HomeMy WebLinkAboutSCIMITAR #3 BLK 1 LT 1Scimitar #3
Block 1
Lot 1
#051-132-68
(Rev 05/018)
178)
Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3
ON-SITE
WASTEWATER INSPECTION REPORT
Permit Number: OSP251052
PID Number: 051-132-68
Dwelling: F0 Single Family (SF)
El with ADU El Duplex (D) F-1 Two Single Family Project: r_1 New X Upgrade
Name
Johnny H 11 & Amy L Spence
A ORPTION FIELD
r h E] Wide Trench F-1 Bed F� Mound
OE] D TTrencc
Site Address
20048 Seika Dr
Other
Phone
Number of Bedrooms
Soil RatingITotal
depth from original grade
3
D/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original de Gravel depth beneath pipe
Ft.
Subdivision
Block Lot
Scimitar #3
1 1
Fill added above original grade G el length
Ft. Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Dis ce between lines
Ft.
SEPARATION
DISTANCES
To
Septic
Absorption
Lift Station
on
Holding
Sewer
Total absorption area
Number of trenches
Dist. between nches
From
Tank
Field
Tank
Line
Ft2
t.
Well
>100'
N/A
N/A
N/A
>25
TANK 9 Septic El S.T.E.P. El Holding El Other
Manufacturer
Greer Tank
Capacity
1000 Gal.
Surface Water
>100'
N/A
N/A
N/A
Material
Plastic
Number of compartments
2
NA
Lot Line
3.5
N/A
N/A
N/A
Foundation
>1 0'
N/A
N/A
N/A
rl,Q,
oIATION
IManufacturer
Capacity
Remarks Note waivers: to field, lot line & deck post
Gal.
Deep burial tank
Alarm location
ctn ' talled b
ea��
PIPE MATERIAL House to tank D3034 Tank to D3034
drainfield
Installer
Territory North
—
Drainfield N/A CO/MT N/A
Inspector Jared Earls
BENCH MARK (Assumed elevation) 100 ft
Inspection st 4/2/25
Location and description
dates:
god
Sonotube #3 from stairs
31d
4,h
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval:
Date
AM,
A
,0' 49
Benja*Schiller
Septic Systpm
CE 12592
Approved
Date4/17/25
I&AW'
ASA'
ote: this approval
does not include well permit require nts.
PROFESSO
®r.
(Rev 05/018)
178)
X
X
X
X
X
X
X
X
X
X
X
X
XX
Benjamin Schiller
CE 12592R
E
GISTEREDPROFES S I O N A L E N GINEER
1"=30'
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
SCIMITAR #3, BLOCK 1 LOT 1
A B
MH 25.0
2CO 27.2
SV 29.0
FC 11.4
MT1 48.0
13.9
16.4
16.0
5.5
41.4FEET
0 30 60
SEPTIC PLAN
4/18/25
SE
I
K
A
D
R
I
V
E
3-B
D
R
M
H
O
M
E
WELL & ACCESS
EASEMENT
15' ELECTRICAL
EASEMENT
NEW 1000-GAL SEPTIC TANK'
EXISTING 28' LONG SEPTIC TRENCH 4.0'
PROPERTY IS SERVED BY A
WELL ON LOT 2
SHOWN WITH 100' RADIUS
A
B
FCO
2CO
MT
3.1
3.7
3.5
BENCH MARK
PROFILE AS-BUILT
(NO SCALE)
98.2
93.9
98.7
FC
O
MH
SV
1000 GAL
SEPTIC TANK
2C
O
98.0
Benjamin Schiller
CE 12592
R
E
GISTEREDPROFES S I O N A L E N GINEER
4/18/25
102.7
1"=3'
4.0
INF
L
U
E
N
C
E
L
I
N
E
3.7
97.8(MEASURED WITH TAPE)
TANK TO DECK POST
93.9
FEET
0 3 6
PERMIT # OSP251052 PID #051-132-68
SCIMITAR #3, BLOCK 1 LOT 1
Municipality of Anchorage i
pirtm•nr
P.O. Box 196650 0 4700 Elmore Road
Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997
http://www.muni.orcl/Onsite
Development Services ivi i
On -Site Water and Wastewater Program
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSV251019 COSA#:OSC261133 Permit#:OSP251052
PID#: 051-132-68
Legal Description: Scimitar#3 Block 1 Lot 1
Engineer: Forge engineering-
Your
ngineering
Your request for a waiver of the required 10 feet horizontal separation from the septic tank to the
property line has been approved. The approved separation distance is 3.5 feet. Your request for a
waiver of the required 5 feet horizontal separation from the new tank to the existing deck post has
been approved, the approved separation is 3.7 feet. Your request for a waiver of the required 6
feet separation to the existing absorption field has been approved, the approved separation 3.1 feet.
This waiver approval applies to the existing septic tank only. Any future upgrade to the on-site
wastewater disposal system will require all separation distances be met or another approval from
this department.
Waiver is Granted: X Waiver is not
Date: cry Approved y
s
somonnowlsommossonsommnmmmmmmmmmmn
**** VARIAN C E/WAIVER REVIEW ****
April 21, 2025
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Scimitar #3 Block 1 Lot 1 – 20048 Seika Dr
Waiver requests: Tank to trench, lot line, and deck support
Dear On-Site Services Engineer:
The permit for this property placed the tank in such a way as to avoid the need for any waivers. At
the same time, we recognized that the placement was very tight because of the existing house,
deck, trench, and steep slopes.
During installation the contractor needed to install the tank in such a way as to work within the
site constraints- in particular the slope to the west prohibited using his machine from that side, and
the sandy soil caused problems with collapsing in the hole. The final location of the tank ended up
in a tight space between the trench, deck, and property line, encroaching into the separation
distances for all of them, but with the goal of at least maximizing the separation from all three.
The tank ended up approximately 3.5’ off the east property line. The contractor managed to install
it without encroaching on the ROW for Seika Drive. There is no threat to the ROW from the tank
in this location. The existing septic trench is only 3.1’ from the side of the tank. Although the
contractor did expose the top portion of the trench, he managed to stay far enough away that the
field did not collapse into the hole, and he was able to fill back in after placing the tank without
affecting the trench. The tank was also 3.7’ from the corner deck post. We were able to get a
measurement down to the bottom of the sonotube, and the profile drawing shows that the tank has
been set outside the soil bearing prism of the bottom of the tube.
For these reasons we request waivers for 3.5’ from the property line, 3.1’ from the existing field,
and 3.7’ from the deck post.
Sincerely,
Benjamin Schiller, PE
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: OSP251052
Work Type: SepticTank Upgrade
Tax Code Number: 05113268000
Site Legal Address: SCIMITAR #3 BLK 1 LT 1 G:1261
Site Mailing Address: 20048 SEIKA DR, Chugiak
Owner: SPENCE JOHNNY H II & AMY L
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Effective Date
Expiration Date:
Mm ;'
h
t)eparl:m�:�nt
Lot Size in Sq Ft:
Total Bedrooms:
3/14/2025
3/14/2026
40501
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: ' �f� P c
Issued By:
Date:
Date:
K,
ON -SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 051-132-68
Property owner(s) Johnny & Amy Spence Day phone
Mailing address20048 Seika Dr, Chugiak, AK, 99567
Site address20048 Seika Dr, Chugiak, AK, 99567
Legal description Scimitar #3, Block 1 Lot 1
Number of Bedrooms 3
Engineering Firm Forge Engineering
Building Permit Number
Not Applicable FE-1
APPLICATION IS FOR: APPLICATION IS AN:
(Z all that apply)
Absorption Field
D Initial ❑
Septic Tank
0 Upgrade
Holding Tank
❑ Renewal ❑
Privy
El
Well
R
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Permit/Rush Fees:
Date of Payment:
Permit No. n's /0 -2-
Waiver Fees: -.,—
Date of Payment:
Waiver No.
Distance:
March 12, 2025
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Scimitar #3 Block 1 Lot 1 – 20048 Seika Dr
Septic system design
Dear On-Site Services Engineer:
The owner of the above lot has a steel septic tank that reached over 30 years of age, and needs to
be replaced. The attached plan identifies the location of the home as well as the wells and septic
location. No conflicts exist between this proposed system and any other well or septic system ,
whether on this lot or adjacent lots. We are replacing the septic tank with the same size designed
for 3 bedrooms.
Wells on this and adjacent lots are shown. The new septic tank will be a minimum of 100’ from
all wells and surface water. Please refer to the attached plan for the septic design. If this design is
followed, there will be no adverse impacts to adjacent properties.
