HomeMy WebLinkAboutKWIK LOG BLK 3 LT 18Kwik Log
Lot 18
Block 3
#013-043-35
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURCES
DIVISION OF WATER
LOCATION OF WELL WATER WELL RECORD
BOROUGH SUBDIVISION LOT BLOCK SECTION QTRS SECTION TOWNSHIP RANGE MERIDIAN
LOCATION/SKETCH:
DEPTHS M~SURED FROM:~casing top'ground su~ace WELL DEPTH: /~? ~ DATE OF COMPL~ION
Depth of hole: ft
BOREHOLE DATA: Depth Depth of casing: ft / /
Material Type and Color From To
~ ' ~ ~ ~k~ ~ ~ / ~ ft below ~ top of casing ~ ground surface
,' o ~ ~ ~ ~ ~ ~ DEPTH IO STATIC WATER L~EL:
"' M~HOD OF DRILLING: ~ air rota~ ~ cable tool
~ ~ ~ USE OF WELL: ~ domestic ~ irrigation ~ monitor
WELL INTAKE OPENING TYPE: ~ o~d ~ screened
~ pe~orated ~ open hole
Depths of openings: to ft
SCREEN TYPE: Diam: in.
Slot~esh Size: Length: ft
G~VEL PACK TYPE:
Volume used: Depth to top:
Depth: from ft to ft
JUN; 8 1996 D~ELOPME~T ~D:
Duration: ~"
Municipalit~ of Anchcrage
Oept. Health & Human S ~rvices PUM~I~ L~EL AND YIE~:
ft after hrs pumping . gpm
PUMP INTAKE DEPTH: ft Horsepower:
WELL DISINFECTED UPON COMPL~ION? ~ YES ~ NO
CONTRACTOR INFORMATION:
Registj~.red Busihess N~.rrre' .
Signatur~.~f- Authorized Respre~entative Date
REMARKS:
PLEASE MAIL WHITE COPY OF LOG TO:
DNR/DIVISION OF WATER
PO BOX 772116
EAGLE RIVER AK 99577-2116
PAGE 1 OF 1
MUNICIPALITY OF ANCHOP~AGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
0N-SITE WELL SYSTEM PERMIT
PERMIT NUMBER:SW940178
DESIGN ENGINEER:DUMMY COMPANY
OWNER NAME:STEWART MINNIE E
OWNER ADDRESS:?21 E ?3RD AVE
ANCHORAGE, ALASKA 99518
DATE ISSUED: 6/16/94
EXPIRATION DATE: 6/16/95
PARCEL ID:01304335
LEGAL DESCRIPTION: KWIK LOG BLK 3 LT 18
LOT SIZE: 1]_134 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
WELL SYSTEM
ALL 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 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:
RECEIVED BY:
ISSUED BY: ~~ ~'
DATE:
DATE:
~f 3
EASEMENT
-~'~:. ....... ,by and between ' i'~',~k,, ~ ~ 0..~,.~ ~l:-~( , J iq[, )
of Anchorage, Alaska, party of the first part, which expression shall
include his, her, or their heirs, executors, administrators
o~ a~s whe~ ~he c~ntex~ so requires o~ admits, and ~.
c~ ~) ]l.n~ ~-> ~. Q 0~ , ~;~,~ )~ of Anchorage, Alaska, party of the
second part~ which exp~ssion includes his, her, or their heirs,
executors ~ administrators, om agents where the context so requires
or admits, witnesseth:
Whereas, the pa~y of the first part o~s and has title ~o that
real esta%e and real property located neam Anchorage, Alaska,
described as follows: :j ~ ~ ~> , ~ ~' ,~i L L>-( ~ ~' ~i~
And whereas, ~he parody of the second pa~ owns and has ~i~le
a parcel of p~m~y which adjoins ~he f~going ~d descmibed as
desires to g~ant a pe~tual ~asem~n~ fo~ the pu~ose of (
and the easement shall be within the radius of
from the well site.
.)., said well shall be
Now, therefore, it is hereby agreed as follows:
The party of the second part does hereby gran't~ assign, and
set over to the party of the first part a perqpe~ual easement for
Page 2 of 3
the purpose of installing and operating a community water system,
as located on that certain amended plat approved by the Greater Anchorage
Platting Board and filed for record~ such easement shall be within
the radius of < / ~ z~ )feet from the well site,
The party of the second part shall fully use and enjoy the
~.for~{d pr~mises~ except as to the riKhts herein granted.
