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HomeMy WebLinkAboutCHUGACH PARK ESTATES BLK 1 LT 20Chugach Park Estates Lot 20 Block 1 #051-481-35 I~-----~~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF 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 E~EW A,',NGADDRESS LEGAL DESCRIPTION LOCATION ~ NO. OF BE?~OOMS DISTANCE TO: +[ O0 ~ ' ~ Materi~ No. of compartments ~ Manufacturer ~~ ~ 5~-~ ~ ~ Liq. capacity in gallon~ ~ Inside length Width Liquid depth / ~O ~ IF HOMEMADE: ~ ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O Z ~ Manufacturer Material Liquid capacity in gallons ~ = DISTANCE TO: Well~[o~ ¢ Founda~ / Nearest~lot line / PERMIT ~. ~ - ~ ~f~s Trench width [ Distance between lines ~ ~ Z No. of lines Length of each line Total ]engt ~ / inches~. Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth ~otal effective absorption area m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Cl~d~ D~ D~ D'~ PERMIT NO.~ ~ - Buildin~oundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: ~'~ ~ ~ I 0~ f ~ I O~ I ~ PIPE MATERIALS SOl L TEST RA~,~ / ~ I NSTALLER R EMAR KS / " APPROVED DATE LEGAL 72-013 (Rev. 3/78) '~'" ~.) L O T' :-'_:, i Z E L20 Bt F:HLIGRCH PRF.:K ESTFITE9 9 ¢2~ 999'La S ~'_.".! U I:q. R,cZ F E E T T':,.'F'E OF '_::;OIL ~EiSOr4:F'TiO?.,i S'¢STEM tS- TF".:EH::H FIR::.:;: !"!Lth~ .'-,!i. JMELE~: OF E:E[:,F.:F~OHL:~; := "['FIE: LE!'.,IGTH [:,ZMENS!Of.~; !:5 THE LENGTH ,:: it'.,! FEET::, OF THE TF:ENCH OR £:,RFITHFZELE'. THE DEF:'Tid OF F¢ TRENCH OR F'!T :ES THE E:,!STRh.!CE BETHEEN THE 5URF'RCE OF 'THE GF.:OLi?,!E:, ~HE:, THE ¢OTTOH OF THE E:XC:,'::tVRTTOI'.,! ,::!N FEET). THE" GF..-:OVEL F_:,EF;TF! I:E: THE i"'I!NIHL!M DEF'TH O?:' GF?VEL E:E'i"HEE?.~ THE OUTFFILL F'IF'E FIN[:, THE; ~'~:OTTOH OF THE; E::.::E:F!'v'FiT!O!',! ,:: ]:l'-~ FEET). F'EF-.':h! 'r 7' F~PF'L. :[ C~NT HR':_:; "r'~-iF ;,cc'c, "ii' ': .r r:, t L. l T:-,' 'T'F't I .~.JF'r'!r~, ',' TH I L:, E:,EF'F!F?:'HEi',iT E:,LtF.: I HG 'T"~.F .,~' N,:.-T.q~; ¢~T'i' -~..i,, .,. _,, i h,i~.;F'ECT Z L-Ii',!:5 !'"iF:'_. ~'-'*',, .......... i,.!F'l I '::; F*;D.:rRCEHT TCi 'i-~4 T,:~,, ...... F'F-:OF'EF~:TY FIN, E:, TH~: Hjr,!FL::R: OF RE:E;:rC, ENE:E:5 THFfT THE HEL. L. ~.,;i:L~. E, RE'F:F!' .... ~N('2 OF R~.,'.: '5'.,':E'TE,". !.,,,'ITHEI. tT F'.]:,~,!~L. I i'-¢'_:_';F'EC.::TIOH F-d'.~.[:, .F!,F'F'FtE,"v'RL E','T' TH!iS; h!!N!MLtH D:[STi-~NCE BETHEE?.,! Fi HELL FINE:, Fih!'T' O,N-:SI-f'E SEt,.!FIGE Di:::;F'O':';FtL S'~..'L:;TEM :!E~O FEET F'OF..: ':i F'F.':i;/~TE lq[ELL OR 1~.50 TO 2E,:3 FEET FROH R F'LiE',LIC HELL [:,EF'Ei'-,IE:,i?.~G LIF'ON THE T:¢F'E OF' F'UE:LZE. HELl. .... i'!IH. IMUi'! C,I:'.:.;TF!i'qCE F:'F:OM '!::i F'Ri',/FfTE !,!ELL.. 'r'o Fa F'F.:!'v'F!TE $Ei.,.iEF4: LINE IS 2E; FEET F~N[:. i:.!ELL LOGS ~RE REEC!UiREE:, ~qE:, .FiLiST E~E RET'UF:!'.,iEE:, TO THE E:,EF'.~,Fi:THEHT I,.!ITHIN OF THE HEL. L COMF'LETIOI'.,t. OTHEF;: RE,':.!LiIF:EME':.NTES I"IR'T' FiF'F'LY. S;F'EC:IFIE:RTIO,~.~S'; RH[::' CO.i",ISTF~:L!CTION R',/P, ! !._.RB~._E TO _T i',!S;UFiE i::'F;:OF'ER I ,NL:...TRLLiqT 1 O1'.4. i F_':EF.:T iF'? 'THFtT -i ....... T Fd'i F'F!M!LT~:~F' : 'rTHi .. ,,, .; ...... "i"NF' ,~:'~:'C,I..~... .............. !IF:Er'!Et'.,!",r'i5 F'OF.: r"¢.J-,q'rTE ':;E'I, P'F":;. ............. RI'-.![:, t,.tF[ L'::-'; FI.':; F-'L".'LP.:TF! E:'T~ 'i-Ht:~' t',*,i~. 'r ... ...... ~ .........i:m":', :._ I . EIF R!",iE:HOF:FIGE .2. Z ,dZLL. IN'STAL ...... THE ::-;:,--'::,'TE.h'! ;i:N Ft :: (: Z F,.'