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Home My WebLink AboutDENALY BLK 1 LT 5b naly Block Lot 5 #050-731-52 Municipality of Anchorage Development Services Department Building Safety Division ~; .... On-Site Water & Wastewater Program, 4700 South Bragaw SL P.O. www.cLanchorage.ak, us (907) 343*7904 On-Site WastewMer DlsposM System and/or Well Inspection Report Permit Number:. SW010229 PID Number:, 050-751-52 Nome: CARL KAPPEN Wastewater System: · New [] Upgrade ~ddress: P.O. BOX 770489 * EAGLE RIVER. AK 99577 ABSORPTION FIELD Phone: No. af (907) 622-5585 4 ~,p Tr*~h · S~I~. Tr*~h n;,~ ~uo,,~ LEGAL DESCRIPTION '~ "~ 1.2 ~ ~ 5.97 - 5 1 DENALY 1.95 - 2.73 n. 4.02 0.5- 1.0 n. 55+ WELL: · New [] Upgrade '~ ~ ~ ~ e.,. la.~ PRIVATE 141 ~t 140.36 n. 550+ s~. n D 3054/ F-810 Id-W DRILLING, INC. 7/17/01 8+/-~.i ,JONES EXCAVATING 7/25-8/1/2001 ~: 2s+/- ~ UNK ,~ 2+ ~ TANK From l'=nk Station Tonk ~ U,,.. ANCHORAGE TANK 1250 Well 100'+ 100'+ - - 2,5'+ - STEEL ~ '~ '""~""'"""~ 2 S.,~a=. Wa~., 100'+ ~00'+ - - - LIFT STATION LOt Un. ~".F 10'+ -- -- -- . ~ I~ ~"':I ~a~.daUo. ~'+ ,o'+ - - _ '"-*" '"~ "~ ~:7...-~'~"' ' J ~ema~k~.' BENCH MARK TOP OF CMU ~ POINT 105.38 ~nd ~/~/2ooI ......... r'~ ........ : .... ¢ ...... ., Department of Health__rand, Human Services approval_ . v~,~. ~ ..:. -~'.-,- '~' ~ ~ .......... ~ .~=~-...... R~vlewed and approved by-/~.~. Date:_L~_~.~_ Z.T.G./J.LM. ALASKA WATER & WASTEWATER ~ ' CONSULTANTS, INC." CARL KAPPEN (907) 622-5585 2 OF 5 DENALY SUBDIVISION; LOT 5. BLOCK 1, AS-BUILT DRAWING OF N~ WELL LOCATION AND SEPTIC SYSTEM A B C FCO 23.5 12.0 - ST1 24.5 10.5 - ST2 29.5 14.2 - DBL1 33.6 18.2 - DBL2. 34.6 19.5 - C01 74.7 46.0 44.6 MT1 75.7 47.2 46.0 C02 98.0 84.4 95.2 MT2 95.7 83.5 93.5 AS-BUILT DRAWING SW010229 050-751-52 RNAL GRADE =, -- 104.g5-105.30= 'roP OF TANK AT-..-~ -- ~TOP OF TANK AT /' NEW 1250 GALLON ,,~,,;~'r or BUNG SEPTIC TANK ~NW_~T Or BU~G AT AT lEI. El' m 99.0,1 ~ ~ OU'R.['T - 98.8t ~ ! - gSOl (Am) 8/28/2001 Z.T.G. ~~ WATER & WASTE~TER CONSULTA~S, INC. __~+. ,~. ~ ........ ? .... CARL KAPPEN (907) 622-5585 3 OF ~ D[.~L~ SU.D~V,S,O.; LOT s. BLocK ~ ...'" PROFILE AS-BUILT DRAWING OF SEPTIC SYSTEM 08/24/2001 19:39 3453287 N W DRILLING, INC PAGE 01 Job No.: 01.1'/4 Permit No,: SW010229 Project No.: N/A. M-W brillimj, Znc. +P.O. ~x ll03?8+Anchora~. AX 99511, ,907-$4§-4000,907-345-3287 Fax, Groundwater Well~is-Built & Lo~ · Wetl Owner: Kappen. Carl ogeg~lD~ct~n: Lo~5, Black I De~alySubdivision Ea~le River, Alaska · Ute of Well: Domestic ConslFuctlon e Hole De~tfi: 141' e Cmlng Sb. e: 6' + C~etl ~'o: 140.36' · Drill Me,host: .Mr Rotary · Wd/C~ Ol~nen~t X $oeen · Screen/Perfordtlon de$cr~otlon: None · Mdteridl: A 53 Steel Me#tod: · Gnat N=: (I 0) Sada-No. 8 b,.'atofllte In~ule3 · WelIDevelopment: Method: + Wdl yldtl tegl ~ 2~ ~ tfllams lset m~mte (GPM)/ ~ for . ~//h N/A ofdrawdown(DD)fromttattcle~el(SW£). · MetAod: Air lift Depth In feet from top of ,--d-_~. t)e~ils of formn_~lA~,~ penetrated~ skr~ of ma~rlal~ color and hardness, 0 TO 2 Casing stickup '- 2 TO 10 ,Sandy~;raYel 10 TO 40 Sandy gravel: brown 40 TO 90 Silty clay.'_ gray ~ ~C 90 TO 136 Clay: gray 136 TO 141 Sandy water gravel OCT ~ TO TO TO TO ,,, TO '~r~A Cert~ed ~:on~c~r MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bregaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Date Issued: Jul 09, 2001 Expiration Date: Jul 09, 2002 Permit Number: SW010229 Legal Description: DENALY BLK I LT 5 Design Engineer: 0041 AK Water & Wastewater Consultant Owner Name: Carl Kappen Owner Address: PO Box 770489 Eagle River, AK 99577- Parcel ID: 050-731-52 Site Address: Lot Size: 44360 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of; [] DisposaIFie d [] Sept cTank [] Ho d .gTa.k [] 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. PRIOR TO CONSRTUCTING THE WATER WELL, THE WELL DRILLER SHALL SUBMIT A DRILLING PLAN TO THIS OFFICE. THIS PLAN SHALL SHOW HOW THE WELL CONSTRUCTION WILL PREVENT ALL LEAKING THROUGH THE CASING ANNULUS FROM THE CONFINED AQUIFER. Received By: Issued By: ~? 7'?'01 Municipality of Anchorage Development Services Department Building Safety DMslon On-Site Water & Wastewater Program 4700 South Bragew SL P.O. Box 196650 Anchorage, AK 99519-6650 www. cl.anchorage.ak.us (907) 343-7904 Parcel I.D. ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Permit Number ~'14/O/O~ ~,~ Properly owner(s) Mailing address (1) Mailing address (2) ~ARL K-.APPEN P.O. BOX 770489 EAGLE RIVER. AK Dayphone 622-2719 ~pCode ~)~77 Legal description (Lot, Block & Sub'd.) LOT 5. I~LOCK 1: DENALY SUBDIVISION Legal description (Section, Townshlp & Range) Lot Size q ~ .~, 0 Acres/Sq. FL Number of Bedrooms THIS APPUCATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade Well Only Water Storage THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Jam,~'-I Water Softening Unit I certify that the above Information Is correct. I further certify that this application Is being made for a Single Family Dwelling and Is In accordance with applicable Municipal codes. ALASKA WATER & WASTEWATER CONSULTANTSr INC. Permit Fees: ~. Date of Payment: Receipt Numben Waiver Fees;. Date of Payment: Receipt Number:,. ALASI WATER & WASTEWATER CONSULTANTS, INC. June 28, 2001 Municipality of Anchomge Development Services Department On-Site Water 8: Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 Ref: Proposed Well and Septic System Design for Lot 5, Block 1, Denaly Subdivision To whom it may concern: The proposed 4 bedroom house will be served by a private well and septic system. Two test holes were excavated in the area of the proposed septic system. The septic system will be designed around the 30 foot radii of these test holes. We are proposing that a 1250 gallon septic tank and a five foot wide drainfield be installed. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring~ and the percolation test results. It is our opinion that an application rate of 1.2 gallons/day/11' should apply and the insitu sandy soils should act as a sand filter. 2. TRENCII DESIGN: a. Percolation Rate: <1 & 1 minutes/inch b. Allowable Application Rate: 1.2 gallons/day/112 c. NumberofBedrooms: 4 d. Design Flow: 600 gallons per day e. Minimum Absorption Area: 500 fl2 f. Total Depth: 7 feet (max.) g. Effective Depth: 4 feet h. Width: 5 feet i. Reduction Factor: 0.50 j. Minimum Length: 55 feet long k Effective absorption area = 550 tt:2 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akxvwc.com 4. TOPOGRAPHY: As can be seen on the attached topography site plan, the average slope of the property is a 5 to 10 percent slope running approximately from northeast to southwest. In short, there are no slope concerns. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. Presider ~ NOTE: Attached is a site plan drawing, a design drawing, two soils log, a topography site plan, and a 7page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwe.com 'l ~~ ' i ~' ~~ . '/,' ", ~ - o~~/~ ' .