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HomeMy WebLinkAboutSOUTHFORK BLK 4 LT 3outhfork Block 4 Lot 3 #078-031-05 C-34- Municipality of Anchorage Page _Lof DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report 6 W %0o240 Permit Number: PID Number: Name6 S ¢EI2L MEQ Wastewater System: Aew EI Upgrade ACIVS. r3 5/ O 95So� ABSORPTION FIELD Phone* No. OI B-drdom4: ❑ Deep Trench hallow Trench ❑Bed ❑Mound ❑Other LEGAL DESCRIPTIO LEGAL $OII Rating: D A GPD/S ft Total Depth from original grade- Lot. Block: ubdrvision: 5 _q Depth to pipe bottom from Onanal gra9e: �. Gravel depth beneath pipe ZV,22ez Ft "4 FI Township: Range. Section: Ftll added above original gradei* y Gravel length: �� Ft FI WELL: New ❑Upgrade Gravel width: Numberollines: Dishncebetweenlines Ft Ft Cl tication (Private. A.B.C): ��I Total Depth: Cased To: Total absorption area Pip ma�t�eanLa�l: � /Q n Pt/ t�� Ft. Ft. SO FI // / Driller: Date Drilled: Static water Level: Installer: ffa 1F Date i 1 led: q2 o J Ft. -LL Yield : Pump Set at: Casing Height Above Ground. TANK GPM Fl Ft. SEPARATION DISTANCES 16septic ❑Holding ❑S.T.E.P. To Seplic Absorplion Ldt Holding ubbUPnvaie Manu actur r;// _/tom Capacity in gallons' /:?_� From Tank Field Simian Tank Sewer Lines/!L /.NJL--••e TT11 Well 1 I ,r _ 41L -- �– _ / ,L 16+ Maleri �y�L rcG Number of Compartments: 2 — LIFT STATION Water I-1• c— Lot (C)'4— to r L T Size in gallons: Manufacturer: Line Foundation 1 *P4-1 1 tQ+ 'Pump on" level at: "Pump all" et: High water alarm et: Curtain. I _s 1 Pump Make 8 Mod lectrical Inspections performed by: Drain NUN Remarks: 40"4&_1157 BENCH MARK Location and Description: 5 tG Assumed Elevation: /�r(5 FL ' ENGINEER'S SEAL ��a a r�• A f 0 t�� S 8 S ENGINEERING *' T Inspections performed by: 1s Eagle River, Alaska 99377 2nd .'..'" +' :b.n A. ShcY..+••. �� a boo Department of He nd Human Services approval �/Date: 'Zi Reviewed and approved !:,7T" • a9.�,.� ->`� 7I-013 (Rev. 9/91) MOA 25 ,VY 7/r/pj%! Aa.7 re�upjatiaY. �j i 1IRSAAMng June 30, 1994 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694.1211 NEALTI/ AUTHORITY APPROVALS Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES R Er 17! ' I F f i Attention: Robby Robinson 825 'L' Street JUL 0 1 19 ? 4 SEWER&WATER P.O. Box 196650 MAIN EXTENSIONS Mu.. - Anchorage, Alaska 99519-6650 Dept. He,34'i c. Huwaa!l =s v ces SEWER 8 WATER INSPECTION REFERENCE: South Fork Subdivision, Block 4, Lot 3 ANDREPORTSSTUDIES On September 10, 1993, a septic system was installed on the referenced property and a 'Wastewater Disposal System and Well Inspection Report' was submitted to your office. WELL94SPECTON TEST 6 FLOW TEST During your site visit in November 1993, you discovered the elevations of the newly installed septic system had changed since we had completed our final inspection. SITE PLANS After careful inspection of the existing drainfields we have concluded both trenches have 3.5 feet of sewer rock. However, monitoring tube one was found to have rocks in the bottom six inches of the tube. ROADDESIGN If you have any further questions, or require additional information for your review,pi contact us. SOLTEST Sely, 'MST TX>H A ,&ber(✓Sh�afer. P.E. T '13AS/LSFAsf URAL 6 MECIAANICAL INSPECTIONS ON SITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 • Permit No. SW930240 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: SOUTH FORK, BLOCK 4, LOT 3 PID No.: 07803105 Page 2 of 2 cot co PS.T.i 93.4 93.2 N.T.S. MT1 C04 70.7' NO WATER FOUND A 7' FOO \ 4 DRIv[ OUSE _eENO1t1EERi15 ./ 11.1TAT1^kf TH #t .e f_ V„AC-, 100' WELL RADIUS WELL SCM2 1' - 40' 72-013 A )2191) MOA 25 FCO 23 24 Cot 39.5 26 CO2 57.5 33 COa /NEB TRENCHES - - CO3 55.5 45-- _ cos un C04 99 73 \\ C05 96 77.5 un \ \ 1IT1 MT2 97 92 74 5 N CO2 \\ c0 0M co 1250 CAL. SEPTICIANK CO3 C01 FOO \ 4 DRIv[ OUSE _eENO1t1EERi15 ./ 11.1TAT1^kf TH #t .e f_ V„AC-, 100' WELL RADIUS WELL SCM2 1' - 40' 72-013 A )2191) MOA 25 PAGE 1 OF MUNICIPALITY OF ANCHORAGE al n m DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930240 DATE ISSUED: 7/13/93 DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE: 7/13/94 OWNER NAME:METS.JOSEPH S & BEVERLY J OWNER ADDRESS:P.O. BOX 5106 FT. RICHARDSON, AK 99505-1016 PARCEL ID:07803105 LEGAL DESCRIPTION: SOUTHFORK BLK 4 LT LOT SIZE: 70993 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: :s•L_'D. ISSUED BY: DATE: ZI / q3 DATE • 1 SEWER A WATER INSPECTIONREFERENCE: South Fork Subdivision, Block 4, Lot 3 ENGINEERING STUDIES He request you issue a permit to install a septic system to ANDREPORTS serve the proposed four bedroom house on the referenced roperty. Three test holes were performed on the property. The aiiOWTEST approximate location of the test holes are located on the attached site plan. After seven day groundwater monitoring he monitoring tubes within the holes were checked; test holes one and two were found to be dry, and water was found SITE PLANS t 10' in test hole three. This property has enough area for a future septic upgrade, which can be seen on the attached site plan. We do not ROADDESIGN anticipate any adverse effects on neighboring properties by he installation of the proposed septic system. If you have any questions, or require additional information for your review, please contact us. SOIL TEST incer v. PERCOLATION TEST STRUCTURAL MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSALSYSTEM DESIGN A. , P.E. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER. ALASKA 99577 ! ROBERT SHAFER. P.E. 40, ROGER SHAFER. P.E. CIVIL ENGINEERS A° Si (907) 694-2979 A 1: FAX 694-1211 July 8, 1993 RrVCR A�'SAR HEALTH AUFMRNY APPROVALS unicipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES SEWER & WATER MAIN MENSIONS 325 L Street chorage, AK 99519-6650 SEWER A WATER INSPECTIONREFERENCE: South Fork Subdivision, Block 4, Lot 3 ENGINEERING STUDIES He request you issue a permit to install a septic system to ANDREPORTS serve the proposed four bedroom house on the referenced roperty. Three test holes were performed on the property. The aiiOWTEST approximate location of the test holes are located on the attached site plan. After seven day groundwater monitoring he monitoring tubes within the holes were checked; test holes one and two were found to be dry, and water was found SITE PLANS t 10' in test hole three. This property has enough area for a future septic upgrade, which can be seen on the attached site plan. We do not ROADDESIGN anticipate any adverse effects on neighboring properties by he installation of the proposed septic system. If you have any questions, or require additional information for your review, please contact us. SOIL TEST incer v. PERCOLATION TEST STRUCTURAL MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSALSYSTEM DESIGN A. , P.E. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER. ALASKA 99577 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS . SOUTH FORK SUBDIVISION, BLOCK 4, LOT 3 GENERAL: 1. The scope of this project includes the installation of a 1250 gallon septic tank and five foot wide drainfields to serve the proposed four bedroom residence for the referenced property. 2. Construction shall be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. Page Two South Fork Subdivision, Block 4, Lot 3 July 8, 1993 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed - up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter and installed approximately in the locations shown on the design. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page Three South Fork Subdivision, Block 4, Lot 3 July 8, 1993 MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: e of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 38 passing the #200 sieve. 7. When sand is being used as a filter material, it's gradation specifications must conform to AMC 15.65.060D. Page Four South Fork Subdivision, Block 4, Lot 3 July 8, 1993 Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre - construction meeting will take place on-site. PERFC IEGAI 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 (C�E / 6TEST RUN B/ETWEEN NO .=I'S" FT COMMENTS-IjJ,WIDE / 'DEEP kv .2rc-,E�f_.To-r,4(- LU^*70,-[Pa11CFf PERFORMED BY: S �& S• E,NvGarIN� EERING ALACCORDANCE WIJH LjfRl0"trML?ft IP" (L 12-0081Re. 1851 A asko 99577 T. GRAAQFAU' AJ 7tW CERTIFY THAT THIS TEST WAS PERFORMED IN ON THIS DATE. DATE: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION:,yZ�Uxz DEPTH (FEET) 1 ��. �(2GRNIcS 2 DATE Township, Range, Section: 3 Gam- Su.-ge Swoy C7RAcSF�Q—� E 5- "D= -FA wtT(4 DGM4. 6- 7- 8- 10- 11 781011 12 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS 314151617181920 0 COMMENTS WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L 0 DEPTH? P E Depth to Water Abu('��,� ^ Monitoring? , (ENGINEERS SEAL) P.a O.. !'- .% r -,f PLAN C ®=mmm PERCOLATION RATE � (mmUteS/InCh) PERC HOLE DIAMETER TEST RUN BETWEEN j4ND /S FT PERFORME[W ENGINEERING I CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Eagle Rivw Loop Road No, ACCORDAN@j^-%4Q'/IkAJ11 *NICIPAL ELINE TON THIS DATE. DATE: 72.008 (Rev. 4185) 7'Y��� PERCOLATION RATE � (mmUteS/InCh) PERC HOLE DIAMETER TEST RUN BETWEEN j4ND /S FT PERFORME[W ENGINEERING I CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Eagle Rivw Loop Road No, ACCORDAN@j^-%4Q'/IkAJ11 *NICIPAL ELINE TON THIS DATE. DATE: 72.008 (Rev. 4185) 7'Y��� k: % d Y U p z0Na W N N w 6 4 i U =ca V) a CL �, O : ; z40 W 0Z —x 0V021 Na3a� H1flOS �I.F..O0� w1D W A tO OZ WZ U0 OC, �Iloll .7 =p z�llcq LJ en �n-W4Z rQ�QIr U W2 2 �Q N\ LLJ - W - .�T-.W V am UNR. L ♦ e > Qo3L. 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C0yscr" gow%^ 5. —Pt Phon• 1 Fu• I Fax SURDN16.ON I LOT I ►LOCK LOCATIONISKETCH: DEPTHS MEASURED FROM;Ocesino top 09mund sl:rface 9011EHOLE DATA: Depth Materlat Type and Cotor From To Dept. LECT,ON WAS FELL HOMES P.01 5ea.19.1993 01:51 0.l ml . STATE OF ALASKA DEPARTMeNT OF NATURAL RESOURCES DIVISION OF WATER WATER WELL RECORD WELL OWNER: CQCTION I IOYMOMP I FAN09 I MERIDIAN Mu 0E OS E3W bwq liDgwD WELL DEPTH: % DATE OF COMPLE71Or�N Depth of I)DIe099 �ft - - _.1__ Depth of Oaten ft I DEPTH 10 STATIC WA.TJR LEVEL: 1t belowL top of casino O around cvrf►ce Date:_ MET HOU OF DRILLING: Y''elr rotary 0 taoia tool O ether _ USE OF WELL.'R domestic E7 IrrioaUD11 O monitor ❑ p'JOic supply Cl Cth2r _ CASINO STICK-UP; 2 ft. in. toeg V1ELL INTAKE OPFN,N(3TYPE: gopen end O screened D perforated E] opan hose Dsp:hs of openl')V: __ to ft SCREEN TYPE: Diam: In. SlotlMesh Size: ��a� Lonolh. ft GRAVEL PACK TYPE. Vofvme Used: Depth to top: GROUT TYPEt V:Ivme: Depth: from itto�_ft DEVELOPMENT Ir1ETHOD., PUMPIr 0 LEVEL AND YIELD - PUMP ft eller ^M flit Cump!nB� OOm PUMP INTAKE DEPTH: ft ttorsepower: WELL DISINFECTED UPON COMPLETIONt p )T ONO CONTRACTOR INFORMATION: a-12lic�tl,.� ep�tt a us nest me —T"— hipndtiite o. ut ntC CS'Pr45C ,vC stv �� REMARKS: PLEASE MAIL V HI'TE COPY OF LOQ TO: DNR!D SION OF WATER P� .OX 772116 EAGLE R . .R AK 9SS77 2116 f�\)E CWAI✓ 05--0312- odaqn0ai&-k Municipality of Anchorage Development Services Department �• Building Safety Division On -Site Water and Wastewater Program s „ 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-0650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 078-031-05 HAA #_ `5'031 �— Expiration Date: 7 1,01a 1. GENERAL INFORMATION Complete legal description Lot 3. Block 4. South Fork Subdivision Location (site address or directions) 1520 South River Drive Eagle River, Alaska 99577 Current Property owner(s) _John and Jennifer Mayer' Day phone 622.6979 Mailing address 1520 South River Drive Eagle River, Alaska 9957 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Four 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site ED Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) 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 affixed hereto and as of the validation date shown below, 1 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.O. Box 240773 Anchorage AK 99524 Engineer's Printed Name Michael E. Anderson P.E. Date 10/19/2005 (J 49th 1 5. DSD SIGNATURE ANUptSOI NO CE -4381 Approved for � bedrooms. ���e tit�o Disapproved. �h�aaEss,�:r Conditional approval for bedrooms, with the following stipulations: NAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date: o (R.v. 12000) Municipality of Anchorage , Development Services Department Building Safety Division Onsite water & Wastewater Program 4700 South Bragaw SL P.O. Box 198850 Anchorage, AK 99519-850 www.cLanchorage.ak. us (907) 343-7WM HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 3. Block 4. South Fork Subdlvblon Parcel ID:_731-03 A. WELL DATA wen type )&rj(g If A, B, or C provide PWSID S. wen Log (YIN) Y Date completed SH2093 Sanitary seal (YIN) I Wires property protected (YIN) Y- Total depth 101 R Cased to AQLfL Casing height (above ground) >18 in. FROM WELL LOG AT INSPECTION Date of test 512/1993 71@005 Statle water level 62 fL 42.1 fL Well production 30 g.p.m. 73 9- p.m-WATER SAMPLE RESULTS: Conform -L-colontes/100 mi. Nitrate , 49-mg.A. Other bacteria _L colonies1100 ml. Date of sample: 10/4121105 Collected by: _ LH B. SEPTICIHOLDING TANK DATA Tank Type/Material seotMJ3teat Date Installed ORCH993 Tank size 1,250 gal. Number of Compartments Cleanouls (YIN) Y Foundation deanout (YAV) I Depression over tank (YIN) j( High water alarm (YIN) N Date of pumping 72=5 Pumper ,IRs Pumotno C. ABSORPTION FIELD DATA Date Installed OROMI13 Son rating (g.p.dAt2 or fl=Ibdrn) A GPplSF System type S Wide Trench Length 42 R Width 5 IL Gravel below pipe 3.5 it. Total depth Q M Effabsorption area ZRft° Monitoring tube.Y Depression over field jq Date of adequacy test 519@005 Results (Pass/FaIQ Pett_ For 4 bedrooms Fluid depth in absorption field before test 4 in. Water addedi19 gal. New depths In. Elapsed Time. 19 min. Final fluid depth I in. Absorption rate k $W g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) _ N If yes, give date D. LIFT STATION Date installed 'Pump on' level at _ in. Datum E. SEPARATION DISTANCES Size in gallons Manhole/Access (YM) 'Pump air level at — in. High water alarm level at in. Cycles tested Meets aiamr b dreuk (worements9 SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAiR station on lot >f110' Absorption field on krt ),100' Public sewer main - WA On adjacent kris >IW On adjacent lots ;,1W Public sewer manholetcleanout WA Sewer /septic service line >25, Holding tank WA SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation >S Property one aI Absorption field >3 Water main WA Water service One >10' Surface water >f00' Wells on adjacent lots >Ilr SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >f0 Building foundation >f0' Water main >flr Water Service line >10 Surface water Ddveway, parkkp/,r W8 storage ),25- Curtain 2SCurtain drain _ N2ns Noted Wells on adjacent lots MW F. COMMENTS G. ENGINEER'S CERTIFICATION �.1 • �OF �qse ��pE ............. s� I ce►dfy that I have determined tMrmVh Re/d inspections and �;'e review of Munk*pal records that the above systems° edon are d 4th lo conformance with MOA HAA guidelines efi'ect on This date, Engineer's Printed Name Michael E Anderson, P.E.y��:tea—r.S°/' Date 1111"I 200S HAA Fee Date of Payment Receipt Number (Rev. 17100) Waiver Fee Data of Payment Receipt Number SCS Rc0 1056627001 , 4 All Dates/rimes are Alaska Standard Time Cllent Name Anderson Engineering�GT 1520 South River Drive Container ID Limits GOP 5 oJTF1 Date Init Printed Date/Time 10/12/2005 15:24 Project Name/# 10/05/05 AZS r -o eu` Collected Date/rime 10/04/2005 15:00 Client Sample ID 1520 South River Drive Received Date/rime 10/04/2005 16:35 Matrix Drinking Water Technical Director Stephen C. Ede PWSID 0 Sample Remarks: Microbiology Laboratory TotalColiCorm 0 col/100mL SM209222B A (<-1) 10/04/05 TLF Allowable Prep Analysis Paramcter Rcsuits PQL Units hicthod Container ID Limits Date Date Init Nitratc-N 0.964 0.100 mg/L EPA 353.2 B (<-10) 10/05/05 AZS Microbiology Laboratory TotalColiCorm 0 col/100mL SM209222B A (<-1) 10/04/05 TLF SGS/CT&E ENVIRONMENTAL SERVICES Drinking Water Analysis Report for Total Coliform Bacteria READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE MUST BE COMPLETED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM 104 T7I PRIVATE WATER SYSTEM [] Send Results ❑ Send Invoice CN. W.W y..m N.r.ppNry CpNnM M.ny 1�4 LC n fa Nunp.r 522-1'7-13 ("-n--7-7U(P 0 $ 0 K DA0773 zece _ SAMPLE COLLECTION: Date:I � ® Zvv 00 M Day V. 200 W. POTTER DRIVE ANCHORAGE. ALASKA 99518 Tet: 907.562-2343 Fax: 907-561-5301 Lab Ref No. 105662711k - iiiiii ❑ Send Results 13 Send Invoke wNN s..r.N.n.Cm�p.�yNwi. [ax.e N.n. Plvr N.n.. fa Nunp.r Ca sur zece SAMPLE TYPE: ❑ Routine ❑ Treated Water Time: W ALI PM ..i Repeat Sample Untreated Water Location: Ism souy4 Zap I -tz 'Y,) AVC. (refer to lab no. CoIlactor. WNpA �f'-NAMN-Z ❑ Special Purpose Transported to Laber• KJ Same as collector Other. 3 T' / �= .. TO BE COMPLETED BY LABORATORY Sample Receiving: Date: 10 A O S ❑ sample.over 30 hours old; Time: I Results may be unrellable Temp: 048H.,W.lver Delivery Method: .4 040 �Rsmotepeati a Received By,.Fe2.£3 I Ad Cc1Q-�� Comments: ❑ RUSH SAMPLE Phone III: Fax #: .............. ....................................... ............. ....... .......... .............. ............................................. Bacteriological Water Analysis Record: Ana"Is8elian: /O/•/�Jr— Analyst: //— Analytical Method: Membrane Filter MMO-MUG (P/A) Reported By: ✓>" pu Nn MMO-MUG (PIA) RESULTS: Tout Coliform: E. Coll: MEMBRANE FILTER RESULTS://: Direct Count Coknies/100ml- Venflwdon: r _[LTB: BGS: EC: Sent to ADEC: PNC FBK JUN Date/nm: Sent to Client Phoned Q Faxed Q Data/rim'. Spoke whh: Satisfactory Unsatisfactory TNTC • Ta. Nun.raw b Ca.nr Date/Time: 10Aye,.' /,.1.,-.0 08.0 r11n I Form p FW- 0053 12/17/03 tWsesinasOl VW K GroupData%PubL-OOCUMENTIFORMStapprovedtColl Form 121703.x1s 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 99519-0650 www.cl.anchorage.ak.us (907)343-7904 _m__4 ` j_ ZD CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 076-031-05 HAA# 105031 Expiration Date: 10 — 19 0 5 1. GENERAL INFORMATION Complete legal description Lot 3. Block 4. South Fork Subdivision Location (site address or directions) 1520 South River Drive Eagle River, Alaska 99577 Current Property owner(s) John and Jennifer Mayer Day phone 6226979 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 1520 South River Drive Eagle River, Alaska 9957 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System Four(4) Day phone Day phone TYPE OF WASTEWATER DISPOSAL: ® Individual On-site ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 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 engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health 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.