Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
COLONIAL PARK BLK 3 LT 8 S2
Colonial Park Block 3 52 Lot #050-301-18 z, 1. Municipality of Anchorage Page —Lof DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW 9243V'y PID Number: 050'30/-/8' Name DHcE 6• FkLLNE12 Wastewater System: 13New PdUpgrade Address:10 ABSORPTION FIELD Phone: 9 7 No. of B room$: ($beep Trench ❑Shallow Trench O Bed ❑Mound O Other LEGAL DESCRIPTION Soil Rating: O. Total Depth from original grade: /3 GPD/Sq Ft. Lol: Block: Subdivision: ,/ Depth to pipe bottom horn original grade: "% Gravel depth beneath pi/pe el.ILO/VIAL. P/7 je Ft. C4 Ft. Township: / Range: / Section: .7 / FIII added above origl� grade:., Ft = Gravel length: 713 Ft. WELL: ❑ New ❑Upgrade Gravel 1-/Vfy Number of lines: Distnabl sen Inez 1 �x/sf. 2 Fl 3 /7- Ft. Classification (Private. A.B.C): P,Q/VA/C Total Depth: Cased To: Total absorption area: /WO Pipe material 303Y ASTM FI. Ft. so. Fr Driller. Date Drilled: Static Water Leat: Installer. - Date Install : Ft. Yield:Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES tnVseptic ❑Holding ❑S.T.E.P. To S•oeo Ate ;tion Lm Holding nate Manufacturer. A/vC/% Capaclly In prrellon2: From Tank iNW Button Tank SwN unes Wel(Materiel: /00' /08 NIA NlA SILL �- Number of Compartments: Watery N/sl Nll /V 1A MA LIFT STATION NIA Lot "14 NIA /pf Size In gallons: Manufacturer. Line Z5, FoundationA'/ / /0 IVI.4 N/A plA Pump on" level at: "Pt at: u ' leve High water alarm atCurtain lA //A IVIA 014 N Make 8 Electrical Inspections performed by: y r / / v//� Remarks: /- )e,;7'; BENCH MARK Location and Description: e ao Assumed Elevation: /00.0 q3IrsAliz = •,a,:491ti .44.Ie • asM•Y,,,• Inspections performed by: 6N6/NfE12 Dates: lst OiZ54/93 I •� 2nd 08 D 9 �j rte: Louis A..Butora ; .; r� •, CEZ736 Js 4+4pROFESSt13"�P�Fv Department of Healt and Huma Services appro al ' Reviewed and approved by: Date: 091CA ���A3 72-013 (1,11) MOA 25 ' Permit No. SW 92-0374 Page 2 of--2.— Municipality f a Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legaluescrlption: sz — 10' UTILITY EA. EMENT _ SHED N 89'56'00' W — — WELL I00' RADIUS ' I LOT 8 oEs 50.2' gA N HOUSE m NEW 1.250 L� SEPTIC TANK ro T 0 I 0 L DRIVEWAY IE152.bpG LEACII TRENCII N 89'56'00' W i � I I t I i ELEVATI❑NS 1 CONCRETC GARAGE SLAB (NOT "TO SCALE) ASSUMED ELEV . 100.00• I I � y x /ORIGINAL GROUND LEVEL 9 98.8 ±6.7' NO I / TANK\ \ ALL 3 FIELDS /78.2 92.4 92.2 918 91.8 12013 A (2/91) MOA 2S SWINE_ TIESS B - 29.5 A -D-25.2 B -D-306 A -E-25.9 B-E - 30.6 A -F-27.1 B -F-296 A - G -67.6 B - O -48.7 C -G-47.7 A -H -e4.9 B- 11 - 410 C -H-46.5 A - 1 - 660 B -,1- 417 C-1-499 A - J - 696 B -43.5 C - J 629 A- K-612 B -K-33.3 C -K-49.3 A -L-42.1 B - 17.3 C -L-31.3 B- N -24A C -M-49.3 B- N -25.1 C - N -49.3 •- MONITOR TUBE 0 - SEWER CLEANOUT 4 - WELL ©UPGRADED LEACH TRENCH - E STOJG LEACH TRENCH EASEMENT ------• - FENCE SCALE 1" = 40' OF . ..y(A►�� . . � * '49 TN m LOUIS A. BUTERA t00 's QF76736 r PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920374 DATE ISSUED:11/03/92 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES EXPIRATION DATE:11//03/93 OWNER NAME : FULLMER DALE B & G/��/ ! "�f 00 OWNER ADDRESS:19709 FIRST ST ,f EAGLE RIVER, ALASKA 99577 ��� 9� � / � ) PARCEL ID:05030118 LEGAL DESCRIPTION: 'COLONIAL PARK BLK 3 LT 8 S -2 LOT SIZE: 17820 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. . SPECIAL PROVISIONS: RECEIVED 1 ISSUED BY DATE: DATE • //- ? � /12 zshc RU'VOT E, nsulnwans&VADE)z Louis Butera, P.E. Registered Civil Engineer October 26, 1992 John Smith, P.E. Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Colonial Park, South 1h Lot 8, Block 3 Narrative Dear Mr. Smith: The proposed septic upgrade will have very limited impact on adjacent properties for the following reasons: 1. The area has established well locations, allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate. This is the second system installed on this lot. The old system will be retained as a reserve system. 4. Drainage will not be effected and is not a major consideration in our design. The area is served by a public storm drain system. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. P.O. Box 773291 • Eagle Rim, Alaska 99517 • Telephone (907) 691-5195 • Fax (907) 691.3297 SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: S 1h LOT 8, BLOCK 3 COLONIAL PARK A. GENERAL 1. The well and septic plan are for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified or modified in the field by the contractor to meet Municipality of Anchorage requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. B. SEPTIC TANK 1. Verify the integrity of the existing tank by exposing for inspection. C. TRENCH 1. The between trench distribution piping is to be 4" PVC 3034, laid level between trenches with all trenches at the same elevation. 2. The bottom of the trenches shall be level, plus or minus 1.5", leachfield piping in each trench level within '/4". 3. The total depth of the trench excavation is not to exceed 15' at any point with relation to the elevation of the ground at the test hole location. 4. The trench gravel is to be covered with typar fabric material. 5. The effluent line is to route through a "Bull Run" diversion valve to allow switching between existing and upgrade leachfields. 6. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. 7. The area over the trench is to be finish graded to prevent ponding of surface water runoff. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = 15' GRAVEL DEPTH = 6' TRENCH LENGTH = 83' TRENCH WIDTH = 2' SOIL RATING = 0.45 GPD/FT= BEDROOM CAPACITY = 4 SEPTIC TANK SIZE = 1,250 GALLONS EXISTING Twenty-four (24) hours notice required for all inspections. WEL� 132.00 WELL WELL LOT 9 1 1 LOT 8 t WELL +100' I T WELL +100' SEPTIC 10' UTILITY EASEMENT z 0 0 LOT 7 c VACANT LOT o o tcv HOUkSTING o J�tV o 13'O0.8'T{{ 4 n1 ® SEPTIC TANK 10'VERIFY INTEGRITY).. 25'NDIVERSION —VALVE\95'FIELD ECH TRENCH DRIVEWAY 132.00 N 89'56'00' W CATCH BASIN CATCH BASIN MOA STORM DRAIN MOA STORM DRAIN Mw MH COMMUNITY WATER TO SOUTH J ® - TEST HOLE • - MONITOR TUBE 0 - SEWER CLEANOUT FIRST STREET ¢ — WELL © — PROPOSED LEACH TRENCH HHHrnH — EXISTING LEACH TRENCH NO SURFACE WATER — — — EASEMENT FENCE NO KNOWN CURTAIN DRAINS SEPTIC SITE PLAN LEGAL: COLONIAL PARK, S1/2 LOT 8, BLK 3 OWNER: FULLMER CONTRACTOR: N/A JOB # 92-169 DATE: 10/22/92 SCALE 1" = 40' EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX. (907) 694-3297 AS Lou!s A. Bulera CE -6736 .• - EAGLE RIVER JOB S1/2 Lot 8, Blk 3 Colonial Park 92-169 ENGINEERING SERVICES SHEET NO. OF P. O. Box 773294 L.B. 10/22/92 EAGLE RIVER, ALASKA 99577 CALCULATED BY DATE Phone 694-5195 CHECKED BY DATE I.T1�MI�T, k.0a Iti Bin -A, Ts — � 1 .. rte:•;9�1 titer�lAi* Municipality of Anchorage�DEPARTMENT OF HEALTH 6 HUMAN SERVICES j 825 "L" Street, Anchorage, Alaska 99502-0650 I rn ; fouls A. eu+ora SOILS LOG — PERCOLATION TEST �d �l cEs736 ••_ �.�� PERFORMED FOR: a'°/�^` 0, DATE PERFORMED: ;.• 07/0/9 Z CO/MIa1 LEGAL DESCRIPTION: ,flk3 P/+•tor S k. Township, Range. Section: T/y... /eI&j Jec , MIASLOPESITE PLAN 1 %uPSei1 2- 3- 4- 5- 6- 7- 8- lo - ll 3 4 56 7 8 10 11 d 12- 13- - .v 1a O 15- 16- 17- 8 5 16 17 8 v O 0'- 20 �U . COMMENTS (,C:,' /117) De"tat � a.,7i 9'ey =..c yr•ssarifC Srro( W.fZ DerarJ. .�77 I T WAS GROUND WATER ENCOUNTERED? NO IF YES, AT WHAT DEPTH? lkplh to Water Alter Monitoring?. '; 811c �` » Reading Date Gross Time Net Time Depth to Water Net Drop :1 •• far %y/!" i6 3 •.rat .» Yi. °/i. ' .. a s VW -2 - 7 PERCOLATION RATE 2L (minutesAnch) PERC HOLE DIAMETER TEST RUN BETWEEN 2 FT AND I FT PERFORMED BY: Eft S' 1 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (A". 4/85) \ MUNICIPALITY OF ANCHORAGE \ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 \ — ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE XNEW ❑UPGRADE MAILING ADDRESS MN 960)( Nvis cmvxrmAy� LEGAL DESCRIPTION p LOCATION NO. OF BEDROOMS tet' Use DISTANCE TO: Well Absorption area \ OO �' 0 Dwelling D PERMIT NO. `1 4-(0 QManufacturer W� �} Material No. of compartments to Liq. capacit in gallons IF HOMEMADE: Inside length Width Liquid depth fj Y Jo=Z DISTANCE TO: Well Dwelling PERMIT NO. Z _f Manufacturer Material Liquid capacity in gallons U W = DISTANCE T0: Well \QQ Foundation 8 Nearest lot line Iii PERMIT NO. 8 `( .W.1 W E F W No. of lines Length of each line 5s Total length of lines s s Trench wi th tt Inches Distance between lines N Irk H p Top of lila to finish grade` U Material beneath the Q inches Total effective absorption area W Length Width Depth PERMIT NO. <F- W� Type of crib r di m er Crib depth Total effective absorption area ti DISTANCE TO: Ville'd 1 11 Building foundation Nearest lot line J J lass(� Y Depth Driller Distance to lot line PERMIT NO. O W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MA ERIALS m o SOIL TEST RATING e S INSTALLER REMARKS lin I tauleo S III 30 4 s A IV 0 Il P e ROVED DATE LEGAL 72-013 (Fev�3/781 {{ ' DEPARTMENT OP HEALTH AND ENVIP.ONMENTHL fWOTEGTfUfV�G'�..r/ —� 823 '(' STREET. ANCHORAGE, Ak. 951 %KS •i 264-4720 v' 11 p 4 /D3 3 1JEL_L FIF.IC] Caul—= ITE SE=WE =F; PERM I T PERMIT.NO. ( 780468 l r fi-- t jRPPLICANJT HARRY MRCN:EV SP, BOX 1173 CHUGIAK 6 `2 i313 .LOCATION A +LEGAL S 1l2 OF L8 D3 COLONIAL PARK S LOT:.SIZE 17320 SQUARE FEET STYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS o 4 SOIL RATING (SQ FT/BR)- 140 i JHE REQUIRED SIZE OF THE SOIL ABSORPTION SY T 1 IS: L�EPTH� 10 LENC3-r RF4VEL C7F_PTH� THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION! (IN FEET). i THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE j AND THE BOTTOM OF THE EXCAVATION (IN FEET). F?EC!u i FzzEF? SEF=D'T i C TF1t-AK S I 2: F—= 12Z510 C3FiL_L_(D S 1 'PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER. OF RESIDENCES THAT THE WELL (JILL SERVE. --- TWO C."m. > INSPECT I ONS RFtE F; r -:Qu I F;zEFj !P.ACY.FILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS ;DEPARTMENT WILL BE SUBJECT TO PROSECUTION. (MINIMUM DISTANCE BETWEEN A WELL AND ANYLON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL) OR 1150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. ,'WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE :AVAILABLE TO INSURE PROPER INSTALLATION. FaERM I T EXP I F2ES 17ECEML4E:M Z:1., 1 KS=470O 'I CERTIFY THAT ;1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 12: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEME14T IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. ! I SIGNED: ------ =--=r i/J .!!�� '°A-�'�/ APPLICANT HARRY MACKEY i 'ISSUED B j =, v r /_--------/ ,moi V3.2 I SOILS LOG � ' -.• MUNICIPALITY OF ANCHORAGE \ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION • TEST IPouch 6650, Anchorage, Alaska 99602 276-2221 - SOILSSIT LOG - PERCOLATION TEST G PERFORMED FOR: Ry IT) Lfzy DATE PERFORMED: " 7(y O /6 SLOPE �� 9!•� ' 1 1 1 -51L-7Y 40WZ5L 2 3 4 5 6 7 c4w- a0se $ Q2Ey �}rwY 6RaruEL 9- 10- 11 10 15 �F' A 16 �- -- 17 • 18 � 19 1 ti, NDs 1625! WASGROUND WATER ENCOUNTERED? IF VES, AT WHAT DEPTH? ND s L� O El _i__i-1-i-1_-I 1A -f] Reading Date Gross Time Net Time Depth to Water Net Drop / " PERCOLATION RATE��l (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS E7.a7 L -OT -i Pkl.L ll,,�JPCP —12�s 2_ ry),6D 1U hl adyp& . PERFORMED BY: �9. S_ CERTIFIED BY: DATE 72008 (7/761 _- i -- Well Log: Lot 8, Blk. 3, Colonial Park Subdivision First Avenue Eagle River, Alaska Drilled by: Harry A. Mackey Owners: Kenneth and Mary Carol Simmom Log: 0 - 22 feet Sand and boulders 22- 39 feet Mostly sand 39- 42 feet Sand 42 feet Large boulder 42- 96 feet Sand and Hardpan 96- 99 feet Pray clay 99 feet Hit gravel with water 5 gal per min. Cased to 1031 10". Static Level 60 Feet Municipality of Anchorage eo On -Site Water & Wastewater Program ' (907)343.7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 050-301-18 1. GENERAL INFORMATION Complete legal description Expiration Date: 7 - Location (site address) 19709 FIRST STREET, EAGLE RIVER, AK, 99577 Current Property owner(s) BETH WILLIAMS Day phone 622-3931 Mailing address 19709 FIRST STREET, EAGLE RIVER, AK, 99577 Real Estate Agent AMY MACKEY-HORNAK W/ KELLER WILLIAMS Day phone 830-1294 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site ❑ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer E Received by: / Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 4/40'40 Date of Payment Jp Receipt Number COSA # 0 S 0-3 Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certfficate 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 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 MDA 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 identmable features. The operational life craft 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 benatt of the owner listed above. Any reliance upon or use of this report by any otherperson or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following Phone 337-6179 Date t. �o�opp4 0F. _T sy20�( f e A. ness;i Vw9{j�" E 79/g3 �O e„ QP�\�YtOF (AtV6 it,,, i ( ON-SITE WATER AND WASTEWATER PROGRAM COZZC Original Certificate Date: 7 -13 - The —13 The 9dricip4litlorAtt6fio—rage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist �L Nitrate Advisory y Septic System Advisory Arsenic Advisory Well Flow Advisory Other (Rev. IV05) If more than 1 septic system is on the lot: COSA Checklist # Of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: COLONIAL PARK S/D; BLOCK 3, LOT 8 SOUTH 1/2 Parcel ID: 050-301-18 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N A Well Log (Y/N) YES Date completed UNSPECIFIED Sanitary seal (Y/N)Y Wires properly protected (Y/N) YES Total depth 104 ft. Cased to 103.8 ft. Casing height (above ground) 12+ in. Date of test FROM WELL LOG UNSPECIFIED Static water level 60 ft. Well production 5 g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Arsenic: N ug./L. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size gal. Number of Compartments _ Cleanouts (Y/N) _ Foundation cleanout (Y/N) _ Depression over tank (Y/N) _ High water alarm AT INSPECTION 5/6/2013 Nitrate 1 9. 3 mg./L. Date of sample: 5/6/2013 ft. 7 — 9 -P.M - Collected by: GEG, Ltd. PUBLIC SEWER Date installed Date of pumping C. ABSORPTION FIELD DATA Date installed Length ft. Total depth ft. Eff. Pumper, Soil rating (g.p.d./ft2or Width i ft Jrm'�_ System type ft. Gravel below pipe ft. Monitoring tube_ Depression over field Date of adequacy test Results (Pass/Fail) For bedrooms >depthabso ' n field before test _ in. Water added _gal. New depth _in. min. Final fluid depth _ in. Absorption rate >= g.p.d. on treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at in. Size in gallons Manhole/Access (Y/N "Pump off' level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A On adjacent lot: Absorption field on lot N/A On adjacent lots Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER Building foundation Water main Wells on adjacent lots Property line Absorption Water service line Surface w SEPARATION DISTANCE FROM ABSORPTION Property line Water service Curtain drain F. COMMENTS G. ENGINEER'S CERTIFICATION Surface water Wells on adjacent lots l certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Nam JEFFREY A. GARNESS Date ��1�13 (Rev. 11105) TO: Water main Driveway, parking/vehicle storage o= OF A Qo ,�F, ........... 500 (1)." TH*I �......................... of r QQP A, ess.- P '•, C>F 793 m, 0� Municipality of Anchorage a GE s Community Development Department ° Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 131194 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 3, Lot 8 South 1/2 of Colonial Park subdivision. This inspection revealed a nitrate concentration of 10.3 milligrams per liter (mg/L) was reported for the property'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. ARCTIC PUMP & WELL INC. Jim Sullivan PO Box 770197 MR Eagle River, AK 99577 WFH W® sws s mrx� (907) 688-2510 5 (907) 258-2510 (907) 745-2510 anw(rd2ci.net Pump Installation Log Well Drilling Permit Number: SW Parcel Identification Number: Date of Issue: Arctic Pump & Wel(, Inc. Page 1 of I Legal Description: Colonial Park Property Owner Name & Address: Lot:8 s2 Mary Williams Block:3 19709 First st Paola Rivar AK QQ977 Pump Installation Date: Pump Intake Depth Below Top of Well Casing: Feet Pump Manufacturer's Name: Dempster Pump Model: Pump Size: hp Pitless Adapter Burial Depth: feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: U/K Well Disinfected Upon Completion? Yes Method of Disinfection: Chlorine Comments: Remove bleed valve Ground is sloping away from well there is no pooling of water at well head at this time Pump Installer Name: Arctic Pump & Well, Inc. Arctic Pump & Wel(, Inc. Page 1 of I ARCTIC PUMP & WELL INC. Pump Installation Log Well Drilling Permit Number: SW Parcel Identification Number: Date of Issue: Jim Sullivan IXYMI MIIa Still PO Box 770197 Eagle River, AK 99577 lio-i 8 RRY31 (907) 688.2510 (907) 258.2510 Mary Williams (907)745-2510 ayW@gci.net Pump Installation Log Well Drilling Permit Number: SW Parcel Identification Number: Date of Issue: Arctic Pump & Well, Inc. Page I of I Legal Description: Colonial Park Property Owner Name & Address: Lot:8 S 2 Mary Williams Block:3 19709 First st Fa ala River AK 90577 Pump Installation Date: 5-14-2013 Pump Intake Depth Below Top of Well Casing: Feet Pump Manufacturer's Name: Dempster Pump Model: Pump Size: hp Pitless Adapter Burial Depth: 12.5 feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: UIK Well Disinfected Upon Completion? Yes Method of Disinfection: Chlorine Comments: Casing 40'+ with no perforations Bleed valve 17' Pump Installer Name: Arctic Pump & Well, Inc. Arctic Pump & Well, Inc. Page I of I SGS Ref.# 113168t001 Client Name Garness Engineering Group, Ltd Project Name/# Colonial Park B3, L8 Client Sample ID Colonial Park B3, L8 Matrix Drinking Water PWSID 0 Sample Remarks Printed Date/Time Collected Date/Time Received Date/Time Technical Director 05/10/2013 16:13 05/06/2013 15:10 05/07/2013 9:09 Stephen C. Ede Allowable Prep Analysis Parameter Results LOQ UnItS Method Container ID Limits Date Date tnit Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 05/08/13 05/09/13 ACF Waters Department Total Nitrate/Nitrite-N 10.3 Microbiology Laboratory E. Coli Negative Total Coliform Negative Page 2 of 4 * 0.100 mg/L SM21450ONO3-F B (<10) 05/10/13 AYC 1 100ml- SM219223B A 05/07/13 SDP 1 IOOmL SM219223B A 05/07/13 SDP 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 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 0,5p _�inl"/R COSA# drjOl54 Expiration Date: 1. GENERAL INFORMATION Complete legal description 01-0/V 1 A -t_ TAj:r.K- B 3 5 Location (site 68dress) 1`1?0-7 Fir—crr 5T. Current Property owner(s) M E -i` -t M E K__ Day phone 950- (o-70-7 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address icrioct fir=- to s -r ACTw iyBK=, At- zq 32 Day phone J I M MoSLeY Day phone 550 - (o+95 Unless otherwise requested, COSA will be held by DSO for pickup. 2. NUMBER OF BEDROOMS: �I 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 Q" The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered In the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. e of Firm45f" R�t-. r._I. a.z y Address 1I - s r .g. i ' Engineer's Printed Name Ckris4pjeher- >-. Wood 5. DSD SIGNATURE Approved for bedrooms: Disapproved. ' Date Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory _ Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other_ By: Original Certificate Date: (Ft., HAS) Municipality of Anchorage "a, ' 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: /04-C.aAL T�7 B :A 51 LS Parcel ID: OSo 301 ��g A. WELL DATA Well type�yjyp+r. If A, B, or C provide PWSID # _ Well Log mN) _Lod. Date completed un&:eewr, Sanitary seal (9N) Total depth JD-44—ft. Cased to 1Q.!� -ft. FROM WELL LOG Date of test rAr7k#WWn Static water level (00 ft. Well production 5 g.p.m. WATER SAMPLE RESULTS: Coliform ,colonies/100 mL Nitrate g•83 mg/L Arsenic: Aa ug/L dale of sample: qia/0� B. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size Wires properly protected (9/N) _I�A - Casing height (above ground) _gin. AT INSPECTION 51-7 .10-7 3. a- g.p.m. Other bacteria 0 colonies/100 mL Collected by: r-A2A,&,4- dr crc_j Date installed gal. Number of Compartments _ Cleanouts (YIN) Foundation cleanout (YIN) _ Depression over tank (Y/N) _ High water alarm Date of pumping C. ABSORPTION FIELD DATA Date installed Length ft. Total depth _ ft. Eff. Date of adequacy test Fluid depth in absorpti eld Elapsed Tim mm. Pumper Soil rating (g.p.d./ft2 or Width System type ft. Gravel below pipe ft. I✓=ft2 Monitoring tube _ Depression over field _ Results (Pass/Fail) before test _ In. Water added_ gal. Final fluid depth _ in. treatment (past 12 mo.) (YIN & type) For _ bedrooms New depth_ in. Absorption rate >= g.p.d. If yes, give date D. LIFT STATION Date installed 'Pump on" level at _ in. Datum E. SEPARATION DISTANCES Size in gallons 'Pump ofPlAve��l� High water alarm level at in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot *1'100 Absorption field on lot t l00 t Public sewer main -!-1001 Sewer /septic service line +a -s Animal containment areas -Y too Meets alarm 8 circuit requirements? On adjacent lots *1'100' On adjacent lots -t l00 r Public sewer manhole/cleanout --In0 Holding tank Manurelanimal excrete storage areas -rl 00 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main Wells on adjacent lots SEPARATION DISTANCE FROM Property line _ Water Service m drain _ F. COMMENTS G. ENGINEERS CERTIFICATION Property line Absorption field Water service line Surfacewa SORPTION)FIkkD CFWLOT TO: Surface water Wells on adjacent lots 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed NameChrl',2f A offid Date 5/23,/D�f COSA Fee $ Date of Payment Receipt Number (Rev. 11105) Water main Driveway, parking/vehicle storage Waiver Fee $ Date of Payment Receipt Number L-01 IS_. Municipality of Anchorage ; • '� Development Services Department su°- Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 070154 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 3 S2, Lot 8 of Colonial Park subdivision. This inspection revealed a nitrate concentration of 8.83 milligrams per liter (mg/L) was reported for the property'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. Aq wqiE 9�j SGS ReEM 1071625001 Client Name Eagle River Engineering Project Name/# Colonial Park Lot 8 Block 3 Client Sample ID Colonial Park Lot 8 Block 3 Matrix Drinking•. Water PWSID 0 All Dates/Times are Alaska Standard Time Printed Date23me 05/032007 11:10 Collected Date/Fime 04202007 14:05 Received Date/Time 04202007 15:00 Technical Director Stephen C. Ede Smote Remarks: 353.2 - Total Nitrate/Nitrite - The matrix spike recovered below the QC criteria. The batch LCS is within QC limits. Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Metals Department I lardness as CaCO3 225 Waters Department Total Nitrate/Nitrite-N 8.83 Private Individual Analvsis Aluminum ND Antimony ND Arsenic ND Barium 26.2 Cadmium . , . , _ ND Calcium 57400 Chromium 3.41 Copper 18.2 Iron ND Lead 0.426 Magnesium 19800 Manganese ND Chloride 60.7 . Phosphorus - - ND Fluoride ND Potassium 1050 Selenium ND Solium 3220 Silicon 4810 Silver ND 5.00 0.100 mg/L SM202340B C mg/L SM204500NO3-F E (<10) 05/01/07 05102/07 TK 0423/07 JDS 20.0 ug/L EP200.8 C 05/01/07 05/02/07 TK 1.00 ug/L EP200.8 C (<6) 05/01/07 05/02/07 TK 5.00 ug/L EP200.8 C (<10) 05/01/07 05102/07 TK 3.00 ug/L EP200.8 C (<2000) 05/01/07 05/02/07 TK 0.500 ug/L EP200.8 C (<5) 05/01/07 05/02/07 TK 500 ug/L EP200.8 C 05/01/07 05/02/07 TK 1.00 ug/L EP200.8 C (<I00) 05/01/07 05/02/07 TK 1.00 ug/L EP200.8 C (<1300) 05/01/07 05/02/07 TK 250 ug/L EP200.8 C (<300) 05101/07 05/02/07 TK 0.200 ug/L EP200.8 C (<15) 05/01/07 05/02107 TK 50.0 ug/L EP200.8 C 05/01/07 05/02/07 TK 1.00 ug/L EP200.8 C (<50) 05/01/07 05/02/07 TK 0.200 mg/L EPA 300.0 D (<250) 0423/07 0423107 JDS 200 ug/L EP200.8 C 05/01/07 05/02/07 TK 0.100 mg/L EPA 300.0 D (Q) 0423/07 0423/07 JDS 500 ug/L EP200.8 C 05/01107 05102/07 TK 5.00 ug/L EP200.8 C (<50) 05/01/07 05102/07 TK 500 ug/L EP200.8 C (<250000) 05101/07 05102/07 TK 200 ug/L EP200.8 C 05101/07 05/02/07 TK 1.00 ug/L EP200.8 C (<100) 05101/07 05/02/07 TK SCS ReEN 1071625001 All Dates/Times are Alaska Standard Time Client Name Eagle River Engineering Printed Dale/flme 05/03/2007 11:10 Project Name/N Colonial Park Lot 8 Block 3 Collected Date/fime 04/20/2007 14:05 Client Sample ID Colonial Park Lot 8 Block 3 Recelved DateMme 04/20/2007 15:00 Matrix Drinking Water Technical Director Stephen C. Ede PWSID 0 Allowable Prep Analysis Parameter Results POL Units Method Container ID Limits Date Date Init Private Individual Analysis Thallium ND 1.00 ugh EP200.8 C (Q) 05/01/07 05/02/07 TK Sulfate 21.1 0.100 mg/L EPA 300.0 B (<250) 04/23107 04/23/07 JDS Zinc 45.7 5.00 ugh EP200.8 C (<5000) 05/01107 05/02107 TK Total Dissolved Solids 334 10.0 mg/L SM20 2540C D (<500) 04/24107 ACF Nickel ND 2.00 ugh EP200.8 C (<I00) 05101107 05/02107 TK IICO3Alkalinity 102 10.0 mg(L SM20 2320B D 04/23107 KP CO3 Alkalinity ND 10.0 mg/L SM20 2320D D 04/23107 KP OIIAlkalinity NO 10.0 mg/L SM20 2320B D 04/23107 KP Conductivity 480 1.00 umhos/cm SM20 2510D D 04/23107 ACF pit 7.75 0.100 pl I units SM20 4500-11 D C (6.5-8.5) 04/23107 ACF Alkalinity 102 10.0 mg/L SM20 2320B D 04/23107 KP TotalColifurm 0 col/IOOmL SM20 9222B A (<I) 04/20107 DLC J � f b'W••r _° -- F-r.Rsr». -- s 132, oo' l97p" l Lr��i-1 s� Int �✓r J_.f 7',.v/.•i n.:T�.� 3�-LY-O% i l •r � t►e'�5.� Robert C. John so : NO. r.EC•5 AS -BUILT I hereby certify that I have surveyed the following described property ,:5 - LoT el B/ock 11 Anchorage Recording Precinct, Alaska• and that the Improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no impprovements on pro pp-- erty 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 indicated hereon. :Dated at F.aele River, Alaska I u✓{c•�•t this ;L•1 _day o 19 7b_ ROBERT C. JOHNSON X'Cfl4-. SCALE: Rvgistered Land Surveyor_ No.`MO-LS 1" = 20 Box 456, Eagle River, Alaska Phone 694.2543 _"_� 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 Parcel I.D. 050-301-18 HAA# o �C D o 51 1. GENERAL INFORMATION Expiration Date: E' / 9 Complete legal description Location (site address or directi Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address DALE & JANICE FULLMER Day phone 227-7938 19709 1st STREET • EAGLE RIVER, AK • 99577 Day phone RANNA FEKRAT W/ PRUDENTIAL JACK WHITE Day phone 762-5815 3201 C. STREET, SUITE 200 • ANCHORAGE, AK • 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well N Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑ Individual Holding tank ❑ Community On-site ❑ Public Sewer 0 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 maybe reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, or prior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat affixed hereto and as of the validation date shown below, I verify that my investigation, 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 Finn ALASKA WATER do WASTEWATER CONSULTANTS, INC. Phone Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE. AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineers Comments: In conducting this evaluation, AKW WC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time otthe test, and separation distances measured to readily Identifiable features. The operational fife of all wells and septic systems depend on the local sells condition, groundwater levels that may fluctuate during the year, end 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. AKWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person orparty Is not authorized, nor will It confer any legal right whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Date 337-6179 Conditional approval for bedrooms, with the flowing stipulations: Note: The well for this property meets existing State and Municipal Codec There are nitrates present. It is suggested that periodic testing be performed to insure the wells continued suitability. Current nitrate concentration Is 6.34 mg/i. 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 (/ Manitenance Agreements Septic System Advisory Supplemental Engineer's Reort Well Flow Advisory Other Original Certificate Date: (Rw. 17)01) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water b Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 995196650 www.ei.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST 5014th hai C LegalOeaorlption: COLONIAL PARK SUBDMSION: LOT 8, BLOCK 3 ParcellD: 050-301—M I$ A. WELL DATA WOO type PWAX If A, B, or C provide PWSID# N/A Date completed NOT STATED Sanitary seal (YM) YES Total depth 104 ft. Cased to 103 R. FROM WELL LOG Date of test NOT STATED Stade water level 60 ft. Well pmdutttion 5.0 g.p.m. Well Log (YM) YES Wires property protected (YM) YES Casing height (above ground) 24+ in. AT INSPECTION 2/04/2004 69 ft. 3.8 g.p.m. WATER SAMPLE RESULTS: ColHomt u` colonies1100 mi. Nitrate 4.AmgAL. Other bacteria colordesl100 ml. Arsenic: N/A mgA_. Date of sample: 2/04/2004 Collected by: AKWWC. INC. S. SEPTIC/HOLDING TANK DATA PUBLIC SEWER Tank Type/Materlat Tank sae gal. Foundation cleanout (YIN) Number of Compartments Pumper Date installed (YIN) _ High water alarm (YIN) C. ABSORPTION FIELD DATA PUBLIC SEWER Date installed Soil rating (g.p.d.IR'or ft'Ibdrm) _ System type Length ft. Width ft. Gravel below Totel depth ft. Eff. absorption ansa _ ft' Monitoring tube Depression over field Date of adequacy test Results a) For bedrooms Fluid depth in absorption field be _ In. Water added _gat. New depth _in. Elapsed Time: Final fluid depth _ In. Absorption rate >= g.p.d. uhrenatton tnsattnent (past 12 mo.) (YM &type) if yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at _in. "Pump E. SEPARATION DISTANCES High water alar level at in. Cycles tested Meets alar & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankfltft station on lot N/A On adjacent lots 1 DO'+ 'A' Absorption field on lot N/A On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/deanout 100'+ Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER Building foundation Water main Property line Absorption Water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: PUBLIC SEWER Property line Water service line F. COMMENTS G. ENGINEER'S Building foundation Water Surface water Wells on adjacent lots I oar* that I have determined through tiefd inspections and review of Municipal records that the above systems are in contormance with MOA HAA guidelines in effect on this date. Engineers Priname JEFFREY A. GARNESS Data a� �nd� HAA Fee E !!:t 30 Waiver Fee $ Date of Payment 2-/3—OV Date of Payment Receipt Number S .Z. i% % .r' �» A Receipt Number (Rev. 12101) storage 4 e A. r ess: —7 15 02/11/2004 14:26 9072767804 ROBERT E JOHNS JR PAGE 02/03 meR tn..,p .• � � Y32. �.00� .. S B eo 66 '00 !E �� �� •... � t / salowt a:a.p • S��D. ' yy�•• , � %o' L!r/IG.• LF-.3`/�l%. Nuc .; ''' �. �' '.,... ;. .•.�. ' �. 1 '...... __: � .,rte:. .. .' .. � .' ANT �. .q� ': .• _ q //-10 s : SURVEY CERTIRCAT oN _ ••��}+ a , ; : I :.. :.: •: • ti?repgred by-......_.,.•. , .:.... _,..... 'E. - :.: ° '•: Robert Johns, Jc:;.:&._Assoc. FWT PLAN ' ._ .� •b,;•,� ..I •.•�(E ..,..,• ��)�tP�• , Professionaf.Land Surveyors) •• 'SQ 1- it AVE . - ' ANCHORAGE "ALASKA .99501 .... . •�: t w..H ..: Aw �r.•R /t ... .. SM4 >_ ' 3 Q .. Rev Plot: no No-* .. FOCNOAI104 Al -a T '.,. ..�:.� .y' .... Oa5e+5.1,er-. - 2-2304 M •- °r" ° J ;. cn.�wp . •. . tA.we.w.:a; r+r...l'r•w t- ::/� w w..A..'e.�.At.•eu.1.r!•.' ......:.. .. : �.••.y + A �j ':' DOLE2D�i -2003 GrJ W.0. 2i_ : . , ' .....; • .; ._ 1 �� '. FWAL S.TIJCTURE AS•-8U0.T•LegaD<xrlptlont L Ar.. F..Le.. e..\..Ap•w. ew i+4-'..,, .. Y' ,SJ ., e'a ... r-.-•••. ..-..•...,e r w . ., • !� peu/estlewd �'� ••• S �, of • LOT' .6'': . t65cx 3 :.. . • .. 1 : ."..:..r....'�"►.� "�•�r'�: ... COLOIJZAS PAP_X:ESTA'YF«S; SUBDIV2510N..': '. . �a����••' toT SI yty St1RUEY i1 T'E ' ' ' ❑ AS-tOLi:SET OZ= •'13 r*ni FRNCI!AE wsA&T REBAA ' °C�' nt�wp►o DRMIACE ASPHALT ' O 'PLOT, F•AN :... A?9LLt ... lOT a11TiET � .. TGPOORAFNV , , o. . FOUN9 REBAR " .�.' OD fIIJfZ a �O<?CR=7E r rsyi N�1 '' 00 '-ASSUtIm IIF1f..iE�G--i(- IAF.TAL'iENCE i. NOfA DE .:- PLOT PLANS P& L07StlRVEYS •.. .. ..:'... .. : NOTE":.• ., :.. .•; '.: .... ;:: '-"'1 ..:., " : : ' :. ` ::.. ,. ' IT IS TilelRESPO`J..+`TBULZY1QR-THE BUILDER OR OWNER. PRIOR TO'., '-ONLY THOSE IMPROVEMENTS *ABOVE '.CROL!ND •AHD:'VIIDBLE• W.LL. BE •, COmSTRuclaON..ta YFffi1EY..7HR060SED:HWtDY1G tRADE R!M^MYC. WHO-". IEMCES.�NEaAb.-aEPnP tLfAMoeiiS.'SiD6wALICsrdU�MAY4: •••• .:,TO FULSMCD CRADC ALIO UTILITY CONNEC90NS'.AND. TD DETERIA:NE rM.'ARE SHOWN IN THEIR- APPROXINAiE LOCA--TIDN•�ONLC'•: SNOW THE E)CSTENCE OF,ANY. £ASE]T3SS5',-CO1�!A.N15 0.4-R6TIZIC-BONS MAY PREVENT SOME PAPROVCWrW-S-FROM VCINQ?JEENIANO LOCATEO-' DO MOT A►REAB :TH£ RECORDED SLURDMASION: PLAT. AL--L DISTANCEe A&EECOAP •WN. .. UfIDm N0,CIRC7MSTAN=7W0U= 1,4 *AS• -BUILT SE V= FOR CONSIRUCTICN:.OF SCR EWrAffiEHwO•SOL=ART OR FLVCr_LNCY.-.....:.. :. •. . . THE. SURVc t7T TAkES RL'SPONSIBUTYFOR YFIS JAL IWEACTION ONLY /EVD-ASMMM'FINANCAL UABIU7Y, ONLY FDA THE -COSI OF'T:1E SORVEX •• . - •...: .. ''. . .. . LISFD -DISTANCES PREVAL:OVER SWLNG. WFIRODUCTTON MAY•CAM ERRORS M S:Xr- •. .... 7 • _ �m . -- -» MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES. Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 , 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# 05030118 HAA# �-A(=�AQ CC) 1. GENERAL INFORMATION Complete legal description South 1/2, Lot 8, Block 3, Colonial Park Subd. Location (site address or directions) 19709 First Street Propertyowner Dale B. Fullmer Day phone 694-6356 Mailing address 19709 First Street, Eagle River, Alaska 99577 Lendingagency Alaska USA Federal Credit Uriopayphone 694-7030 Mailingaddress P-0- Box 196613 Anchorage Ak 99519-6613 Agent prore u f: -- I Day phone IV./n Address N/A Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 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 to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site X Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC -attesting to the legality and status of system. 72-M (Rw VDV F Mt MOA /t1 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 for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. . Name of Firm � 6 p. e. Phone -7 %( (e — (07 3 Address ry U0 ra 1�,,.G" _ra- �a lv" Q,� _ k as 1,4 c Engineers signature 101us 1 A) Date 14 5-1 6. DH , SIGNATURE `� Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Note: The well for this property meets existing State and Municipal Codes. performed to insure the wells continued suitability. Current nitrate noneentration is 8119 -M811 E12A mamlinum eeneentratien is 10.0 .,641. - More information on nitrates is available from the On-site Services Program, —Dmis,-343 474' Additional Comments M Date —L I 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 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. r2-0;5 (Pi-. 1/91) e«k MOAM Municipality of Anchorage RECEIVE DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 8256L" Street, Room 502 Anchorage, Alaska 99501 • (907) 343-4744' IAN 0 5 7 MWv1GDAUTY OF ANCHORAGE EN MONMENTAL URVK23 DIVISION Health Authority Approval Checklist Legal Description: 5112, L8, R3, Colonial Parkparee11D•:050-30118 Subdivision A. WELL DATA Well type Private If A. B. or C. attach ADEC letter. ADEC water system number Log present (YIN) Y Date completed unknown Total depth 9 9 ' Cased to 99, Casing height (above ground) 24" Sanitary seal (YM) Y Wires properly protected (YIN) y FROM WELL LOG AT INSPECTION Date of lest unknown December 20, 1998 Static water level 601below grade 74.3' Below top of pipe Well production WATER SAMPLE RESULTS: &p.m. Coliform Nitrate g t`j tuber bacteria Dateofsamplc: December 21, 1998 Collected by: Stuart Cilbert CT&E #987304 B. SEPTIVROLDING TANK DATA g.p.m. Dau installed 912193 Tads sys 1250 Number of Companmems 2 Cleanouts (Y" Y Foundation cleanout (Y/M Y Depressioo (Y/M N Nigh water alarm (Y/M N DateofPumping 12/22/98 Pumper JR, Eagle River C. ABSORPTION FOLD DATA Date installed 9� 2 193 Soil rating %p.d.litt or ftt/)drm) *45 System type deep t rer c h Length 83 ' Width +2' Gravel thickness below pipe 6 ' Total depth -17 0 " Effxtive absorption Area 1 , 0 0 0 s f Monitoring Tube pnxent(Y/N) Y Depression over field (Y" Vii_ Date of adequ teal 12 / T O / 9 8 Results (Pasa/Fad) Pass For 4 DR bedrooms Fluid depth in absorption field before test (in.); I)I,V Immediately after4ogal. water added (in.): sa " Fluid depth (ins.) Minutes later: 3„(QQ Absorption rate a p.d. Peroxide unaOmem (past 12 months) (YRS N If yes, give date D. LIFT STATION Date installed N o r. a Size in gallons ManholetAccess (Y/N) High water alarm level at' Cycles tested E. SEPARATION DISTANCES -Pump on" level at" "Pump off' Icycl at* ij tTTT^ SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding lank on lot 100' : On adjacent lots 100 Absorption field on lot 108, ; On adjacent lots CT 1100 Public sewer main rore Public sewer manhole/cleanout r. or. e Sewer /septic service line 85 ' Lift station r. o r. e SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 15 ' Property line 251 Absorption field 5 Water maidservice line GT 5t3tirface water/dritmagelPor.eObs yells on adjacent lots CT 100' SEPARATION DISTANCE FROM ABSORP71ON FIELD ON LOT TO: Building foundation GT 10' Water main/servitg IiBe GT 50 Surface water r o r e observed Driveway. parking/vehicle storage area GT 10' Curtain drain r. o e v i d e r. c e Wells on adjacent lots GT 100' F. ENGINEER'S CERTIFICATION Property line 10' I certify that I have determined thru field Inspections and review of Municipal re Signature tlfi ab ' y ore in conformance with AMA R14 guidelines in effect on this date. c•^. i.......... cC'.,•� Signature. IfJll '�II"�.JiC..C'�rV 1;0 •n>�! r t • ,`i;� S tca Engineer's Name 1) nL., 102:4 r. . ', ti : �• i�, Dc cep.,,; T.::ca!ay : . Date .,:T C) ii CE -8176 ' p4 0 na HAA Fee $ eiDD Date of Payment Receipt Number 02", �� %Z Rev. 8/95 OSS: haa.wk.doc Waiver Fee S Date of payment Receipt Number APPLIC"NT FILLS OUT UPPER HAI'` ONLY t:. PJopertY rrier /u Phone Mailing Address %l / ".7,y .;.!:om" .Zip Code Buyer Ij/'! L' ..�� pJ/C c I' ULC /14t1� Date Address i / / �f - /i (�E A I b': /�- Zip Code �' / 777 Date Lending Institution / f. i` Phone �l J Zip Code I ��� % Address (i , J / Realty Co. B Agent /', r r /q (f /{ i.Ur/S/yfj /'Gn/ %J'✓/JI A.G: Phone Zip Code % l % % Address j� -U Fi I J % i / Field Notes: Legal Description �� G->' t 4 C rt, �U(c7 t! rt- (','i: a 4— _'u 0 Street Location /i c' / : � . r -Y J1Yp'^"`�-r J �"'— - ` MUNICIPALITY OF ANCHORAGE OF HEGLT)I & Type of Residence (� ':'` ` SS P ga' Single Family ❑ Multiple Family No. of Bedrooms ❑ Other Water Supply Individual ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. depth log If avallable). ❑ Community For wells trilled prior to that date, give well (attach ❑ Public Utility &,) ++Trt4r- C. RECEIVED Sewer Disposal I $ 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. LI In . , r\ .-16-0 o U IXl Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector V Field Notes: C , __a_ nnnn (J . __ r�/� Lam„ S'r (CJIAA J1Yp'^"`�-r J �"'— - ` MUNICIPALITY OF ANCHORAGE OF HEGLT)I & W- ,y. CA� (� ':'` ` SS P DEPT. ENVIRO�ZA:NTAL PROTECTION �s� �� 0.,—ft Uw� NOV � iyFso &,) ++Trt4r- C. RECEIVED ( APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE I I BY:�1 Soils Date Sewer Installed Well To Absorption Area I O O Well Log Received Tank Size Z SQ IRating Well to Tank /00Septic November 16, 19t33 Tom and Linda Itorrison Route 4, BOX 2219 Branson, tfissouri 65616 Subject: S]/2 of Lot 8, Block 3, Colonia! Park Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: ° The top of the well casing sh?uld be sealed so that it is water tight. - ° Exposed electrical wires to the well head are in violation of the 11unicipality of Anchorage codes and must be encased in conduit. ° The septic tank pumped with a receipt submitted to this department. ° A Lour (4) inch cleanout needs to be installed to the sep- tic tank. C,y-oL .c -or- An An adequacy test needs to be performed on the existing leaching area. This test will determine it the system is adequate according to National Standards. A listing of 1 private firms performing the test is enclosed. This report Y needs to be submitted to this otfice for our review. ° The standpipe to the sewer system need caps on them. Please notify this Department Lor a reinspection when the noted discrepancies have been corrected. It there are any further questions, please call this office at 264-4720. sincerely, Cory %-Jillis, R.S. Acting Sewer 6 Water Program [tanager CW31/ej/E1 Enclosure n ADEOUACY TEST WATER AND SEWER INSPECTION WELL INSPECTIONS AND FLOW TEST SITE PUNS ROAD DESIGN SOILTEST ON SITE WASTE WATER DISPOSALSYSTEM DESIGN EXCAVATION WORK November 28, 1983 ROBERT CIVILENGINEER 6942979 MUNICIPALITY OF ANCHORAGE CEPT. OF HFi I TII S, ENVIRONWNTAL PROTECTION Dave and Sharon Dunckle N 0 V 291,I'Z3 c/o Dynamic Realty ` P.O. Box RECEIVED Eagle River,er, Alaska 99577 Dear Mr. Dunckle, REFERENCE: S�; Lot 8; Block 3; Colonial Park Subdivision A sewer system adequacy test was performed on the system located on the referenced property, as you requested. The septic tank was pumped and verified to have a capacity of 1250 gallons. The absorption trench was tested by a continuous flow of water over a period of 48 hours with approximately,640 gallons passing through the system in each 24 hour period without any adverse effect. It can be concluded from this test that the waste water disposal system located on this property is. currently functioning adequately for four bedrooms. However, the system cannot be guaranteed against subsequent failure. A well inspection was performed and it was determined that the well wires needed to be placed in conduit, this work was accomplished, and the well is now in compliance with Municipal code. A flow test was also performed and it was determined that the well had a static water level before pumping for approximately 72 feet. After thirty minutes of continuous flow at seven gallons a minute, the water level dropped to 85 feet. The well then recovered at approximately four gallons per minute. The clean outs on the septic system were equipped with new caps. It can be concluded that the well and septic located on this property is currently adequate. However, neither can be guaranteed against subsequent failure. SRB 196X EAGLE RIVER. ALASKA 99577 n e'1 w page two adequacy test t If we may be of further service, please do not hesitate to call. Sincere y,_ /,% .-SHAPED, P.E. ss cc: Municipality of Anchorage Department of Health and Environmental Protection e4nu4ctrL �(Su in �l chho�a INICIPALITY C' ANCHOIt<GE 5. LEGAL DESCRIPTION 1_o -r 81 MUNICIPALITY OF ANCHORAGE STREET LOCATION � rIIPIST Aue . DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street • Anchorage, Alaska 99501t�� ENVIRONMENTAL ENGINEERING DIVISION v RECEIVED - NUMBER OF B OROOMS ❑ One Four EDOther Telephone 284.4720 ❑ Two ❑ Five REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incornplets requests will not be Proceerd. Please allow ten (10) days for processing. 1. PROPERTYOWNER .SPK I A f MAD f,fae Y11A�-f;eY1� (� COMMUNITY PHONE 8d' 3 MAILING ADDRESS SI /11N 17,>s, <! ,u I A e s A h 99567 PROPERTY RESIDENT (11 different from above) H NE 2. BUYER t rYIA 11? Y SISS o m . by this Department. PHONE MAILING ADDRESS 3. LE MO INSTITUTION Ft%-• M"4LtAL S-AtJ IAJPS PHONE MAILING ADDRESS .T•- W II_L_ �F1-fueLZ 14 As1J 1) 4. REALTOR/AGENT MAILING ADDRESS 5. LEGAL DESCRIPTION 1_o -r 81 STREET LOCATION � rIIPIST Aue . ' IFA le. IP(UeN S. TYPE OF RESIDENCE - NUMBER OF B OROOMS ❑ One Four EDOther SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY I�1 INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled (� COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) S. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE" "If individual/on-site, give installation date If system is over two (2) Years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72010(3/73) �a THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS I DATE RECEIVEU TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ SINGLEFAMILY ❑ MULTIPLE FAMILY ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY PERMIT NUMBER ❑ INDIVIDUAL DEPTH OF WELL ❑ COMMUNITY ❑ PUBLIC UTILITY DATE DRILLED Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER ❑INDIVIDUAUON-SITE DATE INSTALLED J_-18' ❑PUBLIC UTILITY Connection Verified INSTALLER ❑Septic Tank or ❑Holding Tank Size:—j,Z "0 If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURE TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line WELL T0: r �f Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE By (Tit LEGAL DESCRIPTION 72-010 (Rev. 31781