the following described property. Fox Hill, Lot 2, Block 3 Anchorage Recording Precinct, Alaska, and that no encroachments exist except as indicated. It is the responsibility of the owner to determine the existence of any easements• covenants, or restrictions which do not appear on the recorded subdivision plat. Under no circumstances should any data hereon be used for construction of fence lines, or for establishing boundary lines. v MUNICIPALITY OF ANCHORAGE „. • Department of Health & Human Services DIVISION.OF.ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL. OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # �� 1 ��-13- o HAA # Y LkLA 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 2: >3kock 3: Foxhi.22 Subdivi,5ion Location (address or directions) (b) Property owner oodaP. 6 Couk Mike. Pience Mailing Address (c) Lending Institution Mailing Address P.0.8ox 5074 C Telephone: (home) 688-1363 Business Ata6ka 99567 Telephone (d) Real Estate Company and Agent Address Telephone - — (e) Mail the HAA to the following address: (or check here XX if hold for pick up.) List contact person and day phone number below: ENGIfGc , 17034 Eagle River Loop Road No. 204 ragis River, Alaska 9ss 2. TYPE OF RESIDENCE 2 / Single -Family CSX Number of bedrooms 3. WATER SUPPLY Individual Well lX Community ❑ Public ❑ Note: if community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site M< Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone Address S & 5 ENGINEERING 170"4 aag ® eY Loop Road No 904 rhlasa 99577 � lDate �/ - mti ee •° .• ie •ar ee. ••°e ree.eX r..F�/ •.• .... sr ,°1ST ��• �&IShwfet � ��� No. 1457-E s AV 11 PRop S'DO' 6. DHHS APPROVAL Approved for bedrooms b ate Approved —. Disapproved Conditional Terms of Conditional Approval. //� wp�'/ryr�r9/i`D�/�9y �es� rrnr✓s� o' -e '�ct/l7 i� X1 reqs©�QII h�� ���/� ✓�� � �Q�/A T/,�r ,le 7Z � e -d' c�' 7�--4_7` ����. �.l� l a��o�r —n, mss/ Ae q�CI 6�y1177Z 11),� Y4/Le iYlo,¢ �P410 CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 isnot responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 ,o�ea th Authority Approval( EA(AMOA) p fi�j ���pP� • CHECKLIST - FEBRUARY 1984 M MSN jjEN 343-4744 0, Legal Description: L--o-r A. WELL DATA Well Classification �1 If A, B, C, D.E.C. Approved (YIN)� Well Log Present0/N) Date Completed � f a� _ Yield -, 1,P11,1 Total Depth)_Cased to Depth of Grouting Static Water Level — 414 Pump Set At � Casing Height Above Ground Sanitary Seal on Casing &N) Electrical Wiring in Conduit) Depression Around Wellhead (Y/(9 SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot 10 ; On Adjoining Lots �C) C) I To Nearest Edge of Absorption Field n Lot t4_ro' ; On Adjoining Lots t i To Nearest Public Sewer Line f 0 To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot 45 Water Sample Collected by Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed "��"3�I Size 0000 No. of Compartments Standpipes&N)yAir-,tight Caps49/N) y Foundation Cleanout 6)N) _ Depression over Tank (Yo /X/Date Last Pumped -zG ld Pumping/Maintenance Contact on File (YIN) !Y/� ; for Holding Tank High -Water Alarm (YIN) Temporary Holding Tank Permit (YIN) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well 1 C3 -z) To Building Foundation . 1_ - To Disposal Field /O To Property Line /b To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA l2 Soils Rating in Absorption Strata + Type of System Design Date Installed ` ZZ S 4- Length of Field 5,2.1 Width of Field Depth of Field —3,5- Gravel Bed Thickness OV-�/[�rJ�F2 Square Feet of Absortion Area / S loc5 i Statndpipes PresentON) V Depression over Field (YO /Y Date of Last Adequacy Test Results of Last Adequacy Test .5A'i;IJ P%,4er 4"@ e /=oZ_ 3 51z— SEPARATION 2 SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well / iv r To Property Line To Building Foundatio �o ' To Existing or Abandoned System on Lot �� ; On Adjoining Lots J0 / � To Water Main/Service Line l4 To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course /0,0111- To DD111-To Driveway, Parking Area, or Vehicle Storage Area 70 Comments D. LIFT STATION Date Installed Size iy' n Gallons "Pump On" Leve High Water Alarm Level Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) _ "Pump Off" Level at Vent (YIN�Y_ "Check Permitted Bedroom Rating Against HAA Request" Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines inspection. 