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Home My WebLink AboutSTOCKHAUSEN LT 23Stockhausen Lot 23 #051-062-29 Municipality of Anchorage On-Site Water and Wastewater Section - (907) 343-7904 Page I of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231015 PID Number- 051-062-29 Dwelling: X Single Family (SF) El with ADU [3 Duplex (D) f_1 Two Single Family Project: n New IN Upgrade Name BLUM ABSORPTION FIELD [0 Deep Trench El Wide Trench El Bed [:] Mound Site Address 21311 GINGER LEE DR, Chugiak El Other Phone Number of Bedrooms Soil Rating depth from original grade 3 0.8 GPD/SF JTotal 9.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3 Ft. lFill Gravel depth beneath pipe 6 Subdivision Block Lot STOCKHAUSEN LT 23 Ft. added above original grade 1 Ft. Gravel length 47 Township Range Section Ft. Gravel width 2 Beds: Number of Lines Distancebetweenlines SEPARATION DISTANCES Ft. Ft. TO Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 564 FF 1 R. Well 100'+ 100'+ 50' TANK 9 Septic 9 S.T.E.P ED] H iding D Other Manufacturer ANCH TANK Capacity 1500 Gal. Surface Water 1001+ 100'+ Material Number of compartments Lot Line 10'+ 101+ NA STEEL 2 Foundation 10'+ 10'+ LIFT STATION Manufacturer Capacity Remarks ANCH TANK 1500 Gal. Alarm location SE CORNER OF HOUSE I Electrical installed by ARON CHAMBERS, POWER LIGHTING Installer PIPE MATERIAL House totank 3034Tankto 3034 d rainfield NORTHERN EXCAVATING Drainfield 3034 CO/MT3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 100.5 ft Inspdates: ection 1n3/1123 313/23 Location and description 2f'd TOP OF MH LID 3rd 4th ON-SITE WATER AND WASTEWATER SECTION APPROVAL E"p&pZ _4p V Conditional Approval: Date 7 AC)T H . ...... ... hliChAEL N. Septic SystemCE 96� Approved Date Note: this approval does not include well permit requirements. kmev V7IV41 its) Permit No. OSP231015 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: STOCKHAUSEN LT 23 PID No.: 051-06-229 / I \ 200' COMM WI NWELL ❑ I I B I � / MARK A B Cal 60 65 CO2'- 60.5 66 TC01 65 _ 70. TCO2 70 77 MT1 $1-- 98 MT2 ' 97 95 i i i WELL 1 /TC01/ > \ / CO i ITCO2 MT1 \ \ I v I ASBUILT SCALE: 1'1='50' I I I I I I I I I I I 1 I 1 1 RADIUS \ _ OLD SYSTEM CO \\ \ \ ------BENCH, TOP OF MH \ SEPTIC SECTION N.T.S. TH #1 MT, DRYRCH 2023 / �. EOFq 49 TH �11� MICHAEL N. ANDERSON No. CE 469 —233 •••.• 3-6 .•'' NO WATER, DRY MARCH 2023 i Municipality of Anchorage Development Services Department On -Site Water and Wastewater Section 4700 Elmore St. P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.orQtonsite (907) 343-7904 Soils Log - Percolation Test �.* ..fir=lv.wrslYo,�c�.I r 49TH 4 r/ _+ ? • MICHAEL N• OP DERSON w CE 9469j, Performed For: TI B 1111 ,. Date Performed: Legal Description: e�_ L, A w 4 a" L D I 2 3 Township, Range, Section: 1'h- o v` cS . 2- 3- 4- 5- 6- 7-1 - 3- 4- 5- 6 7- / r 11- 12- 13- 14- 15- 16 -t ---r— ire COMMENTS Silo Plan WAS GROUNDWATER ENCOUNTERED? S IF YES, AT WHAT DEPTH? L O Depth to WaW After p MoNlaring? E Dace: .I A( PERCOLATION RATE _ (nnulewh ) FERC HOLE DIAMETER V TEST RUN BETWEEN Z Fr ANDIf- FT PERFORMED BY: M Al _4, I CERTIFY THAT THIS TES W/1S PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: r 3 , _oto ,t~& cOCO O�W 0-20 t o C -D n �.t-''� 0 a� Qo ►d � o �' C �' cn W l 1 N Z O co �� rn O ci �• OITI Cl) � D o 0-. 