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HomeMy WebLinkAboutGREENLAND BLK 1 LT 1Greenland Block 1 Lot 1 #015-172-19 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221121 PID Number: 015-172-19 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name JOSEPH ZIMMERMAN ABSORPTION FIELD - EXISTING ❑ Deep Trench ® Wide Trench ❑ Bed ❑ Mound Site Address 4970 E 112TH AVE, ANCHORAGE, AK 99516 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 2 GPD/SF 6 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2 Ft. Gravel depth beneath pipe 4 Ft. Subdivision Block Lot GREENLAND 1 1 Fill added above original grade VARIES 1.13 —1.32 +/- Ft. Gravel length 2 X 20' 40 Ft. Township Range Section Gravel width 5 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line *285+ FtZ 2 10 Ft. Well *50'+ __ 251+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ® Other ADVANTEX Manufacturer ORENCO / ANCH. TANK Capacity 1500 Gal. Surface Water *50'+ __ Material COMPOSITE PLASTIC Number of compartments 2 Lot Line 51+ __ NA Foundation 10'+ __ LIFT STATION Manufacturer ORENCO Capacity 1500 Gal. Remarks `AX SYSTEM SEPARATIONS & ONLY USED. ZED FOR ASBSORBTION = 285+ SF OF SAS. NEW FIELDS INSULATED Alarm location 1ST FLOOR Electrical installed by RISING SON EVEN THOUGH THERE WAS ADEQUTATE SOIL COVER. Installer NORTHERN EXCAVATION PIPE MATERIAL House to tank 3034 dra rifled 3034 Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspectionddates: 1s' 6/27/2022 2nd 6/28/22 Location and description 3'd 6/28/22 4" 6/29/22... TOP OF ADVANTEX POD ON-SITE WATER AND WASTEWATER SECTION APPROVAL • • ` `'' ��$ Conditional Approval: Date .W I •.ig BTH • •• ••"•••• •••••••:•• Septic Syste Approved �� �•,Curtis Huffman - �` CE 128991 Z Date �' '�Z ¢ �����', �•,?/15/22 •����� �k�FOPROFESSIO�V Note: this approval does not include well permit requirements. �'���,,,�-��-®.. PID:015-172-19PERMIT:OSP221121 FIRST WATER CONSULTING GREENLAND BLOCK 1, LOT1 MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this /T Day of JA UVY of 20 ? , by and between _j_05_e5'N JA:.vcs csu , herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as ADVANTEX located at (legal description) -GREENLAND BLOCK 1 LOT 1 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) T3 Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. Z'S It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). TA Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. TT Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. -TI Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. S'S Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. aJ Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. T Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNER: By: (signature) Date: j4,4j � GLI �,t; (print name) STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this 1-P+day of 20n, by _TAiQP N sWosoAn�� ,y Commission expires: NOTARY MUNICIPALITY•flO1111 By:OJ (signature) Date: I/ Z Cc / M"1 S 7t, r,..D (print name) Title: G (V(- 1. Vr- (rev. 05/18/2018) Page 3 of 3 MUNICIPALITY OF ANCHORAGE ti Development Services Department 1 Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 015-172-19 Certificate of On -Site Systems Approval Gf Z (0/-10 Z_3 1. GENERAL INFORMATION Complete legal description GREENLAND BLOCK 1 LOT 1 Expiration Date Location (site address) 4970 E 112TH AVE, ANCHORAGE, AK, 99516 Current property owner(s) JOSEPH ZIMMERMAN Day phone Mailing address Real estate agent 4970 E 112TH AVE, ANCHORAGE, AK, 99516 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: Day phone Private Well ® TYPE OF WASTEWATER DISPOSAL: Water Storage ❑ Private Septic Community Well ❑ Holding Tank ❑ Public Water System ❑ Community ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 1� M Date of Payment 7�6/Z2 Receipt Number _ 1140q6' COSA# aSCa�13-Z Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 6/30/22 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FWCS 6. DSD SIGNATURE System #1 Approved for 3 bedrooms E System #2 Approved for bedrooms Disapproved ~' OFAi8111 *: 49 7H ....:* r� /jj . ' • Curtis Huffman j Ir+ �F67 CE 128991 PROF 0( ONPX� Conditional approval for bedrooms, with the following stipulations: Original Certificate Date: Z 11 _�o2 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 Checklist Legal Description: GREENLAND BLK 1 LT 1 Parcel ID: 015-172-19 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA – PUBLIC WATER Well log is filed with Onsite (or attached) Date drilled CIRCA 8/17/1971 Total depth 150+ ft Cased to 40+ ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 5/2/22 Static water level at beginning of test 59 ft. Well production at time of test 5+ gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 0.51 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample 6/16/22 Comments __________________________________________________________________________________ B. TANK DATA Age of tank(s) NEW TANK years Tank type/material ADVANTEX FAP / PLASTIC Measured operating fluid level in septic tank NEW Standpipes/foundation cleanout per record drawing Date of pumping NEW TANK 6/27/22 C. LIFT STATION Required maintenance completed Age of lift station NEW LIFT STATION years Lift station material PLASTIC Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) NEW 6/29/22 ALL standpipes present per record drawing Total measured depth from grade 7.32 ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective ED 4’ TOTAL DEPTH Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date NEW Results Pass For 3 bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) N If yes, enter date Comments/Deficiencies: 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 *50+ ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No *50+ ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ 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 Property Line > 5’ Yes if No ft Absorption Field > 5’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No *50+ ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ 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 Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No *50+ ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No F. ENGINEER’S COMMENTS *THIS IS AN ADVANTEX FAP SYSTEM AND MEETS ADVANTEX SEPARATIONS FOR SUBJECT & ADJ LOTS. G. ENGINEER’S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 7/15/22 1 I w 0 ££ • 1 pr y7 J 112TH AVE w O o 3 13 3 S89 49 45 E 99.32 (S89"55)30))E 100.00' R 12.0' c� SHED SEPTIC VEN T i (t YID ) 0') _ AMH VAULT ., z 000 <GRAVEL r _ O LLQ et- N N dI i 0o N /W O Ory � w N DECK 23.7' O 0 I w w I Q Ld 0 EXISTING o O M O cv HOUSE 0 - � 0 V 25.9' X0.0' z O 0 DECK �--� e 0 x z � LOT 1 8LK 1 X GRAVEL PARKING 0 WELL 30' 33' N89°55'09"E 100.24' (S89"53)20"E 100.00' R) 113TH AVE I ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: GREENLAND SUBDIVISION LOT i BLOCK 1 PLAT P-268 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shout( any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE: SCALE: E—MAIL: JULY 9, 2022 1 "=40' schuller0ok.ne# 22-070 DRAWN BY: CHECKED BY GRED NUMBER: B04K/PA{ JLS SW2636 220247 * = FND 5/8" REBAR , - -q! SUR AMW OF 4 Nk\%���sL A Pq •4 L,,t YA� r / VA i 9 .......... . ........... o •.Jyj _; 0 - - HN L. SCHULLER.• o ` s • LS -10408 qj •. 