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ANOTHER LT 1
Another Lot 1 #020-093-30 3 Municipality of Anchorage - Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: PID Number: D_ _ -X,9330 Name Wastewater System: New ❑ Upgrade L Address: ABSORPTION FIELD A C 21k LoPhone: No. of Bedrooms: ❑ Deep Trench Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: 1.,). Total Depth from original grade: 6.5 GPD/Sq. Ft. L. Lot: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe I�j.Lj Ft. Ft. Township: Range: Section: Fill added above original grade: Gravel length: — Z Ft. Ft. WELL:New ❑Upgrade ' Gravel dWW: wtan4- Number of lines: Distance between lines: I Ft.I %--� Ft. Classification jPrivate, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: TM rvio, i,ob Ft. Ft. 5W SO. Ft. i DrilleA De Dr' led: Static Water Level: Inat Iler. Date installed: 1. 7• 6 Ft. Z Yield: PurAp Set at: I Casing Height Above Ground: TANK 1 It' GPM �I&W Ft. `L Ft. SEPARATION DISTANCES septic ❑ Holding ❑ S.T.E.P. To Septic Absorption LlftHolding Private Ma ufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Linea I V5;, Well Material:/ L •7 Nur of Compartments: Water >I�v! >I�o' LIFT STATION io!• Lot C�! I� r (bSize in gallons: rer: Line 77 Foundation � I'll ¢�! "Pump on" level at: "P High water alarm at: Curtain Pump Ma Electrical Inspections performed by: Drain BENCH MARK Remarks: Location and Description: sl 16 Assumed Elevation: DO Qo Ft ENGINEER'S SEAL ow e. (� mol � //,��yyAA'' ei1v i `Rp1j7 &4 ®0000 Wia°( N f! *IV`, Inspections performed by: Dates: 1s Y BOWOe OB® OOO O A 2nd °®® 4� G1 1 Michael E. Anderson o •i '.a Department of Health and Human Services ap roval �a°°v� 4381-E Reviewed by: JOH14 S�WI24 and approved 72-013 (1/91) MOA 25 Permit No. 4kw 2W 1 Page 2 of 3 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: 72.013 A (2191) MOA 25 Mt toy' b • = �� s2 0 31-5 e2a a4 I 0tpt)�tt1(91 4be Ok0- UM1101 01 If.9y00gr_ tit b'04110)- Pip -I ®® c �o �i�6 tigv "111140 A'S SEAL Michael ®� &000 ®° Michael E. Anderson 9q u � "I A381 - E "X °•° o°�' e.� � 9F04pli'0 FE SSU\'�® Permit No. Page 3 of 3 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:V T4HOIRE1 CSLI(3D PID No.: 02:0_a') 30 p/ 47 i 1 > -Z w c, YoGk �p Q�D "SOF�) R'S SEAL IWO 4m �� ✓ ®m`eeoe®�a�o V���'e �� AV 1 mmom aoaa� p°oaem�• m° , a®m ° a pN�O° ®m® P ichcael E. Anderson' _ . � e 4381 - E Cg 72-013 A (2/91) MOA 26 r. ygg-s-.nota:R*v:wqR'--�-..:��{7PM'����""p;NA�!`W"a ,ic..q:-.,,'�9tw°'.,�..v�w-,r...:.�»rx ...- ,�:�c. •.� -r ... _ "u ,R, .. STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF WATER WATER WELL RECORD jI LUGA 1 IUIY Ur wCLL BOROUGH SUBDIVISION LOT BLOCK SECTION QTRS SECTION TOWNSHIP ❑N RANGE MERIDIAN El ❑S ❑W WELL OWNER: LOCATION/SKETCH: DEPTHS MEASURED FROM:❑casing top ❑ground surface WELL DEPTH: DATE OF COMPLETION Depth of hole: i- ft ft BOREHOLE DATA: Depth Depth of casing: Material Tyoe and Color From To DEPTH TO STATIC WATER LEVEL: _ L5 ft below Estop of casing ❑ ground surface Date: • 3 % Q�ocr METHOD OF DRILLING: ,Er air rotary ❑ cable tool 7J 7 a0 ❑ other USE OF WELL: 9 -domestic ❑ irrigation ❑ monitor ❑ public supply ❑ other CASING STICK-UP: fta Diam: 6 in. to 4/at _ Casing type: in. to ft WELL INTAKE OPENING TYPE: ❑ open end ❑ screened ❑ perforated )open hole Depths of openings: to ft O� SCREEN TYPE: Diam: in. Slot/Mesh Size: Length: ft GRAVEL PACK TYPE: Volume used: Depth to top: GROUT TYPE: �r Volume: Depth: from ft to ft AUG 18 7993 DEVELOPMENMETHOD: Muni�l�uilrmr_c: Duration: ea th & Human Se ge iCes PUMPING LEVEL AND YIELD: 152 © ?� ft after !ZI_ hrs pumping�gpm PUMP INTAKE DEPTH: ft Horsepower: _ WELL DISINFECTED UPON COMPLETION? ❑ YES ❑ NO CONTRACTOR INFORMATION: REMARKS: Regist dam! usiness Name —� /J G PLEASE MAIL WHITE COPY OF LOG TO: 1.2" / DNR/DIVISION OF WATER Signature of Authorized Respre ntative Date PO BOX 772116 EAGLE RIVER AK 99577-2116 oaslla O '11" e Z EAST 4 42,9--" 2 MW Ouanto en.AJl race MULOW IBM# R j Q ` \,, \ r. aQ� � CV KM BULB snAat 2'�I H 2 �S 5- IN ss6 IN'F.L I- D y L 2 oc, F T/>7 of 20E o, 6° N FDUNDl�rraN �' 2= � of ry 32- UNDER NO CIRCUMSTANCES SHOULD AN AS—BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL UABIUTY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. LOT SURVEY SURVEY TYPE SYMBOLS FOUNDATION AS-BUILT SET REBSASPHALT FINAL STRUCTURE AS-DULY o FOUND REBAR DRAINAGE : Q::: D PLOT PLAN ... AS—BUILT ... LOT SURWY ... TOPOpRAM1y a"e� WOOD FENCE CONCRETE AS—BUILT --- NO COMEn �DN AD—BUILT No pmmum WT ® ASSUMED ELEV. x —)E METAL FENCE ® WOOD DECK PLOT PLANS & LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC„ ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. SURVEY CERIIFICATION Prepared by PLOT PLAN ,cj"""' Robert E. Johns, Jr. & Assoc. I I'w`by nron that l''°" "aroor,y'"'Vitt ° • • • • • • 4� Professional Land Surveyors 1M hrt araan and awwea l h f Ow ane that 1 • haw found a e pion W at of tM g soma ° • • • �" 842 E. 12 AVE. a °nam w the �m.