HomeMy WebLinkAboutKASILOF HILLS BLK 7 LT 13Onsite File 05"'P141075 'i's expired. On-site st-aff confirmed I"t was not constructed ot May 05 22 08:24p Anchorage Well & Pump Ser 9072430742 p.1 ,uoijul[sisui duind3o s.Cup 0£ u!gi!m ol!s-u0 o! 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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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By MUNICIPALITY OF ANCHORAG, refs Community Development Department• 0. 9;07'$'43-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program \ ON-SITE SEWER/WELL PERMIT APPLICATION Parceli.b 015-132-18 �I ri�perty owner(s) Mailing address _ US BANK Day phone ' wll Site address 10341 STROGANOF DR ANCHORAGE AK 99516 Legal description (Sub'd., Block & Lot) KASILOF HILLS B7 L13 Legal description (Township, Range & Section) Lot Size APPLICATION IS FOR: (0 all that apply) Absorption Field 0 Septic Tank TYPE OF DWELLING: Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Ft. Number of Bedrooms 4 APPLICATION IS AN: TYPE OF DWELLING: Initial ❑ Single Family (SF) El (w/wo ADU) Upgrade 0 Duplex (D) El EllMultiple Dwellings ❑ (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE ! WAIVER REQUEST FOR: NONE Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. 2 of property owner or authorized agent) Permit/Rush Fees: 60.43tfl q6Waiver Fees: Date of Payment: 05-M/ Date of Payment: Receipt Number: a (_/W3C7 Receipt Number: Permit No. a5p/t/16-4'e7 Waiver No. Permit App_9-1-12.doe SparM afld Enghmearong Environmental Consulting and Design WELL & SEPTIC SYSTEM DESIGN Municipality of Anchorage April 14th, 2014 Development Services Department On Site Water and Wastewater Program 4700 Elmore Road Anchorage, Alaska 99519 Subject: Septic System Installation Permit Kasilof Hills Blk 7 Lt 13 Ladies and Gentlemen: I am writing to request a septic system installation permit for the above referenced property. The proposed system will serve a 4 -bedroom single-family residence. Soil logs, design calculations, a site plan, design drawings and construction specifications are enclosed for your review. Design Calcs: Groundwater observed at a depth of 12 feet below ground surface (4/14/14). Soil Rating. From test hole #1 8/6/01 11 min/in. = 0.8 gal per sq.ft./day From test hole #2 10 min/in = 0.8 gal per sq.ft/day No. of Bedrooms 4 Required Area per Bedroom: 150/0.8 = 187.5 sq.ft. Total area required: 187.5 x 4 = 750 sq.ft. System: We are proposing a 500 gallon STEP tank installed after the existing 1250 gallon septic tank followed by 5' wide trench absorption field. The absorption field will be 80 feet long and 5 feet wide and contain 4.0 feet (800 sq.ft. effective) of sewer rock. Soils: Test holes were originally excavated on August 8, 2001 by Tobben Spurkland, PE. See MOA File. A groundwater monitor tube was installed on April 4th, 2013. Groundwater was observed at 12 feet below the ground surface after the 7 day ground water monitoring period. Ground water monitoring will continue through construction of the septic system. Surface Water: No surface waters were observed within one hundred feet of the proposed septic system upgrade. 203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland@gci net Environmental Consulting and Design Topography: The ground level slopes down towards the northwest at approximately 15 % at the location of the groundwater monitor and lessens to approximately 5-10% grade near the existing field Waivers: None requested The installation of this septic system will not prevent wells and septic systems from being installed on the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. If you have any questions or concerns, please contact me at 279-3916. Sincerely, Lay -� Lars Spurkland, P.E. Civil Engineer 203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland@gci.net \ / pRpSPECi1 HEIGHTS (3 LOT 8 I I \ BLOCK I I I — — — — —_ —_ — — — — — — — — —ILUDL &m— — — — — I — — — — — — — — — — — — — — — — — — — — — — — — — — — — — LOT 13 LOT 11 LOT 27 _ u VACANT ILOT / 4tl Ilk / for 11 I \ /y�' II L 7 7 '5 /BLOCK I I .���P��. • ��..1. THN #1 AND #2 PERFDRMED BY T17BBEN SPURKLAND, PE, 8/6/2801 =IN 49th .....:f..... ..................:..... ; NOT£• THIS IS NOT A SURVEYED PUT. WELL d SEPTIC LOCATIONS TAKEN FROM ON-SITE •.... .�( .�1..) .....................;.. • LA S SPURKLAND �. T ° WATER AND WASTE WATER DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE APPROXIMATE. No, CE- 1500 1�i1' '•~' ♦� .