0 . • ' ���� / 1831 Talkeetna Street o�• : ,,,r Anchorage, Alaska 99508 .Nvk�,C�o fe a� L „�, (907) 227-1455 office L®` ssio®�,�•.... (907) 274--4992 fax MUNICIPALITY OF ANCHORAGE On -Site 411atg F& WasWisatar Program M Elm 19615350 4740 Emma Reed ArchoraW, AJeatoa X3819-fi55p PMM,�. (907)343.7904 Fax= (M) 343-799, h 11 p , A'w*tiw jm rt i , wq kwr5 i to n -Site Wastewater Di p0$a18 ystem Permit Pc rm it Number: OS P221121 lhtark Type; Septir- Upgrade Tnx C -ode Number: 015172190DO -5ite Legal Address: GREENLAND BLK I LT 1 G:2636 Site Mai li ng Ad d rens, 4970 E 112TH AVE. Andhorage Owner: ZIMMERMAN JOSEPFr W Design Englnear= FIRS7WA7ER CONSULTING This permit is forth* constniction cyF; Effective Dates Expiration Date: men r a n rt n t1S' lart11 ant Lot Size in 3q Ft: Total Bedrooms- V3V2022 W31 2716 Q Disposal Field RI peptic Tank ❑ Holding Tank Q Privy ❑ PrIvato 11%rell ❑ Water Storage All conotruai on s hal l be 1 n accordance with: 1. The attached approved design_ . All mquirements speelfied in Anchorgige M unicipal cads Che laters 15.55 -end 15,$5 and the State of Alaska Wastewater Dlspossil Regulations (IBAAC72) and Drinking Vater Regulations (1 C-80} 3, Tho wastewater code requires Inspl2di !� EiLuinq the i R1r-t11mHnn 7hiR L-rboinaAr Rh -q11 n"Ify iM* Dq'v.sl4Pm-�-nt Services Department per AMC 15, 55, Provide noiif!cation by Galling P07) 343-7 (240). 4. , From Odober 15 to April 1-5, a aubaurface sail ab3orption "am under can5trtictlon during freeing weathlar ah JI be either: a_ Opened and Glased on the same day. or b. Covered, sealed, arta heated to prwerrt framing Special Provisions; Ploase note, the ML layer was not perk tasted so cannot be utilized for iirc- required absoipiion area. Fk,"VOd By, Issued P: Date: 5l 31T D -ate- 5-, MUNICIPALITY OF ANCHORAGE Development Services Department r' Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I. D. 015-172-19 Property owner(s) JOSEPH ZIMMERMAN Day phone Mailing address 4970 E 112TH AVENUE, ANCHORAGE, AK 99507 Site address 4970 E 112TH AVENUE, ANCHORAGE, AK 99507 Legal description (Sub'd., Block & Lot) GREENLAND 131, L1 Legal description (Township, Range & Section) Lot Size 27,153 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field 0 Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank El UpgradeX (D) El Holding Tank ❑ Renewal ElDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 595 Date of Payment: (D - 24 ,Z Receipt Number: Permit No. 2--2-112, 1 Waiver Fees: Date of Payment: Receipt Number: Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com May 13, 2022 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: GREENLAND B1, L1 The property owner has requested we obtain a permit to upgrade the failed septic system of the above referenced lot. We propose to install two shallow trenches and a 1500-gallon Advantex FAP 2.0 plastic tank to serve the existing 3-bedroom residence. The design is based on the recent test hole conducted on May 2, 2022. No groundwater was observed at test hole excavation or monitoring. The slopes are moderate at 5% at the proposed upgrade location. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221121, Rebecca Carroll, 05/31/22 FIRST WATER CONSULTING GREENLAND BLOCK 1, LOT1 DESIGN CALCS: NO WELLS WITHIN 50' OF PROPOSED SEPTIC AX SYSTEM NO SLOPES >25% WITHIN 50' OF PROPOSED FIELD. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221121, Rebecca Carroll, 05/31/22 FIRST WATER CONSULTING GREENLAND BLOCK 1, LOT1 DESIGN DETAILS: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221121, Rebecca Carroll, 05/31/22 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 firstwaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: GREENLAND B1 L1 PERFORMED BY: FWCS / FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 5/13/22 DEPTH FEET OG SOILS 1 ORG/OL 2 3 ML 4 5 6 7 8 GM/sm-ml 9 10 11 12 13 14 15 16 17 BOH 18 19 20 Reading Date Gross Time Net Time Depth to Water Net Drop 5/13/22 30 min 6” 1 2/16” 30 min 6” 1 1/16” 30 min 6” 1 1/16” PERCOLATION RATE 28.4 (MIN / INCH) TEST RUN BEWTWEEN 4 & 5 FT PERC HOLE DIAMETER 6” PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH. GROUND WATER ENCOUNTERED: NO IF YES, AT WHAT DEPTH: NA DEPTH TO WATER AT MONITORING: DRY DATE: 5/13/22 TESTHOLE # 22-1 DATE PERFORMED: 5/2/22 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION PERFORMED FOR: JOE ZIMMERMAN 5/13/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221121, Rebecca Carroll, 05/31/22 MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this �2 (; Day of JMav / of 20�, by and between ,herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Svstems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as AN ADVANCED ADVANTEX SYSTEM located at (legal description) GREENLAND BLOCK 1, LOT 1 2. Maintenance. Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. IJ Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNER- By: 5' nature) Date: t name) STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this _ day of 20_, by NOTARY PUBLIC FOR ALASKA My Commission expires: MUNICIPALITY: By: /1j1-JWZ (signature) PdOeCoA, �( (print name) (rev. 05/18/2018) Date: Title: Page 3 of 3 Municipality of Anchorage Page I of –3-- DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 u Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: -5-W . (0 3.6' e _ _ _ PID Number: Name. E R nl C-S 7" S (G. v� Wastewater System: ❑ New VA Upgrade Address: !1201 our (?G(, An ch ffk 995/% ABSORPTION FIELD Phone:p No. of Bedrooms: 3 y6 — 2 ctS3 3 ❑ Deep Trench ❑ Shallow Trench G/ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION ' Soil Rating: Total Depth from original grade 018 GP> U/S Ft Lot. Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe _ I I G RECNL r9N a•9 Ft. v.6 Ft. Township: IZN Range: 3w Section: 22 Fill added above original grade Gravel length: I'H FI. 2Yr Fl. WELL: e--xis r, ❑New ❑Upgrade Gravel width: 20 Number of lines: Distance between lines: Ft. q 5:O Ft. Classification (Private, A,B,C): Total Doplh: Cased To. "Fetal absorption area: a Pipe material: Ft. Fl. 5_(90 SQ. Ft. I it(" DIA SCH EO teo PvC Driller: Date Drilled: Sialic Water Level: Installer: I Date installed: Ft. 64Rt-s GACA vgT•INO-- fie/ it /91 Yield:Pump Set at: - Casing Height Above Ground: TANK GPM Ft. FL _ SEPARATION DISTANCES _ ❑ Septic ❑ Holding W S.T.E.P. To Septic Absorption Lin Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines Atnehora e Tank 1?6_0 Well 10 2 101' 102, — 73 t Material: Sf-ee( Number of Compartments: Surface Water 7 « > loo' > I00' LIFT STATION Lot Line HO' 2' HO' — H0' Size in gallons: 25-0 a Manufacturer: Anc,o e Tun k f/ 0rep co Foundation 32 r 32 , 32 O "Pump on" level at: yztr "Pump oft" level al: 38n High water alarm at: H6n CurtainP rr�p ak��& Mn eIG Ictrical Inspections performed by: rl fV !J Drain 7 yx� M O•A. Remarks: sySFem rnsfal(e�i er BENCH MARK Location and Description: �Fa✓ran d- lb/ lime, waiver, prop S hc, /unk -T'hresholrf c�f bctremenf �c9or alld Ce cb u rr.! �rNe� abandonec/ r'n Assumed Elevation: pace. Perc rine of unolerl rn NG- loo, 00 Ft r 1s < (2o Yntn /ri+ch, l%itrli (e anr�P ceuclrile hryh leve/ a(e(rn, ENGINEER'S SEAL ;y` ;•°°.a easr. nI7 410un1�00C fn S/1 arra a1em-en/ of 6ui(rlrn 6eC4 exCaverhu.q Coverea anriC hevAeae 777nv ccynS ueiTrn Inspections performed by: F(aH*,!? Teeh Dates: 1st 12/3/9( " �,•' f,r ;,_; ; 'e v 4 2nd 12/H/9/.........°.°...•°•..�:... Department of Health ani-d H man Serres approval S'3. •.°.°'`I" `'" `_ A100 .E.f CE -n'j r v��d'`'�= Reviewed and approved by: _—Z _Date: '' �` ' °••••°°•^;'t:;=ci n_ Permit No. .5 W 9 /O 362 Page a of 3 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: 1= 1, 13 1, 6: neem land S /.D PI D No.: 0/,5_/_7212 112 th A VE, New IeS06. STC -P T/+Nf; Lu. 0 M EIYCO G.I Fr STN/ �d-29l 1 20 • , r. NC -w ?o' 7( 29_� So IH AG.C. GeD T6M .,A, a„t=xlsrinG 3 BORr1 HauSC- W07" Flattop Technical Service 14530 Echo Street Anchorage, Alaska 9951 72-013 A (Rov. 9/91) MOA 25 Il ` SLAIN G 7-IG„S LAI—._ I __— 1,n 11 1 ___ Y9„l ENGINEER'S SEAL t OF / a J� �e//nJe o r a d• o o• a e o u a','•�(a/,.'o • .//ey`/��s,('o�_,a.,�l �yG .ereeo •i�si •Ya'ooaa er••( �, ..,.M10 T•ifu;; c;Ud:: i-. i'.CU2E � >i U•�. A.. � rrnenrp ep J �����/�j°��1/�m���/e nvm�'m/V/'!�-eem Irnrn . •A -0r ?{' Slm. yav0ieirtllm<mlerm 0l- QA IV3S S,H33NI`JN3 IS66 b)IsDI i `abpzouau jL palls ouag 069H 0jnzaS jpopgoay do}}pja .4 V0 1'w -4O WaL100 :L" I I I �I II r1N11 51 (1 I r JO 4 l uhh I II 7a7nY✓•J� bJm�S ,�+n No1J.of1 �aV I Na5 9N+roJn�"! 7NN1�JJ}JD I.I rON0 NloO ,6'!OI xJd)d g'2- of rlo� 14'y »SNS vi 9+1J „2 Se VOW 46/6 AOU) V £IO -U S" 1 0-)N7v0 'm %I N+11 d -:7-L5 7V:9 4992-1 �0 vuq `141V 1J.J � 2 G l 510 :'ON (lid Q/ S )0un vaa� J w =�SnoN uoildinsap Ie69-1 }aodaki uol;}oadsul llaM ao/pue uaalsAS lesodslQ JGWAaIsIOM 91IS-u0 Jvt,Lb-6b6 :auoudalaj • 0999-61966 e�SL'ly'ab-eA0gouy • 09996E X09 'O'd NOISIAIO S301AHS 1tl1N3WN0HlAN3 S301Aa3S NVwnH 4Ntl o Iltl3H u01N3WIUVd3a a6saououy j.I W 10 afied Q 'oN 41Lua9d Sol INSPECTION FtPOA't , MUNICIPALITY OF ANC4HORAGE9BUILDING SAFETY DIVISION 3500 EAST TUDOR ROAD ; INSPECTIONS (907) 563-3464 INFCSFiMAT � Igp7) 788-0211 NAMEow PERMIT PERMIT STREET ADDRESS. /_PHONE�7 E LOT-/ BLOCK/ r _ SUBDIV.g/_4t?C FOOTING ❑ ELEC. TEMP, ❑` pLBG, UNDGR; FOUNDATION ❑ ELEC. SERVICE pLRG,:AOUGH BOND BEAM ❑ ELEC.ROUG FRAMING ❑ ELEC. FINAL _ GAS�'.TEMP , INSULATION ❑ OTHER - ❑ GAS _ ❑. SHEETROCK ❑ -- ❑ MECHANICAL ❑ STRUCT, FINAL MECO "FINAL ❑' ❑ FIRE FINAL ❑ PLbGSFINAL ❑ OTHER ❑ ZONING _ _ ❑, OTHER ❑ O NONCOMPLIANCE OBSERVED CORRECTIONS ESSENTIAL AS EXPLAINED BELOW ❑ WILL REEXAMINE AT NEXT INSPECTION ❑ DO NOT 0 fdO AL UNTIL REINSPECTED,-' ,1 COMMENTS 84-002 (Rev. 11/87) 0. OSWD03OU ON-SITE SEWER/WATER SYSTEM PAGE : 0001 COMMENT DISPLAY COMMENT SOURCE: PARCEL TYPE: INTERNAL ID NUMBED'.: 01517219 FINAI, GRADING COMPLETED, OWNER TOOK PICTURES TO BANK UPON 920615 HEDNB 001 WHICH THE BANK RELEASED THE ESCROWED FUNDS. NO REQUEST FOR 920615 HEDNB 002 A NEW HAA WAS MADE, AS -BUILT SIGNED OFF 6/15/92. 920615 HEDNB 003 : COMMODT : PFI:HELP PF3:RETURN PF5:ADD COMMENTS PF7:BACKWARD PF8:FORWARD PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW910362 DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES OWNER NAME:SILVA ERNEST K & GLORIA OWNER ADDRESS:11201 OUR RD ANCHORAGE, ALASKA 99516 PARCEL ID:01517219 LEGAL DESCRIPTION: GREENLAND BLK 1 LT 1 LOT SIZE: 27153 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED:11/13/91 EXPIRATION DATE:11/13/92 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: 1. ENGINEER MUST CERTIFY THAT UNDERLYING ML LAYER WILL PERCOLATE AT LESS THAN 120 MINUTES PER INCH. IF IT IS GREATER THAN 12.0, A NEW DESIGN MUST BE SUBMITTED WHICH PROVIDES A SEPARATION OF 6 FEET TO THE ML LAYER. RECEIVED BY:� DATE: /1 10191 ISSUED BY: DATE: //-/'V---w Municipality of Anchorage Department of Health and Human Services dhh5 Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 November 14, 1991 Ted Moore, P. E. Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99516 Subject: Waiver Request for Lot 1 Block 1 Greenland Subdivision Waiver Request #WR910052, PTD #015-172-19, #SW910362 Dear Mr. Moore: Your request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is 1 foot. This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Sincerely, Susan Oswalt On-site Services Concur: 1.A;,Ihn Smit. ram Manager On-site Services ' r.AUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR910052 PID# 015-172-19 HA# Permit # Date Received: November 7, 1991 Legal Description: Lot 1 Block 1 Greenland Subdivision Engineer: Ted Moore, P.E., Flattop Technical Services 14530 Echo Street, Anchorage, Alaska 99516 Applicant: Ernest & Carol Silva Waiver Requested: Lot line waiver - 1 foot of east property line Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted:_ Waiver is NOT Granted: List Conditions or Reasons for above: Date: By: Name of Reviewer Rec #: 23212/9060 Amount: $ 70.00 Date Paid: Nov 7, 1991 CIVIL & ENVIRONMEN'I'Al, I;NGINEE1tIN(; • ENERGY CONSERVA'IION THEODORE F. MOORE, P.E. PH: (907) 345-1355 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: November 7, 1991 ANCHORAGE WICES DIVISION I • E 14530 ECHO ST. ANCHORAGE, ALASKA 99516 The purpose of this letter is to provide the required design narrative in support of our application for a " permit to upgrade the wastewater disposal facilities on Lot 1, Block 1, Greenland S/D, located at 11201 Our Road. Soils logs, perc test results, a site plan, design drawings and specifications are enclosed for your review. We are also requesting a lot line waiver to allow the proposed soil absorption bed to be within 1 foot of the east property line. The soil test results indicate that the best area for the proposed system is near the east property boundary just north of the 100 foot radius from the well. In order to fully utilize these optimum soils without conflicting with previously disturbed areas, we need a lot line waiver to allow construction within 1 foot of the east property line. Since this property line abuts a road right-of-way, construction up to the property line will have no adverse impact on the ability to construct on-site systems on adjoining lots. The proposed system will be constructed in the vicinity of test hole # 1. As can be seen from the soil log, the native material between 1.5' and 3.5' is a slightly silty sandy gravel with a measured perc rate of 2 minutes per inch. Using the soil application rate of 0.8 gpd/sq. ft. specified for bed type systems in the wastewater ordinance, this 3 bedroom residence requires a total absorption area of Q x 150)/0.8 = 562.5 square feet. The proposed 20' by 29' bed design has a total absorption area of 580 square feet. The septic tank effluent will be pumped into a pressure distribution system. The pump output is nominally 30 gpm. Since each 1/8" dia. hole will pass 0.4 gpm with 5' of residual head, a total of 30/0.4 = 75 holes are needed. Thus, with 108' of laterals, the optimal hole spacing is 18". Since the proposed bed will encompass test hole #1, after water monitoring was completed the owner has been saturating the test hole with water to speed the compaction process and thereby avoid future settlement problems. The proposed project will have the beneficial impact of eliminating a septic tank which is less than 100 feet from a private well and abandoning a presently sub -standard soil absorption system. The project will have no impact on present or future water supply and wastewater disposal systems serving adjacent properties, nor will it have any impact on reserved space/surface and subsurface, or on drainage, Please give me a call at 345-1355 if you have any questions on this submittal. MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION NOV 0 7 1991 RECEIVED Sincerely, Ted Moore, P.E. '.4,/ n ►'/rr" DIR ScHC- U NO PVC O 1250 6A4 SC-Prrc T'ANfT W. Airr srArloN 0 G MIN PLAN VIEW I II =5 f - 0 n M. r. P+ 20 1 — 3 2' Sart, cov�sr3 TnSurRrrunr ri4nwq PAV/ric 2' 2 PARK DIST PIPe 5'C --W rt c -RAVE!, 0 I a. 7r S. L1r/CC,IN(r SANO NAIUC- SANDY G-RAVG4 SCCT ION "A_ �j' lrlq 5r^orI /1 OF A4 ���•p ta�."