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HomeMy WebLinkAboutSOUTH LAKEWOOD HILLS #1 BLK 5 LT 1South Lakewood Hills #1 Block 5 Lot 1 #015-151-35 Municipality of Anchorage 1�;�eaea ee. •; tc��/,-/ Development Services Department e Building Safety Division ei On -Site Water and Wastewater Program a 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. o 1 S- I s- I- 3 S HAA # HA D ilO o 4g S Expiration Date: 6o - / as o / 1. GENERAL INFORMATION Complete legaldescrip$on Lot 1, Block 5. South Lakewood H111S"Subdivisinn Location (site address or directions) 6300 Michigan Blvd Current Property owner(s) Lance Powell Mailing address Lending agency Mailing address Real Estate Agent Day phone 263-5245 4621 Colden'Spring Circle, -Anchorage, AK 99507 Day phone Remax/Audrey Mason Dayphone694-4200 Mailing Address 16600 Centerfield Dr..0201, Eagle River, AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. a1 Z. 4a. 3 At /o i 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well 110 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site X❑ 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, 1 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 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. S & S ENGINEERING Name of Firm 17034 Eagle River Loop Road No. 204 Phone C 9 H — ;L 9 -7 9 _.,,la aver, as Address Engineer's Printed Name Rober 5. DSD SIGNATURE Approved for Disapproved. :,/cl/off Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: �'' ��� Original Certificate Date: 3— i.s 0� (Rm. 12M) Municipality of Anchorage ' Development Services Department Building Safety Division OrrSlte Water 8 Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.cl.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Descriptlon: L O T I Q 1-K S .S O. Lg K f W 0 d 0 Hr «I * Parcel A. WELL DATA 01S -1S-1-3 Well type PQ 1V47t If A, B. or C provide PWSID # Well Log (Y,&-±" 0 Date completed1 -11 Sanitary seal ®M) 2.11 Wires properly protected &N) Y 4 f Total depth 300 ft. Cased to 100 R. Casing height (above ground) I.1 i in. FROM WELL LOG AT INSPECTION Date of test 3 / (./ o 1 Static water level ft. 9 9 ft. Well production g.p.m. $• S g.p.m. Lr.n.ri0 ey 10J. 00 4 WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate O, 5�- mg./1. Other bacteria _ colonies/100 ml. S i S ENGINEERING Date of sample: 310 o l Collected by: jM4 Saab Rivar Leap a...a Na_ 204 B. SEPTIC/HOLDING TANK DATA Eapb Rte' Alaska "577 Tank Type/Material S tpr r L/ Fj RCA a u i I S' l r4 s IL ►000 Y. Soo Tank sizegal. Number of Compartments a Date installed q/7(. A- I o/ T -J Cleanouts 40N) YES Foundation cleanout ®N) YE S Depression over tank (Y® N0 High water alarm (Ya Date of pumping 7 G 4o Pumper 00 7 'd A C. ABSORPTION FIELD DATA tv 0 Date installed 10/3o%c1 Soil rating (g.p.d./ft2 o a 12 System type TRE,. r: N Length 7 3 R. Width 3 ft. Gravel below pipe 6 ft. Total depth l i ft. Eff. absorption area k7 6 ft' Monitoring lube Yr I Depression over field N 0 Date of adequacy test 3/ (o / 0 1 Results Fail) f 4 s S For ly bedrooms , ," Fluid depth in absorption field before test 6 in. Water addeda131-9 al. New deptta fi in. r 6 Elapsed Time: as min. Final fluid depth 2 J in. Absorption rate >= 00 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN 8 type) NUN'( KNO W W If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at _ In. "Pump or leve Datum Cydes tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: f Septic tanknift station on lot / 0 0 + Absorption field on lot /00 �+ Public sewer main N / A Sewer /septic service line a S r4 - High water alarm level at In. Meets alarm & dreult requirements? On adjacent lots On adjacent lots 100 r% Public sewer manhole/cleanout _ Holding tank N /a N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation / a t Property line So rt Absorption field 3 O N Water main A Water service line O + Surface water Wells on adjacent lots / oo �+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: ) 0 �t g ildin foundation 40 Water main N 1A Property late u g Water Service line /0 / 0 0 -I- �� Surface water Driveway. parkingivehide storage SO /t Curtain dra t—ki h. -45166 rd Wells on adjacent lots 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 HAA guidelines in effect on this date. Engineer's Printed Name J?00J e — C. Ce wwN Date 3/11/o/ HAA Fee $ 300. O % Waiver Fee $ Data of Payment Ap l L ` Date of Payment Receipt Number 1 (Q 1 Receipt Number (Rev. 12/00) 9 lamp COWAN CE . 