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HomeMy WebLinkAboutLILAC PARK BLK 2 LT 7ss n aafr ti� �rF �.,,.= i,,: �`',wi�. 5:" au,iu`u'� ��a- w`� �'a�< a,� :.. �.- .✓ Municipality of Anchorage Community Development Depattment Page 1 of 2 On -Site Water and Wastewater Program 4700 Elmore St. - P.O. Box 196650 Anchorage, AK 99519-6650 - http://www.muni.org/onsite - (907) 343-7904 ON-SITE WASTEWATER INSPECTIQN REPORT Permit Number. OSP1 81283 Z—I I &_1 PID Number: 015_1t7:t_31 New R1 Upgradel AARON & STEPHANIE STEELMAN 12241 LILAC CIRCLE Bedroomsoil Rating Total depth from original grade LEGAL DESCRIPTION Subdivision Block Lot LILAC PARK 2 7 Township Range Section SEPARATION DISTANCES To From Septic Tank Absorption Field Lift Station Holding Tank Sewer Line Well 115.7 135.3 N/A NIA 94A Surface Water 100+ 100+ N/A NIA COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Foundation 20.2 478 N/A N/A NA Curtain Drain 50+ 50+ NIA N/A Remarks *FULL ASSEMBLED PACKAGE I , t AGa 1". on level at IPump off level at Hiqh water alarm at make and model jElectrical inspections performeT;� lConditional Approval: Approved Tank to A+ HOME SERVICES Drainfield 3034 C01MT 3034 Inspector PANNONE ENGINEERING SERVICE BENCH MARK (Assumed elevation) ft 61eye_ Inspection dates: 1" 912012018 21A 9/20/2018 Location and description COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp lConditional Approval: Approved 7Z- -SEPTIC -1-11--� AREA -1990 REMOVED & REPLACED 17.OLF OF EXISTING TRENCH 17LFx 5.O'Wx2.0'ED,6.O'T.D. M3 W/MTs & COS AT ENDS M2 REMOVED LAST 15' OF FIELD TO BEND REPLACED WITH MOA TYPE 11 C3 C4 10.1+ C2 INSTALLED PLUG IN ABSORPTION FIELD(E) 1O.OLF FROM BEND USE AS RESERVE, 60LF OF DCO EXISTING FIELD REMAINING 60LFx5.0'Wx2.OE.D.,5.5'-8.0'T.D. DV Ci T2 b IN 135.3 48R -SFD -121.9 624 A )115.7 \�ABANDON SEPTIC TANK(E PER MOA CODE INSTALLED 15000 ADVANTEX (CATIII TANK W/ AX -20 POD W/ DCO & DV AFTER TANK \N z A B C FC . 6.5 27.4 D 0 TI 23.5 33.2 T2 34.0 36.9 0 C1 32.3 34.0 z < DV 62.5 32.5 2z DCO 62.8 32.6 43.0 C2 < 53.1 52.1 mi 51.2 50.3 1 C3 64.5 59.2 M2 Dote 9/28/2018 65.7 59.3 C4 64.9 52.6 M3 65.9 54.6 Ci T2 b IN 135.3 48R -SFD -121.9 624 A )115.7 \�ABANDON SEPTIC TANK(E PER MOA CODE INSTALLED 15000 ADVANTEX (CATIII TANK W/ AX -20 POD W/ DCO & DV AFTER TANK \N z 4- 5 - 6- CM 1 PROFILE SCALE: NTS om p D 0 DRY 8/02/90 0 <z 9- D 0 0 0 z < GP z 2z z < w W z DATE PERFORMED: < u- u u nr. rr. 6o7 TANK606.0 2.6' DRAW ROCK 4- 5 - 6- CM 1 PROFILE SCALE: NTS 7- 606. 8- DRY 8/02/90 9- SP/ GP 14 - DATE PERFORMED: - 80H 15 j0yW,4,'S0 NOTES- PNE ENG SVC, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 Dote 9/28/2018 RECORD DRAWING PHONE (907) 272-8218 FAX (907) 272-8211 W: 7H Scale 1 "=50' -• LILAC PARK B2 L7 4L.1 -a: NO015-2fl-31 AARON & STEPHANIE STEELMAN PERMIT NO. DRAWN ACP 12241 LILAC CIRCLE CE 8149 OSP181283 ANCHORAGE, AK Sheet 2 OF 2 Municipality of Anchorage P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 0 (907) 343-7904 o Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Department On -Site Water and Wastewater Section * * * * VARIANCE/WAIVER. REVIEW * x * * Waiver#: OSV181080 COSA#: Permit#:OSP181283 PID#: 015-211-31 Legal Description: Lilac Park Block 2 Lot 7 Engineer: Pannone Engineering Services Applicant: Aaron & Stephanie Steelman Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 4.0 feet. This waiver approval applies to the existing absorption field only. Any fixture upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. ■............................................................................. 