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T12N R3W SEC 15 LT 109
T12N R3W ec. 1 Lot 109 015-483 -07 S~l~ Comm~ml 'Fa~i~,' Wit~ Es~t~d De~iD~ F~ow &}~ than 500 G.PD~ AS-.BUILT 1111 EAST 10t ST' AVENUE Recard Dra~4ng of Septic Upgrade T12N R3W SEC I5 Let 1.09 Rand)/Meier Parcel iD, 015483-07 Cindy W, Ell:s, P,E, ' Dec¢:mber 26, 2005 Scale 1. inch = 40 fL Watkins Engineering, inc II ~1 L II JllJI I lie L[Z J- P.O,: Box 11044:3 ' ' Anchorage~ Aiaska 99511:0443 Phone: {907)349-1851, Fax: (9071 349,1934 NOTE: Lines under dI:;iveway in;sul:ated w/4" ~'[gid: foam,, Line from Garage Jo CO l:nsdaled w/2" rigid ~oam, FCO FC( ~. CO XX DCO1 ,DL O~ ST1 ST2 FS CJI It&0 65,2, C02 }1'14.6 47.6 35,1! t47 ? 72.3 48~g I1~1 2. HUH!::!_ AS-BUILT B2N~c15LotlO9 .,. ,. ~ . ~a.o~, Watkins ~ng!n: ermg, Inc. Cindy ~( Ellis, P.E RO. ~x 110443 December 26, 2:005 Anc:horage~ Alaska 99511?0443 S~te 1: inch:~ 30 ff Phone: (907) 349-I851, Fa:~; (90'7)349-1934 10- 11- 12- COMe,lENTS Municipality of Ancho~ge Development Se,rvice~ Depa~nt 4700 S~u~b Bmr=aw SL Soils Log -Percolation Randy Meier ~ate Pedotma4 9/9/05 IF CE;S.'~T WHATBEPTH? 9.5 9am: 9flti~¢05 Rea~incj i;~t~ Gcmm~, %me Net Time Depth to We~r No~ Drop I 9/9~05 9:18 0 6 - 3-4 9:2~9:39 10 6- ~ 4.75 5- 6 9:40- 9:50 10 6 -2,0 4.0 7 - 8 9:5~ - lO:o~ 10 6- .2,0 4.0 9- ~0 ~0:02..~u:~2 10 6 - 2.0 4~0 PERCOLATiiON' I¢'¢~TE 2.8 ,:mmu~¢r~ ~ERC I~DL.E D4AMETER ~ ~ERF'O~M~D iN ACCORDAN .CE WFfH ALL :STATE AND MUN~CtP.AL GUtO~L,I IN E~FEOT ON THIS DATE DATE .~PRO V A.L TO C:ONSTR' I-ICT Approved. by Dat~ APPROVAL gma! apcroYa! t::o eperate, LOT 93A Conc. block ret. Wood LOT 108 2' x5' Conc, LOT 93B S89°59'40"E 164.99 f Well deck OH -73.9 Ani~v~lleP.~nn~ LOT 109 85.2 Conc. block 8352G Lot lA Ozzies Knoll Subd. LOT 110 o / / / / / / / / I EAST 164.94 wall 50' U.S. Patent Road Reservation O E. 102nd Avenue REVISED 7-27-10 (Added Septic Vents) AS-BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection of the following described property:LOT 109t SECTION 15, T12N, R3W, Seward Meridian, AK Anchorage Recording Precinct, Alaska, and that the improvements situated Ihereon are within the property lines and do not overlap or encroach on the eroaertv Ivino 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 Randy Meier [~ UPGRADE MAI LING ADDRESS S~ ]747-H Anchorage,_Alaska 99507 LEGAL DESCRIPTION Lot 109~ Sec. 15 T12N~ R3W LOCATION NO. OF ~EDROOMS __~/2 mile north on Pacer Place off O'Halley 3 Iw." I Absorption area Dwelling"" PERMIT NO. ~ DISTANCE TO: 125 ' 50 ' 30 ' 2252-77 ~ Z Manufacturer ~ Ne. of comp~tments ~ ~ Material ~ Greer Steel ~,q00 'F HOMEMADE: Inside~7x' Width N/A Liquiddep~/m ~ Well Found Nearest ~li¢~e ..... ~ ~ DISTANCE TO: i 7 5' ~i6~' P~'~'J¢2z 77 ':~ J. i0 ' 40 ' 36 inches N/A h ~ ~ Top of tile to finish grade Material beneath tile Total effective absorption area __ ~ S ' 7 2 inches 480 S.F. Length Width Depth PERMIT NO. ' ~ DISTANCE TO: ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS Plastic ~_ SOIL TEST RATING -- -- 150 __ o~,~. INSTALLER ~M~a~S Randy Meier drainfield trench ~ , ~ For Ted FerMi & Assoc. 6/19/78 FIF:'PI... :Il CRN'T' [q:l=lN[:'~'r' I"IE 1: LCICI=I 1" I ~ N PI:~CEF~ I" I..,H .E L. IEiG I:::ll I...::L C19=,f=L.." ......... ~I. 5 ] :L,=I,I" '=' 2i:7'13::[ Fit 212 C:HHCff',IE:, F:IP-I' :L 4 I~'Z~:kl L.O"I ....... :, 1 ,,_~' E'"%:C::'~:; ::;I I...I I.[ F:'EiiEi T"r'PE OF:' ').'i;(:) I [.. HE,_,LkEI].Ldl 'c:. .~, · = I [:.t I]....,. TR[:'iI",I(:::Iq I'll:i::':::l:l"ll..li'"l J'l II[,E[. OF EE:[')Iq'--'I"I'::: :F:: 'I'HI:'~ I...E::I',tE!iTFt E:'II"llENE;ION.I."'-.:, 'FHIE I_.[.':NGTH ,'IN FlEE'r) Cfi= THE .... f I. E I',1 .H TFE Ii)EP"I'H OF I::1 TI:;:'.ENC:H OF?. F'I-I' ]:~! THIE D]:~SI"F:II'qC~:: E:IE-I'I,IEEIq i'HE :~i;l~.l[,~]l'-:'l::ll]::lii~ Ol::' (~iROI. J.,l[) FIt'-,IE:, 'THE E:O'l"-I"Ol',l OF' T-E [ :.:,C;F:I'v'Ff'F L( ON ,;'gl~,l'~X~:~l::[:'-I"':~ 'I"HEI:;[.E I'.:_'; i'.,IQ :E;ET I.,.IIE:,'I'H I::'O1:;[: TI:.?.IENCFIF_':S. h~? ...... THE ()['~.I'),EI.. C, EF:TH 1:~: 'THE: hl.I. NIl,I)~lh'[ E:,E. FqI-[ ~:.