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LAKE OTIS HEIGHTS BLK 1 LT 9
Lake Otis Heights Block 1 Lot 9 #014-102-38 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. Municipalityof Anchorage POU~. .650 ANCHORAGE, ALASKA 99502 (907) 279-2511 G£ORG£ M, SULLIVAN, MA YOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (825 'L" Street) MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL I);';© I'~CTION December 29, 1978 JAN 8 1970 RECEIVED #780641 John Comoza 4554 Homer Drive ~32 Anchorage, Alaska 99503 Subject: Lot 9 Block ~lLake Otis Subdivision A permit issued by this department for well and/or sewer system has expired. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal ordinance. If you have drilled the well, a well log should be sent %o this department to document the installation date. If there are any further questions, please contact this office at 264-4720. Sinqerely,~ v Les N. Buchho±z, R Senior Environme~ S~pecialist LNB/1 j w enc: copY of permit PERMIT NO. [:,EPFIRTMENT OF HEALTH FIN[:, EN, IF. JNflEN I HL F'RC~TECTION 825 "L" STREET, FINCHORRGE., FIK. S~95Ei't 264-4728 ( 78Et64:L .':, IqPPL. I CRNT LOCRT I ON L. EGRL JOHN COM(]ZA STRLLFI F'L LS~ B(B) LFIKE OTIS S,."D 4554 HOMER DR. LO]' SIZE 278-,±4]::~: 980C.~ SQUFIRE FEET "F'¢PE OF SOIL FiBSORBTION SYSTEM IS: TRENCH MFi:'..,',IMUM NLIMBER OF BEDROOMS = ]: SOIL RRTING (SQ FT/BR)=: :!..5E~ THE REQUIRED SIZE OF THE SOIL [~BSORPTION SYSTEM IS: THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCFI OR DRIqlNFIEL~D. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURF:BCE OF ]"HE GF.:OLINC, RND THE BOTTOM OF THE E',qCFI',,,'RTION (IN FEE]"). THERE IS NO ':;El" WIDTH FOR TRENCHES. THE GRRYEL. DEPTH IS THE MINIMUM DEPTH OF GRRVEL BE'FWEEN THE OU'FFALL PIPE RND ']'HE 80'FTOM OF 'rile EF','CAYATION ,::IN FEET). F'ERMIT RPPLICRNT FIRS THE RESPONSIBILITY TO INFORM THIS; DEPRRTMENT DURING THE INSTFILL.RI"ION INSPECTIONS OF' taNY WELLS FtDJRCENT "FO THI:5 PROPERI"'.r' RN[.', THE NLIMBER OF RESIDENCES THRT THE WELL WILL SERVE. E:RC:KFILLING OF FIN¥ SYSTEM WITHOUT FINRL. INSPECTION RND BF'F'ROVRL 8Y THiS DEPI=~RTMENT I.,IILL BE SUB.'rECT TO PI:;.:OSEC:UTIOI'-L P'IIN]:MUM [:,ISTI:qNCE BETWEEN F:I WELL FIN[:, RN'¢ ON-.SITE ~EI-,.IFIGE [,I'SPO'~;RL. S'¢STEM IS ±E~C~ FEET FOR FI F'RIVRTE WEL. L.~ OR 15C1 TO ;;'RR FEET FROM FI F'UBLIC WELL [:,EF'ENDING LtPON ]"HE TYPE OF F'OBLIC NELL. WELL LOGS RRE F.:EQUIRE[:, FIN[:, MUST BE F.:ETUF.:NED TO THE [:,EPFIF.:TMENT WITHIN ]:~ DFIYS OF THE WELL COMPLETION. OTHER REQUIREMENTS ['119¢ RPF'L¥. SPECIFICFtTIONS RND CONSTRUCTION DIFIGRRMS FIRE FIVRILFIBLE TO INSURE PROPER INSTFILLFITION. F'IE F;::lh"~ Z. -1- FZ:=-,:F' :[ F~: .E-.2'_::~; [:,EZC:ElPl!F-_=:E£F]: ]:::L.. I CERTIFY THRT ±: I FIM FRMILIRR WITH 'tHE REQUIREMENTS FOR ON-SITE SEWERS RN[:, WELLS RS SET F'ORTH BY THE MUNICIPRLITY OF RNCHORRGE; 2: I WILL INSTRLL THE SYSTEM IIq F:IC:C:ORDANCE NI'rH THE CODES. ]:: I UNDERSTRND THAT THE ON-SITE SEWER SYSTEM MFIY REQUIRE ENLRRGEMENT IF THE RESIDENCE tS REMODEL. ED TO INCLUE:,E MORE THRN S BEDROOMS. : S:S _ ':: ': :: __~_.; .................................... : C ',/S. 2 unicip i o Anchorage POUCH 6-65O ANCHORAGE, ALASKA 99502 (907) 279-2511 GEORGE M. SUL£1VA,'% MA YOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (825 "L" Street) ~ ' January 5, 1978 John Comoza 4554 Homer Drive #32 Anchorage, Alaska 99503 Subject: Lot 9 Block ~Lake Otis Subdivision Permit #774~3 A permit issued by this department for well and/or sewer system has expired. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If there are any further questions, please contact this office at 264-4720. Sincerely, Health and Environmental Protection Sewer and Water Section i:6::¥:'1::: i:;;:'i'h'ti;:;'i.,i'i i.,.i ¥1 i i:',!:::i c!;t iP!h}i¥1' ;'i' 'i't'i :::'I;'' '::: :; ........ 'i i:::il;::! i:::' i::: i::: "? i;;;'i;'li;,? i:::! !:;:'iLl' 'i k,h:::!"i'i:::' i.,.ilx'i .i l"'ti;;' ' i:t~': i.,.ii::'I i i f"li:i':;; i::d.,N.::' !:;?i:cl;)ii'ili:;?F:'~) l::ih,!i:~ h'ii ':::;i i::¥.:' ~;;:i:::;'i'iii:;?.i",!i::ii3, i"('l 't"hlF!; ....... ~" -~...n., I i.,.I)"i'l..-iTi'.,I ":i:l:::l ii'ii::' 'i i-'ii:::' !,.fi:::'i i !":i'ili'ii:::'i i:::;'i' ;f t'lh,i i"i'i'i.ii::i?, i:;?i-::%¢ .I ;; ';' '::i.'!i::: h!"i '::'; i" ~:"? ::: :::'i:::' ¥ '::: !:::'i::;'!'": '; i;::'" i' !::."." 'i' f'ii'-,i':::; i::!i",li3~ !' ':i"lh,i';::;'i"i:;?i .ii: Iiiii!",I i":, 'i i::~i"!ii:;~:t:::i '"!; i:;J',.,~i:::i 'i'i i-h",t ..... " i'Q 'i h,i':..;f i-;iq:;: i:::' :;?I-ti;:'i::¥;? ';i', '- ':"~.", .! .!:::i'i' ;i' 4 6 10 _~ 12 14 16 18 Per'formed For l~ C~o~-~ Legal ~escri~tion: Lot C~ Bloc[: / 'This Form Renorts Soils [oq i/~'% neath Feet ~J.. Soil Characteristics "One t~st t~ w~h a th~sand opinions" 2204 01e~elan6 Anchorage, Alaska 99503' Date Performed . Subdivision ~*k~ ~;~ ~'~ Percolation Test 20 Was 6round Water Encountered? Ie Yes, At what Denth? Readinq Date Gross Time Net Time Depth to H20 Net Dron Percolation Rate Hinute Prnposed Installation: Seenaoe Pit Drain Field ~ Den. th of Inlet Depth To Bott.om Of. Pit Or Trench ' ,~ I \.~, \ fl ___,~._ Test Performed ByI'm -o)V U rata Certified MUNICIPALITY OF ANCHORAGE • Development Services Department p p Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 014-102-38 Certificate of On -Site Systems Approval Expiration Date: Legal description LAKE OTIS HEIGHTS BLK 1 LT 9 Site address 7011 STELLA PL Anchorage AK 99507 Current property owner(s) ANGELA PETER X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date:_ 4/19/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) islare in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY OF ANCHORAGE o 1,''� Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 014-102-38 Complete legal description LAKE OTIS HEIGHTS BLOCK 1, LOT 9 Location (site address) 7011 STELLA PLACE, ANCHORAGE, AK 99507 Current property owner(s) ANGELA D PETER Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ® Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 2 50 Waiver Fee $ Date of Payment q/1 -L A3 Date of Payment COSA # 2 3 I % Waiver # COSA Application.doc COSA Checklist WELL ONLY.docx COSA Checklist Legal Description: LAKE OTIS HEIGHTS BLOCK 1, LOT 9 Parcel ID: 014-102-38 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled CIRCA 1978* Total depth 160* ft Cased to *40+ ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 4/10/2023 Static water level at beginning of test 38 ft. Well production at time of test 6+ gpm Water storage tank volume NA 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 Date 4/10/2023 Comments *Unknown drill date – circa 1978 & per MOA file that includes 907 Water Wells inspection. B. TANK DATA – PUBLIC SEWER Measured operating fluid level in septic tank Date of pumping Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA - PUBLIC SEWER Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Adequacy test date Results Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) in Effective depth used in Effective depth remaining in Comments/Deficiencies: COSA Checklist WELL ONLY.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No NA ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No NA ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No *45’+ ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No * ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below. F. ENGINEER’S COMMENTS *2018 COSA showed 75’+ to sewer main, but per 2001 COSA & AWWU data sewer main is approximately 45’+ to well with 5/1982 ADEC waiver & the connect card shows that the private septic service line is 25’+ away from existing well. G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 4/11/2023 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 4/11/2023 5678910 eb 17 • • ( Municipality of Anchorage a JU `tS _ On-Site Water and Wastewater Program ��� (907) 343-7904 Q. SAF E T Y ti Certificate of On-Site Systems Approval 6 e L 9 �n Parcel I.D. 014-102-38 Expiration Date: c7 2G —/ 1. GENERAL INFORMATION Complete legal description Lake Otis Heights, Block 1 , Lot 9 Location (site address) 7011 Stella Place Anchorage, AK Current Property owner(s) Anita R. Carter Day phone Mailing address 18009 W. Ivy Lane Surprise, AZ 85388 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 ❑ Individual Water Storage El Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer 0 WaiverNariance request for: Distance: Received by: Date: (o10 COSA to be released to the enginee unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment 6 Date of Payment Receipt Number 0oA(40 Receipt Number COSA# 05C- �� `� -Ot 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. Name of Firm Forge Engineering Phone (907) 522-7773 Address PO Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 6/21/2018 • �Agt�i Q. . 49 TH 6. DSD SIGNATURE 0 � 1C System #1 Approved for 3 bedrooms / . Mi• chael E.Anderson : e •. •, 4381-E .•'c`�// System #2 Approved for bedrooms fi srF� G zr � .• ! Disapproved ill\\\�����~` Conditional approval for bedrooms, with the following stipulations: = o‘. s . MAICA ER a c) VVPSTEA Cr -/ PROGRA rc 04,4 ' &t-r•qc Q\1\C. Original Certificate Date: c:7-- G -1 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 r : .c If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Lake Otis Heights, Block 1 , Lot 9 Parcel ID: 014-102-38 $MEA,oQ. D 131( q07 UlAte2 w&-u, seevias Oki la(ry va A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) N Date completed Unknown Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 160 ft. Cased to 40+ ft. Casing height (above ground) 2 in. FROM WELL LOG AT INSPECTION Date of test 6/5/18 Static water level ft. 32 ft. Well production g.p.m. 6.0 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 0 mg/L Arsenic 3.° ug/L Date of sample: 6/05/18 Collected by: 907 Water Wells B. SEPTIC/HOLDING TANK DATA Tank Type/Material Public Sewer Date installed Tank size gal. Number of Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) Depression over tank (Y/N) High water alarm (Y/N) Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2 or ft2lbdrm) System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. absorption area ft` Monitoring tube Depression over field Date of adequacy test Results (Pass/Fail) 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) 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 N/A On adjacent lots >100 Absorption field on lot N/A On adjacent lots >100' Public sewer main >75' Public sewer manhole/cleanout >100' Sewer/septic service line >25' Holding tank >75' Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation N/A Property line N/A Absorption field N/A Water main N/A Water service line N/A Surface water N/A Wells on adjacent lots N/A ABSORPTION FIELD ON LOT TO: Property line N/A Building foundation N/A Water main N/A Water Service line N/A Surface water N/A Driveway, parking/vehicle storage N/A Curtain drain None Noted Wells on adjacent lots N/A F. COMMENTS Well depth determined during inspection. G. ENGINEER'S CERTIFICATION S .9F•A�qs‘i P I certify that I have determined through field inspections and ��' �� %.* review of Municipal records that the above systems are in Air*: 49 TH /\ �t�� conformance with MOA COSA guidelines in effect on this date. 4 Engineer's Printed Name Michael E. Anderson, P.E. F '. Michael 3E.Anderson . / Date A,�t��srF9 4• 2I1 ���`.v .r6/21/2018 kl`FDPROFESSIONP'.� COSA brown sheet 10-10-12.doc c .. ) 0 , __.J97E1J , RESIDENTIAL& COMMERCIAL WATER AND WELL SERVICES 24HR EMERGENCY SERVICES AVAILABLE FREE ESTIMATES John Netherton P.O Box 210249 Anchorage,AK j 99521 9�d�]7_ 30.x„786 In regards to property 7011 Stella Place Anchorage Ak the well flow results are as follows: Total Depth of well 160' Satic Water Level 32' 6.0+GPM If you have any questions please feel free to call at 907 2301868 Thanks John Parcel I.D: ~ 014;102-38 1. GENERAL INFORMATION Complete legal description LAKE: O' S HE: GH § =SUB V S OH; LC Y 9, 8LOCK Location (site. address or directions) 7011 ~ STE:LLA .PLACE: .* 'ANCHORAGE:, AK '99507 Curmn~Propertyowner(s) ' ED &: KARE:N 'GASQUE"." · Dayphone'~/ 349"7342 : Mailing address L~nding agency: Mailing e(~.dr~ Re~l Estate Agent Mailing address 7Oll .STELLA PLACE: * ~ANCHORAGE, AK 99507 PAL,°H I,,~TUKONIS"w/-REAL"i¥ EX£C[~TIVES Dayphoge' · 261-7313 341 ,WEST TUDOR ROaD',SUITE'103 * ANCHORAGE, AK 99503 - Unless o~he~/vls, e. requested, I/AA wfll be held by DSD fgr plckup. . 2. NUMBER OF 'BEDROOMS: 3' 3. TYPE' OF WATER SUPPLY: Individual ~Vell ' Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding lank Communlt,j On-site Public Sewe'r The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations g~ven In paragraph 5 by an Independent professional civil engineer registered in the state of Naska. Ced~ficates of Health Authoflty Approval are required for the transfer of title (except between spouses) for pmper~es served by a single family on-site wastewater disposal end/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authoflty Approval are valid for 90 days from the date of Issue for pmpe~es served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (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 ora public water system. The Municipality of Anchorege Is not responsible for errors or omisslons In the professional engineer's wori<. Note:Alaska Water and Wastewater Consultants, !nc. shall be pald $810.OO at, or prfor ,' · tocloslngfortheenglneerlngse~fcesprovlded. ,> :, ~ .~,= ;., STATEMENT OF INsPEcTION BY ENGINEER` :, .:, : . . As certified by my s~ af~ed he~eto ~d a~'of ~the valida~ da~'s~ bel~, l verify that my · ,. shows that the on-~ite w~ter Supply ancY~r ~/aste~ater disPosal, sYStem Is(are) safe; functional and adequate . for the number of bedroo/ns and lype of ~trdctum Indi~ated hereln. I further vedfy that based on the Informab'on obtained fro/n the Municipality of Anch~ge fileg and from"my Investigab'on 'and Inspection, the . on-site ~at~r supply 'ahd/'~r v~stewata~ disPosal ~ystem Is(are) In'c°mpliance ~th all applicable Municipal , and State codes, ordinances, and regulations in effect at the time of installation., Name of Finn ALASKA WATER &: WASTE-WATER CONSULTANTS, INC. Phone Address 6901 DEBARR ROAD. SUITE 2B * ANCHORAGE. AK 99504 Engineer's Printed Name JEFFREY A. GARNESS. P.E. Engineers Comments: In conducting this evalua~:~, AWWC, Inc. attempted to provfde a ~horou~h, conscientious englnee#ng anaysls of the system In accordance ~th ADEC and MOA DSD Guidelines & Regula#ons. The reported results ~ the pe#onnance of t~e system under the conditions encountered at the b'me of the test, and separag~n distances measured to readi¥ Identifiable features. The operatii;~3al life of all we/Is and septic systems depend on ghe local softs c~liCon, groundwater levels that may I~uctuate during the y~,', and the water usage of the faml~ being sen/ed by the s~tem. These conditions are outside the conbof of the evaluat~ of the system. Eatisfactory test results do not guarantee future pedo~'mance of the system, n~' do they guarantee that there am no hidden defects or encreaclvnen~ AWWC, Inc. can theref~e n~t provide any warranty er fulure estimate of how long the system will ccnUnue 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 abev~. Any reliance upon o~ use of this report by any other person or party Is not authorized, nor will lt confer any legal rlght whaisoever. 5. DSD SIGNATURE Date bedrooms. Approved for '~ Disapproved. Conditional approval for 337-6179 Attachments: HAA Checldist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Englneefs Reort Other Original Certificate Data: ~ - / '~ ' O I Municipality of Anchorage Development Services Department 47ll0 ~x~th Bragaw St. P.O. Box 196850 Anchorage, AK ~9519.6850 Legal OescrlpUon: A. WEt4. DATA Well type Date completed Toteldeplh 55+ It. Date of test 6teUo water level Well production WATER ~U~IPLE RESULTS: Co~orm 0 Date of ~ample: HEALTH AUTHORITY APPROVAL CHECKLIST LAKE OTIS HEIGHTS SUBDMSION; LOT 9, BLOCKI~ ParcollD: 014-102-38 12+ In. colonles/100ml. Nitrate 0.5 mg~.. Otherbacterla 0 colonles/100ml. 4/5/01 COllscted by:. AWWC, INC. a. SEPTIC/ItOLDING TANK DATA PUBLIC SEWER Tank.lze gel. Number of~/N} · ;oondatlon de~~~r ~nk ~/N) High water alarm (Y/N). ABSORPTION FIELD DATA Date Irmt~ecl ~ ~ mUn~ (g.p.dJt'br ft'iixlrm) System type Leng~ lt. Wldt~ fL ~ IL Totaldepth fL Eff. absorpUonama ~ ~ Depmssl~_noverflelct___ Anym n treatment (past 12 mo.) (Y/N & t~e) If yes, give date D. UFT STATION Date instalZed Size in ga;Ions ~3~.~17-'~ __ "Pump on' leWl et In. 'Pump n. High water alarm level et In. Da.~m Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCE~ SEPARATION DISTANCES FROM WFI I ON LOT TO.' ~epflo tallk/l~ ~taUon on lot N/A Absorption field on lot N/A Public sewer main .45'+ Sewer/septic ~erdce line u- V.. ~ ~' *WANER ISSUED 5/82 *ADEC WAIVER ON FILE ~ DHHS On adjacent lots. 100'+ On adjacent lots. 100'+ Public sewer manhole/deanout Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Properly line Building foundation Water main 100'+ · Surface water. SEPARATION DISTANCE FROM ABSORPTION fiELD ON LOT TO: ~ Property line . Bulldlng foundation J/Valarlfi~n. ~ Driveway, paddng/vehlde storage Water line ~ We~ on adjacent lots F. COMMENT~ G. ENGINEER'8 CERTIFICATION I certify ~at I have determined ~mugh field Inspections and review of Municipal records ~hat ~he above aysfems am In conformance with MOA HAA guidelines in effect on this date. Englnem'e P~e/d Nap JEFFREY A. GARNESS of Payment Waiver Fee $ Date of Payment Receipt Number. SUBDIVISION: ~.,L-- (~/~.----~.~ W,~..--/z~' ~Z/~-'-- IBLOCK: / ILOT'- % ? INDICATE NORTH SIZE MAIN: SEWER SERVICE UNE SKETCH SHOW LOCATION OF CONTROL MANHOLES/CLEANOUTS TYPE MAIN: _ ALLEY . CONNECT DEPTH AT MAIN CONNECT DEPTH AT Prop. Line ~_'~ CONNECT LOCATION: COMMENTS: INSPECTED BY: APR-10-01TUE 8:21 ~qUk'U F~ NO. 90?562542? MUNIClPAUTY OF ANCNORAOE ~l-W I--H ~.O CONNECT PERMIT ~c5' : SCHEDULED COMPLETION DATE ~ BINGLI: FAMILY '1.1 MULTI.DWI-'LLIN G No. APTS_ O COMMERCIAL ~ INDUSTRIAL TAX CO E MAIL AbDHESS ~,~- ', L( ' ~')OL~"/ .... ~O~TRACTOR~/, ~ ( ~ ~ ;~ ASSESSMENTS ~c{h~ [ Bondrlqulr~ " ' ~ ' ~ ' ~O~ P~OPER~ ONLY : O Main extension agreement O MAIN TAP--TO PROPER~ LINE ONLY = U Su~ivlsion agreement {MOA~ Sll{e ROW P~It R~ulr~ U Extended conner agreement O MAIN "~ ~./ 'f E I PERMIT ISSUED BY; FEE $ /! ' '-' I {~PA~D C1 CASH cokNEcTION SIZE INSPECTION PERMIf · I~EI~BUR~IBLE UMBER I. HAVIE I~ F.~D .THE CONDITIONS AND flEGULATION~J ON THE REVEnSE SID~ OF THIS PERMIT AND AGREE TO COMPLY WITH THEM. m4iff~ ,. FEE ,S...~ -- , . {~CK#~ TOT^L'~E"OS'T "'" "-" '--'" I~' ' ' AWWU INSPE~OR P, OI 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 1. GENERAL INFORMATION Complete legal description T,9 ]51 Lake Otis Heights ,.L.ocatlo~:~slteaddress or directions) 7011 Stella Place Anchorage, AK 99507 .i '-.'' ProPe~.0Wner Wayne & Nancy Britt. on Day phone · .