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THE TABLELANDS BLK 8 LT 14
The Tablelands Block 8 Lot 14 #051-801-54 / Municipality of Anchorage e Development Services Department � Building Safety Division On -Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.cl.anchorage.ak.us (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT c{ Permit Number. 040183 PID Number. 05180154 K� dt so N.m.: The Thomas Company Wastewater System: El New ❑Upgrade HC05 Box 6929, Palmer, AK 99645 ABSORPTION FIELD Fro..: 746-0682 N~oflled a t 4 O D..o naval 13 Scow. Tmm E IB.a ❑rwM ❑Onwr: LEGAL DESCRIPTION sat R.ag: 0.80 Tar D.pn eaa or," or.a.: CF T' 3,3 Ft. awck 8 L& 14 B.bowwa.TheTablelands D.ommppeo~tNwtorl",W.. C' &Pth Y otpw. 2.8 Fl. 0.5 FL Ta p; Rrg.: Sawa: Fe Waa/ W tm" pact.: cr lwgm: 1.0• Ft. 67 Fl. Well: ❑ New ❑ Upgrade Grit N w : 15 11 w arwc owitwa. e.iw.«, rwF F 3 5 LL 0. 1e two (F 41*. A B. c): Tar D.M. Cn b: Tar Waapwn "a: Fw. wifw: A- community water system Ft FL 1005 Fr I PVC Der. Dow Drava. sift W~ Lwr: ftwwr. D.1. m W. FL Baileys Backhoe 7/13/04 vwa: •'GM wrgsfaL , Ga..pHwptADpwGrWM: TANK FL FL SEPARATION DISTANCES El Septic ❑Hokling ❑S.T.E.P. ❑Other. To Septic Absorption Lift Holding ubiidPrivate W — wuir. Fran Tank Field Station Tank sewer Line Anchorage Tank 1250 Gr. WIfW: N aCant.nnwnw. ww na na na na na steel 2 e.n.a. w.W na na na na LIFT STATION La Ulm 34' 15' na na Gr. FowrM.om 7''Fa.pan 21' na na w .L 'Fumy Qtrw &L Nan Mrr✓m.L h. Pump w.. a uWf EwMr Ywp.cuoa. p.rraawa M tyro ikon na na na na RfnfL.: BENCH MARK Louwn rw 0.frpuon. Nail in tree near tank (temp BM). wv. . 100.0 FL iA •••• ••t* IfISpeC110nS performed by: Kent Shoals, AK Rim Engineering. Irx: Dates: 1r 7�13�04 Vo *� • �j 2ne 7/20/04 / r Developm nt Services Department Approval MerA. shreves : a rlf'•., 9351 Reviewed and approved by Date:CE ,.• 4_7 N, 1111FESSI �' ooDDD SITE PLANs P.O. BOX 2749 4gq AS BUILT Y PALMER, ALASKA 99645 o A lE,.••••,,Gq ENC EE INC. PHONE: (907)745-0222 �' �P' •• `rf FAX: (907)746-0222 S; 9 d� {+� 491H •••'�ir�% W.-00400286 DATE: 1/25/05 SCALE: 1" = 40' FILE:0400286_WWASI % ............° - P Mar Shreves LOT 14, BLOCK 8, THE TABLELANDS SUBDIVISIONf'•. CE 9351 PLAT No. 2004-25, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, ALASKA QQfO•,.••'•d EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE .......... ccRECORDED PLAT ARE NOT SHOWN HEREON. (M)=MEASURED DATA I I (R)=RECORD DATA WATER I U.G.=UNDERGROUND S89.56'06"W VALVE—\I 705 252.84'(R)252.72'(C)CK702 [\-.5 58 703 44/ 1 i 3 20190' NAT'L co GAS "'to LOT 14 DECK a 26.3 4 GRAVEL 06 C6 TYPICAL 30.1' a DRIVEWAY 00 00 40,016 S. F. TWO STORY X 3 � DWELLING 21' c))M BLOCK ® N to N T f oma, as'It O O RiP �CE�� 1 J A �0 30.3' I p O 0 o SEPTIC co co o B CANT. I O O Z Z Z Z RISER THp1 CO3 1.250 -GAL U.G. TYPICAL C04 P to SEPTIC �. TANK ELECTRIC 15' X 67' BED SA a' THTSL1837 TRANSFOR 'ER I PAD I -5/8" FOUNDBEARING S89056'06"W UTILITY Ln REBAR 252.65' R 252.72' ( M ) ( ) PEDESTAL �'- 4094—S TYPICAL TYPICAL I� LOT 15 IDICol S_Q C04 Irn A 10.4 20.2 85.4 m B 31.1 47.3 115.3 i I 1"= 40, I I ooDDD SITE PLANs P.O. BOX 2749 4gq AS BUILT Y PALMER, ALASKA 99645 o A lE,.••••,,Gq ENC EE INC. PHONE: (907)745-0222 �' �P' •• `rf FAX: (907)746-0222 S; 9 d� {+� 491H •••'�ir�% W.-00400286 DATE: 1/25/05 SCALE: 1" = 40' FILE:0400286_WWASI % ............° - P Mar Shreves LOT 14, BLOCK 8, THE TABLELANDS SUBDIVISIONf'•. CE 9351 PLAT No. 2004-25, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, ALASKA QQfO•,.••'•d EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE .......... ccRECORDED PLAT ARE NOT SHOWN HEREON. J 1 1 \& REp�� EME 00 30.3' C T1 SCO2 C01 CO .R � TH#1 CO3 ' L C04 \X � -H1,250-GAL SEPTIC TANK S THTSL18137 �i TRAI FIXED unk ft. BEARING SEPTIC SYSTEM PLOT PLAN FINAL GRADE 97.9 ft" FINAL GRADE 96.6 ft. 2" INSULATION 11 GRADE DATUM (TEMP.) = NAIL IN TREE NEAR TANK - 100.0' 171_ SEPTIC SYSTEM PROFILE �000Opp DETAILSAS P.O. BOX 2749 a PSE9645 ,..F.. A.q f�Q AS BUILT ENC EE y I PALMER. . INC. PHONE: (907)7459 0222 'S�� �9�dfj FAX: (907)746-0222 tr: 49TH.•.•'; it 00 W.O. 0400286 DATE. 1 25 05 SCALE: 1 " = 20' FILE: 0400286. ..... ... ...... o V,% Alar L reves : � LOT 14, BLOCK 8, THE TABLELANDS SUBDIVISION, 9tv"rr•, CE 9351 ;•ted PLAT No. 2004-25, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, �QQ(10�0 OSo ods EASEMENTS OF RECOR EDPLATRARERNOTOTHER SHOWNHAN SE SHOWN ON THE HEREON. BED DETAIL *:;'491H m.m.u.. W.O. ABSORPTION BED PLAN VIEW BED SECTION v `==; SECTION X—X I�III7"., II1II N. 1• MONITOR TUBE DETAIL AS4 P.O. BOX 2749 ttrit I PALMER, ALASKA 99645 E , INC. PHONE: (907)745-0222 FAX: (907)746-0222 ATP- 1 /95/n5 I SCALE: nts FILE: y1 Shreves o LOT 14, BLOCK 8, THE TABLELANDS SUBDIVISION,CE 9351 .:moo PLAT No. 2004-25, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, AK d oleo EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. Municipality of Anchorage Development Services Department • +� Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907) 343-7904 ON-SITE SEWERIWELL SUBMITTAL COMMENT SHEET To: Alaska Rim Engineering, Inc. Legal description: The Tablelands Subdivision, Block 8. Lot 14 The attached paperwork has been reviewed and is being returned for the following reasons: Original signature or stamp missing on _ Calculation error in design. The drainfield irement for a bed design, t,!