1 Waiver is Granted: X Waiver is not Granted: Date: Approved by: ��t-�, &UA Name of Reviewer .............................................................................. I **** VARIAN C E/WAIVER REVIEW **** Poa,� d 1oI15�1 g 1cu--Q �4 # Steven R.Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com October 5,ZOI8 Subject: Lilac Park B2 L7 Lot Line Waiver } am writing to request a separation distance waiver between the recently installed drain field and the west property line to a distance of 4.1 feet. The lot line was staked and the field was located ten feet east of the lot line. But due to ornamental trees the owner and contractor wanted to save, the field got pushed tn4.1feet off the property line. The area tothe westofthe property line isundeveloped and does not encroach onto the neighbor's developable area. The system as installed will not affect the future development of this or the surrounding lots. Please contact me if you have any comments or concerns. Sincerely, Steven R. Pannone 14 Steven R.Pannone, P.E. Owner/Civil Engineer &4@i|ina: P.O. Box 1807, Pa|n1er,AK99645'IDD7 Te!ephon��f9O7174�'D2OO FAX: 1907" f -0 —t m I Z a v M —1 cn m � 3 0 \ LILAC CIRCLE —i Z p M Q Z p s'a CD m OX NORTH 274.42 a k � e e �J \% iC 6R Y 0 M;u 0 Z1. a o j tnl ? + Q -r ' o septic 16s ,f m m n s rrf ig f yl b i j ° O tS� r x c p,s 3- CD to CD to 46 (T3 lip tD p O 00 1 o.;. C Q l Q 0 $ii p m Ci Cr 1 o a ® a ErpQ yry t� 00 ® 0 b p' ® `00 7-y� '6 pC5 m 'O Cl p .fid.%' rOF 9 $� r 9•r... f h C co ® ® ' ,ggbJ CD 3 m ® rn p CIO v NiN J CR F� Oj cep. O Com} owi a O � N `L3 4J 41 @ go (D.+. KD 6U 0 fl Cr > 3 :05 5U Er[ti CD T O = 3@ 60 @ (n tD fV(ti `y„ ' I=- p O d � tn. p X Q. E;"'� 1CD CD (1) 'Cs K!R L> um)*0,�� m m -n W �-a-chi � � �g� z � � ' � d a.9 0 C) x v "` `�° G o K o" -9 u°, 0 `D X II 0 a {7� C S o a A 0. 0 z " p urCDmosu mCD z�s m� m z ` CD rn via I vas mW m cA 3��o 3 -ice o —t - (D ro tz Hca _ , %a 0 O N 4 '0 cog cr� 50 2 =-Ueco �to 00 ` -4 m� CD " 42 o H�r�crrr MUNICIPALITY OF ANCHORAGE yll l I t r On-Site Water&Wastewater Program ,,S , PO Box 196650 4700 Elmore Road �` �. . �" Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 t "` 1 http://www.muni.org/onsite Department 4NcHORNO- On-Site Wastewater Disposal System Permit Permit Number: OSP181283 Effective Date: 8/27/2018 Work Type: Septic Upgrade Expiration Date: 8/27/2019 Tax Code Number: 01521131000 Site Legal Address: LILAC PARK BLK 2 LT 7 G:2736 Site Mailing Address: 12241 LILAC CIR, Anchorage Owner: STEELMAN AARON M & STEPHANIE S Lot Size in Sq Ft: 76785 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 4 This permit is for the construction of: 0 Disposal Field D Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: a,1 ,� Date: "l Issued By: CI : � ( Date: 8097 16 EPLS MUNICIPALITY OF ANCHORAGE Community Development Department ro' ^ Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On-Site Water& Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION .3It Parcel I.D. 015271-31 Property owner(s) Aaron & Stephanie Steelman Day phone Mailing address 12241 Lilac Cir. Anchorage Ak 99516 Site address 12241 Lilac Cir, Anchorage Ak 99516 Legal description (Sub'd., Block & Lot) Lilac Park B2 L7 Legal description (Township, Range & Section) Lot Size 76,785 