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HomeMy WebLinkAboutGRACE #1 LT 2Grace #1 Lot 2 #017-042-59 (Previously McMahon #1 B3 1.37) Municipality of Anchorage Page of Z 72-013 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: r�1c/130/,A,6:r_?:;,LI PID Number: G/�OgZZ�o Name: Fes, �•C. Wastewater System: ❑New upgrade Address�_,,O !�! CoCo3 99sey ABSORPTION FIELD Phone: No, of�rooms: Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: / Z Total Depth from original grade ' GPD/Sq. Ft. /� Lot 1 Block G Subdivision: 1 Depth to pipe bottom from originalgrse: Gravel depth beneath pipe / Ft. Ft. Township: Range: Section: Fill added above original grade Gravel length: Q — Ft. Z.1- Ft. • WELL: El New ED Upgrade Gravel width: J/ Number of lines: Distance b tween lines: d Ft. �-/ Ft. Classification (Private, A//B, C): I fI{�T� E /HJT Total Depth: Cased To: Total absorption area:ggQQ Pipe material: Fgio J�'Q 66 C FL FL SQ. Ft. ✓ Driller: Date Drilled: Static Water Level: Installer: Date installed: Ft. q TIX)6700 Yield Pump Set at: Casing Height Above Ground: TANK GPM Ft, Ft. SEPARATION DISTANCES Xseptic LAk ❑Holding ❑S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines Wellt 45' Materia a Number�fCompartments: Watere I It�t — — LIFT STATIO Lot�` !� �. Size in gallons: Manufacturer: Line 10/ — Foundation 3 gfJ r- �. -- "Pump on" level a "Pump off" level at: High water alarm at: Curtain —^.. I N i hj Puue<ake&Model Electrical Inspections performed by: Drain Remarks: BENCH MARK Location and Description: R eA e 54Ae Assumed Elevation: /zfo� EhLGINe Mf SSE9L m e S e Jar !.: S & S ENGINEERING� a � � � .e �°i Inspections performed by: 170a®ale Rtver L°°P Road, NOD 1st Z ti Eagle ver, Alaska 99577 2nd a 9 i s""' ° �°°"'•� xoe.. s,.t« • ®4. No. 1457-E Department of Heal and Liman ervices approval •.°,°,. Fo �, Reviewed and approved by: Date: 7--12- 12- ]2-013 (Rev. 9/91) MOA 25 Permit No. SW930135 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description McMAHON SUBDIVISION, BLOCK 3, LOT 37 PID No.: 01704226 A B 47 FCO 12.5 14.8 COl 37.0 30.4 CO3 83 3 87.5 NS R N. 40 _ �� ✓ MT4.. 957 8 80.8 M�RGP cos NEW TRENCH T. H. MT -C-------- i-- — — -- C-_----� AUTION GAS LINE) �R (NEW 1250 GAi, - (SEPTIC-- TANK co m coB 3 BDRM W1 ok cot HOUSE ry FCO - \ A - 10•_UTIL ESMT P � \ wER C,0� 0 URL Ip a/Nrq/t SrR£ fr \ o \ \ \ o yIUS SCALE 1" = 40' _ 10' SCREENING &FENCING ESMT c01 CO2 MT L GRA"" rn4: 92.4 1EW 2 0 GAL 72-013 A (Rev. 9/91) MOA 25 78.4' NO WATER SEAL 0 rt�A� Shxfar• � e� �. No. 1457-E a rj�F :,,.•'`....`ter PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW9301.a-g�'A DATE ISSUED: 6/01/93 DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE: 6/01/94 OWNER NAME:FDIC s/ U_O OWNER ADDRESS:P.O. BOX 196639 I CP �� ti— ANCHORAGE, AK 99519-6639 PARCEL ID:01704226 r%i O �? kA L/L LEGAL DESCRIPTION: MCMAHON #1 BLK 3 LT 37 LOT SIZE: 47981 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 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 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: 4� RECEIVED BY: DATE: ��F/?2 ISSUED BY: DATE: ! HEALTHAUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSALSYSTEM DESIGN 10�0 I Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, AK 99519-6650 McMahon Subdivision, Block 3, Lot 37 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907)694-2979 FAX 694-1211 We request you issue a permit to upgrade the septic system serving the referenced property. An adequacy test was performed on the existing system and the absorption capacity of the system was found to be inadequate. A test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information for your review, please contact us. Shafer, P.E. /LSU/lsu 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 40' sc�c� UPGRADE %C o r v �• i O i �� �n p r rn s ANW Z r � o0W 1 � r N cn O v A Y� JC) o 1 o D Z ° o N00+� C� ° O-" OH a ,? m p IA .3 1 _ rl Z m m m C)C)-0 tOr m w �� m .