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HomeMy WebLinkAboutT13N R3W SEC 33 LT 46 E133'T13N R3W SEC 33 Lot 46 E133' #008 - 071 - 1-8 Municipality of Anchorage ' Development Services Department Building Safety Division Onsite Water 8 Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 ww 7ge.ak.us (90) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING/nI n Parcel I.D. 008-071-18 COSA# 1. GENERAL INFORMATION Expiration Date: — /7— Complete 7— Complete legal description T13N R3W SEC 33 LOT 46 E133' Location (site address) 2420 E 48TH AVENUE *ANCHORAGE AK Current Property owner(s) STORMY & MARY HAUGHT Day phone 940-2884 Mailing address 2420 E 48TH AVENUE *ANCHORAGE AK Lending agency Day phone Mailing address Real Estate Agent CASSANDRA RAUN W/ COLDWELL BANKER Day phone 223-1463 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 Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer O 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 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 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. 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineers 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 & Regulations. The reported results described the performance of the system unde- the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Phone 337-6179 Date " 7 bedrooms, with the following stipulations: Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Nitrate Advisory Other By: c (Rev. 11N5) OF � ............... A.ss CE -79 3 \� profession o0 ON-SITE WATER AND WASTEWATER PROGRAM V Original Certificate Date: 9-/-7-1_2_ Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: T13N, R3W, SEC 33, LOT 46 E133 Parcel ID: 008-071-18 A. WELL DATA *PER GEG INSPECTION **PER SURROUNDING WELL LOG Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (YIN) Date completed UNKNOWN Sanitary seal (Y/N) YES Wires properly protected (YIN) Total depth *57 ft. Cased to **40+ ft. Casing height (above ground) FROM WELL LOG Date of test NO WELL LOG Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Arsenic: 11.3 ug./L. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size gal. Number of Compartments Foundation cleanout (Y/N) _ Depressio Nitrate NO mg./L. Date of sample: 7/24/12 Date of C. ABSORPTION FIELD DATA Pumper AT INSPECTION 7/24/12 51 ft, 4.1 —g -p.m. Collected by: GEG. Ltd. PUBLIC SEWER Date installed High water alarm (Y/N) Date installed Soil rating (g.p.d./ft2or ft2/bdrm)_ Length ft. Width ft. Total depth ft. Eff. absorption area_ ft2 Monitoring tube Date of adequacy test Results (P System type _ Gravel below Fluid depth in absorption field before to _ in. Water added _gal. Elapsed Time: Final fluid depth _ in. Absorption rate >= treatment (past 12 mo.) (Y/N & type) — 24+ in. ion over field For bedrooms New depth _in. If yes, give date ... D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off"level ami . High water alar level Cycles tested Meets alar & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankflift station on lot N/A On adjacent lots N/A Adsorption field on lot N/A On adjacent lots N/A Public sewer main *50' Sewer /septic service line *10, Public sewer manhole/cleanout • 100' Holding tank Animal containment areas 50'+ Manurelanimal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main Wells on adjacent lots Property line Absorption Water service line Surface SEPARATION DISTANCE FROM ABSORPTION Properly line Water service Surface water Wells on adjacent lots F. COMMENTS *SEE ATTACHED WAIVER REQUESTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSH guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date COSA Fee $ Q d Date of Payment j 31 ja Receipt Number iQ3,; t (y 67 (Rev. 11105) TO: Water Driveway, parking/vehicle storage Waiver Fee $ `� 16,!Yn , w Date of Payment B���la_ Receipt Number C)S �aia3 Municipality of Anchorage o Community Development Department Development Services 