8801 1114° �i . MnP.-12-2001 W'30 S&S EfIGINEERING 907 694 1211 P.03/03 CTU Ernrironmemal Services Inc. iBR taamttsory [liMsIon Drinking Water O PUBLIC WATER aYSTE'dME )1 PRIVATE WATER SYSTEM 200 W Porter Drive for Total Coliform Bacteria Anchara"• AK 88618-1906 Tel: 190) 562-23$3 D£d£FORECOUELT7NGSAMPLE Fax: (9071561.53D1 '/S Seed Ra.ia ., Scxd fxsattt 170>• [act. River Lppn DUA Xg,�U4TrT Ea6ie River, Abate "571 0 Sred new" O Saedewtelte t SA%TPLC BATE: O 3 O 6 Memb Day Year SAMPLE TYPE: )f Routine O Treated Wats 0 Repeat Sample (for rouulee samPlt 2 Ustreatod Waar Iynalysis show$ this Water SAMPLE to be: -AL1 SQdsfa"ory O Unaadsfacmry O Sample over 30 hours old, temps tiuy be unreliable 0 Semple too Iona in remit; imsple sLas1d not be ovcr3f burs oM at eaatntm12Q to indicate reliable results. Please send new sample via t at dol very mail. Dote Received ' Time R.cei w Analysis Dopa 1-11-40 Anafyttral Method: Membrane Filter MMO-MUG • Numberofcalaies/100m1. Result• Analyst with lab ref, no. o Special Purpose Time Collected SAMPLE LOCATION Collected 0,1 L 1 l3 5 SO-LAstt„d:a N,. Jsrf 3,oap.., Bas C, ® -1� Alin Fbas Jos ❑ Fared Dsl Time: Client verified of wimbfaetery reselts: ❑ ❑ PIgQN feat wttb Fu•d Che: Tbtr. i BACRTm.RIOLOGICAL WATER ANALYSIS RECORD MM6-MUG Rnb� TOW Coldo n E Cab t Membrane Fitter: iwm Cont _ Colonsewleo tot Vefficadox: LTR BCD COLMRM rvrr- rrrrrrar ro cw Few collfermConfirmation w .01a„e,,.,,r Mal Membruae Filter Remits Ceuforann ed Repened IN Date O Time lib bre C'ommrnmr 9Y1MrI 6Y//1 tape MCC IY al ACee r a1)CMWe CI PM1a M, wmC "a*" Abn aMrW:aY 4Rctums wcw rQQLv Own w"? NMIMIA TOTAL P.03 ftikit-12-2E1171 L18:31 S&S ENGINEER1fU CT E Emmonmeraw Earylcoa inc. Ge w w w ..... CT&F. Bern 1011151001 aleft Name S & S Cyn. :fin Project Namem L 1 B S So. Lakewood Hills #1 Client SampkED L I A 5 Rn. Ukewood iiiU, MI Matrla DrinkinE Water ordered By FWSM 0 Sa4vte Rcmukr 9W 694 1211 P.M/w •-•+••• a-naa r.utcus r-utta c"c rat rcaatcd DAWLAoe 03/092001 14:53 CQZ"Ud DAZQM as 03/0612001 15:00 P.eedvedDatetTime 03106=01 1637 Teehokal Director Stcyhea G Fde Rcleued By -O I r.nncter Awia rQL VIYb A�u hk DDau Dllatyaf �e4 Aac ]nit paters Department Nlww-N aticrobloloME Lahoratory Tota: Coliform 0.500?1 0.500 zq/L EPA 300 0 0 eoVlOomL SNIit 92228 10 max 03/06.01 SCL 03106N1 SKW MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 2644720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ---_--- --- Name AISTANCES TO FROMTANK SEPTIC ABSORPTION FIELD WELL Address Phones) Permit No. No. of OadrooLos WELL -1 1 z O 1 ( _ -- LOT LINT: '�z^� l/ 7'C) ISOS r, r l � 46 — L-1a2L lf���— LEGAL DESCRIPTION Lot Bloc Y. --- Subdivision FOUNDATION 1 I- 40I _ 1 Township. Hange, SectionJul AS -BUILT DIAGRAM (Show location of well. septic system. property Imes, four ion. 7 J I driveway, water bodies. etc.) TANKS \ XI SEPTIC ❑ HOLDING S ,1 me"alaclm er t�xjsr i, )J (I00-11 L-; bu 1%InK° :Z/SMf`1r<I N'a1 CapacilY rnTJnigallons GxISy" �<�I«ss If Mateiral– / 4 L/=:�rlS TIA,16—>�rDef}ss _L1L=~=...�.1-f No of Compartments L.7(1577 n/C �(ai—� 11717! 3f ) r)uri a -/c1 /g� '���<n s _ TYPE OF SYSTEM �' — _—'-- -- TRENCH BED ❑ W. DRAIN ❑ OTHER 17s _ Depth to pipe bottom ham ongin l grade -at FT Total depth from original grade -��---- FTFill /� �_> '1 L �'�'� '• added above original grade Gravel depth beneath pipe FT FT GraVL` CrI(ftli FT Gravel wldh S6rl FT h T 7oral absorption area Distance between Imes 5 ' r/ %a SQ F FT �• s — Number of hoes Sod rating Pip n]clonal .�,3 IM p .fCJ.i9 ", �`r — — 1 Q –SQ FT 1 � i Installer Date Installed � � YR `i�, IICYo WELLS'I'G — El PRIVATE Ll OTHER (Identifv) t U' }o " - G l� o O // i q / -Classd¢mmn CA -13 C, Total Depth Cased to / I FT FT10 IS — — Installer '�0 Dm Installed_ 17/.i I,,..n .?�` .�Lh LL Ix Iv •, 'E` REMARKS: � SCale: klTS f '.s ENGINEERS EAL Inspections Perforllecf by: Data. — _--_ -- .