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US SURVEY 3200 LT 12B1
Onsite File US Survey 3200 Lot 12B1 #090-041-46 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221269 PID Number: 090-041-46 Dwelling: ❑® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New [M Upgrade Name ANDREW BROWN ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bedound Site Address 500 INDIAN ROAD *INDIAN, AK El Other Phone Number of Bedrooms Soil Rating Total depth original grade 907-317-3116 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot U.S. SURVEY 3200; LOT 1281 Fill added above original gr Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total orption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well 100'+ 25'+ TANK [I Septic 9S.T.E.P. El Holding [I Other :J Manufacturer Capacity GREEK TANK 1500 Gal. Surface Water 100'+ Material Number of compartments Lot Line 5'+ NA HDPE 2 Foundation 10'+ LIFT STATION Manufacturer Capacity Remarks PER CONTRACTOR OLD TANK HAULED OFFSITE G R E E R TANK *500 Gal. "2ND COMPARTMENT OF 1500 GALLON STEP TANK Alarm location Electrical installed by 'S Lr LW_k, I rv, ofz-P D Rte' ,'-0 Installer PIPE MATERIAL House to tank D3034 Tank to drainfield SCH40 WILCO EXCAVATION Drainfield D3034/EXrsnNc Co/MTD3034 Inspector GARNESS ENGINEERING BENCH MARK (Assumed elevation) 96.61 ft Inspection 1" 6/6/2023 2 - da:3b Location and description - 4th - TOP OF MH1 ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Qo600p4� ,==1� O F Approval: Date ° / 49 ��D Dp.._.:... � ....\........ Q� D 17D Septic Syste / Approved Date ��� ......... �.Jb rey A. arness p ��� CE 7953 Op �d�Ole$J'�z3 � No : this approval does not include well permit requires nts 4�DOOpO���o #AECC884 kn V vowu ion/ PERMIT NUMBER: RECORD DRAWING W I N O PARCEL ID NUMBER: OSP221269 090-041-46 OTE: PIPE LOCATIONS ARE SHOWN PER GEG SHOTS TAKEN WITH LEICA DISTO S910 LASER DISTANCE METER. SWING -TIES TO HOUSE CORNERS WERE GENERATED IN AUTOCAD. T •.•� i:.• '.,. r DRIVEWAY . .� ...•. -+ • i. ..� . f i • 4 If r U r r o r \ 10' TELE. ELECTRICAL EASE__T__�_ �1ENT L ` _ DBL1& MH1 ANCHOREASEMEO MH US SURVEY 3200 LT 12A-1 EXISTING 3 BEDROOM HOUSE / /—EXI 1500 GALLON STEP TANK A_�p ENGINEERING s SALES t, CONSULTING 3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, A<99507' PHONE (907)33M179- FAX (907) 336-3246 • WEBSITE: ww,v.games gin mg. . PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ANDREW BROWN 907-317-3116 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: US SURVEY 3200; LOT12131 D.J.G. TYPE OF WORK: DATE: �,_ SEPTIC TANK RECORD DRAWINGS 6/21/2023 US SURVEY 3200 LT 12C-1 DRAINFIELD I I US SURVEY 3200 LT 12C-1 DRAINFIELD 1"=40' d_ 1 ............9 'E ........................ i LICENSE #AECC884 �I..• .il•. ............./ l ey A_, Ga nesse n -a J�AV C -79 W ftESS\Ctti'' A 1"=40' d_ 1 ............9 'E ........................ i LICENSE #AECC884 �I..• .il•. ............./ l ey A_, Ga nesse n -a J�AV C -79 W ftESS\Ctti'' PERMIT NUMBER: OSP221269 RECORD DRAWING (Z". TOP OF TANK AT INTLET = 89.14 INVERT OF BUNG AT INLET = 88.47 TOP OF MANHOLE #1 = 96.61 MH2 PARCEL ID NUMBER: 090-041-46 TOP OF MANHOLE #2 = 96.74 NEW 1500 -GALLON GREER TANK WITH ANCHORAGE TANK PUMP PACKAGE TANK HOLE WAS DRY DURING EXCAVATION - GROUNDWATER WAS NOT ENCOUNTERED FINAL GRADE = 96.11-96.18 TOP OF TANK AT OUTLET = 89.16 . OF 4 j W' ....:.... 49 ......... `... V� • ........• •....:.`.� I♦- ; J ey .. am s c �- i C 7953 ' :�! 411111. ENGINEERING , SALES CONSULTING _, .. N.:. .,.,.fi 3701 E. TUDOR ROAD. SUITE 101 'ANCHORAGE, AK 99507' PHONE (907) 337-6179' FAX (907) 338-3246 - WEBSITE: w ga ssengineming cum PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ANDREW BROWN 907-317-3116 3 OF 3 LEGAL DESCRIPTION: DRAWN BY: US SURVEY 3200; LOT 1201 D.J.G. TYPE OF WORK: DATE: %,._ PROFILE OF NEW S.T.E.P. TANK 6/21/2023 . OF 4 j W' ....:.... 49 ......... `... V� • ........• •....:.`.� I♦- ; J ey .. am s c �- i C 7953 ' :�! 411111. MUNICIPALITY OF ANCHORAGE on -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http-://www,muni.org/onsite Permit Number: OSP221269 Work Type: SepticTank Upgrade Tax Code Number: 09004146000 Site Legal Address: US SURVEY 3200 LT 12131 G:4455 Site Mailing Address: 500 INDIAN RD, Indian Owner: BROWN ANDREW M 50% & Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: 171 Disposal Field Z Septic Tank 11 Holding Tank El Privy Effective Date: ZMEMMM III C n t p"g epa -tin t 7125/2022 7/25/2023 32967 n Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By: Date: Date: MUMCWAU TY OF ANCHORAGE Development Services Department p P Phone: 907-343-7904 On -Site Water a Wastewater Section - Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 090-041-46 Property owner(s) ANDREW BROWN Mailing address 500 INDIAN ROAD *GIRDWOOD, ALASKA Site address Legal description (Sub'd., Block & Lot) USS 3200; LOT 12131 Legal description (Township, Range & Section) Day