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HomeMy WebLinkAboutPROSPECT HEIGHTS #5 BLK 1 LT 6Prospect Heights #5 Block 1 Lot 6 #015-135-06 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 Wastewater Disposal System and/or Well Inspection Report Permit Number. >�/�I��%� PIDNumber. 1 131 .-06, — Name: GT tz Z)? X Wastewater System: M New ❑ Upgrade Addreae: 069e -D 16 1 1 ( = t=om VLOA\-) ABSORPTION FIELD _ No. of Bgdr—=oms: Ii Phos— („� Deep Trench ❑Shallow Trench ❑Bed El Mound C1 Other_ a LEGAL DESCRIPTION _ -- Soil Rating: 0.11,1GPD/6e: Total Depth from original grade : _ Lot: Block: Subdivision - Depth to pipe bctl �a from original grade: Gravel depth beneath pipe y Township: Range: I Sectio Fill added above- original grade: Gravel length: y 6CJ `— Ft. Pt. WELL: *New ❑ Upgrade Gravel width: — Ft. � Number of lines: Distance between lines' 1 --Fl. _ Classification ((Private, A,B,C): _ Total Depth Cased To: Total absorptioi area: Pipe material: r at T:- Ft. I_I Ft. � )Q„%O SO. FL Y910 3o3y_ Driller: Daterilled g. Static Water Level: Installer: In Date installed: 4 i )'9 7 S UteN q% 1 I Ft. _U�/ e Y Yield: 07GPM Pump Set at I B0 IM FI. 0 Casing Height Above Ground: �>2. FL TANK —_--____— SEPARATION DISTANCES ASeptic ❑Holding ❑S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: Capacity toC From Tank Field Station Tank Sewer Lines Aw t'r _ �411\_ t� g -y Well I 104 175- — I Material: Number of Compartments: Surface Water t`toN �- Ivor,+t LIFT STATION Lot Line I f Size in gallonr Manufacturer: Foundation "Pump on” leve. at: — Pump off' level at: High water alarm at: Curtain \' Pump Make 8 Model Electrical Inspections performed by: Drain 1VL((G ITN BENCH MARK Ramarks: Location and D-scription: //++ — �— Assumed Elevation: •� )0-0 ENGINEER'S 5gALi i U 1 Inspections performed by: � I.Dates: 1s'. 2 �w�i7/ ! 2n�. 1 va Department of Fie�;Z nd Hum Services artprr y Reviewed and approved by: 72-013 (Rev 9/911 MOA 25 L07 9, HAMP70N HILL I LOT 10 I / I / � ------ -------�-- - .0�••P�-OFA��S���1 - --�' -----1 r - -- --- i 49th %;..r .................. i I I I III � ............. TND EN SPURKLAND ��Ctf,,•p. No. CC 2225 ••`��_�� I i FEL 7 I i l i Lar s II I III I�I swrNc TIES: AD 14.2 FT 50 100 150 200 250 300 AC ac 21 III SCALE 1' = 100 FT. AD 32 F BD 42 _ — Af 142 SLOPE DIST 8f 151 AF 52 sF e3 BG 15 L I J LOT 4 I I AB ° I � Wel II I I r I . II I I 1 1 I I II SCHUSS DRIVE ITORREN SPURKLAND P.E. I I LOT 6 DI,OCIC 1 PROSPL'CT IHIC.HYS j/5 I I SEPTIC SYSTEM AS BUILT I 203 W 15TH. AVENUE John J Slropko DATE: JUNE 16, 1997 ANCHM,,% AK. 99501 Schuss Drive SHEET: 2/3 GRID: 2540 PERMIT # SW960187 PID # 015-135-06 PSH01062.DWG __ I Out PRIMARY TRENCH Standard Trench: 2' bide 68' Long 12' Deep 7..5' Sewer rock 4' Cover NO SCAL E IE 61.3 SIL T BARR Double Clean Outs 1250 gal Seplic tank Foundation Clean out P 49th :BEN SPURKLAND No. CE -2225 p�aFEssio�° :' 1250 gal. septic tank IF 61.3 53.8 6 fl J BENCH MARK. GARAGE FLOOR ASSUMED ELFV 100.00 TOBBEN SPURKLAND P.F_. LOT 6 BLOCK I PROSPE'C'T HEIGHTS 115 SEPTIC SvsTEM ASBUILT 203 W15th Ave SEP77C SYSTEM SCHEMATIC DATE' JUNE 16, 1991 Anchorage Ak 99501 — 2�g_a9ia JOHN J. STROPKO SHEET. 3 3 GRID! 2540 PERMIT NO. SW960187 P.I.N. PSH01063,DWG ic rrtlffirh ooc co. ana SULLMN WATER WELD P.O. BOX 670272, CHUCIAK, ALASKA 86567 • TF_LEPHONE 688.2755 _ i OWNER OF LANE) __j= ln�h s -- Q0, 1)—L'_.____--- OEI'TH OF WE LL ' ADDRESS _ --------- ST -\TIC LEN 11 OF WATER F'1'. % LEGAL DESCRIPTION1)T.. fU 04 � C ( d� 11RAtV' DONN FT,_ Qlx_- --_ DATE -Started --_.---- roiled . GA1,S. PER H12 PERMITN1,1NIHER6�•�*j---- -- --------- KIND OF CAS .NG KIND OF FORMATION. From ---Ft. lo_. -Ft._ C•'�}rr NG �� LL�fi✓ From._-.._Pl. '---- From-�-_,__FT. Frum,__ft. to—_Ft. From_-_Ft-to-2� Ft._�.1-.�_'">lr� X'-- From—_Fl. .��---.-...._.�.�......_�..___ to Ft. From ^'- -------- .Ff,_r �� �.r-' rQr4�-1 Fl. to Ft. --�--� From__Ft. to FI` Frmllz�L=_Ft.tO/0-P, F't'om___ Ff. toFt, Fro") Ft- . -Ft. to_�r��' Ft.�6��%__--T--- _ From4Q�_Ft. tq/.Sq I,L4i4Je. r_ From_ FL to FtFrom .J.. � r-, 7__.T .-Ft, to-lq_) Ft___6ykc From -c ,_..__F t, t0 Ft. Froin -.__FI. to --'------FL.- ------------- -------- From ---Ft, to ---FL. ._..._...�.�._._.._._..___ From -----FL to --_-----Ft'---` ------' "------------ From— _FL 10-----Ff.-------__._..�._-- From --_--Ft. to—._FI. _---___-- _ From__.___ . 1, From. ------.Ft. 10 -----Ft.-.----------- ------------ From --....—Ft. to—.-__-Ft-------- ------------- From-_._ --Ft. (0..._ _____Ft..__-___ ____.__.______._______ Frnm_-__-}•t. tu_..._.___Ft. _..___.._-. From ----.Ft. to_ ----Ft.___.------------'--- Froin--_._[ 1. to-.-.--hr' From ------Ff. to ----FL— ------------------._.. Fram.,_—__Ft. to—• ----Ft ---------r-' ��_ I_ V "�. � ---_ _ MISCL_ INFORMATION. JUN 201997 MUt11civitt lly Ol Artcoorage 0(0- }•Iealtll $ FIIIman SprVICeS DRII_LrR'S N \MF ---- -0 .� rrrrtrrtlrtr6L,- ._._:• sI ar•I aalyr•t hJar', I �11'iS l•J� 1:_:0 I1H1 2.5-10-.4 r�LJ 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:SW960187 DESIGN ENGINEER:CONSTRUCTING ENGINEERS, INC OWNER NAME:STROPKO JOHN J DDS & OWNER ADDRESS:1000 WILLOW CREEK RD SUITE K PRESCOTT, AZ 86301 PARCEL ID:01513506 LEGAL DESCRIPTION: PROSPECT HEIGHTS #5 BLK 1 LT 6 LOT SIZE: 114751 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 7/10/96 EXPIRATION DATE: 7/10/97 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 ) (NOT REQUIRED FOR WELL ONLY PERMIT) 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 ISSUED BY DATE: L �%! `'�✓ DATE : 7--�'a .' / LOT 7 0 w C, O J w W 0 z - FOR: PEPPER'S CONSTRUCTION 10224 FRONTAGE ROAD EAGLE RIVER, ALASKA 99577 PHONE: 694-9661 LOT 6 LOT 5 REPLACEMENT TEST PIT PROPOSED DEEP TRENCH �1 ua1 --------- N TEST HOLE LOG ©,l ORGANICS 3, SILT SILTY GRAVEL 17' WATER 18' — PF -PC ® 7' - 7.5' SCALE: 1'=10' 4 NR HOUSE LOT AREA = 114,740 SF C, LESS &E T76ACKS, WELL RADII, 0 257,+ SLOPE AREA, DRIVEWAY AND HOUSE FOOTPRINTS 70,130 SF AVAILAI�L-E FOR \ \ n LOT 4 SEPTIG SYS`PEM 3 z � NOTE: NO WATER OR SEWER DEVELOPMENT WAS O&SERVED , n I WITHIN 100' OF THIS LOT. C:HUSS DRIVB. GE_PTIC ITE PLAN LEGAL-: LOT 6 R�LOCK I PROSPECT HEIGHTS ADD. 1F5 IN NE 1/4, 513, T12N, R3W SM OWNER: DR. GTRPKO DATE_ 7/7/95 �_ CONSTRUCTING ENGINEERS 9601 BUDDY WERNER DRIVE _ANCHORAGE_ALASKA 33516 SCALE: 1' - 100' 346-2000 1 OF 2 LEGEND O WELL -- EASEMENT wrf )1 '414 ry �o rano oon '� kr' co 3t' r� yY a V, �� un�e�aasowmoyooamorummJ moaya w •N y o AR)GOR TION SYSTLM Dr -GO N M' TAILS DEEP TRENCH SYSTEM MOVND SURFACE FIOVSE J 6ROUND -��s LEVEL CLEANOUT V TO 4' �- - NATIVE SOIL BACKFILL FROM FOUNDATION WALL. 4' SILT BARRIER SEPTIC TANK 1250 QALLON 05. - 2' ORAVEL OVER PIPE GLEANOVTS SEPTIC TANK - OPPOSINa�- 4' PERFORATED PIPE CLEANOUTIS IPERFS DOWNI 7.5 -- GRAVEL SOLID PIPE/ / - �GLEANOVTS 34' MONITOR TUBE O/ 4MIN. ' 0' MIN. � SEASONALLY HIpH - AROUNDWATER TABLE PERFORATED PIPE � _ L INSTALLED LEVEL -- BEDROCK OR IMPERMEABLE LAYER PLAN VIEW - SCHEMATIC SECTION TEND VIEW) NTS SCOPE: NEW ABSORPTION SYSTEM FOR A FOUR (4) BEDROOM HOME. THE SYSTEM WILL BE A DEEP TRENCH WITH 7.5' OF GRAVEL BELOW THE PIPE. ABSORPTION AREA CALCULATIONS: MINIMUM REOUIRED: 4 BEDROOMS X 150 GPD/BEDROOM =600 GPD CAPACITY SOILS RATING AT PROPOSED SYSTEM = 0.6 GPD/SF MINIMUM SIZING = 600/0.6 = 1000 SF TRENCH WALL AREA LENGTH = 1000 SF/15' = 66 FT PROBABLE IMPAC'PS TO ADJACENT LOTS: AS SHOWN ON THE SITE PLAN, DEVELOPMENT OF THE: WELL AND SEPTIC SYSTEMS FOR THIS LOT WILL HAVE NO SIGNIFICANT ADVL'RSE EFFECTS ON THE ADJACENT PROPERTIES: A. WELLS B. WASTEWATER SYSTEMS G. RESERVED SPACE / SURFACE AND SUBSURFACE AND D. DRAINAGE: DEE 16N DETAILS r' LEGAL: LOT 6 BLOCK j PROSPECT HEIGHTS ADD. i<5 + IN WE 1/4, 513, T12N, R3W SM OWNED: DR. STRPKO DATE: 7/7/95 SCALE: NO SCALE- . CONSTRUCTING ENGINEERS 346-2000 9601 BUDDY WERNER DRIVE 2 ANCHORAGE, AL=ASKA 99516 r. --n �✓y.y`caa �taaa �Ij��� @��`•y.e',IJ, is ..�a �f ��/ Ln�� iiEPd6�Piflati mte�auna..aaaa4 eaaata NO.Yi32.E F Juno 221, 1%3 OF To Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES , xww«...a.+.«•• 825 "L" Street, Anchorage, Alaska 99502-0650 a� al0 1rsY E SOILS LOG -- PERCOLATION TEST �°'««1D tt� �x •i' PERFORMED FOR: c�2S ���/. DATE PERFORME'rA.`_`r3"31— .� 15 LEGAL DESCRIPTION: L(^ ?kO5f EL7 J+7S- 5 township, Range, Section: ]rI z,t j f{-3UJB S 1--k DEPTH SLOPE SITE PLAN (FEET) Q../ Orly A'NtGs 1 E 2 3 G E✓ G 4 5 /r 8 - _ c tit PE lZ� 8 – 9 10 WAS GROUND WATER ENCOUNTERED? 2S J 11 1A1H0j /110,01role D S e /D /odow o IF YES, AT WHAT L /, ? O W S /4912 DEPTH? _, P E Depth to Water Alter _ f-9SJ 13 Monitoring? / % _ gate: 7 14 15 16 17 18 19 ON 7-Y -TS' Reading Date Gross Time Net Time Depth to Water Net Drop — _ to to 18. (P , 3 �/y • ,�y , 2 `/m (o q. yq „ 3oK lO� `f��v• "'I" _ 20 l�� PERCOLATION RATE '— / (minutesiinch) PERC HOLE DIAMETER g TEST RUN BETWEEN 7 o FT AND 7 FT COMMENTS USC De EP Tp15706H 2'4 wStK�Ihc�K a p, (a Cf'r>,S.F PERFORMED BY. COA]5 II . Cj-) R S I h1Lj� (,UI LSD 0 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. 72-008 (Rev. 4,85) to tA V N 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 G CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING //ttqr Parcel I.D. 015-135-06 COSA# US C II 9L V 0 tp 1. GENERAL INFORMATION Expiration Date: 1 _ 41 - / a Complete legal description PROSPECT HEIGHTS S/D #5; BLOCK 1, LOT 6 Location (site address) 10230 SCHUSS DRIVE * ANCHORAGE, AK * 99507 Current Property owner(s) STEVE DUNNING Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing address 10230 SCHUSS DRIVE * ANCHORAGE AK * 99507 Day phone RICK JARVIS W/ REMAX Day phone 110 W. 38TH AVE, #100 * ANCHORAGE, AK * 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 360-921-9894 244-3590 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 0 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 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 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. /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. attempted 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 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 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. 5. DSD SIGNATURE Approved for 14 bedrooms. Disapproved. 911 337-6179 Date 0000 49 H �* Q....:.. .............. / f y A. .... ... ess,i QO m �E C 7953 .•' �a0 �f��2coAo�O Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist V Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other ON-SITE WATER AND WASTEWATER PROGRAM By. // Original Certificate Date: (Rev. 11105) Municipality of Anchorage ' Development Services Department Building Safety Division On-Sfte Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: PROSPECT HEIGHTS S/D #5; BLOCK 1, LOT 6 Parcel ID: 015-135-06 A. WELL DATA *PER AAROW PUMP AND WELL INSPECTION. SEE ATTACHED. Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (YIN) NO Date completed UNKNOWN Sanitary seal (YIN) YES Total depth *151 ft. Cased to *50+ ft. FROM WELL LOG Date of test 0L Static water level �P� P�� ft. v Well production g.p.m. WATER SAMPLE RESULTS: Coliform O colonies/100 ml. Nitrates• g mg./L. Arsenic: Nug./L. B. SEPTIC/HOLDING TANK DATA Wires properly protected (YIN) YES Casing height (above ground) 12+ in. AT INSPECTION 5/15/2012 Date of sample: 5/15/2012 Tank Type/Material SEPTIC/STEEL Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (YIN) YES Depression over tank (YIN) NO Date of pumping 5/15/2012 Pumper C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 4/17/1997 Soil rating (.p.d./ft r ft2/bdrm) 0_6 Length 68 Width 118 ft. 5.6+ g.p.m. Collected by: GEG, Ltd. Date installed 4/17/1997 Cleanouts(YIN) YES High water alarm (Y/N) N/A ONE STOP SERVICES System type DEEP TRENCH Gravel below pipe 7.5 ft. Total depth * 14.6 ft. Eff. absorption area 1020 ft2 Monitoring tube YES Depression over field NO Date of adequacy test **5/16/2012 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 13 in. Water added 1230 gal. New depth 52 in. Elapsed Time: 195 min. Final fluid depth 37 in. Absorption rate >= 600+ g.p,d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date **HOUSE WAS VACANT AT TIME OF TEST. DRAINFIELD WAS PRE—SOAKED ON 5/15/12 WITH 2190 GALLONS OF WATER. D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN "Pump on" level at in. "Pump ofr level at High water alarm level Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankA'rft station on lot 100'+ On adjacent Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ Animal containment areas 50'+ On adjacent lots Public sewer manhole/cleanout I[ilowl 100'+ Holding tank N/A Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I cert/fy 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 JEFFREY A. GARNESS Date L COSAFee $ `►QU— Date of Payment 513111D Receipt Number 0 334NG� (Rev. 11105) Waiver Fee $ Date of Receipt Number iv......-_............ ey A. Garness.: CE L-1795 ago cS c Municipality of Anchorage Community Development Department Development Services 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 Nitrate Advisory Certificate of On -Site Systems Approval # 121186 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 6 of Prospect Heights subdivision. This inspection revealed a nitrate concentration of 5.88 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. LABOR AAROW PUMA; & WER SEROCE, LLC TO I AL LABOR P.O. Box 110496 WORK ORDERED BY DATE CONIP. TOTAL '. L4riOc. Anchorage, AK 9951t , \1r3. 7,� , 937 , (S Office: (907) 346-9355 •Fax (907) 333-8976 r Eagle River. (907) 622-9335 CUSTOMER ; JOB SITE dr - i' C E11TF t,EU.. F„?H n. r„ _ Oft iticLO #Uh .vir S t5?t P QUANTITY 1 f.. DESCRIPT[i PRICE AMOUNT • r - f y . F f F , r LABOR HOURS RATE AMOUNT TOTAL MATERIAL TO I AL LABOR WORK ORDERED BY DATE CONIP. TOTAL '. L4riOc. PAY THIS AMOUNT 2, SIGNk?URE {7 Hereby Acknowledge the Sansiactory Compie5on of the Above Described Work and agree that if above work is net paid for in 90 days I agree to alimv Aaroyv Pump & Well Service, L.L-C. the right to remove unpaid for equipment and charge For labor already performed & tabor Ye remove i.wpaid for equipment} TERMS: ACCOUNTS PAYABLE AT IGTH GP MONTH FOLLOWING PURCHASE, SERVICE CHARGE AT RATE OF T.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS. . .a, C .AA a at 4�p . .kD 1 } T [2] Fii JG Scs/ll�� ASBUiLT SEWARD & ASSOCIATES LAND SURVEYING 694-0829 1 HEREBY CERTIFY THAT 1 HAVE SURVEYED THE SCALE: FOLLOWING DESCRIBED PROPERTY s�p�1`,�ao �<cTtiEiC��'fd� 964�lta.ScoT� eP �: DATE' *- '\......... OF 4 R4 AND THAT NO ENCROACHMENTS EXIST EXCEPT AS p �� ••"S 4 INDICATED. 1T IS THE RESPONSIBILITY OF THE * T 5' a OWNER TO DETERMINE THE EXISTENCE OF ANY GRID:' EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- ve `�`� •'•G4G�� �� ' • Dne µark Seward M VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB 1 { LS -6918 r ��s ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. O�� MUNICIPALITY OF ANCHORAGE ? • DEPARTMENT OF HEALTH & HUMAN SERVICES U Division Environmental Services On -Site Services Section }s/ P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE Of: HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 2 q Parcel I.D.# 01� 137— ©C-� HAA# ��"C- � S `1 1. GENERAL INFORMATION Complete legal description _ I-0 �P oSP'GLl k4t~I614T Location (site address or directions) lU3u SLl-IU.Ss 0P1\)1= Propertyowner SjRG?tCo Day phone _ Mailing address L H U » Ut'-k\/k- Lending agency E �C'5 A A_JG_ 1(�AN 'K kE\ Day phone _ _ Mailing addressC1- Agent V IwcUt I—c-A LLor C'L4d,L&Pay phone Address 3a _L C_ S Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: _4___ 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF: WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: if community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) From MOA 021 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm oboe h �a, rV_laPhone x-79-3`�l� Address Engineer's signature 6. DHHS SIGNATURE FM Approved for Fa UR bedrooms. Disapproved. Conditional approval for Additional Comments —Date Cs.'