Loading...
HomeMy WebLinkAboutEAGLE RIVER HEIGHTS BLK 3 LT 15AEagle River Heights Block 3 Lot 15A #050-271-51 G~%TER ANCHORAGE AREA BORC"sH HEALTH DEPARTMENT N? 512 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279.2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING ADD RE S noerOlbTinni Lo SEPTIC TANK: /u� A j.,/Ge/` NUMBER OF I DISTANCE FROM WELL v6MATERIAL <0DN CI�P�L° Y/ COMPARTMENTS LIOUID CAPACITY 17112 GALLONS. INSIDE LENGTH ; INSIDE WIDTH_DEPTH_ SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS I OUTSIDE DIAMETER /pg OR WIDTH , LENGTH , DEPTH L / LINING MATERIAL 5 . DISTANCE FROM WELL�.� , BUILDING FOUNDATION , NEAREST LOT LINE Zo TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) J SO. FT. WELL NUMBER OF FOUNDATION , NEAREST LOT ABSORPTION AREA SO. FT. LIN WIDTH TOTAL LENGTH OF LINES_ IN. TOTAL EFFECTIVE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: / DISTANCE FROM WATER TYPE�N,/A DEPTH ,BUILDING FOUNDATION. SAMPLE , NEAREST NEAREST SEPTIC/" i SEEPAGE i OTHER LOT LINE -.SEWER LINE-. TANK ��, SYSTEM 11 � . CESSPOOL , SOURCES_ DISTANCES: _ !zq' V4* DIAGRAM OF SYSTEM 13 M SOO frtf. N S tQ%i 7. nk N�us� DATE :3 1. i GARB -IID -2 GREATEI~ANCHORAGE AREA "OROUGH Case No. V61' �.tv— IIEALTII DEPARTNIENT L327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMI NAME OF APPLICANT Atsly MAILING ADDRESS / E N0. RESIDENCE ADDRESS �5��+*K LOCATION OF INSTALLATION �/ (Z�t�.. �O''4 LEGAL DESCRIPTION Al&+6 ? �``t �S fk_ 4' APPLICATION TO INSTALL: SEPTIC TANK; SEEPAGE PIT// , DRAIN FIELD , OTHER TO SERVE THE FOLLOWING FACILITY 11'6� ft" "d FINANCED THROUGH TO BE INSTALLED BY PERCOLATION TEST RESULTS 32 CE ANTICIPATED DATE OF COMPLETION i 1 i 1 i ■■■■■■■■■■■■■■■■■■■■■■ ■■�■■■■\i�\i art■■■■■■■■■ ■■r7■PON Opal k\IF, Now= NNONE ■ 1 HEALTH AUTHORITY OR LICENSED DESIGNER Ivicertify that I am familiar with the requirementsoTUr_e er Ancliorage Area Borough Ordinance No. 28-68 and that the above described system �`/ is in accordance with said code. � j� OAT tri `' /7r� APPLICANTS SIGNATURE ��+�zll�� fl�•sr�`y�I`� REATER ANCHORAGE AREA. BOROU^,H . ' HEALTH DEPARTMENT CASE d 327 EAGLE STREET ANCHORAGE, ALASKA 99501 W,0• /0740. Performed ror^KP.n 7e-?oleir Legal Description: LotL44LfBIoCk ;{ Subdiv This Form Reports a: Soils Log, t/ - Depth V ibua..� Feet Soil Characteristics _ �t+�• &Val► sandy silf : Date Performed_ n Eo o/P Rivc percolation 1'e s Was Ground Water rr.counteredl__ �q i m If Yes, At Wiat Depth Location Sketch °o o 3 ,• �'•' e•, SilfySandy GraY¢l Room 6 .e P', SiltySthdycnwal (Gk) 44 Sandy 6ruvcl Caw) B'4 ,o Silty Sandy Grave (',n 4 - -- sa"dy 6ravef CGW� /01"o : Date Performed_ n Eo o/P Rivc percolation 1'e s Was Ground Water rr.counteredl__ �q i m If Yes, At Wiat Depth Location Sketch Readirp, Gross :ime Net Time Depth To H2O Net Drop � e Frcpised 'n.:t:.1=,-..-,—.;:Seepage Pit 7 ,� Drain Field Depth Of Inlet Asav Mx fir' De,o bottom Of Pit Or Trench COMMrNTS: A_fyf v'M IMp 4-4 ,ino7h at Irl /P_%cSj /n��n iln`ffA.. _ Test Performed By: A1msR•,_ Data Certified By: tt� Date 1111 Room NNN .C.CC�: Readirp, Gross :ime Net Time Depth To H2O Net Drop � e Frcpised 'n.:t:.1=,-..