� ` AL cantly [hal this inspection was performed according to all •r Municipal and Stale guidelines in ellect on this ./// I� f',. _-----/y I _ °' /da Health Department Approval: L. � Date. - —_ 72-013 (3/85) i� �1L)NlC1PALITY OF ANCHORAGE Department. of Health & Human Services 825 L Street, Anchorage, Alaska 99501 343-4720 ON-SIT� SFWE|( P[RMlT Permit Number: 09()181 Upgrade Date Issued: oB/20/89 Engineer Designed Owner Name: LANCE POWELL Owner �'fddress: 6300 MICHIGAN R|V0,, ANCHURAGIn, AK 99516 /I� '-\ `�/L.L��^-,. Day Phone; 346-2327 Parcel Id: 015-151-35 �� Lot Lega1: Subdivision: SDUTH LAKEWOOD HILLS``vLnt: 1 Block: 5 Section: 23 Township: 12N Range: 3W Lot Size 30400 (sq.ft. or acres) Max Bedrnoms: Tl -is Permit: 4 Total Capacity: 4 SEPTIC TANK: Minimum total septic tank rapacity: 1^250 gallons. Each septic tank mus1 h6ve at least 2 compartments" Depth to top of septic tank(s> < 4n0 feat requires insulation over tank(s). lNFDRM D.H.H`S. PRIOR TO INSPECTIONS BY KNGINEER, IF AFTER 01:1 ICT H0UR5, CALL AND LEAVE A MESSAGF. GONS[RUCT [`ER ENGINE105 ATTACm APPROVED DKSION" THlS PERMIT EXPIyF8 1R/31/8V AND VALID FOR A SlNRLIA FAMILY HDMU" I CE1�1[FY THAI: 1. 1 am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MEM) and Lhe State of Alaska^ 2. I will install the system in accordance with all MOA codes and regulations,, and in compliance with the design criteria of this permit" 3. I will adhere to all MOA and SLate of Alaska requirements for the set back distances from any exis+ing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lo+^ 4, l understand that this permit is valid for a maximum of 4 hedrooms` l also understand that the capacity of the total system is 4 bedrooms and ' � � any enlargement will require an additional permit. Signe0: VATi�: /f -_./--�/��_4-_-- (Owner> LANCL|,OWE|-| Iss'/ed D,/;l DAT[�� NEER'S SEAL) _ & tl Municipality of Anchorage ° { t �� DEPFlRTMENT OF HEALTH &HUMAN SERVIC f' a 825 "L" Street, Anchorage, Alaska 99502-065l5� " t; SOILS LOG — PERCOLATIONTE PERFORMED FOR:_Lh, Pia I- I _ I _ DI s ,PERI`ORMEO'�I cI IFI L_ar I SLK S li ,.,<<"� — 1Zy-q LEGAL DESCRIPTION: _ b Township, Range, Section: -i 12 N P-3 X2-3 DEPTH IL L S SLOPE SITE PLAN ( EF 1 �Op5o1L 2 S OL 3 5 i I il4 6eAVl 6 8 9 10 11 12 13 I I R // 1 J7� ._•L_Le1 e 4nQ 14 SP 5 �•� I NIL Sit+ 16 E NA 16 n 18 19 20 COMMENTS -L-2 1 `nI I — IF YES, AT WHAT DEPTH? Depth to Water Alter t Monitoring? — pale: Reading Qate Gross Time Net Depth to Net Time Water Drop it --J1 LLCL— " L Zd " -08. PERCOLATION RATE LLJl_rOrr (minules/inch) PERC HOLE DIAMETER TEST RUN BETWEEN �TVZ FT AND 4y2- ' FT PERFORMED BY: �ey JEJESS I __ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) Undeveloped L7� Undeveloped L8 Michigan Blvd. L I \�WET,W L SYMBOL / O=TEST \\�\ existing House HOLIs Exis ing Tank, 4 Bdrm. 0 v 1,00 Gal. `� '0�_Ir Exist' _ Existin L2 Systerl System Propo e.d 5 1'qiCX /� a System— o erve A req Existing , ystem \ o 10 1 0 rcL4 1 WELD J PROPOSED SYT�E)TRENCH (4 Bdrm) x (246 -sq. ft./Bdrnl} a&Zf sq. Fill 3'+ Native ' _ ( I Bq� _ 0 3 (6' sewer rock) x (2) x OW Long) =,821 sq. ft. Geo Fabric 4"perf Install either a 500 gal tank after existing tank pipe -OR- Install a 1250 gal tank and abandon¢ existing v tank. New tank will be a steel, two compartment' Sewer M.O.A. approved tank. Rock 6' Depth Install clean -outs between tank and'trench; At each end of trench; Install monitor pipe near_ center of trenches. ' Use 4" solid pipe between tank and teench. Use 4" perf pipe in trench. Insulate tank if cover is less than 4 feet. .SEWED SYSTEM -LOCATIONS PLAN J r �1'tl�l'i SECTION/ TOWNSHIP/ RANGE 0S23 T12 R3W n�(vs 'Sb' SCALES �"' '' 1" - 100' ��I DRAWN BY, ?a /tjI_' NORTH JERRY KRESS SOUTH LAR THE ACCURACY OF LOCATION OF EXISTING PROPERTY'CORNERS, WELLS, AND SEPTIC SYSTEMS INDICATED IS NOT EXACT. DIMENSIONS INDICATED HAVE SEEN DETERMINED BY USE OF CLOTH TAPE AND NOT BY. SURVEYING TECHNIQUES. Mr. LANCE POWELL DATE' SHEET _ OF � Gf2EA, ���pANCHOfRAGEnAREAQBOR�. �� 3330 C Street Anchorage, Alaska 99503 loe ,,H �' /) INSPECT ION REPORT ON-SITE SEWAGE � DISPOSAL SYSTEM �%J NAME_ ILS ` -MAILING ADDRESS %��U �PHONE 517E7 ` "— LOCATION i� LEGAL DESCRIPTION_ ��J^'�"^'r""''�""`•�� SEPTIC TANK: DISTANCE //' NUMBER OF L FROM WELL MANUFACTURER! � MATERIALz- INSIDE LENGTH -�—INSIDE WIDTH _ LIQUID DEPTH_ TILE DRAIN FIELD: �o r DISTANCE FROM WELL/O-� -FOUNDATION ---NEAREST LOT LINE_-. LIQUID CAPACITY/OQO GALLONS. TOTAL LENGTH OF LINES -- NUMBER OF LINES— DISTANCE BETWEEN LINES —TRENCH WIDTH�T IN. TOTAL EFFECTIVE �4o p/ ABSORPTION AREA -- SQ. FT. LENGTH OF EACH LINE DEPTH OF LTER DEPTH: TOP OF TILE TO FINISH GRADE _C/r —MAT RIIAL BENEATH TILE a.p_ r IN. ABOVE TILE T_ —IN. WELL: Q TYPE `),J-Q"1`//n _ CONSTRUCTION(� k, -------DEPTH-- -DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION LOT LINE _ SEWER LINE , TANK--. SYSTEM----- CESSPOOL YSTEM - _CESSPOOL OTHER SOURCES — -- — -- APPROVED_—_._ DISAPPROVED ----REMARKS DISTANCES: INSTALLED BY:V (�\ I�\ SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: REMARKS; DATE Form EQ -032 DIAGRAM OF SYSTEM y■� W //,()O)ov/x I YIPI (:A , 0 1. 