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HIGHLAND TERRACE #5 LT 6
Highland Terrace Lot 6 050-$ ! 2 -2:6 Municipality of Anchorage ~ Development Services Department i~ Building Safety Division . On-Site Water and Wastewater Program, 4700 Bragaw St. ~ P.O. Box 196650 Anchorage, AK 99519-6650 Page 0 of 3 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: OSP111090 PID Number: 050-312-26 Theodore Schindler Wastewater System: [] New [] Upgrade Address: 13111 Sues Way, Anchorage, AK 99516 ABSORPTION FIELD Phone: Number of Bedrooms: [] Deep Trench [] Shallow Trench [] Bed [] Mound [] Other: LEGAL DESCRIPTION so, Rating: Total Depth from original grade: 0.8 GPD~Ft2 8.5 Block: Lot: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: 6 Highland Terrace #5 3Ft. 5.5 Ft. Township: Range: Sec[ion: Fill added above original grade: Gravel Length: .5 Pt. 55 Well: [] New [] Upgrade Grave~ width: Number of lines: I Distance between lines: 2.5 Ft. 1I Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material: Existing Private Pt. .t. 605 pt2 3034 PVC Driller: Date Drilled: Static Water Level: Installer: Date Installed: Ft. Flintstone Enterprises 6/2812011 Yield: GPM Pump Set at: Casing Height Above Ground: Pt. Pt. TANK SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P. [] Other: T~To Septic Absorption Lift Holding ~ublic/PrivateManufacturer: Capacity: From~ Tank Field Station Tank Sewer Line Anchorage Tank 1250Gal. Material: Number of Compartments: We~ 62.3* 110.0 72.0 42.7 Steel / STI P3 2 Surface Water 100+ 100+ 100+ ~ / LIFT STATION Lot Line1.5'* 7.7 1.5~ S~ze: Man~ac[urer: 250 Sa~. Orenco/Anchroage Tank "Pump on" level at: "Pump off" level at: in. High water alarm at: Poundat~on 35.0 54.9 44.0 +40 ~n. +36 +45 ~n. Cu.ain Drain NIA NIA N/A Pump Make & Model Electrical Inspections performed by: P2005-1 .-T, ~-/-.gJ?--q~__~c. j L L, Remarks: *Waved to 60'. **1 request a lot line to septic tank distance BENCH MARK Location and Description: waiver of 1.5', and a lot line to drain field distance waiver of 7.5'. GAS METER/VALVE Assumed Elevation: 100.0 Ft. Engineer's Stamp Inspections performed by: PANNONE ENG. SVC, LLC Dates: 1st 9/27/2011 2nd 912812011 ~.~;~ y). ................ Development Services Department Approve- -~- ...,~:.." ~.~ Conditional Approval Date: -~ ~'" 4~TH ~ ........... ~ ..... ~"~"~t~'"""~ ........ '" ..... ¥'..~ Oo No. CE c~149 aev e ,ed and approved by' 5 ff A B C x '"~ ~ / T1 56.750.2 ~ -~ T2 42.4 56.4 /7/. / M1 68.5 59.8 ~'~'~-~~ W~N EXISTING M2 108.8 82.2 ~ ~SEPTIC CICUTTA WAY ~ AREA NEW PRIMARY FIELD _ ~ 55LF~5.~'EDx2.5'W. 8.5'TD I '¢ ~SEPTIC .~'~ X / ~..-.-. x" ......... T2: ~'" "~ NEW 12509-'~<(" '1 ~¢¢7'~"~"Z ~'US~ Z ~.~...,.~....,..~ ......... PAGE 2/3 ~, 62.3 · ~ ~EXlSTING EXISTINOsEPTic'IOOOgTANK ~i ?~o ~WELL,-(E) ~,/ AREASEPTIC ABANDON PER CODE N~ BY REMOVAL AND DISPOSAL DRAIN FIELD IN P~CE NOTES: P~O~ ~G ~C, L~ ~ ~F Al ?~l Dote ~&~.N .... ~I~, ~/28/1~ RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 ~.. PHONE (907) 272-8218 F~X (907) 272-8211 ~ .- ~..W ~ Scal~ ~,..'~ ~ ~ '..~ 1":so' HIGHLAND TERRACE frS, LOT 6 ..... ~ 050-512-26 THEODORE SCHINDLER ~ ~~,~nno~e'~ PERMIT NO. 13111 SUES WAY-~' bE ~I~V ,~,~~} .~:~' 0SPl11090 PLAN ANCHORAGE, AK 99516 ~ Sheet SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION WAS INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS. 2. ALL WAS BE IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS. 5. SCOPE OF WORK: INSTALLED NEW 1250 GALLON S.T.E.P. TANK AND NEW SOIL ABSORPTION SYSTEM. 4. NO GROUNDWATER WAS OBSERVED AS EVIDENCED BY THE SOIL TEST HOLE. NO APPARENT WATER TABLE WAS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 14.5 FEET BELOW EXISTING GRADE. 5. TANK WAS COATED TO STI PS, UNDERGROUND FUEL TANK, STANDARDS WITHOUT THE SACRIFICIAL ANODE. -- 6" TOPSOIL AND VEGETATION Tm ..~ 99.7 (FO) ¢,/,M J ~ Ys" HOLES © 24" O.C. ~ ~-DRAIN ROCK 2.5 6.0 No groundwoter ~ monitored ~- 6" TOPSOIL AND VEGETATION SECTION ° ~ / ~ ~,"0 PERF P~PE o ~ ~ B ~ -~ OO FILTER FABRIC o o ~ 99.7 (FG)..~__ 99.7 (FO) 85.0-x I 90.7 ~ 90.7 -- · NEW 125~'gu TRENCH - SEE DESIGN l S.T.E.~. PROFILE TANK *SEE NOIE 5, IHIS PAG£. ABBREVIATIONS DESIGN PARAMETERS cu COPPER PRIMARY/RESERVE SEPTIC SYSTEM DIP DUCTILE IRON PIPE LEGEND NO. BEDROOM: 5 (450 gpd) TH TEST HOLE --W WATER LINE/ TANK SIZE: 1250g S.T.E.P. FC FOUNDATION CLEAN OUT WELL RADIUS PERC RATE = 1-5 MPI SOIL RATING: 0.8 GPD/SF TI/ TANK CLEAN OUT NO. AREA RQD: 562.5 SF CC/ CLEAN OUT NO. ~ SS NEW SEPTIC SYS. TYPE: DEEP TRENCH 5.5' E.D. M# MONITOR TUBE NO. MIN LENGTH: 51.1 LF R.I. RIGID INSULATION DCO DOUBLE CLEAN OUT USED: DV DIVERTER VALVE 55 LF X 2.5' WIDE, 5.5' E.D., FS FLOW SPLITTER 8.5' TD FO FINISH GRADE TOTAL AREA: 605 SF OG ORIGINAL GRADE RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 ~-~.::.' ~HONE (~07) 272-8218 ['AX (907)272-~211 HIGHLAND TERRACE #5, LOT 6 ~ ...... i ''''~ P.I.D. NO -~ ~050-312-26 THEODORE SCHINDLER · ~ PERMIT NO. DESIGN DETAILS ANCHORAGE, AK 99516 'li~"9,~;~k¥'S"O~x?~.~.~.~,~v,~o,~..~-~ Sheet Jun ,'~ /U~'~ ~,~/~1 J L~c~'r.J~l~:~c LIe ~Jf-ffU4~-Jbb f;m~e ~ TD:272~211 P.1/1 J ELECTRIC ~,LC 6732 E. 99Ch AVE,. ANCHORaGe, AK. 99507 June 27. 