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CAR-LYNN BLK 1 LT 1
Car -Lynn Block 1 Lot 1 #015-111-13 e3 -ca \ r' MUNICIPALITY OF ANCHORAGE y,r\ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION L ENVIRONMENTAL ENGINEERING DIVISION 825 L Street • Anchorage, Alaska 99501 Telephone 26413720 \ ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAILINGAD S P -2 PHONE NEW — ❑ UPGRADE LEGAL DESCRIPTION -L l LOCATION I 2� NO. OF BEDROOk S O Y DISTANCE TO: Well Absorption area Dwelling 7V PERMIT NO. 7 — GManufacturer W F MaterpL, No. of compartments Liq, 1�7irt allons IF HOMEMADE: Inside length Width Liquid depth -�— 6 Y JVZ DISTANCE TO: Well Dwelling PERMIT NO. S?F Manufacturer Material Liquid capacity in gallons W = DISTANCE TO: Well Foundation Nearest lot line PERMIT NO. j LL Z H ? W No. of lines/ Length of each line Total length of lines Trench width riches Distance between lines G FM- o Top of tile to finish grade // y Material beneath hla inches Total eflective absorption area W Length Width Depth PERMIT NO. It W � Type of Crib Crib diameter Crib depth Total effective absorption area V' DISTANCE TO: Well Building foundation Nearest lot line J J Class Depth Driller Distance to lot line PERMIT NO. W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MAT'RIl C / SOILTEST14ATING, r INSTA ER REMARKS V . ✓ .s i APPROVED DATE LEGAL (Air -Linn! I RKl 72-013 (Rev. /78) JAY WILLIAMS DRILLING 3760447 •c�` � I r i � � i i E � � ; ! a ' o, ii�ll�ff�h , _!ot (FFlil�!!i(r old t4 i ( o• z f N irir ti, , 1dCr Ii r14f a41x E i F F ; !> h >f a ►+ !! d` d E + �'; a at a t 4i M al $41 �in, E5 ED v 1 v! v E a�f u a A Ayt S� rt yri a 04 .i at 34 a 1 a! b • � tA� W W' ; �1..F V'N 31 N � OiNF.£ Uf � 1 Rug ! OF �9pp' � a a a � ! ( � O,E N � P'f! F• i RT� l(1 l`• � .r� C1 In r E ro o. m �, of 11 21. A A � P.04 10'd UU92 'ON Xdd d83 6b:6 NOW 96-61-9f1d ' r�ur-a I L I I r1L_ x TY OF rlr�lcl-,����I�E DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE, AK. 99501 264-4720 WELL rfrJQ ON -'SITE SEWER F ER1.1 I T PERMIT NO. C 830596. ) APPLICANT GRAIG P.APPE P.O. BOX 112062 344-1686 LOCATION LEGAL LOT 1 ELK i CAF,' -LYNN SUB LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH HAXIMUM NUMBER. OF BEDROOMS = 4 SOIL RATING (SQ FT/BR)= 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: E>EF TH= 12 LENGTH= 25 GRn%- EL CHEF TH= E: THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). REQU I REQ SEF}TIC Tf=iNK S I r E= 1.2!51' GFFIL_LONS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTION'= OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER.' OF RESIDENCES THAT THE WELL WILL SERVE. --- TWO C 2 i I NSP ECT I Ot11S F=IRE F:EQIJ I RE13r --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. HINIMUM 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 I -JELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER.' LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL 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'EFZ:tl I T E:XF I RES L`�ECEIlE:ER 2;2s 15+23 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 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQ RE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BED RO - SIGNED:- Q�� --------------- Ar IC r RAI RAP 6 ISSUED Eti7!'11_-------------- -----IrRTEl__ =-- V4.0 ity POUCH 6-650 ANCHORAGE. Al-ASKA 90502-0650 (907) 26-1-4111 '01" • o.Yl C ` VA Y Df P AHTKENT 111 Iq A! 10 %.'A) r NVIRONMENTAL PHOT ECT ION ,Permit #: 820814 January 31, 1983 TO: Permit Applicant Subject: Lot 1 Block 1 Car -Lynn Subdivision A permit issued by this department for an individual well and/or on-site sewer system has expired as of December 31, 1982. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log needs to be sent to this department for documentation of the installation date and to close the permit. If a private engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files and documentation. If there are any further questions, please call this office at 264-4720. Sincerely �C_Td�- Robert C. Pratt, R.S. Acting Program Manager Sewer and Water Program RCP/ljw enc: Copy of Permit SWP/057 �1UNICIPALITY OF ANCHORAGES ►�,Q / Department Health and Environmenta protection U 825 i Street, Anchorage, AK. y9501 264-4720 Permit # v6 N 1A * * * HANDWRITTEN PERMIT WELL AND/M ON-SITE SEWER PERMIT Applicant: ��/r►1 /y, a Glycin Mailing Address: PQ /ScDe /7258 Location: Phone Number: d -IA - 6 Vy Legal Description: / • C4 ►' Kn : Lot Size: -- Type of Soil Absorption System'Is:' Trench: -,X— Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: _ Soil Rating(sq.ft/br) -10 [1 The Required Size of the Soil Absorption System Is: DEPTH 12 LENGTH z 5 .GRAVEL DEPTH P WIDTH NO Sc T The length dimension is the length(in feet) of the trench or drainfield: The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = 1:05 O GALLONS * " Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of.residences that the well will serve. * *.* TWO(2) INSPECTIONS ARE REQUIRED Backfilling of any system without final inspection and approval by this departmen will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fee for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 2 I certify that: (1) 1 am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that`s .bedroomns. �- Signe'd:--�.... � _ Issued by: Applicant Date: Va``��Z SWP/024 (1/81) /, „ `/- 1N�$ 17x17 -TD, iz �r0.inFre(d yDclrnl �' W106 3yZ` U ea u L = 43 Any `V'101-` l of hove —T r.e. s1.c h 4 i3d razes trn P ✓VI rrB /3xr3 3 13olrni Ta --rt eE; c,' w r 1.� 0 3Y2" brave f L= 3 3 -7D Var►aG/e +0 l."