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name _Michael E. Anderson, P.E.Date 710/2005 Aw119U&ZIMIr_V4t1j 4 Approved for bedrooms. 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: t//�.,/ cif: �o `�( Original Certificate Date: % - It? - os— (R«. 12=1 Municipality of Anchorage • Development Services Department Building Safety Division On -SM Water R Wastewater Program 47W South Bragew St P.O. Box 1!18650 Anchorage, AK 99519MW www.d.anchorage.ak.us (907) 343-79W HEALTH AUTHORITY APPROVAL CHECKLIST A. WELL DATA Well type PSS! If A, B, or C provide PWSID s _ Date completed 8n2M Sanitary seal (YIN) T Total depth jn–ft Cased to .141-R FROM WELL LOG Date of test &11211993 Static water level 62 fl. Well production 30 g.p.m. WATER SAMPLE RESULTS: Coltform ,j_coloniesll W ml. Nitrate jLmg.A. Date of sample: Sn911005 Collected by. —t B. SEPTICIHOLDING TANK DATA Tank TypelMaterlal SeoticOW Tank sae 1250 gal. Number of Compartments j Well Log (YIN) Y Wires property protected (YIN) Y Casing height (above ground) >1S in. AT INSPECTION 7nrm 42.1 fL Other bacteria _L colonies/1 W ml. .i II.i I*t Cleanouts (YAV) Y Foundation deanout (YAM Y Depression over tank (Y/N) h High water alarm (YIN) N Date of pumping 7x112005 Pumper ,Rjs Pwnvine C. ABSORPTION FIELD DATA Date installed 9l10n993 Soo rating (g.p.d.fle or fl?/bdrm) ,Q QPDI$F System type S Wide Trench Length 82 fL Width S ft Gravel below pipe 3.5 R Total depth ¢ R Eft. absorption area Zate Monitoring tube X Depression over field jy Date of adequacy test 5n9r100S Results (Pass/Fan) Pass For 4 bedrooms Fluid depth in absorption field before test I in. Water addedW gal. New depth4 In. Elapsed T'me: ¢Q min. Final fluid depth I in. Absorption rate k 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (YAV 3 type) N If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (YM) 'Pump on' level at _ In. 'Pump ofP level at _ in. High water alar level at in. Datum Cycles tested Meets alar & drwk requkements9 E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankNtt station an lot MW On adjacent k8s MW Public sewer main WA Sewer /septic service line >2S On adjacent lots MW Public sewer manhole/cleanout WA Holding tank WA SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation W Property Ane _ff Absorption field >S Water main WA Water service Ane MW Surfaoe water >1W Wells on adjacent lob AO >X P • � SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water main >10' Water Service line Mir Surface water >100' Driveway. parkkrgNeNele storage >2S Curtain drain None Noted Wells on adjacent lots MW P. COMMENTS 0. ENGINEER'S CERTIFICATION ��P�_ KI car My that I have determined through field MspecBorrs and 4 9th review of Munkxpet records that the above systems are in conformance w1M MOA HAA guidelines in effect an this date. aov L c acusm Engineer's Printed Name Mkhaei E Anderson, RE 1A& Ct -1 Date TI812008 HAA Fee E3 Waiver Fee S Date of Payment ! J g ©� Deis of Payment Receipt Number Receipt Number (Rev. two) E 8 SCS ReLp Client Name Project Name/# Client Sample ID Matrix Sample Remarks: 1052819001 Anderson Engineering Lot 3. BIk 4 South Fork Lot 3, Blk 4 South Fork Drinking Watcr All Dates/Times are Alaska Standard Time Printed Date/time 05/26/2005 8:13 Collected Date/Time 05/19/2005 16:00 Received Date/time 05/19/2005 17:08 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date fait Waters Department Nitrate -N 0.720 0.100 Microbiology Laboratory Total Coliform 0 mg/L EPA 300.0 B (<-10) 05/20/05 JIB col/100mL SM209222B A (<-I) 05/19/05 TLF 01111, SGS/CT&E ENVIRONMENTAL'SERVICES Drinking Water Analysis Report for Total Coliform Bacteria READ INSTRUCTIONS ON REVERSE SIDE BEFORC COLLECTING SAMPLE MUST BE COMPLETED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM IN ❑ PRIVATE WATER SYSTEM . . ❑ Sand Resorts ❑ Send h, 412%0 J t4 w etl4l e.w �,.�.... 522.- . r.e. L '17 Pon, z�o�73 its;- >W L SAMPLE COLLECTION: Data: 6+ l9 Thm:—LA-r'3 4 L c o AM A L.Ml.: LJ r 3 R rH rJL. J Cn. Trsnsportad to Lab By: R�ame as collector Other: TO BE COMPLETED BY LABORATORY Sample RecelvinD: Date: Z Time: J75 Delivery Met? Received Comments: ❑ Send Resuhs 1 i 200 W. POTTER DRIVE ANCHORAGE. ALASKA 99518 Tei: 907-562-2343 Fax 907-561-5301 Lab Ref No. 1052819 Irylry��pppplInnppppIl���Iy'y' I��p�ry�I 1pyI�1�nII ea'Yy� INIWYM UYI WI��Y � Saki twok.� SAMPLE TYPE �outine ❑ Treated Water ❑ Repeat Sample ;W-tlotreated Water lZo ILA< • (refer to lab no. 1 ❑ Special Purj)ose Sampo ow 30 hen old; ❑ RUSH SAMPLE R.sutta may be wadable ❑ as Hourw Phone #: " l Fasoru Fax M: .................................................................................... 0.......... 0........ ..................................... Bacterloloolcal Water Analysis Record: I Sentb ADEC: MMO•MUG (PIA) RESULTS: ANC FBK eaJUN Am"Is Ban: 9/b l7�/S Tonal Conform f + o,terrtma: . Amyst. 7,77- _ E. CW: Anety0cal MaMod: Membrane Filter MMO•MUG (PIA) Reported By: tiwP s MEMBRANE FILTER RESULTS: D"d corm CdaxeVIODmi. VerMptlon: rr a.ar. LTD: BGS: Dat*Mm*: $—�.� Z roJ- // ; c� . i \WseslnasOlVWK GmupDatalPubUdD000MENTIFORMS1eppmvedCoB Foran 121703ids Said to Clem Phoned 0 Faxed 0 Dats/Tsrle: Spoke with: tme •T« rlr�r r Ca•e On Form a FW 0053 12/17/03 Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 078-031-05 HAA# AlAQ-) a�5� 1. GENERAL INFORMATION Expiration Date:y2ir& Complete legal description SOUTH FORK SUBDIVISION; LOT 3 BLOCK 4, Location (site address or directions) 1250 SOUTH RIVER DRIVE Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address JACK & BETTY WESTPHAL Day phone /,s1.� SCJrKCiJaCDr- �nc zr�e1�', A� 44577 Day phone EVA LOKEN w/ PRUDENTIAL VISTA Day phone 689-6476 16635 CENTERFIELD DRIVE • EAGLE RIVER, AK 99577 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 Is Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) 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. Note: Alaska Water and Wastewater Consultants, Inc, shall be paid $ 735.00 at, orprior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS. INC. Address 6901 DEBARR ROAD, SUITE 28 " ANCHORAGE. AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AWWC, Inc. 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 lest, 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. AWWC. Inc. 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. DSDSjGNATURE 7 Approved for Disapproved. Conditional approval for bedrooms. Attachments: / HAA Checklist r� Septic System Advisory Well Flow Advisory Phone — 337-6179 bedrooms, with the Illowing stipulations: Manitenance Agreements Supplemental Engineer's Reort Other 5.... -7953 �e By:V Original Certificate Date: 7 `Y )R*v 12101) Municipality of Anchorage Development Services DepartmentBuilding Sa" Division on4a wow & WastewaterProgram 4700 South Bragaw St P.O. Box 198850 Anchorage. w 695198850 "melm%tvageA us (907)943-7604 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: SOUTH FORK SUBOMSION: LOT 3. BLOCK 4, Parcel ID: 078-031-05 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSIDN N/A Date completed 8/12/93 Sanitary seal (Y/N) YES Total depth 101 ft. Cased to 101 ft, FROM WELL LOG Date of test 8/12/93 Static water level 62 ft. Well production 30 g.p.m. WATER SAMPLE RESULTS: Well Log (YM) YES Wires property protected (Y/N) YES Casing height (above ground) 18+ in. AT INSPECTION 3/26/01 52 ft. 6.24 g.p.m. Coliform 90_ colonies/100 ml. Nitrate O- JL. Other bacteria m coloniesH00 ml. Date of sample: 4/15/02 Collected by. AWWC. INC. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 9/10/93 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (YM) YES Depression over tank (YM) NO High water alarm (Y/N) N/A Date of pumping 4/18/02 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA *LOWER TRENCH TESTED ONLY. UPPER TRENCH WAS COMPLETELY SURCHARGED. Date installed 9/10/93 Soil rating 2 rft%drm) 0_8 System type TRENCH Length 82 (20417 ft. Width 5 ft. Gravel below pipe 3.5 ft. Total depth 8+/— ft. Eff. absorption area 759 ft' Monitoring tube YES Depression over field NO Date of adequacy test 3/26/01 Results (Pass/Fail) "PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 999 gal. New depth 13.5 in. Elapsed Time: 1415 min. Final fluid depth 0 in. Absorption rate >= 600+ g,p.d. Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) NONE KNOWN If yes, give date I D. LIFT STATION 1 Date installed "Pump on" level at _in. Size in gallons Manhole High water alarm level at Cycles tested Meets alarm 8 circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT Til Septic tankAifi station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/deanout N/A Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 50+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 100+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parkingtvehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacent Igtg 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and *T.7 �4 review of Municipal records that the above systems are in """"' conformance with MOA HAA guidelines in effect on this date. Engineers Printed Name JEFFREY A GARNESS :Date� HAA Fee$ 375,' Date of Payment t!' cW�2 Q Receipt Number 0/8&55 (Rev. 12100) Waiver Fee $ Date of Payment Receipt Number 03/20/01 TUE 09:37 FAE 8898499 VISTA REAL ESTATE ER Gy s_ v N' v .� N ASBUILT Jp,y_c�ty�h. �•'• DAY//`i�Gwv.• /P i f0� SEWARD & HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE' -OLLOWING DESCRIBED PROPERTY= .COT �il'� ' DATE: %NO THAT NO ENCR06CHMEN{S EXIST EXCEPT AS NOICATED. IT IS THE RESPONSIBILITY OF THE WNER TO DETERMINE THE EXISTENCE OF ANY GRID: :ASEMENTS, COVENANTS, OR RESTRICTIONS fw/,oj-p VHICH DO NOT APPEAR ON THE RECORDED SUSDI- 'ISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB` Bt- at kNY DATA HEREON"BE USED FOR CONSTRUCTION )F FENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN] %RY LINES. O—Ill" Q002 4-22-02;11:4eAM; I ME Environmental Services Inc. s.� IL..714 F1A7R1M.^l/DO :/lJ.�/.JCJG7F./.:Y�>G><1 Cr&E Ref.# 1021903001 Client Name AK Water & Wastewater Consultants Inc. Project Name/# South Fork S/D; Lot 3. Block 4 Client Sample ID South Fork S/D; Lot 3. Block 4 Matrix Drinking Water Ordered By Date Date Init PWSID 0 ;907 661 6301 M 2/ 3 .. Y i' All DatesMmes are Alaska Standard Time .. PrintedDate/fime 04/17/2002 10:24 1i Collected DateMme 04/15/2002 11:15 it Received Datc]Time 04/15/2002 12:40 Technical Direc =hC. � Released By ; Sample Remarks: .. Allowable Prep Analysis' Parameter Results PQL Units Method Limits Date Date Init Waters Department Nitrate -N 0.746 0.200 mg/L EPA 300.0 (<10) 04/15/02 IDT Microbiology Laboratory Total Coliform 0 cot/100mL SM189222D (<I) 04/15/02 KAP r A 1 P i 1 4-22-02:11:49AM: :907 nel 5301 a 3/ 3 LTAME Environmental Services Inc. Laboratory Division riiii��������'�����r����u�����"""'•""""� DillnklnRE Water Analysis Report for. Total L� Bacteria INT•CTIOW ON REVERSE SIDE BEFORE COLECTI)PL __ __.....Teo mmDt IFR TO BE COME sis shows this Water SAMPLE to be: 200 W. Potter Drive eneheraae. AK 99518.1605 Fax: Mru -- p PUBLIC WATAT ER SYSTEM I.D. q PRIVATE WATER SYSTEM p Send Results p Sendfnvosce ALASKA �Wr�-­IN 1•1•'A 't'u num bi,g - 6 Ol F.RA R .+b •u hr•V•eU1.%a:Jav N• LJ:Y�w ----------------- p Send Results p Send Involve r ^ m• AfA'sKA WATER & WASTEWATER ,�. l -,,A "' 6901 DFBARR RD.. SL1rCE 2B •Y SAMPLEDATE: b 1y Month Day SAMPLE TYPE: p Routine p Repeat Sample (for routine sample with lab ref. no. � p Special Purpose SAMPLE LOCATION kkr„ek s/� l D�3 G),, L9 Comments: A L•' Satisfactory Unsatisfactory Sample over 30 hours old, results may be unreliable not Sample p e over�Chour old at a examination to on to indicate reliable results. Please send new sample via special delivery mail. 41/5%u2 Date Received _ N� TlmeReceived Analysis Began Analytical Method:erttbrane Filter p MIMO-MUG e Number of colonies/100 ml. Result* Analyst EE 110219.03 051 ,P Year ' / I A p FEkf J^^ Fated Treated Water Untreated Water I Date: _ Time: Time ca%eet ed .. Collected By Client notified of unsatisfactory results: . ❑ Phoned . . spoke with Eased 1'. i i ��c5fo •.�1 pate: _ Time: Ph." ma BACTERIOLOGICAL WATER ANALYSIS RECORD Iw Coll &l%t0-MUG Result: Total CoOtorm Colonies/loo ml membrane Filter.. Direct Count verification: LTB COLiFIRht� tGB _��� Fecal Coliform Confirmation Coliform/100 ml Final Membrane /Filter �Results �Uti Timebra h _�CZ(�Date LP �Y1JS1— Reported By . TNTC • TN Nn..ee..l to Co.M oa -Ovh eeentrtd Y n Municipality of Anchorage •. \• Development Services Department Building Safety Division .. On -Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.el.anchorage.ek.