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BASE HILL LT 2
Base Hill Lot 2 x'051-441-09 Municipality of Anchorage Page ::L of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: Cpl O S O 33 K PID Number: S 1 —44 k —oq Name: t t Wasewaer System: O New Y 24 Upgrade Addn{La 'r\iTa \AAAG ABSORPTION FIELD I , Phone:No. o- - 45 3 AS l g 9- o Ms'room 3 O Deep Trenc O Shallow Trench O Bed O Mound O Other LEGAL DESCRIPTION Soil Rating Total Depth from original grade: G F Lot: 2 Block: SubdivislM SF 1 LI_ Depth to pipe bottom from original of Gravet depth beneath pipe Township: Range: Section: Ft Fill added above original grade: FI. Gr el length: Ft Ft. WELL: ❑ New ❑ Upgrade Gravel width: Number of s' 0stantabet are liner Clasen n (Prlvele, A,B.CI: Total Depth: Cased To: Ft Total absorption area, Ft. Pipe material: Ft. Ft. Driller: Date Drilled: Static wale Level' Ft. SO Ft. Installer s Dale Installed' Yield GPM Pump Set at: F,. Cam -04,01t n�t Above Ground: \Ft. TANK REPLackMvNi SEPARATION DISTANCES YiSeptic El Holding 0S.T.E.P. To From Saptle Tank Abwrprbn FNId Lift Station Hek10p Tank WkNMua S—r Lines Manufacturer. . ���� Capacity In gallons: l D O o W011 ` 1004 1004 1 Q Q'1' ji I /1 '('i NIA �5 ,�, Material: "9 ^ � r Number of Compartments- waters 100-� (00:1}. /h - '^- LIFT STATION LotLine 101 10 4- 0 I A A • Size In gallons Man f t Foundation l:v $ f v r% I n '` N "Pump on, level at: 'Pump off' level High water storm at• Curtain Draln ♦ 1 i1 Pump Make 6 Model Electrical Inspections performed by: Remarks: BENCH MARK Location and Deserlptlon: a 6 Ae i� z✓ Doo i� Assumed Elevation: EN ^........... T t.� Inspections performed by: S 70 S Cngln 2tn ales: Is 9 ao a �t +r ROBERT C. COWAN fA bepatimetit of Health and Ntiman Sewl es app�ovai ' �? w �i%r;; � Reviewed and approved by: Pjl � Date: g -z 7- okilliii;_ ,. r;via t.ev. wv,t roar. zp PERMIT No. SW050338 PACE 2 OF 3 Municipality of Anchorage DEVELOPMENT SERVICES DEPARTMENT ENVIRONMENTAL SERVICES DIVISION P.O. Box 1966500 Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report LEGAL _LOT 2, BASE HILL S/0 P.I.D. No. 051-441-09 X—X—X—X—X—X—X .. HJ J s�, w o,0 3 X —X —X i h' O , POWERLINE ESMT. DIVISION STREET Ajv__5 U FCO z W W 53.59.5 ST2 z H 60.55.5 X DBL2 63.57.5 W 50.5 57.0 EXISTING 64.0 3 BDRM MT2 HOUSE IBM _1 :. Y. ::ice:. �• U X —X —X i h' O , POWERLINE ESMT. DIVISION STREET SCALE 11% 40' A p, ROBERT C. COWAN14 �4 ''c CE 8801 1\ Ajv__5 B FCO 12.01.0 ST1 53.59.5 ST2 58.03.0DBL1 60.55.5 DBL2 63.57.5 COF 50.5 57.0 MT1 1 64.0 70.5 MT2 95.5 86.0 SCALE 11% 40' A p, ROBERT C. COWAN14 �4 ''c CE 8801 1\ PERMIT No. SW050338 PACE 3 OF 3 Munici alit of Anchorage DEVELOPMENY SERVICES DEPARTMENT ENVIRONMENTAL SERVICES DIVISION P.O. Box 1966509 Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report LEGAL LOT 2, BASE HILL S/D P.I.D. No. 051-441-09 FINAL GRADE 92.0 ST I ST 2 INSULATION 87.5 NEW 1300 GAL. POLY. TANK 87.7 OF lt. (7�T •+���ti sett 10, ROBERT C. AN �vr•. C£-8801 NE'9"S�'s�"s 299.77 ASBUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: AND THAT NO ENCRO4CHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSi3ILITY OF THE OWNER TO DETERMINE THZ EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHANY DATA HEREOOULD FOR CONSTRUCTION OFFENCE L NES,NOR FORBE USDESTABLIISHING BOUND- ARY LINES. ye DATEt GRID- FBS /vim z Z DRAWNi �e r`,`P�� pF. A C�S le �.• Dven. Mirk 5.w --d / �` LS -'6916 • — MUNICIPALI7YOFANCHORAGE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SWO50338 Legal Description: BASE HILL LT 2 Date Issued: Sep 08, 2005 Expiration Date: Sep 08, 2006 Parcel ID: 051-441-09 Design Engineer: 0003 S & S Engineering Site Address: 015811 DIVISION ST Owner Name: HENRY DEACON Lot Size: 40474 SO. FT. Owner Address: GENERAL DELIVERY Total Bedrooms: 3 Permit Bedrooms: 3 GRAYLING . AK 99590-9999 This permit is for the construction of: Ej Disposal Field ❑Q Septic Tank Holding Tank ❑ Privy Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. C n n Received Issued By. Date: 3 1 10 S Municipality of Anchorage .• Development Services Department ' Building Safety Division i On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.c i.enchorage.okus (907)343-7904 Installation Requirements for Septic Tanks in the Municipality of Anchorage: • Steel - Steel septic tanks shall be placed on undisturbed soil at the bottom of the excavation for the tank and backfilled with a granular material free of large rocks or boulders to a maximum depth as prescribed on the exterior of the septic tank. The tank may then be backfilled with 12 -inch maximum layers of granular soil and trampled evenly following the placement of each layer. • H.D.P.E: H.D.P.E. tanks shall be placed on a compacted or undisturbed bedding of sand/gravel mixture or clean granular soil. Allow clearance around the tank to properly place and compact backfill. All H.D.P.E. tanks shall have a vertical length of 4 inch perforated drainpipe installed beside the tank extending from the bottom of the tank to grade to monitor the ground water table. HAKE. tanks shall be installed so that a maximum of one foot of the tank bottom will set in the seasonal high ground water table. The tank shall be backfilled with 12 -inch maximum layers of granular soil and trampled evenly. • Fiberglass Tank - Excavate at least twenty-four inches beyond all sides of the tank to allow room for proper compaction of fill. Set tank level on a minimum 4 inch thick compacted sand or granular bed overlying a firm compacted and uniform base. Backfilling is a layering process that involves backfilling, compacting the backfill, and filling the tank with water to a level just above the compacted backfill layer. Backfill should have a uniform gradation and be free of any deleterious materials. Typically'I" crushed rock or pea gravel or sand is preferred. Each backfill layer should be uniform, no greater than 24 inches thick, and of nearly equal height around entire perimeter of the tank. M mutiicipOity or Anchohlige • -- Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ek.