Sincerely,
Benjamin Schiller, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251052, Curtis Townsend, 03/14/25
X
X
X
X
X
X
X
X
X
X
X
X
XX
Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER
1"=30'
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
SCIMITAR #3, BLOCK 1 LOT 1
FEET
0 30 60
SEPTIC PLAN
3/11/25
SE
I
K
A
D
R
I
V
E
3-BD
R
M
H
O
M
E
WELL & ACCESS
EASEMENT
15' ELECTRICAL
EASEMENT
EXISTING STEEL SEPTIC TANK TO
BE DECOMMISSIONED PER UPC
NEW 1000-GAL SEPTIC TANK
ENSURE 5' SEPARATION TO
TRENCH, 10' TO FOUNDATION,
AND 100' TO WELL
EXISTING 28' LONG SEPTIC TRENCH
TO REMAIN IN SERVICE 4.0'
PROPERTY IS SERVED BY A
WELL ON LOT 2
SHOWN WITH 100' RADIUS
ESTIMATED AREA
OF NEIGHBORING
WELL RADIUS
>5'
>10'
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251052, Curtis Townsend, 03/14/25
MUNICIPALITY OF ANCHORAGE) y.
f i
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
I
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264.4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION
REPORT
NAME
CPHONE
CO
67yi Z9%
2CKEw
❑UPGRADE
MAI 114t&C
A RE :se, c,jn /neei/n
a
LE AL DES/TIO) F N 1'
C
CJ%1 /rf}'2
y��-,
OV
LOCATI OGGN.•.•
S A-1ZR z A
NO. OF BEDROOMS
J
DISTANCE TO:
Well
Absorptigr�rea/
Dwelling
PEWI T-fyp�/. 9 J
Uy
j/Dfl
v!
i Z
Manufactiy+ED
s /
No. of comp rtments 40
y~
Liq. c e$iL) j01 ions
C/C�� IF HOMEMADE:
Inside length
Width
Liquid depth
❑ y
DISTANCE TO: Well
Dwelling
PERMIT NO.
JUZ
2 Z F
Manufacturer
Material
Liquid capacity in gallons
❑
w
DISTANCE TO:
Well/�3 Foundation/�
Nearest giline�
CEJ
PE IT
f
LLJ u
No. of lines
Lengthwje& line Total len lines
Trench }�-dth
60
Distance be an I' es
P a
inches
Top tile to finisbAr?de Material beneath tile
Total effective orp . n ar a
<
of L�
inches
2S
❑
Length
Width Depth
PERMIT NO.
W
c7
Q F
Type of crib
Crib diameter / depth
Total effective absorption
area
M°
/V
y
Well Building foundation
Nearest lot line
DISTANCE TO:
Class y.
Depth Driller
Distance to lot line
PERMIT NO.
J
w
DISTANCE TO:
Building foundation Sewer line
Septic t k
J
Absorption area(s)
OTHER
y�
r -
PIPE MATERIALS
ve
SOIL TEST RATI N
INSTALLER ^
�`i •r6
REMARKS
0
Co
A(�@@3[G•�
M9lTJLN � F
(
tPy�+ .-.may ♦p
eat
M
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�tv+ &•k^41 sh0w � ki.�'
e
�0074A..
IO
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o
APPROVED -.- ->�� yl�lEj\,Qu DATE LEGAL
�f
S&RU 19:;x
x
' ;>,a.'3�it4tx �IVr r�� dA%ie2AaP d . •f•: %` ��% �,i8
�/ .
72-013 (Rev. 3/78)
- ~
~
�KzH IF�7 F-1 P-9 W --- 9 HD V7, rr-::� C"3,��
DEPHRTFIE: �T OF 1 .1 E:HLTH 1114 D E N V I R 0 14 VI E NTAi Pf;i! 0TE C,'TTON
825 L STREET, HNCHORHGE/ HK` 99501
264~4720
��E�E No EVE WTI A 1"! KEE L. R.. Fo, k=����
^
PERMIT NO� 840085
DHTE ISSUED� 0]/28/84
`
HPPLICHNTCONSTRUCTIOIN
HDDRESS� % S&S ENGINEERING
EHGLE RIVER/ HK 99577
CONTHCT PHDNE� 694~2979
LEGHL DESCIO IPSCIMITAR LOT1 BLOCK1
SECTION� 10 TOWNSHIPRHNGE1W
LOT SIZI FT. OR ACRES)
MHX BEDROOMS� ]
LISTED BELOW HRE THE OPTIONS AVAILABLE TO YOU IN DESIGNING YOUR SEPTIC
SYSTEM. CHOOSE THE OPTION THHT BEST FITS YOUR SITE.
-T~PA 4]:.` LI I ED', EE-- P-4
DEPTH TO 4. 0 4.0 40
GRHVEL DEPTH, (FT. 5 ].5
TOTHL DEPTH (FT� ) 8�0 4.5 75
GRHVEL WIDTH (FT ) 2.5 14.0 5.0
GRHVEL LENGTH (FT ) ]2.0 28.0 28�0
GRHVEL VOLUME (CU. ]:.] 14.5 20.7
THNK SIZE (GHLS) 1/000. 0 ** 1/000. 0 ** 1/000, 0 **
SOIL RHTING FT./BR) 85 85 85
**
TA 1, MUST HHVE AT LEHST TWO (AMPHRTMENTS
�
I UIRTIFY THHP
1. I HM FHMILIHR WITH THE FOfK! ON-SITE SEWERS AND WELLS HS SET
FORTH BY THE MUNICIPHLITY OF HNCHORHGE (MOH) AND THE STATE- OF HLHSKH.
2 I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH FILL MOH CODES HND REGULHTIONS/
HND IN COMPLIHNCE WITH THE DESIGN CRITERIA OF THIS PERMIT.
I I WILL HDHERE TO HLL MOH HND STHTE OF HLHSKH REQUIREMENTS FOR THE SET BHCK
DISTANCES FROM ANY EXISTING WELL/ WHSTEWHTER DISPOSHL SYSTEM OR PUBLIC
SEWERHGE SYSTEM ON THIS OR 8NY HDJHCENT QR NEHRBY LOl[
4 I UNDERSTAND THHT THIS PERMIT IS VHLID FOR H MAXIMUM OF ] BEDROOMS HND
HNIT' ENLHRGEMEWT WILL REQUIRE H@ HDDITIONHL PERMIT.
IF 19LIFT P� I��T�LL�� IN HN HREH COVERED BY MOH BUILDING CODES,
THEN (1) HN'ELECTRICHL PERMIT HND INSPECTION MUST BE OBTAINED/ (2) HS-BDILTS
F` F`F,:: D 1,11111OUT HN ELECTRICAL INSPECTION REPORT/ THE
EL-E"..`^"..L A,".` FY011T BE DONE A'
SIGNED)DATE:
=�= �~��+��~-�__--_
HPpLICHNT� MYERS C TR ��
ISSUED BY DATE:
Reading
Date
Gross
Time
J!� SOI LS LOG
Depth to
Water
Net
Drop
MUNICIPALITY OF ANCHORAGE
3
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
PERCOLATION
ltl
t
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
/Gi' f / DATE PERFORMED:
PERFORMED
FOR:
�//�'fG
l 13 zd l iq/2 /
LEGAL
DESCRIPTION:
DEPTH
SLOPE SITE
PLAN
6F E E/T)
U `(FJ
1
J
G✓
2
d
3
_ U
4
C/`
5
6
U
7
L
� 0
$
o
f110
v
9
o
10
G
11
`
@
WAS GROUND WATER / S
L
ENCOUNTERED? !
0
12
!
P
E
IF YES, AT WHAT
DEPTH?
13
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
3
ltl
t
20
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT A,NNDj FT
COMMENTSr
PERFORMED BY: x.. iy�n "'. �..._ CERTIFIED4 /1f!55i DATE:
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 (Please complete either lo, Ib or Ic.) A.D.L. No.
la. Borough Subdfvlelon1 Lot Ib.
1/a gtrs:- Section No. TownshipN� Range EO Meridian-�
An ch Scimitar 1 in -af_at_at-
SO WO
Ice DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS
3. OWNER OF WELL
Mr. Paul Myers_.
Address: Myers Construction
Chugiak, Ak. 99567
Street Address and Area of Well Location
-
2. WELL LOG
Feet Below
Surface
4. WE PTH: (final)
4
S. DATE OF COMPLETION -
tt.
_� — 2A__ - Q�1
tJ4 _
Material Type
TOPBottom
6. O Cable tool ZjlfitaryO Drlven O Dug -
DAuger OJetted OBored C] Other:
Greens tone wl layers 93 290
of redrocK
7. USffZZOQmestic O Public Supply - O Industry
O Irrigation O Recharge 0Commerical"
O Test Well . ❑ Other.
