HomeMy WebLinkAboutSCIMITAR #3 BLK 1 LT 15Onsite File
Scimitar #3
Block 1
Lot 15
#051-132-82
trcev uo/uui 6)
Municipality of Anchorage
On-Site Water and Wastewater Section • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP201448
PID Number: 051-132-82
Dwelling: ® Single Family (SF)
❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade
Name
DONALD & EILEEN MANN
ABSORPTION FIELD - EXISTING
❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
19677 BELDUQUE COURT, CHUGIAK
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision
Block Lot
Fill added above original grade
Ft.
Gravel length
Ft.
SCIMITAR #3
1 15
Township Range
Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area Z
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ft
Ft.
Well
100'+
--
25'.+.
TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
GREER
Capacity
1000 Gal.
Surface Water
100'+
--
Material
HDPE
Number of compartments
2
Lot Line
10'+
--
NA
Foundation
10'+
__
LIFT STATION
Manufacturer
Capacity
Gal.
Remarks
Alarm location
Electrical installed by
Tank to
PIPE MATERIAL House to tank 3034 3034
Installer ,1RS
drainfield
Drainfield CO/MT 3034
Inspector FWCS
BENCH MARK (Assumed elevation) 100 ft
Inspection ection 1�t 10/30/20
11/2/20
Location and description
2nd
3`d
41h
BOTTOM OF SIDING
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
OF A
Conditional Approval:
Date
TH
...... /
• Curtis Huffman : /
Septic System
Approved -
/` _Z�Z
Date " C�
�',�,.• ql-
CE 128991
�'/�
...
lF 1 t/M202Q. �� A.
�'°ROFESSION�`�'�.�.
SSO�
Note: this approval does not include well permit requirements.
trcev uo/uui 6)
PID: 051-132-82
PERMIT: OSP201448
DECOMMISSIONED EXISTING
S.T. & INSTALLED NEW
1000—GAL HDPE SEPTIC TANK
WITH NEW DCO.
A—C=17.3'
B—C=21.0'
A—D=20,3'
B—D=17,8'
A—E=22.3'
B—E=16.7'
SEPTIC SECTION
SCIMITAR #3 BLOCK 1, LOT 15
PREPARED FOR:
DONALD & EILEEN MANN
19677 BELDUQUE COURT
CHUGIAK, AK 99567
FIRST WATER CONSULTING
13030 SUES WAY
ANCHORAGE, AK 99516
907-350-9566 firstwaterAK®gmail.com
SUPPORT SERVICE
o e
DATE: 11/3/20
SURVEY: JLS
DRAWN: FWCS
SCALE: 1" = 30'
SCALEi NTS
OF .A4`
9 TH
rtis Huffman wx04
CE 128991
11/3/2020I N
MIII+ J IPA LITY OF ANCHORAGE
Oii-Site Walar & Wasb wpW Program
PO BOM 109650 VD0 EmOre Rnd
Anrhoraga, Alaska 94-57g.5E50 Phare, t 7) 343-704 Fox; (91)7) 343-7997
h Up; thvrnw • Rr�, 4 f$!a n the
On ite Wastewater Disposa I System permit
Permit Nan10 r; OSP 14 48
Work Type: SispticTank Upgrade
TOX Coda Number. 0611 X2821000
Site Legal Address: -SCIM WTAR 03 ELIC i LT 15 G; 1261
SAR GUIl Ing Addr ; 19B77 BELDUQU E CT, Chuglak
mer: MANN DONALD M & EILEEN Y
D asion Enginser. FIRST WATER CONSULTING
This pormit 4 for the corlstn,ctiarl of
Effeetivc Data:
Sx p iratlo n Bate;
Lot 5Lra in Sq FL
ToW Bedrooms:
Ment
Q �..
u
-itt
1 Oa10
101
43550
0 Disposal Field (Z .5a0c Tank Q Holding lank ❑ Privy ❑ PNVat-0 Vwe1I ❑ Water Storage
All constriction shall he In acauMlonna with:
11- The Bktached appmed deM
2. Ali requirements specified In Anchorage Nlurniclpal oode Chapters 15.66 and 75.8-5 and llhe Skate of Alaska
Wastewater f]ispoSaW RegulffWns (1l3AAC72) arty] Drinking Wafer RngulaVons (18AAC )
3. The wstowakar ode requfres Iris tions during the installation. The engineer shall ncAlfy the Development
Services Depertrnent per AMC 15.05, P Wde norrcatlon by calling (907) 843-7504 ('24R).