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. _ b51- 4L41- 09 Permit Number SW Property Mailing address Sop 026__011 Day phone `}'53-SIZZ, IAAR�y V AW DEEI K7MAX 1 E _ Pa\rw-Was,lla N1C14 - Zip Code 99 US -4 Site address 15 % k\ D tJ\s I'jYk ST Zip Code `19 S t7 4 - Legal description (Lot, Block & Sub'd.) UA- Z- . �f\S'z— N 1 q- S� 0 Legal description (Section, Township & Range) Lot Size -40, 4;?`f-AsreclS 3 THIS APPLICATION IS FOR: Number of Bedrooms 3 Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade 79j THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ certify that the above Information is correct. I further certify that this application is being made for a Single Family Dwelling and Is In accordance with applicable Municipal Codes. S & S INGINKERINC (Signature of property owner or authorized agent) "� `'a" A` &.�r �� �- lap% Rivw, Aloka 99577 Permit/Rush Fees: z<0 . 6U Waiver Fees: Date of Payment: r/& lbs Date of Payment: Receipt Number: Receipt Number: (Rev. 09/04) , .bnGineepin!_ ROBERT C. COWAN, P.E. M 7 CMLENGINEERS (907)694.2979 FAX(907)694.1211 September 2, 2005 1EAUHNITNOWTY APPROVALS MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 SEWER SWATER MkINE%TENSIdd Anchorage, AK. 99519 MAME REFERENCE: Lot 2, Base Hill Subdivision SEWER 6 WATER NSPECTICN It is requested that you issue a permit to upgrade a septic system with a proposed 1000 gallon HDPE septic tank to serve the existing three bedroom dwelling on the referenced property. ENGINEERINGSTtAIES /NDREPORTS We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent WEIMINSI'EA MOWTEST properties. If you require additional information, please contact us. SITE PLANS Sincerely, ROAD DESIGN 4IA" obe C. Cowan, P.EE. RCC/jhm SOS TEST Enclosure PERCOLATION TEST STRUCTURALS MECIWACAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER. ALASKA 99577 SITE PLAN TANK UPGRADE 1" = 40' DIVISION STREET„s q lYA a 151 POWERLINE ESMT. ';',; o n ■ •peon & Tete Esmt o '� Q � OMEJ € CAP $�>� YijQm xozc in Z � m x 0-3 Ex cmx N cj Vl pti NV ~ ref �5 .'.� vim•.Yls<_ C�'�'qOr- PEAT1' Omu C12i ppm Cnrir.;;♦/%:'.YNN ny .0ylV Z. n Elm rc ca WW r Rmo n�r:o- A x—x—x ” r d 0 z co1s 0 QeQ� tz¢`� 1 Z z N m y>e6+ tic I �t ^�p�z� � 4 N M`$�`am �Q/ .O ��I'Dj JCKwI'1 la \AO�f`O y e.aaz 016 3-1a O.. \�cfl m o �7 0 Rmo ON m r X X—X—X—X—X—X—X a tz—v tngineenlnG ROBERT C. COWAN, P.E. CIVILENGINEERS (907)694-2979 ON-SITE WASTEWATER DISPOSAL SYSTEM FAX(907)694.1211 CONSTRUCTION PRACTICES and 'F �TMURM01tl1V MATERIAL SPECIFICATIONS APPRWAI.S REFERENCE: Lot 2, Base Hill S/D SEWERSWATER September 2, 2005 MW E MNSIONS GENERAL: SEWERSWATEn 1. The scope of this project includes the upgrade of the existing system, INSPECTION with replacement of the 1000 gallon HDPE septic tank to serve the existing three bedroom residence located on the referenced property. ENGINEERINGSRpIES 2. Construction shall be in accordance with thea roved site plan and PP ANDREPORTS design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. WELL INSPECTION 8 RLCWTEST 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. ROAD DESIGN 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the 500.TEST Municipal Health Department. PERCO AT,ON TEST SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. WCKA' NrX INSPECTIONS 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. ONSITE WASTEWATER DtSP06ALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER ALASKA 99577 ' Page 2 Lot 2, Base HIII SID September 2, 2005 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 fl. 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. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Tvne 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, Femco, 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. Page 3 Lot 2, Base Hill SID September 2, 2005 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the 4200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted alter 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, cleanouts, 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. 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. CONTRACTORIINSTALLER 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 NAMEPHONE /,�� - ❑ N �.J - �'�'/ a C%L° / ��/ G� lr PGRADE MAILING ADDRESS LEGAL DESCRI N a&//� �' LOCATIONNO. OF BEDROOMS Well/ / Absorption are (� Dwelling ( PE ITN l U DISTANCE TO: yi m Z LU Q ~ Manufacture-'- Maperi� / No. of compartments to Liq, ap it ing�llons IF HOMEMADE: Inside length Width Liquid depth D te JAZ DISTANCE TO: Well Dwelling PERMIT NO. 2 z F Manufacturer Material Liquid capacity in gallons O w= DISTANCE TO: WeII�[ Foundation ,� Near st lomat line �.. — P MIT NO/ / JZ Z No. of lines Length of each line Total length of lines h Trenr2� Distance between lines Z w inches G H Top of the to finish grad / eripl be tieit Total effective absorption area 72- inches Length Width fuvpul PERMIT NO. w (D aF- Type of crib Cri ame er Crib depth Total effective absorption area W WI y Well Building foundation Nearest lot line DISTANCE TO: J J Class eptb �/ Driller Distance to lot line PERMIT NO. W Building foundation DISTANCE TO: Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING t INSTALLER I gyp! •,00 REMARKS 1 57 • No. 0 14 C o ` N lloG- 4. L-) es.;�nA •a . tl�. ` � �lz o� �� roces> Al AP O DATE LEGAL 7k -T3 (Rev. 3/78) Twl 0-3 04 1 (� ���1 -T- Ir' CA FO FA rJ C_ *-i FQ FA Ci EE`_ DEPHRTMEN, HEALTH AND ENVIRONMENTAL !OTECTION 825 'L' STREET, ANCHORAGE, HK, 99501 - 264-4720 (:.-j PA l7- En "I E= C4 EE FA? To'FEE IT! T-1 :10F PERMIT NO. ( 811144 ) APPLICANT JIM SPHNGLER S&S ENG 688-2594 LOCATION DIYISION ST LEGAL OT 5IZE 40000 SQUARE FEET ' ��� ' -'- ���- � ' � /J"10 �/)\ ��/,����«�W��V// L-L���JL� m-u� �]U�u2-/"n�� /���/ TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: Eis Fo" Fo" -y- 0-1 RON I EE r -j (3-r 2i F---- F=* -F�= � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD, THE DEPTH OF H 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). ����LJ I F --En E> co K F="I- I F-7 �F�i Ir -4 �I *2f�= 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. �1.4 CA �����������f_-v ".'H. F�l H E= ����l F?_ lE_�� BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS HRE AVAILABLE TO INSURE PROPER INSTALLATION. I -T' ����: I., I CERTIFY THAT' 1: I HM 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 THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. SIGNED: ISSUED �67 ` SOI LS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 ,�yy SOILS LOG — PERCOLATION TEST � PERFORMED FOR: V DATE PERFORMED: LEGAL DESCRIPTION: 2 ^ `/ /O/Ly/ SLOPE SITE PLAN DEPTH Ems) 1 0 '-' 2 3 V, � 4 " t 5 6 L_ -z7 s or'O. 6 < 13 A.9,., p4ole 14 - OF 4 �. 15 ,,,a fell r. COMMENTS v WAS GROUND WATER S ENCOUNTERED? ,v L Depth to Water O P E IF YES, AT WHAT 18 , + Robert A. Sh, 57-E �� A Ma 1419- 20 COMMENTS v WAS GROUND WATER S ENCOUNTERED? ,v L Depth to Water O P E IF YES, AT WHAT DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop /V PERCOLATION RATE /" (minutes/inch) TEST RUN BETWEEN FT AND FT PERFORMED BY:fi-d �f%62«c1� CERTIFIED B 72.008 (6/79) DATE2_304n CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT Plans for the construction of K�' t y `" ti - ! public water system located in N E- i` Alaska, submitted in accordance with 18 AAC 80.100 by c; have been reviewed and are E approved. 0 conditionally approved (see attached conditions). BY TITLE DATE If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. APPROVED CHANGE ORDERS Change (contract order no. Approved by Date or descriptive reference) The "APPROVAL TO OPERATE" section must be completed before any water is made available to the public. APPROVAL TO OPERATE The construction of the public water system was completed on (date). The system is hereby granted interim approval to operate for 90 days following the completion date. BY TITLE DATE As -built plans submitted during the interim approval period, or an inspection by the Department has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to operate. t „tj '} • _ - Y TITLE DATE Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 051-441-09 Expiration Date: 1. GENERAL INFORMATION: Complete legal description BASE HILL; LOT 2 Location (site address) 15811 Division Street *Chugiak 99567 Current Property owner(s) Timothy & Amanda Sandlin Day phone 854-5357 Mailing address Real Estate Agent --- - 2. TYPE OF DWELLING: © Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $_ 5� 4 2 3d Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number COSA # 2 h Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seas 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:-- Garness Engineering Group, -Ltd (GEG)— — -- — - — Phone: -907-337=6179- -- - -- --- - Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: 106(z, In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and __ are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/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 in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for bedrooms bedrooms OF,rgrrA�'�/���/� 0011at slrE 'Grn) oN- bedrooms, with the following aER AND ' rn WAST'_ - WIq�,- LZ IN m PROGRAM System #2 Approved for Disapproved Conditional approval for . .. .............. l' J r , A. Corn °ss, - 95 �cG .t.4 �.�o'o pr f e s s'%0 #AECC884 Original Certificate Date: 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 _ C Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other % COSA Checklist Legal Description: BASE HILL; LOT 2 If more than i septic system on lot: COSA Checklist # Parcel ID: 051-441-09 of Structure served by this system A. WELL DATA n Well log is filed with Onsite (or attached) Well production at time of test 6.1+ gpn Date drilled 1980 Water storage tank volume gallons Total depth 128 ft Well disinfected for coliform test? ❑ Yes No Cased to 90 ft ® Coliform bacteria is Negative Sanitary seal is functioning correctly Nitrate 0.278 rng/L ❑ Nitrate less than MRL (ND) Wires are properly protected Arsenic ug/L n Arsenic less than MRL (ND) Casing height (above ground) 18+ in. Collected by GEG, LTD Date of flow test for COSA 10/8/21 Date of Sample 9/28/21 / Static water level at beginning of test 52.5 ft. Comments *NO WATER STORAGE PER OWNER B. TANK DATA C. LIFT STATION Age of tank(s) 16 years ❑ Required maintenance completed Tank type/material SEPTC11,15' Age of lift station years Measured operating fluid level in septic tank 39" Lift station material FUJ Standpipes/foundation cleanout per record drawing Comments: N/A Date of pumping i a 1 6 -� /Z6 1,- D. D. ABSORPTION FIELD DATA DEEP TRENCH Which system tested (date installed) 10/7/81 U ALL standpipes present per record drawing Total measured depth from grade 11.08 ft (max) Measured depth to pipe invert from grade 4.83 ft (min) ❑ N/A — pressurized field 0 Monitor tubes go to bottom of effective. If not, state depth into effective Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A gallons Comments/Deficiencies.- COSA omments/Deficiencies: COSA Checklist yellow sheet Adequacy test date 10/8/21 Results ❑✓, Pass For 3 bedrooms Fluid depth prior to test 9 in Water added 554 gal New depth 65 in Elapsed time 120 min Final fluid depth 42 in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) NONE If yes, enter date N/A E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) F/� Septic Tank/Lift Station on Lot > 100' if No ft Community Sewer Manhole/Cleanout > '100' Q✓ Yes if No ft M Yes if No ft Neighboring Tank > 100' r✓ Yes if No ft Private Sewer/Septic Line > 25' EZ] Yes if No ft Absorption Field on Lot > 100' Ov Yes if No ft Holding Tank > 100' 0 Yes if No ft (Neighboring Absorption Fields > 100' * if No Animal Containment > 50' R Yes if No ft 0✓ Yes if No ft Yes if No ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft ,r❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' F/� Yes if No ft Surface Water > 100' {V Yes if No ft Property Line > 5' ✓v Yes if No ft Wells on Adjacent Lots: R11 Absorption Field > 5' Q Yes if No ft Private Wells > 100'✓Q Yes if No ft Water Main > 10'✓Q ft Yes if No ft Community Wells > 200' n./ Yes if No ft Water Service Line > 10' Yes if No ft If septic tank is under driveway comment below 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' R11 Yes if No ft Private Wells > 100'[]✓ Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' ✓Q Yes if No ft F. ENGINEER'S COMMENTS *NO WELL OR SEPTIC FOUND ON LOT TO THE NORTH. OPEN LOT WITH EQUIPMENT AND 2 - 3 SMALL STRUCTURES (STRATFORD HEIGHTS TR B) - NO MOA RECORDS OR ADEC RECORDS IN "SEPTIC TRACKER" G. ENGINEER'S CERTIFICATION o QQ0 F A I certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with O MOA COSH guidelines in effect on this date......... 14 ........ .0 :.....I y.......... (7 .J f re A. Gorn ss, p0 E— z COSA Checklist yellow sheet ��C"y ''fo f e s s,00& 0 #AECC884 ��D�Odoo qb Municipality of Anchorage u On -Site Water and Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-441-09 1. GENERAL INFORMATION Complete legal description Base Hill Lot 2 Location (site address) 15811 Division St Chugiak, AK Expiration Date: G Current Property owner(s) Carruba Day phone 242-3215 Mailing address Real Estate Agent Craig Bennett Keller Williams Day phone 242-3215 2. TYPE OF DWELLING: ® Single Family (w/wo ADU)El Duplex Cr'bC E ❑ Multiple Dwellings (Single Family and/or Duplex)1€eF 2" SEP ?R14 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class C Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Y Received by:. - Date: COSA to be released -to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment '11101411 Receipt Number COSA # E -(V.01 t Date: Date of Payment Receipt Num Waiver c 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 NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 9/9/2014 6. DSD SIGNATURE r' 1 System #1 Approved for bedrooms. .3 System #2 Approved for bedrooms. ` Disapproved. Conditional approval for bedrooms, with the following stipulations: F >> By. L �/t it Original Certificate Date: The Municipality'' 6f Anchorage Devlopment 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 9-1-12 doc If more than 1 septic system is on the tot: . COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: _ ��s r0 Parcel ID: O S I ^ y®,9 A. WELL DATA Well type _p If A, B, or C provide PWSID # Well Log (YIN) Date completed 9/t40 Sanitary seal (YIN) Wires properly protected (YIN) Total depth / ft. Cased to qQ ft. Casing height (above ground) n. FROM WEL LOG AT INSPECTION Date of test 0 2 5 r Static water level 2 / ft Well production l�. Z S g.p.m. f g.p.m. WATER SAMPLE RESULTS: Coliform_colonies/100 mL Nitrate /L Arsenic Arsenic Lf0 ug/L Date of sample: ZS/' Collected by: re B. SEPTIC/HOLDING TANK DATA Tank Type/MaterialS ^ % /G Date installed 2° S Tank size %L gal. Number of Compartments Z Cleanouts (YIN) ) Foundation cleanout (YIN) Depression over tank`(Y/N��7 High water alarm (YIN) �r Date of pumping _� Pumper—) C. ABSORPTION FIELD DATA Date installed 3/ 4PT Soil rating (g.p.d.Ift2 or'/ftz/bdrm) /2 $ System type MAL# Length Z ft. Width 'Y Q ft. Gravel below pipe 4!r ft. Total depth ft. Eff. absorption area 33ft2 Monitoring tube � Depression over field 4L Date of adequacy test 2S r Results (Pass/Fail) J0 For -bedrooms Fluid depth in absorption field before test /Z in. Water added So gal. New depth /S in. Elapsed Time: 6-0 min. Final fluid depth 4 in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) 64VIf yes, give date D. LIFT STATION AJ/1 Date installed Size in gallons _ "Pump on" level at in. "Pump off" level at Datum . Cycles tested _ E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 1Do -f Absorption field on lot 157,0, Public 57f - Public sewer main A" Sewer /septic service line Animal containment areas .O'f ManholefAccess (Y/N) _ in. High water alarm level Meets alarm & circuit requirements? On adjacent lots / O6 :�- On adjacent lots 140,7 - Public 44,tPublic sewer manhole/cleanout N4 Holding tank /t/4 Manurelanimal excrete storage areas /00 SEPTICIHOLDING TANK ON LOT TO: Building foundation �t/ Property line_ 0 Absorption field //I r i Water main Water service line G Surface water l% 4r- Wells fWells on adjacent lots 10a /f" ABSORPTION FIELD ON LOT TO: Property line Building foundation A0 f Water main 41,4 r Water Service line l0 (f" Surface water l616 Driveway, parkingNfei ehicle storage r Curtain drain &!X� Wells on adjacent lots /d O 74- F. F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that t 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 T�641 �N Date COSA brown sheet_10-10-12.doc bF Ai ,,&%�,, .ANlesbee � c4 •s ey r L .----.-_a.` k �..s. Vie••.°... =a �te�vc/nbV1..LEng e/°�..F6,! / r " in. M_ Municipality of Anchorage Development Services Department Building Safety Division Onsite Water and Wastewater Program 4700 South Bragaw St P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 s! �: ..� CERTIFICATE OF HEALTH AUTHORITY APPROVAL 4Y' .L E FOR A SINGLE FAMILY DWELLING Parcell.D. Or) -NHI —0q 1. GENERAL INFORMATION HAA # 0-50LiCI Expiration Date: Complete legal description 1-0 T a (3.4 S6 tit e. L S/a Location (site address or directions) l f V I r A7 VIS /o,✓ Sim_ Ctf V C-jgk Current Property owner(s) 1145NR y D i A c o Al Day phone Mailing address Lending agency Mailing address c;[.N#A41_ b4,wvri tY , (rRAYr-r.V(. 9K 99Scso-9gkq Day phone Real Estate Agent C,9 je o -j ^' E- o v mr.& y R 44 "gay phone 6 g � — ks-o a Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY:, Individual Well Individual Water Storage ❑ Community Class Well C Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water 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 engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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. S & S ENGINEERING Name of Firm 7703E Elmo Rlygr r o a m .,,., Phone `f'7 9 Address Eagle River, Alaska 99577 Engineer's Printed Name 00/3"1- C. Co w4,✓ Date 9 , 6 /0S' 5. DSD SIGNATURE __jZ Approved for 3 Disapproved. Conditional approval for Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory S !;,k ROBERT C. COWAN CE -8801 bedrooms. Q 'Ce hCe rc_ji.�^� bedrooms, with the following stipulations: nnl_clrG �: PROGRAM Maintenance Agreements Supplemental Engineer's Report Other 11) By: Original Certificate Date:_— a %-0 S Rs«. 01J02) Municipality of Anchorage Development Services Department 4` 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 AUTHORITY APPROVAL CHECKLIST Legal Description: "j a, O ASS H I L L Sw . Parcel lb: OV 1 — H y/ — O °f A. WELL DA _ Well type �1VP� fF If A, B, or C provide PWSID # ~ Well Log (DI) Date completed �2ffTj -11bO Sanitary seal SN) �GS Wires properly pr6tectedq§5t) �g j, Total depth 12 L ft. Cased to _10-Lft. Pa6ig nelght (above ground) !Z 1 in. FROM WELL LOG ��AT INSPECTION Date of test 5r_i rn I �3 ZZ OS Static water level._,: --,, _ -�? r ft. LA __3 ft. Wellpr2yc t, 25 g.p.m. SoQj g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate O. 1 mg.A. Arsenic: mg.11. Date of sample: $�. B. SEPTIC/HOLDING TANK DATA Tank Type/Material f r /a 7 r L f fl o P E Tank size 4kioO gal. Number of Compartments Foundation cleanout (N) YE1 Depression over tank (Y/Q r 0 Date of pumping rf liy Pumper Other bacteria 0 colonies/100 ml. Collected "S ENGINEERING 17034 Eagle Rtver Loop Road Na 204 Eagle River, Alaska 99577 Date installed 9l d O J 0 S- Cleanouts&) C. ABSORPTION FIELD DATA Date installed )01311C 7 Soil rating (g.p.d./ftZ ok;�W a` r Length 3 a ft. Width H0 't -fr v1f r High water alarm (Y© H a System type TR 4,a C- /I Gravel below pipe 6 ft. Total depth I_ ft. Eff. absorption area 3 VY ftZ Monitoring tube Yi f Depression over field J✓ 0 Date of adequacy test f/117 I OS_ ResultsPL'�Fail) p,Itl For 3 bedrooms Fluid depth in absorption field before test IL in. Water added L0 gal. New depth SN in. Elapsed Time: 1?/ min. Final fluid depth ?I- in. Absorption rate >= yr O g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N 4 ^ 4 K 04 tie., If yes, give date D. LIFT STATION Date installed Size in gallonsManholelAccess `Pump on' level at _ in. 'Pu _ in. High water alarm level at in. Datum Cycles tested Meets alar & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100 -+1 On adjacent lots 100 t Absorption field on lot / S 7 On adjacent lots / D O r t Public sewer main N 14 Public sewer manhole/cleanout N/* Sewer /septic service line 10 t P 0 Holding tank N 1.4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation rr ' Property line /O '} Absorption field /V Water main 11r 1A Water service line /0 rf Surface water ! o o '-Y- fWells Wellson adjacent lots 100 to- +SEPARATION SEPARATIONDISTANCE FROM ABSORPTION FIELD ON LOT TO: " Property line is- Building foundation r / 0 '/- Water main V 1.4 Water Service line ! 0 'f Surface water � � 0 ' af f Driveway, parking/vehicle storage oe Curtain drain 1`440111- X ivc#+N Wells on adjacent lots 100 #4- F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that / have determined through field inspections and Y...- A review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. >3 -•••• G !� A, ROBERT C. COWAN Engineer's Printed Name IC Q a E R i C . Cp i✓A f/ �s CE • 8801 Date cl la 6 �a ��.,..:.. . . HAAFee $ 130." -i- 17S'-" cR--311) Date of Payment q /;I- /. A'r Receipt Number 0 -7 (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number / e7a _ /?81)(ee,t5 ✓L'��J�... „✓�� ✓ice �, ��.�" 11 �:.• "7 `i_•'.':•C��... L1M.,,f.� .c.L.•. Citi ���-.,�- ` (f �.. MUM^_IPAUTY =F A14C i,7RAGE • • . 8 ,95� RECEIVED I MUNICIPALITY OF ANCHORAGE • -� Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 2 Base Hill Subdv. T15N R1W Sec. 29 Location (address or directions) 15811 Division St. (b) Property owner HUD Telephone: (home) n n - / a - Business 5 6 3-3333 Mailing Address 640 W 36 th Ave Suite 1 Anchorage AK. 99503 (c) Lending Institution n/a Telephone Mailing Address (d) Real Estate Company and Agent _ Add ress •"� ! . .. .k w.SJR, - - Telephone i' ✓ +yl r �'`�:l (e) Mail the HAA to the following address: (or check here ❑, if hold for pick up.) List contact person and day phone number below: 1 ,'_ f •- pickup by engineer 2. TYPE OF RESIDENCE li Single -Family Q Number of bedrooms - 3. WATER SUPPLY ' Individual Well ❑- Community ® Public ❑ Class. "C" If wr(tten confirrnation from the State Department of Environmental Note communitywell;system,must.have Conservation -attesting to th'Iegality and status 4. SEWAGE DISPOSAL e On-site IR Public ❑ Community ❑ Holding Tank ❑ -� r i - ;f " s / s. i..} a < � ;. • r 9 a t A ., r -'3 i sY�i ren`i rs.' eNote: have written confirmation from the State Department of Environmental If community well system; must Conservation attesting to the legailty a`ndstatus. 72-025 (Rev. 7/88) Page 1 of 0 - 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION j As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this x Health;Authorit Approval., yshows tihat the on-site water supply and/or wastewaterdisposal system is safe,;_ functional..and adequate for the number`of bedrooms'and type of structure indicated he'rein. I further ve`rif�/ that.> I based on .the information obtained 'from the Municipality of Anchorage files and from my investigation and,!' nd *. 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.', i Name of Firm ears oni�a �n�(;IpJtF�R;N { F:V�f`r=4 ! S Telephone EAGLE RIVER, AK 99577 Addressn n BOX 7732q4 ;. Date : ao Sr 694-5195 * this"'test-issnot'�re uiY�edas . performed. . q for �.o�•a��®� ADEC approval of well or* compliance QF letter„.update Leachfield adequacy �'��.•••'••�'4�� test performed 9/89 by Corwin & Assoc. ���.•'•• °'•;i.��® -< • 6. ° 49TH 9 o s•a••a• ro..m°•.•°••..•as••. , f3: ton Louis A. Butara t4�� CE -6736 mak' 6. DHHS APPROVAL bedrooms b 9�i Approved f jr '_ y Date —2 / t/ Approved _—! Disapproved Conditional 'berms of,606ditional Approval . 1 , The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Beck Page 2 of 2 A. WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) • Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Date Completed Electrical Wiring in Conduit (Y/N) Legal Description: e t 1_.�'4 r -&- /-/,, // 7?5'N IF iW Scc -_L5 Depth of Grouting SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by .fes c�-Y.,or to h*,&. - If A, B, C, D.E.C. Approved (Y/N) - " Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) On Adjoining Lots On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date Water Sample Test Results Comments �a �i s�r�.-., � � 1'Y+a� f� /�E..r a /7'�t �i r� G cs i-r�,✓/�' tv i � � , L7 .�'. B. SEPTIC/HOLDING TANK DATA Date Installed /5�/ Size a5 No. of Compartments N Standpipes (Y/N) i Air -tight Caps (Y/N) i Foundation Cleanout (Y/N) y Depression over Tank (Y/N) Date Last Pumped Pumping/Maintenance Contact on File (Y/N) �� ; for Holding Tank High -Water Alarm (Y/N) 1_-_/-0_ Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well To Building Foundation S o t To Property Line to t To Disposal Field • 'x -t To Water Main/Service Line t/"' To Stream, Pond, Lake or Major Drainage Course Comments ��,�_u''^,r? s✓v7' Ve e�.rG r p+✓ s�,o7'aa •✓k 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Date Installed 45X_i Length of Field 3-2 *' Width of Field 4o Depth of Field Gravel Bed Thickness Square Feet of Absortion Area 3& 41 �f Z Statndpipes Present (Y/N) %V Depression over Field (Y/N) N Date of Last Adequacy Test Results of Last Adequacy Test SS,'•f SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well _ To Building Foundation Lot A -1a To Water Main/Service Line To Property Line ; On Adjoining Lots io ' To Existing or Abandoned System on .-.30 To Cutback (if present) "'fid To Stream, Pond, Lake, or Major Drainage Course ^'1,4 To Driveway, Parking Area, or Vehicle Storage Area �O Comments -45�ac� 71c✓�'- �e/,,,.,wc6,��_ cor�.,,� �r` ,4�.ro� 9/�9 /X Gf.(. Y rlf .J 7�- fy /Yl.ti/d •5 G / iC B �i.�hGf A4 L. 4 c..� J'�4✓ 7�` NCJ �` ys,��y �!�,�M �m D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) *"Check Permitted Bedroom Rating Against HAA Request"* "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelinesr,'NJn the date of this inspection. ,.'� 41OF Al� Signed /ick •a�F•av $A Eagle River Engineering Services Company p n Bay 772294 , C'_aa a Date3�i�5° Eagle River, AK 99577 .E �c�•�cc�s_ av®, a3mmoov. pl er's Seal C9�4 5fga r� a000e•oa.- MOA No. yO —Ove yy`''� 6736 e �0 Receipt No. 7�% Receipt No. " •+"' Date of Payment Amount: $ '�/ 72-026 (Rev. 7/88) Back Waiver Fee: $ Date of Payment Page 2 of 2 or STEVE COWPER, GOVERNOR 0 0 0 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE WESTERN DISTRICT OFFICE 563-6775 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 FOR: EAGLE RIVER ENGINEERING ATTN: RUSSELL March 16, 1990 P1 SID: #216363 According to the records on file in this office, the Basehill Subdivision Water System is in compliance with the State of Alaska Drinking `.dater Regulations. Sincerely, VERA F. CRAIG Environmental Fiel Officer VEC:bas MUNICIPALITY OF ANCHORAGE M� • Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES - 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # C%6 ` _ i1 1 � L) 1 HAA # L f_� RS Ll�, 20 -i 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) L'o j Z PIA S C H j l i <U&D Location (address or directions) N HK! DiyIS 101, 1 STIFET JAUD A,6F_kLT ` (b) Property ownerJ( 17. �&S;Smziccled grocers Telephone: (home) Business Mailing Address r-1 1121 Al jcC,H- A K 92-'ih'� (c) Lending Institution Mailing Address t� /A (d) Real Estate Company and Agent Address Telephone N /; Telephone LIAL (e) Mail the HAA to the following address: (or check here'd, if hold for pick up.) List contact person and day phone number below: 52Z-1311 TYPE OF RESIDENCE Single-Familyxl Number of bedrooms 3. WATER SUPPLY GLASS "C_ Individual Well ❑ CommunityX Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 Z to Z abed H399 (891L 'A98) SZO-ZL -Naom s,aaeuibua leuoisseloid ayl ui suoisstwoao saoaaa aol algisuodsaa lou si abeaopuy to AliIedioiunw ayl •panssi si aleoilpeo a 9aolaq elep azo laue ao suoil0adsui lonpuoo lou op SHHQ to s99Aojdw3 •sluawaiinbei alels pue jeaapal uieljao Alsiles olaapio ui suoilnlilsui butpual aiayl pue sawoy to siesepind of Aselino0 a se siyl s90p SHHO eq e�Seltf to alelS ayl ui paaalsi6aa aaauibue leuoissaloid luepuedepui ue Aq anoge g ydei6e.ied ui uanib suoileluasaidai ayl uodn Aluo paseq paleoipiao Jenoaddy Aliaoylny ylIeaH sanssi (SHH(3) s901na9S uewnH pue y11eaH to luewl.iedaa 96eaogouy to AilludiolunW ayl N011fldo Jenoaddy leuoilipuo0 to swjal Ieuoilipuoo panoaddesiQ panoaddy Aq swooapaq --E-- aol panoaddy 2� IVAOdddH SHH(3 '9 1e9S s,a99uibu3 ` YYY �m� aleQ NON 11 3 OWI ssaappy !yt- auoydalal wail to aweN •uoiloodsui siyl to alep ayl uo 309339 ui suoilelnBei pue 'sa0ueuipao 'sapoo elels pue jedioiunw ale ylinn eoueildwo0 ui si walsAs jesodsip jejumalsem ao/pue Alddns aalem alis-uo ayl 'uoiloadsui PUB uoile6ils9nui Aw woal pue sail abeaogouy to Al!ledioiunW ayl woal peuielgo uoilewiolui ayl uo paseq leyl Al!aan i9ylanl I •uiaaay pale0ipui a.inl0nils to adAl pue swooapaq to aagwnu ayl aol alenbape pue leuoilounl 'ales si walsAs lesodsip aalemalsem ao/pue Aiddns aalEm alis-uo eql leyl Smogs 1enoiddy Aliaoylny yl1e9H siyl to uoilebilsanui Aw leyl Aliaan I 'moleq umoys 93ep uoilepiIen ayl to se pue ol9aay paxille leas Aw Aq paiplaao sy NOIIVWUOdNI aNd blda'H3ad3S 3'1Id'S1S31'SNOIlO3dSNl ONIalAOad WHIR ONIa33NION3 'S 0eV�; \ p, MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 %�y ` • �` 343-4744 Legal Description: L-01 7 Ph C I_ Lil l I c, I'Z A. WELL DATA Al Well Classification L LASS "r- If A, B C, E.C. Approved (Y/N) Well Log Present (Y/N) _W Date Completed UM >! IWIL LI. Yield m Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground S itary Se` Electrical Wiring in Conduit (Y/ ,� epre 'on A SEPARATION DISTANCES OM V�ELL / To Septic/Holding Tank o6 Lot To Nearest Edge of Absor tion Fiel on Lot To Nearest Public Sewer Li Casing (Y/N) nd Wellhead (Y/N) ,`On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot J Water Sample Collected by , yEu S' ; Date q&-/gn Water Sample Test Results L i1SE9=,ey Date Installed -Size 1 (200 ti No. of Compartments C 1/ Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) Q Date Last Pumped Pumping/Maintenance Contact on File (Y/N) %xl ; for &I /A Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) WIA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well To Building Foundation To Property Line ao + To Disposal Field To Water Main/Service Line >4S To Stream, Pond, Lake or Major Drainage Course JA Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata IZSss-C+ Type of System Design Trfx-:--L Date Installed (56fi 1 Length of Field 3 - Width of Field 40 Depth of Field r i Gravel Bed Thickness Square Feet of Absortion Area 2 04 Statndpipes Present (Y/N) Depression over Field (Y/N) 4 Date of Last Adequacy Test S q Results of Last Adequacy Test S 41_1Ji=A :TcKY SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well / SO 3 + To Property LineO To Building Foundation rr Q t To Existing or Abandoned System on Lot &I 14 ; On Adjoining Lots .- C) To Water Main/Service Line "�S + To Cutback (if present) I� To Stream, Pond, Lake, or Major Drainage Course a ;:— &0 To Driveway, Parking Area, or Vehicle Storage Area E��O Comments D. LIFT STATION `' 44 Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level a Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y\11)_ Comments *'Check Permi d Bedroom ating Against HAA Request" I certify that checke a Pied, or conformed to all MOA and Hiel)r!e ffect on the date of this inspection. Signed Company C Engineer's Seal Date Z Z!T 1%. 