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LODGEPOLE LT 3
Lodgepole Lot 3 #015-061-39 Municipality of Anchorage m e • � Development Services Department Building Safety Division On -Site Water & Wastewater Program, 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW040339 PID Number: 015-061-39 Name: ROGER AND DEANN STAPLEY Wastewater System: ❑ New ■ Upgrade Address: 5901 OLYMPIA CIRCLE * ANCHORAGE, AK. 99516 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 346-2486 55 D Deep Trench ■ Shallow Trench D Bed ❑ Mound ❑ Other* LEGAL DESCRIPTION Sell eating. Total Depth from original grade: 5.0 GPD/Sq- Ft. 6.0 MAX Ft. Block: Lot: Subdivision: — 3 LODGEPOLE Depth to pipe bottom from original grade: Gravel depth beneath pipe: 3.0 MAX FL 3.0 Township: — Range: — Section: — FlII added obove original grade: Gravel length: SEE DWG. Ft. 33 Ft. WELLGravel ❑ New ❑ Upgrade width: 5 Number of lines: Dietanro between lines: 1 — classification (Private. A9.C): Total Dep - Cooed To:( ) Total absorption ones: Ft. Ft. Pipe materiol: ^\G Ft. Ft. 165 so. Ft. D 3034/ F-810 Driller.\V Date Drilled: static Water Level: JJ Inatallen A+ Date installed: HOME SERVICES 8/23-24/2004 Yield: Pump Set At: Casing Height Above Ground: GPM - I Ft. TANK SEPARATION DISTANCES 13Septic ❑Holding ElS.T.E.P. ■Other* To Septic Absorption Lift Holding Public/Private Manufacturer. Capacity in gallons: From Tank Field Station Tank sewer Lines ANCHORAGE TANK 2000 Well 100'+ 100'+ — — 25'+ Mohm", STEEL Number of compartment°: 2 Surface Water 100'+ 100'+ — — — LIFT STATION Lot Line 5'+ **1'+ — _ — Size in gallons: Mmufacturer. 2000 ANCHORAGETANKORENCO SYSTEMS Foundation 5'+ 10'+ — _ _ lump on- level at: Pump off level at: High water alarm at: TIMER TIMER 49" Curtain DrainNONE KNOWN Pump Make t Model: Electrical Inspections performed by: #20 OSI OS HHF M.O.A. Remarks: **WAIVER ISSUED WITH PERMIT. BENCH MARK *THIS IS AN ADVANTEX TREATMENT SYSTEM. Location and Deeanpiion: EDGE OF GARAGE SLAB NEXT TO F.C.O. OLD SEPTIC TANK COMPLETELY ABANDONED PER UP ORENCO AND ANCHORAGE TANK AGREED TO USING 1 Assumed Ele otia"` 100.00 Fc 2000 GALLON TANK AND AN AX -20 POD FOR 5 BEDROOMS ENGINEER'S SF LQoOF O 4 Inspections performed by: GEG, Ltd. Dates: 1st 8/23/2004 * q T, 2nd 8/23/2004 , .•.... ••*.�QO 3rd 8/24/2004 G ss. �0 Development S ices Department Approval " • '•, c 7q53 e„pO 44��e Reviewed and approved by: Date: 8 Z levy eao (Rm. I2/01) �� Profession o� �400000�' u PERMIT NUMBER: AS—BUILT DRAWING PARCEL ID NUMBER: SW040339 015-061-39 / / A B c / CO 50.78 54.52 84.48 ST1 80.70 83.65 112.59 / MH 89.30 93.80 123.09 C01 94.44 96.37 124.59 / GENERAL LOCATION OF MT1 96.99 98.88 127,13 / OLD GRAINFIELD WAS / ABANDONED IN PLACE CO2 91.42 85.90 109.88 NEW ADVANTEX MT2 88.59 83.16 107.39 TREATMENT SYSTEM — — _ MH _ 10' UTILITY EASEMENT 01 �— i- _` e — _ MT1 NEW GRAINFIELD I I / FCO I Hg1 \ 2 \ BOTiArG \ a; NOGSEO,f \ \ 1 C 1 I 1 0' W RA S EXISTING WELL l OLYMPIA CIRCLE / / DATE: n i HTfi,£ 8/24/2004 0� OF DRAWN BY: v0 ............ • qV0� GARNESS ENGINEERING GROUP, Ltd. R.A.L. p o x CONSULTANTS& GENERALCONTRACTORS _ SCALE' 6 4 Py�Oo 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE. AK 99507 •PHONE (907)33] 6179 • FAX (907)338-3246 1 " = 40' ' •' • • " ' • ""' • •""".. PRO D FOR: PHONE NUMBER: PAGE NUMBER: ROGER AND DEANN STAPLEY (907) 346-2486 2 OF 3 •• • """ "" LEGAL DESCRIPTION: O f A. ess. LODGEPOLE SUBDIVISION; LOT3, O�� s C -7953 ceop� TYPE OF WORK:44 fP^0"p M./o �a/ti(o°'p AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE aprOfessiV' PERMIT NUMBER: AS -BUILT DRAWING PID NUMBER: 015 SW040339 015-061-39 TOP OF MANHOLE FINAL GRADE TOP OF ADVANTEX POD - 98.74 = = 97.78-98.04 98.26 2" INSULATION\\\ TOP 93 TANK \ = 93.67 /—TOP OF 93.73NK INVERT OF PIPE = 93.25 — ORIGINAL GRADE 96.00-97.02 2000 GALLON STEEL ADVANTEX TANK I FABRIC OF PIPE _ 94.02 0M OF = 91.02 GROUNDWATER RELATIVE ELEVATION ® 84.18 - BOTTOM OF TEST HOLE RELATIVE ELEVATION ® 81.52t— Ma TH#1 ._......_.._.__ v ... GARNESS ENGINEERING GROUP, Ltd. R.A.L. aaae. n== CONSULTANTS & GENERAL CONTRACTORS SCALE' 3701 TUDOR ROAD, SUITE 101 `ANCHORAGE. AK 99577 `PHONE (907)33]-61]9 `FAX (907)338-3246 N.T.S. �.......... ................. PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ROGER AND DEANN STAPLEY (907) 346-2486 3 OF 3 . ••.J re G rness:' LEGAL DESCRIPTION: �a E_ G LODGEPOLE SUBDIVISION; LOT 3, s�P is Zb/ c�o4 TYPE OF WORK: 044eo.p 0� PROFILE AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE wO °f,,Q000� G-25-2004 10:298 FROMpR+ HOME SERVICES, IN 907-868-6770 TO:3383246 c/ ...._. Z 4'j'3O 8/25/2004 5:35 PAGE 1/1 RightFax RightFaX Inspection Report Municipallty of An h' South brlagaw lding Safety plvlalon 4"0 INSPECTION: VOICE 343-8300 Name Address Legal subdivision Comments or Directions INSPECTION: FAX (907)7+49-7777 pD-5 ELECTRIC 5901 OLYMPIA CIR LT 3 LODGEPOLE AM CALL. 64 FOR ONSITE MTG Inspection + Retro Electrical P:1/1 1 Page I of 1 iNFOa343-7962 permit 04-8701 phone 272-4591 Inspection Date 8/25/ZOO4 SNO NONCOMPLIANCE OBSERVED ❑ CORRECTIONS ESSENTIAL AS EXPLAINED BE0 DO NOT CONCEAL UNTIL REINSPECTION 13 WILL RE-EXAMINE AT NEXT INSPECTION v. COMMENTS: (for inspector Use only)„ - . ✓ / (/J J � n; ^ .+ion N Date, Inspector file://C::%Yrogram%2OFiles%R.ightFRXa (- u Oing�M0003316.000 $/25/2004 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON --SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Permit Number: SWO40339 Legal Descriptl0CLOOGEPOLE LY —S Design Engineer: 0855 Garness Engineering Group, LTD Owner Name: ROGER & DEANN STAPLEY Owner Address: 5901 OLYMPIA CIRCLE ANCHORAGE, AK 99516 - This permit is for the construction of: Z Disposal Field 0 Septic Tank Date Issued: Aug 13, 2004 Expiration Date: Aug 13, 2005 Parcel ID: 015-061-39 Site Address: 005901 OLYMPIA CIR Lot Size: 29219 SQ. FT. Total Bedrooms: 5 Permit Bedrooms: 5 ❑ Holding Tank ❑ Privy ❑ Private Well [I Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. RYZ'410'j — NOTE: No rtFNNoL"r WIC.- OE INTT�4cc W -r En ova To SPecIµL PUS rc�TrI>UL, CLFRN'�Wi4c RF I'N'S rR�cEO 47- 6'VD bC LF ShJeuL�i13E Rp£OvArE. DIo Sir 9cr/FiE�� y,�,� wfP«rio,a o�- 110uav7-Ex 2NSTH�tHTiON Received By: Date: Issued By: Date: /T� WR Date Lega Er5g1 Appli Waivt trite Waiver LisCC'o c><pal><ty of nchorage , _ 'pment Services pepartment .Building9"afety Dlvfjjon _ . ite Water andVastewater Progra__m 4700 w -'a gawStreetB`-'a CM68M AK VAVW.ci.anchorage.ak.us ..- Total, - T By; ar7 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 0 5 — —28 Property owner(s) ROGER & DE NN 4TAP Fy Mailing address (1) Permit Number Day phone _ 346-7485 Mailing address (2) Zip Code 9951_—_ Legal description (Lot, Block & Sub'd.) _ LOT 3 LOT SUBDIVISION POLF SRnIVISION Legal description (Section, Township & Range) N/A Lot Size. (9 19 -- , Acr s/Sq.Ft. Number of Bedrooms g THIS APPLICATION IS FOR: Sewer Only Well Only Sewer and Well S ■ Water Storage Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool 11 Jacuzzi El Water Softening UnitI El I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP Ltd. Permit Fees: "[ L } �!j !A Waiver Fees- _ Date of Payment: _E� rj�G i Date of Payment: Receipt Number. Gf 2�;7 Receipt Number:- ARNESS ENf`rINiERING GROUP, Ltd. CONSULTANTS & GENERAL C0NTRAGT4RS ,1111= . m=u August 6, 2004 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic System Upgrade for Lodgepole Subdivision, Lot 3, To whom it may concern: A design was previously submitted and withdrawn from your department for a new septic system on the subject property. The design and lot line waiver fees have already been paid. The existing 5 bedroom house is served by a private well and septic system. The drainfield is in a state of failure and needs to be upgraded. A test hole was excavated on the property. The drainfield will be designed around the 30 foot radius of this test hole. We are proposing that a 2000 gallon Advantex Treatment System and a 5 -wide trench type drainfield be installed. Comments regarding the design are summarized as follows: 1. SOILS: See the attached log which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that due to the overall appearance of the soils, an application rate of 3.0 gallons/day/ft' should be used. pp 2. TRENCH DESIGN: a. Percolation Rate: 2.0 & 8.0 minutes/inch b. Proposed Application Rate: 3.0 gallons/day/ft2 c. Number of Bedrooms: 5 d. Design Flow: 750 gallons per day e. Minimum Absorption Area: 250 ftZ f. Total Depth: 6 feet (max.) g. Effective Depth: 3.0 feet h. Width: 5.0 feet i. Reduction Factor: 0.58 i. Minimum Length: 30 feet long total j. Effective absorption area = 258 ftZ 3. SURFACE WATERS: There are no surface waters within 100+ feet of the proposed septic system. 3701 E. Tudor Road, Suite 101 *Anchorage, AK 99507 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: garnessengineering.com 4. TOPOGRAPHY: As can be seen on the attached topography site plan, the average topography in the area of the proposed drainfield is reletively flat. In short, there are no slope concerns. 5. LOT LINE WAIVER: We request a 1 foot lot line waiver to the west lot line. We are unaware of any impacts on the adjacent lot with the granting of this waiver. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please— co us at 337-6179. Thank you for your M.S. NOTE: Attached is a site plan drawing, a design drawing, a topography site plan, a soils Zog, and a 7 page construction specification letter which are all part of the design packager this septic system. 3701 E. Tudor Road, Suite 101 *Anchorage, AK 99507 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: garnessengineering.com BERRY AVE.----�- [SEPTIC ARS i I LOT 9 I CRESTWOOD S/D I vje LOT 10 CRESTWOOD S/D I I I l PROPOSED'SEPTIC SYSTEM UPGRADE (SEE DESIGN PGE2 OF 4) ----_—_— [SEPTIC --__—~-- AIOT — PEA i 1 E. D LOT 2 1 LODGEPOLE S/D LODGEPOLE S/D TH#1,-1 i _ 1 EXISTING 1 cvci ` I LOT 7 LODGEPOLE S/D \ ----------------- GARNES4 ROGER AND DEANN STAPLEY r LOT 11 CRESTWOOD S/D CP� I 1 i I I I I I I I I I LOT 13 CRESTWOOD S/D I i I I I L LOT 12 1 CRESTWOOD S/D I 5 700, kat LOT 6 ' CSEPTIC LODGEPOLE S/D ARS i ---------------- i LODGEPOLE SUBDIVISION; LOT 3, OF WORK: SITE PLAN FOR SEPTIC SYSTEM U GROUP, Ltd. A 100' WELL RADIL15 I i I LOT 4 LODGEPOLE S/D/ I % r � I I II I I I I I I LOT 14 1 1 CRESTWOOD S/D I i I I L_.-------. it i I I I I I LOT 15 I CRESTWOOD S/D I I I I I I I I I I I I LOT 16 I I LODGEPOLE S/D I I I I LOT 5 I I LODGEPOLE S/D I I I I --------------- I I C.J.G. 1" = too, 7 OF 4 I f I I I I I I I OF Y� ff / NOTE: THE CONTRACTOR SHALL HAVE THE NORTH AND WEST LOT / LINE AND THE 100' WELL RADII SHOWN FLAGGED BY A REGISTERED LAND � SURVEYOR PRIOR TO CONSTRUCTION. PROPOSED DRAINFIELD. EXCAVATE A TRENCH THAT IS 6 *FEET DEEP INSTALL DOUBLE MAXIMUM BY 5 FEET WIDE BY 30 FEET LONG. ADD 3 FEET OF CLEANOUTS CLEAN, WASHED SEWER DRAINROCK., PROPOSED 2000 GALLON — — — — — — — — — — — ADVANTEX TREATMENT SYSTEM — — I - — — — — — - 10' UTILITY EASEMENT I I I 'IMT 0 — T*#,1 II I I I I INSTALL FOUNDATION \ II I CLEANOUT \ I <IMT ti w HOuS, 04f oa 1 --100' WELL RADIUS ` EXISTING SEPTIC SYSTEM TO BE COMPLETELY ABANDONED EXISTING WELL I \ / CONFlRMATION TESTHOLE TO BE OLYMPIA CIRCLE \ DUG PRIOR TO CONSTRUCTION / _-/ j DATE: 8/6/2004 o9�Qopp GARNESS ENGINEERING GROUP t DRAWN BY: p �.. F C.J.G. 370x4. CONSULTANTS & GENERAL CONTRACTORS �t d'� SCALE: 'rl..l O na:asmuxiv 3701 E. TUDOR ROAD, SUITE 101 `gNCHORAGE, AK 99507' PHONE (907)33]- PREPARED FOR: 6179 • Fax (9077338-3246 r: " c 40' ....... A (1 . 70, O ..7..... * O ROGER AND DEANN STAPLEY PHONE NUMBER: LEGAL DESCRIPTION: 346-2466 PAGE NUMBER: 2 OF 4 .........: O Q " . LODGEPOLE SUBDIVISION; LOT 3, Y Garne - 0�04� TYPE OF WORK: E 7 co0,9 ' DESIGN DRAWING FOR SEPTIC SYSTEM UPGRADE \o pOP ' A o 4eap ofessio�o,��o" 4�DOp00��' AdvanTex Treatment System AX Series - Mode la One (1) 40x96 Pod aL `mse M 2" INSULATION- M INLET NOTE: THE BOARD INSULATION TO BE INSTALLED OVER THE SEPTIC TANK & 4" BEYOND ON ALL SIDES EXCEPT UNDER THE ADVAMEX FILTER. THIS WILL ALLOW FOR HEAT TO ESCAPE FROM TANK & RISE TO THE FILTER ABOVE R. [1NG GROUP, Ltd. LL CONTRACTOR. ___... ROGER AND DEANN STAPLEY PHONE NUMBER: (907) 346-2486 .GAL DESCRIPTION: LODGEPOLE SUBDIVISION' LOT 3, 'PE OF WORK: ADVANTEX PROFILE C.J.G. N.T.S. NUMBER: 3 OF 4 l 'q 2 0 lklffimw F—`--`------_~—_--__` / _—.—_~--.__`�_.MTO ICO IGINAL (D :PAL IS ENGINEERING GROIJP� Ltd. CONSULTANTS& GENERAL CONTRACTORS,, SCALE: E. A [P=AGENUMBER: 37 TUDOR ROAD, SUiTE iOf ANCHORAGE, AK 99507 PHONE (907)317-6119 ` FAX 7X`31-3246 FOR 86 �p� R I ' 2 7=4 IREPARED FOR: FAX (907)Z38-324 N.T.S. 0 R PL PHONE R G PHONE NUMBER: ROGER AND DEANN STAPLEY go rA .346 LODGEPOLE SUBDIVISION' LOT .3, fPE OF WORK DETAIL DRAWING OF PROPOSED DRAINFIvIn GARNESS ENGINEERING FOR"SULTANOUP, .--..--• ,.... - •M1a: lWl1JJ8-]346 -KO gSony— .�com SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: LODGEPOLE SUBDIVISION; LOT 3 PERFORMED FOR: ROGER & DEANN. STAPLEY -_ DATE: 7/17/2004 ORGANICS TESTHOLE 1 iM /SW 19 ) NERCHOLE - -- vniv.i nv�n . E DIA. 6(INCHES) 20 TEST RUN BETWEEN 6.0 FT. AND 6.5 FT. A FOUR HOUR PRESOAK WAS PERFORMED: SOILS LOGGED BY: SUSAN OSWALT YES ❑ NO PERCOLATION TEST PERFORMED BY: ROB CAMPBELL COMMENTS: NUM Y A• arness, JE .. 3 . pro f e s siono� o PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS R ORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: Q j{G GARNESS ENGINEERING GROUP > Ltd. JUIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: LODGEPOLE SUBDIVISION; LOT 3 PERFORMED FOR: ROGER & DEANN STAPLEY DATE: 7/17/2004 DEPTH O GROUNDWATER (feet) t TEST HOLE # 1 (PAGE 2 OF 2) 2 SOIL CLASSIFICATIONS 2-- - GW ORG 3 W GP ML CD GM CL 4 0- GC OL Isc F�S�E 10 SW MH 5 O SP CH O SIM � ,' OH6 � If p 7 -WI DEPTH TO (PAGE 1 OF 2) O GROUNDWATER DATE 8 2-- N1 6F -.__-__—_._W._ GE 10 Of O L�. 1 t DATE READING CLOCK NET TIME WATER LEVEL NET DROP z TIME (MINUTES) READING (INCHES) 12 0 7/20 2004 1 4:16 6 13 Q U 2 4:46 30 2 1/4" - 3 3/4^ _ 3 4:46 - 6„ _ 74 4 5:16 30 2 1/4" 5 5:16 6,. - - 15 0 6 5:46 30 2 1 4" 16 _J O V) 17 W (n 18 19 PERCOLATION RATE 8.0 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 2.5 FT. AND 3.0 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: E YES ❑ NO SOILS LOGGED BY: SUSAN OSWALT PERCOLATION TEST PERFORMED BY: ROB CAMPBELL COMMENTS: PERFORMED BY GEG, IN ACCORDANCE WITH Ltd. I, JEFFREY A. GARNESS, CERTIFY ALL STATE THAT THIS WAS PERFORMED AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 43 0 r� 771 ER RY, AVE. s ARS LOT 13 \\ CRESTWOOD S/D LOT LOT 10 T 11 OT 12 CRES OD S/D CRESTWOOD S/D CRE S/ CRE 09-sfa r -TODD VACANT STING EDROOM T 14 PROPOSE SEPTIC SYSfE UPGRADE SE ESTW S (SEE D GN PAGE OF d� I CSE 'IC RELIC LOT LOT 1 LODGEPO S/D .k LOT 4 LO EPOL-E'S/ L GEPOLE S/D LOT 15 RESTYOOD S/D J rte; SEPTI A TEM LOT 100' K, L OLE S/D A'AD� LOT 7 LO 6 [SEPTIC LOT 5 DGEPOLE S/D LODGEPOL S/ AREAD LODGEPOLE S/ DATE: s/s 04 oao0 Cpp4 DRAWN BY: I� C.J.G. •'• f ter. SCALE: 701 E. TUDOR ROAD I A'JCHORAOE AK 99507 ' E (907) ]-61]9 `FAX (90])538-32L6 - 100. :..:.. . :....D -- .........� PREP ED FOR PHO UMBER: PAGE NUMBER: ROGER AND DEANN STAPLEY 3 6-2 1 OF4 Q ' 0A �^ Gar ess. � —7 LEGAL DESCRIPTON. LODGEPOLE SUBDIVISION, LO 3, pyo fessC000\ TYPE OF WORK: `" SITE PLAN FOR SEPTIC SYSTEM UPGRADE pppp0000� I8-26-04;10:29AM;A11h111ge T2hk ;90727737t5 # 1/ ; August 17, 2004 Anchorage Tank & Welding, Inc. 2700 Porcupine Drive Anchorage, AK 99501 RE: Lodgepole LT 3 Residence Attn: Jim Jensen Jim, After reviewing the design for the Lodgepole LT 3 residence, I have confidence that the system as designed with a 2000 gallon processing tank and single AdvanTex pod and monitored with VeriComm will function properly. Please keep in mind that any recommendations outside our published design criteria will be reviewed and discussed on a case-by-case basis. If I can be of further assistance with respect to Orenco design criteria, or if you have any questions, please don't hesitate to call. Sincerely, Joseph R. Soulia Regional Sales & Technical Service Representative jsoulia@orenco.com Encl. JRS/js 1 I S S-(jA-V C- ®F- P � MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERI,Cr pJ.j($,L�N L.GP.AGe 825 L Street - Anchorage, Alaska 99501 e ; C264r.47'�0 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OFfWEL)LIMINSPECTtONCREPORT NAME IPHONE Jf NEW L. Van Whitehead.:i",,i 344-8001 ❑UPGRADE MAILING ADDRESS SRA 71-A RECEIVED LEGAL DESCRIPTION Lot 3 Lodgepole Subdivision LOCATION NO. OF BEDROOMS East off Birch Road between Abbott Rd & O'Malley 5 Well Absorption area Dwelling PERMI NO. OY DISTANCE TO: r , 34' I 0`z2-Z, IL Z Manufacturer Material No. of compartments wla- r, Steel 2 H Liq. capacity in gallons -�, IF HOMEMADE: Inside length Width Liquid depth =` DISTANCE TO: Well Dwelling PERMIT NO. JaZ SZ F Manufacturer Material Liquid capacity in gallons 0 w= DISTANCE TO: Well Foundation � e Nearest lot line PERMI O. IDSt -jl�r I��ZZL LL LU Z No. of lines Length of each line Total length of lines Trench width Distance between lines P: Z w r r r 6 n inches Imo-. Top of tile to finish grade Material beneath tile Total effective absorption area O r inches Length Width Depth PERMIT NO. w a Q F as w Type of crib Crib diameter Crib depth - Total effective absorption area W DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. r W DISTANCE TO: BuildirrT%Wndation VV Sewer Ii1e05 r Septicnb r AbsorptioI er!(e) OTHER ` PIPE MATERIALS S IL EST RATING $ C INSTALLER Owner REMARKS !'( s �( : `I 2 9 O �}I iF ® o e°p 7/TA� ` V, �/�i `"V!_g6�tl .dry o ev©000000000© e o � � n. 1069 - E 0 o r 1° s p 0 OF F0�1P °. /�//q ®°9°e�dbeee oo e° t APPROVED�C4 oo°oeoaoee _® DATE LEGAL FESSIIan® ;� z� \� ' � � � � � � / > «:<a..w,a, a : � : \�������"�� ������`J��w\\ /�� 1��� � ��� � � � � 2� � � � �_�%:� ���:g���.� ����\\ \� � \ „ � � �� � z � � � � � « � �������������/�������\t7 ° °© \ w� � � »� � � � _,� w . s x� .� « z\ ° -' PERMIT NO. ' Val ��x L__ X LF� xV�rl t-9 I- r_4 k- " Ul pe " I -i k__ DEPHRTMENTO� HEHLTH AND ENVIRONMENTAL TECTI�N 825 '' `STREET/ ANCHORAGE., AK. 9/ , ^ 264-4720 klF_=l L_ ��AE-A :1 _rlE:- �EERR."rl I 'T' APPLICANT L. V. WHITEHEAD SRA 164-W LOCATION OLYMPIA CIRCLE/ LEGAL LOT ] LODGEP8LE SUB TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH Df lbvu 4D LOT SIZE 211'0100 SQUARE FEE -T- �I MAXIMUM NUMBER OF BEDROOMS = 5 SOIL RATING (SQ FT/BR)= 165 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: E -a EF r- -r " — F-=. L_ F="" WZi -r " ���# ���F::� V F= I ����" == �4 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). F --"F=- G:� U l C-- _�-- F= r-' -r I ll:� -F F=f r-4 K _�-- :1 2' E: �!fo CD El 13 Ff I I CR�� PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE ���CA ��� I "—"= F="a f_� -r I RD " =�,, �F;:-'F= ��0 LJ I F;Z a C-8 — —~ BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE I -JELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM A PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ]0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. �E F;_"M I -IF �X P4 I FR E:'H. E--; [-= ff=� F= M E� FEE F2 ��� ���- - I I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IM ACCORDANCE WITH THE CODES. ]� I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REM LED TO INCLUDE MORE THAN BEDROOMS SIGNED� �w_~_~-----_ HPL.V. WHITEHEAD / ISSUE[) BY�DF�T ��_/�. V4.0 ❑ SOILS LOG MUNICIPALITY OF ANCHORAGE i i +®c DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: - / DATE PERFORMED: LEGAL DESCRIPTION: ' SLOPE SITE PLAN DEPTH- (FEET) 3 4 5 7 8 9- 4- 10- v, 10v, 12- 13 14 15 �.q,R►0� 16 •+ '� 17 � 18 N o• o as a %� waft"Ma Q. Tclbor a �� 19 W 4069-E 20P 0 910 eey4 AOFESSNA r. COMMENTS�i PERFORMED BYE--�- Reading Date WAS GROUND WATER J} S ENCOUNTERED? L O co P IF YES, AT WHAT ! E %s DEPTH? 1 Reading Date Gross Time Net Time Depth to Water Net Drop co PERCOLATION RATE I C) (minutes/inch) TEST RUN BETWEEN -) FT AND ,� FT # ( i ATE: CERTIFIEDBY: 1 < 0jp, �1 Io I VI ,/ i J e y- December 29, 1978 #780204 George Clemons 5741 East 10th Avenue 01 Anchorage, Alaska 99504 Subject: Lot 3 Lodgepole subdivision A permit issued by this department for well and/or sewer system has expired. 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 should be sent to this department to document the installation date. If there are any further questions, please contact this office at 264®4720. Sincerely, Les N. Buchholz, R.S. Senior Environmental Specialist L-- B/ljw enc: copy of permit �U AD X 1c E L— ::0-, o����� , DEP�RTMENT OF HEALTH HND ENVIRONMENTHL PROTECTION 825 'L' STREET, HNCHORHGE/ 501 264-4720 PERMIT NO ( 780204 ) HPPLICHNT 6741 E. 101H APT 1 ]]] 410] LOCHTION LODGEPOLE S/D LEGHL L] LODGEPOLE S/D LOT SIZE ]2670 SQUHRE FEET MINIMUM DISTHNCE BETWEEN A WELL HND HNY ON�SITE SEWHGE DISPOSHL SYSTEM IS 100 FEET FOR H PRIVHTE WELL/ OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL WELL LOGS HRE REQUIRED HND MUST BE RETURNED TO THE DEPHRTPI ENT WITHIN ]0 DHYS OF THE WELL COMPLETION OTHER REQOIREMENTS MAY APPLY SPECIFICHTIONS HND CONSTRUCTION DIHGRHMS FIFE HVHILHBLE TO INSURE PROPER INSTHLLHTION 11" E17 If"! RVI X -V Ei K IF'" 1E �IE-H P-1 PIT F=7 FT ���� "f��:g�� I CERTIFY THHT 1� I HM FHMILIHR WITH THE REQUIREMENTS FOR ON~SITE SEWERS HND WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE. 2� I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH THE CODES. �� SIGNED� ��� .. — —~— HPPLICHNT' GEORGE CLEMONS 2 ISSUED BY.� Parcel I.D. 015-061-39 Municipality of Anchorage On -Site Water and Wastewater Program x m� (907) 343-7904 Certificate of Ona -Site Systems Approval 1. GENERAL INFORMATION Complete legal description LOdgepole, Lot 3 Expiration Date: T" 8 -13 Location (site address) 5901 Olympia Circle Current Property owner(s) Steven & Heather Kinzie Day phone Mailing address 5901 Olympia Circle, Anchorage, AK 99507 Real Estate Agent 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request Received by: . 7i .GZ�l4('�'I Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ YqU m Waiver Fee $ Date of Payment _ C��l3 Date of Payment Receipt Number aem Receipt Number COSA # _ (;B -- Waiver # S. 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 Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE V System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Date f ,1�0 0-0 C Conditional approval for bedrooms, with the following stipulations: By: - Original Certificate Date:. " r� Thenici ality 44erage 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 r c If more than 1 septic system is on the lot: COSA Checklist # 1 of Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: LOdgepole, Lot 3 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 5/1981 Sanitary seal (Y/N) Y Total depth 87 ft. Cased to 87 ft. FROM WELL LOG Date of test 511981 Static water level 45 ft. Well production 6 9.p -m. WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate 7.32 mg/L Arsenic ND ug/L Date of sample: 1/22/2013 B. SEPTICIHOLDING TANK DATA Tank Type/Material S.T. E.P./Steel Tank size 2000 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Date of pumping 5/8/2012 Parcel ID: 015-061-39 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 18 in. AT INSPECTION 1/22/2013 41 4.0+ ft. Collected by: P.E.S. Date installed 8/23/2004 Cleanouts (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) Y Pumper Anchorage Tank C. ABSORPTION FIELD DATA Date installed 8/23/2004 Soil rating (g.p.d.Ife or fiz/bdrm) 5 gpd/sf System type Wide Trench Length 33 ft. Width 5 ft. Gravel below pipe 3.0 ft. Total depth 7 ft. Eff. absorption area 285 fe Monitoring tube Y Depression over field N Date of adequacy test 1 /22/2013 Results (Pass/Fail) PASS For 5 bedrooms Fluid depth in absorption field before test 0 in. Water added 760 gal. New depth 5 in. Elapsed Time: 220 min. Final fluid depth 0 in. Absorption rate >= 750+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed $/2312004 Size in gallons 500 "Pump on" level at Timer in. Datum Bottom E. SEPARATION DISTANCES WELL ON LOT TO: "Pump off"level at Timer in Cycles tested 3 Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 50+ Manhole/Access (YIN) Y High water alarm level at 49 Meets alarm & circuit requirements? Y 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 Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS * WR# 040060 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 / ' SO 2 cl COSA brown sheet 10-10-12.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage11 0+ in. Municipality of Anchorage ti Community Development Department s Development Services Division On -Site Water and wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 131028 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 3 of Lodgepole subdivision. This inspection revealed a nitrate concentration of 7.32 milligrams per liter (mg/L) was reported for the property's well water sample. 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. 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. 05/31/2012 15:59 8686770 APLIIS PAGE 05 189 215 sent on ■ Monosson on ■aaaaaa■ on an fIr• ■ ■ ■ ■ I 11 ■ a ■ a ■ ■8r■ esss �* ■t on on ■ on on ■ 88■ Not nows, A�1vaNTexe Rdd Maliftmnee Report gnchorageTank & Welding, Inc. Annual Inspection 907-272-854.q InePab ewaedbsewaae ewrem I r OPeretar - _ _. — _ _ ., Steve Kinzie 2nd Camparbnem Mike Ellakeslee Previous SRO wdnes Pmvious rP 5901 Olympia Cirde, Anchorage AK 99518 (907) 243-2403 3-2403 Ax SM100Ce.mly me Peas M41111.4 peM ntLal Mriyeerbn AX -103985 SW040339 203507 RTL1103547 07/19/2011 Retrieve O&M hrfe Dairy flow Roche ratio Thar sattings: Perform Field Sempllny/06servstlons NTU p 6 s NTUsj pH � 00 ty,g) �' r 5 Oda' lif 41 le lyplasl musty ❑ Earthy ❑ Moldy Non4pical 4901dis ❑Cabbage 00may OlyalMlhPW, ❑Yea 0 N FoeMsrtgrrk ' ❑Tm MNo Check Control Panel Helm Amps Discharge Amps Audible a� visual slamrs OK Dial tone (telemetryony) Yea ON* Inspeet/Ciean Pump System Ine Cyan FdearA.Id ..................... SpIl" Dox .................... Float Cnrds ................... Floats ....................... Pump ........................ I�Cj 9iotubee Fiher................. 9btubs Pump Vauh ...........: Flacirotdating Solder Vohs....... Comments Measure Sludge/Scum Sludge Sarin 1st Campsrlmem ewrem I r Pmvyus Cunent Pmvtaae 2nd Camparbnem Oumem,'/ Previous curmm Pmvious InspectfWasn AdvanTex Filter (aspect Clams Cdpr. Normal ❑Pungent I LateralaAWoes fel` Bianaq onml ❑ Exassahre Pad Mom ,`�' addging/Pmsgng: Noaeninnor ❑likaesalve 1111 Intake Yam "P J Inspen WoJimin Olsakarle Pump System Inspect Inspect cle RysrNa iG''1 Flaatn jd'j �/ aplke Box pump yl Floal cords •/— InapecHSsrvlce Other System Compananta Inspaa C,( llean Inspect Cyan / Disinfection Equipment y_7 Dispersal Laterala/Cdnnes/ Observations Additional Services Rendered "j' El Cleaned Willa sheets? ❑ Replaced W mama? /J ❑ ReplaesdAlaad oiler Rema? Parts Uned: w e warra ft a e I1glabie (✓ appropdato selection) W 9 Ilam Number Dosmfo en Fin��s--,lf9s►aty Inspection SV reinstalled Manitold mannneaed; flush vaNes Closed Srrmmary/Resommendetlons ❑ SYstam PadomNng; no further adilmr needed ❑Calltoreenrice '9Llds bolted on Central panel mastivated ❑Tank nooda pumping ❑ ollrer'1 Fax completed form to 1-866.384-7404 0 0 ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT MEMORANDUM OF UNDERSTANDING BETWEEN MUNICIPALITY OF ANCHORAGE AND Seo-#- THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this Day of of 20L3_, by and between SLD herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Memorandum of Understanding agree as follows: 1. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as A90VH,�1�jG located at L006t Fbt,G , L.OT3 / Sg01 OL?P?PtRLlP.. , Anchorage, Alaska. 2. Definitions. A. Alteration. Any change to the design or function of an AW WTS that Includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Prior to performing any alterations to an AW WTS the owner must obtain a Wastewater Disposal System Construction Permit from the Municipality pursuant to Anchorage Municipal Code (hereinafter, "AMC') 15.65. B. Certificate of On -Site Systems Approval. An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with AMC 15.65. 0 0 These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. C. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. D. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AWWTS that were included in the original design which would allow the AWWTS to continue to perform as designed. E. Permit (Construction) An On -Site Wastewater Disposal System Construction Permit as defined by AMC 15.65. F. Permit (Operating) An Advanced Wastewater Treatment System Operating Permit. An annual permit, issued by the Municipality, that allows the Owner to operate an AWWTS, upon meeting all the requirements of this agreement, the conditions of Operating Permit, the requirements of the On -Site Wastewater System Construction Permit and all relevant provisions of AMC 15.65 3. Fee. Owner shall pay to Municipality an annual fee of Zbxa ($ O .00), payable on or before the issuance of the operating permit and annually thereafter. The annual fee is due on or before the anniversary date of the approval by the Municipality of installed system. 4. Term. The term of this Memorandum of Understanding shall be for the life of the AWWTS. 0 0 The term begins on the date of approval by the Municipality of the installed system and shall continue while the AWWTS system is in use or operational or until the property is sold or title is transferred by owner and a new certificate of On -Site approval is issued to the new owner or transferee of the property. 5. Alterations, Installation and Removal of Additional Equipment. Owner agrees not to make any alterations, removal of parts or additions to the AWWTS without a Construction Permit from the Municipality. 6. Maintenance and Repairs. A. Throughout the tern of this Memorandum of Understanding, the Owner shall maintain AWWTS in good repair. In addition, it shall be the responsibility of the Owner during the term of this Memorandum of Understanding, and any extensions or renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs. Further, Owner agrees to comply will all applicable ordinance, laws, regulations, rules and orders for the AWWTS. B. Owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system pursuant to the terms and conditions contained in the Owner's AWWTS Operating Permit. This schedule shall be submitted to the Municipality annually upon the renewal of the permit. The schedule of maintenance and repair contained in the Owner's AWWTS Operating Permit is: /9S 9C45t 1jC6Y2 C. Owner acknowledges that the fine schedule for failing to maintain and repair an AWWTS are codified in AMC 14.60. 0 D. Owner agrees that only maintenance, repair personnel certified by the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system. E. Owner agrees to grant the Municipality reasonable access to test and inspect the AW WTS upon 24 hours written notice. F. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. G. Owner agrees that the relevant provisions of the standard specification guidebook for AWWTS is the governing professional guidelines for the construction, maintenance and repair of the Owner's AW WTS. 7. Nonwaiver. The failure of either parry at any time to enforce a provision of this Memorandum of Understanding shall in no way constitute a waiver of the provisions, nor in any way effect the validity of the Memorandum of Understanding or any part hereof, or the right of such party thereafter to enforce each and every provision hereof. 8. Amendment. A. This Memorandum of Understanding shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality of this Memorandum of Understanding was executed and such writing shall be attached to this Memorandum of Understanding as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this contract, the only authorized representatives of the parties are: Cl Owner: Anchorage: Purchasing Officer 9 C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 9. Jurisdiction: Choice of Law. Any civil action arising from this Memorandum of Understanding shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Memorandum of Understanding. 10. Severability. Any provisions of this Memorandum of Understanding decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Memorandum of Understanding. Date: 30 :T-aK 13 STATE OF ALASKA THIRD JUDICIAL DISTRICT The foregoing instrument was 20p3 ,by 8e0+4- -t, G MUNICIPALITY: By: Title: Date: ss. J before me this day of Jarlaartj NOTARY PUIJLIC FOR ALASKA My Commission expires: Y - 3 - Ko OF ALA NOTARY PUBLIC Janie R. S'a. Maria Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage. AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. (11 U 01 - �51/�COSA# 1. GENERAL INFORMATION Expiration Date:5 - 0 Complete legal description _ LODGEPOLE. LOT 3 Location (site address) 5901 OLYMPIA CIRCLE 99507 Current Property owners) SCOTT AND BEVERLY ELIASON Day phone C/O AGENT Mailing address 5901 OLYMPIA CIRCLE 99507 Lending agency Day phone Mailing address Real Estate Agent JULIE JEWELL Day phone 223-3211 Mailing address 3111 "C" STREET "ANCHORAGE, AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of Installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described 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 soils condition, 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 the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE _JC Approved for bedrooms. Disapproved. Phone 337-6179 110 13j— Date 7 I e�� �.�� .0•� 6°Qct Conditional approval for bedrooms, with the flowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other .y., ON-SITE ; WATERAND ; WASTEWATER PROGRAM , By: d W Original Certificate Date: 2 1 (Rev. 11M) Municipality of Anchorage '-) Development Services Department Building Safety Division On -Site Water& Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: LODGEPOLE, LOT 3 Parcel ID:OIS' 061' 37 A. WELL DATA Well type PRIVATE If A. B, or C provide, PWSID# N A Well Log (Y/N) YES Date completed 4/1981 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 87 ft. Cased to 87 8. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 4/1981 1/30/2008 Static water level 45 g, . 43 g, Well production 6 g,p,m. 5.1 g.p.m. WATER SAMPLE RESULTS: p Coliform 0 colonies/100 ml. Nitrate Sc `moo mg./L. Other bacteria_colonies/100 ml. Arsenic: 0 • N(.7ug./L. Date of sample: 11/3 0 2008 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 8/24/2004 Tank size 2000 gal. Number of Compartments 2 Cleanout s (Y/N) YES Foundation clea (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) YES Date of pumping N/A Pumper DOES NOT REQUIRE PUMPING C. ABSORPTION FIELD DATA BELOW EXISTING crude Date installed 8/24/2004 Soil rating (g.p.d./ft'o /bdr 5 System type TRENCH Length 30 ft. Width 5 ft. Gravel below pipe 3 ft. Total depth '6.2 ft. Eff. absorption area 165 ft' Monitoring tube YES Depression over field NO Date of adequacy test **1/31/2008 Results (Pass/Fall) PASS For 5 bedrooms Fluid depth in absorption field before test DRY in. Water added 1656gal. New depth -L–In. Elapsed Time: 1050 min. Final fluid depth DRY in, Absorption rate >= 750+ — P g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date – •' PRESOAK ON 1/30/2008 WITH 1641 GSLLONS OF WATER. D. LIFT STATION !INSPECTED BY ANCHORAGE TANK. Date installed 8/24/2004 Size in gallons 2000 Manhole/Access (YIN) YES "Pump on" level at TIMER in. "Pump off" level atTIMERin. High water alarm level at 49 in. Datum B.O.T Cycles tested " Meets alarm & circuit requirements? YES E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ Public sewer main N/A On adjacent lots 100'+ Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 51+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *i'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 5'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS WR040060 G. ENGINEER'S CERTIFICATION A `< OF A 1 certify that 1 have determined through field inspections and p e g Fi 0.......... „y¢, review of Municipal records that the above systems are in 0 conformance with MOA COSA guidelines in effect on this ..... .................. date. a Garn ss: Engineer's Printed Name JEFFREY A. GARNESS ooh E— I p FFG / /0 �Q e, Z /i/DU6(A Date Z-6 / 013 p(CY, roreeelo,�\0\ � COSA Fee c _l DC7. U D Date of Payment Receipt Number G 0 (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number 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.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 080023 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 3 of Lodgepole subdivision. This inspection revealed a nitrate concentration of 6.48 milligrams per liter (mg/L) was reported for the property's well water sample. 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. 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. ANALYTICA GROUP Gamess Engineering Group, Ltd. Attn: Jody GEG, Ltd. 3701 E Tudor Road, Suite 101 Anchorage, AK 99507 907-337-6179 Fax: 907-338-3246 Client Sample ID: Sampling Location: Client Project: Sample Matrix: COC #: PWS#: Residual Chlorine: Comments: Lodgepole Lot 3 Private Well Testing Aqueous 61379 Lab#: A0801221-OIA Analytica International, Inc. 4307 Arctic Blvd, Anchorage, AK 99503 Phone: 907.258.2155 Fax: 907-258-6634 Report Date: 2/7/2008 Receipt Date: 1/302008 Sample Date: 1/302008 Sample Time: 1:45:OOPM Collected By: PB Flag Definitions; MRL - Method Reporting Limit MCL = Maximum Contaminant Limit B - Present also in Method Blank FI - Exceeds Regulatory Limit M = Matrix Interference 1= Estimated Value D = Lost to Dilution •• = RL higher than MCL; target not detected TNC = Too Numerous to Count - result rejected CF = Confluent Growth - result rejected TCNG = Turbid Culture No Growth - rejected Analysis Method Pref Prep Analysis Parameter Result Units Flaks MRL MCL Method Date Date Analyst 92228 (Aqueous) - Membrane Filtration hIF Test was conducted by: Analytica -Anchorage Bacteria, Other <MRL CFU/IOOmL 1.0 1/302008 1/302008 PL Total Coliform <MRL CFU/IOOmL 1.0 1 1/302008 1/302008 PL Lab#: A0801221-OIB Analysis Method Prep Prep Analysis Parameter Result Units Flags MRL MCL Method Date Date Analyst 200.8200.8 (Aqueous) - Family Well Water I Test was conducted by: Analytica -Thornton Arsenic 0.467 ug/L 0.15 10 200.8 2/42008 2/4/2008 GY Lab#: A0801221 -OIC Analysis Method Parameter Pref Prep Analysis Result Units Flaks MRL MCL Method Date Date Analyst 4500-NO3E (' Nitrate as N 6.48 mg/L Reported by: Steve Gaither, Laboratory Project Manager 7esl was conducted by: Analytica - Anchorage 2.5 10 2/12008 2/1/2008 JK Page 1 of I N-. --• i• -- ....... -------v . .,Wu Ul Now -/O- I -/I- Y�2�YG tai GRE srw as suea. ia N 89°59 00 �W 1? l5.00 ,//O� UT•/CITY ESM'T O nt Vehfs , hr �. o j �__ of 2ya O0 3�e 53_ O oo\\ / ST tl' 1r GR.tVEL , ok ►� � _, � ,� orcK .._ hl hN 1 A .,0 1 t44 r. I.L Noy'S9'00W /7/r70 � h tv N d4-YMPIA G/KGLL Recerf 8-2,4-04ft/, ,a SCALE- EASEMENTS CALAEASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. &ALL A"UILT NO CORNERS SET THIS DATE A LY 0 I hereby certify that I have performed aMortgagoe's inspection of the blowing descdbed property; —Lo 7 Lo DG"!5POLS 5UeD/v/.16n/ Anchorage Recording Precinct. Alaska, and that the Improvements situated thereon are within the property lines and do not overtap or encroach on the property lying adjacent thereto. that no improvements on property tying adjacent thereto encroach on the promises In question and that there are no roadways. transmission lines or other visible easements on said property except as Indicated hereon. Dated at Anchorage, Alaska this /:5 dayof TULV 20Q¢ FRED WALATKA & ASSOCIATES (907) 248.1666 Engineers and Surveyors rrom:ANCH TANK & MELDING INC ■■f 277 3715 01/29/2008 15:34 11734 P.001/001 - --- - Homeowner.EF, Technician Responding: 1� t,120 Date of Site Vtsft 7 f 0' Maintenance Activity Activity Check -off /Notes 1) inspect Processing Tank • Verify no leaks In the risers 0/ •Depth of sludge layer d f0 Y • Depth of scum layer 2) Inspect Pumping 8yatem • Verify no leaks in the riser. Inspect the lid for damage • Inspect splice box for moisture and secure any loose connections • Verify neat wrap of cords • Verify condition and location of an floats @/ • Pug pumps) and clean intake screen If necessary r V • Pull Blotube Filter and dean K necessary • Visually Inspect and comment on biomat growth Q/ • Check amp draw while pumps are running 3) Inspect AdvanTex Fiker(s) • Inspect for any damage to the fid 0 JJ • Check for odors • Assess character and color of biology check for even distribution D/ • Verify there are no cfogged orifices • Clean and flush manifold if necessary Q/ r)4) Inspect the Drainflefd • Inspect for standing water In the drainfletd [� Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 SOCERTIFICATE "UF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-061-39 1. GENERAL INFORMATION Complete legal description HAA# QC/ bg0V Expiration Date: Location (site address or directions) 5901 OLYMPIA CIRCLE * ANCHORAGE AK. 99516 Current Property owner(s) ROGER AND DEANN STAPLEY Day phone 346-2486 Mailing address 5901 OLYMPIA ctRri r * AK1^U ,1.... - Lending agency Mailing address Real Estate Agent Mailing address Day phone MARY COX w/ REMAX PROPERTIES Day phone257-016 5 2600 CORDOVA * ANCHORAGE, AK. 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 NTYPE ot The ll for ihis property TYPE OF WASTEWATER DISPOSAL: P P 1 tY meets existing State and Municipal Codes. There are nitrates presen�"ii'ds augWgeested that periodic ting be performe 'lg ual On-s&e ■ Individual Water Storage IndiwduafAofd`ng tan�Clls cpntinue�suitability. CurrerddMt98kfM h ail�i# 5,23 &i /l. EPA maxi LLLJJJ nn nttttmR`1"491 1palden is 10.0 mg/l.[}'Iore informagHW'4 WW1tiSfA1rf available fth the On -Site SeMigs%Wram, at 343-7904. El 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 samples. (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 isnot responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER t my As certified by my seal affixed hereto and as of the validation date shown al Guidelibelow, I nes foify r this application, investigation ased on procedures outlined in the Health Authority App shows t.. site water supply and/or wastewater disposal system is(are) safe, functional and adequate o bedrooms and type of structure indicated herein. I furthern esti ation ar 8at bas� thvede the font, l int obtained from the Municipality of Anchorage files and from my g applicable o water supply and/or we disposal s stem is(are) in compliance with all app t �rl State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, -EG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described 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 soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. uatO rTheseesults do nolt guaranteeons are future performanceside the control of hof thel system, the do they guarani rentee that sfactory t there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content upon or a this report is for the ance otherope son or party s not afit of the owner luthorized above.isted orr will it confer any legal right whatsoever. of this y any 5. DSD SIGNATURE (, Approved for — bedrooms. Disapproved. Conditional approval for Note The well for this property meets exis present. It is suggested that periodic testin t t concentration is 5.23 mg/1. Phone33� 9 Date 8 z6 bedrooms, with the fllowing stipulations: be performed to EPA maximum concentration is 10.0 mg/1. More Current m ra e ilable from the On -Site Services Program, at 343-7904. information on nitrates is ava Attachments: ✓ Manitenance Agreements ---- HAA Checklist Supplemental Engineer's Reort ----- Septic System Advisory Other Well Flow Advisory Original Certificate Date: W-1 r, all By: (Rev. 12101 . 'N(unicpali Development ; euitdtn -a wr Qww Department sion erPrograr ^Sf.- �K 99519=66`50' " ' k.us LODGEPOL`E SU9D7V�SIOIV L073 Parcel ID: 015—OS 1-39 E If A, B, ipr C provide PINSID# N A --L — Sanitary seal (Y/N `YES p p y protected (Y/N) YES ��� •}'_"'-��, _ .tea, Wires ra erl ft. Cased to 87 ''' "� � ft• � Casing height (above ground) 12+ ,n �3 fi va�am.rvi v b t"«�n.rst-tom"..,y.'r. w. "� . AT INSPECTION .4/1981 , 45 Rrtryv v pyj s cc .+ s, ,, c91onies/100 ml Nitrate 5.23 mg,/L. Other bacteria 0 " � � c � : .". �o colonies/100 mi. g./L.. Date of sample: 2004 _ Collected by:GEG L'D' LL _ L`Su''EN YcwYT �Date;installed 8/24/2004 tal• Number of Compartments 2 it (Y/N) YES pepressiort dr°tank (Y/N} NO Hi "' Pomnnr ILJ 04 Size in gallons 2000 Manhole/Access (YIN) • High water alarm level at _ 49 in. el n. Pump off" Tevel atTIMER!n. g YES tested'—'., Meels alarm & circuit require m Cycles tested''— ents? anon -- 100'+ d z 100'+ On adjacent lots on lot N/A un Public sewer manhole/cleanout 25 + a a x m n Holding tank 75 + rvice line ----., �w w,u n ' j)STAfJC)ffS FROM SEPTIC/HOLDING TANK ON LOTTO: 5'+ a' 5'+ Absorption field, 5'+ Property line___—_--- tion 100'+ y'O'a Water's`er`vice line—0'+ Surface water snt lob DISTAN6 FR ABSORPTION fF LD ON LOT TO: N/A 9 10'+ Water main Buildin foua4ion__ 5;+� " 100'+ Driveway, parking/vehicle storage line 1— Surface water NONAN Wells on' adjacenf lots 100'+ r tcx Svfi f ++Yw` . *'rt�d 'hyf•? a a� ,., 9.... �0 in effect do this O determined term nthat the above systemare in a`n`tl inspections� MOA HAA guidelines s date . r A. Gar ss: ` 0 I Name" '" JEFFREYGARNESS QQ�0 E-7 53 O /b 4�0Cy Pro oso���� Waiver Fee $ Date of Payment 07-14-04 02:57PM FROM-CT&E ESI, SGS ENV SERVICES SGS SGS Ref ,# Client Name Project Name/ti Client Sample ID Matrix 1043884001 Garttess Engineering Group, Ltd. Lodgepole Lot 3 Lodgepole Lot Drinking Water Parmneter Results Waters Department Nitrate•N 5.23 Microbiology Laboratory Total Coliform 0 PQL 9075615301 T-064 P. 02/03 F-175 Laboratory Analysis Report All Dates/Times are Alaska Standard Time Printed Date/Time 07/13/2004 6:44 Collected Date/Time 07/06/2004 8:50 Received Date/Time 07/06/2004 11:27 Technical Director te n C. Ede Released B�+�-V/� Units Method Container ID Allowable Prep Analysis Limits Date parr Init 0.100 mg/L EPA 300.0 B (<=10) 07/06/04 118 coU100111L SM20922213 A (<=I) 07/06/04 DKC Laboratory Division 200 West Potter Drive, Anchorage, AK 99518-1605 t 19071562-2343 119071561-5301 w .sgsenvimnmental.corn Member 0V" SGS Grau415oand Genwale du Su'mf anco N DJsA/ 39 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL 4q�-(�96Q OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date —ZZ—U 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Zo f 3 Zod gs role ���Oiy S'ioi✓ Location (address or directions) S90/ Fi�YM�i'G r%rdeoi Re6Eft o% t7t'9P4F Y26S-zz�Y (b) Property Owner A. Telephone: Home Business Mailing Address Fp,91 11 ,s4lr Cy / 5.476 (c) Lending Institution/�• Soh �° ��^ /< Telephone 2 /o S— 22-0 f' Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: or: Check here p, if hold for pick up. List contact person and day phone number below. 2. TYPE OF RESIDENCE Single -Family V Number of Bedrooms 3. WATER SUPPLY Individual Well E' 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. Page 1 of 2 72-025 (Rev 8/86) Front �DVO 198/8 Aad) szo-zL Z to Z abed �JoM S,JaaUlbua leuo!ssaloid ayl ui suo!ss!wo Jo sJoJJa Jol elq!suodsaJ lou si abeJoyouy to AlpedpiunIN ayl 'panss! si aleoippao e aJolaq elep az (leue Jo suo!loodsut lonpuoo lou op SHHO to saaAoldw3 -sluawaJ!nbaJ alels pue leJapal u!elJao Ajs!1es of JapJo ui suopn1!1su! bu!pual J!ayl pue savoy to sJaseyoJnd of Asalanoo a se s!yl scop SHHO ayl 'e�seIy to 01e1S ayl u! paJals!baJ Jaau!buo euo!ssaloJd luapuadapu! ue (q anoge 9 ydeAeaed ul uaA!b suo!leluasaJdaJ ayl uodn Aluo paseq saleo!1!jAeo lenoJddy (luoylny ylIeaH sonss! (SHHO) sao!AJaS uewnH pue ylleaH to luawpedaa abeJoyouy to Allledpunw ayl NOIlf1VO IenoJddy leuo!1!puoO to swJal leuo!1!PuoO panoJddes!Q panoJddy 99 _ ale(] (q swooJpaq Jol panoJddy 1VAO8ddV SHHO '9 IeaS a P w n7[ f— z Z r ale4 L2S� 7I� ' N �'r 7 N y� c5 & OZ Z Z ssaJPPy auoydalal wJ!3 to aweN ('` o -uo!loadsui s!yl to alep ayl uo loalla ui suogelnbei pue 'saoueu!pJo 'sapoo ale1S PUP led!o!unN pe yl!M aouw1dwoo ui s! wals (s lesods!p JaleMalsem Jo/pue Alddns JaleM al!s-uo ayl 'uo!loadsui pue uope611Sanu! !w uJOJI PUP salt' abeJoyouy to Al!led!o!unW eql woJl pau!elgo uo!lewJolui ay1 uo paseq leyl (luaA JaylJnl I •u!aJay paleo!pui aJnlonJls to adll pue swooJpaq to Jagwnu ayl Jol alenbape pue leuoilounl'ales s! wars (s lesods!p JaleMalseM Jo/pue llddns JaleM alis-uo ay11ey1 sMoys 1enoiddy A1!Joglny y1leaH Siyl to uo!leb!lsaAUI AW leyl A1!JaA I 'Molaq UMoys alep uoilep!leA G141 JO se pue OIOJay pax!lle leas Aw Aq paipjAao sy NOI1VW80jNl (INV VIVO `HO8V3S 3113'S1S31'SNOIlO3dSNl ONIOIA08d W81=l ON1833NION3 'S MUNICIPALITY OF ANCHORAMLJNICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION CHECKLIST - FEBRUARY 1984 264-4744 � JUL 11988 Legal Description: 1,913 L�� �< i4lC Svb, RECEIVED �90� A. WELL DATA Well Classification �'+���� �A�i� If A, B, C, D.E.C. Approved (Y/N) N•� Well Log Present (Y/N) Date Completed RXX ��� Yield M rot 9P� Th,'s'TttT Total Depth 7 Cased to 'k 8 7 Depth of Grouting e Static Water Level 5 Pump Set At 72 _ Casing Height Above Ground .2 % & Sanitary Seal on Casing (Y/N) /_ Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot /00 Y ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ��� f ; On Adjoining Lots l To Nearest Public Sewer Line 41 -YY To Nearest Public Sewer so i4— Cleanout/Manhole AVd To ?LA0 Sewer Service Line on Lot Water Sample Collected by �e'4s� �Di' ?LA0 // f ; Date Water Sample Test Results ti`s t''4 6 7-a Comments I 44r,4 41YHs kee��Js B. SEPTIC/HOLDING TANK DATA i0me /?,Y6 N oo?41 Z Date Installed°�Dx / 98/ Size + Soo 9141 No. of Compartments'*- Z - Standpipes (Y/N) y Air -tight Caps (Y/N) '14 Foundation Cleanout (Y/N) %r Depression over Tank (Y/N) Date Last Pumped ' 9 + Pumping/Maintenance Contract on File (Y/N) �; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) � Separation Distances from Septic/Holding Tank: To Water -Supply Well DO To Building Foundation s !� To Property Line To Disposal Field To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course /V U Al,i_^_ Comments ` OW -1 /1'0," �iy1fS /CecQ r�S Page 1 of 2 72-026 (Rev. 8/86) Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 16,5,0 br.,,i, Type of System Design Date Installed q F1y I'7 3I' Length of Field + ZC72 / Width of Field S �Z Depth of Field Gravel Bed Thickness c/ i Square Feet of Absorption Area 3S-,) C' Standpipes Present (Y/N) % Depression over Field (Y/N) rN Date of Last Adequacy Test d 4y ",f �-e Results of Last Adequacy Test Ad r a, , A 1—e Separation Distance from Absorption Field: To Water -Supply Well / y 0 4 -- To To Building Foundation 31111 To Property Line 'k-,3 O To Existing or Abandoned System on Lot I Y // a ; On Adjoining Lots N /14 To Water Main/Service Line To Cutbank (if present) Z� To Stream/Pond/Lake/or Major Drainage Course Ay/2 To Driveway, Parking Area, or Vehicle Storage Area 2s Comments X Q.9r,4 0/os (�<Cord-S LJ,- 44ve 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) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** certify that I h . hike erifie , or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed 3 Date 7 Company��n5S4;:� 6//3 MOA No. Receipt No. �P e10 Date of Payment �_IdW��p�;�`�� Amount: $ �o 110 4460%J 1® k- F %Engineer's Seal MU�NI�C:I�YgA�}CIyrY INYTgALN F AN'gC�II RAGE ON ENVIRC1fVMtFII�L StRVI DIVISION PagePage 2 of 2 1988 198 72-026 (Rev 8186) BaCk RECFIVF BES.SE, EPPS & POTS 2220 EAST 88 AVENUE &4CBORAGEr AK 99507 (907) 349-6451 WATER WELL TEST Date: zs� — LOCATION: 6` Subdivision: Lot: / Block: n Client's Nan-,,-_: Address: / D,/ a 0 xAP (IleIA- �. U TESTER:,�I�"t a Initial Reading on Meter:_ DRAW I GALLONS •-- r GALLONS FI= METER � DOWN TIl`1E GPM a VOLUME d r TOTAL JMONITOR LEVEL READING / /,2,.3 S Q„ _ 1 I I `J:ES: Pr1—jUC--1Jn Rate_ G=:., fuse ac 24 -dour Caoa-_t-, S 10 a •-- r /1 x-30 � � d r 1 I I `J:ES: Pr1—jUC--1Jn Rate_ G=:., fuse ac 24 -dour Caoa-_t-, Besse, Epps, & Potts 2220 East 88th Avenue Anchorage, Alaska 99507 Attn: Andy Potts Source: Lodge Pole Sample ID#: A060888-13 Parameter Unit Nitrate -N mg/1 Result 2.9 Date Arrived: 06/08/88 Time Arrived: 1622 Date Sampled: 06/08/88 Time Sampled: 1530 Date Completed: 06/14/88 0J i7 P..S':7EA s' !� -r. 7931". 2K5 ....N{ -67 277 3372 Besse, Epps, & Potts 2220 East 88th Avenue Anchorage, Alaska 99507 Attn: Andy Potts Source: Lodge Pole Sample ID#: A060888-13 Parameter Unit Nitrate -N mg/1 Result 2.9 Date Arrived: 06/08/88 Time Arrived: 1622 Date Sampled: 06/08/88 Time Sampled: 1530 Date Completed: 06/14/88 ADEC MCC* 10 Reported By: %' �/�-1� Date: 061/15/88 -------------------- -- - -- Francois Rodigari, Anchorage Operations Manager --------------------------------------------- * MCC = Maximum Contaminant Concentration Quality Control Report Client: Besse, Epps, & Potts ID#: A060888-13 Listed below are quality control assurance reference samples with a known concentration prior to analysis. The acceptable limits represent a 95% confidence interval established by the Environmental Protection Agency or by our laboratory through repetitive analyses of the reference sample. The reference samples indicated below were analyzed at the same time as your sample, ensuring the accuracy of your results. Sample # Parameter Unit Result Acceptable Limit ---------------------------------------------------------------------- ----------------------------------------------------------------------- EPA 378-12 Nitrate -N rig/l 7.47 7.17 - 8.01 Reported By: - - - Date_ 06/15/88 -------------------- ----------- --------------------- Francois Rodigari, Anchorage Operation Manager A ! "' "w -� U y 1"2a t5+ a tv r d .� v 6 L .aa' $ i .1 '�✓ ».. �.✓ 6 C U` t, E -S : TY LA r'JEST. SUITE A F -A CUA -IK". E ALASKA : 2_01 AiPeANK:. STREF- .V4C-: _..AGE. vi 2:733'5 .... Quality Control Report Client: Besse, Epps, & Potts ID#: A060888-13 Listed below are quality control assurance reference samples with a known concentration prior to analysis. The acceptable limits represent a 95% confidence interval established by the Environmental Protection Agency or by our laboratory through repetitive analyses of the reference sample. The reference samples indicated below were analyzed at the same time as your sample, ensuring the accuracy of your results. Sample # Parameter Unit Result Acceptable Limit ---------------------------------------------------------------------- ----------------------------------------------------------------------- EPA 378-12 Nitrate -N rig/l 7.47 7.17 - 8.01 Reported By: - - - Date_ 06/15/88 -------------------- ----------- --------------------- Francois Rodigari, Anchorage Operation Manager 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 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) 5a Lylszdy Location (address or directions) (b) Applicant Namze0d Telephone: Home 3— �r�� Business Applicant Address 590/ 01� rn n/ i7�C /VC Dl C2�f� Cs SKS (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder; Buyer ❑ ; Other ❑ (explain); - '® Lending Institution D ri rl rocc (e) , Real Estate Company and Agent; Address Telephone (f) Mail the HAA to the following addre s�: 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms P7 Telephone 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ` 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm /�1,&Z _4% z`z�,ey/-//'Va Telephone t 5"' 0 717 Address Date TE7 %vas �e G(1 u I e i �%is�aasa./ SXme z, s s 5 lem%s Py f a l(j 10.B- c7iifrOf+�:. W Engineer's Seal nt a� GortPi O. Talbot a ;' No. 4069 - E V�4®ROF�ssic�`� . 6. DHEP APPROVAL.GcQ Approved for bedrooms by r—� Date Approved Disapprove Condi conal „ Terms of Conditional Approval Chep 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 Mw"C FALITY OF ANCHORAGE _ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) MAR 1719W CHECKLIST - FEBRUARY 1984 264-4720} Legal Description: A. WELL DATA Well Classification �51,ticlle Az'14 If A. B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) y Date Completed �� %%i� Yield Total Depth 4971 Cased to 97/ Depth of Grouting / Static Water Level Pump Set At Casing Height Above Ground ��y Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) y Separation Distances from Well: > / To Septic/Holding Tank on Lot Aep ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot _4PS ;On Adjoining Lots �w / To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA To Nearest Public Sewer To Nearest Sewer Service Line on Lot 2�_ — ; Date la 49r, ko `i 1 ggVy Date Installed Itee-1 Size —_� No. of Compartments Standpipes (Y/N) y Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) — Depression over Tank (Y/N) N Date Last Pumped Pumping/Maintenance Contract on File (Y/N) /y ; for Holding Tank High -Water Alarm (Y/N) �� Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: 11 To Water -Supply Well // L-) To Building Foundation` / To Property Line 6-e / To Disposal Field To Water Main/Service Line Course Comments Page 1 of 2 70-n9g, 11 1ae1 To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata P/d,�Ubodo Type of System Design T-cy 0,, 41 Date Installed Length of Field r / Width of Field Depth of Field J / Gravel Bed Thickness T Square Feet of Absorption Area 25( L Standpipes Present (Y/N) Depression over Field (Y/N) N Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well �+5� To Property Line To Building Foundation y To Existing or Abandoned System on Lot _�/A ; On Adjoining Lots Z17 //J' To Water Main/Service Line To Cutbank (if present) /tL//J To Stream/Pond/Lake/or Major Drainage Course i To Driveway, Parking Area, or Vehicle Storage Area rs 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) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I ave�/ch�cked, verified,"oar conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ?N� �+�7 Date Company �l 0?�/Rl MOA No. Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) Engineer's Seal March 12, 1986 L. VAN WHITEHEAD 5901 OLYMPIA CIRCLE ANCHORAGE, ALASKA 99516 RE: Sewer System Adequacy Dear Mr. Whitehead: In order for your sewer system to be approved for 7 bedrooms, you must increase the size of your septic tank from 1500 to 2000 gallons. This can be accomplished by adding a tank between your house and exs. ting tank. In addition, your drain field must be increased byb feet. This can be accomplished by putting in a lateral between the existing drain field and your lot line. The following is an estimate of the costs to do the necessary work: Backhoe rental 1 day @ 240.00 $ 240.00 Gravel, 45.9 cu yards @ 19.50 cu yd. $ 895.05 Perforated pipe, 8 lengths @ 8.00 ea. $ 64.00 Elbow 90 degree, 2 @ 1.60 ea. $ 3.20 Sweep T, 3 @ 2.40 ea. $ 7.20 Greer 500 gallon tank $ 387.00 Non Perf. pipe, 3 lengths @ 8.00 ea. $ 24.00 TOTAL COST $1620.45 Very truly yours, Garth Talbot Tc COI IT MAY CONCERP. REGARDIAiG THE H02 -r, OF VAN MiTMFEAD LOCATED ON CLYIvPIA CIRCLE IN ANCHORAGE, ALASKA, i HAVE SEEN Ti?E HC';'.E, BEEN INSIDE OF THE HOTl, AND HAVE PERSONAL KNCWZEDGE THAT IT IS A .SINGLE FAi'ILY M:IELLING NUN' AND HAS BEEN SINCE IT WAS BUILT BY TOR. iJHITEHEAD, TC %IY KNOWLEDGE THERE ARE NO PLANS OR EVIDENCE TC SUGGEST"THAT THERE ARE ANY PLANS TO CHANGE THIS STATUS. GARTH' ��" C. TALBOT vcz:CMN J % OF 444- h a � v4 � 0. 'Cv.'bot t4' oe No. 4469 - E JOROFESSO ' 'F' 5. LEGAL DESCRIPTION ` DATE RECEIVED INSPECTION APPOINTMENTS `TIME TIME TIME DATE DATE DATE 7. WATER SUPPLY j <� INSPECTOR INSPECTOR INSPECTOR( ,,{A ❑ PUBLIC UTILITY MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT"T OF HALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL P ;O FECTION • ENVIRONMENTAL SANITATION DIVISION 0C'1' 2 6 1981 >0 INDIVIDUAL/ON-SITE** Telephone 264.4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND S C E44LEOS DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPER h NER�0 4� e {jam rit PHONE J MAILINGADDRESS f — & /jclj7 g�; 0 "may PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTIO k ���� PHONE r; I t- l a k .])awn MAILING ADDRESS - 4. REALTOR/AGENT PHONE MAILING ADDRESS - 5. LEGAL DESCRIPTION ` STREET LOCATION i 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS SINGLE FAMILY ❑ One � Four El Other ❑ Two Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY Of INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM / >0 INDIVIDUAL/ON-SITE** �d YEAR ON-SITE SYSTEM WAS INSTALLED. /❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-070 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE 5-Ivr, V V BY 4 J,