1. III J I%,I f; 11:711 1. ],.,1 MI 1: :: 1. f9( "III 1' 1 LI I - I U F IF 1:1: 1 :, I f I I' I H , I.! - 11 1 " [I I 'I :. Ill- - 11 , C, :: 11 :��: 11 --, - 11 111 1� .. . -P. Il , 111, If :,!. - I , 1, ., I .:. I . 1 L , , 1 1: 111 1:: 1 1 - 1 .1 'Ah i CA I A kI FI I I I -, 1, I IFN [ 1-1 11, 1 .1 F: f:::, I f:f I I 1 1-1 1. (.11. '1 1: , J I I , I i'I'4'1.1 itil-11,11 N11111':1111 - 1.Iillll I,! If l;. //,()O)ov/x I YIPI (:A , 0 1. 1. III J I%,I f; 11:711 1. ],.,1 MI 1: :: 1. f9( "III 1' 1 LI I - I U F IF 1:1: 1 :, I f I I' I H , I.! - 11 1 " [I I 'I :. Ill- - 11 , C, :: 11 :��: 11 --, - 11 111 1� .. . -P. Il , 111, If :,!. - I , 1, ., I .:. I . 1 L , , 1 1: 111 1:: 1 1 - 1 .1 'Ah i CA I A kI FI I I I -, 1, I IFN [ 1-1 11, 1 .1 F: f:::, I f:f I I 1 1-1 1. (.11. '1 GREATER ANCHOIO(L APLA L'OROUGII Department of Environmental Quality •17 3330 "C" Street al NNN Anchorage, Alaska 99L03 SOILS LOG PEROI,ATION TEST performed for / �7��.�� >_ Date Pcrforrr 1 � - /,>S - _ Legal Description Icri__ _i311 — 1l _ZcLLvkz — ----- _. - — This form reports soils log—j(_ _ Percolation test Depth Feet 2 - --- 3 4 - _ 6- / _ 15c: 8 - 13 - S/0 7)0 14 tL. — Was ground water encountered? �I� If yes, at what depth? 7-r,c 4e cUouis sosieej t o -F /� Sul TigWi . �� A -A) De to Water Net Drop Percolation rate minute. Proposed installat oiof n. Seepage Pit Drain Field Depth of Inlet __---_ Depth to bottom of pit or trench COMMENTS: Reading 1SCAL Date 4L6�C Gross Time Net Time D — -- Performed D,Y._�%��-`�_ ✓?,�6 A"� Certified [3y liQ-040 (6/74) ,)ate 3"rt,,j . A.ppr"a( o-. Lo-� i dK 3 SouiltA L0.ke.woui ` RaXpart Drillkg Works 'l � & q 926 S. Klevin Anchorage, Alaska WATER WELL DRILLING A%'REEMENT & CONTRACT 3 Let it be known among all men that Bernie D. Claus, oi.Rampgrt Drilling Works, Anchorage, Alaska, First Party, and witnesseth: First Party agrees to drill a water well on property owned by Second Party, said property being described as: First Party agrees to supply all materials (casing, test pumping, etc.) and labor for the completion of said well, guaranteeing certified welds and all workmanship will be guaranteed. Second Party agrees to pay for said well drilling at the rate of- - JI Jt0_ per foot 1 ry to the required depth of water bearing formation. A down payment ofT�-�t�o2 shall be paid by Second Party to First Party upon the signing of this agreement. Upon completion of said well and upon receipt of a formation log, showing gallons per minute, etc., Second Party agrees to pay the balance due for said well. IN WITNESS WHEREOF the parties hereto have set their hands this _qf4 day of I STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT ) SIRST PARTY Bernie D. Claus—Rampart Drilling Works SECOND PARTY ------------------ THIS IS TO CERTIFY that on this __9th____- day of ______Au.gust19-71_, before me, the undersigned, a Notary Public in and for Alaska, duly commissioned and sworn, personally appeared Bernie D. Claus, First Party and _Clayton Hunter Second Party, to me known and known to me to be the individuals named in and who executed the foregoing instrument and acknowledged to me that they signed the same freely and voluntarily for the uses and purposes therein stated. WITNESS my hand and notarial seal on the day and year �fin,this ce-rttiiffiicc%ate first above written. -- dill 25�� / ° �- - Notary Public in and for Alaska July 10, 1.974 My commission expires _____ ________.______ ___ MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL MRTIFICATE 1. General. Information Application Date 3-28-84 (a) Legal Description (include lot, block, subdivision, section, township, range) Lot l,_.Block 5, Southlakewood Hills, S23, TJ_2P RW Location (address or directions) SE Corner of Michigan and Magnolia (b) Applicants Name Trish Smith Te 9 - Applicants Address SRA Box 30 Anchorage, Alaska 9951.6 (c) Applicant is (check orei.) Lending Institution ; Owner/builder ; Buyer Other �-1 (explain); (d) Lending Institution Bank of the North A� Telethon 278-4581 Address Pouch 6608 Anchorage, Alaska 99502_ - Debbie Walters (e) Real Estate Co. & Agent Address Telephone _ 2. 