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HomeMy WebLinkAboutTROLL KNOLL BLK 3 LT 2Troll Knoll Block 3 Lot 2 #051-521-04 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: 51.1 g7WRq PID Number: O5) -'sail — CD4 Name. bRQY B?AaLEY Wastewater System: ❑ New ❑ Upgrade Address: 2S7a7 hr�Top DiR vt- CM'r+ rAk-. lFk 99sf,7 Phone: &qg - 3 qq5 I No. of Sedro4(na: F� LEGAL DESCRIPTION Lot: Block:Subdivision: 3 ro« rNet'l- Township: i I Range: Gravel length: s I Section: WELL: ❑ New ❑ Upgrade Classification (Private, A.B.C): Total D Cased To: ('OMtittd NTTY Ft. Ft. Driller. Date Drilled: Static Water Level: / Ft. Yield: (Pump Set at: Date Installed: F -23;-S-7 I Casing Height Above Ground: GPM FI SEPARATION DISTANCES To Septic From Tank WeIF e�oolt Surface 100'+ 1 Water Gravel length: s Lot lDty Line Numberol'lsines: Foundation Stf Curtain 11 1 Ft. Drain �v ABSORPTION FIELD 0 Deep Trench Shallow Trench 0 Bed O Mound 0 Other Soil Rating:a Total Depth from original grade - —7 " 0.1 g GPD/SQ. Ft. Depth to pipe bottom from original grade: Gravel depth beneath pipe y Ft ::lz Ft. Fill added above original grade: Gravel length: s I - 3' Ft 110 Ft Gravel width: / Numberol'lsines: Distancebetweenlines: Ft. oC 11 1 Ft. Total absorption area: Iii Pipe material: 93� $o Ft 39;A 0•3oaN�F-4,o Instal:t'liiKr� Elc_� 1 �sJ L Date Installed: F -23;-S-7 TANK (Septic ❑ Holding 0 S.T.E.P. ADeorl~ Lm Homing PubllkJMrwele ManuI cturer. Capacity In gallons: Field SWIM Tank Sewer Line, AA)GNeTAAJK ISoo / Material: Number of Compartments: 200'1- as STEeL_ a /Co.# LIFT STATION IOrF Size in gallons: I Manufacturer. lot 'Pump on' level at: �,,"Pulevo' at: High water alarm at: `�,tdw/L Pump Mek el Elons performed by: Remarks: i w s rj.-G TANK Pu ,.t n 4,0 , AII.L,td 4- A dANOON (-0, Inspections performed by: s a s ENGINEERING 17034 ERiver Loop Eagle RI f r, Alaska "S Department of Reviewed and approved by: 72-013 (Rev 0191) MOA 25 BENCH MARK Location and Descriptio "berroAt of $r'DTA1G :lose 4-o PorAJT 'Z'" Assumed Elevation: lop F, Dates:1 st S 2 S • 51 c tVo.? 2nd ra s aq-5-7 frvices appr val 'jDate: 1ZL/ql-- p ROBERT G COWAN hc� CE -8801 PERMIT NO. SW970029 PACE 2 OF 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.D. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone, 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 2, BLOCK 3, TROLL KNOLL SUBDIVISION P.I.D. No. 051-521-04 A B WMAUED RDW DNERIER (M)� FCO 47.5' 19.0' NEW 1500 CAL. ST1 46.0' 26.0' SEPTIC TANK ST2 47.0' 34.0' DBL1 48.0' 35.5'; DBL2 48.0' 36.0' B FD 48.0' 37.0' rco C01 29.0' 41.5' n, MT1 32.5' 40.5' ��� , CO2 76.0' 71.0' y0153t!)� co MT2 71.0' 65.5' WATER UNE GQ i CO3 15.5' 57.5' (APPPDX. LOC 0��ZG) MT3 19.0' 57.0' i C04 70.5' 79.5' / A MT4 66.5' 77.0' MT5 7C. r 41.0 KEY BOX (APPPDX. LOC.) T /0.�. SppT1 Sppf2 \ OA II /99.4' II �Fwu. CRADENE �jII 94.9' I 1500 7 CAL 94.7' \ \ �•�, S.T. \ FINAL GRADE NJ.& \ EXISTING CRIB Wrz 0> C12 -> COI - 99.78' /C2.LIT CO3 -101.0'CO2 = 102.5'� CO NT -004 = 102.9' ,COI - -CO2 94.7 94,r CO3 94.6 11T1 = 91.8'x•""){( MT2 - 91.7' A NO WATER FOUND 84.70' B.O.H. w -INSTALLED FLOW DIVIDER N EN NND ABOVE E DGDq UNKNOWN ES SCALE 1' - 40' CO3 94.6 94.7 h;, MT3 = 91.8' MT4 - 91.8' A NO WATER FOUND 84.70' B.O.H. w -INSTALLED FLOW DIVIDER N EN NND ABOVE E DGDq UNKNOWN ES SCALE 1' - 40' '/ PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE Y� � 11 '�/ej� 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:SW970029 DATE ISSUED: 3/05/97 DESIGN ENGINEER:S 6 S ENGINEERING EXPIRATION DATE: 3/05/98 OWNER NAME:BRADLEY LARRY OWNER ADDRESS:23727 HILLTOP DR CHUGIAK, AK. 99567 cc - PARCEL ID:05152104 �mCy✓ a A4A � LEGAL DESCRIPTION: TROLL KNOLL BLK 3 LT 2 LOT SIZE: 23400 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM 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 DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: SUBMIT DOCUMENTATION ON THE EXISTING SEPTIC TANKS' SIZE, (INTERNAL DIMENSIONS AND NORMAL OPERATING LIQUID DEPTH) IF IT IS TO REMAIN N/% S RV CE. V RIFY 1800 GAL. CAPC. RECEIVED BY: DATE: DATE: 3/S /� ISSUED BY: DATE: 465b ROBERT C. COWAN, P.E. ROBERTA. SHAFER P.E. January 30, 1997 CMLENGINEERS (907) 694-2979 FAX(907)694.1211 We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the SOiLTEST installation of the proposed septic system. If you require additional information, please contact us. M�AT1ON Sincerely, '_&/Z STRUCTLIRALB Robert C. Cowan, P.E. MECHANICAL ".KcnCN$ Enclosure ON SITE WASTEWATER - DtSPOSAL55TEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services "EA`THA`RHOftlTM PP AROVALS P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 2, Block 3, Troll Knoll Subdivision SEWER& WATER MNNEXTENSINIS Request you issue a five bedroom permit to upgrade the septic system serving the existing four bedroom house on the referenced property. Also, request you issue a SEWERILWATER Conditional Health Authority Approval on the referenced INSPECTION property due to winter conditions. Upon completion of a site visit to the referenced property the septic system was found to be saturated. There is no ENGINEERINGSTMES eminent health hazard and there are no adverse effects as AND REPORTS a result of granting the conditional approval. A test hole was excavated and percolation test performed in area of the proposed upgrade. The approximate location WELthe of the test hole is located on the attached site plan. &FLOW$PECT1ON aPLowTEST At the time of excavation no water was encountered in the test hole. The monitoring tube in the test hole has been checked and was found to be dry. SITE PLANS Attached is the proposed upgrade design. The septic system is to be upgraded no later than ROAD DESIGN June 15, 1997. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the SOiLTEST installation of the proposed septic system. If you require additional information, please contact us. M�AT1ON Sincerely, '_&/Z STRUCTLIRALB Robert C. Cowan, P.E. MECHANICAL ".KcnCN$ Enclosure ON SITE WASTEWATER - DtSPOSAL55TEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577 I" = 50'I SITE PIAN WALE WA n wE - VN0 Ln %ov G tj=x N W � in r O IN ~ z O s s0 / z 1 Z4 / / / c ;aN-+NWV r—] m c®Q�rno n n cn -4 a '*\ m Z - INOmm-u z r rr- < 0 z 0C)m n oma 0== 0 N a ":E >> m "LAMO z Nm� c)o v m 0 =N \ EA Z >EA n O -<O = q c+ �FA;Z �O\ r �K-rAi O x x w E a DESIGN �o 0 z Z- ` I I:� Vo S VN0 Ln %ov G N W Vo w 11 z NZO 'Ar- TMeO a mfN 91 yz rn Y'D Z tnzc:bomoy m � rn, y009 xC')Ntn mpxa .�.1i 70 O N O yY 1.1 z A n + A O N < c O Y'� s Z Zln ' On C z n N v n 0 0 O 2 H C rzlm CO S� Q ' o v) ) O o :°� z sA A az _ N o �1 zOr E� zz O Z N r 1 e v Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED FOR:1�i�"r DATE LEGAL DESCRIPTION: Lo -V �I- e��-t� 3 'a gW (Township, Range, Section: „ee' IL.�pVV SLOPE Q� 1- �D 2- 3 IJ 4- 5- 6 -5 L1��� 6ll.t `7 - 10- F� 11- _ WAS GROUND WATER ENCOUNTERED? O S I L IF YES, AT WHAT �1 k DEPTH? P E Depth In water Atter 1 �S�q Monitoring? �_Datc r- r Reading Date Gross Net Time Time •(Jjr-i"s o,, mss._ a4l c(" ROBERT C. COWAN 1-t-0001 SITE PLAN Depth to Net Water Drop 16- (`1, 17- T lam,'` 15- 19- 20- 19- 20- ... PERCOLATION RATE 10 Immutevmch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS 5 & 5 ENGINEERING PERFORMED BY: EE17034�E1agle eR�i�velr.,Lgeaap Road No. 204 " l �n"�� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITR�CSTXT�'ntaD'NtUW?7L GUIDELINES IN EFFECT ON THIS DATE. DATE: ;L /"' 9 7 72-006 (Rev. 4165) ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. ON-SITE WASTEWATER DISPOSAL SYSTEM CMLENGINEERS CONSTRUCTION PRACTICES FAX(994.2979 and FAX(907)694-1211 MATERIAL SPECIFICATIONS HMTH APPR "1fHOfir REFERENCE: Lot 2 Block 3 Troll Knoll Subdivision APPROVH$ . � January 30, 1997 GENERAL: SEWERaWATER 1. The scope of this project includes the installation of LWNEUENSKM a five bedroom septic system upgrade with two five foot wide drainfields to serve the existing four bedroom residence on the referenced property. The existing septic tank is to be excavated to verify SEWER&WATER integrity. If of poor integrity, the tank is to be rSKCTION pumped, crushed and abandoned completely; and replaced with a new 1500 gallon septic tank. The existing crib is to be abandoned such that it may be used in the future. ENGINEERMSTLOES ANDREPORTS 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal aPtw+TEST g WELLWON Regulations. TEST 3. The contractor shall be responsible for obtaining any necessary underground utility locates. SITE PLANS 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all ROADDESIcN leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 5. Contractors installing wastewater disposal systems soLTEST must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the PERcounoN Municipal Health Department. TEST SEPTIC TANK INSTALLATION: STRUCTUULa 1. A septic tank is to be constructed by a certified MECIIANICAL septic tank manufacturer. Construction shall include INSPECTIONS two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to ONSITE prevent settling or shifting of the tank. WASTEWATER OtSPOSALSY'STEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER. ALASKA 99577 Page Two Lot 2, Block 3, Troll Knoll Subdivision January 30, 1997 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (roughed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Page Three Lot 2, Block 3, Troll Knoll Subdivision January 30, 1997 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Tvpe of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the $200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Lot 2, Block 3, Troll Knoll Subdivision January 30, 1997 INSPECTIONS: Typically there vill be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanout:., and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. Page Five Lot 2, Block January 30, 3, Troll Knoll Subdivision 1997 S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER _ Gff f'"=R ANCHORAGE AREA BORr%jGH UPDepartment of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME �%� �/i )SOlf) MAILING ADDRESS PQ�4h 69�G��1C141 QPHONE 6 _Z`309 - LOCATION OF%- SK/ J'�oAO LEGAL DESCRIPTION 10/0 71 Z /S/OC'ATiPO/�/1/PO//S/4 SEPTIC TANK: DISTANCE NUMBER OF FROM WELL V() f�i%/�I�L %p� MATERIAL ( O�(/CR�I%C_ COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH I IQUID CAPACITY /OpO GALLONS. SEEPAGE PIT: NUMBER OF PITS DIAMETER OR WIDTH Z LENGTHZ!� ,, DEPTH LINING MATERIAL �rG�/Rf sCR18 SIZE: DIAMETER —DEPTH— DISTANCE FROM: WELL TOTAL EFFECTIVE 2 BUILDING FOUNDATION 3� NEAREST LOT LINE 33 ABSORPTION AREA (WALL AREA) J SQ. FT. ADDITIONAL ABSORPTION /V1 WELL: TYPE CONSTRUCTION ` DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST- SEPTIC SEEPAGE FOUNDATION LOT LINE SEWER LINE , TANK , SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED DISTANCES: INSTALLED BY: n Tn 1 PIPE MATERIAL: 0457- LOT SLOPE: REMARKS: _50/4 �S % �s �/30�PwI Form No. EQ -031 REMARKS 01fl Cb LJAI DIAGRAM OF SYSTEM % i rw . � C/cwt • C'/<9 � sF� DATE �v��/7� APPROVED G.A.A.B. �fl Q GRE[" R ANCHORAGE AREA BOF~ IGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 / INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME �/- �n�` V O� MAILING ADDRESS PQ %30 S9f� ��/��µ-QPHONE (y -941-Z3'0 9 LOCATION O ��` S/�/ i'LOA%� LEGAL DESCRIPTION �� Ti Z %670l /F3 SEPTIC TANK: DISTANCEI NUMBER OF FROM WELL �024 MANUFACTURER f�9�%�� �On% MATERIAL rOR/C/S�C%C� COMPARTMENTS / /$DO INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH I IQUID CAPACITY'' 'V 0 GALLONS. SEEPAGE PIT: NUMBER OF PITS / . DIAMETER OR WIDTH �`'�' LENGTHZ�/ DEPTH LINING MATERIAL f'! -`t' erG�it1f56R1B SIZE: DIAMETER —DEPTH— DISTANCE FROM: WELL TOTAL EFFECTIVE BUILDING FOUNDATION NEAREST LOT LINE 33 ABSORPTION AREA (WALL AREA) 336 SQ. FT. ADDITIONAL ABSORPTION IVA WELL: TYPE CONSTRUCTION DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION LOT LINE , SEWER LINE , TANK SYSTEM CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY. PIPE MATERIAL: 0,07 - LOT SLOPE: REMARKS: t�/� 7e -S7- �s L/3U�Pw1- a"0I th '. `, ru SysTi.y rys.-9d<d Tad 'ci /V9��r. AJe7aa`l zs 3 i3 21C T� a /d-3 �3 DATE �C%/��7� APPROVED G.A.A.B. / GREP?�:R ANCHORAGE AREA BOFrUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330"C"STREET ANCHORAGE, ALASKA 99303 TELEPHONE 274.4361 v - PERMMITIT NO, 9 . �e SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT I11/wI- /pb NAME OF APPLICANT i� l ��-•� s� n MAILING ADDRESS _ / ��tV PMOL` �O INSTALLATION LOCATION LEGAL DESCRIPTION L Z •'''///A/hJy ,' 3 " //]i i1,`,// A o O /"// INSTA- SEPTIC TANK SEEPAGE PIFIELD FACILITY TO BE SERVEp �+'/_Y i✓I�/ / TYPEAND SIZE OF'%/GHS / 'I1,// FINANCED THROUGH TO BE INSTAiLEpyQY � `O� SOIL TEST RESULTS /'/�^ �- �' NOTE, THIS PERMI IS T VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZEA�L/ TYPE vv L MINIMUM DISTANCES. REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT Z C SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK 57 SEEPAGE PIT TO NEAREST LOT LINE. G� ELL SEP C✓c dVELL TO SEPTIC TAN DRAIN FIELD DRAIN FIELD 7 C n � DRAIN FIELD SEEPAGE AREA S12E ,[/,� , M O S TY/P,E DIAGRASTEM SEEPAGE PIT ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD SEPTIC TANK, LLLL`, SEEPAGE PIT r DRAIN FIELD TO RIVER. LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION S FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE /�CAPS. i C e� GRAVEL BACKFILL / / /" 2/ CONFORM TO BOROUGH REGULATIONS REGARDING INSTA'LLLLLAA(T..IOON�N.. G.A.A.B. OR LICENSED DESIGNER i 1 CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA O INANCE NO. 28-65 AND THAT THE ABOVE DESCRI EEDDjSYS EM IS IN ACCORDANCE WITH SAID CODE. / DATE " ,/� Z& / 7? APPLICANT'S SIGNATURE FORM NO. EO -0t6 / �► 11fI,111cTCN EYC40, 0 & E GEM XHNI CAL & DEVELV. 'MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2290 Russe!! oyster Earl Ellis 6942774 SOIL LOG 688-2280 Soils & Foundations Land Development Performed for: Name: 41- 1ARSe)ti/ Tel. No. Mailing Address: Legal Description: Lor z COLc� Death (feet) Soil Characteristics 0 Toe :5,114, 2X101,�B,Q. 1- 2- 3 2 3 4. �7r_ S�/�Df�C7P,el[iEC r 6"O'se£S �� gJ 5 6113ovz.D Fes T /Sy( 6 7 0 9` r 10 11 12— �3 fi%� Gf% ^ sicry 1,0voj) } 3coq� I�EL's� Tifif/rcy �on/Socipg7�'JS 14 15 16 Ground Water Encountered: Yes No If gest what depth Proposed Installation: Seepage Pit Drain Field Comments:8'1J"lEAlr- r-4^02 Ar DEPTH. $viioE,C �cAar 7-a djE MFT LLeW d -5E a P 7' aF SU'4��B„Q. Performed by: �riG C '' .�lG, Date: �< .? le, IF 71 EPLANS MUNICIPALITY OF ANCHORAGE Development Services DepartmentPhone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On-Site Systems Approval ,� l Parcel I.D. 051-521-04 Expiration Date: 2 d-e(2 v 1. GENERAL INFORMATION Complete legal description TROLL KNOLL BLOCK 3, LOT 2 Location (site address) 23727 HILLTOP DRIVE,CHUGIAK,AK 99567 Current property owner(s) SEC. OF VETERANS AFFAIRS... Day phone Mailing address 3401 W END AVE. STE 760W, NASHVILLE,TN 37203 Real estate agent Day phone 2. TYPE OF DWELLING: _] Single Family (w/wo ADU) (^ Duplex Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Private Septic Private Well Holding Tank ❑ Water Storage n Community ❑ Community Well A ® Public Sewer ❑ Public Water System Waiver request for: Distance: Received by: Date: COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 556 Waiver Fee $ Date of Payment 6/ /fQ Date of Payment Receipt Number 0?-01(00 Receipt Number COSA# 05 /q/Ati3 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On-Site staff may visit the site to verify the information submitted. Name of Firm ANDERSON CONSTRUCTION&ENGINEERING Phone 345-3377 Address 4661 SHOSHONI DRIVE,ANCHORAGE,AK 99516 Engineer's Printed Name MICHAEL N.ANDERSON,PE Date 06/26/2019 A! , OF 6. DSD IGNATURE ;4.. * * • '4 System #1 Approved for bedrooms � 404 � •.MICHAEL N. ANDERSON: System#2 Approved for bedrooms i . No. CE 9489 Ai 6/26/19 Disapproved , ssto�� Conditional approval for bedrooms, with the following stipiN%1'►.` OF l�llllll(l(((/f(�(/''i ON-SITE SV cnSi WATER AND o WASTFWATER o • $l PROGRAM F (el gyCis`CY\ "VrS) lll �� By: Original Certificate Date: 7r-`{ 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 �' `C A-cQj c i 7 COSA Checklist blue sheet COSA Checklist Legal Description: TROLL KNOLL BLOCK 3, LOT 2 Parcel ID: 051-521-04 If more than 1 septic system on lot: COSA Checklist# of Structure served by this system A. WELL DATA—CLASS A#210778 ❑ Well log is filed with Onsite (or attached) Well production at time of test_gpm Date drilled Water storage tank volume_gallons Total depth_ft Well disinfected for coliform test? ❑Yes ❑ No Cased to_ft ❑ Coliform bacteria is Negative O Sanitary seal is functioning correctly Nitrate_mg/L❑ Nitrate less than MRL(ND) 0 Wires are properly protected Arsenic_ug/L 0 Arsenic less than MRL (ND) Casing height(above ground)_in. Collected by Date of flow test for COSA Date of Sample Static water level at beginning of test _ft. Comments B. TANK DATA—5/23/1997 1500-Gal C. LIFT STATION -NA Age of tank(s) 22 years 0 Required maintenance completed Tank type/material SEPTIC/STEEL Age of lift station years Measured operating fluid level in septic tank 49" Lift station material ® Standpipes/foundation cleanout per record drawing Comments: Date of pumping 6/20/2019 D. ABSORPTION FIELD DATA— 2 X 55'L x 5'W x 3'ED—@ 0.8 GPD/SF =938SF Which system tested (date installed) 5/29/1997 Adequacy test date 6/21/2019 ® ALL standpipes present per record drawing Results El Pass For 5 bedrooms Total measured depth from grade 8 ft(max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 5 ft(min) Water added 1200 gal ❑ N/A—pressurized field New depth 0 in ® Monitor tubes go to bottom of effective. If not, state Elapsed time 1440 min depth into effective ® Code-required soil cover over field Final fluid depth 0 in ® System presoaked Absorption rate 750 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) N date of test) If yes, enter date Gallons introduced 1200 gallons Comments/Deficiencies Tested both trenches -same results 8-9.9'total depth COSA Checklist Private Sewer copy 3.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot> 100' Community Sewer Manhole/Cleanout> 100' ® Yes if No ft ®Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line>25' ®Yes if No ft Absorption Field on Lot> 100' ®Yes if No ft Holding Tank> 100' ® Yes if No ft Neighboring Absorption Fields> 100' Animal Containment>50' ®Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ®Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations> 10' ® Yes if No ft Wells on Adjacent Lots: Property Line> 5' ® Yes if No ft Private Wells> 100' ® Yes if No ft Absorption Field >5' ® Yes if No ft Community Wells >200' ZYes if No ft Water Main > 10' ®Yes if No ft If septic tank is under driveway comment below Water Service Line > 10' ®Yes if No ft Surface Water> 100' ®Yes if No ft From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line> 10' ® Yes if No ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells> 200' ® Yes if No ft Surface Water> 100' ®Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION k! '.. ,l- I certify that/have determined through field inspections and review "e...-49,.. of Municipal records that the above systems are in conformance I /M140(///114:4 with MOA COSA guidelines in effect on this date. 4 MICHAEL N. ANDERSON. .. No. CE 9489' •• G�4,/ COSA Checklist Private Sewer copy 3.docx , .•••6/27/.11'. Fssio��' .i �.161.,__111P. MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT �"d�; 907-343-7904 On-Site Water and Wastewater Section � Fax: 343-7997 www.muni.org/onsite Septic Tank Advisory Certificate of On-Site Systems Approval #0SC191268 Subdivision: Troll Knoll Block 3 Lot 2 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 22 years old. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. (f.'" .=a r n i�. d ,10 1..... 26114A C, Mailing Address:P.O.Box 196650*Anchorage,Alaska 99519-6650*www.muni.org LOT 5 / ` 66.0 68o 00,00,,,c. LOT 5 566,06 33 F 772 LCT 1 $ O "� S6jo LOT 4 0 s' 22E rL 6j'°Y S/2j, r t weer A 3 CO --. 4„0:, ,ry. LOT 2 tt 2rn /T1ç' o v;,N N o*Ul i D G1 ��j~' 4 CO C. CrI S j 17*§_ 24.2'. y<C. 3 06S7F ._h r� 33.00, 70, v, p0 R`780 0GT/4/1)- LOT 3 Ok •�HOMA 0 <`\002-4 S. STS 4,1,1:::.. ... .‘‘‘,„ ��� o�C.Y OF'A4S4p N o fl 49 rH i' '••;37t ,v 00 •,STEVEN CALLAGHAN: f a NOTE: Q , .+.