HomeMy WebLinkAboutGREENLAND BLK 7 LT 6nland Block 7 Lo-I- 6 #010-171-07 Municipality of Anchorage :'~ Development Services Department ' Bu~cr~g Safety Division On-Site Water and Wastewater Program, 4700 S, Bmgaw SL ~ P.O. Box 196650 Anchorage, AK 99519-6650 Page I of www. ci.anchora~e.ak, us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM .AND/OR WELL INSPECTION REPORT Permit Number:...-~/.,,/.~ O'7- o¥ 19 PID Numbe~ ,i (::~t&-- 1'Ti - Name: ~'~'~z~ /~. /.4/~/-~'o,~ Wastewater System: [] New [] Upgrade Address: I ~ ~o ~ I..,?.~¢o,, b £/'t ,~,~c6 9q~/ ~' ABSORPTIONFIELD 3' I~Oeeplrenc~ ri Shalbwlrencfl [] Bed D Mouml n Total De,th froe~ g~inal LEGAL DESCRIPTION ~"~""~ O. 6' cPo,~,' ry. '7 ' ~ ~-reza [~at' 7. ¥ ;,. ~. Tc,~nshlp: Ra~e: Sec~c~ Fa added abo~ c~;inal ~r"~e: * Gta~n~ ~' ~' n. b' '7 F,. Well: E Y~.C/' [] New [] Upgrade c~-,~,,~ ,~-o~o~. 'Z. ~ n. I - ~' ClasslflcaUon (Private. A, B, C): i Torn Deg~ :ased In: To~ absoq:~o~ n. rt '7 '75' r~ '~-:Zo3'v ,'~c,,,-¢~,~c I ~.~, rill ~t TANK r~;w.¢ r- SEPARATION DISTANCES I la Sapac [] Holding [] s.'r.E.P. [] Oth~c  Septic , Absorption Uft Holding Pub~i~t( Ma~ufac~ Capa¢~ Tank Field Station Tank Se~erL~e ~C~'C:~.~ 7-Z:~n/~ l~'~ w,, iC~6', 106', _ . ~,z~-, "a'~': .~,/.ee/ , s.,,~,w=,,, ~too' i;>too ' - - / LIFT STATION /~,.g.. LotLJne ~,~ I j ~ I $,ze; k~'~aca~tec. Foundation /~ ~. f t~ ~.. I ' kl.in I1% BENCH MARK ,:,F i g~:::,,~ ~'- Engineer's Stamp 2"~ , / ?/oZ, :~.~,,~,.~;,~~' ' Development Se.rv[ce~ Department Approval i ? ,.'- e. THEODORE F. AIOORE RevJewedandapprovedby: ~ Date: dF'?~ ...~ '.:,'t' '- ¢E-3587 .-'.'~''~.,.~...., ,.. PERMIT NO: SW020419 PID NO: 015-171-07 SWING TIES FROM: COR. "A" COR. "B" PT. "C" TO: VALVE "H" 68' 40.5 TR. C.O. "1" 48.5' 25' TR. M.T. "J" 46' 21.5' TR. M.T. "K" 61' 79' 41' TR. C.O. '%" 61.5' 79.25. GROUND ELEV. 100.2' PAGE 2 OF 2 EAST 112th AVENUE R 100' WELL LOT 6 BLOCK 7 13-BDRM ~ ,H~UsE [ ~ TBM NEW $7-FOOT LONG SOIL ABS. TRENCH-- w. 6.8' EFF. GRAVEL EXISTING LOG CRIB SEEPAGE PIT INSTALLED 8/2/1974 ~WELL 1000-GALLON SEPTIC TANK 9/12/1992 DIVERTER VALVE 20' ALLEY INV. 92.9' ~OM "BULL RUN" DIV. VALVE 57-FOOT LONG SOIL ABS. TRENCH w. 6.8' EFFECTIVE SEWER GRAVEL PLAN VIEW SCALE: 1" = 30' BOT. T.H. #1 ELEV. 80.0 M.T. DRY 1115/2002 BOT TRENCH ELEV. 86.1' CROSS-SECTION NOT TO SCALE LOT 6, BLOCK 7, GREENLAND SID SEPTIC TANK INSTALLATION AS-BUILT INSPECTION REPORT FLATTOP TECIINICAL SERVICES 14530 ECIlO STREET ANCIlORAGE, ALASKA 99516 SCALE: AS NOTED DRAWN BY TFM NOVEMBER, 2002 MUNICIPALITY OF ANCHORA GE Development Services Department ~ ~..~' On.Site Water& Wastewater Program 4700 South Bragaw Street ~ ~._~_ P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Oct 16, 2002 Expiration Date: Oct 16, 2003 Permit Number: SW0204t9 Legal Description: GREENLAND BLK 7 LT 6 Design Engineer: 0019 Flattop Technical Services Owner Name: Edward A. Watson Owner Address: 11201 Lipscomb st. ANCHORAGE, AK 99516-0000 Parcel ID: 015-171-07 Site Address: 011201 LIPSCOMB ST Lot Size: 17884 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] 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 calling (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: Issued By: ,~) Date: Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ' ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLI'NG Parcel I.D. (~. i~- - I '7! - O' 7 Permit Number SW Property owner(s) Mailing address (1) Mailing address (2) Legal description (Lot, Block & Sub'd.) ~ Y~a ~/~c~ ~ Legal description (Section, Township & Range) Day phone Zip Code Lot Size /7'~'z'/ Acre~. THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Number of Bedrooms Well Only [] Water Storage [-] Jacuzzi [] Water Softening Unit [] I cedify that the above information is correct. I fudher cedify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: Date of Payment: Receipt Number: (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: CIVIL & ENVIRON.MENTAL ENGLNEERLNG · ENERGY CONSERVATION & ANALYSIS TIIEODORE F. MOORE, P.E. 14530 ECHO ST. PH: (907) 34S-1355 ANCHORAGE, ALASKA 99516 M.O.A. DSD P.O. Box 19-6650 Anchorage, AK 99519 October 7, 2002 Dear Sirs: The purpose of this letter is to provide the required design narrative in support of our application for a permit to upgrade the wastewater disposal facilities on Lot 6, Block 7, Greenland S/D, located at 11201 Lipseomb St. Soils logs, pete test results, a site plan, design drawings and specifications are enclosed for your review. The proposed system will be constructed in the vicinity of test hole # 1. As can be seen from the soil log, the native material below 6 feet is a silty sand with a measured peru rate of 6 minutes per inch. Using a conservative