HomeMy WebLinkAboutDENALY BLK 1 LT 7benaly
Block 1
Lot 7
#050-731-54
- \ Municipality of Anchorage
• �.. Development Services Department •= =";.
Building Safety Division _ -
Onsite Water 3 Wastewater Program, 4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6850
www.d.anchorage.ak.us (907) 343-7904 Page 1 of 3
Onsite Wastewater Disposal System and/or Well Inspection Report
Permit Number. SWO10223 PID Number. 050-731-54
Noma:
CARL KAPPEN
Wastewater System: ■ New ❑ Upgrade
Address:
P.O. BOX 770489 a EAGLE RIVER, AK 99577
ABSORPTION FIELD
Phone No. of Bedrooms:
(907) 622-2719 4
O Deep Trench ■ Shallow Trench O Bad O Mound OOther
LEGAL DESCRIPTION
=a "'" ° 1.2
T� °'°"'° °"° 4.2-5.0
ao/so.
R R
Lot: Block: Subdivision:
7 1 DENALY
Depth to pipe seem sem artpwd grout
po.d depth benedh pips
1.11-1.91
R 3.09 rL
Township: — Range: Section:
N added dare eApnd prod:
Glom ssrrstto
— —
1.0-1.5
R 60 R
WELL: ■ New ❑ Upgrade
Cawed wwm;
5
Hueter of a�
1
ohtorrtw beleewr Beet
—
R
R
ckownooawr Prho* "C .
Towl Depth:
coed T«
Told obeerpwa ares
Pepe maarwb
PRIVATE
301 R
300.51 R
517 so.
R D 3034/ F-810
DrWr.
M—W DRILLING, INC.
Dao aewa:
7/24/2001
staao water Leek
4+/—
bw,*.
JONES EXCAVATING
ode beta*.*
7/10-19/01
R
6+/—
"set� � �
U.K. 2+
TANK
DPu
R R
SEPARATION
DISTANCES
■Septic 0Holding 0S.T.EP. 0Other
To
From
Septic
Tank
Absorplion
field
Lift
Station
Holding
Tank
btk/Prkvu
sewer Lira
tuueAadrren
ANCHORAGE TANK
Cpoctty In eo K
1250
Well
too'+
too'+
-
-
25'+
"w`"wk STEEL
kreb., of a"r`t*..t 2
Surface Water
100'+
too'+
—
—
—
LIFT STATION
Lot Line
5'+
10'+
—
—
—
sae H ewe
uwwrrocbe.r�
Foundation
50+
10'+
—
—
—
ew
Wed at:
rnp a:
Wph ewter Berm oh
Curtain Drain
NONE
KNOW
° '
b"p-`w'w "d""rAd W.
Remarks:
BENCH MARK
taaotbn .w Drerptwt
TOP OF CMU FOUNDATION o POINT "C"
A,t.,re "'t"` 102.70 R
!000!2"
o�
o �
Inspections performed by: AWWC, INC. Dates: 1st 7/10/01
p ... . . ..........
2nd 7/19/01
3rd 8/07/01
��p�.
Department of Health and uman Servi s roval
' G 7 ' F'
�4004dProrsselo�o��
Reviewedand approved by =ate: f - ? 01
n
�4000��
PmmrrNUMBER: AS -BUILT DRAWING PARCEL D NUMBER:
SWO 050-
SW010223 050-731-54
N
DRAINRELD
i
NEW 1250 GALLON
SEPTIC TANK
.,,.:..� w NATE srtE
100' WEII RADIUS
NEW
WELL
\f
10,�
\ DATE:
8/9/2001 _e(( O D
•-'._-_. _.__•--_-�-- := -_r=ter �-._.,. _. .. _ _ .._._ .. _.........
ALASKA WATER $ WASTEWATER C.J.G.
CONSULTAN.
S, INC. 1" = 40�
LE -
6901 0E&A ROAD. SUITE 29 • ANCHORAGE AS 99504 • P40NE 901),131-0179 • FAX 901),336-0246
PREPARED FOR: PHONE NUMBER: PACE NUMBER:
CARL KAPPEN (907) 622-2719 2 OF 3
LEGAL OESCRIPTION:
LOT 7, BLOCK 1, DENALY SUBDIVISION
TYPE OF WORK:
AS—BUILT DRAWING OF WELL LOCATION, AND SEPTIC SYSTEM
•
POMrrNUMBER: AS-BUILT DRAWING PARCEL NUMBER:
SWO
SW010223 050-731-54
TOP OF TANK Al
INLET - 100.54
INVERT OF BUNG -
AT INLET - 99.97
ORIGINAL CRADE
- 98.44-99.24
FINAL GRADE
103.70-103.99
NEW 1250 GALLON
SEPTIC TANK
TANK AT
- 100.53
\\\ (PER EXCAVATOR)
`INVERT OF BUNG AT
OUTLET - 99.73
FINAL GRADE -
f 00.07-10031
FABRIC
31T OF PIPE
97.33
�5'--I `BOTTOM of
TRENCH - 9434
ALASKA WATER & M'ASTEN'AT ER =GALE C.J.G.
CONSULTANTS, INC. N.T.S.