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 078-031-05 HAA# ri iq 010 / ,27 1. GENERAL INFORMATION Expiration Date: Complete legal description SOUTH FORK SUBDNISION; LOT 3, BLOCK 4, Location (site address or directions) SOUTH RIVER DRIVE do SOUTH CREEK ROAD Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address JOE LIETZ Day phone 694-7606 c/o EVA LOKEN w/ PRUDENTIAL VISTA Day phone EVA LOKEN w/ PRUDENTIAL VISTA Day phone 689-6476 16635 CENTERFIELD DRIVE ' EAGLE RIVER, AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NU :iBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 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 engineers work. Note. Alaska Water and Wastewater Consultants, Ina shall be paid $1,110.00 at or prior to closing for the engineering services provided. 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 Investigallon, based on procedures outlined In the Health AuthorityAppro al Guidelines for this application, shows that the on-site watersupp/yand/or wastewater disposal system Is(are) safe,'ftinctonal and adequate for the number of bedrooms and type of structure Indicated herein. I further verily that based on the Information obtained from the Municipality of Anchorage files and from my Investigation and Inspection, the on-site Water supp/yand/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 VIATER & WASTEWATER CONSULTANTS, INC. Address 6901 DEBARR ROAD, SUITE 2B ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In Conducting this evaluation, AK=, Inc attempted to protide a thorough, conscient ous engineering analysis of the system in accordance with ADEC and hf0A DSD Guldelines & Regulations. no reported results described the performance of the system under the Conditions encountered at the time of the test, and separation distances measured to readily tdentKable features. The operational fife of all wells and septic systems depend on the local sopa 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. AWM, Inc can therefore not provide any warranty or fixture estimate of how long the system will continue to moot the Operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole bonerit of Me 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 rtght whatsoever. S. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the filowing Phone 337-6179 Date 2Cl /01 Attachments: HAA Checklist Manitenance Agreements Septic System Advisory Supplemental Engineer's Reort Well Flow Advisory Other 0), : pyo • ON-SITE WATER AND •: WASTEWATER PROGRAM By:— / Original Certificate Date: QUV. nroo> Municipality of Anchorage • Development Services Department r• a ' Bufldlnp Safety DMsbn :. ... Onsite Water a Wastewater Program 4700 South OM98W SL P.O.8=196850 An"age, AK B9SIMM WWW. AChorepe ak es (907) 943.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description; SOUTH FORK SUBDIVISION: LOT 3. BLOCK 4. Parcel ID: 078-031-05 A. WELL DATA Web type PATE If A. 8, or C provide PWSID# N/A Date Completed 8/12/93 Sanitary seal (Y/N)-)ES Total depth 101 fL C8Sed tD 101 R FROM WELL LOG Data or test 8/12/93 Static water level 62 fL Well production 30 g.p.m. Well Log (YIN) YES Wires property protected (YIN) YES Casing height (above ground) 18+ in. AT INSPECTION 3/26/01 52 fL 6.24 — g -p.m - WATER SAM LF RESULTS: Coliform ootonlesl100 ml. Nitrate • $8 mgJL. Other bacterla—(�—colonies/100 mi. Daae of sample: 3/27/01 Collected by: AWWC. INC. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date Installed 9/10/93 Tank size 1250 gel. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Oft of pumping 3/26/01 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA •LOWER TRENCH T SIM ONLY. UPPER TRENCH WAS CouPLVELY SURCHARGE. Date installed 9/10/93 5011 rating(,p,d ft'/bdnn) 0_8 system type TRENCH Length 82 (2041') fL Width 5 R Gravel below pipe 3.5 tt. Total depth 8+ — fL Eftabsorption area 759 fe Monito ft tube YES Depression over field NO Date of adequacy test 3/26/01 Results (Pass/Fag) 'PASS For 4 bedrooms Fluid depth In absorption field before test 5 In. Water added 999 gal. New depth 13.51n. Elapsed Time: 1415 m1n. Final fluid depth 5 in. Absorption rota ri 600+ g.p.d. Arty mjuvenatlon treatment (past 12 mo.) (YIN & type) NONE KNOWN H yea, give date — D. UFT STATION Date Installed 'Pump ore level at ---in. E. SEPARATION DISTANCES Size In gallons High water alarm level Cycles Meets alarm 6 circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tenMift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A On sdjecent IOts 100'+ On adjacent kris 100'+ Public sewer manhde/deanout N/A Sewer /septic service One 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO.- Building O:Building foundation 58+ Property ane 5'+ Absorption field 50+ Water main N/A Water service Una 10'+ Surface water. 100'+ Wells on adjacent Ift 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property one 10'+ Building foundation t o'+ Water main N/A Water service One 100+ Surface water 100'+ Day, par mfthlcle storage 10'+ Curtain drain NONE KNOWN Welts on adjacent l0tS 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I cer* that I have determined through geld brsped/ons and review of Mun/dpe/ records Oral the above systems are In conformance w0 MOA HAW gu/degnes In etfed on Orfs date. Engineer's g N JEFFREY A GARNESS Date �� HAA Fee $ � • ca0 Date of Payment ReoelptNumber Mo. hoof Waiver Fee Date of Payment Recelpt Number 03/20/01 TLB 09:37 FAX 8898499 VISTA REAL ESTATE ER Z002 r r N y: 2 JA b� Iuf lhs ASBUILTSEWAR t HEREBY CERTIFY THAT I HAVE SURVEYED THE -OLLOWING DESCRIBED PROPERTY; %NO THAT NO FNCROCHMENfS EXIST EXCEPT AS NOICATED. IT IS THE RESPONSIBILITY OF THE AYNER TO DETERMINE THE EXISTENCE OF ANY :ASEMENTS,COVENANTS, OR RESTRICTIONS VHICH DO NOT APPEAR ON THE RECORDED SUBDI- 'ISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ,NY DATA HEREON'BE USED FOR CONSTRUCTION )F FENCE LINES, OR FOR ESTABLISHING BOUND- %RY LINES. SCALE, / DATE: / GRID: jai �ofS' FB: Bs- as DRAWN. 4-0I1•Lu �M�04itge OF Al �' •DYMO M.r� $ems .t,` r �4.f.• LS -5910 � ••,is,1l N, m� N / y: 2 JA b� Iuf lhs ASBUILTSEWAR t HEREBY CERTIFY THAT I HAVE SURVEYED THE -OLLOWING DESCRIBED PROPERTY; %NO THAT NO FNCROCHMENfS EXIST EXCEPT AS NOICATED. IT IS THE RESPONSIBILITY OF THE AYNER TO DETERMINE THE EXISTENCE OF ANY :ASEMENTS,COVENANTS, OR RESTRICTIONS VHICH DO NOT APPEAR ON THE RECORDED SUBDI- 'ISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ,NY DATA HEREON'BE USED FOR CONSTRUCTION )F FENCE LINES, OR FOR ESTABLISHING BOUND- %RY LINES. SCALE, / DATE: / GRID: jai �ofS' FB: Bs- as DRAWN. 4-0I1•Lu �M�04itge OF Al �' •DYMO M.r� $ems .t,` r �4.f.• LS -5910 � ••,is,1l 04-02-01 15:47 FROM -CTE ENVIRONIENTAL 5615301 T-015 P.03/03 F-902 ZIL CT&E Environmental Services Inc.NJ Laboratory Division tt��a�►�ia�v/ii»/�w/iii//iiivi►/// 200 W. Porter Drive Drinking Water Analysis Report for Total Coliform Bacteria Anchof■Qe. AK 99618.1606 Tel: (907)662.2343 R£ADlNS7RUCTIONSONREVERSESIDEBEFORECOLLECTINGSTMPtL coMPLET..;V7 YLABi301 r D PUBLIC WATER SYSTEM I.D.N PRIVATE WATER SYSTEM D Srnd Reruln O Srnd lnroke w�V.AYSv� W ^ Al >n 11�C 4 I....w . w ANCHORAGE AR. 99504 O Srnd RarnhrSend Inrere LA ASKA WATER & W151I'EWAIER... 6901 DEBARK RD.. SUTPB 2B : u ad SAMPLE DATE: month 0 SAMPLE TYPE: D Routine D Repent lab ample (for routine sample l D Special Purpose SAMPLE LOCATION Comments: 01 m Day Year Analysis shows this Water SAMPLE to be: Satisfactory D Unsatisfactory D Sample over 30 hours old, results may be unreliable le D not be over3Cle too hours Oldin tlit examshould examination to indicate reliable results. Please send new sample via specia delivery mail. Date Received Time Received Analysis Began Analytical Method: Pd- Membrane iter t/D MMO-MUG 4 Number of colonicOOO ml. Result* Analyst 101150'.9 D Treated Water R Untreated Water Time Collected Collected By rrrr w:r .ch Fbks Jun Fated❑ Date: _ Time KF 3 t5 o�esultr. Client notified of phoned Spoke with a1e Date. La� Tome: I SU J BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG Result: Total Cdlferm & Coll ColonlnllDD ml Membrane Filter: Direct Count rnrC.re.N....e I- C"" Verification: _ COLIFIRM tlon: LTB ne .ar,..a....�. Fecal Coliform confirmation CoILIorm/100 ml Final Membrane Filter ResultsI q () bra Reported By Der 31 3 U Time IVBGS Member at the SOS Group lSocitit6GM6raletiaSurveillance) ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS. MARYLAND. MICHIGAN. MISSOURI, NEW JERSEY. OHIO. WEST VIRGINIA 04-02-01 15:46 FROM -CTE ENVIRONIENTAL 5615301 T-015 P.02/03 F-902 � I rvices_Inc. CT_&_E_Environm_I/ ental Services-- Cf&E Rete 1011509001 Water & Wastewater Consultants Inc. client Printed Ds me 04/02/2001 8:35 Client Name Project Name/# AK Outside H/B Southfork SD 1.3 84 Collected Date/Clme Collect d Date 03272001 14:35 03/28/1001 12:00 Client Sample tD Outside HIB Southfork SD U 114 Received Date/rime Technical Director Stephen C. Ede Matrix Drinking Water Ordered BY Released By PWS1D 0 Sample Remarks Panatela Waters Department Nitrate -N Microbiology Laboratory Total Coliform :' Resale PQL Units Method 0.887 0.500 mg/l. EPA 300.0 0 coVIOOmL SM189222B Allowable Prep Amlyw .,_... n.,� rate [nit 10 max 0328/01 SCL 0328/01 SKW • MUNICIPALITY OF ANCHORAGE !3/ DEPARTMENT OF HEALTH 3 HUMAN SERVICES Division of Environmental Services low On Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D.1t _C�`1$—C�31-t�J HAA If 1. GENERAL INFORMATION Complete legal description. Lot 3; Wck �4; South Folk Subdivision Location (site address or directions) Property owner Joe Me" Day phone Mailing address ' P.O. Box 5105 Ft. Uchandeon, AK 99505 Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. Day phone Day phone 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water • 1 NOTE: If community well system, provide written confirmation from State ADEC attest-" ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. T2-025)i1w.V91) Front MOAl21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my Investigation and inspection, the on-site water supply and/or wastewater disposal system is In compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this Inspection. Name of Firm ENGINEERING Address Eagle River, Alaska Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. M Conditional approval for Comments bedrooms. Phone e 9 c-2/771 Date No. 7137-t bedrooms, with the following stipulations: al e The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct Inspections or analyze data before a certificate is Issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72475ln«.v9p aac% Mom MUNICIPALITY OF ANCHORAGE Agh • DEPARTMENT OF HEALTH & HUMAN SERVICES. Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ,p / Parcel I.D. N 4Q%8— (23I —S HAA H( rT�Y 1. GENERAL INFORMATION Complete legal description _ Lot 3: 132och 4: South Foak Subd%vise on Location (site address or directions) Property owner Joe Mete Day phone Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 4 XXX Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-M(RW.1/91) Fwf MOA121 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system Is safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I Iurtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address 17034 Eagle Eagle River, Engineers signature 1W. 7- - IVS-e,0 7� S'How DEATH OR 1?eD1_19crz- 6. DHHS SIGNATURE Phone 41;ZED 7-0 dF V,6 Z_ 6/) AJ PV:4,77 IJaz-14�-s1 Disapproved. Conditional approval for do , 2 A n^17x= i Additional ,n By Date t J�9't,-i. Z:1* .... K4. URIC with the following stipulations: ., oiFrF� B1l 711 Date �,r�s ✓ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions In order to satisfy certain federal and state requirements. Employees of DHHS do not conduct Inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 72C23(PO.VYi) SKk M0AI21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L 3 B �• >�o� K s Parcel I.D. A. Well Data Well type191PI 0 If ie If A. B, or C, attach ADEC letter. ADEC water system number Log presenl(YYN) vle S Date completed Driller _Z�Zd/ur )Je/LL/tJG Total depth /b Cased to Casing height 2 / Sanitary seal((Y/ J) 'e x Wires properly protectedY/) f/e s FROM WELL LOG Date of test Z 3 1 Static water level Well flow 3� 9•P•m• Pump levell u SEPARATION DISTANCES FROM WELL TO: AT INSPECTION Septic/holding tank on lot l Z3 ; On adjacent lots l0 0 Absorption Feld on lot 4Z7i ; On adjacent lots /0'D f Public sewer main l -P Public sewer manhole/cleanout AJ Irl - Sewer service line Z.� 1 f Petroleum tank /l/ 0 ICI C // /U 0 C.aJ -J WATER SAMPLE RESULTS: Coliform= Nitrate &9,61 Other bacteria Date of sample: / / �r1 Collected by: S & 5 ENGINEERING —T76ta Eagle River Loop Rood No. 204 B. SEPTIC/h*I;DVRGTANK DATA Eagle River, Ala,!ra 99577 Date installed 3 Tank size Z.0, 522 Compartments /�Z Cleanout (Y ) �PS " Foundation cleanout (Y/N) e f Depression (YONlI N 0 High water alarm (Y(Y N/) ; /,4- l% Alarm tested (YM) A/ Date of pumping AJ E Pumper J� SEPARATION DISTANCES FROM SEPTIC/FIAE9ffgEFfANK TO: r Well(s) on lot Z3 On adjacent lots /00 Foundation �f- r To property line /O rf Absorption field % r'= Water main/service line s0 Surface water/drainage /Oa -f- 72426(5'97), Front CONTINUED ON BACK PAGE /Z7 c_ IT n rn c., _ ao Septic/holding tank on lot l Z3 ; On adjacent lots l0 0 Absorption Feld on lot 4Z7i ; On adjacent lots /0'D f Public sewer main l -P Public sewer manhole/cleanout AJ Irl - Sewer service line Z.� 1 f Petroleum tank /l/ 0 ICI C // /U 0 C.aJ -J WATER SAMPLE RESULTS: Coliform= Nitrate &9,61 Other bacteria Date of sample: / / �r1 Collected by: S & 5 ENGINEERING —T76ta Eagle River Loop Rood No. 204 B. SEPTIC/h*I;DVRGTANK DATA Eagle River, Ala,!ra 99577 Date installed 3 Tank size Z.0, 522 Compartments /�Z Cleanout (Y ) �PS " Foundation cleanout (Y/N) e f Depression (YONlI N 0 High water alarm (Y(Y N/) ; /,4- l% Alarm tested (YM) A/ Date of pumping AJ E Pumper J� SEPARATION DISTANCES FROM SEPTIC/FIAE9ffgEFfANK TO: r Well(s) on lot Z3 On adjacent lots /00 Foundation �f- r To property line /O rf Absorption field % r'= Water main/service line s0 Surface water/drainage /Oa -f- 72426(5'97), Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in Vent (YIN) 'Pump on" High water alarm level Meets MOS Ical codes (YM) SEPARATION DISTANCE FROM LIFT STATION TO: "Pump off" Level at tested Well on lot�t nTadjacent lots Surface water D. ABSORPTION FIELD DATA Date Installed ��/�� �/ 3 Soil rating (GPD/Ftz) �'y System type ow Length Width S Gravel thickness 3^S Total depth Total absorption an a �%src/ Cleanout present (Y/) s/ Depression over field (Y© /V a Date of adequacy test Results (pass/fail) v (26'f7for —Bedrooms Water level in absorption field before test y �i� After test Peroxide treatment (past 12�ponths) (Y/N) N O If yes, give date NOTE.: /Poc<fs Erc /V To VLF cL EAA1ErJ f20W M. -77Lr SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on tot On adjacent lots /00 Property line 10 1 To building foundation To existing or abandoned system on lot On adjacent lots Cutbank N D ^1E Water main/service line '5� rf- r f Surface water lb D -1- Driveway, parking/vehicle storage area 3af- — Curtain drain /_= Gl nN 0 W AJ E. ENGINEER'S CERTIFICATION I cer* that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date his inspection. Signature Engineers N S 3 5 NGIti SERING Eagle River Loop Road No. 204 Date ys¢ HAA Fee $ 25�.' Date of Payment /�5� 1 d7Z Receipt Number a t/7-9-9 72-026 (393)• Back Waiver Fee $ Date of Payment Receipt Number 01/04."94 1 YKl .,-I Chemlab Ref.# Client Sample Matrix / 14:53 CTSE EWIMDAVENTAL LAB SERVICES COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMENTAL LADOnATOnY SERVICES FUM11T of ANALYSIS :94.0007-1 ID :LDT 3 BIX 4 SOUTHGOUE S/D :WATER N0.226 o0z 5633 D STREET ANCNCRAGZ. AK 99318 TEL ;90'1 5523313 FAX. 19 071 601-5301 Client Name IS & S ENGINEERING RUSH Order :74505 ordered By sSCOTT SWENOR Report Completed :01/04/94 Project Name s Collected s01./03/94 @ 11:00 hi: Project# s Received 501/03/94 @ 12:45 hr: PWSID sUA Technical Directcr:STEPREN C. EDE Released By t Sample Remarks: ROUTINE SAMPLE COLLECTED BY: Parameter QC Allowable Results Qual Units Method Limits ----------------- ----- ----- -------- -----------• -- W ------------------ ­­­ Nitrate-N ------------•--•-- Nitrate-N 0.61 mg/L EPA 353.2/300.0 10 Ext. Anal Date Date Ini+. - 01/03LL1 cxzaaeswa=cccc=czcasanws=sc.c_zzsasve-=o_zs.z=rs wsu=n:cz=ear ssw,e sss:::ccczwrnw sac_cz=ca=sssas==z= * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA s Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT w Less Then D s Secondary dilution. GT * Greater Than rVII ,5{38 membe• c1 the SGS Group (Socfet4 G4 4ra'« dA Surve,Ilance) 61 ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH. ILLINOIS, CH -0. MARYLAND. WEST VIRGAIA, NEW JERSEY. SOUTH CAROLINA JAN— 4-94 TUE 15:53 CT --E Ft4VIf ONNENTAL 907SS20119 P.01 � COMMERC:1; ESTIN( & EINGINEEFIMG CO. ENVIRONMENTAL LABORATORY SERVICES Drinking Nater Analysis Report for Total Colifonn Bacteria 33 STAseF„^ pc: ; READLVSTP(%CIIG.M1SON EVERSESIDE BEFORECOLLECTIVI7S0PLE 'et:iorlsa-aux rAx. (ct7) 85t.51'1 MUST BE CO &PLETEO BY WATER SUPPLIER 0 PUBLIC WATER SYSTEM LD. ft E1=11 PRIVATE NATER SYSTEM 0 Send ReeuAs 0 Seed fnvoioe 0 Send Raahr ` o Se+dl,<tice , Se.WLEDATE: QiJ ,forth Day Year SAJfPLE n'PF.: Lab Ref..: Routine 0 Treated Water a Repeat Sample (for routine sample 0 Untreated %'ate-. with lab ref. no. — ) 0 Special Purpose Sent to AX.E:. ;.nen F;: i's Time Collected SAMPLE LOCATION Co!lected By Lp r3 OUM 50444 Fg Z K g/4 1106 _ 65 Pkw rr: TO BE COMPLETED BY LABORATORY Ara!ysis shoos this Water S A.`.gLE to be: Satisfacto.-) U:sat:seaetory C Sam -,Ie ober ?u hours oid, rest .s may be uErel;zble 0 Sample too long is trarsit; sample should ` r.ct be ecer 43 hours old at examination t: irdica'e «;:able results. Fleas.- send Mwsarnple 1:z SP..nas d. -:ice mail. Date Rcceised I Time Re -%i -,td 17 --dc S _- Ara!}sisBesa❑ Anal}tical Method: `.'e,Tbrar. FL•er CY N7L.bl. ^f e0!:Ile<'l00 rtl Lab Ref..: Result, Analyst 94. V-7 rr Sent to AX.E:. ;.nen F;: i's Jun C Faced M%. — T:ne. ClEeot ootif7ed of unsatisfactory results: Cl _ C] P:=ned S;4c"Ith Fa%cd D1%. --- T -e: BACTERIOLOGICAL WATER A-NAJ PSIS RECORD .010 -MUG Result: Tctel Co:".rm —_ E. cc 1i sfembrooe Filter: Direct Count O Cel�nles'108 el VerificatWa: LTB — BOB COLIFD:Nl— Fecal Coliform Coefirtnatioa Final Membrane Filter Resor Colifortalloo Ml ReportedB�� late iL— [� Tlae—Ls�s�— brs Cotr:n.-ss: SGt-S te. ef Ine ses ta•ov,- tS.cw& a PART ONE OF TWO: ENw�a:rt��TgSEX-ViCESINAI.AS<A.COLC=L.o uTF� I1,;.^C r",r, "=", , REMAINDER TO FnLU1W