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Home My WebLink AboutHUNDRED HILLS BLK 3 LT 1Hundred Hills Block 3 Lot 1 #078 - 181 - 03 ev. MUNICIPALITY OF ANCHORAGE ••' DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION r . i f I ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 2644720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME VV , '` VStw m...e it PHONE EW i53—(cm 4 ■ UPGRADE MAILING ADDRESS at—Q ` sk 4�-'z �Ft' 1T�.0 s k�- LEGAL DESCRIPTION (�-3-3``-\ Ir -.....Ir-.....\ \ANDR-f..0 V‘tLLS SISI LOCATION \-\1/41 LTN RD E. c1 M1k6S NO. OF BEDROOMS At— SEPTIC TANK DISTANCE TO: ell ISrbtosc, Absorption area ,Dwelling Q ri.V#`G,LAS WidthLiquid PERMIT NO. -% 80 aa�{ No. of compartments 7% depth Manufacturer 511,tileafT )`i1STlCC Liq tapacity m gallons IF HOMEMADE: Inside length 6 Y JZ2 0 —F DISTANCE TO: Well Dwelling PERMIT NO. Manufacturer Material Liquid capacity in gallons TILE GRAINFIELD TRENCH DISTANCE TO: Well Foundation Nearest lot line PERMIT NO. i 8 O �3.14 No. of lines , Length egch line '� Total length ooflines Trench width 4 inc es Distance between lines 1,\I I n Top of tile to finish grade" • "T Material beneath tile inches Total effective absorption area SEEPAGE NT Length Width Depth PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line J iDISTANCE ss�fl Depth Driller Distance to lot line PERMIT NO. TO: Building foundation Sewer line Septic tank Absorption weals/ OTHER PIPE MATERIALS C—n is \Vali 1 sTtc, o A VOA SOIL TEST RATING VT ken a �a, INSTAR `� Ke --s eicw coy- cientec„. —'(.....s I REMARKS we O e. • C.) Air 73115 A4PRgaraN \Alla kt1Ql .t.l512 1 \ PIL \ k-- \rat ccntni 0i t� �1JG jsaaci'. �J kyii 3 1 l SoL 10 y"L'1 4.titc, cc AQP &o r*L Q1E 'OSE CK. SOM? •, 1T \•taSP 1NFaerntxrtaJ QlL_ Stvilc . • • —Ct tJ P VEDs Qt)to) �TE\� LEGAL ev. ' , GEORGE: C. SCHWADERER CnnL'ENGINEER AND SURVEYOR ,1734 BANNISTER DRIVE tNCNORAGE. MAGNA 09504 TOOT 27a-leel ._ t,,.s+Jul1••• • y 5, 1978 '+r,:: Municipality of Anchorage Department of Health and Environmental Protection 825 "L" Street Anchorage, Alaska 99501 Gentlemen: 1;, mItCIPALITY OF p`•� CEPi. OF H -• CNVI2OI `J.IENIAL PrcL:ic�'•.•'4 JUL7 1978 RECEIVED Re: As -Built On-site Sewer Installation Lot 1, Block 3, Hundred Hills Subdivision An inspection was made June 25, 1978 of an on-site sewer installation by Mike's Excavating on the property of Sharon and Fran Nalcutt described as Lot 1, Block 3 of Hundred Hills Subdivision. At the time of the inspec- tion, there was existing a 28' x 35' foundation excavation for a proposed four-bedroom house. Forty feet of four -inch diameter cast iron pipe were in place extending from one corner of the foundation trench to a 1,250 gallon capacity fiberglass septic tank. An additiona1111 feet of four -inch cast iron pipe were in place below the septic tank connecting with approxi- mately 36 feet of four -inch perforated PVC drainfield pipe. A trench averaging four feet in width contained gravel to a five-foot depth below the bottom of the outfall pipe. Scale tickets provided by the contractor indicate that 144 tons of gravel were placed in the trench. The depth of the outfall pipe below the ground surface provides a minimum of four feet of cover. There was no well on the property at the time of the inspection. .(E i e .•••'•..e....:S, 1 CO"Aw ecV *r • N `' •r 't Encl: 2 of ...L `. • eV:: G. C. Scllwoderer . Nle NO. 1006-E :'.-^'e fF P. (0-.e1 0P F SS10�1P�� Very truly yours, George C. Schwaderer, PE Alaska Registration No. 1006-E ,S£ 1 N L,i SECTION A-A 0 0 0 0 C 0 c o o • x Li- W OI to 0 Z 0 Z N O 1- Q m J y Ia- 0 J Z J 0 xxa W O S O W S to z z W Q 1_-xlc. o tnre; 0 N O 0 1- F-�a - CO a 0 m — Z CO OO Q J � •MCF -4I C I 1 .