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HomeMy WebLinkAboutT12N R3W SEC 15 LT 42T12N. R3W. Section 15 Lot 42 #015-052-10 Municipality of Anchorage Page / of 3 _ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site WastewaterDisposalSystem and/or Well Inspection Report Permit Number: PID Number: 12 ' d9Z 4 A0 Name' Wastewater System: stew ❑ Upgrade Address:///1) J!// ZcgW /26 �G !�-1e_7-7)!54 ABSORPTION FIELD Phone: � W jv GdJ No. of Bedrooms. Deep Trench El Shallow Trench 1-1 Bed ❑ Mound ❑Other LEGAL DESCRIPTION Soil Rating: O` a de: Total Depth from original gr / GPD/Sq. Ff. Lot: Block: Subdivision: Depth to pipe bot m from original grade: Gravel depth beneath pipe 11 42,— r t> Ft. Ft. Township: _Lj/ Flange: Section: �l✓/ Fill added above original grade: Gravel len th e & / '05 Ft. I® CJ Ft. WELL: New ❑Upgrade Gravel width: N J /� Number of lines: Distance bebveea lines: 20 Ft. R. Classilication (Private, A,B,C): ��✓/t//j-'% Total Depth: y9 H. Cased To: Ft. Total absorptiJon2ar/ea: /J(pD SO. Ft. Pi a nuclee/ria': 77 Driller: �� lN6 �YL/LLl1/V D/e rill- St if water Level: �(/� Ft. Installer iN�vltlN6 667 Dale installed: I Yield: /J ,ry Pump Set at: Casing Height tAAbove Ground: /"- TANK Lal✓ GPM FL 2 Ft. SEPARATION DISTANCES a/ .ei Septic O Holding ❑ S.T.E.P. To septic Absorption Litt Holding Public/Private Manulaclurer: e� Capacity in gallons: From Tank Field Station Tank Sewer Lines Well /Q� t<- / f' `, �I /V /7 / Material: S L Number of Compartments: Surface /or LIFT STATION A//A Lot Line o / , / /� Size in gallons: I Manufacturer: Foundation /o �L /ON 7 ©/' "Pump on" level at "Pump oil" at at High water alarm at Curtain �r Pump Make &Model Elec al Inspections performed by: Drain Remarks: BENCH MARK ©d 4-15� Location and Description: f� Assumed Elevation: ENGjy+S$Ir:/�4i Inspections performed by: Dates: 1st �!�YGs�. ,•--,��U.,.,...a.. 2m:147�� o so j ;ROBERT C. COWAN Department of HealTM and Human Services approval atf 6 —025' Reviewed and approved by: Date:4 72-013 (Rev. 9/91) MOA 25 PERMIT N0. SW940389 PAGE 2 OF 3 Municipalit of Anchora e DEPARTMENT OF HEALTH AND H AN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 *Anchorage, Alaska 99519-6650 • Telephone: 343-4744 ON -SFE WASTEWATER MSPOSAL SYSTEM AND/OR WELL NSPEC TT m REPORT LEGAL T12N, R3W, Sec. 15, Lot 42 P.I.D. NO. 015-052-10 LOT 38 LOT 37 I TRENCHES coz CO3 � I MT1 NORTH TEST HOLE C01 MT1 j / / B DBLI & DBI -2 C0d CO O w z 0 FCO H Q ST2 STI O 1250 GALLON A E x DRIVEWAY SEPTIC TANK d' G A / SOUTH TIM G TEST HOLE I,I 100' WELL RADIUS c� r�3 I A� J SCALE I u = No LOT 47 `"rte A �.. ............ .. _ ,...,, ROBERT C. COWAN �C �� g�•.6 C1 .8601 z l `y ��LiL �?� PERMIT N0. SW940389 PAGE 3 OF 3 Municipalit o P Anchora e DEPARTMENT OF HEA TH AND AN SEWC ES P.O. Box 196650 *Anchorage, Alaska 99519-6650 • Telephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL NSPECT= REPORT LEGAL T12N, R3W, Sec. 15, Lot 42 P.I.D. NO. 015-052-10 FINAL GRADE 97.1' A B FCO 21.0 19.6 ST1 49.0' 49.0' ST2 56.5' 56.0' DBL1 63.5 63.0 DBL2 64.0' 64.0' C01 79.0' 69.5' CO2 103.5 78.0 NEW CO3 90.5' ' 93.9' 1250 GAL C04 61.5' ' f74 SEPTIC 93.7' MT1 94.0 TANK MT2 61.6 C01=96.7' CO3=96.7' CO2=96.0' C04=97.2' FINAL GRADE C01=92.8' CO3=92.2' SR CO2=92.3' SR C04=92.9' SCALE MTI =85.6' MT2=84.3' o..._ ....... .._....,.._......f.��. ;0 4 ROBERT C. COWAN i �2 NO WATER FOUNDcE-8801 ###� 77.6' B.O.H. FN''4.........:..• `'�d � 1c, J� 3 Feb 24 UU 11:4ba Corvallis Service Center 102 P e LOCATION OF WELL .230-)5 STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING & WATER MGMT WATER WELL RECORD t CONTRACTOR INFORMATI N: REMARKS: t ' I Reglst eo/"us C�� PLEASE MAIL WHITE COPY OF LOG TO- 11noture of AJIV IF utTlanzeo HespresPrp{ative aab a— DNR/DIVISION OF MINING &WATER MOMT lid PO bolt 107005 ANCHORAGE AK 99510-7005 BOROUGH SUBDIVISION V2Y41LS1Ly1't" LOT �j� BLOCK SECTION OTRS 15 SECTION TOWNSHIP ❑N RANGE ❑E MERIDIAN �Ifl� ❑S ❑W LOCATION/SKETCH: WELL OWNER: - i DEPTHS MEASURED FROM:❑casing top ❑ground surface WELL DEPTH: DATE OF COMPLETION Depth of hole: % 9 ft Depth of casing: IT _L/J I BOREHOLE DATA: Depth Material Type and Color From To DEPTH TO STATIC WATER LEVEL: /b (,P _ Jt below N top of casing ❑ ground surface Date:_/ %� oZ r % / ry METHOD OF DRILLING: Wait rotary ❑ cable tool ❑ other r 6 �2 USE OF WELL: Kdomestic ❑ irrigation ❑ monitor ❑ public supply ❑ other r 7.Z / �.JV // CASING STICK- P: ft. Oiam: ro in. to lglft Casing type: —in. to 19 ft p / WELL INTAKE OPENING TYPE: ,fid open end ❑ screened ❑ perforated ❑ open hole // l/{/Q,f✓'l.�s„� �>!S^ 199 Depths of openings: to ft SCREEN TYPE: \ _ Diam: In, Slot/Mesh Size: Leength: ft GRAVEL PACK TYPE: Volume used: Depth to —too.