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HomeMy WebLinkAboutSOUTHFORK BLK 2 LT 3Southfork Block 2 Lot 3 #078-031-04 Parcel I.D. 078-031-04 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Expiration Date: .3 6 a✓ 3 1. GENERAL INFORMATION Complete legal description Southfork BIk2 Lt3 Location (site address) 1515 South Creek Rd., Eagle River Ak. 99577 Current Property owner(s) James Finn Day phone Mailing address 1515 South Creek Rd., Eagle River Ak. 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: El Single Family (w/wo ADU) El Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ —tel O — ( Waiver Fee $ Date of Payment 1 a 1 LP f l a Cie -V:3.- Date of Payment Receipt Number or51� 1 aG% Receipt Number COSA# CfsC\ -k 55 G'\ 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 Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE i/ System #1- Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for By: Phone (907)272-8218 Date 62—COMM az-titer q.til„.Afmk ,tr49TM /\: */ . CE -81 4 4`10*9 bedrooms, with the following stipulations: *Qr' OF `rVcy4.. ifyA ON-SITE WATER AND o� WASTEWATER PROGRAM Pe -t ( Original Certificate Date: / - a 6 - 12- ThdjMGnicipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA blue sheet_E L, c Nitrate Advisory Arsenic Advisory 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: Southfork BIk2 Lt3 A. WELL DATA Well type Private Date completed Total depth 99 ft. 6/82 Date of test Static water level 62 ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate 0.215 mg/L Arsenic ND ug/L Date of sample: 11 /29/12 If A, B, or C provide PWSID # Sanitary seal (Y/N) Cased to 99 ft. FROM WELL LOG 6/82 20 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Steel Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) Date of pumping 11/27/12 Parcel ID: 078-031-04 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 18 AT INSPECTION 8/15/12 62 5.1 ft. g.p.m. in. Collected by: PES Depression over tank (Y/N) N Pumper J R s Pumping Date installed 3/13/98 Cleanouts (Y/N) High water alarm (Y/N) NA C. ABSORPTION FIELD DATA Date installed 3/15/98 Soil rating (g.p.d./ft2 or ft2/bdrm) 4 gpd/sf Length 20 ft. Width 18 Total depth 2.5 ft. Eff. absorption area 360 ftZ Date of adequacy test 8/15/12 Fluid depth in absorption field before test 0 Elapsed Time: 90 min. System type Bottomless IDSF ft. Gravel below pipe 2.6" ft. Monitoring tube Y Depression over field N Results (Pass/Fail) Pass For 3 bedrooms in. Final fluid depth 0 Water added 459 gal. New depth 0 in. in. Absorption rate >= 450+ g.p.d. If yes, give date Any rejuvenation treatment (past 12 mo.) (Y/N & type) N D. LIFT STATION Date installed 3/13/12 Size in gallons 1250 Manhole/Access (Y/N) "Pump on" level at Timer in. "Pump or level at Timer Datum Bottom of Tank Cycles tested 3 E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 100+ in. High water alarm level at 47 SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Meets alarm & circuit requirements? Y in. On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Curtain drain 50+ F. COMMENTS Water main 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Wells on adjacent lots 100+ G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R Pannone Date 12.12-0,6 COSA brown sheet 10-10-12.doc -2-739t ticrketai .rip •.t*,, fro • even Amon 00.•. CE -81449 .* + iRs Pumping inspections Tank Type: (bSJ Name: 5 iE_S /-7/14/ Address: (57C Sc rpJ Ck Ek Phone Number: Inspection #: Timer Setting: c3,74 , t: ) / c>C tie., oP:— Air Flow: crt Elapsed Time: )1(17, 02 - Event Counter: toy 6413 Date & Time: (Zlg 1 �Z Problem: ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT MEMORANDUM OF UNDERSTANDING BETWEEN MUNICIPALITY OF ANCHORAGE AND DAVE AND RAMONA MITTON THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this Day of D o t nn h e_ of 20 12_, by and between 17,1 herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Memorandum of Understanding agree as follows: 1. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as . .c F located at 1515 SOUTH CREEK ROAD EAGLE RIVER , Anchorage, Alaska. ,<() L-1 tLL L'o✓ k i3-2 L-- :3 2. Definitions. A. Alteration. Any change to the design or function of an AWWTS that Includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Prior to performing any alterations to an AWWTS the owner must obtain a Wastewater Disposal System Construction Permit from the Municipality pursuant to Anchorage Municipal Code (hereinafter, "AMC") 15.65. B. Certificate of On -Site Systems Approval. An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with AMC 15.65. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. C. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. D. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AWWTS that were included in the original design which would allow the AWWTS to continue to perform as designed. E. Permit (Construction) An On-Site Wastewater Disposal System Construction Permit as defined by AMC 15.65. F. Permit (Operating) An Advanced Wastewater Treatment System Operating Permit. An annual permit, issued by the Municipality, that allows the Owner to operate an AWWTS, upon meeting all the requirements of this agreement, the conditions of Operating Permit, the requirements of the On-Site Wastewater System Construction Permit and all relevant provisions of AMC 15.65 3. Fee. Owner shall pay to Municipality an annual fee of ZERO ($ 00 .00), payable on or before the issuance of the operating permit and annually thereafter. The annual fee is due on or before the anniversary date of the approval by the Municipality of installed system. 4. Term. The term of this Memorandum of Understanding shall be for the life of the AWWTS. The term begins on the date of approval by the Municipality of the installed system and shall continue while the AWWTS system is in use or operational or until the property is sold or title is transferred by owner and a new certificate of On -Site approval is issued to the new owner or transferee of the property. 5. Alterations, Installation and Removal of Additional Equipment. Owner agrees not to make any alterations, removal of parts or additions to the AWWTS without a Construction Permit from the Municipality. 6. Maintenance and Repairs. A. Throughout the term of this Memorandum of Understanding, the Owner shall maintain AWWTS in good repair. In addition, it shall be the responsibility of the Owner during the term of this Memorandum of Understanding, and any extensions or renewals thereof, at the owner's sole expense, to pay for any and all: (I) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs. Further, Owner agrees to comply will all applicable ordinance, laws, regulations, rules and orders for the AWWTS. B. Owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system pursuant to the terms and conditions contained in the Owner's AWWTS Operating Permit. This schedule shall be submitted to the Municipality annually upon the renewal of the permit. The schedule of maintenance and repair contained in the Owner's AWWTS Operating Permit is: C. Owner acknowledges that the fine schedule for failing to maintain and repair an AWWTS are codified in AMC 14.60. D. Owner agrees that only maintenance, repair personnel certified by the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system. E. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS upon 24 hours written notice. F. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. G. Owner agrees that the relevant provisions of the standard specification guidebook for AWWTS is the governing professional guidelines for the construction, maintenance and repair of the Owner's AWWTS. 7. Nonwaiver. The failure of either party at any time to enforce a provision of this Memorandum of Understanding shall in no way constitute a waiver of the provisions, nor in any way effect the validity of the Memorandum of Understanding or any part hereof, or the right of such party thereafter to enforce each and every provision hereof. 