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HomeMy WebLinkAboutCHICKADEE SLOPES TR A LT 4Aheckadee
Slopes
Tract A
Lot 4A
#015-231-85
Municipality of Anchorage Page 1 of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: 5 a/ 17by 1 5 1 PID Number: 015 — 0,3 1 — 925
Name:
Wastewater System: O New ❑ Upgrade
Address:
i k
ABSORPTION FIELD
, (.
l
Phone: o. of Be r oms:
Deep Trench [I Shallow Trench ❑Bed El Mound 11 Other
LEGAL DESCRIPTION
Soil Rating:
j• 2
Total Depth fro rjgjnal grade:
GPD/
Lot: Block- Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
�_C r ii/H C 14 1 t! L A p JE k S L s
—13 Ft.
Ft.
Township:
Range:
Section:
Fill added above originalgrade:
Gravel length: _
f Ft.
6 Ft.
WELL: fg/New El Upgrade
Gravel width:
Number of lines:
Distance between lines:
Ft.
Ft.
Classification (Private, A,B,C):
Total Depth:
Cased To:
Total absorption area:
Pipe material:
FP M V%'E rG
D & Ft.
e '_5 Ft.
SC. Ft.
F LY / V
Driller: /� 1 )�
AL -P / h-.
Date Drilled:
-Z
Static Water Level:
If Ft.
Installer:
Date installed:
i1 -��
Yield:
Pump Set��at/:
8F
Casing Height Above Ground:
TANK
GPM
ry�0&14 Ft.
Ft.
SEPARATION DISTANCES
Xseptic ❑ Holding ❑ S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer:_ 1
Capacity in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
AN 1-// % N
0
Well-
J
t.
'
Material:
S %1FC L
Number ofCompa ents:
%Q;2
I,4
Surface
Water
N
� 1�. �
LIFT STATION
Lot
►
/
Size in gallons:
Manufacturer:
Line
Foundation
FJ J
2 •
X/
"Pump on" level at:
"Pump off' level at:
High water alarm at:
CurtainL�
f_
Pump Make & Model
Electrical Inspections performed by:
Drain
0 T-1
BENCH MARK
Remarks:
%
�-0
Location and Description:
�I �!i>cr/ l+td-CX
�yf''�c: t%� !.' �t .Lir[8�at
✓j / 1l3�
162
Assumed Elevation: �y
/0(1 —
Ep►g 9-SF„ALL
Inspections performed by:� Dates: 1st -7/s/
r. a .c.s. •..moi..
Tob` :u+'<' -rd r
CE -2225 .f
Department of HeallM and Human Services approval
8•
Reviewed and approved by: Date:
72-013 (Rev. 9/91) MOA 25
I
I
I
I
I
- - - -- - =
I
I •4;,
SWING TIES: DECK,'�'
I
AB 32 FT
I AC 28 TANK CO
BC 40
AD 44.5
BD 50 DOUBLE CO BENC MARK
A£ 32.5 TRENCH CO
BE 34
AF 76.5 A 8
�- BF 66.5 TRENCH CO
AC 69 BG 60 MT 1250 GAL SEPTIC TANK C
REPLACEMENT TRENCH _ PRIMARY TRENCH
LENGTH 45 FT
DEPTH 9 FT
ROCK DEPTH 6 FT
F
TH 7-1e•9�.
•
..
. q
.........
.
I
AV
9 I
�..49th I
,•�.......... ........... ......�
� TOB EN•SPURKLAND f=
F�j •••..........••••''� �••
•,4111 FESS
•••• •
I I
I I
25 0 25 50 75 100 125 150
SCALE, I' = 50 FT I
I I
I I
I
I
TOBBEN SPURKLAND P.E. CHICKADEE SLOPES LOT 4A SEPTIC SYSTEM AS, BUILT
203 W 15TH. AVENUE DATE: JULY 28, 1996
A N C H. A K. 99501 12200 ROCKRIDGE DRIVE
,_ __. ___ __. _ MIKE BRAIN SHEET: 2/3 GRID: 2739
REPLACEMENT TRENCH
Standard Trenches
2' Wide
45' Long
9' Deep
6,0' Sewer rock
3' Cover
PRIMARY TRENCH
O Moni for
Clean Out
1E 94.0
Mir a Fi 140
6,0 Ft of Septic
Double Clean Outs
/ Foundation Clean out
12+ FT. 0-0- O O
1250 gal Septic tank
Clean Out
WIMIWMAN
BENCH MARK, FIN. FLOOR BASEMENT I
ASSUMED ELEV, 1DD.00 Fr
TOBBEN SPURKLAND P.E. LOT 4A CHICKADEE SLOPES SEPT1C SYSTEM AS BUILT
203 W15th Ave MIKE BRAIN DATE; JULY 28, 1996
Anchorage Ak 99501 SHEET: 3 3 GRID 2739
070_�aic 12200 ROCKRIDGE DRIVE 11
e Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: N (C I—i/4 lE`y
DATE PERFORM t� av J ro
LEGAL DESCRIPTION: LO7A C�Ac.Township, Range, Section:
DEPTH SLOPE SITE PLAN
F E 6F)
k
p
N
2
3 ;
4
5
6 T
7
8-
9 9
r
10 j
11
12
13 Y
m v
14 N
15-
16
5 16
E' J
17
18-
19-
20-
COMMENTS
81920COMMENTS
so"L X
f3c W No ��
WAS GROUND WATERj
ENCOUNTERED? KI
IF YES, AT WHAT
DEPTH?
Depth to Water After
Monitoring? Dale:
■11■11■■11
Reading Date
Pit. k
Gross
Time
Net
Time
Depth -w of
Water
Net
Drop
iS 9tv
30 A
% L
!O
i
2
a
3iZ
3
73
z
—
�
4
3
-7 1/9—
L/
—
+
_
3 16
3 3
2 rl
PERCOLATION RATE tminutes/inch) PERC HOLE DIAMETER
rr / TEST RUN BETWEEN R FT AND 8 J FT
et avL�t� `T j4
PtRFORMED BY: s I rS _ CERTIFY
THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
LOCATION OF WELL
BOROUGH 8U plVl 10 LOT BLOCK
LOCATION/SKETCH:
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURCES
DIVISION OF MINING & WATER MGMT
WATER WELL RECORD
SECTION QTRS
WELL OWNER:
r.
