Loading...
HomeMy WebLinkAboutBRUCKNER LT 1Bruckner Lot 1 #051-072-71 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211098 PID Number: 05107271 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New N Upgrade Name WAUGHTAL BRAD ABSORPTION FIELD K Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 21908 GRASSER RD ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 244-1930 4 1.2 GPD;SF 9 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 4 Ft. Gravel depth beneath pipe 5 Ft. Subdi-.rision Block Lot BRUCKNER LT 1 Fill added above original grade 0 Ft Gravel length -1 50 Ft. Tovenship Range Section Gravel vddth iBeds: Number of Lines 3 Ft.l - Distance between lines - Ft. SEPARATION DISTANCES To Septic Absorption Holding Lift Station i Sewer Total absorption area Number of trenches Dist between trenches From Tank Field Tank Line 500 Ft= 1 - Ft. Well 100'+ 100'+ ' na na na TANK N Septic C]S.T.E.P. ❑ Helding ❑ Other Manufacturer Greer Capacity 1250 Gal. Surface+'dater 100'+� 100'+ na na Material Plastic Number of compartments 2 Lot Line 10'+ 10'+ na na NA Foundation 10' } 10' + na na LIFT STATION „Manufacturer Capacity Rernarks DV to Old Trench Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank D3034 Tank to D3034 grainfield Installer J R's Drainrield D3034 GO/MT D3034 Inspector NorthRim Eng. BENCH MARK (Assumed elevation) 100 rt Inspection 1,, 514121 515/21 Location and description dates: 2,..1 Dec k 3-11 Ott', ON-SITE WATER AND WASTEWATER SECTION APPROVAL 1`1 +�A�w OF Conditional Approval: Date . •• s`* .,49a* * f Steve Eng Septic System�,� CE -6256 �C;k 1 �1� '5'/, Approved Date S Z 1.2 % 2-+ Note: this approvaloes not include well permit requirements. Septic O Flat Slope \ Driveway \ A B T1 52 18.5 T2 55 22 dco 56 24 dv 57 24 C01/MT 6( 62 CO2/MT 100 Septic O Flat Slope \ Driveway \ NOR THRIM +-�� � `%o 4 ENGINEERING ��P ' -N BRUCKNER SteveEng.com *'; L❑T 1 PO Box 770724+' . :.. - Eagle River. Alaska 99577 •�, �— .. '= WASTEWATER 907.694. 7028 � 5/12/21' I IPSP MT F CPPTTr 1' = 50' RECORD LAYOUT late:EET. 5/12/21 12 of 3 \ Well o JS G \WellO IQs 4 Bdrn K AB Flat Slope C Flat Slo e b p \ \Slope TI T?do Slope\ \ lope \ \ 1 � Slope \ Gr V% Slope firer \ 11 Ne Decommissioned Septic Tank \ tio Ou PER UPC & C3 Replaced w/ 1250 Gallon S()Rpe Septic Tank 30'/. \TH Slope w/ Double Cleanouts \ \ w/ Diverter Valve 20-25% Flat Slope Flat Slope NOR THRIM +-�� � `%o 4 ENGINEERING ��P ' -N BRUCKNER SteveEng.com *'; L❑T 1 PO Box 770724+' . :.. - Eagle River. Alaska 99577 •�, �— .. '= WASTEWATER 907.694. 7028 � 5/12/21' I IPSP MT F CPPTTr 1' = 50' RECORD LAYOUT late:EET. 5/12/21 12 of 3 (-- � d F-9 �;u FTI F-1 �;uz�d V) fTl n V) -< fTl C-) D Z fel z = F-9 z ti D rp o < <+O TI H IHT I I a F M < �. Frl z ►o, 0 w m m ro Q C+ 0 ro co 0� mm 6 ;;,.;,.;,.;;.;, N F— D rp R) C <+O � C a to M < �. c+ z rrl FTI ►o, 0 w m m ro Q C+ 0 ro co 0� mm 6 ;;,.;,.;,.;;.;, M D rp Ln f'l 03'_' < N O R) Q < D o c+ �F I 0 Q Quo ro o �rD w Q ro Q 0 ro pi bo Oro to 0 5 D rp Ln <+O m to M < Q c+ O -P,5 td -9 -1 �, r N t -F m O (D 5 Q -0 O Q Q O c+ LA bd o < Q Q ro ro Q m p Fri 3 X Q U rF hn : :5- (D (D Frl TI ro O C+ 900 r� `0 0 0 Ln m M < Q o Q o td 0 O ro Q < <� �, r N t -F (O t0 L l (D 5 W Ln N Q O c+ LA bd N c+ N m C+ n Q 90 5 N n s MORTGAGE SURVEY 28' DECK SEPTIC M SEPTC F Lot 11 Lot 1 40,537 s.f. Lot 2 Lot 12 MORTGAGE SURVEY X SCALE 1" —=50' GRID NW 1458 Project No. 21-263/RM2 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone o000�0 p 19n71 599—AR95 Fer o '. r •OO\\w Professional Land Surveyors .com I hereby certify that I have surveyed the following described property: LOT 1, BRUCKNER SUBDIVISION (PLAT No. 83-226) Anchorage Recording District, Alaska, and that this Mortgage Location Survey is a representation of the conditions that were found on the date the survey was performed. This survey does not constitute a boundary survey and Is subject to any Inaccuracies that a subsequent boundary survey may disclose. The Information contained hereon shall not be used to establish any fence, structure, or other Improvements. Dated this the 1'L1h Day of n41=`? ILL , at Anchorage, Alaska I It Is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. I �* 49TH . y* ?A KENN li .O rr rr`ti 90444 p�LS252021!297 o klhz RESSIONA� AECC963 �JNc.ryoF MUNICIPALITY OF ANCHORAGE cnt On -Site Water & Wastewater Program �o� ti»,S;> PO Box 196650 4700 Elmore Road _ �- ! Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite ^ DeI)artment I n,CH OR AG9 On -Site Wastewater Disposal System Permit Permit Number: OSP211098 Effective Date: 4/23/2021 Work Type: Septic Upgrade Expiration Date: 4/23/2022 Tax Code Number: 05107271000 Site Legal Address: BRUCKNER LT 1 G:1458 Site Mailing Address: 21908 GRASSER RD, Chugiak Owner: WAUGHTAL BRAD P & SHEILA M Lot Size in Sq Ft: 40537 Design Engineer: NORTH RIM ENGINEERING Total Bedrooms: 4 This permit is for the construction of: Q Disposal Field 2 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By: Date:Y'_�3Ai Date: Z MUNICIPALITY OF ^l))Lys Development Services Departments =' On -Site Water & Wastewater Section Parcel I.D. 051-072-71 ON-SITE SEPTIC/WELL PERMIT APPLICATION Property owner(s) WAUGHTAL Mailing address 21908 Grasser Rd Site address same Phone: 907-343-7904 Fax: 907-343-7997 Day phone 244-1930 Legal description (Sub'd., Block & Lot) Bruckner LT 1 Legal description (Township, Range & Section) Lot Size 40,537 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Fx_1 Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank ElUpgrade 0 Duplex (D) ElHolding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Existing Waiver Distance: I certify that the above information is correct. I further certify that this is in accordance with appli i alodes. cf� (Signature of p or pener or authorized ag Permit/Rush Fees: -� 59 Date of Payment: q 6 Receipt Number: 6 yJc % D.