�a\ ❑ Additional soils information needed. _ ❑ Water monitoring results Inadequate. ❑ Discrepancy in information submitted. A 00 �� CR 0.4b P64.1 Sy�`'%AYN ❑ Topographic information missing or inadequate. ❑ Incomplete; missing ❑ Incomplete; missing 4V . \%.tea rr-'Yt1. ❑ Additional adequacy test information needed. _ ❑ Water sample unacceptable. _ ❑ Measured/proposed distances/dimensions missing. _ ❑ Locations of all soils, percolation and water monitoring tests not shown. ❑ Proposed system too deep for soils information submitted. _ ❑ Well log required. ❑ Omission in narrative. t7-® Insufficient fill over tank or field. The finished grade over a subsurface Isf%(Y% TounaaTnon wan is regwrea. Name of reviewer: Julie Makela. P. E. Date: 8/18/2004 Please supply the necessary information and re -submit your request. Jan 10 05 01:24p RLRSKR RIM (907)746-0222 p.1 Alaska Rim Engineering, Inc. Engineers - Planners- Surveyors DATE: /- M '-U S TIME: 1P15 FROM: Alaska Rim Engineering, Inc. PHONE: (907) 745-0222 P.O. Box 2749 FAX: (907) 746-0222 Palmer, AK 99645 E-MAIL: akrimnalasbrim.com TO: _ PHONE: -1A/ FAX: ' LA3-25V Total number of pages, including cover sheet COMMENTS: Re' �� /Pelt 4'f V e V4� pt�? CLG vu Q pctf G�r��GscLe'` oZ� THANK YOU 27 Y Municipality of Anchorage e r Development Services Department \ Building Safety Division On -Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. 040183 PID Number. 05180154 The Thomas Company Wastewater System: Q New ❑ Upgrade Ad�. HC05 Box 6929, Palmer, AK 99645 ABSORPTION FIELD Ph": 746-0682 N x of ls,& a c 4 DowTrench 13 Shiiam Tr•,Kh El W OmDos— LEGAL DESCRIPTION �° 0.60 TdrDapeata•prWO•ts: GPdFf 3.3 p, ei a 8 `t` 14 The Tablelands D"M b POO baba Nam or" Dada. Gras! awt brrabl Fee: 2.8 Ft. 0.5 Ft Ta•rrt•P: Rmg•: ii c : F1 Wad above a•D'W pas: Grave Leath: 0.0 Ft. 67 Ft. Well New [3 Upgrade c.ar.,aw` 15 ruroraaw Drtecs atr.e,rr. Ft. 3 5 Ft C kston lemma, A 6. GF Tar D•ptn: carat b: Tar swapt o "s, P" kls e : community water system Ft. Ft Tg05 Ft' I PVC Br+ar D•u Dart. Suit w.w ta.r: brirw Ow bwrad: Ft Baileys Backhoe 7/13/04 Yrb. Puaps.tK c..ty".ybt4Wr.Gra„t: GPM Ft. Ft TANK SEPARATION DISTANCES El Septic ❑Holding ❑S.T.E.P. ❑Other. To Septic Absorption Lift Holding ubnuPtivats ==_W r From Tank Field Station Tank Sewer Una Anchorage Tank 1250 Gr. wo na na na na na Mranr: steel taro« a cenp•rbrrM: 2 sr scevv a na na na na LIFT STATION Eaue 35' 35' na na wt Fand•6m unk unk na na P✓^P om rrr.t Pvr,p art l.w.t ragn ere rea.t I M. u.t.,tD..b na na na na Poap M•raa MWr EYWcr brPra,au PWa,bW bf. R«mrss. AKTH#1 dug on 7/13104. GW at 9.T. GW in N1717(existing) at 8.6•. BENCH MARK Soil rating adjusted to 0.60 gpd/sf after visual aassificaaon. Design changed tonu•nw •crebur. Nail in tree near tank (temp BM). to absorption bed. Foundation not constructed as of this dale. Separation Ft 100.0 distances will be confirmed with final as built survey. O �qt Inspections performed by: Kent sheets. AK Rim Engineedng, Inc. Dates: 1a 7/13/04*' TH •'* 2nd 7/20/04 Development Services Department A 0. Ma . Shreves Reviewed and approved by: Date:///� ` ��� 11 ;;;;``;;;``�� 1-4 h' LO,, 14 46,016 S.F. i 0 LOT 13 S89056'06"W 252.84' 56 � o� PROPOSED °o ., TWO STORY L4 DWELLING ^s m s� � 5a 15'/X 67' BED SAS \ 0" CO / AKTHl 5 I ' I RECOVERED 2"x2" HUB wAATH MARKED LOT 13 LOT 14 BLK 8 I , /'WATER " I P KTY 30 Ir F.F.I ELE .-56' — — 21, -� 1.250 -CAL -REPLACEMENT FIEL L SL188 - �Q�O SEPTIC TANK S89.56'06"W (O H- 58 :::PROPOSED:: 252.65' U :;::PAVED 'DRIVEVj!AY.... jam. I � I000w o I w I Ln � 1 "c4C1' LEGEND I I C 56X - SPOT ELEVATIONS N C 252.65' cl LOT 15 1 "c4C1' LEGEND I rl 56X - SPOT ELEVATIONS N USION NOTE: R IS THE RESPONSIBILITY OF THE OWNER OR BUILDER. PRIOR TO CONSTRUCTION TO VERIFY PROPOSED SS AND TO E NE AND NOTEAPPEEAR RORESTRCTIONSWHICH OF ANY SUBDIVIRM MENSCOVENAN S. OTIVE DO ON HE` RECORDED SION PLAT. SITE P.O. BOX 2749 SITE PLANDZFESMk, �000044p� OF At ��� AS BUILT PALMER, ALASKA 99645 o P( ..•••••.. q� a •FgDd� ENCC. PHONE: (907)745-0222 • • FAX: (907)746-0222 49�H i �D W.O. 0400286 DATE: 7/27/04 SCALE: 1" = 40' FILE: 0400286-WWAS % .. � 1 rt..�... .. ..O -p0-. Shreves ,��� LOT 14, BLOCK 8, THE TABLELANDS SUBDIVISION Q f •. CE 9351 ; •�'d PLAT No. 2004-25, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, ALASKA QQ�•P .......0 EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE Q b000So d RECORDED PLAT ARE NOT SHOWN HEREON. 1 OF 3 SHEET v Oc KAT • 58 30' �: BED SAS •CC \ 00 CO3, ' r _ _ AKTH_#1 _ 5° 0 I TSL18B7 � I 1,250 -GAL NT FIEL SEPTIC TANK Lam, _- °� J S89056'06"W 252.65' FIXED unk ft. *: 49TH SEPTIC SYSTEM PLOT PLAN FINAL GRADE 97.9 ft. FINAL GRADE / 96.6 ft. 2" INSULATION GRADE DATUM (TEMP.) = NAIL IN TREE NEAR TANK = 100.0'7! SEPTIC SYSTEM PROFILE SEPTIC AS P.O. BOX 2749 AS BUILT tuy PALMER, ALASKA 99645 I� ENC EEk- INC. PHONE: (907)745-0222 d� FAX: (907)746-0222 *PD W.O. 0400286 I DATE: 7/27/04 1 SCALE: 1" = 20' 1 FILE: 040028 Shreves,LOT 14, BLOCK 8, THE TABLELANDS SUBDIVISION, 9351 •fid PLAT No. 2004-25, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, ,,,.••''d EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE :SSI��tid'' RECORDED PLAT ARE NOT SHOWN HEREON. r bm"um rte•• p•1uN. , -� BED DETAIL ABSORPTION BED PLAN VIEW BED SECTION v o.r•,.w enc SECTION X—X MONITOR TUBE DETAIL b 44q . OFA % AS BUILT AAS P.O. BOX 2749 A •.6,.....,,<q D� DETAILS ` Rry PALMER, ALASKA 99645 C.jA �P,••' J`F ENC EE INC PHONE: (907)745-0222 9 d FAX: (907)746-0222 d J"' 49TH ••••:� �D •%��%� ......••• •• • ..•••D W.O. 0400286 DATE: 7/27/04 SCALE: nts FILE: 0400286—% A MqaryvShreves•� LOT 14, BLOCK 8, THE TABLELANDS SUBDIVISION,�cf.,•. CE 9351 •:�� PLAT No. 2004-25, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, AK Q��n Oy�E��ood`y� RECORDED PLATOF RARE NOTECORD OTHER SHOWN HEREON.THAN THOSE SHOWN ON THE Municipality of Anchorage Development Services Department Building Safety Division y1 on -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Boz 196650 Anchorage, AK 99519-6650 ww ,rnunl.orglonslte (907) 343-7904 Soils Log - Percolation Test I'� Perfo teed For. The Thomas Company Date Performed: 7/13/04 Legal Description: Lot 14, Block 8, The Tablelands Township, Range, Section: Depth 4ii 1 t) bw rti (VTI )IJ5i1,'�,t1j w) "t,rtA CObblfS s;is SancQ 6-P) I r ! WAS GROUND WATER Q9- t • 1 R Y Ad1 'md' ENCOUNTERED? Yes 1O-' r •'NIy ) l�s W' IF YES. AT WHAT DEPTH? 9.T L ' DC(-', Cpy61tJ Depth to Water After Y 11- 1 Monitoring? E r 12- r 't Date: 130#crm or_T. ff I PERCOLATION RATE (.kk4Wen+) FERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS No pert Leat wn. Test hole was for purposes of IOeMHYk9 amY 9'o"ndw+ler MT tram pin at Ink (THTSLIBM wee probed GW defected ef BS below 9MUM surface. PERFORMED BY: Kent Sheets. AK Rim Engineering. Inc. I Mary L. Shreyes, P.E. CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7/27/04 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Permit Number: SW040183 Legal Description: Qrhe Tablelands Biock'8 W34.17 Date Issued: Jun 11, 2004 Expiration Date: Jun 11, 2005 Parcel ID: 051-801-54 Design Engineer: 0032 Alaska Rim Engineering Site Address: Unknown Owner Name: The Thomas Company Lot Size: 40016 SQ. FT. Owner Address: HC05 Box 6929 Total Bedrooms: 4 Permit Bedrooms: 4 Palmer , AK 99645 - This permit is for the construction of: ❑V Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specked 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 DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By. Date: Issued By. 4ar - Date: -\ Municipality of Anchorage Development Services Department Building Safety Division i On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. V I V 1— f Permit Number SW Property owner(s) The Thomas Company Day phone 746-0682 Mailing address (1) HC05 Box 6929, Palmer, AK Mailing address (2) Zip Code 99645 Legal description (Lot, Block & Sub'd.) Lot 14, Block 8, The Tablelands Subdivision Legal description (Section, Township & Range) Lot Size 40,016 Sf Acres/Sq.Ft. THIS APPLICATION IS FOR: Number of Bedrooms-! Sewer Only 0 Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the ooy� information is corr I further certify that this application is being made for a Sinale Famil=atlif�9aQ is lo&=aKncqAvith applicable Municipal Codes. (Signature of property owner or authorized Permit Fees: U L+ ( C C ) Waiver Fees: Date of Payment: f c a , r/ Date of Payment: Receipt Number. J t 1�s Receipt Number: (Rev. 12/00) (AVoka n(In ellpeehillg, 911c. Phone (907) 745.0222 Fax (907) 746-0222 akdmCrogershsa.com May 18, 2004 Mr. Dan Roth Municipality of Anchorage Development Service Department Building Safety Division On -Site Water and Wastewater Program PO Box 196650 Anchorage, AK 99519-6650 RE: Lot 14, Block 8, The Tablelands Subdivision On -Site Sewer Permit Application AK. Rim Engineering Ref. No. 04-00286 Dear Mr. Roth: P.O. Box 2749 Palmer, Naska 99645 The owner of the above referenced lot is proposing to construct a 4 -bedroom single family dwelling (see attached Site Plan). The proposed dwelling is to be served by a community water system and a private septic system. With this letter we are requesting plan review and a permit to install an onsite septic system to serve the proposed development. DESIGN SUMMARY Soils A test hole was excavated on March 11, 2002, to a depth of 13 feet below grade, and was logged by Mr. Tobin Spurkland (labeled TS TH Ll 8B7 on the attached Site Plan). A percolation test was conducted at that time. The proposed drainfield will be designed around the 30 -feet radius of the test hole. The soils were classified as SM, sandy silt. The percolation test indicates a soil percolation rate of 5 minutes per inch which translates to a wastewater application rate of 1.0 gpd/sgft. Mr. Spurkland's log does not indicate whether he rechecked the groundwater levels. The initial report shows no groundwater was encountered. A separation distance of 6 feet will be applied between the bottom of the trench and groundwater since the groundwater level was monitored in March. Because of the fluctuating groundwater levels in this area, a test hole will be excavated at the time of installation of the septic system. The design will be adjusted at that time, if necessary. We will contact your office to confirm the necessary changes. Engineers • Planners • Surveyors Mr. Dan Roth, MOA Page 2 May 18, 2041 Trench Design The following is a summary of the proposed design of the trench SAS: Percolation rate: Soil application rate: Number of bedrooms: Daily wastewater flow: Drainfield: Septic tank: Minimum absorption area: Total depth (max): Effective depth: Width: Reduction factor: Minimum length: Effective absorption area: Topography 5 minutesfinch 1.0 gpd/sgft 4 600 gpd 5 -wide type drainfield 1,250 gallons 600 sgft 7 f 4 f 5 f 0.50 60 ft 600 sgft The topography of this lot is relatively flat throughout the lot. There is adequate usable area for an onsite septic system and replacement system. Surface Water There are no surface waters within 100 feet of the proposed septic system. Surrounding Properties This property and the parent subdivision will be served by community water system. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. Development on this lot will not preclude development of wells and septic systems on neighboring lots in the future. If you have any questions regarding this report or its recommendations, please feel free to contact me. Sincerely, ALASKA RIM ENGINEERING, INC. Mary L. Shreves Professional Engineer CC: The Thomas Company AK Rim Engineering File No. 04-00286 Attachments: /"0'�%Se, OF A 11# 1/ �QCE......... A'���i •� 6. . *: 9TM shrevee !;�f9f "no 8351 • : p��`�Z /I�itt1 o ss111"`%'`' Mr. Dan Roth, MOA Page 3 May 18, 2004 • MOA On -Site Sewer/ Well Permit Application Form • MOA Soils Log — Percolation Test Form (Tobin Spurkland) • Septic System Plot Plan (3 pages) PERMIT NUMBER PID NUMBER I I I II RECOVERED LOT 13 2'X2" HUB LOT 13 LOT 14 BLKE8 a I I t89*56'06"W WATER I LOT 14 252.84' A KEY T 30, �— x„ (I I 40,016 S.F. X56 40'f a 26 —7 -3 � o PROPOSED xu � DRIVEWAY 00 o TWO STORY H x66 a —f Z h„I w (0 DWELLING �S' I C) rq "a Ind JD 4 N co 2 I w TH TSLte87 . 