6@CTIOry I TOWN61-1IA I RANOE MERIDIAN
ON DE
El OW
0
DEPTHS MEASURED FROM:Ocising tort ❑ground surface WELL DEPTH:� DATE OF COMPLETION
BOREHOLE DATA; Depth of hole: 49� ft
Dept#i Depth of casing:ft ��l,
Material Type and Color From TO
--'IN A - DEPTH TO STATIC W
N
11
13
RECEIVED
JUL 31 1996
iMunicipal"Y t HI►cnvl
Rot. Health & Hutnan &
CONTRACTOR INFORMATION:
ATER LEVEL:
. S ft below top of casing ❑ ground surface
37 Date:
_ METHOD OF DRILLING: .air rotary O cable tool
❑ other
USE OF WELL: 19 domestic ❑ irrigation ❑ monitory
d 0 public supply ❑ other
CASING STICK• P: ft. Oiam: 0 in. to Wlft
Casing type; in. to �' t
WELL INTAKE OPENING TYPE: ❑ open end © screened
❑ perforated Kopen hole
Depths of openings: � to ft
SCREEN TYPE: Diam: in,
Slot/Mesh Size; Length: ft
GRAVEL PACK TYPE:
Volume used: Depth to top:
GROUT TYPE:_ Volume:
Depth: from ft to ft
DEVELOPMENT METHOD:
Duration:
PUMPING LEVEL AND YIELD:
ft after- hrs pumping gprT�
PUMP INTAKE DEPTH; ft Horsepower: _
WELL DISINFECTED UPON COMPLETION? S.YES Q NO
REMARKS:
PLEASE MAIL WHITE COPY OF LOG TO:
> DNR/DIVISION OF MINING & WATER MGMT
3001 C St, Suite 800
ANCHORAGE AK 99503-5935,
Phone (907)269.6639, Fax (907)562-1384
1 SSI -
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 AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW960159
DESIGN ENGINEER:TOBBEN SPURKLAND, P.E.
OWNER NAME:BRAIN MICHAEL A & NANCY
OWNER ADDRESS:12200 ROCK RIDGE DR
ANCHORAGE, ALASKA 99516
PARCEL ID:01523185
LEGAL DESCRIPTION:
CHICKADEE SLOPES TR A LT 4A
LOT SIZE: 49508 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
PAGE 1 OF 1
! r%,(.� C;io f� LV iSl1
DATE ISSUED: 6/26/96
EXPIRATION DATE: 6/26/97
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 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
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:
ENGINEER.3HAJwL..P. AN . DI ' Q ., �'ER�07����QN; T��5,.. ., E
VICINITY OF THE ROP ED ABSORPTION.. ,TPZNC I ' Sim Ru
RESULTS TO FIC W H THE AS - BUILT/INSPECTIgN,4 �.
R 'raz.
RECEIVED BY. DATE : ISSUED BY: 1 �� DATE: ��(C' 4 6,
T.SPURKLANID P.E.
203 W 15th. Avenue, Suite 203
ANCHORAGE, ALASKA 99501
(907)279-3916
Fax (907)-276-6013
SEPTIC SYSTEM DESIGN
LOT 4A CHICKDEE SLOPES
MIKE BRAIN
No Ground Water or Impervious Layer to 15ft.
Use Standard Trench
Soil Rating.
5 min/in = Use 1.2 gal per sq.ft/day
No. of Bedrooms 4
Required Area per Bedroom: 15011.2 = 125 sq.ft..
Total area required: 4 x 125 = 500 sq. ft.
Finish Floor Elevation 104.00
Ground Elevation at Absorption Field 95+-
Testhole Total Depth 15 ft
Rock depth 6ft.
Length of trench 500/ 12= 41.7 ft
SYSTEM CONFIGURATION
STANDARD TRENCH
TOTAL LENGTH
45 FT
TOTAL WIDTH
2 FT
TOTAL DEPTH
9 FT
ROCK DEPTH
6 FT
COVER
3 FT
SEPTIC TANK
1250 GAL
The installation of this septic system will not prevent wells from be installed on the adjacent lots.
There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots.
The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface
runoff will not result from this installation.
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION
JUN 18 1996
RECEIVED
(ENGINEER'S SEAL)
Municipality of Anchorage
w DEPARTMENT OF HEALTH & HUMAN SERVlr =S
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: "I -e - V X-ck-t Yi DATE PERFORMED: V9 ` q &
LEGAL DESCRIPTION: L bT 4 A C L-� ICAID IE L Township, Range, Section:
SLv Pte$ SLOPE SITE PLAN
1 l 1 L vee trot r 1� rr� wyt
2-
3-
4-
5-
6-
7-
8-
9-
10-
11 -
12-
13•
14-
15-
16•
17-
18•
19•
20
COMMENTS
S 1 l I) So"A- c
0
WAS GROUND WATER
1■111■■■■■
ENEENEENNE
IMMENEEMEN,
IF YES, AT WHATNEENNEEMEN
DEPTH?
Depth to Water Alter
Monitoring? �a- Date:
Reading
Date Gross
Time
Net
Time
Depth to
Water
Not
Drop
>�i ! l
S• 9.4 (o � iZ E S
/41L
0 n-ti•t
v
_
.1i1_v_
©.ic
2-0
4 0
y% 3
M
r 1t D
0, f o
Li
t
3. > I'= oto 4'0•lw a -t v
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER h)
TEST RUN BETWEEN FT AND FT
PERFORMED BY: - f S ,-_ I - ll J CERTIFY TH T THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATF DATE:
72-008 (Rev. 4/85)
174
(ENGINEER'S SEAL)
Municipality of Anchorage
K DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: l Q
rco 101 ---DATE PERFORMED:
LEGAL DESCRIPTION: LA '/A Township, Range, Sction;
SLOPE-_� SITE PLAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
WAS GROUND WATER a 1 O
ENCOUNTERED? 1�
S
IF YES, AT WHAT L
O
DEPTH?
P
E
Depth to Water Alter 6120A / 1
Monitoring? C r Date: ,
Gross Dgth to
Time istis,
I I PERCOLATION RATE L '= (minutes/inc�-h)) PERC HOLE DIAMETER
tt__JJ A' TESTI RUN BETWEEN FT AND ( FT
COMMENTS "" r_ F -C
PERFORMED BY: _ T- s. S __ CERTIFY THAT THIS TEST WAS PERFORMED IN
/ e e
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE:. DATE: 1 ��� ! � � 3 "L b
72-008 (Rev. 4/85)
e re- ©v► lam/
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
(ENGINEER'S SEAL).