@Mod nand ld%ON Ynm.l�° dne hm been rrwL � �w ; ' .•� , ANCHORAGE, ALASKA 99601 / 1? • Scale: Rea Lot S.F. Rec. Plat File No. FOUNDATION AS—BUILT �• a a s a to a b• a * 1" = 1.00' 53667 8t-27to 4 ROW E Jahns. it, hereby ewtlfy that I =how vaAbrmW an of lull .,,w) M the Date Surveyed: DrawnY�b Checked by. datlwanthA let end thald IM •••• •.♦ .•a•a•( 5 �, Ii Q,3 PE,� TILT dlmanNwr end MamneNw w sAasn bonen " bu. and na w°maMmw4 ad,t waw• _ ®No... to os JO JR..* ' Date proven; FINAL STRUCTURE AS-BUILT L� >• F _ * _ O� Grid: 3336 W.O-03-053 1, Robwt E J°M°, Jr., hor by ow tnet I �x 'a•a ••••• Legal Deecrlptlon: haw Pwfonnad an Ab-!Wt ./ sbuohwe on this lot and a� d yN: �° • d a a I� a�reaa,a ancrootwwmew,n.r.on a, a is LOT 1 ANOTHER SUBDIVISION �Swsmmoo�.l w awaaahnanb .odst i.aw. r ,,� , MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW920207 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:MCGEE KIRK & OWNER ADDRESS:2441 BRANDY CIRCLE ANCHORAGE, ALASKA 99516 PARCEL ID:02009330 LEGAL DESCRIPTION: ANOTHER LT 1 LOT SIZE: 53667 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 8/04/92 EXPIRATION DATE: 8/04/93 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: 1. INSTALL TWO CLEANOUTS AFTER SEPTIC TANK, IN ADDITION TO REQUIRED MONITORING TUBE AND CLEANOUTS ON TRENCH. RECEIVED BY: DATE: �I/ ISSUED BY: N"" 0"'m DATE: 9 �-/-9p y July 27, 1992 Municipality of Anchorage Dept. of Health & Human Services Environmental Services Division 825 "L" Street, Room 502 Anchorage, Alaska 99501 Subject: Lot 1, Another Subdivision Septic System Design Impacts to Adjacent Properties Dear On Site Services Engineer: The terrain on the subject lot slopes from the back to the front at a 5% to 10% grade with the front 50' virtually flat. The ground also slopes from the south to the north at a 2% grade. A dry drainage ditch exists along the northern boundary of the lot. Another dry ditch is in place along the roadway. These ditches appear to remain dry over the majority of the year. I have inspected the area surrounding this lot and have arrived at the following conclusions: 1. The system, if constructed as designed, will have no adverse impacts on the wells currently in use or to be placed in the future on lots located in the area. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserved space either surface or subsurface on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. Sincerely, E Q4&� Michael E. Anderson, P.E. OF A�q AW ®o®a• aassa �• •a See • as q•• a l�ia cel E. Anderson a nye. ROCKFORD CORPORATION P.O. Box 111706 ANCHORAGE, ALASKA 99511 (907) 344-4551 FAX (907) 344-2130 Job Z o -r /, ANO-rNk'/Z .5u u lyis/ 8ri SHEET NO CALCULATED BY. CHECKED BY RA DATE DATE PRODUCT 2041 (Sln0le Sheets) 2051 (Padded) ®®Inc., Groton, Mass, 01471. To Order PHONE TOLL FREE 1800-2256380 ROCKFORD CORPORATION P.O. Box 111706 ANCHORAGE, ALASKA 99511 (907) 344-4551 FAX (907) 344.2130 JOB �-°'— 1! 4" o -r A& -L Sywyism rl SHEET NO. OF CALCULATED BV / 6A DATE CHECKED BY DATE gA 2M S x BAC. _lo f1 i PRODUCT 2044 (Single Shears) 2054 (Padded) ®® Inc., Groton, Mass, 01411. To Order PHONE TOLL FREE 1.800.225.6360 Municipality of Anchorage e 1 DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: 4AI;ir—c N �y,o S'T"j M,),j DATE LEGAL DESCRIPTION: 1100 / , 4r Ir/4,L7L SUa Township, Range, section: SLOPE 1 0, - Net Time Depth to Water "® . lW97 2 O .0 G 'z,'' 3 D G:QO 4 p. •. �6 TLU v� 3n1 G = /0 /0 5 or •, � R At1EL 6 o o 7 p 0 f 9- 10- 10 11 11 p , 2 12- 13- 1314 14 15 16 17 18 19 WAS GROUND WATER No ENCOUNTERED? S IF YES, AT WHAT L DEPTH? V O P E Depth to Water After 7 Z�f Monitoring? Date: (ENGINEER'S SEAL) Ism(off s 41 AW! Q\ ,ge Michoet E. Anoe 4381-E SITE PLAN L Reading Date Gross Time Net Time Depth to Water Net Drop lW97 9z 5: Sp — G 'z,'' — At22. G:QO /Q 15 3 G = /0 /0 f z f 20-{ IL__1I PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER --�^ TEST RUN BETWEEN_ FT AND FT COMMENTS 7 2r PERFORMED BY: �►%)� sf) I RTI ATT T IS T pgggT WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ` ZIZ- 72-008 (Rev. 4/85) PERFORMED FOR Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST /`I 4�7- CO Jj Sr JW tr/U Al SEAL) SR ,,$ Pe ®O% �Y p 1R }��h e®'Q* � DATE PERFO �Q' 090o �� PIWFE' LEGAL DESCRIPTION: G,or X4iorl4oz S -0y. Township, Range, Section: -rII14 A!3` 1 0 . o D 2 . D 3-0 4- 5 5 6 boo 7 8 9- 10- 12- 13 10 12 13 "o 14 D 0 15 16 17 18 19 B" w"A ► so SLOPE ani R WAS GROUND WATER /O ENCOUNTERED? A S IF YES, AT WHAT L O DEPTH? P E Depth to Water Alter Monitoring? �n ^1 L Date: -7-47--4 JI 1 C rLAN ®���� .. �Iff, � 20 r� IL_ JI PERCOLATION RATE � (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN � FT AND FT COMMENTS /r i/LYL 13 ('_ WGZC. 66IAV7Q11 ((! W145 n P/?av2 ?"Ec' /jSr, PERFORMED BY: A)ZC �`� A1P V2sD V 1 RTI THAT THIS TEP�T WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7�Z?