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DENALI VIEW BLK 3 LT 1
Denali View Block 3 Lot i #015-461-02 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191381 PID Number: 015-461-02 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name NameJENSEN TRONDSite ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Address 8600 SULTANA DRIVE, ANCH., AK 99516 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Fill added above original grade Ft. Gravel length Ft. DENALI VIEW 3 1 Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line FC Ft. Well *97'+ -- 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1000 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 10'+ -- NA Foundation1 Q'+ -- LIFT STATION Manufacturer Capacity Gal. Remarks Existing septic tank decommissioned per code. *See attached letter (WR#040037). Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tankto 3034 Installer A+drainfield Drainfield 3034 CO/MT 3034 Inspector FWCS/ MNA BENCH MARK (Assumed elevation) 100 ft Inspection iso 11/7/19 11/7/19 Location and description 2nd da 3`d 41n BOTTOM OF TRIM ON-SITE WATER AND WASTEWATER SECTION APPROVAL �F�nri�Lamp Conditional Approval: Date ® OF AA 0 or* 49 1H *� N. ANDERSON: No. CE 9489/ Septic SystemMICHAEL Approved �''•. 11/18/ 11/18/.19• , Date *k -'W Note: this ap royal does not include well permit requirements. (Rev 05!02/18) DENALI VIEW BLOCK 3, LOT 1 PID: 015-461-02 PERMIT: OSP191381 A—C=39.7' B—C=45.4' A—D=44.0' B—D=47.0' A—E=47.7' B—E=48.0' CCDTIIr' CCr'71 IAI SCALE: NTS PREPARED FOR: SUPPORT SERVICES: — OF �\\ T> AZ TROND B. JENSEN j�� 4� DENALI VIEW BLOCK 3, LOT 1 y 8600 SULTANA DR., ANCHORAGE, AK 99516 * 49TH * �I Michael N. Anderson P.. Anderson, 11 /12/2019MICHAEL N. ANDERSON / 4661 Natrona Ave. 1�r� No. CE 9489 j Anchorage, Alaska 99516 DRAWN: FWCS 11/12/19 ��sslols�•v ' (907)727 8864/FAX: (907)345 1391 SCALE: 1 i " = 30' \�� iV N O co co co O SULTANA DRIVE N 89°55'59"E 150.00' 5 89 V 55' 13"W 150.00 Eo r O M co Lu O 0 O m NOTE: A BLANKET EASEMENT IN FAVOR OF CHUGACH ELECTRIC AFFECTS THIS PROPERTY RECORDED MARCH 31, 1953, BOOK 87, PAGE 386 THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON. NOTE: ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES OR LOCATE STRUCTURES. ANY PAVING SHOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS. ":� ooP�.�F.A��sp� �� '[�0 '� .49 TFi YI ................................ s SHANE A. HOLT 0 QO i LS -6914 4�^co� �aA �d 0 �n,Ofessiona\�oli= AS -BUILT SURVEY SCALE: 1" = 40' I HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 1, BLOCK 3, DENALI VIEW 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 8 TH DAY OF _NOVEMBER 2019_ HOLT LAND SURVEYING 9344, FB111-74 TEL. 345-5513 9344, FB 111-74, 201-47 O O A. �O �R' � C Pv < Q� 5 m P U) - m m Z • • • C r M.H. .� m S QONo m 9 6 oZ Z o. 35.8 PyQ�P�C p�cl 0' o NO SWELL 9 DECK b P �` O� o0 ,ate 33' UTILITY EASEMENTAND SECTION LINE RESERVATION 10' UTILITY EASEMENT 5 89 V 55' 13"W 150.00 Eo r O M co Lu O 0 O m NOTE: A BLANKET EASEMENT IN FAVOR OF CHUGACH ELECTRIC AFFECTS THIS PROPERTY RECORDED MARCH 31, 1953, BOOK 87, PAGE 386 THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON. NOTE: ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES OR LOCATE STRUCTURES. ANY PAVING SHOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS. ":� ooP�.�F.A��sp� �� '[�0 '� .49 TFi YI ................................ s SHANE A. HOLT 0 QO i LS -6914 4�^co� �aA �d 0 �n,Ofessiona\�oli= AS -BUILT SURVEY SCALE: 1" = 40' I HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 1, BLOCK 3, DENALI VIEW 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 8 TH DAY OF _NOVEMBER 2019_ HOLT LAND SURVEYING 9344, FB111-74 TEL. 345-5513 9344, FB 111-74, 201-47 4/22/2004 Municipality of Anchorage, Mark Begich, Mayor Building Safety Division P.O. Box 196650 - 4700 Bragaw Strcct Ancliorigc, Alaska 99519.6650 - (907) 343-8301- Fax (907) 343-8200 li Ltl)://«1%-xv.liiuni.org Jeff Garness, P.E. Garness Engineering Group 3701 E. Tudor Rd, Ste 101 Anchorage, AK 99507 Subject: Waiver Request for Denali View S/D Block 3 Lot 1 Waiver Request #WR040037 Parcel ID #015-461-02 Dear Jeff Garness: Your request for a waiver of the required 100 feet horizontal separation from the absorption field and septic tank to private well has been approved. The approved separation distance is 96.0 feet. This waiver approval applies to the existing . absorption field and septic tarik to private well separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, 1e all our office at 343-7904. Sincerely, Joroodall Civil Engineer On -Site Water & Wastewater Pro aiVe;r ameelm �;v -Pak, ton . 1 A� %�% roveA to be 9 he We\� Michael N. Anderson, P.E. Civil/Structural Engineering and Construction 4661 Natrona Ave. Anchorage, Alaska 99516 Phone 345-3377 / Fax 345-1391 Support Services Brent M. Western 907-440-4601 November 12, 2019 On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE LEGAL: DENALI VIEW BLOCK 3, LOT 1 Based on being able to maintain elevations, the tank was moved as far as possible away from the well and the well radius was staked prior to install. It appeared based on this staking that the installed tank was around 99’+/- to the well (see attached photo). However based on the recent survey by Shane Holt, the tank is approximately 97’ to the well and we respectfully request continuation of the waiver issued in 2004 (WR#040037). The encroachment has been improved with the tank being installed slightly further away than it was and the tank is constructed of better material (HDPE). The tank is down gradient from the well and based on all data submitted previously, there appears minimal risk associated with continuation and approval of the previously granted waiver. Please contact Brent M. Western or me if you have any questions. Sincerely, Michael N. Anderson, P.E. .w.'ll�«,. MUNICIPALITY OF ANCHORAGEmen; \ On-Site Water&Wastewater Program 0 .s. r' 1 P! Box 198850 4700 Elmore Road .t.A.rMchcEarge,Alaska 99519-6650 Phone:(907)343-79Q4 E ('907) 7997 t. r• `" hn4p ►wv.mur+a.orgfon n : w :::41_ 1epartmcnt 4 bjM4"M!`:t On-Site Wastewater Disposal System Permit Permit Number. OSP191381 Effective Date: 8/28/2019 Work Type: SepeecTank Upgrade Expiration Date: 8/27/2020 Tax Code Number: 01546102000 Site Legal Address: DENALI VIEW BLK 3 LT 1 G:2741 Site Mailing Address; 8600 SULTANA DR, Anchorage, Owner: JENSEN TROND B Lot Size In Sq Pt: 49533 Design Engineer: ANDERSON CONSTRUCTION &ENGINEERING Total Bedrooms: 3 This permit is for the construction of: 0 Disposal Feld RI Septic Tank ❑ i lcldirg Tank ❑ Privy ❑ i'nvate Well C) 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 (2417). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: 8/26/19 Issued By: /6446Mrdr gate: l LPLAOS MUNICIPALITY OF ANCHORAGE Development Services Department _i Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-461-02 Property owner(s) TROND B. JENSEN Day phone 9072500908 Mailing address 8600 SULTANA DRIVE, ANCHORAGE, AK 99516 Site address 8600 SULTANA DRIVE, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) DENALI VIEW BLOCK 3, LOT 1 Legal description (Township, Range & Section) Lot Size 49,533 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial n Single Family (SF) (w/wo ADU) Septic Tank P9 Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. FWCS - Brent Western (Signature of property owner or authorized agent) Permit/Rush Fees: oZg, Waiver Fees: Date of Payment: 7/97116/ Date of Payment: Receipt Number: Oo.35Ot Receipt Number: Permit No. 05P1It 13 '! Waiver No. G:1Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Michael N. Anderson, P.E. Civil/Structural Engineering and Construction 4661 Natrona Ave. Anchorage, Alaska 99516 Phone 345 -3377 / Fax 345 -1391 Support Services Brent M. Western 907-440-4601 August 25, 2019 On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: DENALI VIEW BLOCK 3, LOT 1 To whom it may concern: The owner has requested we proceed forward to obtain a septic permit to upgrade the aged septic tank on the subject lot. The proposed upgrade will serve the existing 3- bedroom house. The lot and area are served by private wells. The proposed design will not impact any of the neighboring properties due to the lot layout. Please contact Brent M. Western or me if you have any questions. Sincerely, Michael N. Anderson, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191381, Deb Wockenfuss, 08/28/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191381, Deb Wockenfuss, 08/28/19 Municipality of Anchorage Page -I of 2 - DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 5W 9y02.'