PERFORMED FOR: 1 4.1 'kk DATE PERFORMED: /9t 9%
LEGAL DESCRIPTION: -LOT 4A C jt,'( i� e.e Township, Range, Section:
iPl 7 to P -e S SLOPE SITE PLAN
a +'r!
t
2
3-,�jS, t I, Sac �
4
5-
6
7
8
9
'i ley SgKd%
10
11
12
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
133o�K�
y' j Depth to Water Aller
1 1
[30 -14•tiµ .4 14, 'e Monitoring? _
14-
15-
16-
17
4151617
18-
19
20
COMMENTS
■■.■■■■■■■I
■■■E■■■■■■
MEN MEN
9eading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
I'LL -`1114& Eke S
DAV-
�{ Z
10
4 3
,
6,5
l7
10
�o L
o2
P.r.-RCOLATION RATE �_ (minutes/inch) PERC HOLE DIAMETER ___ .r _
t
TEST RUN BETWEEN FT AND T
PERFORMED BY: 7-114 I - T—, S — CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
H
(ENGINEER'S SEAL).
Municipallty of Anchorage
.r DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: H; k •e -c-m i 4 , DATE PERFORMED:'-'
LEGAL DESCRIPTION: _ G 7A r C fel. r G 6,de �0_ Township, Range, Section:
1 P w S �O p -e S SLOPE SITE PLAN
E')
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
WAS GROUND WATER �1V
ENCOUNTERED]
S
IF YES, AT WHAT L
DEPTH? O
P
E
DepthMonitoring?
to Water Alter v�
Monitar;np? � �._ Date:
Reading
Date
Gross Net Depth to DNot
rop
Time Time Water
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
r
TEST RU BETWEEN FT AND FT
PERFORMED BY: � 0/
S CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
i
o
TRACT A-]
i S
I
I,
I,
I
I
� I
I,
0 I 0 50 100 150 200 250 3DD
SCALE- I' = 100 FT — — — — —
— — — — — — — — — — — — —
T 3
_ I VACANT
ISI �
LOT 4A
/ I v
I I I
LOTS I -- -- �--�-—
I I
VACANT I CJ LOT 2
Well I I I q I
LOT 4B VACANT
I
LOT 4
9T IA
TOBBEN SPURKLAND P.E. CHICKADEE SLOPES LOT 4A SEPTIC SYSTEM DESIGN
203 W 15TH. AVENUE DATE: JUNE 16, 1996
A N C H. AK. 99501
12200 ROCKRIDGE DRIVE
,a,,,% „70—Ml r MIKE BRAIN SHEET: 1/3 GRID: 2739
I
I I
I
I
F-- — — — — — — — — — — — — — —— - -- - -
Well
I 3.5 MIN/IN
DECK
ND PERC . .
I I
I � I
1250 GAL SEPTIC TANK © #3
I I
I I
REPLACEMENT TRENCH PRIMARY TRENCH
LENGTH 45 FT
547 DEPTH9 FT
I RACK DEPTH 6 FT
W
F
AV
mf 49th. ..... 10
%... � ..... .. .......... .. ' ...0
0.. .. ... .�
�'� TO BEN�SPURKLAND�.�
. J� �.• Ar
No, CE-2225AV
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25 0 25 50 75 100 125 150 W
I I SCALE, 1' = 50 FT
Q)
I
I
I
I
TOBBEN SPURKLAND P.E. CHICKADEE SLOPES LOT 4A SEPTIC SYSTEM DESIGN
203 W 15TH. AVENUE DATE: JUNE 16, 1996
A N C H. AK. 99501
12200 ROCKRIDGE DRIVE
(or) -7) '�70_:0ia MIKE BRAIN SHEET: 213 GRID: 2739
REPLACEMENT TRENCH
Standard Trenches:
2' Wide
45' Long
9' Deep
6,0' Sewer rock
3' Cover
PRIMARY TRENCH
Monitor
Clean Out
Mlro Fi 140
6,0 Ft of Septic
Double Clean Outs
/ Foundation Clean out
12+ FT. 0-0- O O
1250 gal Septic tank
Clean Out
OF
♦��P�� ........ �♦,
49th
TgBBEN SPURKLANN
C
No. CE -2225 �.���•
AV
NOSCAL E•.......... ••NPS ♦♦
FESS
ivu JC HLL
BENCH MARK,
ASSUMED ELEV,
203 W15th SPURKeAND P.E. LOT 4A CHICKADEE SLOPES SEPTIC SYSTEM DESIGN
203 Anchorage
Ave MIKE BRAIN DATE: JUNE 16, 1996
Anchorage Ak 99501
a74-�4u 12200 ROCKRIDGE DRIVE SHEET: ,3/,3 GRID 2739
JUN 15 2(
I
laity of anchorage
:r and Wastewater Program
(907)343-7904
Certificate of On -Site Systems Approval f
Parcel I.D. 015-231-85 Expiration Date:
1. GENERAL INFORMATION
Complete legal description CHICKADEE SLOPES; TRACT A, LOT 4A
Location (site address) 12200 Rockridge Drive *Anchorage 99516
Current Property owner(s) Frank Monfrey Day phone 360-2524
Mailing address
Real Estate Agent Gene Fitzgerald Day phone 351-9606
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: TYPE OF WASTEWATER DISPOSAL:
Individual Well Q Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: N/A Distance: N/A
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
* g- Z 6 .0 a 143/x• Ga1�_'
COSA Fee $ 97�-
Date of Payment 6-15`16
—16
Receipt Number QZ.C932
COSA# e05C1G/Z-33
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 Garness 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' iS G
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.
6. DSD SIGNATURE
System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved OFA
F �rt�yO
Conditional approval for bedrooms, with the follow rUg stiKQi j�ti-n E s
`J4fATERAND rn.
Original Certificate Date: ro _(S '-/ (,,
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 9.1-12.doc
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: CHICKADEE SLOPES; TRACT A, LOT 4A Parcel ID: 015-231-85
A. WELL DATA
Well type PRVATE If A, B, or C provide PWSID# N/A
Date completed 6/28/1996 Sanitary seal (Y/N) YES
Total depth 206 ft. Cased to 83 ft.
