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HomeMy WebLinkAboutPRATOR BLK 12A LT 4Prator Block 12A Lot 4 #017-093-12 Municipality of Anchorage Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: _s(x0 5'o08 S PID Number: 6�. iLoc( Z)cZ Name: «I< IV < Ic A 2 T Wastewater System21 : Address: New ❑Upgrade tie 14- A k CiCD r/6 ABSORPTION FIELDS Phone: _ No. of Bedrooms: 3 Y - 86l Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION I Soil Rating: Total Depth from original grade: Lot:(• G GPD/S . Ft. ^ 1i y Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe Township: Range: Section: Ft' Ft. Fill added above original grade: Gravel length: WELL: IE�.New Gravel width: Ft. ❑ Upgrade Number of lines: Distance between lines: Classification (Private, A,B,C): Total Depth: Cased To: Z o Ft. 2- Z 0 Ft. Rl CAT/✓ ! _ Total absorption area: Pipe material: Driller: 4 Ft. /y/ Ft. /266) !260 SQ. Ft. 303y Date Drilled: Static Water Level: Installer: AC�r�G S%24/4•S q3 ' Ft r4lkXAa' Date installed: Yield: Pum Set at: r�EYtS°i✓ 8 �- P Casing Height Above Ground: 3 ,5' GPM /,v 62 Ft. -2 P_ Ft. TANK SEPARATION DISTANCES Septic ❑ Holding TO ❑ S.T.E.P. Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines A/,) 1L / S bO Welty�gQ Material: Zp3 �— — l�-t- ( Number ofCompartments: Surface L.. Water Lot — — - LIFT STATION - Line I (( — Size in gallons: Manufacturer: Foundation ,Z _ "Pump on" level at: "Pum -� P at at: High water alarm at: Curtain Drain P — Pump Make & Electrical Inspections Performed by: Remarks: re M S MdAnL!`_t*_BENCH MARK wVLT(2(L L/ALYLocation and Description: nJcY)CL.a0 otc.6wE*2. (X cow � Yc..T2 t "� c� `��-o2..�c�ec✓ S Ys�z..0 / � -�� -I Assumed Elevation: C In" e N Inspections performed by: S•QZ�1 a �,,,,m,,�;�.� �� — Dates: 1s 2nde 6 /9e/ 19S- in, M t fav: r R? 4'annone° v Department of Hea handTP5. 02-k cG°uf`9 ` Services approval Reviewed and approved by: L Date: 72-013 (Rev. 9191) MOA 25 R. Pan 8149 �2z5 0 AS -BUILT WASTEWATER ABSORPTION SYSTEM LOT 4, BLOCK 121PRATOR SUBD, cgndary Syst Test Pit Q Diverter Valve NEW WELL 0 Nick & Lisa Brest %�00{ YVlfat2.P3�J6?i OaNeW-� Cq0;$) Z. 4 10` Property Line Set -back imary System Test pit 2 MARQUEZ Ci R, C _1 � Pannone Eng, Svc. P, 0. BOX 142025... ANCHORAGE, ALASKA 99514 272-8218, 272-8218 FAX ATEA 2-25-96 '_ CALEB 1=sm AS -BUILT Permit No.� q s oo$g Municipality of Anchorage Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 . Anchorage, Alaska 99519-6650 ,Telephone: 343-4744 Un—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: R 12A Permit No, -5w `1 -oosg Municipality of Anchorage Page of 8 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 Legal Description: G y 'R PID No, ol-o R3 - POINT CNR. A CNR. B ELEV. GRND. REMARKS ELEV. C1 C2 29.2 _ 79.6 `t3 q q INV. OF PIPE M1 36.6 109.7 cc 4a�� i INV. OF PIPE C3 52.7 123'9 qs� � a 4 � � MONITORING TUBE C4 82.1 152.3 � 9a 1u � 3 s INV. OF PIPE C5 53.4 106.8 u 4a w k 4 � $ INV. OF PIPE C6 88.4 147.2 4s Ij � p INV. OF PIPE M2 65.2 119.0 u�z s q:. 