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Home My WebLink AboutKASILOF HILLS BLK 4 LT 7Kasilof Hills Block 4 Lot 7 #015-131-25 MUNFCIPALITY OF ANCHORAGE DEPARTMENT-bF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street. Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE NEW AJ ❑ UPGRADE MAILING ADDRESS 7 2 4t 7 AGANTA Avc , 79g LEGAL DESCRIPTION L `/ LOCATION Z A1 3 !�✓ NO.OF BEDROOMS U Y Weil AUsarp83real DISTANCE TO: d 5 O �� Dwelling` / J PE "IT NO S 2 6 h-2 N F —� Manufacturer C. No IV_ �,E M +ri. ee / No, of comp yynants G Liq ca achy , allons (J IF HOMEMADE: Inside length Width Liquid depth DOZ DISTANCE TO: Well Dwelling PERMIT NO. Manufacturer Material _ H Liquid capacity in gallons -a W DISTANCE TO: Well 1 Found tion 1 Neareslf�I1M+� �Er7 /00 PE ITS F 2 No. of lines Len h of ,ch nee Total len tfo f links Trench ih to D 6 .S Z 6 Distance t n lifes w 0 inches Top of Filey IInish grade Material beneath file to 3 1 AJS"L TED inches Total eflectivgra nor In area /f W Length s Width Depth PERMIT NO. t7 d F W6 Typo of crib Crib diameter Crib d Total effective absorption area W N Building fo da ion DISTANCE TO: Well Nearest lot line � Class a Do th OSFO Driller Distance to lo[ brie PERMIT NO. W 3 DISTANCE To: Buil ing foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS 1/C 1) rl-Toy5Z. i o SOIL TES RATING Q/B INSTALLER (52 / de —e:CAUAT//Vi.� REMARKS a +'ti OF e is 4.0 �'1,�� .•y• _�� i• a6i 10 10 APPHOV U 623 1CCX DATE LEG ,-.'LE FIVE", AUX:C% P4:577 PH. CC3-=70 g !� 72-013 (Ree. 3/7RI I Ib MLIN I At_ I TY Of= (aNCHOF~AGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 025 L STREET, ANCHORAGE, AK 99501 264-4720 Othl—SITE SEWER t< WELL F-- FE: rR M I T PERMIT NO: 050426 DATE ISSUED: 07/19/05 APPLICANT: % S&S ENGINEERING GIBBS EXCAVATING ADDRESS: SRB 196-X EAGLE RIVER, AK 99577 CONTACT PHONE: 694-2979 LEGAL DESCRIP: SUBDIVISION: KASILOF HILLS LOT: 7 BLOCK: 4 SECTION: 24 TOWNSHIP: 12N RANGE: 3W LOT SIZE: 34000 (SQ.FT. OR ACRES) MAX BEDROOMS: 3 Listed below are.the•options available to you in designing your septic System. Choose the option that best fits your site. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - E3ED W _ DF_<A I N DEPTH TO PIPE BOTTOM (FT..) 3.5 +r* 3.0 ** GRAVEL DEPTH (FT.) 0.5 1.0 TOTAL DEPTH (FT.) 4,0 4.0 GRAVEL WIDTH (FT.) 19.0 5.0 GRAVEL LENGTH (FT.) 36.0 79,0 ** GRAVEL VOLUME (CU.YDS.) 25,4 22.0 TANK SIZE (GALS) 1,000.0 1,000.0 ** SOIL RATING (SQ.FT./BR) 150 150 * DEPTH TO PIPE BOTTOM < 3.5 FT.' REQUIRES INSULATION ** DEPTH TO PIPE BOTTOM < 4.0 FT. MAY REQUIRE A LIFT STATION ** GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH) *+� TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certify that: 1. I am familiar with the requirements for, on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 3 bedrooms and any enlargement will require an additional permit. A LIFT STATION IS iNSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, (EN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS 'LL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE LCTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. GNED DATE: ---------------------------------------------------- 'LICANT: % S&S ENGINEERING GIBBS EXCAVATING (� ]UED BY _� �•� - DATE: g�d s& 15 June, 1998 ROBERT C. COWAN, P.E. CML ENGINEERS (907)694-2979 FAX(907)694-1211 Geneva Smith APPROVALSHEALTH "` T' 1°'0"c/o Fortune Properties RECEIVED Attn: Lisa Herrington 2525 "C" Street, Suite 110 JUN 16 1996 Anchorage AK 99503 M°��ENSIONS Municipality of Anchorage Reference: Lot 7, Block 4, Kasilof Hills Dept. Health & Human Services Ms. Smith SEWER&WATER INSPECTION At your request we have worked out a plan to resolve the encroachment between the septic leachfield trench on the referenced property and the cut-back on Lot 17, Block 4, Kasilof Hills which was created last year with the construction on Lot 17. ENCINEERNGSTUMES AND REPORTS A radio transmitter was run on through the monitoring tube and to the end of the distribution pipe in the lower trench on the Lot 7 leachfield to locate the end of the trench. A steel stake Ewas driven at the end for future reference. A site visit was conducted