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HomeMy WebLinkAboutMELINDA VIEW ESTATES LT 2Melinda View Estates Lot 2 #017-092-39 ev. �. MUNICIPALITY OF ANCHORAGE p t, ; DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION t(. 1 - ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME Fetes Dev-cIor 'f MPrI PHONE �� q ��(� ❑UPGRADE UPGRADE MAILING ADDRESS LEGAL DESCRIPTION ale ((rid, \h, is) 1-64— 2— Sec 35 T- (2_m R._3v.) LOCATION //� JO AVIAe `0%. IC (�-./ i - NO. OF BEDROOMS -3 DISTANCE T0: Well 1 (\ Absorption area 5 Dwelling(� PERMIT NO. $ `/v 6-601— i 2 w F e) Manufacturer .ra� �7v1 �- f ,. Material S , P ( e No. of compartments Liq. capacity in allons f vp� IF HOMEMADE: Inside length Width Liquid depth Y —10 2 DISTANCE TO: Well Dwelling PERMIT NO. = z FQ- Manufacturer Material Liquid capacity'in gallons n z DISTANCE TO: Well II (.S' Foundation 3 s Nearest lot line �� PERMIT NO. Lf p $' 0-6 .Q, LL z S'� —zL No. of linesLength / of each line Total length of lines s---0 Trench width 6Q" nches Distance between lines cc H Top of tile to finish grade , �../ —D Material beneath tile y- inches Total effective absorption area / `3 GO pi ✓ w 0 Length Width - Depth PERMIT NO. i a w Type of crib Crib diameter Crib depth Total effective absorption area W cn DISTANCE TO: Well Building foundation Nearest lot line J w W Clasem� Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line -5". Septic tank `,, ��1 Absorption area(s) OTHER PIPE MATERIALS 14 pvc. Cf SOIL TEST RATING IOD12' 1 Ai. INSTALLER ou,dAh� fe i-ei EX .V-1' / 63 REMARKS/ ie-* a..4.411X" �i t/ IC Cr'e di ear bei ly be 7, y-e1 C,� / Z / v.( 4rc•,..4) 6ectiuTo te e 8' `i. b I3 s) k W rf 40* c., /c n.-, 5 0,•/ C,00tf /z) u� N \ T a .,.._-.90' boat ' 7 2ws.1` re+C/z_ `f" -n 6/..-7lies w.. r47 .7,,;Ie Aly(p.ec%d 67 Da--ey ll%0.Ffpy0zy. //a-7 T e. /2 6� ,j %/t<r,},hi Sat/. pipc ✓ `� • ll. /%' 7 t i i l-t / V ' .( 'iii le ? „ty WES"i--.o .1 d 6P r+-44Fr- 'N o% p+-I", h y �.ypS S� ex. / G arf /'i jird .'i'. r t /6e /e,_--a . y It V .— mot Li12-- APPROVED DATE LEGAL 11 Oct 2 6 /Pit11(1e1,%IcIA Vbe,J Lo i- ec 35-n2mo-3 ev. LOCATION OF WELL (Please complete either lo, Ib or lc.) la Borough Subdivision M0. rid Vr^ Lot 4 Block WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological '& Geophysical Surveys Drilling Permit No. A.D.L. No. Ib. l/aqtrs. —of— of_of— Section No. Township No SO Range ED wO Meridian Ic.II DISTANCE A ' r IRECTION FRO h) ROAD INTERSECTIONS e U(jlJ Street Address and Area of Well Location 3. OWNER OF WELL E ,LJ` 1 7LL Address:• 1 2. WELL LOG Feet Below Surface ,.Iov L A* ;tri 4. WELL DEPTH: ( final) I 5 (DATE OP -COMPLETION — <_�:"C 1 , -' Coble tool O Rotary O Driven -'0 Dug Q Auger O Jetted CI Bored D Other: 1 p) 6,0 g® 7. USE: Domestic 0 Irrigation 0 Test Well O Public Supply ❑ Industry D Recharge ❑ Commerical 0 Other: 8. CASING: - 0 Thre�aded lyl Welded diom. - :(i in. 110 dt7 ! ft. DepthTWeight / 7 lbs./ft. diom. ,6Y to - ft. Depth Stickup ft. 9. ISH OF WELL: ,./ Typed /'°'' ;,r ‘2..rid-- Diameter: Slot/Mesh SUS: Length: Set between ft. and ft. Backfilling - Gravel pack 011 Ax4ci10t p1l1N�GDEPT` OF PROT& i� 4[ eNvtiRON�ceAw 19 " .Ppk2,. 10. STATIC WATER LEVEL: Lr ft. O Above or 'Below land surface Equipment used: i ^fi 15+ 10/1)/ Date 11. PUMPING LEVEL below land surfoce and YIELD it. after hrs. pumping /(j g.p.m. ft. after hrs. pumping g.p.m. 12.GROUTING Well Grouted: 0 Yes IX I Na Material: Neat. Cement 0 Other: 13. PUMP: (if available) HP Length of Drop Pipe ft. capacity Subm. Jet 0 Centrifical D Other g. P.m. 16. WATER WELL CONTRACTOR'S CERTIFICATION: 14. REMARKS: 15. Water Temperature This well was drilled under my jurisdiction and this report is true to the best of myknowledge and belief; Registered Business Name /{y �,{ - Contract License Number Addressi i' �X ! i. f f''.IC.,1-tH(3!r 1'{'1i lir;' Signed r-r9„G.