(7 �- 72-008 (Rev. 4185) Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 020-093-30 Expiration Date 1. GENERAL INFORMATION: 0 3U 0 5 h P E T Y Z iv Az_ Complete legal description ANOTHER; LOT 1 Location (site address) 16401 Chasewood Lane *Anchorage Current Property owner(s) Janine & Ty Nesheim Day phone 250-4042 Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class_Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ H50 Date of Payment �i�7�L / Receipt Number �2Z 51 y CE COSA OSC2 11 53 $ Waiver Fee $ Date of Payment Receipt Number Waiver # 31A 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road Suite 101- Anchorage Alaska 99507 Engineer's Printed Name: Jeffrey A Garness Date: In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE C System #1 Approved for q_ bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, OF :.. (..�................. I Jr ... 1.) ................... f� Lrey A. _5s.1 CE -7.53 le 1 0 essio a #AECC884 j ON_gT Np P with the folloax/i Sufi• ,s�-�ER 5= �G PRO By: Original Certificate Date: /DZ The Municipality of Anch age Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Other G IAA � Y Q�l Legal Description: ANOTHER; LOT 1 COSA Checklist Parcel ID: 020-093-30 If more than 1 septic system on lot: COSA Checklist # of _ Structure served by this system A. WELL DATA ❑ol Well log Is filed with Onsite (or attached) Date drilled 9112/92 Total depth 208 ft Cased to 40 ft ❑Q Sanitary seal is functioning correctly W Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 8/2°/21 Static water level at beginning of test 76.6 ft. Comments B. TANK DATA Age of tank(s) 29 years Tank type/material_C4 Measured operating fluid level in septic tank 49" 0 Standpipes/foundation cleanout per record drawing Date of pumping�� �. D. ABSORPTION FIELD DATA SHALLOW TRENCH Which system tested (date installed) 8/8/92 0 ALL standpipes present per record drawing Total measured depth from grade 6.33 ft (max) Measured depth to pipe invert from grade 4.08 It Omni ❑ NIA – pressurized field Q 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 N/A gallons Comments/Deficiencies: COSA Checklist yellow sheet Well production at time of test 6.3+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes No Coliform bacteria is Negative Nitrate mg/LNitrate less than MRL (ND) Arsenic ug/L R19rsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 8/20/21 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments N/A Adequacy test date 8/2°/21 Results [Dpass For 4 bedrooms Fluid depth prior to test 6 in Water added 766 gal New depth 6 in Elapsed time 6 min Final fluid depth 6 in Absorption rate 600+ gpd Any rejuvenation treatment (past 12 months) NONE If yes, enter date N/A GAJ 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' 0 Yes Community Sewer Manhole/Cleanout > 100' 0 Yes if No _ ft 0 Yes if No _ ft Neighboring Tank? 100' 0 Yes if No—ft _ It Private Sewer/Septic Line > 25' [Z] Yes if No _ ft Absorption Field on Lot > 100' 0 Yes if No _ ft Holding Tank > - 00' 0 Yes if No _ ft Neighboring Absorption Fields > 100' 0 Yes if No _ ft Water Main > 10'✓Q Animal Containment> 50' 0 Yes if No It 0Yes ifNo_ ft 0 Yes if No _ ft Water Service Line > 10' Q✓ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' Yes if No _ ft 0 Yes if No_ ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10` 0 Yes if No _ ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5' 0 Yes if No _ It Wells on Adjacent Lots: Absorption Field > 5' 0✓ Yes if No ft Private Wells .> 100' 0 Yes if No _ ft Water Main > 10'✓Q —ft Yes if No_ ft Community Wells> 200' 0 Yes if No _ ft Water Service Line > 10' Q✓ 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' 0 Yes if No —ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No _ ft Wells on Adjacent Lots: Water Main > 10'✓Q Yes if No _ ft Private Wells _: 100' [2]Yes if No _ ft Water Service Line > 10' Yes if No —ft Community Wells > 200' Yes if No _ ft Surface Water> 100'✓Q Yes if No It F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l 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. COSA Checklist yellow sheet O F fir. .. . ....... #AECC8E4 �ff eyY*�Gdrn ess I. VV CE 79 3 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT � On -Site Water and Wastewater Section www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval # OSC211538 Subdivision: Another Block: , Lot: 1 Ufficumm The septic tank for this property is 29 years old. The average life for a steel septic tank is 20 years. Typical replacement costs range from $7,000 to $11,000. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. Mailing Address P O Box 196650* Anchorage, Alaska 99519 X650 *`www mum org TUtS u$ft • Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 sA =fV CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 020-093-30 1. GENERAL INFORMATION Complete legal description Another, Lot 1 Location (site address) 16401 Chasewood Lane Expiration Date: f za — % 3 Current Property owner(s)William Sargent Day phone Mailing address 16401 Chasewood Lane, Anchorage, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well El Individual FX1 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Received by: -�`��y Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ ? G% L-) Waiver Fee $ Date of Payment /D - / C9 " / 2— Date of Payment Receipt Number 0 2 0 Receipt Number COSA# 0 SC� I Z 7 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certif icate of On -Site System s Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services LLC Phone 272-8218 Address P.O. Box 100217, Anchorage, AK 99510 Engineer's Printed Name Steven R. Pannone Date 6. DSD SIGNATURE System #1 Approved for, bedrooms. System #2 Approved for, bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: By: o Original Certificate Date: Th unicipality of orage Development Sew ices Division (DSD) issues Certificates of On -Site Sy stems 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA We sheet 8-1-12.doc If more than 1 septic system is on the lot: COSA Checklist # 1 of i Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Another, Lot 1 A. WELL DATA Well type P Date completed a"y82 Total depth 208 ft. Date of test If A, B, or C provide PWSID # Sanitary seal (Y/N) Y Cased to 40 ft. FROM WELL LOG 9/12/1992 Static water level 85 Well production 0 ft. Parcel ID: 020-093-30 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 33 in. AT INSPECTION 8/23/2012 108 g.p.m. 6 WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate ND mg/L Arsenic: ND ug/L date of sample: 10/2/12 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/ Steel Tank size 1250 gal. Number of Compartments 2 ft. �Ym Other bacteria Neg colonies/100 mL Collected by: PES Date installed 8/8/1992 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 4/13/12 Pumper JR's Septic Pumping C. ABSORPTION FIELD DATA Date installed 8/8/1992 Soil rating (g.p.d./ftz orft2/bdrm) 1.2 System type Wide Trench Length 70 ft. Width 5 ft. Gravel below pipe 2.0 ft. Total depth 5_5 ft. Eff. absorption area 500 ft, Monitoring tube Y Depression over field N Date of adequacy test 8/23/12 Results (Pass/Fail) PBSS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 600 gal. New depth 2_ in. Elapsed Time: 100 min. Final fluid depth 0 in. Absorption rate , 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed N/A "Pump on" level at _ in. Datum Size in gallons "Pump off"level at_ in. Cycles tested Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer /septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION l certify that t 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 Steven R. Pannone Date /'Z/ ©l Z COSA brown sheet -9-1 -12.doe Absorption Feld 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage110+ in. �— Municipality of Anchorage Development Services Department l Building Safety Division �. On -Site Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 196650 — 1 SSU erJCF 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. 040-09 30 COSA# UA 0q0 ,� 1. GENERAL INFORMATION Expiration Date: 0 41 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address ANOTHER SUBDIVISION: LOT 1 16401 CHASEWOOD LANE • ANCHORAGE, AK • 99516 MICHELLE DUNN Day phone 345-4263 16401 CHASEWOOD LANE ' ANCHORAGE, AK • 99516 Day phone KIM BOOL W/ REMAX Day phone 110 W. 38TH AVE, #1100 • ANCHORAGE, AK • 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site 0 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 perved 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 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 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 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineers 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 8 Regulations. The reported results described the performance of the system under the conditions encountered of 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 fest results do not guarantee future performance ofthe 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 Approved for � bedrooms. Disapproved. 