0 CL m v o L� N n O C) UG�71 CD cn r lotw r' d mcn �• �° �� t••o y� lot rn ocnQ: cn o p 0O O >> m �* sv cn O [� ' ,t~& cOCO O�W 0-20 t �2 -Q ~�ct a� p z � 0--b 0' C.A CD CD c•r 3 O co �� O LOT 16 O -___---_. GINGER LEE DRIVE G� d y N00600'00"E 259.27' (259.31' R) y r- 0 N N N 00'09' 01 "W 259.27' f' (NOO'07)1 0))W 259.31 R) LOT 13 ,�� LOT 12 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP231015 Work Type: Septic Upgrade Tax Code Number: 05106229000 Site Legal Address: STOCKHAUSEN LT 23 G:1460 Site Mailing Address: 21311 GINGER LEE DR, Chugiak Owner: BLUM TIMOTHY MICHAEL Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: cnt :J n U�p��rtment Lot Size in Sq Ft: Total Bedrooms: 2/22/2023 2/22/2024 46174 Q Disposal Field Q 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 Special Provisions: • The edge of the trench is to be located to ensure that the new tank maintains the required 5' separation. • The edge of the trench is to be located to ensure that the new field maintains the required 12' separation. • 7 day groundwater monitoring is required. Construction may proceed at your own risk before the 7 day water monitoring is complete. Please submit stamped and signed results with the As -built Inspection Report. If the results require a design change, construction of the system will stop pending On -Site review and approval. CO #1 Added a disposal field to the permit. 3/1/23 J—�suP -Fo Issued By: Date: Date: Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section - Fax: 907-343-7997 ON-SITE SEPTICM/ELL PERMIT APPLICATION Parcel I.D. 051-062-29 Property owner(s) TIM BLUM Mailing address SAME Site address 21311 GINGER LEE DR, EAGLE RIVER AK Legal description (Sub'd., Block & Lot) STOCKHAUSEN Legal description (Township, Range & Section) Lot Size 46174 Sq. Ft. Number of Bedrooms 3 LT 23 Day phone APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank ElUpgrade 7XDuplex (D) ElHolding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) z Permit/Rush Fees: �(�[� .$59Z giver Fees: Date of Payment:I { ZaQ Date of Payment: Receipt Number: 13-3157 Receipt Number: Permit No. LIS PVi 31015' Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc cow/ Feb. 28, 2023 Municipalities of Anchorage On -Site Water and Waste Water Section 4700 Elmore Rd Anchorage, Alaska Phone 343-7904 Re: CHANGE ORDER (OSP231015) Legal: Stockhausen Lot 23 To whom it may concern: This is a request for a change order permit on the above referenced lot. The field has failed and needs replacement. A new deep trench has been designed, see attached. A new test hole was done and found poorly graded gravels and sands (GP/SP) for the entire depth. No water was observed during the test hole excavation or after 4 days of monitoring. The neighboring lot 22 had no water either to a depth of 16 feet. A STEP tank has been designed to elevate the new trench above the old system for a better design. This new change order will not impact any of the surrounding neighbors, see the attached site plan. Due to winter weather conditions we need to proceed at our own risk concerning the 7 -day water monitoring. Sincerely /&,, Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 I tr I 0 I Lu W I J w W C9 z C7 \ I \ \ I \III I `\ I 1 WELLl 1 1 \ \ \ \ STOCKHAUSEN \♦ LOT 24 I EXISTING 200' COMM. WELL RADIUS FROM NEIGHBORING LOT 11 \ I \ \1 I DRIVEWAY I I I EXISTING 1 HOUSE I /I ii 1 MT ■ I — 5-8% SLOPE D 1 i III moi/ I • III � 1 I PROPERTY LINE EXISTING