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SHADOWBROOK LT 3A
Shadow Brook 3A #015-492-17 2 Municipality of Anchorage V La On -Site Water and Wastewater Section • (907) 343 �9"0�1 �� Page 1 of 2 ON -SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231154 PID Number: 015-492-17 Dwelling: M Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 9 Upgrade Name Catherine Ducasse P Living Trst ABSORPTION FIELD ❑ Dee Trench ❑ Bed ❑ Mound p ❑Wide Trench Site Address 6251 Bubbling Brook Circle ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Shadow Brook 3A Fill added above original grade Gravel length Township Range Section Ft. Ft. Gravel width 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 Ftz Ft. Well 100'+ NA NA NA 25'+ TANK ❑ Septic 9 S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1500 Gal. Surface Water 100'+ NA NA NA Material Number of compartments Lot Line 10'+ NA NA NA NA Steel 2 Foundation 10'+ NA NA NA LIFT STATION Manufacturer Capacity Remarks Tank Replace Only Orenco 250 Gal. Alarm location House Electrical installed by Vannoy Electric Installer PIPE MATERIAL House to tank 3034 Tank to scH 40 PVC drainfield GLW Enterprises, LLC. Drainfield CO/MT Inspector PES BENCH MARK (Assumed elevation) 101.9 ft Inspdatecct Sn vt 10/16/23 10/17/23 Location and description 2�d 3/d 41h See Site Plan, Patio Pavers Under Deck ON -SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date p�G•••..•.• 49 �* .... .. . ....... ••even annope Septic System Approved A Date � � � � •. CE 8149 ••, 20��.��..5�,.• ••....••• Note: this approval does not include well permit requirements, kcv VJ/VG/ 10) /v 00 n - r m_ � m t^ Z1 z _ � m O � V ti w 1' �o o� a o o rn IT o N) b / r r '£ / / i O 2 I i I O / \ � m x 3 0 a �^o W O NOTES: PANNONE ENG SVC LLC (C.1. 1088) P.O. BOX 1807 PALMER, AK 99645 PHONE (907 745-8200 FAX (907) 745-8201 �OF P. *� ....... "fiteren annope CE 8749 ,,��}} 2024.0f.3 REVISIONS DATE 01/29/2024 RECORD DRAWING SHADOW BROOK LOT 3A CATHERINE P & JON C FREY SITE: 6251 BUBBLING BROOK CIRCLE ANCHORAGE, AK 99516 SCALE 50 DRAWN LJC P.I.D. NO 015-492-17 CHECKED ACP SITE PLAN PERMIT NO. OSP231154 SHEET 2OF2 1 I ' ' co C co W W �oy't ~ o� l -J ,20'68Z 3 „S-V,OI.OI S 6 C/) �. oT r � � f Cp 0 CO i JwlOda,� ti O LO � v v o -o c v N12-Su 3 a) x E a Z3 Y U O C — � � L � y � C N o ` c D Qo� 'D L U N ~ O Eru — > 9 d N o u N Y U ? �v vow` M U C GD v= N O dJ N v OL cw 0 E tw'c a D @ o a n � 0 ro O co Z W Ou 1- N (7l c � ^ � v O E 6 n v ^ u N O o a of v a �� _0 _0 ,u 0::>. Q m j @ — U v v� O riO LLo o U W (DLL C7 n LL 0 w w > Ch o< Q ctEl N 11 a- ru U -d V co E v O D U— V 1 7oY ` : .-1 41 C u N 3 "O O O ,n a1 O > C L Q o cl V F" N C twit C OD vun2.E > p N a o v S O` O C N (n�ll u O Q a u N O v v u — W z� Q 0 F- a� O U J1 U W Q, F Q E l� Q F: 3 v o 73 z N W aL-+ v Z C c 'V O `6 o O v o o n c D- LO w > '� L J N U N N (ID (� ' v v a -E � c L ou o u w 3 w —>4 Q U z�o�c O U Fn L O N co . < LLJ�� ' CI] « (r � z cl O m � < _u V o LL �9R2 0 U O W U 45 '0 t. "cCt a W o 0 �8 � �M � O va 0 C\2 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: OSP231154 Work Type: SepticTank Upgrade Tax Code Number: 01549217000 Site Legal Address: SHADOWBROOK LT 3A G:2638 Site Mailing Address: 6251 BUBBLING BROOK CIR, Anchorage Owner: DUCASSE CATHERINE P LVING TRST Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date: incnt S ti° e ionU � Department Lot Size in Sq Ft: Total Bedrooms: 7/7/2023 7/6/2024 52068 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By: Date: Date: 4 MUNICIPALITY OF ANCHORAGE Community Development Department ^' Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-492-17 Property owner(s) Catherine P & Jon C Frey Day phone Mailing address Site address 6251 Bubbling Brook Circle Anchorage, AK 99516 Legal description (Sub'd., Block & Lot) Shadow Brook Lot 3A Legal description (Township, Range & Section) Lot Size 52,068 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) Septic Tank ❑X Upgrade Q (w/wo AD U) Holding Tank El Renewal Renewal ❑ (D) Privy El Multiple Multiple Dwellings and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / 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: Z 2— l Date of Payment: �0 I z' ZO23 Receipt Number: _ - 0 Z L 37l G Permit No. P Z y Permit App_ - :• ; ..:c Waiver Fees: Date of Payment: Receipt Number: Waiver No. X❑ Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231154, Curtis Townsend, 07/07/23 c KNdDalitvofAnchora D _ > On-site rarr�J CD y £ >VO D C/�� REM > .. Cf) 9 0 0 0 I x MU � I I OSP23914 Curti�77 N N� i c>—Z*zZ�miy s ���Do�Ln E m M O U) Z m0—i m o I O m '��� m 0 C Z I n - CO m Z (n O 0 4' = o z r -m p�� O -0 > Frl LA -q Z Cz R, a fel Z7 C/) i Ln r � p U \ m mox oo z� ti I I w •\41 ZD / - - W w -�J N) - - F'— / n. / M 320 ]� om cwer I I �� �Z) / y21 / .?oaor� I Co p m N CD � , I For construction PANNONE ENG SVC LLC (C.1. 1088) P.O. REVISIONS DATE 06/07/2023 BOX 1807 PALMER, AK 99645 PHONE (907) 745-8200 FAX (907) 745-8201 QFAt • • SCALE SHADOW BROOK LOT 3A CATHERINE P & JON C FREY SITE: 6251 BUBBLING BROOK CIRCLE ANCHORAGE, AK 99516 * Ili :* ••• "ie3even annone CE 8149 q 1 " = 50' DRAWN LSC P.I.D. NO 015-492-17 CHECKED ACP SITE PLAN PERMIT NPEERMIT N0. . OSPXXXXXX SHEET 1 OF 2 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231154, Curtis Townsend, 07/07/23 Shadowbrook Lot 3A Subject: 06/28/2023 Originator:LJC Checker: SITE PARAMETERS 1. No angle of repose on backfill material Weight of Water 62.4 lb/ft3 Weight of Soil 120.0 lb/ft3 Tank Bury Depth 4 ft TANK DIMENSIONS Diameter 64.0 in Diameter 5.33 ft Length 10 ft Area 22.34 ft2 Volume 223.40 ft3 Weight 1061 lbf Manholes Yes Percentage of Tank in Groundwater 50% BOUYANT FORCES (weight of the displaced water) 6970 lbf UP RESISTING FORCES (weight of soil & tank) Is Backfill Material Saturated?NO Volume of Manholes 25 ft3 Volume of Soil 188 ft3 (Volume of Soil over Tank minus Volume of Manholes) Weight of Soil 23645 lb DOWN NET FORCE ON TANK 16675 lb DWN Design OK 1500-gallon STEP Tank ASSUMPTIONS 2. 120 lb/ft3 backfill material 3. Tank is empty 4. Tank is 50% submerged. Septic Tank Buoyancy Check Job Number:ACP Job Name: Buoyancy Check Buoyancy Control: 1. No Additional Ballast Required. RESISTING FORCES (weight of concrete blocks) Height 2.0 ft Width 2.0 ft Length 6.0 ft Volume 24.0 ft3 Weight of Concrete 145.0 lb/ft3 Weight of Blocks 1982.4 lb Number of Blocks 2 ea NET FORCE ON TANK 20640 lb DWN Design OK PERMIT NO. SW000306 PAGE 2 OF 3 Municip. Grit; of' BEPARTMENT OF HEAl. TH ANI.) HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,B. Box 196650 eAnchor'o, ge0 Atc~skc~ 99519-6650 · Teteohone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT SA, SHADOWBROOK S/D P.I.D. HO. 015--492--17 -*,TH FV 1 - FV8 ~ 1 /~,'~¢ /~ T.#W' .~ %0 ./ NEW INTERMITTANT DOSING SAND FILTER ILINE EXISTING 1500 GALLON S.T.E.P. TANK (iNTEGRITY VERIFIED) STP TBM LOT 2 I00' LOT 4 ESMT. 40' BUBBLING BROOK CIRCLE CE-8801 PERMIT NO. $W000306 PAGE 3 OF 3 Municip. aH~c of' .A,n~ h.o..r',,o, g.e, DEPARTMENT OF HEA~TH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION p.n. Box 196650 e_Anchocage, A,~taska 99519-665.0e Te.l.e. phone:. 343-4744 ON-SITE WASTEWATER DISPOSAL :SYSTEM AND/OR WELL INSPECTION REPORT LZGAL LOT SA, SHADOWBROOK S/D P.I.D. NO. 015-492-17 ST1 ST2 /99.4' FINAL GRADE/ MH 2" INSULATION I F-x~$r,'¢1500 "x. 94.8, J GALLON S.T.E.P. ~ SYSTEM MT1 = 102.2'-~ MTt DIST. LINE=lO0.1'-d A B FCO 17.0' 54.0' ST1 18.5' 70.0' ST2 18.5' 70.5' MH 19.0' 70.5' V1 21,5' 71.0' V2 21.0' 70.5' MT1 92.0' 125.5' FVl 76,0' 115.5' FV8 93.0' 151.0' yFINAL GRADE ORIGINAL GRADE-~ / ~X~---BOTTOM OF SAND=97.8' GROUNDWATER AT 92.8' 86.8' B.O.H. · ¸%, MUNICIPALITY OF ANCHORAGE Department of Health end Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTE~NATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Aug 18, 2000 Expiration Date: Aug 18, 2001 Permit Number: SW000306 Legal Description: SHADOWBROOK LT 3A Design Engineer: 0003 S & S Engineering Owner Name: Todd LaFlame Owner Address: 6251 Bubbling Brook Cir. Anchorage, AK 99516- Parcel ID: 015-492-17 Site Address: 006251 BUBBLING BROOK CIR Lot Size: 52068 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] SepticTank [] Holding Tank [] Privy [] Private Well [] Water Storage 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. Received By: Issued By: Date: ~-I~ - ou July 19, 2000 ROBERT C. COWAN, P.E. crvlL ENGINEEP~ (907) 694-2979 FAX (907) 694-1211 I~RCOt. AT1ON TEST MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 3, Shadowbmok S/D It is requested that you issue a permit to install a pressurized septic system (Intermittant Dosing Sand Filter) to serve the existing 4 bedroom house on the referenced properly. Test holes were excavated and pemolation tests were performed. The approximate location of the test holes are located on the attached site plan. At the time of excavation on 8/17/93 water was found at 8 feet and after monitoring ground water for seven days water was found at 7 feet on test hole #1 and test hole #2 was found to be dry. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, CC/jBm Enclosure 17034 NORTH EAGLE RIVER LOOP i SUITE 204 · EAGLE R~/ER, N..a~ KA 99577 N.T.S. PROFILE J DETAIL :3. N.T.S. SCARF o.;~. PLAN VIEW N.T.S. PROFILE DETAIL %CALF NORMAL H[IGHT O 84' 0~0 ~ Municipality ~nchorage ~] DEPARTMENT OF HEALTH & HUMAN SERVICES ~* .~ ~;~ ~ ~. ~. ~ , ' 825 'L" Street. Anchorage. Alaska 99502~650 · . SOILS LOG--PERCOLATION TEST ................... i. ,, LEGAL DESCRIPTION: ~g I ~0~¢~0t< I/~ Township, Range, Section: %'~'"'%" ' 2- 3- 4- 5- 7 8 9 10 11 12 13 14 20. SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? ,F YEs. AT W.AT DEPTH? Reading Date Gross Net DePth to Net Time Time Water Drop _ - ; I~ It~ ' : 1~ ~ ~ ~,, ~/~,, PERCOLATION RATE / (f/'J/' (m,nute~/mch) PERC HOLE DIAMETER TEST RUN BETWEEN~ND ~f~>' FT 17p)~Fagle River L~ R~d ~ O~ ~~~ PERFO~E~Iver~ , Alaska ~=~'.za./ ...... ~~1 ~ CERTIFY THAT THIS T~ST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI~CT ON THIS DATE. DATE: .1. ROBERT C. COWAN. P.E. CIVIL ENGINEERS (9O7) 694-2979 FAX (907) 694-121 t INTERMITTANT DOSING SAND FILTER SPECIFICATIONS (Bottomless) Lot 3, July 19, 2000 GENERAL STATEMENT OF WORK The work and plans covered by these specifications consist of furnishing all labor, materials, tools, transportation, and equipment necessary to complete an Intermittent Dosing Sand Filter system as described herein and on thc attached drawings. All work under this project shall comply with current Municipality of Anchorage (MOA) Regulations. 4 Bedroom House 600 GPD Use 18' x 20' Bottomless Sand Filter and absorption area (360 S.F. required) Sand filter to be constructed on accepting soil with all organics removed. SITE INVESTIGATION The Contractor must carefully examine the project documents, have full knowledge thereof, have investigated the site, and be satisfied with the conditions affecting the work. Conditions include, but are not limited to those bearing upon transportation, disposal, handling and storage of materials, availability of labor, water, electric power, roads, and uncertainties of weather, physical conditions at the site including all underground utilities, the conformation and condition of the ground, the character of equipment and facilities needed preliminary to and during prosecution ofthe work. The Contractor must be satisfied with the character, quality and quanti~y of surface and subsurface materials or obstacles to be encountered. Any failure by the Contractor to become acquainted with the available information will not relieve him/her from responsibility of performing the work as stated in these specifications and drawings. Location of utilities will be the contractor's responsibility. 17034 NORTH EAGLE RIVER LOOP ', SUITE 204 ', EAGLE RIVER. ALASKA 99577 Page 2 Lot 3, Shadowbrook S/D July 19, 2000 SEPTIC TANK / LIFT STATION / AIR COMPRESSOR General The work under this section consists of the performance of all operations pertaining to furnishing and installing the septic tank/lift station, air compressor and piping to the sand filt~'. Materials 1. Tank a. Septic tank shall be a two compa~h~ent tank of at least the minimum size indicated on the drawings and MOA approved. b. First compartment shall have a separate 4" pump-out riser. The second compartment shall have a separate 4" pump-out riser. 2. Manhole Riser or Lift Station Tank a. An additional second compartment manhole riser shall be capable of being equipped with the following: 1. A junction (Nema 4x) box or equal, bonded or attached to the pump basin. 2. UL listed electrical cord grips, installed in the J-box. -OR- b. An additional tank (M.O.A. approved) may be provided for the effluent pumping assembly and the items in (a.) above. 