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field [j Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank ❑XJ Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 55i 1 Waiver Fees: Date of Payment: 3) (/C8 Date of Payment: Receipt Number: 691?263 Receipt Number: Permit No. nSP 01 02 .7 Waiver No. Permit App_ : ':..,c Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181283, Rebecca Carroll, 08/27/18 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181283, Rebecca Carroll, 08/27/18 MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT,herein the"AGREEMENT" made and entered into as of this II- Day of ., of 20 1; ,by and between ric5ea.,re.- R.l Y; i ,herein the"OWNER,"and the Municipality of Anchorage,herein the"MUNICIPALITY",in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein,the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System(AWWTS), described as located at(legal description) L; La(. i- r K 3 D Ll- 1 ).-)Li l L V.;.c.. C:. 2. Maintenance,Repairs and Alterations. (Owner is required to read, understand and initial each section) hroughout the term of this Agreement,the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in acc nce with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s),maintenance, adjustment(s),replacement costs,and inspection costs. This includes an annual maintenance fee(typically$400 to$600). caner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. 1,n,25____ Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system,which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 • J\,-- r` " Owner acknowledges that the Municipality may request records of maintenance and —7�—> repairs from the manufacturer's representative or maintenance provider. t/ " Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be V Owsessed in accordance with AMC 14.60.030. ner agrees to grant the Municipality reasonable access to test and inspect the WWTS. The Municipality will give at least 24-hour notice. V Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On-Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing idelines for the construction,maintenance and repair of the Owner's AWWTS. fv7fgt - Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title,and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions,nor in any way affect the validity of the Agreement or any part hereof,or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNER: /'$ By: - (signature) Date: � �� Li (print name) STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this 17- day of P\u(„J a- , 20j, by sC.g-.4.Sa�r •TARY : B •RAL S My Co ssi.• - pires: I% 20 MUNIIPALITY: By: C,L/t WA ,7�z�Z!' (signature) Date: :A?7 1 abe e ct\ (,.,rrv(I (print name) Title: (rev. 05/18/2018) Page 3 of 3 MUNICIPALITY OF ANCHORAGE DEPARTMENt OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 (~/.~-'~ ~ I / ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL DESCRIPTION Township, Range. Seckon TANKS '~' SEPTIC [] HOLDING TYPE OF SYSTEM ,~-rRENCH [J BED [] W, DRAIN [] OTHER Depth tO p~pe bottom from 'lotal depth Irom original grade Fill added above original grade FT Gravel length fetal absorpkon area WELLS [ 'P~RIVATE [] OTHER ddentifv) FT Classification (A,B,C) ] olal Deplh Cased to DISTANCES TANK FED WELL AS-BUILT DIAGRAM {Show location ol well. sepl~c system property Tines, Ioundat~on, driveway, water bodies, etc) Bale: Municipal and State guidelines in effect