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HomeMy WebLinkAboutT14N, R1W, Section 17 (4) Municipality of Anchorage Page ! of ~'- DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: PID Number: Name: I~C_._~__~ ~-&F_~C> Wastewater System: ~ New ~ Upgrade Address: ~ ~ ~'~ ~ ABSORPTION FIELD Iphone: ~~ ~N~.o~edrooms: ~ Deep Trench ~ShallowTrench ~Bed ~Mound ~Other Total D pth m or' inal gr de: ~ ~LEGAL DESCRiPTiON S°il Rating: Lot: ~ Block: Subdiv~ion: Depth to pipe bosom from original grade: Gravel depth beneath pipe Township: ~ Range: i~ Section: [~ 0 Ft. Ft. Number of lines: I D[stanm ~n lines: WELL: ~New ~ Upgrade Grave~width: ~1 Ft. ~I i~ Ft. Cla~ificafion.~(Prlvate, A,B,C): T~t~th: Ft., Casfi~: Ft. Total absorption area: Yield: Casing Height Above Ground: SEPARATION DISTANCES ~Septic D Holding ~ S.T.E.P. TO Sepdc Absorption ~ Holding >ubfic/Pdvate Manufacturer: Capac[~ in gagons: From Tank Field ~..-..~.. Tank Sewer Lines ?~ Sudace Lot ~'¢ &~,~ 21'¢.¢ .~b~,~ iSize in gallons, Manufacturer:g Line Foundation / ¢,~ i~,w 3~,.~ -- "Pump on" level at: I "Pump o~' level at: [ High water alarm at: Cu.ainDrain ~l/~ >, Pump~a~e&MoOe, ~Electricallns~ctionspedormedby: Remarks:~ ~"/~SU~O~ O~ I-t~'' WO BENCH MARK Location nd Description: h~ A~um~ Elevation: b~/' ~ ~t, ENGIN~ ~&L Inspections pedormed by: ~ ~ Dates: 1st I~LI/~ ;)~>t:: ~:;~,L~:~./.o~4~., Depadment of Health and Human Se~ices approval Reviewed and approved by: ~/ ~, ~ Date: 72-013 (Rev, 9/91) MOA 25 Permit No. ~L,~ ~©~ ~ P-ge ~ of ~'- 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 Wast·water Disposal System and/or Well Inspection Report Description J~E.- t/~ 5E-i/'~' ~(/J '~ 'fl~i~.a'-/'~ PID No.: k- /~ / J UNIT 5 ~ / ~- -J--- I RESERVE TRENCH TI,'., 7 \ \ ' -' ^ - c m.8 J~ UNIT 5 ~ ] ~ ??g?7 [ PRIMARY TRENCH 0 TEST PIT BY O~ERS · TEST PIT BY PTS B~ CLEANOUT '~' MONITORING ~BE SYSTEM PROFILE SCALE 1" = 60' (NOT TO SCALE) 675 (O.G. ~ENCH 1) 310CYCLE % 66~.6 ¢'~ / MunJcip of Anchor ¢ o~'o-$~2 -0~ Permit Number~Dite Of Ii~ue_~..-.i_.-cJe Tax Idemlflc~lon Numlae~ T14N R1W SEC 17 MASTERPIECE HOMES, INC. N~SE4NW4 P.O, BOX 77~471 ~OLE RIVER, AK 99577-~471 ~n~so~] g 8 J Wa~r & ~avel 60 80 ~ ~: ~ ~ ~ ~ Qla~& S~d ~0 100 . Clay 100 160 O~h, ~ o ..... ~,~ zo ~ ~u~IJ~JFI~IJtv ~t A~C lOFao~ ~ RV C~ -- Oept. Health & Human 8ervice~ II I I I [ I Al~l)ntlon: The well driller ihall provide a well lOg to the property owner within 30 clayl o! ~mpletlon. Rick Mystrom, Mayor July 8, 1999 Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 http://www.ci.anchorage.ak.us Masterpiece Homes, Inc. PO Box 773471 Eagle River, AK 99577-3471 Subject: T14N RIW SEC 17 NE4SE4NW4 Permit # SW980283 PID # 050-362-06 The subject permit, issued 8/5/98 by this office for a single family well and/or on-site wastewater system, is due to expire as of 8/5/99. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. Ifa licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as-built inspection report must be sent to this office for review, approval and documentation. All inspection reports must he submitted within 30 days of construction completion. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. However a new permit can be issued free of charge for a second year if the application for the renewal is received on or before the date of expiration of the original permit for which a fee was paid. When applying for a new permit after the original permit has expired or for more than a second year, the fees are: $320.00 for an on-site wastewater permit and $120.00 for a well permit. If you have any questions, please call this office at 343-4744. Program Manager On-site Services enc: Copy of Permit ~el~phone lines. !,,a~ lin~. wclla~l p~,ui~s, fill ~LVEI) FUP~TI4~P,. ~ the Mtmlci~ subdi-dsion~..crud other governmenlal ~aatltie$, as of the Company to be fully bound by any do~unent$ ~ ~ew~ liae~ power ]im--~. fight-of-way permit~, a~l any and ~per~y oWrted by ~ Compm~y. , o£Az~fiorage, iu political a~ ~11 title compatfies, bank.~ and ori rh~= r~.okaior, it ~ the intent ar agre~m~ts ~xecuted by *e This Action ma)' be executed in counlm-paO, s daich, when taken together, shall be t~ated as originals a~d the pmties shall be fully b~und theceby. Name: Title: MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Date Issued: Aug 05, 1998 Expiration Date: Aug 05, 1999 Permit Number: SW980283 Parcel ID: 050-362-06 Design Engineer: ~Lr~c~ -~--'Y/~ °" ,~Ncu",,~-~" Site Address: Owner Name: MASTERPIECE HOMES, INC. Lot Size: 871200 SQ. FT. Owner Address: PO BOX 773471 Total Bedrooms: 4 Permit Bedrooms: 4 EAGLE RIVER, AK 99577-3471 This permit is for the construction of: [] Disposal Field [] SepticTank [] Holding Tank [] Privy [] Private Well [] Water Storage Ail construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 houm prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ), ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. THIS PERMIT ISSUED FOR THE CONSTRUCTION OF AN ALTERNATIVE WASTEWATER SYSTEM. THE ATTACHED PROPERTY OWNER MAINTENANCE AGREEMENT SHALL BECOME A PART OF THIS PERMIT PACKAGE. THIS PERMIT FOR UNIT 5. Date: 4155 Tudor Gentre Drive, Suits 103, Anchorage Alasko 99508 (907') 561-6257 fax: (907) December 10, 1998 RECEIVED Daniel Roth, Civil Engineer On-Site Services Section Health & Human Services 825 L Street, Suite 502 Anchorage, AK 99501 DEC '1 1 1998 Re: White Stone Estates Condominiums ~Unit 5-Permit SW980283 Dear Iv~.~oth: The disposal field for the Unit 5 septic system has been relocated due to a field survey by PTS indicating the previously approved site had a slope exceeding 25%. The disposal field has been shifted to the east, and a new test pit was excavated and percolation test performed. The soils log and percolation test, and a revised site plan and detail sheet are transmitted with this letter. Calculations for the disposal field are provided in the table below: UNIT MAX. PERCOLATION APPLICATION ABSORPTION 50% RED, LENGTH GRAVEL RF FOR REVISED PLOW RATE RATE AREA OF AREA OF E' WIDE DEPTH GRAVEL LENGTH BENEATH FOR BIOCYCLE TRENCH PERF. PIPE DEPTH OF 5' WIDE (GPD) (MIN/IN.) (GPD/SF) (SF) (SE) (FT) (FT) (FT) 5 750 11 .8 938 469 93.8 2 .7 65.6 ALASKA PROPERTY DEVELOPMENT SPECIALISTS White 8tone Estates Condominiums 12/10/98 Page 2 If you have any questions, please call me at 561-6266. Sincerely, Professional & Technical Services, Inc. Dean A. Karcz, P~. Vice President Enclosures ALASKA PROPERTY DEVELOPMENT SPECIALISTS /PRIMARY TRENCH r4N~K__ __ BiOCYcLE T. T/~J~MODEL~ 18 0 TEST PIT BY OTHERS · TEST PIT BY PTS []~' CLEANOUT .,.T. MONITORING TUBE SITE PLAN UNIT 5 WHITE STONE ESTATES ~IGU.E 21SC^'E 4"=60' I ~2/~/~ MANHOLE COVER; INSULATED1' I J" INSULA TION ON TIC TANK 1-1/4" DIA. -- PVC FROM 4" DIA. P BIOCYCLE S = 2~ BIOC YCLE MODEL 6000 MOUND SURFACE TuBEMONITORING--~ / FOR DRAINAGE _ / NATIVE SOIL ~,T]T[]]~TTT~ ~ BACKFILL i ,j~ii:~ 2.5' ~ ~ ~:: !":.;::'..?~,:! .-~:',: ~ PERF PIPE NO TES 1. GROUNDWATER DEPTH 8.5 FEET BELOW GROUND SURFACE. 2. BEDROCK GREATER THAN 17' BELOW GROUND SURFACE. J. LENGTH OF SEEPAGE PIT = 65.6'. SECTiOnS ff UNIT 5 ...';~ff WHITE STONE ESTATES Municipality of Anchorage. DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST (ENGINEER'S SEAL) ~ ........L.~ LEGAL DESCRIPTION: ~ '' ~ ~ '/~ Township, Range, Section: DEPT~ ~0~ ~/ /~ SLOPE SITE PLAN~~ 1 2 3 4 (~FEET) 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, ATWHAT DEPTH? Oepm to Water AJter Monitoring? Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE / ] (minutes~lnch) PERC HOLE DIAMETER -- TEST RUN BETWEEN ~" FT AND ~ FT ,~'n¢p/~//>n ~e.~ /~ /~,/~. PERFORMEDSY: ~" ~'* Ct'~'~.,"~"~ ~ I ~(~ ~~- CERTtFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) .,___._ ~- 690 ---" / /,,, UNIT 5 .RESERVE TRENCH ~.P_ROPOSED WELL ~ 5' X g,.~...~' TH 10 ''~...~ ~-- --- _~___ 1000 GAL. SEPtiC J ~ TANK 4" PVC MODEL 6000 SITE PLAN UNIT 5 WHITE STONE ESTATES .~.~ 21 sc~ ,'-~o' I ./,4/. 5 PRIMA R Y X MANHOLE COVER; ,3" INSULATION ON INSULA TED 1" / LID ~~-- DIA., S / SEPTIC TANK 1- 1./4" DIA. -- PVC FROM 4" DIA, PVC, BIOCYCLE S = 2% BIOC YCLE / MODEL 6000 MOUND SURFACE TuBEMONITORING--~ / FOR DRAINAGE ! NATIVE SOIL - ~ BACKFILL IIII IIIIIII IIll / .... ,. .. ~ 4" PER~ PIPE NOTES 1. GROUNDWATER DEPTH GREATER THAN 17' 8ELOW GROUND SURFACE, 2. BEDROCK GREATER THAN 17' BELOW GROUND SURFACE. 49%h ~ ~ No. c -e o3 UNIT 4155 Tudor Centre Drive, Suite I03, Anchorage Alaska 99508 (907) 561-6237 fax: (907) 563-3813 July 13, 1998 Daniel Roth, Civil Engineer On-Site Services Section Health & Human Services 825 L Street, Suite 502 Anchorage, AK 99501 Re: White Stone Estates Condominiums Unit 5-Permit Dear Mr. Roth: This letter transmits the application for the well and septic system permit for Unit 5 of White Stone Estate Condominiums located on an unsubdivided tract of land south of Ptarmigan Boulevard in Eagle River. The legal description for the property is the East ½ of the Southeast ¼ of the Northwest ¼ of Section 17, Township 14 North, Range 1 West, Seward Meridian. The project proposes to construct nine (9) single family style units. Previous permit applications have been received by your office for units 1, 2, 3, and 4 and one (1) well and septic permit has already been issued for a home site on this development, proposed Unit 7. Transmitted with this submittal package will be permit applications for units 5, 6, 8, and 9. Test pits were excavated and percolation tests performed by Crowther Associates. Test Pit 11 has been utilized to design the drain field for Unit 5. Test Pit 11 was excavated to seventeen feet (17') and silty sand was encountered through the depth explored. No ground water was encountered in this hole, based on ground water monitoring. The percolation rate of 47 minutes per inch was used to size the drain field. A Bio-cycle system is proposed to be incorporated into the septic system for Unit 5, allowing the reduction of 50% of the required drain field area. The intent of the drain field design is to install a five-foot (5') wide drain field with a gravel depth of four feet (4') beneath the perforated pipe. The table below summarizes the calculations for the septic system drain field for Unit 5. ALASKA PROPERTY DEVELOPMENT SPECIALISTS White Stone Estates Condominiums Unit 5 07/13/98 P.T.S., Inc. Page 2 UNIT MAX. PERCOLATION APPLICATION ABSORPTION $0% RED, LENGTH GRAVEL RF FOR REVISED FLOW PATE RATE AREA OF AREA OF $' WIDE DEPTH GRAVEL LENGTH BENEATH I FOR BIOCYCLE TRENCH PERF. PIPE DEPTH OF 5' WiDE (GPD) (MIN/IN.) (GPD/SF) (SF) (SF) (FT) (FT) 5 600 47 .45 1333 667 134 4 .5 67 The proposed disposal field for Unit 5 is not anticipated to have negative impacts on adjacent properties. The proposed drainage field is located greater than one hundred feet (100') from the eastern property line of this undeveloped tract. Surface drainage from the area around Unit 5 drains to the north and south of the tract. Thank you for your prompt review of the application information. If you have any questions, please call me at 561-6266. Sincerely, Professional & Technical Services, Inc. Enclosures ALASKA PROPERTY DEVELOPMENT SPECIALISTS 4155 TudorCentre D#ve, Suite 103, Anchorage Alaska 99508 (907) 561-6237fax: (907) 563-3813 September 15, 1998 Daniel Roth, Civil Engineer On-Site Services Section Health & Human Services 825 L Street, Suite 502 Anchorage, AK 99501 White Stone Estates Condominiums Unit 5-Permit SW980283 Dear Mr. Roth: PTS, Inc., on behalf of the builder, is requesting the permit for Unit 5 of White Stone Estates Condominiums be modified to allow for a 5-bedroom house. The septic disposal field has been sized to account for a 5-bedroom house, and a septic tank has been installed in front of the Bicoycle. Modifications will be made to the Biocycle to allow for a 5-bedroom configuration. A revised site plan and detail sheet is transmitted with this letter. Calculations for the disposal field are provided in the table below: UNIT MAX. PERCOLATION APPUCAT[ON ABSORPTION 50% RED, LENGTH GRAVEL BF FOR REVISED FLOW RATE RATE AREA OF AREA OF 5' WIDE DEPTH GRAVEL LENGTH BENEATH FOR BIOCYCLE TRENCH PERF. PIPE DEPTH 3F 5' WIDE (GPD) (MIN/IN.) (GPD/SF) (SF) (SF) (FT) (FT) (FT) 5 750 47 .45 1667 833.5 166.7 4 .5 83.5 ALASKA PROPERTY DEVELOPMENT SPECIALISTS White 8tone Estates Condominiums Unit 5- Permit Revision 09/i5/98 P.T.8., Inc. Page 2 If you have any questions, please call me at 561-6266. Sincerely, Professional & Technical Services, Inc. ?\ Dean A. Karcz, P.E.~ Vice President Enclosures ALASKA PROPERTY DEVELOPMENT SPECIALISTS UNIT 5 5 RESERVE TRENCH UNIT OOM TH 10 11 o~ MODEL 0 TEST PIT BY OTHERS · TEST PIT BY PTS [~"~' CLEANOUT · ,,T.MONITORING TUBE SITE PLAN UNIT 5 WHITE STONE ESTATES .~UR£ ~lsc^u~ ~*=so' 1 7/8/98 UNIT 5 PRIMARY TRENCH .5' X 67' TH 2 MANHOLE COVER; I ,3" INSULA TIOIV ON 4" DIA. DIA. S = 2% --PVC'/'FROM BIOCYCLE BIOCYCLE / MODEL 6000 MOUND SURFACE TuBEMONITORIN% / FOR DRAINAGE / NATIVE SOIL ? ~ BACKFILL NO TES 1, GROUNDWATER DEPTH GREATER THAN 17' BELOW GROUND SURFACE. 2. BEDROCK GREATER THAN 17' BELOW GROUND SURFACE. ,3. LENGTH OF PIT = 87'. ............. ............. Municipality of Anchorage. DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 4- 5- 7 I0 11 '14 15- ~6- 18- COMMENTS Township, Range, Section: ~e~/~ /7 SLOPE SITE PLAN L IF YES, AT WHAT ~ O DEPTH? P E Depth LO Water After., .11_/._.'/~/''~ Monitoring? IFa~ Da~ Gross Net Depth to Net Reading Date Time Time Water Drop 171/ /Tq 2+ PERCOLATION RATE . TEST RUN BETWEEN . ~' 7 (minutes/inch) PERC HOLE DIAMETER '~ FTAND ~- FT PERFORMED BY: ~' ~ (~''0'~'~'~/'~ ' ''~ ~,~~CERTIFY THAT THiS TEST WAS PERFORMED IN ACOORDAHC~ W,TH ALL STATE AND '.'UN,C,PAL O,~,DEL,NES ,N EFFECT ON T.,S O*TE. OAT~ 7./~/q'~ 72-008 (Rev. 4/85) PROPERTY OWNER AGREEMENT FOR ~ MAINTENANCE OF AN ON-SITE WASTEWATER DISPOSAL SYSTEM This agreement, dated ~TulV 10~h 199_~, is made between the Municipality of Anchorage - Department of Health and Human Services (DHH$) and the property owner(s) of: White Stone Estates Condominiums Unit 5 located at: East 1/2 of the Southeast 1/4 of the Northwest 1/4 of Section Township 14 North, Range I West, Seward Meridian. This agreement is made for the purpose of mslntaining an on-site wastewater disposal system on the subject property. 17, The property owners agree to th, e following: Submit to the MuniCipality of Anchorage, on an annual basis, an inspection and operation statement from a registered professional engineer. This inspection and . operation statement shall verify that the engineer has inspected all effluent and air pumps, timers, and alarms, and that any deficiencies have been repaired and that the system is functioning as designed. (Si~ature) (Signature) (Printed Name) (Printed Name) ................................ Notarize Here .......... ~ ...... . .................... /~-~//f~' ~"~/~f personally appeared before mZ who is personally ~o~ to me whose identity I proved on the basis of ~ whose identity I prov~d on the bath/affi~ation of a~i~,;;;~;~,)~,}~z. , a credible witness · ~x~ ' ~:~, to be the smgn~N~g.~ document, and he/she__d that~~ned it. ~ . ~LIC: ~ ~°~7 ~ ' '/#~Ill#Jill I~% Parcel I.D. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.o. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY FOR A SINGLE FAMILY __. 1. GENERAL INFORMATION APPROVAL DWELLING Expiiation Date: Completelegaldescription T14Ni RIW, Location (site address or directions) Current Property owner(s) Mailing address Lending agency Mailing address · Real Estate Agent Mailing address SEC. 17, NE1/4, SE1/4, NWl/4, WHITESTONE ESTATES; UNIT #5 206'~0 PTARMIOAN BOULEVARD JERRISON MINTON Day phone 265-9131 C/O DEBBIE CLOUTIER w/ COLDWELL BANKER Day phone DEBBIE CLOUT1ER w/ COLDWELL BANKER Day phone 2525 "C" STREET * ANCHORAGE, AK. 99503 265-9131 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER suPPLY: Individual Well ' ·'lndividuai Water Storage Community Class Well Public Water System TYPE OF WAsTEWATER DISPOSAL: Individual On-site I Individual Holding tank I--I Community On-site r-] Public Sewer [~] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 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) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (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. e Se 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 Authorffy Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS' ENGINEERING GROUP, Ltd. 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. a:ttemPte~ to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and se~arat/on 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 syster~. These conditions are outside the control of the evaluator of the system. Satisfactory test ' results do not guarantee future performance of the system, nor do they guarantee that . there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide . any warranty or future estimate of how long the system will continue to meet the . operational requirements of the ADEC or MOA DSD. The Content of this' report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. Phone Date 337-6179 DSD SIGNATURE /'~ Approved for ~ bedrooms. Disapproved. Conditional approval for .... bedrooms, with the fllowing stipulatio~.~., . . .o-c~ ,~ ~.~. · Attachments: H,/~A Checklist Septic System Advisory Well Flow Advisory (Rev. t2/05) Manitenance Agreements. Supplemental Engineer's Reort, Other Original Certificate Date: ~l ":/'~ ~ DeVelopment serV,ceS Department . Building Safety Division ~On-Site Water & Wastewater Program At Be HEALTH 4700 South Bragaw St, ~ P.O. Box 196650 Anchorage, AK 99519-6650 .. www.cl.anchorage~ak.us ~ ~ (907) 343-7904 !. AUTHORITY APPROVAL CHECKEIST Le[~af!DesCription:T14N~ RlW~ SEC. 17~ rWHITESTONE ESTATES; UNIT #5 ,P,arcel ID: WELL[DATA - Well,type i ProrATE . If A, B, or C provide PWSID# N/A. Wel! Log (Y/N) Da{e; leted 8/21/1'998' Sanitary seal (Y/N) yEs Wires properly protected (Y/N) YES YES · 24+ in. Toi~l'~epih 180 ft. D',~t~ 'of iest · ~.:ti:i ~ Stabc water level Well P~'dduction WATER SAMPLE RESULTS: · Cased to 'FROM WELL LoG 8/21/1998; UNK 180 ft, ~0 .ft. g,p.m. CoiTorm · 0 colonies/lO0 mi. Nitrate 0.1' · ,' ,l'', !, 4/28/2004 Date of sample: Col!ected by: SEPTIC/HOLDING TANK DATA mg./L. Other bacteria 0 colonies/lO0 mi. GEG Ltd, - 158 · ff. 5.95 g.p.m. Casing height (above ground) AT INSPECTION 4/28/2004 ~fI . '; ". PLASTIC /i ' "~ ' ' BIOCYCLE i ' ' 12/21/1998 Tank Type/Materi.al Date installed i':i ,'.113oo/ ' · ' '. . 2/ Ta~l;, ~ize' 1500 "gal. Number of Oompadments" 4 CleanoutS (Y/N). YES _ ,;.~I,".:I': ' . YES Depression over't;nk (Y/N). NO YES ~-oundahon cleanout (Y/N) High water alarm (Y/N) I '~i: ' l, . ~ ' J.R'.'s pUI~IPING ' Date ~f p~mpmg 5/6/2004 PUmper AB's?R~TION FIELD DATA i~ I'EXISTING GRADEJ Date installed . 7/22/1999 . Soil rating~_r ff~/bd~) 3.0 System type TRENCH ! ~ .... i' .... : Length~ =.~68(2~34) ff. Width :5 ff. Gravel below pipe 2.1 fl. ,,t~I .' - ~, ' ~ Tdtaidepih*S.8 - 8.5ff. Eft. absorption ama 493 ~ Monitoring tube. ~ES ~: Depression overfield NO · ! ' , !~ (Pass/ D~te'ofadequawtest 4/28/2004, ~-Results Fail) P~S ~ For 5 bedrooms ,',' ' 0 in. Fluid de~th in absorption field before test '~0 in. ~ , .Water.added 914 gal: New depth Ela'p~ed Time: 0 min. . , Final fluid depth . in. AbS°rpti~n rate >= 750+ ' g.p.d. I : D.' LIFT STATION Date inStalled.12/21/1998 ~ -Size in gallons ' ?ump on". level at 30.5 in. Datum B.O.I. SEPARATION DISTANCES 15OO "Pump oh'" level at- 19.5 in., Cycles tested I *N/A Eo IBIOCYCLE, MODEL 6000I Manhole/ACceSs (Y/N) YES High water alarm level at- 45 Meets alarm & circuit requirements?. SEPARATION DISTANCES FROM WELL ON LOT TO: *BIOCYCLE MAINTENANCE 'INSPECTION PERFORMED SEE RECEIPT 100'+ .... : N/A 25'+ , '," . Septic tank/lift station ~on'lot ..'Abs0rpti(~n field on lot Public sewer main Sewe~/septic service 'line ' 100'+ * On adjacent'lots ' ' 100'+ On adjacent' lots* Public sewer manhole/cleanout ;, N/A Holding tank ~ -N SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT · Building foundation ', Water main . N/A: Water service line 10'+ Wells on adjacent lots TO: ' 'BIOCYCLE · Absorption field Surface water. [ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:' 10'+,. Building foundation 10'+ .Water main Properly line Water service line 10'+ Surface water 100'+ Wells on adjacent lots . in. YES UNIT ;' ;,~ 5'+ : 100'+ 100'+ ,Curtain drain" NONE KNOWN cOMMENTS* ~ ;' - , G.. ENGINEER'S 'CERTIFICATION Driveway, Parking/vehicle',st~rage 10% I certify that I have determined through'fie/d inSP'octions and rOi4ew of Municipal rocords that the above systems ara Conformance with MOA HAA guidolinos in offoct on Engineer's Printed Name~ JEFFR~ A.'