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Home My WebLink AboutSST BLK 2 LT 2Block Lot 2 2 #015-082-19 Ra /-to A 4P, /o/,�a2 Municipality of Anchorage . '.� Development Services Department - Building Safety Division —• South Bragaw St. ;' On -Site Water & Wastewater Program, 4700 _-_ ' P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 2 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number. Aqj ;AR Swozc3(,&y PID Number. 015-082-19 Name: PAUL & LORRI DAVIS Wastewater System: ❑ New ■ Upgrade Address: 9801 HOMESTEAD TRAIL RD a ANCHORAGE, AK 99516 ABSORPTION FIELD Phone; No. of Bedrooms: (907) 333-5794 ¢ O Deep Trench Cishanow Trench Mad OMound OOth LEGAL DESCRIPTION sa "ung: Tow o.an rmm «a*d R M/4 R Block: Lot. Subdivision: Duple to pipe sottom from 044 Oaee depth NpW 2 2 S.S.T. R Township: Range: Section: — A added — — \� R ae..an Nwn Of iwe: aeto.we esteem ir: WELL: O New O Upgrade R R Cb"r"Wn Pneote. Ae.c. Teta roW se.wpem PIP.metwkk R R M n• OrYlor. Dela OrYed: SlaDo W~ LAW Me Dob MWwG R ""rep seft . nt ceD "'"kt TANK CPU R R SEPARATION DISTANCES ■septic 0Holding 0S.T.E.P. 0Other it an ia Holding bTo *1500 From , Well 1000+ N/A — — 25'+ a`b STEEL a 2 Surface water 100'+ N/A — — — LIFT STATION Lot Line 5'+ N/A — — — sere In fib Yaexec4ew en keel et: at: ttyh Walt 66.m ec Foundation 5'+ N/A — — — ►wro taw. a.cbleat swpeotemu Mangy t7 Curtain Drain NONE KNOW BENCH MARK Remarks: t.eoam end Deewlption: —EXISTING SEPTIC TANK COMPLETELY ABANDONED NORTH EDGE OF PATIO NEXT TO HOUSE *SEPTIC TANK SIZED FOR 5 BEDROOMS Fwd' 100.00 R BURIAL RATED TANK. ENGINEE �F Odd I 6�0�4p •ne Inspections performed by: AKWWC, INC. Dates: list 9/21/2002 *�:..... *�0 . c a/ •, e ray Gam ss. . X00 Development ervices Department Approval .' ., c -2 a :v Reviewed and approved b ��O000e� a= PvRk2Tt NUMBER: AS -BUILT DRAWING PARCEL ID NUMBER: SW0 ,SW020364 015-082-19 EXISTING NEW 1500 SEPTIC FA _F_13 -1 ST1 23.90 39.74 ST2 32.12 42.41 DBL1 34.76 43.17 DBL2 35.42 43.37 SUMP 88.20 98.25 TDP OF 1 oom . PrAXT AF ftffD. 100• WELL RADIUS ( I � I I \/ I /\ I m I I I TNM AT - 93.12 NEW 1500 GALLON I I \ SEP'nC TANK 9 T a Mm AT DUW . 92.31 ' 9/3U/ZUUZ DRAWN BY. C.J.G. ALASKA WATER & WASTE NVATER SCALE. CONSULTANTS.INC. �" = 4OF 4001 DFFARR POAO. SNITF 1B • ANCNOOAGF. AK 00504 • MONF (001)3574170 • PAX (0011534-0T44 PREPARED FOR: PHONE NUMBER: PAGE NUMBER.- PAUL UMBER.PAUL & LORRI DAVIS 333-5794 2 OF 2 LEGAL DESCRIPTION: SST SUBDIVISION; LOT 2. BLOCK 2; TYPE OF WORK: AS -BUILT DRAWING OF SEPTIC TANK UPGRADE of A. ames t� 79 `FOTO ��'4. - ''• ePQv MUNICIPALITY OF ANCHORAGE Development Services Department Onsite Water& Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Sep 19, 2002 Expiration Date: Sep 19, 2003 Permit Number: SW020364 Parcel ID: 015-082-19 Legal Description: SST BLK 2 LT 2 Design Engineer: 0041 AK Water & Wastewater Consultan• Site Address: 009801 HOMESTEAD TR Owner Name: Paul & Lord Davis Lot Size: 49494 SQ. FT. Owner Address: 9801 HOMESTEAD TRAIL Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE. AK 99516-6532 This permit is for the construction of. ❑ Disposal Field ❑? Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: II wa - �•� Date: - i Municipality of Anchorage •. • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-082-19 Permit Number 5woZ 03 64 Property owner(s) PAUL & LORRI DAVIS Day phone 333-5794 Mailing address (1) 9801 HOMESTEAD TRAIL ANCH. AK. Mailing address (2) Zip Code 99516 Legal description (Lot, Block & Sub'd.) S.S.T.SUBDMSION• LOT 2 BLOCK 2• Legal description (Section, Township & Range) N/A Lot Size y9y1 Acres q.Ft. Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade 0 THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. ALASKA WATER & WASTEWATER CONSULTANTS, INC. Permit Fees:, q60 Date of Payment: 25/ C ^9 it02 O Receipt Number. 1 SA Waiver Fees Date of Payment: Receipt Number. ALASKA WATER & WASTEWATER CONSULTANTS, INC. September 13, 2002 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragraw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic Tank Upgrade for Lot 2, Block 2, S.S.T. Subdivision To whom it may concern: The existing 4 bedroom house is currently served by an on-site well and septic system. The septic tank has collapsed and needs to be replaced. We are proposing that the existing 1250 gallon septic tank be replaced with a 1500 gallon septic tank. 1. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 2. TOPOGRAPHY: There are no slope concerns. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assist4e. P.E., M.S. NOTE: Attached is a site plan drawing, a design drawing„ and a S page construction specification letter which are all part of the design package for this septic system. 1 I 1 it 1 NEWSY S/D /1; LOT 4, I I LOT 2: BLOCK 2; NO ENCROACHMENT I 1 1 CONCERNS MARYLAND S/D: I I I I LOT Y: F________________ f NO ENCROACHMENT CONCERNS I 1`�`\ / \\ 1 I ' / I S, 1 NO�IICRWCHMENT FIONCERNS LOT J� ! I i 1 _ ____________ BLOCK 2; 1 I 101YRAM 1—•I I 1 I 1 ----- \ / T12N R3W SEC 14 N2. / / S.S.T. S/D; \ \I `\ 1 ��—� i/ \ SW4, SE4, \ NE4; LOT 2. 1 �� \ BLOCK 1: 1 / f S.S.T. S/D: 1 1 LOT 2. 1 I 1 r f I \ BLOCK 2; ! / S.S.T. S/D; I WACAHTT \ ! LOT 1, 1 \\\ BLOCK 2; 1 S.S.T.LOT 1. / FIELD VERIFY WELL LOCATION BLOCK 1; __—______ — _____________________—_J _—_________—_1_______—_____—___—_ I I I I DATE: 9/4/02 c OF �� ...... 14a1 DRAWN BY: ALASKA NATER & WASTE NVATER B.S.G. :� I Ste. > * CONSULTANTS, INC. 1 " = 100. s% • • 6001 DFReRR ROAD SUITE M • eNf1HWe0F. OK 99706 • PUOUF (00)17))-0A9 • FAX (90)733R-37G9 i / ? PREPARED FOR PHONE NUMBER: PACE NUMBER: PAUL & LOW DAVIS 333-5794 1 OF 3 e U�4 y • •. —7953 ' LEGAL DESCRIPTION: SST SUBDIVISION; LOT 2, BLOCK 2; •....... *.• q\,@�' 4'�V�dpro(esslotle TYPE OF WORK: 100 SCALE SITE PLAN 1 � � I 100' wEu RADIUS I I I I I I STALL _ — — DOUBLE CLEANOLTTS AFTER THE NEW SEPTIC TANK. EXISTING DRAINFIELD \ I EXISTING 1250 GALLON SEPTIC TANK. REPLACE WTH NEW 1500 GALLON 4 BEDROOM DEEP BURIAL SEPTIC TANK. OLD TANK HOUSE IS TO BE PUMPED. CRUSHED. AND ABANDONED BY BURYING ON-SIE. I INSTALL FOUNDATION OLFJN01 T � � I I I � � I I I I I DATE*9/10/02 F� �3![Q�O Ilk / tU— v��; ••... . �4� DRAWN BY: B.S.G. �O�p SCALE: ALASKA NVATER & WASTEWATER , CONSULTANTS, INC. 6001 DF9APP POAD, SUITE 29 • ANCHMAGF AK 00504 • FNONF (007)537-0170 • FAX (001)339-114A 1" = 40' ..............•.. Q""' .... PREPARED FOR: PHONE NUMBER: PAUL & LORRI DAVIS 333-5794 PAGE NUMBER: 2 OF 3 O p p '• f A. am ss- j Q e —795 �0 �e� ,• .••.. •' �qaG 44e p�°fnd°pO\� ��400000� LEGAL DESCRIPTION: SST SUBDIVISION; LOT 2, BLOCK 2; TYPE OF WORK: 40 SCALE SITE PLAN i'UNICIPALITY OF ANCHORAGE ' Hea and Environmental Protei ,n Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 INSPECTION REPbRT Off! -SITE SHWAGE DISPOSAL SYSTEPA NAM�� /d%� -C MAILING ADDRESS e T kQ�_ PHONE '- LOCATION 4-5'�7Q4 IM1 LEGAL DESCRIPTION SEPTIC TAN/KJ: `� DISTANCE PryNUMBER OF FROM WELL W MANUFACTURER Qs`AZeiY -MATERIAL - / _ COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITYALLONS. TIL F npninl r-IrLD:firpr r r , ( TOTAL LENGTH�� DISTANCE FROM WELL OZS _FOUNDATION 110—_NEAREST LOP LINE 2O OF LINE # Of Lines _—( DISTANCE BETWEEN LINES TRENCH WIDTH-?bIN. TOTAL EFFECTIVE ABSORPTION AREA 619�v SQ. FT. LENGTH OF EACH LINE /rzale71- t DEPTH OF FILTER DEPTH: TOP OF TILE l -O FINISH GRADE MATERIAL BENEATH TILE +� 111r. ABOVE TILE IN. SEEPAGE PIT: DIAMETER - OR WIDTH LENGTH.—, DEPTH Log Crib Rings Crib Size: DIAMETER --DEPTH- DISTANCE FROM: WELL -- - TOTAL EFFECTIVE BUILDING FOUNDATION_ , NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT. Well C 1 a s s jZ,,0 Depth: Well Distance To: Lot Line Bldg: Sewer Line: Pipe Materials :ASr1hqoje1 k .sv # of Bedrooms: Installer• Remarks: I I 1 fl - IL t 7- I -rri1 I-1��-oi I '_ t -- -- - J f I 1 DATR''" APPROVED __ tl� �- J. i.. CQ H N .; rn ,'r-' IpVj to W N " . O - p rt �► td9 �- p H N .; rn ,'r-' IpVj to W N " . O - p rt �► td9 W m .. H H t P to O O. 'O O O O O O O O O O v; v to : r; -.`"..., N W O jN CO �--� :0 r' 0 ;i -J ';N l0 :�O \U r^ lJ j N Ul W - jN �t V C!) rt Oco: E� O :iis�o a V] b : ; ti �4� Y i tj i H 3 � COJ r i N n :rr.. ?U b N 'O ;:O Y N i rt td .yam 0(n p x " 1r i t O -t :, } i rt i tl , (DD ::J t" �r rt n rt-_: W CUll:) g`t+ :.�j ' V C C, r; c) v H !] H H H .'H H H H.' H H O H O H O H O H O H O H O' H H O O H O' H" O O ON ? Al " L' Fj r i •N t5 rt n i R' H' H `► 3 � � H H H H H, � � � iz �� :N : Y• ` :Y• - n .0 i`m E r� 'c • (D w •n i✓ rt � O'' •O N. N -Ct ...(D lHn LENGlH DIMENSION IS lHE LENGTH ( 1 N FEET) OF THE TRENCH QR DkHINFIELD- THE LKPlH UF H TRENCH QR PIl IS THE DlSTHNCE GE[WEEN THE SORFHCE OF THE GHUUND HND THE 8QlTOM OF |HE EXCAVATION ON FEET). TM�RE l� NU SEl WIDlH FUR TRENCHES. THE GHMVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFHLL PlP� HND [H� 8UTlOil OF THE EXCHYHTlUN (IN FEET) �ki-n: C�g U 1. Fit FIE Rio M.- 9 K`1: C: ~k -IFA r A F< :1L. t-"� �� F� F-0 1-: lot 100 Ch FIE 11,011-- 111 Iihs -I - KJ W - 9-1.�r--H H PHCKHGE PLHNT MHY 8E lNS|HLLE& HT THE PEHMITT��E'S OPTION SU8JECT lD THE �ULLQWlNG �ONDITlONS� 1E1THE} H CLHSS l UR 11 NSF PLHNT MHY BE INSTHLLED At I"! LOW lNUOUS MHINTENHNCE HGHEEMENT it, REQUIRED. IF H MHINTENHNCE HGREEMENT IS NOT KEPT YOU MHY 8E RE' QUIREED [U ENLHRGE THE SQIL HBS0RPT1ON SYSTEM HND/Q�� YQU MH^/ 8E SUBJECY TO PROSECUTION� �14�� A � � M U A! JL C:: A.: H:-.,, F -I U I U'W RIA l'- 0 9 11�4 It IB—R Fit l -IH fi—i� � DEB HHTMEN| OF��HL[H UNMETHL P TlON HND ENVIRN | HPPROVHL �kE�T, HNCHORHGE/ M.-:- 99�—~\ 279-2511 SU8JEC4 ^ ' |~ �� ^U~� ��P��\«- ` ' FT-HM1l WO. ` HPPLICHNl STEPHHNS CONSl. ]810 EHS[WOUD LUUP �}492I16 Y� LUCH[1UN HOMES7i +Ilj ZF�l\o�^� /\ � LEGHL L2 82 SSTS/D LOT SlZE FELl� lYPE OF SUIL IS: TRENCH MHXIMUM NU018ER UF 8EDRU0MS 4 SOlL RHTING (SQ FT/BR)= 165 fHE R�HUIRED SlZ2 UF THE SO1L H8SURP\IUN SYSTEM IS� I -U= 11, LAC U M. r-4 LJ " H`1-1 Ci IN: I'Ll�� lHn LENGlH DIMENSION IS lHE LENGTH ( 1 N FEET) OF THE TRENCH QR DkHINFIELD- THE LKPlH UF H TRENCH QR PIl IS THE DlSTHNCE GE[WEEN THE SORFHCE OF THE GHUUND HND THE 8QlTOM OF |HE EXCAVATION ON FEET). TM�RE l� NU SEl WIDlH FUR TRENCHES. THE GHMVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFHLL PlP� HND [H� 8UTlOil OF THE EXCHYHTlUN (IN FEET) �ki-n: C�g U 1. Fit FIE Rio M.- 9 K`1: C: ~k -IFA r A F< :1L. t-"� �� F� F-0 1-: lot 100 Ch FIE 11,011-- 111 Iihs -I - KJ W - 9-1.�r--H H PHCKHGE PLHNT MHY 8E lNS|HLLE& HT THE PEHMITT��E'S OPTION SU8JECT lD THE �ULLQWlNG �ONDITlONS� 1E1THE} H CLHSS l UR 11 NSF PLHNT MHY BE INSTHLLED At I"! LOW lNUOUS MHINTENHNCE HGHEEMENT it, REQUIRED. IF H MHINTENHNCE HGREEMENT IS NOT KEPT YOU MHY 8E RE' QUIREED [U ENLHRGE THE SQIL HBS0RPT1ON SYSTEM HND/Q�� YQU MH^/ 8E SUBJECY TO PROSECUTION� �14�� A � O��R0�-�� BHCKF1LL1NG UF MAY SYSTEM WITHUUT FINHL INSPECTIUN HND HPPROVHL BY TH1S mPHHTMENT WILL BE SU8JEC4 TO PRUSECUTION M1NIMUM BETWEEN H WELL HND HNY ON—SI-JE SEWHGE DISPUSHL SYSl�M lS 100 FEET P0R H PRIVHTE WELL OR 200 FEET FUH H PU8LIC WELL WELL LOM-, HRE REQUIRED HND MUST BE RETURNED TU THE DEPHRTMENT WIlHIN �0 DHYS UF THE WELL COMPLETlON� UTHER H�QUlREM�NTS MHY HPPLY� SPECIFlCHYIQNS HND CONS TRUCT%UN DIHGRHMS HRE WEE- Pit M X -K~ IEEE 1-1 F"P X lot FEE to; IJ to I -; FEE Fw1 kit is' to! :11 W..' ��e. I GER|lFY THHT 1: I HM FHMlLIHR WITH THE BIEQUIREMENTS FOR ON—SITE SEWERS HND WELLS HS SB Ftits TH BY THE MUNI C1PHLITIr' UF ANCHORAGE. 2� I WlLL INS/H.L. THE SYSTEM IN HCO]RDHNCE WITH ME CODES. I� I UNDEkSlHND THHT THE ON—SITE �SEWER SYSTEM MHY REQUIRE ENLHRGEMENT IF [HE RESIDENC� lS R�MQDELED TO INCLUDE MURE THHN 4 BEDROOMS 5IGNED� ^-�---- ^=,^--. -HPPL1CHNT STEP [ CIA exvDHTE___[__�,�__��?_ Vl0 ALA LAB Mr. Mike Stephens 3810 Eastwood Loop Anchorage, AK 99504 4040 "B" STREET, ANCHORAGE, ALASKA 99503 PHONE: 907-279-2581 July 25, 1977 W.O. #A18114 Grid #2439. Subject: Subsurface Investigation for Suitability of On -Site Sewer, Lot 2, Block 21 SST Subdivision Gentlemen: Transmitted herein in accordance with your instructions are the results of the above referenced investigation as performed by us on July 18, and 19, 1977. The scope of this project is investigation for suitability of an on-site sewerage system. Included in this transmittal are: Test Hole Location Sketch Figure 1 Test Hole Log .,Table A Explanatory Information Sheets 1-3 The exploration was conducted with a Nodwell mounted Mobile B-50 drill rig using a continuous flight solid stem auger. The rig is owned and operated by Denali Drilling, Inc'. Drilling was supervised, the test holes logged and percola- tion test performed by Mr. Mike -Hewitt, Technician with Alaska Testlab. The log of the test hole is included as Table A of this report. In interpreting the log it would be helpful to utilize the explanatory information contained in Sheets to 3 of this report. When drilling was completed a 3/4" slotted PVC pipe was inserted in the hole to aid in determining the free water level. F'or the percolation test, the test hole was filled with water and left overnight to saturate. on returning the next day, the hole was refilled with water and the drop in the water level carefully monitored over the next 60 minutes. This proceddre is not a standardized percolation test, however, we understand that the Municipality of Anchorage, Department of Public Health and Environmental Protection prefers tests performed in this manner to evaluate a site for a proposed on-site sewerage system. 11r. Mike Stepheni July 25, 1977 Page 2 Using the above method, the observed minimum percolation rate was 8.0 minutes per inch. No water table was observed during drilling. It should be noted though, that the free water level normally fluctuates seasonally and with precipitation. We hope this report meets your present needs. If we can be of further service, please feel free to contact us. Sincerely, ALASKA TESTLAB AO ?k. Ihm 44v�� R. Mark Hansen RMH:rb Enclosures Lot 2, SST Subdivision Block 2 Depth in Feet From To 0.0' - 1.0' 1.0' - 13.0' 13.0' - 19.0' Bottom of Test Hole: Frost Line: Free Water Level: W.O. #A18114 Date: 18 July 77 Logged By: M. Hewitt Soil Description Brown Peat and Organics. F-4, grey Silty Gravelly Sand, SM, medium sand, occasional cobbles, damp, subrounded particles. Includes very gravelly layers below 6'. . F-4, grey Sandy Silt, ML, with fine sand and trace gravel, damp, stiff, Pl+. 19.0' None Observed None Observed Type Sample Depth Blows/6" Mo Sample Unified 1 4.5' -- G SM 2 9.0' -- G SM 3 14.0' -- G ML 4 19.0' -- G ML Remarks: 1. Type of Sample, G=Grab, SP = Standard Penetration, U = Undisturbed. 2. Dry Strength, N=None, L=Low, M=Medium, H=High. 3. Group refers to similar material, this study only. 4. General Information, see Sheet 1. 5. Frost and Textural Classification, see Sheet 2. 6. Unified Classification, see Sheet 3. TH. G/VD. 5U,2FOGE .�dT7-O/Y! OF �'�LO.el1T/O.1/ SOIL PROFILE - 54AI iF ; UVAFZ. TEST NOG,5 DATq Fe:�71w A4::%e4 TESTL4.9 ��Po2T 5 5 , T, 5 U,Ba/Y/�/ov OfjTFO >iY7Ll�GH, /9 7 � TH #� is t MumupnL\Lory @r HugORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section -- Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-082-19 Expiration Date: q — R ( — z Z- 1. GENERAL INFORMATION Complete legal description SST Block 2 Lot 2 Location (site address) 9801 Homestead Trail Current property owner(s) Paul & Lord Davis Day phone (907) 441-0082 Mailing address Real estate agent 9801 Homestead Trail, Anchorage, AK 99507 Dave Windsor 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone (907) 727-3300 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic 00-1 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 55 D Waiver Fee $ Date of Payment Date of Payment Receipt Number 09c(7 5b Receipt Number COSA # D S C ,�- )_1 � 9 7 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. 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. 6. DSD IGNATURE System #1 Approved for __� bedrooms System #2 Approved for bedrooms Disapproved Date 06/15/22 4 0� .q4 /*: 49TMI � •* / ............... Ben)arr)LrSchiller �(�,��slF�. • CE 12592 PROFESS10O Conditional approval for bedrooms, with the following stipulations: `l��tltTV ll((rrrrrrr N_SlT �INgT,- "� WgsT__A ND m V; J G M BY Original Certificate Date: 7" 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 l Legal Description: SST Block 2 Lot 2 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 12/07/77 Parcel ID: 015-082-19 Structure served by this system Well production at time of test 5.6+ Qpm Water storage tank volume N/A gallons Total depth 334 ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to282* ft OR Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate mg/L ❑ Nitrate less than MRL (ND) no Wires are properly protected Arsenic ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) 24 in. Collected by Forge Engineering Date of flow test for COSA 05/30/22 Date of Sample Static water level at beginning of test 92 ft. Comments *Depth of casing taken from HAA approved 1/24/95 B. TANK DATA Age of tank(s) 19 years Tank type/material SEPTIC/STEEL Measured operating fluid level in septic tank 49 ❑ Standpipes/foundation cleanout per record drawing Date of pumping Isaacs Pumping 10/29/21 D. ABSORPTION FIELD DATA Which system tested (date installed) 09/26/77 ❑ ALL standpipes present per record drawing Total measured depth from grade 12.2 ft (max) Measured depth to pipe invert from grade 4.2 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A gallons STATION 06/02/22 ❑ Requi aintenance completed Age of lift station years Lift station material Comments: Adequacy test date 05/30/22 Results ❑✓ Pass For 4 bedrooms Fluid depth prior to test 46 in Water added 713 gal New depth 47 in Elapsed time 1440 min Final fluid depth 44 in Absorption rate '600 gpd Any rejuvenation treatment (past 12 months) N/A If yes, enter date N/A Comments/Deficiencies: Trench cleanout closest to septic tank missing. Far trench pipe is combination CO/MT. Additional double cleanout added pre -tank some time after installation COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Q Septic Tank/Lift Station on Lot > 100' if No ft Community Sewer Manhole/Cleanout > 100' 0✓ Yes if No ft M Yes if No ft Neighboring Tank > 100' [Z] Yes if No ft Private Sewer/Septic Line > 25'[Z] Yes if No ft Absorption Field on Lot > 100' [D Yes if No ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' ft Community Wells > 200' Q✓ Yes if No ft Animal Containment > 50' El Yes if No ft P Yes if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' MYes if No ft M Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' M Yes if No ft Surface Water > 100' P1 Yes if No ft Property Line > 5' M Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Yes if No ft Private Wells > 100' Q Yes if No ft Water Main > 10' Yes if No ft Community Wells > 200' n 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' Q 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' ❑✓ Yes if No ft Community Wells > 200' Q✓ Yes if No ft Surface Water > 100' [] Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION IAW ' ' ' ' ! :q49� I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with /` .. .... .. .. MOA COSA guidelines in effect on this date. • , . ` . • . • , , BenjarT�Ochiller Fc •. CE 12592 • �� /��F ' • 06/16/22, • COSA Checklist yellow sheet I 30.0' 5.0' x 10 WiTH CONC. PORCI 0.9' CANTS 10' C.E.A. EASEMENTS a I t ( 4 S.F. HOUSE DETAIL Scale: 1"=30' Lot 3 I S 89'56'59"E 299.62' CHAIN-LINK FENCE) Z —I '.''GRAVEL`•..' :_`.: �. rri 0) "i rev 175.9' r SEPTIC PAVEMENT Lot 2A ASPHALT PAVEMENT ,0. 12 SHED HED r/ 9.9' x 20.2' SHED- 0 �r 50.0' U) 0 O O m rn N 10.2' Lot 1 I 14.7' x 19.7' SHEDA-�'i N 89'56'59"W 299.55' \ Lot 1 \ 0 \1(Z UTILITY � EA IT / ME �--- MORTGAGE SURVEY X SCALE 1" —=50' GRID SW 2439 Project No 22-374/A1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone (907) 522-4625 Fax y�"tco04p�� Professional Land Surveyors ken4longsurvey.com v OF A, I Jonafhonalangsurvey.com I hereby certify that I have surveyed the following described property: LOT 2, BLOCK 2, S S T SUBDIVISION (Plat No. 77-152) Anchorage Recording District, Alaska, and that this Mortgage Location Survey is a representation of the conditions that were found on the date the survey was performed. This survey does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained hereon shall not be used to establish any fence, structure, or other improvements. Dated this the 4 Day of�na4 't 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. 49TH y*l KENNETH NG �Q�pF ISS -5202. ''�5� AECC963 s. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my invest!gation 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. Phone Name of Firm 17034 Eagle River Loop Roed NO Address a 9577 // b cls Date — E'ngineer's signature — Oar Gam,,........•.. Et1( 9 ROBERT C. COWAN i , -8801 Ile 6.' OHHS SIGNATURE x Approved for bedrooms. - Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments / p Date 'The Muniopality of Andhorage Department of Health and Human Servides (DHHS) issues Health Authority _%'i 'aapprovaI bert(fi;: t s based only upon the representations given in paragraph 5 above by an independent profes ionaleridineerregistered inthe State ofAlaska. The DHHS does thisasacourtesytopurchasersofhomes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not ertificate is issued. The Municipality of Anchorage is not conduct inspections or analyze data before a c ons in the professional engineer's work. responsible for errors or omissi .72-M(Rsd.191). Back MOA #21 - Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: by -f- �, ��C�, S�% s�� Parcel I.D. 0/5 -oe,2- 0 _6Q6 A. Well Data Well typei (2� VA-?l�-_; If A, B, or C, attach ADEC letter. ADEC water system number �,A Log present (Y/N) yds Date completed Driller Total depth 33Y ` Cased to �`v'2 Casing height Sanitary seal (5Y N) YES Wires properly protected %u) 5. WATER SAMPLE RESULTS: Coliform FROM WELL LOG AT INSPECTION Other bacteria m Date test 0, L--�-f ?:i� L 9S of Static water level (riNK 8a r � K �m 6` y D r Well flow 9•P•m 9 P•m• M_ y o Pump levell (�Nk /3/ < 4, t7;< z f Cn M <h W S SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 166 On adjacent lots inr Absorption field on lot /00 �� ; On adjacent lots /04 4 Public sewer main Af% Public sewer manhole/cleanout b-) Sewer service line o25i l Petroleum tank fl)qtU 6wt w WATER SAMPLE RESULTS: Coliform Nitrate 0 • /o mg L Other bacteria Date of sample: t 06 S Collected by: Sk S �[,,JEePING B. SEPTIC/HOLDING TANK DATA Date installed 9 I -:a Tank size /,;LSOCompartments !/1� Cleanouts ) /BC Foundation cleanout (Y/& Depression (Y j High water alarm (Y I Alarm tested (Y/N) 44 Date of pumping Pumper 4 Eeolc SEPARATION DISTANCES FROM SEPTIC/HOtetNG TANK TO: Well(s) on lot I.O6 k On adjacent lots I CO Foundation I U To property line I O Absorption field g Water main/service line 10 + Surface water/drainage 100 4 72-026(3W)'Front CONTINUED ON BACK PAGE [SFT STATION �ON N Date installecl� Size in gallons_ Vent (Y/N)_ "Pump on" t_ High water alarm level Meets MOA electrical codes (Y/N SEPARATION ANCE FROM LIFT STATION TO: Manufacturer Manhole/Access "Pump off" Level at tested on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed - � �� Soil rating (GPDIFFE 16.E S��R System type ��v 2i=rucc! Length _ 61 Width Gravel thickness 8/ Total depth 13 Total absorption area `l �?6 St— Cleanout present Y/ N) 1' 4�_, Depression over field (Y/M Date of adequacy test 1 ��3 r Results (pass/fail) for Bedrooms I � Water level in absorption field before test -After test Not Peroxide treatment (past 12 months) (Y/I$ U vo t KNOW n1 If yes, give date _tVA SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1601-1- On adjacent lots 106 + Property line ! 4 14 To building foundation to 4 To existing or abandoned system on lot _ 6Z/J On adjacent lots as Cutbank �) 14- Water main/service line_ /0 Surface water _ 1 n0 Driveway, parking/vehicle storage area /Q Curtain drain E. ENGINEER'S CERTIFICATION I certify that l have checked, verified, or conformed to all MOA and HAA guidelb -C , - Signature ---�= �• �r,�-- r'' �1'; 1� Engineers Name go g ROPCRT C C OWAN Date 1 I t, °I S `e�y; < '.� ce eeo t ;✓ 'c f� HAA Fee $"IJV Waiver Fee $ Date of Payment Date of Payment _- Receipt Number _ <a - 27 001(J Receipt Number _ 72.026 (3/93)' Back clion. 01/13/95 16:59 COMMERCIAL TE5TIN6 r 9076941211 ME Environmental Services Inc. ZtL Laboratory Division CRef.# 95.0080-1 Laboratory Analysis Report Client Sample ID L2 SLK2 SST SID � Y Matrix WATER NO.527 002 Client Name S # S ENGINEERING WORK Order 11831 Ana), Order- d By R. SHAFER Printed Date 01/13/9S W 18:08 bra. LlcojvOl1 1'""" Collected Date 01/05/95 ® 11:40 bra. Project$ Received Date 01/05/95 a 12:00 bra. PWSID UA Technical Director ST$PHEN C. EDE Released Sample Remarks: ROUTINE SAMPLE COLLECTED BY, J.W, QC Allowable Ext. Ana), Parameter Results Qual •---------------------------'-------------• Unita Method Limits Date Date Init Nitrate-N 0.10 U -------------- mg/L CPA 353.2 ...------------- 10. .---- 01/13/95 CMR ccc........,www==_c===== aczz......==__====......... __ -------- .........wsza==zs==..........=a===caa.r. * See Special Instruction& Above UA Unavailable ++ See Sample Remarks Above NA = Not Analyzed U°= Undetected, Reported value is the practical quantification limit. LT a fie*v Than D'.'= Secondary dilution. GT = Greater Than a .r: 200 W. Potter Drive, Anchorage, AK 99518-1605 — Tel: (907) 562-2343 Fax: (907) 561.5301 ENVIRONMENTAL FACILMES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO. WEST VIRGINIA MUNICIPALITY OF ANCHORAGE..,-, � DEPARTM F HEALTH AND ENVIRONMEf _.PROTECTION 825` L Street, Anchoraae. Alaska 99501 264-4720 #1: Time 9:30 a.m. #2: Time Date 3-22-78 Wednesday Date Date Received: March 20, 1978 #3: Time Date Insp Pratt Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: First National Bank of Anchor 2. Mailing Address: Post Office Box 4-2090 99509 Phone: Property Owner: Darrell Thompson Phone Mailing Address: 3821 West 79th Avenue 99502 3. Legal Description: Lot -2 Block 2 SST Subdivision 243-571 4: Single Family Residence: (x) Number of Bedrooms: Four Multiple Family Residence: ( ) Number of Bedrooms: 5. Well System: Individual Well (x) Community/Public System ( ) Permit # Depth of Well 334' Well Log on File (x) Construction ��,>�� Bacterial Analysis ��1-�Slci� � A 6. Sewage Disposal System: On-site System (x) Public Utility ( ) Permit # Installed 1977 Installer��_ au.,. Septic Tank Size Ia,5'0 Manufacturer / Absorption Area Soils Rate Z�oS� Material 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line i Page_,•.. o , Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 2 Block 2 SST Subdivision Comments: Affadavit Attached: ) Letter Attached: ( ) Approved: Date: -:5 — Disapproved: Date: Department Worksheet: UL -09s ,O U6I c Od0 u 11VW 1VN011VNH31NI HOJ LON IL61 ''dV taals ,ay/o Gas) —MMAMA 39tlN3AM 30NNHOSNI ON 008E WAad Sd (a$elsod snld) })0S-11VW 0313112!30 2103 1d1333d i - _ z .................................... (paslnbas aay oilxa) A83AI130 1tl133dS _ ...................................................... AlNO 33S53HOOtl Ol H3AI130 X09 - 999 """""•• A!uu aassaAPPe 0; AJOA!IaP 41!M S331AH3S Oge " pajeA!1ap asayM pue alep 'WOyM 0; sM04S 'F. 1d1333N Ogg •. •....•... Aluo aassaipDe o; Aian!lap y1!M NN013N OgI-"""""' PaAaA!!ap alep pue WoyM 01 SM04S 1 S333 1tlN011100tl 80d S331Atl3S 1VN011d0 3003 dIZ (INV 31tl1S "0'd 'ON (INV 133HIS 01 1N3S 31tla NO MMUSOd (a$elsod snld) })0S-11VW 0313112!30 2103 1d1333d i - _ z IUNICIPALITY OF ANCHORAG- Department of Health and Environmental Protection a / 825 L Street, Anchorage, Alaska 99501 Irr 264-4720 quest for Approval of Individual Sewer and Water Facilities 1. Property Owner: Mailing Address: Phone: Jam. 2 . Name of Buyer: Mailing Address: Q ,bye a s► l Phone: 3. Lending Institution: Mailing Address: Abet Phone:-�`�•�l`�� 4. Realtor/Agent:hE�e Phone: Z7(.=2,tt Mailing Address: �� r 5. Legal Description: ,,,� �• -+t Street Location: a 6. Single Family Residence: ( Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: 7. Water Supply:.,_ *Individual Well (VI Public/Community System ( ) If Individual Well, well depth If Community System, name of system 8. Sewage Disposal System: *'On-site System ( 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 is over two(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77