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HomeMy WebLinkAboutLOUDERMILK LT 2Loudermilk Lot 2 #015-501-16 MUNICIPALITY OF ANCHORAGE ® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ` ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME A " Iv PHONE �'---�J VNEW I-L—\UPGRADE MAILING AODR LEGAL DESCRIPTION ij_ ' '), f LOCATION NO. OF BEDROOMS 3 Uy DISTANCE TO: We r Absorpti ne tC}d Dwelling l'o PE 1-[NO. a Z W F Manufacturer {' N 9 Mat .L., No. of co partme s r U)Liq. ca acity in gallons IF HOMEMADE: Inside length Width Liquid depth j�Z DISTANCE TO: Well Dwelling PERMIT NO. 2 z FManufacturer Material Liquid capacity in gallons w= DISTANCE TO: Well ��?�!, Foundatio 1 Nearest lot I'n `, PERMIT O e� J LL z F z w No. of lines Length ac line Total leng h oIf lines Trench th , Inches Distance tyv�en, lines ��TT Q H 0 Top of the to finish grade Material beneath tile inches Total effe ive absorption are �. C� Lu Length Width Depth PERMIT NO. 0 a F LU Type of crib Crib diameter Crib depth Total effective absorption area WWell rn DISTANCE TO: Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. W � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER II i LIE QO PIPE MAT,R/]ALS V 1 SOIL TEST RATI NGc7,,. [X� INSTALLER owU<-_::;"� REMARKS r 1 00, APP ED DATE LEGAL j' ��"rl C3 F0 to KJ1 iq EE TYPE OF SOIL HBSORPTION SYSTEM IS TRENCH � �� ''���� |� MHXIMUM NUMBER OF BEDROOMS � ] SOIL RHTING (SQ FT/BR)� 85 DEPHRTMEHT �� HEHLTH HND ENVIRONM�NTHL/~nOT�CTION / STREET, HNCHORHGE, ' HK� 9SJ1 ��� `ru. (/ ~ THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFHCE it P .~',�A- Q VA E31 Q 04 --- W& 11--'E, EE�.. M 1 nA IEEE FTC 1", EPE 140 PERMIT �O( 820746 ) HPPLICH�T MIKE PENDERGRHST SRR BOX 1716 LOCHTIOk! LEGAL L2 LOUDERMILK LOT SIZE 999999 SQUHRE FEE�0 Fol E07 IF It H w! 1 W Eo: 1-1 Fol 3: to: W !Ew Fly EK kl::� O.E"!��� I CERTIFY THH7 1: I HM FHMILIHR NITH THE REQUIREMENTS FOR ON-SITE SEWERS �ND WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHQE.-- 2: I WILL INSTHLL THE SYSTEM IN HCCORDHNCE NITH THE CGDE -S. ]� I UNDERSTHND THHT THE ON�SITE SEWER SYSTEM MAY REQUIRE THE RESIDE1-1CE IS REMOl: INCLUDE: MORE TH N ] DROOMS. ^ / <- '�, SIGNED � .~r ` ���� � ~_�_--�_��_�-~~�.~~_ ISSUED BY__.� �x~~ __DHTE_._��~^������.~ V4 ( �J'/l/l TYPE OF SOIL HBSORPTION SYSTEM IS TRENCH � �� ''���� |� MHXIMUM NUMBER OF BEDROOMS � ] SOIL RHTING (SQ FT/BR)� 85 � THE REQUIRED SIZE OF THE SOIL HBSOFUPTION SYSTEM �R. 2, - 4, - - -,-,: � ����E---.!-1 — �����I , R� � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFHCE OF THE THE EXCHVHTIOINSROUND THE BOF FEET) THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRHYEL BETWEEN THE OUTFHLL PIP� HND THE BOTTOM OF THE EXCHYRTION (IN FEET). EE. 11 i-- :i� PERMIT HPPLICHNT HHS THE RESPONSIBILITY TO INFORM THIS DEPHRTMEMT DURING THE INSTHLLHTION INSPECTION5 OF HNY WELLS HDJHCENT TO THIS PROPERTY HND THE NUMBER OF RESIDENCES THHT THE WELL W111 -1 - ILL SERVE . ���� 1 -7":: POO to -F: F Fit ECIA R-1 1 Fit P17 112. BHCKFILLING OF HNY SYSTEM WITHOUT FINHL INSPECTION HND HPPROVHL BY THIS DEPHRTMENT HILI. BE SUBJECT TO PROSECUTIO�{ MINIMUM DISTHNCE BETWEEN H WELL HND HNY ON-SITE SENHGE DISPOSHL SYSTEM IS 100 FEET FOR H PRIVHTE WELL OR 150 TO 200 FEET FROM H PUBLIC NELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTHNCE FROM H PRIVHTE WELL TO H PRIIv! HTE SEWER LINE IS 25 FEET AND TO H COMMUNITY SENER LINE IS 75 FEET. NELL LOGS RITE REQUIRED HND MUST BE RETURNED TO THE DEPHRTMENT WITHIN ]0 DHYS OF ION. OTHER REQUIREMENTS MHY APPLY. HND FIRE HVHILHBLE TO INSURE PROPER INSTHLLHTION Fol E07 IF It H w! 1 W Eo: 1-1 Fol 3: to: W !Ew Fly EK kl::� O.E"!��� I CERTIFY THH7 1: I HM FHMILIHR NITH THE REQUIREMENTS FOR ON-SITE SEWERS �ND WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHQE.-- 2: I WILL INSTHLL THE SYSTEM IN HCCORDHNCE NITH THE CGDE -S. ]� I UNDERSTHND THHT THE ON�SITE SEWER SYSTEM MAY REQUIRE THE RESIDE1-1CE IS REMOl: INCLUDE: MORE TH N ] DROOMS. ^ / <- '�, SIGNED � .