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T15N R1W SEC 4 LT 47A
T1 N RIW eC. 4 Lot 47A 051 - 072 -56 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name Address Phone(s) Permit NO. NO. of B ms LEGAL DESCRIPTION A l"ec ''' I Township. Range, Section TA~IKS "[~ SEPTIC/J.4~..~ ~--~¥. [] HOLDING Material,~_~ NO. o CompaSs TYPE OF SYSTEM [] TRENCH ,,,~'~D [] W. DRAIN [] OTHER Depth to pipe boltom Irom original grade ~;:31 ~" F'[ ~Fill added above original grade Gravel length Total depth from original grade Gravel depth beneath pipe iravelwidth {~-- S~FT ~:~ FT Number of lines Soil rating ~PRIVATE Pipe material Date Inst ailed WELLS [] OTHER ¢ldentifv) Classification (A,B,C) Tota& Depth FT Cased to Installer REMARKS: WELL LOT LINE FOUNDATION DISTANCES SEPTIC ABSORPTION WELL TANK FIELD AS-BUILT DIAGRAM (Show location of well, septic system, proper[y lines, foundation, driveway, water bodies, e[c.) ENGINEER'S SEAL I $ .~. ~ ~ -~n'~/t F-~le River Loop, Road No, 204 Muflioipal and'Sla~f~ioalms Ifl. O,I[SCI, O~ [~;,~ ....... Health Department Approval: / cedily I h.,~'lhis i.[~peclion was performed according to all 72-013 13/85) I~,. 1457-E Tom Fink, Mayor January 8 , / unicipality Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 1990 Alaska Housing Finance Corporation 520 East 34 Avenue Anchorage, Alaska 99503 Subject: T15N R1W Section 4 Lot 47A Permit #890177, PID #051-072-56 The subject permit, issued by this office for a single'family well and/or on-site wastewater system has exPired as of December 31, 1989. Permits are issued on a calendar year basis by authority of the Municipal Code of Regulations. A new permit must be obtained from this office for an well and/or on-site wastewater system ~ot installed by the expiration date. If you have drilled the well, a well log needs to be sent to this office for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site wastewater system, the original as-built inspection report (three-part form) must be sent to th%$ office for review, approval and documentation. When applying for a new permit, the fees are: $90.00 for an on-site wastewater permit; $50.00 for a well permit; $140.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. Sincerely, John Smith, P.E. Program Manager On-site Services JW/ljm:200 enc: Copy of Permit "Kids Are Our Future" H U N I C :1: F' A L., ]: 't Y D F A Iq C H O R A G E )~)6~'l::Jal"'t;.fil('~)l"i'l:. i:;l{ Hc~a:l. th & J.-h.iman Serv:i.c:es 825 I.. S'krc~e/, Anchor'age~ Alaska 99501 :5zI.:5-472C~ 0 N - S I T E S IE N E R P E R M I "I- ()El/;:75189 Engineer. Designed ()wrier' Flame: AHFC Owner' Ac:h::h~ess: 520 IZ. 34]"H ANCH:., Al< 99503 694-2979 I:::'a r' c: e I I d :: 051.-(Y72-56 Lcrl',. l.,ega],:~ SubdivisJ. on:', 0 Lot: 4'7A B].ock: 0 L..ot Size 1. :!.3A (sq. ~'t., or ac::['es) SIZF"I"!C 'fANK~ I"l:i. nimum to'La1 sel::,'Lic tank tank must haYe at :l. ea~t 2. compavtment~ ie.c.~,t r.I:::,quJ, ves J. rlsu].a'Licln ovc~r' tank (s) ,, c:apaci'Ly: t,0()0 ga].tc:ins. Eac:h septic Del::)t.h to t. op ~3{ ':ii,,.;4q:iti[:: 't'.aFIk (s) '::: 1~,.() TH]:.',':il SYS'I"EM MUST' BE :iZNS"t'A!-LED :[Ixl ACCEIRDAIxlCE WI'ITl "I'HIE AI:::'I::'REIVED IZNt}}:i: NIEER ~ S DES:[ G!'q. EX :[ ST i NG DRA I NFI ELD MUST BE I:::'ROI:::'EIRLY ABAN)) OIqED ,, ).)F!I'~S MUS'T BE Ncr[ ]:t::: I ED I::'R i ElF:it 'i-O AL,I_. ]: NSF'ECT' I E!NS ~ TH ]: S F'IERMI I tS F'OFi'. A 5 BEDROOM SINGL.IE I::AM:[L,Y RES]:DIE!~.ICE DNL,.Y, AND EXF:'II:?ES (::ilxl 12.1::'~;1/89. A L, IF"F S'I'A'I"ION IIqS"I'AI....I..,A]"ION REg~UIRES 'H'"IE APF:'RCiPRIA'!"E ELEt]TRICAL. ]:NSF'E[;TZOitI,, I CERTIt:::¥ "I'I'-IA"I'~i 1,, :1: am fanl:i.l±ar, ~/~:i.'l:.l-t '[,he I'el:lu:i. pemer'YL!~i fop on-"'~!;:i.'Le ~5¢.>weps and ~z~e:[].s as set fc, r'th by 'It. the I~iun:i.c:i.l:a].ity of Arlchcmat]e (MOA) and the State oF Alaska. ~. Z wi],], J.l'is'[,&l] 'Ll'lia system in accor'clanc:e with ali MOA codes and r. egu].a'Lic)ris~ and in compiiarlce with the di.lasJ, gn cr:i.'Leria of' this pepmit,, ~;,~;~ ]: ~lJ.].i ai:JN~.)PE) i:,o aZ], ML)A and State of A].aska Peqt,I~P~?flI~2.H"YIL~i~ fol" the seL back (:J:Lstanc:es fpom any ~)~.(J. st:Ln(~ ~,gE,].].~ W~.S'LEeW,~'~,,(~P cJ~.spcisa~], system ov pub!:i,c: se~,~epa~je sy~B'L(F~lrl (:)r] '[,hJ.~; op any adjac:en'L or' n(~]ar'by ].c)'L. :[ L,~ndE.}P~B'~_aF~d ~:.I"N~S I:)ei"rtii'~. is valid for' a maximum of 3 aIso und~;.:.msta~ that/the c:apac:i, ty of the total system :i.s 2:; bech".ocum[~ and / -- Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: ~1~'~"~'~ 1 2 3 4 5- 6- 7- 8- 9- 10- 11 13- 14- 15- 16- 17 18 19 20 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth lo Water A(ter..~ I Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN/EEN~f FTAND __FT l?O~EaaleRiverLo~l~RoadlU,~ '~n., '"' / //7 ~ THAT THI ,TE~ W S ~EBFORMED IN SULLIVAN WATER WELLS P. O, BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 OWNER OF LAND '"" / :" ' '~' ADDRESS '"" "'" ' ·" LEGAL DESCRIPTION · ' ' DATE-Started /~ ,.~ ~ ,/ ~'?'~' PERMIT NUMBER DEPTH OF WELL STATIC LEVEL OF WATER FT. l.~ ~'~' ~. '~ r' / ' .... ; "< ? ~7' DRAW DOWN FT. Ended ".? 'f ~ GALS. PER HR f KIND OF CASING ~' :')",'" KIND OF FORMATION: From.__. Ft. to.- From_ Ft. to ' From__.Ft, to From / Ft. to From-- Ft. to-- From__ Ft. to From___Ft, to From Ft. to From __ Ft. to From Ft. to From__ Ft. to From Ft. to From Ft. to-- From Ft. to-- From Ft. to From Ft. to__ From Ft. to Ft. Ft. Ft. Ft .Ft. Ft. Ft. Ft. From__ From __ From __ From From__ From From From __ From From From From ___ From From ___ From From___ MISCL. INFORMATION: Ft. to__Ft. .Ft. to Ft. Ft. to Ft Ft. to Ft, Ft. to.__Ft Ft. to Ft. Ft. to Ft. Ft. to Ft. Ft. to__Ft Ft. to__.Ft. Ft. to Ft. Ft. to //.~%~-fl DRILLER'S NAME -/ ,~ ~ -' MUNICIPALITY OF ANCHORAGE BEPARTNENT OF HEALTH ANB ENVIRONNENTAt PROTECTION 325 L STREET, ANCHORAGE, AK 5'9501 264-4720 ON-SITE WELL PERMIT PERNII t~O: 850723 BATE ISSUED: 11/21/85 APPLICANT: CONTACI PHONE: S&S ENGINEERING VICTOR JOHN'ARNOLD EAGLE RIVER, ~K g9577 69;-2979 LEGAL BESCRIP: SUBDIVISION: NA LOT: 47A SECTION: 4 TOWNGHIP: 15N RANGE: IW LOT SIZE: 54450 (SG.FT, OR ACRES) BLOCK: I certify that: 1. I am familiar with the 'equiPements For om-site sewers and wells as set forth ov the Nunicipality of Anchorage (NDA) and the State ot ~laska, 2, I will install the myste~ in accordance with all NOA codes and re§ulations! and in coapliance uith the design criteria ol this permit, 3, I will. adhmre to all NDA and State of Alaska requirements for the set back distances from any existing 4ell~ wastewater disposal system or public sewerage system on this ~r any adjacent or nearby lot, SIGNED ~ ~ /7/D ' . ..... APPLICANT. B&S~.E~SI~ERINB VICTOR JOHN ARNOLD DATE: 4 -~I '- ' MUNICIPALITY OF ANCHORAGE ~ . _~/'~' DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENI'AL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAILINGA 'DRE f )ESCRIPTION DISTANCE TO: Manufacturer Liq DISTANCE TO: Manufacturer DISTANCE TO: Materi~'~_~, L' iF HOMEMADE: Inside length W dth No. of linest~ Top of tile to finish Well ng / Length Width Type of crib Crib diameter DISTANCE TO: Class DISTANCE TO: Well Depth Total~ of~Jines Depth Crib depth Building foundation Driller foundation Sewer line OTHER PiPE MATERIALS SOl L TEST RAT(I~i¢ INSTAELER Material Nearest~.~l t Ji~e~.__ Trench idth ~<~ inches inches NO, OF BEDROOMS No. of ~partments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO. Total effective absorption area Nearest lot line Septic tank Distance to lot line PERMIT NO, Absorption area{s) DATE LEGAL A & L DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 995~7 · TELEI~HONE 694-2588 OWNER OF LAND ADDRESS KC ~ LEGAL OESCRIFT~ON Z o T ~ 7 ~ - ~/~/7 ~ Ended DATE- Started PERMIT NUMBER '70~F) C~ 72 D~T. OF WEL~ 4 / ~? ~C7~ '7 STATIC LEVEL OF WATER FT. / KIND OF FORMATION: From ~) Ft. to ] From / _Ft. to ~ From ~ Ft. to / C> Ft. From__/O Ft. to ~¢~ Ft. Fromm) Cot _Ft. to o~r~ Ft From ,J'6} Ft. to 4~ Ft. · From Ft. to. From Ft. to_ Ft. From Ft. to Ft. From_ Ft. to .Ft. From Ft. to Ft. From __Ft. rD.__Ft. From Ft. to__ Ft. From Ft. to _Ft From Ft. to Ft. From__ Ft. to Ft. From Ft. to. Ft. From _Ft. to~ _Fi From__Ft. to _Ft. From_ ' · ]Tt...to Ft. From. Ft. to_ Ft. From Ft. to Fr c~d'~t-~'F"~rrom Et. to Ft. From _Ft. to Ft. From_ Ft. te Ft. From__ _Ft. to Ft. From Et. to Ft. From__ Ft. to _Ft. From Et. to Ft._ From__ Ft. to Ft. From Ft. to Ft._ From Ft. to Ft. From Ft. to _Ft, From Ft, to_ Ft_ MISCL. INFORMATION: DRILLER'S NAME c,.~-~, ~ ,, ~; . ~ ,. DE:FI ..... 'EI'.{I' ~ '--' ,~.11::~:I -r'il ,",~ ~. r.-,,,,,,~ ..~ .,t ....... /~_..~/F~..~--..,~R.:~,,,~.~.~.~'~ , ,.:,=: .. L.:Z: .... .~ '"'"'~.." ~:.,',~ v .~. r<UNI'"IE~:I'.,FF: _ ~u'- "1::' -'~"~ - ~' ~ ~ 0 ' ~..=. ~ ~:C~ L._. ~__ ~{=:u ~"... U U-", u-'-~ ~:".. u '~.L.: ...... .... ;~ZE ~ ~l~- ~ ~' , t '"Z: c ........ ~::.....-~.- :", ', m NL.' ...... ' "F"r'?E: OF' :~;F'~:L F:i[2:~;(:I{:;;:[~F]..~:(:{{,.4 ,:.,.,, ....:.,. I'" F,-~ ....... '"':::' { t-lc:. :;[ ::: ';~ '~' ;'6::E' ':' "'=' :' ........ ~ ........ OF THE :~;O}L I:IE~;O{:~:F'-F J: ON ?~"'::TI:I'" -':: ...... ' -" ' ......'-'-" ~"" n ~=~ ~'"~ H 8"-'~ .......... 8 ....... "':" "' ':' :"' ~ ~ ~ . ..... ~ ~ "~" ~ ~"~ ~=' ~-- ~:::" ~ IF::~ ~-- 8-'"~ === :8-. .... F'E~:'i" ::, OF' THE" '{"I'JE~ f::'~:{::"l"l'-I OF' Fl "FF':'I'-4"'H FI;? PIT T':: ""HF' D:I:~;"I"FINC[~: ~ ~ .: ...... {3{~?OUND FIN[) TI'IE: E:O"-I-OFI OF:' TI'IE: F2:='=:CFI","/~'I"ZON </[}4 ............... , ~:::;. tflx:. GI:~:I:~',,,~t~L DEPTH :~:5 THI~: H):N]:HLII'q [:'E~:t::'TH OF' (~;~:I:::i',,,~Z[... ~?E'T'['~EN THF' OLITF:FILL FINE:, TI'qE: t~',OTTOFI OF' Y'{'"I~: EJ:'::C:FI","I::t'i':I:ON ':/]:1"~ i::'[~:E"i'::,. '"'' .... .... -::"{~:..~-'" ~ 3i'C'-: -~""~,"".' - ZN~5'T':::L.I ::q"T-'~. -,.,-., .............. 7' -' . ........ ~.-...v,,, tH~:. ..... I,I::,FEL. tIuN'.-z, r"F' FtN"r' .,.F'I [':: I:~D-J'FICt~:N"I' 'FO IP'tz:::, I .~.FE.I',< 'r FIN[) THE L 'CL..,.F ..[-LJ.~',b I'"F' f:lJ'.,l~.r' ,'~' ,-"', , -, - -. =:,' .......... !:::'I;~:F'I~F;:THEN'I" l.,J]:l I ~ .... :,~z, I~:11 1.1~ F?IULlt F:':[NFIL. Z~',¢5:::'F'""t'" '"N '~NI;. F~I:::'Fq:;;:O',,,'FfL ..... :,Fi{ '~ !E Jt'E:(::'i ']'(:J~ F:'F~OSE~'~:::I t-':[{"N H ~"~H..Ft [::']::STFINCE: E~ETNEEN FI I.qE:L.L F~ND FIN"r' ()N'-:~;:['FI~ ~: ...... -, E. l'~ ~"1 b~l:::. E:' ]: _I.~2,/ TO ~:a~j, F'[~EF4'." F'h:tOl'q FI F'I.IE:_ZC I.qELL E:'E:F'[END~NG UPON THE: -t" F'E CF:' :' [~L 'J'2 I.'.IE:LL.. h ::-L LC:;~'5 F:IF:E RE~]:~LI]F:EE:, I~I"JE:, HU'J:T E',E F:[CTI F'H~:-[" TO THE [::'E:F:'FR'-'H[:NT I.'J:<TH]N :~:O E':':'~; ~ F' ' "FIE' F.IELL COHF'[.ETF:f: ON. ' -- ' --. F!'v'Ff~'I.. ::IE','[ ~:' 3"~ ....... ~'-r. -.,t E.-.~-.._.dl Z_J",~:, FIN[:, C('~N':~-t"I;~:I. ICTZFI'~ -. ..hi :,_ '~:E:. :'R'":F'~:F:: :[f',IS3':LL.t::FI"': ':~',L ......................... ~,-..- ~ ~- L:~: :~ ..... .."~ ,,:::~ -::=,, ,,::,, ]: C:E:F:T ]:l:::'.r' THF:.-f' F'OI~:T:'.I [~'.~.' THE FfUN:[CZF'I:::iL]:T'y ~'"~I::' ::~.~"'--"~;,:~.-.,- :: "" ........ -. I::. I ~:': ~ I.'. ~ LL Z N~FFF:IL.L. THE ::~;"~"~"1"!~:1"1 :[ N FtCCOF:DFIt'.4C[/ !.']:1: TH THE ::~:: Z I..li",I[::'/I:~:~F'I"Ftt'.,I[::, 'I"HFIT THE: CN--:~;]:TE: ~:[~I.'.IE:I:~: :5'?'~STE:H HF?~" F~:E)::~LI]:FtE: E~I",!LF:t[~:Cj[F:tqE:NT :[1:' THE :IF'F ]' -'F ~ 't ...... ' - '2 -,, 7~,,-. - O Et E GEC'--TCHNICAL ~ DEVEL~--,~MENT Box 90, Davis St., Eagle River, :Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 Soils ~, Foundations Performed for: Name:_ ~//~/v~ SOIL LOG Tel. No. Hatllng Ad· ~ .... - ~ dress. ~,_~_ /?~j~ ~// ~ '. Legal Description: ~ ~]?~/ ~/:~,~;t~ ~-/.y~¢~ ~/~// ~%/~X ~ 5~11 ~haracte~tstfc~ 0 CO. Earl Ellis Land Developmer~! 3.2.___._ Ground I~ater Encountered: Yes ~" No...___ Zf yes, what depth. _ Proposed Installation: Seepage Pit..__.__ Drain Field Comments. 'rom Fink, Mayor August A unicipality of AnchoraS¢. Department of Health and Human Services 825 "L" Street P,O. Box 196650 Anchorage, Alaska 99519-6650 25, 1989 ..... Robert Shafer, P.E. S ~ S Engineering 17034 Eagle River Loop, Suite Eagle River, Alaska 99577 204 Subject: Lot 47A, Sec 4 T15N, R1W On-site Sewer Upgrade Dear Mr. Shafer: The Department of Health and Human Services (DHHS) has reviewed your design for upgrading the on-site wastewater disposal system for the subject lot. Your design of the new absorption bed is based on a seasonally high groundwater/depth of 7 Ft. We are concerned that your design may not provide the necessary 4 Ft. vertical separation between seasonally high groundwater and the bottom of the proposed absorption, bed. This concern is supported by the fact that groundwater monitoring on adjacent lots has shown seasonally high groundwater levels to be at a depth of approximately 5 Ft. To ensure that the 4 Ft. vertical separation to groundwater is maintained, DHHS will require groundwater monitoring through the end of November, 1989. As an 'alternative to extended groundwater monitoring, the proposed new system may be redesigned with a total depth not to exceed 1 Ft. If you have any questions or concerns please contact this office at 343-4744. Since, ~ J~n~ Smith, P'.'E.' Program Manager, On-site Services ~cC: Susan Oswalt "Kids Are Our Future" 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. o5x-o72-56 COSA# C~ ._~ C //l/ ~. ~-.~_.- Expiration Date: / GENERAL INFORMATION Complete legal description . T~_~;N Range xW Section 4 Lot 47A Location (site address) 2~227 Helluva Road, Chugiak, AK 99567 Current Property owner(s) Mailing address Lending agency Mailing address Secretary of Housing & Urban Dev Day phone 4400 Will Rogers Pkwy, Ste 300, Oklahoma City, OK Day phone Real Estate Agent Matt Arndt, Keller Williams Day phone Mailing Address ~98:[ E. Palmer-Wasilla Hwy., Ste 202, Wasilla, AK Unless otherwise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: "? Individual Well [] Individual On-site [~ . Individual W:~er Storage [] Individual Holding Tank [] Community .c!:ass ~ Well [] Community On-site r-'] Public: Water SyStem [] Public Sewer [--1 · .i 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 Pannone Engineering Services, LLC Phone 272-823.8 Address P.O. Box 3.OO2:L7, Anchorage, AK qg~;~.o Engineer's Printed Name Steven R. Pannone, P.E. Date 8/~7/~:L Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe 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 soil condition, ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. PES can therefore not provide any warranty for future ~......'*.-r~.i~"~ ...... }....,~ performance nor give any estimate of how long the system will continue to meet the operational requirements of the 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. I,~ Approved for '~ bedrooms Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X ON-SITE , WAT[RAND % ASTEWATER .. ....... Arsenic Adviso~ ~;/~T ~~' Maintenance Agreements '~//))~ ~ B~ Supplemental Engineer's Repod Other Original Certificate Date: ,q -/7 -// 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. o5~.-o72-,;6 COSA # Expiration Date: GENERAL INFORMATION Complete legal description T~sN Range ~.W Section 4 Lot 47A Location (site address) 2~-227 Helluva Road, Chugiak, AK 99";67 /n--7- ii Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Secretary of Housing & Urban Dev Day phone 4400 Will Rogers Pkwy, Ste goo, Oklahoma City, OK Day phone Matt Arndt, Keller Williams Day phone · 98~ E. Palmer-Wasilla Hwy., Ste 202, Wasilla, AK Unless otherwise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [~ [] Individual Holding Tank E~] [] Community On-site E] [] Public Sewer j-"] 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 Pannone Engineering Services, LLC Address P.O. Box :too2:t7, Anchorage, AK 99q:to Engineer's Printed Name Steven R. Pannone, P.E. Phone 272-82,8 Date 61271~ Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe 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 soil condition, ground water 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 this system. All systems eventually fail and ~'"' satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. PES can therefore not provide any warranty for future ................... ~". ~o. CE 8~49 performance nor give any estimate of how long the system will continue to meet the operational requirements of the MOA D SD. 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. Y Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: (Rev. 11/05) ,_:/ Original Certificate Date: '7'-- 7 -- l/ · M cipality of Anchorage DeveloPment Services Department Building Safety Division On-Site Water & Westewater Program 4700 Bregaw 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: T~.~N RaW Sec./. Lot ~.?A A. WELL DATA Parcel ID: on~.-o7~,-~6 Well type __P Date completed ~/~61a978 Total depth /+2 ft. Date of test Static water level Well production WATER SAMPLE RESULTS: If A, B, or C provide PWSID # ....... Sanitary seal (Y/N) Y Cased to /~ ft. FROM WELL LOG nla61aq?8 6 ft. g.p.m. Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground).. AT INSPECTION 6127/2oa~ .. 2/+ ft. 6.~+ g.p.m. in. Coliform Ne_~ colonies/100mL Arsenic: ND ug/I B. SEPTIC/HOLDING TANK DATA Nitrate ....a.2', mg/L Date of sample: Collected by: Laura Pannone Tank Type/Material ..Anchorage Tank Steel Tank size aooo gal. Foundation cleanout (Y/N) Y Date of pumping 61~,,,.12o.,., ABSORPTION FIELD DATA Number of Compartments _~ Depression over tank (Y/N) N Pumper JR's Pumping Date installed ~.2/:1oh.989 Cleanouts (Y/N)Y High water alarm (Y/N) Y Date installed =16h. qgo Length ~/. Total depth _~S ft. Soil rating (g.p.d./~ or ft2/bdrm) ~.~ ft. Width a8 Eft. absorption area 6~.2 ft2 Date of adequacy test ~ Results (Pass/Fail) Fluid depth in absorption field before test _o in. Elapsed Time: _o min. Final fluid depth _o in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N Monitoring tube _Y System type Bed Gravel below pipe ..o.~ Depression Over field N Pass For 3 bedrooms Water added99A gal. Absorption rate >=/.no+ If yes, give date New deptho in. g.p.d. UFT STATION Date installed 116h.~,o "Pump on" level at/~.~; in, Datum Bottom of Tanl( E. SEPARATION DISTANCES Size in gallons 500 "Pump off" level at 40.5 in. Cycles tested 4+ Manhole/Access (Y/N) Y High water alarm level at Meets alarm & circuit requirements? Y in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot ~.oo+ Absorption field on lot loo+ Public sewer main N/A Sewer/septic service line 25+ Animal containment areas loo+ On adjacent 10ts lOO+ On adjacent lots loo+ Public sewer manhole/cleanout N/A Holding tank lOO+ Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation lO+ Property line lo+ Water main NIA Water service line 25+. Wells on adjacent lots ~.oo+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line lo+ Water Service line 2~+ Curtain drain None Known COMMENTS As-Built on File Absorption field Surface water ~eo+ Building foundation 1o+ Surface water lOO+ Wells on adjacent lots ~oo+ lOO+ Water main NIA Driveway, parking/vehicle storage 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 Steven R. Pannone, P.E. Date COSA Fee $ Date of Payment Receipt Number (Rev, 11/05) 0-" Waiver Fee $ OF .=. ....... Date of Payment Receipt Number SGS Ref.# 1112615001 Client Name Pannonc Eng. Srv. Printed Date/Time 06/24/2011 14:59 Project Name/# 21227 Helluva Rd Collected Date/Time 06/20/2011 10:30 Client Sample ID 21227 Helluva Rd Chugiak Received Date/Time 06/20/2011 11:30 Matrix Drinking Water Technical Director Stel~hen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 06/21/11 06/23/11 NRB Waters Department Total Nitrate/Nitrite-N 1.21 0.100 mg/L SM20 4500NO3~F B (<10) 06/23/I1 AYC Microbiology Laboratory E. C01i Total Coliform Negative 1 100mL SM20 9223B A 06/20/11 SDP Negative 1 100mL SM20 9223B A 06/20/11 SDP SOLSTICE CONSTRUCTION 7362 W. Parks Hwy, P.O, Box 391 Wasilla, AK 99654 Mat-$u Valley: 357-3325 Eagle Rive]': BID/BILLING INVOICE 696-5296 CLI[~NT: 229-5344 JOB DESCRIPTION: For 21227 l,telh~va Rd. Chugiak, AK. 99567 Fill, grade and compact 18'x34'= 612 sq ft area with I V2 feet of fill dirt.6 "Topsoil and hydroseed, With 3-1 grade on all sides and extension of clean outs as needed. Total = $ 2499.00 Note: Upon acceptance of bid, a 10fY: deposit is required to hold schedule. Prior to stazlup an additional 40% deposit is required for m;~leria[ cost. This bid b; void nl*tcr IhMy ~'30,, days. Make all checks payable Io Solstice Construction. Any changes made to contract prior Io completion may rcsull in a arllcndw, cnl ,'efcrrcd ~o as a change order. A separate billing invoice for time and materials may be required By sighting this agrccmcm I , hercb7 understand the conditions mid temps met by both verbal ami written %,.rccments. tn addition. )5' s g ~ rig, I agree to the description of this job, and have a Ihorough undemtanding of any linar~cinl agreement made Philip T. Phillips ~ Tony Gumley · Chief Executive Officer · 4621 Palmer-Wasilla Hwy. · Wasilla, AK 99654 · 907.373-1851 Office 907.376-9077 Fax GUh/ EY EXCAVATION, INC. QUOTE FOR: Keller Williams Realty Attn: Matt Ardnt DATE:7/1/2011 E-MAIL: akhomesandland~gmail.com PHONE: 907-229-5344 FAX: 907-864-6565 LOCATION: 21227 Helluva Rd. Wasilla, AK 99654 PROJECT DESCRIPTIObi UNIT PRICE TOTAL PRICE -Gumley Excavation, Inc. will place 1 ~/2 feet of soil over the existing septic system field measuring 18'x34' - 3:1 slopes on all edges - Spread grass seed See Below Proposal does not include: Any costs incurred due to slow percolation rates, including but not limited to any and all engineering fees. Any conditions or problems resulting from high, or fluctuating water tables. Any additional gravel hauling not explicitly stated above. Any costs or problems caused by prior excavation. Gumley Excavation, Inc. hereby proposes to furnish all materials and labor to complete the project outlined above for the sum of: $3,200.00 All material is guaranteed to be completed as specified. All work will be completed in quality workmanship according to industry standards. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and may result in additional charges not included in this estimate. All agreements are contingent upon strikes, accidents or delays beyond our control. Customer hereby agrees to carry all necessary insurance coverage in connection with our execution of this project. Employees of Gumley Excavation, Inc. are fully covered by Worker's Compensation Insurance. Payment in full is due 10 days after receipt of invoice. By signing below, customer acknowledges and accepts the terms and specifications of the project as outlined above. This proposal may be voided and cancelled if not accepted within 20 days. Customer Signature Municipality of Anchorage Development Services Department Building Safety Division .. On-Site Water and Wastewater PrDg~arh 4700.South Bragaw SL '" P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak, us (907) 343-7904 fr-l(.;A i r- OF HEALTH AUTHORITY ^ · r~r r t~U V/-~L ...... I-oR ~ ;~iN~LE PTAMILY DWELLING' ..... Parcel I.D. _O5'1 -O 7zL-,t'£ ' · 1. G E N ER/~. L' !N FO RM/~)OI~'-',:.:.', e Expiration Date: ~__.T..~(~ - O/'//- · omplete .legal de~cri,ption.. ;. 'kocatio~ .(si[e.address or direction) .21 · ,,.- :;., ." ~ Current Property owner(s) ..' '. · ." ' :.i .,) Mailing addrC§s....,,~,, .' ,.~, ,..~'~' ,¢ Lending agency Mailing add[ess Real Estate Agent Mailing AddreSs Dayphone Unlessothe~(Sereqqeste~HAAwillbehe~DSD~rp~. NUMBER OFBEDROO~S: . ..~ 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 [-1 Communi~ On-site E] Public Sewer E] The Municipality of Anchorage Development SeMces 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. Certifi~tes of Health Authority Approval are required for the transfer of title (except between spouses) for propedies served by a single-family on-site wastewater disposal and/or water supply system.-DSD ~lso issues HAAs upon request to homeowners. Certi~cates 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 s~.mples.) 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. Legal Description: '7'//' A. WELL DATA weli type ~ Da'te completed Total depth x.s"ft. Date of test iMUnicipality Of:Anchorage DevelopmenfServlces Department Building Safety Division' On-Site Water & ~WastewateJ' Program 4700 South Bragaw St. P.O. Box 1966501 Anchorage, AK 99519-6650 www.c~.anchorage.ak~us ' (907)~343-7904 HEALTH AUTHORI (APPROVAL CHECKLIST 5' 07' If A, B, or C p~'ovide PWSID # Sanitary seal'. (y/N)__~ : Cased to~/~$.5'ft. g.p.m.. FROM WELL LOG. Static~, water level Well production . ~ (:3 WATER SAMPLE RESULTS: Coiiform ~ colonies/100 mi. SEPTIC/~ TANK DATA Well Log (Y/N) Wires properly protected (Y/N),' y Casing height (above ground) "2,0 ft. AT INSPECTION , in. Z '~ g.p.m. Other bacteria _t~ col.onies/100 ~l'..!. Collected by: /,,(~V'tr"~,,-~,: ~,~j, ' I Tank s~ze /~00 gal. Number of Compadments ~ Cleanouts (Y/N) F oundation cleanout (Y/N)~ Depression over;tank (Y/N) ~ High water alarm (Y/N) ' C. ABSORPTION FIELD DATA ! ' Da~e. installed/~-~O"~ Soil rating ~=~rft~/¢drm)/~ System type. ~D I. ~ ~ ~ ft. Gravel below pipe ken,th ~ ft. Wi0th ~ ~, 5 .'f~. lota~ depth / ft. Eft. absorption area ~/~ ft~ ' Monitorin~ tube~ Depression over field Results {~ss/Fail) ff~ For ~ bo0room~ Date' o~ adequacy test ~/g~O~ : ! :~ -- 1 Fluid depth in absorption field before test ¢' in. ' Elap,sed Time:,~'~ min. Final fluid depth // Any rejuvenation treatment (past 12 mo.) (YIN & type) Water added_~5"O gal. New dePth ~. 'in'. ,n. Absorption rate >= z./Z',,5"'O' ~- g.P.dt.~ g//tf/~,,t/'o~J'~' If yes, give dat~ SGS Ref.# Client Name Project Name/# Client Sample ID Matrix 1040908001 NorthRim Engineering NA 21227 Helluva Rd. Drinking Water PWSID 0 Sample Remarks: All Dates/Times are Alaska Standard Time Printed Date/Time 02/27/2004 13:42 Collected Date/Time 02/24/2004 9:30 Received Date/Time 02/24/2004 13:10 Technical Director/ Steph~e~C. Ede Allowable Prep Analysis Parameter Results PQL Un/ts Method Container ID Limits Date Date Init Waters Department Nitrate-N 1.05 0.100 mg/L EPA 300.0 B (<=10) 02/24/04 JJB Microbiology Laboratory Total Coliform col/100mL SMI8 9222B A (<=1) 02/24/04 DKC 03/15/04 ~0N 13:15 F~ 6895499 YXSTA REAL E~A~ ~ ~002 b* · ' ~' ~"*~' :,, ~,*' .'. .~ ...... ~__Z .~'" ~ · . . ~%S~S OF RECORD, O~R T~E ~OSE S~ ON ~ I ~tby ~ m~t I ~vt ~ a }4o~a~me'~ ~* i~stitutiOn5 sbogib~ the 'relattons~'p of ~tng 'no~'overx.p or'en=~=h on ~e pro~ ]Fine edJacent ~ere. StUCCOeS and platted eas~ents ~d lot [~nes. ~.'that.no ~pmv~ep~ ~ ~ lying I~m~nt mere~ not to he used ~or poslti~ln~ ~d~itional n~oacfl nfl tnt ~ze~e9 ~ que~tma a~ that ~ are ~o fo~dwayl. U~lon lJfl~ or ~ther v~ible e~mefl~ ~n S~UC~ O~ ~cel~S. laid propcTf~ except ~ fndJca~d h~ Mumc pallty of Anchorage r : ~ . : ~ ' ' ~ ~ ~ ~ :DeVelOPment Services Department ~ i On-Site Wate~ and Wastewater prOgram i , ; ! .... ' ~4700,South Bragawst.' . P.O. Box i 96650 Anchorage, AK 99519-6650 [ .... I!~ =i : i i ~, '!',www:ci.anchorage.ak:us ~ i ~ I:~,.~ . ~ .~ (907) 343-7904 ;. ' ~ i ' ',' ''1 ' ' ~ SEWER/VVEEL'SuBMiTTAL COMMENT . i~ ;:: !, ~egal description: ;'I'lSN R1W 'Saction 4~,' L~t'47A. i:: ~The attached~paperwork has bee,n reviewed and is being returned for the'following reasons: I--i; ~;':i:!,ti!ingneartr:~ °r stamp missing0'n !ii' .: ' . [-'l . Add~t~onalsods InfOrmat~on needed.,,: I!"' . : . ,... II .Water monitoring results inadequate'.! i :: .1:... : r'-I D~screpa,,ncy In ~nformat~on submitted;.