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HomeMy WebLinkAboutCONIFER HEIGHTS BLK 1 LT 5Conifer Heights Block 1 Lot 5 #015-093-39 j�INICIPALITY OF ANCHORAGE Beal. and Environmental Protect�n i Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME--����— MAILING ADDRCSS,- (/5'�/� PHONED/ LOCATION T LEGAL DESCRIPTION h. �S / v"�� �-e �" SEPTIC TAP�,C: ^ DISTANCE ��o�'�' FROM WELL INSIDE LENGTH 'n^ oo NUMBER OF ff2 MANUFACTUREPu �e'� MATERIAL ��/ NUMPARTMENTS.aL- - INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY OOGGALLONS. TIIX nrIAIL FI I n: ��, J�, ' ( � TOTAL LENGTH �J � DISTANCE FROM WELLPQ.-..d=t�OUNOATION � / NEAREST LOT LINE-2,C), INE w?�!� OF LINE _P`. # of Lines �^^�77 YDISTANCE BETWEEN LINES I—TRENCH WIDTti2L N. TOTAL EFFECTIVE ABSORVTl0N AREA _i SQ. FT. LENGTH OF EACH LINE 1 DEPTH OF FILTER /' DEPTH: TOP OF TILE TO FINISH GRADE 32_MATERIAL BENEATH TILE _J6--L.4#-ABOVE TILE. IN. SEEPAGE PIT: DIAMETER OR WIDTH_, LENGTH_, DEPTH Log Crib Rings_ Crib Size:, DIAMETER _OEPTH_DISTANCE FROM: WELL TOTAL EFFECTIVE BUILDING FOUNDATION_. NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT. Well C Class : "Depth: Well Distance To: Lot Line Bldg: Sewer Line: Pipe Materials:' # of Bedrooms:. Installer• Remarks: L-0-1: — 6UY31 c -►moi, - ;rw- `I - f-- 1- �- 1- - -�-1-I _ -- - - 1=1 cul f .!..i I ;�= i- } -j - -- U1` i -1-t _ i' -►moi, - ;rw- r'11_IF- F=i L T 1 �' F= H r .1 C H L_l h_ F T G IF- DEPHRTMENT UF?'�CHLTH AND ENVIRUNMENTHL PR '^ECTION 825 'L' IkEEI, HNCHORHGE, HK. 995U_ 279-2511 Crr-1—:E; 1 -1-F= !E3 EFEwl=F{ F�EFtt`1 I: 1 PERMIT NU. ( 77824 ) HHVLICHNT SCHHCHLE EXCHVHTING - 3126 E 72ND ST LUCH11UN RED UUUK LEUHL LS B1 CONIFER HEIGHTS LUT SIZE T: IYF'E OF SOIL HBSUNBTIOFJ SYSTEM i5: TRENCH Caw Cr� 344-2911 45237 SQUARE FEET MHYIMUM 14UMBER OF BEDROOMS = 3 SOIL RATING CSQ FT/ESR)= 90 IHE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: L]�F='`1'H= 1.� LEt�tt3TH= .2 { t�FcHw'�L 17E=FsTH= THE LENGTH DIMENSION THE DEPTH OF H TRENCH uP,UUrJU HND THE BOTTOM THERE 15 NO SET WIDTH IHE UKHVEL DEPTH 15 T HND IHE BUllUM OF THE IS THE LENGTH CIN FEET) OF THE TRENCH OR DRHINFIELD OR PIT 15 THE DISTANCE BETWEEN THE SURFACE OF THE OF THE EY,CHVATlUN CIN FEET). FOR TRENCHES. -IE MINIMUM DEPTH OF GRAVEL BET14EEPJ THE OUTFALL PIPE EXCAVATION CIN FEET. ' F1HCFCF=TGF= tJLF=1r-4-1" citz 1- i t3r-1--------- •H PHCKHGE PLANT MAY BE INSTALLED HT THE PERMITIEE'S OPTION SUBJECT TO THE FULLUWING C:ONDITIUNS: I. EITHER H CLASS 1 OR 11 NSF APPROVED PLHNT MAY BE INSTALLED. 2. H CONTINUOUS MHINTENHNCE AGREEMENT IS REQUIRED. IF H MAINTENANCE HUREEMENT 15 NOT KEPT CURRENT YOU MAY BE REQUIRED TO ENLARGE THE SOIL HBSURPTION SYSTEM HND/OR YOU MAY BE SUBJECT TO PROSECUTION. ---------------------------------------- --- --------------------------------------- --- "1'WI_D C 2 7 "F -.:IF- FBF=1>tlJ I F2F-17 --- BHCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS UEPHRTMENT Id1LL BE SUBJECT" TO PROSECUTION. 'MINIMUM DISTHNCE BETWEEN A WELL AND ANY ON-SITE SEWHOE DISPOSAL SYSTEM IS IOU FEET FUR H PRIVATE WELL OR 200 FEET FOR N PUBLIC WELL. UfHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE HVHILHBLE TO INSURE PROPER INSTHLLATION. F_ELF;;::M'1' -1' t=>4F1I IRE`S l>F=t: MIF -Fe :3::1-, 1 CERTIFY THAT 1: I HM FHMILIHP, WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FURTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM IN HCCURDANCE WITH THE CODES. 3: 1 UNUERSTHND THAT THE ON-SITE SEWER, SYSTEM MHY REQUIRE ENLARGEMENT IF THE RESIDENCE 15 REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. S1uFJEU:__ �) H L1CHN1 SCHACHL UHVHTING �L%+(C r _DHl E--1--^� 1SSUED BY - - ------ ' Conibrucilon 9zit .% won* frit is Worth a thousand opinioMs' 2 04 'Cleveland Anchorage, Alaska 99503 Performed For & c H"� G(C,�I%!)TA)(n? Date Performed Lenal Oescrintion: Lot Block Subdivision(-M)lree? 444 This Form Renorts Soils Loq Percolation Test— F62, Sic SeHLC.I4-t� Deoth rear _ Sail Characterist 2 = �� y -t7ta) Ste!/ S 1 � 4- 6— wa& n7xA➢a 8- 10- -10- 12- 12- 14 14 �. O•�E/. 