=1L I T' -r OF RrlCEJ�_•: FII3E DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET: ANCHORAGE: AK. 59501 264-4720 Ot-4—•=ITE - EIJE=F: F CF:r•7 I T PERMIT NO. ( 72220224 ) APPLICANT LOCATION LEGAL FRAN WALCOTT WOLF WHY L1 E:_ HUNDRED HILLS S/D 21-442 APT C CITRUS= ST TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH LOT SIZE (X_M 03 o P i m J{T' IlY.gv) Cyirorr CL JJk (J� bet EIXtsotERS LSA' INS9 . VEEDEI, r'5_ 6274 98079 SQUARE FEET MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BF:)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C•FEF' rI-1= _' LEr-4G71-4-1= = i GF:FI VEL C•EF'T1-1= 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 CIN FEET). THERE IS tJO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUt1 DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM'OF THE EXCAVATION CIN FEET). F:JEC!Ll I F<:EC• -•EF r I �C TFC r JFC SIZE= 1 L « r IRLLC'r-IE PEF:PIIT 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 WILL SERVE. --- Tl•Jc' <2> x r-JSFsCCT I cur -a_. HF= E Ft:CC?LI I Fz:Ec. E:ACKFILLIrIO OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTIOFJ. t1INIt1UM DISTANCE BETWEEN A 1 -JELL 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. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER IFJSTALLATION. F'EF Fi I T E::r I F :EE• GECEF'IE:EF: = 1. 2_1517--8 I CERTIFY THAT 1: I AM FAMILIAR WITH THE_REQUIF:EPIENTS FOR OtJ-SITE SEWER_ AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM INJ ACCORDANCE WITH THE CODES. _: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIIF:E ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDEJ1rr" MAN 4 BEDROOMS. APPLICANT FRAPJ WA COTT ISSUED BY DATE 04C_ V3.2 \ O ° is dues peg IryDivhounL 1.1131--4 T C: I: r- 1=11_ I t'.-' 1_1 F F=1 t -J 1_ Im_1 F=.: t -i 1 i F= DEPARTMENT IJF HEALTH AND ENV IRC!NMENTAL. EROTEC:TiON 2 'L-' STREET, ANCHORAGE., Ali. 99501 279-2511. 1 1. Cit-J—C 1 TF =:F= 1•JFF IRF=-F'F•i .i. U PERMIT NO (' 77550 ) APPLICANT FRAN WRI C:itTT 21-442 APT C CITRUS ST FLMENC; 753-6274 LOCATION III 4. F WHY LEGAL. L:t P-: HIILJC:'F'ED HILI-.= SURD LOT 51 E 5367'A SQUARE FEET t':PF OF SOIL_ AF:SOF:F:TION SYSTEM IS: TRENCH 1':i 11L.IM FJI.II'IF:ER OF BEDROOMS = 4 SOIL RATING (5f' FT: EE)= .._ THE PFC1IIRED SIFE OF THE SOIL RESORPTION SYSTEM I S : I_..,F= 1='TH== '_+ 1_17. F -J1_ 7FH==5: 5 1_iF:F .. E=1_ THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINRIELD. THE DEPTH IIF A TRENCH OF: F'IT IS THE DISTANCE BETWEEN THE SIIFFAC:F_ OF THF ri i-tl IND AND THE F:f TTOr1 OF THE EXCAVATION (I N FEET). THERE I.5 No SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH 15 THE MINIMUM DEPTH OF GRAVEL F:ETWFF1J TI -IE OUTFALL PIPE A,JD THF F(ITTOM OF THE EXCAVATION (IN FEET). F=1F.17-0_1I F:Fr. `_=-F-F'T T C: TIRF-JI:: SIZFE= th..; :`._:C_i til=11_l_1.1FJ F= E=1 1 I -C 1=1 1 F F• !_ F=i F -J 9 0 F=' T T 1-1 t-4 A FAr.VAGF PLANT MAY F:F INSTALLED AT THF PERMITTER'S OPTION 'ABJECT TO THE c I I_CILIIrlG CONDITIONS: 1 ETTHFP FI CLASS I OR TI NSF APPROVED PLANT MAY E:E INSTALLED. 2 A CONTINUOUS MAINTENANCE AGREEMENT IS REI'II.IIREE:'- IF A MAINTENANCE AGREEMENT 15 NOT KEPT CURRENT YOU IIAY BE REPAIRED TO ENLARGE THE SOIL AF,SORF'T10N SYSTEM AND/OR YOU MAY F:F SUBJECT TCI PROSECUTION. CI TION. — — — T L I C i c:57!> :I: F -J "_=. F• FE 1 =: T T 1-1 F -J E. F=i F F- — — — PFCf FTI..L.-ING OF ANY SYSTEM HITHOIIT FINF"AL IIJSPECTION AND ARAFAVAI.. BY THIS DEPARTMENT WILL BF SUBJECT TO f-F:OSEC:I_ITIONJ. MINIMUM DISTANCE PETWEEN A WELL AND ANY ON-SITE SEWAGE 1T 7DO A;_ SYSTEM I5 "!I -Ci FEET FOR A PF:IVATE WELL OP 200 FEFT FOR A PUBLIC WELL nTHFP PEPII1RFhiF'r'JTS MAY APPLY. SPECIFICATIONS AND Cit'NSTP1UT..TIAN DIAGRAr15 ARE 1=!' A1L API_F TO INSURE PROPER INSTALL.FTICIH F•F.F:F-11 V F_.:=<iP T F'F _ r.'F.0:F.F'1SFEF: -:J- . I_N=.917."7" T CFPTIFY THAT 1 • I AM FAMILIAR WITH THE REPIITREMFNTS FOR OrJ-SITE SEWERS AN WELLS AS SET FI IPTH FY THE MUNICIPALITY OF ANCHORAGE. T 11TI-L i11'=TAL.L THF SYSTEM IFI ACCORDANCE WITH THE CODES. T UNDERSTAND THAT THE ION -MTF SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THF c: c:'5 T E c-NCF. IS REMODELED TO INCLUDE MI -IF F THAN 4 PEDF.Of Ir I'S . T I irJFD T'=.