8. Amendment. A. This Memorandum of Understanding shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality of this Memorandum of Understanding was executed and such writing shall be attached to this Memorandum of Understanding as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this contract, the only authorized representatives of the parties are: Owner: DAVE AND RAMONA MITTON Anchorage: Purchasing Officer C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 9. Jurisdiction: Choice of Law. Any civil action arising from this Memorandum of Understanding shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Memorandum of Understanding. 10. Severability. Any provisions of this Memorandum of Understanding decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Memorandum of Understanding. OWNER: MUNICIPALITY: By: _ _ By: Title: Date: /,1///l ,3r<%/ 2— Date: STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT The foregoinginstrumentwas acknowledged before me this // day of - 20/ ,bye/.✓i77 2 11i //t/�/. kRY PUBLIC FOR AL / , ommission expires: 9 4/ Parcel 1 D # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services Onsite Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING 078-031-04 HM# O J O O 13 1. GENERAL INFORMATION Complete legal description SOUTHFORK SUBDIVISION- 1 OT 3. BLOCK 2. Location (site address or directions) SOUTH CREFK ROAD (2nd HOUSE ON LEFT) Property owner MATTHEW DIVFNS Day phone — Mailing address c/o CINDY STERNS w/ COI DWELL BANKERS OF F.R. Lending agency Day phone Mailing address Agent CINDY STERNS w/ COLDWELL BANKERS OF F.R. Day phone (907) 696-9310 Address 10926 FAGI E RIVER ROAD. SSJITE 115 * EAGLE RNER. AK 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well xxx Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding Tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC Ing to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 Computer Version Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1,000.00 at, or prior to, closing for the engineering services provided. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system Is safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and ins.: -'on, the on-site water supply and/or wastewater disposal system is In compliance with all Munici • . f r d State codes, ordinances, and regulations In effect on the date of this inspection. Name of Firm ALASKA W TER & Address 6901 DEBARR R AD S TATER CONSULTANTS. INC. Phone (907) 337-6179 2 A • .O • • GE. ALASKA 99504 Engineer's Signature In conducting this evaluation, AWWC, Inc system In accordance with ADEC and M performance of the system under the conditions encountered at the time of the test, and separation distances measured to readity Identifiable features. The operational life of all wells and septic systems depend ' on the local soils condition, ground water levels that may fluctuate during the year, and the water usage of the famity 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. AWING, Inc. can therefore not provide any warranty for future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DHHS. 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 ft confer any legal right whatsoever. 6. DHHS SIGNATURE Date / 0 S o/ d to provide a thorough, conscientious engineering analysis of the Guidelines & Regulations. The reported results described the _7 Approved for 3 bedrooms Disapproved Conditional approval for c oa D A. Gr'essr s —7953e ` O • .scsooGO Qd4( feeets'S=. 0 ‘40000�� bedrooms, with the following stipulations: Additional Comments BY.,/a/ /-% / Date /— 9 — O The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given In paragraph 5 above by an Independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending Institutions In order to satisfy certain federal and state requirements. Employees of DHHS do not conduct Inspections or analyze data before a certificate Is Issued. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Computer Version Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 8251' Street, Rm 602 Anchorage, Alaska 99501 (907) 343-4744 Health Authority Approval Checklist Legal Descdptlon: SOUTHFORK SUBDIVISION; LOT 3, BLOCK 2, Parcel I.D.: 078-031-04 A. WELL DATA Well Type PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number N/A Log present (YM) YES Date completed 6/1982 Total depth 100' Cased to 100' Casing height (above ground) 18"+ Sanitary seal (WN) YES Wires properly protected (WN) YES FROM WELL LOG AT INSPECTION Date of test 6/1982 12/11/2000 Static water level 62' 67' Well production 20 g.p.m. 6.12 g.p.m. WATER SAMPLE RESULTS: Coliform 15 Nitrate Other bacteria '� Date of sample: 12/11/2000 Collected by: A.W.W.C., INC. B. SEPTIC/HOLDING TANK DATA Date installed 3/12-15/98 Tank size 1250 Number of Compartments 2 Cleanouts (YM) YES Foundation deanout (YM) YES Depression (Y/N) NO High water alarm (YM) YES Date of Pumping 7/2000 Pumper JR's PUMPING C. ABSORPTION FIELD DATA 98 uS Date installed 3/12-15/88 - Sob rating (7p.dJf orft2lbdrm) 4.0 System type BOTTOMLESS ISF Length 20' Width 18' Gravel thickness below pipe 2.6" Total depth 2.3' Effective absorption area 360 SOFT. Monitoring Tube present (YIN)Si Depression over field (Y/N) NO Date of adequacy test 12/11/00 Results (Pass/Fatl) PASSED For 3 Bedrooms Fluid depth in absorption fleld before test On.); 0" Immediately after S.1_981 water added (In ): Fluid depth 0" (Ins) Minutes later. 0 Absorption rate = 450+ Peroxide treatment (past 12 months) (Y/N) NONE KNOWN If yes, give date — 72-026 (Rev.3196r Computer Version D. LIFT STATION Date installed 3/12-15/1998 Size in gallons 1250 Manhole/Access (YM) YES 'Pump on" level ar TIMER 'Pump off' level ar TIMER High water alarm level ar 47' Datum BOTTOM OF TANK Cycles tested 3 E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main 100'+ 100'+ N/A On adjacent lots On adjacent lots 100'+ 100'+ Public sewer manhole/deanout N/A Sewedseptic service line 25'+ Lift station 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Absorption field 5'+ Water main/service line 101+ Surface water/drainage 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: •BorroMLESB ISF IS 10+ FEET. OLD DRNNF1ELD INSIDE UTILITY EASEMENT. Property line • 10'+ Building foundation 10'+ Water main/service line t 01+ Surface water Curtain drain 100'+ F. ENGINEER'S CER11FI I family that I old Inspections and review of Municipal - �•_ . � ; tlrli1r [QZ:';,, : ms are In conformance with MOA etl, ; this date. Signature NONE KNOWN Driveway, partdngNehide storage area 50'+ Wells on adjacent lots 100'+ Engineers Date HAA Fee $ 300 . O O Date of Payment /— 5 —6/ Receipt Number O ( y 72020 (Rev. 319er Computer version Waiver Fee $ Date of Payment Receipt Number 12-15-00 12:41 FROM -CTE ENVIRONIE8TAI • ALL Cl; SE Environmental Services Inc. 5615301 1-475 P.02/03 F-197 CT&E Reid/ 1007658001 Client PO# Client Name AK Water & Wastewater Consultants Inc. Printed Date/Time 12/14/2000 16:38 Project Name/ NIA Collected Date/Time 12/11/2000 12:06 Client Sample ID South Fork S/D 13 132 outside Received Date/Time 12/12/2000 13:45 Matrix Drinking Water Technical Director Stephen C. Ede Ordered By Released By r' % 0 PWSID 0 Sample Remarks: Allowable Prep Analysis !nit Parameter Rcsulu PQL Units Method Limits Date Data Waters Department Nitrate -14 0.533 0.500 mg/L EPA 300.0 10 max 12/12/00 SCL Microbiology Laboratory Total Coliform 0 col/IOOrnL SM18 9222B 12/12/00 KAP 1, 12-15-00 12:42 FROM -GTE ENVIRONMENTAL db. 5615301 T-475 P.03/03 F-197 CT&E Environmental Services Inc. Laboratory Division ►iuiM'SSIS "ISIMPardrnesflstts•"""'•""n 200 W. Potter Drive Anchorage. AK 99518-1808 Tel: (9071582.2343 Fax: 907 581.5301 jnlcing Water Analysis Report for Total Coliform Bacteria READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SA TOE COMPLETED BY LABORATORY. LE MUST BE COMPLETED BY WATER SUPPLIER Analysis shows this Water SAMPLE to be: O Satisfactory O Unsatisfactory O Sample ova 30 hours old. mutts may be unreliable O Sample too long in transit sample should not be aver3t01wun old at examination to indicate tellable al ItdePile a send new sample vi: 3:44/, O PUBLIC WATER SYSTEM I.D. R PRIVATE WATER SYSTEM O Send Resrbe O . Sed Invoke nwarrn ALASKA WATER & WA Cro4 �• 6901 '- RAGE, AK 995(4 0 Sed Rnuhi 0 Sed Grout irMASICA-WiatittniniATER '"w ""'" CONSULTANTS • narAnnniw 2[a a SAMPLE DATE: I,r a0 Month Day SAMPLE TYPE: Routine • O Repeat Sample (for routine sample with lab ref. no. O Special Purpose SAMPLE LOCATION rWFea1L �Qy GL«$c-z Commend: t Ynr O _Treated Water 7:1 Untreated Water Time Collected Collecte,,..d By 2ct� d1� Jt.w� Plow h. BACTERIOLOGICAL WATER ANALYSIS RECORD Total Califon' E. tail M:1t0-MUG Resales Cobaksl100 ml Membrane Filter: Direct Count COLIFIRM Verification: LTD �-- BOB Feral Coliform Confirmation nasi Membrane Fitter Reda Reported By — a �'� Date Received Time Retched Aaalysb Begaa Analytical Method: Membn"e Filter MMO-MUQ • Numb...