FROM WELL LOG
Date of test 6/28/1996
Static water level 51 ft,
Well Log (YIN) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 12+ in.
AT INSPECTION
6/2/16
6-1161
Well production 8.0 9,p -m. 4.0+ g,p,m,
WATER SAMPLE RESULTS:
Coliform 0 colonles/100 ml. Nitrate 6.06 mg./L. Collected by: (EG. Ltd.
Arsenic: NO ug./L. Date of sample: 6/2,/2016
B. SEPTIC/HOLDING TANK DATA
TankTYPa/Material SEPTIC/STEEL 199(, ENDateinstalled/1hi
Tank size 1250 gal. Number of Compartments E
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO
Cleanouts (Y/N) YES
High water alarm (Y/N) N/A
Date of pumping 6/29/15 Pumper A+ HOME SERVICES
C. ABSORPTION FIELD DATA PBELOW EXISTING GRADE
Date installed/15-is%1996Soil rating .p.dJ or ft'/bdnn) 1.2 System type DEEP TRENCH
Length 45 ft. Width 2 ft. Gravel below pipe 6 ft.
Total depth *13 ft. Eff. absorption area 540 fe Monitoring tube YES Depression over field NO
Date of adequacy test 6/2/16 Results (Pass/Fall) PASS For 4 bedrooms
Fluid depth in absorption field before test 17 in. Water added 685 gal. New depth 41 in.
Elapsed Time: 1120 min. Final fluid depth 33 in. Absorption rate >= 600+ g,p,d,
Any rejuvenation treatment (past 12 mo.) (YM & type) NONE KNOWN If yes, give date -
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N
"Pump on" level at in. "Pump oTi" level High water alarm level
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankllift station on lot
100'+
On adjacent lots 100'+
Absorption field on lot
100,+
On adjacent lots 100'+
Public sewer main
75'+
Public sewer manholeicleanout 100'+
Sewer /septic service line
25'+
Holding tank 75'+
Animal containment areas
50'+
Manurelanimal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTICIHOLDING
TANK ON LOT TO:
Building foundation 5'+
Property line
5'+ Absorption field 5'+
Water main 10'+
Water service line
10'+ 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
G. ENGINEER'S CERTIFICATION
l certify that 1 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 do d Name JEFFREY A. GARNESS
Date 6 f q/ b
(Rev. 11105)
Municipality of Anchorage
Development Services Department u,
Building Safety Division S=" r
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # osc161233
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block A, Lot 4A
of Chickadee Slopes subdivision. This inspection revealed a nitrate
concentration of 6.06 milligrams per liter (mg/L) was reported for the
property's well water sample. The Environmental Protection Agency (EPA)
has established a maximum contaminant level (MCL) of 10.0 mg/L for
public drinking water systems. While private wells are not subject to this
regulation, EPA standards are based on existing health information and can
therefore be used to gauge the relative quality of water from private wells.
Please see the attached "Nitrate Fact Sheet" for important information
regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble
in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass
rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is
in the form of ammonia or protein first, which through contact with oxygen and certain
bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from
wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also
result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or
three years, but is associated with a potentially fatal infant disease called
methemoglobinemia. In the digestive system of young children, nitrate converts to
nitrite, which can pass through the intestinal wall into the blood stream. There it
combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The
EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The
standard has been lowered from a previous level of 45 mg/L set by the US Public Health
Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and
other common home water treatment systems such as softening or iron filtration does not
readily remove nitrate. The best method for limiting nitrate in well water is source
control. This can include avoiding overdosing of fertilizer near the well and maintaining
good separation distances between septic tank leach fields and the well. A special anion
exchange filter that contains a media with a strong affinity for negatively charged ions in
water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical"
methods using a spectrophotometer to read the final color endpoint. Specific ion
electrodes also can be used to detect the activity of nitrate in water. This laboratory uses
several different wet chemical methods approved under the public water supply
laboratory certification program. They also have test kits available, which the laboratory
uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test
kit results against a certified analysis from the lab occasionally to verify the accuracy of
the kit. We recommend using a specially prepared bottle that has been rinsed in
hydrochloric acid for collecting samples.
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Municipality of Anchorage �.
v 4pe� 6v
• Development Services Department s
Building Safety Division r
On -Site Water and Wastewater Program s A E T
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. o15-2-�i-85 COSA# O'S,06l,' 166
Expiration Date: I 6j- -
1. GENERAL INFORMATION
Complete legal description Chickadee Slopes, Tract A, Lot 4A
Location (site address) 122oo Rockridpe Drive
Current Property owner(s) Michael and Nancy Brain Day phone
Mailing address 122oo Rockridpe Drive, Anchorage, AK
Lending agency Day phone
Mailing address
Real Estate Agent Careen Muir/ Keller Williams Realty Day phone 727-228g
Mailing Address 1o1 W. Benson #So -4, Anchorage, AK gg5o3
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 ® Individual On-site
Individual Water Storage ❑ Individual Holding Tank
Community Class Well ❑ Community On-site 1-1
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 sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Pannone Engineering Services, LLC Phone 272-8218
Address P.O. Box 100217, Anchorage, AK ggSzo
Engineer's Printed Name Steven R. Pannone, P.E. Date 8/g/2ozo
Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with MOA DSD Guidelines & Regulations. The reported results describe 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 soil condition, ground water
..,6„"1LjkI,
��OF....4� Ito
levels that may fluctuate during the year, and the water usage of the family being served by the system.
•
.��P •.•• ' ' "'•••gSjT �1#
These conditions are outside the control of the evaluator of this system. All systems eventually fail and
�..'�� �'':,#
9
#
satisfactory test results do not guarantee future performance of the system, nor do they guarantee that
49TH
°•••••�
there are no hidden defects or encroachments. PES can therefore not provide any warranty for future
00••••• •• •••• • •••
performance nor give any estimate of how long the system will continue to meet the operational
0
requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed
ip\ :Steven R. Ponnone .' i
����J �:
above. Any reliance upon or use of this report by any other person or party is not authorized nor will it
No. CE 8149 =
confer any legal right whatsoever.••.
