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CROMWELL HEIGHTS BLK 2 LT 3A
Cromwell Heights Block 2 Lot 3A #015-332-28 Municipality of Anchorage Development Services Department Building Safety Division =• -' _ �, (*0V On-Site Water & Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number. SW090002 PID Number. 015-332-28 Name: MARK ZIMMERMAN Wastewater System: ❑ New ■ Upgrade Address: 7250 LAKE 0 THE HILLS CIRCLE *ANCHORAGE, AK ABSORPTION FIELD Phone: No. of Bedrooms: (907) 346-2444 *3 0 Deep Trench Cl Shallow Trench ■ Bea O Mound OOlher LEGAL DESCRIPTION gal Ram. 0.50 Dsplh SEE DWG. rt. SEE GPD/Sq. Ft. Block: Lot: Subdivision: Depth b PIM bosom from odgiow pads: GrwN depth b ,h Pip, 2 3A CROMWELL HEIGHTS SEE DWG. n. 0.51 rt. Township: Range: Section: — — — res added pew• orlgh,al grad•: Grp../ I*Vh: 67 SEE DWG. In. FL Gravel width: Nang al eros: Daloms wt;. does: WELL: ❑ New ❑ Upgrade 18+ Ft.3 5 Ft. Cbewlkawn Pdwl•. A.S.0 : Tqa D•p Cased To:(sawcCR) Teta ab tion onw: gyps matwbl: D 3034/ F-810 n n. 1206 so. r Griller. Das D~ stow WWK Lwa: kwt~. GREY'S CONSTRUCTION Dale MbINM; 1/19-21/09 rL nae: baro Sa At: C." Wight Alwve Uwe: TANK GPY n. FL SEPARATION DISTANCES ■Septic ClHolding CIS.T.E.P. 0Other* To Septic Absorption Lift Holding br•:/PdNote lbnaoclw•r. ANCHORAGE TANK Gapeciq w gabns: 1250 From Tank Field Station Tank es sw un•s Well 100'+ 100'+ — — 25'+ WIwW: STEEL Numew of ewnpalmenU: 2 Surface water 100'+ 100'+ - - - LIFT STATION Sir• M gabm: Wrwlaclww: Lot Line 5'+ 10'+ — — — M Irv•1 ftpump oil a: Nph welw obrm a: Foundation 5'+ 10'+ — — — Curtain Drain 25"+ 25'+ — — — Pump Na4 l: u•cvka Yupeclune pwlormsd M: Remarks: OLD SEPTIC TANK WAS COMPLETELY BENCH MARK Lmmon and pe•crfpem: "A' ABANDONED PER UPC GARAGE SLAB AT POINT *SEPTIC SYSTEM SIZED FOR 4 BEDROOMS. Aewm•d Eb.alwn: 100.00 R ENGINEER'S WEAL Inspections performed by: GEG, Ltd. Dates: 1st 1/19/09 040 4L 2nd 1/20/09 OF o•. o ��.... qsN0 3rd 1/20/09 v .• Development Services Department Approval 4 _ 0 . :..... p........... .. Conditional approval: Date: 0 0. "' " : c ess: 0 CEj 79 ep0 I Ilgl��oo �4p°Professla�°o= Reviewed and approved by: 9 Date:S 4 �4po�000. (Rw. 4/0e) PERMIT NUMBER: SWO90002 T N ST1 37.79 53.08 ST2 43.02 60.31 DBL1 49.17 65.98 DBL2 50.20 66.80 MT1 57.83 76.24 C01 54.42 73.10 CO2 1 52.39 68.94 CO3 51.001 64.98 MT2 52.17 65.09 MT3 115.27 127.03 C04 116.29 127.81 C05 116.56 126.78 C06 115.57 124.22 MT4 113.01 121.63 / AS -BUILT DRAWING P015� 1332.28 ' I SEPTIC SYSTEM SIZED FOR FOUR 4 BEDROOMS MICHAEL ANDERSON P.E.'T ."..'�••: TEST HOLE TH/ •:''.: +�. / \ ALTERNATE SITI WILL REQUIRE AN ADVANCED TREATMENT . MICHAEL ANDERSON P.E. TEST HOLE TH/11 \ \00 \�Pprk• \ f4' GEG THJ1 MTI \ A E%ISTII \ BEDROOM C I 1 MT2 I \ CD GO T4 EW 1250 GALLON \ SEPTIC TANK REBUILT BED / 18• X 67' / / APPROXIMATE LOCATION OP\ \ CURTAIN DRAIN RAN PER ANDERSON ENGINEERING � INSPECTION REPORT(95) \ _ \ � SQ: \ \ 1'-40' GARNGSS ENGINE RING GROUP, Ltd. 4 T - CONSULTANTS S GENERAL CONTRACTORS.- :•_- "•... •' """"""" 3A1 L TI0 TA -0. M 101 . $10410.4[. M M T . A . r4.' Iw)1 =" • e •••.,r.ry.w�•{w.. PREPARED FOR: PHONE NUMBER: PAGE NUMBER: �• •• •••••• ••• MARK ZIMMERMAN 1 346-2444 1 2 OF 3 QQ p .';J r A. Garn ss. - LEGAL DESCRIPTION: DRAWN BY: QO°o,. ' , E 79 CROMWELL HEIGHTS, BLOCK 2. LOT 3A K.D.M. �D�e . 1..01.�< e ate TYPEWORK: DATro Tessio . 2009 ��D�DDoo�� ASS 1/28/2 -BUILT DRAWING I28 I PERMIT NUMBER: AS -BUILT DRAWING PARCEL ID NUMBER: - SW090002 015-332-28 TOP OF TANK AT INLET = 96.58 INVERT OF BUNG AT INLET = 95.97 INSULATION FINAL GRADE = 100.18-100.39 f I ST1 ST2 /TOP OF TANK AT OUTLET = 96.54 NEW 1250 GALLON SEPTIC TANK BOTTOM OF THE ORIGINAL BED WAS 95.14. REMOVED CONTAMINATED SAND, AND REPLACED WITH MOA APPROVED SAND GEG TH#1 r -FINAL GRADE = 99.98-100.44 TOP OF SAND = 95.14 - -INVERT OF BUNG AT OUTLET = 95.76 .TER FABRIC ELATIVE ORIGINAL GRADE = 99.14 INVERT OF DISTRIBUTION LINE - 95.65 (AVG.) BOTTOM OF BED = 93.98 (AVG.) RELATIVE ELEVATION OF GROUND WATER IN GEG TEST HOLE #1 ON 12/30/08 = 86.60 RELATIVE ELEVATION OF BOTTOM OF GEG TEST HOLE #1 = 85.10 GARNESS ENGINEERING GROUP, Ltd. /, CONSULTANTS 3 GENERAL CONTRACTORS �.a•�-- - 370, L now lKQ. wrt tai • ori,owcc Al waor . w,o,c (w7) 7"ln • rm y...ro..., PREPARED FOR: PHONE NUMBER: PAGE NUMBER: MARK ZIMMERMAN 346-2444 3 OF 3 LEGAL DESCRIPTION: DRAWN BY: CROMWELL HEIGHTS. BLOCK 2. LOT 3A K.D.M. TYPE OF WORK: DATE: AS -BUILT PROFILE 5/12/2009 (R.AIM3) �a0p0 .. ... ..............0 /.. .. ....... ....P •• of r A. Garness. O O r E-795j� G�: �k4p .DOS _ ••5�12<I� lcAo -- MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program I l 4700 South Bragaw Street V I I Iq P.O. Box 196650, Anchorage, AK 99519-6650 V (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW090002 Legal Description: CROMWELL HEIGHTS BLK 2 LT 3A Design Engineer: 0855 GARNESS ENGINEERING GROUF Owner Name: MARK ZIMMERMAN Owner Address: 7250 LAKE O THE HILLS CIR ANCHORAGE. AK 99516 - p9D JILPb Date Issued: Jan 06, 2009 Expiration Date: Jan 06, 2010 Parcel ID: 015-332-28 Site Address: 007250 LAKE O' THE HILLS CIR Lot Size: 62702 SO. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: 0 Disposal Field Z Septic Tank Holding Tank E] Privy E] Private Well E] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by catling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By. Date: 6 O Issued By. (y_ar/rIQH/lfiyti Date: Mtmicipality of Anchorage (;,ff CO. hm 196W • Anchoml e, Alnsluk fFA5196 650 . 470) Elmore 1641d \,..