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HomeMy WebLinkAboutMANOR LT 5Manor Lot 5 #050-671-47 A)II II Municipality of Anchorage �' "LA ;j T i. On -Site Water and Wastewater Program • (907) 343-7904 Page ON-SITE WASTEWATER INSPECTION REPORT MAY a® 7 050 671 47 Permit Number: D PID Number: Dwelling: X Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑■ Upgrade Name: JAY BELMEAR ABSORPTION FIELD ❑ Deep Trench X Shallow Trench ❑ Bed ❑ Mound Address 18956 INSPIRATION ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 6 GPD/SF 6.2 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.8 Ft. Gravel depth beneath pipe 2.4 Ft. Subdivision Block Lot MANOR 5 Fill added above original grade 0.5 Ft. Gravel length 25 Ft. Township Range Section Gravel width 5 Ft. Beds: Number of Lines -- Distance between lines -- Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line 192 Ft2 1 -- Ft. Well +100 +100 -- __ +25 TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑■ Other Manufacturer ORENCO Capacity 11500 Gal. Surface Water +100 +100 -- -- Material FIBERGLASS Number of compartments 3 (ADVANTEX) Lot Line +10 +10 -- -- NA Foundation +5 10 __ __ LIFT STATION Manufacturer _- Capacity __ Gal. Curtain Drain +50 +50 -- -- Remarks EXIST TANKS ABANDONED PER Pump on level at -- in. Pump off level at -- in. High water alarm at -- in. MOA CODE. DESIGN REVISED PER CO1 . Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 Tank drainfield 3034 Installer GUARANTEED SERVICES Drainfield 3034 CO/MT 3034 Inspector C&M ENGINEERING BENCH MARK (Assumed elevation) 100 ft Inspection15' 11 /3 11 /9 Location and description dates: 2nd 3`d 11 /9 4.h STAIR LANDING COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineers Stamp ' OF Al "III Conditional Approval: Date ��'-yev ✓ C!' - TH * 49 .......... i 1....:' ......................... RLES G BAIZARINI Q,% No. CE -13854 %�2�'j +, tPROFESS����� Approved� �C��yu-� Date 10/11 18' --��-�',� Inspection Report_9-1-12.doc AW' ..... H • ES G BALZARINI ]DRIVEWAY E-13 X� MANOR LOT 6 PROFESVO t (NO WELL ON—SITE A B C 28.8 31.5 NEW 1500 GAL D 12.1 473 BM STAIR LANDING ADVANTEX TANK W/ AX -20 4 BR j POD HOME C NEW LEACHFIELD 5'x25' TH—SS 87 TH KN D 100' NEIGHBORING WELL RADIUS 00 NO EXISTING CONCRETE SEWER ROCK WITH TANK/SEEPAGE PIT/CRIB NEW IN 5' OF SYSTEM ABANDONED IN PLACE AND FILLED LEGEND 0 CLEANOUT EXISTING e MONITOR TUBE DRAINFIELD TO REMAIN Z TEST HOLE PLAN SCALE: 1" 819 (BOH) _Vo.4 SCHEMATIC ELEVATION — SCALE: NTS LEGAL DESCRIPTION: MANOR LOT5 C&M ENGINEERING SERVICES OWNER: JAY BELMEAR I DATE- 11/12/171 REV: JDRAWN: CB REF: 907-854-5558 SEPTIC RECORD DRAWING MONITOR TUBE A N LUE BOARD INSULATION 3U T 0 +100.0' STAIR LANDING 9 7 4 FILTER FABRIC�A [17-4 R C FABRIC A FINISHED FINISHED SHED GR' GRADE GRADE TESTHOLE SS '87 97.3-\ 18, COVER 96.9' ORIG. GRADE 3' COVER 93.1 INVERT 0,7 1 89.7 90.7 NO GWT AT THIS TESTHOLE 89.7 ON 6-6-87. A TESTHOLE 1500 GAL ADVANTEX TANK 4"0 DISTRIBUTION PIPE WAS NOT EXCAVATED DURING POD NOT SHOWN 2.4' EFFECTIVE SEWER ROCK S CONSTRUCTION. 819 (BOH) _Vo.4 SCHEMATIC ELEVATION — SCALE: NTS LEGAL DESCRIPTION: MANOR LOT5 C&M ENGINEERING SERVICES OWNER: JAY BELMEAR I DATE- 11/12/171 REV: JDRAWN: CB REF: 907-854-5558 SEPTIC RECORD DRAWING Or"401 MUNICIPALITY OF ANCHORAGE ! On -Site Water & Wastewater Program AM— -' ') PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 % http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP171338 Work Type: Septic Upgrade Tax Code Number: 05067147000 Site Legal Address: MANOR LT 5 G:0254 Site Mailing Address: 18956 INSPIRATION CIR, Eagle River Owner: BELMEAR KENNETH J & AMY E Design Engineer: C & M Engineering This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 11/2/2017 11/2/2018 41370 Q Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing timp ecial Provisions: A test hole shall be provided at time of construction to confirm six foot separation to ermeables. No-% re�,.i nod (C.O # 1) 4 1/0 $/ Zo 1? CC) Rev '5e -f-k.I-1k [�rr'er� {�o� 4- dr �l L C..7A`0,j due --/ old sego h c / S w �em ode`s co vereol &,Y- or,', OYDpOSPcv �OCa'f7o7� �Oz G� Received By: Issued By: kLu'r &-- Date: / 4117 Date: 1 11-2A) 0 Municipality of Auch®ragc °'� r P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 o Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV171138 COSA#: PID#: 050-671-47 Legal Description: Manor Lot 5 Engineer: C & M Engineering Permit#: OSP171338 Applicant: Jay Belmear cv#1 Your request for a waiver of the required 50 feet horizontal separation from the absoip�field to the excessive slope has been approved. The approved separation distance is20_0 feet. In addition, your request for a waiver of the required 10 feet horizontal separation from absorption field to absorption field has been approved. The approved separation distance is 5.0 feet. See engineer's waiver requests and profile drawing for justifications. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. ............................................... ■ t ...... 0 a M 0 M M ........... t .... ■ 1 Waiver is Granted: X Waiver is not Granted: Date: 1142 1.2 D 1 -7 Approved by: wj_e� "14 d &'1Z"VZ Name of Reviewer **** VARIAN C E/WAIVER REVIEW **** MUNMPAUTY OF ANCHORAGE ".'!it Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 050Lf 7 Property owner(s)% Fj 0441 C—#4R_ Day phone f594 Mailing address l Si TA1cP1P_6X'_-n/ Site address l 1695& 2AIC, PXP-4--7 -_T'a^� Legal description (Sub'd., Block & Lot) _MA4V0,C_ (,07- 5 Legal description (Township, Range & Section) Lot Size fLL?, 7d Sq. Ft. Number of Bedrooms APPLICATION IS FOR: (® all that apply) Absorption Field Septic Tank K Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: Initial ❑ Upgrade Renew 6aL— 9 7, ti CC i 31 2017 THIS APPLICATION INCLUDES A VAR I'E / WAIVE yA\``e1Eg�g TYPE OF DWELLING: Single Family (SF) (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) QUEST FOR: Distance:O 5 I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. nature of property owner or authorized agent) Permit/Rush Fees: <Re9 Date of Payment: `��- Receipt Number: "5 (a Permit No. Qgp/;Lf 33 Permit App_9-1-12.doc Waiver Fees: t -2,(S _ Date of Payment: 101,31 Receipt Number: Waiver No. C&M ENGINEERING SERVICES Ph: 907-854-5558 Municipality of Anchorage Onsite Water & Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 RE: Manor Lot 5 Dear Reviewer, Co� We are requesting approval to install a new 4 bedroom septic system at the above referenced property. The property is currently developed, and the existing hdpe tank has failed. The Diverter valve appears to have selected both the original bed and the shallow trench system installed c. 2000. The bed was completely surcharged and the drainfield appeared to be near capacity. Due to the unique lot configuration, limited space, and a history of failed septic systems, we are requesting approval to install an Advantex system and new leachfield on the lot. The proposed system will require the approval of waivers. Waiver #1. We are requesting a leachfield to steep slope waiver of 20'. The leachfield will be installed in the flat portion of the yard. The slope varies from 25-30% below the leachfield location according to 1' contours provided on the municipality's website. The waiver is justified because the soils are free draining which will reduce the risk of effluent traveling horizontally through the soil column and onto the ground surface. This effect is further expanded since the effluent from the Advantex will not tend to biomat the leachfield. Erosion is not a concern at this location as the slopes are well established and vegetated. For these reasons, we believe the waiver is justified. Additionally, the waiver meets the following conditions found in the proposed code: I. Vertical separation distances below the disposal field are measured from the bottom of the drainrock at the up gradient side of the field. II. The trench will not exceed 60" in width III. Natural vegetation down gradient of the disposal field is stable and shall not be disturbed. IV. The distribution pipe invert will be 36" below the top of the natural organic ground surface at the lowest point of the downhill side of the trench. Waiver #2. We are requesting a leachfield to leachfield waiver of 5' between the new leachfield and the existing bed system. The bed system will be abandoned in place and long term interaction between the two systems is not a concern. The biomat beneath the bed will "heal" over time, preventing it from impacting the new leachfield over time. For these reasons, we believe the waiver is justified. Installation of the proposed system will not negatively impact adjacent lots, due to the relatively large lot size, and the fact that many of the adjacent lots are served by a shared private well. Drainage is not a major consideration in this design. DD#i Included with this letter is a permit application, plans, specifications, and calculations. A testhole was not excavated on this lot, however the design is based on soils log prepared by KND engineers in 2000, identified as KIND 00-1 and S&S in 1987. The KND test hole is greater than 30' from the proposed drainfield, but includes percolation test results, and shows no impermeable soils or groundwater to a depth greater than 14'. The S&S testhole was only excavated to a depth of 13' and the soils visually rated. If groundwater is encountered, the design will be modified via change order. Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854- 5558 or by email cgbalzarini(@gmail.com with any questions or concerns. Sincerely, Charles Balzarini, PE NOTES: 1. THE PROPOSED SEPTIC SYSTEM IS GREATER THAN: 100' FROM ANY PRIVATE WELLS 200' FROM ANY PUBLIC WELLS 100' FROM ANY SURFACE WATER 10' TO ANY PROPERTY LINE OR FOUNDATION 5' TO ANY TEST HOLES d MANOR LOT 4 SEPTIC AREA DRIVEWAY MANOR LOT 5 4 BR HOME 100' NEIGHBORING WELL RADIUS s 1-96JJ O) SEPTIC AREA OF Ak.4 • • •• HARLES GBALZARI�II ' CE -13854 •'`�/� F�F011 /8/17 11�_ pROFESSO MANOR LOT 6 (NO WELL ON-SITE) r NEW 1500 GAL ADVANTEX TANK W/ AX -20 POD AND DOUBLE AFT TANK CLEANOUTS �yTIE IN TO EXIST DRAINFIELD I (OPTIONAL) 4- DIVERTER VALVE (OPTIONAL) 1 NEW LEACHFIELD 5'x20' 2' EFFECTIVE. EXCAVATE ANY BIOMAT SOIL AND REPLACE W/1' MIN MOA SAND \1 00-1 VERIFY NO SEWER ROCK WITHIN 5' OF ,NEW SYSTEM MANOR 7 \ EXISTING CONCRETE TANK/SEEPAGE PIT/CRIB PUMP AND FILL W/SAND PRIOR TO BACKFILL LEGEND MANOR TRACT A CLEANOUT I NOT DEVELOPED MONITOR TUBE ® TEST HOLE 0.5% \ SLOPE INDICATOR 1' CONTOURS PROVIDED BY MOA EXISTING DRAINFIELD TO REMAIN - APPROX LOCATION OF EXISTING BED TO BE ABANDONED t N C&M ENGINEERING SERVICES 907-854-5558 LEGAL DESCRIPTION: MANOR LOT 5 OWNER: JAY BELMEAR DATE: 10/25/1 A REV:O 1 DRAWN: CB I REF: SITE PLAN C&M ENGINEERING SERVICES 907-854-5558 LEGAL DESCRIPTION: MANOR LOT 5 OWNER: JAY BELMEAR —DATE. 10/25/11 REV -.O 1 DRAWN: C§T—REF: SECTION ENGINEERING SERVICES 907-854-5558 type: shallow trench Septic Design Calculations Residence: Manor Lot 5 gpd/sgft '. Dd±tLCJ1tfiG1 number of bedrooms 4 br Water usage/bedroom 150 gpd/br Water Usage 600 gpd ft Per KND Test hole 00-1 (historic) no gravel depth (D) 14.42 groundwater to 13' @ S&S test hole Ground Water Table ft bgs •une Shallow trench factor ' ANK Tank Size 1500 gal, min Filter Pod WAX-20 system type: advantex type: shallow trench Application Rate 6 gpd/sgft required absorption area 100 sgft trench width (W) 5 ft gravel depth (D) 2 ft below distribution pipe Shallow trench factor 0.70 (W+2)/(W+1+2D) Min Required Length: 14 ft (Shallow trench factor * Required absorption area /W) Total Depth: 8 ft (on uphill side) Cover: 2 ft min Insulation: 2" blueboard Use Length: 20 ft ok Effluent Pipe: 4" ASTM 3034 "1 nom'" C&M ENGINEERING SERVICES Ph: 907-854-5558 October, 2017 A. GENERAL 1. The septic design is for a 4 bedroom, single family residence only. 2. The site plan and drawings shall be a part of this specification. 3. The Wastewater system shall be installed by a certified installer in accordance with moa requirements. All materials and workmanship shall meet the Anchorage Department of Health and State Department of Environmental Conservation requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage, Department of Environment of Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. A licensed surveyor should locate all nearby lot lines, easements, exact 100' radius from the existing and neighboring on- site wells, and any nearby surface water. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. Any remaining open test hole excavations shall be filled and monitor tube removed, after construction of the Drainfield. 9. The contractor shall provide the engineer with adequate notice to perform inspections. 10. Insulate the sewer line if it passes under the driveway or parking area, with a minimum of 2" extruded board insulation, rated for burial, and on the moa approved list. -rIqF_otzTAvk B. SEPTIC TANK 1. The new septic tank shall be of moa approved construction, and rated for standard burial. The Advantex system shall be installed in accordance with manufacturer's requirements and municipal code. 2. Install a foundation cleanout within 5' of the foundation. 3. Install 2 after tank cleanouts between the tank and drain field. 1. The Drainfield is to be located as shown on the site plan. Notify Engineer of any changed site conditions. 2. The total depth of the initial drainfield excavation is to be at maximum 5' deep Bottom of excavation shall be level +/- 1.5" max. If impermeable or inconsistent soils are encountered, notify the engineer immediately. Contractor shall check the groundwater table prior to excavation. 3. In the event of over -excavation, a moa filter sand shall be used to maintain the 6' separation distance from the bottom of each trench to the bottom of the test hole(s).The top of the sand layer shall be level, plus or minus 1.5", and raked, prior to placing sewer rock. Care shall be taken to not compact the sand. 4. A 2 ft effective layer of sewer rock is to be placed in the each trench. The effluent piping is to be set on top of this layer, buried with sewer rock, with 2" of sewer rock cover over the piping. 5. The Distribution pipe shall be 4" perforated pvc pipe conforming to ASTM D3034. 6. The complete Drainfield gravel and piping is to be covered with a geotextile filter fabric. 7. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the drainfield. Mounded side slopes shall not to exceed 3:1. The minimum insulation thickness shall be 2". Insulation shall be moa approved and rated for burial. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, or 200' to any community well. Design Summary: Excavation Depth: 5' at downhill corner, 8' max at uphill corner. Gravel Depth: 2' under distribution pipe, 2" over pipe. Drainfield Length: (1) @ 20' Drainfield Width: 5' Soil Rating: 6 gpd/sqft System Capacity: 4 Bedrooms OF VI* 9 T harles t. CE. AW LIZ, Aw �;90FESSjot� THIS MAINTENANCEAND REPAIR AGREEMENT onudoand entered into usofthis / ��. ' [)ovof ,,�v-�v"��,r of 20jj� by and between I herein the "OWNER," and the Municipality of Anchorage, herein the "MUNI ClPALlTY." }nconsideration ofthe Mutual covenants contained herein, the parties to this Maintenance and Repair Agreement agree as follows: i Advanced Wastewater Treatment Systems. Municipality grants permission to 2. Owner toutilize and operate aoAdvanced Wastewater Treatment System A\VVW7Sl,described uo 62VAN-i EX located at (legal description). Alteration. Any change to the design orftirctionofunAWWTS that includes the installation orremoval ofany purts,components orpieces not included inthe original c000kuotioupconitunddooign. Certificate ofOn-Site Systems Approval (COBA), /\oapproval bythe Municipality ofexisting water and wastewater disposal systems given at the time ofproperty sale and title transfer inaccordance with Anchorage Municipal Code (bcrcinuhc,,^ƒ\MC`) 15.65. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were ioplace udthe time ofsystem construction. Damage. Any man-made nrnatural change in asystem that would inhibit the system from performing usdesigned. Maintenance and Repair. The scheduled and unneeded replacement of existing parts, components and pieces ofou/\VVWT8that were included in the original design which would allow the /\VVWI8 |ocontinue io perform asdesigned. Permit. An On -Site Wastewater Disposal Permit as required by AMC 15.65toconstruct and operate an}\WYYTS. 3. Term. The term ufthis Maintenance andBcouir Agreementshall begin outhe date of approval by the Municipality to operate the installed system or issuance of a COSA, and shall continue while the AWWTS is in use or is operational or until the property is sold or title is transferred by the owner and a new COSA is issued to the new owner ortransferee of the property. 4. Alterations, Installation and Removal of Additional Eguipment. Prior to performing any alterations to an /\YVWT5, the owner agrees to obtain all On-site Wastewater Disposal Permit from the Municipality inaccordance with AMC 15.05. 