~ ,'~'~ ~~ b' / / "- · ..... i~ ~._ ~', ,~'/; ' 6/28/2001 ~SI~ ~rER & ~TE~TER ~ ~ ~) q ~: ~ ~_~ CARL KAPPEN 622-2719 1 0g 2 LOT 5, BLOCK 1= DENALY SUBDIVISION SITE P~N FOR PROPOSED WELL LOCATION AND SEPTIC SYSTEM j \ \\ ........ /...'~" .:'->: '~ ~ .... AI~SI~ ~TER & WASTE~TER ~ , ,CONSOLIANTS, INC. 1" = 40' C [~ ' ~' ~ ........... ~.~ ~o.: ~.o.~ .,.~: ~[ .~: ~ ..... ~. [j ~ ~ ...... ~...:...~ CARL KAPPEN 622-2719 2 0V 2 LOT 5, BLOCK 1~ DENALY SUBDIVISION DESIGN OF PROPOSED WELL LOCATION AND SEPTIC SYSTE~ ALASKA ~VATER & ~VASTE%VATER ~..: ~, , ~o~.~. ,.~. ~3:~.-,.. mso,L LOO - P~RCO~TmON ~Es~m ~ t, )fl ~ OESCRI~O.: DE~Y SUBO=S'O"; LOT 5. BLOCK 1 , ~ . ~ . ~,~o,~o ~o,: ~, ~,~, ,,~: ,~,~oo, ,~.:......~,,,_ ....... ..~ 1--~ ..-., so,~ c~ss,.c~,o.~ 2.?7 4,'~, GM CL 4-- ~.., GC OL ~-"' GP/SP sw MH ::.',, SC 7-- ;'"t' DATE 8- ~?;'? ~ s/~V=oo~ ~ "t' 12' 6/29/2001 lo- ~.-. RE. lNGl CLOCK NET TIME WATER LEVEL NET DROP 11 -- "'"" DATE TIME (MIN~ES} RE. lNG w/ SOME GM 15-- .~ ~s 15- 16- ~t~ 18-- 19-- PERC~TION ~TE <1 .(HIN./INCH) PERC. H~E DIA.. 6" (INCHES) TEST R~ BETWEEN 5.5 FT. ~D 6 20--~ COHHENTS: ~E INS~ ~DY SOI~ SHOULO A~ ~ A ~D RL~R. PERFORMED BY A~ WATER · W~ATER I, JEF~ ~ G~NESS, CER~ T~T THIS W~ P[RFORMED IN ACCORD~CE WITH ~L ~ATE ~D MUNIClP~ GUIDEUNES IN E~ECT ON ~IS DATE: DEPTH TO DATE GROUNDWATER DRY 6/21/2001 12' 6/29/2001 ALASKA ' ATER & VASTE' VATER CONSULTANTS. INC., ISOIL LOG - PERCO~TION TESTm ~& DES~RI~0N: DE~Y SUBDMSION; LOT 7, ~L0¢K 1 ~:=~_.5~=~ OR~ICS ITEST HOLE ~21 t I T ' "' ' 2- ~ GW :===-~ 0RG , " -:-'~, GM CL ~,-~ 4-- <""' GC OL ~... GP/SP ,. ,~ SW MH ~.'Z, ,/sou~ s~LT '. ·., SP CH ' ' ~ SM OH 7- ::['{' I DEPTHTO , ,-. 12' 6/29/2001 10-- ~Jll SH/ML DATE RE'lNG CLOCK NET TINE WATER LEVEL NET DROP 11-~ ./souE c~ TIME (HIN~ES) RE'lNG (INCHES) 12_ 6/21/20011 1 - - 6- - 2 - 6 MIN. O" 6" B.O.~ 5 - - 6- - 15-- 4 - 6 MIN. O' 6' 14-- 5 - - 6- - 6 - 6 MIN. O' 6' 15-- 16-- 17-- 18-- 19-- PERCO~TION ~TE 1 .(HIN./INCH) PERC. HOLE DIA. 6' (INCHES) TEST R~ BETWEEN 5.5 FT. ~D 6 FT. 20--~ COHHENTS: PERFORMED BY A~ WATER & W~I~WATER I, JEF~ A. G~NESS, CER~ T~T THIS W~ P~RFORMED IN ACCORD~CE WI~ ~ ~A~ ~D MUNIClP~ GUlDEUNES IN E~ECT ON DEPTH TO DATE GROUNDWATER DRY 6/21/2001 12' 6/29/2001 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING .¢ Parcel I.D. 050-731-52 GENERAL INFORMATION Complete legal description Denaly, BIockZ, Lot Location (site address) 25628 Bendilent Circle Expiration Date: / Current Property owner(s). Kyunga Chang & Paul Michaud Mailing address Lending agency Mailing address Day phone 25653BendilentCircle, Eagle Rive5 AK 99577 Day phone Real Estate Agent Mailing Address Day phone Unless otherwise requested, COSA will be held by DSD for pickup. 2.~UMB~ERO~iB~ROOMS: 3. "TyPEOF WATER$;UPPLY: Individqal Water Storage [] Community Class Well [] Public Water System [] 'i~6f-'W=A~¥EWA¥ E R i~dividual On-sit~ Individual Holding Tank c°mmunity On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one'year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of 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 272-82:1.8 Address P.O. Box zoo2~7, Anchorage, AK 995~-o Engineer's Printed Name Steven R. Pannone, P.E. Date ~'~ / '/~ gq Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These con&t~ons are outside the control of the evaluator ofth~s system. All systems eventually fail and satisfactory test results do not guarantee future erformance of the s stem, nor do the arantee that p y y gu there are no hidden defects or encroachments. PES can therefore not provide any warranty for future ~.,..~,~..,,~'~C~ ....... ~,,...~ performance nor give any estimate of how long the system will continue to meet the operational ~.~ requirements of the MOA D SD. The content of this report is for the sole benefit of the owner listed ~even ~. Po above. Any reliance upon or use of this report by any other person or party is not authorized nor will it confer any legal right whatsoever.. t / Approved for ~ bedrooms. Disapproved· Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory ON'SITE WATER AND WASTEWATER .......... _' ·. ..... · qlJ))))~ Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type Private Date completed ?h.?/2ooa Total depth ~./+z ft. Denaly~ Block ~.~ Lot 5 Date of test Static water level 8 Well production 25+ WATER SAMPLE RESULTS: Coliform /f,/~'~. colonies/100mL Arsenic: /t//l~ ug/I B. SEPTIC/HOLDING TANK DATA Tank Type/Material Steel/Septic Tank size z25o gal. Foundation cleanout (Y/N) Y Date of pumping ~.',1',21:~o.,~. C. ABSORPTION FIELD DATA IfA. B, or C provide PWSID # ~ Sanitary seal (Y/N)Y Cased to FROM WELL LOG Date installed 8/a12ooz Length 55 Total depth 7. ft. z~o.~6 ff. g.p.m. ParcellD: Nitrate I' ~r'~-- mg/L Date of sample: Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 2/~ AT INSPECTION ~.2181:~o', ~. o ff. . 5,5+ g.p.m. Collected by: '~',~, Date installed 8hl=ooz Number of Compartments _~ Depression over tank (Y/N) N Pumper JR's Septic Soil rating ft. Width 5 Eft. absorption area 55o ft2 (g.p.d./ft2 or ft2/bdrm) =.= GPD/SF ft. Monitoring tube Y Date of adeqUacy test Fluid depth in absorption field before test _o in. Elapsed Time: ~.~o min. Final fluid depth _o in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Results (Pass/Fail) __ Cleanouts (Y/N) Y High water alarm (Y/N) N N System type Wide Trench Gravel below piPe .~ Depression over field N in. Pass For .~ bedrooms Water added77o gal. Absorption rate >= 750+ New depth_o in. g.p.d. If yes, give date D. LIFT STATION Date.-i,~ta~ Size in gallons Manhole/Access (Y/N) "Pump on" leve~h water alarm level at Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: in. Meets alarm & circuit requ~-T~lts~?-----~ Septic tank/lift station on lot ~.oo+ Absorption field on lot ~oo+ Public sewer main 75+ Sewe~/septic service line 25+ Animal containment areas 5o+ On adjacent lots 2.oo+ On adjacent lots ~oo+ Public sewer manhole/cleanout ~oo+ Holding tank ~oo+ Manure/animal excrete storage areas lOO+ Building foundation 5+ Water main ~o+ Wells on adjacent lots SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Property line ~.o+ Water service line 25+ loo+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~.o+ Building foundation ~o+ Water Service line ~o+ Surface water ~.oo+ Curtain drain 50+ Wells on adjacent lots ~oo+ COMMENTS Absorption field 5+ Surface water ~.oo+ Water main 75+ Driveway, parking/vehicle storage ~o+ G. ENGINEER'S CERTIFICATION I certify that I 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, P.E. Date Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number SGS Ref.# 1115904001 Client Name Pannone Eng. Srv. Printed Date/Time 12/13/2011 16:23 Project Name/# Denaly, Blk 1, Lot 5 Collected Date/Time 12/08/2011 19:00 Client Sample ID Denaly, Blk 1, Lot 5 Received Date/Time 12/09/2011 8:15 Matrix Drinking Water Technical Director Steohen C. Ede PWSID 0 Sample Remarks: 4500NO3-F - Total Nitrate/Nitrite - MS recovery is outside of QC criteria. Refer to the LCS for accuracy information. Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 12/12/11 12/13/11 NRB Waters Department Total Nitrate/Nitrite-N 1.35 0.100 mg/L SM20 4500NO3-F B (<10) 12/12/11 AYC Microbiolo~p&r Laboratory E. Coli Total Coliform Negative 1 100mL SM20 9223B A 12/09/I1 MEM Negative I 100mL SM20 9223B A 12/09/11 MEM 12 11 Dad 3388078 Aarow Pump & Welt Service, LLC; b ~::f''''4: P.O. BOx 110496 " Anchorage, AK 99511 Office: (907) 346-9355 - Fax (907) 333-8976 ' Eagle River: (907) 622-9335 No. 9228 CUSTOMER _~Sb~>._..'~ ,~. >..~, -I JOB SITE I- ~,-¢¢~7S' ~._~,'~.r~" ~...> -q OUAN'¥iT~' DEscRIPTION PRICE AMOUNT LABOR HOUR9 RATE AMOUNT TOTAL MATERIAL WORK ORDERED B¥I DATE CO~P. TOTAL "' I L~BOR PAY tHIS aMOUNt ~.¢, ThankYou SIGNATURE (I Hereby Acknowledge the Satisfaclory Completion of the Above Described Work and a§ree that if above work is not paid for in 90 days I agree to allow Aarow Pump & Well Service, LbO. the right to remove unpaid for equipment and charge for labor already performed & labor to remove unpaid l'or equipmenl.) TERMS: ACCOUNTS PAYABLE AT lOTH OF MONTH FOLLOWING PURCHASE. SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS. JRs .Pumping PO Box 773415 Eagle River. AK 99577 (907) 694-6454 ]lallPng Pennons Engineering Po Box 100217 Anchorage, AK 99510-0217 (90.7) 2.72-8248 Office ~ I Job Sits Information Dan 25628 Bendilent Circle Eagle River, AK 99577 (907) .272-8218 Additional Location Comments: Corner lot on right Tan w~'$ next to garage door Septic (~ Back of home Diagram: Job Description: P.O, Number: Terms: Salasrep: Map Book: Cross Streets: Job Comments: 1250g Service Agreement Number: 035124 Order Date: 09-Dec-2011 Service Date: 14-Dec-2011 Technician: Mike & Jeremiah Net 30 Tax %: 0 Kaflia Job Type: Repeat Map Grid; 134- - Denaina Drive Last Serv ';;~9/1612009' 1250g ....... SERV & BILL ........ Normal Tank ~ B/F - 2 X's - Clean & Normal $ ;\Dias rams\2967tl,I;~p Gallons Planned: 1250 Gal. Actual: Hose Length: 2 Double Tank: ~ ~ Pump System; I t,, Baffles Inlet: I I Baffles Outlet: I.'.'] Service Type Septic Serv 1250K Qty Price Each Tax? I $200.00 No NonTaxable To~l Taxable Total Estimated Charges: $200 00 $0.00 Extension Actual $200.00 Ta~, Total Grand Total $0.00 $200.00 Actual Charges: Customer agrees to the terms and conditions shown. THIS I$ A BINDING AGREEMENT. Signatt~'6 a~itle ot~'C'usiom~ Representative '- - A~er 30 Days acoount will be turned over ~ C~LECTIONS. ~0.00 For NSF Checks Returned. Alpine Appraisal, LLC (907) 277-3100 IMain File No. 11160CLI Paqe #11 Ln fl001-0058951 Uniform Residential Appraisal Report File// 11160CL rhe purpose of this summap/appraisal report is to provide the lender/client with an accurate, and adequately supported, opinion of the market value of the subiest properly. Pmpe~ Address 25628 Bendilent Cir City Eagle River State AK Zip Code 99577 Sorrower Victor &Angela Willis Owner of Public Record Paul Michaud~ Kyunga Chang Count/ Munic. of Anchorage Legal Description Lot 5, Block 1, Denaly Assessor's Parcel -If 050-731-52 Tax Year 2011 P.E. Taxes $ 8,610 Neighborhood Name Eaclle River Road Map Reference SW 0363 Census Tract 0002.04 Occupant [] Owner [] Tenant (~] Vacant Special Assessments $ 0 [] PUD HOA $ 0 [] per year [] per month Property Rights Appraised [] Fee Simple [] Leasehold [] Other (describe) Assignment Type [] Purchase Transaction El Refinance Transaction [] other (describe) Lender/Client Residential Mortgage, LLC Address 100 Calais Drive, Suite 100, Anchorage, AK 99503 Is the subject property currently offered for sale or has it been offered for sale in the twelve months prior to the effective date of this appraisal? [] Yes [] No Report data source(s) used, offering price(s), and date(s). DOM 13;$645,000, listed 10/28/2011, Alaska MLS~I 1-13880 [] did [] did not analyze the contract for sale for the subject purchase transaction. Explain the results of the analysis of the contract for sale or why the analysis was not ,ertormed. Arms length sale;No unusual conditions noted in Purchase Aqreement dated 11/08/2011 and Counter Offer dated 11/09/2011, fully executed by both parties. Contract Price $ 645,000 Date of Contract 11/08/2011 Is the properly seller the owner of public record? [] Yes [] No Data Source(s) City records Is them any financial assistance (loan charges, sale concessions, gift or downpayment assistance, etc.) to be paid by any party on behalf of the borrower? if Yes, report the total dollar amount and descdbe the items to be paid. $0;; []Yes []No · Note: Race and the racial composition of the nei~lhborhood are not appraisal factors. ~EOcati°n ~ Urb~'n ~ ~Ubur~' ~ RUral iP~pe~vai~e~ ~ i~easi~g'" '~ sta~l~ ~ o'~clining"I PRi~ AG~ IOne~u~ ~%1 BuiE-up ~ Over 75% ~ 25-75% ~ Under 25% ] Demand/Supply ~ Sho~age ~ In Balance ~ Over Supply I $ (000) (yrs) 12-4 Unit 10 ~Gro~h ~Rapid ~S~ble ~Slow IMarke~ng~me ~Under3~s ~3-6~s ~Over6~sI 150 Low 0 JMuEi-Family 3% Neighbo~ood Boundaries Chugach State Park lands to the no~h and east, Eagle R ver (the creek) so~h ~ 1,000 High 60 ]Commercial 2 ~andEageRverLoopRoad'west. ' ] 350 Pred. 25 liner 2o~l River Road contains a ~de range of size, age, and qualiW single family homes on 1/2 to full acm sAes, many web of the valley and surroundinq mountains. Immediate area has paved roads and is recently developed with moderate to large custom Access to shopping and emplo~ent centers is considered average. No adveme influen~s were noted. Market Conditions (including suppo~ for the above conclusions) Sales activity and prices appear fairly stable over the last few years with softening in upper FHA, VA and conventional financing is available at histori~ily Iow rotes. This quaAer usually brings lower invento~ of the season. Seller ~ncessions are occurring with some frequency and have not changed in the last year. Dimensions irre( Area 1.02 ac Shape Irregular ~rner View B;Mtn; I Class~ication R-IOSL Zoning D~cdption Residential ~pine Slope w/spec, limitations best use of subiect property as improved (or as proposed per plans and specifications) the present use? [] Yes [] No if No, descdbe Utilities Public Other(describe) Public Other (describe) off-site Improvements-Type Public Private U/G Water [] [] private well Street paved [] [] [] Sanitary Sewer [] [] 4-br septic Alley none [] [] Flood Hazard Area [] Yes [] No FEMA Flood Zone X FEMA Map Cf 020005 0420D FEMA Map Date 09~25~2009 Are the utilities and off-site improvements typical for the market area? [] Yes [] No ff No, describe , adverse site conditions or external factors (easements, encroachments, environmental conditions, land uses, etc.)