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GREENLAND BLK 1 LT 5
Greenland Block 1 Lot 5 #015-172-23 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231152 PID Number: 015-172-23 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name ANNE & WILLIAM KITCHENS-ANKLEWICH ABSORPTION FIELD - EXISTING ❑ Deep Trench El Wide Trench E:1 Bed ❑ Mound Site Address TH 4820 E 112 AVENUE, ANCHORAGE, AK ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 3 GPD/SF JTotal Ft. LEGAL DESCRIPTION. Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot GREENLAND 1 5 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gavel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well 100'+ __ 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1500 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 10'+ __ NA Foundation 10'+ __ LIFT STATION Manufacturer Capacity Gal. Remarks 3BR HOUSE /SEPTIC SYSTEM. 1500 -GAL HDPE TANK INSTALLED PER REPORT. Alarm location Electrical installed by Installer DENALI EXCAVATION PIPE MATERIAL House to tank 3034 d a n Tank to 3034 Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection 1st 6/16/2023 ZId 6/17/23 da:3'd Location and description 4't TOP OF RISER / MH ON-SITE WATER AND WASTEWATER SECTION APPROVALOF Ak' • • ' Conditional Approval: Date P'��!'' �:�ll"Ow� *: 49 TM ....... % " " "" """' / Septic System Approved - Curtis Huffman �'F�,�,� CE 128991 Datc/226 ;-'Note: this approval does not include well requireJent ppROfESS10N��'N .� permit kRCv 741 10) MUNICIPALITY OF ANCHORAGE TIN On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 O� http://www.muni.org/onsite Tr J Department On -Site Wastewater Disposal System Permit Permit Number: OSP231152 Effective Date: 6/12/2023 Work Type: SepticTank Upgrade Expiration Date: 6/11/2024 Tax Code Number: 01517223000 Site Legal Address: GREENLAND BLK 1 LT 5 G:2636 Site Mailing Address: 4820 E 112TH AVE, Anchorage Owner: KITCHENS-ANKLEWICH ANNE M & Lot Size in Sq Ft: 27125 Design Engineer: FIRST WATER CONSULTING Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By:�- 1 Issued By: Date: Date: b 1 Z 7-2- 3 MUNICIPALITY OF ANCHORAGE Development Services Department =- Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-172-23 Property owner(s) WILLIAM & ANNE ANKLEWICH Day phone Mailing address 4820 E 112TH AVE ANCHORAGE, AK 99516 Site address 4820 E 112TH AVE ANCHORAGE, AK 99516 r(II-011, Lf V Legal description (Sub'd., Block & Lot) GREENLAND 9 (10 G I< .9-t— Legal description (Township, Range & Section) Lot Size 27,125 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ER Septic Tank IN Upgrade IN (w/wo AD U) Holding Tank ElRenewal ❑ Duplex (D) El Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signa#ureofi:property owner or authorized agent) Permit/Rush Fees: (O a Waiver Fees: Date of Payment: Receipt Number: Permit No. Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com ! !! June 9, 2023 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: RUSH SEPTIC TANK UPGRADE PERMIT LEGAL: GREENLAND BLOCK 1, LOT 5 This property is to be sold immediately and the owner has requested that we obtain a septic permit to upgrade the existing 1250-gallon aged steel septic tank on the above referenced lot. For current functionality & future flexibility, we propose to install a 1500-gallon HDPE tank per the attached design to serve the existing 3-bedroom residence. No groundwater was noted in the MOA on-site file, but if groundwater is encountered during installation an epoxy coated steel septic tank may be required. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231152, Curtis Townsend, 06/12/23 FIRST WATER CONSULTING NO WELLS WITHIN 100' OF PROPOSED SEPTIC TANK GREENLAND BLOCK 1, LOT 5 DESIGN DETAILS: STAKE ALL WELL RADII PRIOR TO CONSTRUCTION. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231152, Curtis Townsend, 06/12/23 PID:015-172-23 PERMIT:OSP231152 FIRST WATER CONSULTING GREENLAND BLOCK 1, LOT 5 Municipality of Anchorage Page of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number. Sui 9 R � 3 J � PID Number: 01,5- - 1 0 - Name: Name: Lq v E 1 MMt = Wastewater System: ❑ New ,Upgrade Address: P.o.ao la ABSORPTION FIELD Phone: 7J I, S V"f;, No. of Bedrooms: 3 Deep Trench O Shallow Trench ❑ Betl ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: Total Depthfrom original grade: D t I..2 GPD/Sq. Ft. Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe t tJ i 6 Q IF InA IVB Y Ft. L Ft. Township: Range: Section: Fill added above original grade: Gravel length - / b Ft. Ft. 7 Ft. WELL: ❑New ❑Upgrade Gravel width: n Number of lines: I Distance between lines: ' 12- Ft. Ft. Classification (Private, A,B,C): Total Depth:Cased To: Total absorption area:: Pipe material: Ft. Ft. SQ. Ft. I /- It) E X03 q Driller: i \ Date Drilled: Static Water Level: Installer: Date ins alled: -/z4 q y \S Ft.�l 2& r Yield: Pump Set at: I Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES ❑ Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Privatel Manufacturer: 1 Capacity in gallons: From Tank Field Station Tank Sewer Lines 1 Well- Material: �4- Number of Compartments: 1'D — — Surface,��� LIFT STATION Water Lot Size in gallons: Manufacturer. Line lD Foundation 119 "Pump on" level at: "Pump off' level at: High water alarm at: Curtain NI Pump Make B Model Electrical inspections performed by: Drain BENCH MARK Remarks: j ' n Location and tion: Descrip/ 1-'o u ue�a 4'wt \ f\ Assumed Elevation: U Ft- PNCiltll'E s SLRt1, F � '27y". -`-q Inspections performed by: S Dates: 1st -L/ ............ 2nd g z 9 q t� e ob_,_ i .lcnd Department of Health and Human Services approval J ' Reviewed and approved by: Date: 72-013 (Rev. 9/91) MOA 25 ....... ...........i E 112 TH.. \ AVE BENC MARK I Well A B 1 # Well I I I SWING N£ AB 42 IT AC 82 BC 75 AD 123 BD 119 C Al 125 00 GAL S, T BE 137 BF 1521 1 AG 155 x T BG 1501 I I 1\YI IE BULLUNDIVERSIONVAL VE �o D ,1 I F I I ►►/ III I G 19.2 D.F. 14 11il\\ -— 25 0 25 50 75 100 125 150 — SCAtr! — �50 -FT — — — — — — RENCH MARK.- POST ARK:POST FOUNDATION ASSUMED ELEV. 100.00 TORREN SPURKLAND P.E. GREENLAND BLOCK I LOT 5 SEPTIC SYSTEM DESIGN 203 W K.99TH. AVENUE JUDY AND JIMMIE LAMB DATE. OCT. 4, 1999 (907) 277 9-391166 11 (NCH. 4820 E 112 TH. AVE. SHEET: 2/3 GRID: 2636 PERMIT N EV990357 PID N 015-172-23 GRE01052,1 VG 49th° SBEN SPURKLAND No. cE-2225 o° PROFESS 91.5 Sil t NEW TRENCH (1999) NO SCALE 85.6 B3 6.0 Ft of Septic Rock Effedive Monitor Cleanouts - 4' Cover 2' Wide 54' Long 10' Deep 6' Sewer rock 4' Co ver W 1000 gal Septic tank 0 85.6 w0o 0 1000 gal. septic tank EXISTING NO SCALE BENCH MARK: TOP POST FOUNDATION ASSUMED ELEVATION 100.00 TOBBEN SPURKLAND P.E. SEPTIC SYSTEM AS BUILT 203 W15th Ave C,REENLAND S/D BK 1 LOT 5 Anchorage Ak 99501 JUDY AND JIMMI£ LAMB DATE, OCT. 4, 1999 P79- 1 4820 £ 1127H. AVE. SHEET: 3/3 GRID: 2224 PERMIT j SW990557 PARCEL 1D 1011-133-37 GRE01053. DWG 4 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 160 -00a✓h ( L a�_c� ' �m ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT trl �I-a�(-�iq Upgrade Date Issued: Sep 27, 1999 Permit Number: SW990357 Legal Description: GREENLAND BLK 1 LT 5 Expiration Date: Sep 26, 2000 Parcel ID: 015-172-23 Design Engineer: 0007 Tobben Spurkland, PE Site Address: 004820 112TH AVE E Owner Name: Jimmie & Judy Lamb Lot Size: 27125 SQ. FT. Owner Address: PO BOX 112294 Total Bedrooms: 3 Permit Bedrooms: 3 ANCHORAGE, AK 99511-2294 This permit is for the construction of: Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations ( IBAAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. This is for the replacement field designed for permit #SW920284 lacmrne�2f tG/L i'Yoclec h5wcLrOS *w- houseL side- oP Y''-_ e/ t lrr G `iced _Pry,2" 9•Z9.99 J Received By: Date: -ZZ0'-• 0' Issued By: l i' ' ( i tie" p" Date: 927-99 ` .S PbJWK LANJiD P.E. 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907)279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 5 BLOCK 1 GREENLAND S/D JIMMIE G AND JUDY M LAMB Municipality of Anchorage Department of Health and Social Services 825 L Street Anchorage, Alaska 99501 September 23, 1999 We are submitting an application for the installation of the replacement trench for this lot. The replacement trench will be located parallel to the existing trench, and within the radii of the two testholes dug in 1992. A diverter valve will be installed to enable use of both trenches. The installation has been indicated on the attached siteplan. The size of the absorption trench is based on the approved design under permit S W920284 SYSTEM CONFIGURATION STANDARD TRENCH TOTAL LENGTH 54 FT TOTAL WIDTH 2 FT TOTAL DEPTH 9 FT ROCK DEPTH 5 FT COVER 4 FT DIVERTER VALVE The installation of this well and septic system will not prevent development of adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. I I I I I I I 1 I I I I Well I ¢ Well I0 I e I I 8 I 73 ut o f -A a J ag I I O t' r I es I �( Test lote_ TOBBEN SPURKLAND P.E. LOT S BLOCK I GREENLAND SIB SEPTIC SYSTEM AS BUILT 203 W 15TH, AVENUE SEC 22 WN R3W DATE- OCT 81992 ANCH^,AK, 99501 XWE LAMB SHEET- 213 GRID- 2636 Municipality of Anchorage Page I of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 995196650 • Telephone: 343--4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 63_q__PID Number: —0 tS'� tea. " gP— 3 Name: Wastewater Systern: New ❑ upgrade Address: ABSORPTION FIELD Phone: No. of Bedrooms: dr/Deep Trench E) Shallow Trench El Bed El Mound El Other LEGAL DESCRIPTION Soil Rating: 1.2- Total Depth mom original grade: GPD/S . Ft. Lot: Block: Subdivision: Depth to pipe bottom from original grade: _( Gravel depth beneath pipe /^� rn tz aM N 0 Ft, S Fl. Township e:Section: ry.^� n Fill added above original grade: ^ Gravel length: WELL: ❑ New ❑ Upgrade Gravel gefli+r VP dN4 Number of lines: Distance between lines: 5 Ft. Ft. _ Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Ft. Ft. .5 q Q SO. Ft. F s iv e io 3 y _ Driller: Date Drilled: Static Water Level: Installer: e G& �� 'B-CIF p f J Dategtgalled: R )q I tTq �. Yield: Pump Set at: Casing Height Above Ground: TANK GPM FL Fd _ SEPARATION DISTANCES _ Septic o Holding a S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ^ ER(,14 T {�"is I[_�I & 6-C) Well �' .�. r-- .-. Material: Number of Compartments: Surface p "_ _ LIF•1• STAT I®N Water Lot �. Size in gallons: Manufacturer:�� Line Foundation —y"Pump on" level at: "Pump off' level at: High water alarm at: Curtain Pump Make & Model Electrical Inspections performed by: Drain �— Remarks: BENCH MARK Location and Description: V Assumed Elevation: y 1a n ENGIIJEIER'$,;;EAL l/ S R` q/`� Inspections performed by: Dates: 1st ?nd z- c . �_. '� Department of Health and Human Services approvalij Reviewed and approved by: Date: 72-013 (1/91) MOA 25 5 9 5 Mirctfi 140 5 feet of' Septtc Rock Cleonouts BOTTOM TESTNOLE 80 93, FBM, TOP OF FOUNDATION ASSUMED ELEV, 100,00 TOB13EN SPURKLAND P,E. L17T J, BLOCK 1 GREENLAND SID SEPTIC SYSTEM ASBUILT 203 W15TH, AVENUE SECTION 22 TIEN RAI DATE, OCT 8, 1992 ANCH, AK. 99501 LIMMIE LAMB SHEET, 313 GRID 2636 (ENGINEER'S SEAL) Municipality of Anchorage —` W— DEPARTMENT OF HEALTH & HUMAN SERVICES V 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR:\ t /V" VVI. OL V'- t DATE PERFORMED: I LEGAL DESCRIPTION: l�o'G 15 13 V� I Township, Range, Section: F.p ,���,� I�M� SLOPE SITE PLAN 1 2 S1L- to 3 4 5 J Si 1 Jan Vv 0 t"') Y0.u-e 7 0 8 N Jr 9 5v T i o U-1 10 11 12 13 14- 15 16 17- 18 19 20 WAS GROUND WATER ��1� ENCOUNTERED? S IF YES, AT WHAT L DEPTH? O P E Depth to Water After Monilorinl17 Dale: Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (mmuleslinch) PERC HOLE DIAMETER 1 ' TEST RUN BETWEEN I _ FT AND FT COMMENTS PERFORMED BY: 1 t • CERTIFY THAT I HIS TEST pWAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW920284 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:LAMB JIMMIE G & JUDY M OWNER ADDRESS:8141 ALATNA DR ANCHORAGE, AK 99516 PARCEL ID:01517223 LEGAL DESCRIPTION: GREENLAND BLK 1 LT 5 SEC 22, T12N, R3W, SM LOT SIZE: 27125 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 I T'1 DATE ISSUED: 9/14/92 EXPIRATION DATE: 9/14/93 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: EXTEND TRENCH 12' TO ACCOUNT FOR 1.5' ML LAYER. PROVIDE SECOND TEST HOLE FOR REPLACEMENT SITE. RECEIVED BY: ISSUED BY: DATE: z9 Z_ DATE: o ~ Z:' -p D~^t p» -C 9-. L- Vou-p t . ..... 20JN15th.Avenue, Suite 206 ANCHORAGE, ALASKAYY5N (?07) 279-3716 SEPTIC SYSTEM DESIGN L- 0 T 5 D L- 0C K I GR E E N I- AN D S / D JlMMlE LAMB No Ground Water or Impervious Layer to 15 ft. Use Standard Trench Soil Rating. From test Aug. 26, 1992 5 min/in 1.2 gal/ft"sq. Required Area per Bedroom: 150/1.2 � 125 sq.ft.. Testhole Total Depth Less 6 feet Less 4 feet cover Number of Bedrooms Length of Trench 15 9 5 3 37"5 ft. SYSTEM CONFIGURATION STANDARD TRENCH / TOTAL LENGTH 40 FT,-/ TOTAL WIDTH 3 FT~ 70 - TOTAL DEPTH 9 FT~--�' ROCK DEPTH 5FT,~/ h6 ' � COVER 4 FT~ SEPTIC TANK 1000 GAL~ ' The of this septic system will not prevent wells from be installed on the adjacent lots. ` There are no developed or natural surface / sub surface drainage courses on this ov lots. The proposed septic system will not change the general slope of thu area, Pnnding and/or concentration of surface runoff will not resu}t from this insLallation, Septic System Design Lot 5 8lock 1 Greenland 112TH, A VE. I LOT 2 II I I LOT 6 I LOT 5 LOT 1 LOT 4 I I I I I I I - B 17 7-- 116, 1 A VE - 116,1,AVEVI I LOT Well I Well V I LOT 2 (� LOT 1 I I LOT 6 I LOT 5 I ° I � SCK 6 -- -_ — — — — 114TH, AVE, • 'i „L: NT 50 0 50100 150 200 250 300 SCALE, P = 100 FT, uuLuv Jr UMNLHIV11 r.L, 203 W 15TH, AVENUE LOT 5 BLOCK 1 GREENLAND S/D SEPTIC SYSTEM DESIGN AN- AK, 99501 SEC 22 T12N R31il DATE SEPT 6 1992 _c9 ?79-�91f I JIMMIE LAMB SHEET: 113 GRID, 2636 1 In 0 Test ole � 0009: R ro DDEN SPURKLAND P.E. LOT S BLOCK 1 GREENLAND SIB SEPTIC SYSTEM DESIGN 203 W 15TH. AVENUE ANCH. AK. 99501 SEC 22 T12N OW DATE SEPT 6 1992 - JIMMIE LAMB SHEET 2/3 GRID, 2636 Clean Out Standard Trench 40' LONG L T„ L 9' LEEP 5' OF SEWER ROCK 41 C,ovev- Mira F; 140 5 Feet of Sep -1c Foundation Clean out 40 u _ C. P I PC Cleah 1000 GAL TANK e� *"4 2,1 1 ro "COAK t,AM, �1�_ m flWk 1000 GAL STEP TANK IUbbLIN JF'UKKLHND r,t, LOT 5, BLOCK 1 GREEN -AND SID SEPTIC SYSTEM DESIGN 203 W15TH, AVENA ANCH, AK, 99501 SECTION 22 T12N R3V DATE, SEPT, 9, 1992 1g07�79��i�LIM141L LAMB LAMB SHEET 313 GRID- 2636 (ENGINEER'S SEAL) • Municipality of Anchorage' DEPARTMENT OF HEALTH &HUMAN SERVICES 825 " L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR:1�iy}Ay�� j , A6!!,6 DATE PERFORMED' / 1 /Q/L LEGAL DESCRIPTION: Lot 6 'BV.\ Township, Range, Section: I Q,3 L) SSC_; 64 P Q. e- VI 1 2 aecv,4N I ls. o• Gravel �� 3 o• (� D 'n 465 yr 7 �Illll III G►r� H L 8- 9- 10- 12 910 12 13- 14- 15 314 15 16 17- 18 19 20 COMMENTS So�a,tm &4 Hale. SLOPE WAS GROUND WATER ENCOUNTERED? 0 S L O P E 9l IF YES, AT WHAT DEPTH? DepthMonitoring? ontt to Wale Menilr Ailet oring7 Dale: SITE PLAN Re / Reading Date Gross Time Net Time Depth to Water Net Drop Q • � �; r7ta j�,{,e. �t7 :a 7 /O 3$ 3 Ib ! q 1.:69] t© A -67/ a 7 Ali, R /0 / «/ /qq10 O PERCOLATION RATE (minutesyinch) PERC HOLE DIAMETER �- TEST RUN BETWEEN P FT AND elz FT PERFORMED BY: I CERTIFY THAT AIHIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) o �(ENGINEER'S SEAL) e Municipality of Anchorage t DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: I I V1/1 wt r @ �A.I,v� DATE PERFORMED: LEGAL DESCRIPTION:_�qbL� e f2� Township, Range, Section: 1 101- r )z DEPTH SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L DEPTH? O P E Depth to Water Aller Monitoring? Date: PERCOLATION RATE�7 � (minutesnnch) PERC HOLE DIAMETER 6 TEST" RUN BETWEEN a /L FT AND ---4�— FT COMMENTS PERFORMED BY: _ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT" ON THIS DATE. DATE: �i G 72-008 fRev_ 4/851 t PERCOLATION RATE�7 � (minutesnnch) PERC HOLE DIAMETER 6 TEST" RUN BETWEEN a /L FT AND ---4�— FT COMMENTS PERFORMED BY: _ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT" ON THIS DATE. DATE: �i G 72-008 fRev_ 4/851 20Nl5TH.AVE. SUITE 206 HCHOkAG[/ALASKA 9Y50i ' SPECIFICATIONS FOR SEPTIC SYSTEM INSTALLATION i LOT 5 BLOCK 1 GREENLAND S/D BEC 2 T12N R3W 1.0 GENERAL 1.1 Owners are Judy and J:immie Lamb. 8141 Alatna Dr. Anch Ak, 99516. Phone 345~6327. ^ 1.2 Engineer is the person or hired by the Owner to j inspect this proect. The Engineer must be recognized by the Municipality of Anchorage, Department of Health and Human Services. 1.3 Contractor the person or entity hired bythe O�ner to install this project. The Contractor must be recognized by Lhe Municip�lity of Anchorage, Department of Health and Human Services. 1.4 The Drawings, sheets 1 through S be part of this specification. 1.5 All materials and workmanship shall meet the require- ments of the Municipality of Anchorage, Department of Health and Human Services, the condjtions of the permit, and all applicable rules and regulations currently in effect. 1.6 All excavation dopths are advisory, and are to be verified and may be modified in the field by the Engineer. It is the responsity of the Owner or the Contractor Lo adhere to the approved design, to verify that the speci~ fied separation distances are met; and that the required inspections are performed. 1.8 The Contractor or the Owner shall report to the Engi- neer any observed condition which would put the septic system in violation of State or Municipal regulations. 2.0 SEPTIC TANK 2.1 If there is an exi�ting septic tank, :it may be used if it meets the capacity requirement for the residenceThe tank shall be inspected by the Engineer, and its" water tightness and structural integrity shall be verified. 2.2 A new septic tank shall be one fabricated by either Anchorage Tank and Welding or by Greer Tank Specifications for septic system installation Lot 5 3lock 1 Greenland S/D The septic tank shall be a UPC `approved two^compartment tank, constructed of 12 gauge, or better, steel with bitu mastj.c coating. The tank shall be set level on undisturbed soil.The tannk shall be covered with the equivalent of four feet of soil. The tank must be designed for the burial depth. 2.3 The septic tank shall be installed a minimum of five feet from 1e house foundation and a minimum of five feet from the absorption area. 2.4 The septic tank shall be a minimum of 100 feet from any well serving a mingle residence; 100 feet from any body of water, creeks or drainage diL.ches with flowing water; 150 feet from Class »C'/ wells, and 200 feet from Class A or Class B w�lls. 2.5 All pipe connections to the tank shall be mechanical watertight calder couplings. Cleanouts shall be installed as designated and capped with air - tight rain caps. Clean~ outs shall extend a minimum of 12 inches above final ground elevation. Provisions shall be made for landscaping and importation if topsoil. 2.6 Lift station shall be as manufactured by Anchorage Tank and Welding 3.0 ABSORPTION FIELD 3.1 Gravel used in the absorption field shall be 0^5 to 2"5 inch screened rock, with less than 3% passing the No" 200 sieve. 3.2 Sand, used for leveling or for filtering, shall have an effective grain size between No. 40 sieve and Na. 18 sieve" Uniformity coefficient shall be less than A. Not more than 5% b; weight shall pass the No. 200 sieve. 3.3 4 -inch perforaLed pipe shall be ASTM F810" For pres� sure distribution, pipe shall be Schedule 40 PVC or ABS. 3.4 Solid 4 -inch pipe shall be Cast Iron or ASTM D3034. 3.5 Monitor standpipes shall be installed as shown. That section of the pipe pe` el -..rating the gravel shall be perfo-- rated, either by drilling 0.5" holes on 6~inch centers or by ing a section of FOB 10 perforated pile to a solid section of pipe. 3.6 Geotextile shall be Mirafi 140. 3.7 Insulation shall be extruded direct burial polystyrene. Dow Chemical Styrofoam HI 40. Specifications for septic system installation Lot 5 Block 1 Greenland S/D p g . 2 3.8 Topsoil shall be a mixture of 40-60% organic matter, 20�30% sand and more that 20% silt. All quantities are measured by voluae. 3.9 Grass seed shall be Kentucky bluegrass. 4.0 INSTALLATION 4.1 Locate all underground utilities, property lines1 future dr:1veways, existing or proposed water wells, watQF- 9 surface and sub surface drainage facilitiesr lakes, ponds, and all other facilities requiring separation dis~ tances from the proposed septic system. Notify Owner- or - Engineer of any observed possible conflict. 4.2 Stake alignment of system with markers showing t:he protective distances from wells and water bodies. 4.3 Establish an elevation benchmark. This BM shall be easily identifiable, stable and permanent. An arbitrary elevation of 100 can be assigned" 4.4 Install the tank as shown on the drawings. Record the inlet and outlet elevations of th(-.D tank. Tank shall be placed on undisturbed native soil. 1.3 Excavate the a!:�)s(jr ptioo field. Bottom of excavation shall hr levcl and scarified. If sidewalls smears� they shall also be scarified. Record elevation of beginning, middle and end of trench. Record elevation of each corner and center point of bed. Construction equipment shall not operate on the floc)r of the excavation. Any material com� pacted by the operation of the construction equipment shall removed and replaced with uncompacted materials. 4.6 Place the rock to the depth specified. Do not contami~ n�--tte rock with native materials or spoils from the excava� tion. Level the rock surface (+� 1^) before installing the ' perforated pipe. 4.7 Install the distribution pipe. Record the elevation of each joint, For pressure system solvent weld the joints^ �.8 Cover the distribuLion pipe witf rock� and cover the excavation with geotexLit le before backfilling and placing insulation, if required. 4.9 Record the fin:ished ground elevation at the beginning, middle and end of trench. Record the finish ground eleva~ tion at each corner and at the midpoint of the bed. 4.10 Furnish a copy of all survey notes to the Engineer. Specifications for septic system installation Lot 5 Block 1 Greenland S/D pg.3 5.0 INSPECTIONS 5.1 A minimum of three inspections are required. The first inspection will be of the open excavation. At this time the soil conditions will be observed and compared to the �esign assumptions. Ground water conditions or presence of bedrock will be ver�fied. The second inspection will be after placement of gravel/ standpipes, distribution piping, tank(s) and other compo� nents as specified. The third inspection will be after completion of the work. Any dficiencics wil\ be noted and the Contractor - (J -I ontractorch deficiencies shall be corrected within ten days, 5.2 All electrical work requires either an MOA electrical inspection or certification licensed electrician, Submit proof of inspection or certification to the Emgineer. 1:7 Submit cataloO data of all mechanical equi1::)fl) ent. 1.3 Notify Engineer at lrast 24 hours in advance of be ning any work. Notify Municipal Department of Health of all inspections. 343-1733 or 343'4681 (recorder). n Specifications for septic systew installation Lot 5 Block 1 Creenland S/D pg.4 IF V� STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological a Geophysical Surveys Slreel Address and Area of Well Location 2. WELL LOG _I Material Type ,® Feet Below Surfoce - Bottom 16. WATER WELL CONTRACTOR'S CERTIFICATION: This well wasrdrilled yrtM dram ris/Ictlon aSE fh report is true to the gest Registered sea Name /pA'/Con Adores Signed'. Aulho Ixetl presentative Form 02-WWR (II/BI) Copy Distribution: WHITE - State DGGSr PI 4. WELL DEPTH: (final) Ste_if. 5. DUE OF C'0 PLETIOO�NN yy �— �—-TL _. . Drilling Permit No. LOCATION OF WELL (Please complete either In Ib or Is.) A.D.L. No, Ip. Borough Subysdi(y(/.nip Lot Block ❑ Test Well Other: Ib. 1/4 qt rn. Section No. Towns hip N❑ Range E❑ Meridian I Type: Dlometer't SIot/M h Size: Length: of_of—of — . S❑ W❑ 10; STATIC WATER LEVEL: 3'r? 99 N. orLj Ic. DISTANCE AN_D DIRECTION �F�--ZAD INT�RSj NS - 3. pWdNeEnR OF WEL}.: offer=hra. pumping _r�/_ 9•p.m. ft. after _tire. pumping g. p.m. - 12.GROUTING Well Grouted: 0 Yea ❑ No Slreel Address and Area of Well Location 2. WELL LOG _I Material Type ,® Feet Below Surfoce - Bottom 16. WATER WELL CONTRACTOR'S CERTIFICATION: This well wasrdrilled yrtM dram ris/Ictlon aSE fh report is true to the gest Registered sea Name /pA'/Con Adores Signed'. Aulho Ixetl presentative Form 02-WWR (II/BI) Copy Distribution: WHITE - State DGGSr PI 4. WELL DEPTH: (final) Ste_if. 5. DUE OF C'0 PLETIOO�NN yy �— �—-TL _. 6!. ,❑ Coble fool 5Nofary ❑ Driven ❑ Dug ❑ Auger []Jetted ❑ Bored ❑ Other: 7. USE: (Domestic ❑ Public Supply ❑ Industry 7❑3 Irrigation ❑ Recharge ❑ Commerical ❑ Test Well Other: 8. CA Nk ❑ T.�hhrreqea�dded 'Welded diem. �in. to -*%A7 Depth - Weight _lbs./ft. y diam, in. fd ff. Depth Silakup ` ft. 9.'F/I NI5H OF WELL: Type: Dlometer't SIot/M h Size: Length: Set between ft. and ft. . Backfilling Gravel pock 10; STATIC WATER LEVEL: 3'r? 99 N. orLj ❑ Above or Below land surf a Date Equipment used: II . P MPING LEVEL balow la d aur face and YIELD �tt, offer=hra. pumping _r�/_ 9•p.m. ft. after _tire. pumping g. p.m. - 12.GROUTING Well Grouted: 0 Yea ❑ No _ Material: ❑ Neat Cement Ej Other: -- 13. PUMP: (if available) HP m Length of Drop Pipe capacity BAm. m w _ft, . ❑ Subm. ❑ Jet ❑ Cenfrificcl ❑ Other r 14. REMARKS: U b 15. Water Temperature —° ❑ F ❑ C of my hnawledge and belief; j ii0� N... tract Llce nse Number G �^/ Date: Nk-Driller, CANARY - Customer unicipa.1t j7 of Anchorage January 8, 1988 P.O. BC 196650 ANCHORAGE, ALASKA 99519-6650 (907)343-4200 rf&kWAXM& Tom Fink, MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES Judy Lamb PO Box 112294 Anchorage, Alaska 99511 Subject: Lot 5 Block 1 Greenland Subdivision Permit # 870102, On-site Sewer/Well Permit A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1987. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as -built inspection report (three-part form) must be sent to this office for review and approval, and for documentation. Effective January 1, 1988, a new fee schedule is in effect. When re -applying for a new permit, the new fees are; $90.00 for an on-site sewer permit; $50.00 for a well permit; $140.00 for a combined sewer and well permit. If there are any further questions, please call this office at 343-4744. Sincerely, Robert W. Robinson Program Manager On-site Services RWR/ljw enc: Copy of Permit DEPARO1EN( UF HEALTH AND RDTECTION 825 L STRLEl, ANCHURAGE" AK 99N01 2�4-47�0 ���� -��,i A i E ��������� I!,! � No Q- 1-A ���and �, U- PERMiT if 0Al� iSSUED: � PF1lCoi1\ ADD[/ESS: ; �DN[HC[ i HUNE: .Of SIZE: MAX 8WRUOMS: 87V10� ��mw�md�� JU0Y LAMB �J !�o3X i1229� ANCHU�AGE, Ak 995�l 345�3600 SUBDIVISION: GREENLAND LOl5 BLOCK: 1 SECT{IS: 22 [OWNSHIP: It RAN8E: 3W 27000 (SQ.FT. UR ACRS> 3 -isLel below are the options available to you in designing your septic systen/. Choose the optiw that best iiLos your site. � 0EPTH l� P1PE !TUM (FT) ��6z/ � � 7—,4"w'�m� ^�4^�7�' /' 111104- DEPTH 0 )r'yr / mw4��7- ~ - SRAVEL WIDTH (FT. ) ��/,�� �' GRAVEL LENGlH �FT.) r ��/�� G�AVEL VOLUME mCU.YDS.) THNR V:lIE (SALS) AOiL RAlNG 'SQ.FT./ Vol > *� [ANy: 1!