2011 JR'$ Septic Pu~ping P. 0. Box 773415 Eagle River, Ak. 99577 1954&. Ctc~ltta~ Way star*ion and al~o bmgk level, ala~ a= the a~eve ad~es~ ~ accordance with the ~C ~d MOA codeg. J ELECT~C LLC Contractors # 34469 Municipality of Anchorage P.O, Box 196650 · 4700 Elmore Road Anchorage, Alaska 99519-6650 · (907) 343-7904 · Fax (907) 343-7997 http:llwww.muni.or.qlOnsite Development Services Department On-Site Water and Wastewater Program ~epartment **** VARIANCE/WAIVER REVIEW **** WR#: OSPl11091 PID#: 050-312-26 Legal Description: Hi.qhland Terrace #5 Engineer: PES HA#: OSCl 11225 Lot 6 Permit#: OSO111090 Applicant: Theodore Schindler Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 1.5 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. Add comments / explanations or DELETE Waiver is Granted: X Waiver is not Granted: Date: 6/29/2011 Approved by: &~/~/~"'/' . ~-/ma~~ewer Rec#: Amount: Date Paid: **** VARIANCE/WAIVER REVIEW **** Permit Number: OSPl11090 Tax Code Number: 05031226000 Work Type: Septic Permit Effective Dates: June 15, 2011 Design Engineer: Subdivision: On-Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Upgrade to June 14, 2012 PANNONE ENGINEERING SERVICE HIGHLAND TERRACE #5 Site Legal Address: HIGHLAND TERRACE #5 LT 6 G:0155 Owner/Address: SCHINDLER THEODORE J & TERESA A 13111 SUES WAY ANCHORAGE AK 995162641 Site Mailing Address: 19544 CICUTTA WAY, Eagle River Lot Size in Sq Ft: 56236 Total Bedrooms: 3 /c"' cO This permit is for the construction of: Y Disposal Field Y SepticTank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection· Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: ~ Issued By: Date: Date: Municipality of Anchorage P.O. Box 196650 ® 4700 Elmore Road AnChorage, Alaska 99519-6650 ® (907) 343-7904 · Fax (907) 343-7997 httl~://www.muni.or~lOnsite Development Services Department On=Site Water and Wastewater Pro.qram epartment **** VARIANCE/WAIVER REVIEW **** Waiverg: OSP111091 COSA#: PID#: 050-312-26 Legal Description: Hi.qhland Terrace #5 Lot 6 Engineer: PES Permit-g: OSP111090 Applicant: Theodore and Theresa Schindler Your request for a waiver of the required 100 feet horizontal separation from the S.T.E.P. tank to the private well has been approved. The approved separation distance is 60.0 feet. The existing tank has been in the same location for 34 years. Water sample is negative for total coliform and only .413 mg/L of Nitrates. The new tank will have the STi-P3 coating. This waiver approval applies to the proposed S.T.E.P. tank only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date: ~2>/~/~' Approved by: ' Name of Reviewer Rec~: 083325 Amount: $1,050.00 ' Date Paid: 6/1/11 **** VARIANCE/WAIVER REVIEW **** UNICIPALITY OF ANCHORAGE Community Development Department Development Services Division On-Site Water & Wastewater Program Mayor Dan Sullivan ~ Phone:907-343-7904 Fax:907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. (:~'~-3i2-- Property owner(s) -1"1-/~ ~2¢-~ ~t.~ 1'~¢46-54 Mailing address ('.~ [I ~ ~------------------~-~. i,d'~ ~( Site address I~/~,.:/z./ (21c.O'T"r'~ c0.~ ,¢ Legal description (Sub'd., Block & Lot) ./¢../~[¢LR,v'.O Legal description (Township, Range & Section) Lot Size ~'~ ~-_;~ ~, Sq. Ft. Number of Bedrooms Day phone THIS APPLICATION IS FOR: ([~ all that apply) Absorption Field ~ Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage [] THIS APPLICATION IS AN: Initial [] Upgrade [] Renewal [] THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: I cedify that the above information is correct. I fudher cedify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (signa~&e ~f propeh~ owner or authorized agent) ~----~Rush Fees: ~ -- --Date of Payment: (~ - ~'- ~ Receipt Number: ~' ~"~ ~ Permit No. ~--'~t¢[!! E) c~o Waiver Fees: Date of Payment: Receipt Number: Waiver No. G:\Building\On Site\Forms\CIient Forms\Permit App_010411 .doc (Rev. 1/11) Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panenRak.com June 14, 2011 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: Highland Terrace #5, Lot 6 Septic System Permit Upgrade Request, Revised Ladies and Gentlemen: I am writing to request a permit to construct an upgraded septic system be issued for this property. The proposed systems will serve an existing three-bedroom house. Currently the lot is developed. The lot is served by a private well. The existing septic system is in failure. The surrounding lots are served by private wells. 