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Home My WebLink AboutEARLES LT 5�1b6189707 r H i �i` ION ! ® Municipality of Ancho � �s�� z On -Site Water and Wastewater Pro rE JAN 2 3 2020 (907) 343-7904 6'A F E T. �a A., CERTIFICATE OF ON-SITE SYSTEMS OV O1 6 9 b Parcel I.D. 012-242-07 Expiration Date: 1. GENERAL INFORMATION Complete legal description Earles Lot 7 Location (site address) 7730 Huckleberry St Current Property owner(s) Timothy J Darnall Day phone 907-341-7318 Mailing address Real Estate Agent 7730 Huckleberry St 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual ❑ Individual Well ® Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class _Well ❑ Public Sewer Public Water System ❑ WaiverNariance request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 6q*80 Date of Payment 1 lag Jaa ao Receipt Number COSA# (AG�Lo Ion 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. Name of Firm ARCTERRA CONSULTING, INC. Phone 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future � �\ occupants or can ArcTerra guarantee that no unseen � -- or aL\ encroachments, deficiencies or discrepancies exist. c�v �XQlT117C_ �j 6. DSD SIGNATURE System #1 Approved for � System #2 Approved for Disapproved. Conditional approval for Pis KENNETH \ qC bedrooms. 7 Is Ale bedrooms. ,r� o z``1.► bedrooms, with the following stipul{' ns: kkkkk r(y°rrF WA7-E,-? A7-Ep IV! V! 1 l t Original Certificate Date: 7Ci Z0 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. n r,� 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Well Flow Advisory COSA blue sheet 10-10-12.doc Arsenic Advisory �c Other rr "ti rR t h I COSA Checklist Legal Description: Earles Lot 7 Parcel ID: 012-242-07 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system 1 A. WELL DATA Well log is filed th-e 'te (or attached) Date drille i t - i (P.- 12 Total dep h 3 0� ft �j Q o Cased t 3 p2 --ft Sanitar eal is functioning correctly Wires are properly protected Casing height (above ground) 36 in. Date of flow test for COSA 1/6/20 Static water level at beginning of test 77 ft. Comments B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA Public Sewer Which system tested (date installed) ❑ ALL standpipes present pet record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into'effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Well production at time of test 6.1+ 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 15'0 /L u g E] Arsenic less than MRL (ND) Collected by Arcterra Consulting Date of Sample 1/6/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date Results ❑ Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate and Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25'k] Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No ft ® Yes if No ft ft If septic tank is under driveway comment below 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: ❑ Yes Absorption Field > 5' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No ft Water Main > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No ft Water Service Line > 10' ❑ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ❑ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No ft Water Service Line > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No ft Surface Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 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. COSA Checklist yellow sheet DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite Arsenic Advisory Certificate of On -Site Systems Approval # OSC201022 Subdivision: Earles, Lot 7 907-343-7904 Fax: 343-7997 A water sample revealed an arsenic concentration of 15.0 micrograms per liter (ug/L). 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. Mailing Address P C) Box 196650 *Anchorage, Alaska 99519 6650 * www` muni 0rg Earles Lot 5 #012-242-09 oi Anchorage January 8, 1988 P.O. BOX 196650 ANCHORAGE, ALASKA 99519-6650 (907) 343-4200 7rxxxwxyx Tom Fink, MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES Mona Thompson 7706 Huckleberry Anchorage, Alaska 99502 Subject: Lot 5 Earles Subdivision Permit #870242, Tax #012-242-09 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1987. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as -built inspection report (three-part form) must be sent to this office for review and approval, and for documentation. Effective January 1, 1988, a new fee schedule is in effect. When re -applying for a new permit, the new fees are; $90.00 for an on-site sewer permit; $50.00 for a well permit; $140.00 for a combined sewer and well permit. If there are any further questions, please call this office at 343-4744. Sincerely, Robert W. Robinson Program Manager On-site Services RWR/ljw enc: Copy of Permit Eq -e. tc S eVerCr sM q 4/e I- r 11 — C i0 i cifoi 4'SL 00 IL 00 'CC . 00311. .- 1 N \ b'G1- zl kiJ —J 1 - Con!►0I Monuntliet sl 099 • 1,1/1 £o 000s 1 "7 J ti u 1\ c i I 11 KY rip •4s0.7�rJ.v..�rlP -0o s1 —��oo -- ; 00 A- -00',13- 00'64 of0 •D --.4111111/4t 0 PDOLI el p1 , limo tit • ... k.�., 11 � I ----------1 -I 1'1 I v IIJ 1 h Ljj 0 CO z 0 0, 5 to ›- w - 1 1- w w 1-- (1) 1- 0 z w Fi5 w w• O (/) z w < z D. 1 Lu 0 z cc 0 ILI 0 LC 0 Z w O 4) FL- < 0 w < z CONNECT DEPTH AT Prop. Line uJ a >1— z - 2s) 0 (907)243-2282 KEN JOHNSON ONURPAWY WATER vvral.mitttmo PUMP ,WIIEH& SERVICE 3.5 YEARS ALASKA DRILLING MONA TECT.CPSON 2706 TITic•UPP-PbliY ST. ,AN ALASNA, 99,5302 1.0,Ig LOT 5 LANLS SUBD. 0 ft to 1 ft 1 ft 2) 4 ft 4 ft to 12 ;rt 12 ft -to 49 ft 49 ft to 00 32 60 ft to 80 ft 30 ft to 106 ft. 106 ft to 3,64 ft 104 il to 175 ft 17"j ft to 193 :.L 1 ft to 205 ft 208 ft 2), 2) ft 218 ft to 228 ft 228 to 2 ft 2'35 ft to 249 :rt 249 ft td255 ft 255 ft to 27) ft 278 ft to 275 ft 27.5 ft to 270 ft 278 ft to 286 ft 286 ft to 289-.6 E89-6 ft to 29) 293 TOO MiLMR WW.T TAG 3163 UNDEN DRI\PT:' APIC ALASKA 99502 OOTObER 2, 1957 MUNICIPALITY OF ANCHORAGEt DEPT. OF HEALTH 8, ENVIRONMENTAL PROTECTION RECEIVED Sandy brn silt Brn sand Blk sand 2organics Gray silty sand Wet gray sand..fino.. Same..heaves 10 ft. Same heaves 20 ft. Clay Claywith sandy seam..Weeps Siltyi--,and.,weops., ooses..10" beave.. Same with slight clay texture,. casing tighter Sandy clay Silty sand..hevos 25'..dirty Sandy clay Clay 2 fine gray..tight..dry Couvse 2: gray silt dry Same W). 60 trace of clay seam Weops.,dirty ..p00r..01120 W eep in 5,0' overnito, Claywith som Clay fine gray..dry Med urav n gray silt..woops Clean mod gxav 2 course sand...water boaring Static 91 ft T002.5s,-,011,.2,0„,1„...YL„flZT,, O rawdown to 1."5 0»OPM Water would not clear with fine bilk snd. a DLY1ky• Clean Water bearing mod Gray 2dand Static water level 84 'ft.0„T.11,0 GPM-“Cle,2n dravaown. 90 14499 11 ln„, TOTAL CASING. / 293.0' TOO Municipality of Anchorage On -Site Water & Wastewater Program (907) 343-7904 e j Stick. rM.0—c CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 012-242-09 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Real Estate Agent EARLES S/D; LOT 5 Expiration Date: IkJev1) 401/1! r 7706 HUCKLEBERRY ST, ANCHORAGE, AK, 99515 ALEXANDER HOMES Day phone 830-6211 650 W. 58TH AVENUE, ANCHORAGE, AK, 99518 2. TYPE OF DWELLING: ▪ Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well • Individual On-site Individual Water Storage H Individual Holding tank Community Class Well LJ Community On-site Public Water System ❑ Public Sewer W aiverNariance request for n/a n ❑ ■ Distance: — Received by: COSA to be released to the engineer. unless otherwise requested by the engineer. Date: COSA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number COSA # OCC -1 (1/04/7 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 1/20/ ILE Engineers 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 wafer usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for Me 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 if confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following On a /j/ 0 %l."i,4 � rn ess.. ...