on June 9, 1998 with &FFLO`�ON WTSTMr. Jim Cross of the M.O.A. Dept. of Health and Human Services. Elevations and measurements were taken and the attached drawing was prepared. Upon additional consultation with Mr. Cross on June 10, 1998 it was resolved that additional fill placed on the cut -bark, as depicted on this drawing, will sufficiently address this encroachment. The fill SITE PLANS shown will need to be placed from the top of the cut to a point about 15 feet from the base of the cut-back. AQADDES*I Upon completion of the placement of the fill an inspection by S & S Engineering is recommended. This inspection or all additional inspections will be charged at $100 per visit. Attached is an invoice for this evaluation. Please advise if we can be of additional service. SOIL TEST ^Sincerely, PERCOLATION ,EST Robert C. Cowan, P.E. cc: Mr. Jim Cross STRUCTUAALS M.O.A. DHHS .ECHAMAL NSPECTIONS ONSITE WASTEWATER OISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER ALASKA 99577 s S s V O Ixc-".sRew b8 ^� R�n<p41 L S s V O Ixc-".sRew MUM I C I IL I TY OF ANCHe--,RAGE DEPARTMENT G. HEALTH AND ENVIRONMENTAL F.,OTECTION 025 L STREET, ANCHORAGE, AK 99501 264-4720 l �! `J ON—SITE SEWEFR o� WELL FSI=FRM 17 - PERMIT NO: 850426 DATE ISSUED: 07/19/05 APPLICANT: % S&S ENGINEERING GIBBS EXCAVATING ADDRESS: SRP 196-X EAGLE RIVER, AK 99577 CONTACT PHONE: 694-2979 LEGAL DESCRIP: SUBDIVISION: KASILOF HILLS LOT: 7 BLOCK: 4 SECTION: 24 TOWNSHIP: 12N RANGE: 3W LOT SIZE: .75A 7(SQ.FT. OR ACRES) MAX BEDROOMS: 3 CSgI6L�p) , Listed below are the options available to you in designing your septic system_ _-- Choose the option that best fits your site. - - - - - - - - - - - - - DEPTH TO PIPE BOTTOM (FT.) ,3,5 *� GRAVEL DEPTH (FT.) 0.5 TOTAL DEPTH (FT.)' 4,0 GRAVEL WIDTH (FT.) 19.0 GRAVEL LENGTH (FT.) 36.0 GRAVEL VOLUME (CU.YDS.) 25,4 TAN): SIZE (GALS) 1,0 .0.0 * ` SOIL RATING (SQ.FT./BR) 1� * DEPiH TO PIPE DOT'fOM < 4.0 MAY EQUIRE A _ * -TANK MUST -HAVE AT_LEAS T COMPARTMEN I cer t i f y that: 1. - - - - - - - - - - - 1. I am familiar with thr re Uirements for on-sii sewer's and wells as set Forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. Twill install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I Will adhere.to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 3 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROV W THOUT AN ELECTRICAL INSPECTION REPORT;. AND (3) THE ELECTRICAL WORK ST P DONE BY,,A LICENSED ELECTRICIAN. SIGNED -- DATE: APPLICANT: ENGINEERING GIBBS EXCAVATING ISSUED BY c --------------------- DATE: -- --�'0 PERFORMED LEGAL 1 i' 2- 3 - Alp 3 v , w ..s v � _ o 10 11 12- 13- 14- 15- 16. 213141516 17- 18- 19- 20 7181920 COMMENTS Munlclpality of Anchorage DEPARTMENT OF HEALTH & HUMAN 825 "L" Street, Anchorage, Alaska 995 SOILS LOG — PERCOLATION I /I 'e e FG�G�cvdl ruc�� LGG %F' ,SIL 7. DATE �. Range. Section: SLOPE / WAS GROUND WATER BG %V C,4 ENCOUNTERED? N O •�• �9 l�jT1t tt.b rt ..rte an.rer � w No. 457.E T/ 2- 4 3 4/ PERCOLATION RATE (mmutes/mch) PERC HOLE DIAMETER TEST RUN/q�TWEE /µ FTAND —FT e !/ •ei c PERFORMED 8Y: —$ Ip.ip T!'14 ) 19GX CERTIFY THAT THIS TEST WAS PERFORMED IN C � ACCORDANCE WrTNiitt(t 111DELINES IN EFFECT ON THIS DATE. DATE: PH: 23 0 72-008 (Rev. 1/85) ---.--._ NO PERCOLATION RATE (mmutes/mch) PERC HOLE DIAMETER TEST RUN/q�TWEE /µ FTAND —FT e !/ •ei c PERFORMED 8Y: —$ Ip.ip T!'14 ) 19GX CERTIFY THAT THIS TEST WAS PERFORMED IN C � ACCORDANCE WrTNiitt(t 111DELINES IN EFFECT ON THIS DATE. DATE: PH: 23 0 72-008 (Rev. 1/85) ---.--._ 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. nr)-131-a5 HAA#_ OrjD5qz 1. GENERAL INFORMATION Expiration Date: Complete legal description KASILOF HIILS SUBDIVISION; LOT 7 BLOCK 4 Location (site address or directions) 10640 KASILOF BLVD. * ANCHORAGE AK 99507 Current Property owner(s) BRETT k RHONDA BACA Day phone (816) 590-1277 Mailing address 10640 KASILOF BLVD. Lending agency Day phone Mailing address Real Estate Agent ROY BRILEY W/ROY BRILEY REAL ESTATE Day phone 297-2911 Mailing address 2960 C st. SUITE 202 • ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 — 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site E 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 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. -- 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 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 riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD. SUITE 101 • ANCHORAGE, AK 99507 Engineers Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSO. The content of this report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for '23 bedrooms. Disapproved. Phone 337-6179 Date 1 t o oS Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: 1�� . o�` Original Certificate Date: (Rev. 12111) ........ . ... Municipality of Anchorage Development Services Department t(Cg Building Safety Division _ Onsite Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 995196650 www.dAndwrage ak.us (907)343.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: KASILOF HILLS SUBDIVISION: LOT 7 BLOCK 4 Parcel ID: 015-131-14 A. WELL DATA *FROM PREVIOUS HAA. 9/8/1999 Well type PRivATE If A. B, or C provide PWSID# N/A Date completed 1985 Sanitary seal (Y/N) YES 070 Total depth •302 ft. Cased to 9Et1R0CKft. FROM WELL LOG Date of test BOG Static water level_ ft. Well production N0 — g -p.m -WATER SAMPLE RESULTS: Coliform Z_ colonies/100 ml. Nitrate Q1mgR. Well Log (Y/N) NO Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 2/23/2004 37 ft. 1.4 g.p.m. - Other bacteria _s—colonies/100 ml. Arsenic: N/A mg./L. Date of sample: 9/28/2005 Collected by: GEG. Ltd. B. SEPTICINOLDING TANK DATA Tank Type/Material __ STEEL/SEPTIC Date installed - 8/3/1985 Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Cleanouts (Y/N) YES High water alarm (Y/N) N/A Date of pumping 9/29/2005 Pumper MCDONALDS PUMPING C. ABSORPTION FIELD DATA w Date instafted 8/3/1985 Soil rating (g.p.d.lft'o 150 System type TRENCH Length (2off) ao TOTAL& Width 5.0 ft. Gravel below pipe 1.0 ft. Totai depth `4.6+ ft. Eft. absorption area 450 ft' Monitoring tube YES Depression over field NO Date of adequacy test "2/23/2004 Results (Pass/Fall) PASS For 3 bedrooms Fluid depth in absorption field before test LILO in. Water added 693 gal. New depth 14,/0n. Elapsed Time: 0 min. Final fluid depth 14/0 in. Absorption rate >= 450+ g.p,d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - **TESTED LOWER TRENCH ONLY/ UPPER TRENCH IS SURCHARGED. 14' IN �CH ON 9/28/2005. D. LIFT STATION Date Installed Size in gallons "Pump on" level at _in. E. SEPARATION DISTANCES High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on kt 00'+ On adjacent lots 100'+ -- Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manholeldeanout N/A Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 5+ ProDeftY line ne 5'+ Absorption field 5'+ Building foundation ' — Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parkingivehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION –1pZ��-- N JJ7� .' 1 certify that I have determined through field inspections and e': „' �...,,;; *, review of Municipal records that the above systems are in . conformance with MOA HAA guidelines in effect on this date. .. .......:... a •.J A mess: JEFFREY A. GARNESS Engineer's Printed Name Po4 •r J9... 3,; Date t 0�lu�oiofe HAA Fee $ L4 () Date of Paymenty ) Receipt Number-3--S�T7 (Rev. 12101) A Waiver Fee $ Date of Payment Receipt Number I Zl— 10' UTILITY EASEMENTS i'. /LOT 8 1°34'39'11 LOT 16 I SEPTIC CLEANM s -4 I � 1 � I I � I I LOT 7 2.0• � lag' CANT 34,000 s.f. WITH BALCONY5 X Ica I 0 I (UPPER LEVEL) 17.7' X 20.0' DECK a I I (.OWER LEVEL) N N I I 25.0' X TA' BALCONY LOT 17 (MIDDLE LEVEIJ I � 4 88.4' O I $ I 2.0' X TO CANT I SEPTIC CLEANOUTS 1 I I I I S131934139 I I LOT 6 LOT 18 1 LOT 8 i T.6 LOT 7 SCALE: I' • 30' PLOT PLAN _, ASBUILT X SCALE 1' - 30' GRID 2541 Project No. 04 -MO Lang & Associates inc. 11500 Daryl Avenue Anchorage, Alaska 99515 Registered Land Surve ors (907) 522-6476 Phone Y (907)) 522-4625 Fax I hereby oatlfy that I have ProP�Y surveyed the following described OF At ,`CC .......,••.,q LOT 7, BLOCK 4. KASROF HILLS SUBDIVISION • .S� Mahorog9 Recording Dletrict. Alaska, and that the Improvements situated thereon are within the Properly Ones and do not enaroach onto the 49 1 adjacent thereto. that no Improvements on the property lying odI=n}01heMo .•.......• ••••• .• ......•• encroach on the surveyed promises and that then are no roadways, transmission en Ones or other visible easements on said property except as Indloated hereon. Dated this the Z(v1' hDay of �-V 4�Zu04 Anchorage, :KENNETH L e: Alaska LS -5202 M Is the respons Wlity of the owner to detennim the existence of anyy eosernents, eovwwMe. or restrictions which do not appear on the recorded sutxlMsbn plot. Rbspw� �G GABIIW WALL (ENCROACHES) 200.00 X00/ I COVERED ENTRY 26.0' OWOOD WALK 14 "'i_ O u6 0 THREE STORY WOOD FRAMEo ASPHALT ,,,RESIDENCE DRIVEWAY / y WOOD wax . N tO SHED w i , 18.2' 200.000 W DETAIL I ' GABIAN WALL ENCROACHMENT 1 LOT 8 i T.6 LOT 7 SCALE: I' • 30' PLOT PLAN _, ASBUILT X SCALE 1' - 30' GRID 2541 Project No. 04 -MO Lang & Associates inc. 11500 Daryl Avenue Anchorage, Alaska 99515 Registered Land Surve ors (907) 522-6476 Phone Y (907)) 522-4625 Fax I hereby oatlfy that I have ProP�Y surveyed the following described OF At ,`CC .......,••.,q LOT 7, BLOCK 4. KASROF HILLS SUBDIVISION • .S� Mahorog9 Recording Dletrict. Alaska, and that the Improvements situated thereon are within the Properly Ones and do not enaroach onto the 49 1 adjacent thereto. that no Improvements on the property lying odI=n}01heMo .•.......• ••••• .• ......•• encroach on the surveyed promises and that then are no roadways, transmission en Ones or other visible easements on said property except as Indloated hereon. Dated this the Z(v1' hDay of �-V 4�Zu04 Anchorage, :KENNETH L e: Alaska LS -5202 M Is the respons Wlity of the owner to detennim the existence of anyy eosernents, eovwwMe. or restrictions which do not appear on the recorded sutxlMsbn plot. Rbspw� 'i 10-11-05:15:52 ■ ■i SGS Ref.lk 1056403 Client Name: Garness Engineering Group Project Name: Kasilof Hills, L7, 84 Client Sample ID: Kasilof Hills, L7, 84 Matrix: Drinking Water PWSID Sample Remarks: ;907 561 5301 # 1/ 1 SGS Environmental Services Inc 200 W. Potter Drive Anchorage, AK 99518 Tel: (907) 562-2343 Fax: (907)561.5301 All datesf imes are Alaska Standard Time Printed Datefrime: 10/11/05 10:00 Collected Datefrime: 09/28/05 12:24 Received Dalefilme: 09/28/05 12:51 Technical Director. Stephen Ede, Released Allowable Prep Analysis Parameter Results PQL Units Method Limits Date Date Init Bacteria 0 OB No Coli 92228 09128/05 09/28/05 Lf Nitrate ND 0.10 mg/kg EPA300.0 10.00 09/28/05 09/28/05 azs 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.enchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-131-0.2S- HAA# 0 4 (7) O % % 1. GENERAL INFORMATION Expiration Date: 6 —to — 014 Complete legal description KASILOF HILLS SUBDIVISION: LOT 7. BLOCK 4. Location (site address or directions) 10640 KASILOF BOULEVARD • ANCHORAGE. AK 99507 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address GLENN ROTH Day phone 344-1965 P.O. BOX 232696 • ANCHORAGE, AK 99523 Day phone CHAD BRILEY W/ DYNAMIC PROPERTIES Day phone 3111 'C' STREET • ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 261-7576 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 0 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 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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 tiles and from my investigation and inspection, the onaite water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Commehts: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines 6 Regulations. The reported results described the performance of rhe system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational fife of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefit of (he owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for 3 bedrooms. Phone 337-6179 Date —44104 Disapproved. Conditional approval for bedrooms, with the flowing stipulations: ?: f1N-SITE WATER AND ; WASTEWATER PROGRAM Attachments: HAA Checklist Manitenance Agreements ��'• Septic System Advisory Supplemental Engineer's Reort JJ�J��'` Well Flow Advisory Otherv` �`` By: nom//// +/ z- Original Certificate Date:��— 0 (Rw. 17101) Municipality of Anchorage .. • Development Services Department Building Safety Division ` On -Sita Water 6 Wastewater Program 4700 South Bragaw, St. P.O. Box 196650 Anchorage, AK 995198650 www.cl.anchorage.ak.us (907) 3437904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: KASILOF HILLS SUBDIVISION* LOT 7. BLOCK 4, Parcel ID: 015-131–O►2S A. WELL DATA *FROM PREVIOUS HAA. 9/8/1999 Well type 7RNAh If A. B, or C provide PWSID# N/A Date completed "1985 Sanitary seal (Y/N) YES *TO Total depth *302 ft. Cased to eft. FROM WELL LOG Date of test OG Static water level Well production CJS g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 0.10 mgJL. Well Log (Y/N) NO Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 2/23/2004 37 ft. 1.4 — 9 -p.m - Other bacteria 0 oolonies/100 ml. Arsenic: N/A mg./L. Date of sample: 2/23/2004 Collected by: GEG. Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL/SEPTIC Date installed 8/3/1985 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (YM) NO High water alar (Y/N) N/A Date of pumping 2/19/2OD4 Pumper MCDONALDS PUMPING C. ABSORPTION FIELD DATA Date installed 8/3/1985 Soil rating (g.p.d./ftrOr® 150 System type TRENCH Length (20402e070TALft, Width 5.0 ft. Gravel below pipe 1.0 ft. Total depth *4.6+ ft. Eff. absorption area 450 ft' Monitoring tube YES Depression over field NO Date of adequacy test *02/23/2004 Results (Pass/Fad) PASS For 3 bedrooms Fluid depth in absorption field before test 14/0 in. Water added 693 gal. New depth L&&in. Elapsed Tkne: 0 min. Final fluid depth 14/0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) NONE KNOWN If yes, give date – ••TESTED LOWER TRENCH ONLY/ UPPER TRENCH IS SURCHARGED. D. UFT STATION Data installed 'Pump on" level at _in. E. SEPARATION DISTANCES Size in gallons High water alarm level at in. Cycles tested Meets alarm 8 circuit requirements?, SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/Iift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent kits 100'+ On adjacent lots 100'+ Public sewer manhole/deanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 1000+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 100+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 1001+ Driveway, parkinglvehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I cer* 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 N me JEFFREY A GARNESS Date 3�4OM HAA Fee $ �t 3 o Date of Payment 3 — -,�- - 0 Receipt Number 7 L7O 0 0 (Rev. rzro+) Waiver Fee E Date of Payment Receipt Number 7- a a N LOT 17 ' IOP UTILITY EASEMENTS N 100, LOT 8 11634 SEPTIC atAnwYs 1 LOT 7 , 10 34,000 s.f. WITH H 5.p' X 10.01 BALCONY 1 (UPPER LELEVEL) I ITX X20.0' DECK (LOWER LEVEL) I 25.0' X TO BALCONY (MIDDLE LEVEL 1 2.0' X 7.01 SEPTIC CLEANOUTS s a� -4 a I� I � � 1 � I �v GABtAN WALL (ENCROACHES) 200A0' �O 1 wELL 1 � Z. N r / COVERED ENTRY 26.0' O WOOD WALK c) 0 51.4 g 1 C= OFMYWOD NRAo ASPHALT DRIEWAYRESIDEG CE WOW WALK 1 N 1 rD SHED w 18.2' 200.00 1 W 1 tea, 1 1 1 1 DETAL GABUW WAIL ENCROACHMENT I tell KA 1 LOT 8 1 7J6 LOT T SCALE: I' PLOT PLAN _ ASBUILT X SCALE 16 ' 30' GRID 2541 Project No. 04-028 Lang & Associates, Inc. 11500 Daryl Avenue, Anchorage, Alaska 99515 Registered Land Surveyors 907)) 522-4625 Fax OF Ors (907) 522-6476 Phone g y .A� Re I hereby certify that I have surveyed the renewing described properly. •`�• '9s LAT 7. BLOCK 4. KASLOF HILLS SUBDIVISION Anchor"o Recording District. Alaska. and that the In averments situated thereon are within the property Ones and do not encroach onto the properly .........::... adjacent threrelo, that no Improvemenls on the properly MnO adjacent thereto encroach on the surveyed premba and that there are no roadways, transmission Ona or ~ visible eosemerds on said properly except as Indicated hereon. & KENNETH LA G: Dated this the ��) Day of fig' at Anchorage. Alaska �7j '•._ LS -5202 R to the responsibility of the owner to determine the exists rae of aanyeasernenb. covenards. or restrictions which do not appear on the rsoorded subdivision pial. 3- 3-04; 3:03PM; :807 6615301 0 2/ 7 _ --M-i - . CS Ref.M 1040905001 :Tient Name AK Water & Wastewater Consultants Inc. !rojectName/H NA .lient Sample W Kas hills S/D Lot 7, Blk 4 4striz Drinking Water 'WSID 0 .ample Remarks: All Dates?imes are Alaska Standard Time Printed Datdrime '02/27/2004 13:42 Collected Date/Time 0223/2004 16:00 Received DateJTime 02242004 11:30 Technical Director _ Ster)hen C. Ede Results Allowable Prep Analysis `mmncter PQL Units Mcthod Container ID Limits Date Date Init latera Department Nitrate -N 0.100 U 0.100 iierobiology Laboratory Total Coliform 0 mg/L EPA 300.0 D (<-10) 01!14/04 JJB col/100mL SM189222B A («)) 02/24/04 DKC Municipality of Anchorage Development Services Department Building Safety Division \� On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907)343-7904 CERTIFICATE OF,HEALTH AUTHORITY; APPROVAL FOR A SINGLE FAMILY+DWELLING arcel I.D. 015=131-25 Zee 1. GENERAL INFORMATION Expiration Date: Complete legal description Lot 7, Block 4, Kasilof Hills Subdivision Location (site address or directions) 10640 Kasilof blvd. Current Propertyowner(s) Evan HardinP Homes Dayphone 777-7741 (roll) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 7220 Sitkin Circle, Anchorage, AK.99504% Day phone Day phone Unless otherwise requested, HAA will be held by DSD for pickup. L7 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Q Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Individual On-site FXI 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 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 Se S time of itNEERING. 17034 Eagle River Loop Road No. 204 Phone �� `f y — ] 9 -7`) Name of Firm Address Engineer's Printed Name Robert C Cowan p.r. Date a/s/c -�: ROURT C. COWAN 5. DSD SIGNATURE �+�r4z CE-EBO1 Approved for bedrooms. l t�jt. « 0. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: rh �/�� W, �� Original Certificate Date: .2' 6 — eg/ // 67 (Rev. 13,te( Municipality of Anchorage •• Development Services Department Building Safety Division ` On -Site Water & Wastewater Program s • " 4700 South Br89aw St. P.O. Box 19WW Anchorage, AK 99519-6650 www.d.anchorage.ak.us (907)343-79(4 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOT- '7 Q LO c -K Al K hs) to K Hrr-LJ ' A3 Parcel ID:D 15 - / 3 / - a S' A. WELL DATA Well type .'V47E Date completed /K Total depth 30 a ft. if A, B, or C provide PWSID 1 _ Sanitary seal &I Yt S Cased to�eie'�tt. FROM WELL LOG Date of test Static water level �VC ft• Well production 9•p -m• WATER SAMPLE RESULTS: Coliform O colonies/100 ml. Date of sample: I /-& 4/ 0/ B. SEPTIC/HOLDING TANK DATA Nitrate O. S mg -A. Well Log (YAO f o Wires properly protected &N) W J Casing height (above ground) IX* in. AT INSPECTION 014A CY l,6S' 9 -P.M. Other bacteria / colonies/100 ml. Collected by: S a S DMINERRING 17034 go* Rlwr Loop Rad No. 204 Roph RWK, Aledm 1!377 Tank Type/Material S .i 4 r. c/ S r C t JL Tank size / O v O gal. Number of Compartments a Date installed $/-3/Ts- Cleanouts6/N) YR f Foundation cleanout ON) y4 J Depression over tank (Y(ON o High water alarm (Y40 r„Q,v�R r'L-'*c 44 0r✓ Date of pumping N 1 A Pumper w 0 C. ABSORPTION FIELD DATA Date installed 1KA %t; s- Soil rating (g.p.d./ft' orIbdrm �SD System typed 3 NAr-" 31M� C i++ j Length $U rcr* L ft. Width S- A. Gravel below pipe I ft. Total depth Ll ft. Eff. absorption area LV ft2 Monitoring tube YjFS Depression over field NO M i. ��tn /•�.A cno /w Spi" re Date of adequacy test A11A Results (Pass/Fail) P9s I For 3 bedrooms Fluid depth in absorption field before test AQ'y in. Water add New depth_ in. Elapsed Time: _ min. Any Final fluff ' in. Absorption rate >= g.p.d. 12 mo.) (YM 8 type) If yes, give date D. UFT STATION Date Installed `Pump on' level at _ in. Datum .f E. SEPARATION DISTANCES Size in gallons Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAlft station on lot OV Absorption field on lot / o o r Public sewer main N Sewer /septic service line in. High water alarm level at Meets alarm 8 circuit requirements? On adjacent lots On adjacent lots Public sewer manholeddeanout wl.4 Holding tank -V /'a SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: i Building foundation S Property line S' + Absorption field S i Water main N 44 Water service line / D r Surface water /00 -+r- r Wells on adjacent lots / 00 f -- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10 Building foundation 10 '+ Water main N / 9 Water Service line 0 �f Surface water 7 0 0 14- Driveway, parkingivehide storage d F Curtain drain rvd-d -'XAdQwW Wells an adjacent lots /00 + F. COMMENTS HAA Fee $ Date of Payment G( Receipt Number (Rev. 12/00) Waiver Fee $ Date of Payment Receipt Number G. ENGINEER'S CERTIFICATION �'� �..vi f4 ` I certify that I have determined through Held inspections and r/ review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. p" 0P)4/`T' CCOweA' .............. % R67MapCCIVAN / A �'r,. `,y' Engineer's Printed Name Ic Cc.rzJ i Date ';: - '. HAA Fee $ Date of Payment G( Receipt Number (Rev. 12/00) Waiver Fee $ Date of Payment Receipt Number 'AL CT&E Environmental Services Inc. CI'&E ReLN 1010493001 Client Name S & S Engineering Project NamdN Lot 7 DIk4 Kasilof Hills S/D Client Sample ID Lot 7 Blk4 Matrix Drinking Water Ordered By PWSID 0 Sample Remarks Paamcter Waters Department Nitmtc-N Microbiology Laboratory Total Coliform E18-1 EO/20'd P89 -i Raultc 0.50011 1013, No Coli Client PON Printed Datelflme 02/01/2001 16:05 Collected Datefrime 01/29/2001 10:00 Received Date/time 01/29/2001 12:25 Technical Director Stephen C. Ede Released By PQL Units Method 0.500 mg/L EPA 300.0 l0EG NS coV100mL SMI89222n Allowable Pmp AnWs Limits Dae Date Init 10 max 01/29/01 SCL 01/29/01 KAP 1Y1N30114081AN3 31"081 60:11 N-10-ZO MUNICIPALITY OF ANCHORAGE DEPARTMENT HEALTH 8 HUMAN SERVICES of Division of Environmental Services VMV— On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.S OIS- – 13 1 – S AAM �� Li ` 1. GENERAL INFORMATION ;;:cc ; _c:r.,,:,;::_•.,.:: ... : . . _ .. _ . ._... _.__. Complete legal description Lor 7 6 t -o CAC kA SI L a F HILL .S S%D Location (site address or directions) /o 6 2 0 k-4 S f a o F 6 L v D. ..ter✓ri rte- ling'address I,G't=,vcvA -SMsTH-F&,A4CA Day phone 616 ,Lt S/i j/#LAA1"7aev ........... Lendingagency'DtrA01 F45,04A,(L–L/L,LYAC Naar✓ Day phone ;,Mailing address w 1 Agent' -LISA Iy 4,A R i N c- ro,✓ _ Fb-t Day phone s �' 2'� 6 S3 E'2- S7 `c' S7-Aitr 801 r )to i"ANcyo.44cc AK Address -a � clciS'o3 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well x Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- Ing ttesting to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site k 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-=(P�.1191) F, MOA911 S. 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 forthe 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 5 & 5 ENGINEERING Phone - 9 17034 Eagle Address Eagle River, Alaska 99577 Engineer's signature Date 6. DHHS SIGNATUREFHA c"E Approved for HA Ebedrooms. Disapproved. Conditional approval for Additional Comments } ROBERT c CE -6801 ,rl� bedrooms, with the following stipulations: Date C)— The— 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 orderto 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. 72-M m«. vsi) e� uw m Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) Health Authority Approval Checklist ntrrFlVE� Legal Description: Lo i 7 0 Lo C�K q *451" Jr Hi t c S Parcel I.D.: O 1 S- 131 —-'\- S A. WELL DATA Welitype P A I V A t f_ If A. B, or C, attach ADEC letter. ADEC water system number Log present M9 r" ° Date completed V / k "s' &,,Pic. /.,.A Lw*") I Total depth 3 ° a P'A Cased to 04 o R o c K Casing height (above ground) f San" seal GYN) Y E, J FROM WELL LOG Date of test Static water level Well production g.p.m. WATER SAMPLE RESULTS: Coliform 0 Nitrate O. Wires property protected (Y/N) NIA -fo Pc...t.P AT INSPECTION y/S/q9 a7' ). c s Other bacteria S Date of sample: C1 /(51.1 9/ $ / g 9 Collected by: S & S ENGINEERING 17034 Eagle River Loop Read No. 204 B. SEPTIC/HOLDING TANK DATA Eagle, River, Alaska 99577 Date Installed g 13 / frS Tank size /o o O Number of Compartments Ciesnouts &N) Yf I no Foundation cleanout (YN) FOJMnArIr� Depression (YO A-40 High water alarm (Y& NO Date of Pumping N�A Pumper C. ABSORPTION FIELD DATA Date installed $' 3/ 8s 'Soil rating (g.p.d Mt' or /bdrrrl S-0 System type 7.44. c .i s S Length � o ' T •T A L Wldth S / Gravel thickness below pipe ) ' Total depth H ' Effective absorption area 'I S'O Monitoring Tube present ®/N) Ya l Depression over Held (Y/N) Date of adequacy test N A Results (Pass/Fail)or 3 bedrooms Fluid depth In absorption Held before test (in.); 1) Y _ ediately atter_ gal. water added (in.): Fluid depth (insMIM Ater. Absorption rate = a.p.d. Peroxide iro ment (past 12 months) (YN) 1f yes, give date * wo 1149„)(. — S ys7fe'+ Hn-j rvh.v4R 9E4N v54 -D 72-020 (Rev. 3/90)' D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES Size in gallons "Pump on" level at' 'Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 100 f'F Absorption field on lot 1 0 0 �+ Public sewer main N I A Sewer /septic service line a S On adjacent lots 100 ' at' On adjacent lots /0J f Public sewer manhole%ieanout Lift station N 14 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: A/ 14 Foundation u0 Fo4 � ay rias Property line S i} Absorption Held S ,� Aro Water main/service line �. " t. Surface water/drainage / 00 I Wells on adjacent lots / oo SEPARATION DISTANCE FROM ABSQR P ION FIELD ON LOT TO: Ass.. 6r N Property line 10 Building foundation NO irh.rAAT 16-4 Water main/service line AO r f Surface water 100 } Driveway, parldng/vehide storage area 3 c + r Curtain drain N 0 W r Wells on adjacent lots /00 / F. ENGINEER'S I certify that I have determined thru field inspections and review of Munidpat pbstems are in confonnanoe with MOA HAA guidelines in effect on this date. Signature r%1/1'� Engineer's Name /nc0L 9i -r C• Cowq,✓ 1 A / �T / a KXEIIr C. COWM4 Data l /p c CE -8801 7%- �! HAA Fee $. 30D, r Date of Payment:5719q 9'10 " q 9�j l Receipt Number l /' 1 /�L !, A 72-026 (Rev. 3/96)' Waiver Fee $ Date of Payment Receipt Number LTE ME Environmental Services Inc. Laboratory Division Drinking Water Analysis Report for Total Coliforr READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING MUST BE COMPLETED BY WATER SUPPLIER p PUBLIC WATER SYSTEM I.D. N (Y PRIVATE WATER SYSTEM �r n a 200 W. Potter Drive 1 Bacteria Anchorage, AK 99518-1605 Tel: (907)662.2343 SAMPLE Fax -(907)561.5301 TO BE COMPLETED BY LABORATORY A lysis shows this Water SAMPLE to be: Satisfactory O Unsatisfactory O Sample over 30 hours old, results may be unreliable O Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample via sp is delivery mail. Date Received Time Received 4L%L Analysis Began kl A S IAnalytical Method: (`b MMO-MUG iter e Number of colonies/ 100 ml. Result* Analyst SAMPLE DATE: ® m ® 994868 Month Day Year SAMPLE TYPE: pt Routine �( Repeat Sample (for routine sample with lab ref. no., h 7 S X ) ci Special Purpose SAMPLE LOCATION 3-d T. 7 BLPC N KA SILef Hr«f Comments: O Treated Water -9 Untreated Water Time Collected Collected By :ed fade C. Maw Prt K.ricJun ❑ Fated Date: Time: Client notified of unsatisfactory results: ❑ ❑ Phoned Spoke with Faxed Date; Time: BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG Reook Total Coliform E. Colt Membrane Filter.. Direct Count lJl� �t �' Colonies/100 ml Verification: LTB BGB COLIFIRM Fecal Collform Confirmation Final Membrane Filter Results Coliform/100 ml Reported By I� 1t� Date Time Le En T.vrC- r» N.�, re Ce.t Oa-ah..a.M. IAVISMMember of the SGS Group (Soci6t6 G6n6rale de Surveillance) ENVIRONMENTAL FACILITIES IN ALASKA. CALIFORNIA. FLORIDA. ILLINOIS, MARYLAND. MICHIGAN, MISSOURI. NEW JERSEY. OHIO, WEST VIRGINIA SEP -16-1999 08:49 S&S ENGINEERING 907 694 1211 P.01/02 ...... aowaui T-870 P.03/35 F-165 CT&E Environmental Services Inc.' 1' Laboratory Division ►ri— — —v Laboratory Analysis Report CUEM.# 99478WM Cliam YW Client Name S & S Engineering Printed DOOTime 09/13/99 15.34 Project Natae/4 N/A Collected DazAMme 09/0819911:45 Client Sample 1D W7131k4 Kasilof Hills S/D Received DaEaMme 09/08/9915:10 Matrix Drinking Wa a Tee6ateal Director. jtephm C. Ede ordered By ',`` PWSID 0 Released 13y /1141JD .�Jfy(OrL(Y f ample Allowele Prep Analysis Perameter NewltS FOL Units Method iiaits Date Date Init Total retiform Ml WE 92220 09/pa/99 KAP Nitrate -N 0.500 u D.S00 eg/L EPA 300.0 10 PMX 09/04/99 09/06/99 SR 700 W. Pouer Drive. Anehonpe,AK 9D91M1605 —Tet: (907) 562.2343 Fax: (907) 561.5301 3190 Peger Road. Fairbanks. AK 997095471 —Tat: (907) 474-8656 Fax: (907) 474.9665