The URL can be used to link to this page

Home My WebLink AboutMCKINLEY HEIGHTS #1 BLK 5 LT 1Mcl(inley Heights lock Lot I t051-213 -10 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201511 Work Type: SepticTank Upgrade Tax Code Number: 05121310000 Site Legal Address: MCKINLEY HEIGHTS #1 BLK 5 LT 1 G:1058 Site Mailing Address: 18368 AMONSON RD, Chugiak Owner: CREWDSON JAMES A & LORELEI Design Engineer: CREWDSON ENGINEERING, LLC This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date 1�'LAI C11[ D AWT Department Lot Size in Sq Ft Total Bedrooms: 3/11/2021 3/11/2022 43560 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: Issued By: Date: 5z 3 {1C! 11[ Municipality of Anchorage Ur�+r'ment P.O. Box 196650 a 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 ® Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Proqram * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV201092 COSA#: Permit#:OSP201511 PID#: 051-213-10 Legal Description: MCKINLEY HEIGHTS #1 BILK 5 LT 1 Engineer: Crewdson Engineering Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 6.0 feet. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date: 3 2 Approved by: Name of Revie ......... 0 0. 0 X. ........... ■ t ............ t .. t t. t t t t ...... B .................. I **** VARIANCE/WAIVER REVIEW **** ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-213-10 Property owner(s) James CreWdson Day phone 907-280-9493 Mailing address PO Box 671389, Chugiak, AK 99567 Site address 18368 Amonson Rd., Chugiak, AK 99567 Legal description (Sub'd., Block & Lot) McKinley Heights #1, Block 5, Lot 1 Legal description (Township, Range & Section) Lot Size 43,560 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank FE Upgrade E Duplex (D) ❑ Holding Tank ❑ Renewal F-1Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: r et- Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: l a 8,'�5 GvVlfl-1�i =1W12 o Receipt Number: a 5� `7 13 Permit No. Waiver Fees: l6 D. 7 5 G) U I D- i Date of Payment: Receipt Number: Waiver No. 0 S V a 01 M 2- GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc James “Jay” Crewdson, P.E. Email: CELLC.1@outlook.com Cell/Text: (907) 280-9493 Fax: (907) 688-2295 PO Box 671389 ● 18368 Amonson Road ● Chugiak, Alaska 99567 December 28, 2020 Onsite Reviewer Municipality of Anchorage On-site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99519-6650 Reference: McKinley Heights #1, Block 5, Lot 1 Septic Tank Upgrade / Drainfield-to-Lot Line Separation Distance Design Narrative / Waiver Request Design Narrative: The owner of the 3-bedroom home would like to replace the existing septic tank, which will be decommissioned in accordance with the code. The proposed 1500-gallon septic tank and double cleanout will be installed in accordance with the code. The existing foundation cleanout is in satisfactory condition and will remain in service. There are no anticipated probable adverse impacts to adjacent properties if the septic tank upgrade is constructed as designed. Waiver Request: During the septic tank upgrade design phase, the existing