16— 6- is- 18- 20— 20— Was Was Ground Water Encountered?4 If Yes, At what Depth? Readinq I Date Percolation Rate Proposed Insta Deoth of Inlet CnHNENTS: A, F C"� Gross Time Minute Seenaae Pit d - —DA.p rain Field _ m Of Pit Or Trench Test Performed ByC^��_ 1%��rc /n<-- Data Certified Byk i Date: NAME OF APPLICANT _N INSTALLATION LOCATION LEGAL DESCRIPTION Y INSTALLATION OF: BEP GREATER ANCHORAGE AREA BOROUGH TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS COMPLETION DATE ANTICIPATED DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 3330"C"STREET ANCHORAGE. ALASKA 99509 TELEPHONE 274.4361 A LICATION AND PERMIT ADDRESS {L" l/ ` eec4// PIT DRAIN FIELD OTHER TO BE INSTALLED BY 3- 2/R NOM THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK SEEPAGE PIT TO NEAREST LOT LINE. DRAIN FIELD DRAIN FIELD SEEPAGE AREA SIZE TYPE WELL TO SEPTIC TANK DD SEEPAGE PIT — — DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD - SEPTIC TANK. SEEPAGE PIT DRAIN FIELD TO RIVER. LAKE. STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION S FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. 1 G.A.A.S. OR LICENSED DESIGNER DIAGRAM OF SYSTEM 1 CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-48 AND THAT THE ABOVE DESCRIBED ,I SYSTEM IS IN ACCORDANCE WITH SAID CODE. / DATE �--R-- 2� APPLICANT'S SIGNATURE FORM NO. E0-014 Fi�jJn�ti uiunnv at c11ap1pflada iomwavc Domestic — Commercial 2488 Pump & Water Systems P.O Box 110496 Job Name I Location Anchorage, Alaska 99511 2 (%01) 945-0202 Thank.You SIGNATURE 0 Hereby AckrKr "e the Satisfactory QmVletion of the Above DescrDeA Work.) TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE. SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS. PHONE e I ouA rTY DATE — DESCRIPTION AMOUNT 01 10, cO AMOUNT TOTAL MATERIAL AK TOTAL LABOR M�Pml& PAY THIS AMOUNT A� Thank.You SIGNATURE 0 Hereby AckrKr "e the Satisfactory QmVletion of the Above DescrDeA Work.) TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE. SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS. Municipality of Anchorage .. Development Services Department Building Safety Division On-Site Water and Wastewater Program .. ... -` 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 A'��gk www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. oq-o9-A-'Aa COSA# O 0030 Expiration Date: 1. GENERAL INFORMATION Complete legal description Conifer Heights Block i Lots; Location (site address) Bioo Red ou An orae AK o Current Property owner(s) Aaron & Jane Middlekauff Day phone 2ro-805-4 Malting address---- — Lending agency Day phone Mailing address Real Estate Agent Teresa Bell/1' x); i liyti 1S Day phone 240-2248 Mailing Address _ o Anchorage AK aasoa Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: -3- 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well - ® Individual On-site Individual Water Storage . ' ;> . ❑ Individual Holding Tank ❑ Community Class - Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ 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 engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Is (are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water supply and/or wastewater disposal system Is(are) In compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services LLC Phone _272-8218 Address P.O. Box lozgsg, Anchorage AK aa510 Engineer's Printed Name Steven R. Pannone, P.E. Date LiCJ'iP7�- Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines R Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water �*' OoSMI aaaO levels that may fluctuate during the year, and the water usage of the family being served by the system. �.�P�E;...••••-•• q�4 These conditions are outside the control of the evaluator of this system. All systems eventually fail and : �j r•• �� satisfactory test results do not guarantee future performance of the system, nor do they guarantee that p 49 r„ t p �� there arc no hidden defects or encroachments. PPS can therefore not provide any warranty for future _ 'i performance nor give any estimate of how long the system will continue to meet the operational 0 requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed �� �+i 1even StR panni onep' above. Any reliance upon or use of this report by any other person or parry is not authorized nor will it `�, No. CE 8119 confer any legal right whatsoever. 