HomeMy WebLinkAboutSEQUOIA ESTATES BLK 2 LT 5Sequoia
Estates
Block 2
Lot 5
#017-152-21
Municipality of Anchorage Page of 2
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 ® Anchorage, Alaska 99519-6650 0- Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW93o21S PID Number: Ol7f S 221
Name: Totin � l.ea� Mc Curfh
Wastewater System: ❑ New ❑ Upgrade
Address: 67zr Spectrum CIrcI
ABSORPTION FIELD N.A.
Phone:
-31y5--S-03 z
No. of Bedrooms:
y
D Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ er
LEGAL DESCRIPTION
Soil Rating:Total
Depth from ori grade:
/Sq. Ff.
Lot: Block: Subdivision:
Depth to pipe bottom from original gra .
Gravel h beneath pipe
j 71 s c—Q cUdl,q -s
Ft.
Ft.
Township:
Range:
Section:
Fill added above original grade:
Gravel le 1:
3 w
26
FL
Ft.
WELL: �15NST(xGT New ❑ Upgrade
Gravel width:
J Ft.
Number of lines:
Distant tureen lines:
Classification (Private, A, B,C):
Total Depth.
Cased To:
Total a' rption area:
Pipet material:
A<s 7—H D 30 3 H
FL
FL
SC. Ft.
Driller:
Date Drilled:
Sialic Water Level.
Installer: ( f4ot DIN(r THNk-)
GXcc?L, (-Pn
Dale installed:
912S/93
Ft.
Carl`s
Yield:Pump
Set aL
Casing Height Above Ground.
TANK -
GPM
FI.
Ft.
SEPARATION DISTANCES
❑ Septic [9 Holding o S.T.E.P.
To
44041c
HOAD 6-
Absorption
Litt
Holding
Public/Private
Manufacturer:
/}nGhorer2 Tank
Capacity in gallons:
`1'0dO
From
Field
Station
Tank
Sewer Lines
`
Material:
(/H t' SfYRI
Number of Compartments:
1
Well
103,
(03
> Z.S''
—
LIFT STATION
Watere
>100
too'
Lot
'
Size i n gallons:
Manufacturer:
Line
tl5 '
"Pump on' level at:
"Pump off' level al:
High water alarm at:
Foundation
Curtain
Pump Make & Model
Electrical Inspections performed by:
Drain
10'
(G`
BENCH MARK
Remarks: New HUbO .-4I )?ola!(n A,/7 Ir hov
I vnt arlmeAl` and r -f mank42clurad
Location and Description:
Con Cre ke -5 fte on N. 5/de bf ara e
o� (/H" rPQf u�i%hS�unr� ld' �urtu!
Assumed Elevation:
d,0.jqj1A, Orr (naf STE.) fU,7/ U on.02,e ✓tmouea(L—LL�
100'0 rt
ENGINEER'S SEAL
rurheGf urea( an sihe. Rlarm flout rc�rcC wrfrDne� 2v"
A.4
�J2.lvW �fi of -)6n k. G.ow Volla f G2lurm 060>eM&U/7 kedon N.
- k`✓ ?✓ ,F
; ee•e n• J O
.4- ..' (. "��,,. '.
Wall InS7oee gGCrclaYP,
Flu f Te Ch Svc 8 Z-57 9 3
Inspections performed by: �— _Dates: 1st
9'Ll' .
�* � : �- .1.
�eeeeo e. of oeare.a ss eeeri,,i.
2nd
eeeesf f9
Department of mean ana,Muman Services approval
� :"`�""i` F. `^��.;li
4j,� " f
-�3
���• � C�
160
��Qrw
Reviewed and approved by: �_-- _ - _ _ _ Date: _/ Z
0
%�'pfnf�till
72-013 (Rev. 9/91) MOA 25
Permit No. SW 9 3 0 2 r,S
Page a of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: 1-5 alk Z
S FG2uarA
CST.
PID No.:
Of 7I S Z Z/
i
/
ion
P
C o 0
00
w boar
/
I�sr
NOW '1000e-,91-
- Hb 407Nlr.iANk
T3M�,
.a.,
SwrN6-
TIES
�
6 -AA.
FROM Co R -AA CaRt R
W' Alarm
U
" Pum au.f
M
rr,�®
G� { 1
W 72-013 A (Rev. 9/91) MOA 25
-SPOCTRUM
CIRC Ile
PG.Am VIEW
{I =so`
Flattop Technical Services
14530 Echo Street
rh(AC-TIFCG NC STEP) _ !vo Anchorage, Alaska 99516
/'�rR BUND
---rr---'LI ENGINEER'S SEAL
rNV R9. 1+!" I yGGO G-ALI eo"
4ouorN6- rhNr-
H .
f4,600.!.... s.JJsse//e �i/1Je aoip!
u: 1:I,Ay�•., CpC
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW930215 DATE ISSUED: 7/13/93
DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES EXPIRATION DATE: 7/13/94
OWNER NAME:MCCARTHY JOHN M & LEAH L
OWNER ADDRESS:6721 SPECTRUM CIR
ANCHORAGE, AK 99516
PARCEL ID:01715221
LEGAL DESCRIPTION: SEQUOIA ESTATES BLK 2 LT 5
LOT SIZE: 49606 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
HOLDING TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY:
ISSUED BY:
DATE:
DATE: zl�✓
CIVIL, & ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATTON & ANALYSIS
THEODORE F. MOORE, P.E. June 30, 1993
PH: (907) 345-1355
M.O.A. DHHS
P.O. Box 19-6650
Anchorage, AK 99519
Dear Sirs:
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
RECEIVED
JUL 2 1993
Municipality of Anchorage
Dept. Health & Human Services
The purpose of this letter is to provide the required design narrative in support of our application for a
permit to install a 4000 gallon holding tank to serve the existing 4 bedroom residence on Lot 5, block 2,
Sequoia Estates, located at 6721 Spectrum Circle. The present 6.5 year old soil absorption bed was
found to be operating in a significantly surcharged condition, and our soils testing revealed no suitable
replacement site on the lot. Soils logs, perc test results, a site plan, design drawings and specifications are
enclosed for your review.
Test hole #1 encountered a shallow water table perched in dense silt. Test holes #2 and #3 contained a
uniform, dense, gray silt with a measured percolation rate in excess of 120 minutes per inch, with no
shallow water table encountered. Due to these unsuitable soil conditions, a holding tank appears to be the
only remaining option for on-site wastewater disposal. To reduce mechanical complexity, we propose to
abandon the present STEP tank and install a gravity fed 4000 gallon holding tank in undisturbed soil just
north of the existing STEP tank.
i; Because the holding, tank will have to be buried almost 10 feet, special construction will be necessary
to assure structural integrity. According to the supplier, Anchorage Tank, a typical 4000 gallon holding
tank constructed of 3/16" steel has a maximum burial depth of 6 feet, but the addition of a 3/16" interior
supporting baffle near the center will allow it to be buried 10 feet. To allow free flow of liquid throughout
the tank, the interior baffle will have a 6" radius cutout at the bottom. A second manhole will be
necessary to provide access to the second compartment. Due to the cutout in the baffle allowing free flow
of liquids and solids throughout the tank, no additional cleanout should be necessary.
The topography of the lot slopes down towards the west at 0 - 5%. During breakup, water
temporarily ponds both in the poorly drained area shown on the site plan approximately 85 feet from the
present lift station manhole and in a shallow wooded depression 25 feet north of the present lift station.
The depression was dry at the time of our adequacy test on May 28, and both areas were dry when last
inspected on June 28. By issuance of the requested permit we will assume that you concur that these do
not constitute surface water.
The proposed project will have no impact on present or future water supply and wastewater disposal
systems serving adjacent properties, nor will it have any impact on reserved space/surface and subsurface,
or on drainage. Please give me a call at 345-1355 if you have any questions on this submittal.
Sincerely,
Ted Moore, P.E.
6/l DeAVIOuN EST
V AC AN T
/ O
/
ZZ
"� L (Z, , -t t. O T S -
tNsrA�,t. N6w
ypdp GR1. TpNK j Rt-AtiM
3/16�STCE� TAN k W
3/tv. PC -RF 64FFI-F IN "I DDaE
------
RDN:ON, DRAIN
/ O°l° EX�StINb� k HSE SIAM°
/ //'���r STEP TANK
U At3AND°NeD
T-�sT• � rest
o OHawF
\ F4uwE #1 67AR. $}2
\ $oft Aas
' r3eo
(To 8 F- ,Z6^
\ A13ANDoNED)
t -OT t5 \
a
sPeCTRUM\
CIRCt.C-
end.;.
,�r%d..•aa............... •.;�. ��;
Jy: THEUDott� r-. goorE •J Fi
;a
3569 ?+ a
�1S"4Nori .
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R� kiku
`�'r'Ttxu`:4`��{ w as
too`
Tmsr� )
HowE 4*3
C->4s T+NG
5 EPTtC s V's r4511
tN THU ARr�/f
RECEIVED
JUL 2 1993
Municipality of Anchorage
Dept. Health & Human Services
Flattop Technical Services
14530 Echo Street
Anchorage, Alaska 9951
SOT S� Q�lc 2, SE0ck0 l ES%,
WAFER WAC TE lvr4TC- R SYSTS.
s rrE- PIAN
Sif,4a6: f" -
$p�
CIATE; 0"/93
p wN. ¢'r; T'F' m
NOTE: T OU IS NOT A
S u R vC y OP PG.AT,
Aa,)- L.oCArioNx i4RE
APPT{o x/ ",4rF_,
NA•N1-latL-
If" R+SER FoR -
Ad.ARM F%.DAr
NC -w tyooc GNe-G.oN
Hol.D IN6- TANk
3/1j" 5TO01- CTR. CAPFaL
O t EX rsTlIY6
l foo �
t STEP TgKz O
I To DE A f3Aiv paNE p
15" PUMpou.T
NqN Hol. 5
611 OIA PurHPOcuT
'/ . 11
('LAN
VIEW
hl" STANOPiPF_
w. Rs•aarr r-e.�sar
�Errr.�nNr to' ±
f
HO G -D 1 N6r TANK �ty1
f
p --?j6" CfR. CSAFF�C^
1
171 2..
SECT 10N "A—A1`
ORIG+NA+-
C-4{0"ND
i
.�• •8t` W
f 491
%fiEODORE F. MOORE
• CE -3589 ;` %r
FON
C. 0.
{DECEIVED
JUL 2 1993
Municipality of Anchorage
Dept. Health & Human Services
Flattop Technical Services
14530 Echo Street
Anchorage, Alaska 99516
t.5, 6 2', S C—Qu0 f A ESTATS
ypo0 6-A I- Hol r> !N G- Tf+Nk'
PL.AIV 4 X -S ECTtOtV
7193
DwN. &Y. TFC
Flattop 7echnica(Services
14530 Echo Street, Anchorage, AK99516
Phone (90 7) 345-1355
Lot 5, Block 2, Sequoia Estates
6721 Spectrum Circle
Holding tank installation
Specifications
1.0 General:
RECEIVED
JUL 2 7993
Municipal; 1, al Aocnorage
Dept, Health & Human Services
1.1 The scope of the project consists of abandonment of an existing 1500 gallon STEP tank and soil
absorption bed and installation of a new 4000 gallon holding tank equipped with a high level alarm.
1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor
deviations from these drawings may be allowed or required by the engineer conducting the inspections.
All construction procedures and material specifications shall conform with Municipal and State
requirements. All separation distances shall be in conformance with Municipal requirements, unless
specifically waived.
1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around any
buried utilities.
1.4 The contractor shall provide adequate cover material and rough grading over all system
components to ensure that proper drainage is achieved after settlement and that there are no residual
depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas.
1.5 Unless specifically agreed otherwise, the property owner shall arrange separately for finish
grading after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the
construction.
2.0 Existing System:
2.1 Tn existing 1500 gallon STEP tank is to be properly abandoned by thoroughly pumping, cutting
out the top and backfilling with clean soil. The contractor may salvage and retain any lift station
components for his own future use.
2.2 The existing soil absorption bed is to be abandoned in place with all standpipes removed. Test
hole standpipes are also to be removed and the ground surface finish graded.
3.0 Holding Tank:
3.1 A new 4000 gallon holding tank is to be installed in the approximate location shown on the site
plan. The tank shall be set level, and the invert of the inlet pipe will be approximately 10 feet below
ground level. The tank shall be fabricated of 3/16" steel, and shall include a center baffle also fabricated
of 3/16" steel to provide additional structural strength. The center baffle shall have a 6" radius cutout in
the bottom to allow free flow of liquids and solids within throughout the tank.
3.2 Two manholes shall be installed in the tank located approximate 2 feet on either side of the center
baffle. A 6" diameter cleanout shall be mounted in the cover for the manhole giving access to the upstream
compartment, and a 4" diameter alarm float riser shall be mounted in the manhole giving access to the
OOwnStream compartment.
3.3 The tank shall have a bituminous coating inside and out in accordance with Municipal
specifications.
3.4 The tank shall be equipped with a low voltage, high level float which triggers an approved
visible and audible alarm mounted inside the residence. The float shall be positioned to trigger the alarm
when the fluid depth is 57 inches above the botom of the tank, meaning there are 600 - 800 gallons of
capacity remaining in the holding tank.
4.0 Inspections:
4.1 Three engineering inspections will be required during the course of the project: (1) initial stakeout
with the contractor to establish the location of the system and to discuss the plans, specifications and
construction procedures, (2) after the tank has been set and connected up, but prior to backfill, and (3)
after the alarm is installed and final backfill and grading is complete.
4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in
advance to ensure the availability of the engineer.
RECE+~f
JUL. 2 1993
Municip-,.
Dept. Health &
Flattop Technical Services ,� k dF"�C
14530 Echo Street ,��,�,(£'NGINE SS1Yj�
Anchorage, Alaska 9951.6*'9f"� • '�*
Municipality of Anchorage ���! .....................
.. DEPARTMENT OF HEALTH & HUMAN SERVICES ..J .a's . . .ox.9r,
825 "L" Street, Anchorage, Alaska 99502-0650 S► L�THEODORE F. MOORED At
CE - 3589 •: +�
SOILS LOG —PERCOLATION TEST ��r�'•.�����.��,,••Q
T. Fi. t$ I $1 m
PERFORMED FOR: _Tack Leah McCgrml DATE PERFORMED:_ --_3128/93
LEGAL DESCRIPTION: R ?euo(al ESt Township, Range, Section: Sec. 26, TI2N,. R3Lv
DEPTH /I SLOPE SITE PLAN .
(FEET) M(„ �FI(1 liG rGr (u i) -
1
PfI I I N
2
M L. irro% 5 -dl -
3 — — -- Hz0 Safttralraf w. f/t0
4 13 GogS 6urIed N. Side of
0
6-{ RECEIVED
s
J U L 21993
Municipality of Anchorage
9 Dept. Health & Human Services
T N.
t0
-
WAS GROUND WATER
-
ENCOUNTERED?
11
s
L
IF YES, AT WHAT O
3
12
DEPTH?
E
Depth to Water Alter
Monitoring? Date:
Reading Date Gross Net Depth to
Time Time Water
Net - -
Drop
19
20
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT
COMMENTS Nn Ihmnt �Dr fGt o -cf So'tl unttctAxL le 47or on -S/ I,g aL ee.p /7b4 Syl %ioir+
PERFORMED BY: . Ftta laZ Techn (rct ( Suc,r I J-�a� %I/I _ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 6/ 9'/q 3
72-008 (Rev. 4/85)
Flattop Technical Services F04'.
