Loading...
HomeMy WebLinkAboutSTOLLE BLK 3 LT 3Stolle Block 3 Lot 3 #020-021-15 — -- Municipality of Anchorage -- Page I or _ z DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL_ SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: "��� �i4 PID Number: b Z bC7z 1 I S Name: ®® ®� Wastewater System: ®'New ❑ Upgrade Address: �'J Z.Q'I �yv c� I1tlYV1 VY 9351(. ABSORPTION FIELD J Phone: No. of Bedrooms: — — -- w 1— ❑Deep Trench kc1 Shallow Trench ❑Bed El Mound ❑Other LEGAL DESCRIPTION Soil Rating: L. Total Depth from original grade: 'I 1, GPD/Sg. FL VAr2twS -_5 -a % --' -- Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe 3 13 5A-aIIe, VAM95- 'W 4, 4' Ft. 3' FI. Township: Flange: Secti9ry I1 rJ �w? G //� s 6 Fill added above original grade: Vit Iles - og 'Ie �Z Ft. Gravel length: Av®R.A6Ir — 65 Ft. WELL: ;4New 1:1 Upgrade Gravel depFh: w rdff!• Number of lines:Distance between lines: 5' F. Z— $117- Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area(E'FFB[t)'jvl: Pipe material: pLaR.p-:.WD Qs Pte. X21 V A 5(6?j Ft. 3 Ft. ab SQ. Ft. S�Ls V •- D )03.1 -- _i Dr Iler: Date Drilled: Static Water Level: 6-30-9 l'ne�rCliilc2v- = I -1S' Ft, Installer:— KtNcAipiSo�s G c,ry prvur2J Date installed: s+�v 29,1997, Yield:Pump Set aC Casing Heighl Above Ground: TANK GPM Ft, Ft. SEPARATION DISTANCES $a Septic ❑ Holding o S.T.E.P. To Septic Absorption Litt Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines /�� �� AK)e FQ%7— iib — Well 4-100' a -too, i-lr.7d Material: $T'Ly WL Number of Compartments: 2, �® Surfac water,-lex' -1-1exi �-too� LIFT STATION [.of r 'h�JO + 50, x-50 Size in gallons: Manufacturer: — � Line Z Foundation 17 ' 'i�ci' _- "Pump on" level at: P Jrr p.ef level at: High water alarm at: -- CurtainPump 456' Make& Electrical Inspections perlormed by: Drain Remarks: T-'1ag r> INsrUL.eP0 Lotto �Li' iC � — BENCH MARK Location and Description: M I N) PAU A? ULF:W U11ZEQ _--®— GA^ AG.S y LAA_„� Assumed Elevatr loo-- �— - ----- -- _ ®PLE,4L flN 'y,pp `�¢® � C $t Inspections by: Dates: 1st ? -z$ -.3z J performed _,.��)r`aa�, �_� 2nd ••z�-.�z M JF,o_�a Department of Hea an Human Services approval Reviewed and approved by:� Date: 2 -/-%'3 I2-013 (1/91) MOA 25 Permlt No. Sw 9zoo 19 Page Z of- z Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL. SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: _ L'353 5+C lle5vU _ PID No.: OZ-obZI I S 2 Eta rG. JI L:3■ 41 Hbuflt 6. FROM -M'r yo LIFO 1 I J) Y �I raNc o, --��— rt' l'b5o G. •YAnAc $ ,79s CrA�D SG+di'Ic�N1SH1�G1. 1- 0 �1 6, ` O �i RIh1lfHkr� Cr2ADE VI��$'- OltvwINNL q�f1N_��p'ru�- �, IZyo GAi. Crz.aoe 9 �� peRR THS 'SYPAy, r-P.4fA "IVY. 66 _ ENGINW S 9A -- I 4 (� OSI l\ .'Ei.^ e 72-013 A (2/91) MOA 25 LOCATiON/SKE=TC tl: RLIRDIVISMN I LO'r I BL.OM STATE or: ALA$KA DEPARTMENT OF NATURALRFSOURCES DIVISION OF WATER VVATER WELL RECORD SCCTION OTRS WELL OWNER: GEC1'I0N To"SIIIP I P.ANGE I MERIDIAN CJN LJE 17J F, IOW DEPTH-` Ex` [ iC'e I Rtema csing top 0ground surface WELL DEPTH DATE OF CUMPI s;f ION ..- .._..,_ _..... ...._ ....,_.__....._�_�.._..,._.,. Depth of hole 0090401-V !)ATA: Depth Depth of rasing b ,xi� idiatorw Type Bend C:olnr from To _. _ WELL INTAKE OPENING TYPE: [D Soreened ._..._..._...._.,_..._..........:..._..._Y......_.,,.._..__..___. .�._...-.._m._.._ Dr.PrH TO STATIC WATER LEVEL: l-� pf:rforated '_ open holo .._._.-._...._.._ ._., __....._.._ ,..� ,.. Wim_. _ _. ftbel0w, Q top of casino 1-1 ground bulfsce f �l SC Rf rN 7 YPY.In, .ft _ :.e, r iNFFG rt UPON COMI nl f 10N? t- y[ :, 0 NU /f I Data.L METHOD OF DRILLING: ENG J>1. air room o'e ton! / '� (lµf / 1 _ ❑ OtI1Gf GRAVEL PACK TYPr! USE OF WELL: /' domestic, D rr lat nn -', 17 3 r1 publio supply GR(JUT TYPE:; .. .. CASING STICK-UP- ,gam—., ft. D i In t0 It C:aslntl typu n to It Df:VLi v: I of); : _...__. .. _. WELL INTAKE OPENING TYPE: [D Soreened ._..._..._...._.,_..._..........:..._..._Y......_.,,.._..__..___. .�._...-.._m._.._ _--l-�--- l-� pf:rforated '_ open holo .._._.-._...._.._ ._., __....._.._ ,..� ,.. Wim_. _ _. .. Depths U1 nponinps ;, tg ...._ .__�.w ... _..., ..._ . .._ _�. ..............�...._..,. - .iP INTAKE M: 3 H ft HOrtepowoi �l SC Rf rN 7 YPY.In, .ft _ :.e, r iNFFG rt UPON COMI nl f 10N? t- y[ :, 0 NU I �! 810JrJ�PSh S ze ,!a CONTRACTOR INFORMArkdr 10MARKS: Re tar d usmoss1661 FLFASE: i;IIAEL WHITE COPY OF LOG TO: --_--- _. E;NNICAVISION OF WATER itur e of Ai [linnzccf re �ntetive Dr,ic - PO BOX772116 EAGLET RIVER AK 99577.2116 GRAVEL PACK TYPr! Volumo used ..-_ Ot-'P lo top; _ GR(JUT TYPE:; .. .. OcFth from fl . ft Df:VLi v: I of); -...,..__-_ FEB _. L JMPIN(, r YIELD: ty of Anch )rage f, hre purnpmg .J gpm _._... _.._Municipal Dept. Health HulTterr ervicea a.. - .iP INTAKE M: 3 H ft HOrtepowoi �l _ :.e, r iNFFG rt UPON COMI nl f 10N? t- y[ :, 0 NU CONTRACTOR INFORMArkdr 10MARKS: Re tar d usmoss1661 FLFASE: i;IIAEL WHITE COPY OF LOG TO: --_--- _. E;NNICAVISION OF WATER itur e of Ai [linnzccf re �ntetive Dr,ic - PO BOX772116 EAGLET RIVER AK 99577.2116 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW920014 DESIGN ENGINEER:CONSTRUCTING ENGINEERS, INC OWNER NAME:LAPKASS JOHN E OWNER ADDRESS:8241 LONGHORN DRIVE ANCHORAGE, ALASKA 99516 PARCEL ID:02002115 LEGAL DESCRIPTION: STOLLE BLK 3 LT 3 LOT SIZE: 152481 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 PAGE 1 OF 1 DATE ISSUED: 2/12/92 EXPIRATION DATE:: 2/12/93 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY:__ CA tg-" __ DATE: ISSUED BY:_4�__ DATE: _____ b -U -O-66 a 9NINVNa 91566 /x'fl 'RDVNOHDNVI IV3S S,N33NI�JN3 xa 8606-b69 as usmHam ans T096 ✓Yrr , OOOZ-9bE susaxlems omilonumsxoa `l4itl076,- IVO AS NNVNa X001 ai�1 TIVJS QIL-.AR .�ya'4";' ..,'i- 0961 In curie. NCA, -4C y O)I$66 ')kV r_J-Ot-�ZsaF�">N�y 1��. ✓ti 3•Y. 6*0H -)P- 14, �s��h u &s o 66 NUON�cvo7 I � 2 S51✓>Ivb1 NHOP '2IQ :2103 QZ2IHdH2id ,�—=,14eo�n..�. AY e� 62L�a'A 4 ,Yv.pwry 'f f 4^r V xoIsxnxasns szzoss E xaoze E soz �g�sp xo2sax zip Q:asxa s yi/Hxs�aM swsssxsaxsodoxa :rjs oaors£ V}9.LSAS Na Lld Nosgy 2'�3 E��� 3�bN'llHnb :}S ISbrl-II (Ye57 4>saabN aoms �,v9n95 'yv171d..f�J �a-rb `cnrayzl -n5m rd913\vlZ Jd SSa� (�s 18-t, z50 .uu-7v oS'€ \raiJV sad r V, c.� d "I �kJaVS I&c ,os �b to Nnt-WSi,� �1�=�4o-1=1n�ClNn a9�+xn 1 ' r �l^K1y� u S2r CUSoa oc�d �"� �\ r Z 's I�N ,��oy .ice• �_ � ���'a�r,, � ��., %S2 2do7S xIVY 9'Inf4dt)L. if Razv 1�awaai;d�y S4 yr m L(9Trd15N! ♦ - � o�`I asd (+�Ud b05 ski t=L�.oN - � i Z / Ct ',; Pln:�U ni r1 Jv swsssxs xoISdHosav HRIUMSI M amv Hzlvm—xKzd ssxs ABSORPTION SYSTEM DESIGN o ao v z//s ' 'L'1H•p. IN3��9n°N Z C^<-1VV— Fkt° C•O• T�x•25rnwOP�N�asse GO. IZSo GIA- ILSo 6hL Z-CoMAWr 'Ygn•K f I"pNK (N11") *ALL 1?IOL° W/ l6if-")W 9' 21 c VrR -S3 r4N TF}.y. INS01J1111w C.o.