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Home My WebLink AboutWYNTER PARK #1 BLK 2 LT 7Wynter Park Block 2 Lot 7 #051-492-08 Municipality of Anchorage Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: Su9800441 PID Number: 05/- YR -200 Name TMnlG Wastewater System: �New ❑ Upgrade Address: PO. ?>DK /07/9 -CAy5liaL t AK, ABSORPTION FIELD Phone: No. of Bedrooms: // 7 O Deep Trench gShallowTrench O Bed O Mound O Other LEGAL DESCRIPTION Soil Rating: /r 2 Total Depth from original grade: r GPD FI. 7 Lot:Block: ^ Subdivision: (� it, 4Q Depth pipe bottom from original grade: .2.39♦ Ft. Gravet depth beneath pipe q FI. Township: Range: ion: Fill added above original 7 b=de: Z G Ft. Gravel length: SO. 7 FI. WELL* ❑ New ❑ Upgrade Gravel width: 5 Number of lines: esu Ke beheen fines Ft / — FI. Classification (Private. A.B.C): Total Cased To: Total absorption area: + Pipe material: D.36341 Ft. Ft. 54o SO, Ft. Frei /D Driller NA Date Drilled: Static Water LOW: Installer. 1' 1 Date Installed: Ft. a M tact Yield: Pump Set at: Casing lfeight Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES *9 septic 0Holding 0S.T.E.P. To From septic Tam Absorption Field Lm station folding Tank PubliciPrinue Sewer Lin Manufacturer. T A/rr�. / A X 1 Capacity in gallons: 112.940 welt zod/+ sod I. — — — Material: SiCC� Number of Compartments: Z Surface /op/� /Oo`l - - - LIFT STATION LhoItt /D / f /d / F � — — Size In gallons: Manufacturer. Foundation /0 /� 1014. — — 'Pump on' level at: 'Pu level at: High water &term at: Curtain /bd r+ /Oct r — Pump Make Electrical Inspections performed by: Drain Remarks: o "u,,,,, cum ;„ d,,Rpm BENCH MARK Location and Description: SA)I I w • S>d�-, Assumed Elevation: /OD s' ENGIN ! 1 O .q setgs'��1 �Q�� performed by: 154ILlee, Dates:ls Dlo /S 9S s.se "' "" ""'Inspections Q 2nd y� , ••• ....... its Kenneth Ms �; Department of Health and Human Services approval , ��`,9�0a� Reviewed and approved by: � /kr'f� Date: 1-747 n-(117 (Rev. "I) MOA gS AS-BUILT SYSTEM DETAILS/SITE PLAN Permit SW980044 WYNTER PARK SUBD. N❑.1, BL❑CK2, LOT 7 PID#051-492-08 ., yl 1 89.05 85,CD 93 / r, 110.00 0 c5ICD. A F w1 DCD 2 ti CD PRIMARY Y$T M D o S.T. o N SEPTIC ® co TH #98-1 i CD MT v� ; RESERVE S`C�T M;' CO :2 O ------------------------------+--+--- ----------- ------------------------------- f%s 110.00 60.00 SCALE= so' i ---- 7.81 98.2 A-C=15.3' W B-C=45.4' A-D=21.9' d d3 97.8 FNISHED GRADE 100.3 B-D=52.5' F ramr+rrc vras A-E=18.4' o 250 B-E=59.8' $ 1SEPTIC L C9 4-4 <3 440 A-F=64.9' : TANK SEWER ROCK .p B-F=89.1' 95.09 94.7 90.40 90.40 ��?\\ 53.7' 01' A 4 SCALE- NTS s24o LS 1 PREPARED FOR; Vr 1 TOM McCORMICK % 6 9* II AK _T.1i CHUGIAK' - (907) 688-2281 / KENNETH M. D - ,S / FIELD BOOKS CwwMo: LG 1J [p%/\ I '- �¢ CE-7116 41.1:A4 EWND r. AN oRA"": KM A I`I ENGINEERING 'sa` / SlmlmG LANG aEWD: KMD 20441 PTARIIIGAN BLVD. 1 �F \ FESS ON �f 'dp'w A� 10: LANG ,An: EAGLE RIVER, AK .99577-0736 \ D P pv 12 29 98 = orc. PLE: MQ: NW1361 AM ME: JC9 Ra: .. 98013.DWC 98013 (9071096-011l FAX (907)096-8111 /'(oe Go P Y MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 J z r.�.srrc.T' s =z7 -ye PAGE 1 OF 1 11 • C)oGt M 1 I ryx L - k�>-C iS ANCHORAGE, ALASKA 99519-6650 01 -LY�ca m ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT (�j� (f -I-) PERMIT NUMBER:SW980044 DESIGN ENGINEER:KND ENGINEERING OWNER NAME:SOMERVILLE JAMES R OWNER ADDRESS:24450 PARK DR CHUGIAK, ALASKA 99567 PARCEL ID:05149208 LEGAL DESCRIPTION: WYNTER PARK #1 BLK 2 IT 7 LOT SIZE: 23698 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 3/27/98 EXPIRATION DATE: 3/27/99 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 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 ISSUED BY DATE: e7 Z& - DATE: 3 -2 7-, B ��h4D ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 �w , (907)696-6111/FAX (907)696-8111 r March 7, 1998 L ! V t Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. 0. Box 196650 Anchorage, Alaska 99519-6650 Subject: New sewer/well permit - Wynter Park No.1 SID, Block 2, Lot 7 Gentlemen: On February 19, 1998, we excavated a testhole for the subject property. The results of this test and water monitoring are attached. We propose to install a 5' wide shallow trench. Although the testhole indicates no water, we have concerns that water may be found later on in the year and want to provide an adequate factor of safety. Additional fill will be placed over the system to provide a minimum of 3' of cover when complete. All lots are served by community water and there are no public or private wells within 200' of our proposed system location. There is neither surface water within 100' nor any known curtain drains within 50'. We do not expect that there will be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, Ir.11M) Engineering Kenneth M. Duffus, .E. attachments: On -Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test b4vU _---- --WASTEWATER DISP❑SAL SYSTEM/SITE PLAN -- 15001 '149j WYNTER PARK SUBD. NOA, BL❑CK2, LOT 7 ar 17 J 16 15 KsD W 5 6 14 b• u w (loll MIT S.Ts[rI7 I TM'OSCO PRIINR ,PROPOSCO RE m / , 1 585130.50• 218.87 [NRI 1 N B9a-T 7� / soy I 3aI B -meq cs�E- 14f, Cl +� 60 00 11000 110 00 13 b, _> 1 9 zq 1 ALL LOTS SERVED BY COMRIMITY WATER. �; P ; YI 4 N C1 R j 3 ,bb'b ° 95b0 N " 12 10 DESIGN CRITERIA p 1. 