• • i0 c°iO 'Oro ressiOVLe �400000�� \1Nii_t1 i(i ti .. ,..,��y & ANCy0Rgi`rr g S�� p -r stipulatioHs� �P� t1PCk � �= S'<E PM t • o 0. rj i 0 �� ?'° t. 4` \ j-9,9—PMENT CI 0 I t Lig sit, iitIA4 i _ Municipality or Anchorage 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. Original Certificate Date: 7. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory tRcv 11 film 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: EARLES S/D; LOT 5 Parcel ID: 012-242-09 A. WELL DATA *WELL FLOW TEST PERFORMED BY MICHAEL E. ANDERSON, P.E. Well type PRIVATE If A, 3, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 10/2/1987 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 293 ft. Cased to 293 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 10/2/1987 *9/23/2012 Static water level 84 ft. *72.1 ft. Well production 5 g p m *3.5 g.p m WATER SAMPLE RESULTS: Coliform(3 colonies/100 ml. Nitrate Al Ctng /L Collected by: GEG, Ltd. Arsenic:p .' 1 ug./L. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Date installed Tank size gal. Number of Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) Depression over tank (YIN) High water alarm Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2or ft2/bdr System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. absorptio . ea ft2 Monitoring tube Depression over field Date of adequacy test Results (Pass/Fail) For bedrooms Fluid depth in absor. .n field before test in. Water added gal. New depth in. Elapsed T' • min. Final fluid depth in. Absorption rate >= g.p.d. y rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date Date of sample- 2/13/2014 PUBLIC SEWER D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off" level at . wa er alarm level at in. Cycles tested Meets alarm & circuit requirements? E': SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A On adjacent lots 100'+ Absorption field on lot N/A On adjacent lots 100'+ Public sewer main 75'+ Sewer /septic service line 25'+ Public sewer manhole/cleanout 100'+ 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 Property line Absorption field Water main Water service line Surface water Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIE • c 1 LOT TO: PUBLIC SEWER Property line B ' . oundation Water main Water service line Surface water Driveway, parking/vehicle storage n drain Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's n{JEFFREY A. GARNESS Date (/ l (Rev. 11/05) <zscas:;%.,. F o,`� • .O. f v u v vA •0,1 1 ,m Vii. I r E—I iO iofesswi, o0 m N D) 0 v 0 m,I 33 r . o r U, 1.3 D 0 O c' m z S C D mm 0-c 1 27 F7 r-0 a • r g� v col c eC230 mo 17~(n no- 6b0sa522�rn017'7 mx �aZnOw zz=°i17s z Z1ccen --za)mPI ITI n c x m m Q Z 8 oo9g`!' 4Et2 5 g <Op�2ESz5mQ-i 0 O z0-10 � O rn O m 0 rn x O 7u4y,y�'nm xi nnCOz C m GsZ m=MZ„rZ 0 >OB 7 6°a) y • .Ooa>r1 3O0 ri StI3N8O0 ON 31V0 SIHI 13S 20' ALLEY N 00°03'30"W 75.00' 10' U11L ESMT. 21.7' 21.7' DECK 22.0 22.0' wawa ONIISIX3 DECK 7.0' • w O r- 0 O 18.0' A 0 0 ti 13.3° N 00°03'30"W 75.00° W O HUCKLEBERRY INN 70 0re— " rn^ A 0 V/ U ra W b ®VIZ SO --I C a Pn ft, V .n v 1 ® (,; N /)V z §22)22)\ 2> :e«ec \ 2, :- M 108 m s S' /1108 Oa; ant SQ � • 0 co co 9266ecs Ji tn \\ 1000 00 0,0(10003 D 01, « wejis /Wage! « G: < 2 ; ., ;§,:;\ ' « .,; m: % .<; 0 a a .>) "C \:\£:\ peoel a>101 lamer : Z , Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 012-242-09 Expiration Date: ,f - T 1. GENERAL INFORMATION Complete legal description Earles Lot 5 Location (site address) 7706 Huckleberry Street Anchorage, AK Current Property owner(s) Southside Church of God Day phone 205-516-7258 Mailing address P.O. Box 221943 Anchorage, AK 99522 Real Estate Agent Jennye Schulenberg Day phone 257-0150 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Three 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well E Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer E Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ L4-10 - Waiver Fee $ Date of Payment 10 \.1 It 2). ddd Date of Payment Receipt Number O6O (oOG Receipt Number COSA # b5C-1?Me5 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 Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Phone 522-7773 Engineer's Printed Name Michael E. Anderson, P.E. DaO�' • '49m��,..•*0 6. DSD SIGNATURE I •••• ' „�•�...�'- •••mss 3 System #1 Approved for bedrooms. I,�� • ts438s.1 ; ��f® System #2 Approved for bedrooms. shy •.;;?�? :e" Disapproved. ',� �! ��`vfvno,ovs Conditional approval for bedrooms, with the following stipulations: By: ///to(((ga( iON SITE • WATER AND • WASTEWATER 6 PROGRAMJ� cave Original Certificate Date: /6 - 9 - �2 The nici=flit ofd Drage 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory X Well Flow Advisory Other COSA blue sneer 9-1-12.boc If more than 1 septic system is on the lot: COSAChecklist# of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Earles Lot 5 Parcel ID: 012-242-09 A. WELL DATA Well type P If A, B, or C provide PWSID # Date completed 87 Sanitary seal (Y/N) Total depth 293 ft. Cased to 293 ft. Well Log (Y/N) Y Wires properly protected (Y/N) Y >12 in. Casing height (above ground) FROM WELL LOG AT INSPECTION Date of test 10/2/87 9/23/2012 Static water level 91 ft. 72.1 ft Well production 5 g.p.m. 3.5 g p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate ND mg/L Other bacteria colonies/100 mL Arsenic: 24 ug/L date of sample: 9/17 Collected by: MEA B. SEPTIC/HOLDING TANK DATA Tank Type/Material AWWU Sewer Date installed Tank size gal. Number of Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) Depression over tank (Y/N) High water alarm (Y/N) Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2 or ft2/bdrm) System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. absorption area ft2 Monitoring tube Depression over field Date of adequacy test Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at in. Datum E. SEPARATION DISTANCES WELL ON LOT TO: Size in gallons "Pump off level at in. Cycles tested Septic tank/lift station on lot N/A Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas >50' SEPTIC/HOLDING TANK ON LOT TO: N/A >75' >25' Building foundation Property line _ Water main Water service line Wells on adjacent lots ABSORPTION FIELD ON LOT TO: Property line Building foundation Water Service line Surface water Curtain drain Wells on adjacent lots F. COMMENTS Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots On adjacent lots >100' >100' Public sewer manhole/cleanout Holding tank N/A >100' Manure/animal excrete storage areas >100' Absorption field Surface water Water main Driveway, parking/vehicle storage 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. Engineer's Printed Name Michael E. Anderson, P.E. Date 9/27/2012 COSA brown sheet 9-1-12.cloc 4.4. f .•9 • 5'88 ®* ' 4911:1 .7 1N. •�0 9 ••••• nms••.HN. i ft , d® - .NRCHAEL E. ANDERSON c 1) ascii] /4.-rh" # ....... SGS SCS Ref.# Client Name Project Name/# Client Sample ID 3latrix 1124420001 Anderson Engineering Lot 5, Earles Lot 5, Earles Drinking Water Printed Date/Time Collected Date/Time Received Date/Time Technical Director 09/27/2012 8:22 09/17/2012 13:10 09/17/2012 13:20 Stephen C. Ede Sample Remarks: 4500NO3-F - Total Nitrate/Nitrite - MS recovery is outside of QC criteria (biased tow). Refer to the LCS for accuracy. Parameter Results LOQ Units Method Allowable Prep Analysis Container ID Limits Date Date Nit Metals by ICP/MS Arsenic Waters Department 24.0 Total Nitrate/Nitrite-N ND Microbiology Laboratory E. Coli Total Coliform Negative Negative * 5.00 ug/L EP200.8 C 1<10) 09/18/12 09/23/12 NRB 09/18/12 CMA 0.[00 mg/L SM214500NO3-F 6 (<10) [00mL SM219223B A 09/17/12 ULC 100mL SM21 92236 A 09/17/12 DLC 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 # 121455 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 5 of Earles Subdivision. This inspection revealed an arsenic concentration of 24.0 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 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 HAA # +f�9°1 CT'2 Parcel I D# L7 I AAI 2 -f 1. GENERAL INFORMATION Complete legal description .` 5 E %'\12 L E S 'S 1.) Location (site address or directions) 77z t HOC L . Balza--/ Property owner ► I-0 Day phone P t.3"- � 1 7f - Mailing address77ct t4 ue kt .e,,,-,n)/Lending agency Day phonef Mailing address Agent tiJ c P r t" 1- r i s Day phone -' 9- I i 1,11 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 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 1/ 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 1.10A *21 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 . 1,i Spv.cle LA� L C- Phone ? q- S I ia, Address P-0 ? t2' f I—ei / .2c s Engineer's signature T-- ,�•-.-J. Date 6/t?! / 6. DHHS SIGNATURE �I Approved for / Y < � EE bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By Date 7- 7-- ci 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. 1/91) Back MOA *21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN S NV}IurvGFANchIURAGk Environmental Services Division ENTAL SERVICES DIVISIG 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 JUL. 0 2 1999 Health pAuthority Approval Checklist Legal Description: s b et r f e s ''tVA Parcel I.D.: O/ 2" ' L% - a t A. WELL DATA Well type L If A, B, or C, attach ADEC letter. ADEC water system number ice//fit Date completed L 7 Log present (Y/N) Total depth 2 q2) Sanitary seal (Y/N) Cased to e„3 Casing height (above ground) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test J c/7- ` / e '1 (:‘,4L7 /41 / Static water level 9 1 '76 Well production g.p.m. 4,..- g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate N i)Other bacteria I �j I Date of sample: 4/25/ 4 `f Collected by: S B. SEPTIC/HOLDING TANK DATA 1,4/ / Date installed Tank size N tuber of Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) Depressio (Y/N) High water alarm (Y/N) Date of Pumping Pumper C. ABSORPTION FIELD DATA Ny 0 - Date installed Soil rating (g.p.d./ 2 or ft2/bdrm) System type Length Width Grave thickness below pipe Total depth Effective absorption area Monitorin Tube present (Y/N) Depression over field (YM) Date of adequacy test Res Its (Pass/Fail) For bedrooms Fluid depth in absorption field before test (in. Fluid depth Immediately after gal. water added (in.): (ins) Minutes later Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/; If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION / Date installed 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 Hof On adjacent lots ' / D Absorption field on lot Public sewer main Sewer /septic service line On adjacent lots /t Public sewer manhole/cleanout % / r.1 --t2 Lift station 14/[1,‘ - SEPARATION DISTANCES FROM SEPTIC/HOLDING NK ON LOTTO: Foundation Property line Absorption field Water main/service line Surface wate drainage Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTI N FIELD ON LOTTO: Property line Building oundation Water main/service line Surface water Driveway, parking/vehicle storage area Curtain drain Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Signature Engineer's Name Date itr ¢ Ir�t a - :J r �� -Vl.r� 7 � HAA Fee $ Date of Payment i — Receipt Number e1/967X 72-026 (Rev. 3/96)* Z'a36 Waiver Fee $ Date of Payment Receipt Number JUN -30-0 08:25 FROM -CTE ENVIRONMENTAL 5615301 T-302 P.05/07 F-750 CT&E Environmental Services inc. 44 L i aix)rat:ory Division K . arwaumri,® d at ars su' aawsl r. Aranzatrammae 200 W Pot'ier Ur:ve Drinking Water Analysis Report for Total Coliform Bacteria Tel (907y 562-2343 Anchorage, 2,K 9961B-1606 RE4L INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE Fan: 1907) 561.5301 MUST BE COMPLETED BY WATER SUPPLIER '1'0 BE COMPLETED BY LABORATORY q.nalyils shows this Water SAMPLE fa be'. 0 PUBLIC WATERS} STEM I.A. l Snhst44t ry PRIVATE WATER SYSTEM n nsansfactory p Sena Rendes 0 Send lnvotee a„4-1 -yuem R-,unc+Gump.,ro N m pr3Rt >! Poole tiuinaer h:Lt�ngA s� 41A Nasonve ,p o Sead Iiesnits Lanpny L512 0 Send Invoice mang SAMPLE DATE; Month Day H1 Year SAM.PLE r't' {,lyte 0 Treated Water CI Repeat Sample (for routine sample 'Air Untreated Water with lab ref. no. ) O Special Purpose Time Calle ed SAMPLE LOCATION Collected By + 11 4, 3 Sample over 33 hours old, results may be unreliable Sample too long in transit; sample should not be over 4E hours old at examination to indicate reliable results. Please send Flew sample via special delivery marl. Date Received l 411 Time Received Analyati Began 10341, Analytical Method: y._Menabranr Filter ' 0 MM0-MLLG Number of colon; ,s/ 1(HJ ml. Result' Analyst 993014 Eel 1-1� Fui:s Jun Farr+f Pale .. - ! unc Clirm notified of asatisfactory results; L L Phoned Spoke mitt faxed Gait Late. RAd !I'ET[OLC iICM- WATER ANALYSIS RECORD MMU -MUG }took: Total Coliform membrane Filter: Direct Count Verification: L163 BG$ Fecal Coliform Confirmation Final Membrane Filter Kesulrs Reported By Date , E, Coli Cu l0U df1 COLIFIRM. ('orilornv'JUU not Time :Vu/400/4i ly « n, •• Chhe+ 130.1fru6 JUN.30-99 08:24 FROM -CTE ENVIRONMENTAL EriviconmentNI ServiCe 4-iar &KM:Word) wAVAYAVIereztik.ev.arAVeVa4FAVAle-44 5615301 T-302 P.02/07 F-750 CT&F Itrf.# 99D14001 Chem Vli# Pre -Paid CoLis/NW Client Name Tobbell Spur4414 P.E. Printed liateiTiole 06/29/99 17:U3 Project Narne/# N/A Collected Daternale 06/25/99 08:45 Client Saint& ID Lot 5 Euless Received Date/Time 06/25/99 09:20 Matrix Drinking Waier Techracal Director: Stephen C. Ede Ordered By PW SID 0 Released By ai Sam* Remarks: Parameter Rsults Toral CoLiform ritrate-N PI writs Alinnaloie Prep Analysis Menial Limits pare Pate IniL 0 co/100m SM18 9222B Ob/6/99 1CAP 0.500 u 0.500 m9/4 EPA 300.0 10 max 06/2. N _ . - Parcel I.D. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1,X-PM-c)y HAA# /-/A 03 / , O Expiration Date: 7- 3 ' 0 3 1. GENERAL INFORMATION Complete legal description i' .6 ff 5 aAe Le S Location (site address or directions) 770 1-1 t -i_E B r— . ') Current Property owner(s) 814 e rrell ivur a Y-- }- Day phone Mailing address Lending agency Day phone Mailing address nn'' ' / Real Estate Agent l�4lrit Stlii R�'- 1/ T. Day phone 338- gAl 2- • • Mailing Address Unless otherwise requested. HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storace Community Class Well Public Water System TYPE OF WASTEWATER Individual On-site Individual Holding tank Community On-site Fubiic Sewer DISPOSAL: ❑ 0 lid The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional cavil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-ste wastewater disposal and!or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Acp:oval 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 6 wells cr a public water system. Tree i`. t::niciba!ty of Anchorage is net responsible for errors cr 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 investication, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Address -OS't' iTtzt Zo3 Engineer's Printed Name Phone P-79--3vb I.)W?4 sr.)./.14lttKIQ Date L/'-5r—o- ,;:c73,:.::.....,:tc..,./..N • °w0 Q; 5. DSD SIGNATURE �.� Approved for bedrooms. Disapproved. ;x;4931. To bon 3purttand . 1 c 223• y ••: �• d► • As •(.0 f DyPo� ��oaa®°oSsc• Conditional approval for bedrooms, with the following stipulations: Additional Comments {Irlrrrr/,,, • WATER AND : 4`1:�b7cl/Ai cry PROGRAM -0,.j1,1, ,•%%:1'. Attachments: HAA. Checklist X Maintenance Agreements Septic System Adviser/ Supplemental Engineer's Report Well Flow Advisory Other , 1 /7 Ev: i// / L . f e•-•!,. •1 / •j Oricinal Certificate Date: ' - 8 - 3 Legal Description: Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST /47 tr 04/U-5 s Parcel ID: O/o2 f Z t%.2 " C A. WELL DATA Well type If A, B, or C provide PWSID # iek Date completed Whip Sanitary seal (YIN) y Wires properly protected (Y/N) Total depth %Q3 ft. Cased to 24! ft. / Casing height (above ground) FROM WELL LOG AT INSPECTION Date of test k/ Lie 7 3/3) /0 3 Static water level g ( • ft. Well production 8.6 g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate N �_ mg. Arsenic: mg./I. Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Well Log (Y/N) 7 76 ft. Other bacteria ND colonies/100 ml. Collected by: r si v i k.14. i . Date installed Tank size gal. Number of Compartmen •- Cleanouts (YIN) Foundation deanout (Y/N) Depression over - (Y/N) _ High water alarm (Y/ Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed Soil rating s.p.d./ft2 or ft2/bdrm) _ Sy -m type Length ft, dth ft. ravel below pipe ft. Total depth ft. Eff. abs. •tion area ft2 Monitoring to • : Depression over field Date of adequacy test Results (Pass/Fail) For bedrooms Fluid depth in absorption ' Id before test _ in. Wate =dded, gal. New depth_ in. Elapsed Time: ___ Final fluid depth _ in. Absorption rte >= g.p.d. Any rejuvenation 1, • atment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed S' - in gallons "Pump on" level at ^ in. "Pump ofr level at Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 84, On adjacent Tots Absorption field on lot YA On adjacent lots Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? Public sewer main t4/A /6o ,) /oco Public sewer manhole/cleanout 7 /04.7 Sewer /septic service Zine >A5 - SEPARATION DISTANCES FROM SEPTICMOLDIN ANK ON LOT TO: Building foundation Property line Absorption field Water main Water se ce line Surface water Wells on adjacent Tots SEPARATION DISTANCE FROM ABSORPTION FID N LOT TO: Property line Building found on Water main Water Service line Surface - er Driveway, parking/vehicle storage Holding tank h%A Curtain drain Wells o adja--nt lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. l or(ibeii gryAGA 4fra Engineer's Printed Name Date HAA Fee $ '376' Date of Payment V/3/e) 3 Receipt Number (Rev. 12/01) os 51 Waiver Fee $ - Date of Payment Receipt Number • • N 89.54 . oo" P/ /80.0D' BZo1 L 7 0 r Al 99 5 !'oo re. r se+r" o Met. Shed 5- P 5Z- ., = / drY MOe!LC /L1& ozs /80.00 N L,i �edlwA411 y. l 44.1 aN. /-ETD' ' fl1'4Maa f 1111 mortis •M� w w, 108= ROPE Ft*, t6RgvEL it- PAR K146 SCALE // qr 54 '00"w /80.00 • erccrI find 3-ZO-030r, REV/SEL 7-/f-.'yeyr AS -BUILT NO CORNERS SET THIS DATE s'k•, 1,,,44•^144\•4144.9 friir J w ,.r a Ce. 1:* r{ 4' Cf EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. five 3 P9.13 ; • £oor 14.5 .11. • • • • •*' N4CKLEgERRY 30 -6- Be 138 USIA 'IT'I.LN30!121a I hereby certify that I lave performed a Mortgagee's Inspection of the following dear bed property' Lors 4 E 5 EARLE5 541647/t//5/0N Anchorage Recording Precinct, Alaska, and that the improvements altuatec thereon are within the property lines and do not overlap or encroach on the property tying adjacent thereto, that no Improvements on property Tying ad•.acent thereto encroach on the prnrnlses In question and that there are no roadways, transm1ssicn lines or other vls',ble easements on arid property except as Iniicated hereon. Dated at Anchorage, AlnoKa this 1 + day of SNE• 19" FRED WALATKA & ASSOCIATES (907) 2481688 Engineera and Surveyors MS Z99 L06 IVd 9£t6T I21d £ll%iZ/£0 4— 6-03;1O:1OAM; CT&E Ref. #: Client Name: Project Name: Client Sample ID: Matrbc PWSID 1031667001 Tobben Spurkland Lot 5 Earles Lot 5 Earles Drinking Water n/a ;907 6616301 n. 2/ 2 (TBE Environmental Services 200 W. Potter Drive Anchorage, AK 99518 Tel: (907) 562-2343 Fax: (907) 561.5301 All dates/limes are Alaska Standard Time Printed DatefTime: 04/08/03 11:05 Collected Date/Time: 03/30/03 19:00 Received DatefTime: 03/31/03 9:00 Technical Director. Released Stteejnde phejE. Sample Remarks: Parameter Total Coliform (MF) Nitrate Results 0 1.0 U POL Units col/100 ml 1.00 mg/L Allowable Prep Analysis Method Limits Date Date !nit SM9222B 03/31/03 KAP EPA 300 10.0 04/05/03 JS r