HomeMy WebLinkAboutBERNARD BLK 3 LT 5Bernard Block 3 Lot 5 #060-321-19 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 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP231358 Work Type: SepticTank Upgrade Tax Code Number: 06032119000 Site Legal Address: BERNARD BLK 3 LT 5 G:0254 Site Mailing Address: 8080 STEWART MOUNTAIN DR, Eagle River Owner: GRIFFITH SHELLEY ANN & Design Engineer: NORTH RIM ENGINEERING This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date: O Departinent Lot Size in Sq Ft Total Bedrooms: 10/18/2023 10/17/2024 27032 ❑ 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 Special Provisions: • The log crib is to be decommissioned. -RpeGk,ed�: L 5-25tAe o i fh /K Date: Issued By: ��� �/� Date: a 8 4 UMHMPAUTY OF ANCHOR AGE 1 Development Services Department ^R Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 06032119000 Property owner(s) RAY GRIFFITH Mailing address 8080 STEWART MOUNTAIN DR Site address same Day phone 405-234-7314 Legal description (Sub's., Block & Lot) BERNARDBLK 3 LT 5 Legal description (Township, Range & Section) Lot Size 27,032 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo AD U) Septic Tank El UpgradeX ❑ Duplex (D) El Holding Tank El Renewal El Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 2 Date of Payment: Receipt Number: Permit No. i Jpz � 13-96 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc SteveEng.com BERNARD B3 L5 SPECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing: The current septic tank has failed- COLLAPSED! The seepage trenches still functioning. This lot is close to a half-acre and on private well. No adverse impacts are expected from tank replacement. No easements are present on the lot. The slope is indicated in the area of the septic system. No conflicts to neighbor properties. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations. New 2- compartment, 1250 gallon septic tank. Watertight couplings on inlet & outlet. 5 minimum between the tank and trench. 5 to property lines & 10 to house. 4 of cover or insulation is required for tank; an equivalent of 1 insulation for 1 foot soil cover. Tank & solid pipe must be set on well compacted, stable soil. No large rocks for tank bedding. Plastic/fiberglass tanks require special bedding per MOA- sand or pea gravel. 4 diameter cleanouts with airtight caps are required 1 to 4 from foundation wall, prior to any 90 degree bend in 4 inch line, in 2 nd tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field, not more than 10 from the tank positioned to provide cleanout access towards the tank and towards the absorption field. Manhole Riser required in 1 st tank compartment. All cleanouts must extend to at least ground level. In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron. Insulation must be placed over any pipe installed under driveways or parking areas. Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, Sewer Service Line is minimum 2% slope. Septic Tank to be pumped every two years or when required. Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal) Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231358, Deb Wockenfuss, 10/18/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231358, Deb Wockenfuss, 10/18/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231358, Deb Wockenfuss, 10/18/23 Job No.: 04-148 ♦ Well Owner: _ ♦ Legal Description: M -W Drilling, Inc. *P.O. Box 110378#Anchorage, AK 99511• ♦907-345-4000 • 907-345-3287 Fax* Project No.: N/A Permit No. SW040120 Groutrdwater We//As-Built & Lor i1GNgICA r-T&j ♦ Use of Well: Domestic Eagle River, Alaska Construction 4Hole Depth: 84' ♦Casing Size: 6" ♦Cased To: 60.35' ♦Alaterial. A53Steel *Drill Method. Air Rotary _ Perf. ♦ Well Completion- Open end X Screen _ Perforated _ Met/hod: ♦Sereen/Perforatlon description: None ♦ Grout Notes: (1) Sack- No. 8 bentonite granules ♦ Notes: ♦ Well Development: Method: Air surge Notes: *Static water level (SWT) 12' (above) (below) top of casing (TOC). ♦ Nell yield test at 15+ gallons per minute (GPM)/gR&ms perlhougGPN) for I hours with 100% of drawdown (DD) from static level (SIVL). _ ♦Method: Airlift ♦ Date of completion: 14 June 2004 ♦ Pump lnstalJ: Well Env Depth In feet from top of casing. Details of formations penetrated, size of material color and hardness. 0 TO 2 Casing stickup 2 TO 3.5 Organics 3.5 TO 24 Silty: boulders 24 TO 28 Boulder 28 TO . 59 Gravelly silt: cobble 59 TO 82 Bedrock: black 82 TO 84 As above: fractures . TO TO TO WAYNE E. WESTBERG TO President, M - W Drilling, Inc. TO NGWA Certified Contractor TO TO Certificate o% 1 ontractorsficense No. -1000 TO TO TO MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WATER SUPPLY PERMIT Initial Date Issued: May 13, 2004 Expiration Date: May 13, 2005 Permit Number: SWO40120 Parcel ID: 060-321-19 Legal Description BERNARD BLK _3 LT -51 Design Engineer: 0000 None Required Site Address: Owner Name: Janice & Guy Fulton Lot Size: 27032 SQ. FT. Owner Address: 8080 Stewart Mountain Drive Total Bedrooms: 4 Permit Bedrooms: 4 EAGLE RIVER. AK 99577-0537 This permit is for the construction of: ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy Q Private Well ❑ Water Storage All construction must be In accordance with: 1. The attached approved design. 2. All requirements specked 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 DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 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 dosed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. THE INSTALLATION OF A WATER WELL SHALL MEET ALL THE ANCHORAGE MUNICIPAL CODE 15.55. PLEASE SEETHE ATTACHED SHEET "PERMIT REQUIREMENTS FOR A DOMESTIC WATER SYSTEM". IF THERE ARE ANY QUESTIIONS PLEASE CALL THE MUNICIPAL ON SITE WATER AND WASTEWATER PROGRAM AT 907-343-7904. Received By. Date: 5 115P Issued By. (l /1 Date: S 1? H Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING s suer• Parcel I.D. (DI Ol J` 3:? 1 —19 Permit Number SW Property (oG(o -Sos-I Mailing address (1) "(2, 0 c6Q M'-�j ri r Mailing address (2) F_ - • tC_ Q '7 � 1 Zip Code Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Lot Size 7) , 0 3 7/Acres Sq.Ft. THIS APPLICATION IS FOR: Number of Bedrooms 4 Sewer Only ❑ Well Only 9 Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. of property owner or authorized agent) Permit Fees: <�Lj D < Waiver Fees: Date of Payment: 10 1 c' 19r.Date of Payment: Receipt Number: I It�Receipt Number: (Rev. 12100) r. v w N •Gd./�✓F ASBUILT-NO CORNERS SET THIS DATE. 0 I HEREBY CERTIFY THAT i HAVE SURVEYED THE SCALEt FOLLOWING DESCRIBED PROPERTY= ����� ••� Of q(��R sf.P.siy.O.ra�Qlorr� '.� : DATE* �.... ...... 1 � AND THAT NO ENCROACHMENTS EXIST EXCEPT AS 9��yy r'�Q.. 41, AND INDICATED. IT IS THE RESPONSIBILITY OF THE i * ; 9TM •• �';9 • OWNER TO DETERMINE THE EXISTENCE OF ANY GRID- •.. ' "•••••• �t EASEMENTS, COVENANTS, OR RESTRICTIONS rw vi-P,i _ . w.► ....... VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD F& o f¢;•. LS -6918 N ANY DATA HEREON BE USED FOR CONSTRUCTION Y9 p f�-,. `•► OF FENCE LINES, OR FOR ESTABLISHING BOUND -DRAWN ±we. �1t'p ARY LINFR �_ Municipality of Anchorage Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343=4744 On-Site Wastewater Disposal System and/or Well Inspection Report. Permit Number: SW91104i22 PID Number: (<a0 ?2//9 Name: Wastewater System: ❑ New Xupgrade E Address: ABSORPTION FIELD P.O. &x 7 ppeme of Bedrooms: To. 'Deep Trench j81 Shallow Trench ❑Bed El Mound C] Other E i vEz? 77 LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: GPD/Sq. Ft. • r Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe S_ 2 /-?6-,;e .4%z S n 6 Ft. ,.S Ft. Township: Range: Section: Fill added above original grade: Gravel length: Ft. ��� Ft. WELL: El New El Upgrade Gravel width: Number of listancebetween 2- ines: lines: D/d S Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: F /C3 P&Z,=- C ^ m0 A) T Y Ft. Ft. 004 SO. Ft. q6TM D303y /? V. C. Driller: Date Drilled: Static Water Level: Installer: %2UCT/O� Date Installed: /l "/ —9 Ft. E" NS Yield: Pump Set at: I Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES Xseptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Man facturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines I 2 T�A /26­0 weltz6;04 2�JU '� 25) � Material: STEEL Number of Compartments: z Wates lav �f LIFT STATION ,�o'f Lot / Size in gallons: Manufacturer: Line 7-Ca 2-7JE_ Foundation "Pump on" level at: mp off' level at: High water alarm at: S- V Curtain K 0 W/1! Pump Model Electrical Inspections performed by: Drain BENCH MARK Remarks: Location and Description: [gym - T P OF aARA06' 71.4.13 Assumed Elevation: xe.m ENGINEER'S SEAL or Fir .............: 2• 17034 Eagle River Loop Road, No. 204 , •,:°r P Inspections performed by: Eagle River. Alaska 99577 Dates: 1st /i -9-9q 2nd /i - /o-9y s! ^'9e I ROEFRT C. COWAN i 4, <� CE-8801 ^firy' Department of Health and Human Services approval 4��4. - -2-Z- Reviewed and approved by: Date: 72-013 (Rev. 9/91) MOA 25 Permit NoSW940422 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal DescriptioH�RNARD SUBDIVISION, BLOCK 3, LOT 5 PID No.: 060321 19 72-013 A (1 /93) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ///-9 PAGE 1 OF 1 1s+ I I�ejR4 C&' z::15opm SlJJ 11 el I °14 @ L 0 �13O PfM ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940422 DESIGN ENGINEERS & S ENGINEERING OWNER NAME:STANFIELD THEODORE L & OWNER ADDRESS: P.O. BOX 772822 EAGLE RIVER, AK 99577 PARCEL ID:06032119 LEGAL DESCRIPTION: BERNARD BLK 3 LT 5 LOT SIZE: 27032 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED:11/02/94 EXPIRATION DATE:11/02/95 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 343-4744 (24 HOURS) . 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: A HORIZONTAL SEPARATION OF 25 FEET FROM THE CUTBANK IS PERMITTED PROVIDINGT TOP OF THE EFFECTIVE DEPTH OF THE DRAINFIELD IS THE B MM OF THE DRAINFIEL,p. DATE : q/4 DATE: RECEIVED BY: ISSUED BY: U nyi� October 22, 1994 ROBERT SHAFER, P.E. CIVIL ENGINEERS (907)694-2979 FAX 694-1211 HEALTH AUTHORITY D APPROVALS Municcpat ty ob Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street P.U. Sax 196650 SEWER &WATER Anchorage, Atazka 99519-6650 MAIN EXTENSIONS REFERENCE: Lot 5; Btock 3; Bernard Subdivision SEWER & WATER INSPECTION Request you -issue a pexmit to upgxade the septic system sexv.ing the joux bedroom house on the %ejeaenced pxopexty. A test hate was excavated and a percotat.ion test per6armed. The ENGINESTUDIES AND REPORTS PORTS }gyp ll a roximate toeation a the test holes i6 toeated on the attached site plan. The monitoring tube within the test hate has been checked and bound to WELL INSPECTION be dry. & FLOW TEST This property is serv.iee4by a public waters system. We do not anticipate any adverse ebbed# on the neighbolLing pnapenties by the insta tat.ion o6 the proposed septic system. There .is no prateeti.ve weU %adii which SITE PLANS encroach upon the property. AtAo xequut you giant a waives box the hoxizontat aepaxation distance, of the teaehi.ieQd to the cut bank to a minimum of 25'. We beet this ROAD DESIGN waiver shoutd be granted because the top ob the e6jecti.ve depth i'6 apprax-i.matety at the same eteva.tion as the bottom o6 the cut bank. Shoutd you require add.it.ionat .in4armat.ion please contact us. SOILTEST S.ineerety, PERCOLATION TEST A�rr ROBERT C. COWAN RCCl_ck STRUCTURAL& ENCLOSURES MECHANICAL INSPECT ONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP SUITE 204 • EAGLE RIVER, ALASKA 99577 b II UJ I U0, v A LEGAL BERNARD SUBDIVISION, BLOCK 3, LOT 5 DRAWN J. ANDERSON cKD• R.C.C. DATq 0-21 -94 ISHT. 1 OF 1 DESIGN CRITERIA: 4 BDRM = 600 GPD SOILS = 0.6 GPD/SQ.FT. R FACTOR = 0.54 600/0.6 = 1000 SOFT. REQ'D �D-RAIN-FIELD S : 5' WIDE_-' DEEP 3.5' EFFECTIVE 108' TOTAL LENGTH (1 @ 53' & 1 ® 55') ALL PORTIONS OF SYSTEM WITH LESS THAN S.5' OF COVER REQUIRE INSULATION. POLE 2 I INF STRUCTURES, EASEMENTS, OR ENCROACHMENTS SHOWN ON THIS SITE PLAN ARE AS SHOWN ON AN AS -BUILT SURVEY DRAWN BY: DUANE MARK SEWARD IT IS THE RESPONSIBILTIY OF THE CONTRACTOR TO VERIFY EASEMENTS, REQUIRED SEPARATION DISTANCES, AND PROPERTY LINES PRIOR TO CONSTRUCTION. VALVE -EXIST. SEEPAGE PIT ABANDON SUCH THAT IT MAY BE USED IN THE FUTURE PROPERTY SERVED BY PUBLIC WATER SYSTEM. NO WELLS WITHIN 200' OF SEPTIC SYSTEM. +� RO1pERT C. COWAN a � CE -8801 CONTRACTOR IS REQUIRED TO OBTAIN UTILITY LOCATES PRIOR TO ANY EXCAVATION WORK. REROUTE THIS SECTION OF THE DRIVEWAY AROUND PROP. DRAINFIELDS SO AS NOT TO BE OVER THE SEPTIC SYSTEM. DRAINFIELDS CLIENT THE ENGINEER MAY YAR+ THE EXACT DIMENSIONS ANO DESIGN PARAMEM1.725 IN THEFEW. I' NECESSARY, TO MF=7 SRE CONDMIONS. n. +� RO1pERT C. COWAN a � CE -8801 CONTRACTOR IS REQUIRED TO OBTAIN UTILITY LOCATES PRIOR TO ANY EXCAVATION WORK. REROUTE THIS SECTION OF THE DRIVEWAY AROUND PROP. DRAINFIELDS SO AS NOT TO BE OVER THE SEPTIC SYSTEM. DRAINFIELDS CLIENT THE ENGINEER MAY YAR+ THE EXACT DIMENSIONS ANO DESIGN PARAMEM1.725 IN THEFEW. I' NECESSARY, TO MF=7 SRE CONDMIONS. e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST �- O F ROBERT C. COWAN PERFORMED FOR: 1 Ftp �1 lfr- �T/�v-�F 1�L� DATE PERFORNi�i��r" b -"N (1r-ES;14 LEGAL DESCRIPTION: �oFr`-� T�Jti►L3 R�Nfu)'J.Township, Range, Section: SLOPE SITE PLAN r,FtiPSH (F6iT) b1L- 1 0� 2 0 3 4- 5 Q 6 e n� 7 8 v 9 10 c 11 12 13 j 14- 15- 16- 17- 18- 1 9 415 16171819 20 COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? "o �— S L O E Depth to Water After Monitoring? —294— Date: PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER �~ TEST RUN BETWEEN S •s FT AND �� FT PERFORMED BY: )L�`bv4n S44� I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINE EFFECT ON THIS DATE. DATE: v' 72-008 (Rev. 4/85) Depth t. oe� oo►�� PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER �~ TEST RUN BETWEEN S •s FT AND �� FT PERFORMED BY: )L�`bv4n S44� I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINE EFFECT ON THIS DATE. DATE: v' 72-008 (Rev. 4/85) GRE - 'ER ANCHORAGE AREA B0" UGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 SEEPAGE PIT: NUMBER OF PITS r LINING MATERIAL DIAMETER -br OR WIDTH101 , LENGTH� %, DEPTH /?-I CRIB SIZE: DIAMETER 54 DEPTH % DISTANCE FROM: �1r��7 TOTAL EFFECTIVE BUILDING FOUNDATION, NEAREST LOT LINE ABSORPTION AREA (WALL AREA) ADDITIONAL ABSORPTION WELL: TYPE 1�` CONSTRUCTION BUILDING NEAREST FOUNDATION -,LOT LINE CESSPOOL APPROVED DISTANCES: INSTALLED BY: PIPE MATERIAL: -1 110 IV LOT SLOPE: REMARKS: Form No. EQ -031 , OTHER SOURCES DISAPPROVED NEAREST SEWER LINE REMARKS DEPTH SEPTIC TANK_ DIAGRAM OF SYSTEM WELL Q .7 SQ. FT. DISTANCE FROM: SEEPAGE SYSTEM INSPECTION REPORT ON-SITE/ SEWAGE DISPOSAL SYSTEM NAME Ier,.�,cy 014L -t MAILING ADDRESSJ� �f A'x 9//L L-uIle killt- /( PHONE LOCATION lllcm • /+ LEGAL DESCRIPTION SEPTIC TANK: DISTANCE CNUMBER "`���'T rIL'> OF 616e-'161.5 FROM WELL MANUFACTURER MATERIAL COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY0440 GALLONS. SEEPAGE PIT: NUMBER OF PITS r LINING MATERIAL DIAMETER -br OR WIDTH101 , LENGTH� %, DEPTH /?-I CRIB SIZE: DIAMETER 54 DEPTH % DISTANCE FROM: �1r��7 TOTAL EFFECTIVE BUILDING FOUNDATION, NEAREST LOT LINE ABSORPTION AREA (WALL AREA) ADDITIONAL ABSORPTION WELL: TYPE 1�` CONSTRUCTION BUILDING NEAREST FOUNDATION -,LOT LINE CESSPOOL APPROVED DISTANCES: INSTALLED BY: PIPE MATERIAL: -1 110 IV LOT SLOPE: REMARKS: Form No. EQ -031 , OTHER SOURCES DISAPPROVED NEAREST SEWER LINE REMARKS DEPTH SEPTIC TANK_ DIAGRAM OF SYSTEM WELL Q .7 SQ. FT. DISTANCE FROM: SEEPAGE SYSTEM GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 3330 "C" STREET ANCHORAGE, ALASKA 99503 L F TELEPHONE 274-4561 6 � SEWAGE/DISPOSAL SYSTEM - APPLICATION AND AND PERMIT NAME OF APPLICANT �ti)�> I� / /~� /`— MAILING ADDRESS�`--'� L' )11 5/12` �� PHONE INSTALLATION LOCATION'(/'' LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK SEEPAGE PIT TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH Z�- TO BE INSTALLED BY DRAIN FIELD , OTHER , SOIL TEST RESULTS , iL & NOTEo THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE /`� !� '1 TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT 21✓ , DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL _ SEEPAGE AREA SIZE SEPTIC TANK , SEEPAGE PIT I DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK SEEPAGE PIT My DRAIN FIELD ALSO CONSIDER AREA WELLS, WATER MAIN TO SEPTIC TANK DRAIN FIELD SEEPAGE PIT SEPTIC TANK, 10V , SEEPAGE PIT , DRAIN FIELD_, TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP _OF - EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE S. GRAVEL BACKFILL CONFORM TO BOROIU01r-MAGULATIONS REGARDING INSTALLATION. G.A.A.B. OR LICENSED DESIGNER TYPE f DIAGRAM OF SYSTEM I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE APPLICANT'S SIGNATURE FORM NO. EQ -016 I I 1 1+ I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE APPLICANT'S SIGNATURE FORM NO. EQ -016 Municipality of Anchorage ;trdA On -Site Water &Wastewater Program 7z (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 060-321-19 Expiration Date: 1. GENERAL INFORMATION Complete legal description BERNARD: BLOCK 3, LOT 5 Location (site address) Current Property Owner(s) Mailing address Real Estate Agent 8080 Stewart Mountian Drive *Eagle River 99577 Janice & Guy Fulton Day phone Mary Jo Cunniff Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 317-3187 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community ClassWell ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ 1Up d �w�w�y�Dra�neld 1 -4v (Jell Ser+�c Ta�VC t t t Distance: �•� 00 •�� waiverNadance request lore Received by: �/ �/ Date: !� COSA to be releasWjd`dne enginee4,�dnless otrtemise requested by the engineer. COSA Fee $ azul oc) Waiver Fee $ t i 2� . 0'0 Date of Payment 12I 2��� U Date of Payment t24 2,170) U Receipt Number OwReceipt Number M''�t/6I COSA#,llpi�i�� Waiver# GSViu 1 IY5 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, AK, 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this amlualion, GEG p ... lead an engineering evaluation of the well and/or septic system in accordance wild the guidelines and regulalians established by the Municipality of Mcho2ge and induslif cm, ces. The mpodediesubs describe the condition olue sysleMs on the dates oRhe evaluation. Separation distances were measured to readily dealifiable features. Hidden defects or encroarLmenls may exist that were not idenlirred during the evaluation. The operational life of all wells and septic systems depend on a variety olvanables including, but not limited to, soil conditions, groundwater levels (Mat may fiuduate during the year), quality of constrvdion (materials and workmanshp), and the water usage of the family utilizing the sysleMs. These conditions cavi vary, and are outside the conbol of GEG. Satisfactory, test results do not guarantee future performance of sysleMs; (herefore, GEG makes no warranty (express orbnpb'ed) regarding the future performance of Me well or septic system. GEG makes pro representation whether an affirmative well or septic system can be installed on the property in the event either of the current systems fail. The content o/this report is for the sole benefit ollhe persoNpady who retained GEG. Reliance upon the in/ormation provided in this report by any offer person or path, including but not limited to subsequent drepeM purchasers, is not authorized In shop. GEG disavows any legal duty to anyone other than The pemoNpany who paid for this mood. 6. DSD SIGNATURE System #1 Approved for A_ bedrooms. System #2 Approved for bedrooms Disapproved. Conditional approval for bedrooms, Phone 337-6179 Date 11) 3oJ1b `\\\Ix\Ix\If iill QP�\�� OF A4 -C, q with the following s,d atior N_SITE .J m: The Municipality or Anchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations 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. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory (Rev. 10112112) Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # _of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: BERNARD; BLOCK 3, LOT 5 - Parcel ID: 060-321-19 A.' WELL DATA Well type PRIVATE' If A, B, or C provide PWSID# N/A Date completed 6/14/04 Sanitary seal (Y/N) YES Total depth 84 ft. Cased to 60.35 ft. FROM WELL LOG Date of test 6/14/04 Static water level 12 ft. Well production 15 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 2.13 mg./L. Arsenic: ND ug./L. Date of sample: 11 /8/16 B. SEPTIC/HOLDING TANK DATA Well Log (YIN) Wires properly protected (Y/N) YES Casing height (above ground) 18+ in. AT INSPECTION 11/7/16 33.7 4.9+ Collected by: GEG Ltd Tank Type/Material SEPTIC/STEEL Date installed 11/11/9 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES .Depression overtank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 11 I r Il to Pumper <<Q 5 PUMP/ N <,- C. ABSORPTION FIELD DATA BELOW EXISTING GRADE AT MTs NORTH/SOUTH Date installed • 11 /11 /94 Soil rating .p.d./ or ft'/bdrm) 0_6 System type SHALLOW TRENCH '54/54!�(ASSUMED) Length ft. Width 5/5 ft. Gravel below pipe 3.5/3.5 ft. Total depth *11 �11+ ft. Eff. absorption area 1000 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 11/7/16 Results (Pass/Fail) PASS For 4 bedrooms 317/305 Fluid depth in absorption field before test 8/0 in. Water added _gal. New depth 17/Oin. Elapsed Time: 120 min. Final fluid depth 14/0 in. Absorption rate > 600+ g.p,d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date - -THERE WAS NO MT FOUND FOR RESERVE SITE,CONDITION OF 1974 CRIB IS UNKNOWN AND INFORMATION ON THE CRIB IS IN THE MOA RECORDS. —BELLY IN LINE (ASSUMED) CAUSES DOUBLE CLEAN—OUTS AFTER TANK TO HAVE 2" OF STANDING LIQUID. D. LIFT STATION Date installed_ "Pump on" level at in. Size in gallons Manhole/Access (Y/N) "Pump off' level at 1. 1 lig wa er alarm level at in. Cycles tested Meets alarm & circuit requirements? l E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1001+ On adjacent lot. Absorption field on lot '90' On adjacent lots 100'+ 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer /septic service line 25'+ Holding tank 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation '4' Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 19+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation `8' Water main 10'+ Water service line 101+ Surface water 100'+ Driveway, parking/vehicle storage "0 Curtain drain NONE KNOWN Wells on adjacent lots 100'+ ;NNIXP 'lM11= 1161 'SEE WAIVER REQUEST "ADDRESSED IN 2001 HAA. 30' FROM DRAINFIELD TO SLOPES <25% ASSUMED THAT WAIVER WAS GRANTED WITH.1994 PERMIT. 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.. ••..... •••••••r• date. - � :••• e A. ess •.'� Engineer's Printed Name JEFFREY A. GARNESS�j#F, :,••• '�I3p3,6•,.'�C?: Datetf I3o� b �j�F P•............••P ��� LICENSE• ����pSp��� •• #AECC884 (Rev. 10/12/12) Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV161145 COSA#:OSC161579 Permit#: PID#: 060-321-19 Legal Description: Bernard Block 3 Lot 5 Engineer: Garness Engineering Group Applicant: Janice & Guy Fulton The following requested waivers have been approved: 1. The absorption field is approved to be 88' from the private well. 2. The absorption field is approved to be 6.5' from the building foundation. 3. The septic tank is approved to be 3.5' from the building foundation. These waiver approvals apply to the existing absorption field and septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by these waivers. ......................................,......................................r Waivers are Granted: X Waiver is not Granted: Date: 12/0 F12ol 6 Approved by: / T" (X'AY Name of Reviewer ............................................................................... **** VARIANCEMAIVER REVIEW **** r 1D unicipaRity ®f Anchorage II1 Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV161145 COSA#:OSC161579 Permit#: PID#: 060-321-19 Legal Description: Bernard Block 3 Lot 5 Engineer: Garness Engineering Group Applicant: Janice & Guy Fulton The following requested waivers have been approved: 1. The absorption field is approved to be 88' from the private well. 2. The absorption field is approved to be 6.5' from the building foundation. 3. The septic tank is approved to be 3.5' from the building foundation. These waiver approvals apply to the existing absorption field and septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by these waivers. ......................................,......................................r Waivers are Granted: X Waiver is not Granted: Date: 12/0 F12ol 6 Approved by: / T" (X'AY Name of Reviewer ............................................................................... **** VARIANCEMAIVER REVIEW **** Bernard Block 3 Lot 5 Parcel ID: 060-321-19 Waiver for 88 feet from well to drainfield Issued 12/08/2016 General Water sample results indicated negative for coliform and nitrate levels at 2.13 mg/I. Well is located up -gradient from septic system. ADEC Criteria Water Table Depth to water bearing layer Depth of drainfieid Soil Sorption Soil descriptions per well log Points 57 feet Depth From 8.5 feet Calc. Pts 48.5 feet 5.2 3.2 Permeability Soil descriptions per well log DEC PTS Depth From Depth To Thickness Calc. Pts Silty: boulders 3.5 8.5 22 13.5 0.97 Boulders 0 22 26 4 0.00 Gravelly silt: cobbley 3.5 26 57 31 2.24 0 0.00 0 0.00 0 0.00 0 0.00 48.5 3.21 3.2 Permeability Soil descriptions per well log Not calculated Horizontal Separation M XX 2.52 Total Points 12.8 As per ADEC waiver guidelines, with a minimum point value of 12.8, no bacteriological pollution possible but chemical pollution possible but unlikely from household chemicals. Since water sample results indicated negative for coliform and nitrate levels at 2.13 mg/I, the waiver is approved. DEC PTS Depth From Depth To Thickness Calc. Pts Silty: boulders 2 8.5 22 13.5 0.56 Boulders 0 22 26 4 0.00 Gravelly silt: cobbley 2 26 57 31 1.28 0 0.00 0 0.00 0 0.00 0 0.00 48.5 1.84 1.8 Water Table Gradient - Not calculated Horizontal Separation M XX 2.52 Total Points 12.8 As per ADEC waiver guidelines, with a minimum point value of 12.8, no bacteriological pollution possible but chemical pollution possible but unlikely from household chemicals. Since water sample results indicated negative for coliform and nitrate levels at 2.13 mg/I, the waiver is approved. i j , t r �CS I � ..waWxrwx.xa GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS November 29, 2016 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Bernard, Block 3, Lot 5 To whom it may concern: The existing drainfield is approximately 8 feet from the home's foundation, and 90 feet from the private well. Additionally, the existing septic tank is approximately 4 feet from the home's foundation. We are requesting that your department issue a variance from the required separation distance of 10 feet from drainfield to foundation down to 6.5 feet, 100 feet from drainfield to well down to 88 feet, and 5 feet from septic tank to foundation down to 3.5 feet. Justifications for granting these waivers are as follows. Drainfield to Foundation • The encroachment has existed for approximately 22 years. • Invert in the drainfield is lower than the foundation, so there is no potential for lateral migration of effluent from the drainfield into the foundation. Drainfield to Well • The encroachment has existed for approximately 12 years. • Water sample results indicate negative for coliform and nitrate levels were only 2.13 mg/I. • The well is located upgradient from the septic system. Septic Tank to Foundation • The encroachment has existed for approximately 22 years. • A collapse of the tank would likely occur near the middle of the tank and not near the end wall, thus limiting undermining of the foundation. We are unaware of any adverse impacts granting these waivers would have on adjacent wells and or septic systems. Pres , M. S. 3701 East Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com S\3 5 0p ,E M \ ` ` Stew Mountain Dr. R'960.56 Lzz 187.96 She CD M 8447T SCALE: 1 "= 40' EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. �F OFVT- q�q C 49th 0 i 00. !:... `.1... 00 •.Fred Wolatka: p / sig • 3255 - S J- Xxxv*1� FS 16-8, pg 73 BE RECERTIFIED 11-22-16�y, AS -BUILT NO CORN RS SET THIS DATE O4 ,45.0 eptic vents�'� \ N 2o \ I I � O I Lot 4 7,3 2 Story Frame / fn " 26.3 House Lot 5 <(S� �—t 25.4 deck N ac cv cY) W tJ o eta / ' L6 CO v TRACT K LU 26.0 v 0 4. r` — — — — o Well Wood fence (typ N76'54'30',VV — — — i 145.00 Alley X20' i SCALE: 1 "= 40' EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. �F OFVT- q�q C 49th 0 i 00. !:... `.1... 00 •.Fred Wolatka: p / sig • 3255 - S J- Xxxv*1� FS 16-8, pg 73 BE RECERTIFIED 11-22-16�y, AS -BUILT NO CORN RS SET THIS DATE Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.d.androrage ak us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING A Parcel I.D. 060-321-19 HAA# ILIAD 10 5-2-7 1. GENERAL INFORMATION Expiration Date: 10 – [f – O ,2 Complete legal description BERNARD SUBDIVISION; LOT 5, BLOCK 3, Location (site address or directions) MILE 1.8 HILANO ROAD • EAGLE RIVER, AK 99577 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address RICHARD WILSON Day phone c/o CAROLYN GREINER w/ REMAX PROPERTIES Day phone CAROLYN GREINER w/ REMAX PROPERTIES Day phone 16600 CENTERFIELD DRIVE • EAGLE RIVER, AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class "A" Well I� Public Water System ❑ 694-4200 TYPE OF WASTEWATER DISPOSAL: Individual On-site I® 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 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 engineers work. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $2,410.55 at, or prior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health 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 riles 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone 337-6179 Address 6901 DEBARR ROAD. SUITE 28 •ANCHORAGE. AK 99504 Engineer's Printed Name JEFFREY A. GARNESS. P.E. Date Engineer's Comments: In conducting this evaluation, AWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational lite of all wells and septic systems depend on the local soils condition, groundwaterlevels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is lar the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will It confer any legal right whatsoever. 5. DSD SIGNATURE _L"O' Approved for Ll- bedrooms. Disapproved. Conditional approval for bedrooms, with the blowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other ON SITE WATER AND •; -WASTV=ER PROGRAM BY D Original Certificate Date: (Rr. woof Municipality of Anchorage • 'r Development Services Department O"Its WasiewderProgram 4700 South Bragaw SL P.O. Boot 198850 Anchorage, AK "5118850 www•ci erlch W,sk•us (007)343.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: BERNARD SUBDIVISION; LOT 5, BLOCK 3, Parcel ID: 060-321-19 A. WELL DATA Well type W If A. B. or C provide PWSID# 212754 Date completed Sanitary seal T Cased to ft. FROM WELL LOG Date of test Statlo water level fL wwgu—cu-;-n� g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate Date of sample Ilected by: B. SEPTIGHOLOING TANK DATA mgA. Well Log Casing height (above ground) in. AT INSPECTION fL — 9 -p.m - ml. Tank Type/Material STEEL Date Installed 11/9-10/94 Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YM) NO High water alarm (YM) N/A Date of pumping 9/14/2001 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA Data installed 11/9-10/94 Soh ratlng .p.d r ft°Ibdrm) 0_6 System type TRENCH Length 108 ft. Width 5 ft. Gravel below pipe 3.5 fL Total depthW75-11.25ft. Eft. absorption area 11000 fe Monitoring tube YES Depression over field NO Date of adequacy test 9/27/2001 Results (Pass/Fall) PASS For 4 bedrooms Fluid depth in absorption field before test 9L3- In. Water added' 1�gal. New depth 12/31n. Elapsed Time:a7 min. Final fluid depth 5/3 In. Absorption rate >a 600+ g,p.d, Any rejuvenation treatment (past 12 mo.) (YM & type) NONE KNOWN If yes, give date - D. LIFT STATION Date installed 'Pump on' level at _in. Size in gallons Pump tom. High water alar level at in. Cycles tested Meets alar & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: COMMUNITY WAT E R Septic tankAift station an lot On adjacent lots Absorption field on lot On ad ac Public sewer main Public sewer manhole/deanout Sew ervice line Holding tank SEPARATION DISTANCES FROM SEPTIC HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main *10,+ Water service line *10'+ Surface water 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 410,+ Water service line'ASSUMED 10'+ Surface water 100'+ Driveway, parkingtvehide storage 0' Curtain drain NONE KNOWN Wells on adjacent lots 200'+ 4,,t4Asf Sim^ rAa%^0er F. COMMENTS 1*10+ ASSUMED. WATER LINE ENTERS HOUSE ON WEST SIDE PERwBERNARD STEWART (694-3305) G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are In conformance with MOA HAA guidelines in effect on this date. Engineer's Pd Name JEFFREY A. GARNESS Date /DD/ HAA Fee E 31d t� Date of Payment 3 Receipt Number (Rev. fame) Waiver Fee $ Date of Payment Receipt Number . V 9 .J ffr A. Go ss.: -7953 r so jay'/GI/ /W. no 'N b O b; u 771 Z/ 3., oi,, Y I v HSI jr l.ng.Z nJ SIJ 1 rhV O —z e Z �< ;, � �•.� os � ., a .Q a ♦ xf66 ;r � .,tea v✓a 11 i y •1 � Y t/ MUNICIPALITY OF ANCHORAGE I �c • DEPARTMENT OF HEALTH & HUMAN SERVICES. Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # ©60 3 I I HAA # dA C14Q&3S 1. GENERAL INFORMATION Complete legal description Lot 5; Stock 3; Sennand Subd.iv.ia.ion Location (site address or directions) NHN H.c,2a.nd Road (Mile 2.2 ) Eagte Riven, AK Property owner Ted zr Dix.ie Sta.nj ietd Day phone Mailing address P.O. Sox 772822 Eag.2e Riven, AK 99577_ Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Day phone Day phone 694-5072 Individual well Community well XXX Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX 3 Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-=(Rev.1/91) Front MOAM21 S. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Sas ENGINEERING Phone 6 9 N —)-q7q 17034 Eagle River Loop Road No. 204 Address Engineer's signature 6. DHHS SIGNATURE X Approved for bedrooms. Disapproved. Conditional approval for Additional Comments Date 1/ jig`- l R y OFA 40. ! tom^ I=�119 9.104_e C.lC4 ROEERT C. COWAN r CE - 8801 t��, � SII•t...c ', .f bedrooms, with the following stipulations: �L ` Date 2 2 - l4 The Municr"' ilty 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-M (Rev.1/91) Bock MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ?E2NR,) SZ,;Rn.. pack 3,l S- Parcel I.D. 06,032 //9 A. Well Data Well type Com wro,u17Y IG B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) A)1,4 Date completed A/1A- Driller A/ZA Total depth it/� Cased to n/%6 Casing height .v/,4 Sanitary seal (Y/N) NIA Wires properly protected (Y/N) Date of test Static water level Well flow Pump levell FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: g.p.m. AT INSPECTION r++ Septic/fig-tank on lot 20,0 ' t ; On adjacent lots Absorption field on lot 4- ; On adjacent lots zoo -�- Public sewer main ZC I _F Public sewer manhole/cleanout La,0 Sewer service line 5 �� Petroleum tank NIA WATER SAMPLE RESULTS: Coliform n1 Nitrate T/l�- Other bacteria — 'J/,4 Date of sample: t,(4 Collected by: `J/ B. SEPTIC/H TANK DATA Date installed 11-11-911 Tank size /Z So GAL. Compartments 7 Cleanouts Y@N) VES Foundation cleanout @N) YES Depression (Yo fio High water alarm (Y(9 %VO Alarm tested (YQ AJ 14 Date of pumping —T NEw TAlii= Pumper PJ /,4 SEPARATION DISTANCES FROM SEPTIC/ TANK TO: Well(s) on lot ZOO f4- On adjacent lots OW -f- Foundation S' To property line 2(o ' Absorption field /0' Water main/service line /0 14 - Surface water/drainage 72-026(3/93)•Front CONTINUED ON BACK PAGE Z G 06 g.p.m. -. o ry 9 r -y 200'+ �. 4- ; On adjacent lots zoo -�- Public sewer main ZC I _F Public sewer manhole/cleanout La,0 Sewer service line 5 �� Petroleum tank NIA WATER SAMPLE RESULTS: Coliform n1 Nitrate T/l�- Other bacteria — 'J/,4 Date of sample: t,(4 Collected by: `J/ B. SEPTIC/H TANK DATA Date installed 11-11-911 Tank size /Z So GAL. Compartments 7 Cleanouts Y@N) VES Foundation cleanout @N) YES Depression (Yo fio High water alarm (Y(9 %VO Alarm tested (YQ AJ 14 Date of pumping —T NEw TAlii= Pumper PJ /,4 SEPARATION DISTANCES FROM SEPTIC/ TANK TO: Well(s) on lot ZOO f4- On adjacent lots OW -f- Foundation S' To property line 2(o ' Absorption field /0' Water main/service line /0 14 - Surface water/drainage 72-026(3/93)•Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Acce /N) Vent (Y/N) "Pump on" level at "Pump off" Level at High water alarm level Cyc tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed // -If - 99 Soil rating (GPD/Ft2) O. (o System type S4t-"4 7- Length Length /6? Width S Gravel thickness 3,5 Tota! depth /S Total absorption area 4000 Cleanout present &N) YES Depression over field (Yo No Date of adequacy test iU/,Q- MEW SVSTEm Results (pass/fail) ,) /Y4 for 1, Bedrooms Water level in absorption field before test A) After test �J A Peroxide treatment (past 12 months) (YAN) AM If yes, give date N 14 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 200 ' � On adjacent lots 200 ` 4 Property line 27' To building foundation /0' To existing or abandoned system on lot i0 ,-k On adjacent lots i0'+ Cutbank 3s ` Water main/service line /O1dr- Surface water /00 ,-i- Driveway, parking/vehicle storage area Curtain drain NONE XA)QK)AJ E. ENGINEER'S CERTIFICATION 1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effg!�:i�ffirftv%*� of this inspection. j< Signature""' Engineer's Name Xc o) '2 % �wA`' `t� 9 ROL°ERT C.* COWAN ; a `e; ^.� CE - 8801 r; Date HAA Fee $ ✓��D • Waiver Fee $ Date of Payment Ll l L,L Date of Payment Receipt Number T5 ����� Receipt Number - 72 -026 (3/93)* Back MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date"11,7 A"(, (a) Legal Description (include lot, block, subdivision, section, township, range) er 5 ?�i.cc(S 3 �C=1011 7� Location (address or directions) (b) Applicants Nam___] 0T 11'`x, &IL Telephone Applicants Address (c) Applicant is (check oml.tLeending Institution � wilder , Buyer r::j ; Other (explain); (d) Lending Institution .� � Iblephone Address (e) Ictal Estate Co. & Anent Address Telephone 2 . Type of Residence Single -Family Multi -Family Other (describe) Number of Bedroom 3. Water Supply Individual Mll Community � Public Note: If c munity well system, must have written confirmation from the State Department of Environmental Conservation attesting to tfie legality and status. Is the well adequate for the number of bedrooms specified in this HAA 4. Sewage Disposal Onsite'�4 Public Community � Holding Tank Is the wastewater disposal system adequate for the number of bedroans /N) (Page 1 of 21 2-151-84 5. Engineering Firm Providing Inspections, lbsts, Data and Information I certify that I have checked, verified, or conformed to all MDA HAA Guidelines in effect on the date of this inspection. Signed �� = Date Name of FiA Lam,_ Tele hone / - �) G Address 1w Signed by Date c �� (ENGINEER SEAL) 6.DHEP Am rp oval Approved for bedromr. Approved Disapproved Terms of Conditional Approval s `y By X", ----Date Conditional The Municipality of Anchorage Department of Health and Environmental Protection doe: not guarantee the continued satisfactory performance of the water supply and/or the wastewater disposal system. This approval indicates that, as of the validation date shown above, based on the data and information furnished by an engireer registexred in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional for the number of bedrooms and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the following address: .r A , KB2/d5/s [Page 2 of 21 2-15•-84 MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH. & HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION CHECKLIST - FEBRUARY 1984 t A, 6723 2 d s A. WELL DATA RECEIVED. 1i Well Classification M If A, B, cr C, D.E.C. Approved) Well Log Present (Y/N) K) (A- Date Completed OV 0= Yield Total Depth IV (A- Cased to A) (A Depth of Grouting ^'(- Static Water Level fJ (A- Pump Stet At "'J (,4 Casing Height Above Ground yt)jA Sanitary Seal on Casing (YZ2) Electrical Wiring in Conduit (Y/N) AJ(A- Depression Around Wellhead (YIN) qh Separation Distances from Well: 7��/tom To Septic/Holding Tank on Lot-)`5?2;F -� On j i ing Lotsuil To Nearest Edge of Absorption Field on Lot +-`rOnAdjoining Lots To Nearest Public Sewer Line VVIA- To Nearest Public Sewer Cleancut/Manhole 'J(A- To Nearest Sewer Service Line on Lot 'U(h Water Sample Collected By A)(a- Date_PJ Water Sample Test Results ^11A Ca[ments i41 ~ if B. SEPTIC/HOLDING TANK DATA Date Installed f'J L_ Size / No. of CaaIpantments 1 Standpipes 0 ) Air -tight Caps Y ) Foundation Cleanout (Y1) Depression over Tank (Y � Date Last Pumped ✓ Pumping/Maintenance Contract on File (Y/N.) AJ14 ; for u( Holding Tank High -Water Alarm (YM)Temporary Holding Tank Permit (Y/N) 42t Separation Distances from Septic/Holding'aten�:[51j� To Water -Supply Well - To Building Foundation 5i To Property Line f�D�y� To Disposal Field To Water Main/Service Line 4./0� To Stream, Pond, Lake, or Major Drainage Course'` [Page 1 of 21 2-15-84 ,5- 05 ria d SID C. ABSORPTION FIELD DATA Soils Rating in Absorpt'Strata j� Type of System Design d4UB Date Installed Ct Length of Field Width of Field iD Depth of Field Gravel Bed Thickness '] Square Feet of Absorption Area Standpipes Present JVY N) Depression over Field (Y— Date of Last Adequacy Test L/ Results of Last Adequacy Zest y� Separation Distance from Absorption F ld ,igvi To Water -Supply Well .#,0-I 0 ©o+ To Property Line t p i To Building Foundation ),,j1 To Existing or Abandoned System on Lot PJ igr ; on Adjoining Lots :tw/ To Water Main/Service Line ..x-15 / To Cutbank(if present) p Pr To Stream/Pond/Lake/cr Major Drainage Course 4-10b' To Driveway, Parking Area, or Vehicle Storage Area pa,,f wnc�k arc r..e1 N — l . _ T _ , 1 A n D. LIFT STATION Date Installed Dimensio Size in Gallonsole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MDA Electrical Co (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed Date �' / �����.••�.....•. eS,. D� Company MOA No. $r - �oZ� �••• ••••% * rN � KBI/d5/s ♦,.. , .° y.• Le C. Reid, Jr. R No. 2281 •E o•.°��� [Page 2 of 21 2-15-84 ALASKA �i jU1N11CYlRAL COnTROL SNUICCS, IX Engineerinq & Enuironmental Studies JULY 23 1984 TARRY HALE SR1 BOX 44245 CHUGIAK AK 99567 SELLER — TARRY HALE BUYER — STANFIELD SUBDIVISION — BERNARD BLOCK — 3 LOT — 5 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A CRIB WITH AN AREA OF 392 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALIANS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 675 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 4 BEDROOM HOME. THE SEPTIC TANK WAS PUMPED ONJULY 16 1984 . SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR THIS 4 BEDROOM HOUSE. 1200 West 33rd Auenue, Suite B • Anchorage, Alaska 99503 • (901) 561-5040 3 i 11L Lll - i � �l BILL SHEFFIELD, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION Telephone: (907) Address: SOUTHCENTRAL REGIONAL OFFICE 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501 274-2533 C DATE: PWS I . D. # To Whom It May Concern: Accord i ng to records on f i. I e i n th i s of f i ce the (�T-e Water System is in compliance with the State Drinking Water Regulations. Sincerely, r