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HomeMy WebLinkAboutLOUDERMILK LT 4Loudermilk Lot 4 #015-501-18 Municipality of Anchorage Page / of 6" 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: qU )`1 it no In PID Number: Name: ✓o.�ds G! c'u eLFy Wastewater System: ❑ New ❑ Upgrade Address: /oyn / �o�od� �'� ABSORPTION FIELD Phone: Zy'i� G 96 9/M ,iS/9-/z7f// No. of B ooins: ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound a Other LEGAL DESCRIPTION Soil Rating: /.z Total Depth from original grade: Lot: Block:— Subdivision: LO✓d6.P1I/L� 0PD1Sq Ft Depth to PIPS bottom from original grade: %F/, Gravel depth beneath pipe Township: Range: Section: .f Ft Fill added above original grade: � Ft Gravel length: Ft. SO Ft WELL: ff New ❑Upgrade Gravel width: Number of lines: DeUncebenreenikle,: Classification (Private, A,B.C): Total Dept : Gaited To: /G Ft Total absorption area: N/ii Ft Pipe material: Ft. /.rlv Ft. G �G S Ft. •O .frM .rO Driller. DaIq Drilled: Static Water Level: At OHNE Oti'/LL /.Jr±/j2/9 Ft. Installer: Cec.o �Y.00 L�l'.JS>� Date Installed: _ >CoT• .Z /49.�j Yield: Yield: /O GPM Pump Set at: 1-Z e' Cong Height Above Grand: z.z TANK Ft. Ft. SEPARATION DISTANCES 0-6eptic ❑Holding ❑S.T.E.P. 7o From Saptic Tank Abwrption Field Lift Station Holding Tank bliNPmala Sa runit, Manufacturer. i� e,/o.ra4GE Capacity In gallons: Well, /y7/ /6 S// ,tJ �.o Al) �.9 �A Material: Number of Compartments: Wates Water / '`jo ">/.a /•o ',o LIFT STATION Lot Line /S / // / AIf V Size In gallons: Manufacturer. Foundation (> ' �/A "t/ A "Pump on" level at: 'P 1" level at: High water slam at: CurtainA,/- Drain /A Pump Mak el Electrical Inspections performed by: Remarks: eA-) �Ew /s .a BENCH MARK LG/i0� O.QAiwJ iwJSr.4cl-4TiO.v. Location and Description: l�,O¢ALd �6/9d Assumed Elevation: /00 � NL OF `4 X11 '��• .� 1 Inspections performed by: Dates: 1s �a'o /�9 �• • j yj 2n : DO • • T. K 4LEY: Department of Health Human rvices approval / .8 11�J,, CES176 •• ' Reviewed and approved by: Date: S l '—'—T� 72-013 tear ",, unit x Permit No. Page X of 6� Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report .egal Description: Lot 4, Loudermilk Subdivision PID No.: CN I I Ng ` I ^' n n � m I t I I Ze I � SS:ceRc� j a o e` 1 1\ CN I I Ng ` I ^' n n � m I I I Ze I � M.l I l - B'I�!J x�anoi 72-013 A (2/91) MOA 25 . DO 3IAS; . KENLEY: 1� "< CE Bllu + j a o e` 1 1\ I l - B'I�!J x�anoi 72-013 A (2/91) MOA 25 . DO 3IAS; . KENLEY: 1� "< CE Bllu + Permit No. Page -4 of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 1966504nchorage, Alaska 99519-6650 • Telephone 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report legol Description: Lot . Loudermilk Subdivision PID No.: :.OT 53WVA O I C 8 V S Y X �F6 \ W N 72-013 A (2/91) MOA 25 .. , J Oa b� v Y `W N Z 1 W � bui S 0 1ooa. ado h ` 0 o m Y a O I C 8 V S Y X �F6 \ W N 72-013 A (2/91) MOA 25 ..'.'.!r !, �_�, 4a•.Y.. ..P � i.• 1. .�-ta�'17+�'.ir'-`1YJ !^ ,y1'..r<✓ . - rellei nbPDESIGNS TO 24857P.01nbt-it • MAR-15-19M o tax transmittal mem7FROM �otope► 4 rO r` iron F'01p , STATE OF ALASKA Mn.+ DEPARTMENT OF NATURAL RESOURCES _ 5-7 7(.f DIVISION OF WATER WATER WILL RECORD aettoueN �61 l.sulowom LOT �de �I ilk 1 4 1 ��` LOCATIONISKQCH: :Tlorr CTRLatt.MN Tow" IN t atERlDIAN DN CMf ❑E OS OW WELL OWNER: DEPTHS MEASURED FROM:Oeesinp top Opround surface WELL DEPTH / DATE OF COMPLETION ItOAEHOIE DATA: Depth Depth of Cast of hole:/ I� It Meterlal Type and Color From To ng tt / .cam..-. ,;,.rr•,...•i�c /i�tn..�/' / CONTRACTOR 'q�str�•• �usu J/ 1 •,/0 n 1 '// "I 11 * lLa�7 Fr..q Ze /I 0 DEPTH T0A1'ATIC WATER LEVEL - -it below tM top of Catfnp O groundsurteoe Date: _ / J. 9 METHOD OP DRIWNG: Lfalr rotary O Cable toot other USE OF WELL; Lei domestic O Irrigation O monitor O We supply O other CASING STICi L Zz_i1 Olam: % In, to 61t `Casing tYPe: tIn to t WELL INTAKE OPENING TYPEt O open and O ecteened 13 perforated O open hole Depths,of openings: ECRM TYPE! Length - It .SIot/Meth Sire: Length: it GRAVE. PACK TYPE: N Volume used: Depth to top: GROUT TYPE: Volume: Depthc from_„__ it to tt DEVELOPMENT METHOD: Durstlon: _ ori PING LEVEL AND YIELD: O it after �/ hrt pumping, .� oem PUMP INTAKE DEPTH! 