HomeMy WebLinkAboutRIVERVIEW ESTATES BLK 9 LT 10ARiverview
Estates..
Block 9
Lot I OA
#050-792-51
Municipality of Anchorage X _�•.,
Development Services Department
Building Safety Division
On-She Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 99519.6650 Page o/ of m 3
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. _t51.J O °/Q z'/ z PID Number, - % 9 2 - S1
_OSO
Name:
Don a. a o r i Wastewater System:New ❑ Upgrade
Addnaa. G er ar Circ E" c rAl—°V
ABSORPTION FIELD
nOM� Numb" W Broom•:
ed
90� 272 — 93310
0Deep Tnndh)(ShaerTromh peed OMouw OOatr:
LEGAL DESCRIPTION
SW Rang:
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eIOC. lr: SupONrdn: (`, J L
O'q Cr✓•C Limit
GPDtFt'
Depth W ppe bottom aem mgnr and•:
2.Z
Si Ft.
Grarr d•pp e•rXath pp,
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Twnwp: Rang•; Sacbon:
FL
FY added apove pnginr pada. W4t
/.S FL
Gravel Lergth:
/. O Ft.
Ft.
• '
Well: ❑ New tar�f�• ❑Upgrade
Gnrr roN:
Numder orNrc D4rww atrnen ane•:
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/ FL
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ork O
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TANK
SEPARATION DISTANCES
XSeptic Cl Holding 0 S.T.E.P. ❑ Other.
To
From
Septic
Tank
Absorption
Field
0t
Station
Holding
Tank
ubtlrJPrIvate=WV..
Sewer Lina
�.
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/- Mm.O ier•LYL
1 F JT /r /DO FL
Wed w r T
OKI
Engineer's Stamp
12 v Ced u er
iH 49�q'
j
Inspections performed by: L-• G/ CSo✓G Oates: 1'b /o8 DfjoL01
-z
CAI G ,X) 2nd ligh I O
.... TG�
Development Services Department Approval
o, RYA.H GESON;.
Reviewed and approved by: �. Date: �- %- O
....No. CE-9698
fP••.,•
Dt.r. wool
O pRaFCS510N�'� J
� ANwI'
Municipality of Anchorage Ji
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 99519.6650 Page
www.cl.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Number.
PARK D
iIt 61' Long by 5' Wide
�\ aj'n?rAbsorbdon Trench
Sts C2
PID Number. o$O_
/WELL`•
Swing Ties
Cl I1
C2 20 33
SI 13 29.4
S2 17 31.3
MTI 41
C3 39.4
NM 34.3 30.7
C4 35.71 32.7
100' RADIUS
Ci
C 5
56.7
55
OOF.
Al
PLAN AS -BUILT..
SCALE l" = 30'
Municipality of Anchorage r >••,,
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program. 4700 S. Bragaw St.
P.O. Box 196650 Anchorage. AK 99519.6650 Page 2 Of 3
www.cl.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM ANDIOR WELL INSPECTION REPORT
ermit Number. S LJ&),, D 2 4/ Z PID Number. USD- J79,2—SI
5 FT
C2 S2
99• TH2
98.0 MTI C3
Finished Grade
i
°"&°0 Insu1- 1000
Nide Trench SEPI
94.3
92.3
L5 ftJ
90.2
86.7
C4 11
It MT -2 TH2
Insulation
FT
PROFILE AS -BUILT
6 FT
COI
III II
96.8
IDLr]
House
97.4
• Estimated Elevation of Finished Grade -
99• landscaping will be completed in the summer
C3 MTI
FT
95.7
NO SCALEx �At%Yn.� .,
'T�'�l.:.No.aE-9e9e
D
MUNICIPALITY OF ANCHORAGE
Development Services Department
Onsite Water 6 Wastewater Program 11�
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ONSITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Permit Number. SWO40242
Legal Description: Riverview Estates 'Block 9 Lot 10A ?