? [] Yes [] No ff Yes, describe as-built survey was provided. Site slopes slightly downward from the street with a .qood view of Eagle River Valley and surroundinq mountains. d septic, which is typical for the neighborhood and acceptable to the market. Upgraded landscaping includes paver beds front and rear with extra lar~le upper deck, and covered patio areas below. No adverse conditions noted. [] One with Accessory Unit [] Concrete Slab [] crawl Spao~ ii:O~,datio~ waii; ~onc biecwavg ' iioors .... cp~ii~d/.qd # of Stories 2 [] Full Basement [] Partial Basement IExterior Walls OSB,shake/a¢~ C/ails TexDw/.qoo~ Basement Area 1,749 sq.ft. IRoof Surface Asph shg/avg' rr m/F n sh PntWd/~ood Basement Finish 100 % IGufters & Downspouts Yes/avg' ' 3ath Floor Tile/.qo(~d [~ Outside Entry/Exit [] Sump Pump IWindow Type Vinyl/a'vg 3ath Wainscot Fb,ql's/Til/good Year Bet 2001 Evidence of [] Infestation JStorm Sash/Insulated DblPan'e/avcl :ar Storage ~ None' 8E [] Dam~ess ~] Settlement IScreens Some/avg ~ Driveway Cf of Cars 5 Attic None IHeating U RNA J[] HWBB I[] Radiant Amenities [] Woo(~stove(s) # 0 Driveway Surface Asphalt/circ Stairs E~ Other I Fuel Natural gas ][] Fireplace(s) # 2 [] Fence None [~ Garage # of Cars 3 Floor [] Scuttle ICooling [] Central Air Conditioning ' I[] Patio/Deck DkPat [] Porch CovPor [] Carport # of Cars 0 Finished [~] Heated li~ Individual IQ Other None J[~ Pool None ~ Other Landscp ~ Att. [~ Dot. ~ Built-in [] Dishwasher [] Microwave [] Washer/DP/er [] Other (describe) wall oven, Viking cooktop~ grill Rnishedaraaabovegradeconfains: 7 Rooms 3 Bedrooms 2.1 Bath(s) 2,876 Square Feet of Gross Livinq Area Above Grade Addiifonal features Features include vaulted living room, cherry cabinets, granite kitchen & island bar, 2-sided ,qas closet shelving, ietted tub, steam shower~ extensive cherry and tile flooring, radiant heat, upper rec room w/fireplace & bamboo floor, * Desodbe the condition of the property (including needed repairs, deterioration, renovations, remodeling, etc.). C3;No updates in the prior 15 years; * lower level rude and recessed lighting, hardware, blinds~ 9' ceilings on upper levels, 6 patio doors to rear deck and patio area. Home has CAT 5 and cable TV. Gar has heated floor and storacle shelving. Subject is a quality built home which shows flood maintenance. No repairs Hired. /, soundness, or structural integrity of the property? [] Yes [] No ff Yes, describe conform to the neighborhood (functional utility, style, condition, use, construction, etc.)? ~Yes []No itNo, descdbe Freddie Mac Form 70 March 2005 UAD Version 9/2011 Page 1 of 6 Fannie Mae Form 1004 March 2005 Form IO04UAD -- "WinTOTAL" appraisal software by a la mode, inc.- 1-800-ALAMODE JMain File No. 11160CLI Pace #21 Ln #001-0058951 Uniform Residential Appraisal Reportfi,e# 1116ocL There are 9 comparable properties currently offered for sale in the subiect neighborhood ranging in price from $ 500,000 to $ 800,000 There are 12 comparable sales in the subiect neighborhood within the past twelve months ranging in sale price from $ 500~000 to $ 800~000 FEATURE I SUBJECT COMPARABLE SALE # 1 COMPARABLE SALE # 2 COMPARABLE SALE # 3 Address 25628 Bendilent Cfr 25731 Denaina Dr 7001 Kulchay Cfr 17603 Shasta Cfr Eagle River, AK 99577 Eag e R ver, AK 99577 Eagle River, AK 99577 Eagle River, AK 99577 Proximity to Subject 0.15 miles SE 0.32 miles SE 5.04 miles W Sale Pdce $ 645,00¢ '~i?i'; I$ 595,00(; I $ 720 000 $ 645 000 SalePrice/GrossUv. Ares $ 224.27sq.ft $ 184.15sq.ft.J ~ :'~! "~' ' 30063~qlftili ~; ,,,, $ "22735 sq.ft Data Source(s) MLS~I 1-3013,AMDS;DOM 62 AMDS,Apprs.;DOM 0 MLS#11-7559,AMDS;DOM 52 Verification Source(s) Lst $615,000 Lst SN/A Lst $685,000 VALUE ADJUSTMENTS DESCRIPTION DESCRIPTION +(-) $ Adjustment DESCRIPTION +(-) $ Adiustment DESCRIPTION +(-) $ Adjustment Sales or Rnancing iii~i ArmLth ArmLth ArmLth Concessions VA;8000 -8,000 Conv;O VA;4000 -4,000 Date of Sale/Time s07/11 ;c05/11 s05/11;c03/11 s08/11 ;c07/11 Location N;Res; N;Res; NiRes; N;Res; Leasehold/Fee Simple Fee Simple fee 0 fee 0 fee 0 Site 1.02 ac 1.19 ac 0 1.39 ac -10,000 15012 sf -10,000 View B;Mtn; B;Mtn; B;Mtn; B;Bluff; 0 Design (Style) 2 Story+bsmt 2 Story 0 Hlsd ranch 0 2 Story+bsmt Quality of Construction Q3 Q3 Q3 Q3 Actual Age 10 9 -2,000 9 -2~000 6 -8,000 Condition C3 C3 C3 C3 Total IB~rms. I Barns Total Bdrms. Baths 0 Total Bdrms.I Baths 0 Total Bdrms. Ba~s 0 7 i~lil~l~llr2.1 9 4 2.1 0 6 2 2.1 0 8 4 3.0 -3,000 Gross LivingArea 2,876 sq.ft. 3,231 sq.ft. -11,400 2,395 sq.ft. +15,400 2,837'sq.ft. +1,200 ~ 1749sfl 749sNv( Osf +49,000 2138sf2138sfwo -10,800 1360sf1250sNvc + 12,000 . lrr~.Oba2o +6,000 lrr2brl.0balo 0 lrrlbrl.0baOo 0 FuncUonal Utility average sim 0 sim 0 sim 0 Heating/Cooling gas radiant gas rad+BB +3,000 gas lad ant gas FA +5,000 Energy Efficient Items typical for age sim 0 sim 0 sim 0 Garage/Carport G3B L9 G3B Lg G4B Lg -8,000 G3B Sm +2~000 Pomh/Patio/Deck CvPor LDk Pat CvPor 2Dk Pat 0 EncPor LDkPat 0] CvPor Dk Pat +2,000 Fence, Etc. XPvg XLndsc Pvg HTub +3,000 XPvg XLndsFp -5,00(; Pvg +5,000 Fireplace, Etc. 2FP KBarCFn FP KBar CFn +3,000 2FP KBarWBr £ 2FP KBar Bis 0 Interior Amenities VC Jac Vac Kit+ VC Jac Vac Bis +2,000 VC Jac Sec Bis £ VC Jac Vac +2,000 Net Adjustment(Total) [] + [] - $ 44,600 [] + [] - $ -20,40£ [] + [] - ~ 4,200 Adjusted Sale Pdce Net Adj. 7.5 % Net Adj. 2.8 % Net Adj. 0.7 % of Comparables Gross Adi. 14.7 % $ 639~600 Gross Adi. 7.1% $ 699~60¢ ~mss Adi. 8.4 % !$ 649~200 I [] did E~ did not research the sale or transfer history of the subject property and comparable sales. If not, explain My research [] did [] did not reveal any prior sales or transfers of the subject properly for the throe years prior to the effective date of this appraisal. Data Source(s) MLS, Assessor deed date, Owner. My research [] did [] did not reveal any prior sales or transfers of the comparable sales for the year prior to the date of sale of the comparab e sale I Data Source(s) Assessor deed dates, MLS Report the results of the reseamh and analysis of the prior sale or transfer history of the subiect property and comparable sales (report additional prior sales on page 3). ITEM SUBJECT COMPARABLE SALE #1 COMPARABLE SALE #2 COMPARABLE SALE #3 Date of Prior Sale/Transfer Pdce of Prior Sale/Transfer Data Source(s) Assessor deed date, MLS Assessor/MLS Assessor/MLS Assessor/MLS Effective Date of Data Soume(s) 12/06/2011 12/06/2011 12/06/2011 12/06/2011 Analysis of prior sale or transfer histon/of the subiect property and comparable sales The subject sold in 2007 for $695,000. A refinance appraisal done 6/28/11 for $690,000 is also acknowledged. Subiect was priced to move quickly this time for dissolution purposes and sold in 2 weeks. No known sales of the comparables were found in the last year. Summary of Sales Comparison Approach The above sales include 2 from the subject's subdivision which bracket by size and price. These homes are felt to best reflect the subject in terms of age, qua fy, features, and Iocational appeal. Comp 1 is a smaller home in close proximity with no basement similar s ze .qara.qe, and inferior features. It has partial radiant heat. Comp 2 is closest in size with a 4th .qarage and superior features. It has full radiant heat. This home was not exposed to the market, but offer was based on appraised value. Site is adjusted due to large pr rate culdesac location with superior view. Comp 3 is located farther afield, as few recent sales were found on larqe vew ots This home is situated closer to town in a planned development with public water/sewer. Higher land value is due to h ,(:Ih deve opment costs in this newer subdivision of upscale homes. Each comp sold well over assessment ($80,000+). Subject appears under-assessed at $650,000. Value is reconciled with weght on the larc~er homes See Page 7 Grid. Indicated Value by Sales Comparison Approach $ 670,000 Indicated Value by.' Sales Comparison Approach $ 670,000 Cost Approach (if developed) $ 655,657 Income Approach (ff developed) $ The Sales Comparison Approach is the most reliable indicator of value in exist nfl homes as it is the most reflective of buyer and seller interaction. The Cost Approach is developed, but is not as reflective of the market. The income approach is not typ. ically a consideration in single family properties and was not developed. This appraisal is made [] "as is", [] subject to completion per plans and specifications on the basis of a hypothetical condition that the improvements have been completed, [] subject to the following repairs or alterations on the basis of a hypothetical condition that the repairs or alterations have been completed, or [] subject to the following required inspection based on the extraordinary assumption that the condition or deficiency does not require alteration or repair: As inspected with no repairs. This appraisal report meets the standards of both FlRREA and USPAP. Baaed on a complete visual inspection of the interior and exterior areas of the sub act property, defined scope of work statement of assumptions and limiting conditions, and appraiser's certification, my (our) opinion of the market value, as defined, of the rea property that is the subject of this report is $ 670,000 , as of 12/06/2011 ~ which is the date of inspection and the effective date of this appraisal. Freddie Mac Form 70 March 2005 UAD Version 9/2011 Page 2 of 6 Fannie Mae Form 1004 March 200. Form 1004UAD -- "WinTOTAL" appraisal software by a la mode, inc.- 1-800-ALAMODE Municipality of Anchorage Development Services Department Building Safety Division ~ On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage. AK 99519-6650 www.muni.org/onsite (907) 343-7904 ( ERTIFICATE OF ON-SITE SYSTEHS ,&,PPROVAL FOR .b, SINGLE FAHILY DWELLING Parcel I.D. 1. GENERAL INFORMATION COSA# )lqO Expiration Date: ,~ -- / (~ - O 7 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address DENALY SUBDN1SION; LOT 5, BLOCK 1, 25628 BENDILENT CIRCLE * EAGLE RIVER, AK 99577 BRYAN AND AMY BELL Day phone c/o CAROL BUTLER w// REMAX PROPERTIES Day phone c/o AGENT CAROL BUTLER w/ REIdAX PROPERTIES Day phone 110 W. 38TH AVENUE * ANCHORAGE~ AK 99503 257-0116 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well PubIic Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Sen/ices Department (DSD) Issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties sen/ed by a single-family on-site wastewater disposal and/or water supply system, DSD also issues COSAs upon request to homeowners, Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties sen/ed by a private or Class C well and may be reissued with new water samples, (Certificates may be reissued for a period of up to one year with valid water samples,) Certificates are valid for one year for properties sen/ed by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work, 4. STATEMENT OF INSPECTION I~Y ENGINEER As certified by my seal affixed hereto and as of the vali~lation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SU~E 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Phone Date 357-6179 Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. Tho operational life of all we/is and septic systems depend on the local soils condition, groundwater levels that may ~luctuate during the year, and the water usage of the family being served by the system. These conditions are outside tho control of the eva/uator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provido any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. Th? content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or parly is not authorized, nor will it confer any legal #ght whatsoever. 5. DSD SIGNATURE ~ Approved for ? bedrooms. Disapproved. Conditional approval for __ '".."C,"O ~: ON-SITE · ~= ~: WATER AND ~ : WAST~ATER: ~ bedrooms, with the fllowing stipulations:~?~o.. Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic A(ivisory Main[enance Agreements Suj3plemental Engineer's Reort Other Original Cehificate Oate:~ 7' Municipality of Anchorage Development Services Department Building Safety Division O~-Site Water & Wastewater 4700 Bragaw Street P.O. Box 196650 Anchorage. AK 99519-6650 w.muni.org/onsite (907) 343-7~04 Legal Description: A. WELL DATA DENALY SUBDMSION; LOT 5~ BLOCK Date of test Static water level Well production WATER SAMPLE RESULTS: Well type ProrATE If A, B. or C provide PWSIDg N/A Date completed 7/17/2001 Sanitary seal (Y/N) YES Total depth 141 ft. Cased to 140,,%6 ft. FROM WELL LOG 7/17/2001 6+/- ft. 25+/- g.p.m. Coliform ~ colonies/100 mi. Arsenic: _.~ ug.~. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Tank size 1250 .gal. Number of Compartments Foundation cleanout (Y/N) YES Data of pumping 3/1/2007 ABSORPTION FIELD DATA Parcel ID: O,,~'O '7 31 --_~".2, Well Lng (Y/N), Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 4/24/2007 0 ff. g.p.m. 5.3 YES YES 24+ in. Date installed 7/2.3-e/'1/'20o~ Soil rating ~r ft=/bdrm) 1.2 Length ,55+ ft. Width 5 ft. Total depth o~,e3 ff. Eft. absorption area 5,.5.0,+ ff~ Monitoring tube YES Date of adequacy test 4/24/2007 Results (Pass/Fail) PASS Fluid depth in absorption field before test 6 in. Water added 655 gal. Elapsed Time: 1020 min. Final fluid depth 7 in. Absorption rate >= Any rejuvenation treatment (pest 12 mo.) (YIN & type) NONE KNOWN System type TRENCH Gravel below pipe 4.02 ft. Depression over field NO For 4 bedrooms New depth 11 in. 600+ g.p.d. If yes. give date - Depression over tank (Y/N) NO Pumper Date installed 7/23-8/1/2001 Cleanouts (Y/N) YES High water alarm (Y/N) N/A SANITARY PUMPERS Nitrate ~.~._~mg./L. Other bacteria --~ colonlas/100 mi. Date of sample: 4/24/2007 Collected by: GE(;, Ltd D. UFT STATION Data installed Size in gallons Manhole/Access (Y/NI ~ "Pump on" level at ~evel at in. ~ ~ Cycles tasted. Meets alarm & circuit requirements?. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas. ,50'+ 100'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cieanout N,/A Holding tank N/A Manure/animal excrete starage areas Building foundation Watar main Wells on adjacent lots SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 5'+ Property line 5'+ Absorption field N/A Water service line. 10'+ Surface watar. 