HomeMy WebLinkAboutFOX HILL BLK 1 LT 2Fox Hill
Block 1
Lot 2
#051-073-20
Permit Number
municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program, 4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.sk.us (907) 343-7904
On -Site Wastewater Disposal System and/or Well Inspection Report
SW050320 PID Number. 051-073-20
Name;
DENYSE BROWN
't! �..
A E
Page 1 of 3
WastAwatar Rve:fam. h ki--. er n_
Addrne:
21627 WOODCLIFF DRIVE • CHUGIAK, AK 99567 ABSORPTION FIELD
Phone: No. of Bedrooms:
(907) 360-6781 3 L1Deep Trench OShcltaw Tmmh NOW GYound ti ONer
LEGAL DESCRIPTION see
Taw
b/ dad"
aDepth ham e°"" e'
0.4 apo/sock.a R
6 sjon;HIL
SEE AWG. R
Depth m e1p, eotlan f ae enpnal wadi
t FOX SEE DWG.
a1m,l depth bomu pip.
R
TownehiP: — Range: — Section: A Md,d essw pig' ereeu
0.5+ R
Pew wgft.
SEE DWG. R
52 pt
WELL:saw ekuu
❑ New ❑ Upgrade 24
Hur Mr er u.« aM.a e.t,.a sac
R
ciee�pnw+. A,e.0 : YOUa,PU: Cad To. Taftl aesorpaa end;
4 6
R'
papa nnaWl,F.
Neon. R 1248 sa R
D 3034/ F-810/ SCH 40 PVC.
swan watw le ak MtO1,r:
GEG, Ltd.
a�
�X�S��N pR
1:51 —11 /3/2005
rma pump So Aa COWW HOW4 Aeaw 0nwwo
ON fti ftl TANK
ce Water
SEPARATION DISTANCES I tfs,atte 1`11MRnn aerrn
To
SepUe
Absorption
UTt
Holdlnp /prhab HO1"'tOCt"'n
Y VU O!
c,pwp. M M
Tank
rl.ld
StcUon
Tank s.a.. ta.. ANCHORAGE TANK
1250
100'+
100+
100'+
— 25'+STEEL2
rLot
ce Water
100'+
100'+
100'+
— — LIFT STATION
ns
5'+
10'+
5'+—
— X12
0 ANCHORAGE TANK ORENCO SYSTEMS
Foundation
5'+
10'1
5'+
— ,a kw au st` e°t" w°"" at:
41" 41" 45"
Curtain Drain
N/A
20'+
N/A
— 25'+ Hery) MOYe "°"� °ice erp.atwr WftffAd
i20 OSI 05 HHF RISING SON
BENCH MARK
I ABANDONED PER UPC. BOTTOM SOF SIDING ON BAY WINDOW
I THE ORIGINAL BED ELEVATION. I
Inspections performed by: GEG, Ltd. Dates: 1st 10/31/2005(
2nd. 11/1/2005
A ^ 3rd 11/3/2005
Development
Reviewed and approved
(e«. 12/01)
ENathEE"
PERUrTNUMBER: AS -BUILT DRAWING PARCEL NUMBER:
SW0
SW050320 051-073-20
STI
47.95
58.93
ST2
50.93
64.77
Mill
51.88
66.44
MT1
68.61
81.40
MT2
88.26
95.94
MT3
88.33
76.98
MT4
73.04
I59.78
\O
Q
\\\ \ EXISTING A
♦ WELL
LAS
\,
NEW 1250
S.T.E.P.
/ / 1
/ 1
EXISTING CURTAIN
DRAIN LOCATION
PER IS DESIGN
DOCUMENTS
\
I �
I \
1 LTi 1 \\�
1 1
1
I 1 1 \
\ 1 1 1 \
\
1 1 j� \�
I J
1 �(TS T \
NEW REBUILT DRAINFIELD. THE I
DISTRIBUTION UNE IS 1.25
MCH PVC w/1/8 INCH HOLES 1
SPACED 33 INCHES ON '
CENTER. (18 HOLES PER
IATERAL/72 HOLES TOTAL)
9wi w
GARNESS ENGINEER CONSULTANTS & GENERALANG GROUP, Ltd. - 7
p....:........ ..........
=I c Vo NWA wart 101 . NSDOW[ M M.D) . w 007)Wf im • .alt O )r " . w o..pw_ynrM�r.
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: •• •• •• •••••• •••........
DENYSE BROWN 360-6781 2 OF 3 DO p J f rey amess..
LEGAL DESCRIPTION: DRAWN BY:
FOX HILL S/D; LOT 1. BLOCK 2. C.J.G. D /• ' G/,7�QS' c���o
TYPE OF WORK: DATE*• 'orofesslo
AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE 1 11/7/2005
PERMITNUMBER: AS -BUILT DRAWING PARCEL IDNUMBER:
SW0 -
SW050320 051-073-20
FINAL GRADE
- 99.69+ TOP OF MANHOLE
TOP OF TANK ST1 ST2 MH - 100.02 (AVG.)
AT INLET - 95.69-\�- TOP OF TANK
/ AT OUTLET - 95.65
INVERT OF
AT INLET -
FINAL GRADE
- 104.12+
TOP OF SAND -
101.01 (AVG.) -
NEW 1250 GALLON
S.T.E.P. TANK
NOTE EXCAVATION WAS LIMITED TO THE
REMOVAL OF ALL CONTAMINATED SAND. THE
BED WAS REBUILT ABOVE -5-6' HIGHER
TWIN THE EXISTING 80 ELEVATION.
FABRIC
INVERT OF DISTIBUTION UNE - 101.52
(AVG.) THE DISTRIBUTION LINE IS 1.25
INCH PVC W/ 1/8 INCH HOLES
SPACED 33 INCHES ON CENTER. (18
HOLES PER LATERAL/72 HOLES TOTAL)
= a�
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS GENERALCONTRACTORS
1101 L TAM VOM. O 101 MOAMOL Mf OMOI MOI[ (0p/)111-0110 • 011 (f01A3 "
PREPARED FOR: PHONE NUMBER: PACE NUMBER:
DENYSE BROWN 360-6781 3 OF 3
LEGAL DESCRIPTION: DRAWN BY:
FOXHILL SUBDIVISION. LOT 2. BLOCK 1,1 1 C.J.C.
TYPE OF WORK: I DATE
OF SEPTIC SYTEM UPGRADE 1 11
A. amens;'
07 2005 11:57HM HP LRSERJET FR%
622-6777
A�!I,I Rising Son Electric. Inc.
r
>, 14916 \Voo&and Drive
P—agle River, AIC 99577
(907) 622-6777
November 7, 2005
Gamess Engineering Group
3701 E. Tudor Road, Ste. #101
Anchorage, AK 99507
Re: Lot 2 Block 1 Foxhill - 21627 Woodcliff Drive
Dear Jeff:
The lift station at the above referenced property has been wired in accordance with NEC
and State/Local codes.
Thank you.
Sincerely,
Kevin S. Hombuckle, Owner
Administrator License Number 1284
Specialty Contractor License Number 27285
P.1
Permit Number: SW050320
MUNICIPALITY OFANCHORAGE
Development Services Department
On -Site Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Aug 25, 2005
Expiration Date: Aug 25, 2006
Parcel ID: 051-073-20
Legal Description: FOX HILL BLK 1 LT 2
Design Engineer: 0855 Gamess Engineering Group, LTD Site Address: 021627 WOODCLIFF DR
Owner Name: DENYSE BROWN Lot Size: 40001 SO. FT.
Owner Address: 21627 WOODCLIFF DRIVE Total Bedrooms: 3 Permit Bedrooms: 3
CHUGIAK . AK 99567 -
This permit is for the construction of:
❑✓ Disposal Field [D Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Date:
Issued By: (_ �f I I - Date: 5- 40
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water 8 Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.cl.anchorage.ek.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcell.D. b51-h_'�U Permit Number
Property owner(s) DENYSE BROWN Day phone 360-6781
Mailing address (1) 21627 WQQQQl IFF QRrVE * CHUGLAK- AK.
Mailing address (2) Zip Code 99567
Legal description (Lot, Block & Sub'd.) LOT 2. ROCK 1- FOXHILL SI ROMSON
Legal description (Section, Township & Range) N/A
Lot Size 46+ D01 Acr Sq.Ft. Number of Bedrooms 3
THIS APPLICATION IS FOR:
Sewer Only ❑ Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade E
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
certify that the above Information Is correct. I further certify that this application is being made fora
Single Family Dwelling and is in accordance with applicable Municipal codes.
