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SECLUDED HILLS BLK 2 LT 5
Onsite File #017-343-13 Municipality of Anchorage _ On-Site Water and Wastewater Section • (907) 343-7904 Pag 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201027 PID Number: 017-343-13 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name Eric & Katie York ABSORPTION FIELD ❑ Deep Trench El Wide Trench El Bed El Mound Site Address 13361 Badger Lane ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Secluded Hills 2 5 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. well100.5T n/a n/a n/a 74.0 TANK E Septic ElS.T.E.P. ❑ Holding [I Other Manufacturer Greer Capacity 1000 Gal. Surface water 100+ n/a I n/a n/a Material Number of compartments Lot Line 61.3 n/a n/a I n/a NA Septic/Plastic 2 Foundation 25.7 n/a I n/a n/a LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tank to drainfield 3034 Installer A+ Home Services, Inc. Drainfield CO/MT3034 Inspector Pannone Engineering BENCH MARK (Assumed elevation) 712 ft Inspdection im 2/28/20 2n 5/19/20 Location and description 3rd 41,, Top of deckat house point A ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval.- d A4 Date OF. ,jky, con— 9 A-1 *-. T � ....... .. ..... Steven R. Pannone Septic System ����I�t;,`'sem Approved Date �:. CE, 8149 • 2`� ° �� $lk 40FESSsa 1 Note: this approval does not include well permit requirements, kmev uoruu_i 8) Lf)mnpv _ z CD CC) O �:o �O m'"Acmi1G Q F- pz�v D moo c 20x-1 z0o1U',O C N D p m O W F p z C� z0 O b /v m Q z n r m O N C7 W W W N O O P D CD co to J W W N -' P N c0 O N U U1 N to -+z-00 zo�Frl �CA C0D �m;— m0U) Z Om C) CD O W `n � D cn m M (D m O `G () NOTES: PANNONE ENG SVC, LLC (C.1. 1088) RECORD DRAWING P.O. BOX 1807 PALMER, AK 99645 PHONE (907) 745-8200 FAX (907) 745-8201 SECLUDED HILLS B2 L5 DRAWN MJL ERIC & KATIE YORK 13361 BADGER LANE CITF- PI ANI Aninrrr-\nArlr Ari nncar_ CE OF" y.�gs''b - 0.. 9 Stave. R. P..n.- CE-8149 \, REVISIONS u` 6/24/2020 1 " = 50, I.D. NO 017-343-13 6 cq "Ie 4� C) 40 caz C),2'6 t Q) Lv > ow 0 U t - 0 1 I (D, Q) -C n_0 C 6666'toOZ7 ' U) E- :3 41 V) -0 0 LL.0 I -Ce c 0 > '0 c 4P, /C'4 0 < CL cp C) 0 C6 cl? 0 -C U) 0 C: 0 oo 3. -1 C < Gi 0 4116w_q� ck� 0 0 1 I '00.m� L_ 00 > LZ In 60. 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CP 0 a- C) — C 0 Q) 00 2.-c :a 4 z 0 c o) (), , -�i c:0 c > E 0 CN 4) (n Q) 8- 00 c0 - co > 0 0 Q) L -C 0 '� o :E U) 0.� 0 0c C: a) C 0 C C7 4 _j _j v -C 0 0 cn 0 C) 0 o %_ C: (D 0 C C 0 11)41 Ld Co E E L6 E > - E:6 -0 4, 0 0 0_0 0 O -r- 0- 0 Lu E I U) :3 u CL 0 a u -r- 0 c 0 'n c E0 -C (D 0 < -v, XtA 'Aw 0 # 6 loor As, 0 E �. ,iii Engineering e i {� - i' is :ii , ; r Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com 31 July 2020 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road P. O. Box 196650 Anchorage, Alaska 99519 Subject: Secluded Hills B2 L5 Inspection Report & Record Drawing Comments Permit Number: OSP201027 Ladies and Gentlemen: On 7/23/2020 we received comments in response to inspection report and record drawing submittal. The comments have been addressed as follows: 1. The as -built survey appears to be missing the tank double cleanouts. Please address. Response: The tank double cleanouts are located next to the diverter valve. See attached photo. 2. The location or orientation of the septic tank on the as -built survey does not match the record drawing. Please address. Response: The survey shows the second compartment of the tank having a manhole. The manhole is used as a riser for the first compartment of the tank as the record drawing shows. See attached photo — septic tank orientation on the record drawing is correct. Please contact me if you have any comments or concerns. Sinc e Steven R. Pannone, P.E. Owner/Civil Engineer Ancho,age IG3 !{![3 P,O Box 1.00,217, AnIchorage, AK 9951.0-021 7 PalrnPer !`4 aihng6 P,O. Box -11807, Palmier, A!, 19645 �. sCf.jL`2�(�«; t 'r}tt0S!elelo'1011 ,SC MUNICIPALITY OF ANCHORAGE On -Site Wmter& Wastewater Program POBox Y8665 470OElmore Road Anchorage, Alaska g9519'GV5U Phone: 904 Fax: (8O7)343-7887 Permit Number: [)GP201027 Effective Date: Work Type: 8opUcTunkUpgnade Expiration Date: Tax Code Number: 01734313000 Site Legal Address: SECLUDED HILLS BLK 2 L 5 G:2837 Site Mailing Address: 13361 BADGER LN, Anchorage Owner: YORK ERIC &KATIE Lot Size inSqFt: Design Engineer: PANMDNEENGINEERING SERVICES Total Bedrooms: This permit isfor the construction of: 2/2512O20 2/24/3021 El Disposal Field 10Septic Tank ElHolding Tank I-] Privy 1-1 Private Well 0 Water Storage All construction shall 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 VVaotevvoba[ Disposal Regulations (18AAC72)and Drinking Water Regulations /18AAC8O> 3. The wastewater code requires inspections during the installation. The engineer shallnotify the Development t Services Department per AMC 15.G5.Provide notification bycalling (S87)343 -78U4(24/' 4. From October 1GhoApril 15. osubsurface soil absorption system under construction during freezing weather shall beeither: o. Opened and Closed onthe same day, or b. Covered, sealed, and heated hVprevent freezing cia|Provisions: Aminimum 2O"nnanvvayriser iorequired tothe first compartment ofthe septic tank. Received B) Issued By: Date: 3 90909-j? MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 017-343-13 Property owner(s) NORMAND & CHARLENE LAGASSE Day phone Mailing address 13361 BADGER LANE, ANCHORAGE AK 99516 Site address Same Legal description (Sub'd., Block & Lot) SECLUDED HILLS B2 L5 Legal description (Township, Range & Section) Lot Size 48,980 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial El Single Family (SF) ❑X (w/wo ADU) Septic Tank ® Upgrade ❑X Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ I(SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: x 5_ Waiver Fees: Date of Payment: a�I QIo�D Date of Payment: Receipt Number: ���i�J(�%L Receipt Number: Permit No. �S �� ��� Waiver No. i a Permit App_:- r Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201027, Rebecca Carroll, 02/25/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201027, Rebecca Carroll, 02/25/20 Municipality of Anchorage Community Development Department Page 1 of 2 On-Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage,AK 99519-6650 • http://www.muni.org/onsite• (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP171179 PID Number: 017-343-13 ❑ New ❑✓ Upgrade Name: ABSORPTION FIELD NORMAND &CHARLENE LAGASSE Address ❑✓ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound 13361 BADGER LANE, ANCHORAGE AK 99516 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 1.2 GPD/SFl 9.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot 3.5 Ft. 6.0 Ft. SECLUDED HILLS 2 5 Fill added above original grade Gravel length Township Range Section 0.0 Ft. 34 Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES 2.5Ft. Ft. To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Lift Station Tank Line 408 Ft2 1 Ft. Well N/A 100+ N/A N/A 25+ TANK ❑Septic ❑S.T.E.P. ❑Holding ❑Other Manufacturer !Capacity Gal. Surface Water N/A 100+ N/A N/A Material Number of compartments Lot Line N/A 40.7 N/A I N/A NA LIFT STATION Foundation N/A 41.5 N/A N/A Manufacturer Capacity Curtain Drain N/A 50. N/A N/A Gal. Pump on level at Pump off level at High water alarm at Remarks in. in. in. Pump make and model (Electrical Inspections performed by House to tank Tank to 3034 PIPE MATERIAL grainfield Installer A+ HOME SERVICES Drainfield 3034 CO/MT 3034 InspectorPannone Engineering Services BENCH MARK (Assumed elevation) 108ft Inspection 151 27JUL17 2nd 09AUG17 Location and description 3d 4th House Trim near foundation cleanout amp COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL ��Engineer's St`"`a .gi 4'�Off'.....0 �i Conditional Approval: Date 00/4.17'••' ,f- r*• 4 • moi\ *#A 0'•t'teven 'A:'15annorae j p J ... Approved (tom `�* /� Date Z C l7 lkVii.P40FESS1�.�+f Inspection Report_1-1-12.doc DESIGN PARAMETERS \ / w` — WATER LINE / PRIMARY SEPTIC SYSTEM \ ' WELL RADIUS \ •NO. BEDROOM: 3(450 gpd) �M 1 WELL (E) y -.I TANK SIZE: 1000g ss ss — NEW SEPTIC 4 z� *� /SOIL RATE: 4.9 MPI \ ABBREVIATIONS ,% ***** _ SOIL RATING: 1.2 GPD/SF ' ' ** '1� '� AREA RQD: 375 SF TH TEST HOLE SYS. TYPE: DEEP TRENCH 6.0'ED (P) PROPOSED MIN LENGTH: 31.3 LF I (E) EXISTING j\ __________ '4•: CO CLEAN OUT NO. / 44 NORTH SCALE : r_5Q' USED: /MT MONITOR TUBE NO. 34.OLFx2.5'Wx6.0' E.D., 9.0' TD / TYP TYPICAL TOTAL AREA: 408 SF / A B / \ \ IE DV 25.0 33.6 CO1 42.8 50.4c . W D MT1 42.4 50.3 `/ lb CO2 65.6 80.5 .fr 4., • ----..... )1 - MT2 65.8 80.6 / / W w y • ,145.5 / 11 5 , • / NN„......,__ 9 � I ! w 121.0 3BR W OA SFD 40.7 /.4410111111, _ / i Nillr-- -/,� IN INSTALLED ABSORPTION FIELD N 34LFx2.5 Wx6.0 E.D.,9.5 T.D. W/ "BULL RUN" DV BEFORE FIELD, 61.8 I W/ COs Sc MTs AT ENDS OF FIELD w 07K K 0 ¢'' GRAIN ROCK 6" ABOVE PIPE INV p z o zo 4"0 PEREORAI'EO DRNN PIPE EA u- FILTFR fA AIIC 1-- EL. 100.0 MST 101 I -61-7;WICK 3.0 O.ay _6. I `0.5 '— " wow . ou 95/ 9fi. 6.0 .—• y ay swo PROFILE ,._ SCALE 1"=10' u— a— is— M— LLC Il p�C.. NOTES: PANNONE ENG SVC, LLC �•, DOS/09/2017 RECORD DRAWING P.O. BOX 102954 ANCHORAGE, AK 99510 �';!•' •. PHONE (907) 272-8218 FAX (907) 272-8211 tD"•• �4�'•. Scale *;' • 1. /\ '.* 1" = 50' ... .`t .... 11) .. P.I.D. NO SECLUDED HILLS B2 L5 , ' .�. ( .17-343-13 NORMAND & CHARLENE LAGASSE ;°�"°". 'cnno�s PERMIT NO. DRAWN JRL ;.*. CE 8149 OSP171179 13361 BADGER LANE ; licv:11/27/2o;r SITE PLAN ANCHORAGE, AK 99516 '',,,' Sheet 2 OF 2 I MUNICIPALITY OF ANCHORAGE mens / ` On-Site Water& Wastewater Program 1° �; PO Box 196650 4700 Elmore Road • Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 http://wwwmuni org/onsite )uparttucnt 4h CNoR On-Site Wastewater Disposal System Permit Permit Number: OSP171179 Effective Date: 7/18/2017 Work Type: Septic Upgrade Expiration Date: 7/18/2018 Tax Code Number: 01734313000 Site Legal Address: SECLUDED HILLS BLK 2 LT 5 G:2937 Site Mailing Address: 13361 BADGER LN, Anchorage Owner: LAGASSE NORMAND & CHARLENE Lot Size in Sq Ft: 48980 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 3 This permit is for the construction of: El Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received B . ,,,1.'