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Home My WebLink AboutCURRIN LT 2Currin Lot 2 #017-341-17 Development Services Department Property Owner Name & Address: gCc'4'C ell'kQ('"6 5000 CurrlK Clr, Building Safety Division On -Site Water &Wastewater Program Pump Manufacturer's Name: �Y '4/ e_ De, 4A al 4700 Elmore Rood W � z - :.- P.O. Box 196650 Mark Begich Anchorage, AK 99507 s A €PTY, Mayor www.muni o /onsite (907) 343-7904 Pump Installation Log Well Drilling Permit Number: SW_ Date of Issue• 1-13-16 Parcel Identification Number: Legal Description CvVV'Lk L 2 Property Owner Name & Address: gCc'4'C ell'kQ('"6 5000 CurrlK Clr, Pump Installation Date: /_/3-& Pump Intake Depth Below Top of Well Casing: 2(,,) feet Pump Manufacturer's Name: �Y '4/ e_ De, 4A al Pump Model: A y,,K 7,r F 3 Pump Size 1?/V hp Pitless Adapter Burial Depth: feet Pitless Adapter Manufacturer's Name:,4//i Pitless Adapter Installer: - Well Disinfected Upon Completion? Yes ❑ No Method of Disinfection: t"'j 2 Comments: Pump Installer Name: vtyr y fvcc < ( ANCHORAGE WELL &PUMP SERV. 330 EAST 76TH AVENUE ANCHORAGE, AK 99518 AWPS.COM PHONE: 907-243-0740 Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Municipality of Anchorage Page I of �— 1 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 5 W q 50 a 9 a PID Number: 017 3`1117 Name: Cl.a¢,Aa 7'Ar,,,ay %osT Wastewater System: ;lNew ❑ Upgrade Y Address: 1�00i xwA-rq AA,cdo,e46,F Ak. g957(o ABSORPTION FIELD Phone: 34 5 - Jl•f S No. of Bedrooms: Lf X Deep Trench E3Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION s°II Rating: Totel Depth from original grade: de: Total a GPD/ Ft Lot: Block: SuS10I 12oR Depth to pipe bottom from original grade: Gravel depth beneath pipe J 1►�1 L3• S FI. 6. S Ft. Township: Range: ,� Section: Fill added above original grade: Gravel length: — 2 Ft. 40 Ft. WELL: ❑New ❑ Upgrade •Lxis-r,w6 p9 Gravel width: =•5 Number oflines: t DistancebeMeentines: Ft. Ft. Classification (Private, A,e,C): Total Depth: Cased To: Total absorption area: Pipe material: ASTmA -p PC IV AtTC Ft. I Ft. S-ZO SO Ft, F810 D4034 Driller.. Date Dri Static Water Level: Installer. 0NS7-. Date installed: 11-30-95 F(, Yield: tamp Sol at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES aseptic 0 Holding ❑ S.T.E.P. To septic Absorption Ult Holdup ubIlNPrwate Manufacturer./ 62GmTi Capacity In gallons: I1250 From Tank Field Stallon Tank Sa-er Linea Welt' 115' 1x91 --� ,� .l5'i Material: STS 6>L Number of Compartments: a sural ;e loo'+ loo'+ — -- — LIFT STATION Lot(b,+ '+ Size In gallons: Manufacturer. Line 10 " - Foundation 49' so' "Pump on' level at: "Pump off" level at: 1gh water alarm at: Curtain Now Pump Maks Electrical Inspections performed by: Drain BENCH MARK Remarks: Location and Description: aoTTer+, or SrDIe+G �1 CrOQN1E� e v. — la IRbw fa of WALL Assumed Elevation: 100.0 Nl� J?•r••. �• .,•�s�-1�flt % . :»«-P ��%!7•• S d. S ENGINEERING' 7034 Eagle River Loop Road,No,a1Q� 11-Oo•QS r Inspections performed Dates: 1st S � a t 2nd II -00-95 !ri ROBERT C. COWAN•• araC r<,` CE -8801 4 ++tJ�� 3rd.ly-z�-mss .f , Department of Hea th and u Services�appsgg ..• �� ,,, Itj PP � t_;t6''. Reviewed and approved b : 1 ^ Date: 72-013 (Ray. 0.191( MOA 25 coq Permit No. SW950292 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LOT 2, CURRIN SUBDIVISION 01734117 PID No_ 12-010 A (R.. PN,) MOA 25 STI S72 99.2' FINAL C LADE CO 98.0' NEW 93. ' 1250 GA 930, _ INS TION S.T. . ;: h{I :�I,�AC03 =ii92.T SR o - ♦ 82.4' NO WATER FOUND 90. 0 5 . A FCO 7' ST1 50' 10 'WELL RA L IUS co1 64' 91' CO2 68' 92' WELL CO3 86' 96' ' C04 104' d,Q NEW TRE CH MT1 102' 9 ' I �pN W. coh i Z i 0 L & .03 r �•.• y •/r- 17 sn C0' NEN 1250 GAL ROBERT C. S PTIC TANK /� �,t• �CE•880101 fa•��' ..•••'+C .� SCALE C - 4++ylf9-•-•� 12-010 A (R.. PN,) MOA 25 (/ \ S & S` ROBERTC.COWAN. PE. E IGtneeizinG ROBERTA.SHAFER,PE. +iaT CML ENGINEERS (907)694-2979 FAX 907) 694-1211 Date: RECEIVED "E"""A" HORIT" APPROVALS FEB 2 6 1996 MUnICIpallly of Anchorage Oept. Health & Human Services Municipality of Anchorage SEWERILWATER DEPARTMENT OF HEALTH AND HUMAN SERVICES MMNE%TENSOIS 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 SEWERBWATER ISPECTON REFERENCE: L� 4 Z ENGINEERINGSTUDIES MOREPORTS The septic inspections for the referenced p p property were performed on ll -2 -o -1S and Prior to submitting the On-site Wastewater Disposal System and/or Well Inspection Report we are waiting for the Cors74.cr,.,j IC FI -44 GR1 I% be WEU ION SFEOWTEST� completed. If we may be of further service please contact us. SITEPLANS Sincerely, al -/all ROAD DESIGN Robert C. Cowan, P.E. 500. TEST PERCIXATON TEST STRUCTURAL S MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 1 I X %blu Sem ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT 1v an-i'� PERMIT NUMBER:SW950292 DATE ISSUED: 9/26/95 DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE: 9/26/96 OWNER NAME:CURRIN FAMILY TRUST OWNER ADDRESS:12801 KEATA ANCHORAGE, AK 99516 PARCEL ID:01734117 LEGAL DESCRIPTION: CURRIN LT 2 LOT SIZE: 51916 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL RECEIVED ISSUED BY DATECl /.2 7 Arj • n DATE • �- S& �....R�iiiiifl SEWER& WATER MAINOMNSIONS SEWER& WATER INSPECTION ENGINEERINGSTUOIES ANDREPORTS WELLINSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECKANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN September 13, 1995 ROBERTC.COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907)694-2979 FAX(907)694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AR. 99519 REFERENCE: Lot 2, Currin S/D Request you issue a permit to install a septic system to serve the proposed four bedroom house on the referenced property. Two test holes were excavated and percolation tests performed. The approximate location of the test holes are located on the attached site plan. At the time of excavation no water was encountered in the test hole• and after seven day ground water monitoring, the monitoring tube was found to be dry. This property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. There are no points of contamination within the proposed well radius which can be seen on the attached site plan. If you require additional information, please contact us. Sincerely, Robert C. RCC/gk Enclosure CoC P. E. 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER. ALASKA 99577 v IT x Z2; m O A T � rrl 1= N O T Z 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER. ALASKA 99577 0 r 1" = 50' SITE PLAN UPGRADE 0 wo .'D Amo VIO Cl) rr0 C_ ___- 0 W OyZ tn> ,-xl -vm O G 0=!> fs C)o m 4( 0� z c DN N D O 9�l ZA Z( r -+ --� ;K0 m OMWO C N z vO"�sZ > xW C) r m = Z� s dco rrl 3Spg.i 1 > K pr Ms O -j� rsO m m 0n .+ 7 N'W E -r�i— y WN VO[i]rn _M O�-"m R' z-mrn ►'� Ra cn OrnC)-U tv DR ARMOUN ROAD tTj `n C/) `" o 4� P til > z o O OF ao En _ �I NU V) o z O� aoaa 0-0 -0o o C: a3so AN c, r`d�o Z7 o a O Z R5 ri CA A C m ox O 0 x m mVl 'nom 'i £Gi N 0O y_ Zy0~ ZOA eE� SED F pVR 9 C)�� N Z o NouSE m A =i $ 2N i� s �z MM � �2r,� oa m r Oro acn> O ' �v N mzLA T myL mz LC Ea 0 0 *Z0 I r -C- Z> OZ z;0_, ZI mmmmm WOx < z M(A >.'L�1 0 wo .'D Amo VIO Cl) rr0 C_ ___- 0 W OyZ tn> ,-xl -vm O G 0=!> fs C)o m 4( 0� z c DN N D O 9�l ZA Z( r -+ --� ;K0 m OMWO C N z vO"�sZ > xW C) r m = Z� s dco rrl 3Spg.i 1 > K pr Ms O -j� rsO m m 0n .+ 7 N'W E -r�i— Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: FRANK 13 E T Pf RR O DATE LEGAL DESCRIPTION:4 7- >� C tJ Q R t A/ SIo Township, Range, Section: DEPTH SLOPE SITE PLAN 1 2 3 4 1 5 C! �� 6 7 8 9 10 it 12 13 14 15 16 17 18 19 020-01vac .S �1 , AwA - Srs-7- S M M L MI YTyRLf suMt Ga��e c G W a'IAvK c thvin� WASGROUNDWAT R/ N O ENCOUNTERED? r SMIML S*pa - stir Mt�tr�ntS •Fa•�1 CAA,ret IF YES. AT WHAT L DEPTH? "O Depth b �l Wat� Ittr cj/E a r Monitoring? _ O Y Dalt: Reading ---Date— TimeGros,s Time Net Depth to Net Time Water Drop 2f AK -s- 3 Tot :oo - II" 01 h.J a r/ ' ' }Y L 1 y " 3 3r� :bN y vr ft 20 „ UPERCOLATION RATE �` (mmutevinch) PERC HOLE DIAMETER TEST RUN BETWEEN `� FT AND (a FT COMMENTS adG 4 f.X- SU trA 4Lit Fo/Z fS /Z Sf ort c PERFORMED BY: 4t at C EE,�,,�� t[ I.�C{T, /_. Lr{ZM✓ CERTIFY THAT THIS TES/j WAS PERFORMED IN ACCORDANCE W�rrr��L�BTRT�A* d'IA04f>14ES IN EFFECT ON THIS DATE. DATE: / t+S9� Rlwr, Alaska f9S77 72-= (Rev. 4/115) . GR�'ER ANCHORAGE AREA BOROIr^7 DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 2738686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM PPH\ON :PTIC TANK: NUMBER OF 7QS MATERIAL rte' �COMPARTMENTS (STANCE FROM WELL :�C 'SYFFx('- INSIDE WIDTH DEPTH �l^� 7/2 LIQUID IOUID CAPACITY�S_ � GALLONS. INSIDE LENGTH SEEPAGE SYSTEM: SEEPAGE PIT: i / '- OR WIDTH le', LENGTH �2 . DEPTH NUMBER OF PITS � OUTSIDE DIAMETER j� % BUILDING FOUNDATION LINING MATERIAL '�F� _�'��Gr .DISTANCE FROM WELL- R NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) " SO. FT. TILE DRAIN FIELD: TOTAL ENGTH DISTANCE FROM WELL FOUNDATION . NEAREST LOT LINE - OF ES . NUMBER OF LI S_��DISTANCE BETWE (NES TRENCH WIDTH IN. TOTAL EFFECTIVE ABSORPTION AREA_ SO. FT. LENGTH OF EA NE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE %� DISTANCE FROM Z SAMPREn,�j�.�= , NEAREST WELL: TYPE�'/_� DEPTH ��7(7 BUILDING FOUNDATION. OTHER NEAREST SEPTIC ?LIS SEEPAGE ��+ CESSPOOL , SOURCES SEWER LINE ,TANK , SYSTEM -2-� DISTANCES: DIAGRAM OF SYSTEM .7 DATE 0/2/Z I If NAME OF APPLICANT _SC INSTALLATION LOCATION LEGAL DESCRIPTION 7 GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3700 TUDOR ROAD POUCH 6.650 ANCHORAGE, ALASKA 99502 TELEPHONE 279.6686 SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT MAILING -q.'2 /3u' &41±tKE.w li /v I'M 541- J7 Rual? INSTALLATION OF: SEPTIC TANK^ SEEPAGE A 1 •. TOPE AND SIZE OF FACILITY TO BE FINANCED THROUGH SOIL TEST RESULTS COMPLETION DATE ANTICIPATED PERMIT NO. " "/ Vp PHONE ?yy/7& FIELD OTHER TO BE INSTALLED BY" M' p ��✓ NOTEI THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE '^"""" TYPE " 07 EEPAGE AREA SIZE 'lo I /6' 9 71? MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL / ,r� SEPTIC TANK � SEEPAGE PIT 701 DRAIN FIELD TO NEAREST LOT LINE. / r WELL TO SEPTIC TANK D SEEPAGE T O DRAIN FIELD ALSO CONST WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD SEPTIC TANK, SEEPAGE PIT DRAIN FIELD TO RIVER. LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION S FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. c GRAVEL BACKFILL C/ CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. l I D n HEALTH AUTHORITY OR LICENSED DESIGNER i Z30 DIAGRAM OF SYSTEM I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 20.68 AND THAT THE ABOVE DE RI ED SYSTEM IS IN ACCORDANCE WITH SAID CODE. P X DA �� APPLICANT'S SIGNATURE` CREAM ANCB^?A'' AEEA E0 \S:{ IWALTIi DD?Ai'"EI T 3" LA'ME STREET ClS r. 99501 Per''crmed Forfj;/� �� Date Perforr..ed icAal DL 'scriptaon: Lot i!:oc . "'•" ^ '- �—hF y 7 This Fcra Reports a: Soij;Lcr• � ..... rerco2etion 'fes: Dept! '_Ie^t Soil char'to^istics T/.e Cu waS vee•y ke'Je' wdYli G /c c� //n Q CGI/eo) 7/,< Sr,) CUOS CCin/�uc� L"IYf, erre//c .Sen /eel.5es �i�rei! f1// Se'dienrniS S/ic c✓rc! t, /c w f/z O Has Ground Water Encountered? If Yes, At What Depth Locaticn Sketch Frcposed Installat� %ona Seepage rit Drain Field eP Depth Of Inlet e D _ COu';£;ITS `� tn io bottom Of Pit Cr :Tenc- h /� . o• Test Performed 5y:_a',r ee o Data Certified Ey: 9�,,��// Date % i i /. /.__15 7 / Municipality of Anchorage°._ On -Site Water & Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 017-341-17 Expiration Date: 1. GENERAL INFORMATION Complete legal description CURRIN S/D LOT 2 Location (site address) 5000 CURRIN CIRCLE, ANCHORAGE, AK, 99516 Current Property owner(s) SCOTT GRIGSBY Mailing address Real Estate Agent Day phone 5000 CURRIN CIRCLE, ANCHORAGE, AK, 99516 EMMA SRANDRIA W/ CARRIGAN & CO Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: 250-3507 250-0908 TYPE OF WASTEWATER DISPOSAL: Individual Well E Individual On-site N Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ Received by:-.�i✓'� /I Date: COSA to be released [bathe engineer, unless otherwise requested by the engineer. COSA Fee $ `t�U • to Waiver Fee $ Date of Payment 67&3_ Date of Payment Receipt NumberP9 Receipt Number COSA # OSe[3/5/'� 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. Phone 337-6179 Date 10 o� OF 4p _T, �pQd �....:. .. .... ........:...� I I ff e A. Garn ss.- E— s:E— 53 e�0 Qua a� • � a.� J.�r. � ��oo %iS. xiY tOFA bedrooms, with the following stipulations: ON -SIVE WATER AND vJAQ' i_,.ATER Original Certificate Date: / 0 — / l7 The A" enicioity 6f_An6horage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations 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. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory (Rev. 11105) LIZ Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # _of_ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: CURRIN S/D; LOT 2 Parcel ID: 017-341-17 A. WELL DATA *PER GEG INSPECTION. **ASSUMED BASED UPON SURROUNDING WELL LOGS. Well type PRIVATE PRIOR TO If A, B, or C provide PWSID# N/A Well Log (Y/N) NO Date completed 8/2/1971 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth *229+ ft. Cased to **40+ ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 9/27/2013 LE Static water level uNPJP\�g ft. 227 ft. Well production g.p.m. 3.43+ g,p,m, WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate• V1&mg./L. Collected by: GEG, Ltd. Arsenic: &Pug./L. Date of sample: 9/27/2013 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1250 gal. Number of Compartments 2 Date installed 11/20/1995 Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 9/24/2013 ft. Pumper DENALI SEWER AND DRAIN C. ABSORPTION FIELD DATA Date installed 11/20/1995 Soil rating .p.d./ft rft2/bdrm) 1_2 Length 40 ft. Width 3 ft. System type TRENCH Gravel below pipe 6.5 ft. Total depth *11.6 ft. Eff. absorption area 520 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 9/27/2013 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 29 in. Water added 600 gal. New depth 68 in. Elapsed Time: 120 min. Final fluid depth 52 in. Absorption rate >= 600+ g.p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access "Pump on" level at in. "Pump off' level E. SEPARATION DISTANCES level Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ Animal containment areas 50'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 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. Engineer's Printed Name JEFFREY A. GARNESS Date 101}!/3 (Rev. 11105) I ►! CURRIN CIPCL_C 25.9 Si SBn40A B"W 262.@ LEGEND S SEWER VENT HEREON IS FOR THE USE OF 4ENTS OF RECORD, OTHER THAN THOSEKNOWN ON THE RECORDEC PLAT, ARE NOT SHOWN HEREON. ANY PENCELINOD SHOWN ARE LOCATED APPROYIMATELY ANO ARE INOT TO BE USED TO DETERMINE P 'ATESTRUCTURES, MNG SHOWN MAY BE APPROXIMATE DUI TO SNOW CONDITIONS. a, I' I I_ ® I D I n I � I I I AS -BUILT SURVEY SCALE: V -4W I HEREBY CERTIFY T,iP T I HAVE PERFORMED A MORTGAGEES INSPE-;TION OF THE FOLLOWING DESCRIBED PROPER" V. LOT 2, CUARIN BUDS ANCHORAGE RECORI INS DISTRICT, ALA )<A AND THAT THE VISIBLE LMPROV:DAENTS SITUATED THEREON ARE WRHIN THE PROPER' Y LINES AND THAT NO VISIBLE ENCROACHMENTS E1 IyT OTHER THAN NOTED DATED AT ANCHORA(.E, AIASRA THIS _1HTH DAY OF OCTOBER—__2005— HOLT LAND SURVEYII All 0601, FB005f TEL 9653513 ID La Im O u b b i P I^ 0 I n I � I I I AS -BUILT SURVEY SCALE: V -4W I HEREBY CERTIFY T,iP T I HAVE PERFORMED A MORTGAGEES INSPE-;TION OF THE FOLLOWING DESCRIBED PROPER" V. LOT 2, CUARIN BUDS ANCHORAGE RECORI INS DISTRICT, ALA )<A AND THAT THE VISIBLE LMPROV:DAENTS SITUATED THEREON ARE WRHIN THE PROPER' Y LINES AND THAT NO VISIBLE ENCROACHMENTS E1 IyT OTHER THAN NOTED DATED AT ANCHORA(.E, AIASRA THIS _1HTH DAY OF OCTOBER—__2005— HOLT LAND SURVEYII All 0601, FB005f TEL 9653513 ID La Municipality of Anchorage 1 Development Services Departme Building Safety Division Onsite Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL r1 FOR A SINGLE FAMILY DWELLING n Parcel I.D. 1 / (1 " 501- i COSA# 0(� 0�1 � 1. GENERAL INFORMATION Expiration Date: : — & — C02 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address CURRIN SUBDMSION• LOT 2 5000 CURRIN CIRCLE • ANCHORAGE AK 99516 SHIRLEY HEFFNER Day phone 223-8210 5000 CURRIN CIRCLE • ANCHORAGE AK 99516 Day phone .a :r.:. DYNAMIr Day phone 244 -54 -Ti — Unless .-fi— Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat axed 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: in conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identirtable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may Puctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there ere no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE L.IX Approved for V- bedrooms. Disapproved. Phone 337-6179 Date 1'1/(76 Conditional approval for bedrooms, with the Mowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory L1__.0' Arsenic Advisory Maintenance Agreements Supplemental Engineers Reort Other By: CL% ),- 6;7' moc — fp. I'M% I A V O/� TSIE • ON- : cn' WATSj ER WPROGRAMR �<%.�••.... •'gig `,,\,� Original Certificate Date: II ` 4 - 0 Municipality of Anchorage • Development Services Department Building Safety Division On•Ske Water a Wastewater Program 4700 Bragaw, Street P.O. BOX 196650 Ancluxage, AK 99519-850 www.muni.org/onsi[e (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: CORRIN SUBDIVISION: LOT 2 Parcel ID: 017-341-17 A. WELL DATA $NEW PUMP IN 2004 Well "a _ply _ RI If A, B, or C provide PWSID# N/A Date completed P8 2 10 Sanitary seal (YIN) YES Total depth 0276+ ft. Cased to 40+ ft. FROM WELL LOG Date of test 1-1 Static water level ft. Well production 9.p -m. WATER SAMPLE RESULTS: Well Log (YM) NO Wires property protected (YM) YES Casing height (above ground) 12+ in. AT INSPECTION 10/12/2006 234 ft. 4.3 g.p.m. Collform _0 colonies/100 ml. Nitrate 1a419 mgJL. Other bacteria _1�colonieWl()O ml. Arsenic: ND mgJL. Date of sample: 10/12/200 Collected by: GEG, Ltd. S. SEPTIC/HOLDING TANK DATA Tank Type/Materlai SEPTIC/STEEL Date installed 11/20/95 Tank size 1250 gal. Number of Compartments 2 Cleanouts (YM) YES Foundation deanout (YM) YES Depression over tank (Y/N) NO High water alarm (YM) N/A Date of pumping 6/10/2006 Pumper NORTHLAND PUMPING C. ABSORPTION FIELD DATA I CRADEE Date installed 11/20/95 Soil rating .p.d ft%dnn) 1_2 System "a TRENCH Length 40 ft. Width Gravel below pipe 6.5 ft. Toted depth '11.5 ft. Eff. absorption area 520 fe Monitoring tube YES Depression over field NO Date of adequacy test 10/12/2006 Results (Pass/Fal) PASS For 4 bedrooms Fluid depth in absorption field before test 31 in. Water added 632 gal. New depth 59 in. Elapsed Time: 123 min. Final fluid depth 39.5 in. Absorption rete >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN 6 type) NONE KNOWN If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at _in. `Pump ofr1gyWAt—.---Wl High water alarm level at In. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankfltfi station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ Public sewer manhole/deanout N/A Holding tank N/A Animal containment areas 50'+ Manureian" excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 1000+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properly line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parkinglvehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots '+ F. COMMENTS 0. ENOINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSH guidelines in effect on this date. Engineer's Printed Name JEFFREY A. WNESS Date III r /06 COSA Fea & G/ �U (.V Date of Payment 1 r)6 Receipt Number (RAW. 1//05) Waiver Fee S Date of Payment Receipt Number 116qf6bl SGS ReEN 1066195001 Client Name Garness Engineering Group, Ltd. Project Name/H Lt 2 Curtin Client Sample ID Lt Curtin Matrix Drinking Water Sample Remarks: All Dates/times are Alaska Standard Time Printed Date/fime 10/24/2006 8:11 Collected Date/time 10/122006 8:21 Received Date/time 10/122006 10:12 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units medw Container ID Limits Date Date [nit Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 10/16/06 1020/06 WAW Waters Department Nitrate -N 1.48 0.100 Microbiology Laboratory Total Coliform 0 mg/L EPA 353.2 D (<10) 10/13/06 XZ col/100mL SM209222B A (<I) 10/12/06 DPT Municipality of Anchorage •. • Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 017-341-17 HAA# A4DOo'L�v� 1. GENERAL INFORMATION Expiration Date: 9 — S— 012 Complete legal description CURRIN SUBDIVISION: LOT 2. Location (site address or directions) 5000 CURRIN CIRCLE ' ANCHORAGE. AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address BILL WEBSTER Day phone 345-8814 5000 CURRIN CIRCLE • ANCHORAGE. AK 99516 Day phone MARY COX w/ REMAX PROPERTIES Day phone 2600 CORDOVA STREET • ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 257-0118 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site N Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. PAI D Note: Alaska Water and Wastewater Consultants, Inc. shall be paid at, or prior to closing for the engineering services provided. .4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal axed 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. /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 ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone Address 6901 DEBARR ROAD, SURE 2B * ANCHORAGE, AK 99504 Engineers Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefil of the owner listed above. Any reliance upon or use of this report by any otherperson or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for 4 bedrooms. Disapproved. 337-6179 Date/071 Conditional approval for bedrooms, with the Illowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other UN-01IC • -Q) - WATFR AND M' WASTEWATER By:— Original Certificate Date:' IJ LD �– (RO.. 17/01) Municipality of Anchorage Development Services Department Building Safety Division ` Onsite water & Wastewater Program 47W South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www. ci. anchorage.ak.w (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOT 2. CURRIN SUBDIVISION Parcel ID: 017-341-17 A. WELL DATA Well type PRIVATE If A, B. or C provide PWSID# N/A PR% / Date completed 8 2 71 Sanitary seal (YIN)YES Total depth 238+ ft. Cased to 40+ ft. FROM WELL LOG Date of test Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform ® colonies/100 ml. Nitrate J,—ajLmgJL. Well Log (Y/N) NO Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 4/30/2002 236 ft. 4.8 g.p.m. Other bacteria 4_oolonies/100 mi. Arsenic: N/A mg,/L, Date of sample: 4/30/2002 Collected by: AWWC, INC. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL (GREER) Date installed 11/20/95 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation deanout (YM) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 4/30/2002 Pumper NORTHLAND PUMPING C. ABSORPTION FIELD DATA 'THE LAST 805 GALLONS INTRODUCED ONLY CAUSED A 30 RISE Date installed 11/20/95 Soil rating .p.d. r ft%drm) 1_2 System type TRENCH Length 40 ft. Width 2.5 ft. Gravel below pipe 6.5 ft. Total depth 10 ft. Eff. absorption area 520 ft' Monitoring tube YES Depression over field NO Date of adequacy test 4/30/2002 Results (Pass/Fall) PASS For 4 bedrooms Fluid depth In absorption field before test 33.5 In. Water added 1130ga1. New depth 052 in. Elapsed Tone: 15 mm. Final fluid depth 45 In. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed "Pump on" level at _in. E. SEPARATION DISTANCES Size in gallons High water alarm level at Cycles tested Meets alarm 8 circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout _ N/A Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main_ N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicie storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in"""' conformance with MOA HAA guidelines in effect on this date. I. i Engineer's PrintName JEFFREY A. GARNESS Date S 1 3 7O Z HAA Fee $ Deft of Payment 6 — JD ' C 9 Receipt Number ? n rJ Z (Rev. 12101) Waiver Fee $ Date of Payment Receipt Number • 1 MUNICIPALITY OF M 1 • � DEPARTMENT OF HEALTHTH & b HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 01 -7 — 3 Lr / —1 7 1. GENERAL INFORMATION HAAN Complete legal description Lo -t 2; G»vi.in Subdlv.f.tdon Location (site address or directions) C1V,,'U*1t Ci_nCEe .lavJ:oxage., AK Property owner fie thand Conetkuct.ion Day phone 345-1615 Mailing address 12901 Reat.a �Ltc4o:.: te, . is 55515 Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: I_ E�Ititii�I:T�•T3';L•Tti �:�3�1�>! A Individual well XXX Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community'on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-0251Rn. 1/111 R"I WAIN S. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system Is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I 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. S & S ENCINEERING (,q y_ a ry '7q Name of Firm —78342k 4 Phone Address Eagle River, Alaska 99577 Engineer's signature 6. DHH SIGNATURE Approved for 4— bedrooms. Disapproved. Conditional approval for Additional Comments Date S' //o /`I bedrooms, with the following stipulations: 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. m m. m.-. ,e,. n... .w.' n. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 625"L" Street, Room 502 0 Anchorage, Alaska 995010 (907) 343-4744MMNIOPAUTM Of EWIRONMEWAL SERVICES DIVISION Health Authority Approval Checklist f.4AY 13 1996 Legal Description: Lar 1 - CvroeiA S/0 Parcel I.D.: 01-7-14 I1-1 RE r F V E D A. WELL DATA Well type ekwwre If A. B. or C. attach ADEC letter. ADEC water system number Log present (WIP- Date completed f <s o e ro 6/2/1, Total depth 'Y36 r } Casal to 4e t } Casing height (above ground) I t Sanitary seal 011) I;is1'Wd5w� Date of test Static water level Well production — 9 -p.m -WATER SAMPLE RESULTS: Wires properly proteaed®Id) AT INSPECTION ab -i l'i5 Z'31 ;11 5 9— p.m- Coliform O Nitrate i • 3 C. Other bacteria O Date of sample: 5-5-9f. Collected bv: g o g 60.4Arl S i S ENGINEERING B. SEPTIC/11OLDING TANK DATA 17054 Eagle Rhear Loop Road No. 204 Eagle River, Alaska 99577�^^ Date installed It -20-45 Tank site 1150 rst.Number of Compartments Z Cleanouts Wry/ Y Foundation cleanout (11" Y Depression (YAD ISI High water alarm (Y/N) N A Date of Pumping Pumper r 1.-4 C. ABSORPTION FIELD DATA Date installed 11-70-015 Soil rating (g.p.d./fl' or fl'/bdmi) 1. 7- System type 'r*'%A44 Length 4 o t Width Z. 5 r Gravel thiel ness below pipe G. i Total dept, I I a Effective absorption area $Lo T Monitoring Tube present®M) Y Depression over field (Y,& t� Date of adequacy test Ac - 4a Results (Pass/Fail) For bedrooms Fluid depth in absorption field before lest (in.)-. - Immediately afler --gair.-water added (in.): Fluid depth - ins.) Minutes later: Absorption rate = _ Peroxide treatment (past 12 months) If yes, give date D. LIFT STATION Date installed Manhole/Access (YIN) High water alarm level at, E. SEPARATION DISTANCES Size in gallons *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: at" "Ptuup off' Ic%cl at" Se t holding tank on lot 115 : On adjacent lots /00 t -F Absorption field on lot 1201 t On adjacent lots /0014- Public ootf' Public sewer main 75 t 4- Public sewer m anholecleanout too' + Sewer /septic service line 7-5 t+ Lift station t o o t 4 - SEPARATION DISTANCES FROM&ROHOLDING TANK ON LOT TO: Building foundation 46 Property line 101 + Absorption field 1z5 t + Water main/servioe line 10 '+ Surface water/drainage t oo 1 + Wells on adjacent lots too'-4- SEPARATION oo'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 801 Water main/service lime Surface water too t + Curtain drain I tao I -l-' F. ENGINEER'S CERTIFICATION I to + Driveway, parkmg/vehicle storage area l oo t + Wells on adjacent lots too' + Property line 2514- I 51 -F 1 certify that 1 have determined thru field iompectionx and review of,l4unicipal records 1J a in conformance with .iJ A 1 gut es in effect on this date. ,. A C2 Signature DD /'h Pte•' .�`` Engineer's Name 403il-i C. Cow4. Date S � (' 9 6 �.« /O i', ?+ N06ERT C. COWAN' HAA Fee S_ _0 Date of Payment Receipt Number Rev. 8/95 OSS: haa.wk.doc Waiver Fee S Date of Payment Receipt Number are