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KASILOF HILLS BLK 5 LT 6
Kasilof Hills Block 5 Lot 6 #015-133-06 Municipality of Anchorage On -Site Water and Wastewater Section - (007) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201427 PID Number: 015-133-06 Dwelling: 101M Single Family (SF) n with ADU n Duplex (D) n Two Single Family Project: n New I Upgrade Name JESS UMPHENOUR ABSORPTION FIELD El Deep Trench n Wide Trench nim Bed 0 Mound Site Address 10200 KASILOF BLVD *ANCHORAGE, AK El Other Phone Number of Bedrooms Soil Rating depth from original grade 907-250-5212 14 *4.0 GPD/SF ITotal SEE DWG —_ -_ --- Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade SEE DWG Ft. Gravel depth beneath pipe 0.50 Ft. Subdivision Block Lot KASILOF HLILS; BLOCK 5, LOT 6 Fill added above original grade SEE DWG Ft. Gravel length 20 Ft. Township Range Section Gravel width 10 Ft. Beds: Number of Lines 2 Distance between lines 5 Ft. SEPARATION DISTANCES To Septic I Absorption � Holding Sewer I Total absorption area Number of trenches Dist. between trenches From Tank I Field Lift Station Tank Line .200 Ftl Ft. Well D1+ 1*1i 501+ *501+- 25'.I TANK g Septic 0 S.T.E.P. [I Holding El Other Manufacturer GREER 11000 Capacity Gal, I Surface Water 50'+ *50'+ *501+, - Material HDPE Number of compartments 1 Lot Line 5'+ *51+ 5'+ NA 10+ Foundation, 101+ilii 10' + LIFT STATION Manufacturer INFILTRATOR Capacity 540 Gat. Remarks 'CAT 11 AWVVTS - OLD TANK DECOMMISSIONED PER UPC Alarm location Electrical installed by PIPE MATERIAL House to tank D3034 drainfieldTankto D2665 Installer WILCO EXCAVATION Drainfield D3034 C01MT D3034 Inspector GEG AND MOA BENCH MARK (Assumed elevation) 97.07 ft Inspection im 11/5/20 11/5/20 Location and description gad dates: TOP OF MANHOLE #1 (MH1) 311 1115/20 41111/10/26 ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp "J Conditional Approval: Date „;jwc� ;'; r�, Septic System LUUIL�__ CA)TX— Datet. Approved 0 _ Note: this approval does not include well permit requirements. "AECC 88.1 (Rev 05102/18) PERMIT NUMBER: PARCEL ID NUMBER: OSP201427 RECORD DRAWING 015-133-06 46.3 35.2 68.8 54.3 1 67.8 52.6 65.7 48.9 L 64.6 47.5 44.6 36.2 NEW NS500 1 1 28.3 1 53.7 1 AREROCELL POD—,,\\ NEW IM -540 INFILTRATOR SEPTIC TANK NEW 1000 GALLON GREER TANK OLD DRAINFIELD Bl. ST MH DBLI RETAINING WALL—, KASILOF HILLS; BLOCK 5, LOT 7 DRAINFIELD .H.#1 HOUSE IKASILOF HILLS; BLOCK 5, LOT 5 1 VACANT A N SCALE: 1"=40' VV �01tjS A" A %ffARNESS ENGINEE-JRING GROUPLtd , oz' --a—mmmarov, ENGINEERING o SALES - CONSULTING 3701 E. TUDOR ROAD, SUfTE 101 'ANCHORAGE, AK 99507 -PHONE (907) 337-6179 -FAX (907) 3383246 *V"SITE: w .gwnmqkmcMZwm PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JESS LIMPHENOUR 907-250-5212 20F3 LEGAL DESCRIPTION: DRAWN BY: KASILOF HILLS; BLOCK 5, LOT 6 D.J.G. TYPE OF WORK: DATE: RECORD DRAWINGS OF SEPTIC TANK AND DRAINFIELD 11/16/2020 SHE� GARAGE i #AECC884 C -795 ? 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O o �. -� 3- CD D A • g , Y� • // CD o --I a) - _0 # # el,4� 9 * - ITICD Fro Ct) Ci Cn a 0 1 n .c 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 Wastewater Disposal System Permit Permit Number: OSP201427 Work Type: Septic Upgrade Tax Code Number: 01513306000 Site Legal Address: KASILOF HILLS BLK 5 LT 6 G:2541 Site Mailing Address: 10200 KASILOF BLVD, Anchorage Owner: UMPHENOUR JESS H & Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date: G n r, 1 t)ehartill ell t Lot Size in Sq Ft: Total Bedrooms: 10/23/2020 10/23/2021 37911 ❑ 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 Special Provisions: The area on the site plan is to be filled prior to Inspection Report approval. Received By: Date: Issued By:Lcrl� Date: O ZE 2t7 4 Municipality ®f Anchorage Ur.partmenr P.O. Box 196650 e 4700 Elmore Road Anchorage, Alaska 99519-6650 a (907) 343-7904 ® Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV201070 COSA#: Permit#:OSP201427 PID#: 015-133-06 Legal Description: Kasilof Hills Blk 5 Lt 6 Engineer: Garness Engineering Group Your request for a waiver of the required 50 feet horizontal separation from the absorption field to the excessive slope has been approved. The approved separation distance is 0.0 feet. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date: f 69ZU Approved by: /l (�/ Name of Review ............................ ■ ............................. ■ ■ ................ ■ 1 **** VARIAN C E/WAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Fax: 907- 343-7997 On -Site Water & Wastewater Program Mayor Ethan Berkowitz On -Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 015-133-06 Property owner(s) LIDIJA UMPHENOUR Mailing address 10200 KASILOF BLVD *ANCHORAGE, AK 99507 Site address 10200 KASILOF BLVD ANCHORAGE, AK 99507 Legal description (Sub'd, Block & Lot) KASILOF HILLS; BLOCK 5, LOT 6 Legal description (Township, Section & Range) Lot Size Single Family (SF) APPLICATION IS FOR: (w/wo ADU) ( ® all that apply) Duplex (D) Absorption Field Multiple Dwellings Septic Tank (SF and/or D) Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Day phone 907-250-5212 Sq.Ft. Number of Bedrooms 4 APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: N/A TYPE OF DEWELLING: Single Family (SF) (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance: - I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: _ 101 Bl a O (] Receipt Number: 0"),5(256 Permit No. OSP a b 1 y -(Irl Waiver Fees: /60.75 GDyin Date of Payment: 10AOZ 2 Receipt Number: 0710-76: Waiver No. 25V20070 (Rev. 01111) Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201427, Deb Wockenfuss, 10/26/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201427, Deb Wockenfuss, 10/26/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201427, Deb Wockenfuss, 10/26/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201427, Deb Wockenfuss, 10/26/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201427, Deb Wockenfuss, 10/26/20 I "o 00 C6 z 0 w c 0 Cl - 0 0 CD - O -S LO 6 (D E m o ,a a- -j '0 'y , w 7- 00 (5\ T zo 00 , :5 A? 100 io o°° 4L/ jw .N AW U, AW z ci 8 'o -1: 2 -0 Co 'C -0 E mJtwOTo w 2 rm- U- -I mc 21D 0 CO 0 < 0:� ui co w < 0 n _j 0) E m co 0 cpm C" GA co G ca a zg C C amcm < M m w c 2 Cc �2 - o .00 E E CD > m - E 0- CD zo cc 15 '0 2 C) In 0 0 aCL 0 a m m '13 0 c LU -a c W LL Ul 2 C 0 CU 0 M r - c o '2 aj -,� -0.2ro m w 7- 00 (5\ T zo 00 , :5 A? 100 io o°° 4L/ jw .N AW U, AW z CD 0_ =4 m 8 'o -1: 2 -0 Co 'C -0 E mJtwOTo w 2 rm- U- -I mc 21D 0 CO 0 < 0:� 1 . .......... co w < 0 n _j 0) E m co 8.1 0 0 J-- 2-0 0 OEA 0-N 0 Q GA (D ro w (D a zg C C amcm < M m ---1 --- ---- 0 N 0) CL cCi O ca LL 3f z F - z < CL /(�Oo- U) WO W- oa� OZ T wx X uj 0 (D 11 omzz r 0641t '01 6e w Z 0 CJ) x °az= Z0-0 w -j ",go 2 zu wo w CY (j) (L o 1-9 2 < co � w co 0 -j < 3: Z w I-- (L D MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS ?vIAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and 7 tai entered into as of this �, Day of 1c l -v L c r of 20> 4 : , by and between herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), located at (le(yal description) 2. Maintenance Repairs and Alterations. (Owner is required to read, understand and initial each section) "'t Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the tern of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. 'Phis includes an annual maintenance fee (typically $400 to $600). iC VOwner- agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. ,Gll Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page I of 3 tt. Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. ( . Y. Owner acknowledges that the fine for failing to maintain and repair an A�"VTS may be assessed in accordance with AMC 14.60.030. GC 1 �t Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. 