HomeMy WebLinkAboutHALL LT 12AHoll Lot #051-092-65  Municipality of Anchorage Development Services Department "-"; ~A"' On-Site Water & Wast°water Program, 4700 Soulh Bragaw SL ,.o. www.cLanchomge.ak.us (907) 343-7904 Page I of On-Site Wast°water Disposal System and/or Well Inspection Report Permit Number SW990266 PID Numbam 051--092--65 N°m4:RON HALL Wast°water Syetem: · New I-I Upgrade 21024 SCENIC DRIVE * CHUGIAK, AK 99567 ABSORPTION FIELD No, of I~edrooml: Ph°ne:(907) 428--6,~91 4 13Delp Trench ElSh~ltow Trench IBed lUou~d lOth°r* LEGAL DESCRIPTION .2.0 ~ ~ -1.5 - 2.5~ 2.5 - 3.5 WELL: · New [] Upgrade 12 PRIVATE 160 ~ 117 ,. 360 ~. r~ o-=o~4/ r-S~0/SCH. 4O ~VC/H~ SULLIVAN WATER WELLR 8/10/99 45 ~. A+ HOME SERVICES 17/2000 3.o ~ UNKNOWN ~ 2+ ~ TANK SEPARATION DISTANCES =s.,~= =.o~=.g ~.~.~... ~o s~pu= ~or~Uon U~t Ho~ng .~"~'~ ANCHORAGE TANK 1500 Well 100'+ 100'+ 100'+ - 25'+ STEF'L 2 s~,o=o ~oto~ ~oo'+ ~oo'+ ~oo'+ - - LIFT STATION ~t Un° $% 10'+ $'+ - - 1500IANCHORAGE TANK/ORENCO SYSTEMS F'aundef~on 5'+ 10'+ 5'+ - -- TIMER TIMER 46" C~,o~n 0.~n .¥~ ~.OW ~=0 0~, OS ..~ I~1~' l;~t~ ~I~c~'~C ~'nC. ~e.~ar~=: .so~ro~ss ~.~.~rr~.~ s~o r~L~. (~s~ BENCH MARK · '1'O BOTTOM OF' EXCAVATION. 2.66 FEET OF U.O.~ TOP OF CMU FOUNDATION SANO ~L'rER N)DED. Bo'FroM OF S.T.E.P. TANK = 90.36 FINAL GRADING, INCLUDING TOP SOIL AND SEEDING. TO 99.7 Inspecfions performed by: AWWC, INC. Dates:lst 6/17/2000 (~'"-; ...... '~"'~;[ ..... 5th 4/19/2001 Department of Health and Human Services approval ItO~'~". ¢~-t *~...'"'~"~'~ R~viewed and approved b Dote: ~.r--./. ~ / Heavenly Lights Electric Inc. 900 S. Grantham St Wasilla AK 99654 To whom it may concern: The lift station at lot /2 ~ block ~-'~t t sub division was-,a,~d.by,a I~scensed electrician, in acco dance w~th current nabonal Ele~:'t'~'~'~e. Under penalty of perjury, I ced[fy this information to be true and correct. John Roudebush PresidentJSecmtary "~;,"o~: AS-BUILT DRAWING "~""~'"":o,, ~t~/ ~ ~X. /1~ ~,. . ~ / .. :~ ~:.. ::, .,.'.-."'... ., ,/ ~ ~ J ~ / / / ~ ~2 29.2 66.9 / / ~. ,. ~o., ~..9 / ~SI~ ~ATER & ~ASTE~ATER ~ ~'~.:~ 4 ', ~ ~,~.~ ,o,: ,,o.~ ,~.,,: ,~ ~,,,-: ,~.~.. ~ ? Z .~....:..., R0, HALL (g07) 428-6~91 2 0F ~ [ [~,~ [;', ~. 0~mess: ~ o~ .o.~: ~{[t?,...,o.t~~ AS-BUILT OF NEW WELL LOCATION AND SEPTIC SYSTEM sw,,o=66 AS-BUILT DRAWING ,ARCELIO NL,~BER:0,51 - 9~,7~ (AV~.) CONSULTANTS, lNG. LOT 12A; T15N, RlW, SECTION 8 ..-'"' PROFILE AS-BUILT OF SEPTIC SYSTEM (BO~OMLESS ISF) °fe's~°e--~&~ 07/17/00 M0N 06:04 FAX 688 $075 -, l~on & Barb Hall &Klds . ~ ~001 "' ' ' '":i'".')'.:: :'. 'i .... "' '''~ · ..'.. .~ ..~.. ..... ,.:.'.! 'LEGA~DE$CRIPTION: /,~/dt'~,.' ".'A"O ~' . .I D:~:;':' '"'~'q: '~'.~'.: . :.,......... ..... .; .. _ ....... ......,~:.,~, PERMff-NUMBE~O,IeofI~;~-I~ ~.-'~'..' · ~:'-'~'.:':',::~;':~ ~:~. ',:'".: r ......:~-"~.:~'...~ ...~' ,..---.. ~, ~ INDE ~IFI~TION NU MBER:~~"~.~ ~ ': :.':"::"" ''' ".'¥ ':'."'.":., . :":?'"''": i" .':~, ' ..... ' D~II~ ~;" .:": .' ; .' ... ..... · ,. ~ '..-'-- ~ ......?...... ....-,.. .....:. ..~.':,.. -. ;...~ ..,..,: ',. · ~ ~'~ g~' . ' ' .... '' , '" ..,~ .:. " 7 · . .....~ ~ . .~, ' rq~. '~.~ .~. · ·~,~. , ..~ r~ei r~tei' · ..'-,~m .....' .... ' ' ..... · ...... ~;a~' io '~; ~ i'~ ,: .. ~ : ~ ;.' ,:': = ' .. ' -: "'..,. .~.... · '. .