-13 PID Number: ©/ "q(m/62. - Name: Wastewater System: ❑ New ;EL upgrade /< LE N ;21CHA1_24RS Address: ABSORPTION FIELD ;Co 00 S LT /4 4)1_2 f VE Phene No. of Bedrooms: 3 ❑ Deep Trench ❑ Shallow Trench )Q Bed ❑ Mound ❑ Other AA)CHQ1Z/Q6f_ Soil Rating: Total Depth from original grad LEGAL DESCRIPTION ./GPD/Sq. Ft. Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe a, s * Ft. 3 D64),461V I E' w SCJ P. .S- Ft. Township: Range: Section: Fill added above original grade: Gravel length: _76' Ft. o Ft. Gravel width: Number of lines: Distance between lines: I WELL: ❑ New ❑ upgrade /8 -Ft. 3 1�/ I–Ft. Classification (Private, A,B,C):EX/S7% Total Depth: Cased To: Total absorption area: Pipe material: F2/6 PegF. P20?2 I?V.C. 'z I VA7–E Ft. Ft. !ZS SQ. Ft. A 57*1" Driller: Date Drilled: Static Water Level: Installer: EEl7 �t CfW AT //UG' Date installed: 7 -2.9 - 9 y Ft. jK Yield:p Set at: Casing Height Above Ground: TANK GPMPum Ft. Ft. SEPARATION DISTANCES JR-SepticExfsT ❑ Holding ❑ S.T.E.P. To Septic Absorption Lin Holding Public/Private Manufacturer: Capacity in gallons: 11060 From Tank Field Station Tank Sewer Lines rite Material: Number of Compartments: WeIN /00 / ll y ZS F STffl Z SurfaceLIFT Water 100 f - STATION Lot S z ns: Manufacture r: Line yDI & / — "Pump on" level at: "Pump o at: High water alarm at: Foundation 71 t 4?1 Pump Make & Model Electrical Inspections performed by: Curtain AjJA) E KAJ Vv A3 Drain 6. BENCH MARK Remarks: Location and Description: Tz"-r - -0 P Ol= 6-r47ZA6£ �l.�4S �PRC3X, CENiE%L ol= i4R-4G-E 202,p- 02,pAssumed AssumedElevation: !00.00 Ft- EINGIN, Rfee 17034 Eagle River Loop Road, No. 204' Inspections performed by: Eagle River, ° a 99577 Dates: lst -Zs-9y z - z.4 2nd -`i �/ e0 A Sa.�r ; 4 v t+a. 1457A Department of Health and Human Services approval . 25 - 9 �✓ 4 Reviewed and approved by: � Date: - 1 72-013 (Rev. 9/91) MOA 25 Permit No. SW940243 Page 2 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 Report Legal Description:DENALI VIEW SUBDIVISION, BLOCK 3, LOT 1 PID No.: 01546102 2 72-013 A (1/93) - Col 002CO FINAL MADE C04 MT 91.1 85.3' 82.8' .......................... .. .......... .............................. ............. ....................................... a ........................... EXISTING . ..................................... .............. ........... ............................. 84.2 1000 GAL 84.0 �_79 4' (C05 &C06)8O.o''SEPTIC TANK MT1 & MT2) A 73.4' NO WATER FOUND .......... . ... .............. . ...... . .......... ............. DRIVE ....... ................................... .................................... ................... SULTANA ............ .......... NEW BED . ...... .............. .... EXISTING C05 SYSTEM A B 7T2AIMSDT0NII SUCH THAT IT MAY BE FCO 46.0 30.0 USeD IN THE C0.1-58.0 63-6 ... .................. ........... ..... .......... ..-ROPRE ...... ........ - ............ ........ ............ CO2 63.5 61.5 D.V. 69.5 60.6 CO3 98.0 75.6 C 4 MTcoC04 98.0 86.6 C05 67.0 76.5 U) 1W 1" 06 129.01 105 .5 D MT1 74.0 184.6 Co ............. ... ..... . . ..... . . ........... ........... ....... ......... ... ... ISTING':'*I'O'O'G***G ...... ...........................................EXISTING.:. .......... ....... AL- D.v SEPTIC TANK CO2 CO3 co co C .... .. . .... . ............... ENi........ % 10 WELL 9{)A .0" ............ 40' A. Shefek' SCALE 1" = t4o. 14r7_1 72-013 A (1/93) - PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE lapfy) DEPARTMENT OF HEALTH AND HUMAN SERVICES 1�C�LI P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940243 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:RICHARDS KATHLEEN OWNER ADDRESS:8600 SULTANA DR ANCHORAGE, AK 99516-2562 PARCEL ID:01546102 LEGAL DESCRIPTION: DENALI VIEW BLK 3 LT 1 LOT SIZE: 49533 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 7/15/94 EXPIRATION DATE: 7/15/95 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) . 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 B ISSUED BY: Y: ' DATE: 7 I DATE: /� 1 M v HEALTH AUTHORITY APPROVALS July 4, 1994 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907)694-2979 FAX 694-1211 PERCOLATION _ TEST //r A. Shafer, P.E. STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN LSU/jk 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street SEWER & WATER P.O. Box 196650 MAIN EXTENSIONS Anchorage, Alaska 99519-6650 SEWER &WATER REFERENCE: Denali View Subdivision; Block 3; Lot 1 INSPECTION Request you issue a permit to upgrade the septic system serving the ENGINEERING STUDIES AND REPORTS three bedroom house on the referenced property. An adequacy test performed on the existing system for Health Authority Approval purposes found the absorption capacity of the existing system WELL INSPECTION to be inadequate. & FLOW TEST A test hole was excavated and a percolation test performed in the area of the proposed upgrade. The approximate location of the test hole is located on the attached site plan. The monitoring' tube within the test SITE PLANS hole has been checked and found to be dry. Attached is the proposed upgrade design. We do not anticipate any adverse effects on neighboring properties by ROAD DESIGN the installation of the proposed septic system. If you have any questions, or require additional information for your revie/ ease contact us. SOIL TEST Scerely, PERCOLATION _ TEST //r A. Shafer, P.E. STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN LSU/jk 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 on Z: a W o z w cc J a A WE Z O O O '.Z z3 QQo = O aV) Da - 0 C)W� w (n V) d Q zrZ_=otn )'''�LLILa LLI wmwZ w a Z W W 0 J OZ � O r F-wX ZD 0(n J W :2F_-W=mZw W U) 9 UzW d V) LA :2 QV)NI-dW 0 7 LM W F= W OO m W� W U _ W OW LL, U V) ~ 0 3Q 0 7 Zcn O F -2Z OLf) O V)V)< �F-0U z a z X O F d U 0-14 E, E- E-, E,, W E~ awz � w y -. WU)— C_"s b 7 W LL - W aV)0LLI OWN w oap.NCy II � II � o V) Coom-'o Q MV)It NV Id 311S x lJ l_�L �ptiw �owN 7zw Jw o oz Waz zhb ;z w �L w az8 W a z p W z o - a a. Z W Oo Jm. W a>►-� W Q cn LLI W x Q p 0 W a) oo PA 3'1tlOS 105 = „l aj 2. a ago r j r � i a . u4 c � on Z: a W o z w cc J a A WE Z O O O '.Z z3 QQo = O aV) Da - 0 C)W� w (n V) d Q zrZ_=otn )'''�LLILa LLI wmwZ w a Z W W 0 J OZ � O r F-wX ZD 0(n J W :2F_-W=mZw W U) 9 UzW d V) LA :2 QV)NI-dW 0 7 LM W F= W OO m W� W U _ W OW LL, U V) ~ 0 3Q 0 7 Zcn O F -2Z OLf) O V)V)< �F-0U z a z X O F d U 0-14 E, E- E-, E,, W E~ awz � w y -. WU)— C_"s b 7 W LL - W aV)0LLI OWN w oap.NCy II � II � o V) Coom-'o Q MV)It NV Id 311S x lJ l_�L �ptiw �owN 7zw Jw o oz Waz zhb ;z w �L w az8 W a z p W z o - a a. Z W Oo Jm. W a>►-� W Q cn LLI W x Q p 0 W a) oo PA 3'1tlOS 105 = „l (Eft KEF-K&.SAL) Municipality of Anchorage e DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650' SOILS LOG — PERCOLATION TEST PERFORMED FOR:"NG^CCN T?t-L�/llC� DATE PERFO, Eb1` LEGAL DESCRIPTION:/—h?� L L6—y z �/D Township, Range, Section: SLOPE ___ SITE PLAN (FEE 1 r Fia- - s,�7y soy 6,4wiilt- 4 1F�47 3 //f/ ` 10 11 12- 13- 14- 15 2131415 16 17 18 19 s, o, 4 . �-- �%SlGT P,,,eAS GROUNDWATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depthto Wate Monitoring? � Date: A 1r') 0 ■■■■...■■■ ■■■■■■■■■■ ' ■■■■■.■■■■ ■■■■■■■■■■ 20 I I PERCOLATION RATE at (minutes/inch) PERC HOLE DIAMETER 6 .. u TEST RUN BETWEEN "'S FT AND �' FT COMMENTS INEERING {G 17034 Eagle River Loop Road No. 204 PERFORMED BE:@ CERTIFY THAT THIS TEST WAS PERFORMED IN agiitiver, Alaska 9"7? ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI S IN EF ECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) DepthWater... 