4711 Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor- in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner- and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNER: / By: ,��- (signature) cel-�.fsa�dfetiyu/(print name) STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) Date: 13: ,Ue&• Zo�� The foregoing instrument was acknowledged before me this 3 day of 20x-0, by �SuSri�i /Ll IjCC•'iu✓Gt v� A—) NOTARY PUBLIC FOR:L K --A My Commission expires: Notary Public, State at Large, KY My commission expires Oct. 20, 2029 ]MUNICIPALITY: By: _ (signature) Date: (print name) Title: (rev. 05/18/2018) Page 3 of 3 Municipality of Anchorage Page of ! DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL'SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number. 9V/0DDy7%L PIDNumber: ��'✓'13'�..0� Name. Wastewater System: ❑ New *Upgrade Adore$$: 0 t ABSORPTION FIELD Phone: No. of Bedroom$: O Deep Trench O Shallow Trench O Bed O Mound ❑ Other 3 Soil Rating: Total Depth from original grade LEGAL DESCRIPTION P Ft Lot: Block: Subdl-4lon:S Depth to pipe bon" from original grade: Gravel depth beneath pipe(0 If I Ft F Township. Range: Section: Fill added sbova original grade: r Isngth: t. Ft Gravel width:Number of lines: Distance bao.wn Tinel WELL: ❑ New ❑ Upgrade 1G% F ct Classification (Private, A.B. CI: Totes Depth: caw To: Total absorption a Pipe malarial: Ft. Ft. F . Drmer: \ Date Drilled: Static water Level: Installer. Date Instal \� Ft. K 1 1,1 t eA Z a I Yield: ♦// PUMP Set at: Gong Haight Above Ground: TANK V GPM I Ft. Fl. SEPARATION DISTANCES Aseptic 0Holding 0S.T.E.P. To S0014 Abeapllon Lm "dl -g btic/Privale Manufacturer. t Capacity In gallons: n From Tans F»ld cation Tan. Sewer Lines Material:Number Of Compa/�ntc weft t o _ — / D _' S 1 1✓ L SurfaceWater o 0 LIFT STAT N Lot Size In gallons: Manufacturer. Line .7 O t 'S O t "Pomo on" IMI st: 'Pump ofr/1-1 High water alarm at: fOVntlaliOn �!� !_ O curtain T V Pump Make a Z; EleCldcN Insps Ilona Performed by: Orcin Remarks: BENCH MARK Loudon and Description: t' rite Ac a _ r 1 Assumed Elevafipn: � e. ENGINEER'S SEAL ul ... �.1 Inspections performed by: 8 • S Dates: is 3 ° ° "' 2nd 'r / Department of Health and Human Services approval 4C 25 r 414,. •� .... -i' Reviewed and approved by: Date: fl—f¢—I" t 72.013 (A" 912, 1 MOA 25 INSUC. 85.31 iE 85. l3 \ , � 1000 OLL. SFFIit IMIR VACANT swiNc TiEs:� _ / AC 27 FT / BC 29 / \ 5 AD 62 / ea 29 / INSTALLrp` 00 CAL SEPT/C TANK / C J� 12 A MARK WellX. 7 s3 K I I I 9 13 _ 1 OF :•• A`.` ��.•. 1 49th /\ =...•� / / 10 I I ••••••••'•• " <i / SO _ B- 0 100 &0 200 250 300 �� �S• TO CN SPURKLAND•; 'n1 SCALE: J( 1 0 FT �.CIJ,N No. CE -2225 i • 4111 p I BENCH MARK: TOP SANOTUUBC ASSUMED ELEVATION 100.00 FT TOBBEN SPURKLAND P.E. hASILUI•' IIILLS SEPTIC SYSTEM AS BUILT 103 W 15TH. AVENUE BLOCK 5 LOT 6 DATE. NOV. 14, 2000 ANCH. AK. 99501 KASILOF BLVD SHEET. • 1/3 GRID. 2541 907 279-3916 11 PERMIT N SV00472 PID # 015-133-06 KAH0506LDV6 Permit Number: SW000472 1APWA j11010 MUNICIPALITY OF ANCHORAGE Lp zn,,.-A Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Legal Description: KASILOF HILLS BLK 5 LT 6 Date Issued: Nov 07, 2000 Expiration Date: Nov 07, 2001 Parcel ID: 015-133-06 Design Engineer: 0007 Tobben Spurkland, PE Site Address: 010200 KASILOF BLVD Owner Name: Daryl Bennet Lot Size: 37911 SO. FT. Owner Address: 3901 W. International Airport Road Total Bedrooms: 3 Permit Bedrooms: 3 Anchorage , AK 99502 - This permit is for the construction of: n Disposal Field n✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified In Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: Date: T.SPURKLAND P.E. 203 WEST 15711. AVENUE SUITE 203 ANCHORAGE, ALASKA 99501 (907)279-3916 Fax (907) 2766013 Bonnie Mehner October 26, 2000 Prudential Jack White Real Estate 3201 "C" Street #2O0 Anchorage AK 99503 Subject: Well and Septic System Lot 5, Block 6 Kasilof Hills Dear Mrs Mehner; Per your request I have inspected and tested the well ans septic system serving this lot. The test consisted of pumping 560 gallons of water from the well and discharging the water into the septic system drain field. Prior to this 1 measured the water levels in the well, septic tank and drain field, and found that the water level in the well was less than 24 feet from the top of the well casing. The bottom of the septic tank was 69 inches below the ground surface, 15 inches of liquid was measured. The trench clean out was 20 inches below ground surface, no liquid was observed here. The trench monitor was 63 inches deep with 12 inches of liquid. During a 85 minute period I pumped 560 gallons of water from the well. Discharging this water into the drainfield caused 46 inches of liquid to be measured. Water did not enter the tank. The next day the water level in the drain field was 16 inches, indicating that most of the water had been absorbed. The records at the Muni Health Department show that this septic system was inspected and approved in 1985, 1988, and in 1993. My inspection, however, found several code violations. 1. The well to septic tank separation distance as well as the distance between the well and the drain field is 95 feet, more or less. The earlier inspections reports showed 103 feet and 105 feet respectively. This is a paper problem only, for a fee of $920 the Health Department will grant waivers, if it can be documented that contamination of the well is not likely. 2. The Waste Water Disposal Regulations require more than 4 feet of cover over the septic tank and more than 3 feet over the drain field. In this case the tank may have as little as 12 inches of cover, and the drain field even less. This can cause freezing problems during the winter months, and the Health Department will not accept this condition. Insulation and/ or soil must be placed both over the tank and the drain field. 3. According to Roto Rooter, the tank was pumped in July of 1999. On October 26, 20001 observed 15 inches of liquid in the tank, normally the liquid depth is 49 inches. It appears to me that the tank may have developed corrosion damage. This can easily be checked by filling the tank with water from the well. If the tank has developed leaks, it must be replaced. Yours Tob n Spurkland P.E. 2A VACANT _ / \ S INSTALL 1000 OAL SL•PTCTANK ' CRUSH CATI .lSrPFIC TANK6 12 Well / , 9 / / / 13OF A 1 q, 11 0 49th' ♦� / / 10 1 .0 / I I •• S RKLANs,..' �•: / 50 _ 4- 0 Loo TWO 200 2s0 900 ••Tj'N•SPURKLAND ; r SCALE: J�= •1C�j+'ti No. EE-2225 f r ♦♦♦ )i6FE5L TOBBEN SPURKLAND P.E. f1ASILOF HILLS SEPTIC SYSTEM DESIGN 203 W 15TH. AVENUE DATE: NOV. Z 2000 ANCH. AK. 99501 BLOCK 5 LOT 6 _ -_ KASILOF BLVD SHEET. 1/3 GRID: 2541 I PERMIT N SVOOOXX PID k 015-133-06 KAH0506LDVG Y • ` • J MUNICIPALITY OF ANCHORAGE - DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION II ENVIRONMENTAL ENGINEERING DIVISION \ 825 L Street. Anchorage, Alaska 99501 Telephone 264-0720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE 3qA1-G3'7j ENEW ❑UPGRADE MAI LINCt/{ DDRESS 7c�(n`R• t o Sae S. STA LEGAL DESCRIPTION 1_6 6S LOCATION„ f r NO. OF BEDROOMS t.1 DISTANCE TO: Wel oo "I" Absorption/rea 5 Dwelbng / So PERMIT NO. y 2 Wa Manufacturer Mater No. of c mpartments NF Liq. c �a�i� n gallons IF HOMEMADE:l^side length Width Liquid depth be DISTANCE TO: Well Dwelling PERMIT NO. 0 H Manufacturer Material Liquid capacity in gallons p W= DISTANCE TO: W II too Foundation Nearest Iqt line . /0(+ PEF� 1 ' W Z F- E WW. No. of lines Lengthof ea h ine ^, Total le ngt r lines Trench wl�1h lam. inches Distance between lines cc O F. Top of tile to finish grade Material beneath tile inches Total gf(�cyt'is absorption area Nsd W Length Width Depth PERMIT NO. ti d F W L Type of crib Crib diameter Crib depth Total effective absorption area W DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. W W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER O PIPE MATERIALLSSi C . T . $OIL TEST RATING Z INSTALLER REMARKS y i ( DOC a APPROVED DATE LEGAL 5-9-76 72-013 (Rev. 3178) tw ML-ir-1 I r_- FtL i TY CsF FIrAc: `�FE DEPARTMENT'vr HEALTH AND ENVIRONMENTAL,.