5 & 5 ENGINEERING Signed �fus agFe River Laap Road No 204 Company EacIle River, Alaska 99577 Date? MOA No. 1,L" _ 00,c Receipt No. � d� oL�o`d Date of PaymentC�_o Amount: $ o - y 6 Receipt No. Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 ift,e,ffect on the date of this 2 ,<, V 7 f:01]9d A. G d 131' �4 1457•E �yq �SIp�4 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET • ANCHORAGE, ALASKA 99518 - TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order # 26384 Date Report Printed: AUG 16 90 @ 09:58 Client Sample ID:L2 B3 FOXHILL S/D PWSID :UA Collected AUG 14 90 @ 11:00 his. Received AUG 14 90 @ 16:30 his. Preserved with :AS REQUIRED Analysis Completed :AUG 15 90 Laboratory Supervisor :STEPHEN C. EDE Released ByV#t>4f Y ................. j ........................................................... Special FAX RESULTS UPON COMPLETION TO 694-1211. Instruct: Chemlab Ref M: 903033 Lab Smpl ID: 1 Parameter Tested -------------------------------------------------- NITRATE-N Sample ROUTINE SAMPLE. Remarks: SAMPLE COLLECTED BY RDJ. Matrix: WATER Client Name S & S ENGINEERING Client Acct SNSENGP P.OJ NONE RECEIVED Req # Ordered By : R. SHAPER Send Reports to: 1)3 & S ENGINEERING 2) Result Units Method ------------------------------------- 1.1 mg/l EPA 353.2 Allowable Limits -------------- 10 ............................................................................................................... 1 Tests Performed See Special Instructions Above UA -Unavailable ND- None Detected See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY ry 6JL 264-4720 Application Date Zz 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name Telephone: Home — Business Applicant Address �16� (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder,g; Buyer ❑ ; Other ❑ • (explain); - (d) Lending Institution Telephone 3. WATER SUPPLY individual Well Community ❑ Public ❑ r, Note: If community well system, must have written confirmation from the State Department df Environmental Conservation attesting to the legality and status. ( f) I 4. SEWAGE DISPOSAL Onsite ,k Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DAl m AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm SS ENGINEERING Telephone 6� —2Q 7 47 1 034 E�gul, RAyer Loop Road No Addre Date ,�•,,•.1, exit b ��q �ecsssse• 'i G II I �C: C}V yM•�/' a••+ An OB +b e 467.6 .° 4 log 6. DHEP APPROVAL Approved for —"s`�- bedrooms by Date�C Approved Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) 1G17P�1TI �R� Ct-S l Oty A. WELL DATA 0le MUNICIPALITY OF ANCHORAGE (MOA, HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: I :�%—_.3 Fa u A1.e'e_ *14 Well Classification S - F If A, B, C, D.E.C. Approved (Y/N, N Well Log Present/N) Date Completed Yield (0 Total Depth ZVI Cased to Depth of Grouting Static Water Level /� 3' Pump Set At Casing Height Above Ground — Electrical Wiring in Conduit (O/N) Separation Distances from Well: Sanitary Seal on Casing 6 1\1) — Depression Around Wellhead (Y& To Septic/Holding Tank on Lot SOS ; On Adjoining Lots /cen') 4f To Nearest Edge of Absorption Field on Lot On Adjoining Lots To Nearest Public Sewer Line R To Nearest Public Sewer Cleanout/Manhole %�� A To Nearest Sewer Service Line on Lot Water Sample Collected by Sd S L N l�7 f -Ir E2 )N G ; Date 7 " Y`9 7 ` Water Sample Test Results Comments Z&Z?:;t F+25 B. SEPTIC/MOLDING TANK DATA --�L ( _ 1 Date Installed �✓ z2 Size �ooD No. of Compartments Standpipes tr N) _ Air -tight Caps O/N) Foundation Cleanout (4/N) Depression over Tank (Y/b Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) Date Last Pumped ; for N! /� Temporary Holding Tank Permit (Y/N) NZ,9 Separation Distances from Septic/Holding Tank: To Water -Supply Well /cbs,/ To Property Line — To Water Main/Service Line — Course N_X Comments Page 1 of 2 72-026(11/84) o14 To Building Foundation L12– To ZTo Disposal Field W To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 3 �7 //�� Type of System Design r Date Installed �l��i Length of Field �Z Width of Field 3 pi Depth of Field A_ S. 5 Gravel Bed Thickness Square Feet of Absorption Area /-5 Loo46 Standpipes Present(N) Depression over Field (Y& Results of Last Adequacy Test Date of Last Adequacy Test � Separation Distance from Absorption Field: To Water -Supply Well / L/01 To Property Line To Building Foundation LVO To Existing or Abandoned System on Lot t_J/4 ; On Adjoining Lots ��r_7L To Water Main/Service Line �y�� To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course N/A To Driveway, Parking Area, or Vehicle