% Permit No. 0 SP )-1 [ 09 _& Waiver Fees: Date of Payment: Receipt Number: Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc SteveEng.com Steve Eng, PE, PH 907-694-7028 SteveEngPE@gmail.com Date: 4/7/21 Number of Pages: To: MOA On-Site Services Subject: Bruckner Lot 1 Septic System Upgrade During an inspection it was discovered that the septic tank & drain-field had levels of fluid, indicating failure. A new design is submitted to mitigate this damage. A previous soil test reveals GM w/Sand and no groundwater; no bedrock at depth- location obtained from previous soil test. The percolation rate for the previous soil test was rated by visual observation, which was allowed. The neighboring lots to the north & east have similar perk rates- an additional test hole could be completed prior to construction to verify the soil. The design calls for a new trench and a new septic tank. The existing trench to be connected via diverter valve. Slopes and easements are depicted on the drawing. The terrain is generally a flat slope at the trench site, and sloping toward the south. The system design size is a single family at 4 bedrooms. No adverse impact to adjacent properties is anticipated. Please review the wastewater system design for the existing single family home. I have included design plans & specs, design guidelines, & soil test. If there is need for additional information or clarification please give me a call. Thanks-Steve Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211098, Deb Wockenfuss, 04/23/21 SteveEng.com Bruckner L1 SPECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing: This is an existing 4-bedroom, single family home. This is a developed subdivision. This is a very large lot with existing approved waivers. A new trench is planned + new 1250 gallon septic tank. The existing trench to be connected via diverter valve. No adverse impacts are expected from trench/tank upgrade. No conflicts to the other lots will take place by this septic system construction upgrade. A previous soil test reveals GM w/Sand. An application rate of 1.2 GPD/FT². Trench Length = 500 FT²/5 x 2 = 50 trench, 5 effective. A new 1250 gallon septic tank will be installed; Decommission old tank per UPC. Water wells & easements depicted in the area. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations.  Two compartment, New 1250 gallon septic tank. Install Double Cleanouts. Decommission old tank per UPC. MOA-Spec Material Under Tank.  10 minimum between the tank trench, tank to house. 10  to property lines,  3 of cover or insulation is required for trench; 2 Minimum thickness for insulation can substitute for 1 cover.  Tank & solid pipe must be set on well compacted, stable soil.  4 inch diameter cleanouts with airtight caps are required 1  to 4 from foundation wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field, not more than 10 from the tank positioned to provide cleanout access towards the tank and towards the absorption field.  All cleanouts must extend to at least ground level.  In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron.  Trench to be placed level, minimum of 4 to groundwater, 6 to bedrock from drain-rock.  Drain rock to be ½ inch to 2 inch screened. Drain rock to be distributed uniformly throughout the trench.  Perforated pipe to be installed level with perforations down.  Silt barrier (filter fabric) to be installed above the drain rock.  Smeared trench sides must be raked or scarified before drain rock placement.  The finish grade must be mounded to promote drainage away from trench.  Insulation must be placed over any pipe installed under driveways or parking areas.  Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661,  Sewer Service Line is minimum 2% slope.  Septic Tank to be pumped every two years or when required.  Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal) Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211098, Deb Wockenfuss, 04/23/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211098, Deb Wockenfuss, 04/23/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211098, Deb Wockenfuss, 04/23/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211098, Deb Wockenfuss, 04/23/21 u,nuTY PED (TYP') 1 TRANS PED (TY'-) o: 00 M GOVT. m LOT 6 0 z GOVT. LOT 11 GRASSER RD. IASPHALT DRIVEWAY 16't Z'a DWELLING 17' 2.1' 4AT. GAS S COVERED C/o DECK mw� 40,537 S.F. 0 I l LEGEND: / (C) -CALCULATED DATA DATA (R)--RECORD/��DfA��T��A�� PER PLAT / U.G.=UNDERGROUND ELEC.-ELECTRICAL NAT. -NATURAL PED -PEDESTAL (TYP.)-TYPICAL `, \ LOT 2 The location of the structure(s)as shown on this record drawing \ \ (as -built) complies with�tle 21, A \ By: U.G. EEC/ \ y\ OSG \ \ G) 4" PLASTIC RISER (TYP.) \ \ RECOVERED \ \ 2" AL -CAP \ \ (TYP•) \ \ N89'57'55"E 229.42'(R) 229.85'(M) GOVT. BASIS OF BEARING LOT 12 4- 1rI" = W NOTES: 1. EXCEPTING FOR GROSS NEGLIGENCE, THE LIABILITY FOR THIS SURVEY SHALL NOT EXCEED THE COST OF PREPARING THIS SURVEY. 2. THIS SURVEY REPRESENTS VISIBLE IMPROVEMENTS & CONDITIONS ON THE DATE OF SURVEY. 3. THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY & IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. 4. THIS SURVEY SUBSTANTIALLY COMPLIES WITH ASPLS MORTGAGE STANDARDS. 5. TIES TO PARTIALLY MONUMENTED OR UNMONUMENTED PROPERTY LINES ARE *I FT. 6. THIS SURVEY PERFORMED FOR GILLESPIE HODS, IT SHOULD ONLY BE USED FOR A SINGLE PROPERTY TRANSACTION. REUSE OF THIS DRAWING FOR ANY PURPOSE NOT STATED ABOVE WITHOUT THE EXPRESS WRITTEN CONSENT OF ALASKA RIM ENGINEERING, INC. IS A VIOLATION OF FEDERAL COPYRIGHT LAW. EXCLUSION NOTE: IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. �Q�`' OF g4 f S� . •.�' :'49TH 9 ......................... : Rob J. Farmer ,o 10615-S d •.• .• Pip p�ESSIpNAL � �rlr 1. ALASKA RIM ENGINEERING, INC. AS—BUILT 9131 E. FRONTAGE RD., SUITE 1 PALMER. ALASKA 99645 � co PH: (907)745-0222 : FAX: (907)746-0222 rmw EMAIL: akrim®alaskorim.com : WEB: www.alaskarim.com W0: 1400485 FB: 14-16 PAGE: 1 of 1 GRID: NW 1458 Engineers: Planners : Surveyors SCALE: 1 " = 50' FILE: 1400485AS I HEREBY CERTIFY THAT A MORTGAGE INSPECTION WAS PERFORMED UNDER MY DIRECTION ON THE FOLLOWING DESCRIBED PROPERTY: BRUCKNER SUBDIVISION LOT 1, PLAT No. 83-226, AN8MFQE RECORDING DISTRICT, ANCHORAGE, ALASKA. SURVEYED ON THE 27th OF OCTOBER, 2014. ©2014 �j MUNICIPALITY OF ANCHORAGE / DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE W R Y I �` �` `v►rts IV J1DZ- [,S1IO EJ UPGRADE MAILING ADDRESS C I ST tc -4 0 re. 1qc5 9 S 11�I LEGAL DESCRIPTION li l— u -r LOCATIONNO. OF BEDROOMS DISTANCE TO: Well O7 Absorption area f� Dwelling PERMI NO. V _Y F- Z CL Manufacturer - Pa% G to D (LLA{, K Material No. of compartments `Z -t E, rfw\-1 y Liq. capacity in gallons IF HOMEMADE Inside length �. Width ..