documented drainfield was found to be approximately 6.5 feet from the east property line. It has been in this location for over 35 years with no known issues and/or impacts to the adjacent property. As such, we are requesting a waiver for the existing drainfield to be no less than 6-feet from the property line. There are no anticipated probable adverse impacts to adjacent properties if the waiver is granted. Please feel free to contact me if you have any questions. James “Jay” Crewdson, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201511, Deb Wockenfuss, 03/11/21 S89° 49'35'W 0.52' I I w O I I U:? EDGEF PAVEME T 18 l 26 1 PUBLIC USE EASEMENT r T PER DOCUMENT NO. i 2013-057333-0 I .,• 6roval SEPTICSTANDPIPE I ,- Co�cratal.1 2 Fri FENCE—X—�—X-� w 2 w I � Lli I � II,} J ['l L7 N T15N R1 W SEC 16 ' SW4SW4 051-21341-000 I z 49 Id . STEVEN CALLA 1L —12034 1Lhi ssianal LOT 1 LEGEND; .,• 6roval SEPTICSTANDPIPE ,- Co�cratal.1 WATER WELL Qyarhpnq: FENCE—X—�—X-� Wood DeekK/,," LOT 1 AMONSON ROAD 8886 57'W 103.10' EXISTING HOUSE: 0 SHED Y� y 35.8' 17.6' Ln 4.8 SHED z DETACHED —,_t 2$•4' 112.4' GARAGE 250 H Street Anchorage, Alaska 94501 �� Survey Department Phone: 562-5291 Mainline �r� .. Inc- Phone; 243.8985 aad_ Ced-Ae_ • 4r^gi eeALV • &-U t AECC 668 I ORDERED BY: JAY CREWDSON FE5 10' UTILITY EASEMENT 5890 WE 128.34' LOT 1ks'y LEGAL DESCRIPTION: LOT 1, BLOCK 5, McKINLEY HEIGHTS SUBDIVISION ADDITION NO, 1 DRAWN DATE: 01/21/2019 DRAWN BY; AP/5C CHECKED BY: SC SCALE: 1 " = 40' WORK ORDER: 18065 PLAT; P-629 GRID: NW1058 FB/PG: 809125 LOT 2 NOTES: THIS DRAWING SHALL NOT BE MODIFIED FOR USE AS A PLOT PLAN WITHOUT THE EXPRESSED WRITTEN CONSENT OF LCG LANTECH. THE BASIS OF BEARING FOR THIS SURVEY DERIVES FROM A FOUND 3-1/4" ALUMINUM CAP MONUMENT LOCATED AT THE SOUTH EAST CORNER OF LOT 1, SPRUCE TREE SUBDIVISION AND A FOUND 3-1/4" ALUMINUM CAP MONUMENT LOCATED AT THE SOUTH WEST CORNER OF LOT 2-A, SPRUCE TREE SUBDIVISION. THE MEASURED BEARING AND DISTANCE 15 5529 40'41 "W 413.97' AND THE RECORD BEARING AND DISTANCE PER PIAT 83-471 15 S520 42' 29"W 414,30', LOT 2 AS -BUILT (PARCEL #:051.213-10 ADDRESS: 18368 AMONSON RD. 1 SURVEYOF THE PROPERTY AS SHOWN ON THIS DRAWING AND CERTIFIES THAT THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO ENCROACHMENTS EXIST OTHER THAN NOTED. €XCLU514NARY NOTE; IT ISTHE OWNERS' RESPONSIBILITY TO DETERMINE THE EXISTENCE OF ANY EASEMENTS. COVENANTS, RESTRICTIONS OR RIGHT-OF-WAY TAKINGS WHICH DO NOT APPEAR ON THE RECORDED SUBDIV.SION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION, FOR RSTA941SHING PROPERTY LINES, OR FOR PLOT -PLAN PURPOSES. 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 MAILING ADDRESS LEGAL DESCRIPTION F- LOCATION DISTANCE TO: Well I- Z Manufacturer ~ L~q.