� s �r c • 4 G U " ti.0.4. bedrooms, with the following stipulations: Date 5- / q I7 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 courtesyto purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-075(a AMI) Beek MOA021 Municipality of Anchorage AUG U X99 0* DEPARTMENT OF HEALTH & HUMAN SERVICES —) Environmental Services Division MUN WPAUIY OF ANCMURA 825 L Street, Room 502 • Anchorage, Alaska 99501 • (966% "T4HVJCEs Dlylslor Health Authority Approval Checklist Legal Description: _LO T Co 13 K 1 flnP>F:LT- tA i� Parcel I.D.: Q 15 135 - 0 6, A. WELL DATA `7 Well type —_ If A, 13, or C, attach ADEC letter. ADEC water system number Log present (Y/N) _ Date completed L �Caasinngg Total depth _ � � —_ Cased to Casing height (above ground) 2 Sanitary seal (Y/N) Date of test Static water level Well production FROM WELL LOG WATER SAMPLE RESULTS: 7 Wires properly protected (Y/N) AT INSPECTION -- x "43 1 Ci `3 J,b– q.p.m. Coliform __—� Nitrate —7Td 3,1�� Other bacteria Date of sample: _ g/091 9 �.—_—_ Collected by: _— 1 - S • --_ B. SEPTIC/HOLDING TANK DATA Date installed _! 7 / i'7 Tank size/,i-50 _ Number of Compartments �_ Cleanouts (Y/N)__�4_ Foundation cleanout (Y/N) _ Depression (Y/N) ��l High water alarm (Y/N) 1 —. Date of Pumping _��Lot —I —_ Pumper Ati el v `e S Joo I C. ABSORPTION FIELD DATA Date installed 111.q 7 —_ Soil rating (g.p.d./ftz or ft2/bdrm) _ �. C> System type Length _ 12 R _Width —_ Gravel thickness below pipe _�— r _Total depth Effective absorption area _L0Monitoring Tube present (Y/N).*_ Depression over field (Y/N) Date of adequacy test _ 615 ` 11 Results (Pass/Fall) _ O —_ For 1 --bedrooms Fluid depth in absorption field before test (in.); ��_ Immediately after SOD gal. water added (in.): _7D _ Fluid depth _.5 Fj (ins) Mimtes later:_ Absorption rate= _> bl� LQs _g.p.d. Peroxide treatment (past 12 months) (Y/N) � 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 on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: "Pump off" level at* Septic/holding tank on lot 10 Cj On adjacent lots > IO -0 Absorption field on lot >,2&-e On adjacent lots > I 0-C-) Public sewer main AZA- Public sewer manhole/cleanout t,//A Sewer /septic service line > 1 nt:? Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 1� Property line 11 JG Absorption field t — Water main/service line >A6 Surface water/drainage N ® Wells on adjacent lots i SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line l 1;2- Building foundation l 4D Water main/service line> I G n Surface water to l U Driveway, parking/vehicle storage area -;� 16, Curtain drain rk�v Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that / have determined thru field inspections and review of Municipal records that the _above systems are in conformance with MOA HAA guidelines in effect on this date. Signature 14 F Engineer's Name T)a Date i HAA Fee oo Date of Payment 0- Lp - 19 Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number AUG -05-99 16:51 FBrm i`, FONMENTAL 5615301 CT&E Environmental Services Inc. LaburatOry Divlslan VAry ,AeApv4V�vr Laboratory Analysis Report T-556 P 62/03 F-395 CT&.R Ref.# 993910001 Client 110li Pre -Paid Cobs/NW Clicut Name TobbeR Spurkland P.)