HomeMy WebLinkAboutLAMPERT ESTATES BLK 2 LT 17Lampert
Estates
Block 2
Lot 17
#051 -791 - 1 8
Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 1
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP181296 PID Number: 051 791 18
Dwelling: ❑■ Single Family(SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑■ Upgrade
Name:
JOE HEALY ABSORPTION FIELD
Address
❑ Deep Trench ❑ Shallow Trench EI Bed El Mound
22426 LAMPERT ❑ Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
3 -- GPD/SF -- Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot -- Ft..-- Ft.
LAMPERT ESTATES BLOCK 2 LOT 17 Fill added above original grade Gravel length
Township Range Section -- Ft. -- Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES -- Ft. -- -- Ft.
To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist.between trenches
From Tank Field Lift Station Tank Line __ Ft2 -- -- Ft.
Well +100 -- -- -- -- TANK ❑p Septic ❑S.T.E.P. 0 Holding 0 Other
Manufacturer Capacity
Surface Water +100 -- -- -- ANCHORAGE 1000 Gal.
Material Number of compartments
Lot Line +5 -- -- -- STEEL 2
NA
Foundation 6 -- -- -- LIFT STATION
Manufacturer Capacity
Curtain Drain -- -- -- -- -- __ Gal.
Remarks
OLD TANK DISPOSED OF PER MOA Pump on level at Pump off level at High water alarm at
REQUIREMENTS -- in. -- in. -- in.
TANK REPLACEMENT ONLY Pump make and model Electrical Inspections performed by
PIPE MATERIAL House to tank 3034 Tank to 3034
Installer drainfield
GUARANTEED SERVICES Drainfield UNK CO/MT UNK
Inspector CHARLES BALZARINI BENCH MARK (Assumed elevation) ft
Inspection
l'' 8/29/18 �a Location and description
dates: 2
3rd 4'^ top of deck
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp
Conditional Approval: Date .< .OF A..gsl1'
*: 49 ni ..* /
..< -
i
CHARLES G BALZARINI
•
/r <'.•. CE-13854 .,‘;01#'
Approved G%-.. �, Date 2-,3 ( ,�jk.„_ _._n..—A-.�
Inspection Report_9-1-12.doc
- OF A�q\S‘1
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. .. .\ /�/I CHARLES G BALZARIKf P
,TI�Fc�sl .CE-13854••�Aiiei
LAMPERT ESTATES l FgFOP Nay
ll ROFESS`� -�-
BLOCK 2 LOT 17 ��\k\-%.--11-`
\TO
XISTING DRAINFIELD
REMAIN
SWING 1115
IA B
b C I 30.1 10.1
0 30.8 11.75
E 32.2 15.6
3 BEDROOM HOME7 13 1 33.5 20.31
BM
B
DECK j ,.
E p =
_______-4:3C
_ _ NEW AFTER
TANK CLEANOUTS
10' UTILITY EASEMENT NEW TANK. GAL
PLAN - SCALE: 1" = 20'
FOUNDATICLEANOUT
CLEANOUT MONITOR TUBE
9.4
N .44
-BM: +100.0'
DECK . NISHED
li GRADE
0'COVER
INSULATION OVER TANK AND LINES
I
t
95.65
'.,5 5z
SCHEMATIC ELEVATION - SCALE: NTS
LEGAL DESCRIPTION: LAMPERT ESTATES BLOCK 2 LOT 17
C&M ENGINEERING SERVICES OWNER: JOE HEALY DATE:10/15/18 REV:O DRAWN: CB REF:
907-854-5558
SITE PLAN
/2'1//( -
se'-'2!,, MUNICIPALITY OF ANCHORAGE m�„�.
On-Site Water&Wastewater Program 10 •S(;,
.air; PO Box 196650 4700 Elmore Road
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 c
httpa/www.muni.org/onsite : f'-V
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On-Site Wastewater Disposal System Permit
Permit Number: OSP181296 Effective Date: 8/28/2018
Work Type: SepticTank Upgrade Expiration Date: 8/28/2019
Tax Code Number: 05179118000
Site Legal Address: LAMPERT ESTATES BLK 2 LT 17 G:1459
Site Mailing Address: 22426 LAMPERT CIR, Chugiak
Owner: HEALY JOSEPH M & KRISTEN L Lot Size in Sq Ft: 19800
Design Engineer: C & M Engineering Total Bedrooms: 3
This permit is for the construction of:
❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
/ _, ViC17/ 5
Received By: Date:
Issued By: ltl/(/ Date: 9A0/g'
MAN EPLAS
MUNICIPALITY OF ANCHORAGE
El!'
Development Services Department i
Phone: 907-343-7904
On-Site Water& Wastewater Section
Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 051-791-18
Property owner(s) Joseph Healy Day phone 854-8494
Mailing address
Site address 22426 Lampert
Legal description (Sub'd., Block & Lot) Lampert Estates Block 2 Lot 17
Legal description (Township, Range & Section)
Lot Size 19,800 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field ❑ Initial ❑ Single Family (SF) 0
(w/wo ADU)
Septic Tank Upgrade ❑
Duplex (D) ❑
Holding Tank ❑ Renewal ❑
❑
Multiple Dwellings ❑
Privy
(SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Code .
(Signature of property owner or authorized agent)
Permit/Rush Fees: 4 34y,uWaiver Fees:
Date of Payment: o "� l Date of Payment:
Receipt Number: OW.tr -D Receipt Number:
Permit No. d 5 P 18 1 aa(o Waiver No.
G:\Development Services\Buiiding Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
C&M ENGINEERING SERVICES
Ph: 907-854-5558
Municipality of Anchorage
Onsite Water & Wastewater Program
4700 Elmore Rd Anchorage, Ak 99507
8/15/2018
RE: Proposed Septic System Modification for Lampert Estates Block 2 Lot 17
Dear Reviewer,
The above referenced property is currently served by an older 3 bedroom septic system. The 1250 gallon
tank has failed and is in need of immediate replacement.
We are proposing that the existing tank be replaced with a new 1250 gallon tank of MOA approved
construction and installed in accordance with MOA requirements.
The tank shall be covered with a minimum of 2” moa approved insulation and 3’ of cover.
The tank will be set no closer than 5’ to the house and the top of the tank will be no lower than the bottom
of the footing. This ensures that foundation does not bear on the tank. Site constraints prevent the tank
from reasonably being placed 10’ from the foundation. The home features a deep crawlspace and a
relatively shallow tank burial depth.
The repair shall be performed by a moa certified installer in accordance with MOA requirements.
The engineer will inspect the tank before backfilling.
Repair of the proposed system will not negatively impact adjacent lots.
Upon completion of the installation, a record drawing will be submitted showing the location of the new
tank, leach field, well, and other applicable features.
Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854-
5558 or by email cgbalzarini@gmail.com with any questions or concerns.
Sincerely,
Charles Balzarini, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181296, Deb Wockenfuss, 08/28/18
CHARLES G BALZARINI
CE-13854R
EGISTEREDPROFESSIONALE NGINEER8/27/18
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181296, Deb Wockenfuss, 08/28/18
K---------N\MUNICIPALITY OF ANCHORAGE
r DEPARTMENT OF HEALTH & ENVIRONMENTAL- PROTECTION
ENVIRONMENTAL- ENGINEERING DIVISION
825 L Street • Anchorage, Alaska 99501 Telenhonn. 7.64-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE
//1�
l4)/fyrie �-e�GCS(/1 EI t- j/ -.'2/.5/0
//
U"KI E W
❑ UPGRADE
MAILING ADDRESS
fit' ,lgcV 76,3 €/
LEGAL DESCRIPTION p'lc Z.
I. /7 'LLA-0npFnf S74:
LOCATION
NO. OF BEDROOMS
UY
I-2
Nti
DISTANCE TO:
ell '.` Q�,�
.,.. Jj
Absorption area
77
Dwelling /
�,/�Z
Mate is
5ttc_2
PERMIT NO. _j
6=Z16.<0
No. of compartments 7
Manufacturer
e c 77e-.
Liq. capacity in gallons
/O vC
!DISTANCE
IF HO EMADE:
Inside length
—
Width
Liquid depth
,�
Y.
-i02
O zt
T I-
TO:
Well
Dwelling
PERMIT NO.
Manufacturer
Material
Liquid capacity in gallons
TILE
DRAINFIELD
TRENCH
DISTANCE TO:
ell Q_
>ti . µSQ
Foundation,/ zf
Nearest lot line
/
PERMIT NO.
620(00
T"
No, of lines
Z
Length of_ e-ic line
47471/ _1/
Total length of lines
/c;•W
Material beneath tile
Trench width
' Makes
Distance between lines
—
Total effective absorption area
Top of tile to finish gr.09,, i
SEEPAGE
PIT
Length
Width
Depth
PERMIT NO.
Type of crib
Crib diameter
Crib depth
Total effective absorption area
DISTANCE TO:
Well
Building foundation
Nearest lot line
-i
w
�-" I
ss ,, 11
Wyha.�.vC.
OO
DISTANCE TO:
Depth
Driller
Distance to lot line
PERMIT NO.
Building foundation
Sewer line
Septic tank
Absorption area (s)
OTHER
7
fy
(
L
PIPE MATERIALS
0 303c4
N
NA.,
owt
a
SOIL TEST RATINGP.
e y
,.
I t r
1
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INSTALLER
�t c(. WOO CIS
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REMARKS
c u Crti 3.'-o tJ F2 _&Jz
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41±it
APPROVED DATE LEGAL
72
72-013 (Rev. 3/78)
!!*,-111 c
DEPARTMENT . ` HF9� /H AND cwVTpnw�Ew�o/ -�n�crr`nm
�� — � �-�`��� �`~ �'�' `'``'"'='''� �.�,` �vn
825 'L STREET, HNCHORHGE, AK. 9� 1 /Yl�A.
264~472G /(^
���0'���� mm���
PERMIT Nn / o�m�um � U
� _��^ � �`� ` �~` ." /L)In/\
| ~
/ APPLICANT WHYNE CUUSINEHU PO BX 763 ER
LOCATION
'
�``��
LEGH| LT. 17 LHMPERT EST S/D LOT SIZE 20000 SQUAWS �' "m
ET
TYPE OF SOIL ABSORPTION SYSTEM IS: DRRI�FIELD - L�.
`~'��~~'~i
� �
MAXIMUM NUMBER OF BEDROOMS SOIL RATING (SQ FT/BR)B 283
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
���!!:-:J! �������
THE LENGTH DIMFNSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD
THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE .
GROUND AND THE BOTTOM OF THE EXCHVRTIoN (IN FEET).
11-11,-EIE .. ;kg ��T1-.1 I f5 FEEEETN.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFHLL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
��IL.- �E15'..,11-,;..
1!::=-1!E:7411-..'11
nA F.- K_CNNA t.5
PERMIT APPLICANT HAS THE RESPONSIBILITY |O INFORM THIS DEPARTMENT DURING THE
INSTHLLHTION INSP-CTIONS OF ANY NELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT !HE WELL WILL SERVE
� < IP��ENFDE:-1.- g_gli--.177.s. ��
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT HUH L BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWHGE DISPO5HL SYSTEM IS
100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC HELL
MINIMUM DISTANCE FROM H PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND
TO R COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO 'WWI:, PROPER INSTALLATION.
,
I CERTIFY THAT
i: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND SET
FORTH BY THE MUNICIPALITY OF HNCHORHGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES
I: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MHY REQUIRE ENLARGEMENT IF THE
• RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS.
'
SIGNED' L'
HPPLICHNTtYHHYNE COUSINEHU
ISSUED BY
�
DRTE_//-13-��
O & E ENG,NEERING & DEVELOb IVIENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster
694-2774 SOIL LOG% /
Performed for: Name• 700/� (4/44/ nJ e lie) L./ '6 r A/ z~• Tel. No �9/-f
Mailing Address: / • O // ��' L/�1fo[_� it1c 4Y �7 7 %"7
Legal Description. L Q T /7 LL.- 4 44/711—
Soil Characteristics
Earl Ellis
688-2280
Depth (feet)
0 v�
1 tL- t c_ f` 2e6,NrC_4�
2
3
4
/�4=1ec 4 k e,0 ri-/ dace -6
6 / �'
.l
8 / 3 iA1c.-Mr.s
9
10
12 13
14
15
16
0d�//�C
sr6aN�,AJ6 .A` 1/
Ground Water Encountered: Yes frNo
C4
PLOT PLAN
PERC. TEST
r- 4/6 44//i!//N(. J
2.7 2:2,"4 cam,
‘tt., Y• •G 6
If yes, what depth ;' c�ae • i1y "• "V #
• ®#
5,1. •0:•••••0 eaair •••e" • o 41
••• • 41-4 o • n •. d
�m�, Russell L, Oyster
'04,-q`„,\.
� �•• No. 4206 • S
�llikpROFEssko`°`� 0
Proposed Installation: Seepage Pit Drain Field
Comments.
Ems'
Performed by:
Date. --//n
OS/il *
(,i Municipality of Anchorage =°
On-Site Water and Wastewater Program mil I I
(907) 343-7904 5 A<
Certificate of On-Site Systems Approval
0511-' tit
-1-741-432
Parcel I.D. 8 Expiration Date: .g.-291—I si
1. GENERAL INFORMATION
Complete legal description LAMPERT ESTATES BLOCK 2 LOT 17
Location (site address) 22426 LAMPERT
Current Property owner(s) JOSEPH HEALY Day phone
Mailing address 22426 LAMPERT
Real Estate Agent Day phone
2. TYPE OF DWELLING:
1 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual LI
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community LI
Public Water System 0 Public Sewer ❑
WaiverNariance request for: Distance:
Received by: Date:
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ 52L Waiver Fee $
Date of Payment 41161 ig Date of Payment
Receipt Number O?Z(D Receipt Number
COSA# 65C 1.7 ltiCA Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm C&M ENGINEERING Phone 907-854-5558
Address 20182 TULWAR
Engineer's Printed Name CHARLES BALZARINI Date 9/4/18 1
eiC„t
kk
.� P• "f..
6. DSD SIGNATURE ;.. ...*..•
System#1 Approved for 3 bedroomsed
CHARLES G BALZARIW
System#2 Approved for bedrooms �� /
CE-13854/
DisapprovedrF4O• .....••� ,�
Conditional approval for bedrooms, with the following s;*
Y
ON-SITE �.
WATER AND
0 WASTEWATER 6
PROGRAM '
964�a�r ERM"
By: Original Certificate Date:
2--
The
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory 1( Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet f c
If more than 1 septic system is on the lot:
COSA Checklist# 1 of1
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: LAMPERT ESTATES BLOCK 2 LOT 17 Parcel ID:051-791-18
A. WELL DATA
Well type PUBLIC If A, B, or C provide PWSID# 210697 Well Log (Y/N)-
Date completed - Sanitary seal (Y/N) - Wires properly protected (YIN)-
Total depth - ft. Cased to - ft. Casing height(above ground) - in.
FROM WELL LOG AT INSPECTION
Date of test - -
Static water level - ft. - ft.
Well production - g.p.m. - g.p.m.
WATER SAMPLE RESULTS:
Coliform - colonies/100 mL Nitrate - mg/L
Arsenic - ug/L Date of sample: - Collected by: -
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC / STEEL Date installed 8/29/18
Tank size 1000 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) yes
Date of pumping NA Pumper NA
C. ABSORPTION FIELD DATA
Date installed 7/20/82 Soil rating (g14-4/1+2 or ft2/bdrm) 285 System type TRENCH
Length 121 ft. Width 5 ft. Gravel below pipe 3 ft.
Total depth 6.5 ft. Eff. absorption area 1043 ft2 Monitoring tube yes Depression over field no
Date of adequacy test 7/31/18 Results (Pass/Fail)pass For3 bedrooms
Fluid depth in absorption field before test 32* in. Water added +450 gal. New depth 36* in.
Elapsed Time: <14z6 min. Final fluid depth 32* in. Absorption rate >= 450 g.p.d.
Any rejuvenation treatment(past 12 mo.) (Y/N &type) none known If yes, give date na
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
WELL ON LOT TO:
Septic tank/lift station on lot -- On adjacent lots --
Absorption field on lot -- On adjacent lots --
Public sewer main-- Public sewer manhole/cleanout --
Sewer/septic service line -- Holding tank --
Animal containment areas -- Manure/animal excrete storage areas --
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 6 Property line +5 Absorption field +5
Water main +10 Water service line +10 Surface water +100
Wells on adjacent lots+100
ABSORPTION FIELD ON LOT TO:
Property line 0** Building foundation +10 Water main +10
Water Service line+10 Surface water +100 Driveway, parking/vehicle storage +5
Curtain drain +50 Wells on adjacent lots +100
F. COMMENTS
*DRAINFIELD MEASURES OVER 90% FULL AT SUMP UNDER NORMAL USAGE.
LIKELY DUE TO SUMP CONFIGURATION. NEW TANK INSTALLED. **Waiver on file
G. ENGINEER'S CERTIFICATION .,r
I certify that / have determined through field inspections and AP' Q`
review of Municipal records that the above systems are in /G7� •57��)
conformance with MOA COSA guidelines in effect on this date. * 49TH
• • • . . . . .;.•--•. • r
Engineer's Printed Name Charles Balzarini
ter. -
Date 09/05/2018 I0 • • • • • • • " • • • •
CHARLES G BALZARINI
�� �'c�G,•, CE-13854 .•��'/
,'k 9 •
F0 PROFEssi00*-4,*
COSA canary sheet_2-6-15.doc
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT • 907-343-7904
On Site Water and Wastewater Section ' Fax: 343-7997
www.muni.org/onsite
Septic System Absorption Field Advisory
Certificate of On-Site Systems Approval # OSC181469
Subdivision: Lampert Estates, Block: 2, Lot: 17
During the absorption field adequacy test, 32 inches of standing water was
observed in the absorption field. This indicates approximately 90+ % of the
absorption area is inundated. Although this system passed the adequacy test, the
remaining life expectancy may be limited.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
Mailing Address:P.O.Box 196650*Anchorage,Alaska 99519-6650*www.muni.org
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.munt.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051 '%q t -)
1. GENERAL INFORMATION
cosA# Oct 03SJ
Expiration Date: i n- 2 1-10
Complete legal description LAMPERT ESTATES, BLOCK 2, LOT 17
Location (site address) 22426 LAMPERT CIRCLE " CHUGIAK, AK 99567
Current Property owner(s) ROY BUYSE Day phone 688-5757
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
23324 GREATLAND DRIVE * CHUGIAK, AK 99567
Day phone
Day phone
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class A Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
❑ Individuat 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 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. 1 further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E. TUDOR ROAD. SUITE 101 " ANCHORAGE, Al< 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
Date
,,,AC.... OF °;op,
X00 '•.Jef A. arness.r QD
Q �. •• CE -79 3 .7 :p-
are i i'al i ti DCcAoo
0
5. DSD SIGNATURE Jam; • ON-SITE ':�
1/- Approved for3 bedrooms. `S WATER AND m
WASTEWATER
Disapproved. o•,• PROGRAM ;
Conditional approval for bedrooms, with the fllowing stipulations: :;re'•' ..... •.
•���,• \
�'fii EV- 0
1i11t1111%)0
By:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
(Rev. 11/05)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Ot -r
Original Certificate Date: /0 - 2 /- 0 9
A.
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:
LAMPERT ESTATES, BLOCK 2, LOT 17 Parcel ID: 051-791-18
WELL DATA
Well type CLASS 'A•
Date completed Sanitary sea i Wires properly protected (Y/N)
Cased to ft Casing height (above ground) in
FROM WELL LOG AT INSPECTION
PUBLIC WATER
If A, B, or C provide PWSID# 210697
Well L
Tota
Date of test
Static water level ft
Well production g.p m
WATER SAMPLE RESULTS:
Coliform
Ars- i•
colonies/100 mL Nitrate mg./L.
Date of sample:
ft
gpm
B. SEPTI :/HOLDING TANK DMA
Tank Type/Material SEPTIC/STEEL
Tank size 1000 gal. Number of Compartments 2
Foundation cleanout (YIN) YES Depression over tank (Y/N) NO
Date of pumping 10/10/2009 Pumper
C. ABSORPTION FIELD DATA
Date Installed 7/20/1982
colonies/100 ml.
Collected by:
Date installed 7/20/1982
Cleanouts (YIN) YES
High water alarm (Y/N)
JR'S PUMPING
N/A
(BELOW EXISTING GRADE
Soil rating (g.p.d./ft'o
Length 121 ft Width 5
285 System type TRENCH
ft Gravel below pipe 3 ft.
Total depth *6.33 ft. Eff. absorption area 1043 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 10/12/2009 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth In absorption field before test "26 in. Water added 670 gal. New depth""34.5 in.
Elapsed Time' 840 min. Final fluld depth'""29.5 in Absorption rate >= 450+
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date —
"4 INCHES BELOW THE INVERT •""4.5 INCHES ABOVE THE INVERT
****0.5 INCHES BELOW THE INVERT
NOTE: DRAINFIELD WAS OVER 90% FULL (LIQUID LEVEL WAS AT 29.5) BEFORE
THEY PUMPED THE TANK ON 10/10/09. ADVISORY NOTICE RECOMMENDED
gpd
D. LIFT STATION
Date Installed Size In gallons
'Pump on level at In "Pump off' leve
Datu i Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot On adjacent Tots
Absorption field on lot On adjacent
Public sewer main ' ublic sewer manhole/cleanout
Sewer /septic service line Holding tank
Ani inment areas Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 51+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 1 O'+ Surface water 100'+
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line '0' Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 1 00'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Welts on adjacent lots 200'+
Manhole/Access (Y/N
High water alarm level at in.
Meets alarm & circuit requirements?
PUBLIC WATER
F. COMMENTS
•WR#990087
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems am in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name
Date 1O1I4JDCt
JEFFREY A. CARNESS
COSA Fee $ 9
Date of Payment " d -//- 15, y
Receipt Number 0.6 / 1 8
(Rev. 1 1105)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
Development Services Department.
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Septic System Advisory
Certificate of On -Site Systems Approval # 090381
During a recent adequacy test on the septic system for Block 2, Lot 17 of
Lampert subdivision, 29.5 inches of standing water was observed in the
absorption field. This indicates that approximately 98% of the absorption
area is inundated. Although this system passed the adequacy test, the
remaining life expectancy may be limited.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval
Parcel I.D.
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
. P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
051-141-0 HAA# O50532-
1. GENERAL INFORMATION
Complete legal description
Expiration Date: lO/s lanbilb
LAMPERT ESTATES SUBDIVISION; LOT 17, BLOCK 2,
Location (site address or directions)
22426 LAMPERT CIRCLE • CHUGIAK, AK
Current Property owner(s) JODY MAUS Day phone 688-6801
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
P.O. BOX 672235 * CHUGIAK, AK 99567
Day phone
Day phone
Unless otherwise requested, HAA will be held by DSO for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well 0
Individual Water Storage ❑
Community Class "A" Well •
Public Water System ❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
Community On-site
Public Sewer
•
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for 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 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 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. 1 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. Date /0A/as
Phone
337-6179
Engineer's Comments:
In conducting this evaluation, GEG, Ltd. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the o0`
system undor 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 bedrooms.
Disapproved. kit JakCIPALIlyO:,
•n
Conditional approval for bedrooms, with the following stipulktlorw .• •9
•
o•y
JoA. Q9,y�ccR
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
By:
(Rev. 12/01)
-9,);,`• CFS • •1
/1///IJ1)I/
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: /bit
S/ams
Legal Description:
A. WELL DATA
Well type cuss •A•
Date completed
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.clanchorage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
LOT 17, BLOCK 2; LAMPERT ESTATES S/D
If A, B, or C provide PWSID# 210697
Date of test
Static water level
Well production / g p m
WATER SAMPLE RESULTS:
Sa
Cased to - ft.
FROM WELL LOG
ft.
Parcel ID: 051-791-18
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
in.
Coliform - colonies/100 ml. Nitrate - mg./L. Other bacteria - colonies/100 mi.
Arsenic: - mg./L. Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL Date installed 7/20/1982
Tank size 1000 gal Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO
Collected by: -
Date of pumping 2/8/2005
C. ABSORPTION FIELD DATA
Date installed 7/20/1952
Length 121' ft.
Pumper
High water alarm (Y/N) N/A
JR's PUMPING
Soil rating (g.p.d./f90
Width 5'
285
Total depth 6'-7' ft. Eff. absorption area 1043 ft=
System type TRENCH
ft. Gravel below pipe 3' ft.
Monitoring tube YES Depression over field NO
Date of adequacy test 9/30/2005 Results (Pass/Fail) PASS
Fluid depth in absorption field before test 25 in. Water added 996 gal
Elapsed Time: 1345 min.
Final fluid depth 28.5 in. Absorption rate >=
For 3 bedrooms
New depth 34 in.
450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) SEPTIC -CLEAR If yes, give date 8/26/05
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at in. "Pump off"
Datu Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOTTO: COMMUNITY WATER SYSTEM
Manhole/A
High water alarm level at in.
Meets alarm & circuit requirements?
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
ptic service line
On adjacent Tots
cent lots
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field
Water main
10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
*0' Buildingfoundation 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage
5'+
Curtain drain NONE KNOWN
Wells on adjacent lots 200'+
10'+
F. COMMENTS
*LOT LINE WAIVER GRANTED (WRN990087). SEE INGRESS/EGRESS EASEMENT. `\ r
G. ENGINEER'S CERTIFICATION
1 certify that 1 have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name
V1 Date /O�Ai" 0 S
i. 4/4
i.
l HAA Fee $ u70
Date of Payment
Receipt Number
(Rev. 12/01)
JEFFREY A. GARNESS
-15 1941 X�
Waiver Fee $
Date of Payment
Receipt Number
UrUubbJrt41tt
INGRESS/EGRESS EASEMENT
GRANT made this 20sday of October, 1999, between Daniel P. Maus and Deena K
worn 4c Maus, P.O. Box 671534 Chugiak, AK , hereinafter referred to as the Grantors, and of
Monty and Susanna K. Buyse, P.O. Box 670185, Chugiak, AK 99567 hereinafter
referred to as the Grantees.
WHEREAS, the grantors are owners as tenants in the entirety of the following described
realty:
Lot 16; Block 2; Lampert Estates according to the official Plat #72-207 in
the Anchorage Recording District, Third Judicial District, State of Alaska,
and,
WHEREAS, the grantees are desirous of enjoying the use of a certain portion of the
grantor's land for the sole purposes of ingress and egress to Grantees land for the purpose
of maintaining a private septic system, and to gain access to a shed located on the east
property line.
and,
WHEREAS, the grantors have agreed, in consideration of $1.00 (one dollar and no cents)
and other good and valuable consideration, the receipt of which by Grantors are hereby
acknowledged, to grant to the Grantees as easement solely for said defined purposes and
for no other,
NOW, this grant witnesseth that in return for said specified consideration paid by the
Grantees to the Grantors, the Grantors hereby grant unto the Grantees, their heirs and
assigns, full and free right to maintain a private septic system upon a portion of Grantors
land and to allow access to the shed located on the east property line.
Page 1 of 3
orsf-S
Brt)J55Jrb4 t
This Grant of Easement is intended to be appurtenant to Grantees above-described land
and touches, concerns and runs with said lands. This is not intended to be an exclusive
easement: the Grantors herein expressly reserves unto themselves equal rights of ingress
and egress and all other rights as the owners as tenants in the entirety of the described
premises.
Any dispute or disagreement arising under or in any way concerning this instrument shall
be submitted for resolution to the process of binding arbitration in accordance with the
Alaska statutes made and provided for said arbitration. The jurisdiction of the Arbitrator
shall commence 60 days from the onset of the dispute and shall operate to toll all
applicable Statutes of Limitation.
IN WITNESS WHEREOF the Grantors and Grantees have hereunto set their hands the
day and year above written
STATE OF ALASKA )
) ss.
THIRD JUDICIAL DISTRICT )
nn,tats P Akou%7
DANIEL P MAUS - GRANTOR „ `
DEENA K. MAUS-GRANTOR;: `°1!,•ft;•
eg,4 •c•nF.
THIS IS TO CERTIFY that on this Way of October, 1999 before me the
undersigned, a Notary Public in and for the State of Alaska, duly commissioned and
sworn, personally appeared DANIEL P. MAUS and DEENA K. MAUS to me known to
be the persons described in and who executed the above and foregoing instnunent, and
acknowledged to me that they signed and sealed the same freely and voluntarily for the
uses and purposes therein mentioned.
written
WITNESS my hand and official seal the day and year in this certificate first above
�•Th 473 .-Pau..zbn
Notary Public in and for Alaska
My commission expires O 1/a-1
Page 2 of 3
STATE OF ALASKA )
) ss. r;' ;c r' .
THIRD JUDICIAL DISTRICT )
THIS IS TO CERTIFY that on this 2Cday of October, 1999 before me the
undersigned, a Notary Public in and for the State of Alaska, duly commissioned and
sworn, personally appeared MONTY BUYSE and SUSANNE K. BUYSE to me known
to be the persons described in and who executed the above and foregoing instrument, and
acknowledged to me that they signed and sealed the same freely and voluntarily for the
uses and purposes therein mentioned.
Br° 5b lib4l
4c117;b31/49.RANTEE
%,f ,.....,,r•........,
SUSANNE K. BUYSE- GR ••,
01Aitlt .
,r PU IA.'
written
WITNESS my hand and official seal the day and year in this certificate first above
1/4\1ttI"(Orrjy'/��
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United States orAmerica)Iss0
n.nr
State orAlaska ) ss 'vvrrnrrttt%
CD >VA •I, ir AADT)
Notary Public in and for Alaska
My commission expires °I /3I % 74.5
066276 19990C22 AH 9:37
RECORDING DISTRICT ' C•GG REOUESTED BY0 CSS
THIS IS TO CERTIFY that the foregoing is a full true and correct
Copy of the document as it appears in the records and hies of my office
IN THE WITNESS WHEREOF. I have hereunto set my hand
and have aff e4 my official ,.31 at IiNCHORAGE. Alaska.
this - ol hof
Page 3 of 3
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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 # tVD\ ' —)CA
HAA # \—\ C-\ (5Y1 k
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block,subdi ision, section, township, range)
,.
Lot 17; Block 2; Lampert\Subdivision
Location (address or directions)
22426 Lampert, Chugiak, Alaska
(b) Property owner AHFC #39951 Telephone : (home) Business
Mailing Address WA #84245
(c) Lending Institution Northland Mortgage Telephone
Mailing Address Anchorage, Alaska ATTENTION: Sue
(d) Real Estate Company and Agent
Address
JACK WHITE COMPANY/Lori Crowder
10928 Eagle River Road, Eagle River, Alaska 99577
Telephone 694-5500
(e) Mail the HAA to the following address: (or check here DI, if hold for pick up.)
List contact person and day phone number below:
S & S ENGINEERING/694•-2979
17034 Eagle River Loop Road, Suite 204
Eagle River, Alaska 99577
2. TYPE OF RESIDENCE
Single -Family Ii
Number of bedrooms 3 ti
3. WATER SUPPLY
Individual Well ❑ Community Uk 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# Public 0 Community 0 Holding Tank 0
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev. 7/88)
Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and
inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
Name of Firm Telephone � Z 97 9
5 & 5 ENGINEERING
Address 17034 Fail:: River Loop Road No, 2')4
Eagle River, Alaska 99577
Date
6. DHHS APPROVAL
Approved for 3 bedrooms by G" L*�!/ Date 2/5 /f7
2(
Approved Disapproved
Conditional
Terms of Conditional Approval
Note: cure. ori rte/ /4s7' puacy zes7 utas are 0/ / 744/'SW7 rs
. caps/Jercd val'6/ �<ar reo6, CZ) yca/ w/ti tXae/az-e.
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88) Back
Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
i V F 1ECKL1ST - FEBRUARY 1984
343-4744
FEB 4191
Pvivaic!pality c. Anchorage,
A. WELL DATA Dept. Health & Human Services
Legal Description• '---o-r 11 v�Z
Well Classification A If A, B, C, D.E.C. ApprovedeN) ./
Well Log Present (Y/N) Date Completed Yield
Total Depth Cased to Depth of Grouting
Static Water Level Pump Set At
Casing Height Above Ground Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot 2-bc- - ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot Z x? ; On Adjoining Lots
To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot
Water Sample Collected by ; Date
Water Sample Test Results
Comments Fs/3S ID Z-\ 17 \-ac\--1
B. SEPTIC/HOLDING TANK DATA
7----20 117
Date Installed 1'??1,- Size 10.007 No. of Compartments
Standpipes (DM NI Air -tight Caps ON) \4 Foundation Cleanout ON)
Depression over Tank (Y& (( Date Last Pumped Z- 1—c\ 0
Pumping/Maintenance Contact on File (Y/N) 1� ; for I
Holding Tank High Water Alarm (Y/N) ) — Temporary Holding Tank Permit (Y/N) MI/A-
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water -Supply Well �'� To Building Foundation LoSA
To Property Line t t7,, } To Disposal Field
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course 100\
Comments Jr'1 PFi—t7 3•-( ��� (STPD t----
1.4 it �:.ti. rJ C.s�. f�tr •
72-026 (Rev. 7/88) Front
Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata lc-- rte -
Date Installed
Width of Field
-1-v2 7 0-V1 -
Type of System Design VC2-D0b$il-IP
Length of Field
Depth of Field
t21'
(0,5 '
Gravel Bed Thickness --
Square Feet of Absortion Area 10/-\--24 Statndpipes Presenter/N) NI
Depression over Field (YC )--, Date of Last Adequacy Test 'L-77 •-'1 0
Results of Last Adequacy Test S.a,T1 s-", ee-.t oma- --SF(is
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well 2--r::7 ,=:, ' 1,- To Property Line 1,ZI
To Building Foundation 2\ .S' To Existing or Abandoned System on
Lot °-‘)4,-- ; On Adjoining Lots 3,=, t-8—
To Water Main/Service Line to' ,- To Cutback (if present) '' )A -
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Pafking Area�, %r Vehicle Storage Area
Comments P ) V ��r�� - yG/ (=t4 F 1( ---et-)
D. LIFT STATION
Date Installed Dimensions
Size in Gallons Manhole/Access (Y/N)
"Pump On "Pump Off" Level at
High Water Alarm Level at Vent (Y/N)
Tested for Pumping Cycles during Adequacy Test.
Meets MOA Electric. -..es (Y/N)
Comm
`*Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and
inspection.
Signed
Company
S F, 5 I'M!iiiT:Hl EZ.NG
17034 izatlle 1 ivy, Leiop I:o,,r1 No, 2u
Fagle RiveY, Alaska 9957.;
Date 2-� 2 /
MOA No. C —
Receipt No. Receipt No
Date of Payment �✓ (fI Waiver Fee. $
Amount. $ D Date of Payment
HAA guidelines in effect or ,tlaedale of this
Lei
72-026 (Rev. 7/88) Back
Page 2 of 2
J �r �
C.7.3 rID
PIO
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE WESTERN DISTRICT OFFICE
3601 C STREET, SUITE 322
ANCHORAGE, ALASKA 99503
FOR: S & S Engineering
Attn: Ray
WALTER J. NICKEL, GOVERNOR
563-6775
January 25, 1991
PWSID: #210697 McKinley View Estates
My review of the records on file in this office reveals that the
McKinley View Estates Class A Public Water System is in
compliance with the provisions of 18 AAC 80.060, State of Alaska
Drinking Water Regulations.
Sincerely,
Timothy . Karnowski
Environmental Engineer
APPLIC JT FILLS
OUT UPPER HAL ONLY
4s /,) 4Zip Code
Phone
` > y ��� f�
Property Owner kIA `(I`l C- CS C,aCl 5 / /1/ )--'//( C(.
Mailing Address L//6 /. I.- //::::'/ k/' %,'. A>/•
Buyer 1,27i /_, 4- i(, -J- C r c t L,t/AA1 PcKAC-<D
Address) I (i0g 11-0 Ile ,----?- \/✓11/f' 7 /10c:..e ✓/, IX, Zip Code (�r:�
Lending Institution Tia .�(, } Ui}1,1 i{ ,(. .1 ✓rJ ,.
Address t ,.2 lJ� i/1 We J.) r.-1 r:=(diel
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Phone
'2
Phone
7 a.//.i
7(.3',f�
Realty Co. & Agent .1 ti vc'':> _} 1,1-)c` c-< l \'v cr,yn.,4, -k to"sy
('s —:!,p, 611/ <�_/t TG
Address � .L"ti W". <E'i A Lief,/,� J Ci
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Legal Description I._. - 1 7 � r% I Ctc
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Street Location (11__/} =Y2 ).2,v/ / C //%C /F'
Type Residence J
Single Family
❑ Multiple Family No. of Bedrooms -
Inspector
❑ Other
Water Su ply
❑ dividual
Community _
❑ Public Utility
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
For wells drill • ' prior to that date, give well depth (attach log if available).
/\' -
Sew;er Disposal
VJ Individual
❑ Public Utility
0 Holding Tank
Year Individual Installed: 7 f a., / F�"�•
When Connected to Public Utility: ./
,71/e'/ ._
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
Field Notes:
( \/APPROVED BEDROOMS --
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE)
'CONDITIONS OF APPROVAL
BY: i l.") 4.1 (.,--/
Soils Rating
D
Date Sewer Installed
7 - 2c) -- S 2_
Well To Absorption Area G IC
Well to Tank (j K__
Well Log Received /`' /-1-
Septic Tank Size / G7c9 ED
72.023(31821
February 7, 1970
ary Lou Lampert
General Delivery
Eagle River, Alaska 99577
Subject: Lampert Estates Subdivision
According to this department's water sampling monitor list,
we have not as yet received a water sample for the above s
tsUb j ect well -system. for the month of January, 1977.
Our records indicate that you are responsible for turning
these mandatory samples in for the subject water system.
If you have not done so as yet, please Obtain a water sampling
bottle from the State Lab, 527 Eat 4th Avenue, as soon as
possible and return the sample to the same address for ana1ysisv
1f you aro no longer in charge of the subject water system,
please notify us immediately to any name and/or address changes.
I1 there are any further questions, plouso contact this office
at 264-4720 or at the above address.
Thank you for your co-operation in this matter®
Sincerely,
Hank Alters
Code Enforcement Officer
A/1jh