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DELUCIA LT 5
r.)eluci a Lot 5 #051-141-47 Jun 13 22 07:04p Anchorage Well & Pump Ser 9072430742 p.1 MUNICIPALITY OF ANCHORAGE Development Services Department- , Phone: 907-343-7904 On -Site Water & Wastewater Section :v ,3 �/ Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: Date of Issue: Parcel Identification Number: 051 141 47 Legal Description Block Lot Property Owner Name & Address: BYRNE JENNIFER ELLEN & JAMES GERARD JR DELUCIA 5 13 LAKESHORE DRIVE SHALIMAR, FL 32579 Pump Installation Date: 05 - 13 - 2022 Pump Intake Depth Below Top of Well Casing: 122 feet Pump Manufacturer's Name: A.Y. MCDONALD Pump Model: 2307SU3LB/6622-075 Pump Size: '75 hp Pitless Adapter Burial Depth: 10 feet Pitless Adapter Manufacturer's Name: MARTS NSON Pitless Adapter Installer: Well Disinfected Upon Completion? Yes ❑ No Method of Disinfection: PELLETS I Comments: Pump Installer Name: _ Company: Mailing Address: ANCHORAGE WELL & PUMP SERVICE 7640 KING STREET ANCHORAGE, AK 99518 907-243-0740 State: Attention: The pump 'installer shall provide a pump installation log to On-site within 30 days of pump installation. • Municipality of Anchorage Page 1 of 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: Sl�l 92-d 16 �L PID Number: 4D"5 114- IQ's'" Name: ' I Wastewater System: '❑ New Upgrade Address: .�� ABSORPTION FIELD U Phone: No.O Brooms: ❑Deep Trench 11 Shallow Trench' ed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: /, Total Depth from original gra de: • I GPD/S Ft. Lot.Block: ✓' Subdivision: ISP Depth to pipe bottom from original orale, 2•CJ Gravel depth beneath pipe i �'� Ft. Fl. Township: 7 Township: Range: Section: Fill added above original grade: Gravel length: / SG 0r- �. Ft. Ft. WELL: ❑ New El Upgrade Gravel width: I�r Number of lines: Distance b 1ween lin F: Fl Classification (Private. A.B.C): Total Depth: Cased To: Total absorption area: Pipe material: 'relO -F4 'D Ply -i)Lf, FL Ft. SO Ft. T`4TT1 Driller: Date Drilled: Static Water Level: Installer: p (4,!Z Date Installed:_ Ft. Yield:Pump Set at: Casing Height Above Ground: TANK GPM FL Ft. SEPARATION DISTANCES ❑ Septic ❑ Holding T.E.P. To Septic Absorption Lin Holding ubliUPrivate Manufacturer: // �� / apacityy In gallons: From Tank Field Station Tank Sewer Lines G L� I�r'R�► !J'L/ Well IOGf 120, 1OGr/.t� .� a Material: Number of.Compartments: Surfac 16vT-� 16L`I' I�1-I' – LIFT STATION Water — Lot I f7 + I p=l- IDI-}- size in gallons: size Man f� actur�� PA �"jPumPo Foundation I Cj / I �� I CJ r �--- "Pump on**level at: f" 11 at: High water alarm at: Curtain �. _ I I/ _ 1 �._ Pum Make 6 Mod¢I�4 EI c rical Inspections performed by: Drain Remarks: BENCH MARK 4oca io nd.Dgscri tion: ' t kl V Assumed Elevation: r Ft ,. •_.mull c t;tic.^;1.1.;,L; ENGINE`Epp S SEAL �.1�1 . OF 4 it 'WeS •• & S ENGINEERING f• 0 Inspections performed by: 1"34 Eagle Ritter LOOP Road, N133M: 1s g l3 y �•••' •••••• •• » »i. • n Eagle River, Alaska 99577 2nd -0j t� QQc-r t,�,�.� ^ L �.t,e� �,�_� / 1 • '••"»•' ••• •••• ROG J. HAFER / / Department of Health and Human Services approval �I��ti66041109 N0' 's Reviewed and approved by: Date:�0 �0 9�- t1ati, FESS A- 4110 �•'C�� T2-013 (Rev. 9/91) MOA 25 Permit No. Page -Z- of 'Z Municipality of Anchorage 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 Legal Descriptions 45 VUG I i X/ l' lAct A . L.01- G PID No.: 015 11 6_143 -�' wii3 rtt�T Gol Co ID -Z 3 r'Sn�.►� �F►v�rF�? X186 3�Fb WP-T=Troµ,,sp RECEIVED OCT 19 1992 Municipality of Anchorage Dept. Health & Human Services Nf� 'F�t't�u tz1 �,D -� as �- r►.N . 'p�lr�►But10�.1 -P�-fl� co( �� 12SpLIFkC� • 'P 72.019 A (Rev. 9M) MOA 25 C-'01 �L M.�4. r'Ff 1 t1 i Z Nf Y�tfq 43' Iq = 2l!s; lee e 22£ V 1 15 '' 1'42 72.019 A (Rev. 9M) MOA 25 J. ini L*04 % J. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 PAGE 1 OF 1 ANCHORAGE, ALASKA 99519-6650 a l9ni ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT 9-JLq'=q PERMIT NUMBER:SW920198 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:WAGNER JOHN W JR OWNER ADDRESS:2440 East Tudor Rd. No. 956 Anchorage Ak. 99507 PARCEL ID:05114147 LEGAL DESCRIPTION: DELUCIA LT 5 LOT SIZE: 70132 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 7/27/92 EXPIRATION DATE: 7/27/93 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: SYSTEM IS DESIGNED AS A PRESSURIZED BED. ENGINEER MUST NOTIFY DHHS AT LEAST TWO HOURS PRIOR TO EACH INSPECTION. RECEIVED BY: C� DATE • �/ O ISSUED BY: �'Jotftq SMiTT+ DATE:_ '7/7,7/7Z. July 3, 1992 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694.2979 FAX 694.1211 HEALTHAUTHORITY Municipality of Anchorage APPROVALS DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, Alaska 99501 SEWER & WATER MAIN EXTENSIONS REFERENCE: Delucia Subdivision, Lot 5 Request you issue a permit to upgrade the septic system SEWER&WATER serving the referenced property. INSPECTION An adequacy test was performed on the existing system and the absorption capacity of the existing trench was found to be inadequate. ENGINEERING STUDIES ANDREPORTS A test hole was excavated and a percolation test was performed in the area of the proposed upgrade. During excavation of the test hole water was encountered at 71, and after seven day ground water monitoring water was at 71. Attached is an WELL INSPECTION upgrade design which shows the location of the proposed &FLOW TEST distribution system. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic upgrade. SITE PLANS If you have any questions or require additional information for your review, please contact us. ROADDESIGN Sincerely, 1 SOILTEST ROGER J. S.Aj R, P.E. RJS/lsu PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 0 O a u =111 j LEGAL DELUCIA SUBDIVISION, LOT 5 4! OF q1 �. tJ�,A� DRAWNL. S. ULSHER cKo. R.✓.S DATE 7/2/92 s►+T. ��Q•(�.•..•.... y.Qs - t,.. Sly f.. ....«.«... ... A A,I ; ROGE J. AFER ty/ f J,rti•• No. 82 5dill •�; ��4'� ei �f'ROFESStON:.+ L 48 �Z����+ GRE DESIGN CRITERIA: m WELL 3 BOW= 450 GPD SO/LS = 0.7 VD/� (SAND FILTER) �w„ /� 100' WELL RADIUS 450 • 0.7 = 643 sq. ft. REOD 12'X 54' OR E0. Y EXIST. HOUSE TO DISTRIBUTION SYSTEM BE REMOVED PUMP = 30 OS105HH - 3 STAGE (-35 GF PROPOSED o \J ) �/ 2 LATERALS =11,50PWLAT I3BDRM EXIST. SEPTIC 12 HOLES/LAT =1•60vu/MOLE HOUSE `�\� TO BE ONE IqFT! HEAD NoLG� PROPOSED 1250 GAL p �1 w T.EP. SYSTEM E ROA ►moi � LAG � Mr rx Mr1' t �• PROPOSED ' PRESSURIZED JASMINE Ft” "RADE ORIGINAL c TOP500- ABSORPTION BED 1 u+suLA 31 S.' ! S SR • • T. 0 —MT 12 MLWdt.T DN CENTER MT Q r •C'6Np FILTER' ' • _•• r 2' ORGANIC IV: �i i i A c V: NaES CAPS 1 1r assuMED waTER vOLE Ll KTO 3' MTA t' SCALE I" =10' SCALE I"= 10• A/E SUPPLIES Isom e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR:r�'if t ` `/�' ��i DATE PI LEGAL DESCRIPTION�U G1 LIOTTz5ship, Range, Section: DC EPr7 SLOPE SITE PLAN 1 2 -Fie i 3 '' •o �� .� 4- -6) Ott,belITi1 �c Ld1�7��5 5- 7-. 7 ' 8- 9- to - 11 9 1011 12- 13- 14- 15- 16- 17- 18- 191 213141516171819 20 COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After I Monitoring? Date: ®Mmm �[ MU iai19O�,�I W-M��Sur. IN .at1'wur'-w �— PERCOLATION RATE -4 J (minutes/inch) PERC HOLE DIAMETER w " TEST RUN BETWEEN 2- FT AND ;�22 FT PERFORMED BY: S & S ENGINEERING I CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Eagle River Loop Road No, 204 ACCORDANCE WITH fE j jWtanjia"Co""UIDELINES IN EFFECT ON THIS DATE. DATE: 72-0081Rev. 4/85) OSI © 1990 ......i...b..4... .. �.......i...:.....:...:.......o..:...........L...... ..:....... .......i...i........ .......:...�.......i.. EFFLUENT PJ . V..9..w.. '20 OS115 HH -11 Stage .«...w..C..9....w..«..«.w«r... :.. ' : .......:...:.........4r««.... P2 ,,7;-, ».;..._ 20 OSI HH 350 :: : : : .•••Mas • n•N.•w «...•.._w.. ..{_I.••_w.x•_N.N•...._.... _•h•. 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P.._.. «.N.. ...h.•P.......:...:...'... .•....m.:.. ........ .... a..i..i.._......:...: with 1/4" Ftow controller...:...:...i...:...........N........i...; :..30 OSI 05 HH - 3 Stage.... ...:...,...a.......i..._.r 0 10 20 30 40 50 60 NET DISCHARGE, GPM 2826 Colonial Road Roseburg ,OR 97470 5031673-0165 va Compliance Inspection Report U.S. Department of Housing Note: Reports of Final end Repair Compliance Inspections left and Urban Development at site always require reviewer's signature to be Official. Office of Housing Consult mortgagee for official reports. Federal Housing Commissioner OMB No. 2502.0189 Builder's Name and Address FHA Case Number a. ❑ Report not left at site. b. F-7 Report not official without Date of Inspection J (•b �/ reviewer's signature.�/-13 3 Mortgagee's Name and Address Property Address G oT $ mel' -y9 " da I. Inspection of On -Site Improvements Reveals: 1. Construction❑ was, ❑ was not begun prior to the date of mortgage insurance approval shown on the commitment, statement of appraised value or "Early Start" letter. (Applies to the Initial report on new construction) 2.0 Builder other than named in application. - 3.0 Unable to make inspection. (Explain below) 41:1 Accepted construction exhibits not available at site. 5.0 Individual Sewage disposal system; ❑ Individual Water supply system ❑ No noncompliance. ❑ Correction essential as explained below. ❑ Submit Health Department letter or form HUD -92573 6.0 Correction req'd. by rprt. dated not acceptably completed. 7.❑ Repairs required by form HUD -92800.58 not acceptably completed. 8.❑ Correction essential as explained below: ❑ a. Will examine at next inspection. ❑ b. Do not conceal until reinspected. 9.® No noncomnliance observed. 10. ❑ Acceptable variations as described below (Request for Change, form HUD -92577, may be submitted). 11. ❑ Extensive noncompliance as explained below (see IV.A below). 12. ❑ On-site improvements acceptably completed subject to receipt of certification that mortgagee's inspection reveals satisfactory completion of all items listed below. 13. ❑ On-site improvements acceptably completed except items listed below, completion of which is delayed by conditions beyond control of the builder (see IV.B below). 14. ❑ On-site improvements acceptably completed. 15.0 Off-site improvements: ❑ a. Correction/Completion essential as explained below. ❑ b. Completion assured by escrow agreement or governing authority. ❑ c. Accentablv completed. II. Explanation of statements checked in Parts I and III ❑ Initial Inspection ❑ Framing Inspection ❑ Final Inspection Other (explain) ❑ Repair Inspection Inspection Number No. No. n � p CZ e4e Lki r1 n ->?�C E ' Certification: I certify that 1 have carefully inspected this property on this date. I have no personal interest, present or prospective, in the property, applicant, or proceeds of the mortgage. To the best of my knowledge I have reported all noncompliance, work requiring correction, and unacceptable work. SignalData ID Number a /1 -� 3�3 tdNi Fee Inspector ❑—t Appraiser g X f di // /7, 7 I I DE Staff Insnnelar I I HUD Insner-tnr .7J On t lfeme or resubmit incomplete 17. ❑ Acceptable Compliance with all specific 18.0 Submit Termite Soil ❑ None as noted above. conditions not requiring field inspection. Treatment Guarantee. ❑ as modified ❑ Direct Endorsement Underwriter by me. X ElChiefArchitect ❑ Deputy IV. To Mortgagee: When signed below, refer to the statement on the back corresponding to the designation checked. ❑ A. Noncompriance ❑ B. Compliance — Incomplete Items. "Mortgagee's ❑ C. Final Acceptance. Closing papers ❑ (a) Variations from exhibits. Assurance of Completion", HUD -92300, may be submitted. may be submitted provided mortgage credit analysis is acceptable. El (b) Unacceptable construction. for completion ❑ (c) Premature construction. $ not later than: Signature Date ID Number ❑ Direct Endorsement Underwriter X❑ Director of Housing Development ❑ Deputy For HUD Use Only for concurrence of Direct Endorsement Processing Signature of HUD Authorized Agent Date of this Compliance Inspection Report. It signed, this final report is considered processed by HUD and, thereby, convertible to the Veterans Administration. X Previous editions are obsolete form HUD -92051 (7/87) (M..-413 leans VMP MORTGAGE FORMS • (313)293-8100 • (8001521-7291 ref. HB 4145.1, 4190.1 Seo the statement below that corresponds to the designation checked on the front of.the form under section "IV. To Mortgagee A. Noncompliance. Construction.is not acceptable or all specific conditions have not been fulfilled in accordance with the terms of the related commitment because of: (a) Variations from Exhibits. Inspection reveals extensive non- compliance, involving variations from accepted construction ex- hibits.'The property will bo consideredineligible for mortgage in- surance (11 unless the work has been corrected so as to effect compliance, or (2) unless reprocessing is requested on the basis of the mortgage security as it is now being constructed, and this is found to be acceptable. Requests for reprocessing must be ac-. companied by a letter, in duplicate, fully describing the work as now being constructed, signed by the mortgagor and approved by the mortgagoe. Where the plan arrangement, or either the ex- terior or interior apperarynGe is affected, the mortgagor's letter i must be accompanied by drawings, in duplicate, fully indicating the variations_ and signed by both the mortgagor and the mortgagee. (b) Unacceptable Construction. Construction reveals extensive noncompliance with applicable FHA requirements or good con- struction practice. The property will be considered ineligible for mortgage insurance until construction has been corrected so as to effect compliance. 1 (c) Premature Construction. Inspection reveals that construction was begun prior, to the, date of approval for mortgage insurance (in noncompliance with the commitment or statement of appraised valSte):-. B. Compliance: (with incomplete items) _ Construction of on-site improvements has been acceptably com- pleted except for any items listed on the front of this form. Completion of those items is delayed by conditions beyond the . parties' control. The property will be considered acceptable for mortgage insurance and closing papers may be submitted provided: (a) All required off-site improvements have been acceptably com- pleted and so reported, or their completion has been assured by an acceptable "Mortgagee's Assurance of Completion" form, and; (b) All specific conditions not requiring field inspection as in- dicated on the front of this form have been acceptably fulfilled or evidence of compliance is submitted with the closing papers, and; (c) The closing papers are accompanied by form HUD -92300, "Mortgagee's Assurance of Completion," properly executed and providing for withholding the sum indicated, or by indicating the sum is available on a commercial letter of credit, and for comple- tion of construction not later than the date stated on the front of this form. C. Final Acceptancer , Construction has been completed and all specific conditions have been acceptably fulfilled. Closing papers -may be-submi:�oq( iro; vided the mortgagee's credit analysis of the borrower is -accept- ably completed. Evidence of compliance. with specific conditions r t not requiring field inspection as indicated on the front of this _ form may be submitted with the closingapers. pom M CS m CD PC 14- 1 !CO -4 CPO 0 O O O O '0 O P CO to Cn pom M CS m CD MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930064 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:WAGNER JOHN W JR OWNER ADDRESS:19722 JASMINE RD CHUGIAK, AK 99567 PARCEL ID:05114147 LEGAL DESCRIPTION:'DELUCIA"LT 5 LOT SIZE: 85000 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 4/22/93 EXPIRATION DATE: 4/22/94 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 343-4329 OR 343-4681 AFTER BUSINESS HOURS 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. SPECIAI RECEIVE ISSUED DATE: o DATE• Z s yr in in I" = 40- rn ,a SCALE r In M1 N a dd C�(f u z m � R 6 UPGRADE e •t l�[O.. I m 3 0 s yr SETgpCK 100CREEK SE i rn m M1 a dd C�(f z mx R �v O �y 1 C H ok om to iny m o UPGRADE e •t l�[O.. I m 3 0 s ON O D m m N A ©I 41 yr SETgpCK 100CREEK SE �co m a dd C�(f z mx I> �v O �y 1 C H ok om to iny m o ON O D m m N A ©I 41 RECLrIVED GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY L J ty/ AM 3330 "C" Street ANCHORAGE ALASKA 99503 Case # B;EATEA NCMORAGF AREA 60ROUCFI ' tfT. O!' ENVIR")NOIATAL QUALITY Performed For Dated Performed Aup, 12, 1972 Legal Descriptio 'Lot 935 Block Subdivision Delucia ub. This Form Reports Soils Log y Percolation Test - Soil Test Must Be Logged To 4' Below Proposed Seepage System - Depth Feet Soil Characteristics 1 — 2- 3- 4- 07U. well ..sorted gravels .... 85 ... 5- 6— —6— water 7- 8- 9- 10- 11- 12- 13- 14— Was Ground Water Encountered? yes If Yes, At What Depth? 5' Reading Date Gross Time Net Time Depth to H2O Net Drop rcl i.Ula1.jull RaoC 19IflULe Proposed Installation: Seepage Pit Drain Field Depth of Inlet Depth to Bottom o Pit or Trenc►F COMMENTS: c5 f -t. 2 Test Performed BY Date Certified BY: Date: 1 N h • '-� Municipality of Anchorage ° On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-141-47 1. GENERAL INFORMATION Complete legal description Delucia_Lot 5 Location (site address) 19722 Lace Rd. Expiration Date: q-6. -�C_ Current Property owner(s) Neal Darrell _ Day phone Mailing address Real- LE -state -Agent PO Box 671073 Chugiak, AK 99567 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class _ Well ❑ Public Water System ❑ WaiverNariance request for: 3 Jay phone TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5-50 Waiver Fee $ _ Date of Payment Receipt Number COSA# QST -22 100't Date of Payment Receipt Number Waiver # stance: 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 ARCTERRA CONSULTING, INC. Phone 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date /Z0- Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerrauarantee that no unseen ` encroachments, deficiencies or discrepancies exist.. _..... _. �a�S> OL -.4i�11\ 1 g ;rel 6. DSD SIGNATURE System #1 Approved for 3 System #2 Approved for Disapproved. Conditional approval for bedrooms. ` KENNETH M. ui_OZ bedrooms. 1 `'ref, y�xz �" "W vr�ofr•.ss; 1(0), bedrooms, with the following stipulations: -- ----- - VG ALITO,cq,, N o m ,gSTFR,gN� � -- _--- - J� o �R -m GAA. ICES-0��\C� ��111;)1!! »111 BY: _ _ _ 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 Septic System Advisory Well Flow Advisory COSA blue sheet_10-10-12,doc Nitrate Advisory Arsenic Advisory Other S ( ���Scurx Legal Description: Delucia Lot 5 If more than 4 septic system on lot: COSA Checklist # of A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 9/24/92 Total depth 125 ft Cased to 125 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 33 in. Date of flow test for COSA 11/25/21 Static water level at beginning of test 112 ft. Comments B. TANK DATA Age of tank(s) 29 years Tank type/material STEP/Steel Measured operating fluid level in septic tank 42" Standpipes/foundation cleanout per record drawing Date of pumping 6/7/21 D. ABSORPTION FIELD DATA Which system tested (date installed) 8/17/92 ALL standpipes present per record drawing Total measured depth from grade 3.5 ft (max) Measured depth to pipe invert from grade ft (min) N/A — pressurized field in Monitor tubes go to bottom of effective. If not, state depth into effective Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel 1D: 051-141-47 Structure served by this system Well production at time of test 4.9 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes No Coliform bacteria is Negative Nitrate 3.75 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L in Arsenic less than MRL (ND) Collected by Arcterra Consulting Date of Sample 11/16/21 C. LIFT STATION Required maintenance completed Age of lift station 29 years Lift station material Steel Comments: Adequacy test date 12/30/21 Results ®Pass For 3 bedrooms Fluid depth prior to test * in Water added 450 gal New depth ** in Elapsed time 1320 min Final fluid depth *** in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date Mtl: 0" Mt2: 5" Mt3: 0" Mt4: 0" ** Mt1: 0" Mt2: 2" Mt3: 17" MM 17" * * * Mtl : 0" Mt2: 1" Mt3: 0" Mt4: 0" E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Yes if No Community Sewer Manhole/Cleanout > 100' If absorption field is under driveway comment below ® Yes if No**** ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25'2] Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No **** ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No **** ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Surface Water > 100' ® Yes if No **X* ft F. ENGINEER'S COMMENTS **** Per 10/20/1992 Inspection report & MOA records. G. ENGINEER'S CERTIFICATION I certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet MUNICIPALITY Development Services Department Phone_ 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Lift Station/Pump Vault j / Maintenance Lag Owner . 61 � yell C [,V M I Street Address—1 � "z Septic Tank: -Sludgelevel 0 inches -Pumping: required Yes� -Pumping completed yes no Lift station: -Pump basket cleaned e' no -Effluent filter cleaned -Control floats cleaned e no -Proper float settings confirmed es no -Operation satisfactoryes no Alarm System: -Dedicated electrical alarm circuit e no -Audible and visual alarm inside dwelling es` no -Alarm system operation `tisfacto not satisfacto ry Manhole Riser -Ground water intrusion at riser to tank connectiones n -Ground water intrusion around pipe penetrations es -Weep hole functional 0 no .*Manhole lid: Functional e§ no Insulated es no Properly Secured es no j Other I f -All manufacturer required inspections and maintenance completed yes no Comments: Qualified Maintenance Provider: Technician __ ��( Date of maintenance Company _�IN , 2p-hCi �'"..... www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval #OSC 221004 Subdivision: Delucia lot 5 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 29 years old. Typical replacement costs range from $9,000 to $12,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 -year-old steel tank MAY look like. 6 ? 8. 9 o. � 4g —� zr 1. • f Munici alit of Anchora e_ p y g 1OnSiteWaterandWastewaterProgram A, 0,:i�!' (907) 343-7904 6 Ste° E T. ti C hC4 Certificate of On-Site Systems Approval ii �� s a L 9 051-141-47 —1 ? Parcel I.D. Expiration Date: L f./ --r 1. GENERAL INFORMATION Complete legal description Delucia Lot 5 Location (site address) 19722 Lace Rd. Current Property owner(s) Zulene & Willis Simmons Day phone Mailing address 19722 Lace Rd Chugiak, AK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: r] 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 0 Individual El Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: I l Received by: Otct _______cDate: q5f I /1 2> COSA to be released to the engineer,unless otherwise request d by the engineer. COSA Fee $ 521, Waiver Fee $ Date of Payment -4-111112 Date of Payment Receipt Number dct36b6 Receipt Number COSA# 0 3C121&5Z) 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 07/17/2018 j*49 T I\ -17.*fir 6. DSD SIGNATURE •" - /� System #1 Approved for 3 bedrooms .Seven R. •onnone: System #2 Approved for bedrooms oo} �• CE-8149 • Disapproved > `� OF•ESSIONis- Conditional approval for bedrooms, with the following stipulations: ep+1 c * civt IC i S Z, I� ea c/'S C9L b �ac-wIC t •01-1) Sty '..i / ���� OF tilvc I w ON-SITE . WATER AND coWASTEWATER o T PROGRAM "Jr qi-cAl Original Certificate Date: Z! H 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 `tea t, { Vt%ic COSA blue sheet_f ,. J 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: Delucia Lot 5 Parcel ID: 051-141-47 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 9/24/1992 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 125 ft. Cased to 125 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 09/24/1992 06/29/18 Static water level U N K ft112.3 ft. Well production 7 g.p.m. 7.0 g.p.m. WATER SAMPLE RESULTS: Coliform NEC' colonies/100 mL Nitrate 6.24 mg/L Arsenic ND ug/L Date of sample: 6/29/2018 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material S.T.E.P./STEEL Date installed 08/17/92 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank .IN) N High water alarm (Y/N) Y Date of pumping q i I v I Pumper .s a 1 C. ABSORPTION FIELD DATA Date installed 8/17/92 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.7 GPD/SF System type BED Length 55 ft. Width 12 ft. Gravel below pipe 0'5 ft. Total depth 3 ft. Eff. absorption area 660 ft2 Monitoring tube Y Depression over field N Date of adequacy test 06/29/1 8 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0/0/0/0 in. Water added 450 gal. New depth 0/0/0/4.5 in. Elapsed Time: 80 min. Final fluid depth 0/0/0/1 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 8/17/1992 Size in gallons 1250 Manhole/Access (Y/N) Y "Pump on" level at 42 in. "Pump off' level at 24 in. High water alarm level at 44 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 10+ Property line 10+ Absorption field 5+ Water main 10+ Water service line 1 O+ 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 '`I'' OF A ,'kk� I certify that I have determined through field inspections and r�p'�P•• `4,•.ti,10 review of Municipal records that the above systems are in 0*; 4.• •i\% •*° conformance with MOA COSA guidelines in effect on this date. ••• .1741 • f•• 0 Engineer's Printed Name Steven Pannone , ... }even '.•150ririorie:••oi Date 07/17/2018 Oi t.. CE-8149 5 Ill \Z` ` r . COSA canary sheet_2-6-15.doc MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT • / t 907-343-7904 On Site Water and Wastewater Section `/1 Fax: 343-7997 www.muni.org/onsite Nitrate Advisory Certificate of On-Site Systems Approval # OSC181350 Subdivision: Delucia, Lot: 5 A water sample revealed a nitrate concentration of 6.24 milligrams per liter (mg/L). 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. Mailing Address: P.0. Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org 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. Mailing Address: P.O.Box 196650*Anchorage,Alaska 99519-6650*www.muni.org <o > 7 95 -ia61 MUNICIPALITY OF ANCHORAGE ;11 _ Development Services Daperkment t d On-Site Water& Wastewater Section e " ' Phone; 907-343-7904 Fax; 907.343.7997 Lift Station/Pump Vault Maintenance Log Owner �. Street Address_7_2_2,2L_ _ ____* 5aPtiP Tank: °Sludge level Q inches Pumping: required yes 49 Pumping completed ano •Pump Gasket cleaned _o •C-ffiuent filter cleaned y •Control floats cleaned �e no -Proper � � 4/7/9per float settings confirmed °Operation satisfactory v np ',Dedicated electrical alarm circuit yds no •Audible and visual alarm inside dwelling jj -Alarm system operation ..-: .efF.. ou no :: I. : •3[•A f anbote Ricin `Ground water intrusion at riser to tank connection •Ground water intrusion around pipe penetrations ' 'Manhole lid: Functional Q �`�' Weep hole functional 4 no insulated no , Properly Secured ze no Other •AIT manufacturer required inspections and maintenance completed rants: 0_02 lii u 1ti rs non P vi w Date of maintenance 7/, f Company ' c_ Sigriatu / ba � o tt r:':Jiiiti l Addir:;b: P.Q. n.»: 1nu(6r :,t;c1)�r;iyL. rxU.F;a ieJ519 GiSU v:ti'r,,; JTtUl1l.o{'‘i MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT ( • 4I r,71 907-343-7904 On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Septic Tank Advisory Certificate of On-Site Systems Approval # OSC181350 Subdivision: Delucia, Lot: 5 The septic tank for this property is 26 years old. The average life for a steel septic tank is 20 years. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. .. .;r ` .. ' $y aCa r'e'f "'s,P zt - - • s Z F 0 1.41 �'i''�z _ •� 'fit i n �..'.:. g03:' 10' 2 Mailing Address: P. 0. Box 196650 " Anchorage,Alaska 99519-6650 x www.muni.org C' Municipality of Anchorage Development Services Department Building Safety Division On -Site Water& Wastewater Program 4700 South Bragaw St. P.O. Boz 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-141-47 HAA# 1. GENERAL INFORMATION --- - - _.__._ Expiration Date: R - 0 4 Complete legal description DELUCIA SUBDIVISION: LOT 5 Location (site address or directions) 19722 LACE ROAD * CHUGIAK AK 99567 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address _CRAIG LIGHTLE W/ L & N PROPERTIES Day phone 441-4114 P.O. BOX 244922 * ANCHORAG AK. 99524 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site Individual Water Storage ❑ individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (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 well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 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. 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone * GE AK 99507 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 ANCHORA , Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date7 d Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE ✓ Approved for _ bedrooms. Disapproved. Conditional approval for bedrooms, with the filowing stipulations: v Zi : ON-SITE WASTEWATER • PR Attachments: HAA Checklist ManitenanceAgreements Septic System Advisory Supplemental Engineer's Reort Well Flow Advisory Other By: �� /�{� P Original Certificate Date: o r 0 (Rev. 12101) unicrpa i y o n Developrnertt Services Building gaietytvS, Parcel 1D � 051 141=47 "" Win• Lasea io; ffu-r tt. Casing height (above ground)12+ in � � ATI S `w • a��r ft ft 111 fi} colonies/100 ml. Nitrate 3.53 mg./L. 8�&�0'�Other bac(eria colonies/100 ml. a /L• Date of sample. Collected by: G.E.G. Ltd a (Y/N) ' YES cnmrmu uttti•_r � •-�sa� "" "3' "'wrama`Wks',�»#rL�:&..ak�L�;assavd3:-x-3ac.swri':�a +w F e;r: r"y�oil rating :p d / r ftZ/bdrm) 0�7 System type BED .�.~��sawcagT��w:,� xi:z.ca,.s'��r�.;t�su��-•�.�a���.��n.. x�: M.�:e=," Width 12 ft. Gravel below pipe 0.5 ft a sorp ion ar'e'a SO ft' Mondormg tube YESDepression over field NO �,r Results (Pass)Fall)PASS For 4 bedrooms �'.t"� s: afore test ___ in Water added 81 f gal.New depth 8 in, �� a aYm.�"s ..trQ ��t�:.�fi+-�'w.a'�`S'-�;`-�a.'e.at�s..a:✓^uu.�-. ,s.tv wn r:w "�Ft-inal fluid depth DRY m .SA; bsorpGon rate > 600+ 9;p d �� ,+" f":.k.,�'r'-.G'v�ti'a4s�."!.��'.''.J+c�..r ^.e.: e;aa�xu``a"ba "�M�G�;,u^K,.tiN`h. a• "sx>. r ...s :, �s�,J:� ate_, - , YP If yes, give date 31 2004 .. Department � Program Sp kTY' 995-6650 as _ Parcel 1D � 051 141=47 "" Win• Lasea io; ffu-r tt. Casing height (above ground)12+ in � � ATI S `w • a��r ft ft 111 fi} colonies/100 ml. Nitrate 3.53 mg./L. 8�&�0'�Other bac(eria colonies/100 ml. a /L• Date of sample. Collected by: G.E.G. Ltd a (Y/N) ' YES cnmrmu uttti•_r � •-�sa� "" "3' "'wrama`Wks',�»#rL�:&..ak�L�;assavd3:-x-3ac.swri':�a +w F e;r: r"y�oil rating :p d / r ftZ/bdrm) 0�7 System type BED .�.~��sawcagT��w:,� xi:z.ca,.s'��r�.;t�su��-•�.�a���.��n.. x�: M.�:e=," Width 12 ft. Gravel below pipe 0.5 ft a sorp ion ar'e'a SO ft' Mondormg tube YESDepression over field NO �,r Results (Pass)Fall)PASS For 4 bedrooms �'.t"� s: afore test ___ in Water added 81 f gal.New depth 8 in, �� a aYm.�"s ..trQ ��t�:.�fi+-�'w.a'�`S'-�;`-�a.'e.at�s..a:✓^uu.�-. ,s.tv wn r:w "�Ft-inal fluid depth DRY m .SA; bsorpGon rate > 600+ 9;p d �� ,+" f":.k.,�'r'-.G'v�ti'a4s�."!.��'.''.J+c�..r ^.e.: e;aa�xu``a"ba "�M�G�;,u^K,.tiN`h. a• "sx>. r ...s :, �s�,J:� ate_, - , YP If yes, give date 31 2004 zx ..t.as 44 Min k Pump b' evet at 42 in High water alarm I`evel a`t' t , Cycles tested 3 Meets alarm & circuit requirements? YES .,u ..., .. ....v ., r .. .�r...K.-�,`..,IL n ? Frt . �. io—hs s e. n,nined ough held inspectiohs and a : �. . . • . , , , , . • .... , ;• he above systems are'in ape � records that t a..... ... .. ith MOA HAA guidelines in effect on this date. a • . • ................. ' Je Gar ss. ted Nape JEFFREY`A GARNESS _. _ a /% 11 1 a Waiver Fee $ �t54 Date of Payment �. 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 2 l (� Parcell.D. 051-141-47 HAA#_ J� ZA1 1. GENERAL INFORMATION Expiration Date: _ — I (_03 Complete legal description DELUCIA SUBDIVISION; LOT 5 Location (site address or directions) 19722 LACE ROAD + CHUGIAK. AK 99567 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address JOHN WAGNER Day phone 688-4639 2440 EAST TUDOR ROAD SUITE #956 * ANCHORAGE, AK 99507 Day phone TINA COLE W/ PRUDENTIAL J.W. Day phone 250-2280 3201 C STREET + ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 4 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 well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. TYPE OF WASTEWATER DISPOSAL: 0 Individual On-site 0 ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 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 well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. Note: Alaska Water and Wastewater Consultants, inc. shall be paid $ at, or prior to closing for the engineering services provided. 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 fries 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 ALASKA WATER do WASTEWATER CONSULTANTS, INC. Phone Address 6901 DEBARR ROAD, SUITE 26 ° ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AKWWC, inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for ! bedrooms. Date 337-6179 B 3 Disapproved. Conditional approval for bedrooms, with the filowing stipulations: t(nC tlltttfl/fA . 0, Jam: ON-SITE WASTEWATER TOGRAM Attachments: %�cn'•. ••.•• HAA Checklist Manitenance Agreements J��/'�J���O • •1����\, Septic System Advisory Supplemental Engineer's Reort ���JO )111)1111 Well Flow Advisory Other By: Original Certificate Date: G — � �- © 3 (Rw.12101) �I .. .. .. ... .............. Je r y Go ess.: e .o ��co pr tessWON ' Disapproved. Conditional approval for bedrooms, with the filowing stipulations: t(nC tlltttfl/fA . 0, Jam: ON-SITE WASTEWATER TOGRAM Attachments: %�cn'•. ••.•• HAA Checklist Manitenance Agreements J��/'�J���O • •1����\, Septic System Advisory Supplemental Engineer's Reort ���JO )111)1111 Well Flow Advisory Other By: Original Certificate Date: G — � �- © 3 (Rw.12101) ... ... ..... .. _...... ......... .......... ...r....�.......... Municipality of Anchorage Development Services Department Building Safety Division < IIA t . r n Onsite Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196.650 Anchorage. AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description. OELUCIA SUBDIVISION; LOT 5 Parcel ID. 051-141-47 A. WELL'DATA Wen typeR, � Nom.. If A. S. or C provide PWSID# N/A Well Log (YM) YES Date completed 9/24/1992 Sanitary seal (YIN) YES Wires properly protected (Y/N) YES Total depot 125 ft. Cased to 40+ ft. Casing height (above ground) 24+ in. FROM WELL LOG AT INSPECTION Date of test 9/24/1992 5/2/2003 Static water level 48 fL 111 ft. Well production 7 g.p.m. 5.5 g,p,m, WATI*R'SAMPLE RESULTS: '� � Coliform _� colonies/100 ml. Nitrate U* 1�11 mgJL. Other bacteria colonies/100 ml. Arsenio N/A mgJL. Date of sample: 512/2003 Collected by: AKWWC, INC. B. SEPTICIHOLDING TANK DATA TankType/Material STEEL/S•T•EP.� Date installed 8/17/1992 Tank stz9 1250 gal. Number of Compartments3 Cleanouts (YIN) YES Foundation cleanout (YIN) YMFS Depression over tank (YIN) NO High water alarm (YIN) YES Data of pumping 5/2/2003 Pumper CHUGACH PUMPING C. ABSORPTION FIELD DATA Date Installed 6/1^/1992 Soil rating fe> ftlbdrm) 0.77 System type BED Lenp 55' ft, Width 12 ft. Gravel below pipe 0.5 ft. Total depth !21=141 Eff. absorption area 660 ft' Monitoring tube YES Depression over field NO Date of adequacy test 2/2003 Results (Pass/Fall) PASS For 4bedrooms Fluid depth in absorption field before test DRY In. Water added 830 gal. New depth 3 in. Elapsed Time: 23 min. Final fluid depth RY in. Absorption rate >= 600+ g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — 0. LIFT STATION Date installed 8/17/1992 Size in gallons 1250 Manhole/Access (Y/N) YES "Pump on" level at 42 in. "Pump off' level at 42 in. High water alarm level at 44 in. Datum BOTTOM OF TANK Cycles tested 3 Meets alarm & circuit requirements? YES E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ h Public sewer main N/A Public sewer manhole/cleanout NIA Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 100+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 1008+ Driveway, parking/vehide storage 100+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that / have determined through field inspections and,� �• y* review of Municipal records that the above systems are in .. • • • .... ' conformance with MOA HAA guidelines in effect on this date. of omes '••• Engineer's Printed Na a JEFFREY A GARNESS e —795 Date �Nd pro t..elOn�� HAA Fee $ .37!5.&v Waiver Fee $ Date of Payment - 03 Date of Payment Receipt Number Receipt Number (Rev. 1201) UO Jun 05 03 02:07p Jack White RCent Services 907-762-7544 p.I MUNICIPALITY OF ANCHORAGE • '• DEPARTMENT OF HEALTH & HUMAN SERVICES w 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. # 051 — I ¢N " +_7 1. GENERAL INFORMATION HAA# 7Jvfs�Z Complete legal description LoT .a �GGLlIc�/� <'e16 Location (site address or directions) 'o / c& den (-'— �RsH„w.s 7G• -//GG suti Property owner �+ U%1 tn:cT�. Day phone Mailing address :?V 99 6 7aP,4XAV S:«L 'jS•Z &cl,4- Ale, %Ela OJ Lending agency Mailing address • Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well _Al Community well Public water Day phone Day phone 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 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 F21 S. 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. David R. Dayton P -E. c Name of Firm 90,310 Dona or S . Phone �C' .'7;Z- Chugiak, Alaska 99567, Address Engineer's signature 6. DHHS SIGNATURE V Approved -for bedrooms. Disapproved. Conditional approval for Additional Comments C' By: Date bedrooms, with the following stipulations: Date ZL 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 indepenuant 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-M (Rev. 1/91) Seek MOA e21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L.ar S OB'uscuA S`'gParcel I.D. A. WELL DATA Well type 20112414L If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) y Date completed �So�' 2`?, i99Z Driller INN TMrZ21 D'Lu„Y+ Total depth ) IiC Cased to 1Z5' Casing heic Sanitary seal (Y/N) X Wires properly protected (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG , cA& IcinZ- NL 1olP"1 g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot los AT INSPECTION 893 I e> 3 t S:9 g.p.m. On adjacent lots 1 oott- Absorption field on lot8� ; On adjacent lots t tet' Public sewer main ^�f/I Public sewer manhole/cleanout N/if Sewer service line L Petroleum tank J WATER SAMPLE RESULTS: Coliform o Nitrate �• 8 Other bacteria Date of sample: ¢/� Collected by: B. SEPTIC/HOLDING TANK DATA 70 T rn rn Date installed �Ly19 -- Tank size I 7- S-0 Compartments �- Cleanouts (Y/N) y Foundation cleanout (Y/N) y Depression (Y/N) Al High water alarm (Y/N) Alarm tested (Y/N) y Date of pumpingN� sYS� Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 10 57' On adjacent lots Foundation I s - I To property linelo'+' Absorption field tai Water main/service line LSA Surface water/drainage I0(p 72-026 (Rev. 7191) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed �L4r Manufacturer Size in gallons I2 roManhole/Access (Y/N) Y Vent (Y/N)� "Pump on" level at 2.�0� "Pump off' level at High water alarm level 3• ZS ' Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: .Well on lot JOS' On adjacent lots 1 oo f' Surface water D. ABSORPTION FIELD DATA Date installed 5epf 19`/2- Soil rating 0 11 eed,e System type 1 IUM2144f AnD Length SS'' Width /Z I Gravel thickness Total depth Z 5.r Total absorption area Cleanouts present (Y/N) Al Depression over field (Y/N) /(Iy Date of adequacy test Results (pass/fail) for bedrooms f13 Peroxide treatment (past 12 months) (Y/N) A/ If yes, give date t SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot J ' On adjacent lots I ©e' 'f" Property line 10 To building foundation j `r To existing or abandoned system on lot % 9� On adjacent lots ( 00 4- Cutbank IJo.uti- Water main/service line Surface water Z, Driveway, parking/vehicle storage area // ± -Curtain drain E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. David R. Dayton P.E. 20210 Donalar St. Ch ak, Alaska 99567 ;+ �• ''vvE Signature Kr:; . ::r -.3 •��tr r Engineer's Name i; ^ � -• •,.t� .. zs Date�/3�93 ., ,; ✓h•, 14 a a ` pRO; ESS�aF HAA Fee $ Z 7 D D� Waiver Fee: $ Date of Payment '- `!! Date of Payment Receipt Number '��� �� C72 X Receipt Number 72-026 (Rev. 2/91) Back MOA 21 D. R. DAYTON, P.E., R.L.S. R�°'xx' 'AR'KI Chugiak, Alaska 99567 (9p7)9VA394 � 20210 Donalar St. 696-2417 April 13, 1993 WELL FLOW TEST Legal Description: Lot 5, Delucia Subdivision Date of Test: April 8, 1993 Well Depth: 125' Static Water Level: 108.3' Driller: Penn Jersey Drilling Requirements: 3 bedroom - 450 gallons per.day Test: The well was pumped with the existing pump through an outside hose bib. Volume, time and drawdown were monitored during the pumping. The well produced 720 gallons in 2 hrs. 5 min. for an average pumping rate of 5.8 gallons per minute. The maximum drawdown was 4.2:. The drawdown completely recovered in 2 min. 45 sec. Results: The well is currently producing adequately for a 3 bedroom home. A4 i David Q. Citlom w ham. 220sC y �pROFESSl9K;� Time APPLIta^NT FILLS OUT UPPER HAI' )ONLY Property Orwner Phone Mailing Address Q , \ l i,„ n too . \ Zip Code ! — 6 - ) J 7 Buyer Address . Zip Code Lending Institution Inspector Phone Address Zip Code Field Notes: r' q)A r /„ x,` C-, p n v Realty Co. S Agent � ly^.- - Phone Address Zip Code Legal Description .: `� o -t '. -- j - 1r 1 u l` t C\ Via'Street Street Location ' (- 2 Cu Type of Residence ( ) DISAPPROVED F. Single Family -• ❑ Multiple Family No. of Bedrooms_ ❑ Other BY: Water Supply Soils Rating Date Sewer Installed - '0 Individual Absorption Area ATTACH WELL LOG. A well log is required for all wells drilled Since June 1975. ❑ Community ...._ ._ ., For wells drilled prior to that date, give well depth (attach log If available). O Public Utility Sewer Disposal Q Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Da Date Date Date Inspector Inspector - Inspector Inspector Field Notes: r' q)A r /„ x,` C-, p n v /,, b �C w , ok � ly^.- - /Tv (_3) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' ce 2 DATE— C BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size Well to Tank 72023 pB1 !"I rROBERT A. SHAFER EXCAVATION ,���� WORK CIVIL ENGINEER A ,� .�!'S 694.2979 August 15, 1982 MUNICIPALITY OF ANCHORAGE CF^.T C' I'L^1.T'i f% ENVIR iil".:t,.A.::0 E.-.i:A Cheryl Langworthy SR 1 Box 1227 Chugiak, Alaska 99567 Dear Mrs. Langworthy Reference: Lot 5; DeLucia Subdivision AUG 17 1982 RECEIVED A sewer system adequacy test was performed on the system located on the referenced property as you requested. The septic tank was pumped and verified to have a capacity of 1000 gallons. The drain field was tested by a continuous flow of water over a period of 24 hours without any adverse effect on the system. It can be concluded from this test that the waste water disposal system serving the three bedroom residence located on this property is currently functioning adequately. However, the system cannot be guaranteed against subsequent failure. As requested by the Municipality the system was excavated to determine the type of system and its proximity to Peter's Creek. The attached sketch shows the approximate location of the system with respect to the creek, the residential well and dwelling located on this property. It has been determined that the system was installed in accordance with ordinance No. 28-68, Section 9-71, Paragraph 7 of table 5 and is considered to be adequate -at this time. If we may be of further assistance, please do not hesitate to call. Si cc: Municipality of Anchorage Department of Health and Environmental Protection SRS 196X EAGLE RIVER, ALASKA