6901 OEBARR ROAD SUTE N • ANCHORAGE. AK 99504 • M40W 7)337-0179 • FA11 90 36-3266
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
CARL KAPPEN (907) 622-2719 3 OF 3
.EGAL DESCRIPTION:
LOT 7, BLOCK 1, DENALY SUBDIVISION
TYPE OF WORK:
PROFILE AS -BUILT DRAWING OF SEPTIC SYSTEM
7953
FROM :KAPPEN FOMES FAX NO. :907-622-5586 Aug. 22 2001 02:04PM P1
97/45/2D01 18:15 9453287_ M 41 DRILLING, J►rPAGE 01
Job No.: 01.173
PWMft NO„ Bw0l0227
ProjwtNo: N/A
M -w Drilling, Inc.
.P.0.8ox 110378.Afthw4 t, AK 99311.
0907-345-4000 • 907-345-3287 Fax*
♦ WtQ Owxa:
♦J,TUDmcr�.
Qnstrocooll
4WeOfWd: Domadc
•NdeDgd: 301' ♦CwftSSttr. 6- ♦Cad Ta 300.S1' 01 &WftL• A33S1ee1
•"moded. Au Rorary _
♦WONCeww"wo. Opmmd X &stew p owsmi X MAS04. Airvafowted
• 6e+wwrJkrJonNow Iacryvtlow: Perforations- 3 rows.) '%" x 3/1" slot petforxtlom 6 per
footpa row: 193' —196'
*Crorr es
Nee: (15)Smckc Ne_■'- -- t..e..,...I—
♦WeDDrvclvpmmt: NNedod: Aireuryc Nora:
#Shc* wwm kwl (SWZ) 4'+ (wborr) (mow) ar oirc;sirl f m -x
•wtpyldflrarn 0+Rwjbwper(UPAQIgWkwVw*mgG +)JLv 24 Amm
Wkh eJ/row+oww (DD)Jrmm snL* lest (SWL).
oUcOod. Alr tlR
• Dwre #f WXr# 16w: 24 July 2001 ♦ Pww fxt".
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 6 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ONSITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Permit Number: SWO10223
Legal Description: DENALY BLK 1 LT 7
Design Engineer: 0041 AK Water & Wastewater Consultan-
Owner Name: Carl Kappen
Owner Address: PO Box 770489
Eagle River , AK 99577-
Date Issued: Jul 05, 2001
Expiration Date: Jul 05, 2002
ParcelID: 050-731-54
Site Address: 025605 DENAINA DR
Lot Size: 40425 SO. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
❑✓ Disposal Field Q✓ Septic Tank ❑ Holding Tank ❑ Privy Q✓ 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 By:
Issued By:
Date: -�2
4!J /' Date:
Municipality of Anchorage
Development Services Department;!„
Building Safety Division'
On -Site Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519.6650
www.d.anchorage.sk.us
(907)343.7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. hS-b — 73 I— SK Permit Number S'W O /O 2.3
Property owner(s) CARL KAPPEN Day phone 622-2719
Mailing address (1) P.O. BOX 770489 EAGLE RIVER, AK
Mailing address (2) Zip Code 99577
Legal description (Lot, Block & Sub'd.) LOT 7. BLOCK 1: DENALY SUBDIVISION
Legal description (Section, Township & Range) _t:(/A
Lot Size yd q2"g— Acres/Sq.Ft. Number of Bedrooms 4
THIS APPLICATION IS FOR:
Sewer Only ❑ Well Only ❑
Sewer and Well N 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 Dwelling and is in accordance with applicable Municipal codes.
ALASKA WATER do WASTEWATER CONSULTANTS. INC.
{Signatorrope� agent)
PennitFees: Isgun .Od
Date of Payment: 01� lD I
Receipt Number. is 6 S ti
Waiver Fees -
Date of Payment:
Receipt Number.
ALASKA WATER l& WASTEWATER
CONSULTANTS, INC.
June 28, 2001
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, Ak 99519-6650
Ref: Proposed Well and Septic System Design for Lot 7, Block 1, Denaly Subdivision
To whom it may concern:
The proposed 4 bedroom house will be served by a private well and septic system. Two test holes
were excavated in the area of the proposed septic system. The septic system will be designed
around the 30 foot radii of these test holes. We are proposing that a 1250 gallon septic tank and a
five foot wide drainfield be installed. Comments regarding the design are summarized as follows:
1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring,
and the percolation test results. It is our opinion that an application rate of 1.2 gallons/day/ft
should apply.
2. TRENCH DESIGN:
a. Percolation Rate: <1 & 1 minutes/inch
b. Allowable Application Rate: 1.2 gallons/day/112
c. Number of Bedrooms: 4
d. Design Flow: 600 gallons per day
e. Minimum Absorption Area: 500 ft2
f. Total Depth: 5 feet (max.)
g. Effective Depth: 3 feet
h. Width: 5 feet
i. Reduction Factor: 0.58
j. Minimum Length: 60 feet long
k Effective absorption area= 517 ft2
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic
system.
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
4. TOPOGRAPHY: As can be seen on the attached topography site plan, the average slope of
the property is a 5 to 10 percent slope running approximately from northeast to southwest. In
short, there are no slope concerns.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact us at 337-6179. Thank you for your
assistance.
P.E., M.S.
