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HomeMy WebLinkAboutHIGHLAND TERRACE #3 LT 21Hi'*ghland Terrace #3 Lot 21 #050-312-23 Municipality of Anchorage Community Development Department Page 1 of 2 On-Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage,AK 99519-6650• http://www.muni.org/onsite •(907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181196 PID Number: 050-312-23 ❑ New 0 Upgrade Name: ROBERT& PAIGE EARLY ABSORPTION FIELD Address 0 Deep Trench 0 Shallow Trench 0 Bed CI Mound 10980 CORRIE WAY El Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot Ft. Ft. HIGHLAND TERRACE#3 21 Fill added above original grade Gravel length Township Range Section Ft. Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Tank Line Ft2 Ft. Well 142.4 N/A N/A N/A N/A TANK ❑p Septic 0 S.T.E.P. 0 Holding 0 Other Manufacturer Capacity •' Surface Water 100+ N/A N/A N/A ANCHORAGE TANK 1000GaI. Material Number of compartments Lot Line 45.8 N/A N/A N/A STEEL 2 I NA Foundation 48.8 N/A N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain 50+ I N/A N/A N/A Gal. Remarks Pump on level at Pump off level at igh water alarm at TANK REPLACE ONLY i in. in. Pump make odel Electrical Inspections performed by PIPE MATERIAL House to tank 3034 Tank to 3034 Installer drainfield NORTHERN EXCAVATION Grainfield Co/MT3670../ Inspector PANNNONE ENGINEERING SERVICES BENCH MARK (Assumed elevation) 890.Oft Inspection1� Location and description dates: 8/13/18 2nQ 10/18/18 3N 4,' AT HOUSE POINT A COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp ,��\k\ �` OF AC\�l Conditional Approval: Date i�Q' •-.0 xl1 -- ----. -- -- i i1 *�r — — lei / TH / ,•tteven•it •I5annotae•le /rl��g. CE 8149 � _ I .r 144.i5/0'U. •-4i'' Approve i Date I 10 it PROpNP Inspection Report_1-1-12.doc N • WELL E \ \ \ \ N. N \ \ • yam\ \ \ N \ \ 970 \ '�J \ \ \\ \ \ \ \ .....• \ \ \ \ N N \ \ \ \\/, \ \ \ \ \\\\\\ \ \ \ \ \ N \ 950 ift\ ,/ \ \ \ \ \ \ \ \ N \ \ \ \ \ \ N N �\ `\ \ \ \ N \ N \ \ ` \ N \ \ ''955 U \ \ \ \ N. \ \„7 O l \ N. \ \ -WELL E \ N.\ \ \ \�\ \ \ \ N.\ N \ \ ,050mV N \\\ � \ / /N ` \ \ \ ` x N ` \ N \ N \ ` \ N N \ \ w N. \ . i •':-•••„„•-„-- � — _ • \ \ \ \ _ \ \ \ 945 N _ ' \\ tt \ \ \ \ \ \ \ o \ N NZ — 1 / N N. \ \ N \ N N 940 N _rc ., — -- s-, N.w� \ \ — \ \ L3 \ N. N, -N N \ \ rte ` Cl \ .k. ,� /� �� \ BDR \ N N N. \ N. N 935 N ` ` O / \/ \ \ ` \ N. N. \ \ N. \ N. Ih N \ 2 \f ` \SED f \ 'RETAINING WALL \ `I 930 ` \ N _ ��1 \ \ \ A \\ \F NCEDB AREA 925, \ — \ 1, \ N \ POINT B IS CORNER c\ N_ — \ \ \ \ , POST 920 \ _ \ x DCO N X-_____ ....„1"......... \\ \\----, \N\ . \\ , ` T2 \ \ \ .91C, \ \ \ \ — \ \ N �'`` +` \‘ ` \ \ \ 905\ \ \ \ \ .......... N \ N - —DRIVEWAY / \ \ w . •REMOVED 1000. SEPTIC TANK 1'9 �`\\*111111;1\ 900 N \ \ W E) PER MOA CODE '895f� ~ \ \ \ \INSTALLED 1000. SEPTIC TANK ��DRAIN FIELDS E W DCO AFTER \ \ \ 890. • \ \ \ N ` \\ \ 885 N \ \ N \ `_ ` V+/�y ti i 9�5 \ \ -______ ______ ______--------__ ` . ____ , , N A B 3\ :-----------------•___.- T1 50.2 5.4 • `/ M T2 56.1 10.6 / / ` WELL,(E) DCO 58.2 12.6 LTJ' Z"-- 0 "-D j D —w w — WATER LINE <0 0 0 WELL RADIUS J D� w w mQ 0 J J _I o f —SS —SS — NEW SEPTIC LL U 0 OG. 0 0 0 - - FG. - - - 885.0 ABBREVIATIONS TH TEST HOLE (P) PROPOSED —L" ' (E) EXISTING 1000 g SEPTIC \ 880.2 CO CLEAN OUT NO. 880.4 TANK MT MONITOR TUBE NO. TYP TYPICAL PROFILE SCALE: NTS NOTES: PANNONE ENG SVC, LLC OF•• Dote 10/23/2018 RECORD DRAWING P.O. BOX 102954 ANCHORAGE, AK 99510 Q'�'•'" PHONE (907) 272-8218 FAX (907) 272-8211 �.'• 1 Scale *;• ••' 1H %N .* 1., = 50> ••• • 4.. P.I.D. NO HIGHLAND TERRACE" #3 L21 .is-40. .•; ' 0-312-23 ROBERT Sc PAIGE EARLY ' even �: �°""oMPERMIT N0. DRAWN ACP10980 CORRIE WAY CE 8149 OSP181196 EAGLE RIVER, AK 99577'•••• Sheet SITE PLAN �' 2 OF 2 .i a� MUNICIPALITY OF ANCHORAGE mens / ' On-Site Water&Wastewater Program / + r air 1 PO Box 196650 4700 Elmore Road ( Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 ,_ r http://www.muni.org/onsite 1)(..partmcnt 44'CH_;PVA On-Site Wastewater Disposal System Permit Permit Number: OSP181196 Effective Date: 7/26/2018 Work Type: Septic Upgrade Expiration Date: 7/26/2019 Tax Code Number: 05031223000 Site Legal Address: HIGHLAND TERRACE#3 LT 21 G:0155 Site Mailing Address: 10980 CORRIE WAY, Eagle River Owner: EARLY ROBERT N & PAIGE I Lot Size in Sq Ft: 55305 Design Engineer: Pannone Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank ❑ Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: & A,' Date: Issued afproIssued By: / � Date: 26 / 618970 u 77 MUNICIPALITY OF ANCHORAGE ,� =` . `� C aJUL 1 1 2018 x.` Community Development Department Phone: 907 -7901ZDV• V .\, Development Services Division Fax: 907- , 2 97 h� On-Site Water&Wastewater Program 01 6 8 L 9 5 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 050-312-23 Property owner(s) Robert & Paige Early Day phone Mailing address 10980 Corrie Way Eagle River, AK 99577 Site address 10980 Corrie Way Legal description (Sub'd., Block & Lot) Highland Terrace #3 L21 Legal description (Township, Range & Section) Lot Size 55,305 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade ❑X Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR: Dis tance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. -- (3tt\N (Signa ure of property owner or authorized agent) Permit/Rush Fees: 421 S S. Waiver Fees: Date of Payment: 7/7/1;IEZ Date of Payment: Receipt Number: Nolte() G Receipt Number: Permit No. OSP testi 9 Qt19(O Waiver No. Permit App .•:_...k: Pannone Engineering Services LIc Steven R. Pannone, Principal Registered Professional Engineer E-mail:steve@panengak.com July 11, 2018 Subject: Highland Terrace #3 Lot 21 Tank Replace Permit Request Design Narrative This is a design narrative for a permit to install an upgrade 1,000g Septic Tank to replace an existing 1,000g Septic tank to be issued for this property. The existing tank is collapsing. It will be decommissioned per code. Currently the lot is developed. The proposed system will utilize a replacement 1,000g septic tank that will be connected to the existing drain field. The existing tank is located approximately 100'+ from the well. The proposed tank will be placed outside the existing well radius. All required separation distances will be met. 1. Upgrade Tank Design. A foundation clean out installed if needed. The tank will be located: 5'+from any property line, building foundation or drain field 10'+from any water line 100'+ from any surface water 100'+ from any private wells 200'+ from any public wells The proposed installation will not affect the future development of the surrounding or existing lots. If you have any questions or concerns, please contact me at 907.272.8218. Sincerely, \ ''� \ N \ —.1:: \ \ \ \ _•`Gtr \ \ \ \ \ \141\E-LL \ \ ` \ \ \ tit \ '1015 \ \ \ \ :". M="!� \\\ N N \ N2-0'; \ \ \ \ \ \ \ \ \ \�� \ \ WEVii \ \ \ \ \ \ \ \ \ f\ - - • N. \� \ \ ` �\ NO ----N LL /I 200' \ \ \ \ \ N \ \ \ \ \ \ \ �� \ N \ \ \ \ \ \N N \ \ \N- N �\ \`\ \ \ \ \ \ \\ \ \100o \ \ \ \ N \ N ` \ \ \ N — y \ \ N \ \ X. -.`\ \ N 6) . 1 '995 \ \ \ \ \ \ \ \ \ \ \ \ \ \ N N \ \ \ \ X. \ \\7,5,--- ' \ \ . \ N N - \ \ \ \ .. ........ \ \ N N \ \ \ \\�\_ \SQ 990, \ ` \ \ \ ` \ \ 4 - _ \\ \ \ \ \ \ \ \ \ \ \ \ N \ `Z� NN '985 N N \ \ \ N \ \ \ \ - - - \ \ \ `^ �1 \ \ \ N \ \ \ \ \ - - - -` \ \ \ /r• N \ ` /�I'\ SN. \ \ N. \ \ \ \ \ \ \ 980\ X. \ \ N \ \ \ \ \ \ \ \ \ N \ X. \ \ X. N/(1/ W L \\ A\ \ N < \t \ \ _ _ \ \ \ \ N \ \ \ N \ \ \ \ \ 975\ \ \ X. \ \ \ APPROX \ \ \ \� \ \ \ \ \ N \ \N. \ N _ \ X. \ N 970 N. X. \ \ / \ _ _ \ \ \ \�\\ \\\ \ _ \ \\ \\ \ \ X. N \ \\ \ \ \ \ \ 965''' \ \ N X. N \ \ N N \ \ N \ N. \ \ \ \ \ /\ \ \ \ N N N X. N \ \ \ \ \ \ N \ 960 [n \ X. \ \ \ \ x/ N N \ \ N \ \ \ \ X. \ �\ \ \. N N \ �\ N N N. \ \ N N N. N N \ \ N. \ N \ N N N 955 \ \ \ \ \\ \ \ \ N \ _ \ \ ` N \ N . \ \ `...'\ \ o ,/ \ \ \ _WELL (E) \ \ \ \ N. N N N \ N \�\ J : \ /pro \ \ \ \ x\ \ \\ \\ \ \ \ � \ \ \ \\ \ \ sso\� � � \ \ \ S l \\ \ \ _ N N N \ ` N + - ` ••••,--,\\ \\ \ \ \ - \ \ \\ \\ ` N N N \ 945 \ N. \/ `.fa N \ \ \ N N N \ \ /\ v\ - '\ ' N N \\ \ \ \ \ N N \940~ N N - \ \ i `\ - \� \\ `3 N \ �\ \ \\ \ N \\ \ \ \ '935 \~ � � o \ \+ N BDR \ N N. N N N N \ ,N \ \ N - \ \ \ SSD ` , N. N \ N N \ \ \% \ \ \\ \\ f930I " N 9z5U _ \ \ \ N 1 \ -, \ \ \ \ \ \ { • _� \ \ \N \ \` — i \ — N N N \ \ \ \ �st5 \ ` \ X� \ \ \ N\\ \ N\\ \ X910 \ 1� \ ''--*-1..s.".... . \ I \ \ \ \ 8.8� \ \ 905 \ 1 Ilik\ W \ ABANDON EXISTING 1000. SEPTIC TANK ass \ N \ PER MOA CODE DRAIN FIELDS E -` - O - _\ \ \ 990. , \ _ INSTALL 1000• SEPTIC TANK P N. \ VERIFY CONDITION OF l N N DCO REPLACE IF NEEDED\ N N. RAE • /� \ \ N —_` 665 N \ \ N ` \ \ — way _ _ N \_ _ \ -875_ - \ l\ N < \ ...... ` WELL E) 1 ABBREVIATIONS / I // TH TEST HOLE (P) PROPOSED ya —w/ \--w - WATER LINE / (E) EXISTING WELL RADIUS CO CLEAN OUT NO. MT MONITOR TUBE NO. TYP TYPICAL Ti— s ss — NEW SEPTIC WELL (E) I 7 NOTES: PANNONE ENG SVC, LLC i / P.O. BOX 102954 ANCHORAGE, AK 99510 P�G.••• 07 23 2018 12042-0-6,�S.Y✓l0c?td it/ PHONE (907) 272-8218 FAX (907) 272-8211 •••. 1,_'•• Scale f�• '�* 1" = 50' *: L \ . / •••• NO HIGHLAND TERRACE #3 L21 •. ' I • • '-312-23 ROBERT & PAIGE EARLY t.le 2.. P.I.D.PPannone PERMIT NO. DRAWN ACPCE 8149 10980 CORRIE WAY •� OSPxxxxxxx SITE PLAN EAGLE RIVER, AK 99577 • . Sheet 1 OF 1 Municipality of Anchorage Page of? DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 6-W 93oS0S PID Number: 06-03/223 Name: LRr[rt V4,u N/EUiVBA1HUYSE Wastewater System: ❑ New pgrade Address: /09Po Co�/e l✓Ay E.vGc6 /2/ve-iz 144 ABSORPTION FIELD fkana. 996-77-F407 No. of Bedrooms: ❑Deep Trench'.ShallowTranch ❑Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: •: GPD/Sq. . Ft. S' Lot: Block: Subdivision: 19'3 Depth to pipe bottom from original grade: Gravel depth beneath pipe Z/ / !ELAND /e-ggAcE ?•S Ft. /••S Ft. Township: Range: Section: Fill added above original grade: Gravel length: 0.3Ft. 90 Ft. WELL ❑New ❑ Upgrade Pg Gravel width: S Number of lines: Z Distance between lines: /3 Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: C'9/6/O PERF /P,te l VANE e6_X 15 Ft. Ft. 5%7 SC. FL � 173O?4 PVG. Driller: Date Drilled: Static Water Level: Installer: Date installed: Ft. %!✓EC'iJ EjccAVFFT/NG- .S /L 9y Yield: Pump Set at: I Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES �Fer4eptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lin Holding Public/PrivatepManUfaCtUrer: /.4.U�- Capacity in gallons: From Tank Field Station Tank Sewer Lines-H0R_,46B /tea Well' /42 /SPWatere : Number of Compartments: /ot/0o t —' LIFT STATION Lot allons: Manufa Line 2/0 /S ' -- Foundation — "Pump on" level at: "Pump off" level at: High water alarm at: 61 (D3/ Curtain NON K,UO N Pump Make &Model I Electrical Inspections performed by: Drain BENCH MARK Remarks: Location and Description: /O? OF YOv,00,4 0AJ WALL EFT CORNr�/Z pY GARRGE Assumed Elevation: /OL) .. ENGINEF;J ::,* AL , p6pl 17034 Eagle River Loop Road, No. 204 Alaska 99577 z 9�/ Inspections performed by: Eagle River, Dates: 1st3�� 2nd /z Department of Health and Human Services approval Reviewed and approved by: Date: 6-2 –174- 72-013 (Rev. 9/91) MOA 25 Permit No.- ";M30505 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report HIGHLAND TERRACE SUBDIVISION #3, Legal Description: LOT 21 PID No.: 05031223 Col CO2 92.8' C04 A85.4' NO FENCE CO2 56.056.0 CO3 67.b 69.0 LOT 21 C04 111.0 113. C05 66.5 63.0 C06 109.0 106. MTl 93.0 93.5 100.'_...WELL iRADl. MT2 95.0 92.0 WELL 3 BDRM HOUSE - CONC. RETAINING WALL NEW 1D00 GAL. Oct FCO - SEPTIC TANK _._ A_..rNEW TRENCHES SCALE 1" = 40`\YV Y 72-013 A (2/91) MOA 25 99.2' FOUND 4RIlk.a 43v?YAeO.POJ nbwl A. Shoal y %i No. 1437.E •:-` V .n .5`3;"3• as PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930505 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:NIEUWENHUYSE ULRICH VAN OWNER ADDRESS:10980 CORRIE WAY EAGLE RIVER, AK 99577-8407 PARCEL ID:05031223 LEGAL DESCRIPTION: PRIGHLAND TERRACE #3 LT 21 LOT SIZE: 55305 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED:12/29/93 EXPIRATION DATE:12/29/94 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THE MAXIMUM TOTAL DEPTH OF THE DRAINFIELD MUST NOT EXCEED 5.0 FEET. THAT PORTION OF THE PARKING AREA OVERLYING THE DRAINFIELD MUST BE FENCED OR PERMANENTLY BARRICADED SO AS TO PREVENT PARKING OR STORAGE OF VEHICLES OVER THE FIELD. RECEIVED BY: ISSUED BY: DATE:- DATE: ATE:DATE: lZ A. HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSALSYSTEM DESIGN December 22, 1993 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, Alaska 99519-6650 REFERENCE. Highland Terrace Subdivision #3, Lot 21 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 �� e We request you issue a permit to upgrade the septic system serving the three bedroom house on the referenced property and issue a conditional Health Authority Approval. An adequacy test performed on the existing system for Health Authority Approval purposes found 401 Pgri capecilyof the existing system to be inadequate; We request a it'opal Health Authocity,Approval be issued until Spring -1994 q40,en.the syste 'be upgraded. - A test hole was excavated and a percolation test performed in the area of the proposed upgrade. The approximate location of the test hole is located on the attached site plan. Thera storing tube within the test hole has been checked and found to be dry. Attached it the proposed upgrade design. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information for your review, please contact us. A. Shafer, P.E. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 LEGAL DRAWN J.ANDERSON I CKD. R.A.S. I DATEI 2/20/93 I SHT. 1 OF 1 I CONTRACTOR IS REQUIRED TO OBTAIN UTILITY LOCATES PRIOR TO ANY EXCAVATION WORK. - 71**4 _k DESIGN CRITERIA: 3 BDRM = 450 GPD SOILS = 0.8 GPD/ SQ. FT. 450/0.8 = 562.5 SQ. FT. REQ'D DRAINFEILD CRITERIA: 5' DEEP 5' WIDE 1.5' EFFECTIrE 88' LONG S '4e 97 /�' X TV FENCE STRUCTURES, EASEMENTS, OR ENCROACHMENTS SHOWN ON THIS SITE PLAN ARE AS SHOWN ON AN AS—BUILT SURVEY DRAWN BY: LANTECH SURVEYERS IT IS THE RESPONSIBILTIY OF THE CONTRACTOR TO VERIFY EASEMENTS, REQUIRED SEPARATION DISTANCES, AND PROPERTY LINES PRIOR TO CONSTRUCTION. ` UT` ESNlT LOT 21 3 BDRM HOUSE O� c� EXISTING 1000 GAL. SEPTIC TANK (VERIFY I�NTE CONC. RETAINING WALL — —DRIVE_ C0 c CORR� WAY`S , DBL EXISTIATRENCH J TO BE ABANDONED TRENCHES AREA GEN ERALY 0 FLAT \ \ 10' WN. \ MT ATH \\TMT CO 0 d eco THE ENGINEER A Y VARY TN'e EXACT GINENSGN5 AND DSI' N PF ETERS IN THE FlEL'r, iF NECESSARY, M NEST S^E 'QW, CNS. PERFORMED LEGAL m 2- 3- 0 3O 4 i 5 -- 6- 7 7 G 8 [6/ 9 s l 10- 11 a 12- 13- 14- 15- 16- 17- 18- 19- 2o4 21314151617181920 COMMENTS ON: WA cop a1= 6-1M w-�NCi)NEIE t ls SEAL) y � P qe Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 F E SOILS LOG — PERCOLATION TEST ✓l PAs V K� 6Gt N'ti!qSa- DA PE L .A"'m'-��L ownship, Range, Section: 6, SLOPE WAS GROUND WATER l.