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T12N R3W SEC 15 LT 65B
T12N R3W SEC 15 Lot 65B #015-053-36 Development Services Department Building Safety Division e On. -Sire Waller & Wastewater program / 47 B Street P.O.O Boxox 19 195550 Mark Begich Anci�oroge, A.K. 99519-5650 Mayor nrvacmuni.org/ansite (907)343-7904 - Pump Installation Log ,J Well Drilling Permit Number: SW Date of Issue: IZy -1 l Parcel Identification Number:_ Legal Description 6e C, /3— Pump Installation Date: i IV Pump Intake Depth Below Top of Well Casing: 170feet Pump Manufacturer's Name: -/R e4 0�r.t4-� Pump Model: S-5 ) >-- Pump Pump Size I hp Pitless Adapter Burial Depth: J O feet 7peOwnerName &Address: q 1� rw oee. rd. gwc4. Pitless Adapter Manufacturer's Name: K4a,4-l`a to J, -r— I Pitless Adapter Installer: Ili 1A- Well Disinfected Upon Completion? Yes F-1 No Method of Disinfection: L?`/ Comments: e 1 Anchorage Pump & 103ell Service Pump Installer Name: 330 East 76th Avenue Anchorage, Alaska 99518 - Phone: 907-243-0740 Fax: 907-243-0742 Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of ptunp installation. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street • Anchorage, Alaska 99501 Telephone 264.4720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NA v l..C-4' PHONE -7117,71 Cl NEW UPGRADE MAILWG ADDRESS / LEGAL DESCRIPTION ' -9-AI (cJ S LaT S LOCATION /j / NO. OF BEDR009 tJ y DISTANCE TO: Well / Absorption area Dwelling PERMIT NO U ��— ;:Z Manufacturer /J PQ Material � No, of com is H Liq. ca ijyty,Nallons C%CJCJ IF HOMEMADE: Inside length Width Liquid depth f3 y —10Z DISTANCE TO: Well Dwelling PERMIT NO. 02< Manufacturer Material Liquid capacity in gallons O W = DISTANCE TO: Well Foundation Nearest lot line PERMIT NO. .w.l LL Z = W No. of lines Length of each line Total length of lines Trench width inches Distance between lines 2 f p Top of the to finish grade Material beneath We inches Total effective absorption area w 0 Length Width Depth PERMIT NO. Q H W 0. Type of crib Crib diameter Crib depth Total effective absorption area W DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. W � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOILTEST AT G INSTALLER REMARK � ,v y y I { I 1 I AVPHOVED DATE LEO L �` (3Li 72-0111,fNev. 3/78) u rl IJ N I C I P F=I L_ I T'-' O F= n"C H p F? Fa r3 E I ' - 1 DEPARTMENT C""HEALTH AND ENVIRONMENTAL F-'_)TECTION 025 'L- STREET, ANCHORAGE, AK. 995 1 264-4720 jv ON—SITE 'SEWER uF}GRFidE F'ERr1 I T PERMIT NO. C 000372 ) APPLICANT JAMES GOURLEY 9601 ABBOTT LOOP 344-7479 LOCATION ABBOTT LOOP LEGAL tT12NR31.1S15. LT._65 LOT SIZE 54000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: DP.AINFIELD MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING CSR FT/BR)= 1• THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C?EPTH= #lD LEtJGTH= O CBMnVaL_ CrEP TH= F2l THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DP.AINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET). THE TREr+FCH LJ I PTH I S O. 0063 FEET. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). REGeU I REF7 SEPT I iG Tn?-4K SIZE= 1O0'0 GnL_LONS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- TL4O <;M ] I rJSPECT I ONS FF RE REG!U I AEC? --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT 14ILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC 14ELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER, LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERMIT EXPIRES OEGEMEER = 1. 1Sc0O I CERTIFY THAT 1: I AM FAMILIAR, WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER, SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. ISSUED BY V4. 0 Gf' %TER ANCHORAGE AREA BOROI�VH HEALTH DEPARTMENT NO 238 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM M SEPTIC TANK: MAILING 7, NUMBER OF C DISTANCE FROM WELL o3 MATERIAL Gt COMPARTMENTS I LIQUID CAPACITY Iso GALLONS. INSIDE LENGTH ArLOTI INSIDE WI�L /�7ODEOPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS / OUTSIDE DIAMETER 5,0, OR WIDTH /'Z'' , LENGTH 13 , DEPTH k' LINING MATERIAL Ccnlal2ETE' r�C-K . DISTANCE FROM WELL /O7' 611 BUILDING FOUNDATION , NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)3o� SO. FT. TILE DRAIN FIELD: DISTANCE NUMBER BETWEEN FT. LENGTH OF tACH LINE NEAREST LOT WIDTH TOTAL LENGTH OF LINES_ DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE wEll: df-4;14741 rl ;//E� DISTANCE FROM WATER TYPE DEPTH , BUILDING FOUNDATION. SAMPLE NEAREST _ NEAREST -7 SEPTIC iSEEPAGE /07' OTHER LOT LINE , SEWER LINE, TANK , SYSTEM , CESSPOOL , SOURCES-- DIAGRAM OURCES=DIAGRAM OF SYSTEM DISTANCES: L l r 7 S� ------------- r.. DATE v�• K��/��19 A"410.2- GREATE:01 CHORAGE AREA'1'OROUGH IIEALTII DEPARDIENT 327 Eagle St. Anchorage, Alaska 99501 279.2511 SEW-A-0"tSRQSAL SYSTEM - APPLICATION & PERMIT Case No.Ll�/ 0 i0/i,:'1i� NAME OF APPLICA T_ Cq4uZ1'1 MAILING ADDRESS 171 /- u 51' PHONE N0333-J?SI RESIDENCE ADORE 4f1 LOCATION OF INSTALLATION LEG CRIPTION C /S^ r12 /l" /2� APPLICATION TO INSTALL: SEPTIC TANK, SEEPAGE PI DRAI_L n�OT TO SERVE THE FOLLOWING FACILITY 1 Qtt",CC C4rcc c,TC4 FINANCED THROUGH TO Id INSTALLED ti°4 rX`�Li1 PERCOLATION TEST RESULTSa 4W ANTICIPATED DATE OF CO L6TiII BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS 1413 1"Zg- , PERMIT TO INSTALL A AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED 2 AA'!4' + SEPTIC TANK SIZE '726 TYPE e4411 SEEPAGE AREA �!�� j r TYPE 1-4 DIAGRAM OF SYSTEM DISTANCES: IIIAdlfo�-& - 4a - So rtizl� xc 0,(, - Mo 91 HEALTH AUTHORITYOR I I I I I I I I I I I I I I ' LICENSED DESIGNER 1 certify that 1 am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. /r7�2w j DATE i'��` 0 APPLICANTSSIGNATURE CfiEP.TEh h1:Cii^.•, , AS'."A ffL, J^ii f1i.:hLTa vLA:T:'E:T i ANCHORAn" s A!,Ac'.KA 335of Perfcrred ForLonw1 ufa EXCAeYl�iri r, , Lca=? .Dascription. of lock ate Fer:or-ed 7'tas fcr Reports e: Soils -,of, f iory�'IG �2NR3A Sf�t rerc^!.itioa [es. ---- Depth Fejt e a S 'I ScIl Char, _cteri :ics �- __ Location Swet^ Small lo.nces J -5aA ani 59,aUO( VCGLAZ in -'Lu *:�) 5P 5P3me'4- Ver.. I(ttle aoe-k per, plf. Has Ground :later Encountered? 110 if Yes, At :i^.at repth DerO. Of ------------- Test Performed by: pZCCp Data Certified By: Q Date:_ 14 N 1 i4l 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. 015-053-36 COSA #_ (>,�'0 i 3 Expiration Date: 1. GENERAL INFORMATION Complete legal description T12N R3W Sec 15 Lot 65B Location (site address) 9601 Elmore Road Anchorage AK 99516 Current Property owner(s) Kelly Reagan and Christine Howard -Reagan Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 10501 Schuss Drive Anchorage AK 99507 Day phone Rona Florio Day phone 1343 G St Suite #104 Anchorage AK 99501 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 2 3. TYPE OF WATER SUPPLY: Individual Well ED Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site ED Individual Holding Tank ❑ Community On-site ❑ 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 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 r As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the 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 102954, Anchorage, AK 99510 Engineer's Printed Name _Steven R. Pannone, P.E. Date 0?CO 1? 2 Engineers Comments: In conducting an adequacy test, l attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. 71tc 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 arc 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 not will it confer any legal right whatsoever. 5. DSD SIGNATURE ✓ Approved for 2 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: ON-SITE IIII�YI II I IGI I W. COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By '�/%%�� /�A �� Original Certificate Date: tn,l.. nus 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: T12N R3W Sec 15 Lot 65B Parcel ID: 015.053.36.000 A. WELL DATA Well type P Date completed -1970 Total depth 155+ ft. Date of test Static water level Well production WATER�SDI RESULTS: Coliform —colonies/100 mL Arsenic: ND ug/I If A, B. or C provide PWSID # _ Well Log (Y/N) n Sanitary seal (Y/N) Y Wires properly protected (YM) y_ Cased to 40+ ft. Casing height (above ground) 12+ in. WELL LOG . ft. g.p.m. y(rfj6Y Nitrateo mgg/L Date of sample: 412812009 AT INSPECTION 412812009 149 n. 3.2+ g.p.m. Other bacteria colonies/100 mL Collected by. 61. WEHR B. SEPTICIHOLDING TANK DATA Tank Type/Material STEEL Date Installed 811311980 Tank size 1000 gal. Number of Compartments 2 Cleanouts (YM) Y Foundation cleanout M) Y Depression over tank (Y/N) N High water alarm (Y/N) N it�f 446699 1�Q Date of pumping Pumper C. ABSORPTION ctFLD DATA() Date installed19H4" Ls -Foil rating (g.p.d./f? or ft2/bdrm)150 System type SEEPAGE PIT Length 12 a ftMre�� Width 13 ft. Gravel below pipe 6 ft. Total depth 6.75 ft. Eff. absorption area 300 fe Monitoring tube Y Depression over field N Date of adequacy test 4128109 Results (Pass/Fail) PASS For 2 bedrooms Fluid depth in absorption field before test Q In. Water added 300 gal. New depth 8 in. Elapsed Time:100 min. Final fluid depth 6 in. Absorption rate >= 300+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) N If yes, give date O. LIFT STATION Date Installed Size `Pump on" level at _in. "Pump Datum Cycles E. SEPARATION DISTANCES , Manhole/Access (YIN) i In. High water alarm level at in. — Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 90• Absorption field on lot 100+ Public sewer main 25+ On adjacent lots 80• On adjacent lots 80• Public sewer manhole/cleanout 100+ Sewer /septic service line 25+. Holding tank 100+ Animal containment areas JLManurelanimal excrete storage areas 100_ + _— SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Property tine 5+ Absorption field 5+ Building foundation 5+ P rtY Water main 100+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line _0 1 ++ Surface water 10+ Driveway, parking/vehicle storage 0• Curtain drain AaWells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION + "91-1 � elf 49n� 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. # VA\Stevan R. Pu,ln( 0� s rl, CE P14) Engineer's Printed Name Stevan R. Pannone P.E.l 12009 #44 6 Dat e 5119 eri�............ E ,:� ��• COSA Fee Date of Payment Receipt Number (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number SGS ReLM 1094878001 Client Name Pannone Eng. Srv. Printed Datef ime 09/182009 14:37 Project Name/® 9601 Elmore Rd Collected Datdrime 09/152009 13:00 Client Sample ID 9601 Elmore Rd Received Date/I Ime 09/152009 13:20 Matrix Drinking Water Technical Director Stephen C. Ede PWSID 0 Samplc Remarks: Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Waters Department TotalNitratcMitrite-N 4.06 0.100 mg/L SM204500NO3-F D (<10) 09/17/09 LCE Microbiology Laboratory Colony Count 0 col/100mL SM209222B A (<200) 09/15/09 DLC Total Coliform 0 col/IOOmL SM209222D A (<I) 09/15/09 DLC Fecal Coliform 0 coU100mL SM209222B A (<I) 09/15/09 DLC Municipality of Anchorage Development Services Department :'�'' a e Building Safety Division On -Site Water and Wastewater Program 5 , , 1t 4700 BragavAStreet 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. 015-053-36 COSA # I i A CA 0 13 V Expiration Date: 151 r, 7/0! 1. GENERAL INFORMATION Complete legal description T12N R3W Sec 15 Lot 65B Location (site address) 9601 Elmore Road Anchorage AK 99516 Current Property owner(s) Kelly Reagan and Christine Howard -Reagan Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 10501 Schuss Drive Anchorage AK 99507 Day phone Rona Florio Day phone 1343 G St Suite #104 Anchorage AK 99501 Unless otherwise requested. COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 2 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 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 verity 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 verity 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 102954, Anchorage, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date 5/19109 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. 71c 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. Theo conditions are outside the control of the evaluator of this system. All systems eventually fail am satisfactory lest 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.7he 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 _V Approved for �_ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By Original Certificate Date: .15—Z7 (R., 11115) Municipality of Anchorage ""4;.. _•" • 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: T12N R3W Sec 15 Lot 65B Parcel ID: 015.053.36.000 A. WELL DATA Well type p Date completed -1970 Total depth 155+ ft. Date of test Static water If A, B, or C provide PWSIIDD # Sanitary seal (Y/N) 41'2 Cased to ��ft5/ p/Oq FROM WELL LOG i ft. WATER SAMPLE RESULTS: \ 'i Coliform colonies/100 mL Nitrate 2.59 mg/L Arsenic: 'ND ugll Date of sample: 41260 Well Log (Y/N) n Wires properly protected (Y/N) Y Casing height (above ground) 12+ in. AT INSPECTION 412812009 149 ft. 3.2+ g.p.m. Other bacteria __L colonies/100 mL Collected by: M. WEHR B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date Installed 811311980 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) y Depression over tank (Y/N) N High water alarm (Y/N) N r Date of pumping 513!2008 Pumper DENALI PUMPERS C. ABSORPTION FIELD DATA Date Installed 9112/1970 Soil rating (g.p.d./ft2 or ft2/bdrm) 150 System type SEEPAGE PIT Length J 2 ft. Width 13 ft. Gravel below pipe 6 ft. 3ee_&44O At5 Total depth 6.75 ft. ff. abporptiocf n¢Le 00 ft2 Monitoring tube Y Depression over field N Date of adequacy test Results (Pass/Fail) PASS For 2 bedrooms Fluid depth in absorption field before test 0 In. Water added 300 gal. New depth I in. Elapsed Time:100 min. Final fluid depth 6 in. Absorption rate >= 300+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date Date Installed "Pump on" level at_ Size in Cycles tested at _ in. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 90• Absorption field on lot 100+ Public sewer main 25+ Sewer /septic service line 25+ Animal containment areas 50+ (Y/N) High Meets alarm & circuit On adjacent lots On adjacent lots 80• Public sewer manhole/cleanout 100+ Holding tank 100+ 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 100+ Water service line 10+ Surface water 100+ In. Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: or} i�h +4e PT +tis p Uric.r t�*ed`rUewoa(• s;'z7107 Property line 10+ Surface water iA 106:t Driveway, parking/vehicle storage O' Curtain drain 25+ Wells on adjacent lots 100+ A �+ CA PF a P�e �i� fnas T,to�l9��°ie corer. i 1,%s OS CavS F. COMMENTS No J.h WA CL VWC, kt�es4 c'SSince ii waS TrtSf�llad circa 198R70 _AII applicable waivers have been granted and are on file o. s s �� o. s —% �'�fi. 6 Z7i� G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and t, +' 4 " •�s v review of Municipal records that the above systems are in »......1.� conformance with MOA COSA guidelines in effect on this date. i j[�iSteven R. •Ponncnc? Engineer's Printed Name Steven R. Pannone. RE, ♦ c . r ♦ � + t,o. CC 8149 �e �• Date 511912009 ��•,• ».... ••� o COSA Fee $ Date of Payment Receipt Number. rJ (Rev. 11105) �; 5 e P} i s -TTC. J +0 ; Qu CD i AC) roc )Y OL 'i oy) 10 t UJ��r f.lcnth X04 (�uJec(ViCe L)vte 10`+ Waiver Fee $ Date of Payment Receipt Number c' II (09 r SCS Reta 1091663001 Client Name Pannone Eng. Srv. Project Name/# 9601 Elmore Road Client Sample ID 9601 Elmore Rd Matrix Drinking Water Sample Remarks: Printed Date/l'ime 05/15/2009 13:50 CollectedDateflime 0429/2009 15:02 Received Date fime 04292009 15:14 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results POI, Units Method Container ID Limits Date Date Ina Metals by ICP/MS Arsenic Waters Department Total Nitratc/Nitrite-N Microbiolocv Laboratory Colony Count Total Coliform Fecal Coliform ND 5.00 ug/I. EP200.8 C (<10) 05/06/09 05/14'09 NRB 2.59 0.100 mg/L SM204500NO3-F B (<10) 05110&109 JD7, 0 col/IOOmI. SM209222B A (<200) 0429'09 DLC 0 col/IOOml. SM209222B A (<I) 6129109 DLC 0 col/IOOml. SM209222B A (<I) 0429,'09 DLC 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 FOR A SINGLE FAMILY DWELLING Parcel I.D. f)r)3' 3 COSA# OtCOOqS 1. GENERAL INFORMATION Expiration Date: -7 Z -1 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address T12N R3W SECTION 15 LOT 65B. 9601 ABBOTT LOOP ROAD ' ANCHORAGE. AK 99507 MICHAEL HUDSPETH Day phone 243-8963 9601 ABBOTT LOOP ROAD • ANCHORAGE. AK 99507 Day phone DAN WOLF w/REMAX Day phone 276-2761 110 WEST 38th SUITE 100 • ANCHORAGE. AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 2 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site N Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Onsite 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 Onsite 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 engineers 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 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, LfD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the lost, and separation distances measured to readily Idontifiablo features. The operational life of all wells and soptic 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. Those 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 _� bedrooms. Disapproved. 337-6179 Date o e Garness: E 793 •':� .�ra�.6'«400G Conditional approval for bedrooms, with the fllo%Mng stip`0 •. WASE GRAM : � Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other jplArtlE2 LEir`r->Z By: Original Certificate Date: Za 9 Municipality of Anchorage ,,..., Development Services Department J Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 995196650 www.muni.orylareite (907)343.7804 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: T12N, R3W, SECTION 15, LOT 65B. Parcel 10: A. WELL DATA Well type PRIVATE If A, B. or C provide PWSID# N A Date completed ^1970 Sanitary seal (YM) YES Total depth 155+ ft. Cased to 40+ ft, FROM WELL LOG Date of test Static water kivel ft. Well production g.p.m. WATER SAMPLE RESULTS: Well Log (Y/N) NO Wires property protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 2/9/2006 152 ft. 5.1 g.p.m. Coliform 0 colonies/100 ml. Nitrate 4.11 mg./L. Other bacteria 0 colonies/100 mi. Arsenic: <5.0 ug./L, Data of sample: 2/8/2006 Collected by: GEG. Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/MateriW STEEL Date installed 8/13/1980 Tank size 1000 gal. Number of Compartments E Cleanouts (YM) YES Foundation deanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 2/10/2006 Pumper MCDONALDS PUMPING C. ABSORPTION FIELD DATA Date installed 9/12/1970 Soil rating (g.p.d.lftWJC1 150 System type SEEPAGE PIT Length 12 ft. Width 13 ft. Gravel below pipe 6 ft. Total depth 06.75 ft. Eft. absorption area 300 ft' Monitoring tube "YES Depression over field NO Date of adequacy test 2/9/2006 Results (Pass/Fed) PASS For 2 bedrooms Fluid depth in absorption field before test 14 in. Water added 576 gal. New depth 26 in. Elapsed Time: 160 min. Final fluid depth 22 in. Absorption rate >= 300+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date — **SEEPAGE PIT INSPECTION PIPE ONLY EXTENDS 4' BELOW TOP OF CONCRETE LID. D. LIFT STATION Date installed "Pump on" level at _in. E. SEPARATION DISTANCES Size in gallons Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAtfi station on lot 090' Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots ""80' On adjacent lots "80 - Public sewer manhole/deanout N/A 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 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 109+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage ""0' Curtain drain 25'+ Wells on adjacent lots 100'+ F. COMMENTS *WAIVER GRANTED WR#890009 **SEE ATTACHED WAIVER PACKAGE ***PORTION OF SEEPAGE PIT UNDER DRIVEWAY. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and e';' f- r* review of Municipal records that the above systems are in eo. conformance with MOA COSA guidelines in effect on thisdate. Garness: Engineer's Printed Name JEFFREY A. GARNESS 53f NO Date 3 to 0[,,!dp._ ned COSA Fee S !�Zc Date of Payments Receipt Number " • Z (Rev. 11/05) J Waiver Fee E Date of Receipt Number FTq SGS Reta 1060629001 Client Name Garncss Enginccring Group, Ltd. Project Name/N T12N R3W Sec 15 Lot 65A Client Sample ID T12N R3W Sec: 15 Lot 65A Matrix Drinking Watcr P%N'SID 0 Samplc Remarks: All Dates/rimes are Alaska Standard Time Printed DateMme 02/14/2006 14:24 Collected Datelrime 02/08/2006 10:00 Received Datclrime 02/08/2006 10:20 • Technical Director Stephen C. Ede Metals by ICP/MS Arscnic ND 5.00 ug/L EP200.8 C (<e10) 02/11/06 02/13106 TK Microbiology Laboratory Total Coliform 0 coUl00mL SM2092226 A (o-1) 02/08106 TLF Allossablc Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Nitratc-N 4.11 0.100 mg/L EPA 353.2 D (<s10) 02/08/06 1C Metals by ICP/MS Arscnic ND 5.00 ug/L EP200.8 C (<e10) 02/11/06 02/13106 TK Microbiology Laboratory Total Coliform 0 coUl00mL SM2092226 A (o-1) 02/08106 TLF L O'S91 M„61,U 1°U n ,00-S9 l 3.9 L.0 t.0 5 , .W ----------------� I I � P'tL Y +gym I I • � m� v! 6 I I I "o I I I I I I I 1 1 < I I 1 I d I > I t I 1 I u I Y o I I 7 I I 1 I 1 I I 1 I I 1 I 1 � I X61 ,I I c 1 1 I 1 I ----------- -------------- 1t'..L.M. PATFNTIPCC(gVAT1mN AND OCVCLPPMCNT.CT.ACK I L O'S91 M„61,U 1°U n Z O r F C O 0 m `z Z y O G Z n O mtiWm l7 «mf W -<o t m W J N �PKy w�nm yymm O< N uOGW N 33F► ° Fina m oa 'w S to z z<m< ABBOTT -LOOP ROA9L— 0 CVA, � w OI-I �<; pp moi'•., °' : I .W w 04"m > m� v! 6 W g Win Z O r F C O 0 m `z Z y O G Z n O mtiWm l7 «mf W -<o t m W J N �PKy w�nm yymm O< N uOGW N 33F► ° Fina m oa 'w S to z z<m< ABBOTT -LOOP ROA9L— 0 CVA, � w OI-I �<; pp moi'•., °' : I Munici�alit�yofAnchorage P.(). bm FX1650 • Anchomgc, Alaska £17,;19-fkZ0 • Telephone (J07) a1.`Lf:'S01 • Fax (`.N)7) a48 -&NX) 4700limpw Simet • Anchomge, Alaska VK507 Nu\r.nnnd.org Mayor Mark I3cgiclt Iluilding Snfet}I Division April 24, 2006 Jeffrey Garness, P.E. Garness Engineering Group 3701 E. Tudor Road, Suite 101 Anchorage, AK 99507 Subject: Waiver Request for T12N R3W Section 15 Lot 65B Waiver Request WR#: 060006 Parcel ID # 015-053-36 IIA060078 Dear Jeffrey Garness, P.E.: Your request for a waiver of the required 100 feet horizontal separation from the absorption field and septic tank to the private well has been approved. The approved separation distance is 80.0 feet from well on subject lot to absorbtion field and septic tank on lot 72 only. This waiver approval applies to the existing absorption field and septic tank to private well separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, o ,00dall it Engineer On -Site Water & Wastewater Program Community, Security, ProsPeiitJ State of Alaska: Separation Distance Waiver Guidelines for S.C.R.O. (State of Alaska Memorandum to District Office Engineers dated January 3,1985) Waiver Request for: T12N R3W Section 15 Lot 65B Parcel I D#: 015-053-36 Waiver Request Number WR#: 060006 Waiver Requested: 80 foot horizontal separation from well on subject lot to septic system on to 72 Engineer: Jeffrey Gamess, P.E. IIA060078 Septic Field Data According to information submitted from Garness Engineering Group Lot 72 was bootlegged and then later documented by Pannone engineering. Lot 72 is considered a multiy family so all documentation was submitted to the D.E.C. All waivers were considered at the time except for the encroahment to the well on subject lot 65B. The septic field and tank encroahment to well is 80 feet. The total depth of the septic field is 10 feet. Well Data There is no wel log for the subject lot however there are well logs in surrounding area that give soil strata down to well water. There was already a waiver submitted March 15th, 1989 for the encroachment of the septic tank on -lot to subject well. Since this waiver request there has been several Health Authorities issued referencing the waiver dated March 15`h, 1989. For the purposes of this waiver, the well log for lot 88 was used to a total depth of 242 feet. The total points yeild 13.5, which is below the minimum level however Garness Engineering indicate there are several layers of silty sand and gravel and clay and hardpan soils that have served to inhibit the migration of untreated wastewater into the aquifer. Municipality of Anchorage Development Services Department • v Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Strcct P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Waiver Review Worksheet WR#:060006 PID#:015-053-36 HAIPermit# HA060078 Date Received: April 24, 2008 Legal Description: T12N R3W Section 15 Lot 65B Engineer: Jeffrey Garness, P.E. Garness Engineering Group 3701 E. Tudor Road, Suite 101 Anchorage, AK 99507 Applicant: MICHAEL HUDSPETH Waiver Requested: 80 foot horizontal separation from well on subject lot to septic system on to 72 Criteria: Geology Points: A. Water Table 7.70 B. Soil Sorption 0.84 C. Permeability 0.82 D. Water Table Gradient 2.00 E. Horizontal Separation 2.2 Total 13.555 ........a...............................................a................a Waiver is Granted: X Waiver is not Granted: List Conditions or Reasons for above: Date: 4124/08 By: Joe Goodall Name of Reviewer ...................................................a.a................aa.. Rec#:t: // 0 Date Paid: 412412006 �ijlllC� F'Et or- 11150 1't7 f6 o/ o 031TI Zn/ a3K/ Sec IS'�r�C State of Alaska: Separation Distance Waiver Guidelines for S.C.R.O. (State of Alaska Memorandum to District Office Engineers dated January 3, 1985) Waiver Request for: T12N R3W Section 15 Lot 65B - Parcel ID#: 015-053-36 rI Waiver Request Number WR#: 060006 �Y Ve'.x Waiver Requested: 80 foot horizontal separation from well on subject lot to septic system on to 72 Engineer: Jeffrey Gamess, P.E. IIA060078 Water Table Points Depth of well: 242 7.70 Depth of septic system: 10 237 Distance from the bottom Point of the system to the highest Value water table In feet 0 0 8 1 17 2 24 3 30 4 40 5 85 6 100 7 290 8 1000 9 10 • Straight line Interpolation Is permitted between any two values Soil Sorbtion Points 0.84 Soil Type I Point Value 22 1.5 +28 1.5 + 84 1 + 35 1 Clean Gravel 0 232, [ 232, [ 232 [232 Fractured Rock 1 Course Clean Sand 1.5 Sand w/ Small Amt of Clay 2.5 Silt 3.5 Clay and Sand Equal 4.5 Clay 6 + l 56 232, 0 + [ 232, 0 + [ 232, 0 + L232] 0 0.1 + 0.2 + 0.4 + 0.2 0 + 0 + 0 + 0 *Use the predominant soil type but values can be averaged for a mixture Permeability Soil TypeT7Point Value Clay(will channel) 0 Silt and Sandy Clay 2 Clayey Sand 3 Fine Sand 1.5 Sandy Gravel 1 Fractured Rock 0.9 Course Sand (30 grit) 0.4 Clean Gravel 0 Points ,am 0.82 [22 + 232, .4 228 32, .4 +( 3 1 .9 + I 32, .9 56 +f 232, 1 +r 232, 1 + 232, 1 + r 232, 1 0.04 + 0.05 + 0.33 + 0.14 0.24 + 0.03 + 0.00 + 0.00 *Use the predominant soil type but values can be averaged for a mixture Gradient I %Slope Points Value -60% 0 In Feet -30% 0.3 0 -20% 0.7 50 -10% 1.2 -5% 2 0% 2.9)- 5% 4.5 10% 6 60% 7 slopes toward well gat slopes away from well °lf the gradient Is unknown, assume the worst case Horizontal Horizontal Point Separation Value In Feet 0 0 25 0.7 50 1 75 2 100 3 150 5 200 6 300 7 Points um 2.00 Points ,am 2.2 *Linear Interpolation between two point value Is acceptable. Horizontally means straight line distance to the well not the contaminate travel distance to water table which may be greater. Conclusion: Grant Waiver Total Points: 13.555 �ti F �.';��r.A�,��!•'a:.� i'�ri"i.` �',: A CI��,{;Jn ./150 y It I) ;I 141 �Y' 4&& L L cj� M, rdoc J,�l Yl 4 YX _lfr, I Milk GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS March 1, 2006 `' F Municipality of Anchorage t` .''. f y Department of Health & Human Services Division of Environmental ServicesT ; : � - --- On -Site Services Section P.O. Box 196650 7953 Anchorage, Alaska 99519-6650 Y k .. s,ioH� s>> 5,, Ref: Waiver Request and Certificate for Onsite Systems Approval for T12N, R3W, Sec. 15, Lot 65B. The existing 2 bedroom house is served by a private well and septic system. We request you grant a 80 feet separation distance waiver from the well on the referenced property to the septic tank and drainfield on T12N, R3W, Section 15, Lot 72. The referenced well was drilled in approximately 1970. According to documentation obtained from ADEC the septic system appears to be a "bootlegged" system that was installed in 2000 and was documented by Pannone Engineering in 2003. Since the well was drilled prior to the installation of the septic system the waiver fees should be paid by the owners of Lot 72. The following items are justification for the waivers: • There is heavy vegetation between the well on the subject property and the neighboring septic system. • The other path of contamination is subsurface migration of wastewater should the tank begin to leak. As can be seen on the attached well logs, the aquifer is relatively deep, with static water levels ranging from 163-187 feet deep. There are several layers of silty sand and gravel, clay and hardpan soils that have served to inhibit the migration of untreated wastewater into the aquifer. • Recent water sample results indicated nitrate levels to be 4.11 and coliform bacteria results to be undetected. Based upon the aforementioned facts, it appears eparation distance waiver. If i for your assistance. E., M.S. that there is minimal risk associated with you have any questions, please contact us at 3701 E. Tudor Road, Suite 101 ' Anchorage, AK 99507 Ph: (907) 337-6179 • Fax: (907) 338-3246' Website: gamessengineering.com i I pE I T12N. R3W SEC. 15. LOT 64A, I� \ V � \.--�f-----0T��"1 I \ � GARNESS ENGINEERING GROUP, Ltd. —�+� CONSULTANTS b OENERAI CONTRACTORS IMI (. NODI, e , ■IR bl . WIMO0.Stl'. W( MSO) MbE }}1-eln • FM b }}e -}}M . ems' e PREPARED FOR: PHONE NUMBER: PACE NUMBER: MICHAEL HUDSPETH 243-8963 1 OF 2 LEGAL DESCRIPTION: DRAWN BY: T12N. RM SECTION 15, LOT 658, C.J.G. TYPE OF WORK: WE: SITE PLAN FOR WAIVER PACKAGE 3/1/2006 (Rev.WWI EXISTING SEPTIC SYSTEM i,� EXISTING � 2 BEDROOM HOUSE I � I � I I \ LITTLE TINY S/D; \ LOT 1. I \\ I 1 N3 I / I I I 1 I I J f G i} fnO33;• o CE— 3 •`� 0n1 ..t.• '' �F�a i i 7 O , f Q I XIsTING w SE'TIC SYSTEM 1 R3W. SEC. 15. LOT 72 0-T12N. I 1 O \ O , J � O \ DO GARNESS ENGINEERING GROUP, Ltd. —�+� CONSULTANTS b OENERAI CONTRACTORS IMI (. NODI, e , ■IR bl . WIMO0.Stl'. W( MSO) MbE }}1-eln • FM b }}e -}}M . ems' e PREPARED FOR: PHONE NUMBER: PACE NUMBER: MICHAEL HUDSPETH 243-8963 1 OF 2 LEGAL DESCRIPTION: DRAWN BY: T12N. RM SECTION 15, LOT 658, C.J.G. TYPE OF WORK: WE: SITE PLAN FOR WAIVER PACKAGE 3/1/2006 (Rev.WWI EXISTING SEPTIC SYSTEM i,� EXISTING � 2 BEDROOM HOUSE I � I � I I \ LITTLE TINY S/D; \ LOT 1. I \\ I 1 N3 I / I I I 1 I I J f G i} fnO33;• o CE— 3 •`� 0n1 ..t.• '' �F�a T12N. R3W. SECTION 15, LOT 64A. I / WELL SERVES \ LOT 64A, — I / St' EXISTING SEPTIC SYSTEM INSTALLED IN 2000 I GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS 6 GENERAL CONTRACTORS M L TI000 IIO.D. 1U1[ 101. uK1l01bNf. m O 7 • F,.`IF (,07W?] 1i • IM (W))SLatN • 00lOL w.yMr. . PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 1 MICHAEL HUDSPETH 243-8963 2 OF 2 LECAL DESCRIPTION: DRAWN BY: T12N, R3W, SECTION 15, LOT 658, C.J.G. TYPE OF WORK: DATE' SITE PLAN FOR WAIVER PACKAGE. 3/1/2006 (Rev.01.0S) �/ P:. 1.e ......C.+... 633:... 11 CE 953 EXISTING SEPTI \ / SYSTEM EXISTING WELL DRILLED 1 •!"'?',•'ri'; � APPROX. 1970 ..4 : sr .. Y•: n I EXISTING 2 BEDROOM HOUSE I / St' EXISTING SEPTIC SYSTEM INSTALLED IN 2000 I GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS 6 GENERAL CONTRACTORS M L TI000 IIO.D. 1U1[ 101. uK1l01bNf. m O 7 • F,.`IF (,07W?] 1i • IM (W))SLatN • 00lOL w.yMr. . PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 1 MICHAEL HUDSPETH 243-8963 2 OF 2 LECAL DESCRIPTION: DRAWN BY: T12N, R3W, SECTION 15, LOT 658, C.J.G. TYPE OF WORK: DATE' SITE PLAN FOR WAIVER PACKAGE. 3/1/2006 (Rev.01.0S) �/ P:. 1.e ......C.+... 633:... 11 CE 953 02/23/06 15:30 FAX 9072897650 - DEC DR&811• PERMIT ND AS -BUILT WASTEWATER DISPOSAL SYSTEM 'LOT 72 T12N, R3W, Sj; 50.00 A 1.E A 324 55.3 TI 22.3� n T2 D 2% 0 48.3 64.5 C1 55.7 70.0 F- 911 a C2 w 130.3 CO A B DC1 324 55.3 TI 34.8 55.9 T2 45.4 62.4 DC2 48.3 64.5 C1 55.7 70.0 MT 911 991 C2 125.0 130.3 72T12NR3V.DVG ! .--JIL RaP' nnonef CC 8149, f _ DC2 1 5% W. Cloy Seorby 9631 Abbot Loop Rood Anchowge, AK 99516 (907) 1 0 002 i u ' JA I w f I iW I� ST I SEG 6 BIO% I £ EXIST'G CLASS C WELL _�-n PN 4� I I I I I I I I I Y I I I I i I P RC RATE= 2 MIN/INCH, 0 1 125 SF/BR, 7 BR HOUSE 875 SF REQUIRED DEEP TRENCH, 6' EFF. 73.5 LF, 10' TOTAL DEPTH i TOTAL AREA -8B2 SF 20009 SEPTIC TANK i PANNONE ENG, SVC, LLC P. O. BOX 102954 ANCHORAGE, ALASKA 99510 227-3522 P, 272-8218 Fax ATE, 1-e0-03 AS -BUILT �y Municipality of An. chor age y✓ Gi BV �- Development Services Department *` Building Safety Division � �W-`- -��•" On -Site Water and Wastewater Program $ a E T Y 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-053-29 HAA # Expiration Date: 2 " z C/ 02 1. GENERAL INFORMATION Complete legal description BLM Lot 65A, Section 15, T12N, R3W Location (site address or directions) 9601 Abbott Loop Road Current Property owner(s) Peter Grunwaldt Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone 346-2154 9601 Abbott Loop Road Anchorage, AK 99516 Day phone Lori Hackenberger Day phone 261-7537 3111 C Street, Suite 100 Anchorage, AK 99503 Unless otherwise requested, HAA 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 Three 3 TYPE OF WASTEWATER DISPOSAL: ® Individual On-site ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued :with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name _Michael E. Anderson, P.E. Date 11/14/2001 01 - i:-NGli`JEER § F� a _ r 5. DSD SIGNATURE c %,n° C~_ y t . Approved for bedrooms. A° Disapproved. Conditional approval for bedrooms, with the following stipulations: QT Y 0, Additional Comments Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: t,/ Original Certificate Date: %" �— Q (Rev. 12100) Municipality of Anchorage E__ Development Services Department Building Safety Division On -Site Water & Wastewater Program S " E T 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: BLM Lot 65A, Section 15, T12N, R3W Parcel ID: 015-053-29 A. WELL DATA Well type Private Date completed -1970 Total depth ft. Date of test Static water level If A, B, or C provide PWSID # Sanitary seal (Y/N) Y Cased to >40 ft. FROM WELL LOG Well production WATER SAMPLE RESULTS: Well Log (Y/N) N Wires properly protected (Y/N) Y Casing height (above ground) >12 in. AT INSPECTION 31112001 ft. 152 ft. 9 -p.m. 5.4 9 -p.m. Coliform 0 colonies/100 ml. Nitrate 2.67 mg./I. Other bacteria 0 colonies/100 ml. Date of sample: 11/912001 Collected by: Mike Anderson B. SEPTIC/HOLDING TANK DATA Tank Type/Material SepticlSteel Date installed 81811980 Tank size 1,000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 1111412001 Pumper Denali Sewer & Drain C. ABSORPTION FIELD DATA Date installed 10/1211970 Soil rating (g.p.d./ft2 or ft2/bdrm) 150 SFIBDRM System type Absorption Crib Length 12 ft. Width 13 ft. Gravel below pipe 6 ft. Total depth 7.5 ft. Eff. absorption area 300 ft2 Monitoring tube Y Depression over field N Date of adequacy test 111312001 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 16 in. Water added702 gal. New depth20.75 in. Elapsed Time: 1,440 min. Final fluid depth 17 in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 90' On adjacent lots >100' Absorption field on lot >100' On adjacent lots >100' Public sewer main NIA Public sewer manhole/cleanout NIA Sewer /septic service line >25' Holding tank NIA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5' Absorption field >5' Water main NIA 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 >10' Water Service line >10' Surface water >100' Driveway, parking/vehicle storage >10' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS See Waiver for Separation Distance Between Well and Septic Tank to 90' Dated 3/15/89.i IC G. ENGINEER'S CERTIFICATION t Al I certify that I have determined through field inspections and-'' review of Municipal records that the above systems are in ;r. •° ° I t conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. % °. C'TRt�'ll Date 1111412001�Fo .p •ee•ee•wkN� 42.3 CC) HAA Fee $ Waiver Fee $ Date of Payment Receipt Number , (Rev. 12/00) Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE ° DEPARTMENT OF HEALTH & HUMAN SERVICESMuti;c;, Division of Environmental On --Site Services SectSonvices �oN.greNTA Srr P.O. Box 196650 Anchorage, Alaska 99519-6650` 343-4744 1 7 99(' %v CERTIFICATE OF HEALTH AUTHORITY s� APPROVAL FOR A SINGLE FAMILY DWELLING , Parcel 1. D. # tom. 1`� - �; ", - �1 HAA # !0 E�2) t, (i '-A h t 1. GENERAL INFORMATION Complete legal description 3 L' r , Location (site address or directions) � � ( A b, b':. Property owner L UL c,. 1h Day phone 'k. 7- !1 1�1 T7 =- Mailing address Lending agency Day phone Mailing address Agent r.Z'-'e,"'4 Day phone % - c Address a Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 1, r;� ,� c� vC2-e 1~ Phone Address .; L& 0 Engineer's signature �_cX 4' 9 9 Date "r C 6. DHHS SIGNATURE X Approved for bedrooms. Disapproved. Conditional approval for Additional Comments IA NUTIr bedrooms, with the following stipulations: Date / _ — %� The Municipality of Anohorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 \ SNI N1 ME � 1 y O� �1 tV O Municipality of Anchorage NT cy DEPARTMENT OF HEALTH & HUMAN SERVICES �S�R�''cso� Environmental Services Division OCT 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 1996 fh Ft V�"'�+ Health Authority Approval Checklist trT Legal Description: 4-e 7 (-�e e- 1 Parcel I.D.: A. WELL DATA 1 1 ;L" t P` -�' W Well type �?-, If A, B, or C, attach ADEC letter. ADEC water system number t-4 Log present (Y/N) Date completed I els % 0 Total depth > J (;, Cased to } I Casing height (above ground) Sanitary seal (Y/N) `/ Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well production g.p.m. J g.p.m. WATER SAMPLE RESULTS: r c ,J Coliform Nitrate `J (� L Other bacteria Date of sample: � r'3, � rr Collected by: B. SEPTICIHOLDING TANK DATA Date installed G_ Tank size !"V Number of Compartments - Cleanouts (Y/N)__/�' Foundation cleanout (YIN) _ Depression (Y/N) Highwateralarm (Y/N) Date of Pumping Pumper ': P 0 C. ABSORPTION FIELD DATA Date installed 011 - 7i:' Soil rating (g -g -deft` or ft'`/bdrm) 1 -0 System type Ll � / dZt rZ' Length Width /'3 Gravel thickness below pipe 6Total depth Effective absorption areal Monitoring Tube present(YIN) �%Depression over field (Y/N) y Date of adequacy test '912))q (v Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test (in.); ';113 Immediately after 4=20gal. water added (in.): Fluid depth (ins.) Itrin 5 later: - 7 Absorption rate = % qtr g.p.d. Peroxide treatment (past 12 months) (Y/N) N If yes, give date D. LIFT STATION N/ Date installed A Manhole/Access (YIN) High water alarm level at* Cycles tested Size in gallons "Pump on" level at* *Datum "'Pump off' level at* E. SEPARATION DISTANCES L_L ( T C\ SEPARATION DISTANCES FROM WELL ON LOT TO: 1' Septic/holding tank on lot 'd ; On adjacent lots / Lo e' Absorption field on lot ( d a( ; On adjacent lots % It:•0-0 Public sewer main N11V Public sewer manhole/cleanout Sewer /septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line y f C) t � Absorption field 3 l ' i Water main/service line � ,,:;Surface water/drainage Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: I Building foundation 516 Water main/service line X Surface water G Driveway, parking/vehicle storage area 1 � Curtain drain V Wells on adjacent lots �> / G� Property line / F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records that the above systems are in conformance with AIOA HAA guidelines in effect on this date. Signature Engineer's Name n% b6e i.- qv cs•t V— t•,,"i L=- Fngin ring Seal Here , Date OJ 17.14 I 4 HAA Fee $ Waiver Fee $ Date of Payment ���f Date of Payment Receipt Number 4�� [J / Receipt Number Rev. 8/95 OSS: haa.wk.doc MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # k `) — C'.I--, S- ,Q C11 HAA # I � QS (Y)(__ ) 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) L©i &Sp SEC- 15, T12.N 1R3 Location (address or directions) ©1 A66n-H- L" (b) Property owner vn GOV r ke-�/ Telephone: (home) 3Y&—z'14bBusiness Mailing Address R&O I 4LLe-# Z_CCD �aQ (c) Lending Institution A L411 V S A- Telephone 72 (0 — 28Fs Vcd-e r l Mailing Address (d) Real Estate Company and Agent 0_'_ Address Telephone LJ(o I — ((01'b (e) Mail the HAA to the following address: (or check hereX, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single -Family 3. WATER SUPPLY 9-7q - 3J16, Number of bedrooms o2 - Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site X Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 Z 10 z abed NaeB (88/L'nad) 9Z0-ZL ->liom s,aaaulbue leuolssajoid ayj uI suolsslwo ao saoaaa.ao} alglsuodsaa jou sl a6eaoyouy jo AjlledlolunW ayl •panssl sl ainip}aao e aao}aq ejep ozAleue ao suoljoadsul }onpuoo jou op SHHa 10 saaAoldw3 •sjuawajlnbaa alels pug Ieaapal ule}aao AAshes o} aapio ul suoiInIpsul bulpual alayj pug sawoy jo saaseyoind of Asalanoo a sg sly} saop SHHa ayl 10 E)IMS ayl ul paaaIsl6aa aaaul6ua leuolssaloid juapuadepul ue lq anoge 9 ydea6eied uI uan15 suol}ejuasaida.( ayj uodn Rluo paseq paleollliao Ienoaddy /C;uoylny ylleaH sonssl (SHHa) saolnaaS uewnH pug y}IgaH }o juaw}aedaa a6eaoyouy jo lj!IudlolunW ayl leuolIlpuoo . x �`'E; igaS s Jaaul6u3 . �' • �� "' V Ienoaddy IeuoljlpuoO jo swial panaiddgslQ pano.iddy !q swooapaq �— ao} pano.iddy IVAOaddV SHHa '9 01 9172(] -q, I ssaippy auoydalal wa13 10 awgNIT 1E- b c-� �t^ ----- •uoljoadsul slyj jo apep ay1 uo joalla uI suoljelnbaa pue 'seoueulpio 'sapoo ajujS pug ledlolunW Ile y}lnn eouelidwoo uI sl wa}sAs Iesodslp jejumalsem ao/pue Alddns aajem ajls-uo ayj 'uoI}oadsul pue uol12611sanul !w woaj pug salt} a6eaoyouy jo AjiledlolunW ay} woaj paule}go uoljewiolul 9y1 uo paseq Wgy1 �4Iaan aayjanj I -ulaaay pajeolpul ain}onils jo adiq pug swooapaq jo aagwnu ayj ao} ajenbape pug leuoljounj 'a}es sI waISAS Iesodslp aa}emalsem ao/pue AIddns jejum ajIs-uo ay1 jeyj snnoys Ignoaddy /(}uoy}ny y11eaH slyj }o uol}gbljsanul AWJBLIJ Ajlaan I 'molaq unnoys aIgp uolIepl len ayj }o se pug o}aaay paxi a leas Aw Aq paipliao sy NOI1VW80dNI CINV V.LVo'HOHV3S 3-11Id'S1S31'SNOLLOUSNl JNICIIAOad Wald ONIa33NION3 '9 NICIPAL1TY OF ANCHORAGE MU VICESOUROPALITY OF ANCHORAGE (MOA) eNVI�ONM • Health Authority Approval (HAA) �ggg CHECKLIST - FEBRUARY 1984 ' 343-4744 JV E Legal Description: Lai �y S E� ?15 71aN, R!5Lx/ A. WELL DATA Well Classification i-� S If A, B, C, D.E.C. Approved (Y/N) Z^ Well Log Present (Y/N) _N Date Completed ��-t (g 70 Yield Total Depth is! Cased to 1 7 Depth of Grouting N0ty Static Water Level Pump Set At /s'-7 f Casing Height Above Ground 12 Sanitary Seal on Casing (Y/N) Y Electrical Wiring in Conduit (Y/N) N1 Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot 9 C) ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot I I-" ; On Adjoining Lots To Nearest Public Sewer Line N�� To Nearest Public Sewer Cleanout/Manhole N1,, To Nearest Sewer Service Line on Lot > .25 Water Sample Collected by % S ; Date 3 zA a Water Sample Test Results Co I % to ' VW 1y o3 Comments B. SEPTIC/HOLDING TANK DATA Iq 7fl Date Installed IQ 80 Size !D-cro No. of Compartments T tx, a Standpipes (Y/N) Depression over Tank (Y/N) Air -tight Caps (Y/N) y Foundation Cleanout (Y/N) 11-1 Date Last Pumped 3/J3/8 el I4a.cDC Pumping/Maintenance Contact on File (Y/N) NIH ; for N, Holding Tank High -Water Alarm (Y/N) NZ,4\ Temporary Holding Tank Permit (Y/N) N/A SEPARATION DISTANCES F�RSFE_( PTIC/HOLDING TANK: To Water -Supply Well To Building Foundation % To Property Line 5 C> f- To Disposal Field VO To Water Main/Service Line > dt 5 \ To Stream, Pond, Lake or Major Drainage Course 4N� / Comments -So' �.��•� 147D ©f_/!7z d/ 7sd :go,/�x ce�r�ia i n ) t n /®oo 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA swoz5f,e Soils Rating in Absorption Strata 1 z5o 15-7 Type of System Design c2. 11?3 Date Installed OGS [glo Length of Field 12 - Width of Field Depth of Field Gravel Bed Thickness (C7 Square Feet of Absortion Area 30,0 �i3�o Statndpipes Present (Y/N) oNL Depression over Field (Y/N) Date of Last Adequacy Test ��84 Results of Last Adequacy Test 15" a2- e-A-G49r490 vats SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well f 1 5 To Property Line 30+ To Building Foundation &.10 To Existing or Abandoned System on Lot �/.4 ; On Adjoining Lots lo -o To Water Main/Service Line > To Cutback (if present) Nln, To Stream, Pond, Lake, or Major Drainage Course N�.A To Driveway, Parking Area, or Vehicle Storage Area O Comments D. LIFT STATION NO Nt Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) **Check Permitted Bedroom Rating Against HAA Request"* "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company -7m Lem SavYI-c-L&m� Date 64a c.ac I o, I q �--� -- Engineer's Seal MOA No. -�/; J Receipt No. �� C. 5 Date of Payment 22 2 Amount: $ — Or) Receipt No. Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 3 W. 15th AVE "C" SUITE 203 �oD ® 2n �;Pu 1�l�Ci Dq l! ®�® 20ANCHORAGE, ALASKA 99501 CONSULTING ENGINEER TELEPHONE: (907) 279-3916 MUNICIPEN A OER ANCHORAGE� S IV SON l�' -a� ENVIRONM Municipality of Anchorage ''°' 19March 15, 1989 Division of Environmental Health Department of Health and Social Servicaes-- MUNICIPALITY OF ANCHORAGE 820 L Street I Anchorage, Alaska 99501 ENVIRONMENTAL SERVICES DIVISI( Subject: REQUEST FOR WAIVER OF SEPARATION DISTANCES FOR MAR 15 1989 PRIVATE WELL TO SEPTIC TANK RECEIVED LOT 65A, SECTION 15, T12N, R3W JIM GOURLEY Gentlemen; We are submitting a request for waivers from the separation distances stated in Title 18, Alaska Administrative Code, Chapter 80.020. During an Health Authority Inspection on March 2, 1989 it was discovered that the distance between the tank and the septic tank was 90 feet, 10 feet less than the presently required 100 ft. Both the well and the septic system were installed in 1970 when the required separation distance was 50 feet. The tank was replaced in 1980 with the appropriate permit, inspection and approval from the Municipality. The well is located up hill from the septic system. The house is situated between the well and the tank. A well log for the well can not be located, however the adequacy test shows the static water level at 154 feet and a drawdown of three feet at a pumping rate of 2.5 gallons per minute. By going through the DEC's procedure of analyzing the potential for contamination I arrive at the following points: Ground Water Soil Sorbtion Permeability Gradient Separation Total ( at 154 ft. ) 3.0 (hardpan) 3.5 ( Silt ) 2.0 ( 0 ) 2.0 ( 90 ) 2.5 13.0 Conclusion: Chemical contamination possible but unlikely. As an added safe guard. Tank is a steel tank. Cast Iron pipe was used. Please issue an waiver for this well. Yours �Q Tobben Spur and P.E. 3-1 9 os - �4. � D I�'� C SLO 4 t ) '3 t -I � v, L-1--., 1 L� �i - 4C,L-�L T12N R3W Sec. 15 5-10271 Lot 65B Plctt # 98-175 MUNICIPALITY OF ANCHORAGE Department of health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Date: May 19, 1998 To: r�Zoning & Platting, CPD From: Cross, P.E., Program Manager, On-SiteAVater Quality subject: Request for Comments on Subdivision(s) - May 15, 1998 The Environmental Services Division, On -Site Services Program, has reviewed the following cases and has these comments: S -9982A: Oberg - First Time Extension (C.A.) No objections. 5-10267: Woodboume Trails, Lots 5A, SA I OA No objections. 5-10268: Eldon - Truss Plant No objections. 5-10269: East Anchorage Ball Fields No objections. 5-10270: Reflection View No objections. 5-10271: T12N R3W Section 15 Lot 65B No objections. S-10272: Alyeska First Addition, Lot 6A block 18 No objections. MUNICIPALITY OF ANCHORAGE COMMUNITY PLANNING AND DEVELOPMENT i P.O. Box 196650 Anchorage, Alaska 99519.6650 PRELIMINARY PLAT APPLICATION A. Please fill in the information requested below. Print one letter or number per block. OFFICE USE RECD BY: 1. Vacation Code 2. Tax Identification No. 3. Street Address loll 5053 qt< I Agg r L o P Rn 4. NEW abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT SUB ELK 3 LOTS 34). S. EXISTING abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOTS 34) full legal on back page. 6. Petitioner's Name (Last - First) ese�eees■ee■■■■■■■■■; 7. Petitionefs Representative 101111 WIN t■■■ Address ']knot dpyr5c�rw Lit= mt>. Address g 4rTz�rC1- City d - • State __A V-, City LL:_ • e -n - State .Lasmo Phone a Zip GgSo-1 Phone n 5eo2 -Zacv Zip fntGr>S 8. Petition Area Acreage 9. Proposed 10. Existing 11. Grid Number 12. Zone -1 Number Lots ' Number Lots 0111©■■■ ■■a ■■o ■■eeee a■e■■■ 1111■■■ ■■■ Ism =101110 11111m 13. Fee S 14. Community Council 4stsor Lcbp B. I hereby certify that If am) (I have been authorized to act for) the owner of the property described above and that I desire to subdivide it in conformance with Chapter 21 of the Anchorage Municipal Code of Ordinances. I understand that payment of the basic subdivision fee is nonrefundable and is to coverthe costs associated with processing this application, that it does not assure approval of the subdivision. I also understand that additional fees may be assessed if the Municipality's costs to process this application exceed the basic fee. 1 further understand that assigned hearing dates are tentative and may have to be postponed by Planning Staff, Platting Board, Planning Commission. or the Assembly due to administrative reasons. Date: 4-f 13140 Signature U 'Agents must provide written proof of authorization. T]d0]/v�1M Nb- C. Please check or fill in the following: 1. Comprehensive Plan — Land Use Classification X Residential Marginal Land Commercial Parks/Open Space Transportation Related 2. Comprehensive Plan — Land Use Intensity Special Study 3. Environmental Factors (if any): a. Wetland 1. Developable 2. Conservation 3. Preservation —Commercial/industrial Public Lands/Institutions Dwelling Units per Acre < I Alpine/Slope Affected b. Avalanche Alpine/Slope Affected Industrial Special Study c. Floodplain d. Seismic Zone (Harding/Lawson) D. Please indicate below if any of these events have occurred in the last five years on the property. Rezoning Subdivision Conditional Use Zoning Variance Enforcement Action For Building /Land Use Permit For Army Corp of Engineers Permi Case Number Case Number Case Number Case Number E. Legal description for advertising. Lc r CoSta , 5Ee_Tto,.t IS I -r- 1-7- N1 IZ t-1 S LA 1 4k_ F. Checklist 30 Copies of Plat Reduced Copy of Plat (8 rh x 11) Certificate to Plat Aerial Photo Housing Stock Map Zoning Map Fee Drainage Plan Topo Map 3 Copies Soils Report 4 Copies Pedestrian Walkways Landscaping Requirements Waiver .+( Water: yPrivate Welts CommunityWell Public Utility Y_ Sewer. i' Private Septic Community Sys. Public Utility maw e.a,a... wa VACATION OF RIGHT-OF-WAY OR EASEMENT APPLICATION * Municipality of Anchorage DEPARTMENT OF COMMUNITY PLANNING & DEVELOPMENT P.O. Box 196650 Anchorage, Alaska 99519-6650 A. Please fill in the information requested below. Print one letter or number per block. 0. Case Number (tFxNOWN). Street Address eeee■eeeee© eoee■MeO■■■ 1. Vacation Code El 2. Abbreviated Description of Vacation (EAST 200 FEET SOME STREET). 3. USE BY: OWN: Tax I.D. Number ee©eeeeL-1 e�■eeee■eee■ese■e■■�■�©e■a■■�■■■eee ee■ee■■eee■�ee■se■©eee■ee■■e�■ee■■■ eee■eee■�e■■se■■eeee�ie�■■■��■■■i■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ Oros ��eNon-No eeee■■um■■� 5. Petitioner's Representative. ��• - � -. 1f sem- i City: State:_ &.t•e— Zip Code: CLCk Scr1 Phone No. City: LS.,.rr• err A State: Ate_ Zip Code: Phone No. Stoz — ,7ornr-5 6. Petition Area Acreage. 7. Proposed Number Lots. 8. Existing Number Lots. 9. Written Justification. 111111 L SI I ❑ FM ❑ 10. Grid Number. 11. Zone. 12. Fee S 13. Community Council Atzts -+tr B. I hereby certify that (I am) (I have been authorized to act for) the owner of the property described above and that I desire to vacate it in Conformance with Chapter 21 of the Anchorage Municipal Code of Ordinances. I understand that payment of the basic vacation fee is nonrefundable and is to cover the costs associated with processing this applicati^n, that it does not assure approval of the vacation. I also understand that additional fees may be assessed if the Municipality's cost to process this application exceed the basic fee. f further understand that assigned hearing dates are tentative and may have to be postponed by Planning Staff. Platting Board. Planning Commission, or the Assembly due to administrative reasons. Date: 4 l t3 Iq4, 20-019.R... 9921' F,. , Signature V -Agents must provide written proof or authorization. C. Please check or fill in the following: 1. Comprehensive Plan - Land Use Classification Fl Residential 7 Commercial O Parks/Open Space 7 Transportation Related 2. Comprehensive Plan - Land Use Intensity: O Special Study 3. Environmental Factors (if any): a. Wetland 7 1. Developable O 2. Conservation D 3. Preservation O O Marginal Land 7 Commercial/Industrial 7 Public Lands/Institutions O Alpine/Slope Affected Industrial O Special Study Dwelling Units per Acre: < O Alpine/Slope Affected b. Avalanche O c. Floodplain D d. Seismic Zone (Harding/Lawson) O D. Please indicate below if any of these events have occurred in the last five years on the property. 7 Rezoning Case Number: 7 Subdivision Case Number: 7 Conditional Use Case Number: O Zoning Variance Case Number: 7 Enforcement Action For O Building/Land Use Permit For E. Legal Description for Advertising. _L -.a1- e.G A. SEG• IS l2 1 � MIR L- 1 ') F. Attached written statement in accordance with AMC 21.15.130.8. stating reasons in support of the vacation. G. Checklist Waiver 7 30 Copies of the Vacation Request 7 Reduced Copy of Vacation (8 1/2 x 11) 7 Certificate of Plat 7 Fee 7 Topo Map 4 Copies 7 Soils Report 4 Copies 7 Aerial Photo M 7 Housing Stock Map 7 Zoning Map Water: 3'Pdvate Wells 7 Community Well 7 Public Utility 7'Sewer: —Z! Private Septic 7 Community Systems 7 Public Utility 30-019.80.9921' Back i IS.04 It .r This Irf 6z° I. 444 ja Is _ _ _ _ _ _1••ir — _ .. �;rl•a. w..e ::' 74° x•1.79 °• .: I•r. q to rA Is. Is � .• _ ! fib. (�• _ EAST �.• :...,._... .....: .ea '.ha � 1 so SCALE:1'so s 1 l) ./ 1 J U I J j;c c; 056303 OWL^ Topographic Map B.L.M. Lot 65B JA D E N G I N E E R S Sec. 15 T12N, R3W, S.M. Ak. Muni Grid No. 2436 1'P ,LE: 1'=100' i027i. 0 30.00' B.L.M. PATENT RESERVATION TO BE VACATED THIS PLAT WEST 330.13' p 50.00 o _ / O to � to La RV O 65 HOUSE tO m 3 -,n m� I/ 54,473 S.P F. I � /�+1.25 AC. I o O I 10' T&E EASEMENT -1 O N 50.00 1 PER BK 101, PC 535 Z 7-7 EAST 330.10 0 m ED a R-6 East 96TH m �0�� Drainage Map B.L.M. Lot 65B AAE N G I N E E R S Sec. 15 T12N, R3W, S.M. Ak. Muni Grid No. 2436 D56303 OCT 16 '96 11:11AM REMRX PROPERTIES - - - - -- - --P.2 T.SPUIUMAND P.E. WEST 15TH. AVENUE SUITE 203 ANCHORAOE,ALASKA 99SO2.396a (j rax(9uiu 6.96013 -- I`-/ J i :t�i! 3 1998 RESIDENTIAL WELL INSPECTION LEGAL: Lot 63, See. 15, T12N, Raw s �,Q .•.- •, LOCATION: 9601 Abbott Road list JPA f OWNER: Robert LlIx hae TYPE OF WELL: Private, Single Family WELL LOG AVAILABLE: NoINSTALLA r ,� +, ce•:,r.3 TIOUIREMENTS AIETt Yes 4 WAIVERS GRANTED: Well to Septic Tank 1989, 90 feet ��n WELL YIELD FROM WELL LOG: Gallons per Minute .'•"" WELL YIELD FROM TEST: 5 Gallons per Minute DATE OF INSPECTION: October 3, 1996 TEST PROCEDURE: Well was pumped ata constant rate while the drawdown was monitored with an acoustic probe. At the beginning ofthe test water level was found at 161 feet below top of casing. At a pumping rate of 5 gallons Per minute the water level stabilized at 166 feet. A total of 620 gallons were pumped In a time period of 125 min. The well recovered to 161 feet within 3 minutes. TEST FOR E.COLI AND TOTAL NITROGEN: Water was tested for E.Coli and total nitrogen on October 3, 1996 E.Coli 0. Other Bacteria N(one) Detected) Total Nitrate•N 2.56 mgA. Max, allowable Total Nitrate -N 10 mg/L 10 Colonies of Bacteria Allowed TEST RESULTS: This well meets the requirements of the Municipality of Anchorage. Y /_ _ _ 'Cas _ 11:._ e ► :._.e . �! ►1.11 _ The Municipal requirement for well flow is 150 gallons of water per bedroom per day. This well exceed this requirement. The assessment of the condition of the well applies only to the conditions as of the day tested. The flow rate tray cbange due to subsurface conditions that may not be observed from the surface, and changes in the land use and other factors that may impact the aquifer feeding the well. OCT 16 '96 11:12AM REMAX PROPERTIES P.3 -- - rai D 1 L' V G� �] K-S.dL. ).).i. �{ D P. 2E 203 WEST 15TH. AVENUE SUITE 203 ANCHORAGE, ALASKA 99502.3904 (907) 279-3916 Fox (907)-276-013 SEPTIC SYSTEM ADEQUACY TEST LEGAL: Loi 65, Sec 15, T12N R31W 9601 Abbott Road LOCATION: :� :•; - '°.t • �.,' OWNER: Robert Lipchac' ' '•' • '' x.027 ,.r 1 LLQ{ J 1i�1.!.,.'a -. �• ,. RESIDENCE: Single Family,2-Be WELL: Family Y. On Site, Single Family 'l ' ' • , �: '. �' SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: 2 Bedroom Systerii.`.;';°:' TANK: Greer Tank 1000 Gal. 2 Compart. ABSORPTION SYSTEM: Concrete Crib ABSORPTION AREA: 300 Sq. Ft. SOIL RATING: 150 INSTALLATION DATE: 1978 Crib, 1980 Tank WAIVERS GRANTED: None Required DATE OF LAST PUNIPING: Anchorage Cesspool Requested October 15, 1996 DATE OF TEST: October 3, 1996 TEST PROCEDURE: System was inspected and measured. Tank was found with 4 feet of cover and with a liquid level of 52.5 inches. Crib was found 8 feet deep and with 25 inches of liquid. 620 gallons of clean water was added to the crib while the water level in the tank and crib were monitored. The level lathe tank did not change while the level in the crib rose l l inches. 18 hours later the level in the crib had dropped 6 inches, indicating that more than 300 gallons had been absorbed. TEST RESULT: This system meets the code requirements of the Health and Social Services Department of the Municipality of Anchorage. NOTE The operational life of all septic systems depends on the local soil conditions, 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 this septic system. We can current not give any estimate of how long this system will function satisfactory for cunt n future occupants. All septic systems ultimately fail. Some systems last 15-20 years, others fail alter less than 5 years.