This agreement is subject to the following provisions:
1. Second Party shall:
a) Restrict the use of that portion of ( ~ ~ ~ ~%';{ ~ )
which falls within the ( ~! ~ )foot
radius of the well from all sources of contamination~
and that portion of said tract which falls within
the ( ~0 )foot radius shall have no sewer,
septic tank, or disposal fields, except that sewer
lines of cast iron pipe with leaded and caulked
joints shall be permltted~ and that portion which
falls within the ( /~.~ )foot radius shall
have no seepage pits, and that portion which falls
within the ( /~ ~ )foot radius shall have no
cesspools, as regulated by the Greater Anchorage Area
Borough Health Department.
To have and to hold the said easement, right, and right of
way unto the party of the first part, successors~ Or assigns for a
period of perpetuity and under the conditions~ restrictions and
considerations as set forth above.
It is expressly understood and agreed that this easement is a
covenant running with the land.
IN WITNESS WHEREOF, the parties hereto have caused this
agreement to be executed under seal as of the day and year first
above written.
STATE OF ALASKA )
) SS,
THIRD JUDICIAL DISTRICT )
before me, the undersigned Notary Public in and for t~e Stgte of
Alaska~ duly commissioned and sworn, personally appeared (
) known to me and to me known to
be the individuals named in and who executed the foregoing instrument,
and acknowledged to me~ each for himself and not for the other,
that they signed and sealed the same as their voluntary act and deed
for the uses and purposes therein set forth.
IN WITNESS WHEREOF, I have hereto set ~ hand and official seal
the day and year first above written.
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
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
: . Expiration Date: '~/* /'/
GENERAL iNFORMATiON ·
OomNete legal description.,
Loc~tion '(site address)
Current,Properly owner(s) ~m~c i~ ~c[~ Day phone
Mailing address
Lending agency Day phone
Mailing addFess
Real Estate Agent ~eA~ P(~ II; Day phone ~1- (fZ~
Mailing Address
831- 0'-/55
Unless otherwise requested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS: .~
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class ~ Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding Tank
Community On-site
Public Sewer
[]
[]
[]
I
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. Cedificates 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 homeo~vners. 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
.5.
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 Cediflcate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disPosal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm --e.~u~-~l~n(~ ~¢~4~i,~¢~.lZl/y'6-
Address 7_03 ~. IS~1' AVz.
Engineer's Printed Name
Phone
Date
'I ~ '
bedrooms, with the following stipulations:
DSD SIGNATURE
Approved for
Disapproved,
Conditional approval for
bedrooms.
Attachments:
COSA Checklist
Septic System Advisory
Well .Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
(Rev. 11105)
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343~7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: ~{~, Parcel ID: 013"
A. WELL DATA
Well type Pe.{vA~e IfA, B, or C provide PWSID #~
Date completed i 9 Sanitary seal (Y/N) ~'
Total depth ~20 ff. Cased to 120 ft.
Well Log (Y/N) Y
Wires properly protected (Y/N)
Casing. height (above ground)
FROM WELL LOG
Date.of test
Static water level J ~ .ft.
Well production ! _(~ g.p.m.
AT INSPECTION
10 ff.
~, 5 g.p.m.
in.
WATER SAMPLE RESULTS:
Coliform /~£6~, .col°nies/100mL Nitrate ~V[:) mg/L
Arsenic: /VD ug/l~ date of sample:
~:.' SEPTIC/HOLDING TANKDATA ~'~b~;c
Collected by:
Tank Type/Material .....
Tank size "- gal. . Number of Compartments ---
Foundation cleanout (Y/N) ,--.,, Depression over. tank (Y/N) ~
Date of pumping - Pumper '"'-
Date installed
Cleanouts (Y/N) '"'
High water alarm (Y/N) ---
C. ABSORPTION FIELD, DATA
Date installed -' Soil,rating (g.p.d./ft2 or ft~/bdrm) "'"
Length " ft. Width - ft.
Total depth ~ ft. Eft. absorption area '-'-ft2 Monitoring tube
System type "-'"
Gravel below pipe
Depression over field ----
Date of adequacy test ~ Results (Pass/Fail) '
Fluid depth in absorption field before test. ---- in. Water added~ gal.
Elapsed Time: "" min. Final fluid depth in. Absorption rate >=
For ~ bedrooms
New depth~ in.
-'-' g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
If yes, give date
D. LIFT STATION
Date installed . "'
"Pump on" level at w
Datum -'-'
in.
Size in gallons -"'
"Pump off" level at -"
Cydes tested
in.
