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TRAILS END BLK 5 LT 4
Onsite File Trails End Block 5 Lot 4 #015-192-27 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221061 PID Number: 015-192-27 Dwelling: © Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name Harold Johnson ABSORPTION FIELD ❑ Deep Trench ❑�/ Wide Trench ❑ Bed © Mound Site Address 11301 Doggie Ave. Anchorage, AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 2.0 GPD/SF 2.64 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 1.22 Ft_ Gravel depth beneath pipe 1.52 Ft. Subdivision Block Lot Trails End 5 4 Fill added above original grade 2.25-2.45 Ft. Gravel length 36 Ft. Township Range Section Gravel width 5 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist between trenches From Tank Field Tank Line 230Ft s 1 Ft. Well 1001+ $$'x 25'+ TANK ❑ Septic ❑ S.T.E.P. ❑ Holding [Z Other Manufacturer Capacity Surface Water I 1001+ 1001+ Orenco 1500 Gal. Material Number of compartments Lot Line 101+ 7.3'r NA Plastic 2 Foundation 1101+ 10.4' I LIFT STATION Manufacturer Capacity Remarks Advantex system allows 50' separation from Gal. well and 5' from lot line. Alarm location Garage Electrical installed by Capstone Electric Installer PIPE MATERIAL House to tank D3034 Tank to drainfield D3034 A+ Drainfield D3034 CO/MT D3034 Inspector Arcterra Consulting BENCH MARK (Assumed elevation) 100 ft Inspection 1st Location and description dates: 3/31/22 2nd 3/31/22 3'" 4/4/22 4th Bottom of siding SW corner ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp OF 444 Conditional Approval: Date i ♦1 49M ♦� M KENNETH FFUS +u` �i�% CE 1 AV Septic System / q_" '�♦ Approved Date ��`�•. • Note: this approval does not include well permit requirements. ♦r♦♦♦�;�i�+ trtev uovulnut AS—BUILT SYSTEM DETAILS/SITE PLAN Permit OSP221061 TRAILS END BLOCK 5 LOT 4 PID# 015-192-27 WELL a •'I . •a I I 4 q . a 4 _ ,d �n DECK W n a BUILDING Q e• .. •'a a a A- a 74 °i4 . a v ' a - e, a• .i..,. DRI VEWAY.d d' .v ,° ° n' .4 - 4 4' d a 4a -a' rn ^ •p 41 x O O O O _ M 11 U A -C=13.0' B -C=30.1' A -D=13,5' o B -D=31,5' A -E=44.0' B -E=49.0' A -F=44.1' T B -F=49.8' , A -G=28.1' B -G=8,7' o A -H=28.9' B -H=8.7' A -I=34,8' B -I=15.5' A -J=37.0' I B -J=16.0' 36' FO 5'Util Esmi y 5�w e.R i C3 0 A 1500 GAL N ADVANTEX TANK MT Al AST t NEW 1500 GAL ADVANTEX TANK W U SCALEI 1' = 20'111 36' OF AZ ,ar�<C PREPARED FOR: rtS , HAROLD JOHNSON ".1 11301 DOGGIE AVE *4 9 TH*. ANCHORAGE, AK 99507 KE�L.M S FIELD BOOKS couPu�u: CE 71 BOUNDARY: N/A DRAWN: KSD STMM N/A MEMO: KMD Mul" BUKU SALIZI DAZE 4/4/22 PESSI DRC, FILE: GRID: sw2641 ACAD FILE FILE I 'IDB NO' 22104 81.00 EM SCALE: NTS gC ER c � fl� m� a o x z � m , 901 nSULTING 6` �� AK. 99577 a� r Q. m tel•: . / v L co IN AO•£6� M,.0£,65068 S — — — Irr3w3se3 uiiln .s — oe Z) I w 0 2i� w w� w S _ Q( v O ED w cj cr LU( x 4 a 1- U) � J N O w p X OINVO CN r Oui O't7Z¢ w w w �. _ }' o O ! No� �, "Q O 0 I 107 CV Q w t UJ.co \ O l 3 t x � 9•ZZ XI _ t X U) 3�N3X N I) O w y ,OB IIII w OFU ,00•£6 �] ..0£,65068 N w o Q ~ >ao " UZ o¢Co o I J I MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221061 Work Type: Septic Upgrade Tax Code Number: 01519227000 Site Legal Address: TRAILS END BLK 5 LT 4 G:2641 Site Mailing Address: 11301 DOGGIE AVE, Anchorage Owner: JOHNSON HAROLD D JR & Design Engineer: ARC TERRA CONSULTING INC This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: j11 c n t i* Department 3/25/2022 3/25/2023 22800 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By: Date: Date: 3 a a2 ®� 3 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-192-27 Property owner(s) Harold Johnson Day phone Mailing address 11301 Doggie Ave. Anchorage, AK Site address 11301 Doggie Ave. Anchorage. AK Legal description (Sub'd., Block & Lot) Trails End Block 5 Lot 4 Legal description (Township, Range & Section) Lot Size 22,800 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ® Initial ❑ Single Family (SF) X❑ Septic Tank p ® Upgrade X❑ (w/wo AD U) (D) ElRenewal Holding Tank El Renewal❑ Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: "m,operty-�• Distance: ' I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Dea Duffus (Signature of property owner or authorized agent) Permit/Rush Fees:e�9 S Waiver Fees: ; Y e �unc� Date of Payment: 12— S- 2Z Date of Payment: Receipt Number: 02 3'&j Receipt Number: Permit No. `� /� 2?_ laF l Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221061, Rebecca Carroll, 03/25/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221061, Rebecca Carroll, 03/25/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221061, Rebecca Carroll, 03/25/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221061, Rebecca Carroll, 03/25/22 ,b r'ev lo,rmznt Services_ Depertrnent '�' Buiidine Sefery Civision On -Site 11 c—jzT' 41-0; Sragaw Street . 'i Mark Begich Anchc•raoe, A: 99519-6650� - Mayor ,.v.vw.munLnr:Jonste (907-1343-7904 - Pump Installation Log Well Drilling Permit Number: SW_ Date of Issue: Parcel Identification Number: Legal Description Property Owner Name S Address: TR /�l1-s E/\lD H,4zuL7 T(->v4n5&j `S— )y'7 Y�4t'IC�a2A6£ AK Pump Installation Date: 6-6-11 Pump Intake Depth Below Top of Well Casing: CV feet Pump Manufacturer's Name: ;q Y Yh r'ij5" R L5,�> Pump Model: OL jD7S3LQ Pump Size 3/q hp Pitless Adapter Burial Depth: 10 feet Pitless Adapter Manufacturer's Name: � Pitless Adapter Installer: Well Disinfected Upon Completion': Yes ❑ No Method of Disinfection: Z lo -e kvf Comments: i t Anchorage Pump & +7veli Ser -v6 Pump Installer Name: 330 Past 76th Avenue Anchorage, Alaska 99513 Phone: 907-243-0740 Fax: 907-243-0742 Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. f MUNICIPALITY OF ANCHORAGE .r � � DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION \ 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE NEW V MAILINGP Z%7 13UPGRADE DRESS" 8 / LEGAL DESCRIPTION L LOCATION in r 7)noner NO. OF BEDROOMS Ave an 3 DISTANCE TO: Weil Absorption area Dwelling PERMIT NO. D iDY Q in F Manufacturer r Material No. of compartments P Liq. capacit in guns Inside len th IF HOMEMADE: g Width Liquid depth d be _10 Z DISTANCE TO: Well Dwelling PERMIT NO. S? Q f, Manufacturer Material Liquid capacity in, gallons w= DISTANCE TO: Well PEHMITNO. Foundation N�Tden�chmdt�h J LL= WH oLxjn— No. of lines f Length of each line Total length of lines sDistance bet70 I to) ¢ Top of tile to finish ra a 9 J. Material beneath the Total effective absorption area- D O inches LengthiMdthhh W PERMIT NO. Q H rtlepth Total effectiveabsorption area to ing foundation Nearest lot line eerDntance to lot line PEHMIT NO. W r line Septic tank Absorption area (sl PIPE MATERIALS SOIL TEST RATING INSTALLER _ s is Or REMARKS O O t LEGAL APPROVED c� yDATE MAILS E:nCISA. RS.1 Ll 72-013 (Rev. 3/78) � MI_ItJ I C I F't�'t_ I T',r' OF F�tJCH� �FiGE DEPARTMENT .._ALTH AND ENVIR.ONMENTALrVOTECTION 825 '. STREET, ANCHORAGE, AK. 95-01 • 2E4-4720 14ELL F r4Cs 0t4—_.ITE CEIJEF=_ F}EF<t•1 I T PERMIT NO. ( 820270 ) APPLICANT KEN SIPES 283 MULDOON RD 20X357 277-8727 LOCATION DOGGIE AVE LEGAL L4 E5 TRAILS END LOT SIZE 22800 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER. OF BEDROOMS = 3 SOIL RATING CSO FT/BR)= 300 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: LIEF TH= a L-E:NIMTH= ::LC -'E: GF _*F -f 'EL L-EF}TH= THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR. DP,AINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIF! FEET). FtEG!IJ I FRED cEF'T I C Tf::4r4 : 'E I 2:E= 1r30r-+ i3FtLL0t45 PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- T14cs C 2 ? I r4inF'EC1- I CA rJ no FIFE FQE7C!LJ I FZ Eo E> BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER. LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER. REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER.. INSTALLATION. F"EFRM I T EXF0I F?Ei3 OEGEMEJEFZ 2T1s 1c+u2 I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR. ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOM SIGNED: ---- ��-C •-�sqn'�..------------------ -' APPLICANTG EF! SIPES cL.�l ISSUED BY V4. 0 t t 1 SOILS LOG MUNICIPALITY OF ANCHORAGE y/ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION /` PERCOLATION 825 L. Street, Anchorage, Alaska 89501 264720 TEST SOILS LOG — PERCOLATION TEST PERFORMED FOR: KEN w rs n DATE PERFORMED: L Z7— 0 2, LEGAL DESCRIPTION: 'TM'AI j IS EnA 65 L LI 1 2 3 5 6 7 8 —� 9 10 11 12 13 14 15 16 17 18 1s 20 o r4 1501 e 4.066614 1cje.r 51 1-r To SiI.TY yrave.j & L/GM) Ct SLOPE ill WAS GROUND WATERA'� L ENCOUNTERED? ,�s O P IF YES, AT WHAT E DEPTH? 71nmo'In✓ .QI' SITE F Reading Date Gross Time Net Time Depth to Water Net Drop f I}10 H-21 10:15 D:Z 5 'g.. ID /ntn a y` 113. .� 0 Io:35 lomtn PERCOLATION RATE,5S7 __ (minutes/inch) TEST RUN BETWEEN FT AND FT PERFORMED BY: LQ6:.t pz, CERTIFIEDBY: 72.008 (6/79) ' , DATE:15L—.77—F r, n A.U.S„ INC. 1710 W. 25tH. AVENUE MUIORAGE, AK. 99501 Supplemental Soils Information. Subdivision %Y2 / /S 4F->) d Block 6,— LOT TH y LOT — TH - LOT TII 4D TH FE DEPTH (FEET) 2 2 6e O S2nc� �re�% 3 O b, CG �/ 3 l 3 4-- 4 4 5 Si /f Van/ 5 5 6 dae 6 .6 7 7: 7 Gro. �i 8 8 e s s 10 10 10 11 11 11 12 12 12 13 13 . 13 14 14 14 15 15 15 16 16 16 17 17 17- 18 18 18. 19 19 19 20 20 20• LOT TH DEPTH (FEET) � 1 2- 3- 4- 5- 6- 7- 8- 10- 11 34567a1011 12- 13- 14- is- 16- 17- 18 - 191 213141516171819 20 1301 1369, STAR 110iJTE A A\CIIORAG)C, ALASKA 99502 349-7719 SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF- 140 ie".t. DRILLED AT THE RATE OF 522.00 PER FOOT. PROPERTY OWNER Get. Xert Sipco 248-3311 LOCATION OF WELL SITE It. N Dtk. 5 Sub. % r": I • F 1, A DRILLER LeAnie C att4 of. PanpaU Dt,UL g LTotkj. i WELL LOG: 0----22' S.i ttij aandtj gmuet. 22---46' lia&dpan. /l cen.eated gtave.t. SeucAat amau boutdc'u. 4 6---62' R fine Ott Jj. ntauc t. 62--140' Bedrock. R 4uUncxaavj. tock. ."atct hemting to a p.otou4 .bjpc &cdtoek,fltoa '132 to 140 feet. ' ,I v to&lc t Loa of 120 .to 150 gates pest houA. 90' -feet of rLa te-t 4 tanVnr, i m cam in,g. 1/2. iloue Subncu.ibtc J'unp .o1Lou,td be bL:.talled 15 fact off bottom. Coat of fl.attting: $22.00 pet foot X 140 feet: v"3080.00 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRO\7.4:NTAL PROTECTION MAY 21983 RECEIVED COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF °3080.00 THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPART DRILLING WORKS DATE dune 79th, 1982 'Z c O oj�a— SERVICE CHARGE 0F IV,% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS. U4� Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-192-27 Expiration Date: �7 - z C2 1. GENERAL INFORMATION Complete legal description Trails End Block 5 Lot_4 Location (site address) 11301 Doggie Ave._Arichorage, AK Current Property owner(s) Harold Johnson _ Day phone Mailing address 11301 Doggie Ave. Anchorage, AK Real Estate Agent _ _ Day phone 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: 3 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. istance: COSA Fee $ -S50 Waiver Fee $ Date of Payment Yaaaa Date of PaymentA�Z Receipt Number 070016 Receipt Number COSA # Q b C, 22 (__� 2 5 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm _ARCTERRA CONSULTING INC. _ Phone 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS_ _ Date Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen `}L encroachments, deficiencies or discrepancies exist. g TH . 6. DSD SIGNATURE System #1 Approved for bedrooms. KENNETH M. Ulf FI711 y .410 �`,. System #2 Approved for bedrooms. , ��''rh,, ��� `� Disapproved.\®� Conditional approval for bedrooms, with the following\s\tk, 6�, t /41 ��j��(/ S ON-SITE VVHI tK HNL G WASTE- V ATE J� PROGRAM JJJ By: Original Certificate Date:— The ate:—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 blue sheet -10-10-12 doc Legal Description: Trails End Block 5 Lot 4 Parcel ID: 015-192-27 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 6/19/82 Total depth 140 ft Cased to 140 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 20+ in. Date of flow test for COSA 4/5/22 Static water level at beginning of test 50 ft. Comments B. TANK DATA Age of tank(s) New years Tank type/material Advantex/Plastic Measured operating fluid level in septic tank New Standpipes/foundation cleanout per record drawing Date of pumping New install on 3/31/22 D. ABSORPTION FIELD DATA Which system tested (date installed) 3/31/22 ALL standpipes present per record drawing Total measured depth from grade 5.0 ft (max) Measured depth to pipe invert from grade 3.5 ft (min) ❑ N/A — pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective 11 Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Com ments/Deficiencies: COSA Checklist yellow sheet Structure served by this system Well production at time of test 2.0 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes No Coliform bacteria is Negative Nitrate 2.89 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Arcterra Consulting Date of Sample 2/1/22 FT STATION ❑ Requ-7S.Qiaintenance completed Age of lift stationyears Lift station materia( Comments: Adequacy test date New Results ❑ Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date 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' Community Sewer Manhole/Cleanout > 100' ® Yes if No ft [7 Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25 2] Yes if No Absorption Field on Lot > 100' ❑ Yes if No 88Y ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ® Yes if No ft ft ft ft ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® 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: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® 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' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No 7.3* ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' Yes if No 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 *Advantex system see Inspection Report. 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. COSA Checklist yellow sheet ft Iii MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this Z � Day of /JACCi4 of 20 ZZ._, by and between Lv��w s •- 2� / ,.herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as located at (legal description) Gn/D 3&K 5 L?' 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) "'� Throughout the term of this Agreement, the Owner shall enter into a service agreement with•an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. 7y--- It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and snake any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. =Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNER: BY — (signature) Date: 3 -47,✓ (print name) STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this4day o eft z— , 2022, by YKA--), G:. K�6, NOTARY PUYLIC FOR ALASKA My Commi 'on expi7 -S (. /a . /O, MUNICIPALITY: (signature) (print name) =*. PURL RY OFALAS�P��\\ ��//111111111\�� Date: '�/—Z Title: (rev. 05/18/2018) Page 3 of 3 94129 Task 003 O h1UNiCIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN S1c7VICE5 ���, Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # Ot!!� YC\a -A l 1. GENERAL INFORMATION HAA # _ U i� 912Dgc'i I Complete legal description Lot 4, Block 5, Trails End Subdivision Location (site address or directions) 11301 Doggie Avenue Property owner Michael LindemanDay phone - (907) 276-8740 Mailing address 1333 E 9th Avenue, Anchorage, Alaska 99501 Lending agency __City Mortgage Day phone 263-0749 Mailing address 121 West Fireweed - Suite 120 Anchorage, Alaska 99503 Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 `,, 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 X Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 IR., 1.911 F,MI MCA .21 1.1 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 furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm DHi Consulting Engineers Phone (907) 345-1385 Address P 11 -1349 Engineer's signature i Date Dee High, P. . DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments bedrooms, with the following stipulations: 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 purchasersof 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. 72M(Pw 191 I awk MOA .21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 a Anchorage, Alaska 995010 (907) 343-4744 9s Av/ 6?6V msec) RECEIVED Health Authority Approval Checklist NOV 141995 Legal Description: Lot 4 Block 5 Trails End Subd. Parcel I.D.: horage A. WELL DATA Dept. Health &Human Services Well type i nrli vi rhrat If A. B. or C. attach ADEC letter. ADEC water syswm number U Log present (Y/N) y Date completed 06/19/82 Total depth _ 140' Cased to 14010 Casing height (above ground) 25"® Sanitary seal (YM) _ _ Y © Wires properly protected (YIN) _ y FROM WELL LOG Date of test 06/19/82 Static water level 50' Well production 2+ WATER SAMPLE RESULTS: AT INSPECTION �'fltr� &p -m. 3.5 9— p.m- Coliform n Nitrate 1 _6d Other bacteria 0 Datc of sample: 1 n/3n/95 Collocted by: Ou_g i n mirrh B. SEPTIC/HOLDING TANK DATA Date installed Qg/28/8 Tank size 1 , 000 (D Number of Compartments 2G)Cleanouts (Y" Yo Foundation cleanout (YIN) Y (9 Depression (Y/N) N© High water alarm (Y/M N Date of Pumping 09/30/94 Pumper >znt•n Rin j -A C. ABSORPTION FIELD DATA Date installed ns/2g/R2 Soil rating (g.p.d./ftr or ft-/bdrm) 300 System . Length 1 Q9 �� Widthy Gravel thickness below pipe 60" Total depth';� Effective absorption area 1090 ©Zts ing Tube present(Y/1�_y ® Depression over field (Y" N Date of adequacy test (Pass/Eai) PaccM For 3 bedrooms re/3v/Yy Fluid depth in absorption field before test (in.): 524 Immediately after 470 gal. water added (in.): 57 Fluid depth _(ins.) Minutes later: 199 Absorption rate — 2891 a.P.d. Peroxide treatment (past 12 months) (Y/N) N If yes, give date — D. LIFT STATION Date installed Manhole/Access (Y/I) High water alarm Cycles tested E. SEPARATION DISTANCES Size in gallons -Pump on" level at* 'Datum "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Sepuc/holding lank on lot 126J2) : On adjacent lots 110+ Absorption field on lot 138' : On adjacent lots 110+ Public sewer main N/A Public sewer manhole/deanout N/A Sewer /septic service line N/A Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 14'0 Property line 1711Z Absorption field 4 Water maidservice line N/A Surface water/drainage None Wells on adjacent lots 110+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 13' Water main/service line N/A Surface water None® Driveway, parkingivehicle storage area 30'+ Curtain drainNone© Wells on adjacent lots 110+ Propertyline F. ENGINEER'S CERTIFICATION �� 4 / cent tha t leterained thru field i ctions and review ofM 7 itico a nos are in conjo tance?vith ).4 /f IA Ruitjeline in /ffp on this date. { (f�%=3 i .• Signature.. Engineer's Name Date -71:J1 y HAA Fee $ 7� Waiver Fee S Date of Payment !/' 3 - V S Date of Payment Receipt Number -3`/ZL (s/ %4S Receipt Number Rev. 9/95 OSS: haa.wk.doc _ n n Alunicipality of f; ? Department of Health and Human Services 825 "L" Street Rick 6(vsrrom. P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor November 22, 1995 Dee High, P.E. DHI Consulting Engineers 800 East Dimond Boulevard Suite 3-545 Anchorage, Alaska 99515 Subject: Waiver Request for lot 4 Block 5 Trails End Subdivision Waiver Request #WR95006-9, PID #015-192-27, RA950497 Dear Mr. High: IoRc6vue-kJ Lrrl Your request for a waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is a lot line waiver of 7 feet to the north property line and 6 feet from the south and east property line(s). This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. S' cerely ames Williams ivil Engineer On-site Services JW/ljm MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR#;-`,Og4,Mn?, PID# 015-192-27 HA# HA950497 Permit # Date Received: NOvember 22, 1995 Legal Description: Lot 4 Block 5 Trails End Subdivision Engineer: Dee High, P.E., DHI Consulting Engineers 800 East Dimond Suite 3-545, ANchorage, Alaska 99515 Applicant: Michael Lindeman Waiver Requested: Lot line waiver of of 7 feet from the north property line; 6 feet from the south property line; 6 feet from the east property line. Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for bove: T�jt,{ it '!� �Cdyz Fio7 ui�G Ac &;,0"'y O/n) krrle ,o YK A .ararriv Date: By: Ntlllv, f (,p,tfvti Natne of Re ewer Rec #: #01500/4180 Amount: $115.00 Date Paid: 11-22-95 D H I CONSULTING ENGINEERS *Civil Engineering •Surveying *Planning November 22, 1995 W.O.: 95241 Mr. Jim Williams Municipality of Anchorage M < Department of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 m Q RE: Lot 4 Block 5 Trails End Subdivision/Lot Line Waiver Dear Jim: We are request a waiver to the a lot line separation for the above referenced property. The existing system consists of a thousand gallon, two compartment steel septic tank with a deep trench. The trench is about 109 feet. In 1982, the on-site Inspection report (see enclosed) indicated that the system was installed seven feet from the north property line and six feet from the south property line and six feet from the east property line. It appears that it is located on the only reasonably level portion of the lot. The location of the house, soil condition and the slope of the lot prevented the construction of a shorter or duel trenches. The only solution at the time appears to have been to encroach on the separation distances to the various lot lines. The neighboring wells, homes, and areas for replacement septic systems are not adversely Impacted by this encroachment. We appreciate your review and approval of our requested waiver. If you have any questions feel free to give me a call. e truly yours, DHI nsultingE Dee 'gh, P.E!g Principal / 241 dw21 n.ltr 800 Fast Dimond Blvd. Suite 3-545 Anchorage, Ak. 99515 Ph (907) 344-1385 Fax (907) 344-1383 .0 M1 t f .. �( + J .. 11 r 1 . '� Jt a ,♦:: 1 f ;: .: w,.t^! 1 L`+ ,j S}Y ♦1 ",j � 4 7f.e r' ,m. V , MU NICIPALITY.OFANCHORAGE: DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION !+ ` �i ,• "' ° s DIVISION OF ENVIRONMENTAL HEALTH U1 _ • "{ 1 i' , i'„rP>, 'v ” +... t.. .r .y..aa r r � ,.Y,.!'r'n i io t it ,'1 , ' ' '' CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY' a ( < OF ON SITE SEWER AND WATER, FACILITY;.',;,' ," • ". 264-4720 a Application Date N d'v 1» '.GENERAL INFORMATION Legal Description (include lot block subdwison`section township range) }` r tsi .,r t •S Cr , -, °. Location (addressor`dlreC11Cn5)rT ' s k s r' _,` •' i 1 ,{ , J Z ' (b) Applicant Name K, 1,0� 4-k" Telephone. Home ��6 - p2J Business 6'6 3- i Applicant Address ' 7ubd/LCENT —p L �ITl3 2 o (c) Applicant is (check one) Lending Institution ❑ , Owner/b+el�r Buyer ❑ , Other ❑ ` (explain), 1 32 (d) ° Lending lnstitutio l d n'�117ov�ona'LK�rf/wY Telephone Address 9 •d• - e 4 950 ;',(e) Real Estate Company and Agent Address Telephone (f) I Mail the HAA to the following address':'! , }'. f , .. A: 2. OF RESIDENCE TYPE k , I i' � ,'. A � Single -Family ;Mull! Family ❑ Other , s 5' a ' : r Number of Bedrooms 3. ,WATER SUPPLY' ) Individual Well❑ [3Community Public Note: If communitywell system musthave written confirmation from the State Department of Environmental Conservation �! attesting to the legality and status , p t > 4. SEWAGE DISPOSAL r 4 Onsit Yl , Public ❑ Community ❑ Holdir ❑ : ;Tank cc Note: )/f mmunity well system, must have written confirmation from the State Department Environmental of Conservation attesting to the legality and status.' \ Page 1 of 2 t f ' ,` , rsoasni+eat �' j 1 n 5 .i ENGINEERING FIRM PROVIDIi.INSPECTIONS, TESTS FILE SEARCH, D• .A; AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, Iverify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, f unctional and adequate for the number of bedrooms and type of structure indicated herein. l further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or ( wastewater disposal system is In compliance with all Municipal and State codes, ordinances, and regulations In effect on the date of this Inspection. Name of Firm r Telephone 91.6.. Address f Date NX Ar 11 ! 49 y�P•' • 'f i+ s �•A% o. 2225-E i Engineer's Seal 11�AJUNE 25. 1971 F . GSM r 1 �L, OIVAL F a„ t .. 6. DHEP APPROVAL Approved for Ttirec 3 bedrooms by Date Approved X Disapproved Conditional Terms of Conditional Approval i CAUTION The Muncipality of AnchorageDepartment of Health anAnvironmental Protection (DHEP) Issues Health Authority ! Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered In the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending Institutions In order to satisfy certain federal and state requirements. Employees of DHEP 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 engineels"work 'r. .t.° Page2of 2`, ,.h 1 + i • t 1 °r, i r r i . w 1 ♦nih re 1 1{, r , .r r `yl 6..,. �. ?71-025(11/84)!..1 T d .+?r. X- L2,• ' , . n��:�f r5 '1 - �. F ,1' 1. r. i'�'�, 1 ra A. WELL DATA r'1 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: 4e 11 T41!ic F w —1130/ mase Sia 2T3W Well Classification R If A, B, C, D.E.C. Approved (Y/N) Well Log Present ,(Y/N) � Date Completed ���� Yield �� iam Total Depth Cased to � Depth of Grouting Static Water Level ire Pump Set Atajflkl' Casing Height Above Ground Sanitary Seal on Casing (Y/N) % Al Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: ,/ To Septic/Holding Tank on Lot le ; On Adjoining Lots z6n i To Nearest Edge of Absorption Field on Lot 36 ; On Adjoining Lots To Nearest Public Sewer Line �� To Nearest Public Sewer Cleanout/Manhole —!(/ To Nearest Sewer Service Line on Lot Water Sample Collected by siv¢1/S _ ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed/ Size 291 No. of Compartments 2 Standpipes (Y/N) [— Air -tight Caps (Y/N) Y Foundation Cleanout jY/N) Depression over Tank (Y/N) iN Date Last Pumped Pumping/Maintenance Contract on File (Y /N) ; for Holding Tank High -Water Alarm (Y/N)_ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well To Property Line To Water Main/Service Line Course Comments Page 1 of 2 72-026(11;84) To Building Foundation To Disposal Field r!� To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata XI Type of System Design �/�EdLf9 Date InstalledA 137_ Length of Field Z Width of Field �;?& Depth of Fie,=7/ Square Feet of Absorption Area 142R0G— Depression over Field (Y/N) Results of Last Adequacy Test Gravel Bed Thickness T — Standpipes Present(Y/N) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well To Property Line To Building Foundation 4 To Existing, or Abandoned System on Lot A11A ; On Adjoining Lots 7?(I To Water Main/Service Line _>3 a To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course 4/04lg To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date InstalledIr9tl1E Dimensions Size in Gallons "Pump On" Level at — High Water Alarm Level at Tested for Electrical Codes (Y/N) _ Comments Manhole/Access (Y/N) "Pump Off" Level at •• Check Permitted Bedroom Rating Against HAA Request •• Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA IcertifythatIhave checked,verified,91conformed to and HAA guidelines in effect on the date of this inspection. Signed .� !X Date _ L Company Receipt No. 3G a 311 Date of Payment -I 1'�b Amount: $ G� Page 2 of 2 72026 (11,64) MOA No. ; j OF ntgs�,�t s�r?: 0 * • 49TH00-_ • '9 * Engineer's Seal J.•-taY7•.•..' .1_• , 2225-C 25, 1911 ' CONSULTING ENGINEER �����'-I�D ���� �20A ANCHORAGE, ALA; TELEPHONE: 1907 S E P T I C S Y S T E M A D E Q U A C Y T E S T LEGAL: LOT 4, BLOCK 5, TRAILS END LOCATION: 11301 DOGGIE OWNER: MICHAEL LINDEMAN RESIDENCE: SINGLE FAMILY, THREE BEDROOMS SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: TANK: GREER STEEL, TWO COMP. 1000 GAL. ABSORPTION SYSTEM: TRENCH ABSORPTION AREA: 1090 SQ. FT. SOIL RATING: 300 INSTALLATION DATE: MAY 1982 DATE OF PUMPING: JULY 3, 1986 DATE OF TEST: MAY 14, 1985 DATE OF INSPECTION: JULY 2, 1986 SYSTEM WAS INSPECTED AND MEASURED. TANK WAS FOUND WITH 2 FEET OF COVER AND A LIQUID DEPTH OF 46.5 INCHES. TOTAL DEPTH OF TRENCH WAS FOUND TO BE 7.75 FEET, LIQUID DEPTH WAS 29 INCHES. 320 GALLONS OF WATER WAS ADDED TO THE TRENCH WHILE THE WATER LEVELS IN THE TANK AND SUMPS WERE MONITORED. NO INCREASE IN TANK DEPTH WAS NOTICED. TRENCH LEVEL ROSE 4.5 INCHES. SINCE LAST ADEQUACY TEST WAS PERFORMED IN MAY 1985 NO INFILTRATION MONITORING WERE PERFORMED. TEST RESULT: THIS SYSTEM MEETS THE CODE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The operational life of all septic systems depends on the local soil conditions, 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 this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requi- rements of the Municipality and State. t OF A ".It v� 49TH 3o . 2225-E JUN: 25. 1971 v 6 •�ONSOULTING ENGINEER - -- fl 7�0 20A ANCHORAGE. ALASKA 99501 TELEPHONE: 19071279-3916 .R E S I D E N T I A L W E L L I N S P E C T I O N LEGAL: LOT 4, BLOCK 5, TRAILS END LOCATION: 11301 DOGGIE OWNER: MICHEAL LINDEMAN TYPE OF WELL: SINGLE FAMILY WELL LOG AVAILABLE: YES INSTALLATION REQUIREMENTS MET: YES WELL YIELD FROM WELL LOG: PUMP YIELD: DATE OF I14SPECTION: 2-3 GALLONS PER MINUTE 6.5 GALLONS PER MINUTE JULY 2, 1986 TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 3 GALLONS PER MINUTE WHILE THE DRAWDOWN WAS MONITORED WITH AN ACOUSTIC PROBE. THE WELL WAS PUMPED TILL THE DRAWDOWN STABILIZED. STATIC WATER LEVEL WAS FOUND AT 42 FEET BELOW TOP OF CASING. AT A PUMPING RATE OF 3 GPM THE WATER LEVEL FLUCTUATED BETWEEN 57 FEET AND 52 FEET. WELL RECOVERD FROM 55 FEET TO 48 FEET IN 7 MINUTES AFTER THE PUMP STOPPED. TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA ON JULY 4 , 1986. TEST WAS NEGATIVE. TEST RESULT: THIS WELL MEETS THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours.This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well. CSF n['4 4grH j 2225-E �a _ 1 'N: 25,1971 .. ' r'•t f_ MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date W04 �yR/9�Jr V (a) Legal Description (include lot, block, subdivision, section, township, range) —AO'7 5; Xe5 i A24m s A�-/Vo SEC 2 Tl2N, 23 Location (address or directions) //So/ pe)aG I t - (b) Applicants Name tY; l{e 4;Ha%eft, 44,,_ Telephone - Home Business Applicants Address //$0/ Do66/E (c) Applicant is (check one) Lending Institution Buyer j XT ; Other E::l (explain); (d) Lending Institution = ; Owner/builder = ; Address N. �, , /3, C A er.4'L (e) Real Estate Co. b Agent NO N L ', � Address Telephone (f) Mail the HAA to the following address: ' 2. Type of Residence Single -Family r5Z� Multi -Family Number of Bedrooms 3 3. Water Supply Individual Well r_11_Z1 Community M Other (describe) Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite Public [—_I Community M Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 21 5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information 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 shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Telephone 971-111k, Address o20-5 Lke- /J "V Date %'�eu4 � � /Qd � „�� �r ^. (ENGINEER SEAL) . .. ..•.. G•. ; 6. DHEP Approval l Approved forbedrooms Approved Disapproved Terms of Conditional Approval I:o**2225-E JUNE 2S, 1971 : ;Vo CAUTION Conditional - Ifd' THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIROM ENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS- EMPLOYEES OF DUEP 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 21 7-19-84 A. WELL DATA f� MUNICIPALITY OF ANCHORAG: DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 1 Description: I,;Af 15 1985, RECEIVED Well Classification i"Z �(s��' If A, B, or C, D.E.C. Approved(Y/N) N/ Well Log Present (YM) Date Completed 4619/8,2 Yield2 * Total Depth 4v Cased to 'to Depth of Grouting ISI oN E Static Water Level Pump Set At Ro+4o w Casing Height Above Ground P -q , Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot 1 2(0 ; On Adjoining Lots + To Nearest Edge of Absorption Field on Lct 130 + ; On Adjoining Lots I n a To Nearest Public Sewer Line _LV o plc To Nearest Public Sewer Cleancut/Manhole_ N O UE To Nearest Sewer Service Line Lot 100 Water Sample Collected By *T'. r. Date 51(31145 t Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed .'t 28 6 2 Size I Oo0 No. of Crnpartments 7— Standpipes Standpipes (Y/N) >� Air -tight Caps (Y/N) i Foundation Clean out (Y/N) Y Depression over Tank (Y/N) N Date Last Pumped Pumping/Maintenance Contract on File (Y/N) VIA for NIA Holding Tank High -Water Alarm (Y/N) fVIA Temporary Holding Tank Permit (YM) WIA Separation Distances from Septic/Holding Tank: To Water -Supply Well I To Building Foundation / To Property Line [ To Disposal Field & To Water Main/Service Line 30 'f' To Stream, Poral, Lake, or Major Drainage Course No NE Comments Receipt # $a Date Paid: Amount: �- [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata .300 Type of System Design TiL� C,14 Date Installed Length of Field 101 Width of Field 3o uE Depth of Field —7 Gravel Bed Thickness 5 JI Square Feet of Absorption Area / 0 10 Standpipes Present (Y/N) y Depression over Field (Y/N) f4 Dateof Last Adequacy Test S1iy/lyi I-, Results of Last Adequacy 'Past rcys.42. W Separation Distance from Absorption Field: To Water -Supply Well 1 30-t To Property Line 10 To Building Foundation 15 To Existing or Abandoned System on Lot Noma On Adjoining Lots 3D 4 - To Water Main/Service Lire Sot To Cutbark(if present) Nokt= To Stream/Pord/Lake% Major Drainage Course K o N t To Driveway, Parking Area, or Vehicle Storage Area 4o 'f' Coin, nts D. LIFT STATION N o NE Date installed Dimensions Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(YM) Comments Manhole/Access (YM) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MDA ** Check Permitted Bedroom Rating Against ELM Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. OF A 4X1 Signed Date �`/� P•.• r 7 C mpary 1 MOA No. & j� i : -O 1 y dl KB1/d5/s j'•:•• '••"''? o. 2225-E '013- JUNE 25. 1971 :... . [Page 2 of 2] vv`a��_ 2-15-84 -'�O GGJ �P�G°swdG;1G`9D9 G°Po�o SUITE 203 ANCHORAGE. ALASKA 99501 CONSULTING ENGINEER TELEPHONE: (907) 278-3816 R E S I D E N T I A L W E L L I N S P E C T I O N LEGAL: LOCATION: OWNER: TYPE OF WELL: WELL LOG AVAILABLE: LOT 4, BLOCK 5, TRAILS END 11301 DOGGIE AVENUE MICHAEL LINDEMAN SINGLE FAMILY YES INSTALLATION REQUIREMENTS MET: YES WELL YIELD FROM WELL LOG: 2 GPM. PUMP YIELD: 6.5 GPM DATE OF INSPECTION: MAY 14, 1985 TEST PROCEDURE: WELL, WAS PUMPED FOR TWO HOURS AT A RATE OF THREE GALLONS PER MINUTE. AFTER TWO HOURS THE RATE WAS INCREASED TO 6.5 GPM. THIS RATE WAS MAINTAINED FOR 15 MINUTES. TEST FOR COLIFORMS: TEST WAS NEGATIVE TEST RESULT: 49TH 6.. • i n: o. 2225-E fr0^ JUNE 2S. 1911 ' . M• The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours.This well surpasses this requirement. The assessment of the condition of this well applies only to the con- ditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the condi- tions of the aquifer feeding the well. &P�JAWAI Q `' ©9 Poco S E P T I C LEGAL: LOCATION: OWNER: RESIDENCE: WATER SYSTEM: SEPTIC SYSTEM: DATE OF PUMPING: DATE OF TEST: l 203 ...t 6th AVE "C' SUITE 203 ANCHORAGE. ALASKA 99501 TELEPHONE: (907)279-3916 S Y S T E M A D E Q U A C Y T E S T LOT 4, BLOCK 5, TRAILS END 11301 DOGGIE AVENUE MICHAEL LINDEMAN SINGLE FAMILY, THREE BEDROOMS PRIVATE WELL FROM MUNICIPAL RECORDS: TANK: GREER TANK, ABSORPTION SYSTEM: ABSORPTION AREA: SOIL RATING: INSTALLATION DATE: MAY 14, 1985 MAY 14, 1985 1000 GAL, TWO COMP. TRENCH 1090 300 MAY 1982 TEST PROCEDURE: SYSTEM WAS INSPECTED ON MAY 13, 1985. 52 INCHES OF WATER WAS FOUND IN THE TRENCH. WATER DEPTH IN TANK WAS 48 INCHES. ON MAY 14 WATER WAS ADDED TO THE TRENCH AT A RATE OF 3 GALLONS PER MINUTE. THE LIQUID DEPTH IN BOTH TRENCH AND TANK WAS MONITORED. A TOTAL OF 450 GALLONS WAS ADDED. THE LIQUID LEVEL IN THE TANK REMAINED 48 INCHES, THE LEVEL IN THE TRENCH ROSE TO 44 INCHES. WHEN CHECKED 4 HOURS LATER, THE LEVEL IN THE TRENCH WAS BACK TO 39 INCHES. TEST RESULT: �'! t:� .!1 • ..1� * • aI;TH �.. .... 2225-E: �• /.'• J NE 25, 1971 _•:4 THIS SYSTEM MEETS THE MUNICIPAL REQUIREMENTS The operational life of all septic systems depends on the local soil conditions, groundwa- ter 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 this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requirements of the Municipality and State. Time APPLI(V"'FILLS OUT UPPER HAU-" .4'LY Property Owner 7PhoneMailing Address ., / ZIp Code Buyer Address - Zip Code Lending Institution rj� �� Date Phone r =� rl Address ,l i Zip Code _- V Realty CO. 8 Agenttx �Cr• - , /y / L� S o c( n M i �r r, /�r — �. ( ,'. S, Phone Address _ ,. J f / Zip Code Legal Description y y ck S Zvo /S C a S.. Street Location Type of Residence Single Family Multiple Family No. of Bedrooms O Other 3 Water Supply enc Individual .4C "'eV 8av a -o ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. U Community ` ` For wells drilled prior to that date, give well depth (attach log if available). O Public Utility CQh n�'�QC'ICKI. tightened so that it is Sewer Disposal DATE MaMaj 1983 be reinspected. Cj. Individual O �_a�-ga Year Individual Installed: ry 17 [j Public Utility daU�-�(, When Connected to Public Utility: O Holding Tank Well To Absorption Area Well Log Received NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time '( Lam G+ Date Date Date Date Inspector Inspector InspectorInspecto PY� a Field Notes: MUNICIPALITYANCHORAGE OHFJ OF TH ENVIROWA:NTAL PROTECTION MAY 21933 RECEIVED 3 (3) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED if monies are escrowed to have the well seal ( 3 ) CONDITIONAL APPROVAL' tightened so that it is water tight. Needs to DATE MaMaj 1983 be reinspected. BY: Solis Rating Date Sewer Installed Well To Absorption Area Well Log Received S 8 Z Well to Tank Septic Tank Size - (00 e) rzL ra,sn