3 INV. OF PIPE C7H 63.3 123.9 4 s MONITORING TUBE C8 113.8 1q-9.9 4QZ_s � Q� s INV. OF IPE 99.9 107.0 �, �Z s if cc —3 INV. OF IPE M3 C9 77.0 128' 7 X86 s 1.1q� �' MONITORING TUBE M4 49.6 97.5 u qz 5 k q6 a INV. OF IPE 89.0 101.0 gFGE 3 MONITORING TUBE Permit No. Sw 75-oc Ap3 Municipality of Anchorage Page of 8 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 Legal Description: 1-41 B12A� A-ro2 s/a PID No. ot7 - 043- POINT CNR. A CNR. B ELEV. GRND. l REMARKS ELEV. VS1 65.7 132.7 ws X43 — 14 FLOW DIVIDER VS2 80.5 119.7 44Z 6° a FLOW DIVIDER FCO DC1 38.0 38.6 qts s. 4114 FOUNDATION C.O. DC2 67.6 131.6 193 ' DOUBLE C.O. DC3 49.6 108.7 , 53 s a 4-' DOUBLE C.O. DC4 51.9 103.3 44s! 44 a DOUBLE C.O. 88.0 133.0 a42 4q} DOUBLE C.O. V1 46.2 100.8 a4a� u q� s VALVE T1 T2 32.5 84.8 4y,3 TANK C. 41.6 96.6 4 a q TANK C. 01 fl > L s > VL a C z5° d L L o = LL La ° U * c � jt A 0� o r{ g v V °eoo°oo°^s°oe Q° a�ao°so°�.°neano ? R, J 49 TN ven R. Pannoi yCE 8149 °'•.....uip..++° 0 AS -BUILT DETAILS WASTEWATER ABS❑RPTI❑N SYSTEM Lot 4, Flock- 12A Pri for aSubd; ission Inc 3ani No. A W IOU" (/1 r. inONV m Mick & I isoLrest 6501 marguet Anchorage, AK 99510- (907) 9515(907) 345-80-13 inONV3-13 inONV3'l3 in➢NV_n3 inONV3l3 inONV3l0 NOIlVONnai W J H C] ry n STEVEN R. PANN❑NE, P,E, P, ❑, BOX 142025 ANCHORAGE, ALASKA 99514 274-0308 272-8218 FAX iTE 3-7-96 ---"----- IT TO SCALE AS—BUILT r, r M F e Municipality of Anchorages DEPARTMENT OF HEALTH & HUMAN SERVICES g 825 "L" Street, Anchorage, Alaska 99502-0650�.x tk SOILS LOG — PERCOLATION TEST `Qa PERFORMED FOR: I t/, ofS 1 DATE PERMED: LEGAL DESCRIPTION: t, 4, 4 � 12- //� Pdc�7`U(�5�,� Township, Ranae. Section: DEPTH (FEET) 1 Cs�GM LL S 2 3 4- 5- 6- 5s (Zt M 8- 91011 9- 10- 11 12 13- 14- 15- 16- 17-- 18- 191 3141516171$19 20 COMMENTS 30 7y0 ✓+! d�1 T. WAS GROUND WATER ENCOUNTERED? IV D S IF YES, AT WHAT L DEPTH? �. O P E Depth to Water After / Monitoring? - 4/0 Bate: 2 3 ,c"eoaecneo olm..., Sfiavan P Pannono a- f 2:6 (CJ��? - 81.19 s,; A y ✓GJZ f y.ry 4 LAN Reading Date Gross Time (N(„,, Net Depth to Time (1V7„,, Water Net Drop (—I; I Per toot /b /o 20 7O I 3� to G 2S' K o 7 0( 2� PERCOLATION RATE 4 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 6, S FT AND Z S FT PERFORMED BY: AlrI k -P—,4)1 <1- c Iiyvj ( LA'' L- (2 ""r f7 7` CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING & WATER MGMT WATER WELL RECORD LOCATION OF WELL -; - 'SECTION TOWNSHIP RANGE MERIDIAN BOROUGH SUBDIVISION LOT BLOCK :' SECTION - ON ❑E 0S Ow WELL OWNER:y LOCATION/SKETCH: Al,�- IL ---- DEPTHS MEASURED FROM: lcasing top []ground surface IIBOREHOLE DATA: From Depth To Material Type and Color CONTRACTOR � ED WELL DEPTH DATE OF COMPLETION 1 s!•<. DeDtit of h.oie. / `�- �=�ft Depth of casing:/�/ DEPTH TO STATIC WATER LEVEL: ,a I t below ,Z top of caasinng- ❑ ground surface Date: METHOD OF DRILLING: air rotary ❑ cable tool ❑ other USE OF WELL: 9 domestic ❑ irrigation ❑ monitor ❑ public supply Ll other `/ CASING STICK-UP: ft. Diam: in. to6—//—ft Casing type: in. to /� ft WELL INTAKE OPENING TYPE: ❑ open end ❑ screened perforated ❑ open hole / q Depths of openings: 4 to ft SCREEN TYPE: th: In Slot/Mesh Size: Length: ft RAVEL PACK TYPE: Volume used: Depth to top: GROUT TYPE: Volume: Depth: from_ ft to ft DEVELOPMENT METHOD: Q�ti PUMPING LEVEL AND Y LD: :, ft after hrs pumping�5—_gpm PUMP INTAKE DEPTH: ft Horsepower: WELL DISINFECTED UPON COMPLETION? ❑ YES ❑ NO INFORMATION: REMARKS: less Name " PLEASE MAIL WHITE COPY OF LOG TO: , ��• ?vim DNR/DIVISION OF MINING & WATER MGMT ithorized Respresentatwe Date PO BOX 107005 ANCHORAGE AK 99510-7005 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 PERMIT NUMBER:SW950088 DESIGN ENGINEER:JAMES MARK WRIGHT, P.E. OWNER NAME:BREST NICK C & LISA M OWNER ADDRESS:6601 MARQUEZ CIR ANCHORAGE, ALASKA 99516 PARCEL ID:01709312 LEGAL DESCRIPTION: PRATOR BLK 12A LT 4 LOT SIZE: 52074 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 PAGE 1 OF 1 (D'n � o �`1 1`- SYSTEM PERMIT S DATE ISSUED: 5/24/9 EXPIRATION DATE: 5/24/96 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL 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 343-4744 ( 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: RECEIVED ISSUED BY: BY : G DATE: 9 a2 DATE: 2 ✓`~ - �S MUNICIPAWY Of AiY hohA"E March 15, 1995 ENVIRONMEWALSERVICES NVIS►ON Department of Health and Human Services MAY 2 2 1995 Anchorage Alaska RECEIVED James Mark Wright P.E. 2900 West 33rd Ave. Anchorage Alaska 99517 (907) 243-4361 RE: On-site sewer system and well permit request for Prator Sub'd, Lot 4, Blk. 12A. Dear DHHS, This is a request for an on-site wastewater disposal system and an on-site well permit. No onsite system presently exists (new residence). The existing systems on surrounding lots appear to be performing adequately. A test pit was excavated but due to the snow melt and saturated surface soils, to a depth of three feet, a percolation test was not preformed. For design a percolation test preformed in Oct. '93 by Carl Abrams was used I did not use the 1.2 gpd indicated but utilized 0.6 gpd ) and will be verified prior to installation of this system. The percolation rate was found to be 2.3 min/inch. No impacts to the surrounding properties are foreseen. The owner intends to install both the primary and secondary systems at the same time. Valves isolating both systems will be installed. Flow spitters similar to Zabel 2200 Flow Divider to split the flow between the absorption trenches are recommended. The topography of the area is sloping from the east to the west at about 5% - 10%. The lot footprint is about 326' by 421' with a wedge shape for an area of 52,200 square feet. Sincerely, James Mark Wright P.E. Permit No. Page � of � Municipality of Anchorage 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 Reaart 65' _ �_.L_L_r\IN uu i u��Hiv vu i PLAN VIEW 3' 5'T SECTION ELEVATION FILTER FABRIC 4" PERFORATED PIPE DRAIN ROCK PRATOR SUB'D, LOT 4, BLK. 12A 5' POLY- 2- o-)-3 4"CLEAN OUT FROM SEPTIC TANK 4"CLEAN OUT 10NITORING TUBES FILTER FABRIC FROM SEPTIC PE TANK O s• • 9 T"* • �i •A . JAMES M, Whf f �% CE 8841 ,wed raj 1 2 .1 h s 6 / 0 9 10 11 12 13 76 15 16 1% 12 Uz�;Jbi-11 I-NIJFJ U ht UNLDULI INU TO 5612809 P. 03 Municipality of Anchorage 1 •i,� DEPARTMENT OF HEALTH & HUMAN SERVICES 826 "U" Street, Anchorage, Alaska 99,402-0650 4 SOILS LOG -- PERCOLATION TEST V Cz _ ' �. t Y'ia �••i _ •�•u N� ttt�[Sis._ PERFORMED FOR: 1Pi Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-093-12 1. GENERAL INFORMATION Complete legal description Prator S/D, Block 12A, Lot 4 HAA# 650N1n4 Expiration Date: 12- 6601 2^ Location (site address or directions) 6601 Marquez Circle, Anchorage Current Property owner(s) Linda & John Wetherby Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 6601 Marquez Cir., Anchorage, AK 99516 Day phone Mary Tutterow / Dynamic Properties Day phone 261-7682 3111 C Street, Suite 100, Anchorage, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well El Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties se"d 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 Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. 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 Watkins Engineering, Inc. Phone 349-1851 Address P.O. Box 110443, Anchorage, AK 99511-0443 Engineer's Printed Name Cindy W. Ellis Date 5. DSD SIGNATURE __LZ Approved for _� bedrooms. Disapproved. Conditional approval for bedrooms, with the following ?V._ :-_, 49RI Cin* W. Ellis CE-im?7 Additional Comments Note: The well for, this property meets existing State and Afunicipal Codes. There are nitrates present. It is suggested that periodic testing be performed to insure the wells continued suitabilky. gent nitrate concentration is 6.88 mg/I. EPA maximum concentration is 10.0 mg/l. Nforc •mation on nitrates is available from the On -Site Services Program, at 343-7904. Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: Ct — 19 — 0 6— (Rev. 01m) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 995196650 www.muni.orgtonsite (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Prator Bik 12A Lot 4 Parcel ID: 017-09312 A. WELL DATA Well type N if A, B, or C provide PWSID # _ Date completed sera Sanitary seal (YIN).Y Total depth 145 ft_ Cased to 141 ft, FROM WELL LOG Date of test 5/29/95 Static water level 43 ft. Well production 5 g.p.m. WATER SAMPLE RESULTS: Coliform o colonies/100 ml. Nitrate 8.88 mg.A. Arsenic: NA mg.A. Date of sample: SSW B. SEPTICIHOLDING TANK DATA Tank Type/Material Steel Tank size 1500 gal. Number of Compartments Z Well Log (Y/N) Yes Wines property protected (YIN) Yes Casing height (above ground) 40 in. AT INSPECTION 7/20/2005 45 [.1pi ft. g.p.m. Other bacteria 70 oolonies/100 ml. Collected by: Working EnOneerhm, Inc. Date installed 8/ M Cleanouts (Y/N) Y Foundation cleanout (YAC Y— Depression over tank (YM) N High water alarm (Y/N) NA Date of pumping 7/20/2005 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed 8/7/95 $011 rating (g.p.dJfe or fe/bdrm) 0_6 System type deep trench Length 105 ft. Width 2.0 ft. Gravel below pipe 6 ft. Total depth 1&4" It. Eff. absorption area 1260 fe Monitoring tube Y Depression over field N Date of adequacy test 7/20/2005 Results (Pass/Fall) Pegg For 5 bed ms Nor+h /54wth N�s Fluid depth in absorption field before test I in. N / 5 Water added1671 gat. New depth 72w in. Elapsed Time: 278 min. Final fluid depth 72m4 in. Absorption rate >= 750 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) If yes, give date D. LIFT STATION Date installed NA Size in gallons 'Pump on' level at _ in. 