- op:GROUT GROUTTYPE: Volume: Depth: from ft//to ft DEVELOPMENT METD: C Duration: / , PUMPING LEVEL AND YIELD: / ft after hrs pumping o40 gprn PUMP INTAKE DEPTH: ft Hors epow¢r: WELL DISINFECTED UPON COMPLETION? ❑YES ❑ NO t CONTRACTOR INFORMATI N: REMARKS: t ' I Reglst eo/"us C�� PLEASE MAIL WHITE COPY OF LOG TO- 11noture of AJIV IF utTlanzeo HespresPrp{ative aab a— DNR/DIVISION OF MINING &WATER MOMT lid PO bolt 107005 ANCHORAGE AK 99510-7005 Municipality of Anchorage ' ; : f ', ro t DEPARTMENT OF HEALTH &HUMAN SERVICES J 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST gg ; ROBERT C. COWAN t ; "IP �'°'• CE -8801 r d PERFORMED FOR: ,� (Cfa7g7c��.il CSC1 ✓� / DATEPERFORMED: LEGAL DESCRIPTION: 10T / j�—/ 47 /1 Township, Range, Section: /j/\( %I. DEPTH II�ISLOPE SITE P AN (FEET) 1 2 c ' 3- 4 c 5 6- 7 u ' 8 9- 10- 11 1011 ee, 12- 13- 14- 15- 16- 17-) 2131415 16 17 ) 18 19 20 COMMENTS 167D t -t - WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L O DEPTH? p E Depth to Water After Monitoring? Date: Reading Date Gross Net Time Time Depth to Water Net Drop 0 MIAJ WPERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND � FT & S ENGINEERING fL. PERFORMED B I , r`-"� CERTIFY THAT THIS TEST WAS PERFORMED IN I kO34 Eagle River Loop Road No. 204 ACCORDANCR:WI46i%WeSTAi3skN[991 "CIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: -3/1-7 �U 0 72-008 (Rev. 4/85) PERFORMED ;' C') Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 1Z, SOILS LOG — PERCOLATION TEST I r �.is D LEGAL DESCRIPTION: _ f� �/}T.7��-Z DEPTH (FEET) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 N COMMENTS 150 0 ii--t \/ DATE PERFORME1 Township, Range, Section: / Z,/« SLOPE SITE P 1=10111• - . NE■■■■■■■■j ■■■■■NONE■I ■■■N■■■■■■ ROBERT C. COWAN CE -8801 IF YES, AT WHAT DEPTH? Depth to Water Atter Monitoring? Date: PERCOLATION RATE `= (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT & 5 ENGINEERING PERFORMED B ;I ' — CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 age River Loop Oa o. 0'3/1-7 ACCORDANCErWbTM WiAe5TATSshta�19" NICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: /0 O 72-008 (Rev. 4/85) ROBERT C. COWAN, RE. ROBERT A. SHAFER, P.E. CIVIL ENGINEERS March 15, 2000 (907)694-2979 FAX(907)694-1211 MUNICIPALITY OF ANCHORAGE Department of Human and Health Services HEALTHAUT14ORITY APPROVALS PO Box 196650 Anchorage, AK 99519 SEWER&WATER MAN EXTENSIONS Reference T12N, R3W; SEC 15; Lot 42 SEWER&WATER A. For your review and action, please find attached a conditional Health INSPECTION Authority Approval request. Per a conversation between Dan Roth, MOA and Mike Clare, S & S Engineering the Buyer, Seller and lending institution have agreed to the escrow of $5,000.00 to defray the costs associated with the work to complete documentation of the existing onsite ENGINEERINGSTUDIES ANDREPORTS system on the referenced property. B. The referenced property appears to have been undocumented. After a search of municipal records, interviews with Hultquist Homes (builder), Bates WELLINSPECTION &FLOW TEST Engineering (designer), and Sonshine Enterprises (excavator), we have determined no inspection report was filed and therefore is not available for the onsite septic system. However, the original soils test logs done by S & S SITEPLANS Engineering and the septic plan done by Bates Engineering Service are in the Municipality of Anchorage files. The work remaining follows: Test hole excavation ROADDESIGN Soils test Ground water monitoring Final documentation SOILTEST B. Attached is an onsite wastewater disposal system inspection report we have completed for your approval. After investigation and visual inspection, ii appears that the design called for by Bates Engineering was followed. PERCOLATION TEST A rod was driven in through the original monitoring tube and appears to confirm the presence of an 8 foot effective depth. Please note, however, that the original monitoring tube only extends through the top 6' feet of sewer rock. It appears that an additional 2 feet of sewer rock exists below the M CUHANICAALL& monitoring tube. The excavation for the installation of the monitoring tube in INSPECTIONS the second field revealed a trench width of approximately 3'.. Porous fabric was placed over the gravel bed with the approximately 3.5' of soil cover. From this we conclude that fabric was used in both trenches. Exposed pipe reveals D3034 and F810 pipe was used in the construction of the system. ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 0 19.A - n. H41-5. Sewer rock appeared to be sized 1/2"-2 1/2". Installation of the monitoring tube also confirmed approximately an 8 foot effective depth of sewer rock in the second trench also. Per a telephone conversation with Sonshine Enterprises, we have established that a 1250 gallon steel tank was installed with rubber watertight couplings. The brand of tank was either Anchorage or Greer tank, but the owner could not remember which tank was used as they "shop" both companies often. The tank was installed level on native undisturbed soil. C. ADDITIONAL CONSIDERATIONS: 1. The existing system has been in service for approximately five years with no apparent adverse effects to the surrounding properties. 2. The water samples from the Lot 42 well show nitrate level 0.851, 0 colonies coliform bacteria and 0 colonies other bacteria. 3. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas, or drainage patterns by the approval of the attached inspection report and the granting of the requested HAA. If we may be of further service, please contact us. Sincerely, WjZjPRobert C. Cowa.E. RCC/mjc A MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW940389 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:ERICKSON RICHARD E JR & OWNER ADDRESS:9310 CARLSON RD ANCHORAGE, ALASKA 99516 PARCEL ID:01505210 LEGAL DESCRIPTION: T12N R3W SEC 15 LT 42 LOT SIZE: 46246 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: / os-Ij PAGE 1 OF 1 DATE ISSUED:10/11/94 EXPIRATION DATE:10/11/95 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) . 