~t:A,~i[:~'.l=l'v'lil BI[' ~f ~., -'-.J[:_" ~dFf'F:'F:tI._I. I::"fi:::'f7 ,':,Nr::, 'rHea: ,:, =' "rHea: ,'m ::, ,'X It'" ~..,,.tl ~::::~ ,::: ;~E: :::,, :lC lt"-41 '.'~= F:' [Fi':'_": C..-~-~i'~ :It:: IF;R: II~iiE IBI::I "' I-:::[::' '[ I [ I I"l 3 CII::' I:lNh.~ ':' ~':-" = ',' .... r =, I L,I I E', r' 'I'H M:I:I'.,IIP'IUI,'I [::, ]: -fi;TF/NC:I5 EflE"I'I.4E[Ef ::[.[:)~3 I:::'E[C]' F'OR I::1 P[RZ',/RTE '-::;F'EI:} I I= )2 C I::1T :[ i:)lq ~i.:, I::INI::, I I",I~;'T'£:II...LI:::I'I :[ \ ON' :,Ell-I~l::. I):lZ:~i;l:'O~:il;FI[. ?','%TEI'I )/'; FI F ..1[ ,I. ]Z C: I.,.IIEI..I .... FtF: F:IVf:I]:I..FIBLI.:2' 1'0 II",tfS;I, Jl~'.l)~ ]: C:I!:{I:RI":[I=~T' 'l'l'ql::l'l' :1.: Z FI['"I Fr~I'"IIL.]iFII~['. ['IITH THE I:~'.EOUZF?.EI"IE O Iq '- :E; Il T Ei :~:EI.4E[I~'.'~ t=OF::"f'H EP'? THE f'IL.INIC:]:F'I:3L. IT'r' OF 2: I IqII...L. ZNf3TFiLI._ THE :.'=T,'¢:ETf-IF:H IN F)COCfi~'.DFII'qCE I'lI'['lq THE iili:: ]: LIIqli)[EF:'.~;TfrlIq[) THFIT 1"HIE ON-SJ;I"I"E 'JSEP~EF;'. :Sh.'Ei;TErq I',lFrlh.' [E'.EC&III;;:Eii ENL.FIF[:(i:iI.:.'i',IEi:N"[ i[I:2 'TIIIE B:E::.:.:]:DEiNCE ~S~, I:~-'.EF1OE:,ELEE:, TO :£1'.,IC:I...UE)E I','IOI~IE THRN 2.": B'IEI~:,[ROOH'.::;. Apri~l 18, 1977 R&M No. 751139 Mr. Randy Meier 3701 Richmond St., Apt. 14 Anchorage, Alaska 99504 Re: Test Hole and Soil Log Reporh for Sanitary System; Lot 109, Section 15, T12N, R3W, S.M., Alaska Dear Mr. Meier: We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject site. This in- vestigation was performed in accordance with your request of April 7, 1977, and those procedures outlined in a letter dated July 10, 1975, by Mr. Rolf Strickland of the Muncipality of Anchorage Department of Environmental Quality. A single test hole was drilled within the subject site area for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Drilling was accomplished with an auger type drilling rig and the test hole was extended to a total depth of 18.0 feet below ground surface. The final log of the test hole has been included in Drawing A-01. Groundwater was not encountered in the test hole while drilling. A percolation test was performed from a depth indicated on the attached table and reflects average infiltration from the depth of the bottom of the hole. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, R&M CONSULTANTS, INC. Edward Yarmak, Jr. Geohechnical Engineer EY/gld Lot 109 Location Diaqram: ~ne~Test Hole Location: is been lo~atedby survey All S~ples A ©RGA~IIC Slightly ® Moist, M~di~ Bens.e,, 35.0' PERCOLATION 9~J,~ST RANDY MEIEF~ R & M NO. 751139 LOT 109, Section 15, T 12 N, R3W, S.M., Alaska March 15, 1977 ELAPSED DROP IN TIME TIME INCHES INCHES 10:50 0 10.75 0.0 10:51 1 ].4.50 3.75 10:52 2 17.50 6.75 10:53 3 19.50 8.75 10:54 4 22.00 11.25 10:55 5 . 24.00 13.25 10:56 6 26.00 15.25 10:57 7 27.25 16.50 10:58 8 28.75 18.00 10:59 9 30.00 19.25 11:00 10 30.75 20.00 11:05 15 35.00 2&.25 ].1:10 20 38.50 27.75 ].1:15 25 41.75 31.00 11:20 30 43.25 32.50 11:30 40 45.50 34.75 11:40 50 47.50 36.75 11:50 60 49.75 39.00 39 Inches Total Drop 1.54 Minutes/Inch ®Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-483-07 1. GENERAL INFORMATION Complete legal description T12NR3W Sec 15 Lot 109 Location (site address) 4821 E 102nd Ave. Expiration Date: �'S d �7_0 2 Current Property owner(s) Robert Elliott Day phone Mailing address Real Estate Agent 4821 E 102nd Ave. Dar Walden Day phone 907-865-6403 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class C Well Public Water System ❑ WaiverNariance request for: 5 TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5—yo Waiver Fee $ Date of Payment LO -17-11 c�iq7,87 Date of Payment Receipt Number � oL q q ©rg, 1 Receipt Number COSA # l'/�L )q) "t Waiver # istance: 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 ARCTERRA CONSULTING, INC. Phone 696-6111 - - ----Address- 20441 PTARMIGAN BLVD..,,, EAGLE-RIVER,—AK-99577-- - - - Engineer's Printed Name KENNETH M. DUFFUS Date !