1� +•, ff� 5. DSD SIGNATURE 0. •_ »�" Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Ni to Advisory —Z— Other Original Certificate Date: 2//8 0 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 -Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Conifer Heights Block s Lo Parcel ID, ost oaa9- A. WELL DATA Well Log (YIN) N Well type P CT f(tL' I`t"I1 If A. B, or C provide PW SID # seal (YM)Y Wires properly protected (YIN) Y Date completed L t&CvA'1 Sanitary Total depth a:: ft. Cased to aii ft. Casing height (above ground) i2. in. FROM WELL LOG AT INSPECTION Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform '''i7 co� 1100 mL Arsenic: Ak mgfl B. SEPTICIHOLDING TANK DATA Uhaho_ °8 9-P.M.2 T� -- 9.p.m. 1'N C.U! spmkc s, vK,b6 �_-{�— %/13/opt Nitrate $cyo m91L Other bacteria colonies/100 mL ?r,1/ / Date of sample: 712310ti Tank Type/Material Fiberglass Tank size a000 931. Number of Compartments E F undation cleanout (YIN) Y Depression over tank (YIN) N Collected by: Dura Pannone Date Installed 9122114 7 7 Cleanouts (YIN) Y High water alarm (YIN) NLA- - 0 Date of pumping k&sLseg Pumper + Home Services C. ABSORPTION FIELD DATA System a DeeoTrench lz Date Installed 921a77— Soil rating (g�p•d•�Z or ft�/bdrm) go__ Y � Width a ft. Gravel below pipe 6 ft• Length 23 Width Total depth 9-.3 ft. Eff. absorption area n6 ft2 Monitoring tube Y Depression over field N Pass/Fail) ass For3bedrooms Date of adequacy test 712'A/2008 Results ( New deptho in. Fluid depth in absorption field before test o In. Water addedgss gal. Elapsed Time: o min. Final fluid depth o in. Absorption rate >= cSo+ 9•p•d• Any rejuvenation treatment (past 12 mo.) YM & type) sl If yes, give date D. LIFT STATION Date Installed Size in ons Manhole/Access (Y/N)�_ "Pump on" level at_ in. `Pump off" I e t _ In. High water alarm level at in. Datum Cycles t t_ Meets alarm 8 circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAitt station on lot zoo+ On adjacent lots zoo+ Absorption field on lotzoo+ On adjacent lots moo+ Public sewer main Public sewer manhole/cleanout mac+ Sewer /septic service line Holding tank zoo+ Animal containment areas zoo+ �_ Manure/animal excrete storage areas zoo__ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation zo+ Property line so+ Absorption fields+ Water main 25+ Water service line zc. Wells on adjacent lots zoo__ Surface water _100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line zo+ Building foundation zo+ Water main 7c+ Water Service line zt+ Surface waterzoo+ �_ Driveway, parking/vehicle storage Curtain drain _ None_ Observed Wells on adjacent lots zoo+ F. COMMENTS G. ENGINEER'S CERTIFICATION ••••••`•e�asss I certify that I have determined through held Inspections and - �•\P�� :�5,�0 review of Municipal records that the above systems are In .� •••rv�e conformance with MOA COSA guidelines In effect on this date. rw s •• �• ... t.....0 r � � Engineer's Printed Name teven R Pannone P E e .... S:,� itSleven R.• Fol n>ne��ji . Data }9�2� ���•. rdo CE Eia9 .: •#1�(. M• •O '-•LJ�-- •• COSA Fee $ q0 Waiver Fee $ Date of Payment Q Date of Payment Receipt Number _ � � � 1 l orf (Rev. I I/o5) Receipt Number I Municipality of Anchorage .• r• Development Services Department ;? -1:. Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907) 343-7904 NitrateAdvisor Certificate of On -Site Systems Approval # 090030 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 5 of Conifer Heights subdivision. This inspection n revealed for the propecentration of 8.08 milligrams per liter (mg/L)reported rty's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. SCS ReLM 1083632001 Client Name Pannone Eng. Srv. Project Name/N LT5,13KI Conifer tits Client Sample ID LTS,BKIConifer tits platrie Drinking Water PWSID 0 Sample Remarks All Dates)TImes are Alaska Standard Time Printed Date/time 08/052008 8:34 Collected Dalelfime 07232008 12:00 Received Date/time 07232008 14:20 