4 BEDROOMS X 150 GAL./DAY/BEDROOM = 600 GPD 2. SOILS RATING- 4.2 MIN/INCII = APPL. RATE 1.2 GPD/SF 3. 600 GPD/I2 GPD/SF = 500 SF 4. (500 SF /(5')) x .5(RF) = 50'L 5. MIN. DESIGN SIZE = 1 TRENCH - 50' LONG x 5' WIDE x 4' DCEP 6. DEPTH OF GRAVEL BELOW PIPE IS 4'• 7. TOTAL DEPTH OF SYSTEM IS 6' FROM ORIGINAL GRADE. NOTES: SCALE:1'=100' 1. TIC INTO TRENCH AT MIDPOINT. 2. INSTALL 1250 GALLON SEPTIC TANK. INSULATE TANK 1F <4' COVER. _ 3. INSULATE TRENCH WITH 2' HD BURIAL FOAM IF 0' COVER. OF A \ \ 4. CONTRACTOR WILL ENSURE MAXIMUM 2% SLOPE INTO SEPTIC TANK. Jlw 49 , PREPARED FOR: �e-1 +f^ , CHUCK MOWER HIT SEPTIC SYSTEMS vnIRN 200. w .f! CCC CONSTRUCTION PHIPfJSfD WELL, EXCEPT AS BEIM ^PA. BOX 770647 Nil PRIVATE IW PUBLIC WELLS WITHIN 200. OE * `I.9 TI I( * I EAGLE RIVER, AK 99577 PRTB•OSTO SYSTEM EXCEPT AS wn[B. (907)688-3273 KENN7II M. UF DF' FIELD BOOKS COunlrtO: �,p� Inl ` �¢ CE -7116 w� / Bou"GARY: ANG ORA""' KMD ENGINEERING 1 frj�2`W / STARINc: LANG pK°tC° KMD 20441 PTARMIGAN BLVD.4`p ASOURT: BAR: EAGLE RIVER, AK 99577-(1736 a�� 798 \4ESS10Np� OwC. EB C: a00: NW1361 ACAO ERC: saol3.owc JOB N>: 98013 (907)r>96-6111 enx (907)696-81 11 PERFORMED FOR:,Ji!'1 mler,✓mj1 lb DATE PERFORMED` LEGAL DESCRIPTION: DEPTH O/(j IG r001ma-T /0/05a W/ji7G/GaS<a / 2 We;4 1J� w//�7G/CaS<A 3 A/1� i�I 4 ire /�� 5 C,.W eo6SleS - /2 6 rari✓y, subavkla/ 6✓O'a4 7 8 9 SLOPE Section: 1D WAS GROUND WATER .. //nn ENCOUNTERED? 11 Ma✓'s>lur�, L IF YES, AT WHAT DEPTH? 104 p 12 E Depth to Water Atter 13 Monitoring? Dite:�7 141 -i'- a O H 15 16 17 18 19 Kenneth M. CE 711 SITE PLAN Municipality of Anchorage tt DEPARTMENT OF HEALTH & HUMAN SERVICES 825 `L' Street, Anchorage, Alaska 99502-0650 jC SOILS LOG — PERCOLATION TEST .� PERFORMED FOR:,Ji!'1 mler,✓mj1 lb DATE PERFORMED` LEGAL DESCRIPTION: DEPTH O/(j IG r001ma-T /0/05a W/ji7G/GaS<a / 2 We;4 1J� w//�7G/CaS<A 3 A/1� i�I 4 ire /�� 5 C,.W eo6SleS - /2 6 rari✓y, subavkla/ 6✓O'a4 7 8 9 SLOPE Section: 1D WAS GROUND WATER .. //nn ENCOUNTERED? 11 Ma✓'s>lur�, L IF YES, AT WHAT DEPTH? 104 p 12 E Depth to Water Atter 13 Monitoring? Dite:�7 141 -i'- a O H 15 16 17 18 19 Kenneth M. CE 711 SITE PLAN 20L_jPERCOLA710N RATE 4.1p (mmutcvmtnl PERC MOLE DIAMETER 7ES7 RUN BETWEEN —�—_ FT AND Fl COMMENTS PERFORMEDDY V�y7CER1tFY THAI THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STAIE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE 72 008 1R" 4,851 Ex MOM MIX MI ®/J1M "NommovA T/m 20L_jPERCOLA710N RATE 4.1p (mmutcvmtnl PERC MOLE DIAMETER 7ES7 RUN BETWEEN —�—_ FT AND Fl COMMENTS PERFORMEDDY V�y7CER1tFY THAI THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STAIE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE 72 008 1R" 4,851 Ex MUNICIPALITY OF ANCHORAGE 1 Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-492-08-000 Legal description WYNTER PARK #1 BLK 2 LT 7 Site address 24450 PARK DR Chugiak AK 99567 Current property owner(s) WESTING FRANKLIN L Expiration Date: 6/7/2025 X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: 0 Original Certificate Date: 10/15/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory X Arsenic Advisory Other COSA Approval June 2022 MUNICIPALITY OF ANCHORAGE r Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051-492-08 Complete legal description WYNTER PARK #1 BLOCK 2 LOT 7 Location (site address) 24450 PARK DRIVE, CHUGIAK, AK 99567 Current property owner(s) FRANKLIN L WESTING Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ® Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 26 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ® Wide Trench ❑ Seepage Pit Waiver request for: Distance: Expedited review requested: ❑ By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ _J; Date of Payment -z = r C�.� COSA # 105G 09 1 y O' -J Waiver Fee $ Date of Payment Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: WYNTER PARK #1 BLOCK 2 LOT 7 Parcel ID: 051-492-08 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA - PUBLIC &/OR CLASS “A” WATER Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume NONE gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank 50” Date of pumping 6/7/2024 Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 12/17/98 ALL standpipes present per record drawing Total measured depth from grade 8.4 ft (max) Measured depth to pipe invert from grade 3.3 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective (ED). If not, state depth into effective 4.7’ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 7/29/24 Results Pass Fluid depth prior to test 10 in Water added 600 gal New fluid depth 15 in Elapsed time 1440 min Final fluid depth 9 in Absorption rate 600 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 48 in (MOA 4’ ED) Effective depth used 13 in (Missing ED + Final Fluid Depth) Effective depth remaining 35 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots & appears approximately 0.3’ or 4 inches of ED is missing – not measurable. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) - NA Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 10/07/2024 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 10/07/24 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section -r www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval # OSC241404 Subdivision: Wynter Park #1 Block:2, Lot: 7 907-343-7904 Fax: 343-7997 The septic tank for this property is 26 years old. The average life of an asphalt coated steel septic tank is 20 years. Typical replacement costs are $15,000 or more, not including engineering, surveying, MOA permitting fees or site restoration. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. CfiLLF-p krAl V rif- S,7/z/ 11- PtAt L 4519 p/`):- Pee )rote )9N19 .,,,7 ,.Spee*r U Al rl L rMf- F-X/464V/gr Ij rejeTIFIED- vo VOW, O-Fq� I SMI., GE 8G Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 s a r E T Y Certificate of On -Site Systems Approval Parcel I.D. 051-492-08 1. GENERAL INFORMATION: Expiration Date: U ath, 1 5, PW 3 Complete legal description WYNTER PARK#1; BLOCK 2, LOT 7 Location (site address) 24450 Park Drive *Chugiak Current Property owner(s) Keith Kollasch Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 854-2951 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class A Well ® Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for. Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 55o Waiver Fee $ Date of Payment $ a0 � C2 Date of Payment Receipt Number 035676 Receipt Number COSA # ©S Ca -) 13 37 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: Gamess Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 / Engineer's Printed Name: Jeffrey A. Garness Date: / 22 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 Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the datels of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), 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 (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be Installed on the property In the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE I -/— System #1 Approved for bedrooms C System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following 0,�+&csne 3 GA, IV IrL'I , Lr-\ ajj-k +a" -\_L Wcu,r)L� .sect 6-- re liq��,d I te( Coed ane Cz,n�;rrne� By: �C Original Certificate Date: 1 rJ a 0-2 �` � Qi g 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_ Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other T �� j � ; S o r� X W Pg1 P0 ?Flo p� GA, IV IrL'I , Lr-\ ajj-k +a" -\_L Wcu,r)L� .sect 6-- re liq��,d I te( Coed ane Cz,n�;rrne� By: �C Original Certificate Date: 1 rJ a 0-2 �` � Qi g 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_ Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other T �� j � ; S o r� X COSA Checklist Legal Description: WYNTER PARK#1; BLOCK 2, LOT 7 If more than 1 septic system on lot: COSA Checklist # of D. ABSORPTION FIELD DATA Parcel ID: 051-492-08 Structure served by this system Well production at time of test Water storage tank volume gallons Well disinfected (form test? ❑ Yes ❑ No ED]C bacteria is Negative Nitrate mg/L Arsenic ug/L Collected by Date of Sample ❑ Nitrate less than MRL (ND) ❑ Arsenic less than MRL (ND) C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Which system tested (date installed) fff Adequacy test date 6/30/22 COMMUNITY Results 21 Pass For 4 bedrooms Total measured depth from grade 8.33 ft (max) A. WELL DATA I WELL Water added 607 gal 0 N/A — pressurized field ❑ Well log is filed with Onsite (or attached) 0 Monitor tubes go to bottom of effective. If not, state 30 depth into effective Date drilled ❑■ Code -required soil cover over field Total depth ft 4. Cased to ft g a ❑ Sanitary seal is functioning correctly date of test) N/A Gallons introduced gallons If yes, enter date - r ❑ Wires are properly protected O' Casing height (above ground) In. ZN Date of flow test for C o Static at beginning of test ft. �ents � 7 !Ji o B. TANK DATA Age of tank(s) 24 years Tank type/material SEPTIC/STEEL Measured operating fluid level in septic tank '4 ❑■ Standpipes/foundation cleanout per record drawing Date of pumping '3 DAYS BEFORE TESTING TEST - 6/27/22 D. ABSORPTION FIELD DATA Parcel ID: 051-492-08 Structure served by this system Well production at time of test Water storage tank volume gallons Well disinfected (form test? ❑ Yes ❑ No ED]C bacteria is Negative Nitrate mg/L Arsenic ug/L Collected by Date of Sample ❑ Nitrate less than MRL (ND) ❑ Arsenic less than MRL (ND) C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Which system tested (date installed) fff Adequacy test date 6/30/22 Q ALL standpipes present per record drawing Results 21 Pass For 4 bedrooms Total measured depth from grade 8.33 ft (max) Fluid depth prior to test 7 in Measured depth to pipe invert from grade 3.5 ft (min) Water added 607 gal 0 N/A — pressurized field New depth 10 in 0 Monitor tubes go to bottom of effective. If not, state 30 depth into effective Elapsed time min ❑■ Code -required soil cover over field Final fluid depth 7 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N/A date of test) N/A Gallons introduced gallons If yes, enter date - Comments/Deficiencies: COSA Checklist yellow sheet CIA E. SEPARATION DISTANCES ❑ Yes COMMUNITY *5'+ ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5' WELL if No ft From Private Well on Lot to: (Please enter distances if less than required or if community well) Yes Septic Tank/Lift Station on Lot > 100' ❑r Yes Community