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HomeMy WebLinkAboutT15N R1W SEC 7 LT 24T15NR1W SEC 7 Lot 24 #051-161-06 \\\\� 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 IPHONE Prr1e l IC;��p 9/2.�� .,R NEW ❑UPGRADE MAILING ADDRES ✓ sq $ox 2 907 LEGAL DESCRIP IQN / iOvvh.: v p 1.3 N W, -s gym, 6.C- t/0h 70 t zit LOCATION Sgjf &,' d NO.0.OF BEDROOMS Z SEPTIC TANK i-J1 Well j0 / I -T DISTANCE T0: v Absorption area/ " Dwelling / q PERMIT 0. •'..evfi- FT Cil? Manufacturer,- 1-,e er Mater'-V , •' No. of compartments 7 Liqh capacity in gallons 1000' IF HOMEMADE: Inside length Width ---- Liquid depth O _ID z DISTANCE TO: Well ' Dwelling PERMIT NO. Ox z FQ- Manufacturer Material Liquid capacity in gallons TILE V { RAINFIELD ITRENCH DISTANCE TO: Well 1 ()/ Q "F Foundation L. �/ Nearest lot line z --, / P MIT O. �t W 1, / tl er, No. of linesLength (i of each I' e / 2.W3r0 Rl Total jou" of lines n 5 r Trench width / /Z x inoses Distance between lines • / 6 _LL- Top of tile to finish grade L / Material beneath tile inches Total ef� �j-7ve absorpt zn area SEEPAGE '" I PIT Length Width Depth PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area .7 DISTANCE TO: Well Build i foundation NearestIo Class Dep II lei Hiera� to R t1 % PERMIT NO. 1.0 DISTANCE TO: tit Ming f n atibA Sewer line : \t9 ,lam Se tic t(y1' dll Absorption area(s) tY� J�� If/77 V�. • p' 0 I NkVi c��1_ �- PIPE MA] MATERIALS . r r SST �` SO L TESVR TI G �D -tr /(adrodrl,0 - r rI,4-1 pry , 'T Z."I ? INSTALLER,- -- -i REMARKS `3 OC.rS> - ..5t1'ti ("e.d <onf"t�16.10 \ well I suice?le, so flr,>—fit1 6 6 i I 9 l _Lill J . 1 vle aharoil rrJE I,•0/ �;i4. ( 7( r b_e_ol ah gee/ c.: N \ T / 6 111,e 0R518,..�- L m /-, Well --- I�- .; �� — 'tel°-e Ver1P1el o1 _ --lµ--ff3 APPR GU/ I DATE LEGAL 1 I Iq 1 a 1-6 N B\w sec. 7. W 12--- - ev. 3/7 3 '. ��I C.:7- L. -11- CDI El PAC LAIFm=1 cat. DEPARTMENT OF HEALTH ANDENVIRONMENTHL PROTECTION 825 'L/ REET, ANCHORAGE, HK 99501 264-4720 : ANCHORAGE 694-2131 : EAGLE RIVER --- JE Mr n5 HA F: 1,11EE IL. IL_ IF" Ea: IR Pc11 ir PERMIT NO. 831112 APPLICANT: TERRY KRUGER PHONE: 694-9125 ADDRESS: SR 1 BOX 2307 EAGLE RIVER/ HK 99577 LEGAL DESCRIPTION - SUBDIVISION: NR BLOCK: NH LOT: 24 LOT SIZE 0 SQ. FT. 1 TOWNSHIP: 15N RANGE: 1W SECTION: 7 MAXIMUM NUMBER OF BEDROOMS = q SOIL RATING = 0 0 0 (SaFT./BR) LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOU IN DESIGNING YOUR SEPTIC SYSTEM. CHOOSE THE OPTION THAT BEST FITS YOUR SITE. I CERTIFY THAT: 1. I AN FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FDRTH BY THE MUNICIPALITY OF ANCHORAGE AND THE STATE OF ALASKA. 2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES AND HAVE RECEIVED H COPY OF THE CODE SUMMARY HND|DIRGRHM ATTACHMENTS WHICH IS PART OF THIS PERMIT. ]. } UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 0 BEDROOMS. PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM PERSONNEL DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. • / IF 8 LIFT STATION IS INSTALLED, AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTHJNED. 8S-BUILTS CRNNOT:BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT. THE ELECTRICHL WORK MUST BE DONE BY R LICENSED ELECTRICIAN. SIGNED: APPLICANT: TERRY KRUGER ISSUED BY: '� DRTE: 12/1]/8] /`���� /\, \- \ ' "^UNICIPALITY OF ANCHORAGE Department Health and Environmental rotection 825 L Street, Anchorage, AK. 99501 264-4720 J4D �Cy Permit # c( 3/, ,-, # * HANDWRITTEN PERMIT * °F / L WELL AND/OR ON-SITE SEWER PERMIT Applicant: -r 1ec�j lya' Pb Mailing Address :,54I ,j���! 23 07 Location: _-T— 1 Phone Number: G: Legal Description: ! /i�.Cj x2„4, 5. 7Ir of Size: _ Type of Soil Absorption System Is: Trench: Drainfield: Seepage Bed: V Holding Tank: _ Maximum Number of Bedrooms: ,3 _ Soil Rating(sq.ft/br) / The Required Size of the Soil Absorption System Is: 1t DEPTH f LENGTH GRAVEL DEPTH _ 6. ar WIDTH/ The length dimension is the 7ength(in feet) of the trench or. drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet).* / * REQUIRED SEPTIC(HOLDING) TANK SIZE = ` 002% GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * # * TWO(2)1 INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 290 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * 11. I certify that: PERMIT EXPIRES DECEMBER 31, 1 9 3 3 (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site the residence ,is remodeled to include more that edrooms. sewer system may require enlargement if Signea: Applica /7 SWP/024(1/81) Issued by: Date: /t' 4 It c 4,a, &P1—) ALASKA CnUIRbnTCnTAL COnTROL %RUlCCs, Inc. engineering & enuironmenlal Studies October 6, 1983 Mountain Gem Log Homes P.O. Box 2055 Eagle River, Alaska 99577 Attn: Terry Kruger Dear Mr. Kruger: On October 5, 1983 I logged a backhoe test hole on T15N R1W SM Section 7 Lot 24. I found that the soil between 3 and 7 feet depth is a well graded sandy gravel