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LYNN DALE LT 4
#015-273-53 Municipality of Anchorage ;;,� •: Development Services Department Building Safely Division On -Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page , of.? (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: 5i✓C�031�0< S PID Number: / " o`% Name Seo f f -.. Wastewater System: [INew J9 Upgrade AddDO1 6 /ate- nl a x'9.503 0 ABSORPTION FIELD Phone 5a Il ^' f q Number of moon7 y I / gyp{Deep Trendy O Shallow Trench O Bad 13 Mound O Other -eSaB LEGAL DESCRIPTION RaIBq� . p p= Total Depth hom original grade: , Block Lot: j % SuDdivlsion: le yI" fl Depth to pipe bottom hom original grade FI. Gravel depth beneath pipe: �/) / FI ToNnsldp' Range: Sectiorr. Fill added above original grade, O J II -t.. /yFI� Gravel Length: a• /) / 13 F1. Well: E] New (] Upgrade Gravel Width: Number flines: Distance between line`: Ft. Clo Ka an Private, A, B. C(�J L Total Depth, Cased to: 1 S P� p FI. FL Total absorption area: 7 / �Fts P CMatMel 2 I J O�J� 1 Drifter. If Dote Dnlled. at¢ Wain Levet to er. to eauG"tin Date Inslalled: •�) `� —pC —QJ1 Ft Yieldump Sol at: Casing Height TANK GPM Fl. FL SEPARATION DISTANCES Kseptic ❑ Holding ❑ S.T.E.P. ❑ Other. To From Septic Tank Absorption Field Lift Station Holding Tank PubfidPrivat SewerUne Manadacure . e re . 5'� G5 capaaty � Gal. 1 L I OlfL �— �— ^�� Material: D is Y Nu rof compartments, Well p(/ sudaee water `,f. I LIFT STATION LOU" 3 ` ` 17' Manufacturer shie duer Gal. Foudalan eA6 'Pump an. kval at or H'gh water alrm at: M In. Pump Maks el Electrical inspections perform Curtain Drain %hC (•(� Remarks: BENCH MARK Locatwn and Descripbon: Orr (�JJt7 /✓7 iOF/ W . M rr Assumed Elevation: ('p 0 FL AL5sh�t, 5 & S ENGINEERING 17034 Eagle River Loop Road, I 04 Inspections performed by: Dattees: tat - ,� 2 g X3_03 . �.. ,.. . COWAN � � Development Se ices Department Approval Date: ye ` ROBERT C �C• �c�'ri�+, CE -8801 f� Itt1�il;`;'::. ° Reviewed and approved by: PERMIT No. SW030245 PACE 2 OF 3 Municipalit of Anchorage DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 *Anchorage, Alaska 99519-6650 0 Tegl�ephone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 4, LYNN DALE S/D P.I.D. No. 015-273-53 I I I i I I I 1 I I I I I I I 1 I I I I I I I I I I I I I LOT 2 I I I I I I I I I I I li I� IN I` W lu I� u Iu I� I to I IJ I- to I^ ---------------J (DIVERTER VALVE) 1 h OBL2 1300 CALLON E SEPTIC TANK FCO DECK TB�A -------------- I EXISTING I TRENCHES I 1 4 BEDROOM IE-------- ------- I I I 1 MTCI&TH C--------- ----- I I I I (DIVERTER VALVE) 1 h OBL2 1300 CALLON E SEPTIC TANK FCO DECK TB�A I EXISTING N i 4 BEDROOM HOUSE I i N I W+ WI DECK �I =I 0I u JI H 71 FI 'L 0 I I I I I 1 I LOT 1 1 I yq i 9 0+9� ` II i oy i N I � SCALE: 1- - 50' I I * f 1 "' 7. 1 s71y�'/A�. ROBERT C. COWAN Cl x801 ?�'� PERMIT N0. SW030245 PACE 3 OF • 3 Municipality of Anchorage DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.D. Box 196650 • Anchorage, Alaska 99519-6650Te�I hone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 4, LYNN DALE S/D P.I.D. NO. 015-273-53 ST1 ST2 98.6' FINAL GRADE 2" IN 17 NEW 95.0' 1300 GALLON POLYETHYLENE 94.7' SEPTIC TANK C01=92.6' CO2=92.5' ::::�� FINAL GRADE C01=87.0' SR CO2=87.0' MT1=80.1' N. T. S. A I B FCO 3.5 *2.0 AL ST1 16.5 66.5 ,,a�rrQ►� ••�•''� '9S i ST2 19.5 66.0 NO WATER FOUND. %0 1+j TMT 18.0 62.5 74.1' B.O.H. i�/ ~ " DBL1 22.0 65.5 g9t6 DBL2 23.5 65.0- _ DV 53.0 67.0 C01 138.5' 1 37.0 �e� ROYERT G c, CE - 580101 CO2 1 184.0 178.0 s v MT1 * 11S3.5' 178.0 4*4 0 R0iE1S �p��� MUNICIPALITY OF ANCHORAGE 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 Permit Number: SW030245 Legal DescriptionLYNNDALE LT Design Engineer: 0003 S & S Engineering Date Issued: Jul 14, 2003 Expiration Date: Jul 13, 2004 Parcel ID: 015-273-53 Site Address: 004001 112TH AVE E Owner Name: Scott & Elizabeth Glacer Lot Size: 40620 SO. FT. Owner Address: 4001 E. 112th Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE. AK 99503-0000 This permit is for the construction of: ❑✓ Disposal Field 0 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: Date: 7 flylo ff Issued By:_ I ",A -Date: t Municipality; of Anchorage • Develophieht Sel-vices Department A ''6� Building Safety Division On -Site Water and Wastewater Program 4700 South bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ek.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 0\ <� --n3-S3 Permit Number SW Property owners) SC.O"'M G kA Cf, R Day phone 5 Z Z -Ill 4 Mailing address (1) 'o Oo 1 Mailing address (2) AK- Zip Code °1851 �0 Legal description (Lot, Block & Sub'd.) Lck- L., hm `p a1 f... Legal description (Section, Township & Range) Lot Size THIS APPLICATION IS FOR: Number of Bedrooms 4 Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade 4!D THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ certify that the above information is correct. I fUether certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. F2 Lii�✓2.� S & S ENGINEERING (Signature of property owner or authorized agent) 17034 Eagle River Loop RiEagle River, Alaska 99577 Permit Fees: �l ao- Waiver Pees: Date of Payment: i leo o3 bate bf Payment: Receipt Number: O 3 $ % /_.1' aecelpt dumber: (Rev. 12/00) S& NFALTNAUTNORITY APPROVALS SEWER d WATER "EXTENSIONS SEWER& WATER INSPECTION ENGNEEAWGSTUDIES ANOREPORTS WELLINSPECTION A FLOW TEST SITE PIANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTIRALL AIECNANi x INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEA) DESIGN ROBERT C. COWAN P.E. CNILENGiNEERS (907) 6942979 July 3, 2003 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 4, Lynn Dale S/D It is requested that you issue a permit to install a septic system to serve the existing four bedroom dwelling on the referenced property. A test hole was excavated and a percolation test was performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation on 6/13/03 no water was found. After seven days of ground water monitoring the test hole was still found to be dry. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, . RWer Cowan, P.E. RCC/jhm Enclosure 17034 NORTH EAGLE WER Lbbp t SURE 204 i EAGLE RIVER, ALASKA 99577 CONTRACTOR IS REQUIRED TO OBTAIN UTILITY LOCATES PRIOR TO ANY EXCAVATION WORK. ALL PORTIONS OF SYSTEM WITH LESS THAN 3.5' OF COVER REQUIRE INSULATION. PROPOSED TRENCH INSTALL DIVERTER VALVE (DV) STRUCTURES, EASEMENTS, OR ENCROACHMENTS SHOWN ON THIS SITE PLAN ARE AS SHOWN ON AN AS -BUILT SURVEY DRAWN BY: WILLIAM D. FLEMING IT IS THE RESPONSIBILTY OF THE CONTRACTOR TO VERIFY EASEMENTS, REQUIRED SEPARATION DISTANCES, AND PROPERTY LINES PRIOR TO CONSTRUCTION. OIW SP¢NP c�G �QI 3 L_----- * EXISTING Ig TRENCHESI cod°=fir =__= col IMT' co I I ITH' zoo===== I 22 . "M I.-- 5 IN I'o 1 1 CO o�G� 126' I /1{1 EXI TING I U 12 GALLON SEP IC TANK INSTALL / 1 (TO E VERIFIED) DOUBLE J i C� DECK lI N CLEANOUT I � � El&Jl nginrrring 17034 EAGLE RIVER LOOP ROAD EAGLE RIVER. ALASKA 99577 PHONE# (907)694-2979 FAX# (907)694-1211 I„ N I EXISTING U U( 4 BEDROOM HOUSE Iw w I x-�- Lzt DECK I I� D I $ 9 112th AVENUE DESIGN CRITERIA: 4 BERM = 600 GPD SOILS = 1.2 GPD/SO.FT. 600/1.2 = 500 SQ.FT. REQ'D. TRENCH CRITERIA: 12' DEEP 5' EFFECTIVE 3' WIDE 65' LONG N L --- LOT 4, LYNN DALE SUBDIVISION DRAWN BY: !�HECKED BY:DATE: SHEET: SCALE: J.H.M. R.C.C. I 7-3-03 I 1 OF 1 I 1" = 60' I 100' WELL RADIUS (APPROXIMATE LOCATION) 4 4 OF 41 'kit ............ :: r c•. Municipality of Anchorage Date NGINEER' `$EA1,Ir � �',Zoo MEMEME Development Services Department Net Drop r"CJr ;;Building % b-7/03 Safety Division0 r' I D I/Z" y� On -Site Water and Wastewater Program L- S MSN ■■■NOM■■■■ G 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650ys �'.. •• »••••^• • • 1twrwr C. COWAN % �� �Ci w ww.ci.anchcrage.nk.us d lr N '•, CE - 880} ��+ 6 M6 u (907) 343-7904 `rt '. ot3 — /0 '/A" U f s og - erco a lon es PerfnrmPd For: C v T -T— C— LDate Performed: U Legal Descripticn: L� r / LYNN DgLdl0 Township, Ranee, Section: Depth (Feet) 0 /LG•A..•I C- S 1- 2_ y r� S►�/G w SA"0 >xt� G-ttAV1 L 4- ` 6- 7- c. 8- 11- e 12- ' 13- 14- 15- �• 16- , 17- 18 19- 20- B-0.11, s ry (IAA VLL WAS GROUND WATER A' ENCOUNTERED? /Y 0 s IF YES. AT WHAT DEPTH? L Depth to Water After p Monitoring? 4 E Date: 647/0) 6/f Site Plan mom Date Gross Time MEMEME Depth to Water Net Drop A/Llaif'c % b-7/03 ■■■M■■■■■■ r' I D I/Z" L- S MSN ■■■NOM■■■■ G ■■■■■■■■■■ s d lr N I ,,$ „ 6 M6 u ■■EMMEM■■■ — /0 '/A" S s' /a r r ■■■M■■E■■■ 6 ala i. ■■■ERE■■■■ ■■■■■■■■■■ ■■■EMU■■■■ ■■■■■■■■■■ Reading Date Gross Time Net Time Depth to Water Net Drop A/Llaif'c % b-7/03 0 r' I D I/Z" L- S MSN /7 7:/Y�1 G s d lr N I ,,$ „ 6 M6 u o — /0 '/A" S s' /a r r 7 n 6 ala i. PERCOLATION RATE U, 7 r (ninutes/nch) PERC HOLE DIAMETER TEST RUN 9ETWEEN —_FT AND f FT COMMENTS VISV4L+-`1 bL7'VA#"tr,..A4 Sd%u LvovA-O rA11 N0, SIrt usc- 1. -a UF -37r —ra- PERFORMED BY: S & S ENGINEERING I t PERFORMED IN AC r +' L' t , .. .�'AL e River, Alaska 99577 :—CJ y, CERTIFY THAT THIS TTE T WAtS IN EFFECT ON THIS DATE. DATE: (7 Z 7 0 3 SA A ?Ii1CLRIi1G ROBERT C. COWAN, P.E. CIVILENGINEERS (907) 6942979 ON-SITE WASTEWATER DISPOSAL SYSTEM FAX(907)694-1211 CONSTRUCTION PRACTICES and W-uTNALITHoRaTY MATERIAL SPECIFICATIONS APPROVALS REFERENCE: Lot 4, Lynn Dale S/D SEWERSWATER July 3, 2003 MAN EXTENSIONS GENERAL: SEWERQWATER 1. The scope of this project includes verification of the existing 1250 septic tank INSPECTION or replacement with a 1300 HDPE gallon septic tank, and installation of a new trench to serve the existing four bedroom residence located on the referenced property. ENGINEERNGSTWES AND REPORTS 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. WaLwPEGnoN EFLOWTEST 3. The contractor shall be responsible for obtaining any necessary underground utility locates. SITE MANS 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. ROAD DESIGN 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SOIL TEST SEPTIC TANK INSTALLATION: PERCOLAMON TEST 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. �L 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of kawINSPECTIONS the tank. ONSITE WASTEWATER WPOSAISYSTW DESIGN 17034 konTH EAGLE RIVER LooO: SURE 204 t EAGLE RIVER ALASKA 99577 • Page 2 Lot 4, Lynn Dale 3/D July 4, 2003 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCII/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. 6. A subsurface disposal field may not be located on a slope greater than 25 percent unless there is an approved exception documented. • Page 3 Lot 4, Lynn Dale SID July 4, 2003 MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pip Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. • Page 4 Lot 4, Lynn Dale SID July 4, 2003 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre - construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 / /J Anchorage, AK 99519-6650 www.muni.org/onsite / 9 (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-273-53 COSA# 05C, / a [ r0 2 a 1. GENERAL INFORMATION Expiration Date: %— /2, Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address LYNN DALE S/D LOT 4 4001 E. 112 AVENUE *ANCHORAGE, AK 99516 BRIAN & KATRINA CAIN Day phone 274-2886 Individual On-site E 4001 E. 112 AVENUE *ANCHORAGE, AK 99516 Day phone Real Estate Agent BRIAN BRODERICK W/ PRUDENTIAL Day phone 227-7671 Mailing address 3801 CENTERPOINT DRIVE #200 *ANCHORAGE, AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site E Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, l 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 Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for 4— bedrooms. Disapproved. Conditional approval for bedrooms, with the following Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Phone 337-6179 Date ('1 8 6 Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other 0[TS ON-SITE WASTEWATER By: Original Certificate Date: (Rev. 11105) Municipality of Anchorage oE, tis 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: LYNN DALE S/D LOT 4 Parcel ID: 015-273-53 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 9/25/84 Sanitary seal (Y/N) YES Total depth 170 ft. Cased to 170 ft. FROM WELL LOG Date of test 9/25/84 Static water level 153.5 ft, Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 1/25/12 Well production 10 g,p,m, 7.41 g,p.m. WATER SAMPLE RESULTS: Coliform --0—colonies/100 ml. Nitrate 0—mg./L. Collected by: GEG, Ltd. Arsenic: ND ug./L. Date of sample: 1/25/12 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/HDPE Date installed 8/23/03 i anK sire ! �Vv yai. rvunioer ui i.omPanrnams �.�earromsTrnvT— Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 5/25/12 Pumper ONE STOP SERVICES C. ABSORPTION FIELD DATA BELOW EXISTING GRADE 12/90rm 0.8 DUAL—DEEP TRENCHES Date installed 8/23/03 Soil rating (g.p.d./ftor r/bd12 System type DEEP TRENCH 2®50=100 2. 7 Length 48 ft. Width 3 ft. Gravel below pipe 7 ft. * 12.08 1400 Total depth *12.08 ft. Eff. absorption area 672 ft2 Monitoring tube YES Depression over field NO Date of adequacy test **1/25/12 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 4 in. Water added 1060 gal. New depth 42 in. Elapsed Time: 141 min. Final fluid depth 31 in. Absorption rate >= ***600+ g,p,d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date **PRE—SOAKED 1990 SOUTH TRENCH ON 1/24/12 WITH 2140 GALLONS OF LIQUID. ***TESTED 1990 SOUTH TRENCH. THE 2003 TRENCH WAS IN USE AND HAD 49" OF LIQUID IN IT. D. LIFT STATION Date installed "Pump on" level at in. E. SEPARATION DISTANCES F Size in gallons "Pump oft' Manhole/Access water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot loo ,+ On adjacent lots 100'+ Public sewer main N/A Sewer /septic service line 25'+ Public sewer manhole/cleanout N/A Holding tank Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ COMMENTS Au— (_ S�51G Aims UVet a c oma- � F St+�wnt o� ACS- S v¢.V' G. ENGINEER'S CERTIFICATION I certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. CARNESS Date 6 l (1{ Z COSA Fee Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number LOT 30 u�D�I �. Janice M. Zilko j LS -8629 Desarlptton: N89°5940"E 110.24' 7.5' DRAINAGEEASEMENT ' 25 © 7" White FVC 1 - - (SID 00 in m' m D r:l mi D m. zi m � Z ® LOT 4 mi i ® o N zPTT Well D 1 w i ° m rn o m � w i :i::. 31.3 13.3' v m2� q . 39.1 Existing 2.0 - -- > House 24r 2 112th AVENUE AS -BUILT Lot 4, Lynn Dale Subdivision LAND & CONSTRUCTION SURVEYORS—PLANNERS- 440 West Benson Boulevard, Suite 200 Phone: Anchorage, Alaska 99503 Fax: plat: 83-281Iced: 2635 6y. Wall NOTE: THIS DRAWING SHALL NOT BE MODIFIED FOR USE AS A PLOT PLAN WITHOUT THE EXPRESSED WRITTEN CONSENT OF LANTECH. Septic Standpip.Q Water Well ® Comrete::_ Fence—X—%—rhang- -iWood 0_eck��,�s,' SURVEY CERTIFICATION: tANTECH hoe conducted a ph,leel curvy of the property as shown on tMs droWing and certtpee that the Improvement. siivalatl thereon ore within the property lines and no en.chment. ",t other thou noted. EXCLUSIONARY NOTE It is the owner. rs.,.n.lbI1lty to datermine the sxistenoe of any easements, covenants, reMil.tia.. or right—af—way takings which do not appear on the recorded subdMston plot. Under no circumstance. should ony data hereon be used far construction, for establishing property Tines, ar for plot—plan purpose.. June 5, 2012 prawn By PL Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEM S A _ APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-273-53 COSA#aSC D -D, 1. GENERAL INFORMATION Expiration Date: _7— /3—/a Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address LYNN DALE S/D LOT 4 4001 E. 112 AVENUE *ANCHORAGE. AK 99516 BRIAN & KATRINA CAIN Day phone 4001 E. 112 AVENUE *ANCHORAGE, AK 99516 Day phone 274-2886 BRIAN BRODERICK W/ PRUDENTIAL Day phone 227-7671 3801 CENTERPOINT DRIVE #200 *ANCHORAGE, AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site N Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ 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 On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 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 Phone 337-6179 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 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 & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal tight whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for M Attachments COSA Checklisty Septic System Advisory Well Flow Advisory Nitrate Advisory bedrooms, with the following stipulations: `I 50 f 6— PL !fJ �- p u•nr /� Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By; , Original Certificate Date: (Rev. 11ro5) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 3437904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: LYNN DALE S/D LOT 4 Parcel ID: 015-273-53 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 9/25/84 Sanitary seal (Y/N) YES Total depth 170 ft. Cased to 170 ft. FROM WELL LOG Date of test 9/25/84 Static water level 153.5 ft. Well Log (YIN) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 1/25/12 140 ft. YES YFS 12+ in. Well production 10 g.p.m. 7.41 g.p.m. WATER SAMPLE RESULTS: Coliform50 colonies/100 ml. Nitrateo•*Ry%mg./L. Collected by: GEG, Ltd. Arsenic: N 0 ug./L. Date of sample: 1/25/12 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/HDPE Date installed 8/23/03 Tank size 1300 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping Pumper 19L"WiAA in Sr�xlntt -k-laa o l '-)' C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE 12/90 Date installed 8/23/03 Soil rating (g.p.d./ft2or f/bdrm 0.8 1_2 DUAL—DEEP TRENCHES System type DEEP TRENCH 2©50=100 2. 7 Length 48 ft. Width 3 ft. Gravel below pipe 7 ft. *12.08 1400 Total depth *12.08 ft. Eff. absorption area 672 ft2 Monitoring tube YES Depression over field NO Date of adequacy test **1/25/12 Results (Pass/Fail) PASS Fluid depth in absorption field before test 0 in. Water added 1060 gal. Elapsed Time: 141 min. Final fluid depth 31 in. Absorption rate >= For 4 bedrooms New depth 42 in. ***600+ 9.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — **PRE—SOAKED 1990 SOUTH TRENCH ON 1/24/12 WITH 2140 GALLONS OF LIQUID. ***TESTED 1990 SOUTH TRENCH. THE 2003 TRENCH WAS IN USE AND HAD 49" OF LIQUID IN IT. D. LIFT STATION Date installed Size in gallons Manhole/Access (—Y/Ni— "Pump on" level at in. "Pump off level a, ' . High water alarm level at Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 100'+ Absorption field on lot 100'+ Public sewer main Sewer /septic service line 25'+ Animal containment areas 50'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS Ce%.sV WarrA4A.- 0* -r,a S�i> e. Pr e�-X Ou E i a SNDW COMDI4 ON C. _ G. ENGINEER'S CERTIFICATION oP�� OF I certify that I have determined through field inspections and �* .' 4 T �+ review of Municipal records that the above systems are in .""' ' ' "" .......... conformance with MOA COSA guidelines in effect on this date. Q J . ... A. ............ Garness:' Engineer's Printed/Name JEFFREY A. GARNESS �0 P 4Q4. sfP GE 7 7. 53 m ` " Date 3 t i a.�3 COSA Fee $ 4 Waiver Fee $ Date of Payment_ Date of Payment Receipt Number r Receipt Number (Rev. 11105) SGS Re£# 1120263001 ClientName Garness Engineering Group, Ltd Project Name/# Lynn Dale s/d L4 Client Sample ID Lynn Dale s/d L4 Matrix Drinking Water Sample Remarks: Printed Date/Time 02/02/2012 10:30 Collected Date/Time 01/25/2012 14:05 Received DatefFime 01/25/2012 14:47 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS EP200.8 Arsenic ND 5.00 Waters Department NRB Total Nitrate/Nitrite-N 0.841 0.100 Microbiology Laboratory (<10) Colony Count 0 Fecal Coliform 0 Total Coliform 0 ug/L EP200.8 C (<10) 01/26/[2 02/01/12 NRB mg/L SM20450ONO3-F B (<10) 01/26/12 CMA col/100mL SM20 9222B A (<200) cot/100mL SM20 9222B A (<1) coU100ml- SM209222B A (<1) 01/25/12 MEM 01/25/12 MEM 01/25/12 MEM '�'�' Fideli Title Agency Of Alaska 3150 C Street, Suite 220, Anchorage, AK 99503 Phone: (907)277-6601• Fax:{907}277-6613 R e. April 13, 2012 Brian and Katrina Cain 4001 E. 112`x' Avenue Anchorage, AK 99516 Dear Mr. & Mrs. Cain: This letter replaces the letter that was issued to you on April 6, 2012, with reference to the $5,000.00 being held by Fidelity Title Agency of Alaska (FTAA). FTAA is in receipt of your funds in the amomrt of $5,000.00 and said funds are being held in our bust account. It is further understood that these funds are being held until such time as the Municipality of Anchorage (MOA) is able to issue/approve the conditional COSA on the property. FTAA will hold these funds until such time we have been notified by you and the MOA as to the release of the funds. Please feel free to contact me if you should have any further questions Sincerely, X Title Age y Aaska ar Escrow Officer 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.ei.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D. 015-273-53 1. GENERAL INFORMATION Ro e witr C. Co r✓it.✓ HAA # MQQ I I Expiration Date: 4-1,3-09- Complete -13-O.S Complete legal description Lot 4; T.vnn nn1P Snhdivininn Location (site address or directions) Anm u 119thAve Anr•hnr a- Ag QQana Current Property owner(s) Scott & Elizabeth Glager Day phone522-1114 Mailing address Lending agency Mailing address same Day phone Real Estate Agent Vicki %aas Day phone Mailing Address -- Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site IXC Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site _ ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with div) -W tWsi ample 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 Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and.State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S & S Engineering Phone' 694-2979 Address 17034 N Eagle River Loon Oro 904 Ragle River, AK 99577 Engineer's Printed Name Robert C. Cowan Date _ ./ i OZA6_ ? % ROBERT C. COWAN 5. DSD SIGNATURE 0% 4CC-88.01 . Approved � bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: original Certificate Date: (Rev. 01102) 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.cl.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST' Legal Description: I-6 7- SYNy O41-0- S/ D Parcel ID: Q/ S--.17 3- S3 A. WELL DATA Well type MVS 7'#- If A, B, or C provide PWSID # - Well Log ON) Y� 1 Date completed q/ �r/gy Sanitary sealN YDS ) _ Wires properly protected (9N) YE s Total depth 06y ft. Cased to 22ELft. Casing height (above ground) P a + in. FROM WELL LOG AT INSPECTION Date of test 01 hk-s-/Ty h / /S -/Of - Static water level 1 S- 3 '/y ft, 1 `f 3 ft. Well production / O g.p.m. H� 7 g.p:m. WATER SAMPLE RESULTS: Coliform , 2 colonies/100 mi. Nitrate 0. I mg./I. Other bacteria 0 colonies/100 mi. Arsenic: mg./I. Date of sample: t dof Collected by;' & S EN/034 GINEERING 18 KIV" Loop Ra d No. 20 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 TankType/Material Sf,Pric- if 0 P f Date installed 3J0 3 Tank size 13'0 0 gal. Number of Compartments Cleanouts( N) Y J Foundation cleanout ®N) YEJ Depression over tank (Y, Jw N High water alarm (Y/0 'V o Date of pumping It 15-1' Y Pumper A t Hemel. Srt,Ay s ctl C. ABSORPTION FIELD DATA Date installed $/-a3/03 Length I{ '3 ft. Soil rating.p:d.1 orfe/bdrm) Systemtype P66'O TIf aH Width 3 ft. Gravel below pipe 7 ft Total depth i a i ft. Eff. absorption area 67.E ft2 Monitoring tubeYflS Depression over field No Date of adequacy test P LA . N 6- u1 Results (Pass/Fail) For L bedrooms Fluid depth in absorption field before test _ in.adder ed_ gal. New depth_ in. Elapsed Time: _ min. Any rejuve ment hflC'a depth _ in. (past 12 mo.) (Y/N & type) Absorption rate >= If yes, give date ... Date installed Size in gallons "Pump on" level at _ in. "Pump off" I t — Datum_ Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: i Septic tank/lift station on lot Absorption field on lot Public sewer main goy N/A i Sewer /septic service line a`r High water alarm level at Meets alarm & circuit requirements? in. On adjacent lots Q-PPRoVKo 4 WAIVNd On adjacent lots �r° orr P0� F"ffl �5-7-7�-�h f Public sewer manhole/cleanout N Holding tank /✓ �A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: � � f Building foundation I a Property line 13 Absorption field Water main N AA Water service line / r Surface water d a Wells on adjacent lots i 0 O �+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1-7 Building foundation )I a 6 Water main A r Water Service line O f Surface water I X90 i Driveway, parking/vehicle storage Curtain drain N oNt kNowN Wells on adjacent lots L 02 i-�- F. COMMENTS 'fr WVpt1- Di&*.A & 'I'd 501.n(- r,M L 194T'V46"J q h-r/r,( G. ENGINEER'S CERTIFICATION I certify that 1 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. < /r� ROBERT 4 COWAN j C Engineer's Printed Name r `�Q�Ai C �wA��e� SCE- 8801`, 411 Date w ) S HAA Fee $ Hao Date of Payment , / r 1 / c S Receipt Number D b aJ''hV t/- 4 ki— (Rev. 12101) Waiver Fee $ Date of Payment Receipt Number JO / 11-08-04 09:14AM 'FRIM-CT&E ESI, SGS ENV SERVICES —SG$— SGS RcU Client Name Project NomeN Client sample ID Magi: Sample Remarks: 1047267001 S & S Engineering Lot 4, Lynn Dale S/D Lot 4. Lynn Dale S/D Drinking Water 9075615301 T-869 P.02/03 F-925 All Dates/Times are Alaska Standard Time Printed Date/Thne 11/04/2004 13:43 Collected Date/time 11/01/2004 15:30 Received DoWrime 11101/2004 16:15 Technical Director Steph Ede Released e..,r7el, 71" Parameter Results PQL Units Method Container ID AOa ' Prep nal Aysis --- imin Date Date lair Nates Department Ni"WN 0.100 U 0.100 Miaroblology Laboratory Total Coliform 0 ma/1. PPA 300.0 8 ("10) 11/02/04 81A coVlOUml. SM2092220 11/01/04 DKC JRs Pumping PO Box 773415 Eagle Rivet, AIC 99577 (907) 694-64540 1 ltng Informatlon Eagle River Engineering 10421 VFW Rd Ste 201 Eagle River, AK 99577 (907) 394-5195 Job Site 6Mormrtlon ---_�. y_.. Chile - Sally Kneeland 2/510 Tony Cirdo Chugiak, AK 09557 (907)994-5195 Service Type Contractor Job Additional Location comments: Service Agreement Number. 015537 Order Dale: 17 -Doc -2004 Service Date: 174Deo-2004 12:03 pm Technician: Tony Job Description: 1000g P.O. Number: Terms: Net 30 Salearep: M kde Job Type Recall Map 00&! Map Odd: 24 ' Cross Streets: Schaff Drive Job Comments: 5et servtoe 06/1W04 1000g 'Thick, heavy solids - a tot of rocks front and back. Tax Percent: 0 _ Qty Price Each x 2 Men Tax 1 $100.00 NO No End of eukle4ac - Cedar w/ Walk Vin, detached garage, Ka on corner by blue tarp, dogs are kenneled. 3bdnn septic behind house. Diagram: . Extension Actual s100.00 Gallons Planned: 1000 Gallons Actual: Gt( DW Hose Length: 2.5 I Double Tank: [] •�� Pump System: F?i Baffles Inlet: [] � H Bafflae Outlet: [] i • Tatk NonTaxable Total Taxable Total Tax Total Grand Total Estimated Charges: $100.00 $0.00 $0.00 $100.00 Actual Charges: Customer agrees to rhe terns and conditions printed on the back. THIS IS A BINDING AGREEMENT. Signature and Mile of Customer Representative Date Accepted by JRa Pumping Date Accepted For your added convenience we accept American Express/ INcovery/Vlsa and Master Card payments over the phone. After 30 Days 1.5% Will be charged or THERE WILL BE A DELIVERY $25.00 Fa NSF Cheeks Returned LOT 30 N89'59'40"E 110.24' 7.5' DRAINAGE EASEMENT 25' I , I , I , I , I , I I , I , I , I , I ' I 6 I M, ➢I M ml M, ml z� z ® LOT 4 ® I I 0 M ➢ W m z I I I I I I I N o N _ I Mrn 11 I � � I � � o D ® fTl I ^ I N C4 0 -P. I r fTl I o W _ 31.3 I 39.1 EXISTING 2.0 ' > HOUSE 9 w � SHEDS I J � I I 68.4 I '. I .24.7,... ..... ::z�::.::•:3:.; �Q00000p�0 :.... .ab ..:.•;: C .............. OF •qtq%a4 I N '• ... .......... .. O 25' p..'�.ZTH.. ........�.. 49— 1 p.m.:................k la.:..�.p 10` UTILITY EASEMENT AND T&E 1h�0 I Q •• Mich el L. JokelO.• a S89'59'40"W 90.25'l L� �Qpe LS -7839 R �p0o ........... ..•'6e°oo w w o fes aion00� _ 41 W 112th AVENLYE- ORDERED e.: EXCLUSION NOTES: It Is the awnerireaponaibRity to'detennine LEGEND: SET FND the existence of any easements• covenants, or restrictions 5/5'RB w/CAPOO 5/e' rte O which do not appear on the recorded subdivision plat. NOTE: �,z5� ,I,LMDI,I. OMONUMEVT, ._ with HOMES UNLIMITED Under no circumstances should my data hereon be used for NUB A TACK I] construction or far estobllehing property tines. HUBFENFEN& —x— x amokSURVEY sur,CERCfthis Uperty has conducted o OVERHANG I wrwyy t .this property nt shown on this CCCD DECKS- t� drowMg and thot the improvements situated ther CONCRETE on are wilhM the property lines and noencroach- ASPHALT ® menta eclat other thou noted. GRAVE.- AS—BUILT tAVa LANDA S —BUILT OF: LEGAL DESCRIPTION: SEPTIC STANDPIPES- ® Y STRUCTION SURVEYORS -PLANNERS -ENGINEERS WATER wELL- 440 WEST BENSON BLVD. # 103 (fax) 561-6626 LOT 4, ANCHORAGE, ALASKA 99503 (907) 562-5291 WORK ORDER NUMBER: OEC. 16, 2004 sc =40' Fl T 83-281 2004—L-4so NRB MLJ ° 2635 go ;4$ LYNN DALE SUBDIVISION MUNICIPALITY OF ANCHORAGE 1 • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services 44 On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 0/ S _ — S3 v HAA # '-A \�� � r it S 1. GENERAL INFORMATION Complete legal description l .J7 L1 LVIUIvy'4 9/2) Location (site address or directions) 41,00/ /z_ AVE i Property owner Day phone Mailing address Lending agency ! Day phone Mailing Agent )—OP—:L ✓7AC Nt3 RGr'�L Day phone 22 -3/3b/'21/2 -o/0/ Address _ ;a ? c - I C- c1, - /y�G -i oc Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: y V 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 X 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 MOAx21 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 gf this inspection. Name of Firm Alaska waiei 7320 fist 14 . Address Arima Engineer's signature , ( 1 6. DHHS SIGNATURE / Approved for bedrooms. Disapproved. M Conditional approval for Additional Comments -7_&I Phone %' ' Date btl�4ftl � ',r , • w 'M' uyy bedrooms, with the following stipulations: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 72-025 (Rev. 1/91) Back MOA #21 } RECEIVED i Municipality of Anchorage APR 14 1998 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division M'dN1CIPALnYOFANC110RAGE 825 LStreet, Room 502•Anchorage,.Alaska,,9950fVMdfr'343rwv. Health Authority Approval Checklist Legal Description: WT Ll LYAIA) C){Ltz S�/% ' Parcel I.D.: A. WELL DATA Well type < tU P-(E If A, B, or C, attach'ADEC letter. ADEC water system number N _ Log present 6k 7 E S Date completed �9 /�S �/bx/ Total depth I %O Cased to D CCasing height (above ground) Sanitary seal eYN) Wires properly protected (9/N) WS FROM,WELL LOG AT INSPECTION Date of test `�/�5'J'y 3 I ;�`I �wo Static water level f 53 CS y3 Well production /Cl -g-P.M. J.O g.p.m. >t WATER SAMPLE RESULTS: Coliform (/J Nitrate a l �. Other bacteria Date of sample: 3f �y�9� Collected by: S w• B. SEPTIC/HOLDING TANK DATA �o ? ruSP EPuti r ON F«i~'" 1aG pea Maa ?!+n Mat Date installed( ZecoanS Tank size 150 mos Number of Compartments _ Cleanouts ON) 2 Foundation cleanout aN) AS Depression (Y,) /-b High water alarm (Y/N) Date of Pumping�aSHR Pumper OU) M CWAI-4S nJO TNS(�E`TlON IAF-R7R7 ON F/CF_'/ — ALL 1"F0.-r4KF.N PBA AXO* RjCWeF C. ABSORPTION FIELD DATA ?F�ti Moes Enos I WO pctP Date installed 11\96 Rfroaos Soil rating (g p.d./ or ft2/bdrm) Q 8 System type 7eericHas JSo, Length �00 Width a•S� Gravel thickness below pipe ' cam• Total depth �3� MMMT. Effective absorption area /y00 SF (ec(e.) Monitoring Tube present ON)-Y- Depression over field (Y/N) _N Date of adequacy test3Ia4lR8 Results (Pass/Fail) For I-Ou2 bedrooms rFluid depth in absorption field before test (in.) .10 5Immediately aftere;n gal. water added (in.): 44Y Fluid depth (ins) Minutes later: 1019 MIAj. Absorption rate = 600 k g.p.d. Peroxide treatment (past 12 months) (Y/0) Nat mow- If yes, give date 72-026 (Rev. 3/96)' TesTEO SouY 4 T2Ex�c,+ U r+t-Y — --� . ALL_ ,W 6 %��" Te rn� sowa 'Tfir..nlGtF TelnoC4u4rr 1�6, i CNUa14 %CNCA+ w,+S Ybur+p SurzcriARu 3-24-9R D. LIFT STATION Date ins a Size in Manhole/Access (Y/N) "P n level at` _ High water alarm level "Datum ested E. SEPARATION DISTANCES "Pump off" level at" SEPARATION DISTANCES FROM WELL ON LOT TO: L'J C) Septic/holding tank on lot ���•� , /��S 6 'A°1 c�� On adjacen lots 69 Mme• ?0 S/P IO&� � �Y Absorption field on lot C) �{ On adjacent lots 99 M &v ?. t/P r moll ow 1hf 91 �'E FKPrP�� Public sewer main NIA Public sewer manhole/cleanout lNI� Sewer /septic service line 0 Lift station rJ1,4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 5 r Property line S r a Absorption field / r� Water main/service line l0 1,1 Surface water/drainage /00 rt Wells on adjacent lots /00 r17 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r Property line 10Building foundation /0 4 Water main/service line Surface water 1ots • k Driveway, parking/vehicle storage area Curtain drain Nor -JE- KNowtj Wells on adjacent lots _ F. ENGINEER'S CERTIFICATION SES A rTac QWEO 7 S/EyvfJ� By n•n_n t/q 9! I certify that I have QQf�q�ermi t u field inspections and review of M nicipal ret in conforma ce withAJr10 A _ Idelines in effect on this date. Signature v v Engineer's Name A fix! Date �I f 3 h & HAA Fee $ 3 0 0,o Date of Payment T4 Receipt Number 72-026 (Rev. 3/96)'' Waiver Fee $ Date of Payment Receipt Number /d o rf ®� A'�q M" t �s are r y '' to `'acs.. �•.•' �� � dktl P11oFES5�0 SUBJECT.:":- '•F* u. EAe k A N w I+ +3I „t I�} � L� is TN•2 q� ry,Y�t; is r'tk'>b ix ib'z. / p qc i.iA�' c. JOB PACK GE '+f•. 71 y • Of �. Aipg y�'""'{QTY$_. �� e, °;'i *x r1A1E/,o•/r•'%d DATE /. ra r1i��tY7�'�/!! 7 /Nff/ MAT/�Ai t L 2f� t s �fl ftu�'sasr.•y:ay 46 -Y w ti `,l+I2q'o 3�yr 2• Nevsf;,AaLArMPe/ Q✓n.r J✓/yfaa Ay ,, ,•fh o'"'Ps EX/srlV6 AJ SNOa.N ` � r �� -'' F/t0.•` A/0.lfM CND Jlf74Ctj TANK. 41,11, A04 ON -4 * s• .4 C•..YNY. �Sy•lk�i � � `-� w��� �f ` t ABA' OODA! 49AC/I ,., pati .vrEsu,�rrr aV frisT /rcn q ra �T��A,xxN/y�Cqq. t t �4 GY > y t ! $>•L�FJ. SE.ZZ 1 fv,. @c��dAffi'9bF�W.N.". '� �,q'3'�il�l',.F:Ph , �ti I � y f. �Yl '. i•r�I; * s• .4 C•..YNY. �Sy•lk�i � � `-� w��� �f ` t V ,., pati .vrEsu,�rrr •i ,ilk �i�' x 9's. GME Environmental Services Inc. ACIL ChemLab Ref. #; 93.1307-001 Client Name: Alaska Water & Wastewater Svc. Project Name: n/a Client Sample ID: Lot 4, Lynn Dale SID Matrix: Drinking Water Ordered By: Jim PWSID n/a Client PO#: n/a Printed Datelfime: 4/6/98 00:00 Collected Date/Time: 3124/98 18:40 Received Date/Time: 3/29/98 08:00 Technical Director: Stephen Ede Released By: Sample Remarks,: Allowable Prep Analysis Parameter Results POL Units Method Limits Date Date Init Total Collform (MF) 0 COO 00 mi SM92225 3!25,98 TMW Nitrate 0.348 0.1 mgiL EPA 300 10.0 414198 RMV FO/T3'd T02S'63GS,06 30bd0H0Nd IS3 343 cd:80 i-1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 H87-0172 Application Date 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 4 Block 1 Lynn Dale Subdivision - T12N R3W Section 21 3 (c) EE Location (address or directions) 4001 East 112th Avenue Property Owner Micki Henson Telephone: Home 344-7594 Mailing Address 4001 East 112 Avenue, Anchorage, Alaska Lending Institution Northland Mortgage Telephone _ KA.Ml n AAA'.. 4000 West Tudor Road, Anchorage, Alaska_ Real Estate Company and Agent N/A Address T I.... L....... (e) Mail the HAA to the followino address: or: Check here 1:1, if hold for pick up. List contact person and day phone number below. 2. TYPE OF RESIDENCE Single -Family E!X Numberof Bedrooms four(4 Business 278-9624 99516 563-5150 99503 3. WATER SUPPLY Individual Well Mxx Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite EX Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-02e rRev 8/861 Front 5; ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site watersupply 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 A. E. C. S., Inc. Address 1200 West 33 Avenue, Suite B Date March 26, 1987 6. DHHS APPROVAL Con 'tion lly Approved for lr bedrooms by Approved Disapproved Terms of Conditional Approval"` Telephone 561-5040 Alaska 99503 Conditional Engineer's Seal Date April 30, 1987 XXXXXXXXXXXXXXXXXXXXXX J. Gc«S}o..wcf h�.w 4 /x�r,eor... Soi/ ySfJ67W..4 -IQW I /Z" Wi iNij / N GO kdGM..�'. CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-026 fRev 8/861 Back MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: jz�w ;;;cey A. WELL DATA Well Classification �!� If A, B, C, D.E.C. Approved (Y/N) N Well Log PresentN) oe"r Date Completed Yield /.3 E79* Total Depth �'�' Cased to Q7-°(4• 5� Depth of Grouting s Static Water Level /(01.5 Pump Set At Casing Height Above Ground Z Sanitary Seal on Casing VA) Electrical Wiring in Conduit&9N) Separation Distances from Well: Depression Around Wellhead (Y(9 i -To Septic/Holding Tank on Lot /ero ; On Adjoining Lots /rte -r To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots ley, ;+l To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Z -� Water Sample Collected by �� /f- /,J/Ay ; Date y -z Water Sample Test Results Comments ACOA)' "4*7,6e� fe% c5�✓ru_1 SS' ` /yrs 5e70716 7�W4/, St"- 4L#h *l 4-E7fyA 1e9 lAb i MZ,&J B. SEPTIC/HOLDING TANK DATA WeA ®wAkR Date Installed 54967- /Me Size 'C No. of Compartments Standpipes (Y ) Air -tight Caps&) Foundation Cleanout) Depression over Tank (ye Date Last Pumped Pumping/Maintenance Contract on File (Y/N) I ; for e�J� Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well ZqV t To Building Foundation eR vx1 JeX� To Property Line A) To Disposal Field To Water Main/Service Line /o t To Stream, Pond, Lake, or Major Drainage Course f� Comments Page 1 of 2 72-026(11/84) soils /off 4-�-8� C. ABSORPTION FIELD DATA Show! 5p Wi sp/_ ✓ Soils Rating in Absorption Strata RW4A. JAI Type of System Design e exb Date Installed ?EZ 0�% /97.3 Length of Field 17- Width Z Width of Field Depth of Field Gravel Bed Thickness / Square Feet of Absorption Area 33 (0 Standpipes Present (Yo Depression over Field (YoV _ Results of Last Adequacy Test Date of Last Adequacy Test -3 ,64-54 vA f'E fns 15� 6e),,ah.5 Separation Distance from Absorption Field: To Water -Supply Well gs To Property Line To Building Foundation Lot v To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Existing or Abandoned System on On Adjoining Lots 24 �-t- To Cutbank (if present) _, r v To Driveway, Parking Area, or Vehicle Storage Area /O f Comments b1AzA6/oaf5 dr` Ssrmy ?&R 70- ✓"E'/`1< S/s` /// paHHant /989. D. LIFT STATION Date d Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I hah%ed, v r�ied, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed G�=-- �--- Date OF A�e®f ••s• a Company fJC"S MOA No. $G ^()Z P'` �•.. •'•;4� ..•.'- Receipt No. 00 �:•4 T t; Q* Date of Payment ?--3/—�7 fA� %������ ���• ��•• .a t Amount:$'1 / .... ... dI JR. �J/fJt�j{lfe�%7S /. C E'77�/t' �`•.�� E - 2251 •: •4� Page 2 of 2 Z • b�/[tefZS �p�oeT F►K PPdiIII ';�sfasi 141 a 3, /1�o S ifYc fie PeihA��° *vzc 72-026 (11/84)5r /�2a S.�H/te FsR 6rfcc'a/J ui62e A*( $/"go, i Municipality of Anchorage April 29, 1987 P.O. bJX 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONY KNOWLES, MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES Alan Wien Alaska Environmental Control Services 1200 West 33rd Avenue Anchorage, Alaska 99503 Subject: Lot 4 Lynn Dale Subdivision Waiver Request WR87-023 Dear Mr. Wien: Your request for a waiver of the 100 foot separation required between the septic tank and well on the subject property has been granted. This distance has been waived to 85 feet. This waiver is based in part on the additional information submitted to this department regarding soils and groundwater conditions on the subject lot. Your request for a waiver of the separation of the 100 foot separation required between the existing seepage pit and the "primary well" on the subject property has been denied. This seepage pit was apparently "bootlegged" without a permit or inspection. In order to obtain a Health Authority Approval for this property a new four bedroom soil absorption system must be constructed. This new absorption system must meet applicable setbacks to surrounding wells. Sincerely, Stephen S. Morris Civil Engineer On-site Services cc Gus Andress, P.E. Manager, On-site and Water Quality Programs ALASKA Ci IROW11TAL COnTROL SCRulces, Inc. Engineerinq & 6nuironmental Studies Municipality of Anchorage Department of Health & Human Services 825 L Street Anchorage, Alaska 99501 Attn: Steve Morris April 27, 1987 MUNIDE �ENTLITT y OF ANCHORAGE ENVIRONMHEALTH & AL PROTECLIOAj 'APR 2 81987 RE: L^t 4, Block 1, Lynn Dale subdivision RECEIVED Dear Steve: This is in response to your request for additional information to evaluate the waiver request. A well log was found in your files for the subject lot and a neighbor lot. Tight silty gravels were encountered to 152 feet along with clay. The subject primary well was deepend to 206.5 feet and cased to the bottom. This well is at approximately the same elevation as the absorption area. The backup well in the garage is at a higher elevation than the septic tank. With the type of soil encountered, more than adequate filtering of the effluent should occur in the 85 feet requested. In the wells, water was not encountered until approximately 160 feet depth. We feel that this 15% reduction in the required separation distance will not pose a threat of contamination to the water supply system. If you have any further questions, please call. Sincerely, Alan Wien Engineer Techi.ni.cian Approved by: LerReid Jr., PhD PE Pr ident 1200 West 33rd Auenue, Suite B 9 Anchorage, Alaska 99503 • (907) 561-5040 ALASKA bUIROWnTAL COnTROL SeRkeS, InC. �ngineerinq & 6nuironmental Studies April 16, 1987 Municipality of Anchorage Department of Health & Human Services 825 L Street Anchorage, Alaska 99501 Attn: Steve Morris Re: Lot 4, Block 1, Lunn Dale Subdivision Dear Steve: MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION APR 1 1 1987 RECEIVED Attached is a soil log you requested for the above referenced lot. The existing absorption is approximately 14 feet deep with approximately 7 feet of gravel depth. Groundwater was not encountered to 2U feet and soil was very dry. The soil from 7.5 to 15 feet is very good sand with gravel. A percolation test was not performed. Soil is visually rated at 150 square foot per bedroom. The adequacy test performed 3/16/87 shows the system is capable of absorbing in excess of 1,000 gallons per day. We. request that you issue the conditional Health Authority Approval for this lot. If you have any gesti_ons, please call. Sincerely, eroy C. id Jr., PhD PE Presi.den ® NF1 >rntA,t�•;. v 1200 West 33rd Auenue, Suite a • (Anchorage, Alaska 99503 9 (907) 561-5040 r~w(• • • i N 4'S V 4) i Municipality of Anchorage i 49 T' DEPARTMENT OF HEALTH & HUMAN SERVICES • •• •••••% *• 825 "L" Street, Anchorage, Alaska 99502-0650 / SOILS LOG - PERCOLATION TEST tE y REID, JR. f 0 C - 2251 * t , PERFORMED FOR: ple &N 50 DATE PERFORM�•CYYY � e) / LEGAL DESCRIPTION: "7 1 OLOeg L✓AA% AAZt Township, Range, Section: �x fj ,� SEC z / Orl Ti I E ) 1. 2- 3-01 3 31c7f IAn/b✓ 6E� 4- 5 6- 7 8- �: 10 —�F r2,, Sz,d(sl�J 11 L�� t Sa,d C�err 12 13 r"��� o� l6snG12n� 14 15 16- 6 17- 18- 1819 19 WAS GROUND ER ENCOUNTERED? S IF YES, AT WHAT L O DEPTH? P E Depth to Water Atter Monitoring? A� Dale: SITE PLAN 20 PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER i TEST RUN BETWEEN FT AND FT COMMENTS cSo7/S �-?� �„A -'^ d Dra PERFORMED BY: W 1e,, 4 1?e , JI CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: /����� % I 72-008 (Rev. 4185) Municipanty of Anchorage April 2, 1987 P.O. L_ �' ( 196650 ANCHORAGE, ALASKA 99519-6650 (907)264-4111 TONY KNOWLES, MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES Alan Wien Alaska Environmental Control Services 1200 West 33rd Avenue, Suite B Anchorage, Alaska 99503 Subject: Lot 4 Lynn Dale Subdivision Waiver Request WR87-023 Dear Mr. Wien: I have considered your request for a waiver of the 100 foot separation required between the septic system and wells on the subject property. A complete review of your request cannot be made with the information you have supplied. Before a decision can be made on your waiver request, uncertainties about the existing absorption system (i.e. the depth of the system in relation to the underlying water table and the type of soils in which the system is constructed) must be resolved. When a separation distance waiver is requested, the engineer should provide justification fora lesser separation. The engineer should show that site conditions (hydrogeology, special construction or other technical considerations) warrant a lesser separation. This justification should be included in the waiver request along with supporting documentation. Your waiver request will be reconsidered when additional information on the septic system and wells on the subject lot have been submitted for review. Sincerely, Stephen S. Morris Civil Engineer On-site Services cc Gus Andress, P.E. Manager, Onsite/Water Quality Programs ALASKA CI U11ROWnTAL COUROL OuUS, InC. Cngineerinq & enuironmental Studies Q94N March 25, 19873yrB% 1 Joel Municipality of Anchorage 825 L Street 4( Anchorage, Alaska 99501 Rn: Lot 4, Block 1, Lvnn Dale Subdivision The above referenced lot consists of a 4 bedroom home with an undocumented on-site sewer system and 2 private wells both serving this home. Per the owner, the system was installed in 1973 and the absorption area is 12 feet long by 12 feet wide by 14 feet deep with approximately 7 foot of gravel depth. There are no concrete rings or log crib in the gravel. The solid pipe from the septic tank dumps directly into the gravel area. The septic tank is new and per the owner was installed in September 1986 and has water tight couplings on the inlet and outlet. Attached is a receipt for the purchase of the tank dated 6/17/86. The.absorption area does not have a monitor tube in it. On 3/16/87, we installed a 1 inch diameter monitor tube into the absorption area and performed an adequacy test. Test results show the system is now working adequately for 4 bedrooms. On 3/11/87, I spoke with Robbie Robinson of MOA to determine all that will be necessary for Health Authority Approval. It was determined that what is needed is a soil test with water monitor, verification of the size of the absorption area and to install a 4 inch diameter monitor tube in the absorption area, all of which could be conditioned until summer of 1987, when conditions for excavation would be more favorable, providing the system passed the adequacy test. The fact that there are no rings or log crib in the gravel area would be acceptable as long as everything else checks out satisfactory. As for the two private wells serving this lot, refer to the attached site plan, the well located in the garage was the original well for the house and the well to the north-east of the house was drilled in 1984 after the original well began to lose production capabilities. The outside well is now the primary well and the original in the garage is used as a backup well. The original well was drilled pre 1975 and has no well log. For the adequacy test, the well in the garage was used and pumped 900 gallons in 2.4 hours at an average flow rate of 6.2 GPM. This well is in a small depression in the garage floor with the top of the casing approximately 3 inches below the concrete slab floor. There is a sanitary seal on the casing and the wires are not enclosed in conduit. Attached is a well drillers report and flow test for the outside well. There is no original well log and this well was deepened in August of 1986. From the site plan diagram, the primary well is approximately 85 feet from the absorption area ofthesewer system. The exact distance will be verified when the absorption area size is verified. The backup well is 85 feet from the septic tank. Attached are satisfactory water sample results from both wells. We request that you waive the required separation distance from the primary well to absorption area and the backup well to septic tank to 85 feet each. We also request that you grant Health Authority Approval with the following conditions: In summer of 1987 to: 1. Perform soil test and water monitor near absorption area. 1200 West 33rd Auenue, Suite 3 • Anchorage, Alaska 99503 9 (907) 561-5040 2. Verify size of absorption area. 3. Install 4 inch diameter monitor tube in absorption area. 4. Extend casing of backup well to 12 inches above garage floor and enclose wires in conduit. The owner of the property is refinancing. Funds from closing could be escrowed to do the necessary work., If you have any questioins, please feel free to call. Sincerely, Alan C. Wien Engineering Technician Approved by: law no • •• V�v no ee94uae � »Ase a e•°� • Y G. REIa, 3R • � a2S1 $00 AV a•••0,4008 see t !. 0. �pralssioc�i� 1►oow,a.� ALASKA ENVIRONMENTAL JOB c°T CONTROL SERVICEP---,,INC. ^, 1200 West 33rd Avenue .uite B SHEET N0. OF ANCHORAGE, ALASKA 99503 CALCULATED BY /4 DATE 3 (907) 561-5040 CHECKED BY DATE_ eref c '5 HIGH-PHUKAN CONSULTING ENGINEERS., INC, Civil 9 Geotechnical 9 Structural e Surveying * Planning December 17, 1990 Mr. Dan Bolles Municipality of Anchorage Department of Health and Human Services Environmental Services 825 L Street Anchorage, AK 99501 RE: On -Site Septic Upgrade / Permit 900352 Dear Mr. Bolles: Enclosed is a "final inspection report" for the on-site sewer upgrade for Lot 4, Block 1 of Lynndale Subdivision. I believe you will find the report complies with the new requirements of the "On -Site wastewater Disposal Regulations" issued on October 12, 1990. If you have any questions, please feel free to give us a call. Very truly yours, HIGH PHUKAN CONSULTING G ERS, INC. Dee High, P. Principal MUNICIPALITY Of ANCHORAGE OFA ENVIRON MENTA L PPOTECTTION UV 1 R 199' RECEIVED 2702 Gambell, Suite 103 • Anchorage, Alaska 99503 • (907) 272-7111 / FAX 277-3177 i ` PROJECT I JOB NO. PAGE 4oT 4 Ad t4 DALE BYZ� 14 CK OF/ SUBJECT 1 - DATEp-/•z. d New ,(,EAci� F/Ei/-O / y' DATE 0\ /ores . 14 • � i /. ToPo InIFo� rnAT/off Z &-A-MOW• FRS' Sueyey /coy AH -t•uba O oN f EA O,p� 1 Vo iY s �Yr�e1e +aw mss.e+ a +ea' •• sir. • ve..." •re +,�•e:a 11.Z TH A Qtmn'¢ Cc�v 580 5C 09.4 Fs • TH'Z RAW 2, tlouSF LocnriD fie✓ � 1' ' �' z5 by 3. alP G,e�06 E?c/s > i 6 N _ p- s� S ysrsfn AS SNdwN Q i., � FRor� Nvc>H �nrD �� s ., i �,- - C zis T sc-o rrc H$ANgOtiI .LEACH . � lclEco ,�j oi v 8 ' co.tucu 6 � C4A4• .... ,. '/ - JBIZ. .EJ'/CLC SGIF✓CY. 1 Vo iY s �Yr�e1e +aw mss.e+ a +ea' •• sir. • ve..." •re +,�•e:a 11.Z TH A Qtmn'¢ Cc�v 580 5C 09.4 Fs PROJECT JOB NO. PAGE o VIV,41 D/9LE BY CK / - OF SUBJECT - DATE DATE i i -q T O U Iy� Y^ ��AwAI ilGd bre EX/ -r7" I /ZSG� GAG J6ji/c �.�A/K I c�CAld 0,i _ L �_.../ mOn1 ta&,� Tµ be- e R !•� OC.�%" iN 8'G ► v r D �p e � R� Q • p• r. I K Q. !A fj • a j tl • ` ilGd bre EX/ -r7" I /ZSG� GAG J6ji/c �.�A/K I c�CAld 0,i _ L �_.../ mOn1 ta&,� Tµ be- e R !•� OC.�%" iN 8'G ► • Civil o Geotechnical 9 Structural 9 Surveying o Planning January 4, 1991 H00001 RECEIVED Ms. Susan Oswald Municipality of Anchorage DEC 8 191 Department of Health and Human Services Environmental Services Municipality of Anchorage 825 L Street Dept• Health & Human Services Anchorage, AK 99501 RE: On -Site Upgrade - Permit 900352 / Tank Inspection Lot 4 Block 1 Lynn Dale Subdivision Dear Ms. Oswald: As a follow-up to our telephone conversation, the septic tank for the above referenced property is a 1,250 -gallon steel, two-compartment tank. Per the owner, this tank was installed in September 1986. During the installation of the new leach field, portions of this tank were uncovered. Both ends of the tank have watertight couplings, and there were no abrasions or damage to the tank or protective coating noted. The tank appears to be in good condition and conforms to the Municipality of Anchorage requirements. Very truly yours, HIGH PHUKAN CONSULTING EERS, INC. Dee High, P.E Principal po/HOOOO1.L19 2702 Gambell, Suite 103 • Anchorage, Alaska 99503 • (9O7) 272-7111 / FAX 277-3177 PROJECT: Lot 4 Block 1 Lynndale Subdivision Permit 900352 OWNER: Ferrol and Micki Henson This project consists of replacing an existing leach field by constructing a new leach field in the northeast corner of the lot. This required placement of approximately 185 lineal feet of 4 -inch PVC drain line and 100 lineal feel of perforated pipe as part of a deep -trench system. Construction of the system was accomplished by the owners of the property, and occurred on the weekend of November 10 and 11. Final inspection and as -built survey was conducted on November 27. During construction, both trenches were inspected. The trenches had been dug slightly deeper than the proposed design. The soils profile did not vary from the initial investigation. The sidewalls had been raked. The project was inspected again after the septic rock was placed and the perforated PVC was installed. The perforated pipes were checked for level and found to be in order. An additional 6 inches of gravel was placed over the perforated pipe, and a permeable building paper was placed over the septic rock. The remainder of the trench was backfilled with care being taken to ensure that the monitoring tubes and cleanouts were straight. The drain line from the septic tank to the leach field was installed and inspected. The line was properly bedded. The slope varied from 2.67 percent to 3.37 percent (see attached profile drawings). There was no water table encountered in any of the excavations. The excavation of the drain line area and the two trenches for the leach field were opened up and backfilled within the twelve hour period on each day. No trenches were allowed to remain open over night. Frost penetration at the surface was approximately 6 inches at the time of the work. No frost was noted on the trench walls at any time during the installation. A final inspection was made cleanouts and monitoring to area along the drain line a properly graded to provide area. on the project. bes were in place nd above the leach positive drainage All caps for the and secured. The field had been away from the The system appears to be installed in accordance with the "new on-site wastewater disposal regulations". Date ° MUN1L1PALI|Y U[ AN�HORAGE ^ Department o� HeaIth & Human Services 8F5 L Street, Anchorage, Alaska 99501 343 ON~SITE SEWER PERMIT �ermit Number: 90O352 Upgrade ~lL��'�~/�� Date Issued: 10/26/90 �ngineer Designed Owner Name� FERROL & MICKI HENSON Day Phone: Owner Address: 4041 E" 112 AVE" 344�3852 ANCHORAGE, AK 99516 Parce1 Id: 015�273~53 Lot Legal: Subdivision: LYNN DALE Lot: 4 Block: � Section: 21 Township: 12N Range: 3W Lot Size 40620 (sq,Ft" or acres) Max Bedrooms: This Permit: 4 Total Capacity: 4 SEPTIC TANK: Minimum total septic tank capacity: 1,2�0 gallons, Each septic tank must have at least 2 compartments" Depth to top o� septic feet requires insulation oyer tank(s)" INSTALL PER ENGINEERS ATTACHED PLANS^ NOTIFY DHHS PRIOR TO EACH lN�PECTION" THIS PERMIT lS ISSUED FOR THE EXISTING 4 BEDROOM SlNGLE FAMILY DWELLING ONLY AND EXPlRES ON 12/31/90. I CERTIFY THAT: 1. I am �amiliar with the requirements �or on�site sewers and wells as set �orth by the Municipality o� Anchorage (MOA> and the State of AIaska" 2` l will install the system in accordance with al� MOA codes �nd regulations; and in compliance with the design criteria o[ this permit" 3. I will adhere to all MOA and State of k-1 the set back CA. �pom any existing well� wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid �or a maximum o[ 4 bedrooms^ I also undersLand that system is 4 bedrooms and any enla dditionaI permit" .... (Uwner) FERROL & MICKI HB�0ON / Issued By: DATE: ... ..... ~ _' A (IIJ C V A.1 Id BYCK �SA1 SUBJECI L - ftikj0e))-) A u SC/A,/,FY /.?y on/ 6US C -3 VYrC-fr) AS 51.16 4✓ t/ Ff2OPA AAM!01 efAIO L - ftikj0e))-) A u , (� � .� � \ /� . . IV / -4,v) L4 \N PROJECT £@m. PAGE 1,67 4 13 - BY CK SUBJECT )2-H. OF DATE DATE % c P 4� -O ƒ \T , (� � .� � \ /� . . IV / -4,v) L4 \N Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR:__I-'G` Igoe- � AI IC141 /-jE/U.SG7 DATE PERI LEGAL DESCRIPTION: Z&7r ii Pw4Aownship, Range, Section:-Tjeltl j DEPTH X -1r. I 11ns.s» .aSLOPE SITE PLAN (FEET) 1 ' 2 f iz u iYt / TCaGt t+� �e� ; rla i 4 i d 5 6 7 8 9 10-- 12 0_-12 13� 41516 14- 15- 16 17 81920 18- 19- 20--1 COMMENTS 0o' �SL. OfzA e'll And �r l �6Z A L.0 S r c.7' 11-1 ,c,/V0 Tis i H6z'57 WAS GROUND WATER ENCOUNTERED-? S 1 1.11 IF YES, AT WHAT L DEPTH? p0 E Depth to Water Alter Monitoring? Date: Reading Date Gross Time Net Time Depth to Water Net Drop 15 T- 30 3�4 ! �: a7 l4-1 PERCOLATION RATE 6 (minutes/inch) PERC HOLE DIAME[t TER g d 1 TEST RUN BETWEEN FT AND —�` ' -FT PERFORMED BY: 7 f:- �1-11e2A/ I ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON 72-008 (Rev. 4/85) CERTIFY THAT THISTEST WAS PERFORMED IN TE. DATE: f'6' do- ! & rte/ -A . -S(-%r / I Z '0- FO I Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: 4d7— 4 yAlAl DAT LEGAL DESCRIPTION: Township, Range, Section: T/z.A( ,c _yYj./ ' D wPT;I1 F' 7— &c-67 SLOPE SITE PLAN [,.% (�3/ -5,/T A )j 1 /% W7 2 1� i . /ia� bS ETP - D . - 3 ' 4 u 6 7 8 9 10- 11 12- 13 2 13 14 r 15- 16 5 16 17 .a'L/C,t�T6� t"a4Z6tUi� SIG -5�,7� w<zzr 6iaWU6(r tic5;041 tory �5>- iJGc 14o4'e- 18 -'�j TG ,, 19o�� WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT 0 DEPTH? 0 P E Depth to Water After d t�Nu Monilaring7 Reading Date Gross Time �rcj" Net Time Depth to Water Net Drop PERCOLATION RATE ({mmutes/mcch�) PPERC HOLE DIAMETER f 3 / 7z 3//4 47e, dam. Joe zi-= j'�2 ! w6 r& -cur, -3 G %(U 1 — CERTIFY THAT THIS TEST WAS PERFORMED IN N ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON TF DATE. DATE: rG : L : 'z Z. ti u : v f41 7 er _ 027 / 0 '7"/j � -- " 20 DIAllueW /r1 4e-fs 6r %HAP !c 1)1i4rzT'Cf' PERCOLATION RATE ({mmutes/mcch�) PPERC HOLE DIAMETER TEST RUN BETWEEN FT AND 40'577 FT COMMENTS Joe zi-= j'�2 ! w6 r& PERFORMED BY: -�) C: e a/[ -,%i I`'�L — CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON TF DATE. DATE: rG 72-008 (Rev. -4i 85) 'J G Ci PROJECT �j JOB NO. PAGE '-/0 7' i � 0 A& 1r BYi CK -(OF- SUBJECT Z l �'!L eGfGLQyit tET/}T/0 DATE DATE eeC 5,/19 f� � 1 i2E/�e <f SeC,IN Sc- I PROJECT JOB NO. BY CK SUBJECT rJ DATE DATE '. '. ' ', * .NDN � •�° 7# ••r CE •rWI '. ,,1 °e•••N•v a X.` A$ H00001 ON-SITE SEPTIC SYSTEM NARRATIVE Project: Lot 4, Block 1 Lynn Dale Subdivision Date: 10/23/90 The following narrative is submitted as part of the leach field upgrade for the on-site septic system for Lot 4, Block 1 Lynn Dale Subdivision, and is submitted in accordance with the Municipality of Anchorage ordinance - Chapter 15.65 (wastewater disposal regulation), Section 030.D.4. Item A• Wells Lot 4 is bordered on all sides by developed and undeveloped lots. The entire west boundary is bordered by an undeveloped five acre tract. Due north is Lot 3 which has a single-family residence with a well. To the northeast is an undeveloped lot (Lot 2). Due east is a single-family residence (Lot 1) with an on-site well. To the south across East 112th is an undeveloped lot. None of the lots surrounding Lot 4 have wells within 200 feet of either the existing or proposed systems. The proposed upgrade does not affect any of the existing wells or prevent placement of new wells on adjacent properties. Item B: Wastewater Systems Lots 1 and 3 have wastewater systems. The system on Lot 3 is over 200 feet from any system on Lot 4 and will not be affected by the proposed upgrade. The existing septic system on Lot 1 will be approximately 100 feet from any point of the proposed upgrade. Lot 4 will not be affected by the planned improvements. Due to the size of the undeveloped lots and the location of existing utilities on the developed lots, the proposed leach field system has minimal to no impact on the adjacent lots. Item C: Reserved Space There is adequate space remaining on all adjacent lots for placement of new systems or upgrade of existing systems. On -Site Septic System Narrative 10/23/90 Page 2 Item D• Drainage Drainage for the entire area is generally to the north- northeast. Drainage from the east side of lot 4 drains north along Zelna Circle, and then northeast towards the west boundary of Lot 1. Lot 4 and the surrounding lots have enough relief to provide positive drainage, and there is no indication of any ponding, channels, or drainage systems that will be affected by the proposed leach field. ***End of Report*** (907) 243-2282 KEN JOHNSON KEN'S COMPAN T UNTDIPAT)l OF E T`.T OF HEALTH &RAGE WATER WELL DRILLING ENVIRONMENTAL PROTECTION! PUMP SALES & SERVICE 30 YEARS ALASKA DRILLING FEB 2 r� I`ki:) FERROL HENSON 4001 E. 122th Anchorage, alaska 99516 -REi LOT 4 LYNN SALE ( HM 344-7594 3163 LINDEN DRIVE ® flof ALASKA 99502 R SEPT. 2 j 1984 ` Wk 274-4025 ) W, TER WELL LOG 0 ft to 9 ft Course gravel & light brown silt 9 ft to 15 ft Same & weeps H2o 15 ft to 20 ft Course grav and gray silt (tight ) 20 ft to 33 ft Med. gran & sand 33 ft to.35 ft Course grav & light bf'own silt 35 ft to 7 ft brown silt with some fine grav 47 ft to 53 ft Ked. grav & brn silt 53 ft to 74 ft Course grav & gray silt ( tight ) 74 ft to 103-6 Same with cobbles 103-6 to 105 ft Boulder ... pull back and rotate casing 180 degrees 105 ft to 118 ft Course grav & gray 'silt 118 ft to 123 ft Sandy Brown silt ( open 4 -ft ) 123 ft to 129 ft Cours grav & It brn silt. ( ti ht j 129 ft to 152 ft Course grav & gray silt (tight 152 ft to 164 ft Mame with brown silt a 164 ft to 166 ft Course grav& brn silt Weeps... Approx 3 GPM 166 ft to 170 ft `Vater bearing sand do gravel Over nite static water Level 153.5 ft 16.5 ft, head Test bailed 1* hrs at 10 GPM 4 ft. drawdown Recover in 1 min, bottom sta)eble a`\ Total casing 170.00 ft.