'Pump air level at _ in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAifi station on lot 180 Absorption field on lot 180'+ Public sewer main 100+ Sewer /septic service fine 120 Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/deanout 100+ Holding tank 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 29 Water main 100+ Wells on adjacent lots 100+ Property line W+ Absorption field 5'+ Water service line 70+ Surface water 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10' Water Service line 50. Building foundation 25+ Surface water 100'+ Curtain drain None known Wells on adjacent lots 100+ Water main 100+ Driveway, paddrg/vehide storage 0' in. F. COMMENTS Tested Primary feild. Secondary field was dry. 'Cleanout C2, in the driveway, could not be found. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Cindy W. Ellis Data 9/14/2005 HAA Fee E A .4 Waiver Fee $ _ Date of Payment 9 (L1� Date of Payment Receipt Number s Receipt Number (Rev. 11101) . W. Ellis rA THEUSEOFLEN WINBTRUNONBSPEOFK:ALLYTOBHDWANYCONFLICTSBETWEEN ED LOT LINES DR EASEMENTS AND IB NOT TO BE USED FOR POBI TDNING ADDITKNIAL RECORD. OTHER THAN THOSE BHONM ON THE RECORDED PLAT. ME NOT SHOWN HEREON. AID ME NOT TO BE USED TO DETERMINE PROPERTY LINES WY BE APPROXIMATE DUE M SHOW CONDITONR. MARQUEZ CIRCLE QF.A.S1. P?.' 49 TH* ........................... > SHANE A. HOLT c LS -6914 a°s AS -BUILT SURVEY SCALE: I' -4(Y I HEREBY CERTIFY THAT 1 HAVE PERFORMED A MORTGAGEES INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 4. BLOCK 12A PRATOR SUB. ANCHORAGE RECORDING DISTRICT. ALASKA AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND THAT NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE. ALASKA THIS ]RD_ DAY OF _AUGUST 2005_ HOLT LAND SURVEYING 8870. FB 11648 TEL. 315-5517 PWA hre�ct�¢5 C4i ?1 . M3 C�Yel-- Z l�C�. oe3�4MARQUEZ �S y- CCC�°°Tii Go CIRCLE CI �CD Cml5Si(15 J \� GRAVEL D�CY• DRIVEWAY /V�afidris S / 5\aG���o�sE 00 ,� OF, At 0,1' YL�• p ,�:' 49 TH, 'b 0....:...... by OQ m SHANE A. HOLT b� Qoso '•, LS -6914 �iC, _e M FOR THE VSE OF LENDING SgTRUTgNB SPECIFICALLY M 811000 ANY CONFUCTS BETWEEN I PLATTED LOT UNES OR EASEMENTS AND 0 NOT TO BE USED FOR P064TIONNO ADOITK TINN THOSE SHOWN ON THE RECORDED PUT, ARE NOT SHOWN HEREON. ME LOCATED APPROXIMATELY ANO ME NOT TO BE USED TO DETERMINE PROPERTY ONES AS -BUILT SURVEY SCALE: 1• • AD' 1 HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 4, BLOCK 12A, PRATOR SUB. ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND THAT NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE, ALASKA THIS 3RD_ DAY OF AUGUST 2003_ HOLT LAND SURVEYING 9870, F811946 TEL. 3451513 OS-13-05;10:.3 ;G4� SGS Rer.N Client Name Project Named Clicut Sample 1l) Matrix PWSID Sample Remarks: 1055785001 Waddos Engineering Prater SD Blk. 12A Lot 4 Prater SD Bk 12A Lot 4 Drinking Wow 0 ;907 Sri 5?01 R 2/ All Dates/Times ore Alaska Standard Time Printed Datt/71me 09/12/2005 14:45 Collated DareMmv 09/06/2005 11:57 Received DateTtoe 09/06/2005 14:05 Technical Director Stephen C. Ede Allowable rep Analysis Patumata Rc3wt3 POL Units Me" Container(D Limits Dae Date Init Nittatc-N 6.33 0.100 mQ2 EPA 353.2 B (a10) 09/06/05 AZ Microbiology Laboratory TotalCotifotm 1001).NoColi col/100m1. SM'_M A (o-1) 09/0"S TL MUNICIPALITY OF: ANCHORAGE ACL • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services ffs 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. # n / 7 - C / 3 / I HAA # 1. GENERAL INFORMATION 1 n `4L_ / 6i Complete