.z`� At11 !lila Date: Issued By: Aer Date: 8 o?OI MUNICIPALITY OF ANCHORAGE Community Development Department %0. gori Phon-• 'o1 ::• Development Services DivisionF On-Site Water& Wastewater Program ry ON-SITE SEWER/WELL PERMIT APPLICATION °- JUL 1 1 2017 3 6 • r. Parcel I.D. 017-343-13 << c,n� NORMAND & CHARLENE LAGASSE a 6 9 L Property owner(s) Day phone Mailing address 13361 BADGER LANE, Anchorage AK 99516 Site address 13361 BADGER LANE, Anchorage AK 99516 Legal description (Sub'd., Block & Lot) SECLUDED HILLS B2 L5 Legal description (Township, Range & Section) Lot Size 48,980 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (El all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑ Upgrade ❑X Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 451A— Waiver Fees: Date of Payment: 7/fj/i '. Date of Payment: Receipt Number: 631'474 Receipt Number: Permit No. ((3Pfl l Waiver No. Permit App__. :..c Pannone Engineering Services ac Steven R. Pannone, Principal Registered Professional Engineer E-mail:steve@panenRak.com July 10, 2017 Subject: SECLUDED HILLS B2 L5 Septic System Request Design Narrative This is a design narrative for a permit to install an upgrade absorption field to be issued for this property. The proposed absorption field will serve an existing three (3) bedroom house. Currently the lot is developed. The system will utilize an upgrade conventional drain field. This lot and the surrounding lots are served by private wells. There are no wells within 100' of the proposed septic system. 1. Soils. One test holes was performed in the vicinity of this system by PES in June 2017, and groundwater was monitored for at least seven days. Ground water was not observed in the test hole monitor tube in June of 2017. Bedrock was not encountered in the test hole to 17.0'. Based on the results of the percolation tests and overall soils appearance; an application rate of 1.2 gallons/day/square was used for a conventional wastewater system in the area of the test hole. 2. Soil Absorption System Design. a. See Sheet 1 of the design package. 3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The existing topography on the lot generally slopes from east to west, with a slope of approximately 0-2% in the area of the drain field. There are no steep slopes within 50' of the proposed drain field. The proposed drain field will maintain 50' separation all steep slopes. 5. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and there are no further comments received from MoA On-Site Department, "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of this or the surrounding lots. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 £DESIGN PARAMETERS N w w — WATER LINE / J �� PRIMARY SEPTIC SYSTEM WELL RADIUS.----- 141111 /NO. BEDROOM: 3(450 gpd) r% TANK SIZE: 1000g —ss\--ss — NEW SEPT-T- \ ...A . PERC -T- PERC RATE: 4.9 MPI ABBREVIATIONS ~�'" ' SOIL RATING: 1.2 GPD/SF - M -� o' ..„, , ce AREA RQD: 375 SF TH TEST HOLE 41 , SYS. T \YPE: DEEP TRENCH 6.0'ED (P) PROPOSED 11,'' / \' MIN LENGTH: 31.3 LF (E) EXISTING - - CO CLEAN OUT NO, 'LJ TRUE NORTH to. SCALE : 1.=50' USE: MT MONITOR TUBE NO. \ 34.0LFx2.5'Wx6.0' E.D., 9.0' TD NP TYPICAL TOTAL AREA: 408 SF ` 1M 1 WEL/ \ 21 li \ 4 I fw I ` ' M ______ 41 i'N--_,/ / 17 • -. • \ / „ WE fr . —/ /• • ~ . / W 135.0 •• �— W $ 5 lil Q /� �5 v ry I W _ 16,0 123.6 3BR ____/_ W SFD /'b I 34.0/ / im_ :� \0 a4 ,, / I. AA INSTALL ABSORPTION FIELD(P W -________ t=i7 34LFx2.5'Wx6.O'E.D.,9.O'T.D. W/ DV BEFORE FIELD, W/ COs & 65.0 MTs AT ENDS OF FIELD i !___ . . . _ . _ . — . _ . _ . — . — . , NO WELLS W/I 100' OF SYSTEM TO SOU Irl I /� TT Q SVC, TT � A NOTES: PANNONE LNG S v C� LLC Dote 07/10/2017 FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, AK 99510 P'tF'•'"' PHONE (907) 272-8218 FAX (907) 272-8211 .• �I Scale *.49 1. .• 1" = 50' •• •• • •'f' P.1.0. NO SECLUDED HILLS B2 L5 .• •\ c. 017-343-13 DRAWN JRL NORMAND & CHARLENE LAGASSE ••kl ^ R• �O^"O"° PERMIT NO. 13361 BADGER LANE -•••eE : 1:•' OSP171179 SITE PLAN ANCHORAGE, AK 99516 ';;, • Sheet 1 OF 3 I TEST HOLE 1 SOILS LOG — PERCOLATION TEST OR TOPSOIL SLOPE 5 L P ; 95_.-------( / -- , Brown Silty 2 SW/SM SAND & GRAVEL , �� A✓ 3 /j Iw v 4 �4.41-4. o 3BR 5 SFD 6 \, X TEST 7 HOLE \*::</- allillIIIIIIIIIIIN 8 9 SM Silty SAND 10 11 12 13 WAS GROUND WATER SLOPE 14 ENCOUNTERED? N 15 TH 1 IF YES. AT WHAT 16 DEPTH? —NA—' — -- 17 I DEPTH TO WATER AFTER DATE PERFORMED: 29JUN17 MONITORING? — DRY DATE: 10JUL17 CLOCK WATER RATE SOIL TEST RESULTS/ANALYSIS READING DATE TIME NET TIME LEVEL NET DROP (MPI) • PERCOLATION RATE 4.9(minlinch) READING (Hydrologic Soils Group: HSG A) 1 10JUL17 1105 5.900" • PERC HOLE DIAMETER 6" 2 1115 10 MIN 8.041" 2.141" 4.7" • TEST RUN BETWEEN_5 FT AND 6 FT. 3 1116 5.900" • TEST RUN FOR OVER AN HOUR, LAST THREE READINGS PROVIDED. 4 1126 10 MIN 7.940" 2.040" 4.9" 5 1127 5.900" 6 1137 10 MIN 7.935" 2.035" 4.9" COMMENTS:Test hole excavated by A+ HOME SERVICES. PERFORMED BY:Joseph Lawendowski_ I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES: PANNONE ENG SVC, LLC Dote FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, AK 99510 p�(�G. •• 07/10/2017 PHONE (907) 272-8218 FAX (907) 272-8211 1 1,_••. Scale — *149 • i NTS r � SECLUDED HILLS B2 L5 'Ili017-343-1? DRAWN JRL (� NORMAND & CHARLENE LAGASSE ' ••43erren :••anno�e - PERMIT NO. 13361 BADGER LANE ..."•RESD'7 0�749 ' OSP171179 SOILS LOGS ANCHORAGE, AK 99516 '-o"• Sheet ‘" 2 OF 3 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH AMC 15.65 AND 15.55. 2. SCOPE OF WORK: INSTALL UPGRADE SOIL ABSORPTION SYSTEM. 3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 17 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 17 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. 4. THE CONTRACTOR (BOTH WELL AND SEPTIC SYSTEM CONTRACTORS) SHALL HAVE ANY WELL LOCATION AND SEPTIC LOCATION STAKED AND ANY LOT LINE AND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET OF THE PROPOSED SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE WORK. 5. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED. 6. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES. 7. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING AND LOCATES SHALL BE IN PLACE PRIOR TO NOTIFYING THE ENGINEER. 8. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS AND SITE CONDITIONS/LIMITATIONS POTENTIALLY CAUSING THE NEED TO MODIFY THE DESIGN. 9. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED—LINE AS—BUILT DRAWINGS TO THE ENGINEER. THE RED—LINES SHALL INCLUDE PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND TANK ELEVATIONS. 10. THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE BOTTOM OF EXCAVATION, TOP OF PIPE WITH CLEAN—OUTS AND MONITOR TUBES INSTALLED, INSTALLED TANK AND FINAL GRADING. 11. THE CONTRACTOR PROVIDED DATA (UPON WHICH THIS RECORD DRAWING IS BASED) APPEARS TO REPRESENT THE PROJECT AS CONSTRUCTED. THIS DATA IN CONJUNCTION WITH THE PERIODIC FIELD OBSERVATIONS BY THE ENGINEER (OR HIS DESIGNEE) AS REQUIRED BY AMC 15.65 DOES NOT GUARANTEE THAT THERE ARE NO HIDDEN DEFECTS BY THE CONTRACTOR. 12. THE CONTRACTOR SHALL SIGN THE FOLLOWING: I CERTIFY THAT ALL WORK WAS PERFORMED IN ACCORDANCE WITH THE APPEND PERMIT, AND ANY AND ALL CHANGE ORDERS, AND THAT THE AS—BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS CONSTRUCTED. CONTRACTOR: BY: . TITLE: DATE: NOTES: PANNONE ENG SVC, LLCDat i FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, AK 99510 07 10 2017 PHONE (907) 272-8218 FAX (907) 272-8211 -•••• 1:••,• Scale • i. % NTS •` :•••• • •• •• P.I.D. NO SECLUDED HILLS B2 L5 , 017-343-13 & NORMAND CHARLENE LAGASSE � ' •• �everi•=• •bri ode PERMIT NO. DRAWN JRL CE 8149 p 13361 BADGER LANE ,••13Ev:o7/18/2o1.7• OSP171179 DESIGN NOTES ANCHORAGE, AK 99516 ''a;AtiEssoi Sheet 3 OF 3 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAI_I'H & ENVIRONMENTAl. PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99§01 Telephone 264-4720 ON-SITE SEWAGE DISPOSAl. SYSTEM AND/OR WELL INSPECTION REPORT NAME LEGAL DESCRIPTION I ~AYoII A [ Absorption area I Dwelling ~ ~ Manufacture Mate ~ ~ kiq' capac?~WnsI IF HOMEMADE ~ 2~ DISTANCE TO Well DweHin9 No. of lines Length of each line Total~iq~ I~length of lin Trench width Top of tile to finish grade Type of crib lepti~ Well Depth Driller DISTANCE TO: Buildin9 foundation Sewer line NO. OFBEDROOMS PERMIT N(~,),/d~)-~.. No, o~.~mpar tments Liquid d e[Ltl) PERMIT NO. L~rquid eapaE~y in gallons ----- PERMIT NO.(~/(~ ~.~. To~ctive~P~On area PERMIT NO. effecdvo absor~v~rea ~ ~ Distance to lot Hne ~PERM]T NO. ~)/¢~ ~ 0 T Ft E R PIPE MATEI~A LS~,~.~./.~ ~" SOIL TEST RA*flNG INSTALL REMARKS , xc.).-4 A aJ DATE LEGAL /, / M-W DRILLING, Inc. P.O, Box4-1224 · 1310C International Airport Road (907) 274-461] ANCHORAGE, ALASKA 99509 DRILLING LOG Well Owner. Tom McGee Use of Well Domes tic Location (address of: Township, Range, Section, if known; or distance main road_ Lot 5 Block 2 Secluded Hills Subdivision Size of casing 6" Depth of Hole_ 321 ~eet Casedto 301 feet Static water level 190 ft. (at~gjK (below) land surface. Screen ( ); Perforated ( ). Describe screen or perforation /~/0///~ff' Well pumping test at 5 gallons per (t~r) (minute) for of drawdown from static level. Date of completion September 22, 1981 Finish of well (check one) open end ( hours with- WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, co]or and hardness 0 .TO. 2 Cas ing 2__TO. 76 TO. 93 .TO. 135 .TO. 150~TO. 195 TO. 210 _TO 220 _TO _225 TO 298 ZO _301 TO ZO _TO TO x ); ft. 76 93 135 150 195 210 220 225 298 301 311 Silty gravel Sand S±ltX-gravel Clay Silty ~raVel Weeping hard Silty gravel Sandy gravel with 1 GPM Silty Kravelly hard pan Sandy gravel & H20 5 GPM MUNICIPALITY OF ANLHORAG[: DEPT. OF HEALTit & RECEIVED Silty gravellZ hard pan 5 GPM IC,'~AVA C cr4~ ,.a~-C on tr ~, cio ~ CCH![ ' ~ Nn~, 81-i 6:'373 1 -- CUSTOMER FII::'F'L I C FiI",IT L..OCFIT ]~ ON LEGRL. I'"ICGEE INDUSTRIES BFIDGER L. FINE L. 5 B2 SECL. U£>E[.', HILLS S,/L":, SF?.FI 80',:.( 566, RNCH. 99507' L.OT SIZE 48980 ':Sg~LIFIIRE .- := , , - ,:',.,,:'":', .,-. /f ~ ~¢~0 T~r'PE elF :,. IL dE,..,..RFIILI,I .-.,*..,1Ell It,. TRENCH MFI~'(ZMI..IM NUHE~ER OF' E,E. E F .... fl ...... .~':~' =,-IL [..Hq Zfla '::2;g! F f,. El ...... ; "I'HE RE[;!Lll:REI} E;:[ZE OF 'TFIE :5OILPE:.FF-]-;l" "'"[ [ .14' _.,r_,TLII':"": :" ZS : '1"'IWE LEHGTFI E:,IMENSION ]:S THE LENCiTH ,::IN FEET> OF TFIE 'I'RENCH OR THE E:'EPTH OF FI TF~'EH:'FI OR PIT .[:, THE L .[._,FHhlLE E,E. TI IE[_f,I THE _,/.IRF[ ..E laF.I_IUI;E. FINE:' TFIE E.,_T1 _11 OF' THE: E::.::IZ:FI',,,'FITION '::IN FEE'I">. THERE ZS 1'.4"f '= ...... I RENL. Ht _,E.I N~[:,TH F'"~' ";'-' " :.c. ]'FIE GRR',/EL. DEPTH Z_., THE MINZMLJM DEPTH OF GRFI',/EL BE. TIIEEN THE CJTF'FILL FIND t'FIE BOTTOM OF THE E::'::CF~'VFYFZON '::IN FEET>. PERi"IZT FII':'PLICFtI';'T HFIS '1"'FIE RESPOi',ISID:[LIT'¢ TO INF'OF,;tM I NSTFILLFFI" 1 ON Z NSI::'ECTI ONE; OF' FIN"r' NEL. L.:'5, FI[),IFICENT TO I";UHES:~: OF RESIDENCEr5 'T'HFIT THE NELL ;4ILL ~;ER',?E. 'I"HIS E:,EF'FIRTMENT [:,I_IRIi',!G THE TI'ti'}; F'f;?.OF'ERT'¢ FINE:, THE HINII"ILIM C'IS;'FFINCE E:E'i"I-,IE[S~",I F:I NELL FIN[:, FII'.,I¥ ON--SI'f'E SENI::IGE DISF:'OSFII._. SW:':;TEH IS ::L80 FEET F:'OR FI F'F::I',/FtTE HELL OR :L58 TO 208 FEET F:'ROH FI F'UEi:LIC NEL. L DEPEiZN[)IN(:~i UPON THE T'T'PE OF PUE~L. IC HELL_ hl]:NIhlUM DI::.;TRNCE FF,'OM R PF'.I',,,'RTE I,JELL. TO Iq F'F..'I',,,'f:ITE ::..;E!.,IER L.~NE IS ;:25 FEE']" FIIqD '!"'0 FI C:OHi"IUNIT'.~' SEI.,.IER L:[NE ]:S 75 F'EET. WELL [..OGS FiRE REg!!JIRED RI'.,ID MUST E:E F.:E'r'uF.]NED 'I"0 THE DEF'RRTP1EEI',IT I.,;I'I'FIIN ]?8 [:,R"r'S OF THE HELL COHPt. ETION. OTHER IREgRJ!REMFNTS MFI'¢ FIPF'L'¢. L:i;PIEE:IFICR'FIONS Ri'q[:' CONS'FRIJCTION [>IFIGRFII"IL:; FIRE FIVFtI LFIBLE TO I I',ISIJRE F'RC~F'EF.': I N'.STFILLRT I ON. :[ CERTIFY' THFFT' ::L: I FIM FFIMIL. IRR 141'TH THE REL-]UIREMEiqT[5 FEIR Of.,F-SITE E;EI.,.IER'-Y FIN;::, NELL'E; Ft5 ~::E"[' FORTH B"r' THE MUI',IIC:IPFiLI'F'¢ OF laNE:HOF?RGE. 2: I IdlLL INSTFILL. THE' S"r'STEM If',! F~C:COF,'.DFINCE IqITH THE CO[."E5. 3:: I IJNE:,ERSTFIN[) THFIT THE ON-SITE SENER :iS"?:E;'I'EM r,lFl'¢ REg!UIRE ENLFIF~GEMEN'f' IF' THE RE....,.[L.[..N...[.. I::, REMO[:,EL. IEC, -FO INC:LU[:,E MI3RE 'I'HFIiq 2]: E:EE:,RO01'"IS. iXloff'9~. ' Lo(_~-~ovO '¢4. 0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264~4720 SOILS LOG - PERCOLATION TEST SOILS LOG [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: Tom McGee of HcGee Industries DATE PERFORMED: Sep 1, 1981 Lot 5 Block 2 Secluded Hills Subdivision Anchorage Alaska 1 2 3 4 5 6 7 8 9 lO 11 12 13 14 15 16 17 18 19 2o Brown Organic Silt (HL) medium stiff, moist Gray Brown Gravelly Silty Sand medium dense, moist SLOPE SITE PLAN Gray Brown Sandy Gravel (GP) medium dense, moist with occassional pockets of Gravelly Silt 0 ~ color change to Gray WAs GRouND WATER Brown Silty San~N~9~b~Eo~ medium dense, moist IF YES, AT WHAT Designates soil DEP'FH2 sample taken No Gross Net Depth to Net Reading Date Time Time Water Drop NO 'ERCOLATI0 TEST(S) ~ERFORMED BECAUSE OF 'HE GRA.NDL~.R NATURE lF THE SO] .. PERCOLATION RATE NOT APPLICABLE (minutes/inch) COMMENTS TEST RUN BETWEEN FT AND FT Ra~d on visual ~×aminatidq_Rf tb~JJ~s~i] reca~mend tb~t s~i]_a~ion system be designed based on 150 square feet per bedroom. Jop';of trench back- fil~, o,,~,~"~-' be art-~-east 4 feet belo~ finfsh §~ade. John R. Chambers CERTIFIED BY: , ,DATE:Sep ]~ PERFORMED BY: ~ -( / P~J~t kng~neer ~K CE H~v' 72-008 (6/79) ~~ 1981 MUHMPA U7Y OF ZL' HCHORAGE b. i Development Services Department p p �_Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 017-343-13 Expiration Date: �, d 1. GENERAL INFORMATION Complete legal description Secluded Hills, Block 2 Lot 5 Location (site address) 13361 Badger Lane Current property owner(s) Joanna L Vogel Day phone Mailing address 13361 Badger Lane, Anchorage, AK 99516 Real estate agent Cody Kelm Day phone (907)250-9558 2. TYPE OF DWELLING: ❑® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑® Private Septic ❑■ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distan Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment �� 1 Receipt Number 01 1 � 3 D Date: Waiver Fee $ Date of Payment Receipt Number COSA # 05G 221006 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering (M.J.) Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date 3/2/2022 i*QP 6. DSD SIGNATURE 3 � •�v'.' '(' '�'" > / System #1 Approved for bedrooms / Ben�arr r Schiller ' ;% System #2 Approved for bedrooms CE 12592 .����Aw'AW �/ Disapproved l�iF�pROFESSIOO Conditional approval for bedrooms, with the following stipulations: i�_\�Y OF 611 amu. -,yO., JZ not elT WATER ANn �r '� rr r .n r �M_ Original Certificate Date: J- 1 / -2CZZ The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: Secluded Hills Block 2 Lot 5 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 9/22/81 Total depth 321 ft Cased to 301 ft ®❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA 2/28/22 Static water level at beginning of test 219 Comments B. TANK DATA lid Age of tank(s) 1.5 years Tank type/material Septic/Plasic Measured operating fluid level in septic tank 49 0 Standpipes/foundation cleanout per record drawing Date of pumping A+ Home Services 3/4/22 D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) 7/27/2017 0 ALL standpipes present per record drawing Total measured depth from grade 12.25 ft (max) Measured depth to pipe invert from grade 5.1 ft (min) ❑ N/A — pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Fm -1 Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 017-343-13 Structure served by this system Well production at time of test 1.1 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No 0 Coliform bacteria is Negative Nitrate mg/L 0 Nitrate less than MRL (ND) Arsenic ug/L ❑® Arsenic less than MRL (ND) Collected by Forge Engineering Date of Sample 3/1/22 STATION ❑ Requir aintenance completed Age of lift station years Lift station material Comments: Adequacy test date 2/28/22 Results Q Pass For 3 bedrooms Fluid depth prior to test 42 in Water added 502 gal New depth 46 in Elapsed time 1440 min Final fluid depth 38 in Absorption rate >450 gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Yes Community Sewer Manhole/Cleanout > 100' Q Yes if No ft M Yes if No ft Neighboring Tank > 100' [✓ Yes if No ft Private Sewer/Septic Line > 25' F✓ Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' P/ Yes if No ft Neighboring Absorption Fields > 100` Yes if No Animal Containment > 50' Yes if No ft M Yes if No ft if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No ft 0✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q✓ Yes if No ft Surface Water > 100' 0 Yes if No ft Property Line > 5✓0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Yes if No ft Private Wells > 100' [7 Yes if No ft Water Main > 10'✓O 0 Yes. if No ft Community Wells > 200' ✓] Yes if No ft Water Service Line > 10' F,71 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10'�]✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10'✓0 Yes if No ft Wells on Adjacent Lots: Water Main >:10' 0 Yes: if No ft Private Wells > 100' U✓ Yes if No ft- Water Service Line > 10' F,71 Yes if No ft Community Wells > 200' E✓ Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION ,®��'Q�� I certify that l have determined through field inspections and review : ' • T { of Municipal records that the above systems are in conformance with_....r, MOA COSA guidelines in effect on this date. ®• Benjar>r Schiller 03/2%2292 . •��A-' �PROFESSOV�,d COSA Checklist yellow sheet MUMMPAUTY OF ANCHORAGE _0 Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 017-343-13 -1( PORI Expiration Date: kA4)jL.Aj 1. GENERAL INFORMATION Complete legal description Secluded Hills B2 L5 Location (site address) 13361 Badger Lane Current property owner(s) Eric & Katie York Day phone Mailing address Real estate agent Day phone 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ED Private Septic El Water Storage Fl Holding Tank EJ Community Well n Community ❑ Public Water System F] Public Sewer ❑ Waiver request for: Distance: Received by: 41 Date: COSA to be released to the engineer, unless otheivilse requested by the engineer. I I COSA Fee $ 550 Waiver Fee Date of Payment 5 _'2 0 Q 1 Date of Payment Receipt Number 0:9, 2 516 Receipt Number COSA# OSC211000 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe 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 soil 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. 6. DSD SIGNATURE System #1 Approved for System 42 Approved for Disapproved Conditional approval for 3 bedrooms bedrooms Date m� OF A� Ate: 9TH .. ... ... ......: Steven •Fannorae �O�PFC. CE 8149 if �r Ge.