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HomeMy WebLinkAboutLAMPERT ESTATES BLK 1 LT 6Lampert Estates Block 1 Lot 6 #051-102-60 Municipality of Anchorage On -Site Water and Wastewater Section . (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211251 PID Number: 051-102-60 Dwelling: IN Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name VANDENBERG MAMIE & LAURIE A6%SORPTION FIELD ❑ Delp Trench E] Wide Trench ❑Bed- ❑Mound Site Address 20880 Oberg Rd Chugiak �❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 D/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original r de Gravel depth beneath pipe Ft. Subdivision Block Lot LAMPERT ESTATES 1 6 Fill added above original grade Ft. G el length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dis ce between lines Ft. SEPARATION DISTANCES ToI Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between nches From Tank Field Tank Line Ft2 Well >100' NA ^ 1t. 1 VA I NA >101 TANK ❑® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1000 Gal. Surface Water >100' NA NA NA Material Number of compartments Lot Line >10' NA NA NA NA plastic 2 Foundation> 1 0' NA NA i NA OF STATION Manufacturer Capacity Gal. Remarks 4" insulation placed over tank Alarm location Electr i ' stalled by PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Installer JRs Septic Drainfield CO/MT3034 Inspector Curtis Townsend BENCH MARK (Assumed elevation) 100 ft Inspe ` 7/13/2021 Location and description tion dnd 2 bottom siding point B 3`" 4m ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Dateco .•'' S OV0..ss.....s. e �"°.� • • .. « . !ewe � • LAW 'yf 'Z-/ ?aL(."� A.u"/ �l°.No CEtt ".4� , ' � Septic System C1zn1G Approved Date ,20.2 k�°PROFFSS .a Note: this approval does not include well permit requirements. (Kev Ub/UZ/1 b) I0 ERG ROAD FRIENDSHIP LANE SEPTIC E� O a Septic Record Drawing Prepared for MAMIE VANDENBERG AND LAURIE VANDENBERG OL q4 20880 Oberg Rd Chugiak Alaska 99567 ?CAF ''.° •'•��� AW 49TH LAMPERT ESTATES BLOCK 1 LOT 6 OSP211251 %.....:........................... ...% %.......... i 4 .............................. • EKLUTNA ENGINEERING LLC DATE: 7/21/2021 ,CURTIS TOWNSENDi 19162 MOUNTAIN ROAD �j�; ' •N� �(11904 . 'AW DRAWN: CLT � ''•. /C / ` >�� CHUGIAK, ALASKA 99567 SCALE: 1" - 30' ���• •...... /•1' ��� (907) 406-1058 1�1; ��� PID: 051-102-60 SHEET 2 OF 3 E- 0 a 3 BEDROOM HOUSE \ 100' B A \ 0 \ / DC S NEIGHBORING SEPTIC IS / 1 y SLOPE 1 / >10' FROM PROPERTY L SCOPE OF WORK 1. NEW 1,000 GALLON PLASTIC SEPTIC /FFECTIVE TANK INSTALLED AND CONNECTED 45' x 35' x 6" TO EXISTING ABSORPTION SYSTEM. DEPTH BED THE TANK WAS PROVIDED WITH MINIMUM 20" 0 MANWAY RISER SERVING THE FIRST COMPARTMENT. TANK WAS INSTALLED OUTSIDE OF WELL RADII. MTS c 2. ALL CONSTRUCTION WAS IN ACCORDANCE WITH ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE — — — — — — — — — — — CHAPTERS 15.55 AND 15.65. 10' Utility Easement FRIENDSHIP LANE SEPTIC E� O a Septic Record Drawing Prepared for MAMIE VANDENBERG AND LAURIE VANDENBERG OL q4 20880 Oberg Rd Chugiak Alaska 99567 ?CAF ''.° •'•��� AW 49TH LAMPERT ESTATES BLOCK 1 LOT 6 OSP211251 %.....:........................... ...% %.......... i 4 .............................. • EKLUTNA ENGINEERING LLC DATE: 7/21/2021 ,CURTIS TOWNSENDi 19162 MOUNTAIN ROAD �j�; ' •N� �(11904 . 'AW DRAWN: CLT � ''•. /C / ` >�� CHUGIAK, ALASKA 99567 SCALE: 1" - 30' ���• •...... /•1' ��� (907) 406-1058 1�1; ��� PID: 051-102-60 SHEET 2 OF 3 4" IN MARK A B SO 41'-0" 22'-8" SV2 40'-6" 27'-2" DCO 41'-6" 30'-8" Septic Record Drawing Prepared for •.���\\\\�11 MAMIE VANDENBERG AND LAURIE VANDENBERG �.�p��•0F 14qS1�� 20880 Oberg Rd Chugiak Alaska 99567�,.�' LAMPERT ESTATES BLOCK 1 LOT 6 49TH .......... ...... ... .: ... OSP211251 � � ' ............................. ' "' ' """' ."' 0 ............................................. � EKLUTNA ENGINEERING, LLC DATE: 7/21/2021 ,� ;cuRTis TOWNSENDc 1'. 19162 MOUNTAIN ROADDRAWN: CLT �1��'' No. E 1.1904 s�,�•., .��� CHUGIAK, ALASKA 99567 .'��• (907) 406-1058 SCALE: 1" = 5' 11 ' 1��-mss � •• 1 1� • PID: 051-102-60 SHEET 3 OF 3 ��\\\���� OBERG ROAD C:) 6 co N89059'20"W 90.00 CU Well Z —7.9 deck 1 69.0 3.1 0 2 Story Frame House I- CD c6 Nt 44.5 C 0 114t deck co N 2 Co 4 5. .0 ®24.0 co Lot 7 SCALE: 1 If= 40' LLJ 1 ON 4a _11_� 0 Manhole 0 a Septic vent (typ) I Chain link fence (typ) Eil 10' Utility Easement N89057'20"W 90.00 b U') FRIENDSHIP LANE OW lv"Nxx Vt 4%, 1� ,ftw X OF *A4 Lot 5 �i® AM 49 th ® ". * C:) 00 Z toh Elizabeth L. Walatk 00 sx, 8036 - LS < AW 0 A W O'C'Esslow��- 7 - Z -C - 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 6, BLOCK 1, LAMPERT ESTATES SUBDIVISION Anchorage Recording Precinct, Alaska, and that the o improvements situated thereon are within the property lines LO and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying 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 — 14th —day of JULY 2021. EASEMENTS OF RECORD, OTHER THAN FRED WALATKA & ASSOCIATES, L.L.C. THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON Engineers and Surveyors FB 21-4, pg 38-39 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. MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 htlp:/1www.muni.orglonsite On -Site Wastewater Disposal System Permit Permit Number: OSP211251 Work Type: SepticTank Upgrade Tax Code Number: 05110260000 Site Legal Address: LAMPERT ESTATES BLK 1 LT 6 G:1359 Site Mailing Address: 20880 OBERG RD, Chugiek Owner: VANDENBERG MAMIE KATE 50% & Design Engineer: EKLUTNA ENGINEERING, LLC* This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms Ment ,,may N llel)artment 7/1/2021 7/1/2022 19841 ❑ 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 (2417). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received B Issued By: i r y: Date:711/ Date: 7 It b d 2 1 !33 MUNICIPALITY ANCHORAGE�4 Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-102-60 Property owner(s) VANDENBERG MAMIE & VANDENBERG LAURIE Day phone Mailing address PO Box 670222 Chugiak AK 99567 Site address 20880 Oberg Rd Chugiak Legal description (Sub'd., Block & Lot) LAMPERT ESTATES BILK 1 LT 6 Legal description (Township, Range & Section) Lot Size 19,841 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank El ❑ Upgrade x ❑ Duplex (D) ElHolding Tank 1-1Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes./j, (Signature of property or authorized agent) Permit/Rush Fees: -225 Waiver Fees: Date of Payment: 7Z11 17-1 Date of Payment: Receipt Number: 08q_�/ D Receipt Number: Permit No. 05192-1 12.5 I Waiver No. G:1Development Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211251, Rebecca Carroll, 07/01/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211251, Rebecca Carroll, 07/01/21 Municipality of Anchorage January 8, 1988 f�s. P.O. BOX 196650 ANCHORAGE, ALASKA 99519-6650 (907) 343-4200 bWXX6NC9R Tom Fink, MAYOR DEPARTMENT OF HEALTH d HUMAN SERVICES Dave Cushman SR Box 5179C Chugiak, Alaska 99567 W�p N Subject: Lot 6 Block 1 LampertxSubdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1987. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as -built inspection report (three-part form) must be sent to this office for review and approval, and for documentation. Effective January 1, 1988, a new fee schedule is in effect. when re -applying for a new permit, the new fees are; $90.00 for an on-site sewer permit; $50.00 for a well permit; $140.00 for a combined sewer and well permit. If there are any further questions, please call this office at 343-4744. Sin erely, Robert W. Robinson Program Manager On-site Services RWR/ljw enc: Copy of Permit MUVJ I C IJCAL I I-V C3 F= AIVCt�JF:AGI_ DEPARTMENTHEALTH AND ENVIRONMENTAL NOTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 OPV—SITE SEWCFi F='El�t"1 T -i" PERMIT N0: 870028 UPGRADE DATE ISSUED: 03/03/87 APPLICANT: DAVE CUSHMAN / S&S ENG. ADDRESS: SR BOX 5179C CHUGIAK, AK 99567 CONTACT PHONE: 688-9845 ��.a' LEGAL DESCRIF': SUBDIVISION: LAMPERT �pLOT: b BLOCK: 1 SECTION: 9 TOWNSHIP: 15N RANGE: 1W LOT SIZE: 19800 (SQ.FT OR ACRES) 1 certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-DUILTS WILL NOT BE APPROVED WITHOUT AN ELEOTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORT: VIST BE PON&DYA LIC,I=NSED ELECTRICIAN. ;;IGNED ✓ DATE: �� . AF'('LICANT: - DAVE CL" IMA' / SSS E .�. ISSUED BY / DATE: -------------�.rl f��fl7 7-0 70 Cl19i%+CsrS Pyo�dnsu� � SZS'�.' S & S ENGINEERING 17034 E. R. LOOP #204 EAGLE RIVER, AK 99577 PHONE #694-2979 ******************ON—SITE SEWER PERMIT APPLICATION***************** APPI.1CANI: DAVE CUSHMAN ADDRESS: S.R. BOX 5179C CHUGAIK AK 99567 CUNT AL: I PHONE: 688-9845 LEUA1_ DESCRIPTION: LOT 6 BLK 1 LAMPERT EST. SEC: 9 TU,4 R:IW 1_O1 SIZE: 19000 (SO FT OR ACRES) MAX. NUML+ER OF BEDROOMS: 2 SOIL RATING: 280 60 FT/BR -cZcz— 014 So/4. TES% SOLI_ TEST DEPTH: 11.5 FT NO WATER PRESENT IN TEST HOLE. Taz•vc r'E4 . r-v+e .reovj = Z8o xs X i.S = 2/00 Ei(t7/NG SfJTE^4 = �S-jS d � /A 4SLF pi=2H%C CC) 01�J VP9-7C Fon Nva/ Sale -TC -J -r No T C.e JED,• (,lam 6::2,09e,46 0 o ^j'pEfPLoW_, -7_4a(./ 0-4 OL -0 S'0 e y '_� 30 po-,ERDc SCALE ELs/E Ae. 0 y Y 71 Z o AL T �7/- 51 2/7o# N h rtl AI 6o ' p o �- lo � ` ,�. I -\ GL� I '� ry �•o � yi C tiry Ir.J �utioEvJ � Li I lh 6 JI M e rn •' x ;.r ��1rU ' /:•r'v 1 0 y Y 71 Z o AL T �7/- 51 2/7o# N h rtl AI 6o ' p o �- lo � ` ,�. I -\ GL� I '� ry �•o � yi C tiry Ir.J �utioEvJ � Li I lh 6 JI Poo NEbfSS L) • ..a •• e v Municipality of Anchorage 6 DEPARTMENT OF HEALTH & HUMAN SERVICES • " 1,er x� A g!r = i'i 825 "L" Street, Anchorage, Alaska 99502-0650 t+^• 1T_i �•. �s SOILS LOG — PERCOLATION TEST l4 F9cp`" •• ;��`F-'" PERFORMED FOR: ✓ AVI:. �IJjy-/M/1/J DATE PERFORMED: Z LEGAL DESCRIPTION: Lor Kik i LAMh27 Township, Range, Section: /15,N ��/ vv • .ScC 9 DEPTH SLOPE SITE PLAN O LbAti 1C 2 3 4 0 .a 5 , 6 7 D 12 13 14 15 16 17 18 19 ■■■.■■■Arr■■ Gross Time Net Time Depth to Water Net Drop i P- "— ■■■■■■■W■■ 4 _ Z '05 3b mi" R4v 11" ■■■■■■■■■■ /o ONMENNOMON ' .3 T " ■■■■..■■.■ 4: 2 S to e..t,A+ '/6 t /d Sb / ■■■■■■.■■■ ENEWEENNEE L VS I VA to V., 5!7 / NNOMMEMONN NNNNE MME ■■.MMOM■■■ ■■■EZZO■■■ ■■■.■■■■■. • .■■■..■■■■ ■■ENR■■■■■ ■■.■..■.■.NEENEEMENE IF YES, A DEPTH? Ikoh to Wale Monitoring? Reading Data Gross Time Net Time Depth to Water Net Drop i P- "— 4 _ Z '05 3b mi" R4v 11" /o A4 ttiJ ' .3 T " G 4: 2 S to e..t,A+ '/6 t /d Sb / L VS I VA to V., 5!7 / A 20 UPERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER 40 TEST RUN BETWEEN c- FT AND ('a FT COMMENTS 5 & S ENGINEERING PERFORMED BY: ,oivoop^gadCERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH AFf*aL'1livkVA79UIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Ree. 4/65) r s of r !r7 4-6 MUNICIPALITY OF ANCHORAGE DEPT. OF H_°ALTII & I� DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOVIRONMENTAL PaOT`_CION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 JAN 8 1982 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PI Q `-' o EW — JS ❑UPGRADE MAILING A DRESS S2/0 -Zo G kt �q� 6 LEGAL DESCRIPTION 1-6 LOCATION // NO. OF BEDROOMS s) Y Well ^D ✓ Absor twn ar _ DISTANCE TO: L' 'f' O 9't� 0`vell'^gam (, f V PEHMI N k i Z in ~ Manufacturer /� / CT 7 M a�n P ! / No. Of compartments 2 Liq.f,ty�n in}tallons IF HOMEMADE: Insida length Width Liquid depth G YDISTAN —ioz CE TO: Wetl Dwelling PERMIT NO. _ �� ManulacturerI Material Liquid capacity in gallons W= DISTANCE TO: Well Foundation Nearest lot line PERMIT NO. � W ZNo. ~Z W of lines Leng e c e Total length of lines Trench width Distance between lines Ir f- inches Top of we to finish grade Material beneath tde Total effective absorption area O inches W Length Width 3,5- / Depth 7/ G PE ITN wType of crib Cribdiameter Crib depth Total effectiw a 3prpSlon are a DISTANCE TO: Well 3� ( Buildindatlpit % Nearest lot "� J J W Class ! VV Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS C )L SOIL TEST RAT G 2 80 " f�i2 INSTALLE � REMARKS //y / i%% /e=,7'i/. I � //-J�^ s Lr 40 1N N •1 • Na/, /1•N I rue - 01 N ... • •r• •qN/j RobertA.•Sho, : -4 ,Ir 5 r 9! 0.1. 1••�O � e.a!• t i APYHOVEO DATE LEGAL � nwu.,, unci E LsiE Ae. n o P y m x e � go o — 1 A •„ R C - o n Gt7y[. Bs.,r/.- Jo '/Coco asur-77 CC,No�v) Li ti I, M e e M �rn . n o P y m x e � go o — 1 A •„ R C - o n Gt7y[. Bs.,r/.- Jo '/Coco asur-77 CC,No�v) Li ti I, M e e MUM I (-- I F-nL- I TY OO F= F-iFaCHUF:;_Fi0E DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE, AI'.. 99501 264-4720 WELL FirjcI OI a-- ITE SEL,FEF< P EFZM I T PERMIT NO. C 810935 ) APPLICANT NED SEVERSON ST RT 1 BX 1020 68883559 LOCATION ELSIE DR LEGAL L6 B1 LAMPERT EST. LOT SIZE 19800 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING CSO FT/BR)= 280 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: LtiEF}TH= 15 LEtJGTH= 1.-42 13FRfif%e EL C•EF}TH= 2 THE LENGTH DIMENSION IS THE LENGTH (IFJ FEET) OF THE TRENCH OR DP.AINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IFJ FEET). THE TFZEtJCH L4 I GTH I �3 Z5. 1000 FEET. THE GRAVEL DEPTH IS THE MIFJIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IFJ FEET). FZE:KnU I FZEF7 SEF='T I C -r n" K E; I ME= �LelE-1C7 13nL-tLOtJS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DUPING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- TWCD C 2 ] I t45~P•ECT I KD"J RFZE FR. EID-lJ I FZE© --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MIFJIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING !UPON THE TYPE OF PUBLIC WELL. MIFJIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER, LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. I -JELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER, REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER. INSTALLATION. F}EFRM I T E:XF„ I FRES} LtiECEME:EFZ ? 1r 15:�l-1 I CERTIFY THAT 1: I AM FAMILIAR. WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I l•JILL IFJSTFILL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER. SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED ISSUED E APPLICANT FJED SEVERSON V4. 0 •. _ O & E ENG JEERING & DEVELOF HENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 666-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG 668-2280 Performedfor. Name: �TF!/EN L . SKi9G45 4oNS7;4. Tel. No.45`1r-2g3y Mailing Address: 145� 0 • .Bax 2 1 CNyF /AK. 41<'• .7 Legal Description: LoT rao . BLOCK / 1-4,47,V1=47- )�57197fS Depth (feet) 0 1 MG Si47- T.c- :5--o/e- 2 o.L Soil Charactertetics 2 3 4�j 5 I11 Ae4c. %P3T 6— 5 M C096e . Y, 6a4 i',C c c,Y, 51c7 -Y 7 :5411 G' /1%E'e>' .TDEr'vs. T -y 6 r, S BoTrD.�f OFT 10 11_ 12- 13- 14 3-14 _ 15 _ 16 PZZP OTp LAN .5G4LE PERC.TEST X/Y "r 44f -T- 30 WI -Al S/o XL/N/iv = 2 80 dle, e. i Ground Water Encountered: Y@S_l,"fNO If yes, what depth Proposed Installation: Seepage Pit— Drain Field X�� OF.AC"111+ '• 9 1 4J'9TH .... .... Earl P. Ellis W. Performed by: ✓ ��� �' r!/�CC!/J Date: - 1z-(,&/ 0 ❑ , 20 PZZP OTp LAN .5G4LE PERC.TEST X/Y "r 44f -T- 30 WI -Al S/o XL/N/iv = 2 80 dle, e. i Ground Water Encountered: Y@S_l,"fNO If yes, what depth Proposed Installation: Seepage Pit— Drain Field X�� OF.AC"111+ '• 9 1 4J'9TH .... .... Earl P. Ellis W. Performed by: ✓ ��� �' r!/�CC!/J Date: - 1z-(,&/ C�rxi cft�e� �dtfi t by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759 OWNER OF LAND 1Vf17 SrUEf_rc-� ADDRESS ..5 ,0 A -7X /OHO CN✓e�.rC .w LEGAL DESCRIPTION L liCnn A .f i A: DATE -Started ��'����� Ended PERMIT NUMBER KIND OF FORMATION: DEPTH OF WELL I �� ' /0 STATIC LEVEL OF WATER FT. i512 DRAW DOWN FT GALS. PER HR `ro U KIND OF CASING 6 -F 00 From Ft. to a Ft. tJC t'G'flc'O F� ✓ From Ft. to Ft. From a Ft. to l 0 Ft. From Ft. to Ft. From/ 2'7 Ft. to L s✓ Ft. eZ 109 le From Ft. to Ft. From/5-`„Ft. to -1 -6 -1 -Ft. From Ft. to Ft From Ft. to Ft. From Ft. to Ft From 0. z Ft. to / 7<_FL l4r' ✓cG From Ft. to Ft. From Ft. to Ft. w A- T From Ft. to Ft. From �—% .