=IIFr. P: APPLICANT FRAN IJALC:OTT ITE--7-=/9^� 0 Et E GEO'CHNICAL £t DEVEL'^?MENT CO. Russel/ Oyster 6942774 Soils & Foundations Box 90, Davis St., Eagle River, Alaska 99577 694.2774 or 688.2280 SOIL LOG Earl Ellis 688-2280 Land Development Performed for: Name: ic-417,4J Pi/4 t C n r r Tel. No. Mailing Address: Legal Description: Lor / , `t/<,' e /4o //Ott_r Svpo- Depth (feet) Soil Characteristics 0 1 2 3 4 5 6 7 5/17Y _S,w S' 64111/4' Co6fr5 ( %&ncF2s rc ;?-41"93 8 C P ,S//AMY G�1d�1.� C= /� 067fG6J f 9 6ovcoer s T'o 5/ r�4SJ 4xsVL42 10 d c,Ei7i✓ COI,L'r2E f,9,yo V 6e/icci 11 12 �3 5577044 o f R T 114 15 16 Ground Water Encountered: Yes Proposed Installation: Seepage Pit, Comments: No 1-7 If yes, what depth Drain Field Performed by: 24 Date: 7//i1/47 Trrtifirh Bruning 'Eng Lc DOC Co. ata SULLIVAN WATER WELLS P.O.B0X 670272,CHUGIAK, ALASKA 99587 • TELEPHONE 8882759 ' 1 OWNER OF LAND /Ain.air feeanJ i'23r.....,. DI:I'TII OF WLLL •I A0 ADDRESS STATIC LEVEL OF WATER FF ,i S LEGAL DESCRIPTION t / CC/ 2 NA r1/).&-0 NLzss DRAW DOWN FT DATE • Started Ended 8/9 / GALS. PER DR f Fa s PERMIT NUMBER I t 12i ktn'a am KIND OF CASING A'r' h 0 KIND OF FORMATION: n From__OFt. to ^ Ft 0e-}c,rt1C Sr,eKs�C' From ") FI toy Ft I J ./ a JR •015-^i From Ft to 7 S Ft 7/ 6 trr/ S, L. T % From From From Ft to Ft Ft to A -RECEIVED Ft to Ft From - Ft to Ft. Siy'.40 3 C efi L .From F1. to From 3< Ft to 43 FIJ4 Ft SEP 2 0 1997 . e) .) (.'2t Jrc... ,. From, Fl io �fvl �rn tp3litYctAnchoraOa 1 irratm a Human Services Froml3 Ft. to et? Ft f/Ai'ir`A.J .‘'({ 1e-4's....From, 'Ft. to Ft From. 9 7 Ft. to / C5 Ft. />c rtiiti )r <' 1, FritFi. to Ft. From 1 Jr Ft tot 0 c Ft.4e‘ N 0-,..) rik' \.tZ41)C.IC-From) Ft. to Ft. From Ft. to FI c' r'//1 From Ft. 10 Ft. From!'` Ft. to/ /9 Ft !" =l1Q .'t 7/1d AJ FromFt to F1 From 1 f C1 Ft. to 1:) 1 Ft. R2 • W.r.J !` e) ad, Ro GtcFrom FI to Ft J. � i r, From Ft to Ft.. " l - ',:Arn ',From ' Ft to Ft i From/ Ft. to 1 3 5 Ft. /? cALC 16 c tc r"'/From Ft to Ft n From Ft to Ft. CSP,)t1-1^., g�,-,... C From Ft to Ft From J'' Ft. to jTC FI. Qr,QQ,)rt Lr orr t (icc&F)rom Fi. to Ft. From!r" S. Ft. to /(-T Ft. 2 �4;1, d C K 6 I A1' From Ft. to Ft. From FI to Ft. From Ft to Ft MISCL. INFORMATION: 19 J1oF n �1 '1 ivc LA) LLL crqs.^-1G DRILLER'S NAME MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW910220 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:WALCUTT SHARRON OWNER ADDRESS:HC 85 BOX 9410 EAGLE RIVER, AK 99577 PARCEL ID:07818103 LEGAL DESCRIPTION: HUNDRED HILLS BLK 3 LT 1 LOT SIZE: 96093 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 0 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 8/01/91 EXPIRATION DATE: 8/01/92 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: THIS PERMIT IS ISSUED TO ALLOW THE CONSTRUCTION OF A NEW WELL. THE EXISTING WELL HAS GONE DRY AND MUST BE ABANDONED IN ACCORDANCE WITH DNR REQUIREMENTS. RECEIVED DATE: r-/-f- ISSUED -/^S' ISSUED BY 'JOHNS SM X1/4 DATE' 60)4/ 1 "••- • :1.7.51.6 i .. "t.: -",a AS -BUILT I herby certify @at 1 have surveyed the following described Ptort Lal't!BIecp ?� J-k.P,veaO-b the- .s $ural Sa-c.14e If ,7-13 , FtteL�sly� Anchorage Recording Precinct, Alaska, and that the improve-. meats situated thereon an wtthirt the property linea and do not. overlap or encroach on the property lying adjacent thereto, that oonn intproverneturIn pso lyingdth adjacentat thre no encroach taramistn lines or other v%tke easements std property wertty.. except as indicated hereon. Dated at Fa1;1e River. Alaska.. .