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line. 10'+ Building foundation 10'+ Watar sewice line 10'+ Surface watar 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ 5'+ 100'+ Watar main N/A Driveway, parking/vehicle storage 10'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspeottons and review of Municipal records that the above systems are in conformance aSth MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A, GARNESS Da. Receipt Number (Rev. 11/05) Waiver Fee $ Data of Payment Receipt Number SGS Ref.# Client Name Project Name/# ClJenl Sample ID .~fat ri~ 1071686001 Garness Engineering Group, Ltd. Denaly Lot 5 Block I Denaly Lot 5 Block 1 Drinking Water All Dates/Times are Alaska Standard Time Printed Date/Time 05/08/2007 15:20 Collected DatoTime 04/24/2007 16:00 Received Date/Time 04/25/2007 10:12 Technical Director' Stephen C. Ede PWSID 0 Sample Remarks: Allowable I~ Analysis parameter Results PQL Units Method Container ID Limits Date Date Init Metals b~ ICP/MS A~senlc ND $.00 ug/L EP200.8 C (<10) 05/03/07 05/08/07 TK Waters De~a:tmen~ Total Nitratc/Nitrile-N 1.09 0.100 mg/L SM204500NO3-F B (<10) 05/05/07 JDS Microbtolo<:.p[ Labora toz-~ TotalColil'orm 0 coVI00mL SM209222B A (<1) 04/25/07 DLC l'la~ l! 2007 !!:OORM HP LASER JET FAX p.2 May 11 07 13,~38a M-W 9073453287 p,2 ~-'w bRll. LTNG, INCj PO BOX 110378 ANCHORAGE, AK 99511-0378 ~ ~ iON QTY : P.~T~ ' At,~O .UNT ^tmchcd WoTk Order # 10505 I ; 100.00 I00.00 ,,f/I- W ~Vleans water/Z/ I v'~~c~c~:l'o~.~? I I lay 11 07 10:3~a Ltl il g0734~287 p.3 XE~-I 131'~]3Slg9 dH WUOO:IT AOOE TT IRew Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAHILY DWELLING Parcel I.D. 050-731-52 HAA# 1. GENERAL INFORMATION Expiration Date: '~-- Z.~ i- 0 3 Complete legal description DENALY SUBDIVISION; LOT 5~ BLOCK 1~ Location (site address or directions) DENAINA DR~VE * EAGLE RIVER~ AK 99577 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address CARL KAPPEN P.O. BOX 770489 * EAGLE RIVER~ AK 99577 Day phone Day phone 622-2719 1 AUDREY MASON w/ REMAX PROPER'RES Day phone 694-4200 16600 CENTERFIELD DRIVE * EAGLE RIVER, AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well [~ Individual Water Storage Community Class Well [~ Public Water System II TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health ~uthority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer*s work. Nole: Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, or prior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined i~, the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my inveatigation 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. NameofFirm ALASKA WATER &: WAST-EWATER CONSULTANTS, INC. Phone 337-6179 Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504 I Engineer's Comments: attain Id mvtde a thorou h In conducting this evaluation, AKWWC, Inc. pt~ to p ' g , conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results' desc~bed the performance of the system under the conditions encountered at the t~me of the test and separabon distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, g'reundwater levels that may fluctuate during the year, and the water usage of the,family being sen/ed by the system. These conditions are outside the control of the evaluator of the system. Satisfactoc/ test results do not guarantee futura performance of the s~stem, nor do they guarantee that there ara no hidden defects or encroachments. AKWWC, Inc. can therefore not previde any warranty or futura estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD.~ The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE J Approved for !~ bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: '... ON-SITE [ WASTEWATER Attachments: HAA Checklist Septic System Advisory Well Flow Advisory ...'o,./ ...... · '; Manitenance Agreements ~ · cr~. c , Supplemental Engineers Reo~ Other (Rev. 12J~1) Original Certificate Date: Municipality of Anchorage Development Services Department Bulla'lng Safety Ok, tsion On-Site Water& Wastewater Program 4700 SOUth Bragaw St. P.O. Box 196650 Anctmmge. AK 99519-6650 www.cLanchorage.ak.us Legal DeScription: A. WELL DATA wen ty~e ~avA'rg HEALTH AUTHORITY APPROVAL CHECKLIST DENNY SUBDMSION; LOT 5~ BLOCK 1 Parcel ID: · tlWt[ LESS THAN 2 YEARS OLO. If A. B. or C provide PWSlD~ N/A Well Log (Y/N) YES 050-751,-52 Date completed '7/17/2001 Sanltmy seal (Y/N) YES Totaldepth 141 ff, Casedte 140.36ft. Date of test Static water level Well procluction WATER SAMPLE RESULTS: Colifom~. 0 colonies/100 mi. FROM WELL LOG 7/17/2001 8+/- ~. 25+/- g.p.m. Nitrate 1~,I~ mg./L. Wires properly protected (Y/N) YES Casing height (above ground) ,24.+ AT INSPECTION Other bacteria 3 colonies/100 mi. Amenic: N/A mg./L.- SEPTIC/HOL~.I[~G TANK DATA Tank Typa/Matedal Tank size it 250 gal. ' Date of sample: 3/19/2003 Collected by: AKWWC~ INC. Number of Compartments 2 Foundation cleanout (Y/N) YES Date of pumping ~/o ~ ABSORPTION FIELD OATA Depression over tank (Y/N) NO Pumper Dateinatalled 7/23-8/1/2001 Cleanouts(YIN) YES H~hwater~arm(Y/N) N/A Date installed 7/23-e/!/2OOl soil rating ~r fl2/bdrm) 1.2 System type SHALLOW TRENCH Length 55+ ft. Width 5 ft. Gravel below pipe 4.02 ff. Toteldepth *a.75 fl. Eff. absoq3tion area 550+ fl= Monitoring tuba. YES Dapressionoverfleld NO Date of adequacy test **NEW Results (Pass/Fall) - For 4 bedrooms Fluid depth in absorption field before test - in. Elapsed T~na: - min. Final fluid depth Any rejuvenation treatmem (past 12 mo.) (Y/N & type) **Sl~'¥1C SY~'i'Ir.M LESS THAN 2 YEARS OLD. Water added - gal. New depth - in. in. Absorption rate >= - g.p.d. N/A, If yes. give date - D. LIFT STATION Date installed Size in gallons Manhole/A_~~ w "Pump on" level at in. "Pump off" . Nigh water alarm level at ; in. ~ ~ Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Publl= sewer manholalcleanout Holding tank N/A N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water service line 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ - Building foundation 10'+ Water service line 10'+ Surtace water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ Absoq~tion field Surface water 100'+ Water main N/A Driveway. parking/vehicle storage 10'+ F. COMMENTS O. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections end mv~ew of Municipal records that the above systems em/n conformance ~ MOA HAA guidelines in effect on this date. Engineer's Printel:l Name o.. JEFFREY A. OA~NESS HAA Fee $ Date of Payment ~/.~/ Receipt Number (Re,,. Waiver Fee $ Date of Payment Receipt Number $G$ Ref.# Client Name Project Name/~ Client Sample ID Matrix 1031496001 AK Water & Waatowater Consultants lac. Denal¥ S/D; Lot 5. Block 1 Dcnaly S/D; Lot $, Block I Drinking Water All Date~Tlme~ are Alaska Standard Time Printed Date/Time 03/24/2003 1*1:56 Collected DateJTJme 03/19/2003 11:30 Received Date/Time 03/19/2003 ]6:50 Sample Remarks: Allowablc Prep Analysis Parameter Result' PQL Units Method Limits Date Date Init Waters Departmen~ Ni~at=.N 1.38 1.00 mg/L EPA 300.0 (<--10) 03/20/03 PLW ~4~crobiology Laboratory Total Coliform 3 OB, No Coli col/100mL SMI8 9222B f~'~ !) 