~r ` ���� � ~_�_--�_��_�-~~�.~~_ ISSUED BY__.� �x~~ __DHTE_._��~^������.~ V4 ( SOILS LOG a MUNICIPALITY OF ANCHORAGE �,c\\ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION El PERCOLATION TEST 625 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: LiN.D>+ oP. LoDmmiLy, DATE PERFORMED: �l'Iby1 LEGAL DESCRIPTION: LO t EKr L O o t>r— \` M i L_k S/Y �� �� �� SLOPE SITE PLAN 1 1 -:.'._I t.®AM 2 3 Ocs 14,r%/ couts'e � -n 4 p` ® ^��i4t�C 6 b � , L) �o t o 11 7 bV'-6 mecca, i+tpy�.ot,Q j6�nt,,t,�,�c Bae ,� r( t t? u L9 .40VIO, 9- A �I a S� 10 �I, WAS GROUND WATER Jy�� S 11 V ENCOUNTERED? 1 ® L P 12 ui �w�C IFYES,ATWHAT E i DEPTH? 13 S , 14 15 16 17 181 1(c-aaa5 19 20 COMMENTS_ LV--& PERFORMED BY: a ing Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN CERTIFIED BY: FT nAN (minuteslinc�h) —77*-77*FT/ ncl DATE: �PIC- r mil CA I 451bv 14, Ora J WATER WELL. RECORD STATE OF ALASKA DEPARTNIENT OF NATURAL RESOURES Oiv{sion of G:ologicol 8 Geophys(col Surveys n Drilling A.V.L.PaerniNo. LOCATION OF WELL (Plat± e avmpltle tlr. df In, Ih OY IC.) A. O.Na. ,�✓�_�� la• Dtraugh suhd vi_Ir I1 Lt. w,1 Ib. /4'911'1 Section No. Town*h! N Range E Meridian l�incrdlem,l. _W °Q�.M Wo lo, DIBTANOra ANP DiRECTiON Pni)M '!OAv'r- QWN rR OFty2LL� • Pe `i1 i 1 e-hSfeL(jv.4lr �'!'..'Munr+ ��+q1'! •1'•c!r,r Addreal Fog d o- l"s X91"1';w x diAdtraet asd Arai t1 ',44:1 Lupe+ an Add, /..._. 14.1 ..i,�._ e,n.c`uu2. e. WELL LOO fit Below 9arrade _ ^� ;icttam q, WELL DEPTH! ! flizl) B. VATS OF COMPLETION B• ,'.-able too! ^ © Rcloey U Drlve11 0 Dug El Auger C3Jettod ClOorte ff--11C 0-h{r; 7.U9`: 1DOM401t �� floblle Supply lJ Industry �rrigat:on Rooharg, commerical LJ Ret We;! 3 Other: It. CAGIfl9 n `Auea b5____ yWa't{d dlom:_ 6,wln, to 11 JJ0��{ssllpI? weight „}-Ib{.1 fI. d'nm,. _...^�Ir:. to . rt. 014th $tltxui, __111__1_.-,_ .. ..............._�....__�_ •__-1111_.._.«. Dlara el/F'--1111__. Llcpth .. ^. �..�.� Set be!ween fl. and Bactfil!'ng �._...m_,- erovtl nock GS UewnlH �{dI .._......-_.a,=• :J: $YAri0 WA1�.R t.EVEI.:_.,.,., 4112 } Q _1.111 - ._ ....� !!C1 fi L .... ,_" Dote - ..-. _... .. (q I �_i Ch^ve dr 9Bq!tw Innd wfue ..._.........._........_..,.i+..�fi�.,�.�-..�lly �--'��--..—�-_.,._._j_...... 7 _--- .._ I' . 1"UMPIN3 L:VLL ::Slow I}und aorfa�aaf�,f .1) _ tA��� �\``y�' I __-�._._...__.......� j^°, ,....fl. cf ler .-._A.-..,.h•e. t�l+.&tst!:: I AtA:t; q.F. m� It otter hrs. pimo!rq --- q,P.m. .�..,r.,...._•-------�..,-....___...�_,.�r �..__......-_ .----.:.F....�_--"_—__1_111-----_-s - _ IE OROUT;N0 Wali Aro,)led: ye I, Ne mater!vl, u Seat Cement ❑ Other; _1111. ___._.-•__�_.—_..._—..-.._.......�__�. _1_11,1__ ____1111 ----.,,... ......-.._....,...,_.... __.._. ..a._,..,...�..�._._.,,...._... ,.,.____""'�"1 Longtn of Drop Pipe _fl. copooily-...._�.._�_ y.p.m QSint. C] Jet^ M Centriflo.l Other L..+ 1St.,....-_.�.. REMARK gw----.-..v..._..._..._.-.._._.Y,...__,-... - �11'1) lav = 72 r le. WATER I !D, Water Temppra14r6 ° ❑ F Thl{ yI11' wo; 11': :ltd yr>,egr 1',y }u ,ed,:!iva cnd this report Is true to tit &I my F,nCw lenge and bel!e}i�' P. Isterse Bvc;neConirntt Liven 4mh Addrott:w �..��c����fi,�.._„ �'�d,.�, 1'x11. ' ° 7 �•'��ii-Li=�.. MY. A•1'.^i�+� �p- . .vx.. .,.....�._-.-.5...,.�i a'�" � AsU•'^orl9f4¢ 4eareq n!+sl vA Fr.... ne. u,..,e ."i.,1' C Municipality of Anchorage 1 Development Services Department Building Safety Division ---% On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 . r � CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015.501-16 COSA # Expiration Date: Q — g — d 7 1. GENERAL INFORMATION Complete legal description Lot 2: Loudennilk Subdivision Location (site address) 10501 Loudermilk Or. Anchorage. AK 99507 Current Property owner(s) Aksel6 Patricia Buhdm Day phone 250.2039 Mailing address same Lending agency Day phone Mailing address Real Estate Agent Carolyn Day phone 297 - Mailing Address -- - - -- --------- -- --- Unless otherwise requested, COSA will be held by DSD for pickup. --2. -NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ID Individual On-site 0 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 sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S s S Engineering Phone 694-2979 Address 15861 S. Birchwood Loop Rd. Chugiak, AK 99567 Engineer's Printed Name Robert A. Shafer 5. DSD SIGNATURE Lef Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X_ Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineers Report Other By: (N , Original Certificate Date: (R. I IM) 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: LOT ;? ; / ovbr}� "I ' f �/_,b Parcel ID: 015 - 501 -16 A. WELL DATA Well type rZ_kV#ntE Date completed O q 6,L Total depth T ft. If A, B, or C provide PWSID # Well L (/) 7C� Sanitary sea &) Wires properly protectei(aI) qM_ Cased to _7y ' ft. Casing height (above ground) M" in. FROM WELL LOG Date of test 10 1 q 10? Static water level 34 ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliformt4o colonies/100 mL Nitrate 1. mg/L Arsenic: r2•C 3 ug/L date of sample: /0"9 B. SEPTIC/HOLDING TANK DATA TankType/Material TIL /gTEC_(_ Tank size tOM gal. Number of Compartments AT IN PECTION tj0 O ft 413 g.p.m. Other bacteria colonies/100 mL Collected by: �a'�61R7F:IlI�^ Date installed 9 A VIAR Z CleanoutsON) 415 Foundation cleanou ( ) J�5 Depression over tank (Aff)-lb High water alarm C(S)_A" Date of pumping JG ff 5 O Pumper Ll -V Cil' 010 7_-,EJW1CTS C. ABSORPTION FIELD DATA Date Installed Z Soil rating (g.p.d.M2 o ft2/bdrm S5 System type &-3C-H Length 33 ft. Width 3r ft. Gravel below pipe ft. Total depth Q ft. Eff. absorption area aZft2 Monitor' be *S Depression over field k)0 Date of adequacy test Result(Pas ail) For a bedrooms H nu Fluid depth in absorption field before test oC in. Water added gal. New depth in. it Elapsed Time: min. Final fluid depth _Z in. Absorption rate >= �'C g.p.d. Any rejuvenation treatment (past 12 mo.) (1 NQ type) K)d) If yes, give date — D. LIFT STATION Date installed Size in gallons 'Pump on" level at _in. 'Pum Datum Cycles tested. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: I Septic tank/lift station on lot Kn + Absorption field on lot IWI a - Public sewer main Pin Sewer /septic service line 6954 Animal containment areas :50 rV High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots /60 I.t On adjacent lots 100'4 Public sewer manhole/cleanout A.% Holding tank _ /A Manure/animal excrete storage areas !0 I4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: / L f I Building foundation 64 Property line $ -j Absorption field 5 ' Water main t7 LA Water service line Surface water !Oo rf r Wells on adjacent lots �02+_ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: IQ Water main /c% A Property line 1 D `E Building foundation I I Water Service line 10 + Surface water /G0 Driveway, parking/vehicle storage _ I Curtain drain AZ" Klt)OM Wells on adjacent lots IOLI''f F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review of Municipal records f e above syste s ar in conformance with MOA COS ui lined inIff o this. Engineer's Printed Date Z� /a COSA Fee $ Ll /��� ' Dale of Payment -2 ` hl Receipt Number Sq F-) (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number I("o A lid& W Bra a. ANALYPICA GROUP S&S Engineering Attn: Tami/Yoshi 17034 Eagle River Loop Rd. Eagle River, AK 99577 907-694-2979 Fax: 907-694-1211 Client Sample ID: Sampling Location: Client Project: Sample Matrix: COC #: PWS#: Residual Chlorine: Comments: L2, Loudermilk SID none Aqueous Lab#: A0704298-OIA Analytica International, Inc. 4307 Arctic Blvd. Anchorage, AK 99503 Phone: 907-258-2155 Fax: 907-258-6634 Report Date: 5/3/2007 Receipt Date: 4/252007 Sample Date: 425/2007 Sample Time: 2:25:OOPM Collected By: YN Flae Definitions: MRL - Method Reporting Limit MCL - Maximum Contaminant Limit B — Present also in Method Blank H - 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 