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HomeMy WebLinkAboutLAKE HILL ACRES #1 LT 30Onsite File Lake Hill Acres #1 Lot 30 #051-052-33 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 11 of 1 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: PID Number: 051-052-33 j Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ®Upgrade Name Timothy & Sandra Mortimer ABSORPTION FIELD I ❑Deep Trench ❑Wide Trench ❑Bed L1 Mound Site Address 22735 Lake Hill fir., Chugiak, AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 907-688-5097 3 GPD/SF ; Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe ! Ft. Subdivision Block Lot Lake Hill Acres #1 30 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption . HoldingSewer Lift Station i Total absorption area Number of trenches Dist. between trenches From Tank Field i ( Tank Line Ft2 Ft. Well191 $ ( I TANK ® Septic ElS.T.E.P. [:1 Holding ED Other i I Manufacturer Unknown Capacity 1000 *i Gal. Surface Water 100'+ j l Material Number of compartments Lot Line ) 51+ i I i NA Concrete ' 2 Foundation 1 1 Q + I LIFT STATION Manufacturer Capacity Remarks * per measured dimensions I Gal. —Documentation inspection, construction date unknown Alarm location Electrical installed by. installer PIPE MATERIAL House to tank Tankto _____ _ drainfie}d _ Unknown Drainfield ' CO/MT3034 — Inspector Crewdson Engineering LLCM* BENCH MARK (Assumed elevation)100 ft Inspdatecti esv 4-7-2020 2�d Location and description bottom of siding at "BM" on record drawing 3,d 4m ON-SITE WATER AND WASTEWATER SECTION APPROVAL p .� �A`\`� Conditional Approval: _ Date ,,''���' �t mes A. Orewds�on 011527, f ' C�rw Septic SystemC ` Approved % f% Date 2 ?© U ,.L4ad0!0 • Note: this approval does include N4 P not well permit requirements.1f too., nr;rmre of a\a„S�,e REESE ROAD D WELL j LAKE HILL ACRES #1 LOT 30 3 0 . Crewdson 0 11527 0 J SWING TIES(fgptj FC S1 3 BR SFH Y 0 36.2 37.0 A BM B o�o B 11.4 52.8 �x C 91' WELL RADIUS X\o SEPTICTANK LOT 30 1000ya11 on {N CONCRETE r 2 S1 DC � 9V WELL RADIUS RADIUS �k 10 LOT 31 2+% GARAGE DRIVEWAY ' • 10' UTILITY EASEMENT LAKE HILL ACRES #1 LOT 31 Civil & Environmental Engineering O Bax 671389 Chugiak AK 99567 - cel1c.1 @outlook.c CelUText: 907-280-9493 - Fax: 907-688-2295 BM ASSUME 100'@ BOS SEPTIC TANK TOT ELEV: 94.9' INLET INV ELEV: 94.3 OUTLET INV ELEV: 94.1 PROFILE NOT TO SCALE NOTES 1. Existing septic tank documentation. LEGEND BM - bench mark 0I BOS - bottom of siding WELL BR - bedroom DC - double cleanout EG - existing ground ELEV - elevation FC - foundation cleanout FG - finish grade IAW - in accordance with INV - invert S# septic tank cleanout SFH - single family home TOT - top of tank Lake Hill Acres #1, Lot 30 Record Drawing Plan and Profile Prepared for: Tim Mortimer Date: 4-20-2020 Permit: OSP20 Page: 1 of 1 ALL INFORMATION SHOWN ON THIS DOCUMENT IS THE PROPERTY OF CREWDSON ENGINEERING, LLC AND SHALL NOT BE USED FOR ENGINEERING OR CONSTRUCTION PURPOSES WITHOUT WRITTEN PERMISSION FROM CREWDSON ENGINEERING, LLC r co 0 . Crewdson PLAN 11527 0 SCALE: V=301 SWING TIES(fgptj FC S1 S2 DC A 24.6 34.2 36.2 37.0 B 11.4 52.8 59.2 60.9 Civil & Environmental Engineering O Bax 671389 Chugiak AK 99567 - cel1c.1 @outlook.c CelUText: 907-280-9493 - Fax: 907-688-2295 BM ASSUME 100'@ BOS SEPTIC TANK TOT ELEV: 94.9' INLET INV ELEV: 94.3 OUTLET INV ELEV: 94.1 PROFILE NOT TO SCALE NOTES 1. Existing septic tank documentation. LEGEND BM - bench mark 0I BOS - bottom of siding WELL BR - bedroom DC - double cleanout EG - existing ground ELEV - elevation FC - foundation cleanout FG - finish grade IAW - in accordance with INV - invert S# septic tank cleanout SFH - single family home TOT - top of tank Lake Hill Acres #1, Lot 30 Record Drawing Plan and Profile Prepared for: Tim Mortimer Date: 4-20-2020 Permit: OSP20 Page: 1 of 1 ALL INFORMATION SHOWN ON THIS DOCUMENT IS THE PROPERTY OF CREWDSON ENGINEERING, LLC AND SHALL NOT BE USED FOR ENGINEERING OR CONSTRUCTION PURPOSES WITHOUT WRITTEN PERMISSION FROM CREWDSON ENGINEERING, LLC r co James . Crewdson 11527 0 ALLq #112279 F r REESE ROAD L=31.47' (C) WELL) R=20.00' (H) Lot 30 M NO RECORD 15,000 s.f. (MOA) n INFORMATION 14,884.2 s f. (C) 40.5' 1 z.1 \ SUNROOM WITH 8.0' x 16.2' N SHED BELOW a N Z O \ 0 BI—LEVEL RESIDENCE 36.2' DECK L / a SEPTIC / / I PIPES / WALKWAYS GARAGE 0 0 M Lot 29 Lot 32 NOTE: THE PLAT IS LACKING CERTAIN DETAILS FOR THIS PROPERTY. DIMENSIONS ARE NOTED AS (R) RECORD (C) COMPUTED (H) HELD PLOT PLAN AS BUILT X SCALE —11= 30' GRID SW 1233 Project No. 20-242/A1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone 000�pppp (907) 522-4625 Fax o F A p04 Professional Land Surveyors kenOlangsurvey.com ! Y jonafhanOlongsurvey.com I hereby certify that I have surveyed the following described property: LOT 30, LAKE HILL ACRES SUED., FIRST ADDITION (Plat No. 64-90) o * 49TH Anchorage Recording District, Alaska, and that the Improvements situated thereon are "'."' ••'••"•.. within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed �... KENNETH .:.r.0 premises and that there are no roadways, transmission lines or other visible (" Io G easements on said property except as Indicated hereon. QO' ra`17126ypQG' }i, U ' ..LS 52 �02.• Dated this the 11�-1 Day of � Mr 2LL , at Anchorage, Alaska �p �a •' ... Nuc 40Z0FrSSIONA� �o It is the responsibility of the owner to determine the existence of any easements, '�vODOo� covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 Municipality of Anchorage P.O. Box 196650 •4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 w Fax (907) 343-7997 hftp://www.muni.or-q/Onsite Development Services Department On -Site Water and Wastewater Section n ent ft�'. * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: WR890022 PID#: 051-052-33 COSA#:OSC201161 Permit#:OSP201073 Legal Description: Lake Hill Acres #1 Lot 30 Engineer: Crewdson Engineering Applicant: Timothy & Sandra Mortimer Your request for a waiver of the required 100 feet horizontal separation from the septic tank to the private well has been approved. The approved separation distance is 9 1. 0 feet. This is a renewal of an existing waiver and applies to the well on Lot 30 and the well on adjacent lot Lake Hill Acres #1 Lot 31. See engineer's waiver request for justifications for renewing the waiver. This waiver approval applies to the existing septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. irrrrrrrrrrrrrrr a rrrrrrrrrrr�rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr a rrrrrrrr■ Waiver is Granted: X Waiver is not Granted: Date:' Approved by: Name of Reviewer �rrrrr a rrr u r u rrr a rrrrrrrrrrrrrrr a rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr■ **** VARIAN C E/WAIVER REVIEW **** Ytf & Envif1 nmentai Engtneetifig:.. April 20, 2020 Onsite Reviewer Municipality of Anchorage On-site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99519-6650 Reference: Lake Hill Acres #1, Lot 30 Septic Tank Documentation and Waiver Request James "Jay" Crewdsor Email: CELLC.1@outlook Cell/Text: (907) 280 - Fax: (907) 688- 0 3 Septic Tank Documentation: The owner of the 3 -bedroom home is preparing to sell the property. During the COSA process, we were unable to find any documentation for the existing concrete septic tank.j The owner states he was told when he bought the house in 1989 that it had a concrete septic tank. The related 1989 Health Authority states the septic system had a 1981 steel septic tank. The engineer of record, Robert Schafer P.E., is deceased and so we are unable to discuss his 1989 report to see if this might, be a typographical error. The extensive well-established landscaping near the septic tank appears to be old enough that it's plausible the tank was installed sometime prior to the current owner buying the house in 1989. The following additional information is intended to be used in conjunction with the attached inspection report to fully document the existing septic tank and show that it's operating in accordance with the code. • Cover Depth: The tank has 3.7 -feet of cover (combination of soil and 2 -inches insulation). • Baffles: The tank baffles appear to be in satisfactory operational condition. • Leakage Testing: The tank was checked for leakage by monitoring the leak down rate over ime. It does not appear to be losing any measurable amount of liquid and as such is considered leak free. • Foundation Cleanout: The existing foundation cleanout appears to be in satisfactory (code compliant condition. • Double Cleanout: The existing double cleanout appears to be in satisfactory code compliant condition. The owner states the double cleanout, which is not shown in the current records!, was installed when,a pipe settlement issue between the tank and drainfield was repaired. • The ground cover over the tank is not depressed/sunk, indicating the tank's satisfactory structural condition. • There are no anticipated adverse impacts to adjacent properties if the septic tank is approved in its current existing and now documented condition. PO Box 671389 • 18368 Amonson Road • Chugiak, Alaska 99567 Page 2 of 2 Date: April 20, 2020 Subject: Lake Hill Acres #1, Lot 30 Waiver Request: 91 -foot Tank -to -Wells Separation Distance: There are two wells less than 100 -feet from the septic frank, one on the subject property, and one to the south on Lake Hills #1, Lot 30. The prior documented' steel septic tank was approved with a waiver for 91 -feet to both of the wells. We are requesting the lame waiver be applied to the existing septic tank. Measurements to the existing septic tank show that it satisfies the prior septic tank waiver for 91-feletto the two aforementioned wells. Shown below are the mitigating reasons to allow the waiver: 1. Both wells are in satisfactory code compliant condition. a. Lot 30: i. Well Log: Available in Onsite's records. 1. Total Depth: 189' (per well log) 2. Static Water Level: 185' (4-7-2020 measurement for COSA) ii. Water Quality (see attached): Bacteria: Non -Detect, Nitrates: Non -Detect b. Lot 31: i. Well Log: 2019 COSA reports the well log is not available. 1. Total Depth: unknown 2. Static Water Level: 192' (10-1-2018 COSA) ii. Water Quality (see attached): Bacteria: Non -Detect, Nitrates: 2.99 mg/L 2. There are permanent structures between both wells and the septic tank, and the septic tank is downhill from both wells. As such, sewage spills are not likely to travel towards and/or irnpact either well: 3. 'There are no known problems with the wells that can be attributed to the existing 911 -foot separation distance. Please fe ree to co ct me if you have any questions. �Q► . icy. ,00 4 TH Jam ay' Crewdson, P.E. / James A. Crewdson 011527 ��\�FESS1����r Received Date/Time 04/07/2020 16:02 04/07/2020 14:00Collected Date/Time 1201325001 Matrix SGS Ref.# Client Sample ID 22735 Lake Hills Dr. Hose Bib Client Name Project Name/# Printed Date/Time 04/15/2020 15:29Crewdson Engineering LLC Technical Director Stephen C. Ede 22735 Lake Hills Dr. Hose Bib Drinking Water Sample Remarks: Parameter Results LOQ Units Method Allowable Limits Prep Date Analysis Date InitContainer ID Metals by ICP/MS DMM04/13/20EP200.8ug/LArsenic 04/09/20ND5.00 (<10)B Waters Department EWW04/10/20SM21 4500NO3-Fmg/LTotal Nitrate/Nitrite-N ND 0.200 (<10)C Microbiology Laboratory VAB04/07/20SM21 9223B100mLE. Coli Negative 1 A VAB04/07/20SM21 9223B100mLTotal Coliform Negative 1 A 2 Received Date/Time 04/07/2020 16:02 04/07/2020 14:00Collected Date/Time 1201326001 Matrix SGS Ref.# Client Sample ID 24415 Grace Client Name Project Name/# Printed Date/Time 04/15/2020 15:29Crewdson Engineering LLC Technical Director Stephen C. Ede 24415 Grace Drinking Water Sample Remarks: Parameter Results LOQ Units Method Allowable Limits Prep Date Analysis Date InitContainer ID Waters Department EWW04/10/20SM21 4500NO3-Fmg/LTotal Nitrate/Nitrite-N 2.99 0.200 (<10) B Microbiology Laboratory VAB04/07/20SM21 9223B100mLE. Coli Negative 1 A VAB04/07/20SM21 9223B100mLTotal Coliform Negative 1 A 2 MUNICIPALITY OF Development Services Department On -Site Water & Wastewater Section Parcel I.D. 051-052-33 ON-SITE SEPTIC/WELL PERMIT APPLICATION Phone: 907-343-7904 Fax: 907-343-7997 Property owner(s) Timothy & Sandra Mortimer Day phone 907-688-5097 Mailing address PO Box 672155, Chugiak, AK 99567 Site address 22735 Lake Hill Dr. Legal description (Sub'd., Block & Lot) Lake Hill Acres #1, Lot 30 Legal description (Township, Range & Section) Lot Size 15,000 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) Q (w/wo ADU) Septic Tank 0 Upgrade 0 Duplex (D) ❑ Holding Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Septic tank to well (existing waiver, no charge) Distance: 91' I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Waiver Fees: Date of Payment: /a3/anao Date of Payment: Receipt Number: Receipt Number: Permit No. dJl�U�U�� Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT _HONE . L~. NEW [ U.GRADE LOCA~/~ ~' / 3'- o weli¢/ ~..~ DISTANCE TO: ~ O <~ DISTANCE TO: No. of lines ~ Le t o~'ea 'p~ Top~f~t~le~fi 'sh !de~"~: / ? gr Inside length Dwelling Width Founda.tion ¢,/ / .~ Material NeareAt Ioty~ Trenct'~.~idth ¢- ' ~0 inches .{te~ial beJ~ea~h tile inches NO. OF BEDROOMS~ No. of cdmpartments ~ Liquid depth PERMIT NO. Liquid capacity in gallons Total effec~4~e 8bsg~rption area Length Type of crib DISTANCE TO: DISTANCE TO: Width Building foundation Depth Crib depth Building foundation Driller Sewerline PERMIT NO. Tota] effective absorption area Nearest lot line Distance to lot line Septic tank PERMIT NQ. Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATtNG~ INSTALLER REMARKS DATE LEGAL PERMIT NO. F!PPLICRN'r E L NO!-4OTN'¢ BOM '?':;t. 6 E R L. OC:RTION Mi 23:. 5 OL[)GLEN 'i, !...E,]FIt.. L,:i,T 2:El ~ LFII';::E N!LL R *:F..'ESn _/~1..~ ¢_~ ~/ T"?PE OF SO.'l;t_ RBSORPTiON S"?STEM IS: TRE:NCH L. OT SIZE 2'?7 ±541 1.5000 SQURRE FEET MR>:i!.h!UH NUMBER OF BEDROOHS = .3: SOIL RR'T!NG ,::SQ FT,.'"BR)= 285 TNE REQUIRED SiZE OF THE SOIL. RBSORPTION S'?'STEr,! IS: THE LENGTH DIMENSION IS THE LENG'T'H (IN FEET) OF' THE TRENCH OR E.',RF-I!NF:tELD. THE DEPTN OF R 'FRENCH OR PIT IS THE DISTRNCE E:ETH:EEN THE SURFRCE OF THE GROUND RNE:, TNE BOTTOM OF THE EXCF!'v'FITION (iN FEET). THERE IS NO SE]" !.,.tIDTH FOR 'T'F..'ENCHES. THE GRR',,,'EL DEF'TN IS THE H!NI?IUP1 DEPTH OF GRFtVEL BETt4EEN THE OUTFFILL. PiPE R,ND THE BOTTOM (_"iF THE E',:--','CFI',,,'RT!ON (iN FEET). PERMIT FIPPLiCRNT HFiS 'THE RESPONSIBiLiTY TO INF'ORi'"! TH, IS DEPRRTMENT DLIRiNG THE INS'TRLLRT!ON iNSF'ECTIONS OF RN'.~" HELLS RD,IK4CENT "FO 'tHiS PF.:OPERT'?' BND THE NUMBER OF RESIDENCES TI-.!FFi' THE NELL HILL SERVE:. BFtCKFiLL. ING OF' RN'.r' S'¢STEH FII]"H. OU'r FINRL INSPE:CTION FINE:, RPPRO'v'F!L B'¢ THIS DEF'RRTMFNT HILL. BE SLIBJECT 'TO PROSECUTION. MiNIML!H DIS'TRNCE BETHEEN R NELL [~,t'4D RNY ON-SITE SEHRGE DISPOSF!L S?S'TEM iS :I.E~O FEET FOR'. FI PRIVFITE HELL OF..: i50 TO 2EE~ FEET FROM R PUBLIC HEL. L DEPEND!t",!G L!PON THE T?PE OF' PUBLIC HELL MINIMIJH DiSTFtNC:E FROH R PF.:IVRTE HELL TO fa PF.:IVRTE SEP.!ER L.!NE IS 25 FEET F-IN[:, ]."0 R COMMUNIT'¢ SEI.,.iER LIN. E !S 75 FEET. O"FI-.!EF.: REQUIRE!',IENTS .1',1F¢¢ FtPPL'¢. SPEE;IFICP, TIONS FIND CONSTRUCTION DIFtGRRMS ERE RVR!LFiBLE: TO INSLIRE F'ROPER tNSTFII_LFYTION. i CEF.:TIF'? THRT ±: t Eh! FF!MiLIF:tR t.4I'T'H THE REQUIF.:EMEI'.,!TS FOR: GN-SITE SEHEF.:S RND I.,.!EL.L.S RS SET' FORTH B'?' THE MUNICIPFILIT'?' OF FtNCHORRGE. 2: ! Ht!...L. !NS"FF~!...L. THE S'¢STEM IN RC:CORDRNCE HiTN THE CODES. 3:: 1[ UNDERS'i-'RND THRT '['HE ON-SiTE SEHER S'?'STEH Mff¢ REQUIRE ENLFd:~:GEMENT IF ]"HE F.:ESIDENCE IL=., REMO[.',ELED TO I NE:LUDE MORE TPIRN 2: E~EE:,ROOMS. RPPL!CRNT E L. NOHOTN'¢ I ::':;,S L~EF.:' EPr' ~ ...................... DfYTE .... -- '0 & E EN~.,qEERING & DEVELO, ,vlENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 Earl Ellis SOIL LOG 688-2280 Performed for: Legal Description: L~ T -~ ~ L Depth (feet) 0 2 Soil Characteristics 5 11__ PLOT PLAN 12__ 13__ 14 15__ 16__ Ground Water Encountered: Yes_~.~__~ No Proposed Installation: Seepage Pit Comments: Performed by: PERC. TEST ~a /-/, ~,/, ~ = ~ ~ ~1~,/~ If yes, what depth Drain Field.__ MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907 On -Site Water & Wastewater Section Fax: 907 Certificate of On -Site Systems Approval Parcel I.D. 051-052-33 Expiration Date: 1. GENERAL INFORMATION Complete legal description rake Hill Acres #1, Lot 30 Location (site address) 22735 Lake Hill Dr,, Chugiak, AK 99567 Current property owner(s) Timothy & Sandra Mortimer Day phone 907-688-5C Mailing address PO Box 672155, Chugiak, AK 99567 Real estate agent Bonnie King Day phone 9.07-244-71 7904 7997 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ . Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. !NUMBER .OF3 BEDROOMS: 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:! Private Well El Private Septic [] Water Storage ❑ Holding Tank ❑ Community Well _ ❑ Community ❑ Public Water System ❑ Public Sewer ❑ is Waiver request for: Distance: I Received by: Date: COSA to be released to the engineer, unless Otherwise requested by the engineer, i COSA Fee $moi O % 02 • J` Waiver Fee $ / Date of �[ Payment � Z.�j lao W Date of Payment Receipt Number �,/C• Receipt Number i COSA # n e Q 1 /lel 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 disposalsystem is (are) safe, functional and adequate for the Inumber 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 �astewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and reg�ulations in effect at the time of installation. 1 acknowledge that On -Site staff may visit the site to verify the information subrrtitted. i Name of Firm Cr&wdSon Engineering LLC Phone 907-280-9493,., Address PO Box 671389, Chugiak, AK 99567 Engineer's Printed Name James Crewdson Date 4' \ ,may. t� 6. DSD SIGNATURE . ' ..: I .. ✓ System #1 Approved for bedrooms System #2 Approved for bedrooms �{jaaD Disapproved Conditional, approval for bedrooms, with the following stipulations: i �-i �k Cc�vec�e � �� t`ci�a tteS uAe� v ct1nI� .. t�ttlttC(((llu CR3\a ! S t) U d ryjkm b Ih�°et- hcs e l'is �La4iaLLON SITS IND �� �O use C�-V\d {�C i 1 S Ye u � 12� � 11VATE t , iS kn J PROG RAM By:Original Certificate Dater f 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 in dependent 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. I 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory L Septic System Advisory Arsenic Advisory Well Flow Advisory Other c6sA Checklist blue sheet .. . . i COSA Checklist Legal Description: Lake Hill Acres #1, Lot 30 _ Parcel ID: 051-052-33 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system __ A. WELL DATA ■❑ Well log is filed with Onsite (or attached) Well production at time of test 5.5+ qpm Date drilled * Water storage tank volume none gallons Total depth 189 ft Well disinfected for coliform test? ❑ Yes X No Cased to 189 ft ❑■ Coliform bacteria is Negative ❑E Sanitary seal is functioning correctly Nitrate �mg/L ❑® Nitrate less than MRL (ND) N Wires are properly protected Arsenic ug/L ❑■ Arsenic less than MRL (ND) Casing height (above ground) 12+ in. Collected by Crewdson Engineering LLC Date of flow test for COSA 4-7-2020 Date of Sample 4-7-2020 Static water level at beginning of test 185 ft. Comments * file unreadable, shown as "existing" on 1981 septic inspection report B. TANK DATA Age of tank(s) years Tank type/material Concre`e Measured operating fluid level in septic tank 53 ■❑ Standpipes/foundation cleanout per record drawing Date of pumping 4-8-2020 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: * unknown D. ABSORPTION FIELD DATA Which system tested (date installed) 8-31-81 Adequacy test date 4-7_2020 ■❑ ALL standpipes present per record drawing Results Pass For 3 bedrooms Total measured depth from grade 10 ft (max) Fluid depth prior to test 53 in Measured depth to pipe invert from grade 6 ft (min) Water added 450+ gal ❑ N/A -pressurized field New depth 70.5 in IN Monitor tubes go to bottom of effective. If not, state 90 depth into effective Elapsed time min V-1Code-requiredsoll cover over field Final fluid depth 63 in E] System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) No date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well mmLot to: (Please enter distances if less than required o/ifcommunity well) Septic Tank/Lift Station nnLot >10/ 91+* Community Sewer >10Y []Yea ifNo_ ft 7]Yes JNoft Neighboring Tank>1OO' Yes ifNoft Private Sewer/Septic Line > 25'[7]Yes ifNoft Absorption Field onLot >1OO' Yea ifNoft Holding Tank > 100' Yes ifNoft Neighboring Absorption Fields >100' Surface VVotor>1OO' Animal Containment> 8' Yes ifNoft El Yes if No � Manure/Animal Excreta Storage >18O' Community Sewer Main >75' [D Yes ifNoft Yes ifNoh From Septic/Holding Tank onLot to: (Please enter distances if less than required) Building Foundations >1O' R1 Yes ifNoft Surface VVatar>1OO' Yeo ifNoft Property Line >5' Yea ifNoft Wells onAdjacent Lots: Absorption Field >5' Yen ifNoft Private Wells >1OO' E] Yes if No 91f^ft Water Main >1O' Yeo ifNoft Community Wells >2OO' E] Yes ifNoft Water Service Line >1O' Yeo ifNoft |fseptic tank iounder driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation >1O' Yeo ifNoft |fabsorption field isunder driveway comment belowPmpertyUno>10' Yes if No 5*ft Wells onAdjacent Lots: Water Main > 10' Yeo ifNoft Private Wells >10O' UYoo ifNo_ft Water Service Line >1{Y Yeo ifNoft Community Wells > 208' El Yes ifNof/ Surface VVotor>1OO' Yeo ifNnft ` F.ENGINEER'S COMMENTS * MOA approved waiver G. ENGINEER'S CERTIFICATION / certify that / have determined through field inspections and review of Municipal records that the above systems are inconformance with MOA COSA guidelines in effect on this date. uOSAuhecmist yellow sheet MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF' ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 30, Lake Hill Acres ~1 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING /~:~/ -6'.~.~-.~-~2 HAA# /~t_¢~ ~/~- ~' Telephone:(home) Round Rock, Texas Telephone 78681 (b) (c) Location (address or directions) f,ake Hill Drive Property owner Nowotn~-y Mailing Address ql ] Lending Institution Mailing Address Business (d) Real Estate Company and Agent John P]y]~r- C~r~-]~nc] R~]hy Address P.O. Box 6~q, f~gl~ P~v~r~ ~- 9~77 Telephone 694-9125 ' (e) Mail the HAA to the following address: (or check her~hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Number of bedrooms Single-Family E~: 3. WATER SUPPLY Individual Well ~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site E~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 ')JJON~ 9,J@eu!J~ue leUO!SSajoJd eql u! SUOlSSlLuO JO sJoJJe Jo,I elq!$uodseJ leu 8! eJ~eJoqou~, lo AUled!e[u nH eqL 'penss! s! eleo!J!iJeo e eJojeq elep eZXleUe Jo suoilo~dsu! lonpuoo ),ou op SHHQ ,to seaAoldLu3 'slu@LueJ!nbeJ elels pue leJepeJ u!elJeo A,tsRes el JepJo u! $uoRnulsu! 8u!puel Jleql pue seLuoq to sJeseqoJnd el Ase~Jnoo e se s!ql seep SHHQ eq.L 'e~iSelV ,to ale,S eq~ u! peJels!6eJ Jeeu~Due leUO!SSejoJd luepuedepu! ue Aq e^oqe g qdeJBeJed u! ue^!l~ $uo!lelueseJdeJ eql uodn/~lUO peseq peleo!~!Jeo le^oJddv Al!Joqinv qlleeH senss! (SHHG) sao!^Jes ueLunH pue qUeeH lo lueLuljedec] eDeJoqeuv ,to AUled!o!unjAI eLIJ. leAoJddV leuoR!puoo ,to $wJe/ leUO!Upuoo peAoJddes!G '~/ pe^oJddV ~. Jo,t pe^oJddV 'IVAO~IddV SHHa '9 e~ec] PO~ 'oN peo~l dool ~o/qB ell~e~ 9NIB~i9NIgN3 $ ~' -~ LU.q.:I ,tO eLUeN 'uoi~oedsu! s!ql,to elep eql uo loejje u! suoi~elnbaJ pue 'seoueuipJo 'sepoo eielS pue led!olunlAt lie q~iM eoueIIdLuoo u! s! LuelsAs lesods!p ~e~eMe~seM Jo/pue Alddns Jele~ el!s-uo eql 'uoRoedsu! pue uo!lebilse^u! ALu LuoJI pue seliJ eSeJoqeu¥ ,to /q!led!olunJAI eql ~uoJ~ peulelqo uoReLuJo~u! eq~ uo peseq 1eLIl A,tpe^ ~eq~,Jnj I 'u!eJeq peleo!pu! eJn~onJls to edA1 pue sLuooJpeq JO JeqLunu eq~ Jo,t elenbepe pue leuop, ounI 'eIes s! Lue~sAs lesods!p Je~eMe~seM Jo/pue ~lddn$ ~eleM el!s-uo eql leq~ SMOqS le^o~ddv /qpoqlnv qlleeH s!ql~ouoi~eBRse^u!ALu~eq~AI!JeAl'M°leq UMOqSe~ep uo!lep!leAeq~,tose pueoleJeq pex!IIe legs ALu Aq pellilJeosv NOIJ.~I/~NO.-INI aNV YJ.¥a 'FIC)t~¥~B =1-114 '$J.$=1J. '$NOIJ. C)=1dSNI !DNlalAOI=Id ~l:llJ ~,DNIkI=1=1NI!DN=1 'g WELL DATA Well Classification OF ANCHORAGE (MOA) $~2.~/t~,~,~!_hority Approval (HAA) ~UKLIST - FEBRUARY 1984 343-4744 Legal Description: Well Log Present~)'N) "/. Date Completed Total Depth ~::~ Cased to ~ Depth of Grouting Static Water Level \ Casing Height Above Ground Electrical Wiring in Conduit~:C~/N) "~ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field or~ Lot To Nearest Public Sewer Line ~/~ To Nearest Sewer Service Line on Lot Pump Set At Sanitary Seal on Casing(~N) y Depression Around Wellhead (Y~I~ if A, B, C, D.E.C. Approved (Y/N) Yield L/-'3¢- "7 - ~5~'~_ / ; On Adjoining Lots --~--'~.~/(~ 0 '~' / ~ ; On Adjoining Lots . To Nearept Public Sewer Cleanout/Manhole Water Sample Collected by ~ ~ ~t~lt~c:~'~j~l~ ;Date Water Sample Test Results ~'~\~~ -~c_~ ~' Comments '~ ~/'~ '~_L~ d-~.~ SEPTIC/HOLDING TANK DATA Date Installed ~-'~.-i~l Size Standpipes ~1) F Depression over Tank (Y/<:~ Air-tight Caps ¢~7N) Pumping/Maintenance Contact on File (Y/.N)! Holding Tank High-Water Alarm (Y/N) ~_X[/f~ No. of Compartments ~/ Foundation Cleanout~N) ~/~Date Last Pumped '~-~:::~ ; for r~//~ Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ~'[ ~ t To Building Foundation To Disposal Field To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course \ ~ ~ Com merits ~'¢ ~ ~~:~t--' "~ i~¢l r~, 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field '~"~' '¢~.7~ Type of System Design ""~'~"~-~-h~L~ Length of Field Depth of Field Gravel Bed Thickness Square Feet of Absortion Area Depression over Field (y/~l Statndpipes P resen t<:(...~TN) y Date of Last Adequacy Test Results of Last Adequacy Test .~'_/~--..-.'¢~ ¢7 ~ "-' ~ ~2~¢---~ SEPARATION DISTANCE FROM ABSORPTION FIELD: I \. C)c> To Property Line To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway,.Pa. rkigg Area, or Vehicle Storage Area C o m m e n t s '"¢z~'~ ,¢'~ ~t-~C-/L · ¢:¢1%5~h''W~ To Existing or Abandoned System on ; On Adjoining Lots °PC>~"'~ To Cutback (if present) ~ D. LIFT STATION A//~ Date Installed Size~ in "Pump On" Level at ~ High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Pumping Adequacy Test. ~ **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date-.:o;.f this inspection. ":'.': Signed $ & $ ENr_.!NEF~INc. Company 17034 Eagle RiYer Loop Aoad No. 204 Eagle River, Alaska ~'¢5Y7 Date MOA No. Receipt No. 02-/// ¢ (~' ¢''/aC') Receipt No. Date of Payment //¢'"'% %/c~ Waiver Fee: $ Amount: $ /.F~¢) Date of Payment 72-026 (Rev. 7/88)Back Page 2 of 2 Tom Fink, Mayor Municipality of Anchorage, Department of Health and Human Services 825 "1_" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 May 8, 1989 Robert A. Shafer, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 30 Lake Hill Acres S/D 91 Waiver Request ~WR890022, HA890158, PID ~051-052-33 Dear Mr. Shafer: Your request for waiver of the required:100 foot separation of a septic system to a private well has been approved. The approved separation distance(s) are: wells located on Lot 30 and Lot 31 to the septic systemon Lot 30 of 91~feet; distance between the leachfield on the west property line to five feet. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincerely, Daniel J. Roth ciVil Engineer On-site Services DJR/ljw~6 ~AUHictPALiI¥ OF ANCHORAGE ~.Nx/ip.O~qMENTAL S~.~/C~S DIVISION /:,PR 2 7 9B9 ROBERT A. SHAFER p,£CEIV[D Apr 1989 CIVIL ENGINEER 694-2979 HEALTH AUTHORITY APPROVALS SEWER &WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, Alaska 99501 REFERENCE: Lot 30; Lake Hill Acres Subdivision #I Request you issue the attached Health Authority Approval (HAA) and grant a waiver for the horizontal separation distance between the septic system and the private we~ located on the referenced lot and the private we~ located on the neighboring Lot 31 at a distance of 91 feet each. Also request you grant a waiver for the distance between the leachfield and the west property line to 5 feet. This property line is adjacent to Lake Hill Drive, therefore, the septic system will not influence any neighboring septic systems due to its proximity to the property Prior to the on-site wastewater disposal system being instated on this property a verbal waiver was granted by the Municipa~ty of Anchorage (MOA) and a note placed in the files for a horizontal separation of 85 feet. The installation was performed in August, 1981. A risk analysis has been performed and it appears that no bacterialogical pollution is possible from this source. Attached for your review are the following documents: A. A site plan showing relative distances between on-site wastewater disposal systems and w~. B. Risk analysis waiver review worksheet. C. Coliform and nitrate analysis of water taken from each well.. D. A well log for the well located on the referenced property (there is no log on file for Lot 31). E. Well flow test results. F. A note found in the Department of Health and Human Service (DHHS) files waiving the separation distance to 85 feet. 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 page two Lot 30; Lake Hitl Acres #I April 27, 1989 It is our opinion that the horizontal separation distance prescribed by 18AAC72.021 is not required in this case. If~re additional ~information, please contact us. SCALE CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ~.~..~ 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907)562-2343 FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order ~ 12855 Date Report Printed: APR 25 89 @ 12:$8 Client Sample ID:L31, LAKE HILL ACRES PWSID :UA Collected @ hze. Received APR 20 89 @ 13:00 hrs. PreserYed with :AS REQUIRED Client Name : S & S ENGR Client Acct: SNSENGP P.O.# NONE REC'D Req ~ Ordered By : Analysis Completed :APR 21 89 Send Reports Laboratory Super¥ispr :STEPHEN C. EDE 1)S & S EHGR Special Instruct: Chemlab Ref $: 4963 Lab Smpl ID: 1 Matrix: WATER Allowable Parameter Tested Result/Units Method Limits NITRATE-N 0.11 mg/1 EPA 353.2 10 Sample ROUTINE SA~4PLE, Remarks: Tests ?et£ormsd ' See Special Instructions Above UA=Unavailable None Detected '= See Sample Remarks Above Not Analyzed LT=Less Than, GT=Greater Than LABoRATORiES CHEMICAL & GEOLOGICAL OF ALASKA, INC. /~¢X 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907)562-2343 FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SA}~LE for Work O~der ~ 12789 Date Report Printed: APR 20 89 8 16:08 Client Sample ID:LSO, LAKE HILL ACRES PWSID :UA Coiiected APR 17 89 ~ 15:15 Received APR 18 89 8 13:00 Preserved with :AS REQUIRED Client Name ; S & S ENGR Client Acct: SNSENGP P.O.~ NONE REC'D Raq ~ Ordered By : RJS Analysis Completed :APR 18 89 Send Reports to: Laboratory Superv?or :~TEPHEN C, EDE 1)$ & S ENGR Special !n~%ruct: Chemlab Ref 4:4931 Lab Smpl ID: ? Matrix: WATER Allowable Paramoter Testad Result/Unit~ ~ethod Limits NITRATE-N ND{O,1) mE/1 EPA 353.2 10 Sample ROUTINE SAt4PLE. Remarks: SAt,~LE COLLECTED BY RJS. Tests Performed See Special Instructions Above UA=Unavailable }]one Detected ~' See Sample Remarks Above Hot Analyzed LT=Less Than, GT=Gzeatez Than .. INSPECTION APPOINTMENTS TIME INSPECTOR I NSPECTOF~- ~(¥ ~' I NSPECTO~ :. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROT~IPALITY OF ANCHORAGE  825 L Street - Anchorage, Alaska 99501 . DEPT. O~ HEALTI-] & ~ ~NVIRONMEN~AL PROTECTION ~ENVIRONMENTAL SAN ITATION DlVlSlON Telephone 264-4720 /[U0u ~: 1981 91RECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER . ~ PHQNE MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAI~I~G 3. LENDING INSTITUTION PHONE 4, REALTOr/AGENT PHONE MAILING ADDRESS 5, LEGAL DESCRIPTION STREET LOCATI O'N 6. TYPE OF RESIDENCE [~'SING EE FAMILY [] MULTIPLE FAMILY 17, WATER SUPPLY [~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM [~1 N DIVI DUAL/ON-SITE** [] PUBLIC UTILITY NUMBER OF BEDROOMS [] One [] Four [] Other~ I~zw ~eTC~.~,/~, [~] Five ,,,,,,~;]--~% h r ee EZ] Six ~¢'/~ 4' ' * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) /¢7,/- ¢, /¢73 YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS ~ SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER E~] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or []HoldingTank Size: tf Tank is homemade SOILS RATING give dimensions; TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCES Septic/Holding Tank Absorption Area Sawer Line ~Nearest Lot Line / WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS PROVED FOB3 BEDROOMS [] CONDITIONAL APPROVAL (latter must accompany cerCficate) [] DISAPPROVED 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 26¢4111 GEORGE M. SULLIVAN, MAYOR August 10, 1981 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PRO] EC FION E.L. Nowotny Post Office Box 716 Chugiak, Alaska 99567 Subject: Lot 30 Block 1 Lake Hill Acres Subdivision Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: 1) ~b~(2) The water analysis repo~ needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. The septic tank pumped with the number of gallons verified by a private engineer, on the receipt. This is to verify the size of the septic tank. This will needs to be submitted to this office for our review. ~(3) The minimum distance from the well to the septic-tank or drainfield is 100 feet. 'The distance from the ~ neighboring well to your drainfield is less than the 100 foot requirement. It will be necessary to relocate the drainfield.  ) Prior to any construction a soils test will need to be · obtained. A listing of private engineers performing  this test is enclosed. A permit from this office will · then need to be obtained for the installation. ~[ ~ there are any further questions, please call this office at 264-4720. Sincerely, James S. Roberts Associate Environmental Specialist JSR/ljw