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LENNIE HEIGHTS LT 5
Lennie Heights Lot 5 #051-063-57 Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191238 PID Number: 051-063-57 Dwelling: ■❑ Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑■ Upgrade Name: Breckenridge Property Fund 2016 LLC ABSORPTION FIELD ❑m Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 2015 Manhattan Beach Blvd #100 Redondo Bea( ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade (907) 290-6044 3 0.6 GPD/SF 11.6 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 4.6 Ft. Gravel depth beneath pipe 7.0 Ft. Subdivision Block Lot Lennie Heights 5 Fill added above original grade 1.5 / 1.1 Ft. Gravel length 2 @ 27 Ft. Township Range Section Gravel width 2.0 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 756 Ftz 2 >14 Ft. Well >100' >100' N/A N/A >25' TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Infiltrator/Ferguson Capacity 1060 Gal. Surface Water >100' >100' N/A N/A Material - Plastic Number of compartments 2 Lot Line >5' >10' N/A N/ANA Foundation >10' >10' N/A N/A LIFT STATION Manufacturer Capacity Gal. Curtain Drain None Noted 1 RemarksOld existing septic tank filled and Pump on level at in. Pump off level at in. High water alarm at in. abandoned in place per MOA code, Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank D3034 Tank to drainfield D3034 Installer Northern Excavation Drainfield D3034 CO/MT D3034 Inspector L. Tidwell, J. Williams BENCH MARK (Assumed elevation) 100 ft Inspecttiones 15� 7/17/19 7/18/19 Location and description 2�d 3rd 8/3/19 4th Bottom of siding COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date ®�p� •'0"1�-q4 g, c9th i s . %• MICHAEL •E�•ANDERSON •��Mr No. CE -4381 ,•' �� ' • 4W �,�•. ...• Approved �iC ,0 Date $ 9®i PROF`-5\&�®®® / 0 r I& link Inspection Report-9-1-12.doc // // // // // x x x x x x x x x x x 385 390 EXISTING WELL 100500 FEET 1"=50' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE DV - DIVERTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND CO1 PERMIT # OSP191238 PID # 051-063-57 LENNIE HEIGHTS, LOT 5 A B FCO 32.2 MH 31.2 SV 34.5 A B 2CO 37.3 DV 38.5 CO1 49.2 MT1 47.2 12.5 42.8 48.3 52.4 53.6 60.0 60.4 8/6/19 L ENN I E C IRC L E 3-B D R M H O M E CHAIN-LINK FENCE10' UTILITY EASEMENTWOODEN FENCE 10' UTILITY EASEMENT CO2 MT1 CO5 MT2CO4 2CO DV SV MH FCO TH1 2-27' LONG x 3' WIDE x 7' EFFECTIVE DEPTH ABSORPTION TRENCHES. 14' FROM SIDEWALL TO SIDEWALL AND 14' FROM EXISTING TRENCH. FS EXISTING WELLEXISTING WELL EXISTING WELL EXISTING WELL NEW 1,060 GALLON SEPTIC TANK w/20" MANWAY PLAN AS-BUILT CO2 45.3 CO4 28.7 MT2 25.6 CO5 25.0 69.6 55.6 68.3 67.9 CO3 CO3 41.372.5 PROFILE AS-BUILT (NO SCALE) 91.9 88.1 92.9 96.9FCOMH SV2CO1060 GAL SEPTIC TANK 91.7 PERMIT # OSP191238 PID # 051-063-57 LENNIE HEIGHTS LOT 5 8/6/19 DEPTH (feet) 1 2 3 4 5 6 7 10 11 12 13 14 15 16 17 18 1 k�� SOILS LOG AND PERCOLATION TEST E N G LEGAL DESCRIPTION: LENNIE HEIGHTS, LOT 5 PERFORMED FOR: RUSSELL TEAGUE DATE: 7/17/19 PROJECT No.: PARCEL ID#: 051-063-57 TECHNICIAN: J. WILLIAMS TEST HOLE 1 1' OB SANDY SILTY GRAVEL GM SANDY SILTY GRAVEL (LESS SILT MORE SAND w/DEPTH) GM SLOPE WAS GROUND WATER ENCOUNTERED? N O IF YES @ WHAT DEPTH? - L DEPTH OF WATER AFTER MONITORING: NONE 0 DATE OF MONITORING: 8/3/19 P SI I L FLAN SEE SITE PLAN DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) DEPTH TO WATER (INCHES) NET DROP (INCHES) 5/23 TEST HOLE PRESOAKED PRIOR TO TESTING: 1 5:10 12 2 5:40 30 13-11/16 1-11/16 3 5:42 12 4 6:12 30 13-12/16 1-12/16 5 6:15 12 6 6:45 30 13-12/16 1-12/16 PERCOLATION RATE: 17.2 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN: 5 FT. and 6 FT. COMMENTS: Test hole 1 deepened to 20 feet with new 7 day ground water monitoring. 10' UTILITY EASEMENT �\ Lot 4 \ WOODEN FENCE 700, Lot / A ROrfc WOODEN (FENCE I 8.3'x7.71 SHED —� 'p O 0 ao Lot 6 \ 3• Lot 5 22,660 S.F. U! �WLL .. � j ' 4.( 3 RFS��FN r W I� ------ WOODEN FENCE (MANHOLE SEPTIC— Lot 5PIPES m R=50.00' 5.1'x11.9' DECK CHAIN—LINK FENCE Unsubdivided / I L10' UTILITY(- - — — — — Y( \\ \ EASEMENT I j \ I / Lot tI II Lot 2 J I Lot 4 I 1 I WELL \ / I / 100, PRO CTIVF PLOT PLAN _ AS BUILT X SCALE —!L= 40' GRID NW 1460 Project No. 19-169/A3 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone 000pp00O (907) 522-4625 Fax Professional Land Surveyors kenolangsurvey.com F q o �, ,. .. q jonathanOlangsurvey.com oOP •.S �O 1 hereby certify that I have surveyed the following described property: LOT 5, LENNIE HEIGHTS SUBDIVISION (PLAT No. 70-70) Anchorage Recording District, Alaska, and that the Improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on sold property except as Indicated hereon. Dated this the Day of puc =i , y.olcl , at Anchorage, Alaska It Is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. IT - *.:...49 .—e. A......... AECC963 1 / I L10' UTILITY(- - — — — — Y( \\ \ EASEMENT I j \ I / Lot tI II Lot 2 J I Lot 4 I 1 I WELL \ / I / 100, PRO CTIVF PLOT PLAN _ AS BUILT X SCALE —!L= 40' GRID NW 1460 Project No. 19-169/A3 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone 000pp00O (907) 522-4625 Fax Professional Land Surveyors kenolangsurvey.com F q o �, ,. .. q jonathanOlangsurvey.com oOP •.S �O 1 hereby certify that I have surveyed the following described property: LOT 5, LENNIE HEIGHTS SUBDIVISION (PLAT No. 70-70) Anchorage Recording District, Alaska, and that the Improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on sold property except as Indicated hereon. Dated this the Day of puc =i , y.olcl , at Anchorage, Alaska It Is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. IT - *.:...49 .—e. A......... AECC963 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: OSP191238 Work Type: Septic Upgrade Tax Code Number: 05106357000 Site Legal Address: LENNIE HEIGHTS LT 5 G:1460 Site Mailing Address: 23818 LENNIE CIR, Chugiak Owner: BRECKENRIDGE PROPERTY FUND Design Engineer: FORGE ENGINEERING This permit is for the construction of: 10 Disposal Field © Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: �t„enc Deparnncnt 6/24/2019 6/23/2020 22660 ❑ 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 3 Special Provisions: Test hole shall be deepened to 16 ft prior to construction of absorption field to confirm minimum 6 ft separation to any impermeable layers. Revised soils log shall be submitted with inspection report. Received By: L Date: / 11 Issued By: Date: i 2 y KAI MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-063-57 Property owner(s) Breckenridge Property Fund 2016 LLc Day phone Mailing address 2015 Manhattan Beach Blvd. #100 Redondo Beach, CA 90278 Site address 23818 Lennie Circle Chugiak, AK Legal description (Sub'd., Block & Lot) Lennie Heights, Lot 5 Legal description (Township, Range & Section) Lot Size 22,660 Sq. Ft. Number of Bedrooms Three (3) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade ❑X Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ 5 Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 5/95 Waiver Fees: Date of Payment: CDL i�1t9 Date of Payment: Receipt Number: Receipt Number: Permit No. c51� �g►� Waiver No. Permit PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) June 17, 2019 MOA Development Services Department of On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Lennie Heights, Lot 5 – 23818 Lennie Circle Septic System Design Dear On-Site Services Engineer: The septic system on the subject lot has failed and must be replaced. We are submitting this permit application for the construction of a new septic tank and absorption trench. The existing septic tank will be decommissioned in accordance with Municipal Code and the absorption trench will be connected to the new system for possible future use. The attached site plan identifies the location of the home and the existing well and septic system along with the proposed location for the new system. No conflicts exist between this proposed system and any other well or septic system on this lot or adjacent lots. The ground surface on the lot slopes to the northwest at shallow grades in the area of the proposed trench. There are no slopes greater than 25% within 50 feet down slope of the trench. Ground surface contours are shown on the site plan indicating the grade and direction of flow. Storm water drainage will not impact this septic system. The new trench will be constructed parallel to the slope as much as possible. The new system will be a minimum of 100’ from all wells and surface water, 10’ from any water service and more than 5’ away from the septic tank. Please refer to the attached test hole log and plan and profile sheets for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Michael E. Anderson, PE 6/17/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191238, Rebecca Carroll, 06/24/19 // // // // // x x x x x x x x x x x 38 5 3 90 EXISTING WELL 10050 0 FEET 1"=50' NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND CO LENNIE HEIGHTS, LOT 5 6/21/19 L E N N I E CIRC L E 3-BDRM HOME CHAIN-LINK FENCE10' UTILITY EASEMENTWOODEN FENCE 10' UTILITY EASEMENT COMT CO MT CO 2COFD FS SV MH FCO TH1 2-27' LONG x 3' WIDE x 7' EFFECTIVE DEPTH ABSORPTION TRENCHES. 14' FROM SIDEWALL TO SIDEWALL AND 14' FROM EXISTING TRENCH. DECOMMISSION EXISTING SEPTIC TANK PER MOA CODE. EXISTING ABSORPTION TRENCH. CONNECT w/FLOW DIVERTER VALVE FOR FUTURE USE. EXISTING WELLEXISTING WELL EXISTING WELL EXISTING WELL 1,000 GALLON SEPTIC TANK w/20" MANWAY NOTE: ALL 100' PROTECTIVE RADII FROM SURROUNDING WELLS TO BE STAKED PRIOR TO CONSTRUCTION. TH1 TO BE DEEPENED TO 16' PRIOR TO CONSTRUCTION TO VERIFY NO IMPERMEABLE STRATA WITHIN 6' OF BOTTOM OF PROPOSED ABSORPTION TRENCHES. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191238, Rebecca Carroll, 06/24/19 LENNIE HEIGHTS, LOT 5 DESIGN FACTORS: SYSTEM REQUIREMENTS: 450 GPD PEAK FLOW PERK RATE: 16-30 MIN/IN APPLICATION RATE: .6 GPD/SF 7' EFFECTIVE DEPTH DEEP TRENCH SYSTEM 1,000-GALLON SEPTIC TANK TYPICAL TRENCH SECTION (NO SCALE) 4" PERFORATED PVC (HOLES DOWN) DRAINFIELD ROCK 5' 6" 6" 2'6" 7' NOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY BOTTOM OF TRENCH: 10' BELOW GRADE FLOW LINE ELEVATION: 3' BELOW GRADE TOP OF TRENCH: 0.5' ABOVE GRADE 450 GPD / .6 GPD/SF /14 SF/LF = 53.6 LF TRENCH REQUIRED (54 LF SPECIFIED) 6/21/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191238, Rebecca Carroll, 06/24/19 LEGAL DESCRIPTION: PERFORMED FOR: DATE: PARCEL ID#: SOILS LOG AND PERCOLATION TEST TECHNICIAN: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 DEPTH (feet) PROJECT No.: TEST HOLE 1 SLOPE SLOPE SITE PLAN See Site Plan DATE READING GROSS TIME (minutes) NET TIME (minutes) DEPTH to WATER NET DROP TEST HOLE PRESOAKED PRIOR TO TESTING: PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH) TEST RUN BETWEEN: FT. and FT. COMMENTS: (inches)(inches) LENNIE HEIGHTS, LOT 5 5/20/19 J. Millette DATE OF MONITORING: WAS GROUND WATER ENCOUNTERED? DEPTH OF WATER AFTER MONITORING: IF YES @ WHAT DEPTH? NO - NONE 17.2 6 5 6 051-063-57 RUSSELL TEAGUE 5:10 5/23 1 2 3 4 5 6 30 30 30 12 13-11/16 1-11/16 12 13-12/16 1-12/16 12 13-12/16 1-12/16 5:40 5:42 6:12 6:15 6:45 1' OB (LESS SILT MORE SAND w/DEPTH) 5/30/19 Professional Engineers Stamp: 6/17/19 GM SANDY SILTY GRAVEL GM SANDY SILTY GRAVEL Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191238, Rebecca Carroll, 06/24/19 �10' UTILITY EASEMENT �\ Lot 4 \ WOODEN FENCES I \ /�I I - • -- -- --• \III"` Lot WOODEN IFENCEJ 8.3'x7.71 SHED— Lot 6 \ Lot 5 22,660 S.F. 4 �I — — — — WOODEN FENCE 14 J SEPTIC o PIPES u Lot 5 I Lot 4 I I S 89'55'00'V 99 10UTILITY EASEM Lot 1 L=22.08' R=50.00 5.1'x11.9' DECK / v / Unsubdivided CHAIN—LINK FENCE 1 1 Lot 2 1 1 1 —LINK FENCE PLOT PLAN AS BUILT X SCALE --I!= 40' GRID NW 1460 Project No. 19-169/A1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone (907) 522-4625 Fax 000O0p40 —� OF q X04 Professional Land Surveyors kenOlangsurvey.com : �.. •. q 4 jonothanOlangsurvey.com 00�,.• S �4 I herebycertifythat I have surveyed the followingdescribedproperty: LOT 5, LENNIE HEIGHTS SUBDIVISION (PLAT No. 7-70) .. 4..TH Anchorage Recording District, Alaska, and that the Improvements situated thereon are"'""""" within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed Q . . . . . a KENNETH G. LANG Q• premises and that there are no roadways, transmission lines or other visible DO me easements on said properly except as Indicated hereon. Dated this the 25� Da of h( rti L °I 1p rs 5202.• gJ Day at Anchorage, Alaska 44kl�,RaFessIoNAL oc It Is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plot. 'UNICIPALITY OF ANCHORAGE Heal ., and Environmental Protec. _)n Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEPA NAME.-"'�!�`--SII-__-.__ MAILING ADDRESSPHONE �9f1Y2 L LOCATION (J_O �_ LEGAL DESCRIPTION (__-__ SEPTIC TAN -K: DISTANCE NUMBER OF FROM WLLL_ -_ MANUFACIURER_/A __MATERIAL_ COMPARTMENTS_ INSIDE LENGTI-i_ INSIDE WIDTFI__-_-__ LIQUID DEPTH -__ LIQUID CAPACITY ld-v GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELI_�i�"yi,-_FOUNDATION # of Lines ABSORPTION AREA - 7:)-f DISTANCE BETWEEN LINES DEPTH: TOP OF TILL TO FINISII GRADE SEEPAGE PIT: TOTAL LENGTH NEAREST LOT LINE-_ -_OF LINE -TRENCH WIDTH 0 -IN. TOTAL_ EFFECTIVE SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER _ MATERIAL BENEATH TILE t' DIAMETER OR WIDTH_., LENGVH_, DEPTH I PM. ABOVE TILE IN, Log Crib _Rings_ Crib Size: DIAMETER _____DEPTH___ DISTANCE FROM: WELL TOTAL EFFECTIVE BUILDING FOUNDA-PION NEAREST LOT LINE---- . ABSORPTION AREA (WALL AREA) Well Class: Depth: Well Distance To: Lot Line _ Bldg: Sewer Line: Pipe Materials: # of Bedrooms: Installer: Remarks: FT, DATEL(J:43--D APPROVED `��' -- 4,4 1 1 , FT I I - - - - - l I i 1 I J -- f i-; Ii �I I i �1I1. I l i T -i- I X11 I -, I - -- I I DATEL(J:43--D APPROVED `��' -- 4,4 tIT by A & L DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 • TELEPHONE 694.2588 1 I � OWNER OF LAND /�N/ S (A) 4"1 DEPTH OF WELL 3 o o ADDRESS A o ,L R ] d / ijk 19 STATIC LEVEL OF WATER FT. LEGAL DESCRIPTION _41,,5h iV(E H E/C 1-1tT S ued DRAW DOWN FT. _ DATE - Started 10 7 Ended 1 77 GALS. PER HR O _ PERMIT NUMBER -% %qC� KIND OF CASING __ ` "�� KIND OF FORMATION: FromFt. to a Ft. bL)FQ 60 IE r/ From Ft. to—Ft.-- o Ft.FromeFt. From e Ft.to .Z_Ft._ _T7 �� rromFt. Froin-Ft. to_ Ft. From )a Ft. to 3�Fc. C4pV-' 6/�pLj,c� d QpU<.i06Fr lop Ft. to__Ft. FromFt. to6xFt. sfti tub 6,e,4j z_ Q aLYxj0 554rom Ft. to Ft. From to Ft. 04-1¢ T' 6Q/4 ✓C - 'I"/.70 '0'ERF'rom_ _Ft, Ft. to Ft Froml-Q_Ft. to Ft. ?o(.< So'_t /> From Ft. to__Ft, From b Ft. to Ft. 6E9/eo� K FR/4<T E 6a�3t 0 l From Ft, to _ Ft, From Ft. to Ft. K sr?[ //J Ft. to Ft. From L f'�_Ft.toQaY Ft /5 From rom Ft. to Ft. From Ft. to 30C, Ft. /3,�eD c S"a,(to From Ft. to_ Ft. From Ft. to Ft. From Ft. to—Ft. _ From Ft. to Ft. From Ft. to Ft. From—Ft. to Ft. From Ft. to—Ft. From Ft. to Ft. From Ft. to --Ft. From Ft. to Ft. From Ft. to Ft. From --Ft. to Ft. From_ Ft. to Ft. From Ft. to Ft. From Ft. to --Ft MISCL. INFORMATION: IJ �% 707/ge, C45inlC �Jrn 0 To Cit /�<r7c c"Q o�ct0 r �o,N % ° pr- CrgsisclG DR[LLER'S NAME ,___ 11111- 37 1=1 lot R .. IV: - V 0 C11 W gill 149 IC: 0-11 WD FG! oil C! ph�J, -0/o P,O/L DIPTIT? FIVENT OF EFQI .11-1 1114D &M I mopmurm. F, mcningy, acammus an r vas.. PC � f il,_ij Vi:::,: 11 __. IL...... low 141 R0 If F__': P. If" FE two it I IV -1 THE (Ilri TFI(i'. !,*%.1-.7:1:1 1_�;: lr:::y H.... RA L. IERM113 -11-11-11 :: « w: IC:!iii Fig Fill %,., L... If, H. , II CI) <: :I.,.,. Y IP,V <H., C_": I IC3 _,*E._,; Ifi-i LJ Iff: F;;? F.1h[At F".*: !�JJBJLD.,Y TC -1 A_1 - IF 1011.4. 111441VRJVI DISGANCE BE714EEN A WELL FIT) We O"FATIM SIVIMOV: DISFOSAL. WSPA IS; 1:EF::*1 FicaR A MINATIE NJELJ f(::: I-IFTA,'. WITI-11J.-I A1,11) FlLi:l F,.: 1T.:f FIROFIEF7:I'di."I"r=1L...1._FI, F1 K RRE Fit 01 IF -f" K X., 0,:1, 1 Fit F" . 0,- R 0 E± E GE01 ®CHNI CAL Ef LEVEL( 'MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG 688-2280 Soils Et Foundations Land Development Performed for: Name:Tel. No.`�L`"`y'\'� Mailing Address: Y12�X :1-7 _ tiLVC'VN< cl/yscl Legal Description: �.. QN av, 24 C-) Depth ifeetj Soil Characteristics 0 t 2 3 4 6 ° r 8 Z7 � 10�� • 1- �<c � � qac t o, � � �`� f_. Z. �7 � � .� V� i 'z.:5 i� °0 c.v� 11 •a� ,l C1 13 14 15 16 Ground Water Encountered: Yes- No If yes, what depth_._ Proposed Installation: Seepage Pit Drain Field-_ Comments : Performed 6y: Date �a � - 1 - 7 0// JWe- Municipality of Anchorage Department of Health and Human Service. 825 "L" Street xmyvocx P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 July 5, 1994 Robert Shafer, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 5 Lennie Heights Subdivision Waiver Request #WR940029, PID #051-063-•57 Dear Mr. Shafer: Your request for waiver(s) of the required 100 foot horizontal separation of a septic system to a private well has been approved. The approved separation distance(s) are a private well on property to the septic tank of 94 feet and a private well to the leachfield on Lot 5 Eklutna Heights of 97 feet. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincerely, Daniel% J. Roth Civil Engineer On-site Services LJM/#7 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR#I_gl ft1,j,j-a(NPID# #051-063-57 HA# Date Received: June 6, 1994 Permit # Legal Description: "Lot 5 Lennie Heights Subdivision Engineer: Robert Shafer, P.E., S & S_Engineering, 17034 Eagle River Loo Applicant: Paul Sulik Road, Suite 204, Eagle River, Alaska Waiver Requested: Private well on property to the 1,000 gallon septic tank; and, private well to leachfield on Lot 6 Eklutna Heights of 94 and 97 feet respectfully. 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 above: feE /477-1q rH&,Q Date Rec #: 25981/4722 By: z 'w d . Name of Reviewer Amount: $ 920.00 Date Paid: 6-6-94 IX (N191 v i? jf q c 5 r f0/? 1 DT L fNN/ hNE/GNTJ sLrQp/v/ s/mit/ - - - - -- IN19Iv,58 1{E(Pu6Sr A16fMVCR W/i'y40029' MINER REggESr F08 7-0cl Oov-[Or tvFL� ro r/4R ON-cor ircpr1c AA1,0 rHE *0?.. at?PTloiv F/eLO ON Lor 6 C-kGU;,.,vg Hp/Gtirs or '7419Ad9 97 F'lc�i- R�sPLGr/vr-L y, SEA/'!c pt?rg -- «a TNS SePTlc /Wso/?flr/on/ AIF -Lt /N leu SP/o.v 1S /tr®%/i �41L rYl°f R/jSUlpF'T/ON /r/!`Llaa TW 6 SND ($J OF TIPE.vCF/ EN CR URC/lF.f GA/ T/4r /i t^ ho� Loe rFn 0" LUT" 3' LFvvlc/IV 9 78 P �B/6fl% f. %�/3 TjPL�NCM d�•/9S CONST/Puf. f' pie ! viqre FArR. % M F hL 41%ORP7-/UA/ PlEL/J /Al GQ uE•STiO OS CUarTreu cTp /N S/L rY Gn�rvL ,�4/?T"E/?/FIL LulTll /� Pe/PC, Ii'!}T 4 z � OF %- CrINDc(C/vC TO rt?F/9,r/A/& s�PT/� rq.vk �FF(uEn�i /ti SHUr�T plsr.�aC rl-lr PtrRr-/v,,, OF r/4 F- IV-osoteorlonv T/?=/l C// / vCl7UR[K.a�G a„� /�1 W rzLL "N 4 t("r $-riU.v /r S4l6/-/7'<y V&L1 N 61V,"'tWeAlr /-A OM TAMP 114E s,F ioTlc J'/gNl( /N C7uf_ STION OA/ )`r"!,@ SK p Tl.7 CT L oT wl?J Cfovfr If rFp /Al ®Cr /977 86fORF ri-i E L, cj j- {,.I'}S (o.vST/PuC/J H 60KEP 1000 64LL a/v % CUMF&RTM.- NT fre.rSL r,4.,N/f. r/llS 7/9N/t pu�f' uG I'F(1S F_n!9 Lugt Can�rT,�kctEp w1TH /av�I?TJ 0 A 7-#F_ IAIIr- - a"rL,C7 f�tip CLF13,v Uvc Tf. 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BF6se- a,,L- rHx- a c/-rtoN ow rhE Srfirlc t. ,4Tp-R 46vsl- /,v 7'/4r c..FGL 14-r � /3a pe T- "" "oo v, Y�AA��9R 7 wfiTErr IS UivpER 5aMF P19Frj-, WE *Av,o r14A- Goa FIA, E p, z h�e o a 1./}Q 1p�por/rs /,vry/oi.rE r"Ar rHeRr /4RE A/O COLr,%Oem /ir9ercre,,q PRerFA1r q r " e Nrr/?�TE L 6v�� /S �. 5- )",qF , i,trl Al 7-R/�7F LEv,-L /J f) Frx/sTs /,- vl9Ri'raG LeVr=LS I&, 7"vCF_ tn. Fit, LS 77-tr2e-t-G/•(Gur rK/S �✓ LL L06S IrRom fU��U`LUYJ/N�j bj-e4jS /tib/C!q!`E Ti-eor j7d,E 5rig0-7 arc r�oA, �PP6rHW2r ra D9cg loos/sr�ti7 7--e�N®y GtrauT �,ue f le 619- . iron- f�o/N TS dv f `R"04 r"r psiorM of Pyo. wpiis, p // ' 'osoRpek // s 142 fi3O / 90 _ 4—:27 x =.22-A 7 So/l- Sof?orloN IVf?rER TflfitE ,1 NV1EA,r SSKPtE Cotis�a��rr�v,E a� ,' 'l-ZOv7- 1- SEr'fll?r;r/ f4 / - - = x.76+ 2. 6844,0 1-07,9L L-2Lf 4 G l? i4 -N T %2 �. q 2.6 2. 9 2.8 19.4 IVf?rER TflfitE ,1 NV1EA,r SSKPtE Cotis�a��rr�v,E a� ,' 'l-ZOv7- 1- SEr'fll?r;r/ f4 / - - = x.76+ 2. 6844,0 1-07,9L L-2Lf 4 G l? i4 -N T %2 �. q 2.6 2. 9 2.8 19.4 Kill ngr�� 0 June 4, 1994 ROBERT SHAFER, P.E. ROGER SHAFER. P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTHAUTHORITY MUNICIPALITY OF ANCHORAGE APPROVALS Municipality of Anchorage p y g ENVIRONMENTAL SERVICES DIVISION DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street 1, 0 6 1994 P.O. Box 1,96650 SEWER & WATER MAIN EXTENSIONS Anchorage, Alaska 99519-6650 RECEIVED SEWER WATER INSPECTION REFERENCE., Lennie Heights Subdivision, Lot 5 ENGINEERING STUDIES AND REPORTSPORTS We request a waiver for the horizontal separation distances between the private well located on the referenced property to the 1000 gallon septic tank on the referenced property and the leachfield located on the adjacent Lot 6, Eklutna WELL INSPECTION Heights Subdivision at 94 feet and 97 feet respectively. & FLOW TEST We believe the above stated waiver should be granted for the following reasons: 1. Water samples obtained and tested on May 22, 1994, did not show SITE PLANS any Coliform or Bacteria and Nitrate levels in the well meet Municipal requirements at 3.5 mg/L. ROAD DESIGN 2. As can be seen from the attached soils log: there exists a good silty sandy gravel, working as a filtration system, purifying the effluent, helping to prevent contamination of the aquifer. SOIL TEST 3. The well log indicates that there is confining clay from 60 feet to 153 feet and bedrock from 153 feet to 300 feet. The clay and bedrock will prevent a subsurface migration into the aquifer: PERCOLATION TEST 4. The existing septic tank and leachfield are located down hill from the well, which would prevent any overflowing of the systems to migrate in the direction of the well. STRUCTURAL& MECHANICAL INSPECTIONS 5. A stretch of heavy vegetation and rough ground will deter effluent from reaching the well in the event of surfacing on Lot 6, Eklutna Heights Subdivision, ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 N RTH EAGLE IVER LOOP SUITE 204 • EAGLE RIVER, ALASKA 99577 Page two Lennie Heights Subdivision, Lot 5 June 4, 1994 6. The foundation of the house is directly between the septic tank on the referenced property and the well. If you have any questions or require additional information, please contact us at 694-2979. A. Shafer, P.E. RAS/LSA/Isf l09 = 114 m \ \ \ Z)— (n Y U \ _ C/) \ L��li. Z n J W p a \ 3snoxLLJ \ z a w \ \ J nQCo a I \ z z o \ w < C ~ \ W oa [ \ N fi ti F 5 W \ c'j W \ a6 98� \\ O C1. \ V7 a W W W o E"ZC7 J a3o l09 = 114 m \ \ \ Z)— (n Y U \ _ C/) \ L��li. Z n J W p a \ 3snoxLLJ \ z a w \ \ J nQCo a I \ z z o \ w < C ~ \ W oa [ \ fi l09 = 114 Commercial Testing & Engineering Co AI Environmental Laboratory Services swa 191, LABORATORY ANALYSIS REPORT CT&E Ref # 94.2463-1 Client Sample ID LOT 5 LENNIE HTS. Matrix WATER Client Name S & S ENGINEERING WORK Order 78721 Ordered By R.J.S. ectNanre Printed Date 05/25/94 @ 14:17 Ins. Project# Collected Date 05/22/94 @14:00 hrs. PWSID UA Received Date 05/23/94 @ 11:45 lns. Sample Remarks: ROUTINE SAMPLECOLLEC"fED BY: RAY. Parameter Results -------- Nitrate -N ---- ----- ---- ------ ------3.5 QC Qual Units Technical Director STEPHEN C. EDE Released By: 4 ' . --------------------------------------- Allowable Ext. Anal Method Limits Date Date Init mg/L EPA 353.2/300.0 10 05/24/94 CMR ----------------____________________------------------ ______________ * See Special Instructions Above UA=Unavailable ** See Sample Remarks Above NA=Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT= Less Than D = Secondary dilution. GT = Greater Tlran 5633 B Street, Anchorage, AK 99518-1600 — Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA Certificate of On -Site Systems Approval Parcel I.D. 051-063-57 Expiration Date: IV ov I C) ),02 1. GENERAL INFORMATION Complete I I egal I description 'Lennie,Heights Sub L5 Location (site address) 23818 Lennie Cir. Chugiak, AK 99567 Current property owner(s) Caleb & Tania Doseck Day phone Mailing address Real estate agent 23818 Lennie Cir. Chugiak, AK 99567 2. TYPE OF DWELLING: FE] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Private Well limill Water Storage E] Community Well 0 Public Water System El Waiver request for: Day phone TYPE OF WASTEWATER DISPOSAL: Private Septic limil Holding Tank 1771 Community 1771 Public Sewer F-1 Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 145 ( Yen, wal Waiver Fee $ Date of Payment V6 /020.2 1 Date of Payment Receipt Number 005 01 b Receipt Number COSA # 05C 1211 q6 0 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 Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date 7/27/21 '00 4� TH 6. DSD SIGNATURE System #1 Approved for 3 bedroomsBenjrrtr S achiller System #2 Approved for bedrooms ��$���slF9 7 272292 Disapproved �klkF�pROFESStO Conditional approval for bedrooms, with the following stipulations: WATER AND W J 0 By: SOriginal Certificate Date:,,/1 O 120 2 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: Lennie Heights, Lot 5 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA Parcel ID: Structure served by this system 1 051-063-57 © Well log is filed with Onsite (or attached) Well production at time of test 2 gpm Date drilled 10-17-1977 Water storage tank volume gallons Total depth 300 ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to 154 ft ❑ Coliform bacteria is Negative Sanitary seal is functioningcorrectly_ ,Nitrate 5.27 mg/L _ ❑_Nitrate less than_M,RND..___ FE -1 Wires are properly protected Arsenic ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) >12 in. Collected by Forge Engineering Date of flow test for COSA 8/8/19* Date of Sample 7/20/21 Static water level at beginning of test 121 ft. Comments See Attached Letter. B. TANK DATA Age of tank(s) 2 years Tank type/material Septic/Plastic Measured operating fluid level in septic tank 44 ❑Q Standpipes/foundation cleanout per record drawing Date of pumping 7/21/21 D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) 7/17/19 © ALL standpipes present per record drawing Total measured depth from grade 13111 23ft (max) Measured depth to pipe invert from grade 4.6 ft (min) ❑ N/A — pressurized field 0 Monitor tubes go to bottom of effective. If not, state depth into effective STATION ❑ Require ainb Age of lift station . Lift station material Comments: ce completed Adequacy test date New Construction Results ElPass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min © Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: Septic tank and absorption trench constructed 7/17/19. See attached Letter. COSA Checklist yellow sheet 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 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' 0 Yes if No Absorption Field on Lot > 100'✓1 Yes if No ft Holding Tank > 100' ✓0 Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' 21 Yes if No ✓� Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75'✓] Yes if No ft M Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' E✓ Yes if No ft Surface Water > 100' ft ft ft ft ft [✓ Yes if No ft Property Line > 5'✓1 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Q Yes if No ft Private Wells > 100' Q Yes if No. Water Main > 10' ✓� Yes if No ft Community Wells > 200' 0 Yes if No Water Service Line > 10'✓� 0 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' ✓l Yes if No ft If absorption field is under driveway comment below Property Line > 10'✓0 Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓1 Yes if No ft Private Wells > 100' U✓ Yes if No Water Service Line > 10' F,-/] Yes if No ft Community Wells > 200' Yes if No Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that I 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 IF Awl 4,9 R �. Benjaa & chiller 7/27021 9 PROFESSIONP.� 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 Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Nitrate Advisory Certificate of On‐Site Systems Approval # OSC211460 Subdivision: Lennie Heights, Lot: 5 A water sample revealed a nitrate concentration of 5.27 milligrams per liter (mg/L). 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. Since nitrates are known to slowly increase, we recommend you monitor the water quality. 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 Nitrate Fact Sheet 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 medi a 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. August 5, 2021 Caleb & Tania Doseck 23818 Lennie Circle Chugiak, AK 99567 8/5/21 Subject: Lennie Heights Sub, Lot 5 – 23818 Lennie Circle Well & Septic System Adequacy Dear Caleb and Tania: On July 20, 2021 we inspected the well and septic system located at 23818 Lennie Circle in Chugiak to determine if it was functioning in accordance with design guidelines and regulations established by the Municipality of Anchorage. Record documents indicate an installation date of July 17 & 18, 2019, just slightly over two years ago. Documents show that a 1,060-gallon plastic Infiltrator septic tank was placed on the property, along with two - 27’ long, 2’ wide, 7’ effective depth absorption trenches, for a total absorption area of 756 square feet. Both of the trenches were completely dry upon our site visit. The septic tank was full and there was no evidence that it was leaking. The well had a sanitary seal and the wires were adequately protected. It was also functioning correctly. A water sample was taken for bacteria, nitrates, and arsenic. The results detected nitrates at 5.27 mg/L but no arsenic. The sample was also clear of any bacterial contamination. In summary, the system is working and is up to code. As a new system or any testing is good for two years, we request that this system be approved without undergoing the formal testing process. Sincerely, Benjamin Schiller, P.E. MUNICIPALITY OF ANCHORAGE fes' . Clime Development Services Department - Phone: 907-343-7904 On -Site Water & Wastewater Section - Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-063-57 1. GENERAL INFORMATION Complete legal description Lennie Heights, Lot 5 Expiration Date: �� �J �l 00— 0 Location (site address) 23818 Lennie Circle Chugiak, AK 99567 Current property owner(s) Breckenridge Property Fund Day phone (907)290-6044 Mailing address 2015 Manhattan Beach Blvd #100, Redondo Beach, CA 90278 Real estate agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic ED Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ �' U0 Waiver Fee $ Date of Paymentcc 101 ZS 1"7,rj) Date of Payment Receipt Number V I IoM Receipt Number COSA # ��l V J 1 Waiver # � A 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 Forge Engineering Phone 907-522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage AK 99503 Engineer's Printed Name Michael E. Anderson, P.E. Date 10/24/19 6. DSD SIGNATURE VSystem #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: By: lam/ �'�% . �C��-I' Original Certificate Date: �� I The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: Lennie Heights, Lot 5 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA OR Well log is filed with Onsite (or attached) Date drilled 10-17-77 Total depth 300 ft Cased to 154 ft ❑ Sanitary seal is functioning correctly FOR Wires are properly protected Casing height (above ground) '12 in. Date of flow test for COSA 3/8/19 Static water level at beginning of test 121 ft. Comments B. TANK DATA Age of tank(s) `1 years Tank type/material SEPTIC/PLASTIC Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping New Construction - 7/17/19 Parcel ID: 051-063-57 Structure served by this system Well production at time of test 2 gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 3.93 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by FORGE ENGINEERING Date of Sample 10/24/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) 7/17/19 Adequacy test date New Construction ❑ ALL standpipes present per record drawing Results ❑ Pass For bedrooms Total measured depth from grade 13.1/12.7 ft (max) Fluid depth prior to test in Measured depth to pipe invert from grade 4.6 ft (min) Water added gal ❑ N/A — pressurized field New depth in ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Elapsed time min OR Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: Both septic tank and absorption trench constructed on 7/17/19. COSA Checklist yellow sheet 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' F/ Yes Community Sewer Manhole/Cleanout > 100' (/ Yes if No ft ✓M Yes if No ft Neighboring Tank > 100' Q✓ Yes if No ft Private Sewer/Septic Line > 25'✓Q Yes if No ft Absorption Field on Lot > 100' Fv Yes if No ft Holding Tank > 100'✓Q Yes if No ft Neighboring Absorption Fields > 100' ✓Q Yes if No ft Water Main > 10'✓Q Animal Containment > 50' Q Yes if No ft P/ Yes if No ft ✓Q Yes if No ft Water Service Line > 10'✓❑ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' 2] Yes if No ft R] Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' F/ Yes if No ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5' n Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' if No Yes if No ft Private Wells > 100' ✓Q Yes if No ft Water Main > 10'✓Q ft Yes if No ft Community Wells > 200' ✓Q 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'✓Q Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓Q Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' Q Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that l 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.c1th MICHAEL E. ANDERSON s o? CE-4381 �. 10/25/19 °=:."°°"' ,.� COSA Checklist yellow sheet/ �p� • Municipality of A M995 2015 , L On -Site Water and Wastewater Pro&grg@hen Stuller (907)343-7904 Certificate of On -Site Systems Approval Parcel 1. D. 0517063-57 1. GENERAL INFORMATION Complete legal description Lennie Heights, Lot 5 Location (site address) 23818 Lennie Cir Current Property owner(s) KelSie Lance Mailing address Real Estate Agent Expiration Date: _ Day phone_ PO Box 771623 Eagle River, AK 99577 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well i] Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Wall ❑ Community ❑ Public Water System I ❑ Public Sewer ❑ i WaiverNanance request for. Distance: Received by: h)uDate: 0 � Pb1 COSA to be released to the engineer, unlss - ermse requested by the engineer. COSA Fee $ -z& / Date of Payment `711b%1 ' Receipt Number 0L ar 42 y COSA# 0552675lS- Waiver Fee $ Date of Payment Receipt Number Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type_ of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site watersupply 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational fife of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sale benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE (/' System #1 Approved for � bedrooms System #2 Approved. for bedrooms Disapproved Date 7/9/2015 Conditional approval for bedrooms, with the following stipulations: By: kw -1 ::2:, Original Certificate Date: : The Municipality, nchorage 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 Septic System Advisory Well Flow Advisory COSAbluesheet E . X Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # + of Structure served by this system Certificate of On -Site Systems Approvat Checklist Legal Description: Lennie Heights, Lot 5 Parcel ID: 051-063-57 r_1M+A411111g111jr,111110 Well type Private If A, B, or C provide PWSID # _ Date completed 1011711977 Sanitary seal (YIN) Y Total depth 300 ft. Cased to 159 ft. Date of test Static water level Well production FROM WELL LOG 10/17/1977 Unknown ft 0.33 Well Log (YIN) Y Wires properly protected (Y/N) Y Casing height (above ground) 12+ in. AT INSPECTION 7/8/2015 125 ft g.p.m. 1.5 9— p.m- WATER SAMPLE RESULTS: Coliform !U_ %—Colonies/100 mL Nitrate 2J�� mg/L Arsenic . � ug/L .Date of sample: � I � Collected by: J B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 10/13/1977 Tank size 1,000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) /High water alarm (Y/N) N Date of pumping S67I10tS Pumper C. ABSORPTION FIELD DATA Date. installed 10/13/1977 Soil rating (g.p.d.tft2 or fe/bdrm) 240 SF/BR System type Deep Trench Length 52 ft. , Width 4 ft. Gravel below pipe 7 ft. Total depth / 6,Eff. absorption area 728 fe Monitoring tube Y Depression over field N Date of adequacy test7/8/2015 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test ofrein. Water added 454 gal. New depth in. Elapsed Time: 230 min. Final fluid depth fy�' iin. geB„or” Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date - D. LIFT STATION Date installed "Pump on" level at in. Size in gallons _ "Pump off" level at in. Manhole/Access (Y/N) _ High water alarm level at Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 94 Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 50+ On adjacent lots 100+ On adjacent lotslmm+ R 7 ` Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wellsonadjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 1,00+ Water main 10+ Driveway, parking/vehicle storage 10+ F. COMMENTS *WR940029 Survey as -built on file; �toNt �,rbe ws �t`-5 r2f AMZ G. ENGINEER'S -CERTIFICATION I certify that l have determined -through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 7/9/2015 COSA canary sheet 2-6-15.doc in. J.. -� Municipality of Anchorage F� Development Services Department Building Safety Division 5 On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.O5)-063-5-7 COSA# 1'7010JQ3 Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 5; Lennie Heights Subdivision Location (she address) 23816 Lennie Gr. Chugiak, AK 99567 Current Property owners) Mark DeMod Day phone 688-2276 Mailing address P%,P)o>< 773003 91-577 Lending agency Day phone Mailing address Real Estate Agent Bonnie King Day phone 244-7176 Mailing Address Unless otherwise requested. COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: %G 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site El Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ i The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of fide (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined In the 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 s s s Engineering Address 15661 S. Birchwood Loop Rd. Chugiak, AK 99567 Engineer's Printed Name Robert A. Shafer Phone 694-2979 Date 5. DSD SIGNATURE ! �.•n• .I<a.. Approved for bedrooms. 7, ,:,}� • �� ,- Disapproved. Conditional approval for bedrooms, with the following stipulations: nil carr WATERAND m= PRnr_DAAj - Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By: Al.'�c 0��� Original Certificate Date: t`o - 3 O 1 m.• II,oSI Municipality of Anchorage V Development Services Department Building Safety Division ' On -Site Water G Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SY�S1TEms APPROVAL CHECKLIST Legal Description: LoL; Lev1r1; ie RATS. 'S/D Parcel ID: 0,J;"1 -QC 3-57 LJ A. WELL DATA Well type _6J A� If A, B, or C provide PWSID # _ Well Log (Y/N) Datecompleted v c1/ -J -J Sanitary seal (Y/N) *S Wires properly protected (Y/N)yQ� Total depthlob ft. Cased to �� ft. Casing height (above ground) n. FROM WELL LOG AT INSPECTION Date of test D bry 7 2o 1 101 Static water level Well production • 33 g.p•m. 6 g.p P.M. WATER SAMPLE RESULTS: i Coliform ! colonies/100 mL Nitrate ��I/S mg/L Arsenic: ND uglL date of sample: 6 17/05 B. SEPTIC/HOLDING TANK DATA Tank Type/Material S Tank size 1000 gal. Number of Compartments Z Foundation cleanout (Y/N) T— Depression over tank (Y/N) NO Other bacteria colonies/100 mL Collected by: 5 �r s �►19 ✓' _ Date installed 1 i Cleanouts(Y/N) VAS High water alarm (Y/N) JV 0 Date of pumping d Pumper �.�-.�5 pvr+.PrhC C. ABSORPTION FIELD DATA % System type +rr nch Date installed io-I _%1 Soil rating (g.p.d./ftz rftz/d� Length ��_ft. Width ft. Gravel below pipe ft. Total depth L ft. Eff. absorption areaftZ Monitoring tube W 5 Depression over field n1U Date of adequacy test of Result (Pass/ ail) 5 S For 5 bedrooms Fluid depth in absorption field before test Z in. Water added 1/f� gal. New depth in. Elapsed Time: ZJ min. Final Fluid de th 5 in. Absorption rate >= `t� g.p.d. Any rejuvenation treatment (past 12 mo.) () /N type) AJ A If yes, give date D. LIFT STATION Date installed /V Size in gallons "Pump on" level at_ in. 'Pum Cycles tested E. SEPARATION DISTANCES Manhole/Access (Y/N) t -water alarm level at _ in. Meets alarm 8 circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: p ri 4 CO 2 C1 i� +Septic tanMift station on lot r ��� %1M On adjacent lots - /D d / 2 � Absorption field on lot / O rl `90n adjacent lots T/f Ci / Public sewer main /OD '/— Public sewer manhole/cleanout /Co ��- Sewer /septic service line Animal containment areas I-011 Holding tank Manure/animal excrete storage areas /00 f SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: /r f Building foundation S f Property line `! { Absorption field Water main d /{ Water service line 0 t 't' - Surface water U o / f Wells on adjacent lots ! V U It SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line !Ci Building foundation U /f Water main ( O rF Water Service line Surface water ADD r ! Driveway, parking/vehicle storage Curtain drain "44- Lic NWells on adjacent lots 160 rF F. COMMENTS tn0� CJ G. ENGINEER'S CERTIFICATION I certify that / have determined review of Municipal records th, conformance with MOA COSA u Engineer's Printed Name Date 0 COSA Fee $ TZ Date of Payment 6 Receipt Number O `1539; c (Rev. 11/05) f-rav% J ec.J - 5ub rough field inspections and the bove/systerr)sl/ae in s in e e on t is 4 ate. Waiver Fee $ Date of Payment Receipt Number '..... off" R fbuIQ 1404 ,1 SOS ReLA 1092643001 Client Name S 8 S Engineering Project Name/N L5: Lennie Hgts SO Client Sam pie I U Lennic l lgts S/D Matrix Drinking Watcr PWSID 0 Sample Remarks Printed Datdfime Collected Date/Fime Received Date/time Technical Director 0624/2009 8:23 06/152009 10:55 06/15/2009 14:40 Stephen C. F.de Allowable Prep Analysis Paramner Results PQL Units Method Container ID Limits Date Date [nit Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 06/17/09 0622/09 NRB Waters Department Total Nitrate/Nitrite-N 4.45 0.100 Microbiology Laboratory Colony Count 0 Total Coliform 0 Fecal Coliform 0 mg/L SM204500NO3-F D (<10) col/IOOmL SM20 92228 col/IOOmL SM209222B col/IOOmL SM209222B A (200) A (<I) A (<I) 06/18/09 LCE 06/15/09 DLC 06/15/09 DLC 06/15/09 DLC 4.Qc>f fGil; iI Ac;snc. � 11 {. �.' •• 1•Y.. . ,`..�.—.ter••+�....w-...n �I s�� �V Jte b�trYc ed' - • y 1.� i{•{. 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Y ' i 23 l8 LlRCYtO Ly RkJ r........... w. ...... ..r. w.�......_..—....�.. ..�. naft•• owal/n�.•� �Ij�!t(jr.Yn' .; Qrld: 1215 .�-S%['� 8 r�ssloltd�l�':►; LCt C• L taus Nalstitf Sub:Ivalon M+t•y avC1! rettno t Sir IrlOwl M- 4tiAN-T-OM a 94s:rM .•R•�Oi1d t'13ttlM rl h SM/..�.1161 uaf S I' NJ Lm drnava uvaun on adAd'aOWh•tf.{HMArq � F.u7r:wYt onNjx✓S.R vtre.draparwrxaa.«r �, Ndaen t4 K/J=A�i1S:E�Y lhwa a'�. rta4rm�te;t tf 0i01�W1hYartrgSt.i 4.Qc>f fGil; iI Ac;snc. � 11 {. �.' •• 1•Y.. . ,`..�.—.ter••+�....w-...n �I s�� �V Jte b�trYc ed' - • y 1.� i{•{. Y ' i 23 l8 LlRCYtO Ly RkJ r........... w. ...... ..r. w.�......_..—....�.. ..�. naft•• owal/n�.•� �Ij�!t(jr.Yn' .; Qrld: 1215 .�-S%['� 8 r�ssloltd�l�':►; LCt C• L taus Nalstitf Sub:Ivalon MUNICIPALITY OF ANCHORAGE V-1 ° DEPARTMENT OF HEALTH & HUMAN SERVICES 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 l.D.# OSI- 003- 57 HAA# HA9L-0!; 1/ 1. GENERAL INFORMATION Complete legal description Lot 5; Lennie Heighfii Subdiv.i6.ion Location (site address or directions) 23818 Lennie C.Acte Chug.iak, AK Property owner Paut Sutt ik 694-0808 Day phone Mailing address 11530 Echo Eag.2e Riven AK 99577 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. 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. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verity that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on_A�e date of this inspection. Name of Firm Address 17034 Engineer's No. 204 6. DHHS SIGNATURE XApproved for bedrooms. Disapproved. Conditional approval for Additional Comments B Phone �F14";_ Z97 bedrooms, with the following stipulations: Date) -7-24 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 theState of Alaska. The DHHS does this as courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-02S(Rev-1/91) Back MOA #21 moi.' .r^ 3 W 4',fi,;.•:mss,.'_ ..:a bedrooms, with the following stipulations: Date) -7-24 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 theState of Alaska. The DHHS does this as courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-02S(Rev-1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:Parcel I.D. A. Well Data Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present ON) _ Date completed \Z) -\'l -11 Driller Total depth -2�c� Cased to _'S_4 Casing height Sanitary sealON) Wires properly protected ('Y= N) FROM WELL LOG AT INSPECTIONLU 0 Date of test \ 0 1 �l - I'j_ - 1-I _� p Static water level Well flow Hca. b G'�m. 1 7 g.p.m. f; 6 `� Q co 1 Pump levell �q —o SEPARATION DISTANCES FROM WELL TO: u� 1 Septic/holding tank on lot _ G1�i ; On adjacent lots Absorption field on lot Public sewer main ; On adjacent lots -I � Public sewer manhole/cleanout S wer service line \l- Petroleum tank 'Z- 71� 5 1�lu- is5J�o WATER SAMPLE RESULTS: Coliform 0 Nitrate � :2i Other bacteria l� Date of sample: 0 - 11 - q q Collected by: S f 5 67 L,2e-- B. SEPTIC/HOLDING TANK DATA Date installed \ - 1-I Tank size \ b00 Compartments 2- Cleanouts OI) Foundation cleanoutON) __Depression ( ry High water alarm (Ye _Alarm tested (Y/N) _ �o, Date of pumping - / `J 3 Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot On adjacent lots l o� Foundation 2Q To property line 1 a Absorption field -1 S rface water/drainage o O 7r� 72-026 (3/93)' Front Water main/service line CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTAN�C OM LIFT STATION TO: On adjacent lots D. ABSORPTION FIELD DATA Manufacturer Manhole/Access (Y/N) 'Rurrt-off" Level at tested Surface water Date installed -11 Soil rating (GPD/Ft2) � 8 System type -T-944c+� Length S2 Width G Gravel thickness %) Total depth —11 Total absorption area Date of adequacy test Iml Ll- 1s-53 Water level in absorption field before test Cleanout present (y N)Depression over field (Y/0) r1 as _Results /fail) ek-ss for 3 Bedrooms y #4 After test ?-r Peroxide treatment (past 12 months) (YQ�I ASD "l 14^4a �J� If yes, give date N ows(-, \l - $ k/ o e.��� Pr-, o K- Ta res „S c, SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation 3� k .)r- On adjacent lots On adjacent lots �l J 1 Property line bio To existing or abandoned system on lot Cutbank 11,,-- Water main/service line Surface water t o c:> k�- Driveway, parking/vehicle storage area Curtain drain s�w- E. ENGINEER'S CERTIFICATION I certify that l have checked, verified; o conformed to all MOA and HAA guidelines iri effect on (he't Signature Engineer's Date 3 River loop R( Alaska 99577 HAA Fee $ ✓� Date of Payment Receipt Number 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number kk to v� inspection. 08/22/94 15:54 CT&E ENVIRONIIENTAL LAB SERVICES NO.136 002 ALtL. AINCA WA) Clicn( Sample Il) Matrix ClientNamc. Ordered H), Project Name. Project# PWSID Commercial Testing & Engineering Co. Environmental Lat)oratorY Services LABORATORY ANALYSIS REPORT 94,4238-1 LOT 5.I,.tNNIE HTS WA'll R S k;. S ENGINEERING R. SHAFER UA 8tuuplekemuka; K.OI1'I'INF.;SAI✓7FLBCOI.t,I:CTFUBY; RAY. Parameter Nitrate•# 1-'L. Rcaul(s Qual WORK Order 81488 PrinlsdDate 08/22/94 "13:16 lu's. Collected Dale 08/17/94 (u 12:40 In. ILeceivedDatc (IS%18/94 ;1-1;10:50 111-4. L'eclinical i)ircotor SI'EPI-IEN C. LDU, Relca4cd ll-����• �.y,�,,,,� Allwmablc Ext, Anal Units Method I.1mits Dale Tate IE:i -------------..... ------------------ 4 2 m /I. LPA 353.2/300,0 i(1 o8/1g/94 DJS Ir SeeSpexi.al lnslrae.li<)jv Above IIA Uiwv)) hbl: + * See Samplo Kemurks Above N.4 =Nut Analyzed U=Undete toil,R>o�tedvalt>eisthepractienlm>antificationliAnit. LT=Less'lhatt "3 D=Secondarydilutioo. (il'==Cti'catu"lhwt 5633 S Street, Anchorage, AK 99618-1600 — lel; (907) 562-2343 Fax: (907) 561.5301 ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA INSPECTION APPOINTMENTS D!i"FFRECEIVED L�% S �nnte TYi Scc��c� - TIME ---. --- - --------- LeY�_r" e_ C >, r c.1 f -�- [TATE INSPF_CTOR----------------`------->.--- --- ----- ^ `/,�V _. —,!�L�-AR� l-[-2:5 _\1 S -- IN�PECTOR MULTIPLE IPt_E FAMILY Two [--I Five MUNICIPALITY OF ANCHORAGE MLINICIPALITY OF ANCHORAGE - DEPARTMENT OF HEALTH & ENVIFIONMENTAL. PROTECTION{ 7T CI'," IT ] " 825 L Street • Anchorage, Alaska 99501 ENVIE X it I , 7.. ;- -.O C TI I i -ENVIRONMENTAL SANITATION DIVISION: j -j ` 7 1982 Telephone 204-4720 REQUEST FOR APPROVAL OF INDIVIDUAL. WATER ANIS SEVK WLM W - DIRECTIONS: Coniilete-all partsoilpage 1..incomplote requests will not be processed, Please allow ten (101 days for processing. -- 1, PROPERTY OWNER -MAILING ---- --- - ADDRESS -.---- - --�.�.__��� �0x -16P- W RTY_iiF.SIOENT (II dlfferent Isom above) - 15Q vnP_ 2. ____..«�"� --" "" - �71 ADDRESS - - -- ---- ------ MAILING ADD 3. i ENDIN[GI/NS'flnll'UTION [) �y4" I I�'--� I ` �_PHONE rnAu In1r, ADnRr-sst 4.- REALTOR/AGENT L-or-(%1Y\Q.L M-(A'�. S- n. --..-.- -J----- Y- ALI-INGADDRESS _-zo t 5. LEGAL OC'SCRIPTION- L�% S �nnte TYi Scc��c� - SfREET LOCATION----�------------- ---. --- - --------- LeY�_r" e_ C >, r c.1 f -�- 6.. TYPE OF RESIDENCE��'-_- --�FUMWTI-OF,i3EDROOMS - - - - K SINGLE FAMILY C7 One n Four 0 Other— ther-MULL MULTIPLE IPt_E FAMILY Two [--I Five O Three -1 Six 7..- WATER#SUPPLY -- -- _ IXl INDIVIDUAL" ATTACH WELL LOG. Awell loci is requiredforall wells drilled LJ COMMUNITY since June 1975. For wells drilled prior to that date, give well _ Cl PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM-- tR INDIVIDUAL/ON-SITE'" —__-lcl? YEAR ON-SITE SYSTEM WAS INSTALLED. 1-1 PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. f HIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OFRESIDENCE` - - ---�-�_'NUMBER OF BEDROOrvIS EI SINGLE FAMILY O ONE C1 THREE ❑ FIVE L1 MOL.TIPLE FAMILY ❑ Two ❑ FOUR ❑ SIX 4. DISTANCES Srptic/tioldurl WELLTO: -- --------- — — ----- - - -- --- - Absorption Area - to nearest L-ot Linn S. COMMENTS LL}-�APPROVED FOR _ . 131-DROOMS CONDITIONAL APPROVAL. (letter must accompany certificate) LJ DISAPPROVED ------- --- -- --_-..__....._'Y_.— ----- -- 72 011) ( Rev. 6/791 ❑ OTHER Lot _PL;iMIT NUMBEH ... �.^ 1. WATER SUPPLY C7 INDIVIDUAL DEPTH OFWEL "---- C1 COMMUNI FY DATE DRIURD F -_I PUBLIC UTILITY Connection Verified____.___. LOG RECEIVED'---- .,,� 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER L1INDIV1DIJALON -SITE pAl'1= INSTAI_I_L=D 11PUBLICLIi'ILITY w �� ConnectionVerified_VINSTALLER L1Septicpl�an,�k� or (_11-lolding Tank Size: �c/1.�!If Tank is hornernade SOf LS HATING give dimensions: f'fPl OF TANK --- -- rt4ANUFACIURER TO-rA.L ABSORPTION An EA I MATERIAL. 4. DISTANCES Srptic/tioldurl WELLTO: -- --------- — — ----- - - -- --- - Absorption Area - to nearest L-ot Linn S. COMMENTS LL}-�APPROVED FOR _ . 131-DROOMS CONDITIONAL APPROVAL. (letter must accompany certificate) LJ DISAPPROVED ------- --- -- --_-..__....._'Y_.— ----- -- 72 011) ( Rev. 6/791 ❑ OTHER Lot k REMAX of Eagle River ATTN: Lorraine Minor P.O. Box 848 Eagle River, Alaska 99577 Dear Lorraine, EXCAVATION WORK Reference: Lot 5; Lennie Heights Subdivision ROBERT A.SHAFER CIVIL ENGINEER 6942979 October. 26, 1982 MUNICIPALITY OF ANCHOP,AGE ENVIR :, ION A sewer system adequacy test was performed on the system located on the referenced property. The septic tank was pumped and verified to have a capacity in excess of 1,000 gallons, The absorption trench was tested by continuous flow of water over a period of 24 hours, without any adverse effects on this system. It can be concluded from this test that the waste water disposal system' serving the two bedroom residence located on this property is currently functioning adequately; however, the system cannot be guaranteed against subsequent failure. It should also be noted that the well casing has been sealed and the well wires have been placed in conduit, as required. If we may be of further service, please do not hesitate to contact us. cc: Municipality of Anchorage Department of Health and Environmental Protection 0 SRB196X EAGLE RIVER, ALASKA D. L, 6n�UXT 1� - P. 0. BOX 6 807 a6-§.96-,, ANCHORAGE, At. S's 95Q2 No TI IE �F �A�A- Mill --DOLLARS C STREET OFFICE, ANCHFAG� 4 u, -Z i oi: h 2 5' 200 3 r, hi: 1,5263-2 le"ll 0894 D. L. ORCUTT I P. 0. BOX 6802 688-9296,) ANCHORAGE, ALASKA 99502 Ir PAY TO THE ORDER OF— u nN AW KN. BWM ii ol�(=OMMERC. s— --- C STREET OFFICE, ANCHORAGE 1 1 MEM 11,000000 5 SOO," i 876 89-363 9a)�� 1252 s DOLLARS of 12 S 200 1111 It: 1, 5 2E 3 2 2,`h 0 13 7 P, 11,000000 2 5001" Y -J'-' Zt 870it D. L. ORCU I P. 0. BOX C 80-36 ANCHORAGE, ALASKA 99502 -F252 3 ',If P T ROE F 'y ----7-----DOLLARS R® AIMSK C STREET OFFICE, B ANCHO A(Iq1 MEMO. 11,000000 5 5001" 5 2003P3 h I: IIS 2, '1)' 08 70 �lj Ajo V QL ()ctobur 8, 19- 82. Hr. Dougla.i Orcul, Box 681.13 Anchorage F Alaska 9950 Subject-. Lot 5 Lennie }its. Subd. Dear Hr. Oruutt: J�pproval. for the inclividu<al. sewer and water 1acil.itie, cMinot be granted until the tollowinq items have b(On cort})leted: ° The top of the well ciasilic.} :-ieill(?d with iA (RIrli.tz0--Y Neal So that it is watel: tight. I.xpo:,od clectr.i.cal, wires to thu well 110,Ad erre irl Violation of the tunici}?al.a.ty of Anchorage codes and mu.c t bc, encca:ieii ill coll(lait. 11,110 wiper anajvg1 s repot -t 110ods to bo ;Submitt(-Cd to this tea office f_tot11 the ChUM 1:0h, 5633 13 tree r., for our review. �° .Phe se:pt;ic t;art;: 1_.)um )ed with a recr_�ij- 1- subfaitte, to this 1, depart.raent . ° .')deauac y test nc�(�d�� •La ))u -}?E .rfnl"laod on the cxi >t.arrg lc>ac:hing area. This tc,st. will (JeLcrwirw it thevSteil is � adequate cICE,EJrc; � nq to i7at>_vnal Standards. 1# lr ,ti_IrcS of �r.sjV private firms }.h'Y'fOrI!lin�J the tE `at iii encloued. This lag)ol:t N/ 11E:edr3 to be 3UhWiL-tQd to oris of ir.O i:r,r OLAI: Vev1.r_W. Please notify this Deipartmunt for a reinspcction when thc: noteci discr:epancics have } uem correctcad. If there are. any further questions, ploatic call this office �At 264-4720. ��ll'LCGY_'el.Yr Robert C. Pratt Arssociato linvlronTCental '111peciaJiSt Ji;nclormr@ -NO; a J MUNICIPALITY OF ANCHORAGr DEPARTM. F OF HEALTH AND ENVIRONMEI +L PROTECTION 825 L Street, Anchoraap, Alaska 99501 264-4720. Date Received: February 1, 1978 #1: Time inn. qnk__ #2: Time #3 Time Date Q2.__nS Date Date Insp Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Alaska Bank of Commerce Mailing Address:Pouch 7-012 99510 _. Phone: 279-5641/350 2.. Property Owner: Max Bevin ` Phone: 279-2491 _ Mailing Address: _640 West 36th Avenue 99503 3. Legal Description: Lot 5 LennieHeights Subdivision 4: Single Family Residence: :�.xk Number of Bedrooms: Two Multiple Family Residence: ( ) Number of Bedrooms: 5. Well System: Individual Well (x) Community/Public System ( ) Permit # Depth of Well _ Well Log on File ((sem Construction Bacterial Analysis 6. Sewage Disposal System: On-site System (X) Public Utility ( ) Permit # Installed 1977 Installer Septic Tank Size Q�� Manufacturer. Absorption Area Soils Rate Material 7. Distances: Well. to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line :Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 5 Lennie Heights Subdivision Comments: Affadavit Attached: ^ ( ) Letter Attached: I Approved: ��_c. Date; Disapproved: Date: _ Department Worksheet: R FG k I PT FOR UR IFII U MAIL --30( (plus postage) - SENT TO POSTMARK OR DATE. - (DO STREET AND NO -- --� —�--�---- - P.O., STATE AND ZIP CODE OPTIONAL SERVICES FOR ADDITIONAL FEES RETURN m t Shows to whoand date delivered . 5'tith delivery to addressee only - .. 650' RECEIPT - a• Shwas to whmn, date and where delivered ., 35¢ SERVICES With delivery to addressee only .. 850 e DELIVER TOO ADUIiESSEF. ONLY ...................................................... 50G SPECIAL DELIVERY (oxtro foo roqui red) • • •• - PS Form NO 3000 INSORANCF�COVERAGI: {'RO 10EU--- ____ (See other side) Apr, 1971 NOT FOR INTERNATIONAL MAIL GPO :19v2 01 460-743 MUNICIPALITY OF ANCHORAGE Department of Health and Environmental. Protection p 825 L Street, Anchorage, Alaska 99501 264-4720 =_ equest for Approval. of Individual Sewer and aLer Facilities J_. Property Owner: Mailing Address: 2. Name of Buyer: Mailing Address Max Bevin 640 W. 36th 3. Lending Institution: Mailing Address: __ 4. Realtor/Agent: Mailing Address: Douglas Orcutt P. 0. Box 6812 Alaska Bank of Commerce Pouch 7012 Alan Hardin Yukon Realty 4619 Spenard Road Phone: 279_2491_ _ Phone: n/a Phone: 279-5641 x 350 Phone: 276-6454 5. Legal Description: [.oY__5_, r.PnnjP_ HPight•a- Street Location: _Lennie Circle __ Chujc�iak 6. Single Family Residence: (x x) Number of Bedrooms: _ 2 Multiple Family Residence: ( ) Number of. Bedrooms: _ 7. Water Supply: *Individual Well (x) Public/Conununity System ( ) If Individual Well, well depth If Community System, name of system 8. Sewage Disposal System: *"On-site System (x ) Public System ( ) If On-site System, date of installation: *NOTE: A well log is required on ALL wells drilled since 6/75. **If on-site sewer. system .s over t-wo(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be ini.tJated. 3/77 10•J4LH I j 1 I I (1 1 t DEPARTMENT OF NATURAL RESOURCES LAND AND WATER MANAGEMENT SOUTHCENTRAL DISTRICT September 12, 1977 Mr. Joe Blair, Division Manager Municipality of Anchorage Health & Environmental Protection Environmental Sanitation Division 825 L Street, 4th Floor West Anchorage, AK 99501 Re: Sewer and Water Approval for Lot 5 Lennie Heights Subdivision Dear Mr. Blair: /AY S HANAFONO, BOYfRNOR 3327 Fairbanks Street Anchorage, Alaska 99503 xrxr�t�x�t�x DErL o` ki*ail-iFl: r.NVI�Oi�ly:=�'I ht Mr. Leonard Hogue, owner of Lot 4, Lennie Heights Subdivision has expressed concern for the location of a well on adjacent Lot 5 relative to his existing well. Mr. Hogue has a very marginal well with a low yield of 3/4 gpm. In compliance with Alaska Statutes 46.15, he has established water rights for his well (ADL 200141) which have priority over rights filed on Lot 5 at a later date. Attached is a map indicating the location of Mr. Hogue's well relative to Lot 5. Mr. Max Bevins is currently nego- tiating purchase of Lot 5. I am confident that your Water and Sewer Section expertise will determine proper placement of the Lot 5 well to accomodate Mr. Hogue's situation and comply with sanitation codes. Thank you for the opportunity to comment. Sincerely, L. A. Dutton District Manager 1"O1 ,� M ' -,OA� By: Lorraine M. Ferrell Water Engineer cc: Leonard J. Hogue Enclosure Z O n V O W U ob CL fr (n W' z a" O LL O W H a W H- ly U u r. 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