-� 3 %ci rAj 1 D = IZ 6, �_ I 1 i^CONSTRUCTION TEST LkB Mu""ALITY OF ANCHORAGE • "One Test is worth a Thousand 0,V4opt":;oiER �l_ a '2204 Cleveland Anchorage, Alaska 99503 277-0231 AUG 13 1982 Performed for Brian Betz �g n=n 10/4/79 Legal Description: Lot 1 Block 1 Subciiv �r lnn This Fora reports: SOILS TEST yes PERCOLATION TEST Depth Soil Characteristics Feet a" Peat Brown Sandy Gravel GP - GW 16' Bottom of Test Hole Was ;round Slater Encountered No If YES, What depth? cc: McGhan Construction Reading I Date I Gross Time EMOMEMMMMMON Net Time Depth to H2O I Net Drainage Percolation Rate Minute Proposed Installation: SEEPAGE PIT DR\IN FIELD Depth of Inlet Depth to Bottom of Pit or Trench -OAMENTS: 100 Sauare Feet drainage area rem,ireA TAY tAArnnm :est Performed oy D. Data Certitied Bv: Construction Test rat, f ate ` 10/5/7Q Approved • Robert Pet d / moo P � �/�zti/. �sIK ��✓3 Managingg Engineer r �� MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR980046 PID# 015-111-13 HA# Permit # Date Received: August 7, 1998 Legal Description: Lot 1 Block 2 Car -Lynn Subdivision Engineer: Jeff Garness, P.E.. Alaska Water 6 Wastewater Cnnsnlranrs Tnr_ 7320 East Chester Heights Circle, Anchorage, Alaska 99504 Applicant: Randy S S Cynthia A Ward Waiver Requested: amending existing waiver to include the separation distance between the private well and the on-site wastewater disposal field (trench) of 95 feet _ Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: Date: By: Name of Reviewer Rec #: 03998/4050 Amount: $ 295.00 Date Paid: AA,g,st 7_ 199.9 Note: difference between $625.00 (well to septic tank) and #920.00 (well to field) is $295.00/ Alaska Water & Wastewater Consultants, Inc. 7320 East Chester Heights Circle - Anchorage — Alaska 99504 Phone (907) 337-6179 — Fax (907) 3384246 August 6, 1998 Municipality of Anchorage Dept. of Health and Human Services Attn: Dan Roth P.O. Box 196650 Anchorage, AK 99519-6650 REFERENCE: Lot 1; Block 1; CarLynn Subdivision Waiver #WR950038 Dear Mr. Roth, L<rCEIVEU AUG 07 1998 MUNICIPALITY OF ANCHORAGE MRONMENTAL SERVICES DIVISIC"' Per your direction, we are requesting that you amend the existing waiver (#WR950038) from the well to the septic tank to also include the separation distance between the well and the trench. The separation distance from the well to the sump is 99 feet. Given the fact that the trench is 4 feet wide, it is possible that the trench sidewall is as close as 95 feet from the well. Therefore, we are requesting that the separation distance from the well to the trench be waived to 95 feet. We do not anticipate any adverse effects to neighboring properties with the amendment of this waiver. If you have any questions, please contact us. M.S. JAG/gk C�el-W �I— S-Z) Alaska Water & Wastewater 7320 E. Chester Heights Circle -- Anchorage, AK 99504 Phone (907) 337-6179—Fax (907) 338-3246 Consulting Engineers July 22, 1998 Municipality Of Anchorage Department of Health & Human Services P.O. Box 196650 Anchorage, AK 99519-6650 REFERENCE: Lot 1; Block 1; CarLynn Subdivision Waiver #WR950038 To Whom It May Concern, During our site visit to the referenced property to perform well and septic testing for Health Authority Approval, we found the separation distance between the well and septic tank to be only 90 feet. A waiver was obtained in 9/95 for the separation distance at 92 feet. Request you amend the existing waiver # WR950038 to 90 feet. The amendment of this waiver will have no adv4rse effect on neighboring properties. JAG/gk enclosures WELL 1 26.8 1 Sit I — 145.5 24.0 Sit — 1 7' 1 1 1 I I 100' WELL RADIUS WELL I I 1 \_Qo 1 S I \� A-43' HOUSE Nn TE: SEPARA710ND DISTANCES FlELD MEASURED 7/21/98. ALASKA WATER AND WASTEWATER o4�oF A o00 7720E CHESTER HEIGHTS CIRCLE, ANCHORAGE, AK 99504 p(` �,...... �I��oo PHONE: (907) 737-8178/FAX: (907) 778-3246 _EGAL CLSCRIPHON: CAR—LYNN SUBDIVISION,' LOT 1, BLOCK 1 49 4 IYF'E OF WORK: D G SITE PLAN 'REPARLU fOR: PHONL NUMULN: •,P .JAMES P. •WILUAM$-•� RANDY WARD 267-3164 (HM)/ 346-3585 (HM) 0 NOCE. ;`o 1nit: JRnwN dr: axc: Pnoa ��•�sdP�ofaselo����0 7/22/98 A.C.G. 1 = 30' 1 OF 1 •. VIS; f �*—rssj* bL I wa ftits ..Pro ..... zq x1l czo- Z-4?4 Jap .r: rim ff 94ALL W rdf I -3- OWM OR OUR= TO PFAM EUVAD(f elk.. VCXWr*NM CCWtVM?l AND 0011 P 1 •u13 T*W MOW VO "OT AMW ONS WOOM"KATANOTO 6UMM3 tWX IMATM TO d6 SURVEYi CERTIFICATION sem top woum"I j�,• its . 116 , " ;, GIs fit �'Arii a3MEE=- 2 1� a $WTI? 1416 o Two-.,; +,l Na.Zcdnq DI t ."]A. da in ce - A..1 Municipality of Anchorage On -Site Water & Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-111-13 Expiration Date: 1. GENERAL INFORMATION Complete legal description CAR—LYNN; BLOCK 01, LOT 01 Location (site address) -10540 OUR ROAD *ANCHORAGE. AK 99507 Current Property owner(s) FRED AMICANGIOLI Day phone Mailing address Real Estate Agent 10540 OUR ROAD *ANCHORAGE. AK 99507 MARCI BOUCHARD W/PRUDENTIAL Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: 230-7123 TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site E Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ Received by: / '�� �`^lti?� Date: f0/,1L_ COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $��>_ Date of Payment 10) 1) a Receipt Number 6a 3� 1 COSA # CSC la1`45� Waiver Fee $ Date of Payment Receipt Number Waiver # 6. 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, l 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 * Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. AK 99507 In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for 4 bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. Phone 337-6179 Date 71 bedrooms, with the following stipulations: OF 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 represenatations given in paragraph 5 try 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 v Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other B, (Rev. �irosr Original Certificate Date: J I 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: SUN VALLEY ; BLOCK 03, LOT 02 parcel ID: 015-111-13 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# NIA Date completed 10/20/1983 Sanitary seal (Y/N) YES Total depth 281 ft. Cased to 281 ft. FROM WELL LOG Date of test 10/20/1983 Static water level 231 ft. Well production 7 9 -p.m WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Arsenid:N ug./L. B. SEPTIC/HOLDING TANK DATA Nitrate I • 7 omg./L. Well Log (Y/N) YES Wires properly protected (YIN) YES Casing height (above ground) 12+ in. AT INSPECTION 8/2/12 238 ft. 5.07 g.p.m. Date of sample: 8/2/1 Collected by: QEG. Ltd, Tank Type/Material SEPTIC/STEEL Date installed 9/8/83 Tank size 1250 gal, Number of Compartments E 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 9/11/12 Pumper NORTHLAND PUMPING C. ABSORPTION FIELD DATA ITELOW EXISTING GRADE Date installed 9/a/83 Soil rating (g.p.d./ft`or /bdrm 100 System type TRENCH Length 25 ft. Width 4 ft. Gravel below pipe 8 ft. Total depth *11.66 ft. Eff. absorption area 400 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 8/2/12 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 990 gal. New depth 10 in. Elapsed Time: 110 min. Final fluid depth 0 in. Absorption rate >= 600+ 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/Access (Y/N "Pump on" level at in. "Pump oft" leve_ I� High water alarm level at Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot *90' On adjacent lots 100'+ Absorption field on lot *95' Public sewer main On adjacent lots 100'+ ' Public sewer manhole/cleanout N/A ' Sewer /septic service line 25'+ Holding tank Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100+ Wells on adjacent lots 1000+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *0' Building foundation 101+ Water main_ N/A Water servic : line 10'+ Surface water 100'+ Driveway, parkir 9/vehicle storage A`* ' Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *WR#950038 (AMENDED IN 1998) **PORTION OF TRENCH IS UNDER DRIVEWAY G. ENGINEER'S CERTIFICATION I cerfify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineers Printed Name JEFFREY A. GARNESS Date 9'64—i2 (Rev. 11105) 51 -Em �.. fr.y A .... ess; . . CE795 7 N m \ 9 za.\ w z\ � / x . g ^` l §/\; �$,2 I`O § ;§ (]/§ [ / !S2 ; ul�7 : °° ! (f); , (\ §/\; �$,2 I`O § ;§ (]/§ [ / !S2 ; WO Z. I� \\) ))() ow �0 'z ) , / 2 ; _ �k\ ! ((; j {\ | : }) §§§ | /(\ \/o.\) ///6E | 2): :.�;�� /\O\\wz. | ! 2!:$§ | \0) \I\)) \ '00§ 0§4 \§\ )(}\\\ � °° ! (f); , (\ I`O (]/§ [ / ; WO Z. I� ow �0 'z ) , / 2 ; _ ! 02< {\ | : }) §§§ | ///6E | /\O\\wz. | | J )/\ | '00§ 0§4 e Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program A E r 4700 South Bragaw Sl. 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. nig-111-ii HAA # 1`)?�CI� Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 1; Block 1;Car—Lynn Snhdivisinn Location (site address or directions) 10540 Our Rd. Anrharage, AK 9g516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Rick Loewen same Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well a Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone 441-1628 Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site Q 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 th"ate of issue for properties served by a private or Class C well and may be reissued with new water sample resujl(Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S & S Engineering Phone 694-2979 Address 17034 N. Earle River Loop Ste. 204 RaQje River, AK 99577 Engineer's Printed Name RbAk,17 C. Czw4.✓ Date S�/,ohniS" OF #k 5. DSD SIGNATURE '0� �f„3. R09CE c COWAN (� �F. C -8801 I/ Approved for bedrooms. titZ .o"N •^ ............ Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: nfZ 4 Lam. ZEQ-�' Original Certificate Date:'` (Rw. 01Ai( Municipality of Anchorage Development Services Department Building Safety Division On-Slte Water 6 Wastewater Program 4700 South Bragaw St. P.O. Box 1981350 Anchorage, AK 995196650 www.ci.anchorage.ek.us (907)343.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOT1 'BI of ICS: L11 tZ - %.`(b►J SILL Parcel ID: A. WELL DATA Well typed VfiTE- If A. B, or C provide PWSID # Date completed 1 D W %v O Sanitary seal a1) S Total depth (r ft. Cased to %Lb. FROM WELL LOG Date of test IO iw 16-5 Static waterlevel Well production rq 94T, g.p.m. WATER SAMPLE RESULTS: Coliform _-Q--colonies/100 ml. Nitrate 1- 3$ mg./I. Arsenic: — mg./I. Date of sample: �/05 B. SEPTICIHOLDING TANK DATA Tank Type/Material '45 PTI C. / ST' _ Tank size 12,50 gal. Number of Compartments 01 Well Log&) %IEg Wires properly protected®) 6S Casing height (above ground) 17-'!+. in. AT INSPECTION xj D 5 oZy 1 1 ft. 4403 g.p.m. Other bacteria I _ colonies/100 ml. Date installed 2 la 1 03 Cleanouts49N) k16g .V Foundation cleanout ON) Depression overt dank (YaD � High water alarm (YAb Ail* Date of pumping _S' Pumper �r eT� Lwb 1T'U Mpuy, SLrP.tl c c� C. ABSORPTION FIELD DATA Date installed2QZ3 Soil rating (g.p.d.Htr o ftzlbdrm 100 System type bp54- Tex -AX -44 Length 25, ft. Width Lir ft. Gravel below pipe ft. i Total depth 12 ft. Eft. absorption area m ft Monitoring tube AL Depression over field tJ0 Date of adequacy test Resufts s eil) �±' s For ' bedrooms Fluid depth in absorption field before testgL In. Water added gal. New depth13rr in. Elapsed Time: I— min. Final fluid depth �M in. Absorption rate >= 4564 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y69 type) If yes, give date &.,>p D. LIFT STATION Date installed fV jq `Pump on' level at AA in. Size in gallons ulh Manhole/Access (YIN) tJ `Pump ofr level at VA in. High water alarm level at A -A in. Datum I019 Cycles tested pi? Meets alarm ti circuit requirements? O Kt E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot ' go `1 Absorption field on lot 15' Public sewer main tyA Sewer /septic service line 2614 1 On adjacent lots 100 On adjacent lots 100 l Public sewer manhole/cleanout UA Holding tank ASA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10 r+ Property line $1�- Absorption field S / Water main 0 Ir} Water service line 10 I+ Surface water 