Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
DENALI HEIGHTS LT 6
Denali Heights Lot 6 #068-021-03 • Municipality of Anchorage Page / of z DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 514Q3O36-9 PID Number OCorazia3 Name: CAS A. P, sorELL Wastewater System: ® New ❑ Upgrade Address: /? 0. /3ox 77aZo/ E.96-46 /2, veg., Ak gem -77 ABSORPTION FIELD Phone: No. of Bedrooms: 3 x.Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: 0.6 GPD/Sq. Ft. Total Depth from original grade; r 2/ Lot: Block: 7 Subdivision: Pew4c / hie -yawn- /j7 Depth to pipe bottom from original grade: Ft. Gravel depth beneath pipe Ft. Township: I Range: I Section: Fill added above original grade: / D. , Ft. Gravel length: c / O / Ft. WELL: N1 New ❑ Upgrade P9 Gravel width:Number 2 Ft. of lines: / Distance betwenlines: °P Ft. Classification (Private, A,B,C): Fie, v.4TE Total Depth: 32-OQD Ft. Cased To: Ft. Total absorption area: U 10 SQ. Ft. Pipe material: 1 /V - e n / - ASTH 51., A7 Driller: SUGG/Vv4,t1 1ih4reLe. hie t. S Date Drilled: /6/q? Static Water Level: /LO Ft. Installer: .�o V/ `1 LL ea:44S r Date installed: �20 �( �:J Yield: GPM Pump Set at: Ft. Casing Height Above Ground, Ft. TANK SEPARATION DISTANCES 1R1 Septic ❑ Holding ❑ S.T.E.P. To From Septic Tank Absorption Field Litt Station Holding Tank Public/Private Sewer Lines Manufacturer: 4N4,yeR T 4 G-� / Aw/c Capacity in gallons: /Goo Well I I ► X , '-'74' ZS y` Material. STEEL Number of Compartments: 2 Surface Water Ido'-- ia-0 LIFT STATION Lot Line 101 a— I O tt Size ns: Manufacturer: Foundation ID I • 4 v "Pump on" level at: "Pump o7Y'ie at: High water alarm at: Curtain Drain kNQ�c/N Pump Make & Model Electrical Inspections performed by: /DOJOS' Remarks: BENCH MARK Location and Description: 1 -i Cir'. Co. Imo. U • �c,vLt—�'�P"510t1 Gc,Q .f.1F 2 ©� k-1-crIA-' Assumed Elevation: /ea . 4 Ft ENGINEER'S SEAL . / !: S a S CNOtNCCRING 17034 Eagle River Loop Road, No. 204 Inspections performed by: Eagle River, Alaska 49577 Dates: 1st 4-/5-93 2nd 9 - zo -93 - -" y -= " , Department of Heal and H an Services approval ,�,i� ;yam 3 -%-9¢ Reviewed and approved by: �� .. - Date 1 72-013 (Rev. 9/91) MOA 25 Permit No. SW930359 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: PID HEIGHTS SUBDIVISION LOT 6 PID No.: 06802103 CO1 CO2 1 96.0' 1 ISI 93.7' 1000 GAL SEPTIC TANK N.T.S. INSULATION 93.5' ° WELL IBM (TOP 0 SCALE 1" = 40' CMU FOUNDATION 3 BDRM HOUSE C01 A TH AT TIME OF CONSTRUCTION A 79:9" NO WATER FOUNDA A B FCO CO1 CO? CO3 CO* MT 5.0 14.0 14.5 24.0 106.0 103.0 19.0 24.5 30.0 36.0 107.0 104.0 N ENGINEER?S :SEAL 72-013 A (1/93) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Ar)15611✓L4_- LEGAL DESCRIPTION: 0-r CO aC.a•,LA 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 DEPTH uivn 4 / a /•� COMMENTS DATE PERFOMED: Township, Range, Section: a�• SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? S L A O -P E Depth to Water After Monitoring? Date: Gt't5-'13 SITE PLAN N 4 spy r oR- Reading Date Gross Time Net Time Depth to Water Net Drop Pe -t -S -.4c{ - (....-47-( 0 0 1 61-0-53 d,00 5Y4" -- 2— 9 -/D -`i3 r?:/J /O w...✓ 334' r//1.+ --5 43-10,53 `3.' /°&Ai'a 3�/f" `I`. 4 9. io-S> S; 3i) 10 ...,,t 33/4" '/l.. PERCOLATION RATE Z (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 4 T AND FT S & S ENGINEERING PERFORMEDBY170M Eagle Rlvertoop Rae d No. 204 I ACCORDANCE tfaaglexiihainAlaalsfa AlferunPAL GUIDELINES I FFE' T ON THIS DATE. DATE. 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN (l1ru ifith �rtllingJ ung Ly DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759 OWNER OF LAND fOIS oT1= Lc C ' _ ,NJ s DEPTH OF WELL ADDRESS f3V Obi< 7 7c -/ l `' k STATIC LEVEL OF WATER FT LEGAL DESCRIPTION Lor 6 06*t.)6 - i /kit: 7%5 DRAW DOWN FT DATE - Started - Ended % 0/? - GALS. PER HR PERMIT NUMBER KIND OF CASING 3 o / (J /go KIND OF FORMATION: From 0 Ft. to CR From 01. Ft. to �jq Ft to ! 1' From I From? l Ft. From rl Ft From/ / 0 Ft. From_ /5751t. to ) rFt. From -_--Ft. to ,),S -3 ---Ft. Ft Ft. Ft. to //3 Ft. to 14o Ft to/ 5 -5 --Ft. hi:3cl t:2) 'c'4\ 4.x•4 S rN 6 J 7`S CKJ1° From Ft to Ft p From Ft to Ft. 4,<e / /9" From Ft. to Ft. 13t` 0' t1C. /? cei C /' From Ft. to Ft % '>I' r/ jC' K cv.: fi=,t' 9 From Ft to Ft L��. ;mtel /)/JG �_ f , '� -4 ,i 6ACproFt. to Ft. %3t- {% k.../JC . ('1 } From Ft. to Ft. 4E11±: /'(t rr/f A',(r1 (;"/` rt tm Ft. to Ft. L L $ - G1A L.L — .)SN'"r iirom Ft. to Ft. 3194,73 'F --<7 i'7/4 / From Ft. to Ft. �7!`,04a G fes- /-7144 0 Kie Com Ft to Ft From Ft to Ft From Ft to Ft From Ft to Ft From Ft. to Ft. From Ft. to Ft. From Ft to Ft Sf L 1 ! ,J' 6 From Ft. to r2 G o Ft. From Ft. to Ft. From 07 6b Ft to )95" Ft From _Ft to 0 51t 6,6"4404.< From Ft to Ft c)3 4 472. / ,.i- Ce rt From 305 - Ft to .. of Ft Z44;°A 6CK-- From Ft. to Ft. From Ft. to Ft. From Ft to __ Ft MISCL. INFORMATION: DRILLER'S NAME 4`r- MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930359 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:DISOTELL CARL A OWNER ADDRESS:P.O. BOX 770201 EAGLE RIVER, AK 99577 PARCEL ID:06802103 LEGAL DESCRIPTION: DENALI HEIGHTS LT 6 LOT SIZE: 287844 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 9/14/93 EXPIRATION DATE: 9/14/94 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY : 3 � W DATE : °1 1 t l f '3 ISSUED BY: C. tail DATE: 9/1 T /3 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P.E. ROGER SHAFER, P.E. August 27, 1993 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, AK 99519-6650 REFERENCE: Denali Heights Subdivision, Lot 6 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 We request you issue a permit to drill a well and install a septic system to serve the proposed 3 bedroom house on the referenced property. Two test holes were performed on the property. The approximate location of the test holes are located on the attached site plan. The monitoring tubes within the holes have been checked and found to be dry. This property has enough area for a future septic upgrade, which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information for your r- -w, please contact us. Sin A. Sha er, P.E. S/LSU/lsu 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 w Q CC E- rn t.0 CO w 1- c (S CT 6 E 0-7 J w w J z w 5 vi Z N O ce 0 Z w0 0 - 0 M3 aCe aI- ao Z<0 0 wt- L- tn Vtna Z wn z rp = ot WaZZ t,.51i- 0 z 0z x00 Q•Ow} I_ • 0_ C F w ZI J V) d MI- UJ Q• tnN0 two w= Cr fnNZz F--)-w4Q0 V) J CC w H D it,=FWD 3 Z ) I- Z ILJJ - fxo 2>I -Z I-SZ0-0 tn0)Q _t -a0 C? c41 c 5 e el.`P K)> I /I 7o ▪ z 0 O_ LJtn� w> / F- 0La 00 trox >_ \ L., -r /- I- Z z CC�Q / 0 O I- / EOE. 0go M 1- Z y / / stn co zZi-0Ct O�OZO?/ �� xW 4.-' / / Z / 0^ / aa /O�W w / oax / �Q / aE� C� / *� / A. / / o / / / //CJ I / / / I / I x to )+j / o w / ah 0 4 SPILL '604 z wu- x cn Yc.)OF= z tL >Qw Z X�z0 w z vi zowao wF-Mc/I- W < K U Z X < w 0 F- UJ CL Z (.J 31YOS X09 = „l • Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR:bSo7Ei_c__ ( Ruc7/off DATE PER ORMED: LEGAL DESCRIPTION: LA, P z/ x ?/%Township, Range, Section: 1 -4 2 E 1 3- 4- 5- 6- 1111111 siA SLOPE GAA- DENkErz. WAS GROUND WATER No Dsfrlk ENCOUNTERED? SITE PLAN 7.11) 2 N CF 7R P3 1 1 11 1 I I 1 I 1 1 I _ ! LAI LA EI - -; fy • {! i r PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST SOTELL. l fyvS`rRucT(oN LEGAL DESCRIPTION: j,6 eniA(.1 DEPTH (FEET) -- — 2- 3- ■ 4- 5- r0 6- 7- 8-� 9- 10 - 13- 14 - 15- 16- 17- 18- 19- 20 - ■ ■ ■ to ■ 1 COMMENTS O KS OffTs DATE PERFORMED: SiD Township, Range, Section: 6AN- S«Zy 7 Gest. 6 -AA. - Gr:4.t w1 -1)541N SLOPE WAS GROUND WATER ENCOUNTERED? rUo S IF YES, AT WHAT L 0 P I Depth to Water After ©19193 Monilorin ? � O�te: o Y DEPTH? SITE PLAN WE -57. 7 U. /714"(4, Reading Date Gross Time Net Time Depth to Water Net Drop 8rills R2etc "7:3 — 73 " — :'1S 10 e2 Sf8 YA K :CS ICS 3" 3e R:OS 10 Pr 4/8" 8:15 io Shy'' VA" " PERCOLATION RATE 013- (minutes/Inch) PERC HOLE DIAMETER 6 TEST RUN BETWEEN AND if FT S & S ENGINEERING 17034 Eagle River Loop Road No.204 PERFORMED BY CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINCT ON THIS DATE. DATE: 72-008 (Rev. 4/85) ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Denali Heights Subdivision, Lot 6 GENERAL: 1. The scope of this project includes the installation of a 1000 gallon septic tank and five foot wide drainfields to serve the proposed three bedroom residence for the referenced property. 2. Construction shall be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. Page Two Denali Heights Subdivision, Lot 6 August 27, 1993 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed - up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter and installed approximately in the locations shown on the design. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page Three Denali Heights Subdivision, Lot 6 August 27, 1993 MINIMUM MATERIAL SPECIFICATIONS: 1 Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Tvpe of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, it's gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Denali Heights Subdivision, Lot 6 August 27, 1993 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre - construction meeting will take place on-site. Municipality of Anchorage On -Site Water & Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 068068— 1. GENERAL INFORMATION Complete legal description DENALI HEIGHTS. LOT 6 Location (site address) Current Property owner($) Mailing address Real Estate. Agent DAR WALDEN Expiration Date: 4151 COTTON GRASS DRIVE *EAGLE RIVER AK 99577 DAVID & ELIZABETH GUINN Day phone — 4151 COTTON GRASS DRIVE *EAGLE RIVER AK 99577 Day phone 2. TYPE OF DWELLING: • Single Family (w/wo ADU) (] Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System • /, El 382-1213 865-6406 TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer • Received by r {{, COSA to be released to engineer, unless otherwise4questetl by the engineer. COSA Fee $ LI Date of Payment 1©L114 Receipt Number 5Cl3l572 COSA # Date: Waiver Fee $ _ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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 al! applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions am outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for 3 bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for Date / 0 73 �P.\�-V tOF foot((( J= ON-SITE rm% bedrooms, with the following stipulations: WATER AND r WASTEWATER 0Z 9);:� )Sl11111 ,sA By: ii l//. / ( Original Certificate Date: / 0 — / U ` % 3 Thenicipality orA'nchorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory Mau wns Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: DENALI HEIGHTS; LOT 6 Parcel ID: 068-021-03 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 10/1/93 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 320 ft Cased to 94 ft Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 10/1/93 9/24/13 Static water level 120 ft. 115 ft. Well production 0.7 g.p.m. 1.55 + g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate NP mg /L Arsenic: 6`x.1 ug./L. Date of sample: 9/26/13 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1000 gal. Number of Compartments E Foundation cleanout (Y/N) YES Depression over tank NO Date of pumping 1/ 0 1 1 3 Pumper al S C. ABSORPTION FIELD DATA Collected by: GEG. Ltd. Date installed 9/15/93 Cleanouts (Y/N) YES High water alarm (YIN) N/A *BELOW EXISTING GRADE Date installed 9/15/93 Soil rating (g.p.d./ft2orCbdrn3 0_6 System type TRENCH Length 81 ft, Width 2.5 ft Gravel below pipe 5.0 ft. Total depth *9.50 ft. Eff. absorption area 810 ft2 Monitoring tube YES Depression over field NO Date of adequacy test **9/25/13 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test o in. Water added 500 gal. New depth 24 in. Elapsed Time: 945 min. Final fluid depth 0 in Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date — **PRE—SOAKED WITH 2000 GALLONS OF WATER ON 9/24/13 D. LIFT STATION Date installed Size in gallons "Pump on" level at in "Pump off' level Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 100'+ F. Septic tank/lift station on lot Absorption field on lot Public sewer main 100'+ N/A Sewer /septic service line 25'+ Animal containment areas 501+ Manhole/Access (Y/N High water alarm level at in Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 1001+ Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas 1001+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 51+ 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 service line 10'+ Surface water 100'+ Curtain drain COMMENTS NONE KNOWN Wells on adjacent lots 100'+ Water main N/A Driveway, parking/vehicle storage 10'+ G. ENGINEER'S CERTIFICATION 1 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. Engineer'sPd m e Date /® 43 JEFFREY A. GARNESS (Rev. 11/05) Municipality of Anchorage Community Development Department Development Services 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 Arsenic Advisory Certificate of On -Site Systems Approval # 131512 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 6 of Denali Heights Subdivision. This inspection revealed an arsenic concentration of 64.7 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/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. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. 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 Parcel I.D. 068-021-03 1. GENERAL INFORMATION Complete legal description Denali Heights SID, Lot 6 COSA# 0 C 101ZOO Expiration Date: 1, f 3 - / 0 Location (site address) 4151 Cotton Grass Drive Current Property owner(s) Jean & Roger Daniel Day phone 694-6858 Mailing address Lending agency Mailing address Day phone Real Estate Agent Eva Locan - Jack White Prudential Mailing Address Day phone 689-6476 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 TYPE OF WASTEWATER DISPOSAL: ® Individual On-site ❑ 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 trt rtifrcateeafer piou- -s servre.. mss o - s or apo. is wa er sys em. 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 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 Pannone Engineering Services, LLC Phone 272-8218 Address P.O. Box 100217, Anchorage, AK qg io Engineer's Printed Name Steven R. Pannone, P.E. Date 8C31/2010 Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. PES can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed • :Steven R. Pannone: above. Any reliance upon or use of this report by any other person or party is not authorized nor will it •• 1, =. No. CE 8149 confer any legal right whatsoever. ���. 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. . STh • 49TH liS Conditional approval for bedrooms, with the following stipulations: i i ■ 00(Ugf �N • ON-SITE ": �• WATER AND ; WASTEWATER : PROGRAM . •�0 �t E S\AC).- Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: /5--/ Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & 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 CHECKLIST Legal Description: Denali Heights SID, Lot 6 A. WELL DATA Well type Private Date completed 2oh/1991 Total depth /2o ft. Parcel ID: 068-021-03 If A, B, or C provide PWSID # Well Log (Y/N) Y Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Cased toY/91)e°41. Delit Casing height (above ground) 18 in. AT INSPECTION FROM WELL LOG Date of test 1.o/2/29g3 6/201.0 Static water level 120 ft. 121 ft. Well production 0.7 g.p.m. 2.0 g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate 0.164, mg//L Other bacteria /Vim colonies/100 mL Arsenic: al.Tug/I Date of sample: 1126 Collected by: (JO B. SEPTIC/HOLDING TANK DATA Tank Type/Material Steel Date installed 0/15/1993 C. Tank size loon gal. Foundation cleanout (Y/N) Y Date of pumping 10/2/2009 Number of Compartments 2 Depression over tank (Y/N) N Pumper JR's Pumping Cleanouts (Y/N) Y High water alarm (Y/N) N ABSORPTION FIELD DATA Date installed 9/20/1993 Soil rating (g.p.d./ft2 or ft2/bdrm) o.6 apd/sf System type Deep Trench Length 81 ft. Width 2.5 ft. Gravel below pipe 5.o ft. Total depth Its ft. Eff. absorption area 8�0 ft2 Monitoring tube Y Depression over field N Date of adequacy test 6/24/202o Results (Pass/Fail) Pass. Fluid depth in absorption field before test o in. Elapsed Time: o min. Final fluid depth in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N For 3 bedrooms Water added gal. Absorption rate >= 450+ If yes, give date New deptho in. g.p.d. D. LIFT STATION Date installed Size in gallons "Pump on", level at in. "Pump off' level at in. in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 145 Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout loo+ Sewer /septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100+ Building foundation 10+ Water main 10+ Property line so+ Water service line 25+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 25+ Surface water 100+ Curtain drain 50+ Wells on adjacent Tots 100+ F. COMMENTS C921&tWQ (.` r s-rqoen2An go '3 _c 5 # 5 ea -cc ®.v ®n./ `29/2.6//o- Water +9i'z I/o - G. ENGINEER'S CERTIFICATION I 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. Engineer's Printed Name Steven R. Pannone, P.E. Date 8/31/2010 Absorption field 5+ Surface water 100+ Water main 75+ Driveway, parking/vehicle storage 10+ ib/2.00.7gs va -N4 a. cx.Ts 4911- •• Steven R. Pannone: 4�'J '•.• No. CE 8149 4 ESS! •0 i i 1.0 • ci • COSA Fee $ (df O Date of Payment a9(9 /,o Receipt Number O053d-6 (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage 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 Arsenic Advisory Certificate of On -Site Systems Approval # 101200 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 6 of Denali Heights Subdivision. This inspection revealed an arsenic concentration of 21.5 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/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. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. SGS SGS Ref.# Client Name Project Name/# Client Sample ID Matrix PW SID 1104452001 Pannone Eng. Srv. Denali Hts S/D Lot 6 Denali Hts S/D Lot 6 Drinking Water 0 Printed Date/Time Collected Date/Time Received Date/Time Technical Director 09/03/2010 16:32 08/26/2010 15:00 08/27/2010 16:14 Stephen C. Ede Sample Remarks: Parameter Results LOQ Units Method Allowable Prep Analysis Container ID Limits Date Date Init Metals by ICP/MS Arsenic Waters Department Total Nitrate/Nitrite-N Microbiology Laboratory E. Coli Total Coliform 21.5 * 5.00 ug/L EP200.8 C (<10) 08/27/10 08/30/10 KDC 0.166 0.100 mg/L SM20 4500NO3-F B (<10) 08/31/10 AYC Negative 1 100mL SM20 9223B A 08/26/10 SDP Negative 1 100mL SM20 9223B A 08/26/10 SDP 08/25/2010 13:17 9073449821 Jets Pumping PO l3ox 773415 Eagle River, AK 99577 (907) 694-6454 [Billini Information Jean & Roger Daniel 4151 Cotton Grass Drive Eagle River, AK 99577 (907) 694-6596 Lob Slte Information T 1 Jean 4151 Cotton Grass Drive Eagle River, AK 99577 (907) 694-6596 Additional Location Comments Last house on the right - Tan 2 story/ #'s on black sign out front Pipes Back of home Service Type Septic Sery 1000K Job Description: P,0, Number: Terms: Salesrep; Map Book: Cross Streets: Job Comments; JRS SEPTIC PAGE 01 1000g Net 30 Dawn -Dawn Mile 6,2 Hiland Road Service Agreement Number: 029849 Order Date: 28 -Sep -2009 Service Date: 02 -Oct -2009 12:00 Technician: Mike Tax %: 0 Job Type: Repeat Map Grid: 161- - Last Service *10/16/2008* 1000g tank normal back flushed 2 times=clean clean outs ok Diagram: S:\Diagrams\1$t91Q,bmo Qty Price Each 1 $240.00 Tax? No Gallons Planned: 1000 Gal. Actual: Hose Length: 3 Double Tank: ❑ Pump System: RI Baffles Inlet: ❑ Baffles Outlet: ❑ Extension Actual $240.00 NonTaxable Total Estimated Charges: 5240.00 Actual Charges: Taxable Total $0.00 Tax Total $0,00 Grand Total $240.00 Customer agrees to the terms and conditions shown. THIS IS A BINDING AGREEMENT. Signature and Title of Customer Representative Date 11( Accepted by JRs Pumping Date Accepted For your added oonvenlence we accept; American Express, Dicover, Visa and Master Card payments over the phone. After 30 Days account will be turned over to COLLECTIONS. 330,00 For NSF checks Returned, 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 Parcel I.D. 068-021-03 1. GENERAL INFORMATION Complete legal description Denali Heights S/D, Lot 6 Location (site address) 4151 Cotton Grass Drive COSA # i0/2 0 0 Expiration Date: 3 _ 0 % C Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing: Address Jean & Roger Daniel Day phone 694-6g58 Day phone Eva Locan - Jack White Prudential Day phone 689-6476 Unless otherwise ,reluested, 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 TYPE OF WASTEWATER DISPOSAL: ® Individual On-site ❑ Individual Holding Tank ❑ Community On-site ❑ Public Sewer z 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 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 Pannone Engineering Services, LLC Phone 272-8218 Address P.O. Box 100217, Anchorage. AK gq, io Engineer's Printed Name Steven R. Pannone, P.E. Date 12/17/2010 Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. PES can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: • 4: ON SITE "Vas WATER AND t rnS ▪ �l:ASTEWATER • • PROGRAM • • , NTS ,oN» Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: ) — , O — / O Anchorage. senates s{a on On -Site Water 8v:VVsstowiaterPriograin 4700 Bragaw Street P:0; Box 196650 :AK 69519-6650 vv. rnuuni.org/onsite • (907) 343-7904 6"T C T1F €',..7,7..E.:'O SITE SYSTE S APPRv.AL'C CK!_ T • •L at:Oesori % 6 Parcel -la • o68-022 -o3 A. SELL tTa' 1 teIt ttIpe,Priu a If A, B, or C provide PWV,SID # Wei Log (YIN) Y . • Date carr a i SMary..0:00:(.Y. . / N.) i Wires Pr �pr d (YIN) Y T *(41tI `.1 ft:Case . 0 °BEDROCK ft. Casing i eigt t (above ground) .18 in. fR.Qt41.10ELL LOi3(AT tE4S:FECTi I Dateeof fest ' 101 6/.z44ozo. Staff va teirel 120 . ft. 21. ft. ►TSR SSE RES TS: 0 ;m t 2.0 L Nitrate • 0.1 rng/L Other bacteria a a " *es/100 ra Arm: S. HOt , G 1 TA Tank `ater(aI..5 f Tank•size , ,gat . Date of sample: 12/01203.0 ' Coi Cted.t y: Pannone Er gineering of C' 9.. SII eats 2 Date installed4%5j1g93 C N) X v kith -1041a rrf> t'rah t 'DepresOop over tank (Y/N) N . High ver atarm {VIN) N Date of C. Date. .- S li ng (g.pp d./ft2 or ft2/bdrrn) Q 6 a sf Sym type"• . ,Tsendi Length 82. ` ft. Width .2.5 ft Gravel below ID'S:0 Total kleptil..8u. ft. Eff. ion: area :sao.ft2 Moniforing tube Y ® over fold N; 0 ;70 Pumper JFes Pumping Date; of adOctial test or aits,(Pass/Fail) Pass Fluid din0, 0,$$ o ' ® gin. � tesf _ Vllater,ad Elapsed Time4rnin. ‘FinaI1uid:depth o in. For•3Iroorns Nev deptao ire. Absorption:rate **4544,g p;d I. Any rejuvenation treatimaitt'tpast Vita) (Y/N & type) N If yes, give date x D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at in. "Pumpoff" level at in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTALS FROM WELL ON LOT TO: Septic tank/lift.station on lot s On adjacent lots loo+ Absorption fieldon lot leo+ On adjacent Tots 20o+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer /septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas soo+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10+ Property line ,10+ Absorption field 5+ Water main 10+ Water Service line 25+ Surface water 100+ Wells on adjacent lots :too+ SEPARATION DISTANCE FROIVI ABSORPTION FIELD ON LOT TO: 2 + Building foundation 10+ Surface water 100+ Curtain drain so+ Wells on adjacent lots 100+ • Water main 75+ Driveway, parking/vehicle storage Original test performed by S&S Eng. on 6/24/1o. PES verified the results on 8/26/2o. G. ENGINEER'SCERTIFICATION I certify that I have determined. through field inspections and review of Municipal rods that the above systems are in conformance with MOA COSA g idelines in effect, on this date.': Engineer's Printed Name Steven R. Pannone. P.E. Date 12/1104#2010 10+ %Steven R. Pannone:: No. CE 8149 / COSA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number (Rev. 11/05) SGS SGS Ref.# Client Name Project Name/# Client Sample ID Matrix 1106584001 Pannone Eng. Srv. Denali Heights Lot 6 Denali Heights Lot 6 Drinking Water Printed Date/Time Collected Date/Time Received Date/Time Technical Director 12/16/2010 16:23 12/13/2010 16:45 12/14/2010 13:15 Stephen C. Ede Sample Remarks: Parameter Results LOQ Units Method Allowable Prep Analysis Container ID Limits Date Date Init Waters Department Total Nitrate/Nitrite-N ND Microbiology Laboratory E. Coli Total Coliform Negative Negative 0.100 mg/L SM20 4500NO3-F B (<10) 1 100mL SM20 9223B A 12/15/10 AYC 12/14/10 DLC 1 100mL SM20 9223B A 12/14/10 DLC MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 068-021-0 3 1. GENERAL INFORMATION HAA# �1n;11 Complete legal description Lot ' 6 Denali Heights Location (site address or directions) NHN Cottongrass Drive Eagle River, AK 99577 Property owner Roger & Monica Fleegel Day phone 696-0546 Mailing address HC85 Box 9339 Eagle River, AK 99577 Lending agency Day phone Mailing address Agent Eva Loken/ Prudential Vista R.E. Day phone 689-6476 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well Public water XX NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site ,r; XX NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system.'r' 12-025 (Rev. 1/91) Front MOA I21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Phone 97--"�1-77 Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, Ls c. Address 6901 DEBARR ROAD, SUITE 28 ANCHORAGE, ALASKA 88604 3 /i3�g� Engineers signature Date / Alaska Water & Wastewater Consultants, Inc Shall be PAID $ 0 at, or prior to, closing for the ENeinperin5 g.P.rvices Provided. 6. DHHS SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for ;;; A. Garner � E.7953 �'/ 1 � •• f ,tom r r 4'�OFESS 0' :v' bedrooms, with the following stipulations: Additional Comments By. Date -/-9q CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates; based only upon the representations given in paragraph 5 -above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1191) Back MOA 021 RECEIVEu Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICESMAR 2 4 1999 Environmental Services Division MUNICIPALITY FANCHORA 825 L Street, Room 502 • Anchorage, Alaska 99501 • b tt1VICES DIVISION Health Authority Approval Checklist Legal Description: LOr Parcel LD.: 06 g- 0 1— 0 3 A. WELL DATA PV--ofitiE lWell type If A, B, or C, attach ADEC letter. ADEC water system number A `/- Log present/N) 7 E5 Date completed i nh.3 u Total depth -d-t)' Cased to Rt -.Duca Casing height (above ground) Jc "/"" Sanitary seal OM `l. --S Wires properly protected 64N) YDS' FROM WELL LOG AT INSPECTION Date of test / �/ 61 3 ~ b _ ` cl Static water level 1,0 ' las' Well production qv 6 --AL. /i- g m I` g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate • 22- )1 13 AL Other bacteria Date of sample: 3/6219 , Collected by: A -Jv-- C i (J G' B. SEPTIC/HOLDING TANK DATA Date installed cl,V)-dA`t3 Tank size I Foundation cleanout((YN) Y& Depression (Y/6 IUB High water alarm (Y0 1"-}/ 8.--Ar3' -98 Pumper /-S 1000 (r -Number of Compartments �-- Cleanouts `N) Date of Pumping C. ABSORPTION FIELD DATA Date installed cA b- KS Soil rating (g.p.d./ or ft2/bdrm) 0, - 4 -System type bE,F,_..A0 7'Nw Length s( Width a,S � Gravel thickness below pipe Total depth 99 MY Effective absorption area B 13 E Monitoring Tube present �GhN) Y Depression over field (Y, N b Date of adequacy test 3""1"9cl Results (Pass/Fail) .13KS For -l-A(Z bedrooms Fluid depth in absorption field before test (in.); PRI Immediately after 535 gal. water added (in.): '6 n Fluid depth a (ins) Minutes later: Peroxide treatment (past 12 months) (Y0 f o-- Li,i6iLy If yes, give date /U/A- 72-026 (Rev. 3/96)* 74-0 Mia. Absorption rate = 150 g.p.d. D. LIFT STATION Date installed //4" Size in gallons Manhole/Access (Y/N) "Pump on" level at* "Pump off" level at* High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot / 0 v On adjacent Tots / CO / Absorption field on lot 100 't On adjacent lots /00'4 Public sewer main N/A Public sewer manhole/cleanout Sewer /septic service line � f Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: -/- Foundation 5 f Property line /v 4- Absorption field Water main/service line 10 1 Surface water/drainage / - Wells on adjacent lots /°O SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line / 4--- Building foundation /o Water main/service line d y Surface water I OO 4 - Curtain drain Nom Driveway, parking/vehicle storage area 606 Wells on adjacent lots /611- F. ENGINEER'S CERTIFICATION A 51.,)0.� c,.) 620un'D• 1:e+�. Abu I certify that / hay.- .• iii, inefi- d inspections and review of Municipal re tr = th;' %oVs are in conformance nide fines in effect on this date. ".,. .'(177 ,= , r • Signature /dL �`` we 0 Engineer's Name de-fF A C,,,I(2.,)&Ss �,��- s►'�`'„ 7933 .•�. Date ?/ 3/5<7 'Serp a'»..r"' a �• ••hOFESSS�` HAA Fee $ c ern Date of Payment -) /7--# f cr Receipt Number 9747- - C 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number MAR -12-99 12:55 FROM -CTE ENVIRONMENTAL 5815301 T-298 P.01/02 F-739 Akt," CT&E Environmental Services Inc_ CT&E Ref.4 Client Name Project Name!, Client Sample ID Matrix Ordered By ?WSW 990878001 AK Water & Wastewater Consultants Inc, N/A Denali Heights SJD Lr6-Outsid Dunking Water 0 Client PU+F Printed Date/Time 03/12/99 12:29 Collected Date/Time 03/08/99 16:20 Received Dente/Time 03/09/99 11:15 Technical Director: Stephen C Ede Released By ; ample Remarks: Parameter Taea1 Coliform Mitrase-N Results POs. 0 0.224 uni ra Memos cQl/1001 0.100 my/e. Atlowabie Prep Limits Pate AnEystis Date tnic SM18 92220 EPA 300.0 33/09/99 KAP 10 max 03/09/99 03/09/99 SCI. ASBUILT HEPEBY CERTIFY •THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY &SEMf NTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. TO 'd 2_L179 689 L06 SEWARD & ASSOCIATES LAND SURVEYING 694-0829 .x' * 9 T '' '.-:;,,,k rte: � •� fli wnn, MArk rw.,0 . a M rt 4M:skxs; 9FQ9!'Z84 Wd 1'T:ZT 66-ZZ-NizIW Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN.SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING OLA-na\-O 1. GENERAL INFORMATION Complete legal description HAA # 1Y9L1nCA% Lot 6; DenaLi: fleLghts SubdLv1&Lon Location (site address or directions) Property owner CARL D.ISOTELL/DISOTELL CONSTRUCTION uayphone 694-5797 Mailing address P.O. Box 770210 Eag1 . Rive4, AK 99577 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 . TYPE OF WATER SUPPLY: Individual well Community well Public water XXX NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer XXX NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/91) Front MOA 021 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm s & g E; CINCERING 17034 Eagle River L Address Eagle River, Ala Engineer's signature Phone 2979 p Road 77 Date 2 0.224 . DHHS SIGNATURE Approved for 3 Disapproved. bedrooms. eta, 437-6 ,O� 1 1� vtl01.iY ti Conditional approval for bedrooms, with the following stipulations: Additional Comments ,t2 Date 3 ` 74 CAUTION The Municipality of Artichorage Department of Health and Human Services (DHHS) issues Health Authority Approval,Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors o. omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST L., \A 6 4-h- SLA -e-2 - O Cob 0 2 I o Legal Description: 1..– L� Parcel I.D. A. Well Data Well type"Pe I v -,47 ---If A, B, or C, attach ADEC letter. ADEC water system number/L)//6.- Log present( /N) Date completed / D�g 3 Driller 5uc_L-rvA�uLe-)P-r e Total depth 3 2 O / Cased to 40 Casing height / Z -t Sanitary sej(/N) y Wires properly protected /N) FROM WELL LOG AT INSPECTION Date of test / °! t 2--lk-`14 Static water level io2D / \ c\I Well flow Pump levell 4-P fl'. -- ,q.n1. l , Z g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot «' ; On adjacent lots /CD fl- Absorption 1Absorption field on lot /5g / ; On adjacent Tots / Z,Z) ' -f— Public sewer main /I"- kde,,,_I Public sewer manhole/cleanout (Lio->J Sewer service line 25 1`' Petroleum tank 0e___ WATER SAMPLE RESULTS: Coliform ' ,) Nitrate , 3q rk9/1, Other bacteria O Date of sample: 21 /b/'!4 Collected by: 54 s 6.1l/ e. B. SEPTIC/HOLDING TANK DATA Date installe 9-z- 9E7 Tank size /4-n ��Z--- Compartments Cleanouts Y/N) L/ Foundation cleanou/N) Depression (Y I (- High water alarm (Y V� JAI Alar tested (Y/N) 04' Date of pumping /J//n, Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s)/�, on lot � �t"'1 On adjacent lots To property line t b I Absorption field Surface water/drainage 1 14-- 72-026 (3193)' Front Foundation 101 Water main/service line 10 ��— CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manu urer Size in gallons Manhole/Access (Y/N) m z Vent (Y/N) "Pump on" level - "Pump off" Level at 5_ 7:7f o z High water alarm level Cycles tested .__ 1 i n C Z a Meets MOA electrical codes (Yrri -v m C ,`C cfl < ) rri co n N C ' SEPARATION DISTAN FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed 191 — 20'16'1 5 Soil rating (GPD/Ft2) _yc z (9. 60 System type DEPT iJC+I f I Length �% Width 2,6 Gravel thickness Total depth Depression over field Total absorption area e o Cleanout presen N) Date of adequacy test l� �� A . Results (pass/fail) Water level in absorption field before test Peroxide treatment (past 12 months) (Y Y,)/#6.- for .5 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 158 On adjacent lots CZ) To building foundation 2 7 1 � r On adjacent lots f Cutbank So/f Water main/service line /0 ra- Surface water / 67) Driveway, parking/vehicle storage area 5 After test Bedrooms If yes, give date Property line To existing or abandoned system on lot t IA Curtain drain tJf— E. ENGINEER'S CERTIFICATION I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name 17034 Eagle R' er Loop Road No. 204 Eagle River laska 99577 2 Date HAA Fee $ ,3c' ` GYD Date of Payment Receipt Number 72-026 (3/93)' Back 0?s7 73 Car& Waiver Fee $ Date of Payment Receipt Number L16 SINCE 1908 Commercial Testing & Engineering Co. Environmental Laboratory Services CT&E Ref.* :q4.0652 3 Client Sample ID :L6 DENALI HTS. Matrix :WATER Client. Name Ordered By Project Name Project# PWSID :S & S ENGINEERING : R . SHAFER :UA REPORT of ANALYSIS 5633 B Street Anchorage, AK 99518-1600 Tel: (907) 562-2343 Fax: (907) 561-5301 WORN Order Printed Date Collected Date Received Date Technical Director Released By :75758 :02/14/94 @ 15:46 :02/09/94 @ 11:00 :02/10/94 @ 15:45 hrs. hrs. hrs. S:P�EDEc�-.__ Sample Remarks: ROUTINE SAMPLE COLLECTED BY: RAY. Parameter Nitrate -N QC Allowable Ext. Anal Results Quai Units Method Limits Date Date Init. 0.37 mg/L EPA 353.2/300.0 10 02/11 LLH * See Special Instructions Above ** See Sample Remarks Above U = Undetected, Reported value is the D Secondary dilution. practical quantification .limit. f�N SGS Member of the SGS Group (Societe Generale de Surveillance) UA = Unavailable NA = Not. Analyzed LT = Less Than GT = Greater Than ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA