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HomeMy WebLinkAboutLANG LT 4Lang Lot 4 #015-273-59 ispecuon nep6n_I-1-1�qoec Municipality of Anchorage Community Development Department Page 1 of 3 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP121285 PID Number: 015-273-59 R1 New ❑ Upgrade Name: Edwin & Roberta Darby ABSORPTION FIELD ❑ Deep Trench ❑✓ Shallow Trench ❑ Bed ❑ Mound Address 4000 Janet Lee Circle ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 1 0.45 GPD/SF 7.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 5.0 Ft. Gravel depth beneath pipe 1 2.OFt. Subdivision Block Lot Lang 4 Fill added above original grade 0-1 Ft, Gravel length 50.0 Ft. Township Range Section Gravel width 5.OFt, Beds: Number of Lines NIA Distance between lines I N/A Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 357 p¢ 1 N/AFt. Well 121.0 128.4 NIA N/A 112 TANK El Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1000Gal. Surface water 100+ 100+ N/A N/A Material Number of compartments Lot Line 25.2 25.5 N/A N/A Steel 2 NA Foundation 36.6 27.1 N/A NIA LIFT STATION Manufacturer Capacity Curtain Drain N/A NIA N/A N/A Gal. Remarks Pump on level at in. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL Housetotank PVC drainfteld Tankto PVC GLW Enterprises Drainfeld PVC CO/MT PVC Inspector Pannone Engineering Services BENCHMARK (Assumed elevation) 100ft Inspections� dates: 11/7/12 2-d 11/7/12 Location and description 30 11/7/12 4h F1 l%tz Garage F.F. COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date`s y*j *..'49 TH t seven nnorae i CE 8149 +� �}l\9tOFESSia_� Approved Date /2_20_a ispecuon nep6n_I-1-1�qoec RESERVE DRAIN FIELD (P) A B C Tl 43.2 45.5 T2 39.4 45.1 DCO 37.7 45.0 Cl 58.5 29.9 mi 56.9 28.3 C2 61.5 54.7 M2 1 60.1 53.6 I INSTALL 12509 TANK AND ADD rn m C2 % 9: K: M2 --m Al m m -zi TH-1 2 NEW UNAIIN FI LD A 5 50LF 5 1 W 2.0'ED x 7.0'TD C'l IMB 313R HOUSE (E) 131.1 7i 25 1 DCO C 130.1 2 128.4 WELL (E) 121.6 �`:: Is WELL (E) NEW 10009 SEPTIC TANK GARAGE (E) IrJ';TAI I Fn nrn 44 LOT UNDEVELOPED NO WELLS OR SEPTICS M NOTES: PAMOM OF AENG SVC, LLC oz!�nkk Date RECORD DRAWING k P.O. BOX 100217 ANCHORAGE, AK 99510 ....... l-.4jko 11/28/12 PHONE (907) 272-8218 FAX (907) 272-8211 AWg Scale 1"=50' ....... . ..... P.I.D. NO LANG, LOT 4 015-273-59 EDWIN & ROBERTA DARBY PERMIT NO. 4000 JANET LEE CIRCLE CE 8149 j OSP1 21285 PLAN ANCHORAGE, AK 99506' /)6fs -•so * 0- Sheet 2 OF 3 CONNECT TO PRIMARY RESIDENCE AND UPGRADE SEPTIC SYSTEM TO ACCOMMODATE 4 BR I INSTALL 12509 TANK AND ADD 20LF x 2.5'W x 6 (ADD 1 OLF TO EA rn m C2 % 9: K: M2 --m Al m m -zi TH-1 2 NEW UNAIIN FI LD A 5 50LF 5 1 W 2.0'ED x 7.0'TD C'l IMB 313R HOUSE (E) 131.1 7i 25 1 DCO C 130.1 2 128.4 WELL (E) 121.6 �`:: Is WELL (E) NEW 10009 SEPTIC TANK GARAGE (E) IrJ';TAI I Fn nrn 44 LOT UNDEVELOPED NO WELLS OR SEPTICS M NOTES: PAMOM OF AENG SVC, LLC oz!�nkk Date RECORD DRAWING k P.O. BOX 100217 ANCHORAGE, AK 99510 ....... l-.4jko 11/28/12 PHONE (907) 272-8218 FAX (907) 272-8211 AWg Scale 1"=50' ....... . ..... P.I.D. NO LANG, LOT 4 015-273-59 EDWIN & ROBERTA DARBY PERMIT NO. 4000 JANET LEE CIRCLE CE 8149 j OSP1 21285 PLAN ANCHORAGE, AK 99506' /)6fs -•so * 0- Sheet 2 OF 3 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION WAS INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS. 2. ALL WORK WAS IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS. 3. SCOPE OF WORK: INSTALLED NEW 1000g SEPTIC TANK AND SOIL ABSORPTION SYSTEM. 4. GROUNDWATER WAS OBSERVED AT A DEPTH OF 13.5' AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE WAS NOT OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 13.5 FEET BELOW EXISTING GRADE. SM SM 50 60 8/21/12 80.6 3r B/7/12 U 0 5 55 0 0 o wo z o U V 00 65.D I1000g SEPTIC TANK (P) DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM NO. BEDROOM: 1 (150 gpd) TANK SIZE: 1000g PERC RATE = 58.8 MPI SOIL RATING: 0.45 GPD/SF AREA ROD: 333 SF SYS. TYPE: WIDE TRENCH 2.0' E.D RF: 0.70 MIN LENGTH: 46.7LF USED: 50LF X 5' WIDE, 2.0' E.D., 7.0' TD TOTAL AREA: 357 SF PROFILE FILTER FABRIC 5.8-96.6 4' 0 DRAIN PIPE DRAIN ROCK 6' ABOVE PIPE INV DRAIN ROCK SECTION z 5 z =5 O .2 o FABRIC o ROCK 6" ABOVE PIPE INV 11 n z U 3 TRENCH SEE DESIGN LEGEND W WATER LINE/ WELL RADIUS — SS — NEW SEPTIC NOTES: PAMONE ENG SVC, LLC RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 LANG, LOT 4 EDWIN & ROBERTA DARBY 4000 JANET LEE CIRCLE DESIGN DETAILS ANCHORAGE, AK 99506 ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT NO. M# MONITOR TUBE NO. R.I. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER BFG BELOW FINISH GRADE OG ORIGINAL GRADE FG FINISH GRADE TS&V TOPSOIL AND VEGETATE 112/14/12 *• 4 (/ " ' • • NTS P.I.D. NO .....:�. Stevenf�.15annone P�tr�. CE 8149 % fi``� 015-273-59 PERMIT N0. OSP121285 Sheet OF 3 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP121285 Tax Code Number: 01527359000 Work Type: Septic Initial Permit Effective Dates: September 19, 2012 to September 19, 2013 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: LANG Site Legal Address: LANG LT 4 G:2635 Owner/Address: DARBY EDWIN R & ROBERTA L 4001 JANET LEE CIRCLE ANCHORAGE AK 995061552 Site Mailing Address: 4000 JANET LEE CIR, Anchorage Lot Size in Sq Ft: 53487 Total Bedrooms: 1 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By Community Development Department Development Services Division On -Site Water & Wastewater Program Mayor Dan Sullivan ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING i Phone: 907-343-7904 Fax: 907-343-7997 Parcel I.D. OIS'- Z73- Sj Property owner(s) 6_W%,V ON= P ol�6e7.z1 J),q Day phone Mailing address 4bbl -:59,VE-t [-e F CGp_c iz- ,/}�Jc MoR/i�c,�J g9S�Ca Site address tOOU crlA(_Le Legal description (Sub'd., Block & Lot) L A) I-, 1-&T cJ Legal description (Township, Range & Section) Lot Size 163,yeg 7 Sq. Ft. Number of Bedrooms THIS APPLICATION IS FOR: THIS APPLICATION IS AN: (® all that apply) MA Initial Absorption Field Upgrade ElSeptic Tank ,K Renewal ElHolding Tank EJ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. or authorized agent) Permit/Rush Fees: rJ�>o — Waiver Fees: Date of Payment: e1t51la cjtw, Receipt Number: O(adaS (a Permit No. MIP 1 al a$ 5 - Date of Payment: Receipt Number: Waiver No. G:\Building\On SiteTormsUient FormsTermlt App_010411.doc (Rev. 1/11) Pannone Engineering Services uc Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@nanengak.com September 13, 2012 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lang, Lot 4 Septic System Permit Request Ladies and Gentlemen: I am writing to request a permit to upgrade the septic system be issued for this property. The proposed systems will serve a new (1) bedroom mother-in-law apartment that will be added to the existing detached garage. Currently the lot is developed. The new system will be installed along the west property line, west of the existing house and existing septic area. This lot is served by a private well that is located over 100 feet from this system. The surrounding lots are also served by private wells. There are no wells within 100 feet of this system. 1. Soils. A single test hole was excavated by Pannone Engineering Services in August of 2012, and the ground water monitored for seven days. Groundwater was observed at 13.5' in the test hole monitor tube after the seven day monitoring period. Bedrock was not encountered in the test hole. It is my opinion, based on the results of the percolation tests and overall soils appearance; an application rate of 0.45 gallons/day/square feet should be used for conventional wastewater system. 2. Soil Absorption System Design. a. See Sheet 2 of the design package 3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The topography slopes from southeast to northwest at approximately 5%- 7% in the area of the proposed drain field. There are no steep slopes in the area. S. Reserve System: The reserve system will be added to the existing primary residence. The existing primary residence septic system will be upgraded to accommodate 4 bedrooms and this system will be Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 tied in. See reserve system design, sheet 3 of 4. 6. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and that there are no further comments is received from MoA On -Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Attachments -Soils Log -Septic System Design Mailing: P.O. Bax 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 RESERVE DRAIN FIELD (P) /CONNECT TO PRIMARY RESIDENCEAND UPGRADE SEPTIC SYSTEM TOI INSTALL 1250g TANK, AND ADD 3EIR HOUSE (E) / /1008g3(P)INSTALL |NS7ALLDCOL �(E) GARAGE/ \ / 187 / WELL (E) � ! | n VV_'..'V�'' 1 0' UTILITY EASEMENT LOT UNDEVELOPED NO WELLS OR SEPTICS NOTES: Date PAMONE ENG SVC, LLC 9/13/12 FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 C95 1 f Scale PHONE (907) 272-8218 FAX (907) 272-82 JANET LEE CIRCLE OSP1 21285 PLAN ANCHORAGE, AK 99506 411 'AR -o- - - Sheet SPECIAL PROVISIONS TO SPECIFICATIONS - 1 . PECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS. 2. ALL WORK SHALL BE IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS. 3. SCOPE OF WORK: INSTALL NEW 1000g SEPTIC TANK AND SOIL ABSORPTION SYSTEM. 4. GROUNDWATER WAS OBSERVED AT A DEPTH OF 13.5' AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 13.5 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. 10009 -- SEPTIC TANK (P) TRENCH SEE DESIGN DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM NO. BEDROOM: 1 (150 gpd) TANK SIZE: 1000g PERC RATE = 58.8 MPI SOIL RATING: 0.45 GPD/SF AREA ROD: 333 SF SYS. TYPE: WIDE TRENCH 2.0' E.D RF: 0.70 MIN LENGTH: 46.7LF USE: 50LF X 5' WIDE, 2.0' E.D., 7.0' TD TOTAL AREA: 357 SF PROFILE LEGEND W WATERLINE/ WELL RADIUS — SS — NEW SEPTIC ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE FILTER FABRIC TEST HOLE FC FOUNDATION CLEAN OUT T# TN -1 4"0 DRAIN PIPE CLEAN OUT NO. M# MONITOR TUBE NO. R.I. ORi;MMIN N ROCK 6" ABOVE PIPE INV DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER 4.5 ROCK BELOW FINISH GRADE OG ORIGINAL GRADE FG SM TS&V TOPSOIL AND VEGETATE .s 5M/ CM 2.0 �_5.0 —I 6.5 5M SECTION Is 0 B/21/12 3 6/7/12 m m � Z O O 0 9 qO w o Zq0 O 0 FILTER FABRIC y 9. U non nU 11 I I n n n n n [/—DRAIN ROCK 6'ABOVE PIPE INV 11 D 10009 -- SEPTIC TANK (P) TRENCH SEE DESIGN DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM NO. BEDROOM: 1 (150 gpd) TANK SIZE: 1000g PERC RATE = 58.8 MPI SOIL RATING: 0.45 GPD/SF AREA ROD: 333 SF SYS. TYPE: WIDE TRENCH 2.0' E.D RF: 0.70 MIN LENGTH: 46.7LF USE: 50LF X 5' WIDE, 2.0' E.D., 7.0' TD TOTAL AREA: 357 SF PROFILE LEGEND W WATERLINE/ WELL RADIUS — SS — NEW SEPTIC ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT NO. M# MONITOR TUBE NO. R.I. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER BFG BELOW FINISH GRADE OG ORIGINAL GRADE FG FINISH GRADE TS&V TOPSOIL AND VEGETATE NOTES: PANNONE ENG SVC, LLC I SOF A(\�� Date FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 i '(�••""••:9S1�) s/13/1z PHONE (907) 272-8218 FAX (907) 272-8211 rrg�p' y+J Scale LANG, LOT 4 EDWIN & ROBERTA DARBY 4000 JANET LEE CIRCLE DESIGN DETAILS ANCHORAGE, AK 99506 y*;• TH *Iy NTS • • / P.I.D. NO • •.. 015-273-59 Steven *k an on PERMIT NO. I!$,% CE 8149 .•,� „ 2 OF RESERVE DRAIN FIELD DESIGN TH-1996-4FILTER FABRIC (GARNESS) 4' 0 DRAN PIPE DRAIN ROCK 6' ABOVE PIPE INV 3.2 F 0.5 6.35 GM DRAIN ROCK _ 7 2.5 I- 6,0 SECTION DESIGN PARAMETERS RESERVE SEPTIC SYSTEM (CONNECT TO PRIMARY RESIDENCE AND UPGRADE TO 4BR SYSTEM) NO. BEDROOMS: 4 (600 gpd) TANK SIZE: 1250g PERC RATE = 28 MPI SOIL RATING: 0.6 GPD/SF AREA RQD: 1000 SF SYS. TYPE: DEEP TRENCH 6.35' E.D. MIN LENGTH: 78.7LF USE: 60LF X 2.5' WIDE, 6.35' E.D., 10' TO (E) ADD 20LF X 2.5 WIDE, 6.35' E.D., 10'TD (P) TOTAL AREA: 1016 SF T T FOR CONSTRUOCTION PANNONE ENG SVC, U.0 r ��OF \\� Date P.O. BOX 100217 ANCHORAGE, AK 99510^ �- ' •• qs+<<` 9/13/12 PHONE (907) 272-8218 FAX (907) 272-8211*'�P'' TM �y*fir Scale P.I.D. NO LANG, LOT 4 • . •.. 015-273-59 EDWIN & ROBERTA DARBY Steven PERMIT NO. 4000 JANET LEE CIRCLE ��j+ 9s. CE 8149 �/ OSPI21285 RESERVE FIELD ANCHORAGE, AK 99506L Sheet DESIGN DETAILS k1ll �� 3 OF 4 p� \\ ��' TEST HOLE 1 ORGANICS I CLOCK NETTIME WATERTIME LEVEL READING 2 1 8!7112 9:27 —� 8121112 WAS GROUND WATER 3 - SM VERYSILTY 15BOH 4.39 0.64 SAND 4 - 16 - 5 DEPTH? -15.0-' 17 4.28 0.53 DEPTH TO WATER AFTER 6 - 3.75 MONITORING? -13.5- 7 10:37 SMI SILTY SAND 0.51 GM AND GRAVEL 8 9 10 11 SILTY SAND 12 SM SILTIER W/ DEPTH SOILS LOG - PERCOLATION TEST SITE Pum SLOPE X TH 77TH -1 13 CLOCK NETTIME WATERTIME LEVEL READING NET DROP 1 8!7112 9:27 —� 8121112 WAS GROUND WATER 14 - 2 ENCOUNTERED? Y 15BOH 4.39 0.64 –� 817112 IF YES, AT WHAT 9:57 - 16 - 4 DEPTH? -15.0-' 17 4.28 0.53 DEPTH TO WATER AFTER 10:07 - 3.75 MONITORING? -13.5- 18 10:37 30 MIN DATE: 8/22/12 19 DATE PERFORMED: 817112 GARAGEW (E) 1 SIR 1APT. (P i 1 \ is SLOPE TH X READING DATE CLOCK NETTIME WATERTIME LEVEL READING NET DROP 1 8!7112 9:27 - 3.75 - 2 9:57 30 MIN 4.39 0.64 3 9:57 - 3.75 - 4 10:07 30 MIN 4.28 0.53 5 10:07 - 3.75 - 6 10:37 30 MIN 4.26 0.51 PEROLATION RATE 58.8 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 6 FT AND 7 FT COMMENTS: Test hole excavated by GLW ENTERPRISES. Prec hole was presoaked. Test run for at least one hour. Last 3 readings reported PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERF( NOTES: PANNONE ENG SVC, LLC FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, AK 99510 i PHONE (907) 272-8218 FAX (907) 272-8211 LANG, LOT 4 EDWIN & ROBERTA DARBY 4000 JANET LEE CIRCLE SOILS LOG ANCHORAGE, AK 9 506 TEST. O A(q�ll) S TH :n •k, Pan CE 8149 .f Date 9/13/12 Scale NTS P.I.D. NO 015-273-59 eet 4 OF Municipality of Anchorage Page 1 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW000039 PID Number: 015-273-59 Name: Wastewater System: ■ New ElUpgrade JACKSON HOMES Address: P.O. BOX 92301 ANCHORAGE, AK 99509-2301 [WEST/Epsn ABSORPTION FIELD [wEs Phone: (907) 694-5890 No. of Bedrooms: 3 ■Deep Trench ❑ Shallow Trench O Bed ❑Mound El Other LEGAL DESCRIPTION Soil Rating: 0.6 Total Depth from odglnal grade: 9.95/10.0 Ft. GPD/Sq. FL Lot: Block: Subdivision: Depth to pipe bottom from anginal grade: Gravel depth beneath pipe: 4 — LANG 3.6 — 3.65 rt 6.35 Ft Township: Range: — Section: — FIII added above original grade: Gravel length: 60' (2 ®30) — 2.5 2.1 Ft Ft Gravel width: Number of lines: Distance between lines: 12'+ WELL: R New ❑ Upgrade 2.5 Ft 2 Ft, Claeshwtion (Private, &%C): Total De Cased To: f Total absorption area: Pipe matedol: �-� /`73Ft /'7� Ft. 760+ so. Ft. D 3034/ F-810/SCH 40 PVC Driller._ e Data Dna: r`� staliWater lev Pt Installer. SANDERS EXC. Date Installed:3/31/2000 Yield: Pump Set At: ling Heighl Aba`v7e Grounrd; TANK 3O CPM R 2 SEPARATION DISTANCES ■Septic ❑Holding ❑S.T.E.P. Absorption Lift Holding Public/Pivots ManufacWrer. ANCHORAGE TANK Capacity In gallons: 1000 Field Station Tank Sewer Linea 100'+ - - 25'+ Material: STEEL Number of compartments: 2 W 100'+ - - - LIFT STATION 10'+ Size in gallons: Monfa •Pump on' level at: Pump aN High water olorm of Foundation 5'+ 10'+ — — — - Curtain Pump Make aectdcal Inspectlone performed by: Drain NO KNOWN BENCH MARK Remarks: Location and Description: TOP OF FOUNDATION CLEANOUT Assumed aeration: 100.9 Ft. ENGINEER'S SFe1 oo�oo � F oov �� • Inspections performed by: AWWC, INC. Dates: 1st 3/31/2000 * :•' 900 2nd 3/31/2000 ..... . ...................0 3rd q1 064th , ��/00 J f I Gar ess; �p� 7953 ' Department of Health and Human Services approval \foo Q°moo•'•• .. ••'' Reviewed and approved by: Date: "IX- a 0 QIP 1* O0�>OOp00 72-013 Rev. 9/9 MM 25 PERMIT NUMBER: AS -BUILT DRAWING P0151-1273- SW000039 59 JANET LEE CIRCLE l l 3 1 0 RESERVE SITE IS A 30' BY 12' ISF UNLESS ADDITIONAL TEST HOLES ARE EXCAVATED FOR A CONVENTIONAL SYSTEM W DRAINFIELDS \ /- FS (FLOW SPLITTER) I I II MT2IWTHI#4/ I CO2 I � � 5' �� �MT1C04� CO1 / R DBL1 -DBL2 �� ST1 32.2 21.4 ST2 36.9 27.8 DBL1 39.7 30.9 DBL2 40.6 32.5 FS 43.2 37.4 C01 12.7 24.7 MT1 29.3 29.9 CO2 41.7 36.2 CO3 53.8 55.0 MT2 44.5 39.6 C04 28.9 39.6 NEW 1000 GALLON SEPTIC TANK LOT 3 / EXISTING THREE BEDROOM HOUSE I \v/ NEW 100' WELL RADIUS WELL f I WELL 120'+ TO SEPTIC SYSTEM 1 ON LOT 3 ALASKA WATER & WASTEWATER -- w CONSULTANTS, INC.= 6901 DEBARR ROAD, SUITE 28' ANCHORAGE, AK 99504' PHONE (907)337-6179 • FAX (907)338-324 PREPARED FOR: PHONE NUMBER: JIM JACKSON (907) 694-5890 LEGAL DESCRIPTION: LANG SUBDIVISION; LOT 4 TYPE OF WORK: AS -BUILT OF SEPTIC SYSTEM UPGRADE K.D.W. 1 " = 30' 2 OF 3EQO f y A Cror ss;' 04 s E-7953 O 4n fm, •' •',�A�o PERMIT NUMBER: AS -BUILT DRAWING PARCEL ID NUMBER: • SW000039 015-273-59 FINN- 6m - 98.1' -98,2' IN5J-ATION 5TI 5f2 f0P OF fPNKf01' OF TANK Af IN-Ef a 95.11' \ Af 011 Vf - 95,02' I I NSW 1000 6&oN I I INVEK(OF 4b5 5MIC TANK N✓ER -9.1.2 Af IM-Ef a 99.55' AT OJft-Ef - 94,2k' � PINK. 6M - 91.1 (AZA.) MINAL QJJ7P - 94,72.95.9 fm fGY I'm - 92.15 QM - 983 (AVG.) omINN- cm - 96.15.97.45 INJERf OP rm - 95.86 50frOM OP im" eorronY c> f(4 NCN WEST TRENCH-67.5(AVG.) EAST TRENCffl -856 (AVG.) DATE: op60p 8/7/2000 DRAWN BY: c� .540 ALASKA WATER & WASTEWATER K.D.W. �DO SCALE: - CONSULTANTS INC - I N.T.S. rt ' ' ' "' """'..........�� 6901 DEBARR ROAD, SUITE 2B • ANCHORAGE. AK 99504 ` PHONE (907)337-6179' FAX (907)338.3246 PREPARED FOR: PHONE NUMBER: PAGE NUMBER: Q JIM JACKSON (907) 694-5890 3 OF 3 ' J f A. ess: LEGAL DESCRIPTION: QO " E-7953 om`p� LANG SUBDIVISION; LOT 4 �04fa '•.,•„ cA�� TYPE OF WORK:4a Eo AS -BUILT PROFILE OF SEPTIC SYSTEM UPGRADE 4 ��OO000pa� Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Pock Mystrom http:/Avww.ci.anchorage.ak.us Mayor Permit Number: #SW 000039 Date of Issue: 3-30-00 Parcel Identification Number: 015-273-59 Date Started: 7-15-00 Date Completed: 7-17-00 Is well located at approved permit location? ® Yes ❑ No Legal Description: Lang Lot 4 Property Owner Name & Address: Jim Jackson PO Box 92301 Anchorage, Ak 99508-2301 Borehole Data: Depth (ft) Method of Drilling ® air rotary ❑ cable tool Soil Type, Thickness & Water Strata From To Casing type: steel stick-up 0 2 Wall Thickness: .025 inches silt 2 7 Diameter: 6 inches Depth: 173 feet gravelly silt 7 53 Liner Type: silty gravel 53 62 cobbly silty gravel 62 159 water sand &gravel 159 173 Diameter: inches Depth: feet Casing stickup above ground: 2 feet Static water level (from ground level): 144 feet Pumping level: 173 feet after 2 hours pumping 30 + gpm Recovery Rate: 30 + gpm Method of Testing: airlift RECEIVED Well Intake Opening Type: AUG 15 2000 ® Open End ❑ Open Hole ❑ Screened Start feet Stopped feet Municipality of Ancnolage Dept, Health & Human Serviaaj ❑ Perforations Start feet Stopped feet Grout Type: Bentonite # 8 Volume: 1 bg Depth: Start 0 feet Stopped + feet Pump: Intake Depth feet Pump size hp Brand Name Well Disinfected Upon Completion? ® Yes ❑ No Method of Disinfection: Clorine Tablets Comments: Well Driller: Alpine Drilling & Enterprises P O Box 110496 Anchorage AK 99511 Attention: The well driller shall provide a well log to the property owner within 30 days of completion and the property n1 -m -r nr th- well Ariller ehall nrnuiA- a 1-1-11 1n- to the Tl-nt of A- 1th .2 r -Inman Rrrvirne within ren rlavc of rnmnlatinn JqN f T I \So C<e 8208 ?D M o N O N � e O 2 N 89'5759"W 269. 42 -3- -z LYN GALE SUBD. - / AS -BUILT NO CORNERS SET THIS DATE -:'OF-OF At � I hereby certify that I have performed a Mortgagee's inspection ai the following described LO T ¢, ��p'(�•,.•'•••••,'ds� ���:': ••,: �t property: LANG SUSD(VI5roN -4971...1rr�...rr��w.. Anchorage Recording Precinct, Alaska, and that the ;(p •• .. t improvements situated thereon are within the property lines and WrdolY� 11 do not overlap or encroach on the property lying adjacent improvements %7t!!.! ,f !1 thereto, that no on property lying adjacent thereto on the premises. question ; rox�J�•s� ✓` GALE roncroach adways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska - this day of T U LY 2000 EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED Fb o0-2 - FRED WALATKA & ASSOCIATES PLAT ARE NOT SHOWN HEREON. ps • 6 - 815 (907) 248-1666 .. Engineers and Surveyors Permit Number: SW000039 Parcel ID: 015-273-59 Legal Description: LANG LT 4 Design Engineer: 0041 AK Water & Wastewater Consulta Site Address: 004000 JANET LEE CIR Owner Name: Jim Jackson Lot Size: 53487 SQ. FT. Owner Address: PO Box 92301 Total Bedrooms: 3 Permit Bedrooms: 3 Anchorage , AK 99508-2301 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 ( 18AAC80 ). 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. Received By: Date: b' -30 Issued By: �%<� / W - �Ja � Date: '3-3 6-o o Qs L /W " MUNICIPALITY OF ANCHORAGE -3/31 Department of Health and Human Services t: LVL On-Site Services Program n /.l 825L Street, Room 502 n On ma",„ I L M_F-Cw'� P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 .y/gko g I � 7-2S_-06 TG , Tara�G ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Date Issued: Mar 30, 2000 Expiration Date: Mar 30, 2001 Permit Number: SW000039 Parcel ID: 015-273-59 Legal Description: LANG LT 4 Design Engineer: 0041 AK Water & Wastewater Consulta Site Address: 004000 JANET LEE CIR Owner Name: Jim Jackson Lot Size: 53487 SQ. FT. Owner Address: PO Box 92301 Total Bedrooms: 3 Permit Bedrooms: 3 Anchorage , AK 99508-2301 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 ( 18AAC80 ). 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. Received By: Date: b' -30 Issued By: �%<� / W - �Ja � Date: '3-3 6-o o ALASKA WATER & WASTEWATER quo:u.'.�srznes.arem..'.:a'.a'nc.., sstcnze:: a:� CONSULTANTS. INC. March 24, 2000 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Well and Septic Design for Lot 4, Lang Subdivision To whom it may concern: MW L D "00 The proposed 3 bedroom house will be served by a private well and septic system. A test hole was excavated on the property. The proposed septic system will be designed around the 30 foot radius of the test hole. We are proposing that a 1000 gallon septic tank and a deep trench type drainfield be installed. Comments regarding the proposed design are summarized as follows: 1. SOILS: Attached is a copy of the soil logs prepared by Anderson Engineering (Mike Anderson, P.E.). The soils on this lot perked from 2.1 minutes/inch to 28 minutes/inch. The primary and alternate systems fit within the 30 foot radius of test hole #4, which perked at 28 minutes/inch. There was no groundwater in the test hole on 7/31/96 and on 8/7/96 per the soil logs. On 10/17/97 water was encountered at a depth of 15.5 feet below grade. There was a depression around the test pit and it is quite possible that this is trapped surface runoff. Regardless, we are going to limit the total system depth to 10 feet. 2. TRENCH DESIGN: a. Percolation Rate: 28 minutes/inch b. Allowable Application Rate: 0.6 gallons/day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 750 ft2 f. Total Depth: 10 feet (max.) g. Effective Depth: 6.25 feet h. Width: 2.5 feet +, i. Reduction Factor: N/A j. Minimum Length: 60 feet total length (2 @ 30 feet long each) k. Effective absorption area = 780 ft2 MAR 2 A' ICHCJkA6F - c s-RVICF" r"", Debarr Road, Suite 2B —Anchorage, AK 99504 -- Ph: (907)337-6179 —Fax: (907)338-3246 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: As can be seen on the attached topography site plan, north of test hole #4 the lot is generally flat from north to south, with grades of less than 5 percent. South of the test hole the lot is generally flat from east to west, but slopes upward (to the south) at 5 to 10 percent. In short, there are no slope concerns. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you E., M.S. NOTE: Attached is a site plan drawing, a design drawing, a topography site plan, two soils logs with a location map, and a 7 page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B — Anchorage, AK 99504 — Ph: (907)337-6179 -- Fax: (907)338-3246 6 J LOT 2, LANG S/D i-- / i LOT 1, LANG S/D II i I RNs i \ `I - / \ goo �/ / / LOT 3, LANG S/D UEE CIRCLE I I I I I I I I I ei TCRuercl i I I I!1 I I R I I I I I I LOT 5, LANG S/D I I I 3 H OUSE I USEO�j HI I I I I I 1 I I I I I ---------------- SEPTIC , PAGE a I100. WELL RA12IL12 I 1 \ PROPOSED \ WELL i i / LOT 1A & 1B; SEC. 21, T12N, R3W / - – – – – – – – — – – – – – – – –/–f>f---ICONCERNS --IIIIIIII –/1 --------------- –R3W i iIIIIII– IIIiIIIIII IIIIIII LOT 3, LYNN +– LOT 32—D; SEC. 21, T72N, SERVED BY A PRIVATE SEPTIC. NO ENROACNT y<–°J\ W ¢0.o (/– LOT 2, DOROTHY MARIE EST. I LOT 32-C; SEC. 21, T72N, R3W DATE: 3/24/2000Mll �,<- <•<`<\ d f � �V •"' i1t DRAWN BY: J.L.M. `: Sr ALASKA WATER &WASTEWATER ` SCALE: . - CONSULTANTS, INC, -- =-- m 00 ..... ............... 6901 DEBARR ROAD. SUITE 20 • ANCHORAGE AK 99504' PHONE (907)337-6179' FAX (907)338-3246 — %� f f ........ 'REPARED FOR PHONE NUMBER: PAGE NUMBER: JIM JACKSON (907) 694-5890 1 OF 2 f re A. r ss:' 71� y� •, C 7953 •`coo j .EGAL DESCRIPTION: LANG SUBDIVISION; LOT 4 .: �� •.. j/ore ,. ,,,..•' ��a Vt�a �dprofessl0 �-\ ;_'� YPE OF WORK: - SITE PLAN FOR PROPOSED WELL LOCATION AND SEPTIC SYSTEM '��,,1;; -Y' JANET LEE CIRCLE NOTE: THE CONTRACTOR SHALL HAVE THE NORTHEAST PROPERTY LINE FLAGGED BY EDLAND AREGITECONSTRUCTION. SURVEYOR PRIOR TO I I I I II I I I ALTERNATE SITE I I I / I PROPOSED DRAINFIELDS. EXCAVATE TWO TRENCHES THAT ARE 10 FEET MAXIMUM BY 2.5 FEET WIDE DEEP OTAL BY 60 FEEr LENGTHC (6.25 30 FEET LONG CH). ADD a FEET OF CLEAN, WASHED SEWER DRA INSTALL TRENCHES C . PARALLELLLEL TO SLOPE CONTOURS. C I CO /�/ CO o o AR / SFp CO PROPOSED 1000 GALLON TANK SEPTIC 114 1�- R S�O� I I I PROPOSED I WELL 100' WELL RADIUS I !1// DATE: 3/24/2000 0060 o QF o* •*00 DRAWN BY: J.L.M. ALASKA WATER & WASTEWATER CONSULTANTS, INC. SCALE' Q 6901 DEBARR ROAD. SUITE 28 • ANCHORAGE. AK 99504 • PHONE (907)337-6179 • FAX (907)538-3246 PA ...... •..� PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JIM JACKSON (907) 694-5890 2 OF 2 Off'. e yA:- ness; Q4°ys E-7953 LEGAL DESCRIPTION: •,. LANG SUBDIVISION; LOT 4 Ofe^e coo 404aProfe s sio" TYPE OF WORK: DESIGN OF PROPOSED WELL LOCATION AND SEPTIC SYSTEM 04pp000�� LA G S/D LANG S/D e��Os . v1 �o ��(( LEE CIRCLE a LOT ,LANG D LOT 1A & 18; SEC. 21, T12N, R3 ATE SI NTE PROPOSED SE TIC SYSTEM (SEE DESIGN, P GE 2 OF 2) 200' CIASS "A' WELL RADIUS yLOT 5, LANG /D NDENEI.OPE p ROPO E 10 4 BED 00 HOU E OPOSED WELL LOT 3, S/D LOT 32-D; SEC. 21, T1 R L ALE SERVED PRIVATE PTIC. N ENROACH CONCERNS o w LO 2, DO OTHY MARIE EST._ J • O Q J LOT -C; C. 2 , T12N, W 2000 WN BY: M. C7 SCALE: 6901 DEOARR ROAD. SU TE 29 • ANCHORAGE. AK 99504 • PHONE (97)337-6 7 L07)330-324 V, — 100' PREPARED FORPH NEN B : PAGE NUMBER: JIM JACKS N (907) 94-589 1 OF 2 LEGAL DESCRIP N: LANG BDIVISION; LOT 4 TYP RK: SITE PLAN FOR PROPOSE WELL LOCATION ANSEPT!EM�, ..,(cnumccn,ag��l Municipality of Anchorage f c DEPARTMENT OF HEALTH & HUMAN SERVICES e 825 "U' Street, Anchorage, Alaska 99502-0650 t SOILS LOG — PERCOLATION TEST PERFORMED FOR: GR-ANAM/'k4A4CS DATEPERFORM15 t`e '^'7A. �9L•• LEGAL DESCRIPTION: LDT" 4 14fJb 5u6 Township, Range, Section: _ SLOPE � SITE PLAN P� 1 17 18�I 1=irtWof Aj0.4 19 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT - DEPTH? Ab DepthMontt to water A.Itpr S -7 9L Monitoring? �^r—Gate: ■.■■■■■ Date Gross Net Time Time 2 vim'' 3 u 4 rfiz0 I S-7 ■■■■.■■■■■ #4 5-. 80 0. tl z 0 6 -aL z:3& 7- 8 'o' :o 9- 10 10- ■■■■■■■■■. 11 11 ° A 12 13 .O. 14- 15 �O J SMrOM 'Dr 40 L(a 16 •e 17 18�I 1=irtWof Aj0.4 19 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT - DEPTH? Ab DepthMontt to water A.Itpr S -7 9L Monitoring? �^r—Gate: ■.■■■■■ Date Gross Net Time Time Depth to Water Net Drop ■E ■■■■■.■R■■ #3 rfiz0 I S-7 ■■■■.■■■■■ #4 z:07 46 tl z 0 EMMONEEME -aL z:3& 7I x„ ■■■■■■■■■■ ■■■■■■■■■. NMEMMENMMM ■■■■■■■■■■ ■■■■■■■■■■ ■■■■■■.■N■ S L O P E Reading Date Gross Net Time Time Depth to Water Net Drop #3 rfiz0 I S-7 L" #4 z:07 46 tl z 0 z'o $ -aL z:3& 7I x„ 20 -� I ` IL—�I PERCOLATION RATE Z8' 3 (minutesnnch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS I ryµ0LZ PLe5of weD . _PPIiIOA- -r'C PmILWL, ' 04 —r "zsT PERFORMED BY: 5, I C,.aS SILT _ I 0t.4k Lt.t R LC�cERTIFY THAT THIS /TrEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: �� Jo/ b 72-008 (Rev. 4/85) LEGAL DESCRIPTION: L,,,T 7, 14,j6 Suis. Township, Range, Section: TyrSLOPE SITE PLAN 1 to;• : p 2 r s o;, t 4 3 t' 4 '. o`, 5 �'•0• 6 8 A' 9 • `' to—, 12 ' of 13 : . ,e 14- 16- 17- is - 19 4 16 17t819 GW GK Gk/ M DF I4O LE 1.5' WAS GROUND WATER - IQ ENCOUNTERED? /v IF YES, AT WHAT DEPTH? Depth to Water Alter Monitoring? A 84 E' _gate: 017 9� Reading Date Ltl`+uirvpcna acne ' � i Municipality of Anchorage zf 1 e r�96 DEPARTMENT OF HEALTH & HUMAN SERVICES _ 825 "L" Street, Anchorage, Alaska 99502-0650 S_ 0•R• 1,l'•% '� C SOILS LOG — PERCOLATION TEST ` t r q' �nM1,Mjcha61 F GaA4A1✓t DATE PERFORNF PERFORMED FOR: rv1GS LEGAL DESCRIPTION: L,,,T 7, 14,j6 Suis. Township, Range, Section: TyrSLOPE SITE PLAN 1 to;• : p 2 r s o;, t 4 3 t' 4 '. o`, 5 �'•0• 6 8 A' 9 • `' to—, 12 ' of 13 : . ,e 14- 16- 17- is - 19 4 16 17t819 GW GK Gk/ M DF I4O LE 1.5' WAS GROUND WATER - IQ ENCOUNTERED? /v IF YES, AT WHAT DEPTH? Depth to Water Alter Monitoring? A 84 E' _gate: 017 9� Reading Date Gross Time Net Time Depth to Water Net Drop zf 1 e r�96 /t. 3o _ /p B„ a- Z- 12:3`f q' /r/-" 3 7&1 At 3 :gt 1915, lZr;1 Z, 7/8„ *5' 11-10 Z:9o. IZ:4 p'B„ 07 / Z.4S 8 st 8 IZ.19 /z" l7B" /ZI SD /o'b" rr/O /Z:Sti< /2" 20 I G N u PERCOLATION RATE Z� (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND 6" FT COMMENTS T'5r-"t.* PaX50A --g 8UPIL, 712 Pla"01, Qd T r PERFORMED BY: S ' 6,l 1f61 tr e"t"CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) HONES BASIS PHONE NO. 907 .522 4654 B LAR INC8 t :'7-17a1 Apr. 23 1137 02:47FT1 P1 3-IOUfP\ SC A.." j FL"N WIGLAND. V io N TESTHOLE LOCA TIQN PLAN seams t^ _ ioo Mt.i . s 9CB tA11TY OF A N = o `=' ;,GE l.. i 'v c, • 1, 7, Development Services Department SEPk 2018 >Phone: 907-343-7904 On-Site Water & Wastewater Section �— _ Fax: 907-343-7997 !Ld ti Certificate of On-Site Systen �.proo a,;w Parcel I.D. 015-273-59 Expiration Date: 1 `t _1 6 1. GENERAL INFORMATION Complete legal description Lang Lot 4 Location (site address) 4000 Janet Lee Circle Current property owner(s) Roberta & Edwin Darby Day phone Mailing address 4000 Janet Lee Circle, Anchorage, AK 99506 Real estate agent Kevin Sigafoos Day phone 907-244-3212 2. TYPE OF DWELLING: I x I Single Family (w/wo ADU) fl Duplex i I Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3/1 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well n Private Septic x Water Storage ❑ Holding Tank I i Community Well ❑ Community n Public Water System ❑ Public Sewer I I Waiver request for: Distance: Received by: Date: /74 ec COSA to be released to the engineer, unless therwise requested by the engineer. COSA Fee $ 5r2(o Waiver Fee $ Date of Payment Date of Payment Receipt Number 0913/71) Receipt Number COSA# d S C [31 c1?6 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 Forge Engineering Phone 907-522-7773 Address 1399 W. 34th Ave Suite 203, Anchorage AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date 9/11/18 sAslco.. 4 ••y 4e : 49TH- A\ 6. DSD SIGNATURE ",� • f System #1 Approved for-J 4I bedrooms �� f • • BenjarriOchiller System #2 Approved for bedrooms I� �F�'• CE 12592 ••(� " Sly • 9/11/18 • • Disapproved �k��F�PROFESStONA� \00\0o72u Conditional approval for bedrooms, with the following stipulations: Lit- , ON-SITE, WATER AND m WASTEWATFR PROGRAM ,D �z 7147'3ER\10'° Original Certificate Date: q The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet 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: Lang Lot 4 Parcel ID: 015-273-59 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 7/17/00 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 173 ft. Cased to 173 ft. Casing height (above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test 7/17/00 8/18/18 Static water level 144 ft 145.8 ft. Well production 30 g.p.m. 6.4 g.p.m. WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate 3.33 mg/L Arsenic ND ug/L Date of sample: 8/28/18 Collected by: Forge Engineering B. SEPTIC/HOLDING TANK DATA Tank Type/Material *Septic/Steel Date installed 4/03/00 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N Date of pumping 9/13/18 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed 3/31/00 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.6 gpd/sf System type Deep Trench Length 2 x 30 ft. Width 2.5 ft. Gravel below pipe 6.35 ft Total depth 11/11.5 ft. Eff. absorption area 760 ft2 Monitoring tube Y Depression over field N Date of adequacy test 8/18/18 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 36/0 in. Water added 337/351 gal. New depth 54.5/14 in. Elapsed Time: 1274 min. Final fluid depth 37/0 in. Absorption rate >= 450 g p d None Any rejuvenation treatment(past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off" level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot >100' On adjacent lots >100' Absorption field on lot >100'100' On adjacent lots >100' Public sewer main '75' Public sewer manhole/cleanout >100' Sewer/septic service line '25' Holding tank 100' Animal containment areas '50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10' Property line '5' Absorption field >5' Water main >10' Water service line >10' Surface water >100' Wells on adjacent lots '100' ABSORPTION FIELD ON LOT TO: Property line ' Building foundation '10 Water main '10 Water Service line ' Surface water '100 Driveway, parking/vehicle storage ' 10' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS *This septic information is for the 3 bedroom home on the lot. G. ENGINEER'S CERTIFICATION 41�t�\\, OF ACq�l�l I certify that I have determined through field inspections and ,i review of Municipal records that the above systems are in �r�P• • conformance with MOA COSA guidelines in effect on this date. * 49 TH %\ *�� Engineer's Printed Name Benjamin Schiller, PE f'" " ` • • " ' 0 Date 9/13/18 el . • •• '.~Benja.;n chiller .' • j �F'••. CE 12592 .• `,,,..4::' 70�f' 9/13/18 / 046,..,* �IV rROFESS\O' ' COSA brown sheet 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: Lang Lot 4 Parcel ID: 015-273-59 A. WELL DATA Well type If A, B, or C provide PWSID# Well Log (Y/N) Date completed Sanitary seal (Y/N) Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 11/21/12 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 9/13/18 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed 11/07/12 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.45 System type Shallow Trench Length 50 ft. Width 5.0 ft. Gravel below pipe 2.0 ft. Total depth 8.5 ft. Eff. absorption area 357 ft2 Monitoring tube Y Depression over field N Date of adequacy test 8/18/18 Results (Pass/Fail) Pass For 1 bedrooms Fluid depth in absorption field before test 4/0 in. Water added 212 gal. New depth 5/0 in. Elapsed Time: 1 1 95 min. Final fluid depth 4/0 in. Absorption rate >= 150 g p d None Any rejuvenation treatment (past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off" level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot >100' On adjacent lots >100' Absorption field on lot 100' On adjacent lots 100' Public sewer main >75' Public sewer manhole/cleanout >100' Sewer/septic service line >25' Holding tank >75' Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation 1 0' Property line �5' Absorption field >5' Water main Water service line 10 Surface water >100 Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: >10'Property line Building foundation 10 Water main 10 Water Service line Surface water 100 Driveway, parking/vehicle storage >10' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS Checklist is for the separate septic system for the ADU G. ENGINEER'S CERTIFICATION 4"tt��\\ kk I certify that I have determined through field inspections and is review of Municipal records that the above systems are in ���• P' conformance with MOA COSA guidelines in effect on this date. %* 49 11-I )\ *�I Engineer's Printed Name Benjamin Schiller, PE 5 ,,r- 9/13/18 % 'r ' Date �j, . ei Benjarkl chiller . •. / re.' •.. CE 12592 •�`��� 4 C�Jf•.. 9/13/18 .•'C��,,.� �kVePROFESSION�.��"' COSA brown sheet 10-10-12.doc • • ' 4 4 JANET JANET LEE CIRCLE L 781• 7 z 0 CP N_ Cr 0 S '0 O_ • t y • • °° ° ° • NOTE: / N X15 A BLANKET EASEMENT IN FAVOR OF CHUGACH ELECTRIC AFFECTS THIS N i • PROPERTY;RECORDED 9-17-86,BOOK 1492,PAGE 976. c 01 i I N t ,6' ' 0.f 4 CV o ..•') SINGLE FAMILY 37v0 g Z 5 °. i FRAME HOUSE U� m a I * � � T D 'h `OO .a :J\ �� �j. 1 .0 # • 1 ----------- 7 ro�RAM°RBuli. HO FF•('' I:a r I \ I I 2130 7 I". I O 0 O Q0 LU yN N N N 0 0 O L iU)l 10' TELE. 8 ELEC. ESN'T. J N 89°57'58"W 259.42' _x000004 oo,`Q `0. `5100 co...49 TH %\\ •.7 vO .. /� o 5 �. AS BUILT SURVEY 1 " = 30' v- 01)1 p• o p NO CORNERS SET THIS DATE A' SHANE A.HOLT .• �i 700 Via'•. LS-6914 ...•..,._0`p HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY 4/k`Ofes si°na\Sao OF THE FOLLOWING DESCRIBED PROPERTY •IS:7 mnB' LOT 4, LANG SUB. ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS EXIST OTHER THAN NOTED. NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN DATED AT ANCHORAGE,ALASKA THIS _19 TH DAY OF HEREON ( UNLESS INDICATED) SEPTEMBER , 2018. NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. tAANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. HOLT LAND SURVEYING 9309 GROVER DRIVE III ANCHORAGE,AK 99507345-55 5759, FB ?C8-39, ;57-?3,%9c-ZS 345-5513 Municipality of Anchorage 116, • Development Services Department Y i P Building Safety Division ,,, .,V On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-273-59 HAA# 0.5' 1. GENERAL INFORMATION Expiration Date: .2— Complete legal description LANG SUBDIVISION; LOT 4 Location (site address or directions) 4000 JANET LEE CIRCLE * ANCHORAGE, AK * 99516 Current Property owner(s) JIM ALESHIRE Day phone 561-9431 Mailing address Lending agency Mailing address Real Estate Agent Mailing address 4000 JANET LEE CIRCLE * ANCHORAGE, AK * 99516 CLAIR RAMSEY/ DYNAMIC PROPERTIES Day phone Day phone 261-7600 3111 "C" STREET * ANCHORAGE, AK * 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3.. ,TYPE OF WATER SUPPLY: Y - Individual Well Individual Water Storage Community Class Well Public Water System 3 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system she-Municipality-of-Anchorage-is-not-responsible-for-errors-or-omissionsin-the-professional_enginee6 work. TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system she-Municipality-of-Anchorage-is-not-responsible-for-errors-or-omissionsin-the-professional_enginee6 work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone 337-6179 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, AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the focal soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKWWC, inc. 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 otherperson or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE __Z Approved for bedrooms. Disapproved. Date to /so 3 O4•pQd`i0 .G OF op ' ffr G 10 y n O CE 795 o G VOI�c�.p�o f e s sioo°o�_4 Conditional approval for bedrooms, with the fllowing stipulations: 'r, ON-SITE VA :R 4 WASTEWATER PR RAM Attachments: %a,�j •. .•'� HAA Checklist Manitenance Agreements J���,,JJ% • • S� Septic System Advisory Supplemental Engineer's Reortr,i II1)WI ' Well Flow Advisory Other By:— Original Certificate Date: 1 Q - - 0-3 (Rev. 12101) Municipality of Anchorage • ' "` Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LANG SUBDIVISION; LOT 4 Parcel ID: 015-273-59 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N A Well Log (Y/N) YES Date completed 7/17/2000 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 173 ft. Cased to 173 ft. Casing height (above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test 7/17/2000 10/14/2003 Static water level 144 ft. 144 ft. Well production 30 g.p.m. 6.78 g,p,m, WATER SAMPLE RESULTS: Coliform D2k_ colonies/100 ml. Nitrate i •a mg./L. Other bacteria _colonies/100 ml. Arsenic: N/A mg./L. Date of sample: 10/14/200 Collected by: AKWWC, INC. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 7/25/2000 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 10/14/2003 Pumper DENALI PUMPING C. ABSORPTION FIELD DATA BElow ExIS—MG C;W Date installed 3/31/2000 Soil rating EDrftlbdrm) 0.6 System type DEEP TRENCH Length 2030(60 TOTAL)ft, Width 3 ft. Gravel below pipe 6.35 ft. Total depth 9-95/1 Oft. Eff. absorption area 760 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 10/14/2003 Results (Pass/Fail) PASS For 3 bedrooms 50.75/ 336 61.0 Fluid depth in absorption field before test 8.0 in. Water added 38 gal. New depth 20. in. 189/ 55.5/ Elapsed Time: 132 min. Final fluid depth16.5 in. Absorption rate >= 450+ g,p,d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date D. LIFT STATION Date installed "Pump on" level at in. Datum— E. SEPARATION DISTANCES Size in gallons Manhole/Ac Pump off in. High water alarmZvelat in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1001+ Absorption field on lot 100'+ ..... Public sewer main N/A ¢ ' Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank 100'+ r 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 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 5'+ Curtain drain NONE KNOWN 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 HAA guidelines in effect on this date. Engineer's Printed Naa JEFFREY A. GARNESS Date f� 20 0 HAA Fee $ 37 S. CIO Waiver Fee $ Date of Payment 0 • Date of Payment Receipt Number 't ' Receipt Number (Rev. 12/01) oa ..... .. .. . ............... ¢ ' of a Go ness:' E-7 eG �0fesaQ JANET LEE CIRCLE NOTE: A BLANKET EASEMENT IN FAVOR OF CHUGACH ELECTRIC AFFECT* THIS PROPERTY I RECORDED 9.17.86, BOOK 1497, PAGE 976. N 89'57'58'W 259.42' AS -BUILT SURVEY SCALER, • W 1 HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGEES INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 4, LANG SUB. O N• O N THEMFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL DIS0 DISTRICT. ALASKA AND THAT ANCHORAGE RECORDING DIS RECORDING STRUCTURES OR FENCEUNES. THE IMPROVEMENTS THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXISI EASEMENTS OF RECORD. OTHER THAN THOSE SHOWN ON THE RECORDED PLAT. ARE NOT SHOWN HEREON OTHER THAN NOTED. NOTE. ANY FENCEUNES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINE DATED AT ANCHORAGE. ALASKA THIS _16TH_ OR LOCATE STRUCTURES. DHOAV OF _OCTOBER 2003_ LT LAND SURVEYING 9159. FS108-19 TEL 1455517 l"� MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (907) 3434744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING Parcel I.D. # 015-273-59 HAA # A4ta' o &'5 1. GENERAL INFORMATION Complete legal description I ANG Stion1Y1c1QN- LOT 4 Location (site address or directions) 4000 JANET LEE CIRCLE ANCHORAGE AK 99515 Property owner JACKSON HQME5 Day phone(207) 694-5590 Mailing address P.O. BOX 92301 ANCHORAGE AK 99508 — 2301 Lending agency Mailing address Day Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 XXX Day phone 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 xxx Holding Tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC ing to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 Computer Version Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1125.00 at, or prior to, closing for the engineering services provided. 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 in�Rection, the on-site water supply and/or wastewater disposal system is in compliance with all Muird of and State codes, ordinances, and regulations in effect on the date of this inspection. / I Name of Firm Address Engineer's Signature Phone (907) 337-6179 V' In conducting this evaluation, AWWC, Inq� are to provide a thorough, conscientious engineering analysis of the system in accordance with ADE C and M A D S Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of 000�opp� the evaluator of the system. Satisfactory test results do not guarantee future performance o s of the system, nor do they guarantee that there are no hidden defects or encroachments. p� AWWC, Inc. can therefore not provide any warranty for future estimate of how long the p� system will continue to meet the operational requirements of the ADEC or MOA DHHS. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, ......... nor will it confer any legal right whatsoever. ' .J f A. ss, 6. DHHS SIGNATURE _I. -I Approved for 3 bedrooms Disapproved Conditional approval for r_'rern=i 0 E-7953 '••.. ....•''eco pro f e s sloc�gc bedrooms, with the following stipulations: Date 246- 6- 19 0/ 6- a o The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1191) Back MOA Y21 Computer Version RECEIVED Municipality of Anchorage AUG 15 2000 DEPARTMENT OF HEALTH & HUMAN SERVICEVSICIVAurroFAN Environmental Services Division 'VIRnNMENTALSERVI 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744 Health Authority Approval Checklist Legal Description: LANG SUBDIVISION; LOT 4 Parcel I.D.: 015-273-59 A. WELL DATA Well Type PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number N/A Log present (Y/N) YES Date completed 7/17/2000 Total depth 173' Cased to 173' Casing height (above ground) 2' Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES FROM WELL LOG Date of test 7/17/2000 Static water level Well production 30 g.p.m. wT ,wlBnCnrin\I g.p.m. WATER SAMPLE RESULTS: (. Coliform © Nitrate IYIQ Other bacteria 0> Date of sample: �Dy Collected by: A.W.W.C., INC. B. SEPTIC/HOLDING TANK DATA Date installed 7/25/2000 Tank size 1000 Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression (Y/N) NO High water alarm (YIN) N/A Date of Pumping NEW Pumper C. ABSORPTION FIELD DATA *BELOW FINAL GRADES Date installed 3/31/2000 Soil rating (g.p.d.KQ or ft2/bdrm) 0.6 System type TRENCH Length 60' (2 ® 30') Width 3' Gravel thickness below pipe 6.35' Total depth *10.8'-11.3' Effective absorption area 760+ SQ FT Monitoring Tube present (Y/N) YES Depression over field (Y/N) NO Date of adequacy test NEW Results (Pass/Fail) For Fluid depth in absorption field before test (in.); Immedia er— gal. water added (in.): Fluid depth (ins) Minu Absorption rate = (past 12 months) (Y/N) 72-026 (Rev. 3/96)` Computer Version If yes, give date D. LIFT STATION Date installed Manhole/Access(Y/N) High water alarm level at* "Pump off' level at* *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot On adjacent lots 100'+ Absorption Feld on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout Absorption field N/A Water main/service line 10'+ Sewer/septic service line 25'+ Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Absorption field 5'+ Water main/service line 10'+ Surface water/drainage 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation Surface water Curtain drain F. ENGINEER'S 1 certify that I I of Municipal 11 with MOA HAV Engineer's ri HAA Fee $ 3O a` 0 O 10'+ Water main/service line 10'+ 100'+ Driveway, parking/vehicle storage area 10'+ field inspections and review systems are in conformance in this date. JEFFREY A. GARNESS Date of Payment 8 / 1- I �y l Receipt Number 10J 09 997 �i J 72-026 (Rev. 3/90)* Computer Version Wells on, Waiver Fee Date of Payment Receipt Number