Loading...
HomeMy WebLinkAboutPROSPECT HEIGHTS #1 BLK 3 LT 6APro pect Heights lock Lot 6A 015-092 -08 Ci2, 8718- 60H �.,N„,,' MUNICIPALITY OF ANCHORAGE �,,, ,,,r '� ; On-Site Water&Wastewater Program �� s;. PO Box 196650 4700 Elmore Road � • Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 ,�� �� �'s http://www.muni.org/onsite Irri:TIV 11 �.� I)ep it tincni 4c.NOPpV6 On-Site Wastewater Disposal System Permit Permit Number: OSP181129 Effective Date: 6/19/2018 Work Type: Septic Upgrade Expiration Date: 6/19/2019 Tax Code Number: 01509208000 Site Legal Address: PROSPECT HEIGHTS #1 BLK 3 LT 6A G:2441 Site Mailing Address: 9201 NORDIC ST, Anchorage Owner: KOZICZ KEVIN A Lot Size in Sq Ft: 148975 Design Engineer: FORGE ENGINEERING Total Bedrooms: 4 This permit is for the construction of: Q Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72)and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: Prior to Inspection Report approval, the structure along the east property line is to be addressed. A building permit may be required. Received By: (hi1L . , 14/ p- Date: G f Issued By: .1 f/l / Date: .a q U MUNICIPALITY OF ANC • RAGE • 1 8 9 10 4) Community Development Department I'ne: 907-343-7904 Development Services Division a JUN Q i; 2018 :'ax: 907-343-7997 On-Site Water & Wastewater Program ti �6 4 ON-SITE SEWER/WELL PERMI X' 'LIG A 10 01 6 8 L Parcel I.D. 015-092-08 Property owner(s) Kevin A Kozicz Day phone (734) 395-7534 Mailing address 9201 Nordic St. Anchorage, AK 99507 Site address Same Legal description (Sub'd., Block & Lot) Prospect Heights #1, Block 3, Lot 6A Legal description (Township, Range & Section) Lot Size 148,975 Sq. Ft. Number of Bedrooms 4 (Four) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field X Initial ❑ Single Family (SF) IXI (w/wo ADU) Septic Tank IXj Upgrade Duplex (D) Holding Tank Renewal I IMultiple Dwellings Privy U (SF and/or D) Private Well Water Storage n THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: � / Waiver Fees: Date of Payment: (0/.71/1 Date of Payment: Receipt Number: OCf IQ5DReceipt Number: Permit No. 88/01-21129 Waiver No. Permit App_ :• c Adr " GE �-- '` ENGINEERING PO BOX 240773 ANCHORAGE,AK 99524 522-7773 677-7766(FAX) June 6, 2018 Municipality of Anchorage Development Services Dept- On-Site Water&Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Prospect Heights#1 Block 3 Lot 6A Septic system design and permit application Dear On-Site Services Engineer: The owner of the above lot intends to upgrade and replace his four-bedroom septic system with a Category III advanced treatment system. We are submitting this permit application for the construction of the new system. The attached site plan identifies the location of the home and the existing well, proposed and existing septic systems and the alternate site. No conflicts exist between this proposed system and any other well or septic system,whether on this lot or adjacent lots. The ground surface on the lot is relatively flat and slopes slightly toward the northeast. There are no slopes greater than 25% within 50 feet downslope of either the primary or alternate site. Contours are shown on the site plan showing the grade and direction of flow. Storm water drainage will not impact this septic system.The new trench will be constructed parallel to the slope as much as possible. The well on this lot is shown and the adjacent property wells are greater than 100' away from any of the property lines. The new system will be a minimum of 100' from adjacent wells and surface water. It will also be more than 50' from the well on this lot(new code for advanced treatment). The absorption trench will be more than 5' from the septic tank. The septic tank will be placed a minimum of 10' from the building foundation. The alternate site is located more than 12' from the proposed absorption trench. Please refer to the attached test hole log,plan and profile sheets for the septic design. If this design is followed,there will be no adverse impacts to adjacent properties. Sincerely, — OFA k�� � * _49 TH /\ �*+�/ Michael E. Anderson, PE fr44 t .Com`` Attachments /fro" Micha 43( �erso \���i/ �1kFRFDPROFESS10' ... PROSPECT HEIGHTS #1 B3 L6A - 9201 NORDIC ST S' l - - - /r=I ( c.. .../ ( - ( - - -- ---1— — —1— 1- /--- (1 r /7 7:1?-- — 7-- N. 10'UTILITY EASEMENT \--- / \ .... / �> 7'/ i / LOT 6A 1 I > ) / 50'WELL RADIUS FOR 1( (I ADVANCED TREATMENT SEPTIC /// / / \ / 850 INSTALL 1500-GAL I— f / / / # \ W/AX20 PODADVANTEX/w EXISTING WELL / _ -7 a W ii 1 , 4-BDRM HOM MH MH "' o ` , 2C0 2C0 0 ALTERNATE SITE I f \ GARAGE %/1411.4 \MT v ' INSTALL 12'LONG x 3'WIDE x 6' 0 ( 11 ' ) 14% CO • EFFECTIVE DEPTH ABSORPTION •• DOUBLE CLEANOUT c--- Ailo JBEFORE AND AFTER J TANK. SHED �' / EXISTING TANK AND CRIB TO BE r DECOMMISSIONED IN ACCORDANCE WITH MUNICIPAL CODE X-C -- illikGE \ ( ( NOTE: s���zekk NO SLOPES>25%WITHIN 50'OR SURFACE WATER WITHIN 100'OF THE LEGEND OF tiglkl, PROPOSED SEPTIC SYSTEM CO CLEANOUT *:49 j� vat ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS 2CO_DOUBLE CLEANOUT •• `•••A•• • • • ••• PROPERTY ARE SHOWN.NO CONFLICTS WITH WELLS OR SEPTIC FCO FOUNDATION CLEANOUT n�`'"�`x'•C SYSTEMS. MT-MONITORING TUBE F : Michael E.Anderson : 0 50 100 SV-SEPTIC VENT �+�F�� 4831-E =�Qi TH-TEST HOLE 9 sl;;•1`;r,.i.tte'� ON — =11 = FEET CONTOUR INTERVAL 5 Rt 49PROFL.s0P ..� 1"=50' PROSPECT HEIGHTS #1 B3 L6A DESIGN FACTORS: SYSTEM REQUIREMENTS: 600 GPD PEAK FLOW 3' WIDE DEEP TRENCH SYSTEM PERK RATE: 3.3 MIN/IN 1500-GAL ADVANTEX FAP TANK APPLICATION RATE: 6.0 GPD/SF AX20 FILTER POD 600 GPD /6.0 GPD/SF /6' DEEP /2 SIDES = 8.3 LF TRENCH REQUIRED (12 LF SPECIFIED) BOTTOM OF TRENCH: 9' BELOW GRADE FLOW LINE ELEVATION: 3' BELOW GRADE TOP OF TRENCH: 6"ABOVE GRADE 6" i-II�iI-= I- 1-1 1=1 11-III-III-1 I I-1 I I-I 2'-6" 1=1 I I- - 111=1111 I I-I 11-1 .:11 I-III-I 11=1 11=11 IEIIi- i-111-III=111-111=111-1 - =1111 I I I-I1-111=11 '-11-I E I I-11 -111,V 1 6" '•''= '= "`--- 4" PERFORATED PVC (HOLES DOWN) • :, . :-::: , ::,:,;, DRAIN FIELD ROCK $11.:•:•,:•:•:•:4•;•.:1:•:•;•:•!•., .::::::•; :;::::::::::::••;:;: • TYPICAL DEEP TRENCH SECTION ~ovF �l .'mss i� (NO SCALE) AM,q)Q •• `I� : MUNICIPALITY OF ANCHORAGE sclice ek DEVELOPMENT SERVICES DEPARTMENT �. �4,:•.4-.1,416 4700 ELMORE ROAD ANCHORAGE, AK 99519-6650 0*,y:9 �`�';V, AND PERCOLATION TEST OA���. Anderson SOILS LOG IilFc/Michael ..4�'� LEGAL DESCRIPTION: PROSPECT HEIGHTS #1 B3L6A i\`\\\"`�'� f PERFORMED FOR: KEVIN A K OZ I C Z DATE: 5/17/18 PROJECT No.: Professional Engineers Stamp: PARCEL ID#: 0I5-092-08 TECHNICIAN: J. MILLETTE DEPTH TEST HOLE 1 (feet) 1' OB SLOPE SITE PLAN 1 is "•s• ^ 4 ' ?• 5 'j._ .. SEE SITE PLAN 6 — 'V.;, 7 :,;'"'1' SANDY SILTY GRAVEL .i"i: GM 8 — 9 l.';...,:•-•,.`.,.:.:..,:f: _. - :t•.•.:,.` WAS GROUND WATER ENCOUNTERED? NO 10 .,:i..-,.,..,..,::::! S �•"••''<`^•��. IF YES u�WHAT DEPTH? - +• DEPTH OF WATER AFTER MONITORING: NONE :; ;? • DATE OF MONITORING: 5-24-I8 12 c.{;::s'r." ; i DEPTH To '}= . ; '.`a DATE READING GROSS TIME NET TIME WATER NET DROP 13 (MINUTES) (MINUTES) (INCHES) :.:ii-:'..... ;.";:.,,.•. •; (INCHES) 14 •:-':: :''':•'' 5/21 TEST HOLE PRESOAKED PRIOR TO TESTING: 15 '"''.•..'.:-.:.'' BOH @ 15' 1 10:16/10:26 10 416-7 ig 216 2 10:27/10:37 10 416-716 3 16 3 10:40/10:50 10 416-716 3 17 �- 4 10:51/11:01 10 4 1s 71s 3 18 5 11:02/11:12 10 416-716 3 19 6 11:13/11:23 10 416-716 3 20 PERCOLATION RATE: 3.3 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN: 4 FT. and 5 FT. COMMENTS: MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT,herein the "AGREEMENT" made and entered into as of this is- Day of of 20 13 , by and between k( v'r ✓' A • /4 0 a U z . herein the 'OWNER,"and the Municipality of Anchorage. herein the"MUNICIPALITY". in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System(AWWTS), described as q Z o l /l/a vJ'c S 'I t' F it"‘ hi.t { located at(legal description) L. ,l B 3 fr ?spe /-1 .eilti / } / 2. Maintenance,Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the term of this Agreement. the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. p, It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance,adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to$600). 14k_ Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. jUt/ Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. 11-Ik Owner acknowledges that the fine for failing to maintain and repair an AWAITS may he assessed in accordance with AMC 14.60.030. y,,(, Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. wkL Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On-Site Systems Approval. .&L Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction,maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system,or upon transfer of title,and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions,nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNER: By __ _ (signature) Date: 6 - I6-- 2-o/c Xevi A • ' o-zit--z (print name) STATE OF ALASKA ) )ss. THIRD JUDICIAL DISTRICT ) �-- The foregoing insent as acknwoedged before me this/ day of 20a by t2' ',i = ��, ',Si - % 14ORD04_.? , NOTAR Grs'7 FORK LAS'KA a *0• T 90% My C ommissio expires: ,�! sor49.1. Z Z N► �auo 'y ;-P All1/47t0 MUNICIPALITY: ''Ihrnitiw / ? By: , lam_ /„ (signature) Date: s �/// De) GO . - (print name) Title: (rev. 05/18/2018) Page 3 of 3 N 89°56 '28' 'E 490.00 10'UTILITY EASEMENT 4 „, S CD 1 J ti M p W A 14) ozz• skci 1-1-1 m h/. • Ct CS) WELL �P+ 19i.y'+ NI' ,,-k \O' k0 m ry 9�4G SPP o ym • / � U 114 5 Ni Q , grr 16r Cr - GARAGE 0 58.9 '""ry 1 _ 524 3 at 0.1' 1 • f / gi 1/ Jj SHED / 3 // Lam__---------.'