-,—.;:Seepage Pit 7 ,� Drain Field Depth Of Inlet Asav Mx fir' De,o bottom Of Pit Or Trench COMMrNTS: A_fyf v'M IMp 4-4 ,ino7h at Irl /P_%cSj /n��n iln`ffA.. _ Test Performed By: A1msR•,_ Data Certified By: tt� Date MIJM I C- I P,flj I TY CFO F1t4Ct-I1DIF'r=iGE 1:30 p.m. DEPARTMENT O( ALTH AND ENVIRONMENTAL F"=CTION Thrus5-17-79 825 'L' wIREET, ANCHORAGE, AK. 995w Kennedy ti 264-4720 WELL F'EFt M I T PERMIT NO. < 781054 io Sam Plr - APPLICANT KENNETH W TAYLOR, BOY, 95 CHAIN OF ROCK RD E.R.Q4 2296 LOCATION BARONOFFtCHAIN OF ROCK RD nCq Dow LEGAL L 15 63 EAGLE RIVER HEIGHTS SD LOT SIZE 34848 SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL; OR 150 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. F'EFt M I T EXF' I FcEMED E: FR a�1 1 L I CERTIFY THAT 1: I AM FAMILIAR, WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IPJ ACCORDANCE WITH THE CODES. ---------- YLOF.ISSUED 0`00 - �------DATE_JL:;J"C4--- V3. 2 Eagle River Road to Chain of Rock Road, turn left, about 4 mile in. on the south corner of Baronof and Chain of Rock Road toe,a e,� ,mow WATER WELL LOG Mu•��ALITY OANCHORAGE :PT. C. : `�LTII & FOSS DRILLING ENVIRONP.'NTl.L � , ,_BION 1396 Ingra Street DEC 2 i' 1978 I Anchorage, Alaska 99501 WELL OWNER_ {e'e r, N ---r.. V Ir) (_ USE k LOCATION •/3) nom,; K c�3 L Dt l X�tul� f . ��i �l�Y' Q , u G e, - SIZE OF CASING_L�_DEPTH OP HOLELJ�2 PP. CASED TO I FT. STATIC WATER LEVEL _FT. YIELD_,f' GAL.PER.MIN. WITH FEET OF DRAWDOWN. REMARKS DATE COMPLETED_1,2 - 7 PUMP TO BE SET AT ,Qt o C2 j 2S@to� /"t o.� kLt o (o_ farg-t o2z a t ofg �t o� ILao ,_L L96 o—(1 /c2t ol�g /790lAg 1-�o— MUHMPAUTY OF AHCHORA OE Development Services Department E ' Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-271-51-000 Expiration Date: Legal description EAGLE RIVER HEIGHTS BLK 3 LT 15A Site address 10334 CHAIN OF ROCK ST Eagle River AK 99577 Current property owner(s) JOHNSON JEREMY S 9/28/2023 X The On-site system(s) is/are approved for bedrooms Conditional approval for 4 bedrooms, with the following stipulations: Comments or advisories: By Date: a L8-1 LV G3 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s)—is/are—in---substantial—compliance with municipal—code. The-- Municipalityof Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 050 271 51 Complete legal description EAGLE RIVER HEIGHTS BLOCK 3 LOT 15A Location (site address) 10334 CHAIN OF ROCK Current property owner(s) JOHNSON 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: X Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑■ Community Septic or Public Sewer a. ISEP iC- ANK: El "iteei ❑ Plastic -❑ Concrete ❑ Fiberglass Age - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 0 07 j Waiver Fee $ Date of Payment ko 2-0 Z-7 Date of Payment COSA # 05C_ ?, 312 02 Waiver # COSA Application—June 2022 COSA Checklist_June 2022 COSA Checklist Legal Description: Parcel ID: If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank Date of pumping Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Adequacy test date Results Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) in Effective depth used in Effective depth remaining in Comments/Deficiencies: COSA Checklist_June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F.ENGINEER’S COMMENTS G.CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Phone Engineer’s Printed Name Date C&M ENGINEERING CHARLES BALZARINI, PE 6/9/23 Name: C & M Engineering Lab ID#: M230531 Mailing Address: 