phone 907-317-3116 Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION 1S AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial Single Family (SF) ❑ Septic Tank ® Upgrade Q (w/wo AD U) Holding Tank ElRenewal ElDuplex (D) El Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: a Waiver Fees: Date of Payment: 7 15 6-2 Date of Payment: Receipt Number: p0 b `a 5 C-1 Receipt Number: Permit No. 51 �a ��c� Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTennit Application.doc a Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221269, Rebecca Carroll, 07/25/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221269, Rebecca Carroll, 07/25/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221269, Rebecca Carroll, 07/25/22 V) F Qo m 0) 0 N, -,I? I 0'6 C6 C14 c C; 4; w 0 o6 x x !,-6 O z < ti 82 t2z m LJ :2 C) z—J - w 0 co (N z < 0 m < Li Jt CL 0 ui —20 x z � .tr�gz V) F Qo m 0) 0 N, -,I? I 0'6 CV clq c C; 4; V) F Qo m 0) 0 N, O c C; 4; U) 0 0 E cL Z 0 > LJ :2 C) z—J - w 0 co (N z < 0 m < Li 0 CL 0 ui 0 x 0 "0 Z w 0 0 U) 0 0 0 c r: _j w o E -F'i.2 V) F Qo m 0) 0 N, O c C; 4; 0- 0 0 E cL C > r 0 m 0.0 CL 0 0 2 CL E t o 0 0 "0 so 0 "0 E 0 0 U) 0 0 0 c r: x o E -F'i.2 , , rn.0 +-C.0 -i r- o to r -O r 0 C4 os m 6! -6 oo -0 '0 CL 0 o 0 c .,C 6 r p .0 —Z o 03: to 0+ 0 C "a 0:5-Y r— 0— 0 "0 oa o 0 0, 0 'a X 0 41 U) CL 04z -o C,4 0 c > Fn a as 0 m 0 0 CL OO c z 0 cl: :E o' E! :; m CL 0 r- 0 Tt w o 0 m— Lo ce tl E "o 0 C'j 0 SCOL M 2 a 'c c me CLID E MO.- 2Oc E 'r —_ EqEf E 0 00 0 0 E a 0 — > 0 c: 0.0 0 a Jeff Garness From: Andrew Brown <ndrw.ak@gmail.com> Sent: Tuesday, August 1, 2023 5:06 PM To: Todd Houston Power and Light Inc Cc: Sonja Blewett; Philip Almeter Power and Light Inc; Jeff Garness Subject: Re: Septic Lift Station Andrew Brown 500 Indian Rd The exterior alarm extends through the wall to a small interior panel with what I assume is a speaker. Sent from my iPhone On 2 Aug 2023, at 6:05 am, Todd Houston Power and Light Inc <powerlightak@gmail.com> wrote: Hello Sonja, There is an exterior control box with an alarm . I do not know if there is an interior alarm. Andrew may be able to answer that question. He is out out of State, but is included in this e-mail. <IMG_1198.jpeg> Todd Houston Power and Light Incorporated 907-522-5678 907-745-5609 MatSu powerlightak@gmail.com On Aug 1, 2023, at 9:56 AM, Sonja Blewett <Sonja@garnessengineering.com> wrote: Is there an interior alarm hooked up inside the house? Sonja From: Todd Houston Power and Light Inc <powerlightak@gmail.com> Sent: Tuesday, August 1, 2023 11:53 AM To: Sonja Blewett <Sonja@garnessenginee ring.com> Cc: Philip Almeter Power and Light Inc <philalmeter@gci.net>; Ndrw.ak@gmail.com Subject: Septic Lift Station Andrew Brown 500 Indian Rd Hello Sonja, We recently connected new floats and pump for an existing/updated lift station for Andrew Brown at 500 Indian Rd. Is there any thing else he needs for approval. Description of our work below. 7-19-23 Trace existing control circuitry for lift station and connect to new floats in the new lift station holding tank. Trace existing power for septic pump and connect to pump in the lift station holding tank. Test Alarm float for operation . Test pump float and pump for operation. All is working. Municipality of Anchorage Page I 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: -C~W c~,-~,O~":~ PID Number: Name: '~,~-i'¢-"( ~ ~.~ ~~ Wastewater System: ~ New ~ Upgrade Address: ~1~ ABSORPTION FIELD Phone: ~ __~ ~o.o, Bodrooms: ~ D Beep Trench ~ Shallowlronch ~B00 D MounO D Other Total Oepth from od~inal LEGAL DESCRIPTION Soil Rating~¢~ ~ ~,c7~,[ · ~ ~ GPD/Sq. Fb ~ ~ -- ~ Lot: Block: Subdivision: Oepth to pipe bottom from original g~ade: Gravel depth beneath pipe Township: R~nge: I Section: Fill added above original grade: Gravel length: I Number of lines: I Bis~a%e between lines: WELL: ~x:CT~ew D Upgrade O,~,~l.id,h: I¢' Ft ~, g' Ft. Classification ~v~te, A,B,C): Total Depth: Cased TO; Total absorption area: Pipe material: ~ Driller: Date Drilled: Static Water Level: Installer: Date installed: ~M ~b [~TANK SEPARATION DISTANCES ~ s~p~ ~ Ho~di,~ ~ S.T.~.,. TO' Seplic Absorption Lif, ,old,ng PubEc/Prwate Ms~,aoturer; ~ Cspscdy i..~ From Tank Reid Stalion Tank Sewe¢ Lines ~0 ~ Number o¢ Compartments: Well IO~' I0~I ~¢~' ~ ~ Material: %T~ Surface ~ I w~t~, /0o¢ tOO~ too'+ h LIFT STATION LOt / Size in gallons: Manufac urer: ,I Curtain Pump Make & Model I Electrical Inspections performed by: Remarks: ~1S?1~C¢ T&~ A~P ~r~,* BENCH MARK Location and Description: I Assumed Elevation: Inspections performed by: S,S - Dates: lst~Z~'"~'~(..~.~:; 17034 Eagle River Lo~ Road Ne.Q~nd /O-¢~-~2 ~.~¢% ROGER j&SHAFER Department of Health and Human Services approval ~ ~ o,~ Reviewed and approved by: ~ ~ Date: //~/~--¢~ 72-013 (Rev. 9/91) MOA 25 Permit No. kW' ~/ZOL~ Page ~2 of. 2_ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 on-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: PID No.: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT NUMBER:SW920357 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:DERDZINSKE ROBERT A & KAREN S OWNER ADDRESS:HC 52 BOX 8804 INDIAN, AK 99540 PAGE 1 OF PERMIT DATE ISSUED:10/19/92 EXPIRATION DATE:10/19/93 PARCEL ID:09004146 LEGAL DESCRIPTION: US SURVEY 3200 LT 12B1 LOT SIZE: 32967 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: TOPSOIL AND SEEDING MUST BE COMPLETED PRIOR TO FINAL APPROVAL BY DHHS. RECEIVED BY: ~ DATE: ISSUED BY: DATE: ROBERTSHAFER, P.E, ROGERSHAFER, P.E. CIVIL ENGINEERS October 12, 1992 (907)694-2979 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECT[ON ENGINEERING STUD]ES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, AK 99519-6650 REFERENCE: Lot 12 B-i, USS No. 3200 We request you issue a permit to upgrade the septic system serving the referenced property. An adequacy test was performed on the existing system and the absorption capacity of the system was found to be inadequate. A test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information for your review, please contact us. Sincerely, Roger J. RJS/LSU/lsu ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 /"= SCALE I N. T.S. SCALE DETaiL Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 ~W Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT ~ ~ DEPTH? P E SITE PLAN Depth to Water Alter Monitoring? Gross Net Depth to Net Reading Date Time Time Water Drop PERFORMED BY: $ & 5 E~'J~ i~l~r~. ~ ACCORDANCE W~T~'~4~¢~ ~d~r,~i~'~8-a~L~s ~N EF.ECT ON TH~S DATE. DATE: 72-008 (Rev. 4185) Eagle River, Alasl~a 9957~' PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN .'~ FTAND ~ FT CERTIFY THAT THIS ~EST WAS PERFORMED IN Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DE$CR,PT,ON: /-----CT ,/.'2. ~-/; (JS.~'~;?~T°wnship'Range'secti°n: SLOPE SITE PLAN 4 WASGROUNDWATER ENCOUNTERED? IF YES, AT WHAT DEPTH? 6- 7- 8- 9- 11 13- I4- 15- 16- 17- 18- 19- 20- S~ Oeplh Io Water Ail r..e,L MonitorinD7 L)'~L ,V Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER -- TEST RUN BETWEEN FT AND FT COMMENTS PERFORMED BY: $ & $ E~GiNEE~]NG. .. I ~ CERTIFY THAT THIS TEST WAS PERFORMED IN 72-008 {Rev. 4/85) , ~ 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 MAILING ADDRESS . LEGAL DESCRIPTION DISTANCE TO: ~ ~ Liq. capacity in gallons~ / Inside length Width Liquid depth IF HOMEMADE: ~ ~ DISTANCE TO: Well/ . Dwelling PERMITNO. O ~ ~ Manufacturer Material Liquid capacity in gallons ~, DiSTANCE TO: WelI/~)Z~ + Foundation.7/ Noarostlotiine/~, PERMITNO. Trench width Distance between lines ~'7 g Materi~b~neat h tile Z(~ inches ~ ~o. ofli~es ~ ke~tho[oacbline lot.ll.n~thoJlines ~ Top of tile to flnish grade ~ ~ inches Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth TotaJ effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Zn~i (/~ Depth j~5~ / ~ [/~,//1~ Distance to lot line PERMIT NO. ~ DISTANCE TO: , Buildin~,~foundation/ Sewer line Septic tan k/o~ Absorption area(s}~/~ OTHER 72-013 , ~.~ MUNICIPALITY OF ANCHORAGE f'.') DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ! ~,~) ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON.SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PH, ONE MAiLiNG ADDRESS~ ~ ~ i '~ M,n,f,cturer A/ 0 ~ ~ Materi,I No, of comp,rtment, Liq. capacity in gallons IF HOME~DE~ / In~ide length Width O ~ ~ Manufacturer /~' Materla~ Liquid capacity in gallons . OTHER ~ O~.~L'~~,. ~ ~ - 7~.013 (Rev, 3/78) PERMZT NS: DATE APPL.: I CANT: ADDRESS ,".. CSNTRC'T F'HONE: Ll~. G Al... DESCR IP: LOT MAX BEDR88MS ~] 86 (),':2'.89 08 / :i, 8/86 NANCY CANA]:Y F'~8,. BOX :~6]. G:[RDW88D, AK' 99587 653".-72',7 ,,.*c,C ,d.¢hh :1.22 'I'SNNSHIF'." :IN ............ ~.(SQ. F'f'. OR ACRE,--*-) ,.LOT,: 1~ BLOCI.., RANGi~:: iW L..',-'4~ .,~..~--,,.] ........,'"' f-..- ,'" '_w- at'e t. he op~..] or~s- - ' ' ' - avaz ].able' "'~.o vou. in designing youp sept :i.c ':~>/=-~'e:~'-', Choose t. he opt ion tha'L best ~_[ -:~ ,lOUt'. s'i'Le,, DE;PTH '10 F'!PE BOT]"Ofd (F"I%) 4. 0 zt.. 0 4,, 0 r.:)RAVEL DEF:'TH (F'['.) 4,, 0 O. 5 :3.5 TCITAL DEPTH (F"f.) 8.0 4.5 7,,5 8RAVEL. W]:DTH (F'T.) 2.5 :1,7,,0 5.0 GRAVEL. L.IENGTH (FI.) 47.0 34.0 41.0 GRAVEL. VOL_LIME (C[.}~ YDS. ) 19.6 2:[. 5 30,, 4 ]"ANK S I ZE (GALS) 1, ()CK). 0 ~'~- 1,000,, 0 -~'~' 1,000,, 0 ~a~- SO]:L RA-FING (S[],,F:T. /BR) 125 125 125 ¢¢-'t~' I'ANI< MLIS'I' I-I¢~vE: A'T' LEAST TWO [.,OMFARIMI:N ,~ cei" ,1:. i f y 'Lhat: 1,, ~],, w:i.'l;.h {.he PequJ. r'(-;.)m~:,l]t!~ for' ctr]--s:i.t!.~-:, s6?wePs and wells a~ se'l:. {cu',t'.h by the hh..n.[i....:~,,,1.~. _y of An~_hc.u ¢.~(]F2 (l'-18A) arid 'Lhe 8rate o£ Alaska. ! ~,,,ci.].l :i. rts'La].]. 'Lhe system ~.n ac:cc, r'dance w_'i. tl'~ all MCIA codes artd Pet~u:l. ations arid in cc)mi.']].J_~:d]c(.}) w:i.t.h the r.:l~:~esi(:lt'] dJ.~Ftt, afli:~a~] fPOB1 any 6~:.x:i. sting t*¢[]ll, ~aste~,~a'Le[' d:i. spcsal sys'Lem or' publ:i.c sewerage s'ys'Lem on t. ). ~ of any adjacent of near'by lo'L.. ] unc:IE.f's'Land that 1:.his ~36 'n 1: J.s va],J.d fop a max:i, mum of' 3 bedpooms arid any f~:.r~].aF, gemenL wi],], peClLtJ, pe a~.r'l adcli'L:i, or~a], per'm;i.t. :iF A I...:[F:"I" STAT:I:ON ~S INS-r'AL.L..E:O IN AN ~..~[~E.~...~ L,OVE. R.z.D BY MOA BLIIL.DIN8 CODIES, il--!t:::.l,l (1) AN ELECTRICAL f [...~M.[1 AND INSF'ECTION MUST BF: ]B"FA]qED; (2) A,:r-.EII]LTc W!I.I.. NS'f BiE ~-*l-'f-,'*U ,[:b W:['i"HOUT AN EL.ECTIRICAL INSI:::'IECTION REF:'OI:]T~ AND (:~.~) THE ......... ............ NAME MUNICIPALITY OF ANCHORAGE ' DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVlRONIVlENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT MAILING ADDRESS LEGAL DESCRIPTION LOCATION DISTANCE TO: Manufacturer Liq. capacity in gallon I Absonsti~ a/rea Inside length NO, OFBEDROOMS PERMIT NO~ ~'~/ No. ~.J~compar tments Liquid depth IF HOMEMADE: Well Dwelling PERMIT NO. DISTANCE TO: Manufacturer Liquid capacity in gallons Foundation Total length f lines Material beneath tile Depth Crib depth Building foundation Driller D,aTANCE TO: No. of ,.es I b.ngth o1 Top of tile to finish grade Length Width Type of crib Material Nearest lot line /d/7 Trench width ,~inches inches Well DISTANCE TO: Depth DISTANCE TO: Building foundation Sewer line PERMIT NO. ~9__0S.~/ Distance between lines Total ef~ti~a~orptlon area PERMIT NO. Total effective absorption area Nearest lot line Distance to lot line PERMIT NO.~ Septic tank Absorpt on area(s) OTHER PIPE MATERIALS DATE 72-013 (Rev. 3/78) LEGAL L("FT ,'.: 'r "::'r.-' --,":'":,"'"':'<' 'I'FIE': F.'.EQLiIF~tEE:, ':::'rzt:: "'- THE S0iL ,tL,_,Lh-..P, I,JH ........... L,- , _.. ,::~,,::.'-~:,:, r Sh.':E';TEH!._,-":". THE LENGTH E:,Ih'IEN:[~i'C$,! I25 THE _E:NGTH FIN FEE:T::, OF THE '~'~",'-~ F',J '"- THE E:'EEF'-I"H OF f~ TF:ENCH CF? F':ET Z2; THE[.''J.;:,l ........ d',.,_[:' ,-,~..,,~..-,.E:'[:'T ~m'p'i,.j THE E:IJF~tF'FIE::E: OF' THEE 'THERE THE L3F;tFFv'EL DEPTH T': THE: ~',"ri' T~','II~ ............. :[:' _._ ]_,1~ I... 1 [.:,~:.F'!PI OF CiF:FI'v'EL. E',ETHEEEh~ THE OLI'TFFILL ~ ].r ,.. FINE:, TF.IE E~OT-FEff'! OF THE: E:qC:FWRTIE~N (iN FEET::,. F'EFtHZT Fi!:::'F'L. ICFd'.~IT H!::r5 'I"HE F..~:.::,FL.I',!:,I,_,.[L...?~ "F'C! .,,F,._F. Ft 'TH?:-Z, .... F *h. lit:., I :[ N:E;'I"F:iLLFFF Z ON Z/.f:J;F'E3Z'T ;[ ON:.E; "*F '" ,.I,, . ......... ' .... H~,,T I.,iF'LI '; FiE:,..)'FN;CENT 'I'0 TH]:S F'ROPE:!;:T'¢ tflr',lD "I'HE hiIJHE:LEFI i-IF $?r:,:'~--~', ...... ,:' ,.r , .......... ;E.,J¢.,E..., THFFF THE HELL. HZNIP!Ijhi E)Z?%TF!!qE:E DETHEEN F~ HEL.L RND FII"~'T' O,N'-E;ITE :SEHRGE L":'I:E;F'OSRL El'eSl'EH ::LE~E~ FE:ET FOF'. FI PR!VFiTE: i.4ELi._. OR t59 TO 2.8(~ FEET F'ROPI FI PUE',LIC HELL [:'EPEENE:'ING LIP(3N THE T'T'PE OF F'UBLZC 1.4ELL. H~NZHL.fH D;[STF~NCE FF'.OH Fl PRZ',/FFTE HE:LL TO R F'?.:[',,,'FFTE E;EHEF'. L. ZNE Z:5 25 FEET TO F! COHHL!NZT'¢ SEHER L. ZNE ZE; 75 FE:ET. HEL. L LOGS FIRE F:E:E:!IJZREE:, FIN[::, HUST BE RE'TUF'.NEE:, "f'O THE DEF'F!F'.THENT !.4]:'FHIH 3E~ DR"FS OF THE HELL. CEd'IF'L.E'.TT[ON. OTHEF: REQLI ]:F:EHENTE: I'!FFF F:iF'F'L.'~'. SPEC:[ F':E(?RTZ OF,!f; FIND C:ONS'f'RLICT ~ ON E:, Z F!GRFff'!S RRE Fi'-,,'RZLRBLE TO ;ENSURE F'F:OF'EF: !NSTRLLFfTZEii"L _T. FOF~?,'H [3'¢ 'TFiE idUN!'C)]F'FIL:[T~'/ OF Fd",ICFIORFIGE. 2.: ! HILL ZNSTRLL THE S'T'E;TEH :[N RCE:OF?.DRNCE HITH THE CODES. Z: Z UNDERE;TF!N[:' THRT THE OH*'"SZTE ~¢EI.qER S'¢S'T'EH r'!F:FT' f;'.EC!UZRE ENL. FIF'.GEHENT tF THE RE:SIE:,E:NCE ZE; REHODELED, TO :[NC:LLiDE HORE THFff4 ]: Z.z,.z,_.IE!..~ E¢'? ................................ D~TE ............... ',,,'q.. C~ E:ERTIF"¢ THRT _ '"" ....... hL .:,E. F 'r RI'"! FFIH Z L Z R?. 14 -, ~ H THE FE:Et;:~I_.i ST/~]LEY BRUST/~D ASSOCIATF?~, ~GII~E_RS SURVEYORS PLANNERS 1610 Dimond Drive, PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8- 9- Phone 344-~4 Anchorage, Alaska 99507 SOILS LOG - PERCOLATION TEST SLOPE [~'fSOILS LOG [] PERCOLATION TEST DATE PERFORMED: ~//6~ ~ SITE PLAN '10 11 12 13 14 15 16- 17- 18- 19- 20- ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE minutes/inch TEST RUN BETWEEN FT AND -- FT COMMENTS PERFORMED BY: ~ ~ ~ / DATE: 72-oo8 (6/79) ."11- .- Development Services Department f' Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval ( I Parcel I.D. 090-041-46-000 Legal description US SURVEY 3200 LT 12131 Site address 500 INDIAN RD Indian AK 99540 Expiration Date: 1 1 Current property owner(s) BROWN ANDREW M 50% &MCMILLAN SAMANTHA H 50% X The On -site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Az Original Certificate Date: 8/24/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 090-041-46 Complete legal description US SURVEY 3200; LOT 12131 Location (site address) 500 INDIAN ROAD *INDIAN, AK Current property owner(s) ANDREW BROWN 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 907-317-3116 3. TYPE OF WATER SUPPLY: X Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: N Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel A Plastic ❑ Concrete ❑ Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS FE -1 Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Waiver Fee $ Date of Payment % _ - -z' Date of Payment COSA # (is <' 2 12.6 Waiver # COSA AppllcaUon_June 2022 I1k COSA Checklist Legal Description: US SURVEY 3200; LOT12131 Parcel ID: 090-041-46 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA AN Well log is filed with Onsite (or attached) Date drilled 8/4/82 Total depth 185 ft Cased to *60 ft X Sanitary seal is functioning correctly Q Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 4/24/2022 Static water level at beginning of test 133.6 ft. Comments B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping N/A ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 10/24/1992 0 ALL standpipes present per record drawing Total measured depth from grade 3.9 ft (max) Measured depth to pipe invert from grade ft (min) Q N/A — pressurized field. FN Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced - gallons date Any rejuvenation treatment (past 12 months) If yes, enter date - Well production at time of test 7.3+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes Q No Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ED Arsenic less than MRL (ND) Collected by uCu Date (0 12-C'1-03 C. LIFT STATION ❑ Required maintenance completed Age of lift station NEW years Lift station material PLASTIC Comments: Adequacy test date 4/24/2022 Results Q Pass Fluid depth prior to test 0 in Water added 665 gal New fluid depth 0 in Elapsed time 0 min Final fluid depth 0 in Absorption rate 450+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 in Effective depth used *0 in Effective depth remaining 6 in Comments/Deficiencies: 'THE EXACT DEPTH TO WHICH THE MT EXTENDS BELOW THE INVERT IS UNKNOWN AS THE FIELD IS PRESSURIZED PER GEG INSPECITON MTi, MT2 AND MT3 ARE WITHIN 3 INCHES OF EACHOTHER, HOWEVER, MT4 IS ABOUT 6 INCHES LOWER THAN MTi COSA Checklist June 2022 ra E.' SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' M Yes if No ft 0 Yes if No ft Neighboring Tank > 100' R Yes if No ft Private Sewer/Septic Line > 25' ❑■ Yes if No ft Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No ft 0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' D Yes if No ft Q Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' Fsk! Yes if No Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' ❑o Yes if No ft Wells on Adjacent Lots: On Yes if No * ft Private Wells > 100' no Yes if No ft Community Wells > 200' ft 0 Yes if No ft n Yes if No ft Water Service Line > 10' Q Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *PER INSPECTION REPORT IN MOA RECORDS G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Garness Engineering Group, LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Gayness Date o /-) Z? 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 systems. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the systems; 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. COSA Checklist—June 2022 " �H :. .flfA ..m ss..: ..... • er v.,.G a {J 9 Cit—,' t),S LICENSEE W7 .Or Of es SIO #AECCW4 618970 0 77 G E B:3 tf .1 t, of Anchorag `,t°2 On-Site Water and Wastewater Program — - (907) 343-7904 a JUN 16 2017 A F E " Certificate of On-Site Systems Appr• •I Parcel I.D. 090-041-46 Expiration Date: 7 1. GENERAL INFORMATION: Complete legal description U.S.Survey 3200; Lot 12B-1 Location (site address) 500 Indian Rd. *Indian,AK 99540 Current Property owner(s) Loma Ruckel Day phone 885-5680 Mailing address 500 Indian Rd. *Indian,AK 99540 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex El Multiple Dwellings (Single Family and/or Duplex) 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 El Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: : Date: CP(2 3 /1 COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5a Waiver Fee $ Date of Payment (e/Igl 11 Date of Payment Receipt Number 0 Receipt Number COSA# 656/91 aL13 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: Gamess Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507 J / Engineer's Printed Name: Jeffrey A. Garness Date: b/ i b/ / 4- r e�oQaoOp�, In conducting this evaluation,GEG provided an engineering evaluation of the well and/or septic system o OF A , 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 Qp Q-.• '•s�OCIOn evaluation. Separation distances were measured to readily identifiable features. Hidden defects or • 4 `` 9 r . CIO encroachments may exist that were not identified during the evaluation. The operational life of all wells ' , ,• VVjy� and septic systems depend upon a variety of variables, including but not limited to, soil conditions, Q �r •••••• groundwater levels (that may fluctuate during the year), quality of construction (materials and 4 workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and 1' } are outside the control of GEG. Satisfactory test results do not guarantee future performance of the fr�'•,J ffr Y, A. Gain•ss••• system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of QO; a c 95� the well or septic system. GEG makes no representation whether an alternative well or septic system Q can be installed on the property in the event either of the current systems fail to perform adequately in � �, .-•6 the future. The content of this report is for the sole benefit of the person/party that retained GEG to %Z: profess1o• nes perform the evaluation. Reliance upon the information provided in this report by any other person orOOP' party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE 3 System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved ;c\( OF AIvC Conditional approval for bedrooms, with the following IOi lations: '>Q = ON-SITE m WATER ANU WASTED\IATFR c �, PROGRAM •✓ Q _1 l/J/ y y: L Lt.f. �t�1�- Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska, The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_10-10.12.doc 618970 • If m• _e,than se.14 system is on the lot: ,,nn O"A Checklist # of JU�trtciur 'ibry 4•y this system Certificate of On-Site Systems A . •val Checklist CL 68 � Legal Description: US SURVEY 3200; LOT 12B-1 Parcel ID: 090-041-46 A. WELL DATA Well type Private If A, B, or C provide PWSID# N/A Well Log (YIN) Yes Date completed 8/4/1982 Sanitary seal (Y/N) Yes Wires properly protected (Y/N) Yes Total depth 185 ft. Cased to 60 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 8/3/1982 6/8/2017 Static water level 100 ft. 135.4 ft. Well production 2 g.p.m. 6.8 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 1.52 mg./L. Collected by: GEG. Ltd. Arsenic: ND<5 ug./L. Date of sample: 5/24/2017 B. SEPTIC/HOLDING TANK DATA *Pre-tank double cleanouts. Tank Type/Material STEP Date installed 10/22-24/1992 Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) Yes Foundation cleanout (Y/N) *No Depression over tank (Y/N) No High water alarm (Y/N) Yes Date of pumping 5/31/2017 Pumper A+ Home Services C. ABSORPTION FIELD DATA *Below Existing Grade Date installed 10/22-24/1992 Soil rating cp.d./for ft'/bdrm) 0.7 System type Bed Length 36 ft. Width 18 ft. Gravel below pipe 0.5 ft. Total depth *2.9+ ft. Eff. absorption area 648 ft' Monitoring tube Yes Depression over field No Date of adequacy test 6/8/2017 Results (Pass/Fail) **Pass For 3 bedrooms Fluid depth in absorption field before test **0 in. Water added**1634 gal. New depth **0 in. Elapsed Time: **0 min. Final fluid depth **0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) None Known If yes. give date - **Based upon an instrument height of 100.00, the bottoms of the MTs were as follows: MT1=89.64, MT2=89.46, MT3=89.81, MT4=90.08 (All MTs remained dry throughout the adequacy test) i ALV hT5 w Estes rr`-"' Ir giNP-LLEA *Second compartement of 1250 gallon STEP tank. **Per MOA inspection record, dated 11/5/1992. ***STEP tank floats were set to the correct factory depths and an interior alarm was confirmed to be functional, per Bev at A+ Home Services on 6/16/2017. D. LIFT STATION Date installed 10/22-24/1992 Size in gallons *415 Manhole/Access (Y/N) Yes "Pump on" level at***42 in. "Pump off" level at***42 in. High water alarm level at ***44 in. Datum Bottom of Tank Cycles tested **3 Meets alarm & circuit requirements? **Yes E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100' On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway. parking/vehicle storage 10'+ Curtain drain None Known Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION �� �F.... NN .,:til 7. I certify that t have determined through field inspections and i ,�' ` 9 " •,�Q�4 review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this // date. V L 1 . . QO •_J. - A. ar ess: Engineer's Printed Name JEFFREY A. GARNESS 1° 795 ep • I ' 4self ...11b / „W Date j �' 44�e0.professi0n.c #AECC884 (Rev. 11/05) }40 - Sc0.i e\ OF'At v\1 / �n S8o 11'05"E s11 / 0 ioe:s/A, i �a '; ® 21 5.2812L. 4, .4.4, Thomas H. Dreyer• #i 4" ¢' f 1 Lt14'Q LS-7825 is ��` °* ' 1 arage Shed 0 a / tul p - rss ,ek Y-/ AP Q; ( - 15.5 36.3 •, E r 29.3�_ I �� • 6ati a�. i __.- ra Noose IC3 1 04 q G. on.. f £'` 1 a w 1 . l of 1o. r �- r it j f Lot 12B-1 I in to' e, _ • _ _ l f , f (., N79lel & Elect Eosr+ ` ' f10' ci / 49'56"W mens -- -I I Ea "(3O' Anchc, 87,17• f-c_ _semen t C� 3 / 140 f 7 © O N / 1 15 N79'S1 oO..W 0 Cs) st 20561. 0 S4 Legal Description. Legend' Tom H Dreyer,P.L.S. Survey Certification: AL. Monume-•: 124E 7th Avenue I hereby certify that a Mortgagee's Inspection wos performed Rebar 0 fleY Anchorage,Alaska 99501 on the described property Asbuilt well Notes: Septic 8 Group (907)306-8104 It is the owner's responsibility to determine the existence of mail@S4AK.com any easements, covenants, or restriction which ore not on 7�� Grovel the recorded subdivision plat. This asbuilt sholl not be used Lot 12 B-1 USS 1 V O. 3200 Overhang Lana Surveying for construction or for establishing property lines. Land Development Consultants - -- Wooc Deck Sutxlvwsion Specialists 'coked by. THD Scale 1" = 30' Drown by. CB Grid 4455 ---. Ganslrucllon Sllrvey.n Job 2017-50 plat 81-267 Field Book: 141 Date: 6/13/2017 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. HAA # 1. GENERAL INFORMATION Complete legal description USS 5200 Lot 12 B I; Location (site address or directions) .,4 mil~s Indian Road Property owner P,o/~¢¢.t ¢ ~-~=~ ne~d,s-*~° Day phone 276---573~ .................... h~ 653-7713 Mailing address~C 55 Box~8_¢O4 ~,H~,~ ~b~ 9q540 Lending agency Day phone Mailing address Agent Day phone Address 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well XX Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: XX Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 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 5 & S ENGINEERING Phone 17034. Eagle I,~iver Loop Roar] No~ 204 Address E~,gle River, Alaska 99577 Engineer's signature Date t \ - ~ ~'~ ~ DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~025 (Rev. 1/91) Back MOA #21 Legal Description: Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST .~Ct/-4.U~,~ ~¢)-6~O,, L.oq' I~L,¢-I Parcel I.D. A. WELL DATA Well type ~'L[U~'7~-- Log present (t~N) Total depth Sanitary seal ~/N) If A, B, or C, attach ADEC letter. Date completed Cased to Wires properly protected (~N) ADEC water system number 8- 6~- ~;2- Driller "~-~y Casing height ~/ FROM WELL LOG Date of test ~;~- Static water level Well flow Pump level g.p.m. AT INSPECTION m g.p.m. ~ O ~ ~ SEPARATION DISTANCES FROM WELL TO: Septic/i-~g tank on lot 10(:> ' Absorption field on lot ]O~t Public sewer main /~//~ Sewer service line ¢-~r-~ ~ + ; On adjacent lots / ; On adjacent lots /~ Public sewer manhole/cleanout ~-)//~ Petroleum tank ~ / T~ WATER SAMPLE RESULTS: Coliform (~ Nitrate Date of sample: {C'2-/~>~¢~~.- Collected by: Other bacteria B. SEPTIC/IC~I~G TANK DATA Date installed Cleanouts (~/N) -~WC~ High water alarm ,~,)'N) Date of pumping Tank size I ~;)'-~'~O Compartments Foundation oleanout (~YN) ~'-nc_ q-~.~z. Depression (Y/~ Alarm tested (Y/~ SEPARATION DISTANCES FROM SEPTIC/N~¢ti~i¢.~ TANK TO: Well(s) on lot lO(:>4 On adjacent lots [00 ' To property line ! ~ Surface water/drainage Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ANALYSIS RESULTS for INVOICE ~ 59746 Chemlab Ref.! 92.5814 Sample I i Matrix: WATER FAX: (907) 561-5301 Client Sample ID PWSlD Collected Received P~eeerved with USS 3200 LOT 12 E-1 Client Name :S & S ENGINEERING UA Client Acer :SNSENGP OC~ 16 92 @ 14;55 hre. BPO~ : OC? 16 92 @ 16:40 ks. Req~ : AS REQUIRED Ordered By :R. SHAEER PO# :NONE RECEIVED Analysis Completed : OCY 19 92 Laboratory Supe~-~lsgr ~ ~ C. EDE Released By : ~"~ ~ Send Reports to: I)S & S ENGINEERING Parameter Results. Units Method Allowable Limits Sample ROUTINE SABLE COLLECTED BY: Remarks: 1 ~ests Performed See Special Instructions Above UA-Unavailable ND= None Detected *' See Sample Remarks Above NA- Not Analyzed L~=Leee Than, GT-Greafe[ ~han ~SGS Member of the SGS Group (Soci~t¢ G~n~rale de Surveillance) MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address or directions) (b) Property owner Mailing Address Telephone: (home) . Business (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent /¢~Z?-/"'~'~?~?~ ,.. Address .~ ,/ ~ ' ~ - ' ~ (e) Mail the HAA to the following address: (or check here ~f hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family E;;?"' Number of bedrooms. 3. WATER SUPPLY Individual Well [~" Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 5, ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in comp!iance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. ~ Name of Firm Address Telephone 6, DHHS APPROVAL Approved for ~ Approved ~ bedrooms by ~//~.~~~' Disapproved Conditional Terms of Conditional Approval 'f;l*il['ii The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 M u n ici pality of Anchorage is not responsi bid for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88} Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE ENVi[Z. ONMEN'rAL SERVICES MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: ~d', ~,..Y, OCT 2. 6 ]988 RECEIVED -/ A. WELL DATA Well Classification /~r'/,¢'~-~ Well Log Present (Y/?. ~" Date Completed Total Depth /~'?,.~-~ C~sed to (¢ O" Cepth of Grouting Static Water Level /-~ 7 ~ Casing Height Above Grou"d ~ Electrical Wiring in Conduit (Y/N) .~/'~'_ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ./0.~.-~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments :h J~(~/-~-~,--,~ I~A, B, C, D.E.C. Approved (Y/N),~ , Yield ¢.~, ~ ?~'/;¢ Pump Set At (..~.,../Z:~ ,~ -~ ,~ Sanitary Seal on Casing (Y/N) ,~-' J Depression Around Wellhead (Y/N) ~' ~' ; On Adjoining Lots ~'~*~'~"- ¢,.,,~y /a-o ' ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole B. SEPTIC/HOLDING TAyK DATA ~. .'~ Date nsta ed ~/~ /~'~ Size /~'~ No. of Compartments Standpipes (Y/N) ~ ~,.~" Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) /v//~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Wate?Supply Well /L>..~ ~ ¢~ ('~- ~. To Building Foundation TO Property Line //2/ ' '~' To Disposal Field TO Water Main/Service Line ~>'~'~ ¢~-~'/- ~r~ .: ~/~'-~,,/~'/~'// TO Stream, Pond, Lake or Major Drainage Course / Comments .'~ ~..,~.~,_.,~.~ ,/'~ ';' ~ 7% /, ,/ Foundation C aJe~onout (y/N) :/~ ;for Temporary Holding Tank Permit (Y/N) 72-028 (Rev. 7/88) Front C. ABSORPTION FIELD DATA Soils Rating in Absorp.tlon Strata Date Installed ~?/4..¢,~ '~ Width of Field ,~ ('~ // "~ Square Feet of Absortion Area .. Type of System Design // ~/ Length of Field Depth of Field Gravel Bed Thickness Depression over Field (Y/N) Results of Last Adequacy Test ,%~7~'(¢~'~'?1, SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~..'~,~,¢/ /O O / To Property Line ~" To Building Foundation i~/ ' ~' To Existing or Abandoned System on Lot /¥/.~ , / ~ ,; O~Adjoining Lots ,./.'1/.¢¢"- /o0 / To Water Main/Service Line ~¢ ~-/,/-/." -¢ ~ ¢/g~.~/////¢ To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ;->~ ~?,.._~.,.,... ,/.¢' ~ ,z2 Statndpipes Present (Y/N) /g ''~ Date of Last Adequacy Test / ~//~ ~/'~'~/ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked~ verified, or conforn.~e,d to all MOA and HAA guidelines, i~e~fect on the date of this inspection, .~./'.,~.,,/-~,/~ ~ ~/)/~'/ ~,:; 0 !' ~:~ ! '~'~ · ; ..... ..... ...... Engin r' S .l ..... Date Receipt NO. ~S~O'~/ ~ ~ ~ Receipt No Date of Payment /~ "-~ -~/~ Waiver Fee: $ Amount: $ / ~¢. O(~ Date of Payment 72-026 (Rev 7/88)B~ck Page 2 of 2 ~ CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. /~-~\-- ~ ~ ~ ~,~..'L~.'O~;,;~,E~'~,~ FEDERAL TAX iD # 92-0040440 ANALYSIS REFONT BY SAI~LE for Work Order g 9977 Date Report Printed: OCT 25 88 ~ 09:41 Client Sample ID:LI2, Bi USS 3200 PWSID :UA Collected OCT 20 SE ~ 20:30 h~s. Received OCT 21 88 PresezYsd with :4 DEG. C Client Name : BRUST & ASSOCIATES Client Acct : ~RUSTAT P.O.~ NONE REC'D Req % Ordezed By : S. BRUST Analysis Completed :OCT 21 SE Send Reports to: Laboratory Super¥~or ,:STEPREN C. EDE 1)ERUST Q ASSOCIATES Released By : Special Instruct: Chemlab Re£ $: 3132 Lab Smpl ID: I Matrix: WATER Allowable Pazametez Tested Result/Units Method Lir~ts NITRATE-N 1.2 mR/1 EPA 353.2 10 Sample ROUTINE SAE~LE Remarks: SAMPLE COLLECTED BY i Tests Periozmed See Special Instructions Above UA=Unavailable ND= None Detected '* See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT-Gzeatez Than BRUST & ASSOCIA'FE~. ENGINEERS . PLANNERS ~ SURVEYORS 1610 DIMOND DRIVE ANCHORAGE, ALASKA 99507 FIELD PUMPING TEST DATA SHEET PROJECT: ~ LOCATION OF ~IELL (Legal Description): N£LL DEPTH:. /~"~"-FT. CASING: · DATE OF TEST: .,/ FT SCREEN: ,"--~,/~,,~,' ~ DRILLER: STATIC WATER LEVEL (Top of Casing): / I Elapsed Time Sincel Clock Pumping Started/ Depth to Drawdown/ Pumping Remarks · .Time Stopped, Hin. Nater, ft. Recovery Rate, GPM · f;e/t~' , o /~ ? (s,~,l) o o Sta,-t 21~'(3~ hours)Ii - , 2~P (4 hours).J ' RRUST & AsSoCIATES1 Engineers - Planners - Surveyors Project NO. ~/~'~ Adequacy Test Log ~egal Description /:--/_7 - / No of Bedrooms Date Time Level Readings' Remarks septic tank APPLI(-"NT FILLS OUT 'UPPER HA(-'"ONLY Address Zip Code Lending Institution /~ ~ A Phone Realty Co. & A~nt Phone Address Zip Code LegalOescript~n ~ ~ -~ /~0~ Type of Resi~nce ~ Single Family ~ ~ultiple Family No. of Bedroo~ Waler Supply ~ Individual A~AC~ WELL LOG. A w~l log Is requi~ed for all wells drilled since June 1975. ~ Community For wells drilled prio~ to that date, give well depth (attach log if available). Sewer Disposal ~ Individual Year Individual Inslalled: ~ q ~ Public ~ilgy Wken Connected to Puklic Utility: Time Time Time Time D.te Date O~te ~ .~ ~ .~ .os& 7 to~ A Inspector Inspector Inspector [(~3~1J~ ~ ( ) DISAP~OVED ~AWN BY ~ A~SKA - I hereby certify that I have surveyed the following described property= ~,~c~,,FR~'Recordlng District, Alaska~ and that the Imp~ovemente situated thereon are within the property lines ahd do not overlap or er~croach on the property lying adjacent thereto and that no improvemente~on property lying adjacent thereto encroach on the premlsee in question and that there ore n0 roadways, transmission lines or other visible easements on this property except as indicated h.9,[eon. Dated ~AI,askathls '~ . BRUST ~ AS$OCIATE_$ Registered Land Su.rveyqes (~,%~,, MUNICIPALITY OF ANCHORAGE 'I~,4~ ~'I DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL HEALTH CASE REVIEW WORK SHEET [] PLATTING BOARD [] PLANNING & ZONING CASE NUMBER NAME //~ S=5632 USS #3200 Lo~ 12B-1 DATE RECEIVED COMMENT TO PLANNING BY ~0~IC SEWER N~ AV~B~E PETITION AREA% , ' . ' ,7- z ,' ~ U~'" 71-014 (Rev. 2/78)