HomeMy WebLinkAboutMCGOWAN LT 2McGowan
Lot 2
#051-091-31
/ MUNICIPALITY OF ANCHORAGE
® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING [)]VISION
£125 L Street - Anchorage, Alaska 99501 Telephone 264-4720
— ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
_NAME-/): - PHONE
/1.rp ///IGJ
171 NEW
UPGRADE
MAILING ADDRESS _
LEGAL DESCRIPTION
LOCATION // ''
/ 6i0GW&; _J
NO. OF BEDROOMS
.�
DISTANCE
Well q� /
Absorp on arja
� "'
Dwelling I ,f„
PERMIT NO,
TO:
' [�
-�G
F- 2
Manufacturer,/_ y
rial e1
No. of compartments
N
Liq. apacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
DISTANCE TO:
Well
Dwelling
PERMIT NO. �
�Z
C) Z h
_
Manufacturer
Material
Liquid capacity in gallons
O
w=
-
DISTANCE TO:
Well /
mo ,,L
Foundation f,,,�
g -,S _
Nearest Ioelin
PER NfJ /e% .
/ C' -�--
'u u.
w
No. of lines
Length r�E ey h �ine
Total I Pg o9lines
Tren boidih
Distance b twx.�/lin cA
2
F _
} r7
-} Yj
C inches
w
_
Top file to ish
M erjp th tily-�
u�
Total
F
of �'rYi rade
/ r
I 2 �
effective absorption area
a
v 4l7 inches
Length
Width
�
Depth
PERMIT NO.
w
(7
Q H
Type of crib
Crib diary. r
Crib depth
Total effective absorption area
Ad
w
/"
N
DISTANCE TO:
Well
Building foundation
Nearest lot line
Classh
s
Y""f
Driller
Distance to lot line
PERMIT NO.
.ui�-
w
DISTANCE TO:
Building foundation
Sewer line
Septic tank
—
Absorption area(s)
OTHER
PIPE MATERIALS
r ,>o
SOILTEST RATING `
17
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INSTALLERS
�- 15�/�.•
REMARKS
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APP ROV DATE
LEGAL
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l S
&
S EngineerincT®�
72-01,WV(ev.3/78) y
9-11 11 -JI 11"A���
DEPHRTMENT 8r HEHLTH HND ENVIRONMENTHL PROTECTION
825 'L' STREET/ RNCHORHGE/ HK. 9950i
26�-4720
�P�_��1�FE ����� �������� ������
PERMIT NO. ( 8106]] )
APPLICANT GF'EHTLHND REHLTY EAGLE ��VER 694�]�87
LOCHTION MCGOW1"N ST
LEGHL 1_2 MCGOWEIIA LOT SIZE 8000 SQURRE FEET
TYPE OF SOIL HB5ORPTION SYSTEM IS: DRHINFIELD
MHXIMUM NUM�ER OF BEDROOMS � ] SOIL RHT1NG (SQ FT/BF".)� 85
THE REQUIRED SIZE OF THE SOIL HBSORPT�ON SYSTEM I'S�
IF` �H-A ��C-i lF IFA -5 F-�` F:l Ea� k---
����V-11= �
THE LENG'TFI DIMENSION IS TF*:. LEP-Ill' TH (IN FEET) OF THE
TREWA OR DRHINFIE'l D
THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SUR -ll CE OF THE
GROUND HND THE BOTTOM OF THE EXCHVHTION (IN FEET).
��A � ������� ���-1" IFA I !.'.'_E'
IC -1 ����,
THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN
THE Cil TFHLL PIPE
HND THE BOTTOM OF THE EXCHVHTICN (lN FEET).
��� ������� ������ ������
�L�����
PERMIT HPPLICHNT HHS THE FIESPi TO v.,FORM
DEPHRTME�T DURPNC7, THE
INSTH�LHTION INSPECTIONS OF HNY WELLS ADJHCENT TO THIS
PROPERTY HND THE
NUMBER OF RESIDEACES THAI THE W�LL WILL SERYE.
��� p 11.4 1 rA -:E.'������������
.. ... ..
8HCKFILLING OF HNY SY�TEM WITHOUT FINHL INSPECTION AND
HPPROVHL BIT, THIS
DEPHRTMENT WILL BE SU8JECT TO PROSECUTION.
MI�IMUM �ISTHNCE 8ETWEE14 H WELL HND FINY ON~SITE SEWRGE DISPO�H� SYSTEM IS
100 FEET FOR H PRIVHTE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING
UPON THE OF PUBLIC WELL
MINIMUM DI.STHNCE FROM Fi PRIVF1TE WELL TO H PRPVHTE SEWER LINE I_E; 2`5 FEET HIII D
TO H COMMLJNlTY SEWER LINE FEET.
OTHER �EQUIR��ENTS MHY �PPLYSPECIFICHT��NS HND �ONSTRU�T�ON DIA���MS HRE
FIVHILHBLE TO PROPER INSTHLL�TION
1 X F;;`AE". C IE-`- IEZ 11-1 L- LEE IP,
I CERTIFY THHT
1: I HM FHM1LIHR WITH THE REQUIREMENTS FOR O��5ITE �EWERS HND WELLS HS SET
FORT� �� THE OF HI'lCHORHGE
2: I 1 111 L INSTHLL THE SYSTEM �N ACC ORDWTH THE CODES.
HHT THIE —C"ITE SEWEF! 11HY REGJUIRE E.11LHRGEMENIT IF' THE:'
(F ,
2 <,
(�
( {
3
4
6
7 r
9- C
/
111
SOILS LOG
Depth to
Net
Time
Time
MUNICIPALITY OF ANCHORAGE
❑
PERCOLATION
Qp
DEPARTMENT
OF HEALTH AND ENVIRONMENTAL PROTECTION
TEST
\
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
J, `-�h /✓ (1
PERFORMED FOR:�J
DATE PERFORMED:
- / C.- 6v
LEGAL DESCRIPTION:
c
DEPTH
dw
SLOPE SITE PLAN
(F ,
2 <,
(�
( {
3
4
6
7 r
9- C
10 I a
WAS GROUND WATER /I / --- S
11 % ,[� f `/J�ENCOUNTERED? L
P - IF YES, AT WHAT E
13 DEPTH?
144p�4®��
15
1
16M f
17
oa•_ U..l n..• ala
Robert A. 5 ' for ;
18 �j �j �•/ Ne. 14"a' •C
g
19
Reading
Date
Gross
Net
Depth to
Net
Time
Time
Water
Drop
Qp
4
c
dw
10 I a
WAS GROUND WATER /I / --- S
11 % ,[� f `/J�ENCOUNTERED? L
P - IF YES, AT WHAT E
13 DEPTH?
144p�4®��
15
1
16M f
17
oa•_ U..l n..• ala
Robert A. 5 ' for ;
18 �j �j �•/ Ne. 14"a' •C
g
19
Reading
Date
Gross
Net
Depth to
Net
Time
Time
Water
Drop
Qp
4
dw
20 �
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT AND FT /
COMMENTS CCS . f (`/r.! r-- t �, �, c,_ C"L>._)v .Pt=' -ir"l c').n- �✓
PERFORMED BY: s CERTIFIED BY. -- G-" o-� " DATE: t
72-008 (6/79)
B�
• `� Municipality of Anchorage &
On -Site Water and Wastewater Program
(907)343-7904 sa ery
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-091-31
1. GENERAL INFORMATION
Complete legal description MCGOWEN LOT 2
Expiration Date:
Location (site address) 20633 SCENIC DRIVE CHUGIAK AK 99567
Current Property owner(s) STAN & TRUDI MITCHELL Day phone
Mailing address
Real Estate Agent
PO BOX 298350 WASILLA AK 99629
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Received by: �111tedby
Date: %/COSA to bereleased to the engineer, unless othenti) er.
COSA Fee $ 'Aq0 " Waiver Fee $ _
Date of Payment O 3' 1 aa� Date of Payment
Receipt Number b1$e%I 2 Receipt Number
COSA # Osc 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 ARCTERRA CONSULTING INC. Phone 8683791
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 10/23/12
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition
of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface
conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate
during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are
subject to these various and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore.
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future,t t¢ yr,.
occupants or can ArcTerra guarantee that no unseen ^A_
encroachments, deficiencies or discrepancies exist
#r74
6. DSD SIGNATURE `
System #1 Approved for. bedrooms.�« ° `a
a0 AV
System #2 Approved for _ bedrooms.~'
>
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
17A
The
Original Certificate
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.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory_
Well Flow Advisory _N/ Other
COSH bale sheet 9-1-12doc
If more than 1 septic system is on the lot:
COSA Checklist # of
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: MCGOWEN LOT 2 Parcel ID: 051-091-31
A. WELL DATA'
Well type PRVT
Date completed 71811970
Total depth 70 ft.
Date of test
Static water level
Well production
If A, B, or C provide PWSID #
Sanitary seal (YIN) Y
Cased to 30 ft.
FROM WELL LOG
ft.
WATER SAMPLE RESULTS:
9 -
p.m -
Coliform NECK colonies/100 mL Nitrate Na mg/L
Arsenic: 12.7 ug/L Date of sample: 10116112
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC I CONCRETE
Tank size 1000 gal. Number of Compartments 2
Foundation cleanout (YIN) Y Depression over tank (YIN) N
Date of pumping 10110112 Pumper JR
C. ABSORPTION FIELD DATA
Well Log (YIN) N
Wires properly protected (YIN) Y
Casing height (above ground) 24 in.
AT INSPECTION
1011612012
ft.
9 -13 -m -
Collected by: ARCTERRA
Date installed 1963
Cleanouts (YIN)
High water alarm (YIN) N
Date installed 71811981 Soil rating (g.p.d./ftz or ftZ/bdrm) 85 System type TRENCH
Length 38 ft. Width 5 ft. Gravel below pipe 2 ft.
Total depth 5_6 ft. (Measured 10110112) Eff. absorption area 271 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 10110112 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 600 gal. New depth 15 in.
Elapsed Time: 60 min. Final fluid depth 1_2 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at in.
Datum
Size in gallons
"Pump off' level at in.
Cycles tested
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot *85'
Absorption field on lot 100'+
Public sewer main 75'+
Sewer /septic service line 25'+
Animal containment areas 50'+
SEPTIC/HOLDING TANK ON LOT TO:
Manhole/Access (YIN) _
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots
On adjacent lots
Public sewer manholelcleanout 100'+
Holding tank 100'+
Manure/animal excrete storage areas 100'+
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 101+ Surface water 100'+
Wells on adjacent lots 100'+
ABSORPTION FIELD ON LOT TO:
Property line *3' Building foundation 10'+ Water main 10'+
Water Service line 10'+ Surface water. 100'+ Driveway, parking/vehicle storage 0'
Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 100'+
F. COMMENTS
in.
*Well data per MOA records. Waivers and grandfathered separations approved per MOA previous COSA I HAA. Water storage in
well house. Vacant system surcharged prior to testing.
G. ENGINEER'S CERTIFICATION
I certify that / have determined through field inspections and review of
Municipal records that the above systems are in conformance with MOA
COSA guidelines in effect on this date.
Engineer's Printed Name KENNETH M. DUFFUS
Date 10123112
COSA brown sheet 9-1-12.doc
KOW-17H s€ ,
;6 �t
Ilk
.'�9'�tisErr'
Municipality of Anchorage
Development Services Department
Building Safety Division sn ,
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
Water Well Advisory
Certificate of On -Site Systems Approval (COSA) # 121502
During a recent COSA on-site inspection and test of the potable water
supply well on Block , Lot 2 of McGowen subdivision, the well's
productivity was determined to be 0.65 gallons per minute. The minimum
well productivity required by this Department (AMC 15.55) for a 3 -bedroom
residence is 0.31 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 Certificate of On -
Site Systems Approval.
Municipality of Anchorage
Community Development Department °
Development Services Division
Sq Eix
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Arsenic Advisory
Certificate of On -Site Systems Approval # 121502
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
of McGowen Subdivision. This inspection revealed an arsenic
concentration of 12.7 micrograms per liter (ug/L) for the property's well
water sample. The Environmental Protection Agency (EPA) has established
a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water
systems. While private wells are not subject to this regulation, EPA
standards are based on existing health information and can therefore be used
to gauge the relative quality of water from private wells. Information on
arsenic is available from the On -Site Water and Wastewater Program
website(www.muni.org/onsi ) or at 343-7904.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
\ Municipality of Anchorage
-� Development Services Department
j
Building Safety Division On -Site Water and Wastewater Program
s• crr
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-091-31 COSA #
Expiration Date: ' 1
1. GENERAL INFORMATION
Complete legal descripti
Location (site address)
Current Property owner(s) EMC Mortgage Corporation Day phone 352-9325
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
EMC Mortgage Corporation Day phone
7495 New Horizon Way, Frederick MD 21703
Elizabeth MacMullen REINW of Wasilla Day phone 352-9325
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding Tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by Viegle-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water,
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation,
based on procedures outlined in the Certificate of Onsite 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 Pannone Engineering Services, LLC Phone 272-8218
Address P.O. Box 102954, Anchorage, AK 99510
Engineer's Printed Name Steven R. Pannone, P.E. Date 4/26108
Engineers Comments: In conducting an adequacy test, l attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions
encountered at the time of the test, and separation distances measured to readily identifiable features.
The operational life of all wells and septic systems depend on the local soil condition, ground water
levels that may fluctuate during the year, and the water usage of the family being served by the system
Thcsc conditions are outside the control of the evaluator of this system All systems eventually fail and
satisfactory test results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. PES can therefore not provide any warranty for future
performance nor give any estimate of how long the system will continue to meet the operational
requirements of the NIOA DSD. The content of this report is for the sole benefit of the owner listed
above. Any reliance upon or use of this report by any other person or party is not authorized nor will it
confer any legal right whatsoever.
5. DSD SIGNATURE
__J�f Approved for -5 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: LIZ, t% -(1f ( Original Certificate Date:
Municipality of Anchorage
Development Services Department ,.... '
Building Safety Division °
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON—SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lot 2 McGowan 51D Parcel ID: osi-ooi-ai
A. WELL DATA
Well type E If A, B, or C provide PWSID #
Fro m 0 a
Date completed 718lig7ori Sanitary seal (YIN)Y
Total depth 20* ft. Cased to 30• ft.
(grand
FROM WELL LOG \
Date of test
Static water level
Well production 9.13•m.
WATER SAMPLE RESULTS:
Well Log (YIN) N
Wires properly protected (YM) Y
Casing height (above ground) 24. in.
AT INSPECTION
_4125/2008
i4 ft.
0.4S g.p.m.
Coliform o colonies/100 mL Nitrate o.2oo mg/L Other bacteria o colonies/100 r1L
Arsenic: o ug/I Date of sample: 2008 Collected by: Steve Pannone
B. SEPTICIHOLDING TANK DATA II
Tank Type/Material Concrete Date installed :%0a '�r6ii1 oyl-5/k Frk,
Tank size 2000 gal. Number of Compartments a Cleanouts (YIN) Y
Foundation cleanout (YIN) Y Depression over tank (YM) N High water alarm (YM) NIA
:Date, of pumping 412412008 Pumper. JR'5 Pumping
C. ABSORPTION FIELD DATA
Date Installed 8 2 82 Soil rating (g.p.dJft2 orft2/bdrm),8; System type Trench
Length 38' ft. Width c' ft. Gravel below pipe 2' ft.
