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HomeMy WebLinkAboutT12N R3W SEC 27 N2SW4NW4NW4NE4TI 2N R3W SECTION 27 N25W4NW4N W4NE4 #017-451-08 r1 Municipality of Anchorage =; '• Development Services Department Building Safety Division On -Site Water and Wastewater Program. 4700 S. Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 Page I of 3 www.ci.anchorage.ak.us (907) 347-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: S W0z/0a%9 PID Number: 0/7— q51 —03 `Gre D.mer- ❑ Wastewater System: New O Upgrade Aft�pt—So r;de ei a K985Y-3a ABSORPTION FIELD Pn3 y 9 -3 9 q g Manba a eaioam' S Q([) a TTaan O S1W . Trach O B d O M.,W o om.r LEGAL DESCRIPTION sw RMrlp O. I �P Tar Depot ft ma.pr.r prM : Q IFtt O�// Ft / elpat�� Lot Lll� /I/W - N�1 of Dorm to P" bamm w.m abti.r r Ft. Or,,. dWhb«..mp,pe Ft TpwnWp-QIV R"'°'3W B.rJlac�� Fi.m.aaba. aq^N paM'./O. t. ` 60 0= iaa Ft. Well: New El Drm.tram 3 p,• I : '/q�/j) DmataW r.r FL clafurtaltn (PMMA, A e. er Taal DFPm: CaeaE b Taal abwrpem a•a 7� P � M* �� la rS Iva>{'G FI FP t DrNar. Dae Suit WMa LBM: 1W1~. Do* 1m0~ YWe G lv..Ga.n TANK TANK GPM FI. iL SEPARATION DISTANCES Lt7,Septic ❑ Holding ❑ S.T.E.P. ❑ Other. To From Septic Tank Absorption Field Lift Station Holding Tank PublidPrlval Sewer Line "t'"'ma"'r / U/mel c.p.utF �Sooea. ' L /(, L —� ^� 'y Mata W. �� J� / Nurow a Camprm.Ms' ^O(� wM �S/ 1 (.. sle o wet_ IQO(/'/jf 100+ LIFT STATION 1 $q , 13 �. Maulxtua La L:. OM � D L 38 •PUN a laM N'. 'Fong Hpn ra« slam M: Faa Wl n in. K.�vw PUN MaAaa E banpW M,pecbma paran.E by D��na.n one Ramaea 4-x 51"4 44nz— [v45 M BENCH MARK lrHs6� aba o.��d. lowbm a,a W wq,wn: Thre56121d Of 511alliIC2' Aa LM .m . �r ne inf �� �t 100 FL En tamp OF i*,1, S i S ENGINEERING 17074 Eagle River Loop Road, No a -6 Inspections performed by: Ms: 1 ar or.xlrtt.�sn— i A A Y ....I 2^°8 /S 0� 1,.r Development Services Department Approval }; If, 11 9 ROBERT C COWAN z CE -8801 Reviewed and approved by Date:(j f•: 'e-' ;,....... "- 1tt l :. C _ PERMIT No. SW040279 PACE 2 OF 3 Municipalit of Anchorage DEPARTMENT OF HEATH 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 LECAL N%Z,SW%,NWI/a,NW%,NE%4,SEC. 27,T12N,R3W P.I.D. NO. 017-451-08 x _H Z C1 N C� 1+ 'Y�Srj NEW 1500 GALLON 'L'C Iq SEPTIC TANK A NCN 090y TBM ITS O n DBL3 O pNa Cf STI Gp� > D ALT. SITE i�7 T7 FCO n00 m iDWERTER Z VALVE (OV) MT R DO �i� TI z G� (F5FLOW _41 TN#I SPLI) TTER N CO NEW TRENCHES CO3 Q 10' UTILITY EASEMENT SCALE. I' - 50' � %7 rk LOT 9 i I, R05ERT G COVA,Ip i ti 70 �yc�ti CE -8808 f .`.�,, PERMIT N0. SW040279 PACE 3 OF 3 Municipalityof Anchoraqe DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Te'lephone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL N%2,SW'/<,NW'/s,NW%,NE%,SEC. 27,T12N,R3W P.I.D. N0. 017-451-08 ST1 ST2 98.7' FINAL GRADE A B FCO 28.0 25.0 -§T _1 23.5 3 5. 0 ST2 30.0 40.0 NEW 1500 DBL1 32.0 a1.0 94.7 .5 GALLON 94 D B L 2 33.0 a1.5 DV�SEPTIC TANK FS 36.0 39.5 FS 83.5 66.5 C01 61.0' 39.5 CO2 60.5 53.5 CO3 121.5 96.5 C04 119.5 103.0 MT1 6-6 5 44.5 MT2 68.5 60.5 C01=98.4' CO2=97.9' VC03=93.5' =97.9' C04=98.3' FINAL GRADE COI =93.7' CO2=93.6' SR C04=93.5' N. T. S. hIT1=86.4 MT2=86.1' NO WATER FOUND �j'.^�� °O8C T C. AN r 80.1' B.O.H. title .. .��?aa ~ MUNICIPALITY OFANCHORAGE �y,�� Development Services Department l Onsite Water & Wastewater Program 4700 South Bragaw Street v P.O. Box 196650, Anchorage, AK 99519-6650(„ (907) 343-7904 �1 J ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial I Upgrade Date Issued: Jul 21, 2004 Expiration Date: Jul 21, 2005 Permit Number: SW040279 Parcel ID: 017-451-08 Legal Description: 4T12N R3W _SEC 27.N2SW4NW4NW4NE4" Design Engineer: 0003 S & S Engineering Site Address: 012501 BAINBRIDGE RD Owner Name: GREG DITTMER Lot Size: 87675 SO. FT. Owner Address: 12501 BAINBRIDGE Total Bedrooms: 5 Permit Bedrooms: 5 ANCHORAGE. AK 99516-3002 This permit Is for the construction of: ❑V Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By. Z Date:_ 71?y/0N Issued BYDate:__Ila I lbq T—T- -�� Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw Sl. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWERMELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 019f- U5-1- 0� Permit Number SW Property Mailing address (1 Day phone 3q9__547 f9 Mailing address (2) frlgo/'�c; A�lr� Zip Code 99.S/1o� C' ' Legal description (Lot, Block & Sub'd.) �L, ) /� Legal description (Section, Township & Range) 'G7 /O/I /, T/,? ,�, K 3 w Lot Size' 0S Acre Sq.Ft. THIS APPLICATION IS FOR: Number of Bedrooms 57 Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade to THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. 5 d ENGINEERING 17033 4 Eagle River Loop Road No. 204 Eagle River, Alaska 99377 (Signature of property owner or authorized agent) Permit Fees: P �/ 6 G v + Waiver Fees: Date of Payment: -7 �/ f /d Y Date of Payment: Receipt Number: (,q S S a. `17 Receipt Number: (Rev. 12100) July 12, 2004 ROBERT C. COWAN P.E. CMLENGINEERS (907)694-2979 FAX(907)694-1211 IEAUHAVTHMTr MUNICIPALITY OF ANCHORAGE APPWNkS Development Services Department P.O. Box 196650 Anchorage, AK 99519 SEWEITS WATER MVID(TEM10M REFERENCE: N'/2, SW%, NW'/., NE%4, Section 27, T12N, R3W, S.M. REVIERSWATER It is requested that you issue a permit to install a new septic system to serve the MPECNON existing rive bedroom dwelling on the referenced property. Two test holes were excavated and percolation tests performed. The approximate locations EIAN M43TLEIES of the test holes are located on the attached site plan. At the time of excavation (5/26/04) ANDMMRTS water was not found. After seven days of monitoring, no ground water was found. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve Pr EESTOTION areas or drainage patterns by the installation of the proposed septic system. The LAONconstruction of this system will not prevent any future development on any of the adjacent properties. 