Design Engineer. 0857 LARRY A. HELGESON
Owner Name: Donald. Dougherty
Owner Address: 4221 Laurel St. #313
Anch . AK 99508 -
Date Issued: Jul 06, 2004
Expiration Date: Jul 06, 2005
Parcel ID: 050-792-51
Site Address: 4221 Laurret St #313
Lot Size: 41977 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of.
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy 0 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 DSO at least 2 hours prior to each inspection. Provide notification by tailing
(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 dosed on the same day.
B. Covered, sealed, and heated to prevent freezing.
tge/oc} 3'c , "A" -4 l�ov oc. 1oc osk,Osre,c c�r.o.�r,�� 51����`1
b\�
Received By.
Issued By.
Date:
Date: -7-6- d `T
Municipality of Anchorage
e 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.ek.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. t%gO% 94040 Permit Number SWO4Oa-42-
Property
Mailing address (1
.f -3/3
Day phone 4;Z79-75547
Mailing address (2) i rle�vra/¢% Zip Code 9F.sa0
Legal description (Lot, Block & Sub'd.)
Legal description (Section, Township & Range)
Lot Size !t4 97% Acre q.F Number of Bedrooms
THIS APPLICATION IS FOR:
Sewer Only ❑ Well Only ❑
Sewer and Well V Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
Lj
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.
Permit Fees: 41 L c 4 1 %.S Waiver Fees:
Date of Payment: (o — 2 / " O T Date of Payment:
Receipt Number: O 1 Receipt Number:
(Rev. 12/00) OL rU 6 176,
Larry A. llelgeson, P.E.
1911 Rebel Ridge Dr
Anchorage, Alaska
907-338-7250
June 27, 2004
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
Anchorage, Alaska
RE: Lot 10 Block 9 Riverveiw Estates Subdivision
Well and Septic Design
Attached are the designs for the subject lot. The system will support the three bedroom
house that is planned for the lot.
The well is an existing well that was designed as a class "A" community well for the
several lots. The plan to use it as a community well was abandoned and the well will be
only used for this lot. The data on the existing well is attached.
The septic system design is for 1,000 -gallon septic tank connected to a wide trench
absorption field. The sandy gravel in the bench where the drain field will be located
percolates very quickly. Two feet of imported sand filter material will be used below the
absorption trench to allow treatment of the effluent in the field.
Sincerely,
Larryflelgeson, P.
Attached:
Figure 1. Site Layout
Figure 2. Cross-section
Well Data Package (S&S Engineering)
Larry A. Elelgeson, P.E.
1911 Rebel Ridge Dr
Anchorage, Alaska
907-338-7250
June 27, 2004
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
Anchorage, Alaska
RE: Lot 10 Block 9 Riverveiw Estates Subdivision
Well and Septic Design
Impacts to Adjacent Properties
The terrain on the lot slopes to from the south to the north. There is a low relatively flat
area at the north end of the property. The land rises from there at a 30% slope to a bench
with a gentler slope of 5-15%. This bench runs about 150 feet to the south before the
land rises again at a greater than 25% slope. The house and septic system will be located
on this bench. The alternate location is on a small rise at eth north east comer of the
property. The majority of the property is very well drained with exception of the low
area at the north end of the property and a small area on the south west part of the bench.
A wide drainfield has been designed for this lot due to the proximity of the water table at
8' 2" below the surface. Two feet of filter sand will need to be installed below the sewer
rock due to the high permeability of the soils. If the system is installed as designed the
following statements can be made:
1. The system will have no adverse impact on the wells currently in use.
2. The system will have no adverse impact on the existing septic systems.
3. The system will have no adverse impact on reserved space on any lots in the area.
4. The system will have no adverse impact on drainage patterns in the area.
Should you have any question please contact me.
Sincerely.
!�lz �
La felgeson, P.E.
NOXE • 9698
Larry A. Ilelgeson, P.E.
1911 Rebel Ridge Dr
Anchorage, Alaska
907-338-7250
July 2, 2004
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
Anchorage, Alaska
RE: Lot 10 Block 9 Riverveiw Estates Subdivision
Well and Septic Design
Subject: Clarification of Absorption Field Total Depth
This letter is response to your telephonic request for clarification of the total depth of the
system. The total depth of the absorption field will be 4 ft below the existing grade. This
will include 2 feet of cover, 2 inches above the horizontal distribution pipe and 18 inches
below the distribution pipe. At this point I have given the building contractor the option
of providing an additional foot of cover or using insulation for protection from freezing.
The additional foot of cover maybe easy to obtain since there is likely to be extra fill
available from leveling out the foot print for the house. I have not heard what option the
owner and builder wants to pursue.
Sincerely,
Lang iftlgeson, P
/ River 4rk D,,"/
1
I �
Well I
&Pile \
i
5'WXO*LKz'D (.s'bela rpc)
W.de rreK&
`, �r�eJI IoW (pH�04 rj'
L.of It
Block S
✓aaaxr
\
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I
,y Gam,
CC
tyle
lot9 i.d4$
Dla<k 9 old .k 9
SCALE 1 "=50'
5/19/04 Lot 10 Block 9 Rivcnv Estates
Figure I SITE LAYOUT
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y
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0
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PERFORMED
LEGAL
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
h VDU o i F lf� 1 DATE
Slav,
, Range, Section:
1 P T Dthaan"C- • 4ctn/rej I00.N/
2- �jv0 v
C,"CC Scl.1tl� Cfr0.0 PSI
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3 O pert. 4 0.5011"I.1e�I `\
0
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5 I
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6-
7 7
8-
10-
10 WAS GROUNDWATER
ENCOUNTERED? t?S
11 S
IF YES, I 1 r
DEPTH?
WHAT /O S / L
12-2coTl•owI d} 11dr- P
� E
Depth to Water Ater/ ii
13 M ?
Donitorin -? Datc O /�/ r"$,
-•
14 I
is 1 es� �lo�e
16
17
is
19
■..■■■■m■m
Date Gross
Time
■■■■■■mmum
Depth to
Water
Net
Drop
l
0 7h"3 8:3H:/E
Reading
Date Gross
Time
Ner
Time H7, y
Depth to
Water
Net
Drop
l
0 7h"3 8:3H:/E
: y.15-10:00
3
33//"
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"
e11
M Cal +30
/01co
7 f,
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3
S'rG"
20
PERCOLATION RATE )minuteLinch))yPERC HOLE DIAMETER
A/ TEST RUN BETWEEN� FT AND ._L_FT /
IMENTS I•ole: ne+-a Iell i7A%�/
re vl 3'�"a -P Ly le -an �letf f �rYr• e
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PERFORMED 8Y:✓ /� f4 'P6� �2 ) _ a r n/ i /�rT 5n�1 CERTIFY THAT THI§ TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE G27�D`/
72-008 )Rev. 4165)
'I"
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PERF
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1
2
3
4
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TEST RUN BETWEEN m45' FT AND 6 FT
IMENTS — 7jhe. Luh Ter I e ve 1 as IcAew wGeo �Jn.(.. . M TLl d
PERFORMED BY: 6";e _P. NCl6 a er+K. I (_u oqy N. He .SC" CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: G IZ 7/Q V
72.008 (Rev. 4/85)
83/2.7/1998 14:43 9076941211 S AND S ENGINEERING PAGE 04
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MUNICIPALITY QF
Development Services Department
On -Site Water & Wastewater Section
Parcel I.D. 050-792-51
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Phone: 907-343-7904
Fax: 907-343-7997
Expiration Date: 1 ® -14- Z d
2-0
Complete legal description RIVERVIEW ESTATES BLOCK 9, LOT 10A
Location (site address) 7486 RIVER PARK CIRCLE, EAGLE RIVER, AK 99577
Current property owner(s) KELLIE & TYLER LINDQUIST Day phone
Mailing address 7486 RIVER PARK CIRCLE, EAGLE RIVER, AK 99577
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
4. TYPE OF WATER SUPPLY:
Private Well
Private Septic
Water Storage
❑
Community Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Private Septic
Holding Tank
❑
Community
❑
Public Sewer
❑
Waiver request for: Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee
Date of Payment -11717,0
Receipt Number. too 7o8 Z
COSA# 05C.201 3 b (o
Date:
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Address 13030 SUES WAY, ANCHORAGE, AK 99516
Engineer's Printed Name CURTIS HUFFMAN, PE Date 7/3/2020
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to r +� A k�
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 g�Q; • • • • �9 ���
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting &NES*• 9 TH ••*
N �. .: ........�
r•
6. DSD SIGNATURE % •Curtis Huffman
System #1 Approved for bedrooms CE 128991
System #2 Approved for bedrooms�1�1FOPROFESSOO a���
Disapproved
Conditional approval for bedrooms, with the following stipulations:
ONcN -S/7E 1BAST I,AND rn
o
PR
OG�i-
M V
1)V r—
a!
By: h— 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
Legal Description: RIVERVIEW ESTATES BLOCK 9 LOT 10A Parcel ID: 050-792-51
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 11/18/1977 Well disinfected for coliform test? ❑ Yes ® No
Total depth 96 ft ® Coliform bacteria is Negative
Cased to 96 ft Nitrate 3.38 mg/L ❑ Nitrate less than MRL (ND)
® Sanitary seal is functioning correctly Arsenic ug/L ® Arsenic less than MRL (ND)
® Wires are properly protected
b
Casing height (above ground) 12+ in. � Collected Y NES
Date of flow test for COSA 6/29/20
Static water level at beginning of test PLUG ft. Date of Sample 6/29/2020
Well production at time of test 4.4+ gpm
Comments Artesian well with plug — Sullivan worked on wellhead adding conduit ...for this COSA.
B. TANK DATA
Age of tank(s) 16 years
Tank type/material SEPTIC / STEEL
Measured operating fluid level in septic tank 49"
® Standpipes/foundation cleanout per record drawing
Date of pumping 6/29/20
D. ABSORPTION FIELD DATA
Which system tested (date installed) 10/11/2004
® ALL standpipes present per record drawing
Total measured depth from grade 3.2 ft (max)
Measured depth to pipe invert from grade 1.7 ft (min)
❑ N/A — pressurized field
® Monitor tubes go to bottom of effective. If not state
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material
Comments:
Adequacy test date 6/29/2020
Results N Pass For 3 bedrooms
Fluid depth prior to test 0 in
Water added 470 gal
New depth 0 in
depth into effective Elapsed time <1 min
❑ Code -required soil cover over field Final fluid depth 0 in
❑ 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) If yes, enter date
Gallons introduced gallons
Comments/Deficiencies: No known frost issues per owner. NES
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
® Yes
if No
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
® Yes
if No
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes
if No
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' ® Yes
if No
® Yes
if No
ft
ft
If septic tank is under driveway comment below
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ® Yes
if No
ft
® Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
® Yes
if No
ft
Surface Water > 100'
® Yes if No_
Property Line > 5'
® Yes
if No
ft
Wells on Adjacent Lots:
® Yes
Absorption Field > 5'
® 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 septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
® Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
® Yes
if No
_ ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft
Private Wells > 100' ® Yes if No _ ft
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
l certify that / have determined through field inspections and review
of Municipal records that the above systems are in conformance
with MOA COSA guidelines in effect on this date.TH
_,Now1
AGW
•. ....•:
... .... ....t......
• Curtis Huffman
711012 2
�� �c�G,/•. CE 128991 ,•��`4�s
���11i� ROFESSI4NP��-,��
ft
ft
ft
ft
ft
ft
ft
ft
Tyler and Kellie Lindquist
7486 River Park Cir
Eagle River, AK 99577
July 12, 2020
To Whom It,May Concern,
We purchased the property 7486 River Park Cir, Eagle River in January of 2013. We have lived
at this property since December of 2012 and during this time we have never had an issue with
either the well or the septic system, which includes no freezing or clogging of the pipes.
Sincerely,
Tyler and Kellie Lindquist
• Municipality of Anchorage
1 On -Site Water and Wastewater Program
(907)343-7904 s. ET
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D.0 - yl
1. GENERAL INFORMATION
2.
Complete legal description
Location (site addretss)
C
Mailing address
Real Estate Agent a`F
TYPE OF DWELLING:
❑ Single Family (w/wo ADU)
❑ Duplex
Multiple Dwellings (Single Family and/or Duplex)
Expiration Date: 9/m/Is
BEDROOMS:
3. NUMBER OF
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual
X,
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Received by: �� ' ' "� Date:
-COSA to be released to the engineer, unless tithea requested by the engineer.
COSA Fee $ qqd
Date of Paymente�a
Receipt Number
COSA#
Waiver Fee $
Date of Payment
Receipt Number
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 Onsite 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.
Engineer's Printed Name
Phone
Date /Z1 3 Z Z --
6. MD SIGNATURE
System #1 Approved for .3 bedrooms.
System #2 Approved for bedrooms.
Disapproved
Conditional approval for
bedrooms,
bedrooms, with the following stipulations:
Original Certificate
1ha.larunicipality 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
_Septic System Advisory
Well Flow Advisory
COSA blue sheet 9-1-12.doc
Nitrate Advisory
Arsenic Advisory
Other
If more than 1 septic system is on the lot:
COSA Checklist # _of
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: �''- ,� �; I ��'�J/tQ (y parcel lD:�,S/
A. WELL DATA
Well type0lQ If A. B, or C provide PWSID # Well Log (Y/N) _�I
Date completed Sanitary seal (Y/N) Wires properly protected (Y/N) A A
Total depth ft. Cased to (ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test C®
.f
Static water level ft.
{N/A ft
Well production g.p.m. (� . g.p.m.
WATER SAMPLE RESULTS:
Coliform. colonies/100 mL Nitrate ,?O mg/L
Arsenic Wb ug/L Date of sample: Collected by: . eoxT
B. SEPTICIHOLDING TANK DATA
Tank Type/Material 6NU Date installed
Tank size = gal. Number of Compartments 2 Cleanouts (Y/N) _�_
Foundation cleanout (Y/N) _Y_ Depression over tank (Y/N) AL High water alarm (Y/N) _
Date of pumpingA11,1, Pumper /_ L-15ZZ. 4011/ Awipee- S
C. ABSORPTION FIELD DATA
Date installed AW61- Soil rating g.p.d./ 2 or ft2/bdrm) 1'(2 System type
Length_ ft. Width _ ft. Gravel below pipe 1, 15 ft.
Total depth ft. Eff. absorption areaoqf Moriitoring tube� Depression over field
Date of adequacy test ® 25 f2 Results (Pass/Fail) "RLSS For,_ bedrooms
Fluid depth in absorption field before test _-R-1 in. Water added 14 4 2 gal New depth in.4
Elapsed Time: 1711 min. Final fluid depth --ie— in.Absorption rate >= 56 O g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) I, / If yes, give date
�C01d&suo-ih�+ick Ind .rto,--4u,v_ 6,1 ?o+ etiuu�tk i -o
IivL I (< /a I-) - -
D. LIFT STATION N I A
Date installed Size in gallons _
"Pump on" level at in. "Pump off' level at
Datum
E. SEPARATION DISTANCES
Manhole/Access (Y/N) _
in. High water alarm level at
Cycles tested Meets alarm & circuit requirements?
WELL ON LOT TO:
Septic tankilift station on lot
Absorption field on lot
1-7)61
Public sewer main
1
Sewer /septic service line _
Animal containment areas
On adjacent lots iirn t
On adjacent lots
Public sewer manhole/cleanout
Holding tank /V.Z
Manurelanimal excrete storage areas _
SEPTIC/HOLDING TANK ON LOT TO: i
1 �
Building foundation} } > Property line Absorption field
Al L
Water main A Water service line �\ Surface water
Wells on adjacent lots �Jb1
ABSORPTION FIELD ON LOT TO:
Property line �;z () X- Building foundation_
Water Service line Surface water
Curtain drain a2\ Wells on adjacent lots 0_
F. COMMENTS
G. ENGINEER'S CERTIFICATION
/ certify that / have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Lv.&rV 4 !��%&ACPL
Date _�/ b T/ /
COSA brown sheet_10-10-12.doc
in.
Water main -AYA
Driveway, parking/vehicle storage __JQ 1
1 11=40'
s
93-164
RIVERVIEW ESTATES SUBDIVISION
LOT 10A, BLOCK 9
41,977 S.F.
RIVER PARK DR.
0
N 89058'50"E
1.37'
SEPTIC SYSTEM
t
Ilk
�R
'7.
GASTALDI LAND SURVEYING
JEFF A. GASTALDI, R.L.S.
4726 WEST 88TH AVENUE
ANCHORAGE, ALASKA 99502
PHONE 248-5454
I
GRID
W 357 I D12/10/2004 I
F.B. I JOB N0,
04-15 RVE10A9
iy
DOOr
WELL \
9P
Anp'\P��'
q
\�
F
I HEREBY CERTIFY THAT 1 HAVE SURVEYED THE
PROPERTY DEPICTED ABOVE 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 SUBDMSION PLAT.
UNDER NO CIRCUMSTANCES SHOULD ANY DATA
HEREON BE USED FOR CONSTRUCTION OR FOR
ESTABLISHING BOUNDARY OR FENCE LINES.
ANCHORAGE RECORDING DISTRICT, ALASKA
NOTE: NO CORNERS SET THIS DATE.
10' UTIL, ESMT.
BUILDING DETAIL
SCALE: 1 "=20'
P49TH *�0
i..., ................... r
Jeffery . Gw ldl
Air
LS -6091 i>°�
°a ......•' 1
�. prDfe55i0 f1O1 L0'
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
A a. www.ci.anchorage.ak.us
i
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. DSD— 792. —SI
;1
.r"�.
1. tGENERAL INFO14 ATION
6ompl4e`legaldescfip(ion k
t Location (site address or directions)
HAA # 05[641
Expiration Date: SS- % - O S-�
Current Property owner(s)---�y�dl
1.ress
Home
4 Day phone
Mailing add1100 0,1.1.ldrrn
Lr
rj5�:, t 1O0 Ame4* .de iEK 7Ts�
Lending agency 61V
C,
Day phone -5re,&/�
Mailing address �6�/�
Gtl •Td�or ,
Artaoro�G
Real Estate Agent �/S/
Q
Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
�3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site ' 9
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 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 iequired 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 of med 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. 1 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
UTMITM
Engineer's Printed Name
5. DSD SIGNATURE
_ z Approved for
Disapproved.
3 bedrooms.
Phone 272-9031c
Dah
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory
Well Flow Advisory
Supplemental Engineer's Report
Other
By: + �& Original Certificate Date:
(Rw. 01M)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 995196650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Olk 9 LD>t 10A Rl~UjELj Es jc-c Parcel ID: 0.5-0 - 79.2 -5I
A. WELL DATA
Well type4R—V-&01r-
Date completed 101177
Total depth -&2A.
If A, B, or C provide PWSID # _
Sanitary seal (Y/N) ytd,IJad
Cased to , y&_ft.
FROM WELL LOG
Date of test I/�7
Static water level A r- i'e a) a K ft.
Well production !W9 9—
P.m-
WATER SAMPLE RESULTS:
Coliform -4—colonies/100 ml. Nitrate L y_ mgA.
Arsenic: * Y-"- mg./l. Date of sample:4465-
B.
CtS
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material S > ee
Tank size Z&Q gal. Number of Compartments __L
Well Log (Y/N)
Wires property Protected (YM)
7F—
Casing height (above ground) 74 n.
AT INSPECTION
mf
� nt tio��er
3. B g.p.m. of houses w,
no Pwwp.
Foundatiorrcleanout (YM) -L O#pression over tank (Y/N)
Date of pumping /Vew TGn�' Pumper
C. ABSORPTION FIELD DATA
Date installed Soil ratin (g.p.dJftz r fte/bdrm) Lz.
Length(01_ft. Width S ft.
Total depth 1 7 ft. Eff. absorption area a21 be
Other bacteria oolonies/100 ml.
Collected by:
Date installedZ11Loy
Cleanouts (Y/N) Y
High water alarm (YM) I_
System type Wide aminl;e-IJ
Gravel below pipe /,S' ft.
Monitoring tube g7, Depression over field
Date of adequacy test LYS W Results (Pass/Fall) For _ bedrooms
Fluid depth in absorption field before test _ in. Water added_ gal. New depth_ in.
Elapsed Time: _ min. Final fluid depth _ in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) I, / I If yes, give date
D. LIFT STATION NSA
Date installed
"Pump on' level at _ in.
Datum
E. SEPARATION DISTANCES
Size in gallons
'Pump off" level at _ in.
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Manhole/Access (Y/N)
High water alarm level at
Meets alar & circuit requirements?
Septic tankltift station on lot /60 On adjacent lots /r70 'i'
Absorption field on lot /3.5 r On adjacent lots /00+
Public sewer main /✓/A Public sewer manhole/cleanout N / A
i
Sewer /septic service line 5� f Holding tank N,/R
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
r / i
Building foundation le Property line _[QQ Absorption field 17
in.
Water main N / A Water service line / O Surface water /UD rt
Wells on adjacent lots /50
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line Building foundation Water main
IV /A
Water Service line �, _ Surface water j�41,4 Driveway. parking/vehicle storage
Curtain drain 2 5 Wells on adjacent lots IL96
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and Id A
review of Municipal records that the above systems are in
(*cjz�-4 9conformance with MOA HAA guidelines in eflct on this date.
Engineer's Printed Name(�Lc�s . it'\r, -9999
Date..........
HAA Fee $ 6-4.SD I 1-45•ObUmfu
Date of Payment -i ICc 0 On
Receipt Number CP3,i101C
(Rev. 12101) iffl3L�
Waiver Fee $
Date of Payment
Receipt Number
1 "=40'
93-184
RIVERVIEW ESTATES SUBDIVISION
LOT 1OAdnBFOCK 9
S.RNER PARK DR.
0
n
N erx3o'c
Ir
� A
♦
■
■IIL \ .P \
�j
UTIL E3vT.
BUILDING DETAIL
SCALE. 1"-20'
AS—BU I LT
HEREBY CENILFY THAT 1 PAVE SURVEYED THE
PROPERTY DEPICTED ABOVE AND THAT NO
CASTALDI LAND SURVEYING
ENCROACHMENTS COST EXCEPT AS INDICATED.
JEFF A. r STALD4 R.L.S.
R IS THE RESPONSINILTY OF THE OWNER TO
472E WEST BBDO AVENUE
DETERMINE ME DOSTEHCE OF ANY EASEMENTS.
ANcHoRAOG ALASKA DY502
COVO4WTS OR RESTRICTIONS WHICH DO NOT
PHONE 248-8454
APPEAR ON THE RECORDED SUBDIVISION PIAT.
UNDER NO CIRCUMSTANCES SHOULD ANY DATA
GID
DATE
HEREON BE USED EOR CONSTRUCTION OR FOR
SDA 337
12/10/2004
ESTABLISHING BOUNDARY OR FENCE LINES.
ANCHORAGE RECORDING DISTRICT. ALASKA
F.B.
Joe NO.
04-15
RVEI0A9
NOTE: NO CORNERS BET THIS DATE.
••OF»AC #
49M q
m" A. 0-wr
._ Ls- l i
To: MOA Onsite Dept.
2/7/05
Re: "N/A" response on well wiring properly protected-- Health Authority Approval checklist.
This is an artesian well, which supplies the house under its own pressure. There are no wires
running to the well casing. (This well does not require a pump.) The well head is completely
sealed, also.
Thanks, _
Donald Dough y
Owner, Lot 110A, Block 9, iverview Estates