/ /- ' j �/ ` / ________ __ a 1 y ------------ th , G0J0L AS-BUILT SURVEY 1' =40' NO CORNERS SET MS DATE I oo��%%.‘‘ N 90°00'00' 'E 379.20' I OFHTHEBY CERTIFY FOLLOWING DESCRIBED T I HAVE VPROPERTYMED A SURVEY 04 OF q��4p LOT 6 A, BLOCK 3, PROSPECT HEIGHTS oPs0 p'`. ���� '��Q ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE o� 49 TH Pc‘ •.7,0A VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN >r *'Q THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS `� THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SNOW ANY EXIST OTHER THAN NOTED. Oa••� ✓T CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS:AND I5 0a' '0 NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES,IMPROVEMENTS,OR FENCELINES. DATED AT ANCHORAGE,ALASKA THIS _15TH DAY OF o a . SHANE A.HOLT O EASEMENTS OF RECORD,OTHER THAN THOSE APPEARING ON THE RECORD PLAT,ARE NOT SHOWN _FEBRUARY , 2017. 000 '• LS-6914 •. 4� HEREON(UNLESS INDICATED) NOTE. FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE 44°, ' ... .•• • d�4 HOLT LAND SURVEYING PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. 9309 GROVER DRIVE pl°'es si°nat T'oo ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. 4�1\OO0000 ANCHORAGE,AK 99507 11445, FB 143-54. 178-10 345-5513 GR['-'-'ER ANCHORAGE AREA BG, ",UGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAMFCharles S. Mortimer MAILING ADDRESS Box 10124 Klatt Statip~ONE 277-0669 LEGAL DESCRIPTION Lot 6A, Block 3 Prospect Hts. LOCATION NordiC' Street SEPTIC TANK: DISTANCE FROM WELl 70 INSIDE LENGTH NUMBER OF MANUFACTURER Stack Steel -'MATERIAL Steel COMPARTMENTS 2 UL # 184987 INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY 1500 GALLONS. SEEPAGE PIT: NUMBER OF PITS 1 LINING MATERIAL Log BUILDING FOUNDATION $0 ADDITIONAL ABSORPTION DIAMETER OR WIDTH 15 ~ LENGTH27 DEPTH ll~ 8x8x6 CRIB SIZE: DIAMETER DEPTH__. DISTANCE FROM: WELL 110 ~ + TOTAL EFFECTIVE NEAREST LOT LINE 100 '+. ABSORPTION AREA (WALL AREA) $04 sQ. FT. WELL: Rotary drilled & cased open TYPE CONSTRUCTIO~I BUILDING NEAREST FOUNDATION 25 LOT LINE 80 ~+ bottom . DEPTH 139 ~ DISTANCE FROM: NEAREST SEPTIC SEEPAGE SEWER LINE 35 ~+__, TANK 70~']-, SYSTEM 110'+ CESSPOOL OTHER SOURCES None APPROVED DISAPPROVED REMARKS DISTANCES: INSTALLED BY: gwnmw PIPE MATERIAL: _~o-Hub Cast Iron LOT SLOPE: 8 % DIAGRAM OF SYSTEM DAT~/' :/Z ~ APP RD V ED / GREATER ANCHORAGE ArEa BOROUGH 3330 "C"STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-456 ! SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO, NaMe Of APPLICANT ~/*/~/~--'~'~/~ f' ~;~/~/~MatLING ADDRESS 6~(J~/~/'~-' PHONE ~7;~'- INSTALLATION OF: SEPTIC TANK SEEPAGE PIT , DRAIN FIELD .i OTHER TYPE AND SIZE OF FACILITY TO BE SERVED ~~ ~/~ ~/~'~ '~~ ~/~ FINANCED THROUGH TO BE INSTALLED BY ~/~~ SOIL TEST RESULTS ~~ ~OTE~ THI~ PERMIT I~ NOT ~ALI~ WITHOUT ~OIL ~ FINAL INSPECTION: 2/~ HOUR NOT~CE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, I~EQUIREMENT5 FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT r~ ~/ DRAIN field SEPTIC TANK TO SEEPAGE Pit WALL SEPtiC TANK .~ / ~2~~2 · . SEEPAGE PIT DRAIN FIELD "~ TO NEAREST LOT LINE. WELL TO SEPTIC TANK ~ . SEEPAGE P t DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK ~/~ / SEEPAGE PIT~~ DRAIN FIELD ' SEPtic tANK, K~/ SEePAge PIt ~/~? , DRAIN field TO rIVER, LAKE, STREAM. CAST lEON INTO AND OUT OF SEPTIC TANK AND INTO crib CROSSING GAP Of EXCAVATION 5 PEET INTO UNDISTURBED SO~L. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED With AIRTight REMOVABLE CAPS. DIAGRAM OF ~YSTEM GRAVEL BACKFILL CONFORM TO BorouGH REGULATIONS REGARDING INSTALLATION. CERT fY THAT AM vaMiL Ar W TH THE REQUIREMENTS OF GrEATE ~AANCH R AREA BOROU O~[ ~NAN ~ .OR~/~ U~O,~ E~-~AN~E NO. 28-6~ AND THAT THE ABOVE 9O ?0 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 47QO~Braga.w_St!~e~t 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, 015-092-05 1. GENERAL INFORMATION COSA# ('~._..~ C ,/0 i%9 ~ Expiration Date: Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address PROSPECT HEIGHTS S/D #1; BLOCK 5, LOT 6A 9201 NORDIC ST * ANCHORAGE~ AK * 99516 PATRICIA HUNA Day phone 9201 NORDIC ST * ANCHORAGE~ AK * 99516 Day phone 24-4-0166 Day phone Unlesso~erwiserequeste~ COSA willbehe~byDSD ~rpick~. 2. NUMBER OFBEDROOMS: 4 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 [] Public Water System [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by i~y seal affixed hereto ~ , ~ ,,~ .... , .,~. invest/gat/On, 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 !nspection, the on-'site water supply and/or wastewater disposal system is(are) in compfianCe with afl appficable Municipal and State codes, ordinances, and regulations in effect at the time of instaflation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 'Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date t~-/~, Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of afi wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system~ nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. o DSD SIGNATURE Approved for Disapproved° "'/ bedrooms. Conditional approval for bedrooms, with the following stipula.ti.~,,~ ~¢:' ON-SiTE ~ : WASTEWATER Attachments: COSA Checklist Arsenic Advisory. Septic System Advi.sory Well Flow Advisory ,~,, ~e Advisory (Rev. 11/05) Maintenance Agreements Supplemental Engineer's Report Other :6)rigirraFC~te Dste: / ~-/¢/~//~ ' Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 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: PROSPECT HEIGHTS S/D #1; BLOCK 5, LOT 6A Parcel ID: WELL DATA *PER GE(:; INSPECTION. **PER AAROW PUMP AND WELL INSPECTION. Well tyPe PRIVATE If A, B, or C provide PWSID# N/A' Well Log (Y/N) Date completed ~ 1973. Total depth '105+ ft. Cased t~ft. SEE AFl'ACHED. NO Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. Date of test Static water level Well production FROM WELL LOG ..--" g.p.m. AT INSPECTION '11/19/2010 103 7.2 g.p.m. WATER SAMPLE RESULTS: Coliform ~ colonies/lO0 mi. Arsenic: ND ug./L Nitrate mg./L. Other bacteria __ Date of sample: 1 1/18/2010 Collected by: colonies/100 mi. GE(; Ltd. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 150,0 gal. Number of Compartments 2 Foundation cleanout (Y/N) *YES Depression over tank (Y/N) ~ Date of pumping t ~-/I/2-c~1o Pumper *INSIDE CRAWLSPACE. Date installed Cleanouts (Y/N) NO High water alarm (Y/N) ONE STOP SERVICES ABSORPTION FIELD DATA Date installed 8/17/1973 Length 27 ft. Total depth '10.2 ft. Eft. absorption area 504 fi2 Monitoring tube YES Date of adequacy test 11/19/2010 Results (Pass/Fail) PASS ~*BELOW EXISTING GRADE] Soil rating (g.p.d./ft2o~ 125 Width 15 .ft. 8/17/1973 YES .ft. N/A Fluid depth in absorption field before test 0 in. Elapsed Time: - min. Final fluid depth 0 Any rejuvenation treatment (past 12 mo.) (Y/N & type) Water added 860 gal. New depth 0 in. in. Absorption rate >= 600+ g.p.d. NONE KNOWN If yes, give date - Depression over field NO For 4 bedrooms System type LOG CRIB Gravel below pipe 6 D. LIFT STATION Date installed "Pump on" level at in. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Size in gallons Manhole/Access ~ __ "Pump off" leve_.J_~, High water alarm level at Cycles tested Meets alarm & circuit requirements~ *INSTALLED PRIOR TO 10/1973 CODE '50'+ Septic tank/lift station on lot Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas 50'+ in. CHANGE. On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas N/A 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water service line 10'+ Wells on adjacent lots 100'+ Absorption field Surface water. 5'+ 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation. 10'+ Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ Water main N/A Driveway, parking/vehicle storage 10'+ F. COMMENTS 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 COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date l'2-/~/~ o COSA Fee $ H Date of Payment ~ '~/~// Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Community Development Department Development Services 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 # OSC 101326 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 3, Lot 6A of Prospect Heights #1 subdivision. This inspection revealed a nitrate concentration of 5.22 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. NORDIE STREET ~m~ ~x~ cOO m~ m m om m~ zo oz Om O~ o~ ~0 o> ~o~ 0~ 0~ ~z ~r~ zomo ~ m ~m~o zlz~ ~0> ~u~<z zE~m ~mO zZ~ mmm ~ m z;z ~ ' Oc~ m~ Oz~ ~ z m~ z~ z> Aarow Pump & Well Service LLC (907)346-9355 Inspection Report 9201 Nordic St. Well camera was ran down to 50' with no perforations found. Brian Ro Wille Aarow Pump & Well Service MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section Pie, Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 015--092-08 HAA# 1. GENERAL INFORMATION ComPlete legal description T,ot 6A; Block 3; ProSpect HeightS~1- Location (site address or directions) Property owner Bill Levett 9201 Nordic Street Anchorage, AK Day phone 346-1055 Mailing address 9201 Nordic Street Anchoraqe, AK Lending agency DaY phone Mailin. g address ' Agent Niel Tysver/ERA Realty Center Address 3333 Denali Street Anchorage, Day phone AK 99503 276-3333 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well xx Community well NOTE: Public water If community well system, provide written confirmation from State ADEC attest' lng to the legality and status of system. : 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank XX Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. '" 72q725(Rev. 1/91) Front MOAi¢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 investigat on and inspection the on-site water supply and/or wastewater disposal system is in complia/~ce with all Municipal and State codes, ordinances, and regulations in effect on the date oft~, ¢i/~spection. NameOfFirm ~,.k.;,J©, I~,._~' 4 ./ .~./ / Phone ~/~/~ Address ~O [ ~~/~~' ~ ~-~ ~' ~' ~'~ ' / ~~ ~ ~ - Date EngineeCs signature (_ ~/~ ~.~/ '~' , Alaska Water & Wastewater Consultants, Inc. is to be paid $1000.00 at closing for engineering services performed. ~? ~ ( , ~ Approved for ~ bedrooms. ~ ~':~ u,~ss~ Disapproved. !.. Oonditional approval for bedrooms, with th-e following stipul8tions: Additional comments 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, '-'- RECEIVED Municipality of Anchorage dAN O;J DEPARTMENT OF HEALTH & HUMAN 8ERVlOE~NiCiP^uw o~ ANkH Environmental Services Division ENVIRONMENTAL SERVICES 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 843-4744 Health Authority Approval Checklist Legal Description: C-~,~7- (o ,4 j f~/~. ~ ~ \ s A. WELL DATA Parcel I.D.: Well type Log present (Y/N) Total depth 130// IfA, B, or C, attach ADEC letter. ADEO water system number /%Jo Date completed *PF~o~- To ~/t7/7~ Cased to z~b fa Casing height (above ground) Sanitary seal (Y/N) FROM WELL LOG g.p.m. Wires properly protected (Y/N) "t(~7:~-~ AT INSPECTION Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform ~ Date of. sample: I~//o/~8 B. SEPTIC/HOLDING TANK DATA Date installed ~/7-~ Tank size Nitrate ~ , 5-~ ,~../ J~ Collected by: / G-DO Number of Compartments Other bacteria / Foundation cleanout (Y/N) Y ~ "~ JoE _ - . ~-o~,,~o~¢~uepress~on (Y/N) ~J O High water alarm (Y/N) Date of Pumping Iz.//o/5'~ Pumper ,~+ /! ~-,~,E- E~'~(.,~ g.p.m. Soil rating (g~.d./ff Gravel thickness below pipe C. ABSORPTION FIELD DATA Date installed Length c~,'7 Width __ Cleanouts (Y/N) ~' Effective absorption area ~'Oz~ Monitoring Tube present (Y/N) ~ Date of adequacy test /?-/~l/?~ Results (Pass/Fail) ~--3 ~ Fluid depth in absorption field before test (in.); ~ ° ~-- Immediately after ~'~ ~)al. water added (in.): System type /~o ~* ~,.~ Total depth // Depression over field (Y/N) /dO For "1 - bedrooms g.p.d. Fluid depth '~ I (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) I ~O Absorption rate = /,~o,v~_~ ~o,,/ If yes, give date 72-026 (Rev. 3/96)* D. LI~..~O N Date i nst all ed-'-'-'""""~ Size in gallons ~ Manhole/Access (Y/N) ~ump off" level at* High water alarm level at* ~..~. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~' /+ Property line Absorption. field Water main/service line. ,/~ f~- Surface water/drainage /00 ~ Wells on adjacent lots / CO/-/- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line fO /~' Surface water / 0 Curtain drain ~ ~ ~jo ~/V' Wells on adjacent lots ENGINEER'S CERTIFICATION /~ . ..~' Icertifythatl~v~det~med/~el Ispectionsandreview°fMunicipalrexc~., SignatureL._~/~ Engineer's Name Date Building foundation /O f~' Water main/service line Driveway, parking/vehicle storage area I ~O I4- are Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* ~_t~ CT&E f~nvironmenlal ~ervices Inc. ~615~01 T=O~$ P. O2/OG 987174001 AI( Water & Wa~tewa~er Cons~han[s Inc. Prospec£ H~s Lo[ 6A, Bk3 l~rosp~c£ HIs Lot 6A, Bk3 Driakxn~ W~er $~plcRem~s: Priated Detc,qFime 12/t5i98 00:08 Collected Dat~/Time 12/10198 15.30 g~ceived DaI~iTime 12111/98 12:30 Teehnlcai Diree;or; $;e~hen C. Ede Ni~r~e,N l 0~, NO COLI COL/lO0 ME, O.lOD ~/L Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2-B - Anchorage - Alaska 99504 Phone (907) 337-6179 - Fax (907) 338-:t246 Consulting Engineers December 14, 1998 Mr. & Mrs. Levett 9201 Nordic Street Anchorage, Alaska 99516 IIEC 15 1998 'V[D Dept. ~ealth & Human Subject: Inspection of Private Well & Septic System. Prospect Hts., Lot 6A, Bk 3. Dear Mr. & Mrs. Levett: Per your request, we inspected/tested the well and septic system serving the subject property. The results of the field investigation and adequacy tests are summarized as follows: A. WELL: The static water level on 12/10/98 was 103 feet below the top of the casing (BTC). Water was pumped from the well, at an average rate of 6.39 gpm for 221.5 minutes (1415 gallons). The maximum drawdown achieved during the test was to 105 feet below the top of the casing. Based upon our test results, it was detemiined that the capacity of the well exceeds the Municipal requirements for a 4 bedroom house (600 gallons per day). B. SEPTIC SYSTEM ADEQUACY TEST: The drainfield b a log crib that was constructed in 1973. According to the MOA records it is 15 feet wide, 27 feet long, and has an effective depth of 6 feet. The total depth of the system below grade is approximately 130 inches (10.8 feet). Prior to starting the test the liquid depth was approximately 8 inches deep. In the initial adequacy test, 1415 gallons were added directly into the crib, causing the liquid level to rise to a depth of 33 inches. The level was checked approximately 20 hours later and had dropped only about 2.5 inches, indicating an absorption of about 150 gallons. An additional t380 gallons was then added directly into the crib, causing the liquid level to rise 31.5 inches, to a depth of 62 inches. The level was checked approximately 22 hours later and it had dropped 21 inches, indicating that roughly 920 gallons had been absorbed. Based upon this data, it was determined that the absorption rate of the bed exceeds 600 gallons per day, as required for a 4 bedroom house. NOTE: The adequacy of a septic system is influenced by numerous factors, including, but not limited to, seasonal surface water infiltration, groundwater variations, septic system maintenance (frequency of septic tank pumping, usage of biological additives), condition of drain pipe and pipe joints (which can be damaged by seismic activity and deteriorate with age), type of substances deposited in septic system (cigarette butts, sanitary napkins, misc. objects), and the amount of water being introduced on a continual basis. Consequently, the results of this adequacy test are only valid for the specific day of the test. Furthermore, because of the limited nature of this investigation, it is possible that there are hidden defects which may not bare been detected. No warrantee is made regarding the future performance of this well or septic system. C. SEPTIC TANK: According to the MOA records, the septic tank was installed in August of 1973, it is made of steel, has two compartments, and a capacity of 1500 gallons. No warrantee is made or implied regarding the structural integrity of the septic tank. D. CLOSING: Prior to applying for the municipal health certificate, the inspection pipe in the crib will have to be r~p, aired. The coupling that connects the ABS pipe to the cast iron pipe below grade is not tight. This coupling should be tightened or replaced. Let me know when the repair is completed and I will make a final inspection. If you have any questions, please contact me at 337-6179. Sincerel' . .~/ Jeffr~,t G. .ess, P.152. /l.S. Presiden Parcel I.D. # 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 1. GENERAL INFORMATION complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING '_:.~:~ '~ ~.': Lot 6A; Block' $; "Pro~p¢ct H~Zght~ #I Location (site address or directio'ris) 9201 Nordic Street Property'owner Mailing address Lending agency Mailing address. Anchorage, AK 'Marikay & Russell Pannone 9201 Nordic Street Anchora~e~ Day phone. 346-1405 AK 99516 Day phone Agent PRUDENTIAL RELOCATION~; MANAGEMENT Attn: Pat Halvorsen Address 2500 city W~st Bl~d. Houston, TX 77042 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 Day phone (713)- 781-5100 Suite 400 '- 3. TYPE OF WATER SUPPLY: Individual well XXX C'om munity well .................. Public wate~- NOTE: If community well system, provide written confirmation from State ADEC attest- ~ng to the legality and status of system.. TYPE OF WASTEWATER DISPOSAL: ?. --. 72-025 [Rev. 1/91) Front MOA Individual on-site XXX Holding tank" ' '.-~' .. . - - ,-- Community on-site ' - - Public sewer ..-:- .. ~ :. -- . -. _... .: . NOTE: If community wastewater system, provide written confirmation from Sta~;'~ADEC attesting to the legality and status of system.'~ :': -'---~- .-- - ..:.~,~!.~i~,::?~e~:~I 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 S & S 17034 Eagle River Loop Road No. 204 Address ~ Engineer's signature DHHS SIGNATURE ~j. = . ' L~//. Approved for . bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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 trte State of Alaska. The DHHS does this as a courtesy to purchasers of homes · institutions in order to satis~ certain federal and state requirements. Employees of DHHS do not andtheirlend~ng ............ '"--~"°IF" of Anchorage is not conduct nspections or analyze data before a cer[iTicate is ssueo.-H~U ~wu.,,.,V" ,] . ! I , responsible for errors or omissions in the professional enginsefs work..'-'.:" 12..O~(Rev. 1/91) Back ~OAI,Y'~I ~ - .-.- - . ~;: Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /-4)7' ~/~, j~/_~' .~ p~oSFEC"/- Parcel I.D. O / ~O~ A. Well D~ Well ~pe ~[¢~ If A, B, or C, attach ADEC letter. ADEC water system number ~/~ Log present (Y~ ~O Date completed ~ Driller Total depth /~' ~ Cased to : -~ ~ :Casing height Sanitary seat~) ~ Wires properly protected ~) AT I~SPECTIO~ Date of test Static water level FROM WELL LOG Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/hhoJ~d!ng tank on lot Absorption field on lot Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform 0//00 ~ Nitrate Date of sample: /oo/ g.p.m. g.p.m. ~____~ .~ ~:> ; On adjacent lots /OO ¢~ ; On adjacent lots / OO ~ Public sewer manhole/cleanout /~ ~ Petroleum tank ~ ~ /~ B. SEPTIC/HOL-D1N~-TANK DATA Date installed ~2/l~ / Cleanout~N) High water alarm ('~ Date of pumping Tank size 1,_~OO ~lC Compartments Foundation cleanout Y~) ~7'~¢7~-_ Depression (Y~_~ Alarm tested (Y/N) Pumper SEPARATION DISTANCES FROM SEPTIC/H(~L-BfNG~TANK TO: Well(s) on lot ¢(.,) r On adjacent lots To property line /~, C/.- Absorption field /0 Surface water/drainage /(~ Foundation ~' ~ Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION /~O/'J(~" ~::~///~,-~"/"JT Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) ~ SEPARATION DISTANC~ATION TO: Well on~/''~'~ On adjacent lots D. ABSORPTION FIELD DATA Date installed ~//? / ~'~r' Length <~"7 ~ Total absorption area Date of adequacy test Manufacturer Man h cie/Access (Y/N)...~ ~ /".~mp off" Level at .~"~ycles tested Width __ Soil rating (GPD/Ft2) /Z~' ~'//~"~ Gravel thickness ~ ' Cleanout present(~N) Results ~'fail) ,¢'~ S ~' Surface water Water level in absorption field before test .~-O ,,~" Peroxide treatment (past 12 months) (Y/Ni SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /~..30 r~.._. To building foundation On adjacent lots Surface water Curtain drain System type Total depth / Depression over field for ~'o u/~- (~"~ After test If yes, give date On adjacent lots / O o /,7~- Property line To existing or abandoned system on lot Cutbank --~O /-~ Water main/service line Driveway, parking/vehicle storage area / Bedrooms E, ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA ouidelines in effect_~l~a~ate of this inspection. Signature Engineers Name ~0P~ ~ ~' ~ ~ '~ .... ~"~' Date H~ Fee $ ~ OO , ~ Waiver Fee $ Date of Payment /~ .~ ~ ~ ~ Date of Payment Receipt Number '~ ~ ~/~,~/ Receipt Number. CT&ERef.# Client Sample ID Matrix Commercial Testing & Engineering Co. Environmental Laboratory Services LABORATORY ANALYSIS REPORT 94.4799-1 LOT 6A BLK 3 PROSPECT HIEGHTS S/D #1 WATER ClientName S & S ENGINEERING WORK Order 82353 Ordered By R. SHAFER PrintedDate 09/21/94 @ 13:07 hrs. Project Name CollectedDate 09/19/94 ~09:45 hrs. Project# Received Date 09/19/94 @ 10:00 hrs. PWSID UA Technical Director STEPHEN C. EDE Sample Remarks: ROUTINE SAMPLE COLLECTED BY: SS. Parameter QC Allowable Ext. Anal Results Qual Units Method Limits Date Date Init Nitrate-N 3.30 mg/L EPA 353.2/300.0 10 09/19/94 CMR * See Special Instructions Above ** See Sample Remarks Ab ove U = Undetected, Reported value is thepmctical quantification limit. D = Secondary dilution. UA = Unhvailable NA = Not Analyzed LT = Les s ~lhan GT = Greater lttan 5633 B Street, Anchorage, AK 99518-1600 --Tel: (907) 562-2343 Fax: (907) 561-5301 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 investi'gation '~)f th is Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functiona end 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 ali Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm /-1 ~"~7~'~-~,~'e: ~'~'///,~_~ ~ Telephone ~ ~ ~ ~--/~ Address ~ ~ /t~z~' ~z//~ ~/ ~ ~/~ ~., ~" ~~ Date ~/~ ~ Seal Approved for y bedrooms / ~ Conditional Approved Disapproved Terms of Conditional Approval //~'/'¢~¢ Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 7/88)Back Page 2 of 2 C MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) IPALFfY OF ~Fi'~[cy~I~T ' FEBRUARY 1984 ~NviRONMENTAL SERVICE~ DiVISlO,~3-4744 APR 2 7 1990 Legal Description: Well Classification Well Log Present (Y/N) /(// Date Completed Total Depth / ¢~ Cased to/'~ Depth of Grouting Static Water Level .~, ~ ¢ Casing Height Above Ground ~-/' ¢ Electrical Wiring in Conduit(Y/N) SEPARATION DISTANCES FROM WELL: 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) To Septic/Holding Tank on Lot '70 ' ~*/'7'2.~) ; on Adjoining Lots To Nearest Edge of Absorption Field on Lot //,/~ ¢ ¢~ ; On Adjoining Lots To Nearest Public Sewer Line ~/~¢ / To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot ~"~ ¢ Water Sample Collected by ~~ ~ ;Date Water Sample Test Results Comments ~~'//~ ¢ ~* ~ ~, ~ ~//~/~, ~~/~ B. SEPTIC/~TANK DATA Date Installe~/~7[7~ Size/~ ~ No. of Compartments Standpipe~ (Y/N) Y' ,/'~/¢~,,~ Air-tight Cap/'(Y/N) Depression over Tank (Y/N) /V Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well '~/ ~c~/~c~' To Building Foundation To Property Line //~' '~ To Water Main/Service Line ¢~ ~ To Stream, Pond, Lake 0r Major Drainage Course Comments Foundation_..//Clean°ut-~'Y/N) Date Last Pumped ,~..//,-,-,-,-,-,-,-,-,-~"/'¢~4¢ ; for Temporary Holding Tank Permit (Y/N) // To Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorp.tion Strata Date Installed '~/7 Width of Field / 6- 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 // Gravel Bed Thickness ~ / Statndpipes Present (Y/N) Date of L~st Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line ~-~,~ ~' To Property Line ~...~4'P ¢--¥ ' To Existing or Abandoned System on ; On Adjoining Lots -/-/,¢¢2~:~2" To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area 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) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test, Comments **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA inspection. Signed Company ,~ ¢-.~c ?~"~-. -~ /~ ¢ MOA No. Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back effect on the date of this Waiver Fee: $ Date of Payment Engineer's Seal Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order { 21218 Date Report Printed: APR 24 90 ~ 10:43 Client Sample ID:L6A, B3 PROSPECT HEIGHTS S/D ADD NO. 1 PWSID :UA Collected APR 19 90 @ 17:00 hxs. Received APR 20 90 ~ 14:35 hzs, Preserved with :AS REQUIRED Analysis Completed :APR 23 90 Laboratory Supervisor :STEPHEN C. EDE Client Name : A~CTIC SLOPE CONSULTING Client Acer : ARCTICN P,O.t NONZ RECEIVED Req { Ordered By : tL~RRY BATES Send Reports to: I)~RCTIC SLOPE CONSULTING 2) Special Instruct: Chemlab Re£ {: 901005 Lab Smpl I'D: 1 ~atrix: WATER Allowable Parameter TeBted Result Unit; Method Limits NITRATE-N 2.6 ~/1 EPA 353.2 10 Sample ROUTINE SAI~LE. Remarks: SABLE COLLECTED Bi ~RRY BATES. Tests Performed ' See Special Instructions Above UA-Unavailable None Detected *' See $ample Remarks Abo~e Not Analyzed LT=Less Than, GT-Greater Than · (~' OLP~MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORA ~ ~ D~E~A~'~MENT OF HEALTH & ENVIRONMENTAL PROTECTIO~EPT' OF HEALTH &  825 L Street- Anchorage, Alaska 99501 ~NVIRONMENTAL PROTECTIO~ ~ ENVIRONMENTAL ENGINEERING DIVISION SEP ~ ~ 1980 )IRECTIONS~ Complete all parts on page 1, Incomplete requests will not be processed, Please allow ten (10) days for processing, PHONE 1. PRQPERTY OWNER MAILING ADDRESS PHONE PROPERTY RESIDENT (If different from above) PHONE 2. BUYER AAI LING ADORESS MAI LiNG ADDRESS /~/ ~~ ~ ~ ~ ~/~/ ~o~ 4. ~E~LTO~/*~T MAILING ADDRESS 5. LEGAL DESCRIPTION ~TREET LOCATION NUMBER OF BEDROOMS 6. TYPE OF RESIDENCE [] One ,~ · Four f SINGLE FAMILY [] Two [] ' Five [] MULTIPLE FAMILY [] Three [] Six [] Other~ 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY *ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Iog if available.) 8. SEWAGE DISPOSAL SYSTEM ~' INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY **If individual/on-site, give installation date /~'~!¢ .% . If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE I NSP ECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS ~ SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO ~ FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY ~g~ INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY ~ Connection Verified INSTALLER Size: I~C)O If Tank is homemade ' SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCES Septic/Holding Tank Absorptio ISewer Line Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS ~ APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78) ALASKA enUIRO[lmenTAL CONTROL SeRUlCeS, Inc. ~cljn¢¢rifl§ ~ ~nuirm~mcntoJ Studies ipALITY O~ ANc~O~AG~ R~C~IV~D