03/19/03 KAP CT&E .Environ'mental Services lnc; 200 W, Potter D~ive · ng Water Aaa r' ' Drinki lys~s Report fo Total Coliform. Bant ria*e~:^""h°r°"U'lgo~l ~-~s~s ^~ -~s~a-~o~ READ. I~$TJ~UCTIOIV$ ON REyERSE ~;IDE 2iEFORE COLLECTING'SAMPZE . . Fax: (907) 561-5301 .' MUS¥ BE COMPLBTED BY WATER SUPPLIER TO BE COMPI.~i'I!D BY LABORATORY PUBLIC WATEi~ SYSTEM I.D. # ~PRIVATE WATER S. YSTEM Cl. Sendlnvolct, ri Send Results ri Send lnvolce' SAMPLE DATE: ' SAMPLE TYPE: . ' ~ Routine O R~/~t S~mpl~; (for rovil'ne sample' with'lab ref..t~o, r ,) et Special Purpose ~lonth . D.ay Year Treated Water Untreated Water Time Collected .SAMPLE LOCATION 'Collectell ,By /~-^,3~'£/~i L~L ~,aI"''H, t~:~o . ABalysls/shows this Water SAMPLE to be: j~ Satisfactoty ' et - Unsatlsfactoi'y .. ri Sarnple over 30 hours old, ~ults may bo unreliable . - et Samt~le too long id transit; sample should not bepver~f~o~rs old'at examination lo indicate telia'ole rcaults. Please ,.cad .~e~v. sample via special deliye~y.mail. Datc~eeelv:d . ~>- / ?-o ~ Time Received lg60' _ I Analytical Method: ~"]tfft--Mcmbrsn¢ Filter ~et MMO-MUO 1031496"1 t om,. Result* Analyst Sent lo A.D.E.C, .~Anch Fbk~ Jun [3 Faxed BACTERIOLOGICAL 'WATER ANALYSIS .RECORD M,~O-MUG Result: Total C61iform , . E. Coil · l',,embrsne Filter. Direct Count · Verification: LTB EGB · COLIFIRM F~ml Collfom Confirmation .. ' . Date: Time: Client no'l find of unsatisfactory resulis.'. l'honed . Spoke with }'axed ~S~S Member of tho S OS Group ,So¢iit§ G6n,rel, ge SurveiI{ailce) . FACILITIES IN ALASKA. CAUFORNIA. FLORIDA, ILLINOIS, MARYLAND. MICHIGAN. MISSOURI. NEW JERSEY, OHIO. WEST VIRGINIA vxumelpality ot Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.alcus (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. '1. GENERAL INFORMATION '.Complete legal description .Location (,site address or directions) "Current Property owner(s) Mail!ng.,ad'dre~s Expiration Date: .Lending agency Day phone _Day.phone Mailing address Real Estate Agent Mailing Address Day phone Un/ess otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: ~/ 3. 'PIPE OF WATER SUPPLY: ' Individual Well Individual Water Storage Community Class -- Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site [~ Individual Holding tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Ce<f~cates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewatar disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further vedfy that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Address ~'¢~ EngineeCs Pdnted Name bedrooms. 5. DSD SIGNATURE p/"" Approved for Disapproved. Phone - Conditional approval for bedrooms, with the following stipulations: Additiohal Comments. Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other X Original Certificate Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O, Sox 196650 Anchorage, AK 99519-6650 waw.ci.anchorage.ak.us (g07) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: WELL DATA Well type ,~:~,"~f,~ Date completed Tolaldepth /~'/ lt. Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform .4- .colon es/100 mi. Arsenic: mg./l. B. SEPTIC/HOLDING TANK DATA Parcel I D: .~ .~] ~. _~' ~.~ If A, B, or C provide PWSID # __ Sanitary seat (Y/N) Y' Cased t~ /'~/'~ It. FROM WELL LOG Ju~.~ /~/ .,gee/ g.p.m. Wall Log (Y/N) ~ Wbes properly protected (Y/N) Casing height (above ground) AT INSPECTION g.p.m. in. Nitrate ~, 77mg./I. Date of sampla: ~.,~, ~ .'~ Other bacteria ',P colonies/lO0 mi. Collected by: ,~",,a~<~ ,~"/4~-,0~..~'7' Tank Type/Material ~',~',~:"'/,~',-+",,-'~",~/--- Tank size /.,~'~ gal. · Number of Compartments ,,~ Foundation claanout (Y/N))'/' Depression over lank (Y/N) ,,U' Date of pumping '~-'/~///= ~/ Pumper Date installed Cleanouts (Y/N) High water alarm (Y/N) C. ABSORPTION FIELD DATA · - / Date il~lalla<~./~ Soil rating (~ or ~) /'Z ~ ~ fl. W~ ~ fl. T~I dep~ ~ ~fl. Eft. abso~fion ama ~ ~ Mon~dng ~ Da~ of ad~ua~ ~t ~ ~ Resu~ (Pas~8il) ~ Fluid dep~ ~ 8~o~on field ~fom ~st ~ ~. Wa~r edd~ ~gal. ~ Time: ~ min. Fi~l flu~ dep~ ~. ~o~on m~ >= ~y rejuvenation ~a~ent (~st 12 mo.) ~ & ~) ~ System type ~"',/'~'~-,~'~-) Gravel below pipe x/ fl. Depression over field For ~'/bedrooms New depth .~,~ in. ~ o~) g.p.d. If yes, give date ~ Eo UFT STATION Data installed 'Pump on" level at in. Datum~ Cycles tasted SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lilt station on lot Absorption field on lot / Public sewer main ,4/,,/~ Sewer/septic sewice line Size in gallons Manhole/Access (Y/N) ~ AJ'/~rm level at Meets alarm & circuit requirements? Building foundation Watar main Wells on adjacent lots On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Properly line -~ Watar sewice Dine SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Absorption field · Surface water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /~ "~'/~ Building foundation /~, ,~/-,x Watar main x.//',,~ Water Service line /~ ""~'*~' Surface water / ~ ~'''.~'~ Driveway, pafldnghmhide storage Curtain drain ~J"'~' '~'~*~"P"/Wells on adjacent lots -/'~' ~'~"~ F. COMMENTS G. E" GINEER'S CERTIFICATION ~a~ w~ MOA H~ gu~ellnes Engin~¢s Pdn~ Name ~~ Waiver Fee $ Date of Payment Receipt Number ATFACtIMENT TO MUNICIPALITY OF ANCtIORAGE HEALTti AUTHORITY APPROVAL CHECKLIST D~tc: Re: Lot 5, Block I, Denaly Subdivision, Eagle River, Alaska The well was an artesian well with a plug roughly three feet below the surface. JeffPoet was contacted by phone during the test and he said there was no need to record the static water level ofthe well on the Health Authority Approval Checklist. The other bacteria count was above I0, so the system was chlorinated. The bacteria count after chlorination was satisfactory. SJS/CT&E ENVIRONMEI~rAL SERVICES' ' · .Drinking water:Analysis R~pod for T0~a[' COlifo~ Bacteria'' ALASKA 99518 3 104531 6'-~ ... MUST BE COMPLETED BY WATER SUPPLIER : SAMPLE COLLECTION: .1'1 Repeat Sample . (refer to lab no. ' Pm'po.se .' to ~, ~. [3 Same as coiled'a' Othec. TO BE COMPLETED BY LABORATORY Received e~: ~"~' Comme~: Untreated Water . .'. SGS Ref.# Client Name Project Name/# Client Sample ID ~,latrlx Sample Remark: 1045316001 Douglas Kenley P.E. Lot 5, Block 2. Denal¥ Lot $, Block 2, Denaly Drinking Water All Dates/Times are Alaska Standard Time Printed Date/Time 08/24/2004 6:56 Collected Date/Time 08/19/2004 14:00 Rereived Date/Time 08/19/2004 16:20 TechnicaIDirector ~ Steph~'C. Ede Allowable Prep Analysis Parameter Results PQL Units Method Container ID l.imit~ Dale Dale Init Waters Department Nitrnte-N 0.767 0.100 mg/L EPA 300.0 B (<-10) 0Sli9/04 JSB Microbiology Laboratory Total Coliform 41 OB, No Coil col/100mL SM20 9222B A (<al) 0S/19/04 DKC [] Rout~ n Repot ~mpb I'l Tm.t.d Wd~ 8~6-L By:. Membmr~ Fief MMO-MUG (P/A) · Drinking W~terAnalysis Report for Total· Coliform Bacte/ia" MUST BE COMPLETED BY WATER suPPUER : .. ANCHORAGE. ALASKA ~9518 Tel:. 907-562-2343 .:" 1045715- I^'I .SAMPLE COLLECTION: ,~MPLE TYPE: .' · .o.,_ , T..- ~.L.':~'°'~ ^. (~'~-~.,,'~" ~l~ Wl~r ~,.~: ~ ~ ' ~ .v.) . ~ e~ . ~e is ~Ue~ ~c , " ~,~, ~.~ ~. C~// ' '". 'Membrane Filter MMO.-MUG (PLA) Repo,edBy: "~'('~ ~ OatefTIm,: e/~t/~'%t Form # FW. 0053 12/17/03 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAHILY DWELLING Parcel I.D. 050-731-52 HAA# 1. GENERAL INFORMATION Expiration Date: Complete legal description DI~NALY 'sUBDMsIoN; .LOT 5~ BLOCK 1 ' Location (site address or directions) DENAINA DRIVE * EAGLE RIVER, AK 99577 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address CARL KAPPEN Dayphone 622-2719 P.O. BOX 770489 * EAGLE RIVER, AK 99577 ' Day phone. AUDREY MASON w/ RE:MAX PROPERTIES Day phone 694-4200 16600 CENTERFIELD DRIVE * EAGLE RIVER, AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well ~] Individual Water Storage Community Class Well [~ Public Water System LJ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Cerlificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a pdvate or Class C well and may be.reissued ~vith new water sample?'. (Certi[icates may be reissued for a pedod of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A er B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ ~22.~o at, or prior to dosing for the engineering services provided, 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Phone Address 6901 DEBARR ROAD. SUER 2B * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS. P.E. Date 337-6179 Engineer's Comments: In conducting this evaluation, AWV¢C, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported rosults described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by ~he system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any wamanty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authortzed, nor will it confer any legal dght whatsoever. 5. DSD SIGNATURE Approved for Z~ bedrooms. Disapproved. Conditionalapproval for __ Attachments: HAA Checklist Septic System Advisory Well Flow Advisory bedrooms, with the fllowing stipulations: Man~(enance Agreements Supp~ementa~ Engineers ~eo~ O~her Municipality of Anchorage Development Services Department Building 6afety Olvlslon On. Its Water & Wastewater Program 4700 ~ Bragaw SL P.O. 8ox 196650 Anchorage, AK 99519-6650 www.ci.anchomge.ak.us Legal Description: A. WELL DATA HEALTH AUTHORITY APPROVAL CHECKLIST DENNY SUBDMSION; LOT 5m BLOCK I Parcel ID: 050-731-52 Wall type P~VA~ If A, B, or (~ provide PWSID# Date completed 7/17/2001 Sanlta~ seal (Y/N) YES Totaldepth 141 ff. Casedto 140.36lt. Date of test Static water level Well production WATER SAMPLE RESULTS: Collfon~ 0 colonies/100 mi. Arsenic: ° 00~ nlgJL. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size 1250, gal. · .. FoundaUon cleanout (Y/N) YES Date of pumping NEW C. ABSORPTION FIELD DATA FROM WELL LOG 7/17/2001 25+/- g.p.m. wen Log (Y/N) YES Wires propedy protected (Y/N) YES Casing heigM (above ground) 24+ AT INSPECTION N;~-b;~ [..O mgm-. Omer bacteria I colonies/100 mi. Date of sample: 1/4/2002 Collected by: AWWC, INC. :~l F.=L Date installed 7/23-8/1/2001 Number of Co~parlments 2 Cleanoute (Y/N) YES Depression over tank(y/N) NO High water alarm (Y/N) N/A Pumbar - System type SHALLOW TRENCH Gravel below pipe 4.02 fl. Depression over field NO For ¢ bedrooms New depth - in. Absmption rote >=, - g.p.d. N/A If yes, give date - *'-Date in~ll~ 7/'~-~/~ So, ~.0 ~=r fl'redrm) 1.2 Length' '55+ ,, lt. ~ 5 lt. Total depth .6.75 lt. Eft. absorption area 550+ it2 Monitoring tube YES Date of adequacy teal NEW Results (Pass/Fall) - Fluid depth in absorption field before test - in. Water added - gal. Elapsed Time: - min. Final fluid depth - in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) D, LIFT STATION Date installed Size in gallons, "Pump on" level at in. *Pump~ High water alarm level at Datu..~.~m ~ Cycles tested. Meets alarm & circuit requirements?. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO:. Septic tank/I;fl station on lot100'+ Absorption field on lot 100'+ Public sewer main N./A Sewer/septic cewice line 25'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N,/A Water sewice line 10'+ Wells on adlacem lets 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Pmberty line 10'+ Building foundation 10'+ Water sowice line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots. 100'+ F. COMMENTS On adjacent lets 100'+ On adjacent lots 100'+ Public sewer menhole/cieanout Holding tank N/A Absorption field 5'+ Surface water 100'+ Water main N/A Driveway, parking/vehicle storage. 10'+ G. ENGINEER'S CERTIFICATION I cerUfy that I have determined thmuglt field inspections end review of Municipal records that the above systems em ~ conformance w~h MOA HAA guidelines in effect on this date. Engineer's Prin~?ame Date JEFFREY A. GARNESS HAAFee$ Date of Payment /- Receipt Number ~)/~t4 ~ C~ c:/' (~v. 12/oo) Waiver Fee $ Date of Payment Receipt Number JAN-08-02 04:SOPU FROM-CT&E ENVIRONI,~NTAL SRV 9075515301 T-498 P.OI/OZ F-S3G ~1~.~. Cl'&E Env~mnmen~l Se~ice8 Inc. CT&£ ReL# Client Name Project N ame.~ clteot Sample ID Matrlz Ordered By 1020145001 AIC Water & Wastewatcr Consuli~ml~ Inc. Dcn=li S/D LS, B 1 Dcn~ly S/l) LS, BI DfinY. mg Water Client PO~ Printed Date/Time 01/08/2002 16:42 Collected Date/Time 01104/2002 8:37 Received Date/l'lme 01/04/2002 17:10 Releas~ ~ ~ Allowable ~ A~b/si$ Limil/ [:~tc I~tc lnlt Arsenic 0,00200 U 0.00200 mg/L EPA 200.9 (<0.05~ 01/0~/02 .IMP Nitrate-N 0.200 m~ EPA 300.0 (<101 01/05/02 SCL Microbiology LaboratorY' Total Colifoml I OB. No Coli COl/I OOmL SMI8 9222B 01/04/02 KAl 200 W. Potter · · , al sis Rcoort for Total Coliform t~actcnTel' (907) 5e2-23~3 D nkingWatcrAn Y - ....... ,,,,,,,- ,rcT~oS~W~'L~ __~1 p.~4D INSTRUCTIONS ON l~VEIt~£ Stsc a~, ...-- COL ~ BE~L~BOKATORY Analysis shows l~is Water SAMPLE to be: SAMPLE DATE: SAMPLE TYPE: c/ Routine SUH~ 2B ':: :N~-,ULTANTS. INC. · ~I~CHO~,,E. AK 99504 Mouth Day Year Satisfactory UnsadsfKtory 0 Sample over 30 hours ohL results may be ~nreliable SL'T~le tOO Io~J in transit: Si~pl~ s~ho~uld O.__. not be ove~ur~ old at ex~m~ma~on to indicat~ reliable results. Please send new sample v~l special delivery Date Re~eived a'l~ RKetved I ~ I 0 Analytical Method: O~ Membrane £iRer MMO-MUG · Number of ¢olonies/100 mL Lab Ref. No. Result*' Analyst S4nt to A.D.LC. Anc# Fbkz Jun ~] Fazed Date: Time: Client notified of uneatllfutor',/resui~: 0 phM~d Spok~ whk Date: _ ,,. Time: 0 Treated Water 0 Repeat Sample (for routine sample ~ Untreated Water vdt~ tab ref. no. · ) G · Sp~clal.Purp4~s._e . . ~ · - CMNcted SAMPLE LOCATION Collected By BACTERIOLOGICAt. WATER ANALYSIS RECORD Verification: LTB Fecal Coliform Couflrmat¼u Finer Melabrtoa Filter ResulU ~..~,~..~ .~,~ , CoUfor~/IO0 mi ReponedBy ~ Date ¥[~"'!0"~-._ Time ~ hfs