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SKYLINE VIEW BLK 1 LT 11
Skyline View Block 1 Lot I I #051-192-44 Municipality of AnchorageMUTT- Community Development Department Page 1 of 3 On-Site Water & Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onslte • (907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP131300 PID Number: 051-192-44 ❑ New ®Upgrade Name: KELLY HANSON ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address: 19341 LUPINE STREET *CHUGIAK, AK 99567 ❑ Other Phone: 244-0742 No. of Bedrooms: 4 Sal muu": GPD/Sq. Ft. Total Depth from original grade: Ft LEGAL DESCRIPTION Depth to pipe invert from original grade: FL (ravel depth beneah n. Subdivision: SKYLINE VIEW S/D Block: Lot: 1 11 Fill added above original grade: Gra ngth: Ft. owns ip: — ange: — section: — Grovel width: �\,.\(p �� \S n' de Number of linea Distance between linea: Ft' SEPARATION DISTANCES TO Septic Absorption From Tank Field Lift Station Holding Public/Prhate Tank Sewer Lines Total abaorpti area: 5D. n.I Number of trenMes: Diet. between trenches: Ft Well 100'+ EXISTING — — 25'+ TANK ® Septic ❑ S.T.E.P. CHolding ❑Other Manufacturer. capacity: Surface water 100'+ EXISTING — — ANCHORAGE TANK 1250 Co1. Lot Line 5'+ EXISTING —material: N/A STEEL Number of compartments: 2 Foundation 5'+ EXISTING — — LIFT STATION Curtain Drain I NONE KNOWN Manufacturer: capacity: Gal. Remarks: OLD TANK WAS DECOMMISSIONED PER UPC Pump on' level at: 'Pump off' level at: Hi er alarm at: Pump Make &Mode' ctrical Inspections performed by: PIPE MATERIAL House to tank D3034 Tank to D3034 drainfield Installer GREEN GENERAL Drainfield EXISTING CO MT EXISTING CO/MT GEG, Ltd. BENCH MARK (Assumed elevation) 100.00 Ft Inspection Dates: 1 st 10/9/1 2nd — Location and Description' 3rd — 4th — BOTTOM OF SIDING ON SIDE OF GARAGE Community Development Department Approval Conditional approval: Date: extaePM'�s WAL ooOF000�N It .............. ............. J f . .arness.. 0� a '• CE—1795 ®�O o�4p° eaPlnl zi�;��a�oo rofesslon o ��40;000�a Approved: Date: 12-5 '1 PERMIT NUMBER: AS—BUILT DRAWING PARCEL INUMBER: - OSP131300 051-11 92-44 \ A B \ / ST1 23.25 34.17 ST2 27.95 42.18 (%'F< DBL1 30.65 45.87 DBL2 31.64 47.06 / )00' k, SKYLINESSLVIEW \, IPo BLOCK 1 OT 17 SKYLINE VIEW STATES S/D; BLOCKI 1, LOT 10 / \ \ C] qa E + W SKYLINE VIEW w ESTATES S/D; r ^ 3 BLOCK 1, LOT 16 (I ING 4 BED OOM .USE o o J / ST2 S0 \ EXISTINEW 1250 GALLON SEPTIC TANK N _—\y— DRAINFI LD m 100' WELL RADIUS \ SKYLINE VIEW ESTATES S/D; BLOCK 1, LOT 12 NE VIEW E LOOCKCK S 1, LOT 15 SCALE: \ , \ 1"=30' _o��F �oopp GARNESS ENGINEERING GROUP, Ltd. T v,�0� CONSULTANTS & GENERAL CONTRACTORS ........ .. ........ ...........0 3701 E MOOR NOM. SWfE 101 • ANOWORME, AN 99507 + PHONE (907)337-8179 • FM (907)338-3246 + WE89NE: WWWNQMa gI0mM9...M PREPARED FOR: PHONE NUMBER: PAGE NUMBER ••• ..... KELLY HANSON 244-0742 2 OF 3 do m ';i Y A. G ness.- LEGAL DESCRIPTION: DRAWN BY: QO9s CE -79 fop SKYLINE VIEW S/D; BLOCK 1, LOT 11 P.N.B 0� lvdj 33' o°d� TYPE OF WORK: DATE: 40pd p7'ofessi06o AS—BUILT DRAWING 1 /13 �OO�0000 (nev. vu.) PERMIT NUMBER: AS—BUILT DRAWING ING PARCEL INUMBER: - OSP13i300 051-11 92-44 TOP OF TANK AT INLET = 95.58 INVERT OF BUNG AT INLET = 94.95 ST1 INSULATION (PER CONTRACTOR) r FINAL GRADE = 99.81-100.07 ST2 NEW 1250 GALLON SEPTIC TANK — TOP OF TANK AT OUTLET = 95.60 INVERT OF BUNG AT OUTLET = 94.83 GARNESS ENGINEERING GROUP, Ltd. Qa: a CONSULTANTS & GENERAL CONTRACTORS Q• • • • • • .. .......... ........... 3701 E. NOM WOr10. SURE 101 • A OR , lM 98801 • PWME (907)337-6179 • FM (907)338-3246 • WE65RE: xwxgwnevenpinee0n9.emn PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ...••••• KELLY HANSON 244-0742 3 OF 3 OQ p Y G Hess: LEGAL DESCRIPTION: DRAWN BY: Q y. CE -79 3 0� SKYLINE VIEW S/D; BLOCK 1, LOT 11 P.N.B ��� a ''�o'.t313•'' �ooG TYPE OF WORK: DATE: ��QOO��QQOao� PROFILE AS—BUILT DRAWING 10/22/13 (Rev. U11W) Permit Number: Tax Code Number: On -Site Wastewater Disposal System Permit OSP131300 05119244000 Work Type: Septic Permit Effective Dates: September 06, 2013 to September 06, 2014 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Design Engineer: GARNESS ENGINEERING GROUP LTD Subdivision: SKYLINE VIEW Site Legal Address: SKYLINE VIEW BLK 1 LT 11 GA 159 Owner/Address: HANSON KELLY PO BOX 772068 EAGLE RIVER AK 995772068 Site Mailing Address: 19341 LUPIN ST, Chugiak This permit is for the construction of: Lot Size in Sq Ft: Total Bedrooms: /017/13 15750 y 'X N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage IPM 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Z2 Received Bv: _ Issued By: Date: Date: 6 MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Fax: 907- 343-7997 On -Site Water & Wastewater Program Mayor Dan Sullivan On -Site Sewer/Well Permit Application For A Single Family Dwelling Parcell.D. Lf Property owner(s) KELLY HANSON Day phone 244-0742 Mailing address 19341 LUPINE STREET *CHUGIAK. AK 99577 Site address 19341 LUPINE STREET *CHUGIAK AK 99577 Legal description (Sub'd, Block & Lot) SKYLINE VIEW S/D; BLOCK 1, LOT 11 Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms A- y APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: (,4all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) Upgrade ® (w/wo ADU) Septic Tank ® Renewal Duplex (D) El❑ Holding Tank ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: Distance: — I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: aOn. 6,0 Waiver Fees: Date of Payment: '91301/3 Date of Payment: Receipt Number: nQ� VW PG7 Receipt Number: Permit No. (JSf 1 -'� 1-4m Waiver No. (Rev. 01/11) '� i,AMC" August 28, 2013 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Rd. P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Ref: Proposed Septic Tank Upgrade Skyline View SID; Block 1, Lot 11, To whom it may concern: Fo., (4) The existing ?a (p) bedroom house on the referenced property is served by a private well and septic system. The existing septic tank is in a state of failure and needs to be upgraded. We are proposing to remove the existing tank and replace it with a new 1250 gallon septic tank We are unaware of any adverse impacts this installation may have on adjacent wells or septic systems. If you have any questjpns, please contact us at 337-6179. Thank you for your assistance. .E., M.S. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com I'/NOTE: THE CONTRACTOR TANK DESIGN ONLY SHALL HAVE THE SOUTH & WEST LOT LINES, AND ALL / WELL RADII FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. CONTRACTOR MUST °O"wF� SKYLINE VIEW CONFIRM THE NEW ` R90,LS ESTATES S/D; SEPTIC TANK / loo"BLOCK 1, LOT n LOCATION IS 5'+00 F` FROM EXISTING DRAINFIELD. SKYLINE 'A STATES S/D; BLOCK 1, LOT 10 k0 SKYLINE VIEW \ w = ESTATES S/D; r ^ 3 BLOCK 1, LOT 16 V I < •• E%IS'[ING 4 BED OOM USE o o J /JKT2 STi c a EXISTING 1250 SEPATIC TANK TO EXISTIN BE REMOVED AND REPLACED IN DRAINFI LD SAME PLCAE WITH NEW 1250 IN� DBL C 0'S 100' WELL RADIU N SKYLINE VIEW ESTATES S/D; BLOCK 1, LOT 12 SKYLINE VIEW IESTATES S/D; BLOCK 1, LOT 15 \ SCALE: \ GARNESS ENGINEERING GROUP, Ltd * P g CONSULTANTS & GENERAL CONTRACTORS ... . • • • • .. . ... • . •D 3"1 E. MOOR RQ•D. SO 101 • ONCHOWC M 9950') • PHONE (907)337- In • FM (99])338-3248 • WfI350E: w garcaeutphw m'.Com D PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ••••• •• ........ O KELLY HANSON 244-0742 1 OF 1 G rness.: LEGAL DESCRIPTION: DRAWN BY: / O SKYLINE VIEW S/D; BLOCK 1, LOT 11 PNB �2 j. 13 \0' TYPE TYPE OF WORK: DATE: QQ4d Professlor% TANK DESIGN UPGRADE 8/29/13 DOpppoo� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I� ENVIRONMENTAL ENGINEERING DIVISION �j 825 L Street • Anchorage, Alaska 99501 Telephone 264.4720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME )/ (' /,12 NEW {`,� Y ALL �Jf�"' /y(y�V 9 Oo Z/ d ❑ UPGRADE MAILING ADDRESS LEGAL DESCRIPTION 4�/ X/� / LK/C.(C. L LOCATION Y ll i?i E -� Z&t NO.OF B DROOMS u Y DISTANCE TO: Well S/ Absorpu rea /O 7 f� (/ Dwelfin9/� �7 PERMIT NO. 7 /D QManufxturer Materia !ST�_�L No, of c partments Li fyingi In gallons LL Z/ IF HOMEMADE: Inside length Width Liquid depth d v JV2 DISTANCE TO: Well Dwelling PERMIT NO. _ f Manufacturer Material Liquid capacity in gallons D m= DISTANCE TO: Well //* � (/ Foun � n/ Nearest - L PERMIT NO. 4. Z 2W No. of lines/ Length of e h line Total eng h of lines Tre h width Distance between lines ~ Inches ¢ y¢.. Tap of lila t ii ish grade % is each / Tota t' a B motion area f] inches [� W Length Width Depth PERMIT li U Wa W Type of crib Crib diameter Crib depth Total all absorption area N DISTANCE TO: Well Building foundation Nearest lot line J J Class Depth Driller Distance to lot line PERMIT NO. W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE E ALS C�✓,JL SOILTESIT/RATING�-� INSTALL 'C7T/V REMARKS �•�`',I. 0 Q — io;�v ........ ;.I + p+r."TH s*d ..: .......t.../ _ .. .. ..• ..:Jr..........� i02 j4�Aw 1000, 111111 4 1,11,6 APPHO EDATE LEGAL 37/D- to �� J� 72-011 I nV_ 3/]RI MUr4 I Cr I F AFL I TY L -1F= FI�JC�H11f2FICiE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE, AK. 99501 264-4720 CIFJ—'S I TE SEWER REF; rl I T PERMIT NO. C 781025 ) APPLICANT DAVID PELLISSIER PO BOX A56 CHUGIAK 688 2906 LOCATION SKYLINE VIEW & LUPINE ST LEGAL L11 81 SKYLINE VIEW 5/D LOT SIZE 15750 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER, OF BEDROOMS = 4 SOIL RATING <50 FT/BR)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: L'tiEPTH= S L-E:r4OTH= 3S GRFiw'EL DEPTH= THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AMD 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). F�'EC1U I FRED> SEPT I C TfihFFC S I ZE= :JL 25 B C3FILLC)F S; 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. -- TWCl C 2 7 I F+ISPECT I C?MS FiFZE MaGQU I REO BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MI14IMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELLi OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. OTHER. REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERM I T EXP I FZES FJEC:EMBEFR 31� :lL s+ -'i I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR OM -SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE 14ITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED : fnr���Cf PPLI RNT DAVID PEIrL ISSIER ISSUEp BY_ ____°t _�__DATE L /�IS- V3. 2 Performed for _ Legal Description: This form reports: r1 r, ..AEATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C' Street Anchorage, Alaska 99503 SOILS LOG — PEROLATION TEST Soils log -- X Percolation test Depth TP 1 Feet - -apth7 Percolation rate minute. Proposed installation: Seepage Pit Drain FieldDepth of COMMENTS: �G✓%I/11c�1� _Dgpth 7ottorp p1 pit - Et]O40 (6/74) C u A 9 C O S wl a Y H A 0 M H A of M J � r 7 z c i i LIN' to F\ T T T T T T T T T T T • �. H H H H H H H H H u A 9 C O S wl a Y H A 0 M H A of M J M U N I C I PAL I TY (DF' Fid tCHORF=iGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE, AK. 99501 264-4720 WELL F'EF2M I T PERMIT NO. C 780015 ) APPLICANT DAVID PELLISTER PO BOX 856 CHUGIAK 688 2906 LOCATION LUPINE ST LEGAL L11 B1 SKYLINE VIEW SUB LOT SIZE 16000 SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. 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}EF2M I T EXP' I FZES} E>ECEUlE3EFZ 31, 1527'ED I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY -THE MUNICIPALITY OF ANCHORAGE. /� C 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. - ' ------- APPLICPNf DAVID PELLLSTER ISSUED BY i.L1s��,�t_ "r' ----- DATE_ jZl Q l h___ V3. 0 MUNICIPALITY OF ANCHORAGE Development Services Department �� Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-192-44-000 Legal description SKYLINE VIEW BLK 1 LT 11 Site address 19341 LUPIN ST Chugiak AK 99567 Expiration Date: 1/18/2025 Current property owner(s) VASQUEZ VALERIE D &KNIPFER VAUGHN ERICH X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: I Original Certificate Date: 1/29/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory x Tank Age Advisory Arsenic Advisory Other COSA Approval—June 2022 0�AUTY OF �UICHOR_GI Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051 192 44 Complete legal description SKYLINE VIEW BLOCK 1 LOT 11 Location (site address) 19341 LUPIN Current property owner(s) KNIPFER 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: X Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: X Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 10 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed M Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance.- By istance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Waiver Fee $ Date of Payment i 2 `� Z Date of Payment COSA # D S G2 Lt 1®1'3 Waiver # COSA Application_ June 2022 COSA Checklist_June 2022 COSA Checklist Legal Description: Parcel ID: If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank Date of pumping Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Adequacy test date Results Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) in Effective depth used in Effective depth remaining in Comments/Deficiencies: COSA Checklist_June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F.ENGINEER’S COMMENTS G.CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Phone Engineer’s Printed Name Date C&M ENGINEERING CHARLES BALZARINI, PE 1/23/24 l�Titrate Advisory Certificate of On -Site Systems Approval # OSC241018 Subdivision: Skyline View, Block: 1, Lot: 11 A water sample revealed a nitrate concentration of 5.60 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. Since nitrates are known to slowly increase, we recommend you monitor the water quality. 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. MaUmg Address P O Box96650 *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 filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. �° � Mailing Address P O ,Box 196650 *�Anchorage,`Alaska 99519 6650 *www mum org am MUNICIPALITYOF ANCHORAGE 0� I -: ;t & Development Services Department i7 Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-192-44 1. GENERAL INFORMATION Complete legal description SKYLINE VIEW BLOCK 1, LOT 11 Expiration Date: I Location (site address) 19341 LUPIN STREET, CHUGIAK, AK 99567 Current property owner(s) MATTHEW SMITH & AMBER KRACHT-SMITH Day phone Mailing address Real estate agent 7016 BIG MOUNTAIN DRIVE, ANCHORAGE, AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $_ 5 50 Date of Payment Receipt Number Z I (:t 13 1 COSA# 03C2116023 Date: Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 10/15/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic i�11\\�l\� applies only to the conditions as of the day tested. The flow and absorption rates may change ,� )kk > due to subsurface conditions that may not be observed from the surface, changes in land use, A V local soil characteristics, groundwater levels that may fluctuate during the year, quality of ��` • • • • • • !� construction (workmanship & materials), the water usage of the family being served by the g •• •;9 �� system and maintenance. The operational life of all well and septic systems are subject to * • —49 TH •• / these various and dynamic characteristics and are outside the control of the evaluator of the .. • . .... ...... well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or / .. . • .. , • , , • . , • , discrepancies exist can be given by First Water Consulting & FWI:5_ :• • Curtis Huffman �Fc %• CE 128991 6. DSD SIGNATURE �J'l�c�•.�o/15/21 .•��v�i System #1 Approved for �' bedrooms l� System #2 Approved for bedrooms Disapproved P,\Ty OFr(����i��� Conditional approval for bedrooms, with the following tions: '0 g ON-SITE G WASTL= V `AT OG o Jr0^ PROGRAM Rpm n Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: SKYLINE VIEW BLOCK 1 LOT 11 Parcel ID: 051-192-44 If more than 1 septic system on lot: COSA Checklist # _of A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 1/27/1978 Total depth 93.5 ft Cased to UNKNOWN ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA 10/13/2021 Static water level at beginning of test 78 ft. Comments Structure served by this system _ Well production at time of test 3.7 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® Nc ® Coliform bacteria is Negative Nitrate 2.14 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) FWC Collected by t Date of Sample 10/13/21 B. TANK DATA C. LIFT STATION Age of tank(s) 8 years ❑ Required maintenance completed Tank type/material SEPTIC / STEEL Age of lift station _ years Measured operating fluid level in septic tank 49" Lift station material ® Standpipes/foundation cleanout per record drawing Comments: Date of pumping 10/13/21 D. ABSORPTION FIELD DATA Which system tested (date installed) 10/30/1978 Adequacy test date 10/13/21 ® ALL standpipes present per record drawing Results M Pass For 4 bedrooms Total measured depth from grade 8.2 ft (max) Fluid depth prior to test *3 in Measured depth to pipe invert from grade 5_0 ft (min) Water added 650 gal ❑ N/A — pressurized field New depth 10 in ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 3.2' of the 5.5' ED Elapsed time 60 min ® Code -required soil cover over field Final fluid depth 1 in ❑System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: *As the 2019 COSA adequacy test — liquid level was brought to a measureable elevation & daily volume subseauentiv added with similar results. Fel[; 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 ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® 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 Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS PORTION OF LEACH FIELD IS UNDER DRIVEWAY -- OWNER & PREVIOUS COSAs STATE & REPORT NO KNOWN FREEZING ISSUES. 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. .mwAW ',t��' 11 Curtis Huffman it f� �``G'�� •. CE 128991�rp'� �� �F,p••a0/27/;1••Fa„� gus/i MUNICIPALITY OF ANCHORAGE ERAVS Development Services Department \ Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On-Site Systems Approval Parcel I.D. 051-192-44-000 Expiration Date: 6/4/2020 1. GENERAL INFORMATION Complete legal description Skyline View B1 L11 Location (site address) 19341 Lupin St. Current property owner(s) Michael & Michelle Dennis Day phone 441-4179 Mailing address PO Box 671703 Chugiak, AK 99567 Real estate agent Brandon Tatum Day phone 382-6129 2. TYPE OF DWELLING: F Single Family (w/wo ADU) gust" n Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic X Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for Distance: Received by: Date: COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ iSO , to Waiver Fee $ Date of Payment (DIll/i. Date of Payment Receipt Number Receipt Number COSA# 6311/9 627 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. I acknowledge that On-Site staff may visit the site to verify the information submitted. Name of Firm Eklutna Eng. LLC. Phone 907.355-9820 Address 19162 Mountain Rd., Chugiak AK 99567 Engineer's Printed Name Curtis Townsend, PE. Date s�� `'Q e fit.. * T6, 6. DSD SIGNATURE - /a r System #1 Approved for q bedrooms /":' i�unst,T•,y6, System #2 Approved for bedrooms 9��• Wo 1111.1 •.a�,. Disapproved �`�oROf ssloo• .�+'"r Conditional approval for bedrooms, with the following stipulations: ��t•�Gf `\•HtYor'1/4Q ��i s J` ON`S � W , lL �v = ATR - mWAAND r �STEwn pRjGR =o R�� a- /S�' SERVICES ,. 1)))))tt))\ By: t � Original Certificate Date: C"/ 2^i q 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 i—_—__ , Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Ci ecerst blue sheet COSA Checklist Legal Description: Skyline View B1 L11 Parcel ID: 051-19244-000 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) Well production at time of test 6.6 gpm Date drilled 1/27/78 Water storage tank volume n/a gallons Total depth 93.5 ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to unk ft ❑i Coliform bacteria is Negative ❑■ Sanitary seal is functioning correctly Nitrate 8.4 mg/L ❑ Nitrate less than MRL (ND) ❑Wires are properly protected Arsenic <MRL ug/L ❑■ Arsenic less than MRL (ND) Casing height(above ground) 39 in. Collected by Brandon L.Jones,Brandon's On-Site Service's LLC. Date of flow test for COSA 6/4119 Date of Sample 6/4/19 Static water level at beginning of test 81 ft. Comments B. TANK DATA C. LIFT STATION Age of tank(s) 6 years ❑ Required maintenance completed Tank type/material steel Age of lift station years Measured operating fluid level in septic tank 49.5 Lift station material 0 Standpipes/foundation cleanout per record drawing Comments: Date of pumping 6/7/19 D. ABSORPTION FIELD DATA Which system tested (date installed) 10130118 Adequacy test date 6/4/19 ❑ALL standpipes present per record drawing Results Q Pass For 4 bedrooms Total measured depth from grade 8.1 ft(max) Fluid depth prior to test 2.5* in Measured depth to pipe invert from grade 4.4 ft(min) Water added 645 gal ❑ N/A—pressurized field New depth 8.5 in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 40 min depth into effective 3.2' ❑■ Code-required soil cover over field Final fluid depth 2 in Absorption rate 645+ gpd ❑ System presoaked (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies:`Note:The liquid level in the leach field was brought to a measurable elevation then the daily value was added. COSA Checklist yellow sheet 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' —2 Yes if No ft Q✓ Yes if No ft Neighboring Tank> 100' ❑✓ Yes if No ft Private Sewer/Septic Line >25'0✓ Yes if No ft Absorption Field on Lot> 100' ❑✓ Yes if No ft Holding Tank> 100' El 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' Q✓ Yes if No ft Surface Water> 100' E✓ Yes if No ft Property Line >5' Q✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' E✓ Yes if No ft Private Wells> 100' I=1 Yes if No ft Water Main > 10' 0✓ Yes if No ft Community Wells>200' ✓� Yes if No ft Water Service Line> 10' 0✓ 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' Q Yes if No ft If absorption field is under driveway comment below Property Line> 10' 0✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells> 100' 0 Yes if No ft Water Service Line> 10' ❑✓ Yes if No ft Community Wells>200' 0 Yes if No ft Surface Water> 100' ✓❑ Yes if No ft F. ENGINEER'S COMMENTS The end of the leach field trench appears to be under the driveway.There are no reports of freezing with the last three issued cosas. The L7&8 well separation distance was field measured at 103'and greater to the end of the measure LI 1 leach field. The drawings from the 10/22/13 tank installation appear to be incorrect for the afore mentioned lots. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. ��of!aCs�l AY '' • `�''17 � ,1 �* TI'I COSA Checklist yellow sheet IA . Date L(////d1r •‘" fa:C�j'..No.CE 11941..` tA N,PROFES$.\J'' 8447 E } / Lot 10 • I / I Lot 17 N89°59'00"W 150.00/ I — — 30 I shed 01— Z I— co Z W . W M LU cc o Lot 11 LI ..-L 'i o 11 } ZI - 43.5 0 60.0 o J Lot 16 O N 2 Story Frame House 5.0 _iO a p 24.3 0 p CS r� \Conc ret.wall(typ) ••' yt•3 N 0. cio Z <0 ?8 32.0 Z I °Septic vents °0O 0 0 V: Well° o N .1 30 � — N89°59'00"W 150.00 • I LOT 12 I LOT 15 I I + ��r.N\\1 �. OF •AL. 1, AS-BUILT NO CORNERS SET THIS DATE .� ��•• • •at 1, I hereby certify that I have performed a Mortgagee's inspection raw C). 49th �\ " � of the following described property: LOT 11, BLOCK 1, ilio*; ... SKYLINE VIEW SUBDIVISION po /• = ' Anchorage Recording Precinct,Alaska,and that the ..Fred Wa I o tka,g / improvements situated thereon are within the property lines 4-.% .. • ,v ^. and do not overlap or encroach on the property lying I • 3255 — S ••y. ,., adjacent thereto,that no improvements on the property lying i, 'o •• • . • . o adjacent thereto encroach on the premises in question and SCALE: 1 30' `��FeSS10NP� �`� that there are no roadways,transmission lines or other %.•:‘,•• `w- visible easements on said property except as indicated hereon. Dated at Anchorage,Alaska this 19th day of October ;2016. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED FRED WALATKA&ASSOCIATES PLAT ARE NOT SHOWN HEREON. FB 16-11, PG 59 Engineers and Surveyors BE (907-248-1666) MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT • 907-343-7904 On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Nitrate Advisory' Certificate of On-Site Systems Approval # OSC191227 Subdivision: Skyline View, Block: 1, Lot: 11 A water sample revealed a nitrate concentration of 8.4 milligrams per liter (mg/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. Mailing Address: P.0. Box 196650 *Anchorage,Alaska 99519-6650 *www.muni.org Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-192-44 1. GENERAL INFORMATION Expiration Date: ��(^ Complete legal description Skyline View Block 1 Lot 11 Location (site address) 19341 Lupin St Current Property owner(s) Hanson Day phone 346-4111 Mailing address$ Same Real Estate Agent Viki Kaas, Homes Unlimited Day phone 346-4111 2. TYPE OF DWELLING: IV ® Single Family (w/wo ADU) ❑ Duplex O .I < ❑ Multiple Dwellings (Single Family and/or Duplex) F\ 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class C Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Received by: Date: v I COSA to be released to the engineer, unless otherwise refiuested by the engineer. COSA Fee $ NIP -00 Date of Payment 1011 g2wp Receipt Number 05055P COSA# QSCI(91g2> Date: Date of 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 NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name _ Steve End Date 10/12/2016 `F {1 6. DSD SIGNATURE System #1 Approved for T bedrooms. M System #2 Approved for Disapproved. Conditional approval for T."q 5'.r �. stay;, y;, :v. rr- bedrooms, with the following stipulations' Original Certificate Date: ( C9 "l q l6 The Municipality of Anchorage Devlopment 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 Septic System Advisory Well Flow Advisory COSA blue sheet 9-1-12.doc X Nitrate Advisory Arsenic Advisory Other 9" If more than 1 septic system is on the lot: COSA Checklist # Structure served; by this system Certificate of ®n -Site Systems Approval Checklist Legal Description: S KY 1- /A/j6 V1 EIAJ $ / L /I Parcel ID:0 S t 192�� A. WELL DATA Well type _ If A, B, or C provide PWSID # Date completed d' Sanitary seal (Y/N) Total depth 93 5ft., Cased to 4ft. FROM. WELL LOG Date of test. Static water level z S ft. Well production l 8 g.p.m• WATER SAMPLE RESULTS: Well Log (Y/N) �z — Wires properly protected (Y/N) T Casing height (above ground) 8 in. AT INSPECTION 9.p -m. Coliform © colonies/100 mL Nitrate /. S'6mg/L Arsenic !Y� . ug/L _ Date of sample: 0 % Collected by: W .rys^7 _^ c B. SEPTICIHOLOING7 TANK DATA , Tank Type/Material S E a C % S' SEL Date installed /Q� Tank size 4E-�Q gal.' Y' Number of Compartments Z Cleanouts.(YIN). Foundation cleahout (Y/N) Depression over tank (Y/N) High water alarm (Y/N) �J Date of pumping:Pumper -SAAI / 2MPU�f/� S C'-/.1I364bt2#TIONFIELL DATA` , Date installed O cr Soil ratio d./ft2 o ft2/brm d 9 (g•p• System typ 30e Length 3 6 ft Width 3 ft. Gravel below pipe i Total depth _� ft. Eff. absorption area 3 ib ft2 Monitoring tube Depression over field .A/ Date of adequacy test Results, (Pass/Fail), p . For 1� bedrooms Fluid depth in absorption field ¢efore test in Water added Coo gal. New depth /d in. Elapsed Time: 4r2 min., j, Final fluid depth � in. Absorption rate g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) A/ If yes, give date, 11 D. LIFT STATION /VA Date installed "Pump on" level at _ Datum Size in gallons Manhole/Access (Y/N) in. "Pump oft' level at in. High water alarm level E. SEPARATION DISTANCES Cycles tested WELL ON LOT TO: Septic tank/lift station on lot /OO +t Absorption field on lot i Public sewer main /O Sewer /septic service line 25 '4 - Animal containment areas !tig %r Meets alarm & circuit requirements? MM On adjacent lots On adjacent lots rJ "f Public sewer manhole/cleanout • �Oo `�` Holding tank _466 Manure/animal excrete storage areas /06 1t SEPTIC/HOLDING TANK ON,LOT TO: Building foundation /D `'f Property line /D `t` Absorption field --< Water main `-f Water service line /0 � �- Surface water lOa it Wells on adjacent lots /60 `-0- ABSORPTION FIELD ON LOT TO: Property line 4D -F- Building foundation /0 F Water main /D � t + Water Service line.-,. l°iiJ�_"f Surface water �: '� Driveway, parkin]/ueJiicle storage _nvi Curtain drain (%f/<G Wells on adjacent lots A00 F. COMMENTS ��� 015 -kb 0 it Z46n(Cff ii f PE,fiQ-f r %4E aldld62 b 1F1 VZ1U J A161. S V ST�at f AA* S /.r ) DR. kL PM W r rW1Jei7' J-55�PI007'I . G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and nF A E review of Municipal records that the above systems are rin conformance with MOA COSA guidelines in effect on this date.; Engineer's Printed Name ., D��/ �Z /� 4 .� .�...,..... Date p"Stt aveq W. Eng ... �fi tit' 1 PE ba. 5 a�18e0p 0✓F/ESSf COSA yellow sheet 2-6-15.doc Municipality of Anchorage �, o n.:. < Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # OSC161484 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 11 of Skyline View subdivision. This inspection revealed a nitrate concentration of 9.56 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test', and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. COSA #07haq Expiration Date: j �) 07 1. GENERAL INFORMATION Complete legal description Lot 11; B1o(* 1; Skyline view subdivision Location (site address) 18341 Lupin st Eagle River, AK 99577 Current Property owner(s) cordon Douglass Day phone 748-0672 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address PO Box 672389 rhugiak, AK 99567 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site El Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an Independent professional civil engineer registered In the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shovmrovl Guidelines for tthat hisnappl cation, based on procedures outlined In the Certificate of On Systems App and adequate shows that the on-site water and type and/or ctture Indicated stewater )disposystem is sal I further verify that based onithe Information safe. L for the number of bedrooms and typ Anchorage files and from my Investigation and Inspection, the on-site water obtained from the Municipality of lsystem 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. Phone 69 4-2919 Name of Firm Address Engineer's Printed Name 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory �-- Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report — Other Original Certificate Date: By: (R«.I tA4) Municipality of Anchorage «, ' Development Services Department ^; Budding Safety Division On -Site Water 8 Wastewater Program --:: :. :. •.. 4700 Bragaw, Street P.O. Box 198550 Anchorage, AK 995198050 www.munl.orglonshe (907) 943-7904 CERTIFICATE OF ON-SITE SYSTEms APPROVAL CHECKLIST Legal Description: I I } �:GYK l/ :_ �Cll tllJE V16u) S/D Parcel ID: n S l - 17Z -917F A. WELL D Well typed VM4 It A. B, or C provide PWSID # = Date completed Sanitary sealtf! 1) 1 Total depth ft.'. Cased to �ft. FROM WELL LOG Date of test Static water level 016J ft. Well production g.p.m. WATER SAMPLE RESULTS: Colfform ID colonies/100mL Nitrate-,$mglL Arsenic: �mgn Date of sample: */0 4,7 Web Loga) 7Lx5 Wires properly, protected 0) �-/M_ Casing height (above ground) 18 r+in. AT INSPECTION /16/0 � t 4i ft. 303t — 9 -p.m - Other bacteria 0 colonies/100-mL B. SE MCIHOLDING TANK DATA Tank TypelMateft eI L Date installed IQ AQ 70 Tank size IJZWGW. Number of Compartments Cleanouts&) y�S Foundationcleanouli& _)k5 Depression over tank -(Ya, 1JOOHHigh water alarm (Y9L__LJ 0 Dateof pumping b 0 Pumper v IS Tif!%IPI�(ea C. ABSORPTION FIELD DATA ' Date Installed 1Qt U 716 Soil rating (g.p.d.M? ft'Ibdnn System type �t Length `!Ad _ ft. Width 3 ft. Gravel below pipe Total depth ft. Eff. absorption area 32- ft2 Monitoring tube ,� Depression over field &70 Date of adequacy test Res (P n) g For a bedrooms Fluid depth In absorption field before test Q in. Water added -mo. New depth in. Elapsed Time: L min. Final fluid depth Q in. Absorption rate >= 4 50 + g.p.d. Any rejuvenation treatment (past 12 mo.) (Y6 type) _ 0 & If yes, give date D. UFT STATION !v _Date installed Size in gallons "Pump on' level at _ in. "Pump ofr levy Datum Cycles tested. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 1 Septic tankilifl station on lot 1004 Absorption field on lot 160f 4 Public sewer main Ili j/g / Sewer /septic service line nJ Animal containment areas High water alarm level at in. Meets alarm & circuit requirements? I On adjacent lots /nD 4 - On adjacent lots I aD ,L Public sewer manhole/deanout v In Holding tank I Manure/animal excrete storage areas /OQ 4 SEPARATION DISTANCES FROM SEPTICIHOMI blG TANK ON LOT TO: f Building foundation �J r� Property line S ;4- / Absorption field 5 "- Water main _ _ Water service line fO Surface water f '4 r Wells on adjacent lots !� / SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line t Building foundation !O Water main Water Service line /t? f-+ Surface water 1©® } Driveway, padcingivehicle storage �U r Curtain drain 0MLIE 9XVWIJ Wells on adjacent lob F. COMMENTS G. ENGINEER'S CERTIFICATION I can'fy that I have determine gh Ned inspedions and �44V���;�� � review of Municipal records t a above s in conformance with MOA CO gu• Ilne m ife his d e. R i� Engineer's Printed Nam ul►f Date !6 Z -7 COSA Fee Date of Paye Receipt Nun (Rev. 11/05) Waiver Fee $ Date of Payment Reoeipt Number Municipality of Anchorage v • Development Services Department Building Safety Division ` On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 070327 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 11 of Skyline View subdivision. This inspection revealed a nitrate concentration of 9.8 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. C/ ' �' vl�nLLLS �� .l`{ s G•�i�jr '�'C"�V'_'Y t- s�. f• �. •,N f . 7 Cc:r:c 7 AS -BUILT fOr✓ti �t ��' 1 hereby cerbify that 1 have surveyed the following descabed PWP"'Lo If , Ertor- N 5VYL/,11E Vf r w S ve G S.c{r„• 76. TrSnf n1w t.� Anchorage Recording Premrct, Alaska, and that the imprvve- nhernts situased thereon are within the property Thies and do not overlap or enaoadn on the property lyinggcaadnjtacent thereto, that no Unprovernertts on oach on � PRm� in 4� and_ tKu these a�oroader ways hwumniaaion lines or other vi mW eaer nests on said property Oct ept as butiated hereon. Usfed at ].a River, Alasia thia >'/ `y' a;r of Y 200E SCALE ROBERT C. JOHNSON —0456. River, AL-La 99577 Phone (9071 AVk543 f� 1 1 r f D # 46 1-4 �/ o v) T_ji -if.<k' I C/ ' �' vl�nLLLS �� .l`{ s G•�i�jr '�'C"�V'_'Y t- s�. f• �. •,N f . 7 Cc:r:c 7 AS -BUILT fOr✓ti �t ��' 1 hereby cerbify that 1 have surveyed the following descabed PWP"'Lo If , Ertor- N 5VYL/,11E Vf r w S ve G S.c{r„• 76. TrSnf n1w t.� Anchorage Recording Premrct, Alaska, and that the imprvve- nhernts situased thereon are within the property Thies and do not overlap or enaoadn on the property lyinggcaadnjtacent thereto, that no Unprovernertts on oach on � PRm� in 4� and_ tKu these a�oroader ways hwumniaaion lines or other vi mW eaer nests on said property Oct ept as butiated hereon. Usfed at ].a River, Alasia thia >'/ `y' a;r of Y 200E SCALE ROBERT C. JOHNSON —0456. River, AL-La 99577 Phone (9071 AVk543 Municipality of Allichorage • �- Development Services Department ° Building Safety Division On -Site Wafer and Wastewater Program ` 4700 South Bragaw, St. ' •' P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ok.us (907)34)-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-192-44 HAA #__ L�� Z — Expiration Date: 1. GENERAL INFORMATION Complete legal description T.nr 11 Rl nr4 1 ; co- 1 i vi c hAa 1 , Q 4 Location (site address or directions) 19341 Lupin St. Eagle River Current Property ow -net' 7y(-)ki, YZlw>L Day phone Mailing address Q_ T1 71S( Z j� (7- q,V�i Lending agency Day phone Mailing address Real Estate Agent rinrig Tinrihlonm Day phone _j;g4-olvs Mailing Address 1 141 1 01 a r 111 It, X0.5 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: E; Individual On-site ❑ Individual Holding tank ❑ ❑ Community On-site 0 ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority engineer eer roval registered in the based only on the of Alaska Certificates of Health esentations given In Authority Apprh 5 oval al are requirredan tfor the transfer orofessional f 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 sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certifictates are Valid lot 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 dale 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. Hie on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and Slate codes, ordinances, and regulations in effect at the time of installation. NameofFirm S & S Engineering Phone 694-2979 Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577 Engineer's Printed Name gobprr r Cnwan — Date 5. DSD SIGNATURE �r�Af r✓_, 'VINGINE *%K;CE;T.Q f COWAN E6001 Approved for 3 bedrooms. 444% - w' *' Disapproved. 1t"A Conditional approval for bedrooms, with the following stipulations: NO-- for this property meets existing State & Municipal Codes. There are nitrates present.It is suggested that periodic testing be performed to insure the wells continued suitability. Current nitrate concentration is EPA -Maximum c rn_n me/1 More information on nitrates Additional Comments is available from the on—Site Services Program, at 343-7904. Attachments: HAA Checklist x Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's' Other —6td�E WATER AND WASTEWATER By: Original Certificate Dale: 03 (Pn . 12m) Municipality of Anchorage ' Development Services Department Building Safety Division < Onsite Water & Wastewater Program e • <<� 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ek.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: l_;r 1_ I 13q OCK ); s w Y u "i rc V 1 L + i 0 Parcel ID. OS/ - /97- -4- A. WELL DATA Well type Date completedI! 6S' �$ Total depth Ll ft Date of test Static water level Well production If A, B, or C provide PWSID t = Sanitary sell,^��a(Y/N) Cased to `7'y'ft. FROM WELL LOG 25• Its WATER SAMPLE RESULTS: Coliform coloniesJ100 ml. Arsenic: — mg.A. B. SEPTICJHOLDING TANK DATA ft. 9— p.m- Nitrate 6.S mgA. Date of sample: tlao 3 Tank Typematerial �5i Tank size ( 216-6 gal. Number of Compartments 2 Well Log (Y/N) _-Y . Wires properly protected (yIN) Casing height (above ground) AT INSPECTION TT Q 10 g.p.m. Other bactens O oolonies/100 ml. Collected by: S & S ENGINEERING 17034 Eagfa River Loop Rad Ne. 264 Eagle River, Alaska 99577 Date installed O 1 3 J'? B Cleanout (Y/N) y JFASI oc Foundation cleanout (YIN) Depression over tank (YIN) =) High water alarm (Y/N) Date of pumping 1O 24 D7i Pumper . TP I S C. ABSORPTION FIELD DATA Date installed '�j�� Soil rating (g.p.d./fe o Ibd ,� System type Trf.0-r t rr r--7 ` . Length 3&o R Width ft. Gravel below pipe S ft. Total depth-1—ft Eff. absorption area 3 rY f 2 Monitorin tube -Y--Depression over field 4 f 0 Date of adequacy test 4 0% Results (Pass/Fail) 7R S5 For -A-bedrooms Fluid depth in absorption field before test O in. Water addedZggal. New depth� in. Elapsed Time: G0 min. Final fluid depth Z4 in. Absorption rate >= _ 00 _ 9_p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) R If yes, give date — D. UFT STATION Date installed IJ 1A 'Pump on' level at n. Datum E. SEPARATION DISTANCES Size in gallons 'Pump off" level at — in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO Manhole!Aocess (YIN) High water alarm level at Meets alarm S Feu@ requirements? If Septic tankfiilj statttm on lot / 0o + On adjacent lots 100 /+ Absorption field on lot I C) i On adjacent lots 100 m + Public sewer main N Public sewer manholeldeanout -J 1A S /septic ce service line 2�r ` ding tank SEPARATION DISTANCES FROM SEPTIC/IiOL TANK ON LOT TO: r Building foundation/0"E- Property fine F /r Absorption field_5 r I Water main /J Water service line 1 O r Surface water /00 ' r Wells on adjacent lots 1pp /+ In. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: / Property line f 0 mr- Building foundation Nn, sr Water main ^J / %} Water Service line f O �+ Surface water OC? ii- Niveway, pari iNivehide storage /ice r Curtain drain&U Jc-�Wells on adjacent lots F. COMMENTS NO Ho -is E ON &-eT-- G. .G, ENGINEER'S CERTIFICATION I car* that f 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. AN 08kR?' C COW4,✓ �QJ 01 Engineer's Printed Name ti Date FSly o 3 Ott>>ii.'yat`' HAA Fee 3 3 7 Waiver Fee $ Date of Payment 4 / hr 3 Date of Payment Receipt Number ®M 01 Y S- Receipt Number (Rev. 12/01) B-13-03: •:18PM; SCS Ref./ 1034911003 Client Name S & S Engineering ProjectNamNM NA client Sample ID LI 1, B I Skyline View Matrix Drinking Water PWSID 0 ;907 5615301 0 Ai 7 MI Dates times are Alaska Standard Time Printed Date/time 08/132003 9:41 CollectedDatenlme 08/062003 16:05 Received Date/Time 08/072003 11:05 Tecbninl Director StepbetyC. Ede Released iample Remarks: 9222D -Positive growth was detected in the method blank. The sample results are not affected. 'aruneta QualifiersAewln Allowable P. PQL Units Method Container ID I.itnib Amlysis It Date Init Catera Department Nitrate -N 6.51 0.100 mg/L EPA 300.0 Bo- ( 10) 08)08)03 JJO Licrobiology Laboratory Total Coliform 0 Col/IOOmL SM189222B A (<=1) 08/07)03 JS