• z � C N CJ ! cn H0 �a O II V %C • v �• i O i �� �n p r rn s %C + z Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825"L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFOR:.:E ^_ FOR S/QQQ)/",/1T/���%U�11E_ �Cl;l3i�Z�r? DATE LEGAL DESCRIPTION:] Yl e/✓ AM,11 GL.I.JTownship, Range, Section: 1 P 2-N 3 4 .o v 5 6 y' 7 B e 10 - 11 12 13 v 14 15 a 16- 17 6 17 aA 18 D 20 c -. 9V V lsaALreU. SANZr w LlI7Lrx 70 No FlNel. GW SLOPE I . —1 WAS GROUND WATER �L ENCOUNTERED? IF YES, AT WHAT c — 1. O DEPTH? P E Depth 10 Wale' Plte Monitoring? Dale. 4h0 SITE PLAN Reading Date Gross Time Net Time Depth to Water Nei Drop — it _ s y MEN M 14 -- r. MMON OMS .OFF: 1/f1i Reading Date Gross Time Net Time Depth to Water Nei Drop — it _ s y y„ 14 -- r. 1 YY &o'R. �( d PERCOLATION RATE _J.— (minutes/inchry)��PERC HOLE DIAMETER TEST RUN BETWEEN �ND _8 FT COMMME�N-TS AAS PERFORMED BYJ7034 Eagle River Loop Road N0.204 Eagto River, Alaska 97577 ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELIN,( 72 008 (Rev. 4,85) I ON THIS DATE. DATE: THAT THIS TEST WAS PERFORMED IN 19VTO 11 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage; Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME - PHONE NEW ❑UPGRADE MAILING ADDRESS LEGAL DESCRIPTION �.-- 3l'1j LOCATION (� �R \1vTR\L NO. OF BEDROOM? J v y DISTANCE T0:ell Absorption artea Dwelling PERMIT NO. '1%\ QManufacturer w F Material L No. of compartments - Liq. capacitygallons IF HOMEMADE: Insidelength Width -` \V Liquid depth N DMZ DISTANCE TO: Well Dwelling PERMIT NO. SZ F Manufacturer Material Liquid capacity in gallons w= DISTANCE TO: ell Foundsion �, C>`O Nearest lot line �,o PERMIT NO. —181© -1 j W Z F= W Ir No. of lines Length of each line Total length of lin s Trench width a inches Distance between lines _ r IV CC Top of the to finish grade ! tt Material beneath the �1 inches Total effective absorption area W l7 Length Width Depth PERMIT NO. <I- Wd Type of IM Crib diameter Crib depth Total effective absorption area ta DISTANCE TO: Well Building foundation Nearest lot line J J ss Depth Driller Distance to lot line PERMIT NO. 3DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS q SOIL TEST RATING INSTALLER NE N AJ�iT N .yr d G -I �q S REMARKS -F I POT pu S m 40 Q1 VED DATE LEGAL /2-u13 (Hev. 3/76) IL. I T'r' JDF FihIG HtiGE %t�taV /7 DEPARTMENT CPWHEALTH AND ENVIRONMENTAL PMETECTIL r 825 'L' STREET, ANCHORAGE, RK. 99501 v c� 264-4720 WELL F=1"ry 01P4—:S I TE = EWEF= F�EI?t't �;-T PERMIT NO. C 781017 ,9LLe�5 APPLICANT ED HERZOG 2415 E. 20TH 277 3166 LOCATION PINTAIL ST LEGAL L31 B3 MCMRHAN S/D LOT SIZE 20000 SQUARE FEET TYPE OF SOIL ABSORSTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT='BR7= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: GEF~TH= 33 LE"C3-r"=2r� C3FZFl%/F t_ EiEPTH= ?' THE LENGTH DIMENSION IS THE LENGTH CIN 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 CIN FEET). THERE IS NO SET WIDTH FOR. TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET7. F2EQ1J I FZEL7 SEPT I I` TF�lr4K " S3 112! E: 11310i0 (3F711 L_ 01 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. --- TWID <;0 ? I N'�F='EC-'T I C3 "'ES RFZE-FZI=-CA _FI F=,�EED, -- 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. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'EFcR'M I T E:XF�' I FRES CD[El_..EME3EFZ s1: 1'_=l :' :s I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FORCON-SITE SEWERS AND WELLS AS SET =ORTH BY THE MUNICIPALITY OF ANCHORAGE. t: I WILL INSTALL THE SYSTEM IN ACCORDANCE 44TH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE 2ESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. > I GNED APPLICANT ED [SSUED ey_ ` s ----DATE '� � V3. 2 PERFORMED LEGAL PERFORMED BY: 72-008(7/76) 0 . SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION Pouch 6850, Anchorage, Alaska 99602 276-2221 TEST L /J SOILS LOG — PERCOLATION TEST 6 j ��� �C Cl 9DATE PERFORMED:z4-2 ff 43,7 /3 V'; -S o r•Vj 4L r J Z j 14s f i�Ly 7 ( i¢7 1 INX11 5C.lh C. SLOPE PLAN WAS GROUND WATER A L ENCOUNTERED? 'V O P IF YES, AT WHAT E DEPTH? Date Gross Time Net Time Depth to Water 1 I I ! �✓ i 14eI till L I =1 � I WAS GROUND WATER A L ENCOUNTERED? 'V O P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water 1 I I ! Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT CERTIFIED BY: DATE:iv-1, 4'/ O SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 85 7eet DRILLED AT THE RATE OF 37.9-00 PER FOOT. PROPERTY OWNER fitt, fd tivt xa 2418 t;. 20th hye. lidwwae LOCATION OF WELL SITEB.LI . Sub. DRILLER BeAAte C aUA of ?.ampalLt A --Z LIJuy U o&k.0. WELL LOG 0----22' Sd.L� c lacy w t & 201£ Vzaue.L. 22---64' Hatdpm. 9tauei with 40% c g&.. lle * haltd. 64---85' Wet 4 tt* q&ave,L with, 150% cdact. A 4ma,LL anount of- teateA pltoductaoa at. 66 feet. wZa 40 deet oj� wa telt 4tWad &L ca tagn . Coot of- j)k,i.LLtaq: $1615.00 Coat of WeU Seat: 422.00 COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF 91637.00 THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPART DRILLING WORKS DATE 12ov. 26th, 1978 �; � ,V�t. Q -jJ ellkk SERVICE CHARGE OF I%z% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS, Parcel LD Municipality of Anchorage A lilil ga On -Site Water & Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL 017-042-59 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Real Estate Agent Expiration Date: 2 15- GRACE S/D #1; LOT 2 ( FORMERLY MCMAHON S/D #1; BLOCK 3, LOT 37) 12725 PINTAIL STREET, ANCHORAGE, AK, 99516 STEVE COCHRAN Day phone 345-6084 12725 PINTAIL STREET, ANCHORAGE, AK, 99516 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Day phone TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ W aiverNariance request for: Received by: 1 r7 Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 52L.— Waiver Fee $ Date of Payment illIgtts Date of Payment Receipt Number �0 5i3C' Receipt Number COSA # (JJ /51 LO Waiver # Distance: - 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 wafer 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 *ANCHORAGE, AK, 99507 Engineer's Printed Name Engineers Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG provided an engineering evaluation of the well an&broptic system in accordance with the guidelines and regulations established by the Munlcipalify of Anchorage and industrypractices. The reported results describe the condition of the systems on the datels of the eva'vatian. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may staid that were not identified during the evaluation. ins operational life of all wells and septic systems depend on a variety of variables including, but not limited to, soil conditions, groundwaterlevels (that may fluctuate during the year), qualify of construction (materials and workmanship), and the water usage of the family utilizing the systeaVs. These conditions can vary, and are outside the confrel of GEG. Satisfactory test results do not guarantee future performance of the cycler s therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property to the am either of the current systems fail. The content of this report is for the sole benefit Mahe persoNparfy who retained GEG. Reliance upon The information provided in this report by my other person or party, including but not imiled to subsequent property purchasers, is not authorized. In short, GEG disavows any legal duty to anyone other than the person/pady who paid for (his report. 