|Sl MVP Al iL:W [ TWO CUMPARTMENTS 1 ceri�{y Lha�: 1 1 am iamilLao, with the remuirements 1 o on-siLe sewers ��d we]ls as s�t forth by the municzpality o[ b1chorage (FICA) and the SLate o Alaska. w 11 sta11 Lhe sysLaw in accordance with all Mur, codes and regu1a!'ions and in comp1iance with the design criLerka o1 Lhis Fe/mit. w/1l adhere Lo a11 MOA and State o[ Aiaska reuiremenL� (or 11 e seL back disiances [rom any existing well, aastewatur dispmsal sysLem or public seweragv on Lhis or any adjacent or :ea/by loL. untjerstand at this permit is va|zd [or a mAxiaum of 3 �edro�ms and any Vol 1a/q"loop L wi1l r41 ouire an additional A. S|7�1[ON ||1EN (1) AN KE [S INSiALLED RICAL IN AN AREA COVERED PERMIT AND 1Nil PECT[LAO MUST IN MOA BUiLD1NG BE Ot)7ANED; (2) COCES, AC~8UlLTS BE API !VED WIflit tUl AN [L[CTRlCAL 1NSPE�l[DN R[PORT� AND (3> THE oj RICAL WORK MUS! 8E In NK BY A 1.WWIIELECTRICIAN. OATE: DA[E: -�-r--�-� �--��-� �BcMIl ND: 0A[E ]SAUEU: I ONTAC| PHUNE 1EitAL �ESCR1P �Ol SllE: �AX 8EUHO�MS d,L0��. 1 � : 1UW; 1 . .1 1 "v � )? Mvsjd.�" Ups"; MCI,. it R[OIL NT 2H HEALlH AN) EISS IROMM0N'QL PRWTUC|1 LN 5lHEF:l, ANCUOA6L, ilk 995O1 SUBUi Q 'SlOW: GREENLAND LO7; 5 SEClION: 2w TOWNSHIP: 12N R�NGE: 3W 2/000 (SQ,FT. UR ACRES) J � . / o"r Sin pLic »* TANk MUS| �O ENlS ' � l cuLi�y 1. +h�� 1 am fami e�a���s �or on-szte sewers and wee (MOA) and Lhe Staio o� AlasLj l MOA codes andnd in cc'he design criLeria o� this permi and Stmlny existing well, wastewnter disposal system or public s�werane system on this or any adjacenf or nearby, lot. 4. l understand thai this perlliL is valid �or a maximun o� 3 bedro�ms and any enlar�ement wil� require an addiLional permit. IF A LIFT STAllON IS INSTALLED IN AN AREA COVERED f*! MOA BUILDING 'i CODES, THE1 GN ELhit lR1CU. FORM IT AND INSPInClION MUST BE OBTAINED; (2) AS-BUILTS WiLL NO B[ A 1 ROVED WITHOUT AN LAWN RICAL INSPECTION OF M? ANO (3) THE ELECTRlCA! 1XIORK 711ST Q DONE BY A LlCENSED ELECTRIClAbl, u Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOO ® PERCOLATION TEST PERFORMED FOR: JC��r�'/ ����"'t-� DATE PERF( LEGAL DESCRIPTION: ,-'�•Pe�_ �! spownshlp, Range, Section: rr_-ctr..� nLL! ✓/L?n A SLOPE n S 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 ON WAS GROUND WATER A ENCOUNTERED? S IF YES, AT WHAT L 0 / d DEPTH? P E Depth to Water Alter Monitoring? Date: Reading Date Gross Time Net Time Depth to Water Net Drop I3: g O D r to v3 /e/oS V -;— Q 1 6 In 10 el. 0 a / L —_ PERCOLATION RATE (minutesii Fitt rARAC' TEST RUN BET EEN FT AND FT COMMENTS/ Chi L) `G t q PERFORMED BY: �� �'�� /(i�(� CERTIFY THAT THIS TEST WAS PERF RMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: () ,tZ1,-J e 2 72-008 (Rev. 4/85) NOTES: i. INFORMATION SHOWN IS BAS50 ON RECORD INFORMATION FROM PLAT OF 'GREENLAND SUBDIVISION° P -P68 AND ItIFOHMATION OBTAINEO CURING THIS SURVEY. 2. NO TITLE SEARCH WAS P5HPORM50 FOR THIS SURVEY. S. A 5/8'X30' REBAH WITH AND AL --CAP WAS SET IN THE NE W NW CORNER OF LOT 5 BLOCK i. A 5/8' HEBAR WAS FOUND IN 1'H5 SE CORNER OF LOT 5 BLOCK i, AND AN OLD HUB WAS FOUND IN THE SW COHNER OF LOT 5 BLOCK I WHICH WAS HEPL.ACEO WITH A 5/8'X30' HEBAH WITH AN AL -CAP. 4. () INDICATES RECORD INFORMATION FROM PLAT P-•288. U. 498.8 114UICATES FOUND E'LE'VATIONS BASED ON AN ASSUMED BENCH OF 500.0 ON THE TOP OF THE: AL -CAP AT THE: NC CORNER OF LOT 5 BLOCK i. 8. =� INDICATES PHOPOSUD DRAINAGE. 7. THE PROPOSED BUILDING ON LOT 5 BLOCK i IB POSITIONUO ACCORDING TO 111STFIUCTICNS FROM THE CLIENT. JUDY LAMB. pp V E� ° °° Goose p� pp� �a00e• • •e•pue� ° GeV 00069 *000000•o0 eeespea c .ROY C. RE10, • ®® CE. a" 4 ° 2ai ; AA p PLOT PLAN CERTIFICATION I HEREBY CERTIFY THAT I HAVE: SURVEYED THE U68CHIMEO PHOPERTY HERRON AND THAT TH5 PROPOSFU] IMPROYEMENTS AND ORAINASE PATTERNS ARE CORRECT AS SHOWN. EXCLUSION NOTE IT IS 11fE RESPONSIBILITY OF THE OWNER OH BUIL.OSR PRIOR TO CUN- STPUCTION, TO VERIFY PROPOSHO BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITIES CONNECTIONS AND TO DETERMINE TH5 a-XISTENCE OF ANY EASEMENTS COVENANTS, OR RESTRICTIONS NOT APPEARING ON THE RECOROE'O SUS- po9rO . b P ti Pp�r3' P�0 9 P tr 6 112th AVE. (100.001) 100.01' • 'm �0.5'X1.51CANTS. L_ to v SS.J 1�. 4.0 r. WOODov DECK 5 iq ja m Y 1I CJ �✓� nl 98.8' 0.7' PHOPOSFD TWO STORY lD FRAME HOUSE 0 F.F.ELEV. 501.0 • 0 �1 101 20.0' (N.o9' 53'06"W. _ 100.00' ) ` W W.89'61'60"W. 99.774 -- +ll AW P rj N x ° tl m 0 n 0 N 4 O p m 0 113th AVEl. ; m '�Y. "' pC••+0••ppYo 4 1 p r ,5RR G� F 1`i. ppo 1 �0� •�•pp�gp, •• rn pp ••p•+so o .0 .. lv +3 g R e +� Bryan E. Coop j o JT�'0 No. LS -5733 o • '1 FO QD��QPe•0'• p0 oopopo`j00�"'�.i �OFESSION P� �P �d COOPER AND COMPANY 4601 NORTHWOOD DRIVE ANCHORAGE, ALASKA 995171 DATE I SCALE: �- -A� • I OHAWN . ^^ I N.U. -- - _ -.- I GRID _ I CK. LE eAL OSSCRIPTION LOT 5 BLK . 1 GREENLAND SUBDIVISION MUNICIPALITY OF ANCHORAGE o Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I. D. 015-172-23-000 Expiration Date: 9/22/2023 Legal description GREENLAND BLK 1 LT 5 Site address 4820 E 112TH AVE Anchorage AK 99516 Current property owner(s) KITCHENS-ANKLEWICH ANNE M &ANKLEWICH WILLIAM T X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 6/22/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist Absorption Field Advisory Tank Age Advisory Other X Well Flow Advisory Nitrate Advisory Arsenic Advisory COSA ApprovaUune 2022 MUNICIPALITY OF ANCHORAGE Development Services Department - Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-172-23 Complete legal description GREENLAND BLOCK 1 LOT 5 Location (site address) 4820 E 112TH AVENUE ANCHORAGE, AK 99516 Current property owner(s) ANNE KITCHENS-ANKLEWICH & WILLIAM ANKLEWICH Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ® Plastic ® Concrete ❑ Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ® Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Distance: Expedited review requested: ❑ By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 55.0 Waiver Fee $ _ Date of Payment �'� 2 3Date of Payment COSA # OSG Z3 Waiver # COSA Application 2022.doc COSA Checklist 2022.docx COSA Checklist Legal Description: GREENLAND BLOCK 1 LOT 5 Parcel ID: 015-172-23 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 5/8/1987 Total depth 327 ft Cased to 327 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 12 in. Date of flow test for COSA 6/2/23 Static water level at beginning of test 294 ft. Well production at time of test 4.5+ gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 0.627 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 6/2/23 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank NA Date of pumping NEW TANK Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 9/29/1999 ALL standpipes present per record drawing Total measured depth from grade 8.9 ft (max) Measured depth to pipe invert from grade 3.2 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced 2000 gallons 6/6/23 date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 6/7/23 Results Pass Fluid depth prior to test 31 in Water added 450 gal New fluid depth 44 in Elapsed time 1440 min Final fluid depth 29.5 in Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 72 in Effective depth used 29.5 in Effective depth remaining 42.5 in Comments/Deficiencies: NO KNOWN FREEZING OR FROST ISSUES PER OWNER. COSA Checklist 2022.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 6/20/23 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 6/20/23 E. M 112th CS WOODEN--" FENCEASPHALT 'DRIVEWAY' 14.8' 14.5'08.2' CARPORT 2.0'x4,9' CANT Lot 6 2.0'x31.8' CANT SEPTIC AVENUE \ 100.00' r7ELL _—_—_ Inn PORCH 2 STORY m RESIDENCEN 42.3' 28.3' DECK O 0 Lot 5 27,125 S.F. NOODEN / ENCE Lot 4 1.3'x20.2' LEAN—TO — N 89'53'2O"W 100.00' — 0 M E. 113th AVENUE PLOT PLAN AS BUILT JL SCALE —!:—= 50' GRID SW 2636 Project No. 23-264/A1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone kenOlangsurvey.com OF \�,� Professional Land Surveyors jonathanOlangsurvey.com q 1� travisOlangsurvey.com AW, AWN P• ° I hereby certify that I have surveyed the following described property: LOT 5, BLOCK 1, GREENLAND SUBDIVISION (PLAT No. P-268) f*: 49TH Anchorage Recording District, Alaska, and that the Improvements situated thereon are within the property lines and do not encroach onto the properly adjacent thereto, that Z no improvements on the properly lying adjacent thereto encroach on the surveyed premises and that then are no roadways, transmission lines or other visible KENNETH G. LANG o j easements on said properly except as indicated hereon. ��f, 0.5!202 Dated this the 21 wt Day of �u u3 , at Anchorage, Alaska ��I�FVA paDy r It is the responsibility of the owner to determine the existence of any easements, `�\MK&kk � covenants, or restrictions which do not appear on the recorded subdivision plat. State of Alaska AECC963 • '� Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-172-23 _. Expiration Date: 1. GENERAL INFORMATION Complete legal description GREENLAND BLOCK 1 LOT 5__ Location (site address) 4820 E 112T11 AVENUE ANCHORAGE AK 99516 Current Property owner(s) STEVEN & MELINDA PARKS Day phone Mailing address Real Estate Agent 2. TYPE OF DWELLING: 4820 E 112TH AVENUE. ANCHORAGE. AK 99516 ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Waiver/Variance request for: Day phone S 'U" 13 M IrTA L MAY 0 6 2014 TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ Received by: % . ✓ Date: COSA to be released.t��'ngineer, unless otherwise requested by the engineer. COSA Fee $ 52/ Date of Payment 5-/o`/y Receipt Number 05-51 COSA # _05C 1) � 1 Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING. INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 4/30/14 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. OF" A \ �� Lf r� 1 P �= 4g7 -Ft /+. 6. DSD SIGNATURE System #1 Approved for bedrooms. ^r���'rn� n '00 System #2 Approved for bedrooms. �aFf iii korF:slcu`L i Disapproved. Conditional approval for bedrooms, with the following stipulations: n 1ArACTFWATER C - IAAio�� Original Certificate Date:it of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA bluesheet 10-10-12.doc 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: GREENLAND BLOCK 1 LOT 5 Parcel ID: 015.172.23 A. WELL DATA Well type PRVT If A, B. or C provide PWS ID # Date completed 51811987 Sanitary seal (Y/N) Y Total depth 327 ft. Cased to 327 ft. FROM WELL LOG Date of test 5/811987 Static water level 309 ft. Well production 10 g.p.m. WATER SAMPLE RESULTS: Coliform NEG- colonies/100 mL Nitrate 6,7&(p mg/L Arsenic: NZ)_ug/L Date of sample: 4124/2014 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC / STEEL Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping 4124114 Pumper A+ C. ABSORPTION FIELD DATA Well Log (Y/N) Wires properly protected (Y/N) Y Casing height (above ground) 12 in. AT INSPECTION 4/24114 ft. g.p.m. Collected by: ARCTERRA Date installed 9/8/1992 Cleanouts (Y/N) Y High water alarm (Y/N) N Date installed 912811999 Soil rating (g.p.d./ft2 or ftZ/bdrm) 1.2 System type DEEP TRENCH Length 54 ft. Width 2 ft. Gravel below pipe 6 ft. Total depth 10 ft. Eff. absorption area 648 ftZ Monitoring tube Y Depression over field N Date of adequacy test 412412014 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 14 in. Water added 750 gal. New depth 40 in. Elapsed Time: 1425 min. Final fluid depth 20 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at _ in. Datum Size in gallons "Pump off" level at _ in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 1004 Absorption field on lot 100'+ Public sewer main 75'+ Sewer /septic service line 254 Animal containment areas 504 SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access (YIN) High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 1001+ Public sewer manhole/cleanout 1004 Holding tank 100'+ Manure/animal excrete storage areas 1004 Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 101+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 10'+ Water main 10'+ Water Service line 101+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+(NONEKNOWN) Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name KENNETH M. DUFFUS Date 4130114 COSA brown sheet 10-10-12.doc OF AL4 t P � 4. Tx*�� + P KENNETH M. EVF S / ��\tie F'ESSla'°av in. [TEY. nr =4AFDJ=)o Raab tAS ---------------------------- E. 112th AVENUE ori) LnlewR mtwaalmxT nwAlT e6aflC 4lBKN 100.00' S89° 55'30"E soE aana aTetoc --- rwAle ...... .. .. .... LL ..... 4.6: �...:. v CAR - - PORTEXISTING HOUSE - 42.0' 27.6' io?WELLnn�IU$.- N N 5 r N 4 w $ w g SHED � $ o $ N C. s 100.00' S89° 53' 20-E� UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE UNES, THE SURVEYOR TAKES RESPCNSIBIUTY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL UABNTY ONLY FOR THE COST OF THE SURVEY USTEO DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. LOT SURVEY SURVEY TYPE SYMBOLS FOUNDATION AS-&ALT�����,,,,,,,,, FINAL STRUCTURE AS -BUILT ' SET REBAR DRAINAGE ASPHALT I ❑ PLOT"... AS -BUILT... LOT SURVEY... TCPOGRAPHY o FOUND REBAR 9 WOOD FENCE"I' CONCRETE AS- . - NO QMVM..Mn TON AS -BUILT .. NO CORNERS MT 00 a ASSUMED ELEV. -X--X-* METAL FENCE ® WOOD DECK PLOT PLANS & LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCATION, THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION ONLY. SNOW MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED, PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED, SURVEY CERTIFICATION rr��ff PLOT PLAN �.•�E,OF f Robert E, Johnrs, Jr. & Assoc. w.nr w� y aw I ww onwmr vwPa a, lalem eq 4reetl Mia,. ew 0ati nw. Avw a ♦ ........... f swr'�P'•"'���• '•• 1f •• Professional Land Surveyors s wNMYw o tlw wt . s +w., ., ew Nm aw a tlw swt a mr �a4w14'w erwrem r -J �:' ••'': f �f 1700 Brink Drive. ANCHORAGE, naw a., r"w a+sRtYwas AN . ALASKA 99504 FOUNDATION AS -BUILT "Iwilm E. !..awlrwUN"I nw P.n.erem...mNwrw a q$th _ {� �••••• +..... / • / Scal« 1" = 501 Rea Lot S.F. Rea. Plat File No. Date Surveyed: Drawn w uaHaMa�,epi,n�e�nwa{; - OC/08/14 5 Ill REJ Checked byMV K .A.a �""�""a �'"'I` I OEIERT OHNS•••, '•••� JJ Date Drawn: 05/08/14 Grid: 2636 W,p 14-168 ,I'+wwe�w �ii�. %�. _S FINAL STRUCTURE AS -BUILT I. Ra4/\ 5 Mb0. J.. M,CY wary Tn I ,Z� ,:` a�°� a ~ d ••. Legal Description: I ••'. °�afessiond Lot 5 Block 1 .nor vP�wMu wammww ww wr ��■■■•.�••� GREENLAND . `Ts - MunicipaUty of Anchorage o Development Services Department Building Safety Division Onsite Water and Wastewater Program 4700 South Bragaw St. 34 t T P.O. Box 196650 Anchorage,•AK 99519650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 016-172—"2_'_5 HAA# NRo3o590 Expiration Date: - 1. GENERAL INFORMATION . Complete legal description Lrn T r—%1 —) G & t f-) I -A ty n 3 u Location (site address or directions) 4BAD L Current Property owner(s) D -�;04 114P Day phone_345— 963 Y Mailing address Lending agency Day phone Mailing address Real Estate Agent Mailing Address -- FS Day phone Unless otherwise requested, HAA will be held by DSD for pickup. 2. .NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System z The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil____ engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. TYPE OF WASTEWATER DISPOSAL: Q� Individual On-site e ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil____ engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Address Engineer's Printed Name 1 p)1bet4 SPU IfV�laKa5C 5. DSD SIGNATURE Phone , a79 -30i /b Date A k l Xg �03 S. L/ Approved for 3 bedrooms. �i�9•` �..r.,.,. ���pR�fESS� Disapproved. �.eo►tw Conditional approval for bedrooms, with the following stipulations: Additional Comments ,�J • ON-SITE G�= Attachments: HAA Checklist X Maintenance AgreEments Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By. Original Certificate Date: I (J2, k7 (RW. 01102) Municipality of Anchorage a Development Services Department Building Safety Division i < On -Site Water & Wastewater Program ° • ■ 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOT S Elk l G fLF:E N LAN p s If Parc el ID:_ 015— 1'7Z-2- A. 7Z— -A. WELL DATA Well type %417 / If A, B, or C provide PWSID #-hVA Well Log (Y/N) Date completed !�(� 1 Sanitary seal (YIN) Wires properly protected (Y/N) —�� i Total depth �—ft. Cased to 3971 ft. Casing height ( above ground) 12 in. FROM WELL LOG AT INSPECTION l r Date of test S_ 1,5l 11113 tt 0 Static water level 30 % ft. 3a o ft Well production 1 g.p.m. g.p.m. WATER SAMPLE RESULTS: 'I Coliform colonies/100 mi. Nitrate 1\10 mg./l. Other bacteria NO colonies/100 ml. Arsenic: mg./l. Date of sample: i�/13!l 013 Collected by: Ts a ✓ r Ig H e� B: SEPTIC/HOLDING TANK DATA Tank Type/Material —T �• C .. S�t �- Date installed q/8• A L Tank size 1 D gal. Number of Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) Depression over tank (Y/N) N High water alarm (Y/N) M Date of pumping, (1) Ile 3 Pumper __ s ASA f 15 C. ABSORPTION FIELD DATA I I Date installed 14q'1 Soil rating (g.p.d./ftZ or ftz/bdrm) 1 Z- System type _ 4 -t -+-r G N Length ft. Width ft. Gravel below pipe _ f� ft. Total depth_ (ti ft. Eff. absorption area 1p4i3ftZ Monitoring tube Depression over field ►_t Date of adequacy test 1111-510.3 Results (Pass/Fail) For __,7 bedrooms Fluid depth i'n absorption field before test .2112 in. Water added jW gal, i New depth_W in. Elapsed Time: Somin. Final fluid depthin. Absorption rate >_ O g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date Vol' i I i � ,i I D. LIFT STATION Date installed "Pump on" level at_ i . Datum E. SEPARATION DISTANCES Size in gallons /an 6e/Access (Y/N) _ "Pump off level at _ in. water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 146, Absorption field on lot 170 Public sewer main Sewer/septic service line 75 On adjacent lots roc) On adjacent lots /0'n Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Absorption field 3 Water main A Water service line 1,004 Surface water in Wells on adjacent lots J o SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation tiq Water main N/A Water Service line ( O Surface water M b Driveway, parking/vehicle storage Curtain drain 1`4 o Wells on adjacent lots /0 F. COMMENTS in. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and o« ro. kp review of Municipal records that the above systems are in : '' «..�«• 'a' conformance with MOA HAA guidelines in effect on this date. a�� t �;,qt,,,,„-�+; Engineer's Printed Name 1 ohiJe vl > pv V,io.r1 `���'A'e"CCS •, m•, Date "lSC. HAA Fee $ 375 vti Waiver Fee $ Date of Payment I r 1 e Date of Payment Receipt Number `'r $5 Receipt Number J (Rev. 12101) 1.1-18-03 04:41PM FROWCUE ESI. SGS ENV SERVICES BET5615301 T-624 P.01/G3 %-138 All Doteell'imea ore Alecks Standard Time SCSI Ref -0 1037437001 Printed Client Name Tobben gpurkland P.E. d DotelTlffI me 11/13/2003 1311/18/2003 10:5 i5 Prolat Nae/11 Greenland Silk 1. Lot S Collected at:2 Nam e/11 Sample ID G eenland Dlk 1, Lot 5 Received Datell lme ! 1/13/2003 Technical Director StephenEde htatris Dnnking Water Released Sample Remarks: Allowable Prep Analysis Init Parameter Results PClL Unita Method Contuner ID pate Waters Department Ninate•N 0.103 0.100 mg /L EPA 300.0 13 (r-10) 11/14/03 JJB Microbiology Laboratory Total Colironn 0 colll00mt 9h11842220 A 111131o3 DKC 11-13-03 04:4111 ;ROU-CTdE ESI. SGS ENV SERVICES 9075615301 Drinking Water Analysis Report for Total Coliform Bacteria S RUCTIONS ON RE TERSE SIDE BEFORE COLLECTING SAMPLE T-624 P.03/03 F-236 200 W. Porter Drive Anchorage, AK 89518.1806 Tel: 1907) 562.2343 READ IN. T BY l & nQ A foto MUST BE COMPLE: fED BY WATl+K aurrLjrr, ❑ rIJBLIC WATER SYSTEM I.D-P t/PRIVATE WATER SYSTEM Send Rrtrfn ❑ &ftl involce S��.�V. h Sanwa xr awn rr1 41P., •\ " r• .m r nr,. wn rt ., P aJ. ❑ SetulRrentes ❑ Sradlnvolce aW,Prl« u�W/M yi Mani A dIs. ne re ro ry .o t-=—� oil E3 SAMPLE DATE: fvlonth Day Year SAMPLE TYPE: Routine G- Treated Water G/ Untreated Water ❑ Repeat sample (for routine sample with lab ref. no. ) 0 Special Purpose Time Collected SAMPLE LOCATION Collected By Gr �ehla� Bpi t>,� I TS - tune trrr Comments: TO BE COMPLETED Analysis shows this Water SAMPLE to be: IL Satisfactory ❑ Unsatisfactory ❑ Sample over 30 hours old, results may be unreliable ❑ not bel oe Chours transit; dat examination onld to indicate reliable results. Please send new sample vie Special de;iv ry mail Date Received C Time Received C Analysis Began r -1 KYR Analytical hiethod: o hmena UG Filter 1 ► Numt+er of rntnnin/I40 ml. Resuftr Analyst 10374.37-4c �' III[N n Fbks JonHIt«.—�e— ❑ Fased Dale: Trmr: Client notified of unsatisfactory results: ❑ C Phoned Spoke wish Faecd Dam: Time: BACTERIOLOGICAL WATER ANALYSIS RECORD NIN10-MUG Result: Total Coliform ,f E- Coll llembrant Filter! Direct Coant Colotdea/IDO ml Verification: LTB nG8 _ COLIFIRM Fecal Coliform Confirmation r r ColifoMV100 ml �p�t Ititak 6r Flail Membrane Filter Rmths � Reported By y6 Date 11/11 (C3 Tlme 12 "� hn i1'rc-rIs huu'roa. Tr G«•� OB - orae ale♦•nn r.l.:l ivvrwn:n�ua�srrt:r;l�w. 1200 West Porter Olive, McMraSe_AK9951&16GS 19071562-743 f19371561 -MOI wrrrvs9!e^.v0ormemal can ._- .�- _..—.._`..—. Mmov ae m. oat -trop �nelrJ GN4nr USwe.4ree1 a SET 4r _xt�aEas ----------------- 0 K-; RO'tz M w " W'X Ye mewl h AVE. 6m 113th AVENUE o ....--. N 89'S3'20' 4—..�.----� — AS -Ml CERiS1C MU I irxs, Carr W I WA Ipm 66 DOM NRL'N A.) iW] W Q0.. F. U- cmvturn OGS1 Davy AS vockl ExCLu= NOTE IsMvnmm7raw 00016 mllu E 6E 0.;70cE 8 ANf FA=V*,S CXWU% a % 6S Mor" 9m%= P.A. X" NO oaasvx s snes Ml DAN NOfON R UO NA Ca- STX,- R a a am;sp" FMS OR IDV. 6f MS. I\ I F A i 49 18 ..mal, c• �.� LOT 5 BLOCK 1 GREENLAND SUBDIVISION COOPER AND COMPANY 4601 NORTHM ANCHORAGE. AI KA 99517 (907) 248-1924 WE 11,wI 0t=sy 9201 35 2636 J.B.C. 4 xm YdWCE e NOTES: ' OtQaRI TWO sm 1. TM SURVEYWASACCOLTMIED USING THE PUT OF RECORD OF CREfN(1ANjD E HOIZJSE SJBDMSM 268 ANCHORAGE RECORDIC DGIM. ALM) y AND SURVEY CONTROL l i DDD COURSE OFMUNCES FOR PLAT THIS OR COl1PU) RECORD FROM 1FMT PUT. Or LOT 5 BLOCK I WAS _ _ _ _ ban iat t SURVEY ORG NAIlYSU BY COOPER AMD COMPANY (JOB 67 -"AND 5))OON 4/30/67 3. THS AS -SUIT WAS ORDERED BY SAY R JUDY LAVEL OR PERFORMEI) FOR TM S. TM SA- ApP�IREG 5 NOT VAL0 WMIDU THE S R VL= ORWERED iCN1L I 6. THE CURRENT ZONING OF EOE s BE=1 CREFNUND MNEM ACCORDING TO ENT FOUND OF M.OA ZOI414 DfDrO W. IS R-7. R-7 SET RACKS ARE 2S FRONT. TP SDE AND 27 REAR i 7. UNIM OMAME NOTED ALL FENCES SFDMN ARE 6' ME x000 FENCES. 6 NOTE THE FOLLOWING ENCROAY IWM' THE CONCRETE PATHO FROM EDT 6 INTO LOT 5, NO MRD READ UTIRY SERVICE LIE FOR LOT 6 TWIT CROSSES THE NM CORNER OF LOT S (NOT SFT #NlI THE SE CORNER OF THE WOW FENCE INTO LOT 4. - I F ANY OTHER PERMANENT FIXED WROVEMENM DCST AT TE TWE OF IM o E SURVEY. THEY WERE NOT MW DUE TO DEEP SHOW. 8601I6fs�--� :; Is/s9 —•• RECLQ;7ICA'D(V 4�COOPER AND COMPANYJOB 99-09-42 I 10. EXCEPT FOR NOTE 9 ALL THE ABOVE NOTES MI APPLY. 11. THE FOILOWNG CHDNCES WERE MADE THEN TFLS RECERIFICATHOFt c ADDED A DECK. STORAGE 9M GRPORT. ASPfkT. AND CONCRETE. • w 12 TIE ASPKT DRNEWAY D004CMS NO TIE RGHI OF WAY OF 1I2EA AVE LOT 6 FNS COIAECTED 6' WOOD FENCES TO THE DZIM WOOD ON LOT S •• N INC PEACES (( NOT WAND, LOT I WS ALSO PAVED THE9I DWEWAY •. AND TFER ASMKT IS K.A15T THE WOOD PENCE OF LOT S. o�mOl PP6 �o oI .I 113th AVENUE o ....--. N 89'S3'20' 4—..�.----� — AS -Ml CERiS1C MU I irxs, Carr W I WA Ipm 66 DOM NRL'N A.) iW] W Q0.. F. U- cmvturn OGS1 Davy AS vockl ExCLu= NOTE IsMvnmm7raw 00016 mllu E 6E 0.;70cE 8 ANf FA=V*,S CXWU% a % 6S Mor" 9m%= P.A. X" NO oaasvx s snes Ml DAN NOfON R UO NA Ca- STX,- R a a am;sp" FMS OR IDV. 6f MS. I\ I F A i 49 18 ..mal, c• �.� LOT 5 BLOCK 1 GREENLAND SUBDIVISION COOPER AND COMPANY 4601 NORTHM ANCHORAGE. AI KA 99517 (907) 248-1924 WE 11,wI 0t=sy 9201 35 2636 J.B.C. MUNICIPALITY OF ANCHORAGE!/ • DEPARTMENT OF HEALTH a HUMAN SERVICES O Division of Environmental Services On -Site Services Section G I P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 01-r,>— 1-12-- v2'3 HAA # 1AQC (o qol& 1. GENERAL INFORMATION Complete legal description LD I .15F Location (site address or directions) �LstP_'D E- Ila 4A Property owner ��1u) rka 49 Day phone Mailing address �• n ��� l 122 cl `� Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: —= 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: / Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rov.1/91) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ola0'eh �u1r1G�c�.utC� Phone L-LI-S1/Lo Address Q ,,,,,, Engineer's signature Date �_— u- a i Y.! 1d ZD ,L 6. DHHS SIGNATURE vApproved for T SEE bedrooms. Disapproved. Conditional approval for Additional Comments UITIC bedrooms, with the following stipulations: Date 10-7-q 9__ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesyto purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. M-025(R..1M) Sack MOAM21 IMMUliU OCT 0 5 1999 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVIMSIPAurY OF ANCHORA Environmental Services Division ENVIRONMENTAL SERVICES DIV 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: LO 7 5, QV- 1 6; agI nI i7 FrNA Parcel I.D.: D 15 - 172- -,2 3 A. WELL DATA Well type P, If A, B, or C, attach ADEC letter. ADEC water system number N/k Log present(Y/N) Date completed �t Total depth 2.) X7 Cased to J'„ 47 Casing height (above ground) 2 Sanitary seal (Y/N) Date of test Static water level Well production FROM WELL LOG mwiiiiiil�.-w•� � oq I) g.p.m. Wires properly protected (Y/N) AT INSPECTION `11A/ lR4 5D3 WATER SAMPLE RESULTS: Vl t Coliform -� Nitrateq� y•7 f�2 9/1 Other bacteria Date of sample:/�/� 9 Collected by: 7 B. SEPTICIHOLDING TANK DATA g.p.m. 9 5D Cleanouts (Y/N) Date installed g/ /� Tank size ! a2 Number of Compartments Foundation cleanout(Y/N) Y Depression (Y/N) N High water alarm (YIN) �_l Date of Pumping Q 3 a 44 Pumper /La s n C. ABSORPTION FIELD DATA Date installed 9lze R $ Soil rating (g.p.d./ft2 or ft2/bdrm) 1. Z System type TA - d -ti Length b Li , Width L Gravel thickness below pipe/e t Total depth 10 r Effective absorption area b 0' Monitoring Tube present (Y/N)_ Depression over field (YM) ly Date of adequacy test fq Results (Pass/Fail) '"/ For 41_-� bedrooms Fluid depth in absorption field before test (in.); Immediately after gal. water added (in.): Fluid depth 'f (ins) Minutes later: Absorption rate = t/ g.p.d. Peroxide treatment (past 12 months) (Y/N) ✓ If yes, give date 72-026 (Rev. 3/96)` D. LIFT STATION Date installed Manhole/Access (Y/N) _ High water alarm level at* _ Cycles tested E. SEPARATION DISTANCES Size in gallons on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot _ Public sewer main Sewer /septic service line 145 1-70 1N1 75 "Pump off" level at* On adjacent lots 1vr& I, Cl U On adjacent lots t1D Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: IY N Foundation 75 Property line Absorption field 'a_ Water main/service line m i N I C>5 _Surface water/drainage t � Wells on adjacent lois SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line ( D Building foundation (t 9 Water main/service line _�Ll D Surface water H I C7 Driveway, parking/vehicle storage area 17-0 Curtain drain N )"a Wells on adjacent lots F. ENGINEER'S CERTIFICATION 1 certify that I have determined thru field inspections and review of Municipal records that the'above systems are in conformance with MOA HAA guidelines in effect on this date. i Signature. u Qt ��•v✓� n Engineer's Name a 166g v r V LawaX V� I✓ - Date (9 (A- q , HAA Fee $ ' �'�� Waiver Fee $ Date of Payment/T -� T `/ Date of Payment Receipt Number S33D (�2/ / Receipt Number 72-026 (Rev. 3/96)*