2y2� of I�2sidence Single --Family Ej Multi -Family F—F Other (describe Number of Bedrooms 3. Water Silly 3 Individual Well r-nj Community Public Note: If: community well system, must have written confirmation from the State Department of Environrm:ntal Conservation attesting to the legality and status. Is the well adequate for the number of: bedrooms specified in this HAA (.YM)_ y__� 4. Sewa e Disposal Onsite Mx Public Community r HoldingTank Is the wastewater disposal system adequate for the run ber of Ledrooms (YM)- y [Page 1 of 21 2-15-84 - 5. Sng_irrcering FirmPr-avic?inq Dfs eacticns, lists! Mita and �.17formation I eertify 'Uiat: I have checked, effect on the, date of x-hJrSl;VhS Signed i.fied, cr conformed to all MDA Fi4A G-uideli.nes in ion. Nara; of Firm Arctic Engin'ee s, Inc p Address 1.506 West -36t4F e., Ste. 201 Signed by _William T. Bawley Date 3-28-84 (ENGINEER SEAL) 6.DHEP Approval Approved for ­ 0 Lxdrooms By Approved tl Disapproved r__I Tercets of Conditional Approval __� Date_^ Telenh0ne 561--1345 Conditional Date �A y The Municipality of Anchorage Deparurent of Health and Environmental Protection dces not guarantee the continued satisfactory performance of the water supply anal/or the wastewater disposal system. This approval indicates that, as of the validation date shoran above, based on the data and information furnished by an engineer registered in the State of Alaska, thq water supply and wastewater disposal system is safe and fi.anr_- tional for the number of bedrooms and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the following address: KB2/d5/s I'Page 2 of 21 2-15-84 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MAR 2 9 10AA RECEIVED Well Classification �individual If A, B, or C, D.E.C. Approve(LY/N) __ Well Log Present LY/N) N_/ Date Completed ^1971 Yield 10 qpm Total Dapth 300' _ Cased to 300' __ Depth of Grouting N/A Static Water Level 91' Pump Set At 286' Casing Height Above Ground m 12" + Sanitary Seal on Casing (Y/N) sq Electrical Wiring in Conduit (Y/N) Y ^ Depression Around tAbllhead (YM) N Separation Distances from M11— To Septic/Holding Tank on Lot 103 On Adjoining Tots 100' + To Nearest Edge of Absorption Field on Lot 100' + —; On Adjoining Lots 100' + To Nearest Public Sewer Line N To Nearest Public, Sewer Cleancut/Manhole_ N/A To Nearest Sewer Service Line on Lot N/A_ Water Sample Collected By W:T. Hawley ; Date 2-23-84 Water Sample Test Results Satisfactory for Total_ Coliform___ Comments B. SEPTIC/HOLDING TANK DATA Date Installed — 9-7Q r Size i nnn„--zj,,,a� No. of Ccmg?artnents 2 Standpipes {) Y _ Air -tight Caps (YM) Y_ Foundation Cleanout (Y/Ni Depression over Tank (Y//L�) m Date Dist Pined d 3-27-84 Pumping/Maintenanm Contract on File (Y/N) N A _ for N(A Holding Tank High -Water Alarm LY8jL N A Temporary Holding 'rank Permit IL/N) N Separation Distances from Septic/Holding Tank: To Water -Supply Tull 103' To Property Lire 51 -+ To Water Main/Service Lire Course 10' + [Page 1 of 21 1 _ / � F) S To Building Foundation 51 + To Disposal Field ® 51+ To Stream, Pond, Lake, or Major Drainage 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 150 sq,' ft/bed Type of System Design Trench Date Installed 9-76 Length of Field 29' Width of Field 48" Depth of Field 17' Gravel Bed Thickness 8' Square Feet of Absorption Area 528 Standpipes Present (Y/N� Y Depression over Field (Y/N) N Date of Last Adequacy Test 3-27--84 Results of Last Adequacy Tbst Passed - 485 gpd Separation Distance from Absorption Field: To Water -Supply Well 100' + To Property Line 101+ To Building Foundation 20'+ To Existing or Abandoned System cn Lot N/A , On Adjoining Lots 30' + To Water Main/Service Line N/A To Cutbank(if present) N/A To Stream/Pond/Lake/or Major Drainage Course 1001+ To Driveway, Parking Area, or Vehicle Storage Area 50' + Comments D. LIFT STATION N/A Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes Dimensions Manhole/Access (YM) "Pump Off" Level at Vent (YM) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedrocm Rating Against HAA Request ** I certify that I have ch , 7ified, or conformed to all MOA HAA Guidelines in effect on the date/bi f/this Ws ionl/ Signed Company KB1/d5/s Date _f-.1 �SJ__! MOA No. ST84-001 A� ��!l�IN [Page 2 of 21or.,, 1 [Page 2 of 21or.,, 1 . r,_. .T,--_=. _ _.�__-.,b•---.�-MUNICIPAL MUNICIPALITY OF ANCHORAGE DEPT. 'G - DEPARTMENT OF HEALTH ..