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DELUCIA LT 23
r.)elucia Lot 23 #051-141-42 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201422 PID Number: 051-141-42 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name David & Shirah Gates A ORPTION FIELD ❑ D Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 22575 Needles Loop, Chugialc, AK Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 /SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original a Gravel depth beneath pipe Ft. Subdivision Block Lot Delucia 23 Fill added above original grade Gr I length Ft. Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dist a between lines Ft. SEPARATION DISTANCES Toj Septic AbsorptionLift Stat'son Holding Sewer Total absorption area Number of trenches Dist. between ches From I Tank Field Tank Line Ft2 Well 100.51 TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water ( 1001+ i Greer 1000 Gal. Material Number of compartments I ` Lot Line I 5,+ 1111 ; NA Plastic 2 Foundation 701+-1 j TION Manufacturer Capacity Remarks Gal. Alarm location Elects Iled by Installer PIPE MATERIAL Housetotank Tank to D3034 drainfield D3034 RPC Drainfield CO/MT D3034 Inspector Arcterra Consulting BENCH MARK (Assumed elevation) 100 ft Inspection n dates: 11/3/20 2nd 11/3/20 Location and description 3' 11/5/20 4'h Door frame lower corner ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Q Date > . ft �iFltiiY3}\fi �tmiti i sa Ssi�wk;� 4 q�a�t . ►tt, tuaurre�av�� Septic System Y. Approve In. Date_ # .0 Note: this approval does not include well permit requirements.*It 11titri ► ti��► 1RGv V:J1 V4! 1 V 1 AS -BUILT SYSTEM DETAILS/SITE PLAN Permit EISP201422 15'Dec Esmt A—C=32.7' 99.18 99.2 SCALEi 1' 301 B—C=53.3' A—D=34.9' B—D=49,7' A—E=3&3' B—E=50,2' fin A—F=39.0' B—F=51.9' 1000 GAL 93.48 SEPTIC TANK 93.29 K OF ASCALE: NTS -1 PREPAREB FOR: DAVID & SHIRAH GATES roti �l`q Esc CT c� 22575 NEEDLES LOOP :4 T CHUGIAK, AK 0 KENNETH us FIELD BOOKS COMPUTED: > CE_ 6 BOUNDARY: N /A KSQ k P4 DRAVN tlSTAKING: CHECKED: KMD NZA �pz . s . s . lo -I0 Arl ASBUILT: JLS DAM, 11/14 20 OM. FILE, cRD- NW125q 0, 'p ACAD FILE TING FILE No' 20201 AK, 99577-5136 M /Volumes/ArcTerra Shared 7s'tor.,,.JWFil A, qFP-nr FI.I.ei Ru A -0,44 A...- DELUCIA LOT 23 PID# 051-141-42 WELL VELL GRAVEL LOT 23 PAcMG 0 a Lr) cq 00 C:5 DECK U-3 �2 6 c"I �2 _j -q- 0 EXISTING HOUSE 0 b p 1 0 0 Z0 CO C) Z/ 13 0 E F SEPTIC VINT 15'Dec Esmt A—C=32.7' 99.18 99.2 SCALEi 1' 301 B—C=53.3' A—D=34.9' B—D=49,7' A—E=3&3' B—E=50,2' fin A—F=39.0' B—F=51.9' 1000 GAL 93.48 SEPTIC TANK 93.29 K OF ASCALE: NTS -1 PREPAREB FOR: DAVID & SHIRAH GATES roti �l`q Esc CT c� 22575 NEEDLES LOOP :4 T CHUGIAK, AK 0 KENNETH us FIELD BOOKS COMPUTED: > CE_ 6 BOUNDARY: N /A KSQ k P4 DRAVN tlSTAKING: CHECKED: KMD NZA �pz . s . s . lo -I0 Arl ASBUILT: JLS DAM, 11/14 20 OM. FILE, cRD- NW125q 0, 'p ACAD FILE TING FILE No' 20201 AK, 99577-5136 M /Volumes/ArcTerra Shared 7s'tor.,,.JWFil A, qFP-nr FI.I.ei Ru A -0,44 A...- MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program Po Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone (907):343-7904 Fax: (907) 343-7997 http:f/w .muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201422 Effective Date: Work Type: SepticTank Upgrade Tax Code Number: 05114142000 Site Legal Address: DELUCIA LT 23 GA259 Site Mailing Address: 22575 NEEDELS LOOP, Chugiak Owner: GATES DAVID J & SHIRAH L Design Engineer: ARC TERRA CONSULTING INC This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy oICnr S O i. r ^ f• or n y De partineut 10/12/2020 Expiration Dater 10/12/2021 Lot size in Sq Ft: 11250 Total Bedrooms: 3 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By:J�� Date: 1119 �v Issued By:� Date: ZG MUNICIPALITY OF 'V Development Services Department On -Site Water & Wastewater Section Parcel I.D. 051-141-42 ON-SITE SEPTIC/WELL PERMIT APPLICATION Property owner(s) David & Shirah Gates Day phone Mailing address 22575 Needels Loop, Chuiliak, AK Site address 22575 Needels Loop, Chugiak, AK Legal description (Sub'd., Block & Lot) Delucia Lot 23 Legal description (Township, Range & Section) Lot Size 11,250 Sq. Ft. Number of Bedrooms 3 Phone: 907-343-7904 Fax: 907-343-7997 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field F-1 Initial❑ Single Family (SF) IN (w/wo AD U) Septic Tank ❑x Upgrade FK Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Dea Duffus (Signature of property owner or authorized agent) Permit/Rush Fees: ��9.75 C000 Date of Payment: I - q - Z D Receipt Number: Permit No. OL p 20 ly 22 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201422, Deb Wockenfuss, 10/13/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201422, Deb Wockenfuss, 10/13/20 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 1 ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAMEn 0 Do s. 13 Ir PHO(NNEE � D 7 �`�✓�c NEW ❑ UPGRADE MAILING ADDRESS SQ z r e 4 LEGAL DESCRIPT N c2 3 U � LOCATION tpl2u '_� L_ / N0. BEDROOMS .ZD 3 O DISTANCE T0: Well jf n -%- Absorption area Dwelling PERMIT NO. Y WQ Manufacturer % Q Material c )Q, V No. of compartments Em N _T IF HOMEMADE: 1^side length Width Liquid depth 6 Y DISTANCE TO: Well Dwelling PERMIT NO. .r02 ZF Manufacturer Material Liquid capacity in gallons O m=rNo!ff ANCETO: Well ��`� Foundation Nearest lotpne (!/ PERMIT NO. •. �= 2 w ines Length of each n Total let of lines rench width inches Distance between Imes —S o to mish grade r [� O J • Rthe Matenal beneath ale I) inches Total effect a sorption are 340 W Length W� th Depth PERMIT NO. a f wd Type of Crib Crib diameter Crib depth Total effective absorption area W to DISTANCE TO: Well Building foundation Nearest lot line J J Class Depth Driller Distance to lot I me PERMIT NO. W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS �?ski c SOIL TEST RATING INSTALLER -J,41" Tri /c i• -w f c z fT — RE KS 1;16 sL F M' l_ c,t-t! 7 Y a he L7L alp lZ- P r APPROVED DATE LEGAL / 6 -(Z -V -Z OP..lucr� �o f •�3 72-017 (Rev. 0178) SULLIVAN WATER WELLS p.O. BOX272. CHUGiAK, ALASKA 99567 · TELEPHONE 688-2759 OWNER OF LAND ,/'1/'/'vT/e= 7"'~ c'/h/ /~a,,x/ /'~/~/4'~' ) DEPTH OF WELL ADDRESS .~,r' ~.,~ '~"'~'Tq' t.O /-~3~'~.-, C//~ ~TAT[C LEVEL OF WATER FT. LEGAL DESCRIPTION .~ ~3 ~_ 0 "'/'~' ~",J6'O DRAW DOWN FT. DATE- Sta.ed 5/'" '?/~' ~ Ended 6 /~/~:t/~ GALS. PER HR PE T UMBER 0 :r OF CASZNG YdND OF FORMATION: From '_/'~ Ft. t" :'~ Ft. ~ '~ -~' ~"~ ~ From Ft. to Ft From ~ Fi. to 10 Ft. .~4~0 ~ ~'~ff~ From Ft. to.~_Fl. From lC= Ft. to / K Ft. ~¢~ ~ ~C From Ft. to Ft. From ~0 Ft. lo ~ ~ Ft ~ ~,V~ -~/ From Fi. lo FL / From Ft. to .FL ~ From Ft. to Ft. From 7 ~ FL to ~"Ft. ~'00 / ~/~ From Ft:~o~FL -=~O~ ~tom~.Ft. to ' "FI: ~/ ~ ~ ~ From e{. to~Y~.?~ ~,~ F~m FL lo FL ~ ~ ~..- ?om ' ~=~FL ~ From F~h Ft. ~O ~' O~ From . It. to. From //~Ft. to I~Fc· -'~ ~ ~l'From FC. to From Ft. to~Ft. 'Z~ /~ t ~/0 From Ft. to Ft. From I'.~.Ft.I Ft. ',~' ~& ~ From " .Ft. to Ft. From ~ Fi. to Ft. C~ ~~0 ~om Ft. to Ft. F~I~ Ft<t- ~t. ~ ~ ~" From /Ft, to Ft MISCL. INFORMATION: DRZLLER'S NAME /P.c,~ ,.'% 1.11_]r-4 I r I F}F-it I -r'F tiF- Rr-aP:Z:HcAF:Fi113'E TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (50 FT/BR)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C•EF -r"= 11 L.ErAC3-rH= �7 GF:Fik'EL CHEF -r"= r THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR, DR.AINFIELD. THE DEPTH OF A TRENCH OR. PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION! CIN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH I5 THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). REC LJ I REO ',EF•T I Cl TFIr4v< fo 12" En == ILCA0 0 C3FILLGt40 PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER.' OF RESIDENCES THAT THE WELL WILL SERVE. --- T'Wf--, C n�L ? FIRE REGL� I REC• --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON! THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER: LINE IS 25 FEET AND TO A COMMUNITY SEWER. LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER, REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F•ERM I T E: KF& I RE"w C+ECE lE 3ER 3nL, 1<+L 22 I CERTIFY THAT 1: I AM FAMILIAR.. WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED ISSUED APPLICANT HOMETEK V4. 