-------- Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. J(DZ O Z Fa- ManufacturerPt Material Liquid capacity in gallons w =. DISTANCE TO: Weil / / Foundation Nearest I ! PERMIT J LL Z No. of lines Length of ea5h.lylg i Total length links Trench Distance Z W of wid betwee�l F- J C,J �� inches Q H D Top of tile to finish grade 5" Material beneath tile a Total effective abs rption,,area 3 & inches Q Length Width Depth PERMIT NO. W O 4 F- Wd Type of crib Crib diameter Crib d p Total effective absorption area LU DISTANCE TO: Well Building foundation Nearest lot line J Class JaeathDriller Distance to lot line PERMIT NO. J � /I/ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS 1- c SOIL TEST RATING zo INSTALLER & -k 0, REMARKS o CIO s G a e ccA as yap n ua, O R i lcbort A. 5haiar� 1a' No. 1457-E rt 1 AMD6 DATE LEGAL SRR 1913X `�� fi [' OLE i;IVER, ALASKA M77 3.01A?07 71-Ul3^ev. 3/76) . / / i3�U�KN�� SSR. Lcq 1 N C3 ._--•-•—", - ivy > ��_ �� i/ v BYO\ i • �,, � � � ��' � pB J9 C:) 10. e �� e• c O / y' :� (— v; o • �a o 11 ' •. v < ' 1' � � �� ' _.� � Z 4 d t _ i W CO . W 1 ---�--- V -- -_ _ _ :� I Z • � o ooh' �7.r ds, � n o ov y -- � } O `� . • Z AI �ln ,� EP G LOT I fJ�//8pel� iV,EI-t- I-aTZ it at, rro�t D F 4crPT iG iuiV DRILLING, Inc. (.D c ' � � P.O. Box 110378 . 10330 Old Seward Highway Q�j\ - (�� a.., 1 (907) 348-8638 i�c r' ANCHORAGE, ALASKA 09 ,1 L�s DRILLING LOG Well Owner CRAIG ANII FVA SiBBETT Use of Welt11 llO,MF�STI'S Location (address of: Township, Runge, Section, if known; or distance main road _LOT 1, BRUCKNER SUBDIVISION: 21908 GRASSER ROAD CHUGIAK, ALASKA Size of casing611 nepth of Hole $8 {set Cased to 88.20 feet :Sthtl�-water levier s ?aglow) land surface. Finish of well (check• one) open end Screen ( ), Perforated Describe screen or perfor4tiV. , Well pumping test at. -30+ 9 e �• of drawdown from static r� Date M completio '► ,,; .•t; " ji Depth in feet from • t 4A,+ ground surface •t 2. • pir'r' � 0 i •�9�A1` p:r yyh Irr�CrCl �n 5� UN • • .• AA rz� •A r -.�._TO�_ (minute) for-- 1 ,hours with 1 nnl {t. WELL LOQ penetrated, size of material, color and hardness r• • 5y, -s� 1 —CUSTOMER Jun -03-04 10:52A PermAt Counter 90'7 343 8250 P,O2 RETI IQ: •Division of Geological and rk sicdl, Survpys (OGGSL -3061 Drive (Tel' .fi: 2774615) - je. Alaska ttsol ,W�11.'TI.A.VALL RECORD OrTlllnq Company Name ' LOCATION Of WELL P104se eompu4 either Is, Ib. or 1c, STATE Of ALASKA DEPARTMENT Of NATURAL IIESOURC" 1•� U.S.C.$. Local No. Drilling Permit No. A.O.L. No. Is. lbrough Subdivision., Lot 1118tk �, ib. Fraction Section No. Township M/S Mnge E/W Meridian 1c. Distance and Direction from Road Intersections Street Address and Area of Wall Location ). OWNER Of VELL:cT1ID Bruckner Addresst Pe 0e BOX 77-2471 Eagle River, Ake 99577 2. WELL LOG tlaterial Type Filet 11slow face op , sottom i. WELL DEPTHt (coeglated) 41 ft. Surface ElevationPete of. C�°�in_tiqn �/ 1 �I T lit grey and hadrd With lar 3 0 5 S. InCable toot []Rotary 0orIvan ❑oug ❑Auger ❑Jetted ❑bred ❑Other: boulders Alluviums brown o it dA0l18 c. Ufit nDomestic 0Publ lc supply ❑ Industry 01rilOition 0Recherge ❑Conssarclei OTest Well 0Othert Till: re end hard* Alluvium: b own and Bof r &and and 0 avel: brown with41-j, Witter 1 m. CASINGS O Threaded®W.1ded �6 in. to 41 ft. Depth Velght 171b./ft. In. to ft. Depth e. FINISH Of WELL: Open end. Type: Diameter: Slot/Mesh size: Length: Set between ft. and ft. Ftttingst 9. STATIC WATER LEYELi 29 ft. OAbove EN"l. land surface Type of Hessurament: sand line FW PING MEL below land surface 3 It. attar 1 .hrs. pum ing 10 g.p.m.' ft. alter hrs. pumping V.P.M. E10. so 11. WELL HEAD COMPLETIONS In Approved Pit O Pltless Adapter 16 inches above grade 12. GROUTING, Well Grouted: 0 Yes ONO Materlai, ONut Cament O Other: nature 17• PUMP: (if available) MP Length of Drop Pipe ft. capacity g.p. Typi, iLIO Submersible O Reciprocating Jet ❑Other: i4. REMARKS: IS.-VATER WELL CONTRACTOR'S CERTIFICATION: This -well was drilled under my Jurisdiction and this report Is true to the best bf my knowledge and belief: Foss Drilling AA 0758 A691sterad lusTness Name ontract cense ar Address: SR3 BOX 7580 Northwood: Dre Chu iak Ake 9 9567 Signed: _e2qA—__ Oates /:rj /% 05-27-04 03:31PII FROM-CHE ESt SGS ENV SERVICES SGS ReEN 1042858001 Client Name Engle River Engineering Project Name//$ Bruckner LTI Client Sample ID Bntckner LTl Matriz Drinking Water Sample Remarks: 9075615301 T-539 P.02/03 F-280 All Dates/Times are Alaska Standard Time Printed Date/Time 05/27/2004 8:46 Collected Date/Time 05/24/2004 11:35 Recelyed Date/Time 05/24/2004 14:36 Technical Directo Steph . Ede Release / Parameter Results PQL Units Method Container ID ALimitsllowabPrep Analysis Limits Date Date Init Waters Department Nitrate -N 0.100 U 0.100 Microbiology Laboratory Total Coliform 0 mg/L EPA 300.0 D (<=] 0) col/100mL SM18 9222B A 0524/04 JJI 0524/04 DK1 I I a ASBUILT-NO CORN S SET THIS DATE. I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER 'TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. 6 zzs. yz SEWARD & ASSOCIATES LAND SURVEYING 694-082 SCALE: DATE j�� ,,,.��., . ' • • . �,l b+� S 5' r GRID: ..�.. .:. '� • �.. 0� Duane Mark ward Ar FB: eo -s7 �� ;S. LS —6918 DRAWN: �'� +k sf�x�. t �a�. "•' © T Ae Municipality of Anchorage Mark Begich, Mayor Building Safety Division P.O. Box 196650 • 4700 Bragaw Strcct Anchorage, Alaska 99519-6650 • (907) 343-8301 • Fax (907) 343-8200 6/18/2004 Chris Wood Eagle River Engineering Services 10421 VFW Road, Ste 101 Eagle River, AK 99577 Subject: Waiver Request for Bruckner Lot 1 Waiver Request #WR040039 Parcel ID #051-072-71 Dear Chris Wood: Your request for a waiver of the required 100 feet horizontal separation from the absorption field and septic tank to private well has been approved. The approved separation distance is 74.0 feet. This waiver approval applies to the existing absorption field and septic tank to private well 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. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Joe Goodall Civil Engineer On -Site Water & Wastewater Program Municipality of Anchorage Gt w. B Development Services Department Vz i •.o • Building Safety Division On -Site Water and Wastewater Program " 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 WR#: 40039 PID#: 051-072-71 Date Received: 6/18/04 Legal Description: Bruckner Lot 1 Engineer: Chris Wood Waiver Review Worksheet HA#: Permit#: Eagle River Engineering Services 10421 VFW Road, Ste 101 Eagle River, Alaska 99577 Applicant: Craig Sibbett Waiver Requested: 74 foot separation septic field on -lot to well on Bruckner lot 2 Criteria: Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: ............................................................................... Waiver is Granted: Waiver is not Granted. List Conditions or Reasons for above: Date: U �� By: Name of Reviewer ............................................................................... Rec#: 53592 Amount: $7- Date Paid: 6/18/2004 riFFof p70 1NGE Loi Z �A/STH�cE1� f� Fri SYS rf-" o,j& Oft W W W Wi in tn vi W W IaiS l000 vnoo• C, C4 -a ernr ICI CIM o r wR ll/�2 RC-QJ07ST Fo/Z QiZuck�lE/j LoT 1 LVAIVEr{ REQUEST FO!?� lrJiU" L_(7T' SFP7 fc SYSTEn-� T� W A rEg- W EI.c_ WFc o.v G o T Z. of FEE r Tv ""/KENT 7y PE'Er To fi8,W00AtFD — SEPT Ic SYSTEn^ Di4*rA THE SUgJ9fc.7T SrPriL 7'2CNCH WI'4S C(tln/S7-12vc rco /N f} COUtz, E 6,ZAVE1_ SI9NtOy (rz�quEL GIsrEq , WHIC-4 ?'yplcrt L, -Y wI4` T2E,17- SEAT IL Tjgfvk Er=Fct VE^/T i^/ RELY T' 1 VELj SHcAT 7-4,E S Uej E'c r WEPT IL. FIFLD .Dor Nor (-QC4- ,6D vN QQ vc rcv.E2 L-oT 2; R V o /F S y5 7 -Sr-,- W£2c To Fps r 4ANp '04 -y4 -10H7- EFF[, [.E�lrl F7 AZO UNb S UrtFi4-cE k;OuL o F-LoW To wj% /ZO S o u r K - E,9S rE r I Y .D, #zcc T loni A�''✓A-� 'cXv^, 7 -1416g -JF -Lc- on) L-07-2_. _r1415 S t/STEr" MltS /3En/ p L ii- c. E S I TC. E Tv t7 L)A r A- - TIgE WL -l -e. UN Lo -r LZ /S 'q ( FE 7- -PEEP. Ti-(rRe is ANOT rIFr'Z ant 4 -OT- Z ApPao)C/,",qre 6, FEET d0fZl:ZcYV-r qL- C.EPAfLA-r,o-j Tri lS IS /9!�/9NOp.vE,o, -rj4E 01-P wFL4- wRS Co'VSTtZvc-rEo DEcE.Mg�r� t I�g3, THE wEL` LOCI FOO, VIE oLb WCL.(- k-'Arnl 13E FovN'b W 000/ , F1 L_F .. THE N E w wf L L. FD/Z j5A vc rc-NE/L Loi 2 WAS pP=Art4 r r r -E D OA/ A-1 , (`(91t T HES I S No WFC -L, uo rp POZ A/S w P-E/Zr•1'rr lo wEI;L . 7 -AJ c i ryErZ Ci}sE &O ri-I of r-WSE AIEZCS A�CRe CoNtrRv«Eo /gfrE� SEP7rc SYST �+-+ hlRS rNS7�4c.c.E� Oma% gidVcKA%Clz- I -Dr �. %KF wet t - Lof, Ct-oSEtz, To r1je- SEPiIc_ SysrEnl of 7'4/ 1,'F_ Wi L BE v5eo r-oZ f m pos FS of A. D. E. c , Po , nrTS . I WPTER TABLE or�tTS FRoA . OLD cvEt-L Lo OPrEp 121(31.03 g07rnr+-1 of SE r'2Tlc SV-%TC0,%'- /0 FEET SPTq OF WELL-- 1/V Fr-6T. LU W _ G vl cn► T sTA r� r w I+Te.(?- [,P-vEL y. •R • Zvl M inLn4 i coo r (o = 3 ( Fz �NF.r► wEtt.� n v ivvc N r r Mso t L S 090 T i o '� ��r.r,�g► cr r T y ,rte r Z, 20 11VATE,+S TABLE 6AA015^J,l �f'Zou� o � LoPEg 'Towit� W EL [� SI-oPF_ GomAMC>� TOWPtrip S0u-rPj-£4ST- Dtf'� S/-DAS - S;1 . �DIZt �c�7A[� SrP�t'�iRT10�1 �.o Z•O C -7M^! D TOM -L / •7 MIT!f7frrir4E7 FtcTcf;kS LvoulcJ TNc luo£ TNS. FAc-7- T-YAT ?KE wEI,L JIIVD SF-P'rlc SYSTEl- Hj9VE jExrSTF_v Folz tdr+E T/* -z L us [ta►�% AND W4TEri SRe-PLES Fold WEL s- GONL SNOrJ WATE0, AWSULTS AME7- rL.1uviciPA&- cooe_. wR I vaq, DEPHRTMENT- H[ALVXD 64VIRO'[-lVQ`iL 825 'L STREET, ANCHORAGE., HK. 99501 264-4720 &-J FE- L_ L_ �P-4 C-- 1=1 I -Ir E: fF. EZ L-A F=- F;;--, ���Irl 1: -Y- PERMIT NO. ( 830499 ) APPLICANT DAVID H THOMPSON 4829 KENT ST 99503 562-2816 LOCATION KEEP AWAY FROM STEEP SLOPE OF +25% LEGAL BRUCHNER L5H 5f*�C-,vo3 LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BR)= 120 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: �E� F-1 -r "= :JL �L. L_ E: " 873 J- "= �� ����FE I- [:.a EE F> !ff. THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIEL[\ 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). ���� ������� ���� �������= A- '19-1 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. �t_j r_-1 < ;2 110 �N=-. F:="E=- RZ: -r I ID r-4 Fl F..*- E_= F_* EE 1_71 I_J I F -t EE IE -1 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. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ]0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F-P_ F;:.M I -F [-= X F::> I R-_" E-=-""--. E.- U 1:� U M E*. U R--* ���E-4":3 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 nESIuEmCEREl'lC-iDELED TO INCLUDE MORE THAN 4 BEDROOMS. «" K ��� ------J�----------------- nPPLICnNT ID H TnuMPSBN �IS5UED BY---�----DATE-.-\r/ = Y4.0 SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: " DATE PERFORMED: /7/wle 1.5~ /Yffz- LEGAL DESCRIPTION: tLj DEPTH SLOPE SITE PLAN - (FEET) Q G'l�C �}�-�i�� 1 2- 345 3- 4- 5 7 8 9- 1012 10- 12 13 14 -z ►3�z� Sic, coi3,8t-E5 COD 5-6 50>/ 511.Lve l tj-/5� 15 Date Gross Time Net Time Depth to Water Net Drop s 18 19 196a �� 20 w'rj.,�� BEENE a 2 ['- WAS GROUND WATER S ENCOUNTERED? L v T O P �7 IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop 1 PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND/� FT COMMENTS S!/LJc;, ST GAy�23 % �Oh'% Z S � G7 "—y �4lisc32t3i/Dti-�. �/�yEi� /`'20•.� ,$ �v � ' �c'��S r�E"�f'C' �O �'� c'. '1�u ,uoi vsE� !i,. PERFORMED BY: 4rcx)5 % E�-'� SNC. CERTIFIED BY: 'v..: DATE: iZ_ WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological a Geophysical Surveys Drilling Permit No, LOCATION OF WELL (Please complete either la, Ib or Ic.) A.D.L. No. la. Borough Subdivision Lot I Block Ib. 1/4gtrs. Section No. Township No Range EE]Meridian !'1 �:'rR-%Ek _Of_Of_Of— SC] WE Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL Address: 4`4S ', 0 1'Ii 'f..14�c y- Street Address and Area of Well Location Feet Below 2. WELL LOG 4. Surface WELL DEPTH: (final) 5. DATE OF COMPLETION !; ft. / — 2 Material Type Top Bottom Y a0'.