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MCKINLEY HEIGHTS #1 BLK 5 LT 2
McKinley Heights #1 Block 5 Lot 2 #051-213-11 \ / ` MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 -� ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAA R ��_ 5`%4G2� EW ❑UPGRADE MAILINGADDfl `O' u -.6 LEGAL DESCRIPTIO6671414 LOCATION N 0.4BEDROOMS D Y DISTANCE TO: Welt/ D If Absorpuon Igea / Owelhn� / PE(�M�l n 2 Wf Manufacturer Materi No. of compartments 4q. cay i ailons � IF HOMEMADE: Inside length Width Liquid depth' OJ t7 Z DISTANCE TO: Well Dwelling PERMIT NO. Z S_a l - Manufacturer Material Liquid capacity in gallons O w= u Z H Z W C DISTANCE TO: Well �ry ( �5/ �_— Foundation /� / TotiN e9pt of Imes aL A Nearest lot li /-f Trenc �Ni Sp inches PERMIT Q �' Distance b t nes Na. of line Lengs7 ofycl� line O'6 c� � t- O Top of tile to finish grade Material beneath Me ( inehrt• Total echq�absorption area C/ W I7 Length Width Depth PERMIT NO. n a W Type of crib Crib diameter Crib depth Total effective absorption area u' DISTANCE TO: Well Building foundation Nearest lot line J J Class Depth Driller Distance to lot line PERMIT NO. W 3 DISTANCE TO: Buildingfoundation Sewer line Septic tank Absorption area (s) p OTHER PIPE MATERIALS SOIL TEST RATING INSTALL&R CFICy+/C/) REMARKS AP 5�VVED DATE LEGAL 3 fly 72-013 (Rev. 3/78) U • O & E ENC:NEERING & DEVELG MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 ,,�1 n / SOIL LOG 688-2280 Performed for. Name: orf L�Z'N Tel.No6Be -c7z6Z Mailing Legal Description: L may- Z� �S -57 4fe Kr R Depth (feet) Soil Characteristics 0 „ 2 3 �4 5 6 'f 7- 8 8 10 .11 12 _ v 13 14 15 16 PLOT PLAN PERC.TEST :E OF A( %%j .%'I Ground Water Encountered: Yes No If yes, what depth h e, 9 0 F'* Proposed Installation: Seepage Pit_ Drain Field ;�,�4T►+ . �, No. 4=6-E 4 Performed by: �Qc fa cc t/(,$yTr- %l Date:.Jt� d qo 1' - ---.\ . Municipality of Anchorage On -Site Water & Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-213-11 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Real Estate Agent Expiration Date: � T MCKINLEY HEIGHTS #1� BLOCK 5 LOT 2 18358 AMONSON ROAD *CHUGIAK, AK 99567 WILLARD GREEN Day phone C/O AGENT 18358 AMONSON ROAD *CHUGIAK AK 99567 SALLY CARMAN—GOODRICH Day phone 2. TYPE OF DWELLING: N Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: 227-0506 TYPE OF WASTEWATER DISPOSAL: Individual Well E Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ Received by: le� Date: �3 COSA to be releasee to the engineer, unless otherwise requested by the engineer. COSA Fee $ 00 Date of Payment !1%113 Receipt Number//1� Qq?i U6 COSA# lose/e/5-76 Waiver Fee $ Date of Payment Receipt Number 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. 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 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. 6. DSD SIGNATURE System #1 Approved for bedrooms. System #2 Approved for Disapproved. Conditional approval for 0 bedrooms. Phone 337-6179 Date 3 0060 4 �4T .... ... ... ;�0 Ia-Cy G .�3.i.1r3 ;�Aa bedrooms, with the following stipulations: � N tOF AV6 ir J ON-SITE WATER AND �o WASTEWATER PROGRAM Original Certificate Date: The Municipality drr2Tgefiorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations 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. ATTCHMENTS COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other raa" ivns 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: MCKINLEY HEIGHTS #1; BLOCK 5, LOT 2 Parcel ID: 051-213-11 A. WELL DATA *WELL WAS DEEPENED & LOGGED ON THIS DATE **ASSUMED BASED UPON SURROUNDING WELL LOGS (ON FILE W/ MOA) Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed *5/12/08 Sanitary seal (Y/N) YES Total depth 320 ft. Cased to **40+ ft. FROM WELL LOG Date of test 5/12/08 Static water level 91 ft. Well production 0.33 g.p.m. uTT/1rtr .�IM1» Tx.Yq1111C. Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION ***10/24/2013 ***35 ***0.51 ***PERFORMED BY SULLIVAN WATER WELLS Coliform 0 colonies/100 ml. Nitrate 3.81 mg./L. Collected by: GEG. Ltd. Arsenic: NO ug./L. Date of sample: 10/17/13 B. SEPTIC/HOLDING TANK DATA *INSIDE CRAWLSPACE Tank Type/Material SEPTIC/STEEL Date installed 8/3/82 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Foundation cleanout (Y/N) *YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 10/12/2013 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE TO BOTTOM OF MT Date installed 8/3/82 Soil rating (g.p.d./ft or �bdrm 100 System type TRENCH Length 23 ft. Width 3 ft. Gravel below pipe 7 ft. Total depth *8.25 ft. Eff. absorption area 322 ft2 Monitoring tube***YES Depression over field NO Date of adequacy test **10/15/13 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 500 gal. New depth 11 in. Elapsed Time: 400 min. Final fluid depth 0 in. Absorption rate >= 450+ g,p.d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date **PRE—SOAKED WITH 2000 GALLONS ON SAME DAY AS TEST (10/15/13) ***PUT IN 2500 GALLONS OF WATER AND LIQUID LEVEL IN MT NEVER ROSE MORE THAN 11". D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/NJ "Pump on" level at in. "Pump off" level High water alarm level Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 5D'+ 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 1 DO'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation-* 10'+ Water main N/A Water service line 10'+ Surface water 10D'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *PER ORIGINAL INSPECTION REPORT. S l J- t5 0 11 (�P�i*SF1t�J` IS q'-7 Rt`ts-t F)6� of DF�K. F.,.',(FL" OF- PIEJZ- 13c�cI�S. G. ENGINEER'S CERTIFICATION I certify that t 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 (Rev. 11105) 14" Ff2-6m ED&C- of 06a. 15 7-4" I A64t I( Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # 131570 During a recent COSA on-site inspection and test of the potable water supply well on Block 5, Lot 2 of McKinley Heights subdivision, the well's productivity was determined to be 0.51 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. ,wo BILL .& COLEDOC CO dba lloULLIVANWA9567 o TE WELL OrP RO, Box 670269, g TO: Sally Carman -Goodrich relo(@iackwhite.com TERMS: PHONE 227-0506 DATE OF ORDER 10/22/13 ORDER TAKEN BY CUSTOMER ORDER NO. ❑ DAY WORK ❑ CONTRACT ❑ EXTRA JOB NAME/NUMBER JOB LOCATION 18358 Amonson JOB PHONE STARTING DATE 10/24/13 QTY. DESCRIPTION OF WORK PRICE AMOUNT Pump Test at 18358 Amonson Time: Meter Reading: 10:25 am 61939 11:00 am 62333 11:32 am 62353 12:04 pm 62353 12:37 pm 62389 1:08 pm 62405 1:40 pm 62411 2:12 pm 62411 2:45 pm 62452 3:17 pm 62452 3:50 pm 62482 149 Gallons in 290 minutes (4 hours 50 min) Average GPM .5138 (30.828 GPH) Resting Static 35' DATE COMPLETED: WORK ORDERED BY: 1011CH1e\rU0 I MtNtBY ALKNOWLEDGE THE SATISFACTORY COMPLETION OF THE ABOVE DESCRIBED WORK. CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-213-11 COSA#�C :111 1 1. GENERAL INFORMATION Expiration Date: —- j Complete legal description fiviluniclpality of anchorage Development 13ervices Department Building Safety Division On -Site Water & Wastewater Program S/D ##1; BLOCK 4700 Elmore Road Location (site address) P.O. Box 196650 * CHUGIAK, AK Anchorage, AK 99519-6650 Community Class Well www.muni.org/onsite Community On-site (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-213-11 COSA#�C :111 1 1. GENERAL INFORMATION Expiration Date: —- j Complete legal description MCKINLEY HEIGHTS S/D ##1; BLOCK 5, LOT 2 Location (site address) 18358 AMONSON ROAD * CHUGIAK, AK * 99567 Current Property owner(s) WILLARD GREEN Day phone Mailing address 2060 HUNTINGTON AVENUE * ALEXANDRIA, VA * 22303 Lending agency Day phone Mailing address Real Estate Agent SALLY CARMEN W/ CENTURY 21 Day phone 227-0506 Mailing. address 400 W. TUDOR ROAD, STE A-440 * ANCHORAGE, AK * 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site N 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 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, dale sr^lown belo}ir, 1 verily alae my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, ` on-site water supply a:rGJOr `.ti'aSteb"Jester disposal system tS dare) safes frrnCfiCna! and anoqttatC shows that tPre On-$ to for the number of bedrooms and type of structure indicated herein. I further verify that based on the inlfGrmatiVrl Obtained livlil the r"vii.iniClpa^iityOfAirGhOrage f'ieS and f'"vrir r"ny'rn'JP,Stig?.t1.^.r' and Inspection, the on-site water supply and/or waste}a,,ater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect of the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd, Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Enaineer's Printed Name JEFFREY A. GARNESS, P.E. 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 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 _Az� Approved for bedrooms. Disapproved. Phone 337-6179 Date g// f 0 F �Op kff'r'k A�arnessi, . Conditional approval for bedrooms, with the following stipulations 95 �� o� o ofession o }IOFr� ON-SITE Gi WATER AND � �= WASTEWATER o., PROGRAM ; JJJM M rr {.tache r COSH Check! ist Flrcan's•c ,Cid«icrrrj/ Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report "itr2te Advisoi:y Other By: / Original e v Certificate Date: F_ (Rev. 11/05) Municipality of Anchorage • Development Services Department Building Safety Division S A% E T Y On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: MCKINLEY HEIGHTS S/D #1; BLOCK 5, LOT 2 Parcel ID: 051-213-11 A. WELL DATA**WELL WAS DEEPENED AND LOGGED AT THIS TIME. ASSUMED BASED UPON SURROUNDING WELL LOGS. Well type PRIVATE If A, B, or C provide PWSID# N A Well Log (Y/N) YES Date completed *5/12/2008 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 320 ft. Cased to **40+ ft. Casing height (above ground) 24+ in. FROM WELL LOG Date of test 5/12/2008 Static water level 91 ft. Well production 0.33 g,p,m, WATER SAMPLE RESULTS: AT INSPECTION 6/17/2011 36 ft, 0.70 g.p.m. Coliform colonies/100 ml. Nitrate tOng./L. Collected by: GEG, Ltd. " Arsenic: ug./L. Date of sample: 6/17/2011 B. SEPTIC/HOLDING TANK DATA *UNDER DECK Tank Type/Material SEPTIC/STEEL Date installed 8/3/1982 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) *YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 10/2/2010 Pumper SANITARY PUMPERS Date installed 8/3/1982 Soil rating (g.p.d./Wor Z/bdr 100 System type TRENCH Length 23 ft. Width 3 ft. Gravel below pipe 7 ft. Total depth *11.3 ft. Eff. absorption area 322 ftZ Monitoring tube YES Depression over field NO Date of adequacy test 6/17/2011 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test **<52 in. Water added **526 gal. - New depth **59 in. Elapsed Time: 120 min. Final fluid depth **<52 in. Absorption rate >= 450+ g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — **SEE ATTACHED LETTER REGARDING TOTAL DEPTH AND ADEQUACY TEST. D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off' E. SEPARATION DISTANCES Manhole/Access igh water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Sewer /septic service line 25'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ 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/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *PER ORIGINAL INSPECTION REPORT. G. ENGINEER'S CERTIFICATION I certify that / 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�I23 // COSA Fee $ —1l.o rr �[ Date of Payment (P - 1 I Receipt Number 0`d5 t Jo (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department s °x Building Safety Division s F Y On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # 111213 During a recent COSA on-site inspection and test of the potable water supply well on Block 5, Lot 2 of Mckinley Heights 91 subdivision, the well's productivity was determined to be 0.70 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. SGS Ref.# 1112598001 Client Name Garness Engineering Group, Lt Received Date/Time Project Name/4 Mckinley Ht 16 B5 L2 Stephen C. Ede Client Sample ID Mckinley Ht 16 B5 L2 Matrix Drinking Wa7er Total Coliform Negative 1 Sample Remarks: Printed Date/Time 06/23/2011 16:10 Collected Date/Time 06/17/2011 10:20 Received Date/Time 06/17/2011 16:20 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date lnit Metals by ICP/MS EP200.8 Arsenic ND 5.00 Waters Department NRB Total Nitrate/Nitrite-N 2.02 0.100 Microbiology Laboratory (<10) E. Coli Negative 1 Total Coliform Negative 1 ug/L EP200.8 C (<10) 06/20/11 06/21/11 NRB mg/L SM20 4500NO3-F B (<10) 06/17/11 AYC I OOmL SM20 9223B A 100mL SM20 9223B A 06/17/11 DLC 06/17/11 DLC GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS June 20, 2011 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Ref: McKinley Heights S/D #1: Block 5, Lot 2; Total Depth and Adequacy Test; Mr. Poet, The existing house is served by a private well and a private septic system. Per the MOA records, the trench has an effective depth of 7 feet. During our inspection (6/17/2011) the monitoring tube was found to only extend 42 inches below the invert of the sump. A heavy sludge layer was encountered 32 inches below the invert (52 inches above bottom of trench, calculated). A liquid level could not be defined below the sludge layer. We began our adequacy test. After adding 240 gallons, the liquid level rose above the sludge layer to 31" below the invert (53" above B.O.T., calculated). We added 286 more gallons, which caused the liquid level to rise 6 more inches (59" above B.O.T., calculated). The liquid level was monitored 120 minutes later and found to have dropped below the sludge layer again (<52" above B.O.T., calculated). According to this data, the trench absorbed 286 gallons in 120 minutes or less. This corresponds to an absorption rate of at least 450 gallons per day. It should be therefore noted that the total depth and liquid levels listed on the C.O.S.A. data sheet are calculated. If you have any stions, please contact us at 337-6179. /' fin° cerlY, b` A,'O'am8ss, P.E., M.S. 3701 E. Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com Municipality of Anchorage • '� Development Services Department l Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 / Anchorage, AK 99519-6650 www.muni.orglonsit/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. COSA# 1. GENERAL INFORMATION Expiration Date: — O cy Complete legal description MCKNINLEY HEIGHTS #1: BLOCK 5. LOT 2 Individual On-site Location (site address) 18358 AMONSON ROAD *EAGLE RIVER, AK Current Property owner(s) JASON do JOEY HAMLIN Day phone 688-9209 Mailing address Lending agency Mailing address Real Estate Agent Mailing address 18358 AMONSON ROAD *EAGLE RIVER, AK Day phone _DONNA ALDERMAN W/ PRUDENTIAL Day phone 689-6464 16635 CENTERFIELD DRIVE *EAGLE RIVER. AK Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 0 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 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-relssued Wth-newwatersamples-'jCertiflcates-maybe reissued fors 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, l 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 riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Engineer's Comments: In conducting this evaluation, GEG, VD. 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 ofthe system under the conditions encountered at the h'me of the test, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the 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 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the filowing Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Nitrate Advisory Other By: (Rev. 11105) �tttQytllU I l l rrr,,, �tY OF,gN�;�,; Gam. OWSITE WATERAND WASTEWATER PROGRAM c L/ Original Certificate Date: '� =1 Municipality of Anchorage Development Services Department - � � Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: MCKINLEY HEIGHTS #I; BLOCK 5, LOT 2 Parcel to: 0 5 -if - ;2-) .3- J J A. WELL DATA *WELL WAS DEEPENED AND LOGGED ® THIS TIME **SEE ATTACHED LETTER Well type PRNATE If A. B, or C provide PWSID# NIA Well Log (YIN) YES Date completed '5/12/2008 Sanitary seal (YIN) YES Wires properly protected (Y/N) YES Total depth 320 ft. Cased to 40'+ ft. Casing height (above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test 5/12/08 10/21/2008 Static water level 91 g, 60 g, Well production 0.33 g.p.m. +•0.75 g.p,m, WATER SAMPLE RESULTS: Coliform ` colonies/100 ml. Nitrate • i 7 mg./L: Other bacteria Q colonies/100 ml. Arsenic: NO ug./L. Date of sample:12/23/2008 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA *UNDER THE DECK Tank Type/Material SEPTIC/STEEL Date installed 8/3/1982 Tank size 1000 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (Y/N) *YES Depression over tank (Y/N)N0 High water alarm (YIN) N/A Date of pumping 10/7/2008 Pumper JR'S C. ABSORPTION FIELD DATA FBELOW EXISTING GRADE Date installed 6/3/1982 Soil rating (g.p.d./ft'o 1 /bdr 300 System type TRENCH Length '' 23 ft. Width 3 1ft. Gravel below pipe 7 ft. Total depth *_ft. Elf. absorption area 300 ft' Monitoring tube "YES Depression over field NO Dale of adequacy test"5/23 do 27/2007 Results (Pass/Fail) ' PASS For 3 bedrooms Fluid depth In absorption field before test18 in. Water added 800 gal. New depth1102 in. Elapsed Time: 180 min. Final fluid depth 18 in. Absorption rate >= 450+ g,p,d, Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date — **DURING OUR SITE VISIT (12/23/08) THE DRAINFIELD HAD 31 INCHES OF LIQUID IN THE SUMP. THE MONITORING TUBE ONLY EXTENDS 52 INCHES BELOW THE INVERT. ••SEPTIC ADEQUACY TEST WAS PERFORMED BY EAGLE RIVER ENGINEERING SERVICES. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Sewer /septic service line 25'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ 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 t 0'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Buildingfoundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 0' 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. O - •.Je f e Garn ss Engineer's Printed Name JEFFREY A. GARNESS vp t 2 3 Date 1 Z-Adc'$ V e rofessW\0o .I ��OO�oo�o eo COSA Fee a 1-19 0 Waiver Fee $ Date of PaymentJr� 0 9 Date of Payment Receipt Number 67 R L4 3 3 Receipt Number (Rev. 11105) Municipality of Anchorage ' Development Services Department i Building Safety Division ° On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Nater Well Advisory Certificate of On -Site Systems Approval (COSA) # 090004 During a recent COSA on-site inspection and test of the potable water supply well on Block 5, Lot 2 of McKinley Heights #1 subdivision, the well's productivity was determined to be 0.75 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Sample Remarks: Arsenic Cata. Nitrate data Allowable Prep Analysis Parameter Results POL Units Method Limits Date Date Init Arsenic (As) ND uglL EPA200.8 10 12129/2008 12129108 SCL Nitrate/Nitrito 4.97 mg1L SM 4500 100 12x2%2008 OIM&D9 JDZ SGS Environmental Services 200 W. Potter Drive Anchorage. AK 99518 Tel: (907) 562-2343 Fax: (907) 561.5301 CT&E Ref. k: 1086793 Client POI+. n/a Client Name: Gamess