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KARELLA LT 20C
Karella Lot 20C #015-141-61 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~kJ~ff4:~O7Cl PID Number --O!-~ Name: I~.~./l~+¥~i,,"~. [J,)~Jl~ Wastewater System: Q New,,,, ~ Upgrade Address: II1~ Li~s~_~ ~+. ABSORPTION FIELD Ph°ne:(~O~ ~'~3 No. of Bedrooms: ~ ~ Deep Trench ~ Shallow Trench BBed ~Mound ~Other LEGAL D ESCRI PTI ON soi~ Rating:. ~5. GPD/Sq. Ft. Total Depth. from/i, original~grade: Township: Range: Section: Fill added abo~e original g~de: Gravel length: Number of lines: Distance baleen tines: ~~ ~ New ~ Upgrade Gravel wid,h: ~ ~t. A /~ Ft. Classification (Pr vat~~__. ~ Total Depth: Ft. Cased To: Ft. Total absorption~ares: SO. Ft. Pipe Driller: ~,~ Static Water Levek Instal,er: C~,~ Date installS: / ~/~ GPM Ft. SEPARATION DISTANCES ~ s~ptic ~ Holding a S.~.~.~. To Septic Absorption Li~ Holding =ublic/Private Manufacturer: Capacity in~allons: Fro~ Tank Field Station Tank Sewer Lines ~. ~, ~ , su~ace luOG I~ ~ IOO/* IFT STATION Water Lot Line BT'* ~ ~ +0/, Size in gallons: Manufac FouRdatioQ +~ 1, J~ ' f ~/ F "Pump onl' level at: "Pump off" ievel at: ~larm at: Cu.ai. Drai, N~ K~O" ~ ~ Pump Make & M0dei Electrical Inspections performed by: Remarks: BENCH MARK Location and Description~,~ Assumed Elevati°n: 10 ~, IG Ft E~GINEER'$ Depadment of Health and Human Se~ices approval Reviewed and approved by ~ ~Date: ¢ -F' ~ 72-013 (Rev, 9/91) MOA 25 PERMIT NUMBER: AS BLTILT DRAWING PARCEL ID NUMBER: SW990015 ' 015-141 -61 /---LOCATION OF OLD TRENCH / WAS SHOWN INCORRECTLY i /ON THE ORIGINAL DESIGN OLDTRENCH TO BE /DRAWING. // ~ USED AS A RESERVE SITE'~ / .,,.~.¢¢¢a444C01 ST1 70.4 46.2 DB DBL~ 81.1- 56.2 oBL2 83.458.5 -_ ,A /¢2 ............. / ', C01-- 79.4 J 58'5 -- MT,4~__'_ %%./~/ SPLITTER (FS) / \ Z IC04 ! 542- DRAINFIELDS J ',4- iMT2 - 158.4 156.7 (lOO' TOTAL LENGTH) J C05 - 140.0 15~15 MT3 - 140.9 155.4 C06 - 168.7 171.0 FS - 132.8 141.6~ PROPER'Pr UNE ~Sf f~kDt ~/¢f ~NGH Mf CO / N~W 1290 5~LON ,~ ...... ~ , ALAS~ WA~R AND WASTEWA~R CONSULTANTS, INC. A B C ST1 70.4 46.2 - ST2_ 78,3_ 53.3 - DBI_I 81.1 56.2 - DBL2 85.4 58.5 - FD_ 85.1 58.1 - C01_ 79.4 58.5 - C02 - 127.7 141.6 CO3 - 127.5 136.4~ MT1 - 128,2 157.2 C04 - !58.2 156.4~ MT2 - 158.4 156.7 005 - 140.0 152.5 MT3 - 140.9 155.4 C06 - 168,7 171,0 MT4 - 169.3 171,6 FS - 152.8 141.6 6901 DEBARR ROAD SUITE 2B, ANCHORAGE, AK 99504 PHONE: (907) ,337-6179/FAX: (907) ,338-3246 LEGAL DESCRIPTION: KARELLA SUBDIVISION; LOT 20C TYPE OF WORK: AS-BUILT OF SEPTIC SYSTEM PREPARED FOR: PHONE NUMBER; CYNTHIA WELLS ,546-,309,3 DATE: 6/1/9 9 DRAWN BY:I' SCALE: PAGE: K,D.W. 1 = 40' 2 OF 2 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 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: May 03, 1999 Expiration Date: May 02, 2000 Permit Number: SW990079 Legal Description: KARELLA LT 20C Design Engineer: 0041 AK Water & Wastewater Consulta Owner Name: Cynthia Wells Owner Address: 11100 LIPSCOMB STREET ANCHORAGE , AK 99516-1511 Parcel ID: 015-141-61 Site Address: 011100 LIPSCOMB ST Lot Size: 44858 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well E~ 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: Issued By: ~~ Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2B ~ Anchorage ~ Alaska 99504 (907) 337-6179 N Fax (907) 338-3246 Consulting Engineers April 19, 1999 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 9951%6650 Reft Septic Upgrade Design for Lot 20C, Karella Subdivision To whom it may concern: The existing 4 bedroom house is served by a private well and septic system. The existing septic system is surcharged and must be upgraded prior to the sale of the house. Two test holes were excavated on the property. Comments regarding the proposed design are summarized as follows: 1. SOILS: Attached are logs which shows the soil profile, and the percolation test results. In both test holes, the soils below the organic layers are a ML material with some SM lenses throughout to a depth of 16.5 feet and 17.0 feet (bottom of both test holes). No groundwater was encountered during the excavation of the test holes. A percolation test for TH#1 was performed between the depth of 5.0 feet to 6.0 feet which had a percolation rate of 120+ minute/inch. A percolation test for TH#2 was performed between the depth of 5.0 feet to 6.0 feet which had a percolation rate of 6.7 minute/inch. Given the wide differences in the percolation rates, the soils were visually rated at 0.45 gallons/day/f~2. It is our opinion that the percolation test performed in test hole #1 does not accurately represent the overall soils condition. However, the new drainfields will be designed around a 30 foot radius of test hole #2. 2. TRENCH DESIGN: a. Percolation Rate: 6.7 & 1204-minutes/inch b. Allowable Application Rate: 0.45 gallons/day/fi2 c. Number of Bedrooms: 4 d. Design Flow: 600 gallons per day e. Minimum Absorption Area: 1333 ft2 f. Total Depth: 11 feet (max.) g. Effective Depth: 8 feet h. Width: 2 feet i. Length: 2 ~ 50 feet long each (100 feet total length) j Effective absorption area = 1600 ft2 (1333 ft2 OK) 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, the average slope is a 5 to 10 percent running approximately from southeast to northwest; 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 for your assistance. J_~ ]A.V~Jarness, ~-~.E., M.S. President [/ NOTE: Attached is a site plan drawing, a design drawing, a topography site plan, two soils logs and a 4 page construction specification letter which are all part of the design package for this septic ,ystem. i LOT 2OA, KARELD~ S/D LOT 5, ARCYLE LOT 2OB, KARELLA S/D 0 LOT 6, EXISNG SE~C ~ SYSTEM ~ 4, S / ', 4 aE~oou~ / X4 '$ HOUSE--'~ / ~-PROPOSED SEPTIC UPG~DE (SEE DESIGN, PA~E 2 OF 2) / LOT 2OD, ~EU~ S/D LO1 21, AR~E S/D LOT 5, BLOCK 1, HOWESTF~ HILLS S/D ~ R~I LOT 13, NW 1/4, SECTION 22, 'rl2N, R3W AND WAS WA CONS TA S, SITE PLAN FOR SEPTIC UPGRADE ~" PREPPED FOR: PHONE NUUDER: ~Oh~l'., ~-7953 .."&.~ CYNTHIA WELLS ~46-,~093 q~ ~ee ""' '"' J.L.M. 1 = 100' 1 OF 2 ,~%%~ t NOTES: I 1. 1HE CONTI~AGTOR SHALL HAVE ll4E WELL RADIUS ] FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR ' TO CONSTRUC'IION. 2. THE CONTRACTOR SHALL F1ELD VERIFY TI-bAT ALI. ~ SEPARAllQN DISTANCES WILL BE MET PRIOR TO ANY CONSTRUCTION. j EXISTING TRENCH 'fo BE /----EXISTING SEFqlC 'rANK USED AS A RESEI~/E SIT1E~--7 (APPROXIMATE LOCAl]ON)/ / TO BE ABANDONED COMPLETELY [NSTAI.L FI_OW DIVERTER----..._ / '"~ ~ / / OF PIPE tJNDER DRiV~IAY INSTALL fLOW SPLrrrERm ~ / "'"-2J / ' /wm~ 2" ~NSULATmN (,V W~D~). y ! ~ --LLIU '~,? ~, "./~'~, ~ PROPOSFD DRAJNRELDS EXCAVATE I ,5/ J '~" WIDE. ADD 8 FEET OF CLEAN, WASHED \ '~O ~ S~VER DP, AINROCI(, SIDEWALLS OF TRENCHES ~ WbLL MUS'T BI:: RAKED PRIOR TO ADDING DRAINROCK. \ INSTALt. TRENCHES PARALLEL TO CONI'OURS, _\ ALASKA WATER AND WASTEWATER. CONSULTANTS, lNG. OF' A./ PHONE: (907) 337-817g/PAX: (907) 33B-~246 .~%4, 'POPE OF WORK= BESIGN FOR SEPTIC UPGRADE .... PREPARED FOR: PI lONE NUMBER: ~[~ I&E-7953 ." CYNTHIA WELLS 346-3093 "~4 "'.V ..'" ~REL~ SUBBIVIS~N, LOT 200) , ... ALASliA WATER. & WASTEWATER CONSLILTANTS~ INC. PHONE (gO7) 337-6179 * FAX (gO7> 338-3248 ]SOIL LOC, - PERCOLATION TEST[ LEGAL DESCRIPTION: KARELLA SUBDIVISION; LOT 20C, I ................. PERFORMED FOR: CYNTHIA WELLS DATE PERFORMED: 4/9/99 DEPTH ......... TEST HOLE #1 ] (feet) i :i~: ORGANICS 2 ~i SOIL C~SSIFICATIONS SITE PLANI : 3--i ; :' ~ GP ML // sEmmc 5--' "" ~ SP , CH '-- 7- DEPTH TO DATE 2ROUNDWATER X / ~ ~ ~9~OOM ~ i DRY ~PROP~SED SEP]IC UPGR~E ~,,4~,{u*:~ DENSE AND DRY ; ~ ; f [SIDEWALL SHEWING) i ~o--i ~ ~;~ CLOCK NET TIME WATER LEVEL NET DROP 11 -- ~i~,~¢; ~ ~ ~/'~ DATE READING ~ ;;; TIME (MINUTES) READING (INCHES) ~ ': PERC CAVI~ PRESOAKED FOR 4+ HOURS ~ ' ; 12" - 13 ; 4/12/9~ 1 2:00 4 ~ ~ ~'; ~ 12" 0" B.O.H. ~- ~e.CO~T~O. ~T~ ~o~ (~../~SC.} 20-- TEST RUN aeTWE~N 5.0 ~./ANU /~.~FT. co. mo.. T: RADIt S AROUND TE~ HOLE THIS DATE, DATE: WAS PERFORM~M~RD ACCORDANCE ..... WITH ALL S~E~ ~¢ NICI~G IDELINES. IN EFFECT ON THIS DEPTH TO DATE 3ROUNDWATER DRY 4/9/99 ALASKA WATER. &: WASTEWATER CONSULTANTS, INC. ~'~ OF' '~ PHONE (gO7) 337--617g * FAX (907) 338-3246 ,oo - .... LEGAL DESCRIPTION: KARELLA SUBDIVISION; LOT 20C, · .................. : .... PERFORMED FOR: CYNTHIA WELLS ~~i DATE PERFORMED: 4/9/99 (feet) !-ii 7~! ORGANICS TEST HOLE #2 '%~;:'*,~ .......... ... ,~-?~ 1~-~ ~. ; ~, SOIL C~SSIFICATIONS 2--: ; :~; SITE PLAN , ~ . GM i~ CL // SYSTEM ~ 6--; i '~ SC ~'*": DEPTH TO ~ :' DATE . GROUNDWATER i[ ,, I DRY 4/9/99 % / t HOUSE~ ~PROP~SED SEPTIC UPGR~E ', ' ~ ML WITH SM ¢ ~y ~"/~- vV (s~ .~..*~E * .r ;~, :~I ~ DENSE AND DRY ,j ,~;, ~ ~, (~ (SIDEWALL SME~ING) 11 --: :¢ ;.: DATE READING CLOCK NET TIME WATER LEVEL NET DROP , ~,~,,~ TIME (MINUTES) READING (INCHES) 2 2'34 30 ",~ ~ ~" ' :~ 5 2:54 6" 4 3:04 30 MIN. 1 1/2" 4 1/2" 15 -- ~ 5 3:0~ 16--~ ~ ~ 6 3:34 30 MIN. 1 1/2" 4 1/2" 17~ ....... B.O,H. _ 19-- PERCO~TION ~TE 6.7 (HIN./INCH) ~C. HOLE DIA. 6" (INCHES) 20-- -rEST RUN BETWEEN 5.0 F,~.tAND ~ FT. C O,HENTS; S Ol~ CONDITION OVE~LL W*S VI SM*ELY ~ ~15 PERFORMED BY A~SKA WATER · WASTEWATER ..