Loading...
HomeMy WebLinkAboutMOUNTAINSIDE VILLAGE BLK 1 LT 4Mountainside Village Block 1 Lot 4 #020-172-16 Septic System Owner -installer Agreement The On -site Water and Wastewater Section (On -site) may issue an approval for a homeowner to perform work on an on -site wastewater disposal system to serve that individual's owner - occupied, single-family or duplex home if the homeowner meets and agrees to the following requirements: 1. The property owner and excavation equipment operator may perform work on no more than one owner -installation project in a 12-month period. 2. Owner's projected active involvement with the installation: Owner to operate equipment(excavator. shovel. and compactor), survey layout for new tank installation. hand dia new tank pad, backfill, compact soil, install piping. 3. The name of the excavation equipment operator: Wiley Wilhelm, Owner 4. 1 agree that there will be no monetary compensation for installation services rendered. 5. The name of the inspecting engineer: Wiley Wilhelm, Owner 6. 1 agree to discuss the following items with the inspecting engineer: a. Permit design criteria and specifications. b. Inspection requirements set forth in AMC 15.65.070. c. Advance notice given to the On -site Water & Wastewater Section for all required municipal inspections (AMC 15.65.070A). 7. 1 agree to have the project -specific On -site Wastewater Disposal System Permit available at the construction site for the duration of all related work. 8. 1 agree that if the system is an advanced wastewater treatment system (AWWTS), I will obtain additional installation instructions and approval from the equipment distributor. N/A As owner of (legal description) Lot 4. Block 1. Mountainside Village Sub. Anchoraae I agree that the information above is true and accurate. Owner's printed name: Wiley W Wilhelm, PE Owner's signature: �� % Date: 7/17/2025 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 hftp://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241365 Work Type: SepticTank Upgrade Tax Code Number: 02017216000 Site Legal Address: MOUNTAINSIDE VILLAGE BLK 1 LT 4 G:3439 Site Mailing Address: 17510 SNOW CREST LN, Anchorage Owner: WILHELM WILEY W & KATHLEEN P Design Engineer: This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft Total Bedrooms: 1. I)eitiartti�c:at1T 6/17/2025 6/17/2026 81046 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing ILI Received By: i L 1 r LJ Date: Issued By: Date: _ Z 2- MUNICIPALITY OF Development Services Department On -Site Water & Wastewater Section ON -SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. D Z_ U Phone: 907-343-7904 Fax: 907-343-7997 Property owner(s) (_ki­,L-r-, $ k14MLg�Aj Li k4lvcn Day phone q6-7 Z'C:T- q T/, Mailing address 1,71TIO 5yv6Q (g,5,7- �-007_ 4kj(_,-(6,eJJ-6c A� _ 90(5_16, Site address i-Ino 5wa'Ll cef*r GA kj --- Legal description (Sub'd., Block & Lot) Nowjryl-t tj 5(oe V 1 13 L_� Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms - 14 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (0 all that apply) Absorption Field ❑ Initial E] Single Family (SF) (w/wo ADU) Septic Tankj Upgrade /0 Duplex (D) ❑ Holding Tank ❑ Renewal ❑Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage EJ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature grpr6perty owner or authorized agent) Permit/Rush Fees: Date of Payment: 2 s- _ / S/ Z-o'-z- Receipt Number: (�) Lo -� �- �%' 3 Permit No. ESP -Z_ Z­i 13 L, S- Waiver Fees: Date of Payment: Receipt Number: Waiver No. GAIDevelopment