�a� . • .... • :; V -F bedrooms, with the following stipulations: By: I U4 A &UV Original Certificate Date: I&/ D 2 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Cheeklisl blue sheet Legal Description: Secluded Hills B2 L5 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 9/22/1981 Total depth 321 ft Cased to 301 ft ON Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 28 in. Date of flow test for COSA 12121r2020 Static water level at beginning of test 221.0 ft Comments B. TANK DATA Age of tank(s) new years Tank type/material S` I. Measured operating fluid level in septic tank 4 ❑ Standpipes/foundation cleanout per record drawing Date of pumping New tank D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) 7/27/2017 ❑ ALL standpipes present per record drawing Total measured depth from grade 12.2 ft (max) Measured depth to pipe invert from grade 6.3 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 5.9 ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 017-343-13 Structure served by this system 1 Well production at time of test 1.93 gpm Water storage tank volume n/a gallons Well disinfected for coliform test? ❑ Yes ❑✓ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Pannone Engineering Date of Sample 12/22/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 12122'2020 Results [DPass For 3 bedrooms Fluid depth prior to test 26 in Water added 460 gal New depth 39 in Elapsed time 1440 min Final fluid depth 26 in Absorption rate '450 god Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' 0 Yes Community Sewer Manhole/Cleanout > 100' ❑✓ Yes if No ft ✓Q Yes if No ft Neighboring Tank > 100' 0✓ Yes if No ft Private Sewer/Septic Line > 25' M Yes if No ft Absorption Field on Lot > 100' ✓v Yes if No ft Holding Tank > 100' M Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' n✓ Yes if No ft M Yes if No ft if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0✓ Yes if No ft M Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' El Yes if No ft Property Line > 5'✓❑ 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' FV -1 Yes if No ft Private Wells > 100' 0✓ Yes if No. Water Main > 10' 0 Yes if No ft Community Wells > 200' ❑✓ Yes if No Water Service Line > 10' M Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' FV -1 Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' M✓ Yes if No ft Community Wells > 200' Yes if No Surface Water > 100' [j Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 4F Aj ! certify that I have determined through field inspections and review Aelie 9 t of Municipal records that the above systems are in conformance with;01.• . I MOA COSA guidelines in effect on this date.k, t ven P. Pannone COSA Checklist yellow sheet ft ft ft ft Parcel I.D. 017-343-13 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Secluded Hills B2 L5 Location (site address) 13361 Badger Lane Expiration Date: Current Property owner(s) Normand & Charlene Lagasse Day phone Mailing address 13361 Badger Lane Anchorage, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Q Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received b 1950(o Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $_ Waiver Fee $ Date of Payment t �$ 61� Date of Payment Receipt Number ()an (0q Receipt Number COSA # _ 06 G 15-j fo Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are)in compliance with all applicable Municipal and State codes, ordinances,and regulations in effect at the time of installation. In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations.The reported results describe 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 welts and septic systems depend on the local soil 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system.The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Address P.O. Box 1807 Palmer, AK 99645 Phone (907) 745-8200 Engineer's Printed Name Steven R Pannone Date 10/5/2018 1 6. DSD SIGNATURE 7* ' - e �� *�,, System#1 Approved for / •• � �� ,,• f bedrooms t� :Seven k ESurinti- System#2 Approved for CE-8149 / bedrooms �i�q•.• ..;,0 r� Disapproved �!l` ti Conditional approval for \% ��`����~ bedrooms,with the following stipulations: jrrvCh ,\\ ' vtJ �,. 0 S1�E ( � _ SER Ppg.R o NS-C co Up'16NTSES\I\& By w`-, �`-- Original Certificate Date: — Q r" The Municipality of Anchorage Development Services Division(DSD)issues Certificates of On-Site Systems Approval (COSA)based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. • 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet f '• . If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Secluded Hills B2 L5 Parcel ID:017-343-13 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log(Y/N) Y Date completed 9/22/1981 Sanitary seal (Y/N) Y Wires properly protected(Y/N) Y Total depth 321 ft. Cased to 301 ft Casing height(above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 9/22/1981 6/9/2017 Static water level 190 ft. 210 ft. Well production 5 g.p.m. 5 g.p.m. WATER SAMPLE RESULTS: Coliform Nei colonies/100 mL Nitrate NO lb Arsenic NO ug/L Date of sample: IGt2I I l; Collected by: ?L S B. SEPTIC/HOLDING TANK DATA Tank Type/Mater ai Septic/Steel Date installed 9/3/1981 Tank size 1 000 gal. Number of Compartments 2 Cleanouts(Y/N) Y Foundation cleanout(Y/N) Y Depression over tank(YIN) N N/A High water alarm(Y/N) Date of pumping 11/29/2017 Pumper A+ Services C. ABSORPTION FIELD DATA 8/9/2017 2 z Deep Trench Date installed Soil rating (g.p.d.Lf or ft/bdrm) / • System type Length 34 ft. Width 2.5 ft. Gravel below pipe 6 ft. Total depth 9 5 ft. Eff. absorption area 408 ft2 Monitoring tube Y Depression over field N • Date of adequacy test NEW Results(Pass/Fail) N/A For bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment(past 12 mo.)(Y/N&type) None Known If yes, give date ' \\ \r b K\ C'�1'\?Vv1 'j.\{\c9.. \ k 1.0c\3 l x'15\C.11 z_o . D. LIFT STATION Date installed Size in gallons Manhole/Access(Y/N) "Pump on"level at in. "Pump off'level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 97.51* On adjacent lots 1001+ 1001+ 1001+ Absorption field on lot On adjacent lots 75'+ Public sewer main Public sewer manhole/cleanout 1001+ Sewer/septic service line 25'+ Holding tank 100 + Animal containment areas 50'+ 100'+ Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 101+ Water service line 101+ 100 + Surface water Wells on adjacent lots 100 + ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 101+ 101+ Water main Water Service line 101+ Surface water 1001+ 101+ Driveway,parking/vehicle storage Curtain drain 501+ Wells on adjacent lots 100 + F. COMMENTS *e11/29/17: Tank was pumped and house has been vacant since. *WR990098 G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and .774e ..*• •• .... review of Municipal records that the above systems are in j k' 1' • rik conformance with MOA COSA guidelines in effect on this date. 0•.. •• Engineer's Printed Name Steven Pannone � •S{even R. 'annone Date 10/5/2018 fig. CE-8149 ,/ COSA canary sheet 2.6-15.doc __� N R=126.21' L=48.26' �NE N \ N >52020f LOT 2 "). • N R=175.00' L=21.84' Covered Storage i` 0 10.1' A,oc / Area rO r+ Wood Shed / / 0.1 v W/Step / a^ii o I l No Found./ / Riser Pipe v 1 /t ( YP200'T 0.1 Brick Retaining Wall (Typ.) ` pc 8.1 o O ago r_.1 ?o 2$;3. C. 11.3, �j v Wood Deck) N Wood Shed io Wire Fence N Wood ,,1 o CO +j.1, 4 �` W/Ramp o Landing No Found. 6 oox----*-----,,,... 1co cd / & Steps n �/ 2-Level 10,4.1 ,Is „1 Wood Frame i� r .. Wood Deck I Residence of o 3T,4' 21 j� N 2.0' Cantilever v of S•5' Z• LOT 1 ]I`� is: _�?6,,• � Well LOT 4 O/127% •---,i Ni _ N•6.7' t.S' •6.4• Pedestal Cnplave ood Shed Cantilever I' W/Ramp E Power Pole No Found. v o & Anchor 0 w T b LOT 5 -Z�- b o BLOCK 2 SCALE : 1" = 30' Pedestal 0' 15' 30' 60' Found 2 1/2" Al. Pipe 10' Utility Easement Cap Destroyed i 149 no' SO'04'12"W Found 5/8" Rebar LOT 4 LOT 3 PREPARED FOR: NOTE: PANNONE ENGINEERING, INC. Dimensions are measured to the wood trim. I hereby certify that an accurate survey of the following described property: /A C _ I III T PSE.�F p�9;11, LOT SECLUDED5, BLOCKHILLS SUBDIVISION (81-1) .y~ .'9+# was mode on November 29, 2017 and that the improvements DWN. DATE GRID r- fr'4h9TH ••:*0i situated thereon ore within the property lines and do not overlap or JSp 12/2/2017 SW 2937 x I7 •'• • • encroach on the property lying adjacent thereto, that no r. ue xa�awinikors:•, improvements on the property lying adjacent thereto encroach on FILE NO. F.OB172016/ JOB NO. �, r the premises in question and that there are no roadways, 1719 1720 PG. 35 +V.••Ne. 3143-6 ... : transmission lines or other visible easements on sold property except w ''�fl +' os indicated hereon. Easements other than those shown on the NJ KARABELNIK OFF NJ !!�,` **�` record plot may not appear on this drawing. 12.1112 .7 Anchorage Alaska, this 3rd day of December 2017. SUR VE YI N G (907) 937-9494 Pd in h1 A " :c • • -' Municipality of Anchorage ;,� 11,.E ,ik.ti ``. 3: t . On-Site Water and Wastewater Program z EA ii (907) 343-7904 a AUG miy T.�s s- 10:2Erto ti Certificate of On-Site Systems Approval << a6 L 9�nc(. Parcel I.D. 017-343-13 Expiration Date: '3 —1 GI -1 .... 1. GENERAL INFORMATION Complete legal description Secluded Hills Block 2 Lot 5 Location (site address) 13361 Badger Lane Current Property owner(s) Normand & Charlene Lagasse Day phone Mailing address 13361 Badger Lane Anchorage, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Distance: WaiverNariance request for: Received by4. to 30 Date: 1 2/lc) i 1 fl COSA to be released to the engineer,unless otherwistquested by the engineer. COSA Fee $ A 11$`5O Waiver Fee $ Date of Payment $l(C)/l9' Date of Payment Receipt Number 041i"3C' Receipt Number COSA# QhC/q 13 YJ Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,and regulations in effect at the time of installation. In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulatigns.The reported results describe the performance of the system under the conditions encountered at the time of the test, and sepa(atipn distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition,greuid 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 8/10/2017 Al co 6. DSD SIGNATURE /*: 49 4.1- *��a. S •, l System #1 Approved for bedrooms d :%Steven h. F onnone: s System #2 Approved for bedrooms • CE-8149/ Disapproved t�t \ '"' kSSI`4'� Conditional approval for ��`��� pp bedrooms, with the following stipulations: ------lekA s S fir, .. ,k s 3 C7 Alectr 01- (_ 1.. 'vertA-le 1l t - ao e ��,,1llltt,i, • \G\Q 0.