•P�F�
X4414k_Z
5. DSD SIGNATURE
�:••�
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory ><
es
PROGRAM
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
ILI
Original Certificate Date:
(Rev. 11/05)
Munidpa ty of Anchorage
Development Services Department °
u x
x
Building Safety Division "
On -Site Water & Wastewater Program 5 A Y
4700 Bragaw Street .
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Chickadee Slopes, Tract A. Lot 4A Parcel ID: 03.5-233.-85
A. WELL DATA
Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y
Date completed 6/28/igo
A Sanitary seal (Y/N) Y_ Wires properly protected (Y/N) Y
Total depth 2o6 ft. Cased to 83_ft.
FROM WELL LOG
Date of test 6128/3.996
Static water level 52. ft.
Well production 8 g.p.m.
WATER SAMPLE RESULTS:
Coliform ND colonies/100 mL Nitrate 6.82 mg/L
Casing height (above ground) 24 in.
AT INSPECTION
8/6/203.0
45 ft•
5.4 g.p.m.
Other bacteria ND colonies/100 mL
Arsenic: ND ug/I Date of sample: 2 2oio Collected by: Dan Moran
B. SEPTIC/HOLDING TALK DATA
Tank Type/Material Steel Date installed 7/16/996
Tank size 3.25o gal.
Foundation cleanout (Y/M) Y
Number of Compartments 2
Depression over tank (Y/N) N
Date of pumping 7/2o/2oio ' Pumper A+ Home Services
C. ABSORPTION FIELD DATA
Date installed 7I3.61z996 Soil rating (g.p.d./ft2 or ft2/bdrm) 3..2
Cleanouts (Y/N) Y
High water alarm (Y/N) N
System type Deep Trench
Length 45 ft. Width 2 ft. Gravel below pipe 6 ft.
Total depth 3.2a ft. Eff. absorption area S�ft2 Monitoring tube 1 Depression over field N
Date of adequacy test 816/2o3.o Results (Pass/Fail) Pass For 6 bedrooms
Fluid depth in absorption field before test n in. Water addedZSo gal. New depth29 in.
Elapsed Time: 3.2o min. Final fluid depth 1 in. Absorption rate >= 75o g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed
t
"Pump on" level at
Datum
in.
Size in gallons
"Pump off" level at in.
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 102'+
Absorption field on lot 102'+
Public sewer main 75'+
Manhole/Access (Y/N)
High water alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots zoo'+
On adjacent lots 1oo'+
Public sewer manhole/cleanout 1oo'+
Sealer /septic service line 25'+ Holding tank zoo'+
Animal containment areas zoo'+ Manure/animal excrete storage areas zoo'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 28' Property line _3o'+ Absorption field 51+
Water main 75'+ Water service line 25'+ Surface water 1oo'+
Wells on adjacent lots 1oo'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 1o' Building foundation 3o' Water main 75'+
Water Service line 25'+ Surface water zoo'+ Driveway, parking/vehicle storage 10'+
Curtain drain None Known Well's on adjacent lots ioo'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION 4�OF
.�.`P�E....
I certify that I have determined through field inspections and JAV
review of Municipal records that the above systems are in n�
conformance with MOA COSA guidelines in effect on this date. `K
Engineer's Printed Name Steven R. Pannone. P.E. ��, ;Steven R. Panno
!n s_ No. CE 8149
Date 8/g/2oio •��•�•ESS�•C
COSA Fee $ z4qv
Date of Payment Sr/[Wo
Receipt Numbier ,6— 0
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
El
Municipality of Anchorage
• "� Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 101166
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
4A Tract A of Chickadee Slopes subdivision. This inspection revealed a
nitrate concentration of 6.82 milligrams per liter (mg/L) was reported for the
property's well water sample. The Environmental Protection Agency (EPA)
has established a maximum contaminant level (MCL) of 10.0 mg/L for
public drinking water systems. While private wells are not subject to this
regulation, EPA standards are based on existing health information and can
therefore be used to gauge the relative quality of water from private wells.
Please see the attached "Nitrate Fact Sheet" for important information
regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
MAY. 24. 2010 3:47PM FIRST ASI TITLE NO. 3970—P. 2
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SGS Ref.#
Client Name
Project Name/#
Client Sample ID
Matrix
Sample Remarks:
1103723001
Pannone Eng. Srv.
Chickadee S/D Lot 4A
Chickadee S/D Lot 4A
Drinking Water
Printed Date/Time
Collected Date/Time
Received Date/Time
Technical Director
08/03/2010 16:04
07/29/2010 10:00
07/29/2010 11:00
Stephen C. Ede
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Hardness as CaCO3 275 5.00 mg/L SM20 2340B C 07/29/10 07/30/10 NRB
Waters Department
Total Nitrate/Nitrite-N
6.82
0.100
mg/L
SM20 450ONO3-F
B
07/29/10
AYC
Microbiology Laboratory
E. Coli
Negative
I
100mL
SM20 9223B
A
07/29/10
DLC
Total Coliform
Negative
1