�t _Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. 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, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future �� �►\ occupants or can ArcTerra guarantee that no unseen OF ALS encroachments, deficiencies or discrepancies exist. Tj:I k 6. DSD SIGNATURE KENNETH System #1 Approved for bedrooms. =i 7 s �� 104 System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: By: ON-SITE �a m^ M WASTEWA-mi m PROGRAM :D Original Certificate Date: D -30 771 R The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc COSA Checklist Legal Description: T12NR3W Sec 15 Lot 109 Parcel ID: 015-483-07 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test 6.6 gpm Date drilled Unknown* Water storage tank volume gallons Total depth 230+* ft Well disinfected for coliform test? ❑ Yes N No 40+"-- - — ----------- -- _---- --- -- Cased to ft Coliform bacteria is Negative sanitary seal is functioning correctly Nitrate 5.92 m /L E] Nitrate less than MRL (ND) -------M-Wires-are-properly-protected---- —Arsenic- ug/L--Arsenic-less-than-MRL-(ND)- 26 Casing height (above ground) in. Collected by Arcterra Consulting Date of flow test for COSA 10/11/19 Date of Sample 10/10/19 Static water level at beginning of test 219 ft. Comments *Previously Approved 3/93 y ADEC/MOA. No well log found. Pump installed 6/7/10 top intake at 230'. Unconfined aquifer. B. TANK DATA Age of tank(s) 14 years Tank type/material Septic/Steel Measured operating fluid level in septic tank 49 Standpipes/foundation cleanout per record drawing Date of pumping 10/10/19 D. ABSORPTION FIELD DATA Which system tested (date installed) L2/26/05 ALL standpipes present per record drawing Total measured depth from grade 10.8 ft (max) Measured depth to pipe invert from grade 5 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 IN System presoaked (Required if vacant for greater than 30 days prior to date of test) 2000 Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 10/23/19 Results Q Pass For 5 bedrooms Fluid depth prior to test 22 in Water added 750 gal New depth 52 in Elapsed time 562 min Final fluid depth 22 in �iVg pd Absorption rate I - Any rejuvenation treatment (past 12 months) If yes, enter date 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 Community Sewer Manhole/Cleanout > 100' Surface Water > 100' ® Yes if No ft rO Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25'21 Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' ft Community Wells > 200' Animal Containment > 50' ® Yes if No ft ® Yes if No ft If septic tank is under driveway comment below _Manure/Animal_Excreta Storage_> 100' 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' ® Yes if No ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: ® Yes Absorption Field > 5' ® Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' ® 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' ® Yes if No ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' 0 Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS Class C well Approved 3/93 ADEC. G. ENGINEER'S CERTIFICATION 1 certify that 1 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 Nitrate Advsory- Certificate of On -Site Systems Approval # osc191498 Subdivision: T12N R3W Sec 15 lot 109 A water sample revealed a nitrate concentration of 5.92 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. �-» ISO -3 r, .; M eta`` r a we� sr � �:..c ''�� ��-4°r`� glidrs�Box665�1ncfiira Alaska 9665'` gAr From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. _...__. _.__SOURCE:__.Nitrate_is.a.major_component of fertilizer. and._wastewater. Often the, nitrate is_.in__the_form of_. ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, - - food solids, and bacterial cells-. It may also result from the breakdown of organic matter buried in the soil.- TOXICITY: oil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby' disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. ���t� ��� �M�i�rag Address $�O ��ox 1965th 3�Anchor�ge A-�ska „�:+�".'