�••• \, \,SS 50 0 50 100 150 200 250 300 SCALE., I' = 100 FT. SPURKLAND ENGINEERING KASILOF HILLS B7 L13 SEPTIC SYSTEM DESIGN 203 W ISTN. AVENUE ANCH. AK. 99501 US BANK DATE•• APR 14, 2D14 (907) 279-3916 10341 STRDGANOF DR, ANCHORAGE AK 99516 SHEET 1/3 CRIB, SW 2541 PERMIT # DSP111OXX PID # 015-132-18 KASILOFHILLSB7L13.SCIODDVG ABANDON EXISTING SEPTIC SYSTEM PER MOA CODE REOUIREMENTS / #2 LOT 14 10' UTIL EASE INSTALL 4 -BEDROOM SEPTIC SYSi INSPECT EXISTING SEPTIC TANK INSTALL 500 GALLON STEP TANK TRENCH LENGTH 80 FEET LOT 13 4 BDRM TRENCH WIDTH 5 FEET SFR MAX EXCAVATION DEPTH 7 FEET ROCK DEPTH 4 FEET COVER 3 FEET (MIN.) Q� Ar -IR v? �Z K A S TH.T #1 AND #2 PERFORMED BY TUBBEN SPURKLAND, PE, 8/6/2001 NOTE.• SLOPES EXCEEDING 25X WERE NOT OBSERVED ����(� ..••.••.•�t►� WITHIN 50 FEET DOWN GRADIENT OF THE PR pmp ♦ �P,.••' ABSORPTION HELD LOCATION. � �.•'• �� NOTE.* THIS IS NOT A SURVEYED PUT. WELL & SEPTIC M......9th ' N#06 LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER �..... .. ....... ............•••••� DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE �... -i7 ..............:....� APPROXIMATE. f :: RS SPURKLAND ' f':, No. CE -11500 V 25 0 25 50 75 100 125 150' ; SCALE, I' = 50 FT SPURKLAND ENGINEERINGI I KASILOF HILLS BLIC 7 LT 13 I ( SEPTIC SYSTEM DESIGN 203 V 15TH. AVENUE ANCH. AK. 99501 US BANK DATE, APR 14 2014 (907) 279-3916 10341 STROGANOF DR ANCHORAGE AK 99516 SHEET.• 2/3 DRIB, 2541 PERMIT If USP1210XX PID # 015-132-18 KASILIIFHILLSB7L13.SC50.DVG Trench Elevation (TyP) Double Clean outs 4 ft of Septic Rock 500 GALLON STEP TANK 1250 GALLON SEPTIC TANK ISPURKLAND ENGINEERINGI I KASILOF HILLS BW7 LT 13 I ( SEPTIC SYSTEM DESIGN 203 V 15TH. AVENUE US BANK DATE, APRIL 14, 2014 ANCH AK. 99501 (907) 279-3916 10341 STRDCAN17F DR ANCHORA6E AK 99516 SHEET, 3/3 GRID, 2541 PERMIT # OSP131136 PID # 015130-18 KASILOFHILLSB7L13.B3.BVG Municipality of Anchorage Page 1 of 3 Department of Health and Human Services Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage. AK 995136650 wwivAtinchorage.ak.us (907)3437904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SWO10345 PID Number. 015-132-18 Nrns: Clare Doig Wastewater System: New Aabesa: 10341 Stro anof Drive Anch., AK 99516 ABSORPTION FIELD P�.a rAa m. 7) 6: 346-3395 Four Bea4 Deep Trench LEGAL DESCRIPTION �F.": T"DepetArm enpnelaaae: .8 Cp e 9 Ft. as We SuEe vim: 7 13 Kasilof Hills DepM b P" tams eom «5nM grrte: 2 Gw.er aevm eseaen p : Ft. 7 rt. Tom": RanOe: s.mon: F. aaeaa avow onp.W yaws: Grano U^9m: 2 Ft. 64 Ft. Well: New c.e.am: IA tw N : Dm ban.aan lrm 4 Fl. 1 - n WssAotm (Pnvtla A B. cy TaUI Depen: Cuae W Ta aoapa ama: Ftpe mi,4 y . Private 409 Ft. 37.6 n. 896 Fr ASTM D3034 PVC DN .. Data DMe: St"c wars twat: eWaMr: pay yt,y,W, M -W Drilling, Inc. 9/17/01 1 35 Fr. Glacier Excavating 9/21-2/01 Y.ee: 1.5 Gpu PUmpsetr: Ft. e.,n' Atw i~,g: 2 Ft TANK SEPARATION DISTANCES ® Septic ❑ Homing ❑ S.T.E.P. ❑ Other. To Septic Absorption Litt Holding to W: n Fran Tank Field Station Tank sewerune Anchorage Tank 1,250 wa 100' >100' N/A N/A >25' Steel Two (2) suracaivew >100' >100' N/A N/A LIFT STATION — NONE ON LOT Ltwe >5' >10' N/A N/A e. Gat Fpneetim >5' >10' N/A N/A °`� " in ti �. an onti None INoted I ttpacaan pWa by, Remarks: Test Hole No. 1 Deepened to 15' During BENCH MARK Construction to Verify Lack of Bedrock or Garage Slab soon: 115.3 rt. Engineers Stamp '....atq a EOF `• aJ �!k•• Inspections performed by: Mike Anderson Dates: 1't 8/22/01 0 -49th 2nd 8/22/01 Department of Heal and Human Services approval : j ANDERSON W m •, s+ No. ••04110` Reviewed and approved by: W' 0 &4 Date: 14. 30 a 1xw. 10,99)aaa1R,l7♦- E5.X��. Permit Number SWO10282 PID No. 017422-22 �,x Page 2 of 3 ` N � 31� ` `p, Op,, 6,0 Ow� „ Ml C4 o TH2 Alternate ` Site C3 I ® S2 I H1 . Sl I 1 00 I� �o I Fur I oroo Home I 1 r 3,•30• Op,Z 7490 c ' 66-96 KASILOF HILLS SUBDIVISION LOT 139 BLOCK 7. 53,747 S.F. PLAN AS -BUILT SCALE 1" = 40' I M 1 1O 1. C2 m 1� w II- I�n 1 I I I I I I I I 1 I I I ,I A 113 S1 2 59.3 S2 4 59.8C3 j30. 9 61.1C4 9 92.2M 1 8 92.8 �,x Page 2 of 3 ` N � 31� ` `p, Op,, 6,0 Ow� „ Ml C4 o TH2 Alternate ` Site C3 I ® S2 I H1 . Sl I 1 00 I� �o I Fur I oroo Home I 1 r 3,•30• Op,Z 7490 c ' 66-96 KASILOF HILLS SUBDIVISION LOT 139 BLOCK 7. 53,747 S.F. PLAN AS -BUILT SCALE 1" = 40' I M 1 1O 1. C2 m 1� w II- I�n 1 I I I I I I I I 1 I I I ,I Municipality of Anchorage Page 3 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number. SWO10269 NO PID No.: 015-164-17 r) _ U t v to PROFILE AS -BUILT Scab. I- _ 10' 0 MICHAEL E. ANDERSON 4, No. CE -4381 4 R8C8'Y8J T'N8 �8V.YG' ���7\�� Received ` '' ~ '- -� TOTAL P.01 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water& Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 Ti`�v ghZ[Dl � l,py a ONSITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Permit Number: SWO10345 Legal Description: KASILOF HILLS BLK 7 LT 13 Initial Date Issued: Aug 29, 2001 Expiration Date: Aug 29, 2002 Parcel ID: 015-132-18 Design Engineer: 0007 Tobben Spurkland, PE Site Address: 010341 STROGANOF DR Owner Name: Clare Doig Lot Size: 53747 SO. FT. Owner Address: 10341 Stroganof Dr. Total Bedrooms: 4 Permit Bedrooms: 4 Anchorage . AK 99511 - This permit is for the construction of: Disposal Field F✓ Septic Tank E] Holding Tank ❑ Privy Z✓ Private Well El 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 fora 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: Z f G 420 Date: �% Z 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-ek.