=. Printed UatelTime 08/05/99 16:0 Project Namelll Lot 6, Bk 1, Prospect Collected Oate/Time 08/03/99 11:00 Client Sample ID Lot 6,13k 1, Prospect Received DateMme 48/03/99 14:10 Matrix PrLaking Water Technical Wrecta : Stephen C. %de Ordered By A'/z, _ I j _ .4 i7' 0 ,1 PWSI]5 0 Release Parameter Tota( Coliform Mitrare9l AiloHabl- Prep AnelrsiS Rosults POL units Met004 LimiL5 bate 01M. Inst 0 c01/100m1 SM18 9222a 05/03/99 KAP 3.58 0.500 ma/L EPA 300.0 10 max 08/03/99 08/03/99 SCL 200 W Paiier Drive, Anchorage, AK 99518-1606 — Tel (907) 562.2343 Fax. (907) 561.5301 3180 Peger Road, Fairbanks, AK 89709-5471 TO (907) 474-8666 Fax (907) 474-9685 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 Parcel I.D. # 01 G — ISG O h 1. GENERAL INFORMATION Nigagtiry NINENrAL OFgNCH UN 2 SERV t CSS �� S pN 0 199? Fc�� AFD HAA# Complete legal description LOT Ly1-2> V_ I DSPEC t 1�EIGwTS -615 Location (site address or directions) Property owner 1 20 1'' VCO O Day phone Mailing address ouX' C -re Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site LI/ Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/91) F.nt MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firmo Abe � ��1�1« 1 • E_ Phone P-71-�°� Address 010 -y ui 1.5 o'er --� Engineer's signature 6. DHHS SIGNATURE � Approved for 4_— bedrooms. Disapproved. Conditional approval for _ 0 FINSi(.TiF1[ •• u�2T 11- Ii Date S bedrooms, with the following stipulations: 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(aev.1/81) Bank MOA#21 MUNI FNVLR t,0 /4 LI NO ONM'NrgI RVNCy Municipality of Anchorage SeRv�CF DEPARTMENT OF HEALTH & HUMAN SERVICES . klUN Environmental Services Division 20 1991 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 3 4rrk/ VED Health Authority Approval Checklist C U Legal Description: LOT(o, 1: KY- 1, RoSptwCl Parcell.D.: dIJ - 13 rj0to H g r A wirs #] A. WELL DATA Well type 2 If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed A txt 19 1 (� Total depth I I{ Cased to 1 4) Casing height (above ground) Sanitary seal (Y/N) Wires properly protected (Y/N) _ FROM WELL LOG Date of test I Static water level I 1 -7 Well production WATER SAMPLE RESULTS: 9 - p.m - AT INSPECTION g.p. m. Coliform NSD Nitrate 0 5 (� 1,114 'A Other bacteria Date of sample: 511fG A7 Collected by: � B. SEPTIC/HOLDING TANK DATA Date installed L111 j Tank size / , D Number of Compartments A- Cleanouts (Y/N)4— Foundation cleanout (Y/N) X Depression (Y/N) N High water alarm (Y/N) Date of Pumping N�.4 Pumper h�( C. ABSORPTION FIELD DATA Date installed t// 7/ g 7 Soil rating (g.p.d./ft2 er-it2fbdrrrr) System type MM - Length L g Width c�- Gravel thickness below pipe 7 5 Total depth 1 Effective absorption area /b 620 Monitoring Tube present (Y/N)-;x- Depression over field (Y/N) rI N Date of adequacy test�/�t Results (Pass/Fail) Fluid depth in absorption field before test (in.); Fluid depth (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) _ 72.026 (Rev. 3/96)* For bedrooms Immediately after_ gal. water added (in.): Absorption rate = I g.p.d. If yes, give date 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 I D On adjacent lots Absorption field on lot _ ' p ���? On adjacent lots Public sewer main C��4 _ Public sewer manhole/cleanout Sewer /septic service line ��s' _ Lift station N//A SEPARATION DISTANCES FROM SEPTIC/H9L[31NG-TANK ON LOTTO: I Foundation _ / Property line ./ Absorption field 110 Water main/service line s Surface water/drainage Imo K 2 _ Wells on adjacent lots I SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: � � 1 Property line _ Building foundation . ) �U --Water main/service line _1 /Sin _ Surface water _v _ Driveway, parking/vehicle storage area _fib . Curtain drain Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that 1 have determined thru field inspections and review of Municipal records thatahe above systems are in conformance with MOA HAA guidelines in effect on this date. Signature _� Qc Engineer's Name Date HAA Fee $ `� �� _ Waiver Fee $ Date of Payment� Iq .1__ _ Date of Paymente. Receipt Number 0� � v_ � �_ Receipt Number 72-026 (Rev. 3/96)* T.7UN-20-1997 09:58 C:T&E ESI ANCHORAGE CT&E Environmental Services Inc. Ack I 9075515301 P.071,1713 CT&E Ref.# 973093001 Client leo# Client Name Tobben Spurkland P.E. Printed Date/Tine 06/19/97 09:45 Project Name/## n1a Collected Date/Tine 06/IQ'1'9'1 10:30 Client Sample LD 6/1 Prospect Received bate/Time 06/16197 15:45 Matrix Drinking Water Technical Director. Stephen C. Ede Ordered By PV'SID 0 Released By Samplc Parlarks Parameter Allnwabte Prep Analysis Results POL Units method Limits pate Date ini" Nitrate -N 3.60 0.200 mg/L Sm18 4500-NO3F 10 maX 06/17/9% Ji L Total Coliform 0 cot/100mL sm18 9222D 06/16/97 FAM TI IF! 21=1-1-I a? I_r :��, -T--'E E'=,1 HHCHORRGE 51-:7:515 177. F 01:'1=7 ME Environmental ;services Irlc. Laboratory 17ivisit� v�+.e�tr .vdr®.#A, r Drinking `hater :\nalysis Report for Total Gnlif`nrr RF (f) ' `".ML'CTIO %"SOF REVERSE SIDE BEFORE COLLECTING SA,1IFLE `IL•ST Bt COMPLETED BY WATER SUPPLIER C PUBLIC WATERSYS'TE\I I.U.# PRIVATE WATER 5''SI Y1 �d Send Resolts J .Bead fneelee 4ner •.,em rami �omo.n`�� �®�"���� I I ii,n� aewyr u p Send Reralo C Send In„olce-- SAMPLE DATE: Il/Z] Month SA,NIPLE TYPE. IK Routine i5 Repeat Sample (for routine sample with lab ref. no. J Special Purpose SALE LOC.:TIOfv D10 RD Day Year o Treated Water qty( untreated W-Accr Time Collected Collected BY Jun -- yc Pfe.v. Pnm �i1�t C1� 210 ”' Potter Drive Anchorage, AK 99518.1605 Tel. (907) 562.2343 Fax: (907) 561.5301 F3E�C"O�IPL6-1ED BY LA@OR.A1'ORI�~� ,lnalvsis shows this Vater SAMPLE to be: _- Satisfauory p L•nsatisfactorry G sample over }O hours ola, results may be ucreliable Same;e [�o'.ong In :r_nsu; �amplc 5`r.ould not be os'er qs hou:5 old at tSaminali0n to inolcme re!iable Muits, Please send new s_rnple via srecia!/delivery mail. Date Rceeis-ed "(ine Received __. .� �-�-• :\nalysis Began Analytical 3lethod: )3-_` embn sL Filtcr Numbero(colonisr dG nv. -- Result" A,ia hsc Tin•.<. —B,kC_TERIOLOGICAt. WATER A_ti.aLYSIS RLC_ORI) \I.\IO-NIUG RehdC Total Colifurm ,-..�,_...��.�_ Coli _. Membrane Filter: Direct Count 7 Verification: LTB —�y��ry�V llll tllkAr/H/rl!/i/ Fecal Coliform CcoiArmation _._ _,�� — . - ------�_--------•��-•-___.. Final Memb nc Filter Results f ��_d..�.-- •---�_- C614emf100 ml Reported B,i.(J L,1M �Q ;��.,�sl=.1 Time �-�'.. �-%l.! hrs is omnrents. _. W Anch F'bks Jun -- Datc:..._.�.-_... .... Tfm,_ Client aoti Cled of unsatlsfaetoty reSulcs! Phoned Spoke with I"axed Tin•.<. —B,kC_TERIOLOGICAt. WATER A_ti.aLYSIS RLC_ORI) \I.\IO-NIUG RehdC Total Colifurm ,-..�,_...��.�_ Coli _. Membrane Filter: Direct Count 7 Verification: LTB —�y��ry�V llll tllkAr/H/rl!/i/ Fecal Coliform CcoiArmation _._ _,�� — . - ------�_--------•��-•-___.. Final Memb nc Filter Results f ��_d..�.-- •---�_- C614emf100 ml Reported B,i.(J L,1M �Q ;��.,�sl=.1 Time �-�'.. �-%l.! hrs is omnrents. _. W