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Home My WebLink AboutLODGEPOLE LT 2Lodgepole Lot 2 #015-061-40 Municipalityof Anchorage Department of Health and Human Services a Division of Environmental Services On -Site Services Section 825'L* Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 Page / of Z www.ci.anchorage.ak.us (907) 343.4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: 91-1 4R n ars / PID Number: 19( 6'— fab/^KO NaTeWastewater System: -New [:]Upgrade Address: ABSORPTION FIELD Phone: Number of Bedrooms: .Zd,[ /�. !✓ ff _lLEG4AL Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound 0 Diner: DESCRIPTION Soil Falling: Tobil Degh fr .t �rJpnxi grade: fib GPDi O. 0 Ft. Blook: Lot Subdivision: Deptb to pipe boli Mori,original grade: Gravel dept, beneath ygpe� oC L 0 G p� �r7CFt. Gf o/ Ft Tp ship: Range: SecEon: Fill added above onginal grade: t.5" Gravel Lengin: C 9 Ft. J Ft. Well: ® New ❑ Upgrade Gravel vnft: Z.o Number of lines: I Distance beGvsen lines: I ^— Ft. Ft Classd.b.n (Prrate. A, S. C): IP f tui tie Tool Dept,: /%4( Cased to. Hyl F, lmabsorpin area: Fe Pipe Matenal: —4034 Driller( ` Dale nlletl: N Sfatc Water Level: 5Yo Install., Lem -5 2r Date Instal tri T/9 / F. 9t t Yield : Pump Set xcasing Height Above Ground: TANK 2p GPM /0/ Ft 3 Ft SEPARATION DISTANCES W(Septic ❑ Holding ❑ S.T.E.P. ❑ Other. Septic Absorption Lift Holding Py4Mc/Privat Manufactu r: -Gpacty Tit h, Tank Field Station. Tank Sewer Line c r1 ", ( 2S 0 GalMaonalNumber 100'4- J`44 N rddf.f S% e ( of Compabmente: 2 /dqt{.. /� gLotLine fod+ LIFT STATION 1po°.6 f ize: Manufacturer: {- ��/ 't" Gal. /: Permit No. SW990361 Page 2 of 2 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 Description: LOT 2, LODGEPOLE SUBDIVISION PID No.: 015-061-40 TEST HOLE (TH) S 89'59'00" E 30' RADIUS 1,Q2-.4&'-_�. ESERVE FIELD 10' UTILITY/EKSEMENT \ -/-�- MT _ _ C04 � ------------ 0O3 - 5 N • 1250 GALLON TANK I j -� -- ° CO2 B /I A C01 MARK A B GRND. ELEV. PIPE ELEV. C01 25 37 95.3 93.2 TC01 27 37 96.0 TCO2 30.3 34 96.0 CO2 36.1 28.6 95.8 91.8 CO3 40.0 25 95.0 90.80 C04 41.67 23.5 94.9 90.86 MT 49.6 35.0 95.2 �I NEW 4 BEDROOM HOUSE \ I^ NI V p \ N O � O \ O O Z \ IAZ \ 1 NEW 100' WELL RADIUS I 1 1 1 S 89'59'00" E 102.5' I - O L Y M P I A C I R C L E- I TCO1,TCO2, rne_ FILTER FABRIC 93. B I T SCALE: 1"=30' 96.0 � 95.2 94.9 SM FINAL GRADE 95.3 90.85 90.86 1250 GAL. o 0 0 0„0„0„ 0 0 0 0 0 0 0_o c TANK 83.5 X0000°0°� 00 00000000°0000 'c 0 0 0 0 DRAIN ROCK 0 02020 0 0 0 2" INSULATION 92.0 TRENCH 0 0 83.5 i0°o0000c.o"0"0"0"000 000°000°0°0 o c -12 GM -1s .bOF A �q *-'49-111 4`c °, MICH.ALL N A IDERSON e CE-446� From : PLFINE DRILL 907 345 02U2 Feb.23.20U0 296:01 Pri 130: Municipality of Anchorage Department of Health and Human Services AEM 525'L' Street P.O. Box 196050 Anchorage, Alaska 99519.6650 Pork Nystrom Nip r/r .u.anchoraonskua Mayor Permit Numlxr: 4SW 990361 Date of Issuc: -29-99 Parcel Identification Number: 015-061-4a Date Started: 11. 5.99 Dale Completed: 11-05-99 Is well located at approved permit location? Yea ❑ No Legal Descriptiogt LO -119-02-01-011`2 Property 0"nerName & Address: Tom Bartholomuew 14250 Golder. view Dr Anchorage, Ak 99516 Borehole Data: Depill (ft) Method of Drilling ® air rotury ❑ cable tool Soil TyK, Thickness & Water Strals From To � Casing type: ¢tgel sfick-op 0 2 Rall Thickmss:.250 itches crganic and silt 2 11 Diameter: ¢ inches Depth: ;ll fret siltysandygrsvel 11 32 Liner Type: gravelly sit 32 63 Diameter: inches Depth: feet Casing stickup Above ground: 2 feet silt co661 y y grave! 63 96 Stotle water level (from ground level): Meet silty wetersand & gravel 96 122 Yum In level: 42 feet after p' e L gravelly silt 122 126 2 hours pumping ZQ glint water sand gravel 126 141 Recovery Raic: 20 gpin Method of Testing: gtfi4 Well Intakt Opening Type: 0 Open End ❑ Open Hoke ❑ Screened SLart feet Stopped feet ❑ Perforntiuns Star) feet Stopped feet Grout Type: hentonlie * t± Volume: L -Ag Dcpth: Stan Q feet Stoppcd _ tett R�C Pump: Intake Depth _ feel r C C�VPump FD size lip Brand Nmw Well Disinfected Upon Completion? ® Yes ❑ No FFe tiro < Dept Neagh Alethod of Disinfection: lorirgJpblele Comments: ij, ur yr70p� 6 yomanSoryges Well Driller: Alpine,6o tilling & Enterprises P.Anchorage AK 99511 Ai teat ion: I he well driller shall provides well.10S lei chs: properly ow= within 30 days ofcanplction srtil the propery na•nr n• 11 ... w.11 4:11r chop . null Ina In 111n r%~ of I4,a111% b I lumen 4n.inne within AA dove of �ntnnlnimt MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 I k1SFEM00 11Ia10 /C19 e aPrP' ` 4/ Pm ONSITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Permit Number: SW990361 Legal Description: LODGEPOLE LT 2 Date Issued: Sep 29, 1999 Expiration Date: Sep 28, 2000 Parcel ID: 015-061-40 Design Engineer. 0088 Anderson Construction & Eng'g Site Address: 005831 OLYMPIA CIR Owner Name: Tom Bartholomuew Lot Size: 14350 SQ. FT. Owner Address: % 14250 Golden View Drive Total Bedrooms: 4 Permit Bedrooms: 4 Anchorage , AK 995164303 This permit is for the construction of: Q Disposal Field Q✓ Septic Tank ❑ Holding Tank ❑ Privy Q Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations (1 SAAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 3434744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either. A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: &4" Date: "?'Z'�Ozu ' Date: _ Y-27-77 Michael N. Anderson, P.E. 14250 Goldenview Dr. Anchorage, Alaska 99516 Ph 345-3377 Fax 345-1391 Date September 20, 1999 Municipality of Anchorage Department of Health and Human Services On-site Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Subject: Lodgepole Subd. Lot 2 To Whom it may concern: This a request for a new four bedroom septic system and well permit on the above lot. One test hole was excavated on the north end of the lot. The soils were light gray silty sandy gravel with water observed at 14.5 feet during excavation. The perc rate was 12 minute per inch which translates into a trench length of 58 feet with 6.5 feet affective depth. The adjoining lot to the west was also tested and had no water however 8 feet will be used as the bottom of the system on both lots due to test hole on lot 2. The test hole on lot 1 is higher then the test hole on lot 2 by approximately 3 feet this might explain the deeper test hole having water in the gravel. The soils were the same on both lots except the bottom 4 feet of the test hole on lot 2 had clean gravel. This gravel layer plus the neighbors existing septic system was only 50 feet away might be some of the reason for the water. This new system will not prevent future wastewater and well development on the adjoining lots as the plan shows. The existing systems on the surrounding lots appear to be performing adequately. Please feel free to call with any questions concerning this system at 345-3377. Sincerely � Michael N. Anderson, P.E. jDESIGN CRITERIA: I ---- \ .4 BDRM 600 CPO'— ISOILS = Q.8 GPD/Sb. FT; ' • 600/0.8 L 750 SO. j FTe'REQ'D le :TRENCH: ; 18.0' DEEPI :6.5' EFFECTIVE I HOUSE 12.0 WIDE :58' LONG j I I � � • 1 L . L. I L ` I j ADJAC�NT WELL RAD US 1.—..—..—..—.. ..—..—..—.. —.. —.. .\—•.--..—..—..—..—...... � 1 L OLYMPIA �'CIRC\ L � I � j • L PROPOSED 1b0' WELL RAbIUS�\ -� PROPOSED 100' WELL RACtiIUS i 1 ADJACENT WELL RADIUS `\ I SEPTIC DESIGN PREPARED FOR TOM BARTHOLOMEW LOT 2 LODGEPOLE SUBDIVISION PREPARED BY MICHAEL N. ANDERSON, P.E. 14250 N. GOLDENVIEW DRIVE (907) 345-3377 / FAX (907) 345-1391 (i SCALE: 1"=60SEPTEMBER 1, 1999 A OF - — � c`Xt y Q�'' ' ... ;9s�11 49TH* -Tit 00 x .............00 PC'% MICHAEL N. ANDERSONck- / �' • CE- 4 9 ------------- I{{ ( �..—..— 10 UTILITY L • 1 I 1 OPOS GUSHlee � FPROPOSED ' LOT 1 - 4 :E E ,- � LOT 2 el 1.—..—..—..—.. ..—..—..—.. —.. —.. .\—•.--..—..—..—..—...... � 1 L OLYMPIA �'CIRC\ L � I � j • L PROPOSED 1b0' WELL RAbIUS�\ -� PROPOSED 100' WELL RACtiIUS i 1 ADJACENT WELL RADIUS `\ I SEPTIC DESIGN PREPARED FOR TOM BARTHOLOMEW LOT 2 LODGEPOLE SUBDIVISION PREPARED BY MICHAEL N. ANDERSON, P.E. 14250 N. GOLDENVIEW DRIVE (907) 345-3377 / FAX (907) 345-1391 (i SCALE: 1"=60SEPTEMBER 1, 1999 A OF - — � c`Xt y Q�'' ' ... ;9s�11 49TH* -Tit 00 x .............00 PC'% MICHAEL N. ANDERSONck- / �' • CE- 4 9 I L I{{ ( .II L • 1 I 1 1.—..—..—..—.. ..—..—..—.. —.. —.. .\—•.--..—..—..—..—...... � 1 L OLYMPIA �'CIRC\ L � I � j • L PROPOSED 1b0' WELL RAbIUS�\ -� PROPOSED 100' WELL RACtiIUS i 1 ADJACENT WELL RADIUS `\ I SEPTIC DESIGN PREPARED FOR TOM BARTHOLOMEW LOT 2 LODGEPOLE SUBDIVISION PREPARED BY MICHAEL N. ANDERSON, P.E. 14250 N. GOLDENVIEW DRIVE (907) 345-3377 / FAX (907) 345-1391 (i SCALE: 1"=60SEPTEMBER 1, 1999 A OF - — � c`Xt y Q�'' ' ... ;9s�11 49TH* -Tit 00 x .............00 PC'% MICHAEL N. ANDERSONck- / �' • CE- 4 9 MOUND.OVER i i b CRADE -t' OR 2' INSULATION OVER i / FILTER FABRIC i I / \\\ I n / \+\ -12.5. SM / `\ CM 20 DRAIN ROCK �ADJA�CENT WELT} RADIUS I-------='�----------- —`----------I------- — 10' UTILITY EASEML•N7' — =------ _`-----_`�%`—=---------e — PRIMARY / \ . ------- --- Mfi--- I PROPOSED ° ° \1250 TANK TH #1 HOUSE 0! i • i °�SECONDARY i I C0 0 _I ` 1 I I PROPOSED I JACENT SEPTIC \\ I I I m i ' i LOT 1 I I LOT 2 I I O L Y M P I A C I R C L E— i SEPTIC DESIGN PREPARED FOR TOM BARTHOLOMEW q�� E .OF.... !q �� LOT 2 %�P'•'s,Fl+ LODGEPOLE SUBDIVISION *:49TH•••. PREPARED BY •••••••• MICHAEL N. ANDERSON, P.E. %'�...... VO . • `r (907) 345-3377 / FAX (907) 345-1391 !! CE -9469 Ike SCALE: 1"=30' SEPTEMBER 1, 1999 R�fESSIOK�� • �, Municipality of Anchorage DEPARTMENT OF HEALTH 6 HUMAN SERVICES 825'1.7 Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: TJM Do r f h o/orr a E.-> DATEPER LEGAL DESCRIPTION: Lo4-2- LO (kS'r PG L-, Township, Range, Section: K 3 4 5 �1�'j4i-CTray `7Gn�y �i%1<T •SM 6 8 9 10 it 12- 13- 14- is 213 1415 17 18 19 20 WAS GROUND WATER ENCOUNTERED? IF YES. AT WHAT DEPTH? Depth to War ARu Map? Al • A .&T •.:...... ^� MICHAEL N. ANDERSON :Ck' C PERCOLATION RATE Immutwy nnj PERC HOLE DIAMETER �E,�T RUN BETWEEN _FT AND ZI FT :OMMENTS Noss, Nt� %"'G�'r'r �' ��*+�� Ar,a{r f+brS Srw+r Sc..t'�'r...s L SO♦Q..._ PERFORMED BY: hd, I kao ( AA a " r i 4 n I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE- 72-008 ATS72-008 (A". 4,851 Municipality of Anchorage ., Development Services Department' Building Safety Division „? �- Onsite Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 l� Anchorage, AK r9g519-6650 www.muni.o onsite V 1 (907) 343-7904 \ CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. nlG-Clro I - L10 COSA# b19205R�1` 1. GENERAL INFORMATION Expiration Date: 3I t'(, OR: Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address LODGEPOLE SUBDIVISION: LOT 2 5831 OLYMPIA CIRCLE • ANCHORAGE. AK 99516 SIGNE ANDERSON Day phone 336-7166 5831 OLYMPIA CIRCLE • ANCHORAGE. AK 99516 Day phone VALERIE WHUMORE w/ PRUDENTIAL JW Day phone 769-5818 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation 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 riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Finn GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date /I bbL Engineer's Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines d 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 He 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 orparty 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 Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineers Reort Other t�� OFttANC'�r. ON-SITE .,.�rt= WATER AND s wasTEWATER� PROGKAM ey: Original Certificate Date: Municipality of Anchorage ' Development Services Department j Building Safety Division Onsite Water 3 Wastewater Program a 47110 eragaw Street i' P.O. Box 1981350 Anchorage, AK 99519$850 www.muni.org/onsM (907) 9437904 !' CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: LODGEPOLE SUBDIVISION; LOT 2 Parcel ID: i A. WELL DATA Well type PRIVATE If A. B, or C provide PWSID# NL Well Log (YIN) YES Date completed 11 /5/1999 Sanitary seal (YM) YES Wires property protected (YM) YES i Total depth 141 ft. Cased to 141 ft. Casing height (above ground) 18+ In. FROM WELL LOG AT INSPECTION I Date of test 11/5/1999 9/12/2006 Static water level 57 ft. 56 ft. Well production 20 9-P.M. 7.47 9.p-m. WATER SAMPLE RESULTS: CoN form _0 colonies/100 ml. Nitrate 3-67 mgJL. Other hacteris n colonies/100 ml. Arsenic: Nn ugJL. Date of sample: 9/12/2006 Collected by: GEG. Ltd. e. SEPTICIHOLDING TANK DATA j Tank Type/Material SEPTIC/STEEL Date Installed 11/20/1999 I Tank size 1250 gal, Number of Compartments 2 Cleanouts (Y/N) YES Foundation deanout (YM)YES Depression over tank (YIN) NO High water alarm (YM) N/A Date of pumping 7/11/2006 Pumper ALASKA SEWER k DRAIN C. ABSORPTION FIELD DATA i Date Installed 11/20/1999 Soil rating (g.p.dJft0.88 Systern we TRENCH i Length 58 ft. Width 2 ft. Gravel below pipe 6.6 ft. Total depth •t to tt Eff. absorption area 788 ft' Monitodrig tube YES Depression over field NO Date of adequacy tact 9/12/2006 Results (Pass/Fail) PASS Fluid depth in absorption field before test28 In. Water added 732 gsl. For 4 bedrooms New depth 32 in. Elapsed Tine: 268 min. Firm fluid depth 30.5 in. Absorption rate >= 600+ 9.p.d. Arry rejuvenation treatment (past 12 mo.) (YM & type) NONE KNOWN If yes, give date — D. LIFT STATION Date Installed Size lo gallons 'Pump on' level at _in. E. SEPARATION DISTANCES High water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAlft station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 1001+ Public sewer manhoieldeenout N/A Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 1000+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 1000+ Driveway, parkinghrehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS 0. ENOINEER'S CERTIFICATION I certify that I have determined through fisid kWocV= and review of Munh*al records that the above systems are in conformance with MOA COSH guidelines in effect on this date. Engineer's Printed Name JEFFREY A GARNESS Data h13101, COSA Fee &y ,-�o • O to Waiver Fee $ _ Date of Payment I ) .1 110 Date of Payment Receipt Number O L/ a .JJa Receipt Number, (WV. t eros) D 0 a a W D a N D O VA S 89054'511E 102.50' Id Nw•u• I/Tlurr w[wtNf — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — • O.N. •[DK 0 0 0 a D/NOL£ SAM/LY FRAME MOUdE W O a N D D Z R PP=K •yOrO �P AMN/ LI If.4 4 /----�� Am.r • pffl FAr / I r ••AFRL I ~A ms AKu I I ' WCLAV I I B B9°59100'E 102.50' pF q v �F...... 4q �0 5wink.wo, flAd- f SHANE A. HOLT: j OfA LS -6914 s�L Ong o A"MT SURVEY (NO CORNERS SET THIS DATE) a YMpI�i —'-----------------'-- QeC� SCALE I' -W EWTWG STRUCTURES AND RATTED LOT LIES OR EASEAEMS AND 151 DT TO BE USED FOR POSITIONNG ADOIDUAL ENCRMGwf11TSE18SIE%DEPTASHOTED. HIFFEBY tsmEFr THAT) HAVE PFRFOTU.EDA DATED A7 NICNORAGE ALASKA 11/15./ND EASEMENTS OF RECORD, OTHER TNN/ THOSE SHD H dR THE RECORDED PUT. ARE HOT SIOVM HEREOKMLESS/DIATED) MORTGAGEES NSPECTEON OF THE POLLOYMq IDTE: AHY FFNOE1lESSHOM AELOCATEDMPRO=ATELYANDARE NOT MBE USED TODETERMHE RROPERTYLNES TEL 34 5013 DESCRIBED PROPERTY. ANY PAWD SHOM M1 LAY SE APFROXIMATE DUE TO SNOW CONDITIONS. LOT 2 LOOGEPOIE 8VB. ANCHORAGE REOORDNO DISTRICT. ALAWA AND THAT THE V15MLE /NROVEAEMS STATED THEREON ARE NITMH THE PIRCPERTY L/ES AS IDIFD A/D ND VL56lf THE NFORWTION HEREON IS FOR THE USE OF LENDM N5TIM10NSSPEC•1GNLY M SHOW ANY CONIUM BEINEEN EWTWG STRUCTURES AND RATTED LOT LIES OR EASEAEMS AND 151 DT TO BE USED FOR POSITIONNG ADOIDUAL ENCRMGwf11TSE18SIE%DEPTASHOTED. STRVDII[ES OR FENCEUES. DATED A7 NICNORAGE ALASKA 11/15./ND EASEMENTS OF RECORD, OTHER TNN/ THOSE SHD H dR THE RECORDED PUT. ARE HOT SIOVM HEREOKMLESS/DIATED) DAYOF_NCNEM6ER 1088. HOLT HAND SUTVEYNG EDN, EB 11617 IDTE: AHY FFNOE1lESSHOM AELOCATEDMPRO=ATELYANDARE NOT MBE USED TODETERMHE RROPERTYLNES TEL 34 5013 OR LOGTE STRUCTURES. ANY PAWD SHOM M1 LAY SE APFROXIMATE DUE TO SNOW CONDITIONS. SCS ReLM 1065431001 Client Name Gamcss Engineering Group, Ltd. Project Name/N Lot 2 Lodgepole Client Sample ID Lt Lodgcpolc Matrix Drinking Water Sample Remarks: All Dates/Tim" are Alaska Standard Time Printed Daterrime 09292006 11:03 Collected Daterrime 09/12/2006 8:45 Receked Daterrime 09/122006 15:30 Technical Director Stephen C. Ede Allowable Prep Analysis Paramos Results PQL Units Method Container ID Limits Date Date Inil Metals by ICP/M3 Arsenic Waters Department Nitrate -N Microbiology Laboratory Total Coliform ND 3.67 0 5.00 ug/L EP200.8 0.100 mg/L EPA 353.2 C (<10) 09/15/06 0927/06 MI D (<10) coUl00mL SM209222B A (<I) 09/12/06 ALR 09/12/06 TLF Municipality of Anchorage • Department of Health and Human Services Division of Environmental Services On -Site Services Section 825 V Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 :. CERTIFICATE OF HEALTH AUTHORITY APPROVAL. FORA SINGLE FAMILY DWELLING . Parcel I.D. of r-;- -OW —&4v HAA# H� YnS Expiration Date: GENERAL INFORMATION Complete legal description (o 4- Z "o be r- Pam Location (site address or directions) Torr. 6 v 1-N o (o#,h ct4.D Current Property owner(s) Mailing address Lending agency Mailing address Day phone 2-'11.1 Day phone Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2.. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates 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. 72025 (Rev. 01/00)' Individual On-site to ❑ Individual Holding Tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates 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. 72025 (Rev. 01/00)' 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 Health Authority Approval Guidelines for the Health Authority Approval application show 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 verity that based on the Information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on- site water supply and/or wastewater disposal system is in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. NameofFirm MleinnPW {p.S. Phone '3�is•'S`�� Address 14(suo eho6hen: Engineer's Printed Name Mt r r. r ( '� n 1 r1 u, -r Date 6. DHHS SIGNATURE - Approved for bedrooms. Disapproved. Conditional approval for Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory By: O F`\ _ .%'hit-��`•" Qrgs,�l, ' * ZG 9 . /,y�C$,••I/7�/N{jµ'E1 r • • ' �, . % .........� MICHAU N. ANCIRSCN :.4 / -9449 00 bedrooms, with the following stipulations. Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Z �)-g _CO Expiration Date: ;- — 21` `00 Reissue Date: 75025 (Rev. 01100)' Municipality of Anchorage RETE • Department of Health and Human Services i VE Division of Environmental Services On -Site Services Section 825 `L' Street Room 502 FEB 2 4 2000 P.O. Box 196650 Anchorage, AK 99519.6650 Motunicipal. nhoraakgHuma(907) 343-4744 �• ;cs HEALTH AUTHORITY APPROVAL CHECKLIST it I �I Legal Description: o tt Z wci s e Prue- Parcel LD.: j A. WELL DATA Well type _fq1ve4.e__ If A, B, or C provide PWSID # Well Log Y e f Date completed /r r +P Sanitary seal P ry _L Wires properly protected_ I Total depth /4/ ft Cased to 1,V( it Casing height (above ground) 3(_ in. FROM WELL LOG AT INSPECTION Date of test r r s Static water level 'S i It fl Well production ZO 9 -p.m 9 -p -m WATER SAMPLE RESULTS: efd 0�'n•l'c . i jr� L Coliform _�colonies/100 mi Nitrate '. � mg/I Other bacteria� �colonies/100 ml Date of sample: _r ab It / r Collected by: 1 B. SEPTIC/HOLDING TANK DATA Tank Type/Material 4>4.,r e i Date installed �(bdlrf Tank size r '+ 4 gal Number of Compartments z Cieanouts 2- Foundation cleanout X Depression over tank rto High water alarm Date of pumping nl ew Pumper r4 +w C. ABSORPTION FIELD DATA F Date installed llhWtq Soilrating d./ft2 or ft2/bdrm 0. 9 (g•P• ) `6 System type DT.v b.+„e/,. 'r Length -it It Width z, ft Gravel below pipe t Lft Ir Total depth y ft Effective absorption area 7110 ft2 Monitoring tubed Depression over field Date of adequacy test Results (Pass/Fail) , For —`L bedrooms Fluid de —� th in absorption field before p rpti test in Water added � at. New de th m. 9 P Elapsed Time: min Final fluid depth ' in Absorption rate >= — g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) /I tew If yes, give date 72026 (Rw. 0I/00)• D. LIFT STATION Date installed "Pump on" level at iri Datum E. SEPARATION DISTANCES Size in gallons off level at in High water alarm level at in Cycles tested Meets alarm & circuit requirements SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankilift station on lot Age' a< Absorption field on lot /oo rf- Public sewer main r"( Sewer /septic service line io o' {- On adjacent lots /co ur �'- On adjacent lots /oa' (- Public sewer manhole/cleanout— Holding tank , SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation /0 1 f Property line 4!5V i A Absorption field /0// - Water 0// - Water main N 1,4 Water service line 4!v' t Surface water / ob / Drainage /0011L Wells on adjacent lots /oo iA SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I G,I t Building foundation z4'+ Water main H1,4 - Water Service line t4d + Surface water - loo 14- Driveway, parking/vehicle storage 1+10f Curtain drain � Wells on adjacent •lots iaio fig F. COMMENTS G. ENGINEER'S CERTIFICATION g6 OF At I certify that I have determined through field inspections and .� review of Municipal records that the above systems are in 0-4„ • , II conformance with MOA HAA guidelines in effect on this date. / / Engineer's Printed Name M% 4%4 At,4. 1 c -.+o r MXHAPIL N. AU, P 2 < 's Date L� 2 00 (r y`, 1 .a, - ^. , •. Vit\ �� ... HAA Fee $ 00 / Date of Payment C�)? /oZ�L�7� Receipt Number UP 1 % 72.026 (Rev. 01100)• Waiver Fee $ Date of Payment Receipt Number CZ -28-00 - 10:35 FROM -M ENVIRMIENTAL 5815301 T-121 P.02/03 F-081 ACT&E Eovironmontol Services Inc. ME RKM Client Name Project Nome/n Client Sample 1D Matrix Ordered By MID 1000675MI Mice N. Anderson. P.E. Lodge Pok Lot 2 Lodge Pole Lot 2 Drinking Water 0 Cliwt Pct! Printed Datdrime Collated Datefrime Reai►ed Date/rime Trcbnkal Director Rebated By 02/2842000 10:31 022212000 8:30 02222000 830 Stepbea C. Ede Sample Remarks: Correct Report Cl=T 10 Allowable Prep Analysis Perowter 0040M PQl Units Method &I ad To Date Date Init I uWAS DEPT xitrate-x O.SG2 NlCRO LAS I TOT41 Collfore i 40 all Gott 0.500 OWl. IPA 300.0 Grt00e4)l a 92225 COO) D&WOO Sci. 02/22/DQ aAP