-C-tyP) A21-- �. it: coy GfL < 4', Z.n i-i•D. ~------------'---","-- 5' Fuw. w. o71i nr P1eL0 4-1 VL' Sewer- RSC 7MC sVoNDENip ABSORPTION AREA CALCULATIONS: 4 Bedrooms x 150gpd/bedroom = 600 gpd (soils rating : 1.2 gpd/sf) 600 gpd / 1.2 gpd/sf 500 sf area Use wide --trench design, trench length = (required absorption area = width) x correction factor [W + 2] / [W + 1 + 2(D)] where W == 51, D = 31; [500 sf/(51) x correction factor (0.58)] = minimum trench length 59' IMPACT ON ADJACENT LOTS: There are no wells within 200' of this absoption system. The proposed absorption system has no impact upon any adjacent lots as shown on attached site diagram. The proposed well reduces the area available on Lot 2 for future septic system installation as shown on the site diagram. i SITE PLAN DETAILS --PROPOSED ABSORPTION SYSTEM LOT 3, BLOCK 3, STOLLE SUBDIVISION •� y, PREPARED FOR: DR. JOHN 1_1NrKA5S Oda' k4 a a tP�s sS9af�, n r. , g Z., g l Lory G-1-}uYZN AQ ,.-rA p Rdt�. t`s32C e'fEf'.`r[B . June 22, 19MI NOT TO SCALE DRAWN 8Y CAL 4� <'0�u4o<u s. ox eaa'ra'i3 CONSTRUCTING ENGINEERS 346-2000 ENG Gf°N'�'etL" 9601 BUDDY WERNER DR 694-9098 ANCHORAGE, AK, 99516 DRAWING 9 91-S2-12-1 'rjcovfr hour a Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOO — PERCOLATION TEST PERFORMED FOR: 3-4) r+AJ L-/j?\<A$S DATE LEGAL DESCRIPTION: I.�J13,3 540IIe,Svl Township, Range, Section 75L- t�+ N & l4 5 ,TI1 N VZlu DEPTH SLOPE SITE PLAN (FEET) S 0Y:qo1Y11e" r I F—F-1 r—F—T—T—T—T—J—T—T—T— 3 4 jjic S �Ya <an_� r1 5 S I r�Qf`h"F -)-,- z c e, 0� S i I i 6 7 8 9 10 WAS GROUND WATER ENCOUNTERED? 11 IF YES, AT WHAT 12 DEPTH? 8l:D FGoU< EiNcn"NTi�D Oepih (a Water Atter 13 Mont(orl"u? -- 14 14 15 16 17 18 19 O No S L — c NW O o P E Dale: 12 1'91 Reading Date Gross Time Net Time Depth to Water Net Drop CIDt 23%91 —�6– ,, ; inMc� 14 v z`l4- 20 ul PERCOLATION RATE �L (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 34 — FT AND —5a—FT COMMENTS PRE"S6H1< -TEST Fla Le 1 'J'Wf BED ROG.K @ IZ.r= USE: S I.L'uu� 'DE51610 Stitt$ '�4T1NG I-! GQD�SI% p PERFORMED DY: �-{��"�'`I—C� I n. -a8_— CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL_ GUIDELINES IN EFFECT ON THIS DATE. DATE. I Z I I91 72-008 (Rev. 4/85) -7-c-'sT' ROLE- #'z u Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 " L" Street, Anchorage, Alaska 99502-0650 SOILS LOC, — PERCOLATION TES'r PERFORMED FOR: z O 4K) LA -0 KA -SS DATE PER LEGAL DESCRIPTION: �--�� Sioll¢.5.��j _ DEPrH Q Township, Range, Section :51 //4Nel/t 5: -T -I iN szzLJ SLOPEE SITE PLANTFE Depth to Water Net Drop sal{- cSr bve+-i�ur e,l� F FM � I :' 3o m IU 3r K 3 4a Qtly s ar,d 6 7 8 9 10 11 12 13 14 15 16 17 18 19 WAS GROUND WATER Nb ENCOUNTERED? S IF YES, AT WHAT L O DEPTH? N P E Depth to Water Aller Monitoring? N p Data: Reading Data Gross Time Net Time Depth to Water Net Drop 3o m IU 3r ga �' ZI q --i only IU��r 161r Z" lb 15'SUT.w IOM 4 Z'�4-� z./4,,, 101- 0 �� PERCOLATION RATE Q�— (minutes/inch) PERC HOLE DIAMETER 8 TEST RUN BETWEEN �S_FT AND 5= FT COMMENTS �IZarSa'i+C Yf7jT FdoLL' F'?-P40cy.- IZI') USE S1iALL,bw1 tATtnff ]'jecgr- .H J7a*kGW SotCg II fl31 NG b Z. CPPD �5i~ PERFORMED BY: �O h?�tvvc.�yr.� G; In e �' (1.^Pa %R,_�_ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL_ GUIDELINES IN EFFECT ON THIS DATE, DATE: IZ'j 119I 72-008 (Rev. 4/85) Municipality of Anchorage •. -�1 Development Services Department Building Safety Division _ On -Site Water 8 Wastewater Program 4700 Bragaw Street 1t P.O. Box 196650 Anchorage, AK 99519519.6650 l www.muni.orglonsite (907) 3434904 V CERTIFICATE OF ON-SITE SYSTEMS APPROL //,, FOR A SINGLE FAMILY DWELLING Parcel I.D. oA'9 - D a I— I J5 COSA# 1. GENERAL INFORMATION Expiration Date: is Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent . Mailing address STOLLE, BLOCK 3, LOT 3 10401 HONEYBEAR LANE 'ANCHORAGE. AK SCOTT STEWART Day phone 608-234-0362 PO BOX 13913 *DURHAM, NC 27709 Day phone BARBARA BOWDEN Day phone 273-7281 3801 CENTERPOINT DR. #200 *ANCHORAGE, AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well N Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site N Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are 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 axed 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 tiles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations In effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. I Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date '1100-9 Engineer's Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines B Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the solo benefit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE t� Approved for L bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing st MlaW 1111611 W. COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory -� Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other By: vv (Rsv. 71A5) Original Certificate Date: Municipality of Anchorage Development Services Department .Oot all, Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196850 Anchorage, AK 99519.8650 www.muni.orglonsite (907) 343.79W CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: STOLLE BLOCK 3. LOT 3 Parcel ID: 07-0-02,11-15 A. WELL DATA Well type PRIVATE I/ A. B, or C provide PWSID# N/A Date completed 6/30/1992 Sanitary seal (Y/N) YES Total depth 368 ft. Cased to 33 R. FROM WELL LOG Data of test 6/30/1992 Static water level 175 ft. Well Log (YIN) YES Wires properly protected (YIN) YES Casing height (above ground) 12+ in. AT INSPECTION 10/29/2007 119 ft, Well production a 9,P,m, 5.0+ g,p,m, WATER SAMPLE RESULTS: 094 Coliform 0 coloniesl100 ml. Nitrate _NQ mg./L. Other bacteria14B. colonies/100 ml. Arsenic: LIQ_ ug./L. Date of sample: 10/30/200 Collected by: GEG Ltd. B. SEPTICIHOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Data installed 7/29/1992 Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 11/2/2007 Pumper MCDONALD PUMPING C. ABSORPTION FIELD DATA Date installed 7/29/1992 Soil rating (g.p.d./WoK !bd 1_2 System type SHALLOW TRENCH Length 65 ft. Width 5 ft. Gravel below pipe 3 ft. Total depth 6 ft. Eff. absorption area 560 fe Monitoring tube YES Depression over field NO Data of adequacy test 10/30/2007 Results (Pass/Fall) PASS For 4 bedrooms Fluid depth in absorption field before test DRY in. Water added 6100 gal. New depth DRY in. Elapsed Time: 0 min. Final fluid depth DRY in. Absorption rate >= 600+ g,p,d, Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date D. LIFT STATION Date installed "Pump on" level at _in. E. SEPARATION DISTANCES Size in gallons "Pump off" Manhole/Acoess water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot too '+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ Manureianimal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line t0'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation t0!+ Water main N/A Water service line 106+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION l certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in efted on this date. y Engineer's Printed Name JEFFREY A. GARNESS "•y CE -795I3 Date(t I �fl�� •.•dpll,..F��c fnl.ubn COSA Fee S_ `%30, 0 h Date of Payment / I / 1 '-/I OZ Receipt Number 1;PM''1I� (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number wqf SGS ReEM 1075867001 All Date%/Times are Alaska Standard Time Client Name Garncss Engineering Group, Ltd. Printed Date/Time ' 11/06/2007 13:55 Project Name/# Stolle L3 03 Collected DateRkme 10/30/2007 14:30 Client Sample 11) Stolle L3 133 RrceiveJ Date/Time - 10/302007 16:16 Matrix Drinking Water - Technical Director Stephen C. Ede P%1 SID 0 - Sample Remarks: Alloeahle Prep Analysis Parameter Results POI. Units Method Comair lD Limits Date Date but Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 10/31/0711/01/07 hill Waters Department Total Nitmic/Nitritc-N ND 0.100 mg/L SM204500NO3-17 D (<10) 11/01/07 LCP Microbiology Laboratory Total Coliform 0 coU100mL SM2092220 A (<I) 10/30/07 SDP I I (� C 26.0 ` rn 5.3' I a HOUSE DETAIL SCALE 1 "=30' LOT 4 10• TRC MIO �EIECTRIC EAUmtmf LOT 3 n. ,a 0 ELL E-:a.ae y e EXISTING Two STORY MOUSE o �ryFt 'off, (SEE DETAIL) GRAVEL DRIVE SEPTIC C.0.'� (TYP) -� J m S 86'18'30" E 372.72' If 1 ' _ ;IDO LOT 2' n V Q 49Ib (ennelh L. Dreyer % { LS -8202 yJ, 4 u E HOUSE DETAIL SCALE 1"='30' LOT 4 • M-C�..r r.v M-IK�.� " w;l,•h PETE •FANO r COMSIAVC111 110 WEST BENSON f A�NOOIICRACC• AEA$NI ie :. 93 -L -35A e' 0 3i1 Fri .. leen � ol.�l; •; �i LS 8202 E.4VSON NOI[[G N N Ne w.wri Irr..rwlf M 0.Nr•wf.r C n'1 ENO �� Iwr r.blrnrr wl wI {r1Y-rn1A w++rNw r IrrYklMr MkA ti wwl {nrr w Yr wrrb0. MFh.wwMOR: f/Ilq b/i� f/{ -M Q OVP MMM {ffY.wrl We. pMAI MI Mr w fr YN. /Y AB' ,I.YOa j bOAMnI ��. {WIiYf11F.../ IV {.IMIMf MMrli bM. , ♦ I.a Y rc /NC(• •—C— fUA.(I AwIiCN wrr rwn4.rlr0. • wnErrM wb..r M U•k Irrr11 wr W.A w Nk ♦r-Yy w+0. IM Mr Mwrw•w+r-U Y.wNI IMr• e.(rYw4- em�a www Kaf- COM'J[R• {n rr MV++ IM YrNI{ hrr Www rwowN. .p1ylM �; wewU obl tlww Iwwn N1.0. P.MI• ' e-VENMGS-ENdNCERS A5—uuf4T OF: KON KStlN'VON. •wKflriwnf- KR{ wnl- iuo» ee2-Si71 LOT 3, BLOCK 3, 100• (I{r)5e1-ee2e STOLLE SU-BDIVISION. Parcel I.D. # MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 020-021-15 let Cf/V4d 0P ' H A A # 11Q1`fI _ 1. GENERAL INFORMATION Complete legal description Lot 3, Block 3, Stolle S/D Location.(site address or directions) 10401 Honey Bear Lane Property owner John Lapkass Day phone _345-5923 Mailing address_ 10401 Honey Bear Lane, Anchorage, Ak 99516 Lending agency National. Bank Of Alaska/Ma J0Dayphone257-3094 Mailing address POQx 1.25, Anchorage, AK 99510_ Agent Kim Paisle,}/JKP Real Estate Day phone .276-2233 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: —4 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confinnation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/91) Front MOA#21 5. I M 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 furtherverify 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 S & S ENGINEERING Phone G`I 'I - a Cq 7 17034 Eagle River Loop Road No. 204 Address Eaale River Alaska 99577 Engineer's signature DHHS SIGNATURE Approved for d V/R bedrooms. Disapproved. Conditional approval for Additional Comments 'llf=nc Date S -1 A a OFA bedrooms, with the following stipulations: DateR-/3" '79 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesyto purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-M (PW. 1/91) Back MOA #21 I. r` i " 6 r, Municipality of Anchorage AUG U 1999 DEPARTMENT OF HEALTH & HUMAN SERVICEE6NICIVAurY Of ANI. C*3 Environmental Services Division NviRONMENrAtseavice. 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: Lo I 3 OLo,_'c -; S 'r o L.Lf- 578_ Parcel LD.: 0 X (9 0'11 1 S_ A. WELL DATA Well type _7R V4F k -_ If A, B, or C, attach ADEC letter. ADEC water system number Log present iq/N) Y12,, } Date completed � It' -3o / `) z Total depth _ 3 C re Sanitary seal O/N) 'Y& S Date of test _ Static water level Well production WATER SAMPLE RESULTS: .M Casing height (above ground) .A Cased to _� 3 ra �• •R_ � Wires properly protected &N) vi J FROM WELL LOG AT INSPECTION 30 lC1 7�AS'�R`� ---g.p.m. �. g.p.m. *- A'.5?/2'GT4-n ✓ 11 PJ,4i" 4 - Coliform O —_ Nitrate __© • C' '�_ N _ Other bacteria Date of sampler_ �1 0L____ Collected by: _ S & S ENGINEERING --R63R-E'09Foit;ve toalRoad No. 2p4 -- B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Date installed 7 / `) A .L Tank size I a S`o Number of Compartments � _ Cleanouts o/N)_ Y4 J Foundation cleanout ON) y4 1 Depression (Y/ l N U High water alarm (Y 141 (Y6Date of Pumping) I W la `)__ Pumper —fJu'' X C. ABSORPTION FIELD DATA Date installed I �� L' Soil ratinggg .d./ft2 or ft2/bdrm) _ _ System type _ 'T ` ✓ c/'! . r It I Length.__ S Width s Gravel thickness below pipe _ 3 --Total depth 17 _ z. Effective absorption area _5 F7 Monitoring Tube present (ON) y0J Depression over field (YO ^' a Date of adequacy test Results(Pass Fail) _ l'A SS J _ For _ --bedrooms Fluid depth in absorption field before test (in.); D� " _ Immediately after6oq gal. water added (in.): r Fluid depth J (ins) Minutes later: -_j g Absorption rate = _ 600 1 _g p d Peroxide treatment (past 12 months) (Y/N) N ddYo 1c,r0," ' If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) _ High water alarm level at* _ Cycles tested � E. SEPARATION DISTANCES Size in gallons "Pump on" level "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot / °O f On adjacent lots / °O + Absorption field on lot /00 "t On adjacent lots °� 4 Public sewer main N /,q Public sewer manhole/cleanout A) Sewer /septic service line a- S- 4 Lift station rJ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: i r � Foundation /0 Property line f a Absorption field fO r i � Water main/service line /0 't- Surface water/drainage / 00 1- Wells on adjacent lots 1004 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: I I Property line 10 -/- Building foundation 1 ° 4- Water main/service line Surface water I00 9 Curtain drain N oN r-- fc. ✓vo w ,) F. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area I0 + 3o 4 - Wells on adjacent lots / 0 0 / 4- I I certify that I have determined thru field inspections and review of Municipal in conformance with M A ,H, AAg�1eline in effect on this date. Signature (Q�/`/ ✓" Engineer's Name l�fld��Rr C. Cow9^,� Date / /C1 I _ HAA Fee $ c-%40. ry Date of Payment � f Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number ,, ERT C COWAN/,4, CE -£3601 are AUG -06-99 17:04 FROM -CTE ENVIRONMENTAL 5615301 T-597 P.02/03 f-457 CUE Environmental Services Inc. P_T&i: Ref.# Client Name Project Nantes# Client Sample ID Matrix Ordered By P'WSID 993929001 S & S Engineering Stolle S/D l.ot 3 Blk 3 Stolle S/D Drinking Waxer Parameter Results Client PO# Printed Date/Time 09/06/99 16:02 Collected Date/Time 08/04/99 10:00 Received Date/Time 08/04/99 13;25 Technical Director: Stephen C. Ede 0 Released $y �,44�.+C /J PDL llnirs Method Atlowaple Prep AnelysiS limits Date Dare Init Total Coliform 0 cot/loom1. SM18 92228 08/04/99 KAP Nitrate•N 0,654 0.500 mgn EPA 300.0 10 max 08/04/99 08/04/99 SCL • MUNICIPALITY OF ANCHORAGE �A DEPARTMENT OF HEALTH & HUMAN SERVICES M� Division of Environmental Services ��I On -Site Services Section h5 P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. S C7.067.11 15 HAA it 'Dnt7 ,�)c1 1. GENERAL INFORMATION Complete legal description LS 133 54o142 Location (site address or directions) �OY� Z -r Lz,.a' — Property owner Mailing addresE Lending agency Mailing address r LaPlerss Day phone Day phone Agent Day phone Address — Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: —,I— I'- 3. TYPE OF WATER SUPPLY: Individual well K Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest•• ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Y" Holding tank — Community on-site — Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (R -v- 1/91) Front MOA 021 LZX VOW %006 (l6/l'1a0)S00-8L • !aoM s,aaou!6uo leuo!ssalad aql ui suo!ss!wo ao saoaaa aol alq!suodsaa ;ou s! abeaogouy 10 Aj!led!o!unVy ayl •penssi s1 aleo!1!liao a wolaq elep azlleue ao suolloodsul lonpuoo IOU op SHHG to soaAoldw3 -sluawaa!nbei awls pue leaepal u!epoo Als!les of Aepio u! suo!;ny!;su! 6u!pual a!ay;pue sawoq 10 siesegoand of Asolinoo a se s!qy saop SHHa ayl'e�selV to alelS aq1 ui paaals!6aa aaau!6ue leuo!ssalad luepuedopu! ue Aq anoge g ydeifted ul u0A16 suo!;e;uasaidej aql uodn Aluo paseq saleo!;!yaao JenoaddV l!aoylnV ylleaH sonss! (SHHO) saowaS uewnH pue LMuOH 10 luowpedap a6eaoyouy 10 A.I!led!o!un!N oql ral 111 :suo!lelnd!;s 6u!Mollol 9q1 411M 'swooapaq ... c -.Z- ale(] sluaulwo'J leuoi;!ppV ao1 lenoidde leuo!;!puo0 •panoaddes!p •swooapeq ao1 panoaddV n 3un.LVNJIS SHHa ainleu6!s s,a9au!6u3 ssouppV 8606-b / �� q auoUd wa!d 10 aweN uo!10adsu! s!ql 10 alep aU1 uo 109110 ui suo!lelnbei pue 'seoueu!pio 'sapoo alelg pue led!ownW Ile Ul!M aoue!ldwoo ui s! wags (s lesods!p aaleMalseM ao/pue Alddns aaleM a1!s-uo 941 'uo!loedsui pue uo!1e61;sanu1 !w woal pue sal!1 96eaogouV 10 !;!led!olunw a41 woal pau!elgo uo!lewaolul aU1 uo paseq leglll!aaAaaglanl I •u!9aay pole0!pu! aanlona;s 10 ad (;pue swooapaq 10 aagwnu ay; aol alenbope pue leuo!1oun1'ales s! wags (s lesods!p.IaleMalseM AO/pue llddns aaleM el!s-uo eql legl smogs uo!leo!Idde !enoaddV (;!aoUlnV UlleaH s!ql 10 uo!le6!;sanu! !w legl (1!aaA I 'Molaq UMoys a;ep uo11ep!leA aq;10 se pue olaaaq pax!;le leas !w Aq pa11p.Aeo sV w 07 833NIJN3 AS N01103dSNl d0 LN3W31b'1S 'S ® Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL. CHECKLIST Legal Description: L353 S4* ,? Sub Parcel I.D. OZ.6 o Z 1 15- A. S A. WELL DATA Well type ?T?IVprT-6 If A, B, or C, attach ADEC letter. Log present (Y/N) \� Date completed Total depth— ;)6 8 Cased to 33 Casing height 3 6 —_—_ Sanitary seal (Y/N) v Wires properly protected (Y/N) ADEC water system number 30-9 Driller Al 1;21 0Q IJrill�_ Date of test Static water level Well flow Pump level FROM WELL LOG —9 'L S g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot -+-100' AT INSPECTIO g. p. m -; On adjacent lots +10o, Absorption field on lot +\00 ; On adjacent lots r1oo Public sewer main + I0 — Public sewer manhole/cleanout Sewer service line _ '}+(00' Petroleum tank _ WATER SAMPLE RESULTS: -4- Fl 00' /0 r7 -t 1-1 Ci W rT1 00 I 1 a CA C) Coliform —— Nitrate Other bacteria —�— Z Date of sample: -t��BZ _3 Collected by: G®rs-Ew c`,'tr\G ��i� B. SEPTIC/HOLDING TANK DATA Date installed _ '7-7-9-97 Cleanouts (Y/N) ?7 High water alarm (Y/N) Date of pumping _ N Tank size_ 17-50 Compartments Z Foundation cleanout (Y/N) Y Depression (Y/N) N _ fk Alarm tested (Y/N) A — NJ C>� Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot— 4-t (od On adjacent lots + 100 Foundation To property line L5� Absorption field Water main/sery ice Iine Surface water/drainage 17 4 -Sc)' 72-026(Rev. 7/91)Front CONTINUED ON 13ACK PAGE <S �c o" z C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y SEPARATI Well o —n lot Manufacturer Manhole/Access (Y/N) CE FROM LIFT STATION TO: D. ABSORPTION FIELD DATA Date installed -7- 29 -97 - Length GS1 Width On adjacent lots p off" level at Cycles tested Surface water Soil rating I T- 994) System type WIDE -rREwr-44 Gravel thickness 3 Total depth vA2 � 91 Total absorption area C -Fr- S -C Cleanouts present (Y/N) Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Y Date of adequacy test W g — tvS(A) for If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot -�-L"0 On adjacent lots ' 100 Property line i- 5U' To building foundation On adjacent lots + Surface water Curtain drain -15b 4-0' Cutbank E. ENGINEER'S CERTIFICATION To existing or abandoned system on lot Water main/service line tJ P% Driveway, parking/vehicle storage area 4"410' bedrooms 1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect o2:the;dnfe otrthis inspection. O i1 t Signature/^ �✓�� ' � Engineer's Name 901%.Ida W¢rt\av�� , r^�`'' AAY\c%®ra,�e 9951(0 Date 'zJ{{ q Ptc1 } 1 d Po" HAA Fee $ l 7CP 1 Waiver Fee: $ — Date of Payment e2 J Date of Payment Receipt Number z� �(o�� Receipt Number 72-026 (Rev. 3/91) Back MOA 21 NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 4563116 • FAX 4563125 2505 FAIRBANKS S1 FEET ANCHORAGE, ALASKA 99503 (907) 2778378 • FAX 2749645 Constructing Engineers 9601 Buddy Werner Drive Anchorage AK 99516 Attn: - Our Lab #: Location/Project: Your Sample ID: Sample Matrix: Comments: A122176 Stolle Subdivision L3, B3 Water Report Date: 02/04/93 Date Arrived: 02/02/93 Date Sampled: 02/02/93 Time Sampled: 1330 Collected By: - * Definitions * B = Below Regulatory Min. H = Above Regulatory Max. E = Estimated Value M = Matrix Interference D = Lost to Dilution MDL = Method Detection Limit Lab - Date Date Number Method Parameter Unite -----------------------'•-------------------'-------'- Result * MDL Prepared Analyzed A122176 EPA 353.3 Nitrate -N mg/l <MDL 0.1 02/02/93 epd By: Susan /CU Tifental Microbiology Supervisor