Greenstone and Ater 290 320
Greenstone with layers 320 900
of gray rock
S. CAST G: O Threaded 'Melded
dram. -In. to93 ft. Depth Weight 17 lbs./ft.
dlam. In. to ft. Depth Stickup ft.
Gray rock with quartz 500 525
seams and. water,
Greenstone
525 545
B, FINISH OF WELL:
Type: Diameter:
Slot/Mesh Size: Length:
Set between ft. and - ft. .
Backfilling Gravel pack
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL PROTECTIOM
10, STATIC WATER LEVEL: ft.
O Above or O Below land surface Date
Equipment used: -
kFICEIVED
it . PUMPING LEVEL below land surface and YIELD- -
ft. of ter hrs. pumping- - g.p.m. -
ft. after hrs.-pumping a. p.m. --
.
-
I2.GROUTING Well Grouted: O Yes C] No -
Material: O Neat Cement O Other:
-
J
13• PUMP: (If available) HP
Length of Drop Pipe ft. capacity g.D•m.
O Subm. 0 Jot O Centrifical O Other .
-
14. REM AY?6duction of 20 GPH
16. WATER WELL CONTR4CTOR'S CERTIFICATION:
15. Water Temperature —0 OF 0 C
This well was drilled under my jurisdiction and this report Is true to the best of my knowledge and belief; -
MagnuGon Drilling
Registered Business Name
AA 5385
- Contract License Number _
P.O. Box 770504 Eagle
River, Ake
99577
Address.
Signed: ,Ci1L
Dale: March 25, 1984
Authorized Representative
Form 02-WWR (II/81) Copy Distribution:
WHITE-Stote DGGS, PINK -Driller, CANARY -Customer -
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: (907)343-7904
On -Site Water & Wastewater Section Fax: (907)343-7997
Certificate of On -Site Systems Approval
OSC251133
Parcel ID 051 -132-68
Legal description SCIMITAR #3 BLK 1 LT 1
Expiration Date: 3/12/2026
Site address 20048 SEIKA DR
Current property owner(s) SPENCE JOHNNY H II & AMY L
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
By;
Original Certificate Date
4/22/2025
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage,
bevelopment Service Department (DSD) issues COSAs based upon representations provided by an
independent professional engineer. The Municipality of Anchorage is not responsible for errors or
omissions in the professional engineer's submittal.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
11111111111 iq� 111191 1
IN
Development Services Department Phone - 907 . -343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 051-132-68
Complete legal description Scimitar #3 Block 1 Lot 1
Location (site address) 20048 Sika Dr,
Chugiak, AK 99567
Current property owner(s) Johnny & Amy Spence
2. ON-SITE SYSTEMS SIZED FOR BEDROOMS
Day phone
3. TYPE OF WATER SUPPLY: * Private Well ❑ Private Well serving 2 dwelling units
El Private Well serving 3+ dwelling units E] Community Well or Public
F-1 Water Storage
4. TYPE OF WASTEWATER DISPOSAL: � Private Septic ❑ Private Septic serving 2 dwelling units
E] Holding Tank Fj Community Septic or Public Sewer
5. SEPTIC TANK: Fj Steel FN_1 Plastic ❑ Concrete ❑ Fiberglass
Age NEW _ See advisory if steel older than 20 years
6. ABSORPTION FIELD: E] AWWTS E] Bed ❑ Deep Trench FE -1 Wide Trench ❑ Seepage Pit
Waiver request for: Tank to field, deck support, property line Distance: 3.1/3.7/3.5
Expedited review requested: F-1
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $
Date of Payment
COSA #
Waiver Fee $ 2Z5 -
Date of Paymentqzllah_�
Waiver#
COSA Application—June 2022
N/A
(907) 522-7773
Benjamin Schiller, P.E.
I` A
0 25 50
o�
US SURVEY
FEET
ti
N 6g 3838
lV
IS66g.
OF
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J e "A. H u f_
fF9�•��J�
ll\ PR�fFSS• NAV`�
/ Q�
/ 4
NOTES
-All dimensions shown are grid bearings and ground distances, record boundaries are per Plat No. 80-51
-49th Star has conducted a physical survey of the property and all details shown on this Asbuilt Survey are correct. Under no
circumstances should any data hereon be used for establishment of property lines.
-It is the owners responsibility to determine the existence of any easements, covenants, or restrictions; no title research performed.
T T!. Tl TTl
AS BUILT SURVEY L"." 49th Star Surveying
� Power Pole PO Box 738
Lot 1, Block 1, Girdwood, AK 99587-0738
Scimitar Subdivision, Unit 3, ® Septic Clean out (907)891-6111
Chugiak, AK O Septic Tank Lid Jeremy@49thStarSurveying.com
O Well W.O. 2508 DATE: 4/7/25
SCALE 1•=50'
1<USft
1 Municipality of Anchorage
On-Site Water and Wastewater Program
mini
(907) 343-7904
S n r r T r
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-132-68 Expiration Date: —(f- ^ / 7
1. GENERAL INFORMATION
Complete legal description SCIMITAR#3 BLK 1, LOT 1
Location (site address) 20048 SEIKA DR, EAGLE RIVER AK
Current Property owner(s) LESLIE WILSON Day phone
Mailing address SAME
Real Estate Agent Day • . -
4\i'`
2. TYPE OF DWELLING: `�G� \oft \,s•
® Single Family (wlwo ADU) — e.? s ,
❑ Duplex o /_
C G7
❑ Multiple Dwellings (Single Family and/or Duplex) p
3. NUM 9$, EZ � xk4
4
BER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System E Public Sewer ❑
WaiverNariance request for: Distance:
Received by: Date: 69/77.(
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ M.(06 Waiver Fee $
Date of Payment (0/71/7 Date of Payment
Receipt Number OLP' i 0 P2-9 Receipt Number
COSA# ,�('/ 3 Waiver#
,66!r ; F
rrira5. 43TATEMENT.,dPINSPECTION 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 MIKE N ANDERSON, P.E. Phone 727-8864
Address 4661 NATRONA AVE.
Engineer's Printed Name MIKE N ANDERSON, PE Date 615117
2 ::: <, .
0 :I:0 0.
C o °
6. DSD SIGNATURE ' 70:
° ° ^'
d ° CE-9469 ANDERSCN..
#1 Approved for 3 bedrooms. r ., // •'ti---
System
`-�2 °Q(1/(17.•'-',
. .�
System #2 Approved for bedrooms. 1/41
34r;�fL�st��';�
Disapproved. J '
Conditional approval for bedrooms, with the following stipulations:
,-\ OF cid;
ON-S1112 ?,;• �
WATER AND
WASTEWATER o
PROGKA 1
•
•
rh
1'T i N r^n\1'
By: `^^' Original Certificate Date: C� 7 - / 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 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: SCIMITAR #3 BLK 1. I.O F 1 Parcel ID: 051-132-68
A. WELL DATA
Well type Private If A. B or C provide PWSID # Well Log (YIN) Y
Date completed 3124!1984 Sanitary seal (Y/N)Y Wires properly protected (YIN) Y
Total depth 545 ft. Cased to 93 ft. Casing height (above ground) 20"+
FROM WELL LOG AT INSPECTION
Date of test 312411984 5/17/2017
Static water level UNKNOWN ft 139 ft.
Well production 0.33 g p.m 1.0 g.p m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/1 00 mL Nitrate ND mg/L
Arsenic: ND ug/L Date of sample: 5/17/2017 Collected by: Mike Anderson
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC!STEEL Date installed 612211984
Tank size 1000 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) NA
Date of pumping 6-7-17 Pumper Alaska Quality Pumping
C. ABSORPTION FIELD DATA— 1985 SYSTEM TESTED
Date installed 6122/1984 Soil rating (sf/bedroom) 85 SF System type 5'WIDE
Length 28 ft Width 5 ft Gravel below pipe 3,5 ft.
Total depth 11 ft Eff. absorption area 259 ft` Monitoring tube Y Depression over field N
Date of adequacy test 511712017 Results (Pass/Fail) PASS* For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 500+ gal. New depth 8 in.
Elapsed Time: 60 min. Final fluid depth 4 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) UNKNOWN If yes. give date
•
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN)
"Pump on" level at in. "Pump off' level at in.High water alarm level at in.
Datum Cycles tested Meets alarm &circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot `97'+ 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 50'+ Holding tank 100'+
Animal containment areas 100'+ Manure/animal excrete storage areas 100'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5' Property line 5' Absorption field 5'
Water main 100'+ Water service line 25'+ Surface water 100'+
Wells on adjacent lots 100'+
ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10 Water main 100'+
Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain 50'+(None Known) Wells on adjacent lots 100'+
F. COMMENTS
' WAIVER ON FILE
AGI
G. ENGINEER'S CERTIFICATION ,`Q: • O+ • %>!4
r y.• '•,y ifs
I certify that I have determined through field inspections and / elT
review of Municipal records that the above systems are in •,•: 49
conformance with MOA COSA guidelines in effect on this date. 17,
720,•• MICHAEL N. ANDERSON
Engineer's Printed Name MIKE N. ANDERSON, I'E fir ' • CE 9 9 :`r
Date 6/6/2017 �
e_6•
Date •�jG �,•
�`�+'
`051IA,
COSA canary sheet_2.6-15.doc
Parcel I.D. 051-132-68
Municipality of Anchorage 4° far
y iF
On -Site Water and Wastewater Program r'
(907)343-7904 sx E,r ry
Certificate of On -Site Systems Approval
Expiration Date: /s
t t
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Scimitar #3, Block 1, Lot 1
20048 Seika Dr.
Current Property owner(s) April Walton & Craig Folsom Day phone
Mailing address 20048 Seika Dr. Chugiak, AK 99567
Real Estate Agent
2. TYPE OF DWELLING:
Day phone
❑ Single Family (w/wo ADU) �,F
F-1Duplex
TTA-
❑ Multiple Dwellings (Single Family and/or Duplex)
NOV 14 2014
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
IndividualWell
Fx1
Individual
Fx_1
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for.
Received by: >,�� Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 5" Waiver Fee $
Date of Payment l(1 i�� Date of Payment
Receipt Number 631itl Receipt Number
COSA # 05C"1`] 1,51? 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 bine of installation.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MCA 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 life 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 sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.D. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone
6. DSD SIGNATURE
System #1 Approved for 3
Jtor�_
System #2 Approved for
Disapproved
Conditional approval for _
bedrooms
bedrooms
Date 11/14/2014
bedrooms, with the following stipulations:
f � %7
f
�, Original Certificate Date: 13 1unicipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 5 _, ,.
If more than 1 septic system is on the lot:
COSA Checklist # 1 of
Structure served by this system I
Certificate of On -Site Systems Approval Checklist
Legal Description
Scimitar#3, B1, L1
Well type Private If A, B, or C provide PWSID #
Date completed 3/24/1984 Sanitary seal (Y/N) Y
Total depth 545 ft. Cased to 93 ft.
Date of test
Static water level
FROM WELL LOG
3/24/1984
Unknown
ft.
Parcel ID: 051-132-68
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 18+ in.
AT INSPECTION
11/12/2014
136 ft.
Well production 0.33 gpm 1.0 g p m
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate 0.35 a. mg/L
Arsenic N . ug/L Date of sample: 11/12/2014 Collected by: PES
B. SEPTICIHOLDING. TANK DATA
Tank Type/Material Septic/Steel Date installed 4/22/1984
Tank size 1,000 gal. Number of Compartments 2 Cleanouts (YIN) Y
Foundation cleanout (Y/N) Y
Date of pumping 5/29/2014
C. ABSORPTION FIELD DATA
Depression over tank (Y/N) N High water alarm (Y/N) N
Pumper Sanitary Pumpers
Date installed 4/22/1984 Soil rating (g.p.d./ft2 or ft2/bdrm) 85 SF/BR System type Shallow Trench
Length 28 ft. Width 5 ft. Gravel below pipe 3.5 ft
Total depth 10.9 ft. Eff. absorption area 259 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 11/12/2014 Results (Pass/Fail) Pass For —L> - bedrooms
Fluid depth in absorption field before test 0 in. Water added 511 gal. New depth 18 in.
Elapsed Time: 100 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NO If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at
Datum -
Size in gallons _
in. "Pump off" level at
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 7
Absorption field on lot 100+
Public sewer main 75+
Cycles tested
Sewer /septic service line 25+
Animal containment areas 50+
SEPTIC/HOLDING TANK ON LOT TO
Manhole/Access (Y/N) _
in. High water alarm level at
Meets alarm & circuit requireplents?
On adjacent lots 100+
On adjacent lots 100+
Public sewer manhole/cleanout 100+
Holding tank 100+
Manure/animal excrete storage areas 100+
Building foundation 5+ Property line 5+ 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 storage11 0+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
*WR# 070050 **As -Built on File ***Water system has 250 gallon holding tank.
Note: No indication of daylighting on slope addressed in 2007 COSA.
G. ENGINEER'S CERTIFICATION
I certify that / have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Steven R. Pannone
Date 11/14/2014
COSA brown sheet 10-10-12.doc
i�P.tT; ; • . �s'F�1
Sl;ven x • 0onnone f
{ CE-8149AN
1
in.
Municipality of Anchorage
Development Services Department
Buiiding Safety Division
On-SiteWater 8 Wastewater,Program
4700 Bragaw Street,
\ P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERT F
ON-SITE SYSTEMS APPROVAL
0
R A SINGLE FAMILY DWELLING
Parcel I.D. 0D – 13Z – 0— COSA# f% 0-703.99
1. GENERAL INFORMATION Expiration Date: 1 V_ – _'), $ – U 7
Complete legal description SCIMITAR #3, BLOCK 1. LOT 1
Location (site address) TERRY MANNING
Current Property owners) 20048 SEIKA DR, *PETERS CREEK, AK Day phone 688-3779
Mailing address
Lending agency
Mailing address
Real Estate Agent
r.
Mailing address
20048 SEIKA DR, *PETERS CREEK. AK
Day phone
ANDY ZYWOT W/ CENTURY 21 Day phone 841-3813
401 E. NORTHERN LIGHTS BLVD.. *SURE 100
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
0
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
0
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of onSite 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 samples. (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 og-slte water supply and/or wastewater disposal system Is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. 1 urther verify that based on the
., information obtained from the Municipality of Anchorage riles and frf+yeinvestigation and inspection, the
on-sith water supply and/or wastewater disposal system is(are) in c plian�e With all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation. '
Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E. TUDOR ROAD, SURE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Zb 6
Engineers Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines 8 Regulations. The reported results described 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 life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report Is for
the sole benofir of the owner listed above. Any reliance upon or use of this report by any
other person or party Is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
_ z Approved for 3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the flowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineers Reort
Other
1139WIZ111111i
c�QP ..., •�y
ON-SITE
WATERAND •;
: WASTEWATER
PROGRAM
By. (/v • Original Certificate Date: ��g' O7
(Rev. i AS)
Municipality of Anchorage
• Development Services Department
Bu&ft Safety Division
On -Site Water b Wastewater Program
47M Bregaw SI.
P.O. Boot 198850 Andwrage, AK 99519-6850
www.d.anrhorage.sk.us
(907) 9437904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: SCIMITAR N3 , BLOCK 1 LOT 1 Paroel ID: 0 51— 1 3 2 - G $
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 3/24/1984 Sanitary seal (Y/N) YES
Total depth 545 ft. Cased to 93 ft.
FROM WELL LOG
Date of test 3/24/1984
Static water level UKN ft.
Well production 0.33 9,p -m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate ND mg./L.
Well Log (YIN) YES
Wires properly protected (YIN) YES
Casing height (above ground) 12"+ in.
AT INSPECTION
9/10/2007
146 ft.
0.70 g.p.m.
Other bacteria 0 colonies/100 mi.
Arsenic: 1.87 ug./L. Date of sample: 9/11/2007 Collected by: GEG Ltd.
B. SEPTIC/HOLDINO TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 4/22/1984
Tank size 1000 gal. Number of Compartments E Cleanouts (YIN) YES
Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A
Date of pumping 11/3/2006 Pumper SANITARY PUMPING
C. ABSORPTION FIELD DATA
Date installed 4/22/19134 Soil rating (g•p•d./fl°ot(jj� 85 System type TRENCH
Length 28 ft. Width 5 ft. Gravel below pipe 3.5 ft.
Total depth • 10.58 ft. Eft. absorption area 255 fe Monitoring gibe YES Depression over field NO
Date of adequacy test 9/10/2007 Results (Pass/Fail) PASS
Fluid depth in absorption field before test DRY in. Water added 507 gal.
For 3 bedrooms
New depth 17 in.
Elapsed Time: 120 min. Final fluid depth E in. Absorption rate >= 450+ g,p,d,
Any rejuvenation treatment (past 12 mo.) (YIN 6 type) NONE KNOWN If yes, give date —
D. LIFT STATION
Date installed Size in gallons Manhole/Access
"Pump on" level at _in. 'Pump ofr level a1==;R� High water alarm level at
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAiR station on lot '97'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer /septic service line 25'+
On adjacent lots 100'+
On adjacent lots
Public sewer manhole/deanout N/A
Holding tank N/A
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service lure 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line '4'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
'SEE WAIVER REQUEST
G. ENGINEER'S CERTIFICATION
i cer* 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 JEFFREY A. GARNESS
Date ntplz& b;�
COSA Fee a Y3 117-5 IR u s H
Date of Payme/-.)-710-1
` 7 71 0 ti
Receipt Number 00 `5 J C "r J*'"'
(Rw. 1 105)
Waiver Fee $ ! -7 S • 0 0 ♦ 715, O 0
Date of Payment gI Z -7I U7
Receipt Number C) 0 155 -as
Sep.27. 2007 1:55PM Garness Ensineerins Group, Ltd.
No -0564 P. 2
GARNESS ENGINEERING GROUP, Ltd.
�**•_��•+z .ate CONSULTANTS & GENERAL CONTRACTORS
September 27, 2007
Municipality of Anchorage
Development Services Department
Building SarLty Division
Onsite Water and Wastewater program
Y.O. Box 196650
Anchorage, Alaska 99519-6650
Attn: Joe Goodall
Rcf: Scimitar Subdivision 113, i.ot 1, Block 1. Dnrinfield immediately Adjacent to 50% t Slope
Mr. Goodall:
As you are aware, the drainficld on the subject lot is immediately adjacent to a slope that is greater than 50% in
grade. Prior to peribrming rite septic text, the drainfield was dry. We introduced a total of 507 gallons into the
drainfield and 120 minutes later it was dry. The GEG field technician did not notice any daylighting cMucnt before
or after the test. Given the 85 soil rating, it it reasonable to believe that there is very rapid downward movement of
the drainfield effluent and very little lateral movement. Based upon our findings, there appears to be no significant
risk associated with th,g drainfield proximity to a 50%t slope.
please contact us at 337.6179. Thank you for your assistance.
3701 E. Tudor Road, Suite 101 ' Anchorage, AK 99507-1259
Ph: (907) 337.6179 • Fax: (907) 338-3246 • Website: www.gamessengbecting.com
09/25/2007 13:46 ' 3733628
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CENTURY 21 PAGE 02/02
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0-p 25 07 02:51p Betty J. Van B 907 688-0993 p.1
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SANITARY PUMPERS
20627 UPPER BOWERY LANE
CHUGIAK, AK 99567
907.688-0602
CUSTOMERS ORDER NO. PHONE
NAME
AAA
ADDRESS
e
SOLD BY
I CASH I C.0,00. I CHARGE ON ACCT. MDSE. RETV.I
PAT;7T
•
DESCRIPTION
2op�
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TAX
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RECEIVED BY
A
TOTAL
j
All clai s and returned goods -hank You!
9206 MUST be accompanied by this bill.
PRODUCT 2531
ANALYTICA
GROUP
Gamcss Engineering Group, Ltd.
Atm: Jody GEG, Ltd.
3701 E Tudor Road, Suite 101
Anchorage, AK 99507
907-337-6179
Fax: 907-338-3246
sc ie"; 1Qv *F 3 G,
Client Sample ID:
Sampling Location: 20048 Seika Dr Chugiak
Client Project: Private Well Testing
Sample Matrix: Aqueous
COC #:
PNS#:
Residual Chlorine:
Comments:
Lab#: A0709113-0IA
Analytica International, Inc.
4307 Arctic Blvd.
Anchorage, AK 99503
Phone: 907-258-2155
Fax: 907-258-6634
Report Date: 9/25/2007
Receipt Date: 9/11/2007
Sample Date: 9/11/2007
Sample Time: 7:30:OOAM
Collected By:
Flaz Definitions:
MRL = Method Reporting Limit
MCL = Maximum Contaminant Limit
B = Present also in Method Blank
J1= Exceeds Regulatory Limit
M = Matrix Interference
J = Estimated Value
D = Lost to Dilution
• • = RL higher than MCL; target not detected
TNC = Too Numerous to Count - result rejected
CF = Confluent Growth - result rejected
TCNG = Turbid Culture No Growth - rejected
Analysis Method Prep Prep Analysis
Parameter Result Units Flags MRL MCL Method Date Date Analyst
92228 (Aqueous) - Membrane Filtration AIF Test spas conducted by: Analytica - Anchorage
Bacteria, Other <MRL CFU/IOOmL 1.0 9/11/2007 9/11/2007 PL
Total Coliform <MRL CFU/IOOmL 1.0
Lab#: A0709113-OIB
9/11/2007 9/11/2007 PL
Analysis Method Prep Prep Analysis
Parameter Result Units Flats AIRL MCL Method Date Date Analyst
4500-NO3E (Aqueous) - Nitrate Test was conducted by: Analytica -Anchorage
Nitrate as N <MRL mg/L 0.10 10 9/14/2007 9/14/2007 AJ
Lab#: A0709113 -OIC
Analysis Method
Pref Prep Analysis
Parameter _ Result Units Flags MRL MCL Method Date Date Analyst
200.8/200.8 (Aqueous) -
Arsenic
Fzt-6
Reported by: Krissy Plett,
Laboratory Project Manager
Nell Water I Test ryas conducted by. Analytica - 7hornion
1.87 ug/L 0.15 10 200.8 9/20/2007 9/21/2007 KS
Page I of I
m-
AZunieipalit,3r of Anehorage
\ -"`� L� / 1'(). IL,x 190f:1(1 • .\nehornge, Ah�skn 0!I.SIl1•Gf:1(1 •Telephone (0071 at&6.'101 • Pa�1 (1Xp) 3t3-ta"'INl
\... ' 470011m1,mw St mct • Anchorage, A)nstw 0!41117 s . • *y
u1m munl.ogt
Mayor Mark BcMich
Iluil(Iing Sliloly DIvision
September 28, 2007
Jeffrey Garness, P.E.
Garness Engineering Group
3701 E. Tudor Road, Suite 101
Anchorage, AIS 99507
Subject: Waiver Request for Scimitar #3 Block 1 Lot 1
Waiver Request WR#: 070050
Parcel ID # 051-132-68
IIA070388
Dear Jeffrey Garness, P.E.:
Your request for a waiver of the required 100 feet horizontal separation from the
septic tank to the private well has been approved. The approved separation distance is
97.0 feet. And a 4 foot lot line waiver to cast property line is approved.
This waiver approval applies to the existing septic tank to private well separation only.
Any future upgrade to the on-site wastewater disposal system will require all separation
distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely,
J
rood a11
vil Engineer
On -Site Water & Wastewater Program
Cor►tntunity, Security, Prosperity
State of Alaska:
Separation Distance Waiver Guidelines for S.C.R.O.
(State of Alaska Memorandum to District Office Engineers dated January 3,1985)
Waiver Request for: Scimitar #3 Block 1 Lot 1
ParcelID#: 051-132-68
Waiver Request Number WR#: 070050
Waiver Requested: 97 FOOT HORIZONTAL SEPARATION FROM WELL ON -LOTTO SEPTIC
TANK. AND A 4 FOOT LOT LINE WAIVER FROM ABSORPTION FIELD TO EAST PROPERTY
LINE.
Engineer: Jeffrey Gamess, P.E.
IIA070388
Seatic Tank Data
The septic system was installed in 1984 at a total depth of 11 feet
from grade. At time of installation the separation distance was
measured and recorded to be 100 plus feet. However a newer
surveyed measurement showed the separation distance to be 97 feet
from well to septic tank.
Well Data
The well was installed in 1984 and has encroached the septic tank
on -lot for more than 23 years. The water sample results show there
are no nitrates detectable and zero other bacteria and coliform. The
water sample results are well with -in municipal standards. The static
water level was recently measured at 146 feet. The water table
gradient moves from east to west, and topography would prohibit any
wastewater from flowing toward the well head.
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343.7904
Waiver Review Worksheet
WR#:070050 PIDp:051-132-68 HA/Permit# IIA070388
Date Received: September 28, 2007
Legal Description: Scimitar #3 Block 1 Lot 1
Engineer:
Jeffrey Garness, P.E.
Garness Engineering Group
3701 E. Tudor Road, Suite 101
Anchorage, AK 99507
Applicant TERRY MANNING
Waiver Requested: 97 FOOT HORIZONTAL SEPARATION FROM WELL ON -LOT TO SEPTIC TANK.
AND A 4 FOOT LOT LINE WAIVER FROM ABSORPTION FIELD TO EAST
PROPERTY LINE.
Criteria: Geology Points:
A. Water Table 7.19
B. Soil Sorption 1.30
C. Permeability 0.60
D. Water Table Gradient 4.50
E. Horizontal Separation 2.88
Total: 16.466
..........................................................................
Waiver Is Granted: X
List Conditions or Reasons for above:
Waiver is not Granted:
Date: 9/18107 By: Joe Goodall
Name of Reviewer
Rec#: 15535 Amount: $92= Date Paid: 9128/2007
State of Alaska:
Separation Distance Waiver Guidelines for S.C.R.O.
(State of Alaska Memorandum to District Office Engineers dated January 3,1985)
Waiver Request for: Scimitar #3 Block 1 Lot 1
Parcel ID#: 051-132-68
Waiver Request Number WR#: 070050 dvf'`vla i`JCL Xii
Waiver Requested: 97 FOOT HORIZONTAL SEPARATION FROM WELL ON -LOT TO SEPTIC
TANK. AND A 4 FOOT LOT LINE WAIVER FROM ABSORPTION FIELD TO EAST PROPERTY
LINE.
Engineer: Jeffrey Gamess, P.E.
IIA070388
Water Table Points
Depth of well: 146 7.19
Depth of septic system: 11
135
Distance from the bottom
Point
of the system to the highest
Value
water table In feet
0
0
8
1
17
2
24
3
30
4
40
5
85
6
100
7
290
8
1000
9
10
• Straight line Interpolation is permitted
between any two values
Soil Sorbtion
Points
..,
1.30
82 11.5
+
f 531
+
+
Soil Type
Point Value
Clean Gravel
0
135
135,
[ 135
H135
Fractured Rock
1
Course Clean Sand
1.5
+
f 1
+
( 1
+ f 0)
0
+
( 0--]
1
0
Sand w/ Small Amt of Clay
2.5
1135 J
l 135)
135
J
1135 J
Silt
3.5
Clay and Sand Equal
4.5
0.9 +
0.4
+ 0
+ 0
Clay
6
0 +
0
+ 0
+ 0
*Use the predominant soil type but values can be averaged for a mixture
Permeability
Soil Type
Point Value
Clay(will channel)
0
Sill and Sandy Clay
2
Clayey Sand
3
Fine Sand
1.5
Sandy Gravel
1
Fractured Rock
0.9
Course Sand (30 grit)
0.4
Clean Gravel
0
Points ,..,
0.60
r 351 .4 + 35, .9 + [73— 1 + [ 135, 1
+ (135, 1 +[ 135, 1
0+[
135, 1 + [ 135, 1
0.24 + 0.35 + 0.00 + 0.00
0.00 + 0.00 + 0.00 + 0.00
'Use the predominant soil type but values can be averaged for a mixture
Gradient
4.5
%Slope
Points Value
-60%
0
in Feet
-30%
0.3
0
-20%
0.7
50
-10%
1.2
2
-5%
2
150
0%
2.93-
.9}5%
5%
4.5
10%
6
}
60%
7
slopes toward well
Oat
slopes away from well
*If the gradient Is unknown, assume the worst case
Horizontal
Horizontal
Point
Separation
Value '
in Feet
0
0
25
0.7
50
1
75
2
100
3
150
5
200
6
300
7
Points ..,
4.50
Points a.,
2.88
'Linear Interpolation between two point value Is acceptable. Horizontally means
straight line distance to the well not the contaminate travel distance to water table
which may be greater.
Conclusion: Grant Waiver Total Points: 16.466,
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS m F• * wT*�
September 26, 2007
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Scimitar Subdivision H3, Lot 1, Block 1. Waiver of Separation Distance Between the Well on Property and the
Septic Tank on Property. Waiver of Separation Distance — Drainfield to Lot Line.
The existing three (3) bedroom house is served by a private well and septic system. The septic system was installed
on April of 1984 and the well was drilled in March of 1984. Per the MOA inspection report, the separation distance
between the well and the septic tank is 100 feet. Per the asbuilt survey (prepared by Walatka and Associates) the
separation distance appeared to be less than 100 feet. We shot the separation distance with a Topcon total station
and determined the separation distance between the well and the first tank cleanout to be 98.16 feet. Attached is a
site plan. Based upon the graphical drawing, it appears that the septic tank is as close as 97 feet from the well;
therefore, we are requesting a separation distance waiver of 97 feet. Justification for the waiver is summarized as
follows:
• The encroachment has existed for approximately 23 years and recent water samples indicated nitrate levels
as non-detectable and no bacteria to be present.
• Attached is a well log for the subject property. The well is 545 feet deep. The first 93 feet of the well is
drilled though a geological profile of sand and gravel.
• Attached arc well logs for a number of adjacent properties. The wells range from 124 feet deep to 600 feet
deep. All of the wells are bedrock wells that are below thick protective layers of sand, gravel, hardpan,
and/or silt.
• The well head extends at least 12 inches above grade, has a sanitary seal, and has appropriate drainage
around it.
• Attached is a topography drawing of the area. The topography is such that overflowing wastewater from the
septic tank would not flow towards the well.
• There is a driveway between the septic tank and the well, so it would be impossible for overflowing
wastewater to reach the well unnoticed.
Based upon the aforementioned facts, it appears that there is minimal risk associated with granting the
requested 97 feet waiver between the well and the septic tank.
According to the asbuilt survey and our field measurements, the drainfield is approximately 4 feet from the property
line that parallels Seika Drive. There are no septic systems with 60 feet of our client's drainfield. In short, there are
no concerns associated with this encroachment. We are requesting that your department is a 4 foot waiver from
the drainfield on the subject property and the closest property line.
have anytiu/itions, please contact us at 337-6179. Thank you for your assistance.
.E., M.S.
3701 E. Tudor Road, Suite 101 • Anchorage, AIS 99507-1259
Ph: (907) 337-6179' Fax: (907) 338-3246 • Website: www.gamessenginecring.com
si,
1' 40"
/
/
/
/
/
/
/
/
/
/
/
hN r
(R.. 01A5)
GARNESS ENGINEERING
GROUP, Ltd.
--•-•�•�-•=-_--..v=.-•. CONSULTANTS 6 GENERAL CONTRACTORS
....•••• •••••••
••••••••
JMt L T NWA M 101 • MC001ML M( N 7 • A (W)jtil-01T • r" (901)SJ " • 0 ' w..p wMp.mn
PREPARED FOR: PHONE NUMBER:
PAGE NUMBER:
•••••
fr
•• ••••
ar ess:
TERRY MANNING 360-5943
1 OF 1
.J
iLEGAL DESCRIPTION:
DRAWN BY:
PNB
E_
OD s
00 9,,
�8G
SCIMITAR #3, BLOCK 1, LOT 1
eoAc
TYPE OF WORK:
DATE:��ed Pro feasjtOt%�
'2007
WELL TO TANK WAIVER
9/26
(R.. 01A5)
w
/ SCIMITAR S/D /2.
/ LOT 37. BLOCK 2,
lus /
\\ SCIMITAR S/D /3,
\ LOT 4, BLOCK 3,
A
GARNLSS ENGINEERING GROUP, Ltd. 1p0
- - -- - ••- -»-• CONSULTANTS & GENERAL CONTRACTORS Q•
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
TERRY MANNING 688-3779 1 OF 1
LECAL DESCRIPTION: DRAWN BY:
SCIMITAR S/D #3. LOT 1, BLOCK 1 K.D.M.
TYPE OF WORK: DATE:
SITE PLAN 9/24/20'
(Rev. OIMSI
:.........
IiFiiiiiiiiF81
MUNICIPALITY OF ANCHORAGE
• '� DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
1 343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel l.D. # C�l�l - 1 �, - In HAA# VA R9
1. GENERAL INFORMATION
Complete legal descriptionLam; i32ocf j, 'Scimctaii #�
Location (site address or directions) 20048 Sei.ha Dkive.
Property owner Edith Newwm Day phone 688-0378
Mailing address 20048 Seika Drive Peten3 Cx.eek. AK
Lending agency Day phone
Mailing address
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: X 3
3. TYPE OF WATER SUPPLY:
Individual well XXX
Community well
Public water
Day phone
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site 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 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 investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm
17034 Eagle
Address
Engineer's signature
6. DHHS SIGNATURE
X Approved for 7/'��� 6 bedrooms.
204
Phone
Date �� S y 3
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
By:
C Lea ->< Q� Date 7-;i-6 —l3
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's wo. k.
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)
Manufacturer
Manhole/Access (Y/N)
SEPARATION JSTA-IgCE FROM LIFT STATION TO:
Cycles tested
p off' level at
lot On adjacent lots Surface water
D. ABSORPTION FIELD DATA
Date installed �' 22 ' Q'4 Soil rating 0S!�'� System type DR-C�r�Ft> uD
�1
Length �� Width h Gravel thickness 3 5 Total depth
Total absorption area —
Depression over field (Yo
SS
Cleanouts present&N)
Date of adequacy test _5---1 2 -93
Results pas il) PGS
for
v
Property line
bedrooms
Peroxide treatment (Past 12 months) (Y& ►"�
If yes, give date
11kb.
To building foundation
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot l3`
On adjacent lots
v
Property line
10
To building foundation
`a To e
isting or abandoned system on lot
On adjacent lots 3 L --)t A--
Cutbank ��
Water main/service line
Surface water 1--p c-> A- Driveway,
parking/vehicle storage area
Curtain drain
E. ENGINEER'S CERTIFICATION
I certify that I have
Signature __ �
Engineer's Na
Ea
Date
or conformed to all MOA and HAA guidelines in effect on thfy date of this inspection.
Alaska 99577
Iii
HAA Fee $ Waiver Fee: $
Date of Payment ys3 Date of Payment
Receipt Number �S°- 2� �� 7 P-6 Receipt Number
Municipality of Anchorage
Department of Health & Human Services M}r+
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: �-r' 1 C7LIL 1 M %TA-t�''5 Parcel I.D. d6-1- 13 L /8
A. WELL DATA
Well type If A, B, or C, attach ADEC letter. ADEC water system number �` P
Logpresent&N) V
Date completed
x''74 -S4 Driller
MprCg�JSaJ
Total depth '5q5 t
Cased to
C� 1� Casing height
Z\ k
Sanitary seal (�YN)
Wires properly protected &N)
24
w O
FROM WELL LOG
AT INSPECTION
Ck
Date of test
3 - 1� _ 3 `Y
S - 12 -`13
o,
LU
\Z--
142
a P'
s
Static water level
N r—
LU
J f.
Well flow
20. O
l
&4".
�_
Pump level
y �
`� 4?_
2 o
iii
Z
SEPARATION DISTANCES
FROM WELL TO:
Septic/holding tank on lot
bo \
; On adjacent lots
c, k �
Absorption field on lot
l \g
; On adjacent lots
Public sewer main
�
Public sewer manhole/cleanout
Sewer service line
2`��
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate O, / Other bacteria 49-
S ! '�3 Collected by:S & S CNGINEERING
—17034Eagle
Eagle River, Alaska 99577
B. SEPTIC/HOLDING TANK DATA
Date installed
G -Z2 -9'�
Tank size 1 onb Compartments
Cleanouts (9/N) _ Foundation cleanout ON) �—Depression (Yo
High water alarm (Y/& 'J Alarm tested (Y/N) �
Date of pumping --`1 3 Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s)onlot X00 On adjacent lots doh / —Foundation
To property line / o r Absorption field
r -r-
Surface water/drainage I & D
S
Water ain/service line /o /
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
RECEIVED
JUL 191995
l rt Munic�paL•ty of Ancho
C
W
Dept. rjeal
AWELL FLOW TEST DATA
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE y
WASTEWATER
DISPOSALSYSTEM
ROBERT SHAFER, P.E.
ROGER SHAFER. P.E.
CIVILENGINEERS
(907) 694-2979
FAX 6941211
CLIENT: JiV XI -k DATE OF TEST:
LOCATION OF WELL (Legal Description) : "T' \ 5L�y � SU c l�Ytk� 3
WELL DEPTH: 45q,5 -'p' CASING DEPTH: 1'>' TESTED BY: YZP �1
DATE DRILLING COMPLETED: DRILLER: M 4l,40 Sa A
CLOCK DEPTH TO DRAWDOWN PUMPING REMARKS
TIME WATER RAW (GPM
MISC. DATA: CASING HEIGHT:Z SANITARY SEAL?:
WIRES IN CONDUIT?s GRADING O.K.?:
BACTERIA & NITRATE--S—A PLEtS COLLECTED: S 1.-93
RESULTS: WELL CURRENTLY PRODUCES I .1 GPM WITH A A �T DRAWDOWN
FLOW RATE NOT GUARANTEED --SUBSEQUENT VARIATIONSCANOCCURI
.-.nn• r n1 0 oivco I nno 01II7C nnA CAf_I C onion A. AOVA nnM77
3`1 L.P'
2.4
2� AC LIP
3' S -7
Gast I�4 .S �aeC�
ofr R-ol?�u�, 3.a lneM
MISC. DATA: CASING HEIGHT:Z SANITARY SEAL?:
WIRES IN CONDUIT?s GRADING O.K.?:
BACTERIA & NITRATE--S—A PLEtS COLLECTED: S 1.-93
RESULTS: WELL CURRENTLY PRODUCES I .1 GPM WITH A A �T DRAWDOWN
FLOW RATE NOT GUARANTEED --SUBSEQUENT VARIATIONSCANOCCURI
.-.nn• r n1 0 oivco I nno 01II7C nnA CAf_I C onion A. AOVA nnM77
e 6o —q1 ��
0,5
—�t
THE INFORMATIOII HEREON 16 FOR TBE USE OF LENDING
INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS
61119111 EXISTIUC STRUCTURRS AND PLATTED LOT LINES
CA EASEMENTS AND IS NOT TO HE KED FOR POSITIONING
ADDITIONAL iTRUiDTUAEB OR FENCaLINES
EASEMENTS OF RECORD, OTHER
THAN THOSE 6NONIN ON THE
RECORDED PLAT, ARE NOT
SHOWN HEREON
', r
L T %�
-43
RECEIVED
JUN 11 1993
iviuMcipallty Oi Anchorage
Dept. Health & Human Services
,�-�p'� .gP,q�qlit
�
0
ow *.'4�3:iIi 'tt ai
V.a' .s.4.
�pf , 1; Shono A. Hol, �o
•,f. LS 6914 ,i ,
to
1 � y 40,141464
0fcssloaA�
[6 rn, YS
AS -WILT SIJWYEY 111 a 40'
1 hereby Certify that t have performed s
Mortga$ate's I,ispection of the followtrp
d!'CGrltaed pr"rtyj`
LOT 1, BLOCK 1, SCIMITAR SUS.,
UNIT No. 3
Anchorage Recording District, Alaska and
that the fffprovswnta situated theram
are within the property linea and do not
overtop or areraach on that property
Wtr trdJecent thereto,, that no
imProvaseents 06 property lying adjacent
thereto encroach on the promisor In
question and that there are no roadways,
transmission linea, or other vlaible
a#semonts on said property except as
Indicated hereon. �atad at Anchorage,
Aleake this �� � day of % k!
19.L3 . 0; Ys -V
MOLT AND ASSOCIATES LAND SURVEYORS
/,398
MUNICIPALITY OF ANCHORAGE 0(
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL kJ 22 _ C�) CW
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date Manch '4, 1988
1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 1; Mock 1; Sc i.m.i tan Subdivision #3
Location (address or directions)
(b) Property Owner FHA - HUD Telephone: Home
Mailing Address
(c) Lending Institution Telephone
Mailing Address
(d) Real Estate Company and Agent ASSOCIATED BROKERS/Eris Dyitud
Address 640 West 36th, Suite 1. Anchorage, Atazka 99503
Telephone 563-3333
(e) Mail the HAA to the following address: or: Check hereX , if hold for pick up.
List contact person and day phone number below.
S 9 S ENGINEERING1694-2979
17034 Eag.Ce Riven Loop Road, Sure 204
Eagle R.ivex, A.2aska 99577
Business
o,.deAed by Eris Dynud
2. TYPE OF RESIDENCE
Single -Family IN
Number of Bedrooms th7¢e
3. WATER SUPPLY
Individual Well g Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite;p Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmationfrom the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 ?Rev 8/86) Front
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm S & S ENTelephone
G er Loop Road No. 204
Address
ga le River,
Alaska 99571
Date
6. DHHS APPROVAL �,,����% �%
Approved for -� bedrooms by _ '�'"" ' Ei' Date
Approved Disapproved Conditional
Terms of Conditional Approval
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
certificates based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in
order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data
before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional
engineer's work.
Page 2 of 2 72-025 Mev 8/861 Back
1AS { O� ANCHDD SGS ON L J ` 3� (9
tiIR,NMEr1T�� SER�SC�S MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
tJt�� 2 9
19�a 264-4744
Legal Description:
A. WELL DATA
Well Classification \ 1120 /xt� If A, B, C, D.E.C. Approved (Y/N) —
Well Log Present (9N) -- Date Completed '72 " "24 - e'�y Yield
Total Depth 05�ACz7 t Cased to 1� 1 Depth of Grouting
Statir. Water Level �2�' Pump Set At
Casing Height Above Ground
Electrical Wiring in Conduito/N)
ON
t3/A,
22 Gf N
Sanitary Seal on Casing(N) -
Depression Around Wellhead (Y(?
Separation Distances from Well: t
I
To Septic/HeldtfigTank on Lot t ; On Adjoining Lots
lX
To Nearest Edge of Absorption Field of 1 ; On Adjoining Lots t
To Nearest Public Sewer Line To Nearest Public Sewer
Cleanout/Manhole To Nearest Sewer Service Line on Lot
Water Sample Collected by ��Z 'T,(' Date
Water Sample Test Results
Comments t� 'F�
B. SEPTIC/HOLDING TANK DATA
Date Installed "c'11'0+ Size � Oo0 No. of Compartments
M
Standpipes (ON) —.�--- Air -tight CapsyE(ON) �-- Foundation Cleanout((YYN)__y�
Depression over Tank (Ya Date Last Pumped -CJS
Pumping/Maintenance Contract on File (Y/N)� ; form
Holding Tank High -Water Alarm (Y/N) I" Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/i-lelding_Tank: I
To Water -Supply Well Obi To Building Foundation
To Property Line 1 c::) To Disposal Field
t
To Water Main/Service Line \ L-�> To Stream, Pond, Lake, or Major Drainage
Course
I_�_
Comments �t7� 665� Dov 'FI) -1 e I r_3�t
Page 1 of 2
72-026 (Rev. 8/86) Front
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata - t�� Type of System Design 27�1 pn
Date Installed Length of Field 2�
I r
Width of Field
Depth of Field
I
Gravel Bed Thickness s
Square Feet of Absorption Area Z Standpipes Presen67N) y
Depression over Field (Yo [J Date of Last Adequacy Test
Results of Last Adequacy Test —2C n6�/S�f�n�/ — � �—
Separation Distance from Absorption Field:
I
To Water -Supply Well
To Building Foundation
Lot
r' /A
To Water Main/Service Line \ o
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION / /L
nstalled (jam
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
To Property Line
To Existing or Abandoned System on
On Adjoining Lots 1_;5z>('r
To CutbankI(if present)
1 'C:o --I—
D.
%
Dimensions
Manhole/Access (Y/N)
— "Pump Off' Level at
Vent(Y/N)
ng Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed S Date9� �Sl
Comparl7o34 Magle River Loop Road N04401A No.
Eagle River, Alaska 99577
Receipt No. o(0 �, 6
Date of Payment3 2 ql�
Amount: $ - --7-() OC)
Page 2 of 2
72-026 (Rev 8186) Back
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date
(a) Legalescrip i n (include blot, block subdivision, sectio, township, range)
OZ-[, C i % �TarH� �/
Location (address or directions)
(b) Applicants Name Telephor.E/r e/
Applicants Address;
(r.) Applicant is (check one) Lending Institution Owner/builder
Buyer � ; Other � (explain);
(d) Lending Institution Telephone
Address
(e) real Estate Co. & Agent
Address
Telephone
2. LTe of Residers
Sirgle-Family Multi -Family
Number of Bedrooms 3
3. Water Supply
Other (describe-)
Individual PLa11 P Community F:=f Public
Note: If ccununity well system, must have written cor•firmation from the State
Department of Environmental Conservation attesting to the legality and status.
Is the X11 adequate for the number of bedrooms specified in this HAA &)
4. Sewage Disposal
Onsite- Public F=j Community Holding Tank
Is the wastewater disposal system adequate for the rimber of bedrooms Y )
(Page 1 of 21
e
2-15-84
5. Engineering Firm Provi�g Inspections, Tests, Data and information
I certify that I hage checked, verified, or conformed to all MOA HAA Guidelines in
effect cn theto f t * inspection. 1
Signed Date
Name of 'Firm Telephone
Address #' ` is"GIf�E�ti�'
. o
gtjCiLt- HMO, ALAS�'-A 11037T
Signed by PH, 04-2.^oil
Date
(ENGINEER SEAL)
6.DHEP Approval
Approved for 3 bedrooms
Approved Disapproved
TV -
Terms of Conditional Approval,
• �.'a � i l � /e3PJ�' ' � M
a�tt h 4
1457 sW
m?e PR,UiE�S��I
By ��_ C E Date 5 b _
Conditional
The Municipality of Anchorage Department of Health and Environmental Protection dces
not guarantee the continued satisfactory performance of the water supply and/or the
wastewater disposal system. This approval indicates that, as of the validation date
shown above, based on the data and information furnished by an engineer registered in
the State of Alaska, the water supply and wastewater disposal system is safe and func-
tional for the number of bedrooms and type of structure indicated.
(DHEP SEAL)
7. Mail the HAA to the following address:
KB2/d5/s
[Page 2 of 21
2-15-84
A.
L / " MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION
HEALTH AUTHORITY APPROVAL (HAA) 170 51984
CHECKLIST - FEBRUARY 1984 pc
Legal - scription:�L
.WELL DATA -A ✓� � �'
Well Classification d �. If A, B, or Cr D.E.C. A proved(Y/N)
Well Log Presentrym) Date Completed g y Yield L�
Total Depth Cased to %� ✓ Depth of Grouting
Static Water Level Z M Pump Set At /
Casing Height Above Ground -7Sanitary Seal on Casing Y, )
Electrical Wiring in Conduit Y) ) Depression Around Wellhead (Y99) '
Separation Distances from Well: " ✓, - —
To septic/Holding Tank on Lot On Adjoining Lots 1490 '�-
To Nearest Edge of Absorption Field on Lot // .! ; On Adjoining Lots l6e) /4 -
To Nearest Public Sewer Line To To Nearest Public Sewer
Cleanout/Manhole !✓ To Nearest Sewer Service Line on Lot
Water Sample Collected By S 6 AI(1%2 ; Date Z 8
Water Sample Test Results
Cents /i< /G'-G� _ j°G> // d�� / /✓� ���
B. SEPTIC/HQLDINC, TANK DATA
Date Installed Size //79() -No. of Ccmpartments
Standpipes ) Air -tight Caps lY} ) Foundation Cleanout ON)
Depression over Tank (yto Date Last P d
Pumping/Maintenance Contract on File (Y ) �G� for - -
Holding Tank High -Water Alarm (Y/N) N A Temporary Holding Tank Permit (YM) All,
Separation Distances from Septic/Holding Tank:
To Water -Supply WJe11 16y r _ To Building Foundation
To Property Line Za r�J To Disposal Field ✓
To Water Main/See v�ice Line 4 To Stream, Pond, Lake, cr Major Drainage
Course 717
Comments
[Page 1 of 21
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorpti n Strata C� -3 Type of System Design DyE'X
Date Installed r�% Length of Field _
Width of Field 'r� Depth of Field
1 —
Gravel Bed Thickness
Square Feet of Absorption Area Standpipes Present6/N)
Depression over Field (YA to of Last Adequacy Test
Results of Last Adequacy 'lest A
Separation Distance from Absorption. Field:
To Water -Supply Well To Property Lire
To Building Fo ndation To Existing or Abandoned System on
Lot On. Ad'oining LotsZ) 7J
To Water Main/Service Line ��i To Cutbank(if resent) 10VIA
To Stream/Pond/Lake/or Major Drainage Course _ 44
To Driveway, Parking Area, or Vehicle Storage Area
.iIF
D. LIFT STATION
i
Date Installed Dinensions
Size in Gallons Manhole Access (Y/N)
"Pump On" Level at " f" Level at _
High Water Alarm Level at A Vent .(YM)
Tested for Pumping c s during Adequacy 'lest. Meets MOA
Electrical Codes(Y/N) j
-
Coim)ents
Check Permitted Bedreran Rating Against HAA Request **
I certify that . In ve chec e , verified, or confornYed to all MOA HAA Guidelines in effect
on the date pf t on. " � �:�700
Date / �+ y ........,, 4,p
Signed C �t ••,
m , %7
Company MOAN . * S° * j.
sro 196% f �
KB1/d5/s I ra 111w..of ALASKA %$�l:� .. a..... ... .•
Robert A. $Us
.....
__.-._ _ .-_ •�,'.� hb. 11.774 1
me
[Page 2 of 21 Mme,
2-15-84