10' SEPTIC C T� K VW X 4T.D. X 60' A DEEPTRENCH SA s 1 3 REPLACEMENT FIELD I O 89'56'06 LOT 15 �I I ;rm >rni ,ZZI 1 "=50' I I I I � I EXCLUSION NOTE: IT IS THE RESPONSIBILITY OF THE OWNER OR BUILDER, PRIOR TO CONSTRUCTION TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITIES CONNECTIONS AND TO DETERMINE THS EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THt RECORDED SUBDIVISION PLAT. 4��Qo�D0p�� SITE PLAN AS P.O. BOX 2749 A ��•0F•gL9�➢� Rty PALMER, ALASKA 99645 ENC EE INC PHONE: (907)745-0222 P c,AQ'' •' ��y�d� FAX: (907)746-0222 O� 49TH•••':* �D W.O. 0400286 DATE: 5/18/04 SCALE: 1" = 50 FILE: 0400286—WW p....f........p� �Q P ;• Mary L Shreves ;� p LOT 14, BLOCK 8, THE TABLELANDS SUBDIVISION P •. CE 9351 'd PLAT No. 2004-25, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, ALASKA S OF THE ISMS o� RECORDEDPLAT RARE RNOT THOSETHER THAN SHOWN ON SHOWN HEREON. I of 3 PERMIT NUMBER 5'W X 4'E.D. X 60' DEEP TRENCH SAS REPLACEMENT FIELD PROPOSED x55 TWO STORY DWELLING TH TSI -18B7 89°56'06 W x.52.65/ n T .nT 1 1'=30' SEPTIC SYSTEM PLOT PLAN el.. SEPTIC SYSTEM PROFILE 1 PID NUMBER 30 X56 0 5' 0m 2' 30' (-12" CO 1,250 -GAL SEPTIC TA cD H- 4�o�ooppp�� SEPTIC AS x P.O. BOX 2749 a ��.OF•A<q��p ENC tuy PALMER, ALASKA 99645 EE INC. PHONE: (907)745-0222 �' Iy�d� FAX: (907)746-0222 O;' 49TH•.••�'t �D W.O. 0400286 DATE: 5/18/04 SCALE: 1" = 30' FILE: 0400286 -WW 0..........•. .....<�-.....p 0� P ;• Mary L Shreves � LOT 14, BLOCK 8. THE TABLELANDS SUBDIVISION P f•. CE 9351 'ted PLAT No. 2004-25, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, ALASKA QQQf`Af� ••.. •p�'b EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE QqQ%POD od RECORDED PLAT ARE NOT SHOWN HEREON. SHEET 2 OF 3 PERMIT NUMBER 8/4• t. r w teat .wu4'AMI . no 6.e. le.i.6 2 m t•►. •t .a4 w hoes tu1a0 ww...t •t ••4 waw Nv I -fest 60' WIDE DRAINFIELD row w T.rZI vrc w.w PLAN VIEW .... w..u..) TRENCH DETAIL rel. k L••V�•wyy—e.. t QNm =mim w ..e.. *u r r t= .a) en M .4 mb.MwlQ a law w ..,W •..� q 1...•m® w t.. ft� w MJ.11s. Md• k M.wm® moll,. W.0 be Mat. 4: Mol •..4 6)ZV. 60.0' 1, ZM. 49.0' BOMM T8 TRENCH SECTION 4' PID NUMBER 5' t v ..,t...w ne holamw• 4 SECTION X—X ull III r/jvi MONITOR TUBE DETAIL .1 00000Op as P.O. BOX 2749 .�F• A(� sD� SITE PLANENC EERrALMER, ALASKA 9645 y INC. PHONE: (907)7459 0222 `;:49TH 9*fid FAX: (907)746-0222 .. � ,j W.O. 0400286 DATE: 5/18/0 4 SCALE: NTS FILE: 0400286_ ..�:. 0.........p L Shreves p LOT 14, BLOCK 8 THE TABLELANDS SUBDMSION CE 9351 : ��PLAT No. 2004-25, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, AK QQQ� 4........ EASEMENTS EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE OpW;��oo RECORDED PLAT ARE NOT SHOWN HEREON. LOT P . •a, v a ::vI mect For TN DescraTat: Lv T I4 t3 K SSlr—r—D—= '21. BoTTca1 H o�E :3•I 2-_1 WAS GROUND WATER ENCOUNTERED? IF YES. AT WHAT DEPTM Depth to Woler ARe• Monitoring? Dale: Reacting Dnn Gross Tune c TFeEti OQUAMICs '1 �- FILL .oz SOAYL 2•I it a: v-0 �— n J i 14 �Otu -711 r 1011 2>1" .1>1"S -e 3•o-0 31� cl,•� 6 +► o•` 3c7 30 I ML '21. BoTTca1 H o�E :3•I 2-_1 WAS GROUND WATER ENCOUNTERED? IF YES. AT WHAT DEPTM Depth to Woler ARe• Monitoring? Dale: Reacting Dale Gross Tune Net Time Depth to Water I vrt D•;r. FILL .oz SOAYL it a: v-0 3a �Otu -711 r 1011 3•o-0 31� cl,•� 6 +► 3c7 30 clr� 6 u ^^11 Z2 rn'vew'enl PERC HOLE DIAMETER r•• TEST RUN BETWEEN -Z FT AND 'ii FT A::FC=:tED?�' �, S, I �1 .•S. CERTIFY THAT TH!S—=S• I -1:S �E?FG= :tEO •TI ACCORDANCE PATH ALLSTATE AND MWICIPAL GUIDELINES IN EFFECT ON TH! SDATE. DATC.. �j�,27•-O•L Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program Ij 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 y~v cl.anchoraoe.ak.Us (907) 040-7904 Soils Log - Percolation Test ^ee°r, AP -C.1 \t` 17��'GC Date Pedo s -_I Gesc:rpl :n O t E nl V I k Vt/ 1\101`2X-4{ Township. Range. Section: LO 118V, 7 60V61 �="v7- /y 6K8 i=FEt,I OW, ANIGS ISua•tcly Si1� \`-1L S0.NC��I 511�- ML WAS GROUND WATER ENCOUNTERED? tit 0 5 IF YES. AT WHAT DEPTH? t Depth to Wale, Alter D v Moniloring? E Dale: Site Pian Reading MEMMIEM- Gross Time Net Tine Ocn'I' :o t•..�:r � '.r:.`•::• i F-IL.L 3- I-ot-PRF- MEMMIEM I MEEM 144; v1 EMI OEM i t MEN i ME ON ME Reading Dale Gross Time Net Tine Ocn'I' :o t•..�:r � '.r:.`•::• i F-IL.L 3- I-ot-PRF- K I I' lr it0 144; v1 i t i PERCOLATION RATE �1^r�Mewanl PERC HO'.E DI: •: F.'E' _ (a a'_. TE ST RUN BE TWEEN FT AND q rT t %:CORDANICE WITH A:L STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS D: --E Ji. -i 3•Q7.OL • Municipality of Anchorage °`� ` rrr.� eT$ On-Site Water and Wastewater Program (907) 343-7904 Certificate of On-Site Systems Approval Parcel I.D. 051-801-54 Expiration Date: 7"-( -10 1. GENERAL INFORMATION Complete legal description Lot 14, Block 8, The Tablelands Subdivision Location (site address) 22444 Sambar Loop, Chugiak, Alaska 99567 Current Property owner(s) Timothy Bloom Day phone (907) 231-5656 Mailing address 22444 Sambar Loop, Chugiak, Alaska 99567 Real Estate Agent Shanna Bloom/Century 21 Day phone (907)231-5656 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 16 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: Distance: Received by: Date: 1( ( 17 COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 52.0-OD Waiver Fee $ Date of Payment 7 f[r1 Iii Date of Payment Receipt Number 2) 1-11q Ghc. 160-7' / Receipt Number COSA# 0.507/2C19 __ 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 Pinard Engineering Phone (907) 232-1347 Address PO Box 871347, Wasilla, AK 99687 1 ��$s Engineer's Printed Name Paul E. Pinard Date 7 4 1 F ALA, it 'Si•• •O �i • 9th ' ` 9 6. DSD SIGNATURE ( System#1 Approved for l bedrooms �`r� • - 793 1� System#2 Approved for bedrooms � PRO FESSIO', I/ Disapproved '111* � t �`7 Conditional approval for bedrooms, with the following stipulations: , - • ON-5l I t. WATER AND• r, WASTEWATER e PROGRAM • =Y - Original Certificate Date: 7--2c9 -I 7 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r .: c 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: Lot 14, Block 8, The Aide Subd. Parcel ID: 051-801-54 A. WELL DATA NA — Public Water System Well type If A, B, or C provide PWSID# Well Log (YIN) Date completed Sanitary seal (YIN) Wires properly protected (YIN) Total depth ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate _ mg/L Arsenic _ ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 7/13/04 Tank size 1 250 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (YIN) N Date of pumping 7/12/17 Pumper Sanitary Pumpers C. ABSORPTION FIELD DATA Date installed 7/13/04 Soil rating (g.p.d./ft2 orttitdur4 0.8 System type Bed Length 67 ft. Width 1 5 ft. Gravel below pipe 0. 