� �p'.I`� VA d�eoee�./g`/o�ele`�-•rpp Pa.P.aJ/../P/./a���.. rp� f �iP 1'FIeOD07iC F. `ACOi2E CE - 3539 r�'��i)l pppppPpcb ��• �t0'• W' L. --)O' u kiattop Technical Services 14530 Echo Street Anchorage, Alaska 99519 L11 13 1 6 R5EN I -AN D ;ID SCPTIC SYS T', (APGRADE _ PG -AN er X ^ SGCT (0(1( 04re: II /9/ C>WN. CtY: rPr7 SCAc.C-: 0=6"^Orr 5' aft�M,r. fTI�•y��.�p+n....- s I'Ay" DrA SCHao Ycj Pvr- I.Arai Al f 5 W. '/S" 01A Not'&S Poll.44WO IN a°rroer 2 SPACE() EvG(?Y 5' M,r. -� -- PLAN VIEW I II =5 f - 0 n M. r. P+ 20 1 — 3 2' Sart, cov�sr3 TnSurRrrunr ri4nwq PAV/ric 2' 2 PARK DIST PIPe 5'C --W rt c -RAVE!, 0 I a. 7r S. L1r/CC,IN(r SANO NAIUC- SANDY G-RAVG4 SCCT ION "A_ �j' lrlq 5r^orI /1 OF A4 ���•p ta�."� �p'.I`� VA d�eoee�./g`/o�ele`�-•rpp Pa.P.aJ/../P/./a���.. rp� f �iP 1'FIeOD07iC F. `ACOi2E CE - 3539 r�'��i)l pppppPpcb ��• �t0'• W' L. --)O' u kiattop Technical Services 14530 Echo Street Anchorage, Alaska 99519 L11 13 1 6 R5EN I -AN D ;ID SCPTIC SYS T', (APGRADE _ PG -AN er X ^ SGCT (0(1( 04re: II /9/ C>WN. CtY: rPr7 SCAc.C-: 0=6"^Orr Flattop Technica(Services 14530 Echo Street, Anchorage, AK99516 Phone (907) 345-1355 Lot 1, Block 1, Greenland S/D 11201 Our Road Wastewater disposal system upgrade Specifications 1.0 General: 1.1 The scope of the project consists of abandonment of an existing septic tank and seepage pit and installation of a new 1250 gallon septic tank with integral lift station and a 2.0' x 29' shallow soil absorption bed with pressurized distribution. 1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All construction procedures and material specifications shall conform with Municipal and .State requirements. 1.3 All separation distances shall be in conformance with Municipal requirements, unless specifically waived. A lot line waiver is needed to allow construction within 1 foot of the east property line. 1.4 The contractor shall be responsible to obtain any necessary utility locates, and to work around any buried utilities. 2.0 Septic Tank: 2.1 The existing 1250 gallon septic tank is to be properly abandoned by pumping, removing the top and crushing and burying the tank in place. 2.2 The new septic tank shall be a 1250 gallon Municipally approved STEP tank with a minimum of two compartments, and shall be. set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type, rigid insulation. 2.3 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The waste line from the residence to the septic tank shall have a minimum slope of 1/4"' per foot. A cleanout shall be installed within 5 feet of the building foundation, and a double cleanout shall be installed within 5 feet downstream of the septic tank. 3.0 Lift station: 3.1 The lift station shall be installed either in the second compartment of the septic tank which has an additional 250 gallon capacity, or in a separate 500 gallon tank. The lift station shall be an "Orenco" system as supplied by Anchorage Tank, or another Municipally approved package system. 3.2 The contractor shall be responsible to obtain the necessary Municipal electric permit and inspection, and to provide a copy of the electrical inspector's report to the engineer overseeing the construction of the wastewater disposal system. 3.3 The on, off, and alarm floats shall be set at the elevations specified by the lift station supplier, and their proper operations shall be verified by the contractor. 4.0 Soil absorption system: 4.1 The soil absorption system shall be constructed by carefully stripping the surface peat and reddish sandy loam to a depth of approximately 1.5 feet over the proposed soil absorption bed site to expose the top of of a slightly silty sandy gravel stratum. 4.2 The bottom of the excavation will follow the natural contours of the gravel stratum. Compacted medium sand complying with Municipal specifications shall be placed on top of the exposed gravel as necessary to create a level base for the bed at the elevation of the highest point in the native gravel. 4.3 A total of 0.75 feet of approved sewer gravel shall be placed on top of the sand with the perforated pressure distribution pipes laid level such that the pipe inverts are no less than 6 inches above the bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the #200 sieve. 4.4 The discharge pipe from the lift station, the manifolds and the distribution laterals shall all be 1.25" diameter schedule 40 PVC, assembled with glued joints. All distribution laterals shall have 1/8" diameter holes drilled in the bottoms on 18" centers and shall be configured as shown on the plan drawing. 4.5 Monitor tubes shall be of 4" diameter and installed in the locations shown on the design drawings. The portion of the monitor tube extending through the sewer gravel shall be perforated. 4.6 Two inches of rigid, burial type, insulation is to be placed over the top of the sewer gravel and then covered with approved filter fabric before backfilling with a minimum of 2 feet of unclassified soil. Fill slopes shall be no steeper than 3:1. 4.7 Topsoil and seeding over the disturbed areas shall be the responsibility of the owner. 4.8. The old seepage pit shall be properly abandoned by pumping, removing the top and backfilling with clean soil. 5.0 Inspections: 5.1 A total of 5 engineering inspections will be required during the course of the project: (1) initial stakeout with the contractor to establish the location of the system and to discuss the plans, specifications and construction procedures, (2) after the native material has been excavated to expose the infiltrative surface to ensure that it conforms with the soil test information, (3) after the sand leveling material has been placed, (4) after the sewer gravel is in place and the distribution pipes have been laid and connected up to the septic tank, but prior to placement of insulation and filter fabric, and (5) after final backfill and grading is complete. The septic tank requires one inspection after it is set level and the piping connected, but prior to backfill. This inspection may be incorporated with any of the above inspections. 5.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in advance to ensure the availability of the engineer. For winter construction the contractor shall protect the bed area from freezing at night by tenting over it and providing heat as necessary. Flattopd °5..•....C•,Q`�b Technical Services 14530 Echo Street A'�;"1 Z;LN Ff,nEA Anchorage, Alaska 99518 •'••ti'••••••••••••....; •';.� • +.� Municipality of Anchorage �I DEPARTMENT OF HEALTH & HUMAN SERVICES F. MOOREgo rcAF F 825 "L" Street, Anchorage, Alaska 99502-0650 "r •• :lI L CE •e3589 oR.' ��`�it go, SOILS LOG —PERCOto LATION TEST 4`�Ooo `fdplOfl]SS�', ����' . �aAr•c ww►.