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Q ` �� �¢ y 0 W > N 3 W o m O J 7 LL (n C O (n Q N ❑ z Y in J LL J -0 cn J F°- to LL � U N 89°58'10''E 282.20' S 0 ° 0 6 ' 2 8 ' ' E 2 1 3 . 4 3 ' CONC . RET . W A L L ASPHALT CONC . BA I N B R I D G E R O A D 13.0 3 4 . 1 24.0 6 . 0 18.7 8 . 0 9.8 1 0 . 1 10' ELEC. & TELE. EASEMENT 10 ' E L E C . & T E L E . E A S E M E N T PID:015-211-24 PERMIT:OSP241178 FIRST WATER CONSULTING LILAC PARK BLOCK 1, LOT 9 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 hftp://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241178 Work Type: SepticTank Upgrade Tax Code Number: 01521124000 Site Legal Address: LILAC PARK BLK 1 LT 9 G:2736 Site Mailing Address: 12000 LILAC DR, Anchorage Owner: KIM SUN HEUI Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Effective Date: Expiration Date: ill l 11 Y f, n f t}t'iY81'CITIc:'llt Lot Size in Sq Ft: Total Bedrooms: 7/19/2024 7/19/2025 60220 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ 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 Received By: S _S L Date: Issued By: Date: - I- 2 5 ON -SITE SEPTICMELL PERMIT APPLICATION Parcel I.D. 015-211-24 Property owner(s) KIM SUN HEUI Day phone _ Mailing address 9440 AUTUMN RIDGE CIRCLE ANCHORAGE, AK 99507 Site address 12000 LILAC DRIVE ANCHORAGE, AK, 99516 Legal description (Sub'd., Block & Lot) LILAC PARK BLOCK 1 LOT 9 Legal description (Township, Range & Section) Lot Size 60,220 Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (Z all that apply) Absorption Field ❑ Initial El Single Family (SF) El (w/wo ADU) Septic Tank Upgrade Gi Duplex (D) ❑ Holding Tank EJ 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 Codes. (Sidnatpre ' of property owner or authorized agent) Permit/Rush Fees: 022 Date of Payment: Receipt Number: Permit No. 0 —c--, P 2- Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and WastewaterTorms\Client FormsTermit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / FirstWaterAK@gmail.com ! !! June 28, 2024 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: LILAC PARK BLOCK 1, LOT 9 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1500-gallon HDPE tank per the attached design to serve the existing 5-bedroom residence. Groundwater was not noted in the MOA on-site file and is not anticipated to affect the septic tank installation. If groundwater is encountered during installation that may affect this septic tank upgrade, an epoxy coated steel septic tank or other action may be required. The lot and area are served by private water and any encroaching wells, easements, … must be staked prior to construction. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241178, Curtis Townsend, 07/19/24 N 89°58'10''E 282.20' S 0 ° 0 6 ' 2 8 ' ' E 2 1 3 . 4 3 ' CONC . RET . W A L L ASPHALT CONC . BA I N B R I D G E R O A D 19.8 4 . 1 1 2.0 7 . 1 12 .6 4 . 9 15.0 8 . 0 13 .0 3 4 . 1 24.06 . 0 18.7 8 . 0 9.8 1 0 . 1 38.0 1 6 . 0 10' ELEC. & TELE. EASEMENT 10 ' E L E C . & T E L E . E A S E M E N T FIRST WATER CONSULTING LILAC PARK BLOCK 1, LOT 9 DESIGN DETAILS: NO WELLS WITHIN 100' OF PROPOSED SEPTIC TANK Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241178, Curtis Townsend, 07/19/24 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ."'-~¢4~" Y,~ ' " (_.2 ,¢?,~',~ PID Number: ~ame: ~t~.~ ~ ~ . /'~///~ ~//Z Wastewater System: ~w ~ Upgrade Address: ~~"~' "" "~'"/" ABSORPTION FIELD Phone~ ~ ~ O ~ '/~. of B~droom~__ ~eep 'french D Shallow Trench D Bed ~ Mound Q Other Soil Rating: Tolal Depth from original grade: LEGAL DESCRIPTION ~.~.~ ~,~s~.,~. /~..~ Subdivisio~ Depth ~o pipe botlom from original grade: Gravel depth beneath pipe Townshi~ ~ IRange: ~ Section: ~¢ Fill added above origlnal grade: Gravel,ength~ Gravel depth: Number of lines: I 0istance between IJnes~j WELL: ~ew O Upgrade /~ Fi, ~ Classification (Private, A,B,O): Total Oepth: Oased To: Total absorpUon area: Pipe material: ~/~¢~ ~ o ? ,,. 2. o~2 ~,. ./7¢o s~.~,. ~ F~/ Driller; Dat~ Drille~:. ,Staticwaler Level:Installer: Yield: I Pomp Set at: Casing Height Above Ground: ~ GPMI ~¢O Ft. '~ Ft. TANK SEPARATION DISTANCES ~pt~o u Ho~ing U S.T.~.~. To Septic Absorption Lift Holding )ubllc/Private Manufacturer: Capacity In gallons: From Tank Field Station Tank Sewer Lines 'M Surface ~ Water -- ~ -- ~ ~ LIFT STATION Lot / / Size in gallons: M~nufacturer: Line ~ ~7 ~ ~ Foundation. ~ F/ ~_~ / ~ -- / "Pump on" level at: "Pump off" level at: J High water alarm at: CurtainDrain ~ ..... ~ ~ ~ Pump Make & Model Electrical Inspections performed by: Remarks: BENCH MARl( Assumed Elevation: /oD, o o f~. ENGINEER'S SEAL OF A ..... Inspections performed by: ~ ~5~ Dates: 1st ?//¢/¢~ '.' ~¢ a~ .... ............... Department of Health and Human Services approval ~,. s~,~o~ ~,.~ , ~ .......... Reviewed and approved by: ~Jot-AW ~r~ Date: ~(~h~_ ~:,e~%~;~.tO~.. .... 