20 I I PERCOLATION RATE at (minutes/inch) PERC HOLE DIAMETER 6 .. u TEST RUN BETWEEN "'S FT AND �' FT COMMENTS INEERING {G 17034 Eagle River Loop Road No. 204 PERFORMED BE:@ CERTIFY THAT THIS TEST WAS PERFORMED IN agiitiver, Alaska 9"7? ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI S IN EF ECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) s 72-013 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE NEW UPGRADE Q MAILING ADDRESS LEGAL DESCRIPTION VI -L w i 71,20 c �• LOCATION c NO. OF BEDROOMS DISTANCE TO: Well Absorption area Dwelling 1 PERMIT NO. Y- y'U I/ _ UY aQ Manufacturer Material 'e No. of compartments W � re � C C / -2-- w Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth G Y DISTANCE TO: Well Dwelling PERMIT NO. Jaz O z < Manufacturer Material Liquid capacity in gallons D DISTANCE TO: Well 7 Qr / FoundatioNearest lot line PERMIT NO. U f LU s'!� J LL Z No. of lines 6 Length of each line Total length of I'nef Trench width Distance between lines Z W /b [ b inches Fes- Top of tile to finish grade Material beneath tile Total effective absorp ' acea I= �i" �j a 13 7^ inches V +� Length Width Depth PERMIT NO. w C7 a H w° Type of crib Crib diameter Crib depth Total effective absorption area y DISTANCE TO: Well Building foundation Nearest lot line J ClaskI,, D th Driller Distance to lot line PERMIT NO, J Vol r7^03 w DISTANCE TO: Building foundation Sewer line f Septic tank Absorption area(s) QCP... OTHER PIPE MATERIALS SOIL TEST RATING 2,C> CI rw INSTALLER 6, REMARKS Zo,cl� (e f- bI .. 1 6 a,14 4&/f 0 a Mo o? erns ,4- c1 fled d ej - jr4- deepe - 6--1- „o,{fi /z Ifs -C-1 J h re / APPRO D! DATE LEGAL Jc-//z 21& 72-013 (Rev. 3/78) � w MUNICIPALITY OF 8NCH�_ ,A0E DEPARTMENT OFHEnLTHAND ENVIRONMENTAL PROTECTION . ' 82 L STREET., ANCHORAGE, HK 99501 ' � 264-4720 �|—���� ������ ���`��� �� -� PERMIT NO: 840477 [)HTE ISSUED: 06/18/84 '' ^ � ' APPLICANT: VAN S. DHILEY ADDRESS: 2440 E TUDOR RD ANCHORAGE., HK 99504 ' u`/� ���t LEGAL DE5CR%P: SUBDIVISION: VIEW LOT: I BLOCK: 3 SECTION: 24 TOWNSHIP: 12N RANGE: 3W �LOT SIZE: 49599 (5Q. FT. OR ACRES) , MAX BEDROOMS: 3 ` LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOU IN DESIGNING YOUR SEPTIC SYSTEM. CHOOSE THE OPTION THAT BEST FITS YOUR SITE., I CERTIFY THAT: 1. I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOH) AND THE STATE OF HLHSKFi` 2' I'WILL INSTALL THE SYSTEM -IN ACCORDANCE WITH ALL MOH CODES AND REGULATIONS, AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT. ]' I WILL ADHERE TO ALL MOH AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK DISTANCES FROM ANY EXISTING WELL, WASTEWATER DISPOSAL SYSTEM OR PUBLIC SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT. 4. I UNDERSTAND THAT THIS PERMIT IS VALID FOR H MAXIMUM OF 3 BEDROOMS AND ' ANY ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT.' IF R LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOR BUILDING C8DES, THEN <1) AN ELECTRICAL PnT.AND INSPECTION MUST BE OBTAINED; (2) H5-BUILTS WILL NOT BE APPROVED WI Ol FIN FLECTRICAL INSPECTION REPORT/ AND (]) THE ELECTRICAL WORK ELECTRICIAN. SIGNED -_ ZDATE: �_-�����I-f�__ __. r APPLICANT: YHN �� ISSUED BY DATE: � � LFAI �---�---=-�=- ----- -��---�--~-7--- _ - -K-FQ_* F= P-4 IZ:- F=*D�w K4' ED, KRK-A ][ r-4 DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0 4.0 GRAVEL DEPTH (FT.) 2.5 0. 5 2.5 TOTAL DEPTH (FT.) 6.5 4.5 6.5 GRAVEL WIDTH (FT.) 2.5 22.0 5.0 GRAVEL LENGTH (FT. ) 124.0 ** 42.0 79.0 ** GRAVEL VOLUME (CU. YDS. ) 34.4 ^ 34.2 43.8 THNK SIZE (GALS) 1, 000. 0 ** 11000.0 ** 1,000.0 ** SOIL RATING (5Q. FT. /BR) 206 201 206 � ^ " ** GRAVEL LENGTH } 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH) ** TANK MUST HAVE HT'LEH5T -----------~-----------------~----~----- TW8COMPHRTMEMT5 I CERTIFY THAT: 1. I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOH) AND THE STATE OF HLHSKFi` 2' I'WILL INSTALL THE SYSTEM -IN ACCORDANCE WITH ALL MOH CODES AND REGULATIONS, AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT. ]' I WILL ADHERE TO ALL MOH AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK DISTANCES FROM ANY EXISTING WELL, WASTEWATER DISPOSAL SYSTEM OR PUBLIC SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT. 4. I UNDERSTAND THAT THIS PERMIT IS VALID FOR H MAXIMUM OF 3 BEDROOMS AND ' ANY ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT.' IF R LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOR BUILDING C8DES, THEN <1) AN ELECTRICAL PnT.AND INSPECTION MUST BE OBTAINED; (2) H5-BUILTS WILL NOT BE APPROVED WI Ol FIN FLECTRICAL INSPECTION REPORT/ AND (]) THE ELECTRICAL WORK ELECTRICIAN. SIGNED -_ ZDATE: �_-�����I-f�__ __. r APPLICANT: YHN �� ISSUED BY DATE: � � LFAI �---�---=-�=- ----- -��---�--~-7--- _ - SOILS LOG �- MUNICIPALITY OF ANCHORAGE . DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 -� SOILS LOG - PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 MY W 2 y'rlo1 sk 1 � Lam, iii 3 4 5------ 6 7 8 9 1 11 12 13 14 15 I 16 17 18- 19- 20- COMMENTS 81920 COMMENTS SLOPE rr i DATE PERFORMED: -"Ilx-C y/ WAS GROUND WATER 11�jS ENCOUNTERED? ..___i�L� L / P C�kY� E IF YES, AT WHAT 1 DEPTH? SITE PLANS Dy - 1 Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT PERFORMED BY:�������� �J'-i CERTIFIED BY: 72-008 (6/79) — DATE: t Y SOILS LOG MUNICIPALITY OF ANCHORAGE p� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION / PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 \\ SOILS LOG - PERCOLATION TEST PERFORMED FOR: LY ` DATE PERFORMED: LEGAL DESCRIPTION: J .C�.i(✓( N i�s%{(/-�+ a /' SLOPE SITE PLAN Pet, r4?r� 2 + `I 3 4 5 6 7 8 9 EMEM ■.I■. MENS MIME ■„■■ ■FIEN ■ INE ■IR■■ 10 11 WAS GROUND WATER j l S ENCOUNTERED? Fwd L O P 12 \ E IF YES, AT WHAT _ DEPTH? 13 14 '� 15 16 17 18 19 Reading Date Gross Time Net Time Depth to Water Net Drop (90 1 7V / 20 PERC TION RATE � JCIo�C �%�e-a%r- %/�� � �c� � c-nv o/m a/ Hole . uutes inch) TEST RUN BETWEEN -�i� FT AND FT COMMENTS PERFORMED BY: CERTIFIED BY: DATE: 72-008 (6/79)'"����� ALASKA %,,A1R0nM6nTAL C011TROL K.JlcCS, Inc. Enqineerinq & Enuironmental Studies PERCOLATION TEST DATA SHEET R�,rr CLIENT _ ;�%f%6�t/ ✓' DATE / ADDRESS ZI P CODE y _! LEGAL LOCATION'S/���'��� TOTAL DEPTH OF HOLES ft. ZONE TESTED ft TO ft READING # A, CLOCK TIME NET TIME DEPTH TO NET DROP RATE (min/in) DATUM 7'12 3C3 iia ,;3 7 _F 2a t" FINAL PERCOLATION RATE � _z (min/in) PERFORMED BY A JL�' a'� j �/ t20t) West 33rd Autnut, Suit -Ye Anckorogt, Alaska 99503 0 (901) 276- II T O M EN� BOX ,1 TAR HOUWE A ANCSORAGEv ALASKA 00502 4 � 1 344-7714 RECEIVED SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 342 DRILLED AT THE RATE OF $22.Q0 PROPERTY OWNER PER FOOT. e ..arc 320 A and.g. Mibi. & !lltd. S.tetre DaV4 344.,0026 LOCATION OF WELL SIT _ Lt.. Ba. .I Star. DRILLER Behni.e UcuL4 o4 Ramnaal Daild,inrr h7mck4. "WICIPALITY n EPT. O�F HEALTH gAGE WELL LOG: ENVIRONMENTAL PROTECTION 0----11 ' Si tv, oavel.. 35% c t a�t binders. 'JUL 9 1", . 11--342' Be tock. A un it aft" 225 A. 226 .to 231 A ahowa a ¢� stype Jiaa VA44 d e a a,Gou t 60 �Pk Ad a f tom 245 ,to 249 ahawa about 50 944za4 peg bout. Thin a4e" o� gAarur," urat," gte-Cdin,yy a-te" an down tz 300 A.Loo fAgnL 305 to 315t ahawa vett', good gAxvuaa& & pa�touo matr,La 1. & atthoulh .the d he�te t4 x4 imaL, the paten t,ia.L .ton urates &&eak ng ,in in goad uotme t4 ve W itke4. Same wa tet be low that a2ea, however the istt 25 ./,,t .tom vecy. -6t ty,. 3/4 ho44e 4u(aeA4i,&.Le pump ahoutd be Zrw tailed .to 315 A. Below ,that depth may, pump veAy of tV wa ter. Wates 4ecove44 .ca back .to within 30 A at 4u4ace. 1.6 gatia" pec A in, ca tn.g. Ovet 400 gaU.on4 o.. wa to t to 4z4e tue. To.tat waatee t ptodu4Aioa pumila at 160 ,to 180 gattorw pec hoot. Thyro wed,L ma4 tapnove t&eae douat4 with use. WeU ahouLd al so be pumped a itew mate ,t ime4 A& c w4 ta.L ctaA ,i Paul 4A Tutt by. eve' a DI) Coast of tDAU,l in.g: $22.00 per A X 320 4 oa4: 17040.00 Paid .in.A-U ;44 26th, 84 COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF RIL WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE S THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPART DRILLING WORKS DATE P4 314.t, 84 SERVICE CHARGE OF 1'/x% PER MONTH WILL BE ASSESSES D/ON PAS E CCOUNTS. MUNICIPALITY F ANCHORAGE Development Services Department p P Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-461-02-000 Expiration Date: 9/1/2023 Legal description DENALI VIEW BLK 3 LT 1 Site address 8600 SULTANA DR Anchorage AK 99516 Current property owner(s) MCLEISH STEPHANIE A X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: a Original Certificate Date: 6/1/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA ApprovW_June 2022 MUNICIPALITY LITANCHORAGE A ly Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 fj6S'`'+5 y Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION _ Parcel I.D. 015-461-02 Complete legal description DENALI VEIW BLOCK 3, LOT 1 Location (site address) 8600 SULTANA DRIVE, ANCHORAGE, AK 99516 Current property owner(s) STEPHANIE A MCLEISH Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass Age 4 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ® Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: 3A Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Waiver Fee $ Date of Payment5�23A 3 -5/3; c)/ Date of Payment COSH ##�2�-L-�� _Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: DENALI VIEW BLOCK 3, LOT 1 Parcel ID: 015-461-02 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 7/31/1984 Total depth 342 ft Cased to *UNKNOWN ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 5/19/2023 Static water level at beginning of test 16 ft. Well production at time of test 3+ gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 1.57 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 5/19/2023 Comments: Well water level visible during flow test with static water level to 37’ total depth. *Well log does not totally state casing depth, but some data in MOA file note 11’ total depth into bedrock. B. TANK DATA Measured operating fluid level in septic tank 49” Date of pumping 5/18/2023 Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 7/25/1994 ALL standpipes present per record drawing Total measured depth from grade 9.9 ft (max) Measured depth to pipe invert from grade 4.0 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) If not, state depth into effective 0.2’ / 0.7’ ED Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 5/19/2023 Results Pass Fluid depth prior to test 0 / 4 in (S / N MTs) Water added 600 gal New fluid depth 3 / 6 in (Up into laterals <1”) Elapsed time 1400 min Final fluid depth 0 / 4 in (S MT missing 0.3’ or 3.6”) Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 6 in (MOA 0.5’ ED) Effective depth used 3.6” / 4 in (Missing ED + Final Fluid Depth) Effective depth (ED) remaining 2.4” / 2 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots & appears approximately 0.3’ ED is missing in S MT & N MT shows 0.7’ ED. MOA IR shows 0.5’ ED below 4” laterals. Septic system operating in the top half of the ED and would recommend switching diverter to original field that was dry. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No *97 ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No *96 ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS *MOA WAIVER WR#040037 G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 5/31/2023 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 5/31/23 ?�;V(IM s MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Section o Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-461-02 Expiration Date: Z-h'Z ZQ 1. GENERAL INFORMATION Complete legal description DENALI VIEW BLOCK 3, LOT 1 Location (site address) 8600 SULTANA DRIVE, ANCHORAGE, AK 99516 Current property owner(s) TROND B. JENSEN Mailing address Real estate agent 8600 SULTANA DRIVE, ANCHORAGE, AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 65b _._ Waiver Fee $ Date of Payment i �"/ doti.- Date of Payment Receipt Number 63--i>3a Receipt Number COSA # oS GPq 1 5 3 7 Waiver # COSA Checklist Legal Description: DENALI VIEW BLOCK 3, LOT 1 Parcel ID: 015-461-02 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 7/31/1984 Total depth 342 ft Cased to 11 ft (INTO BEDROCK) Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 8/6/2019 Static water level at beginning of test 23 ft. Well production at time of test 1.38 gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 1.94 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample 11/4/2019 Comments __________________________________________________________________________________ B. TANK DATA – 11/7/19 NEW TANK Age of tank(s) 0 years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 7/25/1994 ALL standpipes present per record drawing Total measured depth from grade 4.3 ft (max) Measured depth to pipe invert from grade 3.8 ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 1620 gallons Adequacy test date 8/7/2019 Results Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 600 gal New depth 0 in Elapsed time <1 min Final fluid depth 0 in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) N If yes, enter date Comments/Deficiencies: Measured total depth at grade varies (fill varies) from pipe locations – min noted above. S. 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm ANDERSON CONSTRUCTION & ENGINEERING Phone 345-3377 Address 4661 NATRONA AVENUE, ANCHORAGE AK 99516 Engineer's Printed Name MICHAEL N. ANDERSON, PE Date 11/7/2019 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change 1 due to subsurface conditions that may not be observed from the surface, changes in land use, OF AZ Ik local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the , system and maintenance. The operational life of all well and septic systems are subject to Of,•'' these various and dynamic characteristics and are outside the control of the evaluator of the *.4 well and septic system. Therefore, any estimate of how long a system will function satisfactory 04' for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by F S and Anderson Construction & Engineering. V0, cis MQ 4 6. DSD SIGNATURE11/7/19.-•' J t/ System #1 Approved for ,'2 bedrooms � ti System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: J Z l The Municipality of AnchoragDevelopment 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 X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100’ Yes if No*97’+/- ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No *96’+ ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Property Line > 5’ Yes if No ft Absorption Field > 5’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10’ Yes if No ft Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No F. ENGINEER’S COMMENTS *WR#040037 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. 11/12/19 Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 B Street P.O. Boxox 19 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D. 015-46-102 COSA# l D 0035 1. GENERAL INFORMATION Expiration Date: Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address DENALI VIEW BLOCK 3. LOT 1 8600 SULTANA DRIVE 'ANCHORAGE, AK 99518 GORDON HAYES Day phone C/O AGENT 8600 SULTANA DRIVE "ANCHORAGE, AK 99518 Day phone JANELLE PFLEIGER W/REMAX Day phone 110 W. 38TH SUITE 100 'ANCHORAGE, AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well N Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ 242-0076 TYPE OF WASTEWATER DISPOSAL: Individual On-site N Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal axed 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 riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SURE 101 • ANCHORAGE, AK 99507 Engineers Printed Name JEFFREY A. GARNESS, P.E. Engineers Comments: In conducting this evaluation, GEG, VD. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines d Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden dofects 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 ownerlisted above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Date Z )t 0 110 I *..jff G.. ess: CE -7953 dG Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA Checklist Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineers Report Nitrate Advisory Other `VT OF'4 ON-SITE •:��;; WATERAND ; m= WASTEWATER PROGRAM ' k 00 By: O� �/ L V �� Original Certificate Date: 2 .2 • - - LIP (Rev. TINS) Municipality of Anchorage T (\• Development Services Department Building Safety Division On -Site Water 8 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: DENALI VIEW BLOCK 3, LOT 1 Parcel ID: 015-46-102 A. WELL DATA 'CASED TO BEDROCK Well type PRIVATE If A. B, or C provide PWSID# N/A Well Log (YIN) YES Date completed 7/31/1984 Sanitary seal (YIN) YES Wires properly protected (YIN) YES Total depth 342 ft. Cased to "11 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 7/31/84 2/5/10 Static water level 30 ft. 24 ft. Well production 2+ g.p•m• 1.00 g.p,m• WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 2.54 mg./L. Other bacteria 0_colonies/100 ml. Arsenic: <5.0 ug./L. Date of sample: 2/12/10 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 7/21/84 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping Q S O -Pumper,,&'irpl.1a S CJI. T nG C. ABSORPTION FIELD DATA BELOW EXISTING GRADE 7/21/84BED Date installed 7/25/94 Soil rating (g.p.d./fee /bd 0.4 System type BED 44 0.5 Length 25 ft. Width 15 ft. Gravel below pipe 0.5 ft. •4.7 968 Total depth •9.5 ft. Eff. absorption area 1125 ft' Monitoring tube YES Depression over field NO Date of adequacy test •'2/12/10 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before testDR in. Water added 887 gal. New depth 1_5 in. Elapsed Time: 55 min. Final fluid depth DRY In. Absorption rate >= 450+ g.p,d• Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date ••1984 TRENCH WAS TESTED. IT IS SUGGESTED THE VALVE BE ROTATED TO OLD FIELD, IT IS NOW FLOWING TO THE 1994 TRENCH, WHICH HAS APPROXIMATELY 4 INCHES OF LIQUID IN IT. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off" leve High water alarm level Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanknift station on lot '96'+ On adjacent lots 100'+ Absorption field on lot '96'+ Public sewer main N/A Sewer /septic service line 25'+ Animal containment areas 50'+ On adjacent lots Public sewer manhole/cleanout N/A Holding tank N/A 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 N/A 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 N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS i WR#040037 G. ENGINEER'S CERTIFICATION oo`� Q . I certify that I have determined through field inspections and p v y ❑ r* vQ review of Municipal records that the above systems are In 0 conformance with MOA COSA guidelines in effect on this date. QQ •,Je f .f A 'G mess-' Engineers Printed Name JEFFREY A. GARNESS Q a E-7 � :p Date Z'I,r.t'1`�A� �P'o r05s10neoo ��44000�� � COSA Fee S G1 � 10 " Waiver Fee $ Date of Payment I I o Date of Payment Receipt Number (7 �� �+ w Receipt Number (Rev. 11105) Municipality of Anchorage AN Development Services DepartmentBuilding Safety Division ,. On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 �, G www.ci.anchorage.ak.us (907) 343-7904 / Gj CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-461-02 HAA#_ D Q� C�a 1. GENERAL INFORMATION Expiration Date: l " - I Complete legal description DENALI VIEW S/D; LOT 1, BLOCK 3 Individual On-site Individual Water Storage ❑ Location (site address or directions) 8600 SULTANA DRIVE * ANCHORAGE. AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address DAVID & MARY BETH BECK Day phone 345-9736 8600 SULTANA DRIVE * ANCHORAGE, AK 996516 CLAIR RAMSEY W/DYNAMIC PROPERTIES Day phone Day phone 3111 "C" STREET * ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 261-7552 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ 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 served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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 GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 - Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Date !� Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: l`�<<<t%'-Y OF,gN' _gyp, _,....•_ C,c.� WATER AND ; m= WASTEWATER • Attachments: OPROGRAM HAA Checklist Manitenance Agreements J'-%�'' • • • •'� p�\���, Septic System Advisory Supplemental Engineer's Reort rl►► Well Flow Advisory Other By: Original Certificate Date: (Rev. 12/01) Municipality of ,Anchorage r • ;' Development Services Department Building Safety Division On-Site Water & Wastewater Program u` 4700 South Bragaw St.. P.O. Box 196650 Anchorage, AK 99519-6650 l i www.ci.anchorage.ak.us (907) 343-7904 R HEALTH AUTHORITY .APPROVAL 'CHECKLIST I. OT 1 BLOCK 3 Parcel ID: 015-461-02 Legal Description: DENALI VIEW S/D; L i A. WELL DATA *ASSUMED CASED TO BEDROCK Well type hPRWATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES i P Date completed 7/31/1984; Sanitary seal (Y/N) YES s Wires properly protected (Y/N) YES Total depth 342 ft. Cased to *11 ft. Casing height (above ground) 12+ in. g ' IF AT INSPECTIONFROM WELL LOG r Date of test 7/31 /1984 5/13/2004 i22. ` Static water level 30 ft, ft. Well production 2+` 9,p•m• 3.07: g.p.m. { WATER SAMPLE RESULTS: i, Coliform 0 colonies/100ml. Nitrate 2.89 mg:/L. Other bacteria 3 colonies/100 ml. ` Arsenic:: INA mg./L. Date of sample: 5/13/2004 Collected by: GEG, Ltd. B. SEPTIC/HOLDING T r ANKDATAi • Tank Type/Material ,STEEL Date installed /21/1984 it M Tank size �, 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water. alarm (Y/N) N/A r . it i I. _ , ., , ; �i . • Date of pumping 5/10/2004 i pumper A+ HOME SERVICES' k C. ABSORPTION FIELD DATA 1984 BED/1994 BED '*TESTED 1984 BED 7/21/1984 , , , '1984 BED/1994 BED k Date installed 7/25/1994 Soil rating (g p.d./fto /bdr 201 0.4 Syste' type ' l below pipe 0.5/0.5Length 44/25 22/15IWidth Graveft, Ip P 968/ TJi tat depth 5.0/9.5 ft. Eff. absorption area 1125 ft2 Monitoring tube YES Depression over field NO * 4 PASS 3 bedrooms 14 .200 r bed o 5 n o Date of adequacy test / / , .; . Results (Pass/Fail) r � � F . 4 Y ee.. ,? f ** '. - 9a Fluid depth in absorption field before test DRYin. Water added 1000 I New depth .10 in. Elapsed Time: 1417 min ;Final fluid depth DRY in. Absorption rate >_ 450+ g,P,d• Any rejuvenation treatment (past 12 mo.) (Y/N &type) NONE KNOWN If yes, give date '"PERFORMED 1000 GALLON, PRESOAK .ON 5/13/2004 F" _--1___1-----_111-I----"- -, _1--'___ !'--.. --,_-_--._--_-1--i ------ ___ _.__. . D. LIFT STATION Date installed "Pump on" level at in. Size in gallons Manh�eA 'Pump off' in. High larm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot *96'+ Absorption field'on lot *96'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+; Property line 5'+ Absorption field 5'+ Water main N/A 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 N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN , .Wells on adjacent lots 100'+ F..COMMENTS. *SEE ATTACHED WAIVER REQUEST 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 Prin d Yame JEFFREY A. GAR NESS Date &14-104,- bri G HAA Fee $ �io�-e�,c�,J!�,� `,Waiver Fee $ c '.J ff y Garn ss:' QO9� C 7953.tic O A 0,P ro f e s sio0°ate' ���OOooda Date of Payment �Q Date of Payment Receipt Number d Receipt Number (Rev.12101) cu cu O m co 3 Q1% co co 0 c -- CD VA SULTANA DRIVE N 89?55'59"E 150.00' 1 I I i I / r /Z I I ri i S �v I S o j S qQ / SEE DETAIL rq i S S I S� rli -zi I SS t I j I / ; I o. ASPHALT 35.8 d, �9 WELL i o L1ECK r/ M i �• j I � I I I I I i i i I , i i 33' UTILITY EASEMENTAND SECTION LINE RESERVATION i 10' UTILITY EASEMENT WELL — SEWER SEPERATI❑N DETAIL �0 100.0 WELL c') c•) LJ NOTE 4- A BLANKET EASEMENT IN FAVOR OF o CHUGACH ELECTRIC AFFECTS THIS PROPERTY o RECORDED MARCH 31, 1953, BOOK 87, PAGE 386 `49 TH -W 9 ................... �l SHANE A. HOLT:- iI LS -6914 v4�4n�°fessl0ra.� �-d.� AS -BUILT SURVEY SCALE: 11" = 40' 1 HEREBY CERTIFY THAT 1 HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 1. BLOCK 3, DENALI VIEW SUB. INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN ;TING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING AD ITI ORAGE RECORDING DISTRICT, ALASKA AND TIAT JCTURES OR FENCELINES. THE VISIBLE IMPROVEMENTS SITUATED THERED: ARE EMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT. ARE NOT SHOWN HEREON. WITHIN THE PROPERTY LINES AND THAT NO VIS BLE ENCROACHMENTS EXIST OTHER THAN NOTED. E: ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROP .RTI'A SAT ANCHORAGE, ALASKA THIS _20TH____ _ LOCATE STRUCTURES.- DAY OF -MAY ------------ 2004---_ PAVING SHOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS. HOLT LAND SURVEYING 9344, FBIII-74 TEL. 345-5513 18-04; 5:15PM; -GS Ref.# 1042605001 ;tient Name Garness Engineering Group, Ltd. 'Project Name/# Denali View S/D B3, Ll :tient Sample ID Denali View S/D B3, LI 4atrix Drinking Water ample Remarks: 907 5815301 # 2/ 3 All Dates/Times are Alaska Standard Time Printed Date/Time 05/18/2004 6:05 Collected Date/Time 05/13/2004 15:25 Received Date/Time 05/13 4 15:55 Technical Director Ste h/20e 'C. Ede Release y ✓ G Allowable Prep Analysis arameter Results PQL Units Method Container ID Limits Date Date Init 'aters Department Nitrate -N 2.89 1crobiology Laboratory Total Coliform 3 OB, No Coli 0.100 mg/L EPA 300.0 B (<=10) col/100mL SM18 9222B A (<=1) 05/14/04 JJB 05/13/04 DKC 5-18-04; 5:15PM; ;907 5815301 7t 3/ 3 CME -Environmental Services inc.' Laboratory -Division ►� 4;,'�,i�.,.+.�'� �P�.�a�....;.,r��,;.s��r.:�.tsY N!&dGSAJI_fRLE 200 W. Potter Drive a Anchorage, AK 99518-1605 rinking Water Analysis Report for Total Tei: (907) 562-2343 D �y �•,z{UCTI¢NS ONREY .Fit Sla �! �p C Fax: ,(907).561-5301 MUST BE COMPLETED BY WATER SUPPLER TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ❑ PUBLIC WATER SYSTEM I.D. # Satisfactory PRIVATE WATER SYSTEM p Unsatisfactory $e Results Send lnvolee rn; ❑ Saraple.over 30 hours old, results may be unreliable �N� :r. a water ystcm me , _O O • Sample too long in transit; sample should not be,oveol:!4ours u1d'at examination tone ore cr to indicate relic le iesults. Please send (� ',�•�6L'_ ��• < - .aew,samplo via special delivery.mail. 15 Y G� All Date Redeived ��.3 T tr ' Time Received 15 5 ❑ Scnd Results p Send lnvolee Analysts Began nuu moa • mar cmc NW nt A cS7 sort z�v � City SAMPLE DATE:' z ' Month . Day Year SAMPLE TYPE: Routine , O Repeat Sample (for ropiine sample witiilab reL•iio. ) 0 Special purpose SAMPLE.LO•CA,TION O Treated Water O Untreated Water Analytical Method: jai; Membrane Filter ' O MMO=MUG 1042605-10"+ 11 tliIIIIIIIIII III ti ent to A.D.E.C. . Ar Time Collected Coll-ecteil By Plew Print Dom]. Result* Analyst FT 1 erg, Up--. aC; I Fbks Jun ❑ Fazed Date: _ Time: Client otired of iO atlsfactvry resrltst ❑ R Phoned Spoke with Faxed Date: S r, 6 Time: _ lam BACTERIOLOGICALWATE-RANALYSISRECORD Heid For Confirmation N410 -MUG Result: Total Coliform E. Coli Membranenter: Direct Count ?a Oi31, tnnr wt��^ C61onles(106 n;1 Verification: LTB t` t-: SGB iVt-: COLIFIRM TNTC -Too Numerous To Count OB — Other Bacteia Fecal Coliform Confirmation(i1� Final Membrane Filter Results 4't`S ��-�e-►-ti / Coliform/10D ml Reported By Date t'i Time hrs ; Comments: ASNESGIS Member of the SGS Group (Social Gdndrolo de Surveillance) -r-_- - 0 N�JN-4-2004 05:40A FROM:A+ HOME SERVICESY IN 907-868-6770 ra A FULL A+ HOME SERVICES"' 7501 E. 140th Avenue Anchorage, Alaska 99516 345-1890 M! &It*] Of, I#.,] ' Mary Beth Beck 8600 Sultana Drive .11�wZhofage,-.AX 99516 Block - Lot TO:3383246 INVOICE # P:1/1 DATE DESCRIPTION AMOUNT 05-104 h=12 Sofic for adequaj:y test 345-9736 8103 1700 gallons, 7 dandpipps 7 hw*&--q-'-- Tank- located 40' from front of house next to driyg= in elders. do NOT switch fiel& TOTAL REMARKS -4 Nlkf 4-& /)jt& Gallons C/ Septic Leach Area . Holding Tank —J�`StandpipesT/0 Time ❑ PROBLEM AREA CALL FOR MORE INFORMATION ❑ NEEDS TO BE DONE AGAIN IN 6 MONTHS ta Good Shape 0 sludge buildup on bottom E3 Floater on top tD� Jim cap missing or 0 Cut standpipe to 11' above ground El Needs Septictrine needs replacing 4/22/2004 lYlunicipaliiy of Anchorage Mark Begich, Mayor Building Safety Division P.O. Box 196650 • 4700 Bragaw Street Anchorage, Alaska 99519-6650 • (907) 343-8301 • Fax (907) 343-8200 http://«���e.tnuni.or� Jeff Garness, P.E. Garness Engineering Group 3701 E. Tudor Rd, Ste 101 Anchorage, AK 99507 Subject: Waiver Request for Denali View S/D Block 3 Lot 1 Waiver Request #WR040037 Parcel ID #015-461-02 Dear Jeff Garness: Your request for a waiver of the required 100 feet horizontal separation from the absorption field and septic tank to private well has been approved. The approved separation distance is 96.0 feet. This waiver approval applies to the existing . absorption field and septic tank to private well separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Joeoodall Civil Engineer On -Site Water & Wastewater Program Municipality of Anchorage Development Services Department O IP A.<o �..a Building Safety Division :' On -Site Water and Wastewater Program ` 55" 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Waiver Review Worksheet WR#: 40037 PID#:015-461-02 HAM Permit#: Date Received: 6/9/04 Legal Description: Denali View S/D Block 3 Lot 1 Engineer: Garness Engineering Group 3701 E Tudor Road, Ste 101 Anchorage, Alaska 99507 Applicant: David Beck Waiver Requested: 96 foot separation from well to septic tank and septic field waiver Criteria: Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Points: ............................................................................... Waiver is Granted: iy Waiver is not Granted. List Conditions or Reasons for above: Date: �! S ° h By: �'oF_ F7000Rf, I Name of Reviewer ............................................................................... Rec#: 53232 Amount: $1150 Date Paid: 6/9/2004 m vaa N N N N N N WtglvQz, A QUEST FOA, ArN.tLl VIEW SIP LoT I BLoGk -T wal viCa RIEQVFs7 Alvmecq, wr?, &goo3-- W01 VEk RC(?VEST Fvi, ON-Lpr WATtZ W£L` TO oN- & o7 - S E Pr l e- T Av IG S E P 7-1 L F I EC.b OF- 9lo /=E.s T; SGPTIL SYSTEM /BATA — - 60,7`4 of THE SFP7'1c E<►cf(P/ELD A'10 SEP7`Ic ! IfWk- ffRE 40,clTRD boh/A/ C71"OIENvT FRoM TWE w -Lor W A T£2 wEL c., =,F 7-dE SEPTIC- S y S T Ev►1 kvr--AE 7-o FooM- A-nJO O l/F'rz Flow > YE PFf Lc-,c-vr WO vc v A/or T/ZA VE' TDWAA-p T FSE t-�ATE/Z W& 4-c-. - 7'NE Lce-A?'ro•J vF Ty,E SEPTIC SYSTEM /S /N 4 !/IS/4PLf ArtEA, So IN 714E FvFVT of SLr TI,- CFFc,VE,v7' S U,,tp'FA 2--r SNouco 6E NDTIcZo 4*V4D P2oaLjFr� Cc7R/LEL7-E6, j qF- 400(jE SEPT« t YSTFM DHrA- 1^✓/4S P2ov,oeo •6y H/tN15sS 'F"Nfji NEE/t.A/0 EjOaUp TO `l -US TI Fy 96 F007— S EPA /ZA'i iOAJ 7-0 wI+TElZ LJG L4, DAT+`} — gASE1� ON THE r1'77-Ac-JJFP WFl-G LOTS %FE wR TER, 7'5464-E /S ^PP'QOx,A-"A77r-,L y. /So --0 ZS -0 FFA 7- AEEn itNv /N OED2 Dc(c. TMC SrRT1L w476,2 -s !'v 7WZ 4-Re/9- CTF TwE�,�/ 8 A�vD 2Z FEET FAO^l 4nv cwb-SU2F�cE . DoPo, r2 RECENT wATEpt, AESuL7'S A117RAr£,S 14/2A 2.91 •"1lc-1 /Vo COLiFOAM , A^i> 3 O.B. Tm�E SEP71c F/E�p f�rCrrvA�,yME.✓� t4m, Erf5 rev FO/Z 20 Y6925 4No HRS Nor 1MpfG7-Eo 'T/ -(e -r oN - t -or GvtoTE2 ONE �1 w�Lu W W W W W W N N h O O O N O O 1— avv rrr cr cv cr A . D. F . C, SCpA2A7lorJ l0is7*A-%/GE WA-It)F-fZ 6VICEI'INiss C - �f} /1�EirIo2ANOUrI torr+ %NE !>RTEO T��vus�rty 3 �iBS %6L•,F- �2onr WELL God PENAL( VIEW Sip SL 3 L -T SEL.t_ aE PT q b T f rET-. oil t x O i $?'AT lL LvA7£ta,eta Z2 FEES T 14-t A- CvliEck L1 ST, 7-oTPr t- DE P714 or- SE/7-IC_ FlEL.D e_ S- F, --FT n11S Z` 'R 1 SorZ- So,,gT IOA) C/I 3 )� +�/b3)y��C fG3� 4-C! 3� �•5 PEp,w.� A 3 f ! T- y ro , /J X03 WA TFIZ gLE (�2RoI rNT y'� %riE Ej4ouND SL-OPES AL—,l"'-7 REDe" by £t'c' C, S';/ 4/ZAO I6Af7- f(V 2-a- oNT A L- 5E✓ knA7-IOA/ 3. o �rtl}nIo 7-0 rA- L j�"oIAITS AF-QU/Izry TD 13F /(o POIn/TS o2 F,2�t7'7E� -ro F,,ZA^jr Walvp-2. kDWEt1E/2., YNATEa- Wtt,,L 944, CErA/ A -T 96 fool- sfpA✓LRTIOIJ FOZ n4l--os7 Zo YERns ANb 7W4 kVA-ri-2 1./Et-j- -/A-5T- RESt/LTS O#= PAA SNOws TU l3E VITK -SIV /4LL-Ot.✓i ("E L Ifi?ITS WA"' U F- � �j2A� 7ErJ . f GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS �� � May 27, 2004 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Reference: Waiver Request and Health Authority Approval for Denali View Subdivision; Lot 1, Block 3. To Whom It May Concern: The existing 3 -bedroom house is served by a private well and septic system. During our HAA evaluation we shot the separation distance between the well and the septic system using our Topcon total station. It was determined that the well is encroaching upon the septic tank that was installed in 1994, and may also be too close to the drainfield that was installed in 1984. The location of the buried drainfield (installed in 1984) is uncertain, but to be conservative, we are going to assume that it is 96 feet away from the well. Shane Holt, L.S. shot the separation distances and included the information on the as -built survey he prepared (copy attached). Based upon the information we have, we are requesting your department grant a 96 feet separation distance waiver from the well on the referenced property to the septic tank and drainfield on the referenced property. The following items are justification for the waivers: • The lot slopes downhill from the well to the septic system and the two are separated by the house and driveway. If the septic system were to overflow, effluent would not travel toward the wellhead. • The location of the septic system is in a visible area so that if any effluent was to surface, it would be noticed and the problem corrected. The other path of contamination is subsurface migration wastewater should the tank begin to leak. Based on the attached well logs, the water table is approximately 150 to 250 feet deep and in bedrock. Shallow bedrock is present throughout the area and in the immediately vicinity varies from 8 to 20 feet below the ground surface (BGS). The static water level in the surrounding wells varies from 8 to 22 feet below the ground surface. The fact that the water is encountered at 150-250 feet and the static water level is 8-22 feet BGS, is an indication that the aquifer is confined to some extent. Typically, the presence of shallow groundwater is not a mitigating factor when considering a waiver; however, based upon recent water sample results 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: gamessengineering.com (Nitrate = 2.89 mg/L, No Fecal, and 3 O.B.), the subject encroachment/s, which has existed for almost 20 years, has not had a significant adverse impact on the water quality. Based upon the aforementioned facts, it appears that there is minimal risk associated with granting the 96 feet separation distance waivers. We also request that your department issue a Health Authority Approval. If you have any ggestions, please contact us at 337-6179. Thank you for your assistance. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: gamessengineering.com GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORScr May 28, 2004 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Reference: Leachfield Diverter Valve Information for Denali View Subdivision; Lot 1, Block 3. The existing 3 -bedroom house is served by a private well and septic system. The septic system consists of two drainfields, one installed in 1984 and the one installed in 1994. S & S Engineering designed the 1994 field. According to S & S Engineering notes, the 1984 trench is abandoned. During the well and septic system test performed by Garness Engineering Group, (GEG), it was noted that there is a 6 -inch diverter valve. The homeowner's state that the septic tank pumpers switches the valve to alternate between the fields each year. Attached is a pumping receipt from August 2003, stating that the septic tank pumper switched the drainfield during the pumping event. We assume that the old field is connected to the diverter valve. GEG tested the old drainfield during the well test and it passed according to MOA HAA standards. please contact us at 337-6179. Thank you for your assistance. d.S. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: gamessengineering.com xl%NG ren mNG axn. Ewf I r LOCATION UNKNOWN.I —• goo I / / IN, I fix. � ••�' � � ,--'�� ,.•�' I \ _ I_ •I� :� " . EXISTING THREE _ . •., •4• � : ; -. � BEDROOM HOUSE • •' �\ ,:.%� EXISTING I WELL �ODw� ►�,us I I I DATE: 5/24/2004 4pQ0�0 / DRAWN BY: M.E.w v r D ooh' --4 T yQO _ GARNESS ENGINEERING GROUP, Ltd. SCALE: .:ueamm CONSULTANTS 8 GENERAL CONTRACTORS =w 3701 E. TUDOR ROAD. SUITE 101 • ANCHORAGE. AK 99507 • PHONE (907)337.6179 • FAX (907)338-3246 — 1 3O' .......... .. . ...... ........0 QO y , am s.: ° • E 795 f`O �04�� . u�Dedprofess*%Of% � ��Oppoop� PREPARED FOR: PHONE NUMBER: DAVID & MARY BETH BECK (907) 345-9736 PAGE NUMBER: 1 1 OF 1 LEGAL DESCRIPTION: DENALI VIEW S/D; LOT 1, BLOCK 3 TYPE OF WORK: 30 SCALE FOR WAIVER APPLICATION 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify -at my investigation of this Health Authority Approval application shows that the on-site watersupoy 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 dat this inspection. Phone ,y�-z9'7 7 Name Of Firm S & S EN 31WEERING Address - Eagle tzi a a Date --�� Engineer's signature A%j .. ..-... � � .'°aro®ar° a %r �yi• ?• % w ;., On a° 3ddf. 14i• o ff` 99 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for edrooms, with the following stipulation `bs: Additional Comments By: 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 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 is not responsible for errors or omissions in the professional enginear's work. � MO 021 A M.p2S (Rev. 1/91 Back#.� � & ars s'' _. a . : ..art�►iis _._ ... s.. _ .. _ ....:.!..u,..- - ::. .-_..___. _. . _ ._ _ _-. _ _.. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LoT / &ocK 3 / QLALt 060 Parcel I.D. qv A. Well Data Well type ._P—Ki VKl If A, B, or C, attach ADEC letter. ADEC water system number A/A Log presen (Y ) `Ib Date completed 2Driller R ✓ MAA!jg - Ott/ LL/ j,�1 Total depth -WL / Cased to 3 21 Casing height Sanitary seal((Y N) Wires properly protected) 72F --S FROM WELL LOG AT INSPECTION MUNICIPALITY OF ANCHORAGE Date of test /3 f �- %12 % y¢ ENVIRONMENTAL SERVICES DIVISION Static water level 3c) �; F: P 0'? 1994 Well flow , i3 g,p,m. %, g.p. Pump levell 315 /Zfcc�r�ti,�L l 3 D�'"± EC. E 1 V E D, ,�.�zv�c �tJ 3iy 5< 1/ 951 SEPARATION DISTANCES FROM WELL Tb / f/ Septic/holding tank on lot A)n ; On adjacent lots Absorption field on lot %/ 3 ; On adjacent lots 100 ' Public sewer main a 1 fi Public sewer manhole/cleanout /C3 1-,/- Sewer service line 2S �- Petroleum tank N0tJC ELq�,,J WATER SAMPLE RESULTS: Coliform 0 ,,. Nitrate U, %2 � �-� Other bacteria Date of sample: 71z?l1 q7Collected by: � S eAu(-,/A-J B. SEPTIC/#At *4erTANK DATA Date installed r7lZ,l/54- Tank size %� U G,.4 L Compartments Z CleanoutsY/ ) 1� Foundation cleanouKY N) _f(;:�C Depression (WA) AO High water alarm (Y' Alarm tested (Y/N) N%,,} Date of pumping _ 3 �� Pumper _ �%14 L64AJO YO,441'/AJC SEPARATION DISTANCES FROM SEPTIC+etBt" TANK TO: Well(s) on lot /6�z On adjacent lots 00 � t 1 � Foundation .3/ To property line `fes r Absorption fieldWater main/service line A) ��- Surface water/drainage 72•026(3M)•Front CONTINUED ON BACK PAGE C. LIFT STATION /X) �-' 1�91Q5Cr-� Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes SEPARATION lot "Pump on" level at FROM LIFT STATION TO: D. ABSORPTION FIELD DATA On adjacent lots Manufacturer "Pump off" Level at Cycles tested Surface water Date installed iZz I Z f 9- Soil rating (GPD/Ft2) 0. 4- System type 66�) Length t, Width /5-" Gravel thickness U S Total depth IT Total absorption area l 1 ZS� Cleanout present Y/)S Depression over field (Y ) Date of`adequacy test Results (pass/fail) A,/ for 7-1-11Z6C Bedrooms Water level in absorption field before test After test Peroxide treatment (past 12 months) (Y/6 If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1131 On adjacent lots / U O -+ Property line / To building foundation `7`3 To existing or abandoned system on lot On adjacent lots Cutbank AWE i Water main/service line - Surface water /�� Driveway, parking/vehicle storage area � (1- -Zoo drain /ASE K AJb w �.f ' C 0,-1 tS 1 A--dCO t) (T4 E. ENGINEER'S CERTIFICATION I certify that 1 have checked, verified, or confo t all MOA and HAA guidelines in effect -on ahe date of this inspection. i; Signature S & S ENGINEERING , I /U34 Eagle River R No. 204Y Engineer's N Q River, las Date h s HAA Fee $ Waiver Fee $ Date of Payment g Date of Payment Receipt Number Receipt Number 72-026 (3/93)' Back SINCE I90A CT&E Ref.# Client SampleID Matrix Client Name Ordered By Project Name Project# PWSID Commercial Testing & Engineering Co. Environmental Laboratory Services LABORATORY ANALYSIS REPORT 94.3811-1 Ll B3 DENALI VIEW WATER S & S ENGINEERING R.J.S. UA ----------------------- Sample Remarks: ROUTINE SAMPLE COLLECTED BY: JW. QC Parameter Results Qual Units Nitrate -N WORK Order 80801 Printed Date 08/02/94 @ 08:25 hrs. Collected Date 07/27/94 @ 15:23 hrs. Received Date 07/27/94 @ 17:00 hrs. Technical Director STEPHEN C. EDE Released B�r►I�w.�.r. Method 0.72 mg/L EPA 353.2/300.0 Allowable Ext. Anal Limits Date Date Init ---10 -------------- 07 DJS * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA=Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT= Less Than D = Secondary dilution. GT = Greater Than 5633 B Street, Anchorage, AK 99518-1600 — Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA Commercial Testing & Engineering Co. SINCE 19cB Environmental Laboratory Services �i�iii.►iii��iiiii��.rii���������������� 5633 6 Street Anchorage, AK 99518-1600 Drinking Water Analysis Report for Total Coliform Bacteria Tel: (907) 562-2343 READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE Fax: (907) 561-5301 MUST BE COMPLETED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM I.D. 4 ETTI I I I ,�K- PRIVATE WATER SYSTEM ❑ Send Results ❑ Send Invoice .'ater Svrtem hams ompany home ontict none Phone IN umber azi um er MaIngAddress - y pte p Code ❑ Send Result S S:end Invoice ompany Name S C1ry 6� �9 s me p e SAMPLE DATE: Month Day Year SAMPLE TYPE: ❑ Routine ❑ Treated Water ❑ Repeat Sample (for routine sample ❑ Untreated Water with lab ref. no. ❑ Special Purpose SAMPLE LOCATION Time Collected Collected y Please Print V TO BE COMPLETED BY LABORATORY Analysis shows ties Water SAMPLE to be: )Q Satisfactory ❑ Unsatisfactory ❑ Sample over 30 hours old, results may be unreliable ❑ Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample via special del'verymail. Date Received 77g,7 Time Received _f 70 a Analysis Began �7' z —7 ^ Q Analytical Method: 7�' Membrane Filter ❑ MMO-MUG * Number of colonies/100 mi. Lab Ref. No. Result* Analyst ~ 94-3.3 1 1 Sent to A.Ij.r..u. anch Fb{s Jun ❑ Faxed Date: SR19l} Time: Client notified of unsatisfactory results: ❑ ❑ Phoned Spoke with Faxed Date: Time: BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG Result: Total Coliform E COE Membrane Filter: Direct Count Colonies/100 ml Verification: LTB BGB COLIFIRM — Fecal Coliform Confirmation Final Membrane Filter Results _ 2f -Coliform/100 ml Reported By-, m� to I JUI G 8 1994 Time's, V hrs Comments: a vGIS Member of the ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLOR TNTC - Too Numerous To Count OR —OtherBaduia PART ONF- OF TWO: REMAINDER TD FOLLOW i , ,.,t:VV JERSEY, OHIO, UTAH, WEST VIRGINIA + MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description include lot, block, subdivision, section, township, range) Location (address or directions) r (b) Applicants Name, s 'yg'21 �' ��tt®1L0., Telephone Home Bus iness.2?G+,-;b3 Applicants Address(QpC (c) Applicant is (check one) Lending Institution ; Owner/builder Buyer ; OtherE:::l (explain); (d) Lending Institution _I 16 �,� j, �¢ L Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. Type of Residence Single—Family � Multi—Family Number of Bedrooms 3. Water Supply Individual Well M Community Other (describe) Public M Telephone Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite � Public Community Holding Tank E Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] a 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 files and from investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firmff/A�;,;i� Address .�.�Q, �•e.,.o, • Date - �' ,.e°• •� ®sg • de eCN ° o • oessee .• o (ENG................ eroy C Reid 6. DHEP Approval 4�4� No. 2251.E °•• Vri Approved for bedrooms By Approved Disapproved 67" Terms of Conditional Approval CAUTION Conditional Telephone_/_19V Date THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 v �A i a 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 files and from investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firmff/A�;,;i� Address .�.�Q, �•e.,.o, • Date - �' ,.e°• •� ®sg • de eCN ° o • oessee .• o (ENG................ eroy C Reid 6. DHEP Approval 4�4� No. 2251.E °•• Vri Approved for bedrooms By Approved Disapproved 67" Terms of Conditional Approval CAUTION Conditional Telephone_/_19V Date THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 AU AUMT ap c MUNICIPALITY OF ANCHORAGE (MOA) MVIRONMEwiW- M-r0M1dN HEALTH AUTHORITY APPROVAL (HAA) j l 7 Mi CHECKLIST - FEBRUARY 1984 264-4720 ) Legal Descri tion:Q)p- T) L A. WELL DATA Well Classification If A, \B, C, D.E.C. Approved 0q) r�^ Well Log Present ON) Date Completed �,���� � ^�TSS Yield /&—/SPH Total Depth 71t e Cased to s qZ Depth of Grouting Static Water Level _T© Pump Set At Casing Height Above Ground Sanitary Seal on Casin (Y N) Electrical Wiring in Conduit&) Depression Around Wellhead (Y& Separation Distances from Well: + 1.Q� fptj�frs O� To Septic/Holding Tank on Lot RSI Q d���'AAining Lots �� � , f' To Nearest Edge of Absorption Field on Lot " On Adjoining Lots l d To Nearest Public Sewer Line NN To Nearest Public Sewer To Nearest Sewer Service Line on Lot �.taf 1, ;Date �J Cleanout/Manhole Water Sample Collected by Water Sample Test ��R��ess/ults Comments k��t B. SEPTIC/HOLDING TANK DATA Date Installed T,3\1 Size z cc--" No. of Compartments Standpipes&). Air -tight Caps (h) Foundation Cleanout) Depression over Tank (1& Date Last Pumped N1A Pumping/Maintenance Contract on File (Y6 tat ;for "-bk- Holding Tank High -Water Alarm (1 /f Temporary Holding Tank Permit (Y/N) AM zz / Separation Distances from Septic/Holding Tan �1��� To Water -Supply Well /� To Building Foundation 3 To Property Line 2(n To Disposal Field 1� To Water Main/Service Line 1\1 fl To Stream, Pond, Lake, or Major Drainaqe Course Comments Pagel of 2 72-026(11/84) C. 4,164 v>�v ABSORPTION FIELD DATA D i1 Soils Rating in Absorption Strata / Type of System Deign Date Installed Length of Field Widthof Field Ila Depth of Field �•� Gravel Bed Thickness Square Feet of Absorption Area / �/ [�Q Standpipes PresentaN) Depression over Field (1 Date of Last Adequacy Test Results of Last Adequacy Test 1v M Separation Distance from Absorption Field: To Water -Supply Well VA To Property LineLJ To Building Foundation TU Ty�o� Existing or Abandoned System on Lot A) R ; On Adjoining Lots UA To Water Main/Service Line NA To Cutbank (if present) &O'd 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 Electrical Codes (Y/N) Comments- Dimensions hole/Access (Y/N) ** Check Permitted Bedroom Rating Against HAA Request ** p Opel at Ve.nt(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify tha I ave ch ckedAgetie( , or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ,,nn 11.� Date © ��y�� � 4/ Company�LC j MOA No. 'p r ,, 'Z �f •00,01, ®�� Receipt No. Oc(_ p, ye •� Date of Payment j7' -c6 Amount: $ 4,5-C.'6— Page 2 of 2 72-026 (11/84) •N 1• *ONN• - • e. se e : e roy C. Reid, Jr a� �'� •,• No. 2251-E e�•�ee eY•••`•e � d �%''ROFESSONP�" CHEMICAL & GEt""OGICAL LABORATORIES vF ALASKA, INC. TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER usww wrowtes 5633 8 Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE CO1MP�LETE�D BY WATER SUPPLIER - WATER SYSTEM: V) See h on back I.D. NO. Water System Name Phone No. Mailing Address City State Zip Code SAMPLE DATE: �1 F7 Mo. Day Year SAMPLE TYPE: CD�Routine ❑ Check Sample (for routine sample with lab ref. no. ► ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE NO. Time Collected II LOCATION Collected By 2 I 3 4 5 I I READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: Satisfactory Ci Unsatisfactory CI 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 mail. Date Received C(, I� Time Received 3 Y Analytical Method: Fermentation Tube Membrane Filter Lab Ref. No. Result" Analyst L J L= � ( m m L m *No. of colonies/ top ml. or No. of Positive portions. 06.1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1983 Membrane Filter. Direct Count Verification: L BGS Coilform/100ml Final Membrane Filter Results // Collform/100ml Reported By / Date_ TNTC = Too Numerous To Count P.M.