HomeMy WebLinkAboutH & H LT 3IMMIMI-ra 'I
Lot 3
#050-731-58
Municipality of Anchorage
Development Services Department__Building Safety DivisionOn-Site
4SA
Water & Wastewater Program, 4700 South Bragaw St. T r
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SWO30288 PID Number. 050-731-58
Name: JOHN THOMSON
Wastewater System: ■ New O Upgrade
Address:
25750 IMPERIAL DRIVE * EAGLE RIVER, AK 99577
ABSORPTION FIELD
Phone: No. of Bedrooms:
(907) 240-2020 3
O Deep Trench ■ Shallow Trench O Bed 13Mound OOther
LEGAL DESCRIPTION
Soil Rating:
0.8 CPD/Sq. Ft.
Total Depth from original grade:
8 (MAX) Ft.
Block: Lot: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe:
4.11
_ 3 H & H SUBDIVISION
3.89 (MAX) Ft.
FG
Township:—Range: Section: _
rill added above original grade:
Gravel length:
57
_
SEE DWG. Ft.
FL
Crawl width:
Number of tlnes:
Distance between lines:
WELL: ■ New 0 Upgrade
5 Ft.
1
— Ft.
Classification Private, A.B,C):
Total Depth:
Cased To:
Total absorption area:
570
Pipe material:
D 3034/ F-810
PRIVATE
185 Ft.
184 Ft.
SQ. Ft.
Driller.
Date Drilled:
Static water Level:
Installer
rN GENERAL
Date 1 lied- /2003
SULLIVAN WATER WELLS
8/11 03
137 Fz
Yield;
Pump Set At
Casing Height Above Ground:
TANK
25 GPM
UNKNOWN Ft
2 Ft.
SEPARATION DISTANCES
■ Septic O Holding O S.T.E.P. O Other
TOjpsueb."c(purh..
Septic
Absorption
Lift
Holding
ate
Manufacturer.
ANCHORAGE TANK
Capacity in gallons:
1000
From
Tank
Field
Station
Tank
Well
100'+
100'+
—
—
25'+
Material:
STEEL
Number of compartments:
2
Surface Water
100'+
100'+
—
—
—
LIFT STATION
Size to gallons:
Manufoeturor.
Lot Line
5'+
10'+
—
—
—
Pump on level at ump off at
High water alarm at
Foundation
5'+
10'+
—
—
—
Pump Moke del:
ElectRcal Inspections performed by:
Curtain Drain
NONE KNOWN
BENCH MARK
Remarks:
Location and Description:
TOP OF CMU FOUNDATION ® POINT f1Brr
Assumed Elevation:
11.C7.84
FL
ENGINEER'S 5 A I
4p6d0
AKWWC, INC. s 2003
Inspections performed by: Dates: 1 st s / /
• • • • • • • • • • • • • • •0
2nd 9/10/2003
�j, 0
3rd 9/11/2003
�,
Q" j ff y A. or ss.
Development Services Department Approval
X09-,� CE -79
04
ALL
Date: '�
, e F'�c
p��Pro
Reviewed and approved by:
fessio"!\v5
(Rev. 12/01)
PERMrrNUMBER: AS -BUILT. DRAWING PARCEL ID NUMBER:
SWO
SW030288 050-731-58
-TOP OF
.SLOPE
NEW 1000 GALLON
SEPTIC TANK—
'j,
ANK—
\'i STf 4�i h' �SF°oM
ALTERNATE SITE TM11 B I
v�< \� \ �BL1 C
DBL2
THJ1,}�
EW DRAINFIELD \
L
�?o
\O
ST1
ST2
40.32
DBL2
C01
MT1
16.73
MT2
A
B
C-
40.32
18.05
—
44.79
16.73
—
46.46
16.83
—
47.33
16.92
—
69.81
38.48
63.70
64.10
31.07
55.51
61.42
33.81
17.60
61.97
30.62
22.37
DATE: p�0
12/23/2003
DRAWN BY:ALASKA NVATL'R & INIASTLAWTLR SALE: c.J.G. p� . T 00
.>.:,.......�.� �..,. �_�_ CONSULTANTS, INC.. �.4 .:.,_.,�•._...�.. a .�.:a 1 -. 40' D
. . .. ... . . . .
3701 E. TUDOR ROAD. SUITE 101 • ANCHORAGE. AK 99507 • PHONE (901)337-6179 • FAX (907)538-32L6 D
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: r D
JOHN THOMSON (907) 240-2020 2 OF 3 •,J fr, G n s.:
LEGAL DESCRIPTION:E 7953 pO
H & H SUBDIVISION; LOT 3.
TYPE OF WORK:�0 aP�ofessio�o
AS -BUILT DRAWING OF NEW SEPTIC SYSTEM ��OO000�4�
Certifieb 4Dritting - log
by
DOC CO. dba
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2750
OWNER OF LAND: - I, ;j-4 `-j T 1 �• f' 15' 0` ; -j BORE HOLE DATA
ADDRESS:
LEGAL DESCRIPTION: ('� ��'' . f.•
.j Perforations Start _ —feet Stopped feet
Grout Type: ( ' •t r Volume -- ; /=•
Depth: from
0
feet, to .A Q, t feet
Well Disinfected Upon Completion?t3<es J No
Method of Disinfection: C 4144, 6 cL 1 1j f 5'- NIJI
Comments:
;^
Driller's Name •> > --�-� """'
ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality
of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough:
Department of Environmental Conservation.
z -d
DATE-
ATEPERMIT
PERMITNUMBER: L W =' '• '� Date of Isssuse,
TAX IDENTIFICATION NUMBER:
Is well located at approved permit location? • l,>I s .-j No
Method of Drilling: Emir rotary U cable tool
Depth of well: 1 -
Casing Type -� fr' 91- Wall Thickness ��
inches
Diameter tD inches, depth �
feet
Liner Type: i -b *°'',S
Casing Stickup Above Ground: 67!
feet
Static Water Level: I ? __+
feet
�—g
Recover Rate: pm
Method of Testing: 'Y tOZ.
Well Intake Opening Type: _'pen end U open hole
Screened; Start feet Stopped
feet
.j Perforations Start _ —feet Stopped feet
Grout Type: ( ' •t r Volume -- ; /=•
Depth: from
0
feet, to .A Q, t feet
Well Disinfected Upon Completion?t3<es J No
Method of Disinfection: C 4144, 6 cL 1 1j f 5'- NIJI
Comments:
;^
Driller's Name •> > --�-� """'
ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality
of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough:
Department of Environmental Conservation.
z -d
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Permit Number: SW030288
Date Issued: Aug 04, 2003
Expiration Date: Aug 03, 2004
Parcel ID: 050-731-58
Legal Description: [H 8_ H bt'3:
Design Engineer: 0041 AK Water & Wastewater Consultant Site Address: 25752 Imperial Drive
Owner Name: John Thomson Lot Size: 54396 SQ. FT.
Owner Address: 17343 Santa Maria Drive Total Bedrooms: 3 Permit Bedrooms: 3
Eagle River , A 99577 -
This permit is for the construction of:
❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding 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 DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 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.
Received By:
Issued By:
Date: g Ll - 0- ?
Date: 0/ 03
Municipality of Anchorage
• '� Development Services Department
Building Safety Division ,
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. () rV I Permit Number
Property owner(s) JOHN THOMSON Day phone 240-2020
Mailing address (1) 17343 SANTA MARIA DRIVE * EAGLERIVER,AK
y \ S �Z :)Y , Zip Code 99577
ai{-address (2) ��
Legal description (Lot, Block & Sub'd.) LOT 3• H&H SUBDIVISION
Legal description (Section, Township & Range) NZA
Lot Size 3q (0 Acres/Sq.Ft.
Number of Bedrooms 3
THIS APPLICATION IS FOR:
Sewer Only ❑ Well Only ❑
Sewer and Well ■ Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal codes.
ALASKA WATER & WASTEWATER CONSULTANTS INC.
Permit Fees: 4150 + y00 : �J o Waiver Fees,
Date of Payment: % ` R? '- 03 Date of Payment:
Receipt Number: 3�' l C Receipt Number:
ALASKA WATER F& WASTEWATER
CONSULTANTS, INC.
July 25, 2003
Municipality of Anchorage
Development Service Department
Building Safety Division
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Proposed Septic System for Lot 3, H&H Subdivision
To whom it may concern:
The proposed 3 bedroom house will be served by a private well and septic system. Two test
holes were dug on the property. The septic system will be designed around the 30 foot radii of
these test holes. We are proposing that a 1000 gallon septic tank and also a 5 -wide type
drainfield be installed. The well is to be drilled as shown on the attached site plan and design
drawing. Comments regarding the design are summarized as follows:
1. SOILS: See the attached log which shows the soil classifications, groundwater monitoring,
and the percolation test results. It is our opinion that due to the overall appearance of the soils, an
application rate of 0.8 gallons/day/ft2 should be used.
2. TRENCH DESIGN:
a.
Percolation Rate: 8.57 &10 minutes/inch
b.
Proposed Application Rate: 0.8 gallons/day/f12
c.
Number of Bedrooms: 3
d.
Design Flow: 450 gallons per day
e.
Minimum Absorption Area: 562.5 ft2
f.
Total Depth: 8 feet (max.)
g.
Effective Depth: 4 feet
h.
Width: 5.0 feet
i.
Reduction Factor: 0.5
j.
Minimum Length: 57 feet total length
k.
Effective absorption area = 570 ft2
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade.
3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
4. TOPOGRAPHY AND WAIVER REQUEST: As can be seen on the attached design
drawing, the average topography in the area of the proposed drainfield is a 1-5 percent slope
running approximately north/northeast to south/southwest. Approximately 35 feet downhill form
the proposed the drainfield, the slope increases from a 20 percent slope to a 50 percent slope. We
request that the 50 feet setback from a slope greater than 25 percent slope be waived to 35 feet.
Given the porosity of the soils and that the heavily vegetated hillside, there should be no
concerns with the granting of this waiver.
I am unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you /}ave any questions, please contact us at 337-6179. Thank you for your
NOTE: Attached is a site plan drawing, a design drawing, two soils logs, and a 7 page
construction specification letter which are all part of the design package for this septic system.
3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
LOT 1;H&HS/D
CA1�
\\� LOT 2; H do H S/D
\
\C/ ALTERNATE SITE —�
\
Xo
\O
PROPOSED SEPTIC SYSTEM
(SEE DESIGN PAGE 2 OF 2)
TRACT B; H do H S/D
DENALY S/D;
LOT 1,1 BLOCK 1, �.
1
/
LOT 4; H do H S/D
TMNrd���l r� a
DENALY S/D; \
LOT 2, BLOCK 1.
\
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I
I
LOT 6, BLOCK 3;
I MAJESTIC VALLEY EST.
1,
I
Ire
I
♦
I
\
\
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LOT 7, BLOCK 3;
I
MAJESTIC VALLEY EST
<< 1
1 1 _-
1 PROPOSED
1 1 w
1 I
1 II LOT 1, BLOCK 4;
1; MAJESTIC VALLEY EST.
1 \h
1
1 >,♦♦
-PROPOSED ♦ ♦ ��'----���
3 BEDROOM
HOUSE ♦♦♦♦♦\ ���%�i
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7/25/2003
ALASKA WATER & WASTE, NVATER C.J.G.
CONSULTANTS, INC. Ste' _
3701 E. TUDOR ROAD, SUITE IOL • ANCHORAGE. AK 99507 •PHONE (907)337-6179 • FA% (907)338-32L6 1 » — 1 00'
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
JOHN THOMSON 240-2020 1 OF 2
LEGAL DESCRIPTION:
LOT 3; H & H SUBDIVISION
TYPE OF WORK:
SITE PLAN FOR PROPOSED WELL LOCATION AND SEPTIC SYSTEM
' e y me
him E 7953 '`';
��►���?�0 esslo� rte'
-TOP OF
SLOPE
INSTALL
FOUNDATION
CLEANOUT
PROPOSED 1000 GALLON
SEPTIC TANK
ALTERNATE SITE WILL
REQUIRE THE USE OF
ADVANCE TREATMENT
SYSTEM.
i
INSTALL
�X DOUBLE
CLEANOUTS
I T"# �>
O
\� THI
\ �O
\O
1 A•' � �o�l
•`' '. oo' PROPOSED 1
/ ."'. /yF WELL
PROPOSED I 1
3 BEDROOM �•' i'' 1
F�OUSE 's • I
—PROPOSED DRAINFIELD. EXCAVATE A TRENCH I 1
THAT IS 8 FEET DEEP MAXIMUM BY 5.0 FEET I 1
WIDE BY 57 FEET LONG. ADD 4 FEET OF
CLEAN WASHED SEWER DRAINROCK. INSTALL 1
TRENCH PARALLEL TO SLOPE CONTOURS.