~p~B~ty ~n ~Hon~ i / O0 0 IF HOMEMADE: ~ I Well ~ I No. oflinos ILengthofeochlineZ ~/~ ~ Top of tile to finish gr2de I Length ~ ~ ~ Width ~ ~1 Tvpe o~ crib Crib diameter DISTANCE TO: Well ~ ~Class ~ Dep~ ~ DISTAN~;T~ ' -~ildi;g foundation PHONE Absorptio~ea/ Insid2~ IDwelling No. of compartrnents ~ Liquid depth UPGRADE Material Nearest lot line JTrench width PERMIT NO, Liquid capacity in gallons ¢oundation PERMIT NO, Total length of lines Distance between lines inches Material beneath tile Total effective absorption area Depth__./ inches Crib depth Buil din g/f o~d~t~,~e. Driller Sewerline Total e f fect i ye a bso r ~o~_~r¢~..a~ Nearest lot line Distance to lot line PERMIT NO. Absorption area(s) Septic tank OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER R EMAR KS HUN I C I PFtL I T'¢ OF FtNCH'-"~FIGE - ' D, EF'RRTMENT C HEFIL. TH RN[:, ENVIRONMENTRL t-.,OTECTtON ':"::'R L STREET., RNCHORFIGE., F~K 9950:1 ¢' ;Z"64-4720 PEF.:M I T MC' DRTE t_:,.:,IjEC . 84,9496 HFFLI _.HN 'F laD[:'RESS: CONTRCT PHONE: CZ() S & ~ ENGCG. SRB t96X EFIGLE RIVER, RK 694-2979 JFICK BFIRE:EF.: 9957? LEGRL DESCRIP: SUBDIVISION: 'MCKINLEY HEIGHTS ~:L LOT: SECTION: ±6 TONNSHIP: t5N RFINGE: L. OT SIZE: 1~:~ (SQ. FT. OR RCRE5) MFIX BE[:,ROOMS: BLOCK' LI..:,tEE. BELOI.4 FIRE THE OPTIONS RVRILHGt_E TO '¢OU IN DESIGNING '-r'OLIR SEPTIC: SYSTEM. CHOOSE THE OF'TION THFtT BEST FITS '.¢CtUF.: _;ITE. DEPTH TO PiPE BOTTOM (FT. GRFIVEL DEPTH (FT.) 8. 'T'OTFIL DEPTH (F'T.) :L;2. GRFIVEL NtDTH (FT.) 2. 5 GRlaVEL LENGTH ,.':FT. ) 16. GRRVEL VOLLIME ,.':CU. '.¢[:,S. ) :12. 5 "FlaNK SIZE (GRL..S) :1., E~00. 0 SOIL RFITING <E;Q. F'T. /BR) 85 *:+, TFtNK MUST HFIVE FIT LEFIST TklO Cr3MF'F:IF..:TMENTS _.ER f I F 'r TFIRT: :1.. I FIM FRMILIFIR NITH THE REQI.JIF':EMENTS FOF.: UN-.:,iTE .=,ENEF...:, RND' f..tELL.=, RS SET FORTFt E:',:' THE f'IUNT. E IPRL. IT"¢ OF RMCHORFIGE (MOR) FIND ']"HE STRTE OF RLRSKR. 2. I WILL INSTFILL THE S'¢STEM IN RCCORD'RNE:E I.,.IITH FILL MOR C:ODES RND REGLL.RTI3NS., · -,~ c: -.. ('RITERiR OF" THIS PERMIT. I:::It'.,E, IN COMPLIlaNC:E I.,.IITH THE S. i WZLL ME. HEF..E TO FiLL t'tOFt laf',tD STf:iTE OF REFISI<F'I REQJIF:EMENTS FOR TFIE SET BFIE:K [,I=, Pi'-,t,_.E=, FF.:ON FIN"r' E,,,I:,TII,f~ t.,,tELL, .WFtST'EI.,.IFtTER D.T.'.:]F'::SFIL ::,'r.:'fEtl OR F'LtBLIC '- , - '-F' '~'"-]' '" .... :,E.LIEF..H..~E .:'r_TEil ON TNIS f"P FIN'¢ FIDJFICENT OR NERRO"r' LOT. 4. I LIN[:'ERSTFIN[:' THFIT "['HIS F'ERMIT !f"~ VRLID FOR Fl I'lld,'~IltJl't OF ]: E,E[.RJJIt-, RN[:' RN'¢ ,-NLR~.~EI1ENT NILL RE~] IRE FIN RDDITIONFIL PEF".MIT. IF R LIFT STFITION IS INSTRL. LED tN FIN FIRER COVERED, BY MOR BUlL. DING CODES., THEN (i) FIN ELECTRICRL PERMIT RND INSPECTION MUST BE OBTFIINE[:u (2) laS-BUILTS 1.4tLL NOT BE FIPPROVED NtTHOUT FIN ELECTRICRL INSPECTION REPORT.; laND (~:) THE ELECTRIClaL WORK MUST BE DONE B"r' FI LICENSED ELECTRICIRN. PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 8 9 lO 11 12 13 14 15 16 17 18 19 2O COMMENTS PERF( 72-008 (6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LO8 - PERCOLATION TEST SOILS LOG PERCOLATION TEST SLOPE WAS GROUND WATER & ~ S ENCOUNTERED? . ~-~. O L O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop nON RATE fi/ (minutes/inch) TEST RUN BETWEEN /FAND FT ( erl ie Drilling by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX272. CHUGIAK, ALASKA 99567 · TELEPHONE 698-2759 OWNER OF LAND ADDRESS ~-~ ! O LEGAL DESCRIPTION/.- I t.~ ,t~'- .