legal description L �%l'fCt�-c'clE� �f<&- Location (site address or directions) �^C/ J iU Property owner b I � - f Day phone Gk �� r"z Mailing address Day phone Lending agency Mailing address Day phone 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 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 ystem, provide written confirmation from State ADEC NOTE: If community wastewaters attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 lA 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 furtherverify 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 lei i c h c c l A_) /) 7-r cic-° 1_6 c���e Phone Addracc /�l-'iSrn % 114',. _ 1 J , l Engineer's signature DH/HSS SIGNATURE --Y Approved for � bedrooms. Disapproved. Date _21/G / �, g Conditional approval for bedrooms, with the following stipulations: Note: The well for this property meets existing State and Municipal Codes. performed to insure the wells continued suitability. Current nitrate More information on nitrates is available from the On-site Services Program, Additional Comments KAN Date f —/ Q' 1?9 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 courtesyto purchasers of homes and their lending institutions in orderto 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 responsible for errors or omissions in the professional engineer's work. is not 72-025 (Rev. 1/91) Back MOA k21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES,,,,rr\ JI r15 Environmental Services Division ^. t 501 • (907) 343 4744 825 L Street, Room 502 • Anchorage, Alaska 99 Health Authority Approval Checklist �p�glr�c% 12.,4 Pea- Parcel I.D.: C'I T 093 --fZ Legal Description: A. WELL DATA Well type �o d If A, B, or C, attach ADEC letter. ADEC water system number Date completed Log present(Y/N) `' J ;2 Cased to / Casing height (above ground) Total depth 4 � r 6 , -Wires properly protected (Y/N) _ Sanitary seal (Y/N) Date of test Static water level Well production FROM WELL LOG //5/ /-l3' AT INSPECTION g.p.m. WATER SAMPLE RESULTS: J5 1 3 Other bacteria Nitrate Coliform - Collected by: 0° r5 vab Date of sample: C'� a--�18 F g.p.m. B. SEPTIC/HOLDING TANK DATA Number of Compartments . Z Cleanouts (Y/N) Date installed — Tank size NumW Depression (Y/N) l�� High water alarm (YIN) �— Foundation cleanout (Y/N) �— A r Date of Pumping Pumper C. ABSORPTION FIELD DATA Es C � • �"b'E�'LC��l W - Soil rating (g•p•d.ff or W/bdrm) Date installed 0 System type 3 r Gravel thickness below pipe (r r Total depth Length Width z, Depression over field (Y/N) Effective absorption area - Monitoring Tube present (Y/N) P Q , For bedrooms Date of adequacy test " `� Results (Pass/Fail) _� 'S i_� '/immediately after 7S0 gal, water added (in.): Fluid depth in absorption field before test (in.); -It-;F g p d Fluid depth l� (ins) Minutes later: �` Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)' Absorption rate = If yes, give date D. LIFT STATION Date installed Manhole/Access (Y/N "Pump on" High water rm level at* c es tested bat E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot /500 Size in "Pump off" On adjacent lots / o On adjacent lots / ,o i_,' Public sewer main AIAD Public sewer manhole/cleanout A J4 Sewer /septic service line 