Sewer Manhole/Cleanout > ft ❑ Yes if No ft es if No ft Neighboring Tank > 100' ❑ Yes if No ft Private S eptic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > IAnimal Containment > 50' ❑ Yes if No ft Yes if No ft Manure/Animal Excreta Storage > 100' Co ewer Main > 75' ❑ Yes if No ft ❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *5'+ ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5' ❑v Yes if No ft Wells on Adjacent Lots: Yes Absorption Field > 5' ❑r Yes if No ft Private Wells > 100'✓❑ Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' ❑r Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10'❑ Yes if No ft Private Wells > 100' B Yes if No ft Water Service Line > 10' Q Yes if No ft Community Wells > 200' ❑r Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS *MET CODE AT TIME OF INSTALLATION G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet #AECC884 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904 On‐Site Water and Wastewater Section Fax: 343‐7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Septic Tank Advisory Certificate of On‐Site Systems Approval # OSC221337 Subdivision: Wynter Park #1 Block:2, Lot: 7 The septic tank for this property is 24 years old. The average life for a steel septic tank is 20 years. Typical replacement costs range from $10,000 to $15,000. This advisory must be attached to all copies of the subject Certificate of On‐Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. Parcel I.D. 051-492-08 Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 S A f E r I Certificate of On -Site Systems Approval Expiration Date: 5� ) 5__ ) 5- 1. GENERAL INFORMATION Complete legal description Wynter Park #1 S40'Block 2, Lot 7 r Location (site address) 24450 Park Drive, Chugiak, AK Current Property owner(s) Mailing address Real Estate Agent Timothy and Julia Carter Day phone (907) 317-6862 Brian Pennell w/Century 21 Day phone (907) 230-1081 2. TYPE OF DWELLING: l] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual ] Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System l] Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: J 2J'PAIJ COSA to be released to the engineer, unless othe ise requested by the engineer. COSA Fee $ Yg�-� Waiver Fee $ Date of Payment of Payment Receipt Number/�rr �^7,//all Receipt Number IJ COSA# �C�t�`aZCJC/ 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 Douglas T. Kenley P.E. Phone (907) 746-1073 Address 9806 E. Northstar Circle, Palmer, Alaska 99645 Engineer's Printed Name Douglas T. Kenley Date 6. DSD SIGNATURE System #1 Approved for" bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: By: � . Original Certificate Date: The uniciafl of nchorage 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet S � - ff 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: Wynter Park #1 S/D, Block 2, Lot 7 Parcel ID: 051-492-08 A. WELL DATA Well type Public Date completed Total depth ft. Date of test Static water level Well production WATER SAMPLE Coliform If A, B, or C provide PWSID # 2211431 Sanitary seal (Y/N)_ Cased to ft. FROM WELL LOG ft. g.p.m. ESUL lonies/100 mL Nitrate mg/L ug/L Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Well Log (Y/N) NA Wires properly protected (YIN) Casing height (above grounc n AT ft Um Collected by: Date installed 6/17/98 Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) N Date of pumping 5/15/13 Pumper JR's Pumping C. ABSORPTION FIELD DATA Date installed 6/17/98* ,.,.:Length 50.7* ft. Soil rating (g.p.d./f:2orfe/bdrm) Width 5* 6 37* 500+* 1.2* ft. System type Wide Trench* Gravel below pipe 4* ft. Total depth ' ft. Eff. absorption area ft Monitoring tube Y Depression over field N Date of adequacy test .5/15/13 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 1-3/8 in. Water added 1000 gal. New depth 15-5/8 in. Elapsed Time: 1420 min. Final fluid depth 1-3/8 in. Absorption rate >= 600 g p d Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date ---_ D. LIFT STATION Date installed Size in gallons "Pump on" level at ` in. "Pump off level at Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main service line Manhole/Access (YIN) HiWaTeralarm level Meets alarm & circuit requirements? On adjacent lots On adiacent lots Public sewer manhole/cleanout Holding tank Animal containment areas 50+ft• Manurelanimal excrete storage areas 100+ft. SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ft• Property line 10+ft• Water main NA Water service line 10+ft• Wells on adjacent lots 100+ft. ABSORPTION FIELD ON LOT TO: Property line 10+ft• Building foundation 10+ft• Water Service line 10+1 Surface water 100+ft. Curtain drain None Known Wells on adjacent tots 100+ft F. COMMENTS *From M.O.A. records., G. ENGINEER'S CERTIFICATION t certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSH guidelines in effect on this date. Engineers Printed Name Douglas T. Kenley Date COSA brown sheet_10-10.12.doc Absorption field 5+ft• Surface water 100+ft. Water main NA Driveway, parkingivehide storage 5+ft. e.ANTr :dam \ Municipality of Anchorage •//ii-��'l Development Services Department Building Safety Division ' On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907)343.7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. GS I' Ll