�LS-12034 P40 ti ' 7/e/ d o THIS DRAWING SHALL NOT BE MODIFIED FOR / ..... ci°O� USE AS A PLOT PLAN WITHOUT THE EXPRESSED p4A G/ess:onol�°ooa WRITTEN CONSENT OF LCG LANTECH. ORDERED BY. BRENT WESTERN SURVEY CERTiFICATION:LCG SANTECH.INC HAS CONDUCTED A PHYSICAL SURVEY OP TIlE PROPERTY AS SHOWN ON THIS DRAWING AND CERTIFIES THAT THE IMPROVEMENTS PARCEL#: 051-521-04-000 ADDRESS: 23727 HILLTOP DR. SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO ENCROACHMENTS EXIST OTHER THAN NOTED. LEGAL DESCRIPTION: EXCLUSIONARY NOTE IT IS THE OWNERS'RESPONSIBILITY TO DETERMINE THE EXISTENCE 0: AS-B U I LT ANY EASEMENTS,COVENANTS,RESTRICTIONS OR RIGHT-OF-WAY TAKINGS WHICH DO NO' APPEAR ON THE RECORDED SUBDIVISION PIAT.UNDER NO CIRCUMSTANCES SHOULD AN, DATA HEREON BE USED FOR CONSTRUCTION,FOR ESTABLISHING PROPERTY LINES,OR FOR LOT 2, BLOCK 3, PLOT-PLAN PURPOSES. TROLL KNOLL SUBDIVISION LEGEND: CLEAN OUT #C0 1y Overhang I Gravel WATER VALVE D'< �/`Voo`DeC I Ca•acte ; 250 H Street GUY WIRE Anchorage,Alaska 99501 POWER POLE IcG FENCE —X-%— Survey Department DRAWN DATE: 7/8/2019 WORK ORDER: 19059 Phone 562.5291 �� Inc Mainline DRAWN BY: AP PLAT: 73-178 a/Lc�.i&c1zrne• e ne �, Phone 243-8985 CHECKED BY: SC GRID: NW1360 AECC 668 SCALE: 1"=40' FB/PG:815/16 4` • Municipality of Anchorage =p On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 051-521-04 1. GENERAL INFORMATION Expiration Date: legal description Lot 2, Block 3, Troll Knoll Subdivision `f'_lr`ddress) 23727 Hilltop Drive Chugiak, Alaska 99567 tv �, `�1•. David & Emilee Kutch 907-240-9260 r 0*%wner(s) Day phone 14 Mailing addrest 23727 Hilltop Drive Chugiak, Alaska 99567 u�rfr`ag Brooke Stiltner @ Re/Maxpay phone 907-244-6742 z Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual tl Individual Water Storage ❑ Holding Tank ❑ Community Class A Well 0 Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request Received by: � � �U ,� Date: COSA to be released to the en er, nless otherwise requested by the engineer. COSA Fee $ l'(O Waiver Fee $ Date of Payment �II �� q# �t �J Date of Payment b Receipt Number (,Of 1" I J� 1 Receipt Number COSA# OSG l3i j Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pinard Engineering Phone 907-232-1347 Address PO Box 871347 Wasilla, Alaska 99687 Engineer's Printed Name Paul E. Pinard, P.E. Date 3/30/13 6. DSD SIGNATURE !� System #1 Approved for bedrooms pAU,Ep System #2 Approved for bedrooms gry CE -M Disapproved Conditional approval for bedrooms, with the following stipulations: M Original Certificate Date: The'"F1urlKpajWAnchorage 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 Septic System Advisory Well Flow Advisory COSA blue sheet r c X Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # I of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Lot 2, Block 3, Troll Knoll Subdivision A. WELL DATA Parcel 1D: 051-521-04 Well type A If A, B, or C provide PWSID # 210778 Well Log (Y/N) completed Sanitary seal (Y/N) _ Wires properly protected (YIN) Total depth ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1500 gal. Number of Compartments 2 ft. Collected by: Date installed 5/23/97 Cleanouts (Y/N) u Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) N Date of pumping L7/2-//3 7 2- /3 Pumper �2 J�S �um 111 G r -FE-V C. ABSORPTION FIELD DATA Date installed 5/23/97 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8 gpd/sf r1©f2.@ 55 . Lengt ft. Width 5 ft. 'Totpl depth 8 - ft. Eff. absorption area 938 ft2 Monitoring tube _ �� Pass Da e'Ad 4equacy test, 3/22/13 Results (Pass/Fail) 21 System type 5 Wide Trench Gravel below pipe 3 ft. Y Depression over field N 5 Fluid depth in absorption field before test 14 in. Water added 800 gal. `N' Elapsed-rime: 1390 min- Final fluid depth 14 in. Absorption rate > 'Ati�y rejuuenatiori treatment (past 12 mo.) (Y/N &type) None Known •l,� Q .. For _ bedrooms New depth 19 in. 750+ g.p.d. If yes, give date D. LIFT STATION Date insta Te "Pump on" level at Datum N/) E. SEPARATION DISTANCES WELL ON LOT TO: N 11 Size in gallons "Pump off' leve Cycles tested _ Manhole/Access (Y/N) _ Hi h water alarm level at Meets alarm & circuit reauin Septic tank/lift'statie n lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main er manhole/cleanout Sewer /septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 51+ Property line 5'+ Water main 10'+ Water service line 10'+ Wells on adjacent lots 200'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water Service line 10'+ Surface water 100'+ Curtain drain None Known Wells on adjacent lots 200'+ 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 COSA guidelines in effect on this date. Engineer's Printed Name Paul E. Pinard, P.E. Date 3/30/13 COSA brown sheet 10-10-12.doc Absorption field 51+ Surface water 100'+ Water main 10'+ Driveway, parking/vehicle storage 10'+ PAUL E. PINARD CE -4793 ✓ in. PINARD ENGINEERING P.O. Box 871347 Wasilla, AK 99687 (907) 357-ENGR (3647) ADEQUACY TEST LOCATION: Lot 2, Block 3, Troll Knoll Subdivision APPLICANT: Cory & Sarah Sheldon 23727 Hilltop Drive Chugiak, Alaska 99567 SEPTIC TANK TYPESIZE: SteeI/1500 Gallons, per MOA Records ABSORPTION SYSTEM: 5 Wide Trench, per MOA Records DAILY FLOW: 5 BEDROOMS x 150 GAL/BR = 750 Gallons TEST DATA JOB NUMBER: 13-058 DATE OF TEST: 3/22/13 FIELD STAFF: PJ Pinard NUMBER OF BEDROOMS: 5 SCUM: 0.1' SLUDGE: Minimal NEEDS TO BE PUMPED: Yes No XX CURRENTLY IN USE: Yes XX No Time Flow Volume Rate Cumulative Volume Septic Tank Septic Tank Soil Absorption System Comments pM (GPM) (GALS) (GALS) Liquid Level ' A Level Monitor Tube 1 A SAS Level Monitor Tube 2" A SAS Level 2:20 6.7 - - 4.0' - 1.2' - 0.0' - Start Flow -Meter 5740 2:35 6.7 100 60 4.1' 0.1' 1.2' 0.0' 0.0' 0.0' 5840 2:50 6.7 100 120 4.1' 0.0' 1.3' 0.1' 0.0' 0.0' 5940 3:05 6.7 100 180 4.1' 0.0' 1.3' 0.0' 0.1' 0.1' 6040 3:20 6.7 100 240 4.1' 0.0' 1.4' 0.1' 0.1' 0.0' 6140 3:35 6.7 100 300 4.1' 0.0' 1.4' 0.0' 0.2' 0.1' 6240 3:50 6.7 100 360 4.1' 0.0' 1.5' 0.1' 0.2' 0.0' 6340 4:05 6.7 100 480 4.1' 0.0' 1.5' 0.0' 0.2' 0.0' 6440 4:20 - 100 800 4.1' 0.0' 1.6' 0.1' 0.3' 0.1' Stop Test- 6540 RECOVERY Date Time SAS MT1 SAS MT2 3/23 3:30 PIM 1.2'/-0.4' 0.01/-0.3' 'ALL MEASUREMENTS IN FT. TEST: PASSED XXX FAILED COMMENTS: This system was found to be operating satisfactorily. There was 1.2' of measurable liquid in one of the SAS MTs and none in the other prior to beginning the test. With the addition of 800 gallons to the system (slightly more than the design daily flow), the levels rose 0.4' and 0.3', respectively. Returning to the property the next day, about 23 hours after stopping the test flow, recovery measurements were taken. These showed a return to the starting levels. 0 Reviewed by: Paul Pinard Date: 3/30113 04—ID Municipality of Ancliorain �, Development Services Department Building Safety Division _+ On -Ste Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anctiorage.ak.us (907) 343-7904 CERTIFICATE OF HEAL f H AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. ©51- S? ( —bel HAA # 05042.E Expiration Date: —� ^ __0 ro 1. GENERAL INFORMATION Complete legal description LoT 9-i Z(btJc 3' 1 t2e+L Kkx)(L 51 P Location (site address or directions) 23� e2� N luLTt�f' �w-ly? , 6L'4tnr., Ae QqS�� Current Property owner(s) DA,--) {,_f 6 'r ^ Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. Day phone Day phone 7Wr^! - 4� `d 1/31 /0-t- 2. NUMBER OF BEDROOMS: 13 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank Community Class A Well Community On-site L; Public Water System Public Sewer Cl 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 ser;ed by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificzles 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 ureter sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional encineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verity 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. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm '$•a g IGO.�! , tiL ttx Phone 6,qq- 7172 Address _170-54 P. rA4.1-15- VJ05e_ =F e;-W.2VI 61E f2tvrr, Av-. 74157? Engineer's Printed Name i2-0B64r- C. Cog low Date—_/1/0S' 5. DSD SIGNATURE *t ROBERT C COWnN `c a,8801 Approved for 5 bedrooms. sof C:-880 11 Disapproved. f4�,PF0~SS.c► Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory ON-SITE • Gi's VVAI LK U: m= WASTEWATER : - PROGRAM •; � Maintenance Agreements Supplemental Engineer's Report Other By:O��Antj Original Certificate Date: (ileo OIN]l Municipality of Anchorage Development Services Department \ Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHOR ITY.APPROVALCHECKLIST' Legal Description: �_i ��� 3 �r �aw� Kxpou S"r � Parcel ID: 0S1- A. S1-A. WELL DATA C6m wt l: ry t-ty Well type Pt If A, B, or C provide PWSID # 2IOZ-1% Well Log (Y/N) Date completed _ Sanitary seal (Y/N) _ Wires properly prot a&r /N) Total depth ft. Cased to ft. Casing i (above ground) in. FROM WELL LOG INSPECTION Date of test Static water level ft' Well production g.p.m. g.p.m. WATER SAMPLE RES Coliform colonies/100 ml. Nitrate mg./l. Other bacteria colonies/100 ml. Ars ' . _ mg /I. Date of sample: _ Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material ���� ` �L Date installed se Z ~ b Tank size 15Q0 gal. Number of Compartments 2_ Cleanoutsd! 1) I" Foundation cleanout &) `c-5 Depression over tank (Y/®_0 High water alarm Date of pumping ncTr ?A=!4 Pumper PA2 r A!r=y �Edt S C. ABSORPTION FIELD DATA Date installed d2 -5h Soil rating (g.p.d./ft' or telbdrm) 0-8 System type H►4t tOw ( � � r r Length lib 2-55` ft. Width � ft. Gravel below pipe 31 ft. Total depth -10ft. Eff. absorption area fe Monitoring tube Depression over field Jbz9 Date of adequacy test S 4 Results Gail)` For _ bedrooms r. Fluid depth in absorption field before test in. Water added'�l gal. N►.l/a New cle��pth. / � in. Elapsed Time: � min. Final fluid depth 9n in. Absorption rate >= �—g p.d. Any rejuvenation treatment (past 12 mo.) (Y�k type) 00 If yes, give date D. LIFT STATION Date installed 'Pump on' level at _ in. Datum E. SEPARATION DISTANCES Size in gallons Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /s rvice line (Y/N) in. High water alarm level at in. Meets alarm 8 circuit requirements? C�OrhtrlUrl�tT%.( `-l�T-e7e On adjacent lots lots Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r Building foundation 5 Property line $ /f Absorption field .54 Water main /UrZt Water service line It) 4- Surface water /rte Id - Wells on adjacent lots 24!Jd '4 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /b /t Building foundation 1b If- Water main in I4 I Water Service line �t� + I Surface water 100 4- Driveway, parking/vehicle storage /b l4- Curtain drain NGLVtGRXY,t 4U Wells on adjacent lots 2--01 i + 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 9 6 aria% C. Date$— HAA Fee $ 40Q'00 Waiver Fee $ _ Date of Payment 2 Y A4 5 Date of Payment Receipt Number 011q No vReceipt Number, (Rev. 12101) ROBERT C. COWAN C.-8801 MUNICIPALITY OF ANCHORAGE • y DEPARTMENT OF HEALTH 8 HUMAN SERVICES �..' Division of Environmental Services �GlfE�rrypF 5 On -Site Services Section MAcsfRPcNO,igoE PCO. Box 196650 Anchorage, Alaska 99519-6650 FFQ SDI "'VON 343-4744 c �`^ CERTIFICATE OF,HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING VED Parcel I.D. # O S / —Say = o y HAA # r n" 1. GENERAL INFORMATION Complete legal description ' Lot 2; Block 3; Troll Knoll Subdivision Location (site address or directions) 23727 Hilltop Drive Chugiak, AK ,6•)ry: ,� `Prpperty ownei Larry Bradley Day phone 688-3489 1' :t;Mailing 8ddress `' ~ 123727 Hilltop Drive Chugiak, AK 99567 4..a,.......,...- .... ............. .� ,_,.,Lending'agency. ' AK U.S.A. FEDERAL CREDIT UNION Day phone 8G' Zrf $ Mailing address `' y'oo o CR�o vr.� a , D R. A... c// .4 K y 9 J'"a 311 .Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well Community well XXX Public water _ NOTE:' If community well system, provide written confirmation from State ADEC attest- ing to the legalityand status of system. j•;i;tir;; 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. . nau(R«.tAi) F, MOAm S. 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. 5 & 5 ENGINEERING Name of Firm 17034 Eagle River loop Road No. 204 Phone G 9 L/ ' '7 9 Eagle River, Alaska 99577 Address %% Engineel's signature y� 4X41/ GT C� Date ' O 1 9 7 REQUEST YOU ISSUE A "CONDITIONAL" HEALTH AUTHORITY APPROVAL. .SEPTIC SYSTEM WILL BE UPGRADED NO LATER THAN 15, June 1997. -.40- vn% 6. DHHS SIGNATURE Approved for Disapproved. E bedrooms. xxxxx Conditional approval for three(3) ROBERT C. COWAN CE -8801 bedrooms, with the following stipulations: Escrow monies to upgrade the septic system in accordance with engineer's design dated March 4, 1997, Permit #SW970029. All monies must remain in Pcrrnw until final approval is granted from this department. All work must be completed no later than June 15, 1997.' Additional Comments - Date March 5, 1997 The lftrnl 1paliwf Anchorage Department of Health and Human Services (DHHS) Issues Health Authority !°`UP �pproval 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 courtesyto purchasers of homes sand 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: 7:2.Mm".1m) 0" MOAM i I:lYV�1 UN,CirAl7ly Vr A Municipality of Anchorage RO^n1rtiRvNAk DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division FEB 0..19 1* 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907)44 '4Health Authority Approval Checklist SCE J V E, p Legal Description: Lor 2 % B4eev- 3% TkaLA. kd,,._ :5/OParcel I.D.: 0-51 - 521 - 04 A. WELL DATA Well type 4!!�I 4S5 "A" If A, B, or C, attach ADEC letter. ADEC water system number A 10-718 Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production Date completed Cased to FROM WELL LOG WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTICAHOLDINGTANK DATA Nitrate Casing height (above ground) —' Wires property protected (Y/N) g.p.m. Collected by: AT INSPECTION g.p.m. Other bacteria Date installed 10 -13-75 Tank size 1900 *- Number of Compartments i Cleanouts ON) Ir t S V- re QE vrt.v,s,�A:10 PVRinC vPCA.fa4L Foundation cleanout ('�IlY7 NU Depression (YAW) tie High water alarm (YAP too Data of (3a pi frg 1 I - t5'A % Pumper JK PJn1P,O1Ca r C. ABSORPTION FIELD DATA Date installed 10 -13--757 Soil rating (g.p.dAF or 0! r2drrt 85 System type CK119 LengM 14 Width I `r Gravel thickness below pipe L Total depth 101 Zb Effective Absorption area 336 Monitoring Tube presentON) YES Depression over field (Ye 4_ Date of adequacy test Results (Pass/Faiq For bedrooms t Fluid depth in absorption field before test (In.); '— Immediately after= gal. water added (In.): Fluid depth (ins) Minutes later: J Absorption rate g.p.d. Peradde treatment (past 12 months) (Y/N) If yes, give date 72-025 (Rev.3mar -* ABso"*nool rex-o .5uKc-i4*& .P o Aor=QvAc`t' TEST Pti�t'oRa1Ea. ^'O S..IQ<Aa., .•C ti/'.r(a� — tylTf.. l�Acrf .pro Ilr+fL , D. LIFT STATION Date installed Size in gallons - Manhole/Access (Y/N) "Pump on" level at' otr level at' High water alarm level at* 'Datum Cycl$3 tee E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: C-ommmil,( W E.lr_ Septic/holding tank on lot On adjacent lots Absorption field on lot Or,�ulacent lots Public sewer main — Public sewer manhole/cleanout Service line LHt station SEPARATION DISTANCES FROM EPTI OLDING TANK ON LOTTO: Foundation 5 t Properly line r�+ Absorption field S I' Water maintservice line ►or+ Surface water/drainage Ivor+ Wells on adjacent W SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line )o+- Building foundation 10+ Water maintservice line Surface water loo'+ Driveway, parking/vehlcle storage area Curtain drain A/A Wells on adjacent lots Zoo't F. ENGINEER'S CERTIFICATION R � 1 certify that I have determined thru field inspections and review of Municipal record . _966 in conformance with Mat HAA./g/u_idelines in effect on this dale. y4 Signature vz E En ineer'sName IQaBE,e,— �, Cor,,,,f„i r 200'+ �j, Awl R,iil G oYJIUi %•,! Date a / a / 01 -7CE 7Y C��♦.� CE - EEJ i HAA Fee $ x Date of Payment Receipt Numbel[4\1/13 72-026 (Rev. 3/96)' Waterer Fee $ Date of Payment Receipt Number ale , MUNICIPALITY OF ANCHORAGE ARL 1 DEPARTMENT OF HEALTH & HUMAN SERVICES AEML Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. a OSI -S-)'l - 0 'f HAA # '17 D v +f Z 1. GENERAL INFORMATION Complete legal description Lot 2; Block 3; Troll Knoll Subdivision Location (site address or directions) 23727 Hilltop Drive Chugiak, AK Property owner. Larry Bradley Day phone Mailing address 23727 Hilltop Drive Chugiak, AK 99567 Lending agency AK USA FEDERAL CREDIT UNION Day phone Mailing address 4000 Credit Union Dr. ' Anchorage, AK 99503 Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well Community well XM Public water 786-2588 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(Rw.1/91) Front MOA121 5. . STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system Is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my Investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Phone G c)% - a c)'7 c) 17034 Eagle Itiver Loop hoad r4o. i" Address Eagle River, ��Alaska 99577 Engineer's signature y/W"V—Z � — Date 6/2/417 REQUEST YOU ISSUE A NON -CONDITIONAL HEALTH AUTHORITY APPROVAL. ALL WORK REQUIRED ON THE CONDITIONAL H.A.A. DATED 3/5/97 HAS BEEN COMPLETED. 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for Additional Comments bedrooms. 111Th to \ ROBERT C COWAN '0,'. CE -8801 bedrooms, with the following stipulations: Date 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 doesthis as a courtesyto 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. 71245 WAM) 6. MOAm May 2, 1997 ROBERTC. COWAN, P.E. ROBERTA. SHAFER, P.E. CML ENGINEERS (907)694-2979 FAX(907)694-1211 �w�HORITY RECEIVED MUNICIPALITY OF ANCHORAGE Department of Health'and Human Services jUN 1997 P.O. Box 196650 R� Anchorage, AK 99519 Municipality of Anchorage MR�°W� Dept. Health & Human Services REFERENCE: Lot 2; Block 3; Troll Knoll Subdivision SEWER& WATER INSPECTION A Conditional Health Authority Approval (HAA) was issued on 3/5/97 for the referenced property. All work required for the Conditional HAA has been satisfactorily completed. ENGINEERWGSTUDIES Please issue a full Health Authority Approval at this time. MID REPORTS If you require additional information, please contact us. Sincerely, WELLINSPECTION &FLOW TEST Robert C. Cowan, P.E. SITE PLANS RCC/gk ROADDESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECNINIUL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577 ' t Municipality of Anchorage RECEIVE DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 *Anchorage, Alaska 99501 a (907) 34344 4 1997 Municipality of Anchorage Health Authority Approval Checklist Dept. Health & Human Services Legal Description: l0 % a OL -o c,c 3 T.eo" lr"LL Parcel I.D.: O Tl –S -a I –0 5/ A. WELL DATA welltype C ! A rS A Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production WATER SAMPLE If A, B, or C, attach ADEC letter. ADEC water system number aZ ) 0 7 T sr Date completed Cased to FROM WELL LOG Coliform / Nitrate Date of 6ample: Collected by: B. Fs—EP–T—WHOLDING TANK DATA Casing tph t (above ground) Cproperly protected (Y/N) AT INSPECTION Other bacteria S & S ENGINEERING 17934 rayls It)-*, Lwp ROad Na. 204 Eagle Riwr, Alaska 99377 Date installed T I A 3 q 7 Tank size j C'o o Number of Compartments a Cleanouts &N) Y E 3 i Foundation cleanouto/N) Y S Depression (Y& N a High water alarm (Y®) v O Datj of Pumping N �� - N t w Pumper C. ADSORPTION FIELD DATA ` r/'NaA 7 . S/�Icr ow Date installed Soil rating (g.p.dJH' or ft�/bdrn) 0 . $ System type 7 R+E.V c H Length 11O Width S Gravel thickness below pipe 3 Total depth 2 Effective absorption area 013 IT " Monitoring Tube present (9/N)YE f Depression over Held (YO ^r e Date of adequacy test �� ' �' t 4/ Results (Pess/Fe1Q N For bedrooms Fluid depth In absorption Held before test (in.); Immer"alely dner gat. water added (in.): Fluid depth (ins) MinuVjg..ta Absorptlon rate g.p.d. Per d5.9 (past 12 months) (Y/N) It yes, give data 72-028 (Rev. 3/98p D. LIFT STATION Date installed Size in gallons .Manhole/Access (Y/N) "Pump on" level p}' High water alarm level ar l 'Datum Cycles E. SEPARATION DISTANCES l— "Pump off" level at' SEPARATION DISTANCES FROM WELL ON LOT TO: C O r+ n.. r r r y it A J t •Q Septicholding tank on lot Absorption field on lot On adjacent lots scent lots Public sewer main l Public sewer manhole/cleanout Sewer /se rvice Ilne Lift station SEPARATION DISTANCES FROM S I OLDING TANK ON LOTTO: Foundation si + Property line f Absorption field S f I I I Water maiNservice line a -+ Surface water/drainage / • 6 4- Wells on adjacent lots a 00 4 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property Une f o Building foundation /6 ; Water main/service line r f Surfacewater / 6 6 -&- Driveway, parking/vehide storage area aT- �t Curtain drain N m - t A' A'Q iv Al Wells on adjacent lots a 6') 4- F. F. ENGINEER'S I eertMy Meat f have determined thru field Inspecdons and review of MuntdpafreewIds pwwateliq in cordommmepul fines fn effect on M1.9date. y 1 Signature e O. Engineer's Name K a A Ji -e r Co v d.J .. . A CC49P4 WWAR Date 6 �a /9 -7CE-e801 fyi•)+ . • ...... 'L\, +�c A� i,`;irr..,� �':,moi 43 HAA Fee $ 3 00. Waiver Fee $ Date of Payment 'X /'t / 017 Date of Payment Receipt Number o 1433 ( S j? ,) Receipt Number 72-026 (Rev. 3tg6)" MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH 'DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE i I 1. General Information Application Date SVly Z' 158r. (a) Legal Description (include lot, block, subdivision, section, township, range) L. +Z Bloor 3 Doll K..eli S„b .-rllA! /G/st, S/0 Location (address or directions) (b) Applicants Name La. -...1 &allay Telephone — Home Business 694tim Applicants Address S/Lz— 13"'/5730 P, 411:= (c) Applicant is (check one) Lending Institution Buyer ; Ocher f� (explain); (d) Lending Institution P'"I Banti Address Ea -14f?:~ Owner/builder ; Telephone l (e) Real Estate Co. 6 Agent AJ/} Address .. . Telephone .(f) Mail the HAA to the following address: _^ ably fes„ Cols+, 1C'V';j E+q PMari I K_ " P.V. 2. Type of Residence I Single—Family Multi—Family Other (describe) Number of Bedrooms 3. Water Supplv'" 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. i 4. Sewage Disposal ILII Onsite Public Community E:J Holding Tank . Notei;If community well system, must: have written confirmation from .the, State .Department.oflEnvironmentaliConservation attesting,to the.legality;,and itatus.' i (Page l�:of 2] t ,.� .+..: i.:" w.. A.•�. of t r } : L��'. ..�.r} �..�. �I I �... .r :. 1 ` .�: .+. ,' ..�ai�rr •� ., li''-L',i .. •'• r< 1 '1 S iT r Y .,•�1 a �. °,��,.1 .: ., �. r >.. ,' ,r •..� it '.v} [C .:.:�".l. "' �'.'.. 5.j Engineering'Firm'Providing'Inspections;• Tests ,`'File•Search, Dataand`Information As certified by my -seal -affixed hereto'and'as-of the validation date shownibelow, I f 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 regula- tions in effect on the date of this inspection. Name of Firm C�+s-V.vcv�nj G- 9;,e.C4. I.,c, CSr86-Dz3) Telephone 346 ZOOS Address 9�-01 544d., Went D, Date 7-Z-bG r•cj,•�"i' 4 t •t a ca�-- °•• i ER-SFALTj"�/ .O NO. 17 • h/ i �e9CK June 24.1968M� 6. i. DHEP Approval •. �ji`�SSjiPiAL'•F.`-a'„r Approved for fvu,ebedrooms •...ByDate Approved' Disapproved Conditional ' Terms of ConditioniVApproval 1\ CAUTION 1 ;THE'MUNICIPALITY, OF: -ANCHORAGE:; DEPARTMENT;,OF. :HEALTH' AND O.,ENVIRONMENTAV.PROTECTION (DHEP)'ISSUES�HEALTH'AUTHORITY APPROVAL CERTIFICATES BASED SOLELY'UPON THE':REPRESENT- ATIONS 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 REQUIRE- MENTS. 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. RR4/ej/D18 [Page 2 of 2] (DHEP SEAL) MUNICIPALITY OF ANCHDRAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 A. WELL DATA Legal Description: "4Z SIL 'S irol) K ell�b T/S Au 2 / ki -S /o Well Classification If AO B, cr C, D.E.C. Approved(Y/N) Y Well Log Present (Y/N) Date Crnpleted Yield Total Depth Cased to Static Water level Pump Set At Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Depth of Grouting Sanitary Seal or. Casing (Y/N) Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot LOO + ; Cn Adjoining Lots To Nearest Edge of Absorption Field on Lot Zoo'{ ; On Adjoining Lots To Nearest Public Sewer Lire To Nearest Public Sewer Clear.out/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected By ; Date Water Sample Test Results Comments Go-��;,{� sys}c, _ !,4Qk vEc. roR 110778 B. SEPTIC/HOLDING TANK DATA Date Installed 19-T5 Size 1800fw40 No. of Compartments I Standpipes (Y/N) Y Air -tight Caps (Y/N) Y Foundation Cleanest (Y/N) N Depression over Tank (Y/N) r1 Date Last Pumped 3 1y19gc ./ Pumpirg/Mainterance Contract on File (Y/N) NM ; for Holding Tank High -Water Alarm (Y/N) Nn Temporary Holding Tank Permit (Y/N) „IH Separation Distances from Septic/1oldirg Tank: To Water -Supply Wall To Building Foundation 'V' k+c.o. Tc Property Lire 2s'♦ To Disposal Field 10'+ To Water Main/Service- Lire ZS' t- To Stream, Pord, Lake, or Major Drainage Course NO CGmments origoal�n51�113-i�e,. 1975. ck�mle '$isle C.'Par4-V +-f-Q"X, 1000'7 c2oac"') Receipt $ 3q LI -,zjCi C1 Date Paid: $� Amount: 1 ncVlt- (Page 1 of 21 2-15-84 r. C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 85 (pr. c<o.d) Type of System Design xapaSc p } Date Installed 19-15 Length of Field 14' (pe,,. vrt0,8? Width of Field 14' e~ .+kora) ' Depth of Field 142' CK, yz wz Gravel Bed Thickness G' Square Feet of Absorption Area SsG'Cpe..e",cp Standpipes Present (YM) Y Depression over Field (YIN) N Date of Last Adequayy'Test T414 1586 Results of Last Adequacy Tast A44..Ab Xa', 4-6 ,inoses Separation Distance from Absorption Field: To Water—Supply Well Zoo'+ To Property Line ZS'+ To Building Foundation 3s' To Existing or Abandoned System on Lot N a ; On Adjoining Lots 100'+ To Water Main/Service Line 5m'+ To Cutbank(if present) NR To Stream/Pond/Lake/or Major Drainage Course N A To Driveway, Parking Area, or Vehhicle Storage Area 50'1 Cor a, nts L915 bt -9' &W " 1 .GAPS 10 -es -15 D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N).,X Comments Dime W ors ,Mai hole/Access (YIN) "Pump Off" Level at I Vent (YIN) Pumping Cycles during Adequacy Test. ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOVH. AA on the date of this inspection. Signed CA&9,a- .d Date '1 -L -8G Company Ces,.$4,c MOA No. ST86.oZ3 KB1/d5/s (Page 2 of 21 Mee is MOA nvfn'eefect ~00%.7 f .16; NO_ Tmd 4 k" Ione 29.81.19� 2-15-84 '1 EN TECH rl ENGINEERS, INC. CIVIL • SANITARY August 25, 1983 Mr. Larry Bradley SR 2, Box 4530 Hilltop Drive Chugiak, AK 99567 Re: Adequacy Test, Lot 2, Block 3, Troll Knoll Subdivision Dear Sir, On August 24 and 25 I performed an adequacy test on the septic system for the above listed lot. During the test 3200 gallons of clear water were discharged into the seepage pit at the rate of 10 gpm. Just before the water was shut off, the water level in the pit was rising very slowly. It appeared that the pit was absorbing water nearly as fast as it was entering the pit. It also appeared that it would not be possible to fill the pit using the 10 gpm flow rate. At the start of the test there were 4.25' of water in the pit. After discharging the water into the pit the water depth was 5.41. This was a rise of 1.21, and the water surface was approximately 0.5' from the top. Ten and one-half hours later the water surface was measured in the pit and it was 1/2" higher than the original starting level. As part of the test, the septic tank was pumped. A total of 1800 gallons was removed from the tank. I verified this volume by discharging a known amount of clear water into the tank and measuring the rise. At this time the absorption capacity of the seepage pit is very adequate for a 4 -bedroom house. I have attached an amended as -built drawing. Sincerely, Vernon L. Roelfs, PE 13 LE DOUX LANE • EAGLE RIVER, ALASKA 99577 • TELEPHONE (907) 694.3574 i a i a GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received May 11, 1976 Time of Inspection /:,V) p.(!1. 0( ✓�`�MM^ Date of Inspection Dpi - REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Conv. 1. Approval requested by: Alaska Mutual Savings 8 Fran Agate Mailing Address: 601 west 5th Avenue Phone: 274-3561 2. Property Owner: Alan L. & Helga Larson Phone: 694-2309 Mailing Address: Post Office Box 594, Eagle River 99577 3. Legal Description: Lot 2 Block 3 Troll Knoll Subdivision 4. Location: Hilltop Drive off of Ski Road, Peter's Creek z 5. Type of facility to be inspected Single Family No. of bedrooms �+ 6. Well DaCommunity ste�) A. Type B. Depth C. Construction D. Bacterial Analysis 7. Sewage Disposal System: On-site system /l // j A. Installed 10-13-75 B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank Absorption area Sewer Lines Nearest lot line Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages E Page 2 of two pages - Rust for Approval of Individual .`mer & Water Facilities Legal Description Lot 2 Blook,3�Troll,ill Subdivision _ •,' �_ .-ir.•::-:e c-� ' �o'" i.al ri ..,'•,i� c•r:a ^; rrtt:i:�r_. :, CO11iQen�Sr � _ -- r Appro Disapproved uate Ja1,Valid for one year from date signed Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ -034 (1/74) let sold past gas stations on the right is Ski Road, go straight to the-let road to the right off-of Ski Road, -go down road to-a house- - with a= shakes under the windows and is green, the house on the left of this green house-is the one-you-want.---The green -house -is-lot `3 the house on the left is lot.2, - - - — -- - o.k.?? i n MUNICIPA.UTY OF ADICHOPAC: CUT. OF HBAATH Z, ' A\ MUNICIPALITY OF ANCHORAGE ENVIRON..WNT,u KCIECTION 1 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 Em Tudor Road, Anchorage, Alaska 99504 276.2221 MY 1 1 1916 REQUEST FOR APPROVAL OF RECEIVED INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA / FHA CONV x 2. Property Owner: 141t74' Z t/ Mailing Address: PK9 /5nx594 Day Phone: 1,94-2-309 3. Name of Buyer: .L.w-/'y � C �S��rr •� � P Mailing Address:/SOS// Ti���J//i fir p ni +.�1. �Diay Phone: / 4. Name of Lending Institution: f��3 r�? �9v71U �� J,SV/blJp f �l//11 /� �vr '14 .7 Mailing Address: 11O//-t/,5'z/ .�Phone: -Z-74- —5 S6 5. Name of Realtor or Agent: Mailing Address: Phone: Z, 575E — G /� 0 9 6. Legal Description: /-0/0 ) fF/ e -I 31 /77e7 ern Location: 7. Type of Facility to be Inspected: �r� No. Bdrms. 2 8. Water Supply ✓✓ Type of Supply: Public UtilityO`NµT r Individual If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation /© —/y 72 003(7/76) DIRECTIONS FOR COLLECTING SAMPLES Of WATER FOR BACTERIOLOGICAL EXAMINATION- • . , Read Carefully and Follow Instructions Exactly Bear in mind that water analysis deals with materials present in very minute quantities. The least care- lessness in collecting and handling may give rise to results which are misleading. Samples are accepted at the regional laboratories In the early part of the week (Monday -Wednesday) unless there is an emergency or prior arrangements have been made. Arrangements should be made to have the water samples reach the laboratory as quickly as possible and within 48 hours after collection. After 48 hours, the significance of the bacteriological analysis is impaired. In collecting samples from TAPS or PUMPS proceed as follows: (a) Thoroughly flush tap or pump by allowing water to run freely for five minutes. (b) Shut off water and flame the outlet with torch or burning paper. The flame should not be merely passed over the outlet but should be applied until fixture shows indication of being hot. Flame should be directed against inside edge. (c) Open fixture so that a small stream flows. (d) Remove bottle from mailing tube. Hold bottle by the lower half in one hand and with the other remove the screw cap with the fingers, leaving foil protecting cover in place. Fill the bottle to the shoulder. Replace cap with foil cover, screwing firmly into place but do not apply pros - sure which will split cap. (e) Pack bottle carefully in mailing tube enclosing this completed information sheet. DO NOT COLLECT SAMPLES FROM FIRE HYDRANTS, YARD HYDRANTS, DRINKING FOUNTAINS OR SIMILAR OUTLETS WHICH ARE DIFFICULT TO DISINFECT PROPERLY. STERILE WATER SAMPLE BOTTLES ARE AVAILABLE UPON REQUEST FROM: Dept. of Health 6 Social Services Dept. of Health & SoAel Sem;ces Dept, of Health 6 Social Services Southeastern Regional Sanitarian Southcentral Regional Sanitarian Northern Regional Sanitarian Pouch J 778 Denali Strad, MacKay Bldg. 604 Barnette Street Juneau, Alaska 99801 Anchorage, Alaska 99501 Fairbanks, Alaska 99701 OrDistrictOffices in fairbanks, Juneau, Ketchikan, Kodiak, Nome, Palmer, Soldotno and Valdes. Consult local telephone directory for san4ation offices located in these communiliet. Anchorage area—cantact Greater Anchorage Area Borough Department of Environ - Menial Quality. Municipality of Anchorage O Q6 8 • Development Services Deociiiment Building Safety Division On -Site Water and Wastewater Program 4700 South 13ragaw St. s A r[ r r P.O. Box 196650 Anchorage, Ak 99519-6650 www.c1.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-521-04 HAA# //W 0906,27� 1. GENERAL INFORMATION Complete legal description L o t 2 ; Location (site address or directions) Current Property owner(s) Sheri Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Expiration Date: 1_714103 Block 3; Troll Knoll S/D 23727 Hilltop Dr., Chugiak, AK 99567 and Larry bradley same Bonnie King Dayphone 688-3489 Day phone Dayphone 688-2276 Unless otherwise requested, NAA will be held by DSD for pickup. 412 //6 /o L 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class A 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 5 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 sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certifidates 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 dale 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 systerd is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I turther verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S& S Engineering Addressl7034 N. Eagle River Lp Rd, Eagle River Engineer's Printed Name Robert C. Cowan Phone 6qA-297q AK Date OF ENGINE.. '� /nsd:. i ROBERT C. COWAN 2 •+- 5. DSD SIGNATUREji df`Ox:� CE -88.01 �`a Approved for bedrooms. Disapproved. '�zL�L1`"� Conditional approval for bedrooms, with the following stipulations: rf. j ON-SITE 3' WAIEKHNG Additional Comments. kNASTEWATER PROGRAM Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory SUpplemental Engineer's Report Well Flow Advisory Other By: + 1 Original Certificate Date: IZ-1410z (Rev. 12100) G. ENGINEER'S CERTIFICATION l certify`that l 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'sPrinted.Name . ��!� ��Cow4;J Date .. �. `.( o Z , l HAA:Fee $.. :.3:.75 , n o Waiver Fee.$;. Date of: Payment, 24 a Date of Payment Receipt Number a g l t f Receipt Number (Rev. 12/01) Dec 13 02 06:12p Bonnie J King 9076882275 p.2 Sb$- a- 17 E IsOWoto. SIE SErm Fire —cb&- (;E rrZ.oS >Jr �v� r\ a 4` love -- Lc •� : Igor°� 4 1 IWo r -Piz r dE I herghyeartlfy Ilial a survey of l01_V Rlnnk. ,d ..-•---_�_. Supdivision was made on __b41, 3p ....--.--._, and total Ina Improvements situated thereon are wllhln the properly linea and do not overlap or encroach on the property lying adjacent Ulerelo, that no Improvements on property lying adjacent thereto encroach on the premises in quastlon and that there aro no roadways, lransmiealon lines or other visible easomenls on said properly except as Indicated hereon. 11 is the responsibility of Ilia owner to determine the existence of any easements, covenants, or rastriellons which do not appear on the recorded stibdlvlaton plat Under no circumstances should any data hereon be used for consiruclinn or for establishing boundary or fence lines. Doted al Anbhoraga, Alaska, this .-. 1.6___-_ day of 1g T-00 r' CONSTIIUCTINO ENOINEEtts, INC. 0601 Buddy Warner Dr. Anchoraiga, Alaska y.bmep u �C7LrD PS Mp>ule j 1 S&.7 22 201� 3frZ'I •CJ G I'r L G I" -- q O I