~ DA,E-Started ~°/0~¢ Ended PERMIT NUMBER X.rl/'~q /~/'/~'- t,,~O _/~,~' ~ O_,~,..d DEPTH OF WELL /~ ~L~<~ d~_ ~0%TATIC LEVEL OF WATER FT. DRAW DOWN FT. GALS. PER HR . KIND OF CASING KIND OF FORMATION: From 0 Ft. to 0;~:: Ft. ,~',~1.-00 ~ 6~~ From_~Ft. to Ft From~Ft. to ~& Ft. ~ ~ ~~ ~ From~Ft. to_ Ft From Ft. to Ft.C~ ~ ~ t ~ O From ~Ft. to Ft From~Ft. to /~O Ft. ~~ ~O~1~ From~Ft. to Ft Fmm~Ft. to Ft. ~~ From Ft. to Ft. From I~O rt. to l~],Vt ~o6/~ ~g~ From Ft. to ...... Ft From_ Ft. to Ft. ~/ Ft. to From Ft. to Ft. ~ ~ ~ff From.~Ft. to~_ Ft. From ] ~ ~Ft. to ~ C~ Ft. ~ ~ ~0 c ~ ~/~ From__Ft. to_ ~Ft. From Ft. to Ft. ~~ From Ft. to__ Ft. From Ft. to--Ft. From Ft. to , Ft. From Ft. to Ft. From Ft. to ...... : _ - From Ft. to Ff. From~Ft. to~t. ~, NOV 5 Fromm. Ft. to Ft. From Ft. to_ _~Ft From Ft. to Ft._ From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. MISCL. INFORMATION: 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. 051-213-10 1. GENERAL INFORMATION Complete legal description Expiration Date: _,~' '- ./ _~ - .J,/ McKinley Hts #1, BLOCK 5, LOT 1 Location (site address) 18368 AMONSON RD, CHUGIAK, AK 99567 Current Property owner(s) Jack Anderson Day phone 240-7054 Mailing address same Lending agency Day phone Mailing address Rea! E,state Agent Owner ?'UnleSS Qth. erWise 're~ubsted, COSA will be held by DSD for pickup. Day phone 240-7054 2. N'UMBER 'OF.,,I~EDROOMS: 3.'~ ..,.'rypE OF WATER SUPPLY: . i~ndigidlu.hll wei:l . Individual Water Storage Community Class __ Public Water System 3 Well 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 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 NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 5/9/2011 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. DSD SIGNATURE [JApproved for ._~ bedrooms. Disapproved. Conditional approval for Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory bedrooms, with the following stipulations: ON-SITE E : WASTEWATER X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other ,, / Original Certificate Date: 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: M¢~nle¥ Hts #1, BrLOCK 5 LOT 1 A. WELL DATA.. Parcel ID: 051-213-10 Well type P ~RiVATE IfA, B, or C provide PWSID # Date ~mpleted $/1990 Sanitary seal (Y/N) _Y Total depth 460'ft. Cased to 49 ft. FROM WELL LOG 5//990 89 ft. 1.8 g.p.m. WATER .SAMPLE RESULTS: Date of test Static water level Well production Well Log (Y/N) Y_ Wires properly protected (Y/N) _Y Casing height (above ground) 12 in. AT INSPECTION 1~4t°2010 1.0 g.p.m. ABSORPTION FIELD DATA Date installed ,6/Z984 Soil rating Length 24 ff. Width 16 ft. Eft. absorption area 38~ ~ Monitoring tube Y Depression over field N Date of adequacy test 10/4/10 Fluid depth in absorption field before test Elapsed Time: 60. min. Final fluid depth Results (Pass/Fail) Pass For 3__ bedrooms 0.0 in. Water added ~0 gal. New depth 0.0 0 in. Absorption rate >= ~50 g.p.d. in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N__lf yes, give date -- (g.p.d./ft2 or ~/bdrm) 8..