Total depth 6.6' ft. Eff. absorption area 27V ft2 Monitoring tube Yes Depression over field N
Date of adequacy test Oirl2oo8 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth In absorption field before test 4ryA# in. Water addede4o gal. New depths in.
Elapsed Time: L4Ao_ min. Final fluid depth ft in. Absorption rate >= &ro g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) No If yes, give date
D. LIFT STATION II
Date installed I Size in gallons MIA
"Pump on" level at
E. SEPARATION DISTANCES
mp 0"
Cycles test
SEPARATION DISTANCES FROM WELL ON LOT TO:
(YIN)
High water alarm level at
Meets alarm & circuit requirements?
Septic tank/lift station on lot 851 C. � On adjacent lots %oo+
Absorption field on lot soo'+
Public sewer main ioo+
Sewer /septic service line ac+
Animal containment areas None
On adjacent lots ioo+
Public sewer manhole/cleanout %oo+
Holding tank soo+
Manure/animal excrete storage areas None
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 30+ Property line zo+ Absorption field :<c+
Water main ioo+ Water service line 25+ Surface water loo+
Wells on adjacent lots soo+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 3*' Building foundation es+ Water main %oo+
Water Service line 25+ Surface water ioo+ Driveway, parking/vehicle storage o'
Curtain drain None Known Wells on adjacent lots ioo+
F. COMMENTS
*Waiver granted 1112/47 300 601 tark(-51t,(0Re -F,oK is Wt. it ttcll�
G. ENGINEER'S CERTIFICATION
1 certify that I have determined through field Inspections and a '�
review of Municipal records that the above systems are In _
conformance with MOA COSA guidelines in effect on this date. i
-�....._................ ............
, /+1 stl V.q R. Ronncn. i
Engineer's Printed Name Steven R. Pannone. P.E. • c t
0� '. No CE 8149 f
Date th6/zoo8 �d w •.•�Z`:••
COSA Fee $ 4 V70 �
Date of Payment 4 I qgb bp
Receipt Number�b�
(Rev. 11105)
Waiver Fee $ _
Date of Payment
Receipt Number
in.
Municipality of Anchorage
• Development Services Department
Building Safety Division'
/ On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
Water Well Advisory
Certificate of On -Site Systems Approval # 080113
During a recent Health Authority Approval on-site inspection and test of the
potable water supply well on Block , Lot 2 of McGowan subdivision,
the well's productivity was determined to be 0.45 gallons per minute. The
minimum well productivity required by this Department (AMC 15.55) for a
3 -bedroom residence is 0.31 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 Certificate of On -
Site Systems Approval.
Municipality of Anchorage
' Development Services Department
Building Safety Division
s. et♦
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
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-091-31 HAA# fl�J 0 LA Z-)
1. GENERAL INFORMATION
Expiration Date:/ .2 - 9-'0'3
Ik
Complete legal description MCGOVO SUBDMSION: LOT 2
Location (site address or directions) 20633 SCENIC DRNE * CHUGIAK. AK 99567
Current Property owner(s)
j Mailing address
i
Llending agency
t
Mailing address
Real Estate Agent
Mailing address
NATHAN ELUOT
Day phone 227-2915
8071 CLEARHAVEN DR* ANCHORAGE, AK* 99507
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
Day phone
Day phone
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
0
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 period of up to one year with valid
water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the
information obtained from the Municipality of Anchorage riles 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 do WASTEWATER CONSULTANTS, INC. Phone
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
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 Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily Identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of 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. AKW WC, Inc. can therefore not provide
any warranty or future estimate 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.
5. DSD SIGNATURE
Approved for 3 bedrooms.
Disapproved.
337-6179
Date S bob 173
Conditional approval for bedrooms, with the fllowing stipulations:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Manitenance Agreements
Supplemental Engineer's Reort
Other
By: Original Certificate Date: 1� — O 3
(Rev. 12101)
Municipality of Anchorage
Development Services Department
Building Safety Division
OnSlte Water ,& Wastewater Program •
A9 T
4700 South Bragaw St
P.O. Box 196650 Anchorage. AK 99519.6650
www.ci.anchorege ek.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: McGOWEN SUBDIVISION,• LOT 2
Parcel ID: 051-091-31
A. WELL, DATA *PER PREVIOUS HEALTH AUTHORITY APPROVAL
Well type PRIVATE If A. S. or C provide PWSID# N/A
Well Log (YM) NO
Date completed _LINK Sanitary seal (Y/N) YES
Wires properly protected (Y/N) `ES
Total depth •70 ft. Cased to `30 ft.
Casing height (above ground) 18+ in.
FROM WELL LOG
AT INSPECTION
Date of test
6/30/03
7
Static water level ft.
23 ft.
Well production g.p,m.
0.93 g.p.m.
WATER SAMPLE RESULTS:
Collform 0 colonies/100 ml. Nitrate 0.1 mgJL.
Other bacteria 5 colonies/100 ml.
Arsenic: N/A mgJL. Date of sample: 6/30/03 Collected by: AWWC, INC.
S. SEPTICIHOLDING TANK DATA
Tank Type/Materlai CONCRETE
Date installed 1963
Tank stze 1000. gal. Number of Compartments 5
Cleanouts (YM) YES
Foundation cleanout (YM) YES_ Depression over tank (Y/N) NO
High water alarm (Y/N) N/A
Date of pumping „6/30/2003 Pumper
JR'S PUMPING
C. ABSORPTION FIELD DATA •
Date installed 7/e/81 Soll rating (g.p.dJft16bdm) 85
System type TRENCH
Length 38 ft. Width 5 ft. Gravel below pipe 2 ft.
Total depth 6.4rt ft. Eff. absorption area 271 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 6/30/2003 Results (Pass/Fall)
PASS For 3 bedrooms
Fluid depth in absorption field before test8" in. Water added 650 gal. New depth 15.5 in.
Elapsed Time: t 20 min. Final fluid depth 3_5 in.
Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) YES/TERRAL
IFT It yes, give date5/29/2003
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at in.
High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES • GRANDFATHERED
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 85'+•
Absorption field on lot 100'•
Public sewer main N/A
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/deanout N/A
Sewer /septic service line 252+ Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 50+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 1000+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line •"3' Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehide storage 0'
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
a: wen" ai
G. ENGINEER'S CERTIFICATION
I certify that l have determined through field inspections and ff * :
review of Municipal records that the above systems are in """' "' """ "" '
conformance with MOA HAA guidelines in effect on this date.
Engineer's Print
Narpe JEFFREY A. GARNESS '�4p79�!•'
Date 69 03 �M°PrOfastlOna
HAA Fee $ 373 3 Waiver Fee $
Date of Payment t� " �2_ C Q 3 Date of Payment
Receipt Number T �4 2 �p Receipt Number
(Rev. I V01)
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 # 030427
During a recent Health Authority Approval on-site inspection and test of the
potable water supply well on Block , Lot 2 of McGowen subdivision,
the well's productivity was determined to be 0.93 gallons per minute. The
minimum well productivity required by this Department (AMC 15.55) for a
3 -bedroom residence is 0.31 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.
0
.y6'y'rr•'trw•'swi
,�
0
,
a
►l
ASBUILT SEWARD & ASSOCIATES LAND SURVEYING 694-0829
I HEREBY CERTIFY -THAT I HAVE SURVEYED THE SCALE, �
r
FOLLOWING DESCRIBED PROPERTY: /tea zp ,. Q ��F a A
�Ie- dWo-E, �Y .roes laTZ DATE, .w Q� '�:9S' b
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS r��ZG : •'� t' °a
INDICATED. 11' IS THE RESPONSIBILITY OF THE * gTH Tr
OWNER TO DETERMINE THE EXISTENCE OF ANY GRIDS
EASEMENTS, COVENANTS, OR RESTRICTIONS �/'v/�'•s> , sl:F••• ,.:.�.