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING l Parcel I.D. �s_ ��oa 8 Permit Number SW ()L� 3q_f Property owner(s) L LAQF. DOt --i Day phone 3Lj%- qc a Maili��ngaddress(1) 1044 i'�1 guC�ANoI= .51.maing address (2) /031 / f �� �^ - C flr � Zip Code 9 5//- Legal description (Lot, Block & Sub'd.) L -n T 13 by- -1 FLASI I -O E 14 ILL g Legal description (Section, Township & Range) Lot Size 3 7 L-/ % Acre q.Ft Number of Bedrooms q THIS APPLICATION IS FOR: ❑ Sewer Only ❑ _ Well Only ❑ Sewer and Well [ Water Storage Sewer Upgrade ❑ THIS PROPERTY CONTAINS: ❑ Hot Tub ❑ Jacuzzi 13 Swimming Pool ❑ Water Softening Unit Therapy Pool ❑ 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. (Signature of property owner or authorized agent) Lf �� Permit Fees: f� 00 Date of Payment:gnni 0 Receipt Number: t) ' (Rev. 12/00) Waiver Fees: _ Date of Payment: Receipt Number: T.S PITI ELATD P.E. 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 13 BLOCK 7 KASILOF HILLS S/D CLARE DOIG Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street Anchorage, Alaska 99519-6650 Aug. 16, 2001 We are submitting an application for the installation of a well and septic system for this lot. The submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the well and septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. The septic system design is based on the following: No Ground Water or Impervious Layer to 15 ft. Use Standard Trench Soil Rating. From Testholcs 08/06/01 11 min/in = 0.8 gal per sq.ft/day No. of Bedrooms 4 Required Area per Bedroom: 15010.8 = 187.5 sq.ft. Total area required: 187.5 x 4 = 750 sqft Testhole depth 15 feet Bottom Rock At 9 feet Top Rock At 2 feet Rock Depth 7 feet Minimum Trench Length 750 / 14 = 54 R. SYSTEM CONFIGURATION STANDARD TRENCH TOTAL LENGTH 60 FT TOTAL WIDTH 2 FT TOTAL DEPTH 9 FT ROCK DEPTH 7 FT COVER 3 FT SEPTIC ANK 1250 GAL The installation of this well and septic system will not prevent wells and septic systems from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. LOT 8 BLOCK 1 PROSPECT HEIGHTS p4 QVQ J / LOT 27 % p2 1 / [Dr 14 / b � 1 I 1 1 1 I I I •••....%VIV .......... •�.•P�E•............... 49th �.... ° ............ .......... ..'..... � 50 0 50 !m 150 AV ew � • � • ....:..... ........................... SCALES 1' = 100 FT. T HEN $FURKLAN3 '1 ,pp No. CE -2225 I TOBBEN SPURKLAND P.E. LOT 13, H 7 KASILOF HILLS SEPTIC SYSTEM DESIGN 203 W 157H. AVENUE CLARE DO/G DATE. AUG. 17, 2001 (NCH. AK. 99501 907 279-3916 10341 STROGANOF DRIVE SHEET.- 1/3 GRID: 2541 PERMIT p SW0100XXX PID p KAH0713LBVG STAACARD I_BEDR" SUM SWW 1250 CAL SDTC TANK STANDARD TRENCH 60 R LONG 0 R DEEP / R OF SIM ROCK J R COVFR /p y' / 10' MIN' \ `810000 `rJ h7 \ Jew L-5/ S i I' = 50 FT. ITOBBEN SPURKLAZN P.E. I I LOT 13, BK 7 KASILOF HILLS I I SEPTIC SYSTEM DESIGN I 203 W 15TH. AVENUE CLARE DOIG DATE} AUG. 17, 2001 ANCH. AK. 99501 10341 STROGANOF DRIVE SHEET. 2/3 GRID: 2551 /oral 97n_m1a PERMIT # SV010OXXX PID / YY KAH07132.DWG --().Odo 0 N 0 1250 gal Septic tank Z a W CV d 3 C Standard Trench, 2' V/de f 60' Long 9 *C' Beep 7.0' Sewer rock 4' Cover •• w" QF 4�♦.♦ • 49th*/>A. Nil SCALE silt 7.0 ft of Septic Rock Effective Mon/tor NO SCALE IBEN SPURKLAND No. CE -2225 1250 gal. septic tank a Si t2 TUBBEN SPURKLAND P.E. SEPTIC SYSTEM SCHEMATIC 203 w15th Ave LOT 13, BLOCK 7 KASILOF HILLS Anchorage Ak 99501 CLARE DO/G DATE, AUG. 17, 2001 Anchorage STROCAW DRNC SHEETi 313 GRID- 2541STROCA a� DRNE SHEETi 3/3 GRID- 2541 PERMIT I SWOl00XX PARCEL ID f XX KAH07133.DWG Municipality of Anchoragea (ENGINgER'S SEAL) 1 ..Ste �.... � " • "': (1, Development Services Department Building Safety Division r' -. • .....,,�.,.» 7. On -Site Water and Wastewater Program r' 4700 South Bragaw SL 1 .- P.O. Box 196650Anchorage, AK99519-6650;t T- \Sr°':'".t,r.d ;,! .op wwwclanchoraoe.ak.us �,� C_2223 =?i. (907) 343.7904•,"•,� '" Soils Lon - Percolation Test Performed For: C14 VAi.Vf i a1 DatePerfc Legal Description: L -04f 13 3V V -Z Sa t a. ( W14, Township, Range, Section: Depth 2- a- 3- - 5- Date ENCOUNTERED] 6- 6-7-10- Depth to Water 5 7- L 0 Depth to Water After �1J P Monitoring? IE Date: r 10-, 11- � 11;05 12- 5 7/4 E� 13- 11:3 14. i Y2- 15- 16. 18- 18- 19- 19- COMMENTS COMMENTS WAS GROUND WATER Date ENCOUNTERED] O Depth to Water 5 IF YES. AT WHAT DEPTH? L 0 Depth to Water After �1J P Monitoring? IE Date: alto ed: is Reading PERCOLATION Date Grass Time Net Time Depth to Water Net Drop oA- K Z 11;05 3D 5 7/4 E� a 11:3 3 v i Y2- PERCOLATION RATE I V lnwte~) rtrct, nur.c Ww",ctcn p TEST RUN BETWEEN _FT AND L/ FT PERFORMED BY: ! S I I. 5 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 15-M-01 Municipality of Anchorage e;':,-(ENGINEER_SBEAL) ,e Development Services Department ' Building Safety Division r „• �`r��';;,', ,,,,,••,• • , �� On -Site Water and Wastewater Program r •• •- •••••• .' 4700 South Bragaw SL S •• v `� P.O. Box 196650 Anchorage, AK 99519.6650 ,SL,,, , �,t,,rd •; ' - _� www cianchorage ak us C`- :5 "',.• (907)3417904 ',� •-. �. Soils Log Percolation Test : 'r ^" Performed For: C �Ai t� �O 1 S r ' 1 Date Performed: Legal Description: Lzt- -A3 bk IV V .S.Z�4 Township, Range, Section: Tx-' 0 '�-U/4 N IC1 1311 ~fir C!<Ns✓- r-_ 14- '%O bc{Oj� {<io LIQ 1 s- 1 s- 17- 18- 19 - COMMENTS WAS GROUND WATER Nu Gross Time ENCOUNTERED? Depth to Water 5 IF YES. AT WHAT DEPTH? SAF L O Depth to Water After Monitoring?[q_� J P E Date: �(�(a(r1 & • Site Plan Reading Date Gross Time Net Time Depth to Water Net Drop Fl t—� SAF A K q'Id & • 10,:'30 e/ 11:� 30 �' 3 11:30 30 6 a/z o2 :31q 1$.%V-0 30 &I/z- 0231 PERCOLATION RATE I (0 e~) rem, nULc �iro.c cn rie TEST RUN BETWEEN__FT AND__ t�_FT PERFORMED BY: 1 I ' , CERTIFY THAT THIS TETE TSr WIS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: b- 1101 C) (3) � C) NT� coco o o CD N X W o c ca LL ♦ nO V L Na I.L. E O 'a O a a H as O c0 u, U N CL 0 C d O 3 tmC d �a O '0 O TO i C. 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Q L O cn C W N O W W I— > LL � cv m >- z a O o u Q W LL O LL O F- a °' Z3 Q) a� H Urel a• cn a a N O (1)a Z n. (1) U) L :t:! Q O i— H Q CO > Q c� co N M d Ln co W m 0 U N LL N m G m C6 a O WN 0 U Q O U COSA Checklist.docx COSA Checklist Legal Description: KASILOF HILLS BLOCK 7, LOT 13 Parcel ID: 015-132-18 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 9/17/2001 Total depth 409 ft Cased to 37.5 ft (INTO BEDROCK) Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 4/17/2024 Static water level at beginning of test 46 ft. Well production at time of test 1.6 gpm Water storage tank volume NONE 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 4/17/2024 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank 49” Date of pumping 4/17/2024 Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 8/22/2001 ALL standpipes present per record drawing Total measured depth from existing grade 8.5 ft (max) Measured depth to pipe invert from grade 2.3 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) If not, state depth into effective 6.3’ 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) N If yes, enter date Adequacy test date 4/17/2024 Results Pass Fluid depth prior to test 57* in (Including missing 8” ED)* Water added 700 gal New fluid depth 72* in Elapsed time 1440 min Final fluid depth 54* in Absorption rate 600 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 84 in (MOA 7’ ED) Effective depth used 54 in (Final Fluid Depth + Missing) Effective depth (ED) remaining 30 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots & appears approximate with 6.3’ ED of the MOA 7’ ED – missing 0.7’ or 8” ED. The minimum depth is at the lowest end of the septic field with most of the field with 3’+ of cover & no known freezing issues per owner. 1-3 person use the last few years. COSA Checklist.docx 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 if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ 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 Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS 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 FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 5/15/2024 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO 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 First Water Consulting & 5/15/24 Carla & Chris Scott W COSA - Kasilof Hills 137, L13 - 10341 Stroganoff Dr To: First Water Consulting aSir! Found an Address Brent, Here is the seller's statement: "We have not had any problems with the Septic tanks . At times we have had 4 grandkids and their parent and never had an issue with Septic Tank. Forooz Sakata Also we have never had frozen water. Water pressure was low and Frank was not in town . When he came back , he said all they had to do was to change the filter because you had water . Never frozen water that I know about. Forooz Sakata" 2 9:22 .1 IF C. Forooz We have not had any problems with the Septic tanks . At times we have had 4 grandkids and their parent and never had an issue with Septic Tank . Forooz Sakata Also we have never had frozen water . Water pressure was low and Frank was not in town . When he came back , he said all they had to do was to change the filter because you had water. Never frozen water that I know about. Forooz Sakata Carla Scott, REALTOR® Chris Scott, REALTOR®, Associate Broker, CRS Jack White Real Estate 3801 Centerpoint Drive, Suite 200 Anchorage, AK 99503 Cell: 907-830-5354 907-244-7622 ■4 O Q Q Q N E 4. N V) rn v 4-J+ rn cB n 1� t O N q* It Q 0 M M i L O 0 f0 O _ O 0 1i O 4Q) f9 W U fit (D co U Q N N N N U O m O U �N d1 � CU t 4-J N N O Q O LL N L `� Q N L Q 4J O S 0 0 � g"i p U m T �_ O p —r-Im cu L U O ON NCL O 40 Q- N � O 4 r Q ~p Q ^ L -a Z p O G� N v CL A i 41 V u2 N m o o N N U N Q fn ZLn = N -Se 3 _ +Jco cu Ln WG Vv N O O c N +_ C 1 N m 4- Y ;-, Q 4A =3 W0 0 Y O co Qi Ln a Z '" °�w O *' O O LU 41 C 41 O U a + N � _N i a m(n w N 3 v M + Ln 3 0 0 0 u V) 0 O Q Q Q N E 4. N V) Parcel I.D. 015-132-18 n„ Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 �+x Certificate of On -Site Systems Approval Expiration Date: P - 3 ® - / `;` 1. GENERAL INFORMATION Complete legal description Kasllof HMIs, Block 7, Lot 13 Location (site address) 10341 Stroganof Drive Anchorage, AK 99516 Current Property owner(s) HarboryieW Trust Fund Day phone Mailing address 100 National Way Simi Valley, CA 93065 Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Four 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual FX -1 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: J Received by:f'--- ( '. Date. ". COSA to be release(to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number COSA # 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. Name of Firm Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE V System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: 6 - 3 ® - % Thenicip a An o e 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 blue sheet f ], c 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: Kasilof Hills, Block 7, Lot 13 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 9/17/01 Sanitary seal (Y/N) Y Total depth 409 ft. Cased to 37.5 ft. FROM WELL LOG Date of test 9/17/01 Static water level 35.3 Well production 1.5 WATER SAMPLE RESULTS: [in g.p.m. Coliform 0 colonies/100 mL Nitrate 1.79 mg/L Arsenic N/D ug/L Date of sample: 6/12/14 Parcel ID: 015-132-18 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) >18 in. AT INSPECTION 6/4/14 46.3 ft 3.1 g.p.m. Collected by: Anderson Engrg. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 8/22/01 Tank size 1,250 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Date of pumping 6/26/2014 Pumper Around the Clock Pumping C. ABSORPTION FIELD DATA N Date installed 8/22/01 Soil rating (g.p.d./ft2 or ftz/bdrm) •8 GPD/SF System type Deep Trench Length 64 ft. Width 4 ft. Gravel below pipe 7.0 ft. Total depth 10 ft. Eff. absorption area 896 f 2 Monitoring tube Y Depression over field N Date of adequacy test 6/4114 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 60 in. Water added 1250 gal. New depth 72 in. Elapsed Time: 1,440 min. Final fluid depth 68* in. Absorption rate >= 600 g p d Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off' level at Datum Cycles tested _ E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot > 100' Absorption field on lot >100' Public sewer main N/A Sewer /septic service line >25' Animal containment areas >50' SEPTIC/HOLDING TANK ON LOT TO: >5' Building foundation Property line >5 Water main > 10' Water service line >10' Manhole/Access (Y/N) in. High water alarm level Meets alarm & circuit requirements? On adjacent lots > 100' On adjacent lots >100' Public sewer manhole/cleanout N/A Holding tank N/A Manurelanimal excrete storage areas >100' Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line >10, Building foundation >10' Water Service line >10' Surface water >100' Curtain drain None Noted Wells on adjacent lots >100' Absorption Feld >51 Surface water >100' Water main N/A Driveway, parking/vehicle storage > 10' F. COMMENTS Active layer of absorption trench is currently between 70" and 84" above the bottom. "Water was cycled into trench over a 24 hour period. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. Date 6/30/14 COSA broom sheet_10-10-12.doc MEMORANDUM DATE: June 30, 2014 TO: Jeff Poet FROM: Mike Anderson, P.E. SUBJECT: Kasilof Hills, Block 7, Lot 13 Certificate of On Site System Approval The subject property is a foreclosure and the proposed buyer is responsible for all fees involved with the certification of the well and septic system. He has basically purchased the property as is and will be living in the house. He understands that any sale of the house in the future will require a new COSA and a recertification of the septic system. We recently completed two adequacy tests on the septic system as the previous adequacy test apparently had failed. Our test was concentrated in the working level of the trench. Water was found in the trench at 60". The total effective depth is 84". Our first test indicated the working area of the trench was between 70" and 84" above the bottom indicating the trench is nearly 85% failed. The new buyer has been made aware of the status of the trench and has been warned that it is nearing the end of its useful life. We injected water into the trench to the level of 72". We then monitored the drop to 70" and then added water to raise the level to 72" again. This cycle was repeated three times. The final injection brought the level to 76" and a final reading was made after 24 hours had passed from the initial reading of 72". The absorption trench absorbed more than 600 gallons during the 24 hours and is therefore eligible for certification. A copy of the field notes is attached for your review. Yi 'T 0 J 2 Q O U O Q 0 LU Y O w a 0 E m IL 0 I �1 El Cd (0 W Y 01 W m W CO LO N L J W N 0 �V O OU c p fn F m Q M2 . (n z W Q Q O O z O 0 d. U O Cl. Yi 'T 0 J 2 Q O U O Q 0 LU Y O w a 0 E m IL 0 I �1 El Q W u Z Z Z W Y Ul W m W C7 LO N J W N 0 �V O OU c p fn F m Q M2 . (n z W Q Q O J W z O 0 U Q W u Z Z Z W Ul ■❑ ❑ N N 0 (7 C7 C7 O ON ❑ U O Cl. O N Cl. 0 U 0 N L � U f6 N E U a N a N U a N TOW - O W d 11 Q y 7i C L � (n T Q1 U O N - U Q Q I Q N 0000 O O O cp N w N d U N 0 N LO LO CO (O � I� 0 CO 0 0 r -- M M M M M u m M V L 'S F > U .J J N r c N L N C Q U C U i0L7 0 J J 'C U t Q U c U) a 7 j V 0 0 0 N O N O N 0 (O N J J . N t i Q 1 � v (n N C LO LO JO- J '- F L (n L N N N J C O U> s co T 0 U) O ((00 O (r0 O W 0 N 00 L o m > a v (O m N N 0 0 0 0 0 0 0 0 0 0 0 N � CN. NLO C.N. .- V (O 47 N E O N t LO M W 0 O N Q W u Z Z Z ■❑ ❑ ON ❑ Cl. Cl. 0 U N L � f6 E U N U TOW - N n' a Q d 11 Of y 7i C L � (n T U O N - U N 7j d N y m cp N w N d U N 0 ro 3 E FO u u L Q W u 717 • Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval Parcel I. D. 015-132-18 1. GENERAL INFORMATION Expiration Date: W bu a U J Complete legal description KASILOF HILLS BLOCK 7 LOT 13 Location (site address) 10341 STROGANOF DR., ANCHORAGE, AK 99516 Current Property owner(s) US BANK NATIONAL ASSOC. Mailing address Real Estate Agent MARY STEPHENS 2. TYPE OF DWELLING: ❑x Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone Day phone 273-7706 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 ❑ Waiver/Variance request for: NONE Distance: Received by t' Date , COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment Receipt Number "57 a COSA# awqao Waiver Fee $ Date of Payment Receipt Number Waiver # 4 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. Name of Firm SPURKLAND ENGINEERING Address 203 W. 15TH AVE.,STE.202A, ANCHORAGE, AK 99501 Engineer's Printed Name LARS SPURKLAND 6. DSD SIGNATURE System #1 Approved for System #2 Approved for _ Disapproved Conditional approval for H M The Municipality of bedrooms 'ro h L bedrooms Phone 279-3916 Date 4/17/2014 bedrooms, with the following stipulations: Original Certificate `C_ 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA bluesheet r a If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: KASILOF HILLS BLOCK 7 LOT 13 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID #- Date completed 9/17/2001 Sanitary seal (Y/N) Y Total depth 409 ft. Cased to 37'5 ft. FROM WELL LOG Date of test 9/17/2001 Static water level 35.3 ft Well production 1.5 9 - p.m -WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 2'35 mg/L Arsenic ND ug/L Date of sample: 4/14/14 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1250 gal. Number of Compartments Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping Pumper Parcel ID: 015-132-18 Well Log (YIN) Y Wires properly protected (Y/N) Y Casing height (above ground) 34 in. AT INSPECTION ft. g. p. m. Collected by: ANSON MOXNESS Date installed 8/22/2001 Cleanouts(Y/N) Y High water alarm (YIN) N C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2 or ft2/bdrm) System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. absorption area f:2 Monitoring tube Depression over field _ Date of adequacy test Results (Pass/Fail) 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) If yes, give date D. LIFT STATION Date installed _ "Pump on" level at Datum Size in gallons Manhole/Access(Y/N) in. "Pump off' level at in. High water alarm level at E. SEPARATION DISTANCES WELL ON LOT TO: Cycles tested Septic tank/lift station on lot100+ Absorption field on lot 100'+ Public sewer main NA Sewer /septic service line 25'+ Animal containment areas 50'+ Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100+ Public sewer manhole/cleanout NA Holding tank NA Manure/animal excrete storage areas 1004 SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main NA Water service line 1 �+ Wells on adjacent lots100+ ABSORPTION FIELD ON LOT TO: Property line Water Service line Curtain drain Absorption field 54 Surfacewater 100'+(N.O.) Building foundation Water main Surface water Wells on adjacent lots Driveway, parking/vehicle storage F. COMMENTS CASING INTO BEDROCK. WATER SHUT OFF, WELL FLOW TO BE TESTED PRIOR TO ISSUANCE OF COSA. TANK MUST ALSO BE PUMPED PRIOR TO ISSUANCE OF COSA. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name LARS SPURKLAND Date 4/17/14 COSA brown sheet 10-10-12.doc in. Municipality of Anchorage ,•r•. _r 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.cl.anchorage.ek.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. at5-13z- 1$ HAA # 050x3 o`Z Expiration Date: — t!n r 05- 1. Jr 1. GENERAL INFORMATION 13 -4 Complete legal description Lof/r BI«.Ic _g knsil,E hills Location (site address or directions) lo3yl Slroo ,,,j Drive. Current Property owner(s) Day phone 3If,- 33`f5 Mailing address Lending agency Day phone Mailing address Real Estate Agent &Aj Sfc✓c Day phone 933-410(D Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well © Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of 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 newowater 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 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 -9 k lMna £r, ; er Phone 9411-3111(a 4$ Address 203 W. 15 Avc. Sm;Vr_ 203. Ancl er� t AK q`ISc>I Engineer's Printed Name Date -5LG Loo S .�C77y• .'�s d F 5. DSD SIGNATURE ✓ Approved for L bedrooms. fopp��`�' Disapproved. / Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date: l!1 ' G ' os (Rev. 0M) Municipality of Anchorage • 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: Loi 13 Block _� kxs;1,4 E I -i Parcel ID: D / 5- / 32 - / a A. WELL DATA Well typeriun}e, If A, B, or C provide PWSID #= Well Log (YIN) y Date completed 9li Z001 Sanitary seal (YIN) y Wires properly protected (YIN) y Total depth ift_ft- Cased to 31.5 ft. Casing height (above ground) 34 in. SED Roue FROM WELL LOG AT INSPECTION Date of test Q l;Zoo 5 Zy ZocS Static water level 35.3 ft q� ft Well production 115 g.p.m. �• g.p.m. WATER SAMPLE RESULTS: Coliform !� colonies/100 ml. Nitrate 0.40 mg.A. Other bacteria '" colonies/100 ml. Arsenic: FO A. Date of sample: L/2y oS Collected by: Lar 5 B. SEPTIC/HOLDING TANK DATA Tank Type/Material A c Ta Slee Date installed S 2 200 Tank size )250 gal. Number of Compartments Cleanouts (YIN) y Foundation cleanout (YIN) Y Depression over tank (YIN) IV High water alarm (YIN) -- No Date of pumping 05 Pumper R441i Puh+DinJ C. ABSORPTION FIELD DATA Date installed Z Zoo Soil rating (g.p.d.Ift2 or ft2lbdrm) O, System type P&D T a Length (01 ft. Width 9 ft. Gravel below pipe ft. Total depth 13 ft. Eff. absorption area M ft2 Monitoring tube i Depression over field N Date of adequacy test Zy Zoo Results (Pass/Fail) _&ZL_ For '!�_ bedrooms Fluid depth in absorption field before test 78 in. Water added 620 gal. New depth in. Elapsed Time: tow min. Final fluid depth 71 in. Absorption rate >= &OD g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) Novi Uown If yes, give date — D. LIFT STATION Date installed "Pump on" level a in. Datum E. SEPARATION DISTANCES Size in gallons Manhole/Access (Y/N) 'Pump off level at in. High water alarm I at in. Cycles to d Meets ala 8�equirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot '71001 Absorption field on lot i100r Public sewer main NSA Sewer /septic service line 750' i On adjacent lots i 100 On adjacent lots } too r Public sewer manhole/cleanout N7 A Holding tank _ A/ /A ' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ),to, Property line 710' Absorption field 5 r Water main N A Water service line ',P501 Surface water /�/• O. Wells on adjacent lots ? l00 r SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ? 10' Building foundation 710' Water main NIA Water Service line ?