8REPL" If you require additional information, please contact us. Sincerely, RO/DOESICN Robert C. Cowan, P.E. Wt TEST RCC/bjj Enclosure PERCOLATION TEST STRL CTLPA & EECKWCN. PaPECTlora CHWE WASTEWATER CISPOMSMEM CESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER ALASKA 99577 ------------ - NL • S`\4;Y'• � �/�j�, ,�+ Isle4 qq rtLi I vm I o Z f�i 1 0 o O 1 W < _ O<< �) I QUO �� 1 � W C! O Naz 00 =< 1 'no a Za0Y 1. ti OW&O A. uon3 3c 1 � I CQ Z I Exp CROON' w 0\35i. a 1 I u w1 N 'mi 1 E-a Owl ;7I O ou i3oi > 1 a H < F x�ou E ^ I IUl 01 W30W J Z 1 W UyY. < d F L? O 1> a I LJ o I CLEL O� Fri O O tD \\ J u I a U Lo n C> I Ul � Z 11 O � ,_, `> I m � � I N 1 7_ P mJo E- I OL 1 U c� ® EXISTING 20't WIDE GRAVEL ROAD w•i'1i ev 3ow 7 W l..O> Z G<z C0 Q 'y Y N N ��c <no A.m<su n + a �tl:R NVId-311S NOIS30 09 = „L Municipality of Anchorage Development Services Department Building Safety Division yr On -Site Water and Wastewater Program 4700 South Bragaw SL P.O. Box 1S6650 Anchorage, AX SSSIM650 www ci anchorace.ak.us (CO7) 343-7SC4 C 10\ ROBERT C. COWAN 4C" CE -8801 Soils Log - Percolation Test Per'crmedFor: G2e.In, Dar-Trid__DatePaeormed:�a(1 0� Legal Description: n/ Va,S Iv717 IV w '�y �� ray Township, Range, Section: T /a Al (Z j S: G, jz Scope Site Plan TOTS NeLe£. #— / F—F F_Fj 20- i WAS GROUND WATER ENCOUNTERED? f a s IF YES, AT WHAT DEPTH? E O Depth to Water After P Monitoring? DRY E . Date:6 /� Reading Depth Gross Tune Net Time Ij Net Drop R isoA.0 (Feet) 0te404M c -J 1- zit 2 G.M 3- ' 4HAwµ T e 4• D4 Nft= 3 5J- , .e 6- 7. ML 1&,j 8 - SI -50nr�/ r 10- •, 6(AAV4L 11- d' ,So"t • I- SRN D 20- i WAS GROUND WATER ENCOUNTERED? f a s IF YES, AT WHAT DEPTH? E O Depth to Water After P Monitoring? DRY E . Date:6 /� Reading Date Gross Tune Net Time Depth to Water Net Drop R isoA.0 -7/1 /o— _5 0 90 -50nr�/ P•eRCOLATIONRATE&1-+nvttslrGl FERC HE DW.IcTER Ej •• TESTRUN6_"iV/EEN—7 FT AND !JC FT COMMENTS S & S ENGINEERING I ERTIFY THAT THIS TEST %V, S PERFORMED BY: PERFORMED IN ACIF;Q I I C.VUi'TW ,i"�6J�_WA GUIDELINES G: EFFECT ON THIS DATE. DATE: 7 110Y_ Municipality of Anchorage !119flGINEER•%5E4K-- Development Services Department Building Safety DKision yr On -Site Water and WaslevraterProgram- 4700 South Bragaw SL .«. - P.O. Box 196650Anchorage. AK59519.6650 p ROBERT C. COWAN wwwcianchence.ak.Bp�f CE -880) (907) 343-7904 Soils Log - Percolation Test 11'i PercrmedFor: G. /t Lr, (r OIT'iM G __DatePeeormed:_- Legal Description: .02. Sw r/y Nw if Y tL yM Township. Range. Section: 7- I a- n/ -, R 3 W SKC. 7 TEST 1/et� !r<1 Depth 1 I y,I- f'7 I 0RG.AJIC-3 3- 4- 5- _ 4rR�v4tt 8 SOnt 140 13- 14- 15- 17- 18- COIXNAENTS PERFORMED BY: S & S PERFORMED IN ALS+ Reading Dale WAS GROUND WATER . o !'� 9- Depth to Water ENCOUNTERED? PRO'OU '7I't Io S 10- 7'�r �r I. IF YES. AT DEPTH? DEPTO DePlo Water Atter N 11- 7 Monitoring? 4�1A E 17- Dare: 13- 14- 15- 17- 18- COIXNAENTS PERFORMED BY: S & S PERFORMED IN ALS+ Reading Dale Gross Tone NelTime Depth to Water Net Drop PRO'OU '7I't Io O - 7'�r �r - 30 30 7 .iot ai 60 10 hr g 6D — — ci 7 PeRCOLTIONRATE (00 tl— 111 -e) PERC HOLE DI:at_TER-- TEST RUN B=WEEN —_FT ANDFT Alaska 99577 I CERTIFY THAT THIS TESD 1`/j.S �1PA GUIDE INES 4`l EFFECT ON THIS DATE. DATE: 7/ 9010V Municipallity of Anchorage Aug 3, 2004 Attn: Joe Goodall P.O. Box 196650 Anchorage, AK 99519 Dear Mr Goodall, The permit has been approved for my property to install a standard deep trench 5 bedroom septic system. I am writing this letter to inform you that I plan to install the system per the munis owner installed option. I have knowledge and experience in septic systems and my engineer will be watching me closely with inspections during the installation. Thank you. 4itt , mer 12501 -Bainbridge Rd Anchorage, AK 99516 Tel# 349-3949 Parcel # 017-451-08-000-04 ! )MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 0* 825 L Street - Anchorage, Alaska 99507 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME RS M&Atsb Yl PHONE 3336 p t MEW ❑UPGRADE MAILING ADDRESS L. Ln 7 LEGAL DESCRIPTION .r LOCATION NO. OF BEDROOMS Uy DISTANCE TO: Well j3�`3 -i— Absorption area '�r Dwelling p 1 t PERMIT NO. j, 7-b fI 9 P Q Manufacturer Material L No. of compartments 2. v' Liq. capacity in gallons Inside length Width Liquid depth U>J IF HOMEMADE: �. ---- ` O J t�Z DISTANCE TO: Well Dwelling PERMIT NO. = z F Manufacturer Material Liquid capacity in gallons ❑ DISTANCE TO: Well I `,5-(? -+ Foundation '2.'%52-o Nearest lot line PERMIT NO. 41 w= T J z No. of lines Length of each line Total length of lines Trench width Distance between lines F Z w 2e inches -- Q H Top of tile to finish grade Material beneath tile Total effective absorption area p I inches /J'—OQ A Length Width - Depth PERMIT NO. w (7 i F Type of crib Crib diameter Crib depth Total effective absorption area wa W rn Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. J J w � Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE MATERIALS PV SOIL TEST RATING INSTALLER ++�'''' 1.� (0.Vw'll U•! leis REMARKS i p"rrrt-F LZo G65 1 e c"� o -'I' e�tdi o•t APPROVED DATE LEGAL -XV y/9a r 1-L N R3 IV .S2� 72-013 (Rev. 3/78) �Qti I. DEPARTMENT H_r!FL AND ENV 1RCrME?TPL i ,T I -P " STREET, y-, 2 I ` t... ` HF'?I::HOfaHt=F': Eir::. 99501 264-4720 A ..q tr=_. @ A e -'::v r- E R� -n N S 4•. 9 .__ K G .a- - ti I... - t-;;- � _ -.... " @'" . _ .. PERMIT NO. < 820419 419 ,3•,.'--�'-3 : APPLICANT j.:. ;?'. MADISONCMADISON: +.Gt !_.f�f?[Ir? IN 333-6941: LOCATION BAINBRIDGE RD LEGAL FL.. ' 5.27 NE4 LOT '_._t,_E: 8!; 000 'sd>A_ARE_ FEET TYPE OF SOIL. ABSORPTION SYSTEM IS: TREr'.I!::H MAXIMUM NUMBER OF BEDROOMS SOIL RATING (•_.r_? F.T'/BR)= 235 THE REQUIRED SIZE OF THE SOIL_ ABSORPTION :;',_-•TEM IS: _. 107 FA C,: v -x- p-1r..� :_:,, . * 6_3 FT !l -'-@ E> E� THF LENGTH DIMENSION 15 THE: LENGTH (IN FEET) OF THE: TRENCH OR Df=:AINFIEI D. T f jE DEPTH OF A TRENCH :H OR PIT IS THE: DISTANCE BETWEEN THE SURFACE OF THE Ijf':i.}!_IND AND THE BOTTOM OF THE EXCAVATION &IN FEET). !HERE 15 NO EGET WIDTH FOR TRENCHES. THE: GRAVEL DEPTH 15 THE r'!,rT1f•1UM DEPTH OF GRAVEL. BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE Et:.j!_.y11'.ATi;-iN (IN FEET). x_ -,u f P T .. , . 1" •= E.: =, I.' _171 _ s=. E - :1. lc--€ Aid C., _. F: i R_.. C3 9 - PERMIT APPLICANT HAS THE RESPONSIBILITY Ti!ANF_iRM ;'H7_=: DEPARTMENT I;iL.IF'ING "I'H`r INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. .gip,I l__9 z _ To ..... f J S T C. E E C 4-'A d 9 ".'. IF H'F' 5"p:. t:... d . _®101._. _.., ._._ _ F;NC:F:k=LL.J_..T;,IG !::!F Fir?'r' ..:r.c•!e:a•1 I:IiTr-!C!!_n- r_Ir'?!aL IP'd:_.F'r.cTli!r'd AND tiF'F'k7.1'•r'kiL :;!`t' THIS DEPARTMENT WILL. F.E. SUBJECT TO PROSECUTION. MINIMUM DI= TAhI E BETWEEN N WELL. AND ANY ON—SITE SEWAGE DI:_.PC'SAL. SYSTEM J _- ��kFEET =:R trr1trTE iE!_ _G:_—O _ i=-Ei -RCYA F_EL1CWELL frFE_)I YO IJF'ON THE TYPE OF PUBLIC WE!_,i_. MIr,ilt'UM DISTANCE FROM R PRIVATE WELL TO A PRIVATE SEWER LINE. IS 25 FEET i1Y"D TO A C i1''ir•1JYE l_SEWER LINE T ; 73 FEET. . WELL. LOGS ARE: REQUIRED IRED AND MUST BE: RETURNED TO THE DEPARTMENT WITHIN 30 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY' APPLY. SPECIFICATIONS For'D CiJr'STRUC:TIOP-11 DIAGRAM_:; ARE . _ _. F!':JF!'fL..hiF3(_F T -Ci Ip.?:c:!.,IF.:E PR!.!r'E:1=: INSTALLATION. IilY,l. moi'' _._ _ C e- _. FRE= E:= __ a_.:: E_: I+•"R @-3 L-_'_ tY� _...:... I CERTIFY THAT ::L: I I'!I'•'! FAMILIAR WITH THE REQUIREMENTS FOR !:;N -SITE SEWERS AND WELLS AS SET FORTH BY F: MUNICIPALITY firI-IPtLI 'tFFif-nktCE. I WILL INSTALL THE SYSTEM IN ACCORDANCE NCE WITH THE CODES . SYSTEM I. AND THAT THEON-YTTESEWER S S!EM hh.?E:TFfF f _ri`k_F RESIDENCE I•_ REMODELED TO INCLUDE MORE THAN 5 BEDh:;i_u.!MS. •. ,:;I!-. ,'?EL'S'.-�r.-- ,�/ ISSUED i=''-' PERFORMED FOR'. LEGAL DESCRIPTI 1 2 3 mss- —4 5 6 7 S, 9 10 12 13 14 15 16 17 18 19 20 COMM Id SOILS LOG�� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS 1r ` LOG —PERCOLATION TEST ('�� c� maL`,t So(DATE PERFORMED: — �^ 'T I y� IseG-r a SLOPE WAS GROUND WATER L ENCOUNTERED? L Depth to Water _IJV O P I c : a E IF YES, AT WHAT DEPTH? II o.37 Reading Date Gross Time Net Time Depth to Water Net Drop I c : a 1'(o II o.37 to L•N ,a tl - a;K7 � l•3 r t, 1o:si to 09 I t" o -7. 1 PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN �• J FT AND �' C) FT PERFORMED BY: (p on CERTIFIED BY: 72008 (6/79) DATE: K ^, M -W DRILLING, Inc. r.0. Box 10-378 • 10300 Old Seward Highway a (� (907) 349-8535 SQ '� I� ANCHORAGE, ALASKA 99511 / DRILLING LOG Well OwneryinEe "`� `� i�if%�/fJw Use of WellDnmaal-1 Location (address of: Township, Range, Section, if known; or distance main road r Size of casing F" Depth of Hole 929' feet _ Cased to 220'—feet -- - Static water level 1 RO' ft. Xabnr>:)c (below) land surface. Finish of well (check one) open end ( x ); Screen ( ); Perforated ( ).- Describe screen or perforation NOne Well pumping test at l0gallons per PW19 (minute) for 1 rhours with 100% ltbc of drawdown from static level. Date of completiorLJules, 1982 WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness ^ 0 TO 2- 2 To___3— _-3_TO 38 ATO 72 72 TO RF --8-6--To 9Q an To106 106 To 141 141 TO 150 --15-0-To 172 172 T0__l84 -IBA-TO .1 u 194 To 204 204 To 215 215 TO 222 �s- - 9- Z4iiS _ Gf 1 t -Y 4antl f r ra'I Silty Hardpan Silty Hardpan & Gravel • - NXV1VA Certified Contractor Sandy & Gravel krater Gravel 3—CONTRACTOR MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 017-451-08 Certificate of On -Site Systems Approval Expiration Date: 2,o3,3 Legal description T1 2N R3W SEC 27 N2SW4NW4NW4NE4 Site address 12501 BAINBRIDGE RD Anchorage AK Current property owner(s) LISA & MATTHEW HARTFORD X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By: Original Certificate Date: 8/8/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 I UMCI ALA of AHCHORAGE r? Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Applicatinra,, 1. GENERAL INFORMATION s<,. Parcel I.D. 017-451-08 Complete legal description T1 2N R3W SECTION 27; N2,SW4,NW4,NW4,NE4 Location (site address) 12501 Bainbridge Road *Anchorage Current property owner(s) MaTt & Lisa Hartford 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 382-7413 3. TYPE OF WATER SUPPLY: ❑® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4.—TYPE-OF-WASTEWATER DISPOSAL: a Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel 0 Plastic ❑ Concrete ❑ Fiberglass Age 19 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed 0 Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: 01 Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ U g b Waiver Fee $ Date of Payment COSA # 05 C 2 3/ 2' l Date of Payment Waiver # COSA Applicatlon_June 2022 q_4 Legal Description: T12N R3W SECTION 27; N2,SW4,NW4,NW4,NE4 Parcel ID: 017-451-08 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system WELL DATA Lf }y�}ell log is filed with Onsite (or attached) �`-�"ate drilled 7/8/82 Total depth 222 ft Cased to 220 ft r❑Sanitary seal is functioning correctly ` ❑ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 7/20/23 Static water level at beginning of test 177.5 ft. Comments B. TANK DATA Z3 Measured operating fluid level in septic tank 48 J to of pumping 8/2/23 IIuired maintenance completed, if AWWTS omments: D. ABSORPTION FIELD DATA Which system tested (date installed) 8/15/04 ❑ ALL standpipes present per record drawing Total measured depth from grade 11.9 ft(max) Measured depth to pipe invert from grade 4.58 ft (min) ❑ N/A - pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective WITHIN 5" ❑ Presoaked required if (Required if house vacant or field not us r more than 30 days prior to date of test Gallons introduced allons date A=s. =enter reatment (past 12 months) ate Well production at time of test 5.4+ gpm Water storage tank volume N/A gallons e�tgd Well gjS for coliform test? ❑ Yes ❑ No Lei Coliform bacteria is Nitrate • Z 1 mg/L Arsenic ug/L ❑ Nitrate less than MRL (ND) D-Aisenic less than MRL (ND 1,O11e(AeQ Dy Date 7/20/23 C. LIFT STATION ❑ Required maintenance completed Age of lift station ye Lift station mater' Adequacy test date 7/20/23 Results nm Pass Fluid depth prior to test 55 in Water added 655 gal New fluid depth 67 in Elapsed time 120 min Final fluid depth 60 in Absorption rate 600+ gpd FIELD STATUS - POST RECOVERY Effective depth (per record drawings) 84 in Effective depth used 61D in ` t (- Effective depth remaining in 214 � �t4gy- Comments/Deficiencies: TESTED NORTH 1994 TRENCH ONLY - SOUTH TRENCH HAD 33" OF LIQUID ON 8/3/23 1982 RESERVE TRENCH NOT FOUND - CONDITION IS UNKNOWN COSA Checklist June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' DYes if No ft DYes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' QYes if No ft Absorption Field on Lot > 100' FE Yes if No ft Holding Tank > 100' ©Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' -1Yes if No ft M Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Q Yes if No ft Q Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *5,+ ft Surface Water > 100' 0 Yes if No Tank to Property Line > 5' 0 Yes Field to Property Line > 10' © Yes Water Main > 10' Q Yes Water Service Line > 10' FEI Yes if No ft Wells on Adjacent Lots: if No ft Private Wells > 100' if No ft if No ft Community Wells > 200' ft F113-1 Yes if No ft g Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *MET CODE AT TIME OF INSTALL - S__ T 1 IS APPROXIMATELY 72" AWAY FROM 2ND STORY DECK SUPPORT (SEE ATTACHED PHOTOS) G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Gamess Engineering Group, LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Garness . Date 0) 3/?_3 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 o�000 practices. The reported results describe the condition of the system/s on the date/s of the evaluation. 6QOF �\�p4 Separation distances were measured to readily identifiable features. Hidden defects or encroachments may o cam. /� exist that were not Identified during the evaluation. The operational life of all wells and septic systems depend \ -• / �S Q� upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate p during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing ��* i' g H*I the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory lest 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 a .i: . , , �. , • , , , or septic system can be installed on the property in the event either of the current systems fail to perform Q J fde A_ Gar ss: ...:... adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEGQO 9 (f CE— 79 3 v to perform the evaluation. Reliance upon the information provided in this report by any other person or party (144 0o�G (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 'Ile `G)._ 2 F opo COSA Checklist June 2022 #AEcce4� 4�DOp000��o • '� Municipality of Anchorage 4_2� On-Site Water and Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 017-451-08 Expiration Date: 1. GENERAL INFORMATION ' Complefe legaLdescription T1 2N R3W SEC 27 N2SW4NW4NW4NE4 Location (site address) g g 12501 Bainbridge Drive Anchorage, AK 99516 Current Property owner(s) Gregory M. Dlttmer Da hone '* Y P Mailing adyiress Real Estate Agent 12501 Bainbridge Drive Anchorage, AK 99516 Gary Kutil 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Four Day phone 727-2717 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual F71 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ unless otherwise requested by the engineer. COSA Fee $ `d 7 o� 611 Date of Payment 51-2.1/.7 Receipt Number COSA# 105 1&/ r Date: ~% Waiver Fee $ Date of Payment Receipt Number Vaiver # 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 Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 5/2/2013 o®+®��►Y�`114 � 47. 6. DSD SIGNATURE �....� ., ., .. V System #1 Approved for f Y bedrooms. V01 "�0�,��" M�1�gy �ANDERSON.' System#2 Approved for. bedrooms., a-4381 Disapproved. Il��?'p'°.� ;�•'� : +1, p�OfES00;S Conditional approval for bedrooms, with the following stipulatio��:\\��s�� 4 By: 4aW4 / Original Certificate Date: S %� The unicipality 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 Slate 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 9-1-11dw If more than 1 septic system is on the lot: COSA Checklist # of _ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: T12N R3W SEC 27 N2SW4NW4NW4NE4 Parcel ID:017-451-08 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 7/8/82 Sanitary seal (Y/N) Y Wires properly protected (YIN) Y Total depth 222 ft. Cased to 220 ft. Casing height (above ground) >12. in. FROM WELL LOG Date of test 7/8/82 Static water level 180 ft. Well production WATER SAMPLE RESULTS 10 g.p.m. AT INSPECTION 4/19/13 182.5 ft. 2.55 g.p.m. Coliform 0 colonies/100 mL Nitrate •940 mg/L Arsenic N/D ug/L Date of sample: 4/19/13 Collected by: Anderson Engrg. B. SEPTICIHOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 8/15/14 Tank size 1,500 gal. Number of Compartments 2 Cleanouts (YIN) Foundation cleanout (Y/N) _ Date of pumping 4/30/13 Y C. ABSORPTION FIELD DATA Depression over tank (Y/N) N High water alarm (Y/N) _ Pumper Around the Clock Pumping Y N Date installed 8/15/04 Soil rating.45 GPD/SF Deep Trench (g.p.d./ftz or System type Length 22 :.f ts Width 3 ft. Gravel below pipe 7 ft. Total depth 12 ft ',�rr znbsorption area 1,708 fe Monitoring tube Y Depression over field N Date of adequacy test 4/1 4t13 Results (Pass/Fail) Pass For 6 bedrooms Fluid depth in absorption field before test 0 in. Water added 750 gal. New depth 0 in. Elapsed Time: 0 ruin: Final fluid depth 0 in. Absorption rate >= 750 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: >100' >i nn, Septic tank/lift station on lot On adjacent lots 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' SEPTIC/HOLDING TANK ON LOT TO: Building foundation >51 Property line >51 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 None Noted 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 Michael E. Anderson, P. E. Date 5/2/2013 COSA brown sheet 10-10-12.doc Absorption field >51 Surface water >100' Water main N/A , Driveway, parking/vehicle storage > I 0 C A6 E ANDIFIt50N W CE -4381 S -Z -1J ,.• in. m D m m �Z ib NNC) ^. T3 K mm 0�3m -mi -.{boom 0 co m .-mmr m Ei' m 0 m a aq 7 C z n m o m s O m n m m m 0 o m m 2 N T o^ m m Cl c y 8 m N W� WA A O m 7i p N o -i D N � O m m _ AV £ o 8 N^� 93 m Cn Ea n � m m gmn �+ n Z O 0 BAINBRIDGE ROAD w 0 ninnonalnn'lc OnR nn f(n iifnril w 0 o— Fr M m' �a ?e: D M S00001'00"W 208.00 (Computed) O 0 co I V Contour I Acres Subd. Municipality of Anchorage �E • Development Services Department Building Safety Division f 5. Er. On -Site Water & Wastewater Program! 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-451-08 HAA# b 2—) -Z-- 1. / 1. GENERAL INFORMATION Expiration Date: 9-19-03 Complete legal description T1 2N, R3W, SEC. 27, N2, SW4, NW4, NW4, NE4 Location (site address or directions) 12501 BAINBRIDGE RD. Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address JOAN AND MICHAEL TAYLOR Day phone 562-0858 12501 BAINBRIDGE RD. ANCHORAGE, ALASKA 99516 PAULINE HOFSETH Day phone Day phone 229-4007 PRUDENTIAL VISTA * 4241 "B" ST. * ANCH. AK, 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKWWC, Inc. 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 4 bedrooms. Phone 337-6179 Date 7 O3 il&,a Zlv`�JWI, III 'we" ff y Gar ess: s CE— �G 0� rofessio� o Disapproved.