Press Alt + R to read the document text or Alt + P to download or print.

No preview available

The URL can be used to link to this page

Home My WebLink AboutKENO HILLS #4 BLK 6 LT 11Keno Hills #4 Lot 11 Block 6 #020,1 7'1-23 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211302 PID Number: 020-171-23 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name RILEY & CINDY WILSON ABSORPTION FIELD ® Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 17701 SPAIN DRIVE, ANCHORAGE, AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 1.2 GPD/SF 10 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 4 Ft. Gravel depth beneath pipe 6 Ft. Subdivision Block Lot KENO HILLS #4 6 11 Fill added above original grade VARIES 0-0.1+ Ft. Gravel length 42 Ft. Township Range Section Gravel width 2 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 504 Ftz XX XX Ft. Well 100'+ 100'+ 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1250 Gal. Surface water 100'+ 100'+ Material HDPE Number of compartments 2 Lot Line 5'+ 10'+ NA Foundation 10'+ 10'+ LIFT STATION Manufacturer Capacity Gal. Remarks VERIFIED 12'+ FIELD TO FIELD Alarm location Electrical installed by Installer PCN PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Drainfield 3034 CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspdection 1sc 9/23/2021 2nd 9/27/21 Location and description 3rd 9/27/21 4" 6/16/22 MAN HOLE ON-SITE WATER AND WASTEWATER SECTION APPROVAL r- Conditional Approval: Date ,® t� �� 11•I .....�:. •• •••• ••••�;^•� Septic System �,1 Curtis Huffman /® A rove — pp �f �``% w Date — - Z .. CE 128991 ... .49 �� lF'QFD 6/30/22 , PROFESS O Note: this approval does not include well permit requirements. kI uv VJIVG! lo) PID: 020-171-23 PERMIT: OSP211302 SWTS ON E OLD TRENCI A -C=34,9' B -C=50,1' A -D=45,5' B -D=42,7' A -E=46.9' B -E=43.1' A -F=49.8' B -F=44,7' A -G=51,2' B -G=45.5' A -H=50,3' B -H=54,9' A -I=76,9' B -I=58,4' A -J=78.2' B -J=58,5' A -K=72.1' B -K=82.5' A -L=73,2' B -L=79,4' A -M=96.8' B -M=68.5' A -N=100.3' B -N=69.7' PREPARED FOR: RILEY & CINDY WILSON 17701 SPAIN DRIVE ANCHORAGE, AK 99516 SEPTIC SECTION FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 firstwaterAK@gmail.com SCALE, NTS SUPPORT SERVICES: 9T) . k A.n.... DATE: 6/30/2022 tis Huffman.- SURVEY- HOLT CE 128991 DRAWN: FWCS 6./30/202.2 SCALE: 1" = 30' ..... . G U ) 4); 3» «®)� kk\\ »ky-4 \7e; 'CO2 TMEX am} 53)) a<> )2y§ I 7 { ]k §/ )U\ \®) 3-n / izo §� Z:\H / §()2 /m m§ T <�pAIN � All m ? Z $ \f ) Z. �A:\ } — �� •/)q��Y T <�pAIN � All m MUNICIPALITY OF ANCHORAGE On -Site Wator & Wasta4vatar Program Flo Baca 1MG50 4 71W Elmore Reed An&O!Age, Alan a 99519.5654 MOM: [9P7] X43.7904 }iDx;1907) 7997 hhp.NPAv.muni.a4ansite On -Site Wastewater Disposal System Permit Permit Number: O P2t 1 M2 1Nork Type: Septio Upgrade Tax Code Numb$r: 02017123 D06 Site Legal Address: KENO HILLS #4 DLK 6 LT 11 G:3438 Site Mailing Address; 17701 SPAIN DR, Anohomge Owner. WILSON RILED K & CINDY L Design Engineer: FIRS7 WATER CONSULTING This permit is far the construction of - 21 Disposal Field EJ Septic Tank 0 Holding Tank ❑ Privy Effective Datta: Expiration Date; 53i L` r i r �_ rn _ �•ti l epartInonr Lot S I" in Sq Ft: Total Badrna ms, razz 819r2D22 100623 0 P6varte Well ❑ Waller Storage AIG construction shall be Fn accordance with: 1. The attached approved (jesign. 2_ Al l req uiremenls speclfied In Anchorage Municipal code Chapters 15.55 and 15-65 an d th s S1a#s of AlasU Wastewater disposal Reg vlations (18AAO72) -a nd Drinking Water Regu latiorrs (18AAC80) 3. The westewater cede requires inspections during the installatlon, The engineer shall notify U -Me IDeveloprnant Services L�epartment per AMC 15.65. Provide nDffi ation bycalling (907) 343-7904 (247). 4_ f=rom Ocher 15 to April 15, a subsurface sail absorption system under oonslrucGon duriing freezing weather shall be either; a. Opened and Closed on the same day, or b. Covered, sealed. and heated IQ prevent freezing ReC&ved By-, Issued By: 819/2021 Date: Date; 4 MUNICIPALITY C RAGE Development Services Department p<� ; Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 020-171-23 Property owner(s) RILEY & CINDY WILSON Day phone Mailing address 17701 SPAIN DRIVE, ANCHORAGE, AK 99516 Site address 17701 SPAIN DRIVE, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) KENO HILLS #4 BLOCK 6, LOT 11 Legal description (Township, Range & Section) Lot Size 100,623 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Fx� Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank 0 Upgrade Fxl (D) El Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: 7 '� .3 02.0. Receipt Number: Ll i3 2 b3 Permit No. �P 2 I 202. Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com July 22, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: KENO HILLS #4 BLOCK 6, LOT 11 The property owner has requested we obtain a permit to upgrade the failed septic system of the above referenced lot. We propose to install one deep trench and 1250-gallon tank to serve the existing 4-bedroom residence. The design is based on the recent test hole conducted on June 14, 2021. No groundwater was observed at test hole excavation or monitoring. The slopes are flat to moderate at 0-5% at the proposed upgrade location. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211302, Deb Wockenfuss, 08/09/21 S 89°55'15''W 381.29' S 89°55' 15"''W. 415.00'80.040.0 34.04.019.028.0 57.024.030.040.0OWELL SHEDAS P H A L T D R I V E W A Y DECK DECKSPAIN DRIVEASPHALT PARKING AREAL = 260.66DECKPOOL 17.7129.5 FIRST WATER CONSULTING KENO HILLS #4 B6, L11 DESIGN CALCS: NO WELLS W/IN 100' OF PROPOSED SEPTIC UPGRADE NO SLOPES >25% W/IN 50' OF PROPOSED FIELD Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211302, Deb Wockenfuss, 08/09/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211302, Deb Wockenfuss, 08/09/21 4661 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 firstwaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL : KENO HILLS #4 B6 L11 PERFORMED BY: FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 6/22/2021 DEPTH FEET OG SOILS 1 2 ORG/OL-FILL 3 4 5 6 7 8 9 10 GM/gp 11 12 13 14 15 16 17 18 BOH 19 20 Reading Date Gross Time Net Time Depth to Water Net Drop 6/16/21 10 min 6 3 5/16 6 3 5/16 6 3 4/16 6 3 3/16 6 3 3/16 6 3 3/16 PERCOLATION RATE 3 (MIN / INCH) TEST RUN BEWTWEEN 5 & 6 FT PERC HOLE DIAMETER 6 PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH. GROUND WATER ENCOUNTERED: NO IF YES, AT WHAT DEPTH: NA DEPTH TO WATER AT MONITORING: DRY DATE: 6/22/2021 TESTHOLE # 21-1 DATE PERFORMED: 6/14/21 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: FLAT & <5% VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION PERFORMED FOR: RILEY & CINDY WILSON 6/22/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211302, Deb Wockenfuss, 08/09/21 W/ D z a co S 89°55'15"W 381.29' S 89055' 15""W. 415.00' EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON. NOTE: ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES OR LOCATE STRUCTURES. ANY PAVING SHOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS. AS -BUILT SURVEY NO CORNERS SET THIS DATE SCALE:1" = 50' ;AGEE'S INSPECTION OF THE FOLLOWING IBED PROPERTY. 11, BLOCK 6, KENO HILLS SUB., ADD'N. NO. 4 CHORAGE RECORDING DISTRICT, ALASKA AND THAT E VISIBLE IMPROVEMENTS SITUATED THEREON ARE THIN THE PROPERTY LINES AND NO VISIBLE CROACHMENTS EXIST OTHER THAN NOTED. TED AT ANCHORAGE, ALASKA THIS _21 ST Y OF _NOVEMBER 2000_ ILT LAND SURVEYING 91-8,55-18 L. 345-5513 ~.._,/, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT IPHONE 'NEW MAILING ADDRESS LEGAL DESCRIPTION ~ DISTANCE TO:~~~~~ Absorpti:n. ~r~a Dwelling /~ , PERM IT NO. ~ ~ ~ ~ Manu[actu~ ~~ ~ ~ ~~ Ma~~~ No.~ of compartments Liq. cOOac[tg in ~aHons ~ Inside length W~dth kiquid depth -- ~ ~__/:~ IF HOMEMADE: ..... ~ ~ DISTANCE TO: Well Dwelling PERMIT NO, ~ Well Foundation , Nearest lot bne PERMIT NO. ~ DISTANCE TO: ~ ~-~C-~) // ~ ~) / . ~--~~m ~o. of lin,S(O ~ ~ ken,th of eaoh~ linc, Total length o~s, Tronch ~idth~ inchos D,sta~ lin.s ~ ~ Top of tile to finish ~rade ~ ~ ~ ~es Total ef*ective~(~absorption area Material beneath Length Width Depth PERMIT NO. ~ . ~"~ Typeofcrib/~'C?diameter ~~~ Totaleffectiveabsorptionarea.~ ..... ~ ~b~. Depth Driller Distance to lot line PERMIT NO. Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS SOIL TEST REMARKS 72-013~ 3/781 F'EF.:M I T 'NO. aF'PLI ::FINT L 0 C FI. T ! O N LEF4F!.L. ~ DEPARTMENT 'U? HEFIL. TH AND EN',,,'IF::ONMENTaL ],-RCITEC]"ION 825 '"L" STREET., FiNCHORFIGE., AK. ~5450:L 264--4720 ( 8±0:1.:1.6 ) KEIqNETH FU=,T_F.. h ' _SPAIN [. F... ,F.H BOX '~'~R _ ,= ..... FINCH LT. ::1.'~ E,U ..... KENO HILLS LOT SIZE 100000 SC..gJFIRE FEET TYPE OF SOIL aBSORPTION SYSTEM IS: TRENCH MFtXIMUM NUMBER OF BEDROOMS = 4. SOIL RFITING (SQ FT,-'BR)= 85 THE REQUIRE[:, SIZE OF THE SOIL ABSORPTION S'¢STEM IS: fi:, E F" 'l- ~-~ == dL ,~-Z~ L E ~'-~ ~ZSi "T tH == 2 9 i3 F...'. R ",,," E IL [:, E IF:' T H = THE LENGTN [:,IMENS;ION tS THE LENGTH (IN FEET:.', OF THE TRENCH OR DRRINF!EL.D. THE DEPTH OF FI TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND aND THE BOTTOM OF THE E;,..','CFiVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL. DEPTH IS; THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFFILL PIPE aND THE BOTTOM OF THE EXCaVaTION (IN FEET). F.: EL----.~ Li Z: E~-:E[:* ."'E:; E F"'l- I C: "¥"lf~th,~il-=:.' S I' 2'~E== dL;-.~.50 PERMIT FIPPLICRNT HaS THE RESPONSIBILITY TO INFORM THIS [:,EPFIR'rMENT DURING 'THE INS'TFILLaTION INSPECTIONS OF FINY WELLS aDJF1CENT TO THIS; PROPERTY aND THE NUMBER OF RESIDENCES THaT THE WELl_ WILL SERVE. BACKFILLING OF aNY SYSTEM HITHOUT FINAL INSPECTION aND APPROVAL BY THIS DEF'RRTMENT WILL BE SUBSECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN a WELL AND RN'¢ ON-SITE SEWAGE D!SPOSRL SYSTEM IS ±00 FEET FOR FI PRIVFITE HELL OR .&50 TO 208 FEET FROM Ft PUBLIC HELL. DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM [:,ISTFINCE FROM FI PRIVFITE WELL TO FI PRIVFITE SEWER LINE IS 25 FEET lank:, TO a COMMUNITY SEWER LINE IS 75 FEET. !.4ELL LOGS FIRE REQUIRE[:, aND Mt]ST BE RETURNED TO THE [:,EPRRTMENT I.,.IITHIN 3:8 DFIYS OF THE WELL COMPLETION. OTHER REQUIREMENTS; MaY aPPLY. SPECIFICATIONS FINE.., CONSTRUCTION DIAGRAMS ARE R',,,'RIL. RBLE TO INSURE PROPER INSTRLLFITiON. PEZF:ii""I Z T' E."=-4F" ::E F:E---_:-~ [:. E: E: E ~'-I E: E [;;: L~: :.!__,, I CERTIFY THR'r ±: I aM FFIMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FIND WELLS RS SET FORTH BY THE MUNICIPALITY OF aNCNORRGE. 2: I MILL. INSTALL THE SYSTEM IN RCCORDFINC. E WITH THE CODES. ~:: I UNDERSTFIND THRT THE ON-SITE SEWER SYSTEM MaY REQUIRE ENLFIRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THaN 4 BEDROOMS. S I GNE[:,: ................................................... aPF'L ICFIN'r KENNETH FU_,TE~.. ',,,'4. Et DATE RECEIVED INSPECTION APPOINTMENTS TIME I TIME TIME DATE DATE DATE ~ NSPECTOR ~ NSPECTOR ~ NSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF t'fi,-L" & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL Pi~©TECTION ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 REOUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWA DIRECTIONS: Complete a}l parts on page 1. Incomplete raquests will not be processed. Please allow ten (10} days for processin§. 1. PRO~TY OWNER PHONE~ MAI LING ADDRESS PR~)PERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3, LENDING INSTITUTION I PRONE MA~L~NG ADDRESS 4. REALTOR/AGENT I PHONE I MAILING ADDRESS 5, LEGAL DESCRIPTION Lo7 /f /Za,c STREET LOCATION 6. TYPE OF RESIDENCE ~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One ,J~° Four [] Two [] Five [] Three [] Six [] Other 7. WATER SUPPLY ~ INDIVIDUAL~ [] COMMUNITY [] ~ PUBLIC UTILITY * ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) 8, SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 825 "L" S'FREET ANCHOP, AGr'' ALASKA 99501 (907) 264 4111 GEOP, GF M.'. SLILLIVi",,N, [)EPAR I'M?,;T O? ,~iEA[ i ri AND EidViRONMENTA[ P!~OTECTIOI"~ December 31, 1979 Henry J. Orth 1015 West 54 Avenue Anchorage, Alaska 99502 Permit ~ 790243 Subject: Lot 11 Block 6 Keno Hills Subdivision A permit issued by this department for well and/or sewer system has expired. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal ordinance. If you have drilled the well, a well log should be sent to this department to document the installation dat~. If an engineer' has inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please contact this office at 264-4720. Sincerely, Les N. Buchholz, R.S. Senior Environmental Speci~t/ist LN / jw enc: Copy of Permit F'ERH]:T HC TI-.!!~!; L.~i~iq(3'i"H [:, I I'"IE!:N::~;:[ O1',! :!: E; TI"'II~: L.E:!'-4GTH ,:: TH!S: .i.)E:F'TH OF I::1 'TI:;i:E:NCH OF?. I:::']:'l" GI~:OI..IN.f) F:II'.,!E:, THE' 13Ot"TOH OF THE!: 'l"!--I~'.':f;~:l:~:: :!:'.:}; t'4(:~ :ili;E:T HI I:::,"fFI F'OI:;i: THE EiRI::I',,,L[':~;L. I;:,EF:'TH :i;::5 'THE !"I .I.: !.,I :I: HL.IH DE:F'"i'H (::IF: G,r';;:F:I',,,'E~iL. I~::~Ei;'t"i,.L~:i:E:I",i 'T'HE: CILrT'FrFI!.L. I:::' :!: !:::'l;i' FINE:, 'I"I'.'IE: !~OT"FEd'"I OF:' THE: E:?,C:F!',,,'FIT :!: O.N ,:: :[ I"~! I::'[~:E:T ::,. F l:~';:t 1:1: '1" ....... FIF'F:'I T. F:FIIqT ,HF,:::; ............... 'TI-..IEi' F,' ::':: F:' "H'::i, ............... ): iq:iSTFIL.L.I::IT :[ (:li'.,l ]: H'F;.:::'[::; ::: "i' .1. C N:::'; OF I:::hN'.r' !.,.IE!:LL:i!i; I'::iE:,..:rFicE::i'.,tT TCt TH ! :~; F'I:;' ';: F:' E: I:; : T '? Fff',!E:, '(HIE: NL HF, r::;I:;;' Cfi::' R!!i~il; ]: D[:~iI'.,ICE:':'~; THFiT THE: E',F!CKF' :t: EL. .... '[ i'-,lr:i OF' Fff',!"r' :5"r'ff,"l"E:H I.'-! ): THOL!T F' :1: ?',fi:iL .'r H':: F'~:'r':T .... T FIN E:,E:F'FII:;i:Thl[~:NT i.,.I :!: !..L. E',E: :!i~; ~ .I:-:~ .I'I!i'X::T TO I:::'~' :: '::i;F' "~ T '.r- ..... . .::,[':.~..!I' I1. :, .; .... -,1T ,N 'r I',Il tH I) :[ :~TI::INC[~: .F:",I:~i21"I.,.IE:!:'::N F:I I.,.II~!i:L.L.. F:ff',!D F:ff-,l"? Oiq-~:~!;);TFi ..... ' E:, ]: :~i;F:'O?!;(:IL. :i~:',,-':!!i;'i"[ii:!'"l '~'::' _,~._~.l I:::'I~:.:E-I" I::'Ot::~: I::I F'R:[ ,i-II.:. HE~:L.L..~ .........· 'i!;~i~i T();:-::1:_:;i!.:;.i t::' I:~: E: "t" F:'I:;i:Cd'"I 1::i l::' iI:::Ir.]:C.. !.,.![!!:L.i~ I'::,CI.:'E!:iLE,:JN:::_i UF'CII'.,I TI...!liTi: '~'' F.!E::L.L LClI:~i:ii~; l::lt::-::Ei: i:;;:E~:g!l...i]:l:;i:lii? l:::l!qE:, .'P'II...I:::~T Iii:E: I::?