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EAGLEBROOK BLK 2 LT 2
Eaglebrook Block 2 Lot 2 #017-121-19 Municipality of Anchorage On-Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP251146 PID Number: 017-121-90 Dwelling: RN Single Family (SF) R with ADU R Duplex (D) 0 Two Single Family Project: R New OR Upgrade Name PAUL MARTZALL A ORPTION FIELD ERID Tr Trench El Wide Trench R Bed E;; ound Site Address 6400 ANDOVER CIRCLE, ANCHORAGE, AK Other Z' Phone Number of Bedrooms Soil Rating depth original grade 907-671-1956 4 ITotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original de Gravel depth beneath pipe Ft. Subdivision Block Lot EAGLEBROOK 2 2 Fill added above original gr of G I length Ft. Ft. Township Range Section Gravel width �� Ft. Beds: Number of Lines Di between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total gKorption area Number of trenches Dist. between'tvches From Tank Field Tank Line Ft' Well 100'+ EXIST. 100'+ - 25'+ TANK A Septic El S.T.E.P. El Holding El Other Manufacturer D&S CONCRETE Capacity 1500 Gal. Surface Water 100'+ EXIST. 100'+ - Material Number of compartments Lot Line 5+ EXIST. 5'+ - NA CONCRETE 2 Foundation 10'+ EXIST 10'+ - LIFT STATION Capacity IManufacturer Remarks D&S CONCRETE -500 (FOR 2ND COMP.) Gal, Alarm location INDOOR Electrical installed by Installer PIPE MATERIAL House to tank D3034 Tank to D1785 drainfield ARM SEPTIC SERVICES Drainfield EXIST. CO/MT D3034 Inspector GARNESS ENGINEERING GROUP, LTD. BENCH MARK (Assumed elevation) 100.00 ft Inspection is, 6/23/2025 Location and description dates: 2nd 3rd 4,h BOTTOM OF CORNER TRIM AT POINT "A" ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date .... ............ Septic System Jeffrey A. Garness.' Approved Date 7S653 pop 0, 4,-7 ev ....... Note tlis approval does not include well permit requirements. I#AE -cam (Rev 05102118) PARCEL OSP251146 RECORD DRAWING_ 017-121-90 APPROXIMATE -,-- 017-121-90 .-- \ APPROXIMATE LOCATION OF ROAD / " DITCH THAT MAY SEASONALLY // APPROXIMATE 100' CARRY SURFACE WATER. // SETBACK TO DITCHLINE \ ACROSS ANDOVER CIRCLE / \ +' EXISTING PRESSURIZED r BED DRAINFIELD. PER THE��-_- \ CONTRACTOR, ALL FOUR -- I r MONITORING TUBES WERE.- �� 1 �,:•. EXCAVATED AND MADE I • :.: SURE THEY ARE INSTALLED r T3• TO THE PROPER DEPTH \ AND ADDITIONAL COVER AND TOPSOIL ADDED TO , i I THE NORTH HALF OF THE i S BED AND THEN SEEDED. S T1 _ NEW �` : • �.. 1500 -GALLON X CONCRETE STEP TANK / � •� .• •MH2 / MH1 / NOTE: PER THE CONTRACTOR, THE y : •: " OLD STEEL STEP TANK WAS ` 9 i •, .' a•, r y . •� " // DECOMMISSIONED IN PLACE PER UPC. fi,t :., • Y• '•iS •'.•:. .... % FCO N ` «• -B, / �` to \ .�, . , .... •: A 'oO�L C R� A EXISTING /GS ` 4 -BEDROOM ` HOUSE i A B C `� I � I MH1 30.8 36.8 71.2 ` I MH2 39.5 43.8 75.8 1 I NOTE: PIPE LOCATIONS ARE �1 ` ISHOWN PER PER GEG SHOTS ` ��- TAKEN WITH LEICA DISTO `� I S910 LASER DISTANCE I METER. SWING -TIES TO \ \\EMVNl HOUSE CORNERS WERE ` \ -SCREENING SCALE: GENERATED IN AUTOCAD. -�- 'S0' S a TYPE OF WORK: RECORD DRAWING OF STEP TANK UPGRADE DATE: LICENSE - 7/2/2025 #AECC884 Al #ey A. -Garness ,Jw ff CE -7953 -*A S .••� AV ii pROFESS��� �� rrrr»r�•�� ENGINEERING,, SALES CONSULTING ' r 0 3701 E. TUDOR ROAD, SUITE 101 ANCHORAGE, ALASKAPHONE (907) 337-6179' WEBSITE www.gamessengineedng.com •• W-1 b••• .+�• PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 1/ I fn PAUL MARTZALL 907-671-1956 2 OF 3 Ojc�.l,i•• PROJECTILEGAL DESCRIPTION: DRAWN BY: I��,f,••. EAGLEBROOK; BLOCK 2, LOT 2 J.L.M. 1�FQ TYPE OF WORK: RECORD DRAWING OF STEP TANK UPGRADE DATE: LICENSE - 7/2/2025 #AECC884 Al #ey A. -Garness ,Jw ff CE -7953 -*A S .••� AV ii pROFESS��� �� rrrr»r�•�� PERMIT NUMBER:p PARCEL ID NUMBER: OSP251146 RECORD DRAWING 017-121-90 TOP OF TANK @ INLET = 90.34- INVERT OF INLET PIPE = 89.36 TOP OF MH1%FINAL GRADE LID = 96.28 / = 95.50-95.93 HIGH LEVEL FLOAT- - — — — — — — — — — — — PUMP ON FLOAT - PUMP OFF FLOAT - 1500 -GALLON TWO-COMPARTMENT D&S CONCRETE TANK (RATED FOR 10' BURIAL) PROPOSED PUMP TANK FLOAT SETTINGS D & S CONCRETE TANK 1500 VOLUME AT INLET INVERT '1625 GALLONS MIN, OPERATING VOLUME '1250 GALLONS INLET INVERT 45" HIGH LEVEL FLOAT 38.5" PUMP ON FLOAT 3T' PUMP OFF FLOAT 6" FLOAT LEVELS ARE FROM BOTTOM OF TANK. NOTE: MEASUREMENTS ARE WHERE THE FLOAT WIRE ATTACHES TO PIPING WITH A 3.5 INCH TETHER FROM PIPING TO FLOAT. ALL FLOATS MUST BE NARROW ANGLE FLOATS. TOP OF MH2 LID = 95.86 TOP OF TANK @ OUTLET = 90.26 WEEP HOLE LITTLE GIANT HIGH HEAD WE SERIES PUMP (MODEL 20-WE20) IN SIM/TECH PLEATED NO VAULT FILTER -PER CONTRACTOR, PUMP PLACED ON CINDER BLOCKS '+t®aaaq® • OF ®°®o ... ...., ®�P•..••'' rr Ar ' • ®®, GARNESS ENGINEERING GROUP, Ltd ®.....:..... .......................:.....,, ENGINEERING SALES CONSULTING 3701E TUDOR ROAD, SUITE 101 -ANCHORAGE, ALASKA' PHONE (907) 337-6179' WEBSITE: w ..gam ssengmeedng.com.• •............ .............10 .. PREPARED FOR: PHONE NUMBER: PAGE NUMBER: O� •'ffrey mess•► PAUL MARTZALL 907-671-1956 3 OF 3 �# J, : CE -7753 PROJECT/LEGAL DESCRIPTION: DRAWN BY: ® '•,.'1�,�..••+�* EAGLEBROOK; BLOCK 2, LOT 2 J.L.M. r®to"P�, t®® TYPE OF WORK: DATE: 441, � ;SS\St O♦ TA TA RECORD DRAWING OF STEP TANK UPGRADE 7/1/2025 #AE LICC88s®i 4 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 hftp://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP251146 Work Type: SepticTank Upgrade Tax Code Number: 01712119000 Site Legal Address: EAGLEBROOK BLK 2 LT 2 G:3138 Site Mailing Address: 6400 ANDOVER CIR, Anchorage Owner: MARTZALL PAUL CHARLES 50% & Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: 5/16/2025 5/16/2026 54466 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: �t S�"/� Issued By: Date: Date: Z ! 