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MOUNTAINSIDE VILLAGE #1 BLK 3 LT 17
Mountainside Village Block 3 Lo1' 17 #020-172-45 Municipality of Anchorage Page / of ~.-.~- DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ,-~'~/ ~(/ ~ ~ PID Number: Name:~O~7/~E C~7~¢/c7~O~ WastewaterSystem: g New D Upgrade ~o, ~ p~//-~ ABSORPTION FIELD Phone: O~-~aS ],o. of B~m,: =D,pTmnch ZShallowTmnch ~Bed ~Mound ~Other To~l Depth from oHginal g~de: WELL: ~ New D Upgrade G~velwidth: ~ D- SEPARATION DISTANCES O Septic O Holding I / Numar of ~mpanments: s,.~c~ ' ~ ' LI~ STATION Water /~ ~ J~,o ~ /~0 J Remarks: ~ 7 flo~ ¢ = BENCH MARK Rewewed and approved by: Date: J/-~ - ~ LEGAL LOT 17, BLOCK 3, MOUNTAINSIDE VILLAGE S/D DRAWN M.J.G. CED. R.C.C. DATE ! O-- 1 SHT. I OF 1 DESIGN I//EERIt/q4 BDRM = CRITERIA: LOT 16 600 GPD BLOCK 3 SOILS = 0.8 GPD/SQ.FT. X600/0.8 = 750 SQ.FT. REQ'D. DRAINFIELD CRITERIA::~ 9' DEEP $' ,EFFECTIV~ g~ / -- '2,5 WIDE~'- 65' LONG . I ' '1 X ~ BI~dCKI V3 WELL ,, INSTALL PROPOSED 1250 GAL. SEPTIC TANK INSTALL DBL. LOT I0 BLOCK 4 \ \ LOT 11 BLOCK 4 I~O~ERT C... COWAN CE - 8801 STRUCTURES, EASEMENTS. OR ENCROACHMENTS SHOWN ON THIS SITE PLAN ARE AS SHOWN ON AN AS-BUILT BURVCY DRAWN BY: WILLIAM D. FLEMING IT IS THE R£SPONSIBIUTY OF THE CONTRACTOR TO VERIFY [A$CNENTS. REQUIRED SEPARATION DISTANC£S, AND PROPERTY UN£S PRIOR TO CONSTRUCTION, BLOCK 5 LOT 4 BLOCK 5 TRENCH CONTRACTOR IS REQUIRED TO OBTAIN UTILITY LOCATES PRIOR TO ANY EXCAVATION WORK. CLIENT P~MZT NO, SW980477 P~U~Z 2 Or 5 Municip, ~[i't; o? AnchoraQe DEPARTMENT OF HE~THAND HUH'AN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. ]]ox 196650 Anchoroge, At~sk~ 99519-6650 Teleluhone~ 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LI~I4L LOT 17, BLOCK 3, MOUNTAINSIDE VILLAGE NO. tOO NEW ~tz~v~t, ~tztv~ WELL LOT 17 BLOCK 3 NEW 1.%00 GAL. S.T.E.P. ST1 ~2 MT2 020-172-45 LOT 5 BLOCK 5 LOT 4 BLOCK 5 CE - 8801 PERMt? ~o, SW980477 Municioa[i~cv oF Anchorane DEPARTMENT OF HEALTH AND HUP~AN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 ._Anchormge, A_task- 99519-665g Te.[.ejohone,. 343-4744 ON-SITE WASTEWATER DISPOSAL :SYSTEM AND/OR WELL INSPECTION REPORT I~CAL LOT 17, BLOCK 5, MOUNTAINSIDE VILLAGE P.LD. NO. 020-172-45 STI ST2 88.9' ~oo c~ S.T.E.P. FINAL GRADE A B FCO 5.0' 27.0' ST1 15.5' 50.0' ST2 25.5' 54.0' MT1 36.0' 13.0' MT2 100.0' 94.0' DISTRIBUTION PIPE: 1 1/4" DIA. 30 HOLES/ I SR. :8/16" DIA. HOLES I EVENLY SPACED MT2 = 93.9'y · MT1 MT2._JMT! = 100.4' / IMT2 = 10Lo' / /FINAL GP~DE '~'"--INSULATION ~--98.4' MT1 = 93.9' 89.9 WATER FOUND (4/15/98) 84.9' B.O.H. Municipality of Anchorage. DEPARTMENT OF HEALTH & HUMAN SERVICES 825 'L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR:. LEGAL DESCRIPTION: . '%.:r' "...',.?,, DATE PER Township, Range, Section: 7- 8- 9- 13- 14- 16- 18- 20- SLOPE SITE PLAN WAS G ROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Waer AJler ~4T' Idonilo~ing? Oat~ PERCOLATION RATE ~" ~ (m~nutes~nch) PERC HOLE DIAMETER ~0" TEST RUN BETWEEN <: °/'~ FT AND COMMENTS ~0~ P~[~Oc~ ~(- ~ PERFORMED BY:s & ~ ENGINEERING I CERTIFY THbT TH~S TEST W~ PERFORMED IN 17034 Ea~:, Ri.r L~p Road No. ~ Reading Date Gross Net DePth to Net Time Time Water Drop MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343.4744 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Date Issued: Dec28, 1998 Expiration Date: Dec 28, 1999 Permit Number: SW980477 Legal Description: MOUNTAINSIDE VILLAGE #1 BLK 3 LT 17 Design Enginee~ 0003 S & S Engineering Owner Name: Innovative Construction OwnerAddrass: PO BOX 113689 Anchorage, AK 99511-3689 Parcel ID: 020-172-45 Site Address: 017500 MOUNT MCKINLEY DR Lot Size: 54828 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be In accordance with: 1. The attached approved design. 2. Ail requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Ddnking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ), 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either. A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. 1) Maximum depth of excavation is 6 feet from original grade. 2) An additional percolation test shall be performed to vedfy soils outside of the 30' radius of the odginal testhole This is a renewal of penmit #SW970392 Issued By: Date: F~om : RLPIhE DRILL c~7 345 E~2~2 Rpr, Ol, lgg9 10:$1 Pt1 P~I 1%' ~I'ATE D~ARTMENT i O. ~VISION OF- WATER WELL RECORD top I']ground surfece Depth From TO :WELL.OWNER: · 'WELl, DEPTH:','~' ' " Depth .of hole~ ~,,/~*,'~';).* It : 'Depth o~ c.ing.~~L~[Z.g_~.lt' __ 'DEPTH TO' ST. AT[.C'W*~TER l,EV~..' "'; Ir'below El.top '.?? ..;: METHOD OFiDRIt, UICG;.~} 'elf · l"l'i>d~ ** * CASING Dim: Casing tYl~ .." '. Depth* of opting*: " 'SC~ TYPE~ Sio~a~h .Size: 'O~V~ P~CK TY~: · O~O~ TYPE: O~ECO~ENT M~O0 F.OMp INTAKE D.~, ~'.: '. 'f~. REMARKS: ~. ~,¢~,~. · · ' 3601 C: St, Suite 800. ".: : · ~:' ~. /mCHO~ ,OE ? e*~.o:~.~ :aSI' :' ' ~ :::~'... Rick Mystrom, Mayor Mmficipalits of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage. Alaska 99519-6650 http://www.ci.anc,horag e,ak.us 343-4744 November 6, 1998 Innovative Construction & Design LTD PO Box 113689 Anchorage, Alaska 99511 3689 Subject: Lot 17 Block 3 Mountainside Village Subdivision #1 Permit Number: SW970392 .PIDNumber: 020-172-45 The subject permit, issued November 6, 1997 by this office for a single family well and/or on-site wastewater system, has expired as of November 6, 1998. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. Ifa licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as-built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $320.00 for an on-site wastewater permit; $120.00 for a well permit and $440.00 for a combined on-site wastewater and well permit. If you h;.ve any question, s, please call this office at 343-4744. Sincerely, /[ Jj/m-es Cross, P.E.,?.r4gram Manager I/)n-site Services enc: Copy of Permit S & S Engineering PAGE I OF I 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:SW970392 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:R~N jo ERIC LEE OWNER ADDRESS:1904 CONCORD HILL DR. ANCHORAGE, AK 99515 DATE ISSUED:Il/06/97 EXPIRATION DATE:il/06/98 PARCEL ID:02017245 LEGAL DESCRIPTION: MOUNTAINSIDE VILLAGE #1 K BLOCK 3, LOT 17 LOT SIZE: 54828 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO.APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: DATE: ROBERT C. COWAN, P.E. October 14, 1997 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 17, Block 3, Mountainside Village Subdivision Request you issue a permit to drill a well and install a septic system to serve the proposed four bedroom house on the referenced property. A test hole. was excavated and a percolation test performed. The approximate location ofthe test hole is located on the attached site plan. At the time of excavation water was encountered at 13 feet, and after seven day ground water monitoring water was found at 14.5 feet. This property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, please contact us. Sincerely, Robert C. Cox , RCC/mg Enclosure 17034 NORTH EAGLE R~,/ER LOOP · sUn'E 204 · EAGLE RIVER, N..~KA 99577 % PERFORMED FOR: ~.,.~,,I C.. LEGAL DESCRIPTION: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 1 3- 4- 5- 6 7 8 9 10 11 13- 14- 17- 20 DATE PERFORME4 ' ~'~ Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? ¥['$ IFYES, ATWHAT I 3 I' ~ DEPTH? ~ E O~pth to Waer After Gross Net Depth to Net Reading Date Time Time Water Drop ~/~/~? 3:~ - ~" -' ,~'.'47 3 r.,i.,, p'l~." ~1~ " PERCOLATION RATE ~ (minutes/tach) PERC HOLE DIAMETER TEST RUN BETWEEN S FT AND 6 FT COMMENTS PERFORMED BY: ii~ r. agie Kiver Loop KOad~o.zu~, .... v-, ,o/'~ /~ 7 ACCORDAN CE WiT ~a~la ,~l{~_,,~t,~a,'~d~i~;~0'~. G UIDELIN ES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) ~LTEST ROBERT C. COWAN, P.E. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CML ENGINEERS (907) 694-2979 FAX (907) 694-121 REFERENCE: Lot 17, Block 3, Mountainside Village Subdivision October 14, 1997 GENERAL: The scope of this project includes the installation of a 1250 gallon septic tank and a leach field trench to serve the proposed ~o,,e bedroom residence located on the referenced property. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 17034 NORTH EAGLE RIVER LOOP ' SUITE 204 · EAGLE RIVER. ALASKA 99577 Page Two Lot 17, Block 3, Mountainside Village Subdivision October 14, 1997 A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than I0 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCll/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (rafted-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression afier settling. Page Three Lot 17, Block 3, Mountainside Village Subdivision October 14, 1997 MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM FS10 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed ..between the final leachfield gravel layer and the native soil backfill. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the'#200 sieve. ' When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. Page Four Lot 17, Block 3, Mountainside Village Subdivision October 14, 1997 The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTORIINSTALLER Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road Anchorage, AK 99507 www.muni.org/Onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 020-172-45 COSA# ©OC_ Expiration Date: GENERAL INFORMATION Complete legal description MOUNTAIN SIDE VILLAGE #1 BLOCK3 LOT 17 Location (site address). 17535 WOLF CREEK DR., ANCHORAGE, AK 99516 Current Property owner(s) KATHRINE HAGHIGHI Day phone Mailing address Lending agency Day phone Mailing address KAREN CISMOSKI Real Estate Agent ,.Mail~hg Address., ~ Uhie~s otherwise reqOe'~tcd, COSA will be held by DSD for pickup. Day phone242-1761 2, NUMBER O~ BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] Individual Holding Tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER = 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 w~ti~er supply and/or wastewater disposal system is (are) s.~f~, functional and adequate for the number of be~re~r~.~and type of structure indicated herein. I further verify that based on the information obtained from the"~r~ei~'i~al~ty of Anchorage files and from my investigation and lnS~ion, the on-site water supply and/O~r waste~ater 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 Spurkland Enginneering Address 203 W. 15th Ave., Ste 202, Anchorage, AK 99501 Engineer's Printed Name Lars Spurkland bedrooms. DSD SIGNATURE ~ Approved for ~ Disapproved. Conditional approval for Phone 279-3916 Date 11/15/2011 . .°..F. "49TH' ~. ~, .... ~ ,~ .... ~,.~ bedrooms, with the following stipulations: By: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X (Rev. ll/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage; AK 99519-6650 ' www. muni.org/onsite (907) 343:7904 CERTIFICATE.OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal .Description: A. WELL DATA Well type ~)~x. Date completed t~.le~e~r Total depth 'Z°5 ft. I Date of test Static water level Well production ,-% WATER SAMPLE RESULTS: Coliform h/eq ,, colonies/100mL IfA, 'B, or C provide PWSID #__ Sanitary seal (Y/N) ~'/ Cased to '7_o 7_ ft. FROM WELL LOG 13 ft. g.p.m. O'ZO- t-~7_.- q5 Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION g.p.m. Collected by: Date installed Cleanouts (Y/N) High water alarm (Y/N) "/ System type ,~l~//o~ Gravel below pipe /~, ~> Water added ~. gal. __ in. Absorption rate >= in. Nitrate O, ~ 5 mg/L I/ · Arsenic: ND ug/L date of sample: B, SEPTIC/HOLDING TANK DATA Tank Type/Material ~l'fi~'l S'i'~.~.L/~,~r2[~ea~ Tank Size 1:5OC) gal. · Number of Compartments Foundation cleanout (Y/N) "/ Depression over tank (Y/N) . AZ' .. Date of pumPing .JVooo "Lot[ ... Pumper "~.5~ 5 Pump~ Date installed 2/7-ff/1~1~' SOil rating ~ or ~/bdrm) 0o Length ~L{ ' ,fi: Width LI, 5 ff. Total depth ~,~! . ff. Eft. absorption area 'fcof~ ~ Monitoring tube Date of adequacy test . ~ ResUlts (Pass/Fail) Fluid depth in absorption field before test ~ in. Elapsed Time: ~ min. Final fluid depth ~ Any rejuvenation treatment (past 12 mo.) (YIN & type) Depression over field /~/ For -~ bedrooms New depth ~ in. ;~ g.p.d. If yes, give date -- LIFT STATION Date installed ~2/~:~ "Pump on" level at ~q,~ in. Datum !E. SEPARATION DISTANCEs Size in gallons 5;0o Manhole/Access (Y/N) ~/ "Pump off" level at ;~ ,5 in. High water alarm level at ~l Cycles tested {-~ +-,~ Meets alarm & circuit requirements? in, SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic service line Animal containment areas ~'O ! On adjacent lots On adjacent lots ICC> Public sewer manhole/cleanout Holding tank /V/A, Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: ! Building foundation [0 + Property line to~+ Absorption field Water main _, /V/~ Water service line [c,t-t- Surface water Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property'line lO~' Water Service line Curtain drain .?::O'~- Building foundation Surface water Ic)~-t- ~ Wells on adjacent lots Water main Driveway, parking/vehicle storage .F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and ~' ¢~:" '" ~'H~ review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. ~. " , Engineer s Printed Name pt~.~c,,wr~ . · Date rtl t3-~t~ COSAFee $ L./?(~ ~_.C~ ~ ~5~ WaiverFee$ Date of Payment. /~ ~/~ .~/ Date of Payment Receipt.Num~r ~ 7 ~ ~ ~ ~ Receipt Number (Rev. 4/10) HOUSE. DEl'Att. 1"---30' PLOT PLANS & LOT .SURVEYS Prepared by Robert E. Johns, Jr. ,~ Professionol Land Surveyors 1700 Brink Drip, ANCHORAGE. ALASKA 99504 1Rec. Lot SF lRe¢, Plot File No, sco~e: 1" = 60' ' I l').rown by: Checked bY: oct, s.r~.~: 11/09/11 ~ REJ SWL °°~ ° .... ~ ~/0~/~ ~ ~.oSW343~ ~.o ~ ~-392 Legal Description: ..................... MOUNTAINSIDE VILLAGE ~1 BLOCK 3 LOT 17 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 . Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 020-172-45 1. GENERAL INFORMATION Expiration Date: / Complete legal description Lot 17, Block 3, Mountainside Village Subdivision No. 1 Location (site address) 17535 Wolf Creek Drive Anchorage, AK 99516 Current Property owner(s) Katherine Haghighi Living Truct Mailing address 16925 Sandpiper Drive Anchorage, AK 99516 Day phone Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: Four (4) 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 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 sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER 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. Name of Firm Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Phone 522-7773 Date 3/19/2011 DSD SIGNATURE \/..i Approved for ~/ Disapproved. Conditional approval for ...-.. bedrooms. ~t.~'~. . ~- el-l/' ..~ ~ ~ ~ eeee, bedrooms, with the following stipulation. Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitra~ Adviso/~/7/ X (Rev. 11/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other · ?,/. Original Certificate Dat~ ~,// [~ Parcel I.D. 020-172-45 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address) Expiration Date: Lot 17, Block 3, Mountainside Village No. 1 17535 Wolf Creek Drive Anchorage, AK 99516 Current Property owner(s) Katherine Haghighi Living Trust Mailing address 16925 Sandpiper Drive Anchorage, AK 99516 Day phone Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing-Address Unless otherwise requested, COSA will be held by DSD for pickup. 2.' NUMBER OF BEDROOMS: Four (4) 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 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. DSM 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 sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER ordinances and regulations in effect at the time of installation. '"}qame of Firm Anderson Engineering 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, Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. bedrooms. DSD S~NATURE '\~' Approved for H Disapproved. Conditional approval for D,,,~ 11/2/2010 bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev. 11105) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: //'"' ,~"'~/'_~I Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type Private Date completed 12/8/97 Total depth 2o5 ft. Mountainside Village No. 1, Block 3, Lot 17 Date of test Static water level 13 Well production 3 WATER SAMPLE RESULTS: Coliform 0 coloniesll00 mL Arsenic: N/D mg/I B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEP/Steel Tank size 1,500 gal. Foundation cleanout (Y/N) Y Date of pumping 5/09/2010 C. ABSORPTION FIELD DATA Date installed 3/2/99 Length 84 ft. Total depth 6.3-8.4 ft. Parcel ID: 020-172-45 Cased to FROM WELL LOG 12/8/97 If A, B, or C provide PWSID # Well Log (Y/N) Sanitary seal (Y/N) Y Wires properly protected (Y/N) 202 · ft. Casing height (above ground) __ AT INSPECTION "10/30/2010 ff. 23 ft. g.p.m. 1.72 g.p.m. Y >18 in. Nitrate 2.53 mg/L Date of sample: 10/29/10 Y Other bacteda 0 colonies/100 mL Collected by: A. Harala Y Y Date installed 3/2/99 Number of Compartments Three Cleanouts (Y/N) Depression over tank (Y/N) N High water alarm (Y/N) Pumper Isaac's Pumping System type Deep Trench Gravel below pipe 4.5 ft. Y Depression over field N Soil rating (g.p.d./~ or ft2/bdrm) .8 GPD/SF Width 4.5 ft. Eft. absorption area 756 ft2 Monitoring tube Date of adequacy test 10/30/2010 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 39.2 in. Water added 642 gal. New depth 42.9 Elapsed Time: 217 min. Final fluid depth 39 in. Absorption rate >= 55o Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date in. g.p.d. D. LIFT STATION Date installed 3/2/99 Size in gallons 5oo "Pump on" level at 29:5 in. "Pump off' level at 26.5 Datum Bottom of Tank Cycles tested 16 E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot >100' Absorption field on lot >100' Public sewer main N/A Sewer/septic service line >25' Animal containment areas >50' in. N/A Manhole/Access (Y/N) Y High water alarm level at 31 Meets alarm & circuit requirements? On adjacent lots >100' On adjacent lots >100' Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Absorption field >5' Surface water >lOO' Water main >10' Building foundation >5' Property line >5' VVater main N/A Water service line >10' Wells on adjacent lots >100' >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line lO' Building foundation >1o' Water Service line >1o' Curtain drain None Noted COMMENTS: Surface water >1oo' Wells on adjacent lots >1oo' Y Driveway, parking/vehicle storage >25' in. 'G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Pdnted Name Michael E. Anderson, P.E. Date 11/03/2010 COSAFee $ q~'~) Date of Payment (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number SGS Reft# 1105838001 Client Name Anderson Engineering /b'-i Printed Date/Time 11/04/2010 8:40 Pro. iect Name/# L17,B3 Mountainside Village3~: Collected Date/Time 10/29/2010 10:00 Client Sample 1D LI7,B3 Mountainside Village ~s~3 Received Date/Time 10/29/2010 10:25 Matrix Drinking Water ~ Technical Director Stel~hen C. Ede PWSID 0 Saml~le Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic 5.00 U 5.00 ugFL EP200.8 C (<10) I 1/02/10 11/03/10 KDC Waters Department Total Nitrate/Nitrite-N 2.53 0.100 mgFL SM20 4500NO3-F B (<10) 10/29/10 AYC Microbiology Laboratory E. Coli Negative 1 100mL SM20 9223B A I0/29/10 DLC Total Coliform Negative 1 100mL SM20 9223B A 10/29/10 DLC Municipality of Anchorage Development Services Department Building Safety Division - On-Site Water & Wastewater Program .,.."/ '~* ~.~t~ ~,/tj 4700 Bragaw Street P.O. Box 196650 f/f~/,r~'~.l~',. Anchorage, AK 99519-6650 www,rnunl.org/onslte CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. ~ - I~7'' 1. GENERAL INFORMATION COSA. Expiration Date: / O -- ..~O "07 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address MOUNTAINSIDI~ VILLACI~ SUBDMSION ~1; I~LOCK 3, LOT 17 17535 WOLF CREEK DRIVE * ANCHORAGE, AK 99516 APRIL & ERIC LEE Dayphone 336-7455 17535 WOLF CREEK DRIVE * ANCHORAGE~ AK 99516 Day phone CAROL BUTLER w// REIdAX PROPERTIES Dayphone 257-0116 110 W. 38th SUITE 100 * 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 Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ~[~ Individual Holding tank Community On-site DE] 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 sy§tem. 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 pedod 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 A~ 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 Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further vedfy that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installafion. Nameof Firm CARNESS ENGINEERING CROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Phone 337-6179 Date Engineer's Comments: In conducting this evaluation, GEG, ltD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described tho perfon'nance of the system under the conditions encountered at the time of the test, and separation d/stances 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. Satisfactoq/ test results do not guarantee future performance oft he system, nor de they guarantee that there ara 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 oporeb~)na/ requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal tight whatsoever. 5. DSD SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the tllowing stipulations: Attachments: COSA Checklist C.../ Septic System Advisory Well Flew Advisory Nitrate Advisory (Rev. 11~5) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reorl Other Original Certificate Date:_ ? -- _'~ I - O 7 Municipality of Anchorage Development Services Department Building Safety Division On-Site Watm'& wastswatsr Program 4?00 Bragaw Street P.O. Box 196650 www.muni.o~/ofl~ite (g0?) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: MOUNTAINSIDE, VILLAGE SUBDNISlON ~11; BLOCK 3, LOT 17 Parcel A. WELL DATA *CASED TO BEDROCK Well type PmVA~; If A, B, or C provide PWSID~ N./A Date completed 12/8/1997 Sanitap/seal (Y/N) YES Total depth 205 fl. Cased to *8 ff. eD Date of test Static water level Well production WATER SAMPLE RESULTS: ColifmTn 0 colonies/100 mi. Arsenic: ND ug,/L. SEPTIC/HOLDING TANK DATA FROM WELL LOG 12/8/ gs7 15 .ft. .g.p.m. Well Log (Y/N). Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 6/28/2007 7.7 .ft. 2.5 g.p.m. Tank Type/Material Tank size 1500 gal. Foundation cleanout (Y/N) YES Date of pumping 6/29/2007 ABSORPTION FIELD DATA Date installed $//2//1~9 Length 84 fl. YES YES 18 in. Nitrate 2.7 rog.IL. Other bacteria 0 colonies/100 mi. Date of sample: 6/28/2007 Collected by: GE(; Ltd. YES Date installed 5/2/1999 STEP/STEEL Number of Compartments 2 Depression over tank (Y/N) NO Pumper Soil rating (g.p.d./fl2o~D 0.8 Width 4.5 fl. YES Cleanouts (Y/N) High water alarm (Y/N) McDONALD'S PUMPIN(; MTI: NORTH MT2: SOUTH System type TRENCH Gravel below pipe 4.5 ff. Depression over field NO For 4 bedrooms New depth 36.5 in. Total depth ,6.5-8.4ff. Eft. absorption area 756 ft2 Monitoring tuba YES Date of adequacy test 6/28/2007 Results (Pass/Fall) PASS Fluid depth in absorption field before test *'50 in. Water added 602 gal. Elapsed Time: 120 min. Final fluid depth 35.75 in. Absorption rate >= 600+ Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE: KNOWN If yes, give date ** USED MT1 (NORTH) FOR MEASUREMENTS g.p.d. D. UFT STATION Date installed ,3-2-1999 "Pump on" level at 29.5 in. Datum BOTTOM OF TANK E. SEPARATION DISTANCES Size in gallons 1500 "Pump off' level at 26.5 in. Cycles tested ,3 Manhole/Access (Y/N) YES High water alarm level at 31 in. Meets alarm & circuit requirements? YES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankJliff station on lot 100'+ Abeorption field on lot 100'+ Public sewer main N/A Sewer/septic service line , 25'+ Animal containment areas 50'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/deeneut N/A Holding tank N/A Manure/animal excrete storage areas 100'+ Properly line 10'+ Water sen4ce line 10'+ Curtain drain *NONE KNOWN SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Properb/line 5'+ Absorption field 5'+ Water main N/A Water sen, ice line 10' + Surface water 100' + Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 10'+ Water main N/A Surface water 100'+ Driveway, parking/vehicle storage 10'+ Wells on adjacent lots. 100'+ F. COMMENTS PERFORATED PIPE BURIEO AROUND ASPHALT PAD NEXT TO SOUTH END OF TRENCH. NO DISCHARGES DURING SITE VISITS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Enginem*s Prin~[ed Name JEFFREY A. GARNESS Date *[ Z-I /o:~ Data of Pa,mant Receipt (R~. 11~) Waiver Fee $ Date of Payment Receipt Number e,Jul.3l. 2007.:8:27A~,e?-3Garness Ensineerins Group, Ltd. Ho.9583 -P. 1 e2 June 28, 2007 Subj: Mountainside Village # 1, Lot I 7, Blk 3 Adequacy and well flow performed today. Prior to testing, measured water ia both monitoring tubes. MTI at the north ~ad measured 30' of water; MT2 at south end showed 23'. The owner had excavated right up to the pipe to allow for installation ora paved pad for an ice fink. During test, lvfrl rose as expected, while MT2 hovered between 23 and 23.5" of liquid. Took shots on both, using comer of house, bottom of siding as benchmark (hopefully same spot installer used). HI = 104.20 MT1 -- 93.98 lVIT2 = 93.97 Immediately aider the 602+.gallons of water were added, levels Were 35.5" and 23.5' respectively. About 2.5 hours later a reading was taken, and the levels were 36.5 and 24.5. I would _,ssume that since h's a pressure system it might take a while for water to migrate down. Since the level was higher than I previously measured, I elected to return in about 2 hours and check again. At 120.miautes later, levels were 35.75 and 24. I used a total rise of 6.5 inches and total gallons 602, giving 92 galfm. In calculating the drop, I looked at the actual drop in those fmaI 120 minutes, or ,75 inches ia MT2. Using this formula,.I shgw that the system is capable ofabsorbiag about 834 gallons a day. This system has effective depth of 4.5 feet. When I let thc owner know what I found, he admired that the entire family had taken showera while I was away. I had pumped thc tank offat the end of the test, so unless they really used a LOT ofwater, it ~houldn't have an impact. SC, S Ref.# Cl~cnt Name Project Name/# Cl~ent Sample ID Matrix 1073062001 Gnz'ncss Enginecrlng Group, Ltd. Ltl713k3 Mountnlnsldc Village Ltl7 Dk3 Mountainside Village Drinking Water All Dater,4'Times ere A~I~ Standard Time rrlnted Date/Time 07/I 1/2007 12:02 Collected Date/rime 06/27/2007 8:27 Received Date/Time 06/28/2007 13:40 Technical Director Stephen C. £de PWSID 0 Sample Remarks: AIIo~ble Prep Analysis parameter Results PQI. Units Method Container ID Limits Date Dale Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 07/02/07 07/09/07 TK Waters Department Total NJtmtc/N[trite-N 2.70 0.100 mg/L SM204500NO3-F B (<10) 07/10/07 JDS Hicrobiolog~ Laborator]{ TotaIColWonn 0 cot/100mL SM209222B A (<1) 06/28/07 DLC 5432 E. Northern Lights Blvd, Suite fi466 Anchorage, Alaska 99508 (907) 338.4476 Invoice '7 r"c~. ~" ~. ' Phone: ]Customer p.O. Number. Contact Per,on: Description Price ~'~i~ Amount Septic tank pumped Sludge in tank Leach treatment Bio-mat in leach Water level in leach Cap on Stand Pipes Other: ;-, .;4 Recommendations: Total :rest will be charged monthly on unpaid bills until paid. ' 5432 E. Northern Lights Blvd, Suite #46,~.~,~.1] Anchorage, Alaska 99508 (907) 3384476 Invoice Sold To: Date;, - - [Dale of Service: Phone: [Customer P.O. N umb~':. Contact Per,on: Description Price per unitAmount Septic tank pumped Sludge in tank Leach treatment Bio-mat in leach Water level in leach Cap on Stand Pipes '~'~'"' ,~.~,~/~' ,-',:~,.'~:& ,~, Other: %-.o;37.,,¢ ,-~,.,/.,,.v..~, Recommendations: ,':..',e'/'.:7, }../-- ~-;,,t ,..~., ~'.~ '7, .', ...~ ,. -? ;.. , , _; .~;. i /...---/ ,.,...,,..-,..., .._ ~.~.~. Total 1.5% interest will be charged monthly on unpaid bills until paid. 83-3~8 .. MOUNTAINSIDE VILLAGE SUBD., ADDN. NO 1 LOT 17, BLOCK ,3 54,828 S.F, £YJS'T/NG BUILDING $£PT~c Vt'~'TS 01' R~' 48.1, 1"=4-0' PROPE~ D~c'r~ ~ ~ ~T ,0 G~A~I ~D ~C~ACHM~ ~1~ ~C~ ~ INDICia. SURVEY ING~ LLC ff IS ~E R~PONSIBI~ OF ~E 0~ TO J~'F ~ ~1, ~S, DLi~MINE 4726 ~ ~0~ ~ 99502 , ~P~ ON ~E RECORD~ SUBDMSION P~T. PHONE 2~-5454 UND~ NO ClRCUM~C~ SHOU~ ~ DATA GRID DA~ H~EON BE US~ FOR CON~U~ON OR FOR ~439 7/26/2~7 ~USHING BOUN~ OR ~CE UN~. ~CHO~GE RECORDING F.B. JOB NO. 98-13 ~1173 N~ NO CORN~ 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. # CERTIFICATE OF HEALTH AUTHORITY 'APPROVAL FOR A SINGLE FAMILY'DWELLING 020-~72-~5 ~ HAA. 1. GENERAL INFORMATION Complete legal description Lot 17, Block3, Mountainside Village.#l Location (site address or directions) Wolf Creek Dr. & Mt. McKinley ¥iew Drive Prol~erty owner /' .~.. / .- -. ?Mailing address '" ' tTnnc~vat~iv~' ~'mnm~'~'.lcl'imn ' ' Day phone k': "PO BOx 113689, Anchorage, AK 99511 ~',Le'n. di~g agency M..ailing address Day phone Agent ' Day phone Address Unless otherwise requested, HAA will be held for pickup. 4~ NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: · NOTE: TYPE OF WASTEWATER DISPOSAL: :* NOTE: Individual well Xxx Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. Individual on-site Holding tank " Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legafity and status of system. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation' of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Address Engineer's signature Name of Firm s & $ ENGINEERING Phone 17034 Eagle River Loop Road Ne. 204 Z.277 Date DHHS SIGNATURE Approved for Disapproved. Conditional approval for ' bedrooms. bedrooms, with the following stipulations: Additional Comments ~.~_.~ - ._ / ~' ~;rhe Mun!cipality of An~:horage. Departrnent 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~ngineer registe red in the State of Alaska. The D HHS does this as a courtesy to purchase rs of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of Anchorage R EC E I DEPARTMENT OF HEALTH & HU.M. AN. SERVICES APR 2 ;~ 199~1~ Environmental Services Division ~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (90~~ Health Authority Approval Checklist LegalDescription: /-.O~ 17 ]~-e~:~ '~ ParcelI.D.: A. WELL DATA Well type Log present (~N) ¥ ~- J' Total depth ~- o 5" Sanlta~/seal (~N) Ye £ If A, B, or C, attach ADEC letter. ADEC water system number Date completed ) ~- / ~ / ~/Z Casedto o~° '~ a ~'.R. Casing height (above gmund) Wires properly protected (~r/N) FROM WELL LOG AT INSPECTION Data of t ,t / e 7 Static water level ) 3 ' Well production 3 g.p.m. / WATER SAMPLE RESULTS: g.p.m. Be Coliform o Nitrate Date of sample: ~ / / % / ci c) SEPTIC/HOLDING TANK DATA Date installed -~-/3"f/q~l Tankeize I ~'~u0 Foundation cleanout ~/N) Date of Pumping ,~/,4 - ~ ,~ O. 7GS- Collected by: Other bacteria O S & S ENGINEERING 27~-; ~..¥;. ~,.;,.r Loop Ra~d NO. Eagle River, Al&~ka 99577 Number of Compartments ~- Cleanouta(~N) TM J' High water alarm ~/N) Y ~J' YE $ Depression (Y~ Pumper -- Soil mting~r ~/txlrm) O, ~' System ~, ~ Gravel thickness below pipe '9 ~ ' Total depth Monitoring Tube present ~1) YeJ Depression over field (Y~ For ~ gal. water added (In.): ABSORPTION FIELD DATA Data installed Effective absorption ama ~ 5% ~ · '~ Date of adequacy test H/4 ' ~ ¢',/ Results (Pass/Fall) ~ Absorption rate = Fluid depth Pe~l~[Jde-~'~ment (past 12 mo~ths) (Y/N) If yes, give date ~-p.d. 72-o20 (Rev. 3/g6)* UFT STATION Date Installed Manhole/Access High water alarm level Cycles tested Size in gallons I ~' 0 0 "Pump on" level at* ~ ,,% ' "Pump off' level at* *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic sewice line I 0 0 "~ On adjacent lots On adjacent lots Public sewer manhole/cleanout Uft station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation I 3 Property line "/O Absorption field '~ O Water main/sewice line /O -F .Surface water/drainage ]00 -~ Wells on adjacent lots / o 0 -/- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Pmberty line L/o Building foundation )O Water maln/sswice line Jo l o 0 ~--~- Driveway. paddng/vehicle storage ama ~ 5- ' Surface water Curtain drain ~ ~/~ 4. ~: ,,~ o ~ ~/ Wells on adjacent lots / ~ 0 -/- __ __ HAA Fee S. Date of Payment 72-026 (Rev. 3f86)* Waiver Fee $ Data of Payment Receipt Number ~'AFRoZZ-99 16:$1 FRO~'CTE E~VIRO~tENTAL ,d~tK C T&E Envi,onmen tat Servlceslnc T-Z40 P.03/05 F-055 CT&£ Ref.# 99161'1002 Client Nam~ S & S Engineering Project Name// Client Sample ID LIT B3 Mounta~m~de Vill,~ge I Matrix Dnn~ing Water Ordered PWSID 0 Sample Remarks: Client PO// Prinled Date/'flme 04/22199 14:00 Collected l)ate/T[me 04118/99 14:45 Received Date,'l'lme 04/19/~9 Technical Director: Stephen C. Ede Atto~a~Te prep Anitysl$ Limits Date Date 0~/19/99 0~119/99 D~119/99 SCL