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HomeMy WebLinkAboutMOUNTAINSIDE VILLAGE BLK 1 LT 3Mountainside Village Block i Lot 3 #020-172-15 Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP131239 PID Number: 020-172-15 Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade Name: CHARLES & HELEN BARNWELL ABSORPTION FIELD ❑ Deep Trench ® Shallow Trench El Bed El Mound ❑ Other Address 17520 SNOWCREST , ANCHORAGE, AK 99516 Phone Number of Bedrooms Soil Rating Total depth from original grade 4 1.2 GPD/SF 7.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2.81 Ft. Gravel depth beneath pipe 4.19 Ft. Subdivision Block Lot MOUNTAINSIDE VILLAGE 1 3 Fill added above original grade Var. 1.14 — 2.59 Ft. Gravel length 50 Ft. Township Range Section Gravel width 5 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To From Septic Tank Absorption Field Lift Station Holding Tank Sewer Line Total absorption area 500 Fe Number of trenches 1 Dist. between trenches Ft. Well 100'+ 100'+ 100'+ __ 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1 1250 Gal. Surface Water 100'+ 100'+ 100'+ -- Material STEEL Number of compartments 2 Lot Line 51+ 10'+ 5'+ -- NA Foundation 5'+ 10'+ 5'+ __ LIFT STATION Manufacturer ----------------- Capacity Gal. Curtain Drain NA "50'+ NA - Remarks Existing tank decommissioned. New Pump on level at in. Pump off level at in. High water alarm at in. tank insulated. Pump make and model Electrical Inspections performed by Installer Northern Excavation & Construction, LLC PIPE MATERIAL House to tank D3034 Tank to D3034 drainfield Drainfield D3034 CO/MT D3034 Inspector ARCTERRA BENCHMARK (Assumed elevation) 100 It Inspdat es: v' 8/6/13 2nd 8/6/13 Location and description 308/6/13 4"' Bottom of rock siding COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL ,.qb'W'W N Conditional Approval: Date ' Tii xaxril M. o r o i "�'63SIatiPY' ,� Approved Date -/ 3-13 COSA Inspection Report.doc A -C=10.6' B -C=12.3' A -D=15' B -D=19.2' A -E=36.2' B -E=32.5' =74.2' AS—BUILT SYSTEM DETAILS/SITE PLAN Permit OSP131239 MOUNTAINSIDE VILLAGE BLK 1 LOT 3 PID# 020-172-15 0 0 N /P SEPTIC 'ft'jhL'kN OF AL�11 KE D/ /, /I 8 ��; FE331O AV N`_'�w T 2 FINAL GRADE MM FP Cl, SEWER ROCK SD' — PREPARED FORT CHARLES BARNWELL 17520 SNOWCREST ANCHORAGE, AK 99516 HELD BOOKS B°'"Ao' BOUNC STA"Q: STAKII` AMLM JLS DWD. sm. Acm "e FILE OOMPUTM MAW BMW °'Eg'ETM KMD DATE 8/10/1 Saw. SW343E 'SDS N' 13-185 SCALE, NTS oti �gCIE]? rs w c� D � av a 9 a x 9 1-f. UL.T 30 R, AK 9957957 7 -$ On -Site Wastewater Disposal System Permit Permit Number: OSP131239 Tax Code Number: 02017215000 Work Type: Septic Permit Effective Dates: August 01, MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 2013 to August 01, 2014 Design Engineer: ARC TERRA CONSULTING INC Subdivision: MOUNTAINSIDE VILLAGE Site Legal Address: MOUNTAINSIDE VILLAGE BLK 1 LT 3 G:3439 Owner/Address: BARNWELL CHARLES E & HELEN H 17520 SNOWCREST LANE ANCHORAGE AK 995165727 Site Mailing Address: 17520 SNOW CREST LN, Anchorage Lot Size in Sq Ft: 56355 Total Bedrooms: 4 This permit is for the construction of: Y Disposal Field N Septic Tank N Holding Tank N Privy N private Well N Water Storage All construction must be in accordance with: I. 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 must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Receiv Issued MUNICIPALITY OF ANCHORAGE n�ekj 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. 020-172-15 Property owner(s) Charles Barnwell Mailing address 17520 Snowcrest Ln, Anchorage RUSHY , Day phone Site address 17520 Snowcrest Lane Legal description (Sub'd., Block & Lot) Mountainside Village Blk 1 Lot 3 Legal description (Township, Range & Section) Lot Size 56,355 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ElUpgrade F Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage El t r c ! 1 RUSH 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. Permit/Rush Fees: W Date of Payment: N Receipt Number: �8 g Permit No. 05e is 11'01_591 paid oj�ff' Permit APP_:L..:c. Waiver Fees: Date of Payment: Receipt Number: Waiver No. July 29, 2013 ARC 1 ERRA CONSULTING, INC 212 E. 51' Ave, Anchorage, AK. 99503 Office (907) 868-3791, Fax (907) 868-3793 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Upgrade Sewer Permit - Mountainside Village Block 1, Lot 3 It has been determined that the existing absorption field of the subject property is in failure. Subsequently, the owner has requested we proceed forward to obtain a septic permit to upgrade the septic system. The general slope of this lot is from east to west at a grade of approximately 5- 10% in the area of the septic system. On July 9, 2013 a testhole was performed to investigate soils and groundwater. The results of this test are attached for your review. The proposed upgrade will serve the existing 4 -bedroom house. We propose to install Y -wide gravity trench with a diverter valve for the old leach field. Groundwater was not encountered at the time of digging or at monitoring. The property and adjacent lots are served by private wells and there are no wells within 200' other than noted. There are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 868-3791 / FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. Kenneth M. Duffus, E. Attachments: On -Site Sewer Application Wastewater Absorption System Details/ Site Plan Soils Log/Percolation Test 20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793 WELL & WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLA FLAG WELL PRI❑R PR❑f L, I I LlI V J RADII & EASEMENTS TO C❑NSTRUCTI❑N MOUNTAINSIDE VILLAGE BLOCK 1, LOT 3 Scale: 1'= 100' NO PUBLIC WELLS WITHIN B(.' OF DESIGN DETAILS PAGE 1 OF 2 PROPOSED SYSTEM. 4 BDRM X 150 GPD = 600 GPD NO PRIVATEEWELLS WITHIN 200' OF PROPOSED SYSTEM EXCEPT AS NOTED. 600 GPD/1.2 GPD PER SO. FT. <2.8 MIN/IN.)= 500 SO, FT NU SEPTIC WITHIN BOO' OF PROPOSED WELL EXCEPT <500/5'<W)) x (0.5' RF 4' GRAVEL) = 50 FT. TRENCH PT T ASIN NOTED. USE 1 TRENCH - 50' (L) X 5' (W) X 4' 0 graveD Total depth of system is 7.0' from original grade. NOTES: Total depth of gravel below distributlon pipe Is 4.0' 1. VERIFY INTEGRITY OF EXISTING SEPTIC TANK, INSULATE TANK IF <4' COVER. 2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM IF < 3' OF COVER .(MIN 2' COVER W/ INSUL) 3. CONTRACTOR WILL ENSURE ALL OTHER SEPARATIONS TO ADJACENT WELLS, SEPTICS, LOT LINES, FOUNDATIONS & ALL OTHER SETBACKS. i OF A -Z<4 * * 4 TH KENNETH M. D / CE -7116 •wa ,sir PREPARED FOR: CHARLES & HELEN BARNWELL 17520 SNOWCREST LANE ANCHORAGE, AK 99515 (907)620-1213 FIELD BOOKS BOUNDARY: BO STAKING STAB AS9uILD SLS Dwa FILE: Acm FILE` FILE COMPUTED: ORA": KMD CHECXED: KMD DATE: 07/2, GRID: 3439 •TCB N' 13185 oA' a� s n i �9y c �'Pl✓V'v80LTING e'' AK. 99577 WASTEWATER MOUNTAINS. — — EX. WE DISPOSAL SYSTEM DETAILS E_ VILLAGE BLOCK 1, LOT 3 Install FCO n/�—%z/a GEX. WELI Evlating 1250 Tank z Install Post 00 z0 Tank 12'+EXISTINcG � O O I Install (vert rC5 cz co HOUSE O N — — r x � m 34;} D 5 ST HOLE N m I .50' .�.w. CJ1 N I Z I 12'co co i i OF At46 1 ,Or S / CE -711 W� \ ///PROFE59IOS7�' PREPARED FOR, CHARLES & HELEN BARNWELL 17520 SNOWCREST LANE ANCHORAGE, AK 99515 (907)620-1213 FlELD BOOKS BOUNDARM BOUNI STmm STAKIP 'QUILT' SLS DWG. FI ACRD nl.E: FILE COMPUTED: DRAWN: KMD CNECNED: KMD DATE: 07/2 GRID: 3439 0B "° 13185 LN) SccAel 1 30' PAGE 2 OF 2 a �itCTERRq n AncTERRA ('01\`4LiI.TINGj INC = ' 12 F,. 51 " Ave, Anchorage, AK. 99,503 4 Office (907) 868-3791, Fax (907) 868-3793 SOILS PERCOLATION TEST Performed for: Charles Barnwell Date Performed: 07/9/2013 Project:_ Mountainside Village Block Ir Lot 3 TEST HOLE # TH 13-1 Depth---.._.... _._...— --] Ak SEE ATTACHED SITE PLAN ORt,10L FOR HOLE LOCATION Was Ground water encountered? NO What depth? NA Depth to water after monitoring? NO Date? 7/16/2013 Reading Date GP/GM 4- Depth to Water Net Drop 1 7/9/13 - PERC BENCH 5- -7 112" 6-1 5:36 7- 3 4/16" 4 4/16" 8- * 5:38 9- 9_to-it-12- 7112- 112"4 4 5:50 to- 2 14116" 4 10/16" it - * 5:51 12 -6 O - 13- 3-14-15- 6:03 14- 31/16°' 47/16" 15- B.O.H. I6- - 17- 18- 19 - 12 min 3 2/16" HOLE PRESOAKED 20- PRIOR TO TESTING Was Ground water encountered? NO What depth? NA Depth to water after monitoring? NO Date? 7/16/2013 Reading Date Gross Time Net Time Depth to Water Net Drop 1 7/9/13 5:29 - -7 112" 2 5:36 7 min 3 4/16" 4 4/16" 3 * 5:38 7112- 112"4 4 5:50 12 min 2 14116" 4 10/16" 5 * 5:51 7 112" - 6 6:03 12 min 31/16°' 47/16" 7 * 6:04 - 7112" 8 6:16 12 min 3 2/16" 46/16" 9 6:04 7112" - 10 6.16 12 min 3 1/16" 47116" 11 12 * Water Added Percolation Raw .8 (min/in) Pere Hole Diameter 6" Test Run Between 4 feet and 5 feet I, Kenneth M. I?uffus, certify that this test was performed in accordance With all State and Municipal guidelines in effect on this bate. I/ L \ LOT 6 / LOT 5 Y SN OF B 2 \ 2p 86 Ri 6 PS\S 12p N1�0 0 pp„w A56MENT� M 01 0 i GRAVEL D/W ANCHORAGE RECORDING DISTRICT, ALASKA ASBUILT OF: MOUNTAINSIDE VILLAGE SUBDIVISION LOT 3 BLOCK I PLAT 79-177 co Z) O If • LOT 3 BILK 1 SEPTIC VENT • (typ) 10' UTILITY EASEMENT N00'17'22"W 252.79' (N00'06'00"W 252.69' R) SURVEY CERTIFICATE: I, 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 should 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 casements, covenants, or restrictions which do not appear on the recorded subdivision plat. 13-029 JL5 I 3439 LOT 4 O = FND 5/8" REBAR OF— NI ow •�� 49TH '. .JOHN L. SCHULLER:' LS -10408 c O s N g0 N x ycy 'u•. T �CZy450pSDLAND tT +t�j',�✓ w E' a 2� 1851 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax n r4a 00N I r�3• t- p z O M. O N N 0 W J Ld } W N r J c O0 rz O 0 0 O0 o 00 0) Z GO Z L \ LOT 6 / LOT 5 Y SN OF B 2 \ 2p 86 Ri 6 PS\S 12p N1�0 0 pp„w A56MENT� M 01 0 i GRAVEL D/W ANCHORAGE RECORDING DISTRICT, ALASKA ASBUILT OF: MOUNTAINSIDE VILLAGE SUBDIVISION LOT 3 BLOCK I PLAT 79-177 co Z) O If • LOT 3 BILK 1 SEPTIC VENT • (typ) 10' UTILITY EASEMENT N00'17'22"W 252.79' (N00'06'00"W 252.69' R) SURVEY CERTIFICATE: I, 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 should 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 casements, covenants, or restrictions which do not appear on the recorded subdivision plat. 13-029 JL5 I 3439 LOT 4 O = FND 5/8" REBAR OF— NI ow •�� 49TH '. .JOHN L. SCHULLER:' LS -10408 c O s N g0 N x ycy 'u•. T �CZy450pSDLAND tT +t�j',�✓ w E' a 2� 1851 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax \ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-0720 \ ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT VE s PHONE MNEW ❑UPGRADE MAILING ADDRESS 7�Q � LEGAL DESCRIPTION f SLIF LOCATION NO. OF BEDROOMS DISTANCE TO: g Absorption area Dwelling / PERMIT NO. Ube Y-2 6Q Manufacturer Material No. of compartment W � Liq. capacity in gallons IF HOMEMADE: Inside length � Width ^� Liquid depth d Z DISTANCE T0: Well Dwelling PERMIT NO. O _ FQ- Manufacturer Material Mater Liquid capacity in gallons uoJi= IL 2 2 W F"—cc� f O W DISTANCE TO: WC1 d No. of lines Length o� h line / Top of rile to finish grade / Length Width Foundation i Nearest lot line / 33 -�.SV Total length of lin Trench width Inches Material beneath tile ineFes Depth PERMIT NO. g ZU / n P Distance between lines Total effectivee sot tion ea a PERMIT NO. dF Type of crib Crib diameter Crib depth Total effective absorption area W W rn DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lo[ line PERMIT NO. J W T+ DISTANCE TO: Building foundation Sewer line Septic tank Absorption steals) OTHER oD e lt9 PIPE MATERIALS AAi RATING INSTALLER REMARKS Lrj O r APPHOVED DATE LEGAL 72-013 (Rev. 3/781 r7LJr J I C Il '<ilL I T',r' 0F" n n13E: 104_lna� :co DEPARTMENT HEALTH AND ENVIRONMENTAL •-.JTECTION o�,825 'L' STREET, ANCHORAGE, AY,. 99501 264-4720 WELL ANG Qr-a—E I TE ELJER F•EFRr•7I PERMIT NO. C 820187 ) �Sil• 2 �a 3:3r�vm. APPLICANT CHARLES E. BARNWELL 4106 P1AC INNES ST ANCH 99503 274-3852 LOCATION SNONCREST DRIVE LEGAL L 3 B 1 MTSIDE VILLAGE SID LOT SIZE 55000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MA",IMUM NUMBER.. OF BEDROOMS 4 SOIL RATING, (SQ FTIBR)= 150 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: GEF TH= F: L_Er-aGTH= C Z!; GRn%.,PEL GEF' -r"= -I. THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OP PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET). THERE IS NO SET WIDTH FOP. TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). REn!�J I REG EEF T I C _rnr11K E I �E= 1"~.10 GFiL_LOr IE PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DUPING THE INSTALLATION INSPECTIONS OF ANY I -JELLS ADJACENT TO THIS PROPERTY AND THE NUMBER, OF RESIDENCES THAT THE WELL I -JILL SERVE. --- TWO [ "• I r-J� F=* E: r -d nFREREQUI I F:EG BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION At -it) APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIM!IPJ DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OP, 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 20 DAYS OF THE 14ELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'ERrl I T EXF I RE.S GEC--ar JEsEFR = 1: 1 �:4^^ I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IPJ ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWEP. SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED: -------------------------------- Q IC! C. {�c(V APPLICANT CHARLES E. BAR,NWELL ISSUED B4'------------------------------ ------ V4.0 ( JNICIPALITY OF ANCHORAGE Department of Health and Environmental .rotection 825 L Street, Anchorage, AK. 99501 264-4720 Permit �� * * * HANDWRITTEN PERMIT WELL AN OR ON-SITE SEWER PERMITQ Applicant: e,,� -�ng Address: 411 f) Qdj:-ccpd Location: 1�'- Phone Number: Legal Description: L 3 /3 / t Size: .-5- l_ro U Type of Soil Absorption System Is: Trench: t/Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: -:1T Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is:' DEPTH - LENGTH :7-5 . GRAVEL DEPTH 4/ - WIDTH NO S67_ The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE _ �� GALLONS Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * *,* TWO(2) INSPECTIONS ARE REQUIRED Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 2 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes.. (3) I understand that the on-site sewer system may require enlargement if th es'den is remo a ed to include more thatd `bedd000/mmss. Signe3: Issued by: Applicant Date: � SWP/024(1/81) Cr ASA 'A �'EST1�D Dir. Dan Rogers SRA Box 475R Anchorage, AK 99507 4040 "B" STREET ANCHORAGE, ALASKA 99503 (907) 278-1551 October 21, 1980 W.O. OA19551 Grid: 3439 Subject: Percolation Tests Mountainside Village Gentlemen: We have completed percolation tests on Block 1, Lot 3; Block 2, Lots 1, 2, 31 4; and Block 3, Lot 5 of Mountainside Village :subdivision. Test holes were drilled by Denali Drilling, Inc. using a continuous flight auger mounted on a Nodwell carrier. Test hole logging and percolation tests were performed by Mr. O.M. !latch and Mr. T. Barber, Alaska Testlab geologists, and Mr. M.J. Holum, DOWL engineer. After the hole was drilled, a 3/4" slotted PVC pipe was in- serted in the hole to maintain an open hole. The hole was filled with water and left overnight to saturate: On the following day, the hole was refilled with water. The water level was recorded at 10 minute intervals for the next hour. During the tests, the water levels were between 3 and 7 feet below ground surface. The minimum percolation rates were observed during the last 10 minute interval. We suggest that on-site waste disposal systems be designed as follows: Percolation Recommended Rate Absorption Area (minutes/inch) Per Bedroom (sf) Block 1 - Lot 3- 8.0 ISO Block 2 - Lot 1(`' '• ' 2.86 - 100 Lot 2 20.0 225 Lot 3 20.0 225 Lot 4 . 2.86 100 Block 3 - Lot 5 5.0 125 r.. Dir. Dan October Page 2 nn nn Rogers 21, 1980 Absorption trenches are suitable for all tested lots. The recommended absorption rate per bedroom is based on criteria in the "Manual of Septic Tank Practice", U.S. Department of Health, Education, and Welfare. A well in the Keno Hills Subdivision is -located 104 feet from the test hole at Block 1, Lot 3. The drainage system should not be placed within 100 feet of this well. The water table was observed at 14 feet below ground surface at Block 2, Lot 2. Drainage trenches should remain six feet' - above this level. We recommend the absorption trenches be inspected prior to installing the system since the tests are based on a 6 inch diameter test hole. Trench conditions will provide a more extensive picture of subsurface conditions. If trench conditions differ significantly from the test hole condi- tions, the trench length may be changed to improve system performance. The following items are attached: Test Hole Logs Figures 1-6 Test Bole Locations Figure 7 Standard Explanatory Information Sheets 1-3 -We trust this report meets your present needs. If we can be of further service, please feel free to contact us. Very truly yours,' MJ11:rb Enclosures APPROVED W, 4 AXL&-_� Melvin R. Nichols, P.E. Laboratory Manager ALASKA TESTLAB Mark J. Holum i OF At eDt w . ............ q tp < mol✓n R. Nkhol, Q00 Etv.�ciCay�~ 'J I Block 1 - Lot 3 Mountainside Village Depth in Feet From To 0.0' - 1.0' 1.0' - 2.0' 2.0' - 8.0' 8.0' - 16.0' Bottgm of Test IIole: Frost Line: Free Water Level: re�) Date: 10/15/80• Logged By: O.M. }latch W.O. #A19551 Soil Description Brown Peat (Pt), moist, soft. Brown Sandy Silt (ML), moist, stiff, NP. Brown Sandy Gravel (GP/GM) with some silt and occasional cobbles, moist, medium dense to dense, subrounded particles to 6"+. Brown Silty Sandy Gravel (GM) with occasional cobbles, moist, dense, subrounded particles to 6"+. 16.0' None Observed None Observed Figure 1 Type of Unified Soil Sample Depth Sample Classification 1 5.0' Grab GP/GPI 2 10.0' " '• Grab" GM 3 15.0'• Grab GM Remarks: Refer to Sheets 1-3 for Unified Soil Classification explanation. f Figure 1 �... -�s...iL`� _ -- ----- - - - _ _ IZ`�-. ` ' '^r+--.�_�1 ^ �t-��.�'� "p"'..'�t•.�+�►'.+T_•+!�?aYyeLtY,r.�..rm�C•�,s•.c-��-to.w-..,.,.,s.,. �.. D~, Y6'�ti 7 1 a �e� � y .` s r > �,w t < � �\+#'wii Y� � � �t t y, '.:S•.yr�`.r �... � 1a♦t. t !_J'yn r � • �i'�.t '- •`� 4 'T a rl � � ,._..�u �. � _a � Y'.'? �1, t,� F"`-v,� Y ..t r a ._.+ 'moi ', a ..S yn. .Z �. i t ' � + t jal+�n '.'t * �.+. � ,J `� � P'1 it Y i ,,\ �. -.j♦ 1•. a�..a' tl `f � +. hi f. \ty V!. �'.�:' ` , •'.-' � . .t �. :.. 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D i�• + w* < r..�, S �• • Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 020-172-15 ` ' Expiration Date: 1. GENERAL INFORMATION Complete legal description MOUNTAINSIDE VILLAGE 61 Q Location (site address) 17520 SNOW CREST LANE ANCHORAGE AK 99516 Current Property owner(s) CHARLES & HELEN BARNWELL Day phone Mailing address Real Estate Agent 17520 SNOW CREST LANE ANCHORAGE AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class _Well ❑ Public Water System ❑ WaiverNariance request for: Received by:y COSA to be released to the engineer, unless COSA Fee $ �)15b^ RMsh Date of Payment $11.0.5 Receipt Number 00 COSA# OSC.131yt@ 4 Day phone TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ Date: by the engineer. 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. Name of Firm ARCTERRA CONSULTING. INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 8/10113 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. 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, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen C)F 4A encroachments, deficiencies or discrepancies exist. Ar `49TH I l 6. DSD SIGNATURE /-/""�'�u ' s, KEN!`ET DUFFU,' System #1 Approved for bedrooms. , °r, System #2 Approved for bedrooms. , L5; o• .� Disapproved. Conditional approval for bedrooms, with the following stipulations: ZB Original Certificate Date: 7? " 1 3 -) 3 Th urlicip�ylt chorage Development Services Division (DSD) issues Certificates of On-Sfte 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 _10-10-12. doc If more than 1 septic system is on the lot: COSA Checklist # _of _ Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: MOUNTAINSIDE VILLAGE B1 L3 Parcel ID: 020.172.15 A. WELL DATA Well type PRVT If A, B, or C provide PWSID # _ Date completed 813011982 Sanitary seal (Y/N) Y Total depth 86 ft. Cased to 43 ft. FROM WELL LOG Date of test Static water level Well production 8130182 ft. 10 g. p. M. Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 12+ in. AT INSPECTION 71512013* WATER SAMPLE RESULTS: Coliform l&f colonies/100 mL Nitrate .r7.Lo�mg/L Arsenic: A/ug/L Date of sample: JS / Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC 1 STEEL Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping NA- NEW TANK Pumper C. ABSORPTION FIELD DATA ft. Date installed 81712013 Cleanouts (Y/N) Y High water alarm (YIN) N Date installed 81612013 Soil rating (g.p.d./ft2 or ftz/bdrm) 1.2 System type SHALLOW TRENCH Length 50 ft. Width 5 ft. Gravel below pipe 4.19 ft. Total depth 9_5 ft. (Measured s7113) Eff. absorption area 500 ftz Monitoring tube Y Depression over field N Date of adequacy test NA- NEW FIELD Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test in. Water added gal. New depth_ in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at _ in. Datum Size in gallons "Pump off' level at _ in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 1001+ Absorption field on lot 100'+ Public sewer main 75'+ Sewer /septic service line 25'+ Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout 100'+ Holding tank 100'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 51+ Absorption field 5'+ Water main 10'+ Water service line 104 Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 1004 Driveway, parking/vehicle storage 104 Curtain drain 50'+(NONEKNOWN) Wells on adjacent lots 100'+ F. COMMENTS 'Well flow inspection and water samples performed by Gamess Engineering Group Ltd (GEG)See attached letter. G. ENGINEER'S CERTIFICATION I certify that i have determined through field inspections and review of determined through field inspections and review of Municipal records that inspections and review of Municipal records that the above systems are in Municipal records that the above systems are in conformance with MOA above systems are in conformance with MOA COSA guidelines in effect on conformance with MOA COSA guidelines in effect on this date. COSA guidelines in effect on this date. on this date. Engineers Printed Name KENNETH M. DUFFUS Date 811013 COSA brown sheet 10-10-12.doc OF AL4 1111 _T ,+ �y �Ca TN 1� [aJNFE'71M8 mo PF,S10tial, �Z � -►� Municipality of Anchorage ..E Community Development Department ` Development Services Division E. On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 131411 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 3 of Mountainside Village subdivision. This inspection revealed a nitrate concentration of 5.12 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. FARNESS ENGINEERING GROUP, Ltd. saw CONSULTANTS 8, GENERAL CONTRACTORS July 8, 2013 Charles Barnwell 17520 Snow Crest Lane Anchorage, Ak, 94516 REFERENCE: Mountainside Village Stlt; Block 1, Lot 3, 17520 Snow Crest Lane: Well and Septic System Evaluation, and upgrade Proposal for a Septic System Serving a Single Family Residence within the Municipality of Anchorage (MOA). Mi. Barnwell, Per your request, we inspected the well and septic system which serves the subject property for the purpose of obtaining an MOA Certificate of Onsite Systems Approval (COSA). A site visit was performed on 71512013. Our findings are summarized as follows: WELL: According to the drilling log, the well on the property is 87 feet deep. At the beginning of our test, the static water level was 22 feet below the top of casing (B.T.C.). We pumped 500 gallons from the well over a period of 90 minutes, with a maximum drawdown of 13 feet. According to our test, the well produces at least 5.5 gallons per minute (GPM). This is more than the minimum requirement for a 4 bedroom house in the M.D.A. (0.41 GPM) WATER QUALM: Water samples were pulled on 7!5€"2013 and delivered to a state certified laboratory for arsenic, nitrates and bacteria. When we receive the results, we will forward them to you. SEPTIC SYSTEM: The septic system serving the property consists of a 1000 gallon septic tank and a trench type drainfield. Upon our inspection, the drainfield was completely surcharged and could not be tested. In short, the drainfield is in a state of technical failure and must be upgraded before the house can be sold. The following is a summary of costs associated with upgrading the septic system: .Services to date for the well flow test, water sampling septic evaluation and preparation of this report: $850.00 .Excavation of test holes: *$600.00 for the first test hole, $300.00 for each additional test hole. Only one test hole is anticipated. -Soils analysis, percolation test and groundwater monitoring: $600.00 for the first test hole, $300.00 for each additional test hole_ This is based upon the condition that all of the test holes are evaluated on the sante day. .Engineering services to design the septic system: $900.00*. This is based upon a conventional gravity flow septic system with no waivers to property lines, surface waters, or nearby wells. *M.O.A. sewer upgrade permit: $530.00* Payable to the M.D.A. -Engineering services to inspect the installation of the septic system and prepare as -built 370€ E. Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Ph: (907) 337-6179 * Pax: (907) 338-3246 * Website: www.garnessengineering.com drawings. Assuming a conventional gravity flow septic system with a single trench/bed and no sand filter 31200M. The items marked with an asterisk must he paid prior to submitting the design package to the Municipality of Anchorage. For your convenience, we accept 0 major credit cards. The cost for the excavator to perform the installation is unknown at this time. After the soils testing and design have been completed, we will provide you with a bid for the septic installation. Upon completion of the installation, we will need to prepare the MOA Certificate of Onsite Systems Approval paperwork and deliver it to the MOA. The MOA will charge $250.00 to process the COSA. If you have any questions, please contact us at 337-6179. For more extensive information on septic system testing and design, see our website at www,gamessengineering.com, We look forward to assisting you with your engineering needs, and will do our best to provide a cost effective solution. MR 3763 ti. Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259 Ph: (907) 337.6179 • Fax: (907) 338-3246 " WeNita: www.gamessengintering.com H 0 J 00 N O O N 0 N W W O 00 O 0 p O 00 m Z 00 Z H F- LOT 5 LOT 6 � SNE Show CREST BPS`5 OF o -72R\< 20 ag' Ri 12 ,� tN14 00 00 0 DT\L\TY EASEMEN LOT 3 BILK 1 V w SEPTIC VENT • (typ) 10' UTILITY EASEMENT NOO°17'22"W 252.79' (N00°06'00"W 252.69' R) ANCHORAGE RECORDING DISTRICT, ALASKA ASBUILT OF: MOUNTAINSIDE VILLAGE SUBDIVISION LOT 3 BLOCK 1 PLAT 79-177 SURVEY CERTIFICATE: I, 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 cnchroachments exist other than noted. Under no circumstance should 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 casements, covenants, or restrictions which do not appear on the recorded subdivision plat. 13-029 JLS I 3439 I 1 LOT 4 O• = FND 5/8" REBAR 7k� oF..AZ 1%, 49THy11 JOHN L SCHULLER LS -10408 A 'w 05 o NJ, LANDR .q v d r 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax WELL n r4a 03. F— z w w N Q w H F- LOT 5 LOT 6 � SNE Show CREST BPS`5 OF o -72R\< 20 ag' Ri 12 ,� tN14 00 00 0 DT\L\TY EASEMEN LOT 3 BILK 1 V w SEPTIC VENT • (typ) 10' UTILITY EASEMENT NOO°17'22"W 252.79' (N00°06'00"W 252.69' R) ANCHORAGE RECORDING DISTRICT, ALASKA ASBUILT OF: MOUNTAINSIDE VILLAGE SUBDIVISION LOT 3 BLOCK 1 PLAT 79-177 SURVEY CERTIFICATE: I, 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 cnchroachments exist other than noted. Under no circumstance should 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 casements, covenants, or restrictions which do not appear on the recorded subdivision plat. 13-029 JLS I 3439 I 1 LOT 4 O• = FND 5/8" REBAR 7k� oF..AZ 1%, 49THy11 JOHN L SCHULLER LS -10408 A 'w 05 o NJ, LANDR .q v d r 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax ITY OF MUNICIPALEALTH 6 HUMAN • '� DEPARTMENT OF HEALTH 8 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.# �`an-\-1�-\� HAA kIASL0Cl'-n1 1. GENERAL INFORMATION Complete legal description 1 ,_) t 3 R (oc 1< -1 P9oun AtJAXIVtZ t/1104?2 Sin Location (site address or directions) 17 r 20 Snowcrej1' lane Property owner CACI let J- fill fn Betrn we 11 Day phone 2 67 - e3 70 Mailing address 17s -2o Snow cr4rf l un Anchorage A1-, 995-1,r Lending agency-Seeetrr1-�, racrfic Bank Day phone 2$W-7Yyy Mailing address '3 6 H I Ul Dune"#! f3ludf}�ye A t-, 995 iS Agent N A. (re Anonc¢) Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 1� 3. TYPE OF WATER SUPPLY: Individual well Ll� 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. 72-023 (R..1191( Fm t MOA 621 5. 6. 0 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Fla ff„'e Technrcal Serv�ca, Phone Address lgs-30 Ec4io Sfi fl�Gtioragc ,4�c 99S1� Engineer's signature '� ••— yrs- Date Fel A 1992 DHHS SIGNATURE r , i l,• .•.••.. !' fl ! A Ar r.. � �•••:.....................r 1 C.'-v:•�',) �: tea �•• t '47 av'A Q. „Approved for bedrooms. Disapproved. Conditional approval for Additional Comments • b B� A n 3' i bedrooms, with the following stipulations: Date a —/'L 93— 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. MW(P••.1/91) Back k/OAm i, Municipality of Anchorage Department of Health 8 Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: C. c, 0, 0 (Oc (c (, Pifn Stora (/t(I. Parcel I.D. O of O — / 7 L - /S A. WELL DATA Well type f v f If A. B, or C, attach ADEC letter. ADEC water system number N. A. Log present (Y/N) Y Date completed -- B l30 / 8Z Driller Do Ffe ) Total depth 8d*Cased to Int '( 3' Casing height 30 of Sanitary seal (Y/N) Wires properly protected (Y/N) y Absorption field on lot = I Is' ; On adjacent lots > too' Public sewer main N.A. Public sewer manhole/cleanout X. A. Sewer service line > 2 s' Petroleum tank None o brerveo( WATER SAMPLE RESULTS: Coliform O col /IaomL Nitrate I.Otherbacteria O co//IooA.0 Date of sample: 2 / y / 9 z Collected by: 7- B. SEPTIC/HOLDING TANK DATA Date installed 4* / 2.8 / 8 2 Tank size 12-5'0 Ga f Compartments 2 Cleanouts (Y/N) Foundation cleanout (Y/N) N Depression (Y/N) K High water alarm (Y/N) N. A. Alarm tested (Y/N) -- N. A• Date of pumping '2/7 /92 Pumper A + SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 11`6 On adjacent lots > foo r Foundation IZ' Topropertyline > fy' .� Absorptionfield 10' Water main/service line�Zs'' Surface water/drainage too' n-028 (Rev. 75 t) Fmnt `CONTINUED ON BACK PAGE FROM WELL LOG AT INSPECTION Date of test E / ? o / 82 2 / Jr / 9a ;V -n - Static water level 1'71 M Well flow _ I0 * g.p.m. 6.9 + t'r7 9•P•�i m O � � Pump level > Y3' a o 3.3 SEPARATION DISTANCES FROM WELL TO: ', '= M p z Septic/holding tank on lot )) o' ; On adjacent lots 1> ruo' Absorption field on lot = I Is' ; On adjacent lots > too' Public sewer main N.A. Public sewer manhole/cleanout X. A. Sewer service line > 2 s' Petroleum tank None o brerveo( WATER SAMPLE RESULTS: Coliform O col /IaomL Nitrate I.Otherbacteria O co//IooA.0 Date of sample: 2 / y / 9 z Collected by: 7- B. SEPTIC/HOLDING TANK DATA Date installed 4* / 2.8 / 8 2 Tank size 12-5'0 Ga f Compartments 2 Cleanouts (Y/N) Foundation cleanout (Y/N) N Depression (Y/N) K High water alarm (Y/N) N. A. Alarm tested (Y/N) -- N. A• Date of pumping '2/7 /92 Pumper A + SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 11`6 On adjacent lots > foo r Foundation IZ' Topropertyline > fy' .� Absorptionfield 10' Water main/service line�Zs'' Surface water/drainage too' n-028 (Rev. 75 t) Fmnt `CONTINUED ON BACK PAGE C. LIFT STATION m A• Date installed _ Size in gallons --Vent (Y/N) High water alarm level Manufacturer 1 Manhole/Access (Y/N) "Pump on" level at "Pump off" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Cycles tested Surface water Date Installed KY 2 81 8 2 Soil rating t s-0 01 lm'x System type 71-e^ c Length -791 Width 31 Gravel thickness `/� Total depth s Total absorption area- a Clean ouIs present (Y/N) 1' Depression over field (Y/N) N Date of adequacy test 2 6 9 2 Results (pass/fail) Pam for bedrooms Peroxide treatment (past 12 months) (Y/N) )done ltn own c F If yes, give date N. A SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellonlot !` lt0' . - Onadjacentlots > too' Propertyline 6S g M1:2.� 9i. - To ._ . To buildin foundation To existing or abandoned system on lot a A. On adjacent lots 30' Cutbank N. A. Water main/service line 2S' Surface water > t 0o' Driveway, parking/vehicle storage area > Sb ' Curtain drain 1\lane 06"scwe0l _ .... . E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the'date of this'Inspection. Signature Engineer's Name Thsodori• C. Mood Date Fe 6 too 19 9 2 v - HAA Fee 3 SDI Date of Payment obi -- % Z Receipt Number `d- 3WI C?0 72-M (R". 3N1) Bxk MOA 21 n -1, .......: 4Y n V re,.• '••�4 Jam.......JA .� �T;1:0D0;,: F. f.toOB ., it •. CB -3529 f• w"VP ......• Lp•, k 4 AGuoa�'`a� Waiver Fee: $ — Date of Payment Receipt Number n MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date S/ ks / B,r 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) 1.013 . 13//r 1 Kouola,Asrde Vill.,ye s7p Location (address or directions) 17SE O Snuw crud {.a4 t (b) Applicant Name C11p1.14' Ba'4 well Telephone: Home Business 276-06'17 Applicant Address 17.520 Snuwore_ri ITAe- , Aie4erezge. /}I- _99S'/6 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder Ea; Buyer ❑ ;Other ❑ (explain); (d) Lending Institution 61--d Agj'/ $aelr 0,01,4A 5A Telephone 276-6300 Address 70/ C. Sh (e) Real Estate Company and Agent Nth _ Address Telephone (f) Mail the HAA to the following/ address:/ N�,1r.0 �r n1C��4n 2. TYPE OF RESIDENCE Single -Family 14 Multi -Family ❑ Other Number of Bedrooms y 3. WATER SUPPLY Individual Well ® Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite V Public ❑ Communily ❑ Holding Tank ❑ Note: It community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 )2.025111.94) (1- 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is In compliance with all Municipal and Slate codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm Fle(L�04 7-eCA4ird Sfr✓rC<! Telephone - ?YS -/3S:5_ Address (#1130 ECACP Sf. z h'7CAC7n2 & /f Date ��fS�be- e, p�P�E QF'A�gs1� C • 49TH 1, ...................... j 1.:..........`F......... A THEODORE F. MOORE; d Engineer's Seal • ' •• �.CE-3589 �� n g Il�Ar a;gl=snn� a+' 6. DHEPAPPROVAL Approved for J' cam_ bedrooms by Approved A Disapprove Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an Independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending Institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct Inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72.025 0 I/M) MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANCHORAGE HEALTH AUTHORITY APPROVAL (HAA) DEPT. OF HEALTH d CHECKLIST - FEBRUARY 1984 ENVIRONMENTAL PROTECTION 264-4720 MAY 1610 Legal Description: Lot 30 Blstkl Meun �i�t�it t l/i/l ey't A. WELLDARIECEIVED Well Classification pro vat Fe If A, B, C, O.E.C. Approved (Y/N) N. A. Well Log Present (Y/N) Y Date Completed &/30/ 8L Yield > 7 61!v0" Total Depth ootf Cased to 'Or N3' Depth of Grouting MA - Static Water Level �' Pump Set At Uo M Casing Height Above Ground 30 w Sanitary Seal on Casing (Y/N) - Y Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) N Separation Distances from Well To Septic/Holding Tank on Lot it o' 4v C. o. ;On Adjoining Lots 2! WO' To Nearest Edge of Absorption Field on Lot IIS' ; On Adjoining Lots 7 too To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole N. A. To Nearest Sewer Service Line on Lot N.A. Water Sample Collected by 7..Fn ; Date --3 / 13 186 Water Sample Test Resultsfott<evr no 6.«!t�•a Comments B. SEPTIC/HOLDING TANK DATA Date Installed 6128182 Size 1 2JV�"t No. of Compartments 2 Standpipes (Y/N) Y Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) N Depression over Tank (Y/N) 11 Date Last Pumped -"/s/64' Pumping/Maintenance Contract on File (Y/N) W A• ; for N.A. Holding Tank High -Water Alarm (Y/N) M. 14• Temporary Holding Tank Permit (Y/N) N. A. Separation Distances from Septic/Holding Tank: To Water -Supply Well 110' :Pr'"' ", To Building Foundation To Property Line x To Disposal Field to, To Water Main/Service Line 1Y. A. To Stream, Pond, Lake, or Major Drainage Course > too $ Comments Page 1 of 2 L72-026(11,84) ^I � C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ISO O' / a Type of System Design Trm e A ' Date Installed 6 / 26 / 9 2 Length of Field Width of Field 36" Depth of Field y'r Gravel Bed Thickness Square Feet o1 Absorption Area 63 2 Standpipes Present (Y/N) Y Depression over Field (Y/N) N Date of Last Adequacy Test — - + PY /Bd, Results of Last Adequacy Test .4/eyur k r �/ b e�roOmJ Separation Distance from Absorption Field: To Water -Supply Well Ifs, To Property Line = S0 To Building Foundation JS" To Existing or Abandoned System on Lot N.A. ; On Adjoining Lots 30' To Water Main/Service Line N• A. To Cutbank (if present) N.A. To Stream/Pond/Lake/or Major Drainage Course _- ? I00' To Driveway, Parking Area, or Vehicle Storage Area 5e r Comments D. LIFT STATION N. A• Date Installed Size in Gallons "Pump On" Level at — High Water Alarm Level at Tested for Electrical Codes (Y/N) — Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at " Check Permitted Bedroom Rating Against HAA Request •' Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed 17 97k*� Date 5_1krl8ir Company Flai/er Tichma/ Ser " MOA No. 6S'ttr2 Receipt No. Date of PaymentS ��-�� wPti. OF, A4•9 Amount: $ i � •r� Q� ice_ •'•;r�%'� Engineer's Seal 49TH* .9 0 .................•......... Page 2 of 2 72-026 (11,84) .......... )DORE F. MOORE CE -35©9 APPL r- NT FILLS OUT UPPER !-!ArONLY Time Pr%..dy Owner ,7�7 C CR/w Pnone Q j' Malling Address pJOO Zip Code Date Buyer" - .e Address Zip code rJj�3 Lending Institution F/QST Z.-',Oq 1,:5'�AG Phone Address Zip Code Inspector Realty Co. d Agent _�� Phone Address Zip Code Field Notes: S � w.•... V-QAOX-o Ll EarIZOAMUNICIPALITY Legal Description 3 a / XfT _O Street Location Type of Residence Single Family MuItlDte Family No. of Bedroom �— ❑ Other Water Supply f� tA� lndividwf �IOr v"' ATTACH WELL LOG. A wall log Is required for all wells drilled since June 1975. log If U'community For wells drilled prior to that date, give well depth (attach available). ❑ Public Utility Sewer Disposal Individual Year Individual Installed: O Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REOt1EST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Tima Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: S � w.•... V-QAOX-o Ll EarIZOAMUNICIPALITY OF ANCHORAGE V-C"t CFPT. C° i-17,1 9• (' V � 9 COv�St• • fY�L . /[ ENVIE ;tl! �C v UL WeSZ4 GK ti c' C, MUG 2 E 19S2 kAi ��. RECEIVED ( 4, 'APPROVED BEDROOMS Z 'CONDITIONS OF APPROVAL ( )DISAPPROVED ( I CONDITIONAL APPROVAL' U DATE BY: Solis Rating Date Sewer Installed Well To Absorption Area ! O Well Log Received Nr7 I SQ ' to —1B—g Z Well to Tank f4or /D O Septic Tank Size O rears loll T11N 11�t_�_____• T11N '• LM. ti �Lo 'Yr ti 1 I �11i IM {111 {ll V A4C T11N 11�t_�_____• T11N '• LM. ti �Lo 'Yr ti 1 I 200 Potter Area Reference Map -P15 203 4®D- 205 r 206 207 =L.V V . IS..• Gem 9916 !!!9 Id 4'L.] Gppotd�� uLub L-wtt4k u ToUUCf� ��Lt 11 L n- f✓LlOil� ce' G Qom. l a co 4_ �Llv Ipp.' !• i • ^ waia 200 Potter Area Reference Map -P15 203 4®D- 205 r 206 207 a• �a aq^ wCa Mh�1 lK 0 1 bnM Ot 4ar� I� w S X60,00 .0