�' PERFORMED FOR:_ g ca es�- ( /ivc� DATE PERFORMED:_ /0` / �S" /9/ LEGAL DESCRIPTION: (EFtr DEPTH Pf 1 SM 11 1' 1: 1: 14 15 16 17 18 19 20 COMMENTS 6F' M1. r icc ( S/d Township, Range Section: < ReaVtjh scenery (aam S(IyhP/ s6r SCCA 11-1y 6.rave/ Crra+ Cmvetft -,elf CoAesic�r Ht<,raC�ryy(^y Crr c%Y S0170(y S'(l F L Sa.�,Ler WAS GROUND WATER ()(ppjA// ENCOUNTERED? SamC J IF YES, AT WHAT (Ln,�/ilsrf (r -n(2 le DEPTH? 0411110 Water Aller M , T. Ory Monitoring? Date: 1) Z N C 2 /Z PERCOLATION RATE a (minules/inch) PERC HOLE DIAMETER 7 (( TESTRUN BETWEEN -3. O FT AND 3.S _ FT "" Stiaf/ow beet, rYc, san,-.0 �'�(/.�'r rleeo(a� tv S. PERFORMED BY; ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATEflTIFYI I-- T 7— HIS TEST WAS PERFORMED IN 72-008 (Rev, 4/85) Flattop Technical Services 14530 Echo Street m'�,�:.�sEAr Anchorage, Alaska 99518 0"""""""""'••'�•�'• • ar Municlpalily of Anchorage �� • • • • • �, DEPARTMENT OF HEALTH &HUMAN SERVICES TRe000rE r-. ?.100RE; 825 "L" Street, Anchorage, Alaska 99502-0650 CE - 3589ILI ti • SOILS LOG — PERCOLATION TEST 0��,2 '••••••••' p'� 0 T, (�. # I A 4 )A; Prolossl.Ja1±♦ar PERFORMED FOR:—9 r es Cc�t.ro If SI, lvcc DATE PERFORMED:__(O / 25' I9/ LEGAL DESCRIPTION: (3 ,�,_ 4!5:r+Gen (ano( S/d Township, Range Section: SeC Z2, T -r Z A(, DEPTH Pt SLOPE 1 SITE: PLAN t 1 SM Alo�tsh Suno(y Loon, 2 3 6� $Iryhll� sftA Sune(y Travel 4 V 5 M4 Gray gMvefly Srlf 13, K 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? N IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? — Dale: S L O P E Reading Date Gross Time Net Time Depth to Water Net Drop .� �IVL•;�I.��I Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE __ (minutes/mch) PERC HOLE DIAMETER TEST RUN BETWEEN _ FT AND __ FT COMMENTS TCScu (,e C:;tu GZSSeSC hore zonlrA( .eKI-Cel of SoeIS e/IC0C_j rtw in tern Aa(e 4-_ PERFORMED BY:( I TCCh. SvC �=%74�,,� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: /I uV 9I 72-008 (Rev. 4185) .a 416 ". `iL'04 Or Flattop Technical Services 14530 Echo StreetAl Ci) p�srAt�,.gY♦O Anchorage, Alaska 9951S 0 '°' "'•••"•'•••••��� • Municipality of Anchorage 0Y DEPARTMENT OF HEALTH &HUMAN SERVICES ° °�* 0 i •..°R. h%THFODO.iE F. A.100RE % 0. 825 "L" Street, Anchorage, Alaska 99502-0650 G° CE - 3589 . jjr SOILS LOG — PERCOLATION TEST �Or�Jr'`''•••...•••'•� `�w r _ Ff. 9 i 6 PERFORMED FOR: 95ro.eg Cc�#r^o ( 4"14'C_< -DATE PERFORMED: to / ZS" /9/ LEGAL DESCRIPTION:__ Green fano( SIC) Township Range Section: S'•Gt 22� 1 2 n() 3 u! s, rt. DEPTH A f SLOPE FFFTI 1 S M I3Coi�u /i sanot/ (oath �� 2 3 MG �rro� gravt(fY SiIF 4 5 6 7 8 9 10 WAS GROUND WATER ENCOUNTERED? _ N 11 IF YES, AT WHAT 12 DEPTH? 13 Depth to Water Aller Monitoring? Dale: 14 15 16 17 18 19 20 Reading Date Gross Net Depth to Net Time Time Water -Drop L___J PERCOLATION RA1 E (minutes/inch) PERC HOLE DIAMETER T t4. # 13 TEST RUN BETWEEN FT AND _ FT h COMMENTS rdg� G ol2 oQtccr 4r,PSiauf �'!o°^1-znn/r../ ._, Le.,.d ...G' ,SOLL(7GPCt.(( o f s u f Arx,�7 r'� IM 7h1rJ (0 C.Ct fr cin PERFORMEDBY: �(� reck 5t -c i !�. //-'� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 9/ 72-008 (Rev. 4/85) A77;%iy \,. • "4 •1. Flattop Technical Services • q�'�e A• • • •. 14530 Echo Street sEA Anchorage, Alaska 9951E ""'"'••••••••••••••�••• • Municipality of Anchorage Y DEPARTMENT OF HEALTH & HUMAN SERVICES���••�+� •••�'�••••'•'•' y i�OriE F. A,Ac0RI: j ! 825 "L" Street, Anchorage, Alaska 99502-0650 �1 n., '>•THCODCE - 3589 ti SOILS 7. LOGS' PERC CATION TEST ��4`asprof s,J�x���+ PERFORMED FOR: i_= rt? .e7 �ceYO / Slyvice _ DATE PERFORMED: IO / 2S /9/ LEGAL DESCRIPTION:-., 1, G 1, green (cana S/p Township Range SeCtion: S',eC 22 All DEPTH p,f., SLOPE ) SITE PLAN CFC 1 1 SM 2 3 6-P 4 Red,�kxh s-ctno(�, S(I hfly srl� saxc(y Franey (rrUy 1ravelf y srtf WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water Alter Moniloring7 — Dale: PERCOLATION RAT E (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND _ FT 2fCGCt �1GrrZanlet ( -exFanf (--PJC coc< /7 t -e recc , n7 1 V PERFORMED BY:IF— /a��rn— TtCti. SSC I �Q%%?avyL CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON T"HIS DATE. DATE: 9/ 72.008 (Rev. 4/85) M G. 5 13. H. 6 7 8 9 10 11 12 13 14-- 4-151617- 15- 16- 17 - 18- 18- 19- 19- 20 20 -rF ff'1C COMMENTS % l F {1i Red,�kxh s-ctno(�, S(I hfly srl� saxc(y Franey (rrUy 1ravelf y srtf WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water Alter Moniloring7 — Dale: PERCOLATION RAT E (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND _ FT 2fCGCt �1GrrZanlet ( -exFanf (--PJC coc< /7 t -e recc , n7 1 V PERFORMED BY:IF— /a��rn— TtCti. SSC I �Q%%?avyL CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON T"HIS DATE. DATE: 9/ 72.008 (Rev. 4/85) Flattop Technical Services '•'�' 14530 Echo Street �:�: ')FrA� 'StEp ... Anchorage, Alaska 995117 "' `"'•"•'•••••••••�%�• • �.r Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES i e �•�•���'::' ,t , Tf{'OD02E CORE 825 "L" Street, Anchorage, Alaska 99502-0650 ��� '.• CE - 3589 �'�~�a, SOILS LOG PERCOLATION TEST4f10r` *04,44 4W T. 1� -I=#' 4'Z profess;ma'+Ff�� PERFORMED FOR: g I"ilesl^ t, Ccr^o I Silyct DATE PERFORMED: IO LEGAL DESCRIPTION: �S reQn fano( S/� Township Range, Section: Sec 22 7-1 Z A( (? 3 ko X M. DEPTH Pf SLOPE 1 SITE PLAN 1 2 Pt 3 5M liede.(tcA SQnofy (ou/n 4h e mm rnf gray uu . ere(o fh 6 M►. (raY growelly S,(¢ 7 Oense, hard r4 y' ihl 8- 10- 1O �h? M 11 WAS GROUND WATER ENCOUNTERED? 11 CJ -MX SGlno(x Sr(f Soi�-er 0(1�/J 11 DEPTH7AT WHAT 12 N S L O P F 13 Deplh le Water Aller M. T: dna 6 Moniloring? Date: III If 19 14- 15 16 17 18 19 20 1 14 q1tt? Reading Date Gross Time Net Time Depth to Water Net Drop cc Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER COMMENTSTEST RUN BETWEEN _ FT AND _ FT �_A�•Errcc( gPnPrG[ll�, na,¢ �.(P.r'rrccb(C �n Conlfy-uCitvn of an on-Sl�� Sol( c�bsarnhoe) x 1 Aem, PERFORMED BY: FIQ(FD» TCCA SNC ! le -f d CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: I J �6 I9I 72.008 (Rev. 4/85) CIVIL& ENVIRONMI,"N'PAL b;NCINI?I?ItING • ENERGY CONSI:ItVA'I70N & ANALYM6S THEODORE F, MOORE, Y.E. PH: (907) 345.1355 M.O.A. DHHS Attn: Susan Oswalt P.O. Box 19-6650 Anchorage, AK 99519 November 15, 1991 RE: 1/1 Greenland S/D - Upgrade Permit # $W 910362 Dear Sus: 14530 ECHO ST, ANCHORAGE, ALASKA 99516 As requested on the subject permit I hereby certify that in my professional opinion the ML soils underlying the proposed soil absorption bed will percolate at a rate of less than 120 minutes per inch and therefore 6 feet of separation to impermeable soils is not warrented in this design. Sincerely, Ted Moore, P.E. .....�� .. � • .fii�lll �iCTV1CC?S GAAE.HD.I OR TER ANCHORAGE AREA BORAI '>I DEPARTMENT OF ENVIRONMENTAL O.UALII Y ,- _-3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPE=CTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING NAME- - ADDRESS_--- PHONE - - i LOCATION_�r X1'1%-!/�_l%l�%'! /I = I�GAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY SEEPAGE SYSTEM: _(- _GALLONS. SEEPAGE PIT: TERIAL_ ZZ NUMBER OF 1- COMPARTMENTS -'� - 7i "[-� LIQUID INSIDE LEN GTH==_INSIDE WIDTH - DEPTH_ NUMBER OF PITS _L______- OUTSIDE DIAMETER__ 4 -OR WIDTH;%! LENGTH-_-�--Z`, DEPTH__, LINING MATERIAL / f�-_ "-'{</�� ._-__-. DISTANCE FROM WELL lJ� __.. BUILDING FOUNDATION NEAREST LOT LINE_ /��`���TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA). TILE DRAIN FIELD: - _SQ. FT. TOTAL LENGTH DISTANCE FROM WELL _,_F.OUNDATION___ -,-NEQftEST LOT LINE _, OF LINES - NUMBER OF LINE_..