�«-u.� a,�:aa�, .�,..a .�,.,��,�',�,,�,.�t..::r.�:a;�,t�'�.i✓�:.,�%2�..�„�:,�s:r>f..�`'�.���nk.�'�'.�w�..-�':��,'';�-s��..�...�,. �� g..�.�,.r.��X..,.,�;��.�''�-.�.�,,,,t�s�.,��s:g..�,,�...�:.�,.��,2��I LOT 93A _ — j Cone. block ret. walk Wood rr 00 >N O t` O 0 CO 0 Z LOT 108 LOT 93B S89°59'40"E 164.99 2' x5' Conc. ret. wall 0 - indow- well 1.7 OH 28.0 0 h deg, 0 0 2 O 0 h N 28.0 deck LOT 109 i.2 Conc. block ret. wall Well Animal pen Wire fen ;P as�o so /Yo>499 :': i:• 16. 13.0 Oar As Pha{t: { o Port ood reL % wall "e w �Q;`O y / / 8 %0Q`u / J EAST 164.94 ii 50' U.S. Patent Road Reservation _ E. 102nd Avenue O co N M N <O O 0 O O Z 8352G Lot 1A Ozzies Knoll Subd. LOT 110 REVISED 7-27-10 (Added Septic Vents) AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagees inspectic •� F L�\ of the following described property: LOT 109 SECTION 15 T12N, R3W, Seward Merdian. AT % Anchorage Recording Precinct. Alaska, and that the Municipality of Anchora§e 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 Parcel I.D. 015-483-07 1. GENERAL INFORMATION FOR A SINGLi?FAIVIILY DWELLING Expiration Date: Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address T12N, R3W, SECTION 15, LOT 109 4821 E. 102 AVENUE * ANCHORAGE, AK * 99507 RANDY MEIER Day phone 4821 E. 102 AVENUE * ANCHORAGE, AK * 99507 Day phone GARY KUTIL W/ PRUDENTIAL Day phone 727-2717 3801 CENTERPOINT DRIVE * ANCHORAGE, AK * 99503 Unless otherwise requested, COSA.will be held by DSD for pickup. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well [] Individual On-site · Individual Water Storage [] Individual Holding tank [] Community Class C 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. 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: T12N, R3W, SECTION 15, LOT 109 Parcel ID: "~/¢"'- W ~ ~-0 7 A. WELL DATA Well type CLASS C Date completed Total depth __.ft. Date of test Static water level FROM WELL LOG ft. If A, B, or C provide PWSID# 218035 Well Log (Y/N) Sanitary seal (Y/N)__ Wires properly p~ Cased to ft. ~bove ground) in. g.p.m. AT INSPECTION g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/lO0 mi. Nitrate 4,48 mg./L. Other bacteria__ Arsenic: NJ;) ug./L. Date of sample: 7//20/2010 Collected by: 0 colonies/lO0 mi. GE(; Ltd. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1500 gal. Number of Compartments__ Foundation cleanout (Y/N) YES Date of pumping '7/ ,~ ~ / ! C ABSORPTION FIELD DATA Date installed 12/26/2005 (2 @ ,7,0') Length 60 TOTAL ft. '10.8/ Total depth '11.4 ft. Eft. absorption area 720 ft2 Monitoring tube YES Date of adequacy test *'7/22/2010 Results (Pass/Fail) PASS Fluid depth in absorption field before test 42 in. Elapsed Time: 120 min. Final fluid depth 66 Any rejuvenation treatment (past 12 mo.) (Y/N & type) **TESTED NORTH TRENCH ONLY. SOUTH TRENCH 2 Depression over tank (Y/N) NO [*BELOW EXISTING GRABEJ Soil rating ~r ft2/bdrm) 1.2 Width 5 ft. Date installed Cleanouts (Y/N) High water alarm (Y/N) 12/26/2005 YES N/A System type DUAL TRENCH Gravel below pipe 6 ft. Depression over field NO For 5 bedrooms Water added 750 gal. New depth 72 in. in. Absorption rate >= 750+ NONE KNOWN If yes, give date WAS SURCHAR(;ED. g.p.d. D. LIFT STATION Date installed "Pump on" level at__ Datum ~ E. Size in gallons Manhole/Access ~ "Pump off" level~At~-im~-~-. High water alarm level at Cycles tested. Meets alarm & circuit requirements.?. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: '140'+ Septic tank/lift station on lot Absorption field on lot 150'+ Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas 50'+ *WIAVER GRANTED. On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank 150'+ Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: in. Building foundation 5'+ Water main N/A Wells on adjacent lots 150'+ Property line Water service line PUBLIC,/100'+ PRIVATE ADEC PROJECT #4520. 150'+ 150'+ N/A 100'+ 10'+ 5'+ Absorption field 5'+ 10'+ Surface water. 