Prep Prep Analysis Parameter Result Units Flags MRL MCL Method Date Date Analyst 92226 (Aqueous) - Membrane Filtration MF Test was conducted by: Analyfica - Anchorage Bacteria, Other <MRL CFU1100mL 1.0 4/25/2007 425/2007 PL Total Coliform <MRL CFU/IOOmL 1.0 Lab#: A0704298 -01B 4/252007 4/252007 PL Analysis Method PrepPrepAnalysts Parameter Result Units Flags hi RL MCL Method Date Date Analyst 500-NO3E (Aqueous) - Nitrate Nitrate as N 1.50 mg/L Zest tvas conducted by: Analyfica - Anchorage 0.50 10 4/27/2007 427/2007 AJ Lab#: A0704298 -01C Analysis Method Prep s 111 RL MCL Method Prep Analysis Parameter Result Units Flags _ Date Date Analyst 00.8200.8(Aqueous)-Family Well Water Arsenic 2.03 ug/L e Fb-; /' Reported by: Krissy Plett, Laboratory Project Manager was - Thornton 0.15 10 200.8 4/30/2007 4/302007 KB Page 1 of 1 130` RECE /F/ED LOT 3 • x'49"E I Y � �• 41 0 YAM m» e I -h O O M UGNT e Ldo r3 �Q r,. F ,�0 . gST IAa f, SF.PTic SR's nic �p w� SR's I UNR4VE0 :SFWREO • Z79.45' ���� I6 oR AY NB9• ;SO 04' W Loll , Block o i-milouderk �5'uLx�i vision LOr ; * r '•% *y�, Anchorage Recording District, Alaska ra4 fv of reewd afar /tan raaM .Moa rr Nar M Ia.w! an NO Ma.a rrrala rar..I 01b" IH MIN. • •w» ..... I." LOT SURVEY CERTIFICATION LEGEND 1 Nraar earmh tMt I Ea"a wrw4N rlr Ma►•r1r MOM aM ineltaN a onus or Aluminum capped mo ' LSt 197 .'�'� Mf aw a"a M M1 a«I «w:w on Nleern �oMrb .N ri.r OZ f r.Darr s 1uNnyd. i plpa Stowoo • M-.. MN10 We"x 3 P rbar set thi».« •V' �? m 4 rf Im sr far era am M ""Vote, Wlary mme. or ~ Walsb _ �1&iCE LINE CAPPAOX• LO^AT/ON) 1aM"Nl S M Ona IN Opm aHyl as beaHal S.1•M. S61e /11, �. Date Prepared by: R. L. BUTTON r9O�lr7s.�zavkeE,uemrser Rot 2537 F B. No. Property of: Ak,5'e1 Buhdlm G� -GL79 I'd BB9B*LZ uauopllHzyueJj dI4rI0 LO OE JdH Municipality of. Anchorage o� e • Development Services Department*' Building Safety Division On -Site Water and Wastewater Program ° 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 vwvw.ci.anchorage.ak.us 0 (907) 343-7904 tX CERTIFICATE OF HEALTH AUTHORITY APPROVAL '44+ FOR A SINGLE FAMILY DWELLING Parcell.D. 015-501-16 HAA #_ 04 O % a O Expiration Date: _ % ^ / 3 - Q �- 1. GENERAL INFORMATION Complete legal description Lot 2; Loudermilk Subdivision Location (site address or directions) 10501 Loudermilk Cir. Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Greg Kellogg Day phone 346-4140 10501 Loudermilk Cir. Anchorage, AK 99507 Day phone Day phone Unless otherwise requested, HAA will be held by DSD forpickup./���'✓� y �i 3 �o y 2. .NUMBER OF BEDROOMS: 3.. TYPE OF WATER SUPPLY: ' TYPE OF WASTEWATER DISPOSAL: Individual Well 30 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Individual On-site 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 engineer's work. 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 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 S & S Engineering Address 17034 N. Eagle River Loop Ste. 204 Eagle Engineer's Printed Name Robert C. Cowan Phone 694-2979 River, AK 99577 Date -.x//o 6. DSD SIGNATURE Ro6ER1 %-V"Im' i Q /, �+��•� CE .8801 jfL Approved for. 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments wASTEWATER 111 Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other gy.Original Certificate Date: (Rev. 01102) ' Munied ality of Anchora a GE B 1 Development `Services Department Building Safety�Division On -Site Water & Wastewater Program 5 E .4700 South Bragaw St. 1 P.O. Box 196650 }Anchorage, AK 69519-6650 I www.ci.anchorage.ak.us' `(907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: J_ 0 T L0 v p.