1. Soils. A single test hole was excavated by Pannone Engineering Service in May of 2011. See the soil log attached. Ground water was monitored for seven days. No ground water was monitored to a depth of 14.5 feet below ground level after the monitoring period. Bedrock was not encountered in the test hole. It is my opinion, based on the results of the percolation tests and overall soils appearance; an application rate of 0.8 gallons/day/square feet should be used, using a 1,250 gallon S.T.E.P. tank and deep trench type drain field. Soil Absorption System Design. a. See Sheet 2 of the design package 3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and the existing drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The topography in the area slopes generally from north to south. There is a high relatively flat area where the purposed drain field will be located. Just uphill from the tank there is a fill slope that is over 50 feet from the purposed drain field. So Waiver Request: I request the following waiver: a. Well to Septic Tank/Lift Station from 100 feet to 60 feet. The existing drain field serving this lot is located over the property line and is in failure. It is located approximately 90 feet from the well. The existing 1000 gallon tank is located 63 feet from the well. Both will be abandoned per code. A water sample was taken and analyzed on May 6, 2011 and found to have nitrates of 0.413 mg/L. The purposed S.T.E.P. tank will be located 60 feet from the well, and will be coated to STi-P3, Underground Fuel Tank Standards, minus the sacrificial anode. There is an area to the south west of the well that is outside the well radius. We looked at installing the system in this area and found it unsuitable for the following reasons: 1) The well is 24 feet Page 2 of 2 from the house, there is not enough room to install a sewer line outside the 25 foot protective radius. It is easier to control the coating on a tank, than to protect the raw sewage line from leaking; 2) The area slopes at approximately six percent and the proposed tank and drain field would not fit in this area and meet code; 3) installing a S.T.E.P. tank in this area would require pumping the effluent approximately 300 feet, uphill and across a drive way. There would be possibilities of freezing and clogging over that length. The soils we encountered in the area of the drain field (uphill from the tank) were sandy, gravely, silts to 14.5 feet below ground with a percolation rate of 3.8 minutes per inch. The ground at the tank is located approximately level to the ground at the well casing and contamination is unlikely. The well is located on the southern portion of the lot. The static water level in the well is 220 feet below the top of the casing (218 feet below ground level). The hydraulic gradient is 6 to 7 percent from northeast to southwest. Approving the waiver will not create a health problem for this or the surrounding lots. In review of the ADEC Waiver Memorandum the following points are tabulated: Section Points Water Table (220 ft) 8.5 Soil Sorbtion (Silty Gravel / bedrock) 4.1 Permeability 1.0 Water Table Gradient {-0.5%) 2.0 Horiz. Separation (60ft) 1.5 Total 17.1 points 16-25 points: Almost sure to be free from any form of contamination from household sewage. 6. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and that there are no further comments is received from MoA On-Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, ~.....[..~...~..~;.. ~ ~.....~: .................................. ? ". Steven R. Pannone, P.E. Owner/Civil Engineer Attachments Mailing: ?~0~ Bo){ 100217, Anchol'age~ At{ 99510-02i? Te{ephone: (907) 272-82t8 FAX: (907} 272~g211 ~ ~"~-~~ w ~ ,/--SEPTIC ClCUTTA WAY ~ AREA PRIMARY FIELD (P) ~. ~ 55LFx5.5'EDx2.5"W, ,.8~TD ..... ~ ,N / PAGE 2/3 60't ~ , ~EXISTINO ~ / ~ ~ WELL (E) ~ SEPTIC EXISTING lO00g ~1 ~ ~ AREA SEPTIC TANK ~ ~/ ABANDON PER CODE ~ABANDON EXISTING DRAIN FIELD IN P~CE NOTES: P~O~ ~G ~C, L~ ~ ____, ~ Date PHONE (907) 272-8218 tAX (907) 272-8211 PLAN ANCHORAGE, AK 99516 1 OF3 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS. 2. ALL WORK SHALL BE IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS. 3. SCOPE OF WORK: INSTALL NEW 1250 GALLON S.T.E.P. TANK AND NEW SOIL ABSORPTION SYSTEM. 4. NO GROUNDWATER WAS OBSERVED AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 14.5 FEET BELOW EXISTING GRADE, NOTIFY THE ENGINEER IMMEDIATELY. 5. TANK SHALL BE COATED TO STI PS, UNDERGROUND FUEL TANK, STANDARDS WITHOUT THE SACRIFICIAL ANODE. CONTRACTOR SHALL PROVIDE WRI~EN VERIFICATION FROM MANUFACTURER. -6" TOPSOIL AND VEGETATION 0.5 '*'~ (~ ~-FILTER FABRIC X-DRAIN 6.0 No ~roundwoter monitored~,,<,~ °z /- 6" TOPSOIL AND VEGETATION SECTION o ~ / 4.0 NEW 1250 g TRENCH - SEE DESIGN S.T.E.P. i PROFILE TANK *SEE NOTE 5, THIS PAGE. DESIGN PARAMETERS PRIMARY/RESERVE SEPTIC SYSTEM AB B R EVIATI 0 N S LEG E N D NO. BEDROOM: 3 (450 gpd) CU COPPER -- W WATER LINE/ TANK SIZE: 1250g S.T.E.P. DIP DUCTILE IRON PIPE WELL RADIUS PERC RATE = 1-5 MPI TH TEST HOLE SOIL RATING: 0.8 GPD/SF FC FOUNDATION CLEAN OUT ~ SS NEW SEPTIC AREA RQD: 562.5 SF TiC TANK CLEAN OUT NO. SYS. TYPE: DEEP TRENCH 5.5' E.D. CiC CLEAN OUT NO. MIN LENGTH: 51.1 LF M# MONITOR TUBE NO. USE: R.I. RIGID INSULATION 55 LF X 2.5' WIDE, 5.5' E.D., DCO DOUBLE CLEAN OUT ~o~'.~!~ TD ~' ~, ¢.¢. DV DIVERTER VALVE TOTAL AREA: 605 SF FS FLOW SPLITTER NOTES: PANNONE ENG SVC, LLC FOR CONSTRUCTION p.O. BOX ~00217 ANCHORAGE, AK 99510 NTS P.I.D. NO HIGHLAND TERRACE #5, LOT 6 050-312-26 THEODORE SCHINDLER . CE ~149 .~',~-~ 0SPl11090 20F3 SOILS LOG - PERCOLATION TEST TEST HOLE 1 ()N TOPSOIL SLOPE ~:'~ ~'r~['SITE PLAN~ 5 -- " ' "' ~' GB ..... "" ' GB -.. 6-- SANDY / 7 -- GRAVELY 8 -- LARGER TH 9 -- DEPTH 12 --, ~ ........ ? ............. '?' ......... ',r ........ S E 13 -- ,,, WAS GROUND WATER SLOPE 14 -- ENCOUNTERED? N 15 -- BOH IF YES, AT WHAT TH 16 -- DEPTH? -0-' X 17 -- DEPTH TO WATER AFTER MONITORING? -DRY- 18 DATE: 5/18/11 DATE PERFORMED: 5/11/11 READING DATE CLOCK WATER TIME NET TIME LEVEL NET DROP READING I 5/11/11 12:07 --- 5.17 --- 2 12:17 10 MIN 8.03 2.80 3 12:17 --- 5.17 -- 4 12:27 10 MIN 7.81 2.64 ; 5 12:27 .... 5.17 6 12:37 10 MIN 7.75 2.58 PEROLATION RATE 3.8 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 5 FT AND 6 FT COMMENTS: Test hole excavated by SOUTH FORK CONSTRUCTION. Prec hole was presoaked~ Test run for one hour. Last 3 readings reported PERFORMED BY: Steven R. Pannone~ P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. ~~.~. D a t e NOTES: PANNONE ENG SVC, LLC ~.~,.. 9.~. .~,.L~ ~,, 6/14/11 ,=~,'t. ~.;c.^, R~-VlEW 0::':,' P.O. BOX 102954 ANCHORAGE, AK 99510 ~'c_~.~.'' ~ C~x),-.~"r'iP--I,~'7'¢'~,,~ PHONE (907) 272-8218 FAX (907) 272-8211~ --".'~'*."'4c~ TH ~...,~ Scale NTS P.I.D. NO ...... 050-312-26 THEODORE SCHINDLER ~'~,~ ¢~e ve ~EIX ~ lh'4~n n .°.-~ ~ PER M I T N O. 15111 SUES WAY ,~.. ..~,~,~x~___~,.~ 0SPl11090 SOILS LOG ANCHORAGE, AK 99516 ti~.~OF[SS\O~?_~,~ ~'~"" Sheet READING DATE CLOCK WATER TIME NET TIME LEVEL NET DROP READING 1 5/11/11 12:07 --- 5.17 --- 2 12:17 10 MIN 8.03 2.80 3 12:17 --- 5.17 -- 4 12:27 10 MIN 7.81 2.64 5 12:27 --- 5.17 6 12:37 10 MIN 7.75 2.58 ~.i~-.~ GRE~, ER ANCHORAGE AREA BOR~.UGH ~ ~ )~ Department of Environmental Quality 3330 C Street (Z ~ ~-~ f][O ~ Anchorage, Alaska 99503 INSP~C~O~ REPORT ON-SITE SEWAGE DISPOS~. SYSTEM SEPTIC TANK: DISTANCE -'~.~ / FROM WELL (~"/ MANUFACTURER ___ ~'""~' MATERIAL INSIDE LENGTH ,/' INSIDE WIDTFI ""/ LIQUID DEPTH ~ COMPARTMENTS -- LIQUID C APAC I TY [0 ~) ~"E~AL LON $. TILE DRAIN FIELD: / DISTANCE FROM WELL ~'-~--~ ~'~--FOUNDATION NUMBER OF LINES DISTANCE BETWEEN LINES __ TRENCH WIDTH IN. DEPTH: TOP OF TILE TO FINISFI GRADE ¢ q¢__NEAREST LOT LINE TOTAL LENGTH/ OF LINES DEPTH OF FILTER MATERIAL BENEATH TILE TOTAL EFFECTIVE {,~0 ' IN. ABOVE TILE .~' IN. WELL: ~ TYPE 'd[~,/)~ '/~ ['C¢- ~J/ .... CONSTRUCTION BUILDING NEAREST FOUNDATION__ LOT LINE__, CESSPOOL OTIHER SOURCES APPROVED DISAPPROVED NEAREST SEWER LINE DEPTH ........ DISTANCE FROM: SEPTIC SEEPAGE TANK __, SYSTEM REMARKS DISTANCES: ~ _ INSTALLED BY: ~~ ' SEWER LINE DEPTH: PIPE MATERIAL: (~' DIAGRAM OF SYSTEM , ~.,, ~ '~.~ _~_ 7o'___._~--.--~O.~eJl ~or L, ~ ~ ~- - ~ , I:::11::'I::'1,. :1: I:::: I:il",l '1" f. IZI I:'::1:::1'1" :1: O I",t I.., 1:!!: (:!il:::tl .,, I..E; I'"I:I:GHt...I::II",!t) 'i"I!!i:I:;i:I:'::FIE:E: .t.I. ::L: :1: I:::11"'1 I:::'l::'ll'"J:l:l...:l:f::ll';i: I.'.I:I:'TH 'l'Hli~: F'.l:ii:QLl:[t:;?.E:t"'lE:l",t'l"'.iii; I::'Efl;i: OI",t-'t!i;:[TE: :fi;[:::l,.llii:l:;?.:i::; I:::IH[Z:' l.'.tl{:i:I..l. :i: l:::l:i!i; I:::'OI:;i:'FH Iii?,"? 't'HI!!: Ifil N'I'-: I:::'1:::11 'l"l'"r' FI:::' :.:ll'.,Ir":l.l~"l:;'l:::lr:il:!:' ;i?: :lZ I.,.I :1: I..I... :[ I'.,l:i!i;'l"l:::ll...I... 'l"Hlili: :ii!;'.r'r!~:;TE:H :[ t'.,I :::::::::::::::::::::::::::::::::::::::::::::: I.,.I :1: "I'1.t t"l.llii: :::i:: ]: I..IJ,,l[::,Iii~l:;i::iil;Tl:::li'.,Jl:::, I'HI::II' 'l"l..lliii: Ol'.,I...:!ii;:l:"l"E: iiii;l!ii:l,.![ii:Fi: :!!i;"r':iiiFl"l!ii:l"l I"ll:::l"r' I:?. li!i: C! l. .l :l I:;?.liii: E:I,,II.I:::iI:;irGI!~:I','Ili!!ZI'.,Fr' :lZl::: t:~'.E::i!i;:I:I:::,I~i!:I'.,ICE: :l:tiil; I:;i:lii:l','lO[::,l:ii:l.lii~lZ::, "t'~:::~ :ft'~!~::[.l..llZ::,t!i: I"'tOl:;?l!i: 'I'HFiI'.,! ::i!: 1::~1::'t:::'1.r · ' d~:l: ::::FiN"I' ~:1..~;'t' :[ ::. H ::: O 8- E GFO' 'CHNICAL 8- DEVEL Box 90, Davis St., Eagle River, Alaska 99577 6952774 or 688-2280 ?MENT CO. Russell Oyster Earl EIh~ 694-2774 SOIL LOG 688-2280 Soils ~ Foundations Land Development Performed for: Mailing Address: D~~ S~ Characteristlc~ 0 7~ 8 9 ,~ 10 Ground Water Encountered: Yes No Proposed Installation: Seepage Pit Com~lents: ---/ If yes, wh~t Drain Field 0 13' W 294.7 I~ '~ o ~ L'~ It, d_ k-! ~-~,~ ~ ~1.. I~ O~ ~ ~ o~ O ~H ' /~ ~ ~L~ ~ 0~ H ~ H ~ o o 30f ROM MUNICIPAUTY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Section Phone., 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-312-26-000 Expiration Date:bec 16 .acoc-� I. GENERAL INFORMATION Complete legal description Highland Terrace #5 LIS Location (site address) 19544 Cicutta Way Eagle River, AK 99577 Current property owner(s) Austin Gillette Day phone Mailing address 191544 Cicutta Way Eagle River, AK 99577 Real estate agent 2. TYPE OF DWELLING: P Single Family (w/wo ADU) El Duplex n Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic Ej Water Storage 0 Holding Tank Community Well 171 Community ❑ Public Water System ❑ Public Sewer ❑ VVaiver request ;or: Distance: Received by: Date: Cos t' be to be released to the engiree,unless rolherlwis. leMI-1.11 1-. quested by the engineer, COSA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number COSA#. C)5C2)j_r )0' -b Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined In the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with ail applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition; ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. 6. DSD SIGNATURE I/ System #1 Approved for 2 bedrooms System #2 Approved for _ bedrooms Disapproved Date Conditional approval for bedrooms, with the following stipulations: By;'t ((fJ( Q17lL.c G� 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 engineers work, ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA CheMisl blue sheet Legal Description: Highland Terrace #5 L6 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled unknown Total depth 45+ ft Cased to 40'+ ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 8/28/20 Static water level at beginning of test 118.5 ft Comments B. TANK DATA Age of tank(s) 9 years Tank type/material Step/Steel Measured operating fluid level in septic tank 48 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 9/10/20 D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) 2011 On ALL standpipes present per record drawing Total measured depth from grade 10.25* ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field ❑ 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 gallons Comments/Deficiencies: '+/- 2.0' fill added over the top of the drain field COSA Checklist yellow sheet Parcel ID: 050-312-26 Structure served by this system 1 Well production at time of test 2.7 gpm Water storage tank volume n/a gallons Well disinfected for coliform test? ❑ Yes No ❑ Coliform bacteria is Negative Nitrate 2.43 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Pannone Engineering Date of Sample 9/2/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station 9 years Lift station material Steel Comments: Adequacy test date 8/28/20 Results Q Pass For 3 bedrooms Fluid depth prior to test 0/0 in Water added 452 gal New depth 9/7 in Elapsed time 240 min Final fluid depth 0/0 in Absorption rate -"40u gpd Any rejuvenation treatment (past 12 months) no If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' 62.3 Community Sewer Manhole/Cleanout > 100' f7 Yes if No ft [❑✓ Yes if No ft Neighboring Tank > 100' M Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' If septic tank is under driveway comment below Surface Water > 100' Animal Containment > 50' ❑✓ Yes if No ft 0 Yes if No ft waivers on file with MOA for separation distances Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑✓ Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Yes if No ft Surface Water > 100' ® Yes if No ft 15 Property Line > 5' ❑ Yes if No • ft Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells > 100' M Yes if No. Water Main > 10'✓❑ Yes if No ft Community Wells > 200' 0 Yes if No Water Service Line > 10' Q 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' E] Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No 7.7 ft Wells on Adjacent Lots: Water Main > 10' ❑ Yes if No ft Private Wells > 100' E1 Yes if No Water Service Line > 10' M Yes if No ft Community Wells > 200' 121 Yes if No Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS waivers on file with MOA for separation distances G. ENGINEER'S CERTIFICATION l certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. `" �Il s • COSA Checklist yellow sheet ft ft 10 ft IVIUNK"A""IPALITY. OF ANCHORAGE D&w-.)1oj-,.-)rnent 3(.-.,rvices Deparl.nnent 9011-34'-7004 Phone . 1) On-S�te \A./a1`E-,,r & 'V,Jasiewaer St,.,,Nion -7 Lift Station/Pump Vault Maintenance Log Owner—A Street Address Septic Tank: -Sludge level nches -Pumping: required e -Pumping completed rY9LJh_o Lift station: -Pump basket cleaned De no -Effluent filter cleaned e ` no -Control floats cleaned4-Proper float settings confirmed <Aj:) no �no �o -Operation satisfactory e no Alarm System: -Dedicated electrical alarm circuit e ��)n o -Audible and visual alarm inside dwellin<_p��' no -Alarm system operation s tisfaciol- ot satisfactory Manhole Riser -Ground water intrusion at riser to tank connectionyes no -Ground water intrusion around pipe penetrations es n6' -Weep hole functional iLno -Manhole lid: Functionalfes' no Insulated (yg,!�,, no Properly Secured &�S�, no Other -All manufacturer required inspections and maintenance complete es no Qualified Maintenance Provider: / , - Technician Date of maintenanceUt Company Signature— 11�741,1,4�4 D a t 9L� 0a, - V Municipality of Anchorage Development Services Department Bui dng Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 (907) 343-7904 www. muni.org/onsite CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. o5o-3~-2-z6 GENERAL INFORMATION Complete legal description Highland Terrace #5, Lot 6 Location (site address) ~9~4.¢ Cicutta Way, Eagle River Expiration Date: fi" 2. ¢1 - i i Current Property owner(s) Mailing address Lending agency Mailing address Theodore Schindler Day phone ! ~-PLr~T'o,~,, O~A; Day phone Real Estate Agent Mailing Address Unlegs otherwise requested, COSA will be held by DSD for pickup. 2¢':: ,NUMBER OF 'BEDROOMS: 3 3. :: TYP~ 0F WATER ~UPPLY: InldivJ,dUa/;"",W~., [] .Individual Water Storage [] Community Class ~ Well [] Public Water System Day phone 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 On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water 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 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 b,ased on the information obtained from the Municipality of Anchorage files and from my investigation and insp~C~ion, 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 Pannone Engineering Services, LLC Phone 272-82:1.8 Address P.O. Box :too2~7, Anchorage, AK 995~o Engineer's Printed Name Steven R. Pannone, P.E. Date 6/28/2o~ Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. PES can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requir, ements qfthe MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized nor will it confer any legal right whatsoever.. 5. DSD SIGNATURE ~,~"~ Approved for _'~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev. 11/0 X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: ~_~ - ,~,- ~-// Municipality of Anchorage DevelOpment Services Department Building Safety Division On-Site Water & Wastewater program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99~,19-6650 www. m u ni.org/~)~nsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST' Legal Description: Highland Terrace #5, Lot 6 A. WELL DATA Parcel ID: o5o-~.2-26 Well type Private Date completed U/~.,ui~ Total depth~:~' Date of test Static water level Well productiOn IfA, B, or C provide PWSID Sanitary seal (Y/N) Cased to ~ft. FROM WELL LOG ,,°) g.p.m. WATER SAMPLE RESULTS: Well Log (Y/N) N Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION r;Ir;1201~. 221 ft. ~..2 g.p.m. in. Coliform Ne9 colonies/100mL ArseniC: ND ug/I SEPTIC/HOLDING TANK DATA Nitrate o.~,~ mg/L Date of sample: r;16f, o~.~. Collected by: DRM Tank Type/Material Anchorage Tank/Steel Tank size ~25o S.T.E..P. gal. Number of Compartments Foundation cleanout (Y/N) Y_ Depression over tank (Y/N) N Date of pumping &/~.W,/'.~_ Pumper C. ABSORPTION. FIELD DATA Date installed Cleanouts (Y/N) Y High water alarm (WN) Y Date installed 6~'28~'2Oll Length Total depth 9 ft. Eft. absorption area 605 ft2 Date of adequacy test New Results (Pass/Fail) Fluid depth in absorption field before test ~ in. Elapsed Time: Any rejuvenation treatment (past 12 mo.) (Y/N & type) Soil rating (g.p.d./~ or ~/bdrm) 0.8 Width 2.5 Monitoring tube Y Water added in. System type Deep Trench Gravel below pipe 5.5 DepressiOn over field N For ~ bedrooms ~ gal. New depth Absorption rate >= If yes, give date in. g.p.d. LIFT STATION Date installed 612812o3.3. "Pump on" level at ~ in. Datum Bottom E. SEPARATION DISTANCES Size in gallons 250 "Pump off' level at 3~ in. Cycles tested /'q~ SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankJlift station on .lot 62.=~ Absorption field on lot ~.3.o.o Public sewer main 75+ Sewer/septic service line ~2.7 , Animal containment areas 50+ Manhole/Access (Y/N) Y High water alarm level at/~5 Meets alarm & circuit requirements? Y in. On adjacent lots 3.00+ On adjacent lots 3.00+ Public sewer manhole/cleanout 3.00+ Holding tank ~.oo+ Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 35.0 Property line Water main 3.0+ Water service line Wells on adjacent lots Water Service line 53.8 Curtain drain 50+ F. COMMENTS SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 7.7* Building foundation ~,.._cj Surface water 3.oo+ Wells on adjacent lots 3.0o+ Absorption field 57.6 Surface water 3.oo+ Water main 75+ Driveway, parking/vehicle storage I request a lot line to septic'tank distance waiver of 1.5', and a lot line to drain field distance waiver of 7.5'. I ce~i~ that l have determin~ though field insDections and ~. ~.:' ~ '.~. ~ rew~w of Municipal taco,s that th~above sys'tems are in ~ *~", '49~ ~ '*? ~ conformance w~h MOA COSA guidelines in effect on this date. ~'~'~~ Engineers Printed Name Steven R Pannone, P E ~~~;'~ Date ~1~1~.. '*~"'.. ........ ~'"~'~ COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ ;~C~t Date of Payment ~ - ~ - ({ Receipt Number (~)~' ~'-~ c~ SGS ReL# 1111739001 Client Name Pannone Eng. Srv. Printed Date/Time 05/16/2011 13:42 Project Name/// 19544 Cicutta Way Water Sample Collected Date/Time 05/06/2011 11:30 Client Sample 1D 19544 Cicutta Way Received Date/Time 05/06/2011 12:05 Matrix Drinking Water Technical Director Stephen C. Ede PWSID 0 Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals b~, ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 05/09/11 05/09/11 NRB Waters De,oar tment Total Nitrate/Nitrite-N 0.413 0.100 mg/L SM204500NO3-F B (<10) 05/10/11 AYC Microbiolog~r Laborator~r E. Coli Total Coliform Negative I 100mL SM20 9223B A 05/06/11 DSH Net~ative 1 100mL SM20 9223B A 05/06/11 DSH Cl CUTTA ~,4 y Lot 7 ~ CLEANOUTS 6.6' CANT--,..... -.., WITH DECK BELOW PLOT PLAN -SEPTIC MANHOLE / I ~0( \ Lot 1 WELL DECKx 12~2' STORY \\ RESIDENCE WITH BASEMENT Lot 6 56,236 s.f. / ,/ S 89'58'00"W 180.00' \~-[.. ~ Lot2 j SUBD1 E47~ ~WEST AS BUILT X SCALE 1" = 50' GRID NW 155 Lot 5 Lot 5 Project No. 11-088 Lo ng (907) 522-6476 Registered Land Surveyors (907) 522-4625 ken{Hangsurvey.corn / JonathanOlangsurvey.com & Associates, inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-5049 Phone Fax '=~'"~ O ~' A /'%%. e'~;': .............. r ..... ~'::~'~ VJ ~ * " I hereby certify that I have surveyed the following described properly: Lot 6, Highland Terrace Subdlvislon Addition No. 5 (Plat No, 75-12) Anchorage Recording DlsfHcf, Alaska, and that the Improvements situated thereon are within the properly Ilnes and do not encroach onto fha properly adjacent thereto, that no Improvernenfs on the property lylng adjacent thereto encroach on the surveyed premises and that there are no roadways, fransrnlsslon lines or other visible easements on said property except as Indicated hereon. Dated thls the ?~% Day of _ _~J.t~ ........... '~L\ , af Anchorage, Alaska If Is fha responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivlslon plat. Aarow Pump & Well Service LLC (907)346-9355 Inspection Report I ran a camera 45' down the well at 19544 Cicutta Way, Eagle River and did not find any holes/cracks in the casing or leaking around the pitless. Beau Maxim Parcel I.D. 1. MUNICIPALITY OF ANCHORAGE DE"PARTMENT OF HEALTH & HUMAN SERVICES Division of Environmentar Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 GENERAL INFORMATION Complete legal description L-~'T' Location (site address or directions) CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA # "~1 ~-~X~ Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: '~" TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site /~ . 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. 1191) Front MOA ~21 Legal Description: ~,J:)'~-"~ APD~I .%- !-!!6l~(,J~Jb 'T'~_~ .,~-? Parcel I.D.' Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist A. WELL DATA Well type ?¢._{~-'[~'~ If A, B, or C, attach ADEC letter, ADEC water system number Log present (Y/N) Total depth "2--I Sanitary seal (Y/N) ~1~ Date completed .\/JEJ..C PUT !Al [<~¢ ~ Cased to ~>~ftt~ ~'~J-O _ Casing height (above ground) Wires proPerly protected (Y/N) __~) II FROM WELL LOG AT INSPECTION Date of test Static water level Well production g.p,m, WATER SAMPLE RESULTS: Coliform ~;) Date of sample: ,'%E.P'T" ~'~ SEPTIC/HOLDING TANK DATA . Nitrate 0,.737 Collected by: "~h Other bacteria Date installed Foundation cleapout (Y/.N) _ Date of pU 'roPing --~., t z-~(¢{~ C. ABSORPTION FIELD DATA Tank size ~ Number of Compartments _~__ Cleanouts (Y/N)~ Depression (Y/N) ~[ . High water alarm (Y/N) _/V~ .Pumper ~-?_.{~ PO:~,I,~(_.~ Date ih. stalled,. Iq'7 :;7. Soil rating (g.p.d,/fF or fF/bdrm) ~/ . System type _ Leng~/'.~?' "Width, . ~- Gravel thickness below pipe~ ~_ Total depth E~ectlve able r ~l~[ ~a ~ ~ ~) ~ ~ [ Monitoring Tube present (Y/N) ~) Depression over f e d (Y/N) _._~__. Date of ad.qu. y te,t R. u ts PA :? Fo, b.droom Fluid depth in absorption field before test (in,); ~ _ Fluid depth ! (ins) Minutes later: [O! Peroxide treatment (past 12 months) (Y/N) Immediately after,-~-"C'"~gal, water added (in.): Absorption rate = t"'~/dXZ'_;, _g.p.d. If yes, give date 72-026 (Rev. 3/96)* ~.~_~_..~. CT&E Environmental Services Inc. CT&E Ref.# Client Name Project Name/# Client Smnple ID Matrix Ordered By PWSID Sample Remarks: 985024001 Schindler, Ted Lt 6 Adn Highlm~d Terrace Well Outlet Drinking Water Client PO# Printed Date/Time 09/09/98 09:23 Collected Date/Time 09/04/98 10:00 Received Date/Time 09/04/98 11:00 Technical Director: Stephen C. Ede Released By~~,~.~ ~ Parameter Results PQL Units Method Allowable Prep Analysis Limits Date Date Init Nitrate-N 0.737 0.100 mg/L EPA 300.0 10 max 09/04/98 09/04/98 GCP Total Coliform 0 co[/lOOmL SN18 9222B 09/04/98 KAP MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 GENERAL INFORMATION (a) (b) (c) Application Date Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) 19544- Cl'c.u~ Appl!cant Name_ l~'~e,'~, ~ 'Y/,Vq~,,;~ ~'~:~' Telephone: Home ro~Pq- -~.'S~- Business A~ 21icant Address Applicant is (check one): Lending Institution []; Owner/builder [~; Buyer []; Other [] (explain); __ (d) Lending Institution Telephone :'"Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family 13t Multi-Family [] Number of Bedrooms "~ Other WATER SUPPLY Individual Well ~ Community [] Public [] ,, Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SFWAGE DISPOSAL Onsite 1~ 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 ~-o~5 m.84) ENGINEERING FIRM PROVIDIE .NSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION AS certified by 'my sear 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 ~umber 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, ~nd regulations in effect on the date of this inspection. Name of Firm ~'~c-~_ ~,~ )~ Telephone Address ~l ~ ~ ~ ~~ Date ~ t~, Approved ,o, '-~i.~bedrooms by Approved ~/'~ DisapproveoV/ Conditional .(~.J Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: /~UNICIPALITY OF ANCHORAGE DEPT. OF HEAl. TH & /NVI~ONMEN/'AI. PROTEcTIoN SEP '.l ? I[ [i RECEIVED L-co O~O~'~e~,~ T~,~,-~o~ g5 5-7 -F ~4~ Rx~ Well Classification Well Log P~esent (Y/N) Total ~pth . ~n~n(z 7 Z~ Card t v~ Static Water ~vel ~ ~t At Casing Height A~ve Ground Electrical Wiring in Conduit (Y/N) Sep~ation Distan~s f~ ~11: If A, B, or C, D.E.C. Approved(Y/N) Date Completed ~F~o× /~8 Yield ._ Depth of Grouting. Sanitazy Seal on Casing (Y/N) Y Depression Around Wellhead (Y/N) nj To Septic/Holding Tank on Lot ~' ; On Adjoining Lots lco'~ .. To Nearest Edge of Absorption Field on Lots~ ~Lu~¢~; On Adjoining Lots ~ To Nearest Public Sewer Line 5o'+ To Nearest Public Sewer Cleanout/Manhole ~o'+ To Nearest Sever Service Line on Lot Wate~ Sa~ple Collected By Co~.~s~¥u~, .~--~ ~_; Date Water Sant01e Test Results ~te Installed I~ Size 1~o ~ No. of C~[~nts I Standpi~s (Y~) ~ Ai~-tight Caps (Y~) ~[ Foundation Cleanou% (Y~) ~p~ession oveF Ta~ (Y~) ~ Date ~st P~d ~ P~i~g/Maintenan~ Contract on File (Y~) Nh ; for Holding Tank High-Water Ala~ (Y~) ~ Tem~rary Holding Tank Permit (Y~) Separation Distan~s ~ ~ptic~olding Tank: To Water-Supply ~11 G~' ~,h~%k~8 To ~ilding Foundation To ~o~rty Li~ ,o' To Dis~sal Field To Water Main/Servi~ Li~ ~'+ To S~e~ Pond, ~e, ~ Major ~aina~ Cour~ N h ' [Page 1 of 2] Receipt 9 Date :Paid: Amount: 2-15-84 / C. ABSORPTION FIELD DATA Soils t~ating in Absorption Strata Date Installed Width of Field Il' Square Feet of Absorption A~ea ~5~' Depression over Field (Y/N) ~q /~o~ Type of System Design Length of Field %~' Depth of Field ~' Gravel Bed Thickness ~' Standpipes ~esent (Y~) ~te of ~st A~qua~ Test 5~+ Results of Last Adequacy Test .~e~ Z~?~u~ ~_~ Separation Distan~ from~sorption Field: To Water-Supply ~11 ~'+ To ~o~rty Li~ ~ p~~. To Building Foundation ~'~ To Existing or ~ndo~d System Lot 7~' ; ~ Adjoining Lots To Water Main/~rvi~ Line t~'+ To Cutba~(if pre~nt) To St~e~ond~ke/~ Ma3o~ ~ainage Co~se To~iveway, Parking ~ea, or Vehicle Storage ~ea Counts ~ ~9~~ 13~V- ~~ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Dimensions Manhole/Access (Y/N) ~ y "Pump Off" Level at ,r Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Conments ** Check Permitted Bedroc~ Rating Against HAARequest ** I certify that I have checked, verified, or conformed to all MOA HAA on the date of this inspection. Signed Company KB1/d5/s [Page 2 of 2]~g/z~~ ~'~,C,a~} Date 9-~ ~-~55 MOA No. in effect 2-15-84 DEPARIME] 825 MUNICIPALITY OF ANCHORAGE C~o~ OF ttEALTH ~ND ENVIRONMEN PROTECTION L Street, Anchorage, Alaska -9950]. 279-2511, ext. 224 or 225 Date Received: April 22, 1977 #1: Time 10:30 a.m. #2: Time #3: Time Date 4-25-77 Monday Date Date Insp Pratt In~p Insp REQUEST_ FOR APPROVAL OF INDIVIDUAL SEWER' 4. AND WATER FACILITIES Lending Institution Request: Alaska Bank of Commerce Mailing Address: Pouch 7-012 99510 Phone: 279-5641 2. Property Owner: Paul/Carol Jones Phone: 694-2124 Mailing Address: 3. Lega[L Description: Lot 6 Highland Terrace Subdivision #5 4: Single Family Residence: ( ~ Multiple Family Residence: Number of Bedrooms: Number of Bedrooms: Well System: Permit # Construction Public/Community System: ( ) Individual Well: ~ ) Depth of Well Well Log on File ( Bacterial Analysis Sewage Disposal System: On-site System (xJ Public Utility ( ) PermJ_t # ~/~/~ Insl~alled 1968 .(_?_)___ Installe,? A~ f~/~nm~s. Septic Tank Size __/_~)~ Fo~_~j~fO~q_~ Manufacturer Absorption Area ._~1~ ........ Soil. s Rate __.~=~ .... Material 7. Distances: Well to Septic Tank to Sewer Line Nearest Lot line to Nearest Lot Line to Absorption Area 3_ZbZ]'~ Absorption Area MUNICIPALITY OF ANCHORAGE \x) DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 43a-C~J~,4.UL.~:r~A;~+¥ ~'J~:/.>k/ ;;: D;JPI, ~', , REQUEST FOR APPROVAL OF :i ,.,.,~;,,~i,,~.~r, ,~.. ..... . , 'HCI,~ INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: 2. Property Owner,_ Mailing Address: 3. Name of Buyer:__ k'~.C2 Mailing Address:_ VA____FHA Day Phone:_¢ ,- ~7t~ /A'~'DayPhon,: Name of Lending Institution:, ~ X~¢' Mailing Address:_ Phone: Name of Real'tor or Agent: ¢_. <4_ ~.. ~:-;,~ ¢~',..../ { ~¢ O..~:-L~_ Mailing Address: /, (~' ,~ <~,~X ~ ~ X / ' ' Legal Description: Location: 7. Type of Facility to be Inspected: 8. Water Supply Type of Supply: c/ Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well ~/ ~) 9. Sewage Disposal System Type of System: Public Utility If Individual, date of installation Individual (on-site) ! 72 003(3/76) Page Two · Department of He~l%h and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 6 Highland Terrace Subdivision #5 Co~hme~ts: Affadavit Attached:~' ) Letter A%tached: ( Disapproved: Date: Departmen% Workshee%: 1977 Alaska Bank of Com~t~rce Mortgage Loan Section Pouch 7- 012 Anchorage, Alaska 99510 SFbject~ Lot 6 Highland ?efface Subdivision ~5 Before this department will give an ap)?roval on the subject property, s~ve~al discrepancies must be corrected: (a) The seepaqe pit must be one-hundred (100) fee'[: from the well. (b} '/'he septic tank must be uncov~red, an~[ pump(~;d to v~rify its size and existanc~. (o) The well seal must be tightened so that it is air tight ~ If there are any further questions, pluas~ contact this office at 279-~2511, extension 224 or 225. ~)bert Co Pratt, ~oS. Sanitarian RCP/ljh <;e: Paul Jon(~s ~--, Team Real ~elga Larson Post Offioe BOK 594 99577