0 DEPARTMENT OF HEALTH AND ENVIR.'ONMENTAL OTECTION j £25 '�. STREET, ANCHORAGE, AK. 9. A ` 264-4720 �1�C 14KL_L Ffr4c> CAr-d—c. I TE cEWER F7 EZ FQ r'1 I T PERMIT NO. ( £20366 ) APPLICANT HOMETEK SR2 BOX 5974 CHUGIAK AK 99567 6££-2052 LOCATION LEGAL L23 DELUCIA S/D LOT SIZE 11250 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (50 FT/BR)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C•EF -r"= 11 L.ErAC3-rH= �7 GF:Fik'EL CHEF -r"= r THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR, DR.AINFIELD. THE DEPTH OF A TRENCH OR. PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION! CIN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH I5 THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). REC LJ I REO ',EF•T I Cl TFIr4v< fo 12" En == ILCA0 0 C3FILLGt40 PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER.' OF RESIDENCES THAT THE WELL WILL SERVE. --- T'Wf--, C n�L ? FIRE REGL� I REC• --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON! THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER: LINE IS 25 FEET AND TO A COMMUNITY SEWER. LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER, REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F•ERM I T E: KF& I RE"w C+ECE lE 3ER 3nL, 1<+L 22 I CERTIFY THAT 1: I AM FAMILIAR.. WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED ISSUED APPLICANT HOMETEK V4. 0 �_5 'L PFRMIr fill. �ao,s�or, -7enj_ rata -i r 1 fortE rr1: s1r[1)N LEGTR L1:� fCT V--ffr ,F -Ir -31_ L -i-:T •r�lt= t1r•i» Ttf�t?t=lr3F_ t•1`tA_FH AND PROTECrtON S rk-c i, F!?iC7 iURifl;:', rlk_ ;03-soi d1S4-4T Q +_+t`i—`_ T. "r t: •__: t•t f2 t- F �r"� t't r T >>?g VOY 5y74 C: 'JiVC A LOT SIT if25113 •o1�iJliRt }> �V' repi fes' -51? IF_ fl s31)2^ r [ UJt 'S'r`s mll 1-5. TrZF-W'H ff1-1:ti•pJiVr1Ui't'c'£R 1)1 8l:GNUUtY. i SOIL RAT(Plri (SQ 'Frl9Ri= 12s Tfi': ,^•.t QU[REO SIZE O'r iii SOiL IS: �% C'•i=!=•l'I-i:== 3.2. I_C=r-Jt�'E'1-1= :��-' t'�t=:t=i':�>='t_ Gf=�'t {-1�• T Ti•C: LENGTH 15 rw. 1_FHOTH ! rri Ft:m a: rti._ f)R ORAM IEL6. `4 rszc oerm OF A Oil rt f t5 rw- nisnil :E c- rwcEH me _Ut"=rx} f TiF- afzo m ow rw Lorrt)N nFr Td`_ 1 -MC b'11i"I0J1 irur)- Ti#=RE IS 110 .Fr WIDTH FOP T>=:F'rN HCi . .._. I'}!r 13R13Vn_ Vc4. TH M T}tc M [11 t h11JM WPM i OF r3fzA /El. r rLla'tN TtdF OU rFt11J_ P IF'i_ ;1110 rids t:OMIN tar rF E`tf.ii arrou mi FEE.ri. r F--Ir-41-1 I c VE 0 CiFfl_E._f !!•t_: FI -:,OHI 8PM_If`.Vfr 'MTS ITC' i rV TO [WORti r14£•3 i>s RRTrtEriT mA.Ziix1 rw- r rmr_iarcl3:i 1x" tiny nzLu iiG.fACkrli rn mc,-; t't arj-=,^TY titdQ rte ` fd1Y(-*F.F. OF TURf rR= Wt ,— � F: E- _ F-zc,:,;.iuLfzz:t= £stf:ltr'It f.(rlri 01 f0w 54`Sruq id£Ttp?'Jr Fffm carpe •rion timo t1PPmOVN1_ RY THN CfFP; tF. Tm:u r tit t.L SIS: Jr7: r rf) : po-;o:fJ r v)?c rtirlttlUJi OE'�T:iih' rs1s_rf H bk-]_t titch NnY Ort -SIT£ S`'wg C•t5f'11�tiL i iaf IIF f••: .1 1414{ T'r E r FOR A PR f'•h i 1 1.1%3_1. $?i+ L`i>) To -,ee FEET Er4o" A PUSL I C E: f. v lr? f rn3 UPON Ti -3< ViVE OW >✓WLIC LI-U- hJ[ffMUM L)£'SrUbx Ff'.04 A PkEV1'ita t•>'ll TO n PRIVATE S£i•�--N LIM IS 23 FEF_r riN6 iU R 01,41,11JNIrY •x -td:=^ 1 -tri: Eb ?a F'F;_r 1. 1- Lrjt ; i3: Rr_vU t R1:1• wit, ivi r er r-= rum r -o r13 t He cwpn ? rrr�-rf r I4 f Tt i £N 30 UN'r`5 :'• 1:o- I -W 1•>ri t_ CIRL-4._FTIOJt f)rWR PEQUIF.;-1-Pair•;. MAY R'rLY =pj:i3EFtr.rlrW1?3 ;VK, rit`z I.111iIU10LF ru irJ•+ A'P F'fe.#70s e: £ttir:l<_f_Arflilt F'•a~:= r•t L f' � :x:i-' t T%:£= _� r:•£::r.:L:{•jr-�t=t? j-:1_.. �L:_-++= L'[ I f:c�mrEt=Y TRIT 3: 1 Ji11 rAMILEVV. OEM Ckc fi wUlk%'NzIIT`: FOR J3N-;ET1: >>='•}1?= MIP WkcL � 1r- SFT 1=11P.M1 V. T}tt 1.11211r IF'131_ITY 1S67 F1*,HQWtrr. I WIU_ trr UP -1_ Tri`: :Y•SrEri trf 1r;1;t_l on?.nE mim Tim ri1r�1- S: E lulr}rt�TlTti1> fHt1T Tt� 1)Jt��ir1: v;YJ.F.f. 'r�TL•i! i•>if'I f+Ff?'}Eiv_ �t•8_t1:?13+,rp_nr if- TI -t= ' f?e;MzJj,X�l?t=f-PRoW�,q Tn [rKLUOr r1riA� +_. THM s GP_XPOQ1' A tira'Ltt;liJir H1A•�:TEY. - - - --- ----- f y/ SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 1'\I` Pouch 6850. Anchorage, Aloka 99662 776-2721 -- r SOILS LOG - PERCOLATION TEST nn PERFORMED FOR: % C" K K I DATE PERFORMED: I lI s ' s 4 LEGAL DESCRIPTION: �' -3 ' J C— `'1 L c' /A s, DEPTH // SLOPE SITE PLAN (FEET) 0-' L%i-•lR. sl 1f_c .S-It/111 1 2 3 5 6 Trr 16 17 18 19 6, ¢'IS C rc\. v Reading Date WAS GROUND WATER �� L/ ENCOUNTERED? •.' L P E IF YES. AT WHAT DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop 20 { UPERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT PERFORMED BY: If Olds ( � C CERTIFIED 1 72008 (7/76) DATE: Municipality of Anchorage rIN 825 "L" STREET ANCHORAGE, !` LASKA 99501 (907) 264.4111 GCORGFM. SVLLIVAN, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION December 311 1980 Richard J. Kimmel 2221 Muldoon Road Anchorage, Alaska 99504 Permit # 800183 Subject: Lot 23 Delucia Subdivision A permit issued by this department for well and/or sewer system has expired as of this date. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please call this office at 264-4720. Sincerely, j Les N. Buchholz, R.S. Senior Environmental cialist. LNB/ljw enc: Copy of Permit I SWP/057 1i ' I M U N I G I�AIL I T V O F A N G H R A G E DEPARTMENT HEALTH AND ENVIRONMENTAL,OTECTION 825 'L' STREET, ANCHORAGE, AK. 99501 264-4720 O N- S I T E SEWER PERM I T PERMIT NO. ( 800183 ) APPLICANT RICHARD J. KIMMEL 2221 MULDOON ANCH 99504 337-5478 LOCATION MONTGOMERY ST. LEGAL IL23"DELUCIR. LOT SIZE 11250 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SO FT/BR)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: E>EPTH= 7..2 LENGTH= 24 GRAVEL_ E>EF='TH= S THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET>. THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). REiZU I REG SEPTI G TANK S I ZE= 1000 GALLONS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- T W O <2> I N S P E C T I O N S ARE REQUIRE 0 - BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER, LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERM I T EXP I RES I7EGEME3ER 31. 1.5;l^0O I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER. SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED ISSUED APPLICANT RICHARD J. KIMMEL V4. 0 ��JjL � ANCHORAGE, ALASKA 99501 (907) 201.:111 E : Y''47 `:. ti:JL LI V.1 t:, 1'. r PAR f .1 . t Lf nr :. I. i I'. ,;X:) [•'::'Iii:":;a Q.^:TAL PR(?TECTION December 31, 1979 Richard J. Kimmel 2221 Muldoon Road n74 Anchorage, Alaska 99504 Permit # 790618 Subject: Lot 23 Delucia Subdivision A permit issued by this department for well and/or sewer system has expired. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer has inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please contact this office at 264-4720. Sincerely, 4 )On 6 Les N. Buchholz,R.S. Senior Environmental Spa'-st LNB/ljw enc: Copy of Permit LIT'— ri F Fi r -J cz: t� _v F: n ci E DEPARTMENT bF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE, AK. 99501 264-4720 WELL F'EF:r•1 I T PERMIT NO. { 790618 > APPLICANT RICHARD J KIMMEL 2221 MULDOON RD SF' 74 327 5478 LOCATION CHUGIAK LEGAL L2= DELUCIA SUBDIV LOT SIZE 11250 SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON–SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL; OR 153 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS ARE PEOUIPED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN TO DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'EF:rl I T 1—= F' I F:E- C•EE: G`EIrl C'EE: fZ: = -: 1 _=_ r I CERTIFY THAT 1: I AM FAMILIAR. WITH THE REQUIREMENTS FOR ON–SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. SIGNED: ---------------------------------------- APPLICANT RICHARD J KIMMEL ISSUED BST------------------------------ V=. 2 8L • Municipality of Anchorage GE On -Site Water and Wastewater Program N. (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-141-42 _ Expiration Date: 7 -IE -2-02Z 1. GENERAL INFORMATION Complete legal description Delucia_Lot 23_ Location (site address) 22575 Needels Loop Chugiak, AK Current Property owner(s) Kelsea Woll_mann & Patrick Genter _ , Day phone Mailing address PO Box 874953 Wasilla. AK 99687 Real Estate Agent 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 ❑ Waiver/Variance request for: 3 Day 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. istance: COSA Fee Waiver Fee $ Date of Payment Date of Payment __. Receipt Number __ Receipt Number COSA # O.S C 22I l A 1 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 696-6111 Address 20441 PTARMIGANBLVD,. EAGLE RIVERJ. A -K 99577 ,[ Engineer's Printed Name KENNETH M. DUFFUS Date 7 I Ze Engineer's Comments; This investigation was completed in compliance with ADEC and MOA regulations. The assessme 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 4��\ occupants or can ArcTerra guarantee that no unseen OFL\ \ encroachments, deficiencies or discrepancies exist. �er���, ` 9'r I / 6. DSD SIGNATURE System #1 Approved for 3 bedrooms. KENNETH M. DIFF1 j, System #2 Approved for bedrooms. ___--___ Disapproved. Conditional a royal for bedrooms, with the following stipulations: S i, �\S (ctrrr `gam ON-SITE d tn�n rr - V o� ATE A -ND �, --- Fri WAST�.'ATER PROGRAM J "o, .� �JJ JJJNT cRV1 �5 Original Certificate Date: l� )-,) ,' 2007 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory _ Well Flow Advisory Other _ COSA blue sheet -10-10-12 doc Legal Description: Delucia Lot 23 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 6/15/82 Total depth 136 ft Cased to 136 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 21 in. Date of flow test for COSA 10/1/20 Static water level at beginning of test 121 ft. Comments B. TANK DATA Age of tank(s) 1 years Tank type/material Septic,/Plastic Measured operating fluid level in septic tank 42" Standpipes/foundation cleanout per record drawing Date of pumping 2/8/22 D. ABSORPTION FIELD DATA Which system tested (date installed) 6/1982 ALL standpipes present per record drawing Total measured depth from grade 11 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A — pressurized field 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 ID: 051-141-42 Structure served by this system Well production at time of test 3.2 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes No Coliform bacteria is Negative Nitrate 12.1 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L J1 Arsenic less than MRL (ND) Collected by Arcterra Consulting Date of Sample 3/10/22 STATION ❑ Requl aintenance completed Ageof lift station years Lift station material Comments: Adequacy test date 10/1/20 Results ® Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 450 gal New depth 0 in Elapsed time 10 min Final fluid depth 0 in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date 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' Community Sewer Manhole/Cleanout > 100' ® Yes if No It ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25'21 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 ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet �X���`" �� 49TH � MWOiM a yKEA1N 0 CE 711 E3 Nitrate Advisory Certificate of On -Site Systems Approval # OSC 221141 Subdivision: Delucia Lot 23 A water sample revealed-a`nitrate concentration of 12.1 milligrams per liter (mg/Q. 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. z� �Ma�ling Address P O Box 196650 *jAnchorage, Alaska 99519 6650 *www muni org 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 overdo -sing of - fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Municipality of Anchorage S a._. ^ = On -Site Water and Wastewater Program a (907) 343-7904 CERTIFICATE OF ON—SITE SYSTEMS APPROVAL. Parcel I.D. 051-141-42 Expiration Date: 1. GENERAL INFORMATION Complete legal description Delucia Lot 23 Location (site address) 22575 Needels Loop, Chugiak, AK Current Property owner(s) David & Shirah Gates Day phone Mailing address 22575 Needels Loop, Chugiak, AK Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single.Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ® Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class _ Well ❑ Public Sewer ❑ Public Water System ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee q1 ao5o CA�ID-�°I Date of Payment 1 9 a O a o Receipt Number 0 3 0 a z G COSA# 0 5 C' 3(_D Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto. and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of. On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 696-6111 Address. 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The a sessm nt 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 �+►-�.1� occupants or can ArcTerra guarantee that no unseen ,.r OF A T� l encroachments, deficiencies or discrepancies exist. s �p 6. DSD SIGNATURE System #1 Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for KEINNEI't M. WFUS / Cr bedrooms, with the following stipulations: ON-SITE `- WATER AND Cn WAST_v','ATER PRO(3MAM� )))))1m) Original Certificate Date: 6 (-2 Y—za?o 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: see, dg...'L d COSA Checklist X Nitrate Advisory_ Septic System Advisory Well Flow Advisory COSA blue sheet_10.10.12.dw Arsenic Advisory Other Legal Description: Delucia Lot 23 Parcel ID: 051-141-42 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 6/15/82 Total depth 136 ft Cased to 136 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 21 in. Date of flow test for COSA 10/1/20 Static water level at beginning of test 121 ft, Comments B. TANK DATA Age of tank(s) NEW years Tank type/material Septic/Plastic Measured operating fluid level in septic tank NEW Standpipes/foundation cleanout per record drawing Date of pumping New install 11/3/20 D. ABSORPTION FIELD DATA Which system tested (date installed) 6/1982 ALL standpipes present per record drawing Total measured depth from grade 11 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A — pressurized field 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 Well production at time of test' 3.2 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes No Coliform bacteria is Negative Nitrate 11.3 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ME Arsenic less than MRL (ND) Collected by Areterra Consulting Date of Sample 10/1/20 IFT STATION ❑ Requl aintenance completed Age of lift station years Lift station material Comments: Adequacy test date 10/1/20. Results ® Pass For 3 bedrooms Fluid depth.prior to test 0 in Water added 450 gal New depth 0 in Elapsed time 10 min Final fluid depth 0 in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date 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' Surface Water > 100' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25'5Z Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Water Service Line > 10' ® Yes Animal Containment > 50' ® Yes _ if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft P} 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: ® Yes 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.- ots:Water WaterMain > 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 ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 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. a COSA Checklist yellow sheet P.O. Box 670269 Chugiak, AK 99567 P: (907) 688-2759 F: (907) 688-2259 TO: David & Shira Gates 22575 Needles Loop Chugiak, AK 99567 Camera Inspection Report Found normal casing deterioration. No obvious defects or perforations. Date: 10-28-20 www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC201636 Subdivision: Delucia Lot 23 A water sample revealed a nitrate concentration of 11.3 milligrams per liter (mg/Q. 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. t Ma�lmg Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org 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 filterthat 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 mum org LLC Gj o O cn d d fcPi0orn l�noo ,,aoo �7o�d .� xnxas N Oj ,00'0g O ,ZZ'05 L M„00,-b0.00N •J'°�®��� � z o N o 0� oNoo I o0 w w ?AO: E--I ; : aCIO i O Y 0'9 z II II1.o �.W (.� d cC is C m C M O I Uej 0 Lli w X a�i� E v v o LO O c/1 ��� a` l.Cr4 (0 n W O Z m N 11.5'M W In I � V cU�s b = .`^ W o 0) ZI 00 z o ``' c `N3 o•ez I o N o c °cD n o p. z OD o O e `° 00 o C� C,o o W CJ? tC ^ bD y U N (�J ,00.09 L M„OO,-b0.00N) o -.r G o ,ZZ-05L M„9V,0 LOON v H o „ o oZ o w pa 55- 00 -vZ 101 ,02o dUM r�E� �y� W o r�i N LIJ> cca p 00 '� o v�Wp c' Xo ; G d dna via-C W-� 3 N �s- P Municipality of Anchorage Development Services Department Building Safety Division On -Situ Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.orglonsite (907)343.7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051 - I COSA# D(rn_rJqy 1. GENERAL INFORMATION Expiration Date: Complete legal description DELUCIA SUBDMSION: LOT 23 Location (site address) Current Property owners) Mailing address Lending agency Mailing address Real Estate Agent Mailing address 22575 NEEDELS LOOP • CHUGIAK, AK 99567 SHANNON & JERI TALLANT Day phone C/O AGENT Day phone ED ERICKSON w/ PRUDENTIAL VISTA Day phone 227-5275 16635 CENTERFIELD DRIVE • EAGLE RIVER, AK _99577 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well IN Individual Water Storage ❑ Community Class Weil ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site N Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water 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 onsite 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 tiles 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 1 c) /C) 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 8 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 eptic systems depend on the local soils condition, groundwater levels that may 1100,uate during the year, and the water usage of the family being served by the system. Thesa,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 otherperson orparty is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for -3 bedrooms. Disapproved. Conditional approval for bedrooms, with the filowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort I _'� Other OFrlAlilt'''� 00, :: ON-SITE ••: m WATER AND _ WASTEWATER PROGRAM By: `/�//�ir i div. // Com( Original Certificate Date: (Ra Alft) Municipality of Anchorage • Development Services Department Building Safety Division On.Site Water 6 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 995198650 www.muni.orglonsfte (Wn 343.71104 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: DELUCIA SUBDIVISION: LOT 23 _ Parcel 10: A. WELL DATA Well type MATE If A, 8, or C provide PWSID# N A Date completed 15/1982 Sanitary seal (YM) YES Total depth 136 ft. Cased to 136 ft. FROM WELL LOG Data of test 6/15/1982 Static water level 112 ft. Well production S — 9 -p.m -WATER SAMPLE RESULTS: Well Log (YM) YES Wiras property protected (YM) YES Casing height (above ground) 12+ in. AT INSPECTION 12/7/2006 116 ft. 3+ g.p.m. Coliform••►f a cotonies/100 ml. Nitrate $' 0Lm9JL. Other bacteria 0 ootonies/100 ml. Amenia ry � ugJL. Date of sample: 12/6/2006 Collected by: GEG Ltd. B. SEPTICIHOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 6/1982 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (YM) `ES Depression over tank (YM) NO High water alarm (Y/N) N/A Date of pumping 12/12/2006 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA Date installed 8/1982 Soil rating (g.p.dJft°or� 125 System we TRENCH Length 31 ft. Width 5 ft. Gravel below pipe 7 ft. Total depth '11.08 It. Eff. absorption area 434 W Monitoring tube YES Depression over field NO Date of adequacy test 12/7/2006 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test U in. Water added 883 gat. New depth 0 in. Elapsed Time: 0 min. Final fluid depth U In. Absorption rate >= 450+ g,p.d. Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) NONE KNOWN If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at _in. "Pump off" leve High 'water W4ei at in. Cycles tested Meets alarm 8 circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAtft station on lot *98' On adjacent lots 100'+ Absorption field on lot 100,+ On adjacent lots 100'+ Public sewer main N/A Sewer /septic service line 25'+ Animal containment areas 50'+ Public sewer manhole/cleanout N/A Holding tank Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption Held 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots ** 100.79' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent Iota 100'+ F. COMMENTS "MEASURED FROM EDGE OF WELL ON LOT 24 TO *SEE ATTACHED WAIVER PACKAGE. EDGE OF PIPE ON LOT 23. SEE ATTACHED DRAWING G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspecams and review of Municipal 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 \"Llick 106 COSA Fees L/30 1- 176 K o sk Date of Payment :2 O ZO L Receipt Number 3 (Rev. 11/05) Waiver Fee s'NO.00 TaI7K Date of Payment Receipt Number 12/18/2006 11:34 9072432081 FRED WALATKA & ASSO PAGE 02 LOT 25 8308T LOT 20 N69"59'00"W 75.00 — — — c� tuF 20 20�— — — Shed Kennet Well LOT 24 C) 0 C; In 0 ;;I- CD 0 0 iA LOT 23 deck I Story Frame House 42.0 ro 10.7 •CO deck eOh . 15' Witty Easement Book 695, Page 956 N89.59'00"W 75.00 CD ofrE NEEDLES LOOP • tZ Gravel I Driveway CD 0 Teck 0 4 to 0 2 F' 0 � o 1o.t c 0 z 20 LOT 22 I SCALE: 1"=30' 20L -- Revised 12-18-2006, Added septic vent AS43UILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's Inspection ":'N of the following desenbed property- t OT 23. %yam aw DELUCIA SUBDIVISION p? �i "'•1 • �� Anchorage Recording Precinct, Alaska, and that time q hnprovernents situated thereon are within the property Ines do time lying �F;' and not overlap or encroach on property thereto, that no improvements on the lying .• .A a rr�l C: d�r}..� s: adjacent property J r?• P 1, t�}t �� C",c adjacent thereto encroach on the prerNses In question and ';A•'�� that there are no roadways, transmission Ines or other vislole easements on said property except as indicated harem ��' • Dated at Anchorage, Alaska EASEMENTS OF RECORD, OTHER THAN f Z —r e— OG this 12th day of Oecembe_L_;M THOSE SHOWN ON THE RECORDED Fb Wg pg 12-13 FRED A ry ASSOCIATES PLAT ARE NOT SHOWN HEREON. BE rs and Enginears and Surveyors (907-248•1668) `\ Municipality of Anchorage *84" Development Services DepartmentBuilding Safety Division `° On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 060594 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 23 of Delucia subdivision. This inspection revealed a nitrate concentration of 8.9 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS December 14, 2006 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Waiver Request and Certificate of On-site Systems Approval for Delucia S/D; Lot 23. The existing 3 bedroom house is served by a private well and septic system. We request you grant a 98 feet separation distance waiver from the well on the referenced property to the septic tank on referenced property. The following items are justification for the waivers: The lots are generally flat in the area with a slight slope away from the well head. The house is also between the well and septic system If the septic system was to overflow, it appears that the effluent would not travel toward the well head. The location of the septic system is in a very visible area so that if any effluent was to surface, it would be noticed and the problem corrected. The other path of contamination is subsurface migration wastewater should the tank begin to leak. As can be seen on the attached well logs, the static water levels range from 112-142 feet and well depths ranging from 130-440 feet. The silt, sand, clay, and hardpan soils above the aquifer have served to inhibit the migration of untreated wastewater into the aquifer. Recent water sample results indicated nitrate levels to be 8.86 mg/L and coliform bacteria results to be undetected. Attached are recent nitrate samples from the surrounding area that shows naturally high nitrates in the area. Based upon the aforementioned facts, it appears that there is minimal risk associated with granting the requested waiver. If you have aRy questions, please contact us at 337-6179. Thank you for your assistance. P.E., M.S. 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507-1259 Ph: (907) 337-6179 • Fax: (907) 338-3246' Website: www.gamessenginecring.com Municipality of Anchorage • �I l 1!0. IArx VMil:ill • .\nchumgc, .\hiska!tl6il4li:ill • Telephone eM)7) 343-KU)1 • Rix (!X)7 ):43$CMM) 471M BragawSlKrl •.\na horngq .\Intim!Y.6417 amiummLnrg Mayor Mark Begich I3uiklln� Safety Division December 21, 2006 Jeffrey Garness, P.E. Garness Engineering Group 3701 E. Tudor Road, Suite 101 Anchorage, AIS 99507 Subject: Waiver Request for Delucia, Lot 23 Waiver Request WR#: 060074 Parcel ID # 051-14142 IIA060594 Dear Jeffrey Garness, P.E.: Your request for a waiver of the required 100 feet horizontal separation from the septic tank to the private well has been approved. The approved separation distance is 98.0 feet. This waiver approval applies to the existing septic tank to private well separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Deb Wockenfuss Civil Engineer On -Site Water R Wastewater Program Community, Security, Prosperity Municipality of Anchorage Development Services Department +.r Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchoragc.ak.us (907)343-7904 Waiver Review Worksheet WR#:060074 PID#:051-141-42 HAIPermit# HA060594 Dale Received: December 21, 2006 Legal Description: Delucia, Lot 23 Engineer. Jeffrey Garness, P.E. Garness Engineering Group 3701 E. Tudor Road, Suite 101 Anchorage, AK 99507 Applicant Shannon and Jeri Tallant Waiver Requested: 98' from well to tank Criteria: Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Points: 7.1 2.1 1.4 2.9 2.9 Total: 16.4 rsomeone....MeDseDa..ossDae.mM ............................... moss...... ens Waiver Is Granted: X Waiver Is not Granted: List Conditions or Reasons for above: Date: 12/21106 By: Deb Wockenfuss Name of Reviewer sn.... moss..............................................Daemon... Mason.... Rec#: 34889 Amount: $M Dale Paid:12/2112006 Delucia, Lot 23 Parcel ID: 051-141-42 Waiver for 98 feet from septic tank to well Issued December 21, 2006 General 1. From the water sample, total colirorm was 0, and total nitrates was 8.86 mg/L. Wells on surrounding properties were found to have nitrates at 3 to 7.7 mg/L. 2. The well on the subject property was Installed on June 15, 1982 at a total depth of 136 feet. The well is cased to a depth of 136 feet. The well log for this property and other surrounding properties identifies numerous layers of clay with gravel and clay. 3. The existing septic tank on the subject property was installed June of 1982. The septic tank is steel construction. ADEC Criteria Points Water Table 7.1 Depth of water bearing zone in well 112 feet Assumed bottom of septic tank -10 feet 102 feet x = 1'(2/190) + 7.0 x =7.1 Soil Sorption 2.1 Soil descriptions from well log for subject property Overburden 0-2 feet Sand & Gravel 2-10 feet Clay & Gravel 10-18 feet sand & gravel 18-70 feet Fine sands w/ gravel 70-73 ft Sand & gravel w/ clay 73-90 ft Sand & gravel 90-95 ft Clay gravel & boulders 95-115 ft (25/102'4.5)+(74/102'1.3)+(3/102'2.3) Permeability 1.4 Soil descriptions from well log for subject property Overburden 0-2 feet Sand & Gravel 2-10 feet Clay & Gravel 10-18 feet sand & gravel 18-70 feet Fine sands w/ gravel 70-73 ft Sand & gravel w/ clay 73-90 ft Sand & gravel 90-95 ft Clay gravel & boulders 95-115 ft (25/102'2.5)+(74/102'1)+(3/102'1.2) Water Table Gradient 2.9 Subject area Is relatively flat Assume 0% slope Horizontal Separation 2.9 98 feet between septic tank and well x=23/25+2.0 x=2.9 Total Points 16.4 As per ADEC waiver guidelines a point value of 16.4 is almost sure to be free of any form of contamination from household sewage. DELLOCLA S�D. CSEPTIAAC�� AR EECD EXISTING SEPTIC TANK NEEDLES LOOP DELUCIA 5/D: \ LOT 25. 15' UTILITY EASEMENT DELUCIA S/D; LOT 20. DELUCIA S/D; . LOT 22. GARNESS ENGINEERING GROUP, Ltd: p;?`4 CONSULTANTS S GENERAL CONTRACTORS D"••'•• •.. • • ....... "•" XMI L TI000 IMA !IIIc 101 • M41ONO14 MI 00!01 h10MC 0101j11)i1H IN (007)11 " PREPARED FOR: PHONE NUMBER:PAGE NUMBER: ^•••••• •^••• JERI TALLANT 227-5275 (AGENT) 1 OF 1 p ;.1 f Y Garn ss: LEGAL DESCRIPTION: DRAWN BY: OQ�1'o,� E-79 : •`� DELUCIA SUBDIVISION; LOT 23 C.J.G. ��� , A. A.0 �ogv TYPE OF WORK: DATE: 44�OD\ SITE PLAN FOR WAIVER REQUEST 12/14/2006 (Rev. 0105) If EXISTING 3 BEDROOM 3 HOUSE / 1n // O U O U 15' UTILITY EASEMENT DELUCIA S/D; LOT 20. DELUCIA S/D; . LOT 22. GARNESS ENGINEERING GROUP, Ltd: p;?`4 CONSULTANTS S GENERAL CONTRACTORS D"••'•• •.. • • ....... "•" XMI L TI000 IMA !IIIc 101 • M41ONO14 MI 00!01 h10MC 0101j11)i1H IN (007)11 " PREPARED FOR: PHONE NUMBER:PAGE NUMBER: ^•••••• •^••• JERI TALLANT 227-5275 (AGENT) 1 OF 1 p ;.1 f Y Garn ss: LEGAL DESCRIPTION: DRAWN BY: OQ�1'o,� E-79 : •`� DELUCIA SUBDIVISION; LOT 23 C.J.G. ��� , A. A.0 �ogv TYPE OF WORK: DATE: 44�OD\ SITE PLAN FOR WAIVER REQUEST 12/14/2006 (Rev. 0105) Dee 19 06 11:25a December 19, 2006 Shannon and Jeri Tallant (Owners) 22575 Needles Loop Chuguak, AK. 99567 p.2 To whom this may concern, Subject to your agreement to indemnify the company as set forth below, GCI Cable Inc. of Alaska has no objection to the pre-existing septic system encroaching 4' into the 15' utility easement. of the south portion of Lot 23, Block 23, Delucia Subdivision. Known as (22575 Needles Loop, Chugiak, AK. 99567) in city grid # NW1259. This letter of non -objection in no way precludes GCI Cable from full use and enjoyment of any rights it may have within any portion of the utility casement and or the right-of- way, including unlimited access for servicing its facilities. Also any additional and extraordinary costs incurred during any future reyuircd construction, repair or reconstruction of GCI's facilities to accommodate any or all of the encroachments shall be paid by the property owner. By signing below, you agree to indemnify and hold GCI Cable harmless, now and forever, for any damage, costs, expense (including reasonable attorney's fees), liabilities and injury to any person or property occurring as a result of the encroachment. Please indicate your acceptance by signing and returning this letter to myself at the address below. If not signed and returned to GCI within 30 days of issuance, this letter of non-obiection becomes void for all intents and purposes. Sincerely, Rob Hansen CAD Operator Level I E -Mail- RHANSENIOGCI.COM Office # (907) 868-6168 Fax # (907) 868-8580 Property Owner/s signature (Void until signed by the Property Owner/s and returned.) Date 5151 Fairbanks Street • Anchorage, Alaska 99503 • 907 / 868-5600 DEC -18-O6 13:45 FROM-Pudential Jack White Eagle River 9076896499 T-984 P.002/002 F-954 JFN tu ENSTAR Natural Gas Company A DIVISION OF SEMCO M4ERGY Engineering Department 401 F. International Airport Road P. O. Box 190288 Anchorage, Alaska 99519-0288 (907) 334-7753 FAX (907) 334-7798 December 15, 2006 Gamess Engineering Group, Ltd. 3701 E. Tudor Road, Suite 101 Anchorage, Alaska 99507-1259 Re: Letter of Non -Objection : Grid:NW1259 To whom it may concern ENSTARNatural Gas Company has to objection to aseptic pipe encroachment into the Fitt= Feet (15ft) wide utility easement situated on Lot 23, Delucia Subdivision, according to Plat No. P-684, located within Section 9, Township 15 North, Range 1 West, Seward Meridian, Records of the Anchorage Recording District, Third Judicial District, State of Alaska. Acceptance and use of this letter of non -objection by yourself, your heirs, your assigns, or your successors, will constitute agreement to the following stipulations: M ISTAR will be held harmless, now and forever for any damages or injury to any person or property as a result of this variance. Any INSTAR facility damaged or destroyed, as a result of chis variance will be repaired at no cost to ENSTAR Any costs incurred by ENSTAR for special construction necessitated by this variance will be borne by the property owner. All applicable safety code regulations will be observed and maintained. • This leper of non-objecdon will in no way preclude ETSTAR from full use and enjoyment of its rights within any portion of its right-of-way. SiaCetelyG,���%� Andrew Fraiser Right -of -Way Assistant ENSTAR Natural Gas Company cc:. File Dec 18 2006 11:48AM HP LASERJET FAX M T/A NON -OBJECTION TO EASEMENT ENCROACHMENT DOCUIIF.NT P.2 By this document Matanuska Telephone Association, Inc. (MTA) declares that it has no objection to the encroachment of a Peptic system within the platted 15' Utility Easement located along the south property line upon Lot 23, Delucia Subdivision, Anchorage Recording District, Third Judicial District, State of Alaska, situated in Section 9, T15N, RIW, S.M.' •#rtittt#t#ttttrttlttt+t#ttt#tlttf#!#!ti!!###1Mttk##!!#tt!#!!#!!#!!##4!!F#lltit!#t!!#tlttrti Please be advised that MTA through the issuance of this document does not forfeit any of its rights to the use of the area cited. In the exercise of these rights MTA will, if needed, upgrade, maintain, repair, and/or replace buried or aerial telecommunications facilities within the easement. Any repairs that may be required to the encroachment as a result of utility construction will be borne by the property owner of record. This document does not authorize the placement of any additional encroachments within the easement area. Property owners are required to obtain utility locates before doing any kind of work in the utility easements and will be liable for any damages caused by their construction work in the easements. This document is. in no waon of the utility easement and should not be intcmreted as such. Issued for Matanuska Telephone Association, Inc. this 18th day of December, 2006, by, A_1� - , Real Estate &: Properties Supervisor THis Is TO CeRTtm that on this 18th day of December, 2006, before me the undersigned, a Notary Public in and for the State of Alaska, duly commissioned and sworn as such, personally appeared Bonnie Bailey known to me and to me known to be the individual named in and who executed the foregoing instrument and acknowledged to me that he signed and sealed the same as a voluntary act and deed for the uses and purposes therein mentioned. IN ', I have hereunto set my hand and official seal the day and year first above written. GRANTOR: Matanuska Telephone Association, Inc. P.O. Box 3550 MRilfa?ie �lap�r+vAawolatten Int. P.O. Box 3550 Palmer. Alaska 99645.3550 800.748.9510 907.761.2510 007.761.2646 (fax) www.mta soluttons.com Notary P lie ' a d for My co issio xpires: Loos Long Distance Wireless Bush»aa Soludom Inteme Director, OT Municipality of Anchorage O Development Services Department • Building Safety Division _ On -Site Water and Wastewater Program 4700 South Bragaw St P.O. Box 196650 Anchorage, AK 99519.5650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-14-142 HAA# !YA /0) J O O O 1 Expiration Date: - - -a - O -,:2- 1. GENERAL INFORMATION Complete legal description Lot 23: Delucia Subdivision Location (site address ordirections) 22575 Needels Loon, Chueiak Current Property cwner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Nancy Stahl Day phone Day phone Day phone 688-8500 PO Box 671923 Chueiak, AK 99567 Unless otherwise requested, HAA will be held by DSD for pickup. 7&2. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storace Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: YTtI Individual On-site E-3 ❑ Individual Hclding tank ❑ ❑ Ccmmurity Or, -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 Aoproval are valid for 90 days from the date of issue for properties served by a private or Class C we!I and may be reissued with new water sample results. (Certificates may be reissued for a period of up to cre year with valid water samples.) Certificates are valid for one year for properties served by Class A or B we!ls or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional encine&s work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S & S Encineeri Phone 694-2979 Address 17034 N. Eagle River Loop Ste 204 Eagle River Engineers Printed Name Robert C. Cowan Date 5. DSD SIGNATURE +C Approved for bedreoms. Disapproved. AK 99577 RCSIRT C. CC"/1N ti tc,a Cc --03111 'I Conditional approval for bedrooms, with the following stipulations: "( OF e; 1��ii� �'� yVNI CR nlvv I C F1f(JAIER PROGRAM F Additional Comments JJJ'�i t�C. •' ` rjptc- The aa•nll forth nnrrta• mnrh rrictina State nn rt n(nnicipal (' rlrc lberegre nitrgtes present. It is suggested that periodic testing be performed to insure the wells continued suitability. Current nitrate nee s 5 i lorc information on nitrates is available from the On -Site Services Profzram at 3.43-7904. Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: 2� / llJ 1 Odainal Certificate Date: /— -2- ` 3 (Rw. 011M Municipality of Anchorage *A. Development Services Department Building SafetyDivisionOnSRe Water 6 Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519 WSO www.cI.anehorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: GI/,1- ? Parcel ID: OSl' IgL4Z A. WELL DATA Well type / If A, B, or C provide PWSID # = Weil Log (YIN) y Date completed {/3/B0- Sanitary seal (YM) `f Wres properly protected (YIN) Total depth L32 -ft- Cased to A21ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test / SZ'62- / L if L3©d2 Static water level 1/ t ft I r 9 ft Well production ✓r a g.p.m. 2' 9 P.M. WATER SAMPLE RESULTS: Coilform _�colonies/100 mQCi. Nitrate � mgJl. / Other bacteria colonies/100 mi. a s EIRINO Arsenic: mg.A. Date of sample: /Q A/o2 Collected b : IMM r.9y. !! y »p�==wcleeRRosd N0.' B. SEPTICIHOLDING TANK DATA/ go& Rivwr. Alaska 09577 Tank Type/Material �/G / Date installed Tank size 100Number of Compartments Cleanoute (YIN) Y Foundation cleanout (YM) Y Depression over tank (YM) X� High water alarm (YIN) Date of pumping Pumper C. ABSORPTION' FIELD DATA Date installed I / Soil raUng (g.p.d.W or fefbdrm) LZ,5' System type % .e.&�J a Fs< Length 3 / ft. Width • 7 fL Gravel below pipe ft Total depth Lx Eff. absorption area 7.o`+'fe Monitoring tube Depression over field til Date of adequacy test Z 21 07i Results (Pass/Faiq / 49S6 For —3 bedrooms Fluid depth in absorption field before test in. Water added 6)d gal. New depth 10 in. Elapsed Time: 6 min. Final fluid depth .LL in. Absorption rate >= -40 ! g.p.d. Any rejuvenation treatment (past 12 mo.) (YM 8 type) *J If yes, give date D. LIFT STATION Date installed R 'Pump on' level at in. Datum E. SEPARATION DISTANCES Size in gallons Manhole/Access (YM) _ _ 'Pump off' level at _ in. High water alarm level at in. Cycles tested Meets alarm 3 circuit regwrements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/In on lot /Cc � Absorption field on lot IOID �-f- Public sewer main N /fi � r S� /septic service line V_' I," On adjacent lots On adjacent lots 00 rr- )00 10 Public sewer manholetcleanout N 1A Hokfing tank Al SEPARATION DISTANCES FROM SEPTICI1H,0615 (at -TANK ON LOT TO. Building foundation 5 t Property Ane 5 r� Absorption field S I Water main Water service line / O '-- Surface water r Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: I Property line t' d -A- Building foundation rf Water main wJ A Water Service line �� •i rSurface water /l� /{ Ddveway, parkmgNeMde storage Curtain drain/ n!0 rJ ^r Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I cerW that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines In effect on this date. Engineer's Printed Name Datei- HAA Fee s 3 7 S- e J Waiver Fee $ _ Date of Payment t � / 31 /O •Z Date of Payment Receipt Number t7 a 9 r:s- / Receipt Number (Rev. 12101) ?�,3 NDdFA �.. lta�tY4.. • , �I �b � / 11 -DB 02 11:ST FROM-CTiE ENVIROMENTAL SRV CUE Environmental Services Inc. Cf&E Rcf.N Cilent Name Project Namel# Client Sample TD Maul% rwsID Sample Remarks 1027396001 S & S Engineering Lot 23. Delucia SID Lot 23, Dclucia S/D Drinking Vater 0 9075615301 7-676 P.02/03 F-094 All Dates/flmes are Alaska Standard Time Printed Date/flme 11/08/2002 11:44 Collected Date/time 10/30/2002 14:30 Received Date/time 10/30/2002 16:00 Technical Director Stephen C. Ede Released By -- Allowable Prep Analysis Ymameter Results PQL Units Method Limits Date Date Init Waters Department Nitrate -N 9.58 3.00 me/L EPA 300.0 (<-10) Microbiology Laboratory Total Coliform 0 col/IOOmI. SMIS 9222B (<=1) 11106/02 3S 10/30102 KAP j— , <pco 1 11 hereby ces{W - Dated at IL.VIj a- im. SCALE: f J., -PREM11NoP hat - f -have 3 r lesuott sna mat.1hare, are es a- other visible eased as bidicatea bqreor,� yr JA And Sursigor No'. -880-is r1a RIver, juaska, - 5¢8:;C [ 7.r 1.4 f I,: t 1 . 1 It t t L 7 z11 011P o,l I 3 fJ er 41 d:. a A11 vrork sholl bo dorso Own on C)PrcNkr[ plans Ond Z' I 'A f j plot, , ;Jcct;- m -110t -be "ci)"noe w ons It -'or. J,z f 4 j., j— , <pco 1 11 hereby ces{W - Dated at IL.VIj a- im. SCALE: f J., -PREM11NoP hat - f -have 3 r lesuott sna mat.1hare, are es a- other visible eased as bidicatea bqreor,� yr JA And Sursigor No'. -880-is r1a RIver, juaska, - 5¢8:;C [ !/ MUNICIPALITY OF ANCHORAGE �LG[lvtn B y O DEPARTMENT of HEALTH b HUMAN SERVICES Division of Environmental Services INM On Site Services Section P -. /,I P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 051-141-4 1. GENERAL INFORMATION Complete legal description Lot 23, Delucia S/D HAA# VAQ95C_'131. Location (site address or directions) 22575 Needels Loon Property owner Mailing address Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 i 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water Day phone ('�' �' " �" F'31 v,�/_ (�� �t`ISG 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: XXX 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-MM..1/21) Fm MOA621 S. 6. 0 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. l furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm -- S 8 S ENGINEERING Phone 6 q y - -;L`t - % 17034 Eagle River Loop Road No. 204 Address Cad—D:--- AI-J._e,n 111 Engineer's signature DHHS SIGNATURE Approved for _1 E bedrooms. Disapproved. Date -:!; / I s -/C, 9 OF P RCEER7 C. COWAN CE-8soi Conditional approval for bedrooms, with the following stipulations: Note: The well for this property meets existing State and Municipal Codes. --- --- ------ - performed to insure the wells continued suitability. Current nitrate More information on nitrates is available from the On-site Services Program, 811115 343-4744 Additional Comments A/. Date - %- I er The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and theirlending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate Is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-M(w. 1411) ori MOA RI XECEIVED e Municipality, of Anchorage JUL 15 1999 DEPARTMENT OF HEALTH & HUMAN SERVI 6Aun, of AWHOM Environmental Services Division ENVIIIONVINIALSERVICES DIv 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: Lal;L5 AdLLX.h A: 5A Parcel I.D.: 05'1 -)41-1" A. WELL DATA Well type ?9AVkTf, If A, B, or C, attach ADEC letter. ADEC water system number 4 Log presen (Y ) 4j Date completed G - I S - b ti Total depth t'� b I Cased to 1-SLCasing height (above ground) .23" Sanitary seal (9N) V Wires properly protected &N) �[ FROM WELL LOG AT INSPECTION Date of test r Static water level Well production '�V g.p.m. I. / g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate 9, Sto Other bacteria—2 Date of sample: -I- I - 1�9 Collected by: S 4 S el�� R . B. SEPTIClHOLDING TANK DATA Date installed `- 82' Tank size (00t7 Number of Compartments 2- Cleanouts&N)4- Foundation deanotd 6'/N) N Depression (Ydb 13 High water alarm (YM) Date of Pumping Pumper Sa-� -racy_ C. ABSORPTION FIELD DATA Date installed '87, Soil rating (g.p.dJft' or ft°/bdnn) /aI � System We 7X6 e N Length 31 Width Gravel thickness below pipe '7' Total depth //. S - /J, v Effective absorption area Monitoring Tube present&N)-�to Depression over field I� Date of adequacy test I -1r-99 Resuitsai&-pD ail) y � For 3 _bedrooms Fluid depth in absorption field before test (in.); D " Immediately atter �°gal. water added (in.): D Fluid depth 0 64_ (ins) Minutes later. D Absorption rate = 'ySD t a.p.d. Peroxide treatment (past 12 Months) (YM) A414 9-k&d If yes, give date 4w 72-028 (Rev. 3198)• D. UFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES Size in gallons "Pump on" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 1001 �S `� 6J EJF.y, On adjacent lots lov `r Absorption field on lot _ IBJ On adjacent lots lob 34 Public sewer main Ap.1 Public sewer manhole/cleanout ~ A Sewer /septic service line 2S� Litt station too la SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation I;:-%�- Property line _ to Or Absorption field S 1 Water main/service line low Surface water/drainage 100 k Wells on adjacent lots Im I} SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1•D i Building foundation 'ID iF Water main/servics line b t F Surface water loco d Driveway, parking/vehicle storage area Curtain drain n( o^f f, .1 Wells on adjacent lots l0, 1 F. ENGINEER'S CERTIFICATION I ceRlfy Mat 1 have defemrined thru field Inspections and review of Municipal records vdl are In oanlormance-�i}q g7idnas in effect on this date. L/ Signature t. -- kit 1 Engineer's Name d.d f A.T �a w�/r•-- �' ... •.. ......,,.:�",'t;,- ' i0 RORIR C COWAN r J Data — 7 CE - 8801 & - HAA Fee Date of Payment lis f Receipt Number © ro ev LO 72-026 (Rev. 3196)' Waiver Fee $ Data of Payment Receipt Number N r C r r r� n J 0 00 I ji Un J 0. r1P i 1 CA Q1 r m �wQ�P (Ax�HN N b f 2 z LA n 4 -t e S °1 a J Al m z - >} 1 , I j 1N•J�% �, co dOI 1 in ' b m u r u c 0 o m. r p S /fnr o r (A n rl i Y t 1 Ln (11 r 0. r1P i 1 CA Q1 r m �wQ�P (Ax�HN N b f 2 z LA n 4 -t e S °1 a J Al m z - >} MUNICIPALITY OF ANCHORAGE • " DEPARTMENT OF HEALTH & HUMAN SERVICES �t 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 �7 Parcel I.D. # 051— I Li (— 9 Z HAA # 1. GENERAL INFORMATION Complete legal description L.4 a Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 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 .V/ 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. 72-0251Pn.1911 From MOA121 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. l furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 1060 -rlt JP UY.k L0._u_R L Phone7q Address Engineer's signature ,} 6. DHHS SIGNATURE M Approved for ZL02(7bedrooms. Disapproved. Conditional approval for Date t t I t d') 2- bedrooms, with the following stipulations: Additional Comments 1,e-. vjzt= S_ State and Municipal Codes. There are nitrates present. It is is continued suitability. Nitrate concentration is 6.7 mg/1. EPA Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-0250-1/9t) Beck MOA121 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: T oL.1e�lt C2A `+L S/y Parcel I.D. 051— 1L11— Y2— A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number ' y Log present (Y/N) \ Date completed 10/LE ZBA Driller t='awl Total depth f 3 i0 Cased to ( 3 % Casing height Sanitary seal (Y/N) .. Wires properly protected (Y/N) AT INSPECTION FROM WELL LOG Date of test '-7' Static water level Well flow Pump level 5 g•p•m• ao �� 9+1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 10-0 AT INSPECTION il�iziq� ► o2 - _1 �.9 g.p.m. SC c ' A o 00 m g On adjacent lots Absorption field on lot 115 ; On adjacent lots % i &CD Public sewer main Nile Public sewer manhole/cleanout K/A Sewer service line > 50 Petroleum tank N fl WATER SAMPLE RESULTS: Coliform10 —Nitrate �• / Other bacteria, Date of sample: NO,/ 16 { M12- Collected by: e �_'e a44 B. SEPTIC/HOLDING TANK DATA Date Installed L • i Z - 9 t —Tank size Compartments 'Z Cleanouts (Y/N) Foundation cleanout (Y/N) y ✓ Depression (Y/N) High water alarm (Y/N) NZA Alarm tested (Y/N) Date of pumping Z Pumper I K rs SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I f -y On adjacent lots ;! / 012 Foundation Topropertyline 8 ± Absorption field Water main/service line b Surface water/drainage I 72.026 (Rev. 7/9 1) From CONTINUED ON BACK PAGE C. LIFT STATION Date Installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Manufacturer Manhole/Access (Y/N) "Pump off" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Cycles tested Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed �O��7-1 2 Soil rating�� / System type Length 3 I — Width b Gravel thickness--% . Total depth 2 Total absorption area - W 3 y Cleanouts present (Y/N) j Depression over field (Y/N) �` Date of adequacy test I t I 1 L J '12,_ Results (pass/fail) for 3 bedrooms Peroxide treatment (past iz months) (Y/N) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot % On adjacent lots �[Se� r Propertyline 10 To building foundation 4 To existing or abandoned system on lot - N1,4 On adjacent lots - Z d Cutbank _K o m Watermain/service line 5'D Surface water NA o N -P Driveway, parking/vehicle storage area l �7 Curtain drain I C> E. ENGINEER'S CERTIFICATION I certify that l have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name t u rl�t 0� 7 , Date �o ✓ (� 1 c; HAA Fee $ Waiver Fee: S Date of Payment Date of Payment Receipt Number i�o7 Receipt Number 72-M )Hw. 3/91) BaCk MOA 21 - _.. l r"4f MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH D� CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 3 _2-7—e7 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) t I- '3 %/5".1% ,2/a1 SEG 9 Location (address or directions) IEP�tCS 7.P.Ci/s16 rid �' (b) Applicant Name A"e• I - t e"I1,A64 Telephone: Home Business Z7G -SS%f Applicant Address /"o eek /a/ozo 7x -/o (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder: Buyer ❑ : Other ❑ (explain); (d) Lending Institution; Telephone Address (e) Real Estate Company and Agent Ir/tz'sT.✓ /(/fJ LdrGiro7T/ Address Telephon (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Note:lf community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite( Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-023 111,841 Page 1 of 2 Z z3 tccael,4 5. ENGINEERING FIRM PROVIDe-"�i INSPECTIONS, TESTS, FILE SEARCH, [^A AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verity that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. l 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. d� / Name of Firm /%ref Telephone s�'y'SGyo Address Date .3-27-917 SF,07ie 7;V,< cr4&jaA ,m7- LsC.9Te� /,1j&r7A s,7/ 4. Jdl--Al 6. DHEP APPROVAL 44 453 bedrooms by fgr � A' """ Date Disapproved Conditional Approved for Approved _ i EyYTax1tE� .A 011" Terms of Conditional Approval CAUTION 3 -z -;L -W7 The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending Institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. Page 2 of 2 72-025 n van ALASKA CII �OMMAL COnTROL SER. %ES, InC. Enginerrinq & Enuironmenlal Studies 03/26/87 KIM WILMOTH SELLER—AK HOUSING FINANCE KIM WILMOTH 14ARSTON REAL ESTATE MARSTON REAL ESTATE 2804 W NORTHERN LIGHTS BLVD 2804 W NORTHERN LIGHTS BLVD ANCHORAGE AK 99517 ANCHkkGE AK 99517 tAv/,R EZO Op l '�`MlA,r � PRp d 70042 nerc In9� LEGAL:DELUCIA SUBDIVISION LOT 23 " ADEQUACY TEST FOR SEWER SYSTEM r ADEQUACY TEST DATE -03/10/87 THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 434 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 764 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON 03/11/87 . THIS REPORT DOES NOT VERIFY THE INTEGRITY OF THE PIPING FOR THE WATER SUPPLY OR WASTEWATER SYSTEM. FLOW TEST ON WELL WELL FLOW DATE -03/10/87 A FLOW TEST WAS PERFORMED ON THE WELL. 764 GALLONS OF WATER WAS PUMPED AT A RATE OF 3.18 CPM OVER A DURATION OF 4 HOURS. THE DRAWDOWN WAS 16.9 a WITH A RECOVERY TIME OF 60 MINUTES AND THE STATIC WATER LEVEL WAS 112.1 FEET. THE WELL IS ADEQUATE FOR THIS 3 BEDROOM NOME. A4 4 T C REID, JR -2251 ....... - plDiCSS160N 1200 IUesl 33rd Auenue. Suite B • Anehoroge. Alaska 99503 •(901) 5615040 1 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the Stale Department of Environmental Conservation attesting to the legality and status. A... SEWAGE DISPOSAL Onsite• Public E3 Community 13 Holding Tank 13 1.Note_; tf community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025111,64) Page 1 of 2 i MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) S 9 Lo Z3 /zrLi,CiA 75.1 iticl Location (address or directions) t<' J�Dces s�:' 'AA441.fx (b) 'Applicant Name �,l.1,s�Jh Telephone: Home Business i7G , Applicant Address one) -Lending Institution ❑ ; Owner/builder Buyer ❑ ; Other ❑ (explain); (c) Applicant is (check (d) Lending Institution Telephone Address c.,Lsc-,-� .em, a//GNori/ !+ (e) Real Estate Company and Agent su ^ Address - Telephone�— (f) Mail the HA to t/e jgllowiog� ids: �� , ` 2. TYPE OF RESIDENCE Single -Family Multi -Family❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the Stale Department of Environmental Conservation attesting to the legality and status. A... SEWAGE DISPOSAL Onsite• Public E3 Community 13 Holding Tank 13 1.Note_; tf community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025111,64) Page 1 of 2 i L L 3 ) E a/.J 5. ENGINEERING FIRM PROVIDII. NSPECTIONS, TESTS, FILE SEARCH, D. AND INFORMATION 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 shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address /Z_ -V cJ Date _ S Telephone /h/g- SLI/7Z— H 3-/3—Y7 &;t/b/T..W,04- T zoe4t �' zd�' er-&*/Kr /.✓ J' pr'4 ?:fs/.e /,r/ 7/Qir/G /f J-7. SZ. /-Sd"Id /tea✓ /ix' 9Sso 3 6. DHEP APPROVAL Approved for bedrooms by Date-? 7 - Approved Disapproved Conditional 'V Terms of Conditional Approval TRE A/3nvE AfAri/o.v£D COA/O/T/ON If POHPLfrED g, - XU 1 Y YTu1Y /r, /987 CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025(11/84) n n MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) nitoix IECKLIST - FEBRUARY 1984 f , sID INS 2844720, UpµStj, •09 Legal Description: "7-70 �Ecue/A taor Ilk, 'r/st/ z/cJ see -9 A. WELL DATA NvS-1 `O � Well Classification `` If A. B, C, D.E.C. Approved (Y/N) Well Log Present 6NN) Date Completed G -15 _ILL Yield ®3.18 E'AN Total Depth Cased to Depth of Grouting r✓l,4 ' Static Water Level Pump Set At A A i Casing Height Above Ground — 2 Sanitary Seal on Casing) Electrical Wiring in Conduit(!Y N) Se a'tion Distances from Well Depression Around Wellhead (Y© Par / r To Septic/Holding Tank on Lot �� ; On Adjoining Lots To Nearest Edge of Absorption Field on Lo On Adjoining Lots • To Nearest Public Sewer Line N A To Nearest Public Sewer Cleanout/Manhole ^ To Nearest Sewer Service Line on Lot ZS Water Sample Collected by �QfGi /Q, L 1/6✓ ; Date Water Sample Test Results _Xrovs 7O '� Comments 00 G✓C1L "'K -J r 3-/0-87' '9demuArx" B. SEPTIC/HOLDING TANK DATA Date Installed 61 -1Z -YY Size /"_0 No. of Compartments L Standpipes) W 44,1/*e0'r5 Air -tight Caps) Foundation Cleanou6N) Date Last Pumped '� /L 8 7 Depression over Tank (Y© P Pumping/Maintenance Contract on File (Y/N)I '✓jA : for Holding Tank High -Water Alarm (Y/N) � Temporary Holding Tank Permit (Y/N) 6eZ14 Separation Distances from Septic/Holding Tank: r To Water -Supply Well �� / To Building Foundation ?T�o $ 7 To Property Line.. �� To Disposal Field To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage r Course Comments ,ftlzl sle ez&AW✓ r "e,#-rAh. eilJi77n1,#G '70 "e/Pro ZO eZa7h✓r r /'✓ 1Fkidb 7687• Page 1 of 2 72-026(11184) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata SYS T T£E✓�i� ype of System Design Date Installed /L"fy' Length of Field Width of Field/ S Z Depth Of Field � 7b / / Gravel Bed Thickness i Square Feet of Absorption Area Standpipes Present) Depression over Field (Y( Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well /� r y To Property Line /0 To Building Foundation Lot To Water Main/Service Line /o To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Ins Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) _ Comments To Existing or Abandoned System on i On Adjoining Lots /S '71' To Cutbank (if present)l✓fi'4 I Dimensions Manhole/Access(Y/N) 'Pump Off' Level at Check Permitted Bedroom Rating Against HAA Request " Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I h v h ked, erified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date nr Company %�G3 MOA No. 86 -4) Z_ Receipt No. Z O ( 00 31 Date of Paymentl��g Amount: $ Page 2 012 Z. 72.026 (11,84) ALASKA ENVIRONMENTAL ,OB Lai- • CONTROL SERVICFr--, INC. BNEET NO. OF 1200 ONCHORAGEaB ALASKA 99503 A CALCULATED BY DATE (907) 561.5040 CHECKED BY DATE APPLK 'NT FILLS OUT UPPER HAL .ONLY Phone ProprpY Owner p (.t.SF✓ `\,q Time Mailing Address---:) Z Z,<-- f1 Zip Code ) C� O 7 Buyer Time Address -.,i Zip Code Lending InstitutionGc./� V Ci✓Q'>•'L. r Phone / (7FNZip Code -7 f / Inspector Address Inspector Phone Realty Co. d Agent Address Zip Code Field Notes: �D .J. Legal Description Street Location NC CC E 4 Type of Residence X Single Family OMultiple Family No. of Bedroom ❑ Other ( )APPROVED BEDROOMS -CONDITIONS OF APPROVAL Water Supply X Individual well log Is required for all wells drilled since June 1975. =wellsMdrilledtog If ❑ Community that date, give well depth (attach available). ❑ Public Utility Sewer Disposal >sT Individual Year Individual Installed: / / 2, ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank Well To Absorption Area too NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Septic Tank Size 1,0 0 O NvD7tad'9w �—�' l3 Time Time Time Time Date Date Date Date Inspector — Inspector Inspector Inspector P Hv o` Field Notes: �D .J. ( )APPROVED BEDROOMS -CONDITIONS OF APPROVAL ( ) DISAPPROVED /��` ( ) CONDITIONAL APPROVAL' V DATE BY: �--- Soils Rating Date Sewer Installed Well To Absorption Area too Well Lop Received s Septic Tank Size 1,0 0 O G _ 8 -Y Well to Tank hometek SR 2, Box 5974 Chugiak, AK, 99567 Phi 688-2052 municipality of Anchorage Dept. of Health and Environmental Protection Fouch 6-650 Anchorage, AK 99502 MUNICIPALITY OF ANCHORAGE prcr C' :' .,t , e ENVIR J.:..J..?....J. :1—TION r, IU33 RECEIVED February 3, 1982 REt Septic system location Lot 23, Delucia Subdivision. Dear D'.r. Roberts, In your letter dtd January 18th you cited the problem of the septic system for Lot 23 being located underneath a driveway. The subject property is a corner lot permitting driveway access from either the front or the side of the property (assessors map attached). At the time of your inspection access from the front existed but only as a temporary route for the construction process. I have attached a site plan diagramming the location of the driveway as it will exist when final landscaping is completed after spring thaw. Also attached is a copy of the preliminary survey approved by Planning and Zoning dated July 8th substantiating that the driveway design was conceived prior to commencement of any site work. As shown, the final driveway alignment will eliminate any intersection of driveway and drain field. On the basis of this clarification I hope no further discrepancies exist and a final approval can be issued. Thank you for your time and assistance in this matter. erely Donald A. Bray ALASKA If�011 nTAL COnTROL SCI DICES, IX Englneerinq 6 Enuironmenlal Sidles January 31, 1983 Municipality of Anchorage DREP Pouch 6-650 Anchorage, Alaska 99502-0650 Attn: Jim Roberts Dear Jim: MUNICIPALITY OF_ANCHORAGE Cr ni C, ,;;33 RECEIVED The sewer system on -Lot 23,-Delucia Subdivision is buried about 5 feet deep at the eastern end. If the homeowner is going to have his driveway over the system then several things will be needed. 1. I recommend that someone install a metal post to protect the cleanout from drainage. A 3 to 4 inch diameter steel pipe filled with concrete will be adequate. 2. Because frost penetration under a drive can approach 7-8 feet I would recommend that 3 inches of extruded styrofoam board insulation be installed under the drive. The insulation should be placed within a foot of the top of the system and be at least 2 feet wide. It should extend beyond the driveway and axially to the sewer system a distance of at least 5 feet. If these calculations are met then there is a reasonable assurance that the system will not fail because of freezing. Sincerely, Ler y CAR Jr., J/P President 1200 Wesl 33rd Auenue, Suite 6 • Anchorage. Alaska 99503 • (907) 2761361 • � yz�f z r i l \ DR�Y�YlkY pAt21.�N� �• IU'