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HomeMy WebLinkAboutMOUNTAIN AIR ESTATES BLK 3 LT 1A 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 MAI LINCc~ADDR E.~S LEGAL DESCRIPTION Liq, capacity in gallons DISTANCE TO: Manufacture IF HOMEMADE: Absorpti,~are~ DISTANCE TO; No. of lines Inside length Well Dwelling Well Length of each lin~ Top of tile to finish grade Foundation Total length of lines Material beneath tile Length Width Depth Type of cfi meter depth DISTANCE TO: Depth DISTANCE TO: Building foundation Dwelling Width OTHER PIPE MATERIALS SOIL TEST RATINe I NSTALLE.~ REMARKS ~PHONE I.~]NEw 7 UPGRADE NO, OFCDROOMS PERMIT NO. No. o~.~,¢mpar t ments Liqu idJ;19J2th PERMIT NO. Nearest lot line PERMIT I~O. Trench width I Distancahetween lines '.~' ~-~ inches -- - ~ t Total effective absorptio~ area effective a bsor ~K~- Driller Distance to lot line Sewer line Septic tank PERMIT Absorption area(s) APPROVED /2 - DA);E LEGAL DEF'FIRTMEI",IT I-IE~FILTH FIN[) EN',,,' I RONMENTFII_ ?.OTECT I ON ',B2'.5 '"L.'" STF:EET., FtNCHORFtGE., FIK. 9S~=iO:t 264-4720 ."_:; E ~--i E F: F" EE F-." ~""'U .~: -r FIPF'L. I CFINI' [:,Ot. IG + F:I=IF.:OL STOCI<:L"r' F'. O, E,'O:;'.; .1.:t.- t 4-._ ..1.. LEGRL. LOT ±FI BLK 2: MOLINTRIN £4IRE EST LOT SIZE 92¢9999 Sl::il. Ji:i~:[ FEET T"¢F'E OF SOIL. RBSORF"T'ION S'¢STEM IS: 'FRENCH MFIXtMIJI'q NUMBER OF BEDROOMS = 4 SOIL RBTING ,::S6! F'T,-."BR::,= :;L25 THE: REt~.!UIRED SIZE OF THE SOIL RBSORPTION S'¢STEM IS: E::. E F" l- t-t = ::-=: L E ~-~ CiT ~ = e-; Z--: Ci F'--: R "..-" E I_ [)EF'I-H= 4- THE LENGTH DIMENSION IS; THE LENGTH (IN FEE'F) GF THE TRENCH OR DRRINFIELD. ]'HE DEPTH OF R TF.:ENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRE:E OF 'THE GROt. IN[:, RND THE E:OTTOM OF' THE EXCR'v'FtTION (IN FEET). THERE IS NO SET I.,.II[:,TH FOR TRENCHES. THE GRR',,,'E:L [:,EF'TH IS THE MINIMUM DEPTH OF GRFIVEL BETWEE:N THE OLI]"FRLL PIPE FIND THE BOTTOM OF THE EXCRVRTION (IN FEET). F-: EEC=.':., L..~ Z F.: E IE:, ~'; E-: F' T :.[ C: T F=I I'-.I I-:.:: :5 ][ ;Z E = ::IL 2 5 £', ~2:~ FII L_ L_ ,::) t'-.I '.'=E; PERMIT RPPL. ICRNT HRS THE RESPONSIBILITY TO INFORM THIS [:,EF'FIRTMENT DLIRINC~ THE INSTRLLRTION INSPECTIONS OF RN'.¢ WELLS RD..!RCENT TO THIS F'ROPERT'¢ RN[:, THE NI_IME;ER OF RESI[:,ENCES THRT THE WELL WILL SERVE. ........ 'rl..,.iO ,:::: 2 ::, i[ I'-.,II.'-S F" El C T ][ F.]t'-,IS R F-.: E: t:;~: E L----! U :]:. F..."![S... C ................ BFICKF'ILLINCi OF' FIN"r' S"r'STEI'"I WI'f'HOU"I" FINFtL INSPECTION FIN[:, FIF'F'F.:O',,"FII_ E:"r' THIS DEF'FIR. TMENT I,.IIL. L BE SUBJECT TO PF.'.OS, EC:UTION. MINIMUH [:,ISTFtNC:E BE:TWEEN R 1.4EL. L. RN[:' RN'¢ ON-SITE SENRGE DISPOSRL S'¢STE:M IS ±00 FEET FOR R PR I ',,,'RTE 1.4EL. L OF.: iD0 'FO ;?00 FEET FROM R PUBLIC WELL DEPENDING UPON THE T'¢PE OF PUBLIC WELL MINII'qlJM [)ISTRNCE FROM R PRIVRTE WELL TO R PRIVI~TE SEWER I_INE IS ;25 FEET F~I'.,ID 'TO FI COMMUI'4IT'¢ SEWER LINE IS 75 FEET. OTHER REGUIREMENTS MFI'¢ RF'F'L'¢. SF'ECIFIE:RTIOI'4S RND CONSTRUCTION DIRGRRMS FIRE R'v'RILRBLE TO INSURE PROPER INSTRLLRTION. F" E F-.". ~'1 ].: 'T E :.~-=: F' ]: [4: EE LE; E::, E ~2; E U""I B E F: Z=.': :t.., :1. 9 ;EE; I C:ERI"IF¥ THRT :i..: I BM F:'RMIL. IRR WITH THE RE[.:!UIREMENTS FOR ON-SITE SEWERS RND WEL. LS FIS '=;E:T FORTH B'~' THE MUNIC:IF'FtLIT'¢ OF RNC:HORFIGE '2: I 14ILL TN'CTF4LL THE ,~',."~TFM l~.~ R~C:nR[:,RfjF:[ PJITH THE CODE[. 2:: I I.IF, IDERE;~'FiN[:~-THRT TRE- OF~-.S I ] E b, BT. IEF.'. b'~'::,TE:M f"lR'¢ REg!U I Rb ENI_FtRGEMENT I F THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS. V4. 0 s & ENGINEERS, lNG. 7125 OLD SEWARD HWY. ANCHORAGE, ALASKA 99503 549 - 6561 IlS1 6 7 9 IIAIE I'j~ I1' S~T£ PLA~ 10 tl WAS C, ROUND WATER ENCOUNTE-RED~ 12 ir YES. AT WHAT DEPTH~ 14 16 17 18 19 20 Re~d,ng PEFICOLATION RATE TEST ItUN 8EIwEEN AND __ FT COr,~t~qE ~TS D~TE: PERMIT NO. DEF'RRTMEI",IT O~- HEFIL. TH 8ND ENVIRONHENTRL PROTECTION 825 "i. STREET., RNCHORRGE., FIK. 9E 264-4720 t..,.1E L L F" E F-: i"1 ][ ( 830401 :.', RPPLICRNT LOCBTION LEGRL STOC:KLY, C:RROL FIND DOUG LOT .';LB MOUNTRIN RiR EST. BOX ±1-±45i RNC:HORAGE., AK 995± 2?4-859± LOT SIZE 999999 SQUBRE FEET MINIHUI'I DISTRNCE 8ETNEEN FI NELL FIND ANY ON-SITE SENAGE DISPOSRL SYSTEM ±00 FEET FOR R PRIVBTE NELL OR '15Fi TO 200 FEET FROM FI PUBLIC: NELl.. [:,EF'EN[:,ING UPON THE TYPE OF PUBLIC NELL~. MINIMUM DISTSNCE FROH F-I PRI',,,'RTE WELL TO FI F'RI',,,'FITE SEWER LINE iS 25 FEET FIND TO FI COMMUNITY SENEF.: LINE IS 75 FEET. NEL. L LOGS FiRE REQUIF.:E[:, RN[:, MUST BE RETURNED TO THE DEPRRTMENT t.4ITHIN ]:E~ DAYS OF' ]'HE: 14ELL COMPLETION. OTFIER REL.':!UIREMENTS I"11=¢¢ 8PPLY. SPECIFICRTIONS FIN[:, CONSTRUCTION DIRGRRMS FIRE R',,,'RILRBLE 'TO INSURE PROPER INSTI=ILLRTION. F:' E F-: tPi :[ T' EX ::-=." F" I F:: E ."3 E:. E C: E i'-1 E: E F-." 3: :"L .. 1 :_~- :~: .~=: i CERTIFY THRT t: I ~'1FRMILIBR HITH THE REQUIREMENTS FOR ON-SITE SEHERS AND WELLS RS SET' FORTH BY THE MUNICIPRLITY OF RNCHORRGE. 2: I NILL INSTRLL THE SYSTEM IN 8CCORDBNCE NITH THE CODES. WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological 8~ Geophysical Surveys Drilling Permit No. LOCATION OF WELL (Please complete either Io~ lb or lc.) A.D,L. NO. Township N[~ Range E~ MerldiGn ~c,]I~I~TANcE ~"D DIRECTtON FROM ROAD INTERSECTIONS 5. OWNER OF WELL: Street Address and Area of Well Location ~/;,~2~;~~ ~: 2. WELL LOG Feet Below ~LL DE~{ final) 5. DATE OF COMPLETION Set between ft. and ~t. Above or ~'Below land ~urface Date Equipment used; I~.GROUTING Well Grouted: ~ Yes ~ No Moterl~l; ~ Neat Cement ~ Other: 13. PUMP: (if owl~oble) HP Length of Drop Pipe ft. c=pec~ty g,p.m. 14. REMARKS: 16. WATER WELL CONTRACTOR'S CERTIFiCATiON: tS. Wafer Temperature ~.o ~ F ~ C This well was drilled under my jurlsdlct[on end this report is true to fha ~esf.~of my knowledge and belief; Registered Busine~s"Nome, ,- ' ,'~ Co~a~t License Number Form O~-WWR (ll/81) Copy Distribution; WHITE"State DGGS~ P~NK-Driller~ CANARY-Customer • • DE 8o oo-> 'c • Municipality of Anchorage On-Site Water and Wastewater Program .. J' (907) 343-7904 SAFETY Certificate of On-Site Systems Approval Parcel I.D. 017-211-33 Expiration Date: io—i —I 1. GENERAL INFORMATION: Complete legal description MOUNTIAN AIR ESTATES; BLOCK 3, LOT 1A Location (site address) 15000 Mossberry Place*Anchorage 99516 Current Property owner(s) Robert McCoy Day phone 202-6859 Mailing address Real Estate Agent Day phone 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 ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: Z/(8/ 1-7 COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 6?