4. From Goober 16 to April 15, a subsurface soil ObWfpt Dn sysWm under oonsfzuation during in0 weallher
shall be either-
a. Opened and Clowd on the Berne day, or
b. CoVmred, seated, and heated le pravwt freezing
R®cuiaed S
Issued Bir; ,.
I MN202D
Do* #
Bale: #
13030 Sues Way, Anchorage, AK 99516
907-350 -9566 / firstwaterAK@gmail.com
October 20, 2020
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC TANK UPGRADE PERMIT
LEGAL: SCIMITAR #3, BLOCK 1, LOT 15
PHYSICAL: 19677 BELDUQUE COURT, CHUGIAK, AK 99567
The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic
tank on the above referenced lot. We propose to install a 1000-gallon HDPE tank to serve the
existing 3-bedroom residence. The lot and area are served by private water. The design will not
impact any of the neighboring properties. Please contact us if you have any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201448, Rebecca Carroll, 10/23/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201448, Rebecca Carroll, 10/23/20
gELDUQUF CT
LCT 14
BASE OF BEARING
C 4 R}
525.59.30„W 110.45'
® WELL
DECK
LOT 16
t.J•xs. s.
gk Cpryr GRAVEL
8.a ❑/W
rn
Z
o - WRL
1 a
HOUSE z�.s
A
WALK � 4
DECK� 24.p
N N
t''
CA
`•�
x----x—x—x�x�
�
SEPTIC
•
VENT 1 4 P
■ ■
(typ) j
x ✓
I
LOT 15
BLK 1
[—x—x—x—x~x~x~x—x—x—x—X�"�x—x~x~x~x�x~x~x~
F,A
°o
N,39'46'2 7'j
ANCHORAGE RECORDING DISTRICT, ALASKA
AS -BUILT OF:
SCIMITAR SUBDIVISION UNIT No.3
LUT 15 BLOCK 1 PLAT 80-51
SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a
physical survey of this property as shown on this drawing and that the
improvements situated hereon are within the property lines and no
enchroachmenis exist other than noted. Under no circumstance should
any information on this drawing he used for construction of fences,
structures, improvements, or for establishing boundary lines.
EXCLUSION NOTES: It is the owners responsibility to determine
the existence of any easements. covenants. or restrictions which
do not appear on the recorded subdivision plat.
WORK ORDER NUMMB R- o C. SCA : — AL•
OC. 15. 202fl 1 1'=40-
20-076
'=40'
20-076 DRAYM en crEcxm a crewsoot FM
JLS NW1261 200226
Q = FND 518" REBAR
o F .AL'k%1
o�
• 49TH
�X ...........
'-i
``s -AHN L. SCHULLER; •
V r ' LS -10408 a
c�
i�■a '' �Q..[ aye
■� °fessiona� L4.,v
LAft
v 4'
%
rUn n
1B31 Talkeetna Street
Anchorage, Alaska 99508
(907) 227--1455 office
(907) 274-4992 fax
MUNICIPALITY OF ANCHORAGE r;
®
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
PHONE
NEW
J
146ZIJ
❑ UPGRADE
MAILING ADDRESS
/JU)e CT.
LEGAL DESCRIPTION
L &A 1
LOCATION
NO. OF BEDROOMS
�� �L
3
U Y
DISTANCE TO: -
Well
NUY .-ir/'V%'r
Absorption area
_ '�
Dwelling
(� �-
PERMIT NO.
92 .. S 3
l- z
N~
Manufacturer
�H
Material
�6L
No. of compartments rt
oC
Liq, capacity in gallons
IF HOMEMADE:
Inside length ___
Width
Liquid depth _—
DISTANCE TO:
Well
Dwelling
PERMIT NO. -
J02
2 z FQ-
Manufacturer
Material
Liquid capacity in gallons
Lu =
DISTANCE TO:
Well
.__
Foundation
L) ��
Nearest lot lin
� g!"