100mL
SM20 9223B
A
07/29/10
DLC
Private Individual Analysis
Alkalinity
185
10.0
mg/L
SM20 2320B
D
07/30/10
LP
Aluminum
ND
20.0
ug/L
EP200.8
C
07/29/10 07/30/10
NRB
Antimony
ND
1.00
ug/L
EP200.8
C
(<6)
07/29/10 07/30/10
NRB
Arsenic
ND
5.00
ug/L
EP200.8
C
(<10)
07/29/10 07/30/10
NRB
Barium
52.0
3.00
ug/L
EP200.8
C
(<2000)
07/29/10 07/30/10
NRB
Cadmium
ND
0.500
ug/L
EP200.8
C
(<5)
07/29/10 07/30/10
NRB
Calcium
90100
500
ug/L
EP200.8
C
07/29/10 07/30/10
NRB
Chloride
53.0
0.500
mg/L
EPA 300.0
D
(<250)
08/02/10 08/02/10
SDP
Chromium
ND
2.00
ug/L
EP200.8
C
(<100)
07/29/10 07/30/10
NRB
CO3 Alkalinity
ND
10.0
mg/L
SM20 2320B
D
07/30/10
LP
Conductivity
602
1.00
umhos/cm
SM20 2510B
D
07/30/10
LP
Copper
10.8
1.00
ug/L
EP200.8
C
(<1300)
07/29/10 07/30/10
NRB
Fluoride
ND
0.100
mg/L
EPA 300.0
D
(<2)
08/02/10 08/02/10
SDP
HCO3 Alkalinity
185
10.0
mg/L
SM20 2320B
D
07/30/10
LP
Iron
ND
250
ug/L
EP200.8
C
(<300)
07/29/10 07/30/10
NRB
08-15-'10 12:58 FROM-kellerWilliamsPealty 9078656565
/
Li
11
Uniform Residential ADDfaisal Rdtnnrt
T-864 P0001/0001 F-921
here are 10 comparable ro Ales 0umem offered for sale in the subject nelchborhood fanning In price from $ 595,00o n V to $ 650,00o
here are 39 comparable sales In ells subject net htromood wwn the past twelve months r In In sale Ace from S 560 0110 to S 659 000
fEATIJRE SUBJECT COMPARABLE SALE # 1 COMPARABLE SALE # 2 COMPARABLE SALE # 3
ddress 12200 Rockridge Drive 5031 Manytell Avenue 13301 CireaMew DGae 11950 Ginami Drive
Anchors AK 99516-2317 1011 Forest Ridgea/d Mountain Perk Estates 1411 Woodboume
roxdmi to%bject 2.06 milesSouthwest 0.97 miles Scuthwemt D. 4 miles Eastale Price S 609 500 S 640 000 S 600 000 S 659 500
JA,
ale Pace/Gross LIV. Area 249,08s .h. S 23105 s ,ft- S 277,52 s .h, S 200.09 sab Source 6 AMDS MLS 286 da on mkt AMDS Unknown mkl UrneFsb AMDS MLS 31 da s on market
erification Source s MOA MOA M A
LUE ADJUSTMENTS DESCRIPTION DESCRIPTION + - SAdbslment DESCRIPTION t • SAd strtem DESCRIPTION + - SAdiuslmert
ales ornnaindng Conv None Conv None Convomosalons Clsd 512010 Clsd 6/2010 Chid 1012009
DaleofSalamn F 4/2010 EM 3/2011"1 EM 912009
Location SuburbardAv SuburbaNa Suburbs Av aubuMan/Aya
Leaseholo/FeeSlinple Fee Sim le Fee Simple Fee Simple Fee Slm la
.Site 49,508 78 386lS -15 000 33 600/lnfedor +20.000 84.206/Sur)•20 000
Yew Average I-nr I Average Mins Avera a Intoes InletIclt Ad'abv
Design is Two Story Two Sto TWO Story lvro Story
OdillyofConalruction Avera o + Avera a + Avera a+ Avars n +
Actual Age 199618E 1999110E 200214E -24 000 199616E -12 200
Condition Avera 8 + Avera e + Average + Avera "
Above Grade Tata) Bdmts.
earns Tota
edfms.
Balla Taal Bhma
Baths Tp151
Bdrms BaQis
Room Count =8: 4 2.5 JO 1 4 3.6 -5 000 6 3 2.5 6 4 1 3 -3.800
Gross LWIng Area 2.447 s .h. 2770 s ,D, 12,900 2162 5 .h. +11400 3296 s .h. 34 000
Basement8 Rnlshed 1,184 Sq.Ft. 1308 Finished -3,700 1140 Finished +1,300 975 Pinxshed +6,300
Rooms Below Grade 97% 2.0-1 3-0-1 2-1-1 1-D-0 +5 000
FunctionalUif Average Avera a Averacia Avera e
HiatiniiiCooling GHWBB GFA Radiant -2 00 GFA
' EWgy Efficient hems Standard Starxlard Standard SIaMArd
Garage/Carpolf Garage 3 Garage 3 tans +4,000 Garage 3 Garage 2/shop +5000
PorcbRallo/Deck CE L Dk shed CovEnt L De CE Ok shd +3.00 CE. La Dank +500
• SeCS RIVac 9' coil RVDGM VC+ RVDGM VC+ +6.000 RVDGM VC++ RVOG VC++ +4,000
1F 1 a iSty 1 Fre lace 1 Flre lace 1 Fireplace AMD
t S -26600 + K—_9 700 t S -50400
. NdAdjusbnetd obimerossAdi-
A09ed Sale FleeNet Adj. 4.2 % Net Adj. 1.e % Not Adj. 7.6%
ECom aratdes 7.3 % S 613 400 Gmss Ad'_ 10.3 % S 609 700 Gross Ad . 13.9% S 809.100
1 add did not research Are sale or transfer hl5toky of ars r)ubioc property and com aWe sales. h not ex lain
M research Fl did R did not reveal any prior sales or transfers of the subject property for the three years pdor to the effective dale of IIIIS appraisal.
Data SourC s MOA .MLS
research ndid g did not reveal any prior sales or transfers of the comparabieswes for the ear prior to Btc direct sale of the comparable sate.
Data Solaces MO MLS
Report the resues of the research and ane sls of the Prior sale or transfer history of hie sub ect proDwertv and comal-111(report additional pdor sales on ome 3).
ITEM SUBJECT COMPARABLE SALE #1 1 COMPARABLE SALE #2 COMPARABLE SALE #3
Date of PriorSale/Transfer None fotmd None found None found None found
Pelee of Prior SalelTransfsr
Data Sources MOA MLS MOA MLS MOA MLS MO MLS
Date 01 Data Sources 8/2010 8/2010 812010 812010
ArMSIS 01 Vilor sale or transfer history of the sub'ecl r0 and comparable sales No sale of the subject in the nrinr three ears and no sale of trip
comparable safes in the stet year, No sales of the sales in the past 12 months.