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 Arsenic Advisory Certificate of On -Site Systems Approval # 121330 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 46 E133' of T13N R3W Sec. 33 Subdivision. This inspection revealed an arsenic concentration of 11.3 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.or /og nsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage Alaska 99519-6650 a (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program gieue Y' epartment **** VARIANCEAVAIVER REVIEW **** Waiver#: OSP121233 COSA#:OSC121330 Permit#: PID#: 008471-18 Legal Description: T13N R3W Sec33 Lot 46 E133 Engineer: Garness Engineering Group Applicant: Stormy & Mary Haught Your request for a waiver of the required 75 feet horizontal separation from the public sewer trunk to the private well has been approved. The approved separation distance is 50.0 feet. Your request for a waiver of the required 25 feet horizontal separation from the sewer service line to the private well has been approved. The approved separation distance is 10.0 feet. This waiver approval applies to the existing public sewer trunk only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. ........................................................ a . . . . . . . . . . . . . . . . . . . . . . Waiver is Granted: X Waiver is not Granted: Date: e l6 Approved by: AL Name of Reviewer ............................................................................... Rec#: 0465OG Amount: $1,050.00 Date Paid: 8/3/2012 **** VARIANCEIWAIVER REVIEW **** July 30, 2012 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Waiver Request for Well to Public Sewer Main & Private Sewer Line (T13N, R3W, Sec 33, Lot 46, E 133) The existing 3 bedroom house is served by a private well and public sewer. We request you grant a 50 foot separation distance waiver from the well on the referenced property to the public sewer main located on E 48`h Avenue and an additional 10 foot separation distance waiver from the private well to the private sewer line. The following items are justification for the waiver: • The encroachments have existed for over 29 years. • Recent water sample results indicated nitrate levels were non detectable, and no coliform bacteria. Based upon this water quality data, it appears the encroachments, which have existed for over 29 years, have had no significant adverse impacts on the groundwater quality. Based upon the aforementioned facts, it appears that there is minimal risk associated with the granting of the 50 foot and 10 foot separation distance waivers. If you have anA questions, please contact us at 337-6179. Thank you for your assistance. P.E., M.S. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: garnessengineering.com E. 48TH AVENUE/ ASSUMED SEWER SERVICE LINE LOCATION EXISTING HOUSE F 100' WELL GARNESS ENGINEERING GROUP, Ltd.. CONSULTANTS &GENERAL CONTRACTORS,:...._. 1701 E. WWR SURE 101 - MCHOWM 99507 - PHONE (907)337-6179 - FAX (907)336-3216 - WEBSITE: PREPARED FOR: PHONE1 PAGE NUMBER: STORMY & MARY HAUGHT 940-2884 0-28 1 OF 1 LEGAL DESCRIPTION: DRAWN BY: T13N, R3W, SEC 33, LOT 46 E133 PNB TYPE OF WORK: DATE: WAIVER REQUEST 7/31/12 I- W Lij - c n ry LL, L'i J" = MH llbl�"r*n'es—s.- : ... CE -753 k Prof e (/ gC MUNICIPALITY OF ANCHORAGE q ,7 �) WATER CONNECTION —Location Record ACCT. No./—' NQQA��M�E L(3T BLOCK ADDITION /✓/ SIZE CONN. DATE MADE %O-�3 NEW CONN. REPLACEMENT CONN. i nneTtnnv nt i Fv f -I sTRFFT C34 TYPF OF MAIN )SHOW SKETCH ON REVERSE SIDE CORP STOP FL/-.L�� PERMIT NO. r CURB STOP C TO C KEARNY WIRE CONNECTOR W. CURB STOP CTOI OTHER: CONN. CORP CONNECTOR INSP. COUPLING C TO I , PERMIT X BRASS BUSHING TOTAL X GALVANIZED BUSHING COMMENTS: BROKEN MAIN, EXT. CONNECTION, EXTRA PIPE 2 PART UNION CASING, DELAYS, ETC. FT. 3 PART UNION PI LA SERVICE CLAMP X ❑ PAID PREV. Q� COPPER PIPE ❑ W.M.# 1 1/4" KEY BOX ❑ PAID CASH 2" KEY BOX ❑ SUB AGREEMENT THAW WIRE DISCONNECTS ALT. # LOCATION it Lr' OS /a EXCAVATOR El IMP. DIST. APPOINTMENTTIME: # TIME READY: ❑ EXT. AGREEMENT CONNECTION MADE BY Nyioc p�yy INSPECTED BY 31-058'(12/]]) STREET KEY BOX AND SERVICE LINE LOCATION BY SKETCH L _ •f6 33 �NDICATE NORTH ALLEY C11 I I x 00 }Z I j U) J F¢ J< m C m U U ix� t+ Qwava d w OOm} ..yam J N Z E W w w Z z i 00 Z W m m N q O LU U ❑❑ ❑❑C7 a N m5 O H z z y a �0 a O z O z l- G c o c a 'Oo Q li O LLI J rM+ Q ,fQOt d x GN'>uO! Cd C w O. C9 ,a LT2c'nwf CL LL w El O'O O LL, VW O w Um -w UeW Z O ZL 0 V5 O s Ir vO 4 Kgo a a r »W FW» ft_» ()cr 2 W W W Mt CL Q }� F U LL LL Q n'7 K?7 V wMaa �.. at } n a w J O+�fL� T �' .D t,) z z J�v� �Oyi h> cn- m co O -OC Z 2 W Q ¢$' $Q$ N�7y¢¢7� iv1 1..: W �i'.7j }0.00N LL Li til �'�O ''� a'i W n ~ fn T ° w�� k1 Z O rz W OFa n. ui CL `° z m C O z 3 Fz 2v y o o Q m iam, �aZ0CC CC W Q Fz a� o CL z z W 2" J z J Z=n. m Qa2 O m ¢ 5 7i Q O O ' O N w wm N t- m O Ud ❑ LTJ` O U z a.mz Lll Q O c 6 C 6 i i3ti 23 ui7 SUBDIVISION: 1 n,/1 , ; ; BLOCK: I LOT: �j E O A w rt z O F- U w CL _z w w w INDICATE NORTH STREET 11 SEWER SERVICE LINE SKETCH SHOW LOCATION OF CONTROL MANHOLESICLEANOUTS ALLEY SIZE MAIN: _a—TYPE MAIN: Y1_!_ CONNECT DEPTH AT MAIN JL_ CONNECT DEPTH AT Prop. Line CONNECT LOCATION: F -A! i of n7. W 4 P/N COMMENTS: Ll y INSPECTED BY: DATE: 1 Max Okun F -,girt+ a, n �. PR07fCl'iON 4306 Cope $t. Anchorage. Alaska 99503 Us Lot i Lee Subdivision Zvi--& _., 0 ft. to 6 ft. Brown sily with s 1 ome grave 6 ft. to 10 ft, bad gravel with gray silt 10 ft. to 46 ft. Course gravel A silt with occasional ccbbles� 46 ft. to 47 ft. Gravel and sand wesped in 17 ft. water Bailed 47 ft. to 67 ft. Glacial till ( tight 0 67 ft. to 74 ft. Water bearing sand & gravel Med. 12'ft....head Bailee dry 74 ft. to 79 ft. Course gravel and brown out 79 ft. to 8) ft. Course gravel and gray silt 83 ft. to 84 ft. Same but water weepedin overnito 50 ft. Bails 84 ft. to 92 -ft. Glacial till ( tight) «. 92 ft. to 93 ft. Gravel and play 93 ft. to 106 ft. Same but weeps water..* y baila- 106 ft. to 107 ftp. �'poor reoove Clean medium gravel and sand Mater bearing ?est bailed at 10 GPM 3 hours - w 4 Static 36 ft. From surface ( 71 ft. ) xead Drawdown to 87 at 10 GPM Good recovery Bottom Stable water very Clean Set permanent Hama at -IW ft. 15*5%'NG- 107 - F�iy� sot iia7-Z '� WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological d Geophysical Surveys Drtiling Permit No, LOCATION OF WELL IPlease complete either In, Ib or to.) A.D.L. No. lo. Borough Subtllrision Lot $lock ID. �/e 91rs. Section No. TornohipNip Range E❑ Mer101an _tj _5 / 3 E J WR S,: -vv' Ic. DISTANCE AND DIRECTION FROM ROAD INTERSEC,TtONS 5. OWNER OF WELe: / naar••/s: /wt/, got2 c, Street Address and Area of Well Location c�1l�� 'j 2. WELL LOG Feet Belo• S err face 0. WELL OfiPTH: (final) / J ff. 5. GATE OF CO MPLE T1011 _ _ 1 Z Material Type Top Batfom 6, ❑Cable tool 4Rolnry ❑Driven ❑Dug ❑ Av9sv ❑Jet Nd ❑ Bored ❑ Other n 7 -r 'J 7. USE: $4 Domestic ❑ Public Supply ❑ Industry ❑ irrigation ❑ Reshar9e ❑ Commerloaf ' S. CASING Thr; dad Weld d diem. 'a In. Hi io� ft. Depth Wst9ht� Its./ft. aiam.•pill 5tickup—;�_ it. S. FINISH OF WELL: r Type: . L ^i Dlom•tar slot/w"4 Size: Length: Set between ft. and ft. Backfilling gravel pack 10. STATIC WATER LEVEL: 1./ it. ` i ❑ Above or 0'Be1dw land surface Data EOulpment used: It. PUMPING LEVEL below land surface and YIELD D Z eft. after,L hes. pumping '(! 9.P.m. offer hrs. pumping-a.P.m. Oft. 12.GRCUTING Well Grouted: ❑ Yes ❑ No Matsrlal: ❑ Neat Cement ❑ Other: IS. PUMP: (If available) His Length of Drop Pipe ft. capacity q. p.m. ❑ Subm. ❑ Jet ❑ Centritical ❑ Other Ie.REMARKS: 16. WATER WELL CONTRACTORS CERTIFICATION: ❑ 15, Wafer Te mperolure F C thiswellwas ori lied Gee; y u Isdlcllop and thiq_[gport is true to the ot�r o any kn� 1k39a and bellef; Ro9ilil'qI•nd pusiress Name / Contra t License NumIcAr/ Signed /- Date! Authorinstl Representative Form 02•WWR (11/81) Copy Distribution: WHITE -State DGGS, PINK -Driller, CANARY -Customer M -W DRILLING, Inc, A5071/ RO. Box 110375. 10330 Old Seward Highway 99- 1 8 7 (907) 349-8535 ANCHORAGE, ALASKA 99511 DRILLING LOG Well Owner MANOOG'S ISLE MOBILE HOME PARKUseofWelIPUET.TC.. A 'Location (address of: Township, Range, Section, if ]mown; or distance main road. TRACT C -3A, SIMONIAN S/D: 2611 PAGO PAGO AVE Size of casing 81, Depth of Hole 220 feet Cas Static water level 41 ft. (g1Aop r : �Oow) land surface. Screen ( % ); Perforated,( 4 $) K p ASSEMBLY"f RISER 181.5'-18 Describe screen dtXPW Well pumping test at3Q0iga a"s pki' (9W of drawdown from static 14'I, A Date of completion 13 0 C T 0 Ba' 19 9 S § j4'k; Depth in feet from ground surface Gd of 1d, 0 To-2— To O 2TO 3 GRA4 4 f) 3 m 14 1R�icS 14 mn 18 18 TO 68 68 72 72 TO 80 80 1,O 115 __L1 5 TO120 120 -,„ 122 122 TO145 145 TO 165 165 TO 171 171 mn i80 180 .r,n 220 WELL L06 n one) open end ( }; ',0.080"SLOT 187.2"- 0" TAIL, 213..$'-218.3" V Note: Well dry grouted with 2 sacks '06 bentonity. penetrated, size of material, color and hardness SMALL GRAVEL: SILTY/D WATER GRAVEL SMALL GRAVEL: SlIBDY/SILTY/DTRTv WATER GRAVEL: GOOD SATTIaATTnu 02 t fl) -STATE LSU Jv Municipality of Anchorage Development Services Department (� Building Safety Division " On -Site Water and Wastewater Program S. ` 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 008-071-18 COSA # 02016 3 Expiration Date: 1. GENERAL INFORMATION Complete legal description T13N, R3W, SecOon 33, Lot 46,E 13T Location (site address) 2420 E. 48th Avenue Anchorage, AK 99507 Current Property owner(s) Michael and Caryn Gonzales Day phone 715-6436 Mailing address 2420 E 48th Avenue 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: Three (3) 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 OnSde 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 Onsite 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 Onsite 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 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 Certificate of Onsite 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 infomration obtained from the Municipality of Anchorage files and from my investigation and inspection, the on -she 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 Anderson Engineering 522-7773 Phone Address P.O. Box 240773 Anchorage. AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 5. DSD SIGNATURE Approved for 7 bedrooms. Disapproved. Date =008 MIOIAEE E ANDERSON 0 CE -4381 %4lILL a���+'ter Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: / " ' r t Original Certificate Date: Municipality of Anchorage Development Services Department y Building Safety Division On-Sfte Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsfe (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: T13N, RM, Section 33, Lot 46, E 133' Parcel ID: 000-071-18 A. WELL DATA Well type P to If A, B, or C provide PWSID #_ Well Log (YIN) Y Date completed 7113/07 Sanitary seal (YIN) Y Wires properly protected (YIN) Y Total depth 365 ft. Cased to 171 ft. Casing height (above ground) >18 in. FROM WELL LOG AT INSPECTION Date of test 5/2712000 Static water level ft 30' fL Well production g.p.m. 3.5 g.p.m. WATER SAMPLE RESULTS: . Coliform .0 colonies/100 mL Nitrate NID mg/L Other bacteria 0 colonies/100 mL Arsenic: 11.5 ug/I Date of sample: 520106 Collected by: J. Davis B. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size i gal. Number of Compartments _ Foundation cleanout (YM) _ Depression over tank (YIN) _ Date of pumping C. ,ABSORPTION FIELD DATA Date installed Pumper Date installed Cleanouts (YM) High water alarm (YIN) Soil rating (g.p.d./ft or ftz/bdnn) System type Length ft Width A. Gravel below pipe ft Total depth ft Eft. absorption area _fe Monitoring tube _ Depression over field _ Date of adequacy test Results (Pass/Fail) !For bedrooms Fluid depth in absorption field before test in. Water added gal. 1 New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) If yes, give date D. LIFTSTATION Date installed Size in gallons Manhole/Access (Y/N) 'Pump on' level at_ in. 