-co Waiver Fee $ Date of Payment 1 f ID Date of Payment Receipt Number O"? l Oo�G\ Receipt Number COSA# D "C 1"l 17-4RS 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 East Tudor Road, Suite 101-Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: '4-4* �ao�000� 4 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system OF ,4 Q in accordance with the guidelines and regulations established by the Municipality of Anchorage and "IA industry practices. The reported results describe the condition of the system/s on the date/s of the G / / evaluation. Separation distances were measured to readily identifiable features. Hidden defects or nn encroachments may exist that were not identified during the evaluation. The operational life of all wells Q • • H ' �* U and septic systems depend upon a variety of variables, including but not limited to, soil conditions, G)' """ " '. " " �O groundwater levels (that may fluctuate during the year), quality of construction (materials and VA 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 0 •,J. f r- A. Go system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of C/ g E-- 9 3 �Od the well or septic system. GEG makes no representation whether an alternative well or septic system s •c0 can be installed on the property in the event either of the current systems fail to perform adequately in keo, ••L). / cg�d the future. The content of this report is for the sole benefit of the person/party that retained GEG to e prpress pn6%, perform the evaluation. Reliance upon the information provided in this report by any other person or "4ppgooQ party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE r1 System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the followin, iPulations: ON-SITE `y, WATER AND r" WASTEWATER - n PROGRAM U ••/". ,rG• By: Original Certificate Date: 7 7` -(7 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 1O-1p-12.doc 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: MOUNTIAN AIR ESTATES; BLOCK 3, LOT 1A Parcel ID: 017-211-33 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 3/15/83 Sanitary seal (Y/N) YES Wires properly protected (YIN) YES Total depth 114 ft Cased to 114 ft. Casing height(above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 3/15/83 6/21/17 Static water level 60 ft. 59.6 ft. Well production 30+ g.p.m. 4.7+ g.p.m. WATER SAMPLE RESULTS: Coliform ND colonies/100 ml. Nitrate ND mg./L. Collected by: GEG, Ltd. Arsenic: ND ug./L. Date of sample: 6/21/17 B. SEPTIC/HOLDING TANK DATA 34 YEAR OLD SEPTIC TANK IS APPROACHING THE END OF IT'S USEFUL LIFE Tank Type/Material SEPTIC/STEEL Date installed 7/6/83 Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank(YIN) NO High water alarm (YIN) N/A Date of pumping 6/19/17 Pumper A+HOME SERVICES C. ABSORPTION FIELD DATA `BELOW GRADE AT SUMP Date installed 7/6/83 Soil rating (g.p.d./ft'orCbdrrl ) 125 System type TRENCH Length 63 ft. Width 3 ft. Gravel below pipe 4 ft. Total depth '6.1+ ft. Eff absorption area 504 ftMonitoring tube YES Depression over field NO Date of adequacy test 6/29/17 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 2168 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.) (Y/N &type) NONE KNOWN If yes. give date - -SUMP ONLY EXTENDS 15"INTO THE EFFECTIVE DEPTH "THE LENGTH OF DRAINFIELD STATED ON INSPECTION REPORT