✓OTECTION 4 825 "L' STREET, 'ANCHORAGE,' AK.- 445c11 \ 279-2511 WELL f=l r4r-' Cit-J—CE. I TE '3~EL•aI=— JE PEPHIT NO' ( 77413') APPLICANT KFTTH?;TDDINi,4 BOX 10328, SOUTH :TA LOCATION KH_•ILOF BLVD LEGAL LE E5 KASILOF HILLS LOTjSIZE '3870 SO TYPE OF SOIL ABSOR:BTION SYSTEM IS: TRENCH MA:>;IMUM NUMBER OF BEDROOMS = 3 SOIL RATING (50 FT/BR:)= 125/ THE R:ElUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: 0 C:•EPTH= !F4 LEFJGTH= Vic: C•EF'TH= i. mi fiRE FEET n im Lis THE LENGTH DIMENSION IS THE LENGTH (IPJ FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IPJ FEET). THERE IS NO SET WIDTH FOR: TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). F:Ere�J I F:EI� cEF'T I t� TFtt4tC 'c I .=E_ GRLLClt-4�17 TL4(D C ' } I t-.J:E-F'EE f::T I CiFiF:E F:E17!lJ I F:EC� BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A 14ELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 20171 FEET FOR.: A PUBLIC WELL. WELL LOGS ARE R.'EOUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F EF:t1 I T ti. HL I O F= iDF' Cir4FEE YEFiF: FFR C,lrl I-•S~UE I CERTIFY THAT 1: I AM FAMILIAR WITH THE R:EQUIR:EMENTS FOR ON-SITE SEWERS AND I -JELLS AS SET FORTH BY THE PUJNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED:_C A ISSUED BY �r ILA �y � tI 4 ^ .� dh� � j//'/� ` lGl �� _ ,, �-�- �-. u TEST n 0.0' ORGANIC MATERIAL W/SOME SILT (OL) 2.5' SILT W/SOME SAND (11L) .27S -------3.5' GRAVELLY SAND -WfTRAGB-SILT-(SIJ}—t-p 5- � Brown ao�u GRAVELLY SAND W/SOME SILT (SM) a sD / Gray 1 — — — — — — — 14.5' FRACTURED BEDROCK 15.0' T.D. GROUNDWATER WAS NOT ENCOUNTERED a 0' ORGANIC MATERIAL W/SOME SILT (OL) -------2.0' SILT W/TRACE SAND (ML) ------2.5' GRAVELLY SAND W/TRACE SILT (SW) -------7.5' GRAVELLY SAND W/SOME SILT (SM) ----__9.5' FRACTURED BEDROCK - 10.0' T.D. GROUNDWATER WAS NOT ENCOUNTERED These logs depict subsurface soils observed within the test hole at the location shown.' See Drawings B-01 and B-02 for explanation of symbols. r =OAr�LTE. F.B. LOG OF TEST FIOLES KEITEi GEIDEINGS GRID: PROJ.NO. 751172 DWG.NO. A-02 �dQ . 5-5--7 NoT- dj Com/ 7) 30 31() 11 o'C-,O� L� � �,�„ � dao i11a-� � n c�r, �. o� ��� ►� G' ►'`i`0.-�--�~-�S �. b a.Uw�CA- ts' -:�o li'll"'ip v 7 C9(k" t� '1 WATER WELL LOG �, Ii MUNIOPALTTY OF ANCHORAGE DEPT. O: I"_.ALTH & FOSS DRILLING ENVIRONNENT.L e;::,TECT1ON 1336 Ingra Street Anchorage, Alaska 99501 // DEC 5 1978 WELL OWNER et, iu¢ USE OF WELLf'h r, LOCATION � �''IICC SIZE OF CASING.LIDEPTH OF HOLEFT. CASED TO % PT. STATIC WATER LEVEL__Ll�_FT. YIELD_-j_GAL.PER.MIN. WITH / D -ID FEET OF DRAWDOWN. REMARKS DATE COMPLETEDII .�l -' % PUMP TO BE SET AT .,Y?� om L` - • _ VA -12t -ALD 'J ' i �t O_ -t 0— O_ t0_ _t o_. _t 0— _t 0— t o.___ to_ _t o_ t o_ _t o_ to- -_t 0— _t 0— Q Municipality ®f Anchorage On -Site Water and Wastewater Program " (907) 343-7904 Certificate of On -Site Systems Approval Parcel I. D.015-133-06 1. GENERAL INFORMATION: Complete legal description KASILOF HILLS: BLOCK 5, LOT 6 Expiration Date: F�J 1 I Cq() Location (site address) 10200 KASILOF BLVD *ANCHORAGE, AK Current Property owner(s) JESS UMPHENOUR Day phone 907-250-5212 Mailing address Real Estate Agent 2. TYPE OF DWELLING: )< Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual ❑X Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 3 V i o Date of Payment iili]aM Receipt Number 092566 COSA r SC ZC� I I Date: 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: Gamess Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Ancliorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: In conducting this evaluation, GEG provided an engineering evaluation of th6 well'andlor septic systerni in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the systemis on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments ma exist that were not identified during the evaluation. The operational life of all wells y iables, including but not limited to, soil conditions, and septic systems depend upon a variety of vari groundwater levels (that may fluctuate during the year), quality of construction (materials and Wo rkmanship). 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 (2� 4', IS . the well or septic system. GEG makes no representation whether an alternative well or septic system V can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or , kj� party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE #AECC884 \L System #1 Appfoved for bedrooms System #2 Approved for bedrooms OF Disapproved Conditional approval for bedrooms, with the following sti ionsoWsvTE Z \NA'f ER AND Z;Z \NA .0 �0, C _0 i_0 , �'V By: P Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. t, 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other W 0112 Legal Description: KASILOF HILLS; BLOCK 5, LOT 6 Parcel ID: 015-133-06 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 11/30/78 Total depth 140 ft Cased to 27 ft ❑ Sanitary seal is functioning correctly Al Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 9`11120 Static water level at beginning of test 28.8 ft. Comments B. TANK DATA Age of tank(s) NEW years Tank type/material HDPE Measured operating fluid level in septic tank N/A ❑ Standpipes/foundation cleanout per record drawing Date of pumping N/A D. ABSORPTION FIELD DATA Which system tested (date installed) 11/2020 ❑ ALL standpipes present per record drawing Total measured depth from grade 3.47 ft (max) Measured depth to pipe invert from grade 2.7 ft (min) ❑ N/A — pressurized field A Monitor tubes go to bottom of effective. If not, state depth into effective Al Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A gallons Comments/Deficiencies: COSA Checklist yellow sheet Well production at time of test 5.0+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes Vol t Al Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by GEG Date of Sample 9130120 C. LIFT STATION ❑ Required maintenance completed Age of lift station NEW years Lift station material HDPE Comments: Adequacy test date NEW Results Q Pass For 4 bedrooms Fluid depth prior to test in Water added - gal New depth in Elapsed time - min Final fluid depth in Absorption rate 600+ gpd Any rejuvenation treatment (past 12 months) N/A If yes, enter date - E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) 0 Septic Tank/Lift Station on Lot > 100' if No *50,+ Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft✓❑ Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 251771 Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No *50+ ft Holding Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' ✓1 Yes Animal Containment > 50'✓❑ Yes if No ft Q Yes if No ft ✓❑ Yes if No ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 21 Yes if No ft [Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' ❑ Yes if No *50'+ ft Property Line > 5' E] Yes if No ft Wells on Adjacent Lots: ft Absorption Field > 5' ✓❑ Yes if No ft Private Wells > 100' ❑ Yes if No *50'+ ft Water Main > 10' ✓1 Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Water Service Line > 10' ✓❑ 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' ✓❑ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No *5'+ ft Wells on Adjacent Lots: Water Main > 10' ✓❑ Yes if No ft Private Wells > 100' ® Yes if No *50'+ ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Surface Water> 100' ❑ Yes if No *50 + ft F. ENGINEER'S COMMENTS *THIS IS A CAT II AWWTS G. ENGINEERS CERTIFICATION OF I certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with Cj jiT— MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet ..w..... (% J f }1 A. arne,ss: IS, Cc -79 3 o�G `Q O'Proresslo(NaN #AECC884 Q% MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this 21St Day of October of 20 20, by and between Adam Lutchansky , herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as Quanics Aerocell located at (legal description) 10200 Kasilof Blvd. 