HomeMy WebLinkAboutEKLUTNA HGTS STEWART ADDN LT 19#051-063-36
Municipality of Anchorage Page / of
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
Permit Number: O'AJweq 3veo PID Number: o S/- 4tJ6 S - 34
Name
Wastewater System: XNew O Upgrade
`
Address-
17711 01-b - " S44W UVR
ABSORPTION FIELD
Phone'
No Ol Bedrooms
O Deep Trench Ik Shallow Trench O Bed O Mound O Other
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original grade:
15. a GPD/SqFI
v 8'
Lot. Block: Subdivision:
Depth to pipe bottom from original grade
Gravel depth beneath pipe
,,wA07AJ.4 N
/, $-, FI
FI
Township
Range
,'Al 1
Section
'75
Fill added above original grade
/• Z
Gravel length: .
y`i
FI
1716,-
FI
WELL: P6New l7 Upgrade
Gravel width. _
Numbero ones.
Dishmorbehleenlines
Ft
Ft
Classification (Private, A.B.C):
Total Depth:
Cased To:
Total absorption area
Pipe material:
>r6
toe Fl
-.S
/9 FI
SO Ft
G
Driller
iS4s -/F�SsT/4
Date Drilled:
Static Water Level.
/GO
Installer. /
Date In3181ied
-/T/,F
Ft
L
Yield
Pqm el at.
Casing Height Above Ground
TANK
GPM
110 Ft
Ft
SEPARATION
DISTANCES
0Septic 0Holding S.T.E.P.
To
Septic
AbwrPuon
Of
Holding
PubhUPriville
Manufacturer:
Cspecify In gallons:
From
Tank
Field
abtion
Tank
Sswar Lirw1.
/J6 R T
a .ZJrV /
Well
! D /
)01,
tI( '
trod 1
F
1, Z!;
Material.
are.
Number or Compartments:
Surfac
Water
'loo`
1,100`
*loo`
—
*roo'
LIFT STATION
Lot�•�
Line
/
10 /
�•�1
r
�,� /
Size In gallons:
Manufacturer
Z O
NG7AUK.
Foundation
2,7.. r
3 7 '
Z 7 e
O e
"Pump o� level at
"Pump off' level at
High water alarm at:
J
Curtain j('
Drain
4 r
SJ
f F
t J
+ CSF
_
t;OF
Pump Make&Mod
Electrl1'{�ellnspecliona performed by:
o NCO -
(SiL ( M �
Remarks: `�j1O"tu
BENCH MARK
Lor ujc wnrtfa JZ C0 'A
Location and Description:
Eo s c l" Em T t t1, srA.
Assumed Elevation:
e 00
I /
RLS bol� Dates: is 9 it o /
Inspections performed by: GHt
*i ,
_
2nd"bit/4Z
m'tt CHMTOPHERFLWOOD
Department of Health and Human Services approval
I" �,. CEt038T
•h, q
. N G.
Reviewed and approved by: Date: -3 0- o `V
ssitiN►e
77-01J (Rw 9/91) MOA zs
Permit No. SW040346
Page 2 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: EKLUTNA HEIGHTS, LOT 19 PID No.: 051-063-36
U
N 89'57' 10" E 95.5' - -'
Z
RESERVE AREA
TH-2
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-
TH- - -------------------- -
LLJ O
------
S' X 75' DRAINFIELD ------
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L 28.4' 45.5'
n
D 36.6' 50.6'
O m
wv
'• • •e0
- WATER KEYBOX
- LEACH FIELD
o - DRNEWAY
• - MONROR TUBE
+
o - SEWER CLEAN
UT
+ - WELL
¢
- EASEMENT
® - TEST HOLE
N 89'57' 10" E 95.5'
¢
11/22/04
ELEVATIONS NAIL IN TREE
ENGINEER'S SEAL
p0oo000�
(NOT TO SCALE) ASSUMED ELEV • 100.00•
_ ` OF At 444
/LIFT STATION ORIGINAL GROUND
/ LEVEL, 105.9' TEST
07,V
p� •'qS�O
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..........................*D
VA
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Na GVT
1,230 TGAL 01.1' 04.1'
p....:. .
CHRISTOPHER WOOi
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96. '
97.7'
�p�
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1 0.1'too
91. 100.1' x`93.9'
pj,
400 "RVF ESM a�
00400000
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NOV-29-200010N) 14:59 EAGLE RIVER ENGINEERING (FAX)907 694 3297 P.001/001
7640
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MUNICIPALITYOFANCHOR4GE l ��
Development Services Department �i(i�
On -Site Water 8 Wastewater Program `� �) v"
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ONSITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Date Issued: Aug 17, 2004
Expiration Date: Aug 17, 2005
Permit Number: SWO40346 Parcel ID: 051-063-36
Legal Description: EKLUTNA HEIGHTS STEWARD SUBDIVISION LOT19
Design Engineer: 0848 Eagle River Engineering Services Site Address: 12711 OLD GLENN HWY
Owner Name: LARRY CALL Lot Size: 13370 SQ. FT.
Owner Address: 12711 OLD GLENN HWY Total Bedrooms: 3 Permit Bedrooms: 3
EAGLE RIVER. AK 99577 -
This permit is for the construction of:
❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage
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 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
Issued By: A A
Date: ��oy
_
Date:-* I I 1 10'(
Ob/03/03 11:27 FAX 9073433437 MOA_L&ap,USE ENFORCEMENT
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.d.onchorage;ak.us
(907) 343-7904
ON-SITE SEWERJWELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
® 001
Parcel I.D. OS/ - UG 3 - q /o Permit Number SW
Property
{'.�
e o'.
Day phone 5r cf / - 47/ r r
Mailing address (1) /.z 7t1 !`Zd 41, *(/
Mailing address (2) 11 1w'& ...hC' Zip Code '775 7
Legal description (Lot, Block & Sub'd.) f f o� a - , V4Lj,1'11A4Urr
Legal description (Section, Township & Range) 4 . oma. 3 ,. T/S ' /ti,I
Lot Size / 3, 370 Acre 5 t Number of Bedrooms 3
THIS APPLICATION IS FOR:
Sewer Only
❑
Well Only,
❑
Sewer and Well
,®
Water Storage
❑
Sewer Upgrade
❑
THiS PROPERTY CONTAINS:
Hot Tub
❑
Jacuzzi
❑
Swimming Pool
❑,
Water Softening Unit
❑
Therapy Pool
❑
I certify that the above information is correct I further certify that this application is being made for a
Single Family Dweilina,and Is inAccordance with applicable Munidpal Codes.
Permit Fees:
Fees:
Date of Payment '14A - 0%005' Date of Payment:
Receipt Number: 5&&qReceipt Number
(Rev. 72!00) - ,
Eagle River Engineering Services
Chri®topher R. Wood, P.E.
10421 VFW Road Suite 201 (907) 694-5195 tel
Eagle River, AK 99577 (907) 694-3297 fax
August 17, 2004
Dan Roth
Manager, On -Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Eklutna Heights Stewart Addition Lot 19
Narrative & Permit Application
Dear Mr. Roth:
The proposed well and septic permit will have very limited impact on adjacent properties for the
following reasons:
1. This permit is for a new well and septic system.
2. Immediate neighboring septic systems are all +100' distance from proposed well
location, and wells are all located +100' from the designed septic location.
3. Drainage will not be affected and is not a major consideration in our design.
4. Impact on reserve areas will be minimal, as proposed well will not encroach any
further onto adjacent lots as existing wells that are already permitted.
The neighboring lots are relatively small, but we have anticipated and mitigated impact on
adjacent lots, both those that are developed, and those that are undeveloped. We have done this
by ensuring that the proposed well location has very little additional impact, than the wells that
are already in existence. Drainage will not be affected, and is not a consideration in our design.
The well serving lot 18 is on lot 17, serves both lots, and is shown on our site plan.
This work will not affect the reserve area on adjacent lots. If you have any questions please call
our office at 694-5195.
Sincerely,
EAGLE RIVER ENGINEERIN9 SERVICES
Js4topher OR.Wood,E.
Principal
\2003\04-079SEPT[CNARRAMEMOC
EXISTING
WELL
CHANDELLE
ACRES
LOT 6
RUNWAY/AIRSTRIP
SEPTIC
AREA
F+
PROP0 D
WELL
!/1
EXISTING
WELL
LOT 17
95.5 -
N
EXISTING
WELL
MISTING
9
S
n
m
APPRox.
House
LOCATxIN
LOT 16
XLOOT
XISTING
WELL IZLOT
23 SEPTIC
LOT 15
AREA
100' WELL RADIUS • — MONITOR TUBE --- — E 8E#EW------�
DIVERTER VALVE 0 — SEWER CLEAN OUT _._.._------ — PROPOSED LEACH FIELD
® — TEST HOLE ¢ — WELL r ^ — DRIVEWAY
NOTES
1. NO KNOWN CURTAIN DRAINS 2. NO KNOWN SURFACE H2O
WELL RADIOS SITE PLAN
��.•+OF
LEGAL: EKLUTNA HEIGHTS, LOT 19 ��
OWNER: LARRY CALL =
CONTRACTOR: CALL'S EXCAVATION % * _
JOB 04-079 DATE: 08/09/04 SCALE 1 "=60'
EAGLE RIVER ENGINEERING SERVICES ���� RSCE-1038 R. WOOD.
10421 VFW RD. SUITE 201 1A1�
EAGLE RIVER, AK. 99577
(907) 694-5195 FAX: (907) 694-3297 Ill%i\���� :�4'�
} UNDEVELOPED,
SEPTIC +30' RJNWA /ARST
TH-2
A
/ m
_ m
A Z
PROPOSED a c
3 SR
HOUSE /
G .. • m
+30'—
100'
LOT 18
LOT 17
SCALE: 1"= 30'
PROPOSED
/ WELL
Z.25
EXISTING
WELL
N 89*57'10' E, 95.5
, ¢
LOTS 20 EXISTING
LEGEND: WELL
— ---- — 100' WELL RADIUS • — MONITOR TUBE --- — EASEMENT
— DIVERTER VALVE 0 — SEWER CLEAN OUT ________- _ PROPOSED LEACH FIELD
® — TEST HOLE — WELL o _ DRIVEWAY
NOTES:
1. NO KNOWN CURTAIN DRAINS
2. NO KNOWN SURFACE H2O
WELL SEPTIC SITE PLAN �`�••oF�•���
LEGAL: EKLUTNA HEIGHTS, LOT 19 �E �q /�
OWNER: LARRY CALL `P.. i
CONTRACTOR: CALL'S EXCAVATION % * 9 9 o/
JOB 04-079 DATE: 08/09/04 1 SCALE 1"=30'
EAGLE RIVER ENGINEERING SERVICES 0j;011 •CHRIs OP io R WOOD
10421 VFW RD. SUITE 201 �1� . . m
EAGLE RIVER, AK. 99577
(907) 694-5195 FAX: (907) 694-3297 ,1,`0ftasloog-
la-
to'
1.250 GAL
TN -1
S.T.E.P TANK
z
C
0
0
SEPTIC +
O
%
O
a-4 /
�o
LOT/24
} UNDEVELOPED,
SEPTIC +30' RJNWA /ARST
TH-2
A
/ m
_ m
A Z
PROPOSED a c
3 SR
HOUSE /
G .. • m
+30'—
100'
LOT 18
LOT 17
SCALE: 1"= 30'
PROPOSED
/ WELL
Z.25
EXISTING
WELL
N 89*57'10' E, 95.5
, ¢
LOTS 20 EXISTING
LEGEND: WELL
— ---- — 100' WELL RADIUS • — MONITOR TUBE --- — EASEMENT
— DIVERTER VALVE 0 — SEWER CLEAN OUT ________- _ PROPOSED LEACH FIELD
® — TEST HOLE — WELL o _ DRIVEWAY
NOTES:
1. NO KNOWN CURTAIN DRAINS
2. NO KNOWN SURFACE H2O
WELL SEPTIC SITE PLAN �`�••oF�•���
LEGAL: EKLUTNA HEIGHTS, LOT 19 �E �q /�
OWNER: LARRY CALL `P.. i
CONTRACTOR: CALL'S EXCAVATION % * 9 9 o/
JOB 04-079 DATE: 08/09/04 1 SCALE 1"=30'
EAGLE RIVER ENGINEERING SERVICES 0j;011 •CHRIs OP io R WOOD
10421 VFW RD. SUITE 201 �1� . . m
EAGLE RIVER, AK. 99577
(907) 694-5195 FAX: (907) 694-3297 ,1,`0ftasloog-
Eagle River Engineering Services
Ci►riatopher R. Wood, P.H.
10421 VFW Rrl. Suite 201 (907) 694-5195 tel
Eagle River, AK 99577 (907) 694-3297 fax
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: Eklatna Heights, Stewart Add., Lot 19
August 12, 2004
A. GENERAL
1. The well and septic plan is for a 3 bedroom single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of Health and State Department
of Environmental Conservation requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer.
5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet
Municipality of Anchorage, Department of Environmental Conservation requirements.
6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any
adjacent multi -family wells.
7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer
approval.
8. Any remaining open test hole excavations shall be filled and monitor tube removed.
B. SEPTIC TANK WITH LIFT STATION
1. The sewer piping from the house shall be 4" PVC 3034 laid at 2% grade maximum — 1% minimum
and insulated with 2" of burial foam if shallower than 3 ft., with 2 ft. minimum.
2. The septic tank shall be an Anchorage Tank 1,250 gallon septic tank with integral OSI lift station
pump model OSI -05-20-1-111F.
3. A receipt from a licensed electrician shall be provided to the engineer verifying lift station wiring to all
applicable codes.
C. DRAINFIELD TRENCH
1. The trench is to be located as shown on the site plan.
2. The total depth of the initial drainfield excavation is to be 6' relative to existing ground elevation at
ground water monitor tube and end in scarified native GW soil material. The bottom of the trench shall
be level, plus or minus 1.5".
3. A 4.25 foot layer of sewer rock is to be placed over the native gravel. The 1.0" effluent piping is to be
buried within the gravel layer with 2" of gravel cover over the piping.
4. The completed trench gravel and piping is to be covered with typar fabric material.
5. Soil or combination of soil and extruded board insulation to a depth of+3' or equivalent is to be placed
over the leachfield. Soil shall be mounded over the trench to prevent runoff from ponding. One and a
half foot of fill over original grade is anticipated.
RECOMMENDED LEACHFIELD DIMENSIONS:
TOTAL DEPTH= 6' GRAVEL DEPTH = 4.0' under effluent pipe, 2" over pipe
DRAINFIELD LENGTH= 75' DRAINFIELD WIDTH = 5'
SOIL RATING= 0.6 GPD/fig BEDROOM CAPACITY= 3
EFFLUENT PIPE = 1.25" from pump basin to leachfield then 1" manifold to 1" PVC with 1/8" holes
oriented down spaced at 4.0' OC. 2 pipe runs in leachfield 2' between pipes 1.5' from sidewalls and end of
trench.
NOTE: There is virtually zero tolerance for leachfield and septic tank layout. We strongly
encourage installer to employ a surveyor to lay out septic system prior to construction.
Twenty-four (24) hours notice required for all inspections.
\\Eres\DOCS\WPDOCS\2004\04-079drainfield- spec.doc
EAGLE RIVER
ENGINEERING SERVICES
P.O. Box 773294
Eagle River, Alaska 99577
(907) 694-5195
ERES Project No.: 04-079
Calculated By: CW
Date: 08/09/2004
Legal: Eklutna His. L19 Va- V ZT hbb. TEST HOLE 1
Single Family 3 Bedroom Dwelling
Shallow Trench Subsurface Wastewater Disposal Field
Water use at 150 gallons per bedroom = 450 gallons
Percolation rate =
19
minutes per Inch
Wastewater application rate =
0.8
gallons per day per square foot
Required absorption area =
750
square feet
Trench width (W) =
5
feet
Gravel depth (D) =
4
feet
Required length = Shallow trench factor" Required absorption area / W
Shallow trench factor = (W + 2) / (W + 1 +2 D)
Shallow trench factor= 0.50
Total Excavation Depth = 8.0 feet
Required length = 75 feet
04-079 drainfieidCalc.xis 8:38 PM08/09/2004
11
COMMENTS
a c7leM ex feJr
NBA e'
lexx Alp O
oR 6o pour
i'
WAS GROUND WATER
ENCOUNTERED? 4,110
5
IF YES, AT WHAT DEPTH? L
Depth to Water After 0P P
Monitoring? i� � E
Date:
rian
r --
Reading
Date
Municipality of Anchorage
Net Time
Development Services Department
Net Drop
Building Safety DNAsion
•is
2"/5 -
_ '..
i+
Onsite Water and Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.d.onchomce.ak.us
(907) 343.7904
Soils Log - Percolation Test
Performed
For. _ `i A A-ry
e4d d- Date Pe
Legal Description: Fie -1 07VA Township, Range, Sectic
Slope
tr
Depth
9'vjr
2� ea
, 7
(Feet)
1_
�✓w
OteA�r�'�
2-
3-
c
.
4-.
-
/1 pl
5-
.
.
(-r r r,
.
3A D % CAVR,
7-1;D
11
COMMENTS
a c7leM ex feJr
NBA e'
lexx Alp O
oR 6o pour
i'
WAS GROUND WATER
ENCOUNTERED? 4,110
5
IF YES, AT WHAT DEPTH? L
Depth to Water After 0P P
Monitoring? i� � E
Date:
rian
r --
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
•is
2"/5 -
_ '..
y • ..
ex
tr
9'vjr
2� ea
, 7
PERCOLATION RATE /4 T (mhnaehrch) FERC HOLE DIAMETER le '•
TEST RUN BETWEEN _FT AND g FT
PERFORMED BY: ,EAQ.�. &ig .0 < zr- T 1 Liy,Ci.3 W®O.a CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: E
Municipality of Anchorage
Development Services Department
Building Safety Division
id Onsite Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 995198650
www.d.anehorace.ak.us
(907) 3437904
Soils Log - Percolation Test
Performed For. �A
A, -•P/
��c_
Date Performed:
o%//'/p-/
Legal Description: :�t,4
v1;4A4
/,��./E'-yf G. /9
Township, Range, Section:
e
f/1 -Z -
Depth
il
1
1
®Kca✓,tS
5r�>,I arra N6S/TAN
eM
ri.,a /G Pn..•c e. .//riw..c
r ✓G >afo lace
WAS GROUND WATER
Date Gross Time
ENCOUNTERED? .UO
Depth to Water Net Drop
IF YES, AT WHAT DEPTH7 e
8
Depth to Water After
0
P
Monitoring? —
e
Dale.' --
Reading
Date Gross Time
Net Time
Depth to Water Net Drop
cc
70
,a-
b
/
,
/Q t
rcnwv„wn,...,c y,Z lmrnpwrrn) PENC HOLE DIAMETER (fj ••
TEST RUN BETWEEN :.FT AND FT
COMMENTS 'BAJO .Me.r ri rie TV F it Tr'A,t to
PERFORMED BY: ��y/p r,. I �'o CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 11&1/49Y
MunicipaUty of Anchorage
*AR
Development Services DepartmentBuilding Safety DivisionOn-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 198660 Anchorage, AK 99619-6660
www.ci.anchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET
To: EAGLE RIVER ENGINEERING
Legal description: EKLUTNA HEIGHTS STEWART ADDN LOT 19
The attached paperwork has been reviewed and is being returned for the following reasons:
❑ Original signature or stamp missing on
❑ Calculation error In design.
❑ Additional soils information needed.
❑ Water monitoring results inadequate.
❑ Discrepancy in information submitted. T
❑ Topographic information missing or inadequate.
❑ Incomplete: missing
❑ Incomplete, missing
❑ Additional adequacy test information needed.
❑ Water sample unacceptable.
❑ Measured/proposed distances/dimensions missing._
❑ Locations of all soils, percolation and water monitoring tests not shown.
❑ Proposed system too deep for soils information submitted.
❑ Well log required.
❑ Omission in narrative. _
Insufficient fill over tank or field._
® Other. DUE TO RELATIVELY SMALL LOTS: NEED TO SHOW ALL MEASURED DISTANCES TO ALL
WASTEWATER DISPOSAL SYSTEMS WELLS`SURFACE WATER OR DRAINAGE COURSES ROADS PROPERTY
LINES AND STRUCTURES WITHIN 200 FEET OF LOCATION OF ANY PROPOSED ON-SITE WASTEWATER DISOPOSAL
SYSTEMa THE NARRAjIVE DESCRIPTION OF IMPgTS ON ADJASCENT PROPERTIES IS NOT CLEAR.
NEEta 9•vdrr/E2 fiTE Y'LAN; INC 4.�p rlca /30JdIcEn7/4Wpe1_-r/eT
Name of reviewer: JQE GOODALL Date: 8/12/2004
Please supply the necessary information and re-submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
EP #S
MUNICIPALITY OF ANCHORAGE
•
(rfr�,
Development Services Department \ Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On-Site Systems Approval
Parcel I.D. 051-063-36 Expiration Date: 9-6, - 11
1. GENERAL INFORMATION
Complete legal description EKLUTNA HEIGHTS STEWART ADD. LOT 19
Location (site address) 21660 MADSEN'S PLACE, CHUGIAK,AK 99567
Current property owner(s) HARVEY&RAYNA CAMPBELL Day phone
Mailing address 21660 MADSEN'S PLACE,CHUGIAK,AK 99567
Real estate agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
• Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
TYPE OF WASTEWATER DISPOSAL:
4. TYPE OF WATER SUPPLY:
Private Well ® Private Septic
Water Storage ❑ Holding Tank ❑
Community Well ❑ Community I
Public Water System ❑ Public Sewer
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ Waiver Fee $
Date of Payment � Date of Payment
Receipt Number 0a6Q QD Receipt Number _
COSA#____ d 5Clq 1109 Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On-Site staff may visit the site to verify the information submitted.
Name of Firm ANDERSON CONSTRUCTION &ENGINEERING Phone 345-3377
Address 4640 SHOSHONI DRIVE,ANCHORAGE,AK 99516
Engineer's Printed Name MICHAEL N.ANDERSON,PE Date 5/22/2019
Comments:This investigation was completed in compliance with MOA guidelines,regulations, —_�`
and best industry practices/methods. The assessment of the condition of the well and septic �F �
applies only to the conditions as of the day tested.The flow and absorption rates may change �1
due to subsurface conditions that may not be observed from the surface,changes in land use, Air
local soil characteristics,groundwater levels that may fluctuate during the year,quality of f
construction(workmanship&materials),the water usage of the family being served by the �• "�
system and maintenance. The operational life of all well and septic systems are subject to / * 49 TH *�/
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore,any estimate of how long a system will function satisfactory •
for current or future occupants or guarantee that no unseen encroachments,deficiencies or
discrepancies exist can be given by FUJ and Anderson Construction&Engineering. 4 ffiCHAEL N. ANDERSON.:
No. CE 9489
•..5/22/19....• i
6. DSD SIGNATURE t \ ssioo.
System #1 Approved for .3 bedrooms ���
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the following stipllft i(«q,�
OF
q ail
O
ON-SITE
WATER AND m
WASTEWATER Z
PROGRAM
)))1))
By: .1 / Original Certificate Date: , —/
The Municipality of Anchorage Development Services Division (DSD)issues Certificates of On-Site Systems Approval (COSA)based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
COSA Checklist
Legal Description: EKLUTNA HEIGHTS STEWART ADD. LOT 19 Parcel ID: 051-063-36
If more than 1 septic system on lot: COSA Checklist#_of_ Structure served by this system_
A. WELL DATA
® Well log is filed with Onsite (or attached) Water storage tank volume NA gallons
Date drilled 8/25/2004 Well disinfected for coliform test? ❑ Yes Z No
Total depth 200 ft ® Coliform bacteria is Negative
Cased to 159 ft Nitrate 771 mg/L ❑ Nitrate less than MRL (ND)
Z Sanitary seal is functioning correctly Arsenic ug/L Z Arsenic less than MRL (ND)
® Wires are properly protected FWCS
Casing height (above ground) 18+ in. Collected by
Date of flow test for COSA 5/17/2019
Static water level at beginning of test 166 ft. Date of Sample 5/17/2019
Well production at time of test 1.2 gpm
•
Comments 150-gallon water storage inside house.
B. TANK DATA—9/21/2004 - 1250-gal STEP C. LIFT STATION
Age of tank(s) 15 years ® Required maintenance completed
Tank type/material STEP / STEEL Age of lift station 15 years
Measured operating fluid level in septic tank 48 Lift station material STEEL
® Standpipes/foundation cleanout per record drawing Comments:
Date of pumping 5/17/19
D. ABSORPTION FIELD DATA—75'L x 5'W x 4'ED — 0.6 GPD/SF = 750 SF
Which system tested (date installed) 9/21/2004 Adequacy test date 5/17/2019
® *ALL standpipes present per record drawing Results Pass For 3 bedrooms
Total measured depth from grade 7.5 ft (max) Fluid depth prior to test 17 in
Measured depth to pipe invert from grade ft(min) Water added 600 gal
® N/A— pressurized field New depth 25 in
® Monitor tubes go to bottom of effective. If not, state Elapsed time 1350 min
depth into effective
Final fluid depth 16 in
Z Code-required soil cover over field
El System presoaked Absorption rate 450 gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) N
date of test)
Gallons introduced gallons If yes, enter date
FWcs
Comments/Deficiencies:
COSA Checklist.docx
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100'
® Yes if No ft ® 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' Animal Containment > 50' ® Yes if No ft
® Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ® Yes if No ft ® Yes if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ® Yes if No ft Wells on Adjacent Lots:
Property Line > 5' ❑ Yes if No 2.5 ft Private
Wells > 100' ® Yes if No ft
Absorption Field > 5' ® Yes if No ft
Community Wells > 200' ® Yes if No ft
Water Main > 10' ® Yes if No ft
If septic tank is under driveway comment below
Water Service Line > 10' ® Yes if No ft
Surface Water > 100' ® Yes if No ft
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below
Property Line > 10' ® Yes if No _ft Wells on Adjacent Lots:
Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No _ft
Water Service Line > 10' ® Yes if No ft Community Wells > 200' Z Yes if No
Surface Water> 100' ® Yes if No ft
F. ENGINEER'S COMMENTS
OF AL\\
G. ENGINEER'S CERTIFICATION A��`s. . 'i. 6.,
I certify that/have determined through field inspections and review I*49 TH /N * T
of Municipal records that the above systems are in conformance / 7/
with MOA COSA guidelines in effect on this date. / ./
MICHAEL N. ANDERSON.: e /
/1 No . CE 9489 . w
: ??.:.19-.. 'G
Ale
COSA Checklist.docx
1 pEssiolOS' Apr
`\41111:
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 907-343-7904
On-Site Water and Wastewater Section \ Fax:343-7997
www.muni.org/onsite
Nitrate Advisory
Certificate of On-Site Systems Approval # OSC191189
Subdivision: Eklutna Heights Stewart Add. Lot: 19
A water sample revealed a nitrate concentration of 7.71 milligrams per liter (mg/L).
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Please see the attached "Nitrate Fact Sheet" for important
information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
Mailing Address: P.O.Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
Mailing Address: P.0. Box 196650*Anchorage,Alaska 99519-6650*www.muni.org
•
MUNICIPALITY OF ANCHORAGE
I r
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section `- " Fax: 907-343-7997
Lift Station/Pump Vault
Maintenance Log
Owner Street Address 6 0 ;r " 1 ar\ Se c\
Septic Tank:
-Sludge levelinches -Pumping: required o -Pumping completed gaLo
Lift station: Mc,y 1q
-Pump basket cleaned arlino -Effluent filter cleaned es no
-Control floats cleaned es o -Proper float settings confirmedes no
-Operation satisfactory es o
Alarm System:
-Dedicated electrical alarm circuit es no -Audible and visual alarm inside dwelling a no
-Alarm system operation atisfacto not satisfactory
Manhole Riser
-Ground water intrusion at riser to tank connection es a
-Ground water intrusion around pipe penetrations es no -Weep hole functional es no
-Manhole lid: Functional no Insulated •no Properly Secured no
Other
-All manufacturer required inspections and maintenance completed ik no
Comments:
Qualified Maintenance Provider:
Technician \, C��‘-- v �-� S Date of maintenance )1 1"1..x//7;
I� - J 1
Company d' S `�'C v `QJ
Signature Date
Mailing Address: P. O. Box 196650*Anchr,rage,Alaska 99519-6650*www.muni.org
Municipality of Anchorage
Development Services Department
Building Safety Division < '
On -Site Water and Wastewater Program 5 R f E, Y
4700Bragaw Street
P.O. Box 196650
Anchorage. AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 051-063-36 COSA#
Expiration Date: —�
1. GENERAL INFORMATION
Complete legal description Eklutna Heights Stewart Addition Lot 19
Location (site address) 21660 MADSEN'S PL Peters Creek, AK 99567
Current Property owner(s) Orenich ,Tustin s Miller Hannah Day phone 244-1930
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Day phone
Cindy Wilson Day phone 244-1930
RE/MAX of Eagle River
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding Tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm NorthRim Engineering Phone 694-7028
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng Date 7/30/2012
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The
assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow
and absorption rates may change due to subsurface conditions that may not be observed from the surface,
changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the
water usage of the family being served by the system. The operational life of all well and septic sy�set�ns are
subject to these various and dynamic characteristics and are outside the control of the ,tee %%
%
evaluator of the well and septic system. ! � .......,,..4A%
0
5.
DSD SIGNATURE i
k bedrooms. �� c1 Steven W. Eng
Approved for
fir10Fe
Disapproved.
Conditional approval for
Attachments
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
bedrooms, with the following
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
OF
WATER AND
By: Original Certificate Date:
(Rev. 11105)
Municipality of Anchorage s°
• Development Services Department °
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw 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: Eklutna Heights Stewart Edition, Lot 19 Parcel ID: 051-063-36
A. WELL DATA - Public Water
Well type P If A, B, or C provide PWSID # _ Well Log (Y/N) Y
Date completed 8/25/04 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 200 ft. Cased to 159 ft.
FROM WELL LOG
Date of test 8/25/04
Static water level 160 ft.
Well production 1 9 -
p.m -
WATER SAMPLE RESULTS:
Coliform Pass colonies/100mL Nitrate 4.36 mg/L
Casing height (above ground) 24 in.
AT INSPECTION
7/28/12
155 ft.
�. 1 g.p.m.
Arsenic: 0.214 ug/l Date of sample: 7/17/12 Collected by: nr
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEP/Steel Date installed 9 2 04 Tank size 1250 gal.
Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N
High water alarm (YIN) Y Date of pumping d 3 I Z Pumper -,,TS
C. ABSORPTION FIELD DATA
Date installed 9 2 04 Soil rating (g.p.d./ft2 or ft2/bdrm) 0_6 System type trench
Length 75 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth 7 ft.
Eff. absorption area 750 fe Monitoring tube Y Depression over field N
Date of adequacy test 7/28/12 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 3 in. Water added 450 gal. New depth 8 in.
Elapsed Time: 60 min. Final fluid depth 3 in. Absorption rate > 450 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) unknown If yes, give date
D. LIFT STATION
Date installed 9121104 Size in gallons 1250 Manhole/Access (YIN) Y
"Pump on" level at 60 in. "Pump off' level at 62 in. High water alarm level at 59 in.
Datum tank top Cycles tested 3 Meets alarm & circuit requirements? Y
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot 100' +
Public sewer main NA
Sewer /septic service line 25'+
Animal containment areas 50'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout NA
Holding tank na
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 51+ Property line 25'* Absorption field 5'+
Water main 101+ Water service line 301+ Surface water 100'+
Wells on adjacent lots 1001+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 101+ Building foundation 101+ Water main na
Water Service line 10'+ Surface water, 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain n/a Wells on adjacent lots 100'+
F. COMMENTS
*Lot Line Waiver
G. ENGINEER'S CERTIFICATION o 'c�F•Ac°O''A
t certify that I have determined through field inspections and ®k��
review of Municipal records that the above systems are in y.°, Ft
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Steve Eng Steven W..4Eng s 47
Date 7/30/2012 +®��FPF� (�� ` «• ' g
�sd:gGt'i="
COSA Fee $490.00
Date of Payment V-3//l�
Receipt Number 6 /5-3& C
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
.� Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. b ri 1 n3' 3� COSA # n"
Expiration Date: / O- 1 7— O 7
1. GENERAL INFORMATION
Complete legal description
L
Location (site address) "z 1 (o G U
Current Property owner(s) CXIL'44 �� ``P��`— Day phone (Ab 0— 5'9
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
PC Box k,_4 i l (ItA JS R /�-1 ,+ J/ ` 15tc-I- G 14 I
Day phone
�iwvi 1?z� t nc%ia — w_ la(AJ ay phone o1�1�— `1`1 75
/Gfn35 C� lw%rE'r�'iy�- G� AK-, `'tCIs�"1
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
9
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Ell
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 Eagle River Engineering Services
Address Pngla 13hior, AK 519577
Engineer's Printed Name _ehri 54cleher IZ
S. DSD SICrNATURE
- Approved for _� bedrooms.
Disapproved.
Phone _(M -50S
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory _ ' Other
By:4 v Original Certificate Date: %— 17— D
(Rev. 11105)
Municipality of Anchorage
Development Services Department t ;
Building Safety Division `
On-Site Water & Wastewater Program
4700 Bragaw 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: a-1c dn6L- H44:a&4- of I `) Parcel ID: 051
A. WELL DATA
Well type_R]�/_ait, If A, B, or C provide PWSID # _ Well Log ON)
Date completed 0.26 C4- Sanitary seal y&) Wires properly protected ON) _ Ue L
Total depth aoo ft. Cased to 151 ft. Casing height (above ground) ain.
FROM WELL LOG AT INSPECTION
Date of test �� a 5� 04-
Static water level I (Po
ft. 16 •I ft.
Well production I g.p.m. O• `) 9—
p.m-WATER SAMPLE RESULTS:
Coliform _P, colonies/100 mL Nitrate 5•yy mg/L Other bacteria _0 colonies/100 mL
Arsenic: dt> ug/L date of sample: SCJ- Collected by: Nr✓i✓rr v i24 .1 c
B. SEPTIC/HOLDING TANK DATA
Tank Type/MaterialS •T• �• Sf r'—�— Date installed e7 J 7- f J cosi
Tank size 1, X'50 gal. Number of Compartments S Cleanouts CY)N) _l tti
Foundation cleanout J9N) +1- Depression over tank (Y6 LL High water alarm 61N) A
Date of pumping 4/;-17 Pumper zC9 �T�p1
C. ABSORPTION FIELD DATA O
Date installed c 1.11/0 it Soil rating g.p.d./ft orf?/bdrm)17-(r Systemtype .5 A e&o TtP47
Length -'q ft. Width 5 ft. Gravel below pipe +J- ft.
Total depth 3= ft. Eff. absorption area -45;0 f? Monitoring tube Yj!,5 Depression over field
Date of adequacy test Results &TIRFail) .i For q_ bedrooms
Fluid depth in absorption field before test __ti_ in. Water added CO gal. New depth -7,5 in.
Elapsed Time:1,4L Dmin. Final fluid depth 4 in. Absorption rate >= 450 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YA&�& type) tjrnt #e_4-'C J,0 If yes, give date vi I e4-
-
D. LIFT STATION
Date installed J I 1.40-q.
'Pump on' level at _(L(2 in.
Size in gallons A >D Manhole/Access (VN)
'Pump off" level at min. High water alarm level at `I in.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot + 1 oo '
Absorption field on lot * loo'
Public sewer main ; tool
Meets alarm & circuit requirements?
On adjacent lots
On adjacent lots t 10 (1),
Public sewer manhole/cleanout -r 100,
Sewer /septic service line -t ;�, S' Holding tank t -7,; '
Animal containment areas + 100 I Manure/animal excrete storage areas + 1 r�o I
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 4 S ' Property line . S Absorption field + S '
Water main + to I Water service line 4 10' Surface water '
Wells on adjacent lots + (00
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line j 0 I Building foundation ^ 10 1 Water main t 10 '
r
Water Service line 1 10 I Surface water +- I OL) Driveway. parking/vehicle storage I S I
Curtain drain + 1,O 1 Wells on adjacent lots t- I
F. COMMENTS
/A r- Jv+ •1 I tr— . - 10-i . 0
G. ENGINEER'S CERTIFICATION
1 certify that 1 have determined through field inspections and `?
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name e1163-1oelier R. vOcod
Date
CE W
COSA Fee $ t/ ?�o
Date of Payment n�� 2, -Lo
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
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ASBUILT SEWARD h
I HEREBY CERTIFY -THAT I HAVE SURVEYED THE
SCALE=
FOLLOWING DESCRIBED PROPERTY:
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elR-,40'.V" 0 1 ',le!/lrt/f r e-, r/y •
DATE -
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
GRID:
EASEMENTS, COVENANTS, OR RESTRICTIONS
iYw/f'�o
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
FB,
ANY DATA HEREON BE USED FOR CONSTRUCTION
/OS2�9
OFFENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
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Municipality of Anchorage
a• s
Development Services Department
j Building Safety Division a
a.r arr
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 070249
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 5, Lot 2A
of Eklutna Heights Steward Subdivision Lot 19 subdivision. This
inspection revealed a nitrate concentration of 5.44 milligrams per liter
(mg/L) was reported for the property's well water sample. The
Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems.
While private wells are not subject to this regulation, EPA standards are
based on existing health information and can therefore be used to gauge the
relative quality of water from private wells. Please see the attached "Nitrate
Fact Sheet" for important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Sfte Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
cirgz s t,,h-d-jj
(907)343-7904
®' CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D.4sa s 4 a - -'5 Ca HAA.# oG 2
*y Expiration Date:
1. GENERAL IJIF.ORMATIOW.,
Complete le11 gal descriptionry r Z7k ,yam 3 "T" � ds- /4
Lbc itIgn,($ite address or directions) 1l?A
v.
Current Property owners) Day phone .vyj-,ez1j
Mailling:e£Idress . iZ 7V/ A/.s,,.
Lending agency Day phone
Mailing address
Real Estate Agent
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: '3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage ❑
Community Class Well ❑
Public Water System ❑
Day phone
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 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 Health Authority 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 disposaliystem is(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in eN48t at the time of installation.
Eagle River Engineering Services
Name of Firm
Address Ea& RRiiyer AK 99577
Engineer's Printed Name / ,rzaTOw� /? /ens
5. DSD SIGNATURE
1� Approved for 3 beds
Disapproved.
Conditional approval for _
ON-SITE
WATER AND
WASTEWATER
Phone
I. PROGRAM ; --
�ssiar
)edro'AW a'it`h�the following stipulations:
Additional Comments
Note: The well for this property meets existing State and Municipal Codes. There are nitrates
present. It is suggested that periodic testing be performed to insure the wells continued suitability.
Current nitrate concentration is 7.36 mg/L EPA maximum concentration is 10.0 mg/L More
information on nitrates is available from the On -Site Services Program, at 343-7904.
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By. Original Certificate Date: 3 �4
(Rev. 011102)
Municipality of Anchorage
• +�t ` e
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: , v s mor /tet Parcel ID: 4p&3 - 3ew
A. WELL DATA
Well type eEk,,,vw If A, B, or C provide PWSID # _ Well Log ITN) yc3
Date completed Sanitary sealdVN) yam, Wires properly protected�YN) yEe
Total depth iEgtO ft. Cased to /'t4 ft. Casing height (above ground) min.
FROM WELL LOG AT INSPECTION
Date of test 8/2 r/oy
Static water level iGn ft. ft.
Well production / g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform _colonies/100 ml. Nitrate >7 Bee mg./I. Other bacteria x colonies/100 ml.
Arsenic: mg./I. Date of sample: �d�7/ay Collected by: �/.4��+�
B. SEPTIC/Het = TANK, DATA
Tank Type/Material �,T E.R �I SP.Eac Date installed R/g /OH
Tank size o�sro gal. Number of Compartments 3 Cleanouts4YN) _V61
Foundation cleanoutC9N)-y2!Es Depression over tank (Y8P AO High water alarm&VN) �Yas
Date of pumping.t/!A✓ Pumper
C. ABSORPTION FIELD DATA
Date installed 9 Soil ratingd5iip or ft2/bdrm) O_!s System type -s u. d -M0 T.-E-ueh'
Length 75 ft. Width _1' ft. Gravel below pipe 4e ft.
Total depth -7 ft. Eff. absorption area ZSD ft2 Monitoring tube _)/A*_ Depression over field
Date of adequacy test Wove Xla •p Results (Pass/) PA -5 5 For 3 bedrooms
.tJss✓ aY,yry
Fluid depth in absorption field before test — in. Water added= gal. New depth= in.
Elapsed Time: min. Final fluid depth = in. Absorption rate >= QS C? g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y&'l type) If yes, give date A:�/1
Date installed 9/�f1/oV Size in gallons /x ro Manhole/AccessLON) Y
"Pump on" level at Air in. "Pump off" level at 03 in. High water alarm level at ? 2 in.
Datum Cycles tested ^AFAJ Meets alarm & circuit requirements? YDS
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot ion'
Absorption field on lot /e/'
On adjacent lots 1, /w
On adjacent lots filen 1
Public sewer main Public sewer manhole/cleanout f rm0'
Sewer /septic service line 4,06- Holding tank /,ego r
SEPARATION DISTANCES FROM SEPTIC/HAt9#Ne TANK ON LOT TO:
Building foundation .P.2 ' *Property line ,AJ Absorption field S
Water main ri re' Water service line r�o' Surface water roo
Wells on adjacent lots r' 1600'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line /O Building foundation 33, Water main Ero'
i
Water Service line f/DSurface water 1100 Driveway, parking/vehicle storage SC
Curtain drain ,,TWells on adjacent lots 7x,,410'.t.%rsF ;6;W
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that 1 have determined through field inspections and f
review of Municipal records that the above systems are in ~
conformance with MOA HAA guidelines in effect on this date. '; CHMMPHERItWCOD
Engineer's Printed Name
Date _ I I 29 �v+� ssiot�N
HAA Fee $ 50 1 Waiver Fee $ % �r Z f ��
Date of Payment 11 14al Date of Payment
Receipt Number Receipt Number
(Rev. 12/01)
Eagle River Engineerings Services
Christopher R. Wood, P.E.
10421 VFW Rd. Suite 201 (907) 694-5195 tel
Eagle River, AK 99577-3294 (907) 694-3297 fax
November 23, 2004
Dan Roth
Manager, On -Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Eklutna Hts, Steward Add., Lot 19
Septic Tank to Lot line Separation Distance Waiver Request.
Dear Mr. Roth:
This letter is to request a separation distance waiver from the referenced property's installed on-
site septic tank lift station to Lot Line. The centerline of the tank is exactly 5 feet off of the lot
line.
We are requesting a waiver to allow a separation distance of 2' from the septic tank to lot line.
This system was installed in September. A recent as -built survey has revealed that the edge of
the septic tank is only 2.5' from the lot line, due to a faulty stringline used during construction.
ERES believes that granting of this waiver will not adversely affect the developability of the
neighboring lot's future septic system, on-site well, or replacement leachfield sites, if laid out
similar to Lot 19.
Thank you for your consideration of this matter. Please call if you have any questions regarding
this waiver request. I can be reached at 694-5195
Sincerely,
EAGLE RIVER ENGINEERING SERVICES
Christopher R. Wood, P.E.
Principal
\2003\04-079 WA[vERREQUE ST.UOC
Municipality of Anchorage
— P.O. Box 196650 • Anchorage, Alaska 99.519-6650 • Telephone (907) 343-8301 • Fax (907) 343-8200
\\
'W-- 4700 Bragaw Street # Anchorage, Alaska 99507
www.muni.org
Mayor Mark Begich
Building Safety Division
11/29/2004
Eagle River Engineering Services
10421 VFW Rd. Suite 201 Eagle River, Ak. 99577
Subject: Waiver Request for Eklutna Heights Steward Subdivision Lot 19
Waiver Request #WR040089
Parcel ID #051-063-36
HAA# 040622 Permit # 040346
Dear Chris Wood:
Your request for a waiver of the required 10 feet horizontal separation from the
septic tank to property line has been approved. The approved separation distance is 2.5
feet.
This waiver approval applies to the existing septic tank to property line separation only.
Any future upgrade to the on-site wastewater disposal system will require all separation
distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely,
Jeffrey W. Poet
Engineering Technician
On -Site Water & Wastewater Program
Community, Security, Prosperity
ASBUILT
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
AND THAT NO ENCROACHMENTl<EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
EEMENT.$, COVENANTS* OR
WHICH DO NOT APPEAR ON THE RECORDEDIONS SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
SI.[JARD &ASSOCIATES LAND SURVEYING 6
SCALEr �
DATE- OF ..
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Client ID: tat 19 EkkMa HeigWI0470MMI
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Palmer, Ak. 98646
Nu: (007) 7454019
Date Arr(ved:10=104
Reportoats: 102w
Sample pate: 1021104
Sample TOM 1400
Collected By:
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