~~~~,~ , CERTI~ THAT THIS WAS PERFORM~B¢IN ACCORDANCE WITH ALL S~N¢ ~¢NIClP&L GUIDELINES IN EFFECT ON THIS DEPTH TO GROUNDWATER DATE DRY 4/9/99 ,_br~ ~../~.- ~, (~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAL'TH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 QN-SITE SEWAGE DISPOSAL SYSTEIVI AND/OR WELL INSPECTION REPORT NAME [PRONE LEGAL DESCRIPTIQN ~ Manufacturer (~' ~ ~ ~ Ma~ria~_~ (__ No~fcompartments Liq. capacity in 9aliens Inside length Width Liquid depth ~ ~ DISTANCE TO: Well -D~lling ...... O ~ ~ Liqu~pacity in gallons ~ No. oflines Length°f~chline T°tallength°fli~so~/ P ~ ~ ~'~ ~ ~ ~ Trench width,~ ~inches Distance between[~/~lines ~ ~ To~ o¢tile'to finish grade Material beneath tile Total effect~ ~bsorption area Length Width Depth -- ' PERMIT NO, · 4 C~J....,.,~ Depth t Q? Driller ~ Distance to ,o, line , PERMIT NO, Building founda~n Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: %-. %~ 4- ~0 4- I(~ ~t 0 6 OTHER ,, SOIL TEST RATING INSTALLER -- APPROVE~ ~ . DATE LEGAL 72-013 /78) '. , ::::';' '" :. :;' :.':! ':", !;'.i .';:;':i il'!t:'i!' !i'.:': I'!F!li !,i;i :::',I:' .%,% SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage° Alaska 99502 270-222'[ SOILS LOG - PERCOLATION TEST PERCOLATION TEST 7 8 9 10- DATEPER,:OR=EO: SLOPE SITE PLAN i~ ' ~ I ~"-, l-~-'-~'-~ ..... ~ ..... ,"-'"'~ 11 12 13 14 15 16 17 18 19 20- WAS GROUND WATER/V//~ ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Not Reading Date Time Time Water Drop ~ B ,';o ~. ~ " Io " ~. ~ " t~ " ~, ~0" IQ ,' ~. ~3 '~ PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN ¢~'~ ~ FT ANI~"~- '1~- FT PERFORMED BY: ~~~. d- I .=RTIFIEOBY:~ DATE:. WATER WELL LC~ FOSS DRILLING 1336 Ingra Street Anchorage, A~laska 99501 s~z~, oF CA~N~! o~H OF ~o,.,,~=. e== TO ~ .~ ,~ F~,~ oF O~AWDOWN. REMARKS DATE COMPLETED t )- /'- ~____PUMP TO BE SET AT / ~L~t o~ 4~to~ .~to~ MUNICIPALITY F ANCHORAGE Development Services Department 3 Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I. D. 015-141-61 1. GENERAL INFORMATION Complete legal description KARELLA LOT 20C Expiration Date: 7-27-2/ Location (site address) 11100 LIPSCOMB STREET, ANCHORAGE, AK 99516 Current property owner(s) MATTHEW RAICHE Mailing address Real estate agent Day phone 11100 LIPSCOMB STREET, ANCHORAGE, AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ , 0 Date of Payment q— (q - Z1 Receipt Number q (99 ( � COSA# 05C,211 17 5 Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 4/14/2021 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 r' these various and dynamic characteristics and are outside the control of the evaluator of the P�ii • • •�;`I�1� well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or lrJJ discrepancies exist can be given by First Water Consulting & FW(S *' TH •�* /� / . ... .. ......... / .. .... ...�:: 6. DSD SIGNATURE Curtis Huffman ' System #1 Approved for bedrooms ��c�sf . •CE 128991•..����r� �— .4/14/9 System #2 Approved for bedrooms �1lFoPROFESS1o�P� Disapproved Conditional approval for bedrooms, with the following stipulations: OF A4� �` oN-SITE G� WATER AND J 'G W p OGKAM B . Original Certificate Date: -2-1 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 Septic System Advisory Well Flow Advisory Nitrate Advisory z — Arsenic Advisory Other –&+ -04 4d_ i � i dy� tr4 i !- Legal Description: KARELLA LOT 20C Parcel ID: 015-141-61 If more than 1 septic system on lot: COSA Checklist # __of _i Structure served by this system A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 11/1/1979 Total depth 249 ft Cased to 249 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 4/13/2021 Static water level at beginning of test 225 ft. Well production at time of test 5.7 gpm Comments B. TANK DATA Age of tank(s) 22 years Tank type/material SEPTIC / STEEL Measured operating fluid level in septic tank 51" ® Standpipes/foundation cleanout per record drawing Date of pumping 4/12/21 D. ABSORPTION FIELD DATA Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate 7.13 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) FWD; Collected by FK- „ Date of Sample 4/12/2021 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material • uC�Z 1,1ii-nil Which system tested (date installed) 5/25/1999 Adequacy test date 4/13/2021 ® ALL standpipes present per record drawing Results M Pass For 4 bedrooms Total measured depth from grade 11.4 ft (max) Fluid depth prior to test 33 / 39 in (N / S TRENCH) Measured depth to pipe invert from grade 3.6 ft (min) Water added 710 gal ❑ N/A — pressurized field New depth 46 / 66 in ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 7.8' INTO THE 8' ED Elapsed time 1410 min ® Code -required soil cover over field Final fluid depth 33 / 39.5 in ❑ System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date F Comments/Deficiencies: All standpipes present per MOA record docs. E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Water Service Line > 10' ® Yes Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No _ Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No _ Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No _ Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that / 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. TH .. .............. • Curtis Huffman CE 128991 , c4A� ct���, •.4129/21. •'��v�PROFESSO ft ft ft ft ft ft ft ft MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 On -Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval #OSC211175 Subdivision: Karella Lot 20C Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 22 years old. Typical replacement costs range from $8,000 to $11,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 -year-old steel tank MAY look like. Nitrate Advisory Certificate of On -Site Systems Approval # OSC 211175 Subdivision: Karella Lot 20C A water sample revealed a nitrate concentration of 7.13 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Mailing Address P� O Box 196650 * Anchorage,`Alaska 99519 6650 *www muni org From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. y a- £„°-„ae b', n "'" Ta5" eta,= ' Mailing Address P 0 Box 196650 *Anchorage, Alaska 9-6650_1,1 www mini org '' • Municipality of Anchorage On -Site Water and Wastewater Program " (907) 343-7904 s e T r CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-141-61 1. GENERAL INFORMATION Complete legal description: Karrella Lot 20C Location (site address) 11100 Li Expiration Date: � r 13 — t� Current Property owner(s) Lisa Bauer Day phone Mailing address Real Estate Agent 11100 Lipscomb Anchorage, AK, 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ WaiverNariance request for: 4 Day phone TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ SJR Date of Payment to Receipt Number e 771,,?1 COSA# 06C1q /all/ Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: 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 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS . Date (,A& 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, groundwaterlevels thatmay;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 OF AL® encroachments, deficiencies or discrepancies exist. Ar 11S 9 # 6. 77GN TURE � System #1 Approved for bedrooms. ?;� "E`' 7 6 ',�` System #2 Approved for bedrooms. �o atro- ® ' Disapproved. ��. �.�►'�' Conditional approval for bedrooms, with the following stipulations: ````i<<tt TYttrrr���r M 11)))i))lll By: `"- Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of`On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory __Septic System _Advisory_ - Arsenic_Advisory Well Flow Advisory Other COSA blue sheet_10-10-12.doc . �. Legal Description: Karrella Lot 20C If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 11/1/79 Total depth 249 ft Cased to 249 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 13 in. Date of flow test for COSA 4/16/19 Static water level at beginning of test 227 ft. Comments B. TANK DATA Age of tank(s) 20 years Tank type/material Septic/Steel Measured operating fluid level in septic tank 49" Standpipes/foundation cleanout per record drawing Date of pumping 1/29/19 D. ABSORPTION FIELD DATA Which system tested (date installed) 12/5/79 ALL standpipes present per record drawing Total measured depth from grade 8.83 ft (max) n -,�' A d /I Measured depth to pipe invert from grade :ft min) ❑ N/A — pressurized field IN Monitor tubes go to bottom of effective. If not, state depth into effective Code -required soil cover over field IN System presoaked (Required if vacant for greater than 30 days prior to date of test) 600 Gallons introduced gallons Comments/Deficiencies. New standnines installed COSA Checklist yellow sheet Parcel ID: 015-141-61 Structure served by this system 1 Well production at time of test 3.8 gpnn Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes No Coliform bacteria is Negative Nitrate 7.36 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L MI Arsenic less than MRL (ND) Collected by Arcterra Consulting Date of Sample 5/21/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 5/21/19 Results Q Pass For 4 bedrooms Fluid depth prior to test 12 in Water added 600 gal New depth 38 in Elapsed time 180 min Final fluid depth 12 in Absorption rate 600+gpd Any rejuvenation treatment (past 12 months) If yes, enter date 9 -Yeti c% 5,a,4 i L ra Ld o s b q I E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft [w] Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25'2] Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No ft ® Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: ® Yes Absorption Field > 5' ® Yes if No ft Private Wells > 100' 0 Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field. is under driveway comment below Property Line > 10' ® Yes if No ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' 0 Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION ♦�� t 1 certify that I have determined through field inspections and review C?.' of Municipal records that the above systems are in conformance with 49 MOA COSA guidelines in effect on this date. t ~;�'~• l� f KE"�NETt i U E 7 COSA Checklist yellow sheet LOT 19 N 00°09'31" W 150.00' 10' UTILITY EASEMENT --------------------- SEPTIC ------------------SEPTIC STANDPIPES CD Z OD LOT 20-C 00 44C.Q,858 sq. ft. 0 1 (Q EAVE LOT SHED Cq LOT 20-D m 20-B N N CO v C.0 � DECK Cfl ro 26.0' 0 w A N O O) ......... ............................... ................................ GRAVEL 42.5'2 -STORY :.: 14.0' .."'DRIVEWAY::.:::.:: FRAME '' ,:BEPTIC ... ............................ ............................. ............................ HOUSE cLEnrovr:.: : i...... i:4 ii: ..........................-.................. o.......................................... iiiC;..................:...'.::ii':: 25.0' 06.0'0 �!....................... 68.5' 9,01_ic4i:f WELL (k N Cl) ................... ............ PO- ------ O_____ _ _ .................... _ _ ............ POLE OVERHEAD ELEOTRIC 1O'UTILITY EASEMENT-::;Eti:_:.:::" EDH---- ED EDH- EO EOF♦-- ..................... ....:::...... S 00003'10" E 150.00' w w O o ----------LIPSCOMBSTREET— -------- OF *:'49 D * ; 0 20' 40' , ...... ...............:.... i c • Buk iz o •, IS 4837 AS -BUILT tea`_ ��h�PFap' •....... •.•�05°� '111% �„S `ION;;; I HEREBY CERTIFY THAT I HAVE FOLLOWING DESCRIBED PROPERTY: SURVEYED THE LOT 20-C, KARELLA SUBDIVISION EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED SUBDIVISION PLAT (77-213) ARE NOT SHOWN HEREON. ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE THIS DOCUMENT DOES NOT CONSTITUTE BOUNDARY SURVEY AND WITHIN THE PROPERTY LINES AND NO VISIBLE IS SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT BOUNDARY ENCROACHMENTS EXIST EXCEPTAS INDICATED. SURVEY MAY DISCLOSE. DATED THIS 11th DAY OF JUNE, 2019,ATANCHORAGE, UNDER NO CIRCUMSTANCES_ SHOULD ANY OF THE DATA HEREON BE ALASKA. USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR ESTABLISHING PROPERTY BOUNDARIES. FIXED HEIGHT, LLC NO CORNERS SET THIS DATE I SCALE 1" = 40' Land Surveying Services 907.290.8949 WWW.FIXEDHEIGHT.COM JOB 019038 www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC191214 Subdivision: Karrella, Lot: 20C A water sample revealed a nitrate concentration of 7.36 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. it may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. � ,4 Ma�hng Address P 'O' Box 196650 *Anchorage, Alaska 99519 6650 *www muni org x Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bmgaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.d.anchorage.ak.us CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I,D., 015-141-61 ¶. GENERAL INFORMATION Expiration Data: 01o! _3 Complete legal description KARE:LLA SUBDIVISION; LOT 20C, Location (site address or directions) 11100 UPSCOblB , ANCHORAGE, AK 99516 Currant Property owner(s) · Mailing address Lending agency Mailing address Real Estate Agent Mailing address TRACY TRUSTY Day phone 808-875-9862 11100 UPSCOMB * ANCHORAGE, AK 99516 Day phone LLOYD PENNEBAKER w,/ COLDWELL BANKER Day phone 2525 'C' STREET * ANCHORAGE, AK 99505 265-9105 Unless othenefse requested, HAA will be held by DSD for plckup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATEi~ SUPPLY: Individual Wall ~ Individual Water Storage Community Class Well ~_~ Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-sita 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 5 by an Independent pmfesslonal civil engineer registered In the State of AJaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties sewed by a single family on-site wastawater 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 data of Issue for proper'dee served by a private or Class C wall and may be reissued with nnw water sample results less than 30 days old. (Certificates may be reissued for a porlod of up fo one year with valid water samples.) Cort/flcatea are valid for one year for properties served by Class A or B wells or a public water system. The Munldpality of Anchorage is not responsible for errors or omissions In Ihe professional engineer's work. Note: Alaska Wa ter and Wastewater Consultants, Inc. shall be paid ~ a t, or pdor to dosing for the engineering san,ices provided. 4. STATEMENT OF INSPECTION BY ENGINEER AS certified by my saal affixed bereto andes of the validation date shown below, I verify that my investigation, based on procedures outlined In the Hsalth Authodty Approval Guidelines for this app#cation, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and bjpe of s~ucture Indicated herein. I further verify that based on the Information obtained from the Munlclpality of Anchorege files and from my Investigation and Inspection, the on-site water supply and/or wastewater disposal system is(are) In compliance with all applicable Municipal and State codes, ordinances, and regulations In effect at the time of Installation. NameofFirm ALASKA WATER & WASTEWATER CONSULTANTS. INC. Phone 337-6179 Address 6901 DEBARR ROAD. SUITE 2B * ANCHORAGE. AK 99504. Engineer's Printed Name dEFFREY A. GARNESSo P.E. Engineer's Comments: . In conduc~lng fftls evaluaffon, AWWC, Inc. at~empted ~o provlde e ffx)rough, . - oonsdenffous er~glneedng analysls of ff~e R~wn ln a~ wlth ADEC and MOA eepffc ~rystems depmtd on ~e local solls con~ffon, groundwa~' levels ~hat may ... DSD SIGNATURE t/' Approved for /'~ bedrooms. Disapproved. Conditional approval for __ .~';.~'.. ..... :.~'X;"--~ ~:- ON-SITE ~: · WATERAND : ... =_ :. W^STEW^ ER :' bedrooms, with the fllowtng s,puia~o~.: .. PROGRAM .- ., . · . ~../,,,?<,,~-.,... .... · .~ ~..,-~ Attachments: HAA Checldist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: '~-' /~ ' 0 / Municipality of Anchorage Development Services Department O~-S~ Water & Wastewater Program 4/I)0 South Bragaw 6L p.o. Box 196650 AN:ho~ge, AK 99519-6650 Legal Dascdptlon: WELL DATA Well ~ PmVATg If A, B, or C provide PWSID# Date completed 11/1/79 ~artitely ~eal (Y/N) YES Total depth 249 ff Cased to 249 ff HEALTH AUTHORITY APPROVAL CHECKLIST KARELLA SUBDMSION; LOT 20C, Pan:el ID:. Date of test 11/1/79 Stellc water level 232 ff. Well pmduclion 10 g.p.m. wen L=g (Y/N) Wh'es ixoperty ix~,tected (Yn4) Casing ~tg~ (~ ~ AT INSPE~ON 4/24/m 235 ~ 5.76 g.p.~ 015-141-61 12+ In. WATER SAMPLE RESULTS: Date of ~u'nple: 4/24/01 Collected by:. AWWC, INC. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date Instefled 5/5/99 Tankslze 1250 gal. NumborofComparlments 2 Cldanouts(Y/N) YES Foundalio~cluanout(Y/N) YES Dapresslonovertenk(Y/N) NO Hlghwateralarm(Y/N) N/A 4/26/Ol DENAU SEWER Date of pumping . Pumper C, ABSORPTION FIELD DATA ~ ~LESS 2 OLD Date ,,~,lled ~~ ~ ~ ~.~.~)o.,5 s~,= ~ =E. CH Length 20 50' lt. Width 2.0 ft. Gravel below plbe 8.0 It. Toteldepth 11 ff Eff. ab~onarea1600 ~t Monlteltngtube YES Depmsslonoverflelc[ NO Date of adequacy test *NEW Results (Pass/Fall) PASS For 4 bedrooms Fluid depl~ In absorpUon field bofom test In. Water added gal. New depth Elapsed Time: min. Fired auld depth In. A]~ rate >= g.p.d. Any reJuvenaUon b'eatment (past 12 mo.) (Y/N & type) If yes, give date Fe LIFT STATION Da~ installed 'Pump on' level at In. ~?~J~~ SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO.' Septic tanl~fift etetlon on lot, 100'+ Absorption field on lot 100'+ Public sewer main Sewer/sep~c sendce tine 25'+ High water alarm lovel et In. Meets alarm & dmult requirements? On adjacent lots, 100'+ On adjacent lots, lOO'+ Public sewer manhole/cteanout Holding tank N,/A SEPARATION DISTANCES FROM SEY'11C/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field Water main N/A' Water sen'ice line 10'+ Surface water Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION REID ON LOT TO: 100'+ Property line 1 o'+ Water serdce line 10'+ Curtsln drain NONE KNOWN COMMENT8 Building foundation 10'+ Surface water 1 Wells on adjacent lots:: 100'+ Water main N/A Dn~way. gerking/vehlde storage 50'+ G. ENGINEER'S CERTIFICATION I certify that I have determined ~m~gh field inspecUuns end review of Municipal records that the above sysfeme em in confommnce wl~ MOA HAA guidelines in effect on this date. JEFFREY A. C, ARNESS HAAFSe$ oate of Payment Receipt Number $ E, Waker Fee $ Date of Payment. Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 015-141-61 HAA# ~ ,~0~.0~ ('~ ~, ._~,C~ GENERAL INFORMATION Complete legal description Lot 20C; Karella Subdivision Location (site address or directions) Property owner Mailing address Lending agency Mailin. g address_. 11100 Lipscomb Street Anchoraqe, AK Steve & Cynthia Wells Day phone 11100 Lipscomb Street Anchorager AK Day phone 346-3093 99516 Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 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. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 [Rev. 1/91) Front MOA ~¢21 m, uewwoo l~UOp,!ppv :suop,81ndp, s 6U!MOIIOJ alp, q:HM 'suuooJpeq JOt leAoJddB leUO!~.!puoo '9 ~=I=INIIDN=1 AG NOI.LO=IdSNI -i0 £N=I~N=IJ. YJ.S 'g Municipality of Anchorage JUN 0 [ ]999 DEPARTMENT OF HEALTH & HUMAN SERW!~I~I~ALI'rY OF ANCHO~AG~ Environmental Services Division ENVII~ONMENfAL SERVlCEg DiVI,fil 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: Health Authority Approval Checklist ~/D ! /¢ '/'' 20 ~ Parcel !.D.: O I S -/'1/- ¢1 If A, B. or C, attach ADEC letter. ADEC water system number Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION Date completed Cased to 2 ~/ ~/ /2 ' A, WELL DATA Well type ~t"¢' Log present (Y/N) Total depth 2. Sanitary seal (Y/N) y ~,~ FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed /-/,~'¢ /"n/q¢/~-. Other bacteria Collected by: .. '"/ Depression (Y/N) Number of Compartments ~ Cleanouts (Y/N) ~/ High water alarm (Y/N) 1/3 72-026 (Rev. 3/96)* Foundation cleanout (Y/N) Date of Pumping ~//./4-- Pumper C. ABSORPTION FIELD DATA ~ Dateinstalled'~//:/'/¢]~- '~/'¢'/~'~Soilrating g.~d./~orft2/bdrm) (-,), Length ~OO' Width_ 2 Gravelthickness below pipe Total depth I I Effective absorption area ~ (~O0 ¢'1Lz Monitoring Tube present (Y/N) / Depression over field (Y/N) /'~ '"~~st Results (Pass/Fail) For ~ .~------~b~'rdrooms Fluid depth in absorption~h"ft~Hd4:tef,~.~test (in.); __ __ Imme~!y,,.afte~-~- _ gal. water added (in.): Fluid depth __ (ins) Mi..._,_~n~¢,_]ater.~-~ ~ Absorption rate = ______ g.p.d. Peroxide treatm~; months) (Y/N) ~m-..~_.~..~. / JeqgunN ~d!eoew ~,u eLU/,~d JO ,(96/g '^eld) 9gO-gZ :Ol J.O-I NO )tNYJ. 9NIQ-1OH/OIId~]S IAIOEt-t S=IONV. LSIQ NOI.LVI:IVd=IS v/AI ..,, ,~/ :01 /0-1 NO -I-I~ IAIO2J S~tONVISIQ NOIJ_V~IVd:~S eu!l eo!AJes o!Ides/~et~eS u!e~u ~e~es o!lqnd lOl uo Ple!t uo!ldJosqv lOl uo ~Iue~ Bu!plogl/o!~des MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel i.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 20~ (L~/~ KARELLA SUBDIVISION Location (site address or directions) 11100 Lipscomb Anchorage, AK Property owner Mailing address Lending agency Mailing address Elizabeth Locker Day phone 346-3485 11100 ~ Stree~ Anchoraqe Day phone Agent Brian Broderic~ / VISTA REAL ESTATE Day. hone 562-6464 (Brian on vacation call William de. Schw~i~itz 0 V~FA Address 3000 C Street, Suite 101 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: /~ TYPE OF WATER SUPPLY: Individual well XXX ~-Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: XXX Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. ~/91) Fronl MOA &r21 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 furtherverifythat 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 Address Engineer's signature S & 5 ~r~,INEERING, 17034 Eagle River Loop Road No. 204 Eagle River, AlasEa Phone Date D/~ SIGNATURE Approved for / Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: /'f / -- Date The Municipality of Anchorage Department ,~f 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 Ala.~ka. 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 professj,~nal engineer's work. Legal Description: Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Parcel I.D. A, WELL DATA Well type {0~-/Y'/~T-~- If A, B, or C. attach ADEC letter. ADEC water system number Log present(i~N) ,(F/~,.$ Date completed /:~ /¢~ Driller Total depth ~ ~ f ~ Casedto ~ ~ ~ Casing height /~" Sanitary seal ~) ~¢ Wires properly protected ~) FROM WELL LOG AT INSPECTION Date of test Static water level ~ '~ ~ ~ ~--~ ~--~- / / ~ :~:~ Well flow Pump level ~:~' SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot /00 Public sewer main /do./.~ Sewer service line'~O ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank ,/U,c~.~)~.~ ~/tJ WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ? Cleanouts~_E~) ~'~ High water alarm (Y/I~ ,,~O Date of pumping _ Tank size Foundation cleanout (~.~) Compartments L(* ~'_I Depression (Y/~ Alarm tested (Y/N) '"'C~//~ Pumper ,,¢~T /'/0/~- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Surface water/drainage _On adjacent lots Absorption field Foundation ~-~'- / Water main/serviceline ~' ~/- 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE J@qLunN IUaLU~d JO J@qLunN ~UeLU/~Sd JO @leo $ @@3 VVH _/~v.~;~->~/ ~c¢¢ ~Ol uo we,sAs peuopueqe Jo 6uRs!xe Ol ~/¢¢~w~ ~/o-o/q/ u!eJP u!e'JnO _~©~ S~Ol ~ueoefpe uo ) O~ ~ uo!,epuno~ 6u!Pl!nq Ol :01 O-131-1NOI£dMOSBV IAlOId-t 30N¥1SIQ NOI/VB¥dBS '~ooV/eloqueR (N/A) ,USA s~'Olle8 u! oz!s aj~,su! e,ec] DAT'E RECEIVED INSPECTION APPOINTMENTS DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE DEPT. OF HE^LTH DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~VIRONMENTAL ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 REC E 1 V E _ REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed. Please allow ten (10) days for precessing, 1. PROPERTVOWNER ~/ , ~ PHONE MAILING ADDRESS PROPERTY RESIDENT (If ~fferegt~om above) PHONE 2. BUYER MAILING ADDRESS 3, LENDING INSTITU~ION ~ ~ PHONE MAtL1NG ADDRESS / / 4, REA~OR/AGENT PHONE 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE ~ SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER SUPPLY NUMBER OF~BEDROOMS [] One [] Four [] Two [] Five [] Three [] Six [] Other ,~_~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM *ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) /,~PE ,~,~ ~- YEAR ON-SITE SYSTEM WAS INSTALLED. ?~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-010(Rev. 6/79) ¢..~.~) ~~ C.(~,% ~ (6L/9 '^~B) O~O'~L Q3AOIJ4dVSIQ [] (a~eo!Jp.~ao /,uedLuoooe ].snuu Ja]~ral) 1VAOl~ddV -I¥'NOI/IONO0 E~ SIAIOOEI(]~ _~ IaO-I C]3AOEhJa~/~ 31VG au!91°9 ls~JeaN I au!9 JaMaS eaJV uop, dJosqv )lue/I~ujpl°H/°DdasqvIH31V~ I kl~ W ~L.LDV4 n NVI,N 9NI/V~ SqlOS EI~qqV±SN SIN ~tlAII/~O0 'G bBuI-] ],saJeDu o! eaJ~ uol:~dJosq¥ ... ].o-I . :O/-1-13M $~ONVLSIQ ¥'_:lldV NOI/dEIOSSV q¥/O/ ){NVJ. 30 adA/ :SUO!SUaLUIp aAJb apew~woq si. >lue.L JI ~..~Cj-' :aZlS. ~lUeJ. §u!plOH [] .io~4ue/o!]dasE~ paN-pa^ uop. oauuo0 .kZl-I Izn Ol-ISna EEl 3/IS- NO/-IVnQIAIONI [] IAINJ.$AS 'l¥SOaSla ::iDVMBS '8 paN. paA uo!].oauuoO A.LI-IIZrl OIqSnd [] ,*,.LI NfllAl~OO [] -lVnO IAI(3NI [] AlddnS Ua.LYM '~ Xl1~¥~ 3-1411'lnlAI [] A-I IIAJV:I 3-1DNIS [] ~ION3QISBEi -IO =IdA.L 'L ~,INO 3sn -l~'lOla:lO EIO::I 3als SIH.L DATE RECEIVED TII~IE TIME TIME DATE DATE DATE INSPECT/~,, ~ \ INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE DEPT. OF I:EALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~RONMENT'qL F;:O'rECTION 825 L Street - Anchorage, Alaska 99501 JAN 2 !. 19 0 ENVIRONMENTAL SANITATION DIVISION · RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DI~EOTIO~S: Complete all parts on page 1. Incomplete requests will ~ot b~ procassed, Please allow ten (10) days for processing, I. PROPERTY OWNER PHON~ ~AIL~ ADDRESS [ ' MAILING ADDRESS -- 3. [,ENDING INSTITUTION MAILING ADDRESS -- J PHONE MAILING ADDRESS 5. L~-(~L' DESCRIPTION , STREET LOCATION 6. TYPE OF RESIDENCE /~" SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER SUPPLY INDIVIDUAL~ [] COMMUNITY [] PUBLIC UTILITY NUMBER OF~BEDROOMS [] One [] Four [] Other [] Two [] Five /~ Three [] Six * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975, For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~' INDIVIDUAL/ON-SITF** _~. (~'~'~ YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6~79) )1 (a;eON. l:t~ao Auedwoooe ~.snw ~o~,~,al) -IVAO~JdclV ]VNOI/IC]NO;D [] S~OOklQ3fl Z~. IdO-I 8.LN:~IN~O3 'q au!-] ]o-j ),seJeau o! eaJV uo0d~osqv au!-I ).o-1 eaJv uop. d.~osqvI ,?uej. ~ulplOH/OFldaS S~ONV.LSla 't~ ~J31JFI±OVq FINVlAI >INVJ. ~O 3dAI <] :':' d~ ~] :suo!suatu!p __ DNI.LVH SqlOS apeLuawoq s! :,lUe/Jl O.~'T3. I :az]S ': . pa!J!.laA uo!'toauuoO '" - (-) A/IqI.LN :31]SNd[~ oaT]vJ. SNI a±va allS- NO/lVnd IAIQNI [] H~VUnN ±~]~Jad IN:].LSA8 'l~'8OdSla :EIE)'~'~a8 '8 Q~AI~D~U OOq pa!J.!~aA uoBoauuoo All]UN Ol-18 ncl [] Q~'lqlWQ -- A/.I NNIAIIAIO0 [] ]'13M :JO HJ-d~O ]VNOIAIQNI [] H~ ~]IAIFIN J. IIAIH3d XIS [] Id NO:I [] ONk± [] A] IIAJ¥:~ 3'1 dI.L1D~ [] ~tH±O [] aal:l [] 3~]8 H_L [] 3NO [] A] I~V:l BqDNIS [] slNoot:lOaa -40 klaal~nN ]ON.:lOlS~lkl .40 adA& '1,