6. DSD SIGNATURE la System #1 Approved for 3 bedrooms. Phone 337-6179 Date -4-k L am System #2 Approved for bedrooms. `s Rr— '7G Disapproved. �= ON-siTE WATER AND Conditional approval for bedrooms, with the following stipulations: v WAgTEWATER PROGRAM H Original Certificate Date: The gni litykW)j!!cg Develop,emtServices Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenata ions given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. - 7. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory (Rev. 1011912) Nitrate Advisory Arsenic Advisory Other V 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: GRACE SID #1; LOT 2 ( FORMERLY MCMAHON #1; B3, 1-37) Parcel ID: 017-042-59 'SEE ATTACHED AAROW PUMP & WELL SERVICE RECEIPT VERIFYING A. WELL DATA NO BREAKS, CRACKS, OR PERFORATIONS TO ATLEAST 60 FEET. PITLESS WAS SEALED. Well type PRIVATE If A, B, or C provide PWSID#N/AA Well Log (Y/N) YES Date completed 11/26/1978 Sanitary seal (Y/N) YES Total depth 85 ft. Cased to '85 ft. FROM WELL LOG Date of test 1112&1978 Static water level 45 ft. Well production 15 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Arsenic: ND ug./L. B. SEPTIC/HOLDING TANK DATA Nitrate 11.3 mg,/L, Date of sample: 311 212 01 5 Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 3/13/2015 7.18+ g. p, m. Collected by: GEG, Ltd. Tank Type/Material SEPTIC/STEEL Date installed 7/2/1993 Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) NIA Date of pumping 3/12/2015 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA VBELOW EXISTING GRADE Date installed 7/2/1993 Soil rating(Ed./ r ftlbdrm) 1_2 System type TRENCH Length 24 ft. Width 3 ft. Gravel below pipe 8 ft. Total depth *15.0 ft. Eff. absorption area 384 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 3/13/2015 Results (Pass/Fail) PASS For E bedrooms Fluid depth In absorption field before test 20 in. Water added 790 gal. New depth 39 in. Elapsed Time: 1� min. Final fluid depth 23 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date a D. LIFT STATION Date installed Size in gallons ManhoWAccess "Pump on" level at in. "Pump off" level at a r alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanknift station on lot 1011'+ On adjacent lots 100'+ Absorption field on lot IW+ On adjacent lots 100'+ Public sewer main WA Sewer /septic service line 26+ Animal containment areas-----E+— Public reas 50'+ Public sewer manhole/cleanout WA Holding tank WA Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation g+ Property line g+ Absorption field 5'+ Water main WA Water service line 10'+ Surface water . 100'+ Wells on adjacent lots 100'+ PRIVATE( 200'+ COMMUNITY SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation IW+ 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'+ PRIVATEJ 200'+ COMMUNITY F. COMMENTS NOTE: LOT TO NORTHEAST ( FORMERLY MCMAHON S/Dlt1; B3, 1-34) HADA PRIVATE WELL ON IT BUT THE HOUSE WAS DEMOLISHED AND NO FACILITIES APPEAR TO BE ONSITE. ACCORDING TO THE CURRENT LOT OWNER ( GRACE BRETHEREN CHURCH) THE WELL WAS DECOMISSIONED BUT NO OFFICIAL DOCUMENTATIQN EXISTS. THE WELL G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field Inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date �%S-A� (Rev. 10112f/2) k, p 49 TTTH SHANE A. HOLT : e N N8955'06"E 58.61 THE INFORMATION HEREON I5 FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS: AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINE S. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN HEREON ( UNLE55 INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCE55IVE SNOW AND/OR ICE. AS -BUILT SURVEY V = 30' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 2, GRACE NO. 1 ( PLAT 98-173) ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS _19TH DAY OF _MARCH 2015. HOLT LAND SURVEYING 600 HIGHVIEW DRIVE ANCHORAGE,AK 99515 12866, FB 170-39 345-5513 Municipality of Anchorage Community Development Department Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 151150 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 2 of Grace #1 subdivision. This inspection revealed a nitrate concentration of 11.3 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. 01/14/2015 10:17 907-345-0202 ALPINE DRILLING AAROW PUMP & WELD SERVICE, LLC P.O. BOX 110496 Anchorage, AK 99511 Office: (907) 346.9355 , Fax (907) 345-0202 Eagle River: (907) 622-9335 PAGE 01/02 OHMOCE No. 10404 Joe SITE F eve, 00G rc, f xled ck a e, L 3 5- IJ L J I WELLDEPTH SWL CHLOR INATEO PUMP DEPTH aALESPERSON ':DESCRIpT10N.hRICE< ..: AMOUNT . "o Yea s C ack o er ol�a io _ P55 3 G� ofYl 4 t' s PAY THIS AMOUNT Thank You SIGNATURE (I Hereby Acknowledge the Satlefactory Completion of the Above Described Work and agree that if above work is not paid for In 90 days I agree to allow Aarow Pump & Well Service, L.L.C, the right to remove unpaid for equipment and charge for labor already performed & labor to remove unpaid for equipment.) TERMS. ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE. SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS. LABOR HOURS RATE AMOUNT TOTAL MATERIAL TOTAL LABOR WORKORDERED BY TOTAL LABOR PAY THIS AMOUNT Thank You SIGNATURE (I Hereby Acknowledge the Satlefactory Completion of the Above Described Work and agree that if above work is not paid for In 90 days I agree to allow Aarow Pump & Well Service, L.L.C, the right to remove unpaid for equipment and charge for labor already performed & labor to remove unpaid for equipment.) TERMS. ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE. SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS. AST- N GARNESS ENGINEERING GROUP, Ltd =a = - Qmm CIVIL & ENVIRONMENTAL ENG FNEEI2S -- April 27, 2015 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road, Anchorage, Ak 99519-6650 (907)343-7904 REFERENCE: Nitrate Levels and Well Configuration. To whom it may concern, The subject property is served by a private well and a septic system consisting of a 1250 gallon septic tank and a trench type drainfield. A water sample, collected on 3/12/2015, revealed nitrate levels of 11.3 mg/L. While this elevated level raises concern, it is important to note the following facts: The well log indicates that is was cased throughout the whole depth of the well. Surrounding records (see attached), indicate that the water from the adjacent properties wells contain significantly elevated nitrate levels. Certain wells have revealed nitrate levels as high as 12.3 mg/L. In short, we do not believe it is likely that the well casing is culpable for the elevated nitrate levels throughout the surrounding area. It is understood that a nitrate level advisory shall be issued, notifying the buyers of the potential risks regarding the water quality. If you have any questions, please contact us at 337-6179. I55" 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com MUNICIPALITY OF ANCHORAGE M}fi DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# l( 1-1-Il1IO- aln HAA# 0i��\ '01'):]1 1. GENERAL INFORMATION Complete legal description Lot 37: BF'ock 3: McMahan Subdivision � Location (site address or directions) 12640 Mong nnos CL&aLe, Anchorage Property owner Mailing address Lending agency Mailing address Agent Address F.D. I.C. / Contact: Anne. Gainey Day phone 269-3575 Re#5915/unabd'k ¢ P.D. Box 196639, Anchohage, Ataska 99519-6639 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 \+ 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water Day phone Day phone NOTE: if community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: if community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 021 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 Address 17034 Eagle River Engineer's signature 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments 0 WTIC Phone,�; Z/� Date J z.� S. wk .'"' �'•k q. 9-N 1457.E bedrooms, with the following stipulations: Date .,7 1�2 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST HGr'!++'sFo,J auP�c7it/�sioil'Y/ Legal Description: 3-7 Parcel I.D. oma/ ZZ A. Well Data Well type _F 1 VA -rIf A, B, or C, attach ADEC letter. ADEC water system number 0_�/71 . Log presen&N) Date completed P-261 Driller 72A/"/P>42T —Det L/mac/ Total depth Cased to QZ� Casing height /z "t Sanitary sea (Y ) y Wires properly protecte (Y ) FROM WELL LOG Date of test Static water level s i Well flow g,p,m. Pump levell /QV_ AT INSPECTION p m . �? uJ SEPARATION DISTANCES FROM WELL TO: oz Septic/holding tank on lot O 19 `J ; On adjacent lots /o f N GC.., O Absorption field on lot g.p.m. T Public sewer main �� /E o QT m T , f WATER SAMPLE RESULTS: Coliform (N Nitrate ' 22 n!R l/ Other bacteria Date of sample: �2 b 3 Collected by: fi 5 EX 5 t . B. SEPTIC/HOLDING TANK DATA Date installed _7 Tank Tank size /Zw 4 '�2"/-Compartments Z Cleanout(Y ) Foundation cleanout�Y N) Depression (Y� High water alarm (YN) Alarm tested (Y/N) Date of pumping zc) Pumper i.J Illn" SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 45 On adjacent lots Foundation / To property line 62Z— Absorption field 3Co Water main/service line /6 Surface water/drainage /DZ If - 72 -026 (3/93)* Fmnt 7" 72-026(3/93)*Front CONTINUED ON BACK PAGE �? uJ SEPARATION DISTANCES FROM WELL TO: ® Septic/holding tank on lot O 19 `J ; On adjacent lots /o f N GC.., O Absorption field on lot �� Z� ; On adjacent lots 16D Public sewer main �� /E Public sewer manhole/cleanout f Sewer service line 2S Petroleum tank WATER SAMPLE RESULTS: Coliform (N Nitrate ' 22 n!R l/ Other bacteria Date of sample: �2 b 3 Collected by: fi 5 EX 5 t . B. SEPTIC/HOLDING TANK DATA Date installed _7 Tank Tank size /Zw 4 '�2"/-Compartments Z Cleanout(Y ) Foundation cleanout�Y N) Depression (Y� High water alarm (YN) Alarm tested (Y/N) Date of pumping zc) Pumper i.J Illn" SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 45 On adjacent lots Foundation / To property line 62Z— Absorption field 3Co Water main/service line /6 Surface water/drainage /DZ If - 72 -026 (3/93)* Fmnt 7" 72-026(3/93)*Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons _ Vent(Y/N) High water alan on" level at Manhole/Access (Y/N) "Pump off" Level at Cycles tested Meets -PGOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ��ZI `f Soil rating (GPD/Ft) �- 2— System type !)ZE&P 772cUC/� Length �4 Width I Gravel thickness g r Total depth /48 r Total absorption area �81 Cleanout presen (Y N) Depression over field (Y6_11J Date of adequacy test / ��� Results (pass/fail) Bedrooms Water level in absorption field before test Z/Y& After test Peroxide treatment (past 12 months) (Y r) If yes, give date i SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 162 On adjacent lots /6b -t-- To building foundation 85e� line To existing or abandoned system on lot /6 4— On adjacent lots 30 1-- Cutbank /,/0.-/6 Water main/service line /D 4— Surface water / fi Driveway, parking/vehicle storage area ZS Curtain drain E. ENGINEER'S CERTIFICATION I certify that / have checked, verified, or conformed to I Signature 17034 Eagle River Engineer's Name Date HAA Fee $ Date of Payment Receipt Number ��FB/✓� 72-026 (3/93)' Back and NAA guidelines in this inspection. 204 Waiver Fee $ Date of Payment Receipt Number ✓n &) cr.�7s�o-e 1 y may 1 q 5. LEGAL DESCRIPTION - 0. ' DEFT. r._ _ MUNICIPALITY OF ANCHORAGE ��; _-;.,, ;7'ON DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 • PLEA$J�,`t4S2I! Can you tr ENVIRONMENTAL ENGINEERING DIVISION to get this to me in 2 d Telephone 264-4720 Su�j �p Yiate it. REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER PHONE Ed Herzog Builder Herzog Construction ❑ COMMUNITY 277-3166 MAILING ADDRESS depth (attach log if available.) 2418 East 20th Avenue, Anchorage, Alaska PROPERTY RESIDENT (If different from above) **If individual/on-site, give installation date PHONE N/A ❑ PUBLIC UTILITY 277-3166 2. BUYER PHONE LORENTZSON, Carl M. Home 272-3964 MAILING ADDRESS Work 659-5592 2439 E. Northern Lights Blvd., Anchorage, Alaska 99504 3. LENDING INSTITUTION Attention PHONE Alaska Mutual Savings Bank Debbie Johnson 274-3561 ext. 241 MAILING ADDRESS P. 0. Box 1120 Anchorage, Alaska 99510 4. REALTOR/AGENT PHONE Cher Brown - Dynamic Realty 279-7611 MAILING ADDRESS 5. LEGAL DESCRIPTION . Lot 37 Block 3, McMahan Subdivisiont STREET LOCATION NUN Pintail Street Anchorage, Alaska 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS - XU SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY jjj Three ❑ Six 7. WATER SUPPLY XKI INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM XXK] INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) /) U VS? THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE - DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY - ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED INSTALLER SOILS RATING -. - ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL - 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS u.,v' APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE I BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78) 5. LEGAL DESCRIPTION MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO10EPT. OF HEALTH & • 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTION STREET LOCATION ENVIRONMENTAL ENGINEERING DI, ISION �7 T 2 a 1978 Telephone 264-4720 I 'C4jLos REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEKfi WILY" DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE ❑ MULTIPLE FAMILY Pg� Three ❑ Six 7. WATEF3, SyPPLY MAILING ADDRESS 7 INDIVIDUAL* h ❑ COMMUNITY PROPERTY RESIDENT (If differeff from above) PHONE 2. BUYER PHONE **If individual/on-site, give installation date , ❑ If system is over two (2) years old an adequacy test is required MAILING ADDRESS by this Department. 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDEN NUMBER OF BEDROOMS L�K SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY Pg� Three ❑ Six 7. WATEF3, SyPPLY 7 INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date , ❑ If system is over two (2) years old an adequacy test is required PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED INSTALLER ❑Septic Tank or ❑Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS ❑ APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78)