--� f !L- 2 Ft. to Ft. S/'� -.O l<4 JCG l From Ft. to Ft. From Ft. to FLFt'to Ft. .From Ft. to Ft. From Ft. to Ft. -- From - Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. ' From Ft. to Ft. From Ft. to Ft. From - Ft. to ' Ft.From Ft. to Ft. From Ft. to Ft. r From Ft. to Ft. t From Ft. to Ft. From Ft. to Ft. MUNICIPALITY OF ANCHORAGE From Ft. to Ft. From Ft. to FrEPT CIF HJ LTII A ENl[IRGIp'uFYT 1F ''6T'6T16,P1 _ MISCL. INFORMATION: NOV 18 1981 RECEIVED e DRILLER'S NAME - -- - --- _ 1C1 AL1TYF C R E - �+f , Development Services Department' y Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-102-60 Expiration Date: © C 1 GENERAL INFORMATION Complete legal description LAMPERT ESTATES Location (site address) 20880 Oberg Rd Chugiak BLK 1 LT 6 Current property owner(s) VANDENBERG MAMIE & LAURIE Mailing address Real estate agent PO Box 670222 Chugiak Cindy Lindblom 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone AK 99567 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 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 Fee $ 550 Waiver Fee $ Date of Payment Z Z/ 1 Date of Payment Receipt Number Receipt Number, COSA# 0sc�I 3 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 Eklutna_Engineering, LLC Phone 907.406.1058 Address 19162 Mountain Rd Chugiak AK 99567 Engineer's Printed Name Curtis Townsend, PE 6. DSD SIGNATURE JSystem #1 Approved for 3 bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms Dater of 49 TH �LT.. ..... 2 �'• Date ( zo �No. 11 � A, Z\V bedrooms, with the following stipulations: BY: Original Certificate Date: 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 engineers 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: LAMPERT ESTATES BLK 1 LT 6 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑■ Well log is filed with Onsite (or attached) Date drilled 1981 Total depth 181 ft Cased to 181 ft ❑■ Sanitary seal is functioning correctly ❑■ Wires are properly protected Casing height (above ground) ' 18 in. Date of flow test for COSA 6'28'2021 Static water level at beginning of test 165 ft. Comments B. TANK DATA Age of tank(s) 1 years Tank type/material septic plastic Measured operating fluid level in septic tank ❑E Standpipes/foundation cleanout per record drawing Date of pumping new tank installed July 2021 D. ABSORPTION FIELD DATA Which system tested (date installed) 1981 ❑■ ALL standpipes present per record drawing Total measured depth from grade 5.25 ft (max) Measured depth to pipe invert from grade 4.58 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 0.67 ❑■ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 051-102-60 Structure served by this system Well production at time of test 5.8 gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑■ No ❑■ Coliform bacteria is Negative Nitrate 1.91 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑N Arsenic less than MRL (ND) Collected by Curtis Townsend Date of Sample 6'26'202' C. LIFT STATION ❑ Required maintenance com Age of lift >station y Lift station Comment Adequacy test date 6'28'2021 Results E Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 577 gal New depth 5 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate ' 450 gpd Any rejuvenation treatment (past 12 months) no If yes, enter date 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' p✓ Yes Community Sewer Manhole/Cleanout > 100' ❑✓ Yes if No ft ❑✓ 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' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' 0✓ Yes if No ft Water Main > 10' Animal Containment > 50' ❑✓ Yes if No ft 0✓ Yes if No ft 0✓ Yes if No ft Water Service Line > 10' 0✓ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway 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' p✓ Yes if No ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5'✓0 Yes Yes if No ft Wells on Adjacent Lots: ✓0 Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' 0✓ Yes if No ft Water Main > 10' 0✓ Yes if No ft Community Wells > 200' 0✓ 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' E✓ 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' ✓0 Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Service Line > 10' 0✓ Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Surface Water > 100'✓❑ Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION / certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet ENGINEER'S A Municipality of AncFio�age .• • Development Services Departmerit :• C�"�• Building Safety Division .. . , . Onsite Water S Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 995196650 www.ci.anchorage.ak us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 051-102-60 HAA# n�ro3 1. GENERAL INFORMATION Expiration Date: ro a. T ' os - Complete legal description LOT 6. BLOCK 1: IAMPERT ESTATES SUBDIVISION Location (site address or directions) 20880 OBERG ROAD • CHUGIAK. AK 99567 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address VANDI LEHENY Dayphone 753-5568 20880 OBERG ROAD • CHUGIAK. AK 99567 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures ouGined in the Health Authority Approval Guidelines for this application, shows that the onsite 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 riles and from my Investigation and inspection, the onsite 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 Finn CARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD. SURE 101 • ANCHORAGE. AK 99507 Engineer's Printed Name JEFFREY A CARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines d Regulations. The reported results described the performance of the system under the conditions encountered at the time of the lest, and separation distances measured to readily identifiable features. The operational file of a.7 welts and septic systems depend on the local soils condition, groundwaterlevels that may fluctuate during Me 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 lest 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 ownerlisted above. Any reliance upon or use of this report by any other person or party is not authorized, nor will R confer any legal right whatsoever. S. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Phone 337-6179 Date Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory �✓ , i.../ i (R«. mmrm Maintenance Agreements Supplemental Engineer's Report Other ON-SITE , WATER AND WASTEWATER • pRflrRAm ; Original Certificate Date: 3 -.• z — ,oS Municipality of Anchorage Development Services Department �J Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 166650 Anchorage, AK 99519.6650 www.ci.anchorege.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Gaia.a Legal Description: LOT 6. BLOCK 1: LAMPERT SUBDMSION Parcel ID: 051-102-60 A. WELL DATA Well type PWA7E If A, B, or C provide PWSID# N/A Date oompleted 10/13/81 Sanitary seal (Y/N) YES Total depth 182 ft. Cased to 182 ft. FROM WELL LOG Date of test 10/13/81 Static water level 153 ft. Well production 15 — g -p.m - WATER SAMPLE RESULTS: Coliform &_ colonies/100 ml. Nitrate -A-31 mgJL. Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ In. AT INSPECTION 1/24/2002 165 ft. 5.3 g.p.m. Other bacteria )&colonies1100 ml. Arsenic: N/A mg./L. Date of sample: 2/23/2005 Collected by: GEG. Ltd. B. SEPTIC/HOLDING TANK DATA *INSIDE FOUNDATION. FLOOR DRAIN WILL ACT AS A FOUNDATION CLEANOUT. Tank Type/Material STEEL Date installed 12/31/81 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout MN) *YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 2/23/2005 Pumper JR'S PUMPING *PER FIELD MEASUREMENTS. NEW MONITORING C. ABSORPTION FIELD DATA TUBE AND CLEANOUT INSTALLED ON 1/23/02. Date installed 12/31/91 Soil rating (g.p.d./ft'orqfE�) 280 System type BED Length 45 ft. Width 35 ft. Gravel below pipe '0.86 ft. Total depth •3.8 ft. Eff. absorption area 1575 ft' Monitoring tube YES Depression over field NO Date of adequacy test 1/24/2002 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 6_5 in. Water added 12489al. New depth 12 in. Elapsed Time: 275 min. Final fluid depth 8_5 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date – D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at _in. "Pump ofr level at si . gh water alar level at Cycles tested Meets alar & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot •90'+ Absorption field on lot 100'+ Public sewei main N/A On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/deanout N/A Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parkinglvehide storage 25'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS WT-TiTlyfl G. ENGINEER'S CERTIFICATION I certNy that I have determined through field inspections and * 4 y* review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. T A. a eas. Engineees'Priinted Name JEFFREY A. GARNESS GE 7953 Date Prot's I', HAA Fee $ q:?) Date of Payment 0,3'2-,�-Gi�- Receipt Number 5 / (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number 03-04-05 09:1 SAM FRO 11-CTIE ESI, SGS ENV SERVICES SGS SCS ReUX 1050901001 Client Name Gamess Engineering Group, Ltd Project Name/11 Lambert Est SID Lot 6, BK 1 Client Sample 1D Lambert Est S/D Lot 6, BK 1 lltatris Drinking Water Sample Remarks: 9075615301 T-072 P.02/06 F-TG6 All Datesfrimrs are Alaska Standard Time Printed Dateffime 03/03/2005 8:03 Collected Daterrime 02/23/2005 14:42 Received Datrffime 02/24/205 12:42 Technical Director i ,Steppe Ede Released Results PQL Units Method Container ID ALimilmle Prep Analysis Init P+nmeter l.imin Dare Date Watera Department Nitrate•N 3.31 0.100 Microbiology Laboratory Total Colifunn 0 nig/L EPA 300.0 D (<-JO) 02/24/05 XM cat/100m1 SM209222D A (<=J) 02/24/OS DKC Municipality of Anchorage Development Services Department Building Safety Division Onsite Water 8 Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-102-60 HAA#&1A 0.200"10 1. GENERAL INFORMATION Expiration Date: Complete legal description - LOT 6. BLOCK 1: LAMPERT ESTATES SUBDIVISION . Location (site address or directions) 20880 OBERG ROAD • CHUGIAK. AK 99567 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address DAVID CUSHMAN Day phone 688-9845 20880 OBERG ROAD • CHUGIAK, AK 99567 Day phone ARLENE MEYERS w/ COUNTRY REALTY Day phone 20935 EASTSIDE DRIVE • CHUGIAK. AK 99567 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ 688-8500 TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ 2GS5 at, or prior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) In compliance with all applicable Municipal and State codes, ordinances, and regulations In effect at the time of installation. Name of Firm ALASKA WATER do WASTEWATER CONSULTANTS, INC. Address 6901 DEBARR ROAD, SURE 2B ' ANCHORAGE. AK 99504 Engineers Printed Name JEFFREY A. GARNESS, P.E. Engineers Comments: In conducting this evaluation, AWWC, Inc. 