~ Mailingaddress' "7d'11 Stella Place Anchorage, Ag: 99507 '~ Lending agency ' Day phone MailingaddreSs Rick Davids Agent 344-2778 Day phone 261-7662 Address Dynamic Properties ' ' Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. T~PE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. ~ TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Commu?~ity on-site Public sewer XXX 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 inves.tLgation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulat'on.s in~ ..e~,e.c..t.o,~he date of this inspection. 17034 Eagle River Loap Read No. 204 Name of Firm Phone Eagle River, Alaska 99577 Address ~ / , -~' Engineer's signature '.~,,~.~/¢.?//~-~----~// '~,.'~,-, Date DHHS SIGNATURE X A'pproved for ~' Disapproved, Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments ThelML~nicipality of.'~,nchorage Department of Health and Human Sen/ices (DHHS) issues Health Authority Approval; Certificates based only upon the representations given in paragraph 5 above by an independent · pcofessional engii~eer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their, lending institutions in order to satisf7 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 Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:~)7 ~l /~ I~ [~Y_.~ ~.~-H5 /U/y_~, Parcel I.D. (~/~-//0.2, ~-.~ A. Well Data Well type ~[~l d &ff E Log present (Y/~) Total depth Sanitary seal (~fN) If A, B, or C, attach ADEC letter. ADEC water system number ~'~O Date completed ~P_--FoF.~ Driller ~ '4- Cased to ~ '~ Casing height }/~$ Wires properly protected '~N) Date of test Static water level Well flow Pump level1 FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /~/A Absorption field on lot Public sewer main Sewer service line __.~' ~ '~'"~_~ WATER SAMPLE RESULTS: .g.p.m. AT INSPECTION .g.p.m. ; On adjacent lots ; On adjacent lots ~1~$/'~L Public sewer manhole/cleanout · '. .Petroleum tank Coliform ~' Nitrate O. I o Other bacteria Date of sample: S'(I~I c~.~ Collected by: ~ ~ _~ -~:,.~.,,~E_.E~,~ Date ~..-~?'""?~ ...... Tank size Compartments · .:'' '!i .. ":'~oundation.,.' '~''~ ',':,..._~. N C eanoutS (Y/N) ~ cleanout (Y/N) ~.mp~u~u,~ (Y/) High water alarn?i?N).. ,...' ")..? ~'~-"~----.~_~' ~ ~) Date o! pumping :: ~umper SEPARATION DISTANCES .... ~' AN Well(s) on lot,, .j..: . i' ~; .~,._,,~T Foundat3oP~ "-~'"~'"~ "" Absorption field Water main/service ~ To prop~ Su d~aee'W ate r/drainage ~ 72-026 (3~3)°Fron! CONTINUED ON BACK PAGE C. LIFT STATION. Date installed ~ Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" Manufacturer Manhole/Acce,' ~"Pump off" Level at lested SEPARATION LIFT STATION TO: ~N FIELD DATA ~"/,/-J Date installed Length Total absorption area Date of adequacy test Water level in absorption field before test On adjacent lots Soil rating (GPD/FF) Gravel thickness Cleanout present (Y/N) (pass/fail) ~ Peroxide treatment (past 12 months) (Y/N) Sudace water depth lression over field (Y/N) for After test yes, give date Bedrooms SEPARATION DISTANCE FROM TO: Well on lot To building foundation ~- On adjacent lots ~ Surface~ C~drain E. ENGINEER'S CERTIFICATION acent lots ~y. line To existing or abandoned system on"~ Cutbank Water main/service line Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspect/on, Engineer's Name Date HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payme~ Receipt Number CT&E Environmental Services Inc, Laboratory Division Laboratory Analysis RePort CT&E Ref.~ 95.1B19-1 Matrix WATER Clien~ Sample ID 59 BI L~KE OTIS ProJec5 Name DWSID WORK order g & S ~NGINE~RING P~in=ad Date 05/1~/95 $ 10:32 hrs. R. CoWkN Col%e¢=ed DaCe 0~/%0/95 ~ 13:~0 hfs, Re=etvea Date 05/10/9B UA Technlca~ DireCtor STEDF~N C- ED~ Sample Rel~arks: $;~4PDE ~OLLECT~D BY, J.W. QC Allowable EX=- Anal Method Limlt~ Date Da~e Init parameter ~eeul~s Q~al U~ice .................................................................... 10 05/11/95 CMR Nitrate-N 0.10 U ~g/L EPA ~53,2 See Special Inetrudt'lons Above NA - No~ A/~alyzed See Sa,~p%e R~t~a~ke A~ve Undetected, Reported value ia ~h~ practical g~a~%tifldation ~.lmit. LT - Lese Than GT = Greater Than 200 W, Potter DriVe, Anch0,age, AK 99~18-160~ -- Tel: {907) §62-2543 Fax: (907) ~61-5301 c~.%nOmNU~NTAL FACILITIES ~N A~ASKA, CAL1FOEN~. FLORIQA. ILt|N01S, MARYLAND. MICHIGAN. MISSOURI, NEW JERSEY, 0~[0, WEST viRGiNiA MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include Jot, block, subdivision, se~ction, township, range) Location (address or directions) (b) Property owner Mailing Address Telephone: (home) Business (c) Le~~ Telephone Maih'ng A,i:Jress ~'~- (d) Reap Estat ComPany and~~.~,~.~_ Address . - "~'~'~'~-, ~~.~ ~. Telephone ' (e) Mail the HAA to the following address: (or check here,CC, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family ~ Number of bedrooms 3. WATER SUPPLY Individual Well ~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site [] Public I~ Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 ')~JOM 8,J~)eu!bLle leuo!ssejoJd eql u! eUOleS!uJo JO 8JOJJe JOj elq!suodseJ lou 8! eD1BJoqouv jo/9,!18d!o!u nlhi eqj. 'penes! s! e),l~o!j!:jJeo ~ eJojeq 8~p eZ~leUe JO suoi~,oedsu! ~onpuoo ~,ou op SNHQ jo eee,~otd uJ]3 'slUeLUeJ!nbeJ m,m,s pu~ I~JepeJ u!m, Jeo ~JsRes o], JepJo u! suop, nlp, su! bu!puel J!eq~ pue seuJoq jo eJeseqoJnd o~ /~eejJnoo I~ 88 8!Lp, seop SHHQ @q/ 'e~te~lV jo e~m,S eq~, u! peJe~s!l~eJ Jeeu!l~ue i~uo!esejoJd luepuedepu[ u~ ~q eAoq~ ~ qdeJl~eJed u! UeA!§ suoR~jueseJdeJ eq~ uodn,~lUO pes~q pel~D!J!Jeo le^OJdd¥/q!Joq~,n¥ qll8eH sense! (SHHQ) eeo!^JeS ueuunH pue q~,leeH jo ~,UeLU~,Jedec] e§~Joqouv ~o/~,!led!o!u nlAI eq.L leAOJddv leUO!~!puoo ~.o ewJe/ leuoR!puoO peAoJddes!d ~, peAoJddv 01~_¢;2~_ ~/el~a ~ .~ /.~____~AqsuJ°°'peq EJOtpe^OJddV lYAOl=lddY SI-INa '9 leds s,JeeuiBu3 A WELL DATA~'~ ~ MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: Well Classification P ~'~?J ~r~"~ If A, B, C, D.E.C. Approved (Y/N) l~J//~..~,~ WellLog Present(Y/N)yl~-,~. Date Completed ~/~' Yield Total Depth ~ Cased to ~0 Depth of Grouting ~1~ Static Water Level ~ ~ ~ Pump Set At ~ ~1~ Casing Height Above Ground ~ ~ ' Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Y~ Depression Around Wellhead SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ; On Adjoining Lots ~J /~/t A ; On Adjoining Lots To Nearest PUblic Sewer Cleanout/Manhole ;Date To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by ~.. Water Sample Test Results ~J L ~'~"~, Comments ~'~'~j; B. SEPTIC/HOLDING TANK DATA ~ 0 J~ ~' I.,,'~''~,t ~ DaSd Size No. of Compartments Standpipes (Y/IXT~ Air-tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tan~ Date Last Pumped .... Pumping/Maintenance Contact o ,~N) ~ ;for _____ Holding Tank High-Water Alarm (Y/N) ~ Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOL~N~NK: To Water-Supply Well To BI~ Foundation __ __ To Property Line__~ To Dispose__- To Water Main/Service Line ~ ' To Stream, Pond, Lake or Major Drainage Course '%-- Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA ting in Absorption Strata Type of System Design __ Depth of Field ____ Gravel Bed Thickness Square Feet of Abso~.n Area _ ___ Statndpipes Present (Y/N) Depression over Field (~'N-~.__-- __ Date of Last Adequacy Test Results of Last Adequacy-- *":~ Test~'-~... SEPARATION DISTANCE FROM'~'~B~TIO~/: To Water-Supply Well "~.~// ~_o Property Line To Building Foundation '~--'%.....~.. ' -'~- To Existing or Abandoned System on Lot ; On A'(:fjo..!ning Lots To Water Main/Service Line T~)'""C-u_t~ack (if present) To Stream, Pond, Lake, or Major Drainage Course '~'r TO Driveway, Parking Area, or Vehicle Storage Area .~, Comments D. LIFT Date Installed "~-~ Dimensions Man cie/Access (Y/N) Size in Gallons ..... ~- "Pump On" Level at ':-"~'~"~,,~ .... ! ~'..~ Pump Off" Level at High Water Alarm Level at ~'~, ~.. _ Vent (Y/N) Tested for ...... ~-- Pumping Cycles during Adequacy Test, Meets MOA Electrical Codes (Y/N) Comments **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this !" ?~',:. ~ · ..~~".~,,~., Engineer's Seal ~:,.,.., ;b2,:'.:~ ':. ~,~m,'~. (.'.: ; Date of Payment Amount: $ Receipt No, Waiver Fee: $ Date of Payment 72-026 [Rev. 7/88) Back Page 2 of 2 'KE KNIEFEL ENGINEERING 8441 Miles Ct., Anchorage AK. 99504 (907) 337-1121 · Fax (907) 338-1874 Date of Testing: October 10, 1990 Legal Description: Lot 9, Block 1, Lake Otis Heights Street Address: 7011Stella Place Number of Bedrooms: Three (3) Well Flow Test: Depth of Well: Static Water Level 28.5 Average Flow Rate: > 6 gpm Results of Water Quality Analysis: Total Coliform -- 0 colonies Nitrate-N -- >0.5 mg/1 (10 mg/1 allowable) G~m~,~,~.,;,, The house has a private well and is connected to the MOA Sewer system. The well produced a continuous 6 - 7 gpm for a total of 736 gallons. The well drew down to the approximately 44' depth area and maintained that level under all pumping conditions. ~.~...].........~..~.".r..G.~.p~.b.].~.......~.~.pE~.~.NG.~..Q.g.....~.~g.[~.~.~.~.~b.~.Q........~.b.[~.........£..~.~).........~]...]..9.Q.~.......p~.~ m.j...Q.N.~...~..~.[.......~...~...~.~.E.~.~.~9.N~........9~.Ej.~....~..~.~j...Qg.r..r~.~ENA........~.Q~..."~.M~A......~.~Q~.j..~.~ ..... The well was tested in accordance with MOA policy and regulations in force at the time of this test. NORTHERN TESTING LABORATORIES, INC. ~§05 FAIRBANKS ,%TREET ANCHORAGE, ALASKA 99503 907-277-8378 · FAX 274-9645 3330 INDUSTRIAL WAY I=AIR~ANK$, ALASKA 99701 907.456.~1'16 ~, FAX 456-3125 Kniefel Engineering 8441 Miles Court Anchorage AK 99504 Attn: Robert Kniefel Report Date~ Date Arrived= Date sampled~ Time Sampled~ Colleoted ~yt o/o /9o 1505 Kniefel Our Lab #t A106049 Location/Project~ - Your Sample ID~ 7011 Stella Sample Matrix: Water comments= Flag Definitions ~elow De~ection Limit DL Stated in Result Below Regulatory Min.- Above Regulatory Max. Below Detection Limit Estimated Value Date Method Parameter Units Result Flag Analy~ed EPA 300.0 Nitr&te-N mg/1 0.5 U 10/11/90 Ke~or=ed · Red~gari A~chorage ogeratione Manager MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE.z/ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF H~AL~.&c~iON \ (] z'L,/~/~'-825~L Street-Anchorage, Alaska 99501 ENVIRONMENTAL ?RU/'.~, ~L,~// ..~WRONMENTAL ENGiNEERiNG DIV S i"10¥ 5 1980 (x~'~ Telephone 264-4720 DIRECTIONS: Complete all parts an page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE Alaska Statebank 279-7637 MAILING ADDRESS 310 East Northern Lights Blvd. Anchorage, Alaska 99503 PROPERTY RESIDENT (If different from above) PHONE 2. BUYER \L PHONE Clifford Killary J 279-2051 MAI LING ADDRESS 241 North Park 3. ~-ENDINGINSTITUTION I PHONE Alaska Statebank I 279-7637 MAILING ADDRESS 310 East Northern Lights Anchorage, Alaska 99503 · .ble ' ~" I~e. ~ 344-3722 MAILING ADDRESS 620 East 57th Place Ancho. rage, A~la. Ska 99502 5. LEGAL DESCRIPTION Lot 9, Block 1, Lake Otis Heights STREET LOCATION 70.1.]. Stella Place Ancharage, Alaska 6. TYPE OF RESIDENCE SINGLE FAMILY [] MULTIPLE FAMILY 99507 NUMBEROF~EDROOMS [] One [] Four [~[] Two [] Five [] Three [] Six [] Other 7. WATER SUPPLY [] INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * 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.) 8. SEWAGE DISPOSAL SYSTEM ~] INDIVIDUAL/ON-SITE** [] PUB L.IC UTILITY **If individual/on-site, give installation date Sept. 1977 If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/7B} THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR I NSP ECTOR DIRECTIONS: I. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] I NDI VI DUAI_/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tankor [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line ~APPROVED FOR 2~ BEDROOMS ~ CONDITIONAL APPROVAL (letter mus~company certificate) ~'~ DISAPPROVED ~ DATE / /~ ~ I BY (Title) LEGAL DESCRIPTION ~ 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4.111 GEORGE M. SULLIVAN, MAYOR DEPARTMENT OF HEALTI-'I AND ENVIRONMENTAl- PROTECTION December 22, 1980 Alaska Statebank 310 East Northern Lights Boulevard Anchorage, Alaska 99503 Subject: Lot 9 Block 1 Lake Otis Heights Subdivision (Clifford Ki~lary - Buyer) Enclosed is a letter we have received from P.M.V. Construction. Items #1 and #4 have not been complied with, as stated in our letter of November 12, 1980'. Item #1: The water sample was taken, by this department, on November 7, 1980, this is the water report we need for review. Item #4: The depression around the well was filled with sand, this needs to be filled with impervious type soil, as stated in our letter of November 12, 1980. This will need to be reinspected by this department. "Impervious type soil" such as clay. As soon as we have received the water report from the lab that this department has taken and the well depression has been corrected and reinspected by this department; :we will be able to issue an approval. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: Judy Re/Max Properties, Inc P.MoV. CONSTRUCTION 3106 Wo Nth. Lts. Anchorage~ Alaska 99503 December 18~ 1980 MUNICIPALITY OF ANCHORAGE DEPT. OF JENVIRON~V, ENTAL rr' :[ECTION Municipality of Anchorage RECEIVED Department o£ Health and Environmental Protection 825 L S¢. Anchorage~ Alas~ 99501 Subject: Lot 9 Blk I Lake Otis Heights Sub. Dear Mr. Robert Co Pratt~ We have completed the seven requirements for the above subject property. Io The water analysis report is hereby submitted. 2. The exposed electrical wire to the well head was replaced with 12/3 neoprene wire and 3//~'' conduit. 3. The well casing was extended 12 inces above the ground level. ~. The depression around the pit and well casing was £illed mn with sand.' 5- 6. and:?i:~Were all approved by the engineer at Construction Test Lab~ see their report enclosed. Please send final approval o£ this subject property to Alaska Statebank Mr.. Derrell Smith~ 310 E. Northern Lights~ Ardaorage~ Alaska 99503. Sincerly,.~~~ j~ Paul M. Vozar ERG: MATERIALS TESTING o QUALITY CONTROL SOILS ENGINEERING 2204 Cleveland Ave. P.O. Box 10-1126 Anchorage,AK. 99511 P77-O2BI 710 Third Ave. P.O. Box 2540 Fairbanks, AK. 99707 452-1267- 456-5155 SE 'I'IC SYSTEM ADEQUACY REPORT JOB NO. ACTL-80-1488 DATE OF REPORT 12/3/80 DATE OF TEST 12/1-12/3/80 LEGAL DESCRIPTION ' LOT __ OR 9 1 , BLOCK -- SECTION . Lake otis Heights , T N, R W, SUBDIVISION S.M. , ALASKA PERFORMED FOR: P.M.V. Construction 3106 West Northern Lights Anchorage~ Alaska 248-4447 PHONE NO. 99503 REQUESTED BY; Jerry Holland Aardvark Plumbing PHONE NO. TYPE OF SYSTEM NUMBER OF BEDROOMS SEPTIC TANK WAS ABSORPTION RATE SURGE RATE] SEPTIC TANK - SIZE CRIB OR SEEPAGE PIT LEACH FIELD 301 3UMPED [] YES ii%~NO AVERAGE 24 HOURS 450 400 40 GALLONS IN GA LLO NS. MI N UTES. GALLONS Corrugated Fiberglass Since the system was of new construction and had not been used NOTES & OBSERVATIONS: recently, approximately 200 gallons was added to the tank and allowed to stand until a constant water level was achieved in order to start the test. The static level was 82" for the first day with the surge level at 70". The second day static level was 81~" with the surge level at 70½". The third day static level was 80" measured after 21 hours; therefore, the system was approved. (NOTE: The measurements were made from the top of the clearout to the top of the water level.) K.R. BaxterREPORT PREPARED BY:K'R'Baxter APPROVED BY: Kinney R. Baxter TEST PERFORMED BY; ~}25 "/" .%1REET ArgCI~O~{AGE, ALASKA 99501 (,,,)~) 2(~,1 4 1 1 1 November 12, 1980 Alaska Statebank 310 East Northern Lights Boulevard Anchorage, Alaska 99503 Subject: Lot 9 Block 1 Lake Otis IIeights Subdivision (Buyer: Clifford Killary) Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: (1) The water analysis report be deliverd to this office from Chem Lab, 5633 B Street, for our review. (2) The exposed electrical wires to the well head are in violation of the Municipality of Anchorage codes and must be encased in conduit. (3) The well casing extended twelve(12) inches above ground level. (4) The depression or pit around the well casing needs to be filled with impervious type soil so that it slopes away from the well casing. (5) Expose the septic tank manhole to verify its existance. (6) ~he septic tank pumped with a receipt submitted to this department. (7) An adequacy test be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report needs to be submitted to this office for our review. AlaJka Statebank November ].2, 1980 Page 2 Please notify this department for a reinspection when the noted descrepancies have been corrected. If there are any further questions, please call this department at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist cP/ jw cc: Judy Re/Max Properties, Inc. 2800 Gambell 99503 825 "L" STREET ANCHORAGE, ALASKA 99501 (90'?) 264--4111 GEORGE M. SULLIVAN, MAYON DE:PAR i-M~ NT OF I-]EA[.TN AND ENVIRONMFENYAL PI]O April 23, 1981 Bonnie Palmer 7011 Stella Place Anchorage, Alaska 99507 Subject: Lot 9 Block 1 Lake Otis Heights Subdivision According to the request submitted to this office, the sewer system on the subject property was installed September, 1977. This department did not issue a permit or do an inspection of the sewer system at the time of the installation. On November 12, ].980, I requested an adequacy test be performed on the existing sewer system. This test passed and the tank was pumped and verified to have a 1,250 gallon capacity. On April 17, 1981, I reinspected the property and found the ground around the cleanout to the trench to be caved in. The Palmer's said they had had problems with the sewer backing up and overflowing out of the cleanout~ in my opinion, the cleanout has been separated or a break in the line has occurred in this area causing the overflowing problem~ If there are any further' questions~ please call this office at 264-~.4720. Sincere}~ Robert C. Pratt, R.S. Associate Specialist RCP/ljw January 13, 1981 Robert C. Pratt, R.S. Associate Special ist Municipality of Anchorage 825 "I," Street Anchorage, A]aska 99501 MUNI?IPA£1Ty OF A- , DEPT. OF .... ~¥CHORAg~ · ',.,.i 1. i981 RECEIVED Re: Lot 9, Block 1, l,ake O~[s Ueight:s Subdivision Deal? )h;. Pratt: We have so].d tile home at the above referenced ]ocatJon. At c.]osfng v.,c have agreed to Escrow $500.00 for landscaping, This work wil. 1 I>e done soon as weather perm/ts, but not later than June 15, 1981. llt is contemplated that several additional yards of so;i! will bt,. brought into the front yard and the depression around the well will be ¢omp]ete]y filled in. i[f ),()ti hay(~_ any question,s, please call, S]ncerel y, ALASKA STATEI{ANK lt. Derrell Sm:i th Vice PresJdent ltd S: bj r