WELLTH#1 — T 1 100' RADIUS ------- 5-8% SLOPE / I i WELL I � Septic System Replacement TIM BLUM STOCKHAUSEN, LOT 23 Anchorage, Alaska Michael N. Anderson, P.E. DATE: 4601 NATRONA AVE DRAWN: ANCHORAGE, ALASKA 99516 (907) 727-8864 /FAX: (907) 345-1391 SCALE: \`\ I w \ F, \ I� \ D \ O \ STOCKHAUSE \ LOT 23 \ I \ 11 I i I 1 1 I 1 I I I I 1 1 1 1 1 1 1 \ NEW 1500 GALLON STEEL STEP TANK. -MIN. 12' TYP. BETWEEN NEW & OLD TRENCH 5-8% SLOPE EXISTING CO TO BE LOCATED FOR FINAL SURVEY ASBUILT NEW 47' TRENCH W/ / 6' EFFECTIVE 49 TH 2/18/2023 0�t ::MICHAEL N. ANDERSON: ♦ % : No. CE 9469 DJR #j .�2-19-23 .�� 1 —50 DESIGN CRITERIA: NEW TRENCH GO I 3 BDRM X 150 = 450 GPD SOILS = 450/0.8 = 563 SQ FT REQ'D 563/2(6) = 47', (1) TRENCH 9' DEEP 6.0' EFFECTIVE 2.0' WIDE 47' LONG / / / / I 1 I I I 1 1 TH#1 SEPTIC FIELD SECTION \ OUND OVER ILTER FABRIC '0 PIPE VVER ROCK I i • I I � I X TS LT 11 PETERS CRKiERR TMFWS EXISTING 200' COMM. WELL RADIUS FROM NEIGHBORING LOT 11 I / (SHEETS LT 12 PETERS CIRKTERR TWNHMS P / \ I 1 \ EXISTING WELL 1I 0' RADIUSEl nn ` III SHEETS LT 13 PETERS�RKTERR HMS P 3 ul \ / PROPERTY LINE \ \ \ 1 I i I25'I I / I / Septic System Replacement TIM BLUM STOCKHAUSEN, LOT 23 Anchorage, Alaska Michael N. Anderson, P.E. DATE: 4601 NATRONA AVE DRAWN: ANCHORAGE, ALASKA 99516 (907) 727-8864/ FAX: (907) 345-1391 SCALE: / X VICE PROVIDED BY COMM. WELL ON LOT 11 .•�. • P� ••S�♦♦� •••.`y :. AV STOCKHAUSEN ir 49 TH LOT 23 L....:.... .... -.... ----------_--- 2/18/2023 %M� ::MICHAEL N. ANDERSON; 1♦: No. CE 9469 DJR;•.•2-19-23 1 "=100' Municipality of Anchorage Development Services Department <<�r.• ., r�s� On -Site Water and Wastewater Section - •�'� 4700 Elmore St. ' :r • 0 T H � -,'r P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite - (907) 343-7904 • • ° • • • . • ............. 011 • MICHA L N. ANDERSCN d ` CE - 9469 d Soils Log - Percolation Test%� �-3:• ��`� fll�frsC 11�{. Performed For. �I Date Performed: Legal Description: A K S e ti- ( D {` 2 Township, Range, Section: Slone 1 0 v` 9 . 2- 3- 4- 5- 6- c' 7- 8- 9- 10- 11- 12- 13- 14- 15- 17- 18- 19- 20 - COMMENTS ■■■■■■■■■■ Date ENCOUNTERED? Net Time Depth to Water S IF YES, AT WHAT DEPTH? L Depth to Water After 0 Monitoring? E _ E Date: J � h , ■■■■■■■■■■ NEI WAS GROUND WATER Date ENCOUNTERED? Net Time Depth to Water S IF YES, AT WHAT DEPTH? L Depth to Water After 0 Monitoring? E _ E Date: J � Reading Date Gross Time Net Time Depth to Water Net Drop h , r(=MUUuA i 1UN rug i t (minutes/inch) PERC HOLE DIAMETER [� TEST RUN BETWEEN Z FT AND _ FT PERFORMED BY: /BMJ" 1 CERTIFY THAT THIS TESI WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: �W GREh�r'R ANCHORAGE AREA BOh_JGH Department of Environmental Quality —'' 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM 1W14C? F1 MAILING ADDRESS. . R E" L141'4/7aA PHONE 64T-- 641 ~LOCATION NAME. L7W—RV LOCATION LEGAL DESCRIPTION L67— S -Tac k 6WAU.SEA SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH_ TILE DRAIN FIELD: MANUFACTURER MATERIAL _ INSIDE WIDTH LIQUID DEPTH NUMBER OF Z- -COMPARTMENTS LIQUID CAPACITY / 066GALLONS. TOTAL LENGTH J /! r DISTANCEFROMWELL FOUNDATION NEAREST LOT LINE OF LINES 'T10 NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH VYIN. TOTAL EFFECTIVE ABSORPTION AREA �� '� SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER /� Cf /• DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE IN. ABOVE TILE— IN. WELL: TYPE— CONSTRUCTION DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION , LOT LINE , SEWER LINE , TANK , SYSTEM CESSPOOL OTHER SOURCES APPROVED— DISAPPROVED REMARKS ---' DISTANCES INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL:v 4 LOT SLOPE: REMARKS: DIAGRAM OF SYSTEM THE RFQUIRED I, P. OF THE SUIL H6SORPTION SYSTEM IS� ;�!I:: it -I r= �-i�:- 4, U-�Ic-A ji= THF |ENGT� DIME�S�ON IS THF1ENGTH (IN FEET) OF THE TRENCH DR DRHINFIELD THF DEPTH 0F 9 fNCH UR PlT IS THE DISTHNCE BFTWEEN THE SURFHCE OF TME IF fl IND THE ROTTOM 0F THE �XCRYHTION (IN FEET! THERE lS NO SET WIDTH FOR TREMCHES THE GRHVEL DEPTH IS THF MINIMUM DEPTH OF GRHVEL BFTWEEN THE OUTFHLL PIPE HND 1 1 'lE ROTTOM OF THE EXCHYHTION (IN FEET) 5� �� U_�� ;I0 �� ~___ 1 PHCKHGE PiH�1T MHY BE lNSTHiiED HT T�E PERMITTEE'� OPTION SUBJECT TO THE F0LLOWI�G I171 1NS� 1 ETTH[R H CL��SS I OR II NSF HPPROVED PLHNT MY PE INSTHLLED 2 A C0NTTNU0US MHINT[NHHCE HGREEMENT IEQUIRED. IF H MHINTFNHNCE HGR�FME�T IS N0T KEPT CURRENT YnU MHY BE R[QUIREI ENLHRGE THE �nIL H9S0RPTION SYSTEM HND/OR YOU MHY BE SUBJECT TO PROSECUTION ...... ...... ......... �� 0�� RH[KFIL/ TNG OF HNY SYSTEM WITHOUT FINHL INSPECTION HND HPPROVHL BY THIS 1FFHI WIi| �[ SUR T TO PROSECUTION MINTMUM DITHNCE BET1 AI B-| HND Hu RE DISPOSHL SYSTEM I� 100 FEET FGR H PRlVHTE WELL 0R 200 FEET FOR H PURLIC WELL 0THFR RFQUIRFMENTS MRY HPP|v SPECIFTCHTIONS �ND CON�TRUCTION DIHGRHMS HRE �VHIiHB|[ lO lNSi]RE PROPER INSTH|JHTION 1 it It- .1� ;I0 " (7onstptuetion Srest Pali "One test is worth a thousand opinions" 2204 Cleveland Anchorage, Alaska 99503 Performed For /—/Ar" mar—ke,41 Date Performed �oL.2,2�i7 Legal Oescrintion: L t 23 Bloc,. " Subdivision S+a.,K.66usr 5�6• This Form Reports Soils Lon Vee, Percolation Test_ Denth Feet Soil Characteristics ew in a ; s 2- 9M — 9M 8- s:Ity SaN,acy Gr04ue,� 10- 12 0- 12 14 DoH 16- 0 6- 0 20— Was 0— Was Ground Water Encountered?A10 If Yes, At what Denth? A)- R - A-- ' - - -' -- RL —O� Readinq Date Gross Time Net Time Depth to H2O Net Drop' 'r— r— - Percolation Rate Hinute Proposed Installation: Seenane Pit Drain Field Deoth of Inlet Depth To Bottom Of P�l''t Or Trenc Cnmt ENTS: /5"O 4a F'f re au;rep per beclroarn Test Performed By _ Data Certified By: XI Date: 6, %?Z X77 _ d a„ ►e - i sl—�r o K v (Ponstruchon (Jest cRal "ONE TEST IS WORTH A THOUSAND OPINIONS" 2204 CLEVELAND AVENUE • ANCHORAGE, ALASKA 99503 • 277-0231 July 21, 1977 Mr. Harry Mackey Star Route Box 1175 Chugiak, Alaska 99577 RE: Lot 23, Stackhauser Subdivision Dear Mr. Mackey: The test hole on the referenced project was excavated to a depth of 16' and no ground water was encountered to this depth. If you have any further questions regarding this test, please contact our office. Very t,�uly yours,r-, David Paul Laboratory Manager DP/ja Certificate of On -Site Systems Approval Parcel I.D. 051-062-29 Legal description STOCKHAUSEN LT 23 Site address 21311 Ginger Lee Dr Eagle River Current property owner(s) Tim Blum Expiration Date: D ?O 2 X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: BY Original Certificate Date: 31g%1? -o1,3 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MV UHMPAUTY OF A HCH ORA GEE Development Services Department ` �/ Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051-062-29 Complete legal description STOCKHAUSEN LT 23 Location (site address) 21311 GINGER LEE DR, EAGLE