__-_ DISTANCE BETWEEN LINES __TREI CFI WIDTH_ --_IN. TOTAL EFFECTIVE ABSORP'Ti N AREA_--__ _SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE_. DEPTH OF FILTER MATERIAL BITIEATH TILE IN. ABOVE TILE WELL: TYPE •"//!_- - '.•�, DISTANCE FROM , ,-_ , WATER /l., DEPTH � ,BUILDING F-OUNDATION. �-' '=- ---SAMPLE- �� NEAREST /ii /E%19 / NEAREST / SEPTIC / SEEPAGE __. i OTHER LOT LINE -1/` SEWER LINE,TANK SYSTEM_____-? CESSPOOL.X//��� SOURCES DISTANCES: DIAGRAM OF: SYSTEM X� f \4 p 1. \• DATE/��/APPROVED_,. GREATER ANCHORAGE AREA BORuUGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 3500 TUDOR ROAD POUCH 6.650 ANCHORAGE, ALASKA 99502 TELEPHONE 2798686 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT NAME OF APPLICANT _11, T;OZL MAILIN ADDRESS L'� J / k'pH ONE _ INSTALLATION LOCATION L✓k w. -(2d oq, c9luo. LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK - X SEEPAGE PIT_ �I /1 DRAIN FIELD , OTHER TYPE AND SIZE OF FACILITY TO BE SERVED 1/YL t� �SLC6"I K�'i"L/L.C1 � �j'•4f y .�,, FINANCED THROUGH se oT TO BE INSTALLED BY �4c-ic (,/',�}r,�"KCL J/,� v SOIL TEST RESULTS mµ4 NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TES7 COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. ��� , a SEPTIC TANK SIZE 1�W TYPE ���'-v'e'�_n dr SEEPAGE AREA SIZE �"wV �ti( l'L TYPE �& I 0 III MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK D / : FOUNDATION TO SEEPAGE PIT DRAIN FIELD / SEPTIC TANK TO SEEPAGE PIT WALL 15= _ SEPTIC TANK r SEEPAGE PIT DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK SEEPAGE PITy0 DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, �_, SEEPAGE PIT TO RIVER, LAKE, STREAM. SEEPAGE PIT /©a ( , DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO _CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANA AND,,,SE_EPA_GE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. HEALTH A\\\UTHORITY OR LICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCR ED YST ISL IN A�;��NCE WITH SAID CODE.DATE C✓ APPLICANT'S SIGNATURE r) 7C;4" �N'YjaSD'I t (I i a r: * u . — � 1 1. tic( lih'crai Reports, f,, j, on T,T. Depth SWI ///, 6Cv G ( cj i9 t' lin Cp(rf Was Ground vlater Fnoourli.ered .? if ;rsa At Frc: r. d I ')emc". Drca +i Do h To to z romm c. Tei;t Performed By iv`eY Drop;, • Municipality of Anchorage $' On -Site Water and Wastewater Program (907) 343-7904 , Y Certificate of On -Site Systems Approval Parcel I.D. 015-172-19 Expiration Date: J! 1. GENERAL INFORMATION Complete legal description Greenland, Block 1, Lot 1 Location (Site address) 4970 East 112th Avenue Anchorage, AK 99516 Current Property owner(s) Daniel Neary Day phone Mailing address 9800 McCready Circle Anchorage, AK 99507 Real Estate Agent 2. TYPE OF DWELLING: 7 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Three Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well El Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for unless otherwise requested by the engineer. COSA Fee $ qqo — Waiver Fee $ Date of Payment /P -/Y 3 Date of Payment Receipt Number ({orirn Receipt Number COSA# �C�3 l gas 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 andfor 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 Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed'Name Michael E. Anderson, P.E. Date. 1 112 0/2 01 3 6. DSD SIGNATURE / System #1 Approved for System #2 Approved for Disapproved Conditional approval for 7 bedrooms IA10WA& & Atsoe-xsoN : ��" bedrooms ®���F9f0� oho �Ca �S,•°E'�« �,g�pR_���� bedrooms, with the following stipulations: By: / Original Certificate Date: The ni all nchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 9 b 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 engineers work. 7. ATTACHMENTS COSA Checklist X Septic System Advisory Well Flow Advisory COSA blue sheel_E ..c 0 Nitrate Advisory Arsenic Advisory Other 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: Greenland, Block 1, Lot 1 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 8/17/71 Sanitary seal (Y/N) Y Total depth >150ft. Cased to >40 ft. FROM WELL LOG Date of test Static water level ft. Well production 9 - p.m -WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate '624 mg/L Arsenic N/D ug/L Date of sample: 11/11/13 Parcel ID: 015-172-19 Well Log (Y/N) N Wires properly protected (Y/N) Y Casing height (above ground) >12 in. AT INSPECTION 11/19/13 60.9 ft. 6.5 g.p.m. Collected by: Anderson Engrg. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEP/Steel Date installed 12/3/91 Tank size 1,250 gal. Number of Compartments 3 Cleanouts (YIN) Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Date of pumping 08/13 Pumper A Plus Home Services C. ABSORPTION FIELD DATA Y N Date installed 12/4/91 Soil rating (g.p.d./ft2 or ftZ/bdrm) 'S GPD/SF System type Bed Length 29 ft. Width 20 ft. Gravel below pipe '6 ft. Total depth 3.5 ft. Eff. absorption area 580 ft2 Monitoring tube Y Depression over field N Date of adequacy test 11 /19/13 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption Feld before test 0 in. Water added 450 gal. New depth 5 in. Elapsed Time: 1,440 min. Final fluid depth 0 in. Absorption rate >= 450 g p d Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed 1214191 Size in gallons 250 Manhole/Access (YIN) Y "Pump on" level at 43 in. "Pump off' level at 41 in. High water alarm level at 45 in. Datum Bottom of Vault Cycles tested 3 Meets alarm & circuit requirements? Y E. SEPARATION DISTANCES WELL ON LOTTO: Septictank/lift station on lot >100' On adjacent lots >100' J Absorption field on lot >100' On adjacent lots >100' Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line >25' Holding tank N/A Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: >5. Building foundation >5 Property line >51Absorption field >1 00' Water main > 10' Water service line > 10 Surface water Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line 2'*** Building foundation >10 Water main NIA Water Service Zine > 10 > 100' Surface water Driveway, parkinglvehiclestorage > 10 None Noted >100' Curtain drain Wells on adjacent lots F. COMMENTS ***See Lot Line Waiver G. ENGINEER'S CERTIFICATION I certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. Date 11/20/2013 COSA brown sheet_10-10-12.doc ®F,... ® . �, o® * K AFi E- ANDERSON CE=4381 dee /f— Zo pROfESS01— UX" -------------------- DOM EAST 112th AVENUES a M 100.00' S890 55'30"E Mali eaanla mmAac , el.nwa tr..n ■NeINc SE1BAAaf I SHED W LU q01 V I7'. P 1 W co V M. H. p r O Q I cli Z< O I 23.7' sD.a O M o EXISTING HOUSE I U? O 50V O O N O � I WELL M I A CJ I 1 I N890 53'20"W 100.00' UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOR CONSTRUCTION OR FOR ESTABUSHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCAUNG. REPRODUCTION MAY CAUSE ERRORS IN SCALE. LOT suRV£v SURVEY TYPE SYMBOLS 0 FOMDATION AS-BUILT SET REBAR DRAINAGE ASPHALT ❑ nlA 51NumRE AS-BUki O FOUND REBAR e 0 e WOOD FENCE "'I� CONCRETE ❑ PLOT PLAN ... AS-Buu_T ... LOT SURVEY. TOPOWlAPHY 004 ASSUMED ELEV. X X X METAL FENCE ® WOOD DECK A - L D CORN SET FlCATON AS-SV T .. N0 C001BNS SET PLOT PLANS & LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER. PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE CONSTRUCTION. TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES. WELLS, SEPTIC CLEANOUT5. SIDEWALKS, DRIVEWAYS, TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. SURVEY CERTIFICATION ��qy1, of �� Prepared by Robert E. Johns, Jr. & Assoc. PLOT PLAN ...,,Nnwwl ,..A Xd,. �^• we eeY^ °e•+� ^"m• v° "'°L' .•E �� .. 9 / r `P�,.••........ ••• j I.♦ Professional Land Surveyors •^a "0" fwi° °"'�hAi° s m wa °"'-' m eM ybn ytl b tlw eNt N mY C.�•, • 'y •• 170D Brink Drive. ANCHORAGE. ALASKA 99504 Mwoe ••I.ep• oM .Wtl•. all FnwNum Mw Mw m.evae w w emn. •' • *VIP Scale: Rec. Lot S.F. Rea Plat File No. FOUNDATION AS-BUILT 4 th ,.• Afff1"50' ....: .... .....:....:♦ �7•^All nA % — '- Date Surveyed: 11/21/13 Drawn by. REJ Checked b . �MK �Rewa a ave I r l ��,„-^a�. , / sy:. ,ROSE ..� ,,° �. :w exm•wa a wee r.a. w. ad ,„ we•rrwwa .rl Wwe • ROSE :t.KfN"'S, J ♦ t i ♦♦�ey''• Date Drawn: 11 /21 /13 Orifi: 263 W.O. 13-601 FINAL STRUCTURE AS-BUILT t Rae.H c +ver +.. s•+r eNM1 e+l l 4� 2 S �A� �♦ He '''•., yot �1 Legal Description: � .................'• Lot 1 Block 1 : � : .www wW_ a� P"feaso�dI e6:'� p�u..•.•� GREENLAND MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section 44 MUNICIPALITY OF ANCHORAGE P.O. Box 196650 Anchorage, Alaska 99519-6650 ENVIRONMENTAL SERVICES DIVISION 343-4744 CERTIFICATE OF HEALTH AUTHORITY AUG 41 1997 APPROVAL FOR A SINGLE FAMILY DWELLINGS 2 Parcel I.D. # O 15- 17 2 19 HAA # GENERAL INFORMATION Complete legal description I=c, 1 S/oc k Z_C-rceo /ctncl S' /b Location (site address or directions) 1 1201 Our Rd Property owner _F_rne_r� S, lvec Day phone 3K -2V,;,3 Mailing address /! 20 i Our- Rof• A�ctio�cz 4tc �9S/� Lending agency _C/ 6;z V Day phone 2 63 -o 7 ao Mailing address 12i w. F mew eek dune A-ncAo��. /4i< 99so-3 Agent Soon 7P Zla)t c R rz Day phone 27 3 - 7 ZSl Address `J2V1 "0 e. /41-r 99s -D3 Unless otherwise requested, HAA will be held for pickup 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well ✓ Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: ;. Individual on-site V 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 N21 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. Name of Firm 7_,fcA/7 1.c ca f SC�Y (i 1 t �1 Phone 3 `/.r- 13575" Address / iy lO ECho S^i� ,�}�cGrascz�t A6< 995 Engineer's signature !72�6,ee Date ;- a ,. %. i -`S•zf •ate„ a , r 3'•fiAJC600 tesepap�fejLnA'n �`'�, /n��/.��/'�. w e - y y ff 9!•p r t 6. DHHS SIGNATURE bedrooms. Approved for Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments M�^. By: - �,—./ Date atIT 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 W21 MUMCmH4.l'I"i' 01-ANCPIut2riUE Municipality of Anchorage IiNVIRONMEWAL SERYIGIiS DIYIS DEPARTMENT OF HEALTH & HUMAN SERVICE%G 0,1 1997 00* Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907}0.744 kw*t VLU Health Authority Approval Checklist Legal Description: l.al/ 1 Q(oC Lc Green 40o( S/OParcel I.D.: Or S / -7 2/ A. WELL DATA Well type PVA _ If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) _ V Date completed P►'r or fo (9/t7/7/ Total depth 150 1 jq�e r^ M-0-4. Cased to ^= 15'0' Casing height (above ground) 12 " 4- Geacum en Sanitary seal (Y/N) FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: Wires properly protected (Y/N) Y AT INSPECTION 7i2y 197 6Y' g.p.m. 6.O 9 -p.m Coliform O cal /l cVon.e Nitrate O, 2SS° m Other bacteria 3 Co/ Date of sample: 7/ ZZ `i/ 9 7 _ Collected by: F!a f/u�, %rc ti Suc B. SEPTIC/HOLDING TANK DATA Date installed 1'213191 Tank size /ZSU al Number of Compartments < Cleanouts (Y/N) `r STI- P Foundation cleanout(Y/N) Y Date of Pumping 8/1197 _ C. ABSORPTION FIELD DATA Date installed 2 / N / 9 /_ Length 2 9' _Width Depression (Y/N) N High water alarm (Y/N) Pumper :Cc zccef Soil rating (g.p.d./ftz or ft2/bdrm)C7.8 System type aet.1 Ir QeaC ?0' Gravel thickness below pipe C.d' _ Total depth 3,S' Effective absorption area S-60 0' Monitoring Tube present (Y/N) Y Depression over field (Y/N) A/ _ Date of adequacy test 7 /2'i / 97 Results (Pass/Fail) P64i For _ bedrooms 5W M.T. * Fluid depth in absorption field before test (in.); S.S Immediately after ?9'J- gal. water added (in.): 7•S _ Fluid depth 7 i 2S _ (ins) Minutes later: 13 9 Absorption rale`= _ 'IS -0 g.p.d. Peroxide treatment (past 12 months) (Y/N) N If yes, give date N. A. K As avcu-rj%ea CA,,1f+ Delo R0/A on 7/2.5'197 -i-A11 S<of v eYS/r 72-026 (Rev. 3/96)` M S Joy L j W / o ver ly. ac( / Deur cwA e,) fj rll ea A, ¢he lent l oo4 /t+t ha,Ffam o�C /i�;�riu� /u/ o%//rryufzon r,�.0 n<fcuck, D. LIFT STATION Date installed Manhole/Access (Y/N) rA Size in gallons l ZS -O Kcil STEP _ "Pump on" level at* w 3 " _ "Pump off' level at* y/ II High water alarm level at* `iS *Datum cof/v^, oX I • i• L/&u/f Cycles tested "— 6 E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /04' Absorption field on lot Public sewer main 10 1, On adjacent lots _ > (00 ' On adjacent lots _>1GG ' A. Public sewer manhole/cleanout IV - N•. Sewer /septic service line > 2S Lift station /OF- ' _ SE=PARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 3 Z Property line NO ' Absorption field IS Water main/service line > U" Surface water/drainage > laa' Wells on adjacent lots > ro•o 1 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 2Wcrlvrr Building foundation _ 32, Water main/service line I.(ru ax. f Surface water Driveway, parking/vehicle storage area es - Curtain drain NP�n a s -e en Wells on adjacent lots _ > 10 F. ENGINEER'S CERTIFICATION f certify that I have determined thru field inspections and review of Municipal in conformance with MOA HAA guidelines in effect on this date. Signature �M Engineer's Name _ �'h ev aLcy� !_• /`room 0 �7. Date A-fe/urf .2• 1997 HAA Fee $ Date of Payment` Receipt Number d 3 QC;? / 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number let;(li'bave systems are MIL ME Environmental Services Inc. Arm CT&E Ref.#. Client Nance Project Namel# Client Sample ID Matrix Ordered By PWSID 974036001 Flattop Technical Srv. N/A 1.1,S1,0reenland S/D Drinking Water L '3075615301 P.02i05 Client POM Printed Date/Time 07/28/97 16:32 Collected Date/Time 07/24/97 I3:00 Received Date/Time 07/24/97 15,20 Technical Director: Stephen C. Ede Released By Allowable Prep analysis Par_ ame _ter Results POL Units Method Limits Date Date lnit Nitrate -M 0.254 0.100 mg/L SM18 4500•NO3P 10 max 07/25/97 JRJ Total Coliform 3 00 w/0 COLI SM18 92226 07/24/97 TMN F t_ 1 QC c=11 HIVl MUKHUt 9075615301 p.04i05 /1 ME Environmental Services Inc. . fieIL Laboratory Division•�i�s►irir��tiisioii'i®iioiivrrasiois'ri®irniiiri.►o. Drinking Water Analysis Report for Total Colifor READ hNSTRVCTIO.NSO:V REY£RSESIDE BEFORE COLLFCT/.N'GSA.HPL, MUST BE COMPLETE❑ BY WATER SUPPLIER C PUBLIC WATER SYSTEM I.D. e Q PRIVATE WATER SYM4NI Q Stnd Results Send Invoice ❑ Sand /nvoiC(t Fla/ -4,# IecA ntrce1 .SwU 7"rvLvow_ 3 rr 3 yS—e 7" 91G036 �� "/0 car; r' Sent to A. DX C. Anth FbRa Jun G /fAGAC11­0'y4e .�h 91�1� Date: � Time: ❑ SrnJ Rqu(tl ❑ Sand /nvoiC(t Lab Ref. No. Result- Analyst SAMPLE DATE: 22 IT ZZ Month Dsy Year SAMPLE TYPE: p Routine 0 Treated Water 0 Repeat Sample (for routine sample p Untreated Water with lab ref. no. ) 0 Special Purpose Time Collected SAMPLE LOCATION Collected By - L G•re In trot A S•/D / : 0Cj1" rzf. Pont rn Bacteria 200 w atter Drive Anchorage. AK 99618.1605 Tel: 19071 562.2343 Fax:.(907) 561.5301 e� TO BE COMPLETED BY LABORATORY An sis shows this water SAXiFLE to be: ,d Satisfactory 0 Unsatisfactory 0 Sample over A hours old, results may be unreliable Q Sample too long in transit; sample should riot be over =S hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received 12 _ Time Received 2-0 ,\ s.nalysis Be;nn /6V _ Annlytieal .'*Iethot(: Z"Membrane Filter C TIO-bIUG • dumber ofcolaniei 100 ml" - Lab Ref. No. Result- Analyst 91G036 �� "/0 car; r' Sent to A. DX C. Anth FbRa Jun G Filed Date: � Time: Client notified of unsatisfactory results: C] CJ Phoned � Spoke with Fixed Date: _ Tinc: BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUC Result: Total Colirorm E Cali MembraneFilter-,Dire" Count cat Celoniestloo ml VerMestion: LTI3 BGB�-„COLIFIIUNI� LNrC•r r.ctl.r. Fecal Colitarm Confirmation �+�•� __ ON -(N.w Al"fe'd Final Membrane Filter Resalts vs-s� �ColiforMADO ml Reported lir `et , YP _i fly! $,� Tim• (� firs Comments: oL' IN Sim Member of the SGS Croup ISociite Glnhale de 5urrtillnncol ” ` _ - _ "_ _...�. -•.•• ., --.... .. ..nin a+nw ..rr. .nnurr!Aq ..leer 1101 NCW ICOCCV n4nn WMT VIRGINIA 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.# 015717Z19 HAA# 1. GENERAL INFORMATION Complete legal description 1-0 r -Z; 6160c fc 9. green %cna S /1b Location (site address or directions) f 12Gr OCA r- fi?oe. Property owner E r/7 eSf Si lv C -C Day phone 3 y 6 - z 1,5_3 Mailing address 11 20l Our (fid (-k 995/6 Lending agency Naf11 Sank o.F' A(mk� Day phone 257 -3ysi Mailing address erxel) ��Ghoe«cue, i9 k 99SO� Agent None Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: -3 3. TYPE OF WATER SUPPLY: Individual well Ll� 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 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 H21 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. Name of Firm _ FlmkJO e Tech4'Ic0c! Seevr r yr Phone 176S— Address 1 530 /1=660 H'nc1i01-cxc/e A�-, 995'/6' Engineer's signature °%�'`*�%�� �' C Date 2 9191 y+ 7!3. l / -- 1 6. DHHS SIGNATURE ~` �razd4a Approved for bedrooms. Disapproved. / �� ) Conditional approval for Alz���� bedrooms, with the following stipulations: Additional Comments M 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 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 421 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST 44 Legal Description: L. I, B/k 4, 6-reenlqnof Parcel 1. D. —Q1Sl7P- 19 A. WELL DATA Well type Pr1va%e If A, B, or C, attach ADEC letter. ADEC water system number N- A. Log present (Y/N) _ N pate completed Prior 1to 8/7/ Driller (.(n k Total depth 1.4'O ' Cased to 02 ' Casing height 3 y /0 Sanitary seal (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot U Wires properly protected (Y/N) AT INSPECTION 9 / / Z / 9 / MUNICIPALITY OF ANCHORAGE j� Z ' ENVIRONMENTAL SERVICES DIVISION g.p.m. _--' 6, 2. 0 i9,91 KECEI V ECJ ; On adjacent lots _ > ioo ' ; On adjacent lots _ > 1 cAO ' Public sewer main _ 3 ( Gv' Public sewer manhole/cleanout > (��G Sewer service line 75-' Petroleum tank _ N ane r3as�rver� WATER SAMPLE RESULTS: Coliform O cvf /!yo rn .C. Nitrate _ 4 0, 1 my /-e Other bacteria O cm/ /(vO m4 Date of sample: 9 91 Collected by:—Feak!5?' 7 -,?ch B. SEPTIC/HOLDING TANK DATA Date installed 12 /K /9 1 Tank size 1 'ZsD2 gee t Compartments Cleanouts (Y/N) Y High water alarm (Y/N) Foundation cleanout (Y/N) Y Alarm tested (Y/N) Depression (Y/N) N Date of pumping N. A, (new ins f• ) Pumper N, y SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s)onlot 10a --On adjacent lots_> (GU' Foundation_ To property line y0 Absorption field 15' Water main/service line_ 5 S' Surface water/drainage _> IC10' 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed i2 / y 19/ Manufacturer AMC60L-xVe_Te�g /c Z Or"enco Size in gallons 2 �'O d ro C .7' Manhole/Access (Y/N) _ Vent (Y/N) 'r _ "Pump on" level at M 21( "Pump off' level at 301 High water alarm level H6 II Meets MOA electrical codes (Y/N) Y Cycles tested N, A. Cnew iAS/. SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot IO 2 On adjacent lots > 100' Surface water D. ABSORPTION FIELD DATA Date installed I Z / `1 1? r Soil rating 0, 5 Pa /Ff , System type tae Length Width 20' Gravel thickness Total depth 1.6- Total .5 Total absorption area 5-64 A( Cleanouts present (Y/N) c M, 7: '.c Depression over field (Y/N) Results (pass/fail) N. Peroxide treatment (past 12 months) (Y/N) Date of adequacy test Ll -N- (New i�s>`•� for SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot t o J —On adjacent lots > IVO ' If yes, give date Property line To building foundation 3 4- To existing or abandoned system on lot —LO On adjacent lots _> 30 _Cutbank N(A• .Water main/service line 15-15-� Surface water il� «4 / Driveway, parking/vehicle storage area 2b' Curtain drain Nyne aLiC9rwev( E. ENGINEER'S CERTIFICATION bedrooms I certify that I have checked, verified, or conformed to all MDA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name 7�GI ec'c-tca� Date 12/9/9/. HAA Fee $ Z20 Waiver Fee: $ Date of Payment /l]- °f / Date of Payment Receipt Number �r y`{G Receipt Number 79-OPR (R.v 3/91) Rank MnA 21 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. u 6� aaoearaA. TELEPHONE (907) 562-23435633 B Street -� Anchorage, Alaska 99518 I` Drinking Water Analysis Report for Total Coliform,13acteria TO BE COMPLE=TED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM I.D. # - PRIVATE WATER SYSTEM FL 6TTOF TEC N• SVCS 3 �dS- 13 5S Name - Phone No. 1`-f5So�cdJ�T Mailing Addrm ACL4, ( e11y Slate Zip Code SAMPLE DATE: Mo. Day Year SAMPLE TYPE: Routine Check Sample (for routine sample with lab ref. no. _� ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected No. LOCATION Collected By 1 I t 6RC NL/Nb S/D ;ooCh'�els 2 LP KE- 959 E 4 5 TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: >j 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.. iv Date Received / �/Z( 554AnTime Received 1554- Analytical alytical Method: Membrane Filter No. of colonies/100 ml Lab Ref. No. Result' Analyst FT -1 FT -1 L - I Im-1� W A.1) -E -C. BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter: Direct Count ( ) Coliform/100 ml BEFORE COLLECTING SAMPLE Verification: LSB Fecal Coliform Confirmation BGB Final Membrane Filter Results (( y Coliform/100 ml Reported By~ - Date TNTC = Too Numerous To Count OSI = Other Bacteria PAIN ONE OF TWO p.m. REh1AINDER TO FOLLOW CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS REPORT BY SAMPLE for WORKorder# 38205 Date Report Printed: SEP 14 91 @ 12:17 Client Sample ID:1/1 GREENLAND PRESSURE TANK PWSID :UA Collected SEP 12 91 @ 13:00 hrs. Received SEP 12 91 @ 15:54 hrs. Preserved with :AS REQUIRED Client Name :FLATTOP TECHNICAL SRV Client Acct :FLATTOT BPO # PO # NONE RECEIVED Req # Ordered By :TED MOORE Analysis Completed :SEP 13 91 Send Reports to: Laboratory Supe vi o STEPHEN C. EDE 1)FLATTOP TECHNICAL SRV Released By 6 VL-� 2) Chemlab Rof #: 914783 Lab Smpl ID: 1 Matrix: WATER Allowable Parameter Tested Result Units Method Limits --------------------------------------------------------------------------------------------------------------- NITRATE-N ND(0.10) mg/l EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY: CHRIS. Remarks: =veOv 1 Tests Performed See Special Instructions Above UA -Unavailable ND- None Detected °' See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than f,toN sc3s Member of the SGS Group (Soci6t6 Gcn@rale de Surveillance)