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of M Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNER: By: / /' (signature) `fid u z, C Jci X 4Al rc % (print name) STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT ) Date: �–,( O tZO%D The foregoing instrument was acknowledged before me this day of CSL,- 20 by �� cl n� i�y i C1, Gs n uttfJll!!i!///�fl NOTAI�Y PUBLIC FOR ALASKA = �: �•- = My Commission expires: G�� �G' iT i_� 'fes/1 �t'�i'••......••`• �,ti�`�. rA TE l(iil J11� MUNICIPALITY: BY: �1� (signature) print name) (rev. 05/18/2018) Date: 19 b09D Title: Page 3 of 3 L..5r Municipality of Anchorage Development Services Department Building Safety Division ; On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR SINGLE FAMILY DWELLING Parcell.D. 015-133-0to HAA# 050bato Expiration Date: CIO, — D .r 1. GENERAL INFORMATION Complete legal description kosilof U15, SKs LT (n Location (site address oi` directions) t0100 1(6.511o� �iYp ggSlle Current Property owner(s) tA5. Ko.. ;JN*%a.. IDJoV Day phone Mailing address Lending agency . Mailing address Real Estate Agent Mailing Address iotoo k xs; (of 91J. Ane-Lzms.. Ak 145a Day phone T RiVk Day phone Unless otherwise requested, HAA will be held by DSD /or pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 3 TYPE OF WASTEWATER DISPOSAL: ® Individual On-site 9 ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. 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. (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. l - r 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) In compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Address Phone 219-311(a Engineer's Printed Name S. DSD SIGNATURE C-"'� Approved for 2 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: t/e/ L(/. �O- Original Certificate Date: (Rwv 01A7) Municipality of Anchorage +,.•• . Development Services Department Building Safety Division ` On -Site Water & Wastewater Program ' • • , 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 9951946650 www.a.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Kasl�p 1lili4 RK5 LT(o ParceilD: O -IS- 133 -Oro N A. WELL DATA Well type (PrivAc If A, B, or C provide PWStD #= Dale completed I(_30 -W Sanitary seal (YIN) y Total depth 140 ft. Cased to ft. FROM WELL LOG Date of test 11-30-1979� Static water level (g fl Well production 3 g•p•m• WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate -2_ m9J - 43 - Arsenic: 5_AW1. Date of sample: 405 Well Log (YIN) y Wires properly protected (Y/N) _ Y Casing height (above ground) 21 in. AT INSPECTION 28 ft. tc. ( g.p.m. B. SEPTICIHOLDING TANK DATA TankType/Materiai Ani r-44. 7— �siee1 Tank size 1000 gal. Number of Compartments �- Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed 5 9 1 Soil rating (g-p•dJft2 or felbdrm) i25 Other bacteria colonies/100 ml. Collected by. Lars Spm R1unA Date installed II !q 00 Cleanouts (YM) Y High water alarm (YIN) A _ System type Trlt„c-k Length 38 ft. Width 3 ft. Gravel below pipe 5 ft Total depth 8.1 ft. Eff. absorption area O_ft2 Monitoring tube%i Depression over field Date of adequacy lest Results (Pass/Fad) %_ For .3bedrooms Fluid depth in absorption field before test35 in. Water added ` Q gal. New depth L+ in. Elapsed Time: JJJ) min. Final fluid depth _3.5_ in. Absorption rate >= (000 g-p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) Nax known If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) 'Pump on' level —in. 'Pump off"level �alln.. High water alar lev In. Datum Cycles test Meets ala circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on tot T too Absorption field on lot Y t00 Public sewer main N/A Sewer /septic service tine > 15 On adjacent lots > 107 r On adjacent kits >100 t Public sewer manhole/clesnout N A Holding tank -IV A SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation > 10Property line 7 /O' Absorption field >51 Water main NJA Water'service line � 25 r Surface water N. D . Wells on adjacent lots 7100 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line )'101 Building foundation > t0 r Water main N/A Water Service line ';P25' Surface water n/. o . Driveway, parking/vehicle storage 710 r Curtain drain N. 0. Weiss on adjacent lots >/QO r F. COMMENTS 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 HAA guidelines in effect on this date. Engineer's Printed Name TA6en SpuAA nA Date HAA Fee $ ZA00 .OU Date of Payment /o✓ Receipt Number (Rev. 12101) Waiver Fee $ Date of Payment Receipt Number s,vtt.t"A MAR -1-2005 11:308 FROM:A+ HrE SERVICES. IN 907-868-6770 70:2766013 P:1/1 ---------------- . N/D.1 Mr: Rwygp�NM aY•w +..^•a..w �.. `� r v NORTHLAND PUMPING SERVICE, INC. Your Professional Septic 7501 E. 140th Avenus Pumping Service'Company ANCHORAGE, ALASKA 89516 . (907) 344.7146 FAX (907) 668.6770 TO ' No and 203 1Aveaue #206 Ancho Be, AX 99501 Pum'P septic at 10200 Kasilof$Ivd. for adequacy test Invoice to offmc.ell— ,l • 16063 an February 7, 2005 THANK You 41 - �amucPual�c�n,P,u.� Municipality of Anchorage Development Services Department Building Safety Division _ On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-133-06 HAA #Lj P 03 O a 1 -109'- Expiration Expiration Date: 9 - eZ - O 3 1. GENERAL INFORMATION Complete legal description Lot 6, Block 5, Kalilof Hills Subdivision Location (site address or directions) 10200 Kasilof Blvd, Anchorage, Ak 99507 Current Property owner(s) Mike Stisak Mailing address 10200 Kalilof Blvd, Anchorage, AK 99507 Lending agency Unknown Mailing address Real Estate Agent Mailing Address None Unless otherwise requested, NAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ • a CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-133-06 HAA #Lj P 03 O a 1 -109'- Expiration Expiration Date: 9 - eZ - O 3 1. GENERAL INFORMATION Complete legal description Lot 6, Block 5, Kalilof Hills Subdivision Location (site address or directions) 10200 Kasilof Blvd, Anchorage, Ak 99507 Current Property owner(s) Mike Stisak Mailing address 10200 Kalilof Blvd, Anchorage, AK 99507 Lending agency Unknown Mailing address Real Estate Agent Mailing Address None Unless otherwise requested, NAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone 243-8649 Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑✓ Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. 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. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 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 Theta Environmental & Engineering Address 23254 Northwoods Dr, Chugiak, AK 99567 Engineer's Printed Name Ronald E. Godden 5. DSD SIGNATURE Approved for _? bedrooms. Disapproved. Phone 242-0755 Conditional approval for bedrooms, with the following stipulations: Additional Comments ON-SITE --WATERM9 WASTEWATER : RO JJJJ �O Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineers Report Well Flow Advisory Other By:G/��� O Original Certificate Date: Municipality of Anchorage ; .• Development Services Department ° Building Safety Division ` On -Site Water & Wastewater Program • �' 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 6, Block 5. Kasilof Hills Subdivision Parcel ID: 015-133-06 A. WELL DATA Well type P' 810 If A, B, or C provide PWSID # _ Well Log (YIN) Y Date completed Sanitary seal (Y/N) Wires properly protected (YN) Y Total depth 140 ft. Cased l0 27 ft. Casing height (above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test 11/30/78 05/18/03 Static water level 18 ft. 20.97 ft. Well production 3 g.p.m. 6.63 9.p -m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 0.338 mg.A. Other bacteria 0 colonies/100 ml. Arsenic: ND mg.11. Date of sample: 09 m Collected by: R. Godden B. SEPTIC/HOLDING TANK DATA Tank Type/Material Anchorage Tank, Steel Date Installed 11/14/00 Tank sizer 1.000 - gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cIeanout (YN) *** *"',Depression over tank (YIN) N High water alarm (YN) WA . Date of pumping 05/17/03 Pumper Around the Clock Pumping C. ABSORPTION FIELD DATA Date installed 5/9/78 Soil rating (g.p.d./ftor ft /bdrm) 125' System type Trench Length 38' ' ft. ' Width 2' ft. Gravel below pipe 5.0' ft. Total depth 8.2 Eff. absorption area380 ft2 Monitoring tube Y Depression over field N Date of adequacy test 05/18/03 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth In absorption field before test2724 in. Water added 601 gal. New depth_!! 28 in. Elapsed Time: 120 min. Final fluid depth 27_6 in. Absorption rate >= 495 g,p,d, Any rejuvenation treatment (past 12 mo.) (YIN & type) Unknown If yes, give date D. UFT STATION Date installed N/A 'Pump on' level at _in. Datum E. SEPARATION DISTANCES Size in gallons NSA 'Pump off'7 level at _ in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot GT 100.0 It Absorption field on lot 101.0 it Public sewer main N/A Sewer /septic service line GT 2511 Manhole/Access(YIN) N/A High water alar level at in. Meets alar & circuit requirements? On adjacent lots GT 100.0 ft On adjacent lots GT 100.0 Ft Public sewer manhole/cleanout N/A Holding tank NIA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation GT 10 Ft Property line GT 10 n Absorption field 10 ft• Water main N/A Water service line GT 25 It Surface water GT 100 ft Wells on adjacent lots GT 100 It SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line GT 10 ft Building foundation GT 10 Ft Water main NA Water Service line GT 25 Ft Surface water GT 100 ft ng/vehicle Driveway, rki storage pa sl GT 10 ft Curtain drain NIA Wells on adjacent lots GT 100 R F. COMMENTS From Inspection Report 11/14/00 and 5/9/78. Tank and Trench insulated 11/13/00. ••• Inside Foundation Clean Out G. ENGINEER'S CERTIFICATION OF I certify 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 Ronald E. Godden �• • :• • • . _ ..X Date 06/01/03/r•���� •�' L7�7Ti i HAA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number (Rev. 12/01) - N 1 OE= THETA ENVIRONMENTAL ENGINEERING 23254 Northwoods Drive Chugiak, Alaska 99567 (907)688-0755 June 1, 2003 Mr. Jeff Poet Building Safety Division On -Site Water R Wastewater Program 4700 S. Bragaw St. Anchorage, AK 99519-6650 Re: Property Identifier: Lot 6, Block 5, Kasilof Hills Subdivision Health Authority Approval Checklist Per our discussion, 05/27/03,1 revisited the subject property to determine the following: 1. If an inside foundation cleanout existed. I observed an inside cleanout, directly next to the foundation in the craw space. I have attached a copy of a digital photograph taken 05/27/03, showing the cleanout. 2. Exactly how much cover exists over the drain field? I used a transit and a rod on 05/28/03, and determined the following: a. The bottom of the clean out in the drain field on the southwest side of the lot is 5.9 feet below grade. There is a stickup of 3.9 feet. Thus, there is 2.0 feet of cover. b. The monitor tube in the drain field on the northeast side of the lot is 8.03 feet below grade with a stick up of 2.27 feet, during the adequacy test. However, when the adequacy test was performed, all levels were measured, using a float stick. The float stick consists of 3/16 -inch dowel and does not lend itself to being pushed hard down. When using the rod, it was determined that some very thick sludge was present in the bottom of the monitor tube. There was 1.32 feet of sludge and the liquid was approximately 2.0 feet thick. Visual inspection inside the monitor tube did not show any perforated pipe, however, it appears the monitor tube is attached to the horizontal perforated pipe with a "Tee". The joint at the top of the "Tee" is 3.64 feet below the top of the monitor tube. This appears to indicate there is approximately 1.00 feet of cover over the drain field at the monitor tube end. Based upon these observations, it appears additional cover needs to be placed upon the drain field to meet the minimum cover of 3.0 feet. The Buyer is currently living in the house and made arrangements to place additional cover over the drain field. I inspected the amount of additional cover over the drain field, 06/01/03. At that time, I determined there was at least 3.0 feet of cover over the top of the perforated pipe. Attached is an updated Iiealth Authority Approval Checklist. Please discard the checklist dated 05/20/03. If you have any questions, please feel free to call me at 242-0755 S' nald E. Godden, P. E. OE2 THETA ENVIRONMENTAL ENGINEERING 23254 Northwoods Drive Chugiak. Alaska 99567 (907) 688-0755 May 20, 2003 Ms. Kamichia Darby 10200 Kasilof Blvd Anchorage, AK 99507 Re: Property Identifier: Lot 6, Block 5, Kasilof Hills Subdivision Per your request, I tested the well and on-site wastewater disposal system on the subject lot on 05/18/03. The test consisted of removing 601 gallons of water from the well and placing it into the absorption system. Prior to testing, I measured the water in the well and found the static water level to be 29.97 feet below the top of the casing. After removing the water from the well, the static water level was 91.30 feet below the top of the casing. After 88 minutes, the well had recovered to a static water level of 28.45 feet. An occupant in the house took a shower during the recovery and this slowed down the recovery. In any case, the well provided 6.8 gallons per minute and is sufficient to meet the needs of the 3 bedroom dwelling. Prior to testing, I measured the liquid in the soils absorption field. It was 27.24 inches. After placing 601 gallons of water in the soils absorption field, it measured 29.28 inches. After 120 minutes, the liquid in the soils absorption system measured 27.60 inches. This equates to 495 gallons of water. The soils absorption is sufficient to meet the needs of the 3 bedroom dwelling. Water samples were taken, 05/16/03. Samples were taken for coliform, Nitrate, and Arsenic. The tumaround was expedited by the lab at an additional cost. The coliform and other bacteria was negative. The Nitrate was: 0. 3s The Arsenic was: 7JD Q� 6 The liquid level in the septic tank was measured, 05/18/03. The septic tank was empty. The tank appears to have been pumped, 05/17/03. The cover over the absorption field appears to be less than 3.0 feet. However, the inspection report accomplished 10/26/00 indicated a similar problem. According to documents in the MOA records, the tank was moved, and insulation was added over both the septic tank and soils absorption field, 11/14/00. Since you are living in the house and have not experienced any freezing problems, it appears the combination of cover and insulation is sufficient to protect the septic tank and soils absorption field. If you have any questions, please feel free to call me at 242-0755 '=;:Z_.OF.: Vna G en, P. E. 5120103 Darbyl.665KasiloMpll 14 9-21-03; 9:49AM: 5 N SCS Rerx 1032690001 Client Name Theta Env. Engineering Project Name/n Outside Hose Bib Client Sample ID Outside hose Bib Matrix Drinking Water PWSID 0 Sample Remarks: :901 69,530, • 2/ 3 All Dates/Times are Alaska Standard Time Printed Date/Time 05/21/2003 6:46 Collected Date/time 05/16/2003 14:58 Received Date/time 05/16/2003 15:35 Technical Director Steph/eo . Ede Released ! / oa Allowable Prep Amlysts Pammeter Results PQL Units Method Limits Date Date Init Metals Department Arsenic 0.00200 U 0.00200 mg/L EP200.9 (<-0.05) 05/19/03 0520/03 JMP Waters Department 1 Nitrate•N 0.338 0.100 mg/L EPA 300.0 (<---10) 05/16/03 JS ; Microbiology Laboratory . Total Coliform 0 coV100mL SM189222B («1) 05/16/03 KAP u N2SB5'06"E 82.29 lo, of, -I. Es,»4 _ vanfs ..t k SAWAIMWMCOMOt WM " zO.H. Ik iS&." FA WY. K Y• m S •i4pYL7 11000MM KT71.1 Da[ orn•r bwW Iwrbt !