\1Y OFq4,cc ..r . Off. J ON-SITE WATER AND �,, . o WASTEWATER ,. PROGRAM 'c/t,r,QGa\J‘CF / Original Certificate Date: ( Z By: 40 / (7 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory• Well Flow Advisory Other COSA blue sheet i - If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Secluded Hills Block 2 Lot 5 Parcel ID: 017-343-13 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 9/22/1981 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 321 ft. Cased to 301 ft. Casing height(above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 9/22/1981 6/9/2017 Static water level 190 ft 210 ft. Well production 5 g.p.m. 5 g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate ND mg/L ND PES Arsenic ug/L Date of sample: Collected by: Ill VI2Din B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 9/3/1981 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N 41M I( 2.1' 17 Pumper A -1,--Date of pumping ` C. ABSORPTION FIELD DATA As.,_ - 150 GPD/SF Deep Trench Date installe. . ?j e iIrting (g.p.d./ft2 or ft2/bdrm) System type Length 34 ft. I ft. Gravel below pipe ft. Total dept / Eff. absorption area "5416' t Monitoring tube Y Depression over field N Date of adequacy test NEW Results (Pass/Fail) N/A For bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. N Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off" level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 97.55* On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer/septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS *WR990098. G. ENGINEER'S CERTIFICATION ��~2F \ ,�of ACg11 I certify that I have determined through field inspections and r''<P•. 77 A review of Municipal records that the above systems are in 0*y'•• . \ ..* conformance with MOA COSA guidelines in effect on this date. ••• Engineer's Printed Name Steven Pannone :S1everi K'NIA AOr; :•' i Date 8/10/2017 61:-.. CE-8149% 1 orEssia�PP. COSA canary sheet_2-6-15.doc in cV R=126.21' L=48.26' in x`41) LLdd N2 , \ 16 2 00, 152020"f h R=175.1 20 "i `aoe L=21.8, Covered Storage co• 10• .1' N Wood Shed / Area 0.1'to 4 W/Step "co o of No Found. Riser Pipe ; MP-) X20.0' N, o —�� (10.1 Brick Retaining 0 Wall (Typ.) p�� 8.1' , o O o - o 1cV• d25 3' — 11.3' Wood Deck co Wood Shed w ;,� • Wire Fence CO (Ni Wood W/Ramp ,� • 1 4.5 ,.. Landing No Found. 0 Lo oo w Al & Steps / 3 00 "o 4 2—Level 10.4, / o, M (I) Wood Frame K .O o Wood Deck _ Residence of N o 31.4' 21.7' /to 5 5, 2.0' Cantilever z o ni N W, 1 o 120 28.7' Well LOT 4 • I N o• 6 7 ' . N • 152 46.42 .01-25.8' Pedestal----- " Fireplace Wood Shed Cantilever W/Ramp E Power Pole No Found. v & Anchor w b LOT 5 •�--Z--..•� b co BLOCK 2 SCALE : 1 " = Pedestal 0' 15' 30' 1/2" Al. Pipe 10' Utility Easement royed , . �II S0'04'12"W Found 5/8" Rebar LOT 4 LOT 3 PREPARED FOR: PANNONE ENGINEERING, 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 Parcel I.D. O1')-,343-1,'{ 1. GENi~iS, AL INFORMA~J0N CE i-iJ=iCATE OF HEALTH AuTHoRITy APPROVAL FOR A SINGLE FAMILY DWELLING Expiration Date: ,, '"7 - 7' - O ~ C6~l~iete le{l~iae~ci-ilJfibh · sEdLu~I~ HILLS SUBDIVISION; LOT 5, BLOCK 2 Location (site address iii-directions) 13~1 B ,bGE LAN'E · ANCHORAGE, AK Cui-~eh't Pr0pei-ty 0wi~i~ris) Mailing addre§§ 'Len~ling agency Mailing address Real I~state Agent Mailing address AMB~'R HOLIviB~RG 1,3,361 BADGER LANI~ * Day 15hone 868-3371 ANCHORAGE, AK 99516 ' D~yph0ne Day phone Unle§s otherWise requested, HAA will be held i~y DSD for ~ibkup. 2. NUMBERbi .'I'~pE OF wAfi~k SUi~i~LY: Individual Well ~ Individual Water Storage E] Communi{yClass Well E] Public Water System r'-] TYPE OF WASTEWATER DISPOSAL: Individual On-site I Individual Holding tank Community On-site Public Sewer E] I . .:The Municipality of AnchOrage DeveloPment Services Departiment (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in pai'agraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Cedificates of Health Authority Approval are valid for 90 days from the date of iSsue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER · As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation, based on procedures outlined in the Health Authorify 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 fhat 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 ENC, INEERING GROUP, Ltd. Phone Address 3701 E.' TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name 'JEFFREY A. GARNESS, P.E. Date 337-6179 Engineer's Comments: ~ :' In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engin~e~fng analysis of the system in accordance Vw'th ADEC and MOA DSD Guidelines & Regulations. The reported results descrfbed the performance of lhe system under the conditions encountered at the time of the test, end 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 durfng the year, and the water usage of the family being Served by the system. These conditions am outside the control of the evaluator of the system. Satisfactory test results do not guarantee futura performance of the system, nor do they guarantee that them am 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 rupert 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 authorfzed, nor will it confer any legal right whatsoever. DSD SIGNATURE ~ Approved for ~ bedrooms.. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: ...... . 1 WASTEWATER: By: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements "~-~.~,?k~_. Supplemental Engineers Reo~ Other '. ' ' (Rev. 12/01) Original Certificate' Date: LegaI.Descript on: ,ili ,!]t ",]; '~ : !F A. WE~JL DATA *TEST DATA LESS THAN.2',YEARS i'iOLD , Well,type ,, PRIVA39~ ' . , If A, B, or C prowde PWSID# N T°ta. IDate:~,,,~:,: completeddept,h:: ' ~'~' '~.=', ...... 321~ 9/22/1. fl. ~ , 98. 1., Sanitary. Cased' ~ . '~;' ;~t,°~seal, i~'': · (Y/N),r,.2 I'~',fl.,YES"I~';:i,'' ' , ~:' ;'il: :!~ . · FROM WELL LOG :, , - ;,.' . ' ; ~' . ' I:' . ' II '. ' . ~ · Stabc water level ' 19_0.,: , ~- , .fl. ~ ~'iil: ~ ,' HI, ' !Ii "i! : ' " ' 5 ,I Well producbon . :' = ;,' i'g.p.m::~ ,'il ' ,ii' ~, !I~ .... ~ .' WATER SAMPLE RESULTs: , ::·.:,;, !, , ;.?, r ,: , ,;: .' .r,, }i iimg./L C01iform'~ t: O; coionieS/100 mi..:~:.N~trate O : !ii'; '. ~ :. . ~ 'i;:i:,!~i7 ,;~:. ~.i 'I ArSenic:, ;!'N/A mg./L. ;: :;.D~'te o~sampl~: 3/23/2004 B. SEPTIC/HOLDING TANK DATA ,,,~ ~ :,, ,i ;: !'., " I .. . !~' ; ,ii , ~ ..!~ ~i ;;I,,I .i! , T Type/Material .; STEEL :ii' ,,:: Tah~ Siz~ii:1000 gal · Numl~er 0f;Cor~Partm~nts Foundabon-leanoutY/~-YES '.:: ;=, : ,: :, ~ Depression over.:tank (Y/N) NO : MuniciPality,of Anchorage' :i!:, . :, On;Site,Water & Wa§tewater Program ;: ':i!.i' i' ' : ' : .4700 South Bragaw St. =~'~, ,~ P.O. BOX 196650 Anchorage, AK 99519-6650 · ! www.ci.anchdmge.ak.us · ~i:~', ~ .,; ,·!:' ::," ' :,. (907) 343-7904 · :~l~'~,,'.' . : .HEALTH AUTHORITY A VA CHECKEIST; : SECLUDEDi 'SD~ T :5, BLOCK 2- · ~liparcel, iD: 017-343-13 W~Ii Log(Y/N) YES . Wires properly protected (Y/N) ~ YES Casing helg~ht (above ground) 12+ in. AT INSPECTION L' ,' ",'5/1~2003 · ,, ' · 220 !~ '~'fl: . ~.3 ~ "' g'.p.m. Other bactena -; . colonies/100 mi. Col ect~d i~y:i, ; ~r(;E(~, LTD. Date in~talled ~,, ,: 9/3/1981 cleano~i~;~/N).:' ''. YES ' . H,gh ~r'ql~r~ ~/N) -N/~ ::,% ' ' Date of pumping - 2/3/2004 ' !ilP~lmper : ,; C. ABSORPTION FIELD DATA' ';i }i'i, i~'BELOW 'EXISTING GRADE) ", F~!ii "; ':' ' ' ;:" ; , . ~:' IL:' ' :SY:it;,stem',ty, c pe,,, DEEPr TRENCH_ Date tnsta!led: ,9/3/1981 Soil rating, ~rfl~/bdrm)150 , ' .... ~ ' ' Length ~ '..3..4,._ _fl. , , !Width .,~:'.r.~' ;4 : fl. · , Gmv~el ,below pipe 8 fl. · , Total depth 11 .ft.. Eft. absorption area'544 ~ff~ ; Monitoring tube, YES!! ' D~pression over field NO . : , · ~, Date o[ ad~equaey test *.5/1/200 i .iResu!ts pass/Fail) PASS · ; ~ d ':' ' ..... ,, ' r'':~ i'Water added 602 Fl~iu: epth.,: in absorption field before~ test 52.5 in. :: ','. "" II **' '"' ~ "', ........ '1'I i'' , i: . ~': ', hl ~'i ' ' ~' ;,:' Elapsed ;Time:. 165 'min. Final fluid depth .65.5 in. ' Absor .... ', , . ;.,,! ' Any rejuvenation treatment (past 12 mo'.) (Y/N & type) '! TEST'~,DATA LESS THAN 2:-YEAR~":'oLD" · ~ :'r :: ~ ',: :, ' :, i NONE KNOWN ~raie >= ,ii r;If Yes, 'give date ; ,For, 3 bedrooms New dePth 74 in. 450' g.p.d. 'Lli=~ '~:I"ATi0N Date installed "Pump on" levei a{ in. :E. 'S EpA'~,TIbN i~i~'l;~NbEs .. i sEPARATION DISTANCES FROM WELL ON L~T TO: ~ep{ic tank/lif{'{;tatibii On i6t Absoi-'l~tion-fi~ld oh 16t Public ~wer .... main Sewer/septic S~i:viCe line Cycles tes{~d ....... Meets al~r'm & cih~Uit requiremeh't's? N/A 25'+ .SEPARATI°N Dj§'j'ANCE~ 15~OM sEISmiC/HOLDING TANk: ON LOT tO::' *~.,~' Oh i~lj~cent lots ..... 100'+ 100'+, ' On adjaci~nt lots 1 oo'+ 15ubli~ S~wer manh01e/Cleafi0ut H(~ldin~ tank loo + BUilding foundatic~[i ~'+ ' . !pro~y iirie ~'+ , ', Abs0rPfi'6n ~ield water main 'N/A -. - W~t~r §~ice line '1 o'+ .S'Uff,~c~ 'waier. Wells On adjaceht I(~:ts ' 100'+ .... : · sEp/ RATIOI;,,I ..... ' ........ FIELD bN' Lb? TO: i ..... ; DISTANCE FROM ABs0~IOI~.... : Property line .11~'+ Building fouhdatior~ ~' 'i0'+ water main' wate~ service lir~ lO'+ su~ace w~iter 'lbO'+ 'briveway, p~irkiiigh;ehicle storage Curtain Idrain NoNE 'KNOWN. Well~ 0~i adj/~6en{ I~tl$ .COMMENTS. " .' *#WR99009B G. EI~GiNEEI~;S CEI~TIFICA'TION I cei'tifY i~'at i J~ave d;ter~n~ed throUgh fi~'l~ i~s/~'eC~ioh's ahd ~eviow of Municipal records that the ab'o~e ~jiste,is i~re in' conformance with MOA HAA guidelines ih effeCt on this date. En[jineer's Prin~ed N~im'e JEFFI~ A. GARNE~;s Date 10'+ Waiver'Fee $ .: Date o~ pay/fient ReCeipt Number HAA F~e $ ~--~'"'~'~-'- ReCeipt Number (Rev. 12/01). 100'+ " 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 Parcel I.D. 017-343-13 1. GENERAL INFORMATION CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Expiration Date: /~O - 31- o~ Complete legal description SECLUDED HILLS SUBDMSION; LOT 5, BLOCK 2 Location (site address or directions) 13361 BADGER LANE * ANCHORAGE, AK Current Property owner(s) Mailing address 'i Lending agency Mailing address Real Estate Agent Mailing address AMBER HOLMBERG Dayphone 868-3371 13361 BADGER LANE * ANCHORAGE, AK 99516 Unless otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: 3 Day phone Day phone · 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 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water {amples.) 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. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, or prior I to closing for lhe engineering services'provided, I 4. 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, based on procedures outlined in the Health Authodty 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 bedreoms 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Phone Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 337-6179 Engineer's Comments: In conducting this evaluation, AKWWC, Inc. a~tempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results descdbed 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 leve/s that may fluctuate dudng the year, and the water usage of the family being served by the system. These conditions are outside the contre/ of the eva/uator 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. AKWWC, Inc, 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 wi//it confer any legal #ght whatsoever. 5. DSD SIGNATURE Approved for 3 Disapproved. Conditional approval for bedrooms. bedrooms, with the fllowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory = WASTEWATER : . *" Manitenance Agreements Supplemental Engineers Re0d Other (Rev. 12/01) Original Certificate Date: / -O.B Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw SL P;O, BOX 196650 Ar~chorage, AK 995196650 wv~v.ci.anchorage.ak.u$ (907) :~t3-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: , , SECLUDED HILLS S/,D;_LOT 5~ BLOCK 2 , Parcel ID: A. WELL DATA Welltype PRrVA~. IfA, 8, orCprovlde PWSID# N/,A Date completed 9/,22/,1981: Sanitary seal (Y/N), YES Total depth 321 ff.. Cased to 521 ff. FROM WELL LOG 9/,22/,1981 , , · ,190 ff. 5 .... g.p.m, Date of test Static water level Well production WATER SAMPLE RESULTS: ColIform ~O colonies/100 mi. Arsenic: .N/,A mgJL. SEPTIC/HOLDING TANK DATA Nitrate O. t mg./L. Date of sample: ~/!/2005 Tank Type/Material STEEL , Tank size 1000 gal. Number of Compartments . We~l Log (Y/N) Wires prope~,protected (Y/N) Casing height (above ground) AT INSPECTION , 5/.V2oo3 ff. 1~3, , g.p.m. YES YES 12+ in. Other bacteria O colonies/10o mi. Collected by:. Ak'V,~VC, INC. ,.. Foundation cleanout (Y/N) YES Depression over ta~k (Y/N) NO, Oate of pumping , 5/,1/,,2003 , Pumper , , . ABSORPTION FIELD DATA ~ Date installed , 9/"3/'7981,. Soil rating ~or ft~xlrrn) 150 Length ,34. , ff. Wid~ 4 ft. Total depth 11 ff. Eft. absorption area 544 it~ Monitoring tube YES Date of adequacy test 5/1/2003 Results (Pass/Fail) PASS., Fluid depth in absorption field.before test .5_2.5 in. Water added 602 gal. Elapsed Time: 163 min. Final fluid depth 65.5 in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN Date instaged 9/,3/,1981 . .. Cleanouts (Y/N) YES .,. High water alarm (Y/N) N/,A. . A+, SERVICES .... System type DEEP TRENCH. Gravel~below pipe 8 . ft. Depression over field. NO For 3 .bedrooms New depth 7.~_4 in. 450. g.p.d. .... If yes, give date - D. LIFT STATION Date installed Size in gallons ~ "Pump on" level at ~ High water alarm level at in. ~ ~ Cycles tested Meets alarm & circuit requirements?, E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot '97.5' Absorption field on lot 100'+ Public sewer main N/A · Sewer/septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cieanout Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water service line 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Water service line 10'+ Curtain drain NONE KNOWN COMMENTS *i~WR990098 Absorption field, Surface water. ,5'-I- 100'+ Building foundation , 10'+ Water main Surface water 100'+ Driveway, parkingNehicie storage 10'+ Wells on adjacent lots, 100'+ 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 I-MA guidelines in effect on this date. Engineer's Printed Nj3me Date JEFFREY .4. ,,GARNESS HAA Fee $ Receipt Number ~ (Rev. 17.J0t) ~_..~"'~ Waiver Fee $ Date of Payment Receipt Number 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 Parcel I,D. # 017-343-13 1, GENERAL INFORMATION Complete'legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Lot 51 ~[ock 21 Seciuded Hills $~bdi~±s±o~ Location (site address or directions) Property owner Mailing address ~R~61 B~g~r Lane Anohoraqe: AK Reilly Co. Day phone 6210 west Tree Drive Anchorage, AK 244-6640 99516 Lending.agency Mailing acldress Agent Mike Messick/Remax Address Day phone Properties Day phone 276-2761 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual welt XX Community well Public water NOTI=: If community well system, provide written confirmation from State ADEC attest- ~. lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site xx 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-~25 (Rev. 1/91) Front MOA#21 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 Address Engineer's signature ALASKA WA , SUITE 2B Phone Date DHHS SIGNATURE × A?proved 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. Em ployees 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 engineeCs work. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division ~u~c~^~ o~ ^~c~o~ 825 L Street, Room 502 · Anchorage, Alask& 99501 . ~uv)'3'43-4744 N/A Health AuthoritY Approval Checklist Legal Description: SECLUDEO HILLS SUBDIVISION; LOT 5, BLOCK 2, Parcel I.D.: A. WELL DATA Well type PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number 017-343-13 Log present (Y/N) YES Date completed 9/22/81 Total depth 321' Cased to 321' Casing height (above ground) 30" Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES FROM WELL LOG AT INSPECTION Date of test 9/22/81 11/1/99 Static water level t 90' 21 O' 5.0 g.p.m. 0.58+ g.p.m. Other bacteria 0 CHAD HELGESON - E.M,I. 0.5 mg/L Collected by: Nitrate Well production WATER SAMPLE RESULTS: Coliform 0 Number of Compartments Depression (Y/N) NO High water alarm (Y/N) Date of sample: 10/21/99 B. SEPTIC/HOLDING TANK DATA Date installed 9/3/81 Tank size 1000 Foundation cleanout (Y/N) Date of Pumping. 9/99 O. ABSORPTION FIELD DATA Date installed 9/3/81 Length _ 34.' Width YES PumperDENALI SF-WER AND DRAIN *SEE ATTACHED LE.TI-ER. _ Soil rating (g.p.d./fF or fF/bdrm) 150 System type TRENCH 4-' Gravel thickness below pipe 8' Total depth 11' ___ Depression over field (Y/N) 2 Cleanouts (Y/N) YES N/A Effective absorption area.544 SO.FT. Monitoring Tube present (Y/N). YES NO Date of adequacy test 11/1/99 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test (in.); 32.5" Immediately after988 gal. water added (in.): 61.5' Fluid depth 4-6.5" (ins) Minutes later: 1320 Absorption rate = *450+ g.p,d. Peroxide treatment (past 12 months) (Y/N) NONE KNOWN If yes, give date - 72-026 (Rev. 3/96)* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 97,5* LIFT STATION Date installed Size in Manhole/Access (Y/N) ~at* "Pump off" level at* High water alarm level at*~...~--'"'"~ *Datum * WAIVER REQUESTED 100'+ On adjacent lots Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ On adjacent lots Public sewer manhole/cleanout Lift station 100'+ N/A N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Absorption field Water main/service line 10'+ Surface water/drainage 100'+ Wells on adjacent lots 5'+ 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10% Building foundation 10' Water main/service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage area 10'+ Curtain drain F. ENGINEER'S CERTII I certify that/k~¢¢ ~ 'n cen'°rml~ ~['~J Date II / NONE '(NOWN JEFFREY A. GARNESS Wells on adjacent lots 100'+ fieldinspeotionsandreviewofMunicipalrecor, g~?'~x~_ ~ .~sare rfelines in effect on this date. ~" :-7953 ..' ~ HAAFee $ ,.~OO~O Date of Payment //-- 2- 2. - ?? Reoe,~,tNum~er O.¢'~,~/ (~/~) 72-02~ (Ray. 3/9~)~ Waiver Fee $ Date of Payment Receipt Number Alaska Water & Wastewate r Consultants, Inc. 6901 Debarr Road, Suite 2-B ~ Anchorage ~ Alaska 99504 Phone (907) 337.6179 ~ Fax (907) 338-3246 REVISED ON 11/4/99 November 4, 1999 (Previously dated 11/3/99) MUNiC~PALii y O~- ENVIRONM~NTAL SfiRV!C [!S DIVi~ir. , Reilly Company 6210 West Tree Drive Anchorage, Alaska 99516 Subject: HAA for Private Well & Septic System. Lot .~, Bk 2, Secluded Hills Dear Mr. Reilly: Per your request we performed an evaluation of the well and septic system which serve the subject property. The results of the field investigation and adequacy tests are summarized as follows: A. WELL: The static water level on 11/1/99 was 210 feet below the top of the casing (BTC). Water was pumped from the well at an average rate of 0.58 gpm for a total of 1712 minutes (988 gallons). Within the first 93 minutes of the pumping period the water level rkopped 35 feet, to 245 feet BTC. The level remained between 245 feet & 250 feet throughout the rest of the test. In short, the well was recovering as fast as the water was being pmnped out. Based upon our test results, it was determined that the capacity of the well is at least .58 gpm, which exceeds the Municipal requirements for a 3 bedroom house (.31 gallons per minute). B. SEPTIC SYSTEM ADEQUACY TEST: The drainfield is a 4 foot wide trench, which is 34 feet long, and tins an effective depth of 8 feet (per the 1981 irmpection report). On the day of the inspection (11/1/99), the liquid depth in the sump was 32.5 inches deep. Water was introduced into the sump at an average rate of.58 gpm for 1712 minutes (988 gallmm). The first 331 gallons caused the liquid level to rise 14 inches, to a depth of 46.5 inches. The next 506 gallons caused an additional rise of 15 inches (61.5 inch depth). The introduction of an additional 151 gallons (aver a period of 265 minutes) caused no rise, indicating that the water was being absorbed as fast as it was being introduced (. 58 gpm). The liquid level was checked 22 hours later (1.'15 PM on 11/3/99) and the level had dropped 15 inches (46.5 inch total depth) indicating that approximately 657 gallons had been absorbed. The level was checked again on 11/4/99 at 10:50 AM and was found to be 38.5 inches deep, indicating that over 900 gallons had been absorbed in less than 48 hours. Based upon this data, it was determined that the absorption rate of the trench exceeds 450 gallons per day, as requlredJbr a 3 bedroom house. NOTE: JT~e adequacy ora septic system is influenced by numerous factors, including, but not Hmited to, seasonal surface water infiltration, groundwater variations, septic system maintenance (frequency of septic tank pumping, usage of biological additives), condition of drain pipe and pipe joints (which can be damaged by seismic activity and deteriorate with age), type of substances deposited in septic system (cigarette butts, sanitary napkins, misc. objects), and the amount of water being introduced on a continual basis. Consequently, the results of thts adequacy test are only valid for the specific day of the test. Furthermore, because of the limited nature of this investigation, it is possible that there are hidden defects which may not have been detected. No warrantee is made regarding the fi~ture performance of thts well or septic system C. REPAIRS: Prior to applying for a health certificate the following repairs will need to be done: . · The second clean-out at~er the septic tank is full of rocks. It will probably be necessary to excavate down to the sewer pipe in order to reach & remove the rocks · Locate the. se.eond .clean-out on the septic tm~k. During our inspection o~ly one pipe could be found, whtch Is beheved to be the second compartment el.erin-out. Once the first compartment clean-out is located and extended above grade it will be necessary to pump the first compartment of the septic tank. ~.~ · Install a cai> on the septic pipe at the end of the trench ,aner these repairs are made we will need to make a final inspection at which time we will confirm the separation distance between the well and the septic tank, and pull a current water sample. If you have any q~stion~ ~ please contact us at 337-6179. Sincerely, /q'/~// INGORPOR,~\TED November 3, 1999 Memorandum: Environmental Management, Inc. Septic System Adequacy Test Legal Description: Location: Owner: Residence: Dates of Inspections: Lot 5 Block 2 Secluded Hills 13361 Badger Lane Tom and Kelly Edwards 3 Bedroom Home Chad Helgeson visited site on October 11, 1999 Chad Helgeson visited site on October 21, 1999 Tony SlatonBarker visited site on October 22, 1999 During the first site visit the system was inspected and measured. The monitoring tube (MT) had 82 inches of water in the tube. What was thought to be the horizontal pipe was estimated at 84 inches from the bottom. The MT was 138 inches (ground surface to bottom of tube) and was not capped when Chad an'ived on-site and the tube was in the middle of a horse corral with large trees suncounding it. The MT was filled with thick mud about 16 inches from the bottom of the pipe. The rest of the water was thin mud. Not knowing if the monitoring tube was accurately measuring the static level of water in the absorption field due to the mud in the MT the test was not conducted. The kno~nnitoring tube was pumped out by Denali Sewer and Drain to remove the mud and debris that may have been blocking the holes in the monitoring tube. This was pumped on October 1§th, at 10:30 in the morning. ~_ena.li pumped for about 45 minute-;s' the quantity of fluids and mud pumped out were not recorded. There was standing water on the ground surface for the entire length of the absorption field during this visit. On the second site visit by EMI the water in the MT was 38 ½ inches from the bottom of the tube. The absorption test was conducted by adding water to the system for four hours ,in the cleanout pipe at the oppo.site end of the trench fi'om. [he MT. (The water level in the septic tank was monitored during the test and it did not rise.) During the test 450 gallons of water was put into the absorption field. During this time the water level in the monitoring tube raised to 45 ½ inches of water. The water level was monitored after water had stopped and an hour after the water stopped flowing into the system the water had raised to 47 inches. On October 21, 1999 a mound was built over the absorption field to el'~minate the stan"~lm water over the field. The water level was checked 24 hours arier the absorption test was started on the third visit. The water level was 49 inches. The house was vacant so no ,amount of water should have been added ~o the system during this time. The system was not directly being monitored between the second and third visit. Based on the above data the system failed to absorb the required 450 gallons in 24 hours. 206 E. FIREWEED LANE, SUITE 201 * ANCHORAGE, AK 99503-2703 Rick Mystrom. Ma vor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O, Box 196650 Anchorage, Alaska 99519-6650 h~tp://www.ci.anchorage,ak.us December 9, 1999 JeftYey Garness Alaska Water & Wastewater Consultants 6901 Deban' Road, Suite B Anchorage,Al( 99504 Subject: Waiver Request for Secluded Hills Subdivision, Lot 5, Block 2 Waiver Request #WR990098 Parcel ID #017-343-13 HA990572 Dear Mr. Garness: Your request for a waiver of the required 100 feet horizontal separation from the septic tank to private well has been approved. The approved separation distance is 97.0 feet. This waiver approval applies to the existing septic tank to private well separation only. Any future upgrade to the on-site wastewat~r disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, Daniel J. Roth Civil Engineer On-Site Water Quality Program MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Wa'iver Review Worksheet WR~ .WR990098 PID9 017-343-1~ Date Received: 12-2-99 Legal Description: Secluded Hills Subdivision~ I, nt 5_. Blnn~ ? Engineer: Alaska Water & Wastewater Con~Bltant~ 6901 Debarr Rd.~ Anchorage, AK 99504 Retlly Co, Applicant: Waiver Requested: Waiver for a separation ~n~ ~n 97 feet. Criteria: 2. 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: Special Conditions: Points: 3. Other: Waiver is Granted: 5~ Waiver is NOT Granted: List Conditions or Reasons for above: ~ ~)7-~ Rec ~: #05394 Amount: Name of Reviewer Date Paid: 12-2-99 HELL IP,~ TA. - TH~ k,'IELL t/~ ~uESTto,u' I~ Z 0(~7'~ ~ ~ E~T dF THE C. R. O. Poi,c, 2,? ALASKA WATER & WASTEWATER December 2, 1999 Municipality of Anchorage Departmem of Health & Human Services Attn: Dan Roth P.O. Box 196650 Anchorage, Alaska 99519~6650 Subject: Secluded Hills, Lot 5, Bit 2. Waiver of Separation Distance from Septic Tank to Well Dear Mr. Roth, Recently our firm tested the well and septic system on the subject property for purposes of obtaining a Health Authority Approval. After obtaining a current as-built survey, which shows the well and septic system, it became apparent that the septic tank is only about 97.5 feet fi'om the well. We are requesting that your department waive the subject separation distm~ce to 97 feet. Justification for the waiver is summarized as follows: 1) The driller's log for the referenced property shows no bedrock present to a depth of 321 feet. In addition, there is 195 feet of soil, which is primarily sand, silty gravel, and clay, before the aquifer is encountered. Based upon recent sampling analysis for nitrates and bacteria (copy attached), it is clear that these stratas have served to protect the aquifer. In short, subsurface contamination is unlikely. 2) The existing encroachment has existed for 18 years with no adverse impact to the aquifer. Recent water samples taken 10/21/99 indicate no bacteria and nitrate levels of .5 mg/L (see attached water analysis) 3) The topography of the land is such that the well is uplfill from the septic system. If the tank was to ever leak or overflow, there would be no surface contan~ination because it would flow downlfill fi'om the well (see topography map attached). If you have any question2~ please contact us at 337-6179. regarding this/r~latter~// Pre~id~t (/ ~ Thank you for your consideration 6901 Debarr Road, Suite 2~B, Anchorage, Alaska 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * awws~alaska.net / / \ / \ / EXIS~Nd I~ ~LON c TO ST2 = 26.5 ALASKA WATER AND WAS'rEWATER CONSULTANTS, INC. PHONE: (907) ~37-6179/F~: (907) ~58-~246 WAIVEE: WELL TO SEPTIC TANK f COMPANY, MATT REILLY 346-1974 C/O REILLY ~ATE: 1 1/26/99 BY:I SCALE: J,A.G. 1 = 40' 1 OF 1 THE INFORMATION HEREON IS FOR TItE USE OF LENDING iNSTiTUTiONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES OR EASERENTS AND IS NOT TO BE USED FOR POSiT]ON]NG ADDITIONAL STRUCTURES OR FENCELiNES EASEHENTS OF RECORD, OTHER THAR THOSE SHOWN ON THE RECORDED PLAT, ARli NOT SHOWN HEREON 1" = 40' AS-BUiLT SURVEY LNO CORNERS SET THiS DATE) I hereby certify that i have performed a Mortgagee'a inspection of the following described property: LOT 5~ BLOCK 2, SECLUDED RILLS SUB, Anchorage Recording District, ALaska and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property Lying adjacent thereto, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadwaye, transmission Lines, or other visible easements on said property except as indicated hereon~Dated et Anchorage, Alaska this 2Y' day of 197_~. /~a' ,/?- hz HOLT AND ASSOCIATES LANO SURVEYORS )LOC HILL5~ 2 ILLS S/D LOT 8, 1 SECLUDED TRACT A HO~<AMA HEIGHTS LEGAL DESC~IP-TIOI~ SECULI~ED OF ~,.N I~ WASTE~ 690,~/DEBARR ROAD, SUITE 2B. LOT 5, , AK. 338- ~s/D PREPARED MATT R THE NUMBER: 346-19~'4 LLY (~0~ PANY BY: 1OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF FIEALTH & HUMAN SERVICES" Division of Environmental Services On-Site Services Section P.O. Box196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 0/7-- ~V~'~/~ 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner ~'~'L~"~-~-t...~,~ ~ ~__o...~<~.~ _ Day phone Mailing address Lending agency Mailing address Day phone / Address 7~C ~ Unless othe~ise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: Dayphone 3"1~l-;1~ "1 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 - If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. NOTE: 72-025 (Rev, 1/91) Front MOA ~21 5. STA'rEMENT 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 %",~,,'J~ ~¢~0 ," ~ [¢u~,~ ./~'- Phone Address ~ ~ ~ l~ ~ Engineer's signature ~~ DHHS SIGNATURE X Approved for '/'~-~¢~-~ ~} bedrooms. Date Disapproved. Conditional approval for 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 g~ven 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 w,~rk. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Parcel I.D. Well type ~ Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ¢'/~Z--/~r',/ Driller /~/ "~ Cased to ~O ] Casing height ~'~ Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line y Wires properly protested (Y/N) FROM WELL LOG AT INSPECTION 5 g.p.m. I, } ~ On adjacent lots ; On adjaoent lots Publio sewer manhole/oleanoul Petroleum tank WATER SAMPLE RESULTS: Coliform 1 Date of sample: Nitrate Other bacteria Collected by: B, SEPTIC/HOLDING TANK DATA Date installed ~/3/¢ / Cleanouts (Y/N) y High water alarm (Y/N) Date of pumping Tank size / z_,h~-(~ Compartments ',2__ Foundation cleanout (Y/N) / Depression (Y/N) bf////¥ Alarm tested (Y/N) Pumper ~0¢~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line ),_'~0 Surface water/drainage 72-026 (3/93)* Front On adjacent lots /~ /O--c:~ Foundation Absorption field r/q. ~ Water main/service line CONTINUED ON BACK PAGE c. uFT STATION 0 F- Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~/~,/8 t Length ~, ~ Width Total absorption area ~.~ ~ Date of adequacy test I I Ii '~-I Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ft2) I ~ CO System typo / Gravel thickness ~ I Total depth Cleanout present (Y/N) ~// Depression over field (Y/N) Results (pass/fail) '"~ for --~ Bedrooms ,9 1 After test ~ ~ ~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot '~ / ~ On adjacent lots ~ ,/O--d~ Property line To building foundation ~ ~ --+ To existing or abandoned system on lot On adjacent lots ~ ~';~f~ Cutbank ~ O///~ Water main/service line Surface water ~X,//¢ 1,~.~ Driveway, parking/vehicle storage area Curtain drain hl//~:) E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect op the,date of this inspection. Signature Engineer's Name Date HAA Fee $ ~E)E) ¢~fZ) Date of Payment Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF NEALTH AND ENVIRONMENTAt. PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION ," (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 5~ Bk 2, Secluded Hills Subd.; 11-15-85 Sec. 2'?, T22N, R3W, S.M. (b) (c) Location (address or directions) 133~c_Lnae~P.O. Box 110154~ Anchora~;e~ /t~ 99511 Applicant NameBill Pearson~(athy GallaherTelephone: Home 345-5898 Business 265-8396 Applicant Address 13361 Badger Lane~ P.O. Box 110154, Anchorage ~ At( 99511 Applicant is (check one): Lending Institution []; Owner/builder ~; Buyer []; Other [-] (explain); (d) Lending Institution Alaska Mutual Bank Address 60]. W. ~ Anchora2L¢_~ AK (e) Real Estate Company and Agent ~f~: Address 99501 Telephone 274-3561 Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family [~ Multi-Family [] Number of Bedrooms Three Other WATER SUPPLY Individual Well ~ Community [] Public [] Note: If corem unity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite I~ Public [] Community E] Holding Tank [] Note: If cornmu.nity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72025 nLs.h ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION AS certified by my sea[ affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, fanctional 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 Aechorage 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 reguJations in effect on the date of this inspection, Name of Firm Alaska Soil Testing and Engineeri~gTelephone Address ___~alOO A S~aaae_t~ [~c~'~e~_AK 99502 [}ate ] ST85 260 I DHEP APPROV~AL ~/ /~ ' Approved ,/~ Disapproved" Conditional __ Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health .Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of [}HEP 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. Page 2 of 2 MUNICIPALITY__ ....,.~.~ ~,.O~ AHQ AGE ENVI~.ONM~NI^~' r~.~.',~-'"" HEALTH AUTHORITY APPROVAL (HAA) '~0V· ~ 8 ~985 CHECKI.IST-264.4720FEBRUARY 1984 Sec. 27~ T12N~ R3W~ S.M. WELL DATA Well Classification Private Well Log Present (Y/N) Y Total Depth 321[ ft. Cased to 301 ft, Static Water Level Plf-~ ri:. Casing Height Above Ground 20" Electrical Wiring in Conduit (Y/N) Y Separation Distances from Well: If A, B, C, D.E.C,. Approved (Y/N) CommZ, Date Completed 9-22-81 Yield 5 gpm Well log (Re£ · ¢ Depth of Grouting N/A:. Pump Set At 2_80 £t· Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot lO1 ft. ; On Adjoining Lots 170 ±'t. To ~earest Edge of Absorption Field on Lot 110 ft. ; On Adjoining Lots 185 ft. To Nearest Public Sewer Line 100+ £t · To Nearest Public Sewer Cleanout/Manhole ~OO+ ft. To Nearest Sewer Service Line on Lot 30+ ft. Water Sample Collected by Mark Holum, P.E. ; Date 11-14-85 Water Sample Test Results Saf,~ sfactory Comments ~)_ Well yield confirmed at 450 gal/day per four hour drawdown test 11-13-85. B. SEPTIC/HOLDING TANK DATA Size 1000 gal. No. of Compartments 2 Air-tight Caps (Y/N) ¥ _ Foundation Cleanout (Y/N) Date Last Pumped l:L-14-85 N/A ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field 20 ft. 23 ft. Date Installed 9-3-81 Standpipes (Y/N) Y Depression over Tank (Y/N) N Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well lO1 ft. To Property Line 30+ ft. To Water Main/Service Line 2©+ ft. Course lO0+ ft. Comments To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 9-3-81 Width of Field /~ fto Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test 150 ft2/bdrm Type of System Design 34 ft. Length of Field ].1 ft. Depth of Field 8 ft. Gravel Bed Thickness 544 ft2 Standpipes Present (Y/N) Y N Date of Last Adequacy Test 11-14--85 Satisfactor,y ( Absorption exceeds 1000 gal/day), Separation Distance from Absorption Field: To Water-Supply Well 110 ft. To Building Foundation 20 ft. Lot To Water Main/Service Line 20+ ft. To Stream/Pond/Lake/or Major Drainage Course 30+ To Driveway, Parking Area, or Vehicle Storage Area To Property Line 30 ft. To Existing or Abandoned System on ; On Adjoining Lots 1OO+ ft. To Cutbank (if present) 1OO+ £t. 100+ ft. Comments D. LIFT STATION Date Installed N/At Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test, Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked,.v~rifi.cd, or conformed to all MOA and HAA guidelines in effect on the date of this inspection, "~./¢.,~*,,,~~ ~' Date 11-16'485 ' Signed ~¢'-' . . , '' , - CompanyAlaska SO~I Testing& E~A No. St85-260 Receipt No. Date of Payment Amount: $ f,~(~ Page 2 of 2 72-026 (11/84) ALASKA SOIL TESTING AND ENGINEERING 6100 A Street, Anchorage, Alaska 99502 (907) 561-7453 Adequoow Test Location: Lot 5, Bk 2, Secluded Hills Twpe: Septic tank and Trench Address: 13aB1 Badger Lone Client: Bill Pearson Subd. Date Time QuantitW off Depth Below Oepth Below Watem Added 8mode off Brads off Water to Trench Water Level Level in In Trench Septic Tank [Gal] [Inches] [Inches] 11-13-85 1:30 pm 0 127 1/S 105 11-13-85 /:Sa 75 " lOS 11-13-85 a:as 134 125 1/4 los ii-ia-es s:am a0i lBS lOS il-la-as 7:20 SSa las 1/4 10S il-l~-8s 10:~2 am 0 lBS las 11-1~-8S 11:08 BO lay 1/a 205 li-i~-eS ii:ia lO0 il7 i,/~ lOS ll-iS-BS ii:aY soo 10a i/2 i0s 11-1~-8S ll:aS " 113 1/a 10S il-i~-eS ii:S~ iai i/~ los li-is-@s ia:ob pm " 123 ii-iS-SS a:O~ " Conclusion: The absorption cote off the existing trench exceeds 1000 gellons per dow and is adequate flor the three bedroom single ffamilw dwellinO, Comments: The the test. Pemffommed bw: septic swstem mos Mamk Holum, P.E., in use prior to and during ~ .~ C~ 5734 * ~ Time Time Date Date Date Inspector Inspector Inspector Comments Conditional Approval ij~ -2¢-> / Date ~e~er Installed Soils Rating Permit No, Well To Absorption Area Well to Tank Septic 'rank Size Holding Tank Size Well Log Received APPLICANT FILLS ()UT LOWER HALF ONLY Property Owner Mailing Address/,/~/ ¢' ~" ~'~ " Phone Buyer Lending Institution Realty Co. & Agent Address Legal Deserlption~ ~ Street Location Phone t Phone Ty p e .o. Jvi;~e's I d e n c e :~ , ~Single Family Multiple Family No, of Bedrooms Other Water Sj~ply ~h-qndivldual [] Community [~ Public Ulllity Sewage,J:)leposal ¢]~lndlvld ual rD Public Utility LI Holding 'rank ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available,) Year Individual Installed: /'~ ~' / When Connected to Public Utility: NOTE[: THE INSPECTION FEE MUST ACCOMPANY EACH REQIJEST BEFORE PROCESSING CAN BI'; INITIATED. ALASKA [ FIUIROFIITI[ FITAL COF1TROL $[!RUIC[/$, IrIC. December 28, 1981 Department of Health 825 L. Street Anchorage, Ak. 99503 Attn: Les Bucholtz & Environmental Protection Dear Les: On December 28, 1981 I inspected the well and took a water sample for loan approval for L5 B2 Secluded Hills Subdivision. The results of the bacterial test for the water is attached. It was satisfactory. The well has a seal and is approximately 1 ft above the ground level. The septic tank is 106 feet greater distance. The sewer standpipes. from the well. The trench is at system has caps on all PhD, PE 1220 LUesl 251h r~uenu¢ ·/~nchora§e, Alaska 99503 · (907) 276-~361