I
I
ALASKA WATER & WASTEWATER
CONSULTANTS, INC.
01 E. TUDOR ROAD. SUITE 101 • ANCHORAGE. AK 99507 • PHONE (907)337-6179 • FAX (907)338-3246
7/25/2003
DRAWN BY. O
1" = 40'
PREPARED FOR: PHONE NUMBER: r wr_ NUMBER:
JOHN THOMSON 240-2020 2 OF 2
LEGAL. DESCRIPTION:
LOT 3; H & H SUBDIVSION
TYPE OF WORK:
DESING FOR PROPOSED WELL LOCATION AND SEPTIC SYSTEM
15
; fley�. (Gayness
�°da_ _ •,_moo\F:
AT .A.SKA WATER 8& WASTKWATER ` .
CONSULTANTS, INC. �'q
, .�*)
FOi E. TUDOR ROAD. SUrTE iol 0 AWHORAGE. M 99507 --PHONE. (907) 7-8179 • FAX. (907)338-3248 • wtt7snL: oKnrccoi
SOIL LOG — PERCOLATION TEST
LEGAL DESCRIPTION: H&H SUBDMSION; LOT 3
PERFORMED FOR: JOHN THOMSON DATE: 6/11/2003
(feeflffil OVERBURDEN
TEST HOLE #1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
1E
1i
1E
GM/SM
DENSER W/
DEPTH
SOIL CLASSIFICATIONS
DEPTH TO DATE
GROUNDWATER
DRY 6/11/2003
DRY 7/24/2003
ff e Aa6Gmess.-
of 7 .tidlb 1�1
o
V,ZZ rofesswoo,
l�
I
TH#'1+ `
TH% i
SITE PLAN
1"=1oo-
DATE
PERCOLATION
READING
CLOCK
TIME
NET TIME WATER LEVEL
(MINUTES) READING
NET DROP
(INCHES)
111111111
II3II91
3:55
- 6"
K%/M
N/H//1.
•
4:25
30 2 1/4-
III111111
:�'�.��,:�''�
3
4:25
1�Y7t5t
-
I iffilli
4:55
�/�i� •
`4'f ���r
m .t!
5
DEPTH TO DATE
GROUNDWATER
DRY 6/11/2003
DRY 7/24/2003
ff e Aa6Gmess.-
of 7 .tidlb 1�1
o
V,ZZ rofesswoo,
l�
I
TH#'1+ `
TH% i
SITE PLAN
1"=1oo-
DATE
PERCOLATION
READING
CLOCK
TIME
NET TIME WATER LEVEL
(MINUTES) READING
NET DROP
(INCHES)
6/12/2003
1
3:55
- 6"
-
2
4:25
30 2 1/4-
3 3/4-
3
4:25
- 6"
-
4
4:55
30 2 1/2-
/2"5
3 1/2-
5
4:55
- 6"
-
6
5:25
30 2 1/2-
2"
3 1/2 -
PERCOLATION RATE 8.57 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
19
TEST RUN BETWEEN 5.0 FT. AND 6.0 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: N YES ❑ NO
SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: NICK HEITSTUMAN
COMMENTS:
PERFORMED BY AKWWC, INC. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WA,6 PE ORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE:
�o O
ALASKA WATER & WASTEWATER o00 0
0
CONSULTANTS, INC. -�*lD
SOIL LOG — PERCOLATION TEST �...
LEGAL DESCRIPTION: H&H SUBDIVISION; LOT 3 Q .Je a A. Gamess: 0
7953 .•'
PERFORMED FOR.• JOHN THOMSON DATE: 6/11/2003 O�� • �No
(feet OVERBURDEN 40��000os��
TEST HOLE 2
1
SOIL CLASSIFICATIONS
GW ORG
3
>+� GP ML j
GM CL
4 GC OL
°o opo o SW MH
�'• : SP CH
5
SM OH
s
SC
TH#I+
7 — DEPTH TO
GROUNDWATER
DATE m 1
DRY 6/11/2003
8 DENSER W/ DRY. 7/24/2003
9 DEPTH SITE PLAN
10
DATE READING CLOCK NET TIME WATER LEVEL NET DROP
11 TIME (MINUTES) READING (INCHES)
12 6/12/2003 1 3:58 - 6" -
2 4:28 30 2 3/4" 3 1/4-
13 3 4:28 - 6" -
4 4:58 30 3 3
14 5 4:58 - 6" -
6 5:26 30 3 3
15
16
17
B.O.H.
18
PERCOLATION RATE 10.0 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
19
TEST RUN BETWEEN 5.0 FT. AND 6.0 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: ■ YES ❑ NO
SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: NICK HEITSTUMAN
COMMENTS:
PERFORMED BY AKWWC, INC. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS gRFORMED IN ACCORDANCE
WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE:
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 050-731-58
Legal description H&H Lot 3
Site address 25752 Imperial Dr, Eagle River
Current property owner(s) Sonnabend & Barnett
Expiration Date: 1-18-2023
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
By: 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 Arsenic Advisory
Other
COSA ApprovNjune 2022
MMHMP A UTY OF AHC HOR OE
0
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. 050-731-58
Complete legal description H & H LOT 3
Location (site address) 25752 IMPERIAL DRIVE, EAGLE RIVER, AK 99577
Current property owner(s) JOHNATHAN SONNABEND & MEGHAN BARNETT Day phone
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY: ® 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: ® Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age 19 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ 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 $ 55V
Date of Payment dd 1,312Z
COSA # 1461
513G�3
Waiver Fee $
Date of Payment
Waiver #
COSA Application 2022.doc
• �.
Legal Description: H & H LOT 3 Parcel ID: 050-731-58
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system
A. WELL DATA (:v O-- Z C70"s
® Well log is filed withO (or attached)
Date drilled 8/11/ Total depth 185 ft
Cased to 184
® Sanitary seal is functioning correctly
® Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 9/26/2022
Static water level at beginning of test 125 ft.
Well production at time of test 5+ gpm
Comments
B. TANK DATA
Measured operating fluid level in septic tank 49"
Date of pumping 6/23/22
❑ Required maintenance completed, if AWWTS
Comments: 19 YR OLD STEEL TANK
D. ABSORPTION FIELD DATA
Which system tested (date installed) 9/11/2003
® ALL standpipes present per record drawing
Total measured depth from grade 8_6 ft (max)
Measured depth to pipe invert from grade 4_1 ft (min) ❑
N/A — pressurized field.
❑ Per record drawings, field is insulated.
® Monitor tubes go to bottom of effective.
If not, state depth into effective
❑ Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Water storage tank volume NA gallons
Well disinfected for coliform test? ❑ Yes ® No
® Coliform bacteria is Negative
Nitrate 1.63 mg/L ElNitrate less than MRL (ND)
Arsenic ug/L ® Arsenic less than MRL (ND)
Collected by FWi 5
Date 9/22/2022
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 9/26/22
Results E Pass
Fluid depth prior to test 16 in
Water added 470 gal
New fluid depth 25 in
Elapsed time 1380 min
Final fluid depth 15 in
Absorption rate 450 gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 49.3 in
Effective depth used 15 in (FINAL FLUID DEPTH)
Effective depth remaining 34.3 in
Comments/Deficiencies: MEASURES 4.25' ED VS 4.11 MOA INPSECTION REPORT EFFECTIVE DEPTH
COSA Checklist 2022.docx
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'
® Yes if No ft ® Yes if No ft
Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft
Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ft
® Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ®Yes if No ft
_ ®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 ft Surface Water > 100' ® Yes if No ft
Tank to Property Line > 5' ® Yes if No ft Wells on Adjacent Lots:
Field to Property Line > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft
Water Main > 10' ® Yes if No ft
Water Service Line > 10' ® Yes if No ft
F. ENGINEER'S COMMENTS
Community Wells > 200' ® Yes if No ft
If tank or field is under driveway comment below
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 FIRST WATER CONSULTING Phone 907-350-9566
Engineer's Printed Name CURTIS HUFFMAN, PE Date 10/10/2022
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting & FWCS
COSA Checklist 2022.docx
�,`.I�t�\\�l,
49TH ....•:* Irl
. Curtis Huffman
�� �'c"••. CE 128991
���'I' ' 10/10/22 • ' •v dr'
1, ROFESSOH
�,G E $G
• Municipality of Anchorage
On-Site Water and Wastewater Program R .
(907) 343-7904 5 A T ,
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 050-731-58 Expiration Date: I ^ 14- 1 S
1. GENERAL INFORMATION
Complete legal description H&H LOT 3
Location (site address) 25752 IMPERIAL DRIVE, EAGLE RIVER,AK 99577
Current Property owner(s) CHAD BOUCHARD Day phone
Mailing address 1705 N ANDERSON ST., TACOMA, WA 98406
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (wlwo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
TYPE OF WASTEWATER DISPOSAL:
4. TYPE OF WATER SUPPLY: Individual
Individual Well ® Holding Tank ❑
Individual Water Storage ❑ Community ❑
Community Class Well ❑ Public Sewer ❑
Public Water System ❑
WaiverNariance request for: Distance:
Received by: Date: /O- y- ?
COSA to be released to the agirti n unless otherwise requested by the engineer.
COSA Fee $ .5 CO Waiver Fee $
Date of Payment 102 Date of Payment
Receipt Number t WSD Receipt Number
COSA# 06C11-/L106 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 ARCTERRA CONSULTING,INC. Phone 868-3791
Address 20441 PTARMIGAN BLVD.,EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 9/26/2017
THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED
WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING, Engineer's Comments: This investigation was completed in compliance with
ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested.
The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface,changes inland use,
local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the
system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the
control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function
satisfactory for current or future occupants or can ArcTerra guarantee that no unseen
encroachments,deficiencies or discrepancies exist. rf OF' Z
6. DSD SIGNATURE / *f 9T11 \
System #1 Approved for 3 bedrooms.
System #2 Approved for bedrooms. , .'5, 7l1
E 1I Gti�v/
Disapproved. Air
' -
1S, .c)
� l;ssi► ' ��
Conditional approval for bedrooms, with the following stipulations:
‘`���llltltltfrr
crY
=J
aN-SITEATER
WAND
WASTEWATER om
c< r1 GRAM c;.:
eirojah.
By: — Original Certificate Date: L (7-174—) 7'
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X _ Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 1D-10-12.doc
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: H&H LOT 3 Parcel ID 050.731-58
A. WELL DATA
Well type PRVT If A, B, or C provide PVVSID # Well Log (Y/N) Y
Date completed 8111/2003 Sanitary seal (Y/N)Y Wires properly protected (Y/N) Y
Total depth 185 ft. Cased to 184 ft. Casing height (above ground) 36+ in.
FROM WELL LOG AT INSPECTION
Date of test 8/11/2003 9/11/2017
Static water level 137 ft. 136 ft.
Well production 25 g.p.m_ 4.5+ _ g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/1 00 mL Nitrate 1.57 mg/L
Arsenic: ND ug/L Date of sample: 9/1212017 Collected by: ARCTERRA
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 9/1112003
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) N
Date of pumping 9111/2017 Pumper ONE STOP
C. ABSORPTION FIELD DATA
Date installed 9/11/2003 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8 System type SHALLOW TRENCH
Length 57 ft. Width 5 ft. Gravel below pipe 4.11 ft_
Total depth 11 ft. (Measured 9111/17) Eff. absorption area 500 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 9/11/2017 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 7.5 in. Water added_500_ _gal. New depth 17 in.
Elapsed Time: 1410 min. Final fluid depth 6 in. Absorption rate >= 450 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off" level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main 75'+ Public sewer manhole/cleanout 100'+
Sewer/septic service line 25'+ Holding tank 100'+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain 50'+(NONE KNOWN) Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in conformance
with MOA COSA guidelines in effect on this date. .!� OFA N
Engineer's Printed Name KENNETH M. DUFFUS �s� �
Date 9/26/17 i i 9 TH �Y
r
COSA canary sheet 2 6 15.doc
KENNETH M. 1) /
7 l8
Ess{O rs
Municipality of Anchorage
On -Site Water & Wastewater Program
(907)343-7904
�a+m3'V11
Her
JUL 0 3 2014
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 050-731-58 Expiration Date:
1. GENERAL INFORMATION
Complete legal description H&H SID; LOT 3
Location (site address) 25752 IMPERIAL DRIVE, EAGLE RIVER, AK, 99577
Current Property owner(s)
Mailing address
Real Estate Agent
MIKE SPITZ Day phone 317-3914
25752 IMPERIAL DRIVE, EAGLE RIVER, AK, 99577
SUSAN BICKMAN W1 REMAXIDYNAMIC Day phone
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
240-0385
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
Individual Water Storaq_e
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
waiverNarlance request for: MAI/ %1 Dmtanee:
Received by: '' = Date:
COSA to be released [6 the ahq W unle$s ptherwee request' d y the engineer.
COSA Fee $ 5al
Date of Payment
Receipt Number
COSA# ®�Cl �13D3
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 GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, AK, 99507
Engineers Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines 6 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 ofall wells and
septic systems depend on the local soils condition, groundwaterlevels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to 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 orparty is not authorized, nor will it confer any legal right whatsoever.
6. DSD SIGNATURE
System #1 Approved for bedrooms.
in
System #2 Approved for bedrooms.
Disapproved.
Phone 337-6179
Date [J-7-1 rf
Conditional approval for bedrooms, with the following stipulations:
Original Certificate Date:
tOF(tvC "ir,i
ON-SITE
�Z WATER AND
=�Q WASTEWATER o=
PROGRAM J��`
The Mahic4darity(gr4nchordge Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTCHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
(Rev 1(1119117)
Nitrate Advisory
Arsenic Advisory
Other
If more than 1 septic system is on the lot:
COSA Checklist # of
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description:
A. WELL DATA
H&H S/D; LOT 3
Well type PRIVATE If A, B, or C provide PWSID# NIA
Date completed 8/11/2003 Sanitary seal (Y/N) YES
Total depth 185 ft. Cased to 184 ft.
FROM WELL LOG
Date of test 8/11/2003
Static water level 137 ft.
Well production 25 _gp m
WATER SAMPLE RESULTS:
Coliform Aer colonies/100 ml.
Arsenic: N 0 ug./L.
B. SEPTIC/HOLDING TANK DATA
Nitrate 1. -7a mg./L.
Date of sample: 6/4/2014
Tank Type/Material SEPTIC/STEEL
Tank size 1000 gal. Number of Compartments 3
Parcel ID: 050-731-58
Well Log (Y/N) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 24+ in.
AT INSPECTION
6/3/2014
126 ft.
4.12+
Collected by: GEG, Ltd.
Date installed 9/9-11/2003
Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) NIA
Date of pumping G 2
Pumper ZIP ' 5
C. ABSORPTION FIELD DATA `6ELDW EXISTING GRADE
Date installed 9/9-11/03 Soil rating (.p.d./ rft2/bdrm) 0_8
System type WIDE TRENCH
Length 57 ft. Width 5 ft. Gravel below pipe 4.11 ft.
Total depth *10.8 ft. Eff. absorption area 570 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 6/3/2014 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 4 in. Water added 1490 gal. New depth 25 in.
Elapsed Time: 900 min. Final fluid depth 13
p in. Absorption rate >= 450+ g,p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access
"Pump on" level at in. "Pump oft" level at a er alarm level at in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tanknift station on lot 1001+ On adjacent lot,
Absorption field on lot low+ On adjacent lots
Public sewer main N/A Public sewer manhole/cleanout
Sewer /septic service line 26+ Holding tank
Animal containment areas 50'+ Manure/animal excrete storage areas 1001+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Properly line 5'+ Absorption field 5'+
Water main NIA Water service line 10+ Surface water, 109+
Wells on adjacent lots 1001+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 101+ Building foundation 10'+ Water main WA
Water service line 104 Surface water 1001+ Driveway, parking/vehicle storage 10'+
Curtain drain NONEKNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that 1 have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSH guidelines in effect on this
date.
Engineer's Prid Name JEFFREY A. GARNESS
Date f // q
(Rev. 10112/12)
Municipality of Anchorage I°
► f Development Semrices Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Roam'
P.O. Box 196,650
Anchorage, AK 99519-6650
i'
www.muni.orgionsite `
(907) 343-7904
i
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-731-58 COSA#.�
1. GENERAL INFORMATION Expiration Date: _/ 3
Complete legal description H&H S/D; LOT 3
Location (site address) 25752 IMPERIAL DRIVE * EAGLE RIVER, AK * 99577
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
ANDREW KLISKEY
Day phone
P.O. BOX 771514 * EAGLE RIVER, AK * 99577
Day phone
ELENA NOVITSKY W/ PRUDENTIAL VISTA Day phone
351-1405
240-4369
16635 CENTERFIELD DRIVE * EAGLE RIVER AK * 99577
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
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER.
As certified by my seal affixed hereto and as of the validation date shown below, i vel- y that my
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shiovvs if the on-site water supply and,ddr wastevvater dfsposal system is (are) safe, functio`,a' and adegUate
for the number of bedrooms and type of structure Indicated herein. l further verify that based on the
hnurmation obtained from the Municipality oil Anchorage files and T orn ,my i^vestigation and ;-spection the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm
Address
GARNESS ENGINEERING GROUP, Ltd.
3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Enaineer's Printed Name
Engineer's Comments:
JEFFREY A. GARNESS, P.E.
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 long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Phone 337-6179
Date - /
-95��0
...............
... .. .. ...... ........
e r y A. Gar ess.
CE 79 3
4��dprofessio�`�o
Conditional approval for bedrooms, with the following stipulations
M LLGl L,h1 Ic IP—k lLS.
r -.—L1 n r
�Ilu_PX 1..9leGlClist
Septic System Advisory
Well Flow Advisory
Nitrates r"-�dviS:�ry.
L ,_
• t'C- ilii Ad, viSOry
Maintenance Agreements
Supplemental Engineer's Report
Othter
{it1jff(.jLjttI
OF
WATER AND ♦•:
WASTEWATER
PROGRAM •'
JJ�9991 NTS
By: Original Certificate Date:
(Rev. 11/05)
Municipality of Anchorage
4.. ?y
• '-° Development Services Department 11. `x
Building Safety Division . A '`
On -Site Water & Wastewater Program A ` T
4700 Bragaw Street
P.O: Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: H&H S/D; LOT 3 Parcel ID: 050-731-58
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N A Well Log (Y/N) YES
Date completed 8/11/2003 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth 185 ft. Cased to 184 ft. Casing height (above ground) 24+ in.
FROM WELL LOG AT INSPECTION
Date of test 8/11/2003 5/12/2011
Static water level 137 ft. 144 ft.
Well production 25 g.p.m. 3.9+ g.p.m.
WATER SAMPLE RESULTS:
Coliform d colonies/100 ml. Nitrate d Q l mg./L. Collected by: GEG, Ltd.
Arsenic: ug./L. Date of sample: 5/12/2011
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 9/9-11/2003
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping 5/16/2011 Pumper ONE STOP SERVICES
C. ABSORPTION FIELD DATA BELOW EXISTING GRADE
Date installed 9/9-11/03 Soil rating
p.d./ or ftZ/bdrm) 0.8 System type 5—WIDE TRENCH
Length 57 ft. Width 5 ft. Gravel below pipe 4.11 ft.
Total depth*$•7-11.2 ft. Eff. absorption area 570 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 5/12/2011 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 4.5 in.
Elapsed Time: 30 min. Final fluid depth 2 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date —
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N
"Pump on" level at in. "Pump off' level High water alarm level at in.
Datu
E. SEPARATION DISTANCES
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ . On adjacent lots
100'+
Public sewer main N/A 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'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field
Water main N/A Water service line 10'+ Surface water
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
5'+
100'+
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that / 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
COSA Fee s_ggo
Date of Payment -5 , J/1)
Receipt Number
(Rev. 11/05)
Waiver Fee $
a
D
v
.. ,9Spo�
.... ..... .............
I .Je sS.....
�4p
CE 795 m4 4�e�e. •. b���7�t1'��p�4G
4��npro f es sio���o
Date of Payment
Receipt Number
SGS Ref.#
1111842001
Client Name
Garness Engineering Group, Ltd
Project Name/#
H and H L3
Client Sample ID
H and H L3
Matrix
Drinking Water
Sample Remarks:
Printed Date/Time
Collected Date/Time
Received Date/Time
Technical Director
05/26/2011 16:56
05/12/2011 11:30
05/12/2011 15:10
Stephen C. Ede
Parameter
Results
LOQ Units
Method Container ID
Allowable Prep Analysis
Limits Date Date
]nit
Metals by ICP/MS
Alkalinity
163
10.0
mg/L
Hardness as CaCO3
240
5.00 mg/L
SM20 2340B
C
05/13/11 05/16/11
NRB
Waters Department
ug/L
EP200.8
C
05/13/11 05/16/11
NRB
Total Nitrate/Nitrite-N
2.09
0.100 mg/L
SM20 450ONO3-F
B
05/12/11
AYC
Microbiology Laboratory
NRB
Arsenic
ND
5.00
ug/L
EP200.8
E. Coli
Negative
1 100mL
SM20 9223B
A
05/12/11
DSH
Total Coliform
Negative
1 100mL
SM20 9223B
A
05/12/11
DSH
Private Individual Analysis
Alkalinity
163
10.0
mg/L
SM20 2320B
D
05/17/11
ATJ
Aluminum
ND
20.0
ug/L
EP200.8
C
05/13/11 05/16/11
NRB
Antimony
ND
1.00
ug/L
EP200.8
C
(<6)
05/13/11 05/16/11
NRB
Arsenic
ND
5.00
ug/L
EP200.8
C
(<10)
05/13/11 05/16/11
NRB
Barium
7.22
3.00
ug/L
EP200.8
C
(<2000)
05/13/11 05/16/11
NRB
Cadmium
ND
0.500
ug/L
EP200.8
C
(<5)
05/13/11 05/16/11
NRB
Calcium
75600
500
ug/L
EP200.8
C
05/13/11 05/16/11
NRB
Chromium
ND
2.00
ug/L
EP200.8
C
(<100)
05/13/11 05/16/11
NRB
CO3 Alkalinity
ND
10.0
mg/L
SM20 2320B
D
05/17/11
ATJ
Conductivity
491
1.00
umhos/cm
SM20 2510B
D
05/17/11
ATJ
Copper
23.6
1.00
ug/L
EP200.8
C
(<1300)
05/13/11 05/16/11
NRB
HCO3 Alkalinity
163
10.0
mg/L
SM20 2320B
D
05/17/11
ATJ
Iron
489
* 250
ug/L
EP200.8
C
(<300)
05/13/11 05/16/11
NRB
Lead
1.15
0.200
ug/L
EP200.8
C
(<15)
05/13/11 05/16/11
NRB
Magnesium
12300
50.0
ug/L
EP200.8
C
05/13/11 05/16/11
NRB
Municipality of Anchorage A
• '`'` Development Services Department e
a •s
< 4
Building Safety Division 3 , ..:
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
vwvw.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-731-58 HAA# !OLM OR Z,
1. GENERAL INFORMATION Expiration Date: 3 O — 0
Complete legal description H & H SUBDIVISION: LOT 3
Location (site address or directions) 2575 IMPERIAL DRIVE * EAGLE RIVER, AK 99577
Current Property owners)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
JOHN THOMSON Day phone
240-2020 .
17343 SANTA MARIA bt21VE * EAGLE RIVER, AK 99577
Day phone
Day phone
Unless otherwise requested, HAA 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
❑
Individual Holding tank
❑
Community'Class Welt
❑
Community On-site
❑
Public Water System
❑
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 4 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 samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP,. LTD. Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LTD. attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSO 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 long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report Js for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party Is not authorized, nor will it confer any legal right whatsoever.
5. DS,IG
D SIGNATURE
Approved for 3 bedrooms.
Disapproved.
Date /5�
Conditional approval for bedrooms, with the tllowing stipulations:
```
ON-SITE
1NASTEWATER
• 1
Attachments: �,��j'•• ,.•���
HAA Checklist 1/ Manitenance Agreements �.�JJJ i0 • • �,,,,``���1�\
Septic System Advisory 'Supplemental Engineer's Reort ��Jll )111
Well Flow Advisory
Other
By: Al, Original Certificate Date: ✓� �' 7 -
(Rev. 12/01)
I
Mu' nicipality of Anchorage
• '� Development Services Department r `°
Building Safety Division
On -Site Water & Wastewater Program
h $ 4700 South Bragaw St.
4 i ( P.O. Box 196650 Anchorage, AK 99519-6650
vwvw.ci.anchorage.ak.us
(907) 343.7904
HEALTH; t
I
TH ,AUTHORITY APPROVAL CHECKLIST
Legal Description:
H & H SUBSIVISION; LOT 3 _ Parcel ID: 050-731-58
A. WELL DATA
W III type PRIVATE If A; B, or C
provide PWSID# N A Well Log (Y/N) YES
Date completed 8/11/2003 Sanitary seal (YIN) YES Wires properly protected (Y/N) YES
Total depth 185 ft. ;Cased to 184 ft. Casing height (above ground)
I id
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL ' Nitrate ; 1.21 > mg./L.
Other bacteria 0 colonies/100 ml.
II
Arsenic:;! N A mg./L: Date of sample: 3/3/04
Collected by: GEG, LTD.
;i
TANK DATA
B. SEPTIC/HOLDING
Tank Type/Material I STEEL i
Date installed 9/9-11/2003
Tank size' 1000 "gal. Number of Compartments 2
Cleanouts (YIN) YES
I
NO
water N/A
Foundation cleanout (Y/N) 'YES Depression over tank (Y/N)
High alarm (Y/N)
Date of pumping NEW Pumper
NSA
C. ABSORPTION FIELD DATA ; ' •eELow' FINAL cRAOE ;
D Ite installed s/s-22/2003 Soil ratings .p:d./ft r ft2/bdrm) 0.8
System type SHALLOW TRENCH
Length I .: 57 ft Width i 5 :. ft.
Gravel below pipe 4.1 ft.
T Ital depth 1 2.7 MAx ft Eff. absorption area 'S70 ft2 Monitoring tube YES Depression over field NO
i! NEW ! Results Pass/Fail PASS For 3 bedrooms
Date of adequacy test ( )
Fluid depth in absorption field before test G In. Water added
— gal. New depth — in.
Elapsed Time: = min Final fluid depth — in.
t:
Absorption rate >= — g.p.d.
t (past 12 mo.) F { N & type) —
Any rejuvenation treatmen;
If yes, give date —
h
0
_ G. ENGINEER'S CERTIFICATION o4OF 0�4
I certify that'i have determined through field inspections and
review of Municipal records that the above systems are in """"'
conformance with MOA HAA guidelines in effect on this date.
.............
e A. or ss:
Engineer's Printed Na e JEFFREY A. GAR'
ooh ��s C —7953 Z
Date ? �/S O¢ �
De01P
rof e ssW'oo�
a
HAA Fee $ 1 Waiver Fee $
Date of Payment _
Receipt Number_
(Rev. 12/01)
Date of Payment
Receipt Number
D. 'LIFT STATION
Date installed Size in gailons
'Manhole/Ac` `
"Pump on" level at in. "Pump off'
in. High water alarm level at in.
Datu Cycles tested
-Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank%lift 'station on lot 100'+
On adjacent lots 100'+
Absorption field on lot 100'+
On adjacent lots 100'+
Public sewer main N/A
Public sewer manhole/cleanout :N/A
Sewer /septic service line 25'+Holding
tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: .
Building foundation 5'+ Properly line
5'+ Absorption field 5'+
Water main N/A Water service line
10'+Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD
ON LOTTO:
Property line. 10'+ Building foundation
10'+ Water main_ N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE .KNOWN Wells on adjacent Tots
100'+
` F. COMMENTS
0
_ G. ENGINEER'S CERTIFICATION o4OF 0�4
I certify that'i have determined through field inspections and
review of Municipal records that the above systems are in """"'
conformance with MOA HAA guidelines in effect on this date.
.............
e A. or ss:
Engineer's Printed Na e JEFFREY A. GAR'
ooh ��s C —7953 Z
Date ? �/S O¢ �
De01P
rof e ssW'oo�
a
HAA Fee $ 1 Waiver Fee $
Date of Payment _
Receipt Number_
(Rev. 12/01)
Date of Payment
Receipt Number
03-04-04 07:18AM FROM-CT&E ESI, SGS ENV SERVICES
9075615301 T-600 P.02/02 F-789
SGS Ref.#
1040927001
Client Name
AK Water & Wastewater Consultants Inc.
Project Namelit
Lot 3, H & H S/D
Client Sample ID
Lot 3, H & H S/D
Matrix
Drinking Water
Sample Remarks:
All Dates/Times are Alaska Standard Time
Printed Date/Time 02272004 16:58
Collected Date/Time 02242004 15:50
Received Date/Time 02252004 11:35
Technical Director Ste en C. Ede
Releas y /
Results L Units Method Container M Allowable � Analyse Init
Parameter PC Limits Date Date
Waters Department
Nitrate -N 1.21 0.100 mg/L EPA 300.0 B (<=10) 0225/04 JJB
Dec•23. 2003-11:19AM
°.SSUILT
SLVARD h
i •HEREBY CERTIFY THAT 1 HAVE SURVEYED THE
SCALE:
!;-OLLOWING DESCRIBED PROPERTY:
DATE=
AND THAT NO FNC�6ACHMENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
GRID:
EASEMENTS. COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
FB:
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF PENCE LINES, . OR FOR ESTABLISHING BOUND-
DRAWN;
—R ;' LINES.
T -d
No•2658--- -P. 3 -•'--
'y _r
IATES LtM SURVEYING 694 -
OF A
rAr
i . �•c;.yrs+ ,�.
VADv-sr'.0
IE
1/14/2004
Alaska Water & Wastewater Consultants
3701 E Tudor Road, Suite 101
Anchorage, Alaska 99507
To whom it may concern: -
ENSTAR Natural Gas Company
A DNISION pF SEMCO ENERGY
Engineering Department
401 E. International Airport Road
P. O. Box 190288
Anchorage, Alaska 99519-0288
(907)264-3743
FAX (907) 562-0053
Re: Letter of Non -objection
Grid: SW363
ENSTAR Natural Gas Company has no objection to a well and related improvements
encroachment into a utility] easement situated on the eastern property boundary of
Lot 3, H & H Subdivision.
Acceptance and use of this letter of non -objection by yourself, your heirs, your
assigns, or your successors, will constitute agreement to the following stipulations:
i
ENSTAR will be held harmless, now and forever for any damages or injury to
any person or property as a result of this encroachment.
Any ENSTAR facility damaged or destroyed, as a result of this encroachment
Will be repaired at no cost to'ENSTAR.
Any costs incurred by ENSTAR for special construction necessitated by this
encroachment will be borne by the property owner.
All applicable safety code regulations will be observed and maintained.
This letter of non -objection will in no way preclude ENSTAR from full use and
enjoyment of its rights within Eny portion of Its right-of-way.
Sincerel
M. Ma a kgen
Right-of- ENSTARNan
Jan• 5. 2004. 9:21 AM
DEI, J1 uJ Inv [•JJ lw GCI CABLE
December31, 2003
Jeffrey A. Garuess
Alaska Water & Wastewater
3701 E_ Tudor Road, Suite 101
Ancltoragc, Alaska 99507
Dear Gantcss,
Al NO. 9078688580 No.2762 F - 2 2
Subject to your agreement to indemnify the company as set forth below, GC1 Cable Inc,
of Alaska has no objection to the Well encroaching into the 10' utility easement an the
cast property line of Lot 3, H & H Subdivision. Known as 25750 Imperial Drive, in city
grid SW0363.
This letter of non -objection in no way precludes GC1 Cable from full use and enjoyment
of any rights it may have within any portion of the utility casement and or the right-of-
way, including uttiimited access for servicing its facilities. Also any additional and
extraordinary costs imcarred during any future required construction, repair or
reconstruction of GCI's facilities to accommodate any or all of the encroachments shall
be paid by the property owner.
Ry signing below,. you agree to indemnify and hold GCI Cable harmless, now and
forever: for any datttage, costs, expense (including reasonable attorney's fees), liabilities
and injury to any person or property occurring as a result of the encroachment.
Please indicate your acceptance by signing and returning this letter to myself at 111c
address below. -
CC
Sincerely, •—:.-7•G�/�'7 , ' L :� r;�-�,.-•..�._.••_ -�
Acceptance
f�.
ze �^ 7?
Robert Pringle
OSP Dcsien Dili
5151 Fairbanks Street • Anchorage, Alaska 99503 - 907 / 868-5600
E MTA OSP ENG 907 761 2646 12/23 103 14:31 NO.879 01/01
CALL ON YOUR COMPANY � `. • • "
NON -OBJECTION TO EASEMENT ENCROA.CF IkM Dn�Cil11�IENT
t
B this document Matanuska Telephone Association, Inc. ' ' '
By ep n, (MT,I�)'�tieilares that it has no objection to the
encroachment of a well within the platted 15' Utility Easedieift"u'P' on Lot 3, H & H Subdivision, according to
Plat No. 2000-30, Anchorage Recording District, Third Judicial District, State of Alaska, situated in Sedtion
23, T 14N, RI W, S.M.
>tk**k***k*kkde**41kdkf'kkl:*#kk*=k##*kIeIelnkRF'F**k:lcktkk�k*kkk=kAl*fie*F*+yak*=k4*rkktf�Fk*kkktk=k*fi#�ktF�k*****
Please be advised that MTA through the issuance of this document does not forfeit any of its rights to the use
of the area cited. In the exercise of these rights MTA will, if needed, upgrade, maintain, repair, and/or replace
buried or aerial telecommunications facilities within the easement. Any repairs that may be required to the
encroachment as a result of utility construction will be borne by the property owner of record. This document
does not authorize the placement of any additional encroachments within the easement area. Property owners
are required to obtain utility locates before doing any kind of work in the utility easements and will be liable
for any damages caused by their construction work in the easements.
This document is, in no way, an agreement to vacate any portion of the utility easement and should not be
interpreted as such.
Issued for Matanuska Telephone Association, Inc. this 23rd day of December, 2003, by,
Real Estate & Properties Supervisor
THIS IS TO CERTIFY, that on this 23rd day of December 2003, before me the undersigned, a Notary Public in
and for the State of Alaska, duly commissioned and sworn as such, personally appeared Bonnie Bailey known
to me and to me known to be the individual named in and who executed the foregoing instrument and
acknowledged to me that he signed and sealed the same as a voluntary act and deed for the uses and purposes
therein mentioned.
IN WITNESS
to set my
and official $ell the day and year fust above, wvtitten 3- '
Notary Public in and for
My commission expires:
�r
GRANTOR:
Mitariiisl&Tele'pi on ;W66 .Inc.
PA Box 3550
4,'�•}""';,'s,;: �=oy;• • ..r'sb =. =.0 t�•�.�9�`;'it,.�y.-- av:,�.�.•, ;��yk:Fr
:Jte,,,.,, n'.:" `'k.••4 •r_ .-� y:,.•. i:tt•
,•d4/�yc11tiv'i .,5�' ! W Y�.d''Jt�l.
17�.� ,(,a e•; ; ; Matanuska TelephoneAssociation Inc.
P.O. Box 3650. Palmer,
a', �•r.r�^. ,. mer, Alaska 99645-3550
1.800.746.9510 * 907.761.2510 . Fax 907.761.2646
1-31-1996 5:24AM FROM P.2
N
STATEMENT OF NON -OBJECTION FOR ENCROACHMENT
WITHIN UTILITY EASEMENT
Matanuska Electric Association, Inc. (MFA) has no objection with the location of a _
WELL within the utility easement along the EAST lot line of the following '
property;
LOT 3_, H & H SUBDIVISION, according to Plat No. 2000-30 ,
ANCHORAGE Recording District, Third Judicial District, State of Alaska*
Situated in Section 23__, T 14 N, R 1W , S.M.
This non -objection is granted with the full understanding and agreement by all parties
having an interest in the above property that this WELL encroachment will in no.wa
restrict or limit the current or future ability of MEA to fully enjoy the benefits of the
easement for any and all utility purposes that it presently enjoys under the easement.
This non -objection is further conditioned by the stipulation that MEA will be held
harmless from liability for any and all damages to the encroachment that may result
from the existing and future use of said easement by MEA, its contractors, successor:
agents, licensees, or assigns.
Matanuska Electric Association, Inc.
By: U- 1--�t
General M pager or his Repre
2
MEA ACKNOWLEDGMENT
STATE OF ALASKA
SS.
THIRD JUDICIAL DISTRICT
Date
The foregoing agreement was acknowledged before me this 0641�ay of
e.� rt.�qi / _,20 0 by (A rc r to £
Sapp 1In
V..• .. MV•...V �..YV.,VV VV. V.Y •..V ..uV V .w- V•
r ......r �....� 2by _>�n r inn O y�
�jj, ; ; 121
Notary Public for the State of AI "s
My commission expires:. '(�%
NOTARY PUBLIC �
PA T 11101.,; A. McRCiF,rR. V
ATE OF ALASKA f;