2-511- Lift station �✓f( SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation c/ ` Property line Absorption field 5 Water main/service line l •> / 't_Surf— ace water/drainage �0 0 r -F Wells on adjacent lots /a O I f SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /() I � Building foundation Water main/service line Z Surface water / QD r't Driveway, parking/vehicle storage area Curtain drain I\lo,�� �« � � Wells on adjacent lots A✓eae F. ENGINEER'S CERTIFICATION I certify that l have determined thru field inspections and review of Municipal recor ���X�®� in conformance with MO A guidelines in effect on this date. n th�.�atua . ,`Y�.�ti�ns are Vie,. Signature 1�-) �^op t e Engineer's Name �fL r a T t�l •.' •' . . • ...... Date `i /(r q a A ��', d1fC¢iAEL N. ANDER0,4 SON ; � ;A . CE 9 69 : 44 4,." d p,��n Ptrrin5l Q�. .w HAA Fee Date of Payment C111,6 /4 ff - Receipt Number _�y�� C) t\ 573 �,® 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number '\x -V0- I ,9 CT&E Environmental Services Inc. ��� �: � c®o®opo®�®®��oove���o©eeoo© CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID 984973001 Mike Anderson P.E 6601 Marguez Circle Lt 4 Bk 12A Prator Drinking Water Parameter Results Total Coliform 0 Nitrate -N 5.13 Client POft Printed Date/Time 09/08/98 09:05 Collected Date/Time 09/02/98 08:30 Received Date/Time 09/02/98 14:40 Technical Director: Stephen C. Ede 0 Released By PQL Units Method col/100mL SM18 92228 0.100 mg/L EPA 300.0 Allowable Prep Analysis Limits Date Date Init 09/02/98 KAP 10 max 09/02/98 09/02/98 GCP 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 l.D.# 0t-�-o4312 1. GENERAL INFORMATION HAA # VAQ6\UMLILQ Complete legal description LoT N B Lc clL 12 ta. _-PR a_ °rz 5(D Location (site address or directions) Property owner W( OL �(5 A � 9 �s� Day phone 44S_- b« Mailing address &60 QCPUa Aa v0-1106z,akr3 AIL g°�cib 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 MUNICIPALITY OF ANLHUiu+ut ENVIRONMENTAL SERVICES DIVISION =l =g 2 ?, 1996 RECEIVED 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 K 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 _ cI�NNO o t= svc Phone Z4Z-8?-1 8 Address _ R-n•Q0x ikzozs A/iC_[+ Atm C�)C)siLl Engineer's signaturF���— Date 7—as-9L 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments bedrooms, with the following stipulations: 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. 72-025 (Rev. 1/91) Back MOA M Municipality of Anchorage Mu j—\ DEPARTMENT OF HEALTH & HUMAN SERVICEa�yiRplc�PAt�'t ��/ivcr� Environmental Services Division NMENrAI SERVICES 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-474A_ 1996 Health Authority Approval Checklist LEIVLU Legal Description: L /I-1 R 12At2A i o°'L- Parcell.D.: 0��-- LZ A. WELL DATA Well type's D tvA , cx If A, B. or C. attach ADEC letter. ADEC water system number Log present (YIN) Date completed 5- 2,4- ?5- Total STotal depth 14c- Cased to / `I I Casing height (above ground) Sanitary seal (Y/N) Date of test Static water level Well production t FROM WELL LOG ti -Z ?- 41 's 1 -K.s' -3-57 9— p.m- WATER SAMPLE RESULTS: Wires properly protected (Y/N) AT INSPECTION `e 9— p.m- Coliform — d — Nitrate I J77 AgJL- Other bacteria 10, Date 0 -- Date of sample: Z -1 q - 91& Collected by: M. �0130lW B. SEPTIC/HOLDING TANK DATA Date installed 7/ ?S- Tank size 15vo Number of Compartments Z Cleanouts (Y/N) Foundation cleanout (Y/N) ✓ Depression (Y/N) High water alarm (Y/N) h1pTB : $ &�PT I C " COIN 1C f=12o:& i l e-- RART Date of Pumping Pumper cAckc* vSe 4 s,jowPAcL-, -MAA LOAS 6XCA14A-r&'D t W/JS-PQC-r&J0, ;t"r#AW&�D. C. ABSORPTION FIELD DATA ► to pA V�r.� "'� >uoT'X2�Q Date installed Soil rating (g.p.d./ft` or ft'Podrm) 0-(4 System type D l /a i Length /05I i !_ _Width - a=12' Gravel thickness below pipe G' 6' _ Total depth 1? 136 Effective absorption area ._ Monitoring Tube present(YIN) t Depression over field (YN I -f Date of adequacy test N(.W Results (Pass/Fail) TIO S -S For .5- bedrooms Fluid depth in absorption field before test (in.); Immediately after gal. water added (in.): Fluid depth (ins.) Minutes later: I Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date D. LIFT STATION Jl/ Date installed _ Size in gallons Manhole/Access (YIN) "Pum e at* High water alarm E. SEPARATION DISTANCES *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 8 R t On adjacent lots Absorption field on lot -2 c> 3 t ; On adjacent lots Public sewer main 11-/ / to "Pump off' level at* Zcxo -t7 ! oo Public sewer manhole/cleanout Iq A Sewer /septic service line / oca Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: I 2W /oo rt Building foundation 2 4 k Property line a I Absorption field Water main/service line Surface water/drainage / oo -r Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation it 4 t Water main/service line / 0C Surface water _ ! oo Driveway, parking/vehicle storage area Curtain drain looms F. ENGINEER'S CERTIFICATION Zit Wells on adjacent lots 2 cb Property line /0 t 1 cerH y that I have determined thru field inspections and review ofAllunicipal in conformance with 110A IIAA guidelines in effect on this date. �� c Engineer's Name i c`y 12 , su,-Poev t; TPk tis - Date --1-ZS— HAA Fee $ w `-I% Waiver Fee $ _ Date of Payment /�o Date of Payment Receipt Number—Z� �_^�� R) Receipt Number Rev. 8/95 OSS: haa.wk.doc -ds tliat_":the'&bove systems are nEttgilre�xigg ��E1�, ere, L No CT&E Environmental Services Inc. Laboratory Division®®®®®®�m��®®®®®®�®®®���®®����e��oo�®0000 Laboratory Analysis Report PRELIMINARY RESULTS HPN: 96.0550 Client Sample ID: L4 B 12 PRATOR10550-01 Matrix: Drinking Water HSN: 3032 Client Name: PANNONE ENG SRV. Ordered By: STEVE PANNONE Collected: 2/19/96 3:00:00 PM Received: 2/19/96 3:50:00 PM Client PO: - Report Printed: 2/27/9610: 36:33 AM Released by Project Manager: MTT Technical Director: Stephen C. Ede Sample Remarks: Project Specific Notes: CALL 786-3225 WITH RESULTS AND FOR PICKUP. Parameter Result QC Qual. Units PQL Method Analysis Date Analyst's [nit. Nitrate -N 1.17 mg/L 0.10 EPA 353.2 NO2/NO3 18 -Feb -96 BMW U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Sccondary dilution. Page I of 2 GT = Greater Than UA = Unavailable ND = Not Detected 200 W. Potter Drive, Anchorage, AK 99518-1605 — Tel: (907) 562-2343 Fax: (907) 561-5301 3180 Peger Road, Fairbanks, AK 99709-5471 — Tel: (907) 474-8656 Fax: (907) 474-9685 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA