HomeMy WebLinkAboutOVERLOOK ESTATES BLK 4 LT 1Overlook
Estates
Block 4
Lot 1
#068 - 041 - 22
Municipality of Anchorage Page / of 2
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW 970033 PID Number 46W€ -09? 2 Z
Name:
f1//doe/ n. n (oris--/-uci4or/
Wastewater System: 0 New ❑ Upgrade
"°dress:
ABSORPTION FIELD
Phone:
No. of Betlrooms: /
,C/
/
Deep Trench 0 Shallow Trench 0 Bed 0 Mound 0 Other
LEGAL DESCRIPTION
Soil Rating:op
O, p GPD/Sg. Ft.
Total Depth from original grade:
// 7 — /3, Z
Lot: Block:: Subdivision:i
/ `J' Ot'e/�/DD/7 615 /•
Depth to pipe bottom from' original grade:
.3. / — 7' to FL
Gravel depth beneath pipe
I Ft.
Township:
Range: Ir Section:
Fill added above original grade:
t) . 7 Ft.
Gravel length: , /
7 9 FI.
WELL: New ❑ Upgrade
Gravel width:2. Ft,
Number of lines:
(
Distance between lines:
Ft.
Classification (Private, A,B,C):
P,–„�Q 1��
Total Depth:
300 Ft.
Cased To:
/55 5 Ft.
Total absorption area:
/ / V SO. Ft.
Pipe material: /'8/0
0 3e, 3 V
Driller: / /-/�
-5u//1414-y /�IlXP 4e,5
Date Driill`ed:
Z,, %
Static Water Level:
75-0 Ft.
Installer:�le/� l- /
cee L--.0;r/.5AteT"•
Date installed:
/
Yield:
3 GPM
Pump Set at:
e.4.-4.1/11)2 Ft.
Casing H ight Above round:
2 r Ft.
TANK
SEPARATION DISTANCES
XSeptic LI Holding ❑S.T.E.P.
To
From
Septic
Tank
Absorption
Field
Lin
Station
Holding
Tank
Public/Private
Sewer Lines
Manufacture):
A1n/Q e /�/JA
Capacity in gallons: �7 �,
/F.✓D
well
/
/oo +
/Material:
/00 +
—
S e.e/
Number of Compartments:
2
W
Waaterter
/0 0 it
/00
—
—
LIFT STATION
LotSize
Line
/0 f
/0 +
—
—
—
in gallons:
Ma Gfacturer.
Foundation
/
/D +
/
/0 f
—
—
"Pump on” lev at:
"Pump off" leve t:
High water arm at:
Curtain
Drain
/
/00 4'
/
/OD /
—
—
—"
Pump Ma &Model
Electrical Imp tions performed by:
Remarks:
BENCH MARK
Location and Description: 7t" Q 7
ley es
5INearn e. O"/ bet,/ /a'
ly
Assumed Elevation:
/00.0 Ft
ENGINEER'S SEAL
o /40 ph
44°0 Oaefu40
al\ �
off co ,ue 7�
earn e
Flow sa WWI, •
�/ •st
••. •
A% e Kenneth M. u ,: °7 di
411) e,, �c/E "6 °
Q F9F °°..7 °°V4aB.
4®-0pm:• ° „ N- A
Inspections performed by: A/D fir/ eei--/r�� Dates. 1st 067
U 2nd 1
///� y,
Department of Health and Human Services app F al'
/�
Reviewed and approved by: pc -o_ 0 a') Date fI'j3 '�%
72-013 (Rev. 9/91) MOA 25
20(2
AS
UIL T SYST E
v
DETAILS/SITE PLA\
IIVERLDOK ESTATES LOT 1, BLOCK 4
Vantage Ave.
UTILITY ESMT.
°WELL',
V
97-2 O 1250
A
V3uKM SFR
CD FGO
� C
RY SYS T
Permit SW970033 -
PID1069-041-22
B -C=54,4'
A -D=22.5'
B -D=61.0'
A -E-379'
9-E=93.7'
A -E=56.2'
B -E==64.4'
RESERVE SYSTEM
SEPTIC
SCALL: 1" = 50'
La
7 II:
IT
Ta
J
95.74
11 1
T11250 GAL
/
SEPTIC
TANK
91.79
FINISI-IED GRADE
89.86
FILTER FABRIC\
SEWER RUCK
4401
asra3OF44A1
*
/ *//�.
KENNETH M. D /
CG -7116 i
w
4)4,M 4/,EAG
\ ' pkOPE HSl0t41i~
89.63 X77.90
49'
PREPARED RJR:
MICHAEL QUINN CONSTRUCTION
f'.O. I3LX 772641
EAGLE RIVER, ALASKA 99577
SCALE: NTS
71.60
BOH
nELD BOOKS
CGMFUIED
HOUNDARY:
DRAWN: KMD
TAKING: SLWARD
CHECKED: KMD
ADDUCT: SEWARD
DWG. FILL
ACAD FILE: 97005.DWG
DATE: 10/30/97
GRID: SW465
d0s "°'' 97005
�` UJ ENGINEERING
20441 YTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696-8111
111111111iggroiiiiyaEzmisiAT11111primiw1111nuiwy1111111111111111116mwmge1111111111111111111111111111111111iiy711111111111
• • 1.91r
(1;trititrb rtiltitg, Cu
le
. ,
. ,
OWNER OF LAND
• • ADDRESS fi) e •
LW. AL-E.SScRIPTIOI
• -DATE - Stirtiti • Ended
.•
,„t• . • . .
MIMI' NUMBER •
•
I))
DOC Ca. dbl.
SULLIVAN WATER WELLS
P.O. Box 870272, CHUGIAK, ALASKA 99687 • TELEPHONE 8118.276: .
KIND'OF FORMATION;
)41'I 11 OF WILL
STATIC LEVEL OF MiTER FT .
ORAW DOWN,FT. •
CALS. PER HR / F.0
KIND OF C,SttU .6 .
•
g'‘‘
• .1.• 0
,r.
1 ' Fram.-0-Fil,tO...672.1L.4t C Aii,oe, 117,c_ Kii) Frum Ft tu . " 'Ft.
.. " •Ftom127.Ft to fr • Ft. rii (' • From h to . Ft,
Froinlr-Ft. to /.1"N 'Ft: 0 Vt'"..42, 11.)44"....) From Ft, to, Ft
FrOin, to 4L.t..10.f.Ft • l'i /.. T7 CA,ity ,4_6g4,017' Ft ;to. .• .,Ft
- .
- • Froin. --:-Ft. to...:-.— Ft
.. S / C 0.3 3 z."'S' From --F't to . 'Ft
- •• From. i b i :Ft to /420 .gt f1,I 71' •''q ,) ( / . 4 il 4
11 to • Ft. • :
, F11)111
Frool,/.2.20,Ft. to /C4 Ft, ///f/dAir‘./ / Front
:1 . ,FrOnt/574 Ft to IP Os.) Ft. 4 'itle2 1C.14 6,6f Y i
F1411020t.; to e)1(5:F1AEl_kgf../1ti_j7116 „,... . _Ft. ;
r Ft . ' ' : '. ,I 7•1,
e .4 ,'(.- < z7 4171.1" I
FrOM4S;FLI1X2.S_LF t A e d 4 0 C_ ( („4',±L - si, - From _,',..Ft tu Ft
Ft, h erj. 0 C ili i'ill c/)) (.:''Im;k7, Ft to
4.4.7i7d-
!.,... ,.., FroM:4214a)Ft.:irii'5"..Ft 4 (404 oc- lc ‘ 6'11 961-orrorn, Ft:to ' .4.,.. '''.
.4, ., ..1.,.• t' : ' • 3.40401Yirellqd1.4 '.4‘
'• ..." Irfanarre:491477 Ft, iiihi/A C < ' 4,enr From ti,i6.,:tt
, Ft :
Frontait •:;0....za Bizzm e.,. 4,,4 „i /.tin(
7oe57. y 3 ,''TZ.
Ft to -Ft
From Ft to Ft. /<L) r'.11
Ft io Ft.
. ,
. q .Ft; to......:-Frt:
, ..
' MISCL. INFORMATION;
It? • Ft,
From F. to Ft.
From • .Ft.;, Ft
Leib./ (4
•
• DRILLER'S NAME
47,4CA41(14-0--
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
PERMIT NUMBER:SW970033
DESIGN ENGINEER:KND ENGINEERING
OWNER NAME:GRAVEL TIMOTHY M & LISA A
OWNER ADDRESS:P.O. BOX 772641
EAGLE RIVER, ALASKA 99577
PARCEL ID:06804122
LEGAL DESCRIPTION:
OVERLOOK ESTATES BLK 4 LT 1
LOT SIZE: 49528 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
a P m
Lv-3-�t1
1( n ,O
PAGE 1 OF 1 TA Eon_
cti That
DATE ISSUED: 3/11/97
EXPIRATION DATE: 3/11/98
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
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:
ISSUED BY:
DATE:
DATE: 7
/1- 97
D ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696-8111
March 3, 1997
Municipality of Anchorage
Dept. of Health & Human Services
On -Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519-6650
Subject: Lot 1, Block 4, Overlook Estates - Well & Septic Permit
Gentlemen:
Following a request from the owner regarding the proposed development of the
referenced property, we dug two testholes for the proposed system and replacement
field. The results of those tests are attached.
The system will be placed on the mid portion of the lot. As indicated on the site
plan there is sufficient grade to maintain a gravity system. A 1250 gallon tank will be
installed in anticipation of a 4 bedroom house being constructed. There is also
sufficient area and grade to maintain a replacement gravity fed field.
As indicated by the site plan drainage arrows, natural drainage is away from this site
and will be maintained after construction. There is no surface water within 100' of
the proposed installation. There are no known curtain drains within 50' of the
proposed installation. No wells exist within 100' of the proposed installation. The
system has been placed outside a 50' setback from any slope that exceeds 25%.
Additional re -grading of the site is anticipated in connection with the construction
of the house and driveway. Development of this lot should have no adverse effect
on development of adjacent lots.
If you have any questions, please contact me at 696-6111/FAX 696-8111.
Respectfully submitted,
IICINJD Engineering
Kenneth M. Duffus, P.E.
attachments: On -Site Well and Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/Percolation Test
WASTEWATER DISPOSAL SYSTEM/SITE PLAN
OVERLOOK ESTATES LOT 1, BLOCK 4
SEPTIC
BLK 3
LOT 5
VACANT
ARY SYSTEM
SEPTIC
NO SEPTIC SYSTEMS WITHIN 200' OF
PROPOSED WELL, EXCEPT AS NOTED.
NO PRIVATE OR PUBLIC WELLS WITHIN 200' OF
PROPOSED SYSTEM EXCEPT AS NOTED.
Air
�`oFAZ 1
Q t�
*49TH i\
r *TA
KENNETH M. DU %
CE 7116 W�
1111/4 D t'ROFESSIOSN' s
\`-..ale
DESIGN CRITERIA
L 4 BEDROOMS X 150 GAL./DAY/BEDROOM = 600 GPD
2. SOILS RATING: 8 MIN./INCH = APPL. RATE 0.8 GPD/SF
3. 600 GPD/0.8 GPD/SF = 750 SF
4. 750 SF /(2' x 8') = 46.9'L
5, MIN. DESIGN SIZE = 1 TRENCH - 47' LONG x 2' WIDE x 8.0' DEEP
6. DEPTH OF GRAVEL BELOW PIPE IS 8.0'.
7. TOTAL DEPTH OF SYSTEM IS 12.0' FROM ORIGINAL GRADE.
NOTES:
1. TIE INTO TRENCH AT ENDPOINT.
2. USE 1250 GALLON SEPTIC TANK. INSULATE TANK IF <4' COVER.
3. INSULATE TRENCHES WITH 2' HD BURIAL FOAM IF <3' COVER.
4. CONTRACTOR WILL ENSURE MAXIMUM 2X SLOPE INTO SEPTIC TANK.
PREPARED FOR:
MICHAEL QUINN CONSTRUCTION
P.O. BOX 772641
EAGLE RIVER, ALASKA 99577
KND ENGINEERING
20441 PTARMIGAN BLVD
EAGLE RIVER AK, 99577
(907)696-6111/Fax (907)696-8111
DATE. 2/58/97
SCALE: 1
DRAWING U
100' 97005 -SI
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: ,9ic Qd&GI f,ELLT L B-tt 547a
Aye rif q4!/t/],�{1�'�
. °.4.9 9
MCO .'
p H •*a
-
??04e Kenneth M. Dui
tr k•._ CE 7116
5 ;
tl s 3
l'Ro
ES
offoap
'
DATE PERFORMED:
LEGAL DESCRIPTION:4444//6 eSJn/QT /Township, Range, Section: 121 /
DEPTr1Ii/ 4. J-../ rr SLOPE
(FEET) f�iJ �O
1
10-
12 -
13-
14
15 -
16
cP /'a /2 w/sal/
st.6 errydar--
"et
a wz€ r
/niixra/ w come.
5amid sole
eo66/e5 t4, /8 "
-Pe /'C, /0//;,7
17-
18
19 —
o
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Alt
Depth to Water Aller
Monitoring? Drq Dale.
S
L
0
P
E
SITE PLAN
T
CG
'2
Reading
Date
Gross
Time
Ne
Time
Depth o
Water
Net
Drop
o
V.2797
/f 0/
—
2'/2
—
//10
X41;,,
2. "3/1
'1I/
7 /8
to
I
%;o5
3 �lo440
/��,
40
J:01
3 ��ik
Ali L
7
� ; � q
3 %Lb
z/i,
20 - /
PERCOLATION RATE ' /� tmmutesrmchl PERC HOLE DIAMETER 4'
/ TEST RUN RETWEENN, ,. 1 FT AND 5 F1
COMMENTS �t, r 4
/vita' 4:2in/GiL_Dur7-C.s" CERTIFY THAI THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STAVE AND MUNIC AL GUIDELINES iN EFFECT ON THIS DALE DATE
PERFORMED BY L1LYY
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: //!/ Aifl/IQ4tL,LLLI (jolt 51-'L4.C�"I/i>1_-
a'tsivitmekt
OF AL
.e�'•.• •,191
..see
nesr •• •an a a••a••a•• •
oo
94 Kenneth M. Duf s1,�
� : tte
It
CE 7116 "4
4.1
F• .J.2•
It, • ES�19..0
to it •
DATE PERFORMED:
LEGAL DESCRIPTION: 9/Jf/DO,G,Si 4j, i/Dt /Township, Range, Section.
5
10-
12 -
13 -
14 -
15 -
16 -
17
(FPETH �'CO "rt /L
i
18-
19
aa, - blown//s/ l�
and 5a
ere lca.L/D✓I
some Cod/es
13,0,61. Oami7)
20 -
COMMENTS
SLOPE
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depth to Water Ahem/
Monitoring?
S
L
r 0
P
E
Dalt:
3/z/97
SITE PLAN
I
N
Se
/1
tee
Reading
Date
Gross
Time
Net
Time
Depth o
Water
Net
Drop
b
ijz/q7
21 l5
—
5- "
--
/
2: /!o
/ m4;1
5 ,/S
343
7 . /7
5 3/`/
3/3
3
_
2;15
/n�B
34
WA -PPR
An
fl an
-
lr4'iA
y /
5 )61R4
5
2'20
B
j /
PERCOLATION RATE Z' t 7 Iminutesnnchl PERC HOLE DIAMETER
F1 AND FT
TEST RUN BETWEEN
*nae iA pac CERTIFY THAI THIS TEST WAS PERFORMED IN
ACCORDANCE WIT FI ALL ST Al AND MUNICLLlPP♦/AL GUIDELINES IN E'FFECI ON THIS DATE DAIS
PERFORMED BY 421'1!.
IR M
MUNICIPALITY F
41
Development Services Department
On -Site Water & Wastewater Section
Certificate of On -Site Systems Approval
Phone: 907-343-7904
Fax: 907-343-7997
Parcel I.D. 068-041-22 Expiration Date: JCL n 19 0 o�o`
1. GENERAL INFORMATION
Complete legal description OVERLOOK ESTATES BLOCK 4, LOT 1
Location (site address) 27520 VANTAGE AVENUE, EAGLE RIVER, AK 99577
Current property owner(s) BUSS FAMILY TRUST... Day phone
Mailing address
Real estate agent
UNIT 3220 BOX #42, DPO, AA 34032
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.
COSA Fee $ .560
Date of Payment /�A
Receipt Number OIS042
COSA # 0_5C-2_1)_698
Date:
Waiver Fee $
Date of Payment
Receipt Number
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 10/6/2021
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 lt� A�,��
these various and dynamic characteristics and are outside the control of the evaluator of the •�i
well and septic system. Therefore, any estimate of how long a system will function satisfactory K-49
• • • • W
for current or future occupants or guarantee that no unseen encroachments, deficiencies or C
discrepancies exist can be given by First Water Consulting & FWGS ;01P TH ••
6. DSD SIGNATURE
/ Curtis Huffman
y/ System #1 Approved for 7 bedrooms ����F��s•, CE 128991 •.����s''
��c�' • .10/6/Z9 •'F�
System #2 Approved for bedrooms iklF, PROFESS1t3O�
Disapproved
Conditional approval for bedrooms, with the following stipulations:
llltttt(f((�f
ON-SITE
WATER AND
IA/AQTC ,'.1A--rr-,
PROGRAM 6;
By: L01YOriginal Certificate Date: 10111,�ezl
_
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
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Other (oA. Q,Q� Q�c�ivisoru, X
COSA Checklist
Legal Description: OVERLOOK ESTATES BLOCK 4, LOT 1 Parcel ID: 068-041-22
If more than 1 septic system on lot: COSA Checklist #
of
Structure served by this system
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled 6/1997
Total depth 300 ft
Cased to 154 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 10/6/2021
Static water level at beginning of test 158 ft.
Well production at time of test 3.4 gpm
Water storage tank volume NA 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 of Sample 10/5/2021
Comments __________________________________________________________________________________
B. TANK DATA
Age of tank(s) 24 years
Tank type/material SEPTIC / STEEL
Measured operating fluid level in septic tank 51”
Standpipes/foundation cleanout per record drawing
Date of pumping 10/6/2021
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 6/4/1997
ALL standpipes present per record drawing
Total measured depth from grade 12.1 ft (max)
Measured depth to pipe invert from grade 4.0 ft (min)
N/A – pressurized field
Monitor tubes go to bottom of effective. If not, state
depth into effective 8.1’ ED
Code-required soil cover over field
System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Adequacy test date 10/6/2021
Results Pass For 4 bedrooms
Fluid depth prior to test 0 in
Water added 620 gal
New depth <1 in
Elapsed time <5 min
Final fluid depth 0 in
Absorption rate 600 gpd
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Comments/Deficiencies:
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
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
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No ft
Property Line > 5’ Yes if No
ft
Absorption Field > 5’ 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 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
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
If absorption field is under driveway comment below
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No
F. ENGINEER’S COMMENTS
G. ENGINEER’S CERTIFICATION
I certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance
with MOA COSA guidelines in effect on this date.
10/18/21
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904
On‐Site Water and Wastewater Section Fax: 343‐7997
www.muni.org/onsite
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org
Septic Tank Advisory
Certificate of On‐Site Systems Approval # OSC211598
Subdivision: Overlook Estates Block:4, Lot: 1
The septic tank for this property is 24 years old. The average life for a steel septic
tank is 20 years. Typical replacement costs range from $7,000 to $11,000.
This advisory must be attached to all copies of the subject Certificate of On‐Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519.6650
www.muni.org/onsite
(907) 343-7904 •
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 068-041-22
1. GENERAL INFORMATION
Complete legal description Lot 1; Block 4; Overtook Estates
COSA #
Expiration Date:
q_19-07
Location (site address) 27520 Vantage Ave. Eagle River. AK 99577
Current Property owner(s) Art & Nancy Foust
Mailing address
same
Day phone 696-6126
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
4
TYPE OF WASTEWATER DISPOSAL:
❑ Individual On-site
❑ Individual Holding Tank 0
❑ Community On-site ❑
❑ Public Sewer 0
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil
engineer registered In the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm s s S Engineering Phone 694-2979
Address 15861 S. Birchwood Loop Rd. Chugiak, AK 99567
Engineer's Printed Name Roa iftA - C_ Co wit Date 6/Pt 70 7
5. DSD SIGNATURE
Approved for
Disapproved.
Conditional approval for
bedrooms.
OF AN
r..wF.. ,
ft
A, ROBERT C COWAN Ia.
1.++ rr Ci -
ttt1;1Jl,:C----:•'- —...
bedrooms, with the following stipulations:
tiocturruiff
; ON SITE • G1=
WATER AND :T^_
WAS I tWATER .
• PROGRAM
O • •
�•
,.,''//) 1u1111 -
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: l� v 0`7 G Original Certificate Date: 6 - / g' 0 7
(Rev 11,05)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description:LO-- 1; 13t1; 0VEctco14
A. WELL DATA
Well type�RlVftTE-
Date completed 44917
Total depth
&sr. • Parcel ID: 068-04( _
If A, B, or C provide PWSID #
Sanitary seal ( ?1) \IPS
Cased to 154'5h.
FROM WELL LOG
Date of test (den'
Static water level
Iso' ft.
Well production 3.0 g.p.m.
WATER SAMPLE RESULTS:
Well Log 01) .\/ VJ
Wires properly protecteJN) yl
Casing height (above ground) is 4 -in.
AT INSPECTION
I a9' ft.
g.p.m.
Coliform V colonies/100 mL Nitrate 0 mg/L Other bacteria O colonies//1"0"0 mL
Arsenic: 0 ppb date of sample: 4/6/0cneCollected by: SQ' S ricaelA j
B. SEPTIC/HOLDING TANK DATA / / c.
Tank Type/Material S CSG / S _ Date installed 4/'S — li / rci -
Tank size ).A60 gal. ,/ Number
of Compartments a. Cleanout�l) q65 TTTt
Foundation cleanou�l) i tt Depression over tank (Y® /Jo High water alarm (Yr&> Ja
Date of pumping 9 ( I t /b /o Pumper S f>:1� ‘11 1447 Rum PEtS
C. ABSORPTION FIELD DAT
A
/Date installed 4/3 - (g.p.d./ft2 or ft2/bdrm) 0• f3 System type b 6-Er-r2Ffir..i}
Length ill 1 ft. Width a1 ft. Gravel below pipe g• i1 ft.
Total dep
Ifh ft. 13 I �� wL
t Eft. absorption area �" Monitoring tube 7C9> Depression over field 1�
Date of adequacy test G/4/013 Resu Fail `, For I. bedrooms
Fluid depth in absorption field before test Oriin. Water added 63 gal. New depth ill in.
Q it
Elapsed Time: S5min. Final fluid depth O in. Absorption rate >= fid (' g.p.d.
Any rejuvenation treatment (past 12 mo.) (C9 type) kV If yes, give date --
D. LIFT STATION IV I/k
Date installed Size in gallons Manhole/Acc
"Pump on' level at _ in. "Pump off" lev
High water alarm level at in.
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 200 On adjacent lots
Absorption field on lot !00 1 -1 --
Public sewer main N/A
Sewer /septic service line
Animal containment areas 550 14-
oZ51't"
On adjacent lots
10? t.f.
Public sewer manhole/cleanout
Holding tank
/O/ r, Li
Manure/animal excrete storage areas /00 "
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5 It Property line
Water main Ni/1
5
54
Absorption field
Water service line 10 I+ Surface water
Wells on adjacent lots 10e t
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation 10 4 Water main /u R
II -
Property
Driveway, parking/vehicle storage S
Property line
Water Service line /0 r'-
Surface water /00 '-
Curtain drain NOS' Cu''t/ells on adjacent lots 100 -I-
F.
IF. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
leEngineer's Printed Name + ac / " C6wr4.✓
Date 6 //VA 7
s
.41
1,1‘. • ROSURT COWAN /e,
1, rc; CE = 8801. f s!
r '''' x ;941,
COSA Fee $ H 30.
Date of Payment
Receipt Number
(Rev. 11/05)
6fry/ 07
OgS`1g8'
Waiver Fee $
Date of Payment
Receipt Number
01/27/00 11:18 FAX 907 213 8440 PRUDENTIAL VISTA REAL ES
ax .CY.1999 711H1
arviolZ
ASBUILT
s
FIRST FCERICRN TITLE Cr F040r—
eki
iva-ipr-
11"✓ .s40.0•tll3-i'✓
NO.321
•
•
esialboterJ-
1
•
ern* ,terror
Arm M.P.
SWARD & AS
1 HEREBY CERTIFY :NAT 1 HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY'
THAT O M1NT�l�IST D(C�F�+'T
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
EABEMENTS,COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAt. UNDER NO CIRCUMSTANCES SIO-tD
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING POWAD- .,,,.,,,,,,
ANDAS
SCAI-Et
r
DATE
GRID'
. ra✓ r'r-r
®002
P.22
90CIATES LAND SURVEYING )94-0829
r
•r
•,. ;itwon..10.4m.
¢ '.. 1S-6918 vis
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 068-041-22
1. GENERAL INFORMATION
HAA# g4 ac?
Expiration Date: 7 -.2 2- - 0.2.
Complete legal description OVERLOOK ESTATES SUBDIVISION: LOT 1, BLOCK 4,
Location (site address or directions)
27520 VANTAGE AVENUE • EAGLE RIVER, AK 99577
Current Property owner(s) TOM MEANS Day phone 360-3962
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
27520 VANTAGE AVENUE * EAGLE RIVER, AK 99577
Day phone
CRAIG BENNETT w/ PRUDENTIAL VISTA Day phone 242-3251
16635 CENTERFIELD DRIVE • EAGLE RIVER, AK 99577
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
4
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
0
Individual Holding tank
Community On-site
Public Sewer
•
O
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid
water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1,185 at, or prior
to closing for the engineering services provided.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC.
Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504
Engineer's Printed Name JEFFREY A. CARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, AWWC, Inc. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSO Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater 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 the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide
any warranty or future estimate of how tong the system will continue to meet the
operational requirements of the ADEC or MOA DSD. 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 will it confer any legal right whatsoever.
Phone 337-6179
Date
�o6o00p
o �� °F .AI .. op
5. DSD SIGNATURE ,, LL
Approved for '7- bedrooms.
Disapproved.
Conditional approval for bedrooms, with the filming stipulations:
7953 ep0
•gv4
k‘dProres ste .
0000006
1/40101Y OF ifoorri.„
WATER AND : m
r�
: STtWAIIR
• PROGRAM •
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Manitenance Agreements
Supplemental Engineer's Reort
Other
By�I��
(Rev. 12/01)
< ••Fyr
Original Certificate Date:
22- 02.
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196850 Anchorage, AK 995194850
www. d. anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description- OVERLOOK ESTATES S/D: LOT 1, BLOCK 4. Parcel ID: 068-041-22
A. WELL DMA
Well type7�A7E If A, B, or C provide PWSID# N/A, Well Log (Y/N) YES
Date completed 6/1997 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth 300 ft Cased to 154.5 ft Casing height (above ground) 24+ in
FROM WELL LOG AT INSPECTION
Date of test 6/1997 3/27/2002
Static water level 150 ft 120 ft
Well production 3.0 g.p m 3.0+ g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate 0'2 mg./L. Other bacteria 0 colonies/100 mi.
r"--- .004,(es 3/26/2002
Arsenic: mg./L. Date of sample: 3/29/2002 Collected by: AWWC, INC.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL Date installed 6/3-4/1997
Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES
Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A
Date of pumping 3/30/2002 Pumper JR's PUMPING
C. ABSORPTION FIELD DATA
Date installed 8/3-4/1997 Soil rating ,.p.d. "►•r ft'lbdrm) 0_8 System type TRENCH
Length 49 ft Width 2 ft Gravel below pipe 8.1 ft.
Total depth 11.7-13.2 ft Eff. absorption area 794 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 3/26/2002 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth In absorption field before test 0 in Water added 777 gal. New depth 0 in
Elapsed Time: E min. Final fluid depth 0 _ in. Absorption rate >= 600+ g p d
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date
D. LIFT STATION
Date Installed Size in gallons Manhole
"Pump on" level at in. "Pump o _ . High water alarm level at in.
Datu i Cycles tested - - Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM 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 N/A Public sewer manhole/cleanout N/A
Sewer /septic service line 25'+ Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 51+ Property line 51+ Absorption field 51+
Water main N/A Water service line 101+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 101+ Building foundation 10'+ Water main N/A
Water service line 101+ Surface water 100'+ Driveway, parking/vehicle storage
Curtain drain NONE KNOWN
F. COMMENTS
Wells on adjacent lots 1001+
25'+
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name
Date 4/4-/02,
JEFFREY A. GARNESS
HAA Fee $ 3 %4 . °° Waiver Fee $
Date of Payment y- /U -o Q Date of Payment
Receipt Number C1S/5C Receipt Number
(Rev. 12/01)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I D # 068-041-22
1. GENERAL INFORMATION
Complete legal description
HAA # /40 COCO k
Lot 1; Block 4; Overlook Estates
/4/
Location (site address or directions)
27520 Vantage Avenue
Eagle River, AK
Property owner Timothy Gravel Day phone 344-4480
Mailing address C/O Prudential Vista Real Estate
Lending agency Day phone
Mailing address
Agent Larry Sniter/Prudential Vista Day phone 273-7766
Address 4241 "B" Street Anchorage, AK 99503 -
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
4
xx
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
xx
NOTE: 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
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 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 dispos6I, sj stin cpmpliance with all Municipal and State codes,
ordinances, and regulations in efeec on thea $f this inspection.
Wast ata/ o� t nts, inc. 27-61-79
Name of Firm 8901 lV!, c 28 Phone
Address
Engineer's signature
504
Date a
Alaska Water. &
Wastewater Consultants, Inc.
Shall be PAID $ 110At,
or prior to, closing for the
Engineering Services Provided,
6. DHHS SIGNATURE I L
Approved for �t bedrooms.
Disapproved.
By:
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Date 2 2- 00
CAUTION
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 this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025(Ray.1/91) Back MOAM21
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
B ®2000
Environmental Services Division
825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 34+&47441., I r OF ANl.rk-,
RECEIVED
fu1I
I V IPUNMLN I HL SEkV IILS UIVISI
Health Authority Approval Checklist
Legal Description: OVERLOOK ESTATES S/D; LOT 1, BLOCK 4 Parcel I.D.: 068-041-22
A. WELL DATA
Well Type PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number N/A
Log present (Y/N) YES Date completed 6/97
Total depth 300' Cased to 154.4' Casing height (above ground) 2'+
Sanitary seal (Y/N) YES Wires properly protected (YIN) YES
FROM WELL LOG AT INSPECTION
Date of test 6/97 1/25/2000
Static water level 150' 135'
Well production 3.0 g.p.m. 3.0+ g.p.m.
UNABLE TO GET ACCURATE S.W.L. READINGS BELOW
WATER SAMPLE RESULTS: 171 FEET IN CASING DUE TO OBSTRUCTION IN WELL
Coliform 0 Nitrate 0.5 mq/L Other bacteria 0
Date of sample:. 1/25/2000 Collected by: A.W.W.C., INC.
B. SEPTIC/HOLDING TANK DATA
Date installed 6/3-4/97 Tank size 1250 Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression (Y/N) NO High water alarm (Y/N) N/A
Date of Pumping 1/25/2000 Pumper JR'S PUMPING
C. ABSORPTION FIELD DATA
Date Installed 6/3-4/97
Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8 System type TRENCH
Length 49' Width 2' Gravel thickness below pipe 8.1' Total depth 11.7'-13.2'
Effective absorption area 794 SQ.FT. Monitoring Tube present (Y/N) YES Depression over field (Y/N) NO
Date of adequacy test 1 /25/2000 Results (Pass/Fail) PASS For 4 Bedrooms
Fluid depth In absorption field before test (in.); 0" (DRY) Immediately after 637 gal water added (in )O" DRY)
Fluid depth 0" (ins) Minutes later: 0 Absorption rate =
Peroxide treatment (past 12 months) (Y/N)
72-026 (Rev. 3/98)• Computer Version
600+
NONE KNOWN If yes, give date
D. LIFT STATION
Date installed Size in
Manhole/Access (YIN)
High water alarm level
on level at* "Pump off' level at*
*Datum
ested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main
Sewer/septic service line 25'+ Lift station
N/A
Public sewer manhole/cleanout
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 51+
Water main/service Zine 10'+
Property line 5'+
Surface water/drainage 100'+
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
Property line 101+ Building foundation 10'+
Surface water 1001+
Curtain drain
NONE KNOWN
N/A
N/A
Absorption field
5'+
Wells on adjacent lots
100'+
Water main/service line 10'+
Driveway, parking/vehicle storage area 10'+
Wells on adjacent lots 100'+
F. ENGINEER'S CERTIFICATION
I certify that I ha c(ete , = s / =1d inspections and review
of Municipal cords a =a . ve stems are in conformance
with MOA H guide i = ect o ' this date.
Signature
Engineer's Namp7
Date 2 4 Jon°
HAA Fee $ 3 00 ' VU
Date of Payment 2-11/
Receipt Number `-`fig$ C � -i )
72-028 (Rev. 3186)• Computer Version
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 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 668- Di/—ZZ
01 E4 M0.!',iD9 `Or ?-WA).21')d;0.1,e)L
g(CaNrtN OIL%ERVICinUI+1( idb1
WM 10 199T
RECEIVED
HAA # IS��1 n.d--)Yea
ra
1. GENERAL INFORMATION /
Complete legal description ve look cs/ &/c' 1 /h/
Location (site address or directions) NSA/ V6 -44-F r
Avro.
Property owner Midge/Qa h Co -v759 ae tor- Day phone
Mailing address to -So y 7724'/ Fa& /vet A/c
Lending agency Cl Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: T
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA 1121
D✓er/or (� �s� .35//L/
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 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.
Name of Firm
KND Engineering Phone 4 94 —///
23141 f ldrn iyan Blvd,
Eagle River, AK 99577.8736
Address
Engineer's signature
Date ////t'
tatttt
�~`OF A<19
y .,S
rivicep
/t..L .u• e . �a m j.• a
• a..a.Naua
B mtL Kenneth M. Cet.J
®� �.� CE7 6L;,1
/ate,
6. DHH$ SIGNATURE 44Ag..se,//�� Ia/g,.�6d 9#
✓ t o opa! $$t0 0. 4
Approved for ���� bedrooms. �a�..mas� `a
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
By.
Additional Comments
Date Jl'J3.97
CAUTION,
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 this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA #21
Municipality of Anchorage vuiaurAlnv
DEPARTMENT OF HEALTH & HUMAN SERVICES NVIRCNMENTAI.
Environmental Services Division
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 NOV 1
Health Authority Approval Checklist
C1L
VISION
RECEIVED
Legal Description: D✓PY//)7)X gs71. SIK'7 Loi I Parcel I.D.: 66, -D//�2Z
A. WELL DATA /
Well type / / 2 P If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N)
Total depth
300'
Sanitary seal (Y/N)
Date completed lvfr7
i
Cased to /69. S Casing height (above ground) 2. V
Y
FROM WELL LOG
Date of test 6/9 7
Static water level /SD
Well production 3 g.p.m.
WATER SAMPLE RESULTS:
Coliform
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Date installed Z/3/97 Tank size /2 SO Number off /Compartments 2- Cleanouts (Y/N)
4 /
Foundation cleanout (Y/N) / Depression (Y/N) High water alarm (Y/N) �✓A
Date of Pumping — Pumper
C. ABSORPTION FIELD DATA
Date installed 6/97 Soil rating (g.p.d./ft2 or ft2/bdrm) 6,8 System type Dee 71/4/2c/
Length 'i% / Width /2 o/
/ Gravel thickness below pipe 8./ Total depth /o?.`/–/-/�•
Effective absorption area 7 9'7 Monitoring Tube present (Y/N) 7 Depression over field (Y/N) /V
Date of adequacy test Results (Pass/Fail) For bedrooms
Fluid depth in absorptiofield before test (in.); Imm-.lately after gal. water add- • (in.):
Fluid depth (ins) Minutes later: Absorption rate = g.p.d.
Peroxide tr-. ment (past 12 months) (Y/N) If yes, give date
72-026 (Rev. 3/96)*
Wires properly protected (Y/N) I
AT INSPECTION
Nitrate '' d I my/1 ,/ Other bacteria
/1 i 56
Collected by: }0 ZiI1�y�/r°,°✓/�t
g.p.m.
Dile/rink Es/ .BV/ /
D. LIFT STATION
Date installed Size in gallons
Manhole/Access (Y/N) "Pump on" level at* "Pump off' level at*
High water alarm level at* *Datum
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot /00 f On adjacent lots /00 -1-
Absorption
F
Absorption field on lot /DO 1-f- On adjacent lots /DD
Public sewer main ij/4 Public sewer manhole/cleanout V/4
Sewer /septic service line /U D -F Lift station 4/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation /0 if Property line /D f Absorption field /0 f
Water main/service line 25 -f ' Surface water/drainage /00 Wells on adjacent lots /40 ,
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line /0 'f� Building foundation /0 f Water main/service line 25 -f
Surface water /D D
Curtain drain %OD .74-
/
Driveway, parking/vehicle storage area ,2-5 -1-
F. ENGINEER'S CERTIFICATION
Wells on adjacent lots /D 0 1
1 certify that / have determined thru field inspections and review of Municipal records tl@Fata4i y': $ms are
in conformance wit MOA HAA guidelines in effect on this date. Ir,�p ..•' "', °°0..:E.9.+10 q
✓so Jo°• 1tJ •' y 0
Signature -.i �- ` v ® i9m L . %
0i
ti ..u•• •••• �
• •° m
'� Kenneth M. Duff 4
�eech`. C 7116
6 ° or s�a
11
Engineer's Name ,yes7nc/' n /7#5
a/S
Date ///J /l
F • •.
11%, r'
Or[s°t°t7
>
30 <
HAA Fee $ Waiver Fee $
Date of Payment i / //0/ Y7
Receipt Number 0 27 I (V CV ‘. ) Receipt Number
Date of Payment
72-026 (Rev. 3/96)*