NOTE: Attached is a site plan drawing, a design drawing, two soils log, a topography site plan,
and a 7 page construction specification letter which are all part of the design package for this
septic system.
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
LOT 1. BLOCK 1;
DENALY S/D \
LOT 26, BLOCK 1;
DENALY S/D
LOT 2. BLOCK 1•
1 1 11 LOTS BLOCK 1: :'��` �'1—` \\ / i— -- _
DENALY < ALY S/D i, .•;;p_i�• \� / \\ / \
\ LOT 23, BLOCK
\\ DENALY S/D 1 / 1 ` Q \\ 1'2' \ I
AR0 S ;
LOT 6. BLOCK 1; ,S
DENALY S/D ACANT\
1 % TM11 \• W/ ♦ ♦\ �_
1 f ALTERNATE SITE
PROPOSED SEPTIC SYSTEM
TM�2 \
(SEE DESIGN, PACE 2 OF 2)
f P SED
/ i 1 \a 4 BEDROOM
HOUSE I I fD \\ 1
RoT 21, BOCK 1;� \ I \
DENALY IS/D / \ •\ i..\\ `` < _ \� 1 _�, \��—��
•'r\ PROPOSED WELL_
/ 1\
\� I LOT 8. BLOCK 1;0 Jp
�%
LOT 23, BLOCK 1; I \\ 1 I I I DENALY S/D Q
DENALY S/D
lb
LOT 22• BLOCK 1j
DENALY S/D
W� 1 s�i.
1 `
\ LAT 21. BLOCK 1• %� \�\ L `��
DENALY S/D •i `� •� 1�
AA` A
6/292001
C> V
f1�
DRAWN BY:
ALASKA WA'T'ER & WASTE AVATRR
Z.T.G.
<
'
CONSULTANTS, INC. ISCALE:
"� •
6001 NC
DEBARK ROAD, SUTF i8 •AHORAGE, Alf "50,- PHONE 90)UJ1-0110 - FAX 90]USBJ246
1 = 100•
.... . ..........
$
PREPARED FOR PHONE NUMBER:
PACE NUMBER:
CARL KAPPEN 622-2719
1 OF 2
�`1..'. a Comess:
�1 e C 953:
LEGAL DESCRIPRON:
LOT 7. BLOCK 1. DENALY SUBDIVISION
4�4�/s., ;4\`
qN" a,p•........•o\�`:
��a" rofssslot%
TYPE OF WORK:
SITE PLAN FOR PROPOSED WELL LOCATION AND SEPTIC SYSTEM
o�
ALTptWATE PROPOSED DRAINFIELD. EXCAVATE
r
SITE A TRENCH THAT IS 5 FEET
DEEP MAXIMUM BY 5 FEET
WIDE BY 60 FEET LONG. ADD
3 FEET OF CLEAN, WASHED
SEWER ORAINROCK. INSTALL
TRENCH PARALLEL TO ALL
SCOPE CONTOUR.
INSTALL DOUBLE
CLEANOUTS
FOUNDATION
tim0�s0
ALASKA AVATER & WASTENNIATL'R
CONSULTANTS, INC.
:PARED FOR: PHONE NUMBER:
r PROPOSED WELL \\
6/29/2001
LWN BY:
Z.T.G.
1"=40'
;E NUMBER:
CARL KAPPEN 622-2719 I 2 OF 2
LEGAL DESCRIPTION:
LOT 7, BLOCK 1: DENALY SUBDIVISION
TYPE OF WORK:
DESIGN OF PROPOSED WELL LOCATION AND SEPTIC SYSTEM
of ey A G
0"P C 9!
4s
O�oProtsaai
\1
/I
ALASKA «'At LR & WASTE, NN'XrLR y0�
CONSULTANTS, INC. 0 4 e
GWI .(907)M7-6179 • wr: (00 7)=-3246 ..town .... ..
SOIL LOG — PERCOLATION TEST
LEGAL DESCRIPTION: DENALY SUBDIVISION; LOT 7, BLOCK 1 OQ m �.J' r .•Gayness••'
PERFORMED FOR: CARL KAPPEN DATE, 6121/2001 OQQag 7953o;`F•O�
DEPTH - -- ��4°.°gyp••.....•• �op
(feet) ORGANICS TEST HOLE 2 ��DO00000��
SOIL CLASSIFICATIONS
GW ORG
- ' °•• 1
,,_,;••� I GM CL
a •'� GC OL rn 1
` ••, GP/SP o o ` z
o • o o $W MH 1 2—� ; SITE PLAN
••: w SOME SILT '. �•• : $P CH ' TH/1 1"=100'
5 .fir •.. & COBBLES/ , f
OH
BouLOExs SM � � 1 p ;
.°;;.. SC
•�� 1m ; TH/2
7 !;t°•:
iV ••.
DEPTH TO DATE
10-1
\ .