1t Horsepower. WELL DISINFECTED UPON COMPLETION) DYES D NO REMARKS: 0 OR 0 0 0 Percent Passing by Weight 0 W A 0 0 0 O l0 O 0 0 0 0 0 0 0 0 0 0 0 0 O O O N 3 0 E E z o 0 z o 0 o oe o D. o U o A O W O N O O o � � o z W w �' W �• � N O» A r� � r g ^ a � N e W A a y a N aTa iT —i e v i 0 e cXi� a n u GI 1 � O• 5 � s 1 b yN V � 40 � N ' O 'L o b f7 O» A r� � r g o y 52 cXi� N' O• 5 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON—SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW940062 DESIGN ENGINEER:DOUGLAS T. KENLEY, P.E. OWNER NAME:LOUDERMILK STEVE L OWNER ADDRESS:10401 LOUDERMILK CIR ANCHORAGE AK 99516 PARCEL ID:01550118 LEGAL DESCRIPTION: LOUDERMILK LT LOT SIZE: 40430 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 4/04/94 EXPIRATION DATE: 4/04/95 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 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: PRIOR TO CONSTRUCTION OF THE SYSTEM, THE ENGINEER WILL COLLECT A GRAB SAMPLE OF THE RECEIVING SOILS AND PERFORM A SIEVE ANALYSIS TO CONFIRM THAT THE SOILS ARE EITHER A SP OR SW TYPE MATERIAL PRIOR TO CONSTRUCTION OF THE SYSTEM. RECEIVED BY DATE • q • ee '.:iq ISSUED BY: _]Ck414 E410-ff v DATE: 4 ¢194 D"gl" r. Kaley. RE 11C01 R" 6034. Palma, Alaska 99645 (907) 746-1073 Mr. Jim Curley residence ((�� � n nn Lot 4, Ghw"n Subdivision eRnuALr r iidk 1�._fl I'OOUb IL Anchorage, Alaska A n °IU C6VU�L�I l.F Gum jJ � PERCOLATION TEST RESULTS 3-I$'9LI IOSPAA AND J 1Qa4bb�Aj GENERAL SITE INVESTIGATION REPORT Q On February 12, 1994, the above -referenced 40,430 square foot site was inspected in conjunction with soil perk tests being performed for application and approval for the installation of an on-site waste water disposal system. The site is located at the intersection of 104th Avenue and Loudermilk Street in Anchorage, Alaska. The system is being installed to serve a new four- bedroom home scheduled for construction in the spring of 1994. The septic tank will be a 1,250 gallon tank. The site is on the south side of 104th Avenue with a gradual slope ranging from approximately 1% to 2% in the east -west direction and 2% to 3% in the south -north direction. The immediate area that has been selected for the waste water disposal system has an average slope of 1%. The site is moderately treed with birch, spruce and alders. It appears that there are no obstructions that would prevent surface water runoff. On-site observation and physical survey shows that there are no water wells nor private waste water disposal systems within a 100' radius of the proposed system. Consultation with owners of neighboring properties indicate that all adjacent waste water disposal systems are performing adequately. No surface water was observed at the time of the inspection, and it appears that there is no potential for contamination of adjacent water wells or streams. One percolation test was taken at the site to assess the adequacy of subsurface soils to accommodate both the primary and replacement on-site waste water disposal system. The results of this test are attached to this report. The test site had adequate percolation rate to support the proposed four-bedroom residence. Subsurface soils were found to be sand with some gravel overlain by 12" of surface organics. The percolation rate for the replacement site was found to be less than one minute per inch. By inspection, it was determined that the material has a percentage of sand greater than 500/o therefore a sand liner is not anticipated. A sieve analysis will be provided prior to installation of the system for confirmation of the soil type. A copy of the test results will be provided to the Municipality's On -Site Waste Water Department. Mr. Jim Curley 03/2/94 Page 2 If there should be any questions concerning the percolation rate or characteristics of the site, please call me at 746-1073. Sincerely, ba r" T. KUL Douglas"f. Kenley P.E. PE #8176 (v • •j••n •S• •w•v z o �'+'•�• 37NBOSM ATWO Wlf ! i ia V J" '3'd 'A31M)f '1 Sd1Jf100 low x .a F Z a �33N ,��P� • y�l %oi x .a F Z a Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0850 SOILS LOG — PERCOLATION TEST PERFORMED FOR: J s M DATE PER LEGAL DESCRIPTION: LOT A �L-��L'�70tA /Vf, Township, Range, Section: (FEET) 1 2 3 4 5- 6- 7 8 7 •v 8- 10- 11 1011 12- 13- 14- 15-- 16- 17- 18- 19- 20 213 1415 1s17181920 COMMENTS 0RGklJ1C,5 SAND %4tT44 5inMC Gvf.,vELL Sot'Tath DF ACLIF SLOPE WAS GROUND WATER N O ENCOUNTERED? S IF YES, AT WHAT L DEPTH? 0 P E Depth to WaterIle{ Monitoring? ! n"L Date. Z SITE NE■■■N■RN■ Gross Time Net Time ■■■■■■■R■■ Net Drop REENNEENNE ENEMBEEMEN no ENNNE■E eE■_N■■NONE I M1 n i�flllt__Mal h �Ih MiN -. ■EON■ON■■■ t' rHiN Reading Date Gross Time Net Time Depth to Water Net Drop it I M1 n h �Ih MiN -. rr t' rHiN IMin - r e rea 03 iiwe5 Wr /cs71 I L PERCOLATION RATE 4::'l (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN q FTAND Eli?- FT PERFORMED BY: " 1 I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MACIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/8.5) JU — — 1S 1'I! A -v rd--� 34Nv 711.8 -YI It 0 3 •r),.V mi -*Ar f° p»-^ t-'-'rn 4c: ;Olr+ rr)-Xq NINA? rix•`f ylironP ul Lent-amf (�) ^at v US -"-q S.� saint CNI.tDtINvyN �rwNca�'� I�c�4N1 1 1 �•4 a N � a 3 ��' S 1 \` v �-. I e�..i.1 IJ�•Oj •,10 X00 fi 1 Z 711.8 -YI It 0 •r),.V mi -*Ar f° p»-^ t-'-'rn 4c: ;Olr+ rr)-Xq NINA? rix•`f ylironP ul Lent-amf (�) ^at r, ,y LiMO�s' -"-q S.� saint CNI.tDtINvyN �rwNca�'� I�c�4N1 1 1 u J � ��' S 1 \` v �-. I e�..i.1 IJ�•Oj •,10 X00 fi 711.8 -YI It 0 9 a 2 ••r. a 5 711.8 -YI It 0 1 •231 9 a 2 J 1 •231 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. 015-501-18 Expiration Date: L 021— ZOZ - 1. GENERAL INFORMATION Complete legal description Loudermilk Sub, Lot 4 Location (site address) 10401 Loudermilk Cir Current property owner(s) Peters, Nathan David Day phone Mailing address 10401 Loudermilk Cir, Anchorage, AK 99507 Real estate agent Lindsay Sizemore 2. TYPE OF DWELLING: ❑N Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone (907) 727-8445 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Q Private Septic Q Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Date of Payment_ zQleA I Receipt Number 00? L4.5 0 Date: Waiver Fee $ Date of Payment Receipt Number COSA # 05GZ l 1602 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller Date 10/6/21 AlwP� OF g h AKlow 49TM •*� 6. DSD SIGNATURE 4 .r fes• • :: :: System #1 Approved for bedrooms 1 ' ' ' Benjam-4.Schiller % System #2 Approved for bedrooms ���j��slF . , o 12592 .'���� Disapproved i�iF�pROFESSI Conditional approval for bedrooms, with the following stipulations: ttc(rr PLITY 0,, � - ON, O� vVAT o VV ER AND m PROGF E4 R �e A 4 o� -? n )))1�r111`ll����� l BY �^^ ` Original Certificate Date: 10-2-7-V 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 Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic A�dv�irs�or' Other �i-- lL -P Y d,`S taK / Legal Description: Loudermilk Sub, Lot 4 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 4/22/94 Total depth 164 ft Cased to 136 ft Fol Sanitary seal is functioning correctly R Wires are properly protected Casing height (above ground) 27 in. Date of flow test for COSA 5/25/21 Static water level at beginning of test 70 ft. Comments B. TANK DATA Age of tank(s) 27 years Tank type/material Septic/Steel Measured operating fluid level in septic tank 49 FE -1 Standpipes/foundation cleanout per record drawing Date of pumping 7/8/2020 D. ABSORPTION FIELD DATA Wide Trench Which system tested (date installed) 9/2/95 ❑® ALL standpipes present per record drawing Total measured depth from grade 6.1 ft (max) Measured depth to pipe invert from grade 2.7 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 3.4 FN_1 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: 015-501-18 Structure served by this system Well production at time of test 3.5 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ Nc ❑ Coliform bacteria is Negative Nitrate 0.973 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Forge Engineering Date of Sample 9/21/21 STATION ❑ Requireintenance completed Age of lift station years Lift station material Comments: Adequacy test date 5/25/21 Results p/ Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 683 gal New depth 0 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate >600 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' ✓M Yes Community Sewer Manhole/Cleanout > 100' [7✓ Yes if No ft Q Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' R Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' Q Yes if No ft Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' F Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' ✓M Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10'✓0 Yes. if No ft Community Wells > 200'✓Q Yes if No ft Water Service Line > 10' F✓ 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' M 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' Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' U✓ Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS AQ G. ENGINEER'S CERTIFICATION Q1�F"gtS'��d 1 certify that l have determined through field inspections and review TH of Municipal records that the above systems are in conformance with • • • • • • -�• MOA