• th.re i rte. ? day of xi) ly • 19fl RORE>f7 C. JOHNSON' 7.1.*, SSu SCALE; . • Registered Land n eyor No. m84L5 l.. - re/ box 777 044 Eitie River, Alaska 99577 Pho (Irr tfird DrtLting aCng by Lv v/d(/7 SULLIVAN WATER WELLS OWNER OF LAND / •;i% tIF_It4I C I rIRL_ I TY CD r Fit•JC rrFr: PIC C DEPARTMENT O"NEALTH AND ENVIRONMENTAL F TECTION 825 'L STREET, ANCHORAGE, AK. 995w. 264-4720 WELL_ P'ERt1 I T PERMIT NO. ( 810477 ) APPLICANT SHARRON WALCUTT SR 9410 HILAND ROAD E.P. 694-2555 LOCATION HILAND ROAD LEGAL LOT 1 ELK 3 HUNDRED HILLS SUB LOT SIZE 87000 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 PUELIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LIME IS 75 FEET. WELL LOGS ARE REQUIRED AF1D MUST EE 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. PEFflI I T EXr I R'Es DECEMBER n1. 1ss1 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 IN ACCORDANCE WITH THE CODES. SI GNED:_1_%lL�>L1GA w��%C4lctt APPLICAFyfl SHARRON WALCUTT GG ISSUED BY_ - { r1L4�La1s<<PL____DATE_ �4?C V4. 0 Parcel I.D. 078-181-03 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Expiration Date: 2- //i(/ 3 1. GENERAL INFORMATION Complete legal description Hundred Hills BIk3 Ltl Location (site address) 1046 Hiland Rd., Eagle River Ak. 99524 Current Property owner(s) Jeffery Loman Day phone Mailing address P.O. Box 244456, Anchorage Ak. 99524 Real Estate Agent Day phone 2. TYPE OF DWELLING: O Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 OR co i rd. tv Pt/ 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer , ❑ WaiverNariance request for: Distance: Received by: //1 7/2 COSA to be released to the engineer, unless othenvisorequested by the engineer. Date: i///y// COSA Fee $ get 0 Waiver Fee $ Date of Payment / (A/2- Date of Payment Receipt Number 0 7232 6- Receipt Number COSA# DSC 1215/3 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 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 Firm Pannone Engineering Services LLC Phone (907) 272- 8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date rZlllj • fit 6. DSD SIGNATURE ✓ System #1 Approved for q bedrooms % ; .1evWri i2.Ponnane:•" System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: CE -6149 i! ttitote- Skhm\ (oFAN ot- C}1eU.�iS+ v ON-SITE ., By: /Lie7/�rr WATER AND WASTEWATER V PROGRAM J/offfi))MIIf`.0\. Original Certificate Date: II/ Y//7 -- The Municipality of Ancfj6fage Development 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. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA blue sheet <, _, c Nitrate Advisory Arsenic Advisory Other 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: Hundred Hills BIk3 Lt1 A. WELL DATA Well type Private Date completed 8/91 Total depth 160 ft . Date of test Static water level Well production If A, B, or C provide PWSID # Sanitary seal (Y/N) Y Cased to 140 ft FROM WELL LOG 8/91 25 ft. 3 g.p.m. WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Arsenic ND ug/L Nitrate 4.51 mg/L Date of sample: 10/12/12 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Fiberglass Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) Date of pumping 9/13/12 C. ABSORPTION FIELD DATA Date installed 6/20/78 Length 38 ft. Depression over tank (Y/N) N Pumper JRs Pumping Soil rating Parcel ID: 078-181-03 Well Log (Y/N) Y Wires properly protected (Y/N) Casing height (above ground) 16 in. AT INSPECTION 10/15/12 23 1.5 g.p.m. ft. Collected by: PES Date installed 6/20/78 Cleanouts (Y/N) Y High water alarm (Y/N) NA (g.p.d./ft2 or ftz/bdrm) 85 sf/bd Width 4 Total depth 11 ft. Eff. absorption area 380 ft2 Date of adequacy test 10/15/12 Fluid depth in absorption field before test Elapsed Time: 1440 min. 0 System type Trench ft. Gravel below pipe 5 ft. Monitoring tube Y Depression over field N For 4 bedrooms New depth 0 in. Absorption rate >= 600+ If yes, give date Results (Pass/Fail) Pass in. Final fluid depth 0 Water added 600 gal. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N in. g.p.d. D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off' level at Datum Cycles tested Manhole/Access (Y/N) in. High water alarm level at in. Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 100+ SEPTIC/HOLDING TANI< ON LOT TO: Building foundation 5+ Water main 10+ 100+ Wells on adjacent lots On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ Property line 5+ Water service line 10+ Absorption field 5+ Surface water 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS Driveway, parking/vehicle storage 10+ G. ENGINEER'S CERTIFICATION 1 certify that / 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 Name Steven R Pannone Date COSA brown sheet 10-10-12.doc /2115 q t! • even )2,. . # 4p. CE -8149 ,. j I�gtq�ttl�' ,•: Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING cx7t,1 Parcel I.D. Ens- 18I-05 COSA# bgo3a3 1. Expiration Date: GENERAL INFORMATION Complete legal description Lot 1; Bock 3; Hundred Hills Subdivision Location (site address) 1046 Hiland Rd. Eagle River, AK 99577 Current Property owner(s) 0ag & Raley Ottosen Mailing address same Day phone 6221414 Lending agency Day phone Mailing address Real Estate Agent Eva token Day phone 689-6476 Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: ❑ Individual On-site 2 ❑ Individual Holding Tank ❑ ❑ Community On-site 0 ❑ 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 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. 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 Firm S & S Engineering Address 15861 S. Brchwood Lop Ch iak, 567 Engineer's Printed Name P�� - 5. DSD SIGNATURE J� 4 -Approved for "7 bedrooms. Disapproved. Conditional approval for Phone 694-2979 Date ie/ae r • �-.. ,tig1 A. Shaft- • }fid 1457.6 jn n tr • Na. bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev 11p51 Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore 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: / e'T ! i Belt S; gown gas9, Parcel ID: D7 - 191- 03 A. WELL DATA Well type -► /21M -TE Date completed $/ni Total depth d iso ' ft. If A, 8, or C provide PWSID # Sanitary seeN) Cased to /140t� ft. FROM WELL LOG Date of test be99 Static water level c9GG' ft. Well production WATER SAMPLE RESULTS: 3, g.p.m. Well Logrt) 'I PS Wires properly protecte Casing height (above ground) 1Z'l+ in. AT INSPECTION ori l ft (n8 c2 ' ft. /-6 g.p.m. Coliform 0 colonies/100 mL Nitrate mg/L Other bacteria 0 colonies/100 mL ni" Arsenic: MID ug/L date of sample: re Collected by: S4 -S /axe//(. B. SEPTIC/IJOLDIP4O TANK DATA Tank Type/Material Scrnc/ Ft&E/261fiSS Date installed S- /iZeirS Tank size 19S0 gal. • Number of Compartments ,2 CleanoutsON) YL5 Foundation cleano ) `firs Depression over tank (Y/N) _ High water alariT&N) /V/%t Date of pumping lb _q Pumper Sn&,r010/jrnptca-S C. ABSORPTION FIELD DATA Date installed S/lt3/%S Soil rating (g.p.d./ft2 o€2/bdrrr es r Length 3to ft. Width 4' ft. System type / cr&tK Gravel below pipe CO' ft. Total depth.bi, ft. Eff. absorption area 3t0 ft2 Monitoring tube '/r9 Depression over field Date of adequacy test q/g/08 Result Fail) eP S For 4 bedrooms it �� Fluid depth in absorption field before test 0 in. Water addedj� e gal. New depth in. Elapsed Time: i___ min. Final fluid depth 2P in.q1 Absorption rate >= f40+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y(t type) NO If yes, give date D. LIFT STATION k.)11V Date installed Size in gallons "Pump on" level at _ in. • • evel at _ Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Iq� l+ Septic tank/lift station on lot Absorption field on lot 14" Public sewer main /vl Pr Sewer /septic service line Animal containment areas &61+ co it in. High water alarm level at Meets alarm & circuit requirements? On adjacent Tots On adjacent lots in. Public sewer manhole/cleanout /3/A. Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/1461441G TANK ON LOT TO: r Building foundation 6 -f- Water main DO a - r Property line 5 'r Absorption field 5 Water service line /0 r+ Surface water /00 f r Wells on adjacent lots ,CO 't SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1 1÷ Building foundation, /1) rf Water main /00 1-t Water Service line 1014- Surface water Curtain drain /JCL% 141./0,0) Wells on adjacent lots / OO + F. COMMENTS Driveway, parking/vehicle storage /614 SO G. ENGINEER'S CERTIFICATION 1 certify that 1 have determine review of Municipal records hat conformance with MOA COSA Engineer's Printed Name Date ugh field inspections and above syin es ' eff,Pctfonlhis te. vw% r; F A t. ^'i to ; % * a '11.91" t ....• •e • snots• e •�'r j. ,_�i57A •••"•i va/Og VigAg COSA Fee $ 4130" Date of Payment qMOS Receipt Number (Rev. 11/05) %551 Waiver Fee $ Date of Payment Receipt Number SGS SCS ReLN Client Name Project Name/N Client Sample ID Slalris PN SID 1084681001 S 8 S Engineering LI,I33, I lundred hills 1.1,133, I lundred hills Drinking Water 0 - I'RF.LIMINARY- Printed Date/Time Collected Date/Time Kruk ed Date/Time Technical Director 09/18.2008 10:20 09/03/2008 14:45 09/03/2008 15:50 Stephen C. Ede Sample Remarks: Parameter Results PQL Uniu Method Allowable Prep Analysis Container ID Limits Date Date (nit Metals by ICP/MS Arsenic Waters Department ND Total Nitratc/Nitritc-N ND Microbiology Laboratory Colony Count Total Coliform Fecal Coliform 0 0 0 5.00 ug/L EP200.8 C (<10) 09/08.'08 09/17/08 NRB 0.100 mg/L Sh120 4500NO3-I' 13 (<10) col/100mL S\120 922213 co1/100mL SN,120 922213 col/I00mL SM20922213 A A A (<200) (<1) (<1) 09/11/08 JDZ 09/03/08 KAR 09/03/08 KAR 09/03/08 KAR I HEREBY CERTIFY THAT 1 HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: A'a4'eirtzc , .e,r.,rliie,CcTedr= AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE PLA7 UNDER NO CIRCUMSTANCES SSHOULD LD ANY DATA HFOR CONS OF FENCE LINES,�OR FOBE USRE TABLIISHING BUCTIOOUNDN LINES. SEWARD & SCALE: , , /'-deo DATE: ��"*Xoz GRID: Sw,ACO FB: 9l -as DRAWN: ASSOCIATES LAND SURVEYING 694 -ON; n bvasr�w OF...... b i `^• 4.9'" j\ ; t I . c:.. vc. Tot '••*4 : IS 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.clanchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 078-181-03 1. GENERAL INFORMATION HAA» ut, Expiration Date: =1/ ' /c Complete legal description HUNDRED HILLS SUBDIVISION: LOT 1. BLOCK 3. Location (site address or directions) Current Property cwner(s) Mailing adcress Lending agency Mailing address Real Estate Agent Mailing address 1046 HILAND ROAD • EAGLE RIVER. AK 99577 SHARRON & FRAN WALCUTT Day phone 694-2555 Day phcne EVA LOKEN w/ PRUDENTIAL VISTA Day phone 689-6476 16635 CENTERFIELD DRIVE • EAGLE RIVER, AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Weil Individual `Nater Storage Community Class Well Public Water System fl ❑ HOUSE IS 3 BEDROOMS TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewero a ❑ ❑ 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 cr omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 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 cf Firm ALASKA WATER & WASTEWATER CONSULTANTS. INC. Address 6901 DEBARR RCAD, SUITE 29 • ANCHORAGE. AK 9990A Engineer's Printed Name JEFFREY A. GARNE_S. F.E. Engineers Comments: In conducting this evaluation. AKVN✓C. Inc. attempted to prcvice a thorough. conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test. and