6 2 c 2 4 ON -SITE SEPTIC/WELL PERMIT APPLICATION Parcel 1, D, 0 17-121 -19 Property owner(s) PAUL MARTZALL Day phone 907-671-1956 Mailing address 6400 ANDOVER CIRCLE, ANCHORAGE, AK Site address 6400 ANDOVER CIRCLE, ANCHORAGE, AK Legal description EAGLEBROOK; BLOCK 2, LOT 2 Number of Bedrooms 4 Engineering Firm GARNESS ENGINEERING GROUP, LTD Building Permit Number Not Applicable X APPLICATION IS FOR: APPLICATION IS AN: (Z all that apply) Absorption Field 0 Initial ❑ Septic Tank Upgrade Holding Tank ❑ Renewal ❑ Privy D Well EJ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Permit/Rush Fees: �i ajcoc, Date of Payment: 51)1-12 Permit No. CS0511WJ Waiver Fees: Date of Payment: Waiver No. Distance: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251146, Curtis Townsend, 05/16/25 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251146, Curtis Townsend, 05/16/25 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251146, Curtis Townsend, 05/16/25 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251146, Curtis Townsend, 05/16/25 RC RG _/ „ nlfl �- of q j A%%, 49 TH* S 'ws Ilat'l— SHANE A. HOLT e LS-6914 0` 4a o fessiona\ \-2Pa THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN TH05E APPEARING ON THE RECORD PLAT, ARE NOT SHOWN HEREON ( UNLE55INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. AS -BUILT SURVEY 1" = 30' Nofop BfT MYgY THAT I HAVE PERFORMED A SURVEY LOT 2, BLOCK 2, EAGLEBROOK SUB. ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS _8TH DAY OF _MARCH 2012. HOLT LAND SURVEYING 600 HIGHVIEW DRIVE ANCHORAGE,AK 99515 345-5513 11817, FB 150-6 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: ________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. F_ l Municipality of Anchorage Page 0f DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 a Telephone: 343-4744 On - Site Wastewater Disposal System and/®r Well Inspection Report Permit Number: PID Number: Name"s�u pgrade 12, Wastewater System: 1.1 Now Addre6ss: 4,ol ABSORPTION FIELD Phone: No of Bedrooms :5 71 Deep Trench 1-1 Shallow Trench El BedM ound 11 Other LEGAL DESCRIPTION Soil Hating: C,5101_rlt 7WIV Total Depth from original grade B :7GPD/ Lot: Block: Subdivision 691:vv� Depth to pipe bottom from original graday - Gravel depth beneath pipe L�6 rt e5l Township: Range Section: Fill added above original gl Gravel length: :Z,P �Z Ft. Ft. WELL: Ll New [I Upgrade Gravel widthNumber of lines: Distance betwe? lines 3-0 I— 1 (10' , Ft. Ft. Classification (Private, &B,C) -TV Total Depth: Cased To: Total absorption area. Pipe material: Ve A? i r VAI e��16 Ft Ft. 1640 SQ. Ft. 74577"1 P 3 e 3!!�� Driller. Date Drilled Static Water Level. Installer.stall i2 �O IPJ Lq � I Yield: Pump Set at d TANK SEPARATION DISTANCES El Septic El Holding 4_6 T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer _MA14 Capacity in gallons: /S From Tank Field Station Tank Sewer Lines -4V Well® — /+( Sp ® ® Material Number of Compartments: Surfac LIFT STATION Watere LotManufacturer: Line Foundation /Q3 1"Pump on" level at. Pump off' level at High water alarm at: Curtain Lo 1 �10 A-- mpllra�le & Model Electrical Inspections performed by: > Drain Remarks: BENCH MARK Location and Description: Assumed Flevation. F1 E S S ENGINEERING 17034 Eagle River Loop Road# 7&/ 4wk -No Inspections performed by: - ._Ms:1st_2_ agits River, Alask® M77 Eagle 2nd e Iq --;5 0 A. Department of Heal nd Hurn1jervices aper Reviewed and approved by: Date 72-013 (Rev. 9/91) MOA 25 P Municipality of Anchorage DEPARTMENT OF HEALTH y1,, .4 D HUMAN a tRt ENVIRONMENTAL DIVISION P.O. Box 196650 @ Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On -Site Wastewater Disposal System and/orWell InspectionReport Legal Description: EAGLEBROOK SUBDIVISION, BLOCK 2, LOT 2 PID No 01712119 CO1 CO MT1 MT2 FDML DRME FINAL GRADE 95.2' 97' HH e° uasuuTTDn �_ s BAI�RIE FILTER FABRIC E IMPRR1 MBU HARK= 0 0 90.2FNEW0 GAL 90' 92.7'z SAND FILTER 902'922' E.P.TEM A 83.7 WATER FOUND 5/21/93 N.T.S. I FCO COI MH D 12.0 47.4 _ 57.3 1010115 132.0 14g 0 125.0 -------------------------t- 10' UTIL. ESM 4 BDRM MH A T142WELL L Inn, W T r a ATn1TTs SCALE i" - 40' /2-013 A (Rev. 9/91) MOA 25 DRIVE 29'I MT A MT IT 11 T ' L-O MM o 100' E u;. FRES 'URI , DIST AU BED F„ XF 44 r a XI A y :i'" INSPECTION REPORT MUNICIPALITY OF ANCHORAGE, BUILDING SAFETY DIVISION 3500 EAST TUDOR ROAl'.1 INSPECTlo'��NS (907)563-34G4 INFORMATION (907)78G-8211 NAME: SPARRORS ELECT PERMIT 93-7800 ADDRESS: 6300 ENbOVER DR PHONE 345-6467 LOT: 2 BbOCK: 2 SURD: EAGLEBROOK DATE: 7/14/1993 COMMENT! LIFT STATION ------------------------------------- --------------------------------------- TYPE OF INSPECTION: ELECTRICAL ROUGH 0 0 0 0 -------------------------------------------------------------------------------- c NO NONCOMPLIANCE OBSERVED I I CORRECTIONS ESSENTIAL AS EXPLAINED BELOW I I WILL REEXAMINE AT NEXT INSPECTION C 3 DO NOT CONCEAL UNTIL REINSPECTED -------------------------------------------------------------------------------- COMMENTS: INSPECTOR: DATE ------------------------- MADE, PLEASE CALL FOR INSPECTION DO NOT REMOVE THIS NOTICE PAGE 1 OF 1 MUN I C I PAL I TY OF ANCHORAGE /0 ..)6 l -� DEPARTMENT OF HEALTH AND HUMAN SERVICES /O ; rl_)o s/r) P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930140 DATE ISSUED: 6/03/93 DESIGN ENGINEERS & S ENGINEERING EXPIRATION DATE: 6/03/94 OWNER NAME:BAKER ROBERT B & OWNER ADDRESS:6401 RABBIT CREEK RD ANCHORAGE, ALASKA 99501 PARCEL ID:01712119 LEGAL DESCRIPTION: EAGLEBROOK BLK 2 LT 2 LOT SIZE: 54466 (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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: DATE: r ISSUED BY: a z` r DATE: G' - ` 3 1� > IN May 21, 1993 HEALTH AUTHORITY unicipality of Anchorage APPROVALS EPARTMENT OF HEALTH AND HUMAN SERVICES 25 L Street P.O. Box 196650 nchorage, Alaska 99519-6650 SEWER & WATER MAIN EXTENSIONS Eaglebrook Subdivision, Block 2, Lot 2 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-29/9 FAX 694-1211 SEWER & WATER INSPECTION equest you issue a permit to upgrade the septic system erving the four bedroom house on the referenced property. he existing system is currently in a state of failure and is in groundwater. ENGINEERING STUDIES AND REPORTS wo test holes were excavated and percolation tests performed. he approximate test hole locations are shown on the site WELLINSPE.CTION &FLOW TEST Re do not anticipate any adverse effects on the neighboring properties by the installation of the proposed septic upgrade. f you have any questions, or require any additional SITE PLANS information for your review, please contact us. Sin # erely, q ROAD DESIGN /I m/in C s me(s-��P,�W�ieer ivi na eer SOIL TFST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSALSYSTEM DESIGN Shafer, P.E. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 m EAGLE RIVER, ALASKA 99577 1" = 40' 1 UPGRADE SCALE RABBIT GREEK ROAD RN m ANDOVER DRIVE STREAM VACANT �-/VACANT- A N ri F— m N.T.S. SCALE I iq 0 x DETAIL/PROFILE .R 5 Y I 04 6') Un "D ® O Z 0 m D D r- � o D ®rte cn N Q m W -M �✓ ® rrl 0 n Z p D (r ;u ® M ® tA - C) C) o [ ^ D ^� �! r AN (ENGINEER'S SEAL) ® Municipality ®t Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG ®PERCOLATION TESTsar� 1a fii PERFORMED FOR: O_ K4--u�- DATE PERFOR ED LEGAL DESCRIPTION: L-.Okj g,�( A(rLE( r_ SID Township, Range, Section: bEPTH SLOPE SITE PLAN FEET) p ®� 2 1 SAk r St L%y 50't.® tau) N 3 of 6 64A) W51 L CrRAar�C. ��L� stL� b 5 �• ,.� � [ MINIy� ® a 6- 7 7 8 to 9 10-.d •� ° 1 1 ® &'o' H 12 13 14 15 16 17 18 19 20 � COMMENTS V1CL>— (2A141-0 (®la SotLS) t1�� WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? s I L 0 P E Depth to Water After Monitoring? --L&— Date: Reading Date Gross Net Depth to Net Time Time Water Drop da --__ i .12 _ _ � Vii- L,. _ —�� �' `� F� W ft7 _.?Z f>�SS7o✓it . PERCOLATION RATE L L (minutes/inch) PERC HOLE DIAMETER �® TEST RUN BETWEEN FT ND __,5-. Fi (� AOO s ® t C/3. PERFORMED E3�yy _ I ffONTHISDAIE CERTIFY THATTHIS TEST WAS PERFORMED IN ACCORDANC'W a X W&� LINESIN FEC. DATE: oglee River® Alaska 99571 72-008 (Rev. 4/85) ® Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 e SOILS LOG — PERCOLATION TEST 0 , PERFORMED FOR: V AKA;(" DATE PERFORMED: LEGAL DESCRIPTION: Lnai I.��i 1.../- &t�EBit(�r- SA/) Township, Range, Section: DEPTH SLOPE SITE PLAN (FEET) 1 ,� � 1� ®�Cr�t'•d N 2 L)W 3 %lam/1p +Lcy !;F. y 4 4 em Wlr,4 CL4-Vrcr y G#AVL Lrs� s 5 6 v 47t�l+ p WHIN/ U irw — w r G V &A4, •L. w/ Lto-w? 7 vU•' a DAY 8 ®^ WFT a®. 9 D� 10 <�,• d °'+o 11 �< 12 ® jaj.0.1k 13 14- 15- 16- 17 4151617 18 19 20 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After o Monitoring? —YES -- S d L 0 P E Dale: Reading FDate Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE _ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ND FT ov" 114 ( N Y SA v® -/(,7m, PERFORMED BY: Eagle River, Alaska 99577 ICERTIFY T -HAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELIN ECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE [--NEW UPGRADE MAI LING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS 3 DISTANCE TO: Well I //.0 Absorption area I loe'14- Dwelling PERMIT NO - - ____ - - -_ - Z CL < UJ to Manufacturer r A&- Material No. of compartments Lic. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth D I S 14/45w. ellm'PERMIT NO. 0—< Manufacturer rer Material Liquid capacity in gallons _j DISTANCETO: Well Foundation Nearest lot line PERMIT NO. E, K10 W L) _j LL z LLJ No. of lines Length of each lire — --------- Total length of lines Trench width 01 inches Distance between lin WA cc _.inches.- -effective-- - — —To -- cc 1-- Top of rile to finish grade C Ifa Material beneath tile ta-I b syrfa ion area 40) C) inches Length Width Depth PERMIT NO. w < I`_ Type of crib Crib diameter Crib depth Total effective absorption area as w Well Building foundation Nearest lot line DISTANCE TO: _j Class EFep—th— Driller Distance PERMIT NO, DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER --- PIPE MATERIALS ja'E '6- J --s—OILTEST RATING / INSTALLER REMARKS Flo ve ra I + APPROVED DATE LEGAL M U 10 IT Kin 1 Ff L. :1 3- Fo::' 19M ED k FR Q C3 Q ' DE�RRTMENT QC HEGLTH AND ENVIRONMENTHL �NQTECTION ' 825 'L/ STREET/ HNCHORHGE/ E``�.IU�-' 17) Vol --- 264~4720 W][MEH 13 MK^3f: IF��1 T' 7, PERMIT NO ( 810869 ) .�/ ��`"� hd;� HPPLICANT R. BRADLEY JORDEN/FT M C P. O, BOX 4~2882/ 99509 248~2590 LQCHTION HND0147 DRIYEE LEC'iFIL LOT EACALEBR�101,,'. �/D LOT SI�� �44�0 S0�HRE F�ET TYPE OF SOIL HBSQRPTIUN SYSTEM IS: TREACH MAXIMUM NUM6ER OF BEDROOMS SOIL RATING 50 THE REQUIRED SIZE OF THE SOIL H3500TIOW SYSTEM IS: r"I" -r- 1�--i 7r' �P,*::,37" 6-4=.= �� `%,, 11 F::" 7" 1-0 — if �, THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR, DRRINFIE�D THE nEPTH OF R TRENCH OR PIT IS THE DISTHNCE BETWEEN THE THE GROUND HND THE BOTTOM OF THE 0XCAYATI QkI (IN FEET). THERE IS NO SET WIDTH FQR TRENCHES. THE GRAVEL DEPTH IS THE DEPTH OF GRHVEL BETWEEN THE 8UTFHLL PIPE AND THE BOTTOM OF THE EXCHYF�TION (IN FEET) Q W oil 1-0 x FR! M Uj� E F)-'. I ". 1 oin 7" M Pop so: OF: ���E�-.-5; ��fit ��Q 14 10.,; PERMIT HPPLICHNT HHS THE IBILITY TO %NFORM THIS 0EPHRTMENT DURING THE IHSTALLWTION INSPECTIQNS OF HNY WELLS HDJHIDENT TO THIS PROPERTY HND THE NUMM OF RESIDENCES THAT THE WELL WILL SEF&FE. ��~ "Ir- RAJ Kit <� Vn 1 F=0 7- 11 v=1 M REV- Q FEE. R_fl 1. IF;7iv. E-.*-_.-��� �— BHCKFILLING OF ANY SYSTEM WITHOUT FINSL INSPECTION HND HPPROV8L BY THIS DEPHRTME��T WILL BE SUBJECT TO PROSECUTION 1,11NIMUM DISTANCE BETWEEN A WULL AND HPJY ON ---SITE 5EWHGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVHTE WELL QR 150 TO 200 FEET F0OM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTHNCE FROM H PRIVHTE W�LL TO H PRIVATE SEN�R LINE IS 25 FEET HND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS HFRE REQUIRED HND BE RETURW�E'D TO THE DEPHRTMENT WITHIN ]0 DHYS OF THE WELL COMPLETIONr OTHER FTEQUIREMENTS MRY AND CONSTRUCTION DIHGRHMS HRE HVHILRBLE TO INSURE. PF:OPER INST9LLHTION �F:::" 1`1 1 1- �X F"" X FT: EET M 10 1", RM�, FE. -E. ii'--U!E..�� E.-i".'� 7] R. I CERTIFY THAT 1: I GM FHMILIHR WITH THE FOR OM~5ITE SEWERS HND WELLS HS SET FORTH BY TF -IE OF RNCHORHGE 2: I WILL INSTALL THE IN HCCOPDANCE 141TH THE �� � �NDERSTHND THAT THE STYSTE.:�l MHY REQUIFTE ENLHRMEMEW IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS | i | ev�J SIGNED..... ..... .. ....... ~... .... ~~��~�~~_�~ HPPLICHNT R. BRHDLEY JORDEN,A�Il. C. INC IMMETC) � �~... ... ... _~~-_DHTE. 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R GARY PLAYER VENTURES CONSULTING GEOLOGIST BOX 476-M, STAR ROUTE A u ANCHORAGE_, ALASKA 99507, PHONE 344-7071 SOILS LOG Performed for I ' Date t �� Location 0 2 4 6 Soil Type Water Level Remarks 16 18 20 Total Depth of Excavation 1Material at Total Depth Groundwater Not Reached Depth, if Reached Classification Method Visual ( ) Sieve Analysis Bedrock Not Reached Depth, if Reached ( :�::p 5a,,4� f ��� Gary F. Player, Consulting Geologist -n -n -fl -n -n -n ,1 m m m m d \ r 0 1 "n "n Ti i9 i1 i9 i9 T9 TI 91 ri -1 -n -n°n �« -n -n "n ®n ;+ -n r+ r+ -n ;+ T \ n. O O 9 9 O 9 O 9 O 9 O 9 O 9 O 9 O 9 O 9 O & -n "n 'n -1 91 i1 mn i1 91 i1 ®n ;+ r+ 00066656665 -n -1 ®n it "n i1 TI ,1 71 T "n W N W M M M w+ wP W r� r0 I • r I a NEW • a NEW 9 A Pe%rt.� �.�r�rs 5. LEGAL ESCRRIIPTION Of w DATE RECEIVgD INSPECTION APPOINTMENTS — dl TIME 6. TYPE OF RESIDENCE — TIME TIME El One " Four El Other SINGLE FAMILY E7 Two ❑ Five p 6 / DATE 7. WATER SUPP DATE DATE INSPECTOR INSPECTOR INSPECTOR since June 1975. For wells drilled prior to that date, give well MUNICIPALITY OF ANCHORAGE' DDIT. OF r -AI IV I & T l {' C>Ti CTIC)N depth (attach log if available.)' DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTINPO�M�h 925 L Street - Anchorage, Alaska 99501' ® NOV 3 n 1981 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS:'Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER PHONE All MAI ING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYS MAILING ADDRESS :. LENDI INSTITUTION /PHONE car �.GrJ�y MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRES SS 5. LEGAL ESCRRIIPTION Of w STREET LOCATION dl st I , 6. TYPE OF RESIDENCE NUMBER BE ROOM El One " Four El Other SINGLE FAMILY E7 Two ❑ Five E7 MULTIPLE FAMILY D Three 0 Six 7. WATER SUPP INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ED COMMUNITY since June 1975. For wells drilled prior to that date, give well ED PUBLIC UTILITY depth (attach log if available.)' B. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. 0 PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN INITIATED. n -oto (Rev. 6i79)n F ® ® % dn'nC,✓ THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ SINGLE FAMILY ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ MULTIPLE FAMILY ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY PERMIT NUMBER ❑ INDIVIDUAL DEPTH OF WELL ❑ COMMUNITY DATE DRILLED ❑ PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY DATE INSTALLED Connection Verified INSTALLER ❑Septic Tank or ❑Holding Tank Size: O If Tank is homemade SOILS RATING give dimensions: TYPE OFTANK MANUFACTURER TOTAL ABSORPTION AREA T - MATERIAL T 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line WELL TO: _ Absorption Area to nearest Lot Line 5. COMMENTS --`APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY C . r I n c . 0. 'I'lox 4-23B2 A n c: I t o r a e r Ts K' C, Lot 2g 2, Ral'.)Dit Creek Dc,,ar fllr,. �F.4alrer, for tho in(lividual suacr cam", watc.�?,- bf,,qranted u9It ij. the,? f 0 1 lowing it(.',ms� I, We i")eu, n coy-",g"9fntcd ra Yhe water allaly.sis report neceis to 1,e g-,t�ubnllittcd to thill ciem 'Gaby 1633 'J, "")tx-c'et, for our C,,q)plication 's.-l-wws the num"Der ok e)nceed's tho, X YlU311000v Lhc� on--sitc� Y'sunm 4' as oriclina-Ily 3 ped f ur. A,n upqnule, uill !)c, il-r-ior to at, upciradc, a Tpexmit nce6s tc� b(. lsr;ued from thir", dops rtmc"rlt. sincerely, MUNICIPALITY OF ANCHORAGE Ame Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Certificate of On -Site Systems Approval OSC251278 Parcel ID 017 -121-19 Expiration Date: 5/7/2025 Legal description EAGLEBROOK BLK 2 LT 2 site address 6400 ANDOVER CIR Current property owner(s) MARTZALL PAUL CHARLES 50% & X The On-site system(s) is/are approved for 4 bedrooms By: Conditional approval for bedrooms, with the following stipulations: Comments or conditions: Original Certificate Date: 7/11/2025 Thi;ertificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject Ws'tem(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Service 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 submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other MUNICIPALITY OF Development Services Department On -Site Water & Wastewater Section Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 017-121-90 Complete legal description EAGLEBROOK; BLOCK 2, LOT 2 Location (site address) 6400 ANDOVER CIRCLE, ANCHORAGE, AK Current property owner(s) PAUL MARTZALL 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 907-671-1956 3. TYPE OF WATER SUPPLY: 0 Private Well serving # dwelling units F1 Other Non-public well as regulated by MOA El Water Storage n Community Well or Public 4. TYPE OF WASTEWATER DISPOSAL: FW Private Septic E] Private Septic serving 2 dwelling units M Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: 1771 Steel E] Plastic 0 Concrete F'-1 Fiberglass Age NEW - See advisory if steel or fiberglass older than 20 years 6. ABSORPTION FIELD: F-1 AWVVTS RE Bed F-1 Deep Trench R Wide Trench R Seepage Pit Waiver request for: Expedited review requested: 0 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 $_ M Waiver Fee $ Date of Payment 7%`4`/25 Date of Payment COSA It 0� 2 5/2-7 Waiver # COSA App4cation_Apr2025.doc Legal Description: EAGLEBROOK; BLOCK 2, LOT 2 Parcel ID: 017-121-90 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 9/14/1981 Total depth 161 ft Cased to LINK ft R Sanitary seal is functioning correctly R Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 5/6/2025 Static water level at beginning of test 12.3 ft. Comments B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NEW ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 2/28/1993 IN ALL standpipes present per record drawing Total measured depth from grade 3.2-3.8 ft (max) Measured depth to pipe invert from grade ft (min) Al N/A — pressurized field. Q Per record drawings, field is insulated. * Q 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) N/A If yes, enter date Well production at time of test 3.8+ qpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes No Q Coliform bacteria is Negative Nitrate— mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by GEG, LTD. Date 5/7/2025 C. LIFT STATION ❑ Required maintenance completed Age of lift station NEW years Lift station material CONCRETE Comments: Adequacy test date 5/6/2025 Results 0 Pass Fluid depth prior to test **0 in Water added 735 gal New fluid depth **0 in Elapsed time 0 min Final fluid depth **0 in Absorption rate 600+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) **6 in Effective depth used **0 in Effective depth remaining **6 in Comments/Deficiencies: `MT1, MT2, & MT3 WERE EXCAVATED DURING TANK INSTALL AND RESET TO 6" BELOW INVERT OF DIST. PIPE. **FOR MT4. MT4 WAS SET AT CORRECT DEPTH AT TIME OF TEST. MT1 WAS DRY PRIOR TO TEST AND THEN HAD —5.5" LIQUID DEPTH (BASED ON ELEVATION SHOTS BELOW INVERT PRIOR TO REPAIRS BEING COMPLETED) AFTER 735 GALLONS WAS ADDED. MT1 WAS DRY AFTER 1198 MINUTE RECOVERY PERIOD. COSA Checklist June 2022 E. SEPARATION DISTANCES From Well on Lot to: (Please enter distances if less than required) Septic Tank/Lift Station on Lot > 100' 2 Yes if No ft Neighboring Tank > 100' Q Yes if No ft Disposal Field on Lot > 100' ❑✓ Yes if No ft Neighboring Disposal Fields > 100' Fv Yes if No ft Sewer Line/Main > 100' Q✓ Yes if No ft Sewer Manhole/Cleanout > 100' Q Yes Q✓ Yes if No ft Sewer Service/Septic Line > 25'Q✓ Yes if No ft Holding Tank > 100' Q✓ Yes if No ft Animal Containment > 50' Q Yes if No ft Manure/Animal Excreta Storage > 100' Q✓ Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Disposal Field(s) on Lot to: (Please enter distances if less than required) Tank to Foundation > 10' Q Yes if No ft Surface Water > 100' Q Yes if No ft Field to Foundation > 10' Q✓ Yes if No ft Wells on Adjacent Lots: Tank to Property Line > 5' Q✓ Yes if No ft Wells > 100' OYes if No ft Field to Property Line > 10' E✓ Yes if No ft Community Wells > 200' [D Yes if No ft Water Main/Service Line > 10' ❑✓ Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *All MT's are 10'+ from lot line. Exact perimeter of drainrock in bed is unknown. 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 Garness Engineering Group, LTD. (GEG) Engineer's Printed Name Jeffrey A. Garness, P.E. In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may Fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. Phone 907-337-6179 Date p I 49TH .. ...... ................ �... .. .. ......... V. ... .. r . Garne s. 0 —795 z,.1; a119� z V40f ••�l.�.to •�� Lit ENSE4QQapr°ressi°° #AECC884 ��ODOodo LEGEND FOUND 5/8" REBAR, NO CAP EDGE OF GRAVEL PAD UTILITY PEDESTAL DECK CONCRETE FENCE LIGHT POLE EDGE OF ASPHALT RECORD DATA PER PLAT #78-158 SEPTIC PIPE WELL SEPTIC TANK LID FOUND 5/8" REBAR, PLASTIC CAP 2 0 .5 ' 4 . 1 ' 9 .8 ' 1 2 . 0 ' 3 8 .5 ' 2 9 . 8 ' 1 4 .2 ' 2 8 . 5 ' 2 0 .9 ' 1 2 . 1 ' 3 3 .7 ' 3 8 . 3 ' RESIDENCE S H E D CONEX 8'x20' TIMBERLINE SURVEYING AND MAPPING 17035 BARONOFF AVE EAGLE RIVER, AK 99577 907-242-5320 ryan@timberlinealaska.com FILE NO.: 25.161 SCALE: 1" = 30 FEET DATE: 7/9/2025 SHEET: 1 of 1 MOA GRID: SW3138 SCALE: 1" = 30 FEET(11"x17") 30'0' 60' AS-BUILT OF: ADDRESS: 6400 ANDOVER CIR, ANCHORAGE, AK LOCATED IN: ANCHORAGE RECORDING DISTRICT LOT 2, BLOCK 2EAGLEBROOK SUBDIVISIONPLAT #78-158 NOTE: MEASURED DISTANCES BETWEEN MONUMENTS FOUND IN EAGLEBROOK SUBD. DIFFER FROM RECORD DIMENSIONS BY UP TO 5 FEET. THE OFFSET DIMENSIONS SHOWN HEREON ARE SUBJECT TO THESE DISCREPANCIES. 6788 Municipality, of Anchorage On-Site Water and Wastewater Program.. AUG ; "- (907) 343-7904 ca Al Certificate of O 7-Site Systems Approval°` s a 9 Sl � L Parcel I.D. 017-121-19 Expiration Date: 1. GENERAL INFORMATION: Complete legal description Eaglebrook; Block 2, Lot 2 - Location (site address) 6400 Andover Circle *Anchorage, AK 99516 Current Property owner(s) Pat Prosser Day phone 229-8502 Mailing address 6400 Andover Circle *Anchorage, AK 99516 Real Estate Agent Day phone '- 2. TYPEOF DWELLING: ® SingleFamily (w/wofADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. 'NUMBER OF BEDROOMS: -4 4. TYPE OF WATER.SUPPLY: TYPE OF WASTEWATER, DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNadance request for. Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA' Fee $ Waiver Fee $ Date of Payment .01 Date'of Payment Receipt Number, (J`(��,5? Receipt- Number COSA #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. 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 (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: 6 fc In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE System #1 Approved for `t bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms ,j� C' _ bedrooms, with the following gpblatOd - e!%, �\, By: Original Certificate Date: The Municipality of Anchorage 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 Septic System Advisory Well Flow Advisory COSA blue sheet— t0.10-12.doc Nitrate Advisory Arsenic Advisory Other f Legal Description: Eaglebrook; Block 2, Lot 2 If more than T septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 9114MIll Total depth 161 ft Cased to Unknown ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 7/17/19 Static water level at beginning of test 16.6 ft Comments B. TANK DATA Age of tank(s) 26 years Tank type/material septirlrieel Measured operating fluid level in septic tank 48 Al Standpipes/foundation cleanout per record drawing Date of pumping 7/19/19 D. ABSORPTION FIELD DATA Which system tested (date installed) 1993 ❑ ALL standpipes present per record drawing Total measured depth from grade 3.79 ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 017-121-19 Structure served by this system Well production at time of test 3.5+ qpm Water storage tank volume n/a gallons Well disinfected for coliform test? ❑ Yes ❑ N ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by GEG, Ltd. Date of Sample 7/29/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station 26 years Lift station material steel Comments: 1 Adequacy test date' '7117119 Results R Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 602 gal New depth 0 in Elapsed time 0 min Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test) Gallons introduced n/a gallons If yes, enter date - Comments/Deficiencies: see March 22, 2016 letter in MOA records COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' F,1 Yes if No Community Sewer Manhole/Cleanout > 100' 0✓ Yes if No ft ❑r Yes if No Neighboring Tank > 100' R Yes if No ft Private Sewer/Septic Line > 25' Yes if No Absorption Field on Lot > 100' E] Yes if No ft Holding Tank > 100' ❑✓ Yes if No Neighboring Absorption Fields > 100' F. ENGINEER'S COMMENTS Animal Containment > 50'✓❑ Yes if No R Yes if No ft Separation distance between water and sewer service lines is unknown. Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft 0 Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *5+ ft Surface Water > 100' ft ft ft ft ft E✓ Yes if No ft Property Line > 5' F,1 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells > 100' Yes if No. Water Main > 10' 0 Yes if No ft Community Wells > 200'✓0 Yes if No. Water Service Line > 10' El Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' Q Yes if No Water Service Line > 10' 0 Yes if No ft Community Wells > 200' Q Yes if No Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS *Met code at time of installation Separation distance between water and sewer service lines is unknown. G. ENGINEER'S CERTIFICATION Q OF 4 1 certify that I have determined through field inspections and reviewOSP... ... 0 of Municipal records that the above systems are in conformance with C-): " T y MOA COSA guidelines in effect on this date. . • f y A:..... ess.* .. 9. CE-79yyrr,��''3 em`s COSA Checklist yellow sheet 4 Pio f e s s'o� o #AECC884 0000�00�� ft ft ft DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite ( + 907-343-7904 Fax: 343-7997 Septic 'Tank Advisory Certificate of On -Site Systems Approval #OSC191378 Subdivision: Eaglebrook BLK 2 Lot 2 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 26 years old. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. z:g s"a ' a �` ����Ma�I��A�di�ess'`P�O�I3oC1�665I��*��Arichislag�,tA1as�Ca�g519��6�50 �rwwmunii�r`� � ��� '' 07/24/2019 04:32 8686770 APLUS PAGE 02 �Q 111�UNIGIP�►LITY OF ANCHORAGE �0 Phone: Fax: 907,3,113.7997 Development Services DeP attme On -Site Water 8, Wastewater Section �Dv Lift Station/Pump Vault CN' Maintenance Log Street Address PID pwner a Phone Legal Desc. Yew{�� Tek: • ,n re wired �Q •p:ufiPing completed A ��-t '•Sludge level inches pump' 9= 4 'Jl • Ic1 • I uftatafam •Effluent filter cleaned -Pump basket cleaned yes _ •Proper float settings; confirmed -Control floats cleaned .Operation satisfactory 0 •Audibld and visual alarm inside dwelling LY_eR.)_nQ -Dedicated electrical alarm circuit (9" o .Alarm system operation -Ground water intrusion at riser to tenk Connection .Weep hole functional el ..n_.q -Ground water intrusion around pipe penetratlons es ; Insulated �. �- Properly Secured -Manhole lid, Functional..' red insP ectivhs and maintenance completed 9,s -All manufacturer requi Techniciar company Date of malntenance_'L� S�)r Parcel I.D. 017-121-19 Municipality of Anchora, On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Eaglebrook; Block 2, Lot 2 Location (site address) 6400 Andover Circle 99516 MAR 2 3. 0T idn Expiration Date: —/IL Current Property owner(s) John W Pickering Day phone 907-830-6362 Mailing address Real Estate Agent Brett Hull 2. TYPE OF DWELLING: © Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: ❑ Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Waiver/Variance request for: N/A Day phone 351-8047 TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ Received by: Date: 26 /;?- Ll 16 COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ J 9 Date of Payment Receipt Number dB�ig�G� COSA# ()DOWN 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 Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Gayness Engineering Group Ltd. (GEG) Phone _(907) 337-6179 Address 3701 E. Tudor Road, Suite 101 Anchorage AK 99507-1259 Engineer's Printed Name Jeffrey A. Garness Date��2 Z�6 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend on a variety of variables including, but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail. The content of this report is for the sole benefit of the person/party who retained GEG. Reliance upon the information provided in this report by any other person or party, including but not limited to subsequent property purchasers, is not authorized. In short, GEG disavows any legal duty to anyone other than the person/party, who paid for this report. Y OF1q 6. DSD SIGNATURE System #1 Approved forbedrooms ON-SITE WATER AND rn System #2 Approved for bedrooms WASTEWATER z' Disapproved � PROGRAM 0= O J� Conditional approval for bedrooms, with the following s%t ations: p4 �PSid�11C�c LIM The Municipality of Anchorage Development Services Certificate Date: 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet-9.1.12.doc 0 If more than 7 septic system is on the lot: COSA Checklist # _of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: EAGLE BROOK; BLOCK 2, LOT 2 Parcel ID: 017-121-19 A. WELL DATA *PER SURROUNDING WELL LOGS Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 9/14/1981 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 161 ft, Cased to *40+ ft, Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 9/14/1981 3/9/2016 Static water level 16 ft. 23 ft, Well production 10 g.p.m. 4.0+ —9.13111m. WATER SAMPLE RESULTS: A 1.zn O Coliform v r colonies/100 mL Nitrate mg:/L. Collected by: QEQ Ltd. Arsenic: AJ Q/L. Date of sample: 3/9/2016 B. SEPTIC/HOLDING TANK DATA TankTypelMaterial SEPTIC/STEEL Date installed 2/26-28/1993 Tank size 1500 gal Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (Y/N) NO High water alarm (Y/N) YES Date of pumping 5/4/2015 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA Date installed 6/28/1993 Soil rating Oipr ft'/bdrm) 0-7 System type, MOUND Length 29 ft. Width 30 ft. Gravel below pipe 0.5 ft. Total depth *2.33+ ft. Eff. absorption area 870 fe Monitoring tube YES Depression over field NO Date of adequacy test 3/9/2016 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test DRY in. Water added 640 gal. New depth DRY in. Elapsed Time: ' 0. min. Final fluid depth DRY in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date — *BELOW EXISTING GRADE - INSULATED PER 1993 INSPECTION REPORT - SEE ATTACHED: LEITER REGARDING SOIL COVER *SECOND COMPARTMENT OF EXISTING 1500 GALLON S.T.E.P. TANK **PER 1993 INSPECTION REPORT D. LIFT STATION Date installed 2/28-28/1993 Size in gallons *500 "Pump on" level at 40 in. Datum BOTTOM OF 'TANK E. SEPARATION DISTANCES "Pump ofr level at 38 in. Manhole/Access (Y/N) YES High water alarm level at 44 ;n, Cycles tested 3 Meets alar & circuit requirementsZ **YES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent tots 100'+ Absorption field on lot 100'+ Public sewer main 75'+ Sewer /septic service line 25'+ Animal containment areas 50'+ On adjacent lots 100'+ Public sewer manhole/cleanout 100'+ Holding tank 75'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 101+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS SEPERATION BETWEEN WATER SERVICE LINE AND SEWER SERVICE LINE IS UNKNOWN. G. ENGINEER'S CERTIFICATION I certify, that l have determined through field inspections and review of Municipal records that the above systems are in corfglmance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date 3 /27, /6 (Rev. 11/05) GARNESS ENGINEERING GROUP Ltd �e .._.. CIVIL & ENVIRONMENTAL ENGINEERS _ � -- of '' March 22, 2016 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Eaglebrook; Block 2, Lot 2 — Soil Cover Over the Drainfield To whom it may concern: The existing drainfield has four (4) monitoring tubes. The monitoring tube depths were inspected and soil cover was calculated. Per the inspection report, 2 inches of insulation was installed over the drainfield. Three of the four monitoring tubes were found to have adequate soil cover (2 feet of soil cover plus 2 inches of insulation) and the fourth monitoring tube only had 1.58 feet of soil cover with an additional 2 inches of insulation. We are requesting that a COSA be issued even though a small portion of the drainfield does not have 2 feet of soil cover. The following are justifications for the variance; For every one inch of insulation one foot of soil cover is achieved. In short, the two inches of insulation theoretically equates to two (2) feet of soil cover. With the additional 1.58 feet of soil cover on top of the insulation the MOA requirement of 3 feet of insulating cover has been achieved. The drainfield has an average soil cover greater than 2 feet. It is only an isolated section (very minimal) that does not have the 2 feet of cover. This condition has likely existed for 23 years. If you have anyAuestions please call me at 337-6179. P.E., M.S. 3701 East Tudor Road, Suite 101 'Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www,garnessengineering.com ((, Municipality of Anchorage • Development Services Department-- Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road 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 r 11 Parcel I.D. 017-121-19 COSA# GS l:-1 ), WD / 1. GENERAL INFORMATION Expiration Date: C' '- / G — /2 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address EAGL_EBROOK; BLOCK 2 LOT 2 6400 ANDOVER CIRCLE *ANCHORAGE, AK 99516 GLENN ELISON Day phone 6400 ANDOVER CIRCLE *ANCHORAGE, AK 99516 Day phone 345-7476 BOB RINK W/ DYNAMIC PROPERTIES Day phone 261-7619 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (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 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. 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & 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. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE _AZ/Approved for --4— bedrooms. Disapproved. Conditional approval for bedrooms, with the following Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Phone 337-6179 Date ?C'1 h Z Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Nitrate Advisory Other By: (Rev. 11/05) ON-Sn > WATER AND WASTEWATER PROGRAM ` Original Certificate Date: 3 eI 6 / )— Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: EAGLEBROOK; BLOCK 2, LOT 2 A. WELL DATA *PER SURROUNDING PROPERTIES Well type PRIVATE If A, B, or C provide PWSID* N/A Date completed 9/14/81 Sanitary seal (Y/N) YES Total depth 161 ft. Cased to *40+ ft. FROM WELL LOG Date of test 9/14/81 Static water level 16 Well production 10 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Arsenic: ND_ug./L. B. SEPTIC/HOLDING TANK DATA Nitrate ND mg./L. Date of sample: 3/1 /12 Parcel ID: 017-121-19 Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 3/1/12 28 ft. 3.14 g.p.m. Collected by: GEG. Ltd Tank Type/Material SEPTIC/STEEL Date installed 2/26-28/93 Tank size 1500 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) YES Date of pumping 5/10/11 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA *BELOW EXISTING GRAD Date installed 2/26-28/93 Soil rating (g.p.ddit or /bdrm 0.7 System type MOUND Length 29 ft. Width 30 ft. Gravel below pipe 0.5 ft. Total depth *3.75 ft. Eff. absorption area 870 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 3/1/12 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 740 gal. New depth 0 in. Elapsed Time: E min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE If yes, give date — Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchomge.ak.us (907) 343-7904 fi CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: EAGLEBROOK; BLOCK 2, LOT 2 A. WELL DATA *PER SURROUNDING PROPERTIES Parcel I D: 017-121-19 Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 9/14/81 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 161 ft. Cased to *40+ ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 9/14/81 3/11/12 Static water level 16 ft, 28 ft. Well production 10 g. p, M. 3.14 g,p.m, WATER SAMPLE RESULTS: Coliform n colonies/100 ml. Nitrate NO mg./L. Collected by: GEG. Ltd. Arsenic: Nn ug./L. Date of sample: 3/1/12 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 2/26-28/93 Tank size 1500 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (Y/N) NO High water alarm (Y/N) YES Date of pumping 5/10/11 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA "BELOW EXISTING GRADE Date installed 2/26-28/93 Soil rating (g.p.d./ftorCbdrm 0.7 System type MOUND Length 29 ft. Width 30 ft. Gravel below pipe 0.5 ft. Total depth *3.75 ft. Eff. absorption area 870 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 3/11/12 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test E in. Water added 740 gal. New depth 0 in. Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE If yes, give date -