5. Maintenance and Repairs. A. Throughout the term of this Maintenance and Repair Agreement, the Owner shall maintain their /tVVWTS iousatisfactory condition capable o[producing treated septic effluent ill accordance with the equipment's approval for operation inthe service and maintenance provider approved by the municipality and the manufacturer of the AWWTS for the entire term of the AWWTS. In addition, it shall be the responsibility of the Owner during the terrn of this Maintenance and Repair Agreement, and any renewals thereof, at the owner's sole expense, to pay for any and all: (l) repair(s), (2) ruuio1cnoncc, (3) adjustment(s), (4) replacement costs. and (5)inspection costs. B. Owner agrees to comply with all applicable ordinance, iuvvx, regulations, rules and orders for the /\YYYVTS. C. Upon request by the Municipality, the owner agrees to provide the Municipality a written schedule Of routine maintenance and repairs which have been performed onthe systecn. When record ofmaintenance isdocuonCutcdand maintained hv the system vendor, the owner agrees to allow the Municipality uoccae to this information. D. Owner acknowledges that the fine for failing to maintain and repair un/\VVVYT5 may heassessed inaccordance with AMC \4.00for improper discharge. E. Owner agrees that only maintenance and repair personnel approved by the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations tothe uyytmno. F. Owner agrees io grunt the Municipality reasonable access (otest and inspect the /\WVVT5upon 24hours written notice. G. Owner agrees that any sale octransfer oftitle ofthe property will not occur without onew Certificate ofOn-Site Systems Approval. B. Owner agrees that tile &nYWTSinstallation and maintenance nquirementsus provided by thc&WWTS vendor/iostoUerund approved bythe Municipality are the governing guidelines for the construction, maintenance and repair ofthe Owoer`sAWVVTS. |. Owner agrees to provide and maintain mtelephone connection k`the /\\YWTS as required bythe /tYVWTSapproval. b. Nonwaiver. The failure of either party at any time to enforce uprovision of this Maintenance and Repair Agreement shall inunway constitute uwaiver ofthe provisions, nor in any p/uy affect the validity of the Maintenance and Repair Agreement or any part hereof. or the right of such party thereafter to enforce each and every provision hereof. 7. Amendment. A. This Maintenance and Repair Agreement shall only be arnended, modified or changed byuwriting, executed by authorized representatives of the parties, with the same formality that this Maintenance and Repair Agreement was executed with, and such writing shall bcattached tothis Maintenance and Repair &gnucnocntosonamendment. B. For the purposes of any amendment modification or change to the terms and conditions of this agreement, the only authorized representatives of the parties b. Municipality: Director. Community Development or designated auth2Kj!j C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance and Repair Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Maintenance and Repair Agreement. 9. Severability. Any provisions of this Maintenance and Repair Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Maintenance and Repair Agreement. OWNER: By: (signature) Date: %I 6i,j(print name) STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT ) The foregot}'ng instrument was acknowledged before me this I day of NG;embe C , 20 1-1 , bv_4 -(N--I rnear ARY PUBI It� FOR ALASKA ,o►,isgion expires: of /x31&:31 MUNICIPALITY: By: :MYtt�S CDk_�A (signature) 1\ 9.6 C Co.. Cay r o �� (print name) a, "Official Sear Notary Public 1 Justine Diemert State of Alaska commission# 170123013 EXP 07123!2027 Date: 1 2 2,0 11 Title: Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On -Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.ci.anchorage.ak.us (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: _'56'O00(f 2 PID Number: 950 - loll - ri% Name: Wastewater System: E] New N Upgrade 040154 RUds Address: ( N ra off c zZ[Je� k. a ABSORPTION FIELD Phone: Number of Bedrooms: O Deep Trench CifShallaw Trench o Bed ❑ Mound ❑ Other: LEGAL DESCRIPTION Soil Rating: Or Total Depth from odginal grade: GPD/Ft F1. Block: Lot Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: 1y C'"ar /-/,QFt. G tp FI. Township: Range: Section: Fill added above riginal gmtle: Gravel Length: 3 FL 8 7 Ft. Well: E]New ❑ Upgra Gravel width: S O Numberaflines: C Distance between lines: _ r FL F1. Classification (Private, A, B. C): Total Depth: Cased to: Total absorption area: Pipe Material: Ft � F1` / I i Duller: Dale Drilled: Static Water Level: Installer: o Dale Installed: Fl. - Irwel Pr1 (p _/V-00 Yeld: Pump Set at Casing Height Above Ground: TANK GPM Ft. FI. SEPARATION DISTANCES I& Septic []Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Holding Public(Pdvat Manufacturer: Capacity: From Tank Field Station Tank Sewer Line sO L( {-AN� f% G ( (J (7 Gal. Well ��qq�n 1� 100'4 ��nn ��*+�� (12,54 _ f� (VD fi Matenal: S Number of Compartments: Z Surface Water fp0'.f (dv'f - - LIFT STATION y Stoe: Manufacturer: Lot Line U` r .)- �r � Gal. 'Pump on"Ievel at: "Pump or at: High wateralarm at Foundation �� r -)' to T in. in. Pump Make 8 Electrical Inspections performed by: Curtain Drain (00 ji� (00 .f- Barrel; BENCH MARK < g•e cx �k.�z G GI � w Location and Description: - Assumed Elevation: / r R Ft. Engineer's Stamp OF 4k ee a e °o 2 let 6-/3_0 Inspections performed by: ��l% �Nfa/N��r triCy Dates: 1 O E�lv e:4�. `=,i �✓S _. O, .&rad (9 i Department of Health and Human Services �approva Qz4 ,, by: 0.0////./ Ce' 7116 a °•.p Reviewed and approved W _ Date: (Rev. 11/99) 9�� o•C`c�� AS -BUILT SYSTEM DETAILS/SITE PLAN Permit SW000112 MOUNTAIN MANOR S/D, LOT 5 PID#050-671-47 A e of 3' cut bank - ----------------- o A B 4 BDRM M F Conne fletd w/dIver e SFD #KNDOO To of St pe Id HS&s A LOT 5 SCALEi 1' = 50TRAJ Aw, OF ...... *4 . ......... TH *49 * ' * ... .... ............... ... �TETH M. DV.Fi '' CE-7118KM A; . ... ... .... WA 87' 6 WELL PREPARED FOR, GORDON BUDD LOT 5, Mt. MANOR S/D EAGLR RIVER, AK 99577 FIELD BOOKS COWPUTED: A—C=25.8' (:9 =4.4 7 9 �45 AMU: DAM' JOHNSON 6-15-00 B—C=25.7' L ACAD R' 99093.DWGI JW N-: 99093 (907)696-6111/FAX (907)696-8111 A—D=26.6' B—D=27.5' nn n mA96.5 FORIGINAL GRADE 92.9 n A—E=28.4' MF� M l, v B—E=31.0' A—F=21,8' 1250 GAL I ox B—F=46.9' SEPTIC SEPTIC Z9.4 89.50 89.50 A—G=102.0' TANK TANK SEWER ROCK B—G=72.2' 89 8 8 892 85.51 85.4 Aw, OF ...... *4 . ......... TH *49 * ' * ... .... ............... ... �TETH M. DV.Fi '' CE-7118KM A; . ... ... .... WA 87' SCALEi NTS 76.44 PREPARED FOR, GORDON BUDD LOT 5, Mt. MANOR S/D EAGLR RIVER, AK 99577 FIELD BOOKS COWPUTED: ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 MNDMY* JOHNSON �w: VBG STmNc* JOHNSON IHICM: KMQ AMU: DAM' JOHNSON 6-15-00 DM. HM' MO: NW254 L ACAD R' 99093.DWGI JW N-: 99093 (907)696-6111/FAX (907)696-8111 IK14DD ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-8111 June 15, 2000 Municipality of Anchorage Dept. of Health & Human Services On-site Services Section P.O. Box 196650 Anchorage, AK 99519-6650 RE: SEWER PERMIT/ LOT LINE WAIVER — MANOR, LOT 5 Gentlemen: During the as -built process we encountered a problem with the system being in close proximity to the lot line. Subsequently, we verified that the system was constructed within 10 feet of the property line (see attached as -built drawing). The system is still located within the testhole radius and we do not expect there to be any adverse effect on adjacent lots by the location of this system. We are therefore requesting a waiver to 6 feet to lot line at this time. Additionally during the construction of the system, the owner decided to increase the size of the field. Accordingly you will note that the system is 29 feet longer than originally designed. The material remained consistent during excavation of the trench. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, KND Engineering Z Kenneth M. Duffus, P.E. Attachments: As -built System Details/Site Plan Inspection Report HAA w/ waters KND Engineering ATTN: Kenneth M. Duffus, PE 20441 Ptamigan Blvd. Eagle River, AK 99577 - June 22, 2000 Subject: Waiver Request for MANOR LT 5 Waiver # WR000040 Lot Line Request for Parcel ID 050-671-47 Dear Engineer: Your request for a waiver of the required 10 feet horizontal separation of the on-site wastewater disposal system to the lot line has been approved. The approved separation distance is 6 feet. This waiver approval applies to the current on-site wastewater disposal system and lot line separation only. Any fixture upgrade to the on-site wastewater disposal system and lot line will require all separation distances to be met or another waiver approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, Jeff Poet Engineering Technician III On -Site Water Quality Program MUNICIPALITY OF ANCHORAGE Department of Health & Human Services On -Site Services Waiver Review Worksheet WR#: WR000040 PID#: 050-671.47 HA#: HA990587 Permit#: Date Received: 06-16-00 Legal Description: Manor, Lot 5 Engineer: KND Engineering 20441 Ptarmigan Blvd., Eagle River, AK 99577 Applicant: Gordon Budd .......... Waiver Requested: 6 foot lot -line waiver Criteria: 1. Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: 2. Special Conditions: 3. Other: Waiver is Granted: Waiver is not Granted: List Conditions or Reasons for above: Date: h - Z P_ -b n Rec#: 6505 Amount: $115.00 By: Q" , /w/. O e of eviewer Date Paid: 6/16100 I MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW000112 Legal Description: MANOR LT 5 co / 1-3/nn &a" OP I JM60 C3pry L Date Issued: May 18, 2000 Expiration Date: May 18, 2001 Parcel ID: 050-671-47 Design Engineer: 0070 KND Engineering Site Address: 018956 INSPIRATION CIR Owner Name: Gordon Budd c/o KND Engineering Lot Size: 41370 SQ. FT. Owner Address: 20441 Ptarmigan Blvd Total Bedrooms: 4 Permit Bedrooms: 4 Eagle River , AK 99577 - This permit is for the construction of: ❑✓ Disposal Field F Septic Tank Holding Tank [—] Privy ❑ Private Well Water Storage 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 engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: / d_� Date: KND ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 May 11, 2000 Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: Sewer Upgrade — Manor, Lot 5 Gentlemen: The owner has requested we proceed forward to obtain a septic permit to upgrade the system on the subject lot. On April 10, 2000 we dug one testhole for the proposed system. The results of the test is attached. The general slope of this lot is from north to south at a grade of approximately 5-10%, although a steep slope is located in the southern portion of the lot near the original system with grades in excess of 25%. The grade in front of the property is from 5-10% and is directed away from the system. We have designed our system utilizing the percolation rate of 4.0 min./inch for the four-bedroom house. The lot is served by an individual well. We propose to install a 5' wide shallow trench. Additionally, the material appears to be uniform and consistent per the two logs of record, which had percolation rates of 1.2 min./inch. The lot is served by a class "C" well. There are no public or private wells within 200' of our proposed system location except as noted. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, JXF\�1' D Engineering ` _ e� ? dY ``Kenneth NI. Duffus, P.E. attachments: On -Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test (WELL & WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE MANOR S/D, LOT 5 PLA `\ I NO PUBLIC WELLS WITHIN 200' OF PROPOSED SYSTEM. NO PRIVATE WELLS WITHIN 200' OF PROPOSED SYSTEM EXCEPT AS NOTED. AW ,. ........F ........AZ S : nanrcan m. 1 #�Aty �i DFESSIOT��' DESIGN DETAILS 4 BDRM X 150 GPD = 600 GPD 600 GPD/1,2 GPD PER SQ. FT. = 500 SQ. FT 500/5' X .58 R.F. (3.0' GRAVEL) = 58 FT. TRENCH Use 1 trenches 58' (L) x 5'(W) x 3'(D) Total depth of system Is 8.0' from original grade. Total depth of gravel below pipes Is 3.0'. NOTES, 1. USE 1250 GALLON SEPIC TANK. INSULATE TANK IF <4' COVER. 2, INSULATE TRENCHES WITH 2' HD BURIAL FOAM.. 3. CONTRACTOR WILL ENSURE MAXIMUM 2% SLOPE INTO SEPTIC TANK. 4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE PREPARED FOR: Gordon Budd LOT 5, Mt. MANOR S/D Engle RIver, AK 99577 FIELD BOOKS BOUNDARY. JOHNS BTAaND: JOHNS "uar JOHNS DM. FILE ACAD FILE: COMPUTOT: DRAWN: CHECKED: DATE WD: "N°` 99093 Scale; 1'= 100' PAGE 1 OF 3 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 I WASTEWATER DISPOSAL SYSTEM DETAILS MANOR S/D, LOT 5 DRM N/diVCr -D --i I PR QX DX fa. LC -ftb�!L'%kN ,.do. 0�70&q .... AZ PREPARED FOR1 Gordon Budd LOT 5, Mt. MANOR S/D A Eagle RIver, AK 99577 ............. CE -71 ................ W. so� nELD BOOKS BMNDM�.'JOHNSON DMM4: KMD STMING: JOHNSON °"ECS` KMD suILT-JOHNSON DAE 5/10 0m. NW254 ACRD FILE: 99093.DWG NQ.: 99093 #KNDOO-1 rimary Fi Scale: 1'= 20' PAGE 2 OF 3 &N.11 LU) ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 IK D ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 SOILS PERCOLATION TEST sa°oe e°aoceaeeeo oeoe°.'.o a o- Kannetlr M. Duff - e CE 7116a. Performed for: Pete Ostdiek-Target Realty Date Performed: 04/10/00 Project: Manor Lot 5 TEST HOLE # Depth (Feet) 16- 17- 18- 19- 20- ORG - brown/black, moist SP - loose, brown/gray w/ some silt GM/SP - Med dense w/cobbles to 2' moist I:�el"OI PRESOAKED PRIOR TO TEST SEE ATTACHED SITE PLAN FOR HOLE LOCATION Was Ground water encountered? NO What depth? NA (seasonal seeps) Depth to water after monitoring? 14.42 Date? 04/19/00 Reading Date Gross Time Net Time Depth to Water Net Drop 1 4/10/00 1:44 9" - 2 1:54 10 min 63/16" 213/16" 3 * 1:55 9" - 4 2:05 10 min 66/16" 210/16- 5 2:05 66/16" - 6 2:15 10 min 313/16" 29/16" 7 * 2:16 9" - 8 2:26 10 min 68/16" 28/16" 9 2:26 68/16" - 10 2:36 10 min 4" 2 8/16" 11 * 2:37 9" - 12 2:47 10 min 68/16" 28/16" * Water Added Percolation Rate 4_0 (min/in) Pere Hole Diameter 6" Test Run Between 3 feet and 4 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. '% OF IKND ENGINEERING ® eee TH 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 •••••• ....._....._e. 11_1..1..._. . _ . .., .. .. 111,1.. m ac(S nennathh SOILS PERCOLATION TEST Performed for:Pete Ostdiek-Target Target Real!Date Performed: 04/10/00 Project: Manor Lot 5 TEST HOLE # 00-1 Depth ORG - brown/black, moist SP - loose, brown/gray w/ some silt GWSP-Med dense w/cobbles to 2' moist PRESOAKED PRIOR TO TEST SEE ATTACHED SITE PLAN FOR HOLE LOCATION seas essee••s o s U . 16 Was Ground water encountered? NO What depth? NA (seasonal seeps) Depth to water after monitoring? 14.42 Date? 04/19/00 Reading Date Gross Time Net Time Depth to Water Net Drop 1 4/10/00 12:30 9" - 2 12:40 10 min 63/16" 213/16" 3 12:40 63/16" - 4 12:50 10 min 3 6/16" 213/16" 5 12:51 9" - 6 1:01 10 min 65/16" 211/16" 7 1:01 65/16- 5/16"8 8 1:11 10 min 311/16" 210/16" 9 1:12 9" - 10 1:22 10 min 66/16" 210/16" 11 1:22 6 6/16" - 12 1:32 10 min 312/16" 210/16" * Water Added Percolation Rate 3.81 (min/in) Perc Hole Diameter 6" Test Run Between 5.5 feet and 6.5 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES 7 Environmental Health Division ] 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES TO FROM SEPTIC TANK ABSORPTION FIELD WELL Address 12, D Pho�nee((ss))� �j q Per nut No. No. of Betlrooms WELL LOT LINE 1 I� o LEGAL DESCRIPTION _ Lot / Block Subdivision �-A/>`l-)C>- FOUNDATION I~� Township, Range. Range. Section r•' N /t.E— l0 s AS -BUILT DIAGRAM (Show location of well, duveway. water bodies, etc.) septic system. property lines. foundation, TANKS 19 SEPTIC ❑ HOLDING Manulaactu1re1r A— ,1/ Capacity IF)gallons 1C jpgi 2 / z Material No. of Compartments TYPE OF SYSTEM ' ❑ TRENCH ICED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from original grade IO FT Total depth from original grade 7 FT Fill added above original grade FT Gravel depth beneath pipe � FT ___ Gravel length_ FT _ Gravel width J FT _ Total absorption area % 00 / 1/ /GY/ s4 FT Distance between lines / //A F i t G l x 3 r Go L EO eo r 3 0 [y Number of �nl s �J A Soil rating 11-!5_P SQ FT Pipe material � ✓ I l`- I P b) Installer �W WIC ✓J�-ter Date Installed ���"1 l �� WELLS ❑ PRIVATE OTHER (Identity) Cl2ssi6caUon (A, B, C) G Total Depth FT Cased to FT Inslallei Dale Installed. Alk /;! I REMARKS: jTI s 15 I PPte�// Scale: N'r� Inspections Prformed by. Date. W ---- inspection was pe formed according to all ENXG�NF SEAL FY a - •::; , `. G; rA . r s. ...v:,"err �'4F��NE9Ai'/TiloiS-Iitlet�— I Eagle River 1-mp head Ptw. 20 3 ce 1i that This ®17034 -Eaw�h y®� na Municipal and State guidelines in effect on Ihis dole:Z Health Department Approval: � f-. "} Date: 72-013 (3/85) DAlE: ��� o� ' 1-0kj Rho A. 1 � A. 0 unV 4 wlX M 10 1 .2 H -1 UT u, SAW ra.'� ' U[PARlMEJAI l HEALTH AND ENV[RONMENTAL PR[)TECTION 825 L STREE], ANCHORAGE, AK 99501 264~4720 ADKAT~~^10J[N-117: 1 S 0 Ono 1 �. 10 0 4 p! &T WN 1:lK~ FK]SI NO: 670142 UP(]RADK DAlE ISSUED: O6/1Y/(�7 /' ,� APPLlCANl GORDUN MAY / S&S ENG. ADURESS: PO 8UX 771169 EAGLE R[VER, AK 99577 �UNTACl PHONE: �94-297Y L[GAL DESCARK? ]P: SU8DIVISION: MANOR LOT: 5 BLOCK: N/A SECTION: 6 TOWNSHIP: 14N 14AN6E: 1W LOT SlZE: 41370 (My OR ACRES> ^FT. z�.. ��] /map � '/ Bam^4owv' icerti�y thaL� 1. 1 am < liar with We requirements for on-site sewors and we]s, as set 1orth by the Municipality oH Anchora;e (IT UA) and the State m Alaska. 2. I will instoil l '.,.hr: sysLem in accord� knce wiih all MIA codes and regula1ionsq and i: comp1iance with the design crite1 of this permit. 3. I wi1 adhere to all MOA 010 State o| Hlaska re;uirements i or the set back disiances from any existin; well, wastewater disIZIosal system 'OP p:blic seweraqe system on this or any adjacent m` nearby lot. IF A 1UT STAKJON IS INSTALLED lN AN AREA COVE�ED BY MOA BUILDING CODES, THEN (1> AN EL[:TRICA|. PAll VMl[ ANU INSPECTION MUST BE OBTAINED; (2) AS~8UILTS W|U. NDT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELC[RlCAL WORK MUST UE DONE 13Y A LICENSEU ELECTRICIAN. DAlE: ��� o� � ^ d111jj�2��� ����� -7z / 71) exileli _ v111f19_ S & S ENGINEERlNG 17034 E. R. LOOP #204 EAGLE RlVEH, AK 99577 PHONE #694~2979 ******************ON—SlTE SEWER PERMlT APPLlCATION***************** APPLlCANT: GORDON BUDD ADDR�SS: 1.1 1, BOX 77�1699 E.R. AK 99577 CON[ACT PHOM 694-2979 SPECIAL CONDlTIONS OR lNS[RUCTIONS: THE PROPOSED UPGRIDE WlLL ADD 180 Ft. TO [HE EXISTlNG 612 Ft. SEEPAGE 8ED FOR A TU[AL OF 792 Ft. OF ABSORPTlON AREA. THE MINIMUM REQ. FOR EXISTlNG 4 BR HOUSE IS 750 Ft. ^���� ^���u 6— 14 6 S.-7: 0f o�F,</Sr/^/C- r7/���� 2 kZ:/��/ »9» r »® "'till z 99? X { 2 `(EN.0IN9EFi'SZ94L ` i u Municipality of Anchorage, 'rS DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST j :r a PERFORMED FOR: '7 r3r—�'D j fJ)%/� _ DATE PERFORMED:,'"-.'�nl.:ax:it LEGAL DESCRIPTION:_ _� chi S �>`!p!Z Township, Range, Section: DEPTH �^ SLOPE ITE PLAN (FEE T) I I—ice F--T—T 1 2 3 4 v 6 7 d. o 8 0 9 J 10 J; 11 d 0 12 J 13 oK FLor-t 14 15 16 17 18 19 20 /�S 441 L,r -Ste- rs Uc�y �ovsd• WAS GROUND WATER ENCOUNTERED? s IF YES, AT WHAT L O DEPTH? P E Depth to Water Aller Monitoring? &(OWL Date: Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS USC- /�S ���2 Fofr- 41c5/ / O -P Vim C PERFORMED BY: `4 Eagle River Loop R.ad No. 204 CERTIFY THAT THIS TEST WAS PERFORMED IN River, Alaska 99577 ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Nana v C6yd DISTANCES SEPTIC Address Aic/,L TO FROM TANK ABSORPTION FIELD WELL Phonels) 6_ 73 2 I Permit No j�((TJ—A�K07 �O -7 — No. of Bedmoms 3 WELL �,•�, ` f�, t lois _ LEGAL DESCR PT LOT LINE /0 4- (p 4— /J/A LotBlock Subdiy,�i ^ 6-1_ '� i� /\I a 2 J FOUNDATION 7 � - 1b t,.�._ /J �A Township, Range, Section J 'CJ AS -BUILT DIAGRAM (Show location of well, septic system. properly lines. loundahon, / driveway. water bodies. etc.) TANKS -- j� SEPTIC ❑ HOLDING — �Manulac wer � u Material Gapaaty�in gallons ^^ No. of Gontparin ` � -- TYPE OF SYSTEM ❑ TRENCH X RED ❑ W. DRG IF DePih to Pipe botlom I or original grace 6 - Total depth fro -� _F_ -- - t;14 - 14 FT Fill adUed above original grade •f ,,Q Gravel depth I � Q. FT � C Gravei len nth 36 FT Gravel width (_ r r Total absorption area r7 612, Sq FT _y Distance bel &_ _ r Numbcr of lines Sod rating S Q3 FT Pipe mater: Installer uw"ONqej �I _� Dale Instal _ WELLS RIVATEOTHER (Identifv) Classdication (A, B. epth Cased to FT FT —. hlstallE'i lalledl fDoT'19e'_1',7, � Flo IF L1�CCGlyI��/ _ «lJ� (y 2 ' 2 6 / ^ L/ (L/Q� � ✓1 / �(/ � (r A Scale: Inspect n Pe formed by. ENGINEER'S SEAL , l.e'7iS•. DateAr . r � 4' A S & S ENGINEERING " "% I tit23tlgt0Riber cerlily that this inspeclion was perlonned according to all l MunicipaF8taR4TtfillPgil��a6blfarA§���'dale: ` � � '`` I' �' / Health Department Approval: — - Dale: MUNICIPALITY OF ANCHORAGE DEPAn'T'MENT OF HEALTH ANO HILLMAN Strnvicr_:S FmIronmental Health Division 82.5 " L" Street, Anchorage, Alaska 99502, Telephone 264-4/20 ON-SITESEWAGE DISPOSAL SYSTEM AND/OR WE -11 INSPECTION REPORT Name DISTANCES , f0 t,Ef (IL ABSORPTION WELL Address FROM �. _ �,AfdK FIELD If s� /�a c.S�r� fix•- ..T�► .- r�'f/_—.- --- ---'— - __ WELL PLonttsl Permit No. No. of Brdreoms �'y LEGAL DESCR PT ION LOT LINE Lot Block 9ubdr ^ FOONOATIOrd -r ocrtunip. Range, Section Al / {Shov: rotation of well, sepi,c system, properly fines. loundabon, L/�_._� ___._.r•..—� w.(�_______.�.—..___. ,�-{`�j' dr ..v n - .r h etc., --- - -- -- --- -- - TANKS - — - Ca +acil �n gallons Morula mer r Y 9 -� Material No of Compadre5j?s TYPE OF SYSTEM [ tI FRF X BUD LI Vd. DRAIN 7 OTHI-,n Depth to pipe bottom Ifper I total depth from original grade lr Original , rd le FT IWT /1-_ 1 --L-- - - - -- Ftp added above unginal grade Gravel depth beneelh pipe �%,FT ` FT Gravel Gfa\cl width- ��FT i ( FT - — - - -- - - -- - Es I otal ab,orpnon area Distance betwer-n firsts GAJ � G: SQ FT �,�..'� (� � FT -- — -- -- - -- -- -- - Numoer of hnN.; Soli sing Pipe malenal e7. 5Q FT— Inslallcr Date Installed ---- '--- -- -- --` ----'- -- ---- -- - /� - WELLS -K—P {IVATL X,,0THER (Identify) -- -- - -- - - Clasvlw neon IA B� Total Dcplh Cased to Ff FT trtslallrr � - -. Date Installed: REMARKS: o Scale:— __---_.___-__ ENGINEER'S SEAL�.1R P _� J6-l,.__T___.��'=.�/��_ ft�✓���.--- '"i- , 111Fl t5 P lormcdby Date �y�'% �: t�^` C • ?a PF.Ir�. 4f rig. __— cerlily thal I mspnclion was performed according to all � —rr , MuniripaFlJk�le�j!IAt'�Ir�1lgs�if�rA�§M�/date: G / `1 i( ,. r;,�l A.. RFs ,J td. .f Date___ 72-013 t3i8bl'--'k� ngtjl HEALTH AUTHORITY APPROVALS SEWER E WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION d FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCfURALB MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Ms. Catherine Smith BANK OF THE NORTH 3300 C Street Anchorage, Alaska 99503 Dear Ms. Smith, ROBERT A,SHAFER CIVIL ENGINEER F �0") 694.2979 June 2, 1987 �ipO�%z . <<j REFERENCE: Lot 5; Manor Subdivision The conditions o4 the Health Au.thoiLi.ty Apprcovat .issued by the Muni.ci.paei.,ty o6 Anchorage tsar a three bedroom residence located on the re6ereneed property required the excavation o6 the absorption 6ield to detehmine .it's size and the excavation o6 the septic :tank to veri6y it's capacity. This work was required 5 ince .the permit 4or .the on-site wastewater d isposat system was .issued 6oac a three bedroom residence yet the system .installation was apparently not documented by a Municipal or pkivate sector engineer. Per yocuc authoh ization ,the excavation wolLk was pelc4orme.d under our supervision and a MunieipaP.ity o4 Anchorage on-site inspection report has been compte-ted documenting this system. A copy o4 that report is attached. In light o6 Go7cdon A. Budd and RoseMartie McDonald-Budd's letter dated May 20, 1987, (copy attached) we have not asked .the Municipality to .issue a 6.inat Health Authority Approval 6or a three bedroom residence. We have attached an estimate bar the engineering and excavating necessary to upgrade the existing system to hour bedrooms. Please not.i4y us .i4 or when you are ready to proceed 6urther on this project. A. SHAFER, P.E. /ss cc: Gordon A. and RoseMarie McDonald -Budd Terry Beal, Area Realty Municipality o4 Anchorage r SRB 196X EAGLE RIVER, ALASKA 99577 IED' F- 14,1101,.,: ll-. 0 C) f), IM IK DEPARTMENT QF HEALTH AND ENVIRONMENTAL PROTE�TION 4/ry y 825 L STREET, ANCH0RAGE, AK 99501 2 64~4 72 0 k' 0 C] IfNhm-~S3 :1 RE"'. E-3 E- 11.41 1EE: ��G�F44, Vo 11 1. ~� PERMIT NO: 840702 DATE ISSUED: 08/17/84 APPLICANT: FIELDER CONSTRUCTION ADDRESS: 125 E" FIREWEED LN.� SUITE 102 ANCHORAGEv Al.::: 99503 CONTACT PHONE: 277~5702 LEGAL DESCRIP: SUBDIVISI0N: MANOR LOT: 5 BLOCK: N/A SECTION: 6 TOWNSHIP: 141\1 RANGE: 1W LOT SIZE: 41370 (SQ. F-71% OR ACRES) MAX BEDROOMS: 3 Li17.it�d aPti-I the c_-)ptioDg avizxilable �t.) You in Your septic", ' system" Chqose the option that best fits your site, ����01%.11 C14 I VO= ��1;C!I1 :11 VNNP DEPTH TO PIPE(FT. > 5"0 GRAVEL DEPTH (FT") 5"0 0"5 3.0 TOTAL DEPTH (FT") 10"0 6"5 8"0 GRAVEL WIDTH (FT"> 2"5 17.0 5^0 GRAVEL LENGTH (FT.) 38"0 34.0 44.0 GRAVEL VOLUME <CU.YDS.3mm TANK SIZE (GALS) 1,000^0 ** 1:,000,0 ** 1x000"0 X. SOIL RATING (SQ"FT./BR) 125 125 125 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS ... .... .... ... __��~_~~~_... .... ~-_~~_�_.~� I certify that: 1" I am familiar with the Pequire0eDts for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska^ 2" I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit - 3" I will adhere Lt..) all. MOA and StaLe of Alaska requirements for the set back dist�nces from any existing well, wastewat�r disposal system or public sewerage system on Lhis or any adjacent or nearby lot" ' 4, I understand that this permit is valid for a maximuN C) If 3 bedrooms and any will require an additional permit. IF A LIFT STATION IS INSTOLLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST DE OBTHINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICALINSPECTION REEPORT; AND (3) THE ELECT DONE BY A LICENSED ELECTRICIAN" ' SIGNED DATE: ^� ^r ___��___~.~� �.�~s~� APPLICANT: FIELDER CONSTRUCTYON ' ' S Zin ULD SFWARf) HWY_ & ;NGINL R. , INC. ANCHORAGE, ALASKA 99503 S 3,19-6561 JW(H nIl()r., SOLE S 1 U(; Pi1W. I -A 11ON I L S I III It[ I11(MI 1) 1 f)II L 09 1 HAt'G`t?A I E l? _ _ I,n� i- I'GIII IIIIMI-I) �• L131 O 1-I: c;nl Nf�SCIt II'r I()N _�V ( _�---,�/A_�t�A NOiZ _SVB�_T %',�11.T C. ._ I.OrI S I T V [It AIII I 0'.2-0 ORGANIC SILT w/. Some SA-IJD,Bt ACK OL WAS GROUND WATER ENCOUNTERED? i �1 12 IF YES, AT WHAT _ lr •i DEPTH' --_- I Date , &RAYSI\Npy s,1`r Is w/so•MG eR/tv�c ScnTTERED TIGwr col•EES'VE, So liRND,MOIST�M 1 0._0, �j,;o' 5.o_1.4,0'GRAyjSH 13RowN 6 c), o GRAVEGLY 5ANDW/ TRACC rlI-r- rt5.I 1. t5. I NON•COHeStVE/M(9rST <;r�;:>�,;.,;; r o',po POORLY GRAVED -Masi Y Erni 000 ANO COA 2$E SA -Nb, ©C C rti. SS IDA) 14L 01 0 HiQ To n1 Vnr6.k ous corIBLES < 2.0' 9 ota '•'n G� ii 10 'o f WAS GROUND WATER ENCOUNTERED? i �1 12 IF YES, AT WHAT _ lr •i DEPTH' --_- I COMMENTS Date Gross Time r� 15 Net Drop 1 7 18 r e 11 5265 20 COMMENTS Read.ng Date Gross Time Net Time Depth to Water Net Drop 0 MIS i Read.ng Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE -VI-v A i, Initnutes/inch) TEST HUN [SEIWEEN FT AND —/— FT PERF ORMFD BY (. f. Ii TIF1EU OY 17 ooa 0/191 DATE: • '� Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 MAR 2 6 Certificate of On -Site Systems Approval 050-671-47 Parcel I.D. Expiration Date: 1. GENERAL INFORMATION Complete legal description Manor Lot 5 Location (site address) 18956 Inspiration Cir, Eagle River, AK,99577 Current Property owner(s) Katy & Bret ROsane Day phone Mailing address 18956 Inspiration Cir, Eagle River, Ak 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: i] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual FX1 Individual Water Storage ❑ Holding Tank ❑ Community Class C Well 0 Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Distance: Received by: - -- _ �.