$O r Surface water N 0 • Driveway. parking/vehicle storage ZS r Curtain drain Na,e.. Wells on adjacent lots i 100 r F. COMMENTS r G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. TolErr� Engineer's Printed Name -roue,-, Spun rwf7 Date 5�ZG/2oo5 r Altt�FEEt1� HAA Fee S 3c) Date of Payment I .LP a fp�5 Receipt Number (Rev. 12101) Waiver Fee 5 Date of Payment Receipt Number Municipality of Anchorage • '` Development Services Department ' Building Safety Division ` s• a.. On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Septic System Advisory Health Authority Approval # 050232 During a recent adequacy test on the septic system for Block 7, Lot 13 of Kasilof Hills subdivision, 78 inches of standing water was observed in the absorption field. This indicates that approximately 93% of the absorption area is inundated. Although this system passed the adequacy test, the remaining life expectancy may be limited. This advisory must be attached to all copies of the subject Health Authority Approval. x m m Cy ow° i 8 Nale�O• It3f \ Op�� p� Ocv 7,0- c' �pF a D 1 �'• . ,� co � r r0 0_;� a ♦' Z Okol ♦•♦ItisIriV•S,** 0 �S to x m m Cy ow° i 8 Nale�O• It3f \ Op�� p� Ocv 7,0- c' �pF a D r0 O n Z 0 �S to M ,4 w -cn r— '' O C 0o En Z -MCA— Municipality of Anchorage *A. Development Services Department Building Safety Division Onsite Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING p Parcel I.D. 015-132.18 HAA Expiration Date: %- 3 D - O 1. GENERAL INFORMATION Complete legal description Lot 13, Block 7. Kasilof Hills Subdivision Location (site address or directions) 10341 Stroganof Drive Current Property owner(s) _Clare Doig Day phone 346-3395 Mailing address 10341 Stroganof Drive Anchorage, AK 99516 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Four 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 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 less than 30 days old. (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 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 Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 5. DSD SIGNATURE Approved for Disapproved. _1:1L bedrooms. Conditional approval for bedrooms, with the following stipulations: �' ON-SITE WATERAND •; Additional Comments 3�MCTC 4TCD Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other PROGRAM By; _��„� �C�, / -��.(/ Original Certificate Date:155�1 i/ (ae.. +wo) Municipality of Anchorage Development Services Department Building Safety Division OnSle Water 8 Wastewater Program : 4710 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchaage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 13, Block 7 Kasilof Hills Subdivision Parcel ID: 015132.18 A. WELL DATA Web type Plivift N A. B. or C provide PWSID # _ Well Log (YM) Y Date completed 1IM711M Sanitary seal (YM) Y Wires properly protected (Y/N) Y Total depth 409 ft. Cased to 37.6 ft. Casing height (above ground) X24 in. FROM WELL LOG AT INSPECTION Date of test 9fl712001 Static water level 35 Wal Production 1.5 g.p.m. 9 - P.M -WATER SAMPLE RESULTS: Cdlfmm -1-colonies/100 mi. Nitrate 1.28 m9A. Other bacteria 3 colonkW110 ml. Date of sample: 2RU2002 Collected by: MEA B. SEPTICIHOLDING TANK DATA Tank Type/Material SeWdSteel Date installed ti122I21M Tank size 1150 gal. Number of Compartments 2 Cleanouts (YM) Y Foundation deanout (YM) Y Depression over tank (Y/N) N High water alarm (YM) N Date of pumping Pumper New Con trucilon C. ABSORPTION FIELD DATA Data installed BI21J2001 Soo rating (g.p.dJW or ft'/bdnn) .8 GPDISF System type Deep Trench Length 64 ft. Wk7th 4 ft. Gravel below pipe 7 ft. Total depth 11 ft. Eft. absorption area 896 ftr Monitoring tube Y Depression over field N_ Date of adequacy test Results (Pass/Fal) For _ bedrooms Fluid depth in absorption field before test _ in. Water added_ gal. New depth_ in. Elapsed Time: _ min. Final fluid depth _, in. Abs0rpfi0n rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Acoess (,/N) 'Pump on' level at _ in. 'Pump off" level at _ in. High water alarm level at in. Datum Cycles tested Meets alarm b circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankilift station on lot >100' On adjacent lots a1110 Absorption field on krt >100' On adjacent lots >IW Public sewer main WA Public sewer manhole/cleanout WA Sewer /septic service line AT Holding tank WA SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation >S Property line >T Absorption field >S Water main WA Water service line >10' Surface water MW Wefts on adjacent lots 2100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Mir Building foundation >10' Water main >10 Water Service line >10 Surface water >100 Driveway, park;rgh ehide storage >25' Curtain drain None Noted Wefts on adjacent lots >1W F. COMMENTS G. ENGINEER'S CERTIFICATION I cenTy that I have determined through field inspections and review of Municipal records that the above systems are in49t n twnlurmance with MOA MAA guidelkws in effect on this date. o Engineer's Printed Name Michael E Anderson RE%g`k 1CHAEL E. ce�$P sNO 4301 Date/122/2002 ••ei�; _:�',�► HAA Fee $ A1e:� Oo Date of Payment (417,Z /p z Receipt Number (Rev. 12000) Waiver Fee $ Date of Payment Receipt Number