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Water service line 10'+ Curtain drain NONE KNOWN Building foundation. 10'+ Water main N/A Surface water 100'+ Driveway, parking/vehicle storage Wells on adjacent lots 150'+ PUBLIC,/100'+ PRIVATE 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 .... ? i ~'-? //',. COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number Ar, chor~e, A~( 99~!9-6a~0 Pump Installation Lo~ Veil Drilling Permit D~te o£I. ssne: __ Description ~e,.D~th Below Top of We5 Cas~g:~ feet ,ump Mmnuf.~cmrer's Y,~me: ~,-~'-W~.TJ,f~:~'7' ?ump ~ize { hp ?inless ~daptar Buriml Depth: / 0 feet SGS ReL# 1103533001 Client Name Garness Engineering Group, Ltd Printed Date/Time 07/22/2010 16:29 Project Name/# TI2N R3W SEC15 LTl09 Collected Date/Time 07/20/2010 12:10 Client Sample ID TI2N R3W SEC15 LTl09 Received Date/Time 07/20/2010 12:50 Matrix Drinking Water Technical Director Stel~hen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ugfL EP200.8 C (<10) 07/21/10 07/22/10 KDC Waters Department TotalNitrate/Nitrite-N 4.48 0.100 mg/L SM204500NO3-F B (<I0) 07/21/10 AYC Microbiology Laboratory Colony Count 0 col/100mL SM20 9222B A (<200) 07/20/10 DLC FecalColiform 0 col/100mL SM20 9222B A (<1) 07/20/10 DLC Total Coliform 0 col/100mL SM20 9222B A (<1) 07/20/10 DLC ~RANK'H~ t[~URKOWSKL GOVE~O~ DEPT. OF EN'V1 RONMENTAL CONSERVATION DIVISION OF WATER WASTE,WATER DISCHARGE PROC, RAM December 3:2004 Cindy W Elt:is:~ Watkins EngL;~ee:dng, [nc. ILO. Box I !0443 Anchorage, Alaska 995 i t4)443 Re: T 12N, R 3W, Seciim~ 15~ Lo~: i (19 (South Aachomge)~Cm~s;:mctien Approval for thc ReplaCemePt of the On[Site W'a'S~waer Teeatment and DispoSal :System ,.,~EC Project #: 4520 D~r Ms. ElliS: TNs Ls m response to lbo emginec~ng plan submit:taI received on November i 7, 2~]:g for fl~e replaceme:n'l of an onsite wastewater gystem~ A new 1.500 gallon two compartmem septic rank and two 30 iBot l~.g with 6 foot eft~cti've depth deep trenches ~e Planned for ~e site. A ~:rcoblion leSl: perf~d in thc receiving mas res:ulk~ ~ 3.5 ~utes ~3r bch. wNch implies m~ apPti:c:arion rate of 1:2 gallons per ~y per sqnare fi-~OL The system serves two sepamm single i~mii'y homes wkh a total with an estimamd'daiiy' flow of 750 gallons Cond:i:tional approval to cons:Wact i:s hereby given, lbr [he domestic wastcwatcr tream~ent and disposal, systcm~ A "Certificate to Cor~stmc:t" fi)r above sta~ed system is issued. :FMs app~ovai ~ eentingent n~n compliance with the follow[ns conditions: If Ibc applicam fails m co~struct:, alter, install, or modify the sysmm within m,o (7} years at~:r the date that the depamr~eat is:aries an approval [o COitS~:tK:t, [[~ approval is void, and p~a:ns mus~ 'l~ msubmitmd for departmen:~ revie:w and approval, The existing domestic wa.stewa.ter sYslem must be decommissioned: in c:Onf0rmance with lhe [ hliforn! PIumbing Ccgle and shos,,a on thc record drawings, (sec ~tttacN~,nt:~ Devimi:ons from appm:vcd p:lans which a'ffe<:t capacity, i, iow,: opemt:i:om mZkjcr design of t.mits~: poim of disch~ge. ~tm.terials cfi ~jor system cotnpotlmttis ~such as pipc~ lagoon liners. Ok'.:. L o~ xtparation distances, must ~. approved 'by DEC in writing prior to their imptementati 4¸} lq~is approval is comingent upon compliance with the condit:ions of W asrewater Disposal Regulations~ 18 AAC 72.235,. ConxO~wttkm: Ce,~c~tio~i~ Then.oted section of the reguNtions requires [hat a ' C~:rt~ficr~tb?n qf Co~st~crion" N~ comPl.e~ed and submitted to the Depa~.mem within ninety (90} days of co:mp:lefior~ of consm,clion~ As*built pkms or record drawings should indicate any changes or de'viafior~s h~om ~'be approved :plums m thci. litate 'finM review, A "Cert~ ficatim~ qfConsmwtio~F form is cncio~d f(x yo~ usc. ma. stmar~ river, or lake. pe~its From the ! ~'.S~ Army Corps of E~:}~mcers and the Alaska Depanmem of Fish and Ga~ ~y Any pcrstm whc~ disa~'ees Yvilh ~his decision may request an a~[judicato~' heari~ng in accordance wkh 18 AAC 15~195. 