Services\Building Safety\On Site Water and WastewaterTormsCient FormsTermit Application.doc '41;e`-DF A�A�►®i NARRATIVE —REV 1 --�+C, `°•:�'fy 5j30j2025 *�:4511 H +.... • SEPTIC TANK REPLACEMENT I rt+ ey W. Wilhelm •o ;++% WILHELM RESIDENCE 4-bedrooms �% %% LOT 4, BLK 1, MOUNTAINSIDE VILLAGE, ANCHORAGE, AK fi� gFO•, ;,•% Project Scope: The project will include the removal of a 1,250-gallon steel septic tank and the installation of a new 1,250-gallon polyethylene septic tank. No changes to the drain -field will be performed. The tank will be suitable for a burial depth with up to 10-feet of overburden. The depth of cover over the tank will be roughly 4-feet. In order to allow for future regrading over the tank, a 6-foot manhole barrel will be installed. The tank will be purchased from Anchorage Tank. Due to the confined nature of the tank replacement activity and the size of the property, there is minimal potential for adverse impacts to adjacent properties during the tank replacement, or during it use. MOA Chapter 15.65 Wastewater Disposal Compliance 15.65.205.A—Tank Capacity. The tank meets the capacity requirement for a 4-bedfroom house. (1,000-gal + 250-gallons x (4- bedrooms — 3-bedrooms)) = 1,250-gallions 15.65.205.E — Septic Tank Location. 1. Separation Distances. a. Property Lines. The tank is located greater than 5-feet from the property lines. b. Water Mains or Water Service Lines. The tank is located more than 10-feet from any water mains or service lines. c. Foundations. The tank to be located 10-feet from the nearest edge of the house footing, and above the foundation soil bearing prism, depicted as a -45 degree plane extending from the bottom outside edge of the footing. d. Elevated deck supports. The tank will be offset 0.5-feet to the south to maintain a 5-foot separation between the tank and the adjacent second story deck support piles. See site Plan. These piles extend well belew the exeavatiaR depth FequiFed feF the tankiRstailation, theFefeFe, the exr=avatien will not undeFffline the twe piles. in addition, the lateFal lead c-apaeity ef the etheF 4 piles 1� e. Surface Water. Overflowing wastewater would flow down gradient to the west, away from the only surface water (a creek on the east side of the property). in order for overflowing wastewater to reach the creek, it would have to flow across more than 50-feet of significant side slopes. f. Wells. The septic tank and drain field are located over 100-feet from the well that serves this property and all other wells located on the adjacent properties. g. Public Water Supply Systems. There are no public water supply systems in the vicinity of this property. 2. Pumping Access. The septic tank is located approximately 50-feet from the driveway with easy, level access for pumping. 3. Driveway or parking area. The tank is not located under a driveway or parking area. C. Cover and insulation. The tank and piping will be covered with 2-4 feet of soil. A 2-inch layer of DOW Foamular (25 psi compressive strength) rigid insulation will be installed on top of the tank and all piping that has less than 4-feet of cover. The insulation shall extend at least 2-feet beyond the edge of the tank and over 2-feet on each side of piping. D. Buoyancy Forces. High ground water has not been encountered in the vicinity of the septic tank. The existing tank is not anchored, or ballasted, and it shows no signs of buoyancy problems. E. Watertight Couplings. The tank supplier provides MOA approved watertight Fernco couplings forthe inlet & outlet piping connections and pump -out attachments. F. Required Cleanouts. 1. The first compartment of the septic tank will have a 24-inch diameter by 6-foot tall manway, covered with 4-inches of sprayed on insulation with a protective UV top coating. 2. The second compartment will have a 4-inch diameter stand -pipe with airtight cap. 3. A double cleanout will be installed within 1 to 4-feet from the house. The double clean -out shall allow access upstream and downstreet from the opposite side clean -out (see section drawing for more details). 4. A second double cleanout will be installed immediately downstream of the septic tank outlet to clear back not the tank and towards the drain -field. The cleanout shall be installed on undisturbed soil, setting the benchmark for the septic tank installation depth. G. Septic Tank Decommissioning. The steel septic tank will be crushed and disposed of at an acceptable receiving facility. The Anchorage Landfill is one location that receives this type of waste. H. Septic Tank Material. The tank is constructed of polyethylene, a corrosion resistant material. This narrative was prepared by Wiley W Wilhelm, P.E. NOTES: r o \ TB D / PILE NEW 2"�_!� CONECT� m M`� / INSULATiON 50, TO EXISI'w a EXISTING`' P� EXISTING DI PIPE, \ o WO STOR,� - OC j TANK'.DECK STORY-,,,HOUSE I DEL CO NEW Irr 1 DBL CO ti a NEW > \ M ON I TO(R fx EXST CO / 1 _ \ � .TUBE EXTENDEDNEW CD1,250—GAL �0 �\ v ss\ A O 0 SEPTIC TANK 1oN O ,c P� F m k '"CN7 %t , �1 Cl m m BLOCK 1 LOT 4 .. z Ii o IE ", z �010' --_ m 30 co LOT 4 o o Z ueleetmWe 1 � BLOCK 1 / SCALE IN FEET MOUNTAINSIDE VILLAGE - I — Ip U111tt EASEMENT J `" :10:02' (RECORD) N 89' 00' DO" E (REdORD) 10 0,�' (COMPUTED) N 86' 57' 16" E (COMPUTED) 1 TOP OF TANK - 24"ox6' MANHOLE NEW 4"0 SECONDARY TANK ELEV.=95.6' COMPARTMENT CLEAN -OUT = � FFFI I NEW 4"o DOUBLE CLEAN -OUT �4' " ��—� i � � Ts I (TYPICAL OF 2) FFAN00 DOOR" EXTEND AS ROD �G� r � -- .._ ___.__.�--- - � — ---i EXIST 4"0 CLEAN OUT TO REMAIN ro — ±3.9' _ t Z nnc+ 2" INSULATION _ �'I ' SLOPE t r'FTELE _ :AEXIST DI PIPE ELEV 95 1 - - V-95 25, SLOPE-A"/FT TO REMAIN AC iANCHORAGE TANK1 10.0 1,25D-GALLON POLYETHYLENE SEPTIC, TANK MOA CONFIG. I or J • 4, . T ELEVp90.0/ 49TH 00 .... NOTES: � I 1. NEW PIPE & FITTINGS:ASTM 3034, 4"0 SCH 40 PVC. ♦� a..� ���,•�� �•� 2. NEW CLEAN -OUTS SHALL USE LONG SWEEP FITTINGS. 1 41 3. CLEAN —OUTS SHALL HAVE AIR TIGHT CAPS. . Mley W. Withetm 4. NEW PIPE CONNECTIONS TO EXISTING PIPING SHALL �# Js % No. CE-6604 USE WATER TIGHT FITTINGS. : • rf 5. INSULATION SHALL BE DOW FOAMULAR NGX 25—PSI. �'0,00 C ' 414 Aw _ ,_ _ELEV=86.0' 6. MINIMUM COVER OVER INSULATION SHALL BE 2 FEET. � 9FDp �•• "°'�• Q�V AW ROFE SSt�*.,,+ SCALE: 'i "= 5' IT .lcs, OT'� Z.� 13 � �o.��.+e.�-•e". MOUNTAINSIDE VILLAGE, BLOCK 1, LOT 4 WILEY & KATHLEEN WILHELM 17510 SNOW CREST LANE ANCHORAGE, AIASKA DATE: 5-30-2025 DRAWN BY: WWW SHEET: 1 - REV1 SCALE: AS SHOWN CHECKED BY: JOB No: MUNICIPALITY OF ANCHORAGE n �� • DL iTMENT OF HEALTH AND HUMAN SER ES • Environmental Health Division e A 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 • ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES SEPTIC ABSORPTION WELL Address FROM TANK FIELD -7-72-.Lk W ler" vJ�Lc Phone(s) Permit No. No. of Bedrooms WELL Npr 103 1 LOT LINE (o(a y 338- x{'150 9b03 I LEGAL DESCRIPTION Lot Block I Million ► FOUNDATION Za { 1 Township. Range, Section '5 A$ -BUILT DIAGRAM t5ndw location of wen. septic system. property tines, lounoauon, W • T 1 Dili, a,. are, booms. etc) TANKS SEPTIC ❑ HOLDING Manulaoum Capauty In ganons Material No. OI Companmenls two •l fP-9 r f'� Z TYPE OF SYSTEM TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER 6 Go Depth 10 Pipe bottom hOm Total depth hom Original gnaoe 0 onginai grade , FT 10.0 FT fill added auum ongmal glade Gravel depth beneath pipe O— (i FT (a0 FT Gavel leng:n Gravel w1oth SI.O FT ZLS FT X el, Ce Total absorption area (Distance between lines lo1Z SO FTJ A FT 1 , :. s Numb9 of lines Swl raling Hpe matalal 11 150 SO Fr Gam. tr3a- K mstane,staued 45>10i O L 4-VX;—ZD _5?)� t WELLS 1 PRIVATE ❑ OTHER (Identitv) A (,Ia»JRehOn IA.B.CI Iola, Depth (.aae0 to 5 . Fi FT „ Instauel Date InsMned •rT I v.y REMARKS: Scale: I s CST �1.•1? yInspections Performed bya�sL /� a•A•• •aaA % 'J .• ¢JiL. 1 Dale Gi f�i� / R Q�f. t i •,..•• •A.•SA.Yx 3 8i S ENGINEERING f Bendy that this Impeclim was performed according to all RobM ��I• •." . Pb t4874i t,•n� Mumcip3GAGk14 WR;IAK99! 2Z 8 +�+9F�••..,•,;,ar e�bar PROPE"SIO�.� (1/ kA Date. Health Department Approval: 72-019 (9,85) MIJN I L 3 FAL I 'i Y 17F= ANCI JF�AGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 025 L STREET, ANCHORAGE, AK 99501 264-4720 CIN—E3I 1'E SI=W1=F1 tz WELL F'L=-FiMII PERMIT NO: 860341 DATE ISSUED: 09/13/06 APPLICANT: JOHN MCKEAVER ADDRESS: S&S ENGINEERING SRD 196X EAGLE RIVER, AK 99577 CONTACT PHONE: 694-2979 LEGAL DESCRIP: SUBDIVISION: MOUNTAINSIDE VILLAGE LOT: 4 SECTION: 11 TOWNSHIP:11N RANGE: 3W LOT SIZE: 4 FoptAns (T. OR ACRES) MAX BEDROOMS: Listed below a e tavailable to you in designing system. Choose the option that best fits your site. BLOCK: 1 your septic W. DFZAIN 4.0 3.5 7.5 5.0 49.0 36 1,000.0 +�* 150 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - I certify that: I. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 3 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED AP'P'LICANT ISSUED BY DATE: DATE: F F�ENCI-1 FLED DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0 GRAVEL DEPTH (FT.) 6.0 0.5 TOTAL DEPTH (FT,.) 10.0 4.5 GRAVEL WIDTH (FT.) 2.5 19.0 gRAVEL LENGTH (FT.) 8 +YS \' 36.0 ,RAVEL VOLUME (CU.YDS.) 22.9 �l 25.4 Th•K SIZE (GALS) 1,000.0 1,000.0 SOL—RATING (SU.FT./DR) 150 150 BLOCK: 1 your septic W. DFZAIN 4.0 3.5 7.5 5.0 49.0 36 1,000.0 +�* 150 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - I certify that: I. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 3 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED AP'P'LICANT ISSUED BY DATE: DATE: I• _VYIP[ M %qd r ,pro b+l aL) a i Ilk r. •a'� r '�i l t+ ynw U� I � 2 / :t 1 -WH I \ a •cr,•» �c��l'� (crs��• (`�� mac' —�us3j,poSA �71c"'9% �%�� •�1�49 4061 1 s 6 4t / US --/i Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 { SOILS LOG — PERCOLATION TEST �.,• F• PERFORMED FOR: DATE PERFORMED: LEGAL DESCRIPTION: L- Township, Range, Section: REPW V) L.3"P,4& SLOPE SITE PLS 15 16 17 18 19 20 COMMENTS GIQ — faW Ir.1 y t1T' s11_T WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water k1ter Monitoring? a WAO"atc '1-1.'-115b or Fkmk Gross Reading Data Time PERCOLATION RATE TEST RUN BETWEEN 6"* 0.0 - bed A. LAifor 2 O V ;16Z • : s`"�t 3 'T 4 i� 5 6 0. 0. 8- 9 9 a 10 6 t 11 _{0 2 12- a i 13 13 c o„ ,D 14 15 16 17 18 19 20 COMMENTS GIQ — faW Ir.1 y t1T' s11_T WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water k1ter Monitoring? a WAO"atc '1-1.'-115b or Fkmk Gross Reading Data Time PERCOLATION RATE TEST RUN BETWEEN 6"* 0.0 - bed A. LAifor ;16Z lie. 1 ts7l : s`"�t Net Depth to Time I Water (mmutes/mch) PERC HOLE DIAMETER FT AND FT Net Drop PERFORMED 8 CERTIFY THAT TM!'; TEST AS PERFORMED IN r ACCORDANCE WITH !ALLSTATE AND MUNICIPAL GUIDE S I EFFECT ON THIS GATE. DATE: �6 72-008 (Rev. 4/851 . TIF'. UEPTIf r0lFUT[I:N -9441--/,�-./+/�'1'1/l1L_ �iQ_.��.tj� sgrl.� ►�D'':r 17/0 ��'cc�_Ci_�.i �J,_ S. pff 1L'C _.—�^'�-�1._.��•lt��L� �c/' Eli t�t1F/.tcTr�[e %G/�f 1.C1 II. �3 A l--' 7tt'96 =s�o�r.=— �:c//Pic/: ;+ ut ! it, ,'rMPRF:Y Z't Fr:, i 1-1 , — / ��.///�OC/.� :J3 %►r 1.P�.b _�.v Ss.c� Ci f �tsllvat= .._—.. ir l �J�r llrt�l,,voT� • T� I —.—1 1-'o gg649) Dtrt�»-iXA� btfTll'r: Ilifiir i • i ARM - %4 U11011' NJEPM NOW Pr?rlt Pl Upil �Ic:A;lt.tl�::. !1 _r Eit1:F1 -ff'L::_fiL neilm 'T7l QTY; .C'a✓�ev�1,r B.:7/c AlelAl ! I I IC,4:.'LVLL PACE./,(Ile rjo xlQ t i ::v • : ::! s ' l t . ✓.,�-cam.. .r,.��= 7 =�G 41 "`tea NJI Lil , - ,,� ia, �'LV r +... ''`• { ?°� 1'.> i n s , z a. y�. Ak j \ 3 rl �a i T 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. — 020.172-16 1. GENERAL INFORMATION COSA# N0y81 Expiration Date: 15-k-7 Complete legal description Lot 4, Block 1, Mountainside Village Subdivision Location (site address) 17510 Snow Crest Lane Anchorage, AK 99516 Current Property owner(s) John S. and Lome McKeever Day phone 952-7261 Mailing address 17510 Snow Crest Lane Anchorage, AK 99516 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD /or pickup. 2. NUMBER OF BEDROOMS: Four (4) 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ID Individual On-site ❑r Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite 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-Sfte 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 OnSfte 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 Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 5. DSD SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. Phone 522-7773 Date 10/1/2006 bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: 0 (Rw 1IMS) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water 6 Wastewater Program 4700 Bragaw Street P.D. Box 196650 Anchorage, AK 99519-650 www.rnuni.org/onstte (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Descnipbon: _Lot 4, Block 1, Mountainside Visage Subdivision Parcel ID: 020-172-16 A. WELL DATA Well type Private K A, B, or C provide PWSID # Date completed 10/7!1988 Sanitary seal (YIN) Y Total depth i72 ft. Cased to 40 ft. FROM WELL LOG Date of test 10/7/1986 Static water level 22 ft. Well production 75.100 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 1.80 mg/L Arsenic: N/D mgA Date of sample: 9/152008 B. SEPTICIHOLDING TANK DATA Tank Type/Material SeytldSteel Tank size 1,000 gal. Number of Compartments 2 Foundation cleanout (Y/N) V Date of pumping 8117/2008 C. ABSORPTION FIELD DATA Well Log (YIN) Y Wires party protected (YM) Y Casing height (above ground) 18 in. AT INSPECTION 9/12/2008 15.8 ft. 5.2 g.p.m. Other bacteria 0 colonies/100 mL Collected by: F. LeDoux Date installed 9/14/1986 Cleanouts (Y/N) Y Depression over tank (YM) N High water alarm (Y/N) N Pumper A Plus Home Services Date installed Or" ON Soil rating (g.p.d./R' or ft2/bdmr)150 SF/BORM System type Deep Trench Length 51 ft. Width 2.5 ft. Gravel below pipe 6 R Total depth _12 --ft. Eft. absorption area 11-211:2 Monitoring tube Y Depression over field N Date of adequacy test 9/12/2008 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 0 in. Water ceded 620 gal. New depth 8.5 in. Elapsed Tlme: 125 min. Final fluid depth 4.0 in. Absorption rate >= SW g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION vj Date installed Size in gallons 'Pump on' level at _ in. 'Pump air level at _ in. Datum Cycles tested i E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanli ift station on lot >I00' Absorption field on lot >IW Public sewer main WA Sewer /septic service One >25' ManholelAecess (Y/N) High water alarm level at in. Masts alarm & ci cult requirements? On adjacent lots >100' On adjacent lots >100' Public sewer manholelcieanout WA Holding tank WA Animal containment areas None Manurelanimal excrete storage areas None SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5 Property line >9 Absorption field >6 Water main NIA Water service One >IV Surface water >100' Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >IV Building foundation >10' Water mein NA Water Service Ona >10' Surface water >I W Driveway, paAwphrehc* storape >25 Curtain drain Now Noted Wells on adjacent lob >100' F. COMMENTS: G. ENGINEER'S CERTIFICATION I certdy, Mat I have determined Ihrrwgh field inspections and review of Municipal records that Me above systems ane in conformance with MOA COSA guitlednes in effect on this dale. Engineer's Printed Name Michael E. Anderson, P.E. Date 9/27/2000 'b.;� r� s� •� COSA Fee $ Eia U Waiver Fee $ Date of Payment 6A/�o Date of Payment Receipt Number 868.53 Receipt Number (Rev. 11X15) :T V x O o c J N O N + J A O N W r W N N J N O 0 N W+ c t A 0 C" W ICU3 CO N+000 0 O 0 O` N 3 3 b f cninw3 = CD O1 (D c S ,N NN C)0 N + (D A OD N 007 C" MD CA C A O N CL m x O) J 7 c Dv �m vO 7 O� a E. 0co 3 O O N y m NOND Z cn ;f ❑ IN i o D A N W O 1 N++ O (D O N N N p y n � Cl) y O N N N+ j GI 3 d O 3 n a�yo ;. > 3 I v . CD s(DM m m J. :T V x O o c J N O N + J A O N W r W N N J N O 0 N W+ c t A 0 C" W ICU3 CO N+000 0 O 0 O` N 3 3 b f D = CD O1 (D c 0 A N O. ,N NN W N + N W A OD N 007 C" MD CA C A O y� b CL m x 7 c Dv �m vO 7 O� a E. 0co 3 O > >• a m r� ❑ IN +O N W 0 A N W O 1 N++ O (D O N N N p y n � A Co O N N N+ 0 0 0 O O :T V x O o A J N O N + J A O N W J W O 00 N W W N N J N O 0 N W+ O 0 N t A 0 C" W ICU3 CO N+000 0 O 0 O` + 3 3 b D kkk1 ,N NN W N + N W A OD N 007 C" MD V vO 7 U +O N W O> N A N W O N N N++ O A O N p y n � A Co O N N N+ OD O O 3 n I v . S E O NN NNNNNNNN r"y OD V V M Cn A A W Nit _sl U A 0 -+ Q1 + CO G1 O N V COpl, N O D n y Q + 00L"0N0oo> + J N J + Ir' N 0 0�bll 0 n N N N N+ C j W i O I > C, D m E i Z D =rC N 4 N '� N Z3Oo D c "a S m a w y 0 D = y D D<_� A A A W W W W W N W W+N(WDA OOWpp A d1 W N COv N (NO A+ A co W J W coo W j �0 CL m 0� OL u y pn m y +� 3 > c) f m u O T V' (D � N O F 3 D m 0 m r r O � . 0 OR m rtr�T 0 Gw z m 3. C r; Z v • J + N N co E] (x x C C. d 3 ❑ El N ❑ x O o A Tj Q 0 c W m 0' n fu A 0 n m X 00 v� fZi� m o 0 `m -0i # O to -1 0 m . 0 x O o A Tj Q 0 c W Fr :;r to m ,N U a a 0� 0 � N 99LD c y Al O ® /7'/7 V1 L+� ' V p 4 00 00 I ' > ,a N 7 a N � � w IN oN�t-t y m t� y �b tj Q V a i r o L N J m i, ('1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ALIO OF ON-SITE SEWER AND WATER FACILITY 2644720 Application Date 12-110-86 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name 7ar•k McKeaver Telephone: Home 3AA-4581 Business 345-18 5 Applicant Address 7724 Boundary 11rnchorage, AIC 99504 (c) Applicant is (check one): Lending Institution O ; Owner/builder Q; Buyer O ;Other O (explain); (d) Lending Institution — I ct- Feral Bank Telephone Address Northern Lights Blvd. & Arctic (e) Real Estate Company and Agent Dionsa Address Telephone (f)e HAA to the following address: S & S ENGINEERING SR 196X EAGLE RIVER, AK "Sn 2. TYPE OF RESIDENCE Single -Family &) Multi -Family O Other Number of Bedrooms 4/ 3. WATER SUPPLY Individual Well IR Community O Public[3 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 Q Public O Community O Holding Tank O Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 01.84) 5. ENGINEERING FIRM PROVIDINI to INSPECTIONS, TESTS, FILE SEARCH, DAe A 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. l 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 4 SING Telephone ii9 �? p79 Address s 196X Date c a s i;4r6MitX7_j?A 'K 99577 f��i�/B C SR B 196X EAGLE RIVER, AK 99577 6. DHEP`APPROVAL Approved for bedrooms by �. Approved '�� ' Disapprove Terms of Conditional Approval I ?ate d Conditional CAUTION ter, 1 At 1h •• l= A shier •. Na 1u74 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 (11/54) MUNICIPALITY OF ANCHORAGE (MO^) MUNICIPALITY OF AN";V AUTHORITY APPROVAL (HAA) CEFT. CF HEALTH & CHECKLIST - FEBRUARY 1984 CUFZONJ.ENTAL PROTECTION 264-4720 `DEC 151986 Legal Description: Lot 4 Block 1 Mtn. Side Village A. WELL DATA RECEIVED Well Classification _Private If A. B, C. O.E.C. Approved (Y/N) _N/A Well Log PresenION) Yes Date Completed 10-6-86 Yield -5 G.P.M-+ Total Depth 172' Cased to _40'+ Depth of Grouting Static Water Level 22' Pump Set At UK Casing Height Above Ground 1211+ Sanitary Seal on Casing ON) Yes Electrical Wiring in ConduitON) Yes Depression Around Wellhead (Y© No Separation Distances from Well To Septic/Holding Tank on Lot —1001+ ;On Adjoining Lots 1001+ To Nearest Edge of Absorption Field on Lot 100'+ ; On Adjoining Lots 100'+ To Nearest Public Sewer Line _N/A To Nearest Public Sewer Cleanout/Manhole N/A To Nearest Sewer Service Line on Lot 301+ Water Sample Collected by S&S EWineerina ; Date 12-11-86 Water Sample Test Results Satisfactory Comments '54 1e/ -'c-0 TEs7 CQ6eW4.= 7Fa 4L1-ii1B ! B. SEPTIC/HOLDING TANK DATA Date Installed 9-22-86 Size 1250 No. of Compartments 2 Standpipes (Y/N) Yes Air -tight Caps (Y/N) Yes Foundation Cleanout (Y/N) Yes Depression over Tank (Y/N) No Date Last Pumped New Pumping/Maintenance Contract on File (Y/N) _N/A ; for Holding Tank High -Water Alarm (Y/N) N/A Temporary Holding Tank Permit (Y/N) N/A Separation Distances from Septic/Holding Tank: To Water -Supply Well 1001+ To Building Foundation R' To Property Line 66' To Disposal Field 51+ To Weter-Atam/Service Line 301+ To Stream, Pond, Lake, or Major Drainage Course N/A _- Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 15Osg.ft./Br. Type of System Design 'french Date Installed 9-22-86 Length of Field 51' Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area 612 Standpipes Present(Y N) YeS Depression over Field (Y& No Date of Last Adequacy Test New Results of Last Adequacy Test Separation Distance from Absorption Field To Water -Supply Well 1001+ To Property Line 10' To Building Foundation 24' To Existing or Abandoned System on Lot —N/A : On Adjoining Lots 30'+ To Water-Mein/Service Line M1+ To Cutbank (it present) N/A To Stream/Pond/Lake/or Major Drainage Course N/A To Driveway, Parking Area, or Vehicle Storage Area Comments D. t"FT-STAT"M 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 I certify that I have checked, verified, or conformed to all MOA and HAA guideli nes in effect on the date of this inspection. Signed SR& S ENGINEERING Date ��f� 6 _ Comparut _ B 196X 995MOA No. 74 -00 1 EA r Receipt No. r- (,n Date of Payment Amount: $ C � � �` a3AMH Page 2 of 2 'M 9.1 MOIL-91O3d T/1NDV4MIAN3 22-026 (11,84) S H11V3N dO Wila 30Y30HDW do AYW1I 1NfW