—. -.. '9 ml. Result* 100?658 Analyst ...,,...w,s a:. _12. - Ana Ma Jun ❑ F Dau: Time: Client notified of unsatisfactory results: Fab Spoke with wee: Time: Conoltf&tOo ml Time c�C2— bra Fated TNTC -Teo N..nwi To (-1 oa- Other ewwd• * 3 Member of tM sus Group (Sociite CONKS de Survoillennl ENVIRONMENTAL FAOLITIES P4 ALASKA CALIFORNIA, FLORIDA. ILLINOIS. MARYLAND. M104IGAN. MISSOURI. NEW JERSEY. OHIO. WEST VAGINA Sent By: Alaska Water and Wastewater Con; 907 338 3246; Jan -5.01 17:44; Page 2/2 X PROPERTY OWNER MAINTENANCE AGREEMENT ON-SITE WASTEWATER DISPOSAL SYSTEM This agreement, dated S Tjythl fry/ , 20 , is made between the Municipality of Anchorage Department of Health and Friman Ser is (Dl -IHS) and the property owner(s) of � Lo 3 6,_'k t o2 .sDrr %rtc This agreement is made for the purpose of maintaining an on-site wastewater disposal system on the subject property. The property owner(s) agree to the following: The property owner(s) will have an annual inspection of the system performed by a registered professional engineer. This inspection shall verify that all effluent and air pumps, timers, and alarms are functioning as designed. Any deficiencies shall be corrected and the engineer's statement that the system is functioning as designed shall be filed annually with the DHHS. (Notarize Here) OFFICIAL SEAL MON1Y E. BENSON NOTARY PUBLIC—STATE OF ALASKA My Comm. Expires Dec. 19. 2001 Property Owner Name State of /9/4 -c -A p9 - Judicial District '3.1s• SS. On this 51day of Tp/L • in the year Oet)o ( , before me. the undersigned notary public, personally a peared: NNE 5 R. -f//t/X/ known to me to be the ers (s) whose eit(s) jd/are subscribed to the with trument and acknowledged that t /she/they executed the same for the purposes therein contained. In witness whereof, I hereunto set my hand and offic. eal / iQi'✓J.^h.i o tc (signature) /col,f &t1 sot' Notary's'rinted name) My ommission expires: fc. /tel - Ooo N 01/04/2001 20:52 FAX 9078688770 A PLUS HOME SERVICES X HOME SERVICES, INC. 7501 E. 140th Avenue Anchorage, Alaska 99516 345-1890 CUSTOMER Cindy Steams C/o Caldwell Banker Fortune 10928 Eagle River Road Eagle River, AK 99577 ® 001 INVOICE# 19594 DATE DESCRIPTION AMOUNT 9S p° 8417 k» $ /s+o.-L� 01-04-01 eplace/Repaa Mr Blo�'cr L Bat 'AHthcreeK Road 3't ►t.�pect S a"""`? c s turn a$ that After the Chugach State Part gigu there _ g > kes* ker &n , 4. Call Cindy on cell if lost 3514845 or o� �; b5• t it: �, t. • 8 E 1 q����;`�. 8 Matt Divms i% f 1 3 W 8 �� R TOTAL ICi5 UJ fax invoice 696-4507 \• $ r REIRKSa'' ,Y r Gallons Septic Area Holding Tank Standpipes 0 Floater on Time Leach top PROBLEM AREA — CALL NEEDS TO BE DONE AGAIN FOR MORE INFORMATION IN 6 MONTHS ❑ sludge buildup on bottom 0 Cut standpipe to 1' above ground IN ❑ ■ Good Shape ❑ Jim cap missing or needs replacing ■ Needs Septictrine - Municipality of Anchorage Page 1 of 4 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: Stn)cicaot7zg PID Number t 7 —031-04 Name: AQQ,Tpr A•-71 Wastewater System: ❑ New Upgrade Address:, l-^ $5" (lox 930'6 �,K. �r's�••7 YrV ABSORPTION FIELD Phone: w 14 338 - 6 263 I No. of Bedrooms: ❑Deep Trench ❑Shallow Trench ❑Bed ❑Mound Other LEGAL DESCRIPTION Soil Rating: 4 GPD/S .. Ft. Total Depth from original grade: 2.8' zv 3.1 Lot: Block: Subdivision: 3 2 S o N f� Depth to pipe bottom from of inal grader • S -t-o .9 (4*�P-- Ft. Gravel depth beneath pipe 2. (0 14 coas Township: Range: Section: Fill added ab9ve original gradey 1.25 2' q5 Ft. Gravel length: 20 Ft. • 0 New ❑Upgrade Gravel width: /Q A �7 Ft. Number of lines: Distance ween lines: Ft. Classification (Private, = C): Total De Ft. Cased To: FY. Total absorption area: 36 0 SD. Ft. Pipe3m34l: PvG o sci# 4a Driller: = - Drilled: Static Water Level: Ft. Installer: Woo° k Somas Date installed: 3/98 Yield: GPM I Pump Set at: I Ft. Casing Heig ve Ground: TAN K SEPARATION DISTANCES ❑ Septic ❑ Holding %S.T.E.P. • To From Septic Tank Absorption Field Litt Station Holding Tank ' Private Sewer Lines Manufacturer: 1' h"1 . c�JIL Capacity in gallons:•• IZS0 Well- f Ila *• A 140 = / 11 O +• J r 144. r 75 r Material: 'TESL Number of Compartments: 2 surfac Water 1001* loo/* 100/-r 1C)014"LIFT STATION 5:-r%a,f Line A 4 4. A 'v4. / f0 i �� p ��t7ASizengallons: I Manufacturer A..3 CA -11 • .i0 Foundation 1 I / t 'Bet iI 1*ciS "Pump on" level at:Pump Ti f-, e/2... off" level at: TI m ex. High water alarm at: 47 Curtain Drain 1•)/A /0/A NA N/A Pump Make & Model Ce-SJCO Electrical Inspections performed by: ��•L G0014- I tJ LEN" E l -I Remarks:6 E)cIST 4&• S PT C•- ` Jj/- BENCH MARK pit -L. -ED W1714 Sot L.. Location and Description: -`oP of D6G14 C1 �•"7S esia• 00 Prt2 LI!JE 3/A5/ja • y p ,)& t-A-,,� 11.6 —MP $0.1l....! frsgESi Assumed Elevation: 100 . 00 Ft JJ ---Na p Porosi siL�j-!1 1 OF 'a BuLLF.2 k waw es. 00, -Is DoE ENGINEER'S .,,.:t,,,..w .4 r.: '•'•'•' °� ;/t ' .1 ffr (1,k o . 0rES$0 SE: 1 , 1 % . e. AI i' "" Gamest X14 795' ,, 00 : . 14 1. j -r-ii-e. SpL2.LrJCr/Su HMBQ, of 19ni l • Inspections by: I"^ �,t�1 tAMs Dates* 1st 31/2./ 8 performed 2 Ay_ µ,,c WA31-&-I42,O 313/98 J il13/ y� 3, �98 Department of Heal, and u - n $ rvikes approval Reviewed and approved by: 4 '�._ Date 3 -24 -98 72-013 (Rev. 9/91) MOA 25 11. N LA XISTING WELL AC = 19.1 AF = 47.6 AG = 32.4 JC = 49.7 BF = 71,9 BG = 55,6 AD = 18,9 JF = 101.1 AI = 42.1 JD = 53.0 AH = 53,8 BI = 59.7 AE = 20.7 BH = 735 JE=60.3 JH=112.8 SW980028 PID: 078-031-04 NOTE! THE AIR COMPRESSOR IS A THOMAS INDUSTIRES, MODEL 5070, AS SUPPLIED BY ANCHORAGE TANK. THE AIR LINE IS 3/8 INCH DIA. HDPE (NO JOINTS) , INSULATED WITH 1/2 INCH FOAM PIPE WRAP (R3 VALUE), INSIDE A 2 INCH SCH, 40 ABS JACKET. THE LINE IS BURIED TO A MINIMUM DEPTH OF 3 FEET. AIR COMPRESSOR LOCATED IN GARAGE AIR LINE, SEE NOTE ON THIS SHEET. XISTING BERM BER DRAINAGE SWALE NEW 1250 GALLON STEP TANK EOU PPED I WITH INTERMITTENT DOSING TIMER. \ \ BERM \ T IN EACH CORNER \ I' \ EXISTING TRENCHES 1,25 INCH PVC F' e 10' UTILITY EASEMENTS NEW 18'X 20' BOTTOMLESS INTERMITTENT SAND FILTER. TEST HOLE #1 TEST HOLE # AS—BUILT DWG OF SEPTIC UPGRADE: LOT 3, BK 2, S❑UTHF❑RK S/D PREPARED FOR: ANITA TH❑MPS❑N PREPARED BY: ALASKA WATER & WASTEWATER DATE: 3/15/98 I DRAWNI GARNESS I SCALE: 1' = 30' A. Garnessi —7953 .`/O� 4dprofession°\ <=0 �40000.� 1 INCH PVC HEADER. HDPE AIR LINE TO SAND FILTER 1.25 INCH PVC LINE FROM THE STEP TANK. AIR LINE COIL SPACED AT APPPROX 2 FEET. ORENC❑ 'WASTEFL❑W TYPE PROVIDED BY ANCHORAGE TANK. 18' x 20' BOTTOMLESS ISF NO LINER ON BOTTOM, PRESSURE PIPING DESIGNED BY ❑RENCO, AND SUPPLIED BY ANCHORAGE TANK. 4 INCH DIA. M❑NIT❑RING TUBE AT EACH CORNER, FLUSHING VALVE (TYP). BURIED WITH REBAR MARKER, FLUSHING VALVES ARE IN LINE WITH MTs AIR LINE 18' BELOW TOP OF SAND 3/4" PVC LATERALS 2' MINIMUM COVER ioz• 15+ 2' INSULATI❑N BOTTOM = 96.4 TO 97,84 TD = 2.8 TO 3.1 FEET, 6 ` LAYER OF 3/8' PEA GRAVEL WITH THE PVC LATERALS BURIED MIDWAY IN THE STRATUM. INVERT = 100.09. DEPTH OF PEA GRAVEL BELOW PIPE = 2,6 INCHES FILTER FABRIC OVER PEA GRAVEL ORIGINAL GRADE 99.2 TO 100.9 [3:1 SIDE SLOPE VISQUEEN WAS PLACED ON SIDEWALLS ABOVE THE ORIGINAL GRADE. 2.0 FEET MIN. OF FILTER SAND. TOP OF SAND = 99,87 AS- 3UILT ISF D -TAIL DWG SEPTIC SYSTEM UPGRADE : LOT 3, BK 2, S❑UTHF❑RK S/D. PREPARED FOR: ANITA TH❑MPS❑N PREPARED BY' ALASKA WATER & WASTEWATER DATE: 3/15/98 I DRAWN: GARNESS I SCALE: NTS 4/4 PERMIT# SW980028 AS -BUILT DRAWING 96.7'+. MIN. COVER = 4.0+ FEET P.I.D.# 078-031-04 NEW 1250 GALLON STEP TANK. ANCHORAGE TANK. INLET INV. = 92.25 TANK SET LEVEL WITHIN .18 FEET. DROPS TOWARDS THE OUTLET END. DUAL 1.25 INCH PRESSURE LINES. ONE GOES TO OLD TRENCH & THE OTHER GOES TO THE NEW BOTTOMLESS ISF. FLOW CAN BE DIVERTED BY SWITCHING VALVES IN THE LIFT STATION. 4 INCH DIA. PVC LINE FROM HOUSE. INVERT AT THE FIRST DOUBLE C/O = 92.32 SEPTIC AS -BUILT! L❑T 3, BK 2, S❑UTHF❑RK S/D PREPARED F❑R: ANITA TH❑MPS❑N ALASKA WATER & WASTEWATER DATE: 3/15/98 IDWN: GARNESS I SCALE: NTS Gook Inlet Bectric- Chugiak i' 907-688-1590 ial3/16/98 .11:7.26 PM r91/2 Cook Inlet Electric, Inc. P.O. Box 670375 Chugiaic. Ani 99567 907-688-3202 fax 688-1540 Fax Message To: Alaska Water and Wastewater Attention: Jeff Fax Number: 338-3246 From: Marty Date: 10/27/97 Number of Pages ( including this one) 1 In regard to: Anita Thompson - lot 3 blk 2 Southfork This is to certify that the on site sewer lift station at the above address has been wired in accordance with the 1996 NEC and manufacturers specs. The system was checked and performed as specified in the system manual. Martin Lovejoy Electrician Journeyman License #108634 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 i298 W3° PAGE 1 OF 1310-N ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW980028 DATE ISSUED: 3/11/98 DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES EXPIRATION DATE: 3/11/99 OWNER NAME:THOMPSON ANITA D OWNER ADDRESS:HC 85 BOX 9308 EAGLE RIVER, ALASKA 99577-9401 PARCEL ID:07803104 LEGAL DESCRIPTION: SOUTHFORK BLK 2 LT 3 LOT SIZE: 91264 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THIS PERMIT IS FOR THE CONSTRUCTION OF AN INTERMITTENT DOSING SAND FILTER. THIS IS AN ALTERNATIVE WASTEWATER SYSTEM AND THE ATTACHED NOTARIZED PROPERTY OWNER AGREEMENT SHALL BE A PART OF THIS PERMIT PACKAGE. RECEIVED BY: ISSUED BY: 0,40/, /07 -0 -e,2 - DATE : < ` /» 7 g DATE : „) -- // - / e Alaska Water & Wastewa er „�u r ur 7320 East Chester Heights Circle Anchorage M Alaska NMENTAL SERVICES DIVISIOf, February 19, 1998 (907) 337-6179 — Fax (907). 338-3246 Consulting Engineers FEB 2 3 79 94' Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref. Sewer Upgrade for Lot 3, Bk 2, Southfork S/D. To whom it may concern: ...apeOF A "P•r ,CEI 'ED 't/ ' ® S sr A . cis 14,41 • CE -7953 a R OFESSIOt..a The existing 3 bedroom house is served by an onsite septic system, and a private well. The drainfield will not pass an adequacy test (surcharged) at this time, and must be upgraded prior to the sale of the house. Comments regarding the proposed upgrade are summarized as follows: 1. GENERAL: There are a number of site restrictions which limit the available spots to put the new drainfield. These restrictions are summarized as follows: • The lot slopes down steeply from east to west (from the berm to the house); from the gravel berm at >100%, to approximately 25% just east of test hole #1. We are proposing to place the new drainfield between the two test holes on a 10% slope. See the attached site plan. • In addition to the steep slope on the east side of the house, there is a slight drainage swale which appears to function as a pathway to divert surface runoff away from the house. See the attached site plan. The new drainfield site is immediately uphill from this swale, so as not to interfere with its drainage path. • The existing septic system on Lot 3, Bk 2, and the protective well radius' for Lots 2 & 3, Bk 2 "consume" much of the remaining space on the lot. • Groundwater was encountered at 7 feet below grade (TH #2) on 2/17/99. This level will undoubtedly rise in the spring. This dictates that a shallow system be installed. Given these restrictions, it appears that the only suitable site for the septic upgrade is the location shown on the site plan (short of placing the system over two hundred feet to the north). Because of the limited space, groundwater, and tights soils, we are proposing to install a bottomless, Intermittent Sand Filter (ISF). 2. SOILS: On February 10, 1998 two test holes were excavated and percolation tests performed at the area of the proposed septic upgrade, see attached soil logs for soils classification and ground water levels. As can be seen from test hole #1 soils log groundwater was monitored at 7 feet below ground surface. We anticipate that the groundwater levels will rise this spring, but to what extent it will rise is uncertain. Consequently we are proposing a design depth (bottom of pea gravel) of one foot below the ground surface. This will allow for a two foot rise in the current water table, which is currently 7 feet below grade. 3. TRENCH DESIGN: Bottomless Intermittent Sand Filter (ISF) a. Percolation Rate: 20 minutes/inch b. Allowable Application Rate for ISF: 4 gallons/day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 112.5 ft2 f Effective Depth: 2.5 inches g. Width: 18 feet h. Length: 20 feet. i. Effective absorption area = 360 ft2 (>112.5 ft2 OK) j. Air Supply: Thomas Industries, Model 5070, "Anchorage Tank". k. Air Supply Line: "Wasteflow" emitterline, 1/2 inch I.D, "Anchorage Tank". 1. Sand Material: Central Paving Products "Winter Road Sand" m. Pea Gravel: 100% passing 3/8" sieve, less than 20% passing the 1/4" sieve, and less than 1% passing the #8 sieve. We are proposing to excavate down to a maximum depth of 3 feet, place a minimum of 6 inches of sand, install the air supply line, and cover it with 1.5 feet of sand. On top of the sand, we will place 6 inches of 3/8 inch pea gravel, with the pressure laterals midway in the layer. We will use a conventional lift station (Anchorage Tank), equipped with a programmable timer so that flow can be intermittently dosed to the ISF. 4. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system. 5. TOPOGRAPHY: See the site plan for slope information. The slope is approximately 10% at the proposed site for the ISF. Just east of the proposed site for the ISF , the ground slopes upward at approximately 25% to the toe of the gravel berm then takes off up at a slope of >100% (see the 1" = 30' site plan). To the west (downhill) of the proposed ISF the slope is less than 10 %. Based upon our field measurements, it appears that the ISF will be at least 50 feet uphill from any slopes greater than 25% except for those slopes shown which are all uphill from the proposed ISF. In short, there are no slope concerns. 6. MATERIALS AND CONSTRUCTION PRACTICES: The materials used, and the construction practices will comply with DHHS' "Intermittent Sand Filter Design, Installation & Maintenance Manual". The contractor should read this document prior to construction. Copies are available at the Municipal Onsite Services office (5th floor, 9th & L St.). 