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MARYLAND LT 3-A
Maryland Lot 3A #015-082-32 Municipality of Anchorage Page of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska.99519-6650 • Telephone:. 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW q 5" oz3 s PID Number: Name: Wastewater System: L*New ❑ Upgrade Address: ABSORPTION FIELD BOCK �• o 'f3 LV SV t-rt3 3-3CU ��/.S�S Phone: No. of Bedrooms: Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other 3'1 Lt - 2,4;-o l Soil Rating: Total Depth from original grade: LEGAL DESCRIPTION (n. s GPD/Sq. Ft. it'• S 41 Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe 3 A ✓ A,%/t, 61 q, 41 Ft. -7. q Ft. Township: Range: Section: Fill added above original grade: Gravel length: Z Z —0— Ft. -�;, , -Lr Ft. Gravel width: Number of lines: Distance between lines: WELL: New ❑ Upgrade -za Ft l — v — Ft. Classification (Private, A,B,C): Total Depth: Cased To:Total C?& absorption area: Pipe material: 3d3N �QvV�T(✓ 76tj. Ft. Ft. ��'z.S6 SCI.Ft. Driller: Date Drilled: Static Water Level: --?L-� Installer: l ke-AA)DC12 eJ Date installed: Q Ft. fM Yield:Pump Set at: Casing Height Above Ground: TANK GPM ceS Ft. Z Ft. SEPARATION DISTANCES XSeptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: / G -C>0 From Tank Field Station Tank Sewer Lines Material: Number of Compartments: Well 1/Z /2/03 — �•j 5 Surface -r _ — _ LIFT STATION Water /C70 Oo Lot Size in gallons: Manufacturer: Line yS t 35r —' .S'o "Pump on" level at: "Pump el at: High water alarm at: Foundation �8 ' Z S --- — — , Curtain _ Pump M odelElectrical Inspections performed by: Drain BENCH MARK Remarks: Location and Description: wGLL jjeAD —ToP Assumed Elevation: -5,6C) - ENGINEER'S'SEAL, Inspections performed by: Dates: 1st 2nd 'FINAL 3 -2- 96a l.�n 'arausr g Department of Health and uman Services approval f=�'` 3 Reviewed and approved by: Date: 72-013 (Rev. 9/91) MOA 25 AS -BUILT Z13 WASTEWATER ABS❑RPTI❑N SYSTEM Lot 3A MARYLAND SUBDIVISI❑N No wells within 100 feet of new system. Lot 3A Lot 4A (Undeveloped) ;^ 491-1 •; ............................ PO Steven R. Ponnone2 No. CE 8149 New Well Radius Desi n' Perc. Rate of 8 min/Inch 5 Bedroom House 625 SF of Absorption Required 7' Use Deep Trench 7' Deep, 50'.Long 50' 2' PREPARED F❑Ri PANN❑NE ENG. SVC...; Gene & Mickey Sleeper P. ❑. BOX 142025 800 E. Dimond Blvd, Suite 3-300 ANCHORAGE, ALASKA 99514 Anchorage, AK 99515 (907) 344-2501 274-0308, 272-8218 Fax ATE, 3-18-96 AS -BUILT ISCALE, Distances NEW System Y A-1=19.0' A-2=192' B-1=13.6' B-2=14.3' New A-4=302' B-4=23.2' o 1500 G A-5=32.0' B-5=25.0' d MW rSeptic Tank A-6=33.4' B-6=26.2' > + A-7=82.8' B-7=76.8'6 =60.5' B-MW=53.0' a C.7 D 1 o Proposed Lot 2 B 5 bedroom a" House Lot 3A Lot 4A (Undeveloped) ;^ 491-1 •; ............................ PO Steven R. Ponnone2 No. CE 8149 New Well Radius Desi n' Perc. Rate of 8 min/Inch 5 Bedroom House 625 SF of Absorption Required 7' Use Deep Trench 7' Deep, 50'.Long 50' 2' PREPARED F❑Ri PANN❑NE ENG. SVC...; Gene & Mickey Sleeper P. ❑. BOX 142025 800 E. Dimond Blvd, Suite 3-300 ANCHORAGE, ALASKA 99514 Anchorage, AK 99515 (907) 344-2501 274-0308, 272-8218 Fax ATE, 3-18-96 AS -BUILT ISCALE, AS -BUILT DETAILS 3/3 WASTEWATER ABS❑RPTI❑N SYSTEM Lot 3A MARYLAND SUBDIVISI❑N 3 a L C O � P Q m 1nONtl310 ;.•.•. a eyb d "asp✓, d veesee L °. L ajyea L d a °epaa•: 6 4°arae U e.ese° y c La eepe,e q L nc p•e L v d i e°a°s°eti 1� rt > R °p.p. e°i °. O o m osis°ee (U a 3Hn1 21OlINOw N °Qac x u C p ave u �� O 6 O p e •��� 7 rte°e'e°pucno°ne^no see$ 6. F , 00, 60eaOpG0'e Hi e°�a'e°i W L3 °•°�• q 7 O U L e°�eYB r �e°s• LLI w .pep.p �' � rev.•. 13. h 1nONV3'13 • Q.. v o C Cl v v 4. .1 V 1nONtl3'ID 1nONV319 -6 r � `d 3 L dr 1nONV319 4-4, o za _j D C aL3 a — 1nONVY13 v Fl i c d { Wo "In lalklivils 13 00 �O V O ®R. NailwaNnai t� 1 ••pAem.eggpq N 49R c �� .................. I ...................... 10 .....� ® ....... ... ......... .................. PREPARED F❑R1 .Steven R. Pannone; STEVEN R. PANN❑NE, P.E. No, CE 8149 Gene & Mlckey Sleeper P. D. BOX 142025 e°�bo31p 800 E. Dimond Blvd, Sulte 3-300 ANCHORAGE, ALASKA 99514 .......... �®�® Anchorage, DA AK 99515 74 18-008, 272-8218 FAX 90> NOT T❑ SC LE AS—BUILT 03-19-1996 P3�03PM P 01 M -W DRILUNG, Inc. P.O. Box 110378 0 10330 Old Seward Highway (907)343.8638 i— ANCMORAOE, ALASKA 99611 DRILNNG LOG Well Owner– L H PARTNERaUse of WeRMESTIC Location (address of: Township, Range, Section, if known; or distance main roast LOT 3A MARYLAND SUBDIVISIM 6641 JOLLIPAN COURT ANCHORAGE, ALASKA Size of casing fill Depth of Hol ---IM Cased to_ 46---__-- _feet Static water levet 7Q t, ( j below) land surface. Finish of well (check one) open end ( X ); Screen ( } ; Perforated Describe screen or perfotttion...'J1 Well pumping test at. AA—ga> l is of drawdown from static1; ; 4 Date of completion 01 SEPTE:l jRj—.j, Depth in feet from t'• round surface Q—TO 2 _ 2,TO 3 .3 –TO 7 TO 3,7 7 TO 4? 80 TO 84 $ 4 TOIL_ 1iz_TO--i, 5_.. _TO —_TO jp (minute) for tours with 26.5 •t, 'as WTU LOG 0 of formations penetrated, size of material, color and haudaen U'LAY! SILTY P TO _ ,s v MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 1 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW950235 DATE ISSUED: 8/23/95 DESIGN ENGINEER:STEVEN R. PANNONE EXPIRATION DATE: 8/23/96 OWNER NAME:BUCHHOLZ NORMAN & OWNER ADDRESS: S �DfFn PARCEL ID:01508232 LEGAL DESCRIPTION: MARYLAND LT 3-A LOT SIZE: 52161 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED DATE:- ' "?S` c -s DESIGN WASTEWATER ABS❑RPTI❑N SYSTEM Lot 3A MARYLAND SUBDIVISI❑N 7,\ b W 04 L T[] 50, 2' PREPARED FUR: Gene & Mickey Sleeper 800 E. Dimond Blvd, Suite 3-300 Anchorage, AK 99515 (907) 344-2501 Lot Design: 72,40 Perc. Rate of 4Z min/Inch 5 Bedroom House 625 SF of Absorption Required Use Deep Trench 7' Deep, 50' Long STEVEN R. PANN❑NE, P.E. P. ❑. BOX 142025 ANCHORAGE, ALASKA 99514 274-0308, 272-8218 Fax aTE 8-13-95 DESIGN -ALE: 1"=50' DESIGN DETAILS WASTEWATER ABS❑RPTI❑N SYSTEM Lot 3A MARYLAND SUBDIVISI❑N • inoNv3-1D `Q a "4 EL N d .d Q u° II ° 6 ,q gog t U O V O ° tt i o0 NE f f O C] ` Z o ` J \ o 3anl a01[NON °0 000 = U Z tt 000000 000°00°° 122.0' 0 0 o °0 0 0 00 A U 4 7' W c W J H inONv33n J a M inONd31D 1nONv333 v sL inONv330 o J � O C t� U aO Q inONv3-3 Z � c C J a o 0 0 �E gC qS�♦♦ .......... .�!J in[INv330 Air�^ •' ♦ "J°: 'S/ ♦ NNI1tlaNnNj 49TH ': ♦I i ..... h........ ........................9..... io ••^......•• ......••••••.••••••�. PREPARED FOR: STEVEN R. PANN❑NE P.E, I� Steven R. Pannone; i` ♦j� Gene & MickeySteeper P. ❑, BOX 142025 sem•,°•° No. CE 8149 ••,.'� 800 E. Dimond Blvd, Suite 3-300 ANCHORAGE, ALASKA 99514 ♦ F ♦♦1°•S©g2.+•' Fig Anchora e, AK 99515 274-0308, 272-8218 FAX +�+ (907) 344-2501 E DATE+ 8-13-95 DESIGN NOT TO SCALE Steven R. Pannone, P.E. Consulting Engineer P.O. Box 142025 Anchorage, AK 99514 (907) 274-0308, 272-8218 Fax August 13, 1995 Municipality of Anchorage Department of Health and Human Services Environmental Services P.O. Box 196650 Anchorage, AK, 99519-6650 ATTN: Mr. James E. Cross, P.E. RE: Lot 3A Maryland Subd. Request for Sewer Permit Dear Mr. Cross; I would like to request a permit be issued to construct a new soil absorption system as shown on the attached site plan and in accordance with the attached engineering plans and details. My firm conducted a site visit and soil/percolation test on the above property. A single test hole was excavated; results are attached. Based on the results of the testhole results, we are requesting a permit for a five bedroom system. The new system will be a deep trench system 50 total feet long, 7 feet deep and 2 feet wide. It will be start approximately four feet below existing ground level, and will be located in the material identified as silty sands, having a peculation rate of approximately 2.6 minutes per inch. There are no existing soil absorption systems serving adjacent lots from the proposed system. A new individual water system will serves the property, and the service line is located on the east side of the property, well away from the new system. There will be no conflicts with any existing water or soil absorption system. There is no evidence of any surface water within 100 feet of the new system. Please contact me if you have any questions. Sincerely, Sim ` Steven R. Pannone, P.E. , 4 ` S CAwork\3A-MARYL.LTR 3toven P. Pernare CE - 6149 4�4�� �Q Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: G w4c DATE PERFORf3119�L:' LEGAL DESCRIPTION: 1"o`rA/. I�tAaYr-ANS slt� Township, Range, Section: SLOPE SITE PLAN DEPTH I0L- C�2Gvarrc5 1 Net Depth to Time Water Net Drop 2- 3 t Q Yz NEONS 4- t s31 rls 5 ( 6'a 0 ■■ 6 SAN p ` rCoQb�o S t�2m C- 7 8'2 8 a 9 10- 11 12 13- 314151617- 14- 15- 16- 17-1 o N 18 19 P�t� WAS GROUND WATER D ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After 8 —/O-4 Mnnitnrinn9 AIONl2 Date: Gross Reading Date Time Net Depth to Time Water Net Drop lS t Q Yz NEONS v Z 17 t s31 rls 8t8 ( 6'a 0 ■■ Gross Reading Date Time Net Depth to Time Water Net Drop lS t Q Yz B v Z 17 t s31 rls 8t8 ( 6'a 'z 8'2 04 4 a 20 PERCOLATION RATE z• `' $L(minutes/inch) PERC HOLE DIAMETER ro TEST RUN BETWEEN —�6— FT AND FT COMMENTS PERFORMEDBY: 'Crt'iA �Nc�N /3 I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: — Z—`?S 72-008 (Rev. 4/85) ERANS 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. 015-082-32 Expiration Date: I//o7i 1. GENERAL INFORMATION Complete legal description Maryland Lot 3-A Location (site address) 6641 Jollipan Court Current property owner(s) Joseph Budrow Day phone 907-242-1920 Mailing address 6641 Jollipan Court, Anchorage, AK 99507 Real estate agent Day phone 2. TYPE OF DWELLING: �J Single Family (w/wo ADU) ❑ Duplex E Multiple Dwellings (Single Family and/our Duplex) 3. NUMBER OF BEDROOMS: 1 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic Water Storage ❑ Holding Tank n 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 Fee $ 6-50 Waiver Fee $ Date of Payment 5130/IQ Date of Payment Receipt Number OUGoi A6 Receipt Number COSA# QSc !/2a I 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, P.E. Date 5/29/19 . A 0 "64It reP j 'f' 1 yr *: 49TH •* /� 6. DSD SIGNATURE ,' •" System #1 Approved for bedrooms 6 Benjarr n• hiller � ?'F CE 12592 System #2 Approved for bedrooms f • tsFq•, 05/29/19••:a�?^! Disapproved k‘ ,'°ROFESS40NA�.� Conditional approval for bedrooms, with the following stipulations: By: ✓ ei-- Original Certificate Date: 6/o49 The Municipality of Anchf ge Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: Maryland Lot 3-A Parcel ID: 015-082-32 If more than 1 septic system on lot: COSA Checklist# of Structure served by this system A. WELL DATA 0 Well log is filed with Onsite (or attached) Well production at time of test 4.4* gpm Date drilled 9/1/95 Water storage tank volume 300 gallons Total depth 96.5 ft Well disinfected for coliform test? ❑ Yes 0 No Cased to 96 ft 0 Coliform bacteria is Negative 0 Sanitary seal is functioning correctly Nitrate mg/L 0 Nitrate less than MRL (ND) ['Wires are properly protected Arsenic 8.14 ug/L ❑Arsenic less than MRL (ND) Casing height(above ground) 24 in. Collected by Forge Engineering Date of flow test for COSA 5/28/19 Date of Sample 5/16/19 Static water level at beginning of test 42.5 ft. Comments Holding tank prohibited direct measurement of well flow rate.Calculated rate by monitoring static water level while timing tank recovery B. TANK DATA C. LIFT STATION Age of tank(s) 24 years ❑ Required maintenance completed Tank type/material Septic/Steel Age of lift station years Measured operating fluid level in septic tank 50" Lift station material 0 Standpipes/foundation cleanout per record drawing Comments: Date of pumping 6/3/19 D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) 9/16/95 Adequacy test date 5/28/19 0 ALL standpipes present per record drawing Results Pass For 4 bedrooms Total measured depth from grade 11.1 ft(max) Fluid depth prior to test 27 in Measured depth to pipe invert from grade 3.5 ft(min) Water added 450 gal El N/A—pressurized field New depth 31 in 0 Monitor tubes go to bottom of effective. If not, state 140* Elapsed time min depth into effective ❑■ Code-required soil cover over field Final fluid depth 27 in Absorption rate 450+ gpd I=1 System presoaked (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) None date of test) Gallons introduced NA gallons If yes, enter date Comments/Deficiencies:-Tested for 3 bedrooms per current property record,but is adquate for 4 bedrooms 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' Community Sewer Manhole/Cleanout> 100' 0 Yes if No ft 0 Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line >25' 0 Yes if No ft Absorption Field on Lot> 100' 0 Yes if No ft Holding Tank > 100' El Yes if No ft Neighboring Absorption Fields > 100' Animal Containment> 50' 0 Yes if No ft 0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 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' 0 Yes if No ft Surface Water> 100' El Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells> 100' 0 Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells >200' fl Yes if No ft Water Service Line> 10' 0 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' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' El Yes if No ft Private Wells> 100' 0 Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells >200' 0 Yes if No ft Surface Water> 100' El Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION .1 ,OF 14% I certify that I have determined through field inspections and review Ay, ie• ��� •11710j of Municipal records that the above systems are in conformance with %*: 49 111 I\ • * r MOA COSA guidelines in effect on this date. g Vir' ie.' /6 Benja• chiller r+ �F'.• CE 12592 ...`Z;/ �i1 4.p•., 616119 ..\.•,c... :7,� IkV..PROFESSIOte� COSA Checklist yellow sheet IA\\�tt'16* PO BOX 240773 ANCHORAGE, AK 99524 GE 527.7773 677.7766 (FAX) ENGINEERING FORGECIVIL.COM \\\\N� June 7, 2019 r— OF q ..• MOA Development Services, On-Site Water& Wastewater Program „F* •;9 TM 4t.7 4700 Elmore Rd •`. •• Anchorage,AK 99507 /e .•• ..• .• ....: r Benja ' , hiller 111' •. CE 12592 .••4' A.,.• -" f �'r • 6/7/19 •••�G�r Subject: Maryland Lot 3-A–6641 Jollipan Ct '�>t ��\\ Septic Adequacy Testing Dear On-Site Services Engineer: On May 28, 2019,we performed a septic adequacy test at the above address. While the system was designed for 5 bedrooms, property appraisal records indicated the home was currently a 3- bedroom home. Upon arrival on-site,the homeowner confirmed the information on the property appraisal record. Our initial readings of the trench, taken at 10:25 AM, showed a level of 27"of liquid,with a measurement of 91" for the effective depth. We introduced 450 gallons of water into the trench, and the liquid level rose to 31". Our second reading was at 12:40 PM. At 3:00 PM, only 2 hours 20 minutes later, the trench had absorbed all of the water, and the level was back at 27". Counting from the time the test began,the trench absorbed 450 gallons of water in approximately 4.5 hours. In 24 hours,the trench would easily absorb more than twice that amount. In summary,while the test involved only 450 gallons of water,the short time in which it was absorbed indicates it would easily pass for the design capacity of 5 bedrooms. We request that this COSA be approved for 4 bedrooms. Sincerely, Benjamin Schiller, PE MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT I . ` 2"c' 907-343-7904 On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Arsenic Advisory' Certificate of On-Site Systems Approval # 0SC191201 Subdivision: Maryland, Block: , Lot: 3-A A water sample revealed an arsenic concentration of 8.14 micrograms per liter (ug/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. information on arsenic is available from the On-Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. Mailing Address: P.O. Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org 4 N 89 57'18"W 32926 • ' ":c�i1�i T•7 LE Rii EC ESMI 1 $Nfi: 1.4 ,t i, u i �\ ' \ ...,„ i .... 'Ic,c, O \ 7s,......_ 0. \ . i ,0_. ' 1 ; o , E� ,,,I., ,,.\,,,.. a0 • . . ,. o -- ,af it (------ .,,, . ,_ , 1 ,. , , , .,. 0,,,.. ., , \\\\ 00 ....... 1„ I o, 10,00 I . I i WELL• SOL L IPA N uir,41 101E _ , ;J'prrq,,vaGF ES,u'; ,,v 67 COURT AS-BUILT SURVEY 1" =30' • NO CORNERS SET THIS DATE .00000Op� I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY v�� OF A 4'41 OF THE FOLLOWING DESCRIBED PROPERTY o•-...• •••.161' o .1- 0 LOT 3 A,MARYLAND SUB.(PLAT 83-345) * . 49 TH %\ .OA ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE D VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN PA THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS O'� • o O THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY EXIST OTHER THAN NOTED. O,p > CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS 16TH A p '. SHANE A.HOLT .' o�O NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. DATED AT ANCHORAGE,ALASKA THIS DAY OF YYtJ1L LS-6914 ,4 EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN MAY , 2019 `Pap ' c6 p HEREON ( UNLESS INDICATED) �.o/e551QAy\ oo� NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE QbOpO� PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. HOLT LAND SURVEYING ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. 9309 GROVER DRIVE 14231 F8196-49 ANCHORAGE,AK 99507 345-5513 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 Parcel I.D. 015-082-32 Expiration Date: 1. GENERAL INFORMATION Complete legal description MARYLAND; LOT Location (site address) 6641 JOLLIPAN COURT, ANCHORAGE, AK 99516 Current Property owner(s) MERRY FAITH Day phone 947-0997 Mailing address 6641 JOLLIPAN COURT, ANCHORAGE, AK 99516 Real Estate Agent MICHAEL DROEGE W/CENTURY 21 Day phone 230-3372 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. 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 ❑ Received by: I �till Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 900 .CSO Date of Payment all I I lI a Receipt Number QLA 1 G COSA# OSCIa1y1$ 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. 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. 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, LID. 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. 6. DSD SIGNATURE _ System #1 Approved for 5� bedrooms. System #2 Approved for Disapproved. Conditional approval for ' bedrooms. Phone 337-6179 Date oo�`�pp0 oQooP��. OF..q.<qk�o bedrooms, with the following stipulations: G rness: GfJ 7.7?4c°jv ON-SITE WATER AND WASTEWATER PROGRAM The Municipality or Anchorage Develop, emt 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. ATTCHMENTS: [_� COSA Checklist Septic System Advisory Nitrate Advisory Arsenic Advisory Well Flow Advisory / Other By. / . (Rev. 71/0.5) Original Certificate Date: I '13— /2 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: MARLAND; LOT I4 3-rq A. WELL DATA N0z_F : 300 "r.oti1 STUZ -6C– Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 1/9/1995 Sanitary seal (Y/N) YES Total depth 96.5 ft. Cased to 96 ft. FROM WELL LOG Date of test 1/9/1995 Static water level 70 ft. Parcel ID: 015-082-32 t a S, rucr� /.0 S 1 pIF 1+C v SE Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 8/21/12 ft. Well production 4.5 –9 P.M. 2.86+ —9-P M. WATER SAMPLE RESULTS: Coliform �7d colonies/100 ml. Nitrate /UO mg./L. Collected by: _GEG. Ltd Arsenic: tlg./L. Date of sample: 8/21 /12 B. SEPTIC/HOLDING TANK DATA *DOUBLE C/0'S PRIOR TO TANK Tank Type/Material SEPTIC/STEEL Date installed 9/17/1995 Tank size 1500 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 9/4/12 Pumper ISAAC'S PUMPING C. ABSORPTION FIELD DATA Date installed 9/17/1995 Soil rating (g.p.d./ft2br /bdrm 1.2 System type TRENCH Length 52.2 ft. Width 2 ft. Gravel below pipe 7.4 ft. Total depth *11.5 ft. Eff. absorption area 773 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 8/21/12 Results (Pass/Fail) PASS For 5 bedrooms Fluid depth in absorption field before test 18 in. Water added 960 gal. New depth 31.5 in. Elapsed Time: 120 min. Final fluid depth 21 in. Absorption rate >= 750+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date – D. LIFT STATION Date installed Size in gallons Manhole/Acoess (Y/N "Pump on" level at in. "Pump off" level at --i . High water alarm level Cycles tested Meets alar & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lob Absorption field on lot 100'+ On adjacent lots Public sewer main 100' 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 Water main 5'+ Property line 5'+ Absorption field 5'+ Water service line 10'+ 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'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION QF . I certify that I have determined through field inspections and CA q T _ �* review of Municipal records that the above systems are in "' 'conformance with MOA COSH guidelines in effect on thisdate. .Je A. orne s• -Engineer's Printed Name JEFFREY A. GARNESS � 9 �gg mm� 04s / c0 Date dpi 1..1 o°c (Rev. 11/05) PRaRoem rxlwm naGR E11V. (A59JYkD) on'iv°P.° Asz�wm) a mmw ZONING MMMT MONT SULDI XnMCK SIDE EULVNG SETBACK FFAR Bow. SETBACK N89° 57'18"W 329.26 a.a 10' T8E EBMT t— — — — — — — — — — — — — — — — — — — — — SHE — ------------- 60 —_-----_--- 60 e- ro C.Os $ m L 2 EX .... ...... o m SSE N p W N . O F �0 '\ OU w Q i CLL �ti. GOJ ^C� _—--------- 10' GRAIN ESMT �Q zss N87° 03 11"E 279.62' O 1 4A UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL UABIUTY ONLY FOR THE COST OF THE SURVEY. USTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. LOT SURVEY SURVEY TYPE SYMBOLS ❑ FOUNDATION AS -BUILT ❑ FINAL STRUCTURE AS -BUILT rBKo SET REBAR 7- - DRAINAGE 0 ASPHALT ❑ PLOT PLAN... AS -BUILT B...TOPOGRAPHY O FOUND REBAR e e e WOOD FENCE " CONCRETE AS -ROILY ... Na CORNT RECER RECERM T A -i 0 COMIBiS SET ® ASSUMED ELEV. -X-)( I( METAL FENCE ® WOOD DECK PLOT PLANS & LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. SURVEY CERTIFICATION •••r, �.•�E OFgC,gq� Prepared by Robert E. Johns, Jr. & Assoc. PLOT PLAN mraGy�tlB°»� ,--Y° MWIBMN m w let w mt smwew mum.e Bwtm, ma tiwt,�y OSP,.••..................♦ •�. Professional Land Surveyors 1700 Brink Drive. et eam.n °. n°•n m n. Ixm ma to a• a.t a mr V •: �� ANCHORAGE, ALASKA 99504 r °>t.apt ma eetlB.A m arnnNm. n•.. e.m � ��. •' fth y Scale: 1 n — 5OT Rea. Lot S,F, Rec. Plat File No. FOUNCARON AS -BUILT �• •••••• •••• •••.^••• — U Ree«. E .I•mm s.. away twBry um I -,aa. _pwMMBm BBt., bunE°Um m Me bt en0 NM W bx i / •• ..� ...I •••OBE Date Surve d: �` 8/23/12 Drawn b Y REJ ec Checked b . FMK mNm. wN mwwaum m ew.n Iw•m = •" / t www mu amt '~ ••� Date Drawn 8/24/12 °rd 2439 W ° 12-3522 FINAL STRUCTURE AS -BUILT I", R^°BL u.n., wZ a ad 4 9m -'•• . �. �a '•.'•.. Legal Description: .N°� pp(mntl m AseuTt M M Uw 6 ..........• ...•' 5oA�1 Lot 3A en�+enma �a mw°mm.°in maK wi. �° ° .w ♦�iPCa/eosionalV��.� �,,,,.•.• MARYLAND MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES a Division of Environmental Services i On -Site Services Section P.O. Box 196650 Anchorage, Alaska 9951M650 (907)343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING Parcel I.D. # 015-082-32 HAA # O I GU 1 O 1. GENERAL INFORMATION Complete legal description MARYLAND SUBDIVISION- LOT 3A Location (site address or directions) 6641 JOI I IPAN COURT ANCHORAGE. AK 99516 • .. D.(907) 346-2225 Mallingaddress 6641 JOLLIPAN COURT ANCHORAGFAK 99516 Lending agency Mailing address Day phone Agent ream AND Ri AKF RI rrI FR w/ RE/MAX Day phone (907) 975-0160 Address 2600 CORDOVA ANCHORAGE AK 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 5 XXX NOTE: ff community well system, provide written confirmation from State ADEC attest - Ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding Tank Community on-site Public sewer NOTE: ff community wastewater system, provide written confirmation from State ADEC Ing to the legality and status of system. 72-025 (Rev. 1/91) Front F10A #21 Computer Version Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1,110.00 at, or prior to, closing for the engineering services provided. 5.' STATEMENT OF INSPECTION BY ENGINEER: As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and Inspection e on-site water supply and/or wastewater. " disposal system is in compliance with all Municipal add State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ALASKAWATER& T CONSUL ANTS INC. Phone '(9071337-6179 Address 6901 DEB AD B GE.ALASKA 99504 Engineer's Signature Date In conducting this evaluation, AWWC, inc. of d to provide a thorough, conscleiltious engineering analysis of the system in accordance with AD EC and M A H Guidelines & Regulations. The reported results described the performance of the.system under the conditions a countered at the time of the test, and separation distances measured to readily identifiable features. The operational rife of all wells and septic systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the water . ooaoop�0 usage of the family being served by the system. These conditions are outside the control of -- - oo OF q the evaluator of the system. Satisfactory test results do not guarantee future performance v .. Q� of the system, nor do theyguarantee that there are no hidden defects or encroachments.�: AWWC, inc. cin therefore not provide any warranty for future estimate of how long the . C/) 4 bdQ, system will continue to meet the operational requirements or theADEC or MOADIIHS. 0.,,,;, The content of this report is for the sole benefit of the owner listed above. Any 0 reliance upon or use of this report by any other person or party Is not authorized, .. nor will it confer any legal right whatsoever. Op e y A. ess; . CE -7953 6. DHHS SIGNATURE Approved for bedrooms ' p�dp� Disapproved Conditional approval for Additional bedrooms, with the following stipulations: - Q�� / Gil. �—'�7`' Date /_ `%— p Z The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending Institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct Inspections or analyze data before a certificate is Issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1191) Back MOA #21 Computer Version Municipality of Anchorage .. DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 8Y5 OV Street, Rm 502 Anchorage. Alaska 89501 (907) 3434744 Health Authority Approval Checklist Legal Description: MARYLAND SUBDIVISION; LOT 3A Parcel 1.0.: 015-082-32 A. WELL DATA Well Type PRIVATE if A. B, or C, attach ADEC letter. ADEC water system number N/A Log present (Y/N) YES Date completed 1/9/95 Total depth 98.5' Cased to 96' Casing height (above ground) 25" Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES FROM WELL LOG Date of test 1/9/95 Static water level 70' Well production 4.5 9.p -m. WATER SAMPLE RESUL Date of sample: B. SEPTICfHOLDING TANK DATA .S AT INSPECTION 11/28/2000 42' 3.1 g.p.m. Collected by: A.W.W.C.. INC. Data khstelled 9/17/95 Tank stee 1500 Number of Compartments 2 Cleanouts (Y/N) YES Foundation deanout (Y/N) YES Depression (Y/N) NO High water alarm (Y/N) N/A Date of Pumping 11/27/2000 Pumper NORTHLAND C. ABSORPTION FIELD DATA Date installed 9/17/95 Soll rating (g.p.dJft2 or fl2lbdnn) 0.8 System type TRENCH Length 52' Wkfth 2' Gravel thickness below pipe 7.4' Total depth 11.5 Effective absorption area 770 SO FT Monitoring Tube present (Y/N) YES Depression over field (YM) NO Date of adequacy test 11/28/2000 Results (Pess/Fam PASS For 5 Bedrooms Fluid depth in absorption field before test (In.r 33.5 Immediately after9_ 4 gal. water added (in.r32.5_ Fluid depth 32.5" (ins) Minutes later. 0 Absorption rate = 750+ Pero)dde treatment (pest 12 months) (Y/N) NONE KNOWN if yes, ghre date ----- r"2e twv. =Isar Cemp4.v dW D. LIFT STATION Date Installed Size Manhole/Access High water alarm *Datum ar "Pump oft level ar E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main - NSA Public sewer menhole/deanout N/A Sewer/septic service One 25'+ Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property One 5'+ Absorption field 5'+ Water malydservice One 10'+ Surface water/drainage 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property One 10'+ Building foundation 100+ Water malNservice One 10'+ Surface water 100'+ Day, perkingfveNcle storage area 10'+ Curtain drain NONE KNOWN Wells on F F. ENGINEER'S I certify that it with Engineer's HAA Fee S 30UyU Date of Payment 1-5-01 Receipt Number �V y cZ 72-M (Rev• Mr oonoarw VerWm Id lnspectIms and review stems are In combimance this date. Waiver Fee Date of Payment Receipt Number 12-01-00 16:54 FR011-CTE ENVIRON►ENTAL AdLe CUE Environmental Services Inc. CUE Rer.0 1007385001 Client Name AK Water & Wastewater Consultants Inc. Project Namelp Maryland S/D UA Client Sample ID Maryland S/D L3A Matrix Drinking Water Ordered By PWSID 0 Sample Remarks: 5615301 T-070 P.02/03 F-641 Client PON Printed Date/time Collected DateMme Received Date/time Technical Director Released BVVP, 12/012000 14:19 11282000 12:45 11282000 13:10 Stephen C. Ede .V/ i Allowable Prep Analysis Parameter Results PQL Units Method Limits Date Date Init Waters Department Nitruc-N 0.500 U Microbiology Total Coliform 0.500 m8/L EPA 300.0 col/1 OOml. SM I8 92228 lomax 11/28/00 SCL 1128/00 KAP 12-01-00 16:54 FROM -CTE ENVIRONIENTAL 5615301 T-070 P.03/03 F-641 L'I6 ME Environmental Services Inc. Laboratory Division ►.IIaI/ Drinking Water Analysis Report for Total Coliform Bacteria READ INSTAUCn0NSONItI'VEWSWEJISFORECOLUCM SAM�!T t7 PUBLIC WATER SYSTEMLD.A al PRIVATE WATERSYSTEM LM t3 Seel Reeab O SeOdinvelm err " _ 200 W. Potter Drive A -Af lysis shows this Weer SAMPLE to be. Satisfactory Unsatisfactory D Sample ova 30 hours old. results may be unreliable • Sample too len` in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send now sample via special delivery mail. Data Rocsiwd Tim Rood"d I3'• b Aadysis Bel" 1 X03 t) Analytical Metbed:Membrane Pater V7 MMO•MUG • Numbs of colones/ 00 mL pads• Analyst SAMPLE DATE: M� ® ® 1007385.E SAMPLE TYPE: 0 �t' 0 Routine o Traatad Water I Fttb !w Fazed 17 Repeat Sample (Fur roedee sample Unmated Wear wltbAab ref. uo. ,) Mts: Timr. O Special Pnrpoan Iii Calletted Client notified of unsatisfactory results: El SAMPLE LOCATION Collected By Pll� s eP•b• edu Fated mar►, Int��► Lef 3 A �2� G EePia Daw Timr. BACTERIOLOGICAL WATER ANALYSIS RECO MMO-MUG Sasebo TOW CA&M ,A�r�L R: COR Membrane Infect Direct Cent 547— I i J a 1 Ce IN d Veritloa: LTB OGS COLIFIRM nvrre n. n.... +r. c... fles of -a+.a..e.. Foal Coliform CeaRrmattw Find Membrane Filter RUSIN ' c , ' L Courorm/IN of Repww By A ;te ��� TIM 2S� len -i' Comments: 081=1 MemwOrOftneuaaeirOuvrooei &n M&&LaewvOln.na► ...........e..... e.we .wee u....ew& Pa.. 0r1& " ,w rIWR1a WnVILMn. tMCWa&X WtSOWM• NEW J"Sti`r• OIsO. WEST VIRGINIA ME Environmental Services Inc. Laboratory Division►iiiiiiiiisz�iiiiiii����iiiiiiiiiiiiiiiiiiiiiiii 200 W. Potter Drive Drinking y r Water Analysis Report for Total Coliform Bacteria Anehorp•• AK 99818-1805 Tel: (907) 562-2343 READ hVSTRvc.TION.SONREVERSESIDEBEFORE COLLECTINGSAMPLE • Fax: (9071561-5301 _._ _ __ __ ......................ren M mot tvr— I Tr) RF rnMPI.FTFn RV 1 ARnRATORY a PUBLIC WATER SYSTEM I.D, Y PRIVATE WATER SYSTEM ' Sent Reaa4t Seat /aretre jt VL AJI C.� '�inr e 6Sv 0CE"rr Road c,�. fq ��.._ .. "C oaRr•4 W, r� a SeatRssa4a fAl""9UaQ/A.ik-"': `� - rn-n C.6� SAMPLE DATE: FIM = M Month" Day Year SAMPLE TYPE: a Routine a Treated Water Re at Sam le (for routine sample )/ Untreated Water / with lab ref. no. ) a Special Purpose 41 fwlt% Time Collected SAMPLE LOCATION Collected BY VSA i',; Ctllls )ilr•tJ�,,,r nw. PrW Comments: Analysis shows this Water SAMPLE to be: a Satisfactory a Unsatisfactory a Sample over 30 hours old, results may be unreliable 13 Sample too long in transit: sample should not be over,3Chours old at examination - to indicate reliable results. Please send new sample via special delivery mail. Date Received Tome Received 13; ;k6- Analysis rsAnalysis Began \%, 3 - Analytical Method: V -11. -Membrane Filter a MMO-MUG I• Numberef 'mi. 6 result• Analyst Aneh Fbhs Jun ❑ Faxed Date: Time: Client nodfled of unsatisfactory results: Foamd Spoke with Fat t Date: Time: BACTERIOLOGICAL WATER ANALYSIS RECORD MMO`MUG Rault Total Coliform F- CeU Membrane Filter: Direct Count Coloales1100 ml Verification: LTB BGg COLIFIRM Fecal Coliform Confirmation /] Final Membrane Filter Resultts, - t" Collform/100 ml Reported By ��—Date-J Time lin rvrc-Tma.......r.C- os-01Ars«+.-. ti f*EO5MemWr of the 808 Group (Sociha GMMeN de Surveillance) ENVIRONMENTAL FACILITIES IN ALASKA. CAUFORNU. FLORIDA. ILLINOIS. MARYLAND. MICHIGAN, MISSOURI, NEW JERSEY. ONIo. WEST VIRGINIA J111FM ME Environmental Services Inc. Laboratory Division riiiiiiiiitriiiiiiiiiiiiiiiiiiiii��������������� 200 W. Potter Drive Drinking Water Analysis Report for Total Coliform Bacteria Aneh~. AK 99618.1606 Y P Tel: 1907) 562-2343 READ INSTRVC71ONS ON REVERSE SIDE BEFORE -:OLLECTING SAMPLE MUST BE COMPLETED BY WATER SUPPLIER TO BE 1 Analysis shows this Water SAMPLE to be: O PUBLIC WATER SYSTEM I.D. S PRIVATE WATER SYSTEM — i Send Rtsu@r ' A.. I. ',Q ` Send lmeoke - - e fSD�iBff(� •• •� �j6}.gtkon�rStlb6a ?4 p r An hnr. AK 99504 O send Resub Rd7KV yv (to or7ar N. til{.. i ryMIS 4,1 t- t SAMPLE DATE: ® rT Mouth- Day SAMPLE TYPE: O Routine 01 Repeat Sample (for routine sample with lab ref. no. ) O Specie! Purposf SAMPLELOCATION.C O Satisfactory O Unsatisfactory O' Sample over 30 hours old, results may be unreliable O Sample too lona in transit: sample should not be over3lOhours old at examination to indicate reliable results. Please send new sample via spi'R,I/pelivery mail. Date Received lr I Z Tune Received 1 --- Z 5 Analysis Began �1 0'9 Analytical Method: �"�e Filter 13 MM a Number of err-- ' -dlo0 ml. X00?,65,? O Treated Rater Untreated Water Time Collected Collected By 111rtr� It1r1<71 Z M I vl [� X11 is —� MUM Print Date: Rank* Analyst Time: Client notified of unsatisfactory results. Phoned Spot with Fat Date: Time: BACTERIOLOGICAL WATEIt ANALYSIS RECORD MMO•MUG Rm t Total Coliform E Ca11 Membrane Filter. Direct Count Colooks/100 ml Verification, LTB BGS COLIFIRM TNTC-Tw N..rmu T�Ce.r os-Ow.se.rr.i- Feel Coliform Confirmation Final Membrane Filter Results -�2 Coliform/100 ml Reported By /M\L-__ Date 2 Time 15�3 U bra 4 Comments: VPl EKM Member of the S,13 Grow (S*664 GMhale de surveillance) ruu,enuueu*e, ee�,, re I., e. eeV• tie nenouv n. nema nnurm ua a.n ANN 1eV'NVtAN N,,renrmM New ieoCFv rlNln WEST WAMN1A Aneh Fhb Jun ❑ Faxed Time: Client notified of unsatisfactory results. Phoned Spot with Fat Date: Time: BACTERIOLOGICAL WATEIt ANALYSIS RECORD MMO•MUG Rm t Total Coliform E Ca11 Membrane Filter. Direct Count Colooks/100 ml Verification, LTB BGS COLIFIRM TNTC-Tw N..rmu T�Ce.r os-Ow.se.rr.i- Feel Coliform Confirmation Final Membrane Filter Results -�2 Coliform/100 ml Reported By /M\L-__ Date 2 Time 15�3 U bra 4 Comments: VPl EKM Member of the S,13 Grow (S*664 GMhale de surveillance) ruu,enuueu*e, ee�,, re I., e. eeV• tie nenouv n. nema nnurm ua a.n ANN 1eV'NVtAN N,,renrmM New ieoCFv rlNln WEST WAMN1A MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650. 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 01 C � I- - 3 HAA #\�SAS,r`, 2 A 1. GENERAL INFORMATION Complete Legal description Lo 4 Location (site address or directions) /,l �/��o lL-4 rQ V1 Property owner I s_' 1 ::c• -i_`=: Day phone v-'>>> Mailing address C L& 12� % 6 ;-10 !�� 1i✓ � c 1 %� Lending agency Day phone Mailing address Agent _ Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site 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) Front MOA N21 5. 0 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ! < < ; .,c c;, I,:I .r c, I �_ Phone 2 / (-,1ill- Address - 20 u i i) JA c / Engineer's signature - (JQrDate DHHS SIGNATURE V Approved for F I V 15 bedrooms. Disapproved. Conditional approval for Additional Comments 4(-1, 0 bedrooms, with the following stipulations: Date S-12-- q? The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(Rev.1/91) Back MOAo21 N LIKEWED Municipality of Anchorage AUG 1 1 199 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division MUNICIPALITY OF ANC rj 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907)��gN�1 L ERVICE Health Authority Approval Checklist Legal Description: 'H-Al2`/kAND L -6i �5A Parcel I.D.: D15 -QCR,�-' A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number NIA Log present(Y/N) Date completed 01-1-95 Total depth q to G Cased to OIL Casing height (above ground) Sanitary seal (Y/N) FROM WELL LOG Date of test I_9, Static water level 70 Wbll production g.p.m. WATER SAMPLE RESULTS: Wires properly protected (Y/N) AT INSPECTION 17 Coliform ND Nitrate N D Other bacteria N.0 Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA S g.p.m. Date installed 17.9 5 Tank size / 5 C, Number of Compartments Cleanouts (Y/N)T Foundation cleanout (Y/N) Depression (Y/N) t�Q High water alarm (Y/N) N Date of Pumping N6 Pumper SIA C. ABSORPTION FIELD DATA Date installed i Soil rating (g.p.d./ft2 or-W/bdrm) O, System type 7�r Length 5 Width _2 Gravel thickness below pipe % y Total depth / /o L) Effective absorption area 7 73 Monitoring Tube present (Y/N)__�/_ Depression over field (Y/N) Date of adequacy test tVo i/ U s eci( Results (Pass/Fail) `� For 5 bedrooms Fluid depth in absorption field before test (in.); Immediately after gal. water added (in.): Fluid depth (ins) Minutes later: Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) �(O If yes, give date 72-026 (Rev. 3/96)`' D. LIFT STATION >A Date installed Manhole/Access (Y/N) High water alarm level ate Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at' 'Datum SEPARATION DISTANCES FROM WELL ON LOT TO: "Pump off" level at' Septic/holding tank on lot /1I)- On adjacent lots 'a lo -o Absorption field on lot I On adjacent lots 7 10-0 Public sewer main �✓� Public sewer manhole/cleanout 1 Z Sewer /septic service line / Lift station Irl/a SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation /tai Property line `7 �5 Absorption field �5 Water main/service line > 1 ou Surface water/drainage f\�//O Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 3 T-) Building foundation 24 Water main/service line > / ot- Surface water i/C Driveway, parking/vehicle storage area >-y Curtain drain �!(� Wells on adjacent lots I&C% f �v� F. ENGINEER'S CERTIFICATION e IN L n �.• 4 � p 1 I certify that l have determined thru field inspections and review of Municipal rQcords that,(fie at�ove sys .§ are in conformance with MOA HAA guidelines in/ effect on this date. Signature Engineer's Name I -)Ube V]�� u r Ix'J' �� L.( Date 0 HAA Fee $ 3 tom/ Date of Payment Receipt Number 4/U 72-026 (Rev. 3/96)' Waiver Fee $ Date of Payment Receipt Number AL, CT&E Environmental Services Inc. wm®®cam®®®®®®®m®®�®m®w®va®® CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID Parameter Total Coliform Nitrate -N 983963001 Tobben Spurkland P.E. Maryland S.D Lt 3A Maryland S.D Lt 3A Drinking Water Client PO# Printed Date/Time 08/04/98 16:38 Collected Date/Time 07/28/98 15:45 Received Date/Time 07/28/98 16:50 Technical Director: Stephen C. Ede 0 Released By Results POL Units 0 co1/100mL 0.100 U 0.100 mg/L Allowable Prep Analysis Method Limits Date Date Init SM18 92228 07/28/98 TMW EPA 300.0 10 max 07/28/98 07/28/98 RMV