1001+ Wells on adjacent lots 100 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line b i W 2950D'�6� Building foundation (b / 4' Water Service line f Surface water I bO 1 + Curtain drain K50M &Axw4y Wells on adjacent lots /001 F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAAguidelinesin effect an -this date. /� Engineer's Printed Name 4'ak-ti C L dW4., Date S /i © / OS HAA Fee $ 14 3 D Y o Date of Payment 6` /I r /0 S` Receipt Number o sy x (Rev. 12(01) Water main AJ4 Driveway, parking/vehicle storage 0 1 V Wb'EYAJ6/ o Defy . F>{r� 111111 4 A6056 r- x; T,X0 t'a-Ib2 Tn 1"1t� / Waiver Fee $ Date of Payment Receipt Number c�, r ^ Ro"OT C. CMArr 1t tet. May 06 05 02:07p SCALE / .3n r Chris Goard A C4 r. �C iN_ 907-337-6461 i .I. 4 A � S 84`.5/SOS"W -A2 A5KA . Zoo- . . :Rec ert5 5- AS49UILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's Inspection s? fps �[ •�C of the following described property. - Go7- /P �... . t`.,tk ,.«*�•.r 4�'bl8 8[.car,� / GRif-LYNN Sua moyom �r40}'` M. = l Anchorage Recording Precinct, Atabka, and that the ' Improvements situated thereon are within the property lines and .) .. do not aerlap or encroacA on the Pr'>�nY NhC M thenito : hid w . <,, f that n0 improvements on property lying adjacent thereto 1.,17- qo. n. , f encroach on the premises In question and that there are no c, `. •• r toedways transmission Anes w other vWble easements on said v41..r •••,,•......• +'dam„ property except as Indicated hereon. t i ''vx Dated at Anchorage, Alaska %s'ir EASEMENTS OF RECORD,'OTIIER THAN this day of AUlaUST• 19� THOSE $IjOWN ON THE RECORDED J$ yQ•3 FRED WALATKA d ASSOCIATES PLAT ARE•NOf SHOWN HEREON. P3 , 4-5 BE (gp)) 2461868 Engineers and Surveyors R 7 05-10-05 12:31PM FROM-CTSE ESI, SGS ENV SERVICES SCS Re" 1052339001 CHmt Name S & S Engineering Project Natndll CAR -LYNN S/D Ll Hl Client Sample ID CAR -LYNN S/D LI Bl Matrix Drinking Water Sample Renuka: 9075515301 T-655 P.02/04 F-802 Ali DateaMmes aro Alaska Standard Time Printed Date/flme 05/0912005 12:42 Collected Datemme 05102/2005 17:00 Received Data7ime 05/03/2005 14:30 Technical Director Stephen C. Ede Allow" Prep Analysis Puamew Results PQL Units Method Conuioerm Limits Date Date hit iiatara Departwmt Nitrate•N 1.32 0.100 mlVL EPA 300.0 D ("10) 05/04/05 JIB microbiology Laboratory Total Coliform 1O8,NoCon coU100ml. SM209222B A («1) 05103/05 TLF Parcel I.D. # 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 015-111-13 HAA #b�ng2 nanr_� 1. GENERAL INFORMATION Complete legal description Lot 1; Block 1; Car Lynn Subdivision Location (site address or directions) - 10540 Our Road Anchorage, AK Property owner Randy 4lard Day phone 267-3164 Mailing address 10540 Our Rd. Anchorage, AK 99516 Lending agency Day phone — Mailing address Agent Day phone Address Unless otherwise requested. HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 y X E C E I V E D 3. TYPE OF WATER SUPPLY: JUL 29 1998 Individual well xx MUNICIPALITY OF ANCHORAGE Community well-\IVIR09MENTAL SERVICES DIVISION Public water 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 xx y 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.M (Aw. V91) Front MOAN21 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, 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 Address Engineer's signature ALASKA WATER & WASTEWATER.SVCS SHALL BE PAID $650.00 AT CLOSING FOR SERVICES PERFORMED. S. DHHS SIGNATURE �f _ X Approved for Disapproved. Conditional approval for Additional Comments L0 bedrooms. Phone 337-0 79 Date bedrooms, with the following stipulations: Date 6 — 7-98 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-=0; v. VS1) Bwk MOA W ilECEIVE Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES JUL 29 Environmental Services Division MUNICIPALITY Of " 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 349KIMWAL SERVICE; //��a �Health Authority Approval Checklist Legal Descripdon:.� i1/N S/�f &-r L 9111 Parcel l.D.: 015-111-13 A. WELL DATA Well type 121 UFE7C If A, B, or C, attach ADEC letter. ADEC water system number `/ A/ Log present (Y/N) IES Date completed /04,.Ie? Total depth a8 l /Cased to a� I Casing height (above ground) Q f Sanitary seal (YM) &Q Wires properly protected (Y/N) YIFS FROM WELL LOCI Data of test Static water level Well production T EST. g.p.m. AT INSPECTION --�la►I96 AL11 1% 9 9 - p.m - WATER SAMPLE RES U TS: I�1, Q Coliform Nitrate • qs j Other bacteria Date of sample: as _ Collected B. SEPTIWHOLDINO TANK DATA Date Installed $(9 3 T1a/nk size ASO 61K Number of Compartments oZ Cteanouts ON)._ Foundation cleanout (�f/N) �]Depression (Y/Q No High water alarm (Y/N) tiff Date a Pumping CJA4179 Pumper IS A ACS C. ABSORPTION FIELD DATA Date installed 8 B 3 Soil rating (g.p.dAI2 ft=/bdrn X00 System type �QFr�clJ r to n(^7ELG Length g! S Width `is Gravel tlUdmess below pipe `l6 Total depth 16 6 Sum? Effective absorption area '100V ManitWM Tube present R0 ADepression over field (YN) r`� Data of adequacy test 4;4178 Results qS�lFam rP&S For F u it. bedrooms Fluid depth in absorption field before test pn.); = 3'ns" Immediately atter 7 5 gai. water added pn.): - 33 Fluid depth = 3'i.5 '(1m) Minutes later. /I�� '' M Absorption rate . 6 00 < a.p.d. Percodde treatment (paastt,2 months) "o k' Cr K E(Y If yes, give date N/4 Z (Rev. sig8)' T S`""`p �xTENos aHy� 5.9 BELt1W (aSTdnSuTluA. PIPE ni✓E�tr 72-028 0R 'Is Sto Slfy OF ?kPolcr" q�" CrlrCTi✓& j�F/TH� GlWu�n LEt'EL5 Wim. AO3WVE0 BY aS.51'• D. LIFT STATiO��/ /�I} Date Installed ' "/' / Manhole/Access (V/N) High water alarm E SEPARATION DISTANCES `Datum ar gallons 'Pump otr level at* SEPARATION DISTANCES FROM WELL ON LOT TO: S� AT74coep SKE'Rf4 4 A3 6""T Sua-vrw i Septic/holding tank on lot 9� I f" 40/0F `/0 ( % TA"iK On adjacent lots Jori 1'/ 'F Absorption field on lot 9 9 'fo Y"9( Suµr On adjacent lots I oo '4 - Public sewer main NA Public sewer manhole/cleanout N14 Sewer /septic service line d S • Jt Lift station /✓�,4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 16'4 Property line S /4 Absorption field S Cs 7• Water main/service fine / 0 ��- Surface wateddrainage /00 Webs on adjacent kris /UU r4 SEP DISTANCE FROM ABSORPTION FIELD ON LOT TO: I property ne� arL' "�"Building foundation / V Water mein/service Ikre Surface water /OU Driveway, paridng/vehide storage area 0/ &7mic/r Ute. 41voe A Curtain drain ! lyl�-- xNfuww Weds on adjacent lots 10014- F. 004- F. ENGINEER'S CERTIFICATION WAw6/t_ V^' FILr= 4dWR9S 0039 y ► fi FF_4UF�GT Moo T- f A4eHo WR1von CTo '10' VT zE 4 /N 1) Se. 7.