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KNIK HEIGHTS BLK G LT 3
KIn,bk'Hei'Dg hts Block Cm7 Lot 3 #017-372-21 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite " J 1.)epartment On -Site Wastewater Disposal System Permit Permit Number: OSP231065 Effective Date: 4/19/2023 Work Type: SepticTank Upgrade Expiration Date: 4/18/2024 Tax Code Number: 01737221000 Site Legal Address: KNIK HEIGHTS BLK G LT 3 G:2836 Site Mailing Address: 12900 RIDGEWOOD RD, Anchorage Owner: MILLER ALEXANDER JAMES & Lot Size in Sq Ft: 43500 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 6 This permit is for the construction of: ❑ Disposal Field Q 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 Received By: %O . PLS Date: Issued By: Date: ` Zv MUNICIPALITY OF ANCH4r RA"Co""JE Community Development Department r y 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. 017-372-21 Property owner(s) Alexander & Ann Miller Day phone Mailing address Site address 12900 Ridgewood Drive Legal description (Sub'd., Block & Lot) Knik Heights Block G Lot 3 Legal description (Township, Range & Section) Lot Size 43,500 Sq. Ft. Number of Bedrooms 6 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X Septic Tank ❑X Upgrade 0 (w/wo ADU) Tank El Renewal El Duplex (D) El Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Az z5 Waiver Fees: Date of Payment:Llh 2123 Date of Payment: Receipt Number: _ W001 G Receipt Number: Permit No. _ 0--'5P23 1065 Waiver No. Permit App__'- : - :—'.,:c Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231065, Curtis Townsend, 04/19/23 N'luncipality of AndmrdW o Z I I On -sit �er aN ter € t� H £ REVIEw�� �CCEt fUA 11 o 0 0 p k r"� OSP231C Curtis 1' c�Z�2�InoU) I I N Ivo < Z! m" IV Ivo C z~ m Z I ( O o n O m D r ~ n II (� 005 L,y � o m y — I� tn c09 rn 2 0o Z W^ n mND P i_ ' Ll Qj Do I �I x / m y 0-1 / � / 3 3 'c / r k-� ` \ \RIDGEWOO�D ROAD 3 NOTES: PANNONE ENG SVC LLC tC.I. 1088) REVISIONS DATE for construction P.O. BOX 1807 PARR, AK 39645 / ... 04/04/2023 PHONE (907) 745-8200 FAX (907) 745-8201 P,'• SCALE DRAWN LSC KNIK HEIGHTS BLOCK G LOT 3 ••••••• P.I.D. NO CHECKED ACP ALEXANDER & ANN MILLER "fi�evon annoae 017-372-21 CE 8749 PERMIT NO. 12900 RIDGEWOOD ROAD OsPxxxxxx SITE PLAN ANCHORAGE, AK 99516 SHEET DRAWN 1 OF 3 munapaiiiV or Pralorage On-site Water and Wastem a I ( ( I REVIEWED FOR CODE COMP OSP231065, Curtis Towruend, 3 O NN I I I O I I I 0 M I z i aA i v m I I I I O I I II I I I I I i I I I I mo I I I l a n I n I I Nm I I I iI I I I I I I I II I ;I o I I I � a21 i I I N I I I X21 z W N — 0 I I �� �Q N�(�OJ—IC�10w-0� mzD�omx�oS> I ER I I I --zizmo��'���m O�cDi�om:7 z�D= ZO00� O 0n0mZ m z -T, W� ,, � O O z I I I aA I ooz OAF I oe m I m2rn c/) 00 4 c� z (pC (PCD�m D C zf-"W �;d 7°4mD-�1 0 m O' — ZF I I 12n I I O� cc) m E:> D-.-,0 —0 �o0 I I l a x n 20 m co I I I I I I( I l I I NOTES. for construction PANNONE ENG SVC LLC (C.I. 1088) P.O. BOX 1807 PALER, AK 99645 ,SOF REVISIONS DATE 04/05/2023 PHONE (907) 745-8200 FAX (907) 745-8201 P.' SCALE h 49 M'!. :* 1" = 10' DRAWN ��C KNIK HEIGHTS BLOCK G LOT 3 •• ......• P.I.D. NO CHECKED ACP ALEXANDER & ANN MILLER "fiievei� ani.cw9 017-372-21 12900 RIDGEWOOD ROAD CE 8149 ; PERMIT NO. OsPxxxxxx SITE PLAN ANCHORAGE, AK 99516 SHEET 2 OF 3 N cxrslte v_wpr afnd VVa_,%ewa F O AD--1 W J W N A W N n NCO i06 �Ib N A W N 6 ?L4 N f z oom tmoo romQm"'tf � Amm>mmgoom,m fir, �o DOm �➢,� DOy O�x Z�ft10O OCrr COr�l�cDi�OGD nr F§MEVVED RC1 FOR CODE t"{/�•'-`�Ln NNn� m m z1 Dn nDO�Zf=*IZ nf*nnx0. pIAn ACn -� nfn D_Am5 mm AAA m2 �A VOA mo o�D zm n n xZm-_;p v mm-ni jz Z8oAo 7�GZ�ZZOZ ADD , m�?ON? 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BOX 102954 ANCHORAGE, Al( 99510 OFq�,_ REVISIONS DATE 04/05/2023 for construction PHONE 907 272-8218 FAX 907 272-8211 ?;• '' �Ap *:49TH ' W .* "" •' .. ""••• "feleven C, ...40 CE 8149 KNIK HEIGHTS BLOCK G LOT 3 ALEXANDER &ANN MILLER 12900 RIDGEWOOD ROAD SCALE NTS DRAWN LJC P.I.D. NO 017-372-21 CHECKED ACP PEOSPXNO. XXX SOIL LOG ANCHORAGE, AK 99516 SHEET 3OF3 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 017-372-21 1. GENERAL INFORMATION Complete legal description Knik Heights BG L3 Location (site address) 12900 Ridgewood Dr. Current property owner(s) Jamie Kmet Mailing address Real estate agent 2. TYPE OF DWELLING: F -j Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 6 Expiration Date: gz�/Az- Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver 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 5IZA21 Date of Payment I Receipt Number. 02-605G Receipt Number COSA # 05C2.1 1230 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and 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 conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name 6. DSD SIGNATURE Steven R. Pannone P.E. Date ZG®6l OF -AI . �..� .....`..: : System #1 Approved for bedrooms rj Steven R. Pannone CE 8149 System #2 Approved for bedrooms�`��� . Disapprovede`o Conditional approval for bedrooms, with the following stipulations: �o \NAS-pj,'ATtK p� ---- - PR0GKPN1 �\ SEOG By: rte/ '/ ')ADOikWa)l Certificate Date: -� / Z 1 The Municipality of Ar re 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 Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Advisory Other Took o,ot e a d v ��a 7 Legal Description: Knik Heights BG L3 If more than 1 septic system on lot: COSA Checklist # 1 of I A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 11/80 Total depth 128 ft Cased to 128 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 4/28/21 Static water level at beginning of test 108.4 ft Comments (2) 300 gallon storage tanks B. TANK DATA Age of tank(s) "`9'86' years Tank type/material septWM..1 Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping 10/6/20 D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) 9/80 ❑ ALL standpipes present per record drawing Total measured depth from grade 18.7 ft (max) Measured depth to pipe invert from grade 12.5 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 017-372-21 Structure served by this system 1 Well production at time of test 3+ gpm Water storage tank volume 2x300 gallons Well disinfected for coliform test? ❑ Yes Q No ❑ Coliform bacteria is Negative Nitrate 4.0 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Pannone Engineering Date of Sample 4/29121 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments. tank levels normal, tank located under concrete slab Adequacy test date 4/28/21 Results IDPass For 6 bedrooms Fluid depth prior to test 0 in Water added 900 gal New depth 0 in Elapsed time 180 min Final fluid depth 0 in Absorption rate 900+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' * 96 Yes Community Sewer Manhole/Cleanout > 100' if No ft Yes if No ft Q Yes Yes Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' M Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' Yes if No ft Q Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' M Yes if No ft M Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' M Yes if No ft Surface Water > 100' Property Line > 5' ✓v Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' M Yes if No ft Private Wells > 100' Water Main > 10' Q Yes if No ft Community Wells > 200' ®✓ Yes if No ft F7 Yes if No ft 0✓ Yes if No ft Water Service Line > 10' M Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' lZI Yes if No ft If absorption field is under driveway comment below Property Line > 10' Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' M Yes if No ft Community Wells > 200' n Yes if No Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS Survey on file. * Waiver WR8900062 ** RV Parking over Ist 10' of field- approved by dept. 6/15 ***Sump @ SE of trench is 18.7' B.G.- assumed bottom of field. 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. COSA Checklist yellow sheet ft ft MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org Septic Tank Advisory Certificate of On-Site Systems Approval # OSC211230 Subdivision: Knik Heights Block:G, Lot: 3 The septic tank for this property is 41 years old. The average life for a steel septic tank is 20 years. Typical replacement costs range from $7,000 to $11,000. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. • • C i • s `J r'I LOT 3, BLOCK G 43,500 10' UTIL. ESMT. X I X SHED w� FENCE (APX)—� x cci —X—x—x—x-= x—x—x — X --\ x 36.0' CONC. PATI o X p CANT \/ J 4.0' CANT EXISTING BUILDING 4.0' X \ slo X } x—x—x—x—x—x— —x—x— — — — — x 10' UTIt. t T: x—x—x— —Tx / N 5958'00"E 300.00' f ' \ CA110 PATIO -f �o SEPTIC VENT (Typ) AS—BU I LT I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DEPICTED ABOVE AND THAT NO GASTALDI LAND ENCROACHMENTS EXIST EXCEPT AS INDICATED. SURVEYING, LLC IT IS THE RESPONSIBILITY OF THE OWNER TO JEFF A. GASTALDI, R.I.S. DETERMINE THE EXISTENCE OF ANY EASEMENTS, ?000 E. DOWLING RD., SUITE 8 COVENANTS OR RESTRICTIONS WHICH DO NOT ANCHORAGE, ALASKA 99507 APPS ON THE RECORDED SUBDIVISION PLAT. PHONE 248-5454 UNDER NO CIRCUMSTANCES SHOULD ANY DATA GRID DATE HEREON BE USED FOR CONSTRUCTION OR FOR SPIRAL ESTABLISHING BOUNDARY OR FENCE LINES. 2836 2/23/2015 STAIRCASE ANCHORAGE RECORDING DISTRICT, ALASKA F.B. JOB N0. o� �Z NOTE: NO CORNERS SET THIS DATE 01-16 KHS3G 6.0' OF4 .°•.......a qs .p 49TH 00 p. 0•e.O. q..p.....eeq • ... . .... ......... m e Jeffery A. Gostaldi : oAV 0. LS -6091 ��AV P��p °e• 2/23/2015 : tJ a Arofessional —x WELL T� 6.0' Y W N SPIRAL STAIRCASE 6.0' 3 o� �Z 6.0' P—X— X""-x-__x` M A.C. DRIVE 26.0' 4C. WALK OF4 .°•.......a qs .p 49TH 00 p. 0•e.O. q..p.....eeq • ... . .... ......... m e Jeffery A. Gostaldi : oAV 0. LS -6091 ��AV P��p °e• 2/23/2015 : tJ a Arofessional MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Water System Permit Permit Number: OSP171281 Work Type: Well Upgrade Tax Code Number: 01737221000 Site Legal Address: KNIK HEIGHTS BLK G LT 3 G:2836 Site Mailing Address: 12900 RIDGEWOOD RD, Anchorage Owner: KMET CAMERON P & JAMIE Design Engineer: This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: JAI C n t 1 �LT 1)chartiucnt 9/25/2017 9/25/2018 43500 ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well Q 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 Special Provisions: 1. HDPE tanks to be manufactured by Greer. dor ,lo{u 5 � NLtW tot, . AIM 9) Received By: Date: Issued By: L'f PLO p Date: 11Z 5 1.2 p 1-7 AU5WMUNICIPALITY OF ANCHORAGE Community Development Department \ 'J Phone: 907-343-7904 Development Services Division F. •; 9W , , 997 On-Site Water& Wastewater Program RUSH ON-SITE SEWER/WELL PERMIT APPLICATIec, SEP z a ZQ)] / 017-372-21-000 � !�'‘�5 ti Parcel I.D. Property owner(s) Jamie & Cameron Kmet Day phon..2 2, Mailing address 12900 Ridgewood Drive, Anchorage, Alaska, 995 Site address 12900 Ridgewood Drive, Anchorage, Alaska, 99516 Legal description (Sub's., Block & Lot) Knik Heights Blk G Lot 3 Legal description (Township, Range & Section) Lot Size 43500 Sq. Ft. Number of Bedrooms 6 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial 0 Single Family (SF) X❑ (w/wo ADU) Septic Tank ❑ Upgrade ❑ Duplex (D) ❑ Holding Tank El Renewal ❑ Multiple Dwellings 0 Privy ❑ (SF and/or D) Private Well 0 Water Storage 0 b \Vic-A 4.LG ;Nt KS V ct SUU• 1r\ll�} CUrnex- ak-as�� THIS APPLICATION INCLUDES A VARIANCE!WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. ._)- 6Ignature of property owner or authorized agent) Q1,-37 3o_f Way Permit/Rush Fees: 3 (ECU Waiver Fees: Date of Payment: 9/251/1 Date of Payment: Receipt Number: 114"7332, Receipt Number: Permit No. OSP/7/07 Waiver No. Permit App_:-:•::_.._c; NSF Certified Products- Public Water Supply System Components http://www.nsforg/Certified/PwsComponents/Listings.asp?'trade'\amc... EN* Live safer.' NSF Product and Service Listings These NSF Official Listings are current as of Monday,January 21,2013 at 12:15 a.m. Eastern Time. Please contact NSF International to confirm the status of any Listing, report errors, or make suggestions. Alert: NSF is concerned about fraudulent downloading and manipulation of website text. Always confirm this information by clicking on the below link for the most accurate information: http://www.nsf.org/Certificd !PN\sComponents/Listings.asp?l'radeName=Doak+LPDA%2D3220+Ni'+7+1Ii0h+Density+Polvethvlcne+Resin&_ NSF/ANSI STANDARD 61 Drinking Water System Components - Health Effects NOTE: Unless otherwise indicated for Materials, Certification is only for the Water Contact Material shown in the Listing. Click here for a list of Abbreviations used in these Listings. Dow Chemical Company (The) 1803 Building Midland, MI 48674 United States 989-638-6231 Facility : Red Deer, Alberta, Canada Potable Water Materials Water Water Contact Contact Trade Designation End Use Temp Material Potable Water Materials Dow DPDA-3220 NT 7 High Density Polyethylene Resin A,F,P D. 110'1' PI Protective(Barrier) Materials Water Water Water Contact Contact Contact Trade Designation Sipe Restriction Temp Material Tank Material Dow DPDA-3220 NT 71-sigh Density Polyethylene Resin >= 5 gal. D. HOT PE Number of matching Manufacturers is 1 1 oft 1/21/2013 11:33 AM SPECIAL LISTING INFORMATION FOR NSF/ANSI STANDARD 61 ... http://www.nsforg/Certified/Plumbing/EndUseDesignaiion.html Note: Press the BACK button on }'our browser to return to NSF's Listings. NSF End Use Code Resignations: Plastics materials and compounds arc identified in Listings for specific end use applications. The classifications for the various uses are as follows: Designations for Potable Water End Uses I. Pipe 2. Fittings 3. Pipe & Fittings 4. Appurtenances and Coatings other than pipe or fittings 5. Special pipe applications (nonpressure or tubing) 6. Well casing pipe/couplings Designations for Non-Potable Water End Uses First Digit 1. Pipe 2. Fittings 3. Pipe & Fittings 4. Solvent Cement Second Digit 5. DWV 6. Continuous Waste 7. Sewerage Systems 8. Drain, Waste and Vent; Continuous Waste and Sewerage Systems 9. Corrosive Waste Note: Press the BACK button on your browser to return to NSF's Listint s. 1 of 1 1/17/2013 10:23 AM Regulatory Data Sheet DOW DPDA-3220 NT 7 High Density Polyethylene Resin Global Chemical Inventory Compliance All components of this product are on the following Inventory Lists or are exempt: Country Inventory YIN Country Inventory Y/N Europe EINECS Yes Australia AICS Yes Europe ELINCS Yes China IECS Yes Canada DSL Yes Japan ENCS Yes Canada NDSL - Korea KECI Yes United States TSCA Yes New Zealand NZIoC Yes Philippines PICCS No US FDA Food Contact Status When used unmodified and processed in accordance with Good Manufacturing Practices(GMP)for food contact applications,this resin will comply with the U.S. Food and Drug Administration's food additive regulation at 21 CFR 177.1520(c), paragraph 3.1a, under the Federal Food, Drug,and Cosmetic Act,with restrictions. An additive present in this product limits use in finished articles having a volume of at least 2 gallons when contacting fatty foods of Food Types III, IV-A, V, VII-A, and IX described in Table 1 of U.S. FDA 21 CFR§ 176.170(c). Conditions of Use are limited to D-G described in Table 2 of U.S. FDA's regulation at 21 CFR§ 176.170(c). The preceding statement refers to regulatory requirements only, not to the product's physical utility. It is the responsibility of the article producer or food packager to determine that the article is suitable for its intended use. US FDA Drug Master File (DMF) Please contact Dow's Customer Information Group for more information (DowCIG@Dow.com). US Pharmacopoeia (USP) Please contact Dow's Customer Information Group for more information (DowCIG@Dow.com). European Commission Regulation (EU) No 1012011 (Food Contact) The composition of this product has not been assessed for use in contact with food according to European Commission Regulation(EU) No 10/2011. European Pharmacopoeia (EPhC) Please contact Dow's Customer Information Group for more information(CIGEUROPE@Dow.com). Canadian Food Contact (HPFB or CFIA) Although this product has been granted Canadian Health Products and Food Branch (HPFB) No Objection Status,it is the responsibility of the end-user to consult HPFB before using this product in a food contact or pharmaceutical packaging application. This product is restricted to use in food contact applications not exceeding 100°C(212°F) and in finished articles having a volume of at least 18.9 liters(5 gallons). C)QO Supersedes all versions prior to Effective Date Page 1 of 4 ®TM Trademark of The Dow Chemical Company("Dow")or an affiliated company of Dow Effective Date. 11/5/2012 RDS - DOW DPDA-3220 NT 7 High Density Polyethylene Resin Animal Derived Components To the best of our knowledge, this product is not manufactured or formulated with ingredients of animal origin. Food Allergens To the best of our knowledge,there are no raw materials,including additives,that have their origin in peanuts, soybeans, milk,eggs,fish,shellfish,tree nuts, mustard,celery,sesame,and/or wheat or gluten. No sulfates or sulfites are used in the synthesis of this material. This evaluation is based on information provided by our raw material and additive suppliers for the presence of the allergen-stimulating substances shown above. Therefore, although we believe this product to be free of the specified known allergy stimulating food substances,we cannot guarantee this. Materials from Genetically Modified Organisms To the best of our knowledge,there are no raw materials. including additives,that have been derived from genetically modified organisms(GMO). This is based on information from our additive suppliers. Therefore, although we believe this product to be GMO free, we cannot guarantee it at this time. Kosher The raw materials used in the manufacture of this product are derived from non-animal sources. There is no animal fat, no animal derived materials, grain derived,or fermentation products used in this product. The product is not certified as kosher but will comply with the kosher dietary laws. Therefore,this product can be used with kosher products without compromising the status of the products. REACH For information on Dow and the European Union regulation for Registration, Evaluation,Authorization and Restriction of Chemicals(REACH), visit our website,www.reach.dow.com. This product is not manufactured or formulated with any of the Substances of Very High Concern (SVHC)as per the candidate list that was current as of the effective date of this regulatory datasheet. Current information can be found at the ECHA website. http:llecha.europa.eu/chem_data/authorisation_process/candid ate_list_table_en.asp. Please contact Dow's Customer Information Group for more information(CIGEUROPE@Dow,com). EU Directive 2011/65/EU (RoHS) This product complies with the requirements of Article 4.1 of EU Directive 2011/65/EU(RoHS). It is not intentionally manufactured or formulated with cadmium, hexavalent chromium, lead, mercury, polybrominated biphenyls(PBB), or polybrominated diphenyl ethers (PBDE). EU Directive 2002/95/EC, as amended,will be repealed effective January 3, 2013. EU Directive 2012/19/EU on Waste Electrical and Electronic Equipment (WEEE) EU Directive 2012/19/EU on WEEE: Selective treatment of the waste(Annex VII). None of the substances listed in Annex VII are intentionally added or used in the formulation of this product with the following exception, This product is a hydrocarbon; however, liquid hydrocarbons are not present in this product. WORLDWIDE PARTNER Supersedes all versions prior to Effective Date Page 2 of 4 ®'"'Trademark of The Dow Chemical Company("Dow')or an affiliated company of Dow Effective Date. 1115/2012 RDS - DOW DPDA-3220 NT 7 High Density Polyethylene Resin 1 Heavy Metals, EU 94/62/EC and Coalition of Northeastern Governors (CONEG) This product conforms to the Coalition of Northeastern Governors(CONEG)and the European Directive 94/62/EC, as amended,on Packaging and Packaging Waste,Article 11. Any incidental levels of lead,cadmium, hexavalent chromium, and mercury do not exceed 100 ppm total, ASTM F963 - Standard Consumer Safety for Toy Safety This product is not formulated with antimony, arsenic, barium, cadmium, chromium, mercury, lead or selenium. To the best of our knowledge, it does not contain these substances above the limits set in ASTM F 963-95, Section 4.3.5.2., Table 1. Consumer Product Safety Improvement Act of 2008 (CPSIA) This product is not manufactured or formulated with lead, di-(2-ethylhexyl)phthalate(DEHP), dibutyl phthalate (DBP), or benzyl butyl phthalate(BBP). To the best of our knowledge, it does not contain these materials above the limits set in the Consumer Product Safety Improvement Act of 2008,Title 1, Sections 101 and 108. Canadian Environmental Protection Act Challenge Substances This product is not intentionally manufactured or formulated with the Batch Lists of Canadian Environmental Protection Agency(CEPA) Challenge Substances released as of the effective date of this document. However, we do not analyze for these specific substances. (http://www,chemicalsubstanceschimiques,gc,calchallenge-defilindex-eng.php) Bisphenol A This product is not manufactured or formulated with Bisphenol A(CAS#80-05-7). Natural Rubber or Latex This product is not intentionally manufactured or formulated with natural rubber or natural latex; however, we do not analyze for these specific substances or compounds. Phthalates The above mentioned product is not intentionally manufactured or formulated with phthalate esters; however, we do not analyze for these specific substances or compounds. Halogenated Flame Retardants This product is not intentionally manufactured or formulated with halogenated or phosphorous based flame retardants; however,we do not analyze for these specific substances or compounds. Fluorotelomers, Perfluorooctanoic acid (PFOA) and Derivatives This product is not intentionally manufactured or formulated with Fluorotelomers, Perfluorooctanoic acid(PFOA),or Perfluorooctane sulfonate(PFOS); however,we do not analyze for these specific substances or compounds. Residual Volatile Organic Compounds (VOC) The residual volatiles in this product are a maximum of 150 ppm of straight chain aliphatic hydrocarbons. Limited laboratory data has indicated that approximately 50%of the residual volatiles are emitted during film processing. -1110. o WORLDWIDE PARTNER Supersedes all versions prior to Effective Date Page 3 of 4 ®'"'Trademark of The Dow Chemical Company Mow")or an affiliated company of Dow Effective Date: 11/5/2012 RDS - DOW DPDA-3220 NT 7 High Density Polyethylene Resin Clean Air Act This product is not manufactured or formulated with Class I or II substances as defined under 40 CFR part 82 of the Clean Air Act of 1990, as amended (58 FR 8136). California Proposition 65 (Safe Drinking Water and Toxic Enforcement Act of 1986) This product contains no listed substances known to the State of California to cause cancer, birth defects or other reproductive harm, at levels which would require a warning under the statute as of the effective date of this regulatory datasheet. Product Stewardship The Dow Chemical Company and its subsidiaries("Dow")has a fundamental concern for all who make,distribute,and use its products,and for the environment in which we live. This concern is the basis for our Product Stewardship philosophy by which we assess the safety,health,and environmental information on our products and then take the appropriate steps to protect employee and public health and our environment. The success of our product stewardship program rests with each and every individual involved with Dow products—from the initial concept and research,to manufacture,use,sale,disposal and recycle of each product. Customer Notice Dow strongly encourages its customers to review both their manufacturing processes and their applications of Dow products from the standpoint of human health and environmental quality to ensure that Dow products are not used in ways far which they are not intended or tested. Dow personnel are available to answer your questions and to provide reasonable technical support. Dow product literature,including safety data sheets,should be consulted prior to use of Dow products. Current safety data sheets are available from Dow, Medical Applications Policy NOTICE REGARDING MEDICAL APPLICATION RESTRICTIONS:Dow will not knowingly sell or sample any product or service("Product")into any commercial or developmental application that is intended for: a. long-term or permanent contact with internal bodily fluids or tissues. "Long-term"is contact which exceeds 72 continuous hours; b. use in cardiac prosthetic devices regardless of the length of time involved("cardiac prosthetic devices"include,but are not limited to,pacemaker leads and devices,artificial hearts,heart valves,intra-aortic balloons and control systems,and ventricular bypass-assisted devices); c. use as a critical component in medical devices that support or sustain human life;or d. use specifically by pregnant women or in applications designed specifically to promote or interfere with human reproduction. Dow requests that customers considering use of Dow products in medical applications notify Dow so that appropriate assessments may be conducted. Dow does not endorse or claim suitability of its products for specific medical applications. It is the responsibility of the medical device or pharmaceutical manufacturer to determine that the Dow product is safe,lawful,and technically suitable for the intended use. DOW MAKES NO WARRANTIES,EXPRESS OR IMPLIED, CONCERNING THE SUITABILITY OF ANY DOW PRODUCT FOR USE IN MEDICAL APPLICATIONS. Disclaimer NOTICE. No freedom from infringement of any patent owned by Dow or others is to be inferred. Because use conditions and applicable laws may differ from one location to another and may change with time,the Customer is responsible for determining whether products and the information in this document are appropriate for the Customer's use and for ensuring that the Customer's workplace and disposal practices are in compliance with applicable laws and other governmental enactments. Dow assumes no obligation or liability for the information in this document NO WARRANTIES ARE GIVEN;ALL IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE ARE EXPRESSLY EXCLUDED. For additional information,not covered by the content of this document contact us via our web site http:/lwww.dow.comlproducts_senrices/. OW WORLDWIDE PARTNER Supersedes all versions prior to Effective Date Page 4 of 4 (V"Trademark of The Dow Chemical Company("Dow")or an affiliated company of Dow Effective Date: 11/5/2012 Technical Information D ow DOWTM HDPE DPDA-3220 NT 7 High Density Polyethylene Resin Overview Dow DPDA-3220 NT 7 High Density Polyethylene Resin is produced via UNIPOLTM'Process Technology from Dow and is intended for rotational and injection molding is specifically designed for applications requiring excellent processability and aesthetics combined with low warpage and good mechanical properties.Processing and Stabilization:Dow DPDA-3220 NT 7 High Density Polyethylene Resin is fully heat and UV stabilized resulting in a wide processing latitude,good color retention and long life expectancy. • Rotational molding or injection molding • For Large Agricultural Tanks,Intermediate Bulk Containers,Potable Water,Chemical Tanks and Industrial Products • Excellent impact strength.stress crack resistance and processability Complies with • U.S.FDA 21 CFR 177.1520(c)3.1a • Canadian HPFB No Objection Consult the regulations for complete details. Additive • Antiblock: No • Slip:No • Processing Aid:No Physical Nominal Value (English) Nominal Value (SI) Test Method Density 0.942 g/cm' 0.942 glcm' ASTM D792 ------------- -- ---Base Density 0.942 g/cm' 0.942 glcm' Dow Method 1 Melt Index(190°C/2.16 kg) 2.0 g/10 min 2.0 g/10 min ASTM D1238 Environmental Stress-Cracking Resistance 122°F(50°C), 100%Igepal.F50 >743 hr >743 hr ASTM D1693A2 122°F(50°C), 100%Igepal,F50 > 1000 hr >1000 hr ASTM D16939 Mechanical Nominal Value (English) Nominal Value (SI) Test Method Tensile Strength(Yield) 3100 psi 21.4 MPa ASTM D638 2 Tensile Elongation ASTM D638 2 Yield 12 % 12 Break 710 % 710 % Flexural Modulus ASTM D790B 2 143000 psi 986 MPa 1%Secant 107000 psi 738 MPa Impact Nominal Value (English) Nominal Value (SI) Test Method Impact Strength ARM -40°F(-40°C),0.250 in(6.35 mm), >200 ft Ib > 271 J Rotational Molded Thermal Nominal Value (English) Nominal Value (SI) Tost Method Deflection Temperature Under Load ASTM D648 2 66 psi(0.45 MPa).Unannealed 132 'F 55.6 °C 264 psi(1.8 MPa).Unannealed 107 °F 41.7 'C Melting Temperature(DSC) 261 °F 127 °C Dow Method Notes These are typical properties only and are not to be construed as specifications.Users should confirm results by their own tests. 1 Base density is estimated using the assumption that every 1000 ppm of antiblock in the finished product raises the density of the polymer by 0.0006 g/cm'.Base density is the estimated density of the polymer if it did not contain any antiblock. 2 Plaque molded and tested in accordance with ASTM 04976. Form No.400-00153418en Page:1 of 2 ®T"Trademark of The Dow Chemical Company(-Dow')or an affiliated company of Dow. Rev:2011-10-12 Product The Dow Chemical Company and its subsidiaries("Dow")has a fundamental concern for all who make, Stewardshi distribute,and use its products,and for the environment in which we live.This concern is the basis for our (� Product Stewardship philosophy by which we assess the safety,health,and environmental information on our products and then take appropriate steps to protect employee and public health and our environment. The success of our Product Stewardship program rests with each and every individual involved with Dow products—from the initial concept and research,to manufacture,use,sale,disposal,and recycle of each product. Customer Dow strongly encourages its customers to review both their manufacturing processes and their Notice applications of Dow products from the standpoint of human health and environmental quality to ensure that Dow products are not used in ways for which they are not intended or tested.Dow personnel are available to answer your questions and to provide reasonable technical support.Dow product literature, including safety data sheets,should be consulted prior to use of Dow products.Current safety data sheets are available from Dow. Medical NOTICE REGARDING MEDICAL APPLICATION RESTRICTIONS:Dow will not knowingly sell or sample A lieations Polie any product or service("Product")into any commercial or developmental application that is intended for: Pp y a. long-term or permanent contact with internal bodily fluids or tissues."Long-term"is contact which exceeds 72 continuous hours; b. use in cardiac prosthetic devices regardless of the length of time involved("cardiac prosthetic devices" include.but are not limited to,pacemaker leads and devices,artificial hearts,heart valves,intra-aortic balloons and control systems,and ventricular bypass-assisted devices); c. use as a critical component in medical devices that support or sustain human life;or d. use specifically by pregnant women or in applications designed specifically to promote or interfere with human reproduction. Dow requests that customers considering use of Dow products in medical applications notify Dow so that appropriate assessments may be conducted.Dow does not endorse or claim suitability of its products for specific medical applications.It is the responsibility of the medical device or pharmaceutical manufacturer to determine that the Dow product is safe,lawful.and technically suitable for the intended use. DOW MAKES NO WARRANTIES, EXPRESS OR IMPLIED,CONCERNING THE SUITABILITY OF ANY DOW PRODUCT FOR USE IN MEDICAL APPLICATIONS. Disclaimer NOTICE:No freedom from infringement of any patent owned by Dow or others is to be inferred. Because use conditions and applicable laws may differ from one location to another and may change with time.the Customer is responsible for determining whether products and the information in this document are appropriate for the Customer's use and for ensuring that the Customer's workplace and disposal practices are in compliance with applicable laws and other governmental enactments.Dow assumes no obligation or liability far the information in this document. NO WARRANTIES ARE GIVEN;ALL IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE ARE EXPRESSLY EXCLUDED. NOTICE:If products are described as"experimental or"developmental":(1)product specifications may not be fully determined;(2)analysis of hazards and caution in handling and use are required;(3)there is greater potential for Dow to change specifications and/or discontinue production;and(4)although Dow may from time to time provide samples of such products, Dow is not obligated to supply or otherwise commercialize such products for any use or application whatsoever. Additional North America Europe!Middle East +800-3694-6367 Information U.S.&Canada: 1-800-441-4369 +31-11567-2626 1-989-832-1426 Italy: +800-783-825 Mexico: +1-800-441-4369 Latin America South Africa +800-99-5078 Argentina: +54-11-4319-0100 Brazil: +55-11-5188-9000 Colombia: +57-1-219-6000 Asia Pacific +800-7776-7776 Mexico: +52-55-5201-4700 +603-7965-5392 www.dowplastics.com This document is intended for use within Asia Pacific, Latin America,North America Published:2011-07-20 ©2012 The Dow Chemical Company Dow Form No.400-00153418en Page.2 of 2 ®T"Trademark of The Dow Chemical Company('Dow")or an affiliated company of Dow. 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C•f_' t} IFF 1+-0-111 3 L't: l.•h? =?rf; 7 taPJ't ►IYYtr r•13_t r -.s _ I P Fi L I "T'T F ht tV C H I_► t=: n 13 E - PEPAPTMENT � HEALTH AND ENV I RONMENTAL �OTECT I Ott I:�25 'L STPEET, ANCHORAGE, AF'. ? .1 4264-4720 !•IEEE 1=tr-JC• I=rrA—•= I TE-El-1ER I='El<:t,1 I T FEF.t1IT Nn, )� ����� 1 '1�oI r. /'�,,�• F'L I CANT (U mar IC )CATION IL m le LOCPOCL Kia 77[�•�- crntAFE FEET :GAL "'� ,• LOT SIZE q39) - L G Ku IS: ?PE OF SOIL AB_OPPTION SYSTEM I_: ':<IMUM NUMCER OF CEPROOMS EATING (SO FT. EP- -� Ij IE F.EOUIPED SIZE OF THE SOIL ABSCIPPTION SYSTEM IS: i •F=t-•TF-1Iya I=i F=:r-t': EI_ C:-CF`_17 I THE LENGTH DIMEN'-ION IS THE LENGTH <IN FEET) OF THE TPENCti OR DRAINFIELC'. i THE C-EPTH OF A TRENCH OR PIT IS THE DI.7ANCE BETWEEN THE SURFACE OF THE GPOUND AND THE COTTOM OF THE EXCAVATION (IN FEET). THEF'E 15 110 SET WIDTH FOR TPENCHES THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL F'IF'E AND THE E:OTTOM OF THE EXCAVATIOtJ CIN FEET). /-y� :EC>!I_1 I:ECS.. =•EF TIC Tf�rJFC S I EE= /s V� �3r�L_t_.rrr1 :EMIT APPLICANT HAS THE PESPON_SIBILITY TO INFORI-I THIS DEPARTMENT DUPING THE J=TALLATION IN_PECTIONS OF ANY WELLS ADJACENT TO THIS PFOPEPTY AND THE HIRER OF FESIDENCES THAT THE WELL WILL SERVE. < ? I rJ=•PEr_ T I ori=• nr=- E Rt=l?U I f<:IF- C- -- tCKF I LL I NG OF ANY SYSTEM W I THS IL IT FINAL I IJ'-FECT 1 OtJ AND APPPOVAL BY THIS :PAFTMENT !JILL CE SUBJECT TO PROSECUTION. '11IMUM DISTANCE CETWEEN A WELL AND ANY ON-SITE SEIIAGF DISPOSAL SYSTEM IS +_ FEET FOE; A PRIVATE WELL OP 1`'? TO _OO FEET FPOlI A F'LICLIC WELL DEPENDING PON THC TYPE OF PLICL IC WELL. HIMUM DISTANCE FPOM A PRIVATE WELL TO A PRIVATE SEWER LIWE IS 25 FEET ANG i A COMMUNITY SEWER LINE Il 71' FEET. :LL LOGS APE PEOL-IF.ED AND MUST CF P'ETUPNED TO THE DEPARTMENT WITHIN _O DAY= THE WELL COMPLETION. -AEF RECIUIPEMFUTS MAY APPLY. SPECIFICATIONS AND CONSTF'CJCTION DIAGRAMS ARE 'AILABLE TO IlJ LIRE PPOPEP: IN'-TALLATION f-' F= r=: ('1 I "1 E :=K: F=' I E?: L-= `= C-• r ='_' E r•1 F_' E R =- 1- : :L '_-� :_ gD CEP:TIFY THvtT I AM FAMILIAR WITH THE REOUIREMENTS FOP. 0101 -SITE SENEPS• AND WELLS AS SET IFTH BY THE MUNICIPALITY OF ANCH'IF•AGE. I !JILL INSTALL. THE SYSTEM IM ACCORDANCE WITH THE CODE=. I LIrJDEPSTAND THHT THE ON-SITE SEIJFP SYSTEM MAY PEQUIPF ENLARGEMENT IF THE S I DFNCE IS PEMODELED TO INCLUDE MOPE THAN 3 E'EDROOII_ OPPLICANT nn 'SLIER f i i1 .0 SOILS LOG - - ,-CONTRUTINC'(ENCINO S 14 ENGINE G ANDS RVEYING 212 E. INTEpt+ATIONAL"AI PORT ROAD PERCOLATION -AN `f1GE,:ALASK 99502 TEST • �.. p�hlE��(gy27 .PERFORMED FOR: N?A,,CVT -1!{ Uy'Ea.K'-%'-'� •"3• '• • DATE PERFORMED: 9— LEGAL DESCRIPTION: - r SLOPE SITE PLAN e `71 1. Data - 09- to ALV WAS GROUND WATER' N • Net Drop L •'!.ENCOUNTERED? _ 0 12 ;2 ». ... ....' 9 ,30 4 yn Y. - .. 13 6- 41 . 7 7 tjAj�a� 5\t� V g , •. .2,80 5F `71 1. Data - Gross Time WAS GROUND WATER' N • Net Drop L •'!.ENCOUNTERED? _ 0 12 tp. _ P E • ,30 ... IF YES, AT WHAT yn Z 4 DEPTH) 13 41 . • •14 15- +'E OF ...... S 1 16 p 41- •'•• •ti 17 �. o•.•g1sL .wu4.N 18- t� r.• Ralph B. ela ,j �� ;• NO. 1995E 19 tl4a PROFESStC\�Fos ■ uMEMOHVIRINNE No ionNOMENE No -Read IIng 1. Data - Gross Time Net. Time Depthto Water Net Drop 9 �1 O tp. le ,30 3o yn Z 4 41 . V .0 b �11 It 20 `%1%wn7 w'y PERCOLATION RATE' 4.0 (minutes/inch) TEST RUN BETWEEN FT AND %? - FT L COMMENTS // S� 1 U S�IG -�, w f oe r /O )los lii .e_Zw& i.an 4.r.e o1n rYai •�1 evo?�l hn 4,sevot4C✓44., eoveoam 70✓Gs(s PERFORMED n WELL LOG Date Drill ed:�1 tn - 5, & Static Water Level 1 / b feet Draw Down feet Type Material Drilled: MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MAR 4 1981 RECEIVED Gallons Per Minute J Total Feet of Casing 0 feet to J to le /Y L- to ioS 5,9,) d,, /o J to %� 3 C -e I s,�z�— to A) Jim tf 14e ��.% �► �l,'l,o S47q i�o� lSS3-�I F � • Municipality of Anchorage r 'felj4 ,e; scc On-Site Water and Wastewater Program z "l (907) 343-7904 ate, d Certificate of On-Site Systems Approval as s L 9 c" Parcel I.D. 017-372-21 Expiration Date: 11 (7 1. GENERAL INFORMATION Complete legal description Knik Heights Block G Lot 3 Location (site address) 12900 Ridgewood Road Current Property owner(s) Kelton Oliver Day phone Mailing address 12900 Ridgewood Road Anchorage, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 6 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Q Individual Individual Water Storage C Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer WaiverNariance request for: Distance: Received by. x,,40 Ai, (i I � Date: COSA to be released to the engineer, unless otherwise requested by the eng neer. COSA Fee $ j2� — Waiver Fee $ Date of Payment gI-7 � I Date of Payment Receipt Number 66643; Receipt Number COSA# O‘-A,1 7)3 61 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 inforrnation 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 install2tion. In conducting an adequacy test, I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and.regulafi6't s.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 conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. 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 8/7/2017 OF ACIAkk i • 71-Ii� ••* 6. DSD SIGNATURE r•;•�',�de' Or System #1 Approved for bedrooms • even R.'Pannone • . CE-8149 •�� System #2 Approved for bedrooms '$ his, . Disapproved ��k ,PPOFESSIONP Conditional approval for bedrooms, with the following stipulations: S c am. 9 S 7t AkociAS 014 Pc- ot-ex 2_0 Aiecaik,1-' • • `• O'4-StTF WATER AND WASTEWATER c pF?Qc.RAM •'_ .::. By: tof -"•— 04/f Original Certificate Date: '-K-P -7 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet S . ,. If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description Knik Heights Block g Lot 3 _ Parcel ID: 017-372-21 A. WELL DATA Well type Private If A. B. or C provide PWSID # Well Log (YIN) Y Date completed 1111980 Sanitary seal (YIN) Y Wires properly protected (YIN) Y Total depth 128 ft. Cased to 128 ft. Casing height (above ground) 12+ in FROM WELL LOG AT INSPECTION Date of test 11/1980 8/3/2017 Static water level 110 ft 109 ft. Well production 5.0 g.p.m. 2.6 g.p.m. WATER SAMPLE RESULTS Coliform NEG colonies/100 mL Nitrate 3.68 mg/L Arsenic ND ugIL Date of sample: 7/31/2017 Collected by PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEELDate installed 9/1980 Tank size 2000 gal Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (YIN) N/A Date of pumping 8/3/201 7Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed 9/1980 Soil rating (g.p.d./ft2 or ft2/bdrm) 280 SF/BORN System type Deep Trench Length 140 ft. Width 3 ft. Gravel below pipe 6 ft Total depth 18.7 ft Eff. absorption area 1 680 ft` Monitoring tube ' Depression over field N Date of adequacy test 8/3/2017 Results (Pass/Fail) PASS For 6 bedrooms Fluid depth in absorption field before test 0 in. Water added 900 gal. New depth 15 in Elapsed Time: 1440 min. Final fluid depth 0 in. Absorption rate >= 900+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 96* On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer/septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ 5+line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, 0** parking/vehicle storage Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS Survey on file. *Waiver WR8900062. ** RV parking over last 10' of field - approved 6/15 by dept. ***Sump @ S.E. of trench is 16.6' B.G. - assumed bottom of field. G. ENGINEER'S CERTIFICATION �7� i N`•�F ig591-i} I certify that I have determined through field inspections and ,� ". review of Municipal records that the above systems are in Ay, • • 1 %' To conformance with MOA COSA guidelines in effect on this date. , •• r•��•• • • • ••• 0 Engineer's Printed Name Steven Pannone ":'Mcen IR. Pannone • le 8/7/2017 00Date 1:,.. • CE-8149 E' ' / COSA canary sheet_2-6-15.doc 0 Parcel I.D. 017-372-21 Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 (ZE- t S � vee C_& Certificate of On -Site Systems ApprovalC Expiration Date: 1. GENERAL INFORMATION Complete legal description KNIK HEIGHTS S/D; BLOCK G, LOT 3 Location (site address) 12900 RIDGEWOOD DRIVE, ANCHORAGE, AK 99516 Current Property owner(s) KELTON OLIVER Day phone 240-4479: Mailing address 12900 RIDGEWOOD DRIVE, ANCHORAGE, AK 99516 Real Estate Agent KATHI JOHNSON W/PRUDENTIAL Day phone 762-3123 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 6 4. TYPE OF WATER SUPPLY: Individual Well 19 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ WaiverNadance request for: N/A TYPE OF WASTEWATER DISPOSAL: Individual 19 Holding Tank ❑ Community ❑ Public Sewer ❑ Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee Date of Payment Receipt Number COSA# f:_l o9Z Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Garness Engineering Group, Ltd. Phone (907) 337-6179 Address 3701 E. Tudor Rd., Suite 101, Anchoraoe AK, 99507-3246 Engineer's Printed Name Jeffrey A. Garness Date 2 /S In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the systems on the dates of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the - evaluation. The operational life of all wells and septic systems depend on a variety of variables including, but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail. The content of this report is for the sole benefit of the person/party who retained GEG. Reliance upon the information provided in this report by any otherperson or party, including but not limited to subsequent property purchasers, is not authorized. In short, GEG disavows any legal duty to anyone other than the person/party who paid for this report 6. DSD SIGNATURE Y System #1 Approved for bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the following `\`lllltutrutrrrfff \jOFAA1,yo%i/ ON-SITE WATER AND WASTEWATER oz PROGRAM Original Certificate Date: tam - �2 � - 15— The M} icipality'6fcAncfiiomge 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: f COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_9-0-02.tloo If more than 1 septic system is on the lot: COSA Checklist # Of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: KNIK HEIGHTS S/D; BLOCK G, LOT 3 Parcel ID: 017-372-21 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 11/1980 Sanitary seal (Y/N) YES Total depth 126 ft. Date of test Static water level' Well production Cased to 128 ft. FROM WELL LOG 11/1980 110 ft, 5 nnm WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 1.89 mg./L. Well Log (YM) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 2/9/2015 104 ft. 2.33 g.p.m. Collected by: GEG, Ltd. Arsenic: ND ug./L. Date of sample: 6/15/2015 B. SEPTIC/HOLDING TANK DATA NOTE: THE STEEL SEPTIC TANK IS 35 YEARS OLD AND APPROACHING THE END OF ITS USEFUL LIFE. Tank Type/Material SEPTIC/STEEL Date installed 9/1980 Tank size 2000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (YM) N/A Date of pumping IZ lir Pumper A'� Svl c43 C. ABSORPTION FIELD DATA BELOW EXISTING GRADE TO BOTTOM OF MT Date installed 9/7.980 Soil rating (g.p.d.eor Podrm280 ,System type TRENCH Length 140 ft: Width 3 ft. Gravel below pipe 6 ft. Total depth "17:6 ft. , Eff. absorption area 1680 ft' Monitoring tube YES Depression over field NO Date of adequacy test 2/9-10/2015, Results (Pass/Fail) PASS For 6 bedrooms Fluid depth in absorption Mid before test '^-49 in. Water added 1115 gal. New depth " .36 in. 11 Elapsed Time: 120 min. Final fluid depth `=39 in. Absorption rate >= 900+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - NOTE: HOMEOWNER RETAINED DISCOVERY DRILLING TO INSTALL A NEW MT PRIOR TO GEG TESTING. MT EXTENDS 8.55' BELOW THE INVERT OF THE POST TANK CLEANOUT. LIQUID LEVELS ARE CALCULATED BASED UPON THE INVERT OF THE LATERAL LINE ELEVATION. "DEPTH BELOW INVERT TO LIQUID LEVEL. D. LIFT STATION Date installed Size in gallons Manhole/Access "Pump on" level at in. "Pump ofr level E. SEPARATION DISTANCES at in. Cycles tested Meets alarm & vircuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot `W On adjacent lot Absorption field on lot 100+ On adjacent lots Public sewer main WA Sewer /septic service line Public sewer manhdeideanout WA Holding tank Animal containment areas 50'+ Manure/animal excrete storage areas 1001+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 51+ Absorption field 51+ Water main WA Water service line 101+ Surface water. 1001+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 10'+ Water main WA Water service line 101+ Surface water 1ce'+ Driveway, parking/vehicle storage Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS "EXISTING WAIVER #WR890062. "PARKING AREA INSTALLED AFTER SEPTIC SYSTEM WAS INSTALLED. DRAINFIELD HAS BETWEEN 9'-18' OF SOIL COVER OVER THE INVERT. THERE IS NO RISK OF FREEZING TO THE DRAINFIELD. CONDITION HAS EXISTED FOR OVER 10 YEARS. ALSO, PAVED AREA IS VERY STEEP AND ONLY SUITABLE FOR SEASONAL (SUMMEIa USE. GEG CONSULTED JEFF POET W/ MOA ABOUT THE CONDITION PRIOR TO SUBMITTAL OF COSA PACKAGE. G. ENGINEER'S l carry that l have determined through tisid 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 JEFFREY A GARNESS Data 6/ZqJ/s (Rev. 10112n2) Municipality of Anchorage. _ &° On -Site Water &Wastewater Program (907)343-7904 CERTIFICATE OF ON SITE SYSTEMS APPROVAL Parcel I.D. 017-372-21 Expiration Date: _ =2 7 �! 1. GENERAL INFORMATION Complete legal description KNIK HEIGHTS S/D; BLOCK G, LOT 3 Location (site address) 12900 RIDGEWOOD DRIVE, ANCHORAGE, AK, 99516 Current Property owner(s) KELTON OLIVER Day phone Mailing address Real Estate Agent 2. TYPE OF DWELLING: 12900 RIDGEWOOD DRIVE, ANCHORAGE, AK, 99516 KATHI JOHNSON W/ PRUDENTIAL Day phone 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 6 4. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ 240-4479 762-3123 TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank ❑ Community On-site L_i Public Sewer ❑ Waiver/Variance request for DRAINFIELD TO DRIVEWAY/PARKING - Distance: 0 FEET Received by: ,/ Date: y�/�J COSA to be released to the engineer, unless othemise requested by the engineer. COSA Fee $_" 0 ✓ r2� Waiver Fee $ Date of Payment 3��ai/� Date of Payment Receipt Number 00 036 Receipt Number COSA # 0SG516$a Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER 51 As certified by my seal affixed hereto and as of the validation date shown below, i verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK, 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG provided an engineering evaluation of the well anaor septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the systeMs on the dates of the evaluation. separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend on a variety of variables including, but not limited to, soil conditions, groundwater levels (that may fiuduate during the year), quality of construction (materials and workmanship), and the water usage of the fandlyutilizing the system. These conditions can vary, and are outside the contra/ at GEG. satisfactory test results do not guarantee future performance of the systends, therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no represemation whether an alternative well or septic system can be installed on the property in the event either of the current systems fait. The content of this report is for the sole benefit at the persoMpartywho retained GEG. Reliance upon the Information provided in this repod by any other person orpady, including but not limited to subsequent property purchasers, is not authorized. In shod, GEG disavows any legal duty to anyone other than the personipany who paid for this report. System #1 Approved for System #2 Approved for Conditional approval for 337-6179 Date WATER AND Original Certificate Date: The M nicipality or Ah�chorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations 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. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory (Rev. 10112/12) V Nitrate Advisory Arsenic Advisory Other If more than 7 septic system is on the lot: COSA Checklist # _of_ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: KNIK HEIGHTS S/D; BLOCK G, LOT 3 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 11/1980 Sanitary seal (Y/N) YES Total depth 128 ft. Date of test Static water level Well production Cased to 128 ft FROM WELL LOG 11/1980 110 ft. 5 g.p.m. WATER SAMPLE RESULTS: Coliform Jor� colonies/100 ml. Arsenic: NP ug./L. B. SEPTICIHOLDING TANK DATA Tank Type/Material Nitrate Z•oSmg./L. Parcel ID: 017-372-21 Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 2/9/2015 104 ft. 2.33 Collected by: GEG, Ltd. Date of sample: 2/9/2015 NOTE: THE STEEL SEPTIC TANK IS 35 YEARS OLD AND APPROACHING THE END OF ITS USEFUL LIFE. SEPTIC/STEEL Date installed 9 W-fle Tank size 2000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y//N) NO High water alarm (Y/N) N/A Date of pumping ;;2A Pumper -t- A&i1C - vI Lt'_ 5 C. ABSORPTION FIELD DATA Date installed 9/1980 Soil rating (g.p.d./ft or /bdrm 280 System type TRENCH Length 140 ft. Width 3 ft. Gravel below pipe 6 ft. Total depth *17.6 ft. Eff. absorption area 1680 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 219-10/2015 Results (Pass/Fail) PASS For 6 bedrooms Fluid depth in absorption field before test **_49 in. Water added 1115 gal. New depth *36 in, Elapsed Time: 120 min. Final fluid depth **-39 in. Absorption rate >= 900+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - NOTE: HOMEOWNER RETAINED DISCOVERY DRILLING TO INSTALL A NEW MT PRIOR TO GEG TESTING. MT EXTENDS 8.55' BELOW THE INVERT OF THE POST TANK CLEANOUT. LIQUID LEVELS ARE CALCULATED BASED UPON THE INVERT OF THE LATERAL LINE ELEVATION. **DEPTH BELOW INVERT TO LIQUID LEVEL. D. LIFT STATION Date installed "Pump on" level at in Size in gallons Manhole/Access "Pump off' level at wa er alarm level Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot *96- On adjacent lot, Absorption field on lot 100+ On adjacent lots Public sewer main N/A Sewer /septic service line 25'+ Public sewer manhole/cleanout Holding tank Animal containment areas 50'+ Manure/animal excrete storage areas 1004 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 51+ Property line 54 Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 1004 Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 104 Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 1001+ Driveway, parking/vehicle storage **0' Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *EXISTING WAIVER #WR890062. **PARKING AREA INSTALLED AFTER SEPTIC SYSTEM WAS INSTALLED. DRAINFIELD HAS BETWEEN 9'-18' OF SOIL COVER OVER THE INVERT. THERE IS NO RISK OF FREEZING TO THE DRAINFIELD. CONDITION HAS EXISTED FOR OVER 10 YEARS. ALSO, PAVED AREA IS VERY STEEP AND ONLY SUITABLE FOR SEASONAL (SUMMER USE. GEG CONSULTED JEFF POET W/ MOA ABOUT THE CONDITION PRIOR TO SUBMITTAL OF COSA PACKAGE. G. ENGINEER'S CERTIFICATION I certify that f 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 JEFFREY A. GARNESS Date 3k /5 (Rev. 10/12/12) 1'ROFESSt(:�"Wi m m = 11,10 C7 -=i m -o — 0 Z> �CmM7��z r� nm70 .. S t1?;u2• T > a7I m C S zZ F7 C7 O Z j,>In C C, 1 S 0 0 7 m C) -"-� m fel IZD r'l Aii 0 -rj Frj a7 rn C' Ul z C7 C ?u rq X gri m �lj0-1(-) ajjjj x cn C7 > :A > 0 (T( F: > 7> m C�Ca mnm xG- 4 c� .vz Qz C)nm �zzczLFri cn m C7 Z. C r,7 � r m T m �� m ♦�� 41P xl 1 CJ D ° AND o N m f A o r f O i� f °i . •••�0 U Q CYC YK> Yo � f�lf��•♦I► FTI m G7 tYi U`, m r= iUo v m z y 2 b� C r IN :.N Ccs A V)G pr �., — F .� 'I I ( V / n F— O , ` J C U, J 4� --I 7J m m = 11,10 C7 -=i m -o — 0 Z> �CmM7��z r� nm70 .. S t1?;u2• T > a7I m C S zZ F7 C7 O Z j,>In C C, 1 S 0 0 7 m C) -"-� m fel IZD r'l Aii 0 -rj Frj a7 rn C' Ul z C7 C ?u rq X gri m �lj0-1(-) ajjjj x cn C7 > :A > 0 (T( F: > 7> m C�Ca mnm xG- 4 c� .vz Qz C)nm �zzczLFri cn m C7 Z. C r,7 � r m T m �� m ♦�� 41P xl Air :m o e IQ CT D ° AND o N m f A o r f O i� f °i . •••�0 = Yo � f�lf��•♦I► z r'1 N 00°02'00" W 145.00' r� O N 00'02'U"'(Y' ,' 145-00' IN w� RIDGEWOOD ROAD 0 z �7 W Z IQ CT 10' urIL. EsMr. co O i� I— O = FTI I1 r IN � x' I G) .� 'I I ( V / n F— O , ` J C U, J x 9 I x x r O ( C_" I`^.x ' U! �I [9 i E m x f ^y0 x�x x N ..••� U �` • in DEC% iyx :." rzj� � 222 0"�.. zsD Y 30.0* OO4EREoCONC WALK lin . w, x j 39.0' ... `� M n .. O MV DECK o 187 ...C_�. WALK + 367• Zy iY. {OCo 1 O N 00'02'U"'(Y' ,' 145-00' IN w� RIDGEWOOD ROAD 0 z �7 W Z IQ CT —T / \ co O i� I— O = FTI Ca r IN =n G) .� T V / n F— O , ` J C U, J m O Municipality of Anchorage ` Development Services Department -� (G Building Safety Division On -She Water 1£ Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.sk.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 61 q - 3?.,2 - a/ HAA# 0q 050'-)- 1. GENERAL INFORMATION Expiration Date: I " %— 0.6 - Complete S" Complete legal description KNIK HEIGHTS SUBDIVISION: LOT 3, BLOCK G. Location (site address or directions) 12900 RIDGEWOOD ROAD • ANCHORAGE. AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address TODD do ANGIE HARRIS Day phone 345-7252 12900 RIDGEWOOD ROAD ► ANCHORAGE. AK 99516 Day phone JANET DALEY W/ DYNAMIC PROPERTIES Day phone 727-5677 3111 C STREET • ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 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) 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 results less than 30 days old. (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 certiried by my seal affixed hereto and as of the validation date shown below, I verity 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 verity that based on the information obtained from the Municipality of Anchorage riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system Is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Finn GARNESS ENGINEERING GROUP, Ltd. Address 3701 E TUDOR ROAD SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. CARNES$, P.E. 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 B Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational file of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate ofhowlong the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Phone 337-6179 Date ibl/04 -- Conditional approval for bedrooms, with the tilowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other ON-SITE .u.Trn AAIn WASER �R66RARA -' B. , � le.':t Original Certificate Date: 5�71- (Rw. 1)01) Municipality of Anchorage • Development Services Department Building Safety Division On-Sfte Water 6 Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519.0850 www.d.anchorege.ak.us (907) 3437904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: KNIK HEIGHTS S/D: LOT 3. BLOCK G. Parcel ID: 017-372-21 A. WELL DATA Well type PFWATE If A, B, or C provide PWSID# N/A Date completed 11/1980 Sanitary seat (YM) YES Total depth 128 ft. Cased to 128 ft. FROM WELL LOG Date of test 11/1980 Static water level 110 ft. Well production 5.0 g.p.m. WATER SAMPLE RESULTS: Coliform 0_ colonies/100 M. Nitrate "" mgJL. Well Log (YM) YES Wires properly protected (YM) YES Casing height (above ground) 12+ in. AT INSPECTION 9/15/2004 110 ft. 1.2 g.p.m. Other bacteria 0 colonies/100 ml. Arsenic: NIA mgA. Date of sample: 9/15/2004 Collected by: GEG. Ltd. 13. SEPTIC/HOLDING TANK DATA Tank TypelMaterial STEEL Date Installed 9/1980 Tank size 2000 gal. Number of Compartments 2 Cleanouts (YM) YES Foundation cleanout (YM) YES Depression over tank (YM) NO High water alarm (Y/N) N/A Date of pumping 5/24/2004 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA 'MONITORING TUBE 3.27' BELOW INVERT OF POST TANK C/O Date Installed 9/1930 Soil rating (g.p.dJR13r E� 280 System type DEEP TRENCH Length 140 ft. Width 3 ft. Gravel below pipe 6 ft. Total depth «t8.7 ft. Eff. absorption area 1680 ft' Monitoring tubeOYES Depression over field NO Date of adequacy test 9/15/2004 Results (Pass/Fall) PASS For 8 bedrooms Fluid depth in absorption field before test E in. Water added 765 gal. New depth E in. Elapsed Time: •'_0 min. Final fluid depth E In. Absorption rate >= 750+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N S type) NONE KNOWN If yes, give date — •*C/O O S.E. END OF TRENCH IS 12.6' B.G. ASSUMED BOTTOM OF TRENCH IS 6' BELOW C/O INVERT. ***TRENCH REMAINED DRY DURING ENTIRE TEST. D. LIFT STATION Date Installed 'Pump on' level at _in. E. SEPARATION DISTANCES Size in gallons High water alarm level at Cycles tested Meets alarm 6 circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAtft station on lot •96' Absorption field on lot 1001+ Public sewer main N/A On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 1001+ Wells on adjacent lots 1001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 10'+ Water main N/A Water service line 104 Surface water 10(y+ Driveway, parkinglvehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS 0. ENGINEER'S CERTIFICATION 1 cot* that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date O� HAA Fee $ 7 3040- Date of Payment 4/,-) 6/0` Receipt Number 9 (Rw.12JW) Waiver Fee $ Date of Payment Receipt Number SEP -08-04 WED 03:32 PM Dynamic Properties FAX N0. P. 02 aaiunoD snp T£ 3o 0£ a%tcd N 00'0Z'00"W 145.00' 10• VnL ESOT. r--------------------, N 00.02'00'w 145.00' 4 O _RIOCEW000 ROAD_ r• CA C-) % Municipality of Anchorage Development Services Department Building Safety Division On -Site Water 8 Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.sk.us (907)343.7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-372-21 HAA#_a 04,661 1. GENERAL INFORMATION Expiration Date: 2Z26102. Complete legal description KNIK HEIGHTS SUBDIVISION: LOT 3. BLOCK G. El Individual On-site 0 Location (site address or directions) 12900 RIDGEWOOD ROAD • ANCHORAGE. AK 99516 Current Property owners) Mailing address Lending agency Mailing address Real Estate Agent Mailing address JANE CAMERON Day phone 345-7252 12900 RIDGEWOOD ROAD • ANCHORAGE. AK 99516 SHARI BOYD w/ PRUDENTIAL JACK WHITE Day phone Day phone 563-5500 3201 "C' STREET SURE 200 * ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well El Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 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) 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 results less than 30 days old. (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 engineers work. / -fl- Note: I- .Note: 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 seat affixed hereto and as of the validation date shown below, l verify that my Investigation, based on procedures outlined in the Health A uthority Approval Guidelines for this application, shows that the onsite 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 Finn ALASKA WATER & VIASTEWATER CONSULTANTS, INC. Phone 337-6179 Address 6901 DEBARR ROAD, SUITE 28 * ANCHORAGE. AK 99504 Engineers Printed Name JEFFREY A. GARNESS, P.E. Date ftIz.1 or Engineers Comments: In conducting this evaluation, AWWC, Inc, attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines 6 Regulations. The reportedmsuffs described the performance of the system under the condtns encountered at the time of the test, and separation distances measured to madi7yIdentifiable features. The operational rife of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Ina can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the ownerilsted above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will It confer any legal right whatsoever. 5. DSD SIGNATURE Approved for S. bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing Attachments: HAA Checklist Septic System Advisory Well Flow Advisory ON-Srrp AND WASTE TCD T ••PROGRAM °fin Manitenance Agreements Supplemental Engineer's Reort _ Other By: &,;;/— Original Certificate Date: I I Z 2 6 0l (Rw. IZW) Municipality of Anchorage Development Services Department Buildingsa"DivilOn4b Wealewe�Propram 47W Bouch Bragaw SL P.O. Banc 196850 Mdwrape. AK 9951$8850 www.dArdwrape.alLue (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: KNIK HEIGHTS S/D: LOT 3. BLOCK G. Parcel ID: 017-372-21 A. WELL DATA Well �" PRIVATE KA. B. or C provide PWSID9 N/A Wen Log (YN -w YES OA Date completed 11/1980 Sar ftry creel (y/H) YES Total depth 128 fl Cased t0 128 fL FROM WELL LOG Date of test 11/1930 Statlowater level 110 }L Well production 5.0 g.pm WATER SAMPLE RESULTS: Coliform 0 eobnlea/900 ml. Nitrate 1.08 mpA. Wires properly protected (Y/N) YES Casing height (above ground) 12+ In. AT INSPECTION 10131/01 109 tl 2.6 g.p.m. Other bacteria 2 cobnles/100 ml. Data 0f sample: 11/1/2001 collected by: AWWC. INC. S. SEPTiCIHOLDING TANK DATA TankType/Material STEEL Date Installed 9/1980 Tank atee 2000 gal. Number of Compartments 2 Cleanouls (YIN) 'TES Foundation deanout (Y/N) YES Depression over tank (YIN) NO High water atemr (Y" N/A Date of pumping 7/9/2001 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA •MONITERING TUBE 3.27' BELOW INVERT OF POST TANK C/O Date installed 9/1980 Sop rating (g.PAAN /�280 System type DEEP TRENCH Length 140 fL Width 3 ft (travel below pipe—E-1 Total depth -=L7—A Effabsorption area 1680 R' MonWng tube'YES Depression over Held- No Data Of adequacy teat 10/31 /01 Results (Pass/Fap) PASS For? bedrooms PUld depth in absorption field before test In. Water added 825 gat. New depth 1 la Elapsed Time: 0 min. Final fluid depth 0 In. Absorption rate >z 750+ g.p d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN K yes, give data - 000/0 0 S.E. END OF TRENCH IS 12.6' B.G. ASSUMED BOTTOM OF TRENCH IS 6' BELOW C/O INVERT. D. LIFT STATION Date Installed Size in gallons 'Pump on' level at --In. E. SEPARATION DISTANCES High water alamr level at Cycles teested Meets alum & dreuN requirements?- I- equirements SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAlR station on lot 096' Absorption flea on lot 100'+ PubOc sewer main N/A Sewer /septic seMce une 25'+ 'WAVER ISSUED IN 1996 On adjacent Iota 100'+ On adjacent lots 100'+ Public sewer manhoteldeanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 5'+ Property One 51+ Absorption Held 5'+ Water main N/A Water service gm 10'+ Surface Water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property Me 101+ Building foundation 10'+ Water main N/A Water service Brie 10'+ Surface water 100'+ Orivewayparldn"hida storage t o'+ Curtain draln NONE KNOWN Wells on adjacent lob 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION i cer* that I have determined through (led krspecrlons and *! revfew of hfuntdpat records that the above systems we In .. coMbrmarm wfti► MOW HAA gufdefines In effect on this date. Engineers print d Ne a JEFFREY A. GARNESS 4 Date i/r2 a or HAA Fee$ 300• ©� Date of payment //" Recelpt Number 0/42,514 P". lz" Walvar Fee $ Date of Payment Recelpt Number MUNICIPALITY ANCHORAGE • ~� DEPARTMENT OF HEALTH 8 HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # HAA # VI RL r tC'' t LI Ir 1. GENERAL INFORMATION Complete legal description ! oT 3 LocK 6; KSII� (�rS Location (site address or directions) t 2 400 Q2 (D G g W oy D Property owner '=f•Q' _ ?oN,y E Ge—' N O L4= Day phone 3 'g 52- o Q 3 _3 - Mailing addres Mailingaddress &140 E�. ILVFP.4AnJ ,A.vcµ AIS 899/6 Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS 3. TYPE OF WATER SUPPLY: Individual well Community well Public water ti Day phone Day phone 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 < - 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(A.A/91( From MOA.21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify 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`�� ��w as 0 ij S , r Phone 2_7'-2—g2I R Address 'T --o a3ox /cf2oz` /J,yCit Alm T19.5/er Engineer's signature � Date `{—/G-46 6. DHHS SIGNATURE _X Approved for V' bedrooms. Disapproved. Conditional approval for Additional Comments M .x:...... .. . ,.a bedrooms, with the following stipulations: Date .S'2 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 lendi ng institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-0251P«.1/91) B. MOA.21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES � Services °5825*V street, RooEnvironmental SM o� 010 (907) 3HR I V E D APR 171996 Health Authority Approval ChecMist Munlclpallt�yy of Anchorsppe Dept. Health 6 Human Services LegdDescription: f e -i ���LDcK 4 kNi ic WrS Parcell.D.: A. WELL DATA Well type fit) wAry If A. B, or C. attach ADEC letter. ADEC water system number Lots Prese01(Y" Y Dato completed NCO / 4 eO Total depth /28 Cased to 1-2,5% Casing height (above ground) 15" Sanitary seal (Y/N) Wires properly protected (Y" Y FROM WELL LOCI AT INSPEcnON Dam of test I t - $ e 2 --I Q- 46 Static water level Well production Q. l &p -m- WATER SAhIPLE RESULTS: Coliform, O / Nitrate 4 4E Other bacteria Damofsample: t -r4-96 Collected by: S.Q2•1�w.u.J01vrt B. SEPTICIROLDING TANK DATA . Dateinstalled a/80 Tank size ZooO Number of Compartments 2- Cleanmrts (Y" --Y Foundation cleanout (Y/N) Depnxsum (Y/N) K High water alarm (Y/M Date of Pumping i/zv/gS Pumper iSSACS tlo,va-C WAt-Of N C. ABSORPTION FIELD DATA Date installed T/AdA Soil rating (g.p.dJfe o� 2 8 0 System type b T Length / 40 ' Width 3 ` Gravel thickness below pipe 6 Total depth / G F.ff uve absorption area / 680 Monitoring Tube present(Y"__L Depression over field (Y/N) N Date of adequacy test 2 -19 -96 Results (Pass/FW)tp�A ossa ssn For 6 bedrooms Fluid depth in absorption field bdore test (in.); D¢ t Immediately atter gal. water added (in.): A lav' Fluid depth (ins) Minutes later: Absorption ram - G,14V 00 P.& Pert dde treatment (past 12 months) (Y/N) 1-4a If yes, give date D. rf STATION Al Date installed size in gallons ManhOle/Access (Y" on" level at* High water alarm keel u• 'Datum Cycles tested E. SEPARATION DISTANCES "Pump or level at* SEPARATION DISTANCES FROM WELL. ON IAT TO: WA1v¢v &AJFrts Septic) ktmg tank on tot 96 ; On 840c m lots /00 t r Absorption field on tot /0 2 ; on 4aceut lots / oo r Public sewer main N/A Public sewer manholeMeammut N� A Sewer /septic service line 2.5-+ Litt Station ti/ A SEPARATION DISTANCES FROM SEPTIOHOLDINO TANK ON LOT TO: Building [amdation G r property line /0 rt Absorption field S r Water main/service line / G t Surface water/drainage /M * Wells on adjaam lots /00 -1 - SEPARATION oo't SEPARATION DISTANCE FROM ABSORPTION FIELD ON I.OT TO: Building foundation !D Property Line / 0 Water main/semce line Z -5 "t' Surtax water 100-r Driveway, parkingNehicle Smmge ares -2-0 Curtain drain N1A Wells on adjacent lots /C a -t F. ENGIlVEF1b:'S CERTIFICATION I certify that I have determined Amfield impecttons and review ofManicipal records in conformance with MOA MM guidelines in effect on this date. Siglu�Q- Enginoer'SName 5-►'+i/t�.N�+,1�q,urwr+Q,4.?d• Date HAA Fee S �Oo.CO Waiver Fee S Date of payment Lj - -6j 1,rDate of payment Receipt Number Receipt Number Rev. 8/95 OSS: haa.wk.doc Steven R. Pannone, P.E. P.O. Box 142025 Consulting Engineer Anchorage, Alaska 99514 (907)272-8218 Legal: Lot 3 Block G Knik Subdivision Location: 12900 Ridgewood Owner: Residence: 6 bedrooms Septic System: From Municipal Records: Tank: 2,000 gallon Absorption System: Deep Trench Absorption Area: 16,800 sf. (140'L x 6'D x 3'W) Soil Rating: 280 sf/br Installation Date: Sept. 1980 Date of Pumping: June 24, 1995 - Issacs Honey Wagon, Invoice No. 1522 Date of Test: February 19, 1996 Test Procedure: System was inspected and measured. The septic tank was found with five feet of cover. Liquid depth in the septic tank was measured to be 46.5 Inches. The monitor tubes for the drain field had no water in them. Water was added to the system at a constant rate of 4.1 G.P.M. The water levels in the tank and drain field were monitored. A total of 900 Gallons of water was added. During the test, there was no noticeable rise in the drain field and septic tank water level. This system has a fluid infiltration rate greater than 900 gallons per day. The septic tank is located 96 feet from the well. A waiver to the 100 foot requirement was granted to the septic tank in 1989 by the MOA Department of Health and Human Services. The well produced 4.1 gallons per minute during the four hour test period. The static water level was found to be 106 feet below the top of the well casing. The static level was drawn down to 119 feet during the test. The wells total depth is 128 feet, from record. Water samples were taken to test for coliform bacteria and nitrates. Water test results indicate no bacteria and less than 0.1 mg/1 nitrates. The sanitary seal on the well was replaced. TESTS RESULTS: This system meets the code requirements of the Municipality of Anchorage. The operational life of all 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 conditions are outside the control of the evaluator of this system. We can therefore not give any estimate of how long the system will continue to meet the operational requirements of the Municipality and State. CAU'o&p GYNIKHAA t; T �Ltrnn R Permrn MUNICIPALITY OF ANCHORAGE • Department of Health 3 Human Services yj DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel l.D.# rill- .ina-.*l HAA# A C\29C- 4IA 1. GENERAL INFORMATION (Must be completed prior to submittal) ( I -�Q.$9oot a (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 3• Btock "G" KNIK HEIGHTS Location (address or directions) (b) Property owner State oQ Ata6ka Telephone: (home) Business Pehmanent Fund Mailing Address v ^ rt 4-1000 Juneau A aska 99802 (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent A 4TAR REALTY ATTR, Pat JohnAon Address X07 FaAt Tudan Rui p 033 Anchnnago A aAba 99508 Telephone ;41-78?7 (e) Mail the HAA to the following address: (or check here $Y, if hold for pickup.) _ List contact person and day phone number below: �-Q.��N6tNEfRt - 17034 Eagle River Loop Road No. 204 �aslailiver, Aleck� 99577 2. TYPE OF RESIDENCE Single -Family ❑C Number of bedrooms --6- 3. b 3. WATER SUPPLY Individual Well [RX Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site RX Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 'n-025 (A". 7M) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Date Telephone/ �1 %9 5 & 5 ENGINEERING 17034 F.yt�iver ieg Eagle Rlver, Alaska 99577 No. 404 Approved — Disapproved,, f Conditional Terms of Conditional Approval , CAUTION . The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above byan 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 orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections oranalyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 tAw. WN) Beck Page 2 of 2 6. DHHS APPROVAL 6�zzv�(Date Approved for bedrooms by 1017, LAO- Approved — Disapproved,, f Conditional Terms of Conditional Approval , CAUTION . The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above byan 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 orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections oranalyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 tAw. WN) Beck Page 2 of 2 A. WELL DATA JICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 oo� 0 Legal Description: a Well "Classification t If A, B. C, D.E.C. Approved (Y/N) P Well Log PresentLV/!P `_Date Cf✓DMpleted OD Yield Total Depth.l?,e Cased to 1201 Depth of Grouting —_ �� — ,1 ✓ i Static Water Level , O N Pump Set At !)� Casing Height Above Ground , Z Sanitary Seal on CasingdM) y Electrical Wiring in Conduitd9N) _`r. - ^ Depression Around Wellhead (Yo rJ SEPARATION DISTANCES FROM To Septic/Holding Tank on Lot To Nearest Edge of AbsorptionField r To Nearest Public Sewer Line � P To Nearest Sewer Service Line on Lot 7 t On Adjoining Lots 4 l ( ; On Adjoining Lots A_ To Ngarest Public Sewer Cleanout/Manhole J, A 25 -4- Water Sample Collected by S' S-�1E,'t�-• ; Date Water Samples Test Results Comments !' \,-V, V B. SEPTIC/HOLDING ANKPATA / Date Installed '1180 Size -7-49052 No. of Compartments Z Standpipes&N) —Air-tightCapsON) _FoundationCleanout((YYN) Depression over Tank 4N) Date Last Pumped Pumping/Maintenance Contact on File (Y/N) r-\ LP ;for Holding Tank High -Water Alarm (Y/N) P Temporary Holding Tank Permit (Y/N. a SEPARATION DISTANCES FROM IE7C/HOLDING TANK: ` �� 1 To Water -Supply Well... �4 To Building Foundation ^ To Property Line 0 1+ To Disposal Field To Water Main/Service Line 11, o To Stream, Pond, Lake or Major Drainage Courset Comments 72-M (R". ?/N) Fr ml Page 1 of 2 C. ABSORPTION FIELD DATA ✓ Soils Rating in Absorption Str to 2�t�::// — Type of System Design Date Installed q �0� Length of Field Width of Field �� Depth of Field Gravel Bed Thickness r Square Feet of Absortion Area �b Statndpipes Present (27N) Depression over Field (Y/rte ►, Date of Last Adequacy Test Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well => To Property Line a To Building Foundation , Lot P I% - To Existing or Abandoned System on On Adjoining Lots "' A - To Water Main/Service Line�� 14- To Cutback Iif present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area �A Comments D.LIFTSTATION Size in GBflatLs "Pump On" Levelvel at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. "Check Permitted Bedroom Rating Against HAA Request" I certify that I have checked, verified, or conformed to all MOA'and HAA guidelines in effect on the Inspection. . ' Signed r S S ENGINEERING 17034 Eagle River 00P 0aa A....�. Company�ptr— --- Ataatra 00977 Date MOA No. Receipt No. ` 5-7 Date of Payment Amount: $ Z; 62 of this 6wi A. 344w No IA474 .2/ T L k5 / `iR�i0FES51h� a► Receipt No. , tiyr� Waiver Fee: $ a o Date of Payment l D — y n -MMR". 7/88) Beck Page 2 of 2 I We 0 Y U M Ili 13 ac A 4: « l 3lVJS �<:Zsl-I CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 8 STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 5622343 FEDERAL TAX ID N 92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order 1 16292 Date Report Printed: SEP 13 89 1 15:58 Client Sample ID:L3 B6 ERIE HEIGHTS PNSID :UA Collected I hrs. Received SEP 1 89 1 15:00 his. Preserved with :AS REQUIRED Analysis Completed :SEP 1 89 Laboratory Super!22i STEPHEN C. �E"DE Released By : G. [KC/ ................................................... Special Instruct: Chemlab Ref 1: 7310 Lab Smpl ID: 1 Parameter Tested NITRATE -N Sample Remarks: Matrix: NATER Result/Units 0.46 mg/1 Client Nang S 6 S INCH Client Acct SNSENCP P.0.1 NONE RECEIVED Req B Ordered By : R SCRAPER Send Reports to: 1)3 6 S ENCR 2) Method EPA 353.2 .............................................................................................. 1 Teets Performed . See Special Instructions Above UA -Unavailable ND- None Detected " See Sample Remarks Above NA. Not Analyzed 1.7 -Less Than, GT -Greater Than Allowable Limits 10 Municipality of Anchorage Department of Health and Human Services 825 ' L" Street Tom Fink. P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor 343-4744 October 27, 1989 Robert A. Shafer, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 3 Block G Knik Heights S/D Waiver Request #WR890062, PID #017-372-21; HA890412 Dear Mr. Shafer: Your request for waiver of the required 100 foot separation of a septic system to a private well has been approved.' The approved separation distance is 96 feet from well to septic tank. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincer!�7y, Gt�Gti-�C.� Robert W. Robinson Civil Engineer On-site Services RWR/ljm:#6 It. N EALTH AUTHORITY APPROVALS SEWER& WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELL INSPECTION & FLOW TEST SITE PUNS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSALSYSTEM DESIGN lw�P Octobe2 18, 1989 Municlpatity o6 Anchoaage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Staeet P.O. Box 196650 Anchoaage, A2aaka 99519-6650 REFERENCE: Lot 3; Btock G; Kn.i.k Heights; 12900 Ridgewood, Anehoaage, ROBERT SHAFER, P.E. ROGERSHAFER CIVILENGINEERS (907) 894.2979 FAX 694.1211 ic)7-37a-CP i U--�u9actoa Request you .issue the attached Heatth Authority Appnovat and gaant a waives boa the distance between the pni.vate wett and septic tank tocated on the paopeaty at a distance o6 96 6t. The septic system wait .inatatCed and inspected .in SeptembeA o6 1980. The weft was then dad,tted .in November o6 1980. Faom the wet£ tog, these exists a "HARDPAN" tayea 06 zoit between 35' and 65'; a "sandy clay" tayea between 65' and 105'; and a "CEMENTED HARDPAN" tayea between 105' and 123'. The topogaaphy o6 the tot is such that the gaound aua6aee atopen aazy 6aom the wetC, towaad the septic tank, at a scope o6 appaoximatety 25%. A 4iak anatys.i.s was pea6o4med using the Depaatment o6 Env.uconmentat ConaeavatLon Sepaaation D.c6taict Waives Gu.idetine6. The 6ottow.ing .is oua aeautta: Wates Tabte 1110' static) 7.0 pts. Soit Soaption 2.5 pts Pvtmeabitity 2.0 pts. Wates Tabte Gaadient (11 6t. Daaaodown 6aom Ftow Teat) 1.0 pts. Hoa.Lzonta.0 Sepaaati.on : 2.8 pts. TOTAL POINTS - 15.3 It appeaaa that no baetetiatogicat pot ation is poaa.ibte 64om this aouace. 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 Page Two Lot 3; Btock G; Kn,ik Heights 12900 Ridgewood, Anchortage Octobea 18, 1989 It is our opinion that the honizontat separation distance paescaibed by 18AAC72.021 .is not rtequi2ed .in this case. Ib you 4equiae additiont inbonmation bon your. rtev.iew, p2eaae contact us. _ ` DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME ., , DATE DATE DATE ❑ One ❑ Four ❑ Other t� SINGLE FAMILY 9e - rn INSPECTOR INSPECTOR INSPECT 1 ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE - DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOtEPT. OF HEALTH & 825 L Street • Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTION • ENVIRONMENTAL SANITATION DIVISION MAR 1981 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEINiC�ClI�T�E� DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER 0 d rJ PHONE 4S"- Pd'br MAILING ADDRESS /7 X ! PROPERTY RESIDENT (it different from above) PHONE I 1 r 2. BUYER Aj H =N MAILING ADDRESS sQ A Q 4IL-940z:�99s�7 l 3. LEND NSTITUT N - 1, n /L_IL PHONE MAILING ADDRESS , . n (N/ 4. REALTOR/AGENT PHONE MAILING ADDRESS S. LEGAL DESCRIPTION' Lack STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ❑ One ❑ Four ❑ Other t� SINGLE FAMILY 9e ❑ Two X Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY Q� INDIVIDUAL- ' ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ❑ INDIVIDUAL/ON-SITE**_YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72010 f Rev. 6/79) -- THIS SIDE FOR OFFICIAL USE ONLY r 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ TWO ❑ THREE ❑ FIVE ❑ OTHER ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLICUTILITY Connection Verified PERMITNUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLICUTILITY Connection Verified PERMIT NUMBER OATEINSTALLED U INSTALLER SOILS RATING ❑Septic . A T.,a�nsk� or ❑ Holding Tank Size: Z rfa>L_ If Tank is homemade give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: SepticlHolding Tank Absorption Area Sewer Line Nearest Lo[ Line Absorption Area to nearest Lot Line 5. COMMENTS V d3�APPROVED FOR rj BEDROOMS ❑ CONDITIONAL APPROVAL (letter must ac any certificate) L? --DISAPPROVED C DATE — 1 — -r)- By 72010 (Rev. 6/79)