"f * n4 q
i; �£'NGIN*E'S
SEf�
14530 Echo Street Anchorage, Alaska 9951.6 �'gr)t Municipality of AnchorageDEPARTMENT OF HEALTH & HUMAN SERVICES825 "L" Street, Anchorage, Alaska 99502-0650 HEODORE F. MOORE
CE - 3589SOILS LOG — PERCOLATION TEST i:�""''
W114VAI 61wr
PERFORMED FOR: Tctck It L co MsCezrMl DATE PERFORMED: .5-/28/93
LEGAL DESCRIPTION:i.ST2 Se�c)c(Orol jSSf Township, Range, Section: Ser Z6" TTZNj R3GtJ
311 DEPTH 1 Pf SLOPE SITE PLAN
(FEET)
1 SM rtdolrih S'rlf loar�
15"
2 N
3
4
5 M 1. Grar Srtf
6 Pence, Cohesive
Some cob 6 fes
7
E
9d I RECEIVED
10 WAS GROUND WATER
J U L 2 1993 ENCOUNTERED? N
11 S
Municipality of Anchorage IF YES, AT WHAT L
Dept. Health & Human ServicDEPTH? P
12 eSE
13
14'
G/ t1
Gfl�A oS Hole
15
16
17
18
19
20 -�
11_�I PERCOLATION RATE 7 120 (minutes/inch) PERC HOLE DIAMETER 6
TEST RUN BETWEEN Y. o FT AND FT
COMMENTS Maferraf does, not �2crc aI4 an aece.pkzVe ,rrfe fzsr- crn on-si1-e
dor(. a y.COr fl`yn SX1 gym,
PERFORMED BY: F'%tE&?,e TecAl o l` Suu I Y-c� /ytr-� CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: _ 61 y 193
72-008 (Rev. 4/85)
Depth to Water Aber
Monitoring? •T Dr Date: P-7193
Reading Date Gross
Time
Net Depth to Net
Time (Iriin) Water Drop J
12' Soak' 5/28 1t: 36 AN
27 7/16
1)"Is' yS
2 7 '(L
11 : 57
27 'ra
12:22
27 Y2.
12 : If
6Y 27 7/r6 0
Flattop Technical Services ,w jE'NGINE
14530 Echo Street
Anchorage, Alaska 9951.6 * �4SITHI �`� •'����
Municipality of Anchorage ���...'..
.. DEPARTMENT OF HEALTH & HUMAN SERVICES ✓�['
825 "L" Street, Anchorage, Alaska 99502-0650 ,fi THEODORE P. MOORE�� Ar
SOILS LOG — PERCOLATION TEST�� =.••CE - 3589•.
TEsr Hoc. #3 ����,�,•�•••..•• `��'�'�
PERFORMED FOR: .Ta k � !!etch McCezrMl DATE PERFORMED: 57ea/93
LEGAL DESCRIPTION:l.5 13 2� uOfa ES7� Township, Range, Section: Sec 2G, Tl2K, R3Gv
3+DEPTH Pt SLOPE SITE PLAN
(FEET)
I S'+ S M Redrt is h o al ran .t'y (oa n
2 N
3
4
M 1, Gray -W f
5-
6-
6
{;order 0([pgr^c7
t -+ an T. 14. -it 2J
7
!_.ens of Stf> y C.7Ace
8
hear fey of M/-
9
10- WAS GROUND RECEIVED ENCOUNTEREDWATER N
11
JUL 2 1993 IF YES, AT WHAT
12 DEPTH?
M Ilty of Anchorage
13 ep t4�zin}}',�ip� h & Human Services Depth to Water Alter T 6 (3 (93
Monitoring? M•Dry Date:
14
15
16
17
18
19
20
COMMENTS
S
.1i
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT
PERFORMED BY: _ Etotb6W 7ecA17teo i ,S*uc-( CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: _61 t(l?_?
72-008 (Rev. 4/85)
r^ MUNICIPALITY OF ANCHORAGE --
DE .'MENT OF HEALTH AND HUMAN SER'Ji
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name
DISTANCES
1j -,*P1 -j Af-Aj
Tp
FROM
SEPTIC
TANK
ABSORPTION
FIELD
WELL
Address-ucrt��z=
&0 A), L7s. A) ° /6; 9 P5D3
Phone(s) Permit No. No of Bedrooms
WELL
2
O -7
�6
6(' oD 6
LINE
47
-2–V
4—I
LEGALDESCRIPTIONLOT
Lot
Block
Z
Subdivision
QGcu/A F57 ES
FOUNDATION
/ D
/ C>
Township, Range, Section
AS -BUILT DIAGRAM
(Show location of well,
septic system, property
lines, foundation,
2 N '3 W
driveway, water bodies,
etc.)
TANKS
SEPTIC ❑ HOLDING
ir
Manufacturer
'iAjK
Capacity in gallons
A,vc14
/ 2 .So ('Ve'YL)
Material
No. of Compartments
TYPE OF SYSTEM
1
q
e
❑ TRENCH BED [:1W. DRAIN ❑ OTHER
Depth to pipe bottom Irons.,- to /
rVl
Total depth from original grade
original grade
4, ;Q FT
k, %. ¢p: _ FT
Q
Fill added above original grade --(_
Gravel depth beneath pipe
/ o.
FT
FT
Gravel length
Gravel width
46 FT,
FT
/Y
Total absorption area
I Distance between lines
A,! v ¢ SO FT
1 FT
Number of lines
Soil rating
Pipe material
4
/93, Sp FT
/4-7
k
Installer
Date Installed
G--//-86
a
WELLS
PRIVATE ❑ OTHER (Identifv)
:.
Classification (A, B. C)
Total Dep[h
Cased to
/ -5- FT
2/ ; FT
i
Installer
Date Installed:
Wt)11RGf/ffhi_'?2
REMARKS:
Fye A'"ed
Inspections Performed by:
ENSEAL
®®®®% %'�,
�Solooaoa`e84al% ®v7
''L
Y 4i
4�—
o 0
Date.
p
00 oo e000000eoeoeo°o°oo�
°�
� �° cf;nilylflallnisi�spccliooryasperformetlaccorrliogioaii
444 4444944 OPOOOOeOaea^e LC
n
�®
o Robert D. Schilling x
Municipal and Stale guidelines in elect on this date: /G���VlG
�-�z
®�'°° CE - 1411
L /
C
�
®�
Health Department Approval: J ... -
Date:
.
72-013 (3/85)
t / -1
/ATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
i
Division of Geological & Geophysical Surveys
Drilling Permit No.
LOCATION OF WELL (Please complete either to, lb or lc.) A.D.L. No.
la. Borough Subdivision Lot I Block Ib. I 1/4gtrs. Section No. Township N❑ Range E❑ Meridian
—of—of—of— S❑ W❑
Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL:
Address:
Street Address and Area of Well Location
2. WELL LOG
Material Type
Feet Below
Surface
4_ WELL DEPTH: (final)
ft.
5. DATE OF COMPLETION
Top
Bottom
6 ❑ Cable tool ❑ Rotary ❑ Driven ❑ Dug
❑ Auger ® Jetted ❑ Bored ❑ Other:
7. USE: ❑ Domestic ❑ Public Supply ❑ Industry
❑ Irrigation ❑ Recharge ❑ Commerical
❑ Test Well ❑ Other:
8. CASING ❑ Threaded ❑ Welded
diam. in. to ft. Depth Weight Ibs./ft.
diam. in. to ft. Depth Stickup ft.
9. FINISH OF WELL:
Type: Diameter:
Slot/Mesh Size: Length:
Set between ft. and ft.
Bac.kfillin.g Gravel pack
10. STATIC WATER LEVEL: ft.
❑ Above or ❑ Below land surface Date
Equipment used:
I I . PUMPING LEVEL below land surface and YIELD
it. after hrs. pumping. g.p.m.
ft. after hrs. pumping 9-p.m.
\��17
`1'Yoe�d3N
\Al
12.GROUTING Well Grouted: ❑ Yes ❑ No
Material: ❑ Neat Cement ❑ Other:
NDNd
%j
13. PUMP: (if available) HP
Length of Drop Pipe ft. capacity g.p.m.
❑ Subm. ❑ Jet ❑ Centrifical ❑ 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;
Registered Business Name Contract License Number
Address:
Signed: Date:
Authorized Representative
Form 02-WWR (11/81) Copy Distribution: WHITE -State DGGS, PINK -Driller, CANARY -Customer
-`
^
�
� �
system" Choose.Lhe option that best its your site.
~�-..... .... ....
..... ..... -.�.....
PERMIT NO:
DATE ISSUED:
APPLICANT:
AUDRESS:
CONTACT PHONE:
LEGAL DESCRIP:
LOT SIZE:
MAX BEDROOMS:
860056
02/2O/86
ACREA8E SYSTEMS
601 E. NORTHERN LIGHTS #165
ANCHORAGE: AK 99503
345-2122
SUBDIVISION:
SECTION: 26
49606 (SCA. PIT
4
SFQUOIA ESTATES
TOWNSHIP: 12N
. OR ACRES)
LOT: 5 BLOCK: 2
RANGE: 3W
Listed below are the options available to you in designing your septic
system" Choose.Lhe option that best its your site.
~�-..... .... ....
..... ..... -.�.....
Wo is VQ! to X HNJI
�sw 14
.
V: T'0
GRAVEL DEPTH ) 5 1 3
TOTAL DEPTH (FT.) 3.5v' 4"3
1���
1 a. 4 A. 1
1-1 A.. A. H
v
W W-' �������I;
GRAVEL VOLUME (CH "YDS,) 40,9 40.0
tj --4! fil
DEPARTMENT OF
HEALTH
AND
ENVIRONMENTAL
** DEPTH TO PIPE BOTTOM < 3.5 FT. REQUIRES INSULATION
PROTECTION
** DEPTH TO PIPE BOTTOM < 4.0 FT. MAY REQUIRE A LIFT STATION
** 8RAVEL LENGTH > 75 FT" MULTIPLE RUNS (NOT EXCEEDING
75 FT, EACH)
REQUIRES
825 L
STREET,
ANCHORAGE,
AK
99501
1. I am familiar with the requirements {or on-site sewers and wells
as set
forth by the Municipality o[ Anchorage (MOA) and the State of
Alaska,
2. I will install the system in accordance with all MOA codes and
regulations�
and in compliance with the design criteria of this permit,
264-4720
the set back
distances from any existing well� wastewater disposal system
or public
860056
02/2O/86
ACREA8E SYSTEMS
601 E. NORTHERN LIGHTS #165
ANCHORAGE: AK 99503
345-2122
SUBDIVISION:
SECTION: 26
49606 (SCA. PIT
4
SFQUOIA ESTATES
TOWNSHIP: 12N
. OR ACRES)
LOT: 5 BLOCK: 2
RANGE: 3W
Listed below are the options available to you in designing your septic
system" Choose.Lhe option that best its your site.
~�-..... .... ....
..... ..... -.�.....
Wo is VQ! to X HNJI
DEPTH TO PIPE DOTTOM (FT.> 3.0 ** 3.0 **
.
V: T'0
GRAVEL DEPTH ) 5 1 3
TOTAL DEPTH (FT.) 3.5v' 4"3
GRAVEL W�DTH (FT.> 24.0 5.0
GRAVEL LENGTH (FT.) 46.0 120.0 **
GRAVEL VOLUME (CH "YDS,) 40,9 40.0
TANK SIZE (GALS) 1,250.0 ** 1250.0 **
SOIL RATING f-SQ.FI, . /BR > 183 183
** DEPTH TO PIPE BOTTOM < 3.5 FT. REQUIRES INSULATION
** DEPTH TO PIPE BOTTOM < 4.0 FT. MAY REQUIRE A LIFT STATION
** 8RAVEL LENGTH > 75 FT" MULTIPLE RUNS (NOT EXCEEDING
75 FT, EACH)
REQUIRES
** TANK MUST HAVE AT LEAST TWO COMPARTMENTS
... ..... --- --- . .....���������
I certi{y that:
1. I am familiar with the requirements {or on-site sewers and wells
as set
forth by the Municipality o[ Anchorage (MOA) and the State of
Alaska,
2. I will install the system in accordance with all MOA codes and
regulations�
and in compliance with the design criteria of this permit,
3. I will adhere to all MOA and State o| Alaska requirements [(or
the set back
distances from any existing well� wastewater disposal system
or public
sewerage system on this or any adjacent or nearby lot,
4, I understand that this permit is valid for a maximum of 4 bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED
IN AN AREA COVERED BY MOA BUILDING
CODES;
THEN 11} tN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2)
AS-81iILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND
(3) THE
ELECTRICAL
WORK MUEDIAE DOW BY A LICENSED ELECTRICIAN.
�f�. ..... .... .--
APPLICANT:' ACREAGE SYSTEMS
ISSUED BY DATE:
f
—GOO z
`r(ENGEER'S'AL) 'AO(G� Gb
Ir
4 C"a Q
e Municipality of Anchorage to G �,
coot to e,. l�ar^•f--+..�.�
DEPARTMENT OF HEALTH &HUMAN SERVICES � uce J. Corwin
825 "L" Street, Anchorage, Alaska 99502-0650 g) "� a
s e, No. CE -5283•
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: l • ( t? �= �' /•'' '! (t^' '�' DATE PERFORMED:
LEGAL DESCRIPTION: /"` ` / J= -r " ` - Township, Range, Section: _`.: /.::. t t/6', l'� yd? -/�' _`.a
ePTH
-4FF ESLOPE SITE PLAN
s.
ET).:
1
1
1
1
1
1
1
1
1
1
2
fes,
iq)o
WAS GROUND WATER
Date
i
Net
Time
Depth to
Water
S
IF YES, AT WHAT
)
DEPTH?
PO
lJIJ(J
E
Depth to Wale
Monitoring?
Monitoring?
Date:
l
(
7 l
s
WAS GROUND WATER
Date
ENCOUNTERED?
Net
Time
Depth to
Water
S
IF YES, AT WHAT
/� L
!'/
DEPTH?
PO
lJIJ(J
E
Depth to Wale
Monitoring?
Monitoring?
Date:
■■■■■■■R■■
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
'tTZ''.
%' I`tit,
f
NNEEMEMBIN
lJIJ(J
0rlf�
l
(
7 l
s
t�- o
I
MWININNEEMMME
NEMEENNEEN
OW0100iiia■
('j ,yv) I Al
777�
NME
MEMENEEMEN
1z
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
'tTZ''.
%' I`tit,
f
/6> i/1C!
lJIJ(J
0rlf�
l
(
7 l
s
t�- o
n , r
('j ,yv) I Al
777�
PERCOLATION RATES (minutes/inch) PERC HOLE DIAMTER
I
S r
_ TEST RUN BETWEEN FT AND FT
1.>t�. [J� /i li :�/ ! ,��il: ,/-'!,.'t)l ! - !/ ! /f'�f, lj{,4 !J! 1 L"'�^�m/'�.l C� 1`_t,•��'
PERFORMED BY:
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINE IN
72-008 (Rev. 4/85)
c
CERTIFY THAT THIS TESTI WAS PERFORMED IN
ON THIS DATE. DATE:
�' Flberg`"� os lid w/ 2' foQm
and re-i:alNng mechanism
NEMA 4X ,Junction box
1' p V C Ball Valve
- 24' x 4' 6' Culvert Manhole
exible Pressure Hose
V C Pipe Typ
ethane foam (shop applied)
inemec top coat
stable Float Switch Assembly
with RAM-NEK or Equal
er grommet or welded
el 1 1/4' pipe
c flow inducer
'8' hdles 6' ❑C
2' check valve —
mesh polyethylene screen
dia x 39' high
h.p. Veft pump
Float Level alarn i 46' j` 47 v2' ; 42'
Settings on43' �' 44 1/20139'
I off 39' t 40 1/2' 36'
LIFT STATION DATA
I"
iso
Leo
;' e3o
c U0
3n
M
O
m
S 70
f.�
30
48
so
ed
10
GatTons per minute
TYPICAL PUMP PERFORMANCE CARVE
circ cuc1 t A B C
1250
12 GAUGE; 121 1/201810
1250
1500 2000
R—e
Capacity
122a
1
} above Alarm
GAL;
221 GALL 522 GAL
'
Reserve
Capacity
300 GAL
311 GAL
1658� GAL
above pump
on
Capacity
Between
Pump on
& Pump off
113 GAL 1131
GAL
94 GAL
Float Level alarn i 46' j` 47 v2' ; 42'
Settings on43' �' 44 1/20139'
I off 39' t 40 1/2' 36'
LIFT STATION DATA
I"
iso
Leo
;' e3o
c U0
3n
M
O
m
S 70
f.�
30
48
so
ed
10
GatTons per minute
TYPICAL PUMP PERFORMANCE CARVE
circ cuc1 t A B C
1250
12 GAUGE; 121 1/201810
� 40 1/2'
1 (3 BEDROOM)
1500
12 GAUGE 145 1/2"
97' 48 1/2
(4 BEDROOM)
000
10 GAUGEI 194'
129 3/8' 64 5/8' ; (5 & 6 BEDROOM)
SIZE CHART
NOTE – LIFT STATION TANKS MUST BE 250 GALLONS LARGER THAN
STANDARD TANKS FOR SAME APPLICATION
vOTE- - SEE ATTAC}Ell SPECIFICATIONS FOR EQUIPMENT S14OWN HERE
REC€WIF"TION
/
�,•' J�
DATE0
O
a`
A
10
UTILITY + �E EASEMENT
WELL
/ \ c
�( a7
o•
\
e
\
gEPTIC TANK \
\
%tae. \ I
\
,' �It-46.4 'n
SEPnc
1 c a y6
/ 1 DRAIN-
1 27.4 bfp
/ 1 FIELD
1
1 12, ti
1 24 ITS -
1 n
\
24
y
0000
CK
\
L 78.36,
R 50.00
SPECTRUM
MGLf
HUB 8 TACK (HT) 0 FOUND
INSET
IRON PIPE (I P) % FOUND 4DSET BRASS CAP (BC) ®FOUND 40 SE
SPIKE or PK (SFLPa QFOUND
XSET
IRON REBAR (IR) 10FOUND SET ALUMINUM CAP AC FOUND SE
WOOD FENCE - - -
- -
DRAINAGE ------ ELEVATION -ASSUMED
INK FFNrF t t v
PAVING
DATE SCALE LEGAL DESCRIPTION SUR E YPE
GLOBAL ENTERPRISES
30JUNBS 1 =50' LOT 5 BLOCK 2
AS-bul`
PO BOX 112207
GRID ZONING SUBDIVISION
2939 SEQUOIA ESTATES
ANCHORAGE, ALASKA 99518
CHECK BY PROJECT .NUMBER/NAME
(907) 349- 5552
Q� A ��
I-HEREBY CERTIFY THAT THE PROPERTY DESCRIBED HEREON HAS BEEN
1�
SURVEYED BY ME, OR AT MY DIRECTION, AND THAT THE IMPROVEMENTS
�'� ••44•••••�q��'
•it�.• •••�
SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND DO NOT OVER -
THE PROPERTY LYING ADJACENT THERETO UNLESS
•� +�
LAP OR ENCROACH ON
OTHERWISE SHOWN, THAT NO IMPROVEMENTS ON THE PROPERTY LYING
y•4 9 T" *
ADJACENT THERETO ENCROACH ON THE PREMISES IN QUESTION AND THAT
•' •"
ON
"'•'••'•••'•t'•!/
c%GuGec
THERE ARE NO ROADWAYS TRANSMISSION LINES OR OTHER EASEMENTS
$$AID PROPERTY EXCEPT AS SHOWN.
�/�'�•"' "�'t • °_• �!" /
c
1T IS THE RESPONSIBILITY OF THE OWNER OR BUILDER, PRIOR TO
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO
�j
THE EXIS-
��••�
F[NISH GRAD AND UTILITY CONNECTIONS AND TO DETERMINE
"��, I
�..�
TENCE Of ANI' EA5EMLNT3j [OYERANT3j Ofl RESTRIGTI M ""15m P9 "OT
PPEAR ON THE RECORDED SUBDIVISION PLAT.
PSS1tt>t� e��
�ISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE
DISTORTION.
NOTE
jNE Accuiuc_y of bXAncN pr7
crsrtr-�V PRoPt21-\4 CORrt'ERs,wZU--
ljNo EcPT1c. lkoicRrEp IS
Nor Q«cr. D rnEUStorJS iNCrC(�TtA
BJP 4r� ?EE" By USE
of CLO-rri ' 4f.7 AuD Nor Svrzu�(r�C�
c,Ct11.11�v�s. �.� � S
`'I
� 31
R�aPER-ry
I^r��
Gar 2 �
N
\7-
SEPTic
o
o
D
fl2oposEp wr-u DoT S,
/oo
2,;T. /ZAO/US
- PROPOSErj
G.r �/ � � v �•- T H.
r
r
% 3m m l
Wv-t.t_
IW -
.3,, �` _ I f�'f2cPoSPp
DoT 4
c0
NO
�i
SEWER SYSTEM LOCATION PLAN
QQ, �♦ry} x(al,�h n B-�roc-kr, 2—
Lot:
n6, 1�Sub(3°
Prepared for:
Enainaere
Yr C.(Z<4 C>E s SIMS
F)
lei�etV1 SY Y�,ti , iY%.. lh Date'
. unicipali cy
of
Anchorage
June 23, 1986
P.O. B` . 196650
ANCHORAGE, ALASKA 99519-6650
(907)264-4111
TONY KNOWLES,
MAYOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
Acreage Systems
601 E. Northern Lights Boulevard 11165
Anchorage, Alaska 99503
Subject: Lot 5 Block 2 Sequoia Estates Subdivision
On-site Sewer Permit 11860056 - Isseud February 20, 1986
On May 20, 1986, The Anchorage Assembly approved a new ordinance
regulating on-site wastewater disposal systems (septic systems).
All septic systems constructed after the effective date of this
ordinance are subject to the provisions of this ordinance.
Our records show that you currently hold a permit for the installation
of a septic system. We strongly urge that you contact this office
prior to constructing your system. Any changes in the code that could
impact the construction requirements of your septic system will be
identified and brought to your attention. Please contact the
Environmental Services Division at 264-4720.
Thank you for your cooperation.
Sincerely,
Susan E. Oswalt
Program Manager
On-site Services
SEO/SSM/ljw
MUNICIPALITY OF ANCHORAGE
o
Development Services Department p p Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I. D. 017-152-21
Legal description SEQUOIA ESTATES BLK 2 LT 5
Site address 6721 SPECTRUM CIR Anchorage AK
Current property owner(s) GOW
Expiration Date: 2/21 /2025
X The On -site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
Original Certificate Date: 3/19/2024
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, Development Services 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 work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA Approval_June 2022
Development Services Department- r' 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. 017-152-21
Complete legal description SEQUOIA ESTATES BLOCK 2 LOT 5
Location (site address) 6721 SPECTRUM C I R
Current property owner(s) LINDA & ARTHUR GOW Day phone
2. ON -SITE SYSTEMS SIZED FOR 4 BEDROOMS
3. TYPE OF WATER SUPPLY: ®❑ Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ❑ Private Septic ❑ Private Septic serving 2 dwelling units
Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age 31 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
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 $ Sd Waiver Fee $
Date of Payment _/7Ac( Date of Payment
COSA # O !E�)C Z LJ r C) S Waiver #
COSA Application —June 2022
Legal Description: SEQUOIA ESTATES BLOCK 2 LOT 5
Parcel ID: 017-152-21
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 06/16/86 Total depth 215 ft
Cased to 215 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 18 in.
Date of flow test for COSA 02/21 /24
Static water level at beginning of test 196.4 ft
Comments
B. TANK DATA
Measured operating fluid level in septic tank n/a
Date of pumping 02/24/2024
❑ Required maintenance completed, if AWWTS
Comments: Lot served by holding tank
D. ABSORPTION FIELD DATA
Which system tested (date installed) *n/a
❑ ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade ft (min)
❑ N/A — pressurized field.
❑ Per record drawings, field is insulated.
❑ Monitor tubes go to bottom of effective.
If not, state depth into effective
❑ Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Well production at time of test 5.75 gpm
Water storage tank volume n/a gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate 2.97 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by rrcZ'
Date 02/21 /2024
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date n/a
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings)
Effective depth used in
Effective depth remaining in
Comments/Deficiencies: *Lot served by holding tank
One vertical pipe frost jacked out of the rubber coupling. The contractor reinstalled the
COSA Checklist June 2022
111
into the coupling and added a plastic sleeve to prevent new
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100'
❑Yes if No n/a ft 0 Yes if No ft
Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft
Absorption Field on Lot > 100' ❑ Yes if No n/a ft Holding Tank > 100' Q Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No ft
Q Yes if No ft
Community Sewer Main > 75' Yes if No ft
Manure/Animal Excreta Storage > 100'
❑ Yes if No _
❑ N/A — Served by Community
Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10' 0 Yes if No ft
Surface Water > 100' Q Yes if No
Tank to Property Line > 5' Q Yes if No ft
Wells on Adjacent Lots:
Field to Property Line > 10' ❑ Yes if No n/a ft
Private Wells > 100' 0 Yes if No
Water Main > 10' Q Yes if No ft
Community Wells > 200' M Yes if No
Water Service Line > 10' Fn� Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER'S COMMENTS
Lot served by holding tank.
ft
ft
ft
ft
G. CERTIFICATION & 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, indicates that the on -site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm Pannone Engineering Services Phone 907-745-8200
Engineer's Printed Name Steven R Pannone P.E., F. ASCE
COSA Checklist —June 2022
Date 03/01 /2024
OF A�q ��
49 TH
..