& ENVIRONMENTAL PROT,Xqb1{i4NJivii:NijAL i.. - 826, L Street - Anchorage, Alaska 99601 - 0* 'JUN 2 1 ENVIRONMENTAL ENGINEERING DIVISION - Telephone 264-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed, Please allow tonJ10)days for processing, 1, PROPERTY OWNER -DoWq ed C^)T-;'i-9 VL rn PHONE -- MAILING ADDRESS - S X /9 icOrU'r, f�a�r a.clo a d' —� PROPERTY RESIDENT (If different from above) - PHONE z- 2. BUYER 12XXIV . t- - PHONE 7. WATER SUPPLY--- -- MAILING ADDRESS I+ - — 3. LENDING INSTITUTION PHONE SV T JZ. O F r %U o �P __ MAILING ADDRESS - --- ----� 4. REALTOR/AGENTPH > Z; r1,. X139 %3P 5 S —� L�—O GJ r: � -- MAI LING ADDRESS - - 5.- LEGAL DESCRIPTIIO�cN. �l � —- J-- ' STREETLO�A_TI0ON =teles rJa!, c/ 6. TYPE OF RESIDENCE - - NUMBER OF BEDROOMS - - SINGLE FAMILY - ❑ One El Four El other ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY--- -- - —_---- ;. INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY - - since June 1975 I -or wells dri led pri r to that date, give w ll _❑ PUBLIC UTILITY depth (attach log if available,)7j S. SEWAGE DISPOSAL SYSTEM -- **If installation data— T� INDIVIDUAL/ON-SITE** individual/on-site, give - If system is over two (2) years -olden adequacy test is required - ❑ PUBLIC UTILITY by this Department. - NOTE: THE INSPECTIONFEEMUSTACCOIVIPANY EACH REQUEST BEFORE PROCESSING -CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1.TYP F RESIDENCE SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2, WAT SUPPLY INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SWAGE DISPOSAL SYSTEM IIDUAL/ON-SITE ❑PUBLIC UTILITY C nnection Verified PERMIT NUMBER DATEINSTALLE 7 INSTALLER Sep/tiicc Tank or ❑ Holding Tank Size: / If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic /Holding Tank - Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY (T' e) LE L DESC IPTIO 72-010 (Rev. 3/78) MUNICIPALITY Or ANCHOR GE MNC!l0HACJ- OF HEALTH I& DUAR"WNr OF I WWA I K ENV HUNMENI A "n DEPT.MWAIMEWL PPOUCnON I � I ENV I RONFIrIF N i A I - ENUINNc LI DIVISION N OV 2, 1978 -f ohong'lr ]'O R 1---.O(J I K) R APPROVA 1, OF 1 "J D I V i D L I I kNA I F I R AND SR -4- PrYI-I I i� i'j ��: Complete wpm, Page L InvoloQu M,tv"" "611 not W to t" 1 ela"; l TY Qk�N KI Ij ADDRUS PHONE W"AlIDRISS ------ -- ji'ii,i(� NsTi it) ION ----- - Iv. !'H 1 IN AnDFR SS ,'. S�F Of: F[ n)cy.l�� I N G L P -All I LY One ou; Oise!. �vo v! IJ L. i I f I L FAMILY "o f 1\1 D I V 11) UA L' 11, 1-1AC! I vPLLL LOG. A wuI 1 1 og is qEi;cd for all vvells(Ililled 1-Y since jun,! Fo! w,'Ils clri [l(d w lcr L, bio dste, give,veil PUBLIC U I ILI VY de'l,01 log aYltw-ds;�F- --— --- -------- -- .lilGL 1 H 1) 1 VI D U A I � 0 N S I I E i fld I I (I L I ct is i � e, i! P i rls t,, o I i o 11 J a 111 Wysielu is r- ' lyn) 1) ears am an W&qWcy No linspited PUBUC UTHTI-y Ci 'I !1E I NSPI-.0 III ON F F 1. NIUST ACCOMPANY BACH RF 01 IT 81 BE ")it E fy(WESSI ING CAN BE IN I't 1A U D. b b 4, Ixf THIS SIDE POR 01=1'ICIAL. USE ONL' "P- OF RESIDENCE SINGLE I AMILY �JU1_l-IPLE FAMILY I NUMBER OF BEDROOMS r� ONE --T-1 THREE _-, FIVE C7 G -f I1 L=R J IINO iii FOUR SIY. ER SUPPLY PERMIT NUMBER -� hN OI VI DUAL DEPTH Of=I"vE LL I c0i%Ir,.nUNITY- - - - - -----_ DATE DRILLED U,�31_IC UTILJT Y � � nu lection Verlf led_ LOC RECEIVED t:IvCF DISP03AI SYSTFNI ?i IUUAI_rOG-SI Ff- WAIF lNSIAI_LLU I Ir IC unu�l a �J`17G�- ver-- _--- __-- --- INsrnu_eR Tank or !J Holding Tank I�O�. If Tank Is homemade - SOILS RA'I'I ,c- m rtnNUEAcI URI -R. .'. -� SORPTION ARID, IMAIERIAI � 1 ^/ �S -..`;1 IN (,ES ot'ci Heldir9 1a, k �AsPl:o.f:ca S•woi Llie '.V F L L 10: _ ..� ,`.raa to neart-t Lot We i I I /----AI PROVED 1013 _ _ _ - BEDROOMS - CONDITiONAI_ APPROVAL (letter must accompany r.Ctllicate) ..- DISAPPROVFD '. EY I I'iYcl Cc _S:= Pl lO'•� CHEMICAL & GEOLOGICAL LABORATO TLEE ONE (907) 562.2343 ANCHORAGE INDUS R1AL 61�NTERL", p 5633 B St b . I.7•.r ng Water Analysis Report for Total ��ihiform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: [:L—]=—] (') See h on back I.O. NO. Water Sysiem Nem. Phone No. D� 3�0 --- Mclling City `in("'/—•I vjr—v//•� State Y fNZip Cafe SAMPLE DATE: 3 3 � 4' Mo. Day Year SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample ❑Treated Water with lab ref. no.— ---J El Untreated Water ❑ Special Purpose i Water SAMPLE Time Collected NO. LOCATION Collected By 3 L - A L--- L- READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TO BY LABORATORY Analysis shows this Water SAMPLE to be: satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mall. Date Recelved Time Received Analytical Method: ❑ Fermentation Tube Membrane Filter 1 Lab Ref. No. Result' Analyst 6o-1� QE1 \= L i ED --- L I ED --- L -] FT -1 -- L- J ELI .N. of c.Io.