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HomeMy WebLinkAboutSUN SHINE ACRES LT 1,Sun Shine Acr'es I #017-401 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201327 PID Number: 017-401-35 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑.Two Single Family Project: ❑ New ❑ Upgrade Name ALEXIS DELGADO ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 8601 SPENDLOVE DRIVE ANCHORAGE,AK 99516 ❑ Other Phone Number of Bedrooms Soil Rating JTotal depth from original grade 907-351-8499 4 N/A GPD/SF N/A Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade N/A Ft. Gravel depth beneath pipe N/A Ft. Subdivision Block Lot SUNSHINE ACRES 1 Fill added above original grade N/A Ft. Gravel length N/A Ft. Township Range Section Gravel width N/A Ft. Beds: Number of Lines N/A Distance between lines NIA Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line N/A Ft2 N/A N/A Ft. Well >100' >N/A N/A N/A >25 TANK ®❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1250 Gal. Surface Water > 100' >N/A N/A N/A Material PLASTIC Number of compartments 2 Lot Line>5' j >N/A N/A N/A NA Foundation >1 Q' >N/A] N/A N/ALIFT STATION Manufacturer N/A Capacity N/A Gal. Remarks"CONFIRMED DURING INSTALLATION TANK IS NOT LOCATED WITHIN 5' OF DECK OR STAIR SUPPORTS Alarm location N/A Electrical installed by N/A PIPE MATERIAL House to tank D3034 drainfield Tank to D3034 Installer NORTHERN EXCAVATION Drainfield Existing CO/MTD3034 Inspector L.TIDWELL BENCH MARK (Assumed elevation) 100 ft 151 8/26/20 Inspect Location and description 2ion a GARAGE SLAB 3`a 4'h ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp OF Conditional Approval: Date low ASK.%.. • .s�,� .' '.� Benjarri�a,�chiller t� `�'•�6/192Approved Septic Systemaft,0J,LL�A Date 1X021 `�©pROFE SS14NP�'�.. Note: this approval does not include well permit requirements. (Kev U5/U1/ltd) // // // // // // // // // // // 100500 FEET 1"=50' 4-BDRM HOME CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND PERMIT # OSP201327 PID # 017-401-35 SUN SHINE ACRES SUB, LOT 1 A B Jun 10, 2021 SPENDLOVE DRIVE SHED EXISTING WELL EXISTING ABSORPTION TRENCH. 1,250 GALLON SEPTIC TANK w/20" MANWAY. SV A B MH 41.6 SV 46.35 2C0 48.5 36.0 41.0 43.9 PLAN AS-BUILT 6/9/21 MH 2CO PROFILE AS-BUILT (NO SCALE) Jun 10, 2021 97.65 92.1 97.85 101.75FCOMH SV1250 GAL SEPTIC TANK 2CO97.45 PERMIT # OSP201327 PID # 017-401-35 SUN SHINE ACRES SUB, LOT 1 2" FOAM INSULATION 6/9/21 Tract D Gonzales Homestead Subd. K I t'l ^ 0 IT- -71 ^ IT- VVI A I el r% r% ^_ I!, Co 0 _J _C C Ll (I C LL Septic vent (typ) Sheer ®o "eck 3.0 OH Q 46�0 2.0 OH Manhole under stairs .0 3.0 OH Asphalt 0 Well Ret. wall (typ) DETAIL SCALE: 1'= 50' 4*& 4" OF A '� -ot 2 AW ow �Q' aw (/)' " so * 49 th 000 00 •00 01 Elizabeth L. Walatka : o r f �� • ® 8036 — LS J7 MW 1' P"?QFESS10140- SCALE: 1 100' AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection in accordance with ASPLS Standards of the following described property: LOT 1, SUN SHINE ACRES 10' Utility Easement— — Anchorage Recording Precinct, Alaska, and that the CD N89057'52"W 329-51 CD improvements situated thereon are within the property lines CY) co and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying SPENDLOVE DRIVE adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 3rd day of JUNE 2021. EASEMENTS OF RECORD, OTHER THAN FRED WALATKA & ASSOCIATES, L.L.C. THOSE SHOWN ON THE RECORDED Engineers and Surveyors PLAT ARE NOT SHOWN HEREON F13 21-3, pg 22-24 BE 907-248-1666 UNLESS OTHERWISE NOTED. This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. 8/24/20 ON-SITE SEWERANELL PERMIT APPLICATION Parcel I.D. 017-401-35 Property owner(s) Alexis Delgado Mailing address 8601 Spendlove Drive Anchorage, AK 99516 Day phone 351-8499 Site address Same Legal description (Sub'd., Block & Lot) Sun Shine Acres, Lot 1 Legal description (Township, Range & Section) Lot Size 208,217 Sq. Ft. Number of Bedrooms Four APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank FX Upgrade ❑ Duplex (D) ❑ Holding Tank ❑ Renewal ❑X Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance:— I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. ,q4�a,'k E- 0, 'g-� (Signature of property owner or authorized agent) Permit/Rush Fees: C ID? .5 Date of Payment: g is a d� � Receipt Number: 6 5119 Permit No. os e go 13 23 Permit App_:,'- : . - c Waiver Fees: Date of Payment: Receipt Number: Waiver No. PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) August 19, 2020 MOA Development Services Department On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Sun Shine Acres, Lot 1 – 8601 Spendlove Drive Septic System Design Dear On-Site Services Engineer: The permit for the replacement of the existing septic tank on the subject lot has expired. We are submitting this permit application for the renewal of the permit to replace the septic tank. A recent inspection of the property indicates the attached site plan remains as originally designed. No conflicts exist between this proposed system and any other well or septic system on adjacent lots. The new septic tank will be a minimum of 100’ from the well on this and adjacent lots and 100’ from surface water. The tank will be 10’ from the house foundation and 5’ from deck and stair supports. Please refer to the original approved permit for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Michael E. Anderson, P.E. 8-19-19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201327, Rebecca Carroll, 08/24/20 "PAU,, MUNICIPALITY OF ANCHORAGE of On -Site Water & Wastewater Program PO Box 196653 4700 Elmore Road Anchorage, Alaska 99519.6650 Phone: (907) 343-7904 Fax: (907) 343-7997 `. http//wnrmr.muni.orglansite '^'cNUR�ae On -Site Wastewater Disposal System Permit Permit Number: OSP191366 Effective Date Work Type: Sep6cTank Upgrade Tax Code Number: 01740135000 Site Legal Address: SUNSHINE ACRES LT 1 G:2841 Site Mailing Address: 8601 SPENDLOVE DR, Anchorage Owner: DELGADO ALEXIS Design Engineer: FORGE ENGINEERING This permit is for the construction of: ❑ Disposal Field 2 Septic Tank Cl Holding Tank ❑ Privy Expiration Date: �y1tCq(' iIlc—pa i tIT) cnt 8121/2019 8/20/2020 Lot Size in Sq Ft: 208217 Total Bedrooms ❑ Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24%7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed an the same day, or b. Covered, sealed, and heated to prevent freezing Received By: , it {�� ��,'� Date: 6'� �0Issued By. iDate: 4 MUNICIPALITY OF Community Development Department Development Services Division On -Site Water & Wastewater Program 6PIANS ANCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWERM/ELL PERMIT APPLICATION Parcel I.D. 017-401-35 Property owner(s) Alexis Delgado Mailing address 8601 Spendlove Drive Anchorage, AK 99516 Site address Same Day phone 351-8499 Legal description (Sub'd., Block & Lot) Sun Shine Acres, Lot 1 Legal description (Township, Range & Section) Lot Size 208,217 Sq. Ft. Number of Bedrooms Four APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) R (w/wo ADU) Septic Tank ❑X Upgrade ❑X Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST, FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: Receipt Number: iQiO�o� Permit No. _�J� p`L? X3%6 Permit App_.:- : - : L.,:c Waiver Fees: Date of Pavment: Receipt Number: Waiver No. PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) August 19, 2019 MOA Development Services Department On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Sun Shine Acres, Lot 1 – 8601 Spendlove Drive Septic System Design Dear On-Site Services Engineer: The existing septic tank on the subject lot has outlived its useful life and must be replaced prior to the issuance of a COSA. We are submitting this permit application for the replacement of the septic tank. The attached site plan identifies the location of the home and the existing and proposed septic tank site. No conflicts exist between this proposed system and any other well or septic system on adjacent lots. The new septic tank will be a minimum of 100’ from the well on this and adjacent lots and 100’ from surface water. The tank will be 10’ from the house foundation and 5’ from deck and stair supports. Please refer to the attached plan sheet for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Michael E. Anderson, P.E. 8-19-19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191366, Rebecca Carroll, 08/21/19 // // // // // // 10050 0 FEET 1"=50' 4-BDRM HOME NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND 2CO SUN SHINE ACRES, LOT 1 SLOPES > 25% SLOPES > 46% SPENDLOVE DRIVE 8/19/19 SHED EXISTING WELL EXISTING ABSORPTION TRENCH. DECOMMISSION EXISTING SEPTIC TANK PER MOA CODE. 1,250 GALLON SEPTIC TANK w/20" MANWAY. PLACE OUTSIDE DRIVEWAY AND 5' FROM DECK/STAIR SUPPORTS. 2CO SV MH Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191366, Rebecca Carroll, 08/21/19 Mayc:r ~700 $r~w P.O. B~x ~96850 ,~nchoro$~, AK 99~!9-66~0 (~07) ~43-7904 Pump Installation Log Well DrillJ~g Permit Number: Date of Issue: __ paroel Identification Number: O DescCpdon Pump I~stnllption iD ~te: /0 puznp Lutak~ D~pth Be[ow Top of~7Cel] Casin~: ~0 feet Pump [VJ[_.qnufactnrer's h-nme: ~ ,J,~ Pump Size ~ hp pittess Adapt~r iVinnu£..qcCurer:s ~ame: Pitless ~dapt~r In~aHer: ~ ~7¢ a t] D is in fec~e d !~ p o n C o m p [ati,o n ? ~'as ~ bi o }~iethod og Disinfectio n: Comments: Property Owner Name A~en~ion: /he pump instaLler shall provide a pump installation log to ~ DSID witi/n 30 4zTs of pump MUNICIPALITY OF ANPHORAGE DEPARTMENT OF NEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 2..64-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME LEGAL DESCRIPTION LOCATION DISTANCE TO: DISTANC I F HOMEMADE: Inside length Well Dwelling DISTANCE TO: No. of lines P o Ta o:Y Material beneath tile Nearest lot lit lO '7 Length Width Depth PHONE [] NEW NO, OF BEDROOMS/~, PERMIT NO. No. of c.o~partments Liquid PERMIT NO. PERMIT NO. Distance be t we e/~?e~rI Total effective ab~tq~ PERMIT NO. Type of cfi diameter Nearest lot line Class Depth DISTANCE TO: Buildin9 foundation OTHER Driller Distance to lot line PERMIT NO. jO0~C~ Sewer line Septic tank Absorption area(s) PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS APPR~V'F~D ~.~I~'~/~/ DATE · GAL !. 0 CI:::~T ]!: Oh! 'rLlJF'l;ii "IF ~::;l'i'l r IzII::~RE;E~F~:PT ( EIN .: .z t E.I, ;1: :fi;: 'I'!;:E3-,ICI~ Fl't[i: F:E(;:rlJ ;[ t:;i:(:]) :!; [ ;iflt]i; E!F' /-HE: SO ]( L t::IEI:E;I]ZII::~:I:' j' ;[ Ot',! :, .:, ! k.! ! r '-: ' !'HE L.I[t":!C'iTH D :t: HEN:i!; THE: DE{F"i"I'! (_-Il:: F:! [:iF;'.CIUt'.,ID l:::ll",ll) THE '!'HF;Fi% ]25 i',IC~ ::SE:T "IHE C:iI:;i:I::IV!Ei. I)E]:::'TH I:::ff',![:' 'l'k!F; i.:~:CrT!Of'! I:::'E!;Rr,1;I: T r"'""¢"r .... ];CF:ff':!T I"IF!S THE RE;SP(:)NSi(E~[L.I;T~r' TEl 'riqF'()Fifl'"t ]; l:'~:!i;'l'!;::tt._ !. I;;:I"t' ]: CI!"~ ! I I.. t (... t ] _. 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FF:IF1 ]: L. !: I::!Fi: !4 ;[ T14 THE I:;~:~:~:!:;:!f..i :[ F;:EI'IFi:!',I I71; I:::'0t:(: Of",t-'::i; :[ IE: SIEI,.IEI;i:S; F:fi',l[:' NEL. L.S I::!':}, SET F'Ot'?Ti'I E%' THE !"!f.!F.! ]: C: Z F:'F:I(. :[ I"'r' Cfi;: FII"!CH()F~ff:IG!Z. ;7:: :!: l'~iZL..l... J;I",!S;TFI!_.L. t'HE S"/STEH [!'q F!CC()Fi:[)FIHC::E i'!:1:'t"1"I 'THI:~: CODE:E;. :.':::; ;! IJF:!!.)EI:t~%~;fF!N[:, ?fi:If' T!'IE F:E::~;;[ !)IEFIC:E :I] ~:~; I;;;E:H(H)EtJZ[:, '!'O u::sunc, .......... SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF __ :., DRILLED AT THE RATE OF ¢,79_2.~0~)_____ PER FOOT, PROPERTY OWNER ~_ j.{~,l.__C'./.q~ LOCATION OF WELL, SITE WELL LOG: /'c,.te.'a. m'g2h~c~.Lo~ ~]_/~2~n~'. ,c.,-~ . 5u.b;~.e.'~.~bt.e. ;%;~.p..H~lOU.Lcl..be. ' ' "-c/ I'; ,'o 20 p;e.t o;. COST INCLUDES ALL LABOR AND MATERIAL F(:)R COMPLETION OF SAID DRILI.,ING, WRITE CHECK PAYABLE TO RAMPART I::)RILLING WORKS FOR TIdE SUM OF__ THANK YOU VERY MUCH, DATE BERNIIZ G'LAUS OF' RAMPART DRILLING WORKS P R 0 J E C T_ B e2 p ~ ~t_L?£H~ze£_t~y ..... TEST HOLE SHEET 1 ~OF 4 CLI ENT~ _.~os_te_F_flew%on ....... ELEV, TOP OF HOLE~L~..9~_-~.: ...... W. 0 ....... 7~89.67 ............... DATE 3-27-78 1 2 Forest Duff Damp, Organic Sandy Gravelly Silt, OL 3 Dry, Bwn, Slightly Silty Gravelly Sand, SM-SP 9 10 -11 12 13 14 15 $rab Sample Danlp, 'Fan, Silty Gravelly Sand, SM (30% Silt) Less si'It below lle (15-20% Silt) 16 17 18 19 20 21 22 23 24 25 Bottom of Hole No Water Table Field Perculation Rate - 3.6 rain/inch - 19 E- 20 -~ 24 25 Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 017-401-35 Expiration Date: SF -p -o 1. GENERAL INFORMATION Complete legal description Sunghine Acres Sub L1 Location (site address) 8601 Spendlove Dr Anchorage, AK Current property owners) Alexis Delgado Day phone 907-351-8499 Mailing address Real estate agent 8601 Spendlove Dr Anchorage, AK 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic ❑ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA # 0 S C -2 11 3 '15 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage; AK 99503 Engineer's Printed Name Benjamin Schiller Date 6/9/21 AWK 6. DSD SIGNATURE "' •' System #1 Approved for bedrooms Benjarry� chiller -System #2 Approved for bedrooms �� ��%' C612592 •' Disapproved ��F9F�pROFESSI�NP���� Conditional approval for bedrooms, with the following stipulations: �.�itt(tFfftf���� Y OF,f�,��� p ``r ATER AND m r PROGF, ERAM a By: ���I(LegOriginal Certificate Date: 6A2 3 D"?r 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 Checklist blue sheet COSA Checklist Legal Description: Sunghine Acres Sub L1 Parcel ID: 017-401-35 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA Q Well log is filed with Onsite (or attached) Date drilled 5/30/1982 Total depth 250 ft Cased to 40+ ft X Sanitary seal is functioning correctly © Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 8/5/19 Static water level at beginning of test 121 Comments B. TANK DATA Age of tank(s) <1 years Tank type/material Plastic ft. Measured operating fluid level in septic tank N/A ❑ Standpipes/foundation cleanout per record drawing Date of pumping Tank installed 8/26/20 D. ABSORPTION FIELD DATA Absorption Trench Which system tested (date installed) 6/17/1982 F0_1 ALL standpipes present per record drawing Total measured depth from grade 9 ft (max) Measured depth to pipe invert from grade 6.75 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 2.25 FM_J Code -required soil cover over field Final fluid depth 0 in Absorption rate '600 god F-1Systempresoaked NIA (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) N/A Gallons introduced N/A gallons If yes, enter date Comments/Deficiencies: Well production at time of test 4.6 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ N ❑ Coliform bacteria is Negative Nitrate 3.12 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Forge Engineering Date of Sample 6/18/21 C. STATION ❑ Zquire�d*nt( Age of lift station . Lift station material Comments: ance completed ears Adequacy test date 8/5/19 Results Z Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 1250 gal New depth 8 in Elapsed time 1440 min COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ✓V Yes Community Sewer Manhole/Cleanout > 100' Yes if No ft / Yes if No ft Neighboring Tank > 100' [71 Yes if No ft Private Sewer/Septic Line > 25' Yes if No ft Absorption Field on Lot > 100' F7 Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' 0 Yes if No ft F✓ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' p✓ Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' F✓ Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' ✓V Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Yes if No ft Private Wells > 100'✓0 Yes if No Water Main > 10'✓Q Yes if No ft Community Wells > 200' Yes if No Water Service Line > 10' Q Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' El Yes if No ft If absorption field is under driveway comment below Property Line > 10' Yes if No ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' ®✓ Yes if No Water Service Line > 10'✓Q Yes if No ft Community Wells > 200' ❑✓ Yes if No Surface Water > 100'✓0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet .�''121 .40 49 TH ¢�>� BenjanuriGchiller ��' • • CE 12592 • Q`�� 6/10/21 , •'�V�� ����� RROFESSt4�P ft ft ft ft 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.munl.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS ,5,PPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION COSA#bi bl Expiration Date: Complete legal description SUNSHINE ACRES LOT 1 Location (site address) 8601 SPENDLOVE DRIVE ANCHORAGE AK~ 99516 Current Property owner(s) Mailing address Lending agency HARALD MOERTL Day phone 8601 SPENDLOVE DRIVE ANCHORAGE AK~ 99516 Day phone 223-6840 Mailing address Real Estate Agent Mailing address LAURA HELVERSON W/ OYNAMIC Day phone 3111 C STREETf ANCHORAGE AKf 99503 230-4891 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBEROF BEDROOMS: 4 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 sho~n below, I vedfy 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 vedfy 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. NameofFirm GARNESS ENGINEERING CROUP, Ltd. Address ' 3701 E. TUDOR ROAD. SUffE 101 · ANCHORAGE, AK 99507 Engineer's Pdnted Name JEFFREY A. CARNESS, P.E. Phone 337-6179 Date Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious enginee#ng analysis of the system in accordance with ADEC end MOA DSD Guidelines & Regulations. The reported results desctibed the performance of the system under the conditions encountered at the time of the test, end 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 duting 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 pedorrnance of the system, horde they guarantee that there ere 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 authotized, nor will it confer any legal tight whatsoever. 5. DSD SIGNATURE ~ Approved for L~ bedrooms. Disapproved. Conditional approval for : WASTEWATER ~ : PROGRAM bedrooms, with the fllowing stipulations: "~,O,,'.. ...... Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev 11/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other '~~ Original Certificate Date: 5'- 7.- o Legal Description: A. WELL DATA Well type. PRIVATE Date completed 5/,30/1982 Total depth 250 ft. 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 (9O7) 343-79O4 CERTIFICATE OF ON-SITE SYSTEHS ,b, PPROVAL ( HECKLIST SU+HINE ACRES LOT 1 *250' PER RAMPART DRILLING LOG If A, B, or C provide PWSlD# Sanitary seal (Y/N) YES Cased to *40+ ft. Parcel ID: O/~'" Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. FROM WELL LOG Date of test 5/30/1982 Static water level 120 ft. Well production 5-6 ,g.p.m. AT INSPECTION 4/9/2008 11 ft. 4.5 .g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Arsenic: ND ug./L. Nitrate 1.31 mg,/L. Date of sample: 4/9/2008 Other bacteria Collected by: coloniesll00 mi. Ltd. SEPTIC/HOLDING TANK DATA Tank Type/Material GREER/STEEL Tanksize 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date of Pumping 4/10/2008 Pumper ABSORPTION FIELD DATA 1.6£~ow I~XISTING ORAD[] Date installed 1982 Soil rating (g.p.d./ft2oQ 110 : Length 32 ft. Width 5 ,fl. Totaldepth *9.8 ft. Eft. absorption area 448 ft~ Monitoring tube"*YES Date of adequacy test 4/10/2008 Results (Pass/Fail). PASS Fluid depth in absorption field before test ***DRY in. Water added' 615 gal. Elapsed Time: 10 min, Final fluid depth DRY in. Absorption rate >= Date installed 1982 Cleanouts (Y/N) YES High water alarm (Y/N) NORTHLAND PUMPING System ty~'e TRENCH Gravel b~low pipe 7 Depression over fie d__ NO For 4 bedrooms New depth 2 in. 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - *DEPTH OF SUMP BELOW GRADE COULD NOT BE MEASURED EXACTLY DUE TO LANDSCAPING ROCKS. **MONITORING TUBE ONLY EXTENDS 25" BELOW INVERT OF DISTRIBUTION LINE ***PRE-SOAKED ON 4/9/2008 WITH 1020 GALLONS OF WATER. D. LIFT STATION ~ate inst~iled Size in gallons ~ ~ Pump on" level at ~ High water alarm level at ~ in. ~ ~ Cycles tested Meets alarm & circuit requirements?. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot · Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas. 50'+ * 100.3' 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% Absorption field Surface water 5'+ 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation. 10'+ Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wallson adjacentlots. 100'+ Water main N/A Driveway, parking/vehicle storage F. COMMENTS *EXACT DISTANCE RECORDED FROM CENTER OF WELL TO CENTER OF STANDPIPE. 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 ~--/7/0~ COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number APR-07-O8 NON 10:14 Afl DTna,lc Propertlo; FAX NO. P. 02 ,wqll IHSTISUTI~$ SPECIFICALLY TO SHO~ AKY C~}LI~TS ~DITIO~AL ~TRUCTURES ~ ~E~C[LIkES EAEEH[;TS OF RE¢ORD~ OTHER THA~ IKO~E ~Rg'~ C~ THE REGOROE~ PLAT~ ARE #Or SH~,~ KEE£~Xt~ AS-BUILT SUrVEy (~0 C~REHS ~ET THIS DATE) · J #ertoeGee'e Inspection of thw fettering  .crl~ pro~rcy~ LOT 1, ~SNINE ACRES SUB, ere ulthln the pro~rty Ilnel e~ do not I overtap or e~toich ~ the pro~rty I lying adjacent thereto, that ~ tren~leelon I{nes, or ether vlllb[e f~lcit~here~. ~lt~lt A~horlge, ] Al~ike thl..ZY ~ ~y I ~OLT AkO ASS~IATES LAND SURVEYORS SGS Ref.# Client Name Project Name/# Client Sample ID Matrix 1081435001 Garness Engineering Group, Ltd. Sunshine Acres LI Sunshine Acres LI Drinking Water All Dates/Times are Alaska Standard Time Printed Date/Time 04/I 8/2008 '1:57 Collected Date/Time 04/09/2008 13:40 Receh'ed Date/Time 04/09/2008 15:00 Technical Director Stephen C. Ede PWSID 0 Sample Remarks: Allowable Prep Analysis parameler Results PQL Units Method Container ID Limits Date Dale Init :,4etala b~, ICP/t4~ Ilardness as COCO3 184 $.00 mg/L SM20 2340B D 04111/08 04114/08 NRB Waters De,ar tment Total Nitratc/Nitritc-N 1.31 0.100 mg/L SM204$0ONO3-F B 04116/08 LCP Private Individual Analysis Aluminum ND 20.0 ug/L EP200.8 D 04/11/08 04/14/008 NRB Antimony ND 1.00 ug/L EP200.8 D (<6) 04111/08 04114/08 NRB Arsenic ND 5.00 ug/L EP200.8 D (<101 04111/08 04114/08 NRB Barium 16.0 3.00 ug/L EP200.8 D (<2000) 04111/08 04114/08 NRB Cadmium 0.520 0.500 ug/L EP200.8 D (<5) 04111/08 04114108 NRB Calcium 56900 500 ug/L EP200.8 D 04/11/08 04114/08 NRB Chromium ND 2.00 ug/L EP200.8 D (<I001 04111/08 04/14/08 NRB CorF, cr 16.9 1.00 ug/L EP200.8 D (<1300) 04111/08 04/14/08 NRB Iron ND 250 ug/L EP200.8 D (<300) 04/11/08 04/14/08 NRB Lcad 2.00 0.200 ug/L EP200.8 D (<15) 04111108 04114/08 NRB Magnesium 10200 50.0 ug/L EP200.8 D 04/11/08 04114/08 NRB Manganese ND 1.00 ug/L EP200.8 D (<50) 04111/08 04/14/08 NRB Chloride 3.20 0.100 rog/L. EPA300.0 A (<'250) 04/10/08 04111/08 JDS Fluoride ND 0.I00 mg/L EPA300.0 A (<'2) 04/10/08 04111/08 JDS Sclcnium ND 5.00 ug/L EP200.8 D (<501 04111108 04114108 NRB Sodium 4410 500 ug/L EP200.8 D (<250000) 04111108 04/14/0g NRB Silver ND 1.00 ug/L EP200.8 D (<1001 04111108 04114/08 NRB Thallium ND 1.00 ug/L EP200.8 D (<21 04/I 1/08 04114/08 NRB Sulfate 30.5 0.100 mg/L EPA 300.0 A (<250) 04110/08 04/11108 .IDS Zinc 387 5.00 ug/L EP200.8 D (<5000) 04111/08 04/14/08 NRB SGS Re£# Client Name Project Name/# Client Sample ID Matrix 1081435001 G~'ncssEnglnccrlngGroup, Lt~ SunshincAcrcsLl Sunshine AcrosLI D~nkingW~er All Dates/Times are Alaska Standard Time Printed Date/Time 04/I 8/2008 7:57 Collected Date/Time 04/00/'2008 13:40 Recehed DateITlme 04/09/200:8 15:00 Technical Director Stephen C. £de PWSID 0 Allowable Prt-p Analysis paramelcr Results POL Units Method Container ID Limits Date Date Init Private Individual Analysis Total Dissolved Solids 216 10.0 rag. fL SM20 2540C E (<500) 04/10/08 ISC Nickel ND 2.00 ug/L EP200.8 D (<100) 04/11/08 04/14/08 NRB Conductivity 389 1.00 umhos%m SI~L20 2510B E 04/09/08 ISC pll 7.59 0.100 pll units SM20 4500-11 B E (6.~-8.~) 04/09108 ISC Alkalinily 156 10.0 mg/L SM20 2320B E 04/11/08 SDP Colony Count 0 col/100mL SM20 9222B A 04/09/08 DLC TotalColi£orm 0 col/100mL SM209222B A (<1) 04/09/08 DLC FccalColi£orm 0 col/100mL SM209222B A 04/09/08 DLC I~m~R-14-~08 02:~7P FROM: im~ NORTHLAND PUMPING SERVICE, INC. Yuur Prof(:~:~ of~ S~ptic Pum~g Sarvtc~ Co up;t ly 7501 E. 140th Avenue ANCHORAGE. ALASKA 99516 (907) 344-'/146 * FAX (.,307) 868-677[3 ~ ~o~tl P.O. Box 110009 A~chora~e,.~ ~)~11-0009 T0:338~46 P:I/1 19666 6/0S 1200 Tank loca~ ~tmp S~tic for adequac~ t~t ~t g601 Speadlove Drive Bet'ore noon- teeing et 1:00 n110~3g d ~' ~.of'~ step at bac~ deck ~0 Gallons Holding Tank · '"'-4 Scpt.c ~ Sh3ndpipe.', Leach Area Time PROBLEM AREA - CALL FOR MORE INFORMATION NEEDSTO BE DONE AGAIN IN 6 MONTHS ~,(J Shape ~ludg~ buildup orl,bottom J m ca;3 m ~sin~ or ~ C~t s',and~>ipe Io 1 above ground ['1 FIo:~l.~r on lop ~ Needs Septict.'!.ne Parcel i.D. # 1. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & NUMAN SERVICES_ Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description L 6T' I .C:;u~4 sH l~~ ~CR~3 Location (site address or directions) ~Nc~oRAE, E Property owner Vlailing address Lending agency Mailing address Agent _ IVoo~ Address Day phone 3q5'33~.o Ak- ' ' _ Day phone Day phone ' Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well _ Oommunity well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Ffon! MOA #21 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 ~hat 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 frommy,investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance .with all Munici pal and State codes, ordinances, and regulations in effect on the date of this inspection, NameofFirm FLA-r'roP 'TEC I-I ~V'C$ Phone ~qS"- J35'-Z" Address q530 ~ C~-I~ ~T '~NC~o~GE, ~J< ~51~ EngineeYssignature ~~ ~¢ ~ Date ~¢¢}f .I/ I,~y DHHS SIGNATURE Approved for Disapproved. bedrooms. Conditional approval for TA ? bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage DePartment of Health and Human Services (DHHS) issues Health Authority. Approval Certificates based only upon the.reptesei;itations given in Paragraph 5 above by an independent professional engineer registered in theState of Alasl~a;The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy Cbrta'in federal and state requirements. Employees of DHHSdo not COnSuct' inspections or analyze d~ta beforre a:ce~ifi~at8,iSris~ued. The: MuniciPality of Anchorag~ is:nOt responsible for errors or omissions in the professio!~i engineer's work. ~2-025(Rr~',1/91) Back MOA#21 ' Municipality of Anchorage Department of Health and Human Services HEAl. TH AUTHORITY APPROVAl. CHECKLIST LegalDescription: LoT I 5w, I 5H~NE5 ,~¢R85 ParcelI.D. A. Well Data Well type Log present (Y/N) "/ Total depth Sanitary seal (Y/N) ')/ If A, B, or C, attach ADEC letter. ADEC water system number Date completed 5' / 3 o/5 ~ Driller Casedto 22 ~ED~.OCI¢~ Casing height Wires propedy protected (Y/N) Date of test Static water level Well flow Pump level1 FROM WELL LOG AT INSPECTION 1:2. o IlS ~ - G g.p.m. __ ~ 7 ; On adjacent lots SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~oo' To C,0. Absorption field on lot Public sewer main ~/oo Sewer service line ~ /oo ; On adjacent lots ~/oo Public sewer manhole/cleanout ~ 1oo Petroleum tank ~./~. WATER SAMPLE RESULTS: Coliform 0 cc,{/[oa.,~,~- Nitrate 4?,qq ,~¢ /.Z Otherbacteria ,no~¢ r¢/c¢rt~( Date of sample: 3/2.:/clq Collected by: ~L,,~ T'rOP 'T~c ~t $ VC ~, El. SEPTIC/HOLDING TANK DATA Date installed /o/gZ. Tank size I ZSO ~ Compartments Oleanouts (Y/N) _ ~ Foundation cleanout (Y/N) _ "/ Depression (Y/N) High water alarm (Y/N) ~, r~. Alarm tested (Y/N) N, ;4 · Date of pumping -//~-I/~13 Pumper N SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) onlot ~o0' f¢o~ C.O, On adjacent lots '-~ To property line leo' Absorption field Sudace water/drainage ~> Foundation Iq F~o. C.O, Water main/service line > ,g-o ' 72-026 (3/93) * Front OONTINUED ON BACK PAGE C, LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LiFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA / Date installed (o/8 2. Soil rating (GPD/Ft2) ]. '5(o Length 3 2_ ' Width 2- ' Gravel thickness Total absorption area L~ H <~ ¢~. ~' Cleanout present (Y/N) '7/ Date of adequacy test ..~ ,,/2 5 / ~ ~ Results (pass/fail) P/~ Water level in absorption field before test fl¢,4)(~ ,~¢¢4-~x~-ccf- m /1, 7:- Peroxide treatment (past 12 months) (Y/N) Not-.t6- Eliot,/~-I System type Total depth 10 ~ Depression over field (Y/N) k/ for L~ Bedrooms Aftertest ~/~. ~-,.~.~,-~r-~cy ;,~ If yes, give date N, A, SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot IFA- ' To building foundation On adjacent lots Sudace water >. /oO Curtain drain N. On adjacent lots '~./,3o' Property line I oo ' To existing or abandoned system on lot ~, ,,~, Cutbank .5~(~ ~ Water main/servioe line ~> ,5-0 ' Driveway, parking/vehicle storage area 2,5' ' E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on ~tbe,date.e!,.~is inspect/on. Signature %~,.-.---,.-¢~z.-,.~_ Engineer's Name Date ~ / / HAA Fee $ Date of Payment 72-026 (~)' ~ck Waiver Fee $ Date of Payment Receipt Number CT&ERe f,# Client Smnple ID Matrix Commercial 'resting & Engineering Co. Environmental Laboratory Services r~.~×7~7/y/7/~'.~.~7/-Tf/~×~,~7/~/~~~/~ LABORATORY ANALYSIS REPORT 94.1293-1 L1 SUNSItlNEACRES FRONTHOSEBIB WATER ClientName FLATI'OP TECI1NICAL SRV WORK Order 76940 Ordered By TED MOOPdg Printed Date 03/29/94 ~ 09:45 [irs. Project Name Collected Date 03/25/94 ~ 10:30 lu's. Projecl# Received Date 03/25/94 ~ 13:30 lu's. PWSID UA Teclmical Director STEPI1EN C. EDE RcleasedBy: ~--~'~,."' ~*, ~ Smnple Return'ks: ROU'I1NE SAMPLECOLLEC~[~D BY: C}[RIS. QC Allo;vablc Ext. Anal Parameter Results Qual Units Method Limits Date Date hilt Nitrate-N 0.49 mg/L EPA353.2/300.0 10 03/28/94 03/28/94 CMR * See Special hlstractions Above UA = Unavailable ** See Sample Remarks Ab ore NA = Not Analyzed U = Undetected, Repodedvalue is the practical qmntification limit. LT= Less 'lhan D - Secondary dilution. G£ - Greater 1hah 5633 B Street, Anchorage, AK 9951 8-1600 Tek (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, COLORAOO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLF FAMILY DWELLING Parcel I.D,# ~¢'~1'"-~ - 'L/L'~\- ~:~. NAA# 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner ~-¢r~ f~' J-,~.~/t~ ~[c~,,y. Dayphone Mailing address ,,¢~¢-~¢ /,¢,. ¢/'~'~,~ Z)r.j I_ending agency (~ lTV NIORT~t}~E Day phone Mailing address ~.o,~ g/. ':5(?~ AVE. Agent _ ~ON~ Day phone 700 Address 2. NUMBER OF BEDROOMS: 3. 'TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well ~" Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site / Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 '~Jo~ s,~eeu!13ue I~UO!SSe,~oJd eq~ u! suo!ss!wo Jo s Jo J J9 Jo~. @lq!suodseJ ~,ou s! e6~Joqou¥ ~o ~!led!o!un~ @q.L 'panss! s! @~eo!J!~eo ~ eJo~eq ~p ez/q~u~ Jo suo!~oedsu! ~onpuoo ~ou op SHHQ ~o sae,~oldw~ 'szue~ue~!nbe~ e~e~s pus I8~epe,~ u!e~eo,~;s!~s o~ep~o u! suo!~n~!~su! 5u!puel ~!eu~, pus S~Luoq JO sJes~qoJnd O~,~se~no0 ~ s~ s!q~ saop SHHG eqJ. '~Ns~IV ~o e],~lS eq~ u! peJe~s!~aJ Jesu!Bus i~uo!ssa~oJd luepuadepu! ue ,~q aAoqe g qdeJ~8Jed u! ue^!~ suo!lelua~eJdeJ @q~ uodn XlUO peseq se~,~o!JJlaeO le^oJddv ,~j!Joqlnv q~leeH sanss! (SHHQ) seo!AJeS uewnH pus q~leeH jo luauuuedeQ e~eJoqouV jo/q!led!ojun~l eq.L S~UeLULUO0 leUOBipp¥ :suo!~elnd!~@ 6U!MOIIOJ eq~. ql!M '$wooJp@q '9 'G  Municipality of Anchorage Department of Health & Human Services ~"~i HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: I-O'T l 5(Jikl.,Sl~l~E ,'~C~ Parcel l D "~ / '~'- A. WELL DATA Well type PEw~TE If A, B, or C, ~ttach ADEC letter. ADEC weter system number Log present(Y/N) ~ Detecompleted 5/3o(8% Driller Totaldepth_ 2~0¢ Cased to_ 2~' ~bRoCKb Casing height Sanitary seal (Y/N) ~ Wires properly protected (Y/N) F,OM WE'' AT .S,ECT,O. Date of test 5'/30/8 z ~/'/#/~ / Static water level I 2 o / ] ~ 0 ' Well flow 5 ~ ~ g.p.m. 8 ~ ~P~ Pump level 23~/ ~ J~Or g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main ;>/oo Public sewer service line --~/oo ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout '7/oo ' Petroleum tank kl ,~, WATER SAMPLE RESULTS: Coliform ~ Date of sample: ~/c[/~1 Nitrate Collected by: Other bacteria FL RTTOP TEcfl B. SEPTIC/H~-~-~ TANK DATA Date installed ~/~2 Cleanouts (Y/N) ~ Tank size 1'2,LO G Compartments ,2_ Foundation cleanout (Y/N) )/ Depression (Y/N) H High water alarm (Y/N) Date of pumping . Alarm tested (Y/N) N./~, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot loc ' F~o~ C.o, Onadjacentlots To property Ii ne_ I ~ O Absorption field Surface water/drainage Foundation F~o~ C.O, Watermain/serviceline ~ -5-O¢ 72-026 (Rev. 3/91) Front MOA 21 CONTINU ED ON BACK PAGE O:-bt~TSTATfO N Date installed Size in gallons Vent (Y/N) .,.~¢~ "Pump on" level at H}~;~¢~te r a la~rr~l'~ I Meets M(~ elect(.i?~'~es (Y/N) ___ SEPARAT,~~'~' Manufacturer __ Manhole/Access (Y/N) "Pump off" level at Cycles tested Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed (~/~2_ Soil rating Length ~ ' Width Gravel thickness / Total absorption area Z.(~ ~ Depression over field (Y/N) Results (pass/fail) ~'A $$ Peroxide treatment (past 12 months) (Y/N) System type T~ Total depth Cleanouts present (Y/N) Date of adequacy test for ~ If yes, give date HA bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~[L~' On adjacent lots '~ To building foundation ..~-~ On adjacent lots ~ (oO Cutbank Property line To existing or abandoned system on lot ,¢'(~ ~ Water main/service line Surface water I00 Driveway, parking/vehicle storage area 25-~ Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines ir, the date of this inspection. HAA Fee $ ,/~(7 ~ Date of Payment x-r/-~'-'~ '¢/' Receipt Number c~., ~'~ ~ 72-026 (Rev. 3/91} Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY o; A DIVISION OF COMMERCIAL 'rESTING & ENGINEERING 5633 B STREET ANCHORAGE, AI.ASKA99518 TELEPHONE (907)562-2343 ANALYSIS REPORT BY SAMPLE for WORKorder~ 33159 Date Report Printed: APR 10 91 @ 17:04 Client Sample ID:OUTSIDE SPIGOT LOT 1, SUNSHINE ACRES Client Nam :FLATTOP TECNIIICAL SRV PWSID :UA Client Acer :ELATTOT Collected APR 9 91 @ 11:20 l~s. BPO ~ PO ~ NONi RECEIVED Received APR 9 91 @ 11:40 hrs. Req # Preserved with :AS REQUIRED Ordezed By :TED MOORE Analysis Completed :APR LO 91 Send Reports to: Laboratory Supervleqr :~_T~PHEN C. EDE L)ELATTOP TECI[NICAL SRV Chemlab gaf @: 911331 Lab Smpl ID: 1 Matrix: WATER Allowable Parameter Tested Result Units 14ethod Limits NITRATE-N 0,65 mO/1 gPA 353,2 10 3ample SAMPLE COLLECTED BY: T.E. MOORE Remarks: i Tests Performed See Special Instructions Above UA~Nnevailable ND~ None Detected *' See Sample Remarks Above NA= Not Analyzed LT:Loes Then, GT=Greeter Then APPLIC , IT FILLS OUT UPPER HAl ONLY Matllng Address Buyer Address Zip Code Lending Institution Phone Address ~fti(:t~..,.~~ J~/J~':j U/C~' ~:~',~[~. Zip Code Realty Co. & Agent Phone Address Zip Code Street Locatlo~ Type of Residence Single Family '~'~ MulUple Family No. of Bedroorns~:l- [] Other Water Supply ,~ Indlvldual ATTACH WELt. LOG. A weg log is required for all wells drilled since June 1975. Community For wells drilled prior to that date, give well depth (atlach log if awllable). [] Public Utility ,~.~%, I __ Sewer Disposal ~ I.dMdual [] Public Utility When Connected to Public Utility: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN SE INITIATED. 'rime Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector ~UNfCiFAi. J~y OF ANCHORA~T RECEIVED (~1/~) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' BY: ~f" '~ k 2kJ ....... ~(' ~ i( ¢~ g.. / ?-' ~'"I Well ~o Tank /' ¢) ¢:',*. Septic T~k Size ./ -~¢. ~ ~ Peb~:uary 7~ 1983 James 'i'. Clay SRA Box 2420-C Anchora!i[e, AK 99507 Subject: Lot 1 S~ln~;hine Acres Approval for the individual se%./er an(] ~.later facilities c~.~nnet: be granted until the follow, lng items havc been completed: O A %.;ell log submitted to this office for our file~ and review. The %,zator analysis report needs to be submitted to this office from tho Chem Lab, 5633 B Street, for our review. Please notify this Depart:.raent for a reinspec~tion ~,thon the noted discrepancies have been corrected. If there are any furth0r questions, please call this office at 264-4720. Sincerely, J R6 6/p/Ellt Jim Roberts Associate Environmestal Specialist