�L M b w.wrr r•n• bio w fit. b /••mob ti wl W w•q I wwm A b Fw+b MY •M/• W blry��'� brM•tfrrbw�o d blMwM pec Zba �yr� •�T"•_ .�'��•���''{I-amu_-�•L' �{, 3 23'/8'3 rr Kas;/�F Blvd Hse. vi �r n 4 N Q W V ri co .. 8•••. SAWAIMWMCOMOt WM " zO.H. Ik iS&." FA WY. K Y• m S •i4pYL7 11000MM KT71.1 Da[ orn•r bwW Iwrbt !�L M b w.wrr r•n• bio w fit. b /••mob ti wl W w•q I wwm A b Fw+b MY •M/• W blry��'� brM•tfrrbw�o d blMwM �yr� •�T"•_ .�'��•���''{I-amu_-�•L' �{, ev 23'/8'3 Kas;/�F Blvd SAWAIMWMCOMOt WM " zO.H. Ik iS&." FA WY. K Y• m S •i4pYL7 11000MM KT71.1 Da[ orn•r bwW Iwrbt !�L M b w.wrr r•n• bio w fit. b /••mob ti wl W w•q I wwm A b Fw+b MY •M/• W blry��'� brM•tfrrbw�o d blMwM f,. I PWII "S p on IF OD -A.4 3 AC -44 so PWII "S p on IF OD PWII "S p on IF 11 Fri 9. IC16 rI►., . ', 1 M1 11 a 1 rub J1 ■; y � MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES AAAML Division of Environmental Services On -Site Services Section cam P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D.# Of5�- 13?1—Dt, HAA# �,� �060s8a 1. GENERAL INFORMATION Complete legal description {C1�S I L. O I L -L -S S I �6 a Vc Location (site address or directions) t o O-o-c� 11 AS I t- e F SL1l 17 Property owner �nA'Zyt- 'B K=- ^� t4 rm- i Day phone Mailing address s=L'ZL L` Lo L Lending agency Day phone Mailing address Agent NIIF- V1ENNkYZ i IDay phone 76z -3r3'7 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 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 tin -site Public sewer NOTE: if community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72d25CFw.L91) Fm MOA021 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 Iurtherverifythat 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 Icer, m s V+V_(nKt'�f -k phone 274-39/ 6 Address Engineer's signature - 6. DHH6 SIGNATURE x Approved for - bedrooms. Disapproved. Conditional approval for Additional Comments M Date 4S, bedrooms, with the following stipulations: Date ZL /4 -60 CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given In paragraph 5 above by an independent professional engineer registered in the State of Alaska.The DHHS does this as a courtesyto purchasersof homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate Is Issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-M mW. L11) 8. MOA Cl Municipality of Anchorage r • Department of Health and Human Services Division of Environmental Services On -Site Services Section 825 `L" Street Room 502 P.O. Box 198850 Anchorage, AK 99519.6650 www.oi.anchorage.ak.us (907)343-4744 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L r 1 to 13)C S WAS l Le t 14 ILLS Parcel I.D.:ory_/33—ob A. WELL DATA Well type Z_ Date completed U-3-0-76 If A, B, or C provide PWSID # "/A Sanitary seal_ Total depth 14 0 ft Cased to 21 it FROM WELL LOG Date of test I I —3o -7 6 Static water level I A ft Well production '> g.p.m WATER SAMPLE RESULTS: Coliform _*_colonies/100 ml Nitrate I& -q- mg/i Date of sample: ) 0 /02%9 O Collected by: B. SEPTIC/HOLDING TANK DATA Well Log y Wires properly protected _12t_ Casing height (above ground) A LI in. AT INSPECTION Iy -.A4 - m D < jag it 1 r)2, g.p.m Other bacteria__)e colonies/100 ml Tank Type/Material S I E tr L Date installed "/15100 Tank size J60V gal Number of Compartments o- Cleanouts Foundation cleanout 1_ Depression over tank tom- High water alarm Date of pumping '�%4 Pumper N C. ABSORPTION FIELD DATA Date installed 5-9- 78T Soil rating (gam or ft2/bdrm) /Sb System type / -He, 4 Length &--ft Width 2 It Gravel below pipe ft Total depth _q_ft Effective absorption area -&O—#2 tube Depression Monitoring tubDepression over field iJ Date of adequacy test / 016Vloo Results (Pass/Fail) P • For _3 bedrooms Fluid depth in absorption field before test Io2 0 in Water added 5b O gal. New depth_Y_!�o in. Elapsed Time: Aqkrg�_ min Final fluid depth Ito in Absorption rate >_ -5a g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) 1--1 If yes, give date t-4/4 72 026 (Rw. 01/00(• D. UFT STATION Date installed Size in gallons �� Manhole/Access "Pump on" level at in "Pump ofP vel at in Datum Cy tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: High water alarm level at in Meets alarm & circuit requirements. Septic tank/lift station on lot 1 D 5 On adjacent lots > / PQ Absorption field on lot /0.2 Public sewer main I''//A Sewer /septic service line >.7-5 On adjacent lots > //-- Public sewer manhole/cleanout N/Ar Holding tank _ N% SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation y5 Property line D'D Absorption field /© Water main NA Water service line > Surface water N 10 Drainage N IV Wells on adjacent lots /op SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line0 Building foundation to © Water main N'r4 Water Service line >P,5 Surface water N 0 Driveway, parking/vehicle storage > S D Curtain drain f4 10 Wells on adjacent lots F. COMMENTS i.uarvi uI-'a4 � l�i � /u -o G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and IN ' review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name o bb-( N sbvr klw H Date 1 i I 1 y Its 0 HAA Fee $ Date of Payment Receipt Number 72-M6 (PW. DIM)' Waiver Fee $ Date of Payment Receipt Number WWI Environr.lema: Smices Inc. T-226 P.C2/03 F -45T CI& I, Rrl-^ Clitill PO'. N021 Pr,,, J'CJ' [I. Cal I"; I C: t;' I f 0.'d I;' PV Sl It Ine SC L MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D.# n`S-I21:S-nn_ HAA# 1AQS2nll_1 1. GENERAL INFORMATION Complete legal description LOT 6, BLOCK 5, KASILOF HILLS SUBDIVISION Location (site address or directions) 10200 KASILOF BLVD. ANCHORAGE. ALASKA Property owner DARYL BENNETT Day phone 246-7777 Mailing address 3901 WEST INTERNATIONAL AIRPORT RD., ANCHORAGE, ALASKA Lending agency CITY MORTGAGE Day phone 277-0700 Mailing address 121 WEST FIREWEED LN., SUITE 120, ANCHORAGE_, AK 99503 Agent LINDA MELLOR Day phone 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 3 X 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 X 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 Ow. 1/91) FW1 MOA 921 S. 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 TRYCK NYMAN HAYES, INC. Address 911 WEST 8TH AVENUE AN Engineer's signature 6. DHHS SIGNATURE Approved for - bedrooms. Disapproved. Phone 279-0543 Date 49th ip % RoeERT W. WRIGHT ICiCE-8156 44 kt pROFESStOk�"� Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Health Authority Approval Certificates based only upon the representations given In paragraph 5 above by an Independent professional engineer registered In the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending Institutions In order to satisfy certain federal and state requirements. Employees of DHHS do not conduct Inspections or analyze data before a certificate Is Issued. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. Tues (Rw 1A1) 6. MOA nt Municipality.of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOT 6, BLOCK 5, KASILOF HILLSParcel I.D. A. WELL DATA Well type PRIVATE If A. B, or C, attach ADEC letter. ADEC water system number N/A Log present (Y/N) YES Date ccmplated 11-30-78 Driller FOSS DRILLING Total depth 140' Cased to 27' (BEDROCK) Casing height 2 Sanitary seal (Y/N) Date of test Static water level Well flow Pump levet YES Wires properly protected (Y/N) YES FROM WELL LOG 11-30-78 Em 3 g.p.m. 138' SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot 103' 105' On adjacent lots 1001+ ; On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer service line N/A Petroleum tank N/A WATER SAMPLE RESULTS: Coliform NONE Nitrate 0.5 MG/L Other bacteria NONE Date of sample: 07-17-97 Collected by: CHAWN cNTSARENKO B. SEPTIC/HOtBRNG=FIeNK DATA Date Installed OS =0944 Tank size 1000 Compartments 2 Cleanouts (Y/N) •... •YFS " ' Foundation cleanout (Y/N) NO Depression (Y/N) NO High water alarm-(Y/N) NO, Alarm tested (Y/N), N/A Date of pumping'. 08-14-91 Pumper ROTO ROOTER SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s)onlot 103" y Onadjacentlots 1001+ Foundation 47' Topropertyline 10 Absorption field 10 - Water main/service tine N/A Surface water/drainage N/A 72-026(Rev.75nFro t CONTINUED ON BACK PAGE AT INSPECTION o z 02-17-92 n CO 24ft.rn ry :� 9+ g.p.m.a< Co m0 < ?� NOT VERIFIED o �o "' o m On adjacent lots 1001+ ; On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer service line N/A Petroleum tank N/A WATER SAMPLE RESULTS: Coliform NONE Nitrate 0.5 MG/L Other bacteria NONE Date of sample: 07-17-97 Collected by: CHAWN cNTSARENKO B. SEPTIC/HOtBRNG=FIeNK DATA Date Installed OS =0944 Tank size 1000 Compartments 2 Cleanouts (Y/N) •... •YFS " ' Foundation cleanout (Y/N) NO Depression (Y/N) NO High water alarm-(Y/N) NO, Alarm tested (Y/N), N/A Date of pumping'. 08-14-91 Pumper ROTO ROOTER SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s)onlot 103" y Onadjacentlots 1001+ Foundation 47' Topropertyline 10 Absorption field 10 - Water main/service tine N/A Surface water/drainage N/A 72-026(Rev.75nFro t CONTINUED ON BACK PAGE C. LIFT STATION N/A Date Installed Size In gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) —Manufacturer— Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off" level at Cycles tested Surface water _ Date Installed 05-09-78 Soil rating 125 SF/BED. type -System Length g' Width 36" 5, Gravelthickness TI . Total absorption area 380 SO. FT. Cleanouts present (Y/N) Depression over field (Y/N) NO Date of adequacy test Results (pass/fail) PASS for THREE (3) .Peroxide treatment (past 12 months) (Y/N) NO If yes, give date TRENCH ota depth 9 YES 02-17-92 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well onlot 105' On adjacent lots 100'+ Propertyline 10'+ To building foundation 47' To existing or abandoned system on lot N/A On adjacent lots N/A N/A N/A N/A Water main/service line Surface water N/A Driveway, parking/vehicle storage area 1001+ Curtain drain N/A E. ENGINEER'S CERTIFICATION bedrooms I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this Inspection. Signature Engineer's Name M-o&Eer / A5117 Date 6W-1QWRY 04 ii HAA Fee $ _/ d v-�_ Date of Payment Z " Receipt Number 8 72-M (R.v. aNl) a.ok MOA 21 Waiver Fee: $ _ Date of Payment Receipt Number 49th !P,X ROBERT W. WRIGHT y CE•8156 IS,�yRo'•.`..... �pNa`f `ii - INVOICE N SEWERANDDRA 1 20YONTOOF90�� CLEANING SERVICE I ••sway Cfe Dew the DaaGc.• P.O. BOX 112688 PHONE345-2513 ANCHORAGE, ALASKA 99511.2688 I- /7r, 6 e,,v ,,j C-,4-4� L16r kit _ TOTAL FOOTAGE CLEANED ORTHAWED BLADE5UJtu/ PROBABLECAUSE OF STOPPAGE '-- LINECLEANED ❑ JOgNOTGUARANTEE,D(Q FOLL N 1 WORK ACCEPTED BY _ OtAA 5 /Q'u tPL'tl wtTH S veicIr-teo THAT 7//td /_e/\C" f-IGLO wAovT QWL`RE uJf1 t GL[ f1NvvTS Ou GAO �/� ��JZ 7/I6 CLc2NN ?v CONOdC-r 'TfIE /k6covrlcY �C STi NORTHERN TESTING LABORATORIES, INC. 33'1. 0 INCUSTRIAI AVENUE 2505 FAIRBANKS STREET FAIAGANKS. ALASKA 99701 19011456-3116 • FAA 456-3':5 ANCI-ORAGE. ALASKA 99503 (907)77767/8 - FAX 274.9645 Tryck, Nyman, Hayes Inc. Report Dates 02/20/92 911 W. 8th Avenue Anchorage AK 99501 Date Arrived: 02/18/92 Attn: - Cur Lab /: Location/Projectt Your Sample TD: Sample Matrix: Com lents t A116263 Kaeilof Hills Lot 6 Elk 5 Water Date Sampledt 02/17/92 Time Sampledt 1100 Collected Sys BS MDL = Method Detection Limit Flag Definitions B 0 Below Regulatory Min. H a Above Regulatory Max. E a Below Detection Limit Estimated value Date Method Parameter Units Result Flag MDL Analyst --------------------------------------------------------------------------------------------- EPA 353.3 Nitrate -N mg/l 0.5 0.1 02/18/9. 0o JL' F. Reported Bys William E. Buchan Organic Chemistry Supervisor • . ^' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL O� OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) 1 fi Se K S KASfGOF Ole 1-2 Location (address or directions) Sfcor GtiNG'e .u,_. Akita Sr:kG :C"` Business 563- 3766 (b) Applieent Name telephone: Home Applicant Address 3Soo �SOz (c) Applicant is (check one): Lending Institution,; OwnerAmoder ❑ ; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Telephone ' Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: fel L --5"z7 -1 11 - Coru�xtu 2. TYPE OF RESIDENCE �: r Single -Family Multi-FFaamily❑ Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ ; Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11.84) Page 1 of 2 5. ENGINEERING FIRM PROVIDING ,NSPECTIONS, TESTS, FILE SEARCH, DA'i^ 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 crt -V trAa2c • –Telephone Addre Date DHEP APPROVAL �� Approved for bedrooms by Date Approved` — Disapproved Conditional Terms of Conditional Approval CAUTION Engineers Seal u/�•_ f� �flt5' The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending Institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. Page 2 of 2 72-028111184) t MUNICIPALITY OF ANCHORAGE ENVIROtAmENTAL SERVICES DIVISION JUL 81988 RECEIVED A. WELL DATA n r1 MUNICIPALITY OF ANCHORAGE (MOA) Ol b l,7 v HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4744 Legal Description: Lo -r 6 SLK S KA511or HILLS Well Classification PR I VAT ' If A. B. C, D.E.C. Approved (Y/N) g-TotWell Log Present (Y/N) �- Date Completed 11jjoll7f5 0 Yield gr- Total al Depth 140 Cased to27 Depth of Grouting Static Water Level Z I' 0) Pump Set At Casing Height Above Ground Z Sanitary Seal on Casing (Y/N) j Electrical Wiring in Conduit (Y/N) 1 Depression Around Wellhead (Y/N) i Separation Distances from Well: ' 1 To Septic/Holding Tank on Lot O Z : On Adjoining Lots � To Nearest Edge of Absorption Field on Lot 10 S ; On Adjoining Lots /00 To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/ManholeTo Nearest Sewer Service Line on Lot >SU Water Sample Collected bye)� CNFSC - ; Date /�S i Water SampteTest Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed S y size 1006 No. of Compartments -7— Standpipes Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout Y/N) Depression over Tank (Y/N) KI Date Last Pumped 6 Pumping/Maintenance Contract on File (Y/N) IV ;for Kl1A Holding Tank High -Water Alarm (Y/N) M liq —Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: r + To Water -Supply Well �0 r (� To Building Foundation r0 To Property Line t To Disposal Field (0 t To Water Main/Service Line g� To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-076 1Pw 8 861 ROM C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata _I Z 4flM Type of System Design e6-1 0 H Date Installed S Length of Field 38 t ' -: ` ! i .i 1 Width of Field 361M ^ 3 U Depth of Field 9 + JK Gravel Bed Thickness 15 - Square Square Feet of Absorption Area SRO sJ�r4 Standpipes Present (Y/N) r Depression over Field (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test ii/ S %. , t S it d ge, n4e: Separation Distance from Absorption Field: To Water -Supply Well 105-1 To Building Foundation SO 1 Lot To Property Line 10' + On Adjoining Lots — To Existing or Abandoned System on /001 -I- To To Water Main/Service Line �0 + To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area /00 1 Comments oPe/ 10A./4. -P/ D. LIFT STATION „ KL Date Installed Size in Gallons "Pump On" Level at A High Water Alarm Level Tested for Electrical Codes (Y/N) Comments \ Dimensions Manhole/Access (Y/N) _ "Pump Off' Level at '• Check Pe! tted Bedr om- sting Aga nst HAA Request •• Icertifyte(e&cd erlfied,orconformedtoallM Aa Signed Date 7171, CompanOt MOA No. 4� 2 Receipt No. k U Z) d04&- S/ Date of Payment 7—op—PI Amount: $ Q9 Page 2 of 2 72-M lRev 8'861 Rack Vent(Y/N) Pumping Cycles during Adequacy Test Meets MOA guidelines in effect on the date of this inspection. Rtw 'yef- rC 1. Corwin t CE3183 �W yJtl �ESStU!';,Gv Engineers Seal �•eow•.ow�ae CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 t3 STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562.2343 \ FEDERAL TAX ID N 920040440 14AL13IS REPCRT RS SANPLE for Work Order t 7435 Date Report Printed: JON 24 88 8 14:13 Client Sample ID:Le. 85 RASILOP HILLS Client Name : CORWIN 6 1330C P.3ID :UA Client kcct : COP -WIN? Collected JUN 23 89 8 13:15 hrs. P.O.