72-013 (1/91) MOA 25 Permit No. SW930038 2 2 Page of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchoroge, Alosko 99519-6650 · Telephone 543-4744 On-Site W(]stewater Disposal System (]nd/or Well Inspection Report LOT 9, BLOCK 1, LILAC PARK SUBDIVISION Legol Description: 01521124 PID No.: -- 100,2 -- 81.0 TYPICAL TRENCH CROSS SEC]ION NOTES: LINES E-G. AND H-J ARE PERFORATED PIPE AND HAVE 10' OF GRAVEL BENEATH THEM. THERE IS A CLEAR DISTANCE OF 20,2' BETWEEN THESE TRENCHES. LINE R-I IS PERFORATED AND HAS 3' OF GRAVEL BENEATH IT. (NOT CREDITED AS PART OF SOIL ABSORPTION SYSTEM.) THERE IS A MINIMUM OF 4' OF COVER OVER ALL PARTS OF SEPtiC SYSTEM. TABLE OF REFERENCE DISTANCES SCAthe, POINT DISTANCE INV. REMARKS D 60.7 92.7 --- SEPTIC TANK CLEANOUT E 58.6 85,9 97,6 TRENCH CLEANOUT F 64.3 91,g --- MONITORING TUBE H 67.1 42.8 97.7 TRENCH CLEANOUT I 88,1 108,6 97.6 TRENCH CLEANOUT J 110.3 133.8 97,7 ~ENCH CLEANOUT K 59.3 91.3 98.2 CLEANOUT TO HOUSE L 71.8 104.0 97.7 CLEANOUT TO mENCH M 72.6 104.6 98.1 CLEANOUT TO SEP~C TANK P 106,6 129,5 --- MONITORIB¢ lUBE FF 110,72 NE CORNER GARAGE (FIN FLR) From ~ ALF'INE DRILL 907 345 0202 Jul. 29.1993 1i;56 PH STATE OF ALASKA DEPARTMF.~T OF NATURAL RESOURCES DIVISION OF WATER LOCATION OF WELL WATER W£LL RECORD '..' ~=~; =-'-'.;- · ,.,.,,. .... - ,, ~ ~W LOCATIpN/SK~CH= WELL OWNER~ DEPTHS MEASURED FROM;[~]casing top [~]ground surface Depth From To ,BOREHOLE DATA; Material Type end Color WELL DEPTH: _ Depth of caslng:.~.~.~ -fi DATE OF COMPLETION ft DEPTH TO STATIC WATER LEVEL: ~ ft below~top of cesing ground surface D AUG 2 199; Municipality of Anchorage Dept. Health & Human Services METHOD OF DRILLING: ,~. eir rotary ~ cable tool [] othur USE OF WELL;~'domest~C [] irrigation [] monitor [] publi~ supply [] other. Casing type: ..... in, to ..... ft WELL INTAKE OPENING TYPE;/~'open end [] screened ~ perforetod [~ open hole Depths of openings: to _ ft SCREEN TYPE: Diem; in, Slot/Mesh Size: Length:. It GRAVEL PACK TYPE: Volume used: ......... Depth tO top: GROUT TYPE= ...._.j..~.~___~__ Volume: Depth; from ',.' ft to DEVELOPMENT METHO! .... ~ Duretien PUMPING LEVEL AND YIELD: ft~lafter I1rs pumpin[ PUMP INTAKE DEPTH~:~ ft Horsepower: WELL DISINFECTED UPON.COMPLETION? YES REMARKS: ft PLEASE MAIL WHITE COPY OF LOG TO: DNR/DIVISION OF WATER PO I~OX 772116 EAGLE RIVER AK 99577-2116 CONTRACTOR INFORMATION; ea~,~red Business Neme ,[3 NO PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930038 DATE ISSUED: 3/25/93 DESIGN ENGINEER:BRUST AND ASSOCIATES ,~ ~,~..,,~/" EXPIRATION DATE: 3/25/94 OWNER NAME:LAZAR HOWARD A & OWNER ADDRESS:12000 LILAC DR ANCHORAGE, ALASKA 99516 PARCEL ID:01521124 LEGAL DESCRIPTION: LILAC PARK BLK 1 LT 9 LOT SIZE: 60220 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: DATE: ~ ~/~?~ BRUST & ASSOCIATES Engineers - Planners - Surveyors 1610 Dimond Drive Anchorage, Alaska 99507 (907) 562-7878 March 17, 1993 Municipality of Anchorage Department of Health and Human Services On-site Services 825 "L" Street Anchorage, Alaska REOEIVED MAR 1 9199,'5 Municipality o,f Anchorta09 Dept. Health & Hhman Services RE: Lot 9, Block 1, Lilac Park Subd. This letter and attachments are to accompany a permit application for an on- site waste disposal system at Lot 9, Block 1, Lilac Park Subdivision. The following are attached. 2. 3. 4. 5. Drawings of proposed on-site system. Soils logs and percolation test results. Design calculations. Soil grain size analysis. Sheet showing contours on the site. This subdivision is served by individual wells which appear to be adequate. The well on the adjacent lot 10, Block 2 has been used for irrigation regularly. Development of the adjacent properties will not be adversely impacted by construction of the proposed system as distances to adjacent features are in compliance with applicable requirements. The lots in this subdivision average 1 1/2 acres. The distance to the vacant lot to the east is 90'. The closest feature that could be affected is the proposed well, which will be placed at the west side of the lot with adequate separation distance. Slopes on this lot are rolling, and average about 7%. Drainage is to the northwest. There is a large stockpile of fill on the lot, which will be used for landscaping. The area selected for the original on-site system is at the northeast corner of the lot. Three test holes were excavated, and four perc tests were done. No water was encountered in any of the holes. The predominant soil encountered in all holes was a sandy silt, which perced at between 30 and 60 minutes per inch. Test hole 2 had an upper layer of silty sand which perced at 9 minutes per inch. However, as this layer appeared to be discontinuous it was felt prudent to design for 'the slower perc rate. Both the original and replacement systems will fit within the 30' radii of the respective test holes. It is recommended that a permit for the on-site system be issued. Sincerely, RECEIV~U pality ct Anch_ora_g~e__ ./"- ''"~- . ~....,~. ........ ~, ..... ,,_ ....... . ~ /' ~ / / /' ~ ~ ,'~'~ .... ~ '"""'~ / ~--7-~ ~ 100' R ~ STANLEY BRUST ]~ // , /Z ?~ '[---~ ~ xx ' ' i' r-- ~J k~ , ,, VACANT , ' t~ ¢' ', ', , ~ ~.. 1% ', ,'I , =o ', ',k ,~. ~ I , ', ~ ~'~. ~ -X-' ..-' ................ ~% ~ ' , * GENERAL PLAN ~ xxx 1"=100' ~  ' 0 DENOTES CLEANOUTS [LI BARRIER 1500 GALLON ~ SEPTIC TANK PLAN f~e~C~L TRENCH CROSS SECT]ON SCALE: 1'=40' N,T,S, ON-SITE SYSTEM DETAILS ~*~"~' ~ BRUST ~ ASSOCIATES CH.CKSO ~ s. ON-SITE SYS~M LAYOUT DA~; 3/10/95 ENGINEERS-PLANNERS-SURVEYORS SOALE; AS NOrD 1610 DIMOND DRIVE (907)562-7~78 LOT 9 BLOCK 1 SliT. ANCHORAGE, ALASKA 99507 ULAC PARK SUBDIVISION DF NUMBER; 95-~ Munlc Dept. H~ P,I CI IVE D /~ /~,~,~ ~!~"~al~v, Dept. Health & Human Service~LOG -- PERCOLATION TES~O~'.~ .... / ~ -/ ~e~..t~.~ LEGAL DESCRIPTION:, 1 2 ,3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O //'~.¢/2~./¢-ownship, Range, Section: T/ z lk/~/ ~ ~ tK,/ ..~"~' ~., . ~ '~ SITE PLAN /' SLOPE WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E l-- Oaplh to Waler Aller ! $>//¢ Moniloring? ~J,~"~' Dale: , , -~ Reading Date Gross Net Depth to Net Time Time Water Drop (s) /o,' ~ ~ , PERCOLATION RATE -'~'"""'; ~ (minutes/inch)PI--RC HOLE DIAMETER COMMENTS PERFORMED BY: "~", ,/~,,*'"~¢¢<.;-7""' I ~', ,~.~"~,'~5' 7'"' CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: '.~h'~//¢"~', 72-008 (Rev. 4/85) RECEIVED u~ e,~~~ ~9 1995 Ivi~ :)t Armr~?r~ge Oept, H 4uman Services 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20- x,~-~'~~, ........ k4tS~ ~NGINEER'S SEAL) ~:,"' /~F"..~% Municipalily ol Anchorage DEPARTMENT OF HEALTH & HUMAN SE~¢(~ ........ ~ ~'~ 825 "L" Street, Anchorage, Alaska 99502-~., ...... ~.~ ~ .... :~ SmLS LOC -- PER LAT ON /7~p. /~...Township, Range, Section: SLOPE L IF YES, AT WHAT O DEPTH? p E SITE PLAN ,) Depth to Water Alter .... ~///~, Monitoring? t~/O~q¢ Dale: / .'~ , Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE 7 (minules/inch) PERC HOLE DIAMETER TEST RUN BETWEF~'~' .~:~'"' FT AND ~ ~' FT COMMENTS ,~¢- ..~ O ~.~¢~¢' -'~..- J ~ ¢,¢"¢.,¢""1,~ / ,~ l(~- / - PERFORMED BY: ~' ~~ ' -~' ~"~f~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINESlN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) ~,C~ \~. ,~,/"',.~;" ' ' /~l ' ' ?/F(~91NEER'S SEAL) f ~, ~ I V ~ U Municipality of Anchorage ;~...Z .... ~J DEPARTMENT OF HEALTH &HUMANSER~ES _.~~*~ ..... SO~LS LO~ -- ~.COLAT~ON TES~.O;'-~'-. Munici alit of Anchorage ~-~ /~,,~f,- P Y ~ ~ --- .... .-~ .... ~,~;, ~T ,'. Dept Health & Huma~rvice~ ' ~ -- ~ q~/OA~',{~-- LEGAL DESCRIPTION:Z ~1/~= ~ Township, Range,Section: SLOPE SlTFPLAN 1 3 6 7 8 g - ENCOUNTERED? 11 s L IF YES, AT WHAT O 12 DEPTH? p E 13 Depth lo Waler Aller~ Monitoring7 Reading Date Gross Net Depth to Net Time Time Water Drop C~2 ~/¢/~_ 7'.'/~- /,/~ _ ./o ."~/ -7 ~ 14 15 16 17, 18 19 TEST RUN BETWEEN ? FT AND /'O FT PERFORMED BY: .~','/~'/"'/~"~7'" I ' "~ ' 'f~"*"CdK'~/2 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WiTH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: __"~//~/y .~ 72-008 (Rev, 4~85) E IV E D M..,c,,a,,,y o, ^.c,or.ge DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 1 9 1995 SOILS LOG -- PERCOLATION TEST Munic~patiiy ct Arlch~rage ~'/~--~ Dept. Health & HL,~an Services 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20¸ SLOPE //:r~/,~-//¢/dTownship, Range, Section: ~'/~_./~,/'~.~t/'/ SITE~ P LAN WAS GROUND WATER ~/. /~¢ ENCOUNTERED? S L IF YES, ATWHAT O DEPTH? ,P E Depth to Water Aller,,,~ .,, . ,~>j ~oni(oring? ~/7~ ~ Dale: Reading Date Gross Net Depth to Net Time Time Water Drop .¢.. =z z~, .¢"/~ COMMENTS PERCOLATION RATE ___ (minutes/inch) PERC HOLE DIAMETER __ TES'i RUNBE~'WEEN ~ FTAND ? F'T PERFORMED BY: ~" ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) JOB NO. BY ~ ; · ~: , : ' ,. . .... ~_ . , ~ .... ~. .; I , ~ , · I ' ' ' ' I ' ' " .............................. ~ ........ 1 .... ~ I ,. .... ~ . ~. . ~ . ..... I , I , ,'. ~. ' . Ag ,Lq/~ . _ ~ BRgSti& ASSOO ATE8 ..... ALASKA T E !~ T L A B A nivision of [~OWL~ Incorporated Brust & Associates 1610 Dimond Drive Anchorage, Alaska 99507 RECEIVED MAR 1 9 1993 Municipality ot Anchorag, e Dept. Health & Human Serwces W.O. A25488 March 9, 1993 Attention: Mr. Stan Brust Subject: Particle-Size Analysis Lilac Subdivision Project Dear Mr. Brust: The particle-size distribution of your soil was measured in the laboratory. The published methods for this test are: · ASTM C 117, "Material Finer Than 75-gm (No. 200) Sieve in Mineral Aggregates by Washing;" · ASTM C 136, "Sieve Analysis of Fine and Coarse Aggregates;" · ASTM D 422, "Particle Size-Analysis of Soils;" AASHTO T- 11, "Material Finer Than 75-gm Sieve in Mineral Aggregates;" AASHTO T-27, "Sieve Analysis of Fine and Coarse Aggregates;" · AASHTO T-30, "Mechanical Analysis of Extracted Aggregate;" · AASHTO T ~88, "Particle Size Analysis of Soils;" and · AK DOT/PF ATM T-7, "Sieve Analysis of Fine and Coarse Aggregates." Alaska Testlab's standard procedure is in conformance with these standards, with the following descriptions: · The coarse fi'action of non-extracted soils is not washed unless the coarse particles appear to be significantly coated with fines; · The fine fraction of the soil is always washed; · The plus 3-inch fraction is not routinely included in the test due to the large sample mass required for a representative sample; The estimated percentage of plus'3 inch material in the sample is shown on the test report; and · The mass of the coarse and fine test fi'actions are reported. The soil is classified in accordance with ASTM D 2487, "Classification of Soils for Engineering Purposes." The frost classification is identified in accordance with Corps of Engineers and Municipality of Anchorage (MOA) procedures. The test results are attached. If you have tiny qnestions regarding the test procedures or the results, please call. Sincerely, ALASKA TESTLAB Technical Director attachments ~ test results 4040 [] STREET * ANCHORAGE · ALASKA · 99503-6999 · RECEIVED MAR 1 9 199~ Munic~p~dity of Anchorage Dept, Health & Human Services ~; d d d d d d d d ~ / / ~0 / -:,:.: / / l .J ca O Q Q U) a) cn a� 0 4- 0 a) co U A N M5 0 0 C) V N i r N i r C) 0 a� U f� d CO LO Q 1� J 0 Y v m Q 0 Q U Q J_ Q J J_ O J OO c N 0 Q � U O O 70 .0 0) c� J () D LU Z 7� IV ?1: Al LO 0 A •L N ca L O N C w E O A N O N 00 N 00 ill co 0 (D N LPU (D U Rf C 0) q-. U O O O /1 Q. z L a� -0 a 3 (D :3 C E ~ ~ U L O p v C N N 'p N d Oy N> c fC Q Q > o r C Q ' N0 Cl) N 3�Q O � U Q N =O LL o = O U)O 0 3 a) CL .N z Q �� c C.-0 o O m •CL O i L CL C N N 0 i O E m x a) � 0 4- cn�, = B o in N E a. 0 o M Q 0 O 4— fl. 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Q O ❑ C O fn fn (n > � � W ❑ N v F- N Y °) z o "r � a ° °3' 0 0 W LL LL F a �° H O O v LU a w rn W W H z O a) m n. a a a) Cl) O F- H N Q Q >_ C Co co X >� N M u'i cC W O m .r Mul 0) O LL a) > m i I COSA Checklist.docx COSA Checklist Legal Description: LILAC PARK BLOCK 1, LOT 9 Parcel ID: 015-211-24 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 7/23/1993 Total depth 207 ft Cased to 207 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 6/20/2024 Static water level at beginning of test 122 ft. Well production at time of test 4+ gpm Water storage tank volume NONE gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 3.02 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 6/20/2024 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank NA Date of pumping NA – NEW TANK Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 7/16/1993 ALL standpipes present per record drawing Total measured depth from existing grade 10.8 ft (max) Measured depth to pipe invert from grade 3.1 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) If not, state depth into effective 5.7’ & 7.1’ (W / E) Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced 2000 gallons 6/19/24 date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 6/20/2024 Results Pass (West / East Trenches) Fluid depth prior to test 18 / 35 in Water added 900 gal New fluid depth 23 / 44 in Elapsed time 1440 min Final fluid depth 18 / 35 in (ED Missing 52” / 35”) Absorption rate 750 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 120 in (MOA 10’ ED) Effective depth used 70 / 70 in (Final Fluid Depth & Missing ED* - see below) Effective depth (ED) remaining 50 / 50 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots & appears approximate with 4.3’ or 52” ED missing in the west trench & 2.9’ or 35” ED missing in the east trench*. Per above, all standpipes are present – the middle intermediate one is below grade and noted on the septic tank inspection report. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 8/15/2024 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 8/15/24 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: Garness Engineering Group, Ltd (GEG) Phone 907-337-6179 Address: 3701 East Tudor Road Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: 3v Z in conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system.. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, OF __er�Jl Jer�frrey A. Gorness.: VCE 79 3 rofes5o �P01�3, #AECC884 `�oOF Ajvc r���i z ON'S1 k1D with th�fRlow� - QEF a Z — J�ii:pMFh/T SFR` w� Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Other es--� —} a 1p c�N S; �►'� Legal Description: LILAC PARK; BLOCK 1, LOT 9 If more than 1 septic system on lot: COSA Checklist # of Parcel ID: 015-211-24 Structure served by this system A. WELL DATA MR Well log is filed with Onsite (or attached) Well production at time of test 4.5+ gpm Date drilled 7/23/93 Water storage tank volume N/A gallons Total depth 207 ft Well disinfected for coliform test? ❑ Yes ❑Q No Cased to 207 ft W Coliform bacteria is Negative Fil Sanitary seal is functioning correctly Nitrate 2.61 mg/L ❑ Nitrate less than MRL (ND) © Wires are properly protected Arsenic ug/L FIM� Arsenic less than MRL (ND) Casing height (above ground) 12+ in. Collected by GEG, LTD. Date of flow test for COSA 3/10/21 Date of Sample 3/9/21, , Static water level at beginning of test 129.4 ft. Comments HOSE AND WELL HEAD APPARATUS CONNECTED TO WELL FOR LAWN IRRIGATION SYSTEM (SEE ATTACHED PHOTO) B. TANK DATA Age of tank(s) 28 years Tank type/material SEP:IC TEE Measured operating fluid level in septic tank 50" ® Standpipes/foundation cleanout per record drawing Date of pumping 3/24/21 el D. ABSORPTION FIELD DATA C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: N/A Which system tested (date installed) 7/16/93 Adequacy test date 3/10/21 Al ALL standpipes present per record drawing Results ❑✓ Pass For 5 bedrooms Total measured depth from grade 10.91 ft (max) Fluid depth prior to test 7 in Measured depth to pipe invert from grade *3.08 ft (min) Water added 981 gal ❑ NIA — pressurized field 32 New depth in ❑ Monitor tubes go to bottom of effective. If not, state 130 d depth into effective Elapsed time min ❑ Code -required soil cover over field Final fluid depth 17 in ❑ System presoaked Absorption rate 750+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) Gallons introduced N/A gallons If yes, enter date N/A Comments/Deficiencies. TESTED WEST TRENCH ONLY -EAST TRENCH DRY'SEE ATTACHED EMAiL REGARDING NO FREEZING 'YYEST MT EXTENDS 67S BELOW INVERT -EAST LIT EXTENDS G 25' BELOW INVERT COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Q Yes Community Sewer Manhole/Cleanout > 100' Q Yes if No ft M Yes if No Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' []✓ Yes if No Absorption Field on Lot > 100' F, -/J Yes if No ft Holding Tank > 100' ✓Z Yes if No Neighboring Absorption Fields > 100' Yes if No ft Water Main > 10' Animal Containment > 50' ❑✓ Yes if No Q Yes if No ft Yes if No ft Water Service Line > 10' F,71 Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' 0 Yes if No ft M Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) ft ft ft ft ft Building Foundations > 10' Q Yes if No ft Surface Water > 100' [Z] Yes if No ft Property Line > 5'✓L7 Yes Yes if No ft Wells on Adjacent Lots: Q Absorption Field > 5' M Yes if No ft Private Wells > 100'✓[] Yes if No ft Water Main > 10' ❑✓ Yes if No ft Community Wells > 200'✓Q Yes if No ft Water Service Line > 10' F,71 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' [✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' M Yes if No ft Community Wells > 200' Q✓ Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS FOUNDATION CLEANOUT INSIDE CRAWL SPACE (SEE ATTACHED PHOTO). SOUTH MT IN EAST TRENCH IS NON- FUNCTIONAL, (FILLED WITH DIRT/DEBRIS). _�060o O4 G. ENGINEER'S CERTIFICATION o I certify that l Dave detennined through field inspections and review'J�. of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 0. fr 1 x. . ...... QO .Jef Gorne s.• CE7S 3 c G p3j• 11 0 COSA Checklist yellow sheet �Q r f ess1o�oo #AECC884 �N������� Septic 'Tank Advisory Certificate of On -Site Systems Approval #OSC 211145 Subdivision: Lilac Park Block 1 Lot 9 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 28 years old. Typical replacement costs range from $8,000 to $11,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 -year-old steel tank MAY look like. Madmg Address P' O Box 196650* Anchorage, Alaska 99519 6650 * www murn org Erik Widger From: Kurt Mentzer <snmk@icloud.com> Sent: Tuesday, March 23, 2021 3:03 PM To: Erik Widger Cc: Lew Ulmer; Sonja Blewett Subject: 12000 Lilac COSA Erik, During the entire time that I have owned and lived at 12000 Lilac Drive, I have never had any issues with the septic system. The system has functioned without incident, and I have lived at the home throughout the year with no periods of vacancy. Please do not hesitate to contact me for any issues or concerns. Kurt Mentzer 12000 Lilac Drive Anchorage, AK 99516 Sent from my iPad x x 1 3(D Z to \ CD C) \ \ cn ! (D Ln .� N m ? " Q v tom 3 = Z ro v w Q ��i® mNGI m \ g14-15 4 Ln D /�/ 92O a _ v m' 1 o r sG. .��v m gmC ammo ro \ / y / 0-0 r- t71 N t0 N n (D <D Ol T 3 w _ fLt O O (D (,D 0 M = "` n d. N tS (D O fD K <: 1 C a (D C c = M rf 0 -t. OY) '.G e_+. 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C C co I N K �m Um� N m -.. a I �� .O n m o r 0 ch Oco �Iln Li 3 a� y O 00 I cv o a 0 CL (Do m -1 O I m C �aX' 3CD CD O � Z3 CD . d (D w loo w C- O �o S00° 06'28"E 213.43 1 O - CCL I d I tD � ( r+ CL � I o I I W 1A � I ( I I I O h 5 � co � r W N r 00 � n I m (D m N N z' r (0 Cl) to N Iw ( W N o I I � ( I o I I � I ( I I I O h 5 � co � W W 00 m N N W 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. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. GENERAL INFORMATION Complete legal description LOcation (site address) Expiration Date: / - ~ - / / Current Property owner(s). ~., o v-c~ ('~'/ / Day phone Lending agency Mailing address Day phone · Real EState Agent ............................ Day phone Ma!ling~AddreSs . . Unless,Otherwise requested;. COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: TYPE 0F WATER SUPPLY: Individual W611 ' Individual Water Storage Community Class ~ Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank Community On-site Public Sewer I The Municipality of Anchorage Development Services Depadment (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4. by an' independent p[ofessional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single:family on-site wastewater diSposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my. investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. NameofFirm /~'l~'~,~'{A~.,~c[~-~,,.-r ~,E, Address ~,~, / ~[,),-,,,, ,,~, Engineer's Printed Name tc~,.k~ e[iL(/~L-cf~w,) bedrooms. DSD SIC~NATURE ~ Approved for ~ Disapproved. Conditional approval for Phone '~'-f 5'- 'Y"~ ~ ~ Date ;'*: 49Y.~.~" :*4 ~' MICHAEL N. ANDERSON ~.~ %" CE 94 9 .'~ bedrooms, with the follo~ng stipulations: By: Attachments: COSA Checklist Septic System Advisory Well .Flow Advisory Nitrate Advisory X (Rev. 11/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other ~ Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite '(907) 343'7904 Legal Description: CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST z,/,O P~l.r.. ~:,f[e_...t [..OB (~ ParcellD:C)/~'-7,,// I A. WELL DATA Date completed 7..~' Total depth ~.07- ft. IfA, B, or C provide PWSID # . Sanitary seal (Y/N) Cased to 7--~ ft. FROM WELL LOG Date of test ~/Z ~/~ ~ . · Static water level i 2. ~' Well Log (Y/N) ~ Wires properly protected (Y/N) ~" Casing height (above ground) ~ in. Well production ' ?-. $ g.p.m. AT INSPECTION Bm WATER SAMPLE RESULTS: Coliform _..(~__~ colonies/100mL Nitrate ~?_~mg/L Arsenic: .~_ ag/l_ date of sample: ?~[/ SEPTIC/HOLDING TANK ,DATA Tank Type/Material" ,~ ~¢~' (. Tanksize /~ol) gal; .. blumber of Compartments -t-.- Foundation cleanout (Y/N) ~' Depression over tank (Y/N) Date of pumping Pumper /~ wu, ~ ~, ~'1~' ABSORPTION FIELD DATA Date installed.' '7/q '~ Soil rating (g.p,dJft2 or ft2/bdrm) I Length ~ :~'. , ft. Width ~, 0 ft. Total depth I ~ ft. Eft. absorption area ~ ,~,q~ft2 Monitoring tube . Collected by: /'~/~./J~ ' Date installed 7z/P Cleanouts (Y/N) Y High water alarm (Y/N) System type Gravel bel.ow pipe e'~9 , ft. ¥ Depression over field Date of adequacy test ~/"5/)'//// Results(Pass/Fail) '0o~, For .~'bec~r(~/~ · Fluid depth in absorpfi~ field ~%re t~t [ in. ~ Water added ~ gal. New dep~ / in. / ~ Elapsed Time: min. Fin~ fluid depth /in. Ab~ti~ rate >= /~¢~ ~ g.p.d. Any r~uvenation trea~ent (past 12 mo.) (WN & type) ~ If yes, give date ~ D. LIFT STATION Date installed Size in gallons "Pump on" level at~ in. ~ in. Datum. ~ Cycles tested E. SEPARATION DISTANCES High water alarm level at Meets alarm & circuit requirements? in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot ! Absorption field on lot / c~ Public sewer main J' j) 0 Sewer/septic service line Animal containment areas On adjacent lots / OE) ~ On adjacent lots .,, / p ~ ' -/ Public sewer manhole/cleanout Holding tank /%,//.~, Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 'Z.O ~ 1/- Property line '~ O ~- Absorption field Water main ~ ~///Jo-, Water service line /~ ~) t -F Surface water Wells on adjacent lots ! ~P0 ¢ 4- /Pc2 / OO '~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /0 Water Service line ( ~O ' -{-- Curtain drain, Building foundation ~ 0 t'-(-- Surface water ! ~) ~ f .~ Wells on adjacent lots /~ ~ ~L Water main [r-Z'/~., Driveway, parking/vehicle storage ,F, COMMENTS' z. at-(- G. E'NGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Date ~ "~ ~1[- ~ 0 / ~ O l ( COSA Fee $ zl/¢0 o . men, Receipt Number ~ ~ ~:> 05 ~ (Rev. 4/10) Waiver Fee $ Date of Payment Receipt Number ................ S,GS SGS Ref.# 1114509001 Client Name Anderson, Michael Printed Date/Time 09/23/2011 I 1 :l 5 Project Name/# Lilac $/D Lorry Call Collected Date/Time 09/16/2011 I 1:30 Client Sample ID Lilac S/D Lorry Call Received Date/Time 09/16/2011 12:50 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks: 4500NO3-F - Total Nitrate/Nitrite - MS recovery is outside of QC criteria. Refer to LCS for accuracy requirements. Allowable Prep Analysis Parameter ResuIts LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 09/19/11 09/20/11 NRB Waters Department Total Nitrate/Nitrite-N 0.118 0.100 mg/L SM20 4500NO3-F B (<10) 09/16/I 1 AYC Microbiology Laboratory E. Coli Negative 1 100mL SM20 9223B A 09/16/11 CR Total Coliform Negative 1 100mL SM20 9223B A 09/16/11 CR 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.muni.org/onsite (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL . FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-211-24 Expiration Date: e GENERAL INFORMATION Complete legal description Lilac Park, Lot 9, Block 1 Location (site address or directions) 12000 Lilac Drive, Anchorage, AK 99516 Current Property owner(s) G. Michael & Rebecca Poling 12000 Lilac Drive, Anchorage, AK 99516 Residential Mortgage / Jeff Stanford Mailing address Lending agency Mailing address Real Estate Agent .Mailing Address Day phone 250-0327 Day phone 222-8800 1400 W. Benson Blvd., Ste. 200, Anchorage, AK 99503 Gordon Sloane / Coldwell Banker Fortune Day phone 265-9113 2525 C Street, Suite 100, Anchorage, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: 5 TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Public Water System Well [] [] [] [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding ta?k [] Community On-site I'-I 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 sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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 Watkins Engineering, Inc. Address P.O. Box 110443 Engineer's Printed Name Cindy W. Ellis DSD SIGNATURE V"' Approved for jL-' Disapproved. Conditional approval for bedrooms. Phone 349-1851 Date May 22, 2003 bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements. Supplemental Engineer's Report Other Original Certificate Date: ~,- /"Cz - 0 ~ (Rev. 01/02) Municipality of Anchorage Development Services Department Building Safety Olvlsion On-Site Water & Wastawatar Program 4700 South Bmgaw St. P.O. Box 196650 Anchorage, AK 99519-6650 wwv/.muni.org/onslte (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Ulac Pa~ Lot g, Block I A. WELL DATA Well type Prf , Date completed 7.93 Total depth 207 fL If A, B, or C pmvtde PWSID # NA Sanitary seal (Y/N) Yes Cased to 207 fl. FROM WELL LOG 7-27-93 Date of test Static water level 125 - 203 Well production 25 WATER SAMPLE RESULTS: Coliform 0 : : colonies/100 mi. Arsenic: NA_~ mgJI. B. SEPTIC/HOLDING TANK DATA g.p.m. Nitrate 1.33 mgJI. Date of sample: Parcel ID:.015-211-24 Weft Log (Y/N) Yes Wires pmpedy protected (Y/N) Yes Casing height (above ground) 24 AT INSPECTION 4-30-2003 127 - 129 fL 3.8 g.p,m. Other bacteria 0 colonies/100 mi. Collected by: Cindy Ellis Tank Type/Material steel. ,, Date installed 7-14-93 · Tank size 1.500, gal. Number of Compartments 2 Cleanouts (Y/N) yes Foundati0rt~leanout (Y/N) y,,,, Depression over tank (Y/N) no High water alarm (Y/N) NA Date of pumping 4.30-03, . . ..,:. Pumper Northland ABSORPTION FIELD DATA Date installed 7-'I 6-93.. Soil rating (g.p.d./fi or fi/bdrm) 0.45 System type.deep trench Length 87 ft. Width 3.0 ft. Gravel below pipe 10.0 fl. Total depth 13 It. Eft. absorption area 1740 fi= Monitoring tube yes* Depression over field no Date of adequacy test 4-30-03 Results (Pass/Fail) PASS For 5 bedrooms Ruld depth In absorption field before test o in. Water added 13so gal. New depth 18.5 in. Elapsed Time: 252 mln. Final fluid depth 12.5 in. Absorption rate >= 1000 g.p.d. Any rejuvenation treatment (past 12 mo,) (Y/N & type) None known If yes, give date D. LIFT STATION Date in _6t-~.~ NA Size in gallons 'Pump on" level at in. 'Pum..p..~; Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lilt station on lot >100 Absorption field on lot >100 ~!~--_~.~water alarm level at Meets alarm & circuit in. On adjacent lots >100 On adjacent lots >10o Public sewer main >100 Public sewer manhole/cleanout >100 Sewer/septic service line >100 Holding tank NA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >50 Water main >100 Wells on adjacent lots >100 Property line 15 Water Service line >100 Curtain drain None known F. COMMENTS Property line 35 Water service line >100 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 50 Surface water >100 Wells on adjacent lots >100 Absorption field 15 Surface water >100 Water main >100 Driveway, paddng/vehicle storage 30 I certify that I have determined through field inspections and ~.~.e.- Z~.{~[H '~ '...7..~.~ review of Municipal records that the above systems are in ~.:~.~_.~,'....,~..~,..~.¢~.~ Engineer's Printed Name Cirld¥ W. Ellis HAA Fee $ Receipt Number (Rev. 12/ol) Waiver Fee $ Date of Payment Receipt Number BAINBRIDGE ROAD \ \ \ o~ ,85. = ~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH &HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Day phone Day phone Agent ' ~.--:%~ Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: Public water ~ ,~ ~ If community well system, provide written confirmation from State ADEC attesfix " lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site ,~' Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm KND Engineering 20441 Ptarmigan Blvd. ;;;,rne;:r,s signatureEa§l~. ~~- Phone Date DHHS SIGNATURE '~ Approved for --~) Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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. 72-025 (Rev. 1/91) Bsck MOACt21 Legal Description:__ A. WELL DATA Well type Log present (Y/N) _ y Total depth ~O 7 Sanitary seal (Y/N) Health Authority Approval Checklist [511c t; L-I'l&e. Pa,r/C- Parcell.D.: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICJL:ltJ~ICtPALir¥ OFANcHut~,:~ Environmental Services Division ENVIRONMEN-FAL,.q£RVicEs DIVI 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 ..... "~,,~ 1996 [fA, B. or C, attach ADEC letter. ADEC water system nmnber Date completed . / Cased to ~/--) 7 Y Casing height (above ground) ~,.'2/7/// Wires properly protected (Y/N) x/ Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform / Date of sample: '/~/~3/c~,~ B. SEPTICfltOLDING TANK DATA FROM WELL LOG 25- AT INSPECTION /2/,~ ~ g.p.m. 'fi' & 7 g.p.m, Nitrate O, ,~ 7 Other bacteria / Collected by: /(~D ~ nolt?eff, r't~'~G' Date installed Foundation cleauout (Y/N) __ Date of Pumpiug _ q/~ / t~ ~ C. ABSORPTION FIELD DATA Date installed 7/16, I q '5 I 1 Leugth ~ '[ ~ Width Tank size 1500 Number of Compaltments e~- Cleanouts (Y/N) y Depression (Y~) ~ High Water alarm (V~) Soil ratin~r ~ ~ Gravel thickness below pipe _ System type ~e /O~ Total depth / 5/, ,~' Depressiou over field (Y/N) For ~ bedrooms Effective absorption area ] 7 q 0 Monitoring Tube present(Y/N) ¥ Date of adequacy test 12./7/ti ,~f Results (Pass/Fail) ~o,.. > 5 / r ~ "-hnniediateiv after 77~gal. water added (in.): q/tt Fluid depth in abso~tion field before test (in.)', ~,~ . Fhfid depth &~, ~ (ius.) Minutes later: /~ Absorption rate =_ ~ 4 g.p.d. Peroxide tyeatment (past 12 months) (Y~) ~ If yes. give date 1~/~ D, LIFT STATION Date installed / Size in gallons Manhole/Access(Y/N) /"Pump on" level at*// High water alarm level at *Datum / Cycles tested / E. SEPARATION DISTANCES "Pump off" level itt* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorptiou field on lot ! OO t .+ Public sewer ,nam /OO ~ Sexver/septic service line /OO ' 4- /o0 '* : On adjacent lots : On adjaceut lots Public sewer tnanhole/cleanont Lift statiou SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: I Building foundation /0 .4- Property line /0 t ..p_ Absorption field /O t + Water main/service line /O t 4 Surface water/drainage /Od) t -t- Wells on adjacent lots /O O ' '/ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation /O ~ + Water maiWscrvice line / ~ t 4- Surface water Driveway, parking/vehicle storage area /O Curtain drain Wells on adjaceut lots / O O 4 Property line / O * -4- F. ENGINEER'S CERTIFICATION I certiJ, i: ti, at I have determined thrufiekl inspections and review of Munict;ool in con}brmance with MOA HAA guidelines in effect on this date. aignature ~~~, ~/~ HAAFee $~' ~ Waiver Fees Receipt Number ,/~~~ Receipt Number Rev. 8/95 OSS: haa,wk,doc JAM 08 '96 09:38AM NTL ANCHORFtGE P.2/2 NORTHERN TESTING LABORATORIES, INC. 3330 IN DUB'ITt~AL AVENUE FAIRBANKS. ALASKA 90701 {907) 456,3116 · I~AX 456.-31 ~t 5 2§05 FAIRBANKS STR~[I~T ANCHORAGE, ALASKA 90503 (907) ~.77-1EI;~78 · FAX 2?4-9645 DRINKING WATER ANALYSIS REPORTI FOR TOTAL COLIFORM BACTERIA KND Engineering 20441 Ptarmigan Blvd. Eagle River, Pi( 99577-3736 Public Water System I.D,# Date Received: Date Analyzed: Date Reported: Next Sable Due: 12/28/95 Time Received: 09:50 12/28/95 'rime Analyzed: 16~00 01/03/96 Time Reported: 11:22 Comments: S Phone No. U Purchase Order No. POS NO Collected by: KND TNTC Sam~te Type~ CG Routine Untreated HSM Method of Analysis: Me.fane Filtration Comments: SA -- Old ~ Satisfactory Unsatisfactory Positive Test Result None Detected Too Numerous To Count {>200 Colonies) Confluent Growth Heavy Sediment Masking, Results May Not Be Reliable Sample Age >30 Hours But <48 Hours, Results May Not Be Reliable Sample Age >48 Hours, Too Old For Analysis Resample Required No Test * # Colonies/lO0 ml ** # Colonies/mi Sample Sample Total* Fecal* Other* HPC** Location Date Time Lab# Coliform Coliform Bacteria Result Comments 1 Wash Sink Garage 12/28/g50g:05 ABTOgO 0 ND 0 NT S LC/B1 Lilac Pk. JAN 08 '96 09:3~1M HTL AI~CHORP~3E P.1/~ NORTHERN TESTING LABORATORIES, INC. a330 INDUS1TIIAL AVENUE FAIRBANKS, ALASKA 9D701 (GozJ 4§G,311~, PAX 45~-31'~ 250~ FAIRBANKS ,~TRCI~ ANCHORAGE, ALAISKA g~503 (90~') 27~-~378. FAX d~nuary 8, 1996 KNO Engineering A14~6~ ~ash gfnk GPA 353,3 N)~rate-N mg/L 0.~? 0,50 Garage po~t~· FaX Note 7671_ Parcel I.D. # 1, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O, Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site add~ess or directions) Property owner Mailing address Lending agency Day phone Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup, NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: Public water If community well system, provide written confirmation h'om State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1191) Front MOA ff21 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 a, nd/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 --¢~'~-'~'~/--¢~-' ~ /¢~'.5-o ¢ t,,¢~.~< Phone Address Engineer's signature DHHS SIGNATURE Approved for ---%-"' Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 40~'t,,t ~¢-~'n,Tl~- Date ~/iT/C~ ~ By: 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. 72-025(Rev. 1/91) 8ack MOA~21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Parcel I.D. A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) /J Date completed ~'/~-.,-~/~?.~ Driller Totaldepth ~ O ',.~ ~ Casedto ,'~-O"7 , Casing height Sanitary seal (Y/N) ,Y Wires properly protected (Y/N) ,/ FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /Y~"-' / Absorption field on lot ,//,~//Z / Public sewer main Sewer service line g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: ,,,'~,' .¢~¢-¢~'~F¥ Coliform .~¢-~ ~¢~ Nitrate ~* 7~ ~-~/~ ~¢/~ Date of sample: //¢ ¢~ ¢~//%~ Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA (/'~'~'~/¢*~'Y¢ Date installed ¢,/~E~/'¢¢'~ Tank size //~--¢ ¢ ~"~/¢',~. Compartments Cleanouts (Y/N) j Foundation cleanout (Y/N) ,./'b/ Depression (Y/N) High water alarm (Y/N) .~/"---¢ Alarm tested (Y/N) Date of pumping ,~ ~'~-~'~;/¢' Pumper / SEPARATION DISTANCES FROM SEPTIC/JC~_D'.NG TANK TO: Foundation Water main/service line Well(s) on lot .,-/,~,~'"' On adjacent lots ¢,-~' To property line /7//7/ / Absorption field //~- / Surface water/drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION'~ Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N/ "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed 7h Length 4,~7 / Width ,L~ / Total absorption area ./ Depression ever field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating 0,~¢- . System type / Total depth // Gravel thickness .,/dj2 Cleanouts present (Y/N) Date of adequacy test for If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot ./¢J / To building foundation On adjacent lots Surface water Curtain drain //Y//'¢ ? On adjacent lots ,.> ./oD Property line To existing or abandoned system on lot Cutbank /'/'//¢ Water main/service line Driveway, parking/vehicle storage area ~?{--') E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ~ ',:':,~ k) "/.Il., '~ Signature Engineer's Name HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 / 7P oo Waiver Fee: $ Date of Payment Receipt Number COMMFRCIALTESTING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES Chemlab Ref.~ :93.3860-1 Client Sample ID :WELL WATER Matrix :WATER REPORT of ANALYSIS LILAC SUBDIVISION L9 B1 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 Client Name :ROVINELLI, RICHARD A. WORK Order :69113 Ordered By :RICHARD A. ROVINELLI Report Completed :08/06/93 Project Name : Collected :08/04/93 @ 12:30 hrs. Project~ : Received :08/04/93 @ 13:00 hrs. PWSID : UA Technical Director:STEP. HgN_ C. EDE . Released By : ~x~_~--2~' ~ Sample Remarks: ROUTINE SAMPLE COLLECTED BY: JANET ROVINELLI, WITNESSED BY JOE CARGE. Qc Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate-N 0.77 mg/L EPA 353.2/300.0 10 08/05 LLH See Special Instructions Above UA = Unavailable See Sample Remarks Above NA = Not Analyzed Undetected, Reported value is the practical quantification limit. LT = Less Than Secondary dilution. GT = Greater Than Member of the $G$ Group (Soci~t~ GCn~rale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA ENVIRONMENTAL LABORATORY SERVlCE~ R~q~ORT of ANALYSIS 5633 ~ STREET Chemlab Ref.# :93.4026-1 Client Sample ID :L9 Bi LILAC PARK SUBD, Matrix :WATER Client Name :BRUST & ASSOC Ordered By :STAN BRUST ProjeCt Name : Project# ; PWBID :UA ANCHORAGE, AK 99518 TEL: (907) 582-2343 FAX; (90/) 561 5301 WOP~4 Order :69425 Report Completec[ :08/13/93 Collected :0B/11/93 @ 17:30 hrs. Received :08/11/93 8 17:30 hrs. Technical Director:ST~..~Ex]~E~ / Released By : ~34~-'d~ ~ Sample Remarks: ROUTINE SAMPLE COLLECTED BY: S. BRUST. QC Allowable Ext, Anal Parameter Result~ Qual Uni%s Method Limits Date Date Inlt RECEIVED 1 3 Munio~peJi~y o[ Anollorage Dept. Health & Human Services See Special Instructions Above UA - Unavailable See sample Remarks Above NA = Not Analyzed Undetected, Reported value is the practical quantification limit. LT = L~ss Tha~] SeconCl~ry dilution, GT = Greater Than ENVIRONMENTAL SERVICES IN ALASKA, OOLORAOO, UTAH, ILLINOIS. OHIO, MARYLANI), WEST VIFtOINIA, NEW JERSEY, SOUTH CAROLINA ~0~] 69~'0N C~.9~ [:GA A06 ~- SBDIA~BS 8~d7 7~dlNBWNO~IIANB B~±D G~:CI