PERMIT NO. r '�
�j
J LL z
No. of lines
J
Length of each line/
Total length of lines
Trench wic(th
Distance between lines
F z wW
F
o f
inches
N
¢ F-
Top of tile to finish grade i �
Material beneath the
Total effective absorpt on area
a
(-i inches
- Cf
Length
Width
Depth
PERMIT NO.
w
0
aH
Type of crib
Crib diameter
Crib depth
Total effective absorption area
Lu
Uj
ti
DISTANCE T0:
Well
Building foundation
Nearest lot line
_jClass
y
Depth
Driller
Distance to lot line
PERMIT NO.
-
yr _rpl.YrzY
-
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHEE R
PIPE MATERIALS
ZIP
SOIL TEST RATING
U
INSTALLER
s a
REMARKS
L S O
.a
lVj1 Th9LL 6_0 Y1 '
rnt r J
A
�
• ci a�
••s
Q
"fir
APP V
DATE LEGAL
11Uiatinev. alta)
MRXIMUM NUP1BER OF BEDROOMS SOIL RHTING (SQ FT/BR)� 100
THE REQUIRED SIZE OF THE SOIL SYSTEM IS:
W No P -T C-1, W 1-4 07 Q �����E- EF����� �
THE
y����!����! '^`
H�HL|H HND ENVIRONMENTHL �9OTECTION
'
S25 �
-STREET, HNCH�RGE/
.
.
GROUND
264^4720
OF THE Ell CAR VHTION (IN FEET)�
^
�Mill 0-- L.- lot P -A ED
0.1144 '1" LE
Is K RMA fEEE �FTC FWI 11 -V
PERMIT
NO ( 820]]6 )
GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFHLL
PIPE
HPPLICANT
MYERS CONSTRUCTION
PO BOX ]51
CHUGIHK 6944144
LOCHTION
F; -C E:7-1:.:� ME- 1`7-
X W Fol Phi W- ����-..-Eg
51 U W 04�
LEGAL
L15 B1 SCIMITfRR
LOT SIZE 42000 SQU! FEET
TYPE OF SOIL
ABSORPTION SYSTEM
IS: TRENCH
MRXIMUM NUP1BER OF BEDROOMS SOIL RHTING (SQ FT/BR)� 100
THE REQUIRED SIZE OF THE SOIL SYSTEM IS:
W No P -T C-1, W 1-4 07 Q �����E- EF����� �
THE
LENGTH DIMENSION
I5 THE LENGTH WN FEET) OF THE TRENCH OR
DRHINFIELD
THE
DEPTH OF H TRENCH
OR PIT IS THE DISTHNCE BETWEEN THE SURFHCE
OF THE
GROUND
AND THE BOTTOM
OF THE Ell CAR VHTION (IN FEET)�
THERE
IS NO SET WIDTH
FOR TRENCHES
THE
GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFHLL
PIPE
AND
THE BOTTOM OF THE
EXCHYHTION (IN FEET).
��1
F; -C E:7-1:.:� ME- 1`7-
X W Fol Phi W- ����-..-Eg
51 U W 04�
PERMIT APPLICANT HAS THE RESPONSIBILITY TQ INFORM THIS DEPHWTMENT DURING THE
INSTALLATION OF ANY WELLS HDJHCENT TO THIS� PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
�D I 01�4 K EEL RD W X Q Rwi 5ET- 5::�A F -Z E� ����I Ei-E L�-h ��
BHCKFILLING OF PINY SYSTEM NITHOUT FINAL INSPECTION HND HPPRQVHL BY THIS
DEPHRTMENT NILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETNEEN H WELL AND HNY ON-SITE SEWAGE SYSTEM IS
100 FEET FOR H PRIYHTE WELL QR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC NELL
MINIMUM DI5THNCE FROM H PRIVHTE !,!ELL TO H PRIVHTE SEWER LINE IS 25 FEET AND
TO H COMMUNITY SEHER LINE IS 75 FEET.