18 AAC [5.34,(I or art mtom~al review by the Divisicm. Director tn accordance with 18 AAC 15. i 85. l'nlTormal reviews reqm~ts must be del iYemd ~a the Di vision Director. 4 I0 Wibughby AYenue, Suke 303. Juneau, Alaska 99801, within t5 clay s of the decision. Adjudieatory hearirtgs request, mus~ be delivered i~ the Commissioner ,:ff ~l~e. Dcp~mment. of Environmental Conservatkm. 410 Wilc, ughby :Avenue, Sm~e 303.~ Juneam Alaska 99801. within 3ti da~ s of the decision. If a hearing is not re. qued;ted v,:it~ '30 ciays~ the right 'to appeal i~ waivea Thank you lk~r ymtr coc~peranon. If you have a~y qaestion please do not hesila~e ro conmCl r~lc ar 269-7519. 140 ft well radius ~. / t 50 ft wel! radius · Relative Etevations Noted t000 gallon stee~ septic tank (!978}- Proposed /' O/ abandoned tn place Class. C WELL Serving Lots / E×isting Proposed ' 1500 gal steel tank DV ~ ...... ".. Proposed trenches 6 ft effective d:e pin 30 ft loc g Based upon survey by Shane Holt. Registered Cane/Surveyor, £S. 69¢4, Dec, 2¢~ 2004 T'IZN R3W Sec i5 Lot 109 s~p~ Um,.d.D.~.-W,~.~ ~t~r~:~:~o~ Watkins Engineering, !nc. Parcel ID; 01~83=07 December 27, 2004 Anchorage, A]aSk:a 99511*0443: Scale 1 i~ch = 30 ff Phone: (907) 349.I851, Fax: (907) 349-1934 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 0].5-483-07 HAA# 1. GENERAL INFORMATION Complete legal description T12N R3W Section 15 Lot HA920715 109 Location (site address or directions) 4881 101st Avenue Property owner Randy A. Meier Mailing address [:)ay phone Lending agency Mailing address Agent Address [Day phone v'"Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: three (3) TYPE OF WATI-'R SUPPLY: Individual well Community well Public water NOTE: .XXXXX If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXXXXXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 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. NameofFirm James Sizemore¢ P.E. Phone Address 6410 Swi%zerland Drive, Anchorage, Alaska 9916 Engineer's signature Date o D~_~S SIGNATURE ~/-,~) Approved for ~'/7-/-~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additiorml Comrnents ,/,O~,,~ ~ ,~_,/z~_~ ~ (.~ X.~c_.Z~ Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representation,'i 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 hornes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~J25 (Rev. 1/91) B,~ck MOA ~21 WALTER J. HICKEL, GOVERNOR DEPT. OF ENVIRONM][~N'TAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 EAST DIMOND, SUITE 3-470 ANCHORAGE, ALASKA 99515 (907) 349-7755 May 4,1993 Mr. James Sizemore James Sizemore & Associates 6410 Switzerland Drive Anchorage, AK 99516 RE: Section 15, T 12 N, R3W, Lot 109; Certificate of approval for Class C Public Water System, ADEC project no. 9321-DW-048. Dear Mr. Sizemore: The Department has reviewed the submitted materials received in this office May 3, 1993, in response to the interim approval previously granted to the above public water system. From the information contained in the submitted as-built it appears that the system was installed in accordance with the guidelines and regulations in effect at the time of installation. Therefore, for the concerns of this Department final approval to operate this public drinking water system is granted in accordance with State Drinking Water Regulations (18 AAC 80). Enclosed is the signed Construction and Operation Certificate verifying this Department's approval to operate the above water system. Thank you for your cooperation with this Department, if there are any further 'questions please do not hesitate to call. Sincerely, Michael Lu, E.I.T. Environmental Engineering Asst. II attachments ML/pf STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION CONSTRUCTION AND OPERATION CERTIFICATE for PUBLIC WATER SYSTEMS A. APPROVAL TO CONSTRUCT Plans for the construction or modification of__ public water system located , Alaska, submitted in accordance with 18 AAC 80.100 [] approved. [] conditionally