wh}ch I visually rated at 100 square foot per bedroom for septic system installment. The groundwater level was at 7 feet depth at this time. According to Municipality of Anchorage, Department of Health & Envirnomental Protection regulations the groundwater level must be monitored for at least seven days before a septic system construction permit can be issued. In conclusion, the soil on—site is well suited to septic system installment. A shallosi trench or bed system could be installed four feet above the groundwater. If the groundwater remains at the same level the system wouldlbe installed at a depth no greater than three feet. Sincerely, VA 9 -97V1 - Jim Green Geotechnical Engineer 1200 West 33rd Ruejue, Suite 13 • Rnchorage, Alaska 99503 • (907) 276-1361 M. RNG F NN)clpnury �DEf aWTOFrHE MUNICIPALITY DOENVIRONMENTAL PROTECTION GE rEPI. >E pRJ'c,• ENYIgp t�jO-'J)AL 825 L. Street, Anchorage, Alaska 99501 264-4720 �t� T 7 ':`.lu % SOILS LOG - PERCOLATION TEST PERFORMED FOR: $1 SOILS LOG ❑ PERCOLATION TEST DATE PERFORMED: / 0- - -12 LEGAL DESCRIPTION: I nwf1//�ci) /11/) /.l N ,\ , (i i. ��1 5, M. �� FiF-hll SLOPE (0/ ;) O %"��Qh c. �l I"1' u 0 2 - ( (6 1/1).)r,l'1(J1 GI ? (Jf:I 3 Hit r.d 4 - <� ' (`C \IV) We. a a 61 "aid' C r 5- ' 5.:;i {/ Gratvp ,s5? Hzej a" 7 B 1 - 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS �'a •Hcwj D • • +P�.sci . O C. Reid, Jr. ; 4A ' eileopNo. 4251E .,:, Aer WAS GROUND WATER S ENCOUNTERED? (''_: S L0 P IF YES, AT WHAT DEPTH? E I Ian 1' J ,t,1 SITE PLAN y t- r'i fr T rar 111 Lc`)IhIIr 7'f?)\ T Reading 1Time Date Gross Ne Time Depth o Water Net Drop I PERCOLATION RATE TEST RUN BETWEEN FT AND �T 7 (I rtl �� ! ✓ s='r-f i Oi76v 17- On) to (minutes/inch) PERFORMED BY: 72-008 (6/79) CERTIFIED BY: DATE: Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and 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 FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-161-06 1. GENERAL INFORMATION Complete legal description Location (site address) T15N, R1 W, Section 7, Lot 24 COSA# O5C1a`1\ Expiration Date: 7- / 20112 Lori Street Current Property owner(s) Capital Constructors LLC Day phone Mailing address Lending agency Day phone Mailing address Real Estate Agent Day phone MailingrAddress Unlet's otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Three (3) 1515 East Tudor Road, Suite 4 Anchorage, AK 99507 TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public` Water System TYPE OF WASTEWATER DISPOSAL: ❑✓ Individual On-site ❑✓ ❑ Individual Holding Tank 0 ❑ Community On-site 0 0 "- Public Sewer 0 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 sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 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 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Phone 522-7773 Date a/te�g O gmLea f • 49311�� s� ,�®� 8 m : nucHAEt E. ANDERSON: �4 :O 0-4381 : S' ar 5. DSD SIGNATURE 4 '•lipi.., `p -ti-a.../.s pp bedrooms. 44 �49 � �St�ygas Approved for Disapproved. Conditional approval for bedrooms, with the following stipulations: By: oF Pr' sri WATER AND = WASTEWAI etc g PROGRAMayJ . ten SCR. •CN lYil )11O l Attachments: COSA Checklist` X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other (1 Original Certificate Date: % 4 O '1 (Rev. 11/05) 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: T15N, FrSection 7, Lot 24 Parcel ID: 051-161-06 A. WELL DATA Well type Private If A, B, or C provide PWSID # _ Well Log (Y/N) Y Date completed 10111/83 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 205 ft.Cased to 115 ft. Casing height (above ground) >18 in. FROM WELL LOG AT INSPECTION Date of test 10/11/83 4128111 Static water level 190 ft. 37.8 ft. Well production 5 g.p.m. 7.1 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate N/D mg/L Other bacteria colonies/100 mL Arsenic: wD mg/l Date of sample: 3/30/12 Collected by: M. Anderson B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/steel Date installed 11/83 Tank size 1,000 gal. Number of Compartments Two Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping No Sludge Noted Pumper Pumping Not Required C. ABSORPTION FIELD DATA Date installed 11/83 Soil rating (g.p.d./ft2 or ft2/bdrm) 100 GPD/BDRM System type Shallow Bed Length 30 ft. Width 12 ft. Gravel below pipe .5 ft. Total depth 4 ft. Eff. absorption area 360 ft2 Monitoring tube Y Depression over field N Date of adequacy test 4/28/11 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 457 gal. New depth 2 in. Elapsed Time: 90 min. Final fluid depth 0 in. Absorption rate >= 450 Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date g.p.d. D. LIFT STATION Date installed "Pump on" level at in. "Pump off' level at Datum Cycles tested Size in gallons Manhole/Access (Y/N) in. High water alarm level at Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO Septic tank/lift station on lot >100' Absorption field on lot >100' Public sewer main NIA Sewer /septic service line >25' Animal containment areas >50' On adjacent lots >100' On adjacent lots >100' in. Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas >100' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5' Water main N/A Wells on adjacent lots >100' Absorption field >5' Water service line >10' Surface water >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line >10' Water Service line >10' Building foundation >10' Water main >10' Surface water >100' Driveway, parking/vehicle storage >25' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS: House has been vacant since last test on 4/28/11. 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 4/1212012 9 'tvaar%pr tO' ALA400 toe A 4918 tk lir 1 ' -- ors .Mta.Aa € `ANDERSON : Ct a J . CE.4381 :4-`••• rf'. —l8- �+�s �f0'••• Ea41r a pg • 011390" 4610 -1111 ara lea,‘ COSA Fee $ Date of Payment -Ix "'" o Receipt Number (Rev. 11/05) ofs55 -1 6\ Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and 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 FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-161-06 CosA# D`. C\1 115-7 1. GENERAL INFORMATION Complete legal description Location (site address) 20112 Lori Street Expiration Date: 3 - 1 g -/ T15N, R1 W, Section 7, Lot 24 Current Property owner(s) Mailing address Option One Mortgage Loan Trust 1525 S. Belt Line Road Coppell, TX 75019 Day phone Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System Three (3) TYPE OF WASTEWATER DISPOSAL: ✓❑ Individual On-site ❑ Individual Holding Tank ❑ Community On-site ❑ Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties s-rved 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 sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage 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 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 5. DSD SIGNATURE 4•� Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: B Phone 522-7773 Date 5/16/2011 Arm; • �-y 111. • ��.;;; 0.••••NN••• •i...T. vO : ANCHAEl. E. ANDERSON w v �C'i•• CEs4381 : •��'�ri • r 1• f: : ik 00000 • • tY�OF/ ,r to.7 ••• •• • ON-SITE : 0 WATER AND • m= • WASTEWATER : OGRAM •- .- NT SE" ‘`• Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev. 11/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other a- Original Certificate Date: �_ l 'l 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: T15N, Section 7, Lot 24 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 10/11/83 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 205 ft. Cased to 115 ft. Casing height (above ground) >18 in. FROM WELL LOG AT INSPECTION Date of test 10/11/83 4/28/11 Static water level 190 ft. 37.8 ft. Well. production 5 g.p.m. 7.1 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate N/D mg/L Other bacteria colonies/100 mL Arsenic: N/D mg/I Date of sample: 4/28/11 Collected by: A. Harala B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/steel Date installed 11/83 Tank size 1,000 gal. Number of Compartments Two Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping • No Sludge Noted Pumper Pumping Not Required C. ABSORPTION FIELD DATA Date installed 11/83 Soil rating (g.p.d./ft2 or ft2/bdrm)100 GPD/BDRM System type Shallow Bed Parcel ID: 051-161-06 Length 30 Total depth 4 ft. Width 12 ft. Gravel below pipe .5 ft. ft. Eff. absorption area 360 ft2 Monitoring tube Y Depression over field Date of adequacy test 4/28/11 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 0 Elapsed Time: 90 min. Final fluid depth 0 N in. Water added 457 gal. New depth 2 in. in. Absorption rate >= 450 Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date g.p.d. D. LIFT STATION Date installed "Pump on" level at in. Datum E. SEPARATION DISTANCES Size in gallons "Pump off' level at in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot >100' Absorption field on lot >100' Public sewer main N/A Sewer /septic service line >25' Animal containment areas >50' Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? in. On adjacent Tots >100' On adjacent lots >100' Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas >100' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Water main N/A Property line >5' Water service line _ Absorption field >5' >10' Surface water >100' Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water Service line >10' Surface water >100' Curtain drain None Noted Wells on adjacent lots >100' Water main >10' Driveway, parking/vehicle storage >25' F. COMMENTS: House has been vacant since last test on 5/21/2008: Septic Tank Last Pumped on 5/21/08 by Sanitary Pumpers. G. ENGINEER'S CERTIFICATION I certify that / 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 Benjamin Schiller, P.E. Date 5/12/2011 '491li • r .. 0 ... .•• l I. -I 1•• v s pFB'••...•••.•`�,4s ffSSt� :.� COSA Fee $ 'T b '- Date of Payment ✓ 1 1 % 1 l Receipt Number13 (�J 1 b (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number • Municipality of Anchorage Development Services Department Building Safety Division •• On -Site Water and Wastewater Program 4700 --ra- 4700 Elmore Road P.O. Box 196650 Anchorage. AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL _ FOR ASINGLE FAMILY DWELLING Rt- -1 slue— COSA # 0 C; / 6 t ; Expiration Date: % - 2 - Q 7 3.29) a Parcel I.D. 051-161-06 1. GENERAL INFORMATION Complete legal description T15N, R1 W, Section 7, Lot 24 Location (site address) 20112 Lorl Street Chugiak, AK 99567 Current Property owner(s) John and Cindy Inman Mailing address 20112 Lori Street Chugiak, AK 99567 Day phone Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Three (3) 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank Community On-site 0 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 sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 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 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 5. DSD SIGNATURE f/SIApproved for 3 bedrooms. Disapproved. Conditional approval for Phone 522-7773 Date 3/31/2009 .d P :ref -4s ae : µAS. L ANDERSON.�`, iCH; e••�;. CE_438x_rfre1 :stir bedrooms, with the following stipulations: `��<�YhOFr " 4416 0 2. • ON SITE • g.=: WATER AND `• rn • VYAbItYVAlLK ; • PROGRAM .• • • Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: / /1-1,M Original Certificate Date: 19 — 2 — 09 (HH. 11105) - Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING COSA# OgORAO Parcel I.D. 051461.06 1. GENERAL INFORMATION Complete legal description T15N, R1w, Seaton 7, BLM Lot 24 Location (site address) 20112 Lai Street Chuglak, Ak 99567 Current Property owner(s) John and candy Inman Mailing address Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Three (3) 20112 Lori Street l�G Expiration Date: I I y I Cq Chugiak AK 99567 Day phone 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: (] Individual On-site ❑� ❑ Individual Holding Tank 0 ❑ Community On-site 0 ❑ 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 sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. 1 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 Address P.O. Box 240773 Anchorage, AIC 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE ✓ Approved for 3 bedrooms. Disapproved. Conditional approval for Phone 522.7773 Date 10/3/2008 OF. A( tk'! Q:'atksstriC6 p `.k: . 49�-7�g *t4t ifrc MICHAEL E ANDERSON : r "rel. FE -4381 bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory (Rn,. 7145) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Vy/ q Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage. AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: 1.15N, R3W, Section 7, BLM Lot 24 A. WELL DATA, Well type Private Date completed10%11183 Total depth 205 ft. If A, 5, or C provide PWSID # Sanitary seal (Y/N) Y Cased to 115 ft. FROM WELL LOG Date of test 10/11/83 Static water level . • 190 Well production 5 WATER SAMPLE RESULTS: Conform 0 colonies/100 mL Arsenic: NO ugll B. SEPTIC/HOLDING TANK DATA g.p.m. N' r to � mg/L Date of sample: -5Q4&- C a� 0$ 0 eta r A.1(. Tank Type/Material septic/steel ttt��� Tank size 1.000 gal. Number of Compartments Two Foundation cleanout (Y/N) Y Depression over tank (YM) — Date of pumping 5/21/2008 Pumper Sanitary Pumpers C. ABSORPTION FIELD DATA Date installed 11/83 Length 30 fL Parcel ID: 051-161-06 Well Log (Y/N) r Wires properly protected (Y/N) Y Casing height (above ground) >18 in. AT INSPECTION 5/21/2008 38' R 7.2 g.p.m. AttOW$It talon:4: 4300 Other bacteria -0— 1 colonies/100 mL Collected by: -di-Davie C. 64) kick Date installed 11/83 Cleanouts (YM) Y High water alarm (Y/N) N Soil rating (g.p.d./R2 or ft%/bdrm)100 SF/BORM System type Shallow Bed Width 12 ft. Gravel below pipe .5 Total depth 4 R Eff. absorption area 360 ft 2 Date of adequacy test 5/21/08 Fluid depth in absorption field before test 0 in. Water added 1.770 Elapsed Time: 90 min. Final fluid depth 0 in. Absorption rate >= 450 Monitoring tube Y Depression over field Resutts (Pass/Fail) Pass For 3 bedrooms N ft. gal. New depth 4.5 in. g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed Size in gallons 'Pump on' level at _ in. 'Pump off' level at _ in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot >1o0' Absorption field on lot Public sewer main N/A Sewer/septic service line >25' >100' Animal containment areas None Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent Tots >toow in. On adjacent Tots >1oo' Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: None 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 Service line >10' Surface water >100' Water main >10' Driveway, parkingNehicle storage >25' Curtain drain None Noted Wells on adjacent Tots >1oo' F. COMMENTS: Two Post Tank Cleanouts and PVC IJne From Tank to Field Placed to Mow Testing. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems am in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name 'Michael E. Anderson, P.E. Date 528/2068 .40.10•111.11 COSA Fee $ Lf -;i a Date of Payment Receipt Number (Rev. 11/05) l0 —� "o,q 0777190 Waiver Fee $ Date of Payment Receipt Number SGS/CT&E.ENVIRONMENT.AL SERVICES Drinking Water Analysis Report for Tptal Coliform Bacteria READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING WIPLE MUST BE COMPLETED BY WATER SUPPLIER 0 PUBLIC WATER SYSTEM IDs EISIIIVATE WATER SYSTEM $- Send Results ®•� Send Invoice AN t c !!&�t et e -Y Nae. Na` Fiw.br fbue Nrea 3l � tfJtL_troOO MM INM cAt' vac\ e "Nly Tum See SAMPLE COLLECTION: • F Oren Deer n••••seams sa rent maim ...am 1 n I 4 I Zd Yea Wme per • . TISne:_a. 1 OO AM ''' LOcettoIU oR©I I a Lel QS -e TT ." Coilsnor. ��tJ•Af�—� Ue. Pand Kano Transported to tab By: Mame as collector Other: 0 Send Rewits 200 W. POTTER DRIVE ANCHORAGE, ALASKA 99518 Tel: 907-562-2343. Fax 907-561-5301 1 oh Rai No. 1085310 all 11A (Send Invoke WW 61•4ae•O et e -Y Nae. Na` Fiw.br fbue Nrea Mang Mare W, See EP Cres SAMPLE TYPE Routine Treatod Water o Repeat Sample 0 Untreated Water (refer to tab no. 1 Special Purpose Paw Nan. Sown. TO BE COMPLETED BY LABORATORY Sample Rocetviner Date: 9 9C OP • Time: X6/7 Temp: 1.4/Prei ' Delivery Method: Ctiielt Received By ,/Miert tat -7 Comment Pmlee Nene ❑ Sample•ovor30 hours da Results may be unellable • ❑ u Hour Waiver For agnlol$ Locations 0 RUSH SAMPLE Phone it Fax #: pacteriotonleal Water Analysis Record. Analysis Began: Analyst_ Analytical Method: 9 Membrane Fitter MMO-MUG (P/A) MMO-MUG (PIA) RE Total Conform: E. Con: (Sent to fDEC: SULTS: ANC Date/Time: MEMBRANE FILTER RESULTS: Dkect Came Verification: rLTB ( BGB. relarreo Colonbd100nt. Reported By: 6lgeMe Taeetd.a DatotTlmo: FBK JUN 1 Sent to Client Phoned D Date/Time: Faxed Q Spoke WM: ❑ Sa isfactory ❑ Unsatisfactory W C . Tee Nerve to b.nl OS .oa.rSwags Form N FW- C053' 12/17/03 tLisesinas011NM_BmupData\PuWkiDOCUMENTIFORMSapprovodlColl Form 121703.x1s Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muntorg/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-161-06 1. GENERAL INFORMATION Complete legal description T15N, R1W, Section 7, BLM Lot 24 COSA # Og016r Expiration Date: 9 - f -I- -08 Location (site address) 20112 Lod Street Chugiak, Ak 99567 Current Property owner(s) John and Candy Inman Day phone Mailing address Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address 20112 Lori Street Chugtak, AK 99567 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ' Community Class Well Public Water System Three (3) 0 TYPE OF WASTEWATER DISPOSAL: 0 0 0 0 Individual On-site Individual Holding Tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage 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 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name MithaeI E. Anderson, P.E. Phone 522-7773 Date 5282008 �e.o. ovtai •• • �� re*. 491ti yg ; —51.4f + r W ,.., ;Al1CNAEl E ANDERSON: . I 5. DSD SIGNATURE s-4381 ; �'re V-...'. Approved for 2 Disapproved.bedrooms. •+f 4114;`' ESS 0 �•�r Conditional approval for bedrooms, with the following stipulations: By: ��m �O F AN'�% . AT — ��: WAT€RANDON-SI, 1 WASTEWATER : -. y.. • FOAA •....••• Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Vivo. 11105) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other ,/ i i/ (`✓ r !"" ' Original Certificate Date: Municipality. of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 3.43-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: 715N. R3W. Section 7. BLM Lot 24 A. WELL DATA- • ' Parcel ID: 051-161-06 Well type Private If A; B, or C provide PWSID # _ Well Log (Y/N) Y Date completed 10/11/63 .Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 205 ft Cased to 115 R Casing height (above ground) >10 in. FROM WELL LOG AT INSPECTION Date of test 10/11/63 521/2006 Static water level ... 190 ft, 38' ft. Well production 5 g.p.m. 7.2 g.p.m. WATER SAMPLE RESULTS: Coliform 0 ' colonies/100 mL Nitrate 0 , mg/L Other bacteria 0 colonies/100 mL Arsenic: ND ug/I Date of sample: 5/2/06 Collected by: J. Davis B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 11/63 Tank size 1.000 gal. Number of Compartments Iwo Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y •'Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 5212008 ' Pumper Sanitary Pumpers C. ABSORPTION FIELD DATA Date installed 11/63 Soil rating (g.p.d./ft2 or ft2/bdrm)100 SF/BDRM System type Shallow Bea Length 30 ft Width 12 ft. Gravel below pipe 5 ft. Total depth 4 ft Eff. absorption area 360 ft2 Monitoring tube Y Depression over field N Date of adequacy test 521/08 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 1.770 gal. New depth 4.5 in. Elapsed Time: 90 min. Final fluid depth oin. Absorption rate > 450 g.p.d. If yes, give date Any rejuvenation treatment (past 12 mo.) (Y/N & type) N D. UFT STATION Date installed Size in gallons 'Pump on' level at _ in. 