3. Effluent Pumping Assembly, Controls, Alarm & Piping a. Effluent pumping assembly shall be of approved materials, including the following: 1. A 110 volt or equal U.L. Listed effluent pump. 2. High-density PVC cylinder housing the pump, with level controls and screen, serving as a baffle to prevent the screen from clogging. Page 3 Lot 3, Shadowbrook S/D July 19, 2000 3. All piping shall be PVC or other non-corroding material. b. Pump controls and alarm system shall be an approved system with the following options consisting of: 1. Event counter 2. Elapsed time meter 3. Program timer 4. 10 watt heater Remote alarm panel option with a minimum of 80 DB sound pressure at 24", operating temperature 30AC to 65AC, continuous sound to be located in the home. 6. Oil-tight visual alarm with push-to-silence feature. Automatic audio-alarm reset. 15 amp motor rated toggle switch, double pole, double throw with three positions; manual (man), automatic (auto) and center (off) (H.O.A.). 8. Nema 4x-rated, fiberglass, or equal, enclosure with hinged cover. 9. All controls to be installed as per manufacturer's recommendations. 10. Control panel to be installed on outside wall of home within sight ofseptie tank/lift station. Piping from the septic tank to the sand filter is to be 1 1/4" PVC schedule 40 solvent weld piping properly bedded as described in Materials Specifications and sloped to drain back to the lift station. Insulation board 2" thick and 2' wide centered over pipe is to be placed where soil cover is less than 4' depth over pipe. d. The air line from the house to the filter is to be HDPE arctic insulated pipe 3/4"-2" SDR- 1 I. The compressor will have a gauge (0-10 psi) and be installed in a heated area, crawl space, or garage. 4. Air Compressor Page4 Lot 3, Shadowbrook S/D July 19, 2000 a. Air compressor shall be a THOMAS LINEAR SERIES model number 5060-A or 5070V-A or M.O.A. approved equal. CONSTRUCTION SEQUENCE In order to insure proper installation, the system is recommended to be installed in the following order: I. Sewer line from house to tank II. Septic tank/lift station III. Sand filter IV. Final grading CONSTRUCTION I. Construction Instruments Contractor shall provide insta'uments such as transits, or levels, for establishing proper elevations and levelness ofpipe or materials. 2. Pipe Laying All pipe shall be laid with material free of large or sharp rocks and organic matter. Each section of pipe shall be handled carefully and placed accurately. The spigot end shall be fully inserted pointing in the direction of flow and glued in place to make a water tight seal. Each section of pipe shall be properly supported to insure true alignment and an invert which is smooth and free from roughness or irregularity. At all times, when work is not in progress, open ends of pipe and fittings shall be closed so that no undesirable substance will enter the end of the pipe or fittings. Page $ Lot 3, 5hadowbrook July 19, 2000 3. Bedding of Pipe for Sewer Lines The pipe should be bedded with materials free of large or sharp rocks and organic matter, compacted. Native materials may be used as back fill material above the pipe, provided it is free of large rocks and organic matter. All lift stations shall be installed in accordance with the manufacturer's recommendations and standards. Electrical installation is to be in accordance with the National Electric Code (latest adopted edition) by a licensed electrical con~'actor, with M.O.A. inspection where required. IfMOA inspection is not required, a licensed electrician is to provide a letter to the Engineer stating that the system meets or exceeds all applicable codes. 4. Excavation Excavate to proper depth to allow gravity flow, install tank level, tolerance 0.05 foot, on undisturbed or compacted classified sand fill material. Create a level sand surface over the tank and add 2" burial foam +35 PSI directly over tank. Mound unclassified soil over tank with a minimum of 2 feet ofcover and anti-flotation weights that may be required in areas of shallow ground water. 5. Connections All connections to be as per MOA requirements, PVC 3034 piping with Caulder or equivalent couplings for inlet riser pipes. All tank connections are to be completely water tight. SAND ~LTER The work under this section consists of the performance of all operations pertaining to furnishing and installing the sand filter. A. Materials 1. Sand Filter a. The Contractor shall provide a washed sand to meet ASTM C-33 Concrete Sand Specifications with the additional requirement that all but 1% of the materials passing the #100 sieve be removed. All aand shall be approved for use by the Municipality of Anchorage (M.O.A.). If the sample does not meet specifications, all sand will be removed and replaced. Page 6 Lot 3, Shadowbrook S/D July 19, 2000 b. The Contractor shall be responsible for providing pea gravel that shall be a washed material containing no fines (0% passing the #100 sieve) and a maximum size of 1/4" diameter. c. The Contractor shall provide the manifold assembly. The manifold assembly shall be of approved materials with orifice shields and flushing assembly. All drilled holes to be cleaned of burrs and pipes flushed, prior to assembly. Flushing valve to include riser to finish grade. Lateral distribution piping is to be laid level (@ + 0.05'). d. Side walls and top of the filter box to be insulated with 2" direct burial polystyrene insulation. e. The Contractor shall be responsible for providing filter fabric. f. Air coil in sand filter to be geoflow WF16-4-24 150 LF placed 6" above bottom of sand. Construction of Sand Filter The sand filter construction is to follow procedures as outlined below, as applicable to this design. Pea gravel and filter sand are to be hand leveled to proper depth (tolerance within 0.05 feet) in filter, taking care not to allow mud or fine soil material into the filter or gravel layer. This would include any soil material picked up by excavation machinery buckets while loading specified material. The Contractor should estimate filter material volumes such that allowance is made for wastage of material in contact with the ground at site. The area over the sand filter to be finish graded with a minimum of 2 feet ofcover and to prevent ponding ofsurface water run off. Side slopes shall not exceed 3: I. The Engineer will reject any sand or pea gravel that does not meet specifications or is contaminated in transit or while handling. If such material is placed in the filter, all soil material may be required to be removed and replaced with new material. CONTRACTOR / INSTALLER PROPERTY OWNER AGREEMENT FOR TttE MAINTENANCE OF AN ON-SITE WASTEWATER DISPOSAL SYSTEM This agreement, dated ~r~'~l/.J~ /,~>~, is rode be~een ~e M~cip~i, of Anchorage Deponent of ~ ~d Hm~ Se~ices ~HHS) ~d ~e prope~ omer(s) of: LOT This agreement is made for the purpose of maintaining an on-site wastewater disposal system on the subject property. The property owner, agree to th, e following: Submit to the Municipality of Anchorage, on an annual basis, an inspection and operation statement from a registered professional engineer. This inspection and operation statement shall verify that the engineer has inspected all effluent and air pumps, timers, and alarms, and that any deficiencies have been repaired and that the system is functioning as designed. (Signature) (S(g~ture) (Printed Name) (Printed Name) Municipality of Anchorage Page f 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 I Permit Number: y" A/ %3 �,�45 PID Number: D Name: ( Wastewater System: Y-NNew ❑ Upgrade Add`ess: nn ABSORPTION FIELD Phone: No.of. Bedrooms: ❑Deep Trench ❑Shallow Trench ed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: + ' GPD/Sq. Ft. Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe 3 s%f/jtADy1/�yfZGgK �' Ft. .7 Ft. Township: Range: Section: Fill added above originalgrade: Gravel length: .71 .'i FL �O Ft. WELL: VNew C1 Upgrade Gravel width: 3 7 Nu �b�pflines: Distance between lines: Ft. Ft. Classification (Priv te, A,e,C): Total Depth: Cased Total absorption area: Pipe material: AfTM n-303 r � Zi'J ! Ft. Z3 Y Ft. / y&__0 SO. Ft. .J.'4:,44 No PVG Driller:/ Date Drilled: Static Water Level: Ins alfer:Date in tailed: /r rl�l/1 /o�/2�i3 /2S� Ft. Yield: Pump Set at: Casing Height Above Ground: '7i TANK i Z-O GPM Ft. Ft. SEPARATION DISTANCES ❑ Septic ❑ Holding IS. T. E. P. To Septic Absorption Lift Holding PublimPrivate Manufacturer: T Wf_A/_7,V,4, /D S•l. � Capacity in gallons: / So- From Tank Field Station Tank Sew Sewer Lines Well w �� J,t /30 X30 BOO Material: Jft Number of Compartments: 'Y Watere ���' > /oo' LIFT STATION Lot SS' %ZS / /1 Size in gallons: Manufacture y ?fly O S Line d'i Foundation ! 7 _ / / $ i "Pump on" level at: �3" "Pump off' level at: 3 rr High water alarm at: /r,' Curtain . // / / �� Pump Make & Model I Electrical Inspections performed by: T Drain yo os� oSri ✓r/G(� Remarks: /. �u,r. r 0���� S%s�F K BENCH MARK �. .Fir<-J/irfi -Q/6 �S l.Wl L.-r.� 1/✓ Location andApescription: i1bnr / Assumed Elevation: EN.EdINEER S SEAL yCCa : V C 30� 21 r Inspections by: �� Dates: 1st performed 2nd /a/— 1n 9, Department of Health and Human Services approval Date: 3 3t Reviewed and approved by: 72-013 (Rev. 9/91) MOA 25 :Permit No. SIJ 9303 '57 Page of 3 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 Description: PID No.: X58 63.E o 11wl qY:URIC, i ii �w V'K U Nc or 1, w ,w 80 z4' R=s 1 a.0el ti V L i) 5 CJO C CCC �F r�� T/,icncel F_, Ands=r5�n ��' c7 .. ;':r•lyi`: is-�. .' .. .. 50 4r" ..%-'(:I�7 ESTATE OF ALASKA i DEPARTMENT OF NATURAL RESOUROFS ' DIVISION OF WATER WATER WELL RECORD OF WELL � �jCRQUGH SUaDIVISION LOT BLOCK StarIONCTRS SECTION TOWNSHIP RANOE QN (JE 1� ©S OW I�fONf$KETCH. WELL OWNER: ". H FROM-Ocasing top Oground surface WELL DEPTH: DATE OF t;DM • IC�I�Y ,MEASURED Depth of hole: it f ..;. 4tS'IDATA: Depth Depth of casing: 3 it f t1�l TYpe.and Color From To • • DEPTH TO STATIC WATER LEVEL: ai .�.,-�. ft w ,� top of n [� ro nd �i�Ul'F oa below casing 0 u a i ScI • { pate• J. / _/ METHOD OF DRILLING: 0 air rotary ❑ Cable.;d;$I 4 (ee Q $cher ' e USE OF WELL: domestic Irrigation. 0 rnoil}ttir ! e°•..tsr.-,.L._.�.' 2.<.� C. r� roc lv � � © public supply 0 other G 7 CASING STIC ft. Diam: 6 in, ..• casinE. type: , in. 7. y.,.,' WELL INTAKE OPENING TYPE: , open end ©at rigid '!s I ' O perforated Q open hole Depths of openings: to . / r C ;7 fI'1p SCREEN TYPE: Diam: Ip. O/ 610t/Mesh Size: Length.t. ORAVEL PACK TYPE: Volume used: Depth to top - C GROUT TYPE: Volume: L,;) _ ft Depth. from to s DEVELOPMENT METHOD: Duration: ; . iPUMPIN LEVEL AND YIELD: ' ' ft after _� hrs pumpingz0a PUMP INTAKE DEPTH: ft Horsepower: MAR I Municipalit of Ancho age WELL DISINFECTED UPON COMPLETION? cif *114CTOR INFORMATION: TWkOrm us nese Name s � n -W ur$ p ut onzedTietp osontettve atm REMARKS: PLEASE MAIL WHITE GOPY OF Lq DNRIDIVISION OF WATER I' PO BOX 772116 EAGLE RIVER AK 99577-2116 M Manch 24, 1994 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 RECEIVED HEALTH AUTHORITY APPROVALS MUNICIPALITY OF ANCHORAGE 2 5 1994 Department o6 Hea,eth and Human Service,6 P.O. Box 196650 WILInicipaiiiy of anchorage Anchorage, AK 99519 Dept. Health & Human Services SEWER &WATER MAIN EXTENSIONS REFERENCE; Lot 3; Shadowbrook Subdivi6 ion S K S Engineering perbormed de.6ign and eng.ineeAing o6 the on-6.ite SEWER&WATER wastewater dispo6at 6yztem constructed on the neben.ence property. INSPECTION Spec i6 i cati.om provided by S K S Engineming were made a condition of M.U.A. perm -ft # SW93035 dated 9/24/93 and requixed .iupeetions/ documentation ob the 6ystem when constructed. ENGINEERING STUDIES The owner contracted with an excavator to per{yorm the work a6 outt ined AND REPORTS .in ouA 6peci4icati,on.6 and ptans, however S K S Eng.ineea.ing was not the owner's representative and did not .inspect the contAaetor6 aetiv.i ie6. There6ore, S K S Engineering 6haP.2 have no t iabi ity to the owner or to other6 4or actio or omi66.ion6 o4 the contractor or any other per6o" WELLINSPECTION &FLOW TEST per4orm.ing work on this project, or the Sante ob the contractor to carry out the work .in accordance with our con6truction documents. IU you require additi.onat .in6ormation ptea6e contact us, SITE PLANS , ROAD DESIGN ZR . SHAFER, P.E. SOILTEST �K ENCLOSURES PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT d)•a)1 3 PERMIT NUMBER:SW930395 n DATE ISSUED: 9/24/93 DESIGN ENGINEER:S & S ENGINEERING ee�A6' FS&.EXPIRATION DATE: 9/24/94 OWNER NAME:KNOX KIMBERLEE ANNETTE C" OWNER ADDRESS:6251 BUBBLING BROOK CIR ANCHORAGE, AK 99516 PARCEL ID:01549206 LEGAL DESCRIPTION: SHADOWBROOK LT 3 LOT SIZE: 52038 (SQ.,FT.) NUMBER OF BEDROOMS: 4"THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS.AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS 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: . � , RECEIVED BY: a ISSUED BY: DATE: �( ` l DATE: 2 r 4 September 15, 1993 HEALTH AUTHORITY Municipality of Anchorage APPROVALS DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'LI Street P.O. Box 196650 Anchorage, Alaska 99519-6650 SEWER & WATER MAIN EXTENSIONS E: Shadowbrook Subdivision, Lot 3 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907)694-2979 FAX 694-1211 SEWER & WATER INSPECTION Request you issue a permit to drill a well and install a septic system to serve the proposed four bedroom house on the referenced property. ENGINEERING STUDIES ANDREPORTS Two test holes were excavated and percolation tests performed on the referenced property. The approximate locations of the test holes are located on the attached site plan. During excavation groundwater was encountered at 8' in both test &FLOW TESTTION holes. After seven day groundwater monitoring the monitoring tubes within the holes were checked. Test hole #2 was found to be dry and groundwater was found at 7' in all test hole #1. SITE PLANS This property has enough area for a septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring properties by the installation ROAD DESIGN of the proposed septic system. If you have any questions, or require additional information for your review, please contact us. SOILTEST Since y, PERCOLATION TEST obe t A. Shafer, P.E. STRUCTURAL& RAS/LSU/lsu MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 310N13 A0088 SNI -081-18 Q w -i V) j �z r) 0 r) F- 0 w -z (-) �7- 0 0 < < 0 O Z(if < < In 00- 0 wFlo� C) to d LLI pm Z LLJ = LLI LLJ LLJ F- -J WZJ 0 z < V) < 0 CY < < LLI F- 0 LLI Er LLJ > >- LLJ Z :2 Li a- L,J U) a� LjJ 0 a- LLI o L, (,() V) = :i F-- i- L� LLI < < 0 N -J Ld � LLJ �- U� 0 M LLI LL C) C) LLj Z F- > < F- 0 Z (/') < F-- Mo 0 .4: LJ Z < LLI -i V) v > LAJ < El < (.DV) WLVj �TyE-or C) 0 V) V) - C) LLJ >Lj 0 L CD Ld ss 0 0 > L 0 CD N 0 to LLI —j D C; II - - L'Do: — i M cq - II Ld LO CL- -i ?� 1 6 LLJ _j (n f w Qwpx m-10 U) O CD 0 N+ V) CO N rO NO 0 All NVIcl IiIS I O�v = zJ 0 oil z F A°�Ea a w P4 a Q � Fqa w a U 6 ¢Qa 20 U_ N boa o a LI) aC40 _O W- N a O O W w W M .� F M Ca a n uj J F o Al w w J z 0 o Q o m w F a V ® co m El O O r- 2 tel' N Of E� J W CO J Q a W G] w Z Z a N J a O Fa- N Ln 00 W_ z V) LJ o A GO _ h I � `z' Q r®+ w =00 U 6 O Q Q 2i W O V J LO ti O LLI cx? ¢ Od- JUNNp G.al q W M4�JJJ o 1n$ c O Z ~�10 44� �-D �a'Q - "� to 'da 4ka �� Ww1°rin e am 1 �k a 3lVJS lldl34/311d021d 'STN jENGINEER,'S SEAL) P� t e Municipality of Anchorage , t t DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 0 SOILS LOG — PERCOLATION TESTS ' ;, fi'Y_tt:7 s i PERFORMED FOR:_k UtL 15:7AS DATE PERFUiiM�E13` '� (� r,. LEGAL DESCRIPTION: I S �� c f'A—�t�C`�5'? mr—;aownship, Range, Section: SLOPE SITE PLAN I LAy&U WAS GROUND WATER 10 1/S ENCOUNTERED? 1 11 r L IF YES, AT WHAT 0 I7 DEPTH? P 12 p.U,4i. E Depth to Water Atter c 13 Monitoring? Date: oZ 3 14- 15- 16- 17 4151617 18- 19 206 " t__j PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER 11 ��'' TEST RU BETWEEN FT ID /&- FT COMMENTS �/ 61JF— ` �O�' IC - 70R a 6R�r�s c�y� �<,i✓Ul��l'r,8�$ EtFRIN�.i L � S�S. PERFORMED B 17034 Eagle River Loop Road No. 204 I i agle River, Alaska 99577 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINE 72-008 (Rev. 4/85) ON THIS DATE. DATE: THAT THIS TEST WAS PERFQRMED IN DEPTH 1 J SAk S1✓F 2 7,N 2 ; 3 /) S( Sty-cct SP+.i�y �rna��c FOS SA Nth c —revs IN4 iN ' ANt) FFW COI�cd Q" f- TWb A. 5 6il 8 II 9 I LAy&U WAS GROUND WATER 10 1/S ENCOUNTERED? 1 11 r L IF YES, AT WHAT 0 I7 DEPTH? P 12 p.U,4i. E Depth to Water Atter c 13 Monitoring? Date: oZ 3 14- 15- 16- 17 4151617 18- 19 206 " t__j PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER 11 ��'' TEST RU BETWEEN FT ID /&- FT COMMENTS �/ 61JF— ` �O�' IC - 70R a 6R�r�s c�y� �<,i✓Ul��l'r,8�$ EtFRIN�.i L � S�S. PERFORMED B 17034 Eagle River Loop Road No. 204 I i agle River, Alaska 99577 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINE 72-008 (Rev. 4/85) ON THIS DATE. DATE: THAT THIS TEST WAS PERFQRMED IN xr s'ea oaa's n,�y '1y�$'Jn Municipality of Anchorage e R DEPARTMENT OF HEALTH R HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Iv r• «-IES DATE PER R LEGAL DESCRIPTION: L� SrnY�U(N [3GI1i(!ZC SAO Township, Range, Section: - -� ci npF SITE PLAN iQ(sJ�1�3�Cj S((_Yy sp'wvy 0WK,C W/ s,.m L&r,as 71t,611ouz. CL_ — ,ay WAS GROUND WATER V ENCOUNTERED? / IF YES, AT WHAT i DEPTH? Depth to Water Alter !? Monitoring? ate: CJ PERCOLATION RATE� (minutes/inch) PERC HOLE DIAMETER — TEST RUN BETWEEN .2�jFT f,ND 3� FT 17034EagleRiver Loop Road NO, 204 I CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORbI gQeBRiver, Alaska 49577 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI IN EFF CT ON THIS DATE. DATE: 72-008 (Rev. 4/85) ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Shadowbrook Subdivision, Lot 3 GENERAL: 1. The scope of this project includes the installation of a 1500 gallon wastewater S.T.E.P. system (septic tank) and a pressurized absorption bed to serve the proposed four bedroom residence located on the referenced property. 2. Construction shall be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Page two Shadowbrook Subdivision, Lot 3 September 15, 1993 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. PRESSURIZED MOUND SYSTEM INSTALLATION: 1. Any peat or organic matter must be removed from the elevated mound site. 2. The bottom of the basal bed area as well as the top of the sand filter is to be within two inches of level. 3. The distribution piping is to be of PVC (ASTM D3034 or equal). All joints are to be solvent cemented. 4. The side slopes of the top layer of the mound system must not be steeper than 33% (3:1). 5. The top of the mound shall be covered with a minimum of 6 inches of topsoil and vegetated sufficiently to prevent erosion. 6. The distribution pipes are to be embedded in sewer rock. Care should be taken to backfill in such a way as to prevent damage to the piping system. 7. Silt barrier material must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 8. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be iristalled when the backfill depth is 12ss than thirty-six (N) inches. Page three Shadowbrook Subdivision, Lot 3 September 15, 1993 MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, it's gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page four Shadowbrook Subdivision, Lot 3 September 15, 1993 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre - construction meeting will take place on-site. MUNICIPALITY OF ANCHORAGE Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Parcel ID 015 -492-17 Certificate of On -Site Systems Approval OSC251077 Expiration Date: 3/3/2026 Legal description SHADOWBROOK LT 3A Site address 6251 BUBBLING BROOK CIR Current property owner(s) DUCASSE CATHERINE P LVING TRST X The On-site system(s) is/are approved for 4 bedrooms By: Conditional approval for bedrooms, with the following stipulations: Comments or conditions: No comments Original Certificate Date 3/17/2025 This Ceificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject sysm (s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, D velopment 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 Other 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 Application 1. GENERAL INFORMATION Parcel I.D. 015-492-17 Complete legal description SHADOWBROOK LOT 3A Location (site address) 6251 BUBBLING BROOK CIRCLE ANCHORAGE, ALASKA 99516 Current property owner(s) CATHERINE DUCASSE & JON FREY Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 2 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ® Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ .550 Date of Payment COSA# 0`5r,,2 2677 Waiver Fee $ Date of Payment Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: SHADOWBROOK LOT 3A Parcel ID: 015-492-17 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 10/12/1993 Total depth 234 ft Cased to 234 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 32 in. Date of flow test for COSA 3/3/25 Static water level at beginning of test 117 ft. Well production at time of test 3+ 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 ug/L Arsenic less than MRL (ND) Collected by Date 3/3/25 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank *NA Date of pumping 3/3/25 Required maintenance completed, if AWWTS** Comments: *STEP FLOAT LEVELS C. LIFT STATION Required maintenance completed Age of lift station 1.5 years Lift station material STEEL Comments: **IDSF not in use, but buyer did an AWWTS. Air compressor in good shape & all looked good. D. ABSORPTION FIELD DATA Which system tested (date installed) 10/2/93 ALL standpipes present per record drawing Total measured depth from existing grade 4.9 ft (max) Measured depth to pipe invert from grade 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 3/3/25 Results Pass Fluid depth prior to test 0 in Water added 600 gal New fluid depth 3 in Elapsed time 30 min Final fluid depth 0 in Absorption rate 600 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 8 in (MOA 0.7’ ED) Effective depth used 0 in (Final Fluid Depth) Effective depth (ED) remaining 8 in Comments/Deficiencies: Tested in-use 1993 system. Approximate total measured depths from existing grade. ED per elevation measured shots, visual observations, & MOA records 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 03/07/2025 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 & 03/07/25 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / FirstWaterAK@gmail.com March 28, 2025 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: ALTERNATIVE IDSF FIELD SEPTIC ADEQUACY W/ IDSF PANEL LEGAL: SHADOWBROOK LOT 3A An appropriate COSA was completed and issued by MOA on March 17, 2025, but subsequently we were requested to perform a septic adequacy test on the IDSF alternative field that was not in use currently. This IDSF field was designed and installed for 4 bedrooms We therefore presoaked this vacant field & subsequently tested 24 hours later with 750 gallons. At the beginning of this test the IDSF field monitoring tube (MT) was dry. Fluid levels came up 3” in the MT after injecting the 750 gallons with a rapid subsequent drop and was dry within 20 minutes. This IDSF field absorbed the required amount for a 4-bedroom house and meets the criteria of passing this adequacy test at this time. Also, for unknown reasons, the existing control panel servicing the existing and recently installed STEP tank in 2023 consisted of a standard STEP tank panel. Therefore, ARM Septic Services, LLC along with Rising Son Electric & followed by MOA inspection installed an IDSF control panel to serve both the 1993 original absorption bed and the 2000 IDSF field. ARM also performed the IDSF maintenance per the attached log. Please add this document with attachment to the MOA file and contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Attachment: ARM IDSF Maintenance Log MUNICIPALITY OF ANCt30RAGG • Development Service Department • On -Site Water & Wastewater Program P: 907-343-7904 ® F: 907-343-7997 ® P.O. Box 196650 Anchorage, AK' 99519-6650 . littp://www.muni.or,,/building Intermittent Dosing Sand Filter Maintenance Log Owner .Ion frall Street Address6251 bubbling brook Phone Legal Desc. D Septic Tank: -Sludge level o inches -Pumping: required es no -Pumping completed es no Absorption Field: -Liquid level o inches -Flushing valves per approved design &esno-All flushing valves opened, distribution lines flushed, and flushing valves closed Lift station: -Pump basket cleaned es no-Biotube effluent filter cleaned Desno -Timer float setting 36 inc s -High level float setting 42 inches -Reference point Bottom of tank -Pump on 30 seconds -Pump off 45 minutes -Cumulative lifetime cycles 0000 -Cumulative run time0000 hours -Operation satisfactory & no Air System: -Air pump filter cleaned es no -Air pressure 4.5 psi -Date of latest install or rebuild —2024 -Air system operation olol5fisfacto)—up not satisfactory Alarm System. -Dedicated electrical circuit es no -Audible and visual alar ' dwelling es no -Float setting 42 inche -Alarm system operation tisfacto not satisfactory Comments: -New control panel installed 3-25-25. -2 flushing valves repaired and now appear operational. Tank pumped prior to Maintenance................................................. W......................................................................................... ................................................................................................................................................................ IDSF bed not currently in use, system is using other drainfield. ................................................................................................................................................................ Maintenance Provider: Technician Nathaniel Swanberg Date of maintenance 3-25-25 Company Arm septic services a t i Signature Date 3-25-25 IDSF Maintenance Log 040313.doc The air compressor was at 4.5 SPI & all good. Even though not currently in use, the buyer did the attached MOA AWWTs. MUNICIPALITY ADVANCEDWA TEWATE F ANCHORAGE TREATMENT MAINTENANCE AND REPAIR AGREEMENT SYSTEM THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this Day of Of -al of 20-1—C, , , by and between 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 Agreement agree as follows: ,the parties to this I. Advanced Wastewater Treatment S stems. 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) SHADOWBROOK LOT 3A 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) i 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 L accordance with the equipment's approval for operation in the Municipality. 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). Owner agrees that only maintenance and repair personnel approved by the Municipality p Y or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces thep otential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 UC4- Owner acknowledges that the Municipality may request records of maintenance and ,r repairs from the manufacturer's representative or maintenance provider. 1� Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. C 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. Owner agrees to maintain remote monitoring of the AWWTS as required q 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: rq Y (signature) (print name STATE OF ALASKA ) THIRD JUDICIAL DISTRICT j ss. The foregoing instrument was acknowledged before me this 20 --v,� by NOTAR B IC FOR ALASKA My Commission expires: 11 J 262 7 Date: C day of �A ax , of dal sea] State of Alaska Notary pablk S. Chacon G) J ature) Date: name) Title: (rev. 05/18/2018) Page 3 of 3 ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: SHADOWBROOK SUBDIVISION LOT 3A PLAT 94-27 SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shouh any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE: SCALE: E-MAIL. MAR 14, 2025 112=401 schullerakOgmailxom 25-019 DRAWN BY. CHECKED BY. GRID NUMBER: BOOK/PAGE: I JLS SW2638 250130 BUBBLING BROOK CIRCLE FND ALUMINUM MONUMENT FND 5/8" REBAR .%A: Aft'"011cp I *A' 1 X6XN SUI?V A~ 0 F 4 LAN VN P � Amr N V 4�, low of �, ' y L ?�0 * 49TH �A * . ........ ..... U All - t- - - ** -- A ................................ HN L. SCHULLER.• 0 LS -10408 1831 Talkeetna Street ��y " �.'.-3' �' Anchorage, Alaska 99508 0 0 AAW f L (907) 227-1455 office essiono\ \'Aow (907) 274-4992 fax /�• X67 8 9 _ Municipality of Anchorage `� , ,.. -;7.1 � ro \ On-Site Water and Wastewater Program < �V, (907) 343-7904 if AUG 0 J n) t:c2f' ti Certificate of On-Site Systems Approval \\�, h� 015-492-17 / 1" r--q Parcel I.D. Expiration Date: 1. GENERAL INFORMATION Complete legal description Shadowbrook Lot 3A Location (site address) 6251 Bubbling Brook Circle Current Property owner(s) Latosha Frye Day phone Mailing address 6251 Bubbling Brook Circle Anchorage, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: Q Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Q Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: p. Received b 1 /,( t1 /I Q Date: 1 1 -t COSA to be released to the engineer,unless otherwise re sted by the engineer. COSA Fee $ 521, Waiver Fee $ 3/q//9 Date of Payment p f q/i9 Date of Payment Receipt Number Og. 11 d% Receipt Number COSA# 0 5Ciq 3 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 innormatlo;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. In conducting an adequacy test, I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test, and separafion‘dOtbr1d s measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition,groundiwater levels 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 8/9/2017 oF A�gkkk ,ref*:Co: "1,-""" FA Ft :.`9"-i I` ':* / 6. DSD-SIGNATURE " System #1 Approved for C. bedrooms S 'an one: „ �� ¢. CE-8149 System #2 Approved for bedrooms s•., Disapproved 1‘ 4F • ESSCW'C Conditional approval for bedrooms, with the following stipulations: UN-SITE;, WATER AND WASTEWATER , PROGRAM `-_ 'SIT nr-Y•,ft� I ) By: �;; �-. Original Certificate Date: p-f I I --7 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 COSA blue sheet ° - If more than 1 septic system is on the lot: COSA Checklist# 1 of 2 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Shadowbrook Lot 3A Parcel ID: 015-492-17 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (YIN) Y Date completed 10/12/1993 Sanitary seal (Y/N) Y Wires properly protected (YIN) Y Total depth 234 ft. Cased to 234 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 10/12/1993 7/14/2017 Static water level 125 ft 119 ft Well production 100 g p m 4.1+ g.p m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate ND mg/L Arsenic ND ug/L Date of sample: 8/3/201 7 Collected by PES B. SEPTIC/HOLDING TANK DATA S.T.E.P/Steel 10/4/ " ;L11 Tank Type/Material Date installed Tank size 1 ,500 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y Date of pumping 7/11/2017 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed 10/2/1993 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.5 GPD/SF System type Bed Length 40 ft. Width 30 ft. Gravel below pipe 0.7 ft Total depth 4.8 ft. Eff. absorption area 1,200 ft2 Monitoring tube Y Depression over field N Date of adequacy test 7/14/2017 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 0 in Water added 637 gal. New depth 0 in. Elapsed Time: 1 60 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. No Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed 10/2/1993 Size in gallons 250 Manhole/Access (YIN) Y Pump on level at 43 in. Pump off level at 39 in. High water alarm level at 45 in. Datum Bottom of Tank Cycles tested 4 Meets alarm &circuit requirements? Yes E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 1 00+ Sewer/septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ 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 100+ ABSORPTION FIELD ON LOT TO: Property line 1 0+ Building foundation 10+ Water main 10+ Water Service line 1 0+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS Dn n \RA , .2- '(--Ifbo co (DA0p,-t--1, il--__Da---- 1 . (x.w:,\,:,v,-. f_ ,,, ,,a... -,..,,,,,,,,,,,,,,,,,,, out ,_,-1„, , .t,m, ,,,---,,, . ,,xi 5 , In (Se, G. ENGINEER'S CERTIFICATION �+ OFgce�1i' I certify that / have determined through field inspections and or.0.- •N.4,-..1;74A � r !.�`!�� review of Municipal records that the above systems are in r'*• Ta IN. ••*!, conformance with MOA COSA guidelines in effect on this date. d• •••• • �� Engineer's Printed Name Stevenrd R. Pannone -----3• ':S even . Pannone: 81912017 ' CE-8149 f 11 Date �}igtfi., •,_s, G� • rn kk 0044 COSA brown sheet 10.10-12.dac DEL'S SUED. LOT 4 f LOT 3 I 589°5738"E 299.84 I `_,_4—__,—___ 10_T 8 E_ Easement LOT 3A $ LOT 4 Sspccmrtic�_.,g c�e� '7T�o 2.0 s��N 1- soo %K` Via ° / y / o• Easement and Right -of way are vacated ardfid well. Vacation detail: Not to scale C7, 7 ' - --- ,° :~ i14 J�P�k OF.AZ�4��I :} a 49yt�h00 h.Vy�% �t ......7. (... 0 f Th Fred Wdlotko. 3255 - S� 4 SCALE: 1 "= 40' EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. FB 14-8, pit 24, JAG 83990 0 0 m LOT 2 w w OH / •' ,+✓:, (See dmdi M kn) 1d T & E Easwn A L=6�'T8 BUBBLING BROOK CIRCLE BE AS -BUILT NO CORNERS SET THIS DATE 1 hereby Willy that I have performed a tMongagee's knspeclon of the fonowing descdbeW property: LOT aA SNADOWBROOK SUBDNIS Oi Anchorage Recording District, Alaska, and that the Improvements SRUated thereon are whhln the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that them are no roadways, transmission Dies or ester visibta easements on said property except as tndlcated hereon. Dated at Anchorage, Alaska this 24fh day of June 2014, FRED WALATKA & ASSOCIATES (g07-248.1666) Engineers and Surveyors - - LZM VOW 8Da8 hCJL'A0U) 9Z0-ZL -Nj6 n sdeaufto leuolssalo.)d ayl ui suoleslwo`Jo saaaa aol alglsuodew lou sl 96eaoyouy }o �llledlolunN ayy •ponssl sl aleol;llaao,,u aao;aq elep Wpm ao suolloodsul jonpuoo IOU op SHHO to seaAoldw3 •sluawailnbaa algins pue leaapal ule7peo lgslies of iepio ul suo!lnlllsul 6u 1puel ,gayi pue sawoy Io sieseyoand of Aselinoo e+>e slyl saop SHHd ay,)_'a� sely to alelS ayl ul pajalsl6aa aaaul6ua Ieuolsseloid luopuadopul we Aq anoge g ydeibeind w uan16 suolleluasa.idaa ayl uodn Aluo paseq saleoillpaC) Jenoaddy ,14!aoylnV ylleaH sonss! (SHHO) seolnaaS uewnH pue ylleaH Io luawlaedaa a6eaoyouy Io Ajjjud1olunv4 ayl b /� algia +Lir VOSF7•?s�5'tc— A9 - sluawwo0 1euo!I!ppv � Z am St.�-►L �sc�� � � � GLIL jn T a Q q aJ >-1001A �l5y:.: :suollelndlls bu!Mollol ayl yl!m 'swooapeo, aoI lenoidde leuolllpuo0 •panoaddes!Q 1 -swooapaq aol panoaddy Ajio1S 4�� 3uniVNJIS SHRd ,9' , RAS \1 64U UJ •p6 / -.. . 000 LOM, uosJopuV 'g IonyprN 90 0 0 0 o ono r90 OOC 0 aa0�o a9 Ori _ P E 1 , +0000000 �r L^✓ - ainleu6!s sdoauftg �6 -�l-V ,3 >fj' QFn FZ 4 U62 ssa.ippV auoyd 9 Np1m -17 (v.1 9 f! j� 03 t U.t wa!H to aweN •uoiloadsul slyl to alsp`ayl uo loa}}a ul suopulnft pue 'saoueulpao 'sapoo a3elS pue IedlolunlN Ile LIJIM eomildwoo ul-si welsAs lesodslp jejumalsem ao/pue Alddns aolem ails-uo ayl'uolloodsul pue uo1le61j89nui Aw woa; pue salll 96eaoyouy to AllledlolunvN ayI woal poulelgo uollewaolul ayl uo paseq IeylAjlaanaaylinj I •uiaaay paleolpul a.mlonalslo acl/q pue swooapaq to aagwnu aylaol alenbape pus leuoljounl,'ales sl wa;sits Iesodslp aalennalsenn ao/pue � lddns jejum alts-uo ayl ley; sN%oys uo!leo!Idde lenoaddy A41joylny ylleaH slyl to uoile6ilsanul Aw leyl f4laan I 'molaq unnoys alep uo!Isp!!en ayI to ss pue olaaay paxil}e leas Aw Aq palllpeo sy I:133NION9 AS N01103dSNl d0 LN3W21V.LS 'S y .1 Municipality of Anchorage ® Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L� ✓1��� oin � a'C Parcel I.D. d/,-7- /92� Ole, A. Well Data Well type &-Zrc zi If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed io iLo Driller,,.,�//we' , 'k Total depth Z 3 5/- t Cased to Z3'54 r Casing height Sanitary seal (Y/N) Date of test Static water level Well flow Pump levell Wires properly protected (Y/N) FROM WELL LOG /Ly /00 g. p. m. SEPARATION DISTANCES FROM WELL TO: AT INSPECTION SepticAwWkWank on lot ; /30 ; On adjacent lots > Absorption field on lot / On adjacent lots > NICIPALITY Of ANCHORAGE ENVIRONMENTAL SERVICES DIVISION s D p.frf.R 2 1 1994 RECEIVED Public sewer main --�- / 4911r Public sewer manhole/cleanout � ` "' Sewer service line {oa Petroleum tank�9� WATER SAMPLE RESULTS: Coliform �0 Nitrate 4 /o >�g�L- Other bacteria Date of sample: 3.I/e, A4 Collected by: B. SEPTIC/hMHdNNQ TANK DATA Date installed /o /-7i q` Tank size / o'r' 01_40`? Compartments Cleanouts (Y/N) i Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N) % Alarm tested (Y/N) Date of pumping _T�'� Pumper _ AM� SEPARATION DISTANCES FROM SEPTICA40ETMq1G TANK TO: Well(s) on lot T, 130 On adjacent lots ��� j Foundation y 17 -ro property line Absorption field >� Waterer.' -'service line Surface water/drainage y 72-026 (3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed /0 i 3_ _Manufacturer G. A�✓ �'riJCa �YS%GM'� Size in gallons ✓' 7, —Manhole/Access (Y/N) Vent (Y/N) i "Pump on" level at High water alarm level 'f5 Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot 13cy 7 _ On adjacent lots D. ABSORPTION FIELD DATA "Pump off" Level at 2� Cycles tested > baa Surface water > /ten Date installed /< i •-Zes Soil rating (GPD/Ft2) Length 4/01 _Width Gravel thickness System type _Total depth ;A % _ Total absorption area / �e k -Al / p , Cleanout present (Y/N) N Depression over field (Y/N) N _ Date of adequacy test �_ Results (pass/fail) N for '` Bedrooms Water level in absorption field before test �� Peroxide treatment (past 12 months) (Y/N) test If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /3C� r On adjacent lots _ > Property line To building foundation To existing or abandoned system on lot � A� On adjacent lots _Cutbank A— Water Aa4V6ervice line S� Surface water > / bc?7 Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION 1 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 1,4r Cil+ -,4 crr1-�Vx-n-s©i Date .� d HAA Fee $ ��� J _ Waiver Fee $ Date of Payment 3- 02 - _ Date of Payment Receipt Number tz _ Receipt Number. 72-026 (3/93)' Back
