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SILVER CREST BLK 2 LT 18
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 .... Na.~e DISTANCES .~~ ~'~ ~ SEPTIC ABSORPTION WELL ~d~,ess TANK FIELD ,_ Township, Range, Section AS-~UILT DIAGRA~ [Show Iocahon oi well s~ptic system prope~y lines, foundaUon, TANKS ~ I~ ~ Gr~vel length T Qr~vel wtdtb ~ ~ ~otal absorptmon area Dis' .... be, .... X I ~ ~ qumberollines So,,rating Pipemaler,a' --~)~ ~ ~--~ WELLS %~ ~ / mVATE OTUER de.tiN) -- Z ' Municipal and Stale ouidelinos in ellect on this date: ' *~ L Health Depa~ment Approval: ~ ~1 -- -- ~ ' ' -- 72-013 (3/85) .Oc:,par. tmc:,rfl' :::;,i H<,.:,a:!.'t:.li & Human Ser'v:i.c~.::,s 825 I... S't.l"-~:.:l:.:,t :, (.':ll'iC:J"lcli'age, A1asl<a P,l'qCil. IOl:;h'~Gl!ii: :, Al< <795:1.6 · tank mus'L l'~avc~ at. iI.i:;:,ast ~:'i'. c::c)mpal"t, ments,, }.:)c.?p'L!"l tc:)t, op (::)I" sc.,l:)t:i.c:: tatll<(s) < t' e c.)}', r" e q u :i. P (.:.:) E; :i. i'/s u ! a t :i (::)r'~ o v (.:.;.:, p '1'.. a n I.:: ( s ) ,, i:::'{ii:l:;,'N :[ 'i I!:~: X P :I: RI:i:S Dl'ii:Cl?.i]'~lBlii:l::Q 3:1. :, 19l!!)9 ,, NOT :1: I;::'Y Dl-h~l!i!i 01;::' :l: NSI::'Ii{C3T ]: C)IxiS A'/" :::.!;Zl.3..~4744 C)R 34::=.!;....48~3:1. ,, 'I:~:I'X-) .. ~11: ,. t .. I'.'IUS] Vli~:R :1: I:;'Y !!i 31Z I!i!: AND ! F. tTI!ii:(:!)R :i: 'T'Y 01:::' E .,, "~. .......... ,.I ,, ' I:::'I::/OM OLD ........... : I I.,. W :l: I..I.. :EIEi: '1: IxlliiiTAl. J...I :i) AI:::'I:::'F:I[:)X 5 t I-(ENI.,.-I :I: [:::!i!:R T :l: F:"Y' r: IA'I' :: , :1 ,, :!] am I am:i 1 iai' ~z~:i.'l'.l'~ '.l" '.:] r'i~.:.!(::lLi:i, r.(~:.!i'll~i-:,,q']'L!~i .lop (]l"l-...E;:i.'L~.:e ~i(.:;.)w(:.:.~l'"~i 4~'d'](:;I b~(.::,)]. :l.~:i; i:or'.t!"~ by 't.'.1]((.? Mun:i.c:i. pality oF al]c:hl;)l'~':(~J(® (MOA) and 'l:.hc~ Si:. at ~..:~ of A].~',.~i~il.(a,, 2. :I: ~..,~:i :1.:I. :i.r]~ita]]. U](.'i:, ~iy~ili?..(~'.)lll ~.1] aici:::clr'.clal"~c:~.~ i/~l:['l:.,l"~ ail MOA (:::(::i(::l(.~::,~i ar'id ~iri~:l :i r'i c;ci;[il::) ]. ~.;.~.l-lc:c~ ~,..,~.'l'..h 'l'..l'lc.~ r;l~<,~il;i.~.~l"l (1::[, J.t~,i'~ ;i,a c,t' th :i.s i:~mm:i,t.,, :?;. :1: ~,.~;i.].]. adl'~e.n'~c.~ 'l:.c~ a.!.!. MOA and Eitat(a ~::li A:lasl:;a r~c~Clu:i.l'emer~ts I'cll'~ 'l'.l"~c..) scrl'., ba(:::k Ei(-:',M(~:,i";:T~(.:]E..:, ~iyi~it. li:)lii CIl"/ 'I'..]'i:i.~il (:ilp .i;:H/¥ .:':;'(cI.'~./:/i:;:,:'.?l'i~.. C)l" lii:~)~':ll"l':)y ].1']'~ · ':l.,, ]. i.lr!ct(~i)r'-~[:Yl.'..~'~it'P::l ('..I"iaYL 'Lb:is pePm:i.'l. :i.s vaI:i.d l:or a max:i, mum (::il' 4 l::)e,::lr.(::)c)m~!il, . . ........................... ..................................................... 2 ~ ......... ~ ............ HEALTH AUTHORITY APPROVALS SEWER &WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TESf STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN R©BERTSHAFER, P.E. ROGER SHAFER September 12, 1989 Municipality of Anchorage )EPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 ATTN: ROBBIE ROBERTSON REFERENCE: Lot 18; Block 2; Silver Cr~st Subdivision 7201 Stamps Circle, Anchorage CIVIL ENGINEEHS (907) 694-2979 MUNICIPALITY OF A~,/~GI:14'1,2-1 ENV' o ENr^L P OTECrIoN SEP J 3 1989 RECEIVED Dear Robbie, The design for upgrading the on-site wastewater disposal system, dated 9-9-89, will require the new absorption bed (elevated mound) to be installed approximately 5 ft. horizontal distance from the existing trench. The existing trench has a cover depth of 5 ft. consisting ~arily of a poorly permerable GM-CH soil. The bottom of the absorption bed will be placed I ft. vertical distance below the existing ground level. Therefore, a 5 ft. horizontal separation and a 4 ft. vertical separation will exist between the new absorption are~ ~d ~h~ ~l~ trench. A 6 ml visqueen barrier will be placed along the vertical sides of the absorption bed and will extend downward through the sand layer. It is our opinion, that the existing trench system has failed due to the poorly permerable soils and that a separation distance as prescribed by this design is adequate. Vertical separation of 4 ft. plus, from a unseasonable high water table brought on as a result of recent heavy rains, is being maintained in this design. Water monitoring of the test hole on this lot, showed that the water level dropped approximately 3 ft. over a 9 day period after the rai~ ceased. Therefore, during normal conditions the vertical separation will be greater. If you require additional information, please contact us. R,P.E. 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 SCALE Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION:~/t~ ~¢~2 ,.~Z ~/P~'{~ ~'~' Township, Range, Section: 2 3 6 7 10 13 14 15 16 17 18 19 20- SLOPE WAS GROUND WATER ENCOUNTERED? SITE PLAN I- N '/ ~ s IF YES, AT WHAT . ~""'"' O DEPTH? Oepthto Water After¢~ / Ilate' ~ Monitoring? ~ . Gross Net Depth to Net Reading Date Time Time Water Drop ¢ ~.'~ /o" ¢7~"2' ¢ q /. ,. ¢?~ ,, , PERCOLATION RATE ~,~O (minutes/inch) PERC HOLE DIAMETER PERFORMED BY: ~ . . ENGINEERING ~~%RTIFY THAT TH)S TE, T WAS PERFORMED IN - '034 Ea le Ri~er Loop Roa~ No. 2~ ~/ . EWI L E L GUIDELI"E C,O. THIS DATE DATE 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED POR: ~--~/~ ¢: '~. (.]E--Z//~ , nship, Range, Section: LEGAL DESCRIPTION * 2 3 4 11 12 13 14 15 16 17 18 19 SLOPE _/ ENCOUNTERED? IF YES, AT WHAT ~-72 / SL DEPTR? ~_.~-¢) O P E Oepth to Water Alter Monitoring? Dale: SITE PLAN '1 Gross Net Depth to Net Reading Date Time Time Water Drop 20- PERCOLATION RATE TEST RUN BETWEEN ~D FT ~ & S ENGiNEERiNG " 11034EagleRi.verEoopEoadNo. 204 /~ /~ PERFORMED BY: .... ,. ,.I..~.. A~" ¢~7 ACOO RDA" CE. ,T::::':::::-AN D M U N ICI PAL GU ID 72-008 (Rev, 4/85) Municipality of Anchorage Department of Health and Human Services 825 "L" Street Tom Fink, Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 September 27, 1989 Mr. Gerald Serena 12110 Rip van Winkle Huston, TX 77024 Subject: Lot 18, Blk. 2, Silvercrest Subdivision Dear Mr. Serena; Per our telephone conversation, I have enclosed the file for the subject lot. It would appear that the soils in the vicinity of the lot are silt laden sands and gravels with low permeability. In reviewing the files on the surrounding lots I found several which required upgrading within ten years of the initial installation. I have enclosed these as well. I would suggest you contact an engineer ko help you review this material. If you have any further questions please feel free to contact our office. Daniel N. Bolles On-site Services db/95 "Kids Are Our Future" MUNICIPALITY OF ANCHORAGE DE[ .TMENT OF HEALI'H AND HUMAN SER~ !S Environmental Health Division 825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Address ~'-~ I $~o~0 LEGAL DESCRIPTION CreSY TANKS [] SEPTIC DISTANCES ~ SEPTIC ABSORPTION TANK FIELD WELL WELL / 0 '~ / 03 LOT LINE "J~ ?