'Pump off level at _ in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot >toow Absorption field on lot >100' Public sewer main N/A Sewer /septic service line >25 Animal containment areas None Manhole/Access (Y/N) High water alarm level at Meets alar & circuit requirements? in. On adjacent Tots >too' On adjacent Tots >1o0' Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas None SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Water main N/A Wells on adjacent lots >100' Property line >51 Absorption field >5' Water service line >70' Surface water >too' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water main >10' Water Service line >10' Surface water >100' Driveway, parking/vehicle storage >25' Curtain drain None Noted Wells on adjacent lots >too' F. COMMENTS: Two Post Tank Cleanouts and PVC tine From Tank to Field Placed to Allow Testing. G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems am in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson. P.E. Date 528/2008 COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) 1+20 077790 Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and 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. 051^ 161—N p 1. GENERAL INFORMATION Complete legal description 7/Sr(/ HAA # N ti t5b0,2 Expiration Date: iy5/n26Q5 AAA) 6SEera& 7 , C -.e Zy Location (site address or directions) Za /it 1.6 R1, OMucfs%' "K - Current Property owner(s)?FTS e.&"SJ kl2ZtftLdJK( Day phone en- y32y Mailing address ?-0112 LOC/, elfU g -K. Ale ??S67 Lending agency ' Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (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 atmthethtime of installation. Name of Firm (0r iKgf est Address /%?37 Seer el,* Gr. // Engineer's Printed Name Cr�F ,f/ (' Date k i* r49 . : is h� se ft. ••r.•... 03 5. DSD SIGNATURE 0r 04 IA : Steven \V. E � 36 _r/ Approved for 'j bedrooms.011:1:•„.. ta � ..'C•r Disapproved. `,,�� lt:.Z''ert Conditional approval for bedrooms, with the following stipulations: Phone Sy- 7628' Riotdt Retnoe- k(%ttthIA.....•/ �� Additional Comments S:1-* o�YS�Po�• �. a 7 •�Q`�� p �P� .•*1. JJ JJM•••�•.•,,•,- 'J, bc11 �U)111,1\l`l\,\ Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: . Q. UN( `I. nQLo Qo. (Rev 01/07) Original Certificate Date. ,SAM 6/6/07005 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and 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. b51 Ito 1-0 Go HAA# v5noa3 ters Expiration Date: 41 g7/ant, 5 1. GENERAL INFORMATION Complete legal description T15A/ g/V1/ SECTIDM.I 7 / 1. or 24 Location (site address or directions) .QOi/z j 01['/ , Off uCl/'I'k 4 k. Current Property owner(s)Partqc owner(s)Part(t,2/SS' leg zAAI kl Day phone OP—«32 9 Mailing address 0 /12 Lar 1 , aHoc lf} sc ,sl!% IVY Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: 133 Individual On-site ❑ Individual Holding tank ❑ Community On-site ❑ Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (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. 1 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 /1/6 RiitRfrfl 61/Crita C Address/7x37 Sgifie b°u efec e- , 646GE Engineer's Printed Name S76:—VF EA/ C 5. DSD SIGNATURE 4- Approved for bedrooms. Disapproved. Conditional approval for Phone OV -7062e (2NG-2 Date in 0/6 �F%,Iiia .. ci r���O .41-4, 1, 4-1o of AcI : der L:!;i / 4°c.t'iNt i IIfirc,I Steven W e9 • Wg -4 j''•. PE 6256 •• •rid 414:116.• �o�a d`.7 bedrooms, with the following stipulations: Additional Comments (kbA or An iffe, it OW Wirt VINTheirER • POG R • J%Oi�• t�.•• • . 4"4"1 //o111 m P Attachments: I -IAA Checklist X Septic System Advisory Well Flow Advisory Bv: (Rev 01/02) Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Ilc?li Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6850 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: -rig/kJ R14.i sEenav 7 Lora d Parcel ID: A. WELL DATA Well type !� Date completed /0/40-7 Total depth .205 ft. If A, B, or C provide PWSID # Sanitary seal (Y/N) Cased to //S ft. FROM WELL LOG Date of test /0,ti/f3 static water level / 90 ft. Well production S g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate a / mg./104 Arsenic: — mg./I. Date of sample: //ae0.S B. SEPTIC/HOLDING TANK DATA Tank Type/,MiSap,�'Rrtisr /1Pec. Tank size OA'. gal; •1 • 'NPmber of Compartments -? Founda{lon cfeanojj '/N) ' Depression over tank (Y/N) /V Date of pumping O Pumper S. sii'r rrre✓ C. ABSORPTIOND FIELD ATA l Date installed f// ..• So(lvating 4g4340#12 or ft2/bdrm)/00 b Length Well Log (Y/N) yes Wires properly protected (Y/N) 7' Casing height (above ground) 24 in. AT INSPECTION (/loroq 31 ft. g.p.m. Other bacteria Q colonies/100 ml. Collected by: /14. 7'r Rost Ey/ Date installed ///a Cleanouts (YIN) High water alarm (Y/N) Yil/A' PunrPEtt.i System type See .30 '-Ite i Width /2 ft. Gravel below pipe 0. S ft. Total depth 4/ ft. Eff. absorption/area. ° ft2 Monitoring tube / Depression over field /V Date of adequacy test 4 0 f Results (Pass/Fail) frS3 For 3 bedrooms Fluid depth in absorption field before test 3 71in. Water added gal. New depth 4 4 in. Elapsed Time: 36 min. Final fluid depth 3 y in.. , Absorption rate >= Lig 0 + g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) `/Af%GUOw.4/ If yes, give date D. LIFT STATION Date installed Size in gatlo Manh Access (Y/N) "Pump on lev at _ in. "Pump ow evel at _ in. Hi water alarm level at Datum Cycles sted eats alarm & circuit requi E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: r Septic tank/lift station on lot /6011.- On adjacent lots 100 Absorption field on lot /60 r+ On adjacent lots /0 0 /t Public sewer main ' /lr'/A r Sewer /septic service line 5.0 r Holding tank Public sewer manhole/cleanout SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r Building foundation 40Propertyline /0 Water main /V ii Water service line 50 ''f' Wells on adjacent lots /GQr s SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Water main AO Property line '0 Water Service line 50 Curtain drain /44 F. COMMENTS Building foundation r Surface water [Ot? '' Wells on adjacent lots X00 /'b G. ENGINEERS CERTIFICATION I certify that 1 have detemrined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. %rEVE EAJG Engineer's Printed Name Date 4(//o/d� N4 in. Absorption field /0' Surface water / o u'r Driveway, parking/vehicie storage MSS se HAA Fee $ 430 -61) Date of Payment 1 t1 05 Receipt Number tsta$'� (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number DS LCT ib KN LOT 16 t 6/wort n.w• KN WT 10 / Tai LOT 5 / PLOT PLAN u MALT PULEi' - $b WO6 , Nd 1355 h.l.ct P.. 04-234 M.M LOT 36 Lan; do Aseoclahst Ina. /16v0 P•r " • """'er`6'• Nen 44711 Penn Registered Land Surveyors #sos u Registered4C$ rex n..tuntionwr...tsn / 10,46514646ereenerson. 1 teeny safely test I e... s..,./ IA. INM.tej Neelttd pyegt KN LOT u. 715t4. MtY OCC 7 SN. M.M.S. Reser PLV 0�4{. Swat.. ed Mel le. 6It.. pi .ny .fustd t*neetiao en Wenn... p.Hvy Ones end 6e Pet Nat one Pie steer/ Wiest Wenn. int M tpe a '.4 M M 1h es Prie. eaten! leen..n..ese M lie .t..v.1d Orin, ad le.t nen OM tee Mue.wVr.n Few sr .1Mt 'Ube ei.....nH M ..ti ripely ewe es 1eeNlld ~leMn. DOS MN M..L2 os .t O+rt s. . T.s54.e et M.eetele Nivea P 1s M. /NM•N6nNoO...e M..rnor w 6.MAWIte 106 .M.eM..f ..r br a% .eVPMM. et neM.11.ne vM.e 0. not .p.r M the tn.1646 Piet. Lona 11/610-7646 Sent By: ARRC REAL ESTATE; 2652450; Jan -26.05 10:26AM; Page 1/2 ALASKA RAILROAD CORPORATION Corporate Addnst: P.O. Box 107500, Anchorage, Allah 99510 327 West Ship Creek Avenue, Anchorage, Aloka 99501 www.alaskarallroad.com January 24, 2005 Mr, Peter and Mrs. Criss Krzanowskl 20112 Lori Street Chugiak, Alaska 99567 Ref: Krzanowski application dated January 21, 2005 20112 Lori Street, Chugiak, Alaska; BLM Lot 24, T1N R11Y, Sec 7, S.M. Real EstateDeparoarat Telephone: 907-2654627 Facsimile: 907-265-2450 Eanarl: mortiseykeakrr.cem VIA FAX TO (907) 6884329 ORIGINAL TO FOLLOW BY MAIL Dear Mr. & Mrs. Krzanowskl: This letter will confine that the Alaska Railroad Corporation (ARRC) has no objections to the septic system for the above -referenced property that are located within the ARRC track right-of- way, as shown on the October 19. 2004 as -built drawing prepared by Kenneth G. Lang. Approval for this facility is given on the conditions hereafter set forth: • Since this property is currently under a pending sale with a closing date of February 14. 2005, ARRC requires that the buyers secure a permit with ARRC for that portion of the septic system located within the ARRC track right-of-way. A permit application must be submitted to ARRC within thirty (30) days after close of sale. A blank permit application Is enclosed and should be forwarded to the buyers. • All other personal property must be removed, Including the shed and structures shown on the said as-bulit. If there are any questions, please do not hesitate to call me at 265.2617 or Michelle Luedke at 265-2465. Sincerely, mr Karen sey Director, Real Estate Enclosure MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTNEN1 OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application DateL1 <'. --c-,?- t/ (a) Legal Des ri,pt:ion (include lot, block, subdivision, section, township, range) • ..a /--_..�_��_` 2e._�L Z5 /k - __c/.L _// tt_____`-'L1? _--_________e. ________ Location (addres or directions) // r ;:1_Ey,:�iI c ,; I 1 (A):1,__ ' 4� �.I I 1 �-u ((�, h\ i; (� A i , :I L (b�/]S.) c,; N L �. _t ctt :_,.,- f.r ( a /} j_,t, //.// � ( /3 //i) 7 / Applicants Name !_ / r_': ',, i:) ,/ i ru ;Tele hone Home Business /Ir - `j'' �.� . 056,-7773/ ,/' r-. ,-'fir Applicants Address _`. y / 2"<- L.'7 f i' < ' //. t o / t:.G /1 N, j - l- L 2 (c) Applicant is (check one) Lending Institution 1.___ r ; Owner/builder+ Buyer r_ _J ; Other 1_4 (explain); //. (d) Lending Institution �A- j :. ,ti c Y"jPrh ; i <_ Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: hit 2. ape of -Residence Single -Family +,,c Nell„•,'% „t ;,,dL,,,m:,. Multi -Family l Other (describe) 3. Water Supply. Individual Well ° Community L1 Public [_TI Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Di Bowl Onsite Public n: Community pi holding Tank Note: If community well system, must have mitten confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 5. Engineering Firm Providing inspections, Tests, File Search Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I: further verify that, based on the information obtained from the Municipality of Anchorage files and from 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 regula- tions in effect on the date of this inspection. Nasse of Firm a {g, E< i VL6�3?1 HINTx Address SNUTRa- j k.„ 13L;h' ilIVER ALASKA t i7T Date /O // f; ([ 6. DHEP Approval Approved for /`, e (3) bedrooms Approved (ENGINEER SEAL) Disapproved Terms of Conditional Approval. Telephone .' C." v_ A.' • Ralar! 4. Slight. F•<,, ', No. 1457-E •4�r t'j ry� ups �Q @. Conditional CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH.AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- A'TIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE S'T'ATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND TIIEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS„ EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 A. WELL DATA Well Classificatior / 7%74 If A, B, or C, D.E.C. Approved(Y/N) '-'-- Well Log Present /' Date Completed /0e-421977 Yield Total Depth 20S Cased to Tele Depth of. Grouting Static Water Level j90 r Pump Set At 12 Casing Height Above Ground � Electrical Wiring in Conduit(I Separation Distances from Well: To Septics -rank on tot /20 74- ; To Nearest Edge of Absorption Field on Lottee2 •' To Nearest Public Sewer Lihe /V /ice MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION OCT 12i9811 W CEIV Sanitary Seal on Casin Depression Around Wellhead (2G On Adjoining Lots_ /� On Adjoining LotsSZD Cleanout/Manhole /1/1" c Water Sample Collected By SS Water Sample Test Results To Nearest Public Sewer _ To Nearest Sewer y/ a /� e Dat f Service Line on Lot /C2(0 Comments /U D AJ r' B. SEPTIC/ VAO-TANK DATA Date Installed /9 Standpipes Depression over Tank (� Pumping/Maintenance Contract on File (Y/N)N! ; for Holding Tank High -Water Alarm (Y/N) /iY Temporary Separation Distances from Septic/fng-Tank: To Water -Supply Well /O To To Property Line / 0 1_ To Water Main/Service Line,' gv Course /LW TJ V� Size Air -tight Caps Date Last Pumped No. of Compartments Foundation Cleanout €. z -ti Holding Tank Permit (Y/N)ll% To Building Disposal Foundation 4` Field / 0 To Stream, Pond, Lake, cr Major Drainage Convents 1 ZV 0 N [Page 1 of 21 l -t y 7/ S rte <�o c. �/ t,1/ (, c t'4 /' 2 4 .�/o (J-ksX I 2-15-84 C. ABSORPTION FIELD RATA Soils Rating in Absortion Strata Date Installed /7.i3 Width of Field / /'Z /d ,e Type of System Design g 1 Length of Field .30 Depth of Field 1' Gravel Bed Thickness 3 ,PlI Square Feet of Absorption Area 60 f Standpipes Present (Y/2G) Depression over Field (if Date of Last Adequacy Test /✓e -i l A Separation Distance from Absorption Field: - /' 6( Results of Last Adequacy lost To Water -Supply Well To Building Foundation //4 Lot ZOO 71 To Property Line To Existing or Abandoned ; On Adjoining Lots System cn To Water Main/Service Line 700 ( To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course N / To Driveway, Parking Area, or Vehicle Storage Area Comuents /v 0 SSD D. LIFT STATION ** Date Installed Size in Gallons Ditrensions M$nhoje/Access (Y/N) "Pump On" Level at jLevel at High Water Alarm Level at �V Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(Y/N) Comments Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed on the date of this inspection. Signed Company KB1/d5/s 8 a esRB IE. 106X IWEEHINC•i 'g ;411;E EIIVER. ALASKA W511 q4 -?979 [Page 2 of 2] to all MOA HAA Guidelines in effect Date MOA No. (2c.:3O- Tr - (0/( (&s'7 2-15-84 3INVN S N3"I'7INQ 4OIIV iJNO3NI'13SIIN K1 0 ti 7:10 7.1 7 3 3 0 S n 1 '11 "+1 91 'T1 '71 0 0 004 4 S i-.. 1--1 F-- i-' F' N M ixi 10 b J 171 01:19. 0 0 0 3J1 01 b w,. tn b 0 1-71 O rs' 1-i 0 rh 0 0 • sll 0i 07 rt • rh (D 1n F1 0 1=1 01 ro - H N• 0 CD Fh CL cn 91 '-3 H H '-1 H H H H H 0 0 0 0 0 0 0 0 0 0 0 - 0 N -' o .o 01 0 14-1 0 01 III 0 W 01 0 CO N 0 0 U1 -3 ){Do.zpag 3 73 73 000 41 H 7-1H H H H -3 Ci hi 0 hi Cd t 0 + `N R. 3U a. 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