approv@d (see attached conditioes). _have been reviewed and are BY TITLE DATE If construction has not started within two years of the approval date, this certificate is void and new plans end specifications must be sbbmltted for review and approval before construction. B. APPROVED CHANGE ORDERS Change (contracl order no. or descriptive reference) Approved by Date APPROVAL TO OPERATE The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water is made available to the public. The construction of the_:_ ~ I__, '~ ~ ~ ' , public water system was completed on granted interim approval to operate for 90 (lays following the completion date. (date). The system is hereby BY TITLE DATE As-built plans submitted during the interim approval period, or an inspectioe by tile Department, has confirmed the system was constructed according to the approved plans· The system is hereby granted final approval to operate· .'.~9.-/ .' /' -/' - ' !, _ ~__ .~8-0407 (Dev. 1~183 DISTRIBUTION: 1. WHITE - ENGINEER (Complete Seclion C) 2. YELLOW · WATER SYSTEM FILE (Complole SocEon C) 3. PINK - ENGINEERIMUNI-BOROUGH {Complete SecHon C) 4· GOLDENROD · MUNI.BOROUGH (Complete Section A) 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 FOE{ A SINGLE FAMILY DWELLING Parcel I.D.# /(~)\{:,, - I \~.?~)-~ 1. GENERAL INFORMA'rlON Completelegaldescription '~/-/~Af ~ ,~9~./ ~ /~' ~-AC>~L~ ~? Location (site address or directions) Property owner Mailing address Lending agency Mailing address __ Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: --.-'~ TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 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. 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 J.0/¢¢_~ E,~4~'~'~'~'~'~'~'~'~ ~ /.¢¢~_.~¢____.2~_~_ Phone ,7-'~-z~,~-/~c'T'L~ ~ 6, DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for /l~-~f~:~-.~ bedrooms, with the following stipulations: AddiUon 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 DH HS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(Rev. 1/91} Back MOA#21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL. CHECKLIST Legal Description: 7,/2-,/'¢' ~6bb/.~l~> ~//O7 Parcel I.D. ~1 ~ ~:Z - o~ A. WELL DATA ~¢; (~ ~' ~~ Well typ¢__~~} A, B, or C, attach A~tter. ADEC water system numl)er~)./E/¢ ~ ~-/~ ~ Log present(Y/N)___ '/~'I ~ Totaldepth ~_ ~.~ ~. d:~-' Sanitary seal (Y/N) %'/ _ Date completed /¢ ') ~" Driller Casedto ~ ¢'(~/ Casing height ~.~ Wires properly protected (Y/N) y_ FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO~: ~ Septic/holding tank on lot / ~ [ . Absorption field on lot /(~ .~/ ('~ g.p.m. AT INSPECTION g.p.m. ,~ ~;¢ ; On adjacent lots ; On adjacent lots Public sewer main /V/A Sewer service line /~// /:t,- WATER SAMPLE RESULTS: Coliform ~ Nitrate Public sewer manhole/cleanout _Petroleum tank Other bacteria Collected by: o B. SEPTIC/HOLDING TANK DATA / Dateinstalled___~ /~ Tanksize (<%)('J~ C~ //'_Compartments Cleanouts (Y/N) _ ~ Foundation cleanout (Y/N) ~' Depressioq High water alarm (Y/N) /~,1~ Alarm tested (Y/N) Date of pumping ~ ~? ~ ~--~ Pumper~ SEPARATION DISTANCES EROM SEPTIC/HOLDING TANK TO: Well(s) onlot J ~2 ~ . ~ _.Onadjacentlots ~ I0~-' .~ Foundation To property line~ ~ I Absorption field '¢~ ~/ Watermain/serviceline Surface water/drainage [~ O t"~ ~ 72-026 (Rev 7/9~} Fronl CONTINUED ON BACK PAGE LIFT STATION Date installed Size in gallons Vent (Y/N) --_.."Pump on" level at High water alarm level "':-:~ Meets MOA electrical~gode~ (Y/N) '-~, ~. SEPAR~IO~N DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Manufacturer Manhole/Access (Y/N) - ...... Pump off" level at Cycles tested Surface~v~ ater ABSORPTION FIELD DATA Date installed Length 'ZfO / -Width Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Gravel thickness Total depth ~ Cleanouts present (Y/N) Date of adequacy test for ~-'~. bedrooms SEPARATION DrSTANO~ FROM ABSORPTION FrELD TO: ~) / (~) / ~'~ Wellonlot ] ~ ~' On. adjacentlots ~ JO-(~t Propertyline To building foundation ~'(¢' '~ To existing or abandoned system on lot Onadjacentlots /k~' (2~/l~ Cutbank ]k'~"O Watermain/serviceline , Surface water /~ ~ {/ ~ Driveway, parking/vehicle storage area // Curtain drain /'~'~t~)l~'~' i'~'~0(~ ENGINEER'S CERTIFICATION -~ .