> ENCOUNTERED? _� �aA S VKIa: euJ rh RR -C IF YES, AT WHAT L O DEPTH? P PF-- V-" E t%1.1coJriff �� Depth toW Monitoring? ...`bate: �ylstl3 SITE PLAN Reading Date Gross Time Net Time Depth to Net Water Drop a tD ID Z 1 Oro �DIr1,! '5 �� 1> a--> �� wt1Y kV '. tO to rANL PERCOLATION RATE 13.3 (minutes/inch) PERC HOLE DIAMETER f 1 TEST RUN BETWEEN � AND 7 FT a a a ccw u�ccmms PERFORMED BY'7034-Cards Riva II cops Road No 9M I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE VP0%L'L!rrA IAAC7'rJION7CI PAL GUIDELIN S E ECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) - -" - MUNICIPALITY OF ANCHORAGE �- DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME y/� v ' O_%% U PHONE XNEW ❑UPGRADE MAILING ADDRESS ``�j O e c)� LEGAL DESCRIPT[ N2 /! {�/7 ��Uf !d/ /lam / Fe`lYf�C4 it— - LOCATION 0� NO. OF BEDROOM v DISTANCE TO: Well _ ` Absorp n�e2a/ 7' Dwe� �� e PERMIT NO. .Y n zQ WF Manufacturer - Ma i / / No. of compartments e'7Z y Liq. sy ity,ilions (tea IF HOMEMADE: inside length - Width Liquid depth Y J t7Z DISTANCE TO: Well Dwelling PERMIT NO. _O z F Manufacturer MateriaF Liquid capacity in gallons m= DISTANCE TO: Well /Z ` Foun ty� Nearest li PERMIT NO. J z Z F? ¢ No. of lines Length of in� Total 1129k;4 lil( Y�7 Trenc cgth tr L11 inches Distance between lines F O Top of the o fi h gr e � M er'al be r� t-he !/ `2 ZM Y3 ,/2 inches Total effective absorption area w C7 Length Width Depth PERMIT NO.. -11,- Wa TVpe of crib Crib diamete Crib depth - Total effective absorption. area - - u! DISTANCE TO: - Well Building foundation Nearest lot line J J Class Depth Driller Distance to lot line PERMIT NO. W � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS l< C SOIL TEST RAT[ -. INSTALLE O REMARKS As 4% IWIL E gee% 1io.. T447E APP O ED DnATTEE LEG AIV , ALASKA ''SM 72- f (Rev. 3178). r-lur-a I C 10FiL I -rV C)F FiltaC l FiS aE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE, AK: 99501 254-4720 93"—� I TE f3E4dER PERM I T PERMIT NO. { 821077 ) APPLICANT ED SCOTT PO BOX 594 E.R LOCATION LEGAL LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C�EF'TH= E3 LEt-dGTH= ;2E C3FZFi%u'EL E]EPTH= ! THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DR.AINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN 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 CIN FEET). 1;ZEUlJ I REC> SEPTI C Tf::IrA C f5I =E= 10101a 13F=IL-1 Lar S; 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 C �2 7 I NS5PECT I (DrAS; FfiRE RE(aLJ I REC3 — 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, OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERM I T EXP I RE's 6E�EMEER 3�1 �5��� 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 INSTA L THE SY M IN ACCORDANCE WITH THE CODES. 3: I UNDERST T T ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE I R LE 0 C E MORE THAN 3 BEDROOMS. SIGNED: - ----- -------------------------- P ICRNT ED SCOTT ISSUED BY__ - DATE_ --_- 11 - V4. 0 ■ :_®F F=i t-4 C= H IDFRF=E lZi E_ DEPARTI`iENT HEALTH AND ENVIRON7ENTAL:i7TEC:TIOtd t t_` STREET. ANCHORAGE: AF::. _91W91 264-4720 Or -J— I _CE PERMIT paO. 820433'E, j APPLICANT GUS GUSTAFS:ON 8011 NORTHWI'ND 338-1635 LOCATION EAGLE RIMER ' LEGAL #3 LOT SIZE 55305 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER: OF BEDROOMS _ _ SOIL RATING v::SQ FT'BR?= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: CaFF°TF E_ _ LE tto=,TE-1= 93F`Fl"°."EEI EN1=PT'"- -4 THE LENGTHDIMENSION 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). F^EC_®F_F I F°FC" = FF -T I E T F:1r-4F = I 7'E_ :JL uZts-1oa o:3f=1LI_Cot, PERMIT APPLICANT HAS THE R:ESPONSIBILI'T`F 'TCS INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPEC=TIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. T• &4 a=o < 3: t -t = F� E_ Rl_ T' I C-1 r,4 =- F=1 FR F F' E= C71 F_F I F' E= C" — — 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 DEFENDING UPON THE TYPE OF PUBLIC WELL, MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE I'= 25 FEET AND TO A COMMUNIT'i SEWER LINE IS ?O FEET. OTHER' R:EQUIR:EMENTS, MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO .INSURE PROPER INSTALLATION. E=° t= F t'-! I T E:.'--1 F- I F E= :E. C" E= o_: F r-1 E: E-= F' 3: -1 0 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. I WILL INSTALL. THE SYSTEM IN ACCORDANCE WITH THE CODES. : 1 UNDERSTAND THAT THE ON-SITE _EWER: SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE I_• REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED: -------44 e_- --------- -� APPLICANT GUS GLS=TAPE ISSUED € V4. 0 O Et E GEOJPECHNI CAL & DEVELOPMENT CO. t Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Elis 694-2774 SOIL LOG - - 6BB-2280 Soils Et Foundations Land Development Performed for: Name: 6Z -"-1e— Tel. No. G4'4/ -Z:3a 9 Mailing Address: q 46AcfLc Legal Description: L-cr z/ A41- .4,uia-j-gL,Q ac> 1 3 Depth (feet) Soil Characteristics 0 2 J 3 C9 4j,tfio � 4� s -rN 4524Vae 4 5 444.11 oma .....«.... o_1e 6 1® 8 — Rwseli L. Oyster No. 4286-E 10- 11- 12- 13 01112 13 itta-r6.E�A�=S ,Q�3cr�� 14 Lvr 2a 15 16 n are, Ground Water Encountered: Yes No If yes, what depth Proposed Installation: Seepage Pit -, Drain Field Comments: Performed by: 2 f a N RETURN TO: Division of Geological andsical Surveys (DGGSZ w 3001 Porcupine Drive (Tele: 277-6615) -i Anchorage, Alaska 99501 WATER WELL RECORD Drilling Company Name Cotten—MagnUeon Drilling LOCATION OF WELL I Please complete either Ia, It, or It. Ia. Borough Subdivision Lot Block Ib. Fraction Section No. Township Range Meridian NIS E/W 3. OWNER OF WELL: Mr. GUS Gustafson Address: 8011 A)orthwind Apt. .'. Anchorage, Ak, 99504 4. WELL DEPTH: (completed) Surface Elevation Date of 0111 245 ft. -- Se-�1=1 5. ❑Cable tool XEkftiotary ❑ Driven ❑ pug ❑ Auger [—]Jotted ❑ Bored ❑ Other: 6. USE: MQonestic ❑Public Supply ❑ Industry ❑ Irrigation ❑ Recharge ❑Commercial ❑Test Well ❑ Other: 7. CASING: ❑ Threaded yM Welded In. to ft. Depth Weight lbs/ft. In. to ft. Depth R. FINISH OF WELL: - f1 Type: Open hole Diameter:I1 Slot/Mesh Size: Length: Set between ft. and ft. Fittings: 9. STATIC WATER LEVEL: 22 ft. ❑ Above j(❑Below land surface Type of Measurement: 10. PUMPING LEVEL below land surface ft. after hrs. pumping g.p.m. ft. after hrs, pumping g. p.m. 11. WELL HEAD COMPLETION: ❑ In Approved Pit ❑ Pttless Adapter inches above grade 12. GROUTING: Well Grouted: ❑ Yes XO No Material: ❑Neat Cement ❑ Other: U.S.G.S. Local No. Wiling Permit No. A.D.L. No. STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES Distance and Direction from Road Intersections r Street Address and Area of Well Location WELL LOG, - Fast 13. PUMP: (if available) HP Length of Drop Pipe ft. capacity 9.p. Type: ❑ Submersible ❑Rec t pro" ting ❑ Jet ❑ Other: -. 14. REMARKS: Bail tested at 20 g.p.me 15. WATER WELL CONTRACTOR'S CERTIFICATION: This well Was drilled under my jurisdiction and this report Is true to the best of my knowledge and belief: Cottenwla uu on Drilling AA 5385 �agisterc Bus ness Nam Con tract License Number Address: 'P.O. Box 504 Eagle River, At-, 119577. signed: Date:Sune la, lq 1 Authorized Representativ Form 02-WWR Copy -Distribution: -WHITE - State DOGS, PINK - Driller, CANARY - Customer E . M t•1 wJ r4 I C I FI 1_ I _T V CH F t i t -d r_ FIER F• FA 1:3 I=— DEPARTMENT DEPARTMENT HEALTH AND ENVIRONMENTAL11POTECTION 825 STREET, ANCHORAGE, AK. 99501 264-4720 4-i E L L F• E= F' t•1 I -T- PERMIT NO. K 821152 APPLICANT GUS GUSTAFSON LOCATION LEGAL L21 HIGHLAND TERRACE # 8011 NORTHW I ND 338-1615 LOT SIZE 999_=+99 SQUARE FEET MINIMUM DISTANCE E BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM Is 100 FEET FOR A PR'IVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM H PRIVATE WELL TO R PRIVATE _;EWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. 14ELL LOG_, ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAY- OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INURE PROPER INSTALLATION. F" E= E='t 1 I T Ew It F• I FT K 60 E> E ED E= t•1 E: E: F' -_ "I , "I &A 53:12 I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE _EWERS AND WELL= AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. r IGNEy:1_ 0 - ------ - == '------- APPLICANT GUS GUSTAPION --- I S QED BY r/, V4. O Eimm EMS • • " Municipality of Anchorage-46 =�A - On-Site Water and Wastewater Program (907) (907) 343-7904 s F E*r Certificate of On-Site Systems Approval Parcel I.D. 050-312-23 Expiration Date: -2-28— ( (G 1. GENERAL INFORMATION Complete legal description Highland Terrace #3 L21 Location (site address) 10980 Corrie Way Current Property owner(s) Robert & Paige Early Day phone Mailing address 10980 Corrie Way, Eagle River, AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: x Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 52C Waiver Fee $ Date of Payment ii/(511? Date of Payment Receipt Number Receipt Number COSA# () Lig 1S99 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. In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system.The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R Pannone Date 8W/3 OF AL k *'49 TM O -.1r% 6. DSD SIGNATURE •••' 04. go ySystem #1 Approved for 3 bedrooms •Steven K. Hormone• oe System#2 Approved for bedrooms T{� q,• CE-8149 Disapproved l�kV PROFESSC* "r` ANN Conditional approval for bedrooms, with the following stipulations: 0N_S1l ND VAI S�NA-SER Q (.1) pROCIgN r)04/JP/ T C,ER\t\C� Original Certificate Date: I ` ZS2 1 ' The Municipality of Anchorage Development Services Division (DSD)issues Certificates of On-Site Systems Approval (COSA)based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet '- If more than 1 septic system is on the lot: COSA Checklist# I of 1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Highland Terrace #3 L21 Parcel ID:050-312-23 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (YIN) Y Date completed 5/10/81 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 245 ft. Cased to Link ft. Casing height(above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 5/16/81 5/18/18 Static water level 22 ft. 41 .3 ft Well production 20 g.p.m. 3.8 g.p.m. WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate 4.54 mg/L Arsenic ND ug/L Date of sample: 11/8/18 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic / Steel Date installed 8/13/18 Tank size 1000 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N/A Date of pumping NIA - new Pumper C. ABSORPTION FIELD DATA Date installed 5/12/94 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8GPD/SF System type Shallow Trench Length 90 ft. Width 5 ft. Gravel below pipe 1.5 ft. Total depth 6 ft. Eff. absorption area 577 ft2 Monitoring tube Y Depression over field N Date of adequacy test 5/18/18 Results (Pass/Fail) Pass* For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 480 gal. New depth 0 in. Elapsed Time: 180 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. None Known Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed N/A Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 1001+ On adjacent lots 100'+ Absorption field on lot 1001+ On adjacent lots 1 00'+ Public sewer main 75'+ Public sewer manhole/cleanout 1 00'+ Sewer/septic service line 25'+ Holding tank 100'+ 50'+ '+ Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 101+ Property line 5'+ Absorption field 5'+ Water main 101+ Water service line 101+ Surface water 100'+ Wells on adjacent lots 1001+ ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 10g+ Water main 1 0'+ Water Service line 101+ Surface water 1001+ Driveway. parking/vehicle storage 10'+ Curtain drain 501+ Wells on adjacent lots 1 00'+ F. COMMENTS * 4GL-5`111N17)'P?L-s Ara g•<"- ¢t3s -r As s6-ot,o C91-4. --t g- s 'es 7 .>. lig.C c -6CD --- la A WI N A S G. ENGINEER'S CERTIFICATION ..r~ OF AL t I certify that l have determined through field inspections and ..e, 03Se 3.. �1 y,+ review of Municipal records that the above systems are in *: 4 • '1. /\ •,*�y conformance with MOA COSA guidelines in effect on this date. =�0� • • •• 0 Engineer's Printed Name Steven R. Pannone ":SevCiE 14o9ri orie Date �g(11r -• •{!9� - - It \"6-.. COSA canary sheet_2-6-15.doc Lot 1 B 1 _ ,`f.I O f /99.',,C � 1g8.98•R 10' UTILITY EASEMENT 41 M Lot 21 Lot 20 W \ 55,305 s.f. isv \ / '� �o 2 STORY RESIDENCE r w/ WALKOUT BSMT. Tract 1A I = WELL-7 N 1 0 4r I o 7g 8 }06-, ''ca. 0 1 ay o0 0 94.6' rn OAC-B 11' 47 0'•* ? a `�► -RETAINING WALLS u, ` .CO?ItRE' .. CAGE m o �i� ,F,b-{,. " -- LSEPTIC --- ` �5,��. I PIPES � • p4i ` 7.3".2.2,08,,.. '1.9'x15.7' SHED ?7O 8O caRRIE — ` _ — PLOT PLAN AS BUILT X SCALE _11:__,--__50'— GRID NW 0155 Project No. 18-590/A1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone 000444p� (907) 522-4625 Fax oq F A �‘� Professional Land Surveyors kenOlangsurvey.com o ,4 jonothanOlongsurvey.com ,.'' s I) I herebycertifythat I hove surveyed the followingdescribedproperty: Od�P 'j\ $7 LOT 21, HIGHLAND TERRACE SUBDIVISION (PLAT No. 67-150) * 49TH i� •�*t Anchorage Recording District, Alaska, and that the improvements situated thereon are r 1VA within the property lines and do not encroach onto the property adjacent thereto, that / �i�i`I f4 ._, 0 �.:�. 4 4G no Improvements on the property lying adjacent thereto encroach on the surveyed -0,1.,• JJ KENNETH G. IANG(.1: premises and that there are no roadways, transmission lines or other visible c i o0 easements on said property except as Indicated hereon. Q ;- Q � F..'.,LS''S202. ••• 9Jp� Dated this the Day of �.. —, , at Anchorage, Alaska Ot 4A. sSiGNA��$ It Is the responsibility of the owner to determine the existence of any easements, ` .400004 covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 Parcel I.D. 050-312-23 Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems 1. GENERAL INFORMATION Expiration Complete legal description Highland Terrace #3, Lot 21 Location (site address) 10980 Corrie Way Current Property owner(s) Jessica Spayd Day phone Mailing address Real Estate Agent 2. TYPE OF DWELLING: 10980 Corrie Way Day phone 0 Single Family (w/wo ADU) � ! A / J ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) i 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well j] Individual F-1 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Distance: Received Date: N/2 cG z COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 6,215 Date of Payment allalo W Receipt Number 06 7-41ta (_7 COSA# 050Lilr.O6? 