Storage Area :2 U�'F Comments D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S & S ENGINEERING Signeq7O34Eagleate Com River, Alaska 99577 MOA No. t 4 Aew , Receipt No. � Zoo/ b±� -2S� X71 r r Date of Payment "6� i 3�,5`. Amount: $ l �v O sE:<Afi., eer's Se ur °`E: Page 2 of 2 72-026 (11/84) MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL, PROTECTION APPLICATION FOR HEALTH AUTHORITY. APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (inef), de lot, block, s}zbdivision, section, township, range) Location (address or directions) (b) Applicants Name � j�; l.ephone - Home __ Business Applicants Address___ (c) Applicant is (check one) Lending Institution. ; Owner/builder-.; Buyer ; Other Ii_lT(explain); (d) Lending Institution Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. eke_ of Residence Single-•FamilyrTT` Multi -Family Other (describe Number of Bedrooms Telephone 3. Hater Supply Individual Well Community I Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. fir. Sewage Disposal Onsite L =;jj Public Community � T Holding 'Yank Note: If community well system, must: have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 21 5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information As certified by my sea! affixed hereto and as of the validation date shown below, I: verify that my investigation of this Health Authority Approval shows that the on-site mater supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect: on the date of: this inspection. I I!2 Name of Firm i I= Address D (ENGINEER SEAL) ',, 6. DIIEP Approval. Approved for �bedrooms By LL' ;`_ �. Date Approved Disapproved —T Conditional _.._�.. Terms of Conditional Appi'ova CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES LASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE, DLII?P DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL. AND STATE REQUIRE- MENTS. EMPLOYEES OF DIIEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. TIME MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DUEP SEAL.) RR4/ej/D18 [Page 2 of 21 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) i HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 A. WELL DATA Well Classification 'Sr If A, B, or C, D.E.C. Approved(Y/N) �— Well Log Present ) ti Date Completed21 Total Depth )�-y Cased to Z!ZD 1 Xf Depth of Grouting •� Static Water Level Pump Set At Casing Height Above Grounder Sanitary Seal on Casir. (/N) Electrical Wiring in Conduit (OLN) Depression Around T�bllhead (Y Separation Distances from Well: To Septic/H&141-mg Tank on Lot /01-5 On Adjoining Lots�� 7� r � To Nearest Edge of Absorption Field qn/ 449 Lot 2On Adjoining Lots To Nearest Public Sewer Line /A To Nearest Public Sewer Cleanout/Manhole 'v//I Water Sample Collected By To Nearest Sewer Service L'ne on Lot Date o ,I; Water Sample Test Results _.2 i -7-/ :: ;� �_— Caments I A l �;z:Ve' «'s B. SEPTIC/[WG TANK DATA Date Installed ip-z- ttoy Size /6-6961) No. of Ccxrpartm?nts Standpipes 1) Air -tight Caps /N) Foundation Cleanout Q"�%'N) Depression over Tank (Y4 Date Last P d�^`� _ Pumping/Maintenanee Contract on File (Y/N)`�/, ; for Holding Tank High -Water Alarm (Y/N) /L -Temporary Holding Tank Permit (YM)___ Separation Distances from Septics Tank: r To Water -Supply Wall_ Uy To Building Foundations To Property Line _� / -/L To Disposal Field To Water Main/Sery�ce Line it To Stream, Pond, Lake, or Major Drainage Course 114 Continents [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorp ion Strata 3 `i" �'ti Type of System Design n Date Installed �' �- c� Length of Field Z Width of Field —� a ' Depth of Field i Gravel Bed Thickness % Gf t�y2 Square Feet of Absorption Area 16 e-7 U Standpipes Present(CM Depression over Field (YAP D e of Last Adequacy Test Results of Last Adequacy Test I/9� Separation Distance from Absorption Field: To Water -Supply Wall / �%1� To Property Line /O To Building Fo%ndation To Existing or Abandoned System on Lot// On j djoining Lots / To Water Main/Service Line /1 To Cutbank(if resent) /, To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Comments Dinens ions Manhole/Access (Y/N) " Off" Level at Vent (Y/N) Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or, conformed to all MOA on the date of this inspection. r - Signed t� f'rrP(4 Date _ Company PI9 196)C MOA No. � wlwiw, dkd A6;K 4 ^a! FI -L 6339/11, 870 KB1/d5/s [Page 2 of 21 •i -J in effect ' ., /4 E�b✓ A. - 1}u. tfJ.47.F r L .0 yL S•` 2-15-84