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ENGINEER SHALL PERFORM AN ADDITIONAL SOILS/PERC TEST IN THE VICINITY OF THE PROPOSED UPGRADE ABSORPTION FIELD SITE. RECEIVED B ISSUED BY: DATE 199 h a_ll� DATE: Ito - BATES ENGINEERING 441 OCEANVIEW DRIVE ANCHORAGE, AK 99515 (907) 345-0807 September 26, 1994 MOA DHHS 825 'L' Street Anchorage, AK 99502 'th rye ,•9 IV TC. r .. T... . R.J. Bates Subj: Well and Septic System Design for Hultquist Homes Re: Gov't Lot 42, Sec 15, T12N, R3W, SM, AK. The attached Site Plan shows the existing well and septic system locations within 200' of the proposed system on the surrounding lots. WELL IMPACT The well location was selected based on a compatible location to the surrounding systems and should have a minimal impact on the existing aquifer. SEPTIC SYSTEM IMPACT The septic system should have little impact on the ground water. The slow perc rates of 40 and 45 min/inch thru GM material should provide adequate treatment of the effluent. The monitoring tubes are dry to 18'. No bedrock or impervious materials were encountered in any of the test holes. Based on this information we have designed a deep trench system using an 8' deep absorption area. Before construction we will check the monitoring tubes, if water is encountered we will immediately notify your office and coordinate a redesign of the system. RESERVE SYSTEM There is adequate space for an alternate system on this lot as shown on the site plan, however the S. Test Hole (by S&S Engr's) location falls within the 150' protective radius of the well located on Lot 47 thus eliminating an alternate system location within its 30' radius. The two test holes logs and perc tests do indicate that the material in the area is consistent. If the DHHS feels that it is necessary to verify the perc rate in proposed alternate system location than we would respectfully request that we be permitted to do that during the construction of the proposed septic system. DRAINAGE The lot generally slopes at about 0.5% to the west with no cut banks or other problem areas. V) N N w S criv5'00' U- LU 165.03' 0 oI I / 0' BLM POVJ EASEMI:N T Ln m Ln (CAPE SCitJ ROAD) L I j r (i 17 [J '^ cw bwj Lo ow At U6 cad LOP 0. LLA V •w� M;4 o CD —10' CEA EASEMENT BK -99 PG-872— N G872_ N 00'0.5'00" W -d- I,,� o 165.01' l f,:I V. I_ 13.0''J U U i - 30.5' I o \` V% K N ?r UD 62.0 — [J '^ cw bwj Lo ow At U6 cad LOP 0. LLA V •w� M;4 o CD —10' CEA EASEMENT BK -99 PG-872— N G872_ N 00'0.5'00" W -d- I,,� o 165.01' l f,:I BATES ENGINEERING 0 Design 0 Construction 0 Resource Development 441 OCEANVIEW DRIVE ANCHORAGE, ALASKA 99515 Telephone (907) 345-0807 JOB- h'ri 'W/s/' SHEET NO. OF 3 CALCULATED BY //lt /f S DATE /yam/y CHECKED BY DATE - Z S/ Z SCG /S. T/T (/j /C ?6A,,f /i/ Gr//CLL SC Pi�C L(2C � �G� // N69'56'30"E 932.25 (83-98) 1182_76 ABBOTT N N 50 115.13 165.07 I E 0 7 /1 i/ t. O I a 415.15 165.07 280.22 Comp 9 a a t50 4 -7ti280. 3 Comp�t/�uoLILLESTON EAST 660.24 BIM EAST N89'57'25"E 300.49 N89.540P'E 260.00 Q2o• 011 e.mT�E 2eo.za F n 10' Ulil Esml �}'[t1D m �. ar -R: J Bates•5401W28000 (j� 280.21 CompAl ,�}✓s�. 16.07 165.1] 115.13E E0v-]-] /1-] 7i/l/�l ll165.07 I65.IJ115.09 0.22 Comp 2802 mpa�,ornE.le,re SEPI/G sE 280.23 Comp 280.23 Com �••9lvuS 0 am �•. / / � u° pcisT. sEPr/c tyf� 280.24 260.24 BATES ENGINEERING ❑ Design o Construction 0 Resource Development 441 OCEANVIEW DRIVE ANCHORAGE, ALASKA 99515 Telephone (907) 345-0807 Joe X02 %UG TQU/Ii NO�E++//S SHEET NO. OF. CALCULATED BY � �ArC� DATE CHECKED BY DATE SCALE / "= � ld '1& ZA PERFORMED F LEGAL DESCRI 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15• 16- 17- 18- 19- 20- COMMENTS 7- 18- 19- 20- COMMENTS Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Sm — SlL7Y �fJ� 6*t — .C�tLTr SAmoy 6RAt1EL, P,D.o. •S.M, WAS GROUND WATER n I. ENCOUNTEREO% J DATE Section: SITE ,. PERCOLATION RATE Iminutevinchl pERC HOLE DIAMETER -6 'EST� RUN 9ETWEEN/FT AND �FT PERFORMED BY: S & 5 ENGINEERINU CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Eagle River Loop oad No. 204 ACCORDANCE WkT}f"Fjj#1FIWRd4ft"pAL GUIDELINE F ECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) �9 PERFORMED LEGAL Munklpality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST Range, Section: �(Z(r /hJtcC SA�'l — Srt-ry SA,,.p DiLLr A COMMENTS WAS GROUND WATER ENCOUNTERED? S IF VES, AT WHAT L O DEPTH? P E Depth to Wan Alter 'rye �� Monitminp? DILY Dett ®=®mm ■��m�� h PERCOLATION RATE (minutesnnch) PERC HOLE DIAMETER ZEST RUN BETWEEN FT AND 8 FT PERFORMED B)6 R S ENGINEERING 1 CERTIFY THAT THIS TEST WAS PERFORMED IN J4Ig�Bl34 Ea le River Loop ad ,�fQ I INE ECT ON THIS DATE. DATE:ACCORDANCE Lf eE 72-008 (Rev. 4/85) Municipality of Anchorage Development Services Department Building Safety Division NOW - On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519650 � �J www.muni.org/onsite i/ �rim1.✓ (907) 343-7904 AP CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. ejs--D iZ- l d COSA # 1000 CI Expiration Date: 7,1145.&0 1. GENERAL INFORMATION Complete legal descriptioh 77;..