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HomeMy WebLinkAboutLOMARU LT 2Lornaru Lot 2 #051-101-28 �,N� � 5-23-C MUNICIPALITY OF ANCHORAGE On-Site Water&Wastewater Program o t„enr 6 i r c l PO Box 196650 4700 Elmore Road �� 1 } I Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 e, ` �` http://www.muni.org/onsite ,..:- --j —I Iretitirir CHOI% 6 t. I)cithrtink 111 4'VOn-Site Wastewater Disposal System Permit Permit Number: OSP181105 Effective Date: 5/22/2018 Work Type: Septic Upgrade Expiration Date: 5/22/2019 Tax Code Number: 05110128000 Site Legal Address: LOMARU LT 2 G:1359 Site Mailing Address: 23112 MELANA CIR, Chugiak Owner: SECRETARY OF VETERANS AFFAIRS Lot Size in Sq Ft: 29969 Design Engineer: C & M Engineering Total Bedrooms: 4 This permit is for the construction of: E Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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 entire drainfield and the alternate drainfield are not within a 30 foot radius of a percolation test. Additional percolation tests are required prior to construction of the septic field to confirm the application rate. Locations are identified on the site plan. If the results require a design change, construction of the system shall stop pending On-site review and approval of a change order. Please submit stamped and signed results with the inspection report. /2 _ Received By: %...Z. ----C Date: .�2a/t/ j}Q,C Issued By: i .0 k cut.diDate: 5/c2 /18 ft { '� 1 UNiMPA LlTy IF ANCHO " AGE • 101111111111.1. Community Development Department "``'`'p" m Development Services Division :.,.._-+:.-_-/. Phone: 907-34 - On-Site Water & Wastewater Program • Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 05/ _ 10 1 -a% Property owner(s) PA-j/ D eliU 1 pp 9 Day phone Mailing address Site address o. 3 /17. rv( � iet ' Legal description (Sub'd., Block & Lot) LOc"4 Ai V L o r oZ Legal description (Township, Range & Section) Lot Size c21, qI'7 Sq. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: (®all that apply) TYPE OF DWELLING: Absorption Field ® Initial ❑ Single Family (SF) g' Septic Tank il Upgrade (w/wo ADU) Holding Tank ❑ Renewal ❑ 5 6 7 8 •4 (D) El 3Vu . - ► ellings ❑ Privy ❑ ti RUSH/ -'•►•r D) Private Well ❑ r 0 Water Storage ❑ lJ a MAY 21 2018 3 4. THIS APPLICATION INCLUDES A VARIANCE /WAIVER '�-•e,. Ter • ? 6 8 L9 Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable unicipai CA, ( '.nature of p7ppe"rty owner ocau orized n'71.' Permit/Rush Fees: 4 1 ) ,C`0 Waiver Fees: Date of Payment: ______,T1208 Date of Payment: Receipt Number: _M510_ Receipt Number: Permit No. _ pj,_ S Waiver No. Permit App_9-1-12.doc C&M ENGINEERING SERVICES Ph:907-854-5558 Municipality of Anchorage Onsite Water&Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 RE: Proposed Septic System replacement for Lomaru Lot 2 Dear Reviewer, The above referenced property is currently served by an older, failed 3 bedroom septic system. The owner would like to replace it with a new septic system. We are proposing to install a 1250 gallon tank, and a new drain field. The old tank will be decommissioned per moa requirements. The old system is in the utility easement and must be abandoned. Our review of available documentation and field investigation show that this project will not adversely impact any nearby Wells, Wastewater disposal systems, replacement disposal sites, or drainage flowing onto and off the subject property. This lot is served by a private community well. We have contacted the ADEC drinking water program regarding the Lomaru community well, and it has been determined that it is not a public well. The Lomaru homeowner's association keeps a headcount of those served by the well and have determined that it does not meet the threshold for a public water supply. Included with this letter is a permit application and design package, including plans, specifications, calculations, and soils logs. Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854- 5558 or by email cgbalzarini(a�gmail.com with any questions or concerns. Sincerely, harles Balzarini, PE .11\Ott\\\M\, AWI of ��'lll i • • TM „ *o/ LOMARU LOMARU COMMUNITY WELL \ ,,r LOT 6 FORMERLY CLASS "C" .. .. PER 2013 COSA. NOT A ARLES G BALZARIN!' PUBLIC WELL PER AVAILABLE 4 -p •••• • DOCUMENTATION AND HOA. LOMARU LOT 7 IG�J4E.1385k .. AIu / e �� ,l Fd PROFESS ION��.� 10' UTIL EASEMENT I ‘‘‘‘,\"`1 /0 1 ,s, 4 71 HOME DRIVEWAY MELANA CIRCLE 1 \ N. / LOMARU WATERLINE LOT 3 1 \ DECK • NEW FCO \ / LOMARU LOT 2 NEW 1250 GALLON 1 \ it SEPTIC TANK 10' MIN FROM HOUSE \ • _ I � DOUBLE CLEANOUTS ITOP OF STEEP SLOPE LOMARU LOT 1 \ DEMOLISH OLD TOE OF STEEP SLOPE TANK PER (E) POWELINE - MOA CODE A• f�LYG O — — ; P20- 1-4'57- -- — O • 60 i kc/ TiPN NEyy 5'x50' LEACHFEILD DTH-1 - =II=, 10' UTIL EASEMENT ® o WITH 4' EFFECTIVE ,� SEWER ROCK. MAX 5'x50' RESERVE. 4 '4Fid-; fA,� �}/ 6' EXCAVATION DEPTH SYSTEM. MAY REQ PETERS CREEK CAMPGROUND A, RELOCATION OF ABANDON OLD (NO WELL WAN 200') ,7 POWER ,.,A° DRAINFIELD IN �� PLACE h NOTES: LEGEND ADJACENT LOTS SERVED BY LOMARU o CLEANOUT 1. THE PROPOSED SEPTIC SYSTEM IS GREATER THAN: COMMUNITY WELL. 100' FROM ANY PRIVATE WELLS • MONITOR TUBE NO SEPTICS WITHIN 30' OF PROPOSED 200' FROM ANY PUBLIC WELLS ® NEW SYSTEM 100' FROM ANY SURFACE WATER TEST HOLE 50' FROM ANY STEEP SLOPES 0.5%\ SLOPE INDICATOR NO STEEP SLOPES OR CURTAIN DRAINS 10' TO ANY PROPERTY LINE OR FOUNDATION ON 50' DOWNHILL OF SYSTEM 5' TO ANY TEST HOLES SCALE: 1" = 30' LEGAL DESCRIPTION: LOMARU LOT 2 C&M ENGINEERING SERVICES OWNER: DAVID MURPHY DATE:5/20/18 REV:O DRAWN: CB REF: 907-854-5558 SITE PLAN C&M ENGINEERING SERVICES Ph: 907-854-5558 SPECIFICATIONS FOR ONSITE SEPTIC SYSTEM - MOA CERTIFIED INSTALLER LEGAL: Lomaru lot 2 April, 2018 A. GENERAL 1. The septic design is for a 4 bedroom, single family residence only. 2. The site plan and drawings shall be a part of this specification. 3. The Wastewater system shall be installed by a certified installer in accordance All materials and workmanship shall meet the Anchorage Department of Health and State Department of Environmental Conservation requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. The engineer shall perform percolation tests and groundwater monitoring prior to finalizing design. An additional Test hole and percolation test is required during construction. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage, Department of Environment of Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi-family wells. A licensed surveyor should locate all nearby lot lines, easements, exact 100' radius from the existing and neighboring on- site wells, and any nearby surface water. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. Any remaining open test hole excavations shall be filled and monitor tube removed, after construction of the Drainfield. 9. The contractor shall familiarize himself with the new code requirements for inspection notification and notify the engineer at least 24 hours prior to beginning work. 10.The contractor shall set the grades for the tank and leach field prior to commencing work to ensure gravity flow is acheived. B. SEPTIC TANK 1. Septic tank shall be a fiberglass or steel, 1250 gallon tank capacity of MOA approved construction. Installed to meet MOA requirements. 2. Install a foundation cleanout within 5' of the foundation. 3. Install 2 after tank cleanouts between the tank and drainfield. 4. A combination of soil and 4" minimum of insulation shall be placed over the tank, to prevent ponding and promote drainage. The insulation shall be rated for burial and meet moa requirements. C. DRAINFIELD 1. The Drainfield is to be located as shown on the site plan. Notify Engineer of any changed site conditions. 2. The total depth of the initial drainfield excavation is to be at maximum 6' deep Bottom of excavation shall be level +/- 1.5" max. If bedrock or inconsistent soils are encountered, notify the engineer immediately. 3. In the event of over-excavation, a moa filter sand shall be used to maintain the 6' separation distance from the bottom of each trench to the bottom of the test hole(s).The top of the sand layer shall be level, plus or minus 0.5", and raked, prior to placing sewer rock. Care shall be taken to not compact the sand. 4. A 48 inch effective layer of sewer rock is to be placed in the each trench. The 4" effluent piping is to be buried within the gravel layer with 2" of sewer rock cover over the piping. 5. The Distribution pipe shall be 4" perforated pvc pipe conforming to ASTM D3034. 6. The complete Drainfield gravel and piping is to be covered with a geotextile filter fabric. 7. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the drainfields. Mounded side slopes shall not to exceed 3:1. The minimum insulation thickness shall be 2". Insulation shall be moa approved and rated for burial. Te:47>01' 72141 = . 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200' to any public well. 9. The soils at this site may contain fines such as silt and clay. Rake sidewalls and bottom of trench to remove any smears from excavation. Design Summary: Excavation Depth: 6' Gravel Depth: 4' under distribution pipe, 2" over pipe. Drainfield Length: (1) 50' Drainfield Width: 5' Soil Rating: 1.2 gpd/sqft System Capacity: 4 Bedrooms • . CHARLES G BALZARINI;a I CEE g`��` +`,�i-P_ rE$$J=tom- C&M ENGINEERING SERVICES 907-854-5558 Septic Design Calculations Residence: Lomaru Lot 2 RESIDENCE/LOT INFO number of bedrooms 4 br Water usage/bedroom 150 gpd/br Water Usage 600 gpd DRAINFIELD system type: Conventional type: Shallow Trench Application Rate 1.2 gpd/sqft required absorption area 500 sqft trench width (W) 5 ft gravel depth (D) 4 ft below distribution pipe Shallow Trench Factor 0.5 Min Required Length: 50 ft (Shallow trench factor* Required absorption area/W) Total Excavation Depth: 6 ft Cover: 3 ft min Insulation: 2" blueboard Use Length: 50 ft Effluent Pipe: 4"ASTM 3034 Design Summary System type: Con ittpnal Tank: gal New Drainfield: 5'x50'x4' W'xL'xD' shallow trench Total absorption area: 500 sqft Calc By: CGB Date: 5/20/2018 Or • "/49T" , �, FSI i,v ..ES G 8P17AwY1 w ,• No .138 ,'c . -f • Municipality of Anchorage . (ENGINEER'S SEAL) • Development Services Department On-Site Water and Wastewater Section / ' •i' 4700 Elmore St. �; .f ' '� P.O.Box 196650 Anchorage,AK 99519-6650 0 0 www.muni.orq/onsite . ..�.. .... A (907)343 7904 - RL S G SAL:LAINI,',�s i/J+�•�,N��-J 854 .,...tiff Soils Log - Percolation Test y. No���� -- Performed For: DAV; i) / •I(f i2-4'H Y Date Performed: (4/3/1'b Legal Description: L—©044 hV (..-a 2— Township,Range,Section: Slope Site Plan Depth (Feet), d " /`- ' TOPSof-it-, 1- /V 01 & —c5 2-- - B n1 5G :i : OCKY SL} 5- ^ sd 59144F , 6- GT (/`' 7- _ ' 8 J �" WAS GROUND WATER 9- t,iENCOUNTERED? ,//O S 10- V` IF YES,AT WHAT DEPTH? /v O!�� 11- 1(}� Depth to Water After Monitoring? A/7A E 12- i i Date: 5/t (/1C 13 R0 11 14- Reading Date Gross Time Net Time Depth to Water Net Drop 15- ( t-f/L/lg 5.' 0s O 16- a 5, 15 to q- '`//.6 £'1//6 17- 5 : 16 d 00 18- 5' 6 is 4 - /54 . u- '%le 19- 5 5 ' d-7 0 0 0 20- b ` 777 c0 / - 1/16 u- 'w PERCOLATION RATE , ,1 (minutes/inch) PERC HOLE DIAMETER g z 1> TEST RUN BETWEEN i-f FT fAND S FT COMMENTS Y 6/ZG f GS 1 pi---k t(9 1 E i) Ft,/z :L I40(..I ZSe /D4 K244, P - -+JCe 6 ?e Ai (n/ CQ()G'' [( PERFORMED BY: C, (f1412t%ES iI fL ln`_,t'i-11 Cg4gcoS 4/L,-/11C` TIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 432/8e,/ IT \ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION j 825 L Street • Anchorage, Alaska 99501 Telephone 264-0720 \ ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME NEW ❑ UPGRADE MAILING ADDRESS s LEGAL DESCRIPTION ,,ll LOCATION NO. OF BEDROOMS 2 J U a[ DISTANCE TO: Well V I Absorp � rea S r Dwelling 15'5' PERMIT NO. g/ /UO7 Material i Q w Manufacturer n No, of compartmentsn Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth It O U 6 DISTANCE TO: Well Dwelling PERMIT NO. ==FQ- Manufacturer Material Liquid capacity in gallons 0 W = DISTANCE TO: Well I /S-0 Foundation I /Q t- Nearest lot line if PEHMIT NO. � W W No. of lines Length of each line r Total length of lin s_ s Trench width Distance between lines f — m . Clinches t- Top of the to finish grade I Material beneath Ile Total effective a s tion area a inches W Length W.dth Depth PERMIT NO. 61_ Wd Type of crib Crib diameter Crib depth Total effective absorption area y DISTANCE TO: Well Building foundation Nearest lot line J Class /gs it V /l Depth Driller Distance to lot line PERMIT NO. J DISTANCE TO: Building foundation Saver line Septic tank Absorption areas) OTHER PIPE MATERIALS �� C . SOIL TEST RATING wo INSTALLER REMARKS n APPROVED DATE LEGAL / ^ r�u 4 tnev.. 31781 // !"��Ctlrif71/1�1 OF nt-.Ir'HOF�:_t�lGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 025 'L' STREET, ANCHORAGE, AK,. 99501264-4720 Ot-J —� I TE SSEWEFz F�ERt•Y I -r- PERMIT '� g 81 PERMIT NO. r 011007 ) t) <" ^.APPLICANT W. E. WILLIAMS 573 E. DOWLING RD. 349-5076 LOCATION PETERS CREEK, C LEGAL LT. 2 LOMARU S/D LOT SIZE 29959 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS:'01� xvJ &) MAXIMUM NUMBER, OF BEDROOMS = 3 SOIL RATING (SQ FT/ER)= 109 h );L THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:��� cG 1/ C�EF}7'H= LEt-JGTH= ^ _, r3RF1'ti'EL. C>EF}TH= THE LENGTH DIMENSION IS THE LENGTH rIN 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 rIN 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?EL-vU I F<EC� SEPTIC TRt-Jt< _ I =E= 1Oc p GFiLLOtJS~ PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DUPING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE !-JELL WILL SERVE. --- TWO C ^ ] I NJ 7,F"FEE CT I OtJS FIRE RE:LlU I RE[? BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A [,JELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER, LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER. REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERM I T EXF} I REc L�ECEtlE3ER pis 1�:_vL 1 I CERTIFY THAT 1: I AM FAMILIAR, WITH THE REQUIREMENTS FOR ON -t -I TE SEWEF:S AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I 4JILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MOPE THAN 3 BEDROOMS. SIGNED APPLICANT W. E. WILLIAMS ISSUED BY --(;.W ------- ------DATE ?z�� V4. 0 n Municipality of Anchorage rN 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264.4111 GEORGE M. SULLIVAN. MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION December 31, 1980 W.E. Williams 573 East Dowling Road #2 Anchorage, Alaska 99502 Permit # 800111 Subject: Lot 2 Lomaru Subdivision A permit issued by this department for well and/or sewer system has expired as of this date. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please call this office at 264-4720. Sincerely, / AQ /7), A"�` Les N. Buchholz, R.S. Senior Environmental cialist LNB/ljw enc: Copy of Permit SWP/057 MUN I C= I F}RLL I TY OF= nNCHOF;ZRC F= DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE, At'. 99501 264-4720 ON -S I TE SEWER P EFZM I T PERMIT NO. < 800111 > APPLICANT W. E. WILLIAMS 573 E. DOWLING RD. B2 349-5076 'LOCATION PETERS CREEK LEGAL �«� ,- LOT SIZE 29969 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING CSO FTtBR>= 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: L?EPTH- S LENGTH= 25 GRRVEL F>EF}TH= 1S THE LENGTH DIMENSION IS THE LENGTH (IN 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 (IN 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). REWU I RME> SEPTIC TRNK S I ZE= 1000 GRILLOP4+ PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDE14CES THAT THE WELL WILL SERVE. --- TWO <2> I NSF:'ECT I ONS ARE RE:G►U I REE> --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SE14ER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER, REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER. INSTALLATION. F}ERM I T EXPIRES L]ECEFrIBER 31. I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED APPLICANT W. ISSUED BY 1'?O4 AND WELLS AS SET 1%.41 ENLARGEMENT IF THE �dWIYLIAMS , Q ' ne S 7rri Cc iccv-C C - - V4. 0 O & E EN NEERING.& DEVELG MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG 688-2280 Performed for: Tel. No. Mailing Address: -c ox'z'(c1 QAC-Ltv 7yS-77 Legal Description: -- L , z La MA QN 'a ",& Depth (faaQ Soil Charectadstics 0- 2- 3— 2 3 G O - 5'An107 ao,6 t0 e7W 4 e O S e e-' f x,�o�t>; /WBe_ 5— -7 /B 14z.047s. dkoey 6 C�vnl. 7 �8 9 10 11 12 13 14_ 15- 16 5-16 Ground Water Encountered: Yes Noy If yes, what depth Proposed Installation: Seepage Pit_ Drain Field Comments: L o'er z L oma2cl Sib �oR'W I EST Q� PLOT PLAN PERC.TEST Performed by: �'t u s L�c�s>�� Date: A tic- lGr / 979 1 1Vi Mcipality of Anchor age MEMORANDUM DATE: December 22, 1982 TO: Laura Crow FROM: Environmental Health Division SUBJECT: Request for Refund - Account # 2460 Please make arrangements for the following refund - it has been canceled and the inspections were not required for processing. Thank you. Account # 2460 Amount $ 25.00 Sewer and Water Other Receipt # 218851 Lot 2 Lomaru Subdivision Bill Wright Star Route 2 Box 4155 Chapel Chugiak, Alaska 99567 Laura J. Ward Senior Office Assistant Sewer and Water Program attachements cc: File IdCoo `S /{ 6 la 5 $ C. aPl�� 2vj�b������ sIa3�P3 6 91-010 15/781 z 1 ' 00,0ce OOS9I � 1 _ H �If`7 LL p s h O - n o• 3 --------- ;I^ mL W aD I S�ZT 3.50.0s Ask o d i-�-100 Ovl nl O Z N • 1 W I W 0 3 ' W N �OO P V IO co Z N N P � Z' ! > •I o N SZ SZ N O W cr oo v _ � IN ✓�1 LLJ 00911 Qt--+ •A Q m 3. S o 1 h � LLJ _ H �If`7 LL p s h O - n o• 3 --------- ;I^ mL W aD I S�ZT 3.50.0s Ask o d Go P W Z W R Q s O ,6�, vc 1 Z c u 0. M 0 1•- � 0 0 V o o _ oc N ro o > WI) r N O W cr oo v N O H C 0 O < •A Q m o o 1 h h � 0 Z � L N ma ^ N Go P W Z W R Q s a ,6�, 1 en M Q W > WI) r LU) O O < o o 1 h h � Z u, 1 m 1 . i ' N r ` 1 w C p m ; O o t E o m E s 3 0 3 � 1 W V H S_ m •v < 0 �o.�o 46, Municipality of Anchorage 1A'pQGC 84 • Development Services Department = . , <o Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING ge, TSS e� Parcel I.D. 051.101-28 COSA #A 2_1 R Expiration Date: — 1. GENERAL INFORMATION Complete legal description LOMARU LOT 2 Location (site address) 23112 Melana Circle Chugiak AK 99567 Current Property owner(s) Jennifer Zimmerman Day phone 771-9009 Mailing address 10401 Hampton Drive Anchorage AK 99507 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class C Well ® Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ArcTerra Consulting, Inc. Phone 868.3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 1 010112 01 2 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,`4v�r®®� V4 ArcTerra can not give any estimate of how long a OF q system will function satisfactory for current or future ��,��.•••'°'••`•'9S� 6� occupants or can ArcTerra guarantee that no unseen or irr ; • y � encroachments, deficiencies or discrepancies exist. g * Z4STH td• 5. DSD SIGNATURE Az Approved for 3 Disapproved. Conditional approval for Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory CE bedrooms. bedrooms, with the following stipulations: ON-SITE PROGRAM Arsenic Advisory W)4) Maintenance Agreements Supplemental Engineer's Report Other By: 6 � Original Certificate Date: (Rev. 11(05) Municipality of Anchorage a>6 • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: LOMARU LOT 2 Parcel ID: 051.101-28 A. WELL DATA Well type Community - Class C If A, B, or C provide PWSID # 213467 Well Log (YIN) Date completed _ Total depth ft. Date of test Static water level Well production Sanitary seal (YIN) Cased to ft. FROM WELL LOG WATER SAMPLE RESULTS: ft. 9 - p.m - Coliform NEG colonies/100mL Nitrate 3.48 mg/L Wires properly protected (YIN) Casing height (above ground) in. AT INSPECTION ft. a= Arsenic: ND mg/I Date of sample: 4/23/12 & 9/26112 Collected by:ArcTerra B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 101611981 Tank size 1000 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YIN) N Date of pumping 4/25112 Pumper JRs C. ABSORPTION FIELD DATA Date installed 101611981 Soil rating (g.p.d./ftZ or ftz/bdrm) 100 System type Trencq Length 45 ft. Width 5 ft. Gravel below pipe 2 ft. Total depth 4.2 ft. (measured / assumed 11/30/10) Eff. absorption area 300 ftZ Monitoring tube Y Depression over field N Date of adequacy test 11130110 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test *7.25 in. Water added 580 gal. New depth *24 in. Elapsed Time: 1380 min. Final fluid depth *7.25 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) Nlf yes, give date D. LIFT STATION Date installed_ Size in gallons Manhole/Access (Y/N)_ "Pump on" level at in. "Pump off' level at in. High water alarm level at _in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic service line Animal containment areas On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 101+ Surface water 100'+ Wells on adjacent lots 150'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 43' Building foundation 10'+ Water main 10'+ Water Service line 101+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+ (none known) Wells on adjacent lots 150'+ F. COMMENTS *Monitodnq tube extends approximately 1675" below lateral Measurements based on a total effective death of 2'—assuming fluid levels of 7.25" at the bottom of existing monitoring tube depth G. ENGINEER'S CERTIFICATION t certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name KENNETH M. DUFFUS Date 4130112 COSA Fee $490.00 Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number (Rev. 11105) OF Al- Kenneth ` Kenneth M. 0 CE 7116 ballv0 Municipality of Anchorage p Development Services Department a"G6 • � u <e Building Safety Division �. x On -Site Water and Wastewater Program 4700 Elmore Street s n "` P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 051-101-28 COSA# fa 1. ga, Expiration Date: -5-- 1 1. GENERAL INFORMATION Complete legal description LOMARU LOT 2 Location (site address) 23112 Melana Circle Chugiak AK 99567 Current Property owner(s) Jennifer Zimmerman Day phone 771-9009 Mailing address Lending agency Mailing address Real Estate Aaent Mailing Address - 10401 Hampton Drive Anchorage AK 99507 Unless otherwise requested, COSA will be held by DSD for pickup. Day phone Day 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding Tank Community Class C Well ® Community On-site 11 Public Water System ❑ Public Sewer El The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. t 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 868-3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M DUFFUS Date 04/30/2012 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 tare systeir- Tice 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, ®y ArcTerra can not give any estimate of how Ion a 4 ��® A4 system will function satisfactory for current or long e®�C1�o•�'�°c�°S','i occupants or can ArcTerra guarantee that no unseen �, s, •• i encroachments, deficiencies or discrepancies exist. vr ; e aTti �'t $/ 5. DSD SIGNATURE Approved for Disapproved. Conditional approval for Attachments COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory bedrooms. bedrooms, with the following stipulations: Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other ON-SITE / ._ _ 2 BY: ,f �� f� � Original Certificate Date: (Rw. 11105) % Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: LOMARU LOT 2 Parcel ID: 05 1 - 10 1 -28 A. WELL DATA Well type Community — Class C If A, B, or C provide PWSID# 213467 Well Log (Y/N) Date completed _ Sanitary seal (YIN) _ Wires properly protected (Y/N) Total depth ft. Date of test Static water level Well production Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION WATER SAMPLE RESULTS: ft. 9— p.m- Coliform NEG colonies/100mL Nitrate 3.72 mg/L ft. 9— p.m- Arsenic: ND mgA Date of sample: 4/23/12 Collected by:ArcTerra B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 10/6/1981 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (YIN) N Date of pumping 4/25/12 Pumper JRs C. ABSORPTION FIELD DATA Date installed 10/6/1981 Soil rating (g.p.d./ftz orft /bdrm) 100 Systemtype Trenca Length 45 ft. Width 5ft. Gravel below pipe 2 ft. Total depth 4.2 ft. (measured/ assumed 11130110) Eff. absorption area 300 ftp Monitoring tube Y Date of adequacy test 11 /30/10 Depression over field N Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test *7.25 in. Water added 580 gal. New depth *24 in. Elapsed Time: 1380 min. Final fluid depth *7.25 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 E. SEPARATION DISTANCES Size in gallons Manhole/Access (Y/N) "Pump off level at in. High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Animal containment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 1001+ Wells on adjacent lots 150'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 4.3' Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+ (none known) Wells on adjacent lots 11501+ F. COMMENTS *Monitoring tube extends approximate 16.75" below lateral Measurements based on a total effective depth of 2'—assuming fluid levels of 7.25" at the bottom of existing monitoring tube G. ENGINEER'S CERTIFICATION / certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name KENNETH M. DUFFUS Date 4/30/12 COSA Fee $490.00 Waiver Fee $ _ Date of Payment -5/2.0;Z Date of Payment Receipt Number G `tJ1bReceipt Number (Rev. 11 /05) ADDRESS: 23112 Melana Cir LEGAL: Lot 2, Lomaru Address Chu iak AK 99567 Pending Sales Price: 439,400 Randall, Hayes & Henderson EMO Date: 05/03/2011 List Price: 459,900/439400 903 W. Northern Lights Blvd. #210 pending Financing: VA Days on Market 188 Anchorage, AK 99503 Contact:Premier Mtg Ph.#: 907-646-8768 (ph) 907-561-5534 (fax) 907-561-5077 Date of Sale/Time �SC Seller: Zimmerman, Jennil Buyer: Any Qualified Votera Appraiser: Wayne Henderson SRA AK-. File #: 110771 Concessions ($J: 0 ®1988 2007 MADS -Alaska Market Date Systems, Inc Site � �w f231tl12 AREA Melinda Cir Design (Style' g ay: Chugiak Address Chu iak AK 99567 Proximity to Sub'ect Carpet: Sales Price 439,400 Price Gross Living.Area $ 249.80 FIT Data and/or Verification Source Inspection VALUE ADJUSTMENTS DESCRIPTION Sales or Financing Concessions Date of Sale/Time �SC Location N Res Leasehold Fee Simple Fee Simple Site 29969 sf View N;Res-Mtn Design (Style' Multi-level Quality of Construction Q3 Actual Age 7 Condition C3 - Above Grade Room Count Gross Living Area Total Bdrms Baths 5 L l 17595, Ft. Basement & Finished Rooms Below Grade 900sf900sftn Irr2br].0ba0o Functional Utility Avg Heatin Coolin Gfa/None Energy Efficient Items Gara e Car ort Av G -2 -Bi + Sho Porch Patio Deck L CeL Dk kitchen Equip. & fire lace: rvd mF Interior Extras-SsVcJz2Vn FIrCt Compactor Retrigged []Ice[ Transaction History ( 3 year ) None ❑ Prior Sale Date Prior Sale Price Source MLS/Owmerrrax Records Effective Date 09/302011 Zip Code: 996 / Tax#: 051-101-28-000 Grid#: NW 1359 MLS District: 100 MLS Reference #: SITE Zoning: R7 ❑ Waterfront ❑ Bluff M View Details: Mountain Utilities Pubus communhv Water ❑ ❑ ®Well ❑Water Tank Sewer ❑ ❑ ® Septic❑ Hold Tank G&E ® ❑ SFPJPUD DWELLING Year Built: 2004 Remodeled: sfr-PUD❑Dues:$ 0 per❑YearMMonth Tenant Orient $ +Util: Sttl. Detached SFR I❑ Detached Paco ❑ Attached ZLL ❑ Townhouse PUD ❑ MH/Mod❑ Other: ❑ Ranch ❑ Raised ❑ Hillside ❑Basement ❑ Split Entry ❑ 2 Story ❑ Reversed ❑ Td -Level Multi -Level ❑ 1,5 / chalet Other CAR STORAGE ❑ None Oriveway: 2 # of Cars ❑ Paved ❑ Gravel Other: Garage: 2 # of Cars 819 sf Carport: 0 # of Cars sf ❑Atlatched ❑ Detached MOn ®coo ❑ Unfinished ❑ Unhealed IZ Interior Access Shop: of Other: :F -2 Q6m EXTERIOR Siding Flom Back&Sjde Till Aluminum Vinyl Cedar Hardiplank Log OSB Comp Roofing Blt.up El metal Cedar Shk Arch Shingle Gutters/ Downspouts 01her. Open Entry Covered ❑Arctic 210 s1 at Other: NCOpen Deck overed ❑ Trex 425 sf at Other HOpen Patio Covered at of Other: Other Exterior Features al In value) Tub El So a ❑w/Gas Wood Fence CILa Small Average Extensive Other: Average Landscape Custom ❑ Extensive Irrigation System Terraced Walls Lender Contact: Main File N0.63-63-6-0346914 P e #2 II Carpet: KITCHEN MECHANICAL Walls R -V -D -G RI Generator 81 Columns Oven �SC ❑Cnvcin Trim RI Vacuum BI El Doors Range Cook Top Accents RI Intercom BI Glass X Counters wave ( MicroBq Lights RI Security BI Other: Vent Fan Rl Surround Sound Bl Hot Water Dispenser RI Entertain Center Bl Garbage Disposal Laundry: Dishwasher ❑Bink ❑Chute ❑Cabs Compactor Retrigged []Ice[ FlrAel�gent 1 Fire Suppression Lighting System Bar Island It Network: Pan" Nook — Kitchen Upgrades— Other: Comm. Grade Appliances HWBB HVAC High Efficiency Appliances GFA App: EBB �Al Humidifier Grille: HRV Elea Filter Cabs: Radiant lo -Floor Fars: Fuel: Gas Cuts. ENERGY Floor: Star Rating: Other: INTERIOR Total #: 1 Fireplaces) Wood Burning Gas Only Free Standing Wood Stove Custom _ # Sides Other] liehter Scissor T- Ceiling Vaultedn Open Beam T&G ❑ 9' or 19' Open IJ Coffered RaisedLiviIng Area Sunken ::I Conversation MIL (w/ Kitchenette) Balcony Bay Windows: Clerestory Windows Solarium ❑Storage Other: Shelves Belli Book Case Desk B Cabinets Planter Safe Sewlog/Craft Center y Bar Plumbing Phone Contract (Sale) Price at Settlement . ... . $ Windows: nsul: Walls: _ Paddle Fal Other. BATH Hot Tub M Sauna Jet Tub Lg. M Sm. Steam Shower Multiple Lays: 1 Extra Shower Stall -- Bath Upgrades .... all Head ❑Multi -Spray Cabs: Fars: Cors: Floor: Walk-in Closet Bedroom Closet Organizers hall CUSTOM Carpet: Floors: CT/Lam Walls T&G Panel Wallpaper Columns -Cabinets Moulding Trim Railing El Doors Staircase Hardware Accents Glass X Counters Lights Fixtures Other: Contract (EM) Date (last rev. to price or terms) .... .. . Settlement (Closing) Date ........................... Investor: ❑ AHFC ❑ FNMA ❑ FHLMC ❑ Other: Federal: IF] FHA ❑ FMHA [_]VA ❑ Come. Lender/PMI Participation: -]Yes ❑ No InthRate % Loan Tenn: yrs. Sold Out of Foreclosure: Dyes ❑No LVA % Comments: Agents: Listing Selling: Seller Paid Concessions ($): Gy2ys �� 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.ek.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. osi- .n.- 2Y HAA# blkD Expiration Date: — 1. GENERAL INFORMATION: Complete legal description Location (site address or directions) A m ll &P .•�F -. �-� %� Current Property owner(s) . < 1 ,=r4y Day phone mr- 9-e-nd Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. Day phone Day phone 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site 0 Individual Water Storage ❑ Individual Holding tank •❑ Community Class _e:7 Well M 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 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 Eagle River Engineering SerVIMs Address go*Rk AK 99577 Engineer's Printed Name edZ 5. DSD SIGNATURE �/. Approved for bedrooms. Disapproved. Phone 6 ft1-5/S 5— Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Well Flow Advisory Supplemental Engineer's Report Other By. ��/— Original Certificate Date: 4-2,0 `0,5� (Ror. 01102) Municipality of Anchorage ! ° Development Services Department ,�r �•. Building Safety Division , , , , On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 i HEALTH AUTHORITY APPROVAL CHECKLIST r Legal Description: 2. A -e Parcel ID: psi- A. WELL DATA Well type g a.«se G If A, B, or C provide PWSID # _ Well Log (YIN) Date completed _ Sanitary seal (YIN) _ Wires properly protected Total depth ft. Cased to ft. Casing height ve ground) in. FROM WELL LOG T ECTION le Date of test Static water level iN� ft Well production ve g P.M..g.p.m. WATER SAMPLE RESU . Coliformcolonies/100 ml. Nitrate 7-.14_mg.11. Other bacteria 0_colonies/100 ml. mg./I. Dale of sample: y rl os Collected by: C !f K �•� �� I B. SEPTICdSOi'.=6 TANK DATA Tank Type/MaterialDate installed mid �! Tank size zea2 gal. Number of Compartments 7-.. CleanoutsdQN) _,kl� Foundation cleanout&I)N) V._ Depression over tank (Y.M va High water alarm (Y4�1 ec / Date of pumping _6 i , i✓ ' Pumper —7 -,Ir' -% p�•YQ�'� C. ABSORPTION FIELD DATA Date installedf�L Soil rating (g.p.d./ft2 or/bdr iiw System type 2� Length yr ft. Width ft. Gravel below pipe �_ ft. Total depthy 4& ft. Elf. absorption area 30o ft' Monitoring tube _X,&Z Depression over field _,L Date of adequacy testice/ /d_^ Results(EiiWail) aia For 3 bedrooms Fluid depth in absorption field before test _jj5fin. Water added/aTagal. New depths in. dC.✓nlWro ✓I/JVD ��� TL>/IO tiY VS O �G Elapsed Time: /V min. Final fluid depth � in. Absorption rate >= ySo 9-p. d. Any rejuvenation treatment (past 12 mo.) (WO type) 144u4.0 If yes, give date ':�,1,4_ D. LIFT STATION Date installed "Pump on" level at —in. E. SEPARATION DISTANCES Size in gallons 'PumD off" Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Manhole/Access (Y/N) water alarm level at Meets alarm & circuit requirements? Septic tank/lift station on lot On adi V -10K Absorption field on lot �On adjacent lots Public sewer main tip otJ Public sewer manhole/cleanout Sewerervice line Holding tank SEPARATION DISTANCES FROM SEPTIC/I186BAN6 TANK ON LOT TO: Building foundation cs Property line *tit) l Absorption field 13' Water main !e "_!; Water service line Surface water Wells on adjacent lots 1 JQ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: i r Property line *l13 � , Building foundation + 10 Water main 71 .1d � Sti7 '�Dr�Mf=n1r"S o I Water Service line mesio – Surface water Lida • Driveway, parking/vehicle storage +10 Curtain drain _rti-en' Wells on adjacent lots 1S W. Ns,✓e .wui.stt� F. COMMENTS OfUAJAfL T,vsPaTi�� �r bca�. NPROV-10 M" f5 G. ENGINEER'S CERTIFICATION 1 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 GNRJS?DP#M Q. k1ar4 Date 3114&C HAA Fee $ 7` -3 O — Waiver Fee S Date of Payment 3 – 2 4 –0 _r Receipt Number G S :2– �_,Z (Rev. 12/01) Date of Payment Receipt Number in. ASBUILT SEWARD h ASSOCIATES LAND SURVEYING 694-082 1 HEREBY CERTIFY -THAT I HAVE SURVEYED THE SCALE= FOLLOWING DESCRIBED PROPERTY: ���� OF Atq % Lo��yPl1 rUA L�'� DATE:. AND THAT NO FNCROAG�HMENTS EXIST EXCEPT ASV INDICATED. IT IS THE RESPONSIBILITY OF THE :'e} . M '' i'.• OWNER TO DETERMINE THE EXISTENCE OF ANY GRIDS •••• EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED lfSUBDI �•.• VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' Du•n• Merk S•w•rd q •, LS -6918` ANY DATA HEREON BE USED FOR CONSTRUCTION �r .,.........c� OFFENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. DRAWN �� 4-20-05:12:12PM; :807 6016301 0 2/ 4 SGS RAN 1051885001 CuentN■me Eagle River Engineering Project Name/# Lomam Lot 2 Client Sample D) Loment Lot 2 Matrix Drinking Water All Datet?imes are Alaska Standard Time Printed Date/Plme 04/19/2005 16:20 Collected Date/time 04/1112005 13:30 Received Date/time 04/12/2005 14:43 Teelmk:al Director Stephen C. Ede Sample Remarks: EP300 - Sample rerun outside of bold to confirm original concentration. Concentration confirms. Allowable Prep Aaalys4 Parameter Results PQL Units Method Contain" ID Limits Date Dato init Waters Department Nitratc-N 284 0.100 Hicrobiologv Laboratory mgt EPA 300.0 D (c.10) 04/12/05 CAM Total Coliform 0 rol/IOOmL SM209222B A (o-1) 04/12/0S TLF JR5 Pumping PO Bax 773415 Eagle River, AK 99577 (907) 694-6454, Eagle River Engineering 10421 VFW Rd Ste 201 Eagle River. AK 09577 (907) SW -5105 Job Sat Intorrrtatlon Chnt 23112 Melons Gene Chuglak,AK 99W (907)1194.5100 asrvloe Type Extra Ttme 1.5hr total pump time Contractor Job Additional Location Comments: Tank over hill In boas Service Agreement Number: 015260 Order Dste: 11 -Nov -2004 Service Date: 15 -Nov -2004 12:00 am Technician: Dew Job Description: 10000 P.O. Number. Tam%: Net 30 Salesrep: NOmta Job Type Recall Map Book: Map Grid: 25 --I Cross Street$: Chapel Drive — 1 Job Comments: Atleaat 10yn since lest seMcs flecked and pumped tank -2 lot of adids. 1.3hrs total lime to pump. Tdd owner of extra thsrges. has no problems. Tax Percent: I I 0 City Price Each x 2 Men Tax Extension Actual 1 550.00 No No $60.00 1 $100.00 No No 5100.00 Dlelpam: Gallons Planned: 1000 ..-- — —^•^-- 1 Gallons Actual: ^� Hose Length: 4 i •do Double Tank:l--,�� Pump System: FA MLL \\\\ I Battles Inlet: Saftles outlet: I 1 • ._a,a• _l Actual Charges: Customer agrees to the terms and conditions printad on the back. THIS IS A BINDING AGREEMENT. Signature and Title of Customer Representative Data Aooepled by JR% Purnong Data Accepted For your added convenience we accept American Express! DlcoveryMxa and Master Card payments over the phone. After 30 Days 1.5% Will be charyed or THERE WILL BE A DELIVERY $23.00 For NSF Checks Returned NonTexablt Teal Taxable Total Tax Total Grand Total Estimated Charyes: $150.00 50.00 $0.00 $150.00 Actual Charges: Customer agrees to the terms and conditions printad on the back. THIS IS A BINDING AGREEMENT. Signature and Title of Customer Representative Data Aooepled by JR% Purnong Data Accepted For your added convenience we accept American Express! DlcoveryMxa and Master Card payments over the phone. After 30 Days 1.5% Will be charyed or THERE WILL BE A DELIVERY $23.00 For NSF Checks Returned f .il 5. LEGAL DESCRIPTION P e Onrc E EIV D INSPECTION APPOINTMENTS STREET LOCATION TIME1—" -A cL V A f� Y TIME S c� s.rt� d TIME a� .. `,� �a If, DATE ^ l sLu 7. WATER SUPPLY ❑ INDIVIDUAL' ,' y ` fV DATE DA E //� Q tS depth (attach log if available.) � l INSPECT j INDIVIDUAL/ON-SITE" INSPECTO INSPECTOR. ' in'LO-si ( VSq- MUNICrIP�ALITY, CF � C'F!ORAG: MUNICIPALITY OF ANCHORAGE I ,: DEPARTMENT OF HEALTH d ENVIRONMENTAL PROTFTW1,, NP. O: L K., "� ^"':.lENT.:L 7:.JT=CT:ON \ 825 L Street • Anchorage, Alaska 98501 • 1 ENVIRONMENTAL SANITATION DIVISION NPIV 3 1931 Telephone 264.4720 R � (� Aly �% F j� REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SWER F74CfLri(ES DIRECTIONS: Complete all pans on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER G . �/ PHONE - o MAILING ADDRESS .qo 6 MC63t6tS3` z PROPERTY RESIDENT (If different from above) HONE 2. BUYER PHONE MAILING ADD SS 3. LENDING INSTITUTION PHONE Al r nc- 3,4 'SHEMORTtl MAILING DDRESS 6m '�_ Aw 4. REALTORRIAGENT Xf PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION P e aT a 5'0 1 S/ AJ - STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ❑ One ❑ Four ❑ Other SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY ❑ INDIVIDUAL' ,' y ` fV -ATTACH WELL LOG. A well log is required for all wells drilled COMMUNITY `— O t) since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY h depth (attach log if available.) B. SEWAGE DISPOSAL SYSTEM - - luCU61Z 0 S C-! j INDIVIDUAL/ON-SITE" �/p �O-YEAR ON-SITE SYSTEM WAS INSTALLED. /�� O PUBLICUTILITY in'LO-si ( VSq- NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) /417-7 72010 (Rev. 6/70 THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE O SINGLE FAMILY O MULTIPLE FAMILY NUMBER OF BEDROOMS O ONE ❑ TWO O THREE O FIVE ❑ OTHER O FOUR O SIX 2. WATER SUPPLY O INDIVIDUAL O COMMUNITY O PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON SITE OPUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED /v g INSTALLER SOILS RATING ❑Septic Tank or ❑ Holding Tank Size: /( 00 If Tank is homemade give dimensions: TYPE OF TANK MANUFACTURER / TOTAL ABSORPTION AREA MATERIAL _ 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS O APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) []DISAPPROVED DATE BY 72010 (Rev. 6/70 Time APPLI('-*,NT FILLS OUT UPPER HA!" ONLY Property Owner '� 'E W f \ G\ H T Phone Mailing Address S(L.2 PSoY. 4%567 GNAPEt-- ly 6000AK- AY -ZIP Code I -Z, Date Date ^ Inspector Buyer Address N /4 ,. Zip Code Lending Institution %%L AS.KA STATE SANK Phone Address 3IO C. M•d.Ttlfao L14 S 13L.Vb.NCH K Zip Code y (o Really Co. d Agent �1 Phone Address 14 Zip Code Legal Description Lo7 Z ) %oyv+Aau-5v6owlsron4 Street Location 14155 C 144 PrL Pr rvi7 BY: Soils Rating Date Sewer installed Type of Residence 1 Well Log Received Septic Tank SIZe X Single Family Well to Tank O Multiple Family No. of Bedroorns— ❑ Other Water Supply O Individual ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. Community For wells trilled prior to that date, give well depth (attach log If available). ❑ Public Utility Sewer Disposal Individual Year Individual Installed: Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date ^ Inspector Inspector Inspector Inspector RAGE MU 'ICIPALtTYX Field Notes: RECEiv,�� ( ) APPROVED BEDROOM$ 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE BY: Soils Rating Date Sewer installed Well To Absorption Area Well Log Received Septic Tank SIZe Well to Tank ?2W3 OM