-_ Date COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee , ` Waiver Fee $ Date of Payment �b2faI Y' Date of Payment Receipt Number r� `��< 7 Receipt Number COSA# 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 Pannone Engineering Services LLC Phone (907)272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date ACS S 6. DSD S NATURE . System #1 Approved for � bedrooms System #2 Approved for _ bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: ZX The MUf/ A€-chors a Development Services Division(DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet c If more than 1 septic system is on the lot: COSA Checklist # _Lof 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Manor Lot 5 Parcel ID: 050-671-47 A. WELL DATA Well type C If A, B, or C provide PWSID # 213637 Well Log (YIN) Date completed Sanitary seal (Y/N) _ Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliformy— colonies/100 mL Nitrate mg/L f Arsenic KI D ug/L Date of sample: 3 �l I ).b 1] Collected by: PFS L S B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/HDPE Date installed 6-13-2000 Tank size 1300 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 10/121?•94'' Pumper JRS Pumping ao13 C. ABSORPTION FIELD DATA Date installed 6-13-2000 Soil ratingd./ft2 or ftz/bdrm) 0.8 gpd/sf Wide Trench (9�P� System type Length 87 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth 11 ft. Eff. absorption area 870 ft2 Monitoring tube Y Depression over field N Date of adequacy test 03/11/2014 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 20 in. Water added 630 gal. New depth 28 in. Elapsed Time: 220 min. Final fluid depth 20 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons _ in. "Pump off' level at Cycles tested _ E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot _ Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access (Y/N) in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots JET S�'"- ABSORPTION FIELD ON LOT TO: Property line 6* Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 1W F. COMMENTS * Waiver WR000040 G. ENGINEER'S CERTIFICATION I certify that 1 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 Steven R. Pannone Date A1022;2s COSA brown sheet 10-10-12.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 10+ C c> -- A erm III T I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE'/Z FOLLOWING DESCRIBED PROPERTY: mr�Pes�s Gid, a DATE - AND THAT NO fi6ikAMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: EASEMENTS, COVENANTSy OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD F& ANY DATA HEREON BE USED FOR CONSTRUCTION OFFENCE 'LINES, OR FOR ESTABLISHING BOUND- ARY LINES. r� OF Al °t, INV.; wr ' h �R`cssi nt L�`• . _-= Municipality of Anchorage I . Department of Health and Human Services %iDivision of Environmental Services On -Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING /�T � Parcell.D. 050-671-47 HAA# 1�9'%().7171' Expiration Date: 1. GENERAL INFORMATION Complete legal description LOT 5, MANOR SID Location (site address or directions) 18956 Inspiration Circle Eagle River Current Property owner(s) GORDON BUDD Day phone Mailing address 18956 Inspiration Circle, Eagle River AK. 99577 Lending agency Day phone Mailing address Real Estate Agent PETE OSTIEK Dayphone 694-2388 Mailing Address Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site ❑ Individual Water Storage ❑ Individual Holding tank ❑ Community Class C Well ® Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 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) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. 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. (R. 11199) 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 Health Authority Approval Guidelines for 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm KND Engineering Phone 696-6111 Engineer's Printed Name Ken M. Duffus Date 06/15/00 -">'F A' J` •­zINATa•0ae'�Oj e%� a seo.+•-.+.c �.a�. a...�. 6. DHHS SIGNATURE 3 s� °, •F.��d _jZ Approved for _. bedrooms.43p^p8ofEsS��� Disapproved. '14 141-1m. Conditional approval for bedrooms, with the following stipulations Additional Comments Attachments HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: - Original Certificate Date: Expiration Date: _/T — 0 O Reissue Date: Municipality of Anchorage + Department of Health and Human Services Division of Environmental Services On -Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www. ci. anchorage. ak. us (907) 343-4744 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Manor Lot 5 Parcel I.D.:050-(071—g7 A. WELL DATA Well type C If A, B, or C provide PWSID # 213637 Well Log Date completed Sanitary seal Wires properly protected Total depth ft Cased to ft Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level Well production ft aM ft g. p. m WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml Nitrate 4.77 mg/I Other bacteria 0 colonies/100 ml Date of sample: 6/16/2000 Collected by: KIND Engineering B. SEPTIC/HOLDING TANK DATA Tank Type/Material HDPE Date installed 6/14/2000 Tank size 1250 gal Number of Compartments 2 Cleanouts 2 Foundation cleanout Y Depression over tank N High water alarm N Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed 6 45 0 Soil rating (g.p.d./W or fe/bdrm) 0.8 System type Shallow Trench Length 87 ft Width 5 ft Gravel below pipe 4 ft Total depth a ft Effective absorption area 750 ft' Monitoring tube Y Depression over field N Date of adequacy test Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test in Water added gal. New depth in. Elapsed Time: min Final fluid depth in Absorption rate >= g. p. d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) (Rev. 11/99) If yes, give date D. LIFT STATION Date installed _ _ Size in gallons "Pump on" level at _ in "Pump off' level at _ Datum _ Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Manhole/Access in High water alarm level at in Meets alarm & circuit requirements? Septic tank/lift station on lot N/A On adjacent lots Absorption field on lot _ On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer /septic service line Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10'+ Property line 1 0'+ Absorption field 1 0' + Water main 10'•+ Water service line 1 0' + Surface water 1 0 0' + Drainage 10 0'+ Wells on adjacent lots 1 5 0' + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 6'* _ Building foundation 10'+ Water main _1 0'+ Water Service line 10'4. Surface water 1 0 0' + Driveway. parking/vehicle storage 1 0' + Curtain drain 1001+ _ Wells on adjacent lots 1 5 0' + F. COMMENTS * Lot line to field waiver applied for with this installation G. ENGINEER'S CERTIFICATION ���(�•�;F„aL�SO�D 1 certify that / have determined through field inspections and �%� •°•.�V 8 review of Municipal records that the above systems are in ® $gTH a, � conformance with MOA HAA guidelines in effect on this date. �' •^•� •••••• •�••• N Engineer's Printed Name. Kenneth M. Duffus®m Kenneth M. D , ®®Q f� e• CE 7116 �a Date 6/16 8w 9c'°•.. °.0 F�C'� HAA Fee Date of Payment Receipt Number. (Rev. 11/99) Waiver Fee $ Date of Payment Receipt Number _ 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. # (n` I - LO HAA # 0 R'1 \ 62-U LI 1. GENERAL INFORMATION Complete legal description Lot 5; Manors. Subdivision Location (site address or directions) 18956 In6ptinati,on Cikae. Property owner GORDON A. BUDD Day phone 694-5397 ROSE MARIE McDONAL'D-BUDD 694-9436 Mailing address P U Box 771169 Eagte RzveK, Atahia 99577 Lending agency Day phone Mailing address Agent Day phone Address _ Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4`r 3. TYPE OF WATER SUPPLY: Individual well Community well XX 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 XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 tza vow ADRB (usn nsd) szo-zc •�aoM s, aaui6ua leuoissajoid ay; ui suoisslwo ao sjaja jo; alglsuodsei lbu si a6eaoyouy }o �311edlolunyq ayl •panssi si a;eoipl jao a ajo;aq e;ep azAleue jo suol;oadsul ;onpuoo ;ou op SHH4;o saaAoldw3 •s;uawaalnbei a;e;s pue leaapa; uievao i4sl;es o;,)apio ul suol;nll;sul buipuaj aiay; pue sawoq p siaseyand o; Asa�jnoo a se sly; SBop SHHO Gqi T lsely }o a;e;Say; ui paaa;sl69J aaauIbue leuolssapid ;uepuedepul ue !q anoge 9 ydea6ejed ul uanlb suol;e;ussaidej ay; uodn Aluo pas -eq s91e01l11J90 lenoaddy l!joglny glleaH sanssi (SHH4) saoi/usS uewnH pue OeaH ;o ;uawpedap eft, oyouy;o A;lledlolunyj eqi :suol;elndi;s buiMojjo� ay; y;iM 'swooapaq A8 s;uewwo0 jeUOIjIPPV JOI lenoidde lzuo!;!puoo •panoxddesla -swooapeq / ao� panoaddy �`— 3un.LVNJIS SHHO '9 b—Z—� a;ep ain}eu6ls s, equi6u3 _ LLS66 a)Jse)y'.ianib aI6e3 OU— pao21 doo-I moll 810e3 b£OL L ssaappy ouoyd 9NR139NIDNFI cz 3? S wall P aweN 'uol;oadsul sly; p a;ep ay; uo ;oa,4a ui suol;elnbei pue 'saoueulpao 'sepoo a;e;S pue ledloiunW Ile y;!nn eouelldwoo ui si we;sAs lesodslp assenna;sum ao/pue Alddns aa;em ails-uo ay; 'uol;oodsul pue uol;e6l;s9nui !w UJOIJ pue sally a6eaoyouy p A;iledlolunW ay; woa} paule;qo uol;ewao�ul ay; uo paseq;ey; l4ia9naay7pn} I -ulaaay pa;eolpul aanlon4s }o ado pue swooapeq )o aagwnu ay; aol a;enbope pue leuol;oun; 'a}es si wa;sAs lesodslp jelama;sem ao/pue Ajddns jejuni ells-uo ay; Iey; sMoys uoi;eoildde lenoaddy /}iaoylny y;leaH sly;10 u0l;e6ljs9nui Aw ;eql AJiaan I 'molaq umoys a;ep uol;epllen ay;10 se pue o;aaay pexi}ju leas !w Aq peilpeo sy H33NIJN3 AS N01103dSNl d0 LN3W3J.V.LS 'S Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:Idt55: AAAA Dir 6A. Parcel I.D. A. WELL DATA Well type SJAS S C If A, B, or C, attach ADEC letter. ADEC water system number Z 1 3 (0 Z-'� Log present(Y/N)_ Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level Date completed Cased to FROM WELL LOG Driller Casing height Wires properly protected (Y/N) AT INSPECTION SEPARATION DISTANCES FROM WELL TO: O m Z Septic/holding tank on lot ( D _ ; On adjacent lots ti% iq Absorption field on lot (SO + ; On adjacent lots I\j%(A Public sewer main /) I is Public sewer manhole/cleanout /A Sewer service line Z5 � Petroleum tank we, to OVJnJ WATER SAMPLE RESULTS: ,dee AlfAc kod ApprouA l Coliform �i Nitrate Other bacteria /fig Date of sample: ('23 —� ( Collected by: B. SEPTIC/HOLDING TANK DATA Date installed 4o)( (cf 6/4 Tank size —1 500 li4l Compartments Cleanouts (Y/N) Li Foundation cleanout (Y/N) _ Depression (Y/N) AJ High water alarm (Y/N) q Alarm tested (Y/N) /o. Lo Date of pumping — Z (a —tel Pumper P001 iomp't, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot (y D r fi On adjacent lots �f� Foundation To property line—1 0 f Absorption field i Water main/service line 2 S f Surface water/drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE M z� in c O 'L -I Z r Fit N n O g.pnlr m a C > D CDn n rTJ o < v SEPARATION DISTANCES FROM WELL TO: O m Z Septic/holding tank on lot ( D _ ; On adjacent lots ti% iq Absorption field on lot (SO + ; On adjacent lots I\j%(A Public sewer main /) I is Public sewer manhole/cleanout /A Sewer service line Z5 � Petroleum tank we, to OVJnJ WATER SAMPLE RESULTS: ,dee AlfAc kod ApprouA l Coliform �i Nitrate Other bacteria /fig Date of sample: ('23 —� ( Collected by: B. SEPTIC/HOLDING TANK DATA Date installed 4o)( (cf 6/4 Tank size —1 500 li4l Compartments Cleanouts (Y/N) Li Foundation cleanout (Y/N) _ Depression (Y/N) AJ High water alarm (Y/N) q Alarm tested (Y/N) /o. Lo Date of pumping — Z (a —tel Pumper P001 iomp't, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot (y D r fi On adjacent lots �f� Foundation To property line—1 0 f Absorption field i Water main/service line 2 S f Surface water/drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level ump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adiacerrXIots "Pump off" level at Cycles tested Surface water _ Date installed tP{tx lgA4 + b -24-87 Soil rating System type — 6ad Length _ - Width Z Z_ Gravel thickness 1 z Total depth �] Total absorption area (t88 Cleanouts present (Y/N) Depression over field (Y/N) 11) Date of adequacy test �(' 2 - Results Results (pass/fail) —P ilk S S for 4 bedrooms Peroxide treatment (past 12 months) (Y/N) ?J I to If yes, give date til A SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot W I Lo, On adjacent lots I- is a 't Property line ( b r-4 r To building foundation ( n i To existing or abandoned system on lot 1� On adjacent lots _,)o /1 Cutbank A) Water main/service line 2 S Surface water 1J) 1A Driveway,D r� parking/vehicle storage area 3 Curtain drain 01A E. ENGINEER'S CERTIFICATION 1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on tP%date of this inspection. Signature S & S ENGINEERING �� •• 17034 Eagle River Loop Road NO.204 ® ° 491_H o eYe one• • < aroa.•'d Engineer's Nan%gle River. Alaska 99577 No ..R J. �FER, P.E. ° Date �� r`c�°.° � �' HAA Fee $ — Date of Payment Receipt Number 10.cc) 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number S'r ���WALTER J. NICKEL, GOVERNOR 1.1 1�., 1'' DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 FOR: S & S Engineering October 1, 1991 PWSID 213637 563-6775 My review of the records on file in this office reveals that the Manor Subdivision Class "C" Public Water System, is in compliance with the provisions of 18 AAC 80.200, State of Alaska Drinking Water Regulations. Sincerely, Byron Roys Environmental Engineer MUNIC �Nv ?GN^ FNry�r An'�yoe MUNICIPALITY OF ANCHORAGE °R AGF DEPARTMENT OF HEALTH & HUMAN SERVICES IU 50jV/s'0 Aj DIVISION OF ENVIRONMENTAL SERVICES 2 j 198 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAV OF ON-SITE SEWER AND WATER FACILITY �g�_,,Zl 264-4744 j�J nn Application Date 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) /_iti' �? PAR/C— c5 % -7—/.5-;,J g /e_ -5'G G— /O Location (address or directions) S TE P'1yV .. (?4 i e -x 5- (b) (b) Property Owner 11-'e iT-atSiIle-1 Telephone: Home Business Mailing Address (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent /l/i�/'/�T� ��r G��T� Z_ /"j Address Telephone (e) Mail the HAA to the following address: or: Check here ❑, if hold for pick up. List contact person and day phone number below. 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms I 3. WATER SUPPLY Individual Welll Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (Rev a 86) Front 5. 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION N As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of FirmTelephone, Address Date o7 f io y* . 1 3 e 'p•o •. 0 o•oaoe ••••eL to o o o• Cgine8Y 8e �t 90�oo0 mA �° ROY C. REI JR. CE DHHS APPROVAL Approved for �" " C`� bedrooms by rQ' iy Date Approved Disapproved Conditional Terms of Conditional Approval 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. 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. Page 2 of 2 72-025 rRev s/as} Back MUNICIPALITY OF ANCHORAGE (MO. j OF ANCHCMK*TH AUTHORITY APPROVAL (HAA) MDN(CIPAUTY HEALTH & CHECKLIST - FEBRUARY 1984 PROTECTION DEPT, OF 264-4720 ENVIRONMENTAL ( �gB7 Legal Description: 41 �- 2 - —%ice/ P/e�75_ 'fCC /d A. WELL DATA RECE�V ED Well Classification If A, B, C, D.E.C. Approved (Y/N) �f Well Log Present&) Date Completed 5 �' ' �y Yield F Total Depth Cased to ;jy Depth of Grouting Static Water Level / Pump Set At i9 Casing Height Above Ground Sanitary Seal on Casing�Yl) Electrical Wiring in ConduitON) Depression Around Wellhead (Y& Separation Distances from Well To Septic/Holding Tank on Lot /06 T .371- c/h"W ; On Adjoining Lots To Nearest. Edge of Absorption Field on Lot /0-0 'f ; On Adjoining Lots /q To Nearest Public Sewer Line �� To Nearest Public Sewer _ Cleanout/Manhole /%Z_,l_ To Nearest Sewer Service Line on Lott Water Sample Collected by LS /�' )/r -'V ; Date -� Water Sample Test Results S�J'FA6 _),ZY Comments (2) 1/ i/,' 0:C40 '7Er3T 7-10-S'7 B. SEPTIC/HOLDING TANK DATA Date Installed — v Size /ZS�ti No. of Compartments Z— StandpipesY/V) Air -tight Caps((/ ) Foundation Cleanout (YO Depression over Tank (YDate Last Pumped T-/(� -�' � I Pumping/Maintenance Contract on File (Y/N) �/� ;for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) A11114 Separation Distances from Septic/Holding Tank: To Water -Supply Well 7U(0 1'5eeH sT//r/b%iP[r To Building Foundation To Property Line /4 t To Disposal Field To Water Main/Service Line /° To Stream, Pond, Lake, or Major Drainage Course `'7� Comments Page 1 of 2 72-026(11/84) e% II)WI.� � sr C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /y> Type of System Design�� Date Installed %e _S-66-5' Length of Field 5_�_ 7 � Width of Field Depth of Field 7-1 ` Gravel Bed Thickness 0,5' Square Feet of Absorption Area 74f,—Standpipes Present (Y/ Depression over Field (Y& / Date of Last Adequacy Test Results of Last Adequacy Test 4bf Separation Distance from Absorption Field: To Water -Supply Well 'f' To Property Line i 14, To Building Foundation /// To Existing or Abandoned System on Lot /Cld �'f ; On Adjoining Lots 16 _/_. i To Water Main/Service Line AQ To Cutbank (if present) — To Stream/Pond/Lake/or Major Drainage Course /OZ) f �` To Driveway, Parking Area, or Vehicle Storage Area -7- Comments tComments D. LIFT STATION Date In'sMte-1I_ Size in Gallons 1-� "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments — Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumpiq-Gytcles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I hav e ed, ve ified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed �� Date -'-Y� Company�cS MOA No. /�,yc�.w�a`8�9 Receipt No. ©` boo � X41; ®F• A4 "N Date of Payment / .�4 � .J7 3e••• ®•' vq�] Amount: $ f9i �fif1GT5 / GiL2L [ofj coop o•oopo� y, j7�, d S%Jiff'LG5 �4 � IP OY C. pE5 Pu Page 2 of 2 pp CE 2251 F 72-026 (11/84) " y,,•,�'tk lw-'" CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC ansae ANCHORAGE, ALASKA 99518 TELEPHONE 7a562 «2 FEDERAL TAX ID 0 92-0040440 itp h, Pec AN % 1) i' 2«n;t ?000J u To 1 iWC"; II oo W 11d) AV!" «rn ANI:1101 MEA) % I POUT I M, " I P ('Oj U�'C I'l u 0- M- RY A. 0J.,' AEC'; 1, ll,j( clict : f.flolll 1 * 1"d 1, : 6Yj 9 'aIN: "I Ma t r ix, : '. la t x lap i .0.00TINE �X'l I Cn ol hnnili'd jjjJ uci d-9(JO'(1 1-lopoc Gilljdri) V, CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC ,Bees ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 ! S I? EI T 11Y "ANPLE t4 1 10 9 D I P E 10 2 0 JaM:Roved JUN 3 8 2ouccd py ,CQ9 1) 1 !, '1 4 1.1, . »I'M I'J�3111) W, 5 ANCHORAGE, AK. 90503 p I ROOTjNESANN,!, C01 b a , BY A , 1111E It' OF AECS I Owill I lb PC, f 4 ; 6Y 10 ,Ih 1),1111d I 11) : 'I th't c i x ; 11,1 ter bre RrTol;tufl Ro"m I Win Ru 7 I . 0 .:o! /toolill iv)l l(ACORY 44)E9 (1 301? 1111 le C r:0j" flij illolw m«lmuc« "T ','I ion I: Account «9r or t Pr i ij t c!d U U 0 � A I I »@9 n@» 1 n CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. q, TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIERII TO BE COMPLETED BY LABORATORY ❑ PUBLIC WATER SYSTEM LDA � PRIVATE WATER SYSTEM Name r% Phone No. )ZUU G.I 3i Mailing Addre s � t City State Zip Code SAMPLE DATE: z' 4 $ % Mo. Day Year SAMPLE TYPE: `RI Routine ❑ Check Sample (for routine sample with lab ref. no. ) ❑ Treated Water ❑ Special Purpose 13 Untreated Water SAMPLE NO. LOCATION 1 1/ o 7- `7 /i, °r" G c a l 7�t ' 2 �A __ 3 4 5 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Time Collected Collected By I 0 87-0 ej/e � Analysis shows this Water SAMPLE to be: 9 Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received68 Analytical Method: Membrane Filter * No. of colonies/100 ml. Lab Ref. No. Result* Analyst pu U m U m U m BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count Verification: L' Collforml100ml Final Membrane Filters Q Collforml100m1 Reported By Date 06 lAas A1% Time: a.m. p.m. TNTC = Too Numberous To Count OB = Other Bacteria MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY H87--0160 264-4744 Application Date 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 5 Manor Subdivision Location (address or directions) 18956 Inspiration Circle (b) Property Owner Bank of the North Telephone: Home 786-7342 Business Mailing Address % Cathrine Smith (c) Lending Institution Bank of the North. Telephone Mailing Address (d) Real Estate Company and Agent Bob Lock o Dynamic Realty Address 501 W Northern Lights Blvd. Anchorage, Alaska 99503 Telephone (e) Mail the HAA to the followina address: or: Check here ❑, if hold for pick up. List contact person and day phone number below. S & S Engineering 17034 Eagle River Loop Road #204 Eaa1e River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family ®x Number of Bedrooms ) 3. WATER SUPPLY Individual Well ❑ Community Lax Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL OnsiteTYx Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-0251Rev 8/661 From --n 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S Engineering I Telephone Address 17034 Eagle River Loop #204 Date Eagle River Alaska 99577 This department has received written regarding the Conditional Approval of of the on—site septic system has been said engineer. The subject property and is now approved. 6. DHHS APPROVAL µ^ Approved for Approved Engineer's Seal confirmation from the engineer April 2, 1987. The upgrade completed and inspected by the meets with Municipal standards 4h'�-�)bedrooms by 25� /J �/ �"` O Date June 29, 1987 fl XXXXXXXXXX Disapproved Conditional Terms of Conditional Approval 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. 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. Page 2 of 2 72-025 (Rev 8186) Back May 20, 19817 Municipality of Anchorage Department of Health Environmental Services P.O. Box 196650 Anchorage, Alaska 995:1.9-6650 Re: Lot 5 Manor Subdivision ag]_e River, Alaska MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION tAAY 2,11987 RECEIVE® We have recently purchased the above property and a have been informed that the original conditional use permit.-: for the septic system lists a three bedroom house. The septic system should be for a four bedroom home as their are four bedrooms and -they all meet:, the required spec:i.ficat:i.ons. The home has over four thousand six hundred square feet (4,600) of living space. We ca:l.1- this to your attention as the system will be checked in the very near future and any permit issued should be for :Four bedrooms. 7:f you have any questions or comments please do not hesitate to contact us. C� GiAB donuda RoseMa:rie McDonald --Budd cc.. S&S Engineering Alaska Bank of.' the North Terry Beal MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY ADD 264-4720 Application Date - tv 0 r; - 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) "� l� S P`-AQa-rz 5%!� Location (addrf(e�/ss or directions) /i31?s LO /%i.S�/2/'i"%IOY� r i2GLL (b) Applicant Name � a',,im- 12P r -/c NoaTN Telephone: Home 73 Y?-- Business Applicant Address /� e—' A--'iWeWc 3 M r r -H (c) Applicant is (check one): Lending Institution Owner/builder ❑ ; Buyer ❑ ; Other ❑ (ei plain); (d) Lending Institution -r;q cz Telephone Address (e) Real Estate Company and Agent (V tN-M Ky wv� oc r Address Telephone .+bP t (f) Mail the HAA to the following address: 17034 Eagle River Loop Road No, 204 Eagle River, Afailca 99577 2. TYPE OF RESIDENCE - Single -Family G Multi -Family ❑ Other Number of Bedrooms 2 3. WATER SUPPLY / Individual Well El Community 0 Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWA7'Public POSAL Onsite ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11,84) 5. ENGINEERING FIRM PROVIDIf NSPECTIONS, TESTS, FILE SEARCH, D: AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. D I� Name of Firm rtiGINEERING Telephone ('529 y Address Date _ i' river, Alaska 99577 �C c%v w-1- 48� ,f�P%-i o,J cL > To 62/5/ rT li n + c�`��JS� v�S d a� �4 w ii� S onf Qf %� 35vPion> Y`�7z L,u4S d �xrsr�nlc. 3i32 �w�cc�,.�c.. 1�v2k To 3c i'on/� %�Ll ��iJ� CoVO / 77 o" q I- 6. 6. DHEP APPROVAL Approved fort-141em CS edrooms by 'a ' Date A d Disa roved Conditional L__� a 4�„"7 A. shyvx 1o1' OFEni pprove pp Terms of Conditional Approval `^ "`OSS �r°s`o.. S o70 "5orr7V'W'— beeQ a woe �.-m v ✓oea- a s — lti l7� o f s�p�+� S�sf e n . GLPgra �� be� r a�iaSorP wk N�—T .7. he— 90_F. dhep CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) B. SEPTIC/HOLDING TANK DATA Date Installed / 'PPROX ZB`�Size lZS� ')(- No. of Compartments 2 Standpipes Y&IN) Air -tight Caps 6N) Foundation Cleanout (O/N) Depression over Tank (Y&I Date Last Pumped --? ` Z_ Pumping/Maintenance Contract on File (Y/N) ; for �11A Holding Tank High -Water Alarm (Y/N) A Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well /Sb 14 To Property Line �d'f To Water Main/Service Line Course A/jA i To Building Foundation S To Disposal Field /d To Stream, Pond, Lake, or Major Drainage Comments __*—AFPr- .Sc-flTr c ?yMPL-:'2 . Page 1 of 2 72-026(11/84) MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANCHORAGE HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL SERVICES CHECKLIST - FEBRUARY 1984 DIVISION 264-4720 MAR 2 519$7 Legal Description: A. WELL RY&CE I V E D Well Classification If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot r Sd -4 On Adjoining Lots To Nearest Edge of Absorption Field on Lot S-L) -) ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer i Cleanout/Manhole To Nearest Sewer Service Line on Lot 4 C Water Sample Collected by JV42 ; Date Water Sample Test Results 5�% /SFz9CI7�� //�� Comments �SC� A-rTAC-4-1CI `n/F}Y�Pt SAMr�ts B. SEPTIC/HOLDING TANK DATA Date Installed / 'PPROX ZB`�Size lZS� ')(- No. of Compartments 2 Standpipes Y&IN) Air -tight Caps 6N) Foundation Cleanout (O/N) Depression over Tank (Y&I Date Last Pumped --? ` Z_ Pumping/Maintenance Contract on File (Y/N) ; for �11A Holding Tank High -Water Alarm (Y/N) A Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well /Sb 14 To Property Line �d'f To Water Main/Service Line Course A/jA i To Building Foundation S To Disposal Field /d To Stream, Pond, Lake, or Major Drainage Comments __*—AFPr- .Sc-flTr c ?yMPL-:'2 . Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata % a 61,3 P_ Type of System Design Date Installed PP2ox- 15?B11 Length of Field 3 2 � � � 7j Width of Field Z Depth of Field `162 f f Square Feet of Absorption Area Depression over Field (Yt? Results of Last Adequacy Test Gravel Bed Thickness -Y /.S /� 2vx 38((0 Standpipes Presentd9N) Separation Distance from Absorption Field Date of Last Adequacy Test �ATisF Bey �� 3 6Z To Water -Supply Well Soy To Property Line (014 To Building Foundation To Existing or Abandoned System on Lot u( A ; On Adjoining Lots 5D 14 To Water Main/Service Line b To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course ~r(/ A To Driveway, Parking Area, or Vehicle Storage Area 36 Zc Comments 4/�C�}Sv2= nicNi S l H l r r FAc-,a D. LIFT STATION Date Installed Dimensions Size in Gallons &J Manhole/Access (Y/N) "Pump On" Level at A Pump Off' Level al High Water Alarm Level at Vent (Y/N) Tested for Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** N, Pumping Cycles during Adequacy Test, Meets MOA I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Comaa7W4 Eagle River Loop Road No. 2Q4OA No.Z 6 —CSO –? Eag a River, Alaska 99577 Receipt No. zoo / 00)(/, Date of Payment /D e�/ J Amount: $ zD Page 2 of 2 72-026 (11/84) .1A4 0.% 52avkS�o frov S Show n (� a �UpFlnc sl'cONP BILL SHEFFIELD, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION Telephone: (907) Address: ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 DATE: March 31. 1987 PWS I.D.# 213637 Class "C" 274-2533 To Whom it May Concern: According to records on file in this office the Manor Subdivision, Lot 5 Water System is in compliance with the State Drinking Water Regulations Sincerely, James C. Allen Regional Sanitarian Supervisor