\1 OF AN, Conditional approval for bedrooms, with the fllowing stipulations: \`` ��Q .. •. O.pr ON-SITE WATER AND WASTEWATER : PROGRAM • N \ I JJJ Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other By: G�-��'G Original Certificate Date: (Rev. 12101) S � 'llJl��11��1 Municipality of Anchorage L , • Development Services Department W. Building Safety Division ` ~ 4 " , On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: T1 2N R3W SEC. 27 N2, SW4, NW4, NW4, NE4 Parcel ID: 017-451-08 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) Date completed 7-8-82 Sanitary seal (Y/N) YES Wires properly protected (Y/N) Total depth 222 ft. Cased to 220 ft. Casing height (above ground) FROM WELL LOG AT INSPECTION Date of test 7-8-82 5/21/2003* Static water level Well production 180 ft. 179* ft. YES YES 16 in. 10 g.p.m. 5* g.p.m. *WELL FLOW TEST PERFORMED BY TOBEN SPURKLAND P.E. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml Arsenic: N/A mg./L. Nitratey- `-'.3 mg./L/. Other bacteria 0 colonies/100 ml. S-12. 2.i 0. S e U f' -`'du_' Date of sample: 6/9/2003 Collected by: AKWWC, INC. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC TANK/STEEL Date installed — Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 6/9/2003 Pumper DENALI C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE. I **MONITORING ONLY, NO CLEAN—OUT. Date installed 9/9/82 Soil rating (g.p.d./ft o ! z/ ) 235 System type DEEP TRENCH Length 94 ft. Width 3 ft. Gravel below pipe 8.5 ft. Total depth *11.5 ft. Eff. absorption area 1500 ftZ Monitoring tube YES Depression over field NO Date of adequacy test 6/9/2003 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 79 in. Water added 1327 gal. New depth98.25in. Elapsed Time: 240 min. Final fluid depth***96 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — ***SEE ATTACHED REPORT D. LIFT STATION Date installed "Pump on" level at in Size in gallons Manhole/Ac "Pump off' in. 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 75'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 5+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS 0 C�/G /-I P44 ? 64060 /�4 G. ENGINEER'S CERTIFICATION F To I certify that I have determined through field inspections and * Q� review of Municipal records that the above systems are in ' ' .. conformance with MOA HAA guidelines in effect on this date. O e rey A. ar ess: Engineer's Printed Nm e JEFFREY A. GARNESS Q 0 C 7953 G �p 1'' l? 404�s p ' •' .... • ' fop Date C rofessio�oo ��O0000�4 HAA Fee $ 57 • 07D Waiver Fee $ Date of Payment CD '• qDate of Payment Receipt Number l��JA `, Receipt Number (Rev. 12/00) 5(,Z— 5-4115 ALASKA WATER �& WASTEWATER �•- = CONSULTANTS, INC. b June 10, 2003 Prudential Vista Real Estate 4241 B Street Anchorage, AK 99503 Attn: Pauline Hofseth Subject: Septic system evaluation for T12N, R3W, Sec. 27 N2, SW4, NW4, NW4, NE4; 12501 Bainbridge. To whom it may concern: The subject lot has a 4 -bedroom house on it, which is served by a private well and septic system. The results of the field investigation and adequacy test is summarized as follows: A. WELL: Toben Spurkland performed the well flow test. We will need a copy of his data so that we can prepare the MOA health certificate paperwork. B. SEPTIC SYSTEM ADEQUACY TEST: The drainfield is a 3 foot wide trench, which is 94 feet long, and has an effective depth of 102 inches. Prior to starting the adequacy test, the M.T. had 79 inches Of liquid in it. The first 969 gallons that were introduced caused the liquid level in the drainfield to rise 15 inches, to a total depth of 94 inches. The next 310 gallons caused the liquid level to rise 4 more inches (total liquid depth of 98 inches), which corresponds to 77.50 gallons per inch of rise. We then added an additional 48 gallons (1327 gallons total) and noted that liquid was backing -up into the septic tank. At the point at which back-up occurred, the liquid depth in the trench was 98.5 inches. The flow was stopped and the liquid depth stabilized at 98.25 inches within two (2) minutes. The level was checked two hours later and it had dropped 1.25 inches. After two additional hours of recovery (four (4) hours total recovery time) the level had dropped a total of 2.25 inches, indicating a recovery of roughly 175 gallons. This equates to an absorption rate of roughly 43.6 gallons per hour. Based upon this data, it was determined that the absorption rate of the trench exceeds 600 gallons per day, as required for a 4 -bedroom house; however, it is important to note that this rate can only be achieved when the system is filled to 100% of its capacity, and maintained at, or near, that liquid level. C. WATER QUALITY: Water quality samples were pulled and taken to a State certified Laboratory. We will forward the results to you as soon as we receive them. If you have ai jy g&fi�ns, please contact us at 337-6179. ly, PH, M.S. 3701 E. Tudor Road, Suite 101 * Anchorage, Alaska 99507 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com 06/13/03 FRI 10:40 FAX 2738445 PRUDENTIAL VISTA R.E. 1a002 T. SPURIK,AND P.E. WEST 15TH. AVENUE SUITE 203 ANCHORAGE, ALASKA 99502-3904 (907) 279-3916 Fax (907)-276-6013 RESIDENTIAL WELL INSPECTION LEGAL: Nl/2,SWl/4,NW1/4,NW1/4,SE1/4 SEC 27 OWNER: Michael Taylor LOCATION: 12501 bainbridge Road TYPE OF WELL: Private, Single Family WELL LOG AVAILABLE: Yes INSTALLATION REQUIREMENTS MET: Yes WAIVERS GRANTED: None WELL YIELD FROM WELL LOG: 10 Gallons per Minute WELL YIELD FROM TEST: 5 Gallons per Minute DATE OF INSPECTION: May 21, 2003 TEST PROCEDURE: Well was pumped at a constant rate while the draw down was monitored with an acoustic probe. At the beginning of the test water level was found at 179 feet from the top of casing. At a pumping rate of 5 gallons per minute the water level stabilized at 214 after 40 minutes of pumping. The well was pumped for 2 hours. A total of 660 gallons was pumped. The well recovered to 196 feet within 15minutes. TEST FOR E.COLI AND TOTAL NITROGEN: Well was tested for E.Coli and total nitrogen on May 21, 2003 RESULTS: E.Coli 0. Other Bacteria 0 Total Nitrate -N 0.532 mg/1. Max. allowable Total Nitrate -N 10 mg/l. 10 Colonies of Bacteria Allowed TEST RESULTS: This water quality of this well meets the requirements of the Municipality of Anchorage. THIS WELL WILL PRODUCE MORE THAN 3 GALLONS PER MINUTE FOR MORE THAN FOUR HOURS The Municipal requirement for well flow is 150 gallons of water per bedroom per day. This well exceeds this requirement. The assessment of the condition of the well applies only to the conditions as of the day tested. The flow rate may change due to subsurface conditions that may not be observed from the surface, and changes in the land use and other factors that may impact the aquifer feeding the well. Whicipal ity of,Anchorage: • '"r Development Selriiices Department Building 'SafetyfDivision' — s` 3 ; -' ,� . On Site 1Nate� &Wastewater Program j 4700 South BraSt O,'Box196650 Anchorage, AK 99519-6650 www.ci.anchoiag'e.ak u`s � . !; � a ,< r t { (907) 343-7904 • . ; 'C ERTIFICATE.