%, Fi h,. L" E !4ITH THE CFiDF-'Z-:. Z: :[ U!'.~r::E::F..::g'/F,.qi: THFIT THE: ON-SITE ::T,E.b.!EF: 'S 'T"~ 'F FZ !','I i'"iF:l? F:EQUtF:E EHLAF~:GE.,"'!Ef'.~T' IF THE .................. ~;.r:--i. ,'"r .... l:'", ,_ !h,IIZ:LIj[:,E h'll-iF4'E THIq.~4. ;2: E;EE:,F:OOi"~ , ;;'P:":; ~ [ F,".jF F' T :.Z.'; .......... E ....... "rFI ....... .F!P'W!Z .,' !.~ h!!",,': L.~:.LiL!-"!?. i_'!.Jr,i~:, I XX Sol LS LOG MUNICIPALITY OF ANCHORAGE t, DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION • TEST 825 L Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEff i PERFORMED FOR: Jack Reemer DATE PERFORMED: 611 q/R7 LEGAL DESCRIPTION: Lot 20 Block I Chugach Park Estates DEPT" SLOPE SITE PLAN (FEET) 1 Date 2 Net .,,�1� ��� to Net �ri, j Drop ° o 3 0 b � 4 rVr( ••• •! II. 0 5- :t 4 6- 5 7 7 � 0 8- �a '.W I 9 9 0 0 10 .■■■NppirUMMM MONNNIMEEN 0 0 11 t a 12 O ■EM■N1NNEEN D 3 13- 14 14- 15 15- ■.M■NE®.■■ 16-- 16171819 Adm �'• � 17- 18- '91 ■NMEN11®N■■ 20 PERFORMED 72-008 (6/79) Topsoil, Peats GW -Loose Sand & Gravel with cobbles to 10 -inches 85 ft2/Bedroom Bottom of Pit r s, WAS GROUND WATER NO L ENCOUNTERED? O P IF YES, AT WHAT E DEPTH? ■■�M■■■■■■ Date Gross Time Net .,,�1� ��� to Net �ri, j Drop .■■■.."Zo■ rVr( ••• •! II. :t 4 ■■■■■NNNE �a '.W I .■■■NppirUMMM MONNNIMEEN t ■EM■N1NNEEN ■.M■NE®.■■ Adm �'• � ■NMEN11®N■■ NN■■NIO®■■■ t4S4! EENNNEENE MMMM■RNM■ 111RI MINE®NEE Reading Date Gross Time Net .,,�1� ��� to Net �ri, j Drop rVr( ••• •! II. :t 4 �a '.W I t Adm �'• � PERCOLATION RATE N/A (minutestinch) TEST RUN BETWEEN FT AND - FT I CERTIFIED BY: r DATE: RL T C��ex�ifir ignilinu by • DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759 OWNER OF LAND ✓�� �� R E �/ E 2 DEPTH OF WELL S- / 1_40 i-�lJcl f . � F � Arch' `%r/ ADDRESS aT✓ / STATIC LEVEL OF OF WATER FT. o?o a'ec d cN✓C,4,leAt �.� 165'7 "DRAW Fr.At. nFscRttrrtnN l_ DRAW DOWN FT. DATE -Started. KIP d-- ' ..-Ended r / PERMIT NUMBER KIND OF FORMATION:, From (7 Ft. to_L/_0 Ft. YA"o S e""q vt C From Ft. to Ft. r/ ds0"4r df - FromI � 0 Ft. to -t —/Ft. r 16,-Z T .SA,JLi From / / Ft. to / 7 i Ft. SA "-)X h NJr_'G From Ft. to Ft. fl e do d Ed' S From -L 7 IFt. to 'fid Ft. So -16 From /.70Ft. tQD Ft, r/1 n 62H✓Re_ From Ft. to Ft. _V_k H % From r Ft. to L / fFt _S-'VfU.o l� / ✓a L From Ft. to Ft. From Ft. to Ft. L.tJ P rE4- From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. i GALS. PER HR KIND OF CASING From Ft. to Ft. From Ft. From Ft. to Ft. From From Ft. to Ft From o Ft. to—Ft- FtFrom Ft. to From Ft. to Ft. From Ft. to Ft. From Ft. to—Ft.— oFt.FromFt. From—Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. From Ft. to Ft. I From Ft. to Ft. From Ft. to )A IIPAL"Y OF ANCIiORAGE From Ft. to EtJV�ur.<;r..A.:.c1._cTION From Ft. to Ft MISCL. INFORMATION:D C (' t I Vt DRILLER'S NAME • Municipality of Anchorage On -Site Water and Wastewater Program 4, (907) 343-7904 s A F E* Y Certificate of On -Site Systems Approval Parcel I.D. 051-481-35 Expiration Date: 2,11/16 1. GENERAL INFORMATION Complete legal description Chugach Park Est. Block 1, Lot 20 Location (site address) 19311 Chugach Park Dr. Current Property owner(s) Soukup -Owens Joint Revocable Trust Day phone Mailing address 7857 Louden Ct. Fort Collins, CO 80525 Real Estate Agent bay phone 2. TYPE OF DWELLING F Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) - TYPE OF WASTEWATER DISPOSAL: 3 3. NUMBER OF BEDROOMS: Holding Tank 4. TYPE OF WATER SUPPLY: Community Individual Well El Individual Water Storage ❑ , Community Class Well ' ❑ Public Water System ❑ - TYPE OF WASTEWATER DISPOSAL: Individual El Holding Tank ❑ Community 11 Public Sewer ❑ WaiverNariancerequest for: — Distance: COSA to be released to the -engineer,. unless otherwiserequested. by the engineer.