RIVER AK Current property owner(s) TIM BLUM 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: ❑■ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ■❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed X Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 75-b Date of Payment 3131 A ti p` COSA # Gsc g. a -t00-3(05-4 Waiver Fee $ Date of Payment Waiver # COSA Application_June 2022 COSA Checklist Legal Description: STOCKHAUSEN LT 23 Parcel ID: 051-062-29 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system L•AIA4Ig973/a1 ❑ Well log is filed with Onsite (or attached) Date drilled 1961 Total depth 74 ft Cased to 74 ft 0 Sanitary seal is functioning correctly ❑N Wires are properly protected Casing height (above ground) 12 in. Date of flow test for COSA 2/7/23 Static water level at beginning of test 61 ft. Comments B. TANK DATA Measured operating fluid level in septic tank 36 Date of pumping NEW ❑ Required maintenance completed, if AWWTS Comments: NEW STEEL TANK INSTALLED D. ABSORPTION FIELD DATA Which system tested (date installed) NEW ❑ ALL standpipes present per record drawing Total measured depth from grade 10 ft (max) Measured depth to pipe invert from grade ft (min) ❑E N/A —pressurized field. ❑ Per record drawings, field is insulated. OF Monitor tubes go to bottom of effective. If not, state depth into effective _ ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 Well production at time of test 3+ gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑Q No FM Coliform bacteria is Negative Nitrate 4.6 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L 0 Arsenic less than MRL (ND) Collected by Date 2/7/23 MNA C. LIFT STATION ❑ Required maintenance completed Age of lift station NEW years Lift station material STEEL Comments: NEW STEEL STEP TANK Adequacy test date NEW Results Q Pass Fluid depth prior to test _ in Water added _gal New fluid depth _ in Elapsed time _ min Final fluid depth _ in Absorption rate _ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) NEW in Effective depth used _ in Effective depth remaining in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Q Yes if No _ ft Neighboring Tank > 100' Q Yes if No _ It Absorption Field on Lot > 100' FE1 Yes if No _ ft Community Sewer Manhole/Cleanout > 100' Yes if No _ ft Private Sewer/Septic Line > 25' Q Yes if No _ ft Holding Tank > 100' QYes if No _ ft Neighboring Absorption Fields > 100' Animal Containment > 50' QYes if No _ ft 0 Yes if No _ ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' QYes if No _ ft QYes if No _ ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No _ ft Surface Water > 100' [�] Yes if No _ ft Tank to Property Line > 5' 0 Yes if No _ ft Field to Property Line > 10' Q Yes if No _ ft Water Main > 10' 0 Yes if No _ ft Water Service Line > 10' E Yes if No _ ft F. ENGINEER'S COMMENTS Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' E Yes if No _ ft Q Yes if No _ ft If tank or field is under driveway comment below G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm M14 t•%uvi✓ _ eotioyi Phone 727'$$64 i Engineer's Printed Name c7rae, Date a V. r P 1�41��t1 E� S ............ ®< !•�a MICHAEL N. P,\,,.;•:;C 7 • ✓t O' Cr. 9 w r jCi COSA Checklist June 2022 Municipality of Anchorage s Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel 1. D. _05t - OGz-- 29 1. GENERAL INFOgMATION" Complete legal description .` HAA #— 015 N Q q - Expiration Date: a rV Ie ••r a� Location (site address or d(rec( ons) 0Z/;?// 6 -id rFA�' / EF 6-1114 Lrifi if , A JL Current Property oWner(s) L�1,�725� 'AlAckFY Day phone 355- od Mailing address 2/3// CVVLr7fz i 7]P.. CHrwi(ist p ygk Lending agency Day phone Mailing address Real Estate Agent fLLEA/ 8N4G 77.-fA/D 4&4LTY Day phone 6,711 - 9/25 Mailing Address r46 -Lc /2l ✓Efc 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 TYPE OF WASTEWATER DISPOSAL: 19 Individual On-site .E3� ❑ 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 PiVE,< f V 6T-iA4M1f ijVC- S✓S. _ Phone 6974- Sl ` f Address IN2/ VfW Tp.,SrArTc 20/ ,_EK . rfle- eiC?S77 Engineer's Printed Name 51 +�I crnPNi� 'P-. W 00 D 5. DSD SIGNATURE Approved for _�_ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By. ��\1—ri �� 4 OPi_ Original Certificate Date: r (Rev 0IM2) Municipality of Anchorage Development Services Department Building Safety Division a . On -Site Water & Wastewater Program : ..... 4700 South Bragaw St, P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST' Legal Description: I TUCMzlUrrA/L A3 Parcel ID:_pSl - O(oZ-,L-Lq A. WELL DATA Well type If A. B, or C provide PWSIID"" ""#� Well Log 'Date completed /910! Sanitary sea] ON) U _v��- Wires properly protected 6) � o6irc•v� Notal depth eft. $-Cased to -mcft. Casing height (above ground) min. FROM WELL LOG AT INSPECTION Date of test -7- 8'- 97 V - /,2 -07 Static water level G / J* it. /.O ft. Well production WATER SAMPLE RESULTS: Coliform _colonies/100 mi. Arsenic: mg./I. B. SEPTIC/HOLDING TANK DATA Tank Ty ateri Nitrate Y-01 mg./I. Date of sample:OS 9.p -m. Other bacteria _per colonies/100 ml. Collected by: Date installed /977 Tank size 4.1)1)0 gal. Number of Compartments a2_ Cleanouts ON)t at - Foundation cleanout (Y6) 'tU Depression over tank (Yo It& - High water alarm (YIQ tzL1= Date of pumping 9 - 4 -'041 Pumper t ty- rs C. ABSORPTION FIELD DATA Dateinstalled /97'1 Soil rating (g.p.d./ft2 or LO System type 7A -,e .Le_ Length I/& ft.. . Width y ft. Gravel below pipe�P_ ft. Total depth /0_ ft. Eff. absorption area 57 ( fl? Monitoring tube Depression over field Am=-We— Date of adequacy test Results &jis Fail) � _v For 3 bedrooms Fluid depth in absorption field before test -At in. Water added gal. New depth in. Elapsed Time: LOmin. Final fluid depth � in. Absorption rate >= q&9' g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) `%1A— If yes, give date D. LIFT STATION Date installed Size in gallons 'Pump on' level at _ in. "Pu=ested t� Datum _ Cyc E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: High water alarm level at Meets alarm & circuit requirements? Se tic tan&llift station on lot / OS ` On adjacent lots /00 / f Absorption field on lot /To On adjacent lots /00, f Public sewer main 100,1- Public sewer manhole/cleanout /00' f Sewer /septic service line as, i- Holding lank 'M.4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation (0/ Property line S r } Absorption field /0 ' Water main /0' t Water service line /O r Surface water /00 r f Wells on adjacent lots /00' f SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: ral Property line /11- ` Building foundation g!a ` Water main /0 ` f Water Service line /0 ` f Surface water /00' Driveway, parking/vehicle storage Curtain drain /100 ` t Wells on adjacent lots OO r -f- F. F. COMMENTS .A /n/GOtM fTiOhJ FROM EsKTLE OEi✓>ic En/G+'NEfeiNCT ZEGURDS. (.7 7i4f is sKCESS TO SEW Ex r iNE 1n111119, HQUIC G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name 6/-fie1,r P1Yf.0 -/Z . LVV40n Date MAY Z 2005 HAA Fee $ klu , ly Waiver Fee $ _ Date of Payment 5-1,Alb .5- Date of Payment Receipt Number %70.2q 6�� --- Receipt Number (Rev. 12/01) 'i:f 62 4• 4a , n .nk -f< n v. Rcbr.t C. lo•��. sc r. �'',' Ito. C:0 -a /br^ co AS -BUILT it K I� I hereby certify that I have surveyed the following =Mdescribed property: e7— Z ,C s�6d� sw ' Anchorage Recording Precinct. Alaska, and that the improvements situated thereon are within the property lines and do not overlap qr encroach on the property lying adjacent thereto, that no improvements on prop - premises erty lying adjacent thereto encroach on the pses in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Eagle River, Alaska this Z6 � day of A/pyr 4 19Z,,Z_ SCALE: Regiistered Land JOHNSON No. 880 -LS 1� e lto Box 456 Eagle River, Alaska Phone 194-2543 r �1 1 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 2. TYPE OF RESIDENCE Single-FamilyXF'. Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well XX 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 XX 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 72-025 (11/84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. 'i u�RT'TmeTEM7,ioWAPIM2NofI\9JICia�1LHI\IJIJI:q\11111l.'f91YTAILI)2 --. = Add DatE as Louis A. Butera CE -6736 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) I. MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE (MO ENVIRONMENTAL SERVICES DIVISION HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 J U L 1 ; 1987 Legal Description: lot a 3 STocLf �uu r'�i✓ RECEIVED A. WELL DATA Well Classification &' uAfe If A, B, C, D.E.C. Approved (Y/N) "Z Well Log Present (Y/N) N Date Completed 1'76,' Yield Total Depth 7v / Cased to 7,y / Depth of Grouting "lll4 Static Water Level 6W Avg Ic e4s'^5 Pump Set At I-63' Casing Height Above Ground /2 /' Loccled k,i° 'SanitarySeal on Casing (Y/N) Y Electrical Wiring in Conduit (Y/N) ti�a / 4 '^ `/re Depression Around Wellhead (Y/N) Separation Distances from Well: 7 To Septic/Holding Tank on Lot On Adjoining Lots t/oma To Nearest Edge of Absorption Field on Lot Jam 7 On Adjoining Lots tiro To Nearest Public Sewer Line /10i To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot �y Water Sample Collected by Date /g 7 Water Sample Test Results Co/„s — (J� �✓ —Z �i Comments B. SEPTIC/HOLDING TANK DATA Date Installed 1"72 Size /OoD ',4/- No. of Compartments 12 Standpipes (Y/N) Air -tight Caps (Y/N) y Foundation Cleanout (Y/N) N Depression over Tank (Y/N) Al Date Last Pumped /4v� Pumping/Maintenance Contract on File (Y/N) ; for ^� Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well To Building Foundation 60 i To Property Line `/O/ To Disposal Field To Water Main/Service Line *20 r To Stream, Pond, Lake, or Major Drainage i Course t/ao Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 5 �j�� Type of System Design 7 -re r✓c Date Installed / 9 Length of Field %° Width of Field Depth of Field Gravel Bed Thickness 6 Square Feet of Absorption Area �� Standpipes Present (Y/N) Depression over Field (Y/N) n Date of Last Adequacy Test 7Ir�8 Results of Last Adequacy Test r fe for Separation Distance from Absorption'Field: To Water -Supply Well -2a 1 To Properly Line i To Building Foundation 7S- To Existing or Abandoned System on Lot "%� To Water Main/Service Line "YO To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION 1 Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments On Adjoining Lots ae To Cutbank (if present) 075A i — Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Dale 7 SA -7 Company �'z-' r MOA No. Receipt No. a� ——U v Date of Payment Amount: $ i l a j Efiginr's Seal Page 2 of 2 72-026 (11/84) Lodi: S.. ^v4em C 5135 Eagle River Area GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received December 1, 1976 Time of Inspection Ayk Date of Inspection REQUEST FOR APPROVAL OF AaW INDIVIDUAL SEWER & WATER FACILITIES FOR Conv. 1. Approval requested by: Alaska Mutual Savings Bank Mailing Address: Post office Box 1120 Phone: 274-3561 2. Property Owner: Larry M. & Beverly C. Mackey Phone: 688-2379 Mailing Address: Star Route Box 1125, Ginger Lee Lane i 3. Legal Description: Lot 23 Stockhousen 4. Location: NHN Ginger Lee Lane ,5. Type of facility to be inspected Single Family No. of bedrooms. 2 6. Well Data: A. Type Individual B. Depth C. Construction D. Bacterial Analysis 7. Sewage Disposal System: on-site system A. Installed B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area Sewer Lines Nearest lot line Other contamination B. Foundation to septic tank Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages Page 2 of two pages - RE ^ 'st for Approval of Individual ar & Water Facilities -Legal Description Lot 23 Stockhausen Comments 7`� l�PoPl9Q i ��hov /%� �1 /rte S'C'e,(--°`h�, f Approved Disapproved Date7^ C Approval,Valid for one year from date signed Ureater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certifv that the information contained in this reauest for approval to be a true anc accurate representation of the subject sewer and water taciiities ano tnese rac111c1ea are operating satisfactorily. SIGNED Date EQ -034 (1/74) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA FHA CONV X 2. Property Owner: Larry M. and Beverly C. Mackey Mailing Address: SR Box 1125 Ginger Lee Lane Day Phone: 688-2379 3. Name of Buyer: Refinance Mailing Address: Day Phone: 4. Name of Lending Institution: Alaska Mutual Savings Bank Mailing Address: P. 0. Box 1120, Anchorage Phone: 274-3561 5. Name of Realtor or Agent: n/A Mailing Address: Phone: 6. Legal Description: kkXxkRxxRkRxkxkxRxxkyAlxxkRk§lixtRmx Lot 23, Stockhausen Subdivision Location: Peters Creek NHN Ginger Lee Lane FA F3 Type of Facility to be Inspected: Single Family No. Bdrms. 2 Water Supply Type of Supply: Public Utility Individual X If Individual, number of dwellings presently served 1 If Individual, depth of well Sewage Disposal System X Type of System: Public Utility Individual (on-site) If Individual, date of installation 72-003(3/76) (2� O(W&gaber 3019 Larry Hackey Ster Route Box 1125 Ginger Lee Xano chuqiak.. Alaska 99S67 Subject.- Lot 2a Stockhausen Dear t . Mackay: efol:4a this e It '-% V 4.1>PXOV ' 'on h* V'Taal serving the subject ? rt x iihe wel zas1xi€ Aust be extoAdad twelve (12) inchas above silo l oval With the ground sloping away* froa the casing. e do not have records of your zover system on filo. #rnclosga ins uioar.3d be followed 1n order to cit appvwal *a your savor E -ate; . If ire are any queatjonrr plagee contact ale Office at 276-2221, extension 205. 4obart C. ft4tt, A-8- Unitarian =I{ljh jza-zo-7�,