Manhole/Access (Y/N) ---
High water alarm level at --
Meets alarm & circuit requirements?
in.
:E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tanldliff station on lot
Absorption field on lot
Public sewer main ~ 5 ~.l-
Sewer lseptic service line
Anita_al containment areas ~:> 4-
On adjacent lots
adjacent lots
On
Public sewer manhole/cleanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Pu~ll¢. ~.~.~el'Z.
Building foundation '"' Property line "' Absorption field ' - '
Water main Water service line '-" "Surface water ""'
Wells on adjacent lots "--
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line -' Building foundation "'
Water Service line --- Surface water -'-
Curtain drain ---- Wells on adjacent lots -'---
Water main --'"
Driveway, parking/vehicle storage '---
(. Il,
.F. COMMENTS
G. ENGINEER'S CERTIFICATION
review of Municipal records that the above systems are in ~...~..~ ."'.~./.. [1../~"~i;., ',
conformance with MOA COSA guidelines in effect on this date. ~ .
,
COSA Fee $ /--~O-" Waiver Fee $
Date of Payment ?:)/~| '/~}~' Date of Payment
Receipt Number ;- .i Receipt Number
(Rev. 4/10)
SGS Ref.# 1110950001
Client Name Spurkland Engineering Printed Date/Time 03/23/2011 10:00
Project Name/# Kwik Log B3 LI 8 Collected Date/Time 03/16/201 l 13:40
Client Sample ID Kwik Log B3 L 18 Received Date/Time 03/16/2011 13:50
Matrix Drinking Water Technical Director Stel)hen C. Ede
PWSID 0
Samvle Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic
ND 5.00 ug/L EP200.8 C (<10) 03/16/11 03/21/11 NRB
Waters Department
Total Nitrate/Nitrite-N
ND 0.100 mg/L SM20 4500NO3-F B (<10) 03/21/11 AYC
Microbioloqy Laboratory
E. Coli
Total Coliform
Negative I 100mL SM20 9223B A 03/16/11 DLC
Negative I 100mL SM20 9223B A 03/16/11 DLC
LOT 8
BLK 3
LOT 19
BLK 5
ge
LOT 7
BLK 3
$89°48'30"W 82.50'
LOT 6
BLK 5
EXIS~NG ~
~ WOOD FRAME ~ :o~E[ ~ LOI 17
. HOUSE ENVY ~ BLK 3
LANDING ~A~L
LOT 18
ANCIIORAGE RECORDING DISTRICT
ASBUILT OF:
KAVIK LOG SUBDIVISION
LOT 18 BLK 3 PLAT 63-60
SURVEY CERTIFICATION: I,
e. ond.ucted · physi.cal survey of ~is pmpc~y as shown on this
..mawmg and ~at me tmpmvemcnts situatcd thereon am within
me propew/hnea and no encroachmcnts exist other than notcd.
d~E~oeCI-.US ION ,NOTES:It is the owners mspoust'bilit7 to determine
existence otany easements, ¢ovemmts, or mstri&ions which
not appear on the recorded subdivision plat.
· c~< ~ ~ [~C. 26. 2005 l"c~r~1'.30' r~_~_M.~e,..~,.~
05--089 I~.= ~[~ ~1~,.,~.~"'
ENGINEERING, INC.
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
::::::::::::::::::::::::::::::::::::
(007)868-379 I/FAX (907)868-3793
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. O13-O43-3~;
1. GENERAL INFORMATION
Complete legal description
Location (site address)
COSA # O-,¢O 7
Expiration Date: ~:~/~ ~'/~
KWIK LOG ~UBDIVlSION; LOT 18: BLOCK 3
721 CART 73~ AVI:NUI:: ANCHORAGI:, AK 99~;18
Current Property owner(s) WESI FY & TI:RI I FMRI:CK Day phone
Mailing address 7;~1 I:. 73~ AVENUI:: ANCHORAGF: AK 99~1R
Lending agency Day phone
Mailing address
Real Estate Agent OSBORNI: & BRII FY - NTRF Day phone 7R1-2RO0
Mailing Address 20~ I:. BFN~ON BI VD.: ANCHORAGI:~ AK 99~03
Unless otherwise requested, COSA will be held by DSD for pickup,
NUMBER OF BEDROOMS: __3_
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
[] Individual Holding Tank []
[] Community On-site []
[] Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional
civil engineer registered in the State of Alaska. Certificates of 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 vaIid 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 weIIs 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 cf the validation date sh6wn 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 vedfy
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(ara) in compliance with all
applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm KND FNGINEFRING: IN(':. Phone ~§~;-~1 11
Address 20441 PTARMIGAN BLVD.: EAGLE RIVER: AK 99S77
Engineer'.s Printed Name MICHAEL N ANDERSON Date 0S/18/;)006
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations.