SM/ML DATE READING
11 °/ SOME Gu TIME (MINUTES) READING (INCHES)
12
13 B.O.H
14
15
16
17
18
19 PERCOLATION RATE 1 (MIN./INCH) PERC. HOLE DIA. 6" (INCHES)
20 TEST RUN BETWEEN 5.5 FT. AND 6 FT.
COMMENTS:
PERFORMED BY ALASKA WATER & WASTEWATER I, JEFFREY A. GARNESS, CERTIFY THAT THIS W P RFORMED
IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDEUNES IN EFFECT ON THIS DATE:
GROUNDWATER
DRY 6/21/2001
12' 6/29/2001
CLOCK
NET TIME
WATER LEVEL
NET DROP
6/21/2001
1
-
-
6•
-
2
-
6 MIN.
0"
6"
3
-
-
6'
-
4
-
6 MIN.
0"
6"
5
-
-
6"
-
6
-
6 MIN.
0'
6'
ALASKA
«A7 LR & WASTEWATER
SvpO�
--------
28 - AW-HORAOr-
CONSULTANTS, INC.
AK 09504 - PHONE. (907)337-4179 1 FA): .o .......,
o0o
Q.. .
$901 OERW ROAD. SWE
SOIL
LOG - PERCOLATION TEST
0
LEGAL
DESCRIPTION:
DENALY SUBDMSION; LOT 7. BLOCK 1
OQ �• a re A. GOmess. •�
PERFORMED FOR:
CARL KAPPEN DATE; 6/21/2001
QQ'o�C 7953 `F`
(feet
=___
4���°Pro/sad0116
rr"
ORGANICS
ITEST HOLE 3
�4000�a
1
•••
SOIL CLASSIFICATIONSGW 1
r,
2
-Tn••i
^ r
:f Ji
3
•� '
GP 1 1 ML 1 1
v t
GM CLGC
R'-
•:ti::{
°° ° SW MH 1
° ° �
SITE PLAN
5
`':
w/ SOME
"h coeeLEs%
•° ••' •• SP CH ;
Trt�t 1'=100'
BOULDERS
SM : OH `
6
•
SC
.;V—
7
!' .:
...
i
DEPTH TO DATE
GROUNDWATER 1
a
•'
\
DRY 6/21/2001
` TH 3
10' 6/29/2001
92
10-1,
SM/ML
W/ SOME OM
DATE READING CLOCK NET TIME
WATER LEVEL NET DROP
11
TIME (MINUTES)
READING (INCHES)
12
B.O.1L
13
0 6
�
.11P
OF
14
ONS
6 G�
5
15-
SO�gEO
P8
16
16-
NO�
17
17-
�Q
_6�T1I2OO�
18-
18
19-
19
PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6' (INCHES)
TEST RUN BETWEEN 5.5 FT. AND 6
FT.
20
COMMENTS:
THE INSITU SANDY SOILS SHOULD ACT AS A SAND FILTER.
PERFORMED
BY ALASKA WATER & WASTEWATER I, JEFFREY A. GARNESS, CERTIFY THAT THIS W P RFORMED
IN ACCORDANCE WITH ALL
STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE:
5
1
DATE:
. •r::::•
2001YA
-
.•
S
-- ONS
N INC. •
—
'SCALE:
6901 OF
.
t8 • AN[R01tA 99 01 (90 3731 o •
( ]M -3146
�•
1 = 1 D
.. ...... .... .rj
v$ i
PREPARED FO ONE UMB
PAGE NUMBER:
CARL KA
6 2-2 19
1 OF 1
'� " . ..""'
�arne�s.:
•� a
4•,"0, C 9 3
LEGAL DESCRIPTION.
LOT 7 SL
1, DE LY
VISIO
I.i °rO�°yP• •• \�l�Q:�
t°
TYPE OF WORK:
TOPOGRAPHY
N
: uFa
Certificate of On -Site Systems Approval
Parcel I.D. 050-731-54
Legal description DENALY BILK 1 LT 7
Site address 25605 DENAINA DR
Expiration Date: 6/24/2025
Current property owner(s) HOVEY REX & SUZUKI-HOVEY JUNKO
X The On-site system(s) is/are approved for 4 bedrooms
Conditional approval for
Comments or advisories:
bedrooms, with the following stipulations:
By: l/v Original Certificate Date: 7/25/2024
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory X Arsenic Advisory
Other
COSA Approval_June 2022
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 050-731-54
Complete legal description DENALY BLK 1 LT 7
Location (site address) 25605 DENAINA DR
Current property owner(s) HOVEY REX & SUZUKI-HOVEY JUNKO Day phone
2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS
3. TYPE OF WATER SUPPLY: RN Private Well R Private Well serving 2 dwelling units
F] Private Well serving 3+ dwelling units ❑ Community Well or Public
F Water Storage
4. TYPE OF WASTEWATER DISPOSAL: RN Private Septic R Private Septic serving 2 dwelling units
Fj Holding Tank F-1 Community Septic or Public Sewer
5. SEPTIC TANK: RE Steel M Plastic 0 Concrete F-1 Fiberglass
Age 23 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: F1 AV\/WTS ❑ Bed 01 Deep Trench EJ Wide Trench 0 Seepage Pit
Waiver request for:
Expedited review requested: F
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ 550 1.330 Waiver Fee $
Date of Payment 15 Vt 'Z- Date of Payment
COSA# cj 12 T5( Waiver #
COSA ApplicationJune2022
COSA Checklist
Legal Description: DENALY BLK 1 LT 7
Parcel ID: 050-71-54
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system
A. WELL DATA
0 Well log is filed with Onsite (or attached)
Date drilled 7/24/2001 Total depth 301 ft
Cased to 300 ft
❑ Sanitary seal is functioning correctly
A Wires are properly protected
Casing height (above ground) 24 in.