~_5 System type BED Gravel below pipe 0.5 ft. Total depth _7 ft. Coliform NEG colonies/100mL Nitrate <MRL mg/L Arsenic: <MRL mg/I Date of sample: ,4/19/2011 Collected by: NRim Eng. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 6/1_984 Tank size 1_000 gal. Number of Compartments 2_ Cleanouts (Y/N) _ Foundation cleanout (Y/N) _Y_ Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping / / Pumper - LIFT STATION Date installed "Pump on" level at Datum Size in gallons "Pump off" level at Cycles tested E. SEPARATION DISTANCES in. Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot :tOO'+ Absorption field on lot :tOO'+ Public sewer main 7~'+ Sewer/septic service line 25,+ Animal containment areas 50'+ On adjacent lots 1_00'+ On adjacent lots :tOO'+ Public sewer manhole/cleanout 100'+ Holding tank 100'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5% Property line :tO'+ Water main :tO'+ Water service line :tO'+ Wells on adjacent lots 1_00'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line :tO'+ Building foundation :tO'+ Water Service line 1_0'+ Surface water 1_00'+ Curtain drain 50'+ (None Know~) COMMENTS Absorption field 5% Surface water 1_00'+ 10'+ Water main 10'+ Driveway, parking/vehicle storage Wells on adjacent lots 100'+ 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 Steve F.n~ Date. 5/9/'20:t:t COSA Fee $490.00 Date, of Payment Receipt Number (Rev. 11/0,5) Waiver Fee $ Date of Payment Receipt Number t AS-BUILT I hereby certify that I have surveyed ~he foBowing described Anchorage Recording Precinct, Alaska, and that the improve- ments situated theTeon are within the ~roperty lines and ~lo not overlap or encroach on the property lying adjacent thereto, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Eagle River, Alaska r<osErt ci JOHNSON SCALE: R~gJStered L~ncl Surveyor N~'880-LS 1" --/,~t9 r ~.ox 77-045~, Eagle Riv6r, Alaska 99577 ~-none (907~ 694-2543 ANALYTICA GROUP Northrim Eng Attn: Steve Eng 17237 Bear Paw Circle Eagle River, AK 99577 907-694-7028 Fax: 907-694-7026 Client Sample ID: ER 4 Sampling Location: [~J~'~ 4~.o Client Project: Well Safe I ER 4 Sample Matrix: Drinking Water COC #: PWS#: Residual Chlorine: Comments: SP-Analytica, Inc.-Anchorage 4307 Arctic Blvd. Anchorage, AK 99503 Phone: 907-258-2155 Fax: 907-258-6634 Report Date: 5/2/2011 Receipt Date: 4/19/2011 Sample Date: 4/18/2011 Sample Time: 12:00:00PM Collected By: H Flag Definitions: MRL = Method Reporting Limit MCL = Maximum Contaminant Limit B = Present also in Method Blank H = Exceeds Regulatory Limit M = Matrix Interference J = Estimated Value D = Lost to Dilution ** = RL higher than MCL; target not detected TNC = Too Numerous to Count - result rejected CF = Confluent Growth - result rejected TCNG = Turbid Culture No Growth - rejected Lab#: A1104193-01A Analysis Method Prep Prep Analysis Parameter Result Units Flags MRL MCL Method Date Date Analyst 4500-NO3E (Aqueous) - Nitrate+Nitrite pres Test was conducted by: Analytica - Anchorage Nitrate-Nitrite as Nitrogen <MRL mg/L 0.10 10 4/28/2011 4/28/2011 MC Lab#: A1104193-01B Analysis Method Prep Prep Analysis Parameter Result Units Flags MRL MCL Method Date Date