The assessment of the condition of the well and septic applies only to the conditions as of the day tested.
The ~ow and absorption rates may change due to subsurface conditions that may not be observed from
the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the
year and the water usage of the family being served by the system. The operational life of all well and
septic systems are subject to these various and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
KND can not give any estimate of how ,ong a ,,.~.~,'~'~'~.% _~% !~'-- -~,..
system will function satisfactory for current or future ~'.~..~o,,..,O.oo,,q.e, I.
occupants or can KND guarantee that no unseen _~.~V'~,., & -"o,."d- '~
encroachments, deficiencies or discrepancies exist, w v~ .° ~ Oo .~,-~
5. DSD SIGNATURE ,~
Approved for "~ bedrooms. ~--~
Disapproved. ;~'
Conditional approval for bedrooms, with the following stipulations:
Attachments: COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
By: '
(Re,, ~1
X
Amenic Adviso~
Maintenan~ Agreements
Supplemental Engineers RepoK
~her
Original Certificate Date~"~'~~
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw 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: KWIK LOG SUBDMSION: BLOCK 3. LOT 18 Parcel ID: 01 3-043-3 5
A. W~II DATA
Well type PRIVATE If A, B, or C provide PWSID # __
Date completed 6/1 S/94 Sanitap/ seal (Y/N)¥
Total depth 1~O ff. Cased to _lZ.0__ft.
FROM WELL LOG
Date of test 6/1 S/94
Static water level 1 ~ '
Well production ! 0
WATER SAMPLE RESULTS:
Coliform
g.p.m.
Arsenic:
We~ Log (Y/N) Y
Wires I~operty protected (Y/N) y
Casing height (above ground) 18
AT INSPECTION
~Z ft.
~,06 g.p.m.
0 colonies/100mL Nitrate _0.~IL Other bacteria 0 colonies/100 mL
ND mgll Date of sampl~Collected b_v: KND En_aineerin_a. Inc
B. SEPTIC/HOLDING TANK DATA - ~
Tank Type/Material Date installed Tank size gal.
Number of Compartments._ Cleanoute (Y/N)_Foundation claanout (Y/N) _Depression over tank (Y/N) _
High water alarm (Y/N), Date of pumping
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d.lft= or ~/bdrm) __
Length ff. W~dth ft. Gravel belmv pipe
Eft. absorption area ~ Monitoring tube
Date of adequacy tes[
Fluid depth in absorption field before test
Elapsed Time: min. Final fluid depth
Pumper
.System type
ft. Total depth
Depression over field __
Results (Pass/Fail) For
in. Water added__ gal.
in. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (WN & type) If yes, give date .....
bedrooms
New depth in.
g.p.d.
D. LIFT STATION
Date installe;I Size in gallons
"Pump on' level at__in. "Pump off' level at__
Datum. Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot NA
Absorption field on lot NA
Public sewer main 7~'+
Sewer/septic service line 25'+
Animal containment areas
Manhole/Access (Y/N),
in. High water alarm lovel at in.
Meets alarm & circuit requirements?.
On adjacent lots INA
On adjacent lots HA
Public sewer manhole/cleanout 1 00 ' +
Holding tank I 0 0 ' +
Manure/animal excrete storage areas 1 0 0 ' +
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation, Property line Absorption field.
Water main. Water service line Sudmce water.
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Water main.
Driveway, parking~ehicla storage
Property line.
Water Service line.
Curtain drain.
F. COMMENI~
Building foundation
Surface water
Wells on adjacent lots
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name KENNETH M. DUFFUS
Date 05/18/2006
COSA Fee NA-RECERT
Date of Payment.
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
SGS Environmental Services Inc
200 W. Potter Drive
Anchorage, AK 99518
Tel: (907) 562-2343
Fax: (907) 561-5301
SGS Ref. #: 1062424 All dates/times are Alaska ~tandard Time
Client Name: KND Engineering Pdnted Date/Time: 05/18/06 16:40
Project Name: KWIK LOG, L18, B3 Collected Date/Time: 05/15/06 13:10
'Client Sample ID: KV~K LOG, L18, B3 Received Date/Time: 05/15/06 13:16
Technical Director: tephen E
Ma,dx: Drinking Water Released ~'~'~
PWSID
Sample Remarks:
Allowable Prep Analysis
Parameter Results PQL Units Method Limits Date Date Init
Bacteria 0.00 9222B 05/15/06 05/15/06 tlf
Nitrate 0.11 0.10 tug,kg EPA 300.0 10.00 05115/06 05/15/06 air
Arsenic ND 5.00 ug/L 200.8 10.00 05/16/06 05/17/06 scl
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 013-043-3S
1. GENERAL INFORMATION
Complete legal description
Location (site address)
COSA#
Expiration Date:
KWIK LOG SURDIVIRION; LOT 1 8: RLOCK 3
721 EAST 73~ AVENUE: ANCHORAGE: AK 99518
Cu~entPropertyowner(s) WESLEY & TERILEMBECK Dayphone
7~1F_73m AVENUE: ANCHORAGE: AK 99518
Dayphone
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
OSBORNE & BRILEY - NTRE Day phone 751-2G00
205 E. BEN~ON BLVD.: ANCHORAGE: AK 99503
Un/ess otherwise requested, COSA will be held by DSD for pickup,
NUMBER OF BEDROOMS: _3._
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class __
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
[] IndMdual Holding Tank []
[] Community On-site []
[] Public Sewer []
The Municipality of Anchorage Development Sen/ices 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 ara required for the
transfer of title (except between spouses) for properties sen/ed 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 sen/ed 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 sen/ed 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 INSPEC'nON 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 flies 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 KND ENGINEERINR= INC
Phone {;96-6111
Address 20441 PTARMIGAN BLVD.: EAGLE RIVER: AK 99577
5. DSD SIGNATURE
[,~ Approved for _'~
Disapproved.
Conditional approval for
Engineer's Printed Name MICHAEL N ANDERSON Date~
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations.
The assessment of the condition of the well and septic applies only to the conditions as of the day tested.
The flow and absorption rates may change due to subsurface conditions that may not be observed from
the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the
year and the water usage of the family being served by the system. The operational life of all well and
septic systems are subject to these various and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
KND can not give any estimate of how long a
system will function satisfactory for current or future '"'
occupants or can KND guarantee that no unseen
encroachments, deficiencies or discrepancies exist.
,~] ~,~', CE-/946g . .., .-., .~
~ ~','?. ! 2'/2 ~"/~ ~,~'..'
bedrooms.
bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenlc Advisory
~,~0~ ""' ~5~.~'~'~'
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: ! ~ -'~.- ~ - ,0 .~
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-79O4
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description:
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID # __
Date completed 6/15/94 Sanitary seal (Y/N)..Y__
Total depth 120 fl. Cased to 120 ft.
FROM WELL LOG
KWIK LOG SUBDMSION: BLOCK 3; LOT 18 ParcellO: 013-043-35
Date of test 6/1 5/94
Static water level 1 :~ ' ft.
Well production 1 0 g.p.m.
WATER SAMPLE RESULTS:
Coliform
wst~ Log (Y/N) y
Wires p~o~a~fly protected (Y/N) y
Casing height (above ground) 18
AT INSPECTION
2Z ft.
4.06 g.p.m.
0 cotonies/100mL Nitrate _0~ Other bacteria 0 colonies/100 mL
mg/I Date of sample/]~22~'DS Collected by: KND En_~ineerln_~. Inc
Arsenic:
in.
B. SEPTIC/HOLDING TANK OATA - ~
Tank Type/Material Date installed Tank size ~
Number of Compartments_ Cleanouts (Y/N)_Foundation cleanout (Y/N) _D.~m~ssion over tank (Y/N)
High water alarm (Y/N~, - Date of pumping pumper /~
C. ABSORP~..ON FIELD DATA ~
Date installed . Soil rating (g.p.d./It2 or ft21bd,,~ System type
' ' ' ' ~ ' Gmvel.,~pipe ft. To
Length ft. ' Width ft. tel depth fl.
Eft. absoq3tion area ft2 M~3JtO~ng tube Depression over field __
Date of adequacy test / Results (Pass/Fail) For bedrooms
Fluid depth in a.a,~"on field before test in. Water added gal. New depth in.
Elapse~e: mm. Final fluid depth in. Absorption rate >=__ g.p.d.
.~ rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give data .....
D. LIFT STATION
Date instilled Size in gallons ~
*Pum~m. High water alarm level at_ .in.