Date of flow test for COSA 6/24/24
Static water level at beginning of test * ft.
Comments * ARTESIAN WELL, PACKER INSTALLED
B. TANK DATA
Measured operating fluid level in septic tank 48
Date of pumping 6/24/24
❑ Required maintenance completed, if AWWTS
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 7/19/21
0 ALL standpipes present per record drawing
Total measured depth from grade 6 ft (max)
Measured depth to pipe invert from grade 3 ft (min)
❑ N/A — pressurized field.
❑ Per record drawings, field is insulated.
❑ti Monitor tubes go to bottom of effective.
If not, state depth into effective _
❑ Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
*BOTH MT DRY
COSA Checklist June 2022
Well production at time of test 2+ gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes No
fi❑ Coliform bacteria is Negative
Nitrate 0.807 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L V Arsenic less than MRL (ND)
Collected by R JONES
Date 6/24/24
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material
Comments:
Adequacy test date 6/24/24
Results QPass
Fluid depth prior to test 0 in
Water added 600 gal
New fluid depth *1 in
Elapsed time 1440 min
Final fluid depth 0 in
Absorption rate 600+ gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 36 in
Effective depth used 0 in
Effective depth remaining 36 in
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100'
E Yes if No _ ft
Neighboring Tank > 100' ❑� Yes if No _ ft
Absorption Field on Lot > 100' ❑' Yes if No _ It
Community Sewer Manhole/Cleanout > 100'
❑� Yes if No _ ft
Private Sewer/Septic Line > 25' 0 Yes if No _ It
Holding Tank > 100' FEI Yes if No _ It
Neighboring Absorption Fields > 100' Animal Containment > 50' gYes if No _ ft
Ri Yes if No _ ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' Yes if No _ ft Q 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'
0
Yes
if No
_ ft
Surface Water > 100'
Yes if No _ ft
Tank to Property Line > 5'
0
Yes
if No
_ ft
Wells on Adjacent Lots:
Field to Property Line > 10'
❑
Yes
if No
_ It
Private Wells > 100'
Yes if No _ ft
Water Main > 10'
❑o
Yes
if No
_ ft
Community Wells > 200'
Q Yes if No _ ft
Water Service Line > 10'
❑�
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 Finn ✓t �l k f(� n cu 5u it f t r ,
Engineer's Printed Name '�Pv t" L,
COSA Checklist June 2022
Phone 7/15/24
Date
®vim •ao•�q�,
g �•• Ata@�
O. • . • • PJ
•. •...-a
�• MICHAEL N. ANDERSON
P w CE -9469 '"...e
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT j 907-343-7904.
Cin -Site dilater and Wastewater Section (� % Eax: 343-7997
www.muni.org/onsite -
Septic Tank Advisory
Certificate of On -Site Systems Approval # OSC241249
Subdivision: Denaly Block:1, Lot: 7
The septic tank for this property is 23 years old. The average life of an asphalt
coated steel septic tank is 20 years. Typical replacement costs are $10,000 or more,
not including engineering, surveying or MOA permitting fees.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
MUNICIPALITY OF
O Ae
Development Services Department s,4
On -Site Water & Wastewater Section
Parcel I.D. 050-731-54
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Complete legal description DENALY BLOCK 1, LOT 7
EGA --d'dm
Phone: 907-343-7904
Fax: 907-343-7997
s
Expiration Date: �r — S I
Location (site address) 25605 DENAINA DRIVE, EAGLE RIVER, AK 99577
Current property owner(s) DANIEL & LINDA PIKE Day phone
Mailing address 25605 DENAINA DRIVE, EAGLE RIVER, AK 99577
Real estate agent
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
®
Private Septic
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
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 $ .5-5-D Waiver Fee $
Date of Payment V31119 Date of Payment
Receipt Number 017NO Receipt Number
COSA# 195011q/344 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 4661 NATRONA AVENUE, ANCHORAGE, AK 99516
Engineer's Printed Name MICHAEL N. ANDERSON, PE Date 7/26/2019
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
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
OF 1Z,�� 1
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
.• 1
these various and dynamic characteristics and are outside the control of the evaluator of the
* Tx
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
-:49
discrepancies exist can be given by and Anderson Construction & Engineering.
��1�[/��—►
fWf.S
MICHAEL N. ANDERSON:
'. /
6. DSD SIGNATURE
Gr No. CE 9469
11 .7/26/19... •;x,60
,_ System #1 Approved for bedrooms
nsSIOIA ' i
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the following sti ulations:
—/)))))))„t,,
By: 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
Legal Description: DENALY BLOCK 1 LOT 7 Parcel ID: 050-731-54
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
® Well log is filed with Onsite (or attached)
Date drilled 7/24/2001
Total depth 301 ft
Cased to 300 ft
® Sanitary seal is functioning correctly
® Wires are properly protected
Casing height (above ground) 24+ in.
Date of flow test for COSA 7/22/2019
Static water level at beginning of test ART. PLUG ft.
Well production at time of test 2.3+ gpm
• ..C�7 I OTI ii,
B. TANK DATA — 7/19/2001 - 1250 GAL
Age of tank(s) 18 years
Tank type/material SEPTIC / STEEL
Measured operating fluid level in septic tank 48
® Standpipes/foundation cleanout per record drawing
Date of pumping 7/23/2019
Structure served by this system
Water storage tank volume NA gallons
Well disinfected for coliform test? ❑ Yes ® Nc
® Coliform bacteria is Negative
Nitrate 0.812 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ® Arsenic less than MRL (ND)
Collected by FRES.
Date of Sample 7/22/2019
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA — 60'L x 5'W x 3.09'ED — 1.2 GPD/SF = 517 SF
Which system tested (date installed) 7/19/2001 Adequacy test date 7/23/2019
® ALL standpipes present per record drawing Results � Pass For 4 bedrooms
Total measured depth from grade 6 ft (max) Fluid depth prior to test 0 in
Measured depth to pipe invert from grade 3 ft (min)
Water added 600 gal
❑ N/A — pressurized field
New depth 2 in
® Monitor tubes go to bottom of effective. If not, state
depth into effective
Elapsed time 1120 min
® Code -required soil cover over field
Final fluid depth 0 in
® System presoaked
Absorption rate 600+ gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months) N
date of test)
Gallons introduced 1200 gallons
If yes, enter date
W
Comments/Deficiencies:
i
COSA Checklist copy.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'
® Yes if No ft
Wells on Adjacent Lots:
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'
Surface Water > 100'
® Yes
Animal Containment > 50' ® Yes
if No
® Yes
if No
ft
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'
ft
ft
ft
ft
ft
® Yes if No ft
Property Line > 5'
® Yes if No ft
Wells on Adjacent Lots:
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 rr
l certify that l have determined through field inspections and review �� OF `��S
of Municipal records that the above systems are in conformance
with MOA COSA guidelines in effect on this date. �.'
�:4�TH
.A %MICHAEL N. ANDERSON.'
4r No. CE 9469
7/30/1910,
COSA Checklist copy.docx � A' oPESS10,0,
ft
ft
Municipality of Anchorage
Development Services Department
Building Safety Division "•
Onsite Water and Wastewater Program t '
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 9951946650
www.muni.orglonsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. _-'"�i�- COSA #
Expiration Date: - % -0
1. GENERAL INFORMATION
Complete legal description .DAr-al
Location (site address) , 9-5 (o CS
Current Property owner(s) MA
6- r JU I L
r Day phone _(re)
4 - 5 416
Mailing address �SL„US
T-na;s,n
�r }�-1.
cjq��-I_ottUl
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY.
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0/
Individual On-site
12'
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 Onsite 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 Onsite 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 Phone
Address Fanta River AK 99577
Engineers Printed Name Chris-(ottilocc( Date ITI o
5. DSD SIGNATURE
✓ Approved for 4 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flo�/ Advisory
Nitrate.Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineers Report
Other
By. a"-�/, Original Certificate Date: (0-141 -00.
(Rev. 1105)
Municipality of Anchorage
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/onsde
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: L -1 i R I Parcel ID: 0 26-0-7 31 -g*
A. WELL DATA
Well typela(ya4 (. If A. B, or C provide PWSID #
Date completedLa'4 10 1 Sanitary seal JDN) l z /J_
Total depth 3C_ I n. Cased to 00 n.
FROM WELL LOG
Date of test -7 / Aq / Of
Static water level f n.
Well production t (� g.p.m.
WATER SAMPLE RESULTS:
Coliform __colonies/100 mL Nitrate �'• O 6mg/L
Arsenic: a,5Lo mgA Date ofsample:5 /o(o
B. SEPTICMOLDING TANK DATA
Well Log ON) _ L�I-
Wires properly protected ON) �
Casing height (above ground) �_in.
AT INSPECTION
s la3/oLJ
g.p.m.
Other bacteria _0 colonies/100 mL
Coilecledby: l/tLtn�ia- GC(�7Cr/rnl
Tank Type/Material �64(' 1 4 -CL( Date installed 7,41 (O I
Tank size lsj�S gal. Number of Compartments Cleanouts ON)
Foundation cleanoutO/N)� Depression over tank (Yl* J2Q High water alarm (Yf> -110
Date of pumping SI 1 -7 / 0(„ Pumper -TR.'S -Rn m pi nri
C. ABSORPTION FIELD DATA
Date installed Irl 10 I Soil rating(&p•d./ft2 r felbdrm) System type �rn;rt fi t (r(
Length (an n. Width 5 n. Gravel below pipe 3 ft.
Total depth 5 h. Eff. absorption areaSL-Lft2 Monitoring tubelAcS Depression over field no
Date of adequacy test 5 I a31,100(o Results Ni@I=ail) S% u For, bedrooms
Fluid depth in absorption field before test _L In. Water added,aQQgal. New depth -7 in.
Elapsed Time: Lin. Final fluid depth _ I in. Absorption rate >= Gn n g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y(NA type) _ n (2,21 °44.-rur u✓l If yes, give date ✓i Ia
D. LIFT STATION
Date installed Size in gallons Manholel
'Pump on" level at _ in. 'Pump off _ in. High water alarm level at in.