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MCA COSA guidelines and regulations. The reported results describe 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 soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 10/28/2014 6. DSD SIGNATURE r ri r� Seven i� System #1 Approved forte-� bedrooms i CE -814 System #2 Approved for bedrooms �� OT,.,,-jLfh� (= Disapproved{���`= Conditional approval for bedrooms, with the following stipulations: 1 ,411y,IrE v, Original Certificate Dater ( 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet � .. If more than 1 septic system is on the lot: COSA Checklist # 1 of Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Highland Terrace #3, Lot 21 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 5/16/1981 Sanitary seal (Y/N) Y Total depth 245 ft. Cased to unknown ft FROM WELL LOG Date of test 5/16/1981 Static water level 22 ft. Well production 20 g.p.m. WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate 1 .90 mg/L Arsenic ND ug/L Date of sample: 10/24/2014 B. SEPTIC/HOLDING TANK DATA Parcel ID: _ 050-312-23 Well Log (YIN) Y Wires properly protected (Y/N) Y Casing height (above ground) 18+ in. AT INSPECTION 10/24/2014 24 ft. 4.5+ g. p. m. Collected by: PES Tank Type/Material Septic/Steel Date installed 5/12/1994 Tank size 1,000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date ofum in P P 9 l Pumper -3-% S /—ct•-... 5/12�199H� 2 2 0.8GPD/SF Shallow Trench Date installed Soil rating (g.p.d./ft or ft /bdrm) System type Length 90 ft. Width 5 ft. Gravel below pipe 1.5 ft Total depth 6 ft. Eff. absorption area 577 ft2 Monitoring tube Y Depression over field .+.d Date of adequacy test 10/24/2014 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 3 in. Water added 483 gal. New depth 7 in. Elapsed Time: 150 min. Final fluid depth 3 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons _ in. "Pump off" level at E. SEPARATION DISTANCES WELL ON LOT TO: Cycles tested Manhole/Access (Y/N) _ in. High water alarm level at Meets alarm & circuit requirements? Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer /septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS //r �S - LA 4 oma. �� Ce 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. Engineer's Printed Name Steven R. Pannone Date 10/28/2014 COSA brown sheet 10-10-12.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 10+ in. �-� Municipality of Anchorage c� Development Services Department Building Safety Division, On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 wvnu.ci.anchorage.ak.us �( '- (907) 343-7904 CERTIFICATE OF HEALTH AI.ITHOR !T't'APP'RZO AL FOR A SINGLE FAMILY DWELLING "4 Parcel I.D. Expiration Dai-: i 1. GENERAL INFORMATION Complete legal description Le ;% I H 1(, 14 ` A,J 7f 4.?Ace' :tt -3 Location (site address or directions) ccs rt r w 4 y� , 4c t d Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address C-ta,PL 13oSiE,K Day phone _6 `i b 10930 C0A_A,6 Al,vf,4 4-C '7aS77 Unless otherwise requested, NAA will be held by DSD for pickup. Day phone Day phony 2. NUMBER OF BEDROOMS: y 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site 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 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 Approvai 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 sample results. (Certificates may be reissued for a period of up to one year with valid waier samples.) Certificates are valid for one year for properties served by Class A or B wells or a oubiic water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engii.eers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shop er, below, 1 verify that my investrpation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the or, - 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 verity 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. S & 5 ENGINEERING Name of Firm URiver Phone 61 7 �/ — 3 Address _ Eagle Rives, Alaska 99577 Engineer's Printed Name i C. C'�w f ___ Data 5. DSD SIGNATURE Approved for — __ Disapproved. Conditional approval for P p i ROBERT C. COWAN i 'k - CE - 3801 CE -8801 bedrooms. bedrooms, with the following stipulations Additional Comments -m: WATER AND_p G �IZT—_ PROGRAM z Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other gy: v ( Original Certificate Date:�_J s' _ J' (Re, 011021 Municipality of Anchorage Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: "% A 1 fi f & if L 441a 10 T #-R2 9 Lf- *13 Parcel A. WELL DATA Well type P41 V#+r Date completed S // bit Total depth a HS It. If A, B, or C provide PWSID # Sanitary seal &N) YEf To &A. Cased to II H ft. FROM WELL LOG Date of test S /I 6 1% Static water level 3L )- ft. Well production all;) g.p.m. WATER SAMPLE RESULTS: Coliform O colonies/100 mi. Nitrate L 117 mg./I. Arsenio- n,erft. _ Date of sample: L14 -y -to 2- B. B. SEPTIC/HOLDING TANK DATA Tank Type/Material 50-/41 rc- Tank size /'oo o gal. Number of Compartments a Foundation cleanout &N) Y4 Depression over tank (Y/Q N 0 Date of pumping /1/0( Pumper 2 S C. ABSORPTION FIELD DATA Date installed r�'��9y Soil rating 0.d90relbdrm) Length 410 TdTAL ft. Width ft. ©S`b-3/a-23 WeilLog&/N) Y#,f Wires properly protected &N) Y E f Casing height (above ground) a f in. AT INSPECTION �fk ft. S--% 9 -p.m - Other bacteria 0 colonies/100 ml. Collected by 1 A 5 E NGINEERINGoad 9 � P W4 Eagle River, Alaska 99577 Date installed r`/ /;L / a Y Cleanouts O/N) y* -l High water alarm (Y/O ^' O System type 5,44 �" W rR4.VC'0Vq-1 Gravel below pipe 1 , r ft. Total depth o ft. Eff. absorption area 577 ftZ Monitoring tube yxs Depression over field N Date of adequacy test °b' aSlo i Results ass/ ail) /°*-S1 For 3 bedrooms Fluid depth in absorption field before test DAY in. Water added It 1r) gal. New depth G /> in. Elapsed Time: 6o min. Final fluid depth 'P, in. Absorption rate >= ys 0 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) fJa"4- K ^�s" If yes, give date — D. LIFT STATION Date installed "Pump on" level at in. Datum E. SEPARATION DISTANCES Size in gallons "Pump offJaw Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot /04 `i -- Absorption field on lot Public sewer main Sewer /septic service line / 00 '-f- Public -f NIA High water alarm level at Meets alarm & circuit requirements? On adjacent lots /00 r -A On adjacent lots / V 0 4 Public sewer manhole/cleanout N /A Holding tank N/4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation or Property line Absorption field S Water main N ! %} Water service line JO f Surface water / D r Wells on adjacent Tots /00 4 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line / S Building foundation 6 3 Water main fJ OA Water Service line /� rt Surfacewater / 0 d �f Driveway, parking/vehicle storage Curtain dram, NaNh KNowN Wells on adjacent lots / 00 y` F. 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 HAA guidelines in effect on this date. Engineer's Printed Name 48^04/t7- C r`ow,g,✓ Date i0 /l /d —d— HAA Fee $ 3'7 S. ° ° Date of Payment /0 ( x /o Z Receipt Number (Rev. 12101) Waiver Fee $ Date of Payment Receipt Number AM, R - pCOWAN c 8801 in. LOT 20 11 U.G. ELEC. BOX M rJ _,-tib• Yr••',�J:JT HGUSE .���4ulr. ••%"G� i s • Titan os H. Dreyer • ,,l' Om. 1 $-iu2S •• v, G C1cCA ••........- cJ Gr. lE AINHNG WALL P 2 SET FND anu.nco r. t x x x - .y axter�i ,e VV 17 f e a es t ns 1I5J8'za 'e/c4►J s/e' m O n t ...cn c' t 0� 3:a'• AL.MtYI. w {jNJMiNT w t+!-! R E fit / i ��, ! ., - < . , ,.e .,ed tc.- IMJa & T.eK a _ ..•c�m!.c _ a,,,c- -� i.ct::! or m e. i`Et4CE_ n 5 fy E OS sl,—, � c, if % �D C CRS- Lmntmm I drn - r e t"l -.11 l4e e,CON.+RETE s e;' 1 1 rl _In 1. _ J 1 'FPT!C sTAI Da�aEs- V' LAND & CONSTRUCTION SUFZVEYCRS—F;_wN 45—E'V REEF_ �WAIV--WWF 440 WESI BtNSON BLVD. # 103 `.a^,7•, n j LOT ,r �� > ANCHORAGE. ALASKA. 9950_ _`:02-52,'. 1 WORK RDER NJMa'eRTniE 16CC. to t n ; 1 I �I�NLA,ND 1 CRRAH SOBD. ADDITION NO.3 DRnVA gr, ,(,MECRE] 3, Ge3 ^JMJ(R ?JOgl+an,E 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 Parcell.D.# 1. GENERAL INFORMATION HAA# IaV21y�L1�� Complete legal description Lot 21; Highta.nd Tennace Subdivia2on #3 Location (site address or directions) 10980 Connie Wag Eaote Riven. AK Property owner Linda Van N.Leuwenhuyae Day phone Mailing address 10980 Connie Way Eagke Raven, AK 99577 Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water Day phone Day phone r?I -F 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 XXX 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 (Re, 1/91) Front MOA #21 5. Q 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 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 S & S ENGINEERING Address I nae G=,.(e Rwo 001 o. Eagle River, Alasica 99577 Engineer's signature DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments Phone Date bedrooms, with the following stipulations: Date (— 2 ` 7 ¢ 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 orderto 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) Beck MOAN21 ,. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: NkC,01_� 1��� �G� 3 Parcel I.D. 0 031 ZZ-:�2 Lc�f -Z- A. A. Well Data Well type 2 ✓P7 If A, B, or C, attach ADEC letter. ADEC water system number 0/ P Log (ON) (� Nitrate present 7 Date completed Driller C6rrMr4-f-1krelu� fJ0 ]� Total depth 246 r Cased to ItD r � � • Casing height -2- /2 ZO-�J�J seal &N) Wires properly protecte&) y FROM WELL LOG AT INSPECTION Date of test «� Z - -tel �j y 2. m 2, rn i`r'1 Static water level ZZ r 3 o5wW D ' s ° . S Well flow2-� g,p.m. a �0 4+ g p m� C Pump levell cn 6 SEPARATION DISTANCES FROM WELL TO: N -• 0 m / m t N Septic/holding tank on lot 142 ; On adjacent lots Absorption field on lot v, -S1 ; On adjacent lots _ J06 + a 6), i - Public sewer main 1,A Public sewer manhole/cleanout tJ O �� Sewer service line Petroleum tank NJ Y -- WATER SAMPLE RESULTS: Coliform Nitrate I n94 Other bacteria fJ0 ]� Date of sample: /2-/4 �/ /2 ZO-�J�J Collected by: J� S B. SEPTIC/HOLDING TANK DATA Date installed �/Z/9� Tank size le JD Ck6L_� Compartments - I / Cleanouts (Y ) Foundation cleanou6N) Depression (Y� ^f High water alarm (Y16--LI. Y/)Li1 Alarm tested (Y/N) lJI A . Date of pumping �Jo Pumper /JEC.y 'J Ar1,e-- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Wells) on lot On adjacent lots / 105-DFoundation 41�3 To property line �f b r Absorption field S-4 Water main/service line Surface water/drainage / 6-Z -I-- 72-026 ("3)* I-- 72-026(3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level Meets MOA electrical codes SEPARATION DISTAN F Well on lot D. ABSORPTION FIELD DATA "Pump on" level at LIFT STATION TO: adjacent lots Manufacturer (Y/N) "Pump off" Level at Cycles tested water 4 Date installed 2g Soil rating (GPD/Ftz) Y System type�Sm 7 � Length JO Width Gravel thickness A'5 Total depth 45_ / Total absorption area 5�3� Cleanout present y N) _Depression over field (YO /11/ Date of adequacy test Y ��1� Results (pass/fail) �SSi �1`i for __5 Bedrooms Water level in absorption field before test It:y) � After test �/� Peroxide treatment (past 12 months) (t f`l If yes, give date f—)�A SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I ;5�e On adjacent lots (ODI 4— Property line To building foundation _11P :J To existing or abandoned system on lot /b ! J On adjacent lots &6 /_/_ Cutbank Water main/service line Surface water /027) Driveway, parking/vehicle storage area D Curtain drain E. ENGINEER'S CERTIFICATION I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the cite of this inspection HAA Fee $ Date of Payment Receipt Number 72-026 (3(93)` Back 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 LID, # 0'--)D Nn - HAA# 1Z9�<l1�Ci 1. GENERAL INFORMATION Complete legal description Lot 21; H.ightand Teanace Subdiv.iaion #3 Location (site address or directions) 10980 Connie Way Property owner Linda Van N.ieuwenhuyhe Day phone 696-7212 Mailing address 10980 CoiuLie Way Eagte R.ivek, AK 99577 Lending agency Mailing Anent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water Day phone Day phone 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 XXX 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 (H.v. 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 Iurtherverify 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 dat this inspection. S $ S ENGINEERING Name of Firm 17034 Eagle River 1 nn�j a�7N0 $� Phone Eagle River, Alaska Address Engineer's signature _ COI -)0 /7,70JJ-9 L 9�&ds 6. DHHS SIGNATURE Approved for bedrooms. Date :9 Disapproved. Conditional approval for C3 bedrooms, with the following stipulations: - le,o�CZZ„ U� �9s� a,2saU"l'edi C�,.2t / p /th/2/7L I Additional Comments 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(Rw. 1M1) Beck MOA k21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L� 2t N�w\�rD T��� Slv Parcel I.D. p�vo. 3 A. Well Data Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present Qq) J Date completed I`I 9s Driller (-aT-gl� Nitrate A r "h Other bacteria Total depth �t � t Cased to y5 Casing height 1-2- Sanitary seal (S)N) Wires properly protected) FROM WELL LOG AT INSPECTION z Date of test \ `\ g t /z - / - 1_73 m z I Static water level Well flow Zo (..nPf1 g.p.m. �•`z g.p.m. < D Pump levell U>L d/L iii n SEPARATION DISTANCES FROM WELL TO: in C z Septic/holding tank on lot \ t> ; On adjacent lots Absorption field on lot \oC, ; On adjacent lots \pa k Af__ Alp Public sewer main Public sewer manhole/cleanout - Sewer service line 215 � Petroleum tank ZS �+ WATER SAMPLE RESULTS: Coliform Nitrate A r "h Other bacteria oJ�0As- Date of sample: / 2 - /4 -93 // -,2D — 93 Collected by: B. SEPTIC/HOLDING TANK DATA Date installed /;� - 8 2 Tank size / 0v0 Compartments Cleanouts ON) Foundation cleanout 6}N) _ Depression (Ya r High water alarm (Y/Q rJ Alarm tested (Y/N) 1-(14Date of pumping 11-30,93. Pumper -7-A. G�S!Pva L, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /oo l � i00 Foundation /� On adjacent lots S� To property line A> Absorption field Surface water/drainage / L a (I(- o / Water main/service line /a 1114- 72-026 (3/93)* P 7z-026(3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level Meets MOA electrical ( Well on Manufacturer Manhole/Access "Pump on" level at ' "Pump off" Level at ANCE FROM LIFT STATION TO: D. ABSORPTION FIELD DATA adjacent lots tested water Date installed /a -e2- Soil rating (GPD/Ft) 8 ._ � B.L System type -rAe,, cW Length 4-51 Width 30 Gravel thickness S Total depth S / / Total absorption area AfSa� Cleanout present ON) / Depression over field (Yo s� Date of adequacy test /-Z -/-I-? Results (pa s�da� F.�t L for 3 Bedrooms Water level in absorption field before test SS After test r/ _ eroAde treatment (past 12 months) (Y� f/ z If yes, give date _//4 ���� EPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /0V t On adjacent lots DD r Property line /,D ' To building foundation r To Asting or abandoned system on lot `l Q iJ On adjacent lots 3 � Cutbank A- Water main/service line /o 14- Surface water /o t Driveway, parking/vehicle storage area /o Curtain drain E. ENGINEER'S CERTIFICATION / certify that I have checked, verified, or conformed to all S & S ENGINEERING Signature 17034 Eagle River Lo Eagle River, Alaska 5 Engineer's Name Date HAA Fee $ o,% Date of Payment Receipt Number 72.026 (3f93)` Back J_ � 3 and HAA guidelines in effect on the date of this inspection. Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OFANCHOR AQE ' . Department of Health & Human ervices�',' DIVISION [}FENVIRONMENTAL RV10ES� ~_—~ 343^4744 ' CERTIFICATE OFINSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING � Parcel |.O.# I 7 H/\A# ^ 1. GENERAL INFORMATION (Must bacompleted prior t0submittal) (a) Legal Description (include lot, block, subdivision, section, township,range) � Location (address ordirections) ixf ~ �����` ', �:i^,�'� ' ' .... � .� (b) Property owner Mailing Address (o)Lending Institution�Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone '�� ` (o) k4ai|the HAA tothe fn||ovvingaddress: (or check hor-�/��ifho|dfurpiokupj List contact person and day phone nunoberbo|nvv ' 2.TYPE <3FRESIDENCE Single-Famllyx Number of bedrooms� 3. WATER SUPPLY Individual Well)� Community El Public F1 Note: |fcommunity well system, must have written confirmation from the Department o@Environmental Conservation attesting tothlegality undotatuu 4.SEWAGE DISPOSAL �� On-site w,� Public Community Holding Tank [] Note: |fcommunity well system, must have written confirmation from the StatnDepa�nnentofEnw/Vnmnenta| Conaorvudonattesting 1uthe legality and status. ^` � /, Z to Z a6ed M308 (SOIL -8m9Uo-ZL -�JOM s,J98u!6ua !euo!ssatoid eql ui suoissiwojoslaiaaolapsuodsaajou s!a6ejoyouylol!!ed!o!unVqeqj_'panss!s!aleog!lmeaaolagelepez(!euejo suogoadsu! Ion puoolouOpSHHdtoseaAo!dw3sluewejinbeialelspueiejapalupliao pilesoliapiouisuoilnigsui 6u!pual u!ayl pus savoy to sieseyoand of (salanoo ase s!yl saop SHHO ayl "e�!seiy to alelS ayl u! paJals!68a jeaw6ue !euo!ssatad luepuedepu! us Aq anoge g 4de.i6eied u! uaA!6 suogeluesaidej ayl uodn 6!uo paseq paleo!tuao !enoiddV Al!aoylny yl!eaH sanss! (SHHG) sao!AJOS uewnH pue ylleaH to luawpedaQ obeaoyouy to Aplud!o!un W ay1 lenoaddy !euogipuoo to swia1 !euog!puoO panoaddmC] ,; panaddy also —" , Aq swoojpaq Jot panojddy IVAOHddV SHHO '9 jo- I'J1 'ON leas s,j9au!6u3 / «.... ....... a'� y b O / Z also ' 1'J 5 a'1 1 w S sseipp`d euoydele.L '"?I -i (`t -q —b�-1 1 M A WJ!d to aweN •uogoadsui s!yl to alep ayl uo loatta ui suolle!n6ai pue 'saoueu!pio 'sepoo alsiS pue !ed!ownW Ile yl!M eoue!idwoo ui s! wals (s !esods!p aaleMalseM ao/pue Alddns aalem el!s-uo ayl 'uogoadsui pue uo!le6!is9nui Aw woat pus sa!!l ebeaoyouy to Apled!o!unW eyl woaj peu!elgo uoilewiotu! ayl uo paseq ley! AliJaA jaylanl ! "u!aaay paleo!pui amlonils to ad (l pue swooapaq to aagwnu ayl aol alenbaps pus !euo!lount aces s! wals(s !esodsip ialemalseM ao/pue (!ddns jaleM al!s-uo eql leyl smogs lenoaddy Al!joylny yl!eaH s!yl to u01Ie61iSOAUi Aw ley! Al!JaA ! 'Molaq uMoys alep uogep! len ayl to se pue olajay paxgle leas Cw (q pag!pao sy NOIIVWHOdNI (INV V1V0 `HOHV3S 3lld'S1831'SNOI1OUSNI JNIOIAOHd MIA ONIH33NION3 '9 m7i=f a MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 V.ru -31L -23 ET Legal Description: LOT (r 14N 7 ii_fU 0 go Co (R_"% (...4yc l2 L Well Classification L �l t%i�-r If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) _y_ Date Completed It /B Yield Total Depth Z -4:i' Cased to Ilk"K Depth of Grouting J4 . 1(_ Static Water Level ll3 t-`1% i'7 ^ Pump Set At Casing Height Above Ground jiu Sanitary Seal on Casing (Y/N) YDS Electrical Wiring in Conduit (Y/N) %&� Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: r To Septic/Holding Tank on Lot 1$0' N O ; On Adjoining Lots 7 1 Ir To Nearest Edge of Absorption Field on Lot i Sdr i ; On Adjoining Lots 7 1 'Lr To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot To Nearest Public Sewer Cleanout/Manhole - Water Sample Collected by >�N r `�- - ; Date 1-3 t'1 Water Sample Test Results 5 i -,4!:i nr Comments C011.0,.01153 =D -N a B. SEPTIC/HOLDING TANK DATA Date Installed 11 Z Size1 ow_No. of Compartments 7 - Standpipes (Y/N) YEl Air -tight Caps (Y/N) Y&Foundation Cleanout (Y/N) ':F*s Depression over Tank (Y/N) N 0 Date Last Pumped 2- 11-111 (SIL Pumping/Maintenance Contact on File (Y/N) for NIA Holding Tank High -Water Alarm (Y/N) IV _1A Temporary Holding Tank Permit (Y/N) N�fJ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well ( 4t)'f I To Building Foundation SG To Property Line _6 It To Water Main/Service Line N (A To Stream, Pond, Lake or Major Drainage Course Comments To Disposal Field 72-026 Rev. 7/Ba) Front Page 1 of 2 NI(q I C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 8S Type of System Design Date Installed 124 YZ- Length of Field 1 ' u Width of Field 30 Depth of Field Gravel Bed Thickness J Square Feet of Absortion Area *Sb Statndpipes Present (Y/N) YDS Depression over Field (Y/N) N Date of Last Adequacy Test 1-3 t 'y t Results of Last Adequacy Test S t S egG vkey SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well /J-0 �'f To Property Line / f To Building Foundation 6 G � To Existing or Abandoned System on Lot N id ; On Adjoining Lots 7 -� To Water Main/Service Line iJ / A To Cutback (if present) Nun G To Stream, Pond, Lake, or Major Drainage Course AJ (A To Driveway, Parking Area, or Vehicle Storage Area /0 Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Cod Comments Dimensions Manhole/Access (WN)' _ .'Pump bff" Level at "Check Permitted Bedroom Rating Against HAA Request" Vent(Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. SignedOF Company KN i rrt=G—� L�'G�NeCA,.it, ®P��Ac %P Date 2- U - MOA No. GE -Yd —O3y Receipt No. o S - Date of Payment .7--11-91 Amount: $ 176, Receipt No, Waiver Fee: p Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 :al J WALTER J. HICKEL, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 563-6775 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 R E C E D E D April 15, 1991 Ms. Linda Bridgman APR 7 6 19;,1 10980 Corrie Way Mui' � r» ; y or Anchorage Eagle River, Alaska 99577 Dept, yealth & Yuman Services RE: Lot 21, Highland Terrace #3, Eagle River, Alaska, ADEC Project Numbers 9121 - WW -060 and 9121 -DW -060; Review Dear Ms. Bridgman: This is in response to your submittal, received in this office on April 12, 1991, in which you requested approval for the on-site water and wastewater disposal systems located on the above -referenced lot dues to the proposed change from a single family residence to a Bed and Breakfast. I have completed my review of the submitted information and have the following comments. WASTEWATER DISPOSAL SYSTEM The submitted information it appears that the wastewater disposal system was installed substantially in accordance with State regulations and guidelines at the time. The results of two adequacy tests also verifies that on the day the adequacy tests were performed the wastewater disposal system was accepting the necessary flows. In addition, there will not be an increase in the volume of wastewater being treated and disposal by the existing wastewater disposal system due to the change from a single family residence to a bed and breakfast. Therefore, the wastewater disposal system is approved for the concerns of this Department. The enclosed signed Approval of On -Site Residential Water and Sewer Systems, constituting this approval, is enclosed for the existing wastewater disposal system. DRINKING WATER SUPPLY SYSTEM From the information that has been submitted, it appears that the water system was installed substantially in accordance with State regulations and guidelines for public water systems at the time. Including the fact that there will not be an increased in the peak flow demand placed on the existing water system resulting from the change (going from serving a single family residence to a two bedroom bed and breakfast) and the analytical results for Total Coliform Bacteria and Nitrate (as nitrogen) returned satisfactory, the water system is approved for the concerns of this Department. The Final Operation Certificate, constituting this approval, is enclosed for the existing Class C Public Water System. At this time, the Department is assigning Public Water System Identification (PWSID) Numbers to all Public Water Systems in the State. As a result, the PWSID Number assigned to this system is 217013. The present State Drinking Water Regulations do not require any routine water sampling for Class C Public Water Systems; however, I recommend that you have water samples analyzed for Total Coliform Bacteria and Nitrate (as nitrogen) once a year during the month of May. If you do sample, please place the assigned PWSID Number on the lad request form so the results will be credited to proper file. Thank you for your cooperation with this Department. If you have any questions, please do not hesitate to call. Sincerely, Keven K. Kleweno Environmental Engineer Enclosure: As Stated cc: John Smith, DHHS, w/o Enc. KKK/skpf MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) �07 aP Z!<tie✓ Location (address or directions) �c l.E !t a ✓C/1 (b) Applicant Name irks A4 y' Telephone: Home Business Applicant Address 'e0A J3 13 �4 k ye, dlfr 9SS'77 (c) Applicant is (check one): Lending Institution ❑ ; Ownerlbuilderx; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution /_Z ­2r Telephone `I Address &I, � " 'C? /cJy 4 (e) Real Estate Company and Agent Address Telephone (f) Mail the yHyAA to the following address: /' . c -or s„ ' , e :v /; 2. TYPE OF RESIDENCE Single-FamilYX Multi -Family ❑ Other Number of Bedrooms --3- 3. 3 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) Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025(11,8°) 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 State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ..� (l F lelVc� €NGlN€€RiWG &fRV!£ES Telephone Address EAGLE RIVER, AN 99577 P. .BOX 773294 Date � 6-94 5193 !Dais A. 3o4zra p° QS Engineer's Seal CE -6736 "as. ewoe°" ;RDFESStdP® DHEP APPROVAL Approved forbedrooms by ate Approved __._—__ Disapproved Conditional Terms of Conditional Approval I I I I, I I CAUTION The Municipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph S 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 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Lc � / %; aC A.a %Crrtt tt� Legal Description: ,� � T / v r✓ /2 ♦ 4✓ .rem k - A. WELL DATA Well Classification 'eor Wa If A, LB, C,, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Yield Total Depth `/ S z Cased to 15 a-2—Depth of Grouting �V14 Static Water Level ] Pump Set At -7 Casing Height Above Ground a Sanitary Seal on Casing (Y/N) — Electrical Wiring in Conduit (Y/N) i Depression Around Wellhead (Y/N Separation Distances from Well: .2 c- 41 N To Septic/Holding Tank on Lot foo r On Adjoining Lots BOO r To Nearest Edge of Absorption Field on Lot 60 T ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole �/� z To Nearest Sewer Service Line on Lot a 5 - Water Water Sample Collected by ; Date y/ a5 - Water Sample Test Results S`-A'r'%`-06"y Comments B. SEPTIC/HOLDING TANK DATA Date Installed 19�� Size ���� G'I No. of Compartments fR Standpipes (Y/N) ly Air -tight Caps (Y/N) ly Foundation Cleanout (Y/N) y Depression over Tank (Y/N) %t% Date Last Pumped "`"e /9&4- Pumping/Maintenance Contract on File (Y/N) y1_4 ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well — %6o y To Building Foundation z To Property Line /0r To Water Main/Service Line Course Comments To Disposal Field Page1of2 (/C,3c4�)(� OAC, 72-026(11/84) To Stream, Pond, Lake, or Major Drainage 0 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /5S- 2 Width of Field 3D F.S_ r 0 Type of System Design Length of Field -,Y, Depth of Field _> Gravel Bed Thickness S re° c k Square Feet of Absorption Area y5 a Standpipes Present (Y/N) k Depression over Field (Y/N) A) Date of Last Adequacy Test - T74 -e /5�S Results of Last Adequacy Test SS *rr 1"44Y'or y �.- 3 Separation Distance from Absorption Field: To Water -Supply Well /G O 7' To Property Line To Building Foundation BOO To Existing or Abandoned System on Lot /+Joz 2 On Adjoining Lots 2, To Water Main/Service Line /fl ` To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course Hca, To Driveway, Parking Area, or Vehicle Storage Area /d Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) — 'Pump Off' Level at — Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA " Check Permitted Bedroom Rating Against HAA Request °' I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date G�S -/.-t Company MOA No. S T- Q C S - Receipt No.® �� 44eet9 Date of Payment r 1 Amount: $ ee, � � Engineer's Seal �a m•msa•mo aammmyy.. m A • F ®t : Louis A. Butera J, oma CE -6736 Page 2 of 2 tm�,n,° 72-826 (11/84) Time APPLI(WT FILLS OUT UPPER HA ONLY Time �. Prcl v,ty Owner _ I j- jai _ ( /(, _,--�'�"1 Phone Mailing Address. ;J/,. � � ( ) _ -„ f�l�i Zip Code 1 -,._ ,-� (,1 i _.. Buyer Inspector Inspector Inspector D, cl (cl Address Zip Code Lending Institution -. Phone D:,C' p . ENVIR-I 4 L-UION Address ��. /�� , { Zip Code Realty Co. & Agent Phone Address RECEIVED Zip Code Legal Description LGam' Street Location DATE Type of Residence Single Family �) Multiple Family No. of Bedrooms ---,J ❑ Other Water Supply �� l Date Sewer Installed Well To Absorption Area/ 111�1,Individual - 'Community 1 i_�t` � 1 L`7,r 7r ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. LJ ) ri /�"t n. � For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal L�Indivldual,'_l FF Year Individual Installed:'�`� -� ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time �. C� !� Date Date Date Date Inspector Inspector Inspector Inspector D, cl (cl Field Notes:/' 6G--fla a N , ilo'!! i�1't O�- MUNICIPALITY OF ANCHORAGE D:,C' p . ENVIR-I 4 L-UION RECEIVED ( ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( j ) CONDITIONAL APPROVAL' DATE Soils Rating Date Sewer Installed Well To Absorption Area/ Well Log Received Well to Tank Septic Tank Size 72023(3/@) October 27, 1982 Gus and Carol Gustafson 8011 Northwind Anchorage, AK 99504 Subject: Lot 21 Highland Terrace 03 Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: ° The top of the well casing should be sealed so that it is water tight. Exposed electrical wires to the well head are in violation of the Municipality of Anchorage codes and must be encased in conduit. ° The water analysis report needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. 'A permit will need to be issued for your water well. Please notify this Department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, RP208/p/EH Robert C. Pratt Associate Environmental Specialist caw , C, l f -e"- 4' e I<-