5 ca J. covwl" ,Ap,�s• No CU52M MOA No.G� ,� Sp�,, 4A �` °Z `� Receipt No. U Receipt No. C� Date of Payment 9—v� Q / Waiver Fee: $ Amount: $ f�71,, Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information (a) Le ga} Descri G -Z Application Date ,r -Z (include/lot, block, subdivision, section, township, range) Loca, 4on ( address or directions) (b) Applicants NameQ IM Telephone - Home Business Applicants Address �� 0� XU� 2 ? v�e (c) Applicant is (check one) Lending Institution ; Owner/builder; Buyer ; Other E::� (explain); (d) Lending Institution!'lGe" 71 Telephone Address K-. V > fab t G C r (e) Real Estate Co. & Agent Address Aj Telephone (f ) —tt ttt4 the HAA to the following address: Ale _ o, 2. Type of Residence Single -Family Multi -Family Other (describe) Number of Bedrooms ___3 3. Water Supply �, 1 �� Z, t Individual Well M Community Public M Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite Public Community Holding Tank= Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm Aft.a a au01- aj!gtlaff^ Telephone Address;, Date ' Z 6. DHEP Approval' i asn (ENGINEER Approved for 1 bedrooms By Approved Disapproved Terms of Conditional Approval_ CAUTION r � Gi' • s .'ir o •••e• r .. cs•.u• Esx D OAYRJ 1. '� Robert A Sha r ��'•4 No. 1 ' �Lea•�� ,E Conditional i zs� d` �-- THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FJR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Infcurmation Application Date--�0-- (a) Legal Description (includelot, bl k, subdivision, section, township. r pge) °l/ Locat (b) Applicants Name Applicants Address (c) Appli Buyer (d) Lending Instituti s Address ore) Lending Institution Owrer/builder I (explain); ool (e) Real Estate Co. & Agent Address] Telephone 2. Type of Resident: Single -Family Multi -Family Number of Bedrooms 3. Water Supply Individual Toll Community Other (describe) Cz- _S: -r Public Note: If unity well system, must have written confirmation frcm the State Department of Environmental Conservation attesting to the legality and tus. Is the well adequate for the number of bedrooms specified in this 4. Sewage Disposal Onsite Public_ Community f --:j Holding Tank Is the wastewater disposalY q system s adequate for the number of bedro<xns 9M [Page 1 of 21 2-15-84 5. veering Firm ?providing I I certify that I effect on the da Signed checked, ctions, Tests, Data and Information ified, or conformed to all MOA HAA Guidelines in ion. �^ Date Name of AUK Tele hone AddressAlly Signed by Date (ENGINEER SEAL) 6.DHEP Approval 1 A .,wad for bedrooms By Z% G�2� C�.l¢c Tate _ t Apprcved Di apprav d Conditional Terms of Corditional Appraal The Municipality of Anchox-age. Department of Health and Environmental Prote-d-ion does not guarantee the continued satisfactory performance of the water supple and/or the wastewater_ disposal system. This approval indicates that, as of the validation date shun above, based on the data and infc.?rmation furnished by an engir--er registered in the State of ltlaska, the water supply and wastewat-�r disposal syst:etr is safe and func- tional for the numter of bedr ocns and type of struct-Aire indicated. (DHEP SEAL) 7. Mail the HAA to the following address: KB2/d5/s (Page 2 of 21 2-15-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 A. WELL DATA Well Classification If A, B,, or C, D.E.C. Approved(Y/N) Well Log Present (YM) Date Completed Yield Total Depth Cased to Depth of Grouting_ Static Water Level Pump Set At Casing Height�Above Ground Sanitary Seal on Casing (Y/N) Electrical Witing in Conduit (Y/N) Depression Around Wellhead (Z8j) Separation Distances from Well: To Septic/Holding Tank on Lot l / On Adjoining Lots To Nearest Efte of Absorption Field on Lot On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleancut/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected By Date ` Water Sample 'fest Results Comments B. SEPTIC/HOLDING TANK DATA ��"�O �. Date Installe � Sipe ��� No. of Compartments Standpipes ( u) Air -tight Caps ) Foundation Cleanout ( ) Depression ovsr Tank (Y Date Las -- d 7 Pumping/Maintenance Contract on File (Y )ir J for Al il\ Holding Tank High -Water Alarm (Y )A Temporary Holding Tank Permit (Y/C),0'_7-, Separation Distances from Septic/Holding Tank: / To Water -Super- y tnbll ��� T To Building Foundation To Property Line CO 7< To Disposal Field f To Water Mair/Service Line To Stream, Pond, Lake, or Major Drainage Course CoYrnients --- v AW aPAU1Y OF AINQ�Io" ENVIRONMENTAL PROT=ON APR 1 A JQP4 RECEIVED [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating P in Absorption Strata Type of System Design ( _ Date Installed f3 10 c;r Length of Field Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area Standpipes Presen ( ) Depression over Field ( ) Date of Last Adequacy Test -/"a 4c -ie Results of Last Adequacy Test - Separation Distance frau Abscrg6ion Field: To Water -Supply %b 11. , 1,5-0_ 7L To Property Line fl To Building Foundation ,/ f To Existing or Abandoned System cn Lot %`l P ; On Adjoining Lots To Water MsirMService Line L To Cutbank(if, sent) To Stream/pond/L,ake/cr Major Drainage Course To Driveway, Parking Area, cr Vehicle Storage Area d CaL11 nts - -- — D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (YM) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N)_ Tested for Pui6ilng Cycles during Adequacy Test. Meets MOA Elbetr ical Codes(YM) Camients ** Check Permitted Bedroom Rating Against HAA Request** I certify that h•ve checked, verified, or confarmed to all MOA HAA Guidelines in effect on the date Signed Date --'� / �',' ..m�.;�' "° . 9 SR B 1 ""A�" CompanyMOA No. �0� %,9'/ .Cs,� •� • �M Vv Y KBl/d5/s [Page 2 of 21 2-15-84