Datu Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot -t 1(^O
Absorption field on lot -1 100,
Public sewer main + 100,
Sewer /septic service line -1 )-,:;
Animal containment areas + 1 W ,
On adjacent lots + r�r�
On adjacent lots 4-100' —
Public sewer manhole/cleanout i I nr?
Holding tank -1 —1
Manurelanimal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation + 5 Property line 4 S_ Absorption field + S
Water main -1 to ' Water service line r t o ' Surface water t- I
Wells on adjacent lots -t 1 o (1
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line t (0, Building foundation -1- 1()' Water main -( 1C),
Water Service line +- I t )' Surface water I--(00, Driveway, parkinglvehicle storage 15 '
Curtain drain ! O Wells on adjacent lots -4100'
F. COMMENTS
�F-A istiv) --- IAV Lk / PC K(� . IfzO LevEz.
M..•
op 7't-sT:
G. ENGINEER'S CERTIFICATION
I certify that I have determined through Revd inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
}IER R
Engineer's Printed Name�inriC�t24LP r- �+ lmri '•
Date L)
COSA Fee $ r �"
Date of Payment
Receipt Number �I 530
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
Development Services Department:
Building Safety Division
— On -Site Water & Wastewater Program �A
4700 South Bragaw St."
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 050-731-54 HAA# A��r-)soa
1. GENERAL INFORMATION Expiration Date: /1 7fi2
Complete legal description DENALY SUBDIVISION: LOT 7. BLOCK 1.
Location (site address or directions) 25605 DENAINA DRIVE ' EAGLE RIVER, AK 99577
Current Property owner(s) ROBERT RHEES Day phone 694-9134
Mailing address - 25605 DENAINA DRIVE • EAGLE RIVER, AK 99577
Lending agency Day phone
Mailing address
Real Estate Agent KAY ENGLAND Day phone 265-9134
Mailing address 10928 EAGLE RIVER ROAD • EAGLE RIVER, AK 99577
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well
0
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 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 samples. (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.
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid S at, or prior
to closing for the engineering services provided.
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 riles 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC.
Address 6901 DEBARR ROAD, SUITE 28 ' ANCHORAGE. AK 99504
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineers Comments:
In conducting this evaluation, AKWWC. Inc. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. AKW WC, Inc. can therefore not provide
any warranty or future estimate ofhow long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
otherperson or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the fllowing
Phone
337-6179
Date 19JOZ
ill
• r1Al CTC
Attachments: /
HAA Checklist ✓ Manitenance Agreements
Septic System Advisory
Well Flow Advisory
Supplemental Engineer's Reort
Other
By:— i Original Certificate Date:
(R". 12101I J
.,... Municipality of Anchorage
Development Services Department
Building Safety Division
On -Ste Water 6 Wastewater Program
4700 South Bragaw SL
P.O. Bort 196850 Anchorage, AK 09519-6850
www.danchorageaR.us
(907)943.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: DENALY SUBDIVISION: LOT 7, BLOCK 1 Parcel ID: 050-731-54
A. WELL DATA
Well type f'RIVAIE If A, B, or C provide PWSID# N A
Date cornptetad 7/24/2001 Sanitary seal (YM) YES
Total depth 301 ft. Cased to 300.51 ft.
FROM WELL LOG
Date of test 7/24/2001
Static water level 4+/- ft.
Well production 6 —
9 -p.m -
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate 0.487 mg,/L,
Well Log (YM) YES
Wires property protected (Y/N) YES
Casing height (above ground) 24+ in.
AT INSPECTION
8/2/2002
I31
2.2+ g.p.m.
Other bacteria 0 oolonies/100 mi.
Date of sample: 7/30/2002 Collected by: AKWWC, INC.
B. SEPTICIHOLDING TANK DATA
TankType/Material STEEL Data Installed 7/10-19/2001
Tank size 1250 gal. Number of Compartments 2 Cleanouts (YM) YES
Foundation cleanout (YM) YES Depression over tank (YM) NO High water alarm (YM) N/A
Date of pumping 8/7/2002 Pumper JR'S PUMPING
j' C. ABSORPTION FIELD DATA F*&4-Mr p"""ro DRY THROUGHOW TT i
Date installed 7/10-19/2001 Soil rating .p.d. r ft'bdnn) 1_2 Systam type SHALLOW TRENCH
Length' 60 ft. Width 5 ft. Gravel below pipe 3.09 ft.
Total depth_5._ft. Efl. absorption area 517 YES
ft Monitoring tube _ Depression over field NO
Data of adequacy test 8/2/2002 Results (Pass/Feil) PASS For 4 bedrooms
Fluid depth In absorption field before test 0 in. Water added 1091 gal. New depth ' 1.5 in.
Elapsed Time: 10 min. Final fluid depth 0 in. Absorption rate >= 600+ g,p.d,
Any rejuvenation treatment (past 12 mo.) (YM 6 type) NONE KNOWN If yes, give date -
D. LIFT STATION
Date installed
"Pump on' level at _in.
E. SEPARATION DISTANCES
Size in gallons
High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAtIt station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Sewer /septic service line 25'+ Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 58+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 1009+ Driveway, pofldngNehicle storage 10'+
Curtain drain NONE. KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I car* 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.
Engineer's PrintJ���glddd ame JEFFREY A. GARNESS
Date ${6�
HAA Fee E 311 ---
Date of Payment 3 16 1 a
Receipt Number 25164 -
(fw.12AI)
Waiver Fee $
Date of Payment
Receipt Number
e.o
Municipality of Anchorage
Development Services Department Wil:
• Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 050-731-54 HAA# Af-I
1. GENERAL INFORMATION Expiration Date: 4.L22,OZ
Complete legal description r'DENALY SUBDIVISION, LOT 7, BLOCK 1
Location (site address or directions) . 25605 DENAINA DRIVE * EAGLE RIVER. AK 99577
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
CARL KAPPEN do ASSOCIATES Day phone 622-2719
P.O. BOX 770489 + EAGLE RIVER, AK 99577_
Day phone
AUDREY MASON w/ REMAX PROPERTIES Day phone
16600 CENTERFIELD DRIVE ' EAGLE RIVER, AK 99577
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well
N
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
694-4200
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. (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 engineers work.
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $622.00 at, or prior
to closing for the engineering services provided.
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 riles 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone
Address 6901 DEBARR ROAD. SURE 28 • ANCHORAGE, AK 99504
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date
Engineer's Comments:
In conducting this evaluation, AWWC, Inc. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines 8 Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control ofthe evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party Is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for 4 bedrooms.
Disapproved.
337-6179
B pZ
Conditional approval for bedrooms, with the fllowing stipulatio��p"R : ••.L.
' •'p
J � ON-SITE
•• '9
WASTEWATD a
RAM
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
(Rw.12101)
Manitenance Agreements
Supplemental Engineer's Reort
Other
Original Certificate Date: I 2 2 Q,2
Municipality of Anchorage
Development Services Department
Building Safety Dtvbion
OnSRe Water 6 Wastewater Program
4700 South Bragew SL
P.O. Box 196650 Anchorage, AK 9951946660
www.cLanchoWe.ak.us
(907)343.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: DENALY SUBDIVISION: LOT 7. BLOCK 1 Parcel ID: 050-731-54
A. WELL DATA
Wen type SATE If A. B, or C provide PWSID# N A
Date completed 7/24/2001 Sanitary said (YIN) YES
Total depth 301 ft. Cased to 300.51 ft.
FROM WELL LOG
Date of test 7/24/2001
Static water level 4+/— ft.
Wag production 6 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 cotonies/100 ml. Nitrate 0.574 mgJL.
Well Log (Y/N) YES
Wires property protected (Y/N) '1ES
Casing height (above ground) 24+ in.
AT INSPECTION
Other bacteria 0 colonies/100 ml.
Arsenic: M002 mgJL. Date of sample: 1/3/02 Collected by: AWWC. INC.
B. SEPTIC(HOLOING TANK DATA
Tank TypefMatertai STEEL Date installed 7/10-19/2001
Tank size 1250 get, Number of Compartments E Cleanouts (Y/N) YES
Foundation cleanout (YIN) YES Depression over tank (Y/N) NO High water alarm (YIN) N/A
Date of pumping NEW Pumper
C. ABSORPTION FIELD DATA
Date instaned 7/10—Ia/Ml Sol rating .pA r ft')bdrm) 1_2
"'Length 60 ft. Width 5 ft.
System type SHALLOW TRENCH
Gravel below pipe 3.09 ft.
Total depth —IJL_ft. Eff. absorption area 517 ft' Monitoring tube YES Depression over field NO
Date of adequacy test NEW Results (Pass/Fan) — For—i--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.) (YIN & type) N/A If yes, give date
D. LIFT STATION
Date installed
'Pump on" level at _in.
E. SEPARATION DISTANCES
Size in gallons
High water alarm level at
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankRtft station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Sewer /septic service line 25'+ Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent kits 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parkinglvehlde storage 10'+
Curtain drain NONE KNOWN Wells on adjacent Its 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I cePofy that I have determined through field inspections and r�'•?'4
review of Munk(ml records that the above systems are in """' ' "' "' ' ..
conformance with MOA HAA guidelines in effect on this date.
y
Engineers PrinNa a JEFFREY A. GARNESS 7953 F
[�t/�dB �
Data 2
T 's°P�ohH1a`d�
HAA Fee $ 2i 75 • `�"
Date of Payment r' r'10
Receipt Number d1 45p
(rw. l2M)
Waiver Fee $
Date of Payment
Receipt Number
~• ^ 5
yy [F^� a D W c ys� V Y yVj W
yy( YQ o`cn.
1� } pw CCC ,
� W�j•eE�j� 2� �� Z
3 g aLB� S B ca J R
. 40
CD
•4'$:
bt rrr� g
9 Op
y gy, O
gp ,FBd !� GaOJ 7
O � �
bt ♦ O
LC 4 �?� ' ' g� ?♦1 /
e w CD r ' 9l�lO1 /
i ♦p,1^�
1g ♦ /
O Al `
. 6 1F. p♦epg ��
0 gp♦ / O
ss•• obi a
•s��bt.hH �` �.
In
O f 2
y�v
O
Id Wd6b:ZT ZOOZ TT 'uef 060b-ve-L06 : •cN M1d sa 1�2S 6ujFi� S 6ul�U : WMU