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VALLEY VIEW TERRACE BLK 3 LT 3
Valley View Terrace Block 3 Lot 3 #050-352-08 Municipality of Anchorage U � p_ - ��� Community Development Department !l ZO��Page 1 of 3 On -Site Water & Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 ^ http://www.muni.org/onsite • (907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181097 PID Number: 050-352-08 ❑ New ■ Upgrade Name: JASON CRANDALL ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bed ound Address: 23535 UPPER TERRACE STREET, EAGLE RIVER, AK 99577 ❑ Other Phone: No. of Bedrooms: Soil Rating: Total Depth from origin de: 306-5327 3 GPD/Sq. FL Ft LEGAL DESCRIPTION Depth to pipe invert from original grade: F Grave epth beneath pipe: Ft Fill added above original grade: \ Gravel length: Subdivision: Block: Lot:I� VALLEY VIEW TERRACE S/D 3 3 �cj�\\ Fl Ft Township: Range: Section: Gravel width: Beds Number of lines: Distance between lines: Ft SEPARATION DISTANCESFL Total absorp' area: Number of trenches: Dist between trenches: To Septic Absorption Lift Holding Public/Private From Tank Field Station Tank Sewer Lines SD. FL Ft Well 100'+ 25'+ TANK ■ Septic ❑ S.T.E.P. ❑Holding ❑ Other Manufacturer GREER TANK Capacity 12I— Surface Water 100'+ I50 NIA Gal. Lot Line 5'+ D Material: Number of compartments: HDPE PLASTIC 2 LIFT STATION Foundation 10'+ - - Curtain Drain NONE KNOWN Manufacturer. C Gal. Remarks: Pump e� level at •Pump off" level at High water alarm at Pump Make & Model Electrical Inspections performed by: PIPE MATERIAL EXISTING / EXISTING / House to tank D3034 (NEW) Tank to D3034 (NEW) drainfield Installer WILCO EXCAVATING Drainfield EXISTING CO/MT D3034 Inspector GEG, Ltd. BENCH MARK (Assumed elevation) 100.00 Ft Inspection Location and Description: Dates: 1 St 5/25/2018 2nd - 3rd - 4th - TOP OF GARAGE SLAB ENGINEEFVP SEAL Community Development Department ApprovalAV .�•�E®pF�,t��e� Conditional approval: Date: # ,I * . �0 J� 1 ..Garn . ss CE 7 53. AW C �vt��O �S Approved: �Z,N�GC� Date: / ME I #AECC884 �Isk Inspection Report _1-1-12.doc PERMIT NUMBER: PARCEL ID NUMBER: OSP181097 RtC®K® DRAWING 050-035-08 i THE DRIVEWAY LOCATION SHOWN IS APPROXIMATE. OWNER \ HAS RECENTLY REVISED THE DRIVEWAY/PARKING LOCATION \ SO THAT NEW HDPE TANK CANNOT BE DRIVEN OVER. WELL v NOTE: THE OLD SEPTIC TANK WAS REMOVED OFFSITE AND DISPOSED OF IN APPROVED DUMPSITE PER THE CONTRACTOR A-T B ST1 26.4 30.4 ST2 31.4 30.7 TANK MT 29.1 27.5 C01 33.6 32.5 SUMP 85.7 77.0 INSTALLED TANK MT N 1250 GALLON GREER HDPE SEPTIC TANK BI-DIRECTIONAL "T" - C01 EXISTING FCO I ' 70 \ .04 AFF GARNESS ENGINEERING GROUP, Lt CIVIL & ENVIRONMENTAL ENGINEERS - - 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507' PHONE (907) 337-6179' FAX (907) 338-3246' WEBSITE: www.games engineering.com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JASON CRANDALL 306-5327 2 OF 3 PROJECT/LEGAL DESCRIPTION: DRAWN BY: VALLEY VIEW TERRACE; BLOCK 3, LOT 3 J.L.M. TYPE OF WORK: DATE: �, RECORD DRAWING OF SEPTIC TANK UPGRADE 1 6/12/2018 —ASSUMED LOCATION OF EXISTING DRAINFIELD EXISTING SUMP AV �......d4'............. ............ i •a... arnes ' i i LICENSE PROFESS .s IIti�Yl��! #AECC884 / s/L ' O. N,�,PAL MUNICIPALITY OF ANCHORAGE men/ ' On-Site Water&Wastewater Program 411111h I rPO Box 196650 4700 Elmore Road Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 r. http://www.muni.org/onsite Artimui Dci);irtnt nt 4NCHON PGO On-Site Wastewater Disposal System Permit Permit Number: OSP181097 Effective Date: 5/18/2018 Work Type: SepticTank Upgrade Expiration Date: 5/18/2019 Tax Code Number: 05035208000 Site Legal Address: VALLEY VIEW TERRACE BLK 3 LT 3 G:0159 Site Mailing Address: 23535 UPPER TERRACE ST, Eagle River Owner: CRANDALL JASON R Lot Size in Sq Ft: 76666 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: A set of opposing cleanouts (double cleanouts)shall be installed on the downstream side of the septic tank within 10 feet of the outlet. Received By: �� Date: sem/ (S/(8 Issued By: f`�-�ll-GC;Ch Cgnstk' Date: , ./16/1 8 MUNICIPALITY OF ANCHORAGE Community Development Department �: Phone: 907-343-7904 Development Services Fax: 907- 343-7997 On-Site Water & Wastewater Program Mayor Dan Sullivan On-Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 050-352-08 Property owner(s) Jason Crandall Day phone 306-5327 &5le {2�ve Mailing address 23535 Upper Terrace Street*A ctuaferge,AK 99577 _51e VZ;ve Site address 23535 Upper Terrace Street`Aue)iorSge,AK 99577 Legal description (Sub'd, Block & Lot) Valley View Terrace: Block 3, Lot 3 Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: (®all that apply) Initial I I Single Family (SF) Absorption Field ❑ (w/wo ADU) Septic Tank ® Upgrade Duplex (D) ❑ Renewal ❑ Holding Tank n Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well C Water Storage LI THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: N/A Distance: - I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: u? I 5 Waiver Fees: Date of Payment: 3/ 1 1 \ Date of Payment: Receipt Number: U y L ` G Receipt Number: Permit No. OS IS' I S 1 0 19 Waiver No. (Rev.01/11) ..„ ti > _ Quanics GARNESS ENGINEERING GROUP Ltd 'r,, <<rr T:°"" sY_.",m ENGINEERING SALES CONSULTING Dealer May 18, 2018 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic Tank Upgrade for Valley View Terrace; Block 3, Lot 3 To whom it may concern: The existing 3-bedroom house is served by a private well and private septic system. The existing steel septic tank (installed 1983) is in a state of failure and needs to be upgraded. We are proposing to decommission the existing tank per UPC and replace it with a new 1,250-gallon H.D.P.E. septic tank. The installer is to is to maintain a 100'+ separation to the existing private well and a 10'+ separation to all building foundations. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. lerely, i i , carne- P.E., M.S. Pres,-e 3701 East Tudor Road, Suite 101 *Anchorage,Alaska 99507-1259 Phone: (907)337-6179*Fax: (907) 338-3246*Website: www.garnessengineering.com c 1 TION.RI W.SEC 15.NE..E2NW4.NW4NW41 1 PARKSIDE;BLOCK 1.LOT 31 IMMI I5'MEA ELEC ESMT VALLEY NEW TERRACE;BLOCK 3.LOT 21 / \ \ I 7pj.wELL07OS I (VALLEY VIEW TERRACE.BLOCK 3,LOT 41 I ' i • PROPOSED 1250 GALLON VAUN NOPE SEPTIC TANK \ EXISTING OOM \ \ jDD / , \ \ / \ {� \\\ I• \ \\ ;� IC • / 1\ \ FMFro\\ .\ (VALLEY EW TERRACE,BLOCK 2,LOT 61 \\ VIEW T1 \�\ 440,05 \ i\ /oF T VALLEY VIEW TERRACE;BLOCK 2,LOT 91 \ T \\ (VALLEY NEW TERRACE;BLOCK 2.LOT 101 \\\ (VACANT( \ \S ALE: VACAN ............. 151 1"=100' \\ 1��C;.••.• •.•••• ♦A . q V. RING GROUP, Ltd JA.1 49 l• GARNESS ENGINEE • CIVIL&ENVIRONMENTAL ENGINEERS • • 3701 E.TUDOR ROAD,SUITE 101•ANCHORAGE,AK 99507'PHONE(907)337-6179'FAX(907)338-3246'WEBSITE:www.gamessengineering.com '•••• • •• 0 • PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0 t� -ff .. • Gam: s = JASON CRANDALL 306-5327 1 OF 2 0��- E-7• ♦ J'I,'• • �� ••;ar PROJECT/LEGAL DESCRIPTION: DRAWN BY: .♦Fi .. •• 48 `..�J• 41• VALLEY VIEW TERRACE; BLOCK 3, LOT 3 L.K.B. fff, pRpFESS�� ���� 411. TYPE OF WORK: DATE: LICENSE f%ti "`*** SITE PLAN 5/18/2018 #AECC884 1 _ HOUSE/DRIVEWAY LOCATION SHOWN WERE TAKEN FROM A FRED WALATKA,P.L.S.AS-BUILT SURVEY COMPLETED 8/10/2017.PER / OWNER,DRIVEWAY LOCATION SHOWN IS APPROXIMATE AND IS NO \ LONGER ACCURATE.THE PROPOSED HDPE TANK WILL BE N INSTALLED TO THE NORTH OF THE EXISTING DRIVEWAY. N - VALLEY VIEW TERRACE; \ BLOCK 3,LOT 2 TANK LOCATION SHOWN IS CONCEPTUAL(BASED OFF \ OF OWNER DESCRIPTION).THE INSTALLER IS TO \ INSTALL THE TANK PER MOA REQUIRED GUIDELINES FOR A 1250 GALLON HDPE SEPTIC TANK AND IS TO MAINTAIN A 100'+SEPARATION THE EXISTING WELL,10'+ \ SEPARATION TO ALL SURROUNDING FOUNDATIONS, AND A 2'+SEPARATION TO THE EXISTING DRIVEWAY. \ , ��V ILO5 1 100 \�1 '/'���o///. EXISTING 3 a INSTALL MT BEDROOM HOUSE I ' , ,..; 3rø - - PER OWNER,DRIVEWAY EXISTING / . LOCATION SHOWN IS NO FCO - LONGER ACCURATE. / e SEPTIC TANK WILL NOT BE \ tknfAirllg 4 INSTALLED UNDER \ ‘\ DRIVEWAY/PARKING AREA �.s.40t , PROPOSED HDPE SEPTIC GALK LON \ / EXISTING SEPTIC TANK TO 8E \ DECOMMISSIONED VALLEY VIEW TERRACE; 70- - \ PER UPC BLOCK 3,LOT 4 VACANT Fg \ S�M N\ \ C/pp� \ \ tk-RRq \ \ \Fsr� N k•-i,. \ SCAlil "=4 ' 1 1"=400' VACANT / 1.4\\�••'*•• ,.•....4 •••. al GARNESS ENGINEERING GROUP, Ltd 4 ..'='� CIVIL&ENVIRONMENTAL ENGINEERS ... f/� 0 3701 E.TUDOR ROAD,SUITE 101'ANCHORAGE,AK 99507•PHONE(907)337-6179'FAX(907)338-3246'WEBSITE:www.gamessengineering.com • • , , PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0♦ ' - �A. a -ss S to JASON CRANDALL 306-5327 2 OF 2 ♦ i CE- 95 — PROJECT/LEGAL DESCRIPTION: DRAWN BY: •. •• VALLEY VIEW TERRACE; BLOCK 3, LOT 3 L.K.B. •• ♦��'''S I g ./.43.0.' . TYPE OF WORK: DATE: •• O ESS\�•�4 SEPTIC TANK DESIGN UPGRADE 5/18/2018 LICENSE ,1�ims‘s•� J ri 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 / (//�.�� PHONE NEW ❑ UPGRADE MAI LI NG ADD Qy— LEGAL DESCRIPTION f oma% LOCATION NO. OF BEDR!? all O Y D STANCE TO: Well }„�U - e Absorptionarea (� <SC, Dwelling.© e 4 !� PERF OX fVQ_ry �' /� F- Z Man ufactur M I No, of comp ants w Liq./cityq ingallons � IF HOMEMADE: Inside length idth Liquid depth O Y DISTANCE TO: Well Dwelling PERMIT NO. JDZ = z F Manufacturer - _ - Material - Liquid capacity in gallons - = DISTANCE TO: Well �(�� Foundati ( Q Neareut linp+� PERMIT Z No. of lines Length of ac line Total len h of liges Trench loth Distance bQtfvee Ijpes H w� inches FTop of ' e finch grade ( ero bene/a�th the ` +c Z Ya. r (00 inc Total effect i a abso tion area f Length Width Depth PERMIT NO. w Q F- Type of crib Crib diame Crib depth Total effective absorption area wo �f T W - DISTANCE TO: Well Building foundation Nearest lot line J J Class /'T C 7 _C•- Dgpth - N Driller Distance to lot line PERMIT NO. W W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS ��t _ /! T SOIL TESATING ISO INSTALLER REMARKS C� e- d(�% L %-E..S e a,4 a, /De Ave -'4J Ayeell. e •- ^ YG3a P:t F..38 :d e e .,q g yr �z leo? C 17T f I Iu APPED DATE LEGAL. X96}{ R 72-01Y (Rev. 3/78) I 'J MUNICIPALITY OF ANCHORAGE Departments t Health and Environmenta/" Protection 825 Street, Anchorage, AK. .9501 n 264-4720 Permit # /# # # HANDWRITTEN PERMIT # # # WEL%/AND/OR ON-SITE SEWER PERMIT Applicant: t1 11, /� � 1 �( e� Mailing Address : , Location: Phone Number: �j Jy�217 T Legal Description: L Q G�G/G� (/// G� T�/ Lot Size: Type of Soil Absorption System Is: Trench: Drainfield: _ _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: �� Soil Rating(sq.ft/br) 3 �� (The Required Size of the Soil Absorption System Is: r DEPTH _ LENGTH _4Z _ GRAVEL DEPTH�t�"d/0 �6P WIDTH _ The length dimension is the length(in feet) of the trench or drainfield. 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). * * REQUIRED SEPTIC(HOLDING) TANK SIZE _ GALLONS # # 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. ' * * * TWO(Z) INSPECTIONS ARE REQUIRED # # Backfilling of any system without final inspection.and approval by this departme will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. # # # PERMIT EXPIRES DECEMBER 31, 1 9 3 3 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth the Municipality of Anchorage. (2) I will ns a 1 the system in accordance with codes. (3) ;th un erst that the on-site sewer system may require enlargement if es' e i modeled to include more that 3 b rofoms. Signed: Issued by: t0 p licant Date: % . « �� SWP/024(1/81) li �� 1 ❑ SOILS LOG r MUNICIPALITY OF ANCHORAGE o aE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 2644720 S�OILS LOG — PERCOLATION TEST PERFORMED FOR:_//t/ %p�I ' ' " DATEPERFORMED: I cr-ni. DESCRIPTinni. L� c7 ���C `�-✓/ /�` / D�PTH7 (FEET) 2 "I S/G 7-e 3/ 4 5 6 0 `v 7 6' 9 G` i 10 y 11 l 12 13 b 14 15 w raj 17 18 } 19- 20- COMMENTS 9 20 COMMENTS PERFORMED BY: t 72-008 (6/79) 6 P— Lf,�W7S-X&7— Off' A C? P.cha;� R. $hairy Nc- Sfi5% A�t�+1tG, cS'"-:fit cv.=`�• azrJ�Y / SLOPE WAS GROUND WATER )� ENCOUNTERED? /1)0 IF YES, AT WHAT DEPTH? w i c rLNry Tr— Reading Date Gross Time Net Time Depth to Water Net Drop V 4; PERCOLATION RATE TEST RUN BETWEEN CERTI FT (minutes/inch) FT DATE v 1 ❑ SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION X PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: (J ALL /�'L-lGE � DATE PERFORMED: /—�D "[7 -moi LEGAL DESCRIPTION: 1 Ls7- ii L..K :3V%1 <-C-CY Vt e4-)�G�eticz- d+ SLOPE SITE PLAN DEPTH Z' O9�A-W IC— 1 2 3 • lAr 4- 6- 7 6 9 Y'. Q� f 'y 11 12 ) 13 14 15 16 17 18 19 20 COMMENTS PERFORMED BY: 72-008 (6/79) 71-6-ivr 5 /L75° WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? i3o-tT�ow- a� 1-kx� rm 0 c Hobert A, $hn, fat S yo. 14TI4 N'L L O P E Reading Date Gross Time Net Time Depth to Water Net Drop N a F ,4' 3 -'[ 14 .1 4 10 S -Z % I b PERCOLATION RATE -40 (minutes/inch) TEST RUN BETWEEN _4 FT AND 5 ;L FT SPu i96�49a17 �JJ CERTIFIED Y: DATE: - -! `,CATER WELL RECORD t STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of. Geological 8 Geophysical Survey* Drilling Permit No. LOCATION OF WELL (Plssn complete either lar Ib or Id.)' - - A.O.L. No. E-A Borough Subdivision Lot Black Ib. 1/4gtr ; Section -.No. Township No Range E[] Meridian ""; Y ANC H Vr \ / 3 .:. 3:.. _ar_at_af- S❑ W❑ Ic. DISTANCE AND DIRECTION FROM ROAD_ INTERSECTIONS. - S: OWNER OF WELL: OILL y� nnwNLu.� Street Address and Area of Well Location LAC-2LC R►y6iz.'--'A i�'7 {q5.r 7 2. WELL L00- -feet Beller Su rfoce '4. WELL.DEPTN, (final) - S, DATE OF'COMPLETION - 2.1e) ft. 1-A__r 11(n Material Type ;.:'Top -.-- Bottom _ ;- —1�3 ( d;',;, ❑ Cebie tool ® Rotary O Driven 0 Dug Q Auger - Q Jelled Q Beridr,r�' ❑ Othert' _.� . .... z -' -' 7. USE: �Domeelle.:,_.._„_ O Publla�Supp)ySl 0 Industry Q Recharge..` ,1Q Commerical Teel Well <,Q Other: AT S. CASING,-' Q Threaded; ® Welded' /n q dium._�In. to y,Yt. Depth Weight lbt./ft. diem;. In. to— ft. Depth Stickup ) ft. . {. - - 9• FINI7H OF.WELI: - �t.T„Ypt Diameter'' -' SIe1�Mttk SIn: - Length: ' ` 'S.tb.iween fl. and ft. Ski ,o or � Backfilling Gravel pack 10. STATICWATERLEVEL' 64 ft:' ► 0 Above or E] Below land surface Oe1• - Equipment used: sool"I ( II . PUMPING LEVEL below land surface and MI -D 4,.2 30 fl, of ler �_hre. pumping G -g•p•m•. - ft. after _ors, pumping.--'���O.P•m• y • - 12.OROUTING Well Grouted: C:j Vss C3 No Material: 0 Neat Cement 0 Other: 13. PUMP, (if ovallcbie) NP - Length of Drop Pipe fl. capacity g.p.m. 0 Subm. Jet C] Centrlflcol '-. a Other 14.REMARNS: A))Z LSP r P1,111 P1►Vh, ►ZOUS AT 23ay 16. WATER WELL CONTRACTORS CERTIFICATION! 16, Wahl Tempe rel urs f ❑ C This wall as drilled under my jurisdiction and Intinporl U true to IM Seel ol. my knowledge and belief) - w,Nrwu►rt vert LL na►cciNc: � Registered Business Name-Coolrocl.LJeonso Number Aadren: a� z signed: i _. Dani 17 AJC, i?� - Aufhorfzod Repress t°Nve - Form 02•WWR (11/61)' Copy Distribution: WI TE'Slals' OGOSL,.PINK-Driller, CANART'Cuslomor Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 050-352-08 1. GENERAL INFORMATION: Complete legal description Valley View Terrace; Block 3, Lot 3 Expiration Date: / - 1;,— 2 0 2(9 Complete (9 Location (site address) 23535 Upper Terrace Street *Eagle River, AK 99577 Current Property owner(s) Jason Crandall Day phone 306-5327 Mailing address 23535 Upper Terrace Street *Eagle River, AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: Single Family (w/wo ADU) 17-1 Duplex 1771 Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual 0 Individual Water Storage 1:1 Holding Tank 0 Community Class Well 0 Community F71 Public Water System ❑ Public Sewer 1771 WaiverNariance request for: -Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $_ so — Waiver Fee $ Date of Payment a " -7 (o Date of Payment Receipt Number o6Gal 3 Receipt Number COSA# 0 SC I C1 N-7 C) Waiver # OY41 (4 M 6. 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 (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this. report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (includirig"subsequent propery purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE ` System #1 Approved for 3 System #2 Approved for Disapproved Conditional approval for s'c 4 CE 793 L�r�Q ,Vhpr o f e s Sion°oo #AECC884 bedrooms f bedrooms ``\�\Qp,�.��Y OFq*,I�11, g ON-SITE bedrooms, with the follow�rg stlpuY i-FsR AND m m kA/ASTEWATER Z ��Dli}i}.Ii1jt 1—' 7E:�B7Original Certificate Date: o" "l The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist _2 Nitrate Advisory Septic System Advisory Arsenic Advisory _ C Well Flow Advisory Other COSA blue sheet 10-10-12.doc Legal Description: Valley View Terrace; Block 3, Lot 3 If more than 1 septic system on, lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 8/16/83 Total depth 230 ft Cased to *37 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 9/24/19 Static water level at beginning of test 73.1 ft. Comments *To bedrock B. TANK DATA Age of tank(s) 1 years Tank type/material '°°°"D" Measured operating fluid level in septic tank 57.5" Al Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA Parcel ID: 050-352-08 Structure served by this system Well production at time of test 4+ gpm Water storage tank volume n/a gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic33• ug/L ❑ Arsenic less than MRL (ND) Collected by GEG, Ltd. Date of Sample 9/24/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station. years Lift station material Which system tested (date installed) 1983 Adequacy test date 9/24/19 0 ALL standpipes present per record drawing Results QPass For 3 bedrooms Total measured depth from grade 7.2 ft (max) Fluid depth prior to test 0 in Measured depth .to -pipe invert from grade 4.2 ft (min) Water added 882 gal ❑ N/A — pressurized field 8 New depth in ❑ Monitor tubes go to bottom of effective. If not, state 18 depth into effective ' Elapsed time min ❑ Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) No date of test) Gallons introduced gallons If yes, enter date - Comm ents/Def ciencles: aper field measurements, bottom of sump= 87.35 and invert of tank outlet = 92.76 (5.41' difference), assumed that sump goes to bottom of effective (60') COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑✓ Yes if No Community Sewer Manhole/Cleanout > 100' ❑✓ Yes if No ft f 7V Yes if No ft Neighboring Tank > 100' ❑Q Yes if No ft Private Sewer/Septic Line > 25' Yes if No ft Absorption Field on Lot > 100' ❑Q Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' Q Yes if No ft ❑v Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft El Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' E✓ Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Q Yes Absorption Field > 5' 0 Yes if No ft Private Wells > 100' ❑r Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' ✓❑ Yes if No ft Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Q Yes if No ft If absorption field is under driveway comment below Property Line > 10' Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' E] Yes if No Water Service Line > 10' Yes if No ft Community Wells > 200' ❑r Yes if No Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION o OF q �op4 1 certify that 1 have determined through field inspections and review Pv of Municipal records that the above systems are in conformance with91MOA COSH guidelines in effect on this date. .... .. ,....... .......... V, . `W- ...1. . ....... ........ . Q -Jef or ess: O(] -/ E— 95 �/ fe COSA Checklist yellow sheet 404Pa pro f e s $1770„`°0 #AEccasa ��40oo�od It ft O A O N myq o ° V v co co M p � � \ n'Q Q �'a by my FH Fol E \��// cn 00 robs 0- o mmwH�n°m�b� mo a a� d +� i� O dddb •O.Oyi U m-N� m�y O O•, -'U N y v�a� y, d+s g mbcS a .Omi OD V O D�id'Od O bD m F°. ° Ao�O +,A+' m CURVE CHART g 1 > p a� m Ugal) ° NO CHORD RADIUS LENGTH;by °b 1Q N63 -12'40"W 1222.55 135.81 c�a:,),U amp m> D'°y+'� c Om �� P��m �gamia�i 0� 45 ° NM° >m d' H O �70 l.l_I ra N Pk O a 4 0 N O 0 W -100' WELL RADi �+1 O � N Lo w z PAW) 0 Cc" 6.0 a Irzr o w O Lo 0 K U M I- UJ d 18.5 4iILO L0 W 7V/0 STORY i;: S�P�G �xat_r U N9=1 A m g WOOD FRAME(n Cd w U) HOME _ b UO J -WELL J 66.5 _; . 5°}1�i O N a 4 _- - U N 01 / Lh l(J y ---I- -10, clj cJ CLEARINGEAS 77-- - - - ~ O O / Ei17 J Oo-) r„ O Lid N60 -36'00"W 92.35 o - o ; s �, "' m nl .� . o II b m / O �m�o Rif cy) N r [� GRAPHIC SCALE. I Inch = 50 Feet (n cd w � Ate' �� Am 25 6 25 50 100 J www.muni.org/onsite Arsenic Advisory Certificate of On -Site Systems Approval # OSC1914479 Subdivision: Valley View Terrace ,Block 3, Lot 3 A water sample revealed an arsenic concentration of 33..1 micrograms per liter (ug/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/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. information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. i • ° B V ♦*�� tlt�• - Municipality of Anchorage � On-Site Water and Wastewater Program <' (907) 343-7904 s Certificate of On-Site Systems Approval Parcel I.D. 050-352-08 Expiration Date: 1 « '1 7 1. GENERAL INFORMATION Complete legal description Lot 3, Block 3, Valley View Terrace Location (site address) 23535 Upper Terrace Street, Eagle River,- AK 99577 Current Property owner(s) Dona Brekke Day phone (907) 227-0439 Mailing address 18315 Gavin Court, Eagle River, AK 99577 Real Estate Agent Christina Gamez/Keller W. Day phone (907) 952-1496 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Receivede..-.2 ) _ `i 13 (( 7 by: Date: � 1 COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ ,5—Wo Waiver Fee $ Date of Payment OW/9 Date of Payment Receipt Number t g. 1515771Receipt Number COSA# COCr713 Waiver* 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pinard Engineering Phone (907) 232-1347 Address PO Box 871347, Wasilla, Alaska 99687 Engineer's Printed Name Paul E. Pinard Date 8/23/17 ijt�tE OF ALA Z (1it* Li_ . ' 2.12 6. DSD SIGNATURE a 9 � iCSystem#1 Approved for ,3 bedrooms d `�`=' ._,. System#2 Approved �,, Paul E, Pinard :4� y for bedrooms 4111 -° CE .4793��4•��44% Disapproved +...q'...• t4� 4 " �I'RQFESSIa,it l. Conditional approval for bedrooms, with the following stipulation . .�f/ f .t S .S r ( i1 [1C 'ti d,N,- I.S -3 `1 /1, P61-J` ,f t � i ! 1� �o i . ao 4)eovt-S sktat ON-SITE 4-. WATER AND +" T WASTEWATER z ;tom PROGRAM Q,c,4I� ESQ . 417'SERV\C' ''--- • By: -r`�^_ :,aclL4-1Original Certificate Date: 9 - 1' '/7 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work- • • 7. ATTACHMENTS: . • COSA Checklist X • Nitrate Advisory, Septic System Advisory Arsenic Advisory , Well Flow Advisory Other COSA blue sheet E '- .: c • If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On Site Systems Approval Checklist Legal Description: Lot 3, Bk 3, Valley View Terrace Parcel 10050-352-08 A. WELL DATA Well type Pvt If A, B, or C provide PWSID# NA Well Log (YIN) Y Date completed 8/16183 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 230 ft. Cased to 37 ft. Casing height (above ground) 1 2+ in. FROM WELL LOG AT INSPECTION Date of test 8/17/83 8/9/17 Static water level 64 ft. 1 1 1 . 1 ft, Well production _ 6g.p.m. 3.0 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate ND mg/L Arsenic 43 . 8 ug/L Date of sample: 8/7/17 Collected by: Pinard Engineering B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 9/1 6/83 Tank size 1 000 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) N Date of pumping 7/28/16* Pumper JRs Pumping C. ABSORPTION FIELD DATA Date installed 9/16/83 Soil rating (gcputiftbor ft2/bdrm) 1 50 System type Trench Length 45 ft. Width 2. 5 ft. Gravel below pipe 5 ft. Total depth 9-10 ft. Eff. absorption area 450 ft2 Monitoring tube Y Depression over field N Date of adequacy test 8/9/17 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 730* gal. New depth 0 in. Elapsed Time: 240 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) None Known If yes, give date D. LIFT STATION NA Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off" level at in. High water alarm level at in. Datum Cycles tested Meets alarm& circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 1001 + On adjacent lots 1 DO'+ Absorption field on lot 1001 + On adjacent lots 100' + Public sewer main ,NA ( `F Public sewer manhole/cleanout W' + Sewer/septic service line 251 + Holding tank 4- Animal containment areas 501+ Manure/animal excrete storage areas 1001 + SEPTIC/HOLDING TANK ON LOT TO: Building foundation 51 + Property line 51+ Absorption field 5 + i r Water main Z5 Water service line 101+ Surface water 1001 + Wells on adjacent lots 1001+ ABSORPTION FIELD ON LOT TO: pin Property line 101 + Building foundation 101+ Water main Ail 10 r+ Water Service line 10' + Surface water 1001 + Driveway, parking/vehicle storage 1 ' * Curtain drain None Known Wells on adjacent lots 1001+ F. COMMENTS 1 ,..1-a e.va �i•�-e.� -. �. a�n..:t_ `1(,�z4 t '- -rs s—t-- 41/4-43, cut-3 ic7 ST was pumped in July 2016, but home has beem vacant since that time; tank was inspected & found to be clean; drainfield presoaked w/2000 gallons before Adequacy test; SAS MT at end of driveway. G. ENGINEER'S CERTIFICATION OF q/�- l certify that ! have determined through field inspections and �J1/y.+�e OF �'�1 review of Municipal records that the above systems are in 1� 4%0• ''•.s conformance with MOA COSA guidelines in effect on this date. �� �;' _'., t: • Engineer's Printed Name Paul E. Pinard ; • �.y.+.-Q_ " SDP • kit Date 8/23/17 % ;tit. Paul E. Pinard ..L � • -t'.; CE -4793 ..••t % ozas OFESS10 °/11 12g (t7 COSA yellow sheet 2-6-15.doc • Municipality of Anchorage . ::: :e�. iDevelopment Services Department :` a Building Safety Division SA ETY On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Arsenic Advisory Certificate of On-Site Systems Approval # OSC 171387 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 3, Lot 3 of Valley View Terrace Subdivision. This inspection revealed an arsenic concentration of 43.8 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/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. Information on arsenic is available from the On-Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. • 8461U EAST 253.16 15' MEA Easement(Book 1001, pg 67) ry� LOT 2A, iv- ,:.14/a 0 LOT 3 op H �g LOT 4 oWelt 1g ro'o t ' ti:Aa. . O leck e 18 1',..70 0 �C`may ,o 4 - h • h r9` 1 03 0 i ^g. ry a�`�83 f 6- - Gravel _� ,c, . .OF• .A4.Qs\ 13).::'' ` — ?q?q>'�y , �- , driveway' .mir �Q • • 0� 4/613.7222 `—•• 20°h �*• 49th i,' *,I 7 , $S ,0. .: k ptic Ven /. . O 7336873 Tie~ /"rfieFred Walatka :±, or e ay 74( , ate` . �rar,` i� ����• 3255 - S •��o- a 1?,.? C�p 9:*-- AS-BUILT NO CORNERS SET THIS DATE 'T'T'qr � .33- I hereby certify that I have performed a Mortgagee's inspection of the following described property: LOT 3. BLOCK 3.r,Q��T �O VALLEY VIEW TERRACE SUBDIVISION Anchorage Recording Precinct,Alaska,and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto,that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways,transmission lines or other visible easements on said property except as indicated SCALE: 1 50' hereon. Dated at Anchorage,Alaska EASEMENTS OF RECORD,OTHER THAN this 10th day of August ,2017. THOSE SHOWN ON THE RECORDED FRED WALATKA&ASSOCIATES PLAT ARE NOT SHOWN HEREON FB 17-8,pg 18 Engineers and Surveyors UNLESS OTHERWISE NOTED. BE (907-248-1666) Municipality of Anchorage • "1 Development Services Department Building Safety Division On -Site Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 9 www.muni.org/onsite (907)343-7904 Of CERTIFICATE OF ON-SITE SYSTEMS APPROVA FOR A SINGLE FAMILY DWELLING ParcelI.D. t750-35o1—D$ COSA# GENERAL INFORMATION Expiration Date: Complete legal description VALLEY VIEW TERRACE, LOT 3. BLOCK 3 Location (site address) 23535 UPPER TERRACE STREET • EAGELE RIVER, AK 99577 )♦ Individual On-site N Current Property owner(s) FRANK WAKE Day phone 694-9253 Mailing address Lending agency Mailing address Real Estate Agent Mailing address 23535 UPPER TERRACE STREET • EAGELE RIVER, AK 99577 Day phone BARBARA HUNTLEY w/ PRUDENTIAL Day phone 273-7269 16635 CENTERFIELD DRIVE • EAGLE RIVER, AK 99577 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 )♦ Individual On-site N 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 Onsite 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. 1 further verify that based on the information obtained from the Municipality of Anchorage riles 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 d 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 tight whatsoever. 5. DSD SIGNATURE f/ Approved for *3 bedrooms. Phone 337-6179 Date fo W11 c.- 1 I t FS. e; K GarnessC�-79x53 eG Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other ON-SITE WATER AND •; WASTEWATER PROGRAM ))1 By:y(/ Original Certificate Date: �Z— d 7 (Rw. ISM) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragew Street P.O. Box 196650 Anchorage, AK 99519-WSO www.rnuri.org/onaft (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: VALLEY VIEW TERRACE. LOT 3. BLOCK 3 Parcel ID: A. WELL DATA • BEDROCK Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 8/16/1983 Sanitary seal (Y/N) YES Total depth 230 ft. Cased to '37 ft. FROM WELL LOG Data of test 8/17/1983 Static water level 64 ft. Well production 6 g.p.m. WATER SAMPLE RESULTS: Coliform 0_ ooionies/100 ml. Nitrate &L13.-mgJL. Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12 In. AT INSPECTION 6/19/2007 77 ft. 2.8 g.p.m. Other bacteria O colonies/100 ml. Arsenic: 3.0Qrg./L. Date of sample: 6/20/2007 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 9/16/1983 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alar (Y/N) N/A Date of pumping 6/25/2007 Pumper JRS PUMPING C. ABSORPTION FIELD DATA Date installed 9/16/1983 Soil rating (g.p.d./ft=or� 150 System type TRENCH Length 45 ft. Width 2.5 ft. Gravel below pipe ,�, ft Total depth •7.2 ft. Eff. absorption area 450 ft' Monitoring tube YES Depression over field NO Date of adequacy test 6/19/2007 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test DRY In. Water added 470 gal. New depth 1_5 in. Elapsed Time: 115 min. Final fluid depthDRY in. Absorption rate >= 450+ g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - D. UFT STATION Data installed "Pump on" level at —in. E. SEPARATION DISTANCES Size in gallons Manhole/Access (Y/ 'Pump oft"levees High water alarm level at Cycles tested Meets alarm & circuit requirements? 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 Sewer /septic service line 25'+ On adjacent lots 100'+ Public sewer manhole/deanout N/A 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 5'+ Property line 59+ 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 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage *1' Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS , PIPE AT END OF DRIVEWAY 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 COSH guidelines in effect on this date. Engineer's Printed N me JEFFREY A. GARNESS Date /n `D 7 COSA Fee s yJe0 4-1 75 Ru S !f Waiver Fee $ Data of Payment —7hT 7 Date of Payment Receipt Number Or ,^ _ t ' Number (Rw. 11/05) Municipality of Anchorage • Development Services Department Building Safety Division ' - On -Site Water and Wastewater Program 4700 Bmgaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Arsenic Advisory Certificate of On -Site Systems Approval # 070233 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 3, Lot 3 of Valley View Terrace Subdivision. This inspection revealed an arsenic concentration of 53.0 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/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. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. E ; 07/09/2007 18:58 %K JRS Pumping PO Hoz 773415 Eaglo River, AK 99577 (907)694.6454 9073449821 JRS SEPTIC r\1dt,t-t;l vl�) L_3, a3 Blilln Information Gamess Engineering Group 3701 E Tudor Road Suite 101 AK 99507 PAGE 01 Service Agreement C� V* Number. Order Date: 19 -Jun -2007 Service Date: 03 -Jul -2007 12:00 Technician: Don Job Desoripdon: P.O. Number: Terms: Anchorage, salesrep: (907) 337.6179 Map Book: Cross streets: JobSltelnformation Job cannenrb Benny 23535 Upper Terrace Street 1Doog Net 30 Karlia Eagle River Road Tac %: 0 Job Type: Repeat Map Gdd: 121- - 1 •""SERVICE & BILL"""" Eagle River, AK 99577 ICked &Pumped Tank (907) 337.6179 — dd'tl I Location Comments Diagram: =a02mv1173e3 Drax talions Planned: 1000 A t oma #'s are on Tree @ start of DW White - Brown House wBost in DW Single access tank - Pipe in DW Service Type Qty Price Each Tax? Septic Service 15K 1 $170.00 No Gal. Actual: Hose Length: Double Tank: O Pump System: w Baffles Inlet: O Baffles Outlet: O Extension Actual $170.00 NonTaxable Total Taxable Total Tax Total Grand Total Eaemated Charges: $170.00 $0.00 $0.00 $170.00 Actual Chagas: Customer agrees to the terms and concildons shown. THIS IS A BINDING AGREEMENT. Signature and Title of Customer Representat.Na Date Accepted by JRs Pumping Date Accepted For yea aided convenience we aceepr. Arnerkan Express. Dicover. Visa and Master Cad payments over the phone. After 30 Dara eoaaunt will be tumed o~ to COLLECTIONS. $30.00 For NSF Checks Rewmed. JLIL-09-2007 18:50 PRUDENTIAL VISTA REAL EST 907 562 5485 P.01i01 /; 6T rll'�A49A. O :. .1."7o Ac rCr/LL Ca+. :v OAS S t' � Ab. FRAME: P4 1" aDl.' .F yrsrta! 4[AV CL :e.. OCC41•.1. 1 � • h w. .. 1� `�ORIVC � - . . 4, r 4 � `� >�?• a ; HH HEREON IS Fon. W Id9E OF 8r w LEiCINO M Tffuno G sPSC V -4,L Y TO SHOW IUM'DOWUCTS BETWEew t70s7MSTMI=ES EASEMENTS OF ", AM pLX= LOT•lllfe OR EASEMEM AND IS Ti108E SNOWH ON THE REQ \ `ti Wr TO W Lmsn FOR PO MOMN6 ADDnX* AL PLAT..ARENOT SHOWN' :hp. \ ORFB�CfiLWES. .. NO aat -'� _ Book D9 FAN . iW 4R'ID SM 6140 CIA4c! R%lfd9 MICA 1 n..+HMI r ewrN 1 robe AOWWpd"Hbas.Hop dumb" pripwy. Lot 9 llsa ��(� OF A�w mu cy, IltEw .77'rit E..'Ag' !am dh q a WM #mow 4W4 - baHM h ''•, 7% NiPror�.rn. srysre ewnon as tylia+ HM wv«% a a w m fam 9 or wwolo. a �+ 4921 * �; r.. Few*l/ bwq aqm;wy a•r•is. ow b Mpew..r on om r M/9 i'0 . I VWWA anueael on b pnait�a N ari�u►►d ti 7f1Mi W no rWO�r/C tr�oNl�anlMi e1 dirl ... r. r� .. koM, M rid pepi�q. WCDW M NAeiYd lW0llX g �„ Fwnn MtiCM� r ?�% lar- 170La A2FCF27JFI¢D''-VaacY 7aa7..: X44%0r,..•r.•-�.� 7 $i PT IY" TOTAL P.01 G. ...SS �i SGS Ref. M 1072850 Client Name: Garness Engineering Group Project Name: Valley View Terrace, L3, 83 Client Sample ID: Valley View Terrace, L3, 83 Matrix: Drinking Water PWSID SGS Environmental Services Inc 200 W. Potter Drive Anchorage, AK 99518 Tel: (907) 562-2343 Fax: (907) 561-5301 All dates/times are Alaska Standard Time Printed Date/rime: 07/10/07 12:25 Collected Date/11me: 0620/07 9:20 Received DateTme: 0620/07 4:35 Technical Director. ,8teephen Pe Released Bw��j�uA?"./ Prop �— Sample Remarks: Allowable Prop Analysis Parameter Results PDL Units Method Limits Date Date Init Bacteria 0.00 92228 0620/07 0620/07 dic Nitrate ND 0.10 mg/L EPA 300.0 10.00 0625/07 0625/07 jds Arsenic 53.00 5.00 ug/l. 200.8 10.00 0626/07 07107/07 tk MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D.# HAA# 1. GENERAL INFORMATION Complete legal description i Location (site address or directions) 2 3 5 35 Property owner ��? h l hYa-5 /-LDay phone 6 90 '715 Mailing address Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well Public water I CEIVEL� SEP 03 1998 MUNICIPALITY OF ANGiO�GE 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 X Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/91) Front MOA#21 05o -- z -Oa 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify 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. KND Engineering Name of Firm 9 lv Phone T Piarmlgan Blvd. Address Eagle River, AK 99577-8736 Engineer's signature �%. �L�'� Date 6. DHH6 SIGNATURE Approved for 1 �aEE bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments M C ultle Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 92-025 (Rev. IM) Back MOA ♦21 RECEIVEb Municipality of Anchorage SEP 03 199 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division MUNICIPALITY OF ANC i' "IRONMFNTAL cFRVI(_Fq 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: L43 of 3 VCLj[ru Vi J 7-2✓YAce- Parcel I.D.: OSU 3SZ-O� A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed g /93 Total depth 23o Cased to 3 Y'/ b ✓ockIasing height (above ground) % �/Z Sanitary seal (Y/N) FROM WELL LOG Date of test 8,6 3 Static water level Well production 9.P.M. WATER SAMPLE RESULTS: - Wires properly protected (Y/N) V AT INSPECTION 13b.� /m, 83.5 4'.2 g.p.m. Coliform a Nitrate -,' Q. I Q Other bacteria 4— Date of sample: 9 /3 / ?,9, Collected by: 161.2/� ee B. SEPTICIHOLDING TANK DATA Q/�� 2 Cleanouts Date installed � Tank size /DOb Number of Compartments (Y/N) Foundation cleanout (YIN) / _ Depression (Y/N) High water alarm (Y/N) IVA Date of Pumping ---&� Pumper J 3 C. ABSORPTION FIELD DATA Date installed Soil rating r ft2/bdrm 1�5 O System type 14-ew a Length ___JL5 ' Width Gravel thickness below pipe 50 Total depth Effective absorption area �/SD� Monitoring Tube present (Y/N)--Y— Depression over field (Y/N) All Date of adequacy test Results (Pass/Fall) G245.5 For 3 bedrooms Fluid depth in absorption field before test (in.); _ Immediately after 550 gal. water added (in.): Fluid depth (ins) Minutes later: TWO Absorption rate = `�, /Sd 4- g•p•d. Peroxide treatment (past 12 months) (Y/N) A Y /t/ If yes, give date A 72-026 (Rev. 3/96)' 05-0 - 35Z -08 D. LIFT STATION Date installed Manhole/Access (Y/N) _ High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /Ob / On adjacent lots "Pump off" level at* f r Absorption field on lot /Do r4" _ On adjacent lots 1490 -V Public sewer main Public sewer manhole/cleanout Sewer /septic service line 9:5 4- _ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: A/A NA r r r Foundation S 4 Property line /0 "F Absorption field /D 4 Water main/service line zs r'1 Surface water/drainage .U/ b f Wells on adjacent lots /00 + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: r ' r Property line /U 'f' Building foundation —5 "I" Water main/service line Z5 41 Surface water /DD '(- Driveway, parking/vehicle storage area /D `i' Curtain drain l oa �"I- * Wells on adjacent lots )(-X- Alone nou»'1 F. ENGINEER'S CERTIFICATION I certify that 1 have determined thru field inspections and review of Municipal recr in conformance with OA HAA guidelines in effect on this date. a a PF Signature _ Yt Engineer's Name erir�c _ e Date HAA Fee $ Waiver Fee $ Date of Payment _ % Date of Payment Receipt Numberbaa �� / Receipt Number 72-026 (Rev. 3/96)* are MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # —35Z-- og 1. GENERAL INFORMATION HAA# Complete legal description Lor 3 � 3 Location (site address or directions) L/Pp 14 U �MM�S��"" LL2 AAL_ Property owner C70A'"'rO MRS(-°Nr'A- Day phone 361-5-ZZ3 Mailing address a0 gok 27442-3 'a, Qw i5'V kx= '?'9'y77 Z Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 V 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone Day phone 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 X Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify 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. David R. Dayton P.E. Name of Firm 20210 oonalar St. Phone Address Engineer's signature Chugiak, Alaska 99567 6. DHHS SIGNATURE Approved for Disapproved. M Z2 bedrooms. Conditional approval for Additional Comments Date a_3 oaf.)io°�V ?3oil r 3dyb•mum u i my ., ,+ David R. Dayton 2205E bedrooms, with the following stipulations: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesyto purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev.1/91) Back MOA N21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: V,@rw Zt4eACs S/Parcel I.D. oSo 352— n& flop A. Well Data Well type Pe) VA-nr-- If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) y Date completed A�9 I$, 003 Driller QJ -A), Wk -lm Dc w4 Total depth 230 Sanitary seal (Y/N) Date of test Static water level Well flow Pump levell t CAS" >o Cased to % ewle_A- Casing height 1 FROM WELL LOG ('4' SEPARATION DISTANCES FROM WELL TO: Wires properly protected (Y/N) A/ AT INSPECTION ,Ju,y 27, /yy3 G? 7S g.p.m. ® I ta+ y/G � rM 11.7 Septic/holding tank on lot / �0 + ; On adjacent lots 1 oe t— Absorption field on lot 1 0 O + ; On adjacent lots / o� I - Public sewer main ��� Public sewer manhole/cleanout All* Sewer service line I o6 r Petroleum tank Al,�O WATER SAMPLE RESULTS: 0 7 Coliform z z M 3 Nitrate e�•/o Zz2/93 Other bacteria Date of sample: 9%» /43 Collected by: a B. SEPTIC/HOLDING TANK DATA Date installed Vll,�43 Tank size ) Doo Compartments 2 Cleanouts (Y/N) y Foundation cleanout (Y/N) y Depression (Y/N) M High water alarm (Y/N) AA Alarm tested (Y/N) ��A Date of pumping 91 A o Pumper T10 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot t o o+ On adjacent lots 10n � Foundation To property line So d' Absorption field Z57 ° Water main/service line So -t Surface water/drainage I Oo d 72-026(3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed L- A` Manufacturer Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots (Y/N) "Pump off" Level at Cycles tested Surface water Date installed M 4,1 g_3 Soil rating (GPD/Ft2) 5 System type T/Lwu� ! Length s Width ZYL Gravel thickness > 1 Total depth 9 /o' Total absorption area l Cleanout present (Y/N) Y Depression over field (Y/N) A-/ Date of adequacy test_ l -2A3 Results (pass/fail) OQ--�3 for 3 Bedrooms Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) C, SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1001- On adjacent lots I coo t To building foundation After test C3 yes, give date Property line Z-5 t To existing or abandoned system on lot On adjacent lots 51,+- Cutbank V5a Z Water main/service line Surface water (oo+ Curtain drain /otovo CNoWrJ E. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area A,1~ � I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in eff ot.o7T7hl YV�t f of this inspection. David R. Dayton P.E. fj °°oop F' -.T 20210 Donalar St. r `+ f; Chugiak, Alaska 99567 Signature '9 n l C Engineer's Name r( ,,, o .,d 6'�"n� NO. Date HAA Fee$ / --�n ccD c— Date of Payment Receipt Number 72-926 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number NORTHERN TESTING LABORATORIES, INC. 33301NDUSTRIAI. AVENUE 1=AIRRANKS, ALASKA 99701 (907) 456-3116 - I'AX 1563125 8005 SCHOON STRELT ANCIFIORAGE. ALASKA 99518 (907) 349.1000 FAX 349.1016 POUCH 340043 PRUDHOE BAY, ALASKA 99734 (907) 659-1145 • FAX 6592146 DRINKING WATER ANALYSIS REPORT FOR TOTAL COLIFORM BACTERIA KND Engineering Date Received: 9/4/98 Time Received: 15:20 20441 Ptarmigan Blvd. Date Analyzed: 9/4/98 Time Analyzed: 16:00 Eagle River, AK 99577-3736 Date Reported: 9/8/98 Time Reported: 15:15 Next Sample Due: Phone Number: ( )696-6111 Fax Number: ( )696-8111 Collected by: DEA Sample Type: Private water Systems Method of Analysis: Membrane Filtration (SM 9222 B) Comments S = Satisfactory U = Unsatisfactory POS = Positive Test Result ND = None Detected TNTC = Too Numerous To Count (>200 Colonies) CG = Confluent Growth HSM = Heavy Sediment Masking, Results May Not Be Reliable SA = Sample Age >30 Hours But <48 Hours, Results May Not Be Reliable Old = Sample Age >48 Hours, Too Old For Analysis Comments: R = Resample Required NT = No Test * # Colonies/100 ml ** # Colonies/ml Sample Sample Total* Fecal Other* HPC** Date Time Coliform Coliform Bacteria Result Lab# Location Comments 9/3/98 15:00 0 ND 0 NT AC10234 VALLEY VIEW B3 L3 Satisfactory cAvl Sherri L Trask Environmental Analyst 9/8/98 Northern Testing Laboratories, Inc Anchorage, AK SEP 10 '98 02:58PM NTL ANCHORAGE P. 1/1 NORTHERN TESTING A LAKA 9BoORATORIES3 INC16 PAX ,-3126 8005 S SOON ST AVENUE ANCHORAGE, ALASKA 99518 (907) 349.1000 • FAX 349-1016 POU H 34004 STREET PRUDHOE BAY, ALASKA 99734 (9071650-2145 • FAX 659-2146 POUCH 340043 KND Engineering 20441 Ptarmigan Blvd. Eagle River, AK 99577-3736 Atm: client ID: Block 3, Lot 3 Client Project #: Source: Valley View NTLLaW A158005 Sample Matrix: Water Comments: Method Parameter Units Result SM 4500 NO3 E Nitrate -N r"� Qv1R1 4RepBy:Jorma K. Kuusisto Chemistry Supervisor Report Date; 9/10/98 Date Arrived; 9/3/98 Sample Date; 9/3/98 Sample Time: 13;30 Collected By; Des ** Legend MRL=MethodRepat** lxwl MCL - Max Colrfmttilwtt Level B Aesent N Method Blank E = Eathn" Value M - Meuixlnle&mce H .• Above MCL D Lao To Dilution Date Date MML Prepared Analyze 0.10 9/9/98 D. R. DAYTON, P.E., R.L.S. "X VRNM�MN Chugiak, Alaska 99567 (907)."M-5 20210 Donalar 696-2417 July 29, 1993 ADEQUACY TEST Legal Description: Lot3, Block 3, Valley View Terrace Date of Test: July 27, 1993 Septic Tank: 1,000 gallon, 2 compartment, steel tank Absorption System: 45' long x 2'' wide x 5' effective depth trench Soils Rating: 150 sq. ft, per bedroom Requirements: 3 bedroom - 450 gallons per day TEST: Water was pumped into the trench while measuring volume, time and liquid level in the trench. RESULTS: The trench accepted 450 gallons with no rise in the liquid level. The trench bottom at the monitor tube was dry before and after the test. The absorption system is currently functioning adequately for a 3 BR home. ya j. I l�' a°v°e oae toeq% rr• David R. Dayton NO. 2205-E D. R. DAYTON, P.E., R.L.S. '"x`�`�X ' MIM Chugiak, Alaska 99567 (907) MMMM 20210 Donalar 696-2417 July 29, 1993 WELL FLOW TEST Legal Description: Lot 3, Block 3, Valley View Terrace Date of test: July 27, 1993 Well Depth: 230 ft. Casing Depth: 37;', cased l;' into bedrock (per well log) Static Water Level: 83' Driller: W.N. White Drilling Requirements: 3 Bedroom - 450 gallons per day TEST: The well was tested with the existing pump through a hose bib at the pressure tank. The valves were fully open during the test. RESULTS: The well produced 455 gallons in 80 minutes at an average flow rate of 5.7 gallons per minute. Total drawdown was 65'. The well recovered 60 ft of the drawdown in 70 minutes. The well is currently producing adequately for a 3 bedroom home. COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES 511C190B REPORT of ANALYSIS 5633 B STREET Chemlab Ref.# :93.3670-1 ANCHORAGE, AK 99518 Client Sample ID :L3 B3 VALLEY VIEW TERRACE TEL: (907) 562-2343 Matrix :WATER FAX: (907) 561-5301 Client Name :DAVID DAYTON, P.E. WORK Order :68799 Ordered By :DAVID R. DAYTON Report Completed :07/29/93 Project Name Collected :07/27/93 @ 13:00 hrs. Project# Received :07/27/93 @ 15:00 hrs. PWSID :UA Technical Director:���EE��yy''C.'' Released By :V ! — z Sample Remarks: ROUTINE SAMPLE COLLECTED BY: D.R.D. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init ------------------------------------------------------------------------------------------------ Nitrate-N 0.10 U mg/L EPA 353.2/300.0 10 07/28 LLH * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than 4�1 E3GS Member of the SGS Group (Societe Generale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA COMMERCIAL TESTING & ENGINEERING CO. AIS DIV =`F CHEMICAL & GEOLOGICAL LABORATORY ...aM,a�. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY ❑ PUBLIC WATER SYSTEM I.D. # PRIVATE WATER SYSTEM Analysis shows this Water SAMPLE to be: �i9 D� �l^G Satisfactory V/i�l i% P�D� 2y�/7 ❑ Unsatisfactory Name Phone No. nn 2A110t10 JDN��2� ❑ Sample too long in transit; sample should MOIng Address not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. car sae ��ae SAMPLE DATE: = � � Date Received Mo. Day Year - SAMPLE TYPE: Time Received Iwo Routine Analytical Method: Membrane Fitter ❑ Check Sample (for routine sample with lab raf. no. ) ❑ Treated Water ❑ Special Purpose Untreated Water No. of colonies/100 mi. SAMPLE Time Collected Lab Ref. No. Result' Analyst No. LOCATION Collected By Lor- 3 g 3 � y"I" BRd -7 -Si - ® G -C i I VR -"&y VAaj I 193.3 m 2 l 3 I I I m 4 I I IL�JI m 5 'LSI A D E C yob — � BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS MembroneFilter: DlrectCount Cotiform/toomi BEFORE Verification: LSS BGS Fecal Coliform Confirmation C COLLECTING SAMPLE Final Membranes Filter Results f Coliform/too mi Reported By .Kc-;d;,Q,14._ Date > TNTC = Too Numerous To Count Time: I$UCi a.m. OB = Other Bacteria PART ONE OF TWO 126M(3SMember of the SGS Group (Soci REMAINDER TO FOLLOW TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99516 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM I.D. ft PRIVATE WATER SYSTEM SAMPLE DATE: SAMPLE TYPE: = Mo. Day Year OLRoutine ❑ Check Sample (for routine sample with lab ref. no. ) ❑ Treated Water ❑ Special Purpose y Untreated Water SAMPLE Time Collected No. LOCATION Collected By 2 3 4 TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received -712-1 Time Received ( g00 Analytical Method: Membrane Filter No. of colonies/100 ml. Lab Ref. No. 53.3670 "Z u am �1 ■■ ■■ No ■■ Analyst (CJ Y BACTERIOLOGICAL WATER ANALYSIS RECORD 8a'.#-�..E.C.�� READ INSTRUCTIONS eo� ca loo ml Membrane Filter: Direct Count BEFORE Verification: LSB -- BGB Fecal Coliform Confirmation COLLECTING SAMPLE Final Membrane Filter esults � —� Coliform/100 ml (7 Reported By � 1�� Data Z-3— TNTC r Too Numerous To Count Time: �7� a.m. I.M. OB a Other Bacteria PART ONE OF TWO l�� Member of the SGS c REMAINDER TO FOLLOW MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL��� OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include�lot, block, subdivision, section, township, range) YF' -«E y Y f t� 1 s22AtG _- Location (address or directions) (b) Property Owner �'5 Telephone: Home Business SG i C�za' Mailing Address 3Zo( aG, r�en'�7 (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone Telephone (e) Mail the HAA to the followino address: or: Check here W if hold for pick up. List contact person and day phone number below. // essE �rvs z;/ -g0/ %OT 2. TYPE OF RESIDENCE Single-Famil, 171 Number of Bedrooms _ 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Note: If comm unity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsiteo 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. Pagel of 2 72-025 fRev 8/861 Front 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 acssE apps �rr/S Telephone�%-��5� Address Zi LO . ?e n/ 4, Date 6. DHHS APPROVAL /., Approved for /moi —7 bedrooms by Date Approved ` Disapproved Terms of Conditional Approval Conditional CihhS CAUTION or ACA' I% >°...e..e e�4.'.�: eve ee .� Dale R. WWrell No. 2055-E - The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 n -ole lRev 8186) Back MUNICIPAUIT' OF ANCHORAGE ENVI:Oi'MENTAL -.\v FS DTVI"ICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) c1 r' P 2 9 1587 CHECKLIST - FEBRUARY 1984 . 264-4744 RK [F Legal Description: Z_ 3 /3/X_3 A. WELL DATA Well Classification �i✓G�� If A. B, C, D.E.C. Approved (Y/N) W1 14 Well Log Present (Y/N) Date Completed 9'61 gJ Yield 'If �b 23� Total Depth � Cased t � 37 �� Depth of Grouting NA Static Water Level 6/�' Pump Set At 1?,AVA40W17 if Casing Height Above Ground / Electrical Wiring in Conduit (Y/N) Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Al Separation Distances from Well: To Septic/Holding Tank on Lot BOO On Adjoining Lots IOD { t /0eq To Nearest Edge of Absorption Field on Lot �� On Adjoining Lots To Nearest Public Sewer Line NI-qTo Nearest Public Sewer Cleanout/Manhole /V /Q To Nearest Sewer Service Line on Lot Water Sample Collected by /TI/kF l�""�� �!' /lo ; Date Water Sample Test Results Comments -K 0,-/-7,) 173 fac�r B. SEPTIC/HOLDING TANK DATA if Date Installed ' �6 le3 Size /000 No. of Compartments '2— Standpipes Standpipes (Y/N) Y Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) � nate I 2_9t Pumped 1111.9 7 Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) n/A AJ ;for Temporary Holding Tank Permit (Y/N) 14� Separation Distances from Septic/Holding Tank: r To Water -Supply Well s To Building Foundation To Property Line To Disposal Field zs" To Water Main/Service Line ecl-1 To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026 (Rev. 8/86) Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Air- /19� /,?D 3/`' 11�/A Type of System Design ✓� Length of Field _/S/ Width of Field 3or/ Depth of Field /- 5 /Q ✓� - Gravel Bed Thickness Square Feet of Absorption Area4S0 =P Standpipes Present (Y/N) Y Depression over Field (Y/N) i // Date of Last Adequacy Test Results of Last Adequacy Test</�/Si i rro �/ T_i /A 0104 - Separation Distance from Absorption Field: To Water -Supply Well /,00' TT" To Property Line To Building Foundation Lot On Adjoining Lots ZS7f% To Existing or Abandoned System on j fob � To Water Main/Service Line /oo 0, To Cutbank (if present) Node To Stream/Pond/Lake/or Major Drainage Course /�l G/ To Driveway, Parking Area, or Vehicle Storage Area Comments �2;e�ca-d1.7/'i7 /r/� cqh &-14'-6eZ4--!'G» 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 th have ch I d, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed - - Date -���d % Company d MOA No. Receipt No. 2 0 O /, UO /%Or A4 Date of Payment•� (�G*,. .......40 Q� �s rte paVr$� Amount: $ a° co Trt i`� t�� 6 '�� IlouoW y 01,3 ,1 "J °r9 Page 2 of 2 72-026 (Rev 8/86) Back Dalc R. Mejroll P o° No: 2055•`'6 •.cam �V6 PROFESSIC`;. v W6,4L \ 01 �1.\ iiri Vl yA Y � i � 1 1 LEGEND O LOT CORNERS FOUNDATION �\ �— DRAINAGE ARROWS Of ., ,.....•••, , ••••'q;ff�INOTES, y' • , I. IT $HALL' BE THE RESPONSIBILITY OF THE BUILDER OR OWNER TO VERIFY THAT BUILDING LOCATION SHOWN MEETS ALL SUBDIVISION COVEMAMTS AND ZONING �e. _ :...••. ••••••.� _ ORDINANCE$. ,, •:. _ - ••.E / t. IT IS THE RESPONSIBILITY OF THE BUILDER TO VERIFY ALL ELEVATION$ WITH •••••••""•••••••••'•'T•' RESPECT TO ALL UTILITIES, B DRAINAGE. Andrew ,F:. Pods i _ iE. THIS PLAT REPRESENTS THE PARCEL OF PROPERTY DESCRIBED BELOW TAKEN �'�l �•. No. 3514•S . r �� FROM THE RICOROtO PLAT DESCRIBING THAT PARCEL. INSTRUMENTS RECORDED +f�`,•,•• •S��i PRIOR TO OR AFTER YHt FILING OF YA9 RECORDED PLAT ARE NOT SHOWN ON I�op �••••.••••••��� ,;r THIS PLAT. ,049fESSIORO-l" 1 4. THE INFORMATION ON THIS PLAT IS FOR THE USE OF LENDING INSTITUTIONS ��®,`t•�� SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS , THE PLAT IS NOT TO BE USED FOR _ POSITIONING ADDITIONAL STRUCTURES OR FENCES. OURVEYOR'S CERTIFICATION I HEREBY CERTIFY THAT 1 HAVE SURVEYED THEv�LJ1.LT—, -- PROPERTY, DESCRIBED ON THIS PLAT AND THE ' IMPROVEMENTS SITUATED THEREON ARK LOCATED AS SHOWN ON THIS PLAT. ollrto reu _22 DAY or UgE Lei? ::1C1.l=tiJ_ 1"ERRLtGE= 511F57S"-- — BESSET EPPS. & POTTS 2220E. 88th, AVE. 349-6452 ANCHORAGE, ALASKA 99507 349-6454 DRAWN BY, SCALE, I's 50' C -C OWS. NO. CHK. BY, DATE, 818-7 FLO. BK., NORTHERN TESTING LABORATORIES, INC. 2505 FAIRBANKS ST. ANCHORAGE, ALASKA 99503 907-277-8378 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY CLIENT TO BE COMP TED BY LABORATORY ❑ PUBLIC WATER SYSTEM I.D. # Received at: Anch. ❑ Fbks. [PRIVATE WATER SYSTEM Date Received �2% 7 /_ f'1wn11 E /t {A Time Received �� 3 NAME i Mailing Address City / State Zip Code SAMPLE DATE: —00—Phone', n 51 Mo. Day yy. Purchase Order No. SAMPLE TYPE: Routine ❑ Treated Water ❑ Special Purpose ❑ Untreated Water ❑ Check Sample (for original contaminated sample with lab reference no. ) Sample Time o Location , Cole Collected by Laboratory Ref. No. �- 1-33 .J /� �c L-3 i%i�a9Fly/ 2 V4 t-La_�' V S T rurc e V 3 �- 4 5 6 7 8 9 10 Signature of Representative FOR LABORATORY USE ONLY USx GPAPGE PREPAID TRANGMIITAL SPECIAL INSTPUCTIDNS MAIL rvom EDP PICKUP Next Sample Due COMMENTS: SATISFACTORY SS UNSATISFACTORY U RESAMPLE R OTHER BACTERIA OB TOO NUMEROUS TNTC TO COUNT Direct Verification Final count Lits Elvin - Mefurt- t'Ammanta S -Notal Coliform Colonies per 100 mis Reported by Date 1I NORTHERN TESTING LABORATORIES, INC. 600 UNIVERSITY PLAZA WEST, SUITE A FAIRBANKS. ALASKA 99709 9074793115 2505 FAIRBANKS STREET 8/21/87 ANCHORAGE, ALASKA 99503 907-277-8378 Besse, Epps, & Potts 2220E. 88th Avenue Anchorage, Alaska 99507 Attn: Andy Potts Date Arrived: 8/21/87 Time Arrived: 1530 Date Sampled: 8/21/87 Time Sampled: 1330 Date Completed: 8/24/87 Source: L3, B3, Valley View Terrace (Eagle River) Sample ID#: A082187-12 --------------------------------------------------------------------------------- --------------------------------------------------------------------------------- Parameter Unit Result ADBC MCC* Nitrate -N mg/L <0.10 10 Reported By: Date: 8/24/87 Carol J. Garrison, Vice -President - ----------------------------------------------------------------------- * MCC = Maximum Contaminant Concentration NORTHERN TESTING LABORATORIES, INC. 600 UNIVERSITY PLAZA WEST, SUITE A FAIRBANKS. ALASKA 99709 907,179-3115 2505 FAIRBANKS STREET ANCHORAGE. ALASKA 99503 907-2778378 Quality Control Report Client: Besse, Epps, & Potts ID*: A082187-12 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 WS378-6 Nitrate -N mg/L 0.95 0.84 - 1.02 Reported By: C Date: 8/24/87 -- ----------- - -- -------------------------------------------- Carol Gar ison, Vice -President BESSE, EPPS G POTTS 2220 EAST 88 AVENUE ANCHORAGE, AK 99507 (907) 349-6451 WATER WELL TEST Date:?Z7-1197 Subdivision: LLlfy V E7J TErazor E Lot: 3 ' Block: 3 Client's Name: /�A .IJ,E InAE TESTER: miKE erc,EB&7— Ro ODTrwl _ Initial Reading on Meter: NOTES: 16L)SC N07- W it 12 i2t� f/00/4E7-1 ,-IDSA •7' Pz_ 1Q PCr 4-n K PRX "n C jC ER c A CazacirY . 35Z- Gallons _-- NOTES: 16L)SC N07- W it 12 i2t� f/00/4E7-1 ,-IDSA •7' Pz_ 1Q PCr 4-n K PRX "n C jC ER c A CazacirY . 35Z- Gallons ' � �te� '-'•..+1�-' In .twr..,y�axsr *� • �2 � f . ,� .� --,r� d ,,.� d,� �s �n a & � a��"� r�. ,Ak' }F Lm Jh.1 'J+G'XFNJ y�♦ J•e'[ r r ad 7� '! T�• �' YSZ �fYiBS•R�.. ` 1 15r6iX •� �. � rMra�i •••w�w`�I.n�1w • • ^ `f1TER WELL RECORD j - 1 STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES - - - Olv1s;0.: of Geological 6 Geopllyoleal Signed[, 0.1111.1 pronto Ne. LOCATION Of WELL 111,16446 4ewplato door If. D M b.►• A.O.L. Ne. 1 ferNM fNIt1l�d'{Isles LH ft«t o1 1/NVo. t64tlo• Ne. t"owM11NO R:ep [� YGridea AIrt H too Py 3 . 3.. _H�M�M� S❑ W❑ Ie. DISTANCE A"01RECTM FROM ROADINT[RS[CTIONG - - S. OWNER Of W[LL$ r3ut VVALK&e - .«HN: Pb 13ex 1 8 . _99 Q� 1. AE'Tt6 RI VE2 AK _"S77 re a" Aro of Well Lowell" . Slope/ ANw S. WELL LOS - het Bela. • surface 4. WELL Oe►TR, IMe1► Z'� n. t. Ran O►COMe►LETIOM LA,_ 7 -AM& � —63 MeteoritE TTN Ter Salton - 06A 1 re :510pir 1;POffer g; .. ❑ N1N /owl ® Refory 0 D,riv�els., 3�-R,� Q got I ❑ IrrlpMow - ❑ beMrle - : .: ❑ com~IRtf T64f Wtli %13 aroin . A2104T.`O r f. CASS/ING, ' O TRHNN ®W4HN tl".�Io,�Is. it= Il. DepthW4101�Ib.f ft. tlew. So. is -f1. Dean otletee_)� 11. /_ f. FfNISM OF WELT' 01•wMGn _ fIN/WN SIH: Leasm: fH ►tivHR - /t. aN 11. 1H 6 Uak11N;ot srevol peak - STATIC WATER L[Ttl.' 64 -Mel. 1le A116 nate ❑ Able"or O felea 1.64 an glis.sar [tvtowtal ■64t: 1soumprfz 1. PVMPING L[1`[L belts Now /elft" Get 1`191.0 To. vall afi act M Red. OagMt�E.�E.O.w. _11. eller _eH. pvwodt��pp.W • 12.4000TING Well grealN: O Tea O Ne ".foal: O bal Capital O *that! ' IS.Pump, (It urdlable) Mp L"p% of Draft 11164 _to. "Molly • 1.11.01. ❑ Stow. ❑ tet ❑ Ceatrlfle l O OIRer It.R[MARRS! W Aut tolrr odMPollvlsr ROVS AT 230' If. WATER WCLL CONTRACTOR'• CERTIFICATIONS If. Wrier Ts piaupvle -• ❑ r Q c TRIO fell "t 4111114 P1Hr my Ia11141611N a64 this .sped 1. Ir" of IRS ectal of of tau1ete4 aN 1.114/; lw,N.yJuprr yyE-LL DaILL1NlT A=Ie-) AD- • Asltalaret Svelosto Mau Coalrect Ueoau Nrwev AV Aowroe' Ota: f1tYt - •v r off Rglp. al•t + u C. 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 6 / A, 1 14s- 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or 1p h -eh �Yy (b) Applicant Name A Telephone: Home to 1 S%�� Business Applicant Address t v , UJ U 77a «� (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder (explain); (d) Lending Institution 7'�/ ��c/""' '� Telephone Address (e) Real Estate Company and Agent Address Telephone (f) he HAh A to the following address: ti [J '�j 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual WF11AX \Community 11 Public El- i,. 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 OnsiteA Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must havewritten confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) n 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Date 6. DHEPAPPROVAL,,) Approved for bedrooms by Approved— Disapprove Terms of Conditional Approval Telephone Conditional B (/ 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 n a� _°•� CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. `" �. TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER s 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: (e) See h on back I.D. NO. water system Name Phone No. Mailing Add r ss / d n City state zip code SAMPLE DATE: . / Mo Pn.. Year SAMPLE TYPE: "Eoutine - ❑ Check Sample (for routine sample t *.sated Water with lab ref. no. treated Water ❑ Special Purpose SAMPLE Time Collected NO. LOCATION Collected By 2 ✓����y l/�iw f� 4 5 TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received Analytical Method: ❑ Fermentation Tube Membrane Filter Lab Ref. No. Result' Analyst ® .-- J=JG- � o ED I I m I I m •W of colomee/100 ml or No..1 Pwilrve ooroons W1210 tbl BACTERIOLOGICAL WATER ANALYSIS RECORD par. 1983 READ INSTRUCTIONS Membrane Filter. Direct Count Collform1100ml Verification: LTB BGB Final Membrane Filter R sults %i Coliform110omi BEFORE Reported By ? �� Date Time: �OU a.m. P.M. COLLECTING SAMPLE TNTC = Too Numerous To Count Mt)""-,IPALITY OF ANCHORAGE gKEPT. OF HEALTH & (�YYARO MUNICIPALITY OF ANCHORAGE NMENTAL PROTECTION! HEALTH AUTHORITY APPROVAL (HAA) j JUN 17 19R. CHECKLIST - FEBRUARY 1984 284-4720 �_.[L�(l'. E F E D Legal Description: �� " lKe-/c 3 \14 � y J MV -4 T�eJ;-) A -C (�_ A. WELL DATA Well Classification_t V4 "f If A, B, C, D.E.C. Approved (Y/N) Well Log Present Date Completed Yield Total Depth z���l Cased to Lie Depth of Grouting Static Water Level --tP4 1 Pump Set At «�-- n !- Casing Height Above GroundIOZ Sanitary Seal on Casing O/Wj' Electrical Wiring in Conduito/xy Separation Distances from Well: Depression Around Wellhead W& To Septic/Holding Tank on Lot (moo t On Adjoining Lots 1 �� To Nearest Edge of Absorption Field on Lot ( 00 t ; On Adjoining Lots + O n r To Nearest Public Sewer Line h( To Nearest Public Sewer Cleanout/Manhole 6- To Nearest Sewer Service Line on Lot Water Sample Collected by S S b1t-k;;_ --Mb Date �o�4 QiS Water Sample Test Results Sp-'T'�sT--.-,C-c-otz.V Comments B. SEPTIC/HOLDING TANK DATA - - Date Installed b "g'? Siie j O�� �' No. of Compartments 2 1 Standpipes 64WAir-tight Caps&< Foundation Cleanout,914r Depression over Tank (Y4) Date Last Pumped ff 11 Pumping/Maintenance Contract on File (Y/N) �V'} ;for Ih N l�I Holding Tank High -Water Alarm (Y/N) A- Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well { � a i ¢ To Building Foundation Lr p To Property Line t To Disposal Field 3 0 .k t To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage F( Course Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata (S' h z Type of System Design Date Installed Cl ` I (. -, Length of Field ,-I S Width of Field 30 Depth of Field � b Gravel Bed Thickness Square Feet of Absorption Area l �5` �j� Standpipes Present (YEN) Depression over Field,(-) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well l a o t To Building Foundation Lot P`t To Water Main/Service Line �s To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area 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 of Last Adequacy Test To Property Line On Adjoining Lots To Cutbank t.1 L Dimensions t -�- To Existing or Abandoned System on (if present) ^ In 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 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed '8 V 1EMOMEZRI a Date z- >- I8r 81:111135)C .1vO vd CompaR; P,J e 0111=1 nt APKA Zfi SU MOA No. _ 7 c.S- c-0 3 I'la 69421WO '� 6 0 Receipt No.�b� Date of Payment ® , vo a Amount: $ Raberr A. Shako; ; 4v No. 1A57 -E Page 2 of 2 72-026 (11/84)