on Bis date: Health Department Approval: /~'~'~ ENGINEER'S SEAL 72-013 (3/85) .' ~uni¢ipality o{ Anchorage OEi~ARTN4EN'F OF t4~&LTH & HUMAN SERVI 825 "L" StFeoI, Anchorage, Alaska SOILS LOG -- PERCOLATION 1 5 9 10 li 12 13 14- 15 16 17 18 Township. Range, Section: SLOPE SITE eLAN I 19 WAS gROUND WATER ENCOUNTERED? . IF Y~. AT WHAT DEPTH? I I NOTE: All Dimensions And Locations Must Be Field Verified Prior To Construction .SEWER SYSTEM'LOCATION-PLAN NORTH su~vey:l.n.g ~echntques.,: .:' ?,!:.; · ' ' , DEPARTMENT OF Id -EA[,-~ H &ttUMAN SERVIC 825 "L" SGeoI. Anchorage. Alaska 99502~656 SOILS LOG ~ PERCOLATION LEGAL DESCRIPTION: 2 3 4 5 6 7 8 9 10 11 12 13 14 15 17 18 19 20- SLOPE ¥, ',NAS GROUND WATER ENCOUNTERED;' . IF YES. AT WHAT DEPTH? S(TE PLAN PERCOLA't'(ON PATE ~ (m~u~c~k:~h~ PERC HOLE DIAMETER ~'// 7 pERFORMED IN F MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 625 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 o.-S,TE SEWAGE D,SPOSA. SYSTEM AND/O. WEN ,.SPECT,O..EPO.T - ABSORPTION Address TANK FIELD WELL Phone(s) W~LL Permit No. No of Bedrooms TANKS M' SEPTIC ~ HOLDING TYPE OF SYSTEM __~TRENCH ~ BED ~ W. DRAIN ~ OTHER Total absorphon area ' Number el/lies Soil~0 S0 FI Pipe materialp~ ~ATE E OTHER (Identify) Class~hcahon (A,B,C) I Total Dep[h Cased Io 72-013 (3/85) DIVISION O~ GEOLOGICAL AND GEOPHY~ ICAL SU~V~Y~ LOCATION OF WELL DIRECTIONS: MEASURIN(~ POINT: ~]top of caaing ~ground ~ur~ace BOREHOLE DATA: ~othar: Depth MUNICIPALITY OF ENVIRONMENTAL RECEIVED DATE OF COMP LET~ON: METHOD OF OR~LI,ING: ~air rotary ~cable tool J~other: USE OF WELL: ~domestic ~irrigation ~monitor ~pub~tc supply []other: c~szt~s: stick-up_ ,~,_t't. oLar~: ......... ~ i~ WELL iNTAKE: ~ open end [] perforated [~open hole Dopth$ of oponing$'.____~ to Et SCREEN TYPE: .~_. _. Diam: in Slo~/Neah Sizp:__ __bength: Set Betw~otl and ft GRAVEl, PACK TYPE: Volume used: Depth to top: GROUT TYP~I~ ~ Volume: Depth: f~Om ft to ........ ft DEVELOPHENT HI~TIIOD: Duration: P[R,IP!NG bEVEL ANn YIELD · : ~ /~0 ft after 7 hfs pumping__/~, gpm PUMP INTAKE DEPTH:,.. ft l{or,Pepower: Date Pump Installed ~ WATER CHEMISTRY SAMPLE TAKEN? ~yeo j~l'no We~l d%sinfected upon completion9 [~ve ~n PLEASE MAIL WHITE COPY OF LOG WITHIN 45 DA YS TO: D GGS PO BOW 77-2116 EAGLE RIVER, AK. 99577 / / /_.07' 8 PLOT PLAN AS BUILT ~( SCALE I il.thy cL.l~y that I have rarveyed the fonowin~ d~scri]~8 ~o~: . ~ ~l ~o~ ~ ~d do not ~cr~ cato tks ~op.ty ~dj~c~nt th.itc, that no ~~ on ~t ~o~ l~ff ad~c~t ~to ~ncr~ on ~t su~lytd pr~mis~ ~at th~t ~t no r~dways, ~i~don l~u ~ o~tr v~ibh e~ts on s~d prop.t7 except ~ ~cated h~eon. l~ttd~tkt IG~yof ~O~M~I~,19~ ,at ~ch~ag%Alaska It ~ ~]t r~b~ of ~e o~ to dtt~t the e~ence of any easements, covenants, ~ r~o~ W~ do not ap~ar on the receded ~sion plat. 1731 George Bell Circle Anchorage, Alaska 99515 (gOT) 345-6476 ~....~ ' ~ / ;'~ .. , '.. :,.,.,- l? '~'- ~ ~,...~,. ,~' i':)/' )i-'~/?0 % '/ '~ ...... :'- ./ X · ',, ~OTE: Ail Dimensions ~d Locations Must Be Field Verified Prior To Construction · SEWER. SYSTEM 'LOCATION-PLAN ~OT I eL~K I SUeO~WS~O~ ;.~;'4',~.'~'~ ,....~..~. '%, ~;¢) -~ ~1111~ IIII1~ so.ti, ~ . I I UNICIPALIfY OF ANCHORAG �.r f SEP ` 8 2018 X. Development Services Department "07 On -Site Water & Wastewater Section Certificate of On -Site Systems Approval Parcel I.D. O 15-211-31 1. Expiration Date: ( Jan o z a O 1 1 GENERAL INFORMATION Complete legal description Lilac Park, Block 2 Lot 7 Location (site address) 12241 Lilac Circle Current property owner(s) Stephanie & Aaron Steelman Mailing address 12241 Lilac Circle Real estate agent Gina Bergt 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone Day phone 907-230-9699 4. TYPE'OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well- 0 Private Septic El Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: W COSA to be released to the enginly, unless otherwise requested by the engineer. COSA Fee $�"1 • Waiver Fee $ Date of Payment �la� lr� Date of Payment Receipt Number ������ Receipt Number COSA # U JCI 151 Waiver # 5. STATEMENT INSPECTION BY ENGINEER A9 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 myobam is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. | further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspeotion, the on-site water supply and/or woot*wobar disposal system is (are) in compliance with all applicable Municipal and State codes, urdinanoen, and regulations in effect atthe time nfinstallation. �nDOE����O'D��'�O Q07-���_7��7q N808OfFi�� Forge � Engineering �/ � P�0n8 "°' "�-°- " ' '� 01"l�l����O773�np�OF@�� /l������� /\dd[8sS` ^^^~ "--`"''+'"=' Anchorage, [�(�[UBOl'D ��(��'U<�[ �]�� �/�A/1�� En�in88[�PhOt6dN8Dl8 -Benjamin � Schiller, ' ' ^- Date `°"�`° '° co TH 6. DSD SIGNATURErl System #1Approved for __!b8dn3OOOS C 1, �_ ;1011 SySt8nl#2Approved for bHd[OOrOS ;�` C 12592 vFopi 9/28/18 Disapproved kk� Conditional approval for bSdr000S. with the following Sbpu|8tiOOG: By: 6Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD)issues Certificates of On -Site Systems Approva|(COSA) based only upon the representations given inparagraph 5bvanindependent professional civil engineer registered inthe State ofAlaska. The Municipality ofAnchorage is not responsible for errors oromissions inthe professional engineer's work. CO8ACheCNkst Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory,'`, /\[sGOiC Advisory ~ ~ Other Legal Description: Lilac Park, wl [cn 2 Lot 7 A.WELL DATA Well type'[z[/`~^~'v�t� If A,B.nrCprovide PVV8|[)#__ 1 O-1z1-[�0 �/ Date completed '° ' ' "" Gon�aryaea| �YN)_,__ Total depth166ft. Cased to166 ft. FROM WELL LOG Date oftest 10-1/�-QO '~ ' ' ^" Static water level '°~ 1��� ft� WellWellprproduction1� on '" 9 -P.M. WATER SAMPLE RESULTS: � Coliform KJ g_co|onies/1OO mL Nitrate 3-25 mg/L Arsenic ND ug/L Date of sample: 7/16/18 Ifmore than 1septic system kmonthe lot: COGAChecklist # -of ___ Structure served bythis system D1���}1���� Parcel |D�" '" '- ' ' ° ` Well Log (YIN) / \^ Wires properly protected (YYN)_,_______ 1� Ce�ng����b�egm��in. AT INSPECTION 9/12/18 1z1� .,^- ft. �.Q7 - - � 9 -P.M. Collected by: FO[OB Engineering - B.SEPTIC/HOLDING TANK DATA Tank Tvpa/Mahsho| Ad/ant=^/'beFglass. Date insta|ed9/21 / 1 8 150M � `� Tank size ga|. Number nfComps�mentn~�__ C|eonoute(\YN) ' / /n /� Foundation cleanout (Y7N)\/ Depression over tank HK] (YIN) High vvateralarm (Y/N) KJ KJ��VV (`ODSfFU[�f'OD Dote of pumping Pumper New Construction u ��O/1R �[l �_VU'� D�e�����~�~^~ Soil rating Az.p.d»2or*��r�=/� System �ew-vviee � Left. �7 ft. �Width~ ft. Gravel Y �ft. ��� y� �� n Total depth �� ft E��abaorpdonar�o�1 /�^ Monitoring tube / Depr�oaionover�e|d/ �» Date ofadequacy test New Resu|te(Pooa/Fai|)For bedrooms Fluid depth inabsorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth______ in. Absorption nate >= g -pd. D. LIFT STATION Date installed Size ingallons ___ "Pump on" level at in. "Pump off"level at Datum Cycles tested Mm PWanho|e/Acoeos(YYN) High water alarm level at in. Meets alarm & circuit requirements?