Engineering Printed DateTme: 01!09,99 16:00 Project Name: MctGney L2 85 Collected DatelTane: 12123,D8 8:10 Client Sample ID: MCKiney L2 B5 Received Daterrime: 12123/08 11:06 Matrix: Drinking Water Technical Director: Stephen Ede PWSID n/a Released By Deanna Crump Sample Remarks: Arsenic Cata. Nitrate data Allowable Prep Analysis Parameter Results POL Units Method Limits Date Date Init Arsenic (As) ND uglL EPA200.8 10 12129/2008 12129108 SCL Nitrate/Nitrito 4.97 mg1L SM 4500 100 12x2%2008 OIM&D9 JDZ ANALYTICA GROUP Gayness Engineering Group, Ltd. Attn: Jody GEG, Ltd. 3701 E Tudor Road, Suite 101 Anchorage, AK 99507 907-337-6179 Fax: 907-338-3246 Client Sample ID: McKinley Hts. Sampling Location: McKinley Hts. Client Project: Private Well Testing Sample Matrix: Aqueous COC *: PWS#: Residual Chlorine: Comments: Lab#: A0812225-OIA SP-Analytica, Inc. -Anchorage 4307 Arctic Blvd. Anchorage, AK 99503 Phone: 907-258-2155 Fax: 907-258-6634 Report Date: 1/92009 Receipt Date: 121132008 Sample Date: 12232008 Sample Time: 8:10:00AM Collected By: SG Flae Definitions: MRL = Method Reporting Limit MCL = Maximum Contaminant Limit B = Present also in Method Blank H = Exceeds Regulatory Limit M = Matrix Interference J= Estimated Value D = Lost to Dilution •• = RL higher than MCI, target not detected TNC = Too Numerous to Count - result rejected CF = Confluent Growth - result rejected TCNG = Turbid Culture No Growth - rejected Analysis Method Prep Prep Analysis Parameter Result Units Flags MRL MCL Method Date Date Analyst 9222B (Aqueous) - TCbyhlembFilt-Enumerat Test was conducted by: Analytica -Anchorage Bacteria, Other <MRL CFU/100mL 1.0 1223200812232008)L Total Coliform <MRL CFU/l00mL 1.0 Page 3 of 3 1223200812232008)L JRs Pumping POBox773415 r Ea&River,AX 99577 (907)694.6454 Service Agreement Number. 027352 IBillina Information 26 -Sep -2008 Service Date: Jason & Joey Hamlin Job Desoriptbrc 1250g Apt # 864 200 W 34th Ave P.O. Number. Anchorage, AK 99503-3969 jwrrm: Net 30 (907) 685-9209 sump' Dawn -Dawn Map Book: Job Site Information Cross streets: Mile 6.1 Old Glenn Jason Job Comments: Last Sery'11/' 18358 Amonson Road Service Agreement Number. 027352 Order Date: 26 -Sep -2008 Service Date: 07 -Oct -2008 12:00 Technician: Dave 6 Mike Tax %: 0 Job Type: Repeat Map Gild: 53 12508 Sening home -LEAVE NOTES Eagle River, AK 99587 i (907) 688-9209 /y.v k L �. y, 7 i✓br. i++i1 / / SO /I �G Additional Locatlon Comments Dopram: S:%Dlawarnstte7le emn Vr/uy.•, Gallons Planned: 1250 Brown home w/#'s on home 7. 1'rl� Gal. Actual: Pipes are in the rear of house, drive up dw, do not back up (summer only). Hose Length: ,1 Tank Is next to stairway next to deck, Double Tank: ❑ front of tank under deck. 'Never after snowfalls" - Steep dw 8 >� •x " P BafflesInlet• O with tight firms. Baffles Outlet: 0 Service Type Qty Price Each Tax? Extension Actual Septic Service 15K 1 $165.00 No $165.00 r `k tol'4[YT oaH-rTa"Total Grand TotalSias _-_EsBmat;d CMuf$000 165.eD000 ._;... -. A es• tirLvav �. -. Customer agrees to the terms and condltkna shown. THIS IS A BINDING AGREEMENT. - - Signature and TPoe of Customer Representative.; <... ?: ._1 `jf��.�Date p Accepted by JRs Pumping Date Accepted For your added convergence we accept; American €xprns, Dioaver, Ma and Mester Card payments over the phone. After 30 Days a... rt will be tumed coir to COU6TIONS.'$30.00 For NSF Checks Returned. 9r ti: werC'soiv:/ izs_nf „_ '5Q. %SBUILT SrkW i ASSOCIAM I HEREBY CERTIFY THAT I HAVE S.IRVEYED THE OLLOWING DESCRIBED PROPERTY, /s�Xi(K.cd✓sysl �A!.f lO NO THAT NO EnOCMENTS 61ST E�CCEPT AS 4DICATED. IT 13 THE RESPONSIBILITY OF THE WNER TO DETERMINE THE EXISTENC` OF ANY ASEIIENTS, COVENANTS, OR RCSTRICTIONS RICH DO NOT APPEAR ON THE RECOWED 30801• ISION PLAT. UNDER NO CIRCUMSTANCES Sm= YY DATA HEREON BE USED FOR CONSTRUCTION c cv.rr i lure ....... .—..._._.– --•-- SCALE' ��yo i • , 1 DATE GRID, FB' - Ls. GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS 2 p-u:--�--- - --- October 30, 2008 Jason Hamlin 18358 Amonson Road Chugiak, AK 99567 Subject: Private Well Flow Test Results. Afckinley Heights #1, Block 5, Lot 2, Chugiak, Alaska. Mr flamlin: Per the request of your agent we performed a well flow test. Our results are summarized as follows: On the day of our test (10/21/2008) the static water level was 60 feet below the top of the casing (BTC). Four hundred and two (402) gallons were pumped from the well at an average flow rate of 7.8 gallons per minute (GPM) for 51 minutes, which resulted in drawdown to 310 feet BTC, at which point the pump was cavitating and we shut it off (via the breaker). Of the 402 gallons pumped, approximately 375 gallons came from storage in the well casing. In short, about 27 gallons came from actual well production. Over the next 80 minutes, the recovery rate was monitored. During the last 30 minutes of recovery, the level in the casing rose 15 feet, which equates to 22.5 gallons. Based upon this limited data, it was determined that the well production is roughly 0.75 gallons per minute. For low production wells, it is recommended that a 24 hour test be performed in order to validate the wells ability to �pntinually produce over an extended period of time. If you have ,n questions, please contact us at 337-6179. M.S. 3701 E. Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www, garnessengineering.com vu -vi—cvvr%tnW rc•co uxYt ruvrK tMirttJtlitii (1,AX)801 694 3297 P. 802/003 Bagle River En ' Services10121 VFW RL Swie 201 �i0s�` IL WOA P.E. EMU1nW.Ax 99m 1�%WaM lQ • �. TEST DATE 5i6k7 iod SOOPI o7 LEGAL: Mddai@y HeIgfmX l Lott Biock S LOCATiOM: 12352 Amoomm rd. RESMENE: Surds Famitn 3 Bedrooms WELL VIELD. 0.16 Oslions per brsmmto fk+w tab WATML SYSTEM: Privab Well WATER SA34XES: Anermk: aerie dencrod, Nrtraaec 4.63 myl, Baotcria 1 ob. coloeia/100m1 Tak= by Eepoeer on: 5/12/2007 SEPTIC SYSTEM: From Munioipsl Recorder Tank 1000 gaiko A6s°rPOp° SYsIC= VX 23' trench whh 7' enactive pnveL DMALI A77CM DATE 19U INSTAL r ED AHSMMONAREA 300 Squue Feet ORIODIAL SOJL JtAT1NG: 100 $Vfodr k From MII& is Design SF.tIZ6 The kfth&W c0arbet of 3'X 23' absorption bed with 7' etfeetive pave, TM baeh&W wee ehuped wish wooer team a t.aktr truck for a total of appreotimst* Soo pjk Tis septic task and leach" liquid levet' "* awaitored tafamem2 a mta bdow the top of the standpjpq 1200IMDwkg d Oat v We Was added iuo the beebfkid daeout tuba cad the lachfkld water loud wee meai0aed a wstp► wag added and thm absorbed bmto the swround SoilL d b sump st the Start 0f the let Alar dw aMdoa of 500 w, sod Thsrw wase 12' of water In the 3 hOOM The bvd is the Qiceda of stay the crater a stmttomm ft sump had reheemed >A 1 i" iadiatirm2 time addod water he t A1ir aa scekvd tun to 7 fepoed into the The mama kvd in the Septic tack did not rye duff the addkioo of 200 p lio" of water showing that the keehfidd bad accepted the &Wre &now(. 71aTodiaaa dw sqxk *%m will,the mired ISO 2� Per doY ofefflaent W bedroom. which is the required ak ptim Me for MOA sppmvaL 12003V071 or 106 noeuw wam>.xm rry wT-vr–cmt%inw ic•p MLt K1vtx tNUI ttH1NU (FAX)907 994 3297 P. MAW WEI-I: The well was Pumped into the xamp mit imide the boast. Toot dr:wdowa f}om a =* water level d40 feet waa 59 Aw. aaw 20 miouta of p=vb& The well we, than shat oQ and the waw levo! aiktwd Tn tioevet for 40 tttinums. The Walt was dws turned back oq and pumped Wo the tack wbss the WCbIWA in wafer level wee Doted nk PCOM wee tsPeated tttuttiple times, The champ In volsme t4 me WA �itar sad the avatar stoesp toot was used In CwJw edw wide the chops is torte, b dgmmdoa wpv&wdm marrow w 4 fbr tack "w– MW Pmdecdm tm was Lamd to be 0.t 6 pnms per water icwl a the by meovwiw a the wall =9109 ooiecided wM ft rate found by mankcrhtp the s�torap task, W wins this to be as accurate Am raat. WM Cho Wgmk of lbs staap tomk systrmr ft well Pradueooa tate is adequate for a tam bedroom sinpie &m dwaUb& Tzgr1tz=L?s 7U ScP& syelem shsarpom rata and well flow cafe moat or exceed the belie tequWmem of the Mu*Pa6ty of Aneboeap for a 3 bedrom s%& &mibf tasidmca as of da der the astern was %mod Atseuirr Niaawr and CoNtilrm kftb ars whin the Hmca allowed byft Munkipe ty. A=Nmm t of wdaNnp sabwraw eoodidom by du fiLq*Wnp enpiiuep k tlmiiad to hilum atiasobtained bout the evalkbks moahorins tuba and Municipal record sesrch. We do act sunentee the sworaey or quWhy of sabnmfoee tests and htipaa(orr Performed by the orWaW iuupec - milia a teVIW by t L limited to absorption ace ons n end ri& dw sepaadoa tnemroneotr u cur=tly suppb a vvalag 1•/rmieipatiq of Anehaape and does not verity cher iumprity of do Pipl^t for the water MMJYsoca wah WkSWE fuel thea the baccarat and nitrata coats m 7be opcWl*rW life end the matter of C=MAfeoedhlM ind M WIWpd eodsk Lor all wantr and septic mtatm dapasrk m the local son ms mat be observed team : � p & water wgpa otthe btmas betns served b!' the syapaq and the datan of These $ no 3uatamre tbat the well and sePtk system tested will mw the regnUernmu for approval in tha A tm+. 2ha be deft and iavotdpsdoa of existing eandldons Is pravidw to cue cliff fa submhtat to the M=KWhy RaM DVwftw t err dwk mvkw And approvaL Any cancerne with thh bel AftW Municipality. whfi tM featiug if h 4 requested we will submk the report dbe� to lbs Unnwe.... IK .....-- ..._ --- ?nW •UNN EAGLE RTY.... ALASKA 99577 : ft won 6944M TO 1: _JJU1 5_3 uNUVuuLGLF= 69665 r.or[ do d aan orcnn uvun.r gsm.Ena paEn wrtll DAY WORK :..1 CONTRACT ❑ EXTRA .w.w..n...an , U, ■ENEM INIMMIMINNIONO MEMO IMENININNIN IMMEMIN MEMO IMMEMINIMMEMI NINEEIN INNINNIN INIMIN IMINNINION INIMIN IN —■ �MINE TOTAL LABa!—■ ME TOTAL MATESIALS IMMEMO IN % I 1 IMM REM P GENERAL CONTRACTOR Excavation DEAN CONSTRUCTION & DEVELOPMENT 22222 Elkhorn Circle Eagle River, Alaska 99577 BILL TO LEGAL DESCRIPTION 1 g53 $ A-+4ror%Or- DRAIN Invoice � ATE TERMS INVOICE # i�'noo sos 51151.2003 DESCRIPTION AMOUNT OrJ Ge�iel f epfar-e 1%)cde-, lJeip4 lens J S(//0O 1 Tot4f) IOC ;0.00 22222 ELKHORN CIRCLE • EAGLE RIVER, ALASKA 99577 • TELEPHONE (907) 694-9117 Certifieb Onthng Log by Doc on. de. SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 -TELEPHONE 6884759 OWNER OF LAND: J ,4s R_��7r7��Z31 LEGAL DESCRIPTION: 4,) 7 .1 /ita J �.= r kh n DATE PERMIT N MBER: Date of Issue----- TAX ssue_-_-_ TAX IDENTIFICATION NUMBER: Is well located at approved ennit kXation? D Yes D No Method of Drilling: a rotary D cable tool Depth of well: 3�4 V Casing Type/SWall Thickness ;~�% Inches Diameter_ Inches, depth feet Liner Type: AJ o IJ r= Casing Stickup Above Ground: feet Static Water Level: I f feet 6 10)q Recover Rate: vV 9900 Method of Testing: Ari.'_ Well Intake Opening Type: D open end Q_I hole D Screened; Startfeet Stopped feet D Perforations Start feet Stopped feet Grout Type: Volume Depth: from feet, to feet Well Disinfected Upon Completion? dl -Yes D No Method of Disinfection: 4k .^.. 'Su l/d>1 Comments: X IST/.06 tAjr'/_/ _/.3t 4tacL �KFri.l �5,= J.C� CRS G err: n � 1 �✓J,JI.-L Driller'sName =,j4c 1-JLf-,af,%.J ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 67(1272, CHUMK ALASKA 85557 TELEPHONE 668-2755 TO: 0 /;j-3 -,j c r` f�r?/s!lioJ k,z:,viA PHONE DATE OF ORDER ORDER TAKEN BY CUSTOMERS ORDER NO. () DAY WORK () CONTRACT ( ) EXTRA NAME/NUb18ER AL JOB LOCATION JOB PHONE 8T ATE J OTY. I DESCRIPTION OF WORK I PRICE I. I CA/4Jd,.vr I. Lu�LL /¢L Work ordered Signature I MMy a knowlsope" u45faCtory COmpla4on of the abO oaaoriba0 work. ,4J 0 CMIYM NATER 51j�S1EJMS SALTS a SUWE �I ARCTIC •• Jim Sullivan ARCTIC 688-2510 PUMP & WELL or'Xt INC. 258-2510 ( 745-2510 Fax 688-2543 NWWA CERTIFIED PUMP INSTALLER 10357 Alaska Distributor S> P.O. Box 770197 Eagle River. Alaska 99577 Payment due on receipt of invoice unless other arrangements made. C=r O der y4. Phone k 9 D _0 mpletion m �6! i Address oty. Description Price Amount 9 2 7s t f .r•f / Z l(• J � r 1 .. Received in in Satisfactory Condition , y�ie it T[7T • Please pay by invoice. All account Past Due will be charged 11n%. $25 second billing charge THANKYOU Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FORA SINGLE FAMILY DWELLING Parcel I.D. 0 5 1— Z/ 3 %I Expiration Date: 9-3o-01 1. GENERAL'INFORMATION v /' Complete legal description 1.7 - A5Pr rJ" M G11f t s%✓e-/ He i9`I-1-5 S t./ 46d -i-1 Location (site address or directions) l �� y7 i�J�JC7h �✓��, ch V q; ,,7a ') Sc�{ Current" 'r v:A' nPr(Sw ': Gov., /I Day phone _ Mailing address Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well 15 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site )� Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 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 engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority 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 verity 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 .tel a� e ✓ f �e✓�0 /�y Phone—% rJ Z e _ Address folft-IU e-2 YV I-tCr 7 7/`4 v Engin'eer's Printed Name— .." 5. DSD SIGNATURE !/ Approved for Disapproved. 3 bedrooms. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: lCJ Original Certificate Date: (Rev. 1=01 Municipality of Anchorage • Development Services Department Budding Safety Division On -Site Water d Wastewater Program ' • "' 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519MM www.dAnchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 5 /, `cal c✓I%ey1I C,i 4hff Sub4arcel ID: ©-5 —W -3 A. WELL DATA Well type v C)f C If A, B, or C provide PWSID # _ Well Log (YM) Date completed _ Sanitary seal (Y/N) -ty_ Wires property protected (YIN) —� Total depNr�ft. Cased to}�ft. Casing height (above ground) 2.. in. 161— FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: ft. 9— p.m- AT INSPECTION f 3 (g ft. 0. 6 g.p.m. Coliform 0 cotonies/100 ml. Nitrate �� moA. Other bacteria O colonies/100 ml. Date of sample: -6— ! f — 4V J Collected by: J # -$'j ?—, c n'1© tie B. SEPTICIHOLDING TANK DATA Tank Type/Mgterial }�7 `�' E' Date installed Tank size 'L4� gal. Number of Compartments a Cleanouts (Y/N) _ f FounoAtlon daanout (Y/N) p Depression over tank (Y/N) / V High water alarm (Y/N) Aj Da�GbtPunlpfi� 2 0 © Pumper `L� �✓ �Cl /%! / �i 4 C. ABSORP.TIOWh LD DATA Date installed =��ft1 rating (g.p.d.W or ft'/bdrm) ,f OD f+y fystem type Length _ L 3 ft. Width -3 ft. Gravel below pipe _7 lft. Total depth _kL ft. Eff. absorption area 32,Lftr Monitoring tube • Depression over field /V Date of adequacy test —0 Results (PasslFail) —f—'✓ For ✓ bedrooms Fluid depth in absorption field before test __Z- in. Water added -6 C-1081. New depth in. Elapsed Time:S-4()min. Final fluid depth _Z, in. Absorption rate >_ ft_!1 O g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N a type) Pe.r o 0066 if yes, give date D. LIFT STATION Date installed 'Pump on" level at _ In. Datum E. SEPARATION DISTANCES Size In gallons Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankllift station on lot / 2— 97r Absorption field on lot / I Public sewer main O nG1�r— Sewer /septic aelvice line, In. High water alar level at In. 3 drwit requirements? On adjacent lots _��� 00 On adjacent lots } % �8 Public sewer manhole/cleanout AIA Holding tank NA SEPARATION DISTANCES FROM SEP11CIHOLDING TANK ON LOT TO: / Building foundation Property line EY0 Absorption field � 1$ Water main _ N/A Water service line O Surface water ` y Wells on adjacent lotsr loo— SEPARATION DISTANCE FROM ABSORPTION FIELD ONOT TO: Ct \ 4-3 r Property line --/ Building foundation ��'J-' Water main Water Service line B0 Surfacewater __A149n 16 DdvevraY. Paddnglvetdda storage Curtain drain None w crewel adjacent lots ?' F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Munidpal records that the above systems are in conformance with MOA HAA guidelines les in effect on this date. Engineer's Printed Name v a✓c4� F f2i tP'mc4e Date HAA Fee $ '? 1) 0 Date of Payment r- g ?- 0 Receipt Number Al% q,& (Rev. IWO) Waiver Fee $ Date of Payment Receipt Number y Sir NAY -19-01 13:17 FROM- T-849 P.03/03 F-188 AL ME Environmental Services Inc. 4 Laboratory Division yritirrrrarrrrarr�a�ii�os 200 W. Potter Drive )rinking Water Analysis Report for Total Coliform Bacteria Anchorage, AK 99518.1605 Tel: (907( 562.2343 READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTLVCSAMPLE Fax: (907)561.5301 MUST BE COMPLETED BY WATER SUPPLIER o PUBLIC W'ATF.R SYSTEM I.D. n PRIVATE WATER SYSTEM ❑ QSend Rrsulrs O Send Invoice �f rJ1•mnm.woprnr .m, ...wr�iun oM. ❑ Srnd Resnlrs ❑ Send In,ro,rr J SAMPLE DATE: Month Day Year SAMPLE TYPE: ❑ Routine Cl Treated Water o Repeat Sample (for routine sample lR Untreated Water with lab ref. no. " ❑ Special Purpose Time Collected SAMPLELOCArON.%'7 ';. Collected By L2.f91 ra: 4-64'1ii! ✓Nf'ifi�t, F�45)'!New F=1 r TO BE COMPLETED BY LABORATORY A lysis shows this Water SAMPLE. to be: Satisfactory ❑ Unsatisfactory ❑ Sample over 30 hours old, results may be unreliable ❑ Sampie too long in transit; sample should not be over310hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received 5 �' Analysis Began K,30 Anslytict: Method: (Membrane Filter ❑ SIMO-MUG • Number of colonies/100 inl. ei--••it• Analyst 1012613 is Jun ❑ Fazed Date: Time Client notified of unsatisfactory results: ❑ ❑ Phoned Spoke with Fazed Date: , Time: IMIETERIOL:OCICAL WATER ANALYSIS RECORD MMd-FIT1.,;RauIWTotaI Callform S. Coll Membrane Fitter. Direct Count 0 Colunies/100 ml Verification: LTB RCB -, COLIFIRM Fecal Collform Confirmatior Find Membrane Filter Results Catlform/100 ml Reported By PateTime bn Comments: S Member of the 508 Group lSociltaGanarolodoSurvalloncel rvrC. rw ftw „ is C".r Oa E!::^RONMENTAL FACILITES IN ALASKA. CALIFORNIA, FLORIDA, ILLINOIS. MARYLAND. MICHIGAN. MISSOURI, NEW JERSEY, OHIO. WEST VIRGINIA NAV -19-01 13:17 FROM - CUE Environmental Services Inc. .0 Lk. lrrrrrirrrrrrrr "W. CUE Ref.# 1012613001 Client Name James Sizemore $ Associates Project Name/p 1-2 BI 5 McKinlev Heights Client Sample ID L2 B15 McKinley Heights matrix Drinking Water Ordered By PWSID 0 T-849 P.02/03 F-188 Client POv Printed Date rime Collected Date/time Received Date/time Technical Director Released B� 05/18/2001 9:03 05/14/2001 13:45 05/14/2001 15:25 Stephen C. Ede -// A-?,';' Sample Remarks - Parameter Results Allowable Prep Analysis PQL Units Itethod Limits Date Das Inir Waters Department Nitrate -N 3.79 0.500 mg/L EPA 300.0 (<10) 05/14/01 SCL Microbiology Laboratory Tal-1r,r+fomt 0 0 col/100mL SA1189222B J5/14;U1 KAP MUNICIPALITY OF ANCHORAGE M E M O R A N D U M WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL N0. 0 l 02 q ? During a recent Health Authority Approval on=site inspection• and test of the potable water supply well on Lot Block _F of Subdivision, the well's productivity was determined to be (Q gallons per. minute. The minimum well productivity required by this Department (AMC 15.55) for a_ bedroom residence is p . 3 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This adivisory must be attached to all copies bf the subject Health authority Approval.