D Cycles tested Meets alarm & circuit requirements?.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tenk/lift stition on lot NA
On adjacent lots NA
Absorption fielri on lot iNA On adjacent lots NA
Public sewer main
Public sewer manhole/cleenout 1 0 0 ' +
Sewer/septic service line 25'+
Holding tink 11 0 O' '1'
Animal contiinment areas SO'+
Manure/animal excrete storage areas 1 0 0 ' +
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWE~...--
Building foundation. Property line Absorption field
Water main. Water sewice line S~r
on adjacent Io~. ~-
Wells
SEPARATION DISTANCE FROM ABSO~LD ON LOT TO:
Property line ...~ng foundation Water main.
Water Se~.JJl~''''~- Surface water. Driveway, parking/vehicle storage,
Cufl~n drain. Wells on adjacent lots
F. COMMENTS
I certify that I have determined through field inspections and
rev/ew of Munic/pa/ reco~s thal the above systems are /n ~ *: 4 9~H /~ ~ ~ '~
conformance with MOA COSA guidelines in effect on this
Engineer's Printed Name NICHAEL N, ANDERSON ~..'. ¢E/9~6~ .,:~..~:~
Date 12/Za/ZOOS
COSA Fee $430.00 + MOA RUSH $175.00
Date of Payment 12/28105
Receipt Number (~ 7-~ 0 / 2.. ~
(~av. ~ ~/~) ~;/'
Waiver Fee $
Date of Payment
Receipt Number
LOT 8 LOT 7 LOT 6
BLK .3 BLK .3 BLK 3
LOT '19
BLK 5
S89'48'30"W 82.50'
o, 7.5'
WELL , ,,,
WOOD · //, 16.o' 7.6'
WALK ---.--~, ~]~, .~J
28.0' --
EXIS~NG ~ ~
~ WOOD FRAME ~ :O~R[I ~ LOT 17
~ . HOUSE ENmY ~ BLK 3
- ~40.0. ~
CONCRE~
LANDING CRAWL
D/w
~ LOT 18
BLK 5
82.50'
ANCHORAGE RECORDING DISTRICT
ASBUILT OF:
K%VIK LOG SUBDIVISION
LOT I$ BLK 3 PLAT 63-60
SURVEY CERTIFICATION: I, John L Schuller have
eond}lcted a physical smwey of this ~ as shown on this
dravong and ~at the improvements situated thereon are within
thc property hnes and no encroachments exist other than noted.
EXCI.~USION NOTES:It is the owners responsibility to determine
do not appear on the recorded subdivision plat.
~ ~ ~,~er~: C. 26, 200 1%30' ~,.e~..~
05--089 ~LS 21~t 0501/20
20441 PTARMIGAN BLVD.
EAGLE RIVER, Ali 99577-8736
(907)868-3791/FAX (907)868-3793
12-28-05;11:29 ;
SG$ Ret. #:
Client Name:
Project Name:
Client Sample ID:
Matrix:
PWSID
Sample Remadcs:
Bacteria
Nitrate
1058319
KND Engineering
Kwik Log, L18, B3
Kwik Log, L18, B3
Drinking Water
Results
0 OB, WIO Coil
ND
;907 561 5301
# 1/ 1
PQL
Urdts
0.10 mg/1(g EPA300.0
10,00
SGS Environmental Services lnc
2oo W. Pot~r;r~,~
Anchorage; AK 99518
Tel: (907) 56~2343
Fax: (907) ~1'5301
AW dates/times are Alaska Standard Time
Pdnt~d Dat~/Tlme: 12/28/05 10:30
Co]le~'ted~ Date/~e: 12/22/05 16:15
Received Date/Time: 12/22/05 16:30
Tech~ eel Dlrecior. ~,$tephen Erie//
~ !~ i '.~.11
I ; AJlowable Prep Anal~ls
Method ~Llrnlts Dale Date [nit
9222B t2/22/05 12/22/05 dpt
17./22/05 12/22/05 Jc
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Sect[on
P.O. Box 196650 Anchorage, Alaska 99519-6650
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILLY DWELLING
013-043-55
1. GENERAL INFORMATION
Complete legal description KWIK LOG SUBDIVISION: LOT 18, BLOCK 3.
Location (site address or directions) 7:~1 EAST 73RD AVENUE ANCHORAGE, AK 99518
Property owner MINNIE STEWART TRUST
Mailing address c./o TINA COLE W./ JACK WHITE ~00~-~
Lending agency
Mailing address
Agent TINA COLE W? JACK WHITE
Address .3201 "c" STREET ANCHORAGE. AK 99505
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: · .3
3. TYPE OF WATER SUPPLY:
Individual well xxx
Community well
Public water
D~hone
Day phone
NOTE:
Day phone
(907) 250-2280
If community weft system, provide wdtten confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding Tank
Community on-site
Public sewer
NOTE:
xxx
If community wastewater system, provide written confirmation from State ADEC
lng to the legality and status of system.