'Pump off level at_ in. High water alarm level at Datum Cycles tested Meets alar & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A On adjacent lots N/A Absorption field on lot NIA Public sewer main >75' Sewer/septic service line >25' Animal containment areas None On adjacent lots N/A Public sewer manhole/cleanout >too• Holding tank N/A Manure/animal excrete storage areas None SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOTTO: Building foundation Property line _ Absorption field Water main Wells on adjacent lots Water service line Surface water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation Water main Water Service line Surface water Driveway. parking/vehicle storage Curtain drain Wells on adjacent lots F. COMMENTS: Lot Is Served by AW WU Sewer System. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson. P.E. Date srzarzoos COSA Fee $ T 3 18 Date of Payment G -,2- - d q Receipt Number 0% 77 10 (Rev. 11/05) Waiver Fee $ . ..............t�.=._.�..�......... V8 M104AEL ' f.CZ_4381' 0� Date of Payment Receipt Number. Municipality of Anchorage ; ., • Development Services Department Building Safety Division s• .r. - On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Arsenic Advisory Certificate of On -Site Systems Approval # 080163 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 46 E133' of T13N R3WSection 33 Subdivision. This inspection revealed an arsenic concentration of 11.5 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.or /og nsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. SCS Ref.N 1082162002 AR DatWrimes an Alaska Standard Time Client Name Anderson Engineering Printed Dalefrime 05/30/2008 13.39 Project Name/# Water Samples Collected Datefrime 05/202008 12:40 Client Sample ID 2420 E. 48th Ave. Received Datefrime 05202008 13:30 Matrix Drinking Water Technical Director Slephen C.Ede PWSID 0 Sample Remarks: Allowable Prep Analysis Paunder Results Poll Units Methal Container ID Limits Date Date Init Metals by ICP/MS Arsenic 11.5 • 5.00 ug/L EP200.8 C (<I0) 0522/08 0523/08 NRB Waters Department Total NitralJNitritc-N ND 0.100 ml/1. SM204500NO3-F 0 (<10) 0529/08 LCP Microbiology Laboratory Colony Count 0 c*Ul OOmL SM209222D A (<200) 0520/08 DLC Total Coliform 0 coU100ml. SM209222B A (<I) 0520/08 DIX Fecal Coliform 0 croV100mL SM209222B A (<I) 0520/08 DLC k � Moses Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program ` 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 008.071.18 HAA #___a5Lj34e Expiration Date: G+ — a - D .5' 1. GENERAL INFORMATION Complete legal description _ T113N. R3W, Section 33, Lot 46 East 133' Location (site address or directions) 2420 East 48th Avenue Current Property owners) Tracey Lake 8 Karl Stahlecker Day phone 242-3137 Mailing address Lending agency Mailing address Real Estate Agent 2420 E. 4P Ave. Anchorage AK 99507 Mailing Address . Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Weil Individual Water Storage Community Class , Well Public Water System Three 3 Day phone Day phone TYPE OF WASTEWATER DISPOSAL: ® Individual On-site ❑ ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ED The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal aff;<ed 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 Anderson Engineering Phone 522-7773 Address P 0 Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 412712005 EWS 4 5. DSD SIGNATURE f�,* �., No. CE -4381 i Approved for _ bedrooms. ���• •.1'... Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: /l,o-� Original Certificate Date: �- z - � ✓� (Rw. 12M) Municipality of Anchorage o , • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St P.O. Box 196850 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: T13N. R3W. Section 33. Lot 48. East 133' Parcel ID: 808-071-18 A. WELL DATA Well type Private Date completed _ Total depth fL Data of test Static water level If A. B, or C provide PWSID 0 Sanitary seal (Y/N) Y Cased to >1 fL FROM WELL LOG Well Log (Y/N) N Wines properly protected (Y/N) Y Casing height (above ground) 24 n. AT INSPECTION 412712005 it 38 R Well production g.p.m. 7.5 g.p.m. WATER SAMPLE RESULTS: Coliform _Q__oolonies/100 ml. Nitrate .1 mg./l. Other bacteria J_ oolonies/100 mi. Date of sample: 412212005 Collected by: MEA B. SEPTICIHOLDING TANK DATA Tank Type/Material Date installed Tank size gal. Number of Compartments _ Cisanouts (YIN) Foundation cleanout (YIN) _ Depression over tank (YM) _ High water alarm (YM) Date of pumping C. ABSORPTION FIELD DATA Pumper Date installed Soil rating (g.p.d./fe or fte/bdrm) _ System type Length it Width It Gravel below pipe Total depth _ ft Eff. absorption area fte Monitoring tube _ Depression over field Date of adequacy best Results (Pass/Fail) For _ bedrooms Fluid depth in absorption field before test _ in. Water added_ gal. New depth_ in. Elapsed Time: _ min. Final fluid depth _ in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed 'Pump on' level at _ in. Datum Size in gallons Manhole/Access (Y/N) 'Pump off" level at _ in. High water alarm level at in. Cycles tested Meets alarm 8 circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot NIA On adjacent lots >100' Absorption field on lot NIA On adjacent lots >100' Public sewer main >7$" Public sewer manhole/cleanout >1W Sewer /septic service line >29 Holding tank _NIA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Absorption field Water main Water service line Surface water Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation Water main Water Service line Surface water Driveway. parkinpNehide storage Curtain drain Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I car* that 1 have determined through field inspections and review of Municipal records that the above systems are in 49t ;. conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Michael E Anderson. RE �� IULIMEL E 0's , No a .� Data 1126I200S HAA Fee $ 73(3 w Date of Payment/ U S' Receipt Number (a (Rev. 12(00) Waiver Fee $ Date of Payment Receipt Number, RPR -13-2005 10125 PRUDENTIAL VISTA REAL EST 907 562 5485 P.02 r EAST /33 .r 33' PATENT RESERVE rH— 'AVT. 4 a a or x CO tu 4s s tu sg > fffl I � � � M COT 4 r Z 44A z W' m 2 Q. Q 133' wEST LOT 45 Lrtl D .--AST /33 FT, or- DATE OF 44qs{{! Lot 46 , Block i •• %OV ice 33, T -/3N Re3 Wer SMey A/osk Anchorage Recording District, Alaska the lot o 0l record a Rol than (hor* 4h4rno m. tiler of noted. aro nor 4ho.n h4roen unl.e4 � ern4role4 nor4d. �� s� �, =+1192 OT SURVEY CERTIFICATION LEGEND pfo�°•..• .e•'e•'0 1 hrebr nrny rem IM•e 4wreyee the 10roporty sheen ena e4eerlbee {, �9p�fS5 hence, and that the Improv..enr..lruared m.r4pa er..trnln rM 0 Bross or Aluminum copped monument recove�\ erty Ane" ane ea cot 01411010 If 0111110 sn adJaeent 4rep4rty and the O Iron pipe and/or rebar recovered hO linprp them' ah 00taunt pwerrr e.enop or 4naGoah an me O 2 x 2 bub & tock recovered In auwllon and rear 10" ore he rood.ar4, arlllh INw, or othe 10ylelbl4 0 5)6 x tib rebar set Milt survey oa114n4nr4 on Gold property UCeot 06 lodleat4d heroon. L/NE(APPAoX. LOCAs/ON) ERef , Dote Preperedby. RL. BUTTON©• 05-O/-99 Rpq,Srered Land Surveyor/907)279-6200 5/.9 wEi9hyh Ave. Anchorope A/osFo 9950/ 24 F.B. No. Property of: 45-x/ I Traceu LQke TOTAL P.02 4-26-05: 4:26PM: ;907 5615301 s 2/ 4 SGS ReEN Client Name Project Name/H Client Sample ID Matrix Sample Remarks: 1052094001 Anderson Engineering 2420 E. 48th 2420 E. 48th Drinking Water All DatesMmes are Alaska Standard Time Printed Date/Time 04/262005 16:10 Collected DateMme 04222005 13:15 Received Datefiime 04222005 13:38 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Waters Department Nitrate -N 0.100 U 0.100 MiorobioloQy Laboratory Total Coliform 0 mg/L EPA 300.0 B (<-10) coUl00mL SM209222B A (<-I) a 0422105 WAW lMkyuiF3lij>t� i