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ROUSE LT 3A
Rouse Lot 3A #050-321-72 M Municipality of Anchorage Page —I 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: 5 W94000S PID Number: OC632-17Z Name: Wastewater System: ❑ New 9upgrade E N - /2. F TUC-rR E. QDusE Address: ABSORPTION FIELD P.O. ROi( 7701SI 6_/4Cce 99577 Phone: No. of Bedrooms: 3 ❑Deep Trench ❑Shallow Trench ❑Bed O Mound ❑Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: �,� O•�GPD/S . Ft. Lot: 81eelq Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe 319 _- /2-6 USE 5uO'D• -t ' Ft. S Ft. Township: Range: Section: Fill added above original grade: Z Gravel length: 3: Ft. S 3 Ft. Gravel width: Number of lines: Distance between lines: s WELL • ❑New ❑ Upgrade • p9 /s Ft. Z- Ft. Classification (Private, A,B,C): 0X1,5 7. Total Depth: Cased To: Total absorption area: Pipe material: f-P/O PE2F. P I Ft. 7 SO. Ft. fISTm 1?303N ,�V•G• ryq7-C Ft. Driller: Date Drilled: Static Water Level: Installer: �- SOUTH FORK Co."sr. Date installed: 7 -P-9,/ Ft. Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES P5 Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Linesc"ol-Z44 ;, Aj i_ /000 WeIN /yS' /7(0' ZSt{- Material: STEEL Number of Compartments: 2- Surfac 't 't- -- LIFT STATION Water /00 /ao — Lot St Ilons: Manufacturer: Line /O v / ! /O t --- - "Pump on" level at: ff" level at: High water alarm at: Foundation / F 7 3 t Curtain Pump Make & Model Electrical Inspections performed by: Drain lYON KN Dt/� BENCH MARK Remarks: Location and Description: Thi"— ToY OF CON C. PEORSTfIG OR- S,47-6"/TE 4>45/7' Assumed Elevation: /Do . 00 Ft ENGINEER EAL S & S ENGINEERING 17034 Eagle River Loop Road, No. 204 ', y Inspections performed by: —Eagle River, Alaska 92577 Dates: lst f < 2nd Department of Health and Human Services approval �L, Reviewed and approved by: Date: �� Permit No. SW940005 2 Page of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 *Anchorage, Alaska 99519-6650 e Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report ROUSE SUBDIVISION, LOT 3A 05032172 Legal Description: PID No.: - DI SCALE 1- = 40' 100, A ENqp _,.ZE L IS 6* TOPSOM�& SEED q0I CO2 FINAL GRADE MT2 01 NAL GRADE -TOP OF CONCRETE BASE 109.91 102.2' RADIUS ELL A 9* WSUUT ON WERE FR.SIS FAaffic315 '-_ a 98.4' ......... ... ........... NEW 97. . ...................................... A000 GAL SEPTIC 107 . Y 'APPROX. GRAVEL -D=. PIPES � �IN SEWER SEWER ROCK. Or UNDER TANK TIT RUN G X OVER DIST. PIPES A 90.7' WATER FOUND 7-6-94 HE 100, WELL RADIUS ............. ............ ............................ ......... ........... ..... ........... . ....... ................................. ................... ................ . ........ .. WELL .... ............... ....................... FCO 136.5 11.5 C01 112.0 60.0 CO2 110.0 66.0 CO3 83.0 0.0 ..GO.1 120_5 160-0 MT1 123.5 95.0 E- MT2 78.5 104.0 NEW B DIST. BED C 3 BDRM HOUSE E- ......... ..... ............. .... .. ............. - . . ....... ...... EQK* 01 ti T DSL CO 02 EW. 1000 GAL. C SEPTIC TANK .................. . .............. . . ...................................... ....................... ................... . . . . . ............................ .. .......... ......... I ..................... .............. . .................... 3 DI SCALE 1- = 40' 100, A ENqp _,.ZE L IS CIO� -TOP OF CONCRETE BASE RADIUS ELL A PAGE 1 OF 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940005 DESIGN ENGINEERS & S ENGINEERING OWNER NAME:ROUSE KENNETH R & JULIA E OWNER ADDRESS:PO BOX 770131 EAGLE RIVER AK 99577 PARCEL ID:05032172 LEGAL DESCRIPTION: ROUSE LT 3A LOT SIZE: 67090 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 1/11/94 EXPIRATION DATE: 1/11/95 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: ENGINEER MUST CONDUCT ADDITIONAL SOILS TEST NEAR NORTH END OF PROPOSED BED TO CONFIRM DEPTH TO BEDROCK. INTEGRITY OF EXISTING SEPTIC TANK MUST BE VERIFIED. IF NEW TANK IS REQUIRED IT MUST BE LOCATED OUTSIDE THE 100 FT. WELL RADIUS. PAGE 2 OF 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 THE APPLICATION RATE MUST BE 0.7GPD/SQ.FT. REQUIRING A TOTAL AREA OF 643 SQ. FT. RATHERTH N 563 SQ. FT. RECEIVED BY: n DATE: ISSUED BY: -101 Srg(-0 - DATE: �I.1014- np\ A ` December 28, 1993 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTHAUTHORITY APPROVALS Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, Alaska 99519-6650 SEWER & WATER MAIN EXTENSIONS REFERENCE. Rouse Subdivision, Lot 3A SEWER &WATER INSPECTION We request you issue a permit to upgrade the septic system serving the three bedroom house on the referenced property and issue a conditional ENGINEERING REPORTS Health Authority Approval. An adequacy test performed on the existing system by David R. Dayton for Health Authority Approval purposes found the absorption capacity of the existing WELL INSPECTION & FLOW TEST system to be adequate. However, we have determined that the existing seepage pit encroaches bedrock and will need to be upgraded. A conditional Health AuthorityApproval is requested until the system can be upgraded in Spring 1994. SITE PLANS A test hole was excavated and a percolation test performed in the area of the proposed upgrade. The approximate location of the test hole is located on the attached site plan. At the time of excavation water was encountered at 5 feet and after seven day water monitoring water was found at 5 feet. Attached it the ROADDESIGN proposed upgrade design. We do not anticipate any adverse effects on neighboring properties by the SOILTEST installation of the proposed septic system. If you have any questions, or require additional information for your review, PERCOLATION please contact us. TEST Sirl rely, STRUCTURAL& MECHANICAL afer, P.E. INSPECTIONS _,�``o' ert A. Sh ON SITE WASTEWATER DISPOSALSYSTEM DESIGN RASIL SU/Isu 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 w 0 F-: x M N � 101 E" C" O m 0 N�00 z 0 Of ® I-��OQ f �UU O—Ml 0 r 7�2 oJa W mJd'Q� LLJ X00— V1 ® I-0a: W Y� o u Jv)oZ- OU O d 0 wZ (-)-0 � � Q < / C) Z a r / a�a0 o o� o 5 t J � w w cV `1 (D �U W�(A V' / tea? o / z =-j „w 0 ww>- ,m_HO W N>O'U)LLI of w 0 F-: x M N � 101 E" C" O m 0 N�00 z 0 Of ® I-��OQ f �UU O—Ml 0 trOx 7�2 oJa W mJd'Q� LLJ X00— FQ(hY ® I-0a: W Y� o u Jv)oZ- OU O d 0 wZ (-)-0 � � Q < / C) Z a r / a�a0 o o� o ry Or J � w w cV `1 (D �U W�(A V' / tea? o / z =-j „w 0 ww>- ,m_HO W N>O'U)LLI of / rD )--i a- N OVD QMm LJ Z E5 F Of duiw U 0 0000 U V ZV) FwZV�- �T4J �IIoII �Z0� w Cl) 7) OO �i Quo V) r� (nNo �oJ� � oQj fn OO Z Q d' �j M > J Z 0 -j :;E :::) cal ¢ ¢ w Q _ N W J a � O m 0 N�00 z 0 Of I-��OQ f �UU O—Ml 0 trOx >0_w oJa W mJd'Q� USO X00— FQ(hY J F-YS I-0a: W Y� o u Jv)oZ- OU O d 0 M w m Q wZ (-)-0 � � Q < �AI2IQ / d / a / a / EF I / W/ co d � Q / oo,\ /O / / z O Oz / wZ (-)-0 � � Q < / C) Z a r / a�a0 o / N UQ)LLIa a / W w m = �w w / � Z~ z Q X'<z0L.�J / oz3F-oo ar wIV, / z =-j „w / ww>- ,m_HO W N>O'U)LLI of / (n Z m 0wp QV)0 W=V) -N Un ZZ F-FQwwQO V J Of LJ Z E5 F Of duiw U 0 0000 U V ZV) FwZV�- Q (f)><V) F-�Z 0`)O V) V) Q F= I- 0 U 3mioin '0S �. -- -2/�� � j m m§ 55/ I © w \q& e / § n4 \ � - a \ \ \ LU \c » ° \ LLILLI e CQ � \ \ \\\}\ \ IL , V) m_ ® e * o \\ \§\ w o \( m z / LLI � ® § \® / \pq\ \ [g # 2 \ \\ E ` = E ) § , / XAJA , f 311JONd PERFORMED LEGAL DESCRIPTI PTL ELT) 2t/! 3 c 4 i 6 7 8 9 10 11 12 13 14- 15 16- 17 18 19- 20 COMMENTS Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST o OR - PFdt -/- m L /� ML/C�M S Pi 13.0,H. (g>aGt'd DATE PER Range, Section: WAS GROUND WATER ,. ENCOUNTERED? IF YES, AT WHAT 1 DEPTH? Depth to Water After Monitoring? Dale: SITE PLAN ERCOLATION RATE � (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN F AND FT J / _r_- /vl , r s — Sv_ CERTIFY THAT THIS TEST WAS PERFORMED IN// ON THIS DATE. DATE: S & S ENGINEERING PERFORMEIfaj4 Fagle Kiver Loop Road 1 a. 204 ACCORDANE90MV14&it, WA*0491M71NICIPAL GUIDELINEI 72-008 (Rev. 4/85) i r4, r SITE PLAN ERCOLATION RATE � (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN F AND FT J / _r_- /vl , r s — Sv_ CERTIFY THAT THIS TEST WAS PERFORMED IN// ON THIS DATE. DATE: S & S ENGINEERING PERFORMEIfaj4 Fagle Kiver Loop Road 1 a. 204 ACCORDANE90MV14&it, WA*0491M71NICIPAL GUIDELINEI 72-008 (Rev. 4/85) ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Rouse Subdivision, Lot 3A GENERAL: 1. The scope of this project includes the installation of an absorption bed to serve the three bedroom residence located on the referenced property. The existing septic tank is to be excavated to verify its integrity. If of poor integrity, the tank is to be abandoned and a new 1000 gallon septic tank installed outside the 100 foot protective well radius. The existing leachfield is to be abandoned in place. 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: 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. Page Two Rouse Subdivision, Lot 3A December 28, 1993 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. 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. LEACHFIELD BED INSTALLATION: 1. Excavate the proposed Bed Area to the depth shown on the design. The bottom of the excavation shall be within 2 inches of level. If the bottom of the excavation becomes smeared, it must be raked or scratched (ruffed -up) before gravel or sand placement. 2. If a sand layer is required, place sand over entire excavation to the required depth shown on the design. The top of the sand layer must be within 2 inches of level. 3. Sewer rock shall be placed uniformly throughout the entire bed. Perforated distribution pipe must be installed level with perforations down. Gravel depth below the perforated pipe shall be a minimum of six (6) inches. Gravel depth above the perforated pipe shall be a minimum of two (2) inches. The total gravel depth throughout the entire bed shall be a minimum of twelve (12) inches. 4. The perforated distribution pipes must be no more than six feet apart. The distance between the outermost perforated distribution pipes and the sidewall of the absorption bed must be no more than three feet. Page Three Rouse Subdivision, Lot 3A December 28, 1993 5. Silt barrier material 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. 6. Monitor tubes shall be of four (4) inch diameter and installed at the locations shown on the design. The portion of the monitor tube extending through the gravel depth shall be perforated six (6) inches below the bottom of the horizontal distribution lines. 7. 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 finished grade over the bed must be mounded to prevent the formation of a depression after settling. 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: Type 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, Femoo, or equal). Page Four Rouse Subdivision, Lot 3A December 28, 1993 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. 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. Parcel I.D. 050-321-72 Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 5AI-II Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Location (site address) Expiration Date: 9 "2 � - / 4-- Rouse, Lot 3A 18560 18560 Rouse Circle Eagle River, AK 99577 Current Property owner(s) Secretary of Veterans Affairs Day phone Mailing address Real Estate Agent 155 Van Gordon Street Lakewood, CO 80228 2. TYPE OF DWELLING: F Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Three Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual El Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for; Distance: k { f r r I Received by I( 1. r 1; '�, k �" Date:, f Y COSA to be releasl'd to ti' e engineer, unless otherwise requested by the engineer. COSA Fee $ 6;* Date of Payment !f2— 1 tot I ��[� Receipt Number ©�& COSA # os"L{ l tai 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, 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 Engineers Printed Name Michael E. Anderson, P.E. Date 5/14/2014 6. DSD SIGNATURE System #1 Approved for bedrooms- ", � , f "Mi System #2 Approved for bedrooms Disapproved S C5_r� Conditional approval for bedrooms, with the following stipulations"._',_" I (t1: Aftrr0r�� Off! -SITE SNA By: //V . / � Original Certificate Date: a The nici Ity of An ge Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory _�; Other COSAbluesheet f :- ', c 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: Rouse, Lot 3A A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 1970 Sanitary seal (YIN) Y Total depth 420 ft. Cased to >40 ft. FROM WELL LOG Parcel ID: 050-321-72 Well Log (YIN) N Wires properly protected (YIN) Y Casing height (above ground) >12 in. AT INSPECTION Date of test 5/9/14 Static water level ft, 5.5 ft_ Well production g.p.m. •7 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate N/D mg/L Arsenic N/D ug/L Date of sample: 4/30/14 Collected by: Anderson Engrg. Note: Depth of Well and Casing Taken From MOA Files, B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 6/6/94 Tank size 1,000 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YIN) N Date of pumping 4/26/14 Pumper JRs Pumping C. ABSORPTION FIELD DATA Date installed 6/6/94 Soil rating (g.p.d./ft' or ft2/bdrm) .7 GPD/SF System type Bed Length 53 ft. Width 15 ft. Gravel below pipe •5 ft. Total depth 3.9 ft. Eff. absorption area 795 ft, Monitoring tube Y Depression over field N Date of adequacy test 2/21 /14 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 840 gal. New depth 0 in. Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 450 g p d Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off' level at in. Datum Cycles tested Manhole/Access(Y/N) High water alarm level at Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots > 100 Absorption field on lot >100' On adjacent lots >100' Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line >25' Holding tank N/A Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5' Water main >10 Water service line >10' Wells on adjacent lots >100' ABSORPTION FIELD ON LOTTO: Property line >10, Building foundation >10' Water Service line 0 Surface water >100' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS G. ENGINEER'S CERTIFICATION l certify that 1 have determined through held 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 5/15/14 COSA brown sheet -1 0-10-1 2.doc Absorption field >5' Surface water >100' Water main N/A , Driveway, parking/vehicle storage OF A4 t® c in. Municipality of Anchorage o p E s Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # 141199 During a recent COSA on-site inspection and test of the potable water supply well on Block , Lot 3A of Rouse subdivision, the well's productivity was determined to be .7 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is .3 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. 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 Onsite Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519$650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-321-72 COSA # a 0 [)nQcT Expiration Date: a — <� 9 — U to 1. GENERAL INFORMATION Complete legal description Lot 3A Rouse Subdivision Location (site address) 18560 Rouse Circle, Eagle River, AK Current Property owner(s) Daniel Szekely Day phone Mailing address 5115 N. Dixboro Rd., Ann Arbor, MI 48105 Lending agency Dayphone Mailing address Real Estate Agent Mailing Address OI Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 RMlti 2*01a1YLA11L [�K9»WF Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ phone 244-8584 TYPE OF WASTEWATER DISPOSAL: Individual On-site ED Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of Onsite 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 seat 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 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 102954, Anchorage, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date 3/20106 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. ••••••aa The operational life of all wells and septic systems depend on the local soil condition, ground water •• y levels that may fluctuate during the year, and the water usage of the family being served by the system. .•�P�� ♦'� These conditions are outside the control of the evaluator of this system. All systems eventually fail and 1 7 �y�i# satisfactory test results do not guarantee future performance of the system, nor do they guarantee that #0 there arc no hidden defects or encroachments. PES can therefore not provide any warranty for future 0 — •• performance nor give any estimate of how long the system will continue to mat the operational 0 requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed i Steven R. Po one above. Any reliance upon or use of this report by any other person or party is not authorized nor will it 0 0 CE 8149 : confer any legal right whatsoever. 5. DSD SIGNATURE •• t C""" ~ •'• aaaaa••••`` L--"O� Approved for _ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attacnments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: 3 — a q - 0 w (Rev 1185 Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 47W Bragaw Street P.O. Box 196650 Anchorage, AK 99519.8650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST A. WELL DATA Wen type P If A, B, or C provide PWSID S _ Well Log (Y/N) N Date completed ,Qroy I1?70 Sanitary seal (Y/N) Y Wires properly protected (YIN) �— Total depth _M_fL Cased to eft. Casing height (above ground) 124 in. FROM WELL LOG AT INSPECTION Date of test 311WWM Static water level ft. 9 ft. Well production 9.p -m. 0.408 9 - p.m -WATER SAMPLE RESULTS: Conform _J_oolonles1100 mL Nitrate 0.100 mg/L Arsenic: -4&' m9A Date of sample: 3MOM5 B. SEPTICIHOLDING TANK DATA Tank Type/Material Anchorage Tank Steel Tank size _1000 gal. Number of Compartments j Other bacteria _L colonies/100 mL Cleanouts (Y/N) Foundation cleanout (Y/N) X Depression over tank (YIN) y High water alarm (Y/N) WA Date of pumping 3H0/2005 Pumper Ars Pumping C. ABSORPTION FIELD DATA Date installed OW994 Soil rating (g.p.d./fe or ftefbdrm) 0.7 System type Bed Length 53 ft. Width 13 ft. Gravel below pipe 0.5 ft. Total depth ),$ ft. Eft. absorption area TZMfe Monitoring tube Y Depression over field �{ Date of adequacy test 3NOrz00ti Results (Pass/Fail) Pass For ) bedrooms Fluid depth in absorption field before test Q in. Water added],)Q gal. New depth2 in. Elapsed Time: )Q min. Final fluid depth Q in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N ho If yes, give date D. LIFT STATION \ Date installed 'Pump on' level at _ in. Datum iz6 in gallons Manhole/Access (YIN) 'Pu evel at _ in. High water alarm level at in. C sted Meets alarm b dreu t requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/ ift station on krt 100+ Absorption field on lot 100+ Public sewer main 100+ Sewer /septic service fine 50+ On adjacent lots 100+ On adjacent lob 100+ Public sewer manhole/cleanout 106► Holding tank 100+ Animal containment areas 100+ Manure/animal excrete storage areas 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10+ Property line -& Absorption field 15+ Water main 100+ Water service fine 50+ Surface water 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 25+ Water main 100+ Water Service line 25► Surface water 100+ Driveway, parldngivehicie storage 25+ Curtain drain None Observed Wells on adjacent lots 100+_ F. COMMENTS 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's Printed Name Steven R. Pannone, P.E. Date COSA Fee $ O Waiver Fee $ Date of Payment z O Receipt Number. �O (Rev. 11105) Date of Payment Receipt Number Steve^ F, Po��o^et'� 'k ^:o.C: P143 Municipality of Anchorage ,.• N . • '� Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Health Authority Approval # 060095 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block , Lot 3A of Rouse subdivision, the well's productivity was determined to be 0.406 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.316 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. 8297Q ken r Lot 2 $ I $9 `fir �0•� ��O Wei eS 5 Z LOT 3A04 I 0 D r M to 48.0 co \ 2 Story y m septic Vents 's Frame m p House a v 24.7 4.0 W $ Q ROUSE ory �,ec e 27.3 33.7 m CIRCLE v yeo • yoQ } ;�. �pSp� •�a,K •r 1 / I N \ \ \ Septic Vent O a I o' ` a e�nr�\ �y \ \ 1 I d \\ \ satellite dish - - -- - � d /�?p• T S68 \ � \ � 1 ei 44 as. I •:ptl ( e Note) \ a\ems\� \ _ I Lot 4A N �zsso W �. N r4 Note: The well on Lot 3A serves Lot 1, Block 3, Broadview Subdivision. \ Easement filed 7-03-1986, Book 1449, page 0498. Surface features including gravel driveway and concrete walks are approximate due to snow and ice. SCALE 1"=40' AS -BUILT NO CORNERS SETTHIS DATE I hereby certify that I have performed a Mortgagee's Inspection y�� • ��e i� of the following described property: LOT 3A " of At. 'h ROUSE SUBDIVISION v &f �� �qltAncnorage Recorang Preanct, AlasKa, anUTFMTW improvements situated thereon are within the property fines ,> + and do not overlap or encraoch on the property tying e adjacent thereto, that no Improvements on the property tying e� �L�.. •••.» adjacent thereto encroach on the premises in question and �, t lred water o r that there are no roadways, transmission lines or other ¢ be RO 12lS3 j 01 visible easements on said property except as Indicated e �i� 4ep xt" Dated at Anchorage, Alaska this 22nd day of March 2005 EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED S & S FRED WALATKA & ASSOCIATES PLAT ARE NOT SHOWN HEREON. Engineers and Surveyors BE (907-248.1666) SCS Ret# Client Name Project Name/# Client Sample ID Matrix PR'SID Sample Remarks: 1061189001 Pannonc Eng. Srv. Lot 3A Rouse Sub Lot 3A Rouse Sub Drinking Water 0 All Dates/Times are Alaska Standard Time Printed Date/time 03/16/2006 11:24 Collected Daterrime 03/10/2006 12.15 Received Date/Time 03/10/2006 13:50 Technical Director Stephen C. Ede Parametg Results PQL Units Method Allowable ContainerlD Limits Prep Analysis Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<=10) 03/13/06 03/13/06 TK Waters Department Nitrate -N ND 0.100 mg/l, EPA 353.2 D (<=10) 03/10/06 JC Microbiology Laboratory Total Coliform 0 coVI00mL SM209222B A (<=I) 03/10/06 TLF Page 2 of 4 Municipality of Anchorage Development Services Depattment Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, Ak 99519-6650 www.ci.anchorage.A.Us (907) 3434904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-321-72 1. GENERAL INFORMATION HAA # �/`7/ Expiration Date: -7- 1 C: - O 3 Complete legal description Lot 3A; Rouse Subdivision Location (site address or directions) 18560 Rouse Cir. Current Property owner(s) Bill Farber Day phone 696-0900 Mailing address Lending agency Mailing address Real Estate Agent 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 Storage Community Class Well Public Water System Day phone Day phone �&,/Z 2r� Y /8'7 /03 TYPE OF WASTEWATER DISPOSAL: The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period or up to one year with valid water samples.) Certificratps are valid roe 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 emissions in the professional engineer's work. Individual On-site U ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period or up to one year with valid water samples.) Certificratps are valid roe 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 emissions 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 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 [tie time of installation. S & S ENGINEERING Name of Firm 17034 Eagle River Loop Road No. god Phone ;k-97 age ver, ail a Address Engineer's Printed Name E0136,e f �O'^�'f A.1 Date 9/ i) / 0 3 Y +ENGINES 5. DSD SIGNATURE P�,+�`i, tRG>C r 630,lAti cQ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: �SY OF Alii `J ON-SITE ••��: Additional Comments 1A18�T 1NB m� WASTEWATER Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory _X_ Maintenance Agreements Supplemental Engineer's Report Other By. L e'mi't Original Certificate Date: - / (. - C Municipality of Anchorage ,,.�..a • Development Services Department e ! : °; 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 Legal Description: 1.0 T ,3 A R 0 vJ C SAO Parcel ID: OS -0-3'J61- 7 )� A. WELL DATA Well type PR' V#TIL If A, B, or C provide PWSID #= Well Log (Y® N O Date completed 16170 Sanitary seal (9N) ye -F Wires properly protected (S)N) YE J i Total depth �1)0 ft. Cased to 40 f ft. Casing height (above ground) 3 -iR, FROM WELL LOG AT INSPECTION Date of test 3 4*/o 3 Static water level U ft. 3 ft. Well production z g.p.m. Olt/ g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. Nitrate 0,613 mg./I. Arsenic: ./I. Date of sample: 4/3/0 3 B. SEPTICIHOLDING TANK DATA Tank Type/Material St. T II - / S7d t 'L Tank size o e 0 gal. Number of Compartments �- Foundation cleanout O/N) YtJ Depression over tank (Yo ^'o Date of pumping )0I 31 I 0 ',�LPumper c� S C. ABSORPTION FIELD DATA Date installed 6�6/q y Soil rating g.p.d./ft'- or ft2/bdrm) Length S 3 ' ft. Width ) S— ft. Total depth 4 / ft. Eff. absorption area "741f ft2 Other bacteria O colonies/100 ml. Collected b . A S ENGINEERING 7 g e ver p oa Na 204 Eagle River, Alaska 99577 Date installed 6 /6 / aj y Cleanouts 6)N) b t l High water alarm (Y(0) N O System type Mo,, A/ D Gravel below pipe 0. S— ft. Monitoring tube *V -J Depression over fieldM o Date of adequacy test 3 ! Vol o 3 ResultsFail) Ps -+5 Fluid depth in absorption field before test O in. Water addedyA gal. Elapsed Time: 60 min. Final fluid depth 3 in. Absorption rate >= For 3 bedrooms New depth in. ly ro g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONs K oJo w A-' If yes, give date = D. LIFT STATION Date installed "Pump on" level at _ in. Datum E. SEPARATION DISTANCES Size in gallons Manhole/Access (Y/N) "Pump off" level at _ in. Hi a arm level at in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot )16 Absorption field on tot Public sewer main Sewer /septic service line 176 N/A i ;L S- Meets alarm & circuit requirements? On adjacent lots On adjacent lots /o0 4 Public sewer manhole/cleanout _ Holding tank ^V 1A PJ /a SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation fo / Property line 10 � Absorption field .10 4 Water main N /,g Water service line Surface water /00 '4 Wells on adjacent lots /o o 14 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line o "� B 'Id' f d f -73 W ter main 1 ' u� mg oun a ion a Water Service line o Surface water / 0 O �"F Curtain drain No Ntr ic,row,� Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION oo't IV /A Driveway, parking/vehicle storage 171 I certify that I have determined through field inspections and �,;;,," ,,, XJVN--�, ...... review of Municipal records that the above systems are in i conformance with MOA HAA guidelines in effect on this date. ROBERT C.`CflWAN i W `�c�• CE :'8901 ! `� Engineer's Printed Name rC d�'t•L% eDwA�/}'+•. .;`' Date 1%� h lo 3 to .; •�` HAA Fee $ 3 7S-, Waiver Fee $ Date of Payment '1 ('r lo 3 Date of Payment Receipt Number d 33 7i 3 Receipt Number (Rev. 12101) c�T•�'7 )J Municipality of Anchorage Development Services Department Zn Building Safety Division Ir6of On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Water Well Advisory Health Authority Approval # 030141 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block , Lot 3A of Rouse subdivision, the well's productivity was determined to be 0.81 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. 4-10-03:10:14AM: SGS ReE# 1031787001 Client Name S & S Engineering ProjectName/N N/A Client Sample ID Rouse S/D MA Matrix Drinking Water Sample Remarks: Parameter Waters Department Nitrate -N Microbiology Laboratory Total Coliform :907 5615301 8 A- 2 All Dates/Times are Alaska Standard Time Printed Date/Tlme 04/09/2003 17:04 Collected Date/Time 04/03/2003 16:00 Received Datefrime 04/04/2003 8:00 Technical Director tephen ReleasedB Allowable Prep Analysis Results PQL Units Method Limits Date Date Init 0.613 0.200 mg/L EPA 300.0 0 coUl00mL SM18 9222B (<=10) 04/04/03 1S (<-I) 04/03/03 KAP - --------- --------------- ---------- 11111 ---------------- roon�'�ow sax'+ n w 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. # 0 r73 21 % 2 HAA # !-l/4 930 7c/ 1. GENERAL INFORMATION Complete legal description Lot 3A; Rouge Subdivision Location (site address or directions) Rouhe Cix Property owner Ken Rouhe Day phone Mailing address p•d• Box 770131 Ea .2e Riven AK 99577 Lending agency Day phone Mailing address Day phone Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX 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: XXX Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 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 dat this inspection. S & S ENGINEERING Name of Firm 17034 Ea I Phone Eagle River,A sk 99577 Address Engineer's signature 6. DHHS SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for Additional Comments ItITIC P• o F"60 ��� I �Il�la •nf�. Pit bedrooms, with the following stipulations: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto 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 engineers work. 72-025 (Rev.1/91) BaCk MOA #21 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSALSYSTEM DESIGN July 12, 1994 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Rouse Subdivision; Lot 3A 2-77 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 A Conditional Health Authority Approval (HAA) was issued on January 11, 1994 for the referenced property. All work required for the Conditional HAA has been completed. Attached is the On -Site Wastewater Disposal System and/or Well Inspection Report for your approval. We request you issue a Final Health Authority Approval for the referenced property. If you have any questions or require any additional information, please contact us. A. Shafer, P.E. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 D n �.. Z D G y A 1�w ' v ; 4h,m fz3 S o O < D _y G? Q 2 A Conditional Health Authority Approval (HAA) was issued on January 11, 1994 for the referenced property. All work required for the Conditional HAA has been completed. Attached is the On -Site Wastewater Disposal System and/or Well Inspection Report for your approval. We request you issue a Final Health Authority Approval for the referenced property. If you have any questions or require any additional information, please contact us. A. Shafer, P.E. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 R,f 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. # HAA # C 1. GENERAL INFORMATION '>t' Complete legal description LO % A Location (site address or directions) IPOUSF C /,e Property owner GIN /�'Oe�4S6:7 Day phone Mailing address 19 0 1902 '%2D /3 , JFA42LF /d, 6 K Lending agency Day phone Mailing address Agent _ 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 Day phone NOTE: if community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site X Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) From MOA x21 5. STATEMENT OF INSPECTION BY ENGINEER 6. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 17034 Eagle River Loop Road No. Address / Phone - -- -- , -- - --- Engineer's signature Date 1.2-12,& f /U "9 r' )1W Ove �L cJD�c• S'yl7r �2/a2 7Z) JC -(Z- // / 9X44. DHHS SIGNATURE Approved for /9 i 7W C /-/,r 0. bedrooms. e Disapproved. _ Conditional approval for bedrooms, with the following stipulations: NEW WA-S�tQAa-p` 'DISPOSAt- 'S VS d�4OST 13E CoNS�cx�D y J ut.�,f 1, MCI+ l N, 6ccor -D A -N« W rrl+ 6t -M N 7 S_Wc 4OMs7 Additional Comments By: _A(Z) H -Q f'-- Date 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 orderto 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 (B6v. 1/91) Back MOA N21 tN Municipality of Anchorage Department of Health and Human Services 10 HEALTH AUTHORITY APPROVAL CHECKLIST 14EI5� !� ED DEC 2 91993 Legal Description: LOT,: / Ac9Gc, .6 S�D Parcel I.D. ;Nu e Dept. Health & Human Services ces A. Well Data Well type Dot 4 y/9 ZC If A, B, or C, attach ADEC letter Log present( /N) Date completed ADEC water system number A9 70 _Driller t f �<• Total depth 4z a Cased to 40 Casing height Sanitary sea(Y N) i/ 2 S Wires properly protected (Y N) Date of test Static water level Well flow FROM WELL LOG (1q;7e) LA N AT INSPECTION /2 —Z/—?3 *01- L� g.p.m. Pump levell fit- VC 3 & 7 ;eZAJFa Fl�O04 5v 2a CitGlt /P�04ds O/} ZEA 6/30lg70 SEPARATION DISTANCES FROM WELL TO: c f iy p� o — F�/} C i u j2aF-t10, // -F Septic/te�ank on lot 9cS ; On adjacent lots Absorption field on lot /00 / ; On adjacent lots `po �7- Public sewer main /CJ co nl e- Public sewer manhole/cleanout /U 0 ^",F Sewer service line q0 1 Petroleum tank oto ^-1 t= WATER SAMPLE RESULTS: Coliform 6 Date of sample: 2..1/ 6 B. SEPTIC/GTANK DATA Nitrate , 0 - - 1 0 r/ 3 Collected by: 97034 Eagle River Loop Road No. 204 Eagle River, Date installed `q 70 Tank size /,-'>-O 0compartments SU N@ Cleanouts (Y N) (Y t Foundation cleanou ) /~1 � l- ,� li eFgression ( /N) High water alarm (Y/N) Alarm tested (Y/N) 1()rl A-)0 Date of pumping /2- 6 Pumper s &)17 [A V? -!Ir �"60 SEPARATION DISTANCES FROM SEPTICtF#GMW*&-TANK TO: Well(s) on lot 2 / On adjacent lots Foundation To property line /7 6 Absorption field S2 / Water main/service line Surface water/drainage /Da �'/- 72-026(3/93)•Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons— Vent (Y/N) allonsVent(Y/N) High water alarm level Meets MOA electri "Pump on" level SEPARATION DISTANCE FROM LIFT STATION TO: Well on n adjacent lots Manufacturer Manhole/Access (Y/N) Cycles tested off" Level at Surface water D. ABSORPTION FIELD DATA Date installed a0f q-7c� It L7W74 Soil rating (GPD/Ft2) /Z.7 S System type O,e�rN i fL Length /ZS Wil6th 3 ( Gravel thickness Total depth 2 I Total absorption area 3 7S'F Cleanout presen (Y/)V Depression over field (Y N) Date of adequacy test s� � 3 Results (passff'a# 1� SS for 3 Bedrooms Water level in absorption field before test After test .012 Peroxide treatment (past 12 months) ( `N)) Nw If yes, give date 0 AI rJ F t 0 69 A9 e)AJ oo7" �i3� D r / /v ti(.SE SEPARATION DISTANCE FROM ABSORPTION FIELD TO: l ti rJ/e H zh)Li15 /=2c7 rtir ON ADS t,(Ac Tr-. 7 %/owrCal —i20ryl_ Q<1f�/O /2. /J�7 7v� /0� /R /i/vlC'j Well on lot /00 ' ,L On adjacent lots lUo r� Property line / To building foundation - 0 To existing or abandoned system on lot L U On adjacent lots Cutbanky r Water main/service line Surface water A-') v Driveway, parking/vehicle storage area Curtain drain N0IJT 1Y('/UD kJ f)/30 (� /� U T.gGr SCJ F�U�lir Q�vld /2 ,0/46�pNs' [D C /2a O12 i Fve t/dti9 ��1 Z�� 6/lam/�I3 E. ENGINEER'S CERTIFICATION IVO 5,5 - I certify that I have checked, verified)r onformed t all MOA and HAA guidelines in eff ct on th date of this inspection. 50I7 ::r/2o, 1-'3 �7-0. %?jGl�r Signature Engineer's Date INEERING Ule River, Alaska 99577 HAA Fee $ (-)(-)CY-) Date of Payment ( - 11- 9 !7 Receipt Number �LJ_n M 77 noa IQ/OQN- Cont Date of Payment Receipt Number COMMERCIAL TESTING & ENGINEERING CO. L ENVIRONMENTAL LABORATORY SERVICES SINCE 1908 REPORT of ANALYSIS Chemlab Ref.# :93.6765--5 Client Sample ID :LOT 3A, ROUSE S/D Matrix :WATER Client Name Ordered By Project Name Project# PWSID :S & S ENGINEERING :RJS :UA Sample Remarks: SAMPLE COLLECTED BY: RAY. 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 WORK Order :74262 Report Completed :12/21/93 Collected :12/16/93 @ 13:00 hrs. Received :12/17/93 @ 14:155 hrs. Technical corsSTEP� �Gf Released ed BBy QC Parameter Results Qual Units Method - ----- ------------------------------------------- - Nitrate -N 2.8 mg/L EPA 353.2/300.0 Allowable Ext. Anal Limits Date Date Init ' ---------------------------- 10 12/20 CMR * See Special Instructions Above UA = Unavailable. *" See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than (20 SGS Member of the SGS Group (Societ6 Generale de Surveillance) A --AI --III.--- — 1, 11.11 11. 1-111 1Tnu 11 1 111111 nwn A.1Aov1 ANIM IAICCT WIDl- IIA MMAI ICRCFV 4201 ITI-I CAPOI INA