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Medved Container ID Limits Date Date Init Metals�=CP�MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 0725108 08/01/08 NRB Waters Department Total Nitrate/Nitrite-N 8.08 0.100 mg/I. SM204500NO3-F D (<10) 08/01/08 JDZ Microbiology Laboratory Colony Count Total Coliform Fecal Coliform 0 0 0 coVI00mL SM209222B col/100m],SM209222B w1/IOOmL SM209222B A A A 0200) < (I) (<I) 0723108 0723/08 0723108 DLC DLC DLC SCS ReLM Client Name Project \amtfk Client Sample ID Matrix PN'SID Sample Remarks: J 1090466001 Pannone Eng. Srv. 8100 Red Ct 8100 Red Ct Drinking Nater If Results PQL Parameter Waters Department_ Total Nitratc/Nitritc•N 8.06 0.100 j4jcrobiOlOQY Laboratory Colony Count 0 Total Coliform 0 Fecal Coliform 0 Printed Datefrime Collected Daterrime Received Dote rime Technical Director 02/12/2009 11:43 0210512009 16:15 02105/2009 16:50 Stephen C. Ede Allowable Prep Analysis Units Method Container ID Limits Date Date Init mg/L SM204500NO3-F B (<10) 02/10/09 JDZ col/loomt. S%120 9222B collloomL SM2092226 col/100mt- SM209222B A (<200) A (<1) A (<I) 02/05/09 KAR 02/05/09 KAR 02/05/09 KAR 89•S6' 30• —/O__ORAf FRAME Nouse V. e_ y 5[PrrG `it -AND e pfM1as PE 190,00 0 EASEMENTS OF RECORD. OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON. "GSRUILT" OO,e 270, 7z O No corners set 6o' R RED COURT SCALF /�- ¢0' O THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO SE USED FOR POSITIONthG ADDITIONAL STRUCTURES ORFENCEUNES. I hereby certily that I have surveyed the following described property. Lot= -Block I GOW/GEK HE/GNrj SLLRD.Anchoraga recording district Alaska, and that the improvements situated thereon are within the property lines and do not o.erlap or encroach on the property lying ad!acent therPlO. lh Rt no improvements on p'opcfty lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicaled hereon. AnChorago. Alaska /I MAR . 7 00 / ,V LG ER . /rr' o Nov. ?.oen Book P9 rl" :�oF•A i r.t..49 L ............:.. �, 9,.. , Frohlt HJdon.n o � �' � No. 1309•S .• a"'i ��F,y ••,�• 11 -oG'O S,.•• c,J � FSA ••. •••••• 'NC �, ��` AOfESSiOws��� Municipality of Anchorage • j Development Services Department Building Safety Division 4 On -Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.d.enchorage.ok.us (907) 343-7904 I ' ll�tl° Oj CERTIFICATE OF HEALTH AUTHORITY APPRO AL FOR A SINGLE FAMILY DWELLING Parcell.D. 015-093-39 HAA# h5�sG� 1. GENERAL INFORMATION Expiration Date: Complete legal description CONIFER HEIGHTS SUBDMSON• LOT 5. BLOCK 1, Location (site address or directions) 8100 RED COURT • ANCHORAGE, AK 99507 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address COLBY AND CASSANDRA SMITH Day phone 770-2688 8100 RED COURT • ANCHORAGE. AK 99507 Day phone BRIAN BRODERICK W/ PRUDENTIAL JW Day phone 3801 CENTERPOINT DRIVE " ANCHORAGE. AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ 351-9916 TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 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 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 seat axed 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 6 Regulations. The reported results described the performance ofthe system under the conditions encountered at the time of the test, and separation distances measured to readily identif able features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will It confer any legal right whatsoever. 5. DSD SIGNATURE Approved for -_,-_ bedrooms. Disapproved. Phone 337-6179 Date Zo b l000� o/p�0 Oav��� ` Ggs��000 0.'