Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
TONJESS ESTATES BLK 3 LT 4
Ton jess Estates. BIock 3 Lot 4 #051-831-07 / MUNICIPALITY OF ANCHORAGE /� \ & ENVIRONMENTAL PROTECTION DEPARTMENT OF HEALTH 'rl ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 2644720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAM ��tt PI c- ) O PHONE oxi�ya3 AS -NEW ❑UPGRADE i, MAILING ADDRESS C/ti p e ISL / E• p. 1-.• LEG DESCRIPTION (JJ LEGAL /3L� '>,�tiGess �' e LOCATION NO. OF BROOMS DISTANCE TO: Well /no ' G' Absorptsnarfa !i/1rJh Owelbrlp_,/ u—r PEH .Q act U E Z Manufactures ^p�� /'3L..A / i—e L� No. of coLnpartments to~ h Liq. zees gallons �( �(JK�� IF HOMEMADE: Inside length Width Liquid dept e 2 DISTANCE TO: Well Dwelling PERMIT NO. 0 Z < x 1- Manufacturer Material Liquid capacity in gallons 0 —I DISTANCE TO: Well (L /00 e Foundation 1 2 Nearest lot line • 7O / PERMIT N a.,// [,� `� ! / w wi — Z No. of lines( Length o(epci Igie L..�+ f Total len9tt+� fines (6l Trench w�;l}. 7(l1 inches Distanta between lines �/ — Z w Q Ie Cc O Top of tile to finish grade ! Material eneath the �� inches Total el 9. hsorpuon area w Length Width Depth PERMIT NO. 0 <F 0 Type of crib Crib diameter Crib depth Total effective absorption area - IL ILWell tn DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. a Li' � DISTANCE TO: Building foundation Sewer line Septic tank Absorption weals) T/H EEE R 331 /OTHER PIPE MA 03/ALS V� SOIL TESTRATING � INS FWAA /&INsTI REMARKS T1 01 J 14 C4 APP ED �/s n D�i�TE ^ 's/ 72 01 ttllev. 3/781 1 b.) MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH &ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street • Anchorage, Alaska 99501 Telephone 2644720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PR AreLLO MAILING ADDRESS pi , 136V a07 / C ' �. LEG DERIPTION t' i�SCSC/I ?3Lk, 7duGesc Ec7 LOCATION NO. OF BEDROOMS -7- o m DISTANCE TO: Well dao / (Absorpypn arta Dwelyrlg,,,� PERa�j'QQ tag / wfr a Manufactury- t gp ^s I J� (r i, No. of co��=anmennts �1 Liq. cay�ji;iLv yyt gallons Inside length Width Liquid depth �C.1(IO IF HOMEMADE: -iv2 DISTANCE TO; Well Dwelling PERMIT NO. i OEeet Manufacturer Material Liquid capacity in gallons I. If - O Well Foundation Nearest lot hne PERMIT NQy �/ • m▪ = DISTANCE TO: ' ' 'f'i .� 1 �d Ii'O�-D�• W LL u No. of lines/ Length of cn 1' a Total len9yyyyt�h of lines Trench Distance• tween lines IJ -,?6 1 B � ( 0 inches {/ Rp. Top of rile to finish grade Materiel eneath rile �� Total el eti egnsorption area p inches Length Width Depth PERMIT NO. w et 1-- Type of crib Crib diameter Crib depth Total effective absorption area I tud it 40 DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. d W • DISTANCE TO: Building foundation Sewer line Septic tank Absorption vitals) PHONEEW liefigeeigh.L1❑ UPGRADE PIPE MAWIALS SDIL TESTSSe /Z INSTATh" REMARKS APP']y ED vont ev3118) OTHER fVc Let,C4I46 LEGAL vs lvs ML_ItJ I C IfFIL 1 TV' OF= FINCV FZFiGE et," .• DEPARTMENT Oi HEALTH AND ENVIRONMENTAL H OTECTI' 1`� • 825 'L' STREET, ANCHORAGE, AK. 99501 (fli 264-4720 WELL- SFJE> OtJ—SITE SEWER PERMIT g"no'C�/3 PERMIT }10. ( 820241 ) J F , r APPLICANT SAL RIELLO P.O. BOX 2071 EAGLE RIVER 694-4163 LOCATION JESSE LEE COURT LEGAL 'LOT 4 BLK 3 TONGESS ESTATE LOT SIZE 43560 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING <SO FT/BR)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM I5: E?EPTH= LO LErJGTH= fl2 GFZSVEL C•EPTH= '5 THE LENGTH DIMENSION IS THE LENGTH <IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE_EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR, TRENCHES. THE GRAVEL DEPTH I5 THE MINIMUM DEPTH OF,GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE E<CAVATION <IN FEET). REGU I RELY SEPTIC TFIr-JK SOOC_I GALLONS PERPIIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- TWO (2> I NSPECT I OFJS ARE REGI) IREE? --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL'RND ANY ON-SITE SEWAGE DISPOSAL SYSTEM 15 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE I5 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. tr PERr1 I T EXPIRES C`ECEr1BER sSr 1.5'82 I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS A5 SET FORTH BY THE MUNICIPALITY OF ANCHORAGE.' 2: I'WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED APPLI ISSUED B T SAL AIELLO 7/t _ DATE fa%.11 , /q Y Y' 9- a 0 ° U. V4.0 1 , V 7 /s d$ it -frol ss - Q� r AI- •mss, ,..r. 11•!....4; p a•. 2Y Y' O ir. ;N.':` fir, L.; : ryL J i w-` + I. dad♦+C igi r42 AJ:•. •r•. t3 r Y r} ..+ %. j '.,f•; 41.1?PL4lt;,t3• tt C 1 r,'�,',s. ilr" '1 r y 't, i w4 Sf+ •i•,- , • ,zr. l �r , k c •/i• '- 4•t'ryA S� �`JfFferst'r.(�•�S�yr�Lr_I • tv fdks, i y. 4 s✓ Yes r J'�: y .... r.t G114.4) ` y j.sl 4;23 - ft, 4.11:`'z'• ,• a y ..Y'• • % _ s., • ••: tit 0-* :•••••••• [•, t .• •TY'4 y`1r:'i ±r'r'.. •.•r,, t .„.";"`i! . `{ s' L .4 ,:... +rj•. •:hG v."' r. 4 • 1v..1re'm ru.: •1 J >.kt t-. ,Yv-.2.. t : ••*•YMr4 .a.J1a MQM• .aH al- •H 1 • G: +G'21r1II +S ' - • •02..., ";AS -BUILT 4', • ' I hereby certify that I have surveyed the following described property 1 'G , ♦ J On �91 "FOICer 2' S w }• s l J Anchorage Iteeordtng•pminct,/Alaska,and that the'iiprove-` 7'.menta situated thereon are within the property lines and do 1 not overlap or encroach on-ihe property- Iying.adjacent these o r•• to, that no lmprovementsn property, adiacent'thereto encroach on the premises in question and that thea aro no t4 z s-0 roadways, transmission lines:ar. other, visible easements on' .. ., t.[...t- , said property except Ps indicated hereon. •. t:b•a-.i?• i -_i T r to y4: , . L;- thii a rs^.. �laj pr rij9-lj�lty :At r 79�Z `'.p'` +.,,[„ Dated•at EagleAtiver.-Alaska �� t tir. • • CHUGIAK, ALASKA 683-3199 • ' OWNER OF LAND ' ,�''' ..7. a t.i r"_.:;. ADDRESS ?Q. C'..i:..2072. ran Rt' ' .....Pt. WELL -SITE :.'T. 5 4 x:33 7•CTfea.C:.ES.t t0C - DATE - STARTED �'•- DATE- ENDED ©L2ILLII3G CO., ter . WE SERVE -ALL 'A•LASKA • POST OFFICE BOX 42 CHUGIAK ALASKA 99567 DEPTH OF:WELL- " a. £=tit --- STATIC LEVELOFWATERFT.10't• :!' hotc• DRAW DOWN FT.: 1C0%' GALS.PERJIR 300' Gal . Esti.^ate Sch. 40 5?2 KIND OF. FORMATION: FROJI ' ^ FT. TO 4 FTC.aar.; x ec.r_... .. FRO\I 1 FT.TO FTS,rle 3 ..1ti' FROM `^ FT. TO FhZ FTCl.c.'v riCour:e water recrrinci.gravel' FR011 - 75- FT. TO FROM ' FT. TO - FR011 FT TO FROSI FT. TO FROM FT TO FROM FT TO..: FROM ' __ - FT. TO FROM .::. FT.TO MISCL:INFOR\IATION:.' .- ":' ;.. FT. FT: a c t:arrz ,tf. cr r•o,.-.w iaia7 KODIAK, ALASKA 486-4326 -KLNDOFCASING - 6in FROM FROM FROM. FROM FT. TO FT W 1 FT..T0,a, 7.F� _ 0cii; FT3 T09 i-•o'rn...141.1 FT. Top :.� W �UnCL FROM FT. TO.,.;.� rir RTJ e co U4 FRO\1 FL.Tc{ r. r; s'a FROM F . TU' 164 FT, - . FROM FT.TO ' FT. FROM ' FT: TO FT. L • FROST FT..TO FT. ' FROM FT.TO FT - FROM FT.TO. DRILLER'S NAME cja78970 77 ti111161P V-0 • GE P •t _� Municipality of Anchorage ff SEP 0,,,aa `'- On-Site Water and Wastewater Program � `., (907) 343-7904 �� !/;; .�.. �' • it O[`6 9 L 9 5 Certificate of On-Site Systems Approval -- Parcel I.D. 051-831 -07 Expiration Date: '6?..`2 �— ( r 1. GENERAL INFORMATION Complete legal description Tonjess Estates Block 3 Lot 4 Location (site address) 24938 Jesse Lee Ct. Current Property owner(s) Christopher & Terry Morris Day phone Mailing address 6625 Hillside Cir. Milford, KS 66514 Real Estate Agent Day phone 2. TYPE OF DWELLING: O Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received b • r. it Lam +1&‘' ~ _�LI J Date: q 1 COSA to be released to the engineer,unless otherwise requested by engineer. COSA Fee $ 02.42 Waiver Fee $ Date of Payment q/v/r - Date of Payment Receipt Number 60L.M6 Receipt Number COSA# 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. In conducting an adequacy test, I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 9/20/2017 �.�,SP��. . -! -a # f*. TM *�/ 6. DSD SIGNATURE •• }G System #1 Approved for 3 bedrooms r�. -S even 'R.•Pannone.' , System #2 Approved for bedrooms ��49s• CE-8149 .-&,,e Disapproved kkANOFES910-4! Conditional approval for bedrooms, with the following stipulations: i -7‘,4..._). ,c ..t.,.... ,„,,,, ,,,. s T, P 0,,0ewlS Ne.W RIr, , L , , C./ R(2136C-12,14A0Aa, Vt. G ', 6 i vt sa ftt- ak_ -3,--,-,, ,cc � i t n(� Q ��Y OF q�Cy.' '� ON-SITE PFG, WATER AND m WASTEWATER omccPROGRAM J. ,'`�A�Frt By: t"'` Original Certificate Date: � The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet c • c If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Tonjess Estates Block 3 Lot 4 Parcel ID: 051-831-07 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (YIN) Y Date completed 5/19/1982 Sanitary seal (YIN) Y Wires properly protected (Y/N) Y Total depth 82 ft Cased to 40 ft. Casing height (above ground) 1 2+ in. FROM WELL LOG AT INSPECTION Date of test 5/19/1982 9/11/2017 Static water level 10 ft. 77 ft Well production 5 g.p.m. 5'S g.p.m. WATER SAMPLE RESULTS: Coliform14-1''',51colonies/100 mL Nitrate 2 3mg/L Arsenic IADug/L Date of sample: 9/11/2017 Collected by: PES _ B. SEPTIC/HOLDING TANK DATA Tank Type/Material Greer/Steel Date installed 8/18/1982 Tank size 1 000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) N/A Date of pumping 9/7/2017 Pumper JR's Pumping C. ABSORPTION FIELD DATA Date installed 8/18/1982 Soil rating (g.p d./ft2 or ft2/bdrm) 125 SF/t3DRM System type TRENCH Length 47 ft. Width 3 ft. Gravel below pipe 6 ft. Total depth 10 ft. Eff. absorption area 504 ft2 Monitoring tube Y Depression over field N Date of adequacy test 9/11/2017 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 31 in Water added 457 gal. New depth 40 in. Elapsed Time: 30 min. Final fluid depth 31 in. Absorption rate >= 450+ g p.d N Any rejuvenation treatment(past 12 mo.) (Y/N & type) If yes. give date D. LIFT STATION Date installed _ Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer/septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ 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 main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS Survey on file G. ENGINEER'S CERTIFICATION _3.OF ,4 �l ,G Cq kk� I certify that I have determined through field inspections and rrA''�'•IP~� .yt� review of Municipal records that the above systems are in 0*: 49 TH ••*�6 conformance with MOA COSA guidelines in effect on this date. • • • ;• •••• 4' Steven Pannone �� Engineer's Printed Name — /� :5}ev�ri R.•Pannone • i 9/20/2017 io—-. CE-8149 Date #i •,• , COSA canary sheet_2-6-15.doc Municipality of Anchorage• • � • On-Site Water and Wastewater Program P.O. Box 196550 4700 Elmore Road Anchorage.Alaska 99519-6650 Phone: (907)343-7904 Fax:(907)343-7997 http:llwww.muni.org/onsite r 44CMOII"GF' 1 )1'11,11 I Ill l �l� Review Comments Engineer: PANNONE ENGINEERING SERVICES 9/22/2017 Legal Description: TONJESS ESTATES BLK 3 LT 4 Parcel ID: 05183107000 Permit: OSC171443 WellSeptic Report Type: COSA Completed By. T.Ecklund The application has been reviewed and the following comments have been generated. These are to be satisfactorily addressed prior to MOA approval: After doing a site visit please address the following 1. There does not appear to be a FCO Y�p � rN S + mo' 4'1'44 N' 2. There is missing stand pipes That were on the 82 survey but are now missing 44"-A C S 3. Please verify there is no impact from the deck on to the tank S«ttt�O r...) p-De 1`-117 ACT, t`I 0 ,c, Fla ` s ov lam- o �e lL�r p nJ • •} Municipality of Anchorage • i _ Development Services Department 46. Building Safety Division q: T On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On-Site Systems Approval # OSC 171443 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 3, Lot 4 of Tongess Estates subdivision. This inspection revealed a nitrate concentration of 8.73 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. Nitrate Fact Sheet From Northern Testing Laboratories,Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 *Os* CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.OSl- P31-07 COSA# MOP/5 Expiration Date: 9- -0 7 1. GENERAL INFORMATION Complete legal description TOF/J'ESJ ESTATES e3 LI,/ Location (site address) z4/93e resse LEe Co 0E7 Current Property owner(s) .60Ala Mailing address 24,73? Jesse. Lee_ Lending agency. Mailing address Real Estate Agent Mailing Address Coat -t Day phone 4/4/—/930 Day phone amid WI icor% A' 442e OP - Day phone Z714/^ /y3a Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑ Individual Holding tank ❑ Community On-site ❑ Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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 xl04 Pon E Address P0 JSc,1c 7707 02 �f Engineer's Printed Name Ste✓t F,.'q Date (A? 7/07 Phone ,< f./— 702 P 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for 0 ''�S )avcn W. En• 4./ syROFESJ �I ` bedrooms, with the following stipulations: Additional Comments L j : • (,)NI-SITF •• : WATER AND rn: . WASTEWATER 6. PROGRAM 5,4 • In /1/i"ENT S't �1>> Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory By ni�' c, lii� `l/cD o• (R.v.11)05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: tv - 07 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: nnJ ess Es t4 i&S B3 Ly A. WELL DATA Well type P If A, B, or C provide PWSID Date completedSfie Z Sanitary seal (Y/N) Total depth JZ ft. Cased to yO ft. I FROM WELL LOG s/i9/#z Date of test Static water level /Q ft. Well production 5 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 77 mg& Arsenic: S_2( mg/I Date of sample:6l/f/a7 B. SEPTIC/HOLDING TANK CiDATA/ Tank Type/Material fet�r/ -Sfee_I Tank size /DOC gal. Number of Compartments a Foundation cleanout (Y/N) )/ Depression over tank (Y/N) _AL Date of pumping 145/O r Pumper C. ABSORPTION FIELD DATA Date installed 8// P/%2 Soil rating (g.p.d./ft2 Length Li 7 ft. Width ft. Parcel ID: o3 / S 3 -0 7 Well Log (Y/N) y Wires properly protected (YIN) Casing height (above ground) /Z n. AT INSPECTION .CM//c 7 y8 ft. C + g.p.m. Other bacteria 0 colonies/100 mL Collected by. /rt Ea„ f',, Date installed t//i`/eZ Cleanouts (Y/N) Y High water alarm (Y/N) n/A /es System type T?,e.,c It Gravel below pipe 6 ft. Total depth /0 ft. Eff. absorption area -S041 ft2 Monitoring tube f Depression over field it/ Date of adequacy test (�///C 7 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test .26'in. Water added 54J gal.'s*" New depth 3C in. Elapsed Time:KO min. Final fluid depth3 O in. Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) UA/K Absorption rate >= SOW * g.p.d. If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on level at in 'Pump off' level at in Datum Cycles tes E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot /XII" Absorption field on lot /4z 'fr" Public sewer main Ng4 Manhole/Access (Y/N) High water alarm Ie at Meets alarm : . rcuit requirements? On adjacent lots On adjacent Tots /Do rp in. /0drf Public sewer manhole/cleanout Sewer /septic service line /DO ft- Holding tank A//4 N/4 i Animal containment areas /00 'f Manure/animal excrete storage areas /00 `' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r Building foundation 7 a Water main .(//i4 Wells on adjacent lots //10 It SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /D fr Absorption field /4 . t Water service line /0 ''` Property line /6 co- Water '` Water Service line la rt Curtain drain ii(h% F. COMMENTS Building foundation /D if Surface water /Oar Wells on adjacent lots /DQr f Surface water /60 4• Water main NAL Driveway, parking/vehicle storage Al 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 .STEM £4/C Date ( fa 7/0 7 F s i ,2r COSA Fee $ If 50 f1 II / c -C 5k— Date of Payment 114 s /07 - Receipt Number 35--5/3 (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval #070215 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 3, Lot 4 of Tonjess Estates subdivision. This inspection revealed a nitrate concentration of 7.9 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. LOT 3 RICLW SUBD. PLOT PLAN _ ASBUILT _X__ SCALE 1 ' Doi GRID NW 1462 Project No 04-094 Lang & Associates. inc. 11500 Daryl Avenue, Anchorage, 522-6476 Registered Land Surveyors (9073 522-4625 Fax Alaska 1 hereby certify that 1 have surveyed the folbwing described property: LOT 4, BLOCK 3, TONJESS ESTATES SUBDIVISION Anchorage Recording OWMot, Alaska, and Mat the Improvements situated thereon aro rRMn the property Knee and do not encroach onto the property odlocent thereto. that no Improvements on the property Iytng odlocent thereto encroach on the surveyed premises and that there aro no roadways. transmission Bnee or other vhlble imminent, on sold property except as Indicated hereon. itt Dated this the Day of Mil SL-. at Anchorage, Alaska R Is the r+apomibd y of the owner to determine the existence m roe of o easements. covenants, or RIore which do not appear on the recorded suton plat. 99515 ANALYTICA GROUP Northrim Eng Attn: Steve Eng 17237 Bear Paw Circle Eagle River, AK 99577 907-694-7028 Fax: 907-694-7026 Client Sample ID: Sampling Location: Client Project: Sample Matrix: COC #: PWS#: Residual Chlorine: Comments: Tonjess Est B3 L4 Northrim Eng Aqueous 54873 Lab#: A0706099 -01A Analytica International, Inc. 4307 Arctic Blvd. Anchorage, AK 99503 Phone: 907-258-2155 Fax: 907-258-6634 Report Date: Receipt Date: Sample Date: Sample Time: Collected By: 6/26/2007 6/12/2007 6/11/2007 5:00:OOPM SE Flag Definitions: MRL = Method Reporting Limit MCL = Maximum Contaminant Limit 13= Present also in Method Blank 11= Exceeds Regulatory Limit M = Matrix Interference 1= Estimated Value D = Lost to Dilution •* = RL higher than MCL; target not INC =Too Numerous to Count - resu CF = Confluent Growth - result reject( TCNG = Turbid Culture No Growth - Analysis Method Parameter Result Units Flags MRL MCL Prep Prep Method Date Analysis Date 200.8/200.8 (Aqueous) - Family Well Water 1 Arsenic 5.26 ug/L Lab#: A0706099-0113 Test was conducted by: Analytica - 7horr, 0.15 10 200.8 6/21/2007 6/21/2007 Analysis Method Parameter Result Units Flags MRL Prep Prep Analysis Date MCL Method Date 4500-NO3E (Aqueous) - Nitrate Nitrate as N 7.90 mg/L Lab#: A0706099-0IC Test was conducted by: Analytica - Anchor. 2.5 10 6/13/2007 6/13/2007 Analysis Method Parameter Result Units Flags MRL Prep Prep MCL Method Date Date Analysis 922213(Aqueous) - Membrane Filtration MF Bacteria, Other <MRL CFU/100mL Total Coliform <MRL CFU/I00mL Mt-tfr Test was conducted by: Analytica - Anchor. 1.0 6/12/2007 6/12/2007 1.0 1 6/12/2007 6/12/2007 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. • P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF.HEALTH AUTHORITY APPROVAL FORA SINGLE FAMILY L)WELLiNG Parcel I.D. 05F x''& I 0 ? • 1. GENERAL INFORMATION O HAA n Q 1th(C(°1 •Expiration Date: 8 2, L/- — 0 Complete )egal Scription < O/�I 3`�_.sS f� S7 4T 4 ,LO C� ,3'Loc 3 Location (site :address or directions) 2.2M : E 'SS. G c r - Current Property owner(s) /.%ntaey Day phone _418 — 027.2 Mailing address • Lending agency . _ Day phone Mailing address Real Estate Agent ROLf 7M --mg Day phone 4/- 099 . Mailing Address .. p 'T�tlg' fie. Ail, i 32-I i'/v'�� Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: . 3 3. TYPE OF WATER SUPPLY: ' Individual Well Individual Water Storage 0 Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: . Individual On --site Individual Holding tank 0 0 0 . 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 4 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 we!I and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water ssmples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER . As certified by. my seal .affixed hereto -and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on ' ' .site water supply•and/or wastewater• disposal system is(are) safe, functional and adequate•for the.number.of . .bedrooms and type of structure indicated herein. I further 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. Address •• • C .. Date57%7�G 5( Engineer's Printed Name 5.• DSD SIGNATURE • Approved for.. .. 3 bedrooms.- Disapproved. .Conditional approval for t .17C793: A‘i .141. :11114;4 ...kre411.Efrf 6.7:47 • cue' • •V Steven W. En +A' •"' 0, .� PE 6256 % bedrooms; withthefollowing'stipulations: • • Additional Comments' • Note: The well for thispropertSr meets existing and.Mumcpal-- o }es. Ther -e -are -nitrates'." ' . present. It is suggested 'that periodic testing: be perform ed ><ici the_�uells_continued-suitabili Current nitrate concentration. is. 6:18.•nig/1 ; IPA'ii aximum'concentration'is 10 Qing/I 'Mnrp information on nitrates is available fromthe On=Site Services Program, at 343-7904. - Maintenance Agreements Supplemental Engineer's Report .Other Attachments: HAA Checklist . . . X • Septic System Advisory Well Flow Advisory (Rev. 01102) Original Certificate Date: a 7 -0 . . • Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: T iJ1 S.1' ,6.1774/r6.—C L. 6T 4/ &Uuc. 3 Parcel ID: 057 --ST/ Q 7 A. WELL DATA Well type 1 If A, B, or C provide PWSID # Date completed 514142- Sanitary seal (Y/N) Total depth g`Z ft. • Cased to 46 ft. FROM WELL LOG AT INSPECTION Date of test Static water level / 0 ft. Well production -5 9•P•m• WATER SAMPLE RESULTS: Coliform 0 colonies/100 mI. Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) /-2 5M & 2 Arsenic: ^ mg./I. B. SEPTIC/HOLDING TANK DATA Tank Type/Material C%e r /j AFL Tank size /00G gal. Number of Compartments 2 Foundation cleanout (Y/N) ' ( Depression over tank (Y/N) Date of pumping -511//aft Pumper C. ABSORPTION FIELD DATA Date installed 8/ /g/PZ Soil rating (g.p.d./ft2 Nitrate b. /441 mg./II. Date of sample: $/ir/d rf Length 4/ 7 ft. Width 4/.2‘%def 7 ft. g.p.m.± Other bacteria C colonies/100 mI. Collected by: X/nrM lerr.t Frsr Date installed e //cP/P2 Cleanouts (Y/N) Y High water alarm (YIN) Alba S/I-.tfIrr'j/ ruen ) /25 System type %7C�l0j Total depth /6 ft. Eff. absorption area.S"f if ft' Date of adequacy test 4//(/a 5/ Fluid depth in absorption field before test tit? in. Elapsed Time:/26, min. Final fluid depth 1,1a' in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) ft. Gravel below pipe 6 ft. Monitoring tube y Results (Pass/Fail) P Water added5Ogal. Depression over field /V/ For 3 bedrooms New depth_5T in. 450 Absorption rate >= g.p.d. 7• If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off' level in. Datum Cycles tes E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot /0 0 I'`' Absorption field on lot / C 6 ��- Public sewer main J1/4 Sewer /septic service line /DO rt Manhole/Access (Y/ High water alar Meets alar eve/ at circuit requirements? in. On adjacent Tots / GO r4- On adjacent Tots /0 0 /'�' Public sewer manhole/cleanout IV/ Holding tank ,-(//,,1 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation + Property line /0 Water main .V�r� Water service line Wells on adjacent Tots /OO r'1 - SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /d Water Service line / 0 r'e' Absorption field Surface water / Od rf i Building foundation f Water main Al/4 Surface water /60 le' Driveway, parking/vehicle storage - /6 rt Curtain drain /R' Wells on adjacent Tots /6C ff- 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 s/t7/0 Date S7 -Fie Ei —.:::::::, 49 f� le;•1��� R� 1/,�F Steven W. En;In.. csJ �+'•. PE 6256. �l"r' sj%•„• FFSSt� s . HAA Fee $ L/ 3() Waiver Fee $ Date of Payment I VDq Receipt Number Z2 -S( (p S (Rev. 12/01) Date of Payment Receipt Number L • x 15' UTLiTY EASEMENT r,2• 100' PROTECTIVE WELL RADIUS / TWO STORY WOOD FRAME RESIDENCE N 139°53'15.E 120.00' LOT3 - RICLIN SUBD. LOT 9 PLOT PLAN ASBUILT _X_ SCALE 1' ' 5°' GRID NW 1462 Project No. O4'094 Lang & Associates, inc. 11500 Daryl Avenue, Anchorage, A 907 522-6476 Phone Registered Land Surveyors (907) 522-4625 Fax I hereby certify that I have surveyed the following described property: LOT 4, BLACK 3, TONJESS ESTATES SUBDIVISION Anchorage Recording District. Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property Tying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the Day of (ti -I l • Zp0 d-. at Anchorage, Alaska It is the responsibility of the owner to` determine the existence of any easements. covenants, or restrictions which do not appear on the recorded subdivision plat. Iaska 99515 • • • 1 • ;; ;7: • : . , 7. • , . ) '.• • , • . , • / • • ; i.; 1.": Z.; 1-)..„ • L-1 • ."i '•" ; ; 7 • '!"*.' • k. • " 1.; 4.. F „ . • ' t , 1, „. . 7; • D. LIFT STATION Date installed Size in gallons "Pump on" level at Datum in. "Pump off' level Cycles tes Manhole/Access (Y/ in. High water alar E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot JO 0 14 - Absorption "'r'Absorption field on lot • / G G r÷ Public sewer main Meets alar evel at circuit requirements? On adjacent Tots /GO CI - On adjacent Tots in. /U 14- 'f" Public sewer manhole/cleanout Sewer /septic service line / J r -t Holding tank ,(1/,4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation . f Property line /Of," Water main N/4 Water service Zine Absorption field r /4 *' Surface water Wells on adjacent Tots /66 r'f' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property P Y line /d 4" Building foundation jer -E' Water main Water Service line / 0. r't N/A /Od'�- NAS Surface water _650 rC'A Driveway, parking/vehicle storage' /lj'� Curtain drain A//R' Wells on adjacent lots MO' r+` 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 �%� � EA) 6 5/17/1 Date SOF ACtt �'�Q��'•''......,qS+� • • its F °M so co s* 1.49. . • 1P i Steven W. Eng 4,4 a �• PE 6256 • V ;'...+ + i l�pROFFSSt� ""' 3 U %aNN" HAA Fee S Waiver Fee S Date of Payment � J 0 U Receipt Number 7;Z Ss 10 S J l (Rev. 12/01) Date of Payment Receipt Number B 14 04: ! : 0SPM; _sGit SGS/CTE ENVIRONMENTAL SERVICES Drinking Water Analysis Report for Total Coliform Bacteria READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE MUST BE COMPLETED BY WATER SUPPLIER �0 PUBLIC WATER SYSTEM ID# _ i ,RIVATE WATER SYSTEM Send Results Serd Invoice ; 'C EEISSOt at A 200 W. POTTER DRIVE ANCHORAGE, ALASKA 99513 TeL 507-562-2343 Fax: 907-561-5301 Lab Rn! Mn 1042441 MII /.0t :Mein H«t.Companf Non. I lo�T(t.('(vt-, EJ C rti -2flOC Comact taro• Ttiz-? Gam, EI 94C 70X OWN is LAY SIIL ZO Code SAMPLE COLLECTION: !« rota nooks. a.• • nwt h.0tn v sa 0 00 Ms N... pt..0. 0.o. Date: /( Month Osy 4c' YOU SAMPLE TYPE: ( Routine Time: !CCC (l PM owes* Location: 7-0/11 .t I FJ'i L or t.h t ``f6 Collector. SIL — PrniodtIone Transported to Lab By: J Same as co'lector Other: 0 Treated Water o Repeat Sample ❑ Untreated Water (refer to lab no. ) 0 Special Purpose tion• aro untie '0 BE COMPLETED BY LABORATORY Sample Receiving: Date: 5-e1-04( Time: f Sr4.3:41X arpte over 33 flours old: Results may be unreliable 0 RUSH SAMPLE Temp: ❑ 4e Hour Waiver Phone #: Delivery Method: 1 1.14+.,For Remote• rs Fax tt: Received By: Comments: . Ied Name a oro BacterlotogIcat Water_ktlalVslS Record: J�"� MMO.MUG (PIA) RESULTS: Analysis Dagen. �ail 1p'�T n**Sf) TotalCotlform: Analyst: kp�- l E. Coli: sent to AMC: ANC F8K JUN Dotorri re: :tent to Client: A-tatytical Method. r2EMBRANE FILTER RESULTS: Phoned Q Faxed Q Drect Count Colonies/100ml UatclT.mc: - g Membrane Filter Verfncation Gpoke JMMO-MUG (P/A) Reported By: `J•• (9 (t-/ di)M1/'ure o Toat42.. ILTB. BGS: iwtcollom (EC . DatelTimc: 61r31t4( WpetrelpubridDOCUNENTIFORMS\Miarc\Ccli Fermxls Satisfaciory 0 Unsatisactory t' Z4g TNTC •Tee Mu morons to Count 05 -Other eecerla Form it FW- 0G53 10/24)03 • 2. 14 04; _ .2EF0.1; GS RefJI :tient Name 'roject Name/N :tient Sample 11) Iatrix WSID 1042441001 NorthRirn Engineering Tongess Estates Lot 4, Block 3 Drinking Water 0 :007 7.eIt3o1 . A Z. All Datesrfimes are Alaska Standard Time Printed Date/Time Collected Date/Time Received Date/time Technkal Director / Stephen Released 05/14/2004 6:49 05!11/2004 10:00 05/11/2004 13:30 Edc ample Rerr.arks: Results PQI . links Methal Container• 11) Allowable Prep Analysis llmitt rate Gate In t 'eters Department Nitrat:-N icrobiology Laboratory Total Coliform 6.18 0 0.100 mg/L EPA 300.0 B (<=10) 05/12/04 . JB co1/100rrL. SM18 9222D A (<=1) 05/11/04 D::C Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description HAA# Ac1ln)-1S1 In: A; RP' 3; TnnjOAA F.;tr.,tn Location (site address or directions) 24938 Jesse. Lee. Count Property owner Mailing address Lending agency John IItoning City Moa#gage. Day phone 681-9949 Day phone Mailing address Eagle. Rivet. Atttslza Agent Kathy Gehaci./Gat =L7nd Realty Day phone Address 11411 Otd Gtenn Highway, Eagte R.iveh, Ataaka 99511 -- Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 694-9125 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. 72425 (Ray.1/9?) Front MOA F21 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. 1 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 & 5 ENGINEERING Address 1 7111 A r2a1a River l flop Read No. 204 Eagle River, Alaska 99577 -Engineer's signature - - • Phone Date ' lac,—Ito-ct 1 "'.o c:.....Aj '\� - - - • AI?" •:va ;*/49w. .icdi 4. •d • / AFER, P� 4C.". 02 ir0 • •/eId � %\F,pROFES510 r+" . ' 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for in/tc bedrooms. Additional Comments bedrooms,' with the following stipulations: M:UIt1NL` 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 sof Anchorage is not responsible for errors or omissions in the professional engineer's work. 9240 (R«. 141) Back MOA 121 Municipality of Anchorage _ Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lac' A 3t•4 -n7 SW. Percent. 4. A. WELL DATA --- - Well typeCZAV KC- If A. B, or C, attach ADEC letter. ADEC water system number • Log present&N) Date completed - -B-7- • Driller - %it L-4-1 AerIS 44€>"• Cased to Total depth 4r1-` Sanitary seale/N) Casing height Wires properly protected �N) y FROM WELL LOG , AT INSPECTION .• Date of test Ca- 1z:,- - • r.Static water level 12.n 4. • - - _ rrifl� Well flow ' 7CC) Cart g.P•sk e. cl•P•rfr- Pump level rn ILO SEPARATION DISTANCES FROM WELL TO: E, -•\ 1, Ot VC ; On adjacent lots 00 ' vie ; On adjacent lots l'Oo• Septic./holding tank on lot Absorption field on lot Public sewer main MP, t. Sewer service line •• , WATER SAMPLE RESULTS. . aCCra• ••••(2 v^ Coliform la' Nitrate • Ir • Date of sample: 110-4 SA% Collected by: Public sewer manhole/cleanout Petroleum tank B. SEPTIC/HOLDING TANK DATA • Date Installed 6- S Other bacte'rie PAD AS S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Tank slze ktx>c) Compartments 1- Cleanouts0/N) y • - • Foundation cleanout&N) High water alarm (VA) ; 4 Date of pumping 10- lat --ott -'• Depression (ye Alarm tested (Y/N) 'Mr • 4 Pumper Oat, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot los \ On adjacent lots 100 5 '4" Foundation 'To property line —10 Absorption field Water mainiservice line - Surface water/drainage - 72-026 (Rev. 7/91) Front • - - CONTINUED ON BACK PAGE C. LIFT STATION Date Installed / • Size in gallons _ Vent (Y/N) High water alarm level Meets MOA electrical code !Pump on" level at " "Manufacturer Manhole/Access (Y/N) lump off' level at Cycles tested SEPARAT • r ISTANCE FROM LIFT STATION TO: '" ell on lot -c I `' ' On adjacent lots 0: ABSORPTION FIELD DATA 'Date Installed 0-1e-Sti: ::.'1 Length 41Width 1 431; t-- r-1 ;Total absorption area —504 5 :Depression over field (WS) - 4 Resultscaat/fail) QP�s .: i, ti . 2 - Surface water Soil rating 17.5 A', av System type - Gravel thickness Le Total depth Cleanouts present2YN) 7 Date of adequacy test 1 b - C1 -`11 for -1-42-6-c-- bedrooms P(Ot+lE /<�iov1A1 if. .. ,--‘7':' Peroxide treatment (past 12 montns) (Y(f� yes, give date . Y• - SEPARATION DISTANCE FROM ABSORPTION FIELD TO: _, Well on lot toff "- On adjacent lots I0o"" Property line 10" To building foundation To existing or abandoned system on lot 'a LA. Onadjacentlots Sot} Cutbank alb Water main/service line 10"- -,T . Surface water I OO t Driveway, parking/vehicle storage area 15� A l 1. . S ..KN - _.. . l/" ,--.2.1. _L_. • ' Z I I?:"..77;1304 Z E 2 _:v -t L E. ENGINEER'S CERTIFICATIONt't:oct ¶' ?VV &beta,iwi9 "'p.3 [Cr •;.-.1".U..1 I certify that I have checked, verified, or conformed to all MOA and HAA guidelines In effect on ticdate of this inspection. -1 _ a^.v': is - - rm, j1 __ -���•1 i"- ,�' l i Signature s R S PAIMNIFFQ(NG -17034 Eagle River Loop Road 1443:20A Engineer's Name r2g19 River, Alaska 99577 Date 1O- l Lc:- cl HAA Fee $ U Date of Payment ' /0 - /7- 3/s77 7 -3/s77 (k76r> Receipt Number. 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number a -t OF At i*149TH .414` ••• • • /`n • ROG�1 J. FER,V.E /r cl . revs t orRonss ONP+ r,, !:: CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 6 STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 1NILISI3 REPORT RI SAMPLE for VOREordest 39016 Data Report Printed: OCT 8 91 1 07:40 Client Sample ID:L4 62 ION3133 13T. PWSID :UA Collected OCT 4 91 1 10:30 bn. Received OCT 4 91 1 13:45 hrs. Preserved with :13 REQUIRED Analysis Completed :OCT 7 91 Laboratory Supervises : T PEN C. 101 Released By : Client Vane :3 G 3 INGINEERING Client loot :S13ENCP 1P0 1 Req t Ordered By . Send Reports to: 1)3 i 3 INCINELRING 2) PO 1 NONE RECIIPED Chemleb Ref 1: 915285 Lab Smpl ID: 3 Parameter Tested Matrix: WATIR Result Units Method Allowable Limits VITIATE -M Sample ROUTINE SAMPLE COLLLCTID BI: d1I. Remarks: 4.2 mg/1 IPA 353.2 10 1 Tests Performed ND• Nona Detected NA• Mot Analyzed ' See Special Imtructions Above • Sae Sample Remarks Above LT•Less Than. CT•Greater Than ®SGS UA -Unavailable Member of the SGS Group (Societe Generale de Surveillance) �r 7 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIALTESTING & ENGINEERING CO. TELEPHONE (907) 562.2343 5633 B Street Anchorage. Alaska 99518 Drinking Water Analysis Report for Total Coliform Ba:teria TO BE COMPLETED BY VJATER SUPPLIER O PUBLIC VJATER SYSTEM I.D. S I 1• 1 1 1 1 1 4 PRIVATE WATER SYSTEM 4:1 •,41..3.1 Lst Del - 7511 1 Awn. PnY. Ho. 11 f34 Er w C.4 - Li). e> 1 2a 4 M.maAoa.0 c.y SAMPLE DATE' t I o Mo. Day SAMPLE TYPE: Routino s 0 Check Sample (for routine sample -) , with lab ref. no. ) 0 Special Purpose SAMPLE No. LOCATION 1 11.—cr 4 2 1 <0 a1&)5. c.—sr 31 41 5 A.D.E.C. /0%99/ A& - READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Stale LW Year ctct677 ze Coo. 0 Treated Water 0 Untreated Water Time Collected Collected By I X4•.37 r TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: Satisfactory O Unsatisfactory 0 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 r ph° lq( (1(0(3 Analytical Method: Membrane Filter • No. of colonies'1C0 ml. Lab Ref. No. Result* [_0 r 1 1 BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count Verification: LSB Fecal Cotllorm Confirmation Flnal Membrane Filter Results Reported By TNTC = Too Numerous To Count OB = Other Bacteria 20d 900 7;4 BCB LDau Time: 000000000000nnnnnnnn nnnnnnnnnnnAn,,,,A,,,,,,,, Analyst Cotllorrmt100 mt Co0lorm/100 mi (o.q•Rr 3- n MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 2644720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lf 6 3 ;,; j cslrfcs Location (address or directions) (b) Applicant Name John FMtn ni'fill Telephone: Home (Ogg -619g Business 5(O( -a313 Applicant Address 5IZ,-a• Boy (A3D C61U3In1() F}LI►skri- ggSN� (c) Applicant is (check one): Lending Institution 0 ; Owner/builder 0 ; Buyer,e; ; Other 0 (explain); (d) Lending Institution H`in+F . vT/J/N7SJ/0"�nelephone 0,9 /(O -/.1451. r� Address /0 / ( F Balm. l4 /Jn At// /a/C (e) Real Estate Company and Agent�C/CikiF- Address Telephone (f) Mail the HA too 02e following address: 2. TYPE OF RESIDENCE Single -Family' Multi -Family 0 Other Number of Bedrooms 3 3. WATER SUPPLY Individual Welly Community 0 Public 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL ��r°"'_ p� Onsite I1�Il[.` Public 0 Community 0 Holding Tan Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025(11,84) fel n 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verily that my Investigation of this Health Authority Approval 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 tiles and from my Investigation and inspection, the on-site water supply and/or wastewater disposal system is In compliance with alt Municipal and State codes, ordinances, and regulations in effect on the date of this Inect-ion. f� 1 Name of Firm P114waist 4 ►—ob.set p.4 -e& Telephone b Ii76 Address ID 1 41A_ Th �u.c.�— AI< Aci at Date S" 6. DHEP APPROVAL L3 Approved for -iztiedrooms by Approved K Disapprove Terms of Conditional Approval Engineer's Seal "r -r +,f � Date /�ri d lir Conditional" CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) Issues Health Authority Approval certificates based solely upon the representations given In paragraph 5 above by an Independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending Institutions In order to satisfy certain federal and state requirements. Employees of DHEP do not conduct Inspections or analyze data before a certificate is Issued. The Municipality of Anchorage Is not responsible for errors or omissions In the professional engineers work. Page 2 of 2 7 2-02 5 111184) r'1 n "" MUNICIPALITY OF ANCHORAGE (MOM, RITY APPROVAL D A 13 J T ECKLSOT-FEBRUARY 1984 �) 264-4720 LeARLQescription: I-4><1 kdc.le 3 /a'ss £s%►'ts %.....) 4 sr0c2 erist4 ",en w :98612 t AVVJ NOLL-1310W W1N3WNOnIAN3 A. WELL DATA7 H11Y3H iO Yd3C ;DYSON: NY 40 Aif vdIDINnw Well Classification I MI+ ATt- If A, 8, C. D.EC. Approved (Y/N) Well Log Present (Y/N) V Date Completed 5' (-8a Yield 4r 3P.s._ Total Depth 8a Cased to 6 a Depth of Grouting Static Water Level 7.1 Pump Set At un%ynas,. Casing Height Above Ground /St" Sanitary Seal on Casing (Y/N) y Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) A/ Separation Distances from Well: To Septic/Holding Tank on Lot /4 et: ; On Adjoining Lots I4 f To Nearest Edge of Absorption Field on Lot //L , ; On Adjoining Lots /4a't il To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by %./ it)IC ; Date ±C 7'84, Water Sample Test Results SMcTa+ Comments B. SEPTIC/HOLDING TANK DATA Date Installed S'4B-aZ Size idXe No. of Compartments-rato Standpipes (Y/N) Y Air -tight Cats (Y/N) Y Foundation Cleanout (Y/N) Al Depression over Tank (Y/N) Af Date Last Pumped een :i -ti 84 Pumping/Maintenance Contract on File (Y/N) A/ ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) _ Separation Distances from Septic/Holding Tank: To Water -Supply Well To Property Line To Water Main/Service Line Course Comments Page 1 of 2 72-026(11/84) 04 To Building Foundation /8 To Disposal Field /a To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /.35 8y8- ea 34, , Date Installed Width of Field Type of System Design Length of Field 41 Depth of Field /0 Gravel Bed Thickness G Square Feet of Absorption Area a se Depression over Field (Y/N) Al Results of Last Adequacy Test S4.4,/ Separation Distance from Absorption Field: To Water -Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line I 61-• To Existing or Abandoned System on i de4!^_6ff%/Ant ; On Adjoining Lots To Cutbank (if present) 5c IS, Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments •• Check Permitted Bedroom Rating Against HAA Request •• I certify that j have chced, yeritied, or conformed to all MOA and HAA guidelines in effect on the date of this inspection, Signed \- i/J_� Company Lgl+'3•".'b" Receipt No. gR2{SS, 31 Date of Payment S t R Amount: $ Page 2 of 2 72-026 (1144) Date S -is -86 MOA No. S-aS-2B OF Acarls ��.• • i04 etc" Engineer's Seal NORTHERN TESTING LABORATORIES, INC. 600 UNIVERSITY PLAZA WEST, SURE A FAIRBANKS. ALASKA 99701 801-4743115 6951 OLD SEWARD HIGHWAY, SUITE 101 ANCHORAGE, ALASKA 99502 80430.98623 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY CLIENT 0 PUBLIC WATER SYSTEM I.D. #1IIIIII g PRIVATE WATER SYSTEM NAME SR 6'O X. 6486 IA.IHIna to 45 . Alt ag6CC/ City Stat. Do Cod. TO BE COMPLETED BY LABORATORY Received at: 12'Anch. 0 Fbks. Date Received 6/pj/�g�P Time Received g2,5 Next Sample Due COMMENTS: SAMPLE DATE: .0.5 .Ca Phone (e8S 'H49 SATISFACTORY Mo. DW The Purchase Order No. UNSATISFACTORY SAMPLE TYPE: RESAMPLE R '%routine 0 Treated Water OTHER BACTERIA OB ❑ Special Purpose 0 Untreated Water TOO NUMEROUS TNTC ❑ Check Sample (for original contaminated TO COUNT sample with lab reference no. ) Sam* Time tick London Collected Collected 6y 1 L.4:CnYl Ss � RAI 446 2 3 4 5 6 7 8 9 10 Signature of Representative JTAIrorA FOR LABORATORY USE ONLY .....,a I nawsrmr I not asiiuniou Dina Carat v..nanbn Final LS8 BOB R.wR• Comment. • talerm Colonies per 100 rale. O00 Date Time CHEMICAL & CL' OGICAL -LABORATORIES . ALASKA, INC. TELEPHONE (9071.279.4014' •.ANCHORAGE INDUSTRIAL CENTER 274.3364. 5633 8 Street . -Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: TO BE COMPLETED BY LABORATORY LD. NO. rA lei .. CLQe_.t, Water System Name Mailing Addr.0 ; 4 4U� SAMPLE DATE: SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample with lab ref. no- .. - ).. 0 Treated Water ❑ Special Purpose • . . ❑ Untreated Water 0 Phone No. Mo. 1 Analysis shows this Water SAMPLE to be: atisfactory O Unsatisfactory ❑ 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 S-3/'8 12 Time Received %5 -314 - Analytical Method: SAMPLE NO. 1 2 3 4 5 ❑ Fermentation Tube )(Membrane Filter. sie LOCA170r4�� GU A3 /OtJj-sc` �v Time ;. Collected Collected By re) 7> 0 PAW ,. Lab Ref. No. Result' Analyst x.11999 -75-I ; ■i'TI ;I " .No. of solomos/ TOO ml. 0. No of Po.t.n potions READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 044220 (b) Rev. 11175 Date Collected • Date Received Presumptive ' BACTERIOLOGICAL WATER ANALYSIS RECORD 41 Hours Confirmatory 24 Hour' 4a Hoursb. EMO Multiple Tube Report: Membrane Filter. Direct Count -Verification LTB Final Membrane Fliter Result' 1 - ( 0111 ll 'Ui7VE1/4...- Time Received 10m1 lofnl Brum 24 hours: r Reported BY Source a.m. �OJn I.ab Nd. 10m1 10m1 10m1 1.0m1 0.1m1 Broth 4e hours. 10m1 Tubes PositIve/Totel lOm1 Portion CORrorm/100m1 sae' Dat. Time, /;ren Colllorm/100m1 a.m. pan. CHEMICAL & GL LOGICAL LABORATORIES F ALASKA, INC. TELEPHONE (907)-279.4014 - ANCHORAGE INDUSTRIAL CENTER 274-3364 ........... 6833 8 Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER '., WATER SYSTEM: . I" 1 1 11 ....J/7/_ 1//1 To Efr Water System Name z2i), ;` J -o7 / Mailing Address L, p City LD. NO. 4/rE"LLO Phone No. SAMPLE DATE: 0 Mo. 'TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ❑ Satisfactory - Unsatisfactoro ❑ Sample too long in transit: sample should not be over 48 hours old at examination pj to indicate -reliable results. Please send _S-'7 7 =r� -...:new sample. . - 2ip Code ' r SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample with lab ref. no. t ' ) ❑ Special Purpose Date Received - ?- 5y- r? z_ Time Received ^'- /G V. —>r Analytical Method: 0 Fermentation Tube Membrane Filter SAMPLE NO. , LOCATION 1 Result*, Analyst C.11 tI I— 4'/13 '.�,r;Tfss. READ INSTRUCTIONS BEFORE COLLECTING SAMPLE pia EMI ■■ 06-1220 tel BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1976 Date Collected Oats Received Presumptive 24 Hours ' 44 Hours Conrinletory 24 Hours • 4a Hours EMB Multiple Tube Report. Membrane Pater. Direct Count Verification LTO Final Membrane Filter Results Reported By l • ca,%. !^'.- Sours a.m. Time Received 0.111. Lab. No. IOnM 10m1 10m1 10m1 lOml 1.0mM - 0.1rn1 Broth 24 houru ' Broth 46 Noun. 10m1 Tuba PoiRlve/TOW 10m1 Portion CoNrorm/100m1 908 Det* Tine. Colitom1/1O0m1 a.m. 0.11% 1• I I - 1 tri~ TIME - r DATE INSPECTOR r INSPECTION APPOINTMENTS TIMEn, l CL•M m PCD DATE �1 GNI C n .. _ INSPECTOR - ... r, DATE RECEIVED TIME ri Act .Ar tn DATE INSPECTOR MU IrL1iY OF A thb AGE MUNICIPALITY OF ANCHORAGE CFPT. OF HLN.I.T4 R DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO I+ JII�'=f i� A. F':O-ECTY N 825 L Street • Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 AUG 1G 1982 `RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete moats will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER St MAILING ADD ESS PROPERTY R ESIDEENT Nhiti 2. BUYER a[-! 47e L(o . . a ,L' 12o 7/ - . (If different from above) Esse Ie. MAILING ADDRESS 3. LENDING INSTITUTION MAILING ADDRESS 4. REALTOR/AGENT MAILING ADDRESS 5. LEGAL DESCRIPTION atZe I PHONE Afr 97577 . PHONE 'r C•eeik .#47/2 Atr 44r0 1 PHONE AilrA72 J le,.•A/X 1 PH NEv 2 0.3 tc," Sfit.4 7 77 PHsONE -Pa .. ,Q,:r t4' I ; yip d PO note /776 4 c. #,. �... ,41 9SS77 i 1' Asti 3 - j sj fl /r/Au c -r .6f f .P0 77-f is C reet4 ftfL STREET LOCATION 6. TYPE OF RESIDENCE EQ—SINGLE FAMILY ❑ MULTIPLE FAMILY 7. WATER SUPPLY INDIVIDUAL" ❑ COMMUNITY ❑ PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM .. L INDIVIDUALJON-SITE" ❑ PUBLIC UTILITY NUMBER OF,BEDROOMS ❑ One 0 Four ❑ Other 0 Two 0 Five (Me -three 0 Six 'ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) /9S-2.- YEAR ON-SITE SYSTEM WAS INSTALLED. F-/ C-8 NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Ray. 8/79) .. yY� 1. TYPE OF RESIDENCE I -SINGLE FAMILY 0 MULTIPLE FAMILY 2. WATER SUPPLY Er INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM C DIVIDUAL/ON SITE ❑PUBLIC UTILITY Connection Verified ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: TYPE OF TANK ( r2c �/7�- TOTAL ABSORPTION AREA - 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS THIS SIDE FOR OFFICIAL USE ONLY a NUMBER OF BEDROOMS ._ ❑ ONE I2:17/THREE 0 FIVE 0 OTHER ❑ TWO 0 FOUR 0 SIX PERMIT NUMBER DEPTH OF WELL -. 2. DATE DRILLED cc -10'8 LOG RECEIVED - PERMIT NUMB EW DATE INSTALLED INSTALLER SOILS RATING 2 ? MANUFACTURER . 5423. �-j{y I MATFRIAI. /000 V.. .. Septic/Holding Tank Absorption Area Sewer Line / L7 b / 00 1- (( c_lokka- p • s-- t-82 $0 kssej, . Nearest Lot Line Lel APPROVED FOR 3 BEDROOMS 0 CONDITIONAL APPROVAL (letter must accompany certificate) -❑ DISAPPROVED 72010 (Rev. 6/79) is3 Mr. Jesse L. Prince Jr. and Mr. Tony Schaff P.O. Box 467 Girdwood, AK 99587 4040.8" STREET ANCHORAGE, ALASKA 99503 (907) 278-1551 • • September 11, 1978 W.O. #D10766 -rotpip17 Subject: Subsurface Investigation for Proposed Tonjess Acres Subdivision (formerly • proposed as Prince Acres Subdivision) Located within the SW 1/4, Section 2, T.15N., R.1W., Seward Meridian, Alaska 1 Gentlemen: We have now completed the additional testing in Area B of, the proposed project as outlinedlin our report of July 5, 1978. Included with this transmittal are the following: Test Hole Logs Standard Explanatory Information 'Preliminary Plat with Test Hole Locations Table A Sheets 1-3 Drawing 121-28. Each lot in the area investigated with the exception of Lot 1, Block :, is suitable for an on-site sewage treatment system . One or more test holes were placed on each lot in Block 1, (with the exception of Lot 7 which already had a suitable test hole) and on Lots 1-5, Block 3. Six percolation tests were performed. The results of percolation tests are as follows: rqh Test Hole No. Minimum Percolation Rate • 29 4 5 minutes/inch 31 4.4 minutes/inch 33 27 minutes/inch 35 5.0 minutes/inch 36 3.1 minutes/inch 38 5.7 minutes/inch Our recommendations for septic tank absorption system design values, along with the test holes upon which these values. are based, are tabulated below: • 4• Nip �:.. L. .flu, Jr. and Mr. Tony Schafi September 11, 1978 Page 3 When drilling was completed a 3/4" slotted PVC pipe was inserted in the hole to aid in determining the water level. The hole was filled with water and left overnight to saturated. On returning the next day the hole was refilled with water and the water level in the hole carefully monitored for the next 60 minutes. The observed minimum percolation rates are tabulated above. We trust the above meets your present requirements. If you have any questions or if we may be of further assistance, please -do not hesitate to contact us. RMH:rb Enclosures APPROVEDR�I PMgt/ Melvin R. Nichols, P.E. -Laboratory Manager Very sincerely, ALASKA TESTLAB te t. lar sE<n Mr. Jesse L. Prince Jr. and Mr. Tony Schaff P.O. Box 467 Girdwood, AK 99587 4040 "B"STREET ANCHORAGE, ALASKA 99503 (907) 27&1551 September 13, 1978 W.O. #D10766 Subject: Subsurface Information for Tonjess Acres Gentlemen: • The recommendations which indicate the suitability of each lot in the above subdivision for individual waste water treatment systems, are organized as follows: ' Lot and Block Numbers Report Color Date Code Block 1 - All 9-11-78 White •Block 3 - Lots 1-5 9-11-78 White Block 2 - All 7-5-78Blue Block 3 - Lots 6-24 ' •7-5-78 Blue Test.. hole logs with accompanying reports are color coded as follows: Test Hole Report 'Color Numbers' Date Code 26-39 9-11-78 White 14-25 6-28-78 Gold 1-13 5-2-78 Green Idealized soil profiles are near the back of the 6-28-78 (gold) rp,prt. Test holes locations are shown on the accompan ing preliminary plat. Very sincerely, 4 4 RMH:rb Enclosures tRO• VED /• nj//� �,j • Melvin R. Nichols, P.E. Laboratory Manager• ALASKA TESTLAB l.eso-ais.--------Mark Hansen Mr. Ju::cu L. i•! :Yce, Jr. and Mr. Tony Schaff September/11, 1978' Page 2 5 6 BLOCK 3 1 8, 35 5.0 minutes/inch 2 8, 36 5.0 minutes/inch 3 37, 38 5.7 minutes/inch 4 38, 39 5.0 minutes/inch 5 39 5.0 minutes/inch Recommended Design Test Hole # Percolation Rate. 17; 18, 26, 27 28 Not Recommended '22, 23, 29, 30 10.0 minutes/inch 24, 25, 31 5.0 minutes/inch 32 15.0 minutes/inch* 33 . 27.0 minutes/inch* • 34 15.0 minutes/inch* 20, 21 5.0 minutes/inch * We expect these values to be conservative. After the absorption trench is excavated, we recommend inspection of the trench walls and a possible reduction of the area dependinn_on the soil type encountered. r.. Subsurface investigation was conducted on August 24-29, 1978 and consisted of 14 test holes. A Nodwell mounted Mobile Drill 2-50 rig equi¢ped with a solid flight auger was used for the exploration. Test holes were logged and located in the field by Mr. T.L. Barber, geologist with Alaska Testlab. Percolation tests were performed by Mr. Barber and Mr. T.A. Sexton, geologists with Alaska Testlab. The soil most 'generally .encountered was a silty sandy gravel. This material was quite dense and contained occasional cobbles. Thus, it offered considerable resistance to drilling. Test Holes #32 and #34 did not have percolation tests'run because the holes caved in after withdrawingthe auger. • .Test Hole #38 Table A WO #D10766 Logged By: T.L. Barber Date: 8-28x78 Depth in Feet From To Soil Description 0.0' - 0.5' Brown Peat (Pt), soft. 0.5' - 14.0' F-1, brown Silty Sandy Gravel (GM), .damp, very dense, surounded andsounded particles. Bottom of Test Hole: 14.0' Frost Line: None Observed Free Water Level: Nome Observed Type of Dry , , Sample Depth M% Sample Strength Group Unified 1. 14.0' G Remarks: •1. Type.of Sample, G=Grab, SP = Standard Penetration, U = Undisturbed. 2. Dry Strength, N=None, L=Low,.M=Medium, H=High. 3. Group refers to similar material, this study only. 4. General Information, see Sheet 1. 5. Frost and Textural Classification, see Sheet 2. 6: Unified Classification, see Sheet 3. fOE 4 zurotirip