✓ A 3 4v %e. l r /o7-J►Z Location (site addiess) _ Current Property owners) - Ar -0P •.ri+ Pe7-,-it F+Tz Day phone TV'i-72 2/ Mailing address Lending agency Mailing address Atka A4 vy) Day phone SA'63 -3033 D/ ,. t17 i L.z0.7�/ Nri�A/Ili AJ Nfj-,(,, Real Estate Agent -Ta7, 4- Ld&4WI Pew1ryrA/ Day phone 525_2 ^Cf lX Mailing Address 7-801 6cln "e/L1 - r /r/ Jmr Zoo ,yac 1fo1. 4 � 4 Unless otherwise requested, COSA will be held by DSD for pickup. 5-03 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well JK Individual On-site W1 Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Is (are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water suppl�'ardd/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 _DIY ONl .si�%s edi:�1 Phone P7 -71•r Address Z~ dr. roz4ye /e.0 Wia%/e iii f'9�sy Engineer's Printed Name _A;ZZAat.`1 Date `/" /•3!DC7 5. DSD SIGNATURE ✓� Approved for Li bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: .P ` IST€W�7ER Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory X Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: (Rev. 11005( Municipality of Anchorage Development Services Department - Building Safety Division ' On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: l'�rt k34/ !�Ott IF Ler `..Z Parcel ID: 016—' A. WELL DATA . Well type If A. B, or C provide PWSID # _AY Well Log (YIN) �_ Date completedSanitary seal (Y/N) Total depth L -ft. Cased to Of—ft. FROM WELL LOG Date of test 1 �S = P7 Static water level fl. Well production 9— p.m-WATER SAMPLE RESULTS: Coliform _(l1 colonies/100 mL Nitrate 0• Wmg/L Arsenic: 77 ug/L date of sample: -7f0 Wires properly protected (YM) e -S Casing height (above ground) 4/X in. AT INSPECTION /4<8 ft. ' cf.7S' g.p.m. Other bacteria colonies/100 mL Collected by: f // A11*:4;y, B. SEPTIC/HOLDING TANK DATA Tank Type/Matedal Date installed Tank size gal. Number of Compartments a Cleanouts (Y/N) AV 'Foundation cleanout (YM) ,Y Depression over tank (YM) � High water alarm (Y/N) oo A Date of pumping LI -1-`3-10 Pumper Pe lab' P C. ABSORPTION FIELD DATA Date installed l qQi . "Soil rating p k or ft2/6d' �� yam, System type P&Ay ep T4NC1i Length gf �� f4. Width 3, fl. Gravel betow pipe lJ • ft i Total depth , 2� ft. Eff. absorption areatw4t2 Monitoring tube Ye$ Depression over field Ala Date of adequacy test �/— �—fy Results (Pass/Fail) oref For bedrooms Fluid depth in absorption field before test.32 in. Water added gal. New depth � in. Elapsed Time: 3X min. Final fluid depth .21 In. Absorption rate >= 4- oU g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Afg- M If yes, give date (�L D. LIFT STATION A /4 �(� Size in gallons 'Pump•Qlevel at_in. 'Pump off" levi Datum E. SEPARATION DISTANCES Cycles tested cess (YM) High water alarm leve In. Meels alarm rcuit requirementsI SEPARATION DISTANCES FROM WELL ON LOT TO: i Septic tankAift station on lot On adjacent lots Absorption field on lot t f'OD On adjacent lots .f/ao 't•/Oo .1 ap Public sewer main 4"OA Public sewer manhole/cleanout i Sewer/septic service line Holding tank A41 Animal containment areas Manuretanimal excrete storage areas �'��� 01 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Absorption field f"S� �� yP• � i Water main Water service line *Y40 Surface water /DO i Wells on adjacent lots�� SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line �`/� Building foundation Water main Water Service lined Surface water *�� , Driveway, parkingtvehicie storage Curtain drain Niit A&4e w Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION �E OF I certify that I have determined through field Inspections and y: Ali fy� review of Municipal records that the above systems are in �'' 49le t Iii conformance with MOA COSA guidelines in effect on this date. �' •« , i Engineer's Printed Name �7�iw q/sa✓i�rs� r » 1 �.' Wow .• T. 11 s'. No.CWOM {� Date� ..: ass SS100 COSA Fee $ L4 q 0 Waiver Fee $ Date of Payment 3- % Date of Payment i - Receipt Number 1 O y 0 Receipt Number (Rev. 11/05) Municipality of Anchorage • Development Services Department Building Safety Division ° .. �,. On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Arsenic Advisory Certificate of On -Site Systems Approval # 100091 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 42 of T12N R3W Section 15 Subdivision. This inspection revealed an arsenic concentration of 15.7 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.or onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. �RwO NMa �I AAA a0exA ]lA 3 HIRMI EE0 T7 Ner SW TOE I I I mama bomma tdA HYArO a ® 3 g$IAAEXISTM 260 I t3I o •:.:. ul HOUSE b k 0 mama '"�'1$ Z }, S :M-.:�::::::::Lc::bi•: f:_'.:. Af1A O v WELL I I sea•fig asw 26023- A7 a I UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE IVES THE SURVEYOR TAKES RESPONSIBILITY FOR 1HE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS N SCAIE HAT 11 YEN SURVEY TYPE SYMBOLS FOUDAIXIN As- I FINALT SIIAUC.. • SET ROAR DRAINAGE 0 ASPHALT O FOUND REBAR o.{y WOODOOD FENCE NCE '...� CONCRETE AS-GMAS-mT FLD7 AT . o cmm... LOI f11KT ... laPOaAANIT ® ASSUMED ElEV. •R -*-IF METAL FENCE ® WOOD DECK PLOT PLANS & LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER. PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WALL BE CONSTRUCTION. TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES. WELLS. SEPTIC CLEANOUTS, 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 BONO SEEN AND LOCATED. WHICH 00 NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. SURVEY CERTIFICATION Prepared by �T Fu„ +••„yB,, OF �•� Robert E. Johns, Jr. & Assoc. ••.•,�� Professional Land Surveyors r�r....ww rwrr �r�rr,.«rrrrr� ••�P,•' •C, t a Bax E 12 AVE. rrr r r�r r rrr� r U� •. µCH41ACE ALASKA "501 .3-.r Hti.««.• 0 4Lf Scale: RAG Lot S.F. Rem Pbt FN Na FOUNDATIONAS-PAT 0 . •• 13- = 50' V .A..HLNr A..«.riW.4rN / Date ' 4/07/10 'x REJ °"d.° eJ MK ROBE S Date ° a.. ` o'a W. 1^ �•� 1 - 4/08110 2436 178 FINAL STRUCTURE As-BULT a.. �....,.......r 1 r r N�Aw .3-w 3- r ,• • ��., „.•''�,s••• '•mama.. upd De crVUm: LOT 42 r.A•w r= Py 3-r A • °.•• � ��aiiin • TI 2N R3W SEC 15 • Municipality of Anchorage •., C���. • Development Services Department Building Safety Division .. .. On -Site Water 3 Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ek.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING '1 Parcel I.D. 015-052-10 HAA# 0q � � � 4 1. GENERAL INFORMATION Expiration Date: :z— '" 0 S Complete legal description T12N. R3W. SECTION 15: LOT 42. Location (site address or directions) 9310 CARLSON ROAD • ANCHORAGE. AK. 99507 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address MARTY GOBLOWSKY Dayphone (907) 242-0606 9310 CARLSON ROAD • ANCHORAGE. AK. 99507 Day phone MIKE PIKE W/ PRUDENTIAL JACK WHITE Day phone 529-2400 3801 CENTERPOINT DRIVE, SUITE 200 • ANCHORAGE, AK. 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: —" 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual Onsite Individual Holding tank Community On-site Public Sewer ■ R The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat eltixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the onsite water supply and/or wastewater disposal system Is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the Information obtained from the Munlclpality of Anchorage riles and from my investigation and Inspection, the onsite 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. Phone Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines Q Regulations. The reported results described the performance ofthe system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate ofhow long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for L-� bedrooms. Disapproved. 337-6179 Date 3o OS Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements sir,. Ht Supplemental Engineer's Report rfll J I I! Other By. [ I/�1� / r'ifJ /"( Original Certificate Date: T " 0 (R". 12101) J Municipality of Anchorage Development Services Department Building Safety Division OnSke Water 6 Wastewater Program 4700 South Bragaw St. P.O. Box 195650 Anchorage, AK 995196650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: T12N, R3W. SECTION 15: LOT 42, Parcel ID: 015-052-10 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSIDN N/A Date completed 1/5/1995 Sanitary seal (Y/N) YES Total depth 199 R. Cased to 199 ft. FROM WELL LOG Date of test 1/5/1995 Stetlo water level 186 ft. Well production 20 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 0.6 m9A. Wag Log (YIN) YES Wires properly protected (YIN) YES Casing height (above ground) 12+ In. AT INSPECTION 3/11/2005 156 R. 7.4 g.p.m. Other bacteria 0 colonies/100 ml. Arsenio: N/A mgA. Date of sample: 3/11/2005 Collected by: GEG. LtD. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 1995 Tank size 1250 gal. Number of Compartments 2 Cleanouta (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alar (YM) N/A Date of pumping 9/28/2004 Pumper DENALI EXCAVATION AND PUMPING C. ABSORPTION FIELD DATA Date ktstalled 001995 Sol rating Ctj.p.d ft')bdr) 0•0.45 System type DUAL DEEP TRENCH Length 0•85 ft. Width 4•3 ft. Gravel below pipe B R. Total depth •1/ R. Eft. absorption area 1360 R° Monitoring tube •'YES Depression over field NO Date of adequacy test 3/11/2005 1Results (Pass/Fall) PA OS// For 4 bedns Fluid depth in absorption field before test 0 in. Water added 1037 gal. New depth 18 in. 1268/ 15/ Elapsed Time: 1128 min. Final fluid depth 4 In. Absorption rate >• 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &type) NONE KNOWN If yes, give date 9*PER 2000 INSPECTION REPORT. WEST MONITORING TUBE ONLY EKTENDS 2.96' BELLOW INVERT AND THE EAST MONITORING TUBE ONLY EXTENDS 6.22' BELOW THE INVERT. D. LIFT STATION Date installed "Pump on' level at _in. E. SEPARATION DISTANCES Size in gallons High water alar level at Cycles tested Meets alar 8 circuit requirements? - SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot t o0'+ Absorption fteld on lot 100'+ Public sewer main N/A On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/deanout N/A Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation S'+ Property fine S'+ Absorption Reid S'+ Water main N/A Water service fine 10'+ Surface water 100'+ Wells on adjacent lots too'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line t0'+ Building foundation 10'+ Water main N/A Water service line t O'+ Surface water t 00'+ Driveway. parkinghrehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 1000+ F. COMMENTS G. ENGINEER'S CERTIFICATION I cur* that I have determined through field inspections and * �: review of Munidpal records that the above systems are in .... ... .............. conformance with MOA HAA guldellnes in effect on this date. A. ess: Engineers Printed Name JEFFREY A. GARNESS 79 Date o c -°S HAA Fee $ Date of Payment �-, _d Receipt Number Cllr -544' #%V. rtis+t V, Waiver Fee $ Date of Payment Receipt Number a NAR -30-2005 WED 0832 AM LAMCN FAX N0. 