+J7'' aa.n(i Vit' S' j,� S.J Y� 6, a.Cable tool ❑Rotary E] Driven ❑Dug ❑ Auger ❑ Jetted ❑ Bored Other: 1,...f, 4,jv} a '1 (S -;,T,11 ;o_1.0 " : !tl .' �: e , 7. USE: n -Domestic ❑ Public Supply ❑ Industry t'l.d V' x .� ' �{ ❑ Irrigation ❑ Recharge ❑ Commerical :?t??e Test Well ❑ Other: 8. CASING! ❑ Threaded4j Welded diam. ' in. to ft. Depth Weight t lbs./ ft. dlom. In. to ft. Depth Stickup ft. OF HEALT I & 9. FINISH OF WELL: ta.; ?t -.pt t;l ENVIRON! ENTAL PROTECTIO Type: Diameter: '' Slot/Mesh Size; Length: Set between ft. and ft. Backfilling Gravel pack 10, STATIC WATER LEVEL: -r`<! ft. { _ %11 1_:%'. ❑ Above or Q Below land surface Dote Equipment used: f ',il`).,3lak^ I I . PUMPING LEVEL below land surface and YIEL ft, after `" hrs. pumping tt g,p.m. ft. after hrs. pumping g. p.m. 12.GROUTING, Well Grouted: E] Yes ❑ No Material: ❑ Neat Cement ❑ Other: vr; 13, PUMP: (if available) HP Length of Drop Pipe ft. capacity q.p.m. Subm. Jet 0 Centrifical Other 14. REMARKS: 16. WATER WELL CONTRACTORS CERTIFICATION: 15. Water Temperature ° ❑ F ❑ C This well was drilled under my jurisdiction and this report Is true to the best of my knowledge and belief; Registered Business Name Contract License Number t Address Signed: 7r• �' j ' r,.a — Rk�'j.�. Date: Authorized Representative Form 02-WWR (11/81) Copy Distribution: WHITE -State DGGS, PINK -Driller, CANARY -Customer MMW DRILLING, Inc. — , �� P.O. Box 110378 • 10330 Old Sewa•d Highway (907) 349.8535 Fjj �C ANCHORAGE, ALASKA 996 , t y DRILLING LOG Well Owner CRATC AND EVA SIRRETT _ Use of Well DOMESTIC Location (address of: Township, Range, Section, if known; or distance main road_ LOT 1, BRUCKNER SUBDIVISION: 21908 GRASSER ROAD CHUGIAK, ALASKA Size of casing.._._.. —Depth of Hole 88 feet Cased to 88.2 feet Static water lever 51.1 ft. low) land surface. Finish of well (check one) open end ( X }; Screen ( ) ; Perforated (. Describe screen or perfox Well pumping test at 30+ gi of drawdown from static Date of Depth in feet from ground surface 0 2 2 TO 14 14 _TOS_ la—TO 38 $_._TO 41- -- U _TO 58 58 59 —b2—Tq 5 5 _ ^66._.T0M 80 TO 8�8 —TO- -TO- -TO- -TO— (minute) O—TOTO— TO (minute) for hours with. 100.1- ft. a\ WELL LOG formations penetrated, size of material, color and hardness TRAVEL 1 — CUSTOMER MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW960214 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:SIBBETT CRAIG & EVA OWNER ADDRESS:21908 GRASSER RD CHUGIAK, ALASKA 99567 PARCEL ID:05107271 LEGAL DESCRIPTION: BRUCKNER LT 1 LOT SIZE: 40537 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 7/22/96 EXPIRATION DATE: 7/22/97 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIO RECEIVED BY • DATE: 2 ?, 6. ISSUED BY : Lzaodnz Z. / DATE: ;7-22 - /� ASBUILT-NO CORNERS SET THIS DATE. I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. .- " ZLf yL SEWARD & ASSOCIATES LAND SURVEYING 694 - SCALE: 94 - SCALE: / - Y� DATE: GRlyw.r�,�� FB* �a _S7 DRAWN: f 14 OF aJv L°° 7 H�T �r 4 i... •wewee Duane Merk Seward ' •� Al LS -6918 • a�+ �r 'Qr —fes ­12�o �os_30- TJl9t lot 0 b 0. ot � o � ,o ASBUILT-NO CORNERS SET THIS DATE. I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. .- " ZLf yL SEWARD & ASSOCIATES LAND SURVEYING 694 - SCALE: 94 - SCALE: / - Y� DATE: GRlyw.r�,�� FB* �a _S7 DRAWN: f 14 OF aJv L°° 7 H�T �r 4 i... •wewee Duane Merk Seward ' •� Al LS -6918 • a�+ �r MUNICIPALITY OF Development Services Department `. On -Site Water & Wastewater Section Parcel I.D. 05107271 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description BRUCKNER LT 1 Location (site address) 21908 GRASSER RD Current property owner(s) WAUGHTAL BRAD Mailing address Real estate agent 2. TYPE OF DWELLING: Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: Day phone 244-1930 Day phone 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) FJ 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Z Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ yy ff ( RUSH Date of Payment�-1:0 Receipt Number Q/ 9 q7D COSA# OSCE 11 Date: Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and frorn my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm NorthRim Eng. Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 5/12/21 6. DSD SIGNATURE s Com` TI -1., 1k49♦f * ..L L,f System #1 Approved for bedrooms System #2 Approved for bedrooms ff,,,� �,9 44 Disapproved ♦I CE -6256 '='r Conditional approval for bedrooms, with the following stipula`tions: By: Original Certificate Date: The Municipality of Anch ge Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory COSA Checklist Legal Description: Bruckner LT 1 Parcel ID: 05107271 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑■ Well log is filed with Onsite (or attached) Date drilled 7/25/96 Total depth 88 ft Cased to 88 ft ❑■ Sanitary seal is functioning correctly ❑■ Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 3/29/21 Static water level at beginning of test 49 ft. Comments B. TANK DATA Age of tank(s) new years Tank type/material 5e° "_" Measured operating fluid level in septic tank new ❑■ Standpipes/foundation cleanout per record drawing Date of pumping new D. ABSORPTION FIELD DATA New Which system tested (date installed) same ❑■ ALL standpipes present per record drawing Total measured depth from grade 9 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A — pressurized field ❑■ Monitor tubes go to bottom of effective. If not, state depth into effective Well production at time of test 5+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑■ No ❑R Coliform bacteria is Negative Nitrate mg/L ❑■ Nitrate less than MRL (ND) Arsenic ug/L ❑■ Arsenic less than MRL (ND) Collected by 907 Water Well Services Date of Sample 4/8/21 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date new Results Q✓ Pass For 4 Fluid depth prior to test 0 Water added gal New depth in Elapsed time min bedrooms in ❑E Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: New Septic COSA Checklist yellow sheet 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' Yes if No Community Sewer Manhole/Cleanout > 100' F] Yes if No ft Q Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' El Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' Water Main > 10' Community Wells > 200' Animal Containment > 50' 0 Yes if No ft F --,l Yes if No ft Water Service Line > 10' Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' EJ Yes if No ft 2 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. Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: Q Absorption Field > 5' Q Yes if No ft Private Wells > 100' Yes if No. Water Main > 10' Community Wells > 200' Yes if No ft Community Wells > 200' Yes if No. 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' Q Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' El Yes if No Water Service Line > 10' Yes if No ft Community Wells > 200' 0 Yes if No Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS Alternate Field Has Existing Waiver. New Trench Presently In Use. Ar ENGINEER'S`* ;49TM* G. I certify that I have determined through field inspections and review Steve En of Municipal records that the above systems are in conformance with ���% CE_6256A MOA COSA guidelines in effect on this date. �'� ��/1,2/2� ft ft ft ft ft Municipality of Anchorage o Development Services Department pP°E Building Safety Division ° On -Site Water and Wastewater Program 4700 South Bragaw St. E' P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.1j <1`072-7 I. GENERAL INFORMATIC Complete legal, descriptio s. -Location (site address or HAA# I��4Dy©Z 6Q Expiration Date: _[1z r/D S _ 2 ,Lee—& &jz o i 9 Day phone Mailing address Pc� R ok 770'R 1, 29C-7? Lending'agency Day phone Mailing address Real Estate Agent b�/NAwt, E? Day Day phone Mailing Address C'- Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS:_ 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System T� TYPE OF WASTEWATER DISPOSAL: L7 Individual On-site L� ❑ 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. Name of Firm Eagle River EnainParinc, cervices Phone 6 10421 VFW Rd., Suite 201 Address I Engineer's Printed Name_ 5. DSD SIGNATURE t/ Approved for �_ bedrooms, Disapproved. Conditional approval for A.4r1itinna1 CnmmP.ntS Date h9AO&V — bedrooms, with the following (((i(f(; ON-SITE wLrTFWATER . Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: /06 (1 y (Rev. 01=) municipality of'Anchorap Deve1opmeServices pe �t partment Building Safely T3ivision ,�>. On-Site Water & Wastewater�ogrem �� " 70 South ragaw ox 6 0 Anciora a AK 99519,6666.. ci anchorage ak us *a..,,r zea %�UTHOR(TY,A.PPROIVYnAL-CHEG,c,lS8 � ^'��.„ +=raAct/avrl �•w' mar ✓ •s�x� €wF,rvz,:,. m. mn rsrsaa.,+a-vm> -' riptidn tZvl `euv? <,g- Parc I fD f4i"(y if A B or C provide PWSTO 4E g Well Lo t 3/q L Sarntaryseall)s Wires properly protected ON ft Cased to-1—ft.Casing height (above round 1Z m _g ) Navel ft coon i g P.M. _..,�_colomes/100 ml Nitrate Cb / mg./I Otfier bactena �% colonies/100 ml mg /1 Dafe of sample /p i2/v y o este; y GHS'P �.. 4 aetral1Eb/ Date installed ?Z�6/533 gal. Number of Compartments �, Cleanouts yN 'Z leanout bN) Depression over tank a (YIjG� _Q High water alarm (Y& .<J a� �Y .� -�'a 3 Soil rating ( � oifft/bdr LLP System type, hO,&j4 ft. Width /tl/A ft Grave1befow i e;� ` _ ft*� �' 'vAkYd/ ata...:. ,m-K'u clxisa«."rc:SF c ', s.;f 1.mM vae^ie. p p ft. absorptipp area l f1� Momtonng tube Depression over field AVO +NAW"absor awed area aacytest 21 Results Pas ail S Ute., )� For bedrooms '�J+v.�^,r.:i. ..i'1X%i>�✓�,�eYS:�. »FM-4Y A:hmW£Atbt$x* Afi'r`Tu1w�4sW'Lr Jr..5w3:YvT2 w+' - e.. absorption field before fest m. Water addedgal. New depthm �3. .. min.FinalMfluid depth m Absorption rate >= DD g p d ion reatment (past 12 mo)i / type) �UK.thpc,/,tj If yes, give date iV records Size in gallo s ` ---------Manhole/Access(YIN) off' level at _ in. High water alarm level at in. Cycles tested Meets alarm & circuit requirements? On adjacent lots on adjacent lots f l00 e' Public sewer, manhole/cleanout i /00 to VT Property line 6 Absorption field 5 . ..... tntarpr cprvice line +100 r _. Surface water '+" are in this date. CESS Municipality of Anchorage • Development Services Department �.� Building Safety Division='' E On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. e- • 'y f. I. GENERAL INFORMATION HAA #_ A0 -0402&R. Expiration Date: �g/y Complete legal description Location (site address or directions) /q�� �,e,�,�s� Current Property owners) '007.P�� �I�D'.r rr- Day phone Mailing address /?e9 3e 7;7 Lending agency Day phone Mailing address Real Estate Agent tS �►�- Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System , _z . 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•sampies.) Certificates are valid for one year for properties served by Class A or B wells or a publicwater system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. TYPE OF WASTEWATER DISPOSAL: Individual On-site 9 ❑ 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•sampies.) Certificates are valid for one year for properties served by Class A or B wells or a publicwater 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. �, « %����� ii�-.y �-.z� (7cxS• Phone�-�� .Name of Firm , - Address /��/.�,: r/F!r% .�+ �.►��� '� '¢4 Engineer's Printed Name �.S/.e��Tr�,�i'��r-is- ��� Date CHRISTOPHER R. WOOD CE10387 5. DSD SIGNATURE _� Approved for bedrooms. '"��''••••............ •�r�' �`r Disapproved. Conditional approval for bedrooms, with the following stipulations: -llttttlY OFrri(��% ON-SITE Additional Comments �� WATER nein • rrn- -rrcZ-�,�-rtr�� . WASTEWATER O�NT Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By. Original Certificate Date:_UV (Rev. 01102) ` Municipality of Anchorage Development Services Department ` B uilding Safety Division 7 'On -Site Water & Wastewater ProgramS" F ° `T. 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 i' ! www.ci.anchorage.ak.us 907 343-7904 i..