` COSA Fee $ Gl2ia ` Waiver Fee $ Date of Payment f f 23����, Date of Payment Receipt Number 613$? C) Receipt Number COSA# o5cl6 (n Jlo Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validationdateshown 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 forthenumber of bedrooms and type of structure Indicated herein. I further verify that based on the information obtained. from the Municipality of Anchorage filesand from my investigation and inspection, the on-site water supply and/or wastewater disposal systemis(are) in compliance with all applicable Municipal and. State codes, ordinances, and regulations ineffect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientiousengineering analysis of the system in accordance. with MoA COSA guidelinesand regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation: distances measuredtoreadily identifiable features. The operational life of all wells and septic systems depend on the local soil 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 this. system. AW systems eventually fail and. satisfactory test. results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we: cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole: benefit of the owner listed above. _ `Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven Pannone Date 9/29/2015 %'k: 49TH '•*'/ 6. DSDSIGNATURE V/System #1 Approved for bedrooms t $ evnnt'ne: ' System #2 Approved for bedrooms +� �9 CE -8149 Disapproved Conditional approval for bedrooms, with the following stipulations: By: y �u t Original Certificate Date: 12-77-71 7 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (GOSA) based only _ upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. TheMunicipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory, Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSAWuesheel t :,i c If more than 1 septic system is on the lot: COSA't;hecklist# of I Structure served by this system Certificate of On -Site Systems Approval. Checklist Legal Description: Chugach Park Est. Block 1, Lot 20 Parcel ID: Q51-481-35 A., WELL DATA. Well type Private If A, B, or C provide PWSID # Well tog (Y/N) Y Date completed �wSanitary seal (YIN) Wires properly, protected (Y/N) Y Total depth 215 ft. id# /RBS Cased to 215 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test –' &J/ 982 9/24/2015 Static water level 188 ft 192 ft Well production 7 g.p.m.: _ 4.0+ g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate Sco mg/L Arsenic AJ6• ug/L Dateofspmple: Collected by: PC -S B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 7/26/1982 Tank size 11000 gal. Number of Compartments 2—. Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YIN) N Date of pumping 6/30/2015 Pumper Denali Sewer `& Drain C. ABSORPTION FIELD DATA Date installed 7/26/19$2 Soil rating (g•P• d.fft) Y YP 2 or ft2/bdrm 85 SRBR System type Shallow Trench Length 46 ft. Width 5 ft. Gravel below pipe 1 . ft. Total depth 6.1 ft. Eff. a6soptjon area 264 ft2 Monitoring tube Depression over field N Date of adequacy test 9/24/20115 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 0` in. Water added 463 gal. New depth 2 in. Elapsed Time: 14.0 min. Final fluid depth 0 in. Absorption rate >= 450+ ' g,p.d. Any rejuvenation. treatment (past 12 mo.) (Y/N.9 type). NO If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Aecess (YIN) "Pump on" level at " in. "Pump off' le -vel at in. High water alarm'level at in. Datum Cycles tested Meets alarm &circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots',100+ Absorption field on lot 100+ On adjacent lots 100+As Public sewer main 75+ Public sewer Imenhole/cleanout 100+ Sewer /septic service line 25+1 Holding tank 100+ Animal. containment areas 50+Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ 100+< Wells on adjacent iota_ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+.,Water main ,10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS /� Surveyon File ta,r ®AX _CiO(v (l rr CII.SVVI G. ENGINLER'$ CERTIFICATION„ [.certify that I have determined through field inspections.and review of Munici J` paf records that�the ,above. systems -.are in conformance, with MOA COSA guidelines in effect on this date. • • ..... Engineer's Printed Name Steven R. Pannone :$#ereri )i Efannane:CE Date 1 9/29/2015 ,6149 COSAcanary sheet 2-6-15.doe - =a D -I tai) m DmK MMM zoo i�o Cl) _0 M0 =�v mcmo z�m v� o= D -n z a N co m a \ O � 9b gOZ 3Ng�,95oZ�s 0£ n � aj r D � \ rn r- 0 O cn _s 0 57 < g m m m y y''w�anCL s a cNn9: m�?tiomei 90 � =r N 2ooo=L 7 C m oO3ma rA �gm Z \ CL O _� cm a °4��_. 3 g< dm 0 z \ \ �. m 0 o $ � =r r- a \ m �' 'O m � !'� D .Tml �y l� c xw'm� m o3.infD?m a pm V1 m C fM m 7S r N 0 � N Ah 5r ::& .Z 1 -q l/ @ n°tea m Ww oy o o a= =r ID' m w n a 3 m o mCl) a ato ca 1�1 C O r- 0 O cn Municipality of Anchorage Development Services Department Building Safety Division On -Site Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519519 -6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. DS I - 14 8 1-35' COSH . ._ O 6 O 3 ZI 1. GENERAL INFORMATION Expiration Date: I I - I _5" - 0 6 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address CHUGACH PARK ESTATES SUBDMSION: LOT 20, BLOCK 1, 19311 CHUGACH PARK DRIVE • CHUGIAK. AK 99567 DAVID CARLSON Day phone 688 12024 P.O. BOX 672081 CHUGIAK, AK 99567 Day phone GRFO SHFARS w/ COLDW171111 RANK R Day phone 317J3(100 10928 EAGLE RIVER RD. • EAGLE RIVER, AK 99577 I 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 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 jDSO)1ssUes-Certif1cates-of OnSlteSystems Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify, that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality ofAnchorage 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 Finn GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineers Printed Name JEFFREY A. GARNESS, P.E. Engineers Comments: In conducting this evaluation, GEG, UD. allompted 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 the system under the conditions encountered at the time of the test, and separation distances measured to readily identiriablo 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 lest results do not guarantee future pertormance 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. 337-6179 Date 12/0/1A Conditional approval for bedrooms, with the allowing stipulations: Attachments: Septic System Advisory Well Flow Advisory Nitrate Advisory Maintenance Agreements Supplemental Engineers Reort Other 4y A.yerness.r CE -7J53 10 A o Y 0Ff ON-SITE WATER AND ; rt? WASTEWATER : E 1 •PROGRAM .• By: Original Certificate Date: IQ_ �„nay Municipality of Anchorage • Development Services Department Building Safety Division On-Ske Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 995198850 www.muni.org WWW (907) 3437904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST' Legal Description: CHUGACH PARK ESTATES SUBDIVISION: LOT 20, BLOCK 1. Parcel ID: © 51- 4 3.3 A. WELL DATA Well type PWATE If A, B, or C provide PWSID# N A Data completed 6/1982 Sanitary seat (YIN) YES Total depth 215 ft. Cased to 215 ft. FROM WELL LOG Date of t83t 6/1982 Static water level 188 ft. Well production 7.0 —g.p.m. WATER SAMPLE RESULTS: Coliform _0 colonies/100 ml. Arsenic: NI) ugJL. B. SEPTICIHOLDING TANK DATA Nitrate 1.7 mgA. i i Well Log (YIN) YES Wires properly protected (YIN) YES Casing height (above ground) 12+ in. AT INSPECTION 7/14/2006 192 ft. 4.3 g.p.m. + Other bacteria _0 colonies/100 ml. I Date of sample: 7/14/2006 Conected by: GEG, Ltd. Tank Type/Material STEEL Date installed 7/2611982 Tank size 1000 gal, Number of Compartments E Cteanouts (Y/N) YES Foundation cleanout (YM) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 7/25/2006 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA Date Installed 7/26/1982 Soil rating (g.p.d./lt'Or1� 85 System type SHALLOW TRENCH Length 46 ft. Width 5 ft. Gravel below pipe Total depth 6+ ft. Eft. absorption area 264 fe Monitoring tube YES Depression over field NO Date of adequacy test 7/14/2006 Results (Pass/Fall) PASS For 3 bedrooms Fluid depth in absorption field before test DE' in. Water added 705 gal. New depth Ein. Elapsed Time: 8 min. Final fluid depth DRY In. Absorption rate >: 450+ g,p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give data D. LIFT STATION Date installed Stte in gallons "Pump on" level at _in. "Pump OfP�ist� IIT E. SEPARATION DISTANCES Man1141e/Acoess High water alar level at in. Cycles tested Meets alar & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankfift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank Animal containment areas 50'+ Manurelanimal excrete storage areas 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 106+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parldnglvehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I codify that I have determined through held inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date 16/rojnb COSA Fee S 11 ,2,(). eXp Date of Payment O l al E Receipt Number R7G`15 (Wv. 71ne) Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services _ On -Site Services Section P.O. Box 196650 Anchorage. Alaska 99519-6650 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING Parcel I.D. # 051-481-35 HAA # �PtT T� -/ 1. GENERAL INFORMATION Complete legal description Location (site address or directions) 19311 rut GACH Peak DRIVF CHUGIAK. ALASKA Property owner JAMS DAY C/o DON MCKEN71F — Day phone 694-4200 Mailing address 16600 CFNTtronn n DRIVE EAGLE RIVER ALASKA 99577 Lending agency Day Phone Mailing address I Agent DON McKF`71E w/ REMAX OF EAGLE RIVER Day phone 604-4200 Address 16600 CFNTFRnn n QRlVF EAGLF RIVER. ALASKA 09577 Unless otherwise requested, NAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: NOTE: Individual well XXX Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding Tank Community on-site Public sewer NOTE: 1P community wastewater system, provide written confirmation from State ADEC ing to the legality and status of system. I 72-025 (Rev. 1191) Front MCA x21 Computer Version k6 Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1,400.00 at, or prior to, closing for the engineering services provided. 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. l 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 in compliance with all Municipal aState codes, ordinances, and regulations in effect on the date of this inspection. . , �I Name of Firm Address Engineer's Signature Phone (907) 337-6179 fm In conducting this evaluation, AWWC, Ings a em ted to'> v e a thorough, conscientious engineering analysis of the system In accordance with ADEC and M A H S Guidelines & Regulations. The reported results described the performance of the system under the condition 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, ground water levels that may fluctuate during the year, and the water o�00 Oda 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 theyguarantee that thereare no hidden detects or encroachments. v AK=, Inc. can therefore not provide any warranty for future estimate of how long the CO.. H system will continue to meet the operational requirements of the ADEC or MOA DHHS. a 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,. . C, r ..............? nor will it confer any legal right whatsoever. DOp e r A. orness; G 6. DHHS SIGNATURE �0��`e. —7953. .IG Approved for 3 bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: Additional Comments Date R-31 -oO The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineers work. 72-025 (Rev. 1191) Back MOA 621 Computer Version I RECEIVED Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERV8&8 2000 Environmental Services Division j 825 V Street Rm 502 Anchorage, Alaska 99501(Qp21LIPAl WO ENVIRONMEFITAL s�RvICESMOO ory aN Health Authority Approval Checklist Legal Description: CHUGACH PARK ESTATES S/D; LOT 20, BLOCK 1 Parcel I.D.: 051-481-35 A. WELL DATA i Wen Type PRIVATE If A, 8, or C, attach ADEC letter. ADEC water system number N/A Log present (Y/N) YES Date completed 6/1982 Total depth 215' Cased to 215' Casing height (abm ground) 18"+ i Sanitary seal (YIN) YES Wires properly protected (YM) YES FROM WELL LOG AT INSPECTION Date of test 6/1932 Static water level 188' Well production 7.0 g.p.rm. WATER SAMPLE RESULTS: 8/22/2000 194' 5.38 g.p.m. O Nitrate 1.24 ma/L Other bacteria 0 Conform� Dein of sample: 8/17/2000 Collected by: A.W.W.C.. INC. '• B. SEPTICIHOLDING TANK DATA Data installed 7/26/1982 Tenkstm 1000 Number of Compartments 2 Cleanouts (YM) YES Foundation cleanout (YIN) YES Depression (Y/N)—NO High water alarm (YIN) I N/A i Date of Pumping 8/18/2000 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA 'HOUSE HAS BEEN VACANT SINCE MARCH. PREOAKED DRAINFIELD WITH A 1000 GALLON ON 8/21/2000. Date Installed 7/26/1982 Soh rating (9.p.dM2 ol(@�D 85 System type SHALLOW TRENCH Length 46' Width S. Gravel thickness below pipe 1' Total depth • 6'+ Effective absorption area 264 SQ.FT. Monitoring Tube present (YIN) YES Depression over field (yM)NO Date of adequacy test 08/22/2000 Results (Pass/Fan) PASS For 3 Bedrooms i Flukt depth in absorption field before test (In.); o" Immediatelyafter 1291 gal. water added (in.k 100 I Fluid depth o" (ins) Minutes later. 6 Absorption rate - 450+ ! Peroxide treatment (past 12 months) (YIN) NONE KNOWN If yes, give date — 72921 MW. Mr CMVAK Vff" D. LIFT STATION Date Instolled ' Size Manhde/Acoess High water alarm level at• 'Pump Orr level at' *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septidholdfng tank on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100,+ On adjacent kits 100'+ Public sewer main NSA Public sewer manhole/cleanout N/A Sewer/septic service One 25'+ LHt station N/A SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Foundation 5'+ Property One 5'+ Absorption field 5'+ Water maiNservios One 10'+ Surface wateddralnage 100'+ Welts on adjacent lots 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property One 10'+ Building foundation 10'+ Water maln1service One 10'+ Surrace water 100'+ Driveway, parkingivehide storage area 10'+ Curtain drain NONE KNOWN Wells on E F. ENGINEER'S CE Icar* that t Pdv of MuMdpal With MOA D Signature Engineer's Name fd Inspections and review stems are In conformance fids date. FAA Fee S 3" Date of Psyment a Receipt Number :5�& 33 72-028 MW. awr conipuw vwWwn Waiver Fee $ Date of Payment Receipt Number Sent By: RE/MAX OF EAGLE RIVER, INC.; 9076960214; Aug -25-00 11:44AM; SmT BYTACIFIC NR TITLE -Alf ; 2-14- G : 4:SWM : PNI ALASKA -U1,1• NA]L•1797(TRI:I 11:01 PRI IL6 TE6c2i2.9' P /. 1 1 B h 9 w•r+... yFRE . � . .user Auf.ur.u..• .dly��e_ til' .. • . 11=�1�tt011' Ktpel60 stslarn of 1661®c essol lrilfl ts�R ram of t b -w SWAP "ry1 bm smomw., . Mrwrw. T CaEtD lUARj ltSt 901M )Qp(ti• canYa. /. 'ty� t.trd ,Lt • LlfeerHur Kwe•r L tam an UN W lwdlp W.11.it•rq • ,"t v'"pow 3s MA lot agogmum. Y~ �_w� cif• �. WYw�ry/ y�r Lto pot ad *,"tea r Wattle �rI 3M tbe.. M r r1'�lrrV .1.. LIMY s. rre a M w l to p.1t[«ry ••ttti�s 'G i ~�.•�L".'�"'0 s•et•ty R lsralw.. . 4W t•.K•. flr ��� .•rater ptwlllp,s AWncrAat t.snu auavetct.� Page 2/2 ;! 2/ 2 eot ILII +J; I l: i r , I t MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING &_-J,:-O / - - ~,:: J NAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 20; Block I; Chugach Park Estates Subdivision; Location (address or directions) 1931I Chu. gach Park Drive (b) Property owner Mailing Address (c) Lending Institution Mailing Address A. H. F. C. #44690 Telephone · (home) 520 East 34th Avenue, Anchoraqe~ Ak. 99503 Business Telephone (d) Real Estate Company and Agent Re/Max of Address 16600 Centerfield Drive, Telephone 694-4200 Eagle River ATTN: Suite 201, Eagle Sharon Mins ch River. Ak. 99577 (e) Mail the HAA to the following address: (or check here ~r. if hold for pick up.) List contact person and day phone number below: S & $ ENGINEERING 17034 Eagle Ri*vet Loop Road No, 204 2. TYPE OF RESIDENCE Single~Family)~ Number of bedrooms ~ '", 3. WATER SUPPLY Individual Well ~c Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site EZ)( 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 (Rev, 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Telephone ?¢~'~' ~' ~ ~'~ ~ 17034 Ea-~le River Loop i:~oad i~o. 2.04 Eagle River, Al~(a Name of Firm Address Date 6. DHHS APPROVAL Approved for __~' Approved .. bedrooms by Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 Well Classification Well Log Present ~)/J~-i~P' Total Dept~?-~' t~ Cased to~?.-~'' t'~ Depth of Grouting Static Water Level I. ~t Casing Height Above Ground Electrical Wiring in' Conduit (~/N) MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: ~.-~ 7...~..~ If A, B, C, D.E.C. Approved (Y/N) ~"~t~-~ I.,,-~,'Z~ ~ /-~. Yield ~,0 ~,qpr~ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ~ oc:, To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line .~_~i'.~ Pump Set At Sanitary Seal on Casing ON') ~ Depression Around Wellhead ~/~ ; On Adjoining Lots \~¢ ; On Adjoining Lots \oc~ To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments'~ '~----~<.~ ¢. m ~--.r-~ ~) ~,_~ B. SEPTIC/HOLDING TANK DATA Date Installed '7 - Zt-,-157..- Size ~ No. of Compartments Standpipes ~3/1~) Air-tight Caps t~.,Y/I~ Depression over Tank Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) -------- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line To Water Main/Service LiP'e To Stream, Pond, Lake or Major Drainage Course Comments ~;;~-~P~,~ ~ ~iZ.. Foundation Cleanout (~/J~i-) Date Last Pumped "/- ~ - %°1 ~ 1 ~--- ; for ~ Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field lDO ~ 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~J -Z~L. ~ ~Z..- Width of Field Square Feet of Absortion Area Depression over Field (Y/~ Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present Date of Last Adequacy Test ,,./ Resu Its of Last Adequacy Test ~>.~.,.~ ~ ~.~---r~ ~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line \ c~ t+ To Existing or Abandoned System on ; On Adjoining Lots ~ t4- To Cutback (if present) Comments D. LIFT STATION Date Installed Dimensions Size t n-~'C~"~- Manhole/Access (Y/N) - "Pump On" Level at~--"----'"-"-'~~ High Water Alarm Level at _.~~_...~Vent (Y/N) Tested for -"'~in.q Cycles during Adequacy Test. Meets MOA Ele~ Comments ~ **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in.a~l~ ~3~{~iLte of this inspection. Signed S & S ENGINEERs'NG ,.. , ' ' Company =,~,_m~,~.A~sk, 99~7~17034 Date Receipt No. ~~ ~ ~A/~ ~~ Date of Payment /~ - ~/~- h ' Waiver Fee: $ Amount: $ / ~ ~.~ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 i Time APPLI&4T FILLS OUT UPPER HAL^ONLY Property Owner ` AC\.� \ `j PhGo/ne +1 \ Ak Zip Code �O. �� V Q C 9S 7Y I Mailing Address O �. � Q Date Inspector Inspector Buyer v.S 1a��V Inspector Address Zip Code Lending Institution \ CCt/t C, I 1..Q�L,Phone Ad o.g1� ,,,« g� 0.�� ` /� Address Lu \ C. 2 v C� �C V_ O ,K 1 �S.,ZIPCode C(9S % Field Notes: Realty Co. d Agent MUNICIPALITY OF ANCHORAGE Phone Address Zip Code 1 1 l Legal DescriptionL ( 1 0 J 7 v9 rte. C<<. C.ti17C. Street Location . „-� .. .,, •>T ,..: RECEIVED ( y>) APPROVED BEDROOMS Type of Residence ( ) DISAPPROVED �, Srt Single Family -11 --s Multiple Family No. of Bedrooms '0 Other BY: t Water Supply IndividualIItlt�� r ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. ❑ Community /� A� no I.0 (n nj 'IW/. For wells grilled prior to that date, give well depth (attach log It available). ❑ Public Utility Sewer Disposal Q act to199'9 .f] individual �� ! Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector P(OL Field Notes: MUNICIPALITY OF ANCHORAGE 1 1 l ENVIn .: I.'.:I .,F.. l .0 F C = 2 1982 RECEIVED ( y>) APPROVED BEDROOMS -CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE BY: t I Solis Rating Date Sewpe�r Installed Well To Absorption Area 40 C Weil Lop Received Septic Tank Size / Q 7 8 Z Well to Tank -{(N non CM