�WIOO ml or No of Posmvo p Itom. 06122D N1 BACTERIOLOGICAL WATER ANALYSIS RECORD R.Y. 1993 Membrane Filter: Direct Count Verification: LTB T CoilformM00ml Final Mernbrane Filter Results CCoilform1100ml Reported ByL`.� _y_ ,Q —Date_._ Time: ����� — a.m. p.m. TNTC== Too Numerous To Count__. 0e -1220(a) Rey. 1973 ALAS, .PARTMENT OF HEALTH AND SOCIAL SEF DIVISION OF PUBLIC HEALTH Lab No. INDIVIDUAL AND SEMI-PUBLIC DATE BACTERIOLOGICAL WATER ANALYSIS -- INDIVIDUAL LPI SEMI-PUBLIC ❑ CHLORINE RESIDUAL PPM REPORT RESULTS TO NAME LOO (�, I& CITY/JZIP /CODE � DRESS OF SOURCE COMPLETE THIS SECTION ONLY IF W TER IS AN INDIVIDUAL SUPPLY SAMPLE COLLECTED BY - _--/_— --- DATE COLLECTED —I.Z'1 T — 7& TIME COLLECTED �J.�i,�'' Sample Collected From❑ Ki Ba lhroom Tap ElBasement Tap I] Other (List) _— _ Well —❑ Dug I] Driven rIHad I] Bored SOURCE: ❑ Spring I] Cistern Dug Well or Cistern Construction: Wolfs — I] Wood ❑ Concrete ❑ Metal ❑ Tile Brick or . - Top — ❑ Woad I] Concrete EJ Metal ❑ Open Top ❑ Concrete LOCATION: ❑ In Basement ❑ Basement Offset ❑ Under House ❑In Yard ❑ Other — Building Sewer Septic DISTANCE TO: or Other Drainage pipe_—_ --Feet. Tani_ Feet. Tile Seepage Cess - Field --feet. Pit Feet. Pool —__ Feet. Privy _ Feet. Other Possible Sources of Contamination ---- _._ MATERIAL: Building Sower- ❑ Cast Iron ❑ Wood ❑ Tile I] Fibre ❑ Asbestos El Plastic Joint Material - Type Cement GENERAL: Does Water Become Muddy or Discolored? ❑ Yes ❑ No When? — ——.—-- Diameter of Well Depth Feet._ Well Casing Material _ Diameter - Depth Length of Water Depth Drop Pipe From Bottom — Feet. Offset in In Utility PUMP LOCATION: ❑ In Well I] Basement ❑ In Basement ❑ Room O To OFFICE /Anolysis shows this Water SAMPLE to be: Ili] /Satisfactory ❑ Unsatisfactory ❑ questionable E] Sample too long in transit; sample should not be over 48 hours old at examination to indicate. reliable results. Please send new sample. ❑ Bottle broken in transit, please send new sample. - SANITARIAN'S REMARKS ❑ Of W II ❑ Other 1 PURPOSE OF EXAMINATION: Illness Suspected? ❑ Yes ❑ No New Source of Supply? ❑ Yes ❑ No Repairs to System? I] Yes ❑ No Signature -- - READ INSTRUCTIONS ON REVERSE: SIDE BEFORE COLLECTING SAMPLE -061220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1973 (� Doi. Received _ —Time Received .---L._ab. No. - Lactose Broth 10ce 10ec Igee -10'e 10'e 1.0ec 1.0ca 24 Hours 48 Hours - Brilliant Green 24 Hours 48 Hours _ — __.— -- ------ — EMB — Lactose Broth, 24 hrs. Coliform Density — MF Results Reported by (� �j__ This analysis i dicales Coliform Organisms to be: 48 AGAR Present Gram's stain ._— (Most probable No. per 100cc) NE ,�� CHEMICAL & GEOLOGICAL LABORATORIES OF A A K& INC. TEL PHO to TOM P.O. BOX 4-1276 ANCHORAGE, ALASKA 99509 4648 BUSINESS PARK BLVD. Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY PUBLIC WATER SYSTEM: az�m LABORATORY: I.D. NO. - �f,©.fw.res..L.e_-../ NAME SAMPLE DATE: 5771 F J DMI Mo. Day Year SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample with lab ref. no._ ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE NO. LOCATION 3 4 5 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Form No. 18-310 (3.78) Tlme Collected Collected By 9-vj- 90 ADDRESS r Date Received I�- U '?a Time Received —i` y� Analytical Method: ❑ Fermentation Tube Membrane Filter Lab Ref. No. Result" An t EII L m LJ ET -1 No. of col.nlss 1100 ml. or No. of Positive portions. 06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 Date Date a.m. Time Received _ P.M. Lab. No. Presumptive lOrel loml 10.1 1Orel loml 1.0011 0.1011 24 Hours — Hours _48 Confirmatory 24 Hours _ 48 Hours EMB— _ Broth 24 hours:_—Broth 48 hours:_ MultlPle Tube Report; —_10Ml Tubes Positive/Total 10ml Portions Membrane Filter: Direct Count— — Cellf0rm/100m1 Verification: LTB _ —BGB -- Final Membrane Fllte - _ C If m/100In Reported ByG, —Date -- T Im e_____--a:m. P.m. o t' I ;.4 pill 1 � i X14. 1:, E I V 1 I 4- j. _ pock, c rrn ora.cyJ , MAct, ar i 001 Cio - j „ I •.1 t t , r ) Ir In (`n - v -. r J WO Cal A E97 ry - <,I, Dr O rcr ,dv I� J 01WMA Amu, rr P n9 I , n "w ca .mJ Irl+l r+i- i {1r ro a �; (r In u- flon ald Clot i i n urn ) r ,.;,vU/„ Srs rrr�JeJ.,n 6 �,.o e r e i� Fii: �• ny r,i (i7 <a e; • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 ol._ 151_4rtificate of On -Site Systems Approval / Parcel I.D. Expiration Date: 2 s-- 1. 1. GENERAL INFORMATION Complete legal description South Lakewood Hills #1, Block 5, Lot 1 Location (Site address) 6300 Michigan Boulevard, Anchorage, AK 99516 Current Property owner(s) Mailing address Real Estate Agent 2. TYPE OF DWELLING: FHLMC Day phone 5000 Plano Parkway Carrollton, TX 75010 ❑ Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Four Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Received by: s ' ` ` Date 3`'r COSA to be release<co the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment Date of Payment /+ Receipt Number 13ga� v\ Receipt Number COSA # 05C 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 appt r,ebl,e Municipal, and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Phone Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE System #1 Approved for 4 bedrooms System #2 Approved for _ bedrooms Disapproved Date Conditional approval for bedrooms, with the following 522-7773 .�•Ur A�q�1 • �.S,f ®1 49T -H a 77 CE - By i Original Certificate Date: 3-2-5`/3 The M cipality' o age Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the reprd Mentations 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. f,, r 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advibory' - _ Well Flow Advisory COSA blUe sheet ^ Other 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: South Lakewood Hills #1, Block 5, Lot 1 Parcel ID:015-151-35 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) N Date completed y Sanitary seal (Y/N) Wires properly protected (Y/N) Total depth ti ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test 2/22/13 Static water level n. 96.3 ft. Well production 9-p m. 7.2 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate N/D mg/L Arsenic 6.36 ug/L Date of sample: 2/26/13 Collected by: J. Anderson B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Fiberglass/Steel Date installed 9/76 & 10/89 Tank size 50011000 gal. Number of Compartments 2/1 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 3/15/13 Pumper Around The Clock Pumping C. ABSORPTION FIELD DATA Date installed 6/8/12 Soil rating (g.p.d./ft2 orftZ/bdrm) •8 GPD System type Deep Trench Length 73 ft. Width 3 ft. Gravel below pipe 6 ft. Total depth 9 ft. Eff. absorption area 876 ft2 Monitoring tube Y Depression over field N Date of adequacy test 3/5/13 Results (Pass/Fail) PaSs For 4 bedrooms Fluid depth in absorption field before test 4 in. water added 600 gal. New depth 12 in. Elapsed Time: 1,440 min. Final fluid depth 4 in. Absorption rate >= 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons Manhole/Access (Y/N) in. "Pump off' level at in. High water alarm level at Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot >1 00' Absorption field on lot >1 00' On adjacent lots >1 00' On adjacent lots >1 00' Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line >25' Holding tank N/A Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5' Water main >10' Water service line >10' Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water Service line >10' Surfacewater >100' Curtain drain None Noted Wells on adjacent lots >I 00' Absorption field >5 Surface water >100' Water main >10' Driveway, parking/vehicle storage >10, F. COMMENTS Two septic tanks on lot. The 1,000 Gallon Fiberglass Tank was Constructed in 1976. The 500 Gallon Steel Tank was Constructed in 1989. G. ENGINEER'S CERTIFICATION 1 certify that l 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 Michael E. Anderson, P.E. Date 3/19/2012 COSA brown sheet 10-10-12.doc L ANDEWN -4301 in. &4 d Y ��o»e 2fdau5� 0 OF AC,t A TH hums Karl Dowling 15615 . '�OffSS�ONA� It is the responsibility of the owner to determine the existence or any easements; covenants or restrictions NOTES: - eh not appear an the recorded subdivision plat. Un T Y��� OTHER THAN THOSE Under n no cireutnttanees should any data her<on be U EASEMENTS OF RECORD, used for construction or for establishing boundary or SHOWN ON THE RECORDED PLAT. ARI; NOT fence lines. The surveyor takes responsibility for the SHOWN HEREON. initial transaction only.' -> BRASS CAP MONUMENT LOT___Z._ BLOCK . O 1RON PIPE ^eo .:1i /l4 - (PLAT NO.: �) • REAARCORNER FOUND .... ., nnrwr� nlc TQrf T ❑ HUD AND TACK - BY: pOWLING & ASSOCIATES 1426 Hyder Street . Anchorage, Alaska 99501 Inv. A IRCAI F• I REVISIONS WORK ORDER: DATE ELD BOOK: BY NO.: 1101