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HomeMy WebLinkAboutANOTHER LT 3Another Lot 3 #020-093-32  Municipality of Anchorage · Development Services Department:~.___ :~- - Building Safety Division On-Site Water & Wastewater Program, 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 '~ ~' www.ci.anchorage.ak.us (907) 343-7904 Page 1 of On.Site Wastewater Disposal System and/or Well Inspection Report ... Permit Number- SW020134 PID Number. 020-095-32 "arn*:MARK AND DONNA GARBUTr Wastewater System: [] New · Upgrade 16501 CHASEWOOD LANE * ANCHORAGE, AK 99516 ABSORPTION FIELD NO. of Bedrooms: /rl Ph°ne:(907) 346-2,307 4 ri D~ep Trench ri Shallow Trench ri B~d ri Mound.'~ Other LEGAL DESCRIPTION ~' ~ ~ ,~1 ,-. - 3 ANOTHER WELL: [] New [] Upgrad n. ,. A+ NOME SERVICES 26/2002 SEPARATION DISTANCES =s. pu. a,~,~n, as.T.c,, ao~., 'Fro m~'~a SepflCTonk Ab~'~°~dUonSteuonUftHold~ngTank ~.~/~ ANCHORAGE TANK 1500 we, 100'+ I 100'+ - 25'+ STEELI 2 sur~aca ware, 100'+ z 100'+ - - EXISTING LIFT STATION Lot Una 5'+ ~ 5'+ -- - 1500IANCHORAGE TANK/ORENCO SYSTEMS F'oundatJan 5'+ 5'+ -- -- TIMER TIMER Curtain Drain NONE KNOW ~1 ~20 OSl 05 HHF M.O.A. I I I~ernarks: A NEW AX-20 ADVANTEX POD WAS BENCH MARK INSTALLED OVER THE EXISTING S.T.E.P. TANK TOP OF BLOCK HOLDING GAS LINE AND A NEW CONTROL PANEL WAS INSTALLED ON THE OUTSIDE OF THE HOUSE. 100.00 Inspections performed by: AKWWC, INC. Dates: 1st 6/26/2002 "-'-t ...... ~"j,~'l'":'"'! 2nd~ ~ Development Services Department Approval (ll~.~oj-I ~ ......... R~viewed and approved by~Date: ~ -~'~2 AS BUILT DRAWING pERMIT NU~B£R: SW020134 020-093-32 / / ~ ~ ST2 53.6 25.1 ~ / .OTHER S/D ~ / ~ C02 74.0 28.0 ' / / s.mP. ~K "'5 ¢>: / 4¢'Z / ' ....... .... :.:.:.. ~-., .... ,. .......... ~....:...:....~ DATE: 6/27/2002  ORAWN J.L.M. AI.~kSKA '~WI'ER & Y~STIg~VATER 40' PREP~[O FOR: PHONE NUMB[R: PAGE NUMBER: MARK AND DONNA GARBUTT 346-2307 2 OF L[~ O[SCRIPTION: ANOTHER SUBDIVISION; LOT ~E OF WORK: AS-BUILT OF SEPTIC SYSTEM UPGRADE A e ST! 46.5 27.0 ST2 53.6 25.1 MHL 55.8 28.0 CO1 61.5 52.0 MT 68.5 40.0 C02 74.0 28.0 BUILT DRAWING PERMIT NUMBER: AS ~ 020-093-32 SW020134 ~TOP OF.ADccVANTEX POD 99,66 / ~TOP ~F MANHOLE / / ,oo.56 ~ / ~2 / IIIIII ~V~TEX EXISTING 1500 GALLON  (INSTALLED IN 1096) J.L.M. '" ' AI>[SI(A WATER & WASTI~WATER ~:.. ~} ~~~. ~R[P~[O FOR: PHONE NUMBER: PAGE NUMBER: ~ ~c.,.,,o.: 'u~..~, ..~ ......... ..~ ANOTHER SUBDIVISION; LOT PROFILE AS-BUILT Of SEPTIC SYSTEM UPGRADE JUL. 1.2002 2:357M PACIFIC ALASKA MORT Municipality of Anchorage Development Services Department Bu/ldio~ Safety Dlvbion On-Site Wa~w aad W~l~w~a~e~ P~osram 4700 Br~aw Su~t P.O. Box 1944~0 www.cLanchomg~.~k.u~ (9013 ~43-7~04 N0.815 P. 2 PROPERTY OWNER AGREEMENT FOR THE MAINTENANCE OF AN ON-SITE WASTEWATER DISPOSAL SYSTEM This ~grc~n~n~, dated July l, 2002 ,ismadebcv. vcxnfl~eMunicipalRyofAnchorage Development S~vic~ Department (DSD) and tb.¢ property o~a~er(s) of: 16501 CHASEWOOD I~NE ANCHORAGE, ALASKA 99516 This agreement is made for the purpose of m~n~n~ng an on-site wastewater disposal system on the subject property. The property owners agree to the following: L1LY J LOU (Primed N~me) KRA1G A }lAVER (Prhted Name) Thee Fo. regoiag Insmanent was acknowledged before mc by ,/~tl~,.~/{ M,,~ ;~( on this, /~t day of ~otaz7's printe~ My Commission Exph"¢5 07/01/2002 MON 15:31 [TX/ILl NO 9554] ~002 RightFAE 7/3/2002 5:43 PAGE 1/1 RtghtFAX Inspection Report Hunicipality of Anchorage, Building Safety Division 4700 South Bragaw INSPECTION: VOICE 343-B300 Name Address Legal Subdivision Comment~ or Directions INSPECTION: FAX (907)249-7777 ARAI~T ELECTRIC :1001 OLD KLA'IT RD BK 1LT 10 TIMBERLANF PARK ~f I INFO: 34:3-8211 Permit 02-8144 Phone 244-5351 Inspection Date 7/3/2002 2ND ]NSPEC'I'[ON FOR SEPTIC Inspection Other [lectrlcal ,~NO NONCOMPLLRNCE OBSERVED [] CORRECTIONS ESSENTIAL AS EXPLAINED BELOW [] W~LL RE-EXAHINE AT NEXT [] DO NOT CONCEAL UNTIL REINSPECTJON INSPECTION Relnspectl0n N COMMENTS: (for Inspector use only) Inspector MUNICIPALITY OF ANCHORAGE Development Sen/ices Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: May 29, 2002 Expiration Date: May 29, 2003 Permit Number: SW020134 Legal Description: ANOTHER LT 3 Design Engineer: 0041 AK Water & Wastewater Consultan' Owner Name: Mark & Donna Garbutt Owner Address: 16501 Chasewood Lane Anchorage, AK 99516-0000 Parcel ID: 020-093-32 Site Address: 016501 CHASEWOOD LN Lot Size: 50321 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of; r~ Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage A~I construction must be in accordance with: 1. The attached approved design. 2. ,NI requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of AJaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 043-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: ~~/ Issued By: ~ Date: Date: Municipality of Anchorage Development Services Department Building Safety Division 1 On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci,anchorage.ak.us D~. (907) 343-7904 ON-SITE SEWER/WELL PERHIT APPLICATION FOR A SINGLE FAHILY DWELLING Parcel I.D, ~ -~'5 -,~. Permit Number Property owner(s) ~ARK ~: DONNA CARBUTr Day phone 346-2307 Mailing address (1) 16501 CHASEWOOD LANE Mailing address (2) ANCHORAOE. AK Zip Code Legaldescdption (Lot, Block & Sub'd.) LOT 3. ANOTHER SUBDIVISION Legal description (Section, Township & Range) Lot Size ~ ~ I Acres~.~ THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade Ilia Number of Bedrooms 4 ~E] Well Only [] Water Storage [] THIS PROPERTY CONTAINS: Hot Tub ~ Jacuzzi Swimming Pool Water Softening Unit Therapy Pool [] I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. ALASKA WATER & WASTEWATER CONSULTANTS, INC. Permit Fees: /-//~ ,0o_/[ i~?0_= ~' Waiver Fees: Date of Payment: ~' ~ ~ '~ Date of Payment:. Receipt Numbe~ O ~ ~ ~ I ~ Receipt Numbe~ ..... ~ CONSULTANTS, INC. June 7,2002 Municipality of Anchorage Development Service Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 Reft Proposed Well and Septic System for Lot 3; Another Subdivision ADVANTEXTM TREATMENT SYSTEM The existing 4 bedroom home is served by a private well and septic system (ISF). The subject property was recently approved for an upgrade to the sand filter in order to obtain a Health Certificate (SW020134). We would like to request an amendment to this permit. The buyer of the property requests the installation of Advantex Treatment System. We are proposing to use an Advantex treatment system and the existing 5-wide trench type drainfield. The sand filter will be abandoned in place for possible future use. The existing 1,500 gallon STEP tank will be used; however, the manhole riser and pump controls will be changed out to an Advantex retrofit. An AX-20 filter pod will be installed. The system will be manufactured by Anchorage Tank & Welding to meet the latest design criteria established by Orenco Systems, Inc. for the Advantex system. The point ofcontact at Anchorage Tank is Lowell McNutt. As with their standard STEP tank, it is equipped with a high water alarm per M.O.A requirements. Per Toben Spurkland P.E.'s soils log, there was a soil layer that perked at 240 minutes per inch (the test was conservative) that is 4 feet below the existing trench (currently receiving ISF effluent). See my comments on the attached soil log regarding the method of the perk. It is assumed that since the perk was not greater than 240 minutes per inch, the soil layer is not deemed to be impermeable. Therefore, we are proposing to discharge the Advantex effluent into this trench. We have provided a 4+ feet separation distance to groundwater. 6901 Debarr Road, Suite 2B ~ Anchorage, AK 99504 ~ Ph: (907)337-6179 ~ Fax: (907)338-3246 I am open to any suggestions from your department that would be an improvement to the proposed system. I am unaware of any negative impacts that this installation would impose on adjacent wells, or s~tie systems. Ifyou have any questions, please call us at 337-6179. Pres ~le~t ~ NOTE: Attached is a site plan drawing, a design drawing, an ,4dvantex detail, and a 7 page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B ~ Anchorage, AK 99504 ~ Ph: (907)337-6179 ~ Fax: (907)338-3246 I I I I I ~O~HER S/D ~ I ~ ~ I ~ I I ~ / "~a , ' ' ,., '. ~... "-~ ~ ! / -,q~ \ I I~EOROOM HOUSE I I ' ~~!"./'~/ ~ , ,, ~"" '\\', \ ~, / / \.// I k ',. \ ','?,\ \ \ I I ,, -~o,,, ', \\.'\\ \ \ C~o.~ i _,,~_ ,-o~."~/o ~,','~ \ \ --"'~,o,, ', , / , ~./ ',',\ ,. \ ',. ', ,, ,o,~. ',t~ 'x \ "- .... ~ , ',~ \. \ o~,w, e~: ,,~..~....',~ l / r,, ...',3~'~;~.,,, "K.D.W. ~. II I1~ ' ..~,t,, ............ CONSULTANTS. INC.~ 1" =1oo. MARK · DONNA GARBUTT ~46-2~07 1 OF 2 ANOTHER SUBDIVISION; LOT 5 SITE P~N FOR DESIGN OF SEPTIC SYSTEM UPGRADE K.D.W. '-. A~SI~ WATER & WASTEWATER CONSULTA~S, INC.~ 1" = 40' .......... ~ ~o.~ ~o.~ .~.~= .~ .~.~ ~ ~ ~ ~ ~......~.....~ MARK AND DONNA GARBU~ 546-2507 2 OF 2 % ~ o~.~o.: v~.. C[-','~53 .." ANOTHER SUBDIVISION; LOT 5 ~' ' DESIGN OF SEPTIC SYSTEM UPGRADE Munlclpallty of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchor.age, Alaska g9502-0650 SOILS LOG .-- PERCOLATION TEST 4- 5- 6 7- 8 g 10 11 13- 14- 15- 15- 17- 18- 19- 20 COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, AT 1 SITE PLAN DEPTH? PERCOLATION RATE ~. ~1. [m,nutes/inch) PERG HOLE DIAMETER TESTRU. BE WEE. FTAND, 7 FT PERFORMED BY; ~-~_ ~ .~ I I- ~ CERTIFY THAT THla TEST WA~ pERFORMED IN ACCOROANCE INITH ALL ~eTATE AND MUNICIPAL OUIDELIN£S IN EFFEGT ON THIS DATE. DATE: 72~ (R~. 4/~) Municipality of Anchorage Page / of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage. Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~Q~OI~ PIDNumber: Name: F//~ ~_.. ~,~ ¢.,~ ~/ir.~ ~?...T ~_~) ...~ ~ ~ ~ Wastewater System: ~New ~Upgrade Address: l~5~ C~S~~ ABSORPTION FIELD Phone: No. of Beams: ~ Deep Trench ~hallow Trench ~ Bed ~ Mound ~ Other LEGAL DESCRIPTION sci, ,a~in,: ~~,O/Sq. ,~. ~o~,, Oep~h ~rom o~i,i.a,~ ~,.d~:. Subdiv~ion: Depth to pipe bottom frgm ori~i~l grade: Gravel depth beneath pipe Lot: ~ Block: ~NoTH,~dBblVi~o~ /'- ~ Ft. O.~ Ft. Township: I Range: Section: Fill added above origin.ride: Gravel length: I Ft. ~O Ft. Number of lines: Distance between lines: WELL: C New ~ Upgrade Gravel width: ~ Ft. I .... Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Ft. Ft. / ~0 SQ. Ft. F Driller: Date Drilled: Static Water Level: Installer: Date installed: Yield: GPMIm Pump Set at: Ft.I~ Casing Height Above Ground: Ft. TANK SEPARATION DISTANCES u Septic ~ Holding ~S.T.E.P. From Tank Field Station Tank Sewer Lines~ ~ ~ Well' //~' '¢ ~01+ j~om+ Material: 5 ~( NumberofCo~ments: Surface Water '--'~IoNj ~ LIFT STATION LineL°t ~ I 7¢ s,z~ in ¢'o.~: I ~"u'~otur~r:/~  "Pump off" level at: ~ High water alarm at: Foundation ~ ~ ~ ~ f "Pump on"~lllevel at: Curtain Pump~ake & Modpl .lElectrical Inspect~on~ peEfor~e¢ by: Drain ~ ~O~ ~J~ Remarks: BENCH MARK ~.~ Location and Descriptio~ ~ ~ ~ ~ssumod filovation: Dates:2 Inspections performed by: Department of Hea Hu ices re Reviewed and approved ~ ~ Date:. , 72-013 (Rev. 9/91) MOA 25 T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 Subject: Septic System Upgrade Application Lot 3, Another Subdivision PID 020-093-32 June 5, 1996 Gentlemen; The septic system serving this property has failed. The reasons for the failure have been found to be severe groundwater infiltration into the 500 gal lift station, possible infiltration into the septic tank, and absorption trench installation into soil that is more or less impermeable. 1. The lifistation and the septic tank was pumped on May 23, 1996. Water was seen entering the lift sation at that time. The next day 18 inches of water was measured in the lift station and the pump was pumping. On May 28, the septic tank was found full and discharging into the lift station. Only two persons occupies the house, and I f'md it unlikely that the normal use of water from two persons will fill a 1250 gal tank in 5 days. 2. A testhole dug on May 28, adjacent to the failing trench showed three feet of overburden over 3 feet of brown gravelly sand. A tight silt was observed under the sand. A pemolation test 12 inches into the silt showed a percolation rate of 6 inches in 15 hours. 3. The existing absorption trench consists of 5 feet of sewer rock with 4 feet of cover. If this is correct, three feet, or more, of the trench is in the impermeable silt. 4. The brown sand has a percolation rate faster than I minute per inch. A ISF is the only system presently available that can be installed on this lot. By placing a 1-foot sandlayer on top of the in situ sand, a 4-foot separation to the silt can be obtained. Please review the design and issue a permit for installation. T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Mr. Robert Robinson Municipality of Anchorage Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 Subject: "Pink Sheet" Lot 3 Another Subdivision" September 17, 1996 Gentlemen; Re your comments your Pink Sheet dated September 3, 1996. 1. The sandfilter was constructed as shown on the attached sheet 4/4. This sheet shows both a plan view and a profile view of the installation. 2. See above. 3. The PVC pipes are used as markers, identifying the comers of the filter. 4. The 6" capped standpipe is the first of 7 "flowerpots" or cleanouts. 5. Spacing is shown on sheet 4/4. 6. Air compressor is identified and note added showing airline to be insulated. 7. No discrepancy. There is 6 inches of rock under the perforated pipe and 2 inches of rock over the pipe for a total of 12 inches of rock. Design of drainfield is based on 6 inches of rock under the pipe. 8. Pump on/off and alarm settings are shown. 9. HAA checklist is enclosed. YoursTkla ,~ T. ipur T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 James P. Williams Municipality of Anchorage Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 Subject: SW960126 Lot 3 Another Subdivision PID 02009332 As Built Submittal August 2, 1996 Gentlemen; This system was installed during the week of July 11, 1996. Your office was notified of the construction and given due notice of required inspections per permit. The system was installed in accordance with the permit. Filtersand used was as approved, Central Paving Winter Road Sand. Load tickets are attached. The electrical installation was inspected by a Municipal Inspector. Inspection report is attached. Due to gravity flow considerations the location of the drainfield was changed from the permitted plans. You were notified about this change and approved it. You were also notified that a three foot encroachment of the lot line separation was probable. You instructed me to apply for a waiver after the fact. A waiver application is also attached. Yours ~ ~EN SPURKLAND · ~~ ............. ~LW WING AE 28.4 I ~ AB 14.5 FF ~ BC 68.5 ~ AD 42.5  ~ BE J2.5  ............. CF 74 J ' ~ J ~1]~ ~ /~ ~1 ~ INSTALLED ~50Q GA,,.STEP · ~ ~[~' / WITH 6' RISER ' I TOBBEN S'PURKLAND P.E. LDT 3, AN~THEP ~E3?[VZ?/~ SEPTIC SYSTEM AS BUILT 205 W 15TH. AVENUE Jd50J CHAZE~D~ LANE DATE: ~U~, ANCH. AK. 99501 JANE~ FA¢fl3VD¢TH SHEET: 2~ GRID: 333d ~907/ 279-5916 J0 D£AINFIELD 5 FT WIDE 30 FT LONG 3 FT TOTAL DEPTH i FT OF SAND IFT OF ROCK 3 FT OF COVER 1500 GAL STEP TANK I© IE 99.! YLATION 0 ~ o,~ o,~ O,_,Or 12" Sower Rock 4" Distribution Pipe Mirofi 140 50.00 Scruple Access. 8-Inch Sump NO SCALE I02i o o o~o~,o 4 DENSE SILT 5.00 ft ~ 106± 1cH, ~ IE 100. 1 "~ IE 99.8 IE 99.1 98,6 .. 1500 Sol STEP TOBBEN SPURKLAND P.E. 203 Wl5lh Ave Anchorm Ak 9950! LOT 3 ANOTHER SUBDIVISION JAMES FRANSWORTH i650! SHASEWOOD SEPTIC SYSTEM AS BUILT DATE: AUG. I, ~ 996 SHEET: GRID; $336 Air L/ne ~o Drenco Aircompressor, InsuloSed % ~4, erol lank . ING WELL El Illli~lllllllxlllXilH"'4.111i"t-IIIIH'lllIIIIl'lll~'lllllll/llllIlllll ~ -~/// Cleon Bu~ Access COl?ND? MA~KE~ TYP, Prom STEP SAMPLING =~-- 30 M~! PVC L,ner X'x ~' Insulation oil ~;des, $op and bottom TOP VIE~ ,5' Lv' ~0 Vet ~ ~/, v-ZZZZTY]ZT~vf7///////////////., ....... ~ PEA 5~A VEL ~o¥o¥o¥o~¥o~o~o¥o~o~o~o~o¥o~o~o¥o~o~o~o~o~o~o¥o~o-~1 PEA 6P, A VEL SIDE VIE~ So vd ~n ~purkland TOBBEN SPURKLAND P.E. 203 W 15TH. AVENUE ANCH. AK. 99501 (907') 279-.'3916 LI 18z20 SAND FILTER LOT $ ANOrME£ SUBDIVISION dAWES F£ANSWORrH J J SEPTIC SYSTEM AS BUILT DATE: SEPT. 15, 1996 SHEET: 4/4 GRID: 3336 Rick Mystrom, Mayor Mumcipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 September 24, 1996 Tobben Spurkland, P.E. 203 West 15th Avenue #203 Anchorage, Alaska 99501 Subject: Waiver Request for Lot 3 Another Subdivision Waiver Request #WR960039, PID #020-093-32, HA960263, SW960126 Dear Mr. Spurkland: Your request for a waiver of the required l0 foot separation between an on-site wastewater disposal system and a lot line has been approved. The waived distance is 3 feet from the absorption area to the south property line. This approval applies to the existing septic system lot line separation only. Any future upgrade to the on-site wastewater disposal system will require all separations be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our offme at 343-4744. Robert W. Robinson Civil Engineer On-site Services RWR/ljm:Farnsworth MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Wa%v.er Review Wgrksheet WR9%,%~In~;~ PID# 020-093-32 Date Received: August 7, 1996 Legal Description: Lot 3 Another Subdivision Engineer: Applicant: HA~ ~Permit #SW960126 Tobben SPUrk!an..d, P.E. 203 West i5th Avenue, Anchorage, Alaska 99501 Lot line waiver of 3 feet from absoptton trench to ~.~ourth property line Waiver Requested: Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: Special Conditions: 3. Other: Waiver is Granted: ~ Waive~ NO~ ~ra~ed: List Conditions or ~easons for above: ~-' Date: Rec #: CgQ~,LVo I I,O.-h,~ Amount Date Paid: T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 James P. Williams Municipality of Anchorage Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 August 2, 1996 Subject: SW960126 Lot 3 Another Subdivision PID 02009332 Lot Line Waiver Gentlemen; We are applying for a 3 foot lot line waiver for this property. Hydraulic considerations forced this location. The Health Department was notified prior to installation and approved of the encroachment. Yours T.~spur~land p.E. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 PAGE 1 OF ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW960126 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:FARNSWORTH JAMES W & DIANE K OWNER ADDRESS:16501 CHASEWOOD LN ANCHORAGE, ALASKA 99516 DATE ISSUED: 6/18/96 EXPIRATION DATE: 6/18/97 PARCEL ID:02009332 LEGAL DESCRIPTION: ANOTHER LT 3 LOT SIZE: 50321 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS t5.55 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 PROVISIONS: 1. ) CONSTRUCT SYSTEM IN STRICT ACCORDANCE WITH THE ATTACHED INTERMITTENT SAND FILTER DESIGN, INSTALLATION & MAINTENANCE MANUAL (MOA-DHHS MANUAL). DATE' DATE: T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 Subject: Septic System Upgrade Application Lot 3, Another Subdivision PID 020-093-32 June 5, 1996 Gentlemen; The septic system serving this property has failed. The reasons for the failure have been found to be severe groundwater infiltration into the 500 gal lift station, possible infiltration into the septic tank, and absorption trench installation into soil that is more or less impermeable. 1. The lifistation and the septic tank was pumped on May 23, 1996. Water was seen entering the lift sation at that time. The next day 18 inches of water was measured in the lift station and the pump was pumping. On May 28, the septic tank was found full and discharging into the lift station. Only two persons occupies the house, and I find it unlikely that the normal use of water from two persons will fill a 1250 gal tank in 5 days. 2. A testhole dug on May 28, adjacent to the failing trench showed three feet of overburden over 3 feet of brown gravelly sand. A tight silt was observed under the sand. A percolation test 12 inches into the silt showed a percolation rate of/l/inches in 15 hours. 3. The existing absorption trench consists of 5 feet of sewer rock with 4 feet of cover. If this is correct, three feet, or more, of the trench is in the impermeable silt. 4. The brown sand has a percolation rate faster than I minute per inch. A ISF is the only system presently available that can be installed on this lot. By placing a 1-foot sandlayer on top of the in situ sand, a 4-foot separation to the silt can be obtained. Please review the design and issue a permit for installation. T. ToS?U EA 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 3 ANOTHER SUBDIVISION JAMES FRANSWORTH Impervious Layer at 6 feet Use ORENCO ISF Percolation Rate < 1 min/in = Use 4 gal per sq.ft/day No. of Bedrooms 4 Required Area : 4 x 150/4 = 150 sq.ft.. Use 5- Wide Trench 30 feet long Obtain separation to impervious layer by placing 12 inches of sand SYSTEM CONFIGURATION ORENCO INTERMITTENT SANDFILTER 5-WIDE TRENCH TOTAL LENGTH 30 FT TOTAL WIDTH 5 FT TOTAL DEPTH 3 FT SANDLAYER 1 FT ROCK DEPTH 1 FT COVER 3 FT SEPTIC TANK 1500 GAL STEP The installatiOn of this septic system will not prevent wells from be installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. I, I ~1 ' ~ · o ~ --., /~ ... x ~ UNSUE~IVIDEP ~ : 49~h ~ : 203 W, 15TH AVE 16501 CHA~E~OOD LANE ~ATE, JUNE ~ 1996 ANCH, AK 99501 JAH~S FABNSWDRTH SHEET:y/d GRLD, 3336 (907~ / / / X ~/SF Am ~5 O £5 50 Y5 SCALE; J' -- 55 FL TOBDEN SPURKLAND P.E. L~77- ~., 203 w 15TH, AVENUE ANCH. AK. 99501 I POKIER SUPPLY /NSTALL 1500 GAL.~TEP ]6557 CHASE~/DD]] LANE DATE: JUNE 5, 7996 JAMES FA£NS~/ZT~?H SHEET: 2/~ GRID: 3336 AlP Line X ~.~4. e~o I 0 From STEP Iont< i . 0 SAMPLIN~ WELL 0 l{~] Illl~llllllklll'~lll~lll]'%lllll~lllllll Cleon Dot Access  30 Mil PFC Liner ~' Insular/on o17 sides~ top and bottom TOP ,5' ~u~°~°~°~°~°~°~°~°~°~°~°~°~°~°~°~°~°~°~°~°~°~°~°~°~u u u u u u u u u u u u u u ~ u u u u u u u u ....................................... F/l~er So vd OOD'~O OD'GO OD'GO OD'GO OD'dO OD'~O OD'GO 0 o'G ~'d D'~ U'~ ,5' I n~nyr *.J ' L' '.t ' J.' 'J .......................... L". ................... I PEA 6~ VEL TOBBEN SPURKLAND P.E. 18x20 SAND FILTER SEPTIC SYSTEM DESIGN 203 W 15TH. AVEMUE ANCH. AK. 99501 LOT 5 ANOTHER SUBD/VISION DATE: JUNE 5, ~996 (9o71 279-3916 JAMES FRANSWORTH SHEET: 3/4 GRID: 3336 DRAINFIELD 5 FT WIDE 50 FT LONG 5 FT TOTAL DEPTH _F_F SAND .. ~ 5 FT OF COVER 1500 GAL STEP TANK 30.00 fl ) Sample Access. B-Inch Sump 0 5.00 f! I© q NO SCALE 12" SAND 1500 Ga/ STEP I BENCH MARK: BOTTOM S/DING ASSUMED ELEV. / 00. O0 FT TOBBEN SPURKLAND P.E. 203 Wl5/h Ave Anchora< Ak 99501 LOT 3 ANOTHER SUBDIVISION JAMES FRANSWORTH ~650! CHASEWOOD SEPTIC SYSTEM DESIGN DATE: JUNE 5, 1996 SHEEl? 4/'4 OR/D: 5556 PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEAL'TH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG m PERCOLATION TEST LEGAL DESCRIPT,ON: j~) T ~:~ m'~0'~'~:::~ ~ '~>~,~Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH;' p E Oeplh to Water After ~ ~/~/I~ ~:~ Monitoring? ~'7 Date: . SLOPE SITE PLAN C~eading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE ~.. ~"~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND i 7 f'r PERFORMED BY: ~ ~'~ I L,- ~ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. 72-008 (Rev. 4/851 CERTIFY THAT THIS TEST WAS PERFORMED IN DATE:  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 MAI L~G A D D R,E, SS ~ ~ Z Manufacturer Liq~~ gallons IF HOMEMADE: Inside length Width Liquid depth ~ No, of lines Lengtl~ of eac~lin~ ! Total len~ ~1 Tre~h~idth~z Distance between ~ ~ ~ Top of tile to finish grade ~ ~ ]~, Material beneath tile~ inches Total effect~absorpti~n area~.~ ~' ~en~th ~idth Deoth ~BMIT ~0. ~ ~ Tgpe of crib Crib Oiameter Crib depth Total effectNe aBsor~tion area m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TQ: Building foundation Sewer line Septic tank Absorption area(s) OTHER SOIL TEST RATING' APPROVED / DATE LEGAL 72-013 (Rev. 3/78) Box 1369, STAR I~OUTE A ANCHORAGE, ALASKA 99502 SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF Drilled AT THE rate of ~23ooo PeR FOOT. //~o /;~/c ?h..bLbL/:~ 243-79.9-3 PROPERTY OWNER /,05 ,', ~ .\ ~ 0 hUN CrPALITY OF ANCHORAG~ LOCATION Of WELL Site ~L.~ ~:,~&o $'~0o ~e2A~.F~V ~F~T o" ~,;.,.-~ :, ~ DRILLER WELL LOG: 0 ..... 22' I9,92 22 .... 49---405' caz,M.¢ wi:. 1.8 ¢,r_U¢o pc, t.?z-~ o,~:'. @~.~ I[o,'~ Su, b~e,~,LOJ, e. Pu~z.F .¢h.ouJ..d .be~ .~n~.&z,l_Z~d 20 .[.e~L o¢.i4 .bo,bLom., ,~';(?,o50. O0 MUNICIPALITY OF ANCHORAGE DFPT, Or 14EzLTH ,~, ENVli-:' -~i'4/,';;~1',4 ,A. 1'!~0 Er. [I ~ ~ COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. 6,0 V.?u. uu WRITE CHECK PAYAblE TO RAMPART DRILLING WORKS FOR ThE SUM OF THANK YOU VERY MUCH. DATE BERNIE CLAUS OF RAMPART DRILLING WORKS //Z~j. 15;dr, 1952 W~ ~E SERVICE CHARGE O F 1~/~% PER MONTH BE ASSESSED ACCOUNTS. DEPFIF.:TME},tT HERLTH FINE:: Ehi',/i F.".ONME}=ITFtl .... ?.("FFECTi E:2.5 "L. '" I:=:,TREET., FhNCHOF:'.I~GE., I1..,..~ E: L. ii. ...... ~'~., ~-..,~ E3:, C} ~'..,~ .... ',:~;; 3: 'T' E:E ',:~; E: R,,..t! ~E:L' ~R;'.' Il::~ EL=: 7~-=~:: lr,,'~ % 'T F! P F' l.... I C F:I 1,.,! T L..OCFI'T' ]: ON LEGI=!L HRF.:K F'H I L.l.... Z F'E; CFIF:IE;E:HO0[:, L. FINE L.]i: FtNOTHER '=-;LIE:D I ',.." I :i5 :[ Of',! SIZE ;.'2:42:- ';::' :!i;~ 2 54450 SE.'!UFIRE: F::EET 'T'dF'E OF:' :;E;O I L F!E,'SORPT I ON S¥STE]"t I E;: 'TRENCH MFthIIMUM 1,',iUM[:3EF': OF' BEDROOM::E; :: E:i SOil.... F,::FITING ,::S(:] FT,.."E~R)= :1.;2:5 THE RE ;:!_.. I RE[:, S t ZE: ELI=" TFIE SO I l... FIE:SORF'T I 0t'.,t S"r'::.5'I"EM E:> EE IF:" T' H == :::-'" L_ IEEE lf*,~ TH:E L..Z1,',IG"f'H f.)IMENS!Cff',I TS THE LENGTH (Ii",l F'EET) OF' THE TRENCH OR E:,RFII1,',!F'IE:LD.. THEE DEF'TH OF' fa TRENCH OF..' PIT I% '!-FtE [:'ISTRNC.:E BETMEEN THE :L:.:U'F.':FRE:E OF' ]"HE GROUND FIND THE E:Crl"TOH OF THE E',,qCFI',?RTION ':.'IN FEET). THERE I% NO SE'T i,,.II[:'TH FOR TRENCHES. THE GRFt'v'EL. DEPTH ]:.S THE HINIMUH DEF'TH OF' GF.'.R'v'EL. BETNEEt",I THE: OUTFFiL. L. PZF'E FII'.,IE:; THE E:CTTCM OF THE ....... r .. · . E ....I" ,P .ION ,']:I"I FEET':, F'E:RM ! 'T' I=ff:'F'L ! CFINT HFIS THE RESF'ONS 18 ! L I T"r' "FO INFORM TH I :!5 DEF'F'IRTMENT DUR I l",!(':i THE: I N:.E;TRl....LFIT I ON I NL=.:F'ECT I Ot",!2!; OF FIN"? HEL..LS FtE:'JRCENT 'TO TH I S PF. tOPE:RT'~" R!",I[:, THIE NLI!"IE:E:R OF RE:T, IDENCES THRT 'THE HELL HILL SEF:'v'E. ....................... "'ir.` ~..dt O ':: ;:--7: :::" :.]: r-,It S IF:" E C: "F :]:: E::, lf'--t LE; Ft F~: E: BFIC:KF: I L.L ! I''4(3 OF RN'¢ S':'STEM H Z THOUT F ! NflL I NE;F'EC-r.' I OI'.,I FIND F!PPRO'v'FIL L":,EPFtRTMENT f.:tILL. BE SUE',JEC:T TO PROSECUT.I:ON. MIN!MUH DISTRNCE DETHEE:1,.,I Ft P.!EL.L RND FIN'¢ ON-S;ITE SEHFIGE [:,I:..=.,F'OSRL S'.:.'S"FEH tS; ::l..(i!iO FEE"F FOR FI F'RI'v'FITE HELl .... OR ::LSEI 'T'O 200 FE:ET FF':OM F! PUBI....IC I.,.IEL. L. E:,E:F'ENE:,ING UPOi'.,t THE T'-?PE OF:' PUBLIC HELL.. MINiMUH DISTFINC:E F'ROH R F'RZ'v'RTE HELL. TO FI F'F.:t'v'FITE SE:HER LINE IS ;.:.?].~ FEET FINE:, 'TO R COt'4HU1,.,! I T'¢ :~;EI.,.!ER L. ! NE t E; '75 FE:ET. HELL. LOGS FIRE F..'EL=.!U ].' RED FIND MUST BE RETURNED TO THE DEPFIR'1"MENT HITH.f.N 30 OF THE HELL COMF'LETION. OTHER RE(;!UIREMEi'.,tT:.3 MFt'¢ F!PPL'¢. SPEC.T. FZCFITIONS FIND C01,.,tSTi:;~:UCTION DIFIC. iRFIM:5 .FI',/F~ I LF!BI....EE 'TO 11,.,!E;L~RE PROF'EF.: I N::-.',TFILLFIT I ON. I CERTIF".? THFIT :1.: I FIP1 FRMIL.!FIR H I'T'H THE RE(;:!UIREMENT::5 F=OR ON-E;ITE LE;EHER::5 FIN[::, H[ELLE; RIE.: SE:T FORTH Bh-' THE r,!t.. 1'.4 ! c z F:'FIL I T"r' OF FIl"l': FIE F.:FtGE. 2: I HILL INSTF:IL.L THE S"r'S'TE!'"! IN RCCORDRNCE I.,.IITH THE C:OF;,ES. ]i:: :[ i. JN[:,EF.:STFIN[:, 'T'HFI"f' THE ON-:SITE ::.=.;EHER $'¢:=STEt'! I"1F!¥ RE~.T.!UZRE ENLf:ff.=.':GEME!'.,IT IF THE RES I DEI'.~CE I E; R E I"! CE:, E; L. E: [:, 'TO 11,.,!CL.U[)E MORE "FHR1,.,I 5 E:EE:,ROOM:F.;, ~ // L-'::., 5 "0 January 4, 1982 S. Mark Phillips P.O. Box 4-1538 Anchorage, AK 99509 Permit ~ 810987 Subject: L3 ANOTttER S/D A permit issued by this department for a well and/or sewer system has expired as of December 31, 1981. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer inspected the installation of-the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please call this office at 264-4720. Sincerely, Sewer and Water Program Enclosure: Copy of Permit F'ERHIT NO, DEF:'R!;:TMEN.]" ;...,F' HEF::ILTH F'~NI.'> ENVIRONMENTF:It .... I-'"RO]"ECTION 8;.25 '" L." STREET., FINCHOF. IFIGE., RI<. 9S450:1.. 264-4720 il..-Jl E";E IL_ L. IF:il tf"'4 ( 8J. 0987 ]." R P P L I E: Fl N T L. OCFIT 10t",I LEGFIL S. MT:IRK PHILLIPS CHf:ISEHOC!E:, [..FIN[.:: LO]" 3 RNOTHER S,-"'D P. O. BOX 4-J..538 L.O]" SIZE 24!:-"7923 54450 SQURRE F:EET TYPE: OF SCII!_ RBSORPTtON SYSTEM IS: TRENCH MFI::.':IMLIM NUMBER OF' BE[:,ROOMS = 5 SOIL RRTING ,::SQ FT?BR)= 125 THE REQUIRE[) SIZE OF THE: SOIL RBSORPTION S'¢STEM IS: THE LENGTH DIMENSION IS THE L..ENGTH (IN FEET::, OF:' 'THE TRENCH OR DRFIINFIEL.[:,. 'THE DEPTH Of-"' R TF.'ENCH OR PIT IS THE E:,IS].'RNCE BETHEEN 'THE SURFF:ICE OF:' ']"FIE GROUND Rt'.,ID THE BO]"]"OM C)F ]''HE EHCFIVF1TION (IN FEET;:,. .]'HEI;.:E IS NO L::;ET HID].'H FOR TRENCHES. THE GRRVEL [:,EF'TH IS 'THE MINIMUM DEPTH OF GRR',,,'EL BETHEEN THE OU]''FRLL PtI::'E RND 'THE BOT].'OM OF' "['HE E×CR',/R]"ION ,::IN FEET). F'ERMIT RF'F'LICFINT HRS THE RESPONSIBILITY 'TO INFORM THIS DEPRRTMENT DURIt'.,tG THE: IN'.S]"RLL. R]"ION INSPECTIONL. S OF RN"r' HELL. S FIDJRCEt",IT TO ]"HIS F'ROPERTY FIND THE: NUMBER OF RESIDENCES ]"HRT 'THE HELL HILL SERVE. .................. 1- Il. MI C~ BF. IC:KF'ILLING OF RN"r' S'¢STEM 1.4I THOLIT FINRL INSF'ECTION FIND FIPF'RO'v'FIL BY THIS DEF::'FIRTMEr.4T HILL BE SUS.!ECT TO PROSECU'rION. MINIML~M [>ISTRNCE BE]"WEEN Ft 1.4ELL. RND RNY OI'.,I-SI].'E SEt.,.IRGE DISF'OSF:H .... SYSTEM IS ::LClO FEE"[' FOR R PR IVF. ITE HELL OR :1.50 TO 200 FEET FRO!',I R PLfBLIC HELL DE:PEt'.,IDINC~i UPON "rile TYPE OF' F'LIBLIC NELL. M!N!MLff,1 DISTFINC:E FF.:OM R PRI'v'RTE HE:L.L TO R F'RI'v'FfTE: SEt.,.tER LINE IS 25 FEE]" FIN[:, TO R COMMUNITY F;EHER LINE IS 75 FEET. HELl.. LOCiS RRE REQUIRED RND MUS]" BE RETURNED TO 'THE DEF'FIRTMENT HITHIN i:0 DRYS OF THE HELL COMPt..ETION. CrT'HER F.:EQLIIREMENTS MR"r' FIPPLY. SPEC:IFICFITIONS FIND CONSTRUCTION [:,!FIGF::F:IMS F:tRE RVRILRBL..E TO INSURE PROPER II",IS]"RLLRTION. I CERTIFY 'T'HRT :t..: I F:IM Ff:IMIL. IRF.: 1.4ITH THE REQUIREMENTS F'OR ON-SI].'E SEHE:R'::; RNI:::' kIEL. L::2; RE; SET FOR]"H B"r' ']'HE MUNICIPR[-ITY OF RNCHORRGE. 2: I HILl. INSTRLL ]"HE SYSTEM IN FIC:CORDRNCE HITH THE CODES. i:: I UNDE'"RSTFIN[." ]"HFIT ']''HE ON-SITE SEt.4ER SYSTEM MFIY REQUIRE ENLFIF.:QEMENT IF TFIE RES];I[:,ENCE IS REMODELED TO INC:LUDE MORE: THFtN 5 BEDROOMS. V4:0 ALASKA e[1UIRO[lmenTAL COIqTROL SeRUICeS, InC. I~nclineefinc1 8 (~nuironmental SludJes *SR=Soils Rating 18 19 2O 5R~85 (Square Fool: pep bedroom) 18 19 SR x. 8 5 1.01 TII 2 ~"~' ~+ u ,'r"'l ~ 1" .... ~:i MI. /'~ '-/ I I. ~',.~ ';' t8- 2O ' 5R'85 Sheet:. 1 of' 2 1220 ~est 25th /~uenue */~nchoracle, J~laska 99503 · (907) 276-1361 ALASKA e[1UIRO[lme[1TAL CO[1TROL SeRUICe$, I[1C. [~nqineerinq 8 {~nuironmental Studies LOI I H 1 2 3 5 6 5 J -; q:- 27: '- V S W qC ~:~ iF[[ L 0 AM 4 .~.. ~ ..1:_..:.2 1G 17- lg 20 SI:t -× 8 L) /5 rl 6 17 SR'×'8 LOAM Shee~: 2 of 2 1220 LUcs! 25th Auenu¢ * Anchora(je, Alaska 99503 e, (907) 276-1361 ..SR-X-85 ALASKA eilUIROIlrneI1TAL CONTROL SeRUICeS, I[1C. ~nqJneeNnq I~ ~nui~onmental Studies November 18, 1980 Mr. Kirk McGee Scenic Drive Eagle River, Alaska Dear Mr. McGee: Attached are the soils logs for the 8 lots in Another Subdivision. We drilled a total of 22 holes in the lots and road bed. The soils logs presented are for those areas best suited for on-site disposal sysems, and they should be reserved as such. This is not to preclude placement of system on other parts of the lot if additional soils tests are made. There are no slopes within the areas designated for on-site systems that are in excess of 25 percent, nor are there any cut banks that would cause sewage to flow to the surface in th~se area~. This subdivision appears to be well-drained except fo~ the swale between the 274 and 278 ft. contours on the back parts of lots 1, 2 and 3. Drainage from this area is evident by the subsurface flow of water at the general location of the lot lines between lots 1 and 2 and the intersection of the pipeline. My advice 'is that before lot 2 is fully developed, a curtain drain be installed using the new types of synthetic cloth to prevent the intrusion of soil into the drain rock. All lots except number 2 are suited for conventional septic tank trench on-site system. Because of the shallowness of the silt layer on lot 2 this area would appear to be a candidate for high water table during heavy rains or high periods of run off. The prescribed design for this lot would be a septic tank feeding into a lift station and then the effluent going into an elevated field. The field would be built by stripping the topsoil down to the three ft. layer (the top of the GP) and installing three feet of sand and then diking around the system with impervious soil, installing one foot of gravel and then back-filling with three feet of sandy soil in order to encourage envapotransporation and to prevent freezing of the system. Within the gravel layer would be imbedded the pressure distribution pipe for the system. This system has been used satisfactor- ily in other locations within the Anchorage bowl. Although the system is several feet above the ground, proper terracing and landscaping could turn this into a nice yard or garden area. 1220 LUest 25tJ~ J~uenue · Anchora§e, Alaska 99503 · [907) 276-1361 Mr. Kirk McGee Page Two It must be understood, of course, that the installation of the curtain drains may make this area acceptable for conventional on-site systems. If you have any questions, please let us know. Thank you. Sincerely, ALASKA ENVIRONMENTAL CONTROL SERVICE, INC. President �£ s ® Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 5 F E T Y Certificate of On -Site Systems Approval Parcel I. D. 020-093-32 Expiration Date: ' 1. GENERAL INFORMATION: Complete legal description -ANOTHER: LOT 3 Location (site address) 16501 Chasewood Lane *Anchorage Current Property owner(s) Lily Lou Day phone 632-4378 Mailing address Real Estate Agent 2. TYPE OF DWELLING: © Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class_Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Waiver Fee $ Date of Payment �_%- 21 Date of Payment Receipt Number (2 2-01 C Receipt Number COSA # OSC211005 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 _ I q Engineer's Printed Name: Jeffrey A. Garness Date: I / .Z j In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the systemis; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6.IGNATURE System #1 Approved for 14 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: By Original Certificate Date: — 2 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Other a j J tC t0 r`/ 411 COSA Checklist Legal Description: ANOTHER; LOT 3 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA OR Well log is filed with Onsite (or attached) Date drilled 5/15/82 Total depth 405 ft Cased to 405(?) ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 12/14120 Static water level at beginning of test 92.2 ft. Comments 911c` B. TANK DATA Age of tank(s) 24 years Tank type/material sTEP�EEL_ Measured operating fluid level in septic tank *45,: ❑ Standpipes/foundation cleanout per record drawing Date of pumping 'IN ST1 • SEE ATTACHED MAINTENANCE REPORT D. ABSORPTION FIELD DATA SHALLOW TRENCH Which system tested (date installed) 7/15/98 ❑ ALL standpipes present per record drawing Total measured depth from grade 4.75 ft (max) Measured depth to pipe invert from grade *2.91 ft (min) Parcel ID: 020-093-32 Structure served by this system 1 Well production at time of test 5.6+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ NO ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 12/14120 C. LIFT STATION ❑ Required maintenance completed Age of lift station 24 years Lift station material STEEL Comments: ADVANTEX -44,q BITUMINOUS COATED STEEL TANK Adequacy test date 12/14/20 Results Q Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 761 gal ❑ N/A — pressurized field New depth I in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 5 min depth into effective 4' Final fluid depth 0 in ❑ Code -required soil cover over field 600+ Absorption rate gpd ❑ System presoaked (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) * If es, enter date N/A Gallons introduced *389 gallons y Comments/Deficiencies: 'INSULATED '"PRE-SOAKED IMMEDIATELY PRIOR TO SEPTIC TEST ON 12/14/20 COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) R Yes Septic Tank/Lift Station on Lot > 100'Community E]Yes if No **50.+ ft— Sewer Manhole/Cleanout > 100' Q Yes if No ft Neighboring Tank > 100' F/I Yes if No ft Private Sewer/Septic Line > 25'[]✓ Yes if No ft Absorption Field on Lot? 100' R Yes if No **50+ ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' [✓I Yes if No ft Animal Containment > 50' F1 Yes — if No ft Community Sewer Main > 75' M Yes — if No ft Manure/Animal Excreta Storage > 100' [D Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' R Yes if No *5'+ ft Surface Water> 100' El Yes if No **50+ ft Property Line > 5' [✓I Yes if No ft Wells on Adjacent Lots: Yes Absorption Field > 5' P1 Yes if No ft Private Wells > 100' R Yes if No **50'+ ft Water Main > 10' 121 Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No ***3 ft Wells on Adjacent Lots: Water Main > 10'✓R Yes if No ft Private Wells > 100' ❑ Yes if No ft Water Service Line > 10' Yes if Na ft Community Wells > 200' Yes if No ft Surface Water > 100' ❑ Yes if No **54+ ft F. ENGINEER'S COMMENTS *MET CODE AT TIME OF INSTALL **ONLY 50' REQUIRED ***WR#960039 G. ENGINEER'S CERTIFICATION o"DF q I certify that l have determined through tied inspections and review of Municipal records that the above systems are in conformance with p� i MOA COSA guidelines in effect on this date. ao frey A. Garness —79r53 •' v COSA Checklist yellow sheet Qepro ress000 #AECC88d00,;Z:� Septic 'Tank Advisory Certificate of On -Site Systems Approval # OSC211005 Subdivision: Another, Lot: 3 The septic tank for this property is 24 years old. The average life for a steel septic tank is 20 years. Typical replacement costs range from $9,000 to $12,000. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. Madmg Address P O Box 196650 *Anchorage,Alask" `99519'7_6656, *www muni org f-1VU3L UGI /AIL Scale: 1 " = 40' v T2s CO* ryhQ�OJ D FCS o 1.2'x2.3' _ CANT ' I1' 10' UTILITY EASEMENT .4'x2.0' CANT 20' C.E.R. EASEMENT (DOC. No. 301-1982-034238-0)�� � f®I I 4.3'x11.1' DECK Lot 2 O � / SAUNA Lof 3 \ 50,321 S.F O PP•CS�C`„ WELL—,ti0D I Z LO b' o ... • 22� 1 A• G Lot 4 Cn PIPES ENT POD PIPE i OLES f Tract A SEPTIC PIPES I I ( I 1 1 i NOTE: DUE TO SNOW & ICE COVER, THE LOCATION OF THE ASPHALT DRIVEWAY IS APPROXIMATE. 1 PLOT PLAN _ _ A5 BUILT X— SCALE _1_ = 60__ GRID _ SW_ 3336 Project No 20-7811R1 Associates, � m 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 ��jr� Lang C.��. S S Q G I a t e S, I n C® (907) 522-6476 Phone o�o�Opp (907) 522-4625 Fax N%� Professional Land Surveyors ken®langsurvey.com o OF 4 4 jonathanOlangsurvey. com S QO I hereby certify that 1 have surveyed the following described property: LOT 3, ANOTHER SUBDIVISION (PLAT No. 81-279)o .� 49TH •.}'* p Anchorage Recording District, Alaska, and that the Improvements situated thereon are"""""""""" """"""� within the property lines and do not encroach onto the property adjacent thereto, that Q no improvements on the property lying adjacent thereto encroach on the surveyed Q premises and that there are no roadways, transmission lines or other visible Q ��, KENN li G. easements on sold property except as indicated hereon. {� a S— 202..' J Dated this the _ �� r_t _ Day of i~%u�� tiufU L 'ism of Anchorage, Alaska F A • • • • . • • pc� 4v�ROFESSi0NA4 tpQ It is the responsibility of the owner to determine the existence of any easements, 04ppq�a`� covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 0811112020 15;19 Anchorage Tank (FW07 277 3715 P.0011001 Pio/any Owr7e nciCtnp B ..•....••._...�• _..• •••f4Yy Currt:nt citimtor Riser/Ud ..................... Kraig Haver 2nd Compartment Larry Betts .� giro adan7e P Conl�t Pirone 16501 Chasewood, Anchorage AK 99516 Flfntt........................ 907222-3273 AX Mite ID $ County ID i pod X FTN 41UL # Datelaw, Inematton AX -100094 SW020134 1200157 RTU141241 08/1412019 Retrieve O&M lnb Dxay flow R"Im ratio— Ylrmar 4aninp3. Perform Field SamptinglObservations NTU O 5.t: NTUs) pN 0.9) pQ (2-8) "Y Odor -- Odor of Sample Typical L�l Musty C 9arthy Q M0Idly Nori-typlonl 0Sulfide Crnbbeae ❑Decoy oily firm in frau OYaa ZNc Foam fit tank ❑ Yon No Check Control Panel RocimAmpa MchargeAmpa Cl. % /Ql9 Auctihle anct visual alarms ,30K Dial tnnR (talern ttry Only) ZYotr ❑ ho Inspect/Clean Pump System Comments Measure Shad9ofSeum Sludgy scum tut Compartment~ Currt:nt PYBviou9 Riser/Ud ..................... J 2nd Compartment Splice eox.................... .� Current Float Cords ................... Bridolno/Ponding: None/Minor ❑ E.xceaslve Flfntt........................ w 9 (tem Number iDesoe4flGon Pump........................ Blotubok Filter ................. 7 Inspect Biotube pump Yaurt ........... I'Ci Inapoct Rodrowating Splitter value ....... 16 �] Comments Measure Shad9ofSeum Sludgy scum tut Compartment~ Currt:nt PYBviou9 Current PMV16UD 2nd Compartment Current Prowoua Current Ptaviou9 lnspertlClean AdvenTax Filter Inspect Clean Inspett dear; Inspect Clean odor. Normal 0 Pungent LetoMM)rMoos elomat: Nomial Q Excessive Pod eattcm El ReplacedMaed other Items? Bridolno/Ponding: None/Minor ❑ E.xceaslve Intake Vent w 9 (tem Number iDesoe4flGon Inspect/Clean Discharge Pump System Inspect Inapoct Clean Rlsar/Lld A ROpty I� 'PR3vreinmtalled Splice Box pump 9E vonteol panel r&aciivAt;Rd Su FNat Cords i D System pertomtmg; tto further action nooded C 1hnk ncedo pumping 0 cols forsorvico (nspacttServioe Other System Components Inspect Clean Inspett dear; Disinfootiort Equfpmant!� P� Dispersal Laterals/q�llce 4brtxvatlerta�,.,,, Additional Service$ ReNderad.....��.....W ❑ Cleaned textile shoots? C Replaced W items t El ReplacedMaed other Items? Parts Used: W . Warranty, 8 = Bitiabla (V appropriate seloption) w 9 (tem Number iDesoe4flGon Final/Safety inspection 'PR3vreinmtalled ( fids golteci cn F� MFnifofa roconnortsa; flush valvas closed 1mmgryll�ecomrrtandsttnrls 9E vonteol panel r&aciivAt;Rd Su D System pertomtmg; tto further action nooded C 1hnk ncedo pumping 0 cols forsorvico C others bats Pax completed form to '4rF3GS.894.7404 -11UNICIPALITY OF ANCHORAGE THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this )t' Day of �of 20 'M , by and between JIWS '�P - herein the "OWNER." and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC:) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described asx located at (legal description) ;+)L. -i �d L' CAWVT kM U1 3 j 2. 1VIaintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) 4� Throughout the term of this Agreement; the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performingas designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. ( It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), .replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that reClular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 (ice Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. `� Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030, .l-\, �� Owner agrees to grant the Municipality reasonable access to test and inspect the AWwTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions; nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipalint thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction; Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement., 7. Severa it tv. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05118/20 1 8) Pape 2 of 3 OWNER: By: (signature) Date: (print name) STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT ) The for -)oat, My Commission expires: me this It day of STATE OF' AL S KA NOTARY PUBLIC Rhiannon A -Stoke =° ° My Commission Expires: MUNICIPALITY: i By: ., (signature) Date: (print name) Title: (rev. 05/18/2018) Page 3 of 3 Parcel I.D. 1. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Brogaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorag e.ak.us (907) 343-7904 020-093-32 GENERALINFORMATION CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Expiration Date: ,,/ Completelegaldescdption LOT 3; ANOTHER SUBDIVISION Location (site address or directions) 16501 CHASEWOOD LANE * ANCHORAGE, AK Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address MARK AND DONNA GARBUTT Dayphone 346-2307 16501 CHASEWOOD LANE * ANCHORAGE, AK 99516 Day phone LISA HERINGTON w/ DYNAMIC PROPERTIES Day phone 5111C STREET * ANCHORAGE. AK 99503 646-0525 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well [] Individual On-site [] Individual Water Storage [] Individual Holding tank [] Community Class Well [] Community On-site [] Public Water System [] 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 samples. (Certificates may be reissued for a pedod 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 o As certified by my seal affixed hereto and as of the validation date shown below, I vedfy 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 vedfy 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 Finn ALASKA WATER &: WASTE'WATER CONSULTANTS. INC. Phone Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS. P.E. Date 357-6179 Engineer's Comments: In conducting this evaluation, AKWWC. Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DaD Guidelines & Regulations. The reported results described the perfon'nance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions ara outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKWWC, Inc. can therefore not provide any warranty or future eatiroate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. DSD SIGNATURE IL. Approved for ~ bedrooms. Disapproved. Conditional approval for __ va co, ,/_ ;7",;,,,, / Attachments: HAA Checklist Septic System Advisory Well Flow Advisory By:~/~J [Ct, bedrooms, with the fllowing stipulations: .. . Maintenance Agreements Supplemental Engineefs Reo~ ~ ~ '.. .'" ~'~ .... ... Other Original Cer[ificate Oate: ~-/' ~ '(~ ~- Municipality of Anchorage Development Services Department 8u~lg Safety OmS~ Water & Wastmvater Program 4700 Sauth 8ragaw St. PoO. Box 1~0 Anchora~. AK (gO'/) Legal Description: A. WELL DATA Co Well type HRwA1£ Date completed 5/15/1982 Sanitary seal (Y/N) YES HEALTH AUTHORITY APPROVAL CHECKLIST LOT 3; ANOTHER SUBDIVISION Parcel ID: 020-093-32 · INCORRECTLY NOTED AS 0.42 GIdP ON 6/27/02 HAA If A, B, or C provide FqNSlD~ N/A Well Log (Y/N) YES Wires property protected (Y/N) YES Total depth 405 ft, Cased to 405 ft. FROM WELL LOG Date of test 5/15/1982 Static water level 75 fl. Well production 1.0 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. Arsenic: N/A mgJL. SEPTIC/HOLDING TANK DATA Casing height (above ground) AT INSPECTION 5/14/2002 159 .ft. *5.3+ ,g.p.m. 18+ in. Nitrate 0.20 mg.lL. Other bacteria 0 colonies/100 mi. Date of ~ample: 4/14/2002 Collectadby:. AKWWC, INC. Tank Type/Material Tank size 1500 gal. Foundation cleanout ~t'~. ~.~.$ Date of pumping ABSORPTION FIELD DATA Date installed 7/15/~996 Length 30 .ft. S.T.E.P./STEEL Number of Compartments 2 Depression over tank (Y/N) NO Pumper. Date installed 7/15/1996 Cleanouta (Y/N) YES High water alarm (Y/N) YES leRELOW FINAL C.,RADEI NOTE: A NEW ~DV~tTEX POD WAS INSTALLED O~R THE EXISTING S.T.tr.p. ON THE 6/26/2002. Soil rating ~r ft~clrm) 4.0 System type. 5-WIDE Width 5.0 ft. Gravel below pipe 0.5 ft. Total depth .3.a~ ft. Eft. absorption area 150 ff~ Monitoring tuba YES Date of adequacy test 5/14/2002 Results (Pass/Fail) PASS Fluid depth in absorption field before test 0 in. Water added 760 gal. Elapsed Time: C) min. Final fluid depth 0 in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & ty1~) NONE KNOWN Depression over field NO For 4 bedrooms Now depth 0 in. 600+ g.p.d. If yes, give date - D. LIFT STATION Date installed 7/15/1996 "Pump on" level at TIMERin. Datum BOTTOM OF TANK E. SEPARATION OISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Size in gallons 1500 Manhole/Access (Y/N) YES "Pump off' level at TIMERIn. High water alarm level at 45 in. Cycles tasted NEW CONTROLS Meets alarm & circuit requirements?. YES 100'+ Septic tank/lift station on lot Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/deanout Holding tank N/A N/^ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water service line l 0'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *3% Building foundation 10'+ Water service line 10'+ Sudace water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ COMMENTS · SEE WAIVER~ WR960039 Absorption field Surface water 5'+ 100% Water main N/A Driveway, part(lng/vehicle storage 10'+ G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and rev/aw of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Prin~ed llama Date JEFFREY A. GARNESS HAA Fee $ Date of Payment Receipt Number (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw SL ~ ,.~....'_ P.O. Box 196650 Anchorage, AK 99519-6650 ~. www.ci.anchorage.ak.us (907) 343-7904 RUSH Parcel I.D. 020-093-32 1. GENERAL INFORMATION CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HA~ /--/~ 0~0~ Expiration Date: C~ Complete legal description LOT 3; ANOTHER SUBDMSION Location (site address or direcfions) 16501 CHASE'WOOD LANE * ANCHORAGE, AK Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address MARK AND DONNA CARBUTr Dayphone 346-2307 16501CHASIDNOOD LANE * ANCHORAGE~ AK 99516 Day phone USA HFRINGTON w/ D'flqAMIC PROPERTIES Day phone 3111 C STREET * ANCHORAGE, AK 99503 646-0525 Unlessotherwisemquested, HAAw~behe~byDSD ~rpickup. 2. NUMBER OFBEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: 1 Individual On-site Individual Holding tank [] Community On-site , [] Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C weII and may be reissued with new water samples. (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. Nole: Alaska Water and Wastewater Consultants, Inc. aha# be paid $/5~-/.5 at, or pnor to closing forths engineetfng services previded. 4. STATEMENT OF INSPECTION BY ENGINEER ?~s.c?~fied.)~y my seal affixed hereto and as of the validation date shown be/ow, I verify that my ~,.~nvestJgation based on procedures outlined in the Health Authonty Approval Guidelines for this application, ~hows that the on-site water supply and/or wastewater disposal syslem is(are) safe, functional and adequate for the number of bedreoms and type of sttucture indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage r~las 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC. Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504- Engineer's Printed Name JEF~t<EY A. CARNESS, P.E. Phone 337-6179 Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidetines& Regulations. The reported results desctfbed the perfocmance of the system under the conditions encountered st the time of the test, and separation distances measured to readily identifiable features. The operational life of ali wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate durfng the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfaolo~ test results do not guarantee future pedormonce of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any war~nty or future estimate of how long the system witi continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorfzed, nor will it confer any legal dght whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for 4 bedrooms, with the f]lowing stipulations: At the time . ~title transfer the new property owner shall sign the :attabh6d Maintenance Agreement which shall be returned to this office before a unconditional approval is issued. Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South 8mgaw St. P.O, Sox 196650 Anchorage. AK 99519-6650 www.cLanchorage.stcu~ (907) 343-79O4 Legal Description: A. WELL DATA CE HEALTH AUTHORITY ,~.PPROVAL CHECKLIST LOT 3i ANOTHER SUBDMSION Parcel ID: Date of mst Static water level Well production WATER SAMPLE RESULTS: Well e/pa emvA~ ff A, B, or C provide PWSID~ N/A Date completed 5/15/1982 Sanlteryaeal (Y/N) ~ T~de~ ~5 ~. ~d~ ~5 ff. FROM WE~ L~ 75 1.0 g.p.m. 020-093-32 Well Log (Y/N) YES Wires pmpariy protected (Y/N) YES Casing height (above ground) 18+ in. AT INSPECTION 5/14/2002 159 ft. 0.42 g.p.m. Coliform 0 coionios/100 mi. Arsenic: N/A m0Jl.. SEPTIC/HOLDING TANK DATA Tank Typa/Matedal S.T.E.P./STEEL Tank size 11500 gal. Number of Compartments 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date of pumping 2/6/2002 Pumper ABSORPTION FIELD DATA Date Installed 7/15/19g~ Lenglh 30 fl. Totaldepth ,1.83 ft. Eff. absorpUonarea 150 ff~ Monltorlngtube YES Date of adequacy test 5/14/2002 Results (Pass/Fall) PASS Fluid depth in absorption field before test 0 in. Water added 760 gal. Elapsed Time: 0 min. Final fluid depth 0 in. Any rejuvenation Irea~ent (past 12 mo.) (Y/N & type) Nllrate 0.20 mg./L. Other bacteda 0 colonies/100 mL Date of sampio: 4/14/2002 Collected by: AKWWCI INC. THIS IS AN NOW AN ADVANTEX Date installed 7/15/1996 Cleanouts (Y/N) YES High water alarm (Y/N) YES ,A+ SERVICES Soil raUng {~or ft~bdrm) 4.0 System type 5-WIDE Width 5.0 ft. Gravel below pipe 0.5 fi. Newdepth Abso~Uon mte>B 600+ NONE KNOWN fi)es, give(late Depression over field NO Fo~ 4 bedrooms i0 ~. g.p.d. D. LIFT STATION Date installed 7/15/1996 "Pump on" level at TIMERin. Datum BOTTOM OF TANK E, SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Size in gallons 1500 Manhole/Access (Y/N) YES "Pump or level at TIMERn. High water alarm level at 45 in. Cycies testedNEW CONTROLS Meets alarm & circuit requirements?. YES 100°+ Septic tank/lift station on lot Absoq3tion field on lot 100'+ Public sewer main N/A Sewer/septic sewice line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cieanout Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation. 5'+ Property line 5'+ Abcoq3tion field · 5'+ Water main N//A Water service line 10'4- Sulface water. 100'4- Wells on adjacent lots 100'4- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line '3'+ Building foundation 10'+ Water main Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 1 F. COMMENTS *SEE WANERi~ WR960039 G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections end review of Municipal records that the at~ove systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Print? NaTe JEFFREY A, GARNESS Date Driveway, parkJng/vehicie storage 10'+ HAA Fee $ Date of Payment Receipt Number (Rev. 12/ol) Waiver Fee $. Date of Payment Receipt Number Municipality of Anchorage Development Services Department 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 .Water Well Advisory Health Authority Approval # 020289 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block , Lot 3 o£Another subdivision, the well's productivity was determined to be 0.42 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4-bedroom residence is 0.41 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. ,f' oo "1 L- g-'; ": Robert F... dohnm, dr. &'A~o~. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Lot 3~ Another S/D Location (site address or directions) 16501 Chasewood Lane Theresa Motocha 16501.:Chasewood Lane, Dayp~one 345-6738 Anchorage, AK 99516 P[operty owner Mailing address Lending agency Mailin. g address ~,' Day phone Agent' Address. Day phone Unless otherwise requested, HAA will be held for pickup. 4 NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water XXX NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. XXX Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~25 (Rev, 1/~1) Front MOA#21 ~( 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 verifythat 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 & $ ENGINEERING Phone 1zu34 Eagle Ktver Loop Hoa~ ~o, 2~ Address Eagle River, Alaska 99577 Engineers signature ~ 2 ~ Date = DHHS SIGNATURE ~ Approved for 4 Disapproved. ' cc~n~litional approval for Additional Comments bedrooms. bedrooms, with thee following stipulations: By: Date 4 - 24 - 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 courtesyto 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. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist LegalDescription: LeT' 3 A,,,o~,,-/,,~,'{. ~'//~ ParceiI.D.: A. WELL DATA Well type If A, B. or C, attach ADEC letter. -ADEC water system number Log present ~/N) ¥~$ Date completed Total depth L/O 5~' Cased to MO + Sanitary seal Casing height (above ground) Wires properly protected ~/N) Date of test Static water level Well production FROM WELL LOG g.p.m. AT INSPECTION g.p.m. WATER SAMPLE RESULTS: Coliform O Nitrate Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed Foundation cleanout ~N) Date of Pumping C. ABSORPTION FIELD DATA Date installed "~ )l )£ / ¢) Collected by: Other bacteria O $ & S ENGINEEEING 17034 Eagle River Loop Roa~l No. 204 Eagle Rlver~ Alaska ~577 Number of Compartments ~ Cleanouts(~/N). ~'~ Depression (Y~ ,'~ o High water alarm~/N) y Pumper ~'+- H¢,~a Soil rating (g.p.d./fF or ff~/bdrm) L/,o System type I. O. -('. F. Length 30 ~ Widtl'i 5" ¢ Gravel thickness below pipe O. ~-- Total depth 5'-//'.~ ' Effective absorption area_ ~)~o ~.-~ Monitoring Tube present ~N) ¥~ Depression ever field (Y/~ ~° Date of adequacy test //~"/~ Results ~Fail)f)"~$ -'¢ For ~ Fluid depth in absorption field before test (in.); O Immediately after'~-O gal. water added (in.):_ Fluid depth (3 (ins) Minutes later: ~ -~ Absorption rate = ~' o ~ '¢ g.p.d. bedrooms Peroxide treatment (past 12 months) (Y/N) ¢¢o,~¢. /<,~ ob,,~ If yes, give date 72-026 (Rev. 3/96)* LIFT STATION Date installed Size in gallons "Pump on" level at* ~ 3' Manhole/Access O/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES *Datum "Pump off" level at* ~ I SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots / ~0 ;-/- On adjacent lots Public sewer manhole/cleanout '~/'~ Lift station / o o SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation /O Property line ' ~ 5'- Absorption field Water main/service line /O ~ Surface wateddrainage )oo '+ Wells on adjacent lots Io '/ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~ /(/'~,~,~ qb ~)Buil¢ing foundation ~- ~' Water main/service line Surface Water I 0 o Driveway, parking/vehicle storage area Curtain drain ~ o,,,,,., ~,~ ~,~' ,~ Wells on adjacent lots F. ENGINEER'S CERTIFICATION · ,,,'72~.'~.'~'~,'~' ,. I cedify that I have determined thru field inspections and review of Municipal records~'~ ~ems are tn' conformance w/th' MOA ~A~ guidefines in effect on this date. ~ .. ......... ".. S gnature g~' t.~' g"c"~"~F"~ ~""':'""~ / J ~ ~ ROBERT C. COWAN Date ~/~ /oo ~%~ CE-8801 '~, ~'.. ... ,~ · ii, c,~ ............... ,~ HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAA TH & HUMAN SERVICES On-Site Services Transmittal Sheet The attached paperwork has been reviewed and is being retnrned . : for the following reason(s): ' ~:~'i- ~ :. · Discrepancy in legal description and/or owner name. ~ ~ Discrepancy in numbe[ of bedrooms. Signature and/or stamp missing on Show measured distances to sewers/wells, curtain drains2 and streams within 200 feet of proposed system. Replacement disposal site not shown and/or tested. Calculation error in design. Show locations of 811 soils, percolation or water table tests. Proposed system too deep for soil test submitted. Topographic information missing or inadequate. Narrative missing or inadequate. Additional soil/perc test needed. Sand filter requirements not satisfied. Water monitoring results missing or inadequate because Incomplete; missing. Well log required. Water sample unacceptable because ~/ ~%/ ~lease supply the necessary information and ~/~/request. Your cooperation is appreciated. Reviewer ~ LEA VE THIS FORM ATTACHED TO PAPERWORK ~ MA~-07-~000 17:11 S~S ENGINEERING 90? 6~4 1211 P.~2×02  PROPEI~TY OWNER AGREEMENT ~ FOR T~tE MAINTENANCE OF AN ' ON-SI~_~; WASTEWATER DISPOSAL SYSTEM This agreement, dated~_-~--_ '9 LI ~ , is made between the Municipality of Anchorage Department of Health and Human ~e~ices (DHH$) and the property owner(s) of: This agreement is made for the purpose of maintaining an on-site wastewater disposal system on the subject property. The property owners agree to ~,: following: Submit to the Municipality of Anchorage, on an annual basis, an inspection and operation statement from a registerea professiona/engin~er~ Tiffs inspection *.nd operation statement shall verify r,~.ir the engineer has inspected all effluent Md ak pumps, timers, and alarms, and tuar any deficiencies have been repaired a~d that the system is functioning as design~ (Signature) (Print~ Name) (Signatm'e) (Printed Name) (Notarize Here) RECEIVED TIME MAR. 7. E:~05PM TOTAL. P.02 o4-18-o0 0?:58 FROM-¢TE ENVIRONMENTAL .~IK CT&E Envir,,nmen,al Services ,ne. T-SHT P.O1/OE F-5$g Ray Schaeffer Ray's Services & Supplies PO Box 772804 Eagle River, AK 99577 RECEIVED APR 18 2000 Municipality ol AnChor~g.e Dept. Health & Huma~ $~r¢~8,s 200 W. po~e DHve .ameborage, AK. 9951 g-1605 Td: (~071 562-2343 F~.~.: (907) 561-5301 Work Order; Client: Report Date: 1001490 Lt3 Another S/DI6501Chasewd Ray's Services & Supplies ApfillS, 2000 Enclosed are the a~u~lydcal results associaxed with the above workorder. As required by the stare ofAlasl~ ar~ the USEPA, a formal Quality Assurance/Quality Control Program is mainmned by CT&E. A copy of our Quality Control Manual that outline this prograna is available aX your request, Except as specifically noted, all statements and daza in this repor~ are in conformance to the provisions sex forth in our Quality Assurance Program Plan. If you have uny questions reg~rdLqg this report or if we can be of any or. her assistance, please call your CT&E Proj eot M~uager ar (907) 5fi2-2343. "Fne ~bllowing descriptors may be found on your repor~ which will serve to fu~her qualify the data, U Indicates the analyte was analyzed for but not dexec~ed. I Indicaxes an estimated value that falls below PQL, but is greater than the MDL. B Indicates zhe analyte is found in the blank associated with the sample_ The analyle has exceeded allowable limits, GT Greater Than D Secondary Dilution LT Less Than Surrogale out of range Member of the SGS Group (Societe Generale de Surveillance) 04H8-0§ o7:59 FROM-CTE ENVIRONMENTAL zt~__- CT&E Environmental Services Inc. ~815301 CT&E Ref. g Client Name Project Name/g Client Sample ID Matrix Ordered By 1001490001 Ray's Se~ices & Supplies Lt 3 Another S/D 16501 Chasewd I-t 3 ^noth~t S/D 16501 Chasewd Water (Surthcc, Elf-, Ground) Clieu~ pO~ Printed Date/Time 04/18/2000 7:21 Collected Date/Time 0410612000 11:06 Received Date/Time 04/06/2000 12:30 Technical Director · Stvphen C. E~_e . Released BY~~ ~ Sm'nple Remarks, 300 - Nllrare ran upon receipt and w~s ovetr~gc- Sample rerun and tha~ result is reported below. ~.DO 2.00 I~/L EPA 160.2 JOT SCL JMP cal/lOOmL SM]~ 92220 MUNICIPALITY OF ANCHORAGE .;,'::i ,: ?,'i-';:':-~ :-~;'il DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section : .r P,O, Box 196650 Anchorage, Alaska 99519-6650' -": ~' '~ 343-4744 -, : CERTIFICATE OF HEALTH AUTHORiTy ":':'r ". · '" ' , ." ":. ::~ , "~':"':'::. APPROVAL FOR A SINGLE FAMILY DWELLING" ' ' · Parcel I,D,# ~:~)~t';) -,-~'~ --%?--,- NAA# ~c~,(n ~.~{~C,O~ ,..., '~-~ 1. GENERAL INFORMATION ',:~,'? ' . * ~: :'. Completelegai'description ~OT ':'~ ~O~ ~~'~V~~ Location (site address or directions) ' /~, 5e '! C~,._~ ~~ .~L..... :. !-,- · ·, "": Lending agency Day phone Day'phOne rm o from?Sate '~ NOTE: If community Waste~ater system, proVide Written confi ati n attesting to the legality and statUs of system, 72~5 (Rev, 1/91) Front MOA~21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verif~ 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 Municipal~'ty 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. E~gin~¢s'signa'ure :~ '~'~ ~~ Date SIGNATURE )roved ... ~;,i ~-.,' ,,~?. bed r~Oms.~ Date' Th~ M~r~iCiPalitY of AnchOrage Depar~ment of Health and 'HUman Services (DHHS):i~'~es'Health Authority Appr°val certificates based only Upon the representations given in paragraph 5 a'b0ve'b~an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to pUrchasers ~f 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) Beck MOA ~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907) 343-4744 Health Authority Approval Checklist Legal Description: A. WELL DATA Well type J~ Log present (Y/N) Total depth Parcel I.D.: (~)~?.~) -' ~) q 3 _.'z~ ?.., If A, B, or C, attach ADEC letter. ADEC water system number ~"~/~ Date completed ~/~/J-'/~' ~ /3/0 ,~ I Cased to I~-~v-~ c~'~_ Casing height (above ground) Sanitary seal (Y/N) Date of test Static water level Well production Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION 7 2./0 / g.p.m. /~ 7' g.p.m. WATER SAMPLE RESULTS:' Coliform Date of sample: Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed Y'l~/~/~ Foundation cleanout (Y/N) Date of Pumping ~'//A, Tank size ./~-~'~ Number of Compartments ~ Cleanouts (Y/N) ~./ Depression (Y/N) [~'[ High water alarm (Y/N) Pumper I~/~&.- ABSORPTION FIELD DATA Date installed ~//~/G"/'/U Length -~O '~ Width Effective absorption area Date of adequacy test Fluid depth in absorption field before test (in.); Fluid depth I~ (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) Soil rating (g.p.d./fF ~m) /'~ ~ .../ ~;~ Gravel thickness below pipe /.~"O ~ Z. Monitoring Tube present (Y/N)__y__ Depression over field (Y/N) Results (Pass/Fail) ~ For System type b"- I~'C~E.. ~! Total depth ~ / Immediately after /gal. water added (in.): Absorption rate = / g.p.d. If yes, give date bedrooms 72-026 (Rev. 3/96)* D= LIFT STATION Date installed ,~/-~-/~/(" Size in gallons / Manhole/Access (Y/N) '"/ "Pump on" level at* /'Y/-~ ~ "Pump off" level at* High water alarm level at* /'/'/--~" ( *Datum /"~ ~/~ Cycles tested E. SEPARATION DISTANCES Z./// tf SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot J'JO / On adjacent lOts Absorption field on lot ! ~ ! On adjacent lots Public sewer main /"~//'/,4:~ Public sewer manhole/cleanout Sewer/septic service line ~ ./4;-O ! Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation / ~ f Property line o~-~' / Absorption field Water main/service line ~ ~-~ Surface water/drainage /"4/0 Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water Curtain drain 7/ Building foundation ~,~..~ l Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots ~/0-~) ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal reCords that.tl~e above sy,~e~ns in conformance with MOA HAA guidelines in effect on this date. '~~ ~ ~. i Engineer's Name "~'-o~~(~,3,,, ~r [~.[~x J ~ [.~ .... ~:~ ' ':' '"""::: ........... ~':':; Date are HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # GENERAL INFORMATION Complete legal description Lot 3; Another Subdivision; Location (site address or directions) 16501 Chas~wood Lane Property owner Mailing address Lending agency Mailing address S. Mark Phillips & Gw¢~ E--. -Oberm'-~- .-¢~ Day phone 16501 Chas~ood Lane Anchorage. Alaska 99516 Day phone 345-7454 Agent S.Mark Phillips 2600 Denali Address 2001 REALTY Day phone Little. Denali Towers Anchor¢.ge, Ak. 276-2761 99503 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 '× TYPE OF WATER SUPPLY: Individual well XX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: ×X 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 #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~ ~ /'~ ~---~-. ~ I~> A. WELL DATA Well type /"~--~ ~//'~ If A, B, or C, attach ADEC letter. Log present (~;~N) ~ Total depth ~ ~:~ Sanitary seal ~N) '~ Parcel I.D. ~).-.~,,"~-~d/~,?-~2~ ADEC water system number "-'-' Date completed ~'~/~ 1~1~.~'7.-- Driller~~l~'~__./-~- Cased to ~ I ~ Casing height \'"Z--! l'Jr Wires properly protected4~ZN) L/ FROM WELL LOG Date of test Static water level Well flow Pump level g.p.m. AT INSPECTION ~ ~ ~ ~ ~ ~ ~N~UNICIPALITY OF ANCHORAGE .~ ENVIRONMENTAL SERVICES DIVISION ,4- OCT ;5 0 1991 g.p.m. RECEIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot / \ I Absorption field on lot \ ~ ~ Public sewer main t.~-.-~ Sewer service line ,.?... ~_.~ t .~ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank t'--~'--~ WATER SAMPLE RESULTS: Coliform (~ /' ~ -~'~ Nitrate Date of sample: ~ ~ ~ ~'~ "~'~- ( . '~//,,~/ Other bacteria ~ Collected by: ~ ''~ ~-~ ~!~ ~--- B. SEPTIC/HOLDING TANK DATA Date installed ~-.-~7~~ ~'Z-~ Cleanouts ~i~)/N) ~ High water alarm (Y/N) Date of pumping Tank size \ ~_...~ c~ Foundation cleanoutd--(:~N) Compartments Depression (Y~ Alarm tested (Y/N) Pumper ,~"~'' ~'~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: 1 Well(s) on lot \ \ ~ On adjacent lots To proPerty line [ ~ Ij~ Absorption field Surface water/drainage \ ~-~-~ Jr~ Foundation Water main/service line 72-026 (Rev, 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent {~N) '7/ High water alarm level "Pump on" level at Meets MOA electrical codes (~/N) Manhole/Access ~1) V ~, c~. I'-'1~ J-~ "Pump off" level at I \"'/ ~. o, t'-l~ ~, Cycles tested [ ~ '~ SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot 'I I I On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length ~'~ Width Total absorption area Depression over field (Y~:~ Results (pass/fail) Peroxide treatment (past 12 months) (Y,~ Soil rating Gravel thickness ~'~7-'~'~'/~n-' System type ~ Total depth Cleanouts present.N) Date of adequacy test for ~ ~--h~ If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot 1 '~,~ On adjacentlots ~, ~ [Jr- Propertyline To building foundation '~ To existing or abandoned system on lot On adjacent lots %~ :~ Cutbank Water main/service line Surface water Curtain drain E. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in $ & 5 ENGINEERING Signature ~ :z~34 Eaule Ri~er Loop Ra=~I .... ~ ~[' ~iver, Alaska 99577 Engineer's Name Date \ ~.,. ~.~1 ---~ ~ HAA Fee $ / ~ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 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 GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision~section, township, range) Location (address or directions) Applicant Name _l~p~t. ~'~..~I~, Telephone: Home Business Applicant Address ¢-~o~ L.t~c;~5, ~ 1'2~J ~ ~--~.~/~,(/..~F~ ~,J~/'. -~'t, ciSL~ Applicant is (check one): Lending Institution []; Owner/builder~; Buyer []; Other [] (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) M-ait the HAA to the following address: TYPE OF RESIDENCE Single-Family~ Multi-Fami~F1 Number of Bedrooms Other WATER SUPPLY Individual Well~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite~¢- Public [] Community r-I Holding Tan'k [] 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) ENGINEERI'NG FIRM PROVIDING .SPECTIONS, TESTS, FILE SEARCH, DAT ND INFORMATION ~* As certified by my seal affixed hereto and as of the validation date shown below, I verify ti'tat 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 ~ ~;': i" :,: ~::: i~!~ i~-,:';' L Telephone Address :, ,"~.'?"i ..... "~" ~'~ '~"~ :'-ii:!'.: Date .... .... ' .... Iz::=~¢.~i~- ~ Approved for .~'~¢. ~ bedrooms b Approved //~ Disapproved 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 (1t/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Des. cription: L,.,~"E MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONM'=NT;:,L PROTECTION I985 ECEI. V_E WELL DATA Well Classification Well Log Present~:)N) Total Depth /'4"t~~ Static Water Level Casing Height Above Ground Electrical Wiring in CondUit ~N) If A, B, C, D.E.C. Approved (Y/N) Date Completed -~ "~ '~ ' ~'~ Yield ~'~,~'t Depth of Grouting "--' Pump Set At ~-I:~' Sanitary Seal on Casing {L'~N) Cased to Depression Around Wellhead (Y~ Separation Distances from Well: To Septic/I-,l~dmg Tank on Lot · On Adjoining Lots To Nearest Edge of Absorption Field op Lot //~ · On Adjoining Lots I c~c>14''' , · To Nearest Public Sewer Line ~ 1~ To Nearest Public Sewer Cleanout/Manhole ~l~ To Nearest Sewer Service Line on Lot Water Sample Collected by ,~-~ '~=1~.~I,~,.3~~ . Date Water Sample Test Results Comments ~ \~J~.',-~Ji~'~-~ ~ ~ ~ ~_~_~--~--'r"~.~ ! B. SEPTIC/~ANK DATA Date Installed Standpipes~N) Depression over Tank (Y~:) Pumping/Maintenance Contract on File (Y/N) ~ / Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/~e~H~'~--Tank: ! To Water-Supply Well J// 1~ /-/-- L~'~"'E~. size ~.,-~-~;;~ No. of Compartments Air-tight Caps~N) Foundation Cleanout Date Last Pumped ~,O "~"~ ~' 'for / Temporary Holding Tank Permit (Y/N) To Property Line To Water Main/Service Line ~/, ,/~ lA Course _ To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed t.~. _ _~ .. Width of Field ~ - Square Feet of Absorption Area Depression over Field (Y~) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well //.r' ~ To Building Foundation ~..~::~ ? Lot '*J/~ ~=~ ~'t~f/......-~ Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present. N) Date of Last Adequacy Test To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~ ~ / TO Cut~ank (if present) /(.~, Comments D. LIFT STATION Date Installed ~'-'~O ..- ~. Dimensions ~ ~,~,~_ . ~_-~('~ Size in Gallons ~ Manhole/Access (~N) ~'~'~' ~, "Pump On" Level at I[I High Water Alarm Level at -r~..~. c.~ ~'~-~.~z.-'r',.c,~Vent t~N) Tested for ~ ~ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes~)N) ** 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. Date MOA No. Signed Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) APPLIC 14T FILLS"OUT uPpER HALrim NLY Property O~vner ~, j,,.,j ~ ~ j/__ t::?~,' ~ ] ~'l~v~ Phone Mailing Address ~.~) C,~/~ Buyel' Address ~'/~'/~ ~ Zip Code Lending Institution ~ ~-~(~ ~ ~ ~ ~ ~ ~ Phone Address Zip Code Realty Co. & A~nt Phone Address Zip Code Type of Resi~nce Single Family Multiple Family No. of Bedroo~ ~ Other Water Supply ~ndividual A~ACH ~LL LOG. A w~l log is required for all wells drilled since June 1975. ~ Community For-wells ~illed prior to that date, give well depth (attach log if available). ~ Public Utility Sewer Disposal dividual Year Indiv~ual Installed: ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Date Date Date [ / ~~ pate ( ~APPROVED BEDROOMS *CONDITIONS OF APPROVAL Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received W ' ~ O ~ ~ Well to Tank Septic T~k Size 72-023 (31B2)