337-6179 Date /9 0^/ Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA Checklist ✓ Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitro itr Advisory Other By. SaJ pr Original Certificate Date: �r (Rw. 11105) 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: ANOTHER SUBDIVISION: LOT 1 Parcel A. WELL DATA Well type' PRIVATE If A, B, or C provide PWSID# NIA Date completed 9/72/1992 Sanitary seal (YIN) YES Total depth 208 ft. Cased to 40 ft. FROM WELL LOG Date of test 9/12/1992 Static water level 85 ft. Well production 8 — 9 -p.m -WATER SAMPLE RESULTS: Well Log (YIN) YES Wires properly protected (YIN) YES Casing height (above ground) 12+ in. AT INSPECTION 11/25/2008 74 ft. 6.1 g.p.m. Coliform 0-- colonies/100 ml. Nitrate A)Qmg./L. Other bacteria _colonies/100 ml. Arsenic:U=ug./L. Date of sample: 5/5/2009 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 8/1992 Tank size 1250 gal. Number of Compartments 2 Cteanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 10/24/2008 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA "ELOW EXISTING GRADE Date installed 8/7992 Soil rating .p.d.l orft'lbdrm) 1_2 Length ' 70 ft. Width 5 System type TRENCH Gravel below pipe 2 ft. Total depth *6.1 ft. Eff. absorption area 500 ft' Monitoring tube YES Depression over field NO Date of adequacy test 11/25/2008 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test DRY in. Water added6� 55 gal. New depth DRY in. Elapsed Time: 0 min. Final fluid depth DRY in. Absorption rate >= 600+ g,p,d, Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off" level r —.. High water alarm level at Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ Animal containment areas 50'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas 100'+ i 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 109+ Surface water 100'+ Wells on adjacent tots 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 2' Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION v PC` "' ••• < 9S0oo I certify that I have determined through field inspections and :.aOQQ review of Municipal records that the above systems are in 0 0 conformance with MOA COSA guidelines in effect on this 0 •... ., • date. ff Go ess.• Engineer's Print d Namee JEFFREY A. GARNESS �QO ' . 79 �ClIO / Q e �ofefe �� Date OQ dPesio�°4� ��40�000a COSA Fee a Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number (Rev. 11/05) z O II �� �; •LY y ER SH R� gih ti r � � .�� �; • i;�`s Zi�t� 393 II Municipality of Anchorage • Development Services Department IL Building Safety Division -° On -Site Water & Wastewater Program ' 4700 Bragaw Street P.O. Box 196650 % Anchorage, AK 99519-6650 (//J www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 0.20- 623 3 0 COSA# 4A Oc?6 01:2 1. GENERAL INFORMATION Expiration Date: _ .6-- / z — 9 9 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address ANOTHER SUBDIVISION: LOT 1 16401 CHASEWOOD LANE • ANCHORAGE. AK • 99516 MICHELLE DUNN Day phone 16401 CHASEWOOD LANE • ANCHORAGE. AK • 99516 Day phone KIM BOOL W/ REMAX Day phone 110 W. 38TH AVE. #100 • ANCHORAGE, AK + 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 345-4263 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 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 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 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, SUITE 101 • ANCHORAGE. AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineers 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 Limo of the test, and separation distances measured to readilyidenti(able 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 lost 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 Approved for —Y— bedrooms. Disapproved. Date Z)Ia65j Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineers Report Other 0 By: (Rev 11105) . ........... A.Ga ess: OF41 t1f 4`dQ eee.C, ON-SITE • , c: WATER AND WASTEWATER : PROGRAM ' Original Certificate Date: a - / 2 - D 5 Municipality of Anchorage o 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: ANOTHER SUBDIVISION; LOT 1 Parcel ID:OP,D- d 9 3^30 A. WELL DATA Well type PRNATE If A, B, or C provide PWSID# N A Date completed 9/12/1992 Sanitary seal (YIN) YES Total depth 208 ft. Cased to 40 ft. FROM WELL LOG Date of test 9/12/1992 Static water level 85 ft. Well Log (YIN) YES Wires properly protected (YIN) YES Casing height (above ground) 12+ in. AT INSPECTION 11/25/2008 74 ft, Well production 6 g.p.m. b-1 9 -P.M. f WATER SAMPLE RESULTS: . Coliform .O colonies/100 ml. Nitrate N mg./L. Other bacteria colonies/100 ml. Arsenic:5 G5ug./L. Date of sample:l 1/25/200 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 6/1992 Tank size 1250 gal. Number of Compartments E Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 10/24/2008 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA 6ELDw EXISTING GRADE Date installed 8/1992 Soil rating .p.d.l or ft'/bdrm) 1_2 System type TRENCH Length 70 ft. Width 5 ft. Gravel below pipe 2 ft. Total depth +6.1 ft. Eff. absorption area 500 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 11/25/2008 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test DRY in. Water added 615 gal. New depth DRY in, Elapsed Time: 0 min. Final fluid depth DRY in. Absorption rate >= 600+ g,p,d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off" leve High water alarm 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 100'+ On adjacent lots 100'+ Absorption field on lot 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 Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 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 tine 10'+ Surface water 100'+ Driveway, parking/vehicle storage 2' Curtain drain NONE KNOWN Wells on adjacent lots 100'+ 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 ZI1o)Uy COSA Fee $ 10 Waiver Fee $ _ Date of Payment o V Date of Payment Receipt Number OV Receipt Number (Rev. 11/05) NOV-19-2008 03:59P FROM: i■ ■e ■■ ■ . �t„��awT •ies r • • • e A+ HOME SERVICES, INC. 7501 E. 140th Avenue Anchorage, Alaska 99516 345-1890 CUSTOMER • 16401 ChasewoodI.ane An 1 — Block Lot DATE DESCRIPTION TO:3323246 P:V1 INVOICE# 35519 Fust week in Nov_ --- rate mcrease nag Deguu — te-rLavew�}:— — REMARKS c if )1'COGalions Septic Leach Area Holding -rank [I PROBLEM AREA— CALL FOR MORE INFORMATION ❑ NEEDS TO BE DONE AGAIN IN 6 MONTHS Good Shape ❑ sludge buildup on bottom Jim cap missing or C] Cut standpipe to I- above ground needs replacing AMOUNT TOTAL 2– StandpipesTime ❑ Floater on top ❑ Needs Septictrine MUNICIPALITY OF ANCHORAGE - ' DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section R �' �` ���� i P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Z� C / a dal CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING` Parcel I.D. # 03-0 ' O cI3 - 30 HAA # 1. GENERAL INFORMATION Complete legal description Lot 1, Another subdivision Location (site address or directions) 16401 Chasewood Lane a� Property owner nark Phillips Day phone 'Mailing address „16401 Chasewood Lane, Anchorage, AK 99516 Lending agency Day phone .;. Mailing address ; Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water 345-7454 NOTE: If community well system, provide written confirmation from State ADEC attest- 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S& S ENGINEERING Phone 69q- -,)_9 7 g 17034 Eagle River Loop Road No. 204 Address Eagle River., Ainsk, 99c77 Engineer's signature Date /I OF !:�O, ROBERT C. COWAN E :, CE - 8801 6. DHHS SIGNATURE tt,��`•,, ,:.•�`�� Approved for d U R bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: � �. �o-- Date' aUTlc 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 engineer's work. , 72-M (Rev. 1/91) Back MOA #21 ` ttCEIVI�L) Municipality of Anchorage IUN p 11999 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division JAUNIGIPAIITY OF ANC 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907�r8'42WWL sERvic Health Authority Approval Checklist Legal Description: LUT / . Lx!Sb/1//5-/0/4/Parcei I.D.: OZO ' 6? &7.3 30 A. WELL DATA Well type Ael ✓A-12: If A, B, or C, attach ADEC letter. AADEC water system number (Y Log present&N) S Date completed %z z r / + Total depth Cased to Casing height (above ground) Sanitary seal&N) J'C-5 Wires properly protected@N) 7 �S Date of test Static water level FROM WELL LOG q//Z- -12' g6-1 Well production 6 g.p.m. AT INSPECTION 9_ ' �• '� g. P.M. WATER SAMPLE RESULTS: `. Coliform Nitrate a r Z t3 Other bacteria O Date of sample: S` i 1 9 q Collected by: K ^?'✓ &5 hNUINhhKINU B. SEPTIC/HOLDING TANK DATA 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Date installed /?g!_Tank size 12, Number of Compartments z Cleanouts (Y/N)� Foundation cleanout ON) 65 Depression (Yo A,10 High water alarm (Y/N) Date of Pumping 2 d Pumper 140,E 5 ,f g vj cIL I C. ABSORPTION FIELD DATA. Date installed Soil ratin g.p.d./ or ft2/bdrm) 1 System type LLdW NyCff Length Z le Width Gravel thickness below pipe 2 Total depth J� Ca Effective absorption area Q Monitoring Tube present ON)_4 Depression over field (YAM No Date of adequacy test Results (Pass/Fail) tot? -55 For bedrooms Fluid depth in absorption field before test (in.); "'C- Immediately after gal. water added (in.): Z_ v Fluid depth — 114 7—'— (ins) Minutes later: 1-7- Absorption rate = 600 4 g.p.d. Peroxide treatment (past 12 months) (Y/N) a N rc If yes, give date - K rJOAA� N 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles E. SEPARATION DISTANCES ^� A- Size in gallons "Pump o " at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /J5 i Absorption field on lot /30 t "Pump off" level at* On adjacent lots % OO '-�- On adjacent lots 100 -/- Public sewer main /VO Public sewer manhole/cleanout AD/ & Sewer /septic service line �G Lift station _AZO N& SEPARATION DISTANCES FROM:SEPTIC/HOLDING TANK ON LOTTO: Foundation Property line 56 Absorption field f Surface water/drainage I / Water main/service line _ � ge / o � �� Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line / / Building foundation Water main/service line Surface water o f Driveway, parking/vehicle storage area Curtain drain MIA(& K/UD 1V1\1 Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that / have determined thru field inspections and review of Municipal in conformanceuidelines in effect on this date. with MOA H g Signature 4171— Engineer's Name Ac 0'a C 14�- C, caH'�,� Date HAA Fee $ Date of Payment D ,� O / Receipt Number /go �5/ &qev ,/ 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 0A. are MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services me On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # OU -002330 HAA # l4ffA q -S o 6 8 3 1. GENERAL INFORMATION Complete legal description Z'" I AAF Gr -N-2 _Q9hjV)Si0rJ Location (site address or directions) A, L'D I COAsL�r-o oaj l Property owner 14A-t1,1L_ 00,41LI-/i°s Day phone Mailing address Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 4N U "JO ^i EJ �i� J' e Phone Address P O b o X Z VO 17 Engineer's signature 6. DHHS SIGNATURE By: Approved for 14- bedrooms. Disapproved. Conditional approval for Additional Comments A IL Date � os ,�'�C�0000000000� Y Anderson11 lic 44+ tf 4 �.•Tt J - ".��:. _,_...•ate bedrooms, with the following stipulations: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 72-M (Rev.1/91) Back MOA #21 F-3 w 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING OZ -007330 HAA # 1 _Y� �,I AI 1. GENERAL INFORMATION Complete legal description X01 I /4N0-n4cX SU g Dt\/l S lnr1 Location (site address or directions) �' �� C-44 ASC'W OQ b LA -,,j C Property owner K_t A Q MC_ -,s s Day phone Mailing address _2�141 1'�'crxnA'LA. OA, J I Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: '3 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site X Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 Ita vow MOBS 46A'Aedt 4zo-ic ,i jom sdeaui6ua leuolsseloid all ul suoisslwo ao sjoaja jol alglsuodsa.i lou sl 96eaoyouy to Ailledlolunw a41 •panssl sl aleolllpao a aao;aq elep azAleue ao suolloadsul lonpuoo lou op SHHd to saaAoldw3 •sluawaalnbai aleis pue lejapel ulepoo ,(4slles oljapio ul suolinl!lsul 6ulpual.ilayl pue sawoq to siaseyoand of Asalinoo a se slyl scop SHHa ayl •eNsely to alelS ayl ul paialsl6ai aaaul6ua leuolssaloid luepuedapul ue Aq anoge g ydei6eied ul uan16 suolleluesaidai ayl uodn Aluo paseq saimpliao lenaddy A4!aoyln`d ylleaH sonssl (SHH(l) saolmaS uewnH pue 411e9H ;;o luawwdaQ a6ejoyouy to Al!ledlolunlN ayl =Roll S I aled , p :Ae :suollelndlis 6uimollol atl 41!M 'swooapaq fib 2 / ale(] sluawwo0 leuoli!ppy aol leno.idde leUoll!puo0 panoaddeslQ swooapaq— aol paAoaddy 3unIVNDIS SHHd '9 ainleu6ls s�90ulbu3 17 L. l- C).h7 u oEt 0 ssaappy / ask --/5``),s auoyd 9N �2[��(V N0.Szc� plv� wa!3 to aweN •uolloadsul sltl to alep a41 uo loalla ul suolleln6a,i pue 'saoueulpio 'sopoo alelS PUB led!o!unW Ile 41!M aouelldwoo ul sl walsAs lesodslp aalealaalsem ao/pue Alddns aalem ails-uo ayl 'uolloadsul pue u011e6lisanul Aw woa} pue sa!!1 a6eaoyouy to Al!ledlolunvy ayl woal poulelgo uollewaolul ayl uo paseq leylAluanaaUlanl I •ulaaaq paleolpul a.inlon.ilslo ads l pue swooapaq to aagwnu a41 aol alenbape pue leuollouni `ales sl walsAs lesodslp aalemalsem ao/pue Alddns aalum ails-uo aql letl smogs uolleolldde lenoaddy Al!ao4lny ulleaH slgl to u0lle6lis9nul Aw letl Al!aan I 'molaq umoys alep uo!leP!len atl to se pue olaaay paxllle leas Aw Aq paipliao sy d33NION3 AS N01103dSNI :10 1N3W31.d1S 'S Legal Description: A. Well Data Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Parcel I.D. OZ -00 R3310 Well type PR -I V14?Z" If A, B, or C, attach ADEC letter. ADEC water system number \/ Log present (Y/N) A Date completed GII /L I9 L Driller AWJ)"J A P / Total depth -Z-0 b Cased to 4D Casing height - Sanitary seal (Y/N) Wires properly protected (Y/N) Date of test Static