SnVefl R. annone
P�It
CE 8140, o
Ilk
li,° pROEESSONt�`�..�,�
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program `
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
Ung (907) 343.7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. OI �i I S��-�) COSA # 0
Expiration Date: .2 /-/D
1. GENERAL INFORMATION
Complete legal description Lot 5; Block 2; Sequoia Estates Subdivision
Location (site address) 6721 Spectrum Cir. Anchorage, AK 99516
Current Property owner(s) Paul s Wm Mazzohni Day phone 34"786
Mailing address
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD forpickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site❑
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation,
based on procedures outlined In the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Robert A. Shafer
Address 15861 S. Birchwood Loop Rd. Chugiak, AK 99567
Engineers Printed Name Robert A. Shafer
5. DSD SIGNATURE
Approved for l bedrooms.
Disapproved.
Phone 694.2979
Conditional approval for bedrooms, with the following stipulations:
ON-SITE =
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineers Report
Other
By: Original Certificate Date: �'� ' ��
(R. 11,05)
Municipality of Anchorage
-tel Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. _017- /52 -Z I COSA # Oq 0249
Expiration Date: 1 % — S-- O q-
1. GENERAL INFORMATION
Complete legal description Lot 5; Block 2; Sequoia Estates Subdivision
Location (site address) 672: 1 Spectrum Cir. Anchorage, AK 99516
Current Property owner(S) Paul b Kim Mazzofini Day phone 345-8786
Mailing address
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup
2. NUMBER OF
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 On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAS upon request to homeowners Certificates1 nrnvnl
are validor days from a ate o issue or properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below. I verify that my Investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure Indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my Investigation and Inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations In effect at the time of installation.
Name of Firm S 6 S Engineering Phone 694-2979
Address 15661 S. Birchwood Loop Rd. Chugiak. AK 99567
Engineer's Printed Name Robert A. Shafer
Date
A. snow
5. DSD SIGNATURE W�4
Approved forbedrooms. b"'•'%p'
ti hA�af+at�+Pn
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Lo
Attachments:
COSA Checklist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
rn« Iim)
Municipality of Anchorage
(• Development Services Department
\ Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: G-er 51; Sr-auoo &T• Parcel ID: 017-152- 7,1
A. WELL DATA
Well type�f'l VM
Date completed�o/gF'
Total depth o2 S 'ft.
If A. B, or C provide PWSID #
Sanitary seal a) its
Cased to a►s ft.
FROM ELL LOG
Date of test fo �bGt�6
Static water level
Well production S g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate /, 76 r mg/L
Arsenic: Of) ug/L date of sample: /503
Well WON)
Wires properly protecte (Y ) 7
Casing height (above ground) in.
AT INSPECTION
ft.
• g.p.m.
Other bacteria d colonies1100 mL
Collected by: J tG�r 7,t 7CePl94
B. SEPTIC/HOLDING TANK ATA
Tank Type/Material OC,DIX• 4— K STC- Date installed 8 a5A 5
Tank size Jq"� gal. Number of Compartments Cleanout (Y )
Foundation cleanout&) JS Depression over tank (Y6) /UD High water alarn)(61N) Es
Date of pumping b Pumper J_ mcg 5 �ul�JPnt><
C. ABSORPTION FIELD DATA " 11
Date installed Soil rating (g.p.d.lfe or ft2/bdrm) System type
Length ft. Width
ft. Gravel
Total depth _ ft. Elf. absorption area _ft2 Monitoring
over field
f1#
Date of adequacy test Results (Pa JFallr For _ bedrooms
Fluid depth in absorption field before tes m. Water added_ gat. New depth_ in.
Elapsed Time: _ min Final fluid depth —in. Absorption rate >= g.p.d.
Any rejuv n treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION N'i,
Date installed Size in gallons
"Pump on" level at _ in. 'Pu p eff=leP
Datum Cycles tested.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot /JAH
Absorption field on lot
Public sewer main gla
Sewer /septic service line( -
Animal containment areas SD +
(Y/N)
in. High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots /co '+
On adjacent lots /00 r+
Public sewer manhole/cleanout
r
Holding tank
in.
r
Manure/animal excrete storage areas /LYi +
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
r I
Building foundation 5 r Property line S 'I' Absorption field A3
Ll
Water main rU 11 Water service line /D { Surface water
r
Wells on adjacent lots /0' '-
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: "hi
Property line Building foundation Wat
Water Service line Su Driveway�parkingfvehicle storage
Curtain Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION 1 ;•°.?���.
I certify that I have determined th field inspections and t T i "',,,.,..i.••
review of Municipal records f "thyabove sy s ar ,^in �•77
conformance with MOA COV49
,es ' e con 's d te. ��•"" .!^
Engineers Printed Namer r' 4'�'°
Date zzjo 9
COSA Fee $ Waiver Fee $
Date of Payment,��[[ Date of Payment
Receipt Number ogQZ q 6 $J7-9 0 71,N Receipt Number
(Rev. 11105) 1OV 5-17 G
9
j2ltit&:rem- k T
SmE�S_�;' C�Ear� ou
4T : \
43,606. S.F.
T'rr
1 FKIS7'/N�a N
srau�r. 6
�p 285 ® p/ti/
r�1 e„ I i
Z➢��+N °�K `J
24-
LOT 4.
-ScrA0M
Lot _5 , Block _2
Anchorage Recording District, Alaska (82-
375)
o�aa woes' eo mes ee oie .•
�j
•� 9", R. L. Button o
E o ° LS-1192 ? �' •
° °°• QJ A
R-00
0FFsslmp'x �P�,4,
Easements of record other then those shown a, CD?-.30_®,}
the plat of record ore not shown hereon unless•
LOT SURVEY CERTIFICATION otherwise noted.
LEGEND ,
1 hereby certify that Ihave surveyed the property shown and described
hereon, and that the Improvements situated thereon ore within the Bross or Aluminum capped monument recovered
sop- O Iron pipe and/or rebar recovered.
erty lines and do not overlap or encroach on adjacent property and that 0 2 x 2 hub & tack recovered
no improvements on adjacent property overlap or encroach on the premises 0 5/8° x 30° rebar set this surve
In question and that there are no roadways, utility lines, or other visible y
easements on said property except as Indicated herson. .
Scale / /l - �n Date /� _ Q Prepared by: R.L. BUTTO/V
• J 3 Registered Lond Surveyor
(907)279- 6200 . 519 W. Eighth Ave. Anchorage Alaska 99501
Ref. F. B. No. � _
Z933 p�_�5 Property of:
_ o a
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel l.D.# Cl-)-N�>9,-a\
1. GENERAL INFORMATION
HAA# "QCVLXQ.au
Complete legal description of S, 6112 2, SeCeuc;tcr_. fS1*1Vr
Location (site address or directions) 672 f S,nrcfrut-. Crrc le
Property owner Jotin j J.tcch NC Cu,r fAk Day phone `lam ZT6 -Z76/
Mailing address `lo ge Nexe. Pro�rar/rrr - Jerr� Sfra��y
Lending agency Ur) (,cnawn Day phone
Mailing
Agent
Terry S/r�1 Re Max
Pro,jver Ker
Day phone 2 �-d-z7G/
Address
260U Cvrdavc,
AnchcorGye
Ak 99s03
Unless otherwise requested„HAA will be held for pickup.
2. NUMBER OF BEDROOMS: `� t
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
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 furtherverify 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
Tecl,nlcul Servicer Phone 3 Vs-- 13sS-
Address 1N S-3 a Crrrcho V-, A -,I e, Ak
Engineer's signature �19 Date € / 93
6. DHHS SIGNATURE
A
49L11
YY111 ,, .44<9 .194iA
�• THEODORE F. MOORE
CE - 3589 Y6 �a a
•'• ' 1
y IV,V4#04,40. Q
9 a"
%s Atrr>�sts��''�
_)L Approved for 4 bedrooms.
Disapproved.
Conditional approval for
Additional Comments
111TIC
bedrooms, with the following stipulations:
/
Date " 2 ',a
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.
72-025(Rev.1/91) Back MOAH21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L o+` S 13 /l c2� S�uv(ec Esq Parcel I.D.
A. Well Data
Well type Prt'Lla f e_ If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Y
Date completed 6'116766' Driller
wll t fewc f-er
Drr1hn ti
Total depth 215 1
Cased to
2 /S Casing height
/Z +
Sanitary seal (Y/N) Y
Wires properly protected (Y/N)
Y
M
FROM WELL LOG
AT INSPECTION
Date of test
6 / 16 / 6
S/ (/ 9 3
r �`t
>
C
o n
m
Static water level
1 89"
(99,
N
O
Well flow
1.15"g.p.m.
> `1•�'
g.p.m.
<
Pump levell
> 203 '
Iffn
to
w
n
2 o
K_77<
SEPARATION DISTANCES
FROM WELL TO:
G)
p 'T'
Z
Septic/holding tank on lot
10 3 '
; On adjacent lots >
(6,0 '
Absorption field on lot
N• A.
; On adjacent lots >
(oU '
Public sewer main
N• 4.
Public sewer manhole/cleanout
11414.
Sewer service line
tv'
Petroleum tank None
seee)
WATER SAMPLE RESULTS:
j U- �j�s�G3
Coliform O eat /(oa
Me Nitrate
1,02 M91 -4e Other bacteria
none
rep
od ftd
Date of sample: s7 -/l(
/9 3
Collected by: F la b*
T{c h
S c
B.HOLDING TANK DATA
Date installed 6/ F-5-1 9 3 Tank size y000 at Compartments
Cleanouts (Y/N) y Foundation cleanout (Y/N) i Depression (Y/N)
High water alarm (Y/N) Y Alarm tested (Y/N) Y
Date of pumping N• A. ( (`1 ew) Pumper N. A.
SEPARATION DISTANCES FROM /HOLDING TANK TO:
Well(s) on lot 1031 On adjacent lots > ZS
T. ProPe'ti lirie -/.5 ' Absorption field N -A_
Surface water/drainage > (00'
72-026 (3/93)' Front
_Foundation 1/'
Water main/service line
CONTINUED ON BACK PAGE
C. LIFTSTATION (N. A•)
Date installed
Size in gallons
Vent(Y/N)
"Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
D. ABSORPTION FIELD DATA CV• A.
On adjacent lots
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
Date installed Soil rating (GPD/F?)
Length Width Gravel thickness
Total absorption area Cleanout present (Y/N)
Date of adequacy test Results (pass/fail)
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Surface water
_System type
Total depth
Depression over field (Y/N)
for
After test
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot On adjacent lots Property line
To building foundation To existing or abandoned system on lot
On adjacent lots Cutbank Water main/service line
Surface water Driveway, parking/vehicle storage area
Curtain drain
E. ENGINEER'S CERTIFICATION
rooms
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature ' a ;,
Engineer's Name 7–h eoao rt 1=• /I a re
Date 6/ 27 / 93 9_ * THEODORE . „r,00KE
9$a;:a °•..°.° •••''fit, 47
HAA Fee $
Waiver Fee $
Date of Payment � — Z7 _ ?_3 Date of Payment
Receipt Number 25D Y2–C'177 Receipt Number -
72 -026 (3/93)' Back
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL�g- LIS l l
OF ON-SITE SEWER AND WATER FACILITY
264-4744 A
`7 Application Date O
1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, ran e)
1,07 5 6�Y. OfLJ- C9idj F—s �e
Location (address or directions)
i9 -7 �2_
1loag-�{,-7
(b) Property Owner P4� C�� tMCtii Telephone: Home �� �-a(� Business
Mailing Address
(c) Lending Institution LX a � Tele hone I
Mailing Address Gly C 1 1- I 4 F
(d) Real Estate Company and Agent �� r�r ( K �
Address 19-0 ! C_ <z
Telephone 5(0 3 - 5��{{5 �
(e) Mail the HAA to the following address: or; Check here fes, if hold foick up.
List contact person and day phone number below.
2. TYPE OF RESIDENCE
Single -Family b�
Number of Bedrooms _
3. WATER SUPPLY
Individual Well IXI 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 ISI Public El Community ❑ Holding Tank 11Note: If (community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-026 (Rev 8/861 Front
POO (seie 1,08) seo-ze Z to Z abed.
-NioM S'Aaau!6ue
leuo!sseloid agl ui suo!ss!wo ao saoaaa aol alq!suodsai lou s! @beaogouy to Al!led!o!unlnl agl -panssi si aleo!l!laao a aaolaq
elep azAleue ao suo!loadsui lonpuoo lou op SHHO to saa (o!dw3 sluawaa!nbei alels pue leaapal u!elaao (ls!les of aapio
ui suoiln.l!lsui bu!pual a!agl pue sawog to saasegoand of (sapnoo a se s!gl saop SHHO OU 'eWe!y to alels agl ul paaalsibei
aaau!6ue leuo!ssaloAd luopuedapu! ue (q anoge S gdeat3eaed ui uaAlb suo!leluasaidai agl uodn Aluo paseq saleolpliao
lenoaddy (1!aoglny glleaH sanss! (SHHO) sao!AaaS uewnH pue glleaH to luawpedap abeaogouy to (1!led!o!unlnl ag1
NOunvo
lenoaddy leuop!puo(] to swia1
-- leuo!)!puo(] panoaddes!(] panoAddy
6119- /v8 ale(] �� (q swooapaq ojddV
� pa SHHO
ItlAOUdHddtl SHHO '9
. l � A
lc6t cz 3rnr
leas saaaulbu3 ,•.p • • • p
zi ssaappy
auogdalal wa!d to aweN
Wi�sul s!gl to alep agl
uo loalle ui suo!leInbei pue'saoueu!pao'sapoo alelS pue led!o!un!N lie gl!M aoue!ldwoo ui s! wals (s lesods!p aaleMalsm
ao/pue Aiddns Aelum el!s-uo agl 'uo!loadsui pue uo!leb!lsanu! AW woAl pue sal!l abeaogouy to !1!led!o!unlnl agl woal
pauielgo uo!lewjolui agl uo paseq legl Al!aaA aagunl 1 •u!aaag paleo!pui ainlonAls to adAl pue swooapaq to aagwnu agl Aol
alenbape pue leuo!lounl'ales st walsls lesods!p aalumalseM jo/pue Alddns AaleM al!s-uo ag) leg) sMogs lenoaddy A1!aog1ny
glleaH s!gl to uo!le61lsanu! Aw leyllluaA l 'Molaq uMogs alep uo!lep!leA agl to se pue olaaag pax!lle leas Aw (q pa!l!uao sy
NOI1VWtlOdNl ONV V1V0'H0HV3S 311A 'S1S31'SNO1103dSNl JNIOIAOHd WHij JNIH33NI!DN3 '9
of PNGNOQllooN
NICIPALITY OF ANCHORAGE
01ANC,\ �NjP�HEA TH AUTHORITY APPROVAL (HAA)
EN�219 HECKLIS -F FEBRUARY 1984
Legal Description: tco IQ
A. WELL DATA
Well Classification �� �' If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) — Date Completed 1AAmx lczee� Yield ;44
Total Depth Cased to al -t; Depth of Grouting
Static Water Level i go L Pump Set At T;c,
Casing Height Above Ground �C6 Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot 10 A ; On Adjoining Lots > /0 a
To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots ,Z/w
To Nearest Public Sewer Line i14To Nearest Public Sewer
Cleanout/Manhole To Nearest Sewer Service Line on Lot J/ 0�
Water Sample Collected by ; Date 7/,92&F e
Water Sample Test Results F r ocI iD N/TRA ifs O
Comments
B. SEPTIC/Het H" TANK DATA
Date Installed orliqP6 Size 15U -t2 No. of Compartments
Standpipes (Y/N) JJ Air -tight Caps (Y/N) � Foundation Cleanout (Y/N) — N
Depression over Tank (Y/N) i� Date Last Pumped .4 f/dr,
Pumping/Maintenance Contract on File (Y/N) VA ; for
Holding Tank High -Water Alarm (Y/N) k Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well iv b
To Property Line ,2! '5�
To Water Main/Service Line � / Q
Course ).-'i 0
Comments
Page 1 of 2
72-026 (Rev. 8/861 Front
To Building Foundation 1 0
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata Type of System Design
Date Installedrr) L_ t I%' Length of Field qi�
Width of Field — Depth of Field ">`
Gravel Bed Thickness Q ej
Square Feet of Absorption Area Standpipes Present (Y/N)/-
Depression over Field (Y/N) i Date of Last Adequacy Test _3
Results of Last Adequacy Test
C
le
Separation Distance from Absorption Field:
To Water -Supply Well 's To Property Line `10
To Building Foundation To Existing or Abandoned System on
Lot iYullj ; On Adjoining Lots i /'0-'
To Water Main/Service Line/cam
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
To Cutbank (if present) No ti <7
Date Installed ��- r 1 q Dimensions''
Size in Gallons Manhole/Access (Y/N) YC� yr
1
"Pump On" Level at �/ "Pump Off' Level at
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 conformed to al MOA and HAA guidelines in effect on the date of this inspection.
Signed/ _ Date 6_ L .
Company MOA No.
Receipt No.
Date of Payment d ��
Amount: $
Page 2 of 2
72-026 (Rev 8/86) Beck
i+L2a Engineer's Seal
�aoa i �YiFFa.e�a` a��9
j (' .2225-Fi
"C" SUITE 203
20A CHORAGE,EALASKA 99501
CONSULTING ENGINEER TELEPHONE: (907) 279-3916
SEPTIC SYSTEM ADEQUACY TEST
LEGAL: Lot 5, Block 2, Sequoia Estate C;` _1 C.4,••
LOCATION: 6721 Spectrum Circle a&
OWNER: Barry Chapman
RESIDENCE: Single Family, 4 Bedrooms =
WELL: Residential, On Site
SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: 4 -Bedroom System
TANK: Anch. Tank. Steel 1250 gal 2 Comp.
ABSORPTION SYSTEM: Bed
ABSORPTION AREA: 1104
SOIL RATING: 183
INSTALLATION DATE: June 1986
DATE OF LAST PUMPING: April/ May 1988 Receipt Submitted to HHS
DATE OF TEST: July 25, 1988
TEST PROCEDURE:
System was
inspected
and measured. Tank was
found with 8 feet of
cover and
4o inches
of liquid. Pump chamber
had 15 inches of
liquid.
Bed had
three standpipes. Two
cleanouts and one
monitor.
Monitor was
68 inches deep[ and
showed 4.5 inches of
liquid. Both
clean outs
were dry.
850 gallons of clean water were added to the bed via the monitor
tube. This caused the water level in this tube to rise 3 inches.
17 hours later the water level in the monitor was 5 inches,
indicating that most of the water had been absorbed.
TEST RESULT: This system meets the code requirements of
the Health and Social Services Department of the Municipality of
Anchorage.
NOTE The operational life of all septic systems depends on the
local soil conditions, 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 this septic system. We can therefore not give any
estimate of how long this system will function satisfactory for
current or future occupants.
ITT DIP 13 1� INA tP", RL D9 PU1C
CONSULTING ENGINEER
LEGAL:
LOCATION:
OWNER:
RESIDENTIAL WELL INSPECTION
Lot 5, Block2, Sequoia Estate
6721 Spectrum Circle
Barry Chapman
TYPE OF WELL: Residential, On Site
WELL LOG AVAILABLE:
Yes
203 W. 15th AVE "C" SUITE 203
ANCHORAGE, ALASKA 99501
TELEPHONE: (907) 279'3916
FS i
�. n • • �� `/••e�a
INSTALLATION REQUIREMENTS MET:Yes
WELL YIELD FROM WELL LOG: 4.5 gallons per minute
PUMP YIELD FROM TEST:
DATE OF INSPECTION:
4.5 gallons per minute
July 25, 1988
TEST PROCEDURE: Well was pumped at a constant rate for three
hours. Static water level was found at approximately 190 feet
below top of casing. Drawdown could not be measured due to well
obstruction. A total of 850 gallons were drawn without the pump
sucking air.
TEST FOR E.COLI AND TOTAL NITROGEN: Water was tested for E.Coli
and total nitrates on July 1988.
E.Coli 0. Total Nitrates 1.0 mg/1.
Max. allowable Total Nitrates 10mg/1.
TEST RESULTS: This well meets the requirements of the
Municipality of Anchorage.
THIS WELL WILL PRODUCE MORE THAN 3 GALLONS PER MINUTE FOR MORE
THAN FOUR HOURS
The Municipal requirement for well flow is 150 gallons of water
per bedroom per day. This well exceed this requirement. The
assessment of the condition of the well applies only to the
conditions as of the day tested. The flow rate may change due to
subsurface conditions that may not be observed from the surface,
and changes in the land use and other factors that may impact
the aquifer feeding the well.
- MUNICIPALITY OF ANCHORAGE
e 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
Application Date l
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
p --?/—&(G
(b) Applicant Namefzd"t G'WPA-f,*V Telephone: Home 34S�' ?43?22 Business r -
Applicant Address 4�v f /il o L7°s ll 'We4 'OCA X -X
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builde(X; Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution U �� Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
2. TYPE OF RESIDENCE
Single -Family, Multi -F/ Maly' Other
Number of Bedrooms / 4--
3.
3. WATER SUPPLY
Individual Well x 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 K Public ❑ Community ❑ Holding Tank ❑
Note; it community no System, must have written o0nfirmativn from the State Department of Lnyirvnmvntal Gvnsvrvwivn
attesting to the legality and status.
Page 1 Of 2 72-025(»/94)
j-1171
5. ENGINEERING FIRM PROVIDINU INSPECTIONS, TESTS, FILE SEARCH, DA A AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, l 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 informatioi`f-zbtaingd
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. 1
Name of Firm Telephone
Address
C:1A
Date / o — 2-( ^ 49
Engineer's Seal
m
® o°o49 o 000°°v°e°e0
�} °000000 0 0 ooeao 0000e
8 Robert D. Schilling 'ate
CE - 1 0.
DHEP APPROVAZa
Approved for bedrooms byy Date
Approved — Disapproved Condi4�
Terms of Conditional Approval
CAUTION
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 tv satisfy cei-ta n teaerai and state rQ9wremenw. 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 (MO. j
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: % 0 Jr /3L, -)GK Z
ScQ U edit E' 57-AE7—,C S 55.03 i>
A. WELL DATA
Well Classification Pitt u*:T7c If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) y Date Completed 6— /G —OG Yield 4, S
Total Depth _Z ! S Cased to
Z i 5
Depth of Grouting N ohm
Static Water Level / 8 R
Pump Set At &�?
Casing Height Above Ground
Z
Sanitary Seal on Casing (Y/N) ly�
Electrical Wiring in Conduit (Y/N)
/
Depression Around Wellhead (Y/N) 'Y
Separation Distances from Well:
To Septic/Holding Tank on Lot
3
; On Adjoining Lots o ue-d- /00
i
To Nearest Edge of Absorption Field on Lot On Adjoining Lots
To Nearest Public Sewer Line
—
To Nearest Public Sewer
Cleanout/Manhole
To Nearest Sewer Service Line on Lot
Water Sample Collected by R. Q,
6
Date
Water Sample Test Results
yr u
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed Size / Z 6a No. of Compartments
Standpipes (Y/N) Y Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) Y
Depression over Tank (Y/N) /4 Date Last Pumped ti e �cJ
Pumping/Maintenance Contract on File (Y/N) ; for
Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) "'—
Separation Distances from Septic/Holding Tank:
To Water -Supply Well / 0 3 To Building Foundation O
To Property Line 47 To Disposal Field 7
To Water Main/Service Line `— To Stream, Pond, Lake, or Major Drainage
Course —Comments 'Ve-f 4
Page i or z
72-026(17/84)
OP HEALTH &
1WIi0S t4TAL PROTECTION
OCT 2 2W,
CUIVED
t�
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata . / �6 Type of System Design
Date Installed 6, — //— �g Length of Field q
Width of Field Z¢ _ Depth of Field 4- "
Gravel Bed Thickness
Square Feet of Absorption Area _ //O4- Standpipes Present (Y/N) Y
Depression over Field (Y/N) /Y Date of Last Adequacy Test Ne��
Results of Last Adequacy Test -- "—
Separation Distance from Absorption Field:
To Water -Supply Well / F"'_
To Building Foundation
Lot
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
Date Installed G —/1 y E
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
To Property Line
On Adjoining Lots
ZYs
To Existing or Abandoned System on
D VP_s uo
To Cutbank (if present) —
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments 5e -e 'Ae___e_1 sole.= ea¢i - a . -Z s/eA C_" 44�oq
** 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��/��� • Date ly u l`yG
Company MOA No.
Receipt No.
Date of Payment /O i �_ ®� ®� eQ� ��
lOs 11 �� ,°• °°,° d Engineer's Seal
Amount: $
°
®moo° 9TH
�a�000aaeeooe00000°oD 000e°erd
Page 2 of 2
72-026 (11/84)
Oe0ea o0e00L SOY 00°°° ••��
Robert D. Schilling o g/
CE -1411<f
� 04 °o°O00000°/°p° 0 i