separation distances measured to readily identifiacle features. The operational life ci all wefts and septic systems depend cn the local soils condition, grouncwarer levels that may fluctuate during the year, and the water usage of the family being servec by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance c/ the system, ncr do they guarantee that there are no hidden defects or encroachments. AK•vW✓C. Inc. can therefore not provide any warranty or future estimate of how Icng the system will continue to meet the operational requirements cf the ADEC cr MCA CSD. The content of this report is fcr the scie benefit of the owner fisted above. Any reliance upon or use of this report by any other person or party is nct authorized. ncr will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval fcr bedrooms, with the flowing stipulations:. • Phone 337-6179 Date O;�. .:Lg�T_/lit yz), '4^t Q'• etfrC;� A795_. 79rss �O •.I .,mac JVf es Attachments: HAA Checklist Septic System Advisory Well Flow Advisory By: iRov. Iron \./ Manitenance Agreements Supplemental Engineers Reort Other Original Certificate Date: Legal Description: A. WELL DATA Welt type PRIVATE If A, B, or C provide PWSID# N/A, Date completed 8/1991 Sanitary seal (Y/N) YES Total depth 160 ft. Cased to 140 ft FROM WELL LOG AT INSPECTION Date of test 8/1991 7/1 /2002 Static water level 25 ft 41 ft Well production 3 g p m 1.23 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. Nitrate 1.13 mg./L. Other bacteria 0 colonies/100 ml. Arsenic: 0.0024 mg JL Date of sample: 7/15/2002 Collected by: 1/20/2003 B. SEPTIC/HOLDING TANK DATA Tank Type/Material FIBERGLASS Date installed 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.cLanchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST HUNDRED HILLS SUBDIVISION; LOT 1. BLOCK 3. Parcel ID: 078-181-03 Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in Tank size 1250 gal. AKWWC, INC. 5/28/78 Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 7/14/2002 C. ABSORPTION FIELD DATA Date installed 5/28/78 Soil rating (g.p.d./fl'or(t Ibdr.rp) 85 System type TRENCH Length 38 ft Width 4 ft Gravel below pipe Total depth 8+ ft. Eff. absorption area 380 ft2 Monitoring tube YES Pumper JR'S PUMPING •DELDw EXISTING GRADE Date of adequacy test 7/1/2002 Results (Pass/Fail) PASS Fluid depth In absorption field before test 0 in. Water added 607 gal. 5 ft Depression over field NO For 4bedrooms New depth 12 in. Elapsed Time- 110 min. Final fluid depth 2 In Absorption rate >= 600+ g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN 1f yes, give date — D. LIFT STATION Date installed Size In gallons "Pump on" level at in "Pump off" Datu E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent Tots Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer/septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation N/A Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent Tots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Manhole/A _m High water alarm level at in. Cycles tested Meets alarm & circuit requirements? 100'+ Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 101+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Na e Date 1fn/03. JEFFREY A. GARNESS HAA Fee $ 50. — ZIAsN !I Date of Payment Receipt Number (Rev. 12/01) 1-22- 03 30421 Waiver Fee $ Date of Payment Receipt Number 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. 079-181-03 HAA# 1. GENERAL INFORMATION n,V)zf/c)7 Expiration Date: 1 .2 — / g — 0 2 Complete legal description HUNDRED HILLS SUBDWISION; LOT 1, BLOCK 3, Location (site address or directions) 1046 HILAND ROAD * EAGLE RIVER, AK 99577 Current Property owner(s) SHARRON & FRAN WALCOTT Mailing address Lending agency Mailing address Real Estate Agent Mailing address Day phone 694-2555 Day phone EVA LOKEN w/ PRUDENTIAL VISTA Day phone 689-6476 16635 CENTERF ELD DRIVE • EAGLE RIVER, AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 0 0 HOUSE 15 3 BEDROOMS 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 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. 