20182 Tulwar Drive Date Sampled: 06/06/2023 Chugiak, AK 99567 Time Sampled: 1447 Legal Description: 10334 Chain of Rock Street Sampled By: CB Date Received: 06/06/2023 Sample Site Location: Ext Spigot Time Received: 1526 Health Guard I Parameter Method Result Unit MRL MCL Date Total Coliforms Colilert (SM 9223B) A --- --- --- 06/07/2023 E. coli Colilert (SM 9223B) A --- --- --- 06/07/2023 Total Nitrate/Nitrite – N TNTplus 835/836 (Hach 10206) 0.204 mg/L 0.200 10.0 06/13/2023 Arsenic Arsenic by ASV Metrohm AB 416/3 8.386 µg/L 1.000 10 06/08/2023 Method Reporting Limit (MRL): the lowest concentration that can be reported reliably Maximum Contaminant Level (MCL): highest acceptable level in public water systems as set by EPA mg/L: milligrams per liter; 1/1000th of a gram µg/L: micrograms per liter; 1/1,000,000th of a gram Absent (A): none of this type of bacteria was detected Present (P): one or more bacterial cells of this type were detected Results Reported By: _____________________________ Patience Obermann Laboratory Analyst Reviewed By: 9131 E Frontage Rd, Ste 15 Palmer, AK 99645 (907)745-3005 matsutestlab.office@gmail.com Signature: Email: Lynne Hill (Jun 14, 2023 12:33 AKDT) Lynne Hill office@matsutestlab.com CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 050-271-51 COSA# 090, a Expiration Date: la—la-03; 1. GENERAL INFORMATION xcg _. Mtinicipality of Anchorage ;'. ... Development Services Department EAGLE RIVER HEIGHTS BLOCK 3 LOT 15A Building Safety Division Location (site address) 10334 On -Site Water and Wastewater Program 61 c„ 4700 Bragaw Street Current Property owner(s) P.O. Box 196650 Day phone Anchorage, AK 99519-6650 Mailing address www.muni.org/onsite EAGLE RIVER. AK 99577 (907) 343-7904 Lending agency CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 050-271-51 COSA# 090, a Expiration Date: la—la-03; 1. GENERAL INFORMATION Complete legal description EAGLE RIVER HEIGHTS BLOCK 3 LOT 15A Location (site address) 10334 CHAIN OF ROCK EAGLE RIVER AK 99577 Current Property owner(s) MATTHEW GILLMAN Day phone Mailing address 10334 CHAIN OF ROCK EAGLE RIVER. AK 99577 Lending agency Day phone Mailing address Real Estate Agent SHAWN BABBITT Day phone 441-2500 Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site ❑ Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer 0 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 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. 1 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 FIm1�lrcTerra Engineering &Surveying Inc Phone _868-3792 Address _20441 PTARMIGAN BLVD, EAGLE RIVER AK 99577 Engineer's Printed Name KENNETII M. DUFFUS Date 06/27/2008 Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen OF •q�•9��� encroachments, deficiencies or discrepancies exist. �'�Q.•'•• •_A ��••;r� +1� 5. DSD SIGNATURE Approved for-3—bedrooms. Disapproved. Conditional approval for bedrooms, with the follov ON-SITE •' ATER AND o�,• PROGRAM INN Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By Q Original Certificate Dater (Rev 11105) Municipality of Anchorage + Development Services Department _ Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: EAGLE RIVER HEIGHTS BLOCK 4 LOT 15A Parcel ID: 050-271-51 A. WELL DATA Well type PRIVATE If A. B, or C provide PWSID # -- Well Log (Y/N) y Date completed 12/23/1978 Sanitary seal (Y/N)X Wires properly protected (Y/N) y Total depth ,48 ft. Cased to _24B -ft. Casing height (above ground) 12+in. FROM WELL LOG AT INSPECTION Date of test 12/23/1978 6/26/08 Static water level 98 ft. 99 ft. Well production 5 g.p.m. 4.5 g.p.m. WATER SAMPLE RESULTS: Coliform t2colonies/100mL Nitratee/L mg/L Other bacteria ocolonies/1 00 mL Arsenic: &Jung// Date of sample: o6/26/o8 Collected by: ArcTerra B. SEPTIC/HOLDING TANK DATA - PUBLIC SEWER Tank Type/Material— ' Date installed -Tank size _ gal. Number of Compartments_ Cleanouts (Y/N) _Foundation cleanout (Y/N) _Depression over tank (Y/N) _ High water alarm (YIN) _Date of pumping _,Pumper C. ABSORPTION FIELD DATA -PUBLIC SEWER Date installed _Soil rating (g.p.d./ff or felbdrm) System type Length -ft. ' Width _,ft . Gravel below pipe ,ft. Total depth _ R (bottom of effective) Eff.'absorption area _ e Monitoring tube _Depression over field Date of adequacy test Results (Pass/Fail) _ For _bedrooms Fluid depth in absorption field before test _ in. :Water added_ gal. New depth In. Elapsed Time: —min. Final fluid depth _ in. Absorption rate >= g.p•d• Any rejuvenation treatment (past 12 mo.) (Y/N & type) Jf yes, give date D. LIFT STATION Date installed "Pump on" levet at_In. Size in gallon "Pump off" level at_in. J I Manhole/Access (Y/N) High water alarm level at_in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot NA Absorption field on lot NA Public sewer main •50'+ Sewer/septic service line ]o'+ Animal containment areas 501+ On adjacent lots 1001+ On adjacent lots ]oo'+ Public sewer manhole/cleanout •501+ Holding tank NA Manure/animal excrete storage areas loo'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: — PUBLIC SEWER Building foundation Property line Absorption field Water main Water service line Surface water Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: — PUBLIC SEWER Property line Building foundation Water main Water Service line Surface water Driveway, parking/vehicle storage Curtain drain Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and i 9� review of Municipal records that the above systems are in �*4'4 •••conformance with MOA COSA guidelines in effect on this date. om1(.nneih A D W Engineer's Printed Name _KENNETH M. DUFFUS IIIA FA 7� Date 06/27/2008 •� ^uFESSt0r�.= COSA Fee $430.00 Waiver Fee $ Date of Payment Date of Payment Receipt Number // d `i Receipt Number (Rev. 11105) SCS ReEM 1083028001 Client tame ArcTerra Engineering and Surveying Project lame/t! E.R. Fits. B3,L15A Client Sample ID E.R. Fits. B3,1,15A hiatrix Drinking Water PNVSID 0 Sample Remarks: Parameter Results POL 06/26/2008 13:15 Received Date/rime 06/26/2008 15:45 Metals by ICP/MS Stephen C. Ede 11 Arsenic 10.7 • 5.00 Waters Department SM209222B A Total Nitrate/Nitritc-N 0.143 0.100 Microbiology Laboratory Colony Count Total Coliform recall Coliform All Dates/rimes are Alaska Standard Time Printed Daterrime 07/03/2008 9:08 Collected DalefTime 06/26/2008 13:15 Received Date/rime 06/26/2008 15:45 Technical Director Stephen C. Ede Allowable Prep Analysis Units Method Container ID Limits Date Date Init ug/L EP200.8 C (<10) 06/30/08 07/02/08 NRB mg/L Shf204500NO3-E 11 (<10) 06/27/08 JDZ 0 col/IOOmL SM209222B A (<200) 06/26/08 DLC 0 col/IOOmL SN1209222B A (<I) 06/26108 DLC 0 col/IOOmL SM209222B A (<I) 06/26/08 DLC Municipality of Anchorage • '� Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsitc (907) 343-7904 Arsenic Advisory Certificate of On -Site Systems Approval # 080233 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 15A of Eagle River Heights Subdivision. This inspection revealed an arsenic concentration of 10.7 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/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. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.mtini.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Municipality of Anchorage �A�,.• • Development Services Department / Building Safety Division . • . Onsite 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. 050-271-51 HAA# QLA Z ` I � / 1. GENERAL INFORMATION Expiration Date: 1 — I " 0 — Complete legal description EAGLE RIVER HEIGHTS SUBDIVISION; LOT 15A, BLOCK 3 Community Class Well ❑ Public Water System Location (site address or directions) 10334 CHAIN OF ROCK STREET • EAGLE RIVER. AK • 99577 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address DALE COLBY C/O AGENT Day phone Day phone BROOKE STILTNER W/ REMAX PROPERTIES Day phone 694-4604 16600 CENTERREL.D DRIVE ' EAGLE RIVER, AK • 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑ Individual Holding tank ❑ Community On-site ❑ Public Sewer N The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat 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 typo 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(aro) 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. Address 3701 E. TUDOR ROAD. SURE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines d Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwaterlevels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the ownerlisted 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 3 bedrooms. Disapproved. Phone 337-6179 Conditional approval for bedrooms, with the fllowing stipulations: � Gar ess: 53 .... ' �eQ `�.-Qr;.•- -••.;'gyp ��•WATER AND •: WASTEWATER • PROGRAM Attachments: J�� ape•.. 'S HAA Checklist Manitenance Agreements J�ir ''NTSE`n Septic System Advisory Supplemental Engineers Reort Well Flow Advisory Other By: ��� Original Certificate Date: — — ' — t C�7 4411 4-1 (R". 12101) Municipality of Anchorage er • '-' Development Services Department t' - Building Safety Division On -Silo Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ok.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: EAGLE RIVER HEIGHTS SUBDIVISION; LOT 15A. BLOCK 3 ParcelID: 050-271-51 A. WELL DATA . WeII type PRIVATE If A, B, or C provide PWSID# NIA Date completed 12/23/1978 Sanitary seal (Y/N) YES Total depth 148 ft. Cased to 148 ft. FROM WELL LOG Date of test 12/23/1978 Static water level 98 ft. Well production 5 —9 -P.M. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Arsenic: N/A mgJL. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 5/17/2004 99. n. 6.6+ g.p.m. Nitrate 0.1 mg./L. Other bacteria 0 colonies/100 ml. Date of sample: 5/17/2004 Collected by: GEG, Ltd. PUBLIC SEWER Date installed Tank size gal. Number of Compartments Foundation cleanout (Y/N) _ ss er tank (Y/N) High water alarm (Y/N) mpmg Pumper C. ABSORPTION FIELD DATA PUBLIC SEWER Date Installed Soil rating (g.p.d./ft'or n'/bdnn)_ Length ft. Width ft. Total depth ft. Elf. absorption area— n' Monitoring tube Date of adequacy test Results ail) Fluid depth In absorption field Elapsed Time: n. System type Gravel below over field For bedrooms r ,1 _ in. Water added _gal. New depth _in. Final fluid depth _ In. Absorption rate >= g.p.d. treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date Installed_ 'Pump on" level at —in. E. SEPARATION DISTANCES Size in gallons High water alarm level at Cycles tested Meets alarm & circuit requirements?, SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A Absorption field on lot N/A Public sewer main 050'+ Sewer /septic service line 10'+ On adjacent lots 100'+ On adjacent lots 1000+ Public sewer manhole/cleanout •50'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER Building foundation Property line Absorption field Water main Water water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: PUBLIC SEWER Property line Building foundation Water Water service line Surface water �u ivy Wells on adjacent lots F. COMMENTS *SEPERATION DISTANCES MET PER 1977 REGULATIONS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Print Na a JEFFREY A. GARNESS Date — '70704 - INSTALLED 1 HAA Fee $ Waiver Fee $ Date of Payment s �G Y Date of Payment Receipt NumberUU Receipt Number (Rev. 12/01) storage SEWER 0 ✓.... ............ ... J re Games w '•' SFO ........... .14 own 05/12/2004 12:39 6944988 EROOKE i■ � .✓e9�s� is �/ ss �� Q 0 0 4 ri I 33' PAGE 01/01 i � I , t�t ASBUILT-NO CORNERS SET THIS DATE. SEWARD 6 ASSOCIATES LAND SURVEYING 594-0629 1 HEREBY CERTIFY -THAT I HAVE SURVEYED THE SCALE. �o o•sya FOLLOWING DESCRIBED PROPERTY, Z OF AZ4%% E9�lEil�!•t�i!'if•L�/1.y71'fG �oTisyi9.C•T DATE, 0:4f\ . AND THAT NO ENCROACHMENTS EXIST EXCEPT AS i��y �Q •' ,,�' .•-j INDICATED. IT IS THE RESPONSIBILITY OF THE , „ q n 7 • OWNER TO DETERMINE THE EXISTENCE OF ANY ORIDr '' ••• EASEMENTS, COVENANTS, OR RESTRICTIONS % �..l� WHICH DO NOT APPEAR ON THE RECORDED SUBDI- f o�,0" AAO,k Sn vd . A VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: f '•. LS -6918 tky ANY DATA HEREON BE USED FOR CONSTRUCTION. * OFFENCE LINES, OR FOR ESTABLISHING BOUND- �� Rpr .•••. . i' ARY LINES. DRAWN: q�A�skgu� oar \ Ni s IN � 0 n U � Q/ SV 1 ' 00 Q 0 0 4 ri I 33' PAGE 01/01 i � I , t�t ASBUILT-NO CORNERS SET THIS DATE. SEWARD 6 ASSOCIATES LAND SURVEYING 594-0629 1 HEREBY CERTIFY -THAT I HAVE SURVEYED THE SCALE. �o o•sya FOLLOWING DESCRIBED PROPERTY, Z OF AZ4%% E9�lEil�!•t�i!'if•L�/1.y71'fG �oTisyi9.C•T DATE, 0:4f\ . AND THAT NO ENCROACHMENTS EXIST EXCEPT AS i��y �Q •' ,,�' .•-j INDICATED. IT IS THE RESPONSIBILITY OF THE , „ q n 7 • OWNER TO DETERMINE THE EXISTENCE OF ANY ORIDr '' ••• EASEMENTS, COVENANTS, OR RESTRICTIONS % �..l� WHICH DO NOT APPEAR ON THE RECORDED SUBDI- f o�,0" AAO,k Sn vd . A VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: f '•. LS -6918 tky ANY DATA HEREON BE USED FOR CONSTRUCTION. * OFFENCE LINES, OR FOR ESTABLISHING BOUND- �� Rpr .