_____. E. SEPARATION DISTANCES WELL ONLOT TO: �� - ' . 1OD' Septic e�m��mK0- �n��nonk� '"" On �� '/uu ' OO ' Absorption field onlot �,1~` O0Onadjacent �� �v'1"~ / �"7�C' Public sewer main '~ Public sevvernnanhole/cleanout >100'^~~1�O �� Gevver/aeobceen>^-~' >1�O/ service line Holding tank / w`� Animal containment areas >50'~`c�O' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ONLOT TO: /l/ ��1 Building foundation /v Property line >51 Absorption field /' VV D Water main >1 '" Water service >10'ce|ine ^~ 8urfaoewater _ Wells onadjacent lots >1 00' ABSORPTION FIELD ONLOT TO: ^ .� >1 00' ^� �J�' >1 0, >1 0, Property line ' BuUdinQfoundat�n__`_..^____ Water main '~ ' OO VVa�rSeniceline >10' Surface ��~1 ce�a r >1 00' Driveway, parking/vehicle storage >1O' NOD��N0f�d >100'Curtain drain None Noted ^~~ VVe||sonad�oent|otu_._._=.�_ E COMMENTS +�� |r`f |' ' ' f;| ������ m� /i[l�� \���\\/��[ �[l file G. ENGINEER'S CERTIFICATION / certify that / have determined bhn»uAh fieldinspections and review of Municipal records that the above systems are in conformance with MOA CO3Aguidelines ineffect on this date. Benjamin ` �� ��'U []��49 TH ����������iyl ��(�//!n��[ / �_ EngineersPhnt�dNan�e ' ` 1 /l��/1 �� / w/��/ / �� DateBen' in Schiller C 12592 10/2/18 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING L~\,~, - .0,/\-%~ HAA# 1. GENERAL INFORMATION Complete legal description Lot 7; Block 2; Lilac Park Subdivision Location (site address or directions) Property owner Mailing address 12241 Lilac Circle Anchorage, AK Scott and Lisa Baird Day phone C/O Bonnie Mehner JACK WHITE CO. 3201 "C" Street: Suite 100 Lending agency Mailing address Agent Bonnie Mehner/ JACK WHITE CO. Address 3201 "c" Street Suite 100 Anchorage, AK Day phone Day phone 563-5500 Anchoraqe, AK 99503 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well x×x Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Fronl MOA 921 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 inves_tLgation 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 ¢ ,:?,'..',;.',; Phone ~.. . Address C/ha4 ~....,.,t~'dv~.,r,,l~,~,~oa?'No..20.4, ~ agle ~ Engineer's signature Date /,/ Approved for ' ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: 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 DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LoT- ri d'L.~-- 7_ ~_lz./~c_. P/t,'d< ~/,0 Parcel I.D. A. Well Data Well type ~,¢-lu'~ Log present(~N) Total depth Sanitary seal~q) ¢~-~- Wires properly protected (~N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed /O/14-//?O Driller Cased to /~,G Casing height '7'EJ FROM WELL LOG g.p.m. Date of test Static water level J~ ~-- Well flow Pump level1 /6© ' AT INSPECTION ; On adjacent lots ; On adjacent lots SEPARATION DISTANCES FROM WELL TO: Septic/C~tank on lot Absorption field on lot Public sewer main Sewer service line Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform (__..)//C)O,~-~ . Date of sample: /~/2_./¢ ;~ Nitrate (-~. ~ ~--~ Other bacteria '7-//Z~/¢3 Collected by: ~-~' B. SEPTIC/H~i~,fl'~ TANK DATA Cleanouts(~N) High water alarm (Y(~..~, Date of pumping 9/~'/~.-~ Tank size /~-~D~) Compartments Foundation cleanout ,~) ~'~J Depression (Y/~ ,."~'-~ Alarm tested (Y/N) Pumper /~C~,.~ /~U*44,'c//JG SEPARATION DISTANCES FROM SEPTIC/H~!L~"H~SP'TANK TO: Well(s) on lot To property line ,.~ Surface wateddrainage On adjacent lots Absorption field Foundation /~/ r Water main/service line /o re. 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Manhole/Access (Y/N) Size in gallons Vent (Y/N) "Pump on" level at ~1 at High water alarm level ~ested Meets MOA electrical codes (Y/N)_~.~~ SEPARATION DIST~M~"'E~ROM LIFT STATION TO: ~ On adjacent lots Surface water Soil rating (GPD/Ft Gravel thickness Cleanout present (~4) Results ~/fail) D. ABSORPTION FIELD DATA Date installed ~ / Length ¢~-~' / Width Total absorption area Date of adequaoy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water System type Total depth ~.~',~' -- / Depression over field (Y/~_)~ ,,,.~'o for ~'- Bedrooms After test O If yes, give date /C///~ On adjacent lots /¢-~-~/¢' Property line }~---) To existing or abandoned system on lot Cutbank /¢o,~'E ¢~E--C~-~T Water main/service line ~O,kJ~/~_jE/~?- Driveway, parking/vehicle storage area ~ O / Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA Signature ~ ,.~ '~.l¢~,N~,i~l.N~~'~'~'--'~'''~--'-~ Engineer's ~,,9~u J.,,~,/, ............. z., Date ~ ~// this inspection. HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING /~) \.~ - ~\ / '-~'/ HAA# ~0I 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property owner Mailing Address //~- ¢?/ ~'~¢~.-~ (c) Lending Institution Mailing Address //~ (d) Real Estate Company and Agent Address Telephone /~ (e) Mail the HAA to the following address: (or check here ~ for pick up.) List contact person and day phone number below: / Telepho~: (h, pme) _ /C'/~/¢' Bu.,,siness ,~'d E' -")-¢6~/ · Tale--phone/~ ///~./?~//,¢_'.'¢" 2. TYPE OF RESIDEN,.C~~ Single-Family~ Number of bedrooms ~ 3. WATER SUPPLY J ./ Individual Well ~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DI~AL On-site~ Public [] Community[] Holding Tank Note: If community well system, must have written confirmation from the State Department o.f Environmental Conservation attesting to the legality and status. 72-025 (Rev. ?/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION ~ As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of th is 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. 6. DHHS APPROVAL Approved for ~k~ bedrooms by /~ ~'¢/) Approved X~ Disapproved _Engineer's Seal Date / 6 -- c7- ~/~/ ,/ Conditional Terms of Conditional Approval ~;',111 ['ii The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back ¢ Page 2 of 2 A. WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 MUNICIPAUTY OF ANCHORAGE NMENTAL SERVICES DIVISION OCT - 1 1991 Welt Log Present (Y/N) Total Depth Legal Description: R j~ /'~/kT~/'"~'~"/'~--~'"' If A, B, C, D.E.C. Approved (Y/N) /(/~/,~'. Y Date Completed //~)/fZ~ Yield /~' 'Cased to_ /~'~'"/Depth of Grouting /~/~r Static Water Level _ /3 ~:~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot Pump Set At /~0 / Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) o ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments /'2.¢~ / ; On Adjoining Lots ~'/(--)O /' To Nearest Public Sewer Cleanout/Manhole /O/7/~r' Date / B. SEPTIC/HOLDING TANK DATA Date Installed '¢~/'¢".~_S ze l~/~dg No. of Compartments ~-- Standpipes (Y/N) /'~' Air-tight Caps (Y/N) _ ~ Foundation Cteanout (Y/N) Depression over Tank (Y/N) ,/~ Date Last Pumped Pumping/Maintenance Contact on File (Y/N) /¢~/¢¢- ;for Holding Tank High-Water Alarm (Y/N) /~ Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTiC/HOLDING TANK: To Water-Supply Well To Property Line To Water Main/Service Line /"Ir' To Building Foundation /'~ / 'to Disposal Field /y.~' t To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88} Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field ,-~ Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Statndpipes Present (Y/N) Date of Last Adequacy Test Length of Field Depth of Field Gravel Bed Thickness SEPARATION DISTANCE FROM ABSORPTION FIELD: / '~ / To Property Line To Water-Supply Well To Building Foundation /'<~ / Lot /¢~/7r~ To Water Main/Service Line ~ -¢"<:~ ! To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Existing or Abandoned System on ; On Adjoining Lots ~l~ To Cutback (if present) , X-,';,",4 Comments D ' LDlaFt~ ~nTs ta~lleOdN. Dimensions Size in Gallons Manhole/~___ "Pump On" Level at /~/~~ff" Level at_ High Water Alarm Level at ././'~__~ Vent (Y/N) ___ Tested for ~ /--! Pumping Cycles d~14.~ng Adequacy Test. Meets MOA Electrical Code~.Y~~ ~.-~.~t., ~ ' Comments ~ "Ohec PermT Bedroom ting Against HAA equest" I certify that I/h, Cv'e~cJ~ecked,/~vC~ied, or conformed to all MoAi"~hd i n s pa ct ion./////~¢¢//// Signed ,/////.~'/~f/.~.,,~ f~/ / Date //,~//~/~.-~) /" E nginee r's Seal MOA No. ~"~' ~-'/"~"" ~ Receipt No. Date of Payment /¢]' / ~ ~/ Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL IABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. TO BE COMPLETED BY WATER SUPPLIER # Ph~ ~. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Ale aka 99518 DriRking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY LABORATORY Mo. Day Year SAMPLE TYPE: [] Routine I~,.~,~ '~'~_._~T' [] Check Sample (for routine sample with lab ref. no. [] Special Purpose [] Trsated Water [] Untreated Water SAMPLE Time No. LOCATION Collected ~ [L~-r q- ~h~ .... J I Collected Analysis shows ibis Water SAMPLE to be: a~ory U Unsatisfactory E] Sample too long in transit; sample should not be over 30 hours old at examine[ion to indicate reliabJe resulls. Please send new sample via special delivery mail, Date Received .... Analytical Method: Membrane Filter · No. of colonies/100 mi. Lab Ref, No. Result* Analyst so?l L BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TNTC- = -Too Numerous To Count ' ' Membrerm Filter: Direct Count Verification: I..SB BGB Fecal Coliform Corlflrmatlon Colllorm/10o mi Collfor nv'100 mi p,m, CIIEMICAL & GEOLOGICAL LABORATORY 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: {907) 561-5301 AHALI8IS REPO~? BI SABLE for HO~Kordort 38708 Dote ~opo~t Printed: 8[P 80 91 ~ 08:55 Client 8ample ID:INITIAL TEST NEW ~LL L7 B2 LILAC PHMID :UA Collected gE? 26 91 { 13:12 Completed :OEP 27 91 Laboratory 8upe~vlepr )8~gPltEN C. EDE Client Name :A~ RI~ Client Ae~t :flLVENOT BPO t PO ! NONE RgCEIYED Roq ! O~ao~ed By Chemlab l~ef It: 915091 Lab 8apl ID; I Netllx~ Allowabl* ?a~ameter ~e~ted ~e~ult U~t~ Method ROUTINE 8A~LE COLLECTED BI; J. FELTON. ' SUB. I ~e~t~ ?o~fotmed ' 8es 8peclal In~ttuettom Above U&-Unavmllable ND- Hone Detected "See 8~ple Re~tk~ Above HA- Not Analyzed LT-Loe~ II.n, O~-O~eato~ II~n ~,~SGS Member o! the 8G$ Group ($ocldt~) GOnOmle do Su~ell}..oo> i%3- PLOT PLAN .. AS BUILT J< I]CAL]-; I% $(~_' ORID. 'Z.~, JOB 1,1o_.~o- ~ ~t ~O~F ~u ~ 4o mot ~ onto ~t Fo~rty ndj~c~t ~eto, that no ~/.~ ,.