--^L,.,_-- Date: GGGfff Authorized Representative - - Form 02-v/WR (1i/8i) Copy Distribution: WHITE- State DGGS, PINK, -Driller, CANARY -Customer c ae 0 r c 2 0 MILJPAMIGIVF"PhIL_I. he 'OFF CIONIC:1-41rENFnqi(EIE - DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION B25 L STREET, ANCHORAGE, AK 99501 264-472O DP4 ��WFEFR'. WIEEDLA___ .PAOF:EFZMITT- PERMIT NO: DATE ISSUED: APPLICANT:, ADDRESS: 'CONTACT PHONE: LEGAL DESCRIP: LOT SIZE: . LOT LOCATION: MAX BEDROOMS: 840806 09/21/84 FEJES DEVELOPMENT P 0 BOX •11-2009 ANCHORAGE,.AK 99511 349-8011 SUBDIVISION: MELINDA VIEW ESTATES LOT: 2 -BLOCK: NA- SECTION: 35 TOWNSHIP: 120 RANGE: 3W 49549 (SQ.FT. OR ACRES) JOANNE CIRCLE/144TH 3 Listed below are the optionsi available to you in designing system. Choose the option that best fits your site. DEPTH TO PIPE BOTTOM (FT.) GRAVEL DEPTH (FT.) TOTAL DEPTH (FT.) GRAVEL WIDTH (FT.) GRAVEL LENGTH (FT) ' GRAVEL VOLUME (CU.YDS.) TANK SIZE (GALS) /mmn SOIL RATING (SQ.FT./BR) /000 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS your septic bU/15" Dw7/17*Wp�em.D Bac77 V' 8 / --~~�- � "� �[� U°/5./ / � ~r�/ __ / 0 0{) 0nP Z^0� -•^ ••.-� I certify that: 1" I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska - 2" I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit` 3" I will adhere to all MOA and State of Alaska requirements for the set back diStances frbm any existing well, •wastewater disposal system or public sewerage system on this or any adjacent or nearby 1pt` 4. I understand that this permit is valid jor a maximum of 3 bedrooms and any enlargement will require an additional Permit" IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDIN| CODES HEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTA-�NED; .(2)��) AS-B,UIL- TH' S MILL �NOT BEAPPROVED WITHOUT AN ELECTRICAL INSPECTION REPRT; AN�� (3) THE �.� �EC/xICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.^ �SIGNED �� DATE: APPLICANT: FEjES DEVELOPMENT ISSUED BY - -)42/ yy,fq DATE: PERFORMED FOR: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST Fees f�ev-e forote/f LEGAL DESCRIPTION: Mel fkciw View qt��z\ IDD , /L. VCS"/" COMMENTS Lb+ 2— SLOPE DATE PERFORMED: SOILS LOG qL/ 0 6 ❑ PERCOLATION TEST WAS GROUND WATER VD S ENCOUNTERED? L 0 P IF YES, AT WHAT DEPTH? E SITE PLAN P+ 17- ►q&)L THS L 8— rro (2 Re Date Gross Time Net Time Depth to Water Net Drop en -T3 L G - PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN 'a lb ra.:f@al v,St-ozlt e• C /'b p '/j FT AND FT PERFORMED BY: 72-008 (6/79) 7 g 4-- y>2 / CERTIFIED BY: Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 0l7 --3V ea') 1. GENERAL INFORMATION cosA# (),5e12, 1,1&23 Complete legal description MELINDA VIEW ESTATES, LOT 2 Expiration Date: 5/2-54 7 -- Location Location (site address) 1 450 0 JOANNE CIRCLE *ANCHORAGE, AK Current Property owner(s) AMY COCKERHAM Mailing address Lending agency Mailing address Real Estate Agent Mailing address Day phone 1 450 0 JOANNE CIRCLE *ANCHORAGE, AK Day phone Day phone Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System • 3 TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer • n ❑ 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 verify that ray 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 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system unde- 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 V Approved for 3 bedrooms. Disapproved. Phone 337-6179 Date Si 342 �r� DD vA vA vA A. Garnet' CE 79 3 5.T�J re,„ I' cd d Proressionoo ��040o��a Conditional approval for bedrooms, with the follow0,041114IMtior \50 OF Aivezi ON-SITE % WATER AND o yWASTFWATER PROGRAM Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory By: AQ//Vdt-4e (Rev. 11/05) ti -91),S-NT J,-))))))))10111))) S Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: _CA S%z- Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: MELINDA VIEW ESTATES, LOT 2 Parcel ID: 017-092-39 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (YIN) YES Date completed 10/18/1984 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 89 ft. Cased to 89 ft Casing height (above ground) 12+ in FROM WELL LOG AT INSPECTION Date of test 10/18/1984 4/27/12 Static water level 50' ft. 48' ft. Well production 10 g.p.m. 3.01 g p m WATER SAMPLE RESULTS: 1 Coliform 0 colonies/100 ml. Nitrate N p mg./L. Arsenic: ug./L. Date of sample: 4/30/12 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEPIC/STEEL Date installed 10/24/1984 Tank size 1000 gal Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (Y/N) NO High water alarm (WN) N/A Date of pumping 4/25/12 Pumper NORTHLAND PUMPING C. ABSORPTION FIELD DATA Date installed 10/26/1984 Soil rating (g.p.dff2orf/bdnr 100 System type SHALLOW TRENCH Length **50 ft. Width 5 _ft. Gravel below pipe 2 ft I"8EL0W EXISTING GRADE Total depth *8.92 ft. Eff. absorption area 300 ft2 Monitoring tube YES Date of adequacy test 4/27/12 Results (Pass/Fail) PASS Fluid depth in absorption field before test 0 in Water added 600 gal. Elapsed Time: 120 min. Final fluid depth 0.5 in. Depression over field NO For 3 bedrooms New depth 3 in Absorption rate >= 450+ Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date — **CREDT FOR 42' ONLY g p.d. 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 Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main 100'+ 100'+ N/A On adjacent lots 100'+ On adjacent lots 100'+ 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 * S <►' Water main N/A Water service line 101+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N /A Water service line 10'+ Curtain drain NONE KNOWN F. COMMENTS * AdSuMF-0 Surface water 100'+ Driveway, parking/vehicle storage 10'+ Wells on adjacent lots 100'+ G. ENGINEER'S CERTIFICATION I certify that t 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 q€i-Z SOF A���4 A 7. :/igia.:16:4. P ,- r r: y A. Garness: • ' e`15 V I fir•'`cp0 prof esslonoo '4O0oo�� COSA Fee $ Waiver Fee $ Date of Payment 5/207 Date of Payment Receipt Number () qt q`'/ Receipt Number (Rev. 11/05) O O 0 z JOANNE CIRCLE L6'179 L 3110010000 N w a000Vo;4 0 so avPi o °ap $i �' �� 1 a '. '4 �' yam ' o4 00 �r La �zto ' w0 04Oo �e 1 0, ea ao e.4o %p S* E6c50 �Oo0 0 �oo� la' TELECOMM.. ELEC., ANO UTILITY ESMT. z w m w ZO' RI6HT OF WAY EASEMENT 100.99 L 311G'b,Z000 S Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 1. GENERAL INFORMATION 0 cosA# OIO3IL5 Expiration Date: / fa. ' 2. 0 — 0 7 Complete legal description MELINDA VIEW ESTATES, LOT 2 Location (site address) 14500 JOANNE CIRCLE *ANCHORAGE, AK Current Property owner(s) DARLA WARNKE Day phone Mailing address 14500 JOANNE CIRCLE *ANCHORAGE. AK Lending agency Day phone Mailing address Real Estate Agent Mailing address 110 W. 38TH SUITE 100 • ANCHORAGE, AK 99503 JANELLE PFLIEGER W/ REMAX Day phone 242-0076 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System • TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer • The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water 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, 1 verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 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 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 ldentitiable 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 systom. 