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HomeMy WebLinkAboutGINAMI HILLS LT 2AGinomi Hill Lot 2A 015-461 -42 Municipality of Anchorage Page 1 of 2 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 545-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW990286 PID Number: 015--461--~F~ Name:CAROLYN MUNIZ Wastewater System: [] New · Upgrade Address: 12121 CINAMI STREET ABSORPTION FIELD No. of Bedrooms: Ph°ne:(907) 545--5677 5 [3Deep Trench rlShailow Trench IBed F1Mound rl0ther LEGAL DESCRIPTION 0.7 G~5/s.. r~ 9.8 TO TOP OF SAND ~ 2A - CINAMI HILLS 9.3 ~ 0.5 Ft. - - - 0 - 1.4-' ,. 45 ~,. WELL: [] New [] Upgrade 15 r~ 3 n. ~ CARL'S EXCAVATING 8/19/99 ., ~ TANK SEPARATION DISTANCES · S.ptic [] Harding [] S.T.E.P. From Tank Reid Stet[on Tank S.wor N.c. ANCHORAGE TANK 1250 Well 100'+ 100'+ - - 25'+ STEEL 2 SuffaCewater 100'+5,+100'+10,+ - -- -I ..LJ[T ST~ Line Foundation 5'+ 10'+ -- _ 'Pump on' ,~.1 M: ~ ~~ Fhweter a~arm ~t: Remarks: Bottom of Excavation was clean sand. BENCH MARK SOUTHWEST CORNER OF DECK. , " 100.3 Ft. Inspections performed by:_ AWWC, INC. Dates: 1st 8/18/99 2nd 8/19/99 '~;""I 3rd 8/20/99 1~,.~_ .~.-~ ~-, .' ~ ~';ffeTlr~/JA-'-~-~-rness': ~ of Health and Human Services approval ~v0~?,~"..'...~-79~....':,~~;,~ -.- .... ---~ Department Reviewed and approved by: Date: ~,~.~'o'"'.,°_?~.°~.=~'='~'~ P..~ HU~.~: A S -- B U I LTD R A W I N G 8W990286 ( ~ ~) ~,0 - ~,~ ~ 10 ~ ~SEMEm ~ ~ RESERVE sm~ X ~ N~ D~N~ELD /~ DB~ ~.2 247 - GINAMI HILLS SUBDIVISION; LOT 2A DESIGN DRAWING OF SEPTIC SYSTEM UPGRADE 'fl 345-5~77 CAROLYN ~UNIZ (907) qh~_ ..j ~ ... Department of Health and Human Sen/ices~,t~.,~f)~,,,~-~ 825 L Street, Room 502 ~ P.o. Box '196650, Anchorage, AK 995'19-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Aug 17, 1999 Expiration Date: Aug 16, 2000 Permit Number: SW990286 GINAMI HILLS LT -~A ~'cL~\\n-L~ Legal Description: Design Engineer: 0041 AK Water & Wastewater-Consulta Owner Name: Carolyn Muniz Owner Address: 12121 Ginami St. Anchorage, AK 99516- Parcel ID: 015-461-4~ ~ Site Address: 012121 GINAMI ST Lot Size: 99783 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] SepticTank [] Hotding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Date: Date: Alaska Water & Wastewater Consultants, Inc. 6901 DeBarr Road, Suite 2B ~ Anchorage, AK ~ 99504 (907) 337-6179 ~ Fax (907) 338-3246 Consulting Engineers August 11, 1999 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Sewer Upgrade for Ginami Hills Subdivision; Lot 2A To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. The drainfield is in a state of failure, and must be upgraded prior to obtaining a Health Authority Approval for the sale of the house. Comments regarding the proposed upgrade are summarized as follows: 1. SOILS: Attached is a soil log which shows the soil profile, and the percolation test results. Below the organics was a tight SM layer to a depth of 10 feet and then transitions to a SW material to a depth of 15.5 feet. At 15.5 feet the soils transitions back to a SM material to a depth of 20.5 feet (bottom of test hole). A percolation test was performed between 10.5 feet to 11 feet and found the rate to be 1.5 minute/inch. No ground water was encountered during the excavation of the test hole. One week later water was found at 14.5 feet below grade 2. BED DESIGN: It is our intent to excavate below the dense SM soils placing the bottom of the bed in the sand layer. a. Percolation Rate: 1.5 minute/inch b. Allowable Application Rate for sand filter: 0.7 gallorffday/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 643 ft2 f. Maximum depth: 11 ft. g. Effective Depth: 0.5 ft. h. Width: 15 i. Length: 45 ft. j. Sand filter = 2 ft. M.O.A. approved sand filter: (2 ft.) k. Effective absorption area = 675 ft2 4. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic upgrade. 5. TOPOGRAPHY: Attached is a topography' map of the area. The area for the proposed bed is generally flat. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179, or at 244-9612. Thank you for your assistance. Sincerely, ~ Presider ANCHGR VIE~/ / , GINAMI HILLS I z ~ I I I I J LOT j I I ~AS~ WATER ~ WASTEWATER CONS~T~S, ~C. SITE P~N FOR SEPTIC UPGRABE 345-5677 CAROLYN MUNIZ (907) DA~:8/12/99 O~WN BY: PAGE: K.D.W. 1 = 100' 1 OF 2 EXISTING DRAINFIELD / ~-- TO BE USED AS A '/ ~ ~ PROPOSED P~EL TO ALL SLOPE CONTOURS. SEPTICS, ~D SURFACE WA~R. ~AS~ WA~R ~ WAS~WA~R CONS~T~S, GINAMI HILLS SUBDIVISION; LOT 2A ALASKA WATER & WASTEWATER CONSULTANTS, INC. -~-~ I SOIL LOG - PERCOLATION TEST I LEGAL DESCRIPTION: GINAMI HILLS LOT ~ ~ ....... J 'r" PERFORMED FOR: CAROLYN MUNIZ ~i~,~::':''"~~ss ~e j]~[[~ SOIL C~SSIFICATIONS '~SlTE PLAN} GH CL  ~ GC OL GU (TIGHT) SH / OH DEPTH TO DATE ' 3ROUNDWATER DRY 8/2/99 I Z ~o%o%c CLOCK NET TINE WATER LEVEL NET DROP 11 % °%° DATE READING oo~ 8/5/99 PERC. HOLE was PRESOAKED 4+ HOURS PRIOR TO TESTING 12 %~o , o%?Z?ff SW 15~oc°° o o , 1 2:45 6" oo~o%c 2 - 8.42 14 %o%°' °%o%e 4 -- 8.58 7 -- 6" 17 8 ~ -- 8.72 0" 6" ~ 9 - 6" 18 SM ~ 10 - 8.73 0'~- 6" 19 PERCOLATION RATE 1.5 (HIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 10.5 FT. AND 11.0 FT. 20 B.O.H. COHHENTS: PERFORMED BY A~SKA WATER & WAST~ATER. I, JEFFR~ A. GARNESS, CERTI~ THAT THIS WAS PERFOEM~ IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON DATE: ~, kt/ff~ DEPTH TO DATE 3ROUNDWATER DRY 8/2/99 14.5' 8/10/99 MUNICIPAL)TY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAILING ADDRESS EGAL DESCRIPTION LOCATION DISTANCE TO: I Manufacturer Liq. capacity in gallons Well /'00 0 IF HOMEMADE: DISTANCE TO: Manufacturer DISTANCE TO: Well Length of each line PHONE ~33 ~7 ~'~ [] UPGRADE NO. OF BEDROOMS Absorption area PERMIT NO. Inside length Dwelling oz~ I Foundation Total length of lines Dwelling / ¢/-~. Materi;~//f,/,~ IWidth " Material · Nearestlotline Trench wdth No. of compartments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO. Distance between lines No. of lines inches Top of tile to finish grade Material beneath tile Total effective absorption area inches Length Type of crib DISTANCE TO: DISTANCE TO: Depth Width :rib diameter Wel,!~ · epth Building foundation PERMIT NO. Crib depth~ Building fo~Lnd~tion ~ 'YO - Driller Sewer line Total effective absorption area Nearest lot line //.5-o ~ Distance to lot fine Septic tank PERMIT NO. ,, Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS APPROVED DATE LEGAL 72-013 (Rev. 3/78) 264-4?:20 : FINCHORFIGE PERMIT NO. BPF'LtCflNT: CHRIS MUNiZ flDDRESS: ~4D SOVLIZ CR flNC:HORflGE, flK 99504 L. EGBL DESCRIPTION - SUB[:,IVISION~ GINBMI TOWNSHIP: DEPFIRTMENT OF HEFlLTH KIND ENVtRONMENTFIL PROTECTION R25 "L" STREET, RNCHORFIGE, iRK 9950d- 694-2i.7± : EFlGLE RIVER F'HCNE: 3:]:]:-0742 BLOCK: - SEIZ:T i CIN: 24 LOT: 2R HRi:-:;iI"iUM NLIi',IBEF.: OF E:E:DF.:OOMS = ~: SOIL RRTING = ]:49 (SLTL FT. ,-."E:R::, LiSTE£:, BELOPl RRE THE OF'TIONS RVRILRE;LE TO ~'CllJ IN DESIGNIIqG 'th]UR SEF'TIC :,t:TEIt. CHI]OSE: THE OPTII]N 'FHRT BEST FiTS y-Il IF' SITE. T' "hr" PJ. IE:'TH = 23:. E~ FT. 'z~ ~) LENGTH = ' 46. ¢3 FT. -~- GRFlVEL DEPTH = O. 5 FT. aRH,EL VOLUME = ~'~. d- CU. TFlNK SIZE = ±., OE~O. ~'-I GFlLLONS (THO C:AMPFIF-:TMENT TFlNK) ' P!iDTH = 5. 0 FT. LENGTH = ±6~:. ~_'-~ FT. TOTRL DEPTH = 6. 0 FF. GRFlVEL E:,EE:TI-I = d,. 5 Fr. -.n,-, r- VOLI_IME~ = 60. Z:: C:l_l. VI')S. TFlNK SIZE = ±., 000. E1 GFlLLONS '::TWO c:oMpFlRTMENT TFlNK) ' ' tR LiFT STFI"f'iAN MFl¥ BE RE6ILIIRED. NIE:'TH = 5. 0 FT. LENGTH = ±d-3. 0 FT. TCTFlL DEPTH = 6. 0 FT. ~ ~ Nr~TE ~ ~ - REQUIRES INSI..ILFITION GRFlVEL DEF'TH = ]':: 5 FT. TFlNK SiZE = % 000. 0 GFtLLONS '::TNO CnMPRRTHENT TRNK::, i r:ERTIF¥ THFlT: ±. i RM FFlHILIFlF.: P.IITH ]"HE F.:EC!LIIF.:EMENTS FOR ON-SITE =,Eli_l-.;, FINE:, WELLS FlS SET FnF.:TH B'¢ THE M_tNIC:IPFILIT'¢ OF FINCFIOF.:FIGE FIND THE STFlTE RF FlLRSKFl. 2. i HILL iNSTRLL TI-IE SVSTEM iN flCRAF.:DFINCE P!tTH THE CAE:,ES RNE:, HFI'v'E R__EI Er Fl COPV AF THE: iDAE:,E L-,_I'It'IHF..~ FIND £:,IFIlGF.:Flf'I FITTI=I(]HMENTS P~HiC:H 1S PFlF.:T OF THIS F'ERM I T. 3:. i UNDERSTFlND THRT THE ON-SITE 5;EI.,.IER S'¢STEH HFI'~' REC,!IJIRE ENLFlRGEMENT IF' THE F.:ESiDENCE !S F.:EMODELED TO INC:LUDE ML]RE THFlN 3: BEDROnMS. ~l ~''tT't TO iNF-F.'H F'EF."C, nNI'.JEt [:,ItRII'.,IC.i THE F'ERMIT FIF'F'LICFINT HFlS TI-tE F.:ESF']t'.,ISIE:~.~ ~ ......... iNSTFILLFITICiN INSF'EC:TIONS t]F FlN'¢ WELLS FI[:,J'FICENT TO THIS PF.:OF'EF.:TV FIND THE NUMBEF.: AF F.:ESIDEHCES TIdFIT THE bIELL bIILL SEF.:'/E. S ! GNED: L-:HR i S MU±'.41Z flF'PL I CRNT: / G~Ab~ VOL!JHE = ~9. · CU. YDS. N[DTH ~ 5, 0 FT, i~ CGF"¢ OF THE ~N3DE '-,-i,'~' Date Drilled: Static Water Level 18 feet Gallons Per Minute Draw Down N/^ feet Total Feet of ~asing 4? Type Material Drilled: 0 feet to 15 C!av/Cravel 15 feet to 20 Ssnd 20 feet to 35 Grave]. to 43 C,]sv to 47 Gravel/ rock/ water 47 feet to 60 g~d~oclt Hefty Drilling S.R.A. Box 1553 H Anchorage,Alaska 99507 &'; £NGINEER$, INC. PERFORMED FOR'. LEGAL DESCRIPTION 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 ~.-~). 18 19 20 SOILS LOG -- PERCOLATION TEST "~ ~ -/- ~Z j SLOPE ' o -/, /,.¢'- '7' Co/K~ ~ .... [~ PERCOLATION 349 - 6561- ~ST IF YES, ATWHAT /~,// E DEPTH> , , SiTE PLAN Gross Nel Depth tO Net Reading Date Time Time Water Drop ~OMMENTS /~)~7¢ r PERFORMED 'rEST RUN .FT,'VEE. , · - FT -' z- .......... = ..........: ........ '-' -= '']''' .................' .................. /'~/00' CFo8 ~02~ ~ ~ ~ j APPLI(, NT ~LLS OUT UPPER HAl ONLY prc. pertyOwner; '9 ~/1(~) ~ C~;;~ r)~ t/-? ~"."C Phone Ma[l!ngAddr]Bss ~ ,iz~. (.~,;'~'~ , i~ j"~. 9~5Oy ZipCode Address ..... ' ' Zip Code J (~ ~ Zip Code Realty Co. & Agent Phone Address Zip Code Street Locat[o~ Type of Residence [] Mulhple FaT ly No. of Bedrooms [] Other Wster S.pp,y Xlndi¥idusl A~I-ACR WELl- I_OG. A well log is required for all wells drilled since ,June tO75. [] Community ~' For wells drilled prior to that date, giYe well depth (attach log if availabls). Sewer Disposal · [J Public Utility When Connected to Public Utility: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, Time Time Time H'~ 0 Time Date Date Date l/..[ ~ ~/ ~ Date Inspector Inspector Inspector Inspector Field Notes: (~Jd ~ ~ 0 ~ MUNICIPALITY ©~ ( ~ ) APPROVED BEdROOmS 'CON,TONS OF APPROVAL ( ) D~SAPPROVED ( ) COND~T~ONALA~ROVAL' DATE J ~ ~ - ~'~ Soils Rating Date ~wer Installed Well To Absorption Area ~ ~ ~ ~ Well Log Received ~ ~, g--Z'~3 WelltoTank ~ ~ ~ SeptioT~kSize ~ovember 1~, 19U3 Carolyn Muniz 6949 Soyuz Creek Anchora ge, AK 99504 Subject: Lot 2A, Gin~mi Hills Subdivision Approval for the individual sewer and water facilities oannot be granted until the following items have been cor~,pleted.° o A well log submitted to this office for our files and review. o Was 4 foot of cover or insulation added to the.top'~ of, the bed area? Please notify this Department for a reinspection wtlen the noted discrepancies [~ve been corrected, if there are any further questions~ please c~ll this office at 264-4720. Sincerely, Cory Willis, R.S. Acting Sewer & Water Program Manager CW19/ej/E1 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 015-461-42 Certificate of On -Site Systems Approval Expiration Date: ?- Z0Z Legal description G I NAM I H I LLS LT 2A Site address 12122 GINAMI ST Anchorage AK 99516 Current property owner(s) NOLAN _�_c The On -site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or advisories: bedrooms, with the following stipulations: Original Certificate Date: This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory x Arsenic Advisory Other COSA Approval June 2022 Development Services Department= Phone: 907 343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I. D. 015-461-42 Complee legal description GINAMI HILLS; LOT 2A Location (site address) 12122 GINAMI STREET, ANCHORAGE, AK 99516 Current property owner(s) NOLAN GENEVIEVE Day phone 907-903-9233 2. ON -SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: M Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: 0 Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 24 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS 0 Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On -site staff to verify the accuracy of the information provided. COSA Fee $ Date of Payment 3 / Z 0z" COSA# h �llOulg Waiver Fee $ Date of Payment Waiver # COSA Application June 2022 Septic 'Tank Advisory Certificate of On -Site Systems Approval # OSC241048 Subdivision: Ginami Block: , Lot: 2A The septic tank for this property is 24 years old. The average life of an asphalt coated steel septic tank is 20 years. Typical replacement costs are $10,000 or more, not including engineering, surveying or MOA permitting fees. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. COSA Checklist Legal Description: GINAMI HILLS; LOT 2A Parcel ID: 015-461-42 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 A. WELL DATA FEW Well log is filed with Onsite (or attached) Date drilled 8/1911983 Total depth 60 ft Cased to 47 ft [EN Sanitary seal is functioning correctly ❑Q Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 11/30/2023 Static water level at beginning of test 17.4 ft Comments B. TANK DATA Measured operating fluid level in septic tank 50 Date of pumping 0 a y ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 8/18-20/99 FM ALL standpipes present per record drawing Total measured depth from grade 8•9 ft (max) Measured depth to pipe invert from grade 7A ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. R Monitor tubes go to bottom of effective. If not, state depth into effective FX Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced 1961 gallons 11/30/2023 date Any rejuvenation treatment (past 12 months) N/A If yes, enter date Well production at time of test 5.3+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes Al No 2"C"oliform bacteria is Negative Nitrate3 •'IL% mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L L"Arsenic less than MRL (ND) Collected by GEG, LTD. Date STATION ❑ Require Age of lift station Lift station niaW Adequacy test date 11/30/2023 Results Q Pass Fluid depth prior to test 0 in Water added 485 gal New fluid depth 0 in Elapsed time 0 min Final fluid depth 0 in Absorption rate 450+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 in Effective depth used 0 in Effective depth remaining 6 in Comments/Deficiencies: STARTED ADEQUACY TEST IMMEDIATLY AFTER PRESOAK. DID NOT EVALUATE CONDITION OF OLD (1983) BED. COSA Checklist June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' FolYes if No ft p■ Yes if No ft Neighboring Tank > 100' g Yes if No ft Private Sewer/Septic Line > 25' QYes if No ft Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' ■❑Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No ft ❑i Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑N Yes if No ft Q Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *5+ ft Surface Water > 100' Q Yes if No ft Tank to Property Line > 5' Fm_1 Yes if No ft Field to Property Line > 10' n Yes if No ** ft Water Main > 10' Q Yes if No ft Water Service Line > 10' M Yes if No ft Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' 0 Yes if No ft 0 Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *MET SEPARATION DISTANCE AT TIME OF INSTALL. **SEPARATION DISTANCE FOR 1983 BED IS ASSUMED BASED UPON 1983 INSPECTION REPORT AND LOCATION OF ONLY PIPE IN 1983 BED. G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on -site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Gayness Engineering Group, LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Garness Date In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. COSA Checklist June 2022 y� tPr ` LICENSE �1Q Pro f e s sla"�c MECC884 .. Municipality of Anchorage Development. Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite _ (907) -343-7904 CERTIFICATE OF ON-SITE SYSTEHS APPROVAL FOR A SINGL '%AHILY DWELLING Parcel I.D. 015-461 -~-4'~ 1. GENERAL INFORMATION Expiration Date: / O .~ ~-- ~ j ~ Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address . Real Estate Agent Mailing address GINAMI HILLS S,/D; LOT 2A 12122 GINAMI STREET * ANCHORAGE, AK * 99516 JOHN & ANN WITHERS Day phone 3705 ARCTIC BLVD, #463 * ANCHORAGE, AK * 99503 Day phone KATHLEEN POULIN W/ KELLER WILLIAMS Day phone 242-4223 101 W. BENSON BLVD, #503 * ANCHORAGE, AK * 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well · ~ Individual On-site · Individual Water Storage [] f Individual Holding tank [] Community Class Well [] Community On-site [] Public Water System [] . Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses)for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may .be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As ce, t/fled 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 appfication, 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 afl applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 537-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 5~ Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under 'the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions 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 Iong the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is. not authorized, nor will it confer any legal fight whatsoever. DSD SIGNATURE ~'"" Approved for bedrooms. Disapproved° Conditional approval for bedrooms, with the fllowing stipulations: OF ....... ~. WATER AND ; m~ ~ ~ WASTEWATER · .- ¢ · PROG~M <, ~,., .- ~-~ '¢¢-,- .. ,. ¢ ~ Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory By: (Rev. 11/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Repot[ Other Original Certificate Date: Municipality of Anchorage • Development,Servioes Department Building Safety Division On -Site Water & Wastewater Program / 4700 Bragaw Street P.Q. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON -SITE SYSTEMS APPROVAL CHECKLIST Legal Description: GINAMI HILLS S/D; LOT 2A Parcel ID: 0 /5'- q G / - 412 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 8/19/1983 Sanitary seal (Y/N) YES Total depth 60 ft. Cased to 47 ft. Date of test Static water level FROM WELL LOG 8/19/1983 18 ft. Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 6/14/2010 22 ft. Well production 10 g.p.m. 5.74 9-p.m. YES YES 12+ in. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate�� 7 mg./L. Other bacteria colonies/100 ml. Arsenic: ug./L. Date of sample: 6/2/2010 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed _ Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) 8/19/1999 YES Foundation cleanout (Y/N) YES Depression over tank (Y/Nt) NO High water alarm (Y/N) N/A Date of pumping � 1 7 i D Pumper OrYIG 1 S(f vie ✓ ,� t�Y n- 1983 BED/ C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE 1999 BED 8/2/1983/ 284 FTZ/BDRM BED/ Date installed 8/19/1999 Soil rating (g.p.d./ft2or ft2/bdrm) 0.7 GPD/FTZ System type BED 50/ 23/ 0.5/ Length 45 ft. Width 15 ft. Gravel below pipe 0.5 ft. *4.3/ 1150/ 2 Total depth *7.5-8.9 ft. Eff. absorption area 675 ft Monitoring tube YES Depression over field NO Date of adequacy test **6/14/2010 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 490 gal. New depth 1.5 in. Elapsed Time: 80 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - **TESTED 1999 BED THAT IS CURRENTLY IN USE. 1983 BED WAS SURCHARGED. D. LIFT STATION Date installed "Pump on" level at in. Datum ~ Size in gallons Manhole/Access ~ "Pump off" leveJ_&L~, High water alarm level at Cycles tested. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot. 100'+ Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas. 50'+ in. 100'+ Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas N/A 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main ' N/A Water service line 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Absorption field 5'+ Surface water. 100'+ Property line 10'+ Building foundation. 10'+ Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ COMMENTS Water main N/A Driveway, parking/vehicle storage 10'+ 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 JEFFREY A. GARNESS Date (c,I 'Z~'tl ° COSA Fee ~ 7~ Date of Payment Receipt Number 0 (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On-Site Systems Approval # 101104 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 2A of Ginami Hills subdivision. This inspection revealed a nitrate concentration of 8.17 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. I LOT 3B J LOT 3A-t ./ LOT 2A N89°57'2g"w 327.23 LOT 2B LOT lA 8351E 3O 30 SCALE: 1"= 40' EASEMENTS O~ RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT AI~E NOT SHOWN HEREON. Fb 10-.3, pg 48-50 AS-BUILT NO CORNERS SET THIS DATE hereby eer~fy ~hat I have parlay, ed s I~gee~. InspeclJon ofthafollowingde~c~bedpropmt~. LOT 2A. QINAMI HILL8 8UBI~VI$1ON BE Anchomga Recording Precinct, Naska, and that ~e rmp;,oveme]lt~ situated Utere~n am v,~hin ~he property Enes fids 2_qst ,., dayaf JUNE ,2010 (go7-248-1655) SGS Reft# 1102471001 Client Name Garness Engineering Group, Ltd Printed Date/Time 06/11/2010 17:11 Project Name/# Ginami Hills Lot 2A Collected Date/Time 06/02/2010 14:00 Client Sample ID Ginami Hills Lot 2A Received Date/Time 06/02/2010 14:17 Matrix Drinking Water Technical Director Stephen C. Ede Saml~le Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Hardness as CaCO3 188 5.00 mg/L SM202340B C 06/03/10 06/07/10 SCL Waters Department Total Nitrate/Nitrite-N 8.17 0.100 mg/L SM20 4500NO3-F B 06/02/10 AYC Microbiology Laboratory E. Coil Negative 1 100mL SM20 9223B A 06/02/10 DLC Total Coliform Negative 1 100mL SM20 9223B A 06/02/10 DLC Private Individual Analysis Alkalinity 136 10.0 mg/L SM20 2320B D 06/03/10 LP Aluminum ND 20.0 ug/L EP200.8 C 06/03/10 06/07/10 SCL Antimony ND 1.00 ug/L EP200.8 C (<6) 06/03/10 06/07/10 SCL Arsenic ND 5.00 ug/L EP200.8 C (<10) 06/03/10 06/07/10 SCL Barium 27.6 3.00 ug/L EP200.8 C (<2000) 06/03/10 06/07/10 SCL Cadmium ND 0.500 ug/L EP200.8 C (<5) 06/03/10 06/07/10 SCL Calcium 58600 500 ug/L EP200.8 C 06/03/10 06/07/10 SCL Chloride 15.5 0.100 mg/L EPA 300.0 D (<250) 06/07/10 06/07/10 SDP Chromium ND 2.00 ug/L EP200.8 C (<100) 06/03/10 06/07/10 SCL CO3 Alkalinity ND 10.0 mg/L SM20 2320B D 06/03/10 LP Conductivity 405 1.00 umhos/cm SM202510B D 06/10/10 AHJ Copper 15.9 1.00 ug/L EP200.8 C (<1300) 06/03/10 06/07/10 SCL Fluoride ND 0.100 mg/L EPA 300.0 D (<2) 06/07/10 06/07/10 SDP HCO3 Alkalinity 136 10.0 mg/L SM20 2320B D 06/03/10 LP Iron ND 250 ug/L EP200.8 C (<300) 06/03/10 06/07/10 SCL SGS Ref.# 1102471001 Client Name Gamess Engineering Group, Ltd Printed Date/Time 06/11/2010 17:11 Project Name/# Ginami Hills Lot 2A Collected Date/Time 06/02/2010 14:00 Client Sample ID Ginami Hills Lot 2A Received Date/Time 06/02/2010 14:17 Matrix Drinking Water Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Private Individual Analysis Lead 0.732 0.200 ug/L EP200.8 C (<15) 06/03/10 06/07/10 SCL Magnesium 10100 50.0 ug/L EP200.8 C 06/03/10 06/07/10 SCL Manganese 1.05 1.00 ug/L EP200.8 C (<50) 06/03/10 06/07/10 SCL Nickel ND 2.00 ug/L EP200.8 C (<100) 06/03/10 06/07/10 SCL OH Alkalinity ND 10.0 mg/L SM20 2320B D 06/03/10 LP pH 6.80 0.100 pHunits SM20 4500-HB D (6.5-8.5) 06/03/10 LP Selenium ND 5.00 ug/L EP200.8 C (<50) 06/03/10 06/07/10 SCL Silver ND 1.00 ug/L EP200.8 C (<100) 06/03/10 06/07/10 SCL Sodium 6410 500 ug/L EP200.8 C (<250000) 06/03/10 06/07/10 SCL Sulfate 10.2 0.100 mg/L EPA 300.0 D (<250) 06/07/10 06/07/10 SDP Thallium ND 1.00 ug/L EP200.8 C (<2) 06/03/10 06/07/10 SCL Total Dissolved Solids 250 10.0 mg/L SM20 2540C D (<500) 06/03/10 AYC Zinc 488 5.00 ug/L EP200.8 C (<5000) 06/03/10 06/07/10 SCL hborhood Name Upper Hillside Map Reference 2741 Occupant [] Owner [] Tenant [] Vacant SpecialAssessments $ none [] PUD HOA$ Census Tract 28.13 [] per year [] per month iraised [] Fee Simple [] Leasehold [] Other (describe) Assignment Type [] Purchase Transaction [] Refinance Transaction [] Other (describe) Lender/Client Residential Mortgage Address 100 Calais Drive, Anchorage, AK 99503 Is the subject property currently offered for sale or has it been offered for sale in the twelve months prior to the effective date of this appraisal? [] Yes [] No )crt data source(s) used, offering price(s), and date(s), earnest money agreement; list pirce was $539,000; market time was had several offers and was in a competitive biddin~l situation. I [] did [] did not analyze the contract for sale for the subject purchase transaction. Explain the results of the analysis of the contract for sale or why the analysis was not performed. The sales contract overall appears to be typical for the market. Contract Price $ 562,000 Date of Contract 6-15-2010 Is the property seller the owner of public record? [] Yes [] No Data Source Is there any financial assistance (loan charges, sale concessions, gift or downpayment assistance, etc.) to be paid by any party on behalf of the borrower? If Yes, report the total dollar amount and describe the items to be paid. none see sales agreement [] Yes [] No Note: Race and the racial composition of the neighborhood are not appraisal factors. Location [] Urban [] Suburban [] Rural [] Increasing [] Stable [] Declining Built-Up [] Over 75% [] 25-75% [] Under 25% Demand/Supply [] Shortage [] In Balance [] Over PRICE AGE One-Unit 82 % Growth [] Rapid [] Stable [] Slow [] Under 3 ruths [] 3-6 mths [] Over 6 ~hs 400 Low Neighborhood Boundaries Neighborhood boundaries include: Hillside Park to the north, Chugach State 1,800 High Park to the east. Rabbit Creek Road to the south, and the lower hillside to the west. 2-4 Unit 2 0 % 40 Commercial 1% 500 Pred. 20 Other 15 Neighborhood Description The subject neighborhood is located on the mid to upper hillside 6 miles south SE of downtown Anchora¢ above average; many lots have larger size and may accommodate horses. Site views and proximity to the ski influences. There are no known adverse influences in close proximity to the subject. Market Conditions (including support for the above conclusions) The market has remained relatively stable for several years. Loan discounts and interest downs are not widespread but do occur. Please see attached 1004 MC addendum. Dimensions Rectangular Area 99,852 SF Shape Rectangular Specific Zoning Classification R-9 Zoning Description (Suburban Residential) ;)liance [] [] Legal Nonconforming (Grandfathered Use) [] No Zoning [] Illegal (describe) Is the highest and best use of subject property as improved (or as proposed per plans and specifications) the present use? View Average+ [] Yes [] No If No, describe Utilities Public Other (describe) Public Other (describe) Off-site Improvements- Type Public Private Electricity [] [] Water [] [] private well Street Gravel [] [] Gas [] [] Sanitary Sewer [] [] Individual Septic Alley none [] [] Flood Hazard Area [] Yes [] No FEMA Flood Zone Zone C FEMA Map # 020005 244 Are the utilities and off-site improvements typical for the market area? [] Yes [] No If No, describe FEMA Map Date 9-18-1987 Are there any adverse site conditions or external factors (easements, encroachments, environmental conditions, land uses, etc.)? [] Yes [] No If Yes, describe Easements There are no apparent or disclosed encroachments; as-built survey of 8-22-1983 has been provided. Due to site size and view, overall site appeal is comparable to slightly superior to the majority of other lots in the immediate area. Units [] One [] One with Accessory Unil # of Stories 2 Type [] Met. [] Att. [] S-Det./End Unit Basement Area Concrete Slab [] Crawl Foundation Walls Concrete Block-Ave Floors Carpet/Tile-Good Full Basement [] Partial Basement Exterior Walls TI-Il-Ave Walls Gypsum-Good Metal-Ave Trim/Finish Wood-Ave none s~ Roof Surface Basement Finish % Gutters & Downspouts Rain,quEer Bath Floor Tile-Good Outside Entry/Exit[] Sum Window Type Casement-Ave Bath Wainscot Tile-good Storm Sash/Insulated None Effective Age (Yrs) 10 Screens # of Cars Attic [] None Amenities 'Surface Gravel Drop Stair [] Stairs Other Fuel Gas Fireplace(s) # 1 [] Fence # of Cars 2 Gara¢ Floor [] Scuttle Central Air Conditioning Patio/Deck large [] Porch covered # of Cars [] Finished [] Heated Individual Other Pool [] Other [] Att. [] Met. [] Built-in 31lances [] Refrigerator [] Range/Oven [] Dishwasher [] Disposal [] Microwave [] Washer/Dr~er [] O~er (describe) Under 2 Story/Ave Year Built 1983 Evidence of [] Infestation None No/Yes Dampness [] Settlement No/Yes Finished area above grade contains: 9 Rooms 3 Bedrooms 3.5 Ba~(s) 2,956 Square Feet of Gross Living Area Above Grade Additional features (special energy efficient items, etc.), covered entry, 2 large side decks, extensive vaulted ceilings and clerestory windows,, 2 sided 9lace, extensive tile flooring, loft area above master bathroom, and middle bedroom, custom shower, security alarm system, 10 x 15.5 shed Describe the condition of the property (including needed repairs, deterioration, renovations, remodeling, etc.). Overall condition is superior with respect to the market. The subject appears to have been extensively remodeled inside and out. No home inspection has been provided. No deferred maintenance or functional inadequacies noted. Are there any physical deficiencies or adverse conditions that affect the livability, soundness, or structural integrity of the property? [] Yes [] No If Yes, describe none 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 015-461'-' - L~ ~. HAA# GENERAL INFORMATION Complete legal descriptior Lot 2A; Ginami Hills Subdivision Location (site address or directions) 12121 Ginami Street Anchorage, AK Carolyn Muniz Ginami St. Anchorage, Dayphone 345-5677 AK 99516 Day l~hone PropePry owner ~ailirig address · 12121 Leqdi .~g agency Mailin. g' address Agent: Peggy Gonza'les/Fortune ?roperties Address .Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER sUpPLY:. NOTE: Individual well 4. TYPE OF WA~TEWATER DISPOSAL: NOTE: Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of s~.$tem. , xx Individual on-site Holding tank Community on-site Public sewer U community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/B1 ) FrOnt MOA ~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 corn 31lance with all Municipal and State codes, ordinances, and regulations in,6~f~r~l~a~e of ~is inspection. Wastewater Cop~ult~f~., Address Engineeds signature __//f ~'// '~-~ Alaska Water & Wastewater Consultants, Inc. Shall be PAID $ t [OO-- 'at, or prior to, closing for the Engineerin~l Services Provided; DHHS SIGNATURE ,, ...... ' I/" Ap. proved for --/-fL//~ E'E bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: The ~ell for th±s property meets e×:[stin8 State and Hun±c±pal Codes. Note: There are nitrates present. It is suggested that periodic~testing be .performed to insure the weils continued suitability.~:~Current~nitrate concentration is 6.0 'mg/!. 'EPA m~ximum concentration i~ !O.O mg/1. More information on nitrates is available from the Qn,site Services Program, DHHS~ 343 4744. Additional comments By: ate / o- y- ?? 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 DH HS do not conduct inspections or analyze data before a certificate is issued, The Municipality of Anchorage is not responsible for errors or omisaions in the professional engineer's work. RECEIVED OCT 0 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division MUNI¢IPALI]¥ OF ANC~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (90~~--sERVIcEs DIVISION Legal Description: A. WELL DATA Well type PRIVATE Log present (Y/N) Total depth 60' Sanitary seal (Y/N) Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 0 Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed 8/19/99 Foundation cleanout (Y/N) Date of Pumping NEW C. ABSORPTION FIELD DATA Date installed 8/19/99 Length ~-5' Width __ Health Authority Approval Checklist GINAMI HILLS SUBDIVISION; LOT 2A Parcel I.D.: 015-461-44 If A, B, or C, attach ADEC letter. ADEC water system number YES Date completed Cased to ,~7' YES B/1 g/83 Casing height (above ground) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION 8/1 g/83 §/19/99 18' 19' N/A 12"+ YES 10 g.p.m. 5,5+ g.p.m. Nitrate 6.0 Other bacteria 8/23/99 Collected by: A.W.W.C.. INC. Tank size 1250 Number of Compartments 2 Cleanouts (y/N). YES YES Depression (Y/N) NO High water alarm (y/N) N/A Pumper - Soil rating (g.p.d./~ or ft2/bdrm) 0.7 15' Gravel thickness below pipe System type BED ,5' Total depth 9,5 TO TOP OF SAND Effective absorption area 675 SQ Fl' Monitoring Tube present (y/N) YES Depression over field (Y/N) NO Date of adequacy test NEW Results (Pass/Fail) For ~.---------"-b'~edrooms Fluid depth in absorption field before test (~ed (in.): Fi 'd~, AbsoTion .rate .=' q.p.d. · reatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION ~ Date installed Manhole/Access (Y/N) ~el at* "Pump off" level at* High wate~ *Datum ~sted E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line 100'+ 100'+ N/A 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 5'+ Properly line 5'+ Absorption field. Water main/service line 10'+ Surface water/drainage 1 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water 10'+ N/A 5'+ Wells on adjacent lots 100'+ Curtain drain NONE KN IWN Wells on adjacent lots F. ENGINEER'S CERTIFIC~T~/ I certify that I,~ d~ ~¢n~e.~.~¢ru.l ,Id inspections and revim ,:pC?, Signature '-~_~f~f/~ ~/- ~ ~ Engineer'sNa~¢ ' ' ~ Date ~/L4 ,~,~JEFFREY: GARNESS Building foundation 10'+ Water main/service line 10'+ 00'+ Driveway, parking/vehicle storage area 10'+ 100'+ me ar(~ :E-7953 ...' ~ HAA Fee $ Date of Payment /CO ~ 4::),/'-- ~ ~. Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)*