..c . .................... Conditional approval for bedrooms, with the following stipulations: _6r' Note: The well for this property meets existing State and Municipal Codes There are nitrates present. It Is suggested that periodic testing be performed to Insure the wells continued suitability. Current nitrate concentration is 5.66 mg/l. EPA maximum concentration Is 10.0 mg/l. More Information on nitrates is available from the On -Site Services Program, at 343-7904. Attachments: HAA Checklist Maintenance Agreements Septic System Advisory Supplemental Engineers Report Well Flow Advisory Other By: Original Certificate Date:/ — L — 0 (Rw. 11101) Municipality of Anchorage , • Development Services Department Building Safety Division On -Site Water i4 Wastewater Program 4700 South Bragaw St. P.O. Box 19665D Anchorage, AK 99519.6650 www.ci.anchorage.ak.us (907)343.79W HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: CONIFER HEIGHTS S/D: LOT 5, BLOCK 1. Parcel ID: 015-093-39 A. WELL DATA Well type PWAU If A. B, or C provide PWSIOX N/A Date completed'UNK (1977?) Sanitary seal (YM) YES Total depth 222 ft. Cased to 222 ft. FROM WELL LOG Date of test, Static water level �0 rte' ft• Well production g•p.m. WATER SAMPLE RESULTS: Well Log (YM) NO Wires party protected (YM) YES Casing height (above ground) 12+ in. AT INSPECTION 06/15/05 196 ft. 3.2 9— p.m—Con form �_ coionies/100 ml. Nitrate%p(�mg./ Other bacteria 4_colonies/100 ml. �p 10 20015, Arsenic: N/A mg./L. Date of sample: 6 16 2005 Collected by: GEG, Ltd. B. SEPTICIHOLDING TANK DATA Tank TypetMaterial FIBERGLASS Date installed 9/22/1977 Tank size 1000 gal. Number of Compartments 2 Cleanouts (YM) YES Foundation deanout (YM) YES Depression over tank (YM) NO High water alarm (YIN) N/A Date of pumping 6/15/2005 Pumper NORTHLAND PUMPING C. ABSORPTION FIELD DATA 'BELOW EXISTING GRADE Date installed 9/22/1977 Soil rating (g.p.d./ftzor((�90 System type DEEP TRENCH Length 23 ft. Width 3 ft. Gravel below pipe 6 ft. Total depth • 9A ft. Eff. absorption area 270 fe Monitoring tube YES Depression over field NO Date of adequacy test 6/15/2005 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 471 gel, Now depth 14 in. Elapsed Time: 1 min. Final fluid depth 0 In. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N 6 type) NONE KNOWN If yes, give date D. LIFT STATION Date installed "Pump on" level at _in. E. SEPARATION DISTANCES Size in gallons High water alarm level at in. Cycles tested Meets alarm & circuit requirements?, SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank 100'+ 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 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service fine 10'+ Surface water 100'+ Driveway, parking/vehicle storage 20'+ Curtain drain NONE KNOWN Wells on adjacent lots 1001+ F. COMMENTS G. ENGINEER"S CERTIFICATION I certify that t have determined through field inspections and review of Municipal records that the above systems are in contormance with MOA HAA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date f, hy AS— HAA Fee $ 1-1 V{ Date of Payment \1 -R--ds Receipt Number C (Rev. 12100) Waiver Fee $ Date of Payment Receipt Number 8-20-057 8:21PM; ;907 5815301 0 2/ 4 iCS Rcf.N 1053437001 :hent Name Gamess Engineering Group, Ltd. Project Name/# Lot 5 Blk 1. Conifer Ilts :Vent Sample ID L5 BI Conifer Ilts, 8100 Red Ct $atrix Drinking Water ;ample Remarks: All Dates/Times are Alaska Standard Time Printed DateMme 06/10/2005 16:30 Collected Date/fime 06/15/1005 8:36 Received Date/time 06/16/2005 13:47 Technical Director Stephen C. Ede Allowable Prep Analysis 'ammeter Results PQL Units Method Container ID Limits Date Date Inst Patera Department NitraaaN 5.66 0.100 ticrobiology Laboratory Total Coliform 0 mg/L EPA 300.0 B (0.10) 06/16/05 WAW coV100mL SM209222B A (<-1) 06/15/05 TLF Municipality of Anchorage • Development Services Department - Building Safety Division Onsite Water S Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.d.onchorage.akus (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-093-39 HAA# UA 0106941 1. GENERAL INFORMATION Expiration Date: — 114-A 1 Complete legal description CONIFER HEIGHTS SUBOMSION• LOT 5. BLOCK _t, Location (site address or directions) 8100 RED COURT- ANCHORAGE. AK 99516 Current Property owners) RON HALL Day phone ' 562-7444 Mailing address 8100 RED COURT ANCHORAGE, AK 99516 Lending agency Day phone Mailing address Real Estate Agent DENNIS PITT w/ PRUDENTUIL JACK WHITE Day phone 727-0745 Mailing address 3201 "C" STREET ANCHORAGE, AK 99503 ` Unless otherwise requested, HAA will be held by DSD for pickup. 2. •• NUMBER OF BEDROOMS: 3 8..TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an Independent professional Civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 1^ 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my sear affixed hereto and as of the validation date shown below, I verffy that my investigation, based on procedures outlined in the Health AuthorityApproval Guldelines for this application, shows that the ton -site water supply and/or wastewater disposal system ls(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 lnvestgation and Inspection, the on-site water supplyand(or wastewater disposal system ls(are) In compliance with all applicable MunicIpal and State codes, ordinances, and regulations In effect at time tme of Installation. Name of Finn ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone 337-6179 Address 6901 DEBARR ROAD, SUiTE 2B • ANCHORAGE, AK 99504 Engineers Printed Name JEFFREY A GARNESS, P.E. Date 10f Engineers Comments: In Conducting this evaluation, AWKV, Inc. attempted to proOde a thorough, ConaclPIMm engineering anatyats of the system In saxxdance WM ADEC and MOA DSD GukWnes Q Regulations. The reported rasufts desoiibed Ora performance of tine system under the condillons encountered at ft time of title Gent and separation distances measured to readilyldentigable features. The opersdonai pre of off web and sepi c systems depend on ft local Bogs conoldw, grourrdwaterleveis that may fluctuate during dw year, and tine water usage of the famly being served by time system. These conditions are outride tine contra of the evaluator of tine eyelan. Satiafactay test results do not guarantee &*M PWlb r�of ft system, nor do trey guarantee that there are no hidden defects or enavedr nts. AMW, Ina can Mereiore not protide any warrent' or future estimate of how bog the system wgl continue to meet the operational requirements of Me ADEC or MOA DSO. The content of M report is for the sole benefit of tine ow wAsted above. Any regance upon or use of refs report by any ofher person or party is not authorized, nor will B confer any legal right vAstsmw. 5. DSD SIGNATURE kf Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the filowing Attachments: HAA Checklist Septic System Advisory Well Flow Advisory V OF 4*, ON-SITE WATER AND ipulations: WASTEWATER : PROGRAM Manitenance Agreements Supplemental Engineers Reort Other By. 041Z- 11� &J, O &Et` Original Certificate Date: 3 - i' �' O 1 pw. uaa) Municipality of Anchorage Development Services Department i JJ Bulk" Bafea OMWW Onsite Water 3 Wastewater Program 4700 SSM Bmgaw SL P.O. Bar 198050 Andarage, AK 99519 -WW vwvwxLw ch="Akue (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: CONIFER HEIGHTS S/D• LOT 5. BLOCK 1, Parcel ID. 015-093-39 A. WELL DATA Well type PMAM If A. B, or C provide PWSID# N A Date CompleteeUNK (19774) Santry seal (Y/N) YES Total depth 197+ IL Cased to 40+ IL FROM WELL LOG Date of test Static water level We on g.p_m. WATER SAMPLE RESULTS: Coliform 0 cdonlea/100 ml. Nitrate 4.45 nVA- Well Log (YIN) NO Wires property p (YIN) YES Casing height (above ground) 12+ in. AT INSPECTION 2/27/01 197 g, 2.96 g.p.m. Other bacteria _0 cot0nie31100 ml. Date of Sample: 2/27/01 Collected by: AWWC, INC. B. SEPTIC/HOLDING TANK DATA Tank Type/Mater181 FIBERGLASS Data tnsta8ed 9/22/77 Tank atze 1000 981. Number of CompaMterds 2 Cteanouts (YIN) YES Foundation d88ncut (YIN)YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 2/23/01 Pumper NORTHLAND PUMPING C. ABSORPTION FIELD DATA Date installed 9/22/77 Soo rating (g.p d 90 System type TRENCH Length 23 R. Width 3 fL Gravel below pipe a IL Total depth 12 R. Elf. absorption area 270 R` Monitoring tube YES" Depression over field NO Data of adequacy teat 2/27/009. Result (pesalFal) PASS For 3 bedrooms Fluid depth in absorption Held before teat 0 In. Water added 475 gal. New depth 17 In. Elapsed Tlme: 0 min. FkW fluid depth' 17 in. AbSmpaon rate >: 450+ 9.p d. Any rQuvanation treatment (past 12 mo.) (YIN 3 type) NONE KNOWN M yes, give date •• ONLY EXTEND 47' BELOW THE INVERT D. UFT STATION Data installed 'Pump on' level at ---in. E. SEPARATION DISTANCES Size in adorn High water alarm level at in. Cyder tested Meets alarm S circuit requirementsZ_ SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAiR station on lot 100'+ Absorption Held on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cieanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 50+ Property One 5'+ Absorption field 5'+ Water main N/A Water servlce One 10'+ Surface water 100'+ Wells on adjacent kNs 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property One 10'+ Building foundation—Lo '+ Water main N/A Water service One 10'+ Surface water 100'+ Driveway, perklrrgNehkie storage 50'+ Curtain drain NONE KNOWN Wails on adjacent k►ts 100'+ F. COMMENTS G. ENGINEER'S CERTIRCATION I car* that / have deferm/ned through Ae/d &rsperx/ons and 4 3 mWow ofMunk1pa/ records that the above systems are In .......... omftmanoe WO MOA NAA gu/dellnes In effect on this date. A. Gcmess.- Englneer's Pdn d% am JEFFREY A. GARNESS ! -7953 xDate 31910/f•••op_ ...... _d� HAAFeei_ 306.E Date of Payment 3-17-0/ RecelptNumber_ 160 (moi o2 OWV. law) Walver Fee S Data of Payment Recelpt Number 03-06-01 17:08 FRW-CTE ENVIRONVENTAL . ME Environmental SOMICee Inc. CUE Rat•# 1010961001 Client Name AIC Water & Wastewater Consultants In— project Name/# Co-.ufet Heights ST Lot S Bk 1 Client Sample 10 COnjfar lietghts SD Lot S Bk 1 alstrix Drinking Water Ordered By PWSID 0 Swilple Renwk+: 5615301 T-337 P.OZ/03 F-976 Client PO# Printed Date/Time Collected Date?Ime Rtccived Dateffime Tecbalcal Director Released By ry, 03/06,2001 9:33 0227/2001 16:15 02282001 14:30 Stcpben C. Ede AM%able Prep MaNsis PA-tmaer Reialu PQL L1du Mellw Um(u Doc Date Ina Ptatere Department Nurate•h 4.43 0.500 m8/L EPA 300.0 Microbiology Laboratory Total CoMotm 0 coytoomL S.MI$ 9222B Y 10im" 0228101 SCL 0223'01 KAP o9.3 39 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH E HUMAN SERVICES . DIVISION OF ENVIRONMENTAL SERVICES OU CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date 7-7, ST 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, Subdivision. section, township, range) i e. ... . /. ther-i+ Nit / /J,% 73.-J 56-1- f • .M Location jadCross ordirections) •�8'iov • ..,`LCD �' �•C7' (b� roperty,Owrief /� � 5*11J65 >{k Telephone: Home Business y •Mailing Address ��•.�a 97-M AAW %e 9950% (c�� �Ld�ding Institutiory. �-.6aifing Address= (d) F!"I Estate 601npar) _..� ..r Address Telephone id Agent --/LSU• (e) Mail the HAA to the followina List contact person and day F 2. TYPE OF RESIDENCE Single-Family)Q Number of Bedrooms 3 3. WATER SUPPLY Individual Well Community ❑ Telephone or. Check here hold for pick up. nber below. Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72.025 (A" 8,861 PW Page 1 of 2 We (99 19 "U1 Sio-CL Z jo Z abed •)pom s,jaau!6ua leuoissapid ay} u! suO!sslwo Jo SJOLa ioj alglsuodsaj lou sl a6eLo4ouy jo AAledio!unyq a14l •panssi s! aleoijivao a arojaq elep azAleue Jo suopoadsui lonpuoo lou op SHHO !o saaAoldw3 sluawannbaL aleis pue lejapal u!etiao A}s!jes of japio u! suollnlpsu! 6u!pual na41 pue sawoy jo sjaseLloLnd of Asapnoo a se si yl saop SHHO 941 'e�lsely jo alelS ayl u! paials!6ai Laau!6ua leuoissajad luapuadapul ue Ag anoge S 4deL6eLed u1 uaA!6 suo!leluasaidai 041 uodn Aluo paseq saleogipao lenaddy Aluoylny 411eaH sanssl (SHH(3) saoiALaS uewnH pue 4)1eaH jo luawlLedaa 06ejopuy jo A4!ledloluny4 a14l ♦0AC ��"t\ i .•� l9LL � 3J •y 'y�y I•••:DR••Me .14 NOI1f1Vo lenaddy leuo!1!puo0 jo swal leu0111pu00 panaddes!o —T— panaddy ale Aq swoaLPaq sol panaddy i IVAOHddVSHHo AV -?4r o�os �02-C GAIdaial 4$/? -1— oleo ssalppy wLlj jo aweN voiloadsul siLIj jo aiep 9141 uo looj}a u, suopeln6ai pue'saoueu!pJo'sapoo ale1S pue lediolunlnl pe yl!m eouelldwoo u! s! walsAs lesods!p lalemalsem jo/pue Alddns Jalem Ol!s-uo 941 'uogoadsut pue uo!le6psanul Aw woLj pue sal!j 96eLoyouy jo AUled!o!unyj 9141 woL} pauielgo uoliswjo}uj eyl uo paseq leyt Apia A jayUnj I •u!aia4 paleo!pu1 ainionils jo adAl pue swoojpaq jo Lagwnu 9yj jo; alenbape pue leuo!lounj'ajes si walsAs lesodsip jalemalsem jo/pue Alddns Salem ells-uo ayi 1e41 smo4s IenaLddy A;!Loyln V 41leaH s!41 jo uo!le6!lsanul Aw 1ey1 AjuaA I'molaq um04s aiep uo!lep!leA a41 jo se pus olaJay paxyje leas Aw Aq pa!1!Lao sy NOIIVWHOdN1 CNV V1VC'HC)UV3S 311d'S1S31'SN01103dSNl EJNICIAOkld WUI.4 E)NIH33NION3 'S ?W//WV /p S I*1 ' EES ALITY OF ANCHORAGE (MOA) UN\G\Pp�\ OSE SF�EA� TR H AUTHORITY APPROVAL (HAA) M t EtzPCHECKLIST - FEBRUARY 1984 2844720 P�G 2 O Legal Description: Lois /i%riP /T%J . A. WELL DATA Well Classification �' tlh6 If A. B, C, D.E.C. Approved (Y/N) AA Well Log Present (Y� Date Completed uax.1^1V Yield. go 3.7 6?h 1A Total Deptho jZ7ase Cto Z2 Depth of Grouting Static Water Level X93 Pump Set At Casing Height Above Ground Z'j Sanitary Seal on Casing ON) Electrical Wiring in Conduit N) Depression Around Wellhead (Ya Separation Distances from Well: To Septic/Holding Tank on Lot G �Oj s r ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot MTV 9' ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer CleanouVManhole — 44 To Nearest Sewer Service Line on Lot LS t Water Sample Collected by /Q�5 /�/E� ; Date Z -//W Water Sample Test Results 4Ae T -'6,j- comments AZZ A --"J 7212' 77//-'oDQitCGtl ?.�e27. tidi�"Rr' 7a etwV—T B. SEPTIC/HOLDING TANK DATA Date Installed %_u-77 Size /MYD No. of Compartments ?I Standpipes) Air -tight Cap (Y ) Foundation Cleanou (Y/ ) Depression over Tank (YON Date Last Pumped 7-/2 8.P /1fA4rS Pumping/Maintenance Contract on File (Y/N) A ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well /03•S r To Building Foundation L9 s' To Property Line /O t' To Disposal Field r --o Water (Jlain/Sq[wce Line /y To Stream, Pond, Lake, or Major Drainage Course ,..�. 1, *'(„- -Comments � " - ' • � 4 Pagel of 2 ' 72-026111184! [.S $I 47✓i/ro An. C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design TQt,�ltt/ Date Installed '7 -LZ -77 Length of Field Z3 / r � Width of Field — 3 Depth of Field Z Gravel Bed Thickness L Square Feet of Absorption Area Depression over Field (Y© _ Results of Last Adequacy Test /f aft.4Td 717(. Standpipes Presen (Y ) Date of Last Adequacy Test 7'11 ,fb Separation Distance from Absorption Field: To Water -Supply Well 't To Property Line To Building Foundation Lot If ZO To Existing or Abandoned System on On Adjoining Lots ZO •0 - To Water Main/Service Line /0 4- To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course /m rt To Driveway, Parking Area, or Vehicle Storage Area /0, -)1- Comments Comments D. LIFT STATION D ' ed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) _ Comments Dimensions Manhole/Access (Y/N) — "Pump Off' Level at •• Check Permitted Bedroom Rating Against HAA Request •• Vent(Y/N) ng Cycles during Adequacy Test. Meets MOA Icertify that lha%y�he% ed/, le fled,orconformedtoallMOAandHAAguidelinesineffectonthedateofthisinspection. Signed _ L�� - <� Date Company /Me3 MOA No.++�QF At,�� Receipt No. � / Q►•.•• p s .• •. Date of Payment p '�� 0 *%a9TH P* 2 Cr /.... 0.0 •.• •...... Amount: $ l %D - its ngi e at 1 ij G Rt!ID• JR. ;� �.�•. CE -2251 n Page 2 of 2 72026111,841 'r_` 4 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 5622343 FEDERAL TAX ID N 920040440 ............ ANILTSIS REPORT 11 SIMPLE for Work Order 1 7801 Data Report Printed: JUL 14 88 1 15:52 Client Sample ID:L5, E1, CONILIR HIS. PN3ID :UA Collected JUL 11 88 8 17:48 hrs. 8eceired JUL 12 18 8 09:00 his. Preesrnd with :4 DEC. C Client Nave : UCS Client ►cct : ►EECSRP P.0.1 NONE REC D Req 1 Ordered Ry : 1. MIEN ►nslysis Completed %JUL 13 88 Sand Reports to: Laboratory Super GC icor •371PHEN C. LD,L- _ 1)UCS Released Ey : J; •79'� 2) .................................................................................................................................... Spacial Instruct: Chealab Ref 1: 1751 Lab Smpl ID: 1 Parameter Tested MITRIU-N Sample ROUTINE SIMPLE. Remarks: SAMPLE COLLECTED RL ►. MIIN. Matrix: Neter Result/Units Method 3.8 aq/1 IPl 353.2 plowable Limits 10 .............................................................................................................. 1 Tests Performed Set Spacial Instructions lbore U►•Onsrailable NO. Nona Detected " Sea Sample Remarks lbon NA- Not ►mined IT -Leis Than. CT -Greater Than