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HomeMy WebLinkAboutTRAILS END BLK 7 LT 2Trails End Block 7 Lot 2 #015-192-04 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page of ON -SITE WASTEWATER INSPECTION REPORT Permit Number: OSP241127 PID Number:01 5-192-04 Dwelling: E Single Family (SF) El with ADU R Duplex (D) F-1 Two Single Family Project: El New E Upgrade Name DOUGLAS P SIMON ABSORPTION FIELD - ADVANTEX W1 FAP 2.0 El Deep Trench n Wide Trench E Bed E Mound Site Address 11441 BROWDER AVENUE, ANCHORAGE 0 Other Phone Number of Bedrooms Soil Rating Total depth from original grade 1 3 2 GPD/SFI 0.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 0 Ft, Gravel depth beneath pipe 0.5 Ft. Subdivision Block Lot TRAILS END 7 2 VARIES 2.49'— 2.55 Ft. Gravel length 15 Ft. Township Range Section Gravel width 15 Ft. Beds: Number of Lines 3 Distance between lines 5 Ft. SEPARATION DISTANCES To, Septic Absorption Holding 1 Sewer Lift Station ; I Total absorption area Number of trenches Dist. between trenches From Tank Field Tank 1 Line 225 Ft2 NA NA Ft. Well 50'+ 50'+ 50'+ 25'+ TANK El Septic El S.T.E.P. El Holding 0 Other ADVANTEX Manufacturer ORENCO ANCH. TANK Capacity 1500 Gal. Surface Water 50'+ 50'+ 50'+ Material COMPOSITE PLASTIC Number of compartments 2 Lot Line + 5'+ 5'+ 5' NA Foundation 10'+ 10'+ 10'+ LIFT STATION - PUMP BASIN Manufacturer ORENCO Capacity 75+ Gal. Remarks DECOMMISSIONED OLD SEPTIC SYSTEM & INSTALLED NEW AX FAP2 W/ PUMP BASIN & FIELD, BED INSULATED. Alarm location Electrical installed by FIRST FLOOR DRS Installer JRS PIPE MATERIAL House to tank 3034 drainfield Tank to 3034 Drainfield 3034 CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspection 16t 6/24/2024 . Location and description 3rd 6/26/24 4 1h 6/27/24 FOP OF MANHOLE MH) ON -SITE WATER AND WASTEWATER SECTION APPROVAL Conditional Approval: Date A t F 1H " 9 i ....4.... . ......... Septic System Aroved - Curtis Huffman Date CE128991 6/27/24 . S X� OPROFESSO,-0- Note: this approval does not include well permit requirements. kmtev VDIUZ/ jo) PID:015-192-04PERMIT:OSP241127 FIRST WATER CONSULTING TRAILS END BLOCK 7, LOT 2 3030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 firstwaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL : TRAILS END B7, L2 PERFORMED BY: FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 6/14/24 DEPTH FEET OG SOILS 1 2 ORG/OL 3 4 5 6 GM/sm/ml 7 8 BOH 9 10 11 12 13 14 15 16 17 18 19 20 Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE NA (MIN / INCH) TEST RUN BEWTWEEN NA & NA FT PERC HOLE DIAMETER 6” PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH. GROUND WATER ENCOUNTERED: YES IF YES, AT WHAT DEPTH: 4’ DEPTH TO WATER AT MONITORING: 4.5’ DATE: 6/14/24 TESTHOLE # 24-2 DATE PERFORMED: 6/7/24 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: GROUNDWATER MONITORING ONLY – SIMILAR SILTY SOILS PER ORIGINAL TESTHOLE. ADVANTEX BED WILL BE 3.5’+ ABOVE GROUNDWATER LEVEL MONITORED IN JUNE. PERFORMED FOR: DOUG SIMON 6/14/24 1 LOT 1 BLK 7 1 30' N89"59'30"E 190.00 If 7 V GRAVEL PARKING LLJ CD (D 0 0 0 0 w LOT 2 > < BLK 7 SHED r LLB Ld L) CK ctr_ 3' X 15' 16,32 0 (,ij CD CANT (D 0 0 .0, 2al-v 0 WELL co 301, 5'— (D 0 0 6_3 5 1�0 cc �SHED 1 CJ ry (D PAVED 0 it MHO M D/W a o EX/STING •�) 0 HOUSE M H VAULT SEPTIC 0 36. PIPE DECk- (typ) 1w _00 Cv X C14 83.0* N89*59'30"E 190.00' 4 K, LOT 3 BLK 7 ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: TRAILS END SUBDIVISION 00 FND 5/8" REBAR LOT 2 BLOCK 7 PLAT P-604 'W &X NN SUP SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a lopw��'. O.FN. L ANr AW physical survey of this property as shown on this drawing and that the 0 '� �~lop improvements situated hereon are within the property lines and no 00, enchroachments exist other than noted. Under no circumstance should , C'� 49TH 0�, �, r any information on this drawing be used for construction of fences, ..... .......... ....... structures, improvements, or for establishing boundary lines.?A ,� / tit .............. EXCLUSION NOTES: It is the owners responsibility, to determine yj ...... JPHN L. SCHULLER.- OR the existence of any casements, covenants, or restrictions which -.7'11� '-. do not appear on the recorded subdivision plat. �; LS-10408 1831 Talkeetna Street WORK ORDER NUMBER: -DATE: SCAILE. E-MAIL A JUNE 29, 2024 1 30' schullerokOgmail.com Anchorage, Alaska 99508 DRAWN BY. CHECKED BY; GRID NUMBER: 0 (907) 227-1455 office 24-066 e S S i 0 0 & N"A'alwow JLS SW2641 240230 (907) 274-4992 fax MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241127 Work Type: Septic Upgrade Tax Code Number: 01519204000 Site Legal Address: TRAILS END BILK 7 LT 2 G:2641 Site Mailing Address: 11441 BROWDER AVE, Anchorage Owner: SIMON DOUGLAS P Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft Total Bedrooms: 6/6/2024 6/6/2025 Q Disposal Field © Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed ori -e day, or b. Covered, sealed, an'd heated to prevent freezing---- ................. .... � I Provisions: • 7 day groundwater monitoring is required prior to construction. Please submit stamped and signed results with the As -built Inspection Report. If the results require a design change, construction of the system will stop pending On -Site review and approval. {deceived -By: ✓�f,�'�i� 'ho giL Date: Issued By: (/v Date: C;' ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-192-04 Property owner(s) DOUGLAS P SIMON Day phone Mailinq address 7955 MESQUITE CIRCLE, ANCHORAGE, AK 99507 Site address 11441 BROWDER AVENUE, ANCHORAGE, AK 99507 Legal description (Sub'd., Block & Lot) TRAILS END BLOCK 7, LOT 2 Legal description (Township, Range & Section) Lot Size 22,800 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (Z all that apply) Absorption Field 0 Initial D Single Family (SF) (w/wo ADU) Septic Tank Ifl Upgrade M Duplex (D) D Holding Tank D Renewal El Multiple Dwellings D Privy ❑ (SF and/or D) Private Well ❑ Water Storage D THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable MunicipaC (Signature of property owner or authorized agent) Permit/Rush Fees: dggz Date of Payment: Receipt Number: Permit No. 05 P c'2,�i 11 ZZ Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and WastewaterTorms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com ! June 6, 2024 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: TRAILS END BLOCK 7, LOT 2 The existing septic system has been found failed and will be completely abandoned or removed as designed and per the owner we request a septic permit to upgrade the existing septic system on the above referenced lot. We propose to install an elevated bed-mound with an Advantex FAP 2.0 system with pump basin to serve the existing 3-bedroom residence per the attached design. This will be a remove & replace per the proposed design. The design is based on the 5/18/84 test hole percolation rate of 27.8 minutes per inch or 239 square feet per bedroom also noted on the MOA Inspection Report conducted along the edge of the existing bed. Groundwater was observed on 1983 test hole at 8’ per MOA records. An unsatisfactory test hole on the north side of the property was recently conducted and the soils log is attached. Prior to construction a test hole will be conducted to verify groundwater per the attached design. The slopes are moderate at 0-3% at the proposed upgrade location. The lot and area are served by private water with no known private wells within 50’ of the proposed septic system. Based on visual observations and review of available information, the design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241127, Deb Wockenfuss, 06/06/24 FIRST WATER CONSULTING TRAILS END BLOCK 7, LOT 2 DESIGN CALCS: NO WELLS WITHIN 100' OF PROPOSED SEPTIC TANK NO SLOPES >25% WITHIN 50' OF PROPOSED FIELD. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241127, Deb Wockenfuss, 06/06/24 FIRST WATER CONSULTING DESIGN DETAILS: TRAILS END BLOCK 7, LOT 2 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241127, Deb Wockenfuss, 06/06/24 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 firstwaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: TRAILS END BLOCK 7, LOT 2 PERFORMED BY: FWCS / FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 6/5/24 DEPTH FEET OG SOILS 1 ORG/OL-PT 2 3 4 GM-sm/ml 5 6 7 8 9 BOH 10 11 12 13 14 15 16 17 18 19 20 Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE NA (MIN / INCH) TEST RUN BEWTWEEN NA & NA FT PERC HOLE DIAMETER 6” PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH. GROUND WATER ENCOUNTERED: YES IF YES, AT WHAT DEPTH: 4’ DEPTH TO WATER AT MONITORING: 2.7’ DATE: 6/5/24 TESTHOLE # 24-1 DATE PERFORMED: 5/29/24 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: ATTEMPTED PERC, BUT SATURATED SOILS NO PERC TEST / SOILS RATING PERFORMED FOR: DOUGLAS P. SIMON 6/5/2024 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241127, Deb Wockenfuss, 06/06/24 W&UNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC ON ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME Fele$ .PHONE 176 —/�` NEW ❑ UPGRADE MAILING ADDRESS a/d seW2��l �w LEGAL DESCRIPTION L.o4 Z Block 7 Trelith Ehd LOCATION ra 1. dai 5)4-ce /.,y NO. OF BEDROOMS .3 U Y DISTANCE TO: Well //S �� Absorption area��l TT Dwelling /O� PERMIT OS� ~ Manufacturer Greer Material SV No. of compartments z N Liq. capacity in gallons /O O IF HOMEMADE: Inside length Width Liquid depth DOz DISTANCE TO:. Well Dwelling PERMIT NO. _ F Manufacturer Material Liquid capacity in gallons w= DISTANCE TO: Well IZ •� Foundation 1 �Z-F Nearest lot line p �! T PERMIT NO. LL Z F Z No. of lines Le gthof pch line , Total length of lines Trench width inches Distance betwe lines Q F T op of tile to finish grade Or Material beneath the nches13 Total effective absorption area q'4 w f7 Length Width Depth PERMIT NO. i F w ° Type of crib Crib diameter Crib depth Total effective absorption area H DISTANCE TO: Well Building foundation Nearest lot line J J W Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER 6 PIPE MATERIALS P Ve SOIL TEST RATING ES i 11e1 r r f 3 O INSTALLER e REM RKS C2C rope of O - ()% Aqj!f Wck4 23Ct,F 2 - APPROVED APPROVED DATE LEGAL 42 72-015 (Rev. 3//8) try 1 � 6 k v '.!"'•. T R. F=#L—+11n ■ T �P` +�1 M1v..L.i� R%a ,� 44..1n DEPIRRTMENT OF' HEALTH FIND ENVIRONMENTAL`.PROTMTR N 825 L STREET, ANCHORAGE,,AK 96p6 i 264-4726 _ ,� QP4—:E3 I _r FE :SS:WF=FR & FSFEF_F_ FI'E'F-ZMi I d7tl '11 ' NG: i 8'4005 E' SSUED: 03/15104, ` _ICANT: FEJES DEVELOPMENT Ess: PO BOX 11-2009 ANCHORAGE, AK 99531 rAGT PHONE: 345-5022 iL,DESCRIP: SECTION: '24 TOWNSHIP: 1.2N RANGE: - $12E: 22560 (SQ.FT. OR ACRES) EDRo6MS: 3 E6 BELOW ARE THE OPTIONS AVAILABLE TO YOU IN DESIGNING YOUR SEPT IC EN CHOOSE THE OPTION THAT BEST FITS YOUR SITE.` FBF=F 4- TO -PIPE BOTTOM SFT.) 3.5 =1- DEPTHCFT. 7 0.5 ;DEPTH <FT.) 4.0 �,L '-WI:DTH . C FT'.) 26.0 # LENGTH (FT. > 51.0 EL • VOLUME'- CCU. YDS.) 49.3 >, litE CGALSY 1, 0019. 0 RATXNG` {SGA. FT. /BR) 296 EPTH TO PIPE BOTTOM < 4.1 FT. MAY REQUIRE A LIFT STATION 'RrK MUST HAVE AT LEAST TWO COMPARTMENTS kt IFY - THAT AM "FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND' WELLS': f RTH BY T14E LMUNICIPALITY OF ANCHORAGE (MOj) AND THE STATE.'.OF FIL ,,,WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND, In, f}ND'IN,COMPLIANCE WITH THE DESIGN CRITERIA OF THIS: PERMIT: TWILL ADHERE TO ALL MOA AND STATE OF ALASKA :REQUIREMENTS ;FOR THS- ' 'Vi StANCES'FROM ANY EXISTING WELL, WASTEWATER DISPOSAL SYSTEM ORI'OUi SEWERAGE SY,STEM'ON THIS OR ANY OR OR -NEARBY LOT. JNDERSTAND . THAT THIS PERMIT IS VALID FOR A MAXIMUM ,OF 3. BEY)R i( i 19KY.ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT. *..: LFT 51tA ION:IS INSTALLED IN AN AREA COVERED BY MOA'BUILDING CO C ).RN ELECTRICAL• PERMIT AND INSPECTION MUST 6E OBTkINED,'C2 ASS NQT,k APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT;-, ANDC ) �l fom WORK MUST BE DONE BY A LICENSED ELECTRICIAN. Df�tE • � j�'� '�^'r SANT. FEJES;DEVELOPMEN tr.. UN PALITY OF ANCHORAGE 1`0 6X_e,_, Department Hth and Environmenta*501 o0tion 825OStreet, Anchorage, AK. 264-4720 Permit #g&xoaO # # # HANDWRITTEN PERMIT # # # WELL AND/OR ON-SITE SEWER PERMIT Applicant:e�_t1�-.Gv ,c,( Mailing Address:t7 Location: Phone Number: y 0/ Legal Description: L a Q") o/4e"Lot Size: 'r Type of Soil Absorption System Is: Trench: Drainfield: _ _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: -3 Soil Rating(sq.ft/br) -:G 2 f?bJu"%Ib The Required Size of the Soil Absorption System is: DEPTH V __ LENGTH-24vyd' _ GRAVEL DEPTH 6 �/ WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(Fet:B MG) TANK SIZE _ /00 y GALLONS # # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * # * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection.and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that 3b)gdrooms. Signed: Issued by: j �pplican �' Date: -7 SWP/024(1/81) ❑ SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 2644720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Cnri S F�d`P'S DATE PERFORMED: 5-19—Ptl LEGAL DESCRIPTION: Lf' 1 SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19- 20 -,147, v.vo � so,b a� le,,io syjA-.n WAS GROUND WATER ENCOUNTERED? flfC- IF YES, AT WHAT DEPTH? '13-w ° k^IA ■■■■■■■■■■ Date Gross Time Net Time Depth to Water Net Drop ■N. ■■■.■■■ 1 5-1q-84 1,00 1a ■©. oas ■■■■M■■ EMISOMMOMME tl a NO NEINIENE t■0\�JI■I 3 I log EMw .3 - „ 1.,aI a - Io� 1' rU 11 1; 33 N EE S 1:43 mom KPI .vim) INEENEEMENE I I MENEENNIMMOMM Reading Date Gross Time Net Time Depth to Water Net Drop 1 5-1q-84 1,00 1a .5-45 oas — tl a 3 I Itdl .3 - „ 1.,aI a - Io� 1' rU 11 1; 33 _ S 1:43 KPI .vim) I I PtH(:ULA I ION HAIL y—/ --/j' lJoN C%04minutes/inch) TEST RUN BETWEEN 3 A FT AND J-13 FT PERFORMED BY: (26AA2n ! MC4 tn+ CERTIFIED 72-008 (6/79) • �• �• IQ SOILS LOG - / MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: `-I'I )K J DATE PERFORMED: Y A j lY. !fl-Y.J DESCRIPTIOPVWIJI -2 Date Grass Time 3 Depth to Water C -1M -^ 4 6 id3 5 69 7 6 7 5.to „ 8� 9 pit- 10 - t a 11 - id- A0 nor) 13 14 15- 51617181920 16- 17- 18- 19- 20 SLOPE q2�-/z06 �'/) Jo5 WAS GROUND WATER S ENCOUNTERED? LO P E IF YES, AT WHAT _Ca1Q01la3 DEPTH? /.i I W-� �i COMMENTS CIA PERFORMED BY: T 72-008 (6/79) Reading Date Grass Time Net Time Depth to Water Net Drop `I 5— 6 id3 69 7 ,U 176 t a Ia'- - id- A0 nor) PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN L�. J�sFT AND FT CERTIFIED M CP0n0 nTRL C0nTROL SAGS InC. RLR�KR , Engineering & 6nuironmental Studies SPECIFICATIONS FOR SEEPAGE BED ALTERNATIVE WASTEWATER TREATMENT SYSTEM— LOT 2, BLOCK 7, TRAILS END SUBDIVISION 1.0 GENERAL 1.1 THE DRAWINGS, SHEETS 1 THRU 2, SHALL BE A PART OF THIS SPECIFICATION. 