DOES NOT AGREE WITH AS-BUILT. THE DRAINFIELD APPEARS TO BE APPROXIMATELY 95' LONG BASED ON SUMP LOCATION. DISCUSSED WITH TIM EKLUND ON 7/6/17. D. LIFT STATION Date installed Size in gallons Manhole/Access(Y/N) "Pump on" level at in. "Pump off"level at a er alarm level at in. Datum-- Cycles tested Meets alarm &circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout '100'+ Sewer/septic service line 25'+ Holding tank 75'+ Animal containment areas 50'+ 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 "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 100'4- F. 00'+F. COMMENTS `ASSUMED BASED UPON WELL&TANK LOCATION G. ENGINEER'S CERTIFICATION i • '., ••••• I ')1 % * . i certify that I have determined through field inspections and , ' � ' review of Municipal records that the above systems are in ••••• 1 I ; conformance with MOA COSA guidelines in effect on this 1.01-._ •,`Sr'•}' • .- date. : JAff y Gar ess iu= ♦ ‘ tE-79 3 A, Engineer's Printed Name JEFFREY A.GARNESS ♦ s'f •.• ��,, • Date -71t7/" — +� ' FESS 1� .• LICENSE rrII%% t** SAECC8B4 (Rev. 10/12/12) LOT 2A 8460E S89°59'40"E 259.00 1 25 06 Tr 3.0 0 4.0 O ii„ '9• 0 ' 1.0 0 /� o Ron' C (',--17I` 3.0 0 5`° e -0 . 77.3 - co J� a, E z.00 � 1 'Aon �/ a M o /�ti2 N NCo o s•r.> txp \\ // O CC eptic vent , G \ / 7 UJ � � O ° ` .1ve/ r o coO 05 ancoQ vei.aY J Z co CD O � _` 0 o N 0 Z Lot 1A 0 Well 0 co (-1 — — 25 .- — — C -- .- - — - - o 5' Q3, "e. 267 - ° �0 _- l- - N7 ---------- -- _--------- 0 E /' OPp — RgCTGRE ' ,K u,o - - AS-BUILT NO CORNERS SET THIS DATE _� OF � ' I hereby certify that I have performed a Mortgagee's inspection �P,`� • • I . qs,� of the following described property: LOT 1A, BLOCK 3, MOUNTAIN AIR ESTATES SUBDIVISION ,. (.). 49th �1_ .�7 �0 f .• 1\ • , , Anchorage Recording District,Alaska,and that the . / improvements situated thereon are within the property lines / •• / and do not overlap or encroach on the property lying • • / adjacent thereto,that no improvements on the property.tying •.Brett • •A. Wilmot , / adjacent thereto encroach on the premises in question and ,i .: ., •112392- LS .•�.4' mir that there are no roadways,transmission lines or other �, •• •• c, = visible easements on said property except as indicated o • • ,..0= I hereon. SCALE: 40' l 1 E-ss�otol. � Dated at Anchorage,Alaska EASEMENTS OF RECORD,OTHER THAN 't/1.VV‘` this 1St day of JULY 2017. THOSE SHOWN ON THE RECORDED FRED WALATKA&ASSOCIATES PLAT ARE NOT SHOWN HEREON. FB 17-4, pg 44, LK BE (907-248-1666) Engineers and Surveyors MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING O~.~ ~:':~\\ ~ ,.~ HAA# ~'\(~[ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot IA; Blo_c~:~; Mountain Air Estates Location (address or directions) 15000 Mossberry Place (b) Property owner _Douglas & Carol Stockly Telephone : (home) 345-6261 Business~ Mailing Address 15000 Mossberry Place~ Anchora.qe~ Ak. 99516 (c) Lending Institution Telephone 243-2200 Mailing Address (d) Real Estate Company and Agent TOTEM REALTY ATTN: Lillian Nobreqa Address 724 East 15th Avenue, Anchorage, Ak. 99501 Telephone 272-0571 Beeper 273-3117 (e) Mail the HAA to the following address: (or check here ~if hold for pick up.) List contact person and day phone number below: S & S i~N.Gti'~.F-.P, iNG 17034 Eagle River Loop Road 2. TYPE OF RESIDENCE Single-Family [~ Number of bedrooms 4 3. WATER SUPPLY Individual Well [];( Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site E~:]X Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 /,J~pALiT,Jk,~I~°O~.~'~Y._ OF. ANCHORAGE (MOA) I~NTAL SER~IIDI1V~I~u°rlty Approval (HAA) '~,,. CHECKE~T - FEBRUARY 1984 JUN 6 1990 343-4744 Legal Description: /_-o't' ._/_ '~ ": RECEIVED A. WELL DATA Well Classification Well Log Present (Y/N) Total Depth I I~ Cased to . . . Static Water Level Date Completed ~ - !~- - ~ ~. / I~ ' Depth of Grouting -- / Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by ~ Water Sample Test Results If A, B, C, D.E.C. Approved (Y/N) Yield ,~/ Pump Set At ~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole Comments Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) B. SEPTIC/HOLDING TANK DATA Date Installed -'~- ~-~ Size ~-2--~4&~_( No. of Compartments Standpipes (Y/N) ~1 Air-tight Caps (Y/N) ~1 Foundation Cleanout (Y/N) Date Last Pumped ~- ~/~ ;for ,tO/ Holding Tank High-Water Alarm (Y/N) ~///:} Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/H6H_--E~NG TANK: To Water-Supply Well To Property Line To Water Main/Service Line To Stream. Pond. Lake or Major Drainage Course Comments ,~.,0'~ /~u~,~ ~ To Building Foundation To Disposal Field IOO 't- 72-026 (Rev. 7/88) Front Page 1 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE, ALASKA99518 · TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT ~Y SAMPLE for Work Order # 22121 Date Report Printed: JUN 4 90 @ 13:58 Client Sample ID:L1A, B3 MOUNTAIN AIR ESTATES PWSID :UA Collected }dAY 30 90 @ 14:20 Rocaived }{AY 31 90 ~ 12:30 hrs. Preserved with :AS REQUIRED Client Name : S & S ENGR Client Acct: SNSENGP P.O.# NONE RECEIVED Req # Ordered By : R. SHAFER Analysis Completed :JUN 1 90 Send Reports to: Laboratory Superviso~ .~EN C. EDE 1)S & S ENGR Special Instruct: Chemlab Roi #: 901618 Lab Smpl ID: I Matzix: WATER Allowable Parameter Tested Result Units Method Limits NITRATE-N ND(0.10) mg/1 EPA 353.2 10 Sample ROUTINE SAMPLE. Remarks: SAMPLE COLLECTED BY RDJ. i Tests Performed * See Special Instructions Above UA-Unavailable ND- None Detected "See Sample Remarks Above NA- Not Analyzed LT-Less Than, GT-Greater Than CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, ,~C. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER ~:~PRIVATE WATER SYSTEM Name Mailing Address Phone No. S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 City State Mo. Day Year Zip Code SAMPLE TYPE: ?.Routine Check Sample (for routine sample with lab ref. no. [] Special Purpose ) [] Treated Water [] Untreated Water SAMPLE Time Collected NO. LOCATION Collected By. TO BE COMPLETED BY LABORATORY sa SiS shows this Water SAMPLE to be: tisfactory ,i [] Unsatisfactory / [] Sample too iong in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received Analytical Method: t2. 5~:~ Membrane Filter No. of colonies/100 mi. Lab Ref. No. Result* 90.1618 Analyst READ INSTRUCTIONS BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count Verification: LTB Final Membrane Filter Results Reported By TNTC = Too Numberous To Count OB = Other Bacteria BGB. Coliform/lOOm! Collform/100ml Time: /~ a.m. PART ONE OF TWO REHAINDER TO FOLLOW MUNICIPALITY. OF ANCHOgAGE DIVISION OF ENVIRONMENTAL HEALTH DEPAKTMENT OF HEALTH AND ENVIRf~MENTAL PROTECTION APPLICATION ~OR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Informaticn A~plication Date {.%~u ~-.:, ~ (a) Legal Description (include lot, block, subdivision, section, township, range] (b) Location (add~ess or directions) Applicants N~ [)0 0 G ~ ~ -~) (c) Applicant is (check cne) Lendin~ Institution (d) Lending Institution Address (e) Real Estate Co. & A~ent Address Te le phone 2. TIDe of Pesidence Single-Family Numhe~ of 3. Water Supply Multi-Family ~-~ L~.. Othe~ (describe) IndividUal Well ~ Ccm~nunity,~ Public ~--~ Note: If cu~,unity ,~11 system, must have written confirmation frown the State F3epa=tmgnt of Environmental Conservation attesting to the legality and status. Is the ~].1 adequate, for the ~lmaber of bedrocms specified in this HAA (Y/N) 4. Sewage Disp(k~al ~'$~" Is the wastewate~ disposal system adequate fc~ the num~.~ of bedro~ns [Page 1 of 2] 5. Engineering Firm P~oviding Inspections ~ 'Ibsts, Data and Information I certify that I have checked, verified, or conforms, d to .all MOA ~J%A Guidelines effect on the date of this inspection. I ( ENGINEER SEAL) 6. D~P Approval App~o~d for App~o~d [~[ Telephone Disapp~o~dF~-~ Conditional~-~ Temps of Conditional Approval The Municipality of An. cho~age Department of Health and Environmental Protection not guarantee the ~ntinued satisfactory perfoutmance of the water supply' and/or wastewater disposal system. ~is approval indicates that, as of tt~e validation shcw~ abo~, based on the data and informatior, ft~nished by an engineer registe~ the State of Alaska, the water, supply and wastewatec disposal system is safe and tional fo~ the numbe~ of beck. cc~s and type of struct,~e indicated. ( D[]EP SFL%L ) 7. Mail the HAA to the following address: KB2/d5/s [Page. 2 of 2] MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 WELL DATA Well Classification ~ ~ I~)~i I~%%_ Well Log P~esent .(.Y/N) / Total Depth ~ I ~ Cased to Static Water ievel ~2) Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances fram Well: To Septic/Holding Tank on Lot ~) ~ To Nearest Edge of Absorption Field on Lot MUNICIPALITY OF ANCHORAGE' DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MAY 'l 6 1984 Pump Set At ~ .' Depth of Grouting. Sanitary Seal on Casing (Y/N) y Depression A~ound Wellhead (Y/N) ~ ; O~ Adjoining Lots JO~ . .; On Adjoining Lots To Nearest Public Sewer Line N /t~ .____ TO Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected By ~ ~ ; Date Water Sample Test Results _C~"~'I~,F/4~. 'i"~ t'¢';/ Cc~ments B. SEPTIC/HOLDING TANK DATA Date Installed ~UL~ 19~'5 Standpipes (Y/N) ~ Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) Depression over Tank (Y/N)~.~,/ Date ~st P~d P~ing~inte~n~ ~n~a~ ~ File (Y~) ; fo= Holding Ta~ High-Wate~ Ala~ .(.~) ~=a=y Holdi~ Tank ~t (Y~) Sep~ation Distan~s f=~ ~ptie~o~,ing Tank: To Water-Supply ~11 I~ ~ ~ To ~ilding F~ndation To P~ty Li~ ~ f TO Dis~sal Field To ~ter Mai~=vi~ Li~ No. of Ccmpa~tmsnts . ,'~ ~ O To Stream, Pond, Lake, c~ Major Drainage Course Co, ments ~TIC, b~,TA~. F~-(9~ [Page 1 of 2] 2-15-84 .HEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHOh~E (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER I 5633 B Street ! Drinking Wat~er Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: I I I I I I I (') See h on back Mailing Address City , State Zip Code Mo. Day Year SAMPLE TYPE: r-1 Routine r-] Check Sample (for routine sample with lab ret. no. ' [] Special Purpose SAMPLE NO. LOCATION 3 I , I D Treated Water [] Untreated Water Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ¢Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mall. Date Rece,v,~ ~/~"--?/ Time Received ~ ?C© Analytical Method: [] Fermentation Tube l~Membrane Filter Lab Ret. No. Result* Analyst I,~h~'//,~ C~t 06.122o(b) Rev. 1983 BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAM PLE Membrane Filter:. Direct Count Verification: LTB. BGB. 'Final Membrane Filter Resul~ ~eported By ~ .'~ o.-4- ~ Date Time: TNTC = Too Numerous To Count Colltormll00ml Colltormll00ml I HEREBY CERTIFY THAT I AM A REGISTERED LAND SUkVEYOR AND IHAI THIS PLAT REPRESENTS A SURVEY MADE BY ME. ASSUMED DATUM PROPOSED BUILDIHG LOCATION LOT lA MOUNTAIN AIR ESTATES Beltaine C. Koztowski 4620 Emerald Court Anchorage, AK 99502 SUBD. DATED: 5-15-83 SCALE: 1"=40' C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ( .~_..~ Date Installed "-')'- b - ~ Width of Field -~ ~, Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field Depth of Field '7. ~ / / Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutback (if present) ~/Y'~ To Water-Supply Well To Building Foundation ~ / Lot /~/~ To Water Main/Service Line I (2 '1~ To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area /_/o~ Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company Date _~ & _~ ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle .Klverj/~ .... ~- MOA No. Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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 flies 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 Address Date Telephone 6. DHHS APPROVAL Approved for /7/ bedrooms by Approved ¢/~_. _ Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph S 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 inordertosatisfycertain federal and state requirements. Employees of DHHSdo not conduct inspections or analyze data before a certificate is issued. TheMunicipalityofAnchorageis not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev 7/88) Back Page 2 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed _~L;~ /9~ Length of Field ~ Width of Field ~, ~,% Depth of Field 7~ ~ /~7- ravel Bed Thickness ~/f 7" Square Feet of Absorption A~ea ~O. ~ Standpipes P=esent (Y/N) Depression ove= Field (Y/N)~ug,' Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance frtma Absc~ption Field: To Wate=-Supply Well /O ~ To P=operty Line Type of System Design TO Building Foundation Lot To Wate= Main/Service Line To St~eam/Pond/Lake/c~ Majo~ Drainage Course To Driveway, Pa=king Area, om Vehicle Stcmage A~ea To Existing or Abandoned System ; On Adjoining Lots ! O(; 9 + To Cutbank(if p~esent) D. LIFT STATION Date Installed Size in Gallons "P~;~ On" Level at High Water Alarum Level at Tested for Electrical Codes(Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets ~f)A Cc~ments ** Check Permitted Bed~ocm Rating Against HAA Request ** I certify that I have checked, verified, o= confommed to all MOA HAA Guidelines in effec' on the date of this inspection. Signed ~ .Date Company ~~~A~~MOA No. KB1/d5/s [Page 2 of 2] 2-15-84