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 seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 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 Firm ALASKA WATER & WASTEWATER CONSULTANTS. INC. Phone 337-6179 Address 6901 DEBARR ROAD, SUITE 28 • ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's 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 DSO Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. 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 or parry is not authorized, nor will it confer any legal right whatsoever. Date /651- 5. DSD SIGNATURE r Approved for 4' bedrooms. Disapproved. Conditional approval for bedrooms, with the Mowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory By: ty t"SYfOF q f er. • ON-SITE •.o t : WATFR AND • nil WASTEWATER : PROGRAM :,(( Manitenance Agreements ��en/�NTSEv` �5\\\ Iti Supplemental Engineer's Reort Other (Rev. 12101) Original Certificate Date: q — IS 0 Legal Description: A. WELL DATA 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 HEALTH AUTHORITY APPROVAL CHECKLIST HUNDRED HILLS SUBDIVISION; LOT 1, BLOCK 3, Parcel ID: 078-181-03 Well type PRNATE If A, B, or C provide PWSID# N/A Date completed 8/1991 Sanitary seal (Y/N) YES Well Log (Y/N) YES Wires properly protected (YIN) YES Total depth 180 ft. Cased to 140 ft Casing height (above ground) 12+ in FROM WELL LOG AT INSPECTION Date of test 8/1991 7/1/2002 Static water level 25 ft. 41 j ft, Well production 3 9 P m 1.23 ' g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 1.13 mg./L. Other bacteria ' 0 colonies/100 ml. Arsenic: 0.0021(mg /L Date of sample' 7/15/2002 Collected by" AKWWC, INC. B. SEPTIC/HOLDING TANK DMA Tank Type/Material FIBERGLASS Date installed 5/28/78 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO ; . High water alarm (Y/N) N/A Date of pumping 7/14/2002 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA Date installed 5/28/78 Soil rating (g.p.d./ft'orbdnn 85 1 System type TRENCH Length 38 ft. Width 4 ft Gravel below pipe 5 ft. Total depth 8+ ft. Eff. absorption area 380 ft' Monitoring tube YES Depression over field NO Date of adequacy test 7/1/2002 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test U In. Water added607 gal New depth 112 in. Elapsed Time: 10 min. Final fluid depth E In. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN 8 type) NONE KNOWN If yes, give date — PBELOW EXISTING GRADE D. LIFT STATION Date installed Size in gallons Manhole/A "Pump on" level at in "Pump off' - _in High water alarm level at in Datu Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main 100'+ 100'+ N/A Sewer /septic service line 25'4- SEPARATION 5'+ SEPARATION DISTANCES FROM S On adjacent lots On adjacent lots 100'+ 100'+ Public sewer manhole/cleanout Holding tank HOLDING TANK ON LOT TO: N/A N/A l Building foundation ThAk.5 t " o"arty line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 1 OO'+ Wells on adjacent Tots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A P Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 1 O'+ Curtain drain NONE KNOWN F. COMMENTS G. ENGINEER'S CERTIFICATION Wells on adjacent Tots 100'+ I certify that 1 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 PrintedName Date �/Ir 0a JEFFREY A. GARNESS ss. —7953 (sic, 0� 0 r f 0'011 de �OO000� . HAA Fee $ 375• — Date of Payment 9/i', if('b2- Receipt Number I g (Rev. 12'01) Waiver Fee $ Date of Payment Receipt Number