WELL LOGS HRE REQUIRED AND MUST BE RETURNED TO THE DEPHRTMEP-.!T ��ITHIN ]0 DHYS
OF THE WELL C0-IFLETIOKi
OTHER REQUlFfEMENTS MHY HPPL? SPECIFICAR! IONS HND CONSTRUCTION DIHGRHMS HRE
HVH1LRBLE TO INSURE PROPER INSTHLLHTION
WEENT11"I 1: -y- WNW" X F -W27 W EEL Q ME. V1 W K IT: is fl-' ���1-12
I CENTIFY THAT
1 I HM FHMILI8R NITH THE REQUIREMENTS FOR ON-SITE SEWERS HND WELLS A.S. SET
FORTH BY THE MUNICIPHLITY OF HNCHORHGE
2: I WILL INSTHLL THE SYSTEM IN HCCORDHN[:E WITH THE CODEw
1 uRu� RE EV -41 HF�'GEMENT IF THE
PERFORMED
X SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION O PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
DATE PERFORMED: "V )'g1fq;2
LEGAL DESCRIPTION: Z D/ /t) <SC irCc!/ �U W
�.� oco aiUUC' SLOPE SITE PLAN
2 L !
3
0.`
Gross
Time
?
�4
Net
Drop
5
= v
6
4 l7
/
S
7r
L7
"9-
10-
9 1011
11
12
0
13-
3
14
14
`
5
15-
16
16
SpNoY Cravel
/ av
OF AQ
j0V"000.
17 e
18 :.... -..
9 s Robert A. Shai e
19 �s� °°° No. 1457-E ��
�° JQ
20 ���OFFSSIONPt
COMMENTS
WAS GROUND WATER AL
ENCOUNTERED?
O
P
IF YES, AT WHAT E
DEPTH?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT AND FT
PERFORMED BY: CERTIFIED
72-008 (6/79)
DATE:
j 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 la, Ib or Ic.) A.D.L. No.
la. Borough Subdivision Lot Block Ib. 1/a glrs. Section No. Township N ❑ Range E ❑ Meridian
' 8— ,—of_of—of — E W[]
Ic. DISTANCE ANO DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL:
Address:
Street Address and Area of Well Location t-
2. WELL LOG Feet Below
4, WELL DEPTH: (final)
5. DATE OF COMPLETION
Surface
ft
Material Type Top Bottom
6. ❑ Coble tool Rotary ❑ Driven ❑ Dug
_;_❑
E] Auger ❑Jetted E] Bored E] Other;
,L;;-
..I,, ,1 ,j,,�
TC
7.1.18E� ❑ Domestic ❑ Public Supply ❑ Industry
❑ Irrigation ❑ Recharge ❑ commerical
❑ Test Well ❑ Other: -
,.. - •.
_ ,,, ]_') :° '; Ss+".
i::, l ;i �;�•
-
8. CASING ❑ Threaded ❑ Welded
diam. �f`_ in. to ft. Depth Weight. - Ibs./ft.
diam. in. to ft. Depth Stickup ft.
9. FINISH OF WELL:
Type: �. _ _- Diameter
G.
...
Slot/Mesh Size: Length:
Set between ft. and ft.
Backfilling Gravel pack
10. STATIC WATER LEVEL: ft.
❑ Above or ❑ Below land surface Date
Equipment used:
II. PUMPING LEVEL below land surface and YIELD
ft. after hrs. pumping g.p.m.
OF ANCHO
MUNICIPALITY
ft. after hrs. pumping g.p.m.
DEPT. O•.-=�'-'-
EINY 11-
12.GROUTING Well Grouted: Yes rl No
Material: El Neat Cement ❑ Other:
I I O e�f_
OO
13, PUMP: (if available) HP .-A,
Length of Drop Pipe -';,-' ft. capacity g. p.m.
O'Subm. ❑ Jet ❑ CenPrifical E] Other
_ - -- "-
14. REMARKS:
16. WATER WELL CONTRACTOR'S CERTIFICATION:
15. Water Temperature —° ❑ F ❑ C
This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief;
r. t
Registered Business Name Contract License Number
Address:` '
Signed : - i _.. - ..-. _ . Date:
Authorized Representative
Form 02-WWR (11/81) Copy Distribution: WHITE -State DGGS, PINK - Driller, CANARY- Customer
lL W' L9 U f 6 ta:0 M A U T k'.1 O PJ ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On-S.ite Systems Approval
Parcel I.D. 051-132-82
1. GENERAL INFORMATION
Complete legal description SCIMITAR #3 BLOCK 1, LOT 15
Expiration Date: e2 ` (p' 2-0Z (.
