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JUNIPER VALLEY BLK 3 LT 4
Juniper Valley Block 3 Lot 4 #050-751-30 MUNICIPALITY OF ANCHORAGE ? tIA 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 VA99@ffEtQ4 REPORT NAME PHONEy LIJKNEW •�J('�J h.a�t Y•� �L�Ly'LE �•--1 ' �" tC�(4 _, IZ'7•Y' ❑ UPGRADE MAILING ADDRESS 7-1+11_ L(2-kOt t_ . x-4_ «(ei � ,j `j LEGAL DESCRIPTION ��y5 l.)-+.,,) \\ ,+�� .Y. � p & 6 LOCATION NO. OF BEDROOMS u DISTANCE TO: Well t , ��U bsorption area -� f Dwelling PERMIT NO. ,F .---»� .�' /\ ®Y H Z [MaflUfactUrer Material No. of compartments W Q i _ ed q. capacity in gallons Inside length Width Liquid depth 1-rte. IF HOMEMADE: _�.-.••---- -- ----- °0z DISTANCE TO: Well D ailing PERMIT NO. ©z Q T I- __ Manufacturer Material _ Liquid capacity in gallons 8 Well I Foundation t Nearest lot litre PERMIT NO. w • DISTANCE TO: � . ) _-t -----------� w_ .0 u. • No. of line Len th Qpf ea h line g Total length oflinesTrench ACS width Distance betty t fines ��S z Lrlp�g 1 Cap inches Top topf�nish Material beneath tile Total m of tile grade f f %Jtv effective absorl on area ".�t (V `-•t,j i, inches �"`�' Length Width Depth PERMIT NO. ui Q h Type of crib Crib diameter ri depth Total effective absorption arca as w N Well Building foundation Nearest lot line DISTANCE TO: J Class Depth Driller Distance to lot line PERMIT NO. w Building oundatio4..`he11 rr Ijiie''.• I';• Septic tank Absorption area(s) DISTANCE TO: �cr,� ; _,� y. �1M1r I:c4 •r. OTHER rid .. ° $":` PIPE MATERIALS �' •y „$,._,� ,.• 6°a °•a• a .aur.-; a,°n-° SOIL TEST RATING a +• +• •+••••^ f6ort R. Shofar p' °n— hto 1ASf INSTALLER V jr) REMARKS �� rE�✓�, .-.1—p."T i Y•�i )lr�J+'•I�..r�lJ 1 t 1.., 1 PPR VED DATE LEGAL x lYzi .;f � tn�vC /yn January 31, 1983 TO: Permit Applicant .Permit #: 820526 Subject: Lot 4 Block 3 Juniper Valley '-Subdivision A permit issued by this department for an individual we1l. and/or_ on-site sewer system has expired as of December_ 31_, 1-982. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log needs to be sent to this department for documentation of the installation date and to close the permit. If a private engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files and documentation. If there are any further questions, please call. this office at 264--4720. Sincerely ``\• c--Z� Robert C. Pratt, R.S. Acting Program Manager. Sewer and Water_ Program RCP/l.jw enc: Copy of Permit SWP/057 DEPHRTMEMT HEHLTH HN0 EMVIROMMENTHL OTE` 825 'L' STREET, HwCHORHGE, HK99581 2�4~4720 \ PERMIT NO ( 820526 ) THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS� I CERTIFY THHT 1� I HM FHMILlHR HITH THE REQUIREMENTS F8R ON.SITE SENERS HND |�ELLS HS SET FORTH BY THE MUHICIPRLITY OF HNCHORHGE 2� I WILL INSTHLL THE SYSTEM IN HCCORDHNCE NITH THE CODES ]� I UNDERSTHND THHT THE ON~SlTE SEWER SYSTEM MHY REQUIRE ENLHRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THHN 7 BEDROOMS ART - _ •�.: 'G, is °'�-e �l:. -t .'+'.,r_ t}--,i lip.9 c i - .- t'..- I _ ..i OWN (f t 7`-_- ,}' i3gU .' 111".m 1 0 �UvlodvI-.' f imm it- •'1I _ i - , �_ -' f = r _ ? 1i.1 r0 :(Own 1 1i �_., 1. is I:1--_i'i-I JAY? f t(I. I' 1 ;!v F ; l 1 N- it"i +. i i )l. :if ! ? .'t .. -r - - I.'•.. - 1 .. r .:t ..,. 1.;,-1 _ _..LI i ". a :1 til it r 1 ii_ . . , �. - _ . - ; 00 1 1 1 P ' I j !I i 4 t l _ ! _ i Al 1 v 4 3 , _. _ } I-,-.v { i t j.. -. -, -. i , .SII_' _' _ ." .. .a {!.. i. ..i -1 i� - (1 .j ii-. i_-' Ili (f; I' -,y- i?' FIT- 0f fI ii'll -.. 1 i -' ,. Y A- i :F. _ i [ 1 I: -- t , I rub M I_i 0 41-1, 1 -,i-}I _: i- 1J� -• F i -I - i-"l i`3'. •'.... it) - ill .11i 7_ 13 100 ".1 :1 I 1 nin. TKY i:f (11 !-1-11-`�•_ PERFORMED MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 �SO`ILS LOG — PERCOLATION TEST t treqJ ec,, DATE PERFORMED: LEGAL. DESCRIPTION:_ D PTH �� •t i�v�C �L (/t t , 2 G c` —.3 C' C 4- 6 6 7 c. 8 (,t 9 10 �. 11 - 12 13 14 15 16 17 18 c 19 �g/ 4 20 COMMENTS PERFORMED BY: 72-008 (6/79) cz- `." 64t h r� % ° �^ Kul>art A SAa r i XSOILS LOG ❑ PERCOLATION TEST SI E PLAN WAS GROUND WATER 1..� L - ENCOUNTERED? 0 P IF YES, AT WHAT E DEPTH? Reading Date Gross I ime Net Time Elk PCs MEN RINE njow No mm.. NMN ME OL M, N XSOILS LOG ❑ PERCOLATION TEST SI E PLAN WAS GROUND WATER 1..� L - ENCOUNTERED? 0 P IF YES, AT WHAT E DEPTH? Reading Date Gross I ime Net Time Depth to Water Net Drop 1457.- V PERCOLATION RATE .(minutes/inch) OFE$$Cti Qi9 TEST RUN BETWEEN FT AND FT CERTIFIED DATE:1%141^I M -W DRILLING, Inc. P.O. Box 10.378 • 10300 Old Seward Highway (907) 349.8535 ANCHORAGE, ALASKA 99511 DRILLING LOG Well Owner John Fraley of Well DomestiO Location (address of: Township, Range, Section, if known; or distance main road _ LIQ B3 Juniper Valley Subdivision casing 61" 3$0 21 b'" Size of casing Depth of Hole— feet Cased t 7 feet w w/ AFS liner Static water level ��� ft. (aJx (below) land surface. Finish of well (check one) open end XXX Static ) Screen ( ); Perforated ( ). Describe screen or perforation None Well pumping test atm—gallons per xMJST .. (minute) for 1 hours with loch K?CX of drawdown from static level. Date of completion May,12,1983 WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness OL -To 3 3 To fro 80 TO 217 217 218 TO 218 Tn 225 225 TO 359 TO- -TO- TO- TO- TO- -TO- -TO OTOTOTOTOTOTO TO Casing stickup Sandy gravel. Silty sandy gravel Boulder N W WACertifisd Conirj�; f�tificate NO'N. 8}¢—Wte'r 3—CONTRACTOR I B 9 rQ 7 • G U •-4.71 � Municipality of Anchor. • '�� o�..f s On-Site Water and Wastewater Progr: 8 Izo� (907) 343-7904 a.. AUG 3 0 2017 ETY a w Certificate of On-Site Systems Ap • 5\ 01b9L°' Parcel I.D. 050-751-30 Expiration Date: i 1; 9 - ( r` 1. GENERAL INFORMATION Complete legal description Juniper Valley Block 3 Lot 4 Location (site address) 3946 Mariah Dr. Eagle River AK 99577 Current Property owner(s) Paul Schmit Day phone 907406-3829 Mailing address Same Real Estate Agent Day phone 2. TYPE OF DWELLING: El Single Family (w/wo ADU) 0 Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 2 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for. Distance: Received by: Date: ctiti 17 COSA to be released to the engineer. ess otherwise requested by the engineer. COSA Fee $ 4 5240 Waiver Fee $ Date of Payment X3131//7 Date of Payment Receipt Number o6/52ac Receipt Number COSA# ' f)(,/7/11401 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. Name of Firm Forge Engineering Phone 907-522-7773 Address 1399 W. 34th Ave. Suite 203 Engineer's Printed Name Benjamin Schiller Date ° 14e0 It tae49 6. DSD SIGNATURE yrs O0OD0 iC ge 1.tialco ; System #1 Approved for 2— bedrooms 4i.� .._ pee m System #2 Approved for bedrooms 0 � '&1��` @'a'Q ftVi ��p Disapproved Conditional approval for bedrooms, with the following stipulations: A-\/%42A,A-ed-e k I's 2 Oi Qat/ S \-s` OF- V rC�O r „pi Jam' ON-SITE WATER AND WASTEWATER cr PROGRAM 47.c- Original Certificate Dater ( �� 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 . . Septic System Advisory Arsenic Advisory • Well Flow Advisory Other . ' . COSA blue sheelj c If more than 1 septic system is on the lot: COSA Checklist 4 of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Juniper Valley Block 3 Lot 4 Parcel ID: 050-751-30 A. WELL DATA Well type Private If A, B, or C provide PWSID 4 Well Log (YIN) Y Date completed 05/12/83 Sanitary seal (YIN) Y Wires properly protected (Y/N) Y all Total depth 380 ft. Cased toy ft. ?, Casing height (above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test 05/12/83 08/17/17 Static water level 200 ft. 220 ft. Well production 4 gpm 0.35 g p m WATER SAMPLE RESULTS: Coliform NA colonies/100 mL Nitrate -552 mg/L Arsenic NAug/L Date of sample: 08/10/17 Collected by: Forge Eng. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/SteelDate installed 1983 Tank size 1000 gal Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) NA Date of pumping 08/11/17 Pumper JR's Septic C. ABSORPTION FIELD DATA Date installed 1983 Soil rating (g.p.d./ft2 or ft`/bdrm) 1 1 0 System type 5 Wide Length 40 ft. Width 5 ft. Gravel below pipe 3 ft. Total depth 6.5 ft Eff. absorption area 344 ft2 Monitoring tube Y Depression over field N Date of adequacy test 08/17/17 Results (Pass/Fail) Pass For 2 bedrooms Fluid depth in absorption field before test 20 in. Water added 500 gal New depth 31 in. Elapsed Time: 1 380 min. Final fluid depth 22 in. Absorption rate >= 300 g.p.d. N Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off" level at in. High water alarm level at in. Datum Cycles tested 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 NA 7 75' Public sewer manhole/cleanout NA ->)00 Sewer/septic service line >25' Holding tank NA 7 ?ca r NA Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: >5' >5' >5' Building foundation Property line Absorption field Water main NA > lo' Water service line >10' Surface water >100' Wells on adjacent lots >1 00' ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water main NA 7 101 Water Service line > Surface10' water > Driveway, parking/vehicle storage X10 Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS G. ENGINEER'S CERTIFICATION '6.4016 . C, �j4///Q I certify that I have determined through field inspections and MP, 4. .••'' -tea , �� review of Municipal records that the above systems are in rxd r • T , 1 .Y conformance with MOA COSA guidelines in effect on this date. ji,Tw • Benjamin Schiller Engineer's Printed Name s To,....., Date 08128/17 e. « /1 Si / o , # •''VADIIW•' dr 414°1 uE Qo®. COSA brown sheet 10-10-12.doc • Municipality of Anchorage L• u. i ' .- I Development Services Department Building Safety Division S,F E T Y On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Certificate of On-Site Systems Approval (COSA) # OSC 171401 During a recent COSA on-site inspection and test of the potable water supply well on Block 3, Lot 4 of Juniper Valley subdivision, the well's productivity was determined to be .35 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 2-bedroom residence is .2 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. D] Parcel I.D. 050-751-30 Municipality of Anchorage On -Site Water and Wastewater Program a (907)343-7904 < snrery Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description JUN Expiration Date: 9-30-1-4 Valley, Block 3, Lot 4 Location (site address) 3946 Marlah Dr. Current Property owner(s) Secretary of Veterans Affairs Day phone _ Mailing address 155 Van Gordon St. Lakewood, CO 80228 Real Estate Agent Day phone 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ��'ia� r ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 MAY 2 3 2014 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual F� Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Puioiic'v""Vater System ❑ Public Sewer ❑ Waiver/Variance request for., Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 52-(� - Date of Payment 5lf'a3 h L Receipt Number o4-7-'-) COSA# �L1�(IZl^1 Date: Waiver Fee $ Date of Payment Receipt Number, 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. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Alk. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for .3 bedrooms System #2 Approved for bedrooms Disapproved Date 4/23/2014 Conditional approval for bedrooms, with the following stipulations: By: /� �i� Original Certificate Date:J The Munici ality f A orage 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet f c If more than 7 septic system is on the lot: COSA Checklist # + of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Juniper Valley, Block 3, Lot 4 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 5/12/1983 Sanitary seal (Y/N) Y Total depth 380 ft. Cased to 217 ft. FROM WELL LOG Date of test 5/12/1983 Static water level 200 ft. Well production 4 g.p.m. Parcel ID: 050-751-30 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 18+ in. AT INSPECTION 4/18/2014 216 ft. 0.49 9-p m. WATER SAMPLE RESULTS: Coliform AA?--colonies/100 mL Nitrate0. L�_ff mg/L Arsenic Nb ug/L Date of sample: t Collected by: AG> B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,000 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping 4/21/2014 Pumper JR's Pumping Date installed 1983 Cleanouts (Y/N) Y High water alarm (Y/N) N C. ABSORPTION FIELD DATA Date installed 1983 Soil rating (g.p.d./ftz or ftZ/bdrm) 110 SF/BR System type Shallow Trench Length 40 ft. Width 5 ft. Gravel below pipe 3 ft. Total depth 7 ft. Eff. absorption area 344 ftz Monitoring tube Y_ Depression over field N Date of adequacy test 4/21/2014 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 13 in. Water added 500 gal. New depth 16 in. Elapsed Time: 20 min. Final fluid depth 13 in. Absorption rate >= 450+ g,p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum in. E. SEPARATION DISTANCES WELL ON LOT TO: Size in gallons _ "Pump off"level at Cycles tested _ Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 100+ in. Manhole/Access (Y/N) _ High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS (/ AS — t, a.L G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 4/23/2014 COSA brown sheet 10-10-12.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 110+ in. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. ci. anchorage. ak.us (907)343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # 141217 During a recent COSA on-site inspection and test of the potable water supply well on Block 3, Lot 4 of Juniper Valley subdivision, the well's productivity was determined to be 0.49 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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 S a s Engineering Address 15861 S. Birchwood Loop Rd. Chugiak, AK 99567 Engineer's Printed Name Roberta Shafer Phone 694-2979 Date >R 5. DSD SIGNATURE � • � 1477•! l✓ Approved for 3 bedrooms. 4 QTF9Fo ,•�•��",• Disapproved. l46�a�F Conditional approval for bedrooms, with the following stipulations: N -ft Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: OAetllOriginal Certificate Date: J'�- g —� (R" IM) Municipality of Anchorage ' Development Services Department ' Building Safety Division On -Site Water & Wastewater Program ' • " 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST 1 It3 v tf� Legal Description:_ LOQ- ; f;�k ��n;n r�ll) ParcellD:D'6 SSI -3o A. WELL DATA Well type C�vEI t If A, B, or C provide PWSID # _ Well L 09�) �c..e5_ Date completedG I2/S Sanitary sealN) 5 Wiresro rl 6i ) p pe y protected /N y -t Total depthaEo ft. Cased toZt "' t9 �_ft. Casing height (above ground) r* in. FROM WELL LOG Date of test ! L d 3 AT INSPECTION Z $ eo Static water level '2,00 ft. o?cZ I ft. Well production y.0 g.p.m. n, g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitratemg/L Other bacteria v colonies/100 mL Arsenic: � ug/L date of sample% G 0 7 Collected by: S S' .kms 1" of B. SEPTIC/HOLDING TANK DATA I Tank Type/Material Se A; L S�t,' G Date installed % 13 Tank sizetoo() gal. Number of Compartments Cleanouts (9N) e S Foundation cleanout N �°'S tank Depression over tafVU ® _ _ P l High water alarm (YA@ AJy ^�(Y Date of pumping rJ I Pumper J a- • S PJ MD (n q C. ABSORPTION FIELD DATA Date installed 135 Length 4 Soil rating (g.p.d./ft2 o ' r // U Width S ft. System type Gravel belowlpipe 3 ft. Total depth -1: ft. Eff. absorption area-Yfi—ft' Monitoring tube P� _ Depression over field 6t0 Date of adequacy test C� l Result (Pas Fail) i� t S CI For � bedrooms f 13,, Fluid depth in absorptijonn� field before test �'� in. Water added al. New depth, 1� in. Elapsed Time: S Final fluid depth Zt In. Absorption rate g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) /P/O/jd IVOO! yes, give date y�2�'� D. LIFT STATION, Date Installed 'Pump on' level at E. SEPARATION DISTANCES Size in gallons `Pump off level at _ in. Cycles tested (Y/N) High water alarm level at Meets alarm ti circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1004 On adjacent lots Absorption field on lot 1004 Public sewer main A Sewer /septic service line /--")o It Animal containment areas 1190AJIE [OC) 4 On adjacent lots — ( Leo A Al Public sewer manhole/cleanout A - Holding tank /��4 i Manure/animal excrete storage areas _4t - SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: � 1 st l7 Building foundation 1( Property line _.�_1_ Absorption field Water main I& Water service line 10f Surface water ADS+ Wells on adjacent lots foo f SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: '' / Property line I L)+ Building foundation %_ Water main /••u 1 R' Water Service line to* Surface water 1Q0 + Driveway, parking/vehicle storage IN Curtain drain n/r,nk "00 Wells on adjacent lots IMO+ F. COMMENTS G. I certify that I have determined review of Municipal records th, conformance with MOA COSAgL Engineer's Printed Name Date COSA Fee $_ Date of Paymenl Receipt Number (Rev. 11105) o Z field Inspections and r ��i f ` r ~%�q love system in jti� 1 effe on t is ate. / y No.. """" Mev Waiver Fee $ S /}%/ 9 Cl Date of Payment Receipt Number In. AvErb - Ivs Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Nater Well Advisory Certificate of On -Site Systems Approval (COSA) # 090123 During a recent COSA on-site inspection and test of the potable water supply well on Block 3, Lot 4 of JuniperValley subdivision, the well's productivity was determined to be 0.33 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. SCS ReLN 1091540001 Client Name S & S Engineering Project Name/N L4;B3;Juniper Vally Client Sample ID L4;B3;1uniperVally Ntatric Drinking Rater PN'SID 0 Printed Date rime 05/042009 16:52 Collected Date/rime 04212009 12.55 Received Date/time 04212009 14:35 Technical Director Stephen C. Ede Sample Remarks: Parorneter Results POL Units Medal ContainerlD Allowable Limits Prep Analysis Date Date Init Metals by ICP/HS Arsenic ND 5.00 ug/L EP200.8 C (<10) 0428/09 05/01/09 NRB Waters Departmant Total Niirate/Nitritc-N ND 0.100 mg/L SM20 450ONO3-F B (<10) 0423/09 1DZ Microbiology Laboratory TotalColifotm Negative 1 100mL SN1209223B A 0421109 DLC E. Coli Negative 1 100mL SM209223B A 0421/09 DLC F O a 0 0 0 C C C 0 0 0 3 3 3 r r r y y y O O O N N N N N N a a a A n A 0 O IV AD r oCJ.. 4 0 lin VOi � O till Pt. w'� w CA x" rA g m a 3 v g „ N � � lin VOi � O / •ill.!. �'1,•; •r• ''{ `..J� � �� / 7 i �r7 �j 'n �� j•S'�. :1� ...i•�iv :fly: �i —y 11111r4,/ .c.. ,A all . tt 1 a rNpC y�Ii 1 •/ NAV uA .' �� •'�//`%.i. • C) / to :; (� •�j . ..11 C r ti) ' / t-� irk' ��C •'C• , �1 ��' f�� :' . � r��� // '/ X11 • � � y• '' • 1 �f / •ill.!. �'1,•; •r• ''{ `..J� � �� / 7 i �r7 �j 'n �� j•S'�. :1� ...i•�iv :fly: �i —y 11111r4,/ .c.. ,A all . tt 1 a rNpC y�Ii 1 •/ NAV uA .' �� •'�//`%.i. • C) / to :; (� •�j . ..11 C r ti) ' / t-� irk' ��C •'C• , �1 ��' f�� :' . � r��� // '/ X11 • � � y• '' • Municipality of Anchorage i., Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196"050 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Parcel LD CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 0S -o --7.i1-30 1. GENERAL INFORMATION HAA go 305-64' Expiration Date: a. - S'• 0 1_� Complete legal description Lot 4 • Blocker; i- �i�,,Pr vat 1Py Location (site address ordirections)3946 Mariah Dr vP, FA41P River- AK Current Property owner(s) Day phone Mailing address Lending agency Day phone Mailing address Real Estate Agent Lau= mi 1 * on _ Day phone694-4200 Mailing Address 16600 Centerfield Dr'�J AK Unless otherwise requested, HAA will be held by DSD for pickup. jf l5l0 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well 91 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 91 Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional enaineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm SSS Engineering Phone 694-2979 Address17034 North Eagle River Loon- SrP 704 Eagle River, AR 99577 Engineer's Printed Name _%� 0 8f.? r C Co cw9.J Date 1113103 S 5. DSD SIGNATURE re'.." � ,• t ROBERT C COWAN _AZ Approved for _ bedrooms. CE -8801 Disapproved. "•••-•••" . Disapp Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: GiJ. Original Certificate Date: 1 1- S_-03 )Rev 01102) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program ' I TV 4700 South Bragaw St. P.O.Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 //--H--EALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LCE4 ; 3; ��uNyn�LY/�L1F7 Parcel ID:�— 79/- 30 ---�-.. sly A. WELL DATA Well type lrZIE7If A, B, or C provide PWSID #= Well Log (Y/N) Date completed!F11014413 Sanitaryseal (YM) Wires properly protected (Y/N) y Total depth 7J r p �ft. Cased to �ft. Casing height (above ground) r8 in. FROM WELL LOG AT INSPECTION Date of test S /Z /O o3 Static water level rZco ft. Z Z Z ft. Well production 4 • D g.p.m. • d g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml.' Nitrate 0- / mg.A. OthcIll "98INImi,it1olonies/100 ml. Arsenic: mgJl. Date of sample: 10�a8�03 Coli 17034 Eagle River Loop Road No.404 Vga vv B. SEPTIC/HOLDING TANK DATA Tank Type/Material�r„fi I 6voz" Date installed I%P3;K Tank size /GCO gal. Number of Compartments Z Cleanouts (Y/N) _ I/ Foundation cleanout (Y/N) Depression over tank (Y/N) —:�Si High water alarm (Y/N) Al Date of pumping 10131,03 Pumper ,T21 S C. ABSORPTION FIELD DATA Date installed I OS*, Soil rating (g.p.dJft2 or 2/bd 10 System type 4f;,VC ff Length 40 ft. Width ft. Gravel below pipe �� ft. Total depth —fL ft. Eff. absorption area 544ft2 Monitoring tube _� Depression over field tJ Pass/Fail PA -:S Date of adequacy test 10 3 !' Results ( ) For -3 bedrooms oe Fluid depth in absorption field before test 9Z41n. Water added gal. New depth 7& lin. Elapsed Time: I& min. Final fluid depth ';O�in. Absorption rate >= 46-0 g.p'.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed AJ /4 "Pump on" level at in. Datum E. SEPARATION DISTANCES Size in gallons Manhole/Access (YIN) "Pump off" level at _ in. High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanknilt-et6on on lot r Absorption field on lot 1004- Public 00'1"Public sewer main N A SeAw /septic service line 2 ► r - On adjacent lots 100 On adjacent lots I b 0 ► Public sewer manhole/cleanout N Holding tank NA- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: I d - Building foundation 'r Property line 4' Absorption field Water main__OA-� Water service line 1 'I— Surface water 1 Wells on adjacent lots 10 O t� SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line i o ►4" Building foundation '4- Water main N Water Service line 1 ''- Surface water, l 00 t� Driveway, parking/vehicle storage Curtain drain /Jet1f NOW Jwells on adjacent lots �w t : " F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and . _ ... review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date.. . Engineer's Printed Name 9 0 ,0k't;C- Date 1d/3/a3 HAA Fee S 3 7 5 a J Date of Payment Receipt Number i a (Rev. 12101) �L , o ; ROBERT C. COWAN f I0 .. CE -8801 ; Waiver Fee $ Date of Payment Receipt Number r r� .� 1.14 11-03-03 02:58PM FROM -CUE ESI, SGS ENV SERVICES Sf;-S-L- SGS Ref .# 1037064001 Client Name S & S Engineering Project Name/N L4, B3 Juniper Valley Client Sample ID L4, 83 Juniper Valley Matrix Drinking Water Sample Remarks: 9075615301 T-485 P.02/03 F-993 All Dates/Times are Alaska Standard Time Printed Date/Time 10/31/2003 15:51 Collected Date/Tlme . 10/28/2003 14:30 Received Date/Time 10/29/2003 14:40 Technical Director QSte Ede Released Allowable Prep Analysis PalatnCwr Results PQL Units Method ContaincrID Li]nit Limits Date Date Waters Department Nitrate -N 0. too U 0.100 Microbiology Laboratory mg/L BPA 300.0 B (<=10) 1029/03 JJB Total Coliform 0 col/100mL SM1892228 A (<=j) 1029/03 DKC MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES ''dUTP OF ANCHORAGE 0* Division of Environmental Services MrNiA( <rRVICESDtYISION On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 JUL 2 2 1997 343-4744 CERTIFICATE OF HEALTH AUTHORITY R 6 C E I VE E D APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I. D. # U S o -7 S i e 3 HAA # 0 P�9_� 1. GENERAL INFORMATION Complete legal description Lot 4; Block 3; Jun Location (site address or directions) NHN Mariah Property, owner Sazanne & Rodger Ewy Day phone 696-7336 Mailing address 3946 Mariah Drive Eagle River, AK Lending agency National Bank of AK Day phone 257-3615 Mailing address Attn: Pat Angevine Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 'I 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX 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. 72-025 (Rev. 1/91) Front MOA A21 1 L24VON N3¢8 ll6wAqu)9zD-u -�joM s, aau!6ua leuo!ssa}oid ayp u! suo!ss!wo Jo sioiaa aol algpsuodsai ;ou si a6ejoyouy jo Apdio!unw ayy 'panni s1 a;eoipliao a aaopq ejep az/leue ao suo!;oadsu! ;onpuoo IOU op SHHC1 }o saa/oldw3 -sluawaimbai ale;s pue leaape, u!ejjao /}s!pes ojaapjo ui suo!lnipsui bu!pue a!ay1 pue savoy }o siaseyoind of Asaunoo a se s1t4I saop SHHC1 ay,- TN1sely P a}eIS ay>, u paaa;s!6aJ peau i6ua puoissa}ad juapuadapui ue Aq anoge g ydei6e.)ed ul uan16 suo!jejuaswdaa ayj uodn (luo paseq saje31}!I.1aC) lenojddy 4!aogjny yIleaH sanes! (SHHCI) sao!naaS uewnH pue y11EGH }o }ueupedaa 96ejoyouy }o �4ijed!o!unjN ayL suollelnd!ls buimol!ol aql ql!m `swoapaq :10 sluawwoo Ieuo!IIppy JOI lenoidde leuoll!puoo panoiddes!d •swooapaq ao; panoaddy 7 3Sf11VNJIS SHH9 '9 L a}ea _z ain}eu6!s s, a9u!6u3 ssaappy LLS66 R)1S8IV'J8A1a 01Be3 b 9 auoyH 9N12133NI�N3 S 8 S walk �o aweN •uo!joedsul slyj 10 a}ep ayj uo joage ul suoijeln6ai pue 'saoueu!pao `sapoo ajejS pue ledlolunw Ile yl!m aouelldwoo ui si welsAs lesodslp aaIemajsem ao/pue llddns aalenn ells-uo aye `uolloadsul pue u0!je61jsanu1 /w woal pue sal! a6eaoyouy;o Aj!Ied!olunW ay; woaj paule}qo uo!jewaojui ayj uo paseq jeyjlq!aanjay)pnj I •ulaaay pa}eo!pul ainjonjis p adAj pue swooapaq jo aagwnu ayj ao} alenbape pue leuoljoun j'apes sl waleAs lesodslp aapma}seM ao/pue Alddns aa}em al!s-uo ayj Ieyj smogs uo!jeolldde lenoiddy Al!aoglny yl!eaH s!yJ 10 uo1je6!jsanu1 AW jeyj /41aan I 'molaq uMoys amp uo!Iep!len ayJ-10 se pue oIaaay paxgp leas Aw Aq pa!jpgo sy H3314I0143 A8 N01103dSNl d0 1NEIW31` IS '9 n :''.. '`�•�'y�'r is ��` yam? Loge -3:) �.� Nvmo� ia3aoa :10 sluawwoo Ieuo!IIppy JOI lenoidde leuoll!puoo panoiddes!d •swooapaq ao; panoaddy 7 3Sf11VNJIS SHH9 '9 L a}ea _z ain}eu6!s s, a9u!6u3 ssaappy LLS66 R)1S8IV'J8A1a 01Be3 b 9 auoyH 9N12133NI�N3 S 8 S walk �o aweN •uo!joedsul slyj 10 a}ep ayj uo joage ul suoijeln6ai pue 'saoueu!pao `sapoo ajejS pue ledlolunw Ile yl!m aouelldwoo ui si welsAs lesodslp aaIemajsem ao/pue llddns aalenn ells-uo aye `uolloadsul pue u0!je61jsanu1 /w woal pue sal! a6eaoyouy;o Aj!Ied!olunW ay; woaj paule}qo uo!jewaojui ayj uo paseq jeyjlq!aanjay)pnj I •ulaaay pa}eo!pul ainjonjis p adAj pue swooapaq jo aagwnu ayj ao} alenbape pue leuoljoun j'apes sl waleAs lesodslp aapma}seM ao/pue Alddns aa}em al!s-uo ayj Ieyj smogs uo!jeolldde lenoiddy Al!aoglny yl!eaH s!yJ 10 uo1je6!jsanu1 AW jeyj /41aan I 'molaq uMoys amp uo!Iep!len ayJ-10 se pue oIaaay paxgp leas Aw Aq pa!jpgo sy H3314I0143 A8 N01103dSNl d0 1NEIW31` IS '9 U Q I� 1 �I z MUNICIPALITY Of AN(J10RAO Municipality of Anchorage ENVIRONMENTAL SERVICES DIVIS DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division JILL 22 1997 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4RECEIVED 7tltl44� / r� Health Authority Approval Checklist Legal Description: l�� �.�v� \ iy> rcel 1.D.:_ 0 0 S- A. WELL DATA Well typey��� _ If A, B, or C, attach ADEC letter. AD EC water system number Log present (Y/ Date completed -5-- /-), - F-3 Total depth 3 � D _ Cased to 07/ 7 r Casing height (above ground) 114 Sanitary seal&/N) Wires properly protecteg6N) _ FROM WELL LOG AT INSPECTION PI PF 6V Date of test S--(Z-R3 Static water level Well production g.p.m. WATER SAMPLE RESULTS: tT 1 C 1J S. "41 L444 ffL /I D 9 -10 -m - Coliform , Nitrate Q, % 0 2 Other bacteria 0.6s r-e%n.pled Date of sample: _ `%-.l 7 i 7 Collected by: 5 ` S XlY Q B. SEPTIC/HOLDING TANK DATA Date installed i 9&3 Tank size loa'a Number of Compartments Cleanouts /l ) Z Foundation cleanout((! N) Depression (Yor-1 High water alarm (Y/N) , +o Date of Pumping 7- r'1 C. ABSORPTION FIELD DATA Date'installed 83 Soil rating (g.p.d./ft2 or ft2/bdrm) ! -system type LA) 77-; 4--�� �l Length' 7� Width _ Gravel thickness below pipe 3 Total depth Effective absorption area ? Monitoring Tube present (Y)N)--�/_ Depression over field (YAP i" Date of adequacy test S- / l Result as Fail) S For 3 bedrooms Fluid depth in absorption field before test (in.), Immediately after3S'"gal. water added (in.): --- vi 4 - Fluid Fluid depth (ins) Minutes later: e\90 Absorption rate7J o �- g.p.d. Peroxide treatment (past 12 months) (Y(% yes, give date I� 72-026 (Rev. 3/96)* Dae NeM03 •0 iaaeod ` d 00( .(96/S 'nad) 9Z0 -EL jegwnN }dlaoaH jegwnN ldlaoad 1uawAed }o a}ea ��� }uawr(ed }o algia $ aaJ aanlaM 7 $ aaJ VVH 'a;ep s/y# u /ed/o/unpV jo me.iAea pue s101 }uaoefpe uo sl eem aBem}s alolyan/Bul�jed Dull 001njas/ulew Jeje/N t V13f� 1 P alea aweN s,jaaul6u3 2 einleuB!S u/ sau/m6 /apVVH VopV y//M eouew.ro/uoo ur Isu/ play n.ry/ peu/wje4ep avec/ /;ey; Appeo / N011V31d11a30 S,a33NION3 'J ,,/,V - -"Ye ulejp up3pn0 76> ja}em amens Pol}epuno} Bulpling / p� Dull A}jadojd 01 IM NO a131J NOIldaOSI]V wOdJ 30NV1SIa NOUVUV'd3S o o slol luaoefpe uo spam l �oq aBeulejppolem eonpnS Dull aolnjas/ulew j31eM -f S plat; uo1ldjosgd r 01 Dull Aljadad I uo1lepunoJ :0110-1 NO NNVl EJNIa1OH/OIld3S wOH=l S30NV1SIO NOIIVHVd3S „1e uol}a}s }fly ' �� Gull Dolmas oI}das/ AemeS f lnoueelo/aloyuew jamas ollgnd -v r, ulew jamas ollgnd 8101 }uaoefpe UO r - }ol uo plat} uol}djosgy 1 <a o 8101 }ueoefpe UO }ol uo �ue1 Bulplo4/ol}deS :Ol 1M NO 73M INOW S30Nd1Sla NOliVHVd3S wn}ea* .1e lanai „uo dwnd„ su01186 ul az!S S30Nv.Lsia NOIIVEd /d3S '3 palsel sa }P lanal wjele ABIUM yBIH (NU.) ssaooV/aloyuew palle}sul algia NOIl`d1S 1JIl 'a �I CT&E Environmental Services Inc. Laboratory Division Drinking Nater Analysis Report for Total Colifor REA D INSTRUCTIONS OrV REVERSE SIDE BEFORE COLLECTING SAMPL! MUST BE CONIPLETED BY WATER SUPPLIER d PUBLIC WATER SYSTEM I.D.0 PRIVATE WATER SYSTEM Srnd Ret U -„ / Send Jnvo/iyce ,r��L//Vj 7 f&7/ ��tv Dote Oluua SAMPLE DATE: 22 1.51.1 I M Nfonth Day Year SAMPLE TYPE: ® -h kRoutine ❑ Treated Water ❑ Repeat Sample (for routine sample ❑ Untreated Water with lab ref. no. ) Date: Time: ❑ Special Purpose Time Collected SAMPLE LOCATION Collected By Plcu Print ,-n Bacteria 200 w. Potter Drive Anchorage, AK 99518.1605 Tel: (907) 562.2343 Fax: 1907) 561.5301 TO SE COMPLETED BY LABOPLATR? ORY An ysis shows this Water SAMPLE to be: Satisfactory a Unsatisfactory ❑ Sample over 30 hours old, results may be unreliable D Sample too long in transit: sample should not be over 48 hours old at examination to indicate reliable results. Please send new snmplcvia spe ial delivery mail. Date Received Time Received 10 0—. Analysis Began - /:13(�) Analytical Method: 41110vtembrane Filter . ❑ ty1l".10-MUG • Numberofcolonics/100ml. Lab c iNo,__ Result" Analyst 97.4272 ® -h $enr to A.D.E.C. Anch Fbks Jun W Faxed Date: Time: Client notified of unsntisractoty results: ❑ ❑ Phnntd Spoke with Faxed Date: Time: BACTERIOLOGICAL NATER ANALYSIS RECORD NIMO \IUG Result: Total Coliform E. Cali Membrane Fitter. Direct Count 0 Colonies/100 n l VeriGeation: LTB BCH COLIFIRM_ Fecal Coliform Confirmatiru �j Final Membrane Filter Results K-✓ Coliform/100 ml Reported By -(4 Darc Time q— hrs Comments: IIcrCO ruu iYygmm7 ru Gwnf OH -Ort,d 11"Wiu rvi ISOS Member of the SGS Group (Socimi GAnArale de Surveillance) sem_ 10i10'd 10ESi9SL06 39Ua0H9Nd IS3 3219 8G:I1 L66i-80– d CT&E Ref.X Client Name Project Name/X Client Sample W Matrix Ordered By PWSID CT& Environmental Services Inc. ei 974038002 5 & 5 Engineering N/A Lot 4 Bk 3 Juniper Drinidug Water Parameter Results Client PDX Printed Date/Time 07/30/97 12:29 Collected Uate/Time 07/24/97 13:45 Received Date/Time 07/24/97 17:10 Technical Director: Stephen C. Ede 0 Released By Nit rate -N 0.102 Total Coliform 40 OB W/O COLI Allowable Prep Analysis PQL Units _ Method Limits _ Date Date lniC 0.100 ms/L SM18 4500-No3F 10 max 07/25/97 ,12d SM18 92220 07/24/97 TMW 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. # 05-O 75-/-"23C) HAA # V, 1. GENERAL INFORMATION / Complete legal description eL.�Y'3_ M)Petlz y'4"Lt✓� F 3 4 Location (site address or directions) Property owner 19 4,A) DA -w&) F/�LL=-Y Day phone 6W -Z2-7,4 Mailing address �Q 2� ' )%� ���� �� �� �- q9h Lending agency Mailing address Day phone Agent C��vu,Ly Z1 6&f—W. Wik-2rt/J Arz Day phone C76 -96W Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site X— 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. 72-025 (Rev. 1/91) F1onl MOA 1121 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 verifythat 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 David R. Dayton P.E. Phone 20210 Donalar 5t, Address Engineer's signature 6. DHHS SIGNATURE A— Approved for bedrooms. Disapproved. Conditional approval for Additional Comments Date ZZAf3 v y c ,n 1 c R4 r s ` �n a. �u• ;4ac�r 7 [)uvid a. °Dayton ° rqo. 2205-t bedrooms, with the following stipulations: fay: 4tu� Date e— -5--93 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. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L4 63itno)GK-/G Parcel I.D. bSd 7S/ z,?" A. Well Data Well type & V4-7.2 If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) _ Date completed Driller ✓li-W Total depth Cased to 35:2� 4=g�5 Casing height Sanitary seal (Y/N) Date of test Static water level Well flow Pump levell FROM WELL LOG f�/ 43 7,00 SEPARATION DISTANCES FROM WELL TO: Wires properly protected (Y/N) AT INSPECTION u/C (7u,uo, F",V, w�Fe_� c. )VAP&6c-nonce 1-0 PL:'s-mD Uig Y,n E rvs J av,- S�iL t.}7 W •� W 4 7- g.p.m. K K-- r� U Z v Septic/holding tank on lot On adjacent lots /v�> M - 1 y a Absorption field on lot On adjacent lots Public sewer main _ A.) Public sewer manhole/cleanout n Sewer service line Petroleum tank A-) -6 WATER SAMPLE RESULTS: Coliform C% Nitrate 0, / C) Other bacteria cn Date of sample: T7��i /� 3 Collected by: 0 o 0 B. SEPTIC/HOLDING TANK DATA Date installed I9 S�) Tank size I D o O Compartments Cleanouts (Y/N) High water alarm (Y/N) Foundation cleanout (Y/N) ,y. 01 Depression (Y/N) lAlarm tested (Y/N) AJ�i3� Date of pumping/l3 / Pumper SEPARATION DISTANCES FROM SEPTIC/H®L-BMh1&TANK TO: Well(s) on lot _On adjacent lots Foundation To property line O+ Absorption field S Water main/service line Surface water/drainage 1 0C> f - /S_ '1�1/ 6:5- 72-026 S` 0 `Z 72-026 (3/93)• Front CONTINUED ON BACK PAGE aagwnN ldlaooU luewMed }o ala(] $ aad aanlaM N0e9 AM) sao-at aagwnN ldlaoa)A luawAud }o ala(] $ aad b'dH np too a-soz„ .(,JN A s, 2 ala0 UI / aweN slaaaul6u3 d, oUes aA eNAG. p E! o d aanlau6ls "1➢ d F L9966 aMsely'siNlfn.- 'IS rp1eu00 OLZOL .3.d uoaAe®'b pineG uo/loedsu/ spi /o elep ay; uo )oajja a saugapm6 b'HH pue yOn/ pe o} pauuo{uoo ao payuan `p040ayo aney I Iey11gfjJ90 I NOIIVOldlIU30 S.H33NIJN3 '3 n -ply a.a rC1 ^ JJ l a?F-l1v (v MON pNo uleap Ulejan'J 26-x-5 g'P. uu� .S'•• •'f',O/ N:a��?7i1. rv0ild7•nc td IV aaae 86eaols alolgaA/bul�aed `Mannan ai Q t�� . aalann aoapnS Gull aolnaas/ulaw aaleM– / �uagln0 a rn I slol luaoefpe UO n+oN Tol uo walsMs peuopuege ao 6ullslxe of �2 uollapuno} 6u!PI!n9 0l aull Muadoad - c) 0 slot luaoefpe UO lol uo IIaM Ol (]131d NO1ld8OS9d AOH=1 30NViSI0 NOliVU dd3S alae an16 `saM ll •9^ loN (N/A) (sgluow F[ lsad) luawlaaal aplxoaad r ferry— 9Z,T Tsai aal}b 7 Tsai aao}aq plat} uolldaosga ul lanai aalaM swoaapae ao} ZFUU, (Ilayssed) sllnseut lsal Moenbepe to ala(] (N/A) Plal} aano uolssaada(] /vI/l Z -1-/S gldap lalol (N/M luesaad lnoueelO ssauP!gl laneaO �c adMl walsMs 7rrd �<; O (zld/(]d J) bullea I!oS aalann aoi3pns slot luaoefpe UO 7�� g eaae uolldaosge lelol glplM O� gl6ua� "b l Pallalsul ale(] viva O131:1 N0I1dHOS9b '0 lol uo IIaM :Ol NOIlb1S ldlq WOH=J 30NVISI0 NOIldHdd3S (N/.l) sapoo laouloala VON slaaW palsal sGloMO la lana -1„}}o dwndl, le banal „uo dwndA (N/,k) ssaooy/alo aaanToelnueA lana) waale aalenn q6!H (N/A) IuGA suolle6 ul azlS / ' n/ pallelsul ale(] / NOLLVIS kill '0 D. R. DAYTON, P.E,, R.L.S. HQUOUNIUM Chugiak, Alaska 99567 (907) MMM 20210 Donalar 696-2417 July 26, 1993 ADEQUACY TEST Legal Description: Lot 4, Bl.k 3, Juniper Valley Subdivision Septic Tank: 1,000 gallon, 2 compartment, steel tank (DHHS Records) Absorption System: 40'long x 5' wide x 3' deep trench (DHHS Records) Soils Rating: 110 sq. ft. per bedroom (DHHS Records) Requirements: 3 BR - 450 gallons per day Test: Water was pumped into the absorption trench while measuring volume, time, and liquid level rise. After pumping was stopped, the liquid level drop was measured at timed intervals. The results were graphed on a graph of time and gallons absorbed and extrapolated to 24 hrs. Results: The absorption system is currently functioning adequately for a 3 bedroom home. Qt C°eoe n.• a ;r.eosv us ° W ,,,'• Uach: R. Daylon 1 W ?205 -E=d � �I` `2J'ROFESU) - D. P. DAYTON, P.S., R.L.S. MUMMAM` Chugiak, Alaska 99567 20210 Donalar July 26, 1993 WELL PLOW TEST Legal Description: Lot 4, Blk 3, Juniper Valley Subdivision Date of Test: July 25, 1993 Well Depth: 380 ft. Casing Depth: 217' Static Water Level: 200 ft per well log Requirements: 3 BR - 450 gallons per day, 0.3125 gpm (907) MAM 696-2417 Test: As the pump drop pipe is hung from the well cap, static water level and drawdown measurements were impractical. The flow was tested by pumping the water level down to the pump and measuring the flow for 4 hrs. Results: The well produced a constant flow of 0.93 gallons per minute with the water leve]. at the pump. The daily volume at the pump level is 1339 gallons per day. The well is currently producing adequately for a 3 bedroom home. A t' ,.• :n Uavi, F. Dayton „ ,;' r:o. 2205-E o°UP�y® to PR0FESS'J', — COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES SINCE 106 REPORT of ANALYSIS 5633 B STREET Chemlab Ref.# :93.3635-1 ANCHORAGE, AK 99518 Client Sample ID :L4 B3 JUNIPER VALLEY TEL: (907) 562-2343 Matrix :WATER FAX: (907) 561-5301 Client Name :DAVID DAYTON, P.E. WORK Order :68733 Ordered By Report Completed :07/29/93 Project Name Collected :07/25/93 @ 14:00 hrs. Projectit Received :07/26/93 @ 11:30 hrs. PWSID :UA Technical Director:STEP E � E� Released By Sample Remarks: ROUTINE SAMPLE COLLECTED BY: D.R.D. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init -------------------------------------------------------------------------------------------------- Nitrate--N 0.10 U mg/L EPA 353.2/300.0 10 07/27 LLH * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than "INSGS Member of the SGS Group (Societe Generale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA C MUNICIPALITY OF ANCHORAGE: DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CLRTIFICATE OF INSPECT ION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILI EY 254-4720 Application Date _ i - tk-S 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) C isE eT2 _—_VA1 L t Location (address (address or directions) (b) Applicant Name. v—t t ___C'� Telephone: Homer- "���` Business Applicant Address (c) Applicant is (check one): Lending Institution D ; Owner/builder Buyer C1 ; Other D (explain), (d) Lending Institution — ---_ Telephone Address --- (e) Real Estate Company and Agent Address Telephone (f) .Mail- the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family,, Multi -Family El Other Number of Bedrooms 3. WATER SUPPLY Individual Well Vzr Community E1 Public D Note: If community well system, must havewritten confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsiteo Public El Community El Holding Tank El Note: If community well systern, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 77-O 5 (11.64) 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 bedroorns 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 --_•,.--- Telephone s t , Address ---- t Date s. �NEP APPROV 1 Approved for ': ul _.- _ bedrooms by -�_ ,. J ' n– -------- - j Date Approved — _ -- Disapproved __— _— Condidin I _ Terms of Conditional Approval ---- i 1 Ae rr CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTII,,, MUNICIPALITY OF ANCHORAGE (MOA) 2 2 5' HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 RECEIVED 264-4720 Legal Des�r-ilp-tion: A. WELL DATA I If A, B, C, D.E.C. Approved (Y/N Well Classification PP ) Well Log Present (U)N) Date Completed `1- Yield z-2 , I I Total Depth - Cased to Depth of Grouting Static Water Level` ��= Pump Set At J Casing Height Above Ground ,>(r_� Sanitary Seal on Casing l) Electrical Wiring in Conduit('N) Depression Around Wellhead (Y(Q Separation Distances from Well: To Septic/H..Izldd pg Tank on Lot On Adjoining Lots ti= To Nearest Edge of Absorption Field on Lot � ��` ; On Adjoining lots _V ' To Nearest Public Sewer Line _ To Nearest Public Sewer Cleanout/Manhole 3 T To Nearest Sewer Service Line on Lot 1A--) '- Water Sample Collected by -� L�� `^� ` ; Date �71 Water Sample Test Results— Comments V�\ ►� - l i SF�rs iFkte \Ajge� "'�'yL,, B. SEPTIC/fff tk -TANK DATA Date Installed `N V_2'?2 Size zs No. of Compartments StandQSG pipestN) _� Air tight Caps ON) Foundation Clea oub-(-Y� Depression over Tank (YO / Date Last Pumped Pumping/Maintenance Contract on File (Y/N) _NlI14 ; for � Holding Tank High -Water Alarm (Y/N) Jn Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/-Hntdfrrg"Tank: To Water -Supply Well __— , 0-� To Building Foundation To Property Line To Water Main/Service Line _. Course Comments Page 1 of 2 72-028111/841 I,, To Disposal Field N To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption StrataType of System Design Date Installed \EL," Length of Field 4-�D, Width of Field lacµ Depth of Field — Gravel Bed Thickness 1W Square Feet of Absorption Area ��'�' Standpipes PresentON) Depression over Field (Y/P Date of Last Adequacy Test o p Results of Last Adequacy Test Separation Distance from Absorption Field: i To Water -Supply Well ?� To Building Foundation Lot `— { To Water Main/Service Line Vc� It A— To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle,Storage Area Comments D. LIFT STATION Date Installed d To Property Line To Existing or Abandoned System on On Adjoining Lots "2-o �r To Cutbank (if present) N )>n Dimensions Size in Gallons f Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at AA Vent (Y/N) Tested for Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all/MOA and HAA guidelines in effect on the date of this inspection. Signed3a �° t '1f31f�F i ihlCx Date ley 12� k�n+� Cornp�fV I LV�1 , t11 IC Jaz MOA No. (&'S — Oo3 V0. 604-P979 Receipt No. C�:=t Date of Payment q1._. c P c�Cs Amount: $ �-- Page 2 of 2 72-026 (11/94) ■ ••vl-C Jw'