HomeMy WebLinkAboutEKLUTNA HEIGHTS #1 BLK 3 LT 15Eklutna
H
ights
Block 3
Lot 15
#051-06 ! - 17
Municipality of Anchorage ~~'-
Development Services Department ~'~'~"-
·. Building Safety Division
On-Site Water and Wastewater Program, 4700 S. Bragaw SL
"' P.O. Box 196650 Anchorage, AK 99519-6650 Page of
www.d.anchorage,ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW030134 PID Number: 051-061-17
Name:
Larry & Reoina Harville WastewaterSystem: [] New [] Upgrade
Address:
PO Box 670781 Chuoiak. AK. 99SS7 ABSORPTION FIELD
Phone: Number O! Bedrooms:
~R R-RO R 1 3 [] Deep Trench [] Shallow Trench I-I Bed I"1 Mound [] O~er:
LEGAL DESCRIPTION s~, ..~.,: Total Depth Irom ~ig!nal grade:
1.2 ~,o~Fr' 8
3 1 S Eklutna Heights No. I 2.97 F,. 5.03 FL
0.9 3 ~t. 3 9 Ft.
Well: [] New [] Upgrade o.,.~.,~: .umbe, of,..:
Public Water Ff. F, 392 ~r, D3034 & F810
F~ R.P.C. 6/10/O3
Yield:GPM IPump set at: Ft. Icasing Height AbOve c'mund:Ft TANK
SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P. [] Other:
T'~_ To Septic Absorpbon Lift Holding Public/PrivalMdnulactuteL
Capacity:
Tank Field Station Tank Sewer Line Anchorage Tank 1000
we, 200% 200'+ NA NA 25'+ M.~..~: ,
Steel 2
s~.~c~w.te, 100'+ 100'+ NA NA ~ / LIFT STATION
~, L~. 5% 10'+ NA NA~ ~ze. M,nulactui'eL
Fo~.~ S'+ 10'+ NA NA 'Pump on' Jevel at. 'Pump o~ ,.~,~ I H~gh water alarm
c...~, o,.i. NA *50'+ NA NA ~..p Make & Model Elec~icai Inspections ped<x/l~ed by:
*none known BENCH MARK
Previously existing septic system Bottom door sill
abandoned. ~..u.~
100
Engineer's Stamp
Inspections performed by: KND Enoineefina. Inc Dates: lSt~ ~ "' -'-4,~'H ~
2"" -6/-11/-Z0
Do¥olopm~nt Servi¢o$ Department Approval ~ ~*i*~lo~
AS-BUILT SYSTEM DETAILS/SITE PLAN Permit SW030134
EKLUTNA HEIGHTS S/D, BLOCK 3, LOT 15 PID#051-061-17
SH4D~,~ I
13 14 15
..-'' "'... ~LJ O~ 10~
~"°*-~
I
I SC~[[: 1' ~ 50'
I
B-E=98.9'
B-F=90.1' SE~R ROCk
,~.... ..... ~¢~,~ PREPARED FOR: ~ --
. LARRY A REGINA HAR~LLE
~ , CHUGIAK, AK. 99567
· '~e / "~"':FLEU~N9 ~*~: ~9 ENGINEERING
',~;~~ ~' ' s,~ FLEMING ~: KMD 20441 PTARMIGAN BLVD.
' '"' ....... '"~ *~': ~EMIN6 0'~: 10/27/03 EAGI,E RIVER, AK 99577-8736
~~ "~ "~ ~'~ .w~ [i`~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~`~~~~~~~~~~~~~~~~~~~~~~~ ...............................
MUNICIPALITY OF ANCHORAGE
Development Sen4ces Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: May 15, 2003
Expiration Date: May 14, 2004
Permit Number: SW030134
Legal Description: ',EKLUTNA HEIGHTS #1 BLK 3 LT 15
Design Engineer: 0070 KND Engineering
Owner Name: LARRY & REGINA HARVILLE
Owner Address: 21212 ROCK PTARMIGAN STREET
CHUGIAK, AK 99567-
Parcel ID: 051-061-17
Site Address: 021212 ROCK PTARMIGAN ST
Lot Size: 18867 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field ~ Septic Tank [--] Holding Tank [--] Privy
r~ Private Well [] Water Storage
Ail construction must be in accordance with:
1. The attached approved design.
2. Ail requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date:
Parcel I.D.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
OF/- O61 - / 7
Permit Number SW O ~0 ! ~-
Property owner(s) Larry & Regina Harville
Mailing address (1) PO Box 670781 Chuglak: AK 99567
~address (2) 21ZI Z A pr~N//r~ ~T Zip Code
Legal description (Lot, Block & Sub'd.) Eklutna Heights ~1~ Lot 1~ Block 3
Legal description (Se~ion, Township & Range)
LotSize /8~ g~7
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Acresl~~
Day phone 2 2 7-1 0 4 0
Number of Bedrooms 3
[] Well Only
[] Water Storage
[] Jacuzzi
[] Water Softening Unit
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Sig of property owner or authorized agent)
Permit Fees:
Date of Payment:
Receipt Number:
(Rev. 12/00)
Waiver Fees:
Date of Payment:
Receipt Number:
~D ENGINEERING, INC.
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696-8111
May 3, 2003
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: New sewer permit - Eklutna Heights Add. #1, Lot 15, Block 3
Gentlemen:
The owner has requested we proceed forward to obtain a septic permit on the subject
lot. On April 7, 2003 we performed one testhole for the proposed system. The results
of this test are attached. The general slope of this lot is from north to south at a grade of
approximately 0-10%.
We have designed our system utilizing the testhole that was excavated for the existing
3-bedroom house. An undocumented septic to the west of the house w~l be properly
abandoned. The lot is served by public water. We propose to install one wide trench.
Water was not encountered during the excavation or monitoring.
There are no public or private wells within 200' of our proposed system location except
as noted. There is no surface water within 100' of the proposed system and there are no
known curtain drains within 50'. We do not expect there to be any adverse effect on
adjacent lots by the development of this system.
If you have any questions, please contact me at 696-6111/FAX 696-8111.
Respectfully submitted,
~'~) Engineering, Inc.
K
enneth M. Duffus, P.E.
Attachments:
On-Site Well and Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/Percolation Test
WELL &: WASTEWATER DISPOSAL SYSTEM DETAILS/SITE PLAN
EKLUTNA HEIGHTS S/D, LOT 15, BLOCK
5 1 4 '
~ GRAIL
d Drb.o os ,
~ TSEPTIC
.. .... . ~ , /TANK
.. ...
~s~,c'... ..- ~co~~o
-....' I~ ~°~°s~o ~,~,~ r, :~ ,
~nMFqTFAD ROAD
uSE ~ TRENCH
.o ~c ~t~s ~mJN ~'¢ Total depth of s~tem is 8.0' fram original grade.
~.~o s~u. Total depth of grovel below distribution pipe is 5.0'.
.o ..~*~ ~s .~. ~' ~ NOTES:
No ~PmC S~S ~N 2~ ~
~ ~ [x~,r,s ,omo. 1. INSTALL 1000 GALLON SEP~C TANK, INSULATE IF < 4' OF CO~R
2. CONTRACTOR ~LL ENSURE M~NIMUM 2% SLOPE INTO SEPTIC TANK.
5. ADDITIONAL FILL ~LL BE ADDED O~R SYSTEM TO ACHIE~
CO~R IF REOUIRED. OR INSULATE TRENCHES ~TH 2" HD BURIAL FOAM.
4. CONTRACTOR ~LL ENSURE ALL SEPARATIONS TO ADJACENT
~~ ~LLS, SEPTICS. LOT LINES, FOUNDATIONS AND ALL OTHER SETBACKS.
LARRY ~ REGINA HAR~LL[
CHUCIAK, AK. 99567
~ (907) 227-1040 PAGE 1 OF 2
fIELD B~KS C~.O:
..... · -~,,: 0,,, EAGLE RIVER, AK 99577-8736
~ ~sSIO ~ - 30 APR 03
~~ o~. ~[: ~ NW146~ I" ..... '"" '"'""" '"'""" "' '"' ...... ""'"'"'""' ...... "Il
· ~ ~[: 05014.DWO ~ ~': 03014 (907)696-6
K D
PTIC
WASTEWATER DISPOSAL SYSTEM DETAILS
EKLUTNA HEIGHTS S/D, BLOCK ,3, LOT 15
HOUSE
GRAVEL
DRIV~
PROPOSE
SEPTIC
TANK
' 22.5
CO
PROPOSED PRI
PROPOSED R
0
ARY
:RVE
05 1
D
LD
ELD
.,~,~,,,~:,~.~.... · - .... PREPARED FOR:
c,uc,~. ~.
.................... ~ (SOT) ~7-~o~
~ FIELD BOOKS c~
%'. ........ ..:~
· ~ ~: 03014.OWG
~cx~:~,: KMD
~)*~: 30 APR O~
~,o: NWl 461
Scale: 1"= 20'
PAGE 2 OF 2
~~ ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-6736
03014 696-611 I/FAX (907)696-8111
]~X'qD ENGINEERING, INC.
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
Performed for:
Project:
Depth
(Feet)
1
11.
15-
16-
17-
18-
19-
20-
SOILS PERCOLATION TEST
Regina Harville
Eklutna Heights #1, Block 3, Lot 15
1.
~° "i.,~''''''''.....~.~...:A · ~
Date Performed: 4/7/03
TEST HOLE # 03-1
ORG/OL -red/brown
overburden
SP-SM/GP -med dense,
w/cobbles to 1'
B.O.H.
HOLE PRESOAKED
PRIOR TO TEST
SEE ATTACHED SITE PLAN
FOR HOLE LOCATION
Depth to water after monitoring? DRY
Was Ground water encountered? NO
What depth? NA
Date? 4/14/03
Reading Date Gross Net Depth to Net
Time Time Water Drop
1 4/7/03 1:00 8"
2 1:10 10min 1 10/16" 6 6/16"
3 * 1:11 - 8"
4 1:21 10min 1 11/16" 65/16"
5 * 1:22 8"
6 1:32 10 min 1 13/16" 6 3/16"
7 * 1:33 8,, .
8 1:43 10 rain 1 13/16" 6 3/16"
9 * 1:44 8"
10 1:54 10 min 1 13/16" 6 3/16"
11 * 1:55 - 8"
12 2:05 10 min 1 12/16" 6 4/16"
· Water Added
IPercolation Rate 1.6 (min/in) Perc Hole Diameter 6"
Test Run Between ~; feet and 6 feet
I, Kenneth fyi. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in
effect on this date.
]~ND ENGINEERING, INC.
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907) 696-6111/FAX (907) 696-8111
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES AND MATERIAL SPECIFICATIONS
LEGAL DESCRIPTION: Eklutna Heights Addition #1, Lot 15, Block 3
GENERAL:
1. The scope of this project includes the installation of a septic tank and/or drainfield to serve a
single-family residence on the referenced property as delineated on the attached Municipality of
Anchorage (MOA) permit and site plan.
2. Construction shall be in accordance with the approved site plan and design drawings; MOA
permit with any special provisions or conditions, and all applicable State and Municipal
Wastewater Disposal Regnla tions.
3. KND Engineering, Inc (KND) assumes no responsibility of the accuracy of the as-built survey
provided by the owner or owner's representative.
4. The owner or contractor is responsible to notify the engineer of any discrepancies n~ted on the
design plans or drawings prior to commencing work. These discrepancies could be, but not
limited to, possible encroachments, surface water, varying soils, unplatted easements, types or
ttse of dwellings on or adjacent to property, nearby public wells, etc.
5. The contractor shall be responsible for locating any necessary underground utilities, easements,
property lines and surface water. The owner and/or contractor shall ensure, if deemed
appropriate, that a registered land strrveyor prior to construction flags all setbacks.
6. The contractor shall be responsible for verifying all pertinent separation distances and
component layout.
7. Unless specifically agreed other~vise, the property owner shall be responsible for final grading
areas subsequently depressed from soil settling. On all leachfield mound systems, the property
owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded
area.
8. The MOA Development Services Department On-Site Water & Wastewater Program must
certify contractors installing wastewater disposal systems. Owners installing their own systems
must also receive prior approval from said MOA Department.
SEPTIC TANK ! HOLDING TANK / LIFT STATION INSTALLATION:
1. A septic t,'mk is to be constructed by a certified septic tank manufacturer. Construction shall
include two 4" cleanouts for pumping access.
2. The septic tank shall be sufficiently bedded with proper material and compacting to prevent
damaging, settling or shifting of the tank.
3. All standpipes on the septic tank shall extend a minimtun of 12 inches above the final grade.
4. Septic tanks installed with less than 4 foot of cover shall be insulated. The contractor will
ensure that the fill over the tank does not exceed the burial depth rating.
5. A foundation cleanout shall be installed one to four feet from the building foundation. In the
line between the tank and the leachfield there shall be hvo adjacent cleanouts (tmless an effluent
pumping system exists within the septic tank). These cleanouts shall be located on undisturbed
soil not more than 10 feet from the tank. The second cleanout, in line, shall be to clean toward
the septic tank.
6. Final grading over the septic tank shall be such that a positive slope exists away from the septic
tank.
Page I of 3
Reference: Eklutna llts. #1 L15, b3
Date: 05/01/03
Page: 2 o f :3
7. All H.D.P.E. tanks shall have a vertical length of 4-inch perforated drainpipe besides the tank
extending to the bottom of the tank to above grade to monitor ground water.
8. All tanks shall be anchored when there is not enough adequate soil cover to resist buoyancy
forces in high-groundwater areas.
9. All holding tanks and lift stations shall have an audible and visual alarm inside the residence.
10. All lift stations shall be wired in compliance with the Uniform Electrical Code and all MOA
guidelines.
11. The contractor shall remove the old tank, or abandon it in compliance with the Uniform
Plumbing Code. The contractor is solely responsible for the abandonment procedure.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the
excavation shall be within 2 inches of level. If the sidewalls of the excavaction become smeared,
they must be raked or scratched (roughed-up) before gravel (sewer rock) placement.
2. Once the sewer rock is installed, the distribution pipe is installed level with the perforations
facing downward. Gravel is then to be placed over the distribution pipe to provide a minimum
of 2 inches of cover over the pipe.
3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure
the silt barrier covers the entire gravel surface before placing backfill.
4. Monitoring tubes shall be four- (4) inch diameter, installed approximately in the locations
shown on the design, and extend a minimum of 12 inches abOve final grad6. The pOrtion of the
monitoring tube extending through the gravel shall be perforated from the bottom of the trench
to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as
noted on the design.
5. Backfill over the final gravel layer must not be less than twenty-four inches. Insulation must be
installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the
trench must be mounded to prevent the formation of a depression after settling.
6. All advanced technology waste water disposal systems (Advantex, Biocycle, Intermittent
Dosing Sand Filter, etc...) shall be constructed, installed, maintained and monitored per
manufacturer's specifications and MOA requirements.
MINIMUM MATERIAL SPECIFICATIONS:
1. A MOA approved septic tank manufacturer must construct any septic tank proposed for
installation.
2. The following pipe materials are MOA approved for use in septic system installations:
_T,vpe of Pipe perforated ~olid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company
Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or
equal).
5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between
the final leachfield grnvel layer and the native soil backfill.
6. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing
the//200 sieve. If deemed necessary, a sieve analysis should be performed.
7. When sand is being used as a filter materinl, its gradation specification must conform to current
MOA or DEC requirements.
Reference: Eklutna tits. #1 L15, b3
Date: 05/01/03
Page: 3 of 3
INSPECTIONS:
Typically there will be three (3) inspections required during the installation of the wastewater
disposal system. These inspections will occur as follows:
1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds
and before the installation of any gravel. A septic tank may be set in place, but may not be
backfilled before this inspection.
2. The second inspection must be conducted after the placement of the sewer rock, distribution
lines, standpipes, and cleanouts, but before the placement of the silt barrier, insulation, or any
other backfill.
3. The final inspection is to occur upon final grading of the property.
Often there will be more than these 3 inspections required, especially with the installation of multiple
trenches, sand filters, pressurized distribution systems, etc. The inspecting engineer is to be contacted
at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take
place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractor's
activities.
The owner shall contract with the contractor to perform the work outlined in these specifications and
attached plans and in accordance with the attached MOA permit. All materials, components, and
construction practices shall comply with the MOA's and the State of Alaska's latest ordinances,
regulations, or policies regarding wells and septic Systems. Th6 failure Of the inspecting engineer'to '
notice a material or construction non-compliance does not relieve the contractor of his/her
responsibility to correct such deficiency. There will be no contractual arrangement existing behYeen
the contractor and KND Engineering, Inc. KND shall be the owner's representative and will inspect the
work as stated above to document the contractor's activities. Final acceptance of the contractor's work
rests with the owner and the MOA.
KND shall have no liability to the owner or to others for acts or omissions of the contractor or any other
persons performing work on this project or the failure of the contractor to carry out the work in
accordance with these construction documents. KND's inspecting engineer will not be responsible for
the construction means, methods, and techniques, sequence, procedures or the safety precautions
incident to this project.
BY PROCEEDING FORWARD WITH THE INSTALLATION OF THE WATER AND/OR
WASTEWATER SYSTEM (S), THE PROPERTY OWNER, CONTRACTOR, AND WELL DRILLER
ACKNOWLEDGES HAVING READ AND ACCEPTED THESE SPECIFICATIONS.
Owner:
Contractor:
Driller:
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: (907)343-7904
On -Site Water & Wastewater Section Fax: (907)343-7997
Parcel ID 051 -061-17
Certificate of On -Site Systems Approval
OSC251162
Expiration Date: 5/6/2026
Legal description EKLUTNA HEIGHTS #1 BLK 3 LT 15
Site address 21212 ROCK PTARMIGAN ST
Current property owner(s) GERLACH SCOTT J & JENNIFER A
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
No comments
By: - Original Certificate Date: 5/8/2025
f,
T14"Ce ificate 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 Service Department (DSD) issues COSAs based upon representations provided by an
independent professional engineer. The Municipality of Anchorage is not responsible for errors or
omissions in the professional engineer's submittal.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
Development Services Department Phone: 907-343-7904
On -Site Water R. Wastewater Section MR,
Certificate of On -Site Systems Approval Application WAY 0 7 W
bc)b PciIrk pr
1. GENERAL INFORMATION
Parcel I.D. 05106117000
Complete legal description
EKLUTNA HEIGHTS #1 BLK 3 LT 15
Location (site address) 21212 ROCK PTARMIGAN ST
Current property owner(s) GERLACH SCOTT Day phone 688-6211
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY: E] Private Well serving # dwelling units
R Other Non-public well as regulated by MOA R Water Storage
FEW Community Well or Public
4. TYPE OF WASTEWATER DISPOSAL: � Private Septic ❑ Private Septic serving 2 dwelling units
r_1 Holding Tank M Community Septic or Public Sewer
5. SEPTIC TANK: no Steel 0 Plastic n Concrete n Fiberglass
Age 23 _ See advisory if steel or fiberglass older than 20 years
6. ABSORPTION FIELD: Fj AWWTS ❑ Bed � Deep Trench F-1 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 $ CAJ Waiver Fee $
Date of Payment Date of Payment
COSA # J,4 Waiver #
Al P4�70 0
COSA App11cation_Apr2025.doc
COSA Checklist
Legal Description: EKLUTNA HEIGHTS #1 BLK 3 LT 15 Parcel ID: 05106117000
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled Total depth ft
Cased to ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Comments
B. TANK DATA
Measured operating fluid level in septic tank 52
Date of pumping 5/6/25
❑ Required maintenance completed, if AWWTS
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 6/10/03
❑■ ALL standpipes present per record drawing
Total measured depth from grade 9 ft (max)
Measured depth to pipe invert from grade 4 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
Comments/Deficienci
COSA Checklist June 2022
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes ❑■ No
❑ Coliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by
Date
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 4/24/25
Results g Pass
Fluid depth prior to test 30 in
Water added 450 gal
New fluid depth 33 in
Elapsed time 30 min
Final fluid depth 30 in
Absorption rate 450 gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings)
Effective depth used 30 in
Effective depth remaining 30 in
60 in
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'
❑■
Yes
Community Sewer Manhole/Cleanout > 100'
Yes
if No
ft
El Yes
if No ft
Neighboring Tank > 100' ❑ Yes
if No
ft
Private Sewer/Septic Line > 25' ❑ Yes
if No ft
Absorption Field on Lot > 100' ❑ Yes
if No
ft
Holding Tank > 100' ❑ Yes
if No ft
Neighboring Absorption Fields > 100'
Yes if No
Water Main > 10'
Animal Containment > 50' ❑ Yes
if No ft
Yes
if No
ft
❑■ Yes if No
Water Service Line > 10'■❑
Yes
if No
Manure/Animal Excreta Storage > 100'
If tank or field is under driveway comment below
Community Sewer Main > 75' ❑ Yes
if No
ft
ri Yes
if No ft
❑■ 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'
❑■
Yes
if No
ft
Surface Water > 100'■❑
Yes if No
Tank to Property Line > 5'
■❑
Yes
if No
ft
Wells on Adjacent Lots:
Field to Property Line > 10'
❑■
Yes
if No
ft
Private Wells > 100'■❑
Yes if No
Water Main > 10'
■❑
Yes
if No
ft
Community Wells > 200'
❑■ Yes if No
Water Service Line > 10'■❑
Yes
if No
ft
If tank or field is under driveway comment below
F. ENGINEER'S COMMENTS
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
Engineer'~ Printed Namc
COSA Checkpst June 2022
Phone 694-7028
Date
+•+�� OF IRS
1
c Steve Eng
�, CE -6256 * Ar
��1 5'/t�/2��e
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT •
On -Site Water and Wastewater Section
www.muni.org/onsite
Septic Tank Advisory
Certificate of On -Site Systems Approval # OSC251162
Subdivision: Eklutna Heights #1 Block:3, Lot: 15
907-343-7904
Fax: 343-7997
The septic tank for this property is 23 years old. The average life of an asphalt
coated steel septic tank is 20 years. Typical replacement costs are $15,000 or more,
not including engineering, surveying, MOA permitting fees or site restoration.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org
Municipality of Anchorage
Development Services ,Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw:St. '
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 0 51-0 61 - 1 7 HAA # C) /1/- O O _/-7/- 7
" Expiration Date: 3 '" /- O
GENERAL INFORMATION
Complete legal description
EKLUTNA HEIGHT.g #1= BLOCK 3= LOT 1 5
'Location (site address or directions)
21212 Rock Ptarmigan St.: Chugiak; AK 99567
C6rrent Property owner(s) Larry.
Mailing address
Lending agency
& Regina Harville
Day phone. 688-8081
Day phone
',.,.. Mailing address
Real Estat~'Agent
"'Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
NUMBER OF BEDROOMS:
TYPE oF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Claudia Montgomery,
Countrv. Realty
Well []
Day phone 688-F, 000,
TYPE OF WASTEWATER DIspOsAL:
Individual On-site
Individual Holding tank
Community On-site
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional
civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the
transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal
and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health
Authority Approval are valid for 90 days from'the date of issue for properties served by a private or Class C well
and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one
year with valid water samples.) Certificates are valid for one year for propedies 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.
Mu ipality
nic Of AnchOrage,
Development ServiceS DePartment :
· . . *iBuilding:S'afety Division '~
: On:Sitfi Writer &:Wastewate'r. Program
, . :4700'Sduth Bragaw St. :
~i iP.O. Boxq96650 Anchorage, AK 99519-6650':
. . wwW.Ci.anchorage.ak.us
HEALTH AUTHORITY, APPROVAL CHECKI_IST
Legal Descn)t,on:- EKLUTNA HEIGHTS -#1. BLOCK 3.~ LOT 1 5 · i parcel ID: 0 5 1 -0 6 1 - 1 7
'Well:;type Public ! ".} ~lf A, B, or C pi'0vi,de:PWSlD # ',:
~: Date'~compieted ~:'.;~ - Sanith~ ~e~l (Y/N)
. .: : :~ . .. '~ .~,~ .- ~ .; .~ ~ ~ _ro_erl__rotected (Y/N)
' ..' Total. , 'depth, .~': ':ft,~:. ~:~. :,. Cased. ~- r~t° '~,:~: :::-ft,~. 1~ ~- Casing height ~above ground) '
' : .~? I ~[~: ' ~FROM WELL LOG ~:
, , ~ , . , ,, . ~ ~ .... . , , , . ~ ~j, ~, . .. .
, : Date' of test : , ~: :~ : i '~.",
'~Li ...[~'. ,: i .... :.: , , . .
'" Statm water level :~'-~ ... ,:. :fl.
' i~t'
Well ;proddction i~ :..;
WATER SAMPLE R'ESUI~TS:.
Coii~6rm ' ~:
i~,~' .colonies)'J00 mi..
· - .~.- ~-:
~: :Other bacteria
g.p.m.
' col0nie~/100 mi.
Date.,,i.:: ,"°f adequacy,,,:.11,1 ' test:: ',.- "'NA -NEW,, .. SYSTEM, ', : ill ",. ",.'~' :'" : i: Results;..~.,. ..j,l(P'assJFai'), ...... r' ;' ,. . ....:'. Pass i r ,,. ~ I :,, r'.':'' ,'For. 3 . : .bedrooms·
Flmdidepth m absorpbon.field before test ~,. :.inl : Water, added . . :galJ · ..'. ;New depth 'in.
Elapsed T~me. . m~n.. Y~nal fired depth ,. m, .. Absorpton rate->= . : · g.p.d.
, . ! v , , , , . ' .... i ' :,, - I ~ , ' :': , ..... , ~ ,, L : ? '
.~Any rejuvenation treatment (past 12 mo.) (WN'&;type)~ N 1,.~ .. ." :' .... If yes, give date
' . : ' ' ': :" ,. ' ~: ~ ~ ' ~ ; ' ~
ASBUILT
.. ; .'. 15~-'~..~'~-~~ .... ;.r'.~. -
S~/ARD & ASSOCIATES LAND SURVEYING 694-0829
SCAL~, .-
DATE:
GRID:
DRAWN:
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY;
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, or FOR ESTABLISHING BOUND-
ARY LINES.