7. CLOSING: Given the site restriction, and the soil/groundwater conditions, I think the ISF is the most viable option for this lot. I am open to any suggestions from your department, which would be an improvement to the proposed design. I am unaware of any adverse impacts this installation would have on adjacent wells (there are none within 100 feet) of the proposed septic system. If you have any questions, please contact me at 337-6179. Thank you for your assistance. Sincerely, Jeffr: ' �'. mess, ' . ., M.S. Pri ip a c. c. Prudential, Vista, Eva Loken Anita Thompson APPROXIMATE LOCATION THE SEPTIC SYSTEM. TO 7.5 FEET. \ \ \ F AL DEFT 1 XISTING TRENCHES NEW SEPTIC SYSTEM. BOTTOMLESS ISF CARROLL MOON HOMESTEAD (G/30/72) PID #1 078-041-02-000-99 PRIVATE WELL AND SEPTIC PER M.O.A. RECORDS. THE WELL IS MUCH GREATER THAN 100 FEET FROM THE PROPOSED SEPTIC SYSTEM UPGRADE ON LOT 3, BK2 SOUTHFORK S/D, NUTEI THIS IS NOT A SURVEY. THE LOCATION OF ALL WELLS, SEPTIC SYSTEMS, AND STRUCTURES IS APPROXIMATE. THE CONTRACTOR SHALL VERIFY THE SEPARATION DISTANCE FROM THE SEPTIC SYSTEM UPGRADE TO ALL WELLS ON ADJACENT LOTS. SEPTIC UPGRADE: LOT 3, BK 2, S❑UTHF❑RK S/D PREPARED FOR: ANITA TH❑MPS❑N PREPARED BY: ALASKA WATER & WASTEWATER DATE: 2/19/98 DRAWN' GARNESS I SCALE: 1" = 100' y A. •rn ss,� E-7953 '�04 df'rofesio�bf"d �OaDoc�000 NOTE! THE AIR COMPRESSOR SHALL BE A THOMAS INDUSTIRES, MODEL 5070, AS SUPPLIED BY ANCHORAGE TANK, THE AIR LINE SHALL BE 1/2 INCH DIA, SCH. 40 PVC, INSULATED WITH 1/2 INCH FOAM PIPE WRAP (R3 VALUE), INSIDE A 2 INCH SCH. 40 PVC JACKET. THE LINE SHALL BE BURIED TO A MINIMUM DEPTH OF 3 FEET. NEW F❑U DATION C/ EXISTING 100 GALLON EPTIC TANK, REMO E TOP AN FILL - WITH SOIL. XISTING WELL GENERAL LOCATION OF EXISTING DRAINAGE SWALE. BE MAINTAINED AFTER UP- GRADE IS COMPLETED. AIR COMPRESSOR THE AIR COMPRESSOR SHALL BE LOCATED IN THE GARAGE. THE CONTRACTOR SHALL PROVIDE A 0-10 PSI PRESSURE AT THE COMPRESSOR. NOTE: A 30 PSI GAUGE WILL NOT WORK, THE CONTROL PANEL FOR THE STEP TANK SHALL BE LOCATED IN THE GARAGE. EXISTING TRENCHES AIR LINE• SEE NOTE 0 THIS DWG. XISTING BERN NEW 1250 GALLON STEP TANK\OUIPPE WITH INTERMITTENT DOSING TI ER. SUPP. R SHALL BE ANCHORAGE TANK AND WELDING C❑MPAN . :WIDE DUAL OUTLETS ON TANK AND PIPE SO THAT'{'L0 BE ALTERNATED BETWEEN THE NEW ISF AND HE OLD TRENCH SYSTEM. \ L25 INCH PVC SLOPED BACK TO STEP TANK TO ENSURE LINE DRAINS BERM COMPLETELY. \\ T IN EACH CORNER 1�1. \\ 25� \ NEW 18'X 20' BOTTOMLESS INTERMITTENT SAND FILTER. <1% TEST HOLE # «1. 10' UTILITY EASEMENTS E ay.Si-� TEST HOLE #1 SEPTIC UPGRADE; LOT 3, BK 2, S❑UTHFORK S/D PREPARED FOR: ANITA TH❑MPS❑N PREPARED BY+ ALASKA WATER & WASTEWATER DATE: 2/19/98 DRAWN: GARNESS I SCALE: 1' = 30' e 'r I A. GiiSss; C 7953 -Q • Vivo `af3rofessio� a= �OOano�o 1 INCH PVC HEADER. PVC AIR LINE TO SAND FILTER 1.25 INCH PVC LINE FROM THE STEP TANK. \ AIR LINE C❑IL SPACED AT APPPR❑X 2 FEET. ❑RENC❑ "WASTEFL❑W' TYPE PROVIDED BY ANCHORAGE TANK. 18' x 20' BOTTOMLESS ISF NO LINER ON BOTTOM. PRESSURE PIPING DESIGNED BY ORENCO, AND SUPPLIED BY ANCHORAGE TANK. 4 INCH DIA, M❑NIT❑RING TUBE AT EACH CORNER. FLUSHING VALVE (TYP), BURIED WITH REBAR MARKER, AIR LINE 6" ABOVE BOTTOM OF SAND 3/4° PVC LATERALS 2' MINIMUM COVER 2° INSULATI❑N FILTER FABRIC OVER PEA GRAVEL ORIGINAL GRADE 3:1 SIDE SLOPE 6 " LAYER OF 3/8° PEA GRAVEL WITH THE PVC LATERALS BURIED MIDWAY IN THE STRATUM, PR❑VIDE VISQUEEN ON SIDEWALLS ABOVE THE ORIGINAL GRADE, 2.0 FEET MIN. OF FILTER SAND, CPP'S "WINTER ROAD SAND°, 3LITT v LESS ISE ETAIL SEPTIC SYSTEM UPGRADE : LOT 3, BK 2, SOUTHF❑RK S/D. PREPARED FOR: ANITA TH❑MPS❑N PREPARED BY: ALASKA WATER & WASTEWATER DATE: 2/19/98 IDRAWN: GARNESS ISCALE: NTS /(337., 00 • 0ll 10 :D A. e., .--ss;. —7953 4451 (47'1411:1;r01°7- Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: ,AVM TA V �dz��e���Q®� o i O• e ( 'S SEAL) may. = t • 1p i: 4 9q 6. ic • •a F M44 .•a• #� ; . JAMES P. WILLIAMS• NO. 9608 O�``� a4,fr C.E. • • �, '� DATE PERop ESS. LEGAL DESCRIPTION: JOOtATNFOtK c/o fp.Township, Range, Section: DE j{J (FEET) 1 I" .0. • 0 • .: ..• ( • • e • 13- 14- 15- 16- 17- 18- 19- 20 – 0 bRfsA tcS �•N• —�- 11/4(4/g,stt.-cy SAG �o SAt'T I.N M/ 1-1&14T GRAVEL aEC0M►n>rs De_rf:ER (Mf i7EPTAf• .o• 4. COMMENTS kW Sys PERFORMED BY ACCORDANCE 72-008 (Rev. 4/85) SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? 0 Depth to Water After I Monitoring? Uate: �1i`�� S L 0 P E SITE PLAN I N s E FE rt Reading Date Gross Time Net Time Depth to Water Net Drop altdier8 TE1-04614_ deo fiuoR 'h+ ;MA* 5:oipm - 6" :S3 $o Ain,.. ;.1/).** 3 tip" ADD 81.0 - 6 0 - :t8 6:08 30 /ow 3'/sl" aI/y" 4/0 ?OM+.• 3 %Y" .7 3/4/'' PERCOLATION RATE _. (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN _ FT AND 3•5 FT Eb- S(tJ1FAcG CERTIFY THT T S TEST WAS PERFORMED IN I`98 H ALL STATE AND MUNICIPAL GUIDELINE IN EFFECT ON THIS DATE. DATE ►0 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED FOR: 14Wi* TWO,/ LEGAL DESCRIPTION: SOA Ipi .. /0, 1w.g2 1 2 3- 4- 5- 6- 7- 8- 9 • • • • • • • • { • • • • 10- 11 - 12- 13- 14- 15- 16- 17- 18- 19- 20 - • • • a •ii y 5 J JLr+I/ • , ,44 • s /. Y• •• •.. •••• • to : FROM ALASKA WATER 8:MSTEWATER PHONE ND. : 9073383246 Mar. 10 1998 0 i : t 16PM P2 PROPERTY OWNER AGREEMENT FOR 'ME MAINTENANCE OF AN ON-SITE WASTEWATER DISPOSAL SYSTEM This agreement, dated MAP -C4 I1 199.1 , is made between the Municipality of Anchorage Department of Health and Human Services (DENS) and- the property owner(s) of: L,o 3....6t,OCie- Z :So01?+r021z- This agiieeznent is made for the purpose of maintaining an on-site wastewater disposal system on the subject property_ The property owners agree to tI a following: Submit to the Municipality of' Anchorage, on an annual basis, an inspection and operation statement from a registered professional engineer. This hispectioa and operation statement shall verify that the engineer has inspected ali effluent and air pumps, timers, and alarms, and th t any deficiencies have been repaired and that the system is functioning as designed. (Printed Name) (Si nate e) (Przl1ted Name) -Notarize Here State of On this c./ of _rf24r-C h/ Q/ 9 k / 1-/Iheci J>%V2/1 5 personally appeared before me, who is personally known to see )( Whose identity X proved an the basis of AICrsIc4J�i'Iy�vsL�eVlsP whose identity 1 provdd on Ithe. oatFfaffjrmatzon. of a credible witness to be the signer of the above document, and he/she acknowledged that he/she signed it. 9 ( f Ulz_Lce Notary Public My commission expires 1,J -(a -O° p URA) LINDA OFFICIAL NOTARY PUBLIC -STATE OF ALASKA My Comm. Expires 12/6/00 ASBUILT-NO CORNERS SET THIS DATE. I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY' Southfark Subd„Lot 3Bik. 2 AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE•THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. SEWARD & ASSOCIATES LAND•SURVEYINVr 688-4566 SCALE! DATE' 1-2£8-92 GRID' Sw 1059 FB' 26-29 DRAWN: DI1S s.0000r11,4 11 i. 4.`ri ...... 7 06 4 •. Duane Mark Seward 0 * '', LS - 69111 '� 4'4it '• `' a1Vtayvr13,,+ • / MUNICIPALITY OF ANCHORAGE \,__./ t _ t DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION II ► ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE 6 36-2st i NEWbe[ail-'cl(Ge.b4 ❑ UPGRADE MAILING ADDRESS ZO'TC .2 3 It W c..t 9I5-7? LEGAL DESCRIPTION y / L3 &, 2 di, �i'tZK VA6 LOCATION NO. OF BEDROOMS a U Y DISTANCE TO: Well /OU 1 Absorption area 4:3{ Dwelling Q /_ / PERMIT NO. ,� g n5 -7c1 i- Z LLI 1- Manufacturer Material No, of compartments Liq. capacity in gallons woe) IF HOMEMADE: Inside length — Width ^�_ Liquid depth rs— a z DISTANCE TO: Well Dwelling PERMIT NO. Z Ia„ I- Manufacturer Material Liquid capacity in gallons 0 -I = DISTANCE TO: / Well l �v Foundation C ,O 7 ' Nearest lot line p PERMIT NO. Q 20��� C5 J LL Z i-Z� No. of lines Length of each line ani, 58, 3s Total length of lines rz�� Trench width r �' inches- Distance between line ?i,.,^ G , Top of tile to finishhg� e Material beneath tile t'( l ir+e#sa Total effective a rption area 64a p w L Length Width Depth PERMIT NO. ct 1- wa Type of crib Crib diameter Crib depth Total effective absorption area Lu DISTANCE TO: Well Building foundation Nearest lot line W Class i f2fdA Depth Clr,.,lvLr�un Driller a-1‘44-i.4 1.4.c 4-bc Distance tyjot line iG _K�-Glervr PERMIT NOe. 2- 65-1? DISTANCE TO: Building foundation Sewer line ( Septic tank - Absorption area(s) OTHER PIPE M`AATERIALS4 SOIL TEST RATING INSTALLER REMARKS ..tK�'(,�¢rj‘c/it per' 60 Cr - /�.A.`f £- ' C _P44 -612-s . i4 -2G4, APPRROVED DATE>TELEGAL -v,s Ittev. IAi; i0-eG"`5,�J tD',D T g f -g tE= D -ND Fn,PD: CD FE DEPARTMENT O- HEALTH AND ENVIRONMENTAL ' `OTECTION 264~4720 PERMIT NO. ( 820579 APPLICANT DEHN~DELUCIH LOCATION LEGAL L] B2 SOUTH FORK SUB BOX 234 EAGLE RIVER TYPE OF SOIL HBSORPTIQN SYSTEM IS: DRHINFIDLD 694-]424 LOT SIZE 222222 SQUARE FEET MAXIMUM NUMBER OF BEDROOMS - ] SOIL RATING (SQ FT/BR)z 200 .~~^��� ��m' ;An it YY'r- t&w THE REQUIRED SIZE OF THE SOIL ABSORPTION SYS!EM IS: E)EE F" I- FAI Pq FED F=�~^ THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). 1- FA ���=P-4 D-4 DA T 1F1-1 ' DED OHO F=. THE GRAVEL DEPTH IS THE MINIMU�� DEPTH OF GRAVEL BETWEENTHE OUTFALL PIPE AND THE BOTTQM OF THE EXCAVATION (IN FEET). �E:11:7111J I FR FE ED. ���"T' *-F KR; f< fE, =�� oaji/,,z9 ULL.__n055 PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS QF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE ��— 1 -DA < > I O'HLS EiE C.; I- 11:1CMMES: FED F.!E Fe D-o-51Xof 0_,74 • BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND HPPROVR, BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARF REQUIRED AND MOST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY HPPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTHLLHTION. �Ei�h9 -1- E::: F;�E-E� I CERTIFY THAT 1� I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CWDES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEN NAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] 8EDRnOMa APPLICANT DEAN-DELUCIH ISSUED O & E ENCS -(VEERING & DEVELO,--MIENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 SOIL LOG Earl Ellis 688-2280 Performed for: Name L — za °A Tel. No 61 Lif 41'°C7 Mailing Address' Legal Description. Depth (feet) 0 1 L or - 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 x i Vie. ;I „) , _ 4.)Z -_-`7A2 Ai' c795-77 Soil Characteristics 1,14 AtPy —CST .pJ /�i21✓/!_ /t14`T_= / iX.(� ,,''' 1,-_- ' 1.M3 ^y 7l•S -,V. -- 84 S'e. 1:0 E VRi•4b 666f 49f P2p ¢ E t '-T-Th �y�,��""� /�'% /� jl ��e E Q4 ��' RGss4:'l L. Qy er ' <�" K.p 4a d,,°a No. 4256-E `b`.`cr�H' k' "C,''b tea'"/,�i�ff t 0..‹.�'''' e -Lk OROo * `"'" 77 �°V.4,74 `itiY`#. '",,�* it D 7 PLOT PLAN PERC. TEST 2 'i-'r`4e Ground Water Encountered: Yes (�No If yes, what depth /0 , Proposed Installation: Seepage Pit Drain Field Comments/J uIr Performed by: `c d- - 64cot 47---749/i; h f , 7—.04 fl/ (:;;e) /17hi+ , i J Date '' Z / /?,e Q1rttftr1 flriLLtnGug by OWNER OF LAND 5`14'4 DOC Co. dba SULLIVAN WATER WELLS P. O. BOX 272, CHUGIAK, ALASKA 99567 e TELEPHONE 688-2759 ADDRESS 1`96i?0 LEGAL DESCRIPTION DATE - Started PERMIT NUMBER Ended f DEPTH OF WELL `':.? r� STATIC LEVEL OF WATER FT 1 r DRAW DOWN FT GALS. PER HR % ci2 0 0 KIND OF CASING � KIND OF FORMATION: From G? Ft to ' -, Ft (90e / r�r -=`<./ From Ft to Ft From ' Ft to c f Ft �-C'i'�i ,9,u %.;''n v c�%F= `From Ft. to Ft. i From (71 Ft. to / 06 Ft. Sr-"'f d ? 6`'','r- = - From Ft. to Ft. From Ft to Ft. 't, 4Ti5:--i.'__ From Ft. to Ft From Ft. to Ft From Ft to Ft Frons Ft. to Ft From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to _Ft. From Ft to Ft From Ft to Ft From Ft to Ft From Ft to Ft From Ft to Ft. From Ft to Ft. From Ft to Ft From Ft to Ft From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft to Ft. From Ft to Ft MISCL. INFORMATION: DRILLER'S NAME PERFORMED FOR: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST LEGAL DESCRIPTION: �--r t,) tK 1 t, i‘::e oF \n ° e00Q o°'tie?'�''t. w.9^^ 0000°..."so°o®o�0°oo°nsae�/� COMMENTS .i./Ja 91,e PERFORMED BY: i"-.--"� DATE PERFORMED: Jt,l )Z\/s. SLOPE gi SSOI LS LOG ❑ PERCOLATION TEST SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? E Ell t_ Reading Date Gross Time Net Time Depth to Water Net Drop _sg. r' ' J .' / i ` , `?, c I) I,..,� {la/ 0 ` / t Cil ,7rY 1;��1 r 1 t k _5 `/ / / -/--/ - PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN 'Y •6 FT AND -7 FT 72-008 (6/79) -sr-MT -417.4rridViIrSV,Lramr..,1 CERTIFIED BY: DATE: • MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # h'1 B - 03 f -04- 1. GENERAL INFORMATION Complete legal description HAA # L✓0T 3 Bv-z1 SIP Location (site address or directions) Property owner A-) 11-4 , rt04Pse J Day phone -21 r 59-6 Mailing address Lx, "n - A 6.( -Z -4---r LA -0 r -c Paiu uA. Ba s W K 563 - .3 26 Lending agencyDayy phone Mailing address i F ' b-63 -174 Agent 1"2-1-4D�.l-rxt, vtVIVI- / f:j/A- L.o1 ___J.-1 :Day phone 6 8q- 647 Address l Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 QEF& En2 - .tea K-& • NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer k NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA •21 5. STATEMENT OF INSPECTION BY ENGINEER r As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature & stewater Phone 33 7-6/19 �l,(NFS�L L�k(A3lC.A PA•'c0 An— Sv S r—i 1—r —D -rn PG4-0gos-rwI . wiz w4a, CI-0Sv,1&-.ZNVOIC- ��--I-GA JD r-1v-i.s o cs..1 3//9/90 6. DHHS SIGNATURE Approved for 3 Disapproved. Conditional approval for By bedrooms. Date bedrooms, with the following stipulations: Additional Comments CAUTION Date 3-24 -?8 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA M21 2 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: Loi 3) g4 2) Sou ;l-k-VelL Parcel I.D.: 0-7 8 - 0 31 -04 A. WELL DATA Well type p�• If A, B, or C, attach ADEC letter. ADEC water system number N �' Log present (Y/N) yDate completed 618 2 r Total depth (00 Cased to 1°O Casing height (above ground) j2n Sanitary seal (Y/N) \lEs Wires properly protected (Y/N) yES FROM WELL LOG AT INSPECTION Date of test 482 2/Z0/c/8 r �5 I Static water level 6 Z Well production ZO g.p.m. '' (3 + g.p.m. WATER SAMPLE RESULTS: Coliform q Nitrate ' 3� % '^' `� /� Other bacteria sZ Date of sample: 3 //S/98 Collected by: a S B. SEPTIC/HOLDING TANK DATA ►s. -J s -r- Date installed /98 Tank size 1250 Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) 'i Depression (Y/N) High water alarm (YIN) "1 Date of Pumping NIA- Pumper NJ/p. C. ABSORPTION FIELD DATA g0er-1t¢5 S -LESF .o-r-,zr+t..SS Date installed 3%98 Soil rating (g.p.d./ft2 oK#?ibtirrti) 4 System type ySF Length 2-o Width / g Gravel thickness below pipe �- 6 u Total depth Z. S iv 3.1 Effective absorption area 36,0 Monitoring Tube present (Y/N) i1 Depression over field (Y/N) No ate o a test Results (Pass/Fail) For Fluid depth in absorption field before tes . ; Immed'- • er gal. water added (in.): Fluid depth (ins) Minut- - . Absorption rate = g.p.d. reatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* tL 0 0 D. LIFT STATION Date installed E. 3/g• Manhole/Access (Y/N) High water alarm level at* 4-7 If Cycles tested ^l IA SEPARATION DISTANCES Size in gallons I2-0 s'T'aP "Pump on" level at* -n"44=R-- "Pump off" level at* '111`1Era` ' `Datum go "' -1".4%1K-- SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 100 + On adjacent lots 10D 7"1' Absorption field on lot 100(4- On adjacent lots b0if Public sewer main NA Public sewer manhole/cleanout t li4 Sewer /septic service line 25 /� Lift station 100 �+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 1111' Water main/service line 10 4" Property line 4/4- l+- g Absorption field Surface water/drainage 100/4- Wells on adjacent lots l00 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: J 1 / Property line 1 D+ Building foundation ID * Water main/service line I a } ^� //4- Surface water 100 -4- Driveway, parking/vehicle storage area "fes NONE oWfi r Curtain drain � Wells on adjacent lots 100 r4 - F. ENGINEER'S CERTIFICATION I certify that l ha - .ete in conforman Signature i r l —wrz�ESS Engineer's Name • 3/i 9/913 * /s).& --v,) 1a �, ierr`I t-rr? inspections and review of Municipal redid& t es in effect on this date. su Date (SFA ..o.oay th :52 ins ins are ®®e® »..v... :ad y A. Garnett ; 41; CE -7953 ; �s „ <<-080FESS\ONs0. HAA Fee $ 3trt) Date of Payment 3 /2a Receipt Number 5-171- !� G/ % 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number MAR -19-1998 15:20 CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID CTgE ESI ANCHORAGE C7&& Environmental Services Inc. eserrariesnasseamereareerassiesesasseatere 981157001 AK Water & Wastewater Services Lot 3, Bk2Southpark SoNT ° L S/49 Lot 3. Elk 2-Seothparic S o... , .-.r u t S/D Drinking Water 0 9075515301 P.02/03 Client POM Printed Date/Time 03/19/98 11:59 Collected Date/Time 03/15/98 15:00 Received Date/Time 03/16/98 11:40 Technical Director: Stephen C. 1de Released By c Sample Remarks: Parameter Total Coliform Nitrete-N R0sults P0L Units 0 0.376 eel/100mt 0.100 Ms/t Method Allowable Prep Analysis Limits Date Date init SM18 9222e EPA 300.0 10 max 03/16/98 TMW 03/16198 RMV NAR -19-1999 15:21 LTB CTR:E ESI ANCHORAGE 9075615301 P.03/03 CT&E Environmental Services Inc. Laboratory Oivision restAmowAry/rymp►OsivatosIirtsAr Drinking Water Analysis Report for Total Coliform Bacteria 200 W. Potter Drive AK E 4D 90(71562.2 INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE Tai: (90Anchorage. 99518.1805 343 Pax: (907) 581.5301 MUST BE COMPLETED BY WATER SUPPLIER a PUBLIC WATER SYSTEM I.D. a PRIVATE WATERSYSTEM 1i1 0 Sind Rid Remits 0 Send Invoice Wnm ariuw Nmmto...m. NIA* •^�,•.r Aloka•water to warlit9ilfitter •-......• 7..32O.Baaf Cheater Hes Pirtle MORIN Anchorage, Alaska 99504 Faa 'lumber tummy NNW %Irlrr ANION Zen 0 Said Aveiro !VA at tele SAMPLE DATE: 2132 1701 0 0 Moate. Der Year SAMPLE TYPE: cl8C Routine a Repeat Sample (Ike routine sample with lab ref, no. 0 Special Purpose Treated Water --. Untreated Water Time C011eeted SAMPLE LOCATION %. " fo(2.44— CoDattelb ij Mar Pile TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: Satisfactory 0 Unsatisfactory D Sample over 30 hours old. results may be unreliable a Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable resoles. Please send new sample via special delivery mail. Date Received ` (G?� Time Received Analysis Began a34 Analytical Method, (S4embrane Filter MMO-Mua • Number ofcolonies/ 100 mi. Result* Analyst 9$115? Cg nth Fake Jae Faxed Dur. Tune: Client notified Of unsettshetory results: ❑ a Phoned Spoke with Fang Oaten Time: :;omments: BACTERIOLOGICAL WATER ANALYSIS RECORD MMMO. MUG Result: Teta' Callrorm L coil Colonies/100 ml McmbreneFilters Direct Carat YerifieiHaat LTS BOW Peal Coliform Confirmed,* • Final Membrane leer Ras ea Reported By . I' • /Pr -/4 1' , COLWIILW Tints Calibres/19d mi Ch» :ane•r—xm..rreee.e UE • OM owner ..r.� Mambaralthe Sti6Group{5oeietr6inlralsdeSurveillenu) TOTAL P.03 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I D # f i�,- h22-)1 1. GENERAL INFORMATION Complete legal description HAA # n gc't Lot 3; Block 2; Southfork Subdivision Location (site address or directions) South Creek Road Property owner .Tay T Pri eGt Day phone Mailing address Lending agency Day phone Mailing address Agent Eva Loken - RE/MAX OF EAGLE RIVER Day phone 694-4200 Address 16600 Centerfield Drive, Suite 201, Eagle Riv_er, Alaska 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 XXX NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer XXX NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 5 & s ENGINEERING Phone Address 17334 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Engineer's signature Date '' 1-92 6. DHHS SIGNATURE, X. Approved for 3 bedrooms. Disapproved. By. Conditional approval for bedrooms, with the following stipulations: Additional Comments (+14 1T7-1- ' CAUTION Date l//6/9Z The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given iri paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA 921 Legal Description: Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Z S�r��� ''Parcel I D A. WELL DATA Well type PeAvneC'f- If A, B, or C, attach ADEC letter. ADEC water system number Log presentOY N) Total depth 14\ Sanitary seal C6N) Date of test Static water level Well flow Pump level Date completed (p -S2 Driller SJw��la� Cased to 1 Casing height 12" k Wires properly protected ON) y FROM WELL LOG AT INSPECTION h-82 �2 t Z0, 0 uV- SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ) o0 1 t On adjacent lots (0 0 `4. Absorption field on lot I I O� t� ; On adjacent lots t 17c,i� Public sewer main 'A 14. Public sewer manhole/cleanout +A Sewer service line 25 `� Petroleum tank Z.--`� gpm (D7 U1� WATER SAMPLE RESULTS: Coliform col,/oow -e, Nitrate 4-1O `" -4. Other bacteria /JD .•/‘... Date of sample: q-2-1?-- B. SEPTIC/HOLDING TANK DATA Date installed 7-2''' 32-- Tank size \ 000 Compartments 2- Cleanouts ON) \I Foundation cleanout&NI) .1 Depression (Yf Al High water alarm (Y/ 4 Date of pumping Collected by S & S ENGINEERING 17034 Eagle, River Loop Road No. 204 Eagle River, Alaska 99577 Alarm tested (Y/N) Pumper , C E-OSroe L. - SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: k 1 k Well(s) on lot 1, o t On adjacent lots 1 bo Foundation Z (o To property line 10 Absorption field Le 1 Water main/service line IO tk Surface water/drainage (dv t LO G A4sv 0 1 >N, &k.0.4),..- 7P -t-. 72-026 (Rev 7191) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pump off" level at High water alarm level Cycles tested Meets MOA electrical codes (Y SEPARATIO - TANCE FROM LIFT STATION TO: on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed "7'2-27 - e2 - Length IvD` Width Soil rating 7.-004I- System type Gravel thickness 0.5 Total depth Total absorption area teOo4 Cleanouts present1 /N) Depression over field (Y//y Date of adequacy test I-2-• I -I 2— Result pass il) ?Fess for / Peroxide treatment (past 12 months) (Y '/k ,1 kJ If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1,9C>t On adjacent lots I o0 I Property line 10 To building foundation 2S 1 k To existing or abandoned system on lot )-S44. '° 1k On adjacent lots Cutbank Water main/service line 1 `a` Surface water tom Driveway, parking/vehicle storage area '4O Curtain drain /VA E. ENGINEER'S CERTIFICATION I certify that f have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. 5 & S ENGINEERING Signature 1/334 tingle River Loop Road No. 2Q4 z:at, aer, Ivas a V95// Engineer's Name — 9 Date 2-- .. OF pv 1 tsr * Ca 9rn 3 0 °f el% 666$6vg$6��0egV! �oi CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS for INVOICE t 57855 Chemlab Ref.# 92.4695 Sample t 1 Matrix: WATER Client Sample ID : L3 B2 SOUTHFORR S/D Client Name :8 & S ENGINEERING PWSID : UA Client Acct :SNSENGP Collected : SEP 2 92 @ 13:30 hrs. BPO# : Received : SEP 3 92 @ 15:15 hrs. Reqs : Preserved with : AS REQUIRED Ordered By :R. SHAFER Analysis Completed : SEP 4 92 Laboratory Supe vi or STEPHEN C.EDEE Released By : Send Reports to: 1)S & S ENGINEERING 2) Parameter Results Units Method Allowable Limits PO& :NONE RECEIVED NITRATE -N 0.46 mg/1 EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY: RAY. Remarks: __==..=1Tests Performed • See Special m'c====.._____.==• =Instructions Above UA=Unavailable ND= None Detected " See Sample Remarks Above NA= Not Analyzed LT -Less Than, GT -Greater Than SGSMember of the SGS Group (Societe Generale de Surveillance) CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER 0 PUBLIC WATER SYBTEM I.D. # ,PRIVATE WATER SYBTEM Name S & 5 EN/GINEER ING cf 4 Phone No. 17034 Eagle River Loop Road No. 204 Mailing Address . Eagle RIv.rr Alaska Cay SAMPLE DATE: SAMPLE TYPE: D Mo. 0 2 Day State v Year Zip Code Routine 0 Check Sample (for routine sample with lab ref. no. ) 0 Treated Water 0 Special Purpose 0 Untreated Water SAMPLE Time Collected No. LOCATION Collected By 1 1 Lor 2 [3 LAA. 2 11op 2 1 sa 6-t-IrkG0 31 4I 51 TO BE COMPLETED 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 mail. Date Received Time Received 9/ Pa ts,3-) Analytical Method: Membrane Filter • No. of colonies/100 ml. Lab Ref. No. Result' Analys, 92.4695 421, A.o.E.C• 42 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count 0 Coliform/100 ml Verification: LSB BGB Fecal Coliform Confirmation Final Membrane Fiber Rults esColiform/100 ml Reported By CSL /j G Date if 7- //z 9_ TNTC = Too Numerous To Count PART ONE OF TWO OB = Other Bacteria REMAINDER TO FOLLOW a.m. p.m. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # MR— (1-') 1 - 1. GENERAL INFORMATION HAA # 110,9Ql{")r*V Complete legal description Lot 3; Block 2; South Fonk Subd(v.Ld.Lon; Location (site address or directions) Sough Cneek Road Property owner Jay= T" -Ph c e3 Day phone Mailing address Lending agency Day phone Mailing address Agent Eva Loken RE/MAX OF EAGLE RIVER Day phone 694-4200. Address 16600 Cewtenfieid Vnive, Eaate Riven, Ata4ka 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 XX NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer XXX NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA t#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Phone 17034 Eagle River Loop Road No, 204 Address Eagle River, Alaska 99577 Engineer's signature Date 6. DHHS SIGNATURE ( . Approved for - bedrooms. Disapproved. By r ar. Artl n�a.. es ''.1..'p• �G+ t^ ROa . GS) J'SHAFER :.L1d ©� `•'J7 .a No. 1215 •'4 1,f94;.8•a......t.•6�\,'c�*- c4 PRO Conditional approval for bedrooms, with the following stipulations: Additional Comments Date a -7j2___ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA 921 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: \ 3 4-2 47o°1 -A FoK-� (D Parcel I D A. WELL DATA Well type ? t iT' - i - If A, B, or C, attach ADEC letter. ADEC water system number �//S. Log presenf3N) ! Date completed Co 02- Driller VP r1. V°A-S..Q-- Total depth cl9 ‘ Cased to 9c 1 Casing height 12.1 Sanitary seal i(DN) y Wires properly protected 0/N) FROM WELL LOG AT INSPECTION Date of test Le - 82 1 -21=1/ - Static 21°I2Static water level Le12 15 Well flow Za.o gpm 3.2k Pump level L)11.- UI - SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 10o"k ; On adjacent lots 10c)13- Absorption field on lot \ c>c>L-1/4- ; On adjacent lots 100% k Public sewer main JP• Public sewer manhole/cleanout 4i). Sewer service line 25 Petroleum tank -2.5-" r Y WATER SAMPLE RESULTS: Coliform Date of sample: ! -20 -`i ?_ Nitrate o \ °qL B. SEPTIC/HOLDING TANK DATA Date installed 1 -1-3 Tank size 1 vd Compartments Cleanouts ON) Y Foundation cleanout &/N) 4 Depression (Y ,J High water alarm (Y0 Alarm tested (Y/N) /.1I4 Collected by' Other bacteria N-101•3 F S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Date of pumping ! - L2 --° 2_ Pumper S¢- • LF55 Pao L. - SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 16a To property line 10 Surface water/drainage 72-026 (Rev. 7/91) Front On adjacent lots 1 e e l A -- Foundation 2 Coy Absorption field lQ1 Water main/service line l� t 1.b6 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pump off" level at High water alarm level Cycles tested Meets MOA electrical codes SEPARATI STANCE FROM LIFT STATION TO: on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed 1 -Z'), 432- Soil rating 2vo 4/6g- System type DR•c11.SF11 t.D Length 1 -c2 Width 5 + Gravel thickness C>, , Total absorption area (-.ocA Cleanouts present OYN) Date of adequacy test 1-2_t-c\-2— Depression over field (Y/a) Results ��i ail) PP4s Total depth Y 3� L1)JsL)Lort' .a) for "1rleFG. _ (3i bedrooms Peroxide treatment (past 12 months) (Y(%N�l /��( Veld oVi/J SEPARATION DISTANCE FROM ABSORPTION FIELD TO: If yes, give date Well on lot 1 db On adjacent lots \'o k+- Property line l b To building foundation ZS (t' To existing or abandoned system on lot On adjacent lots Cutbank �Inr- Water main/service line 1� t Surface water l oo t Driveway, parking/vehicle storage area Curtain drain Ott E. ENGINEER'S CERTIFICATION I certify that t have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. 6'94' ^ ti . S & S ENGINEERING 17034 Eagle River Loop Road No. 204' �g Eagle River, Alaska 99577 �y. d?��Cc sfali9acena69 sia1 l e. � Engineer's Name �, ry % Signature Date --�Z dna`"w 110( :R J. iHAI: GFI )Ue,_;: rd t �0° HAA Fee $ /76 . Date of Payment Receipt Number / d 47-9 �? 39/— --,c) 70 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee• $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 8 STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS for INVOICE # 50495 Chemlab Ref.# 92.0227 Sample # 3 Matrix: WATER Client Sample ID : L3 82 SOUTH FORK S/D PWSID : UA Collected : JAN 20 92 @ 10:45 hrs. Received : JAN 20 92 @ 14:30 hrs. Preserved with : AS REQUIRED Analysis Completed : JAN 22 92 Laboratory Supervisor : TEPHEN C. EDE Released By : GGA, Client Name :S & S ENGINEERING Client Acct :SNSENGP BPOI : Req# : Ordered By :R. SHAFER Send Reports to: 1)S & S ENGINEERING 2) P0# :NONE RECEIVED Parameter Results Units Method Allowable Limits NITRATE -N Sample ROUTINE SAMPLE COLLECTED BY: RAY. Remarks: 0.41 mg/1 EPA 353.2 10 1 Tests Performed ND- None Detected NA- Not Analyzed ' See Special Instructions Above UA -Unavailable " See Sample Remarks Above LT -Less Than, GT -Greater Than SGS Member of the SGS Group (Societe G4ndrale de Surveillance) CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM I.D. # IA PRIVATE WATER SYSTEM S Name 61 -2979 Phone No. i 7031" E-4-4 eD ze Mailing Address -�AZ-rte ��JF-L City State Zip Code SAMPLE DATE: SAMPLE TYPE: 0 Mo. Z 0 Day Year lk Routine ❑ Check Sample (for routine sample with lab ref. no. ) 111 Treated Water 0 Untreated Water 0 Special Purpose SAMPLE Time No. LOCATION Collected 1 I L - g(Ac_2 la 4Sar 2 1z.��12.-tL— Sin 3 4 Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: FSatisfactory ❑ 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 mail. Date Received Time Received 4,3 Analytical Method: Membrane Filter ' No. of colonies/100 ml. Lab Ref. No. Result` 92.0227 Analyst A.D.E.e. i- a. /4NC READ INSTRUCTIONS embrane Filter: Direct Count BACTERIOLOGICAL WATER ANALYSIS RECORD BEFORE COLLECTING SAMPLE Reported By TNTC = Too Numerous To Count;, iJ Coliform/100 ml Verification: LSB BGB Fecal Coliform Confirmation Final Membrane Filter Results 7I -z) PART ONE OF TWI3: OB = Other Bacteria Coliform/100 ml REt1AINDER. TO FOLLOt Time M Time J;e Date Date Date -42-'C2/1 1 — Inspector Inspector Inspector Comments 111 3 Conditional Approval Date Sewer Installed 7- L 3 —13- Permit No. S `-/i r 7 7 Septic Tank Size Holding Tank Size Soils Rating ;..3 c) Well To Absorption Area / 6 Well to Tank / d -- Well Log Received / J APPLICANT FILLS OUT LOWER HALF ONLY Property Owner William E. Johnston MailingAddress P.O. Box 334, Eagle River, AK 99577 Phone 694-9766 Buyer Jay T. Priest. Address 100 McCarrey #4, Anchorage, AK 99504 Lending Institution First National Bank of Anchorage, Eagle River Address P.O. Box 548, Eagle River, AK 99577 Phone 694-2103 Realty Co. & Agent Commonwealth AREA, Inc. (Myrna Johnston) Address P.O. Box 249, Eagle River, AK 99577 Phone 694-9555 Legal Description Southfork Subd. Block 2, Lot 3 Street Location South Creek Rd. (Mile 7.0 Hiland Rd.) Type of Residence KI Single Family El Multiple Family No. ❑ Other of Bedrooms 3 Wate Supply A] Individual ATTACH WELL LOG. A well log is required for all wells drilled since June ❑ Community 1975. For wells drilled prior to that date, give well depth (attach log if ❑ Public Utility available.) Sew a Disposal Individual Year Individual D Public Utility When Connected ❑ Holding Tank Installed: 1982 to Public Utility N/A 140,thonii IRIPitTiollErrElaiMIA4 Accbgri VAgIYFIROOtsi@BiltiAtTPAMMINGVAN BE INITIATED. CHEMICAL & GL,.OGICAL LABORATORIES w, 1j' ALASKA, INC. TELEPHONE (907)-279.4014 ANCHORAGE INDUSTRIAL CENTER 274-3364 5633 B Street Drinking Water Analysis Report for Total: Coliform: Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: I.D NO. Water System Name Phone No. Mailing Address City SAMPLE DATE: Mo. Day State SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample with lab ref. no ❑ Special Purpose SAMPLE NO. 1 1 LOCATION r' Year Zip Code 0 Treated Water 0 Untreated Water 2 31 1 41 1 5f 1 Time Collected Collected; By ,/1 _ TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: • Satisfactory ❑ Unsatisfactory 111 Sample too long in transit; sample should not be over 48 hours old at examination to indicate •; reliable results. Please send new sample. Date Received Time Received Analytical Method: 0 Fermentation Tube 0`Membrane Filter Lab Ref. No. Result* Analyst 111141 • *No. ofcolonies/100 ml. or No. of Positive portions. READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev.1978 Date Collected Source Time Received p m Lab No Presumptive 10m1 10m1 lOml. 10m1 - 10m1 - 1.Om1. - 0.1mI 24 Hours - - - - 48 Hours. Confirmatory - - - - 24 Hours - - 48 Hours - - - EMB Broth 24 hours• Broth 48 hours• Multiple Tube Report - lOml Tubes Posltive/Total 10m1 Portions Membrane Filter: Direct Count - Collform/100m1 Verification: LTB BGB Final Membrane Filter Results - Coliform/100m1 Reported BY Date TIme• - - a m P.m.