-/.(.(.(¢'~;. ~¢'"<"~, ~' '~ ¢'" , , ~/(,~/?* I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection, SignetiCs Nam '- // _ - , Engine e,.~,~,¢.~.~-%,~~ /L. c/'~(.-~_d~/r,~(~)/~('~ Date /(t~ .~/~ ,~ ~'~_ HAAFee$ ~/'70 ,~'-~D Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA Waiver Fee: $ Date of Payment Receipt Number A. APPROVAL TO CONSTRUCT STATE OF ALASKA DEPARTMEN']' OF ENVIRONMENTAL CONSERVATION CONSTRUCTION AND OPERATION CERTIFICATE for RECEIVED PUBLIC WATER SYSTFMS MAR 1 2 1993 Munlc~pahty ct Anchorage Dept, Health & Human Services Plans for the'c~.nstruction or modification of %... public water system located in ~ ,////, Alaska, submitted in accordance with 18 AAC 80.100 by '%~/ have been reviewed and D approved, ~ ~ [] conditionally app~ (see attached c~ If construction has not st~.Cted within two years of the approval date, this certificate is void and new plans and specifications must be/.~b~ew and approval befora construction. / APPROVED CHANGE ORDERS Change (contract order no.'or descrlpEve relecence) Approved by Date C. APPROVAL TO OPERATE! The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water is made available to the public, The construction of the 0.1a.~ ~ ~.t~ .~._ hz~¢ JOq~ ~.z.'~[~, 1.5'~ 1'/2/v'.~.~.~ ~__~.~. public water system was completed on (date). The system is hereby granted interim approval to operate for 90 days following the completion date. As-built plans submitted during the interim approval period, or an inspection by the Department, has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to operate. BY TITLE DATE DISTRIBUTION: 1, WHITE - ENGINEER (Complete SocDon C) 2. YELLOW · WATER SYSTEM FILE (Complete Section C) 3, PINK · ENGINEERIMUNI-BOROUGH (Complete Sactlon C) STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION APPROVAL OF ON-SITE RESIDENTIAL WATER AND SEWER SYSTEMS PROPERTY DESCRIPTION Let, Block & St~bdlvlsion or U.S, Survey RECEIVED MAR 1 2 199; Dept. He-';tth ~, F-lu~'na~' ~-~r~v~ces This approval does not constitute a guarantee of any kind, explicit or implied, as to the perforrnance of the water supply and wastewater disposal systems. WATr!R SUPPLY A recent water sample was tested and found to meet Department of Environmental Conservation drink- ing water standards for total coliform bacteria. WASTEWATER DISPOSAL The domestic wastewate~ystem was: [] inspected by the Depart~qent of Environmental/G n~servation and found to be in compliance with applicable requirements%f 18 AAC 72~.-/ [] inspected by a Professional Engine~er"who certifies that the system complies with applicable re- quirements of 18 AAC 72; ~ [] installed by a Certified In;.st-'a'll&[' who certifies that the system complies with applicable requirements of 18 AAC 72; or~ ~ , [] tested by a Pro/fe'ssional Fngine~r who certifies that the performance of the system is satisfactory and that/~e/system comp.~lies wi~h the minimum separation distances specified in 18 AAC 72. This.atYproval is valid for a [] singl6 family [] multi-family unit with a total of bedrooms. 18.0404 (Rev. 81851 DISTRIBUTION: WHITE--BANK/LENDING INSTITUTION; CANARY--APPLICAN'~ PINK--DEPARTMENT Sizemore & Associates 6410 Switzerland Drive Anchorage AK 99516 Report Date: ].0/22/92 Attn: James Sizemore Date Arrived: 10/16/92 Date Sampled: ].0/16/92 Time Sampled: 0900 Collected By: JS Our Lab #: Location/Project: Your Sample ID: Sample Matrix: Comments: A121074 4881 E. 101st T12N B3W S15 Lot 109 Water MDL = Method Detection Limit Flag Definitions B = Below Regulatory Min. H = Above Regulatory Max. E = Below Detection Limit Estimated Value Date Method Parameter Unite Result Flag MDL Analyzed EPA 353.3 Nitrate-N mg/1 0.3 0.1 10/20/92 N[i~robio logy