[~TLIF:f'.,!I:~:[::, TO THE: ,.. L.I ~. !!1.. O1::' '1"!-.tI:~: I.,.!E:L.I... :] ': I".i::'L F'T '.r O1'.,! . ':'"I"HF."R [:E!::.!. 'iI::~'IFHI::'I'.q"':::; l"ll::l"r' 11. fl .... '~F'!"--CTt:::'I":FIT'i:ON':'i!; t:::iNI) ~""I"P:::'T'F' '" "" ]' ~] i"1 F:IVFI 'J: L!::![E:L.[E: 'T'O :[ t",It~:::Ltt:;~tE: i:::'RI.-.II::'E]F?. .I I",I:'~;"I'!:::IL.t_.F:!'I" I. OIq. ! C££RTZI::""~" "FHI:::IT ::L: :[ FIH F'F:II"I :[ L. :[ !:::IF: !.,.IITH THE.:.: F:..'E!:(;:!I...I:[IE:[~I"'I[~:i",!'i":5 F'CIFi: OI",I'""~"::: :[ T!:!: :::~;E:I.,.t?~:R:~; FINE:' i.,.!I::!:!...L.::::; !:::l:i~; ':'ii;E:'? F'ORTH ?."r' 'I"Ht~: I"ILIt"~ Z C :[ F'I:::!L :[ T"r' OF: 2: Z l.q :[ EL :[ N'."~;TI::IL, L, THEi: :::?'r'??l"E:h'l :!: I",I (::~I::::C:OFi:!:::,FhNC:!i!!: I.,.I ~:: I UNt:::,Ei:Fii:ii;TF:IN[::, THI:::IT ']"!'-I[~: Oi'.,!-...:L:;ITE~: :i~iE._'!.,l[:~:F:: :i:;"r':~;'t"E.:!"i R?.::: :[ DI:!:"NC:I!i!: :t.':~!; I:a:E:HOE:,Ii~:iLE:I)'T'O INC:L. LiI::,I::!: I"!L:~Fit!!~: 'Ff"fi:!N ~/ ~ Q_~.}, SOl LS LOG MUNICIPALITY OF ANCHORAGE [] PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST Pouch 6-650, Anchorage, Alaska 99502 276-222~ SOILS LOG - PERCOLATION TEST 1 2 3 4- 5 6 7 8 9- -lO- 11 12 13 14 15 16 17 18 19 20 0-1 SLOPE L_ WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SITE PLAN ...... i ---T~'- ! Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND __ FT PERFORME:BY:~ ,~ CE:TI lED : ~ 72-008 (7/76) 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 E' Parcel I.D. 020-171-23 Expiration Date: 1. GENERAL INFORMATION Complete legal description KENO HILLS #4 BLK 6 LT 11 Location (site address) 17701 SPAIN DR, ANCHORAGE, AK, 99516 Current property owner(s) RILEY & CINDY WILSON Day phone Mailing address Real estate agent 17701 SPAIN DR, ANCHORAGE, AK, 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ �0 Waiver Fee $ Date of Payment 6L_�'qb Date of Payment Receipt Number O 10 3 /a Receipt Number COSA # 05 c X9,1 3 a D Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 6/28/2022 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 �+�s111 these various and dynamic characteristics and are outside the control of the evaluator of the �' •�f(i well and septic system. Therefore, any estimate of how long a system will function satisfactory ��Q:. • • .. for current or future occupants or guarantee that no unseen encroachments, deficiencies or g•• '9 discrepancies exist can be given by First Water Consulting & FWCS ' *• 49 TH •* / . ... .. ......... 6. DSD SIGNATURE .... • •' �" Curtis Huffman P6` * . CE 128991 ••`�i System #1 Approved for bedrooms ��cisF9Fo Q/28/?2 • -.\��`"� System #2 Approved for bedrooms ili pROFESSIOO Disapproved Conditional approval for bedrooms, with the following stipulations: \ OA O 41 v 19/ -1FR �_k Original Certificate Date:7- g-2- The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other • Legal Description: KENO HILLS #4 BLOCK 6, LOT 11 Parcel ID: 020-171-23 If more than 1 septic system on lot: COSA Checklist # _of A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 7/30/1981 Total depth 182 ft Cased to 17.3 ft (INTO BEDROCK) ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 5/28/2021 Static water level at beginning of test 33 ft. Comments B. TANK DATA Age of tank(s) NEW TANK 9/23/21 years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank ® Standpipes/foundation cleanout per record drawing Date of pumping * D. ABSORPTION FIELD DATA Which system tested (date installed) NEW SYSTEM ® ALL standpipes present per record drawing Total measured depth from grade 10.1 ft(max) Measured depth to pipe invert from grade 4_1 ft (min) ❑ N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective 6'ED IR Structure served by this system Well production at time of test 2.7+ gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate 1.32 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected b FS y < �, Date of Sample 6/16/2022 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: *NEW SYSTEM Adequacy test date NEW SYSTEM Results 0 Pass For 4 bedrooms Fluid depth prior to test _ in Water added gal New depth in Elapsed time min ®Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced gallons Fln�`�S Comments/Deficiencies: AT GRADE MT/CO:, E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No ® Yes if No ft ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Manure/Animal Excreta Storage > 100' Building Foundation > 10' Community Sewer Main > 75' ®Yes — if No ft ®Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells >' 100 _ ®Yes if No Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. OF k M • . . . . . . . . . . V 'V • • Curtis Huffman CE 128991 ROFESSI \.��Azw �', ft ft ft ft ft ft ft ft Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING 0~0-171-~3 H A# fqRC O LO I GENERAL INFORMATION Complete legal description KENO HILLS SUBDIVISION ~4: LOT 11. BLOCK 6 Location (site address or directions) 17701 SPAIN DRIVE ANCHORAGE AK 99516 Property owner Mailing address Lending agency, Mailing address DONALF' LF'ITCH 17701 SPAIN DR~VE ANCHORAGE AK Day phone ('9071 345-2479 99516 Day phone ' Agent TERR~E PISA w/ JACK WHITE Day phone (g07~ 762-.3114 Addmss 3201 *c" ~R~ ANCHORAGE AK ggs03 Un/ess othemgse requested, HAA will be held for pickup, 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well xxx Community well Public water NOTE: ff community well system, provide wrftten confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xxx Holding Tank Community on-site Public sewer NOTE: ff community wastewater system, provide wrftten confirma~on from State ADEC lng to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 Computer Version INote~ A/aska. Water. and Wastewater Consu./tants, In.c. sha/l be paid $400.00 at, or prior to, closing mr the engineering set. cee prodded. 5. STATEMENT OF INSPECTION BY ENGINEER As cer~fied 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 further vedfy that based on the Information obtained from the Munidpal[ty of Anchorage files and from my investigation and Inspection. the on-site water supply and/or wastewater disposal system ls In compliance with all Munlcipal~and State codes, ordinances, and regulations In effect on the date of this inspection. Name of Firm ALASKA wA,T~'~& W~TE~,Z{,'r=ER CONSULTANTS, INC. Phone (907)337-6179 / Address 6901 DEBARR ROAD. SUIT;; Engineer's Signature [~.~ iJ tn conducting this evaluation, AWWC, Inc. system in accordance with ADEC and MOA[ DHH.~ performance of the system under the conditions e~ measured to readi~ identifiable features. The operational life of all wells and septic systems depend on the local soils condition, ground water levels that may flucluats dudng the year, and the water usage of the fami~, being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee futura performance of the system, nor do they guarantee that there ara no hidden defects or encroachments. AWW~, lng can therefore not provide any warranty for future estimate of how long the system v~ll continue to meet the operab'onal requirements of the ADEC or MOA DHHS. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor ~ll It confer any legal right whatsoever. 6. DHHS SIGNATURE Approved for - ~ Disapproved Conditional approval for bedrooms / I ~/~"~ Date . ~1 to ~'evide a thorough, conscientious engtnsedng analysis of the Guidelines & Regulations. The reported results described the ~untered at the time of the test, and separation distances bedrooms, with the following stipulations: Additional Comments Date /' ~.,. - The Municipality of Anchorege Department of Health and Human Services (DHHS) Issues Health Authority ^ppreval Ce~ficates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of AJaska. 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 en'ors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Sac~ MOA ~1 Computer Version Municipality of Anchorage R E C E I V E DEPARTMENT OF HEALTH & HUMAN SERVICES Envtmnmentm Sendces DIv~lon DEC 0 5 ZOO0 625 'L' Street, Rm 502 Anchorage, Naska 99501 (907) 343-4744 Health Authority Approval Che~Rot,'~r~ ~ onnaoN KENO HILLS S/D J¢; LOT 1 1, BLOCK 6 Percel I.D.: 1~2' FROM WELL LOG 17' $ 020-171-23 g.p.m. 1,8,3 g.p.m. Nitrate 0.5 mq/L Collected by:. Other becteda A.W.W.C. INC. 1250 Depressinn (Y/N) Pumper issAcs *LOCATED IN CRAWLSPACE PER I HOMEOWNER AND PRE'~OUS HAAJ Soil mUng (g.p.d,./fl2 or ft2/bdrm) 85 .6yetem type TRENCH Gravel thlm below pipe ~' Totel depth t0.5 Number of Comperlmente ;~ Cteanoute (Y/N) ~ NO High water alan~ (Y/N) N/A Effective al:mmpUon ema 560 SCl FT Date of adequacy test 4/28/2000 Ruld depth in ebsoq)flon field before test (in.);, Fluid depth 2.5' (ins) Minutes later. Peroxide treatment (past 12 monltm) (Y/N) {;2' Immediately alter 791 :?0 Abso~fien rote :, NONI[ KNOWN If yes, give date Monfiedng Tube presem (Y/N) YF, S Depression over field (Y/N) NO Resulls (Pass/Fell) PASS For ~ Bedrooms , gat. water added On.): ;}' 450+ Date of test Steflo water level Well producfien WATER SAMPLE RESULTS: Cc~orm o Date of sample: 11/17/2000 B. 8EP11C/HOLDING TANK DATA Date Installed 6/11/81 Tank ~ Foundafien deanout (Y/N) 'YES Date of Pumping 4/28/2000 D. AB~ORPllON fiELD DATA Date inst~e~ e/11/81 Lsr~ 3o' ~ A. WELL DATA Well Type PRIVATI~ Log present (y/N) Total depth If A, B, or C, attach ADEC letter. ADEC water system number N/A Y~:$ Date completed 7/50/81 Cased to 17.3' (TO BEDROCK;) Csslllg height (above ground) 2o" ~ properly protected (Y/N) ~ AT INSPECTION 4/2s/2ooo D. UFT 6TATION Date Installed Manhole/Access (Y/N) High water alarm level at' Size In gallons level *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Se~c/holdtng tank on lot 100'+ · ad:~orptJon field on lot 100'+ Publlo ~ewer main N/A 8ewar/~epfio eendce line 25'+ On adjacent lots. 100'+ On adjacent lots 1 oo'+ Public ~wer manhole/cloanout N/A Uft atatioll SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Abso~don field 5% Water main/service line 10'+ Surface water/drainage 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Surface water 100'+ Driveway, paddng/vehlcte storage area lO'+ ,Water main/sendce line. 10'+ Date of Payment /'~-- ~-- RecelptNumber ~ (.~-~'T'(~ Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 ,~,nchorage, Alaska 99519-6650 ~343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ~'~ ~ - .~'~ HAA# ~-~ GENERAL INFORMATION Complete legal description _/-~ ~ IIj ~ [oc_/,~- ~.., Location (site address or directions) Property owner ~--r'g Mailing address ~,-/~o_O Lending agency Mailing address_ ~(~'O Agent /..yon ~¢¢,~z'~ Address~ I?--Z'~ R~fn Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 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 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Engineer's signature .~.~ ,~. ~ Date DHHS SIGNATURE /~ Approved for -~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does th is as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOAI¢21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDe'scription: 1...11! ~/1~' ~ /'"C¢~ 1Jr~llj ~¥ ParcelI.D, A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Cased to I?' ~'~n fo /~¢cZfoc~,) Casing height Wires properly protected (Y/N) Date of test Static water level Well flow Pump level If A, B, or C, attach ADEC letter. ADEC water system number A/, ~. ~ Date completed '7 / .~o/8/ Driller ~,~e,') f~.c ~O t, FROM WELL LOG 5" g.p.m. AT INSPECTION /'7' ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank /~oa~_ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~c- ~5'5" Absorption field on lot Public sewer main Sewer service line ICC,, WATER SAMPLE RESULTS: Coliform ~;~ col /'iOo~.-~ Date of sample: ~/~ Nitrate Collected by: Other bacteria 0 col /IC,,C~m ,,~ B. SEPTIC/HOLDING TANK DATA Dateinstalled ~ / l l / ~'1 Cleanouts (Y/N) Y' High water alarm (Y/N) Date of pumping' '~ ! 85~ / ~) $ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lOt ~ 15-5" On adjacent lots To propertyline ~' 5'O~ Absorption field 11 Tank size / ~-5"~ ~'c4/ Compartments ~- Foundation cleanout (Y/N) Y -r ,- . . I'~,z/',4~ ~ Depression (Y/N) /), Alarm tested (Y/N) /'1,/r, N Foundation Water main/service line Surface water/drainage "~ loo' 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION N. ,4-. Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles 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 g / II / ~'/ Length .3'0' Width Total absorption area ~ o"'O Depression over field (Y/N) Results (pass/fail) ~ ¢_ _c_¢ Peroxide treatment (past 12 months) (Y/N) Soil rating ~'..4" z2r//3'~¢,~ System type Gravel thickness ¢~ ~ Total depth Cleanouts present (Y/N) ~' Date of adequacy test 'P_ / ?.. P- / 9 ..,? for '~ l',lo~ ~ I'~n ~ ~.,,~ o3c If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~ I ~',¢' To building foundation On adjacent lots ~ ~O Surface water '7~ Curtain drain Ik/o 4 ~. On adjacent lots '~ !oo ' Property line ~ O ' To existing or abandoned system on lot Cutbank /'4, ,4, Water main/service line ~6'O' Driveway, parking/vehicle storage area ~ 5'0 ' E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature -_~~~,'~.- ~'. Engineer's Name ~'~ Date '~. / ~5- HAAFee$ //6 Date of Payment Receipt Number 72-026 (Rev, 3/91) Back MOA Waiver Fee: $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE · Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include Iht, block, subdivision, section, township, range) Ln.¢ 11; h~r~k 6; K¢.~n Hx'£1z~ ~4 Location (address or directions) 17701 _qpaJ~ (b) Property owner K~h Mailing Address 12595 North 73rd Plac~ (c) Lending Institution Telephone Mailing Address CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING .Telephone.: (home) -'Business Scottsdale~ Arizonia 95260 (d) Real E~tate Company and Agent Jack White Company ATTN: Dale Murphy Address 3201 C Street Suite 100, Anchoraqe, Ak. 99505 . Telephone 563-5500 /~7. (e) Mail the HAA to the following address: (or check here [~,Xif hold for pick up.) List contact person and day phone number below: ~NGINEER[NG River Loop Road No. 204 2. TYPE OF RESIDENCE - Single-Family EXx Number of bedrooms 5 3. WATER SUPPLY Individual Well [~( Community [] PubJic [] Note: If commuqitywel[system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, Iverifythat my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Telephone Name of Firm Address 17034 Eagle River L~p Eagle River~ Alaska Date This Health Authority Approval request is to remove the conditional issued March 28,1990. Refer to the letter from Stepahn Siren to Dan Bol~m~ dated April 12, 1990. 6. DHHS APPROVAL Approved for -.3 -bedrooms by Approved _~./'~ .Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Ftuman Services(DHHS) issues HealthAuthorityApproval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHSdo not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANC'HORAGE ~ Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Lot II; Block 6; '-~¢no Hills #4 Location (address or directions) 17701 Spain Drive (b) Kenneth & Mary Lou Foster Property owner Mailing Address - 12595 North 7$rd Place (c) Lending Institution Telephone: (home) Business Scottsdale. Arizonia 95260 Telephone Mailing Address (d) (e) Real Estate Company and Agent Address Teleph6~e Jack W~ 'n~t~ Company ATTN: Dale Murphy .qu,i,¢a. lfifl A~.t*hn~taga.: /~b. 9q~;03 . 7 Mail the HAA to the following address: (or check here.~, if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 Eagle R~ver Loop Road No. 204 Eagle R~ver, Alaska 99577 2. TYPE OF RESIDENCE Single-Family,~ Number of bedrooms 3, WATER SUPPLY Individual Well ~X Community [] Public [] Note: If community well system, must have written confirma!ion.from theState Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-siteJ;~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88} Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION. As certified by my seal affixed hereto and as of the validation date shown below, Iverifythat my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Date S & 5 ~-NGINEF. Rii4G 17034 Eagle River Loop Road No, Eagle River, Ala~.~ 99577 Telephone ~-~ ~::; ¢'~'¢ ~'¢:~ 7 ¢ 6. DHHS .~.PPROVAL . ,~ Approved for f-,3 bedrooms by _ _ _ Date Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and staterequirernents. Employees of DHHSdonotconductinspections or analyze data before a certificate is issued. The MunicipalityofAnchorageisnot responsibleforerrorsoromissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 S. NVIRo,\,MrzNTAL SE,R~,~c MUN.!C .P_AL/TY OF ANCHORAG (M©A~ ~.~/~JlON ~ealth Authority Aporoval I~E~( "' ~.,:4)'u , 343-4744 A. WELL DATA [ We ~ Classmcat~on ~ ifA, Total Depth~ Cased to~ ~ I - ~ ~ - ~/ Y~e/d ~ uepth of Grouting ~ C Static Water Level ~ ~ Casing Height Above Ground ~ - Pump Set At ~ Sanitary Seal on Casing Electrical Wiring in Conduit (Y/N) ~ Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ~ .... To Nearest Edge of Absorption Field on Lot / ~ '~ , On Adjmmng Lots · . ~ On Adjoining Lots To Nearest Pubhc Sewer Line ~ To Nearest Public To N~arest Sewer Service Line on Lo ~ / Sewer Cleanout/Manho~e Comments _ ~ B. SEPTIC/HOLDING TANK DATA · . Dat Pumping/Maintenance Contact. on File (Y/N~ /u//~,~- , e Last Pumped ~,~ o~dmg Tank HJgh-WaterAlar .... ;..-' . /~ ' ; for m [~/N) ~ Temporary Holding Tank SEPARATION DISTANCES FROM SEPTIC/HOLDiNG TANK: To Water-Supply Well ~0 / ~ " '~ ' ~~ To Building Foundation ~ To Property Line ~ T '. ~ -To Disposal Field ~ To Water Main/Service Line ~ ~ To Stream, Pond, Lake ...... x- u, ~ajor urainage Course ~ ~ ' '~i ' -' Ho~ t ~/~ 72-026 (Rev. 7/88) Fronl ' Page.1 of 2 · ABSORPTION FIELD DATA ~Type of System Design Soils Rating in Absorption Strata oate installed ~- Length of Field ~ ~ Depth of Field ~ Width of Field z~ravel Bed Thickness ~ · Present (Y/N) Square Feet of Absortion Area ~ (00 -' Statndp~pes ~ Date of Last Adequacy Test Depression over Field (Y/N) ~ . .-- -b ¢~ Results of Last Adequacy Test ~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-SuPPlY Well ~ To Property Line ~ To Existing or Abandoned System on Foundation ~ . To Building ~, On Adioining LotS ~O Lot ~ To Water Main/Service Line / '/' To Cutback (if present) To Stream, Pond, Lake, or Maior Drainage Course ~~-/.J. To Driveway, Parking Area, or Vehicle storage Area Comments D. LiFT SnTsAt~ieOdN ~. Dimensions Date I ~ Manhole/Access (Y/N) Size in Ga'l,on;,,~t ~/~ "Pump Off" Leve, at_ "Pump On Level at ~/ ~ Vent (Y/N) -- Adequacy Test· High Water Alarm Level at ~ Pumping Cycles during Tested for -~--~- ~ ~ Meets MOA Electrical Codes (Y/N) ~ ~ Comments **Check Permitted Bedroom Rating Against HAA Request ::' .~?~,~:. ~4te;~.'~Cf'this ~ certify that Signed ~~o* Ro~8 No. ~04 :" _ ..... Date MOA No. (.) ~ [:: ~ )~ Receipt No. Date of payment -~ .... ' * '- ~¢ Date of Payment Amount: $ April 12, 1990 Mr. Dan Bowls Municlpality of Anchorage Anchorage, AK 99501 Re: Ken & Mary Foster Lot 11BIk 6 Keno Hills, Well Construction Mr. Dan Bowls: Chapter 15.55 Water Well Standards for Municipality of Anchorage Sec. 15.55.060 states, "In cases where bedrock is encountered before the minimum depth, the casing will be driven and seated into bedrock." As the contractor who personally installed and constructed this well, I know it was installed according to the standards set forth in the Municipality Standards. All wells done by Syren Bros. Drilling are seated until the drive shoe begins to crimp because of the force used to ensure a good seal. This is done in cases where bedrock is encountered before forty feet. I hope this can clear up some of the confusion about this particular well. I hope this statement will enable this well to get a clear approval by your office. I would like to be informed about any changes in this situation and the reasons surrounding activity about this well. Thank you. Stephen D. Syren, Owner Syren Bros. Drilling HC016761 Palmer, AK 99645 Anch. 349-5966 (message) Pal mer 746-0606 MUNICIPALITY OF ANCHORA(~I~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION APR 1 RECEIVED ~,-~ MUNICIPALITY OF ANCHORAGE ~"~'~ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (incluCe lot, block, subdivision, section, township, range) - Location (address or directions) (b) Applicant Name ) ~¢.¢*.,',-~.~?-z~ ~-~'.~-~-,,~¢,~ Telephone: Home ':?"/~'"--~"'~'~"~ Business Applicant Address _~/--~-t ,..r.' ~.? //~-- ~ ./~-.-'.¢ ~?-~ ,~: (c) Applicant is (check one): Lending Institution []; Owner/builder ~]/i Buyer []; Other [] (explain); (d) Lending Institution ~)/"~. P :A~. Ui~ ~C~' ~ Z_o .~."~elephone ~:~ '~ ~'-/~/'~ i (e) Real Estate Company' and Agent Address Telephone Mail the HAA to the following address: (f) TYPE OF RESIDENCE Single-Familyfl~ Multi-Family [] Number of Bedrooms ,~ Other WATER SUPPLY individual Wellj~' Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite/~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 01/84) 5.' ENGINEERING FIRM PROVIDING IN~,~-i~'ECTIONS, TESTS, FILE SEARCH, DATA/~'~'~lJ INFORMATION As certified by my seal a, ffixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection, r Name of Fir~¢:~ :~' : Telephone Date ~- ~ ~ '~ ~ DHEP APPROVAL ~-'~ Approved for ~;; rmOsV;~ Co n/.d i~iio n al Approva~iSapproved Conditional Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72~025 fl 1/84) WELL DATA ~' ....MUNICIPALITY OF ANCHORAGE (MO~;)~' HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description:--'/'~-¢~- b :' ...........'-'~ '~r4LHORAOE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION Q O 1986 Casing Height Above Ground Electrical Wiring in Conduit,,~)~l) Well Classification. ~¢ /c4~/~//-~ if A, B, C, D.E.C. Approved (Y/N) Well Log Present',J) ~-~ / ':;~-' ~ -~ ~'''' Da~e Completgd - Yield Total Depth Cased to ~%~z, 4',~¢/,' Depth of Grouting Static Water Level ~¢ ? Pump Set At ~'~'/ '" Separation Distances from Well: Sanitary Seat on Casing ~'~¢1) Depression Around Wellhead To Septic/Holding Tank on Lot //,¢'~' .--~ ; On Adjoining Lots ~//' ~ ; On Adjoining Lots To Nearest Edge of Absorption Field on>ct . To Nearest Public Sewer Line ,~'//,~¢¢ To Nearest Public Sewer Cleanout/Manhole "'~u//-'~ To Nearest Sewer Service Line on Water Sample Collected by ~ ~¢'/~-/¢ ,/~ ,4~,/ ;Date Water Sample Test Results ~,~] B. SEPTIC/HOLDING TANK DATA Date Installed '~' '-//¢ ~ Standpipes ~) Depression over Tank (Y/~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: ./ To Water-Supply Well ~ To Property Line .~ /.. To Water Main/Service Line "-~ Course /¢'/¢' '¢~ ~-¢'/ Comments ~;~ /~-¢~ Size /?*~-~ No. of Compartments Air-tight Cap,~/,N) "(~'~' Foundation Cleanout ~(~N) Date Last Pumped ,~,~ ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field .// To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~"-> Date installed ~ --//~ ~> Width of Field .':3'~ Square Feet of Absorption Area Type of System Design Length of Field Depth of Field Gravel Bed Thickness Depression over Field (Y~) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well. ~2" To Building Foundation .~ To Water Main/Service Line 4¢~¢' / To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Standpipes Present) Date of Last Adequacy Test ~ -'--~'~'¢ -- ~:~¢ / To Property Line ,-'3~''~ '/- To Existing or Abandoned System on ; On Adjoining Lots ,/~' '¢ TO Cutbank (if present) ~:~ ~~ ~ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I I~ave che?/~ed, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Si g ned~//A~-~¢ /'/~ ..¢-'~¢/-¢.,'¢~;.~ Date Compan~-~¢: .~: ~ ~:~OA No. .e ei t 0 Date of Payment ~ ~ ~ Amount: $ ~-~ ' Page 2 of 2 72-026 (11/84) BESSE, EPPS & 2220 EAST 88 AVENUE ANCHO~A~, AK 99507 (907) 349-6451 WATER WELL TEST Subdivision: ,/~'~:--.~D Lot: / / Block: ~ Client's Name: Adc]res s: Initial Reading c~ Meter: Production Rate-~,/~ GPM 24--Hour Capacity Gallo~s