5 ft. Total depth 3 . 333eft. Eff. absorption area 1005 ft2 Monitoring tube Y Depression over field N Date of adequacy test 7/10/17 Results (Pass/Fail) Pass For 4 bedrooms 2 & 5 & Fluid depth in absorption field before test 0 in. Water added 600 gal. New depth 2 in. 2 & Elapsed Time: 1 125 min. Final fluid depth 0 in. Absorption rate >= 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION NA 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. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: NA Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5 ' + Property line 10 + Absorption field 5 + Water main 10' + Water service line 101 + Surface water 1001 + Wells on adjacent lots 200' + ABSORPTION FIELD ON LOT TO: Property line 10' + Building foundation 10' + Water main 101 + Water Service line 10 ' + Surface water 1001 + Driveway, parking/vehicle storage 20' 4- Curtain Curtain drain None Known Wells on adjacent lots200' + F. COMMENTS *MOA records show that the bed is insulated with 2" of insulation. G. ENGINEER'S CERTIFICATION �f '� .�F a.;..s• I certify that 1 have determined through field inspections and — • `�* • 9th ♦� •*� review of Municipal records that the above systems are in ........ conformance with MOA COSA guidelines in effect on this date. : 4 Engineer's Printed Name Paul E. Pinard E. Pinard �s,.:• CE -4793 :*- �� Date 7/14/17 ••.....••'��k�'�11 '°ROFESSIONPl1 (iA-111 COSA yellow sheet 2-6-15.doc Parcell.D. 051-801-54 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION _ Expiration Date: Complete legal description THE TABLELANDS; BLOCK 8, LOT 14 Location (site address) 22444 SAMBAR LOOP 'CHUGIAK, AL 99567 Current Property owner(s) MARK BENAGE Mailing address Real Estate Agent Day phone 972-786-4307 22444 SAMBAR LOOP "CHUGIAK, AL 99567 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: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Waiver/Variance request for: N/A Received by: Day phone TYPE OF WASTEWATER DISPOSAL: Individual 19 Holding Tank ❑ Community ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. Date: N/A Date of Payment AA(o ��ir7 (�— Date of Payment Receipt Number lby 6 Receipt Number COSA# DeAS12,57 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 onproceduresoutlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Garness Engineering Group, Ltd. (GEG) Phone (907) 337-6179 Address 3701 E. Tudor Road, Suite 101, Anchorage AK 99507-1259 Engineer's Printed Name Jeffrey A. Gayness In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municioal ity of Anchorage and industry practices: The moorted results describe the condition of the systems on the date/s of the evaluation. Seoara tion distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified Wring the evaluation. The operational life of all wells and septic systems depend on a variety of variables including, but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanshio), and the water usage of the family utilizing the systems. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the systems; therefore, GEG makes no warranty (exoress or implied) regarding the future performance of the well or septic system. GEG makes no moresentatlon whether an alternative well or septic system can be installed on the orooer y in the event either of the current systems fail. The content of this report is for the sole benefit of the persoNparty who retained GEG. Reliance upon the information provided in this reood by any other oerson or Deny, including but not limited to subsequent property purchasers, is not authorized. In short, GEG disavows any legal duty to anyone other than the pemon/oarty who paid for this moort. Date By: The Original Certificate Date: 6 - 2; - /.S— 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 9-1-12.doe ltitttftttt ��illOF AIV6,1rit DSD S. DSD NATURE ` J2 ON-SITE System #1 Approved forbedrooms _ WATER AND r System #2 Approved for bedrooms ' oWASTEWATER a^ PROGRAM Disapproved Conditional approval for bedrooms, with the following stipulations: By: The Original Certificate Date: 6 - 2; - /.S— 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 9-1-12.doe 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: THE TABLELANDS; BLOCK 8, LOT 14 Parcel ID: 051-801-54 A. WELL DATA Well type Date completed Total depth ft. Date of test Static water level Well production WATER SAMPLE RE: Coliform If A, B, or C provide PWSID# Sanitary seal (Y/N)— Cased to ft. FROM WELL LOG MI. Ac: ug./L.: B. SEPTIC/HOLDING TANK DATA Well Log (Y/N) Wires property protected (Y/N) Casing�heightbo round) in. AT INN ft. a.D.m. Nitrate mg./L. Collected by: Date of sample: TANK APPEARS TO HAVE 2' OF COVER PER 2005 INSPECTION REPORT. ASSUMED TO BE INSULATED. Tank Type/Material SEPTIC/STEEL Date installed 7/13/04 Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping Pumper ` S C. ABSORPTION FIELD DATA *BELOW EXISTING Date installed 7/13/04 Soil rating (.p.d r ftlbdrm) 0_8 System type BED Length 67 ft. Width 15 ft. Gravel below pipe 0.50 ft, Total depth *3.33 ft. Eff. absorption area 1005 ft' Monitoring tube YES Depression over field NO Date of adequacy test 6/1/15 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 733 gal, New depth 4_5 in, Elapsed Time: 130 min. . Final fluid depth 3 in. Absorption rate >= 600+ g.p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) TERRALIFTED If yes, give date 5/2/15 D. LIFT STATION Date