1.2 ALL MATERIALS AND WORKMANSHIP SHALL MEET THE REQUIREMENTS OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERMIT. 1.3 IT IS THE RESPONSIBILITY OF THE OWNER TO OBTAIN ALL NECESSARY PERMITS OR EASEMENTS. 2.0 LIFT STATION (NOT USED). 3.0 SEEPAGE BED 3.1 THE GRAVEL FOR THE BED SHALL BE SIZED BETWEEN 0.5 TO 2.5 INCH AND RELATIVELY FREE FROM SILT OR SAND. 3.2 THE BOTTOM OF THE EXCAVATION SHALL BE RAKED WITH THE BACKHOE BLADE TO INSURE THAT THE BOTTOM HAS NOT BEEN COMPACTED DURING EXCAVATION. THE BOTTOM ELEVATION SHALL BE PLUS OR MINUS 2". 3.3 THE DISTRIBUTION PIPE SHALL BE 4 INCH RIGID PVC OR POLYETHYLENE. THE PIPES SHALL BE LAID LEVEL. 3.4 AN OBSERVATION PIPE SHALL BE PLACED AS SHOWN IN THE DRAWINGS. IT SHALL BE RIGID PVC, ASTM 3033 D-3034. THE SECTION SHOWN WITH HOLES MAY BE EITHER DRILLED 0.5" HOLES @ 6 INCH CENTERS ON OPPOSITE SIDES OF THE PIPE OR A REGULAR SECTION OF REGULAR PERFORATED DISTRIBUTION PIPE MAY BE CLAMPED TO THE SOLID SECTION WITH A NO HUB COUPLING OR SOLVENT JOINT. A RUBBER RAIN— CAP (JIMCAP OR EQUAL) SHALL BE PLACED ON THE TOP THE PIPE. 3.5 THE GRAVEL SHALL BE COVERED WITH A LAYER OF UNTREATED BUILDING PAPER OR A NONWOVEN FABRIC SUCH AS MIRAFAR FIBRETEX 200 GRADE, OR POLY—FILTER X OR EQUAL. 3.6 THE INSULATION SHALL BE DOW EXTRUDED BLUE STYROFOAM BOARD, ARCO GEOFOAM EMBANKMENT INSULATION BOARD OR WESTERN INSULFOAM II OF THE THICKNESS SHOWN ON THE DRAWINGS. 3.7 THE TOP OF THE BED SHOULD BE PLANTED WITH A WHITE CLOVER AND RED FESCUE MIX. 1200 West 33rd Ruenue, Suite B • Anchorage, Alaska 99503 • (907) 276-1361 ALASKA AIMERTAL COnTROL SAUS, InC. Engineerinq & Enuironmental Studies June 29, 1984 Department of Health and Environmental Protection 825 L Street UG Anchorage, Alaska 99501 Attention: Keith Bandt Re: Trails End, Block 7, Lot 2 Dear Keith, Qin 13)3a P6619 Inc NOND31oud 1b1N31'VN0 $®Y8NI ®tb dOALnd1 81,> I visited Lot 2, Block 7, Trails End on June 25, 1984, at approximately 1:00 P.M. The preliminary landscaping has been canpleted and no depression exist$ over the drainage field. The water test, sampled May 21, 1984 resulted in a satisfactory analysis. I recarmend removal of the conditional Health Authority. Approval for the Certificate issued May 18, 1984. REG/caj e- '1' 0u 1200 West 33rd Ruenue, Suite 3 9 Anchorage. Alaska 99503 9 (907) 561-5040 ALASKA ENVIRON JOeTa is -thy a{oma 7 L_of 2 CONTROL SERVICE SHEET Ho. 1 OF 2 1200 West 33rd Avenue ui e B M . La n r L -24 - S3 ANCHORAGE, ALASKA 99503 CALCULATED BY DATE ,Phone 276.1361 CHECKED By DATE OOOOI ml N[. [ M 01471 ALASKA L ERONM S CONTROL ERVICf 1200 West 33rd Avenue UMFB ANCHORAGE, ALASKA 99503 Phone 276.1361 aoe Ir is Gn� dla�k � Lok Z SHEET NO.{� • -OF `L -CALCULATED BY M L4VV' DATE CHECKED BY DATE MWIICfmLI �� 6+a IK aril. LOCATION OF WELL SO .f'ry (Please complete either la, Ib or Ic.) fOATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geologicol & Geophysicol Surveys Drilling Permit No. ;1, A.D.L. No. to. Borough ANCH Subdivision TRAI(5 ENV Lott ph Block 7 Ib. /4gtra. _of_of_af_ Section No. Township N❑ Sp Range EE] WE] Meridian Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS Street Address and Area of Well Location 3. OWNER OF WELL; Address: CH1215 F£!E$ SRA QOX 9-0 1 t f1 epi AR 95 2. WELL LOS Feet Below Surfoc Material Type Top Bottom B 4. WELL DEPTH: (final) J 16/7 ft. 5. DATE OF COMPLETION R LCA-- — &L — - - -j- 6. ❑ Cable. tool � Rotary ❑ Driven ❑ Dug Auger ❑ Jetted ❑ Bored ❑ Other: /{ YE 6 — ty❑ e -F AV CIL s ` $t SLAY?® — Domestic ❑ Public Supply ❑ Industry Irrigation C] Recharge ❑commerical ❑ Test Well ❑ Other: I I4 V f `y"❑ A).24f(10.r1 N i^ U l�/ II t� (Z 8. CASING! ❑ Threaded 19 Welded diam.(_In. tol-4 ft. Depth Weight 17"t Ibs./ft. diam. _ In. to_ ft. Depth Stickup ft. "WIV S. FINISH OF WELL; Type: Diameter _ Slot/Mesh Size; Length; Set between ft. and ft. Backfilling Gravel pack 10. STATIC WATER LEVEL: 4? ft. 1'en tAT/83 C] Above or ❑ Below land surface . Date Equipment used: it I1. PUMPING LEVEL below land surface and YIEL JW _L52—fl. after _A_hro. pempin9mg•P•m. ft. after _hra, pumping — 2-P In. 12.6ROUTING. Well Grouted: [] Yea ❑ No Material; ❑ Neat Cemenfl C] Other: 13. PUMP: (if available) HP Length of Drop�,Pipe ft. capacity 9 -P.M. CS ubm. 0 Jet 0 Centrifical ❑ Other 14. REMARKS: All? LIEF e,flMp(NG 16. WATER WELL CONTRACTORS CERTIFICATION: 15. Water Temperature _o ❑ F ❑ C This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief; .. W N. W H iTE W GU ,U2lLL N46 A- (o-7 goo Registered Business Name Contract License Number Address: A Signed: Date: 27 49c 7- 93 Aufhorizsd Representative s = Form 02-WWR (11/81) Copy Distribution: WHITE -State OGGS, PINK-Drillert CANARY -Customer :mm Certificate of On -Site Systems Approval Parcel I. D. 015-192-04 Legal description TRAILS END BLK 7 LT 2 Site address 11441 BROWDER AVE Anchorage AK Current property owner(s) SIMON Z Expiration Date: � Z2 Sf X The On -site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or advisories: M bedrooms, with the following stipulations: Original Certificate Date: 7/1 /2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval June 2022 MUNICIPALITY OF ANCHORAGE "A MOM= 4 Development Services Department AQ01, Phone: 907 -343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Ef" Certificate of On -Site Systems Approval Application' 1. GENERAL INFORMATION Parcel I.D. 015-192-04 Complete legal description TRAILS END BLOCK 7, LOT 2 Location (site address) 11441 BROWDER AVENUE, ANCHORAGE, AK 99516 Current property owner(s) DOUGLAS P SIMON Day phone 2. ON -SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: Z Private Well 0 Private Well serving 2 dwelling units El Private Well serving 3+ dwelling units E] Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: Z Private Septic R Private Septic serving 2 dwelling units R Holding Tank R Community Septic or Public Sewer 5. SEPTIC TANK: Fj Steel H Plastic R Concrete R Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: Z AWWTS E Bed 0 Deep Trench F1 Wide Trench F1 Seepage Pit Waiver request for: Expedited review requested: Z Distance: By applying for this entitlement, this property is subject to inspection by municipal On -site staff to verify the accuracy of the information provided. COSA Fee $ Waiver Fee $ Date of Payment Date of Payment COSA # 05C Z_ Waiver # COSA Application.doc COSA Checklist NEW.docx COSA Checklist Legal Description: TRAILS END BLOCK 7, LOT 2 Parcel ID: 015-192-04 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 10/19/1983 Total depth 160 ft Cased to 159 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 5/22/2024 Static water level at beginning of test 58 ft. Well production at time of test 1.8 gpm Water storage tank volume NONE gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 2.17 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 5/22/24 Comments B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NA – ADVANTEX <1YR Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station NEW years Lift station material PLASTIC Comments: NEW ADVANTEX SYSTEM D. ABSORPTION FIELD DATA Which system tested (date installed) NA - NEW ALL standpipes present per record drawing Total measured depth from grade 2.55 ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective (ED). If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date NA – NEW FIELD Results Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS – POST RECOVERY – NOT TESTED Effective depth (per record drawings) 6 in (MOA 0.5’ ED) Effective depth used 0 in (Missing ED + Final Fluid Depth) Effective depth (ED) remaining 6 in Comments/Deficiencies: Approximate total measured depths from existing grade. COSA Checklist NEW.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No *50+ ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No *50+ ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No *5+ ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No *50+ ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No *50+ ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS *MAY MEET CONVENTIONAL SEPARATIONS, BUT SYSTEM MEETS CATIII SEPARATION DISTANCE REQUIREMENTS. G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date XXXX Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & XXXX DocuSign Envelope ID: 4A9DB65A-C781-48D3-885B-4E521484FC50 MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this Day of '-3—,k l -L of 20q, by and between -a OC.�iFf t-V , herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced 'Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as AN ADVANTEX SYSTEM located at (legal description) TRAILS END BLOCK 7, LOT 2 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Q X Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. '�),,�4—"Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 DocuSign Envelope ID: 4A9DB65A-C781-48D3-885B-4E521484FC50 Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. ;' Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided r--•-rb the�,�„.}+, WTS, uendor4astaller and approved by the Municipality are the governing uictPit�'fo,klieinucton, maintenance and repair of the Owner's AWWTS. ii -1 ()wr a ,a�r�ggsAoSftointain r1mote monitoring of the AWWTS as required by the 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 DocuSign Envelope ID: 4A9DB65A-C781-48D3-885B-4E521484FC50 OWNER: By: _ 1_ (signature) Date:. �- r~,y�,� a C/ H fi 1 A L-b (print name) STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this day of J un2 20A,by `ockeQtq )-or 01 J,` t o.fAlaska NQTARY 1'UBLi 'FOR ALASKA State My Commission expires: — u --,),O;� NOTARYPUBLIC Qrade Hanneman My Comft1cn EVIms Apr 10, 2027 MUNICIPALITY r By: �� (signature) 7D L,,-5 (%" (print name) Date: t/a),2' Title: C t v? (-- C'-4 (";, 7 /Z (rev. 05/18/2018) Page 3 of 3 Municipality of Anchorage On -Site Water & Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-192-04 Expiration Date: 1.1-141-13 1. GENERAL INFORMATION Complete legal description TRAILS END; BLOCK 7 LOT 2 Location (site address) Current Property owner(s) Mailing address Real Estate Agent 2. TYPE OF DWELLING: 11441 BROWDER *ANCHORAGE AK 99507 BJARNE & ROBIN HOLM Day phone 11441 BROWDER *ANCHORAGE AK 99507 AUDREY MASON Day phone N Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 346-3910 632-0573 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ Received by: 2- Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ _ q O Date of Payment r cJ l I Receipt Number 0ouk 3r+� COSA # neD ' l Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 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 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 report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE _System #1 Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following Phone 337-6179 Date - Z o, -c �.....,... . x, A. r ess CE 3 .•' ttll OF ON-S►TE VVATER AND " E PROGRAM Original Certificate Date:�t J The Munrcipalo or A, age Develop,emt 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 engineers work. 7. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory ram ivnel Nitrate Advisory Arsenic Advisory Other 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: TRAILS END; BLOCK 7, LOT 2 Parcel ID: 015-192-04 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (YIN) YES Date completed 10/19/83 Sanitary seal (Y/N) YES Wires properly protected (YIN) YES Total depth 160 ft. Cased to 159 ft. Casing height (above ground) 12+ in. FROM WELL LOG Date of test 10/19/83 Static water level Well production AT INSPECTION 7/17/13 ft. 60 ft. g.p.m. 2.4+ g.p.m. WATER SAMPLE RESULTS: Coliform U colonies/100 ml. Nitrate L S L mg./L. Collected by: GEG. Ltd. Arsenic: N P ug./L. Date of sample: 7/17/13 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 4/20/84 Tank size 1000 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (YIN) N/A Date of pumping 6/7/13 Pumper ONE STOP PUMPING C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 4/20/84 Soil rating (g.p.d./ft2or /bdrm 290 System type BED Length 24 ft. Width 56 ft. Gravel below pipe 0.5 ft. Total depth 5.08 ft. Eff. absorption area 1344 ft' Monitoring tube YES Depression over field NO Date of adequacy test 7/17/13 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 4�0 gal. New depth E in. Elapsed Time: 0 min. Final fluid depth E in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) TERRALIFTED If yes, give date 6/12/13 THERE ARE NO C/O'S IN THE BED, ONLY A SINGLE MT. BOTTOM OF MT IS 0.62 FEET LOWER IN ELEVATION THAN THE POST TANK C/O. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off' level at—====r High water alarm level Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankilift station on lot 100,+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Sewer /septic service tine 25'+ Animal containment areas 50'+ 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: Properly line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 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 COSA guidelines in effect on this date. Engineer's Pr dName JEFFREY A. GARNESS Date /I 2-' i (Rev. 11/05) OF ,J fr Ga ess:. -E 7 . � bL r V 'V 1 pm,.'c3w m .1 lVi C CD 9 M Z �� +� Cr aC� �•, P�� z Alt r a S Y TO ALASKA STATEWIDE TERRALIF€ 'The EorMsholrlrtg solIdlon for Problem Soils" 4212 Harca St., Eagle Raver, Alaska 99577 907-622-7153 2182 RAY WORK TERMS- T#TY..i . � � ;.OATEkIAL..' Wit GYFAMMC ®I-"= TOTAL MATERIALS VES s+ RIP'tION OF WORK TOTALOTHER TOTALLABOR TOTAL MATERIALS TOTAL OTHER Worhor6eredby %�Yfril�iiTC/�C� T Signature I ",-byaCmrnskA9e 41e sati5lartory ccmP�tion W €he atwve daectiUed work. T " k -s7 O MUNICIPALITYHEA OF TH& ANCHORAGE • DEPARTMENT OFFHEALTH &HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE _OF -HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 01 5— 142 — O U 1. GENERAL INFORMATION 2. 3. 4. �� •.li ` • Complete legal description Loi 42, BV, 7 i 1? A. I Lg I= N iI Location (site address or directions) 11 44 t QouUD t-- r2 Propertyowner 40Lt-4( S 3A4t Day phone 3+1b— 3g/o Mailing address Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone Day phone 9 "" Imo P51� NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site v 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(R".1/91) Front MOA#21 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. Name of Firmi m 46e H Phone Address Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for Additional Comments bedrooms. Date '/ %9 Y 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 does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. n.M(Bev.1N1) Balk MOA821 C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pump off" Level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed va /G • 2-Y Soil rating (GPD/Ft) A Q O System type 73 EU Length g ('0 Width 2 Gravel thickness d It Total depth 5 IF Total absorption area 13Y V Cleanout present (Y/N) _Depression over field (Y/N) Date of adequacy test 2 to Results (pass/fail) for Bedrooms r/ Water level in absorption field before test b 0 After test b Peroxide treatment (past 12 months) (Y/N) nI If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1.2S On adjacent lots ? X00 Properly line 44 To building foundation _> 10 To existing or abandoned system on lot —V On adjacent lots >30 Cutbank N O A t Water main/service line i 50 Surface water N 0 heff Driveway, parking/vehicle storage area > 6c Curtain drain�[� E. ENGINEER'S CERTIFICATION I certify that l have checked, verified, or conformed to all MOA and HAA guidelines in Signature Engineers Name I glob_-- ui c` Date HAA Fee $ 1300 • UD 02 Date of Payment Receipt Number 72-026 (6193)' Back oil Waiver Fee $ Date of Payment Receipt Number. Q11V% to of this inspection. OFA4. `11 ,en Spurkland CE -2225 � �OFESS��`® ® Municipality of Anchorage aim • Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L 2, BK 1 1 roK I4 iN ef Parcel I.D. 0/ A. Well Data Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed 1*11q 9' Driller 4 r tJ, 014 / 7A;: Total depth )/•O Cased to />; 9 Casing height A1. Sanitary seal (Y/N) Wires properly protected (Y/N)—E FROM WELL LOG AT INSPECTION /� A n Date of test l 0 •1 Q • 8� ' l G • 4 y rn C7 �, M 1'71 ry Static water level Ll 7 %C Well flow 'S g.p.m. g.p.m. ry-1 4�- 1 �b > 13`� v <i Pump levell y c O II Z SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot //S ; On adjacent lots i 1 rrt� Absorption field on lot 1 •Z5 ; On adjacent lots i 1OO Public sewer main Iy/i4 Public sewer manhole/cleanout W/A. Sewer service line 1 rD Petroleum tank W C ✓1 *-- WATER SAMPLE RESULTS: Coliform Nitrate 6.Ii�;rtOther bacteria - Date of sample: r� • / L r 4 y Collected by: -T-7.% B. SEPTIC/HOLDING TANK DATA Date installed #2Ua -Tank size I Compartments 'ice Cleanouts (YM) Foundation cleanout (Y/N) 7V Depression (Y/N) High water alarm (Y//N) N�/�- Alarm tested (Y/N) ' onA Date of pumping, W) 1113 Pumper A 11 J SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 11.5 On adjacent lots i 1 B{7 Foundation 10 To property line 1 10 Absorption field h Water main/service line _i �6 D Surface water/drainage qh 72-026(U3)'From CONTINUED ON BACK PAGE T 00 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 2 B-ock 7 Trails End Subdivision Location (address or directions) (b) Applicants Name Fejes Development 1blephone Applicants Address (c) Applicant is (check one) Lending Institution Owner/builder xx ; Buyer Other � (explain); (d) Lending Institution Rainier. Mortgage % Linda Telephone Address (e) Real Estate Co. 5 Agent Banner Realt Address Telephone 2. Type of Residence Single -Family EEKI Multi -Family Other (describe Number of Bedrooms three 3. Water Supply Individual Nkll r—x—xl Commanity � Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Is the well adequate for the number of bedrooms specified in this HAA (YM) 4. Sewage Disposal Onsite Eli Public r:::� Comaunity Holding Tank Is the wastewater disposal system adequate fcr the rumber of fedrooms (YM) [Page 1 of 21 2-15-84 5. Engineering Firm Providing Inspections, Tests, Data and Information I certify that I have checked, verified, or conformed to all MDA HAA Guidelines in effect on the date of this inspection. Signed Date Name of Firm Telephone Address Signed by Date (ENGINEER SEAL) 6.DHEP Approval Approved for three bedrocm Approved � Disapproved Terms of Conditional Approval The engineer(A.E.C.S.) has confirmed the conditions set forth have been completed and documentation is on file with this Department. This property is now fully approved and meets with MOA Ordinances and codes. By (LWa-[ Date July 9, 198 Conditional The Municipality of Anchorage Department of Health and Environmental Protection does not guarantee the continued satisfactory performance of the water supply and/or the wastewater disposal system. This approval indicates that, as of the validation date shown above, based on the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and funr tional for the number of bedrooms and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the following address: KB2/d5/s (Page 2 of 21 2-15-84 of MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information (a) (incline lot, block, L>//1 f L T Location (address or directions) (b) Applicants Applicants Application Date section, tainSship, range) (c) Applicant is (check one) Lending Institution Owner/builder ; Buyer Other r:::j (explain); (d) Lending Address (e) Real Estate Co. & Agent eL�e (_ T Address ( `' , l / lr. Y"� : r Telephone 2. Type of Residence Single -Family L7:" Number of Bedrooms 3. Water Supply Multi -Family i Other Individual ill = Community Public Note: If community. well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Is the well adequate for the number of bedrooms specified in this HAA (YM) Y 4. Sewage Disposal Onsite � Public Ccmminity Holding Tank Is the wastewater disposal system adequate for the number of bedrooms (Y/N) Y (Page 1 of 21 M4=011 •0 �s 5.,Engineering Firm Providing Inspections, Tbsts, Data and Information B certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Date I Name of Firm CS -77"U4 Address (?c'v 33r,1 /�Lyc S✓-) R-eC-O MvVkd CvK 46`bKal orP1 Signed by id\- LaVJSC[�)ol Nj c. -j "S14 1 f s a P WAFert Date /9 1 (ENGINEER SEAL) 6.DHEP Approval Approved for - bedroc s Approved Disapproved P, Conditional The Municipality of Anchorage Department of Health and Environmental Protection does not guarantee the continued satisfactory performance of the water supply and/or the wastewater disposal system. This approval indicates that, as of the validation date shown above, based on the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional for the number of bedrooms and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the following address: KB2/d5/s [Page 2 of 21 2-15-84 f40 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 A. WELL DATALegalZ 13 Legal Description: �K -1 _V4:IS ttJp SubdiViS Ion/ Well Classification -xua w;d.Aa) If A, B, cr C, D.E.C. Approved(Y/N) N// - Well Log Present a) Date Completed OCi )`{� /Q �3 Yield 5 q em Total Depth Cased to I Depth of Grouting uN8 Static Water Level 4-7-4- Pump Set At Casing Height Above Ground ).$ �4- Sanitary Seal on Casing &N—) Electrical Wiring in Conduit Ay" Depression Around Wellhead (YAQ Separation Distances from Well: To Septic/Holding Tank on Lot i On Adjoining Lots GT /oo,�I- To Nearest Edge of Absorption Field on Lot 125- ; On Adjoining Lots CrT/ooft To Nearest Public Sewer Line N 'Gl- To Nearest Public Sewer Cleancut/Manhole N//� To Nearest Sewer Service Line on Lot N/ Water Sample Collected By n GooDcnl ; Date 13 m4q84 11:30pw1 Water Sample Test Results Counts B. SEPTIC/HOLDING TANK DATA 1,l,1e 14"I'l 2 Date Installed y - to Size /C)Or) No. of Carpartments 2 - Standpipes Standpipes (Y/N) Y Air -tight Caps (Y/N) Foundation Cleanout (YIN) Depression over Tank (YM) jJ Date Last Pumped Pumping/Maintenance Contract on File (YM) — ; for --- Holding Tank High -Water Alarm (YM) Temporary Holding Tank Permit (YM) Separation Distances from Septic/Holding Tank: To Water -Supply 4 11 IIJ 44- To Building Foundation To Property Line To Disposal Field (y�l To Water Main/Service Line s- To Stream, Pond, Lake, or Major Drainage Course GT 1 oo 4- '� i (Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design 561161 lbee( Date Installed �j , -Lo -14 Length of Field SG 10 - Width of Field y,( -t JL Depth of Field (p i H Gravel Bed Thickness Square Feet of Absc ption Area Standpipes Present (Y/N) �( Depression over Field (Y/N) Y Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well ( Z To Property Line / 1.Z2 To Building Foundation 2 L To Existing or Abandoned System cn Lot Or. Adjoining Lots CGT /auk To Water Main/Service Line — To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course G T / Op i_1— To Driveway, Parking Area, or Vehicle Storage Area S C(� f - Convents GrwUwo _,oW VtYurncFo CuN,15caWl' D. LIFT STATION J Date Installed _ Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) -� Vent (Y/N) Pumping Cycles during Adequacy 'Inst. Lets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all M on the date of this etion. Signed ) Date Company / t C -S MOA KB1/d5/s [Page 2 of 21 2-15-84 =t