�✓z M �. y� 'JD --: , ;Parcel ID: 015 I A. WELL DATA r Well type �w -i 'E l ; If A, B; or C provide PWSID # Well Log &N) Y� S Date completed J0 Sanitary Sanitary sea!!!l (QYN) Wires properly protected &N) Yf- S Total depth ft. Cased to ' 7 i �ft. :I . Casing height (above ground) I -a-+ in. i ;FROM WELL L'OGAT INSPECTION Date 'of testi t o �y l 19' 2 4 g b I Static water level 3 i Well (production 140 - E` g.p.m• g.p.m. i WATER SAMPLE RESULTS F:. (-i A, s r Esc ;'; /3 Y e vmod -f-40 Coliform " colonies/100 ml. Nitrate • -7 e mg./I. Other bacteria c7 colonies/100 ml. ! Arsenic:' C Date of sample ►�6 °'� A . Collected by: S & S ENGINEERING ver Loop Road No. 204 B. SEPTIC/HOLIDING TANK DATA ` 'Eagle Rlrer, Alaska 99577 I Tank Type/Material:'•$ SPr� c L I / , Date installed 7 F Z Tank size d 06 `, • al ) .�_ g ;,Number of•Compartments -�- Clean !J J Sim .5 ! j Foundation cleanout &) yet Depression over tank (Y/� V o High water alarm (YOh a Date of um m 7 I a g �d !3 ' l 1. P P 9 Pumper 14, N o .., '" s E � v� C. ABSORPTION FIELD DATA Date installed °j /� � �y 2-; ,Soil rating (g p d:/ftZ�or ft /bdrrn System type 7'Q Length • ;3t 3 ft. i I Width �'' 3 k ft. , I i; Gravel below pipe ft. I S ' m� ' I• a. i x ' 0 z k Total �� :; de th � S` p ft. Eff ,absorption area �ft Monitoring tube �� S , Depression over field I. cl Date'of adequacy est' �ig w Al Results ` ss Fail) 133 s1 :For bedrooms Fluid depth in absorption fieIdbefore test �lIKI ' `'.'Water addeda-on0gal. New depth S in. Elapsed Time '7 'min. Final fluid depth- in Absor tion'!rate P g.p.d. ` I Any rejuvenation treatment (past 12 mo.) (Y/N' & typej' N0w�✓ If yes, give date' k D. LIFT STATION Date installed Size in gallons Manhol ss -(-YIN) "Pump on" level at in. "PIUMD in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1 00 �"/' On adjacent lots y 0 0 Absorption field on lot /,D 0 �'� On adjacent lots / Public sewer main N ` -4 Public sewer manhole/cleanout A) 14 Sewer /septic service line a r �4" Holding tank X14 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation S �4- Property line SAbsorption' field Water main N 14 Water service line % 0 Surface water J 0 o Wells on adjacent lots 1 0 D SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: . Property line Building foundation 10 Water main %,4 Water Service line i o 4 Surface water 1 0 o f Driveway, parking/vehicle storage Curtain •drainN o Nth . k No wN ' ' Wells on adjacent lots 100 F. COMMENTS'. .v!................ t G. ENGINEER'S CERTIFICATION I certify that t have determined through field inspections and i „• `' ,° ;+ review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. X.. Engineer's Printed Name R a Q x•27' C Caw�.�j`�i �F =Fvn� �:' Date �/ a l 0 y tkj HAA Fee $ 3 y 4' Date of Payment Receipt Number .D s -o y 7 (Rev. 12/01) Waiver Fee $ _ Date of Payment Receipt Number r!C'r !1.41LTC•^7. �.:•1':9.�c+:.i•�uu�.arrr�wr� •w.w•..�•.,� E•' �l �� 1. ��.�. M w.r. w�...M�, r�.�i..... �� ^.�• .ter..• � y� A Lot 2 , Block =Loudermilk Suri vision Anchorage Recording District, Alaska i OT SURVEY CERTIFICATION I heretty artlfy that I have surveyed the property shown and described hereon, and that tM hnprovaunts situated thereon are within the prop- erly Itnes and do mot overlap orenordooh on ad)ooent property and that no Inwove wnfo on adjacent property overlap or encroach on the promises In 4lueelios and that there we no roadvoys, atlltty tines, or other visible easments on sold property except as Indlooted hereon. Easements of record othgr than (hose ohm the plat of record we not shown bersoe vni etherwlee noted. LEGEND to Brass or Aluminum capped monun O Iron pipe and/or rebar recovered. 0 2 x hub & tack recovered e 5/8 t x 30° rebar set this survey 10 - R.. n :ice h�QvOred 1S-1192 s Fpeo °r °e. r'JQ jROF"*mo 'O'��� Scble 4n /j), `'�.� Date C � -O9 _� 0 Prepared by: R. L. BUTTON Regi*t*rred Load Surveyor . _•- (907)279-6200 519 W. Eioth Am. AlwhwWe Alaska SMW Ref. 2537 F.B. NO. -CO3Property of; ' G . Ke/% SGS Ref.# 1041644001 Client Name S & S Engineering Project Name/# Lot 2 Loudermilk S/D Client Sample ID Lot 2 Loudermilk S/D Matrix Drinking Water sample Kemarks: All Dates/Times are Alaska Standard Time Printed Date/Time 04/09/2004 17:04 Collected Date/Time 04/06/2004 20:30 Received Date/Time 04/07/2004 10:58 Technical Director Stephe . Ede Released By / Parameter Results PQL, Units Method Container ID Allowable Prep Analysis Limits Date Date Init Waters Department Nitrate -N Microbiology Laboratory Total Coliform 2.74 0.100 mg/L EPA 300.0 0 col/100mL SM18 9222B B (<=10) 04/08/04 HE A (<=I) 04/07/04 DKC Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division cn 825"L" Street, Room 502 • Anchorage, Alaska 995010 (907) 744; c rri Health Authority Approval Checklist ` s Legal Description: 4.o a 1- o u 061e M I L K S%O Parcel I.D.: A. WELL DATA Well type P,?i V4 -T f If A, B, or C, attach ADEC letter. ADE/I/F1 C water system number Log present (DN) YES Date completed /o / I / F 1 Total depth '7 q Cased to "7 Y Casing height (above ground) 1 t 4 - Sanitary seal 6" Y6 S Wires properly protected a" Date of test Static water level FROM WELL LOG 10 /q4a 37 Well production 0 4- g.p.m. WATER SAMPLE RESULTS: AT INSPECTION �laa/cls— �7 YF s, Coliform 0 Nitrate ). • 17 Other bacteria () Date of sample: ( 5" �i 5 Collected by: S & 5 ENGINEERING 34 Eagle River Loop Road No. 404 B. SEPTIC/HOLDPiG TANK DATA Eagle River, Alaska 99577 Date installed 1 / Tank size 1 U 0 0 Number of Compartments Cleanouts &N yds Foundation cleanout (VM Y -f5 Depression (Y/& N 0 High water alarm (Y/)) Al Date of Pumping - 4� - r/S� Pumper C. ABSORPTIONFIELD DATA Date installed 9 1 7 Sf 7- Soil rating (g.p.d./ft2 o 2/bdrm S- System type 'T'/� cy Length 33 / Width 3 ( Gravel thickness below pipe C Total depth Effective absorption area S Monitoring Tube present&/N) ) �) Depression over field (YA ti Date of adequacy test ��K / 15 Resultsas /Fail) P4 --f 1 For -3 bedrooms Fluid depth in absorption field before test (in.); G I S'410 41jumediately after i6" gal. water added (in.): 1 3 Fluid depth Ix Minutes later: I- (in.) Absorption rate = 4< 5-0 4' g.p.d. Peroxide treatment (past 12 months) (Y/& If yes, give date ry%� 4wv.iL SJ'A13.'zC0 47' w✓�rEr2 Karf d,C Y GP.�I D. LIFT STATION Date installed Manhole/Access (YIN) High water alarm level E. SEPARATION DISTANCES Size in gallons *Datum at* "Pump off' level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/IrW4w-,g tank on lot 1 0 0 I �" On adjacent lots Absorption field on lot /00 On adjacent lots Public sewer main /v //i Public sewer manhole/cleanout /ao I -A Sewer /septic service line y` Lift station N SEPARATION DISTANCES FROM SEPTIC[HeL-BRIG TANK ON LOT TO: I t Foundation S Property line 1 a t Absorption field � I Water main/service line "5_ -"- Surface water/drainage "0 7` Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: t Building foundation Surface water /00 r Curtain drain ^i •� '� o �� ,✓ F. ENGINEER'S CERTIFICATION Water mam/service Ime Iv f 4 - Driveway, parking/vehicle storage area Wells on adjacent lots 1 certify that 1 have determined thru field inspections and review of Municipal in conformance with NIOAAA guidelines in effect on this date. Signature &/.� Engineer's Name Po e -n r Co (,,) 9n/ Date 9 � -3 l %c7 S— HAA Fee Date of Payment/ /,�9. Receipt Number Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number u /A f U F A ` Ronw C. COWAN i a 6iJ f� CE�%N, A �Mple Remarks: SAMPLE COLLECTED BY: SOB C. ar AlloWable Ext. ® ME Environmental Services Inc. Unite Method 3 Laboratory Division -----------------------------------------------g----- :;.zrage-N 2.47 r+r. :: R€ef.# 95,3637-1 Laboratory Analysis Report 08/28/95 OM 11 b�.crix WATER Tient Sample ID L2 LAtPDERMILK S/D ,,-)Sent Name S & S ENGINEERING WORK Order 17512 Ordered By R. COWAN Printed Date 08/31/95 0 12:09 hre. '�oject Name Collected Date 08/25/95 a 13:15 hre. ;oject$ Received Date 08/25/95 0 15:05 hra. ^;c D UA Technical Director STEPHEN C. EDE Releaged 8yr�� .ter+. - .•-.w-- �=�_ �Mple Remarks: SAMPLE COLLECTED BY: SOB C. ar AlloWable Ext. Anal Parameter RedUlta Qual Unite Method Limits Date Date Init -----------------------------------------------g----- :;.zrage-N 2.47 ` m /L --------------------------------- EPA 353.2 10. 08/28/95 OM 11 —11............rs.mamama-M--w- ...............n ...Wr.ama¢¢aaa.............mmaa.n...M..i,YMrr............... Se® Special Instructions Above UA . Unavailable See Sample Remarks Above VA a Not Analyzed j"- Undetected, Reported value is the practical quantification limit, LT - Lees Than Secondary dilution. GR' Greater Than _200 W. Potter Drive_, Anchorage, AK 99518-1605 --Tel: (807) 562-2343 fax: (907) 561-5301 ennnnnninn[mTA1 [ALU met ,hl Al ASKA CAI Ifr1ANIA. FLORIDA- ILLINOIS_MARYLAND, MICHIGAN, MISSOURI, NEW jERSEv. OHIO, WFST VIRGIN!/ r. -• MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES y}j 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 Parcell.D.# (11�j-�"�h HAA# dj£��i'1h11(n`l 1. GENERAL INFORMATION Complete legal description Lot 2; Loudermilk Subdivision Location site address or directions) 10501 Loudermilk, Anchorage, Alaska Property owner Katherine Portlock and Jan Daniels Day phone 343-4098 PAn;I;ren oArlrole 10501 Loudermilk, Anchorage, Alaska 99516 Lending agency Day phone Mailing address Agent Day phone A J J ........ !1441 li V V - Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 ~ 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. 1791) Front MOA 021 g. STATEMENT OF INSPECTION BY ENGINEER I verify that my As certified by my seal affixed hereto and as of the Vicat on shows that he onalidation date shown o site water supply investigation of this Health Authority Approval app and/or wastewater disposal system ein. I furtherveis safe, lofy that based onnal and tthe infoe for rmation mation obtained from and type of structure indicated he investigation and inspection, the on-site water the Municipality of Anchorage files and from my liance with all Municipal and State codes, supply and/or wastewater disposal system is in comp wi ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Phone 17034 Eagle River Loop Road No. 204 Address Date Engineer's signature Of Ake%I6 � 'ue,�po•orov o. 3 oleo c 6. DHHS SIGNATURE Approved for / j bedrooms. Disapproved. Conditional approval for Additional Comments n Ai,, IJ a e �Q�QpROFESStQ��� bedrooms, with the following stipulations: (j q Date By: issues Health Authority of h 5 above by an independent The oval Certificates based only upon the representations ons given inan to rvices HHS) Approval Cert professional engineurchasers of homes er registe n orded in ht satisfy cee State of irtafn DHHS does this and ate requiirs a courtesy rements. EMP op ees of DHHS do not and their lending institutions ndatas in the oreprofacertsion ificat ineer's work Municipality of Anchorage is no conduct inspections or analyze responsible for errors or omissio Municipality of Anchorage / Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /�C�T2r Lc�UDERW IUC Parcel I.D. d ll f — U11 Z-Z)/—l1, A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number lu Log present (Y(V Date completed f w/—/� _r}'Driller� Total depth �I Imo/ Cased to /� Casing height �►O� Sanitary seal /�/N) L Wires properly protected &N) /F -S B. SEPTIC/HOLDING TANK DATA Date installed —gZ Tanksize 160o I Compartments -OUYSIDE Cleanouts &) TWO Foundation cleanout la —Lq!" C.X, t Depression (Y/OI No High water alarm (Y/9 N A ested (Y& ^ Date of pumping 7' - oZ o - 72— Pumper -TS/.+A CS' (jWP-t t J cr SEPARATION DISTANCES FROM SEPTIC/110t TANK TO: Well(s) on lot loo r�- On adjacent lots /00 f Foundation 5 �� i To property line 10 /+ Absorption field 86 1Water main/service line /011 Surface water/drainage 100 4- 72-026 (Rev. 7/91) From I- - . " CONTINUED ON BACK PAGE Z, FROM WELL LOG AT INSPECTION 0 z 1`9 2 — M m a Date of test a— /. r" f" r 7 3 Static water level rn m o Well flow g.p.m. G, g g-15*.S < z Q0 t7T, y3 * M n N O Pump level ® o O M SEPARATION DISTANCES FROM WELL TO: Z r Septic/ho#kng tank on lot 106 ; On adjacent lots !OQ ��Q �QU Absorption field on lot ; On adjacent lots Public sewer main N/A Public sewer manhole/cleanout r Sewer service line Petroleum tank d& ly wd WATER SAMPLE RESULTS: Coliform O Nitrate a,0 m8- �e Other bacteria 0 Date of sample: t�7 2 Collected by: S�S �ltGlW, 11G/�!i B. SEPTIC/HOLDING TANK DATA Date installed —gZ Tanksize 160o I Compartments -OUYSIDE Cleanouts &) TWO Foundation cleanout la —Lq!" C.X, t Depression (Y/OI No High water alarm (Y/9 N A ested (Y& ^ Date of pumping 7' - oZ o - 72— Pumper -TS/.+A CS' (jWP-t t J cr SEPARATION DISTANCES FROM SEPTIC/110t TANK TO: Well(s) on lot loo r�- On adjacent lots /00 f Foundation 5 �� i To property line 10 /+ Absorption field 86 1Water main/service line /011 Surface water/drainage 100 4- 72-026 (Rev. 7/91) From I- - . " CONTINUED ON BACK PAGE C. LIFT STATION Date Size in gallons Vent(Y/N) High water alarm level "PUrn-D-G !' level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off" level at Cycles tested Surface water Date installed Soil rating - 8 S SF 6SA System type 12ZE1VcI-F Length � � Width -Gravel thickness � b Total depth /0 Total absorption area 2S� 1U SF (CIN -0- Cleanouts present &N) OPJ/_s Depression over field (Y/& lyc, Date of adequacy test _—_ —A j-9 L Results (pass/fail) I?A S for 3 bedrooms Peroxide treatment (past 12 months) (Y/6) bYT kNc.+wr`+ If yes, give date j�ER ZNSf'. fiCPorrT IJFI-7�� `J -l'i�2 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: * Well on lot r On adjacent lots TUU i' Property line To building foundation `f o (�. To existing or abandoned system on lot A)14 r b On adjacent lots o2 Cutbank /00 ',4Water main/service line Surface water - nn II loy Driveway, parking/vehicle storage area 5 f Curtain drain LAt^ kry wrj E. ENGINEER'S CERTIFICATION I certify that f have checked, verified, or conformed to all MOA and HAA guidelines in effect o ftfjf to of this inspection. S & S ENGINEERING Signature 17034 Eagle River Loop Road No. 204 age Iver, as Ca Engineer's Name Date — % 9 — 9 2-- HAA Fee $ Waiver Fee: $ Date of Payment Date of Payment Receipt Number Receipt Number ��> FFS HAA Fee $ Waiver Fee: $ Date of Payment Date of Payment Receipt Number Receipt Number CHEMICAL & GEOLOGICAL LABO"T. ORS' A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. $633 B STREET ANCHOHAGE, ALASKA 99516 TELEPHONE (807) 562-2343 i FAX: (907) 561-6301 ANALYSIS RESULTS lot INVOICE 1 55986 Chemlab Ref A 92.3560 Sample 1 9 Nattiv WATER Client Sample ID : DRINKING WATER L2 LOUDERKILK S/D Client Name :s & 8 ENGINEERING MID : UA Client but :39SENGP Collacted JUL 16 92 A 16:10 hre, BPOY : POI :NONE RECEIV0 Reoelyed JUL 17 92 t 15:15 hxe. Req# Preserved with AS REQUIRED Ordered Bp :R. SHAPER Apalyeia Completed : JUL 20 92 Send Reports to: Laboratory Supexyis x : TEPNEM C. ED 1)S & S ENCINEEEING Released Ey ���' 2) Semple ROUTINE SAMPLE COLLECTED EY: J.W. TEMP 23,2 DECREES C. Remarks:...YNP..........w..... i ..Noss i.w..............................1................................................... ......... .....w..........____ .............. ... ............. 1 Toots Performed See Special Instructions Aboye UA•Unayeilable MD- None Detected See sample Reroaxke Aboye MA- Not Analyzed LT -Less Than, GT-Gtoater Than ifaw'S139 Member of the SGS Group (SooldtO Gdnerale de Surveillance) ................................ Y........Y. «..........i.....f..1...inff...i,...Y.i....Ti YY....... Pnramatax Y.a.....ilYlnY.-..................... Result# Unita .. Method Allowable Limits .=,.-;. - _- NITRATE -N 2.0 ng/1 EPA 353.2 10 Semple ROUTINE SAMPLE COLLECTED EY: J.W. TEMP 23,2 DECREES C. Remarks:...YNP..........w..... i ..Noss i.w..............................1................................................... ......... .....w..........____ .............. ... ............. 1 Toots Performed See Special Instructions Aboye UA•Unayeilable MD- None Detected See sample Reroaxke Aboye MA- Not Analyzed LT -Less Than, GT-Gtoater Than ifaw'S139 Member of the SGS Group (SooldtO Gdnerale de Surveillance)