installed "Pump on" level at in. E. SEPARATION DISTANCES Size in gallons Manhole/Access "Pump ofi" i_�at_—irr— High water alarm level at in. Cycles tested Meets alarm $ circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankniR station on lot Absorption field on lot Public sewer main Sewer /septic service line areas On adjacent On adjacent lots 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 10'+ Surface water, 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ F. COMMENTS SIX (6) OF THE PIPES ARE FLUSH WITH GRADE OR SLIGHTLY BELOW GRADE G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspecilons and review of Municipal records that the above systems are in conformance with MOA COSH guidelines in effect on this date. Engineer's Printed N me JEFFREY A. GARNESS Date L/ 3i (Rev. 11/05) 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 w (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING /�CCnn Parcel I.D. 051-801-54 COSA# (l5C121 325 1. GENERAL INFORMATION Expiration Date: / — 2 6— / Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address THE TABLELANDS, BLOCK 8, LOT 14 22444 SAMBAR LOOP * CHUGAIK. AK 99567 TERRY VOORHEES Day phone 602-2990 22444 SAMBAR LOOP * CHUGAIK. AK 99567 Day phone JOE LOWNDES W/ KELLER WILLIAMS Day phone Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 317-4830 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site E Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System 0 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 samples. (Certificates maybe 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 ray investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. i further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. 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 & 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 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 otherperson or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE ` V/Approved for _A_ bedrooms. Disapproved. Conditional approval for bedrooms, with the following Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Phone 337-6179 Date ! 12 - y Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other CE 7 53 E Prof essW'a, OF ON-SITE WATER AND WASTEWATER PROGRAM By: L�Original Certificate Date: _ (Rev. 11105) 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.ok.us (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: THE TABLELANDS, BLOCK 8, LOT 14 Parcel ID: 051-801-54 A. WELL DATA Well type Date completed _ Total depth ft. Date of test Static water level PUBLIC WATER If A, B, or C provide PWSID# Sanitary seal (Y/N)— Cased to ft. FROM WELL LOG Well production / —9 -P.M. WATER SAMPLE Well Log (Y/N) _ Wires properly protected Casing height (abo n AT IN CTION Coliform colonies/100 ml. Nitrate mg./L. Collected by: A ic: ug./L. Date of sample: B. SEPTIC/HOLDING TANK DATA TANK APPEARS TO HAVE 2' OF COVER PER 2005 INSPECTION REPORT. ASSUMED TO BE INSULATED. Tank Type/Material SEPTIC/STEEL Date installed 7/13/2004 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping Pumper r S C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 7/73/2004 Soil rating (g.p.d./ftbr /bdrm 0.80 System type BED in. Length 67 ft. Width 15 ft. Gravel below pipe 0.50 ft, Total depth *3.33 ft. Eff. absorption area 1005 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 7/26/12 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 932 gal. New depth 5_5 in. Elapsed Time: 920 min. Final fluid depth 1 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date — HOUSE VACANT STARTING MAY 29, 2012 D. LIFT STATION Date installed "Pump on" level at in. E. SEPARATION DISTANCES F. G. I Size in gallons Manhole/Access "Pump oftlevel High water alar level at in. Cycles tested Meets alar & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot On adjacent Absorption field on Public sewer main Sewer /septic service line areas- m On adjacent lots manhole/cleanout Holding tank anure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 53+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 101+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ COSA Fee L. '1 '7 6 ) Date of Payment Receipt Number d 7I)q 6 0Rsv. 11/05) Waiver Fee $ Date of Payment Receipt Number Terry Voorhees 22444 5ambar Loop Chugiak AK 99567 I have lived at this address for the past couple of years. We have serviced the system every year in June by JR septic company. The septic system has never frozen while I have owned the house. Terry Voorhees Municipality of Anchorage ° Development Services Department Building Safety Division On -Site Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 j_ /y/�/ www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. OS J- 901-S`/ COSA# OCIOQ6d 1. GENERAL INFORMATION Expiration Date: 7-7 — / o Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address THE TABLELANDS, BLOCK 8, LOT 14 22444 SAMBAR LOOP * CHUGAIK, AK 99567 BILL HODGES Day phone 22444 SAMBAR LOOP * CHUGAIK, AK 99567 Day phone 830-7718 LAVONNE VOGT w/REMAX PROPERTIES Day phone 884-1025 110 W. 28TH SUITE 100 • ANCHORAGE. AK' 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System N TYPE OF WASTEWATER DISPOSAL: Individual On-site N Individual Holding tank ❑ Community On-site ❑ 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 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 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 riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD. SURE 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 8 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 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 _q__ bedrooms. Disapproved. Phone 337-6179 Date 6 -L3 05 Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory y Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Nitrate Advisory Other By: (Rw 11/5) OF ,ANC+,s,% . O ••ON-SITE WATER AND ; fn= WASTEWATER PROGRAM ' Original Certificate Date: —7-7-0-9 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: THE TABLELANDS, BLOCK 8, LOT 14 Parcel ID: 0-5-1- 901 - Sy A. WELL DATA PUBLIC WATER Well type If A. B. or C provide PWSID# _ Well Lo Date completed Sanitary seaLLYlN _ Wires properly protected (Y/N) �IaLdaPt R Cased to ft. FROM WELL LOG Date of test Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate mg./L. Casing height (above ground) in. AT INSPECTION ft. g.p.m. 00 ml. Ar Date of sample: 'Collected byi B. SEPTICIHOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 7/13/2004 Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 6/22/09 Pumper ' ' JR'S PUMPING C. ABSORPTION FIELD DATA PEELOW EXISTING GRADEJ Date installed 7/13/2004 Soil rating (g.p.d./ft'o /bd 0.80 System type BED Length 67 ft. Width 15 ft. Gravel below pipe 0.50 ft. Total depth •3.60 ft. Eff. absorption area 1005 ft' Monitoring tube YES Depression over field NO Date of adequacy test 6/18/2009 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth In absorption field before test DRY in. Water added 1000gal. New depth DRY In. Elapsed Time: 0 min. Final fluid depth DRY In. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &Type) NONE KNOWN If yes, give date - D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at in. "Pump off" leve High water alarm level at in. Datum Cycles tested Meets alarm &circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank lift station on lot On adjacent lots Absorption field on lot On adjace Public sewer main Public sewer manhole/cleanout Sewer /septic service ' Holding tank 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 101+ Surface water 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: h Property line 10'+ Building foundation_ 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ F. COMMENTS G. ENGINEER'S CERTIFICATION a I certify that I have determined through field Inspections and p l Ivo, review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Q J f A. Corn ss.-' Engineer's Printed Name JEFFREY A. GARNESS QQ E— :� Date Pro re° slo^°q4 4O�0��0p00u. � COSA Fee 5 i/O L Waiver Fee $ Date of Payment -71/1 U9 Receipt Number. o G a (Rev. 11105) i Date of Payment I Receipt Number ■■■ 06/26/2009 10:14 9073449821 JRS SEPTIC ■ ■ i■ sus si JRs Pumping PO Box 773415 ' Eagle River, AK 99577 (907) 694-6454 Billin Information =J Bill Hodges Job Description' 12508 22444 Sambar Loop P.O. Number Chuglek, AK 99567 (907) 688-8799 Job Site Infer �.-I Kyle w/Games 22444 Sambar Loop Chugiak, AK 99567 (907) 694-4722 360-3835 Terms! Net 30 selesrep' Dawn -Dawn Map Book: Cross meets: Oberg Road Job Comments' Last Service normal -1250g flushed 1 time I outs normal I L tion Comments Diagram: c tniwt sms119751 bm- n PAGE 01 Service Agreement Number. 028913 Order Date: 1"un-2009 Service Date: 22 -,jun -2009 12:00 Technician: Bruce Tax %: 0 Job Type: Repeat Map Grid: 14 - - 1250g Gallons Planned: 1250 Addltlona oca trs are on Chocoalle Brown Home • • LF Gal. Actual:—' w/Gold Trim - Red Door - 4-Bdrm Hose Length: 2.5 Septic (M Left Rear of Home Double Tank: ❑ Pump System: 0 Baffles Inlet: ❑ tW Baffles Outlet: ❑ Service Type Qty Price Each Tax? Extension Actual yP Septic Sery 1250K 1 $0.00 No $0.00 NonTaxable Total Taxable Total Tax Total Grand Total Estimated Charge'' Actual Charges: Customer agrees to the terms and eondItions shown. THIS Is A BINDING AGREEMENT. ndTItl of Custome+Representative Date Atsapted by JRa Pumping Date Accepted For your added corivanlonea we accept; American Express. Dicover. Visa and Master Card payments over the phone. Aller 30 Days account whl be turned over to COLLECTIONS. $30.00 For NSF Checks Returned. Municipality of Anchorage---�J�� Development Services Department ^' Building Safety Division onSite Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-0650 www.muni.org/onsfte (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-801-54 COSA # OCol) 13 Expiration Date: 5P-7 �L tf — 0 7 1. GENERAL INFORMATION Complete legal description Lot 14 Block 8 The Tablelands Location (site address) 22444 Sambar Loon Chuglak AK 99567 Current Property owner(s) Shelly & Chet Garroutte Day phone 688-8595 Mailing address 22444 Sambar Loop Chugiak AK 99567 Lending agency Day phone Mailing address Real Estate Agent Hope RussoMorthem Trust Day phone 301-0701 Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class A Well ® Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite 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 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 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 Pannone Engineering Services, LLC Phone 272-8218 Address _P.O. Box 102954, Anchorage, AK 99510 Engineer's Printed Name IStever R. Pannone. P.E. Date 5/18/06 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 under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water *�( 444 levels that may fluctuate during the year, and the water usage of the family being served by the system. •`�P��"'""' e�� These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that o w w +� �, there are no hidden defects or encroachments. PES can therefore not provide any warranty for future 0 performance nor give any estimate of how long the system will continue to meet the operational • „`� requirements of the MOA DSD. The content of this report is for the sols benefit of the owner listed �0 r- Steven k. Pa��nonel : above. Any reliance upon or use of this report by any other person or party is not authorized nor will it 00c' N� CE 8114 confer any legal right whatsoever. 5. DSD SIGNATURE ✓ Approved for 4L bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By:/, �s�t Original Certificate Date: _-2 (Rev i1g5) Municipality of Anchorage Development Services Department Building Safety Division `4061", Onsite Water & Wastewater Program 4700 Bragew Street P.O. Box 196850 Anchorage, AK 9951943850 www.muni.orglonstte (907) 3437904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: rot 14 8k 8 The Tablelands Parcel ID: C) S I - 8 O1- 6 q A. WELL DATA Well type A Date let Total depth _ Date of test Static water levet Well production WATER SAMPLE Coliform _ z MO If A. B, or C provide PWSID ff Aug, U Sanitary seat (Y/N) I� Wires No Cased to fL LOG_ ` g.p.m. 00 mL Nitrate m91L B. SEPTICIHOLDING TANK DATA Date of sample: Tank Type/Material enehonas Tank !ileal Tank size 1250 gal. Foundation cleanout (Y/N) Y Number of Compartments Y Depression over tank (Y/N) H Date of pumping -WIMM— Pumper JRs Pumping C. ABSORPTION FIELD DATA Well Log (Y/N) Ard%cted (Y/N) (above ground) in. . AT INSPECTION ft. g.p.m. colonies/100 mL CSI Cleanouts(YIN) High water alarm (Y/N) WA Date installed TROR004 Sail rating (g.p.d.lfe or fe/bdrm) 0,4_ System type Bed Length 7 R Width 15 R Gravel below pipe 0.5 fL Total depth 12 ft. Eff. absorption area naftz Monitoring tube Y Depression over field it Date of adequacy test 0 110 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test In. Water added= gal New depth— Elapsed in. Elapsed Time: =min. Final fluid depth =1n. Absorption rate >= 800► 9•p•d• Any rejuvenation treatment (past 12 mo.) (YIN & type) NO If yes, give date D. UFT STATION D installed Size in gallons 'Pump on I gt _ in. 'Pump ofr level at _ in. Datum Cycles tested i E. SEPARATION DISTANCES SEPARATION DISTANCES FROM Septic tank/I'SW on on lot Absorption field Public sewermain TO: dol (YIN) 7— water alarm level at - Meet& alarm & circuit requirements? On adjacent lots On a' nt lots Public sewer Sewer ptic service line Holding tank imal containment areas Manure/animal excrete storage are SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation T Property linetom' Absorption field 10+ Water main 100+ Water service line 25+ Surface water 100+ Wells on adjacent lots _100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 15' Building foundation 21' Water main 100+ Water Service Ane 25+ Surface water 100+ Driveway, parkingh*We storage 35+ Curtain drain pone Observed Wells on adjacent lots 200+ F. COMMENTS O. ENGINEER'S CERTIFICATION .••�� G S '4e 1 ceM/y that I have determined through field in J'' `• 9 review of Municipal records that the above systems are in oorrfamance with MOA COSH guidelines in effect on this date. Engineer's Printed Name Steven R Pannone. P.E. steve^ Po, 1\o. CE 8149 rr 6�i Dat@ •ee z ..... ' COSA Fee E 3 d Waiver Fee S Date of Payment Z v Date of Payment ' Receipt Number ` (l Receipt Number (Rev. 1 trot) in. tq- ,Tku err 1` ZSZ,6 S .::•'G '....�.. c.• . •M fpaM .:�, rn a 3,•i f' y.'}3 � 'an " :� p NjJ]4Ne�Np q.v O. v•1MCH �,�' t •M'a�'Yf1�. f..a4 fv . AS -BUILT I hereby certify that 1 have surveyed the following described property: L e7 /!'- l e c r. F Th Z. r a n,4S 'f 3� sr ion 'L, i' 1it/ y 5N1, Anchorage Recording Precinct, Alaska, and that the improve- ments situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Eagle River, Alaska !S2 y r, Ham_ this a of ROBERT C. JOHNSON;, - SCALE- Registered Land Surveyor Nd. 88(1LS 1' 1. Z�o r Box 77-0456, Eagle River, Alaska 99577 Phone f9M 694-2543 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 05180154 HAA # d-5 0 n3-4- Expiration Date: _ 1. GENERAL INFORMATION Complete legdt description Lot 14, Block 8, The Tablelands Location (site addressor directions) 22444 Sambar Loop, Eagle River, AK 99577 Current PropetW owoer(s) The Thomas Co. Day phone 746-0682 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address HC05 Box 6929, Palmer, AK 99645 1 st National Bank of Anchorage Day phone 777-5607 PO Box 100720, Anchorage, AK 99510-0720 Gina Duncan, Prudential Jack White Day phone 230-9699 3201 C Street, 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 ❑r Individual Water Storage ❑ Individual Holding tank ❑ Community Class A 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 tide (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 Finn Alaska Rim Engineering, Inc. Phone 745-0222 Address PO Box 2749, Palmer, AK 99645 Engineer's Printed Name Mary L. Shreves 5. DSD SIGNATURE Approved for _—LL_ bedrooms. Disapproved. Conditional approval for Date 1/25MS bedrooms, with the following Attachments:. HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: I ;I LEGEND: LOT 13 ; (C)-CALCULATED DATA (M)=MEASURED DATA (R)�RECORD DATA WATER I U.G.�UNOERGROUND 589.56'06"W VALVE 252.84'(R)252.72 (C) H ;1 30' I 30' NAT'L0 GAS- I w v v r7 17 O M M'1 m 26. 06 06 LOT 14 TYPDECKICAL 30.1 u GRIVEWAY 00 00 In j 7W0 STORY 3 40,016 S.F. DWELLING r 33 > a 3 3 BLOCK ® I 1`0 ae'4 IA N nLO N O 3 Y O O O ® Z Z SEPTIC � CANT. I o O RISER C'1�Jr�© Z Z U.C. I TYPICAL S to ELECTRIC S ~ TRANSFORMER I ko PAD FOUND BASIS OF BEARING CLEAN I 518' REBAR 589 56'06"W OUT UTILITY PEDESTAL 4094-S252.65 (R)252.72 (M) TYPICAL I LOT 15 i m I I I I;I I Im Z 150' NOTES: 1. THIS SURVEY COMPLIES WITH ASPLS MORTGAGE LOCATION STANDARDS. 2. THIS SURVEY REPRESENTS VISIBLE IMPROVEMENTS & CONDITIONS ON THE DATE OF SURVEY. 3. THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY & IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. EXCLUSION NOTE: R IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS. COVENANTS. OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. AS—BUILT ASP.O. BOX 2749 PAGE 1 of 1 RIM PALMER, ALASKA 99645 P�rL •OF• qL�� ENC EE INC. PHONE: (907)745-0222 S�•' �y FAX: (907)746-0222 F.B. 05-03 *' 9TH*•••';o- W O. 0400286 DATE: 1/12/05 SCALE: 1" = 50' 1 FILE: 04-00286AS 1 HEREBY CERTIFY THAT A MORTGAGE INSPECTION WAS PERFORMED UNDER MY DIRECTION ON THE FOLLOWING DESCRIBED PROPERTY: :Robe1 J. Former : b' LOT 14, BLOCK 8, THE TABLELANDS SUBDIVISION f,�9• •• 10615-S : ' PLAT No. 2004-25, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, ALASKA �j;;'*.1S1 ... *•* EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. DATED AT PALMER, ALASKA, THIS 13th DAY OF JANUARY, 2005.