Analyst 9223B-PA (Aqueous) - Coliforms in DW E. Coli Pass PASS/FAIL 1.0 Total Coliform Pass PASS/FAIL 1.0 Lab#: A1104193-01C Test was conducted by: Analytica - Anchorage 1 4/19/2011 4/19/2011 KM 1 4/19/2011 4/19/2011 KM Analysis Method Prep Prep Analysis Parameter Result Units Flags MRL MCL Method Date Date Analyst 200.8/200.8 (Aqueous) - Family Well Water I Arsenic <MRL ug/L 0.15 Test was conducted by: Analytica - Thornton 10 200.8 4/25/2011 4/25/2011 RM Page 3 of 3 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, subdivision, section, township, range) Lot 1; Bloc~ 5; Mc Kinl~y Heiqhts Addition #I Location (address or directions) NHN Amonson Road (b) Property owner Cnrr~a Henderson Mailing Address Telephone: (home) (c) Lending Institution Telephone Mailing Address (d) Business Real Estate Company and Agent TARGET; INC. REALTY At-f'~: Dx'ok B4own Address 17034 Fr~g?¢ R,iua~r Lnop Rn~rl; Fr~g~a R,fu~, Ab.99577 Telephone 694-2388 (e) Mail the HAA to the following address: (or check here [~,Xif hold for pick up.) List contact person and day phone number below: S & S F_NGiNEERiNG 17034 Eagle Ri,vet Loop Road No. 204 Eagle ~.iver, Alauka ~577 2. TYPE OF RESIDENCE Single-Family E~x. Number of bedrooms 3. WATER SUPPLY Individual Well t~ 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: tf 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 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 Address i?'0?,': ~;i)e [:ive~' Loop ~o~d No. 204 Date Telephone 6. DHHS APPROVAL b~..~ Approved for drooms Approved Disapproved Conditional Terms of Conditional Approval ~_~AJ ~ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph S 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 DHHSdo not conduct inspections or analyze data before a certificate is issued. TheMunicipalityofAnchorageisnot responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) ~ Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: bom \ BY--- ~.~ A. WELL DATA , ...... Well Classification J,~> ~ ',/~ ~ Well Log Present {~N) X/ Date Completed Total Depth~L,*O ' Cased to Static Water Level ,I Casing Height Above Ground Electrical Wiring in ConduitS/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot /cPO Depth of Grouting Pump Set At Sanitary Seal on Casing ~/N) Depression Around Wellhead If A, B, C, D.E.C. Approved (Y/N) Yield ; On Adjoining Lots /¢o / To Nearest Edge of Absorption Field on Lot //~5 / ; On Adjoining Lots /¢o ¢ ¢'- To Nearest PUblic Sewer Line /'///¢ To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot ,2 ~' ~ ~ Water Sample Collected by ~ ~ ~ ~,---~,L~t~F-...~P_~ ¢3, Lfl ; Date [ ~ ~ Water Sample Test Results ~'.N--C~C-~-~--~r~o¢-~ - ~,~'"------~ ~ Comments B. SEPTIC/HOLDING TANK/DATA Date Installed /~-' g ~' Size Standpipes (~/f~) ~ Depression over Tank (~/(1~ Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well /~o ! C- To Property Line /o ~ ~- To Water Main/Service Line /o / ¢' To Stream, Pond, Lake or Major Drainage Course Comments ~2~?¢~t~ t~u ":~-~. /OO0 ¢ No. of Compartments Air-tight Caps ~.~/1~) '¢ Foundation Date Last Pumped , for Temporary Holding Tank Permit (Y/N). ~ To Building Foundation To Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field / Type of System Design Length of Field ~;&'~ ~ Depth of Field -/ ' Gravel Bed Thickness Square Feet of Absortion Area ~¢~ Statndpipes PresentS/Cd) ~ Depression over Field (~ ~ Date of Last Adequacy Test Results of Last Adequacy Test .~A-~t.5~.4-~,'~¢'~4/ .,¢<O.,¢_~ ~'~ .~¢~.~. SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well / /~ ' To Property Line _ ~/)_ To Building Foundation ~ /(~' ' To Existing or Abandoned System on Lot f¢/~_ ;On Adjoining Lots .... _~:~ '~ '¢ To Water Main/Service Line /~ ~ .w- To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course / z~o ¢ ~ To Driveway, Parking Area, or Vehicle Storage Area ~ ~ ~ Comments D. LIFT STATION Date Installed ~ons "Pump On" Level High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N~)_~~,~'~ ~ Comments ~ Dimensions Manhole/Access (Y/N) _ "Pump Off" Level at. ~__ ~ Ve n t~(YJN~ _ ~_---------~'"¢~ Pumping Cycles during Adequacy Test. ~-~. **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 inspection. Signed this Receipt No. .~..~.~, Date of Payment Amount: $ 72-026 (Rev. 7/88) 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 I.D. #92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order $ 3i227 Date Report Printed: JAN 14 91 @ 11:28 Client Sample ID:L1 B5 MCKINLEY HIS $2 PWSID :UA Collected JAN 8 91 @ 17:00 h~s. Received JAN 9 91 @ 1i:45 hrs. Preserved with :AS REQUIRED Client Na~o Client Acer EPO $ Roq $ Ordered By S ~ S ENGINEERING SNSENGP PO ~ NONE RECEIVED R. SHAFER Analysis Completed :JAN 9 9]. Send Reports to: Laboratory Supervisor :STEPNEN C. EDE 1)8 & S ENGINEERING Released By : ~.~, ~,~-~- 2) Chemlab Ref $: 9J. 0084 Lab Smpl ID: 1 Matrix: WATER Allowable Parameter Tested Result Units Method Limits NITRATE-N ND(O.iO) mR/1 EPA 353.2 i0 Sample ROUTINE SAMPLE. Rmnarks: SAMPLE COLLECTED BY RAY. i Tests Perfom'ned * See Special Instructions Above UA=Unavailable ND= None Detected ** See Sample gemarRs Above NA= Not Analyzed LT=Less Than, GT=Greater Than by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 870272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 OWNER OF LAND ADDRESS LEGAL DESCRIPTION DATE - Started PERMIT NUMBER Ended DEI'Ttt OF WELL ST.\ IFC LEVEL OF WATER FF. DRAW DOWN FT. GALS. PER HR KIND OF CASING KIND OF FORMATION: From Et. to-'; ' Ft. From Et. to Ft From Ft. to Ft. From Ft. to _Et From Ft. to Ft From Et. to Ft, From_ Ft, to Et.__ From Et. to_ Ft. From Ft. to Ft. From _Et, to_ _Ft.. From Ft, to _Ft. From _Et. to Ft From _Et. to_ Ft From Ft. to _Ft.~ From Ft. to .... Et, From Et. to Ft. From Et. to .... Ft._ From Ft. to_ Ft. Frofiq _Ft. to Ft. From Ft. to ..... Ft.. From _ Ft. to __ Ft. From Ft. to From .... Ft. to .... Et, From Ft. to __ Ft. From Ft. to ....... Ft. From FI. to _ Ft. From Ft. to_ F From __ Ft. to Ft From _Ft. to__ Ft. From Ft. to Ft. From Ft. to FC From. Ft. to~ Et, MISCL. INFORMATION: DRILLER'S NAME PRINICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date ~/~89~ (a) Legal .Description (inDlude.~lot, block, sub~v~ts/ion, sectio~n, township, range) Locatio~ (address or directions) (b) Applicants Name ~ ~f ! Telephone - Home Business Applicants Address (c) Applicant is (check one) Lending Institution ~ ; 0wner/builder.~.; Buyer ~--~ ~ Other ~ (explain); (d) Lending Institution ~ ~ ' Telephone Address (e) Real Estate Co. & Agent Address (f) Tel~ephone ~a~ t.e HAA to the following address: 2. T_~vpe of Residence Single-Family~ Number of Bedrooms 3. Water Supplj! Individual Well~ Multi-Family Other (describe) Community I~[ Public ~-~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite ~ 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. [Page 1 of 2] .Engineering, Firm Providing Inspections~ Te~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. Name of Firm Telephone Address Date_ DHEP A r~]_~ Approved for J.4~<~DJ bedrooms Approved _ ,~- Disapproved Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF I~ALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. TI-~ 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 MUNICIPALI%~f OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 A. WELL DATA Well Classificat If A, B~ or Well Log P~esen~ (¥//~) Date Completed Total ~p~ Z ~ ~d to Static Water ~1 ~ ~ Casing ~ight ~ Ground ~ ~ /~ Sanit~y ~al on Casing~ Elec~ical Wiring in Conduit ~) ~ession ~ound ~l~ead~ ~p~ation Distance fr~ ~11: To ~ptic/~ Ta~ ~ ~t To ~arest Edge of ~sorption Field on To Newest Public ~ Line Clean~t~a~ole ~ ~ To ~est Water S~le Collected By ~, ~ Wate~ S~le Test ~sults ~ //,f~ c~ ~ - .- Co~,e nts // r -- SEPTIC/HOLDING TANK DATA Date InstalAd ~/e t~ size /Op O No. of Compa~t~nts _ Foundation Standpipe ~/~ Air-tight Cap~/4~ C !e anou~/k~) Tank ~f~ Date Last.~mped /Je Depression over Holding Tank High-Water Alarm (Y/~ /~ Temporary Holding Tank Permit (Y/~///% Separation Distances frc~ Septic/Holding Tank: To Water-Supply Well /d~O (-~ To Building Foundation To Property Line /'O To Water ;~/Service Line COL~ To Disposal Field ~ t e../_ TO stream, Pond, Lake, or Major Drainage Comr~nts /~JO ~J ~ [Page 1 of 2] C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~/~ Width of Field Square Feet of Absorption A~ea Depression over Field (~ Results of Last Adequacy Test Date of Last Adequacy Test Type of System Design ! Length of Field ~ ~ Depth of Field '~7 Gravel Bed Thickness ~ Standpipes P~esent ~/t~) Separation Distance from Absorption Field: To Water-Supply Well //~ e To P~operty Line /O To Building Foundation /O~ ! To Existing or Abandoned System on Lot /~ff dP ~f/~ ; On Adjoining Lots 30 To Water ~R~/Service Line ~ /~L To Cutbank(if present) To Stream/Pond/Lake/or Majo~ Drainage Course /3 / To Driveway, Parking Area, or Vehicle Storage Area ~_.~3 C~%~nts ~O ~J ~ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Dime ns ions /Manhole/Access (Y/N) ,'~mp/~ Off" Level at ~'---_ Vent (Y/N) m~ing Cycles during Adequacy Test. Meets MOA Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, o~ conformed to all MOA HAA ~C~,~es in effect on the date of this ~inspection. .... I [Page 2 of 2] 2-15-84