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ZANTHA VISTA BLK A LT 1
antha Vista Block A Lot 1 #015-472-01 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191277 PID Number: 015-472-01 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑■ Upgrade Name ROGER TAPP ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ound Site Address 10980 TRAILS END ROAD *ANCHORAGE, AK El Other Phone Number of Bedrooms Soil Rating Total depth original grade 1-206-300-5356 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot ZANTHA VISTA; BLOCK A, LOT 1 Fill added above original gr Ft. Gravel length Ft. Township Range Section - Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total orption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well 100'+ TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER TANK Capacity 1250 Gal. Surface Water 1004 01 Material Number of compartments Lot Line 51+ NA HDPE 2 Foundation 10'+ LIFT STATION Manufacturer Capacity Remarks OLD TANK DECOMMISSIONED PER UPC Gal. PER CONTRACTOR Alarm location Electrical installed by PIPE MATERIAL House to tank D3034Tank to D3034 drainfield Installer DENALI EXCAVATING Dralnfield D3034/EXISTING CO/MTD3034 Inspector TIM ECKLUND AND DAVID GARNESS BENCH MARK (Assumed elevation) 103.29 ft Inspection 15' 8/5/2019 - Location and description TOP OF MH 3rd — 4'h _ ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Sta p �o6op0 O Conditional Approval: Date ........ .... .................. � ..... ...... .... Q Septic Syste e ey .. G irn ss: OQ �oO -E-79 Approved �` Date — 4p sfPre ..e i3 @@� Note: this approval does not include dell permit requirements.#nec ��4��4�00'10' (Kev Ub/OZ/l6) PERMIT NUMBER: RECORD DRAWING I N G PARCEL NUMBER: OSP 191277 015-477 2-01 FA B I PTC01 29.5 30.5 PTCO2 55.5 58.5 DBL1 73.2 83.5 DBL2 75.5 85.0 MH 77.5 86.5 ST1 82.5 90.5 TMT 81.5 91.0 DBL3 85.5 94.0 DBL4 86.5 95.5 C01 92.5 105.0 MT1 90.4 104.5 CO2 80.5 106.0 MT2 79.5 104.9 1 PREPARED FOR: 1 I I � ROGER TAPP I I 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: ZANTHA VISTA; BLOCK A, LOT 1 D.J.G. TYPE OF WORK: DATE: ,,_ SEPTIC TANK RECORD DRAWINGS 8/13/2019 1 ZANTHA VISTA; BLOCK A, LOT 2 EXISTING DRAINFIELD DBL182 DBL3&4 I I 1 1 PTCO2 1250 HDPE GREER TANK \ Tl 2N R3W SECTION 24 N2NE4SE4NE4NW4 — LOCATION OF SURFACE H2O PER 12/12/15 STEVE PANNONE, P.E. RECORD DRAWING IN MOA RECORDS; COULD NOT FIND SURFACE H2O ON THIS LOT WITHIN 100' OF THE NEW TANK AND EXISTING DRAINFIELD DURING SITE VISIT ON 8/13/2019 BY DAVID GARNESS, P.E. \w \ loo S EXISTING 3 PTC01 \ BEDROOM HOUSE GARNESS ENGINEERING GROUP, Ltd _--ENGINEERING o SALES -CONSULTING 7 __- -- -- 3701 E. TUDOR ROAD. SUITE 101 ' ANCHORAGE. AK 99507' PHONE (907) 337-6179' FAX (907) 33&3246' WEBSITE: �gamessenginee6ng.cam PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ROGER TAPP 206-300-5356 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: ZANTHA VISTA; BLOCK A, LOT 1 D.J.G. TYPE OF WORK: DATE: ,,_ SEPTIC TANK RECORD DRAWINGS 8/13/2019 N / SCA / V140' GARNESS ENGINEERING GROUP, Ltd _--ENGINEERING o SALES -CONSULTING 7 __- -- -- 3701 E. TUDOR ROAD. SUITE 101 ' ANCHORAGE. AK 99507' PHONE (907) 337-6179' FAX (907) 33&3246' WEBSITE: �gamessenginee6ng.cam PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ROGER TAPP 206-300-5356 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: ZANTHA VISTA; BLOCK A, LOT 1 D.J.G. TYPE OF WORK: DATE: ,,_ SEPTIC TANK RECORD DRAWINGS 8/13/2019 .**'w`lL 11 .•,�� OF .'14, 44 P..•. •''�:� ....... ... ..., 00 eIn,y A�..arn , s... e � i #1 ;�• C ff-79 =i LICENSE•ROFE1,\\S,\`_� •• #AECC884 / PERMIT NUMBER: RECORD DRAWING I N G PARCEL ID NUMBER: OSP191277 015-472-01 FINAL GRADE = 102.8-103.2 MH ST2 2" INSULATION PER CONTRACTOR TOP OF TANK AT INTLET = 99.09 TOP OF TANK AT OUTLET = 99.10 NEW 1250 INVERT OF BUNG AT INLET = 98.45 GALLON H. D. P. E. INVERT OF BUNG AT OUTLET = 98.36 SEPTIC TANK - --. AW •�.,.ry�i 4 GARNESS ENGINEERING GROUP, Ltd ....... ENGINEERING SALES o CONSULTING =-_– _ __ �__ 0 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK 99507PHONE (907) 337-6179- FAX(907) 338-3246' WEBSITE Nxw.garnessen9neering... 0 ...., ,. ....... .. . / PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ROGER TAPP 206-300-5356 3 OF 3 /�j .� . Y A..,.ar,ess �.% CE -79 3 '�=i LEGAL DESCRIPTION: DRAWN BY:Aw ZANTHA VISTA; BLOCK A, LOT 1 D.J.G. 8�''•••��• TYPE OF WORK: DATE: ♦♦, FQ•IIIIIp�•••...... •• Q`: •• SEPTIC TANK PROFILE 8/9/2019 #Aeccaaa, ♦ JNO 'r MUNICIPALITY OF ANCHORAGE it S ,..........,__` . 111 C j On-Site Water&Wastewater Program "° ti. PO Box 196650 4700 Elmore Road Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 httpa/www.muni.org/onsite '* . \ i )ep<irtment NCH ORPO On-Site Wastewater Disposal System Permit Permit Number: OSP191277 Effective Date: 7/5/2019 Work Type: SepticTank Upgrade Expiration Date: 7/4/2020 Tax Code Number: 01547201000 Site Legal Address: ZANTHA VISTA BLK A LT 1 G:2640 Site Mailing Address: 10980 TRAIL'S END RD, Anchorage Owner: TAPP ROGER L Lot Size in Sq Ft: 33550 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 4 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 Received By: .--G(, ,(� J Date: 6 J Issued By: /cLt-e,(1X1 A Clicztizzre, Date: 74577 MUNICIPALITY OF ANCHORAGE (:,, -.) ,,y 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. 015-472-01 Property owner(s) ROGER TAPP Day phone 206-300-5356 Mailing address 10980 TRAILS END ROAD*ANCHORAGE,AK 99507 Site address 10980 TRAILS END ROAD*ANCHORAGE,AK 99507 Legal description (Sub'd, Block& Lot) ZANTHA VISTA; BLOCK A. LOT 1 Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms 3-SEPTIC SIZED FOR 4 BEDROOMS APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: (Nall that apply) Initial ❑ Single Family (SF) Absorption Field ❑ (w/wo ADU) Septic Tank ® Upgrade Duplex(D) ❑ Renewal ❑ Holding Tank ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ 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: as 5-0(' Waiver Fees: Date of Payment: -{ h!O? O 161 Date of Payment: 4 Receipt Number: 05-4WC1 Receipt Number: Permit No. OS l_iGlia.T -- Waiver No. (Rev.01111) __ Quanics GARNESS ENGINEERING GROUP, Ltd ENGINEERING SALES CONSULTING Dealer July 2nd, 2019 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage. AK 99507 Ref: Proposed Septic Tank Upgrade for Zantha Vista; Block A, Lot 1 To whom it may concern: The subject lot is served by a private well and septic system. Per MOA memorandum, a steel septic tank over 30 years of age must be physically inspected and/or replaced. Per MOA records, the existing septic tank material is unknown and was installed in 1965. Based upon this fact, we are proposing to install a new septic tank. Per the owner, the property is 3-bedrooms, however, we are proposing to decommission the existing septic tank per UPC and install a new IM-1530 infiltrator septic tank. See attached design drawings for tank location and other MOA requirements. 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. S' cerel , J.effr-y ' . Garn-ss, .E., M.S. Presid/ nt 3701 East Tudor Road, Suite 101 *Anchorage,Alaska 99507-1259 Phone: (907)337-6179*Fax: (907)338-3246*Website: www.garnessengineering.com c o LJ \ / \ --t–Lill ZANTHA VISTA#1; ,\ir ///'' W(�\\\ S 11 BLOCK A,LOT 9 / / 0011 11 \ ek V ZANTHA VISTA; Z \ \ /BLOCK A,LOT 3! W \fCO 1 /1J \J /__ 1\\ /1TIM81I1UNE;L(�72/ - ����� ZANTHA VISTA; `\ ~ / ` / / / ,// ,-/ `�—•\\ BLOCK A,LOT2 \\ -- // ZANTHA VISTA#1; \\ \\ \\'Q ��+k� / / / BLOCK A,LOT 10 • \ // ---_— \\ WELL RADIUS / I 1 1 ` \ I ECL RAO/V I I L. TIMBERLIN$LOT 3 I J� I I 1 ��i \ `\ \ �\ % / 1 GS I I \♦ Q4 1 '�a�I I \\ / / 1 „E ... _......... PAN i .. _ �� -J' \\ / _ T12N R3W SECTION 24 // •�`� \)/ /// TIMBERLINE;LOQ 4� \ , /e/' ��•` N2NE4SE4NE4NW4 /� \ • ,/ ALLEN COMBS; • \\ / \ \\ / LOT2 \\ / / \ / / / \\ • / / \I \I_ J k— o\J�# \ ii ��o I1 moo\ , ir I 1 3 , 1/4/ \ j \\ // \�\ // N „, ,.... _ ��----�' O S ALE: , _ 1"=100' n / ,. . 4 4 GARNESS ENGINEERING GROUP, Ltd ; 114.11 ENGINEERING a SALES'CONSULTING / 0 3701 E TUDOR ROAD.SUITE 101•ANCHORAGE,AK 99507'PH4 1E(907)337-6179'FAX(907)338-3246'WEBSITE,www.garnessengineering.com ••• PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0 c" • jt I y A. amess /Iv: ROGER TAPP 206-300-5356 1 OF 2 •. , C 7 3 ,' PROJECT/LEGAL DESCRIPTION: DRAWN BY: . / • ZANTHA VISTA; BLOCK A, LOT 1 D.J.G. ��<D•''.....................PROFESS .f_' (`''. • 4 TYPE OF WORK: DATE: LICENSE ,1 1 L. ) 44 SEPTIC SYSTEM DESIGN UPGRADE 7/1/2019 #AECC884 '•���� r l ( GEG,Ltd.HAS AN 8 PAGE SPECIFICATION LETTER THAT PERTAINS TO THIS DESIGN.BY PROCEEDING NOTE:THE CONTRACTOR SHALL HAVE FORWARD WITH THIS INSTALLATION,THE ALL WELL RADII AND SOUTH LOT LINE ENGINEER,WELL DRILLER,CONTRACTOR AND FLAGGED BY A REGISTERED LAND PROPERTY OWNER AGREE THAT THEY HAVE SURVEYOR PRIOR TO CONSTRUCTION. READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND CONDITIONS OUTLINED. N ....---- ---,.......... I N \ ' ZANTHA VISTA;BLOCK A,LOT 2\ / APPROXIMATE LOCATION OF EXISTING DRAINFIELD / -------- z w ' w 700, M w M - I l �0iG 5 1,::'..'. 0 IS o 4.' •' ... I 0 ,II- • • - / k i.1:,:1.!....?.. Q ' (_/) EXISTING 3 BEDROOM ` W �• J • :f•�•• 4 1 a .. HOUSE -�� o , INSTALL FUNCTIONAL CLEANOUT AND 1J . '4. N- I I- MT AT SOUTH END OF DRAINFIELD '% ASSUMED LCOATION OF SEWER LINE :•'', -,0.."! ;,,i..- `APPROXIMATE PARKING AREA NOT SHOWN ON SURVEY \ EXISTING SEPTIC TANK TO BE DECOMMISSIONED PER UPC PER ,....,4, PROPOSED IM-1530 INFILTRATOR SEPTIC TANK;INSTALL \ DOUBLE CLEANOUTS BEFORE AND AFTER SEPTIC TANK; MUST BE INSTALLED OUTSIDE OF"PARKING PAD T12N R3W SECTION 24 N2NE4SE4NE4NW4 / \ _ A v / I SCALE:\ / ril 1"=40' / I ��\\\\ 11 44. • vaL a/ tie mi . ♦� / 4 4 I it A4.....0 1 GARNESS ENGINEERING GROUP, Ltd • "9"'. z` ' • • ENGINEERING•SALES•CONSULTING = -- • 3701 E.TUDOR ROAD,SUITE 101•ANCHORAGE.AK 99507•PHONE(907)337.6179•FAX(907)33&3246'WEBSITE:wwwgamessengineenng corn • PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ♦T^ en ; •. - ess .tu ROGER TAPP 206-300-5356 2 OF 2 ♦�G-U,:. •CE-79 3 '= PROJECT/LEGAL DESCRIPTION: DRAWN BY: ♦♦ �' .•��}I Z r�.•' i ZANTHA VISTA; BLOCK A, LOT 1 D.J.G. ♦ I (,1_1 .., TYPE OF WORK: DATE: LICENSE♦,1 1 ESS` 4 • DESIGN OF SEPTIC TANK UPGRADE 7/1/2019 L LICENSE %%alm v.::444 -I i 1 c 8178K CO t Lot2 a) a� u) N89°55'36"E 300.31 w 30 a @Iw co '� > CD o ,. o 0 c a 0 r 0 Lot 10 W a) Lot 1 4.0 OH ,yll Well i W I W N w ^�� 34.7In Y 2 Sto F u) } Septic vent rn u rame :411.6-9.4 °O �, House S`a Q Q o — 3 4.7 Q . o 0 Z 4 • = rM7N-D � IO I-`/ •S Z 1-ro I i 01 N89°55'37"E 300.28 Wire fence 1 n 30 iv I Unsubdivided A- NOTE: There exists encroachment permits in Book 310 at page 513 and in Book 3281 at page 938 AS-BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection of the following described property: LOT 1. BLOCK A. ZANRH VISTA SUBDIVISION Anchorage Recording District,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 fes. SCALE: 1"- that there are no roadways, transmission lines or other \. - 40 visible easements on said property except as indicated hereon. Dated at Anchorage.Alaska EASEMENTS OF RECORD, OTHER THAN this 17th day of JUNE , 1997. THOSE SHOWN ON THE RECORDED FRED WALATKA&ASSOCIATES, L.L.C. PLAT ARE NOT SHOWN HEREON. Engineers and Surveyors UNLESS OTHERWISE NOTED BE 907-248-1666 Municipality of Anchorage Page of 2 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 14. PID Number: OIs —472 --OI Name: Sv�rl Crcl�l<s�rJ Wastewater System El Upgrade stewater v tt s�� Address: P. o. (3nx IIloas Allo . N4 961 ABSORPTION FIELD Phone: �3 a z No. of Bed ooms: p Deep Trench . M Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: 85 ¢7/BOQ� ,' O Total Depth from original grade: 6 � Lot: Block: Subdivision: A Depth to pipe bottom from original grade: Gravel depth beneath pipe ZA4T{ IS1A �'fI _ Ft. —_�l Ft. Township: Range: Section: Fill added above original grade: Gravel length: / O I c,0 Ci Ft. Ft. WELL: Ext w ❑ Upgrade Gravel width 51 Ft. Number of lines: I Distance b_ elween lines: -- Ft. Classification ( vete-A, PIZ1V O. Tofal Depth: G2 -•o Rl&WA 1-f0. Ft. Cased To: gEp Ro6KFt. Total absorption area: 4 J i13 SQ. Ft. Pipe material: aSTnk 0-303y Driller: DRt6AI1RL. ORILLEje. U �g6Dilled: a Static Water Level: Installer: v/I� — Date installed: Pg 101$% M-IJ OFILLIIG P6'lYfplZ Mabe -Uec k �� Ft. op- Yield: 3Pump Set at I Casing Height above Ground: I / TANK GPM U Ft. I -I- Ft. — SEPARATION DISTANCES I$soptic L1 Holding ❑S.T.E.P. To Septic Absorption Lin Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines Well x -]51Surface .____ �, Material: Numher of Compar/ me ts: Water Ioo1+ loolfi -- -- LIFT STATION / Lot 1 k) 50 Size in gallons: Manufacturer: %. Line -- f0 i' Foundation 81 751 } -^ —1— "Pump on" level at: "Pump_qjj�ke9el at' High water alarm at: CurtainC� - t , a _ Pump Make & Dyad Electrical Inspections performed by: Drain Remarks: WELL 021LLEn I� 1965 BENCH MARK — Location and Description: Assumed Elevation: 100.0 EN — �P�� ~q 4 itit1 ----- Inspections performed by: & 8 LNGINEBRINO Qp s: 1 St . %~ art;l Road,a . N W •NfNIN\i.:1\ 970 "aq a Dole River, Alaska 99577 2nd f"ROIIERT C. COWAN ! 0�, CE-8801 �\av Department of Healt and Human Services approval ... ifil". •• ....III- Date:? Reviewed and approved by: 72-015 (Rev. 9/91) MOA 25 Permit No. N/A Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LOT 1, BLOCK A, ZANTHA VISTA S/D -- PID No.: 015-472-01 72-013 A (Ru. 9/91) MOA 25 J m m m 07/18/07 08:48 $9073402038 ERIKSSON ®001 y T7CA/L5 CAI bR. �, 4cF — cc„yc. au t. Wa// , .NOp05/5"e (09,99. ESM'Y ' A . �9 g•nwc. scr' Tb D (.� P N i .ett IA. S1” •�SEPrIC o°m. I J MEwt3+ Fair_ pax' Js 6-Ln� ago Recording Precinct, Alaska, and that the situated thereon are within the property lines Mtl i co h an the promises In question and that Koro are no roadways• transmission lines or other vlsiblo easements on said - TN �. d Zp0J'7 FRED WAIATKA a ASSOCIATES - (907) 2a04666 Engineers and Surveyors PIAT ARE NOT SHOWN HEREON. Fb q 9. 7 y3 E C F, (J Mr95.S SN PDIN L.—� m 0 m IIOEERY C. COWAN . CE -8801 D' wrn.(,. 7413197. Post- ' brandllax transmittal memo 7677 rmp(+ser Tb D (.� P N from r/L/(LSS u IA. — .—� o°m. I phone'6•L03� Fair_ pax' Js 6-Ln� co � r I f � DlV/OED -�_�_—�-._..,__ . __, ..: •---' 6' urszrlsovoN � j'' PrG( �I SCwd� 1 2' t_ Rock tl. tea ,x.s cop A, a' 1:Frter yr X a 51� x 6 0.7 RnGroe X S35_ r rn/b�0keep) AS•13UILT Nd CORNERS SET THIS DATE Jv_ certify Ihel I have porlormed a Mpdgagea's inspection — .—� llowing �060ribud property'. r 7 --0K If}� ZA7V T/ -I V65'r��--. rAnQhorago DN060¢'7,/"6 /G9, YU ago Recording Precinct, Alaska, and that the situated thereon are within the property lines Mtl mantS erlap oriencroachon the prepedyying adlacent thereto, improvbmonL5 on property lying adjacent thereto h an the promises In question and that Koro are no roadways• transmission lines or other vlsiblo easements on said - property except rag indicated hereon. - Dated at Ancho age, Alaska this /7VA� 'day of_��E -.111 EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED FRED WAIATKA a ASSOCIATES - (907) 2a04666 Engineers and Surveyors PIAT ARE NOT SHOWN HEREON. Fb q 9. 7 y3 E Municipality of Anchorage t DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: .i V "6,J 6IR'G/C So /J DATE PERF LEGAL DESCRIPTION: L07- r ALK A 7,A. r,14 wsM Township, Range, Section: r--1 1 SLOPE (FEET) i 2 'c�1 3 t: 4 -C!> 5 6 7 8 t 9 L -P• 10 11 12 13- 14- 15- 16- 17 3141516 17 18- 19- 20 - COMMENTS 6) LrY SA-N/IY (- AA• V$L WAS GROUND WATER Al 0 ENCOUNTERED? S L IF YES, AT WHAT —• O DEPTH? ___ P E Depth to Water After7 ��/ pf % Monitoring? Dale: SITE PLAN A0N Reading Date GrossNet Time Depth to Time Water Net Drop NJ natsu.sK '7 15-197 N '. 33 — 6 -f PERCOLATION RATE 0' T ¢(minutes/inch) PERC HOLE DIAMETER G TEST RUN BETWEEN V /y FT AND 9-1 /Z FT PERFORMED BY: 17034 Eagle River Loop Road No. 2011CERTIFY THAT THIS TEST WAS PERFORMED IN Eagle Rlver, Alaska 99577 ..) 21- 3 A 7 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) M -W DRILLING, Inc. P.O. Box 110378. 10330 Old Seward Highway (907) 34J•8535 ANCHORAGE, ALASKA 99511 DRILLING LOG Well 0wner %yv;, �o _ Location (address of: Township, Range, Section, ff known; or Size of casing �Vth of-1401et=—ieet Cased tor. Static water level 4d_ft. }� " (below) land surface. Finish o Screen ( ); Perforated ( ), Describe screen or perforation- 34, *Y, 1 ,7_n , _o f 4 Y' pyr Well pumping test at.}—gal per (hour) (minute) for_ Z_ of drawdown from static level: Date of completio ' WELL LOB Depth In feetfro m ------ Mund surface Give-de4eils of formations penetrated. ti--_,.........�— _ _ pc ed, size of Cl .TO ..62 —62—TO-110- 0- -TO-- I 62TO 11no T0,I —TOS_ To q'0 -- TO TO 86-191 of Wenj2-a ; o. main road (check one) open end ( ); with_._10QV2 color and Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D.015-472-01 Expiration Date: 1. GENERAL INFORMATION: Complete legal description ZANTHA VISTA: BLOCK A LOT 1 Location (site address) 10980 TRAILS END ROAD *ANCHORAGE, AK Current Property owner(s) ROGER TAPP Day phone 206-300-5356 Mailing address Real Estate Agent CHERIMARSTON Day phone 2. TYPE OF DWELLING: Z Single Family (w/wo ADLI) F71 Duplex F] Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 2 SEPTIC SIZED FOR 4 BEDROOMS 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community El Public Water System E] Public Sewer El WaiverNariance request for: --Distance: ISBN IN I Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. r COSA Fee $ 5-6-D Date of Payment ag Receipt Number COSA # 66 �A13H Date: Waiver Fee $ Date of Payment Receipt Number Waiver # I 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 1(31�1 Engineer's Printed Name: Jeffrey A. Garness Date: 16 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 (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD„SIGNATURE _/ System #1 Approved for Z bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following 5a0atior!$�grN S7T� p qs Rq O�"7 44 1 L19VICES 4)' Original Certificate Date: 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_ Nitrate Advisory_ Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: ZANTHA VISTA; BLOCK A, LOT 1 If more than 1 septic system on lot: COSA Checklist # of DEEPENED 6/26/1986 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1965(?) Total depth 170 ft Cased to LINK ft ❑ Sanitary seal is functioning correctly NO Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 6/27/19 Static water level at beginning of test 26.4 ft. Comments *1000+ GALLONS -SEE ATTACHED PHOTO B. TANK DATA Age of tank(S) NEW years Tank type/material HDPE Measured operating fluid level in septic tank NIA FOR Standpipes/foundation cleanout per record drawing Date of pumping N/A D. ABSORPTION FIELD DATA Which system tested (date installed) 7 — tJT.' Q ❑ ALL standpipes present per record drawing Total measured depth from grade 5.9+ ft (max) Measured depth to pipe invert from grade 4.4+ ft (min) ❑ NIA — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 2.42 FEET Parcel ID: 015-472-01 Structure served by this system Well production at time of test 1.3+ gpm Water storage tank volume * gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 7.19 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by GEG Date of Sample 6/27/19 C. LIFT STATION ❑ Required maintenance Age of lift station Lift station materi Adequacy test date 6127/2019 Results p✓ Pass For 4 bedrooms Fluid depth prior to test 6.25 in Water added *534 gal New depth 17.5 in Elapsed time 149 min ❑ Code -required soil cover over field Final fluid depth 10.5 in ❑ System presoaked Absorption rate 600+ and (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NIA date of test) N/A Gallons introduced N/A gallons If yes, enter date Comments/Deficiencies: 'PER CORRESPONDENCE WITH TIM ECKLUND ON 6/27/2019, TEST COULD BE USED FOR FOUR (4) BEDROOMS 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 ❑✓ Yes if No Neighboring Tank > 100' F71 Yes if No ft Private Sewer/Septic Line > 25' 0✓ Yes if No Absorption Field on Lot > 100' P71 Yes if No ft Holding Tank > 100' 2 Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' 0✓ Yes if No 0✓ Yes if No ft Manure/Animal Excreta Storage > 100' —0✓ Community Sewer Main > 75' 0 Yes if No ft Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' ft ft ft ft ft ED Yes if No ft Property Line > 5'✓0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0✓ Yes if No ft Private Wells > 100'✓Q Yes if No Water Main > 10'✓❑ Yes if No ft Community Wells > 200' 0✓ Yes if No. 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' ❑✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓Q Yes if No ft Private Wells > 100' 0✓ Yes if No Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' 0 Yes if No Surface Water > 100' ✓0 Yes if No ft F. ENGINEER'S COMMENTS COULD NOT LOCATE SURFACE WATER ON LOT TO THE SOUTH. FIELD MEASURMENTS WERE TAKEN 100' FROM SOUTH DRAINFIELD CLEANOUT G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet J ffr am s.:... E(Q— i7 95 O13`o o,p�ofess., #AECC884 ft lil fV ft DEVELOPMENT SERVICES DEPARTMENT � ©n -Site water and wastewater Section www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval #OSC191377 Subdivision: Zantha Vista , Block: A, Lot: 1 , A water sample revealed a nitrate concentration of 7.19 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. 6goti�-+uvu�� From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform,an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Lot 114A / 8.7'x16.2' SHED a N 89'53'004 300.38' Lot 1148 40SEMENT/' WATER 44,938 S.F. EAo(„ / WOODEN FENCE � POWER LINES / BALCONY 16.0'x16.0' DECKN CONCRETE PATIO SEPTIC--/ o o`w / � PIPES/ 11 / 75' ELECTRIC EASEMENT / ♦ 1 L , Lot 113 / • / �1, / 1� o 22.3• . 24.3'x20.6' + WIRE FENCE 1 z CHAIN-LINK FENCE -SHED MANHOLE 1 2 °' \\ / 27.3' / 100' PROTECTIVE 2 STORY g / WELL RADIUS M RESIDENCE / I WELL 174.3' 2e.3' N 213' / 3 / 1.7' CANTS \ 8.2' Wo X15' UNDERGROUND o T&E EASEMENT\ \_rt KAREN AVENUE 76.1-1 J WOODEN FENCE GARAGE 4.1'x10.1 PORCH CA C 30.3' ASPHALT ` DRIVEWAY,. , J L i I I .. 30.0' I . I I N m m I .4 ° Y n 0,15 ° `r a � m al o o m Co s I L I I I y/ p ot> Q 011 O + > '0 ' I I .4 ° Y n 0,15 ° `r a � al o o O Co s L m C° m p ot> Q 011 O + > '0 ' a ^ ° ° . a ° a o'0 v E°-om O a i p0 C `I o O q o nn°•L on E« 2 m 9N�°Omm mL Lw `J 3 pNp O C C.'D C °� 0 E ° O° O° t 00:0 0 n. a o rn3 m 9 V� 0 0 9 v O O T 00 �C TZh C d 20 0 _4MOC x ° O on.°o°� L1np0 2a oc rn� c« a r 0«v a« G « ^ 00 C OC w 0mimo.Eco 0 0-0o ' 00>° n n m`0 G m ago«amnmo m p O c E of mt E oo ^> Lc 0`a°o o z0 §! He= \ a \2!J! ! .; ;i, . „K )\ §\� §! FT Municipality of Anchorage Development Services Department Building Safety Division Onsite Water and Wastewater Program a F. 4700 Bragaw Street Q P.O. Box 196650 L 7 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904;, CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-472.01 1. GENERAL INFORMATION Complete legal description Z.antha Vista Block A Lot 1 Location (site address) 10980 Trails End Drive Current Property owner(s) John Stroud Mailing address Lending agency Mailing address Real Estate Agent Mailing Address COSA# 10-1 I)MR Expiration Date: G - a R - O % 10980 Trails End Dr., Anchorage, AK 99507 Day phone Day phone Kris Abegg / Paragon Properties Day phone 349-1200 3111 C Street, Suite 555, Anchorage, AK 99503 Unless otherwise requested, COSH will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well ✓❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank ❑ Community On-site ❑ 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 Onsite 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 OnSfte 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-sfte water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. l 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 Islam) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Finn Watkins Engineering, Inc. Phone 349-1851 Address P.O. Box 110443, Anchorage, AK 99511-0443 Engineer's Printed Name Cindy W. Ellis Date S. DSD SIGNATURE ✓ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: ! Original Certificate Date: 3 ` (RH IIX5) Municipality of Anchorage so Development Services Department Building Safety DWftn Onsite Water 6 Wastewater Program ' • •' 4700 Bregaw Street P.O. Box 198850 Anchorage, AK 99519850 www.muni.org/onsfte (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Zamha Vista Block A Lot 1 Parcel 0: 015.472.01 A. WELL DATA Weft type Prl If A, B, or C provide PWSID 8 _ Well Log (YIN) Yes Date completed 1985 / 198W Sanitary seal (YIN) Yes Wires property protected (YIN) Yes Total depth 170 ft. Cased to 3a°' ft. Casing height (above ground) 181+ in. FROM WELL LOG AT INSPECTION Date of test June 28, 1988 February 27, 2007 Static water level 20 ft. 27 ft. Well production 3 9.p -m. 1.0 9 - p.m -WATER SAMPLE RESULTS: CotifOrm 0 colonleal100 mL Nitrate 8.70 mg/L Other bacteria 0 oolonles/100 mL Arsenic: 40_005 mpll Date of sample: 3115/07 Collected by: Rocky Trainor B. SEPTICIHOLDING TANK DATA Tank Type/Material Septic Tank / material unknown Date installed 1985 Tank size 1200 gal. Number of Compartments I Cleanouts (YIN) Yes Foundation cleanout (YIN) Yes Depression over tank (Y/No No High water alar (YIN) NA Data of pumping March 5. 2W7 Pumper A+ Home Services C. ABSORPTION FIELD DATA Data installed 1955 Sal rating (g.p dJttr or felbdnn) 85 Systern type Shallow Trend, Length 55 ft. Width 6 ft. Gravel below pipe 2 ft. Total depth 5.8 ft. Eff. absorption area 343 ft' Monitoring tube Yes Depression over field No Dace of adequacy test 212712007 Results (Pass/Fog) Pass For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added455 gal. New depth 0 in. Elapsed Tina: 0 min. Final fluid depth 0 in. Absorption rate a= 450 g,p,d_ Any rejuvenation treatment (peat 12 mo.) (YIN 6 type) No If yes, give date �b _ jegwaN 4wom lueuuted to eleO S p/ (90nt 'mv) .K96 b �egwnN 490e8 Im"Od to eleO S eod VSOO ela0 $1113 M AP 1�NI)l BweN Peluud S�aeu!6u3 x1113'M ul0elep elw u0 lode ul seuSemna VS00 Van Mum eoueuugww {, w are Swels�ts &uqo ow low spmw ledlalunn /o Memel�6Y PUS SUOODG& ! P199 4�g1 PewuueleP ena4 I law AXm l a.,u, .: ;a NOLLVOWMW 5.2133NIJN3 'O 1Sel Mot van AMAOM POMPu09 'Y 0£ tom 4tdep 15L"B* X4 Luwmpbw 996 t '0I Nam led 'AU of .0E WdoP Min.. '9561 ul V OLL of pouedeep Pus It Z9 03 9961 u! POUPP f4JIMBIJO NOM.:S1N3WWOO 'd +,00t qq lueoe(pe uo sneM VIN ulejp umnO +AOt a6swp ePRfQAA#4wd'AWAGAU0 +AOL Jale* eo WnS +A9 81418oweS Jewm *AOL ureal ieleM +A9 uopepunol 6ulplln8 +AZ eta AlLedwd :01101 NO 01314 NOLLdaOSGV WONA 33wma NOLLVHVd3S +AOL slot luaoe(pe uo Suem +AOL 1emm emms +A£ sun eolnies Jemm +AO t ulew JGWm +AZ pled uopdroSQV .9Z eau AyedOid +At LmpMunol 6ulpllne 01101 NO HNVl ONIOIOWOLLd3S WOW S33NV1SI0 NOIlVHVd3S +,001 Sege often ela=m "uelwnueyl +AOL Some luewumpmo lew!uV VM XUM GulP10H +Wp ' )nouealOMO4uew J"VS glgnd TX—T qq luene(pe UO +,Dot qq weoe(pe u0 +49 sun a 166 owes/ JwwS +A01 Ww ANws glgnd +.001 p uo ple5 uoqdjozW T lq uo uanois V"uet Dodos :01101 NO IT" W021d S3ONV1S10 NOLLVHVd3S 83ONVISIO NOLLVHVd3S '3 tumuannbei Nnwp Y uusls gmn pelsel sepAO uuwa w is level uuele ieleM 40tH •u! — w leml yo dwnd. 'u! w level .uo dumd. (NIA) 28e00pe104u8n Sugle6 w ems VM peuelsu! ova NOLLVIS kill 'O Municipality of Anchorage ' 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.orglonsite (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 070069 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block A, Lot I of Zantha Vista subdivision. This inspection revealed a nitrate concentration of 6.7 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. SCS Ref.X 1071060001 Client Name Watkins Engineering Project Name/p Zantha Vista Client Sample ID Zantha Vista Dlk A Lot I Mattis Drinking Water PWSID 0 Sample Remarks All Dates/Times are Alaska Standard Time Printed Date/time 03272007 10:14 Collected Date/Time 03/152007 12:05 Received Date/time 03/152007 12:42 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 0321/07 0322/07 TK Waters Department Total Nitratc/Nitritc-N 6.70 Microbiology Laboratory Total Coliform 0 0.100 mg/L EPA 353.2 D (<I0) 03/17/07 1DS coV100mL SM209222B A (<I) 03/15/07 DPT /p M O O f") f") co N coco iJ Trails End Road ------------ r3 8 .66'60L nAAM70.0S N O O fh M O CD � k . '. LL. O. Nz; � C) . `Rly 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 MUNICIPALITY OF ANCHORAGE RONMENTAL SERVICES DIVISION AIN JUL 231997 RECEIVED CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 10 i3 — `Y %J_ _ 0/ _ HAA It 1. GENERAL INFORMATION Complete legal description Le T- (3Lcca /� Zr}r rr4-4 Y7 s;Ff/ie Location (site address or directions) /O �c 7-/Q A R0 y_0 Property owner _$ v ie i✓ 6 A t C w 5 ,g ry Day phone 3 V L- 3c 3 J Mailing address P 75 A Lending agency — Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: ti 3. TYPE OF WATER SUPPLY: Individual well X 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 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 (flm 1/91) Front MOA 021 5. STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my 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. S & S ENGINEERING Name of Firm ver mop Phone Address Eagle River, Alaska 99577 Engineer's signature 6. DHHS SIGNATURE -X Approved for 4 bedrooms. Disapproved. Conditional approval for Additional Comments AM Date 7Al3Al 6 $ERT C. COWAN CE -8801 bedrooms, with the following stipulations: Date 8-13-97 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA p sit Municipality of Anchorage MUNICIPALITY OF ANCHORAG l I +� ENTAL SERVICES DIV DEPARTMENT OF HEALTH & HUMAN SERVE NI,/, Environmental Services Division .11II III q 3 1997 825 L Street, Room 502_ • Anchorage, Alaska 99501 • (907) 3�}3 X47"44 Health Authority Approval Checklist RECEIVED Legal Description: 1-01- I aLK 'A' .7-NNrNq V/Srf)_Parcel l.D.: -- A. WELL DATA Well type PR I V R 7 L If A, B, or C, attach ADEC letter. A//�DEC water systemnumber 0Riy ✓/N/r4 Log present &N) Date completed 099-P�=Nr0 Total depth _ ) 7o Cased to _8 )i_ b R U c, K Casing height (above ground) /--- Sanitary seal &N) 'Y S Wires properly protected (9/N) Y S FROM WELL LOG AT INSPECTION Date of test / (3-C / S 6 — Static water level cl 0 / Well production 3 WATER SAMPLE RESULTS: Coliform O g.p.m. Nitrate _ I/ • '73 �)7 1, 3 Other bacteria O. ,.Yom Date of sample: 3 0 % Collected by: S & S ENCINFFRING —. 17034 Eagle River Loop Road No. 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Date installed _ 1 0 G S Tank size 19. 0 0 Number of Compartments 01K Cleanouts ( N) YE S Foundation cleanout,.(Y/6) /'0 Depression (Yo / / o _ High water alarm (Y/O " 0 Dateof'Pumping l 1,9 '7_ Pumper h+ pDmc 5''i2V/c1fS C. ABSORPTIONFIELD DATA rct� �oLLour:�G U/1 -r4 vERr�rEi> Date installed A Soil rating (g.p.d./ft2 or ftp/ s System type r216 'c_" Length S r Width _."S / Gravel thickness below pipe a —Total depth 6 Z Al 0 Effective absorption area zz.34 3 r r Monitoring Tube present �Y%N)� ESDQP�presggion over field (Y/O _G rNONIY a R0vc T✓BG _�T ALA'LLO ANO C.Liq�OUT l/✓SYALLfD 7//S'(el7, Date of adequacy test / 6 9 Results a`s /Fail) P S _f For _ _bedrooms Fluid depth in absorption field before test (in.); A Y Immediately afterll yee gal. water added (in.): a f r Fluid depth 1 r (o r (ins) Minutes later: I a 3 Absorption rate = _ G0() -F- g.p.d. Peroxide treatment (past 12 months) (Y/N) NI)rj"- rc,w" If yes, give date _ - 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* "Pump on" *Datum Size in gallons "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot SU On adjacent lots ) 0 Absorption field on lot / o o 4- On adjacent lots /00 Public sewer main N 1A Public sewer manhole/cleanout r� Sewer /septic service line a Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation s )- Property line S t Absorption field Water main/service line )0 Surface water/drainage /00 f f Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: N /A >J 1A i S f /00 �k I Property line )d 4- Building foundation / u f Water main/service line 10 f Surface water % 0 o /} Driveway, parking/vehicle storage area /U o 4 - Curtain Curtain drain tv 0)-d ti K N0 w nl Wells on adjacent lots I U o F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal re in conformance with M • A I gumlines in effect on this date. Signature Engineer's Name Date 7 �� 3 A) 7 HAA Fee Waiver Fee $ _ Date of Payment Date of Payment Receipt Number -3- �� Receipt Number 72-026 (Rev. 3/96)* Fr[