q2 COSA# NA 6CIO06 Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 7; Block 2; Wynter Park Subdivision #1 Location (site address) 24450 Park Dr. Chugiak, AK 99567 Current Property owners) Dept of Veteran Affairs Day phone Mailing address Lending agency Day phone Mailing address Real Estate Agent Kathi Olmstead Day phone 696-2209 Mailing Address ReMax of Eagle River 16600 Centerfield Dr. Eagle River, AK 99577 Unless otherwise requested, COSA 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 0 TYPE OF WASTEWATER DISPOSAL: Individual On-site Q 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 sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S s s engineering Address 15661 S. Birchwood Loop Rd. Chugiak, AK 99567 Engineer's Printed Name Robert A. Shafer 5. DSD SIGNATURE _Letf'� Approved for _3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations..«a+.*� Phone 694-2979 Date _3-17-09 Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineers Report Other By: Original Certificate Date: 3—d-0-9 (Rav IIM) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTE PPROVAL CHECKLIST Legal Description: JeT 'I; a �V e flP Parcel ID: A. WELL DATA n I Well type�S )! If A, B. or C provide PWSID t/ oU Well Log (Y/N) completed _ Sanitary seal (Y/N) _ Wires properly protected Y Total depth ft. Cased to ft. Casing height ve ground) in. M WELL LOG AT ECTION Date of lest Static water level ft. Well production g.p.m. g.p.m. WATER SAMPLE�RESY Coliform onies/100 mL Nitrate mg/L Other bac colonies/100 mL Arse ' . ug/L date of sample: _ Collected by: B. SEPTICIHOLDING TANK DATA c�� q Tank Type/Material J�1ric cJIt�� Date installed %`1/7 /is Tank size 16GO gal. Number of Compartmentso3 ,, 11 Cleanout 1P) Foundation cleanout (91)16 Depression over tank (Yo Nb High water alarm Date of pumping 5 D Pumper <� F— S umPlrl'E6 g C. ABSORPTION FI LD DATA Dale installed Gli7 S8 Length ✓��ft. Soil rating p.d./ftZ r fe/bdrm) 1,42 Width 5' ft. System type Jtintaxio llerxxiif r Gravel below pipe 4 ft. it Total depthF 7� ft. Eff. absorption area ftp Monitori tube E Depression over field Date of adequacy test 3 I Results asst il) S For A— bedrooms rr Fluid depth in absorption field before lest 0 in. Water added gal. New depth in. Elapsed Time: 0 min. Final fluid depth in. A Absorption rate >= �_ g p.d. Any rejuvenation treatment (past 12 mo.) (Y(JF^pe) / ` ' 0 If yes, give date D. LIFT STATION Date installed 'Pump on' level at _in. Datum E. SEPARATION DISTANCES Size in gallons 'Pump off" Cycles tested anhole/Access(Y/N) water alarm level at Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: NIA Septic tank/lift station on lot On adjacent lots Absorption field on lot Public sewer main Sewer Public sewer manhole/cleanout Holding tank Animal containment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r r r Building foundation s t Property line S Absorption field 64 I / Water main t) rt Water service line /D Surface water r Wells on adjacent lots _ate f SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: / r r Property line /O 'F Building foundation /O f Water main /d a Water Service line /O f Surface water / lJ0 f Driveway, parking/vehicle storage S Curtain drain ,trOC, KA-1CrcV Wells on adjacent lots AfO !V COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined fi review of Municipal records that conformance with MOA COS3L2,c Engineer's Printed Name Date .3— /% —CJ 9 J COSA Fee Date of Payment Receipt Number (Rev. 11105) field inspections and in gffepl on Waiver Fee $ Date of Payment Receipt Number in. " ,toter . S'nofa : � LOT 7 PLOT PLAN _ AS BUILT X SCALE 1' 30' GRID ±ff 1361 Project No• 09-028 Lan &Associates Inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang 907) 5Z2-6476 Phone Registered Land Surveyors 907) 5Z2-4625 rax��F A kglonglo*olcska.net / jclongle0olasko.net � 'll 1 hereby certify that I have surveyed the following described property. LOT 7, BLOCK 2, WYNTER PARK SUBDMSION No. 1 (PLAT 73-149) p * • 49J : • Anchorage Recording District, Alaska, and that the Improvements situated thereon are 0....:...•,•••• •. within the property lines and do not encroach onto the property adjacent thereto, that G� no improvements on the property lying adjacent thereto encroach on the surveyed. promises and that then are no roadways, transmission lines or other visible KENNETH C. easements on sold property except as Indicated hereon. LS -5202 Dated this the -MI-11 Day of MpIz }1 1,-.c!> . at Anchorage, Alaska Q11 ,��.'ao it 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. L�n�l�r�/er�a�rdPz Municipality of Anchorage • i' Development Services Department Building Safety Division Onsite Water and Wastewater Program 4700 South Bragaw St. a • ... P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-492-08 HAA # nQg2 1. GENERAL INFORMATION Expiration Date: Complete legal description Lot 7. Block 2. Wvnter Dartr . Location (site address or directions) 24450 Park Drive Current Property owner(s) Aobln Worth 8 Zack ary Richardson Mailing address 2dd911 Pa& n.r..e Day phone 688.1126 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 Water Storage ❑ ❑ Individual On-site Community Class A Well ® Individual Holding tank ❑ Public Water System ❑ 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 valid supply system.0 days fromalso Issues the date of Issue for proppeertes served buest to homeowners.private Certificates or Class CfHealth well and ay be reiss%Iare 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, I verify that my Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system Is(are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. i further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system Is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of Installation. Name of Firm Anderson Engineering Phone 522.7773 Address P 0 Box 240773 Anchorage AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 9/812005 5. DSD SIGNATURE Approved for �_ bedrooms. Disapproved. Conditional approval for Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory L MMRSM bedrooms, with the following stipulations: ON-SITE WASTEWATER rrcvurwm �. Fi., .... • .ate": Maintenance Agreements Supplemental Engineer's Report Other By: L, c On�. Original Certificate Date: (R« 12M) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water 6 Wastewater Program !, 4700 South Bragaw SL j P.O. Box 198850 Anchorage, AK 99519-850 www.d.anch orege.ak.ua (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 7. Block 2. Wvnter Park Subdivision No 1 Parcel ID:_ 051!492-08 A. WELL DATA Well type Claes A If A, B, or C provide PWSID t 2211431 Web Log (YIN) Date completed _ Total depth fL Date of test Static water level Well production Sanitary seal (YIN) _ Cased 10 ft. FROM WELL LOO WATER SAMPLE RESULTS: Coliform coloniesM00 ml. Date of sample: B. SEPTIC/HOLDING TANK DATA R g.p.m. Nitrate mg.A. Collected by: Tank Type/Material seffifd5teel Tank size 1.250 gaL Number of Compartments: Wires properly protected (YIN) Casing height (above ground) in. AT INSPECTION M 9 - p.m - Other bacteria colonies/100 ml. Cleanouts (Y/N) Y Foundation deanout (YIN) I Depression over tank (YIN) d High water alarm (YIN) N Date of pumping M005 Pumper Jft pumping C. ABSORPTION FIELD DATA Date krsiatled onyi9ge Soil rating (g.p.d.1f? or It=Abdrm)11 GpMF System type S Wide Length 50.7 R Width 5 ft. Gravel below pipe 4 ft Total depth I ft. Eff. absorption area We Monitoring tube X Depression over field tj Date of adequacy test _ 825f2005 Results (Pass/Fall) Pass For EM bedrooms Fluid depth in absorption field before test 14 in. Elapsed Time: jj min. Final fluid depth JU in. Water addedM gal. New depthJU in. Absorption rate ` 800 g.p.d. Any rejuvenation treatment (pest 12 mo.) (YIN 8 type) N If yes, give date D. LIFT STATION Date installed 'Pump on' level at _ in. Datum E. SEPARATION DISTANCES Size in gallons Manhole/Access (Y/N) 'Pump raid' level at _ In. High water alarm level at in. Cycles tested Meets alarm b circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/Oft station on lot WA Absorption field on lot WA Public sewer main WA Sewer /septic service One WA On adjacent lots WA On adjacent lots WA Public sewer manhole/cleanout WA Holding tank WA SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation >S Property line _2!f Absorptionfield >S Water main >10' Water service One >10' Surface water ),IW Wells on adjacent lots >2W SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property One _ >10' Building foundation N0' Water main >10' Water Service line >10' Surface water XW Driveway, paddng/vehide storage >S Curtain drain None Noted Wells on adjacent lots ),2W JW4•P.L'Jit-? G. ENGINEER'S CERTIFICATION I certily that I have determined thnwgh field inspections and o' review of Municipal records that the above systems are in 9t conformance with MOA HAA guidelines in effect on this date. ..............��„ t treowi a aacast Engineer's Printed Name Michael E Anderson. P.E. vje `: Na a -un Date &VM5 �ehe, , . HAA Fee $ �� ' )� Waiver Fee S Date of Payment 4�g/D Date of Payment Receipt Number Receipt Number (Rev. 12/0e) i Pq ., ... - Rk DRIB .� f t9 60'41'W f9OD' •r NEI W•Cbff Lot 7 ` erwcn.• ur. eix errt ` u• � t� .; tin? I toga :;'•'' r ' ' � er: at• I I Cm 1" I Lot- 6 I I I C4 Lot 8 I I aKFM i I waoMr, N RB'JB$0'L Tract 9 PLOT PLU . ASRU1lT Kenneth 0. Lang -Registered Land Surveyor 1 im ON 8"ff IMf i hers "d Mi Lot 9 � I I ' ' 1 � t SCALE ' V • 3W Caro -NO Proloof No. "_e4 0071 1500 Dory) AVlnu4 Aeoherage, Alas" 90315 Js22-5476 Phone 00sil522-4625 Fax ".l ortMN� rn eaON mu °MM may: pt p= twoom Oae.e fids 1At, Ory H 32f6tP Ma ., tML of McMropw Alak. %,11 In fbi paponsUMV of the I* dAwwanSWMINS gddom& of on ;;:Zwwf. 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N N Municipality of Anchorage 0 • Development Services Department / Building Safety Division On -Site Water and Wastewater Program r 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.sk.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.0514920`U HAA# Q4CQ(0Sj Expiration Date: 1. GENERAL INFORMATION Complete legal description _W'�r'E2 POLK'01 R LIC Z LeT 7 Location(siteaddress ordirections) ZNy50 r�gkK IJ►2 . Current Property owners) _MjLHj EL 4 Crte— At1 Ro P,f4x oel Day phone 4" –13 7 7 Mailing address Lending agency Mailing address Day phone O Real Estate Agent Cc9NArrr`y 2K -ALT / Day phone 69y-4Srn0 Mailing Address Unless otherwise requested, NAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY:, Individual Well Individual Water Storage Community Class _.A Well Public Water System 3 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 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 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined In the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. NameofFirm L'.41 izzyee_ Sea,rcA5 Phone(9y-5-/95- Address /nNZ1 VF�J 2o4 sw-C 2" 1 EWE 2n/ert, *r-')957 Engineer's Printed Name GHkrSToPHE< R - Qoet> Date 3�L31bY S. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: 0000. Additional Comments ___ `J2:. .ON-SITE ?qG�= Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other ByOriginal Certificate Date: �{ (nw.01Ai) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 111/1✓71ft P'kgt. 0 GLI( 2 LOr 7 Parcel ID: PS 1 4 1-1 Zv "y A. WELL DATA Well type IAOLrG Date completed 1 Total la ft. Date of test Static water level Well production If A, B, or C provide PWSID # 7Z11N31 Well Log (YIN) 0/4 Sanitary seal Wires properly protec Cas oN'ft. Casing heig ) IJ in. FROM WELL LOG t ft. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate mg./I. Arsenic: _ mg./l. Date of sample: _ SEPTI OLDING TANK DATA Tank Ty a� terra i t44 • TANZ � STCG L Tank size LZ Qo gal. Number of Compartments AT INSPECTION N ft. g.p.m. Other bacteria colonies/100 ml. Collected by: Date installed CleanoutsO(/N) Y Foundation cleanout l&) -�L Depression over tank (Y(N') High water alarm (Y/N) N/ A Date of pumping -5 WS Pumper Z /09/01/ C. ABSORPTION FIELD DATA Date installed 1 %-� Soil rating (g.p.d.�r fe/bdrm) Q System type 0,'hir A�2ATN.-'atLA Length GLI ;'7 ft. Width $ ft. Gravel below pipe Ll Total depth 2L ft. Eft. absorption area -;Cp J z Monitoring tube Depression over field N Date of adequacy test 2 /11 /0°i Results Pas Fail) PA5 S For li- bedrooms Fluid depth in absorption field before test JL in. Water added gal. New depth in. Elapsed Time: (YjQmin. Final fluid depth 2-1 in. Absorption rale >= 6 0 g.p.d. Any rejuvenation treatment (past 12 mo.) (Yt!�& type) A If yes, give date V �W D. LIFT STATION Date installed "Pump on" level at _ in. Datu E. SEPARATION DISTANCES Size in gallons N fA :PumpvfPTevel at _ in. High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tan lift station on lot On adjace is Absorption field on lot iU P On adjacent lots Public sewer main line Public sewer manhole/cleanout Holding tank i SEPARATION DISTANCES FRO EPTI HOLb1NGTA K ON LOT TO: Building foundation _ /J� / Property liner v /r-) Absorption field J� Water main /�°D� I Water service line 4J+ Surface water /("01' i Wells on adjacent lots AYQr SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /Ufi r Building foundation /p t r Water main /d o /r Water Service line 36 Surface water /o o t Driveway, parking/vehicle storage 2 5 Curtain drain /,c„ K.yo ✓.J Wells on adjacent lots /LrJ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name G NRl STvPrterc IZ- Aley+A Date _31c) 3 1oN HAA Fee $ 30-�" Dale of Payment 3 3 0 4 Receipt Number 4 9 Ieof (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number DPHER R MiM FROM : COLNTRY REALTY PHONE NO. : 9076881238 Mar. 03 2004 11:09AM P1 FARK e I-W41.w saw I I I I r toItOtt, WIT Lot 7 ` eiMiiw• • Ie.elsern I7.6N a � I .ate I I Lot 6 I 1 ,x. na' I I 040KLot 8 / �`" tmwm IV IMiliw . _ _ I N 8 1 Lot 9 9'79'3O'E W=' I I 1 I 1 I Tract 9 I PLOT PLAN _ ASNUILT A SCALE _!Ll 3o' CRID M 1361 "*a Na 90-P6 Ksnnoth 0. Lon 1500 DAvenue. Anch6rega, Alaska 99515 Repi9tend Land S t� r (907) 522aryl —6476 Phona yD r �^'.907)y522-4625 Fax 1 IM Y. r-90140184 id i� m PAM gy�D�im. 1. (FP%i N4.. 773- Niemenlu MMry. 9M.rw�»ollrw. Ab14 ww Nr rr an � r �r�/�f1� NAGS d M M wSift 1M p1r��/�rr11y� 6�w11 9wMw Nw MM Mw rah yMa 6�w.M 6wMr M S wwwll M Mr MuIaM/ ani M O M*011111111111011M*011111111111011MNnr K �Illw �IIY4 MMIIwMfJ M MI! 7r�1ab 1► .MOW meA6 ~ IM/Nn. GM 1h4 MN �7 Dq N Dt-wmgws- - t'�.. d An�wrN. ANnk• `tl r Iy .wM.YII, N IM arwr b Krw l%* IM whlh w N �qr �w�i, w wkM.n. Ml" N wM 6ry.w M IM A.w4a Public Water System Summary For DAWN DEVELOPMENT CORPORATION AK2211431 Public Water System Information ility Local Name City Served County Served ActiveSSourceCCount ro Primary Count Ptt'SType Service WYNTER PARK ANCHORAGE A GW 5 C 140 Sanitary Survey Date: 01/072002 Surveyor. JACKSON, PAULA Lost CCR: 2002 Comments Chugiak Estimated Use by Population Type Analyte Analyte Coliform Avenge Population Annual Openling Annual Operating Effectheaegin Effective DMIN Count Type Period Slar1s Pernod Fnde Dale F.nd Date 852 R 1 / 1 12/ 31 01/01/1997 soc Public Water System Facilities HAAs 01/012001 aeNSF Facility Name Facility Code Active Waler Type Available DAWN WA'I ERCOMPANY DSWI A GW P ST DAWN WATER COMPANY SF001 A GW P DAWN WATER COMPANY SS001 A GW P WL DAWN WATER COMPANY WLO01 A GW P WL MORNING DRIVE WELL WL002 A GW P Administrative / Owner Information Owner Owner Add" Last Sample Date by Analyte Group Analyte Analyte Coliform Old Inorganics New Inorganin Nitrates Nitrites Arsenic 01/06/2004 0002000 08/302000 09/152003 0429/1997 08/302000 Lad/Copper Asbestos soc TTIIni HAAs 01/012001 aeNSF 09/152003 09/152003 **NSF Sample Schedule Pbone Number Fas Nomber voc Gross Alpha 09/152003 **NSF Facility Analyte Analyte Sample Sample Sample Number Group Code Begin Date End Dale Tyne Freauenry Count AK2211431 COLIFORh1, TOTAL (I CR) 3100 01/01/1991 RT MN 1 DS001 LEAD &COPPER PBCU 01/012002 RT 3Y 10 W1.001 ARSENIC -SINGLE ARSN 01/012002 RT 3Y 1 WLOOI ASBESTOS -SINGLE ASBS 01/012005 RT 3Y 1 WL001 INORGANICPIIASE2 INP2 01/012002 Rx 9Y 1 WL001 INORGANICPIIASE5 INP5 01/012002 RT 3Y 1 W1,001 NITRATE -SINGLE NITS 01/012003 RT YR I W'L001 PESTICIDES PHASE 2&5 5025 01/012007 12/312007 R"1 QT I W1.001 RADIOA RADA 01/012002 RT 4Y 1 W1,001 VINYL CHLORIDE P2 VCL2 01/012002 RT 3Y I WLW I VOC P2 CONTAMINANTS VOP2 01/012002 RT 3Y I W1,001 VOC P5 CONTAMINANTS VOP5 01/012002 RT 3Y I WL002 ARSENIC -SINGLE ARSN 01/012002 RT 3Y 1 WL002 ASBESTOS -SINGLE ASBS 01/012005 RT 3Y 1 WL002 INORGANICPIIASE2 INP2 01/01/1995 RT 3Y 1 WL002 INORGANICPIIASE5 INP5 01/01/1996 RT 3Y 1 WL002 NITRATE -SINGLE NITS 01/012001 RT YR 1 WL002 PESTICIDES PHASE 2&5 5025 01/012007 12/312007 RT QT 1 WL002 RADIOA RADA 01/012002 RT 4Y I WL002 VINYL CHLORIDE P2 VCL2 01/012001 RT 3Y I WL002 VOC P2 CONTAMINANTS VOP2 01/012001 RT 3Y I WL002 VOC P5 CONTAMINANTS VOPS 01/012001 RT 3Y 1 Facility Analyte Levels (FANLs) PWS Facility: Analyte Summary Contra[ Level LOST Daystolllonitor Samples Required Eneatire"in dame Tvne Cade Tvne Per hlonth per Day Date 2/102004 Page 1 of 11 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH 6 HUMAN SERVICES AEML Divislon of Environmental Sernces - On=S)te'Seniices Section P.O. Box 196650 ` Anchorage, Alaska': 99519-6650 343-4744 i; . _. . CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # OS f' y9 - 20$ � HAA #_11A Q�SC) S24 Q 1. GENERAL INFORMATION Complete legal description Wyn fr. �a. l� a/k 2 L.f 7 Location (site address or directions) yySD f Q�/c !%int �, C'lr u' �G E 4& Property owner Tti^ We 666 -r -f Ze << Day phone Mailingaddress PO 3oX 07197/ C6k4mkf AK 9'�5&7 Lending agency Day phone Mailing address Agent Day phone Address _ Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: `l - 3. TYPE OF WATER SUPPLY: Individual well Community well —2< Public water 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 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-=(11&,.1/91) Ft MOAF21 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. If urther verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm KND i5h� inee,,L f Phone beflo- 111 Address Engineer S. DHHS SIGNATURE �L/Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments M 9tITIC Date L 7— U 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 purchasersof 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. reins m... wi) e.a Mw 021 Municipality of Anchorage RECEIV DEPARTMENT OF HEALTH & HUMAN SERVICES DEC 30 1 Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343+In oe " EI,W1tot4WENUL SERVICES DIVISION Health Authority Approval Checklist Legal Description:�w>t / Pa, -k 2 L?Ik Z, L� % Parcel I.D.: O5/ A. WELL DATA Well type COMW4/ri It A, B, or C, attach ADEC letter. ADEC water system number o2 y 3 Log present (Y/N) , Total depth Sanitary seal (YM) Date of test Static water level Well production Data completed WATER SAMPLE RESULTS: m Date of sample: S. SEPTIClHOLDINO TANK DATA Nitrate Casing height (above ground) Wins properly protected (Y/N) 9— p.m- Collected by: AT INSPECTION Date installed bib -1 S' 9 Tank size 1-2 S -D Number of Compartments 2 Cleanouts (Y/N)Y Foundation cleanout (Y/N) _� Depression (Y/N) A/ High water alarm (Y/N) -- Date of Pumping — Pumper C. ABSORPTION FIELD DATA Data inatelled D � -/7- 9 g Soil rating (g.pAAF or ll'/bdrm) /• 2- System" Sk,/(o..• 7,e. el, Length • -I _ Wktth S r Gravel thickness below pipe V r Total depth 7.4 S r- 997 / Effective absorption area 5614 zf t Monitoring Tube present (Y/N)--�— Depression over field (Y/N) tj Results (Pass/Fall) Fluid depth in absorption fiek! before test mmeolately after gel. water added (in.): _ Fluid depth (Ins) Minutes later. Absorption rate = a.p.d. Peroodde treatment (past 12 months) (Y/N) It yes, give date 72.026 (Rev. M6p D. LIFT STATION Date installed Manhole/Access (YM) High water alar level at" — Cycles tested E. SEPARATION DISTANCES 'Pump on" 'Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer /septic service line Size In gallons "Pump ofP level at" _ On adjacent lots _ On adJa�ot-1� Pubtic sewer menhole/deanout Litt station SEPARATION DISTANCES FROM SEPTIGIHOLDING TANK ON LOT TO: Foundation /0 �/ Property line A) i� Absorption field /d Water maintservice line ZS f Surface water/drainage /0 r Wells on adjacent kb 2oa SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property fine /0 /f Building foundation /01-t- Water maln/service Oro 2 S /* Surface water /00"" Driveway. paddrrg/vehide storage area 2 f 4 - Curtain drain /,010 f Wells on adjacentlots 2,00 4- F. ENGINEER'S CERTIFICATION I osrtlfy that I have determined thnr held tr►spectlons and review of Mun fjWj&Vj bove systems are in conformance wllh DA guldellnes In erred on this date. . ♦..••MOF 44��11 Signature Q'C«»•••• 4 1 FlrgineersName �rsnt�� Nl. was so "�'t' *I Date�2 1` 5'�' p,• h*m :♦ � � Kenneth M. � ti• CE 71 ja HAA Fee $ Waiver Fee a Date of Payment �Z — 3 D — e �' Date of Payment Receipt Number Receipt Number 72.026 (Rev. 3MB)"