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-•• Cven, M,rk 3ow#4 A
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' �1Q'•, 1S-0918 ,•
ANY DATA HEREON BE USED FOR CONSTRUCTION d -r, as ��{�'�,� •....• �p
OF FENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN,
ARY LINES. ��� ��'ay►�°f`O
08/19/2003 08:55 FAX
GMG General Inc.
General Contractors
"Your Total Asphalt Service Company"
Anchorage/Eagle River 349-7854
Mat -5u Valley 745-3438
FAX 349-8354
X001
CSair fft �'lj$'�(,,
P.O. Box 230489 7j2_`'�
8000 Petersburg Street
Anchorage, AK 99523
'MEMBER OF BBB CARE PROGRAM"
Licensed/Bonded/Insured
Contractors License No. 20774
Pmpnsal Submit cd Pbcoc
Date
o +/6--0
Strcel Mail Address Job Name npr
05:L3 0 caS;P/ Fe- O Pmpnunl a
City. state, zip 2 j lob Location
nC r �7'�1✓'E7 `O )eoL
Scope of Work:' ` .J,X"f, 1•Ct� �1kyt�
f6 C, Cee 55.
xra1.4PIdA�1an
085 1
Lie / as 4 .vh4n) extauc,-L t�\5 eAJ 0'-rmllle-t �1 re. rto,
$ food
C
$
PAYMENT DUE UPON COMPLETION Total $ J&46
Placing le" int carne A acphal l pavement on owner approved sub -grade. Price does not include any responsibility for ab-grstk or utility adjustment unless otherwise stociliel. Ccoifu is of insurance available upon regceat.
Terms: 1.5% Service chane on balances over 10 days Acceptance of Pr :The ve prices attached, specification & conditions
VISA, MASTER CARD, AND AMERICAN EXPRESS ACCErMTI are satisfactory and a hereby a e You are authorized to do the work as outlined.
25% Deposit required to:unrantee schedulinR• LATE PAY M E N IDS WARRANTY.
Name of aalespers n: a Accepted by owner oa agent
`JII. b -p
Company:
Connpanien are nquired by low to be limnsad and regulated by the Coolmator i State license Board. Any rptealiona eoruerning a codlranalnayia+t(emd 10 IV register of the band whose addrea is:
Coara:lm's Slate License Bard, 3601 C Street, Anchomgc, Alaska
All material is ruarantoed to be as spcdfiml. All work to be eompk:led in a worknwdiko manna according to the standard practices. Any altcrivion or deviation from above specifications involving extra cost will be
executed only upon w ktcn order, and will become an extra charge over and above the euimne. All agreements contingent upon strikes, aecidcros or delays beyond our control. Our workers arc fully covered by
Workmen's Compensation Insurance.
ALL WORK IS GUARANTEED FOR ONE YEAR FROM DATE OF COMPLETION
Sep 05 03 04:30p
■
■0■
Brian Broderick
Brion Broderick
Prudential Vista Real Estate
42418 Street
Anchorage, AK 99503
Phone: 907 273 7261
Fax: 907 273 7362
To: ��Wltilt�y
907-273-7362
From: 6,=e*edau' Brion Broderick
Fax: 33$ -3d yI.D Date:
Phone: Pages:
^ ;"�%J ✓�c.�2. .� � �"��._,t`.:� CEJ
L, f,�, r� ►,�,�,� cry.. I 0 lr 33 .Sem �x�.c,
p.1
Uj
Brian Broderick
Sep 05 03 04:30p Brian Broderick
9-20-1995 10sd2PM FROM SPARROWS 3445538
"SPARROWS" ELECTRIC INC.
'7370 BULEN DRIVE
ANCHORAGE, AK 99507
1 To
PRUDENTIAL VISTA
ATTN, SITYI.ENE
4241 B ST.
ANCHORAGE, AK. 99503
907-273-7362 P•2
P. t
P.O. Numbs(
20633 SCENIC...
Onto lnvoiee
9/5/2003 IOOd
Terms
Due on receipt
Qmuity
Desaiptinn
Ratc
Amount
FDC HIT LIST AND CHECK LIGHT IN•KTTCMN. LIGHT
NEEDS TO BE REPLACED
2
4 -SQ. BOX SPECIAL
2.89
5.76
2
4 -SQ. BLANK
1.88
.1.76
3
1" ROMEX CONN.
1.23
3.69
10
1213 MC CABLE
0.89
8.90
4
MC CABLE CONN.
0.59
2.36
3
3/4" FL$X ALL. '
0.62
1.86
2
314" FLEX CON. STRT
0.79
1.58
2
112" FLEX CON.STRT.
0.89
1.78
R
1/2" FLEX ALL.
0.59
4.72
2
1/2" ONEHOL£ STRAPS
0.39
0.78
1
SINGLE RECEP. RAISED COVER
2.89
2.89
1
DOUBLE RECEP, RAISED COVER
2.94
2.94
3
SPEC GRADE OUTLET
10.89
32.67
16
LR SCREWS M8-1" ST
0.10
1.60
1
G.F.C.I.OUTLET
14.87
14.87
1
BELL INUSE COVER 1 -GANG
27.89
27.99
1
BELL BOX 2 -GANG EXTENSION
19.78
19.78
10
314" EMT
0.38
3.80
2
314" EMT CON.DC
0.59
1.18
2
314" EMT ONEHOLE STRAPS
0.42
0.84
10
012- HHN •
0.27
2.70
20
TAN WIRENITI'S
0.17
3.40
2
1ASCREWS 1110-1"
0.38
0.76
2
GROUNDING BAR KITS
6.56
13.12
7.5
LABOR STRT: TME
65.00
487.50
PLEASE REMIT TO ABOVE ADDRESS WrM COPY
Total $651.13
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I
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division. of Environmental Services go
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING1�
Parcel I. D. # DSI - e 2' '� ' HAA # t' c1 q� cnkc1
1. GENERAL INFORMATION
Complete legal description
Lot 2;'McGowen Subdivision
Location (site address or directions)
20633 Scenic Drive
iak
` Property, owner
John & Donna Matthews
Day
phone 688-3812
Mailing address
P.O. sox 670975 Chugiak, AK
99567
Lending agency
Alaska USA Fed. credit Union
Day
phone 786-2823
Attn:- Pam
Mailing address
Agent
Day
phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well XXX
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system,
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XXX
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-029 (Rev. 1/91) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER.
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
S & S ENGINEERING
Name of Firm j7034 Eagle River LOOP Road No. 204 Phone 6" ��
Address
Eagle River,Alask 9577
,e
Engineer's signature
Date G %.2 y l77
REQUEST YOU ISSUE A FULL HEALTH AUTHORITY APPROVAL AT THIS TIME. ALL REQUIRED
WORK ON THE CONDITIONAL HAA DATED 3/11/97 HAS BEEN SATISFACTORILY COMPLETED.
6. DHHS SJGNATURE
w/Approved for
Disapproved.
In
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Note: The well for this property meets existing State and Municipal Codes.
There are nitrates present. It is suggested that periodic testing be
performed to insure the wells continued suitability. Current nitrate
concentration is 8.47 mg/1. EPA maximum concentration is 10.0 mg/1.
1e3 f tion c)n n'trates ;c available from the nn -cite Services Program,
DHHS 343-4744.
Additional G°omments
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employeesof 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.1M) Back MOA#21
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
s&S�
�Ineentnq
R E C E I V E gBERTA. SOAFER, P.E.
JUN 2 4 1997 91VIL 07)694-29E9RS
June 23 1997 FAX (907) 694-1211
Municipality of Anchorage
DePt. Health & Human Ser_yje.
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Boc 196650
Anchorage, AK 99519
REFERENCE: Lot 2; McGowen Subdivision
Request you issue a full Health Authority Approval (HAA) for the
referenced property.
A Conditional Health Authority Approval was issued on 3/11/97. All
work required for the Conditional HAA has been completed. (see
attached checksheet).
If you require additional information, please contact us.
Sincerely,
Robert C. Cowan, P.E.
RCC/gk
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
N
v
Q
�W
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division JUN Z4 I�
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 3M413- c p�4ty of Anchorage
Dept. Health &Human Services
H'teaalth Authority Approval Checklist
Legal Description: Loam -7i U- \L L.., --7o SI t� Parcel I.D.: Q5- 1 1 3/
A. WELL DATA
Well type� , o%a 1 oy M, If A, B, or C, attach ADEC letter. ADEC water system number "� y
Log present (Ye �� Date completed 09, PRr_F rt, ;rteyi<.
Total depth jr 7a Cased to °�3`�'= Casing height (above ground)
Sanitary seal ON)
FROM WELL LOG
Date of test
Static water level
Well production g•p-m-
WATER SAMPLE RESULTS:
Wires properly protected3Y )
AT INSPECTION
(W5"-91
Coliform Nitrate m 1 Other bacteria
Date of sample: �v " j `� ��"`�� Collected by: S S �i��7y�•
B. SEPTIC/HOLDING TANK DATA
r" o
Date installed
Tank size
C°
Foundation cleanout (Y/N)
4 C
oDate
of Pumping
WC.
ABSORPTION FIELD DATA
V
Date installed
Length Width
Effective absorption area
Date of adequacy test
g.p.m.
L—(nc>- " A oF-t,k-�,re-I fie_ 61,e>,,1v—,> ,
Number of Compartments Cleanouts (Y/N) _
Depression (Y/N)
Pumper _
-Soil rating
ftz/bdrm)
High water alarm
System type
thickness below pipe Total depth
/ Monitoring Tube present (Y/N) Depression over field (Y/N)
Results (Pass/Fail)
For bedrooms
Fluid depth in a rption field before test (in.); Immediately after_ gal. water added (in.):
Fluid de (ins) Minutes later: Absorption rate = g.p.i
Poxide treatment (past 12 months) (Y/N) If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at`
Size in gallons
"Pump on" level at*
*Datum
Cycles tested
E. SEPARATION DISTANCES 7
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer /septic service line_
SEPARATION DISTANCES FRO
Foundation
Water main/service
SEPARATION D
Property li
Sura water
urtain drain
On adjacent lots
adjacent lots
"Pump off" level at*
Public sewer manhole/cleanout
Lift station
OLDING TANK ON LOTTO:
Property line
Surface water/drainage
;E FROM ABSORPTION FIELD ON LOT TO:
Building foundation
F. ENGINEER'S CERTIFICATION
Absorption field
_ Wells on adjacent lots
Water main/service line
Driveway, parking/vehicle storage area
—Wells on adjacent lots
l certify that / have determined thru field inspections and review of Municipal
in conformance with Mui linea on this date.
in
Signature
Engineer's Name
Date
HAA Fee $
Date of Payment _
Receipt Number _
72-026 (Rev. 3/96)'
Waiver Fee $
Date of Payment
Receipt Number
ICKI I . WWAN.
CE - 8801
AV
are
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. # �S��!' HAA #
1. GENERAL INFORMATION2�� C7cny
Complete legal description Lot 2; McCowen Subdivision
Location (site address or directions)
20633 Scenic Drive
Chugiak, AI<
Property owner_
John
& Donna Matthews
Day phone 688-3812
Mailing address=
P.O.
Box 670975 Chugiak,
AK 99567
Lending agency Alaska USA Fed. Credit Union ��� Day ,phone
Mailing address_aC e' Ed Rooney Ill —)b `
Anant
AdfIraGG
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
Day phone
786-2823
3. TYPE OF WATER SUPPLY:
Individual well xxx
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site xxx
4 _
Holding tankez
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/81) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER.
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm S & S ENGINEERING Phone GI V - a -q 7
17034 Eagle River Loop Road No. 204
Address j
Engineer's signature ' Date V 3 ( P7
REQUEST YOU.ISSUE A CONDITIONAL HEALTH AUTHORITY APPROVAL
EXTEND WELL CASING AND RECONSTRUCT A NEW WELL HOUSE.
NO LATER THAN 15 JUNE, 1997.
6. DHHS SIGNATURE
Approved for
bedrooms.
TO PROVIDE WATER STORAGE,_
WORK TO�C1�'LETED
�s r
ru�
.� R. ROBERT C. COWAN Q d
CE -60301 r dA
•r
4,
Disapproved.
XXXXx Conditional approval for three(3) bedrooms, with the following stipulations:
Escrow monies to perform all work necessary to extend well casing. Monies
to remain in escrow until -,final -;.approval is granted from this department.
All work must be completed by June 15 1997'x'*Include (1) provide
verification of reported well depth and casing depth. (2) perform well
Additional Comments UTILITY EASEMENT ADVISORY: The wastewater disposal system
serving this property is partially located within a utility easement' At
aban n and re o at he e fisting on-site wastewater disposal system if the
y vv Date
.f.
CAUTION
. The t uniclpality of "Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only Upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev.1/81) Back MOA Y21
MUNICIPALITY OF ANCHORAGE
ENYIRONMENTAL SERVICES DIYfS10N
Municipality of Anchorage MAR 04 19
0* DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division RCEI v
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-474
Health Authority Approval Checklist
Legal Description: Ler 2, Mc c G o Lj trf S�p Parcel I.D.: O 5 i- o 91 - 3,1
A. WELL DATA
Well type Pr��\/ A -TE If A, B, or C, attach ADEC letter. ADEC water system number
Log present (YO �0 Date completed - /�b /"t o
Total depth 0-1 _ Cased to A Casing height (above ground)
i"i1 /) iv -
Sanitary
Sanitary seal (Y/N) Y ri-.5 Wires properly protected (Y/N) w nom- w'v'>L'kwAf
FROM WELL LOG
Date of test
Static water level
Well production 9 -p.m
WATER SAMPLE RESULTS:
AT INSPECTION
2 - 13- a"1
Nei
Coliform G Nitrate /. 3 C Other bacteria O
��y� l
a'tIe of sample: 7 Collected by: _�_� �t � �-F-�-L ) L-7
B. SEPTIC/HOLDING TANK DATA
Date installed _Tank size /000 Number of Compartments Z CleanoutsOJ) Y6s
Foundation cleanout (Y/ No Depression (Yo o High water alarm (YN! /4r)
Dateof.Pumping 2't�'�>_Pumper
C. ABSORPTION FIELD DATA
Date installed -7 �8�8 I Soil rating (g.p.d./ft2 o ft2/bdr 85 System type TRetJcrf
Length -38 Width — 0 Gravel thickness below pipe �`! " _Total depth 6�' -
Effective absorption area :2'71 Monitoring Tube present (Y)N) V45 Depression over field (YAM N a
Date of adequacy test
2 --13-9_?
Results as ail) PA -Sc For _ 3 bedrooms
Fluid depth in absorption field before test (in.); 10 Immediately after Sw gal. water added (in.): (_7
Fluid depth / G" (ins) Minutes later: (0 Absorption rate = '/SD + g.p.d.
Peroxide treatment (past 12 months) (YAV tAoa9 kJ -w0 If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at`
Cycles
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level at*
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot 87 CGRAaDChTHECGD) On adjacent lots
Absorption field on lot
Public sewer main
Sewer /septic service line
loop
On adjacent lots
00 i+
100, -f
A Public sewer manhole/cleanout
25 I + Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 22' t: Property line 1(oI f Absorption
Water main/service line to' -f- Surface water/drainage loo l -t Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line 3 / Building foundation yfo 1+ Water main/service line
Surface water 1 00' -1 -
Driveway, parking/vehicle storage area
Curtain drain N /A Wells on adjacent lots
F. ENGINEER'S CERTIFICATION
f certify that i have determined thru field inspections and review of Municipal
in conformance withM A uZZ-)
es in effect on this date.
Signature
Engineer's Name
Date V 3;
HAA Fee $ z7 6b ' 0
Date of Payment
n�/Z
Receipt Number
72-026 (Rev. 3/96)*
1001+
rd,�he�kQ s are
yC9
♦N ..1 1.. ti0. if .. 1 JYiYI.. t.p
-per ROBERT C. COWAN@
1 Gi CE - 8801 .?aw
tai U, •. • i ��J�
Waiver Fee $ % / �
Date of Payment ,i� • i
Receipt Number
NEAITH AUTHORITY
APPROVALS
SEWER 6 WATER
AKIN EXTENSIONS
SEWER WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
d PLOW TEST
SITE PIANS
ROAD DESIGN
SOIL TEST
PERCOIATION
TEST
STRUCTURAL d
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPUSAL. SYST EM
DESIGN
s&S�
Ill1eeRll q
WELL FLOW TEST DATA
f ROBERT C. COWAN, P.E.
ROBERTA. SHAFER, PE
CIVIL ENGINEERS
(907) 694.2979
FAX (907) 694-1211
CLIENT: (A kyr4vi s DATE: 2-(3-% '7
LEGAL DESCRIPTION: I -oT -z-
WELL
z
WELL DEPTH: _�7! _ CASING DEPTH:
DATE DRILLING COMPLETED: _ ._19toW DRILLER:
otL
MISC. QATA: CASING HEIGHT: A -I-R SANITARY SEAL:
WIRES IN CONDUIT: T o GRADING O.K.: _ 730 jL
BACTERIA AND NITRATE SAMPLES COLLECTED (date):
TEST DATA:
RESULTS: WELL CURB NTLY PRODUCES ,D GPM WITH A 1)tt -"DRAWDOWN
TESTED BY: �Ga "_
FLOW RATE NOT GUARANTEED --SUBSEQUENT VARIATIONS CAN OCCUR.
17034 NORTHEAGLE EAGLE RIVER LOOP • SI IITE 204 • FAGI E RIVFR, AI AS KA9q577
METER
PUMPING
DEPTH TO
--
CLOCK
READING
RATE
WATER
REMARKS
TIME
(GAL)
(GPM)
(FT)
—
SWI
1
J
--� —
--
C OCAL�r� —
L1.
RESULTS: WELL CURB NTLY PRODUCES ,D GPM WITH A 1)tt -"DRAWDOWN
TESTED BY: �Ga "_
FLOW RATE NOT GUARANTEED --SUBSEQUENT VARIATIONS CAN OCCUR.
17034 NORTHEAGLE EAGLE RIVER LOOP • SI IITE 204 • FAGI E RIVFR, AI AS KA9q577
s&s\
�tn��nlnG
February 24, 1997
ROBERTC. COWAN, P.E.
ROBERTA. SHAFER, P.E.
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL. SERVICES DIVtSIQN
HEALTH AUTHORITY
MUNICIPALITY OF ANCHORAGE
MAR
APPROVALS
Department of Health and Human Services 0 4 1997
P.O. Box 196650
Anchorage, AK 99519 RE G E.1 V
SEWER&WATER
REFERENCE; Lot 2; McGowen Subdivision
MAIN EXTENSIONS
Due to winter conditions, request you issue a Conditional Health
Authority Approval on the referenced property to provide water
storage, extend well casing and reconstruct a new well house. All
SEWER &WATER
INSPECTION
work to be completed no later than 15 June, 1997.
Water storage is required due to the prospective buyer obtaining an
FHA loan with a minimum requirement of 3 gallons per minute (gpm).
ENGINEERING STUDIES
The water storage tank is to be installed as a means of supplementing
AND REPORTS
production from the existing well. From the well flow test performed
2/13/97 it was determined that the well currently produces 1.0 gpm.
The tank proposed for installation is a NORWESCO POLYETHYLENE WATER
WELLINSPECTION
STORAGE TANK - 300 gallon vertical an equivalent steel, galvanized
&FLOW TEST
steel, or aluminum storage tank (300 gallon minimum required). Tank
selected for installation on this facility must be NSF approved for
potable water. The pressurizing pump will be a , horse jet or
centrifugal pump suitable under NSF testing for potable water and must
SITE PLANS
be installed on a platform of a minimum of 18" above the floor. All
pressure switches or low water pump protectors must be installed 18"
above the floor surface.
ROADDESIGN
Water samples were taken and tested for nitrates, coliform bacteria,
and other bacteria. The results were satisfactory.
The septic adequacy test performed verifies the septic absorption rate
SOILTEST
meets Municipal requirements for a three bedroom single family .
residence (check sheet attached).
The septic tank was pumped on February 10, 1997 by J.R. Pumping.
PERCOLATION
TEST
If you require additional information, please contact us.
Sincerely,
STRUCTURAL&
/
MECHANICAL
� zyz KJTL�
INSPECTIONS
1/„J',I
Robert C. Cowan, P.E.
RCC/gk
ONSITE
ENCLOSURE
WASTEWATER
DISPOSALSYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
oe* Municipality ®f Anchorage
Department of Health and Human Services
825 "L" Street
rtll�
Rick Mystrom,
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
March 12, 1997
Robert C. Cowan, P.E.
S & S Engineering
17034 Eagle River Loop Road
Suite 204
Eagle River, Alaska 99577
Subject: Waiver Request for Lot 2 Mc Gowen Subdivision
Waiver Request #WR970004, PID 4051-091-31, HA970069
Dear Mr. Cowan:
Your request for a waiver of the required 10 foot separation
between an on-site wastewater disposal system and a lot line has
been approved. The waived distance is 3"feet from the leachfield to
the property line.
This approval applies to the existing on-site wastewater disposal
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 questions or concerns regarding this waiver,
please call our office at 343-4744.
Sincerely
James P. Williams
nn -site Services
ljw #7
Matthews
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR# WR970004 _ PID# 051-091-31 HA# RA970069 Permit #
Date Received: March 4, 1997
Legal Description: Lot 2 Mc Gowen
Engineer: Robert C. Cowan, P.E., S & S Engineering _
17034 Eagle River -Loop Road, Suite 204, Eagle River, Alaska 99577
Applicant: John & Donna Matthews _
Waiver Requested: Lot line waiver of -3 feet from the leachfield to the propert;z line
Criteria: 1. Geology:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
2. Special. Conditions:
Points:
Waiver is Granted: 1 Waiver is NOT Granted:
List Conditions or Reasons for above:
Rec #: 02641/5683 Amount: $_115,00 Date Paid: March 4. 1997
S & S�
�rn��nrnG
March 4, 1997
ROBERT C. COWAN, P.E.
ROBERTA. SHAFER, P.E.
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
--
MUNICIPALITY OF ANGHOKAQIE
SERVICES DIVISION
ENVIRONMEKTAI
HEALTHAUTHORITY
APPROVALS
MAR 0 4 1992
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
Box 196650
��P.O.
SEINER&WATER
Anchorage, AK 99519
MAIN DCTENSIONS
(�
REFERENCE: Lot 2; McGowen
SEWER&WATER
Request you grant a waiver for the horizontal separation distance
INSPECTION
between the leachfield and the property line
at three (3) feet.
We do not anticipate any adverse effect on
the adjacent properties.
The property line is adjacent to Scenic Drive
ENGINEERING STUDIES
ANDREPORTS
If you require additional information, please
contact us.
Sincerely,
WELL INSPECTION
&FLOWTEST
Robert C. Cowan, P.E.
SITE PLANS
RCC/gk
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER. ALASKA 99577
4,
Q
8
�0
6 . • 4 �Q 'C9�.I� Q i�� . Pb �• o ..d, A. h
b1
ASBUILT
S.EWARD &
I HERM CERTIPY -THAT I HAVE SURVEYED THE
SCALE, ,
FOLLOWING DESCRIBED PROPERTY:
/rs Oro
DATE
AND Tt•IAT NO ENCROACHMENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
x���,/
OWNER TO DETERMINE THE EXISTENCE OF ANY
GRID'
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
FBt
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
DRAWN,
ARY LINES.
-0824
Ar Q, • . S�h4A
or
` •• • Dvane MErk Sowcrd +• s; • �
a� 1S-6918 `�•�
AURORA.PROPERTIES
TEL No.907-688-1310
Mar. 3,97 13:27 P.03
a
ENSTAR
r_�r
February 24, 1997
ENSTAfi Nalural Gas Company
AUlvrrON Vf FAGUIi tNHiCiv l:Urp'�u rnilVN
3000 S)rxiin'd Rung
P.o 9ox 190268
Anchorage, Alaska 99519.0288
Aurora Properties
Ms. Nancy Stahly
ir.O, Box 671923
Chugiak, Alaska 99567
Dear Ms. Stahly:
KNS11'AR Natural Gas Company has no objection to the sewer
standpipe that encroaches into the utility easement. on Lot 2
of McGowen Subdivision.
It you have any questions please call me at 2G4-3743,
ve . truly %Yours,
*1eerveJ.t
Right -Of -way Agent
AURORA.PROPERTIES
1'I I IM �.. '.i l'I it Qt_ i 1,.J11
TEL No.907-688-1310
Mar. 3197 13:26 P.02
Ma1.a1>Iuskz� /�el��pi>,�><lt� ASSOCJH "ion, 1110.
P.O. DOX (f W PAL MER, ALAW,A 99045.3550 PHUNE (9DY) V45.96W Roal Eslale 9110 Plop®rlies Seolion. •�
t •0D01748.9510 FAX (007) 7469946
HY11.Iu1411n11 /1.1111 r1111 •/N 11111I1J1n110 a 1111111111111,111//1111 6 111111111111.1 111.1. too
NON-OBJi%CTION 7'O EASIRMUNT ENCItOACIIMENT D0CUM1eNT
y this docttnte(11 Matlumska Telephone Association, lac. (MTA) declares thnl. it his no objection to the
ac cnnant of the cancrvactunCnl an existing, sand pipe and fence feet withilt the utility easement along thr, west
de of 1,01, 21 MCGOWEN SUBDIVISION, within Township 15 North, Range 1 West, flection 8, Seward
leridian, Alaska.
�.MWWB.yA:ttWpWAlklrMgWW4M'NMN4NW*{1dRWWA1*1M&9141M+11TT�T���1414��A�R1`�14W*W�WMM#'IF�1FW1�*I�IkWWWWp WekM4*WWh
leaac be advised that MTA thiough the issuance; of this document does not foritit any of its rights to the use
I• the. right of• wny cited, In the, exerelse of these rights MTA will, if needed, upgrade, maintain, repair, and/or
+plricc bnied or aerial tcleconnnnunioatiotls facilities within the casement, Any repairs that may be required to
le cntaoaclnnent o.5 a reGult of utility cons(ruclion will be borne by the proper1y owner of record. This
ocsument does not authorize the plslcement of any additional encroachments within the casement area.
document is, ht no way, an agreement to vacate any portion of the right of way and should not be
acted as such,
for Mr+taauska Telcphonc Association, In,,. this 28th duly February 1997 by,
(•../_, Real 1-s stale and Propertlos Supervisor
'I'H[s 11,4 TO CERTIFY, that oil this 28th day of February, 1997 before me the undersigned, a Notary Public in
and for the State of Alaska, duly connlnissionod and sworn ns such, personally appc,trod UVOW Glenn known
to me and W me known) to be the individual named in and who executed the foregoing instrumealt and
acknowla(Itted to me thal she slened and sealed the same as it voluntary act and decd for the uses and purposes
therein mentioned.
IN WITNESS W111?RI30F, I ln;rvc hereunto set my hand and official seal the day and year first above written.
GRANTORS AI.)DRFSS:
Please Ret"rn to,
Mntanuckn Telcph.one Association, Inc.
1Zea)17stale and Properties Section
Box 1,550
Pa)mer, Alaska 99645
Nolary Pbli
uc in and for -
My comnlisMon expires;
GRANTIWS ADDRESS;
John W. Matthews &
Sandra A. Bartorillu
P.O. Box 670975
Chugiak, AK 99567
AURORA.PROPERTIES TEL No.907-688-1310 Mar. 3.97 13:27 P.04
FT I IF A HU Lkl.,
i
STATEMENT OF NON-O13JECTION FOR ENCROACHMENT
WITHIN tjiTILITY EASEMENT
Matanuska Electric Association, Inc. (MEA) hes no objection with the location of a
IwpTI JgTANlPW_E within the utility i3esement along the WF, Sy boundary of the
following property;
I_ot 2, MCCOWEN SUBDIVISION, ac4ording to plat #67-Q45, Anchorage Recording
District, Third Judicial Distriet, Staw of Alaska.
TIS N, R1W, Sec 6
This non -objection is conditioned by the stipulation that MEA will be held harmless from
any and all damages to the encroachment that may result From the existing and future
use of Said oasernent.
Matanuska Electric; Asso fation, Inc.
13y:_ visak r
_G-
General Manager or is Represe tative
_ February 26.1997,_,
Date
MEA At:KNOWLE.DGMENT
sTATE OF ALASKA )
THIRD JUDICIAL DISTRICT )
I IIV Iwr yawns - -- r.-...._..._ .. y,.
Eft bru .ryL,19997ertnxiohm.-
M' W OWS ORWANONOW2.00T
Notary Public for the State of Alaska
My commission expires:
NOTARY PUBUC
PATRICIA A. MCROREM
$TATE OF NASKA
Cl IL rs. Lo
5. LEGAL DESCRIPTION
MUNICIPALITY OF ANCHORAGE (/��° / J�
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT poNN LAS
- - 825 L Street - Anchorage, Alaska 99501 MUNICIPALITY OF ANCHORAGE
DL -PT. OF h,EAL'(ii &
IRONMENTAL P:i>TECTION
0*
ENVIRONMENTAL ENGINEERING DIVISIONV.
Telephone 264.4720 Utile
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE E A ES
AR - -
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER
PHONE
Richard M. & Kay Larkin
688-3119
MAILING ADDRESS
General Delivery Chugiak Alaska 99567
PROPERTY RESIDENT (If different from above) - -
PHONE
Lot 2 Mc Gowen Sub.
--
X1 INDIVIDUAL* 87'
2. BUYER -
PHONE -
John Mathews & Sandy Bartrillo
694-9225
MAILING ADDRESS - -
P.O.B. 1324 Eagle River Alaska
3. LENDING INSTITUTION
PHONE
AHFC F" ��.,, b Age, V,
`�
❑ PUBLIC UTILITY
MAILING ADDRESS
C_Yao� SG�r.>'p
4. REALTOR/AGENT - - - -
- PHONE
Kathy Geraci
694-9125
MAILING ADDRESS
P.O.B. 633 Eagle River Alaska 99577
5. LEGAL DESCRIPTION
Lot 2 Mc Gowen Sub.
STREET LOCATION
Mc Gowen St.
6. TYPE OF RESIDENCE
NUMBER OF BEDROOMS
;EI SINGLE FAMILY
❑ One ❑ Four ❑ Other
❑ Two ❑ Five
❑ MULTIPLE FAMILY
IM Three ❑ Six
7. WATER SUPPLY
X1 INDIVIDUAL* 87'
*ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY_
depth (attach log if available.)
B. SEWAGE DISPOSAL SYSTEM
_
in 11/79
� INDIVIDUAL/ON-SITE**
**upgraded
Ifindividual/on-site, give Installation date -8__.
If system is over two (2) years old an adequacy test is required
❑ PUBLIC UTILITY
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
U � ^n n
�T C a -L
M-po r _ G
w.A 4-`--u. qd E
(,,SJV Gera
14-QQ,
c I
THIS SIDE FOR OFFICIAL USE ONLY
-
INSPECTION APPOINTMENTS
DATE RECEIVED
TIME
TIME
TIME
DATE
DATE
DATE
INSPECTOR
INSPECTOR
INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL 7 0•
DATE DRILLED
6
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON -SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATEINSTALLED
INSTALLER
1
❑Septic Tank or ❑ Holding Tank
Size: /0 063 If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTUELER -
E
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELL T0:
-Septic/Holding Tank -
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
tyJ"APPROVED FOR 3 BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE
BY (Titl
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
t
CL
J0 4 i
DFF _ f villi%j I I'I iki.TI; aI_-i:i:;.•
June 17, 1981
Richard Mt.,/Kay Larkin
General. Dc--�livery
Chugi_ak, Alaska 995.0-7
Subject:: Lot 2 Mc Gowen Subdivision
Before an approval_ may be cri-anted to !:Ah(-, lending ctgency,
1 -he following items will need to be completed:
(l.) Locate the well and sewer system sei. -vincj "-.he tr.ai.le?r
directly behind you. We than can dei:ormi le i_ they
meet the protective radius r_equ.r.ements bet.ween a
water supply and an on-sil::e sewer system, If 1 -hey
are the proper distance away, tau fol;.owinq wi.l.l
need to be comp eted:
(a) Install a cleanout: to the sepLic- tan],
(b) The sept-ic tank pumped with a receipt subrni.tted
to this office.
(c) An adequacy test needs to be performed on they
existing leaching area. This test: will determine
if the system is adequate according to National
Standards. A .-Listing of private fiL-111s performing
the test is enclosed. 'Phis report needs to be
S Llt)1➢ jA-Led to this office for- our review.
(2) If Lhe sewer and wager supply are wi,thii') the protective
radius, then one or possibly both systems would need to
be relocated. if your well or sewer needs to be relocated,
a permit wi_11 need to be obtained from this office. Pr-ior
to a sewer X'T"I t]. t. being .issued., a soils :e„f: will need to
be obtained so 'that a new system can be designed.
If there are any further quest:.i.ons, please call this office
at 264-•472.0.
Sincerely,
Rober_L C. Pratt, R.S.
Associate Special.isL
4fq TgAYOiAGL ASfA
S`F ay,
u
s
LeiD
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received 5/21
Time of Inspection 10:00 �m
Date of Inspection —5 LV 4
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
1. Approval requested by: Alaska sank of, Comim rre
Mailing Address: 3purti 7012 An rage Phone: 27g_�- pYr 21
2. Property Owner: Ronald Schwiger Phone: 333,0176 _
Mailing Address:
3. Legal Description: ice• 2. N1cGnwan S���j�����i�10Y1 __
4. Location: North Birchwo d (Loon Read —
5. Type of facility to be inspected ale Family No. of bedrooms 3 _
6. Well Data:
A. Type
Drilled
B. Depth 87'
C. Construction Above Ground Well House D. Bacterial Analysis Satisfactory
7. Sewage Disposal System:
A. Installed 1963 B. Installer Self
C. Septic Tank: 1. Size 1000ag llons 2. Manufacturer Mc Gowan -
D. Seepage Pit: 1. Absorption Area 2. Material
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Septic tank 801
._, Absorption area Sewer Lines
Nearest lot line Other contamination
B. Foundation to septic tank , Absorption area 20'
C. Absorption area to nearest lot line
EQ -034 (1/74) Page 1 of two pages
Page 2 of two pages - Req--,st for Approval of Individual 5,.,ver & Water Facilities
Legal Description Lot 2 Mc Gowen Subdivision
Comments
Disapproved
Date 6/5/74
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
EQ -034 (1/74)
Date
rfi REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AND WATER FACILITIES
(Fill out in Triplicate)
_ Name .of person requesting approval.
V 2, Name of propertyr owner
gal descri do --'Z (J�
3. Le p ����
4, Number of ,bedrooms in house A0 Cr y+ "L �,A>
\� C
5. Water, --Analysis:
a. Bacterial
b. Detergent ,
M
6, Well data:
a. Type Vlc% L f cep �.
b. Depth--
c. Casing Size
d, Distance from well to closest existing or prop
4v 1, Sewer line
yI 1
2, Septic tank-
,lY 3. Seepage Areaol`j
4. Cesspool' \
5. Property Line
6. Other sources of possible contamination, i.e., creeks, lakes,
houses, barn, drainage ditch, etc, ,
7. Sewage disposal system,
a. Age of system �� 2 -AIW ,
b. Septic tank capacity in gallons
c. Name of septic tank manufacturer - C7n ,.
I. If "home made" show diagram on r v rse-side)of this form.
d: Disposal, field or seepage pit size and type_
1. Distance to property -line_ ---Y to house foundation `'ls?
e. Percalation Test results
f. Percolation Test performed by
Use the reverse.side of this form to
he following information: property
`13eptic tank location, disposal area
an� direction of ground slope.
9. The Information.on this form is true
show diagram. Diagram should include
lines; -well location, house location,
location, location of percolation test,
and correct to the best of my knowledge.
S Fna.ture of Applicant Date M--ned
0
TO BE FILLED OUT BY HEAL'T'H DEPARTMENT PERSONNEL
=-The above described sanitary facilities are hereby approved, subject to the
".following condi-tions:
Conditions:
The above described sanitary facilities are disapproved for the following
reasons:
CPJ:cw
0 �
July 170 1910
Vc;t2ranns Administration
P.O. box 1399
A nchoraLu, Alaska 99501
SUBJECT: SOWCr and Water
facilities for Houser oil
Lot Z, h;#:(3owen : ubolvisioil
Dear `Sirs:
At this ruquctst of air. Lyle E. Joiarsoal, an iasj�ecti.on was waac!c,
of: the sewer and water facilities for the subject hawse.
'DIV suF:rr systen consists of: a septic tank and drain ficl(i
which !;tvm this Department's approval.
In tilt L110 toll) Of the well c:asiini, is located in ai y;i.t, tfif
ill' Kill& well docs ►lot p-t(,cat tilts Departr»ont's ai+irrcwaal.
3ilci lollowiii;•, i.ri,trovc;i±tents to W)v wV11 [+lust bo done in order
to insure a potable water supply:
1.. l xtund titc well casing 11" alb= trio, surface of the
i round.
2. Bacifill the well pit with air:polvious soil.
1. A tCrQ.iEaif ing altoraLions. marc: cciiplutc, sanitize thv
W011. Call this Departirc iat: for information on well
sa"itizativu if needed.
4, Install as sanitary seal on toil of tho well ciasi.nt.
when the a bovo i.irTprclvvt4ilts have bvuia r3aasic, 23mthcr insptactiol,
of the well will be wheduled. for Information or assistance,
please contract this ON=
siacorely,
CLIFIDko V. JUDNINSI R,6,
Au'll-i.liistratalvo Wroctor
by:
w'f1r( .'j. l a3Fit;Wlll
Sanitarian
n
cc: Lyle h. Juhnsoll
David r Associates