5616626 0 r 4 z 10'691 3 „00,S0.00 S 1N3N3SV3 Ug Od 66 N8 1NMSV3 V30 ,01 cn G� D rn f � C a r c 0 1' N -I 0 Z co 7o N 0 to CA iF cn � � w y O N L rn o ug ;m gP'� s C5 o _ bF� 4�y v•� �o R� y A rj 3. T• 11 "na G3e C E i P i > � S nA O �q P r zr.k . in { r'; 1 (700 t �r IIIII y 0 U I t9 0 0 0 r O N a•'•�•67 �Tq. P. 02 5 u e 0 (b 0 1 =g CA mZ (OV02J NOS-18VO) 1N3W3SV3 MON MG ,06 ,£0 Sgl M «00,50.00 N w OD cn w 0 m W CA 0 N 0 0 5 [•] R It Municipality of Anchorage • Department of Health and Human Services Division of Environmental Services On -Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci. anchorage. ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FORA SINGLE FAMILY DWELLING Parcel I.D.06-2— lli HAA# Expiration Date: 1. GENERAL INFORMATION Complete legal description %/l2N .�3rc) G�S�. Lf1l4Z Location (site address or directions)4W I—:` 919 Rol,ifT/Glfa/�LJCr�/ �!G Current Prope�I rty owner(s) KlG LO Y �nrAN&7tK� Gr4%JDay phone --34 Mailing address Lending agency Mailing address Real Estate Mailing Address Day phone n� 7'*CK t✓r1/r Say phone qlo Z —5B5�-�z Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage TYPE OF WASTEWATER DISPOSAL: Community Class Well ❑ Public Water System ❑ Individual On-site f4 Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. 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. 72-025 (Rev. 01/00)' 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 Health Authority Approval Guidelines for the Health Authority Approval application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. 5& S ENGINEERING 69 q -X 9 7 17034 Name of Firmver Phone ___[_ ,. +.._ (load 1. 04 Address Eagle River Alaska 99577 Engineer's Printed Name Date a 00 y_zz.—,- ALL C0r+o[Y[0N3 1�CI,J /Y(,Ln 13 '( V'N"lL 1144� ._ 3/(7/00 )-1Av2 13uM00r p ,\ c ' ;'ENGINEER'i ATURE 00 , % ROBERT C. COWAN +, i 6. DiXSSIGA proved for .� bedrooms.; /4+a�JlF''^'4CE-88o1 \`` N Disapproved. .ttaiasamtLa `sy Conditional approval for bedrooms, with the following stipulations. M Additional Comments Attachments: HAA Checklist Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other Original Certificate Date: —6-00 Expiration Date: % — � — 00 Reissue Date: 75-025 (Rev. 01100)' Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 'V f.. ( 9§ 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 % (/ Health Authority Approval Checklist 011114 Legal Description: //� g31/t/, A& L67'11�% 4Z Parcel LD.: O/�`DSZ /D A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present ION) �C� Date completed S Total depth q9 Cased to % (?9 / Casing height (above ground) Sanitary sea AN) 6 Wires properly protectecio) �CS FROM WELL LOG Date of test Static water level % lii cO Well production g•p•m- WATER SAMPLE RESULTS: AT INSPECTION 2 �Z Zlay L�� f 3, Z- g.p.m. Coliform CJ _ 1 Nitrate 0 _ 95-1 Other bacteria Date of sample: v U Collected by: `� S-�U//j/(�/2IA46-- B. SEPTIC/HOLDING TANK DATA Date installed ) qq 5- Tank size 1 Z5 -z Number of Compartments 2— CleanoutsoN)A� Foundation cleanour/N) C� Depression ( /N A/O High water alarm (Y/N) / Date of Pumping Z o U Pumper SG S C. ABSORPTION FIELD DATA Date installed j "1 q5- Soil rating(g.p.d./ft2 r ft2/bdrm) L0,4S System type A& i�L�—n7Gfi Length r SIL Width Gravel thickness bel�ell}o��w pipe / Total depth Z Effective absorption area Monitoring Tube preserN�iYdN)� Depressions over field (Y{y1��%(Z Date of adequacy test Results (Pass/Fail) Yv% SS For f�Gl� fit// bedrooms I/ � /O/' Fluid depth in absorption field before test (in.); Z� Immediately after all.. water added (in.): Fluid depth / 8f/ (ins) Minutes later:�1(� _% %I / Absorption rate = ,1),9 t g.p.d. Peroxide treatment (past 12 months) (Y/N) /I 0n1&/<Ol1MA11lf yes, give date 72-026 (Rev. 3/96)' D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: "Pump off" level at* Septic/holding tank on lot IeLg /�- On adjacent lots /dry Absorption field on lot l0tq '-- On adjacent lots Me) /f Public sewer main /V Public sewer manhole/cleanout IV14 '7 Sewer /septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: i Foundation 674 Property line 6 Y- Absorption Water main/service line /Q f Surface water/drainage I07?i Wells on adjacent lots --2/2-7J � SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: If / Property line /0 -f Building foundation �� t' Water main/service line Surface water �Q� 7 4- Driveway, parking/vehicle storage area / 7— Curtain drain6N0ZM1 Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal re r,*banes o,Jd'systems are in conformance ;itWhAgui lines in effect on this date.�Signature Y ,ty Engineer'sNameERT C. RoeCE 8801 AN Date @%k,j hn"OF[SS HAA Fee 60 Date of Payment Receipt Number ~ U41-1 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage • Department of Health and Human Services Division of Environmental Services On -Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us% (907)343-4744/ CERTIFICATE OF HEALTH` AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 0 I S O 5- - a 7 HAA# I-EnQQ0 0B - Expiration Date: GENERAL INFORMATION Corripletelegaldescription T12N, R3W, Section 15, Lot 42 Location (site address or directions) 9310 Carlson Road, Anchorage, AK Current Propertyowner(s) Richard &Annette Erickson Mailing address Lending agency Day phone 346-1520 Day phone Mailing address Real Estate Agent Prudential Jack White/Elaine GirvaOayphone 762-5857 MailingAddress3210 C Street, Suite 200, Anchorage, AK 99503 Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well I Individual On-site In Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. 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. 72-025 (Rev. 01/00)' 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 Health Authority Approval Guidelines for the Health Authority Approval application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. S & S ENGINEERING G� Name of Firm 17034 Eagle River Loop Road No. 204 Phone } q -7agle Rim, Alaska 99577 / Address Engineer's Printed Name 7\ D 6 & A, % C • CO W,4 DateConas Health June1,2000, hole , C�;�••• L9S;Z1a1, P Y , Thereis no eminent health hazard and there will be rr�.Nrn G's no adverse effect as a result of granting A„ Conditional HAA. ,.- 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. y' ROBERT C. COWAN CE -8801 IQ ,L"," _ xxx Conditional approval for 4 bedrooms, with the following stipulations. Money shall be put in escrow for the amount of $5,000.00 to accomplish the remainin=_ tasIts as stated in the ettg4_-neer's report dated Mareh 15, 2000 (�tvaehed) #0 s the subject wastewater disposal system. money in escrow snall not be released until is office has Issuect rinaland full approval of this Health Authority Approval Certificate. This work shall be completes no Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Expiration Date: 6` ZO _00 75-025 (Rev. 01100)• Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date Reissue Date: .3 -20-00 KLCEIVED Municipality of Anchorage MAR 0' 9 2000 DEPARTMENT OF HEALTH & HUMAN SERVICA�cirnutr 0FANCHOM Environmental Services Division JC ^'iMENTALSWsow — 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: �� A-6,15'Com/1S, %rZ-- Parcel I.D.: C 1 S- - O S- �L -/0 A. WELL DATA B. Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present Y&) Date completed / Cl yrs Total depth _ ° (��q`i Cased to ff Casing height (above ground) Sanitary se (Y ) 7 C� Wires properly protect 6N) T C FROM WELL /SLOG Date of test Static water level Well production g-p•m- WATER SAMPLE RESULTS Coliform Nitrate 00 961 Date of sampler (J Z/ Collected by: SEPTIC/HOLDING TANK DATA AT INSPECTION Other bacteria g.p.m. Date installed 161-15- Tank size i' X S -o Number of Compartments r� Cleanout Foundation cleanoY/) ` �� Depression (Y/ ) /VV High water alarm (Y/N) Date of Pumping 1 a �C! Pumper -/ 5,4A C rS C. ABSORPTION FIELD DATA Date installed 1 It -- Soil ratingg..d./ftp r ft2/bdrm) 0-"S- System type dgZ Length . $ S T° A� Width 3 - Gravel thickness below pipe $ Total depth Effective absorption area 1360 91� Monitoring Tube present/ I) GS Depression over field (Y(9 /v -/O Date of adequacy test Results (Pass/Fail) &55 For Ue— bedrooms ti/ it Fluid depth in absorption field before test (in.); 0-P Immediately after gal. water added (in.): � 0 Fluid depth /g, (ins) Minutes later Absorption Absorption rate = ! 600 g.p.d. Peroxide treatment (past 12 months) (Y/N) A10A✓16- /07still If yes, give date 72-026 (Rev. 3/96)` D. LIFT STATION Date installed Manhole/Access(Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: "Pump off" level at* Septic/holding tank on lot /X 'f On adjacent lots l/00 /7- Absorption field on lot Z� -/- l On adjacent lots 0 / f Public sewer main // /A- Public sewer manhole/cleanout N A Sewer /septic service line Lift station /y/ 1xi SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation Property line Absorption field Water main/service line 162,7' Surface water/drainage AcgO f Wells on adjacent lots %dam 7�` SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: i Property line /0 7� Building foundation r/ Water main/service line Surface water l b0 / Driveway, parking/vehicle storage area Curtain drain NON(- 1C/�� ul V Wells on adjacent lots /-` F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal reco CJg--',4rthre1hb" elms are n conformance=wi guid lines in effect on this date."Signature .a r ' //�J p ......:...... ... .......if... Engineer's Name 90% A/ - Id -;o,\ ROBERT C. COWAN�Z Ag Date _ _ 3/-7 /yo �p ` 3, • u - 8801 r :. HAA Fee $ ,�5 hD r 03 Date of Payment �/%f P,7J Receipt Number �6` 7 �Rd C(,2 7�� 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number March 15, 2000 ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907)694-2979 FAX(907)694-1211 MUNICIPALITY OF ANCHORAGE HEALTHAUTHORITV Department of Human and Health Services APPROVALS PO Box 196650 Anchorage, AK 99519 SEWER&WATER MAIN EXTENSIONS Reference T1 2N; R3W; SEC 15; Lot 42 SEWER&WATER A. For your review and action, please find attached a conditional Health INSPECTION Authority Approval request. Per a conversation between Dan Roth, MOA and Mike Clare, S & S Engineering the Buyer, Seller and lending institution have agreed to the escrow of $5,000.00 to defray the costs ENGINEERINGSTUDIES associated with the work to complete documentation of the existing onsite ANDREPORTS system on the referenced property. B. The referenced property appears to have been undocumented. After a WELLINSPECTION search of municipal records, interviews with Hultquist Homes (builder), Bates &FLOWTEST Engineering (designer), and Sonshine Enterprises (excavator), we have determined no inspection report was filed and therefore is not available for the onsite septic system. However, the original soils test logs done by S & S SITEPLANS Engineering and the septic plan done by Bates Engineering Service are in the Municipality of Anchorage files. The work remaining follows: Test hole excavation ROADDESIGN Soils test Ground water monitoring Final documentation SOILTEST B. Attached is an onsite wastewater disposal system inspection report we have completed for your approval. After investigation and visual inspection, it appears that the design called for by Bates Engineering was followed. PERCOLATION TEST A rod was driven in through the original monitoring tube and appears to confirm the presence of an 8 foot effective depth. Please note, however, that the original monitoring tube only extends through the top 6' feet of sewer rock. It appears that an additional 2 feet of sewer rock exists below the M CHAN AL monitoring tube. The excavation for the installation of the monitoring tube in INSPECTIONS the second field revealed a trench width of approximately 3'. Porous fabric was placed over the gravel bed with the approximately 3.5' of soil cover. From this we conclude that fabric was used in both trenches. Exposed pipe ONSITE reveals D3034 and F810 pipe was used in the construction of the system. WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577 P G of a 3/;s/ °O tH.o.h, O.W-N.S. Sewer rock appeared to be sized 1/2"-2 1/2". Installation of the monitoring tube also confirmed approximately an 8 foot effective depth of sewer rock in the second trench also. Per a telephone conversation with Sonshine Enterprises, we have established that a 1250 gallon steel tank was installed with rubber watertight couplings. The brand of tank was either Anchorage or Greer tank, but the owner could not remember which tank was used as they "shop" both companies often. The tank was installed level on native undisturbed soil. C. ADDITIONAL CONSIDERATIONS: 1. The existing system has been in service for approximately five years with no apparent adverse effects to the surrounding properties. 2. The water samples from the Lot 42 well show nitrate level 0.851, 0 colonies coliform bacteria and 0 colonies other bacteria. 3. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas, or drainage patterns by the approval of the attached inspection report and the granting of the requested HAA. If we may be of further service, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/mjc O2-24-00 16:42 L� FROM -CTE ENVIRONMENTAL 5615301 ME Environmental Services Inc. laboratory Division T-074 P.03/03 F-810 200 W. Potter Drive Drinking Water analysis Report for Total Coliform Bacteria Teen°rase' AIC ess,a•,eos RE.,4D I.VS'I'RVCTION'S ON REpERSE SIDE BEFORE COLLECTING SAMPLE Fax MLT BE COMPLETED BY WATER SUPPLIER TO BE COMPL£TI Analysis shows This Water SAMPLE To be Satisfactory ❑ Unsatisfactory ❑ Sample over 30 hours old, results may be unreliable ❑ Sample too long in transit, sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample via special delivery m:=11. Date Received Time Received 6 G� Analysis Began u v BYLABORATORt o PUBLIC WATER SYSI EM I.U. # FI -1 .PRIVATE WATER SYSTEM Ondkelrs �^ ' ❑ Send /nvulce C ,V'n-`�' .mv�emVm/> ,nn -arvn nmz nr .m r Cl Scnd ResWrs ❑ Sendlnrutre a �nnm emWnr nwe xi.. ni mrc. SAMPLE DATE- l�lonth Day Year Ponth SAjvIPLE TYPE: Routine ❑ Repeat Sample (for routine sample with lab ref. no. I ❑ Special Purpose SAMPLE LOCATION Lam" 4Z� G3 ii7 �u5o�ID Comments: ❑ Treated Water eUntreated W4ter Time Collected Collected By J = '—� TG PICYO Pam Analytleal Method: * Membrane Filter ❑ MMO-MUG • Number of colontes/100 ml. :esulY analyst Dara Time E— Finks Jun ❑ Faxed Client notified of unaatisfacrory results: ❑ ❑ Phoeeq Spoke wah Fazes Date Time. BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG Result: Total Coliform f. coli Membrane Filter: Direct Count Colonlesl100 ml Verification: LTB BGB COLIFIRM Fecal Coliform Confirmation Final Membrane Filar Results_1 ColiformA00 mi Reported By �lD r Date — = Time 110 brs TbTC -Too lvumera.= Tv fmmr e$ - elbbr BGnIrv. %sum Member of mo SGS Group(Soc,ete Genoraleoe Surveillance) ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND. MICHIGAN. MISSOURI, NEW JERSEY. OHIO, WEST VIRGINI. 01-24-00 16:42 FROM -CTE ENVIRONMENTAL CT$E Environmental Services Inc. �> vsrw•ryioswrsri�ri�ia 5615301 T-074 P.02/03 F-810 CT&E Ref.# 1000695001 Client PO# Client Name S di: S Engineering Priated Date/Time 02/24/2000 15:45 Project Name!# Lot 42; 9310 Carlson Rd Collected Date/Time 02/22/2000 15:40 Client Sample ID Lot 42; 9310 Carlson Rd Received Date/time 02/22/2000 16:00 Matrix Drinking Wator /J Technical Dire ito S eptten C. dZ.E'iC Ordered lay Released PWSID 0 Total Coliform Sample Remarks: SM18 92228 02/22/00 Parameter Results POL units Method A(Lowebte Prep Anatysis Limits Date Date Iniz WATERS DEPT witrate-w 0.651 0.500 MA EPA 300.0 (s10) 02/22100 SCL MICRO LAB Total Coliform 0 COL/100ML SM18 92228 02/22/00 KAP