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HomeMy WebLinkAboutJOY LT 2Joy Lot 2 #051-154-54 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME /4 nnA PHONE >7— 91'T RNEW ❑ UPGRADE MAILING ADD SS©� LEGAL DES IPTION D LOCATION S 0 `4�J\ L t,,/ NO OF BEDROOMS Well Absorption a j Dwell to PER�YJjIT, Uy DISTANCE TO 0 ��jj PZ Manufacturepl / No of compartmen}ej LU r G Ch Liq 4� pl,�C..d ig,�allons C/(! IF HOMEMADE Inside length Width � Liquid depth ODISTANCE z TO Well Dwel ng PERMIT NO O Z < Manufacturer Material Liquid capacity in gallons O Well Foundation Nearest lot line PERMIT NO �= DISTANUJ CE TO T u. Z No of lines Length of each line otal It of lines Trench width Distance between lines F Z w inches mf Top of the to finish grade Matertil beneath the Total effective absorption area o inches Length ( Width Depth„ j ,+ /' / PERMIT � 9 w (� 7c Qa Type of crib Crib diameter Crib dep$h _ Total effeAjveFabsorp o area y DISTANCE TO Well ,� Q ( ` Buddin ou atbn Nearest lot lire !� zzj w J Cl/ Gy� Depth Driller Distance to lot line PERMIT NO W DISTANCE TO Building foundation Sewer line Septic tank Absorption area(s) e/ OTHER PIPE MATERIALS SOIL TEST R ING INSTALLE l2 tit /1'N REMARKS i C0 s "£' a ••� • Oa Hardt No. 1457.9 i1�•aa` ••a '�i ARM P � APPROVED SRS 196X DATE LEGA LL r,,4,E RIVER. ALASKA =577 72-013 (Rev 3/78) I Ild'9 N K H -H 11 j k hjl 7l_ IL_." .11. IF::::. 0 :% IL.— IT IC" ',e' V11 S " 0PA II_._. 11•--N')L` 1 =a 1 "a tl_ � L--: s T)F-"PF•RrI"li l\iT OF` HFAI TH AN5 rNVTR(:)NMENr(1•( 1-'ForF t: r:ioI,I 1. t Y I I••tL_C._ I , ANCI-•I()F ("1(H -E„ 1` /�K 1:995 0 264 -1120 10110'41 - 1-3 ]r T" I[ ' d....., IF-:" 8" IF=" F- 117c V,111 I it PERMT r NC1„ DATE I #:iE.1JE D ti APF'L T("-'Al\ll ODDF,Ef S.; CON rAC:T I'l-IC]N1. - I_i"=t".:ifal_ aJf�f:it":Ft! I"`u I._ilr SIZE- MAX IZE-M ix BEDROOMS- E3/1094t:) 1 1 l 1," 1f3A N0RMA1\1 1010NE3TFil_)CI ] C) I IN E1911 -ti I /III fFi(JDDIVTfi10NI, J 0 Y 61.. C 1 1131\1 . B /1'C';1 030. FT. I"C1WI'I`YF I I I.. 151\1 OR ACRES) I_isiod k)S=•glow ;_1f'(:-' tilS: c)p)-lJcm-,ckvc-t]lablcll to sy ,t+."ern. C.Il(:]ose Lhe oI:7 t t on th,::tl best f ] k I_ (IT - ”' e� tnnn �Lis��� V f t� /(::){.A A-1 i. G?;:i 1 gll l , )t.] 'y/0LU- (:) 0 )t 1.0 05 �( I.}L=F'TH TO F.-D:IE= !:�$ DE F'TH TC) FIEF='r" x:OI TOM (I 1 ) ; �'„ () � , ORAVEL Df--PTI--I C F'E TOTAL X UPTH (F"T 4) i 2" 9 (,Rr�Vri_ W11)rl•-I (1= T. 14.0 GRAVEN I_E:h(C3TF4 (F l „) 2E3„ 0 GrZAVEl_ VOLUME= (C:LJ YD13) 7 IAF„ 4.) TANK STZE (OAL- 5) , 1;, (;C)().. (]) Er'OII._ 1i�1T11�IC:) Cti[?„I""'I" /BR)\ C)`i I_ (IT - ”' e� tnnn �Lis��� V f t� /(::){.A A-1 i. G?;:i 1 gll l , )t.] 'y/0LU- (:) 0 )t 1.0 05 �( I.}L=F'TH TO PIPE BOTTOM .." 1-1% 'EO(..)TFtFa T19SUL_sATTf:.IN rt x DEPTH I TOF' C F'E Ftt:) l 'I t:IM •tl (;) ZY riF:C;I(.! l F?F_ A I, l F" r 5TAT 1 ON TAN[-., IvIUS l HAVE" Ar LEAST TWO C OIff: (_ R rm hl'l cen,tify 'khrair, 1.. r <5m f;'Ami I iar, 4.17 t thF•t I" aCll"4.1 roffler-It' lGRI' rW)r', fe)r'ttl b tPic) I"!{.Arl L ]r)ail i t t:)f Arlt Il(iE'lrls (1I0() A,l(1 'tl"'c 3tLc+ c6 f -'takF rA.0 '' T vd1 ] ] ]rl <••,t <tl I 'kh(a i:>y^'l t 1::,;.. a w" „ qr F�� in ] Il r.:l t:` C (:) E" r.a cl l"i t C ln) i z_ 1"i all 1 I , l� r� c_ t::) t.. r_ _> <at t`i (:., I' t..: ' E L{ I .;:r l i ') 4 i *: p <:.11"i t! ill C' C:)!il (:7 l ] c31'l {" d? W ] l_ t'i t. i i L:a (:1 C-R?:`a 1 ! i C_ r ] 'k e E" i d o f i 1"i ] -, rl e r` fn l k .� -�u T tali1l ci(:I In {:.a i, c- 't C) r.:tl] ML.A arl dt..3't cl•1.c oI Ai;•t �.,].a r'e�s(..15_ii r',iafir(?1-It _:� fC)i" 't t'I{"r �•:t f•::ii_ (-)f..'t..( dist a n c-- es t r'C)in ri.ny ex i':3'i inn INc'1.1 , lv4ca9.,tr1wo,Ier' cI9'-•I'"oc-,zi R - �„' Lorn C7 r' 1::)L(I)I -I c s ew(-r c1ge t•v y' -,t C'+in 0711 t II 1 •> (:))' ZR1")\/ cA Cl )atC PJ -I i_ (:)1" n(;,e.:Yr b'y I u i d I Under skasrld t haat k1"i 1 =S pF4 1^7n] I I'6 V'.AI ] d f fir' at fnakx ]. fYI'A in o 1.)r�dr (:){:7737-e a rld atfly e n I+::.-ir )§:''fr)(::' rl i w i ] 1 r ("fl Lt i I'rs' cin ;.x,1(::13 L ] (:)1'l;::i! 1".,Ar an w IF 61 I._TFT E31"FiTTC)IV TS) TNf r(ll._I._C L) LIV AN t11 tI."f\ G: flVI: I"i7.-) E3''( I"IC)1� tl .r l... S>l ('{C:, ('L'!I)F FY, I FIEfV ( I ) tAN r. l I"CI I{ I COL I`E RM] T (a(' D LNSPEC:1"] ON MUS i" BE_ 001 A11 I\IFT])a (') (".3 BL! r I"f_; W I LL NOT BE. APPROVL_1~) W T I VIOU I ni\l E-A. r. -.c rR T CAL C 1t11F'EC 1 T ON I'tEF'OR ! AND ( ) TI--Ir- FL EC TR T CAL WOR`I MLI(S"I" B DO Vh_ 8Y 0 L 1 CE N911 -D (EI CC'T(= ] C; I ,'•1.1\1 SIGNED DATI="c AF:'F',L_TCANT. NOIRIIA L:ONED,I RCI LOIN 19SUED F1 y MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AD ENVIRONMENTAL PROTECTION 825 L, Street, Anehoreye, Alaska 88501 2644720 I.; SOILS LOG — PERCOLATION TEST ❑ PERCOLATION TEST PERFORMED FOR AEOV '! ""LlAe�7GZ' N[�{Z Com^ ��`tDATE PERFORMED J�- L f / /ti /V . LEGAL DESCRIPTION ?► ../� S DEPTH FEET) 0 1 r % QED So/ Z' 7''OV SiJ/NP s u, •o 3 OF v a v` 4fCa 40 jr3 G f %b6- �.. 7 � 5 8 11 J /n EASG NTER7 12 IF YES, AT WHAT DEPTH? 13- 14- 15- 16- 17- Is - 19 3 la 16 16 17 is 19 !4eL Reading ;tyate Gross Time Not Time Depth to Water Not Drop e r, F ••e• +'• � er 20 410r P . \Q -'q° PERCOLA�" Iminutee/Ineh) A ,• TEST RUN BETWEEN FT AND FT COMMENTS 1Y10 V: COQ ISG , "JdF 4 /N -f PERFORMED BY 72-006 (6/79) I J I� SOILS LOG .` MUNICIPALITY OF ANCHORAGE ` DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION O PERCOLATION TEST 825 L Street, Anchorage, Alaska 99501 264-0720 SOILS LOG — PERCOLATION TEST PERFORMED FOR /L� / ""`(C G� r '✓ �/� DATE PERFORED J D L / ? r 1AJ ltAJ LEGAL DESCRIPTION �L Jo S d ,-�7 SLOPE SITE N 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS /v A PERFORMED BY�� 72 008 (6/79) WAS GROUND WATER ENCOUNTERED? Reading Data G line NetDepth 1me to Water Net Drop AI PERCOLATION RATE W! 4- (minutes/inch) TEST RUN BETWEEN FT AND FT ?- ,ee /.Ou -P 7w L"� go, CERTIFI I '✓ S 770 8 juw 2 5 MUNICIPALITY OF ANCHORAGE DEPART W-ALTH & ENVIRONMENTAL PROTECTION 1 E'nvlronmental Health Division �� Ut CASE REVIEW WORKSHEET CASE NUMBER S-7708 DATE RECEIVED June 6 1984 COMMENTS DUE BY June 22, 1984 SUBDIVISION OR PROJECT TITLE Lots 1, 2 Joy Subdivision ( ) PUBLIC WATER AVAILABLE `) PUBLIC SEWER AVAILABLE ( ) COMMUNITY WATER AVAILABLE COMMENTS / J � P l f _ e-" r nj�''r' r C F,�a !` l �♦ c 3 t! 1� it y' fcl ) l pp p>r /7 f p G ago O u<d 4:�3-2 IC- � s �a qc� 71 (o gfc. L9 ,e oU-e This well !s prod+ 5, moo PALMER, ALM TELEPHONE 7 .a r INTA CA6W„� � O'1T .8 1 a 7 i p �w ' �� 11 •” i } i ' 7 k, a $2 * L't 34— n r 38 �t a i• ti ac �iitiF�tUr.� '—{42 �• ' ai as —45 61 F , _ 62 c ,1XI n,,a 66 •6 ( v, 67 H 76 71 Ts 74 m t 76 �x A T6 77 76 } 7• s 0 i1 i 82 N 3 N m a k N i7 N N ? •1 •a 94 04 i6 NIT q 66 fV j PLEASE PAX) r. t w ■ ■ R9 `ice` � �ereNxew: 5i IMM SX ... MAI 1�101 3 moo= MM G1 � x'Fv • y x a ■� i 1 �■ I 1 i B Pli�loi _ i63k'J4L�GttuAtl 9 ifl , a� aeFA CAIMAMMA*4 '."% MaIrMam .- � A1,'ZtaeFAA m4awsom WfV44IM&M I 1t �� 0.a mar a �a tau �z n �➢"x��a�t:,°��i'� r... ��r' sew r-� �•+'� '' „fid ete" W, MMM � �k3Wwip '�WmE6T-/Tl+.�.i,�.i4 W�n`uY44¢Y Vryv.t.'.� M�. Aja Y SZ[" Wl fdY i?..Yit?�',yF pug esu. xI,CY' EMIR, n v Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-154-54 1. GENERAL INFORMATION Complete legal description Expiration Date: 6—S-13 Location (site address) 19920 Scenic Drive, Peters Creek, AK Current Property owner(s) Maps Shannon Day phone 351-3516 Mailing address same Real Estate Agent Birch Lake Realty Day phone 244-3355 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class C Well Public Water System 3 TYPE OF WASTEWATER DISPOSAL: ® Individual ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer ❑ Received by Date:. =. = COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ "b -! b Date of Payment 1 Receipt Number 035557 COSA # 05C 131U'� 3 Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 3/5/2013 6. DSD SIGNATURE x s+xo- a o System #1 Approved for � bedrooms. fl System #2 Approved for bedrooms. s , z✓. ens t Disapproved. 45 r3 �. l Conditional approval for bedrooms, with the following stipulations By: l Original Certificate Date: 3 The Munic pati 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.doe Nitrate.A<dvisor�`= c Arsenic Ativiolq > 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 Descrip A. WELL DATA GOT 2 Paroel ID:Q5 / — / Sri— Sy Well type P_ If A, B, or C provide PWSID # Well Log (Y/N) Date completed Z6 2 Sanitary seal (Y/N) __� Wires properly protected (Y/N) _ Total depth ES ft Cased to ft.. Casing height (above ground) —2-41—in. : Date of test Static water level FROM WELL LOG d 2 8 ft. Well production g,p,m, WATER SAMPLE RESULTS: AT INSPECTION z as/3 Zy ft. Sg:p:m. Coliform ,= . D oolonies/100 mL ;• Nitrate 3.68mg/L Arsenic O. 37uglL . Date of sample. (-tCollected by 2t B. SEPTICIHOLDING TANK DATA p TankType/Material Tri sane l Date installed/ 00 Tank size zodo . gal. Number of Compartments 2 Cleanouts (Y/N) 5/ Foundation cleanout (Y/N) Depression over tank (Y/N) AlHighwateralarm (YIN) /U Date of pumping t 3 Pumper. gd , C. ABSORPTION FIELD DATA Date installed/ d` Y Soil rating (g.p.d.W or ftz/)drm) S S System type SACD Length 2 5 ft. Width/,( ft. Gravel below pipe G S fL Total depth ft Eff. absorption area y00 fe . Monitoring tube. Depression over field �B Dated adequacy test 012 ell7 Results (Pass/Fam AgJJ For bedrooms Fluid depth in absorption field before test d in. Water added 5o - gal. New depth Z in. Elapsed Time: min. Final fluid depth U in. Absorption rate g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION AI , Date installed Size in.gallons •Mantiolefmcess (YIN) "Pump on' level at in. 'Pump off" level at in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tankAift station on lot _ /DO �� On adjacent lots /00 Absorption field on lot _ /�4 `fi On adjacent lots /O r't Public sewer main Aloq Public sewer manholetcleanout Sewer /septic service line 75 r Holding tank Animal containment areas Manurelanimal excrete storage areas / SEPTICIHOLDING TANK ON LOT TO: Building foundation S t Property line /cl t Absorption field S t Water main / 6. �r` Water service line Z O `�. Surface water Wells on adjacent lots p �t ABSORPTION FIELD.ON LOT TO: . Property line %Q �f Building foundation Q `t Water main N, Water Service line Surface water /GG �fi Driveway, parldnghretdde storage Curtain drain IlAj i Wells on adjacent lots fi F. COMMENTS �f�oa�^ ino�1 Gt�E irtFo G. ENGINEER'S CERTIFICATION 1 certify that I have determined through veld 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 Date COSA brown sheet_10-10-12.doc E :rGtid u STA01i Municipality of Anchorage •• • Development Services Department ;y ��•: Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 ✓ - - y�1' www.muni.orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 05-1— � � COSA# 1. GENERAL INFORMATION Expiration Date: — 17— QTS Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address JOY LOT 2 19920 SCENIC DRIVE " CHUGIAK AK 99567 JODIE COLLISON Day phone 261-3065 6369 CITADEL LANE " ANCHORAGE AK 99504 Day phone JOE MILLER w/REMAX PROPERTIES Day phone 276-2761 110 W. 38TH SUITE 100 " ANCHORAGE AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 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 On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 337-6179 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 12 I2 0 Engineers Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the Gime 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 moot the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefif of the pwner 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 1"O'O�Approved for a bedrooms. Disapproved. e rrey,tyGarness: CE -7q3 :, �Q �e'�•1'�//'L.G�e4do Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory v Arsenic Advisory Maintenance Agreements Supplemental Engineers Reort Other (R..1105) 4 ••' •••0 ON-SITE • I WATERAND • i WASTEWATER .: • PROGRAM ccam�.• iginal Certificate Date: 12L-17 —O7 Municipality of Anchorage Development Services Department Building Safety Division :. On -Site Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.8850 www.muni.orylonsits (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: JOY LOT 2 Parcel ID: OSI ' /S�-s''4 A. WELL DATA PERFORATED 40'-43' Well type PWATE If A. B, or C provide PWSID# N/A Well Log (YIN) YES Date Completed 10/24/198 Sanitary seal (YIN) YES Total depth 85 ft. Cased to *40+ ft. FROM WELL LOG Data of test 10/24/1984 Static water level UKN ft. Wires properly protected (YIN) YES Casing height (above ground) 12+ in. AT INSPECTION 11/26/2007 27 ft. Well production 10 g.p.m. 5.25 g.p.m. WATER SAMPLE RESULTS: Coliform � Colonies/100 ml. Nitrate � `�mg./L. Other bacteria coloniesl100 ml. Date of sample:11/26/200 7 Collected by: GEG Ltd Arsenic: 01) ug./L, B. SEPTIWHOLDING TANK DATA *UNDER DECK Tank Type/Material SEPTIC/STEEL Date installed 11/15/1984 Tank size 1000 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (Y/N) *YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 11/25/2007 Pumper JR'S PUMPING *PER ENGINEER THAT SIGNED C. ABSORPTION FIELD DATA 16DELOW ExtsnNa G OFF AS—BUILT DRAWING 11 15 1984 BED Date installed / � Soil rating .p.d. r }P/bdnn) 85 System type Length 25 ft. Width 16 ft. Gravel below pipe *0.5 ft. Total depth *6 ft. Eff. absorption area 400 ft' Monitoring tube YES Depression over field NO Date of adequacy test 11 /26/2007 Results (Pass/Fail) PASS For 3 bedrooms ! i Fluid depth in absorption field before test DRY in. Water added 630 gal. New depth 4 in. Elapsed Time: 300 min. Final fluid depth DR in. Absorption rate'= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN 8 type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed "Pump on" level at —in. E. SEPARATION DISTANCES Size in gallons "Pump off" Manhole/Access water alarm level at 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'+ On adjacent lots 100'+ Public sewer main N/A Sewer /septic service line 25'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 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 Welts on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I Wrti/y 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. .......................... east' Engineer's Printed Name JEFFREY A. GARNESSC –79 3� Date 1 �ItZ/o� h�r•, .1.c i2 "11i COSA Fee S `7' 2 0 , o cn Date of Payment 1 13 O 7 Receipt Number -7 7n (Rev. I IMS) Waiver Fee Date of Payment Receipt Number Municipality of Anchorage • Development Services Department , Building Safety Division ' s• s.• — 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 0 070468 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 2 of Joy subdivision. This inspection revealed a nitrate concentration of 5.47 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. r• wv •a•vv F I FST fll!EP.i TI1LE TEL f1o.907-54•2—O510V 1 q I,tict • VC_ 3 10•.5 •UI5 P.03 •AS BUILT SURVEY • .voRrrl '• . ,. 1 4. ' •'}r'i .Its •. • :I r• •• .i• . I. .• .. •. t.•:, • • .. axe Ero e. •. ; •1 L-4 .. • rte•--- +—.� n . 1 .. N cao•io'eo•�I� /Lo.il raft, • O � ' 1. "ICAWd P• ffonkrn•, t}•r•by cerilsy thot,r hqn eurrq•d the foil dnerlS•d " •- L07- 7: JOY �a�ll t owap Recwdin rAletfictl Atgako, and MCI do enrroa hm ;:! �•' -' except as fndfcaf#d't;wjon,' _ C Mb LLI,it:•w. of AL '1. U b rh• rerpon Its o ••'� •,,`S•f k .` eiW y f It's Owner to del•imfn• ihi •xl•tenc•'ol f5 •r , .'y 1� .� c^Y eCr«nanb, rnrMonlar or tetl/lctlgne wh[6-da pof p •• ;KY 1 - ♦�r qr��i ,i yt the recorded subdirieicxt plat: Under po clrtumalenc•e •h� ' r am t' �.} 1 !... ony data t»rron uwd for conn ctl or _ bolndg ry m lof ketoDllsuslnQ,, ' ;', • ;.::� ; ry a lento lines. ,1 •}. 'rrs..;r:?, , . I / "r 1 Dldi ! � '• •feet'•[ }.• 1" • 11 a'' �'��••. i. . �+�r �"��✓ .A v.aar O!g!1.1>7 :•• ORwn •1r l•Dare ej natri-vf. ,•• �r:} RI Cl{ ARO ;p.NANK1t1Sy•••.'�` :�' nLoisrcrtm moFCSS}vrlAL-LAD Stmvtygst Scat•t Plot /lsinp no,P.9, BOx 1103='EAGL.E• RlVEfl,5SKA . / :wo• Fs:x•s Ptf, 694•2371 , ' n977nl,.A... 1• t flee �. ,,,i,r•. , SGS RCO 1076177001 Client Name §Gamcss Engineering Group, Led. Project %ame/M Joy Lot 2 Client Sample ID Joy Lot 2 ' ►latrix Drinking Water P%% SID 0 Sample Remarks: .. .. . . Parameter Results 12/102007 8:28 Collected Date rime Metals by ICP/MS Received Daterrime Arsenic ND Stephen C. Ede 5.00 ug/L EP200.8 C , 1127/07 12/06/07 Waters Department , Total Nitratc/Nitritc-N 5.47 t , Mi crob ioloay Laboratory Totd Coliform 0 , , , Allowable • All Dstes/rimes are Alaska Standard Time Printed Datefrime 12/102007 8:28 Collected Date rime 11262007 17:30 Received Daterrime 11272007 8:15 Technical Director Stephen C. Ede , Allowable Prep Analysis POL Units Method Container ID Limits Date Date Init 5.00 ug/L EP200.8 C (<10) 1127/07 12/06/07 TK , , A 0.100 mg/L S\120 4500NO3-F D (<10) 1127/07 LCP , r coU100mL SM209222B A (<1) 1127/07 SDP ' , A t t MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date 12 -0 3— g (a) Legallescrip�� y(in l c�ee lot, block, subdivision, section, township, range) /Location (address or directions) 4 FF cl #q!4 k !A Lj."e ojea rar we (b) Applicants Name/(I/(.CQl'phone - Home Business Applicants Address (c) Applicant is (check one) Lending Institution ; Owner/builder ; Buyer E:1 ; Other E -::l (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent �(Pi� C=Zii -� Ial Address Telephone (f) Hai he HAA to the following address: pion �`& �Np1fitEEE;IIV� x$577' 2. Type of Residence Single -Family Multi -Family Other (describe) Number of Bedrooms 3 3. Water Supply Individual Well D4 Community = Public = Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite Public Community Holding Tank Q Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] IN r, 5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information . As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm Telephone & ti �:�JC�Ifd��Filld� Addres Date 6. DHEP Approval Approved Approved fore C bedrooms Disapproved Terms of Conditional Approval CAUTION Conditional /.L, /0 - Ist THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 ENVI RONMENTAL�PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) DEC i 100°t CHECKLIST - FEBRUARY 1984 RECEIVED Legal Description: L 2 J0S A. WELL DATA Well Classification 51'r If A, B. cr C. D.E.C. Approved(Y/N) Well Log Present (Y ) Date Ccnpleted /O / B Yie ©' SR Total Depth I Cased to r Depth of Grouting i Static Water Level 40 —Pump Set At ex- 6< Casing Height Above Ground D (1 Sanitary Seal on Casing ( ) Electrical Wiring in Conduit (Y i) _ Depression Around Wellhead (Y Separation Distances from Well: To Septic/Helelift Tank on Lot On Adjoining Lots /DV To Nearest Edge of Absorption Field on Lot �l%y ,i"� ; On Adjoining Lots /a o #4 To Nearest Public Sewer L� Al Z ta-- To Nearest Public Sewer Cleanout/Manhole l,�J To Nearest Sewer Service Line on Lot FD Water Sample Collected ByS dS'�K �/? Date fZ 4 Water Sample Test Results 57'A '/ -r/ Comments A -D o B. SEPTICS TANK DATA Date Installed l Size _ Standpipes (Y �f) Air -tight Depression over Tank ('t' Date Pumping/Maintenance Contract on Filet/ Holding Tank High -Water Alarm (YIN fio d No. of Compartments (Y WFoundation Cleanout ) st, dumped eve cJ A- ; for --- -Temporary Holding Tank Permit (YA !2 Separation Distances from Septic/Holding Tank: To Water -Supply Well /.3J Or To Building Foundation 29 To Property Lire /10 `L To Disposal Field 7 To Water Main/Service Line 570 `id To Stream, Pond, Lake, cr Mayor Drainage Course N a wiz - Comments rComments _.62 d ^_/ A= Receipt # Date Paid: Amount: Q [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Z Type of System Design Date Installed' Length of Field Width of Field a/ Depth of Field z - - Gravel Bed Thickness Square Feet of Absorption Area /U ° Standpipes Present (Y Depression over Field Or �) Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: r / To Water -Supply Well A)o {' To Property Line To Building Foundation To Existing or Abandoned System on Lot ZVJ On Adjoining Lots' To Water JJwm/Service Line To Cutbank (if present) o f l9 A-J6-� To Stream/Pond/Lake/or Major Drainage Course AJ C= &/FF d To Driveway, Parking Area, or Vehicle Storage Area ,E�?o o Comments .Cj r,� A -J D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (YM) "Pump On" Level at -�?-� "Pump Off" Level at High Water Alarm Level at J, Vent (YLM) Tested for Pumpifg'Cycles during Adequacy Test. Meets MOA Electrical Codes(Y Comments ** Check Permitted Bedroom Ratirg Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. GF Signed I' tit' 4Date �� 7 [ qq�, c 1�. Company " ' MOA No.�_ ', a� ,•'EN �.. �txw KBl /d5/s (Page 2 of 21 2-15-84 N r o p F O pi O m\ y D C 4 N C ip d ti ]I a' o ¢o � O^ J k O h a a ti' m 2 0 Qz A p N F d -----------T'--- 41 r 1. I 50 50 Qz co Ir W > N O OWN 1 : �84=288)FO