~ :::: :~ '. ' , , · I-"1 Topggmphic information missing or inadequate; i. : ' :.. - . · ~ .in~c~o~pl,e,!e; missing AsbUilt sum/ay,With Le~oI cliscr;il~tion oncl clote.i~ objection t inus;l' be obtained from 1.ha I~iqh¥ 'i)1= !Wo¥ da'pia~n~ent, r-] .Additional adeqUacY test infor~ation'hee~l~l: ! ~..,,.; :. ::i ~' Water sample unacceptable ~ ',': :.' · :,:'..~ I--I '~easured/proposed distances/dimenSion{ missino :!:::I:: ,' ': ~' F--I Locations o~ all soils, percolation and Water monitorin~'t~sts not shown I"1 Proposed system too deep fo~.soils infofination subrriitiedi': :" :. ' I~] Well Iogrecluired. . ~. : ! .'~.. I' ~i .' : !.~ : . . r-I um~ss~on~nnarrative. ,, . ~' ' . : !'~.-,?' .. :. ~" . ' . : MUNICIPALITY OF ANCHORAGE Department of Heallh & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Lot 47A; Sec. 4; TISN; RIW; SM Location (address or directions) NHN H~lluva Road, .~ /~¢q (b) Property owner Mailing Address (c) Lending Institution Mailing Address A.H.F.C. #74095 520 East 34th Avenu6 Telephone:(home) Aneborg¢, z6a~ka 99503 Telephone Business 561-1900 (d) RealEstate Company and Agent R6/Max of Ea.ql6 Riv6r A~n: Doc Crouse Address 16600 Cent6rfie~d Drive, Suit6 201, Earl6 Riv6r, A~aska Telephone 694-4200 (e) Mail the HAA to the following address: (or check hereX(~, if hold for pick up.) List contact person and day phone number below: S & S ENG~NEEI~ING 17034 EagJe Ri,vet Loop Eoa~ No,. 204 2. TYPE OF RESIDENCE Single-Family ~X Number of bedrooms $ '~ 3. WA'I;ER SUPPLY Individual Well,'~: Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site r~XX Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) 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 end inspection, the on-site water supply and/or westewater 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 Address Date Telephone 17034 Eagle River Loop Road No. 204 F..agle River, Alaska ~-~577 6, DHHS APPROVAL Approved for 3 bedrooms by Approved '~ _Disapproved Terms of Conditional Approval. Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificeted based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 A. WELL DATA Well Classification (~ ,M,.UNICIPALITY OF ANCHORAGE (MOA) ~ MUN;CtP,H~itI~I~ A'uthor, i~LApproval (HAA) VI RoNtv~ E N~HE~ EI~'~vF~r~J~,~R U A R Y 1984 343-4744 ?F~ ~ 6 ~920 Legal Description: ~ ~ ~ "~ RECEIVED ~),~?]~ 1-~. A/~,/~ IfA, B,C,D.E.C. Approved(Y/N) Well Log Present (Y/N) ~./ Date,Completed I/- ~._3~--~-~' Yield ( J.- _ ~. £,~,~ J~ Total Depth z~ _'~ ~ Cased to z./..~ (~ Depth of Grouting Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line A~/~ To Nearest Sewer Service Line on Lot Pump Set At LJ,l~/ Sanitary S~al on Casing (Y/N) Y Depression Around Wellhead (Y/N) Water Sample Collected by Water Sample Test Results / OO t~- To Nearest Public Sewer Cleanout/Manhote r -I~ ~ ~ ~--¢~o?;~Oe..~¢~/d~ : Date ; On Adjoining Lots ! O0 '~ ; On Adjoining Lots /' O0 "f' Comments ~T~,~o,~ B. SEPTIC/HOLDING TANK DATA Date Installed (~ -~O-~.'~ Size 1 ~---,) No. of Compartments ~-- Standpipes (Y/N) "1 Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contac[ on File (Y/N) Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: ,~ Foundation Cteanout (Y/N) Date Last Pumped /J/~' /O/Ft ; for Temporary Holding Tank Permit (Y/N) To Building Foundation ,2. ~ ,. "'r-' To Disposal Field 'Z/O - To Water-Supply Well [ To Property Line / o To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Width of Field ! ~> Type of System Design Length of Field _?~ z../ / Depth of Field [,, 0 Gravel Bed Thickness o ~ Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test SEPARATION DISTANCE FFIOM ABSORPTION FIELD: To Water-Supply Well __ To Building Foundation Lot To Water Main/Service Line / To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Date of Last Adequacy Test To Property Line / O To Existing or Abandoned System on ; On Adjoining Lots { ~o~ 7'-' To Cutback (if present) Comments D. LIFT STATION Date Installed Size in Gallons !~OO ~Fl/ "Pump On" Level at __ High Water Alarm Level at _ Tested for 1~ - 80 - e ¢ Dimensions 46 Manhole/Access (Y/N) /-/'/"'iL "~Z" "Pump Off" Level at /"'{ "~ ~ Vent (Y/N) A]/(,~ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ~~-~'; ....... / ~¢2 ¢- .~-/~¢~-¢~/'~,~ ~c~/~,'~,~.-/L'//o,t), inspection. Signed Company Date MOA No. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this 17034 Ea~lle RiYer Loop Road No. 2D4 Receipt No. Date of Payment Amount: $ 72-026 (Rev 7188) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 idlhl, L3i,3 Rg?0k2 B~ 8t~M?l,J~ ~.o~: Work Order ~ 1974~ 5at~ k~po~t P'~lnterl: ~ 12 90 6 !2:46 Collected FE~ 7 90 @ 13:00 hrs. ?ze~e~ved wl~h ;~S Req R Ordozod By : R. S}~FER Chemlab Re~ ~: 900050 Lab $~pi ID: 3 Matzi×: WtY~R Allowmbl~ Pa~amo~ez Te~ted Result Unite l~ethod I.i~ts iIIT~ATE-It 0.80 ~/1 EPA 353.2 JO ~emazks: $A[~?I,E C05LECE~O BY ~DJ. See Special h~*tructioas AbcYe UA-UnaYail[,hte MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, s. ubdivision, section, township, range) LOT 47-A; SEC.4; T15N; R1W; SM. Location (address or directions) North Birchwoc~ Loop - HelluCa (b) Property owner Mailing Address Owners of record - Henry and Alice Perkins A.H.F.C. 74095 Telephone: (home) Business 520 East 34th (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent RE/MAX OF EAGLE RIVER MS. Eva Loken Address 16600 Centerfield Drive, Suite 201, Eagle River, AK 99577 Telephone 694-4200 ' (e) Mail the HAA to the following address: (or check here [~, if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 Ea<~_le River Loop Road No. 204 F. aale River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family [] Number of bedrooms 3 3. WATER SUPPLY Individual Well ~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site;~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72qj25 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS~ FILE SEARCH, DATA AND INFORMATION AS certified by my seaJ 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 end 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. S & S ENG~NEEEING Telephone 17034 E~gle River Loop Road No. 204 Eagle RIver~ Alaska 99577 Name of Firm Address Date 6. DHHS APPROVAL Approved for ,-~' bedrooms by Approved i~.. Disapproved Terms of Conditional Approval Conditional I ~.'Tl~l[e] ~, ilrln The Municipality of Anchorage Department of Health and Human Services (DH HS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. A. WELL DATA W~ll Classification Well Log Present (~YN) ( Date Completed Total Depth~_Cased to ~G~' Depth of Grouting MUNICIPALITY OF ANCHORAGE (MOA) ..... LI~_ ?~lh,~ut, l~i~ Approval (HAA) ~MUNt~'~r~'~t~,I~ [:L~R,~I~¥I~EIB R U A R Y 1984 fIRONM 343-4744 JUN 2 1989 Legal Description:~T +~ -A , If A, B, C, D.E.C. Approved (Y/N) I1 :~-: ~ Yield Static Water Level'-' Casing Height Above Gr.ound Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot Pump Set At [_,~i ~ Sanitary Seal on Casing (Y/N) ~' Depression Around Wellhead (Y/N) I~ ; On Adjoining Lots .f ~ "'~' ; On Adjoining Lots To Nearest Public Sewer Line ~/A To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot ~ ~' ~ Water Sample Collected by ~ ~?~ _~,/"k~C..~l'~ / ;Date WaterSacpleTe~stResults ~,~.~.1-~'~C-~1/'"'0¢~' ~' }'~1'1~'~'1"1~:~ "~ '~,"~-'~(~ - Comment~t~j!~) ~oVc..e_~~ ~("'f'..2 ~,~1 ~Cf rr~ik)o..~, o~O B. SEPTIC/HOLDING TANK DATA Date Installed ~_ Size Standpipes (Y/N) ~ Depression over Tank (Y/N) ,/~ NO. of Compartments ~- Air-tight Caps (Y/N) ~" Foundation Cleanout (Y/N) Y I~ Date Last Pumped ~ O [~x'°£:. ~ Pumping/Maintenance Contact on File (Y/N) ; for HoldJng Tank High-Water Alarm (Y/N) '~//~ Temporary Holding Tank permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line To Water Main/Service Line Io To Stream, Pond, Lake or Major Drainage Course To Building FOundation To Disposal Field Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field /'~O ~ ~ ~-' ~l~/~i~, Type of System Design Length of Field ~",~ ~ Depth of Field ~ ~' ~ Square Feet of Absortion Area ~ ~,~-- ~ Gravel Bed Thickness [, O' Statndpipes Present (Y/N) Depression over Field (Y/N) ~ Date of Last Adequacy Test Results of Last Adequacy Test .~¢l.Jr~ ~.~.¢~_."}~¢¢¢/~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well (,~ ~ I To Property Line [ © "/'- To Building Foundation ,¢~./.~L To Existing or Abandoned System on Lot /"Y¢I ;On Adjoining Lots -~O / 'J/-- To Water Main/Service Line I O /.~.. To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course / 00 / To Driveway, P~ark~ng Area, or Vehicle Storage A,rea ~ O -- D. LIFT ST"A~ Datelnstalled~ . ~/¢'~ Dimensions Size in Gallons "~') I"~ Manhole/Access(Y/N)' "Pump On" Level at ~ ~'~. "Pump Off" Level at High Water Alarm Level at ~ Vent (Y/N) _ Tested for .____~~ Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or con!prmed to all MOA and HAA guidelines in effect on inspection. Signed __ Company Date MOA No. S & S ENGINEERING ~~p-Read~o. 204 Receipt No. Date of Payment Amount: $ 72-026 (Rev 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 & GEOLOGICAL LABORATORIES OFALASKA, INC. ~ I~ ~TR--'~ ~~1: (907) 562-2343 rEDER^, *A× ,D # 92-oo4o44o/ ANALYSIS RE?OR~ EY S~MPLE fo~ Woxk Order ~ 14061 Date Report Pminted: 3UN 19 89 ~ 13:56 Client Sample ID:L47A SEC 4 TISN RW SM PWSID :UA Collected JUN 15 89 @ 10:20 h~. Received JUN 15 89 @ 14:00 b~s. Preserved with :AS REQUIRED Client Name : S ~ 8 ENGR Client A¢ct: SNSENGP P.O.# NONE REC'D Req ~ Ordezed By : Analysis Completed :JUN 16 89 Send ~spozts to: Laboratory Super~z~TZP~N. C:.~?E l)S ~ S ~NDR Released By : Special InstYuct: Chemlab Re~ ~: 5760 Lab Smpl ID: 1 Matrix: WATER Allowable ?a~ameter Tested Result/Units Method Limits NITRATE-N 0.15 r~/1 EPA 353.2 lO Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY RJS. I Tests Pe~forme~ * See Special Inst~uctions Above UA=Unavailable ND- None Detected *' See Sample Re~a~ks Above NA- Not Analyzed LT=Less Than, GT=Gzeater Than IVIUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF iNSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date /~9 - ~i'/¢ ~,~'_ GENERAL NFOREqATION (a) ,'~egal Descript!on (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~/~_ ~ ~¢~ Telephone: Home Applicant Address ~ ~o~ ~d/~ /.~ (c) Business Applicant is (check one): Lending institution []; Owner/J;~u~h~er-;~; Buyer []; Other [] (explain); (d) Lending lnstitution ,,~/~ /'?Z~-I~/~ //~'¢¢'~_. Telephone Address ~/~./'~ ~ ~,~'. (e) Real Estate Companyand Agent _~l~-r'/,u4 Address --~C--~ 4~-~-~ ~¢'e Telephone (f) .~il the HAA to the f(~llowing address: TYPE OF RESIDENCE Single-Family,~ Multi-Family [] Number of Bedrooms ~2~ Other WATER SUPPLY Individual WellJ~- Community [] Public [] Note: If community well system, must have written confirmation from the State Departmenr of Environmen[al Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite~c- Public [] Community [] Holding Tank [] Note: if community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. Page 1 of 2 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 regulations in effect on the date of this inspection. Name of Firm , , ~ ~ ',~ :,;~ ~i'~t,'/: Telephone Date ¢ DHEP APPRO.V~.A.L bedrooms bye- Approved for ~ Approved ,/~ _ Disapproved _ Conditional Terms of Conditional Approval Date 'fl, CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval 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. Page 2 of 2 72-025 (11/84) A. WELL DATA MUNICIPALiTy OF ANCHOP. A MUNICIPALITY OF ANCHORAGE (MOA) '.,_ DEPT. OF HEALTH HEALTH AUTHORITY APPROVAL (HAA) r~¥1RONMENTAL PROTE~TfON 2 ? Legal Description: ~ ~ ~ ~ Well Classification Well Log Present ,<,<,<,<~N) Total Depth ~F~ Static Water Level · ~, ,~¢. Ii A, B, C, D.E.C. Approved (Y/N) Date Completed ~ ! - ~'~'~'~,¢" Yield Cased to ~ ~ ~' Depth of Grouting -'----' 7 ~ Pump Set At U'~/¢~· Casing Height Above Ground " ~" Electrical Wiring in Conduit~:~/N) Separation Distances from Well: '1o Septic/M4~l, ing Tank on Lot [ c>~' Sanitary Seal on Casingd~N) Depression Around Wellhead ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ~ ~"~ ; On Adjoining Lots To Nearest Public Sewer Line ~/'~ To Nearest Public Sewer Cleanout/Manhole ~/~ To Nearest Sewer Service Line on Lot Water Sample Collected by !~ J~ .~ '~r,~,~-.-~- ; Date [! ~'Z-~ Water Sample Test Results ~"l Comments .~,~¢'~-,,.-~ ~ I ~:::~1 .~ ~ B. SEPTIC/14EH_--DIN~ TANK DATA Date Installed I~;~ -t '~- ? ~5 Size [ ¢~-'-'-'-'-'-'-'-'~ Standpipes~C~/N) Air-tight Capsd~/N) Depression over Tank (Y~:~ Pumping/Maintenance Contract on File (Y/N) ~ Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/b~,Idi;¥.2-Tank: To Water-Supply Well To property Line To Water Main/Service Line Course No. of Compartments Foundation Cleanout CN) Date Last Pumped ~- /~' ; for Temporary Holding Tank Permit (Y/N) T~o Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date installed \~ Width of Field Square Feet of Absorption Area Depression over Field (Y/~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot Type of System Design ~ ~..-~'¢'~ ~ Length of Field f~(,¢ Depth of Field . ~¢, ~' Gravel Bed Thickness t , Standpipes Present (~N) Date of Last Adequacy Test To Water Main/Service Line k ~:. 1.4' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line ~. ,~,~4-- 'Fo Existing or Abandoned System on ; On Adjoining Lots ~ 'Jo To Cutbank (if present) f~//% Comments LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) ]~- "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I hav~ checl~¢d,,y,ed.f,i,~d, or conformed to all M CA and HAA guidelines in effect on the date of th s inspection, Signed .~'J~l l,,o,( . ~ __ ~q-~ ..... ?~ . ,~ Date Compa~¢..31,1~ ......... Amount: $ l~ ~-~ Page 2 of 2 72-026 (11184) '~ DATA'RECEIVED ~- I NSPECTI ON APPOI NTM E NTS TIME TIME TIME DATE DATE DATE ,NSPECTOR 'NSPECTOR 'NSPEC r_ ' MUNICIPALITY OF ANCHOP.~,GE MUNICIPALITY OF ANCHORAGE DEPT. OF t~,EALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT[~I~IRONMENTAL P~OTECTION' 825 L Street - Anchorage, Alaska 99501 6 1980 ENVIRONMENTAL SANITATION DIVISION REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE I I ~DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. PROP RTY OWNER ~ ~O~E MAI L~ ~G~DR ~S PROPERTY RESIDENT (If different from above) PHONE ' PHONE MAI LIN~ ADDRESS REALTOR/AGENT - PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four ~, SINGLE FAMILY [] Two [] Five E] MULTIPLE FAMILY ~ Three [] Six [] Other 7. WATER SUPPLY ~ INDIVI DUAL* * ATTACH WELL LOG. A well Icg is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] .:, PUBLIC UTI LITY depth (attach Icg if available.) 9. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** (~ 7 ~' YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTI LITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) ~ I THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] I N D IVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: JOO(~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTIQN AREA MATERIAL 4. DISTANCESwELL TO: Septic/Holding~_.~,.~o., Tank Absorption%¢.¢ ~ Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR -5 BEDROOMS [] CONDITIONAL APPROVAL {letter must accel[any certificate) [~] DISAPPROVED ... ~/'~ (' DATE / ~.~.~'~ ~ ' BY -- 72-010 (Rev. 6/79) // EASEMENTS:OF RECORD, OTHER TH~N THosE SHOWN ,ON"'I~IE RECORDED-PLAT ARE' NOT SHOWN HEREON. ' · The information hereon is for the use of lending institQti0ns Sho~ihg the'relationship of existing; strflcture's a~d platted easemehts and lot lines';.:.'" It is not!to ib'e used for positioning additional' structure's orlfen~elines. I hereby certify' that spection of the IoUowing described property: Lot 47A, Sec. 4, T15~T~RIW~ S.M. Anchorage ~cording Precinct, 2Llaska. mhd that the improve- merits situated thereon are withLn the property lines and do "not'overlap or'encroach on the property lying adjacent'there- to, 'that no improvements on property lying adjacent thereto encroach on the premises in question nnd that there are no roadways, trsnsmLssion lines or other visible e~.sements on said property except as indicated hereon- Dated at Anchorage, Alaska thi~ '~f~ day e~ l)aCt. 19 88 688-4566 , '~EWARp..8... ASSOCIATES LAND SURVEYING