GARNESS ENGINEERING GROUP, Ltd.
Permit Fees: 4(00
Date of Payment: Q' )3 `0�;
Waiver Fees,
Date of Payment:
Receipt Number: -%---�OnReceiptNumber:
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS
August 22, 2005
Municipality of Anchorage
Development Service Department
Onsite Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650,
Anchorage, Ak 99519-6650
(907)343-7904
Ref: Proposed Septic System Upgrade for Foxhill Subdivision; Lot 17, Block 2,
To whom it may concern:
The existing 3 bedroom house is served by a private well and septic system. The drainfield is currently
in the state of failure and needs to be upgraded. We are proposing that a new 1250 gallon S.T.E.P. tank
be installed. Due to the limited space on the property we are proposing to rebuild the existing mound
type drainfield. Comments regarding the design are summarized as follows:
1. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications.
2. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system.
3. TOPOGRAPHY: As can be seen on the attached design drawing the average topography in the area
of the drainfield is a 1-5 percent slope running approximately northeast to southwest. In short there are
no slope concerns.
We are unaware pf any adverse impacts this installation would have on adjacent wells or septic systems.
If you have any Aqestions, please contact us at 337-6179. Thank you for your assistance.
P.E., M.S.
NOTE: Attached is a site plan drawing, a design drawing, one soil log, which are all part of the design package jar
this septic system. (Contact C.E.C. Ltd. for 7 page construction specification letter.)
3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507
Ph: (907) 337-6179 0 Fax: (907) 338-3246 • Website: gamessengineering.com
LOT S, BLOCK 2
FOXHILL SUBONSION
I
I
I
1
\ �z
OLOT 7, BLOCK 2
fOXWLL SUBDNSION \ Q
LOT S. BLOCK 2 / •
FOXHILL SUBONSION /
LOT B, BLOCK 1
FOXHILL SUBDIVISION
LOT S, BLOCK 1
FOXHILL SUBONISION _
LOT 4, BLOCK 1
FOXHILL SUBDNSION
LOT 3, BLOCK I
FOXHILLSUBDNSION cr ACFA'
LOT Y. BLOCK 2
FOXHILL �UBDN ON 1
\\ 1
EfE1I�c AReD � � — — J
-------------J
i
CURTAIN
DRAIN
—D(=NG SEPHC
SYSTEM
1 �DtISDNC \ A'-,
/ 3 BEDROOM
HOUSE `
li LOT 1, BLtlpC 1
I FOXHILL SUB IVMON
I �
�L---------T-----
F-----------
I
/'PROPOSED SEPTIC
�/ srsrEu UPGRADE (SEE
i� DESK:N PAGE 2 OF 2)
i\
-----1— `--------------�--
GLACIER ROAD
GARNESS ENGINEERING GROUP, Ltd. ;?:'
CONSULTANTS i GENERAL CONTRACTORS ••
i c nca coa int +o� • AMDIOMOi. � uNr • na[ -cin •rout w •cane
WYARED FOR: PHONE NUMBER: PAGE NUMBER:
DENYSE BROWN 360-6781 1 OF 2 QA.e'
FOXHILL SUBDIVISION; LOT 2, BLOCK 1,
OF WORK
SITE PLAN FOR SEPTIC SYSTEM UPGRAD
IMF/. VIM)
R.A.L.
LOT 3, BLOCK 1
KUAPTON SUBDNSION
C nn AReD
LOT 7, BLOCK 1
KIMPTON SUBDNWON
C (;OTG93•' •••
7995/3
,!co4�� i
NUMBER OF BEDROOM5:3
GALLONS PER DAY (GPD): 450
PERCOLATION RATE/S: 20 MIN./INCH
PROPOSED APPLICATION RATE 0.4
MINIMUM DRAINFIELD SO.FTa 1125
IM DEPTH: *SEE NOTE
24 FEET
L•54 FEET
APPROVED SAND FILTER: *SEE NOTE
ON FACTOR N/A
SO.FL: 1298
TO OBTAIN A COPY OF THE LETTER
CONTACT CEG. BY PROCEEDING FORWARD
WITH THIS INSTALLATION. THE ENGINEER.
WELL DRILLER, CONTRACTOR AND
PROPERTY OWNER AGREE THAT THEY
HAVE READ THESE SPECIFICATIONS AND
AGREE TO ACCEPT THE TERMS AND
NOTE: EXCAVATION IS TO BE LIMITED TO
THE REMOVAL OF ALL CONTAMINATED
MATERIAL THE BED IS TO BE REBUILT TO
OR A80VE THE EXISTING ELEVATION.
NOTE: THE CONTRACTOR SHALL HAVE ALL 100
WELL RADII SHOWN FLAGGED BY A REGISTERED
LAND SURVEYOR PRIOR TO CONSTRUCTION.
\ DUSTING DRAINFIELD TO BE REBUILT TO
\ OR ABOVE EXISTING ELEVATION. THE
\ DISTRIBUTION LINES ARE TO BE 1.25 INCH
\ PVC W/ 1/18 INCH HOLES SPACED 33
\ INCHES ON CENTER. (18 HOLES PER
IATERAL/72 HOLES TOTAL)
PROPOSED
FOUNDATION
cLEANour /
EXISTING
WELL
rn /
O \
1. ;.
A
— T-1—
\ \ I 1 1250
GALLON SL.EP. TANK J /
EXISTING 1000 GALLON
\ \ / SEPTIC TANK AND 5DO
\� 1 GALLON LIFT STATION TO BE
/ COMPLETELY ABANDONED—
\\
\
' Via' , EXISTING
�
CURTAIN
DRAIN
SWAB
GARNESS ENGINEERING GROUP, Ltd.
R�*?' 4 :�I
CONSULTANTS A GENERAL CONTRACTORS �....: •• .•• •••• • .........
3101 G T0Y1 0010. MR 101 • M1010MOL M( •Y00) . NOL[ 007LII1�1T • W oa*&i •nu •
PREPARED FOR: PHONE NUMBER: PACE NUMBER: •••• •••• •••• ..... •••
DENYSE BROWN 360-6781 2 OF 3 p ' ey A. MOSS:
LEGAL DESCRIPTION: DRAWN BY: Q °a, CE 795 •' Jlt
FOXHILL SUBDIVISION; LOT 2, BLOCK 1, R.A.L . ' $T�� moo`
TYPE OF WORK: DATE s
�� dProfsssiolld�'
DESIGN FOR PROPOSED SEPTIC SYSTEM UPGRADE 8/22/2005 ��DOo�dg
A
FROM S.T.E.P. TANK
NOTE THE DISTRIBUTION LINES ARE TO BE 1.23 INCH
PVC W/ 1/15 INCH HOLES SPACED 33 INCHES ON
CENTER (18 HOLES PER LATmvn HOLES TOTAL)
MTO
MTO
THE REMOVAL OF ALL CONTAMINATED
MATERIAL REBUILD WITH SAND TO AN
EVATION EQUAL TO OR HIGHER TAN TI
NOTE THE DISTRIBUTION LINES ARE TO BE 1.25 INCH
PVC W/ 1/16 INCH HOLES SPACED 33 INCHES ON
CENTER (1E HOLES PER LATERAL/72 HOLES TOTAL)
1 2{• 1
SECTION A—A
GARNESS ENGINEERING GROUP, Ltd. ��'
CONSULTANTS i GENERAL CONTRACTORS Q•••••• •• • ......••••••
=I L TA011 0014 YR 101 • MOWYF SII MW, • r1C1t 00)W- tft • W .907AM- " • .00Rl wa�•,�•p•w�F�n
PREPARED FOR: PHONE NUMBER PACE NUMBER: • •• ••• •••• ......•••••
DENYSE BROWN 360-6761 3OF 3 Q rey omess.*
LEGAL DESCRIPTION: DRAWN BY: O0°O,, ' CE 795 : ' .`i
FOXHILL SUBDIVISION; LOT 2, BLOCK 1, R.A.L.ts`'Z.3��o4d�
TYPE OF WORK: OATS
PROFILE DRAWING OF PROPOSED DRAINFIELD UPGRADE 6/22/2005
(Rev. 01M)
MUNICIPALITY OF ANCHORAGE
D &RTMENT OF HEALTH AND HUMAN SEI _ES
Environmental Health Division
825 "L." Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Namc�� y
S4-SN Cir IP•1 G
J i=��i? (�
DISTANCES
'�
)0
FROM
� -
SEPTIC
TANK
_
ABSORPTION
FIELD
T
WELL
Address
WELL
�.�.�
_—L� o �_
_ C>o
Phone(s)
_�-l�
Permito.V f6-RPk_
No. of Betl ms
LOT LINE
LEGAL DESCRIPTION
Lot
Block
Subdrvrson
S�i5
FOUNDATIONt
-__
L/ C_:' "�".
`-�L —
'"--'-
Towns, Range. Section
- I
AS-BUILT DIAGRAM (Show location of well. septic system, property lines, loundabon,
driveway. water bodies, etc-)
TANKS
—
SEPTIC t_,n/Sit M ❑ HO®IN
Manulacturer in gallons
-
—
—
Matenal
jCapacity
of Compartments
TYPE OF SYSTEM �
-
--
E�,^�_
❑ TRENCH X RED ❑ W. DRAIN ❑ OTHER
Depth Io pipe bottom fon
original grade _
UP F
total depth from onginal grade
rv�+ro
ov7
S
py
—
r
1
to
67
1
r
1
-
r
i
Z
��
Fill added above original grade
n
Z illy.-Z-INSL)I_AV0NFT
---
Gravel depth beneath pipe
c9.5 FT
-
Gravel length
S FT
Gravel width
?- FT
Total absorption area
__NSQ FT
Distance between hoes
Co FT
c
7
'-�—
5b
1,
G
T
c
5 T
}
umber of ImesSorl
`/ -
rating
a SQ FT
Pipe ma(ena!
5i rh J 3r�3
Installer
Jc�. �L122.r� �QN�-'•
Date Installed
Flo
—
—
_.�=20
WELLS
—
C;J�'PRIVATE 1, 6�ST r ❑ OTHER (Identifv)
ClassiLcation (A.B.C)
- — --
1 otai Depth Cased to
- I=T FT
Ans�taller _ Dale Installed.
REMARKS:-
�o
A16 IS _ l�G/� f�G✓ Jd a t CST/N�-
r
�" /'� �y ��N • � dU- !�
2d �� l� �. w� 7e.t ��/� � f
` p
-
scaleri
: c S 1
inspectionssPPeriiormed by.
ENGINEERS SEAL
_
Date ,216
inspection was perforl Ied according In allns
� d
Date.
IvIf _�Z.Ly,
S & S ENORAWERING
•— — ceriily [hat this
�� ��
Municipal a¢S� laalee urR B d eelineessiin effect this
yonV09
L� IIAI�j Eh`ir I91Health Department Appro_�
lF A LIFT STAiION IS INSTALLED IN AN AREA COVERED BY MOA 8UILDIHG CODES,
THEN (1) AN EL T AND INSPECTION MUST 8E OBTAINED; (2) AS�BUILTS
W�LL NOT BE Zri
W AN ELECTRICAL INSPECTION �EPORT; AND (3> THE
ISSUED
---l/---`-`-~--~�~-----------��~~~~~
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DATE:
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°
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�i k��� i�
DEPART�E�T ' HEALTH AND EN�lRONMENTAL 'RO|ECTION
825 L STkEET, ANCHORASE, AK 99501
264-4720
�N if��'
PB�MIT
NO:
860411 UPGRADE
DATE
lSSUED:
11/04/U6
APPLICANT:
BR�CE PHAU
ADDRESS:
C/U S&S ENGINEERING
EAGLE RIVER, AK 99577
CONTAC7
PHONE:
694-2979
LEGAL
DESCRIP:
SUBDIVISION: FOXHILLBLOCK:
1
SECTION: 4 TOWNSHIP: 15N RANGE: 1W
LO�
SIZE:
40�01 (SQ.Fl. OR ACRES>
l certi�y
that:
/ami1iar
in! Lhe requirements [nr on�site sewers and wells
as set
forth by
the Municipa1ity o[ Anchorage (MOA) and the State of
Alaska.
2.
I will instal�
Lhe system in accordance with all MOA codes and
regulations,
and in compliance
wiLh the design criteria o� this permit.
3.
l �i�l adhere
to all MOA and State o� Alaska requirements �or
the set back
distances
>rom any existing well, wastewater disposal system
or �:blic
sewerage
system on this or any adjacent or nearby lot.
lF A LIFT STAiION IS INSTALLED IN AN AREA COVERED BY MOA 8UILDIHG CODES,
THEN (1) AN EL T AND INSPECTION MUST 8E OBTAINED; (2) AS�BUILTS
W�LL NOT BE Zri
W AN ELECTRICAL INSPECTION �EPORT; AND (3> THE
ISSUED
---l/---`-`-~--~�~-----------��~~~~~
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o ,~�
DATE:
V��/�=^� ��^� �
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Municipality of Anchoracie
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502.-0650 � #wtwt A. 5hwh
SOILS LOG - PERCOLATION TEST j
PERFORMED FOR: DATE •E' �� °Gi-C/� DATE PERFORMED:
LEGAL DESCRIPTION: 1—.2 /J =o>'<H1!l Tovw
DEPTH
(f'E Ef )
1 c j'
2
,3
4 ,(C �.
5 /fit
6
7 G
(� ti
8
9
10
11
12
13
14
15
16
17
18
19-
20-
COMMENTS
920COMMENTS —
nship, Range, Se
SLOPE
WAS GROUND WATER
SITE PLAN
ENCOUNTERED?��
S
IF YES, AT WHAT L
DEPTH?3 O
9,6W E 4 /4
Depth to Water After 3 ,)
Monitoring? Date:
Reading Date Gross
Time
Net Depth to Net
Time Water Drop
ULI�
�
-tZ
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
6"
TEST RUN BETWEEN _ FT AND 2-- FT
PERFORMED B� Vj..,R' AK 9977 CERTIFY THAT THS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDEL EFFECT ON THIS DATE, DATE: L� ✓� ��
72-008 (Rev. 4/85)
o Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L-" Street, Anchorage, Alaska 99502-0650
SOILS LOG ® PERCOLATION `PEST
PERFORMED FOR:T 0/
LEGAL DESCRIPTION: G 2
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
(C'
G DATE PER
c. Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED? {/
r7 IJV, IF YES, AT WHAT
DEPTH?
Depth to 1 Wale All �dJ Monileflhi — Date
Q
d
J�
INC
O
P
E
ltA6
TE PLAN
N
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
1
//zz A
7' "
a
to
vl
t
w
' to
to 1•
L0 c
PERCOLATION RATE (minutes/in/ch) FERC HOLE DIAMETER 161
TEST RUN BETWEEN �FT AND
i
9K 0 1 YOX
PERFORMED BY: EAGLE RIVER, AK 99577I l -o
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS
72-008 (Rev. 4185)
TE:
WAS PERFORMED IN
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYS-ORM LL INSPECTION REPORT
NAME PHONE NEW
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MAI LING AD[)R'E S
LEGAL DESCRIPTION _
LOCATION
NO. OF BEDROOMS
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No, of lines
Length of each line
Total length of lines
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0
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Absorption area(s)
OTHER
PIPE MATERIALS
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SOIL TEST RATING�-7�
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REMARKS
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❑ SOI LS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
DATE PERFORMED: 2 v
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SULLIVAN WATER `YELLS
P. O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTION
DATE, - Started Ended
PERMIT NUMBER
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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. 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 wastewaterdisposal system,is(aie)-in compliance with all applicable Municipal
and State codes; ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 *ANCHORAGE, AK, 99507
Engineer's Printed Name JEFFREY A. GARNE SS, RE. Date
Engineer's Comments:
In conducting this evaluation, GEG provided an engineering evaluation of the well and/arseplic system in accordance with Me - .��"`t��11
guidelines and regulations established by the Municipality ofAnchomge and industry practices. The reported results describe the ��.C� OF +f�
condition of the systerNs on the dates of the evaluation Separation distances were measured to me* identifiable features- `�,c A\
ar�♦♦
Hidden defects encmachmenfs may that am not idenlfred during the evaluation The operational of all wells and septic` • \r;
systems depend on a variety of variables Including but not limited to, sal conditions groundwater levels (that may fluctuate during. Ar
the year), quality of construction (materials and workmanship) and the wafer usage oflhe family utilizing the sysfenvs These Xg
conditions can very; and are outside the control of GEG. Satisfactory lest results do not guarantee future performance of the
- ...I
sysfeMs;therefore, GEG makes no wananfy(expressorimpfied) regarding the future performance of the well or septic 0 ....... ... system.' /
GEG makes no representation whether an alternative well or septic system can be insfaged on the property in the event either of the 0
current systems fart The content of this report is for the safe benefit of thepmonyany who retained GEG. Reliance upon the 0 "" '0
f r^ ? Gaines . 4r ■
information providedin this report byanyotherperson orpedg including but not limited to subsequent pmpedypumhasers,isnot �� -Cvr
amhorized.Inshort GEG disavows anyfegal duty to anyone otherthan the perso0any whopsidforthsmicort. ♦ i� CE-7 5 _:
♦�j�`�''c� )}1.61 P� ��•:
6. DSD SI/GNATURE' 4o,,ii ;S=
v
System #1Approvedfor_ bedrooms.
System #2 Approved for bedrooms.
Disapproved.
OFAN��'lir
Conditional approval for bedrooms, with the following stipulafiQ
J= ON-SITE
o TEWATER o
PROGRAM a
BYOriginal Certificate Date:
TheMunicipalityor Anchorage Develop, emt Servic6S Division (DSD) 'Issues Certificates of On-Site Systems Approval (COSA) based only
-upon the represenatations 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.: ATTCHMENTS:
COSA'Checklist Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
(Rev. 10112112)
If more than 1 septic system is on the lot:
COSA Checklist # _of
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description
FOXHILL; BLOCK 1, LOT 2
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 4/1984 Sanitary seal (Y/N) YES
Total depth 140 ft, Cased to 140 ft.
FROM WELL LOG
Date of test 4/1984
Static water level 100 ft.
Well production 30 g.p.m.
Parcel ID: 051-073-20
Well Log (Y/N). YES
Wires properly protected (YIN) YES
Casing height (above ground) 18+ in.
AT INSPECTIQN;
10/28/15
102 ft.
3.5+ g.p.m.
WATER SAMPLE RESULTS:
Coliform d coloniesl100mi. Nitrate 'mg./L. Collected by: GEG. Ltd.
Arsenic: Date of sample: 10/28/15
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material -/STEEL Date installed 10/31-11/3Z2005
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (YIN) NO High water alarm (YIN) YES
Date of pumping 10/12/2015 Pumper ONE STOP PUMPING
C. ABSORPTION FIELD DATA I*F3FLOW EXISTING GRADE"
Date installed 10/31-11/3/2oosSoil rating (g.p.d./ft`ar bdr 0_4 System type BED
Length X52. ft Width 24 ft. Gravel below pipe 0.5 ft.
Total depth *3.7 ft. Eff. absorption area `1248,ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 10/28/15 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 540 gal. New depth 3 in.
Elapsed Time: 135 min. Final fluid depth E in. Absorption rate >= 450+ gp,d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date -
mw
D. LIFT STATION *PER 11/7/05 INSPECTION REPORT FROM RISING SON ELECTRIC
Date installed 10/31-11 /3/05 Size in gallons 1250 Manhole/Access (Y/N) YES
"Pump on" level at 62 in. "Pump off' level at 62 in. High water alarm level at 60 in.
Datum TOP OF MANHOLE Cycles tested 3 Meets alarm & circuit requirements? *YES
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO
Septic tank/lift station on lot
100'+
On adjacent lots
1.00'+
Absorption field on lot
100'+
On adjacent lots
100'+
Public sewer main
75'+
Public sewer manhole/cleanout
1 OD'+
Sewer /septic service line
25'+
Holding tank
75'+
Animal containment areas
50'+
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING
TANK ON LOT TO:
Building foundation 5 +
Property line
5'+ Absorption field
5'+
Water main 10'+
Water service line
10'+ Surface water
100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+
Building foundation
10'+ Water main
10,+
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain w -W 4,Wells on adjacent lots 100'+
F. COMMENTS
*PER 1986 INSPECTION REPORT. DRAINFIELD REBUILT IN 2005
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 Pri ted Name JEFFREY A. GARNESS
Date It &/1
(Rev. 11/05)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water 8 Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
eA `v
Q� J&
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel l.D. OS` I -0�3 - a 0 COSA# H A L_)q O04 0 C,
1. GENERAL INFORMATION Expiration Date: 5- .7,
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
FOXHILL S/D: BLOCK 1, LOT 2
21627 WOODCLIFF DRIVE ' CHUGIAK. AK • 99567
BRENDAN do CODI COSTELLO Day phone 688-4960
21627 WOODCLIFF DRIVE ' CHUGIAK. AK • 99567
Day phone
JACKIE THOMSON W/ PRUDENTIAL VISTA Day phone
317-9046
16335 CENTERFIELD DRIVE ' EAGLE RIVER. AK • 99577
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
0
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
E
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
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 riles and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system fs(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations In effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, UD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines d Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily Idontifiablo features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the ownerlisted above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
S. DSD SIGNATURE
v Approved for 3 bedrooms.
Disapproved.
337-6179
Date Z U
oF At
vo `� ...... gS,4V
OSP' •' � DO
4 .I. •..*0
O P f G ness: 4
CEI— :p
QO�n � '•7;1.1'1.i3��go40
Conditional approval for bedrooms, with the fllowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
y Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
OFc,
l
•. tie,,
ON-SITE • •'.
WATERAND • m=
WASTEWATER
PROGRAM
By -0 Original Certificate Date:
JAW. AADS)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519.6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: FOX HILL SUBDIVISION; BLOCK 1, LOT 2 Parcel to:
A. WELL DATA
Well type PRNATE if A. B, or C provide PWSID# N/A
Date completed 4/1984 Sanitary seal (YIN) YES
Total depth 140.75 ft, Cased to 140.75 ft.
FROM WELL LOG
Date of test 4/1984
Static water level 100 ft.
Well Log (YIN) YES
Wires properly protected (YIN) YES
Casing height (above ground) 18+ in.
AT INSPECTION
1/30/2009
109 ff,
Well production 30 g,p,m, 5.5 g,p,m,
WATER SAMPLE RESULTS:
Coliform --k— colonies/100 ml. Nitrate )' fdS mg./L. Other bacteria colonies/100 ml.
Arsenic: MD ug./L. Date of sample: 2/2/2009 Collected by: GEG Ltd.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material S.T.E.P./STEEL
Tank size 1250 gal. Number of Compartments 2
Foundation cleanout (YIN) YES Depression over lank (YIN) NO
Date of pumping 10/2/2008
C. ABSORPTION FIELD DATA
Date installed 10/31-11/3/2005
Cleanouts (YIN) YES
High water alarm (YIN) YES
JR'S PUMPING
Date installed 10/31-11/3/2005 Soil rating (g.p.d./ff'o Ibdr 0_4 System type BED
Length 52+ ft. Width 24 ft. Gravel below pipe 0.5 ft.
Total depth•3.8-4.2 ft. Eff, absorption area 1248 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 1/30/2009 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test DRY In. Water added 660 gal. New depth DRY in,
Elapsed Time: 0 min. Final fluid depth DRY In. Absorption rate >= 450+ g.p•d,
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date
D. LIFT STATION
Date installed 10/31/2005 Size in gallons 1250 Manhole/Access (Y/N) YES
"Pump on" level at 41 in. "Pump oft" level at 41 in. High water alarm level at 45 in.
Datum BOTTOM OF TANK Cycles tested 3 Meets alarm & circuit requirements? YES
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer /septic service line 25'+
Animal containment areas 50'+
On adjacent lots 100'+
On adjacent lots
100'
Public sewer manhole/cleanout N/A
Holding tank N/A
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
10'+ Buildingfoundation 10'+ Water main N/A
Water service line 106+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain '201+ Wells on adjacent lots 100'+
F. COMMENTS
*PER 1986 DESIGN DOCUMENTS.
G. ENGINEER'S CERTIFICATION
I certify that 1 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 JEFFREY A. GARNESS
Date 2' V? /L)9
COSA Fee a N O Waiver Fee $
Date of Payment a I I V 9 Date of Payment
Receipt Numbery000-77 Receipt Number
(Rev. 11105)
Municipality of Anchorage ••,
• j Development Services Department
Building Safety Division ..
On -Site Water 8 Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ok.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. Q61— b 3 '�11 HAA# O SO S g
1. GENERAL INFORMATION Expiration Date: 2 — -7 o
Complete legal description FOX HILL SUBDIVISION• LOT 2, BLOCK 1.
Location (site address or directions) 21627 WOODCUFF DRIVE • CHUGIAK, AK 99567
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
DENYSE BROWN Day phone 360-6781
21627 WOODCLIFF DRIVE • CHUGIAK. AK 99567
Day phone
SIAN ASHCRAFT w/ PRUDENTIAL J.W. Day phone
3801 CENTERPOINT DRIVE • ANCHORAGE, AK 99504
273-7240
Unless otherwise requested, HAA will be held by DSD for pickup. ICONDITiONAL HAA 1500 TO B
PUT IN ESCROW FOR TOPSOIL
2. NUMBER OF BEDROOMS: 3 1 2006
AND RESEEDING BY JUNE 15TH
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
Individual On-site
E
Individual Holding tank
❑
Community On-site
❑
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 Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid
water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's
work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seat axed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Hoafth Authority Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
Information obtained from the Municipality of Anchorage riles 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 GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, Ltd. attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily Identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG. Ltd. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report Is for
the sole benefit of the owner listed above. Any reliance upon or use of this repot by any
other person or party is not authorized, nor will It confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for :3 bedrooms.
Disapproved.
Phone 337-6179
Date fl I
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist ✓
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
10 F
0F�r;ir.
ON-SITE_
WASTEWATER t..'—
By: i 94 /_ Original Certificate Date: //— 14 — O "6--
(R".
tRw. iw+l
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water 6 Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. ��I -D`�3 w HAA# 05-0607
1. GENERAL INFORMATION Expiration Date: 2/71ab
Complete legal description FOX HILL SUBDMSION• LOT 2. BLOCK 1.
Location (site address or directions) 21627 WOODCLIFF DRIVE * CHUGIAK, AK 99567
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
DENYSE BROWN Day phone 360-6781
21627 WOODCLIFF DRIVE ' CHUGIAK. AK 99567
Day phone
SUW ASHCRAFT w/ PRUDENTIAL J.W. Day phone
3801 CENTERPOINT DRIVE ' ANCHORAGE, AK 99504
273-7240
Unless otherwise requested, HAA will be held by DSD for pickup. CONDITIONAL HAA. DRAINFIELD
ITO BE TOPSOILED AND SEEDE
2. NUMBER OF BEDROOMS: 3 IN SPRING SUMMER OF 2006
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
Individual On-site
Individual Holding tank
❑
Community On-site
❑
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 Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid
water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
IV
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, f vgrify that my
investigat/64 based on procedures outlined In the Health Authority Approval GuidelineWor this application,
showsjhAt the on-site water supply and/or wastewater disposal system Is(are) safe, functidhaLend adequate
f0f the number of bedrooms and type of structure indicated herein. I further verify that based on ke
formation obtained from the Municipality of Anchorage riles 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 GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507
Engineers Printed Name JEFFREY A. GARNESS, P.E.
Engineers Comments:
In conducting this evaluation, GEG, Ltd. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the lest, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwaterlevels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will R confer any legal right whatsoever.
5. DSD SIGNATURE
By:
Approved for bedrooms.
Disapproved.
Phone 337-6179
Date (1 17 PS -
Mai 11,
-X Conditional approval for a_ bedrooms, with the following stipulations:
Memey im the amieumt of 1.5 times the high bid of a inimisruin of three b4i from at'Froved
contractors shall be port in escrow for b" topsoil & seeding to be completed no Inter than
June 15, 2005. Money in escrow shall not be released until this office has given final
approval.
Attachments:
HAA Checklist Maintenance I
Septic System Advisory Supplemental
Well Flow Advisory Other
��: WASERA�ER
v WPSSEWp M c
Original Certifica14 Date: PR�GRI�
%moo �'••... .•�y\��.
Municipality of Anchorage
Development Services Department
Budding Safety Division
On-Ske Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 19WW Anchorage, AK 995190850
www.ci.enchorage.ak.us
(907)343.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: FOX HILL SUBDIVISION: LOT 2, BLOCK 1. Parcel ID: 05-1-0 73 -9.0
A. WELL DATA
Well type PR ATE If A. B, or C provide PWSID# N/A
Date completed 4/1984 Sanitary seal (Y/N) YES
Total depth 140.75 ft. Cased to 140.75 ft.
FROM WELL LOG
Date of test 4/1984
Static water level 100 ft.
Well production 30 —
g -p.m -WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate 0.477 mg./L.
Well Log (YM) YES
Wires property protected (YIN) YES
Casing height (above ground) 18+ in.
AT INSPECTION
7/25/2005
107 ft.
5.26 g.p.m.
Other bacteria 0 oo►onies/100 ml.
Arsenic: N/A mg./L. Date of sample: 10/7/2005 Collected by: GEG. Ltd.
B. SEPTIC/HOLDING TANK DATA
TankType/Material STEEL/S.T.E.P. Date installed 10/31-11/3/2005
Tank size 1250 gal. Number of Compartments 3
Foundation cleanout (Y/N) YES Depression over tank (YIN) NO
Date of pumping NEW Pumper
C. ABSORPTION FIELD DATA
Cleanouts (Y/N) YES
High water alarm (Y/N) YES
Date installed 10/31-11/3Z2 Sod rating (g.p.d.lft'or® 0_4 System type BED
Length 52+ ft. Width 24 ft. Gravel below pipe 0.5 ft.
Total depth 03.11 ft. Eff. absorption area 1248 ft' Monitoring tube YES Depression over field NO
Date of adequacy test NEW Results (Pass/Fail) - For 3 bedrooms
Fluid depth in absorption field before test = In. Water added =gal. New depth =in.
Elapsed Time: = min. Final fluid depth = in. Absorption rate >= - g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) - If yes, give date -
D. LIFT STATION
Date installed 10/31/2005 Size in gallons 1250 Manhole/Access (Y/N) YES
"Pump on" level at 41 in. "Pump ofP level at 41 in. High water alarm level at 45 in.
Datum Cycles tested NEW Meets alarm 8 circuit requirements? YES
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tanklidt station on lot 1009+
Absorption field on lot 100'+
Public sewer main N/A
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Sewer /septic service line 25'+ Holding tank N/A
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain 20'+ Wells on adjacent kits 100'+
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 WAA guidelines in effect on this date.
......
y mass.-
Engineer's Printed Name JEFFREY A. GARNESS' , CE -79//53
Date f1 -7/05— .seP,o�,lp� Fo
HAA Fee $ M f
Date of Payment
Receipt Number
(Rev. 12101)
Waiver Fee $
Date of Payment
Receipt Number
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Municipality of Anchorage
Development Services Department : ; n ►°:
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www907) 343-7 e.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-073-20 HAA# IJ#oz;oo& 7
1. GENERAL INFORMATION Expiration Date: '.47- z 3
Complete legal description FOX HILL SUBDIVISION; LOT 2, BLOCK 1,
Location (site address or directions) 21627 WOODCLIFF DRIVE s CHUGIAK, AK 99567
Current Property owner(s) JOEL & TERI LITTLE Day phone 688-4866
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
21627 WOODCLIFF DRIVE " CHUGIAK, AK 99567
Day phone
CAROL
BUTLER w/ REMAX
PROPERTIES
Day phone
Individual Water Storage
❑
2600
CORDOVA STREET +
ANCHORAGE,
AK 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
276-2761
TYPE OF WASTEWATER DISPOSAL:
Individual Well
a
Individual On-site
N
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 Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid
water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
"IV
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid S at, orprior
to closing for the engineering services provided.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. t further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone
Address 6901 DEBARR ROAD, SUITE 2B *_ANCHORAGE, AK 99504
Engineer's Printed Name
Engineer's Comments:
JEFFREY A. GARNESS, P.E.
In conducting this evaluation, AKWWC, inc. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. AKWWC, Inc. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
___fes Approved for 3 bedrooms.
Disapproved.
337-6179
Date i D
Conditional approval for bedrooms, with the fllowing stipulations:
41
FRO - V
Attachments: ��C��'•.• .•'••G�`
HAA Checklist Manitenance Agreements
Septic System Advisory Supplemental Engineer's Reort
Well Flow Advisory
Other
l -J. 0 — Original Certificate Date: 1_03
('5�
(Rev. 12101)
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 89519,6650
www.danchorage.ek.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Desctiption: FOX HILL SUBDIVISION, LOT 2. BLOCK 1. Parcel ID: 051-073-20
A. WELi. DATA.
Well type PRE3 It A. B, or C provide PWSiD# N/A Well Log (YM) YES
Date completed 4/1984 Sanitary seal (YM) YES Wires properly protected (YM) YES
Total depth14. D.75 ft. Cased to 140.75 ft. Casing height (above ground) 18+ in.
FROM WELL LOG AT INSPECTION
Date of test 4/1984 2/3[2003
Static water level 100 ft. 108 ft.
Well production 30 g.p.m. 5.76 g,p,m,
WATER SAMPLE RESULTS:
Coliforrn 0 colonies/100 mi. Nitrate, s mg./L. Other bacteria -.,0— colonies/100 mi.
Arsenic: WA mg./L. Date of sample: 2/3/2003 Collected by: AKWWC. INC.
B. SEPTIClHOLDjNG TANK DATA
Tank Type/Material STEEL Date installed 6/15/1984
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (YIN) NO High water alarm (Y/N) YES
Date of pumping 2/3/2003 Pumper CHUGACH PUMPING
C. ABSORPTION FIELD DATA
Date installed ltj�20�/10886_ Soil rating (g.p.dAiDr drm 284 System type BED
Length .� 54 ft. Width 24 ft. Gravel below pipe 0.5 ft.
Total depth •4t+ - ft. Elf. absorption area 1296 ft' Monitoring tube YES Depression over field NO
Date of adequacy test . 2/3/2003 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test'. in. Water added 720 gal. New depth 12.5 in.
Elapsed Time: 697 min. Final fluid depth 10.5 in. Absorption rate >= 450+ g,p,d,
Any rejuvenation treatment (past 12 mo.) (YM & type) NONE KNOWN If yes, give date -
**WATER LEVET. 2.64• BELOW INVERT
i,
I
D. LIFT STATION
Date installed 11 /20/1986 Size in gallons 500 Manhole/Access (Y/N) YES
"Pum on" level at38+ ~
� p min. Pump off" level at38+ — in. High water alarm level at 45+/— in.
Datum BOTTOM OF TANK Cycles tested 3 Meets alarm & circuit requirements? YES
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
j Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 1000+
Public sewer main N/A Public sewer manhole/cleanout N/A
Sewer /septic service line 25'+ Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
l Property line 10'+ Building foundation 100+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
i
Curtain drain •>30' Wells on adjacent lots 100'+
F. COMMENTS
'APER AS—BUILTS
G. ENGINEER'S CERTIFICATION OF q�U
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.
Q A amess.,
Engineer's Printed Name
+ JEFFREY A. GARNESS D�e —7953
Date 7111 'q e9 3 s .......•
Wassi0n�
HAA Fee $ 00 + 1) ,50 to U S�1 fee Waiver Fee $
Date of Payment �L, 40.3 Date of Payment
Receipt Number. 03 15%10 Receipt Number
(Rev. 12/01)
MTA OSP ENG 907 761 2646
M
CALL ON YOUR COMPANY
NON -OBJECTION TO EASEMENT
02/06 103 10:47 NO.146 01/01
By this document Matanuska Telephone Association, Inc. (Its)$'1`c ares that it has no objection to the
encroachment of a well within the platted 15' Telephoa. k Efectric Easement upon Lot 2, Block 1, Fox Hill
Subdivision, situated at 21627 Woodcliff Drive, Chugiak; Alaska.
nip
Please be advised that MTA throtYgh the issuance of this document does not forfeit any of its rights to the use
of the area cited. In the exerbnse of these rights MTA will, if needed, upgrade, maintain, repair, and/or replace
buried or aerial telecommunications facilities within the easement. Any repairs that may be required to the
encroachment as a result of utility construction will be borne by the property owner of record. This document
does not authorize the placement of any additional encroachments within the easement area.
This document is, in no way, an aloeement to vacate any portion of the utility easement and should not be
interpreted as such,
Issued for Matanuska Telephone Association, Inc. this 6t° day of February, 2003 by,
r
Real Estate & Properties Supervisor
THIS IS TO Cbumy, that on this 6th day of February, 2003, before me the undersigned, a Notary Public in and
for the State of Alaska, duly commissioned and sworn as such, personally appeared Bonnie Bailey known to
me and to me known to be the individual named in and who executed the foregoing instrument and
acknowledged to me that he signed and sealed the same as a voluntary act and decd for the uses and purposes
therein mentioned.
IN WITNE$A,Vj! jERBOF, I have hereunto set my hand and official seal
t, � ,�r�il,l
y
App✓ '!. - r •C
O
., I
1'-
NotaryoblicQnd f
' r, •,�
My commission expires:
_
GRANTOR:
Matanuska Telephone Association, Inc.
"...P.O. Box 3550
.I'a1z»ez AK;99645
ZZ,
,
r
:=
ray'
.�.:a:�.lt►j'.►S
day and year first above written.
a
Matanuska Telephone Association, Inc.
P.O. Box 3550 . Palmer, Alaska 99646-3550
1.800.746.9510 . 907.761.2510 • Fax 907.761.2646
1-24-1995 St38AM FROM
i
STATEMENT OF NON -OBJECTION FOR ENCROACHMENT i
WITHIN UTILITY EASEMENT
i
Matanuska Electric Association, Inc. (MEA) has no objection with the location of a JyjI
within the utility easement along the west boundary of the following property;
Fox Hill Subdivision, Lot 2, Block 1, Plat 83-555, Anchorage Recording District.
Situated in Section 4, Township 15 North, Range 1 West, Seward Meridian
This non -objection is granted with the full understanding and agreement by all parties
having an interest in the above property that this well encroachment will in no way
restrict or limit the current or future ability of MEA to fully enjoy the benefits of the
easement for any and all utility purposes that it presently enjoys under the easement;
This non -objection is further conditioned by the stipulation that MEA will be held
harmless from liability for any and all damages to the encroachment that may result
from the existing and future use of said easement by MEA, its contractors, successors
agents, licensees, or assigns,
t
i,
Matanuska Electric Association, Inc. ,
By: —JAJ0_
General M nager or
MEA ACKNOWLEDGMENT
STATE OF ALASKA )
) SS.
THIRD JUDICIAL DISTRICT )
The foregoing agreement was
hrwuv:3 .20p11"b yL
NO 1RRY
li'M
before me this r day of
Notary Public for
My commission e:
I
P. 1
Jan 24 03 12:51p Butler & Butler
w eCnu r_, • NO��/I
907-276-1584
/ss• YJ
aawiuw a AbbuWAT45 LAND SURVEYING 694-0829
1 HEREBY CERTIFY -THAT I HAVE SURVEYED THE SCALE:
FOLLOWING DESCRIBED PROPERTY: p' -Ae
FoY,c/[L �isC,<e�rr du / ' DATE< OF Q ��
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY GRID:. .....
EASEMENTS, COVENANTS, OR RESTRICTIONS NN/jGrB
WHICH DO NOT APPEAR ON THE P.ECORDED SUBOI- w.w. M. ► s_.. t
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB` 1 r� •. lS-e918 y
ANY DATA HEREON BE USED FOR CONSTRUCTION +1
OFFENCE LINES, OR FOR ESTABLISHING
ARY LINES. DRAWN �► -x�
oma, f .,q,,,.,•-
p.2
E
MUNICIPALITY OFANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES 1°
Division of Environmental Services
Onsite Services Section
P.O. Box 196650 Anchorape,Alaska 99519-ee50
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILLY DWELLING
Parcel I.D. #- — 051-073-20 HAA #����.r�y
1. GENERAL INFORMATION
Complete legal description -Fox HILL SUBDIVISION- LOT 2. R1 0 K 1
Location (site address or directions)21627 WOOD .I IFF STREET CHUGIAK, AK 995647
Mallingeddress clo MAMIC PROPFRTIFS
Lending agency
Mailing address
Day phone
Agent USA CONNFRS W f DYNAmic PgopirgnFs Day phone (907) 244-2013
Address 3111 •C" STREET ANCHORACF- AK 9450
Unless otherwise requested, HAA will be held for pIckup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
3
xxx
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
Ing to the legality and status of system.
72-015 (Rev. 1197) Front MOA 021 Computer version
Note: Alaska Water and Wastewater Consultants, Inc. shall be pald $1,210.00 at,
or prlor to, c/oslnq for the enc1neer1nn ,-znndl nr,,,,,,r.,.r
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below. I vorify lhat 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 typo of
structure Indicated herein. l further verify that based on the information obtained from the Municipality of
Anchoradisposal system Is ne Vies and from complianceewith Sion and ll Mun cl a and State codes ordinances land and/or
regulations Ineffecton the date of this Inspection. /
Name of Firm
Phone 07 33.7-6179
EningeersSignaturen,At C, - Date � ' N
/n conducting this evaluation, At WC, I i fe ted to provide a thorough, conscientious engineering analysis of the
systom In accordance with ADEC and o D S Guidelines & Regulallons. The reported results described the
performance of the system under the conditions Mauntered of the time of the test, and separation distances
measured to read*identlflable features. The operational Afo of all wells and septic systems depend
on the local soils condition, groundwater levels that may fluctuate during the year, and the water
usage of the famllyboing served byfhe system. These conditions are outside the control of 4doo�pp4
the evaluator oftho system. Satisfactory test results do not guarantee future performanceF 0
of the system, nor do theyguarantee that there are no hidden defects or encroachments. �' s
AMM, Inc. can therefore not pro Oda any warranty for future estimate of how long the `P
system wlil continue to meet the operational requirements of the ADEC or MDA DHHS. * �'
The content of this report is for the solo bonefit of the owner listed above. Any .. •. ....... •••
regance upon or use of this report by any other person or party Is not authorized,
nor wit itconferanylegal right whatsoever. OOp .J r Aess;
6. DHHS SIGNATURE A.
E—.
7953
Approved for_ bedrooms o4p��,,`••••.•••
— Disapproved
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
a
Date /0- Z.6-00
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 engineers work.
72-025 (Rov.1191) Back MOA //21 Compuler Version
Municipality of Anchorage RECEIVED
DEPARTMENT OF HEALTH & HUMAN SERVICE�CT 2 5 200
Environmental Services Division
825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 3434744
MUNICIPALRYOFANCH
• Health Authority Approval Checklist ENVIRONMENTAL SERVICES DIVISION
Legal Description: FOXHILL SUBDIVISION: LOT 2, BLOCK 1 Parcell.D.: •051-073-20
A. WELL DATA
Well Type PRIVATE If A. B, or C. attach ADEC letter. ADEC water syetem number_ N/A
Log present (YIN) YES Date completed 4/1984
Total depth 140'-9" Cased to 140'-9" Casing height (above ground) 1 e"+
Sanitary seal (YM) YES Wires properly protected (Y/N) YES
FROM WELL LOG
Date of test 4/1984
Static water level 100'
Well production 30 g.p,m.
WATER SAMPLE RESULTS:
AT INSPECTION
9/28/00
5.2 U.P.M.
Coliform 0 Nitrate 0.500 rna/L Other bacteria 0
Date of sample: 10/5/2000 Collected by: A.w.w.C.. INC.
B. SEPTICIHOLDING TANK DATA
Date Installed -6/15/1984 Tank size 1000 Number of Compartments 2 Cieanouts (Y/N)�1 .�
Foundation cleanout (Y/N) 'SES Depression (Y/N) NO High water alarm (Y/N) NIA-
Date
/A-Date of Pumping 9/28/00 Pumper JR'S PUMPIN
C. ABSORPTION FIELD DATA
Date Installed 11/20/1986 SoII rating(§�r f0bdrm) 284 System type BED
Length 54' Width 94' Gravel thickness below pipe 0.5' Total depth 4.5'+/—
Effective absorption area 1296 SO -Fr. Monitoring Tube present (YM) YES Depression overfleld (YM) NO
Date of adequacy test 9/28/00 Results(Pass/Fad) PASSED For 3
Bedrooms
Fluid depth In absorption field before test Qn.); 4.0" 5.0" Immediately after 765 gat. water added 0n.): 7.578.00
0"
Fluld depth 5.75"/6.5" I(Ins) Minutes later. 780 Absorption rate = 450+
Peroxide treatment (past 12 months) (YM) NONE KNOWN if yes, give date -----
72-M (Rev. 3190)' Computer version
D. LIFT STATION
Date Installed_ 11/20/1986 Size In gallons 500
Manhole/Access (YIN) YES "Pump on" level at• 38'+/— "Pump oft" level at* 38w+/—
High water alarm levet at•- 45"+/— 'Datum LO.TrOMOF TANK
Cycles tested 3
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septiclholding tank on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main N/A Publlc sewer manhole/cleanout- N/A
Sswer/septic service line 25'+ Lift station 100'+
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOTTO:
Foundation 5'+
Property line 5'+
Absorption Held
5'+
Water main/service line
10'+ Surface water/drainage 100'+
Wells on adjacent lots
100'+
SEPARATION DISTANCES
FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+
Building foundation 10'+
Water main/service line
to'+
Surface water
100'+ Driveway, parking/vehicle
storage area
25'+
Curtain draln
F. ENGINEER'S
I certify that t I
ofMunic/pal ryry
with MOA H.4
Engineer's Name
field Inspections and review
systems are In conformance
on this date.
Wells on t
ou
HAA Fee Waiver Fee $
Date of Payment a
Receipt Number 66q6B 1
72-026(Rev.9/66)• ComputerVonton
Date of Payment
Receipt Number
I I I I 1x
' w Gl.(,eUam KnameJt 688-3367
Property . owrier` Day phone _
Ma)ling address _ P.O. Box 77 1724" Baa�e. Rivet; AK 99577 `
Lending age ncy," i Day phone
Mailing address}$`
Agent _ ` Day phone
Address p h TM
a
i r r� r•131 - t r ' : I 5'MY�#G rs ^�Yd"t T 3 , �' yi'' , 3 w E "S' , } a
Unless otherwise requested„HEwil! beheld for pickup
SR-,��3"1�Yg
'':
1!
N' T.'T.fii ,
x
NUMBER OF BEDROOMS.
r'ty, e, .. e , , ,t t r
TYPE OF WATER SUPPLY: � ” � � ��'�<'
ite. r
ta
j ry J� f
l _ � ^M
Individual
n
— 1
it
r � .well ', .p
-.-. . , ..-s a 4 -... .y..
..:.. ,::
1� S,y�
. „ #,
Commurnty well
`
NOTE ;:7f community, well sysfem„ provide written, confirmation from State ADEC
attest `
00
inq to the legality and status of systema`;Y -
....
TYPE OF WASTEWATER DISPOSAL 1
f
r
NOTE If community wastewater, system, provide writte,
attesting to the legality, and status of system.
"rA �jr '72-025 (Rev.1/91) , Front - MOA #21
Y.
)State
1 confirmation -from ADEC
'':
%WM -_Q&CE-GRO
C�AV
qE
WOO,
4'4) ox
0 vvanx
for 'bedrooms
R
Irrd
o
IE 'n
24 4 A 1 — 4 JIN
T
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pp "
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WA
To
1a .";-Add itlofiALCo rn ments
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r
21
W
'"MA A OU A 110.011.
110 whic pit u1s; A
ow
A
Date
r*
o Municipality of AnchorageSim
Department of Health and Human Services t o
HEALTH AUTHORITY APPROVAL CHECKLIST
r� 0
YL1 'T
Legal Description: "r 2 tom' e c- c s o _Parcel I.D. ®� < v
L
A. Well Data
�c
Well type ,,i If A, B, or C, attach ADEC letter. ADEC water system number_ A o IT'
Log present &N) Date completed 4-2q Driller L/A l
Total depth 1 AQ k 9 Cased to A o flo Casing height 122
Sanitary seal (a) Wires properly protected 6N).
FROM WELL LOG AT INSPECTION
Date of test el -y `/' 1 -7- 1 -`i L -� P ia9 M F_-�> ti
Static water level /00 _ I bS
Well flow '30,0 g.p.m. C.
�-f 9.p -m.
Pump levell _ 0/L Jt_
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot _ I -' ; On adjacent lots l oo'
Absorption field on lot _ l (S ; On adjacent lots ^ 1040
1J_
Public sewer main A IM Public sewer manhole/cleanout n
Sewer service line ZS t k Petroleum tank
WATER SAMPLE RESULTS:
Coliform O Nitrate D - S 3 Other bacteria
Date of sample: 9-5- Collected by: S /,s
13. SEPTIC/HOLDING TANK DATA
Date installed L - / S -Tank size /0C) o Compartments Z
Cleanouts (2N) _ _,7__- Foundation cleanoutCDN) y Depression (Ya ,.l
High water.alarm (Y& / _Alarm tested (Y/N) _tI4
Date of pumping ___ 7-,� 7--9s- _Pumper :If--�'J MP,,i (,
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) oh lot On adjacent lots ) °o I + Foundation 2(a
To property line /V Absorption field Water main/service line la _
Surface water/drainage /o o
•72-026(3M)'Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed /o -a 9 - �3 u Manufacturer
Size in gallons So o Manhole/AccessVJN)
Vent (j�N) "Pump on" level at 3 3 /I 'Pump off" Level at Z8
High water alarm level 3(, Cycles tested
Meets MOA electrical codes (Y/N) A -T Tia+ IJST� u
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot /6Z ' On adjacent lots /&Z) ' + Surface water /66 14-
D. ABSORPTION FIELD DATA
Date installed / o _a 9 -a t� Soil rating (GPD/Ft') 41 �/& System type 4" V. 61ED
Length SV Width Z y / Gravel thickness 013- / Total depth 2 • s i ��5� L��o
Total absorption area / �?_ 5 4. Cleanout present ON) �Z Depression over field
Date of adequacy test ? - / - 1,5-- Results as sail) ��.s for _
Water level in absorption field before test b " After test
Peroxide treatment (past 12 months) (Y4&, lJo ^JA� r<,JD H✓. -J If yes, give date
3 Bedrooms
N
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 115- On adjacent lots 106 ' ¢ Property line 30 '
To building foundation .-Z. ' To existing or abandoned system on lot 0
On adjacent lots 3 a ' 4- Cutbank
1,4 Water main/service line / o 4 -
Surface
Surface water / 0 o Driveway, parking/vehicle storage area .-D '
Curtain drain
.3 0 I -.k-
E.
E. ENGINEER'S CERTIFICATION
! cer* that / have checked, verified, or conformed to all MOA and HAA guidelines in effect on
Signature �/,",/ Z /�vr —
Engineer's Name /?i/ (f- C", ,4�
Date _ If I q S�
HAA Fee $ Jal) t CO
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
a
Mb
inspectibn.
«aft^'s>ttt•K:e tVwa 1:64 r........!!..w
7, ROBERT C. COWAN Q
CE - 8801
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVALg�
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date September,6, 1286
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 2; Block 1; Foxhill Subdivision
Location (address or directions)
(b) Applicant Name —Bruce Phan Telephone: Home — Business 786-6364
Applicant Address United Bank of Alaska
(c) Applicant is (check one): Lending Institution 1 ; Owner/builder ❑ ; Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution United Bank of Alaska Telephone _ 786-6364
Address 440 East 36th Avenue, Anchorage, Alaska 99503
(e) Real Estate Company and Agent none
Address
Telephone —
(f) NKthe HAA to the following address:
S & S Engineering
SRB 196X Eagle River Road
Eagle River, Alaska 99577
2. TYPE OF RESIDENCE
Single -Family P Multi -Family ❑ Other
Number of Bedrooms
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 (wsa)
. f
5. ENGINEERING FIRM PROVIDIN,,, INSPECTIONS, TESTS, FILE SEARCH, DAaA 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 fsA&ENGINEERING
Name of Firm _SR B 1.96X Telephone Z497S _
Address EAGLE RIVER, AK 99577
Date - 17116 /,r6
/✓/L6 lejF?"II? /e/Nrjc 6:�/2,Qa/n/4,
/9nJ0 szopAi#:Cour, le 00n2 Y/4"/ re u-1
/}FTF2 62 NAWL4fO !9 67.
(br�ui A. SP,arhar ."d ej
14.17.1
'i��of�isstv�t>�4��,
6. DHEP APPROVA (3-)a
Approved for e� bedrooms by `� ate
- --7
Approved _ Disapproved _ Conditional
Terms of Conditional Approval A S_ 1'7.9 -7E'rJ�9BUrJC. 44_Ytl 'e, ke � �3 o ri
g7 /s ✓zAe..
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of Homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11184)
A. WELL DATA
CNo0 PGE
pF r \{VPIJWPALITY OF ANCHORAGE (Mbr )
\\G\! Si N4QgCf11�ALTH AUTHORITY APPROVAL (MAA)
MVC O�QNMENAP CHECKLIST - FEBRUARY 1984
tiN�\PD % 264-4720
Legal Description:—G 2'
S Z
Well Classification _ �'clUGr If A, B, C, D.E.C. Approved (Y )
Well Log Prese (Y N) Date Completed — — Yield o '/✓`"
Total Depth Cased to Depth of Grouting �'f —
Static Water Level _ lao r Pump Set At y
rr
Casing Height Above Ground Sanitary Seal on Casin C(Y N)
Electrical Wiring in Condui (Y N) Depression Around Wellhead (/N
Separation Distances from Well:
r
To Septic/Holding Tank on Lot On Adjoining Lots
r r
To Nearest Edge of Absorption Field onLot On Adjoining Lots 1620
/
To Nearest Public Sewer [-me N ` To Nearest Public Sewer
Cleanout/Manhole To Nearest Sewer Service Line on Lot 1 J_
—
Water Sample Collected by S';(s!'Ajt:'l e_" ;Date
Water Sample Test Results
Comments
l Lo
//y
-e ,siZ,e t % IVs, 6
B. SEPTIC/HOLDING TANK DATA
�.cG•e.s1 6.5 <YI
Date Installed ��J Size No. of Compartments Z
Standpipe (Y/ ) -- Air -tight Cap (Y/ ) Foundation Cleanou(Y/ )
Depression over Tank (Y(N) Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) ; for
Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well '/n '_ /
To Property Line _ Ao r /
To Water Main/Service Line
Course
Comments
Page 1 of 2
72-026(11/84)
,ZJ F
r
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata Z T//Q/"e Type of System Design ��L U. /4 ✓J
Date Installed /o 12-,9 /8' -1161epq �/�d�/� ) Length of Field 15 -
Width
Width of Field 2 Depth of Field %� J
I
Gravel Bed Thickness V, 0
Square Feet of Absorption Area /Z 'F G Standpipes Present 6N)
Depression over Field (Y( !� Date of Last Adequacy Test
Results of Last Adequacy Test '0i . Z�4
Separation Distance from Absorption Field:
To Water -Supply Well /0L To Property Line
i
To Building Foundation eS2.
Lot
To Water Ma#T/Service Line
D `4
; On Adjoining Lots
Neff
To Existing or Abandoned System on
To Cutbank (if present) /00
To Stream/Pond/Lake/or Major Drainage Course /Jb AJ,=
To Driveway, Parking Area, or Vehicle Storage Area c5_0 //
Comments ?off Ta 4f�c/22ooi✓ plie .4si,v D w ti0Rae1 5<e?r or
e.( w 0
D. LIFT STATION
Date Installed <a 12? C Dimensions
Size in Gallons SU9 u / Manhole/Access(Y N)
"Pump On" Level at 39 "Pump Off' Level at z8
High Water Alarm Level at 3 <O Vent (Y/
Tested for /oS x44 1Pumping Cycles.d -A [e
Electrical Codes (X/3N A / a T /-k� r7 -1i wle,= 9
Comments e,� led'
"' 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 S & S ENGINURING Date12- 4- Zt
SR B 196X
Company EAGLE RIVER. AK 9Y577 MOA No.
Receipt No. /00/
D O O 1a r,
Date of Payment s/���
c� t,
Amount: $ �O� d�° A",, fvtr7� "s a
Page 2 of 2
72-026 (1 1Y84)
U rR^ pC` i
A
iir...t :.
HEALTH AUTHORITY
APPROVALS
Juty 20, 1986
ROBERT A.SHAFER
CIVIL ENGINEER
694-2979
Mun cipa ity ob Anchonage
SEWER &WATER Depan,tment ob Heatth and Human Sen.vices
MAIN EXTENSIONS 825 L Stn.ee-t
Anchan.age, Ataska 99501
ATTENTION: Susan Oswatt
SEWER & WATER
INSPECTION REFERENCE: Lot 2; Mock 1; Foxh,%U Subdivision
An on-site wastewaien disposa2 system was ins,taUed on the nebenenced
pa.opekty under pen.mit #840012 on June 15, 1984. Inspections wen.e pen.bon.med
ENGINEERINGSTUDIES and ane documented on an inspection nepont on b.Lze in our, obbiee. This
AND REPORTS tepon.-t has not been submitted bon n.eeon.d due .to non-payment ob bees
assocxa d With the wokk.
Sneene2,
WELL INSPECTION
&FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
5R` -A. SHAFER, P.E.
/ss
SRB 196X EAGLE RIVER, ALASKA 99577