`bF� HEALTH AUTHORITY, _APPROVAL FOR A SINGLE FAMILY DWELLING it Parcel I.D. 017-451=08 HAA# O 10 l T 1. GENERAL INFORMATION Expiration Date: Complete legal description T1 2N, R3W SEC. 27, N2, SW4, NW4, NW4, NE4 Location (site address or directions) 12501 BAINBRIDGE RD. Current Property owner(s) Mailing address.. • - Lending agency Mailing address Real Estate Agent Mailing address JON SHIPE Day phone 349-2761 12501 BAINBRIDGE RD. ANCHORAGE, ALASKA 99516 Day phone SHARI BOYD Day phone 762-5863 PRUDENTIAL JACK WHITE 3201 "C" ST. ANCH. AK, 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. .TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well . •- ® Individual On-site 12 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (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. Note: Alaska Water and Wastewater Consultants, Inc. shall be pald $1155.00 at, or prior to closing for the engineering services provided. t :STATEMENT OF INSPECTION BY ENGINEER As osrtifred by my seal affixed hereto and as of the validation date shown below, I verify that my„ ' `• ini,6stigation, -based on procedures, outlined !n the '1 ebAh`AufhorifyApprovaI Guidelines for this application; ' shows that the on-site water supply and/or wastewater disposal sysferri 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 fles,and from my Investigation and lns .. tion, the , on-site water supply and/or wastewater disposal system ls(are) In compliance with all applicable Municipal and State codes, ordinances, and regulations In effect at the time of Installation. Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone 337-6179 Address ••6901 DEBARR ROAD, SUITE 26 * ANCHORAGE, AK 99504 Engineers Printed Name Engineers Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, AWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. The operational life of all walls and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty or future estimate of how long the system W11 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. Conditional approval for -,Date. 4 1 D i Y OPgj�rrri Jam: • ON-SITE WATER AND. •,rn bedrooms, with the filowing stipulations o WASTEWATER PROGRAM JJJJ�J`O, ^ • . �N SOWr ,,, Attachments: HAA Checklist ✓ Manitenance Agreements Septic System Advisory Supplemental Engineers Reort Well Flow Advisory Other By: Original Certificate Date: (Rev. 12100) I I, ' Munici ali of Anchorage ! �Q ,. p apt :.Development Services Departmentvia Building Safety Division On-Site Water & Wastewater Program 5 T'. i 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519_-6650 I ! www.ci.anchorage.ak.us d (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST'' Legal Description T1 2N R3W SEC. 27 : N2, SW4, NW4, NW4, NE4 Parcel ID: 017-451-08 I A. WELL I DATA I ; Well type' PRIVATE If A, B, or C provide PWSID# NIA' ' Well Log (Y/N) YES I'i U 7-8-82 Sanity seal /N YES ,: Wires proper) protected /N YES Date completed ry (Y ) Y (Y ) r Total depth 1222 i ft. Cased to 220 ft. Casing height (above ground) 16 in. FROM WELL LOG AT INSPECTION Date of (test 7-8-82 4-5-01 Static water level 180 ft. 180 ft. I I Well,productlon ; t 0 g:p.m: s 2.6 g.p.m. ;:Iii I WATER SAMPLE'RESULTS: ' Colifo I 0 I colonies/100 ml. Nitrate' 0.5 mg./L. Other bacteria 0 colonies/100 ml. r Date of sample 4/4/01 Collected by: ` AwwC, INC. i B. SEPTIC/HOLDING TANK DATA Tank'*ype/Material SEPTIC TANK/STEEL' i Date installed 9-9-82 Tank size 1500 gal Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Iof Date ;oflpumping 4/5/01 Pumper NORTHLAND f9B2 �; ,, � •. SFS. C. ABSORPTION, FIELD DATA "' `AT-MONITORING TUBE. MONITORING ONLY, NO CLEAN-OUT. 1,4S If (2SPO't'rf I. Date installed ; 9/9/82 Soil rating (g.p:d./ft o /bdr ) 235 System type DEEP' TRENCH t Length) l !' X94 ft.. Width 3 ft. Gravelbelow pipe 8.5 ft. 'hill, I ! 7 p > > s ft. Eff. absorption area, t 500: ft2 r Monitoring tube "YES Depression over field N0 Total depth p ' 9 Date'of, adequacy test 4/6/01 Results (Pass/Fail) PASS For 4 bedrooms Fluid dlepth in absorption field before test 63.5 in. Water added 600 gal, ; : ;! New depth 72.5 in. ' Elapsed Time . min. Final fluid depth Absorption rate >= 600 � ' � 150 71.5 in. Absor g.p.d. Any rejuvenation treatment (past 12 mo) (Y/N &type) NONE KNOWN If yes, give date — D. LIFT. STATION Date installed Size in gallons "Pump on" level at in. "Pump off' in. High water alarm level at in. Datu 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 Absorption field on lot 100'+ On adjacent lots 100'+ 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ "Holding tank 75'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ : Water main N/A Water service line 10'+ Surface water 100'+ 7.0 m Driveway, parking/vehicle storage 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 HAA guidelines in effect on this date. Engineer's Printed N me JEFFREY A. GARNESS Date HAA Fee $ 3 0 a � C7 Date of Payment Receipt Number �2, % Q (Rev. 12100) = I I uo0 ,,t re A. G�-rress:' !! 7953 v u40��P� o f e s s�o^°oma Waiver Fee $ Date of Payment Receipt Number 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. # ��I' Z/ r° f%9 HAA # t Q'1 InQ REI 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address. Agent Address Day phone ✓�� %%1 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. 4. TYPE OF WATER SUPPLY: Individual well Community well Public water X Day phone Day phone 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 X NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 724)25 (Rev. 1/91) Front MOA #21 5. A M 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 7.0441 Address Engineer's signature DHHS SIGNATURE X_ Approved for bedrooms. Disapproved. Conditional approval for Additional Comments Phone Date i! OF A` .a.c��• ..ee.r.ejgS a9 ee 4�8tkboFF"sst�Q°"" bedrooms, with the following stipulations: 4l1TIC The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesyto purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(Rw.1/91) Back MOAH21 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION Municipality of Anchorage JUL 11 1997 DEPARTMENT OF HEALTH & HUMAN SERVICES n C E _ Environmental Services Division R C Vf" 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: WeW Ser_ .;?7 / A2AIR3 K Parcel I.D.: &90/ 4a I J A. WELL DATA Well type 1461 If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed -7-,Y- YZ / Total depth '22Z,/ Cased to Casing height (above ground) Z Sanitary seal (Y/N) 1 Wires properly protected (Y/N) FROM WELL LOG Date of test Z - ?- Static water level IA2 Well production AT INSPECTION 7-Z J7 g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform Com_ Nitrate 0,37 Other bacteria Date of sample: 1-1--97 Collected by: B. SEPTIC/HOLDING TANK DATA Date installed 94-472 Tank size,x.31 DD Number of Compartments 2 Cleanouts (Y/N)1_ Foundation cleanout (YIN)Depression (Y/N) High water alarm (Y/N) f Date of Pumping (® "/J ;-_1427 Pumper Twm :��a PY7 C. ABSORPTION FIELD DATA / Date installed �� Soil rating (g.p.d./ft2 or ft2/bdrm) Z�JJ� System type 1i'�I2c/� ! / Length 21 Width Gravel thickness below pipe J� Total depth Effective absorption area X sq Monitoring Tube present (Y/N)-/— Depression over field (Y/N) Date of adequacy test 7'�- �� Results (Pass/Fail) / For bedrooms Fluid depth in absorption field before test (in.); 471 // Immediately after6/� gal. water added (in.): log fi Fluid depth /'/ // (ins) Minutes later: /aoo Absorption rate = �__o g.p.d. Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* If yes, give date A14 D. LIFT STATION Date installed Manhole/Access (Y/N) _ High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: i Septic/holding tank on lot 6�J4 f "Pump off" level at* On adjacent lots Xod i'/- Absorption field on lot Idd -/- On adjacent lots Public sewer main Public sewer manhole/cleanout W14 r Sewer /septic service line h9d -/ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 9 / Property line :5 !% 114 Absorption field r r � Water main/service line a A Surface water/drainage 10P Wells on adjacent lots 040 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Z5 Building foundation /D Water main/service line Surface water /04 Driveway, parking/vehicle storage area 119 f Curtain drain Wells on adjacent lots //'Uib F. ENGINEER'S CERTIFICATION / certify that / have determined thru field inspections and review of in conformance with MOA HAA ouidelines in effect on this date. Signature Engineer's Name Date HAA Fee Date of Payment 7/U/77 1 Receipt Number . Z� 7 % L / 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number C9 i16 above systems are 5. STATEMENT OF INSPECTION. BY ENGINEER As certified by my seal affixed,hereto.and as ofahe validation date shown below, I verify that my ,investigation of this Health AuthorityApproval application shows that the on-site water supply and/or wastewater disposal system Is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance, with all Municipal and State codes, ordinances, and regulations in effect on the date f th s inspection. Name of Firm Envirornnenehl Manago)ent. Tn�. / Phone 272-9336 Address 206 E. Fireweed Lri., Site ZU1 chora e AK 99bU3-Z/U3 '�'/" � ,Engineer's signature Date .,.tw't1RC�S1Y1`S1i I John Earl Simpson rj ,� v r 1135c fh: C E 6061 A ` 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for "bedrooms, with the following stipulations: Additional Comments Date -12 _ F¢ B ys ewunn1 ;The Municipality of Ahchora a De artment of HealtH and Human Services (DHHS) issues Health Authority Approval Cortificatet6ba7sed 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. 72-025(RW.1/91) Back MOAN21 ® Municipality of Anchorage ACWL Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Parcel I.D. A. Well Data Well type Individual If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Datecompleted T„1y 9 1989 Driller M -W Drilling Total depth 222 Ft. Cased to 220 Ft. Casing height 1 Ft. `F Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y FROM WELL LOG AT INSPECTION Date of test 2& 8. 1982 March 16 1994 4 MUNICIPALITY OF ANCHORAGE Static water level 180 Ft. 174 Ft ENVIRONMENTAL SERVICES DIVISION Well flow 10 g.p.m. 7-8 9.11-tP.i 2 ? 1994 Pump levell Unknown h,kr own q� E C E I V E D � RECEIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 140 Ft. ; On adjacent lots 100 Ft. + Absorption field on lot 140 Ft. ; On adjacent lots 1 nn Ft + Public sewer main N%A Public sewer manhole/cleanout N/A Sewer service line N/A Petroleum tank N/A WATER SAMPLE RESULTS:I e Coliform 0%100m1 Nitrate 0.17 irk,/L Other bacteria f Date of sample: March 16 1994 Collected by: Simn Schroeder B. SEPTIC/HOLDING TANK DATA Date installed Sept. 1982 Tank size 1500 Gal. Compartments_ Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) High water alarm (Y/N) tested (Y/N) Date of pumping July 6, 1993 Pumper A+ Home Services SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 140 Ft. On adjacent lots i 100 4+ Foundation 9 Ft. To property line 80 Ft. Absorption field 5 Ft. Water main/service line N/A Surface water/drainage None Observed 72-026(3M)•Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) 'Pump on" level at "Pump off" Level at _ High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed 1982 Soil rating (GPD/Ft2) 235 Ft 2, bdr System type Trench Length 94 Ft. Width 3 Ft. Gravel thickness 7 Ft- Total depth 10 Ft Total absorption area 1316 Sq. Ft. Cleanout present (Y/N) Y Depression over field (Y/N) N Date of adequacy test March 16, 1994 Results (pass/fall) Pass for 4 Bedrooms Water level in absorption field before test 56 inches below G.L. After test 50 inches below r. T. Peroxide treatment (past 12 months) (Y/N) N If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 145 Ft. On adjacent lots 100 Ft + Property line 60 Ft. To building foundation 9 Ft. To existing or abandoned system on lot N/A On adjacent lots 30 Ft. Cutbank N/A Water main/service line N/A Surface water None observed Driveway, parking/vehicle storage area 30 Ft. Curtain drain None observed E. ENGINEER'S CERTIFICATION HAA Fee $ &66 Waiver Fee $ Date of Payment- J L1-1 Receipt Number ,2 3s 72026 (3/93)' Back Date of Payment Receipt Number ■ Application Date May 16 , 1986 1 �, GEN. ERAL INFORMATION ,,,V Lbgal Description (include lot, block, subdivision, section, township, range) t m�sx'sd 'M NW.' . NW' , NE'Sec. 27. T12N . RAW Location;(address or directions) t, Y Bainbridge Drive, Anchorage int �t •...,. ,. Applicant, Name Bob Madison Telephone: Home 345-0517 Business N/A ` A 1250 Bainbridge Road Applicant Address g + Anchorage, AK 99516 Applicant is (check one): Lending Institution ❑ ; Owner/builder ® ; Buyer ❑ ; Other ❑ (explain); (d),141 -ending Institution Alaska State Bank Telephone 277-5661 Address 301 E. Northern Lights, Anchorage, AK (e) Real Estate Company and Agent N/A Address _— Telephone (f) Mail the HAA to the following address: pickup by owner, please call 2. TYPE OF RESIDENCE Single -Family) Multi -Family ❑ Other Number of Bedrooms 4 3. WATER SUPPLY Individual Well ® Community ❑ Public ❑ Note: If community well system, must have written confirmation frori) the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ® Public ❑ Community ❑ Holding Tank ❑ A Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 P 72-025 (11,84) "MUNICIPALITY OFANCHORAGE ^f P+, DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION s/ n, jsp DIVISION OF ENVIRONMENTAL HEALTH t/ CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date May 16 , 1986 1 �, GEN. ERAL INFORMATION ,,,V Lbgal Description (include lot, block, subdivision, section, township, range) t m�sx'sd 'M NW.' . NW' , NE'Sec. 27. T12N . RAW Location;(address or directions) t, Y Bainbridge Drive, Anchorage int �t •...,. ,. Applicant, Name Bob Madison Telephone: Home 345-0517 Business N/A ` A 1250 Bainbridge Road Applicant Address g + Anchorage, AK 99516 Applicant is (check one): Lending Institution ❑ ; Owner/builder ® ; Buyer ❑ ; Other ❑ (explain); (d),141 -ending Institution Alaska State Bank Telephone 277-5661 Address 301 E. Northern Lights, Anchorage, AK (e) Real Estate Company and Agent N/A Address _— Telephone (f) Mail the HAA to the following address: pickup by owner, please call 2. TYPE OF RESIDENCE Single -Family) Multi -Family ❑ Other Number of Bedrooms 4 3. WATER SUPPLY Individual Well ® Community ❑ Public ❑ Note: If community well system, must have written confirmation frori) the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ® Public ❑ Community ❑ Holding Tank ❑ A Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 P 72-025 (11,84) ENGINEERING FIRM PRO!J 1NG INSPECTIONS, TESTS, FILE SEARO�ATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from 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 EAGLE RIVER ENGINEERING SERVICES Date y/.47 -e P n ROX 77394 694-5195 DHEP APPROVAL Telephone A.. \ "' e,::, r engineer's Seal % 6) Louis A autera s � v e CE -6736 Approved for ! / bedrooms by Approved Disapproved Conditional — Terms of Conditional Approval CAUTION Datei�_3� Th Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Agroval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. sA Page 2 of 2 72-025 (11/84) M"MCIPALITY OF ANCHORA0. � .DEPT. Of HEALTH & n MUNICIPALITY OF ANCHORAGE (MOA) rNviRQNMENTAI PROTECTION HEALTH AUTHORITY APPROVAL (HAA) J UN ,1 8 19* CHECKLIST - FEBRUARY 1984 R [ C V D 284.472() %is FNS �y Legal Description: Sec , a 7 T/a �✓ /c 3 w A. WELL DATA Well Classification "iFI /G f= If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Y Date Completed _���Z Yield S z/ GFm Tea1r�! Total Depth a Cased to aao Depth of Grouting /4-/ Static Water Level /8/' &B I, . Tb mar. s Pump Set At 4� Casing Height Above Ground a & " Sanitary Seal on Casing (Y/N) y Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot On Adjoining Lots 1W To Nearest Edge of Absorption Field on Lot y�� ; On Adjoining Lots To Nearest Public Sewer Line , 4 To Nearest Public Sewer Cleanout/Manhole All -f To Nearest Sewer Service Line on Lot tis Water Sample Collected by �`��"'� `~-s'"'e� �'^�S ; Date ��� y�yG Y Water Sample Test Results �s o Comments B. SEPTIC/HOLDING TANK DATA Date Installed Size �� - 1 No. of Compartments a Standpipes (Y/N) Air -tight Caps (Y/N) i Foundation Cleanout (Y/N) y Depression over Tank (Y/N) Date Last Pumped —6'-'J_G Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) � Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: iI To Water -Supply Well To Property Line To Water Main/Service Line Course A11AA Comments Page 1 of 2 72-026(11/84) To Building Foundation To Disposal Field S ` To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata a 3� �� Type of System Design 7Ye�ic� Date Installed &Y-) Length of Field7�1 i Width of Field 31 Depth of Field Gravel Bed Thickness � Square Feet of Absorption Area r Standpipes Present (Y/N) y Depression over Field (Y/N) All Date of Last Adequacy Test G�ii�S�0 Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well `� "J" To Property Line Y° To Buildina Foundation -29/ To Existin or Abend d S t Lot To Water Main/Service Line r1V To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments g an one ys em on On Adjoining Lots `3,.) To Cutbank (if present) /z/4 — Dimensions Manhole/Access (Y/N) "Pump Off' Level at — Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I ha vg h��e ked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed iy Date 6// Company MOA No. Receipt No. Date of Paymentr 7Y Amount: $ Engineer's Seal IT rJ ��°�°jo�• .{.00av�e°.o eo.A Page 2 of 2 72-026 (11184) Louis A. Butera CE -6736 4a po.e�a.N APPLIC �T FILLS OUT UPPER HA(- `ONLY Time Phone J Mj- 0/ f 0 =-- Time 0 - M,& Address 3 7 % p [ lheuly Zip Code r'G Boyer S � x- M Address Zip Code Date Phone Lending Institution „�/ ! Gil J �f�L �'.F'G j /7 //e✓i d/✓ Date - Zip Code ! 2. 1V Address Inspectorr) Phone Realty Co. & Agent 9 —, Address Zip Code �/ IceAs Legal Description '7 7"1f '�// / t 2 W .�--P-� a / A� A` Street Location 1.9 5-0 Z v /7"?2 f3 Type of Residence Single Family SJ ❑ Multiple Family No. of Bedrooms ❑ Other �fY� �ij y,�1 _ Water Supply �- ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. X-(Individual For wells drilled prior to that date, give well depth (attach log if available). El Community O Public Utility Sewer Disposal Year Individual Installed: L ,1Kfndividual ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time 0 Date Date Date Date Inspector Inspector Inspector Inspectorr) �/ IceAs MUNICIPALITY OF ANCHORAGE Field Notes: DFPT. Cr 11'c11.T�I P. �fY� �ij y,�1 _ ENVIRUN,,'--la;X_ i.,O, ECTION 2 1,088 -D RECEIVED (S) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONALPLPROy' DATE / _ BY: Soils Rating Date Sewer Installed Well To Absorption Area / -.(? u r Well Log Received Septic Tank Size el 2�Z�) Z �� oly_ C,J_, d ?e- Well to Tank / 3 p y ]2.02313(@I