72-025 (Rev. 1/91) Front MOA fl21 Computer Version
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $800.00 at,
or prior to, closing for the engineering services provided. J
5, STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my
investigation of this Health Authority Approval application shows that the on-site water supply and/or
wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of
structure indicated herein. I fudher verify that based on the information obtained from the Municipality of
Anchorage files and from my investigation and injl.pection, the on-site water supply and/or wastewater
disposal system is in compliance with alt Muni~lC~and State codes, ordinances, and regulations in effect
on the date of this i nspection,~,~ /¢ ' //y !
Name of Firm ALASKAV~ATER &/~ %$T?~/ATE~R CONSULTANTS, INC. Phone (907) 337-6179
Address 6901 DEBARR ~OADI ,~{/ ~t,~ANCF~ORAGE, ALASKA 99504 / /
Engineer's Signature ~___.~/L~/'(/,,~ ~ Date
,, conducting tids evaluation, AwwC, In~. 4¢er~ ,ted to pr'~/o de a thorough, conscientiou, engineering analysis of the
system in accordance with ADEC and MOA~J:)Ht S Guidelines & Regulations. The reported results described the
performance of the system under the conditions encountered at the time of the test, and separation distances
measured to readily identifiable features. The operational life of all wells and septic systems depend
on the local soils condition, ground water 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 . .'. .,f l?~.
of the system, nor do they guarantee that there are no hidden defects or encroachments.
AVWVC, Inc, car, therefore not prot4de any warranO/ for future estimate of how long the iF{_ ~¢~;
system will continue to meet the operational requirements of the ADEC or MOA DHHS. .~r~,~_.
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, A, ..~,.ness..
;-7953
nor will it confer any legal right whatsoever.
6, DHHS SIGNATURE
~ Approved for ~
Disapproved
Conditional approval for
bedrooms
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of
homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of
DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA ¢Y21 Computer Version
RECEIVED
Municipality of Anchorage OCT 2 ?
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4~IICIPALITY OF
ENVIRONMENTAL SEE~EF.B.I~ISlUN
Legal Description:
A. WELL DATA
Well Type PRIVATE
Log present (Y/N)
Total depth 120'
Sanitary seal (Y/N)
Health Authority Approval Checklist
KWIK LO(; SUBDiVISiON; LOT 18, BLOCK 3, Parcel I,D,:
If A, B, or C, attach ADEC letter. ADEC water system number
Y Date completed
Cased to 120'
YES
Nitrate
PUBLIC
Date of test
Static water level 12'
Well production 10
WATER SAMPLE RESULTS:
Coliform 0
Date of sample: 10/19/00
B. SEPTIC/HOLDING TANK DATA
013-043-35
FROM WELL LOG
6/15/94-
6/15/94
easing height (above ground)
Wires preperiy prete~ed (Y/N)
ATINSPECTION
10/19/00
N/A
YES
19.5'
g.p.m. 4.2 g.p.m.
0.5 mg/L Other bacteria 0
Collected by:. A.W.W.C.. INC.
SEWER
Date installed Tank size Number o~ C~eanouts (YIN).
Foundation Cleanout (Y/N) ~/) _ High water alarm (Y/N)
~ Pumper
C. ABSORPTION FIELD DATA
Date installed Soil rat ng (g.p.d./ft2 or~'~ System type
GraVel thickness below pipe
Length
Effective absorption area Monitoring Tube present (Y/N) .~Deprassion over field (Y/N)_
Date of adequacy test Re~__ For __
Bedrooms
Fluid depth in absorption field b~ Irnm~.diatel~ after gal. water added (in.): _
Fluid depth J (iRs~"~inutas latar~bsorption rate =_ _
Ioln2 months) (Y/N) If yes, give date ,
D. LIFT STATION ~
Date installed._ Size
~at* "Pump off" level at*
Manhole/Access
(Y/N)
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
N/A
N/^
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
75'+
On adjacent lots N/A
On adjacent lots N/A
Public sewer manhole/cleanout 100'+
25'+
Liffstation. N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation Property line
Water main/service line ~water/drainage
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
PUBLIC WATER
Wells on adjacent lots
Property
line_ Building fou nd~
~ .....