� HEALTH AUTHORITY APPROVAL CHECKLIST . i Legal Description: ,tom �,Y� .t1,E .4'T Parcel ID:_ DTA" ,z/ A. WELL, DATA ` Well type 1044 If A; B, or C provide PWSID # Well Log 6N) Vo3 Date completedc�iS�9Lc Sanitary seal (SIN) Wires properly protected 0/ ) Y; --j . ' Total de fC] ./ ft. Cased to ft. Casing height (above ground) / Z—in. FROM WELL LOG AT INSPECTION; Date of testi �i s Ili. StaticsI at er level ? Well prod don .m. `{a , 9 P g.p.m. WATER SAMPLE RESULTS: ! Colifor Jm I- i_Q colonies/100 ml. Nitrate' �• mg./L 'N�!`ti Other bacteria C9 colonies/100 ml. /J Arsenic,:: mg./I., . Date of'"am le: S" dy .Collected b p y G �ayrr neiG-.�,� T. ! B.-SEPTIC/HOLDING TANK DATA I ; Tank T pe/Material 5Tr'F_ L ! Date installed Tank `size / y0 al: Number of Co 1 3� g mpartments M Cleanouts�lj r>.,' I' it o-.;� Foundation Ieanc,66N) -y3 Depression over tank (Y&i . WD i High water alarm (Y4P 'Date .� of primtping A0 Pumper f TI2 �_s .w�A71 1G- C. ABSORPTION# FIELD DATA Date 1insta lie tl,zr/ 3 Soil rating (9.p.d./ft2 or /bdr IA6: System type T.�f.t t✓h' Length Width ft "Gravel below pipe ,nth,, Total depth E'ld5 ft., 'fEff. absorption area Sop !ft2 Monitoring tube - / Depiression over field •04 Da of adequacy test c - Results/Fail) r ` for bedrooms M Fluid depth in,absorption field before testy in� 1 Water added gal. New depth. in. Elapsed ITime.+ min: Final fluid depth � in.: Absorption rate >= ' ®fes g.p.d. . ! : Any rej 1 ven tion treatment (past �12 mo.).(Y/N &typej :__�(JD.Uic' ,kyd�J,rl If yes, give date D. LIFT STATION ii"11 0 s Date installed Size in gallons le/Access (Y/N) UP Pum "Pump on" level at in. um e at Y [p, in. High water alarm 'level at: in. h Datum Cycles tested Meets alarrn & circuit requirements?, Meets e E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 2Lp�tfii�ctal L&tatieR-en lot /2i Z On adjacent lots' Absorption field on lot --_Z1 9 On adjacent lots "I _anh011 Public sewer main t "496 Public sewer'm e/cleanout Sew6r /septic service line Ili if Holding tank �e!�90 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK. ON LOT Tii '!I k"I I Building foundation 3 V Property line '5 Co Absorption field.,' :,Water service Water main 7' line S u 7' 1' Water: Wells on adjacent lots /C9el �'' IIF �I ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:, - ' � Property line Building foundation � � ,I Iii i i I . Water main Water Si line --116 Surface water t �,Driveviay,,parking/vehicle ,,, tora6e i" Curtain drain';! Wells on adjacent lots 741 1757 W F. COMMENTS', A 7- 7-25-K C&ArZ of - 92=9SR G. ENGINEER'S CERTIFICATION I certify thatJ have determined through field inspections and review of Muhicipal records that the above systems are in conformance with MOA HAA guidelinibsin effect on this date. Engineer's Printed Name efZIAIInif 7- &D Date HAA Fee $ 30 Date of Payment16 — I " Receipt ,Numb&.* (Rev. 12/01) Jr Waiver Fee $ II Date of Payment j Receipt Number (STOP Ifil J11 � Lim ii"11 111,�T 1:1 7 Eagle River Engineerm*glServices Christopher R. Wood, PX.10421 VFW Road Suite 201 (907) 694-5195 tel Eagle River, AK 99577 (907) 694-3297 fax June 10, 2004 Dan Roth Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Bruckner Sub. Lot 1 HAA Report of Findings, Waiver Request from on-site septic, to neighboring well Dear Mr. Roth, Eagle River Engineering Services (ERES)has performed a Health Authority Approval inspection at the above referenced property, and has noted the following item of concern. The separation distance to the neighboring well on Bruckner Lot 2 is only 79 feet, and only 74 feet to an abandoned well on the property. This was determined using a roto -rooter type snake and camera with locator beacon. ERES has used the method of points to determine the health risk of this arrangement, and have attached it for your consideration and review. Please consider this as a waiver request, and upon your consideration, grant Approval to Lot 1 as the septic system was installed on July 28, 1983, and both wells on Lot 2 installed after that date. Thank you for your timely consideration of this matter. Sincerely, EAGLE RIVER ENGINEERING SERVICES (11ristopher . Wood, P.E. Principal \2003\04-035HAARgroRr.noc MUNICIPALITY OF ANCHORAGE ' DEPARTMENT OF HEALTH & HUMAN SERVICES i Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 1— (11_l%). -_� \ HAA # i=, L'\I L. L 1� 1. GENERAL INFORMATION Complete legal description Lot 1; Bnucknen Subdivi4ion Location (site address or directions) 21908 Gna4zen Road Chuaiak. AK Property owner David Thompson Day phone 688-4330 Mailing address 21908 Gaas4en Road Chug iak, AK 99567 Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 'd Day phone Day phone 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1,91) Front MOA u21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Phone Xq 7y 17034 Eagle River Loop Road No. 204 Address Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for Additional Comments Date S` r/ 7 --� of' A611N .......... S ROBERT C. bedrooms. bedrooms, with the following stipulations: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA a21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division I r1 R 44ANCH©w�,c;E 825"L" Street, Room 502 •Anchorage, Alaska 9950 • N A S VICES DIVISION MAY 0 6 199E Health Authority Approval Checklist: RECEIVED Legal Description: wf �(L.,�LtG--,�,�. Parcel I.D.: A. WELL DATA Well type ?9-%Q om-k- If A, B, or C, attach ADEC letter. ADEC water system number Log present &9N) Date completed 7-Zo-9? Total depth 'S7- Cased to Casing height (above ground) 12-14 Sanitary seal (�y N) Wires properly protectedONj FROM WELL LOG AT INSPECTION Date of test '7 -7—o - S 3 'S'" 2 Static water level 4.2,1 t4 cl Well production lo, ID g p.m. g.p.m. WATER SAMPLE RESULTS: Coliform a Nitrate D, ?S Other bacteria O .I S & S EN{31NEERIN6 Date of sample: `i - L q -9(0 Collected by: 17ID34 Eagle River Loop Road No 04' B. SEPTIC/.HOLDING TANK DATA Eagle River, Alaska 99571 Date installed '7 , 2 6 -5 3 Tank size iSvo Number of Compartments Cleanouts EDN) ,4 Foundation cleanout S)N) q Depression (Y� C High water alarm (Y/N) 41" T Date of Pumping Pumper 450vw 1- h-u C. ABSORPTION (FIELD DATA Date installed 7 S -83 Soil rating (g.p.d./112 or ft2/bdrm)System type Tim C P Length -o ' Width- Gravel thickness below pipe -r Total depth /� l'f'� rNr/�• Qtr�tiT ) Effective absorption area ,j'ba Monitoring Tube presen115X g Depression over field (Yi� .�..f A.* w4r&2 6t-4i i e., OF T+an�roit�Nf. TvQ! Rt irAtL700 Ao4S n.sT EW7'1-••,0 To B#7)-4J, uA7.es„+cy, Date of adequacy test '"a -5 G Results4jjj1YFaiI) IAW For 1 bedrooms Fluid depth in absorption field before test (in.); 101 H Immediately aftert*60 gal. water added (in.)� �a Fluid depth 2-S ~ (ins.) Minutes later: I0.. Absorption rate = (,bn # g.p.d. Peroxide treatment (past 12 months) ( e aoC V�a*jO If yes, give date '�' A- L t"*-6- "s*- tro SAN 0014 TA& F►ws Lou lsryM., ,Mbt»I-P M+��M STK, t.Q 9'1L ►b L-1 d o-L-- „ rv-wT - D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES Size in gallons "Pump oil le "Pump off' level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot bb ; On adjacent lots Absorption field on lot 1 v o On adjacent lots Public sewer main ' !' I D- Public sewer manhole/cleanout Sewer /septic service line �� Lift station oily. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 401 Property line 10 1 -�- Absorption field $ Water main/service line %e I + Surface water/drainage X V 0 kt Wells on adjacent lots 10-b t -- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Surface water Curtain drain Al S -a t "I- d i+ Water main/service line 10 \ 4 - Driveway, Driveway, parking/vehicle storage area '5`6, t� Wells on adjacent lots 1v -c> L} Property line 1 D� F. ENGINEER'S CERTIFICATION ,ql.i STAdO )`rfES RJ 14.4 1 certify that 1 have determined thru field inspections and review of Municipal records„ in conformance with MO HAA uideli in effect on this date.' Signature r Engineer's Name ' `' " t2 T C • Co wAAo� Date HAA Fee $ ? 0c) \ OU Date of Payment - Ccs -moi lD Receipt Number gctbs Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number ROBERT C. COWAN C€--8801 are y., ► 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 Application Date September 18, 1986 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 1; Bruckner Subdivision Location (address or directions) (b) Applicant Name Dave Thompsen Telephone: Home 688-330 Business Applicant Address --sR 1, Box 7634, Chugiak, Alaska 99567 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder IR; Buyer ❑ ;Other ❑ (explain); - (d) Lending Institution City Mortgage Telephone 373-0660 Address ATTENTION: Sandy Allen, Wasilla, Alaska (e) Real Estate Company and Agent none/refinancing Address Telephone - (f) &;% HAA to the following address: S & S Engineering SRB 196X Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family 51 Multi -F it Oiner Number of Bedrooms 3. WATER SUPPLY Individual Well IN 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. SEWAGE DISPOSAL Onsite 12 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. Pagel of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDIK_ INSPECTIONS, TESTS, FILE SEARCH, DA..a 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 regulations in effect on the date of this inspection. Name of Firm S & 5 ENUINEERM0 Telephone T `Zf 7 < Address SR B 196X Date EAGLE RIVER, AK 99577 57105Pr; 4'f J, __14C u+. �. Sherr 1457-1 00 lay � j, 1 6. DHEP APPA AP,; ©�L� �� Approved for --F—= bedrooms b l ate �� l �� Approved _ Disapproved Conditional 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) tom'' cid 1G\Q BOE � 00tos MUNICIPALITY OF ANCHORAGE (MOA). HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST -FEBRUARY 1984 264-4720 Legal Description: L oT I iGr.LG1W L'4t- 5//> Stie ��Q A. WELL DATA 1�wv Well Classification •F If A, B, C, D.E.C. Approved (Y/N) Well Log Present ON) Date Completed 72- 2v, 13 3 Yield Ca, 5 Gt'M '- Total Depth Z t Cased to �Z r Depth of Grouting Static Water Leveler Pump Set At u Casing Height Above Ground /g Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (ON) Depression Around Wellhead (Y& Separation Distances from Well: To Septic/Holding Tank on Lot (bf'ar ; On Adjoining Lots Zoe -f' i To Nearest Edge of Absorption Field on Lot On Adjoining Lots To Nearest Public Sewer Line q To Nearest Public Sewer Cleanout/Manhole NVIA- To Nearest Sewer Service Line on Lot Water Sample Collected by 54-5 ; Date AC. Water Sample Test Results S Aq,t5 izikC,Ioty Comments w&,'-- YZL41 !)- ?LIVE SHOW40 W44J— PRo'>(4c. b IL) &XC&55 B. SEPTIC/HOLDING TANK DATA Date Installed 3!-Z83-8.1 Size 1500 No. of Compartments - Standpipes 62N) Air -tight Caps (15N) Foundation Cleanout (6i' N) Depression over Tank (Yo Date Last Pumped Pumping/Maintenance Contract on File (Y/N) IJIA ; for Holding Tank High -Water Alarm (Y/N) )V/h+ Temporary Holding Tank Permit (Y/N) Ail* Separation Distances from Septic/Holding Tank: _ To Water -Supply Well To Building Foundation To Property Line ��� 4- To Disposal Field 8r i To Water Main/Service Line fy f To Stream, Pond, Lake, or Major Drainage Course ` V Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ZZ-Ol- Type of System Design Date Installed 3 - Z8 -93 Length of Field n Width of Field U •k• Depth of Field Gravel Bed Thickness s Square Feet of Absorption Area Sb4 Standpipes Present(SAN) Depression over Field (Y& Date of Last Adequacy Test fZ Z,4, ns& Results of Last Adequacy Tes hl Separation Distance from Absorption Field: To Water -Supply Well / a r To Building Foundation so,± Lot To Water Main/Service Line lot+ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parkin re Vehicle Storage A� Cnmmantc _X-, //_A-eAo.i D. LIFT STATION v To Property Line }b To Existing or Abandoned System on On Adjoining Lots .304 -j. To Cutbank (if present) 0464 N/ A Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High -Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/NI Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify th&&&JPM?#gL%1ft or conformed to all MO and AA guidelines in effect on the date of this inspection. Signed SR R 196X Date Z b CompanyVA LE RIVER- AK 99577 MOA No. D //���� •. ��. Receipt No. V ©f d U �� "' A`.4 fee %I Date of Payment �� / "•• •iti4 `�RA Amount: $ 61 s. • Page 2 of 2 72-026 (11/84) fl1 � o M . 1467