water level Well flow Pump levell FROM WELL LOG g1�� 1Z_ SEPARATION DISTANCES FROM WELL TO: 93 AT INSPECTION --M6NICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION g,p("M. 0 2 1993 4 Septic/holding tank on lot 115 ; On adjacent lots � ado s r Absorption field on lot 130 ; On adjacent lots > zoo Public sewer main /JO")C' Public sewer manhole/cleanout A/0rJ6_ Sewer service line WATER SAMPLE RESULTS: 50 Petroleum tank Coliform Nitrate Date of sample: B. SEPTIC/HOLDING TANK DATA Collected by: A/ 0,Q c Other bacteria Date installed 018 /qz— Tank size 160 0 6AA-- Compartments Cleanouts (Y/N) y Foundation cleanout (Y/N) Y Depression (Y/N) High water alarm (Y/N) IMA Alarm tested (Y/N) A/ 14 Date of pumping /\ L=am 610 57-7W CT_ /0,-J Pumper '11)IA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot On adjacent lots 7 zoo Foundation To property line __3 5 Absorption field Water main/service line Surface water/drainage /\ 0 AJ f /7 72-026(3/93)~Front CONTINUED ON BACK PAGE G. 61FT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Date installed 0,18 �� Soil rating (GPD/Ft') `- Z Length 7 © Width !: Gravel thickness _ Total absorption area S60 S, r Cleanout present (Y/N) Date of adequacy test A etJ 1�N07- Results (pass/fail) Water level in absorption field before test 0 0 Surface water System type Z Total depth , _Depression over field (Y/N) _,Ad 'PA5S for Bedrooms After test Peroxide treatment (past 12 months) (Y/N) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1,30 / To building foundation 3 Z On adiacent lots > Ldd Property line To existing or abandoned system on lot /I/A On adjacent lots 7 Z -OP Cutbank A10^J C-' Water main/service line 70 i Surface water 0n/'�- Driveway, parking/vehicle storage area S Curtain drain /l oyc E. ENGINEER'S CERTIFICATION certify that I have checked, verified, or conformed to all MOA and HAA guidelines in -tpn.-thb. r flte_pf this inspection. A � signature �.r ----� }' ( c!TsFAv co +pine+ p R c f) a c1''e hC��-Cff. � k..i)°411E1 �C2fi1 r .HN Engineer's Name 11/1 / U -1 4 -G -L A 0 &72S 0 ///Q r ' DateFJ� HAA Fee $ 006 " Date of Payment Receipt Number ��/ v LO 93-1) 72-026 (3/93)" Back Waiver Fee $ Date of Payment Receipt Number N -x:--x==x�=cxsxcx-xoa� axx=oao-c--=a=c...oxo._c=a==xc_.sa=c.--x--c=--=-oar-cna-zc=rxsa=asa=..c=.-=xx * 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 = Secondaty dilution. GT = Greater Than r�1 SGS Member of the SGS Group (Soci6l:6 UnArale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRQINIA, NEW JERSEY, SOUTH CAROLINA COMMERCIAL.TE4TING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES - SINGE 1908 REPORT of ANALYSIS : Chemlab Ref . # :93.5595-3 5633 B STREET ANCHORAGE, AK 99518 client Sample ergs ID :PRIMATE WELL WATER I�1 AN ,8Ll�D• ' TEL: (907) 562-2343 MatriX !WATER *=; .:. _. FAX:. (907) 561-5301 Client'Name :ANDERSON, ENGINEERING WOT2K Order :72392 .Ordered I By .Report Completed :10/25/93 ' Project. Name -Collected :10/20/93 @ 13:15 hrs. Project# : Received :10/20/93 @ 13:30 hrs. PWSI'D :UATechnical Director:STEPHEN C. EDE Released By Sample Remarks: ROUTINE SAMPLE COLLECTED BY: A HARALA,,WITNESSED BY MARK PRILLIPS. Allowable;;.xt . _ Anal Parameter Results Qua1 Units Method Limits Date _• Date' Init Nitrate -N - E}� U ro mg/L EPA .353.2/300.0- - 10 --- --10/21 +LLH -x:--x==x�=cxsxcx-xoa� axx=oao-c--=a=c...oxo._c=a==xc_.sa=c.--x--c=--=-oar-cna-zc=rxsa=asa=..c=.-=xx * 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 = Secondaty dilution. GT = Greater Than r�1 SGS Member of the SGS Group (Soci6l:6 UnArale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRQINIA, NEW JERSEY, SOUTH CAROLINA V LABOM7oRY COMMERCIAL TESTING & ENGINEERING CO. AK DIV CHEMICAL & GEOLOGICAL LABORATORY TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER ❑LIC WATER SYSTEM I.D. # gr PRIVATE WATER SYSTEM Name Phone No. e6? - 4� �%�'° 7 7 3 mamng Rourms Chy state Zip code SAMPLE DATE: Mo. Day Year SAMPLE TYPE: SAMPLE ❑ Check Sample (for routine sample with lab ref. no. ) ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected No. LOCATION Collected By Ag 7Xi-er 2 3 4 .I i 5 TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received 'r Time Received r 33a Analytical Method: Membrane Filter ' No. of colonies/100 ml. 1 Lab Ref. No. Result' 93.5595 m f Anal s BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter: Direct Count 0 Coliform/100 ml BEFORE Verification: LSB BGB Fecal Coliform Confirmation COLLECTING SAMPLE I Final Membrane Filter Results Collform/100 ml n Reported By ' Date TNTC = Too Numerous To Count rime; a.m. OB = Other Bacteria 0SGs PART ONE OF TWO: Member of the SGS Groul REMAINDER TO FOLLOW I