= NONE REC D Received JUN 23 89 8 14:00 hrs. Req 8 ?raserved with :NON; Ordared By : J. ERESS Analysis Completed :JUN 24 88 Send Reports to: Laboratory Supervisor :STEPNEN C. EDE 1)CORWIN 6 1330C Released by N24-J'P� G, �ll� 2) . .................................................................................................................................... Special Instruct: Chemlab Raf 8: 1500 Parameter Iested -- ----------- NIIRATE-N Lab Sap1 ID: 1 Metrix: Water Sample RGUTINI SWLE Remarks: Welt COLLECTED 81 J. E. Result/Unite Method 0.17 eq/l EPA 353.2 Allowable Limits 10 .............................................................................................................. 1 Tests Performed ' Sae Special Instructions Above Uk-Dnavallable ND. Nona Detected a' Sea Sample Remarks Above NA- Rot lnalpred LT -Lose Ihan, CI -Greeter Than '' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) 1DZoo A/gtit AF QER�.tf[ 99i/6 (b) Applicant Name wfilSBN l Telephone: Home JJIL 3833 Business Applicant Address DRIVE (c) Applicant is (check one): Lending Institution P(; Owner/builder ❑ ; Buyer ❑ ; Other ❑ (ezptain); (d) Lending Institution Address (e) Real Estate Company and Agent Address Telephone (1) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family g Multi -Family ❑ Other Number of Bedrooms e Telephone 3. WATER SUPPLY , Individual Well K Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Certser ea!on attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite x Public ❑ Community ❑ Holding Tank ❑ Note: II community well system, must have written confirmation from the State Department of Environmental ConserrV_�on attesting to the legality and status. 72IMS 1111511 Page 1 of 2 r') r1 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 venfyV.at rnyinves_Sa=c" of Mis Wes _n Authority Approval shows that the on-site water supply and/or wastewater disposal system is sale, f unc3sa' a -+C a'vCue for the number of bedrooms and type of structure indicated herein. I further verify that based on Ve ir.!orr. x -on oV*an*c from the Municipality of Anchorage files and from my investigation and inspection, the on-s,:e ur-er s:::ty W4'or wastewater disposal system is in compliance with all Municipal and State codes, ordinances. and rec,2z_ers in effect on the date of this inspection. f Name of Firm1S'�� Q<tnr.e� Telephone �3y6"x/90 Address /A+,16/ A4 en Oh Al Date 1-s0 a6 19 C. It -stir Cr 31:0 DHEP APPROVAL Approved for 7141e-- 3' bedrooms by "" (�Q t� Date Approved X Disapproved Conditional (Terms of Condittonat Approval tt CAUTION Engineer's Seat V�a�ryi The Municipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Feez J At t:x=TY Approval certificates based solely upon the representations given in paragraph 5 above by an incepere-W- prdessic+ral' engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of hornes &-d ttsrr L-nTiV Institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not cor*uct vtsfec'tiom or analyze data before a certificate is Issued. The Municipality of Anchorage is not responsible for errors or crrxss+ors in L`e professional engineer's work. Page 2 of 2 ra-on 0il 0 Wit, "EAItH E 110N EpNt��N1A` � R'ECE�v TSD A. WELL DATA n n MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: Ja4t, Well Classification AdVA - If A. B. C, D.E.C. Approved (Y/N) — Well Log Present (Y/N) V Date Completed _/h .30-76 Yield _ii.!79.4m Total Depth /40 Cased to 2i>[ Depth of Grouting Static Water Level /8 Pump Set At J� Casing Height Above Ground — E4 .AI Sanitary Seal on Casing (Y/N) y Electrical Wiring in Conduit (Y/N) y Depression Around Wellhead (Y/N) Al Separation Distances from Well: To Septic/Holding Tank on Lot On Adjoining Lots df00 To Nearest Edge of Absorption Field on Lot JOS ; On Adjoining Lots /00 To Nearest Public Sewer Line Cleanout/Manhole _ To Nearest Public Sewer To Nearest Sewer Service Line on Lot Water Sample Collected by _4�� ; Date '7-80'86' Water Sample Test Results , �� Q� �� py-, Lila �kY Ln C Comments iE+E CJ4SED aC e s aedal.i �t,ct B. SEPTIC/HOLDING TANK DATA Date Installed _5-9.78 Size -JO-00No. of Compartments - Standpipef (Y/N) Y Air -tight Caps (Y/N) y Foundation Cleanout (Y/N) Jy Depression over Tank (Y/N) Al Date Last Pumped x'80-85' Pumping/Maintenance Contract on File (Y/N) for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well /gns -044 To Building Foundation -910t- To BITo Property Line ��� To Disposal Field O IAL To Water Main/Service Line �' To Stream, Pond, Lake, or Major Drainage Comments YJ I Page 1 of 2 r 72-02611,84) C. ABSORPTION FIELD DATA f_ 1 Soils Rating in Absorption Strata aly .1115 "r, Type of System Design T Date Installed 5-9-7A Length of Field -,#A 0' Width of Field 3(& JA/ Depth of Field 90 Gravel Bed Thickness _aT.' Square Feet of Absorption Area 380 SF Standpipes Present (Y/N) Y Depression over Field (Y/N) At Date of Last Adequacy Test 7- 29 -BS - Results of Last Adequacy Test n.-gesed Separation Distance from Absorption Field: To Water -Supply Well /Ac To Property Line Z6,10- To !9tTo Building Foundation Sn't To Existing or Abandoned System on Lot I I To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area R Comments _A61241;"Al -rte. .+. •..� n D. LIFT STATION Da Iled . Size in Gallons __`�� "Pump On" Level at _ High Water Alarm Level at Tested for Electrical Codes (Y/N) _ Comments On Adjoining Lots i�raf f To Cutbank (if present) t Dimensions Manhole/Access (Y/N) _ "Pump Off' Level at Check Permitted Bedroom Rating Against HAA Request •• Cycles during Adequacy Test. Meets MOA I certify tihal have ec ced, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date 7 Company MOA No. X&V- 22$ Receipt No. x,4,0(, `1Ci DateofPayment _k_ A_SS Amount: $ A'S p0 Page 2 of 2 72-024 J 1,84) " APPLIC"NT FILLS OUT UPPER HAI" -`ONLY Time v �> t..n ��� Owner =PhoneProperty �K ��`v-'P �e — 3-73 /� / cJMallirg F—G Address Date Buyer D A..1 Svs/1�J c• Inspect �Q 21D Code Address r- Lending Institution r— _ /, (� _1 1 .1 Phone G t MOQ7 G%/�L SIO �+• "' w�� � 251933 Zip Code Address Phone Realty Co. d Agent G RECEIV ED Zip Code Address ��„o� Lepel Description / K L15 / LQ r L S Street Location OOMSPPROVAL' Type of Residence rDATE Q�,Single Family -Multiple No. of Bedrooms [i Family ❑ Other Water Supply _'Com dunl Community �,L,�, �+� ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. For wells trilled prior to that date, give well depth (attach log If available). O Public Utility �S71 Sewer Disposal �Individual Year Individual Installed: / When Corrected to Public Utility: ublic Utility e Septic Tank Size QOO ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time v �> t..n ��� Time n C Date Date �� vs Date Inspector Inspector Inspect �Q r1eS Lt.00 L.IJQ-O v–'..�,�;NTAL NICIPALITY OF ANCHORAGE �'� M DE IL OF F ALTH f. PwOTECTION �uCR 251933 G RECEIV ED 19 ��„o� OOMSPPROVAL' 'CONDITIONS OF APPROVAL rDATE Solis Rating Date Sewer Ins+talled Well To Absorption Area Well Log Recelv00 e Septic Tank Size QOO '-/ _� r Well to Tank ! 7w 0