Summay of Sales Com adson Approach Three sales of similar design two story homes with basements As IrnCated in the same hillside area of the
d'W were used for comparison, The sales bracket the sub'ecA in size and amenities and are all homes wht h wound be directly competitive in
IEAecilve
this market- Land value ad ustmeni5 are needed MAI Cnrac all rfun 19dKerences in the site values which Is attnhuha-d to;: and view
differences between (he sates and not strict due to view or size. Adjustments are relatitgy fewmain) for a aim and ament variances and all
ad'ustmonts are well within the recommended guidelines. A narrow range in value is developed front the sales and that range uhctudes the
P-er4ing sales price of the subject property which is $609.500. That price la therefore considered to be well support das a confusion of
value fnr the a rl ,
IrdoatedValueby Sales Comparison roach S 610,001)
Indicated Value by. Sales Comparison App mach S 610-000 Cost A roach (if developed) S 599,495 Income Approach if developed) S NIA
Sales compansw a roach is iven reateel wei ht as h best reflects the drat reaedon or bu ershellem In themarketplace. Cost 2�qyroach not t 'owl used D the
.market bur In this case supports the market approach. Income alViroach Is not applicable due (crack of relavenl rental data as well as Na fact Ihst home- of this
are not rchwed for dhefr income elm potential
Itype
This appraisal Is made 'as IS', subjeel W completion per plans and specifications on the basis of a hypodldical condhlon drat the Improvements have been
completed, ❑ subject to the following repairs or anerarlons on the basis of a hypothetical condition that the repair or ahastiorls have been completed, or ❑ subject b the
following required inspection based 01) the extraordinary assumption mal are conaMon or dellclency does not require attention or realr
Based on a complete visual Inorpeclion o1 the Interior and exterior areas of the subjeeh groperty, defined scope of work, statement dl assumptions and limiting
conditions, and appfabeps ceMillcallon, my (oud opinion of the market value, es defined, of the real prop/ Ay That Is the subject of this repos is
S 610.000 as of August 10 1010 which Is the dale of Ins ion and The effective date of this appraisal.
Freddle Mac Form 70 March 2005 Page 2 of 6
Form 1004 — VKOTAL• appralaal a0hw81`e by a la mods, Inc. —1.800•ALAMODE
Fannie Mae Fomt 1004 March 2005
It FU',lrycJ
A,+RON/lE SERVICES INC.
7 55 0 1 J 4.0th Avep-we
Anchorage, Alaska 99516
345-1890
INVOICE Pt
`Gallons
Seritic
Leach Area Holding Tank
Standpipes Time
F❑I
PROBLEM AREA —
CALL FOR MORE INFORMATION
El
NEEDS TO BE DONE. AGAIN IN 6 MONTHS
Good Shape
Ej Sludge bufldup on bottom
011 Floater, on -top
❑
Jim cap missing or,
D Cut standpipe to 1' above ground
0 Needs Septictrine
needs,, repacing
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 015—A31-05 HAA #
1. GENERAL INFORMATION P'A x-1'4
Complete legal description T VIAL < A` CkAi CV—A D F_S LO p GiS
Location (site address or directions) ! Z20 t� Rdcl�r►"c��2
Property owner 13RA1 �4 ,. m 1 C14 A I✓ L Day phone
Mailing address
Lending agency
Mailing address.
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
Day phone
Day phone
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm I o Lb e vl p v r Ica �oK t� Phone ZW - 3 91,6
Address
Engineer's signature
X20 3
6. DHHS SIGNATURE _
__%1_ Approved for bedrooms.
Disapproved.
Conditional approval for
Date I I r b! Q b
LWy i-✓ Ja ie03 � l 1 �j�]
1 1
''�10 DOi f say 'a9a3flG 059..000
Yom, J'
bedrooms, with the following stipulations:
Additional Commentgote: The well for this property meets existing
State and Municipal Codes. There are nitrates present. It is
continued suitabi�ijy. /Nitrate [oncentration is 5.47 mg/1. EPA
_flrx� FA 1111
MITIC
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-M (Rev. 1/91) Beck MOA #21
MUNA-WALITY Lir AIY-HUKAVt
ENVIRONMENTAL SERVICES DIVISION
�- Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES NOV 1 X99
Environmental Services Division
825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343 -PEC E I `1 I E
DIA
Health Authority Approval Checklist
Legal Description: j R&I A C 41 x -14 l D E L S Lo Pr= arcel I.D.: D 15-1—
A. WELL DATA
Well type 'e- If A, B, or C, attach ADEC letter. ADEC water system number
Log present (YIN) ___Iy_ Date completed �S; � 1/ 4 1 b
Total depth .206, _ Cased to 83 Casing height (above ground)
Sanitary seal (YIN)
FROM WELL LOG
Date of test
Static water level
Well production g•p•m-
Wires properly protected (Y/N)
AT INSPECTION
9—
p.m-
WATER SAMPLE RESULTS:
, `I 1, Other bacteria � j
Coliform Nitrate �u
:,� � / ' L,
Date of sample: I / r f b Collected by:
B. SEPTICIHOLDING TANK DATA
Date installed k, Tank size 1 a2 60 Number of Compartments_ Cleanouts (Y/N)
Foundation cleanout (Y/N) Depression (YIN) N High water alarm (YIN)
Date of Pumping 12 Pumper N/0- N F—VU
C. ABSORPTION FEELD DATA
Date installed -7//,S- I9b
Soil rating (g.p.d./ftZ orf mt) 1. System type 1 %L4IV6#
11 r t
Length 115'; Width _ Gravel thickness below pipe (o Total depth
Z
Effective absorption area 5416 Monitoring Tube present(YIN)—Y— Depression over field (Y/N)
Date of adequacy test NIP— Results (Pass/Fail) 'Pve
For 7 bedrooms
Fluid depth in absorption field before test (in.);
Fluid depth 1/ (ins.) Minutes later:_
Peroxide treatment (past 12 months) (Y/N)
Immediately after ✓gal. water added (in.):
_ Absorption rate = g.p.d.
If yes, give date
L/
D. LIFT STATION N © N �
Date installed
Manhole/Access (YIN)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level at*
*Datum
-Pump off' level at*
SEPARATION DISTANCES FROM WELL ON LOT TO:
r i
Septic/holding tank on lot 10 a ; On adjacent lots i � C.0
t
Absorption field on lot 102 ; On adjacent lots 1 ��
Public sewer main o o e— Public sewer manhole/cleanout No ll e—
Sewer /septic service line �, ° 5 Lift station 0 N !=
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation o28 _ Property line 3 © Absorption field i rJ
1 p
Water main/service line i,25 Surface water/drainage Nlyv/ ?- Wells on adjacent lots > 1 o
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation 60 1 Water main/service line > t2
Surface water N n O •e- Driveway, parking/vehicle storage area
Curtain drain o v1 .t? _ Wells on adjacent lots > 10-0 Property line
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal records that the above systems are
in conformance with MOA HAA guidelines in effect on this date.
Signature
Engineer's Name 66 •e ait v r V� �tQ� .En veering $e1 Hefe
L _
Date -
� �w
---------------------------------------------------------------------------------- ----=� �:~: -' �'_- , ------------
HAA Fee $ 119/0 - CTE)
Date of Payment
Receipt Number 5 yJ
Rev. 8/95 OSS: haa.wk.doc
Waiver Fee $
Date of Payment
Receipt Number
RE�Efv �
ptC 0?_ 19g6
CT&E Environmental Services Inc.'ZtL h®rag®
Laboratory Division ►oiiii///�//�/�'////�'�//
Dept. Health &Hum
Drinking Water Analysis Report for Total Coliform Bacteria 2001. Potter Drive
Anchorage, AK 99518-1605
READ INSTR UCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE Tel: (907) 562-2343
Fax (907) 561-5301
MUST BE COMPLETED BY WATER SUPPLIER
o PUBLIC WATER SYSTEM I.D. #
X PRIVATE WATER SYSTEM
❑ SendResultt
0
❑ Sendlnvoice
„ ,tv Srssem N�m ampanYNamt0 t2,K�.N D ons Hunt
one umoef
li. umber
.M—ng AdNaS
Month Day
,.y
D Dee
DoteMFG--
O Send Results O Send Invoice
ompmy ante =namc
Ma, tng Aaa —
iry
tate p Doc
TO BE COMPLETED BY LABOKA 1 UK
alysis shows this Water SAMPLE to be:
Satisfactory
❑ Unsatisfactory
❑ Sample over 30 hours old, results may
be unreliable
❑ Sample too long in transit; sample should
not be over 48 hours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
Date Received l� Z� Q
Time Received
�-
Analysis Began la —
Analytical Method: /i Membrane Filter
❑ MMO-MUG
Number of colonies/100 ml.
- Result* Analyst
M - ® RN
SAMPLE DATE:
Year
9'70T�
� . � 148
Month Day
SAMPLE TYPE:
❑
❑ Routine O Treated Water
ch Fbics Jun
Fazed
Repeat Sample (for routine sample X Untreated Water
with lab ref. no. )
Date: Time: —
o Special Purpose
Client notified of unsatisfactory results:
Time Collected
SAMPLE LOCATION Collected By
�.
❑
Phoned Spoke with
El
Faxed
�
D
ate: Time:
Plesse Print
BACTERIOLOGICAL WATER A`tALYSIS
RECORD
MMO-MUG Result: Total Coliform
E. Coli
Membrane Filter: Direct Count
O Colonies/100 ml
TNTC -r.' lyu-crus
To c'-1
Verification: LTB BGB
COLIFIRM
OB Other Bacteria
Fecal Colifo Confirmation
Final Membr n Filter a
Coliform/100 ml
ao
Reported B ate
Time hrs
Comments:
r®: s 3s Member of the SGS Group (Socidt6 G6n6rale de Surveillance)
v
cnt�non,... c..-.. .. .... ._.-.. ,.. ...eva r•a''cr'onnA a noinA 11 1-1110 —0—
.,.., .—.. .-_,.-.. .,-- ...-......r,.-..1,.
CT&E Environmental Services Inc.
' ML ®
CT&E Ref.#
Client Name
Project Name/#
Client Sample ID
Matrix
Ordered By
PWSID
Sample
Parameter
Nitrate -N
Total Coliform
11
966075001
Tobben Spurkland P.E.
Tract 4A Chickadee Slopes
Potable
Drinking Water
Client PO#
Printed DatelTime 11/15/96 11:26
Collected Date/Time 11/07/96 15:15
Received Date/Time 11/13/96 15:50
Technical Director: Stephen C. Ede
Released By 2h9r1-- C LrL/
Allowable Prep Analysis
Results POL Units Method Limits Date Date Init
5.47 1.00 mg/L SM18 4500-NO3F 10 max 11/14/96 WEP
0 0 col/100mL SM18 92228 11/13/96 TAV
19 OB W/O COLI
PARCEL: 015-231-85-000-97
CARD: 01 OF 01 RESIDENTIAL SINGLE FAMILY
STATUS:
RENUMBERED TO/FROM:
- -
- - 1
------------------------------------------------------------------------------
MICHELSOHN &
DAUGHTER
CHICKADEE
SLOPES
CONSTRUCTION
INC
TR A LT
4A
750 W DIMOND
BLVD #100
0
ANCHORAGE
AK 99515
1515 SITE 12200 ROCK RIDGE
DR
------------------------------------------------------------------------------
LOT SIZE:
49,508
---DATE CHANGED---
----DEED
CHANGED ----
ZONE : R6
OWNER : 07/23/96
BOOK :
2951 PAGE: 0152
TAX DIST: 002
ADDRESS: / /
DATE :
07/16/96
GRID . 2739
HRA # 000000
PLAT :
820192
NOTES
----------------------------------ASSESSMENT
HISTORY --------------------------
---
LAND-- --BUILDING- ---TOTAL---
FINAL VALUE
1994:
32,300 0
32,300
FINAL VALUE
1995:
32,300 0
32,300
--EXEMPTION---
FINAL VALUE
1996:
42,400 0
42,400
-----TYPE-----
EXEMPT VALUE
1996:
0 0
0
STATE EXEMPT 1996:
0
-COMM COUNCIL -
FINAL VALUE 1996: 42,400 MID -HILLSIDE
GREP-XF-a- ANCHORAGE AREA BOROUGH
DEPAR OF ENVIRONMENTAL QUALCASE
3500 TUDOR ROAD
ANCHORAGE, ALASKA 99502
Performed For Date Performed -71
Legal Description: Lot+Btar-k /4 Subdivision1c
— 5ill -
This Form Reports Sails 0 9 -r 7 - 4ttn Test - 11)
Depth
Feet
i 1��
2
Soil Characteristics
3-
4
5 -St-_
I
5—
clay _; A , ,,tL I-dIT F___I
6
7
8
9
10
Water Encountered?
Was oun
�
Lf—V s, At What Depth? (2tQV.-II UA C k 4111.j
lif _T( 7
16 &,-r7cw, 01 " J
Reading I Date I Gross Time
Net Time IDepth to H2O 1 Net Dro
vercoiation Kaye- 1 n u t e
Proposed Inst .page Pit Drain Field
Depth Of Inl,,,,,-0.,'Depth To Bottom Of Pit Or TrencW_
COMMENTS: -
Law- Fertormed a------
wIt Data Certified By:
Date:
4p