� Ts Y I car* that / !re date ru Held pecd and review of Munklpel rsQXM ft jpQ�blp�,eYsWM are In corrforrnarrce MOA gu el to effect an this dale. .! � OF A ,q r 1 •....'k S �1 Signature Engineers Date HAA Fee S '/ 7 Waiver Fee $ _ Date of Payment /%7� Date of Payment Receipt Number ,�7 71"f 3G Receipt Number 72-M (Rev. WOW i ry�e{{. x. . .. RN2�''� no.>� I.•._ C.E. _,•'•tai � Al6tinicipality of Anchorage D,4151 Department of Health and Human Services m- 825 "L'• Street Rick Alystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor hl:p::w:•.rv.ci.anchors, .aa.us 343-4744 August 10, 1998 Jeffrey A Garness, P.E. Alaska Water & Wastewater Consultants, Inc. 7320 East Chester Heights Circle Anchorage, Alaska 99504 Re: Lot 1 Block 1 Car -Lynn Subdivision, Waiver Number WR980046, HAA Number HA980200, P.I.N. 015-111-13 Dear Mr. Garness: Your request for the waiver of the required 100 feet separation between a septic system and a well has been approved. The approved separation is 95 feet from the on -lot absorption field to water well. This waiver also amends the existing waiver in place (WR950038) of 92 feet from the on -lot septic tank to water well to be replaced with 90 feet. These waivers apply to the existing wastewater system to water well only. Any future upgrade to either will require all separations be met or another waiver approval from this office. If you have any questions of the above, please call me. Sincerely, Z"/Zz:r'7 /��' Daniel J. Roth Civil Engineer On -Site Services Program ° MUNICIPALITY OF ANCHORAG.. Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR#LQRS0. 0()3R PID# HA# 11A9�03Lna Permit # Date Received: August 21, 1995 Legal Description: Lot 1 Block 1 Car -Lynn Subdivision Engineer: Ted Moore, P.E. Flattop Technical Services 14530 Echo Street, Anchorage, Alaska 99516 Applicant: Tim & Jean Mc Daniel Waiver Requested: Waiver of septic tank on lot of 92 feet from the private well lot line allowing trench to remain 0 feet from vronerty line Criteria: 1. Geology: Points: A. Water Table -it+ B. Soil SorFtion 4()(AVO C. Permeability %,() D. Water Table Gradient 2.15 E. Horizontal Separation TOTAL: 11.1 2. Special Conditions: 3. Other: ►9.'Z Waiver is Granted: X Waiver is NOT Granted: List Conditio2ns� or Reasons for above lbitse gwr�• W;,L f Sr.-vcnTAmL o �M1w6 cwlr WE -Ll $grt� Ti+�Y<< ' (� NCtiUf7E LF,✓si_ OF �� I �`✓�L Date: Rec #: tAFC,7 AA C- AAIAI Pt. MUIREM TJ 01221/2459 S By: N Amount: $ 625.00 of Reviewer Date Paid: August 21, 1995 --------------- -- - ---- - 11- -- _ _ . </ Z1 fri 2� -- -- - - -- - --- -- -- --- - -� ✓'/ l �LYC.��� . . S(HA. $Hro 1 HRL� IRS. 3.0 I:� - - _. 7 --------- �-------- ---� ___ _._ I T_ ._—_..___ .. __. _.___—__ �. � �A'Z S2 Vi?c.F �i/1M5�-� ((,(E . 4 � .� 9 %..�an1 .. _-..____. _- _ __. _.-___..___ .. _. _ _._. ___ _.__ _ __.. _.- .. -_ _ -_ .__ I ___. _. - _..-_-._______--____�_________-___.-__.__-_.-__'-._-__.--_. _... -._ __ _..__..._. .____l.. -.___. ._.__-._ Lt�c3<< CAILSID it e1911(7 ( REO IlAwLE) CISOOSS FS7 r/L�RlvE2 (F SEP7ic T'Je aN LOT U WPII fuR7i) ONST G `la' a> BE cAStty �REC'fF0 _ 3> NSE Low=Eo TA—k i7au�o (�fzf�� awrN, (tJ�LL { T^ -ix, \ 77/,4T ,S,OPC3 To"Aaos -GAM6E. -6EE plc-rc.4FSl A&�Z-L f/�r7c.�7 UC�firi9M6� YFlna� flnau v� G�e�� N�a� / "U ✓F�RDTSIUJ fri24UN/i li`16LL. He"o WEL" -T 11 u&'7N 12 61 &SIN& �S — FLcW S�p7fC 7vFy: — PSO 57L. ;�C..W'. Task — �rS7Rcu�� y�ala; —Awe. S 7-JALE 2.1 SOIL SgZf�•Tlonr Slsuo/Sif.7 O/j�' i.$Ol, t4uo tow llf'47 /S8' �d3S' 6F r . laq � � d.svcs = 3z2.51•f tii� 6 •J�,UIy ' SSCP+f 3ab 7ols cl/. fy pS) Rick Mystrom, Mayor l�IuniUpality of Anchorage Department of Health and Human Services 825 V Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 August 31, 1995 Ted Moore, P.E. Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99516 Subject: Waiver Request for Lot 1 Block 1 Car -Lynn Subdivision Waiver Request #WR950038, PID #015-111-13, RA950363 Dear Mr. Moore: Your request for waiver(s) of the required 100 foot horizontal separation of a septic system to a private well has been approved. The approved separation distance(s) are a private septic tank to the private well on lot of 92 feet; lot line allowing a trench to remain 0 feet from the property line. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincerer I� / James P. Williams Civil Engineer On-site Services JPW/ljm SER! G�yp MM & ENVIRONMENTAL ENGINEERM • ENERGY CONSERVATION 6 ANALYSIS THEODORE F. MOORE. P.E. 14S30 ECHO ST. PH: (907) 345-1355 ANCHORAGE, ALASKA 99S16 August 18, 1995 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK Dear Sirs: By means of this letter we are requesting issuance of a separation distance waiver allowing the existing septic tank serving the residence on Lot 1, Block 1, Car -Lynn S/D to remain in its present location which is 92 feet from the private well on the same lot. We are also requesting a lot line waiver allowing the trench to remain within 0 feet of the front property line. A site plan, well log, water sample test results and copies of other relevant documents are enclosed to assist you in your review. According to the as -built inspection report on file in your office, the wastewater disposal system was installed in September of 1983 and consists of a 1250 gallon septic tank followed by a 25 foot long soil absorption trench containing 8 feet of sewer gravel, with 4 feet of soil cover. On July 27, 1995 we tested the adequacy of the system by adding 748 gallons of water into it through the second compartment of the septic tank. The monitor tube at the far end of the trench extends to a depth of 140 inches below ground level, and the fluid depth in this monitor tube was 3 inches prior to the start of our test. The addition of 748 gallons of water to the system at 4.7 gpm caused no measurable change to the fluid depth in the monitor tube. Based on this data, the system appears to still be functioning adequately for the 4 bedroom residence which it serves. According to the enclosed drillei s log, the well serving this residence was drilled in October of 1983 and has a total depth of 281 feet, a yield of 7 gpm, and a static water level of 231 feet below the top of the casing. The soils between 36 feet and 133 feet are reported to be a gravelly silt. A small aquifer was encountered between 133' and 137', but this is underlain by clay and hardpan strata down to 235 feet where more gravel was encountered above the aquifer being drawn upon by the well. On July 27, 1995 the static water level stood at 239 feet below the top of the casing. Steady pumping of 748 gallons of water from the well at the maximum pump output of 4.7 gpm caused no measurable change in the water level in the casing. Based on this data we concluded that the yield of the well is in excess of 4.7 gpm, which is more than adequate for any single family residence. Water samples collected on July 27, 1995 were satisfactory, showing 0 coliform or other bacteria per 100 ml., and 0.89 mg/I of nitrate -N. Our measurements made at the time of the adequacy test show the monitor tube at the end of the trench to be 99+ feet from the well. In a telephone conversation with Robbie Robinson on July 28, 1995, I was told that this separation distance was verbally okayed by him, and that DHHS would not require issuance of a formal waiver for this well -soil absorption system separation distance. Subsequent plotting of other field measurements made between the well and septic tank cleanouts and house corners revealed that the actual separation distance between the well and the cleanout on the first compartment of the septic tank is 93 feet. This well -tank separation distance waiver request is for 92 feet, to compensate for underground portions of the tank being slightly closer to the well. The topography of the lot is essentially level, meaning that there would be no tendency for effluent from a leaking septic tank (were that to happen) to flow on the surface of the ground towards the well. The 235' depth of the water bearing aquifer supplying this well means that it is extremely unlikely that contamination originating near the surface of the ground in the vicinity of the well could make its way through the overlying silts and clays into the aquifer. The following is a breakdown of how waiver analysis points could be assigned per the 1985 "Separation Distance Waiver Analysis Guidelines for SCRO". Category Points Distance to water table (133' to 1/2gpm - 9' tank depth = 124') 7.12 Soil sorption (27'@ 0 + 97'@ 3.5)/124' _ Permeability (27'@ 0+97'@ 3)/124' _ 2.73 2.34 Water table gradient (assume 0% parallel to ground) 2.9 Horizontal separation (921 2.68 Total 17.77 Based on this point assignment, it appears that the requested waiver can be safely granted without concern as to contamination of the well from a potentially failing septic tank. This conclusion is bome out by the fact that the recent water samples showed no evidence of contamination. According to our measurements coupled with an as -built survey of the lot, the monitor tube at the end of the trench is 2 feet inside the east property line which fronts on Our Road. The requested waiver distance of 0 feet is to allow for possible underground projection of the trench up to the property line. Because the affected lot fine fronts on a road R.O.W., granting of the waiver will not impact the ability of any other septic systems to be developed on adjacent lots. Please give me a call if you have any questions on this waiver request. Sincerely, J� ltlo� Ted Moore, P.E. cc: Jean McDaniel 1 \ - - - LOT 6 (VACANT) LOT 3 CqR % [Y N \ CIRC[& LOT 2 WELL a goo 0 Poo ----------------- / LOT 1, BLK.1 L CAR -LYNN SID ° - -- - ------ -- 5 ne�z""; 0 GALLONSEPT ------------------- 25' LONG SOIL ABS. TRENCH W. 8' SEWER GVl- BELOW PIPE_ L+• o :•'� :�1' THEODORE F. pMOORL' f'i • CE -Cu-) LOT 24, SECTION 15 T12N, R3W, S.M. NO WELL FOUND WITHIN 100 FEET g Parcel I.D. Municipality of Anchorage Development Services Department *A9 Building Safety Division On-SiteWater and Wastewater Program 4 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 015-111-13 1. GENERAL INFORMATION HAA# 6/a 0IOa06" Expiration Date: V — Z q - O / Complete legal description Lot 1, Block 1, Car -Lynn Subdivision Location (site address or directions) 10540 Or,+' Road Current Propertyowner(s) Jon Kiefner Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 10549 Our Road Dayphone 346-4488 Anchorage. AK 99516 Day phone Janet Gorton Prudential Jack White/ Dayphone 762-3148 3201 C Street, Ste 200, Anchorage,—AK.-99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 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 sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. 5 & 5 ENGINEERING Name of Firm 17034 Eaglo River Loop Road No. 204 Phone O`I `('a 4 7 Eag a River, AlaSIM Address Engineer's Printed Name Robert C. Cowan, P.E. Date S�iolo� :=yr. OF Ai _h. '� n •Z ROURT C. COWAN 5. DSD SIGNATURE ,+1 o *w CE -8801 ✓ Approved for _� bedrooms. �fti Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist x Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other ON-SITE I" WASTEWATER i �..�• .c By: Original Certificate Date: (Rev. 12•CO) Municipality of Anchorage • Development Services Department Building Safety Division On-Sfte Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196850 Anchorage, AK 99519.6850 www.ci.anchorage.ak.us (907) 3437904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: J -0 T- I O L o r -IC I C• +.J - 'f/p Parcel ID: O / S- - f f f - / 3 A. WELL DATA Well type L&IyArc Date completed 70��A/t 3 Total depth a 8 I ft. If A. B, or C provide PWSID # = Sanitary seal OI) _Lt J Cased to Z fC —'ft. FROM WELL LOG Date of test 10/a.0 / t-3 Static water level '131 ft. Well production % 9 -p.m - WATER SAMPLE RESULTS: Coliform O colonies/100 mi. Date of sample: S- /f, /o t B. SEPTICIHOLDING TANK DATA Nitrate 1./I mg.A. Well Log (SN) Y E S Wires Property protected CAN) V 4 J Casing height (above ground) I a + in. AT INSPECTION S-/-0/01 Q 4Z ft. q.K 9•P•m. Xr LI IP -k,-* AY /*JMA Other bacteria O colonies/100 ml. Collected by: E A S ENGINEER 1176W—Eagle River Loop Read No. 204 E61114 elver, Aloka t19M Tank Type/Material S itf t i c- / S i B t L Tank size /.169-0 gal. Number of Compartments i Date installed Cleanouts &TI) q/ -V/ 83 Y4, S Foundation cleanout BYN) YIJ Depression over tank (YAO r �% High water alarm (YAO h+ 0 Date of pumping 4J/01 _ Pumper R o r o - 8 0 4 7-f- A C. ABSORPTION FIELD DATA % Date installed q I I/ ki Length a S ft. Soil rating (g.p.d.W orv&W / 00 Wklth 0 ft. System type Gravel below pipe T ft. Total depth 1�. ft. Eff. absorption area b o0 fta Monitoring tube YIJ Depression over field N 0 Date of adequacy test Sl H /0 I Results (Pass/Fail) PAs f For Al bedrooms Fluid depth in absorption field before test 1 in. Water added 6 T gal. New depthq 4- in. Elapsed Time: �Iv 0 min. Final fluid depth g in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N 6`e Absorption rate >= 600 g.p.d. K N o w 1w If yes, give date D. LIFT STATION Date Installed Size in gallons "Pump on' level at _ in. Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank1 itt station on lot 90 Absorption field on lot 9 S R in. High water alarm level at in. Meets alarm b circuit requirements? On adjacent lots / 00 On adjacent lots too � Public sewer main N 44 Public sewer manhole/deanout _ Sewer /septic service line r ,+ Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation /011- Property lineS r 4" Absorption field 1` Water main N %4 Water service line , 10 ,t Surface water 00 Wells on adjacent lots 100 rt SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: w P9.foGi 10 f+ W1.4 Property line 0 � � Building foundation Water main Water Service line %0 r Surface water 100 I + Driveway, padtirgWehide storage 0' Curtain drain N6 -t K wig 60w Wells on adjacent lots F. COMMENTS 7 Ar%A G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspecdons and review of Munidpal records that the above systems are in 5..,,. i, .... .....:..., conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name R 0 A kA C - OWAr Al�, ROSSW MlilWAN r% tiff iCE'f8801 Date NAA Fee S zoo, 1,0 Date of Payment Receipt Number (Rev. 12100) 5-110101 0a 4lfv5" Waiver Fee $ Date of Payment Receipt Number MAY -11-21J,01 UyISS S&S EMiINEERINU 9W 694 1211 P. Cj-"3 J lw rcyw ....w., ......... —.. --. -- ENYtRONVENTAL FACLRI£S IN ALASKA. CAUFO99IA. fLORIDA, M1LINOIS. MARYLAND, MICHIGAN. MISSOURI. NCW JERSEY, ONTO. VVIST vtRCINL CT&E lttvlronrtttotal SarMcss Inc. sr:rr�r�rs�a�aas�r� ...:. La; 10,44,31 = Cllcs: Naau s & s rrsiacrr Project NAtst:.m Lot i E"• 1 C ;- Lv= E1D CGmt Sampir ID Lot 1 IMI Cu Ly=SM Matras Ordrred Ey PWSID 0 Seetple Remarks: Mat AM; Prlatcd Dam?lma Ca`r»Le3 Datt?iam Recelred DateRlme Technical Director Releafed 05It(2001 1623 031,=.00, 11:100 0310 D01 11:25 Sttphm C. £de 41I Mlu UW rM Analysis POW—E, Rdahf PQL Units Maim Limits Date Dat Ilit W.Lezr DaystcA.out NihsrN I.11 0.500 MEIL EPA 3000 {<30) Kricrobiolocry Laboratory TotalCohlmm 0 0 colnWirl. SM189222B 05mg/01 SCL 05!08/01 KAP IUIIIL f1.U3 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 • i ; . CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA# klOCA �b31al Parcel l.D.# n15- 111-121 1.' GENERAL INFORMATION Complete legal description 1 -of h Otee k 1 ear - /_y.,., S/n Location (site address or directions) 10 SYa Our Ro ed Property owner Mi.n E Zen,? Nc 04,7 he f Day phone 2 7 6 Mailing address /a S'Yo 0" r qo( {}„�� y 4(r 94 y Lending agency Day phone Mailing address Agent - loan He PTY -e1. ERA ClCtu AM( Elf:' Day phone 276 -3333 Address 3333 VencrlL _(c',te /le A^c%oryp Ak lfr03 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: y 3. TYPE OF WATER SUPPLY: Individual well v Community well Public water NOTE: ':.1community well system, provide written confirmation from State ADEC attest- _ !ng to the legality and status of system. i + 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. ' rias [1«. vop F. t MOA@21 S. 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 furtherverify 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. -See ce.a weer rv�..rrf- NameofFirm FlpF�_y, %cAiniral SPwir#-/ Phone 3 as- rsss Address I ys 34, c A6c Engineer's signature Date 2121 /9s OF •l `F Y; ef e / * 921 • 'TAMP �.. •..•-.... e0,60Ue-.1e .! HEODORE F. OORE; /t Nc' CE -3589 • Q. 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for' bedrooms, with the following stipulations: Additional Comments . ,10 mumapenry or Ancnorage 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 engineers work:. 72-=m«.1A1) Deck Mwm I . . . I. l . .. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist rn c m Legal Description: _Iof 1. 3/6e1c 1, <ar- 4nn S/1b Parcel I.D.: (7 ry I'TI o A. WELL DATA C Wcll type Pro La Fe If A. B, or C, attach ADEC letter. ADEC water system number Z o 0 �c Log present (Y/1) Y &ol , h ed Date completed r o / 2 o/ 8 ? 7 - Total Total depth 2 B r ' Cased to 2B/ ' Casing height (above ground) 2,1" Sanitary scat (Y/N) Y Wires properly protected (Y/N) Y FROM WELL LOG AT INSPECTION Date of test 7/ 27 1PS- Static water level '239, Well production g.p.m. H. 7 rt 9 -P.M. WATER SAMPLE RESULTS: Coliform O cot/roomk Nitrate G. 89 nrq/-t' Otherbactcria none rt��arfrt( Date of sample: 7/-27/95- Collected by: Flal-&,A TieA Su c - B. SEPTIC/11OLDLNG TANK DATA Date installed 9/,9/63 Tank size 1 Z",?*/ Numbcr of Compartments 2 Cleanouts Foundation cleanout (Y" Y Depression (Y/1) N High water alarm (Y/N) _ N. A DateofPumping 1013/9Y Pumper S'SeuaE/ C. ABSORPTION FIELD DATA Date installed 9/,9,1,9-3 Soil rating (g.p.d./ft' or ft'/bdrm) loo a' System type TreA C4(Iolrn Length ? S Width Y' Gravel thickness below pipe '91 Total depth I t o Effective absorption area loo a' Monitoring Tube prescnt(Y" 'r Depression over field (Y" N Date of adequacy test 7/2 7 / 93' Results (Pass/Fail) Poxy For l bedrooms Fluid depth in absorption field before test (in.): 3 " Immediately aftcr74YB gal. water added (in.): 3 Fluid depth Go I Minutes later: 3 (in.) Absorption rate = > 6or, e,p.d. Peroxide treatment (past 12 months) (Y/N) Non a kA.�If yes, give date N. 4 D. LIFT STATION N• A. Date installed Manholc/Acccss (Y/N) High water alarm level at* _ Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* "Pump off' Icvel at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: VScptic/holding tank on lot 9 2' ( S'ee tt--t c 1 • On adjacent lots 1>IOO -f Absorption field on lot 9 9'F •Jv e. o _ ; On adjacent lots > too br ONH(, Sre ean...+rnf in war..cr rC5?4er/ Public sewer main N. A Public sewer manitolc/cicanout N. A Sewcr /septic service line 7> 2 S' Litt station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 20' Property line 12' Absorption field S' Water main/scrvice line 7 2S' Surface water/dminagc > Ioo ' Wells on adjacent lots > too SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 3s" Water main/servicc line > 25-' Surface water too' Driveway, parking/vehicle storage arca Parr er an &te- olr,a at Curtaindrain None see•t Wells on adjacent lots > Ioo' F. ENGINEER'S CERTIFICATION At°:e: TrepcA Gnaf n.ew./t.r %a6e Z' fra- See wai..e r re9Ner/ be.ieo! on / certify that f and review ojAfunicipal records f/nrt the above systems err in conformance with HOA fLLi guidelines in effect on this dat5, t K cry f o.t nofro(, s+/P°O a la 6 e Signature ••tee L ��'"�1ti ,` Engineer's Name r^eoo•(ore F. Nuore_ ��;• /�'•.�r,` r,r9TH I Date 'Z!, u /99S �1.•......................: - • c ,.c MOOR - HAA Fee S 3 0 0 2= er' F 3,,,g•9—• ''4441 Waiver Fee S 62S • Date of Paymentgp % - / C� Date of PaymentKiri Receipt Number _ ) 7_74 � ,77 Receipt Number Rev. 8/95 OSS: haa.wk.doc �1L CT&E Environmental Services Inc. Laboratory Division►iiiiiiiiiiiiiiiiiiiiii�����i������������������ Technical Director STEPHEN C. EDE Released Sample Remarks: SAMPLE COLLECTED BY: T.F. MOORE. 95.3170-1 LaboratoryAnalysis Report MateRef.# Matrix WATER 7 1' Results Qual Client Sample ID L1 ELK1 CAR -LYNN S/D Limits Date Date Init Client Name FLATTOP TECHNICAL SRV WORK Order 16682 Ordered By TED MOORE Printed Date 08/03/95 6 13:06 hrs. Project Name Collected Date 07/27/95 a 16:00 hrs. Project# Received Date 07/27/95 0 16:45 hrs. PWSID UA Technical Director STEPHEN C. EDE Released Sample Remarks: SAMPLE COLLECTED BY: T.F. MOORE. .................................................................................................................... ` See Special Instructions Above UA - Unavailable •• See Sample Remarks Above NA - Not Analyzed U'- Undetected, Reported value is the practical quantification limit. IT - Less Than D;i- Secondary dilution. GT - Greater Than r. 200 W. Potter Drive, Anchorage, AK 99518.1605 — Tel: (907) 562.2343 Fax: (907) 561.5301 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS. MARYLAND. MICHIGAN. MISSOURI, NEW JERSEY, OHIO. WEST VIRGINIA QC Allowable Ext. Anal Parameter -------------------------------------------------------•------------------------------------------------------------ Results Qual Units Method Limits Date Date Init Nitrate-N 0.89 mg/L EPA 353.2 30. 07/28/95 CMR .................................................................................................................... ` See Special Instructions Above UA - Unavailable •• See Sample Remarks Above NA - Not Analyzed U'- Undetected, Reported value is the practical quantification limit. IT - Less Than D;i- Secondary dilution. GT - Greater Than r. 200 W. Potter Drive, Anchorage, AK 99518.1605 — Tel: (907) 562.2343 Fax: (907) 561.5301 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS. MARYLAND. MICHIGAN. MISSOURI, NEW JERSEY, OHIO. WEST VIRGINIA AUG -16-95 WED 14:56 ERA FAX NO.. 2764372 P.01 i \1 4 CqQ cY� . ofI of , w e ..... ... ter, Q 4U O/. ,dos• R:•Ar •_ U �-o 1 _ a Fx/s►lual ErLb4. 0 P D'n M.nnni is )` �' •1 a7 �F 9 N•`` �p � Na wwd recta ITrp _ _ - o-- --- moo: :r. v -z w L.1C, �Q� � I I; wt.T li Ans-,.PDuI,..T- I (RPiCIL t3(-:Si��•,•R�is� t�c.c iWd!Ca,e�.+� .t SFanlla�Fnr.. , 95;./ Q; 2 K, ! 15wi�4 22 #TN -.r c, REce¢j.cicnrl �N "�• $ IT SHAM Bf. THE RESPONSIBILITY OF THE D /w4 19 vPK B OWNER OR 8V11DER TO PROVIDE EASEMENT :IIG1. Alro; ••1;1.. y7r.K�':, I' ' : a .O„ DESCRIPTIONS. CL 14AN AND RESTRIC-TIONS WHICH DO NOT APPEAR ON THE SrAn1r,T'IFr�/ Dw•.rwA' It'q,ti r REMRDEDSUBDM(,MNIKAT AND TOVERUY 1, •. c�)`y' PROPOSED BUILDIN3 LUZADE RELATIVE TO k�f k14'�a711ym FINISH GRADE AND UTILITY CONNECTIONS. LOT SURVEY CERTIFICATION LEGEND: Bonn Cao Monument (R)-Rceo Lu s Iron PID• Iw+oA.ut,u.� Lot 81tek=3= Aron QEF Cq.Pfe p Surviypl.. B Taek L') � IaroenATha Plot File No. Zoning District= 1 n Aje. r• < Anchorage Recording District, Alaska ' REVISIONS I DATE I BY WA Reeldenae of: • A • 5Teut KCMOKAeS, ALASKA Da/a:SC a: W. is F.B.:t Crld: