HomeMy WebLinkAboutGREENLAND BLK 1 LT 6Greenland Block 1 Lot 6 #015-172-24 Development Services Department Building Safety Division ocnr GE. BG ; ; On -Site Water & Wastewater Program 4700 Elmore Road Z , J' P.O. Box 196650 a " Mark Begich Anchorage, AK 99507 s n E T Y Mayor www.muni.org/onsite (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW Date of Issue: Parcel Identification Number: Legal Description Property OwnerName& Address: Green a n G, 6 �G`�✓(3(,\ V 0' woo L Pump Installation Date: Pump Intake Depth Below Top of Well Casing: Ift feet Pump Manufacturer's Name: 14,17e Pump Model: -551?., Pump Size 1/ ;?, hp Pitless Adapter Burial Depth: AI feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: Well Disinfected Upon Completion? Ell Yes ❑ No Method of d, Disinfection: �/% Comments: N 2—/)(ZioJCZ Pump Installer Name: ANCHORAGE WELL & PUMP SERV. 330 EAST 76TH AVENUE ANCHORAGE, AK 99518 PHONE: 907-243-0740 AWPS.COM Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Municipality of Anchorage Page of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 S Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW 9 4 01-7 3 _ -- PID Number: _ 15 - 1-7 2 - 24 - Name. 77+4 Wastewater System: o New Upgrade Address: v a J' 4 8 a o a4-s---rl � Z; �-F A e. ABSORPTION FIELD Phone: 3q- .3 DQ Z. No. of Bedrooms: �j ��..(( XDeep Trench ❑ Shallow Trench O Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating Total Depth from original grade: 9I.(04'— iD.66� •4*5 GPD/S.Ft. Lot r!- Block: Subdivision- I - L'')•D Depth to pipe bottom from original grade: / t 3 7 — 2. Gravel depth beneath pipe . �% FI. S , Ft. Township: r, (�- Range: Section_ - Fill added above original grade: e-. Gravel length: C� 6J N I , 14- Z- J(o+ Ft. Ft. ❑ New ❑ Upgrade Gravel width. / + Numberoflines: Dislanceb ween lines: FL Fl. Classification (Priya ,B,C). Total Depth: ased To: Total absorption area: Pipe material: Iii; Ft Ft. 10-18 SO. Ft. 0303+- ii _ Driller ate Drilled: Slatic hater Level: Installer. , CA -2.L5 ExCAVAil J6- Date install d: % i6 FL Yield: ump Set al:ng Height Above Ground: TANK CPM Ft. FL SEPARATION DISTANCES )A Septic ❑ Holding ❑ S.T.E.P. To Seplic Absorption Lift Hold,ny Public/Private Manufacture[ I' ii ^r'n^J K- Capacity in gallons: 1 d o 0 From Tank Field station Tank Sewer Lines y -w -f Well / t l I� / ^ ro /* Material: Number of Compartments: Surface K �� ,� LIFT STATION Water Lotz� / 4,�D / ��15i Size in gallons: Ma Curer: Line _ Foundation "Pump on' level at: "P off' lev n High water alarm at: - Curtain /� /,4 Pump Ma . oriel Electrical Inspections performed by: Drain / t4 N/� Remarks: BENCH MARK Location and Description: 7PP Glo �f 006- 2-L PUA-j V'�J (;'2 LoCA.:__1 //�� r •, J/1 -h1-(__, -(=. J a� j�i�� -1-}�� Assumed Elevation: 10 0 . 0r-) Ain so/ -1& 624 -VAC. (f�s� s, pili ,s v P10MAA1 Win c Y:4 t • s.« p ee ov , �e�E�S 6 /6 R4 Inspections performed by: Dates: 1st 2nd /6 ��{' ; r Y Garneu' - r iii C�f1.CiO,;,�—=,+.- /a//0/Gl `�- �/iP . j a 95310 Department of Health d Hu .�^ ervices approval �O9FoPROF iii /'g- Reviewed and approved by: Date: fax V 72-013 (Rev. 9/91) MOA 25 /N lam— Dw (�r a/a DO(I Run I FaoN S5- too. E. "jTLF...�CFF N®vJ C/o po1NT D To P C/o 15 T}E MSume-D REJCHmAr2g 100. op U ISI TANK c/O fel V.X15'n..�C-r IT SUMP J V� I� f J 13S BE..)D ..%� NEW 1000 .... .....-^"". SF-(mc Ct o/o {'o1Nr o/p Tn T('l.F_'JG+ /ap- 16'3 'ro , .�c Tn-IVBD= 39'-3° AZ- = 7z ri �uJI "M-E�JC11 —s Aun- w-Nn-mR. vPwE 8 E: = '70 L S" poiNT�Fu M T A = g� u TFsr (3F- 0I -4 1 n CI CT= 100-8 3o RG3 4i' -1O„ �o m Ino. no S.O u K,_-� r-- i 1 3 -"A ANF= _ .pRaPaasD P-oQR: (zap 1 N4A.JCVY ljMt`n-t �- 'PATE : 6118 /9.4 DzAWN : &ARPS-5s sC.,a.� ( 2/A m -OF A Z"A4 4840 sea ilto 96899 A*,, 0 / f ey A. Gal aaL.w s- f.� CE -7953 ���� l� FOOUUNJDDAMVJ C/ M CID es 175' ®TaP T"Y- = 9z.05 10 oo Co\ _o'3 -. SECri c IN�T INV. = 91.61 OUTLET INJ. _ 'q1.�32 LTev VAL.'J.NQ-rrG; VAL_V E E=x i s•n,.l (=- c/o, Ir,W. Z5r� $r �j 1 + N.T.S n:r.5 N.T.S Ci/o -T- Go 3pr cI6.S7- I- F LbG P -UN FEJCE. G(zoVND G EJa; ON IN DOCS- RvrV AREA. IS , �o.nPvc-iv(��Pt�r�P 4' lasuia�onl QoA-20 nNs=....K sf-=Wsg-SR('e IN-n-yiS T7 J Cr A(T�A . COULD NOT pW c E MuRF=( Sti l Go /C� �l_F_.v S '8 �E�D ND poa2 �-1-�-�S1anl.ti Is a-f'Pf�oX. �r-�E C/D IDO, 0O 6aA-DG o g3.(0 ® MOUNDED Soil OVER 6P--oJNO EI V. = of 13 4D i'R-Fs1cN .. 6POUND C-IF-J- O\IE.P-riwiv- In -462'I - c/o-r/'TG-p..Jc+iPWE Q10 7T.)soil le— MpVNQI=p / 94.1+ ®TaP T"Y- = 9z.05 10 oo Co\ _o'3 -. SECri c IN�T INV. = 91.61 OUTLET INJ. _ 'q1.�32 LTev VAL.'J.NQ-rrG; VAL_V E E=x i s•n,.l (=- c/o, Ir,W. Z5r� $r �j 1 + N.T.S n:r.5 N.T.S Ci/o -T- Go 3pr , o.4 4 N.T. PIPIaG P�cv, H-vuSE. fry SEPTIc'r•AJIL t�lr*S Nc>1 INSP�C C -.D P,y 'VVOP-K WA"• DOn1F• INDE-Pf JO E,ITI.� l Cl 0 N `f?� L^r-D2 a p 1112 Lj AV 4,711 N E5 = g0'rTpM TC-- :T 1-40 LF ND C�L'OVNDWA"r[.P ENCoVtv?EJE� '���� %%% 441 OF ,q L,4 SEPTIC UPC �nOG L;:5T (o BK 1 G2Fs---N L/a>JSU s /Dio • p = P.EPa►2�D I j �� o c �f fr A. Garn e-- MIZPAaaD Wi ALASKA WATER, dj WASTER! A7 -E -p, SEP-V[C Es ,,�J nn�n� E-7953 AW (0%18. q4 peawN : C�APJNI) s�,,art_. o�� c Municipality ®f Anchorage �i��� Department of Health and Human Services d r Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 June 28, 1994 Jeff Garness, P.E. Alaska Water & Wastewater Services 8471 Brookridge Drive Anchorage, Alaska 99504 Subject: Waiver Request for Lot 6 Block 1 Greenland Subdivision Waiver Request #WR940037, PID #015-172-24, SW940173 Dear Mr. Garness: Your request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is 0 feet. This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Since ely, Robert W. Robinson Civil Engineer On-site Services ljw#7 MUNICIPALITY OF ANCHORAGrt Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR940037 PID# 015-172-24 HA# _ Permit # SW940173 Date Received: June 24, 1994 Legal Description: Lot 6 BLock 1 Greenland Subdivision Engineer: Jeff Garness, P.E., Alaska Water & Wastewater Services 8471 Brookridge Drive, Anchorage, Alaska 99504 Applicant: Rodney S. Smith Waiver Requested: Lot line waiver - 0 feet Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Points: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: ,7/ o U1101 Date: &/.z 7 /jvl By: �-c� �C�-Gc� Name of Reviewer Rec #: 00044 Amount: $115.00 Date Paid: 6-24-94 Alaska Water & Wastewater Services "Preserving The East Frontier" MEMO FAX 338-3246 PHONE: 337-6179 DATE: NUMBER OF PAGES: i7 (Including Cover) TO: M.O. A D1-1 11S FROM: �16FF=�l1fL�t�Ss COMPANY: M • O . /� SUBJECT: �T-I O- -g u k L--% l 04' G,o� Q,IL � 6(t�-ECJ IA�+D SAP MESSAGE: 'i`(Z�' W A� �, 1 S i1�t,LS D i 544at.lAw64 Dr1 ! —144,1) 4o.J o0-161n,A1 v P2 o Po S E!J Ea co u,a-rE.� v �,• Soca 0 sorts-(�u'an u � r -f -c �s,--ras'.K�6 LGri�i�1 JD C- s`15?�E�-t' lS JF2 CoaS�ILvsk�vE 2. �XIS�11� - cat , SFP±1L 74 1y sx15'7' 0L -D K wR3 A-B"OonrF� r�J P� . ZI�2 bF off - )cam t vA3 vF-F Pitz? . T���G4� USS 1/J SI Q ii P2oQ�n'C`1 LIrJ CONrzE-L �� 0t -D <- cS W 1TI-1 ArL-A E0 -At A -" b,2 JA L -VF-- l P �lYl�-fid 4 1 S Now INSiD� P2oP "7 �fP @ I S AR o LA Z'/z �-5-1 S H-oa:;( `tom g 0 21� V Eta ( S N a t Lo J •� A l� o L4 I Fao r Ca v6e. Q 5 "A-i,Lo W aS� �1N7",Q9,CorJizXl , y a CL IriSuy��0J g04jZO ov£2- eiPia'. Sincerely, CMALD NOT ADD SO1L, 0-0\r6f, -T)4 E S 4-v D I -P Jeffrey A. Garness, P.E,, M.S. Owner/Consultant Telephone: (907) 337-6179 • Fax: (907) 338-3246 . 8471 Brookridge Drive . Anchorage, Alaska 99504 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE 1)UL)-YA DEPARTMENT OF HEALTH AND HUMAN SERVICES is_1(09( P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940173 DATE ISSUED: 6/13/94 DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES EXPIRATION DATE: 6/13/95 OWNER NAME:SMITH RODNEY S & NANCY L OWNER ADDRESS:4800 E 112TH AVE ANCHORAGE, AK 99516 PARCEL ID:01517224 LEGAL DESCRIPTION: GREENLAND BLK 1 LT 6 LOT SIZE: 27117 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK 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 343-4744 (24 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: A LOT LINE WAIVER WILL BE REQUIRED IF INSPECTION REPORT INDICATES THAT THE STILL 1N USE, IS LOCATED ENTIRELY ON WITHIN 10 FT. OF THE PROPERTY LINE.-, RECEIVED BY: ISSUED BY: THE AS -BUILT EXISTING TRENCH IS THE PROPERTY, AND IS DATE: DATE: l )" Alaska Water & Wastewater Services "Preserving The Last Frontier" May 28, 1994 Municipality of Anchorage Department of Health and Human Servic=es Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: ,epti.r- System Upgrade for Lot 6, Block 1, Greenland Subdivision. To whom it may concern: Attached is the application, site plan, and design drawings for the subject septic system upgrade. C=omments regarding the propose=d system are as follows: 1. TRENCH DES_IGAN = As can be seen f rom reviewing the attached percolation test results, the soil "perked" at .34.3 minutes/inch at the location proposed for the system= For a trench system, this corresponds to an application rate of .45 gpd/f t2. Since the e=xisting Biome Has 3 bedrooms, the to[:al design flow is 450 gpd. Based upon this, the minimum amount of absorption area is 1000 ftp. The proposed trench is B feet deep and 65 feet long, providing an absorption area of 1010 ft2. 2.. SURFACE WA7"FRn None observed 3. TOPOGRAPHY: No slope concerns 4. UTILIZATION OF EXISTING TRENCH AS STANDBY SYSTFM_ The as -built survey of the property revealed that the er<ist.ng septic tank :is not on the property. Our intention i_a to abandon the existing septic tank, and find the end of the existing trench. If it is determined that the 1,rench is on the property, an alternator valve will be installed so that the homeowner can switch back and fort=h between the: ncaw and existing systems. It is likely that the existing trench will k)e closer than 10 feet from the property line;-, and a waiver will be required.: I am unaware of any adverse impacts associated with ttre proposed waiver; therefore, 1 am requesting that; the separation distance to the property line be pre -waived to 1 foot. It we are able to connect to the old trc nc1-1, 1, will note it on the as-•bui.lts, and submit the $115.00 fee Por the lot line waiver. Z realize this is not Telephone: (907) 337-6179 . Fax: (907) 338-3246 . 8471 Brookridge Drive . Anchorage, Alaska 99504 the usual process for obtaining a, waiver, however, since we are unsure whether it is going to be necessary, I don't want to have my client prepay the fee= If you are unable to do this please nate on the permit that the inspecting engineer will have to request a lot; line waiver if field conditions dictate. Your flexibility in regards to this would be greatly appreciated. I am unaware of any negative impacts that this insllall.ation would impose on adjacent wells, or septic systems_ If you have any question, please call me a 337--0179. Sincerely, Jef Own JAG/jag Smith2.WPS M -S. I1 ..• aOFESS10..N.w� CAOT Ioolle P21vA� W 6� sspnc. wEI.l. �0712� aK'1 LoTn� BK—f palvr w 9i>E G O Q -I wEU. w�u- Q, L07- Z I Lor 1 BY -6 gk !a U/ uo,asE^ R Y, goo ptzj,A LoT 3 w2u- 4 ak 2- 5=� a Fla sv_ i I'OT6 L07 S SEPn�- �o QK I RKI Y BK I BK \-O-T- -o'rY, Y, ptzj,A LoT 3 w2u- 4 ak 2- 5=� 3 0 Y SSP ri C UPGPA�F Loi (b Qp -P2 pA2ED %Y : ALASY-A WATER. � WAS 7-ERI �� .p4-rF- I. 5/zo/C(4 De_awN -. GA2NE.—'5%S sa.LF- = I = 10o -• OF A qj ���PqE•......., *,,4 ff e A, Garne'ei,_..; • E•7953 (C ••• ••' • /7 F DoNDA-n D^) c/o 1 Dora RvN 1.-*' 140H ,s N6N1 c/o "y I \S � 1=XIS71..1G SEPTIL ' EXiS-r'I,�U <EwF1L, LINE ,,--11'' F2or-t HovSE TD E`�I�l'1..1G SEPTIC. Ta-Jk . 40C.A'Tpa U� LINE IS Q�SVt"I Fes, e NEVJ "cb Pv C SEWER l..t,vE, %1k n EXlsn,.sCr SI.oPE �J NEW 1000 64-t,WN 5Ef'11G 'j"K1NK W 3 C/o •TD TC-NcN nn< I1 TANK c/D C/o -ro '>SPTic TA-JV- V I I i I I --- -- NF -"j -W-EsrC" Q -/D �-No'I'� � >=xlsnaCT SCPrIe. F;��,aG wt-n� GanveL. .�+VEIZIF�I 1F- EXI<�-ti,�•fCr'j'C'�1CLJ IS o� P2opt=lr�y„. IF `off CDNNEGT (.V,TI-� NF�^1 �jY2F�JC FI OF �JEVJ SE P� c TRK Q 510 G- A^� INEFe Wll.l_ APPL.�1 Fol l.o'f- II � i lWE walvER. loy, 0O T -L F_,4 ST I l � TH -?P—fFPAe,ED 6Y : ALAsV-A WA'r'EZ W4S'TEWAI—=k, <-EP—VIC .La PATE: 5�zfl�g4 DeAwN 6AP�ESS scALE - I �ar �(E OF q� .Q`-aNpe••ee. Al O Ne9eVf It me aaefe riva..ar e • r,i. r1• •...• ♦• 3J', E-7953 ���� f f j�9Rp'•••..a...••'•�`��r'r ��� ROFES51o�aP� Fol t_OCA norJ MDNIT0�INC> ' �— • MOUNDI l L1F-D SOIL_ TV C3�. S z f=— F_ r4TTA-G�-I�•.,p �1'f'E. 'PLAN Q// F � 7 NATIVE SOIL"� Sll_T BAR2l o(Z � I NSN LAm O� �oA2'P M i7�Alrs P1P�; t;viTN ._ STA l.�D L,EV E L it4,0 o °Q wAl�s MUST BE �A'�� - o- AL. TY2,Ei fGl 1 / I-SJCv' 4 =dww�5 oR sCa21�IEP P�1n2'TD 4Sso2ST10N (ZEA .z =� 10+0 0 a, I -A41 -14 o \ Z. I rJ S Crit /`� DRAIN RFK ' „ � �INsn-u So1L� 2r^Orr �Min1 Ol E p2AIN PGY-5UAL.L li�E 1/2 V4CA '70 - OF A 10 [f2�NCN NAIL : LOT 6� SKS J C���Lf�1� SII 0 j •• �i Sir P(7�PAr2.E.D F'02.: 120 ►'� � No..i Cy 5 ra � 'I�-+ .... �'./......... �a J fr y A. Ga�5 ALP.SKA WA-rER: � \KA-�7rENA E!' C S.V I C" �e CE -7953 �•.' ��d e Q 9;'••..........•• Dq �pROFESSIO��A"r; ( 5/zg/q4 ppAv,rN : C 1.J�S5 CA LE : N'iS INN% 0�®.. r Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES ~ 825 "L" Street, Anchorage, Alaska 99502••0650 ' SOILS LOG — PERCOLATION TEST + PERFORMED FOR: Ro D I—c--i- DATE PERFORM LEGAL DESCRIPTION: i>`1LF�D s(p Township, Range, Section: N SLOPE 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 (FEET) O(L�vgn�ICS '5 I L•T�f sOr.� PO GIGE� ISAADy - s � 5oit-• A A �,�.. ,:; ,"°—•� IgA H 13 ? A i• 40.08, • . • 4444 ;... Ro, A. Garn )CE -7953 ?w`� ;RQFESSIO��,,�5 1A4- 72-008 9`p- !''t) M.an (a'j re >% S {�LASTI C/ L IF YES AT WHAT O �I„rE. s. err aoNDED SILZ-`1 ewy 1307 To f-1 µo tE DEPTH? a P E Deplh to Waler Aller Monllorinp? N A Bate: S z9 �tl &14 5oi b• 1 P✓asrl Bib C�bw Sb. -IE Poc1�-rS orr FI�P� SLi.�]�. SOME SorIDE-0 t�.asE,S of 511.T' % WAS GROUND WATER �s S1L-r WA -S ENCOUNTERED? !''t) M.an (a'j re >% S {�LASTI C/ L IF YES AT WHAT O �I„rE. s. err aoNDED SILZ-`1 ewy 1307 To f-1 µo tE DEPTH? a P E Deplh to Waler Aller Monllorinp? N A Bate: S z9 �tl 20-I I ^�� IL—�I PERCOLATION RATE J�+-' ?(minutes/inch) PERC HOLE DIAMETER 6 /t TEST RUN BETWEEN �' �_ FT AND -7 FT 'OMMENTS �(or•-"e-.JD DP516Q ?A -SE:) UPI)/ -J -r'tl'�r sclu . PERFORMED BY: �p �^a`C' I V 'TOSS CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: _ �j¢' 72.008 (Rev. 4/85) Bib 20-I I ^�� IL—�I PERCOLATION RATE J�+-' ?(minutes/inch) PERC HOLE DIAMETER 6 /t TEST RUN BETWEEN �' �_ FT AND -7 FT 'OMMENTS �(or•-"e-.JD DP516Q ?A -SE:) UPI)/ -J -r'tl'�r sclu . PERFORMED BY: �p �^a`C' I V 'TOSS CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: _ �j¢' 72.008 (Rev. 4/85) 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/Olt wEI I IN.-:PF:r.TInNI RPPnPT NAME '— PHONE ❑NEW RADE MAI LING AD ESS 7 y LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS NK j DISTANCE TO: Well Absorption area Dwelling PERMIT NO. v Y a. Z Manufacturer Material No, of compartments ` NF � Liq. capacity in gallon s //000 IF HOMEMADE: Inside length Width Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. 02 F Manufacturer Material Liquid capacity in gallons O W 2 DISTANCE TO: Well t 9z - Foundation o Nearest lot line PERMIT NO. of J LL z No. lines Length of each line Total len th of lines Trench w[id�th Distance between lines ~Za�7 Q Top finish TI Inches I- © of tile to grade % 2 1 Material beneath tile Total effective absorption area inches 14010 lu Length Width Depth PERMIT NO. aH 1 Type of crib Crib diameter Crib depth Total effective absorption area IL DISTANCE TO: Well Building foundation Nearest lot line j Class Depth Driller Distance to lot lint, PERMIT NO. ..I LU DISTANCE TO: Building foundation Sewer line Septic tank Absorption area (s) OTHER � •� ' PIPE MATERIALS //�� SUI L TEST RATING :7 0 INSTALLER ` REMARKS n 1110 — tui 17 APPROVED //_DATE "�' l�LEE,GAL 1,elk.JP-4 I C I' FvL_ I --Fl-e OF�- F-llr-4C:+.q DEPARTMENT k, HEALTH AND ENVIRONFIENTAL t-,,-,.,OTECTI%1r--4 825 'Le' STREET, ANCHORAGE, A[:". 99501 264-4720 C-1 r-4 _F FF: 0=-. F:: 1.4 IE F;P" F:::u EE F -Z P1 Ir '-I- r, �zJJAS, I& �T PERMIT NO. E-:00217 �u --fib-k , 18-vt �) - APPLICANT MCL. IN CONTRACTORS PO BOX 8-82<5 [IT. VIEW 33.25-1294 LOCATION 112TH.&WINDCHESTER LEGAL LOT 6 BLKO I GREENLAND SUB LOT SIZE 27110 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF' BEDROOMS = 3 SOIL RATING (SQ F'T*,,*BR)= 150 THE REQUIRED SIZE OF 'THE SOIL ABSORPTION SYSTEM 15,: I:> u F=:°,lr " -_l.!5 t- E=Er-4 0 -F H = =<:3 1:3 fR, n %.-"E: L_ C -"n OF Ft-i w THE LENGTH DIMENSION 15 THE LENGTH IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). F-"F=0LJ 1 FAF=E.0 S-5f-=lF-`V :1 f__: _lr 19 Ir -4 K 'F5 Y ._'.I--- :IL 0 0 IEN f3 F::i L_ L__ L -_l Ir -4 E. PERMIT APPLICANT HAS THE RESPONSIBILITY 'TO INFORM THIS DEPARTMENT DURING3 THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL L41LL SERVE. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION FIND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT' TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL FIND ANY ON --SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE 'S'EWER LINE Is 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER RE,.-,!LIIREtqENI*S MAY APPLY. SPECIFICATIONS FIND CONSTRUCTION DIAGRAMS ARE AVAIL -ABLE TO INSURE PROPER INSTALLATION. F,'ERE-F;Nrel I -IF f=_*w_4F=l* 1 Fes: E:!S. CSA EE: C-E:r-lF_3E:FZ 2-c-1 .. d- f-7-1 I CERTIFY THAT t: I AM FAMILIAR WITH THE REOUIREMENT'S. FOR ON-SITE SEWERS FIND WELLS AS SET ''GIRTH BY THE MUNICIPALITY (IF ANCHORAGE. I WILL INSTALL THE SYS -TEM IN ACCORDANCE WITH THE CODES. I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE ESIDENCE 1: R..EM0. LEDN0.1 -'LUD MORE THAN 2; BEDROOMS. 13NED: T)J Ck 4T rj� n APP ORES 11ED BIT, V4. C, i SO I LS LOG \ MUNICIPALITY OF ANCHORAGE \ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST Pouch 6.650, Anchorage, Alaska 99502 276-2221 SOILS LOG — PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: i=' / z'yo LEGAL DESCRIPTION: �-0 / 6 K �� I`e.c.,.l.�.-..! S Lid'g , _ Net Time DEPTH SLOPE r—,--- SITE PLAN (FEET)- 5 2 -- — — I --r i ' 4 5{/cl s r 6 !, L 4, ) r - 8 - /7//eS, j �J7 ., r. 6 kr 10• 11 ' WAS GROUND WATER S ENCOUNTERED? L - 12 — 13 14 - �O 15 16 17 18- 19---- 20- COMMENTS 819 --- 20COMMENTS PERFORMED BY: ( ✓ / J 72-008 (7/76) O P-__-.---.-- IF YES, AT WHAT E DEPTH? '.. Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN utes/inch) ° �� -csQd aon c �. ob_ ac Boa ooc for C. Reid, Jr. rf j G No. 2251.6 TE: - DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME 30n, SINGLE FAMILY _ ❑ Two ❑ Five DATE DATE DATE �fJ/ ►-g.9- M ® (1�2y_L 1 ER INDIVIDUAL* ' ATTACH WELL LOG. A well log is required for all wells drilled INSPEC R ` INSPECTOR INSPECTOR � MUNICIPALITY OF ANCA MUNICIPALITY OF ANCHORAGE DEPT. OF I ALTI1 E, DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECFNIeRONVENIr.'._ ,- •-'iECTION 825 L Street - Anchorage, Alaska 99501 tN • ENVIRONMENTAL SANITATION DIVISION Telephone 264.4720 V 1T® REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWEW DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE 344-4465 MAILING ADDRESS SRA Box 1720 B. Anchorage, Ak. 99507 PROPERTY RESIDENT (If different from above) PHONE i S� X�1CX��I XX i�fPff3titiC�iX$$ti��dd� 112th & Winchester 232KXZRX 2. BUYER PHONE Eric C. and Ann -Marie Lindboe 337-1.271 MAILING ADDRESS 5325 Sharon Apt. D, Anchorage, Ak._ _ 3. LENDING INSTITUTION PHONE Coast Mortgage Co. 279-0665 MAILING ADDRESS 4797 Business Park Blvd., Anchorage, Ak. 99503 4. REALTOR/AGENT -- PHONE Reese Real Estate - Bud Retzlaff, Associate 276-6266 MAILING ADDRESS 4489 Business Park Blvd. Anchorage, Ak. 99503 5. LEGAL DESCRIPTION Lot 6 Blockreenl and �— Subdi vi si nn STREET LOCATION 112th & Wi nt-hPS+-Rr 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ED One ❑ Four ❑ OtherEX SINGLE FAMILY _ ❑ Two ❑ Five ❑ MULTIPLE FAMILY kJ Three ❑ Six 7. WATER SUPPLY ER INDIVIDUAL* ' ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM EN INDIVIDUAL/ON-SITE** unk. _YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. T C`S 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY �- �. 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ SINGLE FAMILY ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ MULTIPLE FAMILY ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY PERMIT NUMBER ❑ INDIVIDUAL DEPTH OF WELL ❑ COMMUNITY DATE DRILLED Cl PUBLIC UTILITY Connection Verified___ LOG RECEIVED - 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER ❑INDIVIDUAL/ON -SITE DATEINSTALLED ❑PUBLIC UTILITY Connection Verified _ INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line WELL T0: Absorption Area to nearest Lot Line - 5. COMMENTS \�• l,�jlh !d.d'v��E/ �!-'4�F� P t i,..,�..4� - - s,J�t,_e,. ,, Jo AfCe-`- i-`. .Ai.C,s s1. ,G61 !,.(.�ri r -c'}- ,; ih.-°' A 4�•� I�l„7 .f•L„F. )-,Q'f-.a .l.s -,=.. b1 ''+.a. (/fit /� � -r�-1 1-.�—dam— . f x..lp _'[�.:,lr �o..f 1 CV' APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must a om any certificate) ❑ DISAPPROVED DATE �� BY 1' r 77_mn (Rev. 6/791 January 9-9, 1900 John L. rrisom TT an upgrado is necessary a i)ormi.t rause be i:ssixed by this departwht. Prior to obtaining a permit a soils -test will need to be su'Smitte d to this office. please notfly this department for a re -inspection when thc' noted descrepanc.i.es have been corrected. Tf there vire any further question, please contact this office at 2_64-47120. Sincerely, Robart C Pratt, R.S. Associate Special -100 cc a (saast T-TortgGLgo CO. 4797 nusiness Park Blvd. 99503 Reese Ileal l,state n> Bud Retzla f 4489 Business Park Blvd. 99503 Jannary 2(), 1920 N. 09509 l};JC?Ct Lot (p 3lonk It (-')7eE'.i1J.R1! yt1b(I-1vi::Acn-i Approval for your Inrlividija1 z3mier zino wator fac.ilitie's can not I o grcinteJ ilnt,ii, the. ni tMowi.nq items hav-:� 'nen c-c>npletcd-. (1} n :soul: (4.) inch cast iron clucanoul.- nemlo to km ;i.n,t-alle J in t:hu, Septic tan" a1-1r'R/ar. lfr tc:h?.n�l areas . (2) The septic tan , ix-tioed 1` it -A3 a b:'L}Cl`.Apt. to office. (3) An 7(lE3cxuncy ttost: bo I743r 0r_ylecl on t be c'::i_stinq 1c"['.11J4.11Cj Arora. This ceSt:. will ("tetermine if the osif3te)-ii is aclaquat e ELccC):i;'C1ing to 7aLional StandArds. A JAf ti.:cIft O:F iJrivat Q Cirr n k art'cirming (n) 91i'. Well cas in.- . e1 ?m?1�:C:W3�Vc (7�) jncI1 =F; zllrvo crund n• and cCStltent: the floor_ aro-un( t Ilri w,,,J1. CF1silly. (.,3 The '."Jc1t."_ analysis report ,c. JS.::I.i,vc,�.-d to i:I1is o''F;icr-- ,:xo)'n \C! (�`ll�y 3f 33 Ft tr�3C?l ''or uux revi,Civl. �I'ne st=wer & ut'm mms. be 1001 frc11 ur-111. T' xre'Fore a�zf oro you have your adequacy P rt`c r-med You will probably wiantr to loolr into this. 1r t?zp 1eachinq area is not 100, from tile t?e11 it wil ;. zlo ba necclrls cavy to )lrave an L1degllacy tPem> porl''ormc i ; yoil will. rrep? to relocates the leaching aroa. Municipality of Anchorage On -Site Water & Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-172-24 Expiration Date: 1. GENERAL INFORMATION Complete legal description GREENLAND S/D; BLOCK 1, LOT 6 Location (site address) Current Property owner(s) Mailing address Real Estate Agent 4800 E. 112TH AVENUE, ANCHORAGE, AK, 99516 JAMES LEWIS Day phone 4800 E. 112TH AVENUE, ANCHORAGE, AK, 99516 BETH SIMPSON W/ KELLER WILLIAMS Day phone 2. TYPE OF DWELLING: ■ Single Family (w/wo ADU) gH 7. ❑ Duplex "� ❑ Multiple Dwellings (Single Family and/or Duplex) OCT 2 4 2014 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: 602-9035 727-2384 TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class - Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: L C J N Received by: � � Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ J Waiver Fee $ Date of Payment Date of Payment Receipt Number C7(vla� Receipt Number COSA # ot> « 15�,c�) Waiver # Distance: - 1 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. Address 3701 E. TUDOR ROAD, SUITE 101 `ANCHORAGE, AK, 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG, UG attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance ofthe system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend an the local soils condition, groundwaterlevefs that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments GEG, LTD. can therefore not provide any warranty or future estimate ofhow long the system will continue to meet the operational requirements of the ADEC or MOR DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person orparty is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE k-0' System #1 Approved for j bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. Phone 337-6179 Date l� i zt I4 r bedrooms, with the following stipulations: A. G�iness .e 4 = c j ...... fROFESS� SITE J WATER AND © �nlaTEWATER o _AM By: /�� / {! 7 r -� Original Certificate Date: U — 7 The Municipality or Anchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations 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. ATTCHMENTS: / COSA Checklisty Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other 1p- 10,19,191 If more than 1 septic system is on the lot: COSA Checklist # _of_ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: A. WELL DATA Well type PRNATE GREENLAND S/D; BLOCK 1, LOT 6 Parcel ID: 015-172-24 *PER GEG INSPECTION. **ASSUMED BASED UPON SURROUNDING WELL LOGS. Date completed -1956 Total depth *103+ ft. If A, B, or C provide PWSID# NIA Well Log (YIN) Sanitary seal (YIN) YES Cased to **40+ ft. FROM WELL LOG NO Wires properly protected (YIN) YES Casing height (above ground) ***12+ in. ***SEE 2007 COSA . AT INSPECTION PAPERWORK. Date of test 10/9/2014 E Static water levelUNP P�VP�V ft. 69 ft, Well production —9 P.M. 4.33+ g.p.m. WATER SAMPLE RESULTS: Coliform _-O�_ colonies/100 ml. Nitrate �j `7 mg./L. Collected by: GEG, Ltd. Arsenic: N7 ug./L. Date of sample: 10/9/2014 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 6/16-18/1994 Tank size 1000 gal. Number of Compartments 3 Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 10/1012014 Pumper, C. ABSORPTION FIELD DATA ISAACS PUMPING Date installed 6/16-18/1994 Soil rating .p.d.l r ft�/bdrm) 0.45 System type TRENCH Length 65 ft. Width 2+ ft. Gravel below pipe 8.29 ft. Total depth *12.3 ft. Eff. absorption area 1078 ft2 Monitoring tube YES Depression over field NO Date of adequacy test **10/9/2014 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 30 in. Water added 500 gal. New depth 45 in. Elapsed Time: 120 min. Final fluid depth 40 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date **PREVIOUSLY DOCUMENTED 1980 TRENCH WAS CONNECTED VIA DIVERTER VALVE AND NOT IN USE AT TIME OF TEST. 1994 TRENCH TESTED ONLY. D. LIFT STATION Date installed Size in gallons Manhole/Access "Pump on" level at in. "Pump oft" level level at in. Cycles tested Meets alarm $ circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanktlift station on lot 100'+ On adjacent lots 1001+ Absorption field on lot 1001+ On adjacent lots 109+ Public sewer main N/A Sewer /septic service line 25'+ Animal containment areas 501+ Public sewer manhole/cleanout N/A Holding tank Manure/animal excrete storage areas 1001+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Properly line 51+ Absorption field 51+ Water main N/A Water service line 10'+ Surface water, 1001+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: (1990 TRENCH / (1994 TRENCH) Property line "011101+ Building foundation 10'+/10'+ Water main N/A Water service line 10'+/10'+ Surface water 100'+/100'+ Driveway, parking/vehicle storage 10'+/10'+ Curtain drain NONE KNOWN Wells on adjacent lots —0041100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSH guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date Io Z!/1 (Rev. 10112/12) re e wo ( ok vt (�IIZ6 wCII <`ov" fav�rej Fb.r Municipality of Anchorage Development Services Department *A1 Building Safety DivisionOnsite Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orgtonsite (907) 3437904 C n)( CERTIFICATE OF ON-SITE SYSTEMS APPROVAL (,J,✓"t FOR A SINGLE FAMILY DWELLING �m Parcel I.D. 0/5- - r 2 - 2y COSA# 070/ yK Expiration Date: 1. GENERAL INFORMATION Complete legal description 4 o F 6, 13/oc k f 4: conn laic( S / Location (site address) �yboo E 112. r" A pr^"c A nt/io�ugP Mc 99Sr/ Current Property owners) ,o t ii' DQ u'..( Jensen Day phone Mailing address Ak 995*11 Lending agency Day phone Mailing address Real Estate Agent tie.f ejn l.r^n eeen- Rene% Pwn Day phone ?_5-'7-0'9S- Mailing 5-7-or9rMailing Address IIIj w 3et'Aye Se ly lya, h"e+vrage 99So? Unless otherwise requested, COSA will be held by DSD forpickup. PlQ„'r,, Cul/ ocuAe� 2. NUMBER OF BEDROOMS 3 af- 2yy— 1979 Lub.n Lott r-ivo1,io. p•u, 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of Onsite Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water 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 engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. I verify that my Investigation, based on procedures outlined In the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system Is(are) In compliance with all applicable Municipal and State codes, ordinpnces, and regulations in effect at the time of Installation. Rin cwa f aF CotA an r� w.Fti n. w wa tr Sampre !u/ ry/c.Ffy Al) ade9wary }tihJ and e/+�er etr }zfrea/iun b�Goie.yr Name of Firm F/af /op -ee- .n;ek( Sej-r,e. Phone 3 yS-�3 rr Address /�/S30 15cAe e,,pn,in Re/ A-0%ehor_4zle A"t 99s41 Engineers Printed Name "77,to clo/e 7= HvoeLe Date. Sewl-e &o. N 2f_o) 5. DSD SIGNATURE Approved for Disapproved. ==L bedrooms. OFA ............... THEODORE F. Moo, '-_ CE.nrpo Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev. 11005) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date:7 SGS RtLM 1074449001 Client Name Flattop Technical Srv. Project Name/N Lot 6 Dlk 1 Greenland SD Client Sample ID Lot 6 Dlk I Greenland SD Slatrix Drinking Water P%VSID 0 Sample Remarks: All Datesrrimes are Alaska Standard Time Printed Date rime 09/072007 11:07 Collected Datelllme 08292007 15:10 Received Daterrime 08292007 16:00 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Waters Department Total Nitratc/Nitritc-N 0.386 0.100 eng/L SM204500NO3-F D (<I0) 09/05/07 JDS Microbiology Laboratory Total Colilomt 0 col/I00ml- SM209222B A (<I) 0829/07 SDP Municipality of Anchorage •° Development Services Department Building Safety Division >..... On -Site Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 w lonsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING r�/ Parcel I.D. �� �' � �' COSA# I�' 01 L1 (.0 1. GENERAL INFORMATION Expiration Date: R — 02-67- � Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address GREENLAND SUBDIVISION, LOT 6, BLOCK 1, 4800 E. 112TH AVE. • ANCHORAGE. AK 99516 DAVID JENSON Day phone 868-1680 4800 E. 112TH AVE. • ANCHORAGE. AK 99516 Day phone VALESA LINNEAN w/REMAX PROPERTIES Day phone 110 W. 38TH SURE 100 • ANCHORAGE, AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well lit Individual Water Storage ❑ Community Class Weil ❑ Public Water System ❑ 257-0195 TYPE OF WASTEWATER DISPOSAL: Individual On-site lit Individual Holding tank ❑ Community On-site ❑ Public Sewer . ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, f 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 verity that based on the information obtained from the Municipality of Anchorage riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system !slate) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SURE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines d Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wefts and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. Those conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance ofthe system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will R confor any legal right whatsoever. 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. 337-6179 ..if A. Gem ss: e E_ Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA Checklisty Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Reort Nitrate Advisory Other • ON-SITE • WATERAND WASTEWATER No, PROGRAM 'Oi;;rNf SEN�11��`l By: U. /l//�, [� O —_ Original Certificate Date: �'� �— fl 7 (Rw. 11105) Municipality of Anchorage • Development Services Department BUlding Safety Division On -Site Water & Wastewater Program 470D Bragew Street P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.orglon3ke (907)343.79W CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: GREENLAND SUBDIVISION, LOT 6. BLOCK 1, Paroel ID: 01,—/2 q A. WELL DATA 'SEE ATTACHED WELL LOGS "PER ARROW PUMP & WELL Well type PRNATE If A, B, or C provide PWSID# N/A Well Log (YIN) NO Date completed 1956 Sanitary seal (Y/N) YES Total depth 73+ ft. Cased to '40+ ft. FROM WELL LOG Data of test V Static water level 4&\;e NO ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 2.3 mgJL. Wires property protected (YIN) YES Casing height (above grouna) 12+ in. AT INSPECTION 4%t JFK 4/23/2007 *•73 ft. 4 g.p.m. Other bacteria 0 colonies/100 mi. Arsenic: ND ugJL. Date of sample: 4/23/2007 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Matedal STEEL Date installed 6/16/1994 Tank size 1000 gal. Number of Compartments E Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 4/23/2007 Pumper MCDONALDS PUMPING C. ABSORPTION FIELD DATA '6/16/1994 Date installed 6/20/1950 Soil rating(ji�r ft'/bdrm) •45 150 System type TRENCH Length 65/35 ft. Width 2/4 ft. Gravel below pipe 8.29/7 ft. «12.66 1078 Totai depth 014.87 ft. Eft. absorption area 490 ft' Monitoring tube YES Depression over field NO Date of adequacy test "4/23/2007 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth In absorption field before test 19 in. Water added 785 gal. New depth 36 in. Elapsed Time: 1400 min. Final fluid depth 19 In. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date – "TESTED THE 1994 SYSTEM D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at _in. "Pump otr leve High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAt t station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Sewer /septic service line 25'+ Public sewer manhole/cleanout Holding tank N/A Animal containment areas 50'+ Manurelanimal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line '0 Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS •WR940037 G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and a review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS s Date SJI s/o3 COSA Fee $ ! '� 0 O C) Waiver Fee $ _ Date of Payment ZQ 7 Date of Payment Receipt Number Receipt Number. (Rev. 1 1105) GARNESS ENGINEERING GROUP, Ltd. x - CONSULTANTS & GENERAL CONTRACTORS r> May 4, 2007 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Ref: Waiver for Greenland Subdivision; Lot 6, Block 1, To whom it may concern: On 4/23/2007 a site visit was made to perform a well and septic adequacy test for the purpose of obtaining a Certificate of On-site Systems Approval. During the site visit we discovered that the well was in a "pit". The well pit is connected to the foundation of the house and the only access to the well pit is through a door in the daylight basement. The well extends 18+ inches above the floor of the well pit. The only possible way for sewage to directly reach the top of the well head would be for the septic system to backup into the basement, to a depth of 6 inches. It is unlikely that such an event would go unnoticed. The existing encroachment has existed since 1956 with no known adverse impacts. We are unaware of any adverse impacts this waiver would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank ,, M.S. 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507-1259 Ph: (907) 337-6179' Far: (907) 338-3246' Websitc: www.gamessengincering.com Cybersource Business Center - Transaction Details User: pwsxo [] Log Out Virtual Terminal Tools & Settings Transaction Search General Search Auths Ready To Capture Auths Needing Review Pending Settlement Exception Search Reports Account Management Support Transaction Search Details Order Information: 1180125796867 Order History Amount State Authorization 175.00 USD Capture 175.00 USD PENDING (Void) Authorization Status success Page 1 of I Account IC Merchant IC I need help wit Date May 25 2007 01:43:16 PN May 25 2007 01:43:16 PN f_ .' Create Subscri Source UBC Virtual Terminal Authorization Amount 175.00 U< User pwsxo Credit Card Type Visa Authorization Code 09479C Credit Card Number xxxxxxxx) AVS Y - Match: address and 5 -digit postal code match Expiration Date 10/2009 CVN IM Customer Information Billing Information Name CAROL_JENSEN Company Carol Jensen Address 4800 E. 112th Anchorage, AK 99516 Us Phone Number 9075633200 Email Address null@ecybersource.com Customer ID Order information Comments key 34 175.00 lot line waiver ai Cyl https://businesscenter.cybersource.com/ebc/transactionsearcWransactionSearchDetailsLo... 5/25/2007 M o ID �2!tl5%19 u is CS z?25i3. -'— — =I:_LL1t�N P aC 01 .JY.Ir ' RAit__r_ G . Me, 09ZSP, I J J • �t �L • � K i •t 9 2 � go� �._ ..j T Ra,t r � !•: tcaY ONZ'R,. i%' - fit WS1 . ila f ti in h .r a ..... _ .. ' ._..... a v . '. ....._ . - EASeI PeNT•<. >.'.;:::tRO,' OTF!t.R TN:APJ 1R ihi>;F::F:�•.. :!v TGIF R;CORDES ?:AT, Tiley '• /n0., _..-____,_. .• : t ... pa Cam+- cot Tlat Cnf] foe.; PLO. � P'cp1, No. I OZ 1. 71: _vJ Ca'J74 pert % Y� »retri= 7F> ial'`-Hcq E7� lwj J'rr✓arN. Lat 6 tl.ttk �. ! � ,�+ �t�`l5 „'la ��� . �'srlveM`ah f}i_ (5:?,rr,JlL�t'.tt7 '�G--�• .fSraft•.Ctr:P cx:r./l'D.9.xr.. it. r11:•`.7. a:J t^..^. , ,{e�•�.d+ .''.f iR.:n]Wn-n7 ' C"aJ::".7 M:1C.G Crf ri1'.'tl'A Ih9 LaC.'`'Tt7 11AQ1 ilcd C) hat vj;7i= • e-+� _ 'n} • ahsr.�zh cr ta•.Pn f Pja;7 yt,:�a.`nc' Gs:rq;7, UIGi .fo :1�„re:eN�Jn7 C./ ( \' � "� ylr.;j= :c:.ot :.t:ccro ers l t� 7ira p:txa Ll c]: un and VITt!it[a L" -In 5tY-iT..`.7R1rr 17.E Cr Cr'..'^ til'J:517 +'LJI^.] Oh 4^Y inWrC.' h. C=Pt i1+�i:=j:'C iC = u).i�i:✓ Ci" r ass MUNIC11ALITX OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPAR'T'MENT OF HUALIJ'H AND ENVIRONMENTAL PROTECTION APPL,J:CATION FOR HEALTH AUTHOItTTX APPROVAL CERTIFICATE 1. General Information Application Date (G7 ( U { I' (a) Legal Description (include lot, block, subdivision, section, township, range) Location (add*oss Cdr directions) . (b) Applicants Name_, � �.+_a.-- 0-0( r_..-_ _.__. ___w___ _._7�1.ehor Applicants Address (c) Applicant is (check ore) Lending Insti.tuLion r Buyer Other (explain); (d) Lending Institution�i�' `%'�`- I�L`�L\ Tel i)hone Addre s (e) Peal Estate Co. & Agent. Address Te.lephon, 2. Fn of Pssidence Single-FamilyM�a].ti�Family Other (desc:ri.l) �- =� NLUTIber of P3edrex ms 3. Water Supply. Individual loll 17-f Comwni.ty �� Public Note. If community well system, must have written confi.r•m-ation from the State Department of Environirental Conservation attesting to UK-) legality and status. Is the well adequate for the number of badrocnts specified in this HAA 4. Sewage Dais oral Onsite;.. Public Community Holding Tank Is the wastewater disposal system adequate for the number of bedrocros O,X ) [Page 1 of 21 0 2-15`84 5. EngineerinclFirm Providing Inspections, lbstsf Data and Inf:oruation I ca:rti.fy that I have c}-&,cked, verified, or conformed to all r/iUA HAA Qiidalines in effect on the date of this inspection. Signed �r ����' rpt f ";4 Date Nava of Firm /`I /_`-.. e �. _ _ 'il? lephone Address 1:' (.i' i i z) >; ?'.i I VF? 4<<-c( _ �", •'k� �B VVV Signed by DcatE3 �j §74'+9`�a wEna EA oa �4 ea (EMINEER SEAL) �� ` 4P z; � C. Vol , aF. a IA orf 6 . DlEP Ap�pr ova 1 •� �i� � ,� f �, � , Approved for �-�edror4mDl'_ U_ lRate Approve� "f— a Disapproved � Conditional Terms of Conditional Approval Me municipality of Anchorage Lepartment of lk-,al.th and Environanntal. Protection does not guarantee; the continued satisfactory p3:rforrnance of ti -r-, water supply and/or the wastewater disposal system. This approval indicates that, as of the, validation date shown above, baked on the data and information furnished W an engi.i73er registl)r_od in the state of Alaska, the water supply and wastewater disposal system is safe and func-• tional for the number of bedroom, and typo of structure i.ndi.catecle (DHEP SEAL) 7. Mail the HAA to the following addLess: KB2/d5/s [Page 2 of 21 2--15-8n A. WELL RATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTF.C1'ION JUN 2 91984 Legal Description: PC I® Well Classification Tn�,VAuql If A, B. or C. D.E.C. Approved(Y/N) Well Log Preset (Y,2 Date Completed nRvuJv) Yield 5-,0,gTotal Depth�Cased�to kj<flown Depth of Grouting (. o er\av1N Static Water Level _ _ Pump Set At UvIkrt w Casing Height Above Ground Sanitary Seal on Casing Electrical Wiring in Conduit <&4) Depression Around Wellhead (YE Separation Distances from Well: To Septic/Holding Tank on Lot 1,c/ -L / ' On Adjoining Lots X690+1 To Nearest Edge of Absorption Field fU on Lot.... ;�J On Adjoining Lots To Nearest Public Sewer Line N /A " To Nearest Public Sewer Cleancut/Manhole !)l A To Nearest Sewer Service Line on Lot Water Sample Collected By Dated �l Water Sample Test Results Scr�is.�'c,L�ol,L Cents B. SEPTIC/HOLDING TANK DATA Date Installed(o "Ol'o_ Size No. of Ccnpartments �- Standpipes -.t ) Air -tight Caps 91N) Foundation Cleanout Depression over Tank (Y& Date Last Pumped _ 10// Pumping/Maintenance Contract on File .(LM) for Holding Tank High -Water Alarm (YIN) IV Temporary Holding Tank Permit (Y/N) Separation Distances from .Septic/Hoo �iFg Tank: / To Water -Supply %bbl 110 `V- To Building Foundation__ To Property Lire 2-6-1 6-1 To Disposal Field 0 / To Water ;Mai.,Service Line (U1r1 To Stream, Pond, Lake, or Major Drainage Course Commeni r (Page 1 of 21 2-15-84 7 C. ABSORPTION FIELD DATA L� �)a( 'o 6(62(\6vd Sub, t_64 �C> - st/0 Soils Rating in Absorption Strata is Q Type of System Design iLjj_�- Date Installed (o 4 9fe O Length of Field�� Width of Field 1( Depth of Field Gravel Bed Thickness Square Feet of Absorption Area L-{ q6) Standpipes Present Q10 Depression over Field (YODate of Last Adequacy Test Results of Last Adequacy Tbst ect 6eay Separation Distance from Ab or tion Feld: To Water -Supply We11 1D � ' - To Property Line LL To Building Foundation To Existing or Abandoned System on Lot l On Adjoining Lots- (d� C�•f To Water Main/Service Line N M- To Cutbank(if present) 1/ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area q Comments ,��n _<�n Snnip= ih��idtn (�dLO/BJP D. LIFT STATION Date Installed Dimensions _ Size in Gallons Manhole/Acres Y ) "Pump On" Level at �'.=lhucp Off" Level at High Water Alarm Level at Vent (YIN) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Co Y/N) Comitent>s Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Mk s in effect on the date of this inspection. "�' Signed (fj� Date1—��? -1 Company /i ! MOA No. 014--02� •.e FiQ KBl/d5/s � C. itald, if.� o. 2251 (Page 2 of 21 2-15-84 ALASKA Ci iOIROWnTAL COnTnOL RWUS, InC. Engineerinq & Cnuironmental Sludies JUNE 27 1984 ANN LINDBOE 4800 E 112TH AVENUE ANCHORAGE AK 99516 SELLER — ANN LINDBOE BUYER — ROD & NANCY SMITH SUBDIVISION —• GREENLAND BLOCK — 1 ILT — 6 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTMA IS A TRENCH WITH AN AREA OF 490 SQFT. THE SYSTEM IS CAPABLY.; OF ACCEPTING 310 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF TETE SYSM IS 156 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 2 BEDROOM HOME. THE SEPTTIC TANK WAS PUMPED ON6/16/84 FLOW TEST ON WELL THE WELL FLOW RATE WAS 5. GPM FOR 4 HOURS. SEPTIC 'DANK ADEQUACY THE EXISTING SEPTIC TANK WLUME OF 1000 IS ADEQUATE FOR THIS 2 BEDROCI�4 HOUSE. u 'o . Reid, Jr. ; �. 2251.6 NZ 1200 .o saaeaa• �� SSION�,�@y 1200 fest 33rd Auenue. Suite B • Anchorage. Aloska 99503 • (907) 561-5040