Location (site address) 19677 BEDUQUE COURT, CHUGIAK, AK 99567
Current property owner(s) DONALD & EILEEN MANN Day phone
Mailing address
Real estate agent
19677 BEDUQUE COURT, CHUGIAK, AK 99567
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER
DISPOSAL:
Private Well
®
Private Septic
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for:
Distance:
Received by:
Date:
COSA to be released to the engineer, unless otherwise requested by the
engineer.
COSA Fee $ 1 a. 50(60V lit -1 I /
Waiver Fee $
Date of Payment j 1 1 3 % g02 C7
Date of Payment
Receipt Number. 3 0 7
Receipt Number
COSA#_.. 6,S C�2_ 0 IG 1 O
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Address 13030 SUES WAY, ANCHORAGE, AK 99516
Engineer's Printed Name CURTIS HUFFMAN, PE Date 11/02/2020
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of theAw
•�
well and septic system. Therefore, any estimate of how long a system will function satisfactory A g�Q:' • • . • �,9 ���
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting & FWr.S . * . TH ....•:*
•�/
6. DSD SIGNATURE Curtis Huffman /
System #1 Approved for bedrooms ���c�s� . •CE 128991
FR 11/2/�020cQ�
System #2 Approved for bedrooms 1\>1FOPROFESStoNP`�.�
Disapproved
Conditional approval for bedrooms, with the following stipulations:
Y
1�z J yrs
`g o/_, o�
M In/„ „
�m PRo�� ATE
R
.,.•z.f -ter. —
� Jlt�t.
t E'er — Original Certificate Date: 2-020
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
Legal Description: SCIMITAR #3 BLOCK 1 LOT 15 Parcel ID: 051-132-82
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
® Well log is filed with Onsite (or attached)
Date drilled 6/4/1982
Total depth 285 ft
Cased to 143 ft
® Sanitary seal is functioning correctly
® Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 10/3/2020
Static water level at beginning of test 198 ft.
Well production at time of test 0.55 gpm
Comments
Structure served by this system
Water storage tank volume 500 gallons
Well disinfected for coliform test? ® Yes ❑ No
® Coliform bacteria is Negative
Nitrate 0.20 mg/L F-1Nitrateless than MRL (ND)
Arsenic ug/L ® Arsenic less than MRL (ND)
Collected by
NES
Date of Sample 10/16/2020 &
B. TANK DATA C. LIFT STATION
Age of tank(s) NEW TANK years ❑ Required maintenance completed
Tank type/material SEPTIC / HDPE Age of lift station years
Measured operating fluid level in septic tank NA Lift station material
® Standpipes/foundation cleanout per record drawing Comments:
Date of pumping NA — NEW TANK
D. ABSORPTION FIELD DATA
Which system tested (date installed) 5/30/1982
® ALL standpipes present per record drawing
Total measured depth from grade 7_5 ft (max)
Measured depth to pipe invert from grade 4_9 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective 2.6' INTO THE 5' ED
® Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies:
Adequacy test date 10/3/2020
Results a Pass For 3 bedrooms
Fluid depth prior to test 0 in
Water added. 1050 gal
New depth 7 in
Elapsed time 30 min
Final fluid depth 0 in
Absorption rate 450 gpd
Any rejuvenation treatment (past 12 months) N
If yes, enter date
FWES
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
® Yes
if No
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
® Yes
if No
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes
if No
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No
Neighboring Absorption Fields > 100'
Surface Water > 100'
® Yes
Animal Containment > 50' ® Yes
if No
® Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ® Yes
if No
ft
® Yes
if No
ft
ft
ft
ft
ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No ft
Property Line > 5' ® Yes if No ft Wells on Adjacent Lots:
Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft
Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft
Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
® Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
® Yes
if No,
_ ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft
Private Wells > 100' ® Yes if No —ft
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
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 thi1s date.
�•' lei
.. .......
..... ...
• Curtis Huffman
CE 128991 . ��`�®
pR4FESS10N��'�-��,�
Municipality of Anchorage
r �
® Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage. AK 99519-6650
www. ci. anchorage. ak. us
(907) 343-7904
Water Well Advisory
Certificate of On -Site Systems Approval (COSA) # OSC201610
During a recent COSA on-site inspection and test of the potable water
supply well on Block 1, Lot 15 of Scimitar #3 subdivision, the well's
productivity was determined to be .55 gallons per minute. The minimum
well productivity required by this Department (AMC 15.55) for a 3 -bedroom
residence is .31 gallons per minute. Although the subject well currently
exceeds this minimum requirement, all parties concerned are advised that the
production capacity of -the well may fluctuate. Restriction of non-critical
water uses such as washing cars and watering lawns and gardens may be
required.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
fa CD
,�,LLC
� 0
10
a) W • .
F- 447 �x x x
to C73
En to IM
J N71°2919 vj 229' 4 X i
cu cQ
F, ' CQ
+o�o
V
�?
F=,?nxDs
ui
24.0' I "`n{ 0�
Ur ,� 0 �{ co
CO
Y xoa�
N C®
N X Q �: :ca 0 N
Q itsI \ 7 Oco
W �a
' a �.
3 a.o s.o Ln x r -> o
LL-
oIle,LLIO
OQ (n o O m ell
x cL
7� ^ m 6.0'
CD V.I \ Y a
O
X O N
0-) 3 I co� c m C
e�
v J Nb C v w U 0
Q
C .
mN
o
N r? b on 10 ti
W U) ® 26.0' p o. a •^ g 9 W
Ctf
�( E o > ,_. a1 U e -8 U
t� k X 0) �.y, (O 0)1(U�{ �Hj Ey ''Si'i .� Q
v 1Li 'y ' ' 7' U N U .A
W 66 2- x I 0i �-
�U C C r� D C yU O❑
' I A O 301 N� o
o.
x X !.Z/ C7 O
o ani @ v,
:LJ Z- H aoa N o v a N
> w w m n
�X�X x Cp GQ H ti a 0, m oCCy �X` vca bai
6� f 0 z
LZ ` gm
102 60-04
0,co.gX o�a p4>Y�•sK zoo m N
N H as co
7- L) Z
,n y"
cn
Oa V � r -r F � .c x O o
Q cn�'' iU/1 0
a• °' M W '0 0 O
M
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
1. GENERAL INFORMATION
Age- act
Application Date /(O
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name �r=/LA I/hN derLwb/ Telephone: Home
Business
Applicant Address
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution 1rANr'010ST &W7W6ir [A• Telephone�'�
Address '4000 ®La® c'OG✓�i210 �7 tnzn c e &t.' 7.0 I<D �� e-0?4ijv, ?
(e) Real Estate Company and Agent
Address
Telephone (y
(f) Mail the HAA to the following address:
SR B 196X
EAGLE RIVER AK 0047_7
2. TYPE OF RESIDENCE _
Single -Family M,'*'Multi-Family ❑ Other
PER Bo® 5, 40
Number of Bedrooms 3 li-/0-4
3. WATER SUPPL—Y/
Individual Well L7 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 D OSAL
Onsite Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Pagel of 2 72-025 (11/84)
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DAiA AND INFORMATION
91
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 thatthe 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 Telephone y� Zy 7f
Address
Date
DHEP APPROVAL
Approved for 1�_ bedrooms by Date
Approved X Disapproved Conditional
Terms of Conditional, Approval
CAUTION
// 4/2 - b'fo'
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11/84)
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984 NOV 7 1�p��
264-4720
Legal Description: L nT �� R' 1 V L D
A. WELL DATA
Well Classification c> 9' If A, B, C, D.E.C. Approved (Y/N) N A
Well Log Present( N) Date Completed —(P - �:l `gZ Yield l-Pt;
Total Depth Cased 1*to /cY 3 t Depth of Grouting
Static Water Level Pump Set At
t�
Casing Height Above Ground Sanitary Seal on Casin (Y N)
Electrical Wiring in Condui (Y N) Depression Around Wellhead (YN)
Separation Distances from Well:
To Septic/Holding Tank on Lot ��lf On Adjoining Lots
To Nearest Edge of Absorption Field on Lot I0c) On Adjoining Lots
To Nearest Public Sewer Line ~lam To Nearest Public Sewer
Cleanout/Manhole To Nearest Sewer Service Line on Lot
Water Sample Collected by S d S CNc:.t,,4 Inco ; Date /o-3o'c5'Lb
Water Sample Test Results S�i-t tSRAC Z*LY
Comments 1n. u��,.5. Z� W: LL. Zyr�uc: tlit
B. SEPTIC/HOLDING TANK DATA
Date Installed S` -3�-SZ Size Koc:>d No. of Compartments�—
Standpipes6%) Air -tight Caps (�/ ) Foundation Cleanout �}N)
Depression over Tank (Y/A
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High -Water Alarm (Y/N)
)-h.