~GARNESS ~tel'-' ~ ~/~ ' ' ....... HAA Fee $ D~te o:[' Payment Receipt NUmber .(R.e.,,..!~0.0)~ .... ; Waiver Fee $ Date of Payment Receipt Number 5- 4--0~; GS Rcf.# :lient Name 'roject Name/// :lient Sample ID {atrix 1042144002 Gamess Engineering Group,' Ltd. Various TI4N,RIW, S 17 Whitstone Est #5 Drinking Water ~VSID 0 ample Remarks: ;907 5615301 All Dates/Times are Alaska Standard Time Printed Date/Time 05/04/2004 14:11 Collected Date/Time 04/28/2004 12:48 Received Date/Time 04/29/2004 9:55 Allowable Prq~ Analysis arameter Results PQL Units Method Container ID Limits Date Date Init raters Department Nitrate-N .0.100U 0.100 mg/L EPA300.0 B (<=10) 04/29/04 .IMP ~cr~biology Laborator~ Total Coliform 0 col/100mL SMI8 9222B A (<=1) 04/29/04 DKC 5-- 4--04~ 4:43PM; ;907 5615301 SGS/CT&E ENVIRONMENTAL SERVICES · Drinking water Analysis Report for Total Coliform Bacteria' READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING ~,~AMPLE ' MUST BE COMPLy- J =1~ ElY WA'lbt~ SUPPUER 'E~ PUBLIC WATER SYSTEM ID~I _- . , SAMPLE COLLECTION: I .~oo w..P'OTTE~ DP,~,E ANCHORAGE, ALASKA 99518' Tel: 907-562.2343. . . Fax: 907-56'J-5301 Lab Ref ag. 1042144-2 SAMPLE TYPE: · - .~oufi'ne [] Treated.Water '' '. .: · I-I Repeat Sample . !-1 Untreated Water.. (refer to lab no. ..,. :) · · i-] Special Purpose . RL) .SH ~AM ..PLE.. . .. BE COMP. LETED BY LABORATORY ' . Sample Receivinq: .' Date: t'(r - ~. ~ "0 ~'/r.'' .. E~ Sample °~' 30 hours cgd; Temp: ¢,.~,,t;,~,,~ [] 4~ Hour VVah~er Phone MMO-'MUG (P/A) RESUL'I~: FBK J~N - Analy~ca! Method: MEMBRANE RL~ RESULTS.' IPhOl'l~::l E] . Faxed [r--] [~ Membrane Filter · Ver~ca~,:; : . iSpo~ew~.. '- ' ~:. [] Sa.tisfact&y ..,~,., [ EC: [] . Unsatisfactory " .JRs Pumping PO Box 773415 Eagle River, AK (907) 694-6454, 99577 Billing Information Garnosg Egineering Group 3701 E Tudor Rd 'Suite 101 Anchorage, AK 99507 (907) 337-6179 Moagan & Chris ~._o.~.81t e Information Rick 20660 P~armlgan Bird Eagle River, AK 99577 (907) 337-6179 Service Type Septic Service Under 2k Additiorml Location Comments: Brown Brick House Lot# $ Oty 1 Job Description: 10009 P.O. Number: Terms: Net 30 Semester: Nikole Map Book: Cross Streets: Ptarmigan Blvd Diagram: Service Agreement Number: 013020 Order Date: 04-May-2004 ServiCe Dale: 06..May-2004 12;00 am Technician: Tony Job Type: Repeal Map Grid: 110 Job Comments: [1'~'~ 12/07/01 ...... !Pumped and cleaned tank - heavy solids IBio-Cyc~e System~Pump Tank ONLY IFex Lahsen Mahl('new home owner) completed work order Fax #696- Tax Percent: 17008 . Price Each X 2 Men Tax Extension ~ctuel $95.00 No NO $95.00 Gallons Planned: 1000 Gallons Actual: __ Hose Length: Double Tank: Pump System: 'Baffles Inlet: Baffles Outleh NonTaxable Total Estimated ChargeS: $95.00 Taxable Total TexTotal . GrandTotal $0.00 $0,00 $95.00 Actual Charges: Customer agrees {o the ferret"and conditions printed on the back. THIS I~ A BINDING AGREEMENT. S~gnature and 'riUe o1' Customer Representative ~,ccepted by .]Rs Pumping Date Date Accepted For your added convenience we accept Visa end Master Card payments over the phone. After 30 Days 1.5o/~ WiLL BE CHARGED! [nil . Bi~--'yele Alaska 43630 Strawbelmy Road Kena/, AK 996 ! I ggg-790-212O 293-9003 / fax 283-811 g Customer ~0 ~4,i~ mvd Eagle River, AK 99577 Qrt. Maintenance Rep,.)rt DF-.~CRIP'RON PKIMARY CI.[AM'~ SCUM HIGH AERATION CHAMBER & SYSTEM: BLOWER NOISE ~ GENERAL CONDITION PIPES: AIR LEAKS DIFFUSERS: AIR SUPPLY MIXED LIQUOR CONDITION: ODOURLE$S 120 HIGH HIOH POOR IGH R CLARIF/CAT/ON CH.4MBER: DISCHARGE CHAMBER: SLUDGE ACCUM Jib/HOPPER CLARITY OF EFFLUENT PUMP OPERATngG .AIJdKMS CHECI~D & OPIEKAT~G · ,tlR/PO]ArER HIGH WATER NO COMMENTS 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 1, GENERAL INFORMATION Completelegal description NE~- SE¼ NW~ T14N R1W SEC.17 ~+~ directions) Uni~ 5 Whitestone Es%a~es Location (s.,~ address or ' Property owner Mast,¢,-¢? ece Homed Mailing addres!~ PO Box 773471 Day phone 69~.-7320 Lending agency Mailing address Day phone Agent Address Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well Community well Public water X If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site X Holding tank Community on-site Public sewer 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 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 verifythat 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 . ?TS ' T_nc. Phone Address 41 55 Tudor Centre Dr., Suite 03 Engineer's signature Date DHHS SIGNATURE Approved for ~-~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.  Municipality of Anchorage JUN--'~ DEPARTMENT OF HEALTH & HUMAN SERVICES rvlces Division MUN C PALH'¥ Ol: ANCH~'~'~,~ Environmental Se .... ' ~r PC)NMENTAL SERVICES 825L Street, Room 502', Anchorage, Alaska "501 · ('07) 343-47.4.~4. Health Authority Approval Checklist ~J~ Legal Description: N~ ~]~ ]~W~ T'I/+bT R1 W ,~EC. 1 ? Parcel I.D.: MuNICiPALITY OF ANCHORAGE A. WELL DATA ',,!Rr3klMENTALSERVICES DIVISr~' Well type P r ± Ya f,e If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) ~ Date completed 8/21/1 998 Total depth 1 80 t Cased to 1 80 t Casing height (above ground) Sanitary seal (Y/N) ¥ Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level j ~"~ ~ Well production g,p.m, g.p.m. WATER SAMPLE RESULTS: ,,~C- Date of sample: '~/?/2000-')/20/2000 Oollectedby: ]3-cuce ]3~-ow~-H~c~: ~,~n~j B, SEPTIC/HOLDING TANK DATA Date installed 1 2./21 /1 c)c~STank size 1 300 Number of Oompartments 2 Oleanouts (Y/N) ¥ Foundation' cleanout (Y/N) ~ Depression (Y/N) ~ High water alarm (Y/N) bT Date of Pumping Pumper C. ABSORPTION FIELD DATA. Date installed 7/22/1 999 Soil rating ~g.p.d./ft~ or ft~/bdrm) 0.8 : System type Trench Length ~g/+ Width 5 Gravel thickness below.pipe 2.1 Total depth 4. ~ _ Effective absorPtion area 62 ~ s £ Monitoring Tube present (Y/N) ~Z Depression over field (Y/N) Date of adequacy test ['~/A Results (Pass/Fail) ~/A For i~/A bedrooms Fluid depth in absorption field before test (in.); Immediately after gal. water added (in.): Fluid depth (ins) Minutes later: Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* .Biocycle D. L-IF-T-6-T-A-TtON Date installed 1 2/21/1 998 Manhole/Access (Y/N) y High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum 1 500 "Pump off" level at* SEPARATION DISTANCES FRQM WELL ON LOT TO: Septic/holding tank on lot 1 21 . 1 On adjacent lots 259 ~ Absorption field on lot 2??. 7 On adjacent lots .31/+ t Public sewer main N/^ Public sewer manhole/cleanout N / A Biocycle Sewer/septic service line 99.1 4=if ......... 1 35,9 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 1 8.8 Property line 226.5 Absorption field 1 5/~. ~ Water main/service line 1 00' Surface water/drainage k)//~-~-d Wells on adjacent lots 221 , 9 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 68.2 Building foundation 1 '78. ? Water main/service line Surface water``) ~oo ~ ~/,)'~ ~(0-~ Driveway, parking/vehicle storage area 60' Curtain drain ob",~.¢-',/¢4¥ .-p. Wells on adjacent lots 1 51 . 4 F. ~NGINEER'S cERTIFICATION , certify that I/'rave determined thru field inspections and review of Municipal rec~ +200' in conformance.iwith MOA HAA guidelines in effect on this date. s,,n tu Engineers Name bF.