~ 1 0 -~' 5Q~ t FOUNDATION '~ d "Z. ~'/ AS-BUILT DIAGRAM iSNow location of well, septic system, property hnes, ioundatlon, driveway, w~ter bodies, otc.) [] HOLDING TYPE OF SYSTEM ['~TRENCH ~ BED ~ W. DRAIN ~} OTHER ong~nal grade FT Fill added above original grade Gravel lengln Gravel depth beneath pipe FT FT Total absorpt ..... e~.) ¢ O 8¢~T ~istance between ,,nos Installer WELLS E~ PRIVATE Class~ncahon (A.B.CJ [] OTHER {Identify) Total Depth Cased to ~ ~" [ Date ,npalle,: FT REMARKS: 5'e~ ,~'//-,~4e~ ,~'¢,"1' /~? Municipal ang 8lste guidelines Jl~ ellect on this dale: Health Deparlment Approval: 72-013 (3/85) Inspections Pedormed by: ) certil¥ tllat Ihis inspecli0n was periormsd according / A ~ Date: . ENGINEER'S SEAL ' ~ ' ' C)]:,"C ' ~ ' [.)i.?EE.'].'. ' '']' VC)Lit" LEGAL DESCRIPTION: Municipalily of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: ~.~'"~ ~ownship, Range, Section: *'-~-,4%A/' (ENginEER'S SEAL) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O eH.- T~t0¢ WAS GROUND WATER ENCOUNTERED? SLOPE SITE PLAN S L IF YES, AT WHAT O DEPTH? p E (]epth Io Water After Monitoring? Dale: ! Gross Net Depth to Net Reading Date Time Time Water Drop ;,dc e ~-~-~'~ ~'~-/,t,~ /,~ ~./,,,/ .~,7./,./~' PERCOLATION RATE '"~' '~ (minutes/inch) PERC HOLE DIAMETER __ COMMENTS ~a/c ~,4y%;~ .¢/2 A ,. } ' PERFORMED BY: ~'ff /¢. ~1~ I /~ ,' /~//' CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) ALASKA ENVIRONI~-NTAL CONTROL SERVICE, INC. 1200 West 33rd Avenue, Suite 0 ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO OF CHECKED BY DATE SCALE /; ~ 0 / / / / / / 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 LOCATION l~4~ '~ "t (o 5- [] UPGRADE Ne. OF BEDROOMS DISTANCE TO: j I C) ~ -4- Manufacturer ~. R r2.,~S~ ILiq. capacity nga OhS ~ ~ ~0 [ IF HOMEMADE; .jo~ I DISTANCE TO: IWell Manufacturer 1 Well , , DISTANCE TO: I I~o ~ No, of lines Length of each line Top of tile to finish grade Length .... ~Nidth DISTANCE TO: ..... Well IOass Depth DISTANCE TO-~ Building foun~atio% Absorptio~area Dwelling Material PERMIT NO, No, of compartments 2~. Inside length Width Liquid depth PERMIT NO. IDwelling Fouedation Material Nearest lot line Trench width 4<!~ inches ~f~' I 0-5-- inches Total length of lines ~ zL Material beneath tile Depth Liquid capacity in gallons PERMIT NO. Distance between lines Total effective absorption area PERMIT NO. Crib depth Total effective absorption area Building foundation Nearest lot line Driller Distance to lot line PERMIT NO. Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS PV¢.- p gP-.l'7 SOIL TEST RATING Y INSTALLER REMARKS APPROVED DATE LEGAL 72-013 (Rev. 3/78) P ,, O ,, I!!iO X 1 O"'. t. t~. I....O'T' iii;I ZE :!.(:)(;) 'f'"e,,:.:,';:: f:'(:~v ~;~ !:>v:i.w~!:e w~:);i. Zi oi' !!;i;O ~:o 2!OO 'i::e~!i: .¢'vc,'m ,:':~ I:)t..d::,l:i.,::: well ttl}c,l"~ thf? 'l::yl:>,::~ o-F !:>u.I;>;! :~. (:: ~,.,[(.:.:,1 i ,, Other' r'0:,<:lt..t:i.r'e~i'~e'~'~'~s '~'f~,':'~y ¢:¥> i:> ;J Y , (~i:>ec:~¢::i.c~:;n"i::i.o'r'~s ,]Yl"~<:l Eof't~:~.'~:J"Lt(::"(::i.o'¢'~ the ~.¥s';::,~:;,m :i.¢'~ ,'.:i (: (:: ,'::, i" (:i ~:;i 'r"~ (:: (:¢ ~..'.,t:i. 1:t'~ th,:..~ co<:les,, 'i:l'¢~;!~'(: the o~'~-..*s:(te s0:,~.,,,er' sysi:e'm 'f'¢'~.~*.' i'¢<:lt..t:i.i"e e'~'2;i,~;i~l'~.j~i~i'i'i,:i:,'~'~"(: :i../: the PERMIT NO. :IPPLIC¢~NT ROBERT FOREMAN P.O. BOX±O-±~49 _OCRT 101",1 GROVER DR I YE ~- .EGFtL LOT 2L8 B 2 SILVERCREST LOT SIZE FYPE OF SOIL FIBSORPTION SY,'STEM IS; TREf',ICH 'IRXIHUM NUi'dBER OF BEDROOHS = 4 SOIL RFlTING (S~] FT?BR)= "125 tHE REQUIRED SIZE OF THE SOIL FlBSORPTION SY,'STEH IS: Z:,EPTH= :::!_2 LENIG'TH= 32 6RR%.'EL DEPTH= r.ll_lN I C I ~ RL I T"¢ C,F Ri'-.ICH .RAGE DEPARTMENT OF HEALTH FIND ENVIRONMENTRL PROTECTION 825 "L" STREET, RNCHORRGE., RI<. 9958'1 264-4'728 HFLL ~qN[-':"- Ob.l--S I TE SEI.qER PEF.:I'd ][ T ( 800'1'15 ) 46462 SQUARE FEET THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRFIINFIELD. THE DEPTH OF Ft TRENCH OR PIT IS THE DISTANCE BETI4EEN THE SURFFlCE OF THE GF.:OUND FIND THE BOTTOM OF THE EXCAVATION <IN FEET>. THERE IS NO SET 14IDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRFIVEL BETWEEN THE OUTFFILL PIPE FIND THE BOTTOM OF THE EXCRVFITION '::IN FEET>. qE¢4O_~ I RE[:-, SEPT I ~ TRI'-,II<_- -'=: I L~.E= :t250 (~iI:ILLOI'~.IS · ERflIT RPPLICFINT HAS THE RESPONSIBILITY' TO INFORM THIS DEPFIRTMENT DURING THE · -5 - N_THLL. RTI'ON INSPECTIONS OF PIN'.P I,.IELLS FIDJFICENT TO THIS PROPERT'¢ FIND THE lUMBER OF RESIDENCES THFlT THE WELL Wit. f_ _ERS, E. Tl--IL--I ,[ 2 ::, I I'-.ISF"E--] CT I Ol'-.IS I-IRE REt':~U I RED ;RCKFILLING OF Fl1'.¢¢ _T_.TEM WITHOUT FINAL INSPECTION AND RPPRO%CFIL B'¢ THIS )EPFlRTMENT WILL BE _qUBJECT TO PROSECUTION. IINIMLIM DISTANCE BETWEEN Fl WELL AND RN~¢ ON-SITE SEWAGE DISPOSAL SYSTEM IS .0£1 FEET FAR £~ PRIVATE 14ELL OR '150 TO 200 FEET FROM Fl PUBLIC ~EI_L DEPENDING ~PON THE TY,'PE OF PUBLIC WELL. IINIMUM DISTFlNCE FROM R PRIVFITE WELL TO Fl PRIVFlTE SEL4ER LINE IS 25 FEET FIND '0 R COMMUNITY SE~4ER LINE IS 75 FEET. IELL LOGS ARE REQUIRED FIND MUST BE RETURNED TO THE DEPFlRTMENT WITHIN -?.0 DFt'¢S IF-" THE NELL COMPLETION. ~THER REE-~UIREMENTS MAY 8PF'L~¢. SPECIFICFITIONS AND CONSTRUCTION DIFIGRRM$ ARE IVRILRBLE TO INSURE PROPER INSTRLLFITION. PERI'.1 I 'T E:|'<P I RES DEOEr. IBER 3::k., '~ 980 CERTI F'¢ THRT : I Rf'l FAMILIAR WITH THE REQUIREMENTS FOR Of.I-SITE SEI-4ERS FIND 14ELLS FlS SET ORTH BY,' THE MUf',IICIPI=ILITY,' OF FINCHORRGE. : I 14ILL INSTALL THE SYSTEM IN RCCORDFINCE WITH THE CODES. : I UNDERSTAND THFlT THE ON-SITE SEWER SYSTEM MAY,' REQUIRE ENLARGEMENT IF THE :ESIDENCE IS REMODELED TO INCLUDE MORE THFlN 4 BEDROOMS. V4. 0 ~0 ~ J 1. ~[LL L~n #/$ In, to ~_~ft. Depth lt. ~[LI HE~ COHPLFTION: ~ln A~prnved pit ,.~,.,... ~., ~.~.~ []o~., N~I WATER WELL LOG FOSS DRILLING 1336 Ingra Street Anchorage, Alaska 99501 WE~ ow~ - ~ ~ r ~ ~s~ o~ w~j~~ ~,,. LocA~o~ ~ ~ ' ' a HOLE.~PT o CASED TO ~ , SIZE OF CASING~_DEPTH OF ;, ~ ~ STATIC WATER LEVEL___~PT. YIELD /~GAL.PER.M~N. WITH___ PEEl' OF DRAWDOWN. REMARKS DATE COMPLETED__~~'- ~ :- 8D PUMP TO BE SET AT Zto_ ......... t ,~tO~ ~t O_____ ~t O~ ~to~ _____t O~__, to _~=t O~ 678910 •--.11c- Municipality of Anchorage I `-:` -'' 1� On-Site Water and Wastewater Program 1 _ (907) 343-7904 .da�+ i 7-1 i n 69j /i/! j / Certificate of On-Site Systems Approval z 0[ 6 8 L 9 c)Ac. Parcel I.D. 015-062-49 Expiration Date: al )5 ; Q 01 1. GENERAL INFORMATION Complete legal description Silver Crest Block 2 Lot 18 Location (site address) 7201 Stamps Circle Current Property owner(s) Suzanne Gromoff Day phone Mailing address 7201 Stamps Circle .pc(1G\RI) e1 ,qv! rjb) Real Estate Agent Day phone 2. TYPE OF DWELLING: O Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well E Individual El Individual Water Storage ❑ Holding Tank ❑ Community Class _ Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: - _ Distance: i ' 0 ,, 464_ A Received b . la. A. ,._;.< "T,.. Date: COSA to be released to the engineer,unless otherwise requested by/the -ngi -er. COSA Fee $ sace Waiver Fee $ Date of Payment 42401 Date of Payment Receipt Number O? aaM Receipt Number COSA# OOGI211?3 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,and regulations in effect at the time of installation. In conducting an adequacy,test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and 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.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 4/24/2018 V"-�OF Aqc4kk Azr ti %* 's ,4\ *y 6. DSD SIGNATURE %•' •N�+���•• 6 System #1 Approved for _ bedrooms ' •Steven R.'Pannone• / ��� CE-8149 &O System #2 Approved for bedrooms •� Disapproved 1�1s•.�, oS'sioNA`'�-.s Conditional approval for bedrooms, with the following stipulations: ko \s •3 4,e cur s o lel. �t; Hre � ca�,Lt 0C She\ 1�s �S 0 L , P�\-0 OF- F 4/vc, Q�SITE WATER AND C:101 WASTEWATER o `� PRO(RAM 4,k s, nfr qr.p\is, ' By: �,l-Cr1. eA-.;t t Vl Mon Original Certificate Date: 5/i 5 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory X Septic System Advisory Arsenic Advisory Well Flow Advisory Other -Tan (adv;soy v, X COSA blue sheet r . ,. J If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Silver Crest Block 2 Lot 18 Parcel ID:015-062-49 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 5/23/1980 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 104 ft. Cased to 104 ft. Casing height(above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 5/23/1980 2/27/2018 Static water level 75 ft. 79.9 ft. Well production 12 g.p.m. 4.4 g.p.m. WATER SAMPLE RESULTS: Coliform NEC' colonies/100 mL Nitrate 5.20 mg/L Arsenic ND ug/L Date of sample: 4/12/2018 Collected by: PES B. SEPTIC/HOLDI A IK DATA Tank Type/Materia /ste_fillaTi 6 bate installed 6/25/1980 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout(Y/N) Y Depression over tank(Y/N2 N High water alarm (Y/N) Y Date of pumping 5 itLe Pumper A1- **MO/ , e V ICLS • C. ABSORPTION FIELD DATA Date installed 10/13/1989 Soil rating (g.p.d./ft2 or ft2/bdrm) 213 sF/sDRnn System type BED Length 50 ft. Width Varies ft. Gravel below pipe 6 ft. Total depth 5 ft. Eff. absorption area 1742 ft2 Monitoring tube Y Depression over field N Date of adequacy test 42/27/2018 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 600 gal. New depth 0 in. Elapsed Time: 90 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. N Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed 10/13/1989 Size in gallons 500 Manhole/Access (Y/N) Y "Pump on" level at 32 in. "Pump off' level at 27 in. High water alarm level at 42 in. Datum Bottom of Tank Cycles tested 4 Meets alarm&circuit requirements?' E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer/septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS -AN, CtiNkC1WL Uti -t *ai an rz rt• ..* Dc('Awook at ifte oi 4r5tivl . ___\ G. ENGINEER'S CERTIFICATION �� QFr ,L\q�II • I certify that / have determined through field inspections and �ig�P �,� 1.7I review of Municipal records that the above systems are in j* , • /` •,*0, conformance with MOA COSA guidelines in effect on this date. 0••• 4.10, Engineer's Printed Name Steven Pannone i ':ev ri 1 .•Pannone• jii 4/24/2018 1,1:•.. CE-8149 /kJ: Date Date , 9 �1PRSS COSA canary sheet_2-6-15.doc MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT ( • '�', 907-343-7904 On-Site Water and Wastewater Section -`s Fax: 343-7997 www.muni.org/onsite • • Nitrate Advisory Certificate of On-Site Systems Approval # OSC181173 Subdivision: Silver Crest, Block: 2, Lot: 18 A water sample revealed a nitrate concentration of 5.20 milligrams per liter (mg/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. Mailing Address: P.0. Box 196650 *Anchorage,Alaska 99519-6650 *www.muni.org Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids,and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Mailing Address: P.O.Box 196650*Anchorage,Alaska 99519-6650*www.muni.org MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT • f '� 907-343-7904 On-Site Water and Wastewater Section ` Fax: 343-7997 www.muni.org/onsite Septic Tank Advisory Certificate of On-Site Systems Approval # OSC181173 Subdivision: Silver Crest Block:2, Lot: 18 The septic tank for this property is 38 years old. The average life for a steel septic tank is 20 years. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. Mailing Address: P.O.Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org p/2818 15:26 868677E F`uV PAGE el MUNICIPALITY OF ANCHORAGE �)t� ' ?^ Phone: 90c 3. : 944nt Services Department '` /ter a Wastewater Section '.=�, Fax 907-3• , 997 Lift Station/Pump\/a.�lt Maintenance Log.�anr,�oro_- , StreetAddress__,_1 C�?I 3+-c=ps .C�•5'C'Lp_ Lega; Desc_-- . ------- --- -_ _ �_. PID__ --k:el ..inches •Pumping: required ye_s_Ao •Purnping completed eyes, o Littltatisim5,t''4.1 a - -Pump basket cleaned :Q -Effluent filter cleaned (y4Llo . -Control floats cleaned WsLao. •Proper float settings confirmedke •Operation satisfactory Do AJ CnL .Vl.: •Dedicated electrical alarm circuit ' au -Audible and visual alarm inside dwelling(.` nQ - ', _ -Alarm system operation ate?t _t14�sztssf roti Maxillae Riles - •Ground water intrusion at riser to tank connection ye LLQ - -Ground water intrusion around pipe penetrations yes ej -Weep hole functionsno •Manhole lid: Functional Q Insulated k@ no Properly Secured Oder -All manufacturer required inspections and maintenance complete yeJ iftiateaallolf-mkten b2►►�` of maintenance,,. -,7P. _�y�'�' Company _ _�_ /? DatCx / - / Signature i ;a�, 19665 0* Anchorage, Alaska `195158-G‘.93 • www.m%imo ,.A.11 Frontier Surveys, LLC Project No: 18-148 Date:April 25th, 2018 NORTH Ordered By: Katie Likkel PIat:77-176 Grid:N/A Scale 1"=40' /�- LOT 16 --- �'� C(F\C�PSE/moi i-- NONE t' ---- ..- ---// i'-- 10/tempi— LOT 17 Z60•p3 ��..--' E T S6�°3, �� Silver Crest Subdivision Lot 18, Block 2 46,461 sq.ft. +/- i /// /// nD 2 Story7201 Stamps Wood FramedHle ouse / p w/Attached 2 Car Garage / -/ e (s Cs` tDM / e / , •CONCRETE . 1.4' ^4 / may' / a: i 1.Q' S.0' w /// b °a /// 0 84s 1 N 4 WV*o 4e* 1 s / O / e L5.0' Zo \ // 0 / `5� N 1.3' 8.3' of o / �+�� / Z / RETAINING WALL \Z 19,3, 5.5' 195, 74.3 0.7 1 ;;,) 10.2' 0.7' ss8°0 \\ � / I j to, ` 0.7' 10.2' O O „ \ I 1 1�� 22,3, 0.7' ^, .. Off,4 I �_-T� Sivr�,.A`. 5.5'19.5, , QO •oo \`/ / -1 1,4v , \ o Ya, / �t" \ �� �i . Q >,/ \ \ \ /a \ \ \ Ti \ N V \ ` // \ LIGHTPOLE ELEC.WIRES N \ 19 \\ (TYPICAL) 1'r \ N G,pO \ \ \ iD 1 L� !p1 \ ; \ �'pi 1j'j8 \\ w, �� \ `F 0 ''TS \ \ y Io J Rxou • \ \ \\ Ill I ` \\ 1\ T N90°00'00"W 38.12 3 \ 1=73.30 o \ 5.00 c _ !` t)0�J ) N ` �` Opo S66',9\ 0 0 StAMPSCIRCLE—�— ---�-- \�' / Legend: Yy Electric Meter Outside Power y / co-) Telephone Pole Q Bollard X Gas Meter ;moi Deck -0- Fence -3*- Light Pole 0 40 80 20 ,S; Septic OW; Water Well El Mailbox -0- Over Hanging Power iigi Feet General Notes: 1.This document is created for the purpose of a single property transaction and is subject to Federal Copyright Law. 2.Excepting for gross negligence,the liability for this survey shall not exceed the cost of preparing this survey. 3.All measurements/setbacks are to the visual/apparent building footprint. 4.Dimensions to property lines are plus/minus 0.lft. \\` ` N‘%" Fq'\111 t t t This survey complies with ASPLS Mortgage Location Standards.The survey represents visible improvements and 11 conditions at the time of the survey.This document does not constitute a boundary survey and is subject to any • � inaccuracies that a subsequent boundary survey may reveal.It is the responsibility of the Owner to determine .�P•'• • •`S4 /// the existence of any easements,covenants,or restrictions which do not appear on the record plat.Under no Lj • • .•.11 // circumstances should this document be used for construction or for establishing a boundary or fence line. — *: 491_H .* / As-Built Survey of: - 2' ? -- ... ..--- Lot 18, Block 2 Silver Crest Subdivision j FREDERIC W.laRtNER ' I,Frederic Wagner,herebycertifythat this Mortgage Ins Inspection Surveywasperformed byme,or To • NO.1.S:9946 A. gp // �'i <c, - under my direct supervision on April 25th,2018. //`'l • 5/09/2018 • 44 - I O •. O '►1 pRo VP� Frontier Surveys, LLC FRONTIER* t 1.,000.\\\\..•%.,..- 650 W.58th Ave.Suite E Anchorage,Alaska 99518 S 1t Essior 907.460.1686-info@frontiersurveys.com PROFESSIONAL SEAL www.frontiersurveys.com MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section ~-'~-'~ P.O. Box 196650 Anchorage, Alaska 99519-6650 /~.~ 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA # GENERAL INFORMATION Complete legal 8escription Location (site address or directions) Property owner Mailing address Lending agency Mailing address Day phone Day phone Agent F~-~,.~, ~.. ~,v' ~/[ ~ , I~,~ Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: Day phone ~?~-~?~/ TYPE OF WATER SUPPLY: individual well Community well NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA#21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspeption, the on-site water supply and/or wastewater disposal system is in compliance with all Mun!cipal and State codes, ordinances, and regulations in effect on the date of this inspection. Engineer's signature "/ ' %~'~ Date D~IGNATURE ~ Approved for '~L)~ \ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality o: Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certific8,,..<;i~ based only upon the representations given in paragraph 5 above by an independent professional en~inec-:; 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, 1/91) Back MOA ~1 K ClJi¥ Municipality of Anchorage MAR 26 1999 DEPARTMENT OF HEALTH & HUMAN SERVICES CHO EnVironmental Services Division MUNICIPALITY OP AN 825 L Street, Room 502. Anchorage, Alaska g9501. Legal Description: A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Y Health Authority Approval Checklist ~ I/-.. ~ ~ ( L.W I~ f~- Parcel I.D.: If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to I O t~ Casing height (above ground) Wires properly protected (Y/N) Date of test Static water level Well production FROM WELL LOG /,2. .g.p.m. AT INSPECTION /7- g.p.m. WATER SAMPLE RESULTS: Coliform ~ Date of sample: ~"/7 Nitrate a~, ~ 3 ~ J~//~' Other bacteria Collected by: ~Y ,' ~ B. SEPTIC/HOLDING TANK DATA Date installed ~, ' Foundation cleanout (Y/N) Date of Pumping C. ABSORPTION FIELD DATA Number of Compartments ~_ Cleanouts (Y/N) y Depression (Y/N) P'q. High water alarm (Y/N) Pumper ~.¢%" Date installed Length Effective absorption area Date of adequacy test JO.l%,,¢'~ Soilrating (g.p.d./fForft2/bdrm) ¢,~/,~ Systemtype /t¢o0~42 Width V,,,.¢ ;.c f, Gravel thickness below pipe ~," ,~~1~,// Total depth ~ ~. /7/7/~-- Monitoring Tube present (Y/N) y Depression overfield (Y/N) ~?/~'~ Results (Pass/Fail) '=P For / bedrooms Immediately after ~¢JOgal. water added (in.): Absorption rate = ,~ ,~"¢_~ g.p.d. If yes, give date Fluid depth in absorption field before test (in.); ~--.f/~"-/ Fluid depth 4¢,/ (ins) Minutes later: { Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level Cycles tested Size in gallons "Pump on" level at* ',~ ~ *Datum' '~. 7/~.¢.t.4,4 "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: ..- I Foundation ,~ Property line , / Water main/service line /~.~_5- Surface wateddrainage SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Surface water Curtain drain Absorption field (~ ~) ~ Wells on adjacent lots ~ /~-O Building foundation ,~o ~' Water main/service line Driveway, parking/vehicle storage area ~ Wells on adjacent lots ';> / ~ Signature '~, ,..~Engineer's Name Date ENGINEER'S CERTIFICATION ~,;.~:, I certify that I have determined thru field inspections and review of Municipal recor~l~.-:tb~,,tl~ ~buv~ in conformance with MOA HAA guidelines in effect on this date. ¢~, ~-:~ 2' HAA Fee $. Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMANSERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 APR '1 0 1997 CERTIFICATE OF HEALTH AUTHORITY RECEIVED APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # .O-15 10~2 49- HAA# /;- 1. GENERALINFORMATION oilve,~c ........ Subdivision Completelegaldescription Lot 18 Block 2 °' Location (site address or directions) 7201 Stamps Circle Property owner David Pritchard Mailing address 7201 Stamps Circle, Lending agency Anchorage, Day phone 346-2850 AK 99516 Day phone Mailing address Agent P. HH Ral. ocation Address 3201 'C' Street~ Suite 200, Anchorage, AK Unless otherwise requested, HAA will be held for pickup, NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: Day phone 762-31 52 99503 Public water If community well system, provide written confirmation from Sta, te ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my inves!i_gation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm DHI Consulting Engineers Phone .344-1385. Engineer's signature %~~~.~,~" Date ~-~ The adequacy test on th~ 1¢~¢h filed for this appro~--al~Jnducted in July of 1996. A visual'~hspection of the monitoring pipe, clean out, septic tank, lift station, and well was made on 4/3/97. Everything looked in good condition. DHHS SIGNATURE ,' /', I /~' Approved for '~t-d"[t"/f Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments /, / ' ':/ / /.; ,, By: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does th is 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. Legal Description: A. WELL DATA Well type RES Log present (Y/N) Total depth 1 Sanitary seal (Y/N) Municipality of Anchorage SERV ('~I~-~I¢IPALI'I'Y Of ANg, HU~A~ DEPARTMENT OF HEALTH & HUMAN Eh~i'~'ONMENTALSERVICg8, Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 APR 10 1997 Health Authority Approval Checklist Lot 18 Block 2 Silvercrest Parcel I.D.: RECEIVED [f A, B, or C, attach ADEC letter. ADEC water system number Date completed 5 / 23 / 80 Cased to 104 ' Casing height (above ground). 1 . 1 ' Wires properly protected (Y/N) Y FROM WELL LOG AT INSPECTION 7/2/96 77.5' 4.2 g.p.m, g.p.m. Date of test N / A Static water level N / A Well production N/A WATER SAMPLE RESULTS: Coliform -0- Date of sample: 4 / 3 / 97 B. SEPTIC/HOLDING TANK DATA Date installed 6/25180 Tank size Foundation cleanont (Y/N) y Date of Pnmping 4 / 7 / 97 C. ABSORPTION FIELD DATA Date installed 1 0/89 Nitrate 1 . 7 Other bacteria -0- Collected by: Dustin High 1250 Number of Compartments 2 Cleanouts (Y/N)_ Y Depression (Y/N) N High water alarm (Y/N) {q/.A Pumper Denali Sewer & Drain Service Soil rating (g.p,d./ft2 or ft2/bdrm) 2 1 3 System type BED Total depth 48" Length .gEE DHHS Width SEE DHHS Gravel thickness below pipe 0.5 ' FILES FILES Effective absorption area 1742 Date of adequacy test 7 / 2 / 96 Fluid depth in absorption field before test (in.); 0" Fluid depth 0" (ins3 Minutes later: 154 Peroxide treatment (past 12 nmnths) (Y/N) N Per DHI Consulting Engineers Per DHHS Records Monitoring Tribe present(Y/N) Y Depression over field (YFN) N Results (Pass/Fail) PASS For 4 bedrooms Immediately after600 gal. water added (ill.): 0" Absorption rate = > > 600 .g.p.d. If yes, give date Records D. LIFT STATION Date iustalled 1 0 / 89 Manhole/Access (Y/N) y High water alarm level at* 92 Cycles tested Pour E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot 105'+ 105'+ Publicsewermain None Sewer/septicsemiceline >50' "Pump on' level at* *Datum Top Sizein gallons 400 1 02½" "Pump off' level at* 1 07½" of Manhole ; On adjacent lots 1 20 ' + · On adjacent lots 1 20 ' + Public sewer manbole/cleanout Lift station '1 I 0 ' + SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: None Surface water None Driveway, parking/vehicle storage area 20 ' + Curtain drain None No'ced Wells on adjacent lots 1 05 ' + Property. line 1 5 ' + F. ENGINEER'S CERTIFICATION ,~' l cert~v~<have determined thrufield ,.spectionxandreview in c°nf°~an~h MOA I-[Wgu)elin~? effecton this date. HAA Fee $ ~ Waiver Fee $ Date of Payment ~r~ ./¢~ q¢ Date of Payment Receipt Number 02 82 S (~ 7 ~ l) Receipt Number Rev. 8/95 eSS: baa.wk.doc Building foundation 40 ' + Water main/service line > 40" Building foundation 5 ' + . Property line 1 0 ' + Absorption field 30 ' + Water Inai~ffservice line > 50 ' Surface water/drainage None Wells on adjacent lots 1 20 ' + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343~4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # ~-' \'~- ((~(~'~ - j'-'/~'~ HAA # ~ \~ 1. GENERAL INFORMATION Complete legal description Lot 18 Block 2 Silvercrest Subdivision Location (site address or directions) 7201 Stamps CircLe Prop?ty owner David Pritchard Mailing address 7201 Stamp-~ Circ]e~ Lending agency Day phone 346-2850 Anchorage~ AK 99516 Day phone Mailing address- Agent Globespec Day phone Address 402 E. Roosevelt Rd., Wheaton, IL 60187 Unless otherwise requested, HAA will be held for pickup. 800-231 -1 301 NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site NOTE: Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my inves!i_gation 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 DH~' C~.r.m~u_] ~.~9 Rn91 n~-~ Phone 34_~4-1 385 = Address 800 E. D~'mond Bi'vd. Suite 3-5.~5, Anchorage, 'AK 99515 Engineer's signature . ,,~/.'.~. ?~ Date 7-~'~.- ?~'~. DHHS SIGNATURE -. ¢~' Approved for ¢ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in' order to satisfy certain federal and state requirements. Employees of 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. W.O. 96278 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVIC~NIClP^LITY OF ANCHO Environmental Services Division ENVIItONMENTAL SEP. VtCE$ DI' 825"L" Street, Room 502 · Anchorage, Alaska 99501e (907) 343-4744 JUL 15 1996 Health Authority Approval Checklist RECEIVED Legal Dcscril)tion: Lot 18 Block 2 Silvercrest Parcel I.D.: A. WELL DATA Well type RES. Log present (Y/N) ,/~3¢ dJ, Q Total depth 104' Sanitary seal (Y/N) yGP If A, B, or C, attach ADEC letter. ADEC water system number Date completed 104'~ Cased to 5/23/80 Casing height (above ground) 1 . 1 Wires properly protected (Y/N) Y FROM WELL LOG AT INSPECTION Dateoftest ..~3~1~,O ~ ~ 7/2/96 Static water level ~ '75 I 77.5 ' Wellproduction ~ 12, g.p.m. 4.2 WATER SAMPLE RESULTS: Coliform '- O ~ Nitrate ;2- &Q, Other bacteria ~ 0'9" Datc of sample: ?-~-~G ~ q/d/q¢ Collected by: Dustin Hiqh B. SEPTIC/HOLDING TANK DATA Date installed 6 / 25 / 8 d~ Tank size 1 250(~ Number of Compartments__2 ® Cleanouts (Y/N).__ Foundatim~ cleanout (Y/N) Y (~ Depression (Y/N). NQ~ High water alarm (Y/N) N/A Y Date of Pumping_t~°/~" ~' Pumper ABSORPTION FIELD DATA Date installed i~0/8¢(~) Soil ratin.~ (g.p.d./ft20rft2fodrm) 21 3 ,VariesQ> ' Varies ~ keogthSee DHHS WidthSee DHHS Gravel thickness below pipe 0.5' Totaldepth 48" Files F~xes Effective absorption area. 1742 --~ Monitoring Tube present(Y/N) y~b Depression over field (Y/N) N~ Date of adequacy test 7 / 2 / 96 Results (Pass/Fa/t) P AS S For 4 bedrooms Fluid depth in absorption field before test (in.); 0" hnmediately a£ter600 gal. water added (in.): 0" Fhfid depth 0" .(ins.) Minutes later: 1 5 4 Absorption rate = > > 600 g.p.d. Peroxide trcatlnent (past 12 months) (Y/N) N , If yes, give date D. LIFI' STATION Date installed 1 0 / 89 Manhole/Access (Y/N) y High water alarm level at* 92" Cycles tested Four E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holdiag tank on lot 1 05 ~ + Absorption field on lot 1 05 ' + Poblic sewer main None Sewer/septic service line .5. ~5 O ' Fo Size in gallons 4006'13 "Pump on' level at* 1 02-}." *Datum Top of Manhole ; On adjacent lots 1 20 ' + On adjacent lots 1 20 ' + Public sewer manhole/cleanont None Lift station 110'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building fot, ndatio,~ 5 ' + Property line 1 0 ' + Absorption field 30 ' + Water main/service linc ~ ;50 ' Surface xvater/drainagc Non?:'.. __ Wells on adjacent lots 1 20 ' + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Water mai~ffservice line > 4 I] t Driveway, parking/vehicle storage area 20 ' + Wells on adjacent lots 1 05 ' + Building foundation 40 ' + Surface water None Cu,lain drain NOris Noted ENGINEER'S CERTIFICATION ! certiJ~'v tl~t-Lh~e dete,?nined thru field inspections and review o h' co'~/ar~ *~ MO/l ~u?li,~ect on this date. Signature ~~ _ ~~ Engineer's Name ~¢~: Date ?-!.z~q~ "Pomp off' level at* 107'} Rev. 8/95 OSS: haa.wk.doc HAA Fee $ ~ ~ a 6'r~) Waiver Fee $ Date of Payment ~//~-'-/~3 Date of Payment Receipt Number V fi) ~ ~ ~t / t~ .) Receipt Number line 15 ' + 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 \ ~q ~D,~.:~ "L'~.cl NAA# ¼/~-~ ~ \..~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) (b) LO~ 18, Block ~,. Silver Cr¢~t Location (address or directions) Property owner G¢.~,~ld S&r¢.~a Mailing Address Telephone: (home) .~,¢~-3724 Business (c) L. ending Institution HOMEQf~ITY Telephone Mailing Address (d) Real Estate Company and Agent Address 320! P: qt~, q,~ !0~0. Aneh~g~., A~aska 9950~ Telephone ~-55~ (e) Mail the HAA to the following address: (or check hereof hold for pick up.) List contact person and day phone number below: S & S ENGINEERING ~7034 E,glo, ~i~,e*- Loop l~o~d NO. 204 Eagle River, Alaska 9957~Z 2. TYPE OF RESIDENCE Single-Family E~ Number of bedrooms 4 3. WATER SUPPLY Individual Well ,!~X 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-siteY~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 8 ,to 8 abed '~JJOM S,JaSU!BUa leuoIssaJoJd aql u! SUO!SS!LUO JO SJOJJa JO,t alq!suods@J iou s! aBeJOqOUV JO Ai!led!o!u n!Al aq.L 'panss! s! ateo!l!lJeo e aJO,taq elep azAleue JO suo!loadsu! ~,onpuoo ~,ou op BHHCI lo saaAoldLU=I 'sluaLuaJ!nbaJ re, els pue leJapaj u!elJaO A~sBes o1 Jap Jo u! suop, nlBsu! Bu!puel J!~q~, pue SaLUOLI ~0 sJaseqoJrid ot ~satJnoo e se s!tB saop SHHCI aqj. 'eHseIV to a~,m,8 aq~, u! paJm, s!baJ Jaau!§ua leUO!SSajoJd 1uapuadapu! ue Aq aAOqe ~ qdeJBeJed u! UaA!B suoBeluasaJdeJ aq~, uodn/~lUO paseq pm, eo!I!Jao le^oJddv Al!joq~,nv qileaH sanss! (SH HC]) sao!AJa$ ueLunH pue LIlleaH tO ~,uaLu~,Jedacl abeJoqouv to ,q!led!o!unlAI aqL leAoJddv leuoB!puo0 ~o SLUja.L paAoJddes!C] ;X' peAoJddV Aq SLUOOJpeq-~'~ JOe peAoJddv 1VAOHddV SHHO '9 ONIM3':tNI'BN'=1 $ "~ S ssaJppv w~!4 Jo aLUeN · UO!lOedsu! siql,to elep aql uo lOaOe u! suoilelnSeJ pue 'seoueuipJo 'sepoo elelS pue led!o!unl~ lie LIi!M aoUe!ldLUoO u! s! cum, sAs leSOdS!p Jm, eMalSeM Jo/pue Aiddns JeleM al!s-uo aLI1 'uo!loedsu! puc uo!let~!lSe^u! ALU LUOJj puc Sel!,t eSeJOClOuV jo XlIled!ofunlAI eq), LUoJj pau!elqo uoBeLUJo,tu! eqj uo peseq leCll A,t!JeA JeqlJnJ I 'u!aJeq peleo!pu! eJnlonJjs ,to adA1 pue sLUooJpaq jo JeqLunu eql Jo,t ejenbape pue leuoiloun,t 'a,tes s! LuelsAs lesOds!p JejeMelSeM Jo/pue Alddns JeleM el!s-uo eq~, 1eLI1 SMOqS le^oJddv XlpOCljn¥ qlleeH ,s.!LIl,to uo!lelSBSeAU!/~LU 1eql,~,t!Ja^ I 'MOleq UMOqS elep UO!leP!le^ alii jo se pue oleJeq pex!,t,te leas ALU Aq pe!jilJao sv ' NOI.LVINHO_-INI aNV viva 'HOI:IV~S SI'II..-I 'SJ.S~tJ. 'SNOIIO~dSNI 9NlalAOMd INHI:I ~DNII::I~iMNI!gN:i 'g MUNICIPALITY OF ANCHORAGE (MOA) MLINIC~IEPpATL. tC~'~CHH&OI~AG~' Health Authority Approval (.AA) ENVI~(~~(~TECTION CHECKLIST- FEBRUARY 1984 A. WELL DATA OgT 't 6 t989 343-4744 Legal Description: RECEIVED Well Classification Well Log Present (..,~;Z:N) ~L___ Date Completed ~"' '~-"'~'- '~ Total Depth~,~r¢~ Cased to }g::~¢~ Depth of Grouting ~ -' If A', B, C, D.E.C. Approved (Y/N) _ Yield"~_'-'~¢~""7 Pump Set At Sanitary Seal on CasingCN) Depression Around Wellhead Static Water Level '~]~'"~"/. Casing Height Above Ground \ '"~ Electrical Wiring in Conduit,CC~'N) SEPARATION DISTANCES FROM WELL: To Septic/Fielding Tank on Lot ; On Adjoining Lots \ '--~"7--~ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole To Nearest Edge of Absorption Field ~)n Lot To Nearest Public Sewer Line 14 To Nearest Sewer Se.[.vice Line on Lot Water Sample Collected by~'.'?OO~ U,,~FI¢;2-~)¢_~ ; Date Water Sample Test Results B, SEPTIC/HOLDING TANK DATA Date Installed ~ Standpipes ¢~'/N) ~ Air-tight Caps ~N) Depression over Tank (Y~ Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) ,,SEPA~RATIO. N DISTANCES FROM SEPTIC/HOLDING TANK: Y pate Temporary Holding Tank Permit (Y/N) No. of Compartments Foundation~_~ C lea nout 4~"4) Last Pumped'"r/~ ~, ---' \ ; for ~To Property Li'n~ ' ~ ' To w&~e~Mai~Ser~ibe',Line I ~ To StCeam, ~nd,' Lake or Major Drainage Course Comme~ts~ ~ To Building Foundation To Disposal Field I..~ 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~'\"~'~ ~//'"~-"~ Type of System Design Date Installed / ~ \~-~--~,~J Length of Field ~ tr-~'~ Width of Field ~ ~'~¢-~, ~ Depth of Field ~ I ~ ~,~,~ Gravel Bed Thickness Square Feet of Absortion Area \'"7z3¢'Z---'¢~ Statndpipes Present~/N) Depression over Field,~j) ~ Date of Last Adequacy Test Results of Last Adequacy Test l"~'~"t~ ~'"'(-] '.~ SEPARATION DISTANCE FROM ABSORPTION FIELD: ~ L~"'~") To Property Line ,,¢~.~-4 To Existing or Abandoned System on 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 ; On Adjoining Lots '2.'.'.~ I ~ ~ To Cutback (if present) Comments D. LIFT STATION Date Installed~ Size in Gallons ~"Pump On" Level at High Water Alarm Level at Tested for Dimensions ~:~"'-'~mm~,~/,,~ ~ ~ Manh01e/AccesS:~N) V ..~ "Pump Off" Level at Vent <¢i~'N) ~ .~"'.,.¢'~--¢..~ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes4~,l) V Comments **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 2 & $ ~. 17034 Eagle River Loop Road No. 204 Eagle River, Aleska inspection. Signed Company Date MOA No. Receipt No. Date of Payment Amount: $ [ "hO, 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 · ~ I~Y OF ANCHO 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907)~6~)-~ _ P-~ FEDERAL TAX ID # 92-0040440 ~. u~'l. OF HEALTH & ~%~ ~NV~RONMENTAL PROTECTIO~ RECEIVED k}IMJYSiS REPORT BY SA),I?LE for Work Order ~ i'76L0 Date Report Printed: OCT 25 89 @ .t9:12 Chent San,plo ID:LOT 18, BLK 2, SILVER CREST S/D ?WSID :UA Collected OCT 18 89 ~ 1,5:00 hrs. Received OCT 18 89 g 16:00 hrs. Client ~[ame : S & S EIIGR Client A. cct: SNSEI{GP P.O.~ IlONE RECEIVED P, eq ~ Ordered By : R. SCHAEFER Analysis Completed :OCT 20 89 Send Reports to: Laboratory Snperwsor :STEPHF, H C. EDE I)S & S EHGR Released By : /~/~'~J ~A 1~~ 2) Special Chemlab P~ei ~i: 8119 Lab Si,ipl ID: 1 !,[atrix: WATER Allowable Parameter Tested Result/Units Method Limits HITRATE-t[ 0.63 rog/1 EPA ::53.2 I0 Sampke ROUTIIIE SIkI,I?LE. SAI,~LE COLLECTED BY Remarks: Tests Performed See Special h:stzuctions M)ove Uk-IJnavailable ~one Detected "See Sample Remarks /~bove llot krmiyzed LT~Eess Than, GT~Greater Than MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES '~_:"~ DIVISION OF ENVIRONMENTAL SERVICES ~----- - CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 dj:- ~) ~_/---O -~--/-~- - L"7/~ Application Date ' GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property Owner ~(--~"~¢--~ ~~ ~Telephone: Home Mailing Address ' ¢ ~7 · Business ~,~- ~ (c) Lending Institution Mailing Address Telephone (d) (e) Real Estate Company and Agent ~tCY'Y~' ~-~',,-\ ~"~ Address '-~"~ "T'~_..~¢ ~-~ / "~/-.,,~ Telephone Mail the HAA to the followina address: or: Check here ~, if hold for pick up. List contact person and day phone number below. :~c~; ?!/c~: .... .'' ~ ::% :..,,'~: :'-' ' ' ' ..... ' TYPE OF RESIDENCE Single-Famil~ Number of Bedrooms WATER SUPPLY Individual We Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsit~--~ 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 72-025 (Rev 8/86~ Front 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 flies 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 JF'JFE~ CWc.)V--~\ Address Date ~ L-'~-OA,~.~ <~C[ A ....,._', ..... % DHHS APPROVAL Approved for ~ bedrooms by Approved L,"~/~, Disapproved Terms of Conditional Approval Conditional Date CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of 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. Page 2 of 2 72-025 fRay 8'86~ Back WELL DATA CHECKLIST - FEBRUARY 1984 JUN 1 3 19 9 264-4720 Well Classification Well Log Present ¢~__~ Total Depth I d.~¢ ~ Cased to Static Water Level ~"~ Casing Height Above Ground Electrical Wiring in Conduii ~7~1) Separation Distances from Well: Legal Description: LO'T- J ~ j If A, B, C, D.E.C. Approved (Y/N) ~[A Date Completed ~/2.5/~ Yield ~'~ ~P~ To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/_Man hole. Water Sample Collected by Water Sample Test Results ~+"'~.~C,'~,,-~ j Comments ~-~ [~,.~1~ 5,2~¥/L Depth of Grouting .1._)c'¢_l '),..~ OA%lV~g, Pump Set At Sanitary Seal on Casing Depression Around Wellhead ; On Adjoining Lots Ii I / q) ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ;Date . B. SEPTIC/HOLDING TANK DATA Date Installed 2..-'~'k7~r'? ~ize ,2-~:~ ~No. of Compartments Standpipes ~ _ "~ ~'~ Air-tight Caps Depression over Tank ~ Pumping/Maintenance Contract on File (Y/N) - Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Uolding Tank: To Water-Supply Well J~l To Property Line _ ~ +" To Water Main/Service Line Course + l~t Foundation Cleanout~CJD Date Last Pumped ;for . Temporary Holding Tank Permit (Y/N) Comments To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(1~/84) ABSORPTION FIELD DATA 2 Date Installed i ~-- ~.7~.,.)¢%~_ ?~[~ d~ Length of Field (c~:~ Width of Field ~ TC, ..~i ~ Depth of Field I~-. Gravel Bed Thickness ~ Standpipes Date of Last Adequacy Test Square Feet of Absorption Area Depression over Field ~I~N~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~ ~ ~ "~ To Building Foundation Lot To Water Main/Service Line To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~ ¢ '~ To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ¢'~0'[7=~ ~"~ ~ ~-~ ~ 0~. -I'~' Dimensions LIFT STATION ~ et~, '-7--c~': ~- C~ co Date In~.~ Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Manhole/Access (Y/N) "Pump Off" Level at ~ Vent (Y/N) ~y~les during Adequacy Test. Meets MOA · . Check p r~tted~droom-Rett~( ;gai~/t/ClAA Request ** i ce r ti f y t h~a.t.I h~e c h~.~ d.~ve ~/t~. i~ormed to all MOA and HAA guidelines in effect on the date of this ins ~ection. Signed ~~~, ~ NO¢c~ ~ ~ ~}~ Company m , ~ r . Receipt No. ~ o - ~ / ~ ~-~ Date of Payment Amount: $ L,, --/3--,¢ ? /7¢, Page 2 of 2 72-026 (11/84) CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BT SAMPLE for Work Order $ 13787 Date Report Printed: JUN ? 89 @ 17:42 Client Sample ID:?201 STAMPS CIR - RITCHEN TAP PWSID :UA Collected JUN 6 89 ~ 09:45 hrs. Received JUN 6 89 0 10:18 hrs. Preserved with :AS REQUIRED Client Name : HIGH,PI~KEN,SORENSON CONSULT ENGR Client Acct: HIGHPtlgt P.O.~ NONE REC'D Req g Ordered By : DOUG WASIIBURN Analysis Completed :JUN 7 89 Send Reports to: Laboratory Superyisor,:S~EPHEN C. EDE 1)DIGtI,PHU~EH,SORENSON CONSULT ENGR Released By :.~~ ~ ~ 2)DOUG WASHBURN OR DEE HIGH Special Instruct: Chemlab Ref $: 5597 Lab Smpl ID: 1 Matrix: WATER Allowable Paralseter Tested Result/Units Method Limits NITRATE-N 1.4 mg/l EPA 353.2 10 Sample ROUTINE SAMPLE : Remarks: SAMPLE COLLECTED BY DSW Tests Performed ' See Special Instructions Above UA-Unavailable None Detected "See Sample Remarks Above Not Analyzed LT=Less Than, GT=Greater Than MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) lO,, Location (address or directions) (b) PropedyOwner ~.0'~ g~'<~ Telephone:Home Mailing Address Business Telephone (c) Lending Institution Mailing Address '7~/ ~ '-~'~,..j'~ V" (d) Real Estate Company and Agent Address ,.~ Telephone (e) Mail the HAA to the followino address: or: Check here [~ if hold for pick up. phone number below. List contact person and day --- I. TYPE OF RESIDENCE Single-Family']~ Number of Bedrooms WATER SUPPLY Individual Well"~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 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. 72-025 (Rev 81861 From 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, J 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 flies 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 ins~:~ ~ Name of Firm Telephone Address ¢~,,.~ ~,.,~ /,~ Date ~-~- /-~i '/ ~ ~"7 Engineer's Seal Approved for ./~ ./z.:¢---(~'_/~/,,~ bedrooms by Approved ~ Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of 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. Page 2 of 2 72-025 fRev 8/86) Back HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST-264.4744FEBRUARY ~984 WELL DATA Well ClassifiCationr Well Log Present (YIN) Total Depth ilo ? Cased to Static Water Level Legal Descriptign: ,¢~t... /~ TIC. N; Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot If A, B, C,.D.E.C, Approved (Y/N) Date Completed '"~'/~ '~/1~"~) ' Yield Depth of Grouting I'~ 0 Pump Set At ~:~ ~ T"~O Sanitary SeaL'on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ~; On Adjoining Lots To Nearest Public Sewer Line J%~'J~, ~ To Nearest Public Sewer Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ['~)J[~L~,___ To Nearest Sewer Service Line on Lot ~ / ~ ;Date 7 B. SEPTIC/HOLDING TANK DATA Date Installed ~' Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well J TO Property Line ~ To Water Main/Service Line ~ / 1~' Course N Size 1 ~-.'~.~ 0 NO. of Compartments "'ir" t.~ i~ Air-tight Caps (Y/N) y Foundation Cleanocjt (Y/N) Date Last Pumped ~"/"¢ i I"~ Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026 /Rev 8/861 Fron~ C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~"//~,° ~ ~:~ Width of Field i~- ·'' ~' Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance h;om Absorption Field: To Water-Supply Well To Building Founidation Lot Date of Last Adequacy Test To Water Main/Service Line ..~ / ~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) / Type of System Design Length of Field ~ I?-. ; On Adjoining Lots To Cutbank (if present) . To Property Line J [~ To Existing or Abandoned System on Comments D. 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 Comment~ ** Check Pe'rmitted Bedroom Rating Against HAA Request ** I certify that~ ~,,"~ ~ , --"~?1 have checked,.verified, Q,~conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~- Date /~"/'b ' ~ "~ Company ~' MOA No. Page 2 of 2 72-026 fRev 8/861 Back Seal ANCHORAGE, ALASKA 99501 CONSULTING ENGINEER TELEPHONE: 1907) 279-3916 LEGAL: LOCATION: 7201 Stamp Circle OWNER: TYPE OF WELL: WELL LOG AVAILABLE: Yes INSTALLATION REQUIREMENTS MET:Yes WELL YIELD FROM.WELL LOG: MUNIcIPALiTY, OF, . . ~NVIRON~EN1A; RESIDENTIAL WELL INSPECTION RECEII/ED ~8, BZoe~ 2, SLZve~crest Subd&v~s~on Home Equity Relocation Private, Single Family PUMP YIELD FROM TEST: 8 Gallons Per Minute DATE OF INSPECTION: December 11, 1987 TEST PROCEDURE: Well was pumped at a constant rate of 8 gpm while the drawdown was monitored with acoustic probe. At the beginning of the test Water level was found at 8~ feet below top of casing. At a pumping rate of 8 gDm the water level dropped to 88 feet after 15 minutes of pumping and remained at that level for the remainder of the test, 90 min. A total of 720 gallons were pumped. TEST FOR E.COLI AND TOTAL NITROGEN: Water was tested for E.Coli and total nitrogen on E.Coli 0. Total Nitrogen 1.2 mg/1. Max. allowable Total Nitrogen 10 mg/1. TEST RESULTS: This well meets the requirements of the Municipality of Anchorage. THIS WELL WILL PRODUCE MORE THAN 3 GALLONS PER MINUTE FOR MORE THAN FOUR HOURS The Municipal requirement for well flow is 150 gallons of water per bedroom per day. This well exceed this requirement. The assessment of the condition of the well applies only to 'the conditions as of the day tested. The flow rate may change due to subsurface conditions that may not be observed from the surface, and changes in the land use and other factors that may impact the aquifer feeding the well. ,~ ~, r~ ANCHORAGE, ALASKA 99501 CONSULTING ENGINEER TELEPHONE: (907) 279-3916 LEGAL: LOCATION: OWNER: RESIDENCE: WELL: SEPTIC SYSTEM: ENvhUNiCiPALiTyM OF A ~ ,~ IRoIVMENiAL -"'~ ~ LEs D/V/StON OL{'C ,1 1987 got18, ~ZoaA 2, Silve~arest Sub&L~t',:,~N~ 7201 Stamp Circle Home Equity Relocation Co. Single Family, Four Bedrooms On Site FROM MUNICIPAL RECORDS: TANK: Greer Steel, Two Comp. 1250 gal. ABSORPTION SYSTEM: Trench ABSORPTION AREA: 1040 sq. ft. SOIL RATING: 256 INSTALLATION DATE:Tank 1980, Trench 1986 DATE OF LAST PUMPING: December 14, 1987. Isaacs Pumping Service DATE OF TEST: December 14, 1987. TEST PROCEDURE: System was inspected and measured. Tank was found with four feet of cover and 46 inches of liquid. Clean out to Lrench was 4.5 feet deep and dry. Trench sump was 12.5 feet deep and dry. On Dec. 11, 700 gal of clean water was added to the trench. This caused a water depth of 21 inches to be measured in the sump. After 24 hours the depth was 10 inches. After 62 hours the sump was dry. On Dec. 14, 2000 gallons of water was added to the trench. This caused a water depth of 48 inches to be measured. After two hours the water level was 45 inches, After 24 hours the depth was 29 inches. Approximately 875 gallons of water had been absorbed in the 24 hour period. TEST RESULT: This system meets the code requirements of the Health and Social Services Department of the-Municipality of Anchorage. NOTE The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long this system will function satisfactory for current or future occupants. MUNICIPALITY 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 Legal Description (include lot, block, subdivision, section, township, range) Looatiog (address or directJ.ons) '7~ol ~ T/~P (b) .Applicant Name DON P/TT~ER.SeAJ' Telephone: Home ,3¥6'-$qqz. Business ;LApplicant Address (c) Applicant is (check one):' Lending Institution []; Owner/builder J~; Buyer []; Other [] (explain); Telephone GENERAL INFORMATION (a) (d) Lending Institution ,. Address (e) (f) Real Estate Company and Agent Address Telephone Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family J~ Multi-Family Number of Bedrooms Other WATER SUPPLY Individual Well ~ Community[] 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. 72-025 (11/84) Page 1 of 2 ENGINEERING FIRM PROVIDING ,,,$PECTIONS, TESTS, F~[r SEARCHi DAT~-, .,ND INFORMATION :: i 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 ~E~"-,~, //1'/'C,-' Telephone ,,.,~'/-,,,~"-O¢~) Address for ,- /Condition~l ~_.~ Approved /y Disapproved Terms of Conditional Approval 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 landing 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 f?r errors or omissions in the professional engineer's work. '. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST~ FEBRUARY 1984 264-4720 MUNIcIPALITy OF ANCHORAGL: DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION Legal Description: WELL DATA Well Classification ~/~/D I~/I ,OU/~-~ If A, B, C, D.E.C. Approved (Y/N) Well Log Present ~N) Date Completed ,~/~.,~/¢0 Yield ,. Total Depth __~0~ Cased to lO ~ Depth of Grouting Static Water Level ~ '~ ?~,~/ Pump Set At ~ / Sanitary Seal on Casing ~N) Depression Around Wellhead (Y~ Casing Height Above Ground Electrical Wiring in Conduit CN) Separation Distances from Well: To Septic/Holding Tank on Lot / t O0 ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot .]~'~ / ; Onk Adjoining Lots To Nearest Public Sewer Line _ /¥'//'~ ~ To Nearest Public Sewer Cleanout/Manhole /~r//:j__ To Nearest Sewer Service Line on Water Sample Collected by ~. /~/~J rC/'/l~/~ K ;Date Water Sample Test Results _ ',~1~l,-5 F~'E.,TO~ ~ Comments '~ ~)~;fi ~rTY/~['~,~-~) I/b/~/~C~O¢,~ ~ SEPTIC/HOLDING TANK DATA Date installed ~ll~lll~l~ll~Size Standpipes ON) Air-tight Caps ~/N) Depression over Tank (Y~ PumPing/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ]0(~ / To Property Line 2~) ' To Water Main/Service Line /~//~ CoUrse No. of Compartments Foundation Cleanout (~N) Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) To 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 ~/1~//~ Width of Field / /~-/%~/ 2,5'6 Square Feet of Absorption Area / 0 Depression over Field (Ye Results of Last Adequacy Test J¥/~ Separation Distance from Absorption Field: To Water-Supply Well ~ ((4'"jlJlJ~. /'0~-~ To Building Foundation ~2. ,[ Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field Depth of Field ! 2.. Gravel Bed Thickness Standpipes Present t~N) Date of Last Adequacy Test To Property Line /0 / To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) j'V'//'~ Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions ~ Manhole/Access (Y/N) _/ "Pum~_ __ __ /""~uVmep~'tn(gY~)cl~ss ~ ~ddequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I~h ~/~.c.k~e?'~l, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed (~/~ Date / 1,~)-;~-.~ //V'~'~. MOA NO, Company . ~:::'~' Receipt No. ~Joo Date of Payment Amount: $ Page 2 of 2 ALASKA ENVIRONMENTAL CONTROL SERVIC , INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO OF CALCULATED BY CHECKED sc^L~ 1%.30' °ATE OATE 3-~IV K ~ DATE RECEIVED ~ I NSP ECTI O N APPOINTM RUTS ~.~L~/'~,~L.~._~.~ > ~~ TIME TIME TIME DATE DATE DATE MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO~EPT' OF I.{2>,LTH & 825 L Street - Anchorage, Alaska 99501 ENVIRON~v~NTAI. P;rOTECTION ENVIRONMENTAL SANITATION DIVISION ~U~ ~ 0 10~0 Telephone 264-4720 .o.A...ow. o. DIRECTIONS'. Complete all parts on page 1, Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PR~ERTY OWNER PHONE ~AILiNG ADDRESS PRQPERTY R~SIDENT (If different fr~m above) PHONE 2. BUVER~ PHONE MAILING ADDRESS M~ILING ADDRESS 4. REALTOR/AGENT ] PHONE ~MUNG ADOaaSS ~5. LEGAL DESCRIPTION [ 6, TYPE-OF RESJDENeE /~' ' - NUMBER OF,,BEDROOMS [] One [] Four ~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six [] Other 7, WATER SUPPLY ~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975, For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE D~DSAL SYSTEM ~ INDIVIDUAL/ON-SITE** /P,-~) YEAR ON-SITE SYSTEM WAS INSTALLED, [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 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 [] INDIVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS [~'/APPROV ED FO R ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED /~~ DATE BY 79-010 (Rev. 6/79)