COSA guidelines in effect on this date. rr *-. BenjantWSchiller ; 4 �� F�,, •. CE 12592 • c� / �� ��%�c� • 10/6/21 , • F��. PROFES� COSA Checklist yellow sheet Septic 'Wank Advisory Certificate of On -Site Systems Approval #OSC 211602 Subdivision: Loudermilk Lot 4 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 27 years old. Typical replacement costs range from $9,000 to $12,000 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 20 -year-old steel tank MAY look like. Mailing Address P b t'Box'196650 *Anchorage, Alaska 99519 6650 * www muni org 1 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL 1 Parcel I.D. 015-501-18 r Expiration Date: 1. GENERAL INFORMATION Complete legal description LOUDERMILK LOT 4 Location (site address) 10401 LOUDERMILK CIRCLE, ANCHORAGE, AK 99507 Current Property owner(s) JEN TU Day phone Mailing address 10401 LOUDERMILK CIRCLE, ANCHORAGE, AK 99507 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class_ Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: i Received by: OSI G Date: Z' , COSA to be released to the engineer, unless ise requested by the engineer. COSA Fee $ Waiver Fee $ _ Date of Payment fa/�7,��13 Date of Payment Receipt Number �3 �JolJ�q Receipt Number COSA # Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING. INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 6126/13 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future OFA `;%� \, occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. (� 6. DSD SIG ATURE System #1 Approved for 4— bedrooms. System #2 Approved for bedrooms. Disapproved. KENKETH_�T. �UIE�f'lL' / 4e AN' By: Original Certificate Date: �' 1 The nicipd it of A oraga 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 We sheet 10-10-12.doc 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: LOUDERMILK LOT 4 Parcel ID: 015.501-18 A. WELL DATA Well type PRVT If A, B, or C provide PWSID # _ Date completed 412211994 Sanitary seal (YIN) Y Total depth 164 ft. Cased to 136 ft. FROM WELL LOG Date of test 412211994 Static water level 75 ft. Well production 10 9.p -m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 0.399 mg/L Arsenic: ND ug/L Date of sample: 612 012 01 3 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC 1 STEEL Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (YIN) Y Depression over tank (YIN) N Date of pumping 2118113 Pumper A+ C. ABSORPTION FIELD DATA Well Log (YIN) Y Wires properly protected (YIN) Y Casing height (above ground) 24+ in. AT INSPECTION 213012013 ft. g. p. m. Collected by: ARCTERRA Date installed 811994-91211995 Cleanouts (YIN) Y High water alarm (YIN) N Date installed 811994 - 91211995Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 System type SHALLOW TRENCH Length 50 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth 6.2* ft. (Measured 2/20/13) Eff. absorption area 650 ft2 Monitoring tube Y Depression over field N Date of adequacy test 212012013 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0* in. Water added 700 gal. New depth 2.4 in. Elapsed Time: 10 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at _ in. Datum Size in gallons "Pump ofr level at _ in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main 75'+ Sewer /septic service line 25'+ Animal containment areas 50'+ SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access (YIN) High water alarm level at Meets alarm & circuit requirements? On adjacent lots 1004 On adjacent lots 1004 Public sewer manhole/cleanout 100'+ Holding tank 100'+ Manure/animal excrete storage areas 100'+ Building foundation 5'+ Property line 5'+ Absorption field 54 Water main 10'+ Water service line 104 Surface water 1004 Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 104 Water Service line 104 Surface water 1004 Driveway, parking/vehicle storage 3'+1 - Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 100'+ F. COMMENTS *Per MOA docs / previous 2005 HAA and recent site measurements—MT extends approximately 33-37" into the effective depth G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review of determined through field inspections and review of Municipal records that inspections and review of Municipal records that the above systems are in Municipal records that the above systems are in conformance with MOA above systems are in conformance with MOA COSA guidelines in effect on conformance with MOA COSA guidelines in effect on this date. COSA guidelines in effect on this date. on this date. Engineer's Printed Name KENNETH M. DUFFUS Date COSA brown sheet 10-10-12.doc ��� OF�A�(�v4\ ��C] Tf l /.\ Nom.., in. A„ KENNETH 1. D Fi IkS '�'�'� 7 18 i// 4k'/ aha IWiini `ipaiity of Anchorage 'Deveiopinent Services Department Building Safety Division CL On -Site Water S Wastewater Progiam 4700 South Bragaw St. „ P.O. Box 196650 Anchorage, AK 9951„ 9.6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 015-501-18 HAA#_ 09r���C++15- 1. GENERAL INFORMATION Expiration Date: l0 — % — 4� Complete legal description LOUDERMILK SUBDIVISION- LOT 4 Location (site address or directions) 10401 LOUDERMILK CIRCLE • ANCHORAGE AK. 99516 Current Property owner(s) AMY AND DAVID SEAMAN Day phone X907) 929-2324 Mailing address 10401 LOUDERMILK CIRCLE • ANCHORAGE AK. 99516 Lending agency Day phone Mailing address Real Estate Agent JULIE ERICKSON w/ PRUDENTIAL VISTA Day phone 242-9282 Mailing address 3801 CENTERPOINT DRNE, SUiTE 200 • ANCHORAGE, AK. 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 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 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties 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. 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 AuthorityApproval Guidelines for this application, shows that the onsite water supply and/or wastewater disposal system ls(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 riles and from my Investigation and Inspection, the on -silo 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. GARNESS, 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 d 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 INe of all wells and septic systems depend on the local sells condition, groundwatertevels 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 ofthe 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 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 sofa benefit of the ownerlisted above. Any reliance upon or use of this report by any other person or party is not authorized, nor MY it conlerany legal right whatsoever. 5. DSD SIGNATURE Approved for L4- bedrooms. Disapproved. Phone 337-6179 Date / S Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other WASTEWATER By.Original Certificate Date: 3 ' 0 1R«. raor> �. Municipality of Anchorage Development Services Department �l J Building Safety Division On.Ske Water 6 Wastewater Program 4700 South Bragaw, St. P.O. Box 196650 Anchorage, AK 99519.6850 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOUDERMILK SUBDIVISION: LOT 4. Parcel ID: 015-501-18 A. WELL DATA WOO type MATE If A, B. or C provide PWSID# N/A WOO Log (YM) YES Date completed 4122/1994 Sanitary seal (Y/N) YES Wires property protected (YM) YES Total depth 164 ft. Cased to 136 ft. Casing height (above ground) 24+ in, FROM WELL LOG AT INSPECTION Date of test 4/22/1994 3/9/2005 Static water level 75 ft. 59 R, Well production 10 g,p.m. 4.42 g,p_m, WATER SAMPLE RESULTS: COliform �S- colonies/100 ml. Nitrate . 5 mg;A. Other bacteria —'G,coloniesH00 ml. Arsenic: N/A mg jL, Date of sample: 3/9/2005 Collected by, GEC. LtD. B. SEPTICIHOLDING TANK DATA Tank Type/Material STEEL Date installed 8/1994 — 9/2/1995 Tank sae 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (YM) YES Depression over tank (YAV) NO High water alarm (YM) N/A Date of pumping 10/20/2004 Pumper NORTHLAND PUMPING C. ABSORPTION FIELD DATA 8/1994 Date installed 2/199!s � Soil rating .p.d ft'IYbdnn) 1_2 System type TRENCH Length 50 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth!L1 ft. Eft. absorption area 650 fl' Monitoring tube YES Depression over field NO Date of adequacy test 3/9/2005 Results (PasslFati) PASS For 4 bedrooms Fluid depth in absorption field before test '=0 in. Water added 695 gal. New depth 0 in. Elapsed Time: 0 min. Final fluid depth 2 in. Absorption rate >: 600+ g.p.d. Any rejuvenatbn treatment (past 12 mo.) (YM 8 type) NONE KNOWN If yes, give date — *$MONITORING TUBE ONLY EXTENDS 33 INCHES INTO DRAINROCK. D. LIFT STATION Date installed •Pump on' level at _in. E. SEPARATION DISTANCES size in gallons High water alarm level at in. Cycles tested Meets alarm 8 circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAt t station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/deanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 101+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service Um 10'+ Surface water 100'+ Driveway, parkinglvehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 car* that I have determined through field inspections and review of Municipal records that the above systems are in contomrance with MOA HAA guidelines in effect on this data Engineer's Printed Name JEFFREY A GARNESS Date 3A `x'r �J HAA Fee S �� Date of Payment Receipt Number (WV. 1201) Waiver Fee $ Date of Payment Receipt Number Mar 14 05 03:10p r 0 A PRUDENTIAL VISTA REAL EST 907-273-7398 ,3 Lot.tt7E'�MtLK G�{2G� 9 � -Taw*, pZ,ww.(, , zsmey , I.e O..,JWpH+M.1 Z G a 100 9y Kd 1-4 -f-o w 0 a , II . JI I Soo_ol••So'W i 1 -OT 1 r a ULl7 A501J 8 �. t,l _ 121 PLOTPLAN ASBVILT V- SCALE 1•z4o' GRID 2s �Z, ProJsel Nk . 94-4.1 1�@It1Ea1@�1 ��1731 George BOQ Circle ��% • Anchorage, Alaska 99515 (9(7) 345-6476 olvUsreby� eFii(yJLa! R Aaaurvt tl.yr ¢ Aln,rti — L YC, he fullowinj; described ropccty: .az �o� _ �F A� It d1SlAtitG Recording Dietriet, Alesks• end that the In rovemenu situated theroon era within the property -,q�•: P P Y lines end Jo not eacroach onto the property : t { aJjaeeal Ikereto, shot oo buprovcments on the property lying adjacent thereto •n e10a06 •o the rurvcycd premises and shat there era 'Do roadway, tr•mt0iaioo �Kw a1,e : 4c •ri lines or other visible earetheuts on said property oxetpt all indicated bcrcon, L• " ndted lhls the1� Day of Mill ki is _, at Aecbor■a<. Aluk• �4 F:: �0• t • ks-szaz 'eat an thkdi•Hatoa ptar. �l i5 �11t lC3Q011kthlii'y not e` h 10 not spper to mie recorded ev ae the existence or say eese>,.euta. ,`\ \� _ 3. 03/14/2005 KON 10:48 (Tx/R: NO 54801 Q002 3-15-05; 9:56AM; CS ReLN Tient Name !rolect Name # :Ilent Sample ID latrix Imple Remarks: 1051270001 Gamess Engineering Group, Ltd. Loudermilk IA Loudermilk L4 Drinking water ;807 5615301 All Dates/rimes are Alaska Standard Time Printed Datelrlme 03/15/2005 8:31 Collected Date rime 03/09/2005 15:20 Received Datefrlme 03/09/2005 16:30 Tecbnical Director /fS�tepbe C. Ede Released 0 2/ 4 ammeter Results PQL Units Method Container ID Allowable Prep Analysis Limits Date Date Init 'atera Department Nitrate -N 0.550 0.100 mg/L EPA 300.0 H ("10) 03/09/05 CAM icrobiology Laboratory Total Coliform 0 cOVl00mL SM20 92228 A 03/09/05 DKC f V H Municipality of Anchorage Lo Development Services Department 1 Building Safety Division On -Site Water and Wastewater Program '• " 4700 South Bragaw Street 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. 01550148 HAA# A010 ESQ% Expiration Date: 1. GENERAL INFORMATION Complete legal description r Lot 4 Loudermilk SID Location (site address or directions) 10401 Loudermilk Circle, Anchorage, AK 99507 Current Property owner(s) James Curley Day phone 561-7287 Mailing address 10401 Loudermilk Circle, Anchorage, AK 99507 Lending agency Day phone Mailing address Real Estate Agent Dynamic Prop/Careen Muir Day phone 727-2289 Mailing Address 3111 C Street, Ste. 100, Anchorage, AK 99503 Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class 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) on properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. (Ra.11M) 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation based on procedures outlined in the Health Authority Approval Guidelines for this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. 1 further verify that based on the Information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is In compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Finn Pannone Ena. Svc. Phone 272-8218 Address P.O. Box 102954, Anch, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date /t–/S—o( Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system mrder 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. IAll 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. PFS can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above Any reliance upon or use of this report by any other person or party is not authorized nor will it confer any legal right whatsoever. 6. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for {z; 4024 •Steven R. Ponnone� No. E 8149 aEVSIRILILUS bedrooms, with the following stipulations: Additional Comments WATER AND : m PROGRAM - Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By:P � Original Certificate Date: / 1 – / el – O I � Expiration Date: Reissue Date: (Rao. 111M Municipality of Anchorage • Development Services Department Building Safety Division On -She Water and Wastewater Program 4700 South Bregaw Street P.O. Box 198050 Anchorage, AK 09519-8850 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 4 Loudermilk Sip Parcel I.D.:_015-6,01-1E A. WELL DATA Well type P If A, B, or C provide PWSID # _ Date completed 4122/1994 Sanitary seal Y Total depth JJ4_ft Cased to 128 ft FROM WELL LOG Date of lest 4/22/1994 Static water level 75 ft Well production 10 g.p.m WATER SAMPLE RESULTS: Coliform -4�—colonies/100 ml Nitrate JG 3 mg/I Well Log Y Wires property protected Y Casing height (above ground)�3 _in. AT INSPECTION 11/13/2001 75 ft Other bacteria __[_ colonies/100 ml Date of sample: 11/13/2001 Collected by: Laura Pannone B. SEPTICIHOLDING TANK DATA Tank Type/Material Steel -Anchorage Tank Date installed 9/2/1895 Tank size 1250 gal Number of Compartments I Cleanouts Y Foundation cleanout Y Depression over tank jy High water alarm N/A Date of pumping _1012912001 Pumper Anchorage Cesspool C. ABSORPTION FIELD DATA Date installed 9MIS95 Sal rating (g.p.d.lft2 or ft2/bdrm) 1,2 System type Wide Drain Length _0 ft Width J_ ft Gravel below pipe O ft Total depth 7 ft Effective absorption area J&ft? Monitoring tube Y Depression over field N Date of adequacy test 11/13/2001 Results (Pass/Fail) Pass For 4• bedrooms Fluid depth In absorption field before test Pmt in Water addedQ00 gal New depthQ In. Elapsed Time: Q min Final fluid depth jU in Absorption rate >=00+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) N If yes, give date (Rev. I IM) D. LIFT STATION Date installed Size in gallons 'Pump on' level at _ In'Pump off" level at Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 147' Absorption field on lot 164' Manhole/Access In High water alarm level at _ In Meets alarm & circuit requirements? _ On adjacent lots 1000+ On adjacentlots 100'+ Public sewer main 100'+ Public sewer manhole/cleanout 100'+ Sewer /septic service line 25+ Holding tank NIA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 6' Property line 16' Absorption field 17' Water main 100'+ Water service line 2V+ Surfacewater 100'+ Drainage 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 11' Building foundation 12' Water main 100'+ Water Service line 26'+ Surface water 100'+ Driveway, parkingWehicle storage Or Curtain drain 100'+ Wells on adjacent lots 100'+ F. COMMENTS jZV_�,ieKr�j4. LR G. ENGINEER'S CERTIFICATION I certify that 1 have determined through Held 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 Steven R. Pannone, P.E. Date 11kirm HAA Fee $moo VU Date of Payment (j�7 Go Receipt Number 1,75 S D 5— r7 (Rev. 11MG) Waiver Fee $ Date of Payment Receipt Number 4 w� ^Steven R. Fonncne�' !n'�. No. CE �1a9 .rte. Pannone Engineering Services, LLC Consulting Engineers (9071 272-8218 November 18, 2001 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 4 Loudermilk S/D Final Inspection Gentlemen: P.O. Box 102954 ge, Alaska, 99510 1071272-8218 Fax My firm conducted a Health Authority Investigation at the above referenced lot. During this investigation, we discovered that the driveway encroached over half of the existing drainfield. You conducted you own investigation and determined that a barrier needed to be constructed to prevent vehicles from parking over the drain field. The Owner installed railroad ties around the drain field to prevent parking over said field. The railroad ties are pinned to the driveway be means of a 5/8" rebar driven through the tie. The ties cannot easily be removed. I believe this installation meets the intent of the code requirement to prevent parking or driving over drain fields. I request the HAA be approved. If you have any questions or concerns, please contact me at 227-3522 or 272-8218. Sincerely, teven annone, P.E. Attachments: C:\Work\Letters\4 Loudermilk.001.doc M-10-ol CS:OVY FROHME [WIRCNtfNTIL SRV CT&! hnrlronmsntsl iervlCss IMC. • rr���raM�NrN�ra• 9075615301 1-e+• r.u'rua ' ""- Cy" R+LN 1017/37001 Cuntpoo Cort Name Pannone Ens, sty. PrlendDaWrlme 11/16/2001 8:49 Project %,Sgwo Lot 4 L mdemdlk Collected DawTime 11/13/2001 13:00 CIMntSem9M 1D O/S Hou Alb RwW"4 Date/Time 11/13/2001 13:10 Mah1rz DfWting Water Technical DWwwr 8lgiee C Lde o. 8y R+1++++d er FWSIDWBID o AI:ow" Prep Ass"Is parnn•sr Rest KL Ueia 14" Umiu Dew Dex Init Mat:�r� O�Oert �enL xittew-N Os61 0.l00 mall. ITA300.0 (<10) 11/13;01 sm Kera%4mJ,ery ?a%Orat= TowlColiform IOB. NoCON eoU100mL SMIS92228 (<l) 11113AI KAP OF MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES'! Division of Environmental Services ces ...... On -Sita 4S66tion 5 -' P.O.' Box 1966, O"AnchorageAlaska151 .3434744, CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.#­-n_%,,�z4nl�o,% rl HAA # - L,h) 1�71 I.Y.jGENERAL INFORMATION.:- Complete legal description ,"tr 'I .,r.. Location (site address or directions): agency:= gen, Address n erwo.4 �_.,NUIMIJB FS 3,.�-.TYIPE OF WATZ N ty -N a r 7 Ma agency:= gen, Address n erwo.4 �_.,NUIMIJB FS 3,.�-.TYIPE OF WATZ N ty -N a 4;4ei .... .. TExIf community well system, provide written confirms ;ing to the legality and status of sjiie T OF:WASTEWATER DISPOSAL* a' h y phone 7 _s..i 4;4ei .... .. TExIf community well system, provide written confirms ;ing to the legality and status of sjiie T OF:WASTEWATER DISPOSAL* a' h y phone 5. STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that 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. If urther verity that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water. 77 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. -r^ -• Name Firm ou as (e Phone C9diUfe 1073 ox •' 03 h waw F'c� �� (o S Address _Engineer's signature Date %P I� S A( - �1 • iy'�. ' • '��f 11 ; , ''<. - cE8176 FA 6 DHHS SIGNATURE l ^N Approved'for rt bedroom$ a , L �, ty °ar Conditional approval for bedrooms, with the following stipulations Z t , 14 1 1 7 t , l \Additional Comments _ , ,ef r, The Municipality. of Anchorage Department of Health and HumanServicas;(DHHS) issues Heakh Authority Approval Certificates based onlyFuponthe representations given inparagraph 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 to order to satisfy carte n federal and state requirements. Employees of DHHS do not conduct Inspections or'analyze`data before a,certificate Is Issued ,The Municipality of Anchorage Is notes _,.. _. _ responsible for errors or omissions In the professional engmeees work.`? .l l t •. 7?�Mw.1Nt) i,t, NOA X71 . f -F. r ' , dKP'.hi.......,.i�.PiiR,.,a1 b.e,._P.J(.-.a.:.r.�.a_.r..u%.+1.•r...+y-�.,=..eu u.w e. .sat. i.�+.•t. t 6-a.._., .. .....x ..a •. •_. -_.. .. .... Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist o Legal Description: Low Lo..OEc.N/L. A --,'Parcel I.D.: —t A. WELL, DATA rn o Well type Pa.✓erG Cn C If A, B, or C, attach ADEC l ner. ADEC water system number PPL cin Log present (YN) Y Date completed z99� Total depth Cased to Casing height (above ground) X Z Ff Sanitary seal (YN) Y Wires properly protected (YN) Y FROM WELL LOG AT INSPECI70N Date of test Static water level 7fFif Wetlproduction i4 g.p.m. g.p.m. WATER SAMPLE RESULTS Coliform Nitrate Other bacteria Collected by: IL SEPTIC/11OL DING TANK DATA Date inualled•%r`•� � Tank sire i47 —47'o -f-Wamber of Compartments z Cleanouts (YN) Y Foundation cleanout (YN Y Depression (YN) A) High water alarm (YN) Date of Pumping —14 Pumpet. 't/A C. ABSORPTION flXLDPATA Date installedSire- ��rSoil rating (g.p.d./ft' or ft'/bdrm) "'1 4 System t pe Length 8"ofi� Width J 74 Gravel thickness below pipe Total depth 1111�14 Eff Clive absogxion area 6,SO Ft s Monitoring Tube present(YN)Y Depression osw field (YN) A/ Date of adequacy test Results (Pass/Fail) For bed Fluid depth in absorption field before test (in.): �y r_ gal. water adel (in.): (ins.) Minutes later: Absorption rate = a.p.d. Peroxide treatment (past 12 months) (YN) If yes, give date ��'� D. LIFT STATION Date installed Site in gallons Manhole/Access (Y/N) "Pump on" lle%vi at' o ' level at" n" High water alarm level at' 'Ddt1mt C%viesiMfed E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 141-71 -1. -. On adjacent las /©O' Fi/ Absorption field on lot /X'l Fi _-.On adjacent lots /00 ',Z/. Public sewer main Sewer /septic service line / yo F1. Public sewer manhole/cleanout Nzv Lift station 414 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Ff • Property line /' Absorption field %F Water mai /service line ,i0 V// Surface water/drainage !t� Wells on adjacent Ica SEPARATION DISTANCE FROM ABSORP71ON FIELD ON LOT TO: Building foundation /.2 F/ . Water main/service line Surface water oil Driveway, parking/vehicle storage area Curtain drain /,,o Wells on adjacent lots /Oo'`F� Property line /lct<• F. ENGINEER'S CERTIFICATION I certify that 1 have determined thru field inspections and review of"unicipal recotdl'.��: jhti'ab s are in conformance with/POA IUA guidelines in effect on this date. i Signature gnare lw y $ ••�9,,/ Engineer's Name ISS u �• �gt Date %Cj' —li'r / / j- �/` DO CES175 .. �► ) HAAFee $%�00 16t) Date of Payment l bll,0/gs Receipt Number /07T . 3 Z j) Rev. 8/95 OSS: haa.wk.doc Waiver Fee S Date of Payment Receipt Number