Surface water / D '~/veh'm~e storage area
Cu~,~~ Wells on adjacent lots
F. ENGINEER'S C~
I certify that I
of Municipal rpco
with MOA H/jA g
Signature I_.~
Engineer's Nam,
Date
~]~lat~h~ab~ve systems are in conformance
HAA Fee $ ~ ~
Date of Payment -/~,/~-~
Roceipt Number
72-026 (Rev. 3/96)* Computer
Waiver Fee $
Date of Payment
Receipt Number.
lO-Z§-O0 11:25 FROI&-CTE ENVIRONMENTAL
,~t~. CT&E Environmental Services Inc.
5G15301
T-935 P.O1/O2 F-043
CT&E Ref,#
Client Name
Project Name/#
Client Sample 1D
Matrix
Ordered By
PWSID
1006565001
AK Water & Was~ewater Consultants Inc.
Kwik Log Lot 18 Bk 3
Kwik Log Lot l § Bk 3
Drinking Water
0
CLient PO#
Printed Date/Time 10/25/2000 11:10
Collected Daterl'ime 10/19/2000 13:40
Receiver} Date/Time 10/19/2000 17:00
Technical Director Stephen C. Ede
Sample Remarks:
Attouabte Prep AnaLysis
Parameter Results PaL Units Method Limits Date Date Init
Nitrate-N 0.500 U 0.500 mg/L EPA 300.0 10 max
IO/20/O0 SCL
TotalColiform 0 col/100mL SMI89222B 10/19/00 JDT
~JEPARTHF?,FF OF Ei'!VIRO[,~"iEHTAL 0UALITY
A, :cHo~'~,T,'~s~,~°~99~7
~AI'E :~ECEIVF. D: ....
INSPECT:__
TIME:
REqUES'r FOR APPROVAL OF
II~IVIDUAL SB'!ER N'D HATER FACILITIFS
FOR
1, APPROVAL REQUESTED BY~_.I(asslerJJVest Mortgage .Corporation
ADDRESS: ..............604 .~a~.~h~enue, ,~c~ Alaska
9 PROPER~ ~'~" ' ' .
,11 R, . ....
~, ,'.': _~Ogi-~...~J~a~ ~a ~llOi'.~E~ 344-6409
~, ~6AL DES~IPTIOi;:~_18,_~o~:~~ LOA Sub.
4, ~PE FACILI~ TO BE INSPE~',~t~___ _S~E~:~21_._~. 73rd St.
[IU~E'.R OF: 5EI)RO014S: ....
~'1~ ' ,
SlZ~ ....
SEPTIC TANK (IF !4OHD,~E, SILO,/DIA6R~I ON ~AC~
1, ~;IZ:L ........
2, AS~
I~,~UFAC~RER _
99501
!)9502
,~ -
APPROVAL RF."'U'.T..ST FO, P. 9~ !ER ".' :~'~'ER FACILITIES
~ AGe 'P. !0
1, SIZ::._....~_
2, LI :I;:O ~.
C, DISPOSAL FIELD "'
1, .~UI.L~,~, C)F LI ;ES ........
2, TOTAL LENGTH_
CA~ ~,,.~LL~TO SEPTIC
B,, ,,ELL TO~EE~AGE PIT
!'}, HELL TO PROR.ERTY LI ''~
E, '!ITLL TO OT~,~r'm
F, FOUf,DDATIOil TO SE'F4FIC TAF]K
F,,,FOUf,fDATIOr,.i TO SEEPA6E PIT
II, SF,EPAGE PIT TO PROPERTY,
o,
AR-FA .BOROUGH DEPARTMGFF OF BiVIROD$1F_.J, FFAL ~UALITY
ED 7!
[/[ MgISANCE COMPLAINT FORM
Complainant ' s Name: ¢ ~, ~ ~
Street Address:
Phone No.
Name of Person Against I~hom Complaint is Made:
Owner of Property ~here Nuisance Exists:
Owner's Address:
Location of Complaint:
Stmeet Address: .
Receiving Complaint:,, ~-~.,~,.
Per~on
Phone No.
I certify that such statement of facts is true to the best of my belief and know-
ledge, I request 'that the foregoing matter be investi?ated and that appropriate
action thereafter be taken. I am willing to testify to the facts stated in the
foregoing complaint in court if necessary,
Complainant
Investigator:
)ate Investigated:
etlon Taken:
REPORT OF ACTION TAKEN
7E C(1MPLAINANT WAS CALLED REGARDING DISPOSITION OF COMPLAINT: