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LONGVIEW #1 LT 4
Longview #1 Lot 4 #015-163-57 MUNICIPALITY OF ANCHORAGE ® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME s Ile / PHONE kNEW F-11UPGRADE MAILING ADDRESS .Yo LEGAL DESCRIPTION // LOCATION j " NO. OF.BEDROOMS v DISTANCE TO: Wellp 460( Absorption area Dwelli PERMIT Y wQ Manufactur�� p � Materi No. oartments pacyty 1_Blions Liq. c=042B (TSO: IF HOMEMADE: Inside length Width Liquid depth Y J � Z DISTANCE Well Dwelling PERMIT NO. = z4EManufacturer Material Liquid capacity in gallons w = DISTANCE TO: Well �' — Foundati n -�— j Nearest to lin PERMIT NO. � `® J LL z Z w ~ No. of lines Len o each line ( Total lend'h of "nes Trench oy �+ �j inches Distance between IIiines :� F cc Top of the to finish grade Material bedeath tile c� % 6� inches Total effective a o tion area Lu (D Length Width Depth PERMIT NO. Q I- as UJ Type of crib Crib diameter Crib depth Total effective absorption area Lu DISTANCE TO: Well Building foundation Nearest lot line J J Class Depth Driller Distance to lot linePERMIT NO. W DISTANCE T0: Building foundation Sewer line Septic tank Absorption areas) OTHER ]� `^' PIPE MATERIALS .�- '56 3 G,�st" ..G�.o,� SOIL TEST RATING 160 INSTALLE REMARKS APPR ED DATE LEGAL E`� MI's, D IL IN WO S 13OX 13699 STAT. HOUrrIN A ANCUO aAGE, AILASIKA 99502 344-'i'714 SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 240 Feet. DRILLED AT THE RATE OF 1520.00 PER FOOT. PROPERTY OWNER lilt. & llbt4. S-teue Ti,ia. LOCATION OF WELL SITE Lt. v Bim" su'" L© nUie W DRILLER BeAni_e CdaA of 2amna&t 1,ot� . WELL LOG: 0-----21 ' �taue t and Oma U bou tde1Z4. 20% al�. 21----44' R tae t 4VAy, fine gAauet WU , 30% catcui. 44----59' /la)tdpw7,. /l cemented, gAaueL. 59----78' Bedrock. R b&o ea 4o f t ma tc& at . Cong tomeAa te. 78---240' R twe hated Bred wcl . Sed unerLta�w tack. Atea,j of- Poto" and gAanv f.a z- rtocL 4howi.nc, good ptadac tton of- watet fAoa 218 to 233 .feet. Y.i e (d ,ind cated a ueluj. 4t)tonq f tow and pu,Ued down ,to 8 C/'lll after one howzA purap,na150 f ect (3f- Oaten 4 taading. in ca4,in.n o" bottom. 3/4 ldo&4e Submet4 ire %aaa 4hotttW he !jL6 aU.ed 20 ,to 30 feet a"- hattom. Comet of- D&i Li irtg: 320.00 12et f-oot X 240 Tee -: ' `4800.00 Ro Cha�tge fat lucU Seas. COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF THANK YOU VERY MUCH. 134800.00 BERNIE CL OF RAMPART DRILLING WORKS DATE /ip,t, 1 24th, 1981 TYPE OF SOIL ABSORPTION SYSTEM I S : TRENCH MAXIMUM tdt._1MBER OF BEDROOMS _ 4 SOIL RATING SG! FT.'E;R 1= 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: F� s EL 9==° -F"= = °S� €_. F-- P-4 92i -F E-•-# === 4 9:28 a: 3 F -" f=Q "°a ° �- l THE LENGTH DIMENSION I S. THE LENGTH (IN FEET) OF THE TRENCH OR DDA I NF I ELD. THE DEPTH OF R TRENCH OR FIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BO-F'-F'CiM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL P I i"`'r=. AND THE BOTTOM OF THE EXCAVATION (IN FEET). Fes, 1--Z! U 1 F? firms E� F--° -T' TL v. -F €= r -,d V, _^ I = FE -1-:2?tee C-1 93 F-1 L_. L_ i.= e P-4 PERMIT APPLICANT- HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT G'±_RIt•G THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE L 1 SERVE. DEPARTMENT NT HEALTH ; AN ENVIRONMENTAL _ITECT I C std (c,CJ 825 `L- STREET, ANCHORAGE, AK. 99501 JuU3 ».. 264-4720 4 E L_ L- F=0 i° -a U- CD PJ —!EF I -F E-- '—S E- I.°A F-- F;-! F- F"—:' F-_ rl l I !o-. PERMIT NO. ( 810-379 ) LA, ' J K. APPLICANT STEVE PISA S. R. A. BOX `�•�'S-'= LOCATION _=N OWLINE -FRAIL LEGAL L 4 LONGVIEW LOT SIDE 511000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM I S : TRENCH MAXIMUM tdt._1MBER OF BEDROOMS _ 4 SOIL RATING SG! FT.'E;R 1= 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: F� s EL 9==° -F"= = °S� €_. F-- P-4 92i -F E-•-# === 4 9:28 a: 3 F -" f=Q "°a ° �- l THE LENGTH DIMENSION I S. THE LENGTH (IN FEET) OF THE TRENCH OR DDA I NF I ELD. THE DEPTH OF R TRENCH OR FIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BO-F'-F'CiM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL P I i"`'r=. AND THE BOTTOM OF THE EXCAVATION (IN FEET). Fes, 1--Z! U 1 F? firms E� F--° -T' TL v. -F €= r -,d V, _^ I = FE -1-:2?tee C-1 93 F-1 L_. L_ i.= e P-4 PERMIT APPLICANT- HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT G'±_RIt•G THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE t•,g_tMBER OF RESIDENCES DENCES THAT THE WELL WILL SERVE. a-1- 4 ®. m < ;2 i I F=° EE Q_= -- I �. -w IN8 �—=. " F :: E -EE FP Ems.' d`A L.3 I F--_ FE F o :;ACKF I LL I NG OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. ° MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET- FOR A PRIVATE WELL OR 150 TO 200 FEET- FROM A PUBLIC WELL DEPENDING UPON THETYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE Is 25 FEET AND Ti i A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS, ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT" WITHIN ]ZO DA'T' S OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. I CERTIFY THAT 1:I AM FAMILIAR WITH THE REQUIREMENTS F�=�Ft: Ohl --SITE S E}}ERS AND t IELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. HORAGE. 2: 1 WILL INSTALL THE '_SY_•TEM/LLDE FtCCC iF�:DFiNCE WITH THE CODES. I UNDERSTAND THAT THE 0.4E SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REt'1�: DEED T(f I MORE THAN 4 BEDROOMS. SIGiSEC?:_/� APFL T i -ANT STEVE PISA BY- ---------- DATE_ —&( V4. 0 J V August 31, 191*1 Ml— Carl 1,11chs.inger 9 AID 1.) 1 C - . .,I . , . n ... ...... . . ;C. "", . '..' --V' ;'.1 .'.l . 11.'V ?.'" RvM No. 751220 Anchorage, AK 99507 J 0 X Subject: soil investigation for Sanitary Sewer system, Parcel 49 24, T12M-R3W, S.M., Alaska Dear Mr. Luchsinger: sec. At Your request of August IS, 1977, we W"duuled a s"bsurrace soils investigation at the proposed locations of two sanitary sewer systems on the subject parcel. The investigation complied with those procedures required by the municipality of Anchorage, Department of Health and Environmental Protection. qvis investigation, which was Acc"mjdishcd on August 17, 1977, consi.stud of two Lost holes, each drilled to a depth of 25 Feet below Che existing ground surface. The test holes were siLed according Co Your instructions. Their locations and soils logs are shown in attached Drawings A-01 and A-02. Drilling was accomplished with a rotary drill rig using continuous - flight soli -d -Stem auger with an outside diameter of 6 inches. A sample was Laken in Test Hole No, I at Lbc depth shown on the soils log in Drawing A-02. ThO sample will be hold in storage at our lab for approxi- md!OIY six months. In addition, all material brought to the surface by the augers was continuously monitored by on experienced engineering geologist. The topugraphy at the drilling site is gently nlopinq to the west, At the time of the investigation the site had original vegetation consisting of grass and alder. The top of each Lent hole was located at original ground surface. 110 soils encountered in the Lest holes are shown in the test hole logs in Orawing A-02, The symbols Used in Drawing A-02 are explained in Drawings B-01 and H-02. Each 109 displays specific conditions encountered at We test location, However, Subsurface conditions may vary in other parts of the lot without any apparent surficiaj evidence of the change. Groundwater was elhu)""kercd in Test Hole No. 2 at a depth of 16 feet. Bedrock was not encountered. At the time the holes were drilled, seasonal frost was not present and permafrost was not encountered. In accordance with the requirements set forth by the Municipality of Anchorage and the visual classification of the soils encountered, neither Lost hole required a percolation test. 1 � I I i � I If1 w _ ° wl O 9.:.5 n z C) � Jo o } :. U 1 In 33°Hoodt ml Not Urd.co"d f; fig°SS nfi"[ 33U.Oa Ii. V. L. r+(C,"�G' n 0' c 779.101-w pn '10 30 _ _..__ _ i 112 th Avenue �•ro ,o --._ I r I lm I I "1 fvJ I III V ' fl tl `1 "'iS a5 L .!JD.S+<1 t (!✓ U 1 ENIv" <r 330.00 0 \ rl \ ) I(v n — aD9.n9 m w O - I r \ o fl 41 f'r N VI - l '7 0 LOT 3 r � 0 C I I i Varcel l9, >cc. 2d,'P].2t1-1?3F7, I)):• ,�nrr:: :ai�n:�u ,ire• .�I,In ,�xirtii Cc nn<I },n rot. In:,•n ruxisurecl !)y iod:; N() t- Co wC.1I_c I ----------------------------- -- - - --- — — — �,r.wr� ur o,ar 11-10-77 r�+o�rcr „0 7`i122Q I'l CnfO nv Mhf Scn�C Unnwirvc r�o. A -OL t_)UC-1 A..._.__.. 1 i CART, i,ucu;;lNCj'R ANC-IIoRnrr;, AMSKn qn. .0" 1 0 D . I A U'1011"L 6,/TRACE SILT kM Sli(IM-1V ;,Ioi!;L lo.ol Sj 1,"Y s;A']D, r-IM!"(wir.c.; D;wk Bmwil, I kif." 1,/,Orn;QW111J, 0 - zi, !;AND W/TRACI: D.,It rown 1;I.i,IhL-.1%/ H(df;t: U/SoIll: 'PRAM' 5 SAIMY Q,'AV1:1, b o Bo rv"n I i'ol-A hy In(,;.-,1.L'T ;11 ; Q 1) Yb .0 D0 1 ow; (,,()16 h"; 11(m I lkn S(Mi: 13yown , mo i.!; I row[ I ], G 6.0 .0" 1 0 D . I A U'1011"L 6,/TRACE SILT L111A M--f}—_S_0-77 _ CHE CKI D nY . U3 PROACT NO 7512 A-02 ANCI i(DRAGE , A CA S, KA 25.0' T . D . kM Sli(IM-1V ;,Ioi!;L lo.ol .0 D0 S(Mi: row[ I ], G .00 no L, en C-0 ill I t(! rCCI oil I I Ic. 1 it t d . :;ll56m lc,` C L:; lbSUr J_,JC6 5011S w holl, .0: r v ot I w It(, locat:: oil shotyll 0 .,('(2 D) ill(j:; 13 iild 13-0:� for_ D. (': P tc):! ol. 0' ('XI)LIIIJILimi o[ 0 .0 L111A M--f}—_S_0-77 _ CHE CKI D nY . U3 PROACT NO 7512 A-02 ANCI i(DRAGE , A CA S, KA 25.0' T . D . r-- ----- Sul Is Insw I umnon I x agwrimm, mi i) syNI 13(),,t, ATIMI: 1XII t if hv L ion and c I I !�q Fic, I I ion of Lhr toil a(, -t ollip[i I, I c (I it) 'WC01 ('wills Lht Lj!'' t "' Soil " 0'"A f1c,l Lit' System. Normally, the train ;i/c cli';l rilml ion dt tk rnlijwl; I)( Lhk, soil Ill(' !:;,)I,[ idcf:inC,Cl accordiny Lo Irlai�)r and III ill, -I_ I, it u(NiM wiLh Hip inin,jr irjl as jljo(jifi(�rs of Lht-. r (AdIv qivu s0i 15, the c My becomes t 11 c, I))- inc it),, I noun kvi t 11 L ljc of -hoc 111,1jor soli :,)I I s, I ' t I '(''I I 'i (I sI!kl a'ludil WC: i.e, silly clay, wIIp1j the clay particles ,!rk shat ( ilk' clay d0n, in,lt !,� �;oil propucL ics, nQuyr soil consLiLuunks relay be 'ANIA to t A' ClassAicaLion brcakdo-,tn in accordaij,-t! wiLh LII, ;),I �iej listchl 1111MV; i . u. sandy Q w/: ;Dole w/rn(l 1101vul,trace 1: c size proporuion no (.aII L c, I c I solllc - 13 - :30",:, Sol!, copuls] WXY - CIVITIAZIN ?'oil consi 'Ll-nCY as dKint-d below and ALUrmined 1), fiChl and iaboraLorY muthods allilics only to non -frozen rnMer4d, ror thk'!;I! MaLcrioiv, Llu- inFluorim- of sLICAI [nWLOJ.s , a, soil SLI.LICILII.-C, i.(!. Cis sure Systems, slickunt;itIc-,, etc. , IIjkjc;t be Ltti<en iAIU0 C01I.SidQraLj0jj in makkyj any corrWation with Lhe Consistency k"llues listed below, In perniat . ros L ZoIl c's, t. 111, c oil v is L cnicy and s L runE L h of frozen so i 1 s n lay vary s ipi i I -j( -an L ly and Lin, -xpl a ill ab I Y with ice (:on L en t anj soil type, (_ohI_:-,iojIIoss ----------- sive PVX �HIY;;Yl) RuIaL kv I)k, r!;i t yI'-(LA) - know! 0 .10 0 Lo 4 Ol!", Vet. -y Soft 0.25 Alwjiurn Myst. 10 40 Le 70"n so F L 25 Dense 3O 70 to mv):, Stiff 0.5 Ary Dense (1 0 90 Lo 100";, Firm 1,0 2.0 and,trd Ptort rat iml Blowl; Pill, Coot (if V(!)_A, I'irm ), 0 '1 0 10-I)OLIT111 halillner. falling 30 inches on a I to rk] - 11 ,0 2 -inch 01) split -spoon except \vhk,t(: noted. Not c: bVatpr levels jjIdj(,aLL2 d on the h0rillj: 10115 a02 the 1MVIS InuJISUred W Lhc bol in;3 al In ficIrvioti-i: unfrozen WHY, Lhu indicated clevakons arc (:0nsi'Ik!rk'd (1) reps ,('nL ac-LUal Llrmund water conditions. In 611purvious, and Il ro Zt ' I I so it s, ,hell ra L(' 1.1k. Lc F I I I i 11, It iot Is, of I.: rou it Cl Iva L t' r (l IC V-1 t it) I I S Call I Io L be ob (.a incd within 11 timiLud I)C -Ahl A obsemwim, arld other uAdunce on ground waLcc ele%,aLiojjs and Id CClk Ii( inns , 13: (2 1.- ( ! k I u i ce d - --------- L. D. S r" , _M_ 17141 M C3 Ci rd S U Qr1k Pj -r E3, i no" 3- 1-72 -------- --- N/A GENERAL NOTES RAL OUL W1): 10y'll il.e. 1)], i I I inl: Water er 1.,Cvt� I H (211 Before Conint; Removal LV(A %vol, Cave In A ( , - I Z AfL(_,r Casinj" Kcillovol I WI: Dry Cam In A Ik Artut: (1orig" kAtj `;: While S, I I I I I I I inl; T I ) : TO ( III I )L,I) L it Not c: bVatpr levels jjIdj(,aLL2 d on the h0rillj: 10115 a02 the 1MVIS InuJISUred W Lhc bol in;3 al In ficIrvioti-i: unfrozen WHY, Lhu indicated clevakons arc (:0nsi'Ik!rk'd (1) reps ,('nL ac-LUal Llrmund water conditions. In 611purvious, and Il ro Zt ' I I so it s, ,hell ra L(' 1.1k. Lc F I I I i 11, It iot Is, of I.: rou it Cl Iva L t' r (l IC V-1 t it) I I S Call I Io L be ob (.a incd within 11 timiLud I)C -Ahl A obsemwim, arld other uAdunce on ground waLcc ele%,aLiojjs and Id CClk Ii( inns , 13: (2 1.- ( ! k I u i ce d - --------- L. D. S r" , _M_ 17141 M C3 Ci rd S U Qr1k Pj -r E3, i no" 3- 1-72 -------- --- N/A GENERAL NOTES RAL SIANDARD SYMBOLS TYPICAL BORING LOG B0A'/NGlUi+.';LY7._ l LI. 30 15 Elev 274 G CLCV-jo/V IN FFTT OATF O.SYIL::O-.:.10-21-70 All Samples Ss"-'S/MIPLfR TYPC Ss - }IillCR TA BCI_ - `� x - cRn0AT1u1VA1.. C//ANG["-- Cd ORGANIC MATERIAL O I Con sed. VisIce 0-7 ICE+ML ICE -SILT �Estimole 65% Visible ICC l l� 90, 56.2% STRi1TA C//ANGF SANDY SILT ,APPRC.1'iAfA7E 571?AIA CIDING(- L -illle to No Visible Ice 13-30' Vx ---ICF_', OL.SCA'/f (/()N LI C1 AS 1F1C.'111(hV (2 7 2, 571 %, 135.9 pcl, 28° GP (CORf'.S 01' F_IV IN(ERS /7(:7//00'1) UNI//,' 0 08 I -AA CL A.55V ICATION \ CRY OF. NS/ / �Y "Affli CO:V%f/✓T L1L011'S%`7>0T .SAAfI'LL NUilf:li:.i' -SANDY GRAVEL.- 2 G - -1 - - -- - --- -- -- — — ' s/ 95 SCHIST - GIi NFRA,' 1ZFO 501L OR ROCK O1__$(.'1?1PT101V SAA7/Lf, LOCATION -- - -- - - - - ----- 30 - 01O LL. OU'ne M ;V0. - WHILE GRILLING, Aft - Al LCR 90P/AIG ORG&I:IC MATERIAL_�S'lt Gi?!D - COBBL.E:S t3 BOULDERS -� 4l GENERAL IGNEOUS ROCK /,/j SANDY SILT EXPLANATION F7L„M CC1fVSULTA NTS, INC. Un11:FEB. 197?_ ._..,....,.......,,_ ...,_. OF :,r,nLL NONE. - SELECTED SYMBOLS CLAY �"o'_°� CONGLOMERAIE METAMORPIiIC ROCK G: SILT GRADING T.. _— jjj t'O" ,1�J� 51.110, 11) SANDY SILK l� S1L1 I((I SANDSTONE sNl ; c ICE, MASSIVE ooa SANDY GRAVEL 1`�-/� SCAITERFD COBBL E"I t..__� "I (ROCK FRAGMENT S: SAND II( _ MUDSTONE "y ((Mjt'4�"(� ICE - Sll_l (F''S'��`�"'l{� INTERLAYERED S ANE) _ Q SANDY GRAVEL E'`l GRAVEL I� [ j LIMES PONE ORGANIC SILT - Z / SILTY CLAY w/TR. SAW) SAMPLER TYPE SYMBOLS S I 1.11 SPOT SPOON WI1 H 47 /`� RAMMER Ts . . . . SHELBY TUBE Ss . . . . . 14 SPIJT SPOON 'WI 111 140 /,/ IIAMMI-R 7m, . . . MODIFIED SHI_LOY TUBE SI 25 SPLIT SPOON WITH 140// HAMMER Pb . . , . PITCHER BARREL. Sh25 `SPLIT SPOON WIIH 340/f HAMMER Cs . . . . CORL BARREL WITH SINGLE TUBE S. . . . . . 20 S1'I_IT SPOON WITH 140// HAMMER Cd . . . CORE BARREL. WITHDOUBLETUBE: St . , . . . 1.-1 SPLIT SPOON WITH 340,0( HANIM ER Bs . BULK SAMPLE Sp 2.5" SPLIT SPOON, PUSHED - A. AUGER SAMPLE Hs I.•7' SPLIT SPOON DRIVEb) I WITH AIR HAMMER G. GRAB SAMPLE Hl 2.5" SPLIT SPOON DRIVEN WITH AIR HAMMER NOIEC' SAMPLER TYPES ARE EITHER NOTED ABOVE THE 13013ING LOG OR ADJACENT TO IT AT 1'HE RESPECTI`JI: SAMPLE DEPTH. TYPICAL BORING LOG B0A'/NGlUi+.';LY7._ l LI. 30 15 Elev 274 G CLCV-jo/V IN FFTT OATF O.SYIL::O-.:.10-21-70 All Samples Ss"-'S/MIPLfR TYPC Ss - }IillCR TA BCI_ - `� x - cRn0AT1u1VA1.. C//ANG["-- Cd ORGANIC MATERIAL O I Con sed. VisIce 0-7 ICE+ML ICE -SILT �Estimole 65% Visible ICC l l� 90, 56.2% STRi1TA C//ANGF SANDY SILT ,APPRC.1'iAfA7E 571?AIA CIDING(- L -illle to No Visible Ice 13-30' Vx ---ICF_', OL.SCA'/f (/()N LI C1 AS 1F1C.'111(hV (2 7 2, 571 %, 135.9 pcl, 28° GP (CORf'.S 01' F_IV IN(ERS /7(:7//00'1) UNI//,' 0 08 I -AA CL A.55V ICATION \ CRY OF. NS/ / �Y "Affli CO:V%f/✓T L1L011'S%`7>0T .SAAfI'LL NUilf:li:.i' -SANDY GRAVEL.- 2 G - -1 - - -- - --- -- -- — — ' s/ 95 SCHIST - GIi NFRA,' 1ZFO 501L OR ROCK O1__$(.'1?1PT101V SAA7/Lf, LOCATION -- - -- - - - - ----- 30 - 01O LL. OU'ne M ;V0. - WHILE GRILLING, Aft - Al LCR 90P/AIG F H N /A ---... Gi?!D - N/A -------- PROJ.NO GENERAL CI'•U G.L.H. R -D2 _.- EXPLANATION F7L„M CC1fVSULTA NTS, INC. Un11:FEB. 197?_ ._..,....,.......,,_ ...,_. OF :,r,nLL NONE. - SELECTED SYMBOLS F H N /A ---... Gi?!D - N/A -------- PROJ.NO GENERAL DW(” NO R -D2 _.- E � e'C' e, 0) IQ P L UW', 1� i Municipality of Anchorage \ j Development Services Department: Building Safety Division „ On -Site Water & Wastewater Program 4700 Bragaw Street / P.O. Box 196650 C Anchorage, AK 99519-6650 www.muni.orgionsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. to,;)-COSA# 0`0350 1. GENERAL INFORMATION Expiration Date: , I - G - D Complete legal description LONGVIEW 41 SUBDMSION, LOT 4 Location (site address) 11250 SNOWLINE DR. • ANCHORAGE. AK 99507 Current Property owner(s) JEFF BATTON Day phone 770-0780 Mailing address Lending agency Mailing address 11250 SNOWLINE DR. + ANCHORAGE. AK 99507 Day phone Real Estate Agent CAROL BUTLER w/REMAX Day phone 257-0161 Mailing address __110 W. 38TH SUTIE 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 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, t verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. /further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site watersupplyand/orwastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineers Printed Name JEFFREY A. GARNESS, P.E. 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 the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by Ne system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any — - other person or party is not authorized, nor will it confer any legal right whatsoever. S. DSD SIGNATURE _IeL*00� Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the filowing stipulations: Attachments: / COSA Checklist l/ Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other By. Original Certificate Date:._. _p /Rw HM1 is • ON-SITE WATER AND •; WASTEWATER : PROGRAM Municipality of Anchorage Development Services Department Budding Safety Division I, On -Site Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-8850 www.muni.org/onsite (907) 343.7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: LONGVIEW #1 SUBDIVISION, LOT 4 Parcel ID: 0 15- / 6 3 - f7 A. WELL DATA *PER WELL LOG, BUT PROBABLY ONLY TO BEDOCK Well type PRIVAYE If A, B. or C provide PWSID# N/A Date completed 4/24/1981 Sanitary seal (Y/N) YES Total depth 240 ft. Cased to •240 ft. FROM WELL LOG Data of test 4/24/1981 Stafic water level 90 ft. Well production 8 9 -p.m. WATER SAMPLE RESULTS: Well Log (Y/N) YES Wires properly protected (YM) YES Casing height (above ground) 12 in. AT INSPECTION 8/8/2007 31 ft. 6.14 g.p.m. Coliform 0 colonies/100 mi. Nitrate Z c,I mgJL. Other bacteria Qcoionies/100 ml. Arsenic: � ug./L. Date of sample: 8/8/2007 Collected by: GEG Ltd. B. SEPTICIHOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 7/9/1981 Tank sae1250 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation deanout (Y/N) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 8/7/2007 Pumper MODONALD'S PUMPING C. ABSORPTION FIELD DATA Date installed 7/9/1981 Soil rating (g.p.d.Keor( 100 System type DEEP TRENCH Length 43 ft. Width 3 ft. Gravel below pipe 6.0 ft. Total depth t 0.2 ft. Eft. absorption area 516 ft' Monitoring tube YES Depression over field NO Date of adequacy test 8/8/2007 Results (Pass/Fall) PASS Forbedrooms Fluid depth in absorption field before test 8_5 in. Water added760 gal. New depth24 in. Elapsed Time: 165 min. Final fluid depth 8_5 in. Absorption rate >= 600+ g.p.d. Any rejuvenatlon treatment (past 12 mo.) (Y14& type) NONE KNOWN If yes, give date — D. UFT STATION Date installed Size in gallons "Pump on' level at —in. "Pump oft" E. SEPARATION DISTANCES Manhole/Access water alar level at in. Cycles tested Meets alar 8 circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankilift station on lot 100'+ Absorption Heid 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/cleanout N/A Holding tank N/A Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicie storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS 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 Printed Name JEFFREY A. GARNESS Date 64�8 /0:7 COSA Fee % 000 Data of Payment �7 U Receipt Number. y I (Rw. 11!05) Waiver Fee $ Data of Payment Receipt Number 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 Nitrate Advisory Certificate of On -Site Systems Approval # 070350 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Lot 4 of Longview #1 subdivision. This inspection revealed a nitrate concentration of 7.09 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. SGS SCS Ret.N 1073995001 Client Name Garness Engineering Group, Ltd. Project Name/N Lt 4 Longview No 1 Client Sample ID Lt 4 Longview No 1 Matrix Drinking Watcr P\\'SID 0 Sample Rcmwks: All DalcvTimes arc Alaska Standard Time Printed Daterrime 08272007 14:46 Collected Daterrime 08/082007 8:46 Received Daterrime 08/082007 11:50 Technical Director Stephen C. Ede Allnssable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 Waters Department Total Nitratc/Nitritc-N 7.09 0.100 Microbiology Laboratory Total Coliform 0 u8/L EP200.8 (<10) 08/15/07 0824/07 TK m8/L SM204500NO3-F D (<10) 08/13/07 1DS coV100mL SN1209222B A (<I) 08/08/07 SDP FA N 0*02'21 "E 16«92' FA ƒ k G � % . W04'40"E 164.e7' -----5now�§I/�P\e m `� |j �§, |- \/ / ■2| H FA N 0*02'21 "E 16«92' FA ƒ k G � % . W04'40"E 164.e7' -----5now�§I/�P\e m •yCL Municipality of Anchorage Development Services Department Building Safety Division ••��//�/ Onsite Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.sk.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 015-163-57 HAA# D�SZb?59 1. GENERAL INFORMATION Expiration Date: 9 — a O — Q _5� Complete legal description Location (site address or directions) 11250 SNOWLINE DRIVE • ANCHORAGE AK 99507 Individual On-site ❑ Current Property owner(s) DOUG ESPOSITO Day phone 344-4227 Community Class Well Mailing address Lending agency Mailing address Real Estate Agent Mailing address 11250 SNOWUNE DRIVE • ANCHORAGE, AK 99507 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 Day phone Day phone 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site ❑ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (NAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer 'of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water 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 or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers 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 Health AuthorityApproval 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 riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system fs(are) In compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Finn GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineers 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 B Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life ofall wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE _� Approved for 4 bedrooms. Disapproved. Phone 337-6179 Date 5 2z C Conditional approval for bedrooms, with the following stipulations: Note: The well for this property meets existing State and Municipal Codes There are nitrates present. It is suggested that periodic testing be performed to insure the wells continued suitability. Current nitrate concentration is 5.78 mg/l. EPA maximum concentration is 10.0 mg/l. Vlore information on nitrates is available from the On -Site Services Program, at 343-7904. Attachments: ✓ HAA Checklist Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: ��� t Original Certificate Date: �D — ;2, 0" 0 (R.. 17)01) I Municipality of Anchorage • Development Services Department Building Safety Division OnSke Water 6 Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 995196850 www.ci.anchorage.ak.us (907) 3437904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LONGVIEW SUBDIVISION N1: LOT 4. Parcel ID: 015-163-57 A. WELL DATA Well type SATE If A, B, or C provide PWSID# N A Date oompteted 4/24/1981 Sanitary seat (YM) YES Totai depth 240 ft. Cased to 40+ ft. FROM WELL LOG Date of test 4/24/1981 Static water level 83 ft• Well Log MN) YES Wires property protected (YM) YES Casing height (above ground) 12 in. AT INSPECTION 5/19/2005 28 ft. Well production 8 g.p.m. 6.0 9•P•m. WATER SAMPLE RESULTS. Coliform *- colonies/100 ml. Nitrate 18 mg./L. Other bacteria 4—lblonies/100 ml. p 9 Arsenic: 1 ./L. Date of sample: m N A le: 5/19/2005 Collected by: GEG. LtD. _ B. SEPTICIHOLDING TANK DATA Tank Type/Material STEEL Date Installed 7/9/81 Tank size 1250 gal. Number of Compartments 2 Cteanouts (Y/N) YES Foundation desnout (Y/N) YES Depression over tank (YIN) NO High water alarm MN) NLA Date of pumping ' ' 7/28%2004 Pumper ISAACS PUMPING C. ABSORPTION FIELD DATA '8 LOW EXISTING GRAD Date filled 7/9/81 Soil rating (g.p.d.lftbr bdr 100 System type DEEP TRENCH Length 43 ft. Width 3 ft. Gravel below pipe 6 ft. Total depth •10 ft. Eft. absorption area5� 66 ftt Monitoring tube YES Depression over field NO Date of adequacy test 5/19/2005 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption Reid before test 19 in. Water added 743 gal. New depth 34 in. Elapsed Time: 180 min. Final fluid depth 15 in. Absorption rate >- 600+ g,p.d. Any rejuvenation treatment (past 12 mo.) (YIN 8 type) NONE KNOWN If yes, give date D. UFT STATION Date installed 'Pump on" level a1 _in. E. SEPARATION DISTANCES Size in gallons High water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAlft station on lot 100'+ Absorption Heid on lot 100'+ Public sewer main N/A Sewer /septic service fine 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank _ N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 106+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parldnglvehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacent kris 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and 1* 7i review of Municipal records that the above systems are in -''"" .. ' ""' """""" conformance with MOA HAA guidelines in effect on this date. r G mesa: Engineer's Printed Name JEFFREY A. /GGARNESSr CE -7 Date HAA Fee $ 30 Date of Payment Receipt Number (&;05- Alh (Rev. 11/01) Waiver Fee $ Date of Payment Receipt Number 02/13/1999 03:56 937346201' EURCALASKATOUR.S PAGE ... n. . \... •I. Jr. w. .....• .1flY_. YAU ii�YZ 13J 13- j. JOWN .• i � t'7 �'= So r r • ' t• � I .l r ire , of At. BU 'TJ4 gi•I t��e ���OW 'rd ., It is :he responsibility of the caner to determine+ f -i >M" roll 0-4" the ezistance of any easements, covenants, or re - j.4, tsus striC:ions which eo npt appear on thq recorded Sub- ,� 4�'t�.-;°.•;....•-•�� divisicn Flat. Under no cimmstances should any NOT +:�''a "" •' data hereon be used for construction or for estab- NTS oFR(Cpqo,OmEh'TnaxTxOst lishinu boundary 'or fence lines. The surveyor take! eNowN ONmeRCCOROEOItAT, AMC tror iNQNN NZ7490N. . responsibility for the initial transaction MIX. � ••' l[GCND _ ' LOTtz� g <� � ea4e11 e.P ranrwcmttoM on pf PC . .. La -r I I% IT+c•t. Mir LAI' No - 1.O AgOARralptca11.rMs - ... . ANCHORAGE' RECORDING DISTRICT 0 "°` • T0` -- �a � j !� ZZ I i, ire , of At. BU 'TJ4 gi•I t��e ���OW 'rd ., It is :he responsibility of the caner to determine+ f -i >M" roll 0-4" the ezistance of any easements, covenants, or re - j.4, tsus striC:ions which eo npt appear on thq recorded Sub- ,� 4�'t�.-;°.•;....•-•�� divisicn Flat. Under no cimmstances should any NOT +:�''a "" •' data hereon be used for construction or for estab- NTS oFR(Cpqo,OmEh'TnaxTxOst lishinu boundary 'or fence lines. The surveyor take! eNowN ONmeRCCOROEOItAT, AMC tror iNQNN NZ7490N. . responsibility for the initial transaction MIX. � ••' l[GCND _ ' LOTtz� g <� � ea4e11 e.P ranrwcmttoM on pf PC . .. La -r I I% IT+c•t. Mir LAI' No - 1.O AgOARralptca11.rMs - ... . ANCHORAGE' RECORDING DISTRICT 0 "°` • T0` -- 06-13-05 04:24PM FROM -CUE ESI, SGS ENV SERVICES —S&%— SCS ReLN 1052802003 Client Name Gamess Engineering Group. Ltd. Project Name/# Various client Sample ID Longview SID; Lot 4 Matrix Drinking Water PWSID 0 Sample Remarks: EP300.0 - Sample run outside of hold time for nitrate. Results PQL Waters Devartment Nitrate -N 5.78 9075515301 T-048 P.04/10 F-498 All Dates/rimes are Alaska Standard Time Printed Date/time 06/13/2005 13:16 Collected Date/time 05/192005 12:00 ReceivedDate/rime 05/192005 12:22 Technical Direetor Stephen C. Ede Allowable Prep Analysis Units Method Container ID Limits Date Date 0.100 ms/L EPA 300.0 B (-10) 06107105 JIB Microbiology Laboratory Total Coliform 0 coV100mL SM209222B A (<-I) 05/19/05 TLF ' Municipality of Anchorage • Development Services Department g'• ' Z Budding Safety Division .. ... , ' On.Sile water b wastewater Proprsrim 4700 South Brepaw St. P.O. Box 196650 Mdimaye, AK 99519•b650 . ' .. ..: • ' www.eLenetwrage.ak'us' ... .. � . ... . (907) 343.7904 =' 'CERTIFICATE OF HEALTH •AUTHORITY. APPROVAL .. FOR 'A SINGLE FAMILY *DWELLING ParceII.D. . - 015-163-57 .'_ :.. :HAA1l� 1:. GE NERAL'INFORMATION ExplraIII onDate :' Complete legal description " LOT.4 10NGy1EW SUBOMSioN %• LocaUori (site address or directions) PO BOX 220004, ANCHORAGE.-AK 99522 Current Propertyowner(s) CHRISTOPHER A MSTRONG Dayphone "243-3926 Mailing address.... PO BOX 220004' ANCHORAGE, AK 99522' Lending agency' Day phone •• Mailing address ' Real Estate Agent WENDY HOWARD Day phone 257-0109 Mailing address RELIAX PROPERTIES 2600 CORDOVA ANCHORAGE, AK. 99503 Unless otherwise requested, HAA will bo held by=forplckup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Wen ® Individual On-site Individual Water Storage •_ ❑ Individual Holding tank ❑ Community Class Wen ❑ Community On -alto ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are nand 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 less than 30 days old. (Certificates maybe reissued fora period of up to one year with valid water samples.) Certificates are vand for one year for properties served by Class A or B wens or a public water system. The Municipality of Anchorage is not responsible for errors or omisslons In the professional engineer's work 4. tdIs lc, Note: Aaeska Waterand WesfewaterConsulfants, lila shall bepa/d 3ttjat; orprior to dosing for theenglneering serNces provided. STATEMENT OF INSPECTION 6Y ENGINEER •. ' As cartirrsd bymyseal at!ired hereto end es of`the vvrdadon date shown below, l verily tfiet my, ; lmwstlgation, based tin procedurres oiwiried Gi the Heahh'"w1tyAAwbii6l Guldeiines for shows that the on-site watersuppyand/or wastewaferdisposal system is(are) safe, functional and adequate:., ..::.. for the number of bedrooms and type of structure Indicated herein. 1 further wdfy that based r n the" t -- Information .:Information obtalried from the Mui9dparrtyofAnchow9b files and from myGrvesUgadori eriiJlrrspecdon, the :..:; on-site watersuppyarid/orwestewaterdisposal system IS(are)IncomplioncewfthSIT applicableMunldpal. E and State codes, ordinances, and regulations In effect at the time of Installation. Name of Flan • A WATER do WASTEWATER CONSULTANTS, INC. Phone 337-6179 ; Address 6901 DESARR ROAD. SUITE 26 • ANCHORAGE. AK 99504 JEFFREY A CARNESS, P.E. Dale Engineeris Printed Name • . Erigineer's Commend: — At111L, tna attempted to prwtde a mon;ugh In Conducting V" avaArebOn, h a�ordance AD EC and MOA consdandous erglne"V anahs►s Of the eysWm ki coord nc twit h ADECanoe of the DSD GA101nos d Rogutadaos. The reported system under the cmxVons enccunwadat the dine of the test, and sopamUm dlsftnces measured breadily tdontiffable featuros. The opal trnwit tofsmawelfs and • sopde systems depend on the beat segs oondldan trrovr;d"a duduate durlrg the year, and the water usage of dre famRy biting sorwd bytha system. These oweldons art oubtde the conbat of db ava/uafor 0f the system. Sadstactory tort tesuRs do notgusrantse A&" pe/formanee of the mien nor do they guarantee that than; are no hidden defects or wavadunents. AM. M trra can therefore not prvvtdc e�rau0nafry or Aftm isoofMeAtDof t caMOADthe X meoonteconn otwsreeptorrttbror the sato benefit tithe owneristedabow.Rrvr0ance upon Or use Of Ws "Pod by any otherpamon orparyk not avtowired, twpaRconfer any bgal right whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Note: The w present. it is on Attachments: HAA Checklist Septic System Advisory Well Flow Advisory from Services program, at re 'Comess�o� ; �•yp% • E 7953 :: are nitrates Hued suitability. N�'�.' '•.�O • �� w TERAND WASTEWATER _-- Manitenance Agreements Supplemental Engineers Reart � o •' Other J�J !n. • • • •,.: 6Y Original Certificate Date: pr.•. uwI Municipality of Anchorage Development Services Department Bumv on -se, alArater wWety..ts+r.DMW rWRoanm • • • • • ' 4700 South Brapew CL Pb. Box 198650Andwrepe,AK905194M W WWANKII ra0e.ek.w (907) M-7904 HEALTH AUTHORITY APPROVAL CHECKLIST L0al O en; LOT 4 LONOWEW SID *f/ parse! o: 015-163-57 A. WELL DATA Wen type AT K A. G. or C pie PW81DA N/A pgtg complgted 4124/81 8wftq lea! (Y&4 y€ Total depth 240 tL Cased to N0 + IL FROM WELL LOO Date of test 4/24/81 Static water level 83. fL Wen pmduWon 8 "-M WATER t3AMPLE t'tESIJLTs: Codform OoionlesM00rrd. Nttrale 5.3,3nVA. Weft Lop (YIN) YES Wires prpD6M p (YM) YES Casing helpht (above @pond) 12• In. AT INSPECTION 6/26/01 40 1L 5.3 p.p.m. ether becierla 2' eotonlesl100 ml. Date of sample: 6/26/01 Collected by AWWC. INC. EL SEPTiGHOLDINO TANK DATA T4nk7ype11A8terlei STEEL Date irulanad 7/9/81 Tank size 1250 PL Number of Ca M Mtenb 2 Cieanouts (Y" YES FOur4atiort cbargtrt (YM) Y. p Depre"lon Over tank (YIN) NO Wph water alarm (YIN) N/A Date Of pxr4*0 0/26/01 pumper A+ HOME SERVECES C. A83ORPTION FIELD DATA Date In %WW 7/1/81 Sod ratln0 (9• Afie011!E�0)L System We DEEP TRENCH Lamm Q. R, Width 3. t. Gravel below pipe 6r R Total depth a.» fL Eftabaorptbn aroa-*-16—R? Monitc M htbe YES Depres3lon Over deldN9 _ Date Of adegvaW test 6/26/01 Rew tte (Pa3 T00) PASS For 4 bedroom F4dd depth N absorption held before teat Q131 Im Water added 790.90J.. New depth t t in, Elapsed Time: 16 n*%. F4tet SM depth .4•S In. Absorption rate >- 600+ p.p.d. Any ro)uvenatkm treabmM (past 12 M) (YIN & type) NONE KNOWN H yea, give date - D. LIFTSTATION Cale Installed SIN In cations -Pump on' level at—in. E. SEPARATION DISTANCES Hlph orator alarm level at Cycles Meeb alarm 6 drartt rK dmmeres? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic targot station on lot 100'+ Absorption f W on bt 100'+ P011c sewer main N/A Sewer kepoo service ane 25'+ On adJO wd {ors 100'+ On adjacent lots 100'+ PubpCsaw ma0defdeancidt N/A Homm tom N/A SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: StdldbV four%MM 3'+ Property ane S'+ Absorption UM S'+ Water "min N/A Water service Ira 10'+ Surface water 1000+ Wens on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO. Property Itne 10'+ BuUm 10'+ Water matrr N/A Water aervlca line 10'+ Surface water 100'+ DAveM. parldnpNahfde storage 750+ Cwtaln "In NONE KNOWN Wells on adjacent btr 100'+ F. COMMENTS 0. ENGINEER'S CERWICATION I M* that 1 have detemrlaed fMough fold Inspectibm and reylaw of Mun�*al records that the eDova systems era In cordorrnance w1Br MOA HAA gW*kws In affect on fhb data. Enpineere Pr4rted Ft"'r JEFFREY A. GARNER Date HAA Fee i 509 -' Date of Payment 7,160421 RecelptNtatrber la 791 trw•uool • Wahw Fee i Date of Payment Reeelpt Number eta-ec-OE 11:11 FRO Ult ENVIWKATAL SRV - CTA EErtvlrormertatSorvkeaIre. trrri�r�rrrrrrrrrr� CfAE Rett COeet Nage Project Nart N Client suwk1D Matric Ordered By MID Single Remarkr. 1013664001 AX Water dowuteWeter C=Wtanta IDC, Lonrtview SID. Lot 4 Longview SID. Lot 4 Drinking Water 1015815301 T-181 1.02/03 F -SST Qleat PoR PrinteAllnemmc 07/02/2001 14:91 CalNetedI)Slcmmc 06126!200111:40 Rteehd Datefraw 06/162001 14.03 Tec►■ical DI GWry � Edq � Ftekaeed A A�/L1i- Allowebk Tree Am ytia Iaramcm Rtaw% 1QL Unto FACOW lkau Date Data !nit Waters DoWt tent Nitretc-N Microbiology Laboratory TOW Coliform Y 333 0.100 trtg/L EPA 300.0 (<10) 062tilUl SCL 20B.NoC61i coV100raL SM1892220 (<I) 0626101 KAP MUNICIPALITY OF ANCHORAGE • `" DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# 015-163=57 HAA# 1. GENERAL INFORMATION Complete legal description Lot 4; Longview Subdivision Location (site address or directions) 11250 Snowline Drive Anchorage, AK Property owner Roswitha Waldstein_ Day phone 745-4433 Mailing address P.O. Box 220004 Anchorage, AK 99522 Lending agency Day phone Mailing address Agent John Buchanen/Prudential Vista Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4" 3. TYPE OF WATER SUPPLY: K" Individual well Community well Public water 762-5866 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xx Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72.025 (Rev. 1/91) Front MOAl21 5. By: 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 yf this inspection. & WA;a"ATER Name of Firm Address 28 Engineer's signature Alaska Water & Wastewater Consultants, km Shall be PAID $ 9 DU 0 or prior to, closing for the Engineering Services Provided. DHHS SIGNATURE Approved for C%�\ bedrooms. Disapproved. Phone 22 7-6 / 7 Date (0 1 a � Conditional approval for bedrooms, with the following stipulations: Note: The well for this property meets existing State and Municipal Codes. There "__a nirrnteq nraganr Tt i c gyigPQfer1 that pa di f-p2ting 1,A performed to insure the wells continued suitability. Current nitrate concent:r-}tieais5.45 tng�,tfta�Eifftuffteaneentration 0 s/ More information on nitrates is available from the On-site Services Program, DHHS, 343-4744. Additional Comments Date 6 - !q CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rw. 1/91) Back MOA 021 �� Municipality of Anchorage JUN 11! 1999 `� DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division "'UNICIPALITy OF ANCHUNA ENVIRONMM��n�rr ICES DIVISION 825 L Street, Room 502's Anchorage, Alaska 99501 • (907) 343A� Health Authority Approval Checklist Legal Description: � o"f Parcel I.D.: �/ 5 - /� ' '-37 A. WELL DATA Well type lat'I J ate, If A, B, or C, attach ADEC letter. ADEC water system number 6' Log present CYf.�,)ye-5 Date completed q119 4 18 % 7btal depth C-9 L10 Cased to yO 4- Casing height (above ground) l Sanitary seal FROM WELL LOG Date of test / ;:Matic water level g Well production c3 g.p.m. WATER SAMPLE RESULTS: Wires properly protected (i!Y%N) Y Z-.5 AT INSPECTION b /y/9 9 .3 Coliform Nitrate 5 - q 5 rrt q IL_ Other bacteria �J 4 Date of sample: �� I g 9 Collected by: A Vj Q B. SEPTIC/HOLDING TANK DATA Date installed 7, Iq /e/ Tank size 1 2 50 Number of Compartments 9, Cleanouts (� `,)N) Foundation cleanout&N) Depression (Y&� High water alarm (Y/� /v Date of Pumping (&/* 67 Pumper Gd��V2q��i j C. ABSORPTION FIELD DATA Date installed �� `���'/ Soil rating (g.p.d./ftz o ft2/bdrm) /00 System type deed Cjvl) Length _ ! Width Gravel thickness below pipe Total depth ` 7S z Effective absorption area 51& �f Monitoring Tube present (VA)—Y, Depression over field (Y/O) CJ Date of adequacy test %11-14 Results Pas Fail) For L� bedrooms / Fluid depth in absorption field before test (in.); d— Immediately after`73 gal. water added (in.): l • rJ er Fluid depth c-�- (ins) Minutes later: Absorption rate = 600 J- g.p.d. Peroxide treatment (past 12 months) (Y/6) If yes, give date 72-026 (Rev. 3/96)` Y D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm E. SEPARATION DISTANCES on" level at* *Datum gallons "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: 1 r Septic/holding tank on lot ZOO On adjacent lots Absorption field on lot /0 On adjacent lots Public sewer main &V14 Public sewer manhole/cleanout Sewer /septic servic@ line a Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: �J t Foundation .• Property line —Absorption field — Water Water main/service line iO • * Surface water/drainage iOO Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: � 1 � Property line �� Building foundation /� Water main/service line '� Surface water 1[)O ' Driveway, parking/vehicle storage area 7 f 6 Curtain drain n0k7 k1?0&z)%q Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that f in conformar inspections and reyiew of Municipal ?s in effect on this date. Signature k.–XJJA -4 Engineer's Na e ^� G�� ;ss Date ! 2 cc HAA Fee Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ - Date of Payment Receipt Number A the ti h 6 are a �a-ea ;n • oyam• 3e. i �:. ae•OaB 8N H..� r�Wl gA. s �}p.7�at���i�� a� JUN -10-99 16:03 FROIJ.-CTE ENVIRONMENTAL JlekCT&9 Onvironmontal Services Inc. � .s.. CT&E TWX 992481001 Client Name AK Water & Wastewaicr Consuhanrs Inc. Project Name/# Longview SIT) Lot 4 Client Sample ID Longview S/P Lm 4 Matrix lhinicing Water tlyderell By PWSU) 0 Parnwrer 6615301 T-608 P.02/03 F-644 Client PW Printed Vale/Time 06110199 12:20 Collected Daft/Tient! 06/04/99 14:10 Received ]DWITime 06107/99 08:14 Tecltuiml 01rectur: Stephen C. fife Released By a A n r I'A _ _ i1 RacuLte POI- uniu Metnaa Allouaple Prep Analysis Limits Date Date snit Total Coliform 0 col/i00mL SM18 92220 D6/05/99 SKw Nitrate -N 5.45 D.SDD MOIL EPA 300.0 10 max 06/04/99 06/04/99 SCI- 3. TTPE VF WATER SUP L7: Individual well Community well r z _ if communitywastewater system; provide written confirmation from State AD attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 1121 ...The.Muni.cipality-6f Approval .-a I Certificate professional efigineE i paragraph,5 above b y an v. . I'thls"acobriesyt6purcha- and theirlending institutions in order to satisfy certain federal and state reci6irements.,Employees-of conductinspections or analyze data'before'a certificate' ls-"isisdecl.'7he Municipality -of An& responsible for errors or omissions in the professional engineer's work. 72-025(Fiev.1/91) Back MOA821 Legal Description A. Well Data Municipality of Anchorage Department of Health and Human Services ��� 9�s °A` HEALTH AUTHORITY APPROVAL CHECKLIST ;'C" Q<' toT L11 1-01\/(;'V/Eta/ SID parcell.D. Well type �/ If A, B, or C, attach ADEC letter, [ADEC water system number 1V1,4Log present (Y/N) 1 Date completed 7 2y- Driller )(FAMPME DRI[tI�J b W)CS. Total depth 2 Ll O��. Cased to 00 rC C or of Casing height \// Ll lei CA es �/ Sanitary seal (Y/N) 1 Wires properly protected (Y/N) 1 FROM WELL LOG Date of test Static water level Well flow m - g.p.m. Pump levell V/17kh w SEPARATION DISTANCES FROM WELL TO: AT INSPECTION 5 /slay 1995 26.5 T�. bL./oma 6.0 g.p.m. U/liCmo�n �7 66-,P. below 3r -o," d ! e'vc l Septic/holding tank on lot / / 7 FT . ; On adjacent lots i 1 0 0 �'l Absorption field on lot % 50 On adjacent lots 0 0 Public sewer main `)U l a& II ca h 1 t'_ Public sewer manhole/cleanout 1104 61 4ra � 1� Sewer service line 0¢ ��r�lrcab!e Petroleum tank 406t Oke�C-ed7i l00 WATER SAMPLE RESULTS: 2 / Coliform O CD)on [� e S 100M � Nitrate 7. 7 '-('3/ L Other bacteria Date of sample: me, �:j 9 9 5 Collected by: > C jnlo /J Sch '�-Oe_- de r B. SEPTIC/HOLDING TANK DATA Date installed I -` 16 Tank size / Z .5(? a\f/ Compartments �& / Cleanouts (Y/N) Foundation cleanout (Y/N) T Depression (Y/N) /y High water alarm (Y/N) M /V Alarm tested (Y/Nf) l,Jv4 Vil Date of pumping y a 19 q5- Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot -7 On adjacent lots /77 /0/r0 Ic / . Foundation / 7 0 To property line Absorption field rr !� �7 _ Water main/service line Surface water/drainage foo 7 72-026(3/93)'Front - CONTINUED ONBACKPAGE C. LIFT STATION Date installed NO� Aff//CgPC_ Manufacturer Size in gallons Manhole/Access (Y/N) Vent(Y/N) High water alarm level "Pump on" level at "Pump off" Level at Cycles tested Meets MOA electrical codes (Y/N) / SEPARATION DISTANCE FROM LIFT STATION TO: / v U n, c G c Well on lot On adjacent lots / Surface water D. ABSORPTION FIELD DATA Date installed 1 ( c1 6 r / Soil rating (GPD/Ftz) /�50 / System type _ / , L° n c q2 Length TI -Width �€7 //I CS Gravelthickness x/601 S Total depth /20 ;ocheS Total absorption area -Cleanout present (Y/N) r Depression over field (Y/N) Date of adequacy test /!I �esults (pass/fail) 4 S S for 4Z Bedrooms Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) z ✓v /0 Ch e S After test SEPARATION DISTANCE FROM ABSORPTION FIELD TO: 7_ 8 'inches If yes, give date n� M Well on lot 1330 ,^ /On adjacent lots 7 7 •�" � U 0 'r Property line 7 � / 0 t To building foundation -5 /7 tt? 4• To existing or abandoned system on lot /\/114 On adjacent lots >� /(90 7 7 Cutbank 7 50 fT . Water main/service line /VP Surface water X. - / 0 U 'f • Driveway, parking/vehicle storage area >% %5 -ir Curtain drain awe V �Scffr/ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Enginaf's Name Date c) Cj HAA Fee $ 300 Date of Payment Receipt Number �� rl 76 >' o `°, John Earl Simpson eo° Waiver Fee $ Date of Payment Receipt Number I I`-, I I`+ 1_P 1 1-1'-1 : i_ 1_11 11'IL-l-,_ I FiL I L'.-. 111 11_, -['S1 , - , .-__11 - CME Environmental Services Inc. zltw— Laboratory Division►�ir�►�i�si.�ri�i��riii��./i�sw.�r.►r�iii►,�siiiri,�i�i�./� E. REf.ti ,36-I Laboratory Analysis Report M:.tr 1x 'WATrR ('irer.t S:i atple i6 1t;t40 t vowLIME DRIVE i -:tea. t:amc F..M1'J[RONAtEN'I'A[. MGM'I' INC (Fa4Ii vair red BY sjmfiN:;C'Hfi�ECRR Vroecc. ?lame hroje. CN PnsI l: UA - :�1 tpl- RsrnaLl:e. 3AN FL L: C1 LLEI, nC L3Y. -. WORM. Order 14453 ptil:et-rd Dae 05/09/95 :v 04:49 1.�7 05/OS/5 12:41) hr,-:. of lFC'F 9d J.iC `- - F.eCe.tverl Date OS!JS/95 rc 13:70 hra. Techrnlca:. Di rector STEPHEN EDE Al lowahile Ext. Aral Qc l:e Cate Re eu 1'.. r: Qual !!nit .,u QS/^X.' 95 t'd e s_____»,.___==__ -- ___________ S ri,3 2p.3 c•aa1 Inatruacuona Atx,ve NA - NJt Alalyzc(5 •• eH E'at.pit Remarks A,ove !, - Lege Ttt:aa fi -_ Ir.<intected, Eeportetl vale` 1a the pt'9Cu cal G':f.Ll'.)i O -I _ r�roac=r Th -J!, Ij gecnnda r}' cia Ur. So:i. 7) 562L3�3 Fax (907) 561=53 01 200 W Potter Drive, Anchorage, AK 99518-1605 -- Tel: (90_ _ _... -- ------- -----_---._......� ..,��r.nnl nnISSOl1R1. NEW JERSEY. OHIO. VEST VIRGINIA p.\ • `� � M�NICIPq(! r N of DFP ANcly MUNICIPALITY ORAGE OF & H SERVICES NHORA f NV I R�NMENrgt OF f RrH �N , DEPARTMENT OF DIVISION OF ENVIRONMENTAL SERVICES ! q CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL 5 19g1r OF ON-SITE SEWER AND,WATER FACILITY RCEI VE 264-4744 ` D(( '' Application Date W na-L a 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) .l eb,n V i Cln) 57,1� f Kofi Location (address or directions) ll�.so S[�r�l hY „ HCl ,,fl/8,945/(0 (b) Property Owner)+&j10 Dd Don TDbTblepho4i,.Home -�q�'/3JD Business 2761—ecEll Mailing Address [ i v5J v 7 4�•1/ i r J hoZ �d� (c) Lending Institution C> MAC_ .' Telephone Mailing Address "IDI r CYnv' Sz fo7, �Y�• .L��L. G%%Sa� (d) Real Estate Company and Agent Y ?` Address Telephone (e) Mail the HAA to the following address: or: Check here if hold for pick up. List contact person and day phone number below. TD _ , s3_0 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms 3. WATER SUPPLY - Individual Well 6 Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsiteg- Public ❑ 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. Page 1 of 2 ` 72-026 (Rev 8186) Front 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 shows that the on-site watersupply 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 d}isposalsystem'is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this`inspection. Name of Firm RA',L'rM f i _11SOQfl*e5 Telephone 84(0'//'70 Address 18461 ij2ArApot-/ D/2 DateOF 44 2-5-87 or C -i a• Vr + � T j Engineer's Seal 'f� Y.9. .. i)t.ON rtA,,, •ebV V'f •il R••�•.) to jta bif F. Q• �} Tony D. DO, IOC % •s C.r7 5130 'ORD F 6. DHHS APPROVAL Approved for bedrooms by Date Approved X Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (Rev- 81861 Back MUNICIPALITY OF ANCHOR&NICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION CHECKLIST - FEBRUARY 1984 264-4720 FEB 51987 Legal Descri tion: RECEIVED Y"�,u/ �tac� i A. WELL DATA Well Classification PAIumle_ If A, B, C, D.E.C. Approved (Y/N) Well Log Present & Date Completed 4-a4-81 Yield oa Total Depth ZqO / Cased to Depth of Grouting Static Water Level '�L8 Pump Set At L)A1900W n� r/ Casing Height Above Ground l Sanitary Seal on Casing ON) Electrical Wiring in Conduit (Y/N) v� Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot /b3� ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot /2�� ; On Adjoining Lots /r�f To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Z Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date a - Al- g,7 Date Installed 1)-9-81 Size /2 No. of Compartments 40JO Standpipes (Y/N) �� Air -tight Caps (Y/N) y Foundation CI aaan / L/ Depression over Tank (Y/N) ?K__ `" Date Last Pumpe Pumping/Maintenance Contract on File (Y/N) ;forXV Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: i To Water -Supply Well /(�$/ To Building Foundation To Property Line /0 To Disposal Field To Water Main/Service Line Course II '— Comments Kc�� Page 1 of 2 To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /60 5F Type of System Design Date Installed %–g"8 / Length of Field Width of Field -440 Depth of Field / Gravel Bed Thickness Square Feet of Absorption Area 1/6 4F Standpipes Present (Y/N) Y Depression over Field (Y/N) -),e A/ Date of Last Adequacy Test 12 ---az – 615 - Results of Last Adequacy Test AS PeoeFOOWED BY AECS Separation Distance from Absorption Field: To Water -Supply Well /z2 To Property Line To Building Foundation ?A To Existing or Abandoned System on Lot To Water Main/Service Line C D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments On Adjoining Lots —" To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Dimensions Manhole/Access (Y/N) 'Pump Off' Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have the <ed, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date 4-4-8'7 Company s44SdCJ476 MOA No. 81 - Receipt No.tt Date of Payment 7 �`e� % �o0g Amount: $ ���� �G–�° rr'Y `e°y Engineer's Seal JW Page 2 of 2 `�d'�`c a i�n;87 ;' `.�✓ 72-026 X11/84) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL_ OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date _ /�7_-�Y t; _GENERAL INFORMATION I = fa; ty_gaF Description (include lot, block, subdivision, section, township, range) eest:r r raddress or directions) > (b) / b 6 Business Name ._Telehone: Home SzL-/U�0 t ,;r�rr;'.P':drrs �/y_'� �-oJ�e..f✓� ��je. ���,��� !fix' ,�s�� it faeck one): Lending Institution ❑ ; Owner/builder,; Buyer ❑ ; Other ❑ (explain); i !*�j =�• r_'rs:rj ;"r;�t;tu+itis rb_i Gr rnpany and Agent Ibj /,ail H,:. , tJ lhr: following address: 2. TYPE OF RESIDENCE ,r3., r r y Multi-Farnil ❑ Other Telephone MATER SUPPLY /Yy.Y (( . 1'iommunlly ❑ Public ❑ ,rrrr:,P;' i;r N:;ystern; must have written confirmation from the State Department of Environmental Conservation a? >:"r ' , lr.e ' ;al `y and r,tatus. a. 5EVIAGE DISPOSAL fir,>i e t, ❑ Community ❑ Holding Tank ❑ G M1r�tr:. If ,r rr. rr:,r / vr-;ii /:tern, mu, t have written confirmation from the State Department of Environmental Conservation f';: t? nf� '*i thy: ie., ; li'y and StatUS, Pad:. of 2 72-025(11,84) I i 9 f� IS MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL_ OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date _ /�7_-�Y t; _GENERAL INFORMATION I = fa; ty_gaF Description (include lot, block, subdivision, section, township, range) eest:r r raddress or directions) > (b) / b 6 Business Name ._Telehone: Home SzL-/U�0 t ,;r�rr;'.P':drrs �/y_'� �-oJ�e..f✓� ��je. ���,��� !fix' ,�s�� it faeck one): Lending Institution ❑ ; Owner/builder,; Buyer ❑ ; Other ❑ (explain); i !*�j =�• r_'rs:rj ;"r;�t;tu+itis rb_i Gr rnpany and Agent Ibj /,ail H,:. , tJ lhr: following address: 2. TYPE OF RESIDENCE ,r3., r r y Multi-Farnil ❑ Other Telephone MATER SUPPLY /Yy.Y (( . 1'iommunlly ❑ Public ❑ ,rrrr:,P;' i;r N:;ystern; must have written confirmation from the State Department of Environmental Conservation a? >:"r ' , lr.e ' ;al `y and r,tatus. a. 5EVIAGE DISPOSAL fir,>i e t, ❑ Community ❑ Holding Tank ❑ G M1r�tr:. If ,r rr. rr:,r / vr-;ii /:tern, mu, t have written confirmation from the State Department of Environmental Conservation f';: t? nf� '*i thy: ie., ; li'y and StatUS, Pad:. of 2 72-025(11,84) Gy 0 �0 LaJnvicsd � / b. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FIDE SEARCH, DATA AND INFORMATION As certified by myseat affixed hereto and as of the validatiorrdate shown below, I verify that my investigation of ; lea Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and ade eu,ffr quote for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm A/- 61 ;11'fr1#d7i& TiIoL �¢, . iA1� Telephone 611-36slo Address _--��— Date Y .4a%%1 OF e z \: op e°i�S1�F��°aea.,: rssa.ea> c a � ;Xq Engineer's Seal � � o f.ero C. F:�EJ, Jr az t•I c 6. DHEP APPROVAL +' Approved for bedrooms by_j� ate _ , / Approved __i _ _ Disapproved#- Conditiond- ti Terms of Conditional Approval The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 � P,, Legal Description: L� / ����� "/( ����� A. WELL DATA Well Classification )M � If A, B, C, D.E.C. Approved (Y/N) "/y9 Well Log Present ((YjN) Date Completed r`yT Yield -5J Total Depth VO Cased to . Depth of Grouting W114 i Static Water Level -X- Z'7y, Pump Set At up,/ A)e4& i Casing Height Above Ground �° Sanitary Seal on Casing (Y N) Electrical Wiring in ConduitiON) Depression Around Wellhead (Y N) Separation Distances from lllWell: To Septic/Holding Tank on Lot /03 ; On Adjoining Lots r � To Nearest Edge of Absorption Field on//Lot ��L ; On Adjoining Lots /6re) � To Nearest Public Sewer Line N To Nearest Public Sewer Al Cleanout/Manhole n /4 To Nearest Sewer Service Line on Lot N/� Water Sample Collected by ft��s �'; Date 7"7-3 Water Sample Test Results Comments -)� IVELL rt B. SEPTIC/HOLDING TANK DATA Date Installed �' V Size 1250 66L No. of Compartments 2�_ Standpipes (Y N) Air -tight Cap(Yi ) Foundation Cleanou (Y N) Depression over Tank (Y N) / Date Last Pumped /713tiSss' Pumping/Maintenance Contract on File (Y/N) N/� ; for Holding Tank High -Water Alarm (Y/N) %} Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well /off To Building Foundation /� To Property Line To Water Main/Service Line Course Comments Page 1 of 2 AIIA To Disposal Field /U To Stream, Pond, Lake, or Major Drainage Z f /) �O "A.1t; V'JL-70 *r f C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /6t ���e�% Type of System Design Date Installed Length of Field Width of Field _j Depth of Field Gravel Bed Thickness Square Feet of Absorption Area 5 ��' Standpipes Presen(Y N) Depression over Field (Y& �J Date of Last Adequacy Test 7'Z-3`�Y Results of Last Adequacy TestFQU�'l� Separation Distance from Absorption Field: To Water -Supply Well To Property Line �n i To Building Foundation / �� To Existing or Abandoned System on Lot On Adjoining Lots fi To Water Main/Service Line Awl To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course NyYI To Driveway, Parking Area, or Vehicle Storage Area 5Je Comments D. LIFT STATION Date Dimensions Size in Gallons` nn� h in �� ,vinn "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments "Pump Off" Level at Vent (Y/N) umping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have hecked, ver' ied, or conformed to all MOA and HAAguidelines in effect on the date of this inspection. Signed ��� Date Company _�€�' i MOA No. tYS� DZT Receipt No. Of A�4`i3t �+� e••!o!!!Ao S% Date of Payment '•••!•' Go o°�••���(�,ineer'sSeal Amount: $ �.•a ryLC�' 00 of Lero •Reid, Jr. o CU Q Page 2 of 2 ®® �••0 2251•Eae, " r 000 J !, l� �PROFES00\0089�o� 72-026(11/84) `��® 50432 ALASKA RUIROW11TAL COnTROL engineerinq & enuironmental Studies DAVID BOLZ 11250 SNOWLINE DRIVE ANCHORAGE ALASKA 99516 SORUICOS, Inc. AUGUST 1 1985 SELLER—SAME DAVID BOLZ 11250 SNOWLINE DRIVE ANCHORAGE ALASKA 99516 LEGAL:LONGVIEW #1 BLOCK 0 LOT 4 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE—JULY 23 1985 THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 516 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 927 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 4 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR THIS 4 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON JULY 31 1985 FLOW TEST ON WELL WELL FLOW DATE—JULY 23 1985 THE WELL FLOW RATE WAS 5.1 GPM FOR 4 HOURS. THE WELL IS ADEQUATE FOR THIS 4 BEDROOM HOME. innn lll_. oo..,l R.A,Ai ,e Al.An ooFfl4o1007l 5R1-5114(1 ALASKA ENVIRON�^ENTAL SHEET NO. / CONTROL SERVIC INC. A/ 1200 West 33rd Avenue, Suite B CALCULATED BV ' ANCHORAGE, ALASKA 99503 CHECKED BY (907) 561.5040 aces F OF DATE PAORC? : is G'0!9n. Vic O;< . me ' , i Time .(e Date Date Date ) Inspector Inspector Inspector Comments Conditional Approval �cp---�� Date Sewer Installed ; n Permit No. Septic Tank Size g� Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner 3 -tV C Phone Mailing Address > X,4 8 G X 7 / S /� N cfio P,d G c 7,? -r6 7 -� Buyer V 7 0 _, U 7 Address 25,50 t PC- ^1A ( J 7-. C/O 2 Lending Institution A- Phone Address L-/G//1S 27G 1/.' /(NDN. /1 ✓. g9J v Z- 2 77- 7637 Realty Co. & Agent C /t 0A -rH Phone Address / j f`C S7-, S v / f e- Legal Description O -r cf O /C cv Street Location S 7'4 A Type,gf Residence �iSS Single Family ❑ Multiple Family No. of Bedrooms ❑ Other Wate�Supply ' Individual ATTACH WELL LOG. A well log is required for all wells drilled since June ❑ Community 1975. For wells drilled prior to that date, give well depth (attach log if ❑ Public Utility available. Sewa Disposal /1 Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.