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 ofall 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 evaluatorofthe system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC. Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE YApproved for %3 bedrooms. Disapproved. Phone 337-6179 Date 2 S 0 L Conditional approval for bedrooms, with the fllowing stipulations: Attachments: HAA Checklist _� Manitenance Agreements Septic System Advisory Supplemental Engineers Reort Well Flow Advisory Other WAIuER Lf1TER IvR0260Ot By: < vG� A f l!. Original Certificate Date: '2113-10Z (R".11ron Municipality of Anchorage • Development Services Department Building Safety Division Oo-Site Water & Wastewater Program 4700 South Bragew St. P.O. Box 196650 Archorage, AK 995198850 www.d.arrctwrsge.ak.us (907)343.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOT 6, BLOCK 1: LAMPERT SUBDIVISION Parcel ID: 051-102-60 AIL WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 10/13/81 Sanitary seal (YIN) YES Total depth 182 ft. Cased to 182 ft. FROM WELL LOG Date of test 10/13/81 Static water level 153 ft. Well production 15 O.P.M. WATER SAMPLE RESULTS: Wen Log (Y/N) YES Wires property protected (YM) YES Casing height (above ground) 12+ in. AT INSPECTION 1124/2002 165 ft. 5.3 g.p.m. Coliform 0 colonies/100 ml. Nitrate 1.9 mgJL. Other bacteria O—colonlesil00 ml. 1/25/2002 Arsenic: N/A mgA. Date of sample: I /30/2002 Conected by: AKWWC. INC. B. SEPTIC/HOLDING TANK DATA 'INSIDE FOUNDATION. FLOOR DRAIN WILL ACT AS A FOUNDATION CLEANOUT. Tank lype/Material STEEL Date installed 12/31/81 Tank size 1000 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (Y/N) _ Depression over tank (YIN) NO High water alar (YM) N/A Date of pumping 1 /9/2002 Pumper SANITARY PUMPERS *PER FIELD MEASUREMENTS. NEW MONITORING C. ABSORPTION FIELD DATA TUBE AND CLEANOUT INSTALLED ON 1/23/02. Date installed 12/31/81 Son rating (g.p.dJft1bnJ!!EE0 280 System type BED Length 45 ft. Width 35 ft. Gravel below pipe '0.86 ft. Total depth 03.8 ft. ER. absorption area 1575 ft' Monitoring tube YES Depression over field NO Date of adequacy test 1/24/2002 Results (Pass/Fan) PASS For 3 bedrooms Fluid depth In absorption field before test 8 in. Water added 1284ga1. New depth 10 in. 1 9.9/ Elapsed Time: 9 min. Final fluid depth _ in. Absorption rate >= 450+ g,p,d, Any rejuvenation treatment (past 12 moa (YM & type) NONE KNOWN If yes, give date — D. UFT STATION Date installed Size in gallons "Pump on" level at _in. E. SEPARATION DISTANCES High water alar level at in. Cycles tested Meets alar & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankilift station on lot •g0'+ Absorption field on lot 100'+ Public sewer main N/A *SEE ATTACHED WAIVER REQUEST On adjacent lots 100'+ On adjacent lots 1000+ Public sewer manhole/deanout N/A Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service Ane 101+ Surface water 100'+ Wells on adjacent kits 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property Ane 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parldnglvehide storage 25'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Munldpal records that the above systems are In conformance with MOA HAA guidelines in effect on this dale. Engineer's Printed Name JEFFREY A GARNESS Date HAA Fee $ * a7 5 Date of Payment 9-1 —110 Receipt Number CA 5�0b3 (Rn. 11/01) Walver Fee $ tk 1pco Gh Date of Payment CIT Receipt Number of t (089 2/15/2002 Municipality of Anchorage George P.11'uereh,Mayor Department or Public Works Bttilding Safcty Division P.O. Box 196650 • 4700 S. Bragaw Street Anchorage, Alaska 99519-6650 • (907) 343.8301 li ttp://aitiv.ci.ancliorage.ak.tis Jeffrey A. Gamess, PE Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2B Anchorage, Alaska 99504 Subject: Waiver Request for Lampert Estates Subdivision Block 1 Lot 6 Waiver Request #WR020005 Parcel ID #051-102-60 Health Authority Approval Certificate Number HA020040 Dear Mr. Gamess: Your request for a waiver of the required 100 feet horizontal separation from the septic tank to private well has been approved. The approved separation distance is 90.0 feet. This waiver approval applies to the existing septic tank to private well separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, OYV-- Daniel J. Roth Civil Engineer On -Site Water & Wastewater Program WAIVER RfQuEsr FOR 1-i9HPEKT 1=STRM5 PLoac- / Lor WIlIVER MEQUEST NUMDER WR020005- WAIVER REOUE$r FOR ON -LOT NATER WELL ro fk r/C T4NA Of 90 FEET. — SF PTI c DATA — THE SEPnc TANx Ib Q uEfr/ow wAf co,vsrRkcrEv IP DEC. 1178/. TIkE MAf'KFACTwRER OF rl-(E fEPr/c rRuK /f GIeEER /9d/D /r I S A STEEL /000 GAtLav rlA,,jt. 7 -HE WAMM A.f LL k.)9J /w PLACE WH6N THE SEPric r/4NK A-I¢f C6pvSTiPucT6� t'HE SD/L rRE Sepr/c 74,Vk If CV.vfrlekcrEo /N /s PESc,eipto BY rkE EN6J�/EERA! 1q SH wlrrt e000LEJ SILT � i.4.vD HEPIkm PE,vJirj- Tiff PEKCOLATIo,v RATE lv4y 40 H�NKTCT�/�vEH, THIS IS A �PEtpT�ut[ SLOW PFRCoJ-ATiA,&- silt f wiLL rREAr fEPric iqw,,� EFFcuE.rT VXRY ►"ELL IIVA SHoET 0.17 if.CE (12 ") WELL DATµ - THE WATER mea IN Rides-nov wAf cdusrRxcrtD la Ocr /98/. THE WF -U If 188 FEET DEEP W/Ti! .4 frprlc WArCk LEVEL, of /6S FEE FRom C ROw.O SucF.4cF wr:I-L LOGS IN THE A96A r/IOI.✓ THE SNBSkRFAca S7-RorJF/c*T/ON /S COwF/AiJNb Ll4YF-kf OF SOIL EXIST w"PEEP G-ROuA-b SURFACE A'ND THE INATER AQuiFER RT 143 F6Er B&Lvw GKou.vG SuKfi4cE, rl-f6 6vWT$IZ Wm LL /A/ 4urESriO.✓ /S L.00Arr D UP 6RIVGIb� FRO„ rNE SfPric /,v ELEV4770N A,v o aN TNF 5**AtIE ca"Tva+ NYOX4uL'EA-i,LY AS ;r/4F- f6PJ7L 7-NA/X Iti quEsr/a.v, A/)4rbR SfiAlOU"I fROAl r14E w)9TER wFL(. /AN QasSr/o.v I.vPICAU rH)g7- IVo 6ACTEK/A AXE: PRESENT" **,P i4- AACk G)4owvP N/Te j OF l.%h7lr Ea/Srf. / r R 5. of R. E. C.A W. G. wnrEle IWOLE 'TArK DEirit c 5-01L SORBTION NNN W W „„ F�RnD p�u THE E.vnR6 DirT/hv�E . . coo ava AAA hhH PON6,40ki T% e.1 s &uF Af y60VE {VATF-x TAYL.E (rIPpD✓6Nr ASSNME COA�fER✓i►r✓V[` /�S DELL 7OM4< OAv SRN>: R/�Roa��i+TE GRI�OIEnj' C�TOuR —3 % , . 0 HOKI Z OA Lh t FOAxATIOA fig Gr{�vv 7-07AI COAICLU.Siunv 67Aivr wr4 / VER po/N r -s 79 4.F Z.J- 2.0 2.0. /9.r ALASKA WATER F- WASTEWATER CONSULTANTS, INC. January 31, 2002 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Waiver Request and Health Authority Approval for Lampert Estates Subdivision; Lot 6, Block 1, The existing 3 bedroom house is served by a private well and septic system. We request you grant a 90 feet separation distance waiver from the well on the referenced property to the septic tank on the referenced property. The well that serves the subject property was drilled on October 13, 1981, and the septic system on December 31, 1981. The following items are justification for the waivers: The well location is at a slightly higher elevation than the septic tank. The house sits between the well and the septic tank. If the septic tank was to overflow, the effluent would not travel toward the well head. The location of the septic system is in a very visible area so that if any effluent was to surface, it would be noticed and the problem corrected. The other path of contamination is subsurface migration wastewater should the tank begin to leak. As can be seen on the ajjtached well log, the aquifer is relatively deep, with approximately 153 feet of silt, sand, and hafdpan soils that have served to inhibit the migration of untreated wastewater into the aquifer. Recent water sample results indicated nitrate levels and coliform bacteria results to be satisfactory. Based upon the aforementioned facts, it appears that there is minimal risk associated with the 90 feet separation distance waivers. We also request that your department issue a Health Authority Approval If you have any, q*stions, please contact us at 337-6179. Thank you for your assistance. P.E., M.S. 6901 Debarr Road, Suite 2B • Anchorage, AK 99504 Ph: (907) 337-6179 • Fax: (907) 338-3246 • Website: akwwc.com TRACT 81-8, LAMPERT EST. S/D: E%ISTING J BEDROOM H0 TRACT A. LAMPERT EST. S/D: O: 'i ROAD / \ j13 TRACT &7&S/D:\—✓� / �\ LAMPERT FRIENDSHIP LANE ---------------� r-------- -------------- --------------- I I EXISTING SEPTIC SYSTEM I 1 I 713N, R1W, SECTION 9, LOT 57, WACANTD T15N, R1W, SECTION 9, LOT 56, T15N, R1W, SECTION 9, LOT 55, 1 t iu N3BY/2oo2 DRAW ALASKA WATER & WASTE WATERs c„ 1.G. 4ry� CONSULTANTS• INC. 1' — 100 / *... . ............ kk41 6901 DFRARR ROAD, SUTF 79 • ANCNORAGF. AR 993DA • PNONF (907)]374179 • FAX (907)338.3746 - L� PREPARED FOR PHONE NUMBER: PAGE NUMBER: . � DAVID CUSHMAN 688-9845 1 OF 2 �% 1,. •• a it Gar ess � � LEGAL DESCRIPTION: LOT 6. BLOCK 1; LAMPERT ESTATES SUBDIVISION ILA- TYPE qF1YP SITE PLAN FOR WAIVER REQUEST �'�;°,s1� OBERG t ROAD _ _ _ _ _ EXISTING SEPTIC / SYSTEM FOR LOT S, BLOCK 1; LAMPERT EST. S/D \ 1 I I I p0, W I I ( I I I EXISTING 1 WELLEXISTING \ OV I L____J \\ 3 BEDROOOMHOUSE I \ /EXISTING 7000 I �CALLON SEPTIC TANK $ / I / I / 1 (:-S'EPTIC i \ _ FRIENDSHIP LANE EXISTING DRAINFIELD _ .. /31/2002 o p _ �• ' 4 DRAWN BY: ALASKA WATER & WASTEWATER C.J.G. SCALE -S.INC. 1 • = 40F 6001 DFPAPP POFD. WTF 29 • ANCPOPAGF. AK 0954. • MMF (WI) 51-6170 • FAX (90M38-3?L6 PAGE PREPARED FOR: PHONE NUMBER: NUMBER: DAVID CUSHMAN 688-9845 2 OF 2 QO p'•, f e me e.: Q • 7953 : LEGAL DESCRIPTION: LOT 6, BLOCK 1; LAMPERT ESTATES SUBDIVISION 4p�00oo. TrP DRAWING FOR WAIVER REQUEST AS-BVMT I'hereby certify that I have 3urrpyed the fol3o-W PJ Anchemp gswelit Trecjllc-. AlaWw, wd fbet the Lmrrove- ments s"sted Olerectl An 10"W" ths lines and da p or sOkrOV±% OU LIVIA ;,r=ti hot OT 7. nir 4060elit then - 0 0 -),ev - . . .. ... . •,�- %;%. �'n LA" to.* that to Im is I pg*pww mdj�lt � I in that,thm are Do lnQWoL OD': the ' qUe"jon, m visibt* essewomtg On roadmam din. limet ow -0tbec 01 A I Saw p operty Augpt as I"Cvw harmob. Dated xt yr. Alalia I; ..,Aux thlL � t�.h fkft 4K FAtIOW •TnT,vI . MUNICIPALITY OF ANCHORAGE n r DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH Ff31 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY) 2644720 iS I Application Date Z 1. GENERAL INFORMATION (a) Legal Description (in de lot, block, subdivision, section, township, range) I n iv LL _/hc I ( A M>r" 12 7 C 57 Location (address or directions) (b) Applicant Name QA0 C-!,twmd" Telephone: Home &SA— 42VE Business Applicant Address .5 k i Jon S/ �7 L� CH rc,1AA 415 if SG '- (c) Applicant is (check one): Lending Institution ❑"; Owner/builder ❑ ; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution r'Z ,M'n7&A&C2 Telephone Address O M.hQ.. (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: c S a ENCINEPR ING Y 17034 Eagle River Loop Road No. 204 Eaffle River, Alaska 2. TYPE OF RESIDENCE Single -Family L9 Multi -Family ❑ Other ' Number of Bedrooms 3. WATER SUPPLY Individual Well 2- Community ❑ Public ❑ f Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DI POSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-02501184) Page 1 of 2 (12*Ni 1. 5. ENGINEERING FIRM PROVIDINu INSPECTIONS, TESTS, FILE SEARCH, DA.A AND INFORMATION 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 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 Telephone C!$L Zq%y Address 17034 Eagle River Loop Road No. 204 Date Eagle River, Alaska 99577 oNsire 5GPTic /,VS?4L[T/J ,;,e 34?.f ..cF2 A 6 O Gr9 L. _ ogo0/On/ 7_01Nlf O�N17 A00,610 �;:c �6soRPn�a B6a amore 2 Boer. ,4 soic �•��v:¢�ke TEST PGOTpG9,✓ fir✓D f.eDln !llJf% vc" •L eTs al r� 6. DHEP APPROVAL Approved for 'It- edrooms byVe�Date Arered Biaapproved Conditional /` Terms of Conditional Approval AS STA 7-&0 A9B64fF. .- 490/1K Ta Be COh9/%LE7,Eo v. L. T. o/NL (967• &,J77r7J Vol Z< YV ,.? '"Op4lx $O as 711 da lt�Al : U.,0' t L4W,- • ��13 7.d6 7' IV4 Z;O, +0 h, �TOz1% 7a 11. CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending Institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 pts) MUNICIPALITY OF ANCHORAGE (MOa) MUNICIPALITY 6 �iQl'ffHORITY APPROVAL (HAA) DEPT. OF ENVIRONMENTAL pRIST - FEBRUARY 1984 284-4720 FEB 2 31X87 Legal Description: L &7 to A. WELL DATA RECEIVED t_'4MPC*: Well Classification S. F If A, B. C. D.E.C. Approved (Y/N) t -)/A Well Log Present t)N) Date Completed —49 � IA/ Yield o•B�% f Total Depth sL` Cased to / sZ Depth of Grouting Static Water Level /153, Pump Set At V V� Casing Height Above Ground / (�" Sanitary Seal on Casing O/N) Electrical Wiring in Conduit &N) Separation Distances from Well Depression Around Wellhead (Y/4 To Septic/Holding Tank on Lot On Adjoining Lots To Nearest Edge of Absorption Field on Lot 10014 ; On Adjoining Lots le -0 To Nearest Public Sewer Line 11A To Nearest Public Sewer / Cleanout/Manhole /J To Nearest Sewer Service Line on Lot ZS Water Sample Collected by S t -S = 1 r - n) -. - 1" V ; Date ZZ Water Samp Comments B. SEPTIC/HOLDING TANK DATA Data Installed _L Size _/ No. of Compartments e�_' Standpipes& N) Air -tight Caps6YN) Foundation Cleanout (Y6 r Depression over Tank (Y& Date Last PumpedJL Pumping/Maintenance Contract on File (Y/N) A Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) FJ '4 Separation Distances from Septic/Holding Tank: 7 r To Water -Supply Well 1 tld '1' To Building Foundation S To Property Line / b• / 4- To Disposal Field 436 To Water Main/Service Line to 4- To Stream, Pond, Lake, or Major Drainage Course / `I Page 1 of 2 72.026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 11I t Type of System Design G% Date Installed /�3A A I t ength of Field Width of Field 3S Depth of Field ;rr Gravel Bed Thickness Square Feet of Absorption Area / 5 iS Standpipes Present (Y/N) Depression over Field (YA/ Date of Last Results of Last Adequacy Test S All-? S PACb*_- / FG*- Separation Distance from Absorption Field: To Water -Supply Well / oo To Property Line /O I /4- To Building Foundation 93 To Existing or Abandoned System on IU Lot a ; On Adjoining Lots 30r4 To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course _ To Driveway. Parking Area, or Vehicle Storage Area nl%r D. LIFT STATION To Cutbank (if present) Date Installed Dimensions — Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) — Comments •' Check Permitted Bedroom Rating Against HAA Request " Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that l have checkeQd, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S s��ftgk{t ING Sign ate 2 —2,0-67 Come err Alaska" S" MOA No. Ff6—vD 3 '"��a�ee;rt.y c2 C2/ r� n ,...; .� t No. DD « V .r '�� •• �Y•ry;� Date of Payment cQ -4�3 7 �/�� a� f Receipt , •i Amount: $ r s al » Page 2 of 2 72-026 111,84) APPLICra-NT FILLS OUT UPPER HAL`--*\)NLY Time Ime " Property Owner 50 Al i Act n Phone Mailing Address4,01L /7 , Zip Code Buyer )A V, D (j V's H M R A% Date tr1 DateDate � of - \� - 1 Address Zip Code r1 Lending Institution N A A Inspector /� Phone Inspecto ne (/ -1z Address iQ r V- T Zip Code -5 Realty Co.aAgent 7D7 -,C,, 6�:Ai-Ty A"ARA 0-%)9GA/1TZ Phone . Address iq. ei! Zip Code -� �f41- ✓f /` Legal Description ` �. Z '.LAM pr.r7- �c TA TSS Street Location Type of Residence Single Family MultipleFamilyNo. of Bedrooms ❑ Other Water Supply Individual ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. Community (�' I L�� For welts billed prior to that date, give well depth (attach log If available). ❑ Public Utility 1 ' ( APPROVED BEDROOMS *CONDITIONS OF APPROVAL Sewer Disposal Individual Year Individual Installed: �9X Xn lJ Public Utility When Connected to Public Utility: DATE�a�fv ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. " Ctrs ccsLl�-•x� Time Time Time Ime " Act n IMo Date Date tr1 DateDate � of - \� - 1 nn r1 Inspector Inspector /� Inspector Inspecto J� fico . 7' ( APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE�a�fv BY: Solis Rating Date Sewer Installed Well To Absorption Area / / O +- Well Log Recelved Well to Tank Septic Tank Size f�Q 12 M even