~J ~ ~ Z HAA Fee $ ~ ¢ ~ ' ~ Date of Payment '~,/?2? ~ Receipt Number ~'-~ (~' Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 · FAX 456-3125 8005 SCHOON STREET ANCHORAGE, ALASKA 99518 1907) 349 1000 · FAX 349-1016 PQUCH 340043 PRUDHOE BAY, ALASKA 99734 (907) 659-2145 · FAX 659-2146 DRINKING WATER ANALYSIS REPORT FOR TOTAL COLIFORM BACTERIA Masterpiece Homes, Inc. cio PTS, Incorporated 912 E. 15th Avenue, Ste #102 Anchorage, AK 99501 Phone Number: ( )561-6266 Fax Number: ( )563-3813 Collected by: WJB Sample Type: Routine Method of Analysis: Membrane Filtration (SM 9222 B) Comments: Date Received: 9/20/00 Time Received: 09:30 Date Analyzed: 9/20/00 Time Analyzed: 13:45 Date Reported: 9/29/00 Time Reported: 08:15 Next Sample Due: Comments S = U = POS = ND = TNTC = CG = HSM = TLIT = R = NT = Satisfactory Unsatisfactory Positive Test Result None Detected Too Numerous To Count (>200 Colonies) Confluent Growth Heavy Sediment Masking, Results May Not Be Reliable Sample Age >30 Hours, Too Long In Transit Resample Required No Test * # Colonies/100 mi ** # Colonies/mi Sample Sample Total* Fecal Other* HPC** Date Time Coliform Coliform Bacteria Result Lab~ Location Comments 9/19/00 12:10 0 0 10 NT AW4561 Whitestone Estates, Satisfactory Unit 5 Isaac A. Maceo Northern Testing Laboratories, Inc Anchorage, AK 9/29/00 NORTHERN TESTING LABORATORIES, INC. 3330 INE)USTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456 3116 - FAX 456-3125 8005 SCHOON STREET ANCHORAGE, ALASKA 99518 (907) 349-1000 · FAX 349-1016 POUCH 340043 PRUDHOE BAY, ALASKA 99734 (907} 659-2145 · FAX 659-2146 Masterpiece Homes 912 E. 15th. Avenue, Suite 102 Anchorage, AK 99501 Attn: Client ID: Unit 5 Client Prqiect #: Source: NTL Lab#: Sample Matrix: Comments: Wlfitestone Estates A168563 Water Report Date: 9/25/00 Date Arrived: 9/20/00 Sample Date: 9/19/00 Sample Time: 12:10 Collected By: WJB ** Legend ** MRL - M¢thodReportLevel MCL =Max. Contam~antLeval B = Present In Method Blmzk E = Estimated Value M - Matrix Laterference H - Above MCL D = Lost To Dilution Date Date Analyzed IMethod Parameter Units Result MRL Prepared SM 4500 NO3 E Nitrate-N mg/L <MRL 0.i0 9/23/00 Reported By: Wendy M. Mitchell Anchorage Chemistry Supervisor NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 · FAX 456-3125 8005 SCHOON STREET ANCHORAGE, ALASKA 99518 (907) 349 1000 · FAX 349 1016 POUCH 340043 PRUDHOE BAY, ALASKA 99734 (907) 659-2145 · FAX 659-2146 DRINKING WATER ANALYSIS REPORT FOR TOTAL COLIFORM BACTERIA Attn: Bruce Brown Professional & Technical Services 4155 Tudor Centre Dr. Anchorage, AK 99508 Date Received: 3/7/00 Time Received: 13:20 Date Analyzed: 3/7/00 Time Analyzed: 15:30 Date Reported: 3/18/00 Time Reported: 17:46 Next Sample Due: Phone Number: Fax Number: Collected by: Bruce Sample Type: Private water Systems Method of Analysis: Membrane Filtration (SM 9222 B) Comments: Comments S = Satisfactory U = Unsatisfactory POS = Positive Test Result ND = None Detected TNTC = Too Numerous To Count (>200 Colonies) CG = Confluent Growth HSM = Heavy Sediment Masking, Results May Not Be Reliable TLIT = Sample Age >30 Hours, Too Long In Transit R = Resample Required NT = No Test * # Colonies/100 mi ** # Colonies/mi Sample Sample Total* Fecal Other* HPC** Date Time Coliform Coliform Bacteria Result Lab~ Location Comments 3/7/00 12:00 <1 ND <1 NT AW2506 Outside Hose Bib Satisfactory Isaac ~o Microbiologist Northern Testing Laboratories, Inc Anchorage, AK 3/18/00 NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 · FAX 456 3125 8005 SCHOON STREET ANCHORAGE, ALASKA 99518 (907) 349 1000 · FAX 349-1016 POUCH 340043 PRUDHOE BAY, ALASKA 99734 (907) 659 2145 · FAX 659-2146 Masterpiece Homes 4155 Tudor Centre Dr. #103 Anchorage, AK 99508 Attn: Dean Karcz Client ID: Client Proiect #: Source: NTL Lab#: Sample Matrix: Comments: Unit 5 Whitestone Estates A165787 water Report Date: 3/28/00 Date Arrived: 3/21/00 Sample Date: 3/20/00 Sample Time: 15:30 Collected By: Mick Ewing ** Legend ** MRL = McthodReportLevel MCL -Max. ContaminantLevel B - present In Method Blank E - Estimated Value M - Matlix Interference H = Above MCL D - Lost To Dilution Date Date ] Method Parameter Units Result MRL Prepared Analyzed SM 4500 NO3 E Nitrate-N mg/L <MRL 0.10 3/24/00 Reported By: Wendy M. Mitchell Quality Assm'ance Officer