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. Date 5. DSD SIGNATURE 3 ✓ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the filowing stipulations: A. ess.: O El -7953 : 1 1 " b 61CiTi' poe�s�•o six o�tf eqr- •••j:ON-SITE • c WATER AND m: WASTEWATER PROGRAM • • irk j11SENS Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory BY.)dviisory / % Other /4 / P Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort (Rev. eros) Original Certificate Date: 9 -2o -o7 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: MEUNDA VIEW ESTATES, LOT 2 Parcel ID: 017 - D R 2. - 31 A. WELL DATA Well type�A If A, B, or C provide PWSID# N/A Weil Log (Y/N) YES Date completed 10/18/1984 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 89 ft Cased to 89 ft. Casing height (above ground) 14 in FROM WELL LOG AT INSPECTION Date of test 10/18/1984 8/28/2007 Static water level 50' ft. 47' ft Well production 10 g p m 3.74 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate �O mg./L. Other bacteria 0 colonies/100 ml. Arsenic .L ugJL. Date of sample: 8/28/2007 Collected by: GEG Ltd. B. SEPTICIHOLDING TANK DATA Tank Type/Matertal STEPIC/STEEL Date installed 10/24/1984 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 8/28/2007 Pumper MCDONALD PUMPING C. ABSORPTION FIELD DATA Date installed io/2s/1st14 Soil rating (g.p.d./ft2o4//bdr100 System type SHALLOW TRENCH Length **50 ft Width 5 ft Gravel below pipe 2 ft Total depth *9.04 ft Eff. absorption area 300 ft' Monitoring tube YES Depression over fled NO Date of adequacy test 8/28/2007 Results (Pass/Fail) PASS Fluid depth in absorption field before test 4 In. Water added 455 gat. For 3 bedrooms New depth 12.5 in Elapsed Time 149 min. Final fluid depth 9_5 in. Absorption rate >= 450+ g p d Any rejuvenation treatment (past 12 mo.) (WN & type) NONE KNOWN **CREDIT FOR 42' ONLY If yes, give date - D. LIFT STATION Date installed Size in gallons Manhole/Access (V/ "Pump on" level at in "Pump or leve = High water alarm level at in. Dat u 1 Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankflft station on lot 1001+ 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 Heid 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN F. COMMENTS Wells on adjacent lots 100'+ 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 cl143'04 COSA Fee $ - t) U Date of Payment 9,4 / S f U 7 Receipt Number � 0 cc (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number 2 N 0 0 z JOANNE CIRCLE L6r9L 3„00,0000 N 1 IA • • • • 13. 10' MONT OF WAY ,00 9L 3&t7,3 Roe N B9°59130"E 300.24' SGS Rer.a Client Name Project Named Client Sample ID Matrix FW SID 1074405001 Garness Engineering Group, Ltd. Lt 2 Melinda Vicw Lt 2 Melinda Vicw Drinking Water 0 All Dates/Times are Alaska Standard Time Printed Dater rime 09/11/2007 8:51 Collected Date/Time RetchedDate/Time Technical Director 08/28/2007 8:32 08/28/2007 12:25 Stephen C. Ede Sample Remarks: Parameter Results PQL Allowable Prep Analysis Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic Waters Department 5.86 Total Nitrate/Nitritc-N ND Microbiology Laboratory Total Colirorm 0 5.00 ug/L EP200.8 C (<10) 09/03/07 09/07/07 htll 0.100 mg/L Sh120 4500NO3-F 13 (<10) 09/05/07 1DS co1/100mL SM20922213 A (<1) 08/28/07 SDP MUNICIPALITY OF ANCHORAGE .DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH ARID ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) } 6/o( if- Vit. /�I-'jr �:C e.- (,ir e�rGi �(.:�� 5�'C F55- %7�)f,•' x'736? --z Location (address or directions) (b) Applicants Name Applicants Address /c) .-17V : telephone — Home Business (c) Applicant is (check one) Lending Institution Buyer ; Other (explain); (d) Lending Institution ; Omer/builder ; Tele hone Address (e) Real Estate Co. & Agent Address )(\ /-!- • Telephone J (f) Mail the HAA to the following address: 2. Type of Residence Single—Family17 l Multi—Family ri Other (describe) Number of Bedrooms 1 3. Wates Supply Individual Well Community E Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite Public r Community Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] Engineering Firm Providing Inspections, Tests, File Search, Dats and information As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation of this Health Authority Approval shows that the on-site watersupply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm%14r, Telephone `>C�-/ >c--� Address , ZC79 (e): = „c- tc- Date (7-83- DHEP Approval Approved for Approved E (ENGINEER SEAL) v G 000000EnCG0.:A �E3aO V mQ"p Le 111 o, y C. Rs?d Jr, • /No. o. 2251 ;i bedrooms B Disapproved Terms of Conditional Approval itional Date. ��,c� ����.� r✓�''� CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS EPRESENTATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 21 7-19-84 A. WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 ��//�jj�� Legal Description: LIE GE�/�VCEt� //4ff 4L Oe' Sub.Seca rT0J//g3C? Well Log Present m ) Total Depth 9,9 Static Water Level MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION APR 19 1985 If A, B, or C, D.E.C. Approved(Y/N) //A} Date Completed /0-75'-0e( Yield /c7jpw Cased to £aR Depth of Grouting Gfc �uawv� ,p Pump' Set At (,f of KLduiG1 /06 Sanitary Seal on, Casing 1) Casing Height Above Ground Electrical Wiring in Conduit /N) Depression Around Ye1]head (Y) Separation Distances from Well: / To Septic/Holding Tank--on-Lot /// & ; On Adjoining Lots /®c To Nearest Edge of Absorption Field on Lot `///' ; On Adjoining Lots / O (4 To Nearest Public Sewer Line Lilk To Nearest Public Sewer Cleanout/Manhole Nl, Water Sample Collected By Water Sample Test Results Counts To Nearest Sewer Service Line on Lot C;75 -'L �/7-� ; Date %or B. SEPTIC/HOLDING TANK DATA / Date Installed /0-26_53'4/ Size /OCO �,.! No. of Compartments Standpipes (Y ) Air -tight Caps (Y/N) Foundation"�l`Cleanout Depression over Tank (Y V Date Last Pumped /2/- Pumping/Maintenance Contract on File (Y/N) A4 ; for /01 Holding Tank High -Water Alarm (Y/N) /1,4 Temporary Holding Tank Permit (Y/N) 4/'4 Separation Distances from Septic/Holding Tank: To Water -Supply well 1/1 To Property Line To Water Main/Service Line Course e6_ /Iz5%1PGiovi G'S- / G7 67 To Building Foundation /6 To Disposal Field S O Convents 0 To Stream, Pond, Lake, or Major Drainage [Page 1 of 2] Receipt # 3 Z� (0-57 Date Paid: Amount: U S` 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed-- car< Width of Field S � .-35' % l;?.✓. ���s!-� / 109(c77/g,0'% Type of System Design Ur Length of Field y 9� () Depth of Field U A401 ditp /O ( 4e Gravel Bed Thickness m 02 Square Feet of Absorption ea O Standpipes Present g/N) Depression over Field ( Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: ( To Water -Supply FA 11 #4.5— To Property Line 5`)-- / To Building Foundation 'a[-2_; To Existing or Abandoned System cn Lot p/4 ; On Adjoining Lots �- (� To Water Main/Service Line 451 4 To Cutbank(if present) /(///4- To Stream/Pond/Lake/or Major Drainage Course /QL2 To Driveway, Parking Area, or Vehicle Storage Area , C)7't \ r 1 Connents -moi' /u <K eel-ro/A u_s-Lci, J_ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Comments Pump Diner ions Maph 11 /Access /N) Level at Vent (Y/N) ycles curing Adequacy Test. Meets MDA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed Date /-/7 Company Ala‘,.&,L-74,01 sera r! 5 MOA No. �S o— KB1/d5/s [Page 2 of 2] �["tea JI e11,e.3� s.. l V �vei ;.�. r.: cn��©j ENGiN£ERS e ?g O. 2-15-84