•••. . i' ARY LINES. DRAWN: q�A�skgu� oar 05/25/04 11:10:28 AM �D '? I??IyI •' `• Til-'•It2ldl I27 P-) Ell R f�ra`9k E _ + FEE 1 1 W W ee�Nt. m WELL 1 o i E`Ev •' S6 1 -•-Id 1 � Ip 1 ' a 1 I rn 1 L 12, t r XI I� i2' �N /.9 BEAD 1 _ -- I - - �- --- --B---- — 1----------- —T—�----G----+ ''''�� 1 STA. 3+31.50C �5 u TIL7TY TBMV NLR 50-8 G 17,1 1 C31 01611 DICV1 i !I II - ----- Help, press F1 [27.60X Pagel 0l1 Start IJ 3_:� �j � gS E2 2 ® ® ©J�- � � PHProlekt-... J'Au6DLT.. QYehoolMail-j BRDrewinq s ORd4517-1...y1 t�t� 11:10 AM 05/24/2004 11:15 FAS 907 582 0824 AWWU ENGINEERING e004 J ``EI 'vim I i 1 1 I r,AA IJ i p r:= r+ 14 IIlk' P I 1 S ON2758 2759 € ; E „.4513 t ! ! ! ! t `. sY TIT- I j� 11 t i�^ 'MR11 oil 11111i� q 1 1 ! }} Piicil G•�P I • ] i[ 4 e 1 =[! }lyy C u N Mme" A. T' F � E S/ S c i�,e�' , ri , �s g; 1•;441 lilt r- YYH •a[ IF" 9E 1 S ON2758 2759 € ; E „.4513 t ! ! ! ! t `. MUNICIPALITY OF ANCHORAGE (1 50 • 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 l.D. t1 nen -a-1t- S1 HAA M JM51-11)Mn GENERAL INFORMATION Complete legal description Lot 15A• Btoeh 3; Eagte Rivet Heights Location (site address or directions) 10334 Chain o6 Roc( Eagte RiveA. AK Property owner Donand Penny bfewtyman Day phone C/0 REMAX OF EAGLE RIVER Mailing addressAt—�Aini Koh6idd 16600 Centen6iekd Dk. Eagte R.ivert, AK 99577 Lending agency Day phone Mailing address Agent Vika in.ia Koh6dei7.d/ REMAX OF EAGLE RIVER Day phone 694-4200 Address 16600 CenteA6.ieEd Daive Eagte R.ivea, 0 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 \' 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water 99577 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer XXX NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-0250" 1/91) Fmm MOA41 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 Iurtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 5 e ENGINE£RI Phone (;5 Address »034 Eagle River Loop d N .204 age River, AlaSk2 Engineer's signature Date 6. DHHS SIGNATURE u Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 0 Date /— 2 O - 94 The Municipality of Atichorage 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 thei r lendi ng i nstitutions 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. 22025(Rw.1/91) Reck MOAe21 Municipality of Anchorage Ak AEML Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: E kt:kE _Parcel I.D. f-INt b-4, Ar> A. Well Data Well type Qt✓r J), - If A. B, or C. attach ADEC letter. ADEC water system number Log present N) 4 -Date completed Ix --23-75 Driller 1=o SS Total depth /lot Cased to /49 r Casing height µ. / Z Sanitary seal&9/N) Wires properly protected 6iN) X/ FROM WELL LOG AT INSPECTION Z o 00 ii Date of test /2-- z 3 i9 l - S.q ¢ 0 N a, LLJ Static water level W Well flow 570 o g.p,m• L.Z g.p.m. LLJ Pump levell V lL y9- W Q/ SEPARATION DISTANCES FROM WELL TO: W r 1 Septic/holding tank on lot ; On adjacent lots /� Absorption field on lot — ; On adjacent lots Public sewer main rfi 75- Public sewer manhole/cleanout /Dorf Sewer service line 2-s- 14- Petroleum tank :2 r r WATER SAMPLE RESULTS: Coliform D Nitrate D. 1 y Other bacteria U Date of sample: - `1 Collected by: 5 i S E,f�, ii✓Ef < rJ4 B. SEPTIC/HOLDING TANK DATA Date installed Tank size Compartments Cleanouts (YM) Foundation cleanout (YM) Depressior High water alarm (YM) Alarm Date of pumping SEPARATION DISTANCES FROM S /HOLDI Well(s) on lot On adjacent lots TANK TO: Foundation To prop ine Absorption field Water main/service line Surface water/drainage CONTINUED ON BACK PAGE 72-028 (397)' Front C. LIFT STATION Date installed Manufacturer Size In gallons Manhole/Access (YM) Vent (Y/N) 'Pump on' level at "Pump off" Level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA .Date installed Soil rating Length Total absorption area Width :.;Date of adequacy test Water level in absorption field before Peroxide treatment (past 12 SEPARATION DISTANC Well on lot To building On adiac& ravel thickness Surface water System type Total depth present (Y/N) Depression over field (Y/N) Results (pass/fail) (YM) ABSORPTION FIELD TO: for Bedrooms After test yes, give date adjacent lots Property line To existing or abandoned system on lot _ lots Cutbank Water main/service line water Driveway, parking/vehicle storage area drain E. ENGINEER'S CERTIFICATION �d - Icert fy that I have checked ve ' or conformed to all MOA and HAA guidelines in eNect ori th to o/ this inspection. )s s' r. Signature GINEERING Engineers Na t'4" . E e River, Alaska 99577 Date ",• ' HAA Fee $-L.CJ. �— Waiver Fee $ Date of Payment 1 1 E) TC% l Date of Payment Receipt Number P -5'S4 Receipt Number 72.026(a93)' Back eo �% MUMCtPAETy OF ANCHORPAbNICIPALITY OF ANCHORAGE (MOA) E,,,,ONMENTAL SERVICES 014 ALTHAUL SOTRIFEBRUA OVA198(HAA) DEC 2 9 1981 2644744 Legal Description: A. WELL DATA Well Classification S. F- If A. B, C• D.E.C. Approved (Y/N) N/A Well Log Present) Date Completed /> - Z a —R7� Yield /f• Total Depth /NF� r Cased to Depth of Grouting Static Water Level I n/. ' Pump Set At L� Casing Height Above Ground / y n Sanitary Seal on Casing64 N) Electrical Wiring in Conduit) Depression Around Wellhead (Y& Separation Distances from Well: To Septic/Holding Tank on Lot "k ; On Adjoining Lots r To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots /yJ f= To Nearest Public Sewer Line 9' S 1 + To Nearest Public Sewer Cleanout/Manhole le='' -F- To Nearest Sewer Service Line on Lot Z S Water Sample Collected byS� z N 1^n� t—_Date Water Sample Test Results Comments 2K♦ 7-e> As i B. SEPTIC/HOLDING TANK DATA Date Installed :�(= * Size No. of Compartments Standpipes (Y/N) Air -tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract 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 Line Course Page 1 of 2 72-M IHry 6661 Front Foundation Cleanout (Y/N) Date Last Pumped for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream. Pond, Lake, or Major Drainage /1, C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Date Installed Length of Field Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area Standpipes Present(Y/N) Depression over Field (Y/N) Date of Last Adequacy Test . Results of Last Adequacy Test 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 Comments .1F�wE CL_ftilw r To Property Line To Existing or Abandoned System on ;On Adjoining Lots To Cutbank (if present) /d—/e->�� �w�i� U 1��2crcA D. LIFT STATION ' nstalled Dimensions _ Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at /N) Tested for ing Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) _EE Comments Check Permitted Bedroom Rating Against HAA Request •' I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signec5 A S ENGINEERING pa to 17034 Eagle R ver ooP Roado, 04 CompJ%la-Rlw*rANsk 4957 MOA No. Receipt No. __ l O O / O O Date of Payment ��— I •• T �� Amount: $ !o e� ... ........5.. p i er's.....,.. t,,/1 A. SRa6o • • 'k,�X Page 2 of 2 77-0761Rw 81"1 swk