HomeMy WebLinkAboutSECLUDED HILLS BLK 2 LT 4clud
d Hills
lock 2
Lot 4
017-343
-12
L ' '~ Municipality of Anchorage
Development Services Department ,.~.,~.
Building Safety Division ~'~-
On-Site Water and Wastewater Program, 4700 S. Bragaw St.
P,O. Box 196650 Anchorage, AK 99519-6650 Page of
www. cLanchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: .~-~cO ~ ~"(~) l¢5)~ PID Number:.
Ra"~: "~"o..~.'tt-- {"Z. ko~.~.~, WastewaterSystem: [-INew ~'Upgrade
Aririress:
! %'-5 '5( ('~ ~,, ct- Lo,.,~...- ABSORPTION FIELD
Phone:
Number of Bedr~.~,m, ~eepTm~c~ r'l ~hallowTrench r'l Bed r-i Mound
"5 ~ct- HZ.t?- '7-' r~ oth..
LEGAL DESCRIPTION .~Ra,r~: //,, ?
BIo~k: Lot: ~ GPD/FI~ FI.
Subdivisiofl: __
Depth to I~ipe bottom, from o~gi,,al grade: Gravel depth beneath l~ipe:
Township: Range; Section: I Fill edded abov~ odgmal grade'~ ~ FI, FI.
Number of lines: I Distance between lines:
Clas,~fication (Private. A. B. C): T~ Cased to: Total absorpfio~ area: Pipe Material:
FL .~ Dele Ins
. SEPARATION DISTANCES [] Septic r'l Holding J~S.T.E.P. [] Other:
Septic Absorption Eft Holding =ublic/Pdvate Manufacture¢:. Capaaty:
Tank Field StalJon Tank Sewer Une __
Mate~a~: ~ -- Number of Compartments:
Manu~acluren
Loc~ao~ and
Assumecl 6levat~on:
[Otj r ~l.
E_ngj~eZ'g,~tamp
Inspections performed by: /v~r~ ~]¢~./~ {,, Dates: 1~' ~ ~ ..... .......~
Development Services Department ApproVal
Rev,·wed approved by: Date:
Perr~!.t No. SW950188
Page .. 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: .343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: LOT 4 BLK 2 SECLUDED HILLS S/D
· of 2
PID No.: .017-343-12
Lof 4
77~ s.f.
~ MAI:~N /~ B GRND. PIPE
ELEV, ELEV.
B1 76,8 97 100.5 94.8
55.7 84 100.5 94.6
40.0 73.0 ~oo.5
35.0j 70.9 100.5
DI~R~ER ] 32.0~ 60.8 100.6 95.5
co4 - ~ ~~ ~o.~ ~oo.~ 9~.~
co~/ /~. ~.~~oo.~ .~.~
c06/ / 45. ~.4 ~00.7 95.8
· 96.0
MT2 50.~ 100.6
SE~'IC
N.T.S.
Lot 3
C06
C08
\,,,GARAGE
1 1/4"
STEP TANK
\\HOUSE
\
~'WELL
,,ASBU LT
SCALE: 1"=40~,/
/
I
I
/
/
/
/
/
/
¢08
yTEST HOLE RA~)IUS
' I
I
o , DIVERT~R
/
/
/
TCO
7.7'
SHED
.o.z
MICHAEL N. ANDEI
CE.
I !
Rick Mystrom,
Mayor
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
September 30, 1996
Fred A Rhoades
2441 Oak Drive
Anchorage, Alaska
99508 3267
Subject: Lot 4 Block 2 Secluded Hills Subdivision
Permit #SW950188, PID #017-343-12
The subject permit, issued August 4, 1995 by this office for a
single family well and/or on-site wastewater system, has
expired as of August 4, 1996.
A new permit must be obtained from this office for a well
and/or on-site wastewater system NOT installed by the
expiration date.
If you have drilled the well, a well log must be sent to
this office for documentation of the installation and to
close the permit.
If a licensed Professional Engineer has inspected the
installation of the on-site wastewater system, the original
as-built inspection report must be sent to this office for
review, approval and documentation. Ail inspection reports
must be submitted within 30 days of construction completion.
W-hen applying for a new permit, the fees are: $320.00 for an
on-site wastewater permit; $120.00 for a well permit and
$440.00 for a combined on-site wastewater and well permit.
If you have any questions, please call this office at 343-4744.
On-site Services
enc: Copy of Permit
cc: James Mark Wright, P.E.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
PoO. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE)
PERMIT NUMBER:SW950188
DESIGN ENGINEER:JAMES MARK WRIGHT, P.E.
OWNER NAME:RHOADES FRED A
OWNER ADDRESS:13331 BADGER LN
ANCHORAGE, ALASKA 99516
PARCEL ID:01734312
PAGE 1 OF 1
PERMIT
DATE ISSUED: 8/04/95
EXPIRATION DATE: 8/04/96
LEGAL DESCRIPTION:
SECLUDED HILLS BLK
2 LT 4
LOT SIZE: 51773 (SQ. FT.)
NUMBER OF BEDROOMS: 7 THIS PERMIT: 7
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
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 (iSAACS0) .
THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4o PROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED
July 20, 1995
Department ef Health and Human Services
Anchorage Alaska
James Mark Wright P.E.
2900 West 33rd Ave.
Anchorage Alaska 99517
(907) 243-4361
RE: On-site sewer system permit (upgrade) request for SECLUDED
HILL SUB'D, Block 2, Lot 4.
Dear DHHS,
This is a request for an on-site wastewater disposal system
permit. The present system is in failure. The existing systems
on surrounding lots appear to be performing adequately. A test
pit was excavated and a percolation test preformed with a
percolation rate of 4.5 min/inch.
The existing septic tank will be replaced with a 2,250 gallon
S.T.E.P. tank.
No impacts to the surrounding properties are foreseen.
A flow splitter similar to Zabel Z200 Flow Divider to split the
flow between the absorption trenches are
The topography of the area is sloping from the north east to the
south west at about 5% - 10%. The lot footprint is 320' by 275'
for an area of 51,773 square feet.
Sincerely,
Permit No. Page l_ of 3
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 .Anchorage, Alaskc 995'19-6650. Telephone: 545-4744
On Site. s. ~--~Wa°~S~Later Disposal Sv~stem and/or Well Inspection Report
Legal ueocr p[ion: '--~... ~r ~- ~--i ~.e~z .'h PID No.
/
~LL
SCA
p-,,-f'
45'
CLEAN OU¥'~
I 4"CUEAN OUT
FR Oivl SEPTIC
45'
~ ~-- ~'~ 4"CLEAN OUT
4" CLEAN OUT
PLAN
~..45 LIN. FT,
S -- 0.0%,
VIE~W ~x'x"X~ -IvlONITORINC TUBES
TER FABRIC
~~~ i FROM SEPTIC
} PIPE TANK
4" PERFORATE
¢" MIN. COVER
ELEVATI ON
SECTION
FILTER FABRIC
4" PERFORATED PIPE
DRAIN ROCK
SECLUDED HILLS SUB'D, BLOCK 2, LOT 4
Municipallty of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION: ~'~C. L (,..~/~/~__ ~ /~//~-L~' Township, Range, Section:
PL2 ~)J~ SLOPE
9
10
11
12
13
14
15
16
17
18,
19-
20-
SITE PLAN
WAS G.OUND WATER
ENCOUNTERED;'
IF YES, AT WHAT
DEPTH?
Depth Io Wilef After
Mon~ing? ./,,/0/¢'~-.- Dam:
Reading Date Gross Net Depth to Net
Time Time Water OroD
71~/q3~ I~ ~;~' ~ '~
t; I1:. 1~' ~ ~"'
PERCOLATION RATE ~ (mtnute~mch) PERC HOLE DIAMETER ~-~ ''~/
TEST RUN BETWEEN ~1~. FT AND ,
.~OMMENTS
ACCORDANCE V~H ALL STATE AND MUNICIPAL GUIDELINES iN EFFECT ON THIS DATE.
MAILING ADDRESS
LEGALs/DESCRIPTION
LOCATION
DISTANCE TO:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAl. SYSTEM AND/OR WELL INSPECTION REPORT
O DPGRAOE
Liq. c~
DISTANCE TO:
Manufacturer
IWe. Il ~00 / 1 Absorption aJ;ea Dw. eJJing ~/-
I F HOMEMADE: Inside length Width ~d~.
Well
line
DISTANCE TO:
No. or lines/ Lengt. y~h
Top of tile to finish grade
Dwelling
Foundati~_~ f-
Total I~th~f lines
Material ~eeneath tile
Material
N eares~,J~.g~ Ii n e
Trenc]:~.~ d~
~2~ r,~ inches
inches
NO. OF BEDROOMS
PE O. ~
No. of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
Dist~)~72)er] Ii n~s
I Total ef.f~c,tive absorption area
IPERMIT NO.
Length
~r
Width
Depth
Type of crib Crib diameter Crib depth Total effective absorption area
Well Building foundation Nearest lot line
DISTANCE TO:
Class Depth Driller Distance to lot line PERMIT NO.
DISTANCE 'FO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
~OI L TEST R~TZ
REMARKS
DATE LEGAL
[:,EF'I::tF.:THENT OF HEFtLTH FINE:, EN',,,' I RONHEI'.,ITFtL F'~'OTEC'r
HF F L,[ ..Mt ~ I RODERT I-,.IRGNER
LOCFFFI ON I'J,.;~NRZP.I 5. 2'7 -~~C~ '-'"- ~
LEGFIL. ~E:~ SECI_U[:,E[:, HII_I_S LOT SIZE :~'3,5~:~:~'~, SC~LIRRE FEET
.["¢F'E OF %:~IL FIE~SORF'TION S'T'S.['EH IS: TFEN_.FI ~/~
OF E:E[:,ROOHS = 4 SOIL RRTING
I','IFIX I HIJH
N.HEEF'
THE REQUIRE[:, SIZE OF THE SOIL RBSORPTION S'.r'STEM IS:
THE LENGTH DIP1ENSION :ES THE LENGTH ,::IN FEET) OF '['HE TRENCH OR [:,RRINFIEL[).
THE [:,EF'TN OF' Ft TF.:ENCH OR PIT IS THE DISTRNCE E:ETklEEN THE SUF.:FFIC:E OF' ]"HIE
GF.:OLIND FINE:, THE BOTTOH OF' TFIE E::.::CR',,,'FtTION ,::IN FEET>.
THEF.:E IS NO SET I.,.IIE:,TH FOF.: TRENCHES.
TFIE GF'.I-qVEL E:,EY'TI4 IS THE I"IINIHLIH [:,EPTH OF GRFI',,,'EL BET[,.IEEIq .['HE OLITFRL. L PIPE
FIND .['HE BOTTOH OF .['FIF EXCFI',,,'FfFION <IN FEET>.
F'ERHI.[' FtF'F'LlCaNT HFIS THE F.:ESF'ON'=;tB ILI T"r' .['O INFCIRH TFII S [:,EPRRTHENT [:,LIR I NG "['FIE:
INSTRLLFITION II'.~SF'ECTIONS OF RN'¢ I.,.IELLS RD.IFtCEN.[' TO TFI]:'S PROPERTY RN[:, THE
NLIHBER OF RESI[:,ENE:ES THRT THE klELL, klILL SERVE.
BFICKFIL. LING OF FtN'T' S"r%TEH I.,.I]:THOUT F'INRL INSF'EC:TIOIq RND RPF'RO',,,'RL B"," TFII."5
DEPRF:.']'HEN.[' P.III_L E:E SUBJEC:T TO P[;.:OSECUTION.
HINIHUH [:'ISTFINIi:E E:E:.['I.qEE:N FI I.,.IFLL RND RN'¢ ON-.~SII'E £.:;EI.qRGE DI'.SF'OSFtL S'T'STtEH IS
J.E~E~ FEET FOF.'. FI PF..'I',,,'FITE 1.4ELL OR :[5F~ TO ;F:E~C~ FEET FROM FI F'UBLIC NELL [:,EF'EN[:,ING
UF'ON THE TYPE OF PUBLIC ~4ELI_.
I'"IIt'.,III'"ILII'"I [:,I:STFaNC:E F:'F;~:OI"'I R PRI',,,'FITE 1.4ELL TEl FI F'RI',,,'RTE SEklER LINE IS 25 FEE.[' Ftl",l[>
"FO R E:OI"IHUNI.["¢ SEI.,.IEF.: L. INE IS 75 FEET.
[]ELL LOGS FIRE REQLIIR, ED RND I"IUST BE F.'.ETLIRNED TO THE [:,IEF'RRTHENT I.,.II]"HIN 3:t~l
OF .['I4E klELL COHF'LETIL-~N.
OTHEF.'. F..'EQUIREHENTS HFI"r' FIF'F'L'T'. :SF'ECIFiCRTIONS Rf',l[:, C:ONSTRUCTION DIFIGRFIHS RF..'E
R',,,'R T LRB[...E TO i NSUF.:E F'F. tOF'EF.: I NSTFILLRT I
I C:ERTIF-'T' THRT
:[.: I FII"I FRHII_IFIR 1.4ITH "FFIE RE:C~LIIREMENTS FOR ON-SITE :SEI.,IERS FtN[.', I.,~ELLLE, RS SET
FORTH BY THE IdLINICIPRLIT'T' OF RNCHORRGE.
2: I [4ILL.. INSTRLL THE S'.r'STEH IN RCCOF.'.E:,RNC:E klITH THE CO[':,ES.
~:: I UN[:,ERSTRN[:, THRT THE: ON-:5ITE SEI.qEF.'. S"r'S'I'EH HR'¢ F.:EC!UIF'.E E"NLRF.'.6iEHEt",IT IF THE
F.:ESIE:,EN(":E IE; REI'"IO[:'ELEE:' TO INCLIJ[:,E HORE THRN d. E:EE:,ROOHS.
'~,l~r ~PPL~O~r~F H~ THE RESPON~L~P~ TO ~NFORH rHZ¢ DEP~RTD~N~ (~U~ THeE ~
THE ~,~LL ~r~xtc~. ~ ,
C;E~T [FY T~T
PERFORMED FOR:
LEGAL DESCRIPTION:
2
4
7
10
~2
13
14
15
16
17
18
19
2O
COMMENTS
[] BOILB LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERCOLATION
TEST
SLOPE
DATE PERFORMED: ¢
TI21V 27
SITE PLAN
C. Reid, Jr.
22,~: .E
WAS GROUND WATER ~/~
/t/ o
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
~,F"
Gross Net Depth to Net
Reading Date
Time Time Water Drop
/-/,t o 4'/->'-- ~.-" ?: a.: .-- , '74
'1. ~/,'/:- IO,,.,'o . ¢,¢ , o:
t'1z 0 'L'I~, -- , 7¢
t'12 0 (/,'2 7 '~- ,7q
7. ¢.',~ 7 /0,,',',, · 71 , dY
4. '/;'¢~ lO,.,'. · 7/
.C '):y'y lO ,.,'~, ,o? . d~.
P'E~cOLATION RATE 2 / (minutes/inch)
TEST RUN BETWEEN '~'- FT AND ::~'"'¢'~ FT
PERFORMED BY: ~,, /'~0 //
CERTIEIED BY:
72-008 (6/79)
WATER WELL RECORD'
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological a Geophysical Surveys
· -.~ . Drilling Permit No.
LOCATION OF WELL (Pleoeo complete either Io, lb or lc.) A.D.L. No.
~IDISTANCE AND DIRECTION FROM ROAD INTER'ECTIONS //,~t
5-,~WNER OF WELL: .
, Feet Below 4. WELL DEPTH= (final} 5. DATE OF COMPLETION
2. WELL LOG '~ S'uffoce ~0~ ft.
Mottrlol Typ4 ' .: Top Bottom
' Bockfllllng Growl pock
Dote
~ Abovo or ~ Below Iond turfoco
~qulpmont ueed:
II,PUMPING L~V~ below Iond
, ~ ~ ~ ~ · ft. offer hrs. pumping g.p.m.
· · 12.GROUTING Well Grouted: ~ Yes ~No
' Meterlal: ~ Neat Cement ~ Ofhlr:
I~.PUMP*' (If available) HP
Length of Drop Pipe fl. capacity
14.REMARKS:
16. WATER WELL CONTRACTOR'S CERTIFICATION: 15. Water Temperolure ~ ~ F ~ C
This w~/:.~ /was~-dri'llad~'under'my ~ ~ jurlsdlcllon~ end Ibis report Is true lethe /~best~'~°~mY~O~kn°wledge and belief;
~.~glster.d Buslness.~N'~) ~2 . Conlrocf L~cense Number
'-." ~/"./~'. Authorized Representative
Form O2-WWR (11/811' Copy Distribution: WHITE- St=fo DGGS~ PINK- D~iller~ CANARY' Customer
APPLIC NT FILLS OUT UPPER HAl ONLY
Property Owner \/)~"'~'~ 'I ' " Phone
Realty Co. & Agent / Phone
Address Zip Code
Type of Residence
~ Multiple Family No. of Bedrooms
~ Other
Water Supply
dividual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
mmunity For wells drilled prior to that date, give well depth (attach log if available),
~ Public Utility
Sewer Disposal
~ Public Utility When Connecled to Public Ulllily:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time Time
Inspector Inspector Inspector Insp~,~or
~//
Field Notes; t
,., , ~ ~, ~_~,,x ';~-j
3) APPROVED BEDROOMS ) DISAPPROVED
) CONDITIONAL APPROVAL'
MUNICIPALITY OF ANCHORAGE
DEPT, OF H!,,LTH 2:
ENVIRONM:~N rAL PRO J~C I ION
RECEIVED
*CONDITIONS OF AFPROVAL
Soils Reting
Date Sewer Installed
Well To Absorption Area
Well to Tank
Well Log Received
Septic Tank Size
•
''t Municipality of Anchorage SQPGE
On-Site Water and Wastewater Program milli
(907) 343-7904 ASFE Y
S A F E T Y
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 017-343-12 Expiration Date: l -2 6 _ <C)
1. GENERAL INFORMATION
Complete legal description SECLUDED HILLS BLOCK 2,LOT 4
Location (site address) 13331 BADGER LANE,ANCHORAGE,AK 99516
Current Property owner(s) WILLIAM & MELISSA CRAIG Day phone
Mailing address 13331 BADGER LANE,ANCHORAGE,AK 99516
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 6
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by:/Gell Date: 7/
l / '
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ 5 Waiver Fee $
Date of Payment ( r iq—ig C , 0% C' Date of Payment
Receipt Number (9"a'(42g Receipt Number
COSA# 05C. IM--r? Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm ANDERSON CONSTRUCTION & ENGINEERING Phone 345-3377
Address 4640 SHOSHONI DRIVE,ANCHORAGE,AK 99516
Engineer's Printed Name MICHAEL N.ANDERSON,PE Date 06/18/2018
(*%9 *f
TH •:�'r�0
I . ° :. ..
6. DSD SIGNATURE 4A .; MICHAEL N. ANDERSON • p°
i •�•. CE-94 9 ``.,.s
System#1 Approved for bedrooms. �i(e (PI/Y/,&/• `� �
System#2 Approved for bedrooms. �k .���� p�,:k c;,.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
iro
r . V3 /Qa. s 1..
D
Av.vLie 01A --& S 2f i.c mak\ 2.0 6k 4 L7
6,0,e,
.64r- -9„
::j ON-SITE co. .
: WATER ANn
•
o WASTEWATER o:
.12;<\ PROGRAM
\e-��'4CT car
A/ R\I\C�G�
�---� � �_ / Original Certificate Date: 2y9---`
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:
Nitrate Adviso ,•
COSA Checklist X ry �'
Septic System Advisory ) Rrsenic Adv •isory ,-,; .. , , .
Well Flow Advisory 'Other' •-' , ••• ' _
COSA blue sheet 10.10-12.doc '• — ^,. ••
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: SECLUDED HILLS BLOCK 2,LOT 4 Parcel ID: 017-343-12
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (Y/N)Y
Date completed 05/1983 Sanitary seal (Y/N)Y Wires properly protected (YIN) Y
Total depth 308 ft. Cased to 308 ft. Casing height(above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 5/1983 5/24/2018
Static water level 198 ft. 229 ft.
Well production 5 g.p.m. 1.47 g.p.m.
WATER SAMPLE RESULTS:
Coliform ND colonies/100 mL Nitrate ND mg/L
Arsenic: ND ug/L Date of sample: 5/24/2018 Collected by: Brent Western
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC I STEEL Date installed 8/1995
Tank size 3000 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y
Date of pumping 4/13/18 Pumper A+
C. ABSORPTION FIELD DATA
Date installed 8/14/1995 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 System type DEEP TRENCHES
Length (2 X 45') 90 TOTAL ft. Width 2 ft. Gravel below pipe 5 ft.
Total depth 8.5-9 ft. (Measured 5/24/18) Eff. absorption area 900 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 5/24/18 Results(Pass/Fail) PASS For 6 bedrooms
Fluid depth in absorption field before test S 10/45 N in. Water added 1200 gal. New depth 20/60 in.
Elapsed Time: 150 min. Final fluid depth 10/47 in. Absorption rate >= 900+ g.p.d.
Any rejuvenation treatment(past 12 mo.) (Y/N &type) N If yes, give date
D. LIFT STATION
Date installed 8/14/1995 Size in gallons 3000 Manhole/Access (Y/N) Y
"Pump on" level at 40 in. "Pump off' level at 34 in. High water alarm level at 48 in.
Datum Bottom of Tank Cycles tested 2 Meets alarm&circuit requirements? Y
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main 75'+ Public sewer manhole/cleanout 100'+
Sewer/septic service line 25'+ Holding tank 100'+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 10'+ Property line 10'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
ABSORPTION FIELD ON LOT TO:
Property line 10' Building foundation 10'+ Water main 10'+
Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain 50'+(None Known) Wells on adjacent lots 100'+
F. COMMENTS
North trench is operating in the top half of the effective depth and the South trench is operating in the lower half.
G. ENGINEER'S CERTIFICATION �""%"°`7‘-‘A. ,
c- CFAt It
I certify that I have determined through field inspections and p`�;'• Sti
review of Municipal records that the above systems are in 4'. ••;�v i
conformance with MOA COSA guidelines in effect on this date. ;*149TH
.k :49TH •• *
Engineer's Printed Name MICHAEL N.ANDERSON.PE
9 � MICHAEL N. ANDERSON :Z"�
Date 06118118 1 c•. C -969 .'�%f
t1��►tto.S���
COSA canary sheet_2-6-15.doc
Pre/iss-
MUNICIPALITY OF ANCHORAGE
(ria
Development
�-- ;
- Phone: 907-343 7904�� � _ 907-342.7997
Development Services Department � t
On-Site Water & Wastewater Section Fax
lift Station/Pump Vault
Maintenance Log
Street Address.
331 f r,
_
PiD ._----
Phone_.22 .a c'al- - Leo: Desc.__._..._ _ ---�
3g ti .Tan -Pumping completed
-Sludge level inches -Pumping: required y_e
if sta Qa
.Pump basket cleaned agLii.S2
-Effluent fitter cleaned ge
-Centro' floats cleaned (gQ
-Proper float settings confirmed €4_0.0
-Operation satisfactory ( ,._!' '
Nam-SOW=
-Dedicated electrical alarm circuit f Q •Audible and visual alarm inside dwelling NO7) o
-Alarm system operation „§At.i_f c✓ of s i SiBrat
tanbaie Rios Y� ��,
-Ground water intrusion at riser to tank connection -Weep hole functional ;r:y: n.�
-Ground water intrusion around pipe penetrations yes_ �o
Properly Secured
-Manhole lid: Functional Insulated
--AAP manufacturer required inspecttons and maintenance completed yes ne
r oms____ en> _ . ...
pc.5.S C.oc.:e. ...
.M7 .n mance Provide
s Date of rnaintenance.� yr i8
Technician Laces, f/
Company .fl �� _ '� �'�� _
Signature
/ - Dateithy
Nlailin<l Address: P. 0. Box '196650 * Anchorage,Alaska 99519-6650 ' www.muni.org
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON;-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. O ( ':)-., '5~'~ --/' "~
GENERAL INFORMATION
Complete legal description
Location (site address)
Expiration Date:
Current Property owner(s)
Mailing address
Day phone :~7~'..- %~/'-(
Lending agency
Day phone
Mailing address
Real Estate Agent
"Mailing Address '
Un/ess othem, ise requested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS: ~
Day phone
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class __
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[~ Individual On-site
[] Individual Holding Tank
[] Community On-site
[] Public Sewer
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of 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
title (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 /'v3'l,'~,~.//',,'~ ,/~
Address ~-/~ ~, [ /~,.~ 4-w~,,.~ /~__.
Engineer's Printed Name
Phone
Date
[,//' Approved for '~:P
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
By:
Attachments:
COSA Checklist
Septic System Advisory
Well .Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
if_,/', / Original Certificate Date: '?~ -/~) ',//'
· (Rev, 11/05)
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Road
P.O~ Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description:
A. WELL DATA
Well type ~)~ ~-i,-c~ IfA, B, or C provide PWSID #~
Date Completed 5"/~'~ Sanitary seal (Y/N) ,y'
Total depth 30~ ff. Cased to 30~ ft.
FROM WELL LOG
Date of test '~/~'~
Static water level ! q ~1 ft.
Well production ~, 0 g.p.m.
Parcel ID: O[ ~z_ TH ~ -[ 7~
Well Log (Y/N)
Wires propedy protected (Y/N)
Casing height (above ground)
AT INSPECTION
· -02. ft.
/, 3 ~ g.p.m.
WATER SAMPLE RESULTS:
Coliform ~ colonies/100 mL Nitrate 4 m.g/L
Arsenic: .'~ ug/L ' dateofsample:~'/~//~!
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material '5/-- ~-~ l
Tank size 3o00 gal. Number of Compartments
Foundation cleanout (Y/N) ~/ Depression over tank (Y/N)
Date of pumping ~//~"//, Pumper
C, ABSORPTION FIELD DATA
Date installed ~/t'~/q~' Soil rating (g.p.d./ft2 orft2/bdrm)~
Length L~-I /'/¢ ft. Width
Collected by:
Date installed ~"/95'"
Cleanouts (Y/N) y
High water alarm (Y/N)
[,'Z..- Systemtype D,e...p '~¢J,~..
ft. Gravel below pipe ~;;~ ft.
Total depthS'0/,5'' ft.
Date of adequacy test 'z/l'~/q ,Results(Pass/Fail) Pe~
Fluid depth in absorption field before test?~ln. ,,~ ,?Vater added/om, g%l.
Elapsed Time: ~ j~ ~.-'~:n. Final fluid depth q~-//~n. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
Eft. absorption area "/~ ft2 Monitoring tube ~' Depression over field
For ~, bedrooms
New depth / in.
/ po o 1- g.p.d.
~o If yes, give date
Do
LIFT STATION
Date installed ~x///,~/~ Size in gallons ~fiooC)
"Pump on" level at z-/O in. "Pump off" level at "5~ in.
Datum ~o ~ow, v'~- '["o~f/.-. Cycles tested · t-O-c '7.,.
E. SEPARATION DISTANCES
Manhole/Access (Y/N) y
High water alarm level at /4 ~
Meets alarm & circuit requirements?
in.
Absorption field on lot
Public sewer main
Sewer/septic service line
Animal containment areas
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tSl~k/lift station on lot ! OD' ./---
l
/~ ' 4-'
i01)
On adjacent lots 1
On adjacent lots /Cz)
Public sewer manhole/cleanout
Holding tank 7'/1
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 2 0 ~ ~L
Water main
Wells on adjacent lots /0o' ~
Property line ?--~'
Water service line
Absorption field ! ~"
Surface water t'O0
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Water Service line
Curtain drain
Building foundation ~) /-~-
Surface water !~0 %/--
Wells on adjacent lots loo ~f--
/.
Water main ['J/~ ·
Driveway, parking/vehicle storage
F. 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.
Engineer's Printed Name
Date ~fi/W////t'
COSA Fee $. ~ '~'0
Date of Payment '3/G"/~ /
Receipt Number / ~
oo3g
(Rev. 4/10)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
w,,w~.ci.anchorag e.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AU'I"HORITY APPROVAL
FOR A SINGLE FAMILY DWEELING ......
RUSH
G EN Ei:~t.; IN FORMATIO.N.,.
Cor~plet~ legal descriptiod:
Locatien (site address Or'dir~:[ions)
Current Property owner(s) '"~
Mailing agdr~ss , ~}"
Lending a~jency"
'HAA# C)-L/- O ,2,.
Expiration Date:
Day phone
Mailing address
Real Estate Agent
Mailing Address
Unless otherwise requested, HAA v/ill be held by DSD for pickup.
2, NUMBER OF BEDROOMS:. - -
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site ~
Individual Holding tank []
[] Community On-site []
[] Public Sewer [-"J
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for propedies served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon reqdest to homeowners. C'edificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water 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
e
As certified by my seal affixed hereto and as o[ the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-
site water.supply and/or wastewater disposal system is(are) safel 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
..i, wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,'ordinances,
· i'.~a~id ireg~l~.'tions :~p~:ffect at the t me of insta ation. ..
DSD SIGNATURE
~ Approved for
Disapproved.
'7 bedrooms.
Conditional approval for '~
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist'
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
"Original Certificate Date: ~ ""
(Rev. 01/02)
Legal Description:
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
HEALTH AUTHORITY APPROVAL CHECKLIST
~oq' z..~/~['l.c, ~. '~,~ ~'[~ ~[.~-, ~ (( ,5 Parcel ID:
WELL DATA
Well type
Date completed .~-/'2,,/5-
Total depth '~O ¢ ft.
IFC.. B, "' r- ........ PW$iD-il
Sanitary seal (Y/N) Y
Cased to ~o't~ ft.
FROM WELL LOG
Date of test
Static water level
ft.
Bo
Well production 5-', O
WATER SAMPLE RESULTS:
Coliform ¢ colonies/100 mi.
Arsenic: ~ mg./I.
SEPTIC/HOLDING TANK DATA
Tank Type/Material · · '~ ~.~' (
g.p.m.
Nitrate ~, ( mg./[. ,
.
Date of sample: -~//u H
Tank size '~ ¢~,~ gal. ' ' Nur~be,r' of Compartments
Well Log (Y/N).
Wires properly protected (Y/N).
Casing height (above ground)
AT INSPECTION
~' 'g. '~o ft.
/, "-*"'" g.p.m.
Y
Other bacteria 4 colonies/100 mi.
Collected by: . ,t,./[ M ~
Date installed
Cleanouts (Y/N)
in,
Foundation cleanout (Y/N)' ~: . Depressi:on over tank (Y/N) /4- High water alarm (Y/N)
Date of pumping ~ -. / , . '. pumper ,,'~o~ ~., ~'~-¢.~c¢-'"'~/
C. ABSORPTION FIELD DATA : /iL ¥'o~ 'Fbc., C.~0 ~V-,
Date installed ~>...S~il. r~ti~g (g.p.d./ft2 or ftt/bdrm)~ I, ~ System type O
Length. ~% ~ ~ ~ ft. Width ~, o ft. Gravel below pipe
Depression over field.
For "~
Total depth ci'0 ft../.Eft' a~sorption area Cf'Ob ft2 Monitoring tube ~'
Date of adequacy test ¢/'"//~ ~ Results (Pass/Fail)
, /
· h{~ ~-- z~"
Fluid depth in absorption field before test_~_ t..I~ Water added '%o~.
I ~H ~ . /,.l c~ ¢4~ "J-fl'"
Elapsed Time:__ mm. Final flu. id depth __~.~ ~,, zy '~ Absorption rate >=
Any rejuvenation treatment (past 12 mo.} (YIN & type) ~ If yes. give date
New depth
I 2.¢'o -/--
bedrooms
g.p.d.
D. LIFT STATION
Date installed ~/~"-
Eo
Go
size in gallons ~
'.'Pump on" level at ~t0 in. ·'"Pump off'~ level at.
Datum "t-u p I'; ~. .Cycles tested ~
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic-~5~ift station on lot /~ '~ .. On adjacentlots
Absorption field on lot I'¢:° !J,- ,
Public sewer main /'/. ..
Sewer/septic service line /aO ~,1¢. ' ' l
SEPARATION DISTANCES FROM SEPTIC/~G TANK ON LOT TO:
Building foundation ~ ,~"/.~Z' .Property line ~-~. /-/-
Water main ~ , ' ' Water service line / c~ o -'~
Wells on adjacent lots tu~ '
SEPARATION DISTANCE FROM'ABSORPTION FIELD ON LOT TO:
Property line '7"'-~/'¢ Building foundatior~
Water Service line lo o ['¢-, ' SUrface water' ~:/o0 '¢..(..
Curtain drain /4 ' Wills On adjaceni' "'
lots tod
COMMENTS :
Manhole/Access (Y/N) ~
High water alarm level at ~ in.
Meets alarm & circuit requirements? ~
On adjacent lots /t9 ,.) f.-{--
Public sewer manhole/cleanout
Holding tank /4/.,~',
ENGINEER'S CERTIFICATION:
I cer/ffy that I have determined through ~elcl inspections and
review of Municipal records that tt~d above SysteMs 'are in
conformance with MOA HAA gbide{ines in effect °?i'th'is 'date.
Engineer's Printed Name /'//t';'~'~ (
,,,., ,.,.!
Date(~ ~ ., :, ~:':;
Absorption field
Surface water
/,
' Water main /'"/ /'~.,
Driveway, parking/vehicle storage
HAA Fee $
Date of Payment
Receipt Number .
(Rev. 12/01)
Waiver Fee $
Date of Payment
Receipt Number
Lot ;5
Lot
51,773
119.7'
~-~WELL
Lot 5
SEPTIC
2~
/
/
/
/
/
I
I
I
53.1' I
I
I
I
I
51.1~
Lot 2
~H~L~
I
I
I
Lot :5
C
PLOT PLAN AS BUILT x SCALE 1"-40' GRID 2g37 ProJect No. 04-104
Long
(907) 522-6476
Registered Land Surveyors (907) 522-4625
www.langsurveyore.com / infoOlangsurveyom.com
& Associates, inc. 11500 Oaryl Avenue, Anchorage, Alaska 99515-3049
Phone
Fax
I hereby certify that I have surveyed the following described property:
Lot 4, Block 2. SECLUDED HILLS SUBD.
Anchorage Recording Dlstrlot, Alaska, and that the Improvements situated thereon are
within the properly lines and do not encroach onto the properly adjacent thereto, that
no improvements on the properly lying adjacent thereto encroach on the surveyed
premlses and that there ore no roadways, transmission lines or other visible easements
on eald properly exoept os Indicated hereon.
Dated thls the 7-~?th Day of Iw~ , ,?-coat , el Anchorage, Alaska
It I, the responslbllNy of the owner to determine the exlslence of any easements,
¢ovenanfe, or restrictions which do not appear on the recorded subdivlslon plat·