soil application rate of 0.6 gpd/sq, ft., this 3-bedroom residence requires a total absorption area of(3 x 150)/0.6 = 750 square feet. The proposed 54-foot long trench design with an effective gravel depth of 7.0 feet has a total absorption area of 756 square feet. We also proposed to install a "Bull Run" diverter valve allowing for the possibility of future reconnection to the original log- crib seepage pit. The topography of the lot in the area of proposed construction slopes down towards the west at approximately 2% The proposed project will have no significant impact on present or future water supply and wastewater disposal systems serving adjacent properties, nor will it have any significant impact on reserved space-surface and subsurface, or on drainage. Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, Ted Moore, P.E. ,,' ,' , S 1/2 LOT 21, SEC. 22 ', ', ,, , T12N, R3W, S.M. '· ', ~o-__'?~' ~r~100~ .... ~-- .... ~ __.__ ',, '-, I · PARCEL 12, SEC. 22 T12N, R3W, S.M. RETAIN EXISTING SEPTIC TANK (DOCUMENT INST.) ~I'NSTALL "BULL RUN" DIVERTER VALVE ' ! EAST 112th AVENUE : R lOO' WELL--% : WELL I~,LOCK 7 ,' ' 3-BDR~ , , / HOUS ,, rRfiRCH w. 7.0' GVL ~ 20' ALLEY SEPTIC AREA LOT 7 R 100 ,~.'? C: ~ ~ -/ ................ '" ??.....,.........,... .... ~ ~ ~ THEODORE F. ~O0~E ~ SEPTIC AREA LOT 8 LOT 6, BLOCK 7, GREENLAND SID WELL AND SEPTIC SYSTEM SITE PLAN FLATTOP TECIlNICAL SERVICES 14530 ECIIO STREET ANC! IORAGE, ALASKA 99516 I INCH = 40 FEET DRAWN BY TFM SEPTEMBER, 2002 NOTE: THIS IS NOTA SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. , O,A. ~IOPERF. P,PE \ / CONSTRUCT NEW 54-FOOT LONG SOIL ABSORPTION TRENCH w. 7.0' EFFECTIVE SE'VVER GRAVEL PLAN VIEW SCALE: '1" = 10' INSTALL ,,. 'BULL RUN" /~ EXISTING \ TO EXlSTING~ SEPTIC SEEPAGE PIT TANK ILL 6" 14 -- ORIGINAL GROUND -- 4" DIA. F-810 PERF. PIPE 2" - 2 1/2" SEWER GRAVEL CROSS-SECTION "A - A" SCALE: 1" = 5' LOT 6, BLOCK 7, GREENLAND S/D SEPTIC SYSTEM UPGRADE PLAN AND CROSS-SECTION FLATTOP TECHNICAL SEP, VICES 14530 ECHO STREET ANCIIORAGE, AK, 99516 SCALE: AS SI[OWN DRAWN BY: TFM OCTOBER, 2002 JTEST HOLE LEGAL DESCRIPTION: DATE PERFORMED: PERFORMED FOR: FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 SOILS LOG - PERCOLATION TEST Lot 6, Block 7, Greenland S/D S ~p !em_ ~bg_ r_26,__2 q02 Edward A. Watson DEPTH (feet) 1 11 12 Pt. SM Reddish sandy loam SM/ML Gray, very silty sand Dry, hard, some smearing SM Gray silty sand Softer than above Becomes cleaner with depth SLOPE SITE PLAN BLOCK 7 .._ 3-BDRM .HOUSE Depth to Groundwater Date _No. grOundwater 9/2§/02 .Monitor_tu~_~ry 10/3/02 20.25'I I COMMENTS: Date Reading Clock Net Time Percometer Net Drop Time (minutes) Reading (inches) 9/26 12" Presoak 27 1/2 - ' 12"-R~so_ak 27_-3i8 · Add._w~te r__&_s_ta Et 12:58:20 23_3/8 #1 1:28:20 30 18_1/4 5'~)8 Add_water 1:28:30 23_3/8 #2 1:58:30 30 18 3/16 5._3!_1_6 Ad~water 1 .;59- 23.-1_~/2 ~_3 2:_29 30 183/8 5 118 PERCOLATION RATE 6 (minutes/inch) PERC HOLE DIAMETER 5" TEST RUN BETWEEN~.0 FT AND 8.5__ FT PERFORMED BY FLATTOP TECHNICAL SERVICES. b~'_-~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCEWITHALLSTATEANDMUNICIPALGUIDELINESlNEFFECTONTHISDATE. DATE: /~ /<:~ / <:~ ~. q'lattop T¢chnical$o~ces 14550 ~_xbo Street, Aadtora~e, AK 99516 (907) s4s43ss Lot 6, Block 7, Greenland S/D 11201 Lipscomb Street Wastewater disposal system upgrade Specifications 1.0 General: 1.1 The scope of the project consists of constructing a 54-foot long soil absorption trench containing a total of 7.5 feet ofsewer gravel. 1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All construction procedures and material specifications shall conform to Municipal and State requirements. All separation distances shall be in conformance with Municipal requirements, unless specifically waived. 1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around any buried utilities. 1.4 The contractor shall provide adequate cover material and rough grading over all system components to ensure that proper drainage is achieved after settlement and that there are no residual depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas. 1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after the soil is compacted, as well as placement oftopsoil and reseeding all areas disturbed by the construction. 2.0 Septic Tank: 2.1 The existing septic tank may be retained in service, provided adequate information can be obtained documenting its installation and integrity. 2.2. The waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. A "Bull Run" diverter valve shall be installed in the approximate location shown on the plans. 3.0 Soil absorption system: 3.1 The soil absorption system shall be constructed by excavating a 54ofoot long trench to a depth of 14 feet below ground level in the vicinity of test hole #1. 3.2 The bottom of the excavation shall be level. Any compacted or smeared surfaces shall be raked to allow proper infiltration. 3.3 A total of 7.5 feet of approved sewer gravel shall be placed in the bottom ofthe excavation with the perforated distribution pipes laid level such that the pipe inverts are no less than 7.0 feet above the bottom ofthe sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the #200 sieve. 3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on the design drawings. The portion of the monitor tube extending through the sewer gravel shall be perforated. 3.5 Approved filter fabric shall be placed over the entire top surface ofthe sewer gravel. A minimum of 2 feet of soil cover is to be placed over the filter fabric.. 3.6 The top surface of the cover material shall be raised a minimum of 6 inches higher than the surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill slopes shall be no steeper than 3:1. 3.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have the site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and seed to promote rapid revegetation of all areas disturbed by the construction. 4.0 Inspections: 4.1 A total of 4 engineering inspections will be required during the course of the project: (1) initial stakeout with the contractor to establish the location ofthe system and to discuss the plans, specifications and construction procedures, (2) after the native material has been excavated to expose the infiltrative surface to ensure that it is level and at the right elevation, and conforms with the soil test information, (3) after the sewer gravel is in place and the distribution pipes have been laid and connected up to the septic tank, but prior to placement of insulation or filter fabric, and (4) after rough backfill and grading is complete. 4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in advance to ensure the availability of the engineer. Tom Fink, Mayor Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 September 10, 1993 Edward A. Watson PO Box 190552 Anchorage, Alaska 99519 Subject: Lot 6 BLock 7 Greenland Subdivision Permit ~SW920277, PID #015-171-07 The subject permit, issued September 10, 1992 by this office for a single family well and/or on-site wastewater system, has expired as of September 10, 1993. A new permit must be obtained from this office for a well and/or on-site wastewa%er system NOT installed by %he expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as-built inspection report must be sent to this office for review, approval and documentation. Ail inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $320.00 for an on-site wastewater permit; $120.00 for a well permit and $440.00 for a combined on-site wastewater and we].l permit. If you have any questions, please call this office at 343-4744. E°_ sg .~ Service~anagers enc: Copy of Permit cc: Mountain Engineering PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920277 DESIGN ENGINEER:MOUNTAIN ENGINEERING OWNER NAME:WATSON EDWARD A & OWNER ADDRESS:il201 LIPSCOMB ST ANCHORAGE, AK 99516 DATE ISSUED: 9/10/92 EXPIRATION DATE: 9/10/93 PARCEL ID:01517107 LEGAL DESCRIPTION: GREENLAND BLK 7 LT 6 LOT SIZE: 22000 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL, PROVISIONS: RECEIVED BY: /~~ ~ ~~ DATE D AT : Mountain Engineering 3868 Shannon Circle Anchorage, AK 99508 September 9, 1992 Municipality of Anchorage On-Site Services P.O. Box 19-16506 Anchorage, AK 99519 Dear Sirs: Re: Emergency Septic Tank Replacement Greenland Subdivision, Lot 6, Block Owner - A1 Watson The purpose of this letter is 'to provide the required design narrative in support of our application for a permit to upgrade the septic tank on the above referenced lot. Attached for your reference is a surveyor's site plan, and our design drawing. The existing septic tank is apparently fiberglass, and it has failed. The soils on the tank have collapsed, and sewage is surfacing. We are requesting that this permit be processed as soon as possible so that we can correct 'the unsanitary condition. The topography of the lot in the vicinity of the proposed tank replacement is approximately level. All water wells within 200 FT of the proposed system are indicated on the attached design drawing. Please contact me at 562-1500 or Brent Eaton at 562-2514 if you will need any additional information. Sincerely, '~, ' ,,', ,c:~" = '! ~ .' ~ v~ ,. he fo]lowing , ' ,.,'? .Lot (., '5~ -?~ 6.fi£'F~M£AIV~ ~L~II2tSION ........ '\nchor.~lze ]]r'c.rdm~t ~ I~-,'met, ,'\h~'~ica. .:,d lhat a'~' indicaled bm'eon Dated at Anehr~rage, Alaskn · , ' 'l~ngineer~ ~lld ~til'veyors , ' oGRE,' 'ER ANCHORAGE AREA BO?"UGH Department of Environmental Quality 3330 C Stree~ Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME MAILING ADDRESS LOCATION / LEGAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL /o iNSIDE LENGTH / _ MANUFACTURER '~"~'~/~ r' NUMBER OF MATERIAL /~//¢ ~..~ ~/¢/?_r' COMPARTMENTS INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY. /¢¢D GALLONS. SEEPAGE PIT: .~2x'3/'~ I.J-/x ~3' NUMBER OF PITS / DIAMETER OR WIDTH LENGTH DEPTH /_~, .C / LINING MATERIAL~~$ q/C//¥~J' CRIB SIZE: DIAMETER__DEPTH ~ i ~ DISTANCE FROM: WELL .. //-- TOTAL EFFECTIVE ~''~// SQ. FT. BUILDING FOUNDATION_~_, NEAREST LOT LINE 2-¢.' . ABSORPTION AREA (WALL AREA) ADDITIONAL ABSORPTION ' ¢~/ 7'0 ']'-/&~/,~ ~-.,~, 0 /~,¢-,¢L¢,/,'.¢~o 2.'"~ F~'; /'~¢ WELL: TYPE ~'~',,y',,O/~, CONSTRUCTION ~ // ¢..¢i; L..':-¢ DEPTH 2J~°/ A/e(t~ DISTANCE FROM: BUILDING /-/~ NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION ~-O LOT LINE '~0 I-t'- /~ ~ / SEWER LINE TANK__ SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED __ REMARKS DISTANCES: INSTALLED BY: PIPE MATERIAL: ~,q:T :Z-,~/v/ LOT SLOPE: REMARKS: .~'¢ f- ~ 71.1 Form No, EQ-031 DIAGRAM OF SYSTEM %'~/~ 2-.~-~/7 / G,A.A.B. Dec. 7. 2004 10:52AM Garnoss Ensineerins Group, Ltd. No.2553 P. 1 t~ GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS SEEPAGE PIT ~ ., DRAIN FIELD OTHER NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED· BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL. QUALITY AUTHORITY WILL be SUBJECT TO PROSECUTION. SEPTIC TANK SIZE FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PIT WALL MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK DRAIN FIELD TYPe O~J~/~-/~EEPAGE A~A SIZE--~-;/~/-)I/~2~ ~ TYPe DIAGRAM OF SYSTEM ,/ SEEPAGE PIT ~/ O O ALSO CONSIDER AREA WELLS, /o · SEEPAGE PIT , DRAIN FIELD TO NEAREST LOT LINE. WELl TO SEPTIC TANK /~O ~ DRAIN F~ELD WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, /~! .. SEEPAGe PIT TO RIVERi LAKE· STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION.~5 FEET INTO UNDISTURBED SOIL, 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE W,TH SAid CODE. ~ ~ ~r /~/~ Performed For Legal ~escription: Lot $ Block 7 This Form Re~orts Soils Loq yes "0~ ~es~ is wor~4 a ~housa~d Hartke Date Performed. Subdivision Greenland Sub. Percolation Test 9 lO Peuth Feet Soil Characteristics 2~ 3 5~ 6-- Silty Sand Thruout Depth of Test , Hole Bottom of Test Hole @ - 12 Was Ground Water Encountered?. No Ie Yes, At what Depth? Readinq Date Gross Time Net Time Depth to H20 Net Dror Percolation Rate Hinute/F~.. Proposed Inst~-T]~ion: SeenaQe Pit yes~'~ Drain Field Deoth of Inlet Depth To Bottom Of Pit Or Trench Cm~!~ENTS: 2~0 sq,. ft. drainage area reqBired per bedroom No Bedroo'k or water Cable 4- f~' below seepage pit ~' DA~:E RECEIVED . INSPL--CTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR I NSP ECTOR I NSP ECTO/R-~ DEPT. OF MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEOT~IROB:j'/%~ h''L .... '~!{CTION 825 L ~treet - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION REQUEST FOR APPROVAL OF INDIVIDUAL ~ATER AND SEWER FACILITIES DIRECTIONS: Comple~ all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) deys for processing. 1. PROP~YOWNER ) PHONE PROPERTY R~8IUENT (If dif~ f~om above) // , PHONE MAILING ADDRES~ 3. L~DINGINSTI~UTIO~, /~ ~ , PHONE MAILING ADDR SS STREET LOCATION/ . /i I 6, TYPE OF RESIDENCE ' ~LE FAMILY ~ MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One I-] Four [~] Two ~] Five [~] T"~hree [] Six [] Other INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) 8. SEWAGE DISPO~,,~AL SYSTEM ~ INDIVIDUAL/ON-SITE [] PUBLIC UTILITY YEAR ON-SITE sYsTEM WAs INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE pRocEsSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] iNDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connect[on Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTENI PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [~ Holding Tank Size: If Tank is homemade SOILS RATING give dimensions'. TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line ] Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS ~ APPROVED FOR 3 BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY.~. ~~~. /',8 Clio (.90,7) Feb.~.'ua:y :L]., 1981 Dennis }!anise % Jeanetf_e GrJ.ggs Century 21. - [:[erJt:age Homes 207 East Nert:he:n [,ights i3ou]evard Anchorage, Al aska 99503 Subjec[: i.,ot 6 I~,]_O¢;k 7 Greenland Subd:.v:J_sion Approval Eot t:he ind.i, vJdual ~',:~ -" ' ..... a..~ and waker canno~ be g:aql:ed unLi] the following '~- . / cell,s have co~'ap ]_e {'e{,: The ~,.,',,her ' , · ' "~"'· " ~,m_ 5.-~1,~' reporh neects ho be rle].i:m,se{ ho La..s o:[:~:ce ~rom [:N:~ Chem J',a]:)r 5633 B Sttreet:, {Ell/ our review. (2) The sep[:[c.' 'hank :amlped ~'' ~ , . v, ]_ .~1 a :i/eceJ pt s~})i'~ii{:ted to :his of:ffJ, ce. (3) An adequ:cy hes{:, z~eeds to be per:[ormed on [he exish.i, ng ].eaching area~ 'Phis hes[: w:[]_l de{:ermine J_f hhe sysL:em ~_s adequate accord.~ng N) Nah:Jonal Standarc~s,. A ofl private f:i:ms per:orm:[r~g {:he i:es{: i.s enc].osed. '.lFltJ. s report: rt:ed: ko be submi[:hed ho '[:his fiepartmenh for our r e i yew. l[f [here are m:]v f~ri:.her crees[Joins ,:].ea~.:= v ' n ' ah 264.-4'720. Sincere].y, Rotlerl: C. Plca{:!:, R.S. AssocJa[te Spec:iai J.st: RCP/]_jw Alaska Nal:.ional N'mk of hhe Nor{ih 330]. C 8breck, Oa].a'tJ.~3 i'[ 99!503 [~lV'J t - DTRUCTURAL EGTRIGAL IVIECHAN %, LAND ~3URVF. YII'kit:~ I N r- ~) R P ORATED ENGINEEIqS & SURVEYOrqS SEPTIC SYSTEM ADEQUACY TEST DATE 1/22/81 CLIENT: Name Dennis Hanlce Telephone 344-5727 Address c/o Jane Woytusik ~-l~-s~k~N~°nal ff~--o-{~-~e North Pouch 6608, Anchorage, Alaska 99S02 [E6A[ DESCRIPIION: Lot 6, Block 7 Greenland Subdivision SEPTIC TANK: LEACH PIT: Material Type _FihemLgl~ 8x10xS' deep Size 1 ~_000_g~_l. ~ c ri.b__ _ Number Bedrooms 5 Required Tank Size Surcharge Test 400 gal. water; 0.80 (150 x Rate of percolation 680 gal ./day Sludge condition in tank: Not critical _(_last ]8 months ago) Remarks: System installed 1976 DRAIN FI ELD: No. bedrooms) min. pun_q)ed approxim_ate]y · Civil En~'eer - MUNIUPALITY OF ANCHORAGE Development Services Department ; Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 015-171-0� Certificate of On -Site Systems Approval Parcel I.D. -�"' Expiration Date: 1. GENERAL INFORMATION Complete legal description Greenland B7 L6 Location (site address) 11201 Lipscomb St. Current property owner(s) Keeter & Kristen Brown Day phone Mailing address Real estate agent Kelleigh Shea 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic FE Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ � 12.E coOQ Waiver Fee $ Date of Payment -7/M) ,2 02 0 Date of Payment Receipt Number. 0 3'5 51 G Receipt Number COSA # DSG 2+713 39 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe 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 soil condition, ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. 6. DSD SIGNATURE Phone (907) 745-8200 Date _a�99 W-7— OF A� k Aa THl Vr t System #1 Approved for 3 bedrooms 6 5teveiPaiiriori 4 CE 08149 s' System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following ```plYtQoF�rrrrt�� J ON -SIT WATER AND )))1W II - BY `^— Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Advisory Other ot,,_ 2 g )(v- Legal Description: Greenland B7 L6 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA FER Well log is filed with Onsite (or attached) Date drilled 8,1-1974 Total depth 268 ft Cased to 268 ft Al Sanitary seal is functioning correctly © Wires are properly protected Casing height (above ground) 23 in. Date of flow test for COSA 7/7/2020 Static water level at beginning of test 251.1 ft Comments B. TANK DATA Age of tank(s) 28 years Tank type/material Steel Measured operating fluid level in septic tank 4 F -1 Standpipes/foundation cleanout per record drawing Date of pumping 7/7/2020 D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) "/7/2°02 ALL standpipes present per record drawing Total measured depth from grade 14.2 ft (max) Measured depth to pipe invert from grade 6.5 ft (min) ❑ N/A — pressurized field n Monitor tubes go to bottom of effective. If not, state depth into effective n Code -required soil cover over field © System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 2000 gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: Structure served by this system 1 010-171-07 Well production at time of test 4.78 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes 0_1!0 i © Coliform bacteria is Negative Nitrate a_9-3 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L XKArsenic less than MRL (ND) Collected by f�6t n.1/1 r) it X_._ Date of Sample 71 5� . C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift statibn material Comments: Adequacy test date 7m2020 Results ED Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 500 gal New depth 106 in Elapsed time 260 min Final fluid depth 0 in Absorption rate '450 gpd Any rejuvenation treatment (past 12 months) If yes, enter date no E. SEPARATION' DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' El Yes Community Sewer Manhole/Cleanout > 100' ft �j✓ Yes if No ft Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' Q✓ Yes if No ft Absorption Field on Lot > 100' [Z] Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' Surface Water> 100' 0 Animal Containment > 50' ❑✓ Yes if No ft ft F/� Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' P/1 Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' Yes if No ft Wells on Adjacent Lots: Absorption Field > 5'✓Q Yes if No ft Private Wells > 100' 0 Yes if No ft Water Main > 10' F,71 Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' F,-/1 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' El Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓Q Yes if No ft Private Wells > 100' ®✓ Yes if No ft Water Service Line > 10' El Yes if No ft Community Wells > 200' Yes if No ft Surface Water> 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review Of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect 0/7 this date. COSA Checklist yellow sheet AW OF A(qs�� � • is Leven R. Par roie ' MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTW1E0T9O7-343-79O4 On -Site Water and Wastewater Section Fax: 343-7997 m/vxvx.nnoni.org/onmite Septic Tank Advisory Certificate of On -Site Systems Approval #OSC 201339 Subdivision: Greenland 87lot 5 Storting at ZO years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 28 years old. Typical replacement costs range from $8,000 to $11,000 This advisory must be attached to all copies of the subject Certificate of On -Site 8VItenns Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. 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. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. o~.5-~.7~.-o7 COSA # L¢~,_.~( Expiration Date: GENERAL INFORMATION Complete legal description Greenland S/D Block7, Lot 6 Location (site address) :~z2oz Lipscomb Street Current Property owner(s) Ira Autrey & Rhonda Price Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Public Water System Coldwell Banker/Bethany Stamper Day phone Day phone Day phone 265-9~.69 TYPE OF WASTEWATER DISPOSAL: Well [] Individual On-site [] Individual Holding Tank [] Community On-site I--1 [] Public Sewer [-1 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 sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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 Pannone Engineering Services, LLC Phone 272-8218 Address P.O. Box ~oo2~7, Anchorage, AK 99_5~o Engineer's Printed Name Steven R. Pannone, P.E. Date Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe 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 soil condition, ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. PES can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the 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 ,.-_~,O bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: WELL DATA Well type Private Date completed 818h.974 Total depth a68 ft. Greenland SlD Block 7, Lot 6 IfA, B, or C prOvide PWSID Sanitary seal (Y/N) Y Cased to a68 .ft. FROM WELL LOG Date of test 818h.~_74. Static water level Well production WATER SAMPLE RESULTS: .Coliform Neg colonies/100 mL Arsenic: ND ug/I B. SEPTIC/HOLDING TANK DATA Tank Type/Material Steel Tank size ~.ooo gal. Foundation cleanout (Y/N) Y Date of pumping =.o1:~:~1~,o=.o C. ABSORPTION FIELD DATA ff. g.p.m. Nitrate a,87 mg/L Date of sample: Number of Compartments _2 Depression over tank (Y/N) N Pumper A+ Home Services Inc. Parcel ID: o[~-~7~-o7 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) =4 AT INSPECTION ~.olael:~o2o 2Sa ff. 5.9+ g.p.m. Date installed ~Al?laoo~ Length 57 ft. Width Total depth =.zr.a ft. Eft. absorption area ??_n Date of adequacy test =.ol2ol',e',e Results (Pass/Fail) __ Fluid depth in absorption field before test o_ in. Elapsed Time: 8_~0 min. Final fluid depth _o in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N in. Other bacteria Neg colonies/100 mL Collected by: pannone Engineering Date installed qlaal:tQ,~, Cleanouts (Y/N) Y High water alarm (Y/N) N System type Deep Trench Gravel below pipe 6.8 Depression over field N For 3 bedrooms Soil rating (g.p.d./~ or ~/bdrm) o.6GPD/SF ft. Monitoring tube _Y Pass Water added46a gal. New depth_o_ in. Absorption rate >= z~5o+ g.p.d. If yes, give date LIFT STATION Date installed "Pump on" level at Datum in. E. SEPARATION DISTANCES Size in gallons "Pump off" level at ~ Cycles tested in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 208 Absorption field on lot zoo+ Public sewer main 75+ Sewer/sePtic service line 25+ Animal containment areas Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? 200+ on adjacent lots zoo. on adjacent lots zoo+ Public sewer manhole/cleanout 2oo+ Holding tank zoo+ Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Property line Water service line 25+ Absorption field 5+ Surface water zoo+ Building foundation zo+ Water main Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 2o+ Water main 75+ 25+ Surface water zoo+ Driveway, parking/vehicle storage 3.0+ Wells on adjacent lots zoo+ Property line Water Service line Curtain drain F. COMMENTS . Lot contains Seepage Pit and Deep Trench drain field. Only Deep Trench tested. in. (Rev. 11/05) I ced~ that I have datelined through field inspections and review of Municipal re~s that the above systems are in . conformance with MOA COSA guidelines in effect on th~s date. Engineer's Printed Name Steven Ri Pannone, PiE. Date ~1~1~o~o COSA Fee $ ~ Waiver Fee $ Date of Payment ~/~~ Date of Payment Re~ipt Number~~ Receipt Number Municipality of'Anchorage Development Services Department Building Safet~ Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cLanchorage.ak.us (907) ~43-7904 CERTIFICATE OF HEALTH AUTHORITY ,PPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. _~ / O '-- / 7 I '- ~:) 7 1. GENERAL INFORMATION 0 Expiration Date: Complete legal description GREENLAND SUBDMSON; LOT 6, BLOCK 7, Location [site eddmss or directions) 11:~01 UPSCOMB STREET * ANCHORAGE, AK. 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address I~D WATSON Day phone 346-1001 11201 lrlPSCOMB =I'p~EET * ANCHORAGE, AK. 99516 Day phone LARRY DYKES w/PRUDENTIAL VISTA Day phone 4241 'B' STREET * ANCHORAOE, AK. 99503 562-6464 Unless othenvise requested. HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for propartles served by s single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeownem. Certificates of Health Authority Approval are valid for 90 days flom the date of Issue for properties served by a private or Class C well and may be reissued with new water samples. (Certiticates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage flies and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(areJ 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 537-6179 Address 3701 E. TUDOR ROAD, SUrE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC end MOA DSD Guidelines & Regulations. The mpo~ed 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 futura performance of the system, nor do they guarantee that them ara no hidden defects or encroachments. GEG, Ltd. can themtom not provide any warranty or futura estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this mpolf is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other pemon or party is not authorized, nor will lt confer any legal dght whatsoever. 5. DSD SIGNATURE ~ Approved for ~ bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: -- ' WATERA D :'" Mamtenan~ Agreements ~~,..,, Supplemental Engineers Roo~ Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O, Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: WELl. DATA Well type PRIVATE Date completed 8/8/1974. Total depth 268 ft. GREENLAND SUBDMSIONI LOT 6~ BLOCK 7m Parcel ID: IfA, B, or C provide PWSIDf¢ N/A Sanitary seal (Y/N) YES Cased to 268 ft. 015-171-07 Well Log (Y/N) YES Wires propedy protected (Y/N) YES Casing height (above ground) 12+ in. Date of test Static water level Well production FROM WELL LOG AT INSPECTION 8/8/ g74 ./23/2004 249 fi, 257 fl. 9 g.p.m. 4.6 g.p.m. WATER SAMPLE RESULTS: Coliform ~ colonies/100 mi, .Arsenic: N/A mg,/L, Nitrate I.\c3 rog.IL. Other bacteria Date of sample:11/23/2004 Collected by: ·, colonies/100 mi. GEG! LtD. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date of pumping 11/23/2004 Pumper Date installed Cleanouts (Y/N) High water alarm (Y/N) MCDONALDS PUMPING 9/12/1992 N/A ABSORPTION FIELD DATA 6/2/1974 / Date installed Length 3~/ ft. 14,2/ 684/ft2 Total depth .13.5 ff. Eft. absorption area 775 Monitoring tube YES Date of adequacy test *'11,/23/2004 Results (Pass/Fail) PASS Fluid depth in absorption field before test 22.5 in. Water added 1074gal, Elapsed Time: 133 min, Final fluid depth 30.5 in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN **TESTED ~RENCH ONLY.  SEEPAGE Soil rating System type TRENCH Width 2,;3~.~5/ ft. Gravel below pipe 66./8 Depression ever field NO For 3 bedrooms New depth 40.5 in. 450+ g.p.d. If yes, give date - Date installed, Size in gallons "Pump on" level at in. ~ .----- Cycles tested. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ High water alarm level at Meets alarm & circuit requirements?. in. On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank N,/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water service line 10'+ Wells on adjacent lots 100'+ Absorption field Surface water. 5'+ 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Water service line 10'+ Curtain drain NONE KNOWN Building foundation, 10'+ Surface water 100'+ Wells on adjacent lots 100'+ Water main N/A Driveway, parking/vehicle storage ,5'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Date 1'~/~- V- JEFFREY A. GARNESS HAA Fee $ ~-'~ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number EASDV,£NTS OF RECORD, OTHER THAN THOSE SHOWN O1'~ THE RECORDED ARE NOT SHOWN HE~EON. 7193A I hereby certify that I have surveyed the Dated at Anchorage. Alaska MUNICWALITY OF ANCHORAGE Development Services Department ; Phone: 907-343-7904 On -Site Water & Wastewater SectionFa,.. x _ _ 907 3 �3 7997 Certificate of On -Site Systems Approval 01.E --17 In -DZ Parcel I.D. Expiration Date:. 2-©Z-0 1. GENERAL INFORMATION Complete legal description Greenland B7 L6 Location (site address) 11201 Lipscomb St. Current property owner(s) Keeter He Kristen Brown Day phone Mailing address Real estate agent Kelleigh Shea 2. TYPE OF DWELLING: [71 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well E Private Septic I -XI Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ � 1,2. 5,19 coyiO Waiver Fee $ Date of Payment -7 '/M) ,2020 Date of Payment Receipt Number US 5 51 G Receipt Number COSA# DSC20133q Waiver# STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal systQm is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe 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 soil condition, ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. 6. DSD SIGNATURE System #1 Approved for 3 System #2 Approved for Disapproved Conditional approval for Date ­7— OF A� k *. 4RTILFX�1 •-* � v.bedrooms Steen Ponnone F CE 8149 bedrooms�csr� k M, ��-�ROFESS'�V" � bedrooms, with the following Stipu "11Y u _ ` J ON-SITF`9_� WATER AND m By , W, Original Certificate Date: 7 -.2_3 -2dZ�-) The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Advisory Other ada._ P 2 gr— Legal Description: Greenland B7 L6 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA MR Well log is filed with Onsite (or attached) Date drilled $"11,1974 Total depth 268 ft Cased to 268 ft R Sanitary seal is functioning correctly. 0 Wires are properly protected Casing height (above ground) 23 in. Date of flow test for COSA 772020 Static water level at beginning of test 251.1 ft. Comments B. TANK DATA Age of tank(s) 28 years Tank type/material Steel Measured operating fluid level in septic tank 48° FRE Standpipes/foundation cleanout per record drawing Date of pumping 7/7/2020 r D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) "1"2002 411 ALL standpipes present per record drawing Total measured depth from grade 14.2 ft (max) Measured depth to pipe invert from grade 6.5 ft (min) ❑ N/A — pressurized field Q Monitor tubes go to bottom of effective. If not, state depth into effective R Code -required soil cover over field Q System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 2000 gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 010-171-07 Structure served by this system 1 Well production at time of test 4.78 gpm Water storage tank volume— gallons Well disinfected for coliform test? ❑ Yes 0-90 Coliform bacteria is Negative Nitrate 9-9-3 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L XKArsenic less than MRL (ND) Collected by &0.1/10 /1 Date of Sample 71 . C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift statibn material Comments: Adequacy test date 7/7/2020 Results [DPass For 3 bedrooms Fluid depth prior to test 0 in Water added 500 gal New depth 106 in Elapsed time 260 min Final fluid depth 0 in Absorption rate '450 gpd Any rejuvenation treatment (past 12 months) no If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ✓® Yes Community Sewer Manhole/Cleanout > 100' ft �✓ Yes if No ft Yes if No ft Neighboring Tank > 100' F1 Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' Yes if No ft ❑✓ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5'✓Q Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' El Yes if No ft Private Wells > 100' ✓� Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' [71 Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ✓® Yes if No ft If absorption field is under driveway comment below Property Line > 10'✓❑ Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓Q Yes if No ft Private Wells > 100' ®✓ Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' n✓ Yes if No ft Surface Water > 100'✓0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l 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. COSA Checklist yellow sheet of ,a�gsr�� en Pannore CE 8149 .— Septic 'Tank Advisory Certificate of On -Site Systems Approval #OSC 201339 Subdivision: Greenland B 7 lot 6 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 28 years old. Typical replacement costs range from $8,000 to $11,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like.