Date Last Pumped
;for
Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well IC>r�/-f' To Building Foundation /r4-
pr
To Property Line rU/`f To Disposal Field - �
To Water Main/Service Line (V To Stream, Pond, Lake, or Major Drainage
Course
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata /Ct> Type of System Design
Date Installed G_>o )3� Length of Field
Width of Field __ S 1 Depth of Field
#ravel Bed Thickness S
Square Feet of Absorption Area 3`/b Standpipes Present/N)
Depression over Field (Y& Date of Last Adequacy Test / /' u/
Results of Last Adequacy Test Y !-rte M
Separation Distance from Absorption Field:
To Water -Supply Well /oUr F
To Building Foundation ID 14
Lot K/A
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
To Property Line
To Existing or Abandoned System on
On Adjoining Lots 3,>r514
To Cutbank (if present) t-116
Allis
.±3c-�> I
Date Installed Dimensions
Size in Gallons Manhole/Access (Y/N)
"Pump On" Level at / "Pump Off' Level al
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
Vent(Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
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 & SSENGINEERiNG Date '6
Compan�R B 196X MOA No. d
EAGLE RIVER'�!� �,I� 99577 ��:�"�'��ay�
Receipt No. ZCe, i �f,? B (n� b
Date of Payment /�%��� 6 r.< '_ . %S, . �
Amount: $ /�1 �� l� .•, .�F�gr eah.,
.W .... b.. �0obn8.O •J U�
Page 2 of 2
72-026 (11/84)
y10{c1I0p0c�9{C{O \••rOt
Rv wi A. Shwr ,
No. 1457•E s
PRO
Time 1 Time
'-
Date
Date
Date
Inspector
Inspector
Inspector
Comments
Conditional Approval
(3) Approved Bedrooms
( } Disapproved
( } Conc tional A.9p oval
�
P �Lte �-� 1
Date Sewer Installed
Permit No.
Septic Tank Size
E —8 `7,
Holding Tank Size
Soils Rating
Well To Absorption Area
Well Log Received
Well to Tank
APPLICANT FILLS OUT LOWER HALF ONLY
Property Owner P•Vers COnstructlonr Inc.
Phone
PO Box 351, Chugiak, AIC 99567
694-9633
Mailing Address
Buyer Doug ICacirich & Sheila. Vanderlust,
SRA Box 914, Anchorage, AK 99502
Address
Lending InstitutionAlaska Bank of Conaner
Phone
Residential Real Estate
Address r`C" Street, Anchorages AK
264-5351
Realty Co. & Agent ThteTi Realty, Inc. Jim kliontague
Phone
PO Box 911, Eagle River, AK
694-9494
Address
Legal Description Int 15, Block 11 Scimitar #3
Street Location miN Lelduque Court, Peters meek
Typ of Residence
Single Family
❑ Multiple Family No. of Bedrooms
❑ Other
Water Supply
�f] Individual ATTACH WELL LOG. A well log is required for all wells drilled since June
❑ Community 1975. For wells drilled prior to that date, give well depth (attach log if
❑ Public Utility available.
See Disposal
Twa�ggIndividual Year Individual Installed: 19$2
❑ Public Utility When Connected to Public Utility:
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.