^ 011icc: (107)34 MV1 • rL%: (017)14.4-f�VN) hup://w���c.munLorg Mayor Mark Bef/ich Dcvcloprncnt Scr%3ccs Dclmrtnient January 6, 2009 Jeffrey Garness, P.E. Garness Engineering Group 3701 E. Tudor Road, Suite 101 Anchorage, AK 99507 Subject: Waiver Request for Cromwell Heights, Block 2 Lot 3A Waiver Request WR#: 090003 Parcel ID # 015-332-28 SW090002 Dear Jeffrey Garness, P.E.: wtn e `oQ z r. �Ii1J� Department Your request for a waiver of the required 10 feet horizontal separation from the new absorption field to the existing absorption field has been approved. The approved separation distance is 0.0 feet. This waiver approval applies to the new absorption field to existing absorption field separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, W_ Deb Wockenfu� Civil Engineer On -Site Water & Wastewater Program Community, Security, Prosperity Municipality of Anchorage Development Services Department • '� Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchoragc.ak.us (907)343-7904 Waiver Review Worksheet WR#:090003 PID#: 0 15-332-2 8 HAlPermit# SW090002 Date Received: January 6, 2009 Legal Description: Cromwell Heights, Block 2 Lot 3A Engineer. Jeffrey Garness, P.E. Garness Engineering Group 3701 E. Tudor Road, Suite 101 Anchorage, AK 99507 Applicant: Mark Zimmerman Waiver Requested: 0' from new field to existing field. Bed will be rebuilt. Criteria: Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Points: ZD Total: .......................................................... a .... ........... Waiver is Granted: X Waiver is not Granted. List Conditions or Reasons for above: Date:6/1/ 08 By: Deb Wockenfuss Name of Reviewer ...................................sees... and..... see.... as.............. Rec#: 84263 Amount: $M Date Paid: 1/6/2009 Municipality of Anchorage Development Services Department ' Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION G FOR A SINGLE FAMILY DWELLING Parcel I.D. 015 - 332-2$ Property owner(s) MARK 71MMFRMIAN Day phone 346-2444 Mailing address 7250 LAKE 0' THE Hit IS CiRCi E + ANrHORAGE. AK Site address faro e— Zip Code 99516 Legal description (Sub'd, Block & Lot) CROMWELL HEIGHTS ';QBDIVI ION• BLOCK 2. LOT 3A Legal description (Township, Section & Range) N/A Lot Size 6-2,707 Sq.Ft. Number of Bedrooms 4 THIS APPLICATION IS FOR ( ® all that apply): Absorption Field ❑ Septic Tank 19 Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP Ltd. Permit/Rush Fees: W 4o Date of Payment: _l lIZSf09 Receipt Number: 0 S q Z 63 (Rev. 11/05) Waiver Fees: 1 %J5- Date of Payment: _ 11.A'52616 Receipt Number: (2$ 22.63 GARN E SS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS = , , December 3, 2008 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Cromwell Heights, Block 2, Lot 3A. Response to Comment Sheet, Per the homeowner's request, the previously submitted 3 bedroom design has been upgraded to a 4 bedroom residence, attached arc new documents indicating this change. 1. The waiver request is necessary in this case because we are proposing to rebuild an already existing bed which had performed to code for 15 years and we sec no reason why any other alternative absorption field should be used. Because of the setbacks from the stream and also the location of the curtain drain, minimizes the availability of appropriate space to install an absorption field in a new location that meets with a 10' setback requirement. This is also another justification of why we are asking for a waiver between the existing bed and the proposed rebuilt bed. 2. An approximate location of the curtain drain has been drawn on the 100 scale drawing. 3. Per Anderson Engineering groundwater was monitored during the seasonal high water and was found to be @ 5.5' below grade. Per the inspection report the absorption field was installed 1.5' below original grade which gives a 4' separation distance between groundwater and the field. Based upon this information we do not see it necessary to dig a monitoring well and provide 7 day water monitoring. In short, we request that you re -consider the need for additional water monitoring. 4. Slopes have been addressed on the 100 scale drawing and an additional topo drawing of the area has been attached with this letter. If you havT a� questions, please contact us at 337-6179. Thank you for your assistance. P.E., M.S. 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507-1259 Ph: (907) 337-6179' Fax: (907) 338-3246 0 Websitc: www.gamesscnginecring.com GARNESS ENGINEERING GROUP Ltd. CONSULTANTS & GENERAL CONTRACTORS - �• -- December 3, 2008 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Ref: Proposed Septic System Upgrade for Cromwell Subdivision; Lot 3A, Block 2, To whom it may concern: The existing 4 bedroom house is served by a private well and threc(3) bedroom septic system. The septic system is in a state of failure and needs to be upgraded. We are proposing to rebuild the existing 18 foot by 60 foot bed, and lengthen it by 7 feet making the bed 18 feet wide and 67 feet long. Given that the bed width will be greater than 15 feet a waiver will be required. The existing 18 foot wide bed functioned adequately for 15 years, so there is no reason to believe that reconstructing it to its current dimensions will be problematic; therefore, we arc requesting that your department grant us a waiver to allow for the bed's width to be 18 feet wide. We are requesting a waiver for the required 10' separation distance needed between a proposed and existing drainfield. We arc proposing to rebuild the existing bed, thus it will have a zero foot separation distance to the old bed. All of the contaminated soil will be removed and replaced with NIOA filter sand. In short, once the contaminated material is removed it will be the equivalent of constructing a system on insitu soil. We have successfully rebuilt numerous drainficlds over the last 18 years. We are requesting that you grant a 0' separation from the existing and proposed drainfields. As we have always done in the past, the contaminated soil will be used as the first layer of backfill over the new drainfield. Comments regarding the design are summarized as follows: I. SOILS: We are rebuilding over the existing drainfield site. 2. DRAINFIF.LD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system. 4. TOPOGRAPHY: As can be seen on the attached design drawing, the average topography surrounding the drainficld slopes at 5-10%. We arc unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, plep c contact us at 337-6179. E., M.S. NUTS: Nt cited is a site plan drawing, a design drawing, one soil log, which are all part of the design package for this sel is 4vstcnn. (Contact G.E.G. Ltd. for 7 page construction specification letter.) 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507-1259 Ph: (907) 337-6179' Fax: (907) 338-3246' Wcbsitc: www.gamcsscngincering.com \ J IQ ' � � REVISED 1 I I I I i I I I LAKE 0 THHE ILLS FAST; I CROMWELL HEIGHTS; I I CROMWELL HEIGHTS; TRACT C 1 BLOCK 1, LOT 12 I I BLOCK 1, LOT 1 I li 15th - Ave --! / , \ CROMWELL HEIGHTS; BLOCK 2. LOT 2 L—fes CROMWELLHEIGHT f BLOCK 2,. LOT M I I I �•,{ \ CROMWELL HEIGHTS; h,yt\IVILOCK 2. Lor 1 i �• � !%'� Aad \ I � LourgN or I I \\X I` / - \orRsoR ""cNcwcc, I ------—��----- \ \ J L_1—\ ---- \ \ \ APPROXIMATE LOCATION \\ 1 OF CURTAIN DRAIN THE SUMMIT LOT 1 THE ESUMMIT TRACT '� \ I I / e r — �"•��_ _ _ _ / i frd` d'• 1 IA S LE: \ 1, loo, _00604 GARNESS ENGINEERING GROUP, Ltd. "' -• ^^ CONSULTANTS b GENERAL CONTRACTORS—, OA PHONE NUMBER: PAGE NUMBER: MARK ZIMMERMAN 346-2444 1 OF 1 Q a f A. arness.. LEGAL DESCRIPTION: DRAWN BY: O�ap� ' . CE -953 CROMWELL HEIGHTS; BLOCK 2. LOT 3A PNB Op e'' iz�3,.04B, TYPEW PLAN GATE:ORK: sToo SITErores� t1/tt/os � 00000 0 Rov 01,051 NUMBER OF BEDROOMS: 4 LETTER PERTAINS TO THIS DESIGN. GALLONS PER DAY (GPD): 600 TOBTAIN A COPY THE LETTER CONTACT GEC. BY PROCEEDING EDING FORWARD I EE�IS7ED PERCOLATION RATE/S: 12 MIN/IN WITH THIS INSTALLATION. THE ENGINEER, ' PROPOSED APPLICATION RATE: 0.5 WELL DRILLER. CONTRACTOR AND MINIMUM DRAINFIELD SO.FT.: 1200 PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND DRAINFIFLD DESIGN• AGREE TO ACCEPT THE TERMS AND MAXIMUM DEPTH: REMOVAL OF ALL CONDRIONS 0 INED. CONTAMINATED SOIL WIDTH: 18 FEET I LENGTH: 67 FEET IMPORT M.OA SAND FILTER AND REBUILD THE BOTTOM OF THE BED TO THE SAME ELEVATION AS THE EXISTING BED, OR HIGHER. EFFECTIVE: 0.5 FEET REDUCTION FACTOR: N/A ACTUAL SO.FT.: 1206 / / ALTERNATE SITE \ WILL REQUIRE AN ADVANCED TREATMENT / SYSTEM / •60'•BED.'..•;. -EXISTI G•18'• : BE RE 1 T AS .A. 18'•. .b* INSTALL '. •, ' \ r DOUBLE CLEANOUTS '.�''•a s: EXISTING 4 BEDROOM HOUSE 0 WELL ��/ / J� G0 REMOVE EXISTING 1000) � �Oo SEPTIC TANK AND IXISTINC FCO \ f GALLOINSTN SEPTIC TNEW ANK. APPX. LOCATION OF SOLID r, 1 PIPE DISCHARGE UNE PER i \ AND[RSON ENGINEERING APPROXIMATE LOCATION 0\ \F f ANDERSON ENC NEERNG \ \ —� INSPECTION REPORT(95) \ SEALS: \ \\ 1 �4�_ GARNESS ENGINEERING GROUP, Ltd. ppb:' 4 T CONSULTANTS 3 GENERAL CONTRACTORS---- •-.,..,.PWA101. . . ....... ....... o»1 Ln f �.•..:.• . . r waa . woc Lw>un-�I» • ru (n>)a�s-�tw • r�iL •...yuwwpiw.y.•.e PREPARED FOR: PHONE NUMBER: PAGE NUMBER:........ MARK ZIMMERMAN 907-346-2444 2 OF 2 O^ •.J f Gar ess•: LEGAL DESCRIPTION: DRAWN BY: QO �i ! E-793 e� CROMWELL HEIGHTS S/D; BLOCK 2• LOT 3A A.J.G. X40 e ' •�z.L.j�n8' foo TYPe OF WORK: DATE sslorlo DESIGN OF PROPOSED SEPTIC SYSTEM 11/11/2008 ���oo��6� III I I � I I I I I I I I I 1 I I I I I HEIGHTS; 1 I LOT 12 I I I I I I 4-I CnA-mUra HEIGHTS; LOT 1 i \ CROMWELL HEIGHTS; BLOCK 2. LOT 2 \y-1 OMWELL HEIGHTS; \ ,s^ LOCK LOT 1 14 � n LE I^ \� APPRO OF UDRAIN (MATE ION ' .f RTAI \ I I \\1 I T E SU IT L 1— _ __I 0 I I I I Ilk GARNESS ENGINEERING GROUP, Ltd. "' •• • CONSULTANTS 6 GENERAL CONTRACTORS-�:.�•... •.,.-..... ,.,. ro, c nuae son, curt ,o, • w+cHowwx. wt rotor . wa«t (aos}vi-a�» . ru (oonve-u.s • Kesrt_ .... PREPARED FOR: PHONE NUMBER: PAGE NUMBER: .... MARK ZIMMERMAN 346-2444 1 OF 1OOP'.J r A. rness.: LEGAL DESCRIPTION: DRAWN BY: Q E-79 3 CROMWELL HEIGHTS: BLOCK 2, LOT 3A PNB �' �Q�i'�c%a TYPE OF WORK: SITE DATE: PLAN11/1 �4 O rolseato°oo 11 /1 1 /08 �Opoo 0 � I i I I I I I I I E O ILLS EAST; i I ' Cl TTHE RACT e i I \ , \ Y^ •4 C MW H HT III I I � I I I I I I I I I 1 I I I I I HEIGHTS; 1 I LOT 12 I I I I I I 4-I CnA-mUra HEIGHTS; LOT 1 i \ CROMWELL HEIGHTS; BLOCK 2. LOT 2 \y-1 OMWELL HEIGHTS; \ ,s^ LOCK LOT 1 14 � n LE I^ \� APPRO OF UDRAIN (MATE ION ' .f RTAI \ I I \\1 I T E SU IT L 1— _ __I 0 I I I I Ilk GARNESS ENGINEERING GROUP, Ltd. "' •• • CONSULTANTS 6 GENERAL CONTRACTORS-�:.�•... •.,.-..... ,.,. ro, c nuae son, curt ,o, • w+cHowwx. wt rotor . wa«t (aos}vi-a�» . ru (oonve-u.s • Kesrt_ .... PREPARED FOR: PHONE NUMBER: PAGE NUMBER: .... MARK ZIMMERMAN 346-2444 1 OF 1OOP'.J r A. rness.: LEGAL DESCRIPTION: DRAWN BY: Q E-79 3 CROMWELL HEIGHTS: BLOCK 2, LOT 3A PNB �' �Q�i'�c%a TYPE OF WORK: SITE DATE: PLAN11/1 �4 O rolseato°oo 11 /1 1 /08 �Opoo 0 _0060 GARNESS ENGINEERING GROUP, Ltd. � .'4 v�00 -^ •- --• ��CONSULTANTSS GENERAL CONTRACTORS•-.vim+-.�-.-..-.........•,..,. 2701 L MOOR ROI°. AVIE 10, • .Ru AAGE. we 99W7 • Na,L (WW7—!IN • Fu 907 —32.6 • WCB51fL ym.rrp:�wip.oem • • • • • • . • • • • . • • • • • • •' • . D SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: CROMWELL HEIGHTS, BLOCK 2. LOT 3A P f r A. ness;• PERFORMED FOR: MARK ZIMMERMAN°o. CE -7953 DEPTH etp� DATE• 12 19 2008 v/e^e•. 1,7- 3o%O6'cq�p� o (feet) ORGANICS TEST HOLE 1 ��0000���o� 1 = _ == SOIL CLASSIFICATIONS 2 EXISTING 3-r: c GP ML GM CL a GC OL °• • o e SW MH 5 • SP CH GM SM i i OH 8 SC 7 — DEPTH TO CROMWELI HEIGHTS GROUNDWATER DATE 8— DRY 12/19/08 9.5 12/30/08 -----act 9 10 11 SM DATE READING CLOCK NET TIME WATER LEVEL NET DROP 11.O.I I. TIME (MINUTES) READING (INCHES) 12 13 14 15 16 17 18 19 PERCOLATION RATE — (MIN./INCH) PERC. HOLE DIA. — (INCHES) TEST RUN BETWEEN — FT. AND — FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: E3 YES ❑ NO SOILS LOGGED BY: KYLE MAUS PERCOLATION TEST PERFORMED BY: — COMMENTS: PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS,.FO MED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 2 30 0 6 4 BEDROOM I HOUSE I i I BLOCK 2, LOT 3A, ------ -------------------- ' 1' � 100' i5� Municipality of Anchorage Page f of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: -�� L `� 1if)�3,(� PID Number: fll- '2j�)a- -SC Name: Wastewater System: New ❑ Upgrade Address: ABSORPTION FIELD Phone: 3 )L(o ZSS ¢ No. of Bedrooms: 3 ❑ Deep Trench ❑ Shallow Trench Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: ; Total Depth from original grade: 7 GPD/Sq. Ft. Lot: Block: Subdivision:[ 3* 2 4A9!r fW6W7_151. Depth to pipe bottom from original grade: /.0 Gravel depth beneath pipe S rrr✓✓Eil�— Ft. • Ft. Township: Range: Section: Fill added above original grade: Gravel length: 315' Ft. Ft. WELL: C1Kew ❑Upgrade Gravel width: /$ Number of lineT,,tancebetw 3Ft. enlines: Ft. Classification (Private, A,B,C): Total Depth: `l Cased To: H01 Total absorption area: /I Pipe material:.f5r?," 0-303 g1 C G/P I"/✓Rflr Ft. Ft. t0190 SC. Ft. 8/O Driller: Date Drilled: 9-A1/93 Static Water Level: o Ft. Installer: r� i� c�E W5r Date installed: 1 _515,,.423' Yie d:ump Set at: Casing Height Above Ground: TANK S GPM uN/C�/� Ft. Z Ft. SEPARATION DISTANCES septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Qw64WPrivate Manufacturer: L Capacity in gallons: From Tank Field Station Tank Sewer LinesryG i� &— /OC79 Well �?j / r r �� � / � D / s Materiae 5 NumberCompartments: Surface � � D �• . � /�5 >�o ��¢- LIFT STATION Water Lot i / Size in gallons: Manufacturer: Line Foundation So Ce' / /� / "Pump on" level at: at: Prica� High water alarm at: Curtain � j > YVl / /O Pump Make & Madel l Inspections performed by: Drain Remarks: �•�../< ' in �G�.af� BENCH MARK / �� X4 Location and Description: 00--i!�rt'c� -Y»' GateC- Nibs /� u�afd ► //I� Z 11 Ui Assumed Elevation: /6 6 = Ft SEAL _Xd*01114ft !G. FJt B tQ �a • 41 °rrKOS.Jd�� :i6Ee•00°®� O A �' F^C•p'lip Inspections performed by: ������-- Dates: 1st 57 _X V. •� ® ° W • ®•. S 93•ems Michael E. Anderson / . '•• 4381 - E .. �- - •sem¢• � �'`'.,z9 ces�approval Department of Health and_Huma `fJ�y�•.,y,P. F Reviewed and approved byf"` r 72-013 (Rev. 9/91) MOA 25 63 G Municipality of Anchorage Page Z of _ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 a Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: PID Number: AARE IIIA v�/ a r � ce Vis" etl so e Anderson <u a E. ' M,.010ei E o i c J` Municipality of Anchorage Page 3 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection- Report Permit Number: STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF WATER --WATER-WELt* RECORD LOCATION OF WELL CONTRACTOR INFORMATAON: REMARKS: PLEASE MAIL WHITE COPY OF LOG TO: atm DNR/DIVISION OF WATER PO BOX 772116 EAGLE RIVER AK 99577-2116 BOROUGH CK SUBOMM N LOT BLOCK SECTION QTRS SECTION TOWNSHIP RANGE MERIDIAN ON OE 3A OS OW WELL OWNER: DEPTHS MEASURED FROM:❑casing top ❑ground surface WELL DEPTH: ' J DATE OF COMPLETION Depth of hole: 7 ft Depth of casing: 94� ft ✓� !�/ 9� BOREHOLE DATA: Depth Material Type and Color From TO./ 2— DEPTH TO STATIC WATER LEVEL: \,,� 40 ft below �Q top of casing ❑ ground surface �. Date: -s— I' CJ p� —7f f METHOD OF DRIWNG:,,I!§ air rotary ❑ cable tool / 2 ❑ other USE OF WELLX domestic ❑ irrigation ❑ monitor lu _ ❑ public supply ❑ other CASING STIC -UP: Z ft. Diam: �Zin. to ft !/ Casing type: ..IAOL� _Z__in. to eft WELL INTAKE OPENING TYPE: ❑ open end ❑ screened ❑ perforated" 7 open hole Depths of openings: to ft SCREEN TYPE Diam: in. Slot/Mesh Size: Length: ft GRAVEL PACK TYPE r LR G 10 4 Volume used: Depth to top:Ir . Municipality i A(IChol go GROUT TYPE: Volume: man v C�" Depth: from O _c -4-a ft to t D ft • DEVELOPMENT OD: Duration: ET PUMPING LEVEL AND YIELD: ,L;L y -�, ft after hrs pumping__�--gpm PUMP INTAKE DEPTH: ft Horsepower. WELL DISINFECTED UPON COMPLETION? '@-YES ❑ NO CONTRACTOR INFORMATAON: REMARKS: PLEASE MAIL WHITE COPY OF LOG TO: atm DNR/DIVISION OF WATER PO BOX 772116 EAGLE RIVER AK 99577-2116 u� 0cML o® v e Municipality of Anchorage ®, •3 , - n DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 c ©�® ����•®J �•��• • SOILS LOG — PERCOLATION TEST ��•• ••`•'• l E. Anderson •• ®� ;Michael E. Anderson 4381 - E PERFORMED FOR: A e'k A'4 It,y /� ��-�✓IG L r� T. i �, (r>t DATE PERFO%� LEGAL DESCRIPTION: �-3/� V✓EL(, Township, Range, Section: wepl.0 SLOPE SITE PLAN . F Pr 2 ; y ; •`; S� 3 v✓ �a o°a sMliM /-e s 5-.0' 7 8- 9 9- 10"WAS GROUND WATER , j 10 o ENCOUNTERED? 00/1 0 S 11 / AlL IF YES, AT WHAT O 12 DEPTH? P E 13 Depth to Water After Monitoring? Date: 14 15 16 17 18 19 20 r//- If PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS 51v116NI /yl,¢Y-E&Ac- !S -T-J-� !941y-1 AS cwHlC-44 —r� If i PERFORMED BY: A I ERTIFY THAT T IS T ST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: Z�97 72-008 (Rev. 4/85) Depth to Water PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS 51v116NI /yl,¢Y-E&Ac- !S -T-J-� !941y-1 AS cwHlC-44 —r� If i PERFORMED BY: A I ERTIFY THAT T IS T ST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: Z�97 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON—SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930020 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:KASER DUSTY & CONNIE A OWNER ADDRESS:2021 INNES CIRCLE ANCHORAGE, ALASKA 99515 PARCEL ID:01533228 LEGAL DESCRIPTION: CROMWELL HEIGHTS BLK 3A LOT SIZE: 62702 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 2 LT THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 2 DATE ISSUED: 2/24/93 EXPIRATION DATE: 2/24/94 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: 1!'o__PLAT NOTE LIMITS DEVELOPMENT ON THIS LOT TO 3 MAXIMUM. 2Z SEPTIC TANK MUST BE INSULATED IF LESS THAN 4' USED. BEDROOMS OF COVER PAGE 2 OF 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 3.tl�-LOCATION OF SYSTEM MAY NOT BE ALTERED DUE TO PLAT NOTE RESTRICTION. 4.VLL ORGANICS WILL BE REMOVED IN BED AREA; A MININUM 6" OF IMPORTED SAND IS REQUIRED TO PROVIDE 4' SEPARATION TO GROUNDWATE . RECEIVED BY: DATE: f - Z _e' DATE: ISSUED BY: ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 February 20, 1993 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 3A, Block 2, Cromwell Heights Septic System Design Impacts to Adjacent Properties (r , Dear On Site Services Engineer: gly-1, This lot was thoroughly investigated during the subdivision phase of the property to determine the best location for an onsite septic system. Soils on the property are excellent for a system, but subsurface water prevents placement of a trench type system and limits the locations available. Testholes dug in September of 1991, revealed water at depths of 8.5' after 7 days. Continued monitoring of the testholes through the Spring of 1992 indicated the water depth came to within 5.5' of the surface. The proposed system is designed based on water depths of 5.5' below the surface. We have spent a substantial amount of time on this lot and feel that if it is constructed according to the attached design the following conditions will result: 1. The system, if constructed as designed, will have no adverse impact on the wells currently in use or to be placed in the future on lots in the area. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have , joverse impact on drainage patterns in the area. ..��`i" Sincerely, `�` rS �'©®L`Y�0® Opti' 9COJ�.i' ee0Y0 ODY v' e• ode aaeoO eGoCY_eoeeee a e• Vi • Michael E. Anderson IQ e �'e 4381 - E Y $ Michael E. Anderson, P.E. i�4�`�ee•ep'e• eQY,e•',Cgo OF . .... .. . _ � G. •a a `9e ®� J TiYI L.A Alry .... . ... ..... .. .. ..... .: ./... ..... .. .V V �0 !@ 00900gY 00e •OiO O •se0a®e N'Fiaer E. Anderson 1' _ n1orE: Er w 770^jS . _. ,SN 4381 E t�� PC (.Arl�/. �_.. AA Q .... 1%1.0 r:.. A CTVI-)L ���F� ���••�j�,���,�VV PRODUCTiu1,Inc. Canon, Mm. 01471. JOB - Lor 3A , t -o Z, SHEET NO. OF CALCULATED BY M T DATE Z f �9✓ CHECKED BY DATE— SCALE W... ..... _ . :. ._.. . _ .. ............... . ........ ....... ............ ............ _C'xis n.nt G ........... ...... !..... .... ... ..... ........ ...... _.... . .................. ... ... .. ..... ... %ter....... _ ...... ....... y0 _ r_ .A.. Ex►.Sn.�t.... , C2g . -. 0 o :..... . ... ; .. Lo.r.... ..... ................ ...... . .- ... .......... .. ._.......... iAjL .. ,V y S I -cm .. .... ... _ .......... ..... ......... ..... : ........... f Pos.EO C S' ................ ......... ... Fu / DT . 1..._ . L...... ..... 1 /I- !? E ... . ... ...... ... ........... .... : ........... .. .. ....... - ............. - . ........... ...... i .. _.. \ ....... _.... .. .. . . ...... OF . .... .. . _ � G. •a a `9e ®� J TiYI L.A Alry .... . ... ..... .. .. ..... .: ./... ..... .. .V V �0 !@ 00900gY 00e •OiO O •se0a®e N'Fiaer E. Anderson 1' _ n1orE: Er w 770^jS . _. ,SN 4381 E t�� PC (.Arl�/. �_.. AA Q .... 1%1.0 r:.. A CTVI-)L ���F� ���••�j�,���,�VV PRODUCTiu1,Inc. Canon, Mm. 01471. Joe Z-07- 34, &0Q(- Zq1 V W M Vim% E.LL SHEET NO. OF e CALCULATED BY M F -A DATE Z 3 CHECKED BY DATE PROD--1css Inc., Cmt., Mau 01471. . a� � :e°en•MeAt • �gR� AL) e -beMunicipality of Anchorage ®.�-"°� Ole Sao as m.m• *see A17111.09 " m DEPARTMENT OF HEALTH 8, HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 °•°° •• °•'•••" • " meq; ichael E. Anderson SOILS LOG — PERCOLATION TEST ®, s• m 4381 -E 4 �. 14t-80i=E `v,., PERFORMED FOR: Sc'�d%�lQL'J DATE PERFORM��' I LEGAL DESCRIPTION: Lor 3A 14ou-Z Cp,,,A L. I&I/Township, Range, Section: %17n1 P 7iL I S 7 Z 9 10 11 12 13 14 15 16 17 18 19 20 vgQ141S10A WAS GROUND W TER SLOPE SITE PLAN A ENCOUNTERED?----iF— S IF YES, AT WHAT L DEPTH? �� O P E Depth to Water After i Monitoring? Date: 1 Reading Date ;AF Net Time 1 Net Drop ji 2 3 4 �i r '•' ' . Or 3I D b, 5 ri '�•• 6- of 7 8 o a� 9 10 11 12 13 14 15 16 17 18 19 20 vgQ141S10A WAS GROUND W TER SLOPE SITE PLAN A ENCOUNTERED?----iF— S IF YES, AT WHAT L DEPTH? �� O P E Depth to Water After i Monitoring? Date: 1 Reading Date Gross Time Net Time Depth to Water Net Drop ji /0. /•S 3I Q of DO w yu /1: 3o / S L� '` / PERCOLATION RATE / L (minutes/inch) PERC HOLE DIAMETER a �j ^ - n TEST RUN BETWEEN 3 FT AND 4 FT COMMENTS {� PIZC'SO14jz-w4 P12-oIL 7D P9MCV 44•r704 -7V$ 7. /Tjr D �+ 1"0 &I jT-04_ LTZJJ�CC— ' +FTwL 9 b A- VS. PERFORMED BY: �'1 I �4LRTIFY THATHIS CEHST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 200.3 72-008 (Rev. 4,85) sblas_ Municipality of Anchorage DEPARTMENT OF HEALTH 81 HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: ERS OntAi- 5cmy1 cc' 111 t1j D2�TE PEA LEGAL DESCRIPTION: 1*r 3A, 8bui.2-; C"mWC.LTownship, Range Section: DEPTH�T 5 v13DIWs/04 SLOPE ^ZK-FY) 2 7'-X fl L P 3 6rm 6roWn 4 pbp c. 0 6 4�M Y✓rY G�Grh✓ 1 • ! . vet i�,oar�i rc �a v 8 D 9 10 L13 12- 13- 14- 15- 16- 17- 18- 19- 20-1 b' G j 11 �r 121314151617181920 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? S .gyp` o P E Depth to Water After i I I Monitoring? 7 Date: Reading Date Gross Time Net Time Depth to Water Net Drop 1L/ g r a 9/ 3:) U '(Z y 1' — #Z =30 44 y: o o /s-- s „ LD Z 1 L N rtL yr: 3D u PERCOLATION RATE�S (minutes/inch) PERC HOLE DIAMETER it TEST RUN BETWEEN FT AND 40 FT COMMENTS I _ p1t-E$OAILL-� PIL401L "TD PaZC.0Ld /0,J 77CS-77rJ&, 4 I""/T'e1L -rVI3E o, r a- 7 �' S PERFORMED BY: - t7• 4aA L, I AT THI TE/T WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) lip C J P- Municipality of Anchorage On -Site Water & Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL 3 -;;1 / Parcel I.D. 015-28 Expiration Date: 1. GENERAL INFORMATION Complete legal description CROMWELL HEIGHTS S/D; BLOCK 2, LOT 3A Location (site address) Current Property owner(s) Mailing address Real Estate Agent 2. TYPE OF DWELLING: 7250 LAKE O THE HILLS CIRCLE, ANCHORAGE, AK, 99516 MICHAEL & KRISTI KISSEE Day phone 7250 LAKE O THE HILLS CIRCLE, ANCHORAGE, AK, 99516 STEPHANIE OLENDORFF W/ KELLER WILLIAMS Day phone Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) JUN 2 5 2014 C/O AGENT 229-6099 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ WaivarNariance request for:_ N/A Distance: Received by - - => Date: COSA to be released to the eBgineer, unless othenvise requested by the engineers—� COSA Fee $ 511(0 Date of Payment (,I ;Z25 ` I q 1`l -\h- Receipt Number 6333 5 G, a COSA# nt)CA1;65 Waiver Fee $ Date of Paymen Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, t verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 .ANCHORAGE, AK, 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. 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 lime of the test, and separation distances measured to modify 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 contralofthe evaluatorof 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 womanly or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSO. 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 otherperson or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE M System #1 Approved for bedrooms. t System #2 Approved for Disapproved. Conditional approval for bedrooms. Date 337-6179 bedrooms, with the following stipulations: Original Certificate Date:' The MtfnrcipakTy orAnchCrage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory mom innmvi Nitrate Advisory Arsenic Advisory Other OFtA&6�6 ��' i i ON-SITE WATER ANDrca Z= ;o WASTEWA;" o� Original Certificate Date:' The MtfnrcipakTy orAnchCrage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory mom innmvi Nitrate Advisory Arsenic Advisory Other 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: CROMWELL HEIGHTS S/D; BLOCK 2, LOT 3A -Parcel ID: 015-332-28 A. WELL DATA 'WELL HAS A "PACKER". UNABLE TO VERIFY STATIC WATER LEVEL. Well type PRIVATE If A, B, or C provide PWSID# NIA Well Log (Y/N) YES Date completed 5/10/1993 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 245 ft. Cased to . 94 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 5/10/1993 6/19/2014 Static water level ARTESIAN ft, 'N/A ft, Well production 5 g.p.m. 0.85+ 9.p.m. WATER SAMPLE RESULTS: Coliform U colonies/100 ml. Nitrater_Qmg./L. Collected by: GEG, Ltd. Arsenic: &La ug./L. Date of sample: 6/17/2014 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 1/19-20/2009 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N)II NO High water alarm (Y/N) N/A Date of pumping L Pumper A+ 1-t0mz, civ e, e S C. ABSORPTION FIELD DATA ITELOW EXISTING GRADE:] Date installed 1/19-20/09 Soil rating .p.d./ft r ft /bdrm) 0_5 System type BED Length 67 ft. Width 18+ ft. Gravel below pipe 0.51 ft, Total depth '4.9-5.3 ft. Eff. absorption area 1206 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 6/19/2014 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test DRY in. Water added 775 gal. New depth DRY in. Elapsed Time: = min.. Final fluid depth DRY in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at in. "Pump off' level atwa er alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOTTO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A On adjacent lot: On adjacent lots Public sewer manhole/cleanout 100'+ 100'+ N/A Sewer /septic service line 25+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 51+ Absorption field 5'+ Water main N/A Water service line 104 Surface water 1004 Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain "25'+ Wells on adjacent lots 100'+ F. COMMENTS 'PER MIKE ANDERSON, P.E. ORIGINAL DESIGN. G. ENGINEER'S CERTIFICATION i certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date (Rev. 10/12/12) CE— "ROFESSf&'�% E: Municipality of Anchorage aL Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # 141285 During a recent COSA on-site inspection and test of the potable water supply well on Block 2, Lot 3A of Cromwell Heights subdivision, the well's productivity was determined to be 0.85 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4 -bedroom residence is 0.41 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Municipality of Anchorage - • Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-332-28 COSA# QSe—(7;k a II OL / f 1. GENERAL INFORMATION Expiration Date: — a `7 I ` Complete legal description CROMWELL HEIGHTS; BLOCK 2 LOT 3A Location (site address) 7250 LAKE 0 THE HILLS CIRCLE *ANCHORAGE AK 99516 Current Property owner(s) MARK & ROSEMARY ZIMMERMAN Day phone 520-818-9721 Mailing address. 7250 LAKE 0 THE HILLS CIRCLE *ANCHORAGE AK 99516 Lending agency Day phone Mailing address Real Estate Agent BRIAN BRODERICK W/ PRUDENTIAL Day phone 227-7671 Mailing address unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 4 TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 ❑ Individual Holding tank ❑ �— Community On-site n ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, f verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the oh -site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation. GEG, 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. 5. DSD SIGNATURE Approved for --4— bedrooms. Disapproved. Conditional approval for bedrooms, with the following Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory l/ Phone 337-6179 Date ` l7,3//z Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other ON-SITE WATER AND WASTEWATER PROGRAM By: �✓ Original Certificate Date: (Rev. 11105) Municipality of Anchorage • ;` Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL BLOCK 2, LOT 3A Legal Description: CROMWELL HEIGHTS; A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N A Date completed 5110/93 Sanitary seal (YIN) YES Total depth 245 ft. Cased to 94 ft. FROM WELL LOG Date of test Static water level 5/10/93 Well production WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Arsenic: ND ug.IL. B. SEPTICIHOLDING TANK DATA ft. CHECKLIST Parcel ID: 015-332-28 Well Log (YIN) ___AES Wires properly protected (YIN) YES Casing height (above ground) 12+ in. AT INSPECTION 3/27/12 *N/A ft. 1 33 (AVG.) g.p.m. —9•P.m. HAS A RALLED, UNABLE TO CHECKSTATIC WATERLEVEL. Nitrate ND mg./L. Collected by: aE ' td — Date of sample: 3/28/12 SEPTIC/STEEL Tank Type/Material Number of Compartments 2 *FCO IN CRAWLSPACE Tank size 1250 gal. Foundation cleanout (YIN) *YES Date of pumping I-` a a G S PTION FIELD DATA Depression over tank (YIN) NO Date installed 1Z19 -20Z09 Cleanouts (YIN) YES High water alarm (YIN) N/A Pumper ISAAC'S PUMPING +'BELOW EXISTING GRADE C. ABSOR nate installed 1/19-20/09 Soil rating (g.p.d.lft`or /bdrm 0_5 Length _ 67 ft. Total depth *5.45 ft. Width 18+ ft. System type BED Gravel below pipe 0.51 ft. Eff, absorption area 1206 fe Monitoring tube YES Date of adequacy test3/� 27 /12 Results (Pass/Fail) PASS Fluid depth in absorption field before test - in. Elapsed Time: a min. Water added 630 gal. Final fluid depth 0 in. Any rejuvenation treatment (past 12 mo.) (YIN & type) Depression over field NO For 4 bedrooms New depth 3 in. Absorption rate> --600+ g.p.d. NONE If yes, give date – D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN "Pump on" level at in. "Pump off' level ' . High water alarm level Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main Sewer/septic service line 25'+ Animal containment areas 50'+ Public sewer manhole/cleanout N/A Holding tank 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 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain *25'+ Wells on adjacent lots 100'+ F. COMMENTS *PER MIKE ANDERSON, P.E. ORIGINAL DESIGN G. ENGINEER'S CERTIFICATION a I certify that I have determined through field inspections and p * : 49 H '•� review of Municipal records that the above systems are in �.... "" ' ....... conformance with MOA COSA guidelines in effect on this date. -.J ffr4y A. Go s. Engineer's Printed Name JEFFREY A. GARNESSP E 7953 m� Date Pr.a COSA Fee $ ' Waiver Fee $ _ Date of Payment la(419 Date of Payment Receipt Number G� Receipt Number _. (Rev. 11105) SGS Re£# 1120958001 Client Name Gayness Engineering Group, Ltd Project Name/# Cromwell Hts B2 L3A Client Sample ID Cromwell I -Its B2 L3A Matrix Drinking Water Printed Date/Time 03/30/2012 12:02 Collected Date/Time 03/28/2012 13:30 Received Date/Time 03/28/2012 15:42 Technical Director Stephen C. Ede Sample Remarks: EP200.8 Arsenic ND 5.00 Parameter Allowable Results LOQ Units Method Container ID Limits Prep Date Analysis Date Init Metals by ICP/NIS EP200.8 Arsenic ND 5.00 Waters Department ACF Total Nitrate/Nitrite-N ND 0.100 Microbiology Laboratory (<10) E. Coli Negative 1 Total Coliform Negative I ug/L EP200.8 C (<10) 03/29/12 03/29/12 ACF mg/L SM214500NO3-F B (<10) 03/29/12 AYC 100mL SM219223B A IOOmL SM219223B A 03/28/12 DLC 03/28/12 DLC xlo IT C' oz SID mIZ LAKE O' THE HILLS CIRCLE o 115TH AVENUE co 183.61' N890 53'27"E DRIVEWAY I I I I NCO.' '--�-� ENCROACHMENT U3 + . .'. I 00\ LLI C"O�?s'�i \\ a o \� ro Ib G o N eP \` ��.� TRACT D g by CD 1p1�' AQ� t rye \C. C. .S \ i 4,\'"',' o EHOU EO 42.4\ rna A 6 \ WELL I W I o \ � In IV UTIL ESMT —� — J 249.21' N890 59'00"E UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION CNLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. Lj LOT SURWY SURVEY TYPE SYMBOLS ' ❑ MNDA11ON AS -BUILT o" SET REBAR ° DRAINAGE ASPHALT ❑ RNu SMUCIURE AS -BUILT ❑ PLOT PLW AS LOT SURVEY TCPCGRAPNY O FOUND REBAR .e 8 0 WOOD FENCE'"I CONCRETE ... -BUILT ... ... 171 As -SUR -T ... we caRNEws wr 0 RECFRSRCATIOI AS -BUILT ... NO CORN SET � ASSUMED ELEV. 3( it—X- METAL FENCE ® WOOD DECK PLOT PLANS & LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE CONSTRUCTION. TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES. WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC_ ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS. COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. SURVEY CERTIFICATION •..L+ ,44 q Prepared by Robert E. Johns, Jr. & Assoc. PLOT PLAN mma�an am�NwbaIrI.n^°le^Wl o M1a�IwMm, ,.KKN .n^.1.o �• P.X\ j Professional Land Surveyors •o.-tl.wntles[. da 1700 drink Drive.w �M� In11qMew- wwKK wr°N.,pOMn.«ft,wwI ,Na •�. ANCHORAGE. ALASKA 99504 Scale: 1 n _ 60l Roc. Lot S.F. Ree. Plot File No. T1? FOUNDATION AS -BUILT ••..'•'9t •' ....... — l, Rmwl c aw.. ♦.. n.ey nwlwr Mie r •• ..,. Oat. Surveyed: 4/1 3/12 Drawn by REJ Checked by J M K >^•^ •� �N„b �•• ROBERT . JOHNB •J •• Oate Drawn: 4/13/12 Grid: 2639 W0. 12-83 iw.l OeN . ,P ;• o t �� FINAL STRUCTURE AS -BUILT s'•.., 1 21-s :• ;�� Legal Description: IoeMm Iru IN qpl •jj ...............•o�d 9:.�1` WueM• ✓r MY KK m! Mol W 1M e�p LOT 3A BLOCK MwWo.Flamw<bn a leas lrur bw wM m �wmhn�lb aiX u'iw 111%% ::�••. CROMWELL HEIGHTS MUNICIPALITY OF ANCHORAGE xw R r. TMENT. OF HEALTH &HUMAN SERVICES DEPA Division of Environmental Services `u -�r�xss; `. On -Site Services Section ..�... - "f;,,,� <..�..:..� P.O: Box 196650 Anchorage.' Alaska `,,'99519-6650 S Y q i —4744 4 f •fit, i K: v:, a . .*� bid: w...r.nria:-c,�..<._a..,ac..• ..• •: ... :.: . . ....:_ „ '• __ .C. V 7•, sM < s: _ .. .. ..... - ._ CERTIFICATE OF HEALTH AUTHORITY _ C APPROVAL FOR A SINGLE FAMILY DWELLING p aar ,� � �,`„�..°Er^°�� �i".; r .i a'��s' �:,' � �rr:.�:" rr..�. i•• � ._ ... ....:. �" 3Z- L lS1i larcegr _E: 3 HAA r.i x?'?s EWA, FORMATION ., + - , r - 1. mpFe�legaC descr�pt on.� 3A, $tot z� eRpiy► i7 ALL.: H � . , t• - � Location. (site;address ocdirections) 77- 0 10 iL" ac. LC �, U STS/ )G1 S Cn- t r-01 owner Day phone T {` 4 �r�M�ili aefdre 5 . ending agency ; Day phone.' ' ., t :M r" -t �r-w a.ZL a rt: -'r f z'a Pr".te-.,';•r"4-.-�,, .'C .1 .. ro NOTE " Ifcommuni ywell system, provide written confirmation from State ADEC attest ' I •a!'�#wnwak dt } IA + r ., ,..Ny#ism'. st ,rC'Y ++tr ,*.. T , rng to the legality and status of system "gt' 2J�� j_; qtr r ._ rr t- t t `y,• r r 4 PE OF NFAS EWATER DISPOSAL F Y 4}� X V } JJ j ��^fin s ri Individual on-site aXXX Y i''' M Holding tanker, f C&site. ommunity ., _.,+►;�_ j'���1 ,t on- """,+'.�ix,.t+ "�<�����. ^�' ' .,1¢+SatViM:it- �r R��,+#�?'i}i'hl.�a?�"i�:+,��r`��srl�ri"^�.k•'M��'"r�'�•k`?� �"�C�tr 1�7 yi9 � r�rKk i,S i�.�a d �R � - �' Pubhcsewer �zTr� f r iiti"v'3 ��'vud j,« °'.YStrf Ja".. trrr ry G A Y , - 4�,NOT E- if community wastewater system, provide written confirmation from State ADEC Aatresfing to e legality andel status ofsystem.- :Y'N� � � Y •Py����� the ad �M iY -e. ::iii Y'k�y.'�i.�i•. s�i � nr Ii tifi� � � M1�i;t'�: '�Ti'WA�*�'y.1 ,:'r � �qil�� ,� Y _ ,. - +i r 772-2 (PAA 1/91' Froft MOA r2i _ . - ... {rM,L ,.LL$^.•,, .' ;' - a Q se 5.fy STATEMENTOF. INSPECTION BY ENGINEERS As certified ie . - 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:: AV ._ Name of Firm AnlbQisonl 9'ry �•.Phone .�4 s-jr iTOK'4o'7cNor�, .4L "aSz�4d Engineer's signature,. Date F.Ali� ahs . qb• . Jed,• ,Michael E Anderson +��� ,.r- �" c % 6`,Q� fie. �' , •e.�' �ta� - IS, SIGNATURE ,= hww�wve�a ;wr-�.a»a �:-'."�.. ,. � ,,•L.w.l�wwwwwi^�+. �'• -Nu"�"„' F Conditional approval r+uuurc�nar �mmenLu rl rf' ;�fi m.rY.r.rx['�.f>•FYiH"s-^f`�ibC�-/Y'�i"vi.4� -3vY f p a Yr y4 32 L - 5;!� eds i' T;,*•x'.':.;�•!a f -x"5 {- W sib -.yr..,.," "'['. yr �'�i� �'�MitY h'f, CAUTION Te ERS sr -Mie. Munici' ali ok'#nchorage Department of Health and Human Services (DHHS)issues Health Authority ar \ �r Apj rov�al ,Certif es based only upon the representationsgrven in paragraph 5 above by an independent professign,91 engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their Lending institutions in order satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate.isissued.. The Municipality of -Anchorage is not � responsible for errors or omissions in the professional engineer's work. - 72-M (Rw:1/91) Back ' MOA N21 Well production $� g.p.m. 9— p.m-WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Nitrate Collected by: Other bacteria Date installed S $ 3 Tank size 1,000 Nutnber of Compartments TKJO Cleanouts (Y/1) Y Foundation cleanout (Y/N) _ Depression (Y/N)_ J High water alarm CW A/ Date of Pumping AB 3 S' Ptunper A Nn Ame Sgtto , C. ABSORPTION FIELD DATA Date installed L 9 3 Soil rating (g.p.d./ft' or ft2/bdrm) -S System type I?" Length io D Width / Gravel thickness below pipe Total depth , 4- Effective absorption area 6 -yo S F Monitoring Tube present(Y/1) Y Depression over field (Y/1) 4 Date of adequacy test $ lb Results (Pass/Fail) PASS For --N�26L bedrooms Fluid depth in absorption field before test (in.); Immediately after -QV gal. water added (in.): 3 Fluid depth 1'1490 Minutes later: a �(in.) Absorption rate = SDO t g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date /V/� Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 OM O Health Authority Approval Checklist -P y Legal Description: Low 3AB B w uc. Z,� Cf!&20A WQL 1-6. Parcel I.D.: A. WELL DATA Q � � 7 - Well Well type RZ t V47 -C If A, B. or C, attach ADEC letter. ADEC water system number Log present (Y/1) T Date completed 5bo/q.3 Total depth Z-�S r Cased to % Casing height (above ground) Z 1 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y FROM WELL LOG AT INSPECTION Date of test 0110 Static water level Supuz AGG"— /+a%r -444 SU WA -P—C - 42i 8-SiA*J Well production $� g.p.m. 9— p.m-WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Nitrate Collected by: Other bacteria Date installed S $ 3 Tank size 1,000 Nutnber of Compartments TKJO Cleanouts (Y/1) Y Foundation cleanout (Y/N) _ Depression (Y/N)_ J High water alarm CW A/ Date of Pumping AB 3 S' Ptunper A Nn Ame Sgtto , C. ABSORPTION FIELD DATA Date installed L 9 3 Soil rating (g.p.d./ft' or ft2/bdrm) -S System type I?" Length io D Width / Gravel thickness below pipe Total depth , 4- Effective absorption area 6 -yo S F Monitoring Tube present(Y/1) Y Depression over field (Y/1) 4 Date of adequacy test $ lb Results (Pass/Fail) PASS For --N�26L bedrooms Fluid depth in absorption field before test (in.); Immediately after -QV gal. water added (in.): 3 Fluid depth 1'1490 Minutes later: a �(in.) Absorption rate = SDO t g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date /V/� D. LIFT STATION Date installed Manhole/Access (Y/1) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot '> /60 Absorption field on lot >/00/ On adjacent lots On adjacent lots "Pump off' level at* Public sewer main r' 1 W's Public sewer manhole/cleanout Sewer /septic service line > 590 Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: > /00 > AAi ws AJ D m Ca Foundation 50 Property line 11-3 Absorption field ? S' Water main/service line > SO, Surface water/drainage >/00 Wells on adjacent lots ?/DD SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ? V5 Water main/service line > Sd Surface water > /001 Driveway, parking/vehicle storage area > 40 1 Curtain drain 50 Wells on adjacent lots >/00 F. ENGINEER'S CERTIFICATION 1 certify that 1 have determined thru field inspections and review of Municipal rech11 e e in conformance with MOA HAA guidelines in effect on this date. y Signature soa ®aa®®m®e• ........ Engineer's Name A4f WALL AD WU0rJ ®f �, . Mic6liciJ E Date 8/1Z1y'�— HAA Fee $ �� ` C/D Waiver Fee $ Date of Payment ,/) Date of Payment Receipt Number �9 C�o�7` / Receipt Number Rev. 8/95 OSS: haa.wk.doc 08/15/95 08:53 COMMERCIAL TESTING i 5635389 o- �. � .r, ME Environmental Services Inc. AA& Laboratory Division Ref.# 95.3353-1 Laboratory Analysis Report Matrix WATER Client Sample ID L3A, CROWELL EMITS. SUED. Client Name ANDERSON =GIRSBRING WORK order 16987 Ordered By ALAN ANDERSON printed Date 08/14/95 a 15:32 hre. Project Lfame Collected Date 08/08/95 a 11:30 hrs. Project$ Received Date 08/09/95 • 11:30 hre. PxsID UA Technical Director STEPHEN C. !DE Released HY..'.�~ / �.r....... sample Remarks= SAXPLZ COLLECTED BY: A.A. 0C Allowable UL. ADA), Parameter Results puai Units Method Limits Date Data Init ------------------------------------------ Nitrate-S 0.10 Rg/L EPA 353.2 10. 08/11/95 CIM .c:.��r...s:s.�M.....ss.l►........... *..................................r.......ss.�.......... • See Special Instructions Above IIA . tUavailable Rh . Not Analysed 1t} see Sample Remarks Above LT = Lose Than IR . Undetected, Reported value is the practical quantification limit. > Secondary dilution. 6T Oseater Than 200 W. Potter Drive, Anchorage, AK 99518-1805 —Tel: (907) 562-2343 Fax: (9071561-6301 ERSEY. OHIO, WEST VIRGINIAENVIRONMENTAL FACILITIES IN ALASKA, CAUFORNIA, FLORIDA. ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW J ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 563-7155 563-5389 (FAX) August 15, 1995 RECEIVED Ms. Rosemary Palmer AUG 1 51995 4011 Arctic Boulevard, Suite 203 Niuh!c,palay of Anchorage Anchorage, AK 99503 Dept. Health & Human Services Subject: Lot 3A, Block 2, Cromwell Heights Subdivision Dear Ms. Palmer: The septic system serving the house on Lot 3A, Block 2, Cromwell Heights Subdivision was installed in May of 1993. All work was completed in accordance with requirements of the Municipality of Anchorage and the State of Alaska. Upon completion of construction a certified as -built of the system was submitted to the Municipality for their review and subsequent approval. A copy of that as -built is attached to this letter. A subdrain was placed up gradient from the absorption bed to protect the bed from groundwater infiltration. This drain was placed 50' away from the edge of the bed as shown on the attached drawing. The Municipality requires a subdrain be placed a minimum of 20' up gradient from any disposal system. The absorption bed on this lot is more than twice as far away from the subdrain as required by Municipal Ordinance. In summary, the septic system on Lot 3A, Subdivision was designed and constructed Municipal and State Statutes. It is currently functioning as it was designed to do. Sincerely, Michael E. Anderson, P.E. Attachments Block 2, Cromwell Heights in strict conformance with in excellent condition and OF 4 ®� p��� ••rr � jQJ y k11 % �6 gyp® •eqp® •®ipGemd�c�cac�,s���eia :r �i.g eeeee:i•u�io ere®+eo •s of �' Michael E. Anderson i �i� •� 4381 - E r 4`wm AO 90-48 (S-1) page 13 undisturbed soil not more than ten feet from the tank. The first cleanout, in line, shall be to clean the line toward the distribution system and the second cleanout Will be oriented to allow cleaning toward the septic tank. D. All septic tanks must be fitted at the inlet and outlet with watertight couplings approved by the Department. E. Septic tank manholes must be equipped with gaskets so as to minimize infiltration of water. F. if a septic tank is not buried or is buried at a depth of four feet or less, the tank must be insulated. G. A septic tank must be installed only in an area that will continue to be readily accessible to a pump truck. The point of access for the pump truck must be no more than 100 feet from the septic tank. The ground surface at the point of access for the pump truck must not be more than 11 feet higher than the bottom of the septic tank. 15.65.060 Subsurface disposal fields. A. The location of an original or replacement subsurface disposal field must be in accordance with the following standards: 1. A subsurface disposal field may not be located less than: a. 100 hundred feet from the mean annual flood level of any surface water, major drainage course or any source of domestic water supply; b. 50 feet uphill from any man-made or any natural break in the natural slope of the terrain where the slope changes to 25% or greater unless the top of the drainfield is lower in elevation than the toe of the slope; -b CO S Sb D o w '�J G �f1.OM S V 8S UR.F'A �' C. 50 feet upgradient or 20 feet downgradient from any portion of a_subsurface drain. d. 2 times the depth of gravel below the level of the horizontal perforated pipe or 10 feet, whichever is greater, from any existing or abandoned subsurface disposal field; e. 10 feet from any property line; f, 10 feet from any building or structure foundation;