~,.... ~'. -'.. '" ~"~ "" ". "" ~ n~}~..8 ':].."~" t. :':'":"~ ; '~" '~101sinf~M~ U~n ~mp~on?..~.. ~ N9 ,. : ":; '..':: : .. :'* ? ~mmnB:.'~':.' : ~ ":" · ..... · '"'. : -';". ..'-.":. 'l~&~"?...' .... .. :.- ': ..... '.~ '.;...... ~ .'; . .~ ,..... ... j'...... ~...... ~...'..... ,-.'...?........... ~... o~ Ancno.rage., uepam'nen[, o~ H~alth & Human ~erv~es. anoJo~.uepart~ent of,Environmental Consen/ation..'MatSu B .oh:~g.' h: ' · ' . - . .. . . . -. '. · . .'~ .. ... ..:. ...; .' . · :.... .; . .. .. ....' ..... . . ,.. 04/13/01 FR! 0S:20 FA/ 088 5075 Ron & Barb Hall & Kids ~]001 MUNICIPALITY OF ANCHORAGE Deparlment of Health and Human Services On. Site Services Program 825 L Street, Room 502 P.O. Box 196650. Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Date Issued: Aug 10, 1999 Expiration Date: Aug 09, 2000 Permit Number: SW990266 Legal Description: HALL LT 12A Design Engineer:. 0041 AK Water & Wastewater Consulta Owner Name: Ron Hall Owner Addrass: PO Box 670955 Chugiak. AK 99567- Parcel ID: 051-092-65 Site Address: Lot Size: 45460 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be In accordance with: 1. The attached approved design. 2. Ail 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. IssuedBy; "~~ ~. ~'~ Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2B ~Anchorage ~Alaska 99504 Phone (907) 337-6179 ~ Fax (907) 338-3246 Consulting Engineers July 27, 1999 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Reft Well and Septic System for Lot 12A, Section 8, T15N, RIW PROPOSED BOTTOMLESS INTERMITTENT SAND FILTER SYSTEM To whom it may concern: 1. GENERAL: The proposed 4 bedroom home will be served by a private septic system and a private well. A test hole was excavated on the referenced property by Eagle River Engineering on 6/24/92. Groundwater and impermeable soils was encountered at 5 feet in the test hole. On 6/1/99, our company had a test hole excavated and found groundwater to be at 4.5 feet and impermeable soils at 7 feet. The lot is generally flat and it is our opinion that the groundwater level and impermeable soils stratum is constant. Given these site constraints, we are proposing that a Intermittent Sand Filter (ISF) system be installed. The soils are summarized as follows: 2. SOIL CONDITIONS: Attached is a log which shows the soil profile, and the pemolation test result. The soils below the organic layer are a GM to GM/SM material (with cobbles) to a depth of 7 feet (bottom of the test hole). Groundwater was encountered at 4.5 feet during the excavation of the test hole. After 7 days, water was found to be at 4.5 feet. A percolation test was performed between the depth of 1.0 feet to 4.5 feet and found the rate to be <1 minutes/inch. 3. TRENCII DESIGN: Bottomless Intermittent Sand Filter (1SF) a. Percolation Rate: <! minutes/inch b. Allowable Application Rate for ISF: 2 gallons/day/ft2 c. Number ofBedrooms: 4 d. Design Flow: 600 gallons per day e. Minimum Absorption Area: 300 ft2 f. Effective Depth below pressure pipes: 3+ inches g. Width: 12 feet h. Length: 30 feet. i. Effective absorption area = 360 tt2 (>300 ft2 OK) j. Air Supply: Thomas Industries, Model 5070, "Anchorage Tank". k. Air Supply Line: "Wasteflow" emitterline, 1/2 inch I.D, "Anchorage Tank". I. Sand Material: M.O.A. Approved Sand Filter m. Pea Gravel: 100% passing 3/8' sieve, less than 20% passing the 1/4' sieve, and less than 1% passing the #8 sieve. We are proposing to excavate down to a depth of 2.0 feet (maximum), place a minimum of 6 inches of sand, install the air supply line, and cover it with 1.5 feet of sand. On top of the sand, we will place 6 inches of 3/8 inch pea gravel, with the pressure laterals midway in the layer. We will use a conventional lift station (Anchorage Tank), equipped with a programmable timer so that flow can be intermittently dosed to the ISF. 4. MATERIALS AND CONSTRUCTION PRACTICES: The materials used, and the construction practices will comply with DHHS' "Intermittent Sand Filter Design, Installation & Maintenance Manual". The contractor should read this document prior to construction. Copies are available at the Municipal Onsite Services office (Sth floor, 9th & L St.). 5. SURFACE WATER: There are no surface waters within 100 feet of the proposed septic system. 6. TOPOGRAPIIY: The referenced property is generally fiat; in short, there are no slope concerns. 7. CLOSING: I am open to any suggestions from your department that would be an improvement to the proposed system. I am una~vare of any negative impacts that this installation would impose on adj,~cent wells, or septic systems. Ifyou have any questions, please call me at 337-6179. ! \ ! ~'~'-- ~' ~0 LOT 4. SEC. 8 i ~, / LOT 5, SEC. 8 / .... ~ T15N, RlW. I LOT8 ~ '/ VALL~ AVENUE LOT 22B. SEC. 8 T15N. RlW LOT 21, SEC. 8 ~ T15N, RlW, (C~EE ACRES) L~I~: ~? ~ ~ [ LOT 20. SEC. 8 T15N; R1W; SECTION 8; LOT 12A SITE P~N FOR THE PROPOSED WELL LOCATION AND SEPTIC SYSTEM .............. :.,,: RON HALL (907) THE AZR C[3~4PRE$$rlR SHALL ~E I. fl3CATE~] VITNIN S~L ~ ]/2 I~H ~I~ HDPE (1 PZECE), ZN~TED VITH ~/ I~H r~H PZ~ VR~ ~3 VALe), OEPTH ~ 3 FEET. // 1.25 INCH HDPE ~E SLOP~ ~K TO !1 U~ ~A~N FOR D~E OF UN~ NO (6/24/92) PROPOSED ~--~T~.~ pROPOSED O RN~'~'AY WEE NOTES) ~' I I 1500 GALLON *~ ~' ~' S,T.F-P. b~YSTEM I I l l l l / / / / / ! PROPOSED :' WELL ALASKA WATER AND WASTE, WATER CONSULTANTS, INC. 5g01 DE,ARE ROAD SUIT~ 28. ANCHORAGE, AN ggs04 PHONE.: (907) ~57-617g/FAX: (907) ~58-~246 / / T15N; RlW; SECTION 8; LOT 12A OF WORK: DESIGN OF' PROPOSEO WELL LOCATION AND SEPTIC SYSTEM FOR: PHONE NUMBER: RON HALL (907) 428-6591 7/27/99 J.L.M. I = 40' 2 OF 5 P~N VIEW ~'~ PROFILE VIEW ~S~ WA~ A~ WAS~WA~ CONS~TA~S, ~C. ~E OF WORK: BOnOU~ESS INTERmnENT SAND FILTER ~Te7/27/99 D~WN ~:j.L.M. N.T.S. FOR ~ MAINTENANCE OF AN ON-SITE WASTEWATF. R DISPOSAL SYSTE~ Anchorage Depar~me~ of H~lth .ca Hurn~,n Serw, c~ (DHHS) e.d the property This agreem~ Ls made for the propose of maimalnlag an.on-slrc was~ewazer disposal sysmm on the subjecz propenT. The l pe.m, ow. . agr th, e foUowing: Submit to the Municipality of Anchorage, on an .nmml basis, an/nspe~tion and operation smtemem f~om a registered professional engineer. This inspection and . Opel"'eltiOI1 ~ $h:~11 vez~fy thai: the cngineer?~ i~spected all effiuen~ ~.rl air pumps, ~m.r~, and alarms, and that any deficiencies have b~-"n repaked a~d rl~ the sys',em is P;-_~onlnZ as desired. ~ N~mc) (P~-'"~ Nm~) --Notarize Here ---- personally appeared befor~me, who is personally k~owu to me ~ ~ ~/__ . ~~t whose identity I provid on the bath/affirmation of , a credible witness (,,] ~ ryPublic .AL&SKA WATEII. &: WASTEWATER CONSULTANTS, INC. _~'~'~'~"-%~mO.F.. ~ { ~. e~o~ D~ ~o~. su~ :B · ~C.Oe,~. ~X. ~0,~e.,..~X.:... ,~'x~-.ri'"~ ISOIL LOG -PERCO~TION TESTI ~ ~ ~c.~o.: ~s.: .~w: s~o. ~: ~ ~ r./-'" .~,.,.~ ............. P~FOR~ED FOR: ~N ~'- ~ DA~ P~FORMED: 6/1/99 ~h~ ~z ... ~F~~ o.~,cs reTEST HOLE ~1 I GM TO GM/SM :~'~ GW I°RG 3 WITH COBBLES :3~:~ GP~1 )ML (8/24/92) ~ GM ICL ~0~ 6 , SC 7 , DEPTH TO DATE ,~ ~ L 3ROUNDWATER ~ 4.5' 6/1/99 ]) 4.5' 6/8/99 ~ ~ / ~ s~  SITE P~] ' = 00~ 10 11 DATE READING CLOCK NET TIME WATER LEVEL NET DROP TIHE (HINGES) RE. lNG (INCHES) 12 13 19 PERCO~TION ~TE <1 20 (HIN./INCH)/~ PERt. HOLE DIA. 6~ .(INCHES) TEST R~ BETWEEN 1.0 FT. ~D ~ .5 FT. COHHENTS: SOI~ C~SlR~ TO BE IMP~M~ AT P~FORMED ~ ~ WA~ ~ W~A~ I. ~ ~~ , C~ ~T ~,~ w~ .~o.~ ,..cco.~c~ ~ ~ ~.~/~, ~.,c,.~,~u.~ 0~-1~-I99~ I~:~PH F~Otl £.R. £n~lneerir~ ~vc~. TO ~n~i~ Of ~chorlp DEPARTMENT OF H~L~ & HUMAN ~EflVICE8 82S 'L' Strut, ~ch~ge, Aluka ~2~ 801LS LOG -- PERCO~TION TEST LEaA!.DESCI~PTION: ~,~-/2.,4 7'/%J~ t~t~ ,Ct. F Township, Range. Section: T/~,~ ~/~, ~.~& ~ ~f 4 WASGPOUNDWATER PLAN J A 11 14 15 16 17 ~- RUN BETWEEN . PERCOLATION iRATE ~ (m~n~l~,4m~d~) P~RC HOLE DLAMETER , ,~ '"' C~RTiPY THAT THI~ TEST W&$ PF..qFORMED iN MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 925 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT MAILING ADDRESS LEGAL DESCRIPTION Well Absorption area ~,~ I Dwelling ~d'~'~. / -L Manufacturer Material DISTANCE TO: 70 .~ / ~ Poundatlon N*~ IOt~ aDPG.ADE NO. OFBEDROOMS Liquid depth PERMIT NO. Liquid capacity in gallons Tota~c~a~rption area No. of line~ Top of tile fish grade Length W~dth Type of crib DISTANCE TO: DISTANCE TO: Building inche~ PERMIT Crib depth Building foundation Nearest lot line OTHER PIPE MATERIALS iNSTALLER ~EM.~RKS Septic tank PERMIT H0. tlU~,~ T C I PRL I T'T' OF R[-ICHORRGE DEPARTMENT OF HERLTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE, ° 264-4729 I,!ELL Rt'.iD Ot-,I--S 1' Ti SEI.qER PER£'I 1' T ( 828-?46 ) APPLICANT CALVIN MOORE LOCATION , LEGAL Ti5N RiW SEC 8 LOT 12 5400 DAVIS HIGHHRY LOT SIZE 108900 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: DRAIHFIELD MAXIHUM NUHBER OF BEDROOMS SOIL RRTING (SQ FT?BR)= 100 THE REQUIRE[, SIZE OF THE SOIL ABSORPTION SYSTEM IS: Er.EF'TH= 4 LEf46TH= 42 6RR%.'EL Er.EPTH= 2 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETHEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THE TF.'Ef-~CH I,.I I Er, TH T S 5. ¢Z~C'Z~_-~ FEET. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL DETHEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE E×CRVRTION (IN FEET). SEPT I C TflNK S I ----"-E= :2888 6FtLLOf4S PERMIT APPLICANT HRS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIOHS OF ANY HELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE HELL WILL SERVE. TI40 ( 2 ) I I'-ISPECT I Or*IS RRE REQU I REEf. BACKFILLING OF ANY SYSTEM WITHOUT FINRL INSPECTION RND APPROVAL BY THIS DEPflRTHENT HILL BE SUBJECT TO PROSECUTION. MINIHUH DISTANCE BETWEEN fl HELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 3.0A_ FEET FOR R PRIVATE HELL OR ~.50 TO 200 FEET FROM R PUBLIC HELL DEPENDING UPON THE TYPE OF PUBLIC WELL HINIMUM DISTANCE FROM A PRIVATE 14ELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEHER LINE IS 75 FEET. HELL LOGS ARE REQUIRED AND HUST BE RETURNED TO THE DEPARTMENT HITHIN ~0 DAYS OF THE HELL COMPLETION. OTHER REQUIREMENTS MAY AF'PL¥. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PER['1 I T E×P I RES Er.ECEI"IBEI~: I CERTIFY THAT I AM FAMILIAR WITH THE REO. UIREMENTS FOR ON-SITE SEHERS AMD HELLS RS SET FORTH BY THE HUNICIPRLITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE HITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEHER SYSTEM MAY REQUIRE ENLARGEMENT IF THE e _ . . . . . V4. 0 /"DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION . TEST 825 L. Street. Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~ ~"/~ ~'/'~/~/~ ~ LEGAL DESCRIPTION: // /// 2 /~ 1 2 3 4- 5- 6- 7-' 8- SLOPE 10- 124 13/__ 14- 15- 16 17l 18 19 20 72-008 (6/79) WAS GROUND WATER ENCOUNTERED? IP YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop / PERCOLATION RATE ~///~' (minutes/inch) Di,~/Z~t//~/~.~EST RUN BE~EEN FT AND MUNICIPALITY OF ANCHORAGE Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Certificate of On -Site Systems Approval OSC251055 Parcel ID 051 -092-65 Legal description HALL LT 12A Site address 21040 SCENIC DR Expiration Date: 6/27/2025 Current property owner(s) HALL RONALD R & BARBARA A X The On-site system(s) is/are approved for 4 bedrooms By: Conditional approval for bedrooms, with the following stipulations: Comments or conditions: Original Certificate Date 2/27/2025 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject s stem(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Service Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory X Other COSA Checklist.docx COSA Checklist Legal Description: Hall Lot 12A Parcel ID: 051-092-65 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 8/10/1999 Total depth 160 ft Cased to 117 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 36 in. Date of flow test for COSA 6/27/24 Static water level at beginning of test 38 ft. Well production at time of test 2.5 gpm Water storage tank volume NONE gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic 17.3 ug/L Arsenic less than MRL (ND) Collected by Date 6/27/2024 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank NA* Date of pumping 6/27/24 Required maintenance completed, if AWWTS Comments: FLOATS*_____________ C. LIFT STATION Required maintenance completed Age of lift station 23 years Lift station material STEEL Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 4/19/2001 ALL standpipes present per record drawing Total measured depth from existing grade 2.7 ft (max) Measured depth to pipe invert from grade NA ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 6/27/24 Results Pass Fluid depth prior to test 0 in Water added 600 gal New fluid depth 1 in Elapsed time 10 min Final fluid depth 0 in Absorption rate 600 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 3 in (MOA 0.25’ ED) Effective depth used 0 in (Final Fluid Depth) Effective depth (ED) remaining 3 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots & appears approximate. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 8/23/2024 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 8/23/24 MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this JP)tk Day of Fe for"card . of 20.x, by and between trishicw� Svrc—Asoma Aotnns eve , herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as AN IDSF - INTERMITTENT DOSING SAND FILTER located at (legal description) HALL LOT 12A 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) IT Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. KSy It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). g'7- Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. r5f Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 "T Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. �� Owner acknowledges that the fine for failing to maintain and repair an AWWTS maybe assessed in accordance with AMC 14.60.030. K SS Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. _gs Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. �_(;y Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS, Vg.� Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNER: / By; � _.. /tom— _--_� (signature) Date: 209-50a( 4) Ljti&fM, &,gu sai JOAM I M (print name) STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT } Theforegoin instrument was acknowledged before me this & day of , 20'x, , by Y \sf10-y) U� hS NOTARY PUBLIC FOK ALASKA My Commission expires: (rev. 05/18/2018) ture Date:t ;'V)67 name) Title: Page 3 of 3 MMC[PALPFY OF ANCRORAOS T Corr mnity laevelopment Department • On-Sitc Water & W"tewateir Z'rogrum. P: 407-3437904 - F: 907-343.7997 • P•Q. Box 196650 A.noborage, AK 99519-6650 ^ http://Wmrw.muni,org/buildia2 intermittent Dosing Sand Filter Maintenance Log Owner o l) t, Phone 9o?, &� /�_SS Legal Desc. ko i PID Septic rrttc: -Sludge level inches -Pumping: requiredev s no *pumping completed�,j_e_.I oCtion Field: 1 3'("X4'61_9 -Liquid level , inchas -Flushing valves per approved design Le. o -All flushing valves open A, distribution lines flushed, and flushing valves closedj g3 no Uft station: -Pump basket cleanedes o •Biotube effluent filter cleaned es no -Timer float setting7.2, inches -High level float setting „Llinches -Reference point, r -x, -Pumpon- .6() seconds -Pump of(- minutes -Cumulative lifetime cycles -Cumulative run time hours -Operation satisfactory es o Air Svstern. •Air pump filter cleaned no -Air pressure ps' ,Date of latest install or rebuild ab 2.� *Air system operation a isfacto no sati:a,',actory Marr ,,�vs#enn: *Dedicated electrical circuites no -Audible and visual alarm inside dweilin �no -Float setting 3 _inches -Alarm system operation (Satisfacto not sati ,factory Comments: .........................................................................................................................................,........ ........................................................................................................................................................ Maintenance Provider: Technioian �O'V-6`�u ) �� F Company .��.�' (0Qt Signature IDSF Maintenance i,og_gq.033�,dQc i Date of mainten2nce36 SE'� CC ©site LTJ, S L t i' �hEl+. loll!+ k ,� lt'.r1S61&S i C�zi;'Itf 1Ta MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT (� On -Site Water and Wastewater Section www.muni.org/onsite \' Arsenic Advisory Certificate of On -Site Systems Approval # OSC251055 Subdivision: Hall, Block: , Lot: 12A 907-343-7904 Fax: 343-7997 A water sample revealed an arsenic concentration of 17.3 micrograms per liter (ug/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org 9 00000000 OF A 0 �,A 49 T CD SHANE A. HOLT qjG Q� LS -6914 5J4� Q,���DOO". ofessiona\ \-2'o N 89 59'43 " W 330.34 DECK rn N O X19 �,• m • ,a 0 o• • O M. I * O O• w • N 80 304.84 0 • SEWER SYSTEM PIPE THE INFORMATION HEREON /S FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLA T, ARE NOT SHOWN HEREON (UNLESS INDICA TED) NOTE.- FENCELINES THA T MA YAPPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPER TY L INES OR POSI TION A DDI TIONA L IMPROVEMENTS ANY PA VING SHOWN HEREON MA Y BE APPROXIMA TE DUE TO EXCESS/ VE SNOW AND/OR ICE. GRAVE DRIVEWAY WELL 131.6 ASBUILTSURVEY 1" =20' NO CORNERS SET THIS DATE /HEREBY CERTIFY THA TI HA VE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT12 A HALL SUB. (PLAT96-127 ANCHORAGE RECORDING DISTRICT, ALASKA, AND THA T THE VIS/BL E IMPRO VEMENTS SI TUA TED THEREON ARE W1 THIN THE PROPERTY L INES AND NO VISISL E ENCROACHMENTS EXIST OTHER THAN NOTED. DA TED A T A NCHORA GE, A LA SKA THIS 10 TH DA Y OF DECEMBER .2024 16185 239-72 HOL T LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 223-8615 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wssfewater program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.d.snchorage.sk.us (9o7) 343-7~4 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAHILY DWELLING Parcel I.D. ' 051-092-~ ~.~ GENERAL INFORMATION Completelegaldescription LOT 12A; T15N, R1W, SECTION 8[,J-J ~L.~-"~t Location (site address or directions) 21024 SCENIC DRIVE * CHUCIAK, AK. Expiration Date: ~ - / - O I' ' RON HALL ' Day phone 428-6.391 · Cun'ent Pr~party o~er~s) Mailing eddre~..,. Lending agency 'P.O. BOX 670955 * C~UGIAK, AK 99567 ' ' · .."~ '; " " ' ' ' ' Day phone. Mailing address Real Este{e Agent . Mailing address Unless o~erwl~e requested, HAA wfll be held by DSD for plckup.~ 2. NUMBEROF BEDROOMS: 4 '. Day phone. 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTE'WATER DISPOSAL: Individual On-site ~ · Individual Holding tank E] Community On-site u Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In poragmph 5 by an Independent pmfesalonal 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 slngle family on-site wastewater disposal end/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,) Cer'dficates are valid for one year for pmpartiee served by Class A or B wells or a public water system, The Municipality of Anchorage Is not responsible for errors or omlsslons In the professional engineer's work, Note:Alaska Water and Wastewater Consultants, Inc. shali be pald ~30~9~ a& or prior I to closing for the engineering services provided. ' I 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validaUon date shown below, I ye#fy that my InvesEgaUon, based on procedures outlined In the Health Au~ Approval Guidelines for this applica#on, shows that the on-site water supp~ 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 informs#on obtained from the Municipali~ of Aschorage files and from my Investtgaffon and inspection, the on-site water supply and/or wastewater disposal system Is(are) in compliance v/4h 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 357-6179 Address ~ 6901 DEBARR ROAD. SUITE 2B * ANCHORAGE. AK 99504 - ' Engineer's Printad Name JEFFREY A. GARNES$, P.E. Date" "~'/2.$'/0! Engineer's Commen ' .............. ' ' "· Wstam under lhe cono?flona encounteead st a~e flme of ~he ~es~ and aeparaffon the acx~ benefit of the o~,w~r 8s,'ed above.'Any re#ance upon or uae ~ ~,~/s report by any 5. DSD SIGNATURE I,"'/ Approved for L/[ bedrooms. Disapproved. Conditional approval for __ . .. ~. ON-SITE . ~_ · ~-' WATERAND -~: m=~ .Le.I ..... ~ [ WASTEWATER :' ~ . ~ Attachments: . ·HAA Checklist Septic System Advisory Well Flow Advisory · Manitenanca Agreements Supplemental Engineer's Reort Other Ortglnal Certificate Date:' .~-/- ~ / Municipality of Anchorage Development Services Department On-Sits Water & Westamvater Program P.O. Box 196650 Anchorage, AK gg51g-6650 A. WELL DATA HEALTH AUTHORITY APPROVAL CHECKLIST LOT 12A; T15N, RlW, SECTION 8 ParcellD: 051-092--1~ Wlill'ly]3e PRIVAT[ ffA, B. orGprovldePWSlDft N/A Date completed 6/26/2000 Sanltsp/~ (Y/N) YES Totaldepth 160 fl. Casedto 117 It. FROM VV~ i LOG 6/26/2000 45 Well pmduc~on 3.0 WATER SAMPLE RESULTS: Data of sample: 4/19/2001 .g.pJn. well Log (Y/N) W~es pmpe~ protected (y/N) Casing belght (above ground) AT INSPECTION g.p.m. A~VC, INC. SEPTIC/HOlDING TANK DATA Tank Type/Matarlal STEEL Tank size 1500 gal. Number of Compartments 2 Foundation deanout (Y/N) YES Depression over ta~ (Y/N) NO Data of pumping NEW Pumper ABSORPTION FIElD DATA Data installed e/~7/2~oo Length 30 ft. Total depth =2.06 It. Eft. absorption oroa 360 fit Monitoring tube YES Date of adequacy test NEW Results (Pass/Fall) - Auld doplh In ebeorptJon field before test - In. Water added - gal. Elapsed TIme: - min. Final fluid depth - In. Any rejuvenation treatmont (past 12 mo.) (Y/N & type) - .~ colonies/100 mi. Depression over tleld NO For 4 bedtoums Newdeplh - In. Absorption rata >~ - g.p.d. If yes. give data - Goll mtlng (l[~or fttredrm) 2.0 System M3e BOTTOMless W1dlh 12 .It. Grovel below pipe 0.25 2+ In. Data Installed 6/17/2000 C;eanouta (Y/N) YES High watar alarm (Y/N) N/A D. UFT STATION Data Installed 6/17/2000 'Pump on" level at TIMERIn. Oatufft BOTI'OM OF TANK F. SEPARATION DISTANCES Size In gallons 1500 'Pump off' level at TIMERIn. Cycles tested NEW SEPARATION DISTANCES FROM WELL ON LOT TO: ~eplic tank/lift ~talion on lot 100'+ AbsorplJon field on lot. 100'+ Public ~war main N/A Sewer/septic ~ewlce line 25'+ High water alarm level at 46 Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100'+ Publl= sewer manhota/ctaanont Holding tank N/A Proberty line 10'+ Water esndce line 10'+ Curtain drain NONE KNOWN F. COMMENTS SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO.' Building fonndafion 5'+ . Property line ,5'+ Water main N/A Water eswk:e Ilne. 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO.' Bulldingfoundal/on .10'+ Surface water 100'+ Wells on adjacent lots. t 00% AJ~ field. 5'+ Surface water 100'+ Water main Driveway, parldngNetdclc ~orage 50'+ G. ENGINEER'8 CERllFICATlON I cerUfy that I have determined through field Inspec~es and review of Munlclpal reon~s ~ the above systems are In conformance with MOA HAA guidelines In effect on U~s date. Englneel's Prl~ Na~pte JF_~H~EY A. GARNESS Date ~ HAA Fees Data of Peymont Receipt Number, Waiver Fee $ Data of Payment Receipt Number,