Loading...
HomeMy WebLinkAboutLAKE HILL ACRES #6 BLK C LT 2Lake Hill Acres #6 Block C Lot 2 #051-122-56 ._ Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP151179 PID Number: 051-122-56 Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade Name: Steven & Lori Becker ABSORPTION FIELD - EXISTING Address ❑ Deep Trench ❑ Shallow Trench ® Bed ❑ Mound 2221 Anthem Place, Chugiak, AK 99567 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 -- GPD/SF -- Ft LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot -- Ft. -- Ft. Lake Hill Acres #6 C 2 Fill added above original grade Gravel length Township Range Section -- Ft. -- Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES -- Ft. Ft. To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line -- Ft2 -- Ft. Well 100'+ -- -- 25,+ TANK ® Septic 0 S.T.E.P. 0 Holding 0 Other Manufacturer Capacity Surface Water 100'+ -- _ __ ANCHORAGE TANK 1000 Gal. Material Number of compartments Lot Line 5'+ -- — -- STEEL 2 • NA Foundation 5'+ -- -- -- LIFT STATION Manufacturer Capacity Curtain Drain NA -- NA -- Gal. Remarks Pump on level at Pump off level at High water alarm at Existing septic tank decommissioned per code, new tank installed, insulated and in. in. in. reconnected to existing system. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank D3034 Tank to D3034 Installer JRs drainfield_ Drainfield -- CO/MT D3034 Inspector ARCTERRA BENCH MARK (Assumed elevation) 100 ft Inspection 1"7/9/15 2nd 10/12/15 Location and description 3rd 4" Bottom of Siding COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL ,,41.-4 .11L, �{, OF .4 i r Air < ,. ' _ .4,\-, II Conditional Approval: Date /� .x •y ` i%* 4 ! ---. # $ y „ENNET . BU 10 4 il CE71 { 16, /s '7i Approve , .•-L'. e,._--( Date b'iEl'j+7 "olh ►ob:4` Inspection Report ST copy 3.doc AS—BUILT SYSTEM DETAILS/SITE PLAN Permit ❑SP151179 LAKE HILL ACRES,,SUBDIVISI❑N L2 Blk "C" PID# 051-122-56 89.2'+/_ STEEL LO1 24.2' (A CD X m t 1T::":.• w p Z COC EXISTING f ��� BED LOT 2 m co SMT �e n 24.2' BM BLK C INSTALLED NEW STET 1000-GAL CTS SEPTIC TANK WITH CLEANOUTS & CONNECTED TO GRAVEL DRIVE EXISTING BED CO o. v W Ci + I SHOP V) N W CC U 4 2 yWyy 1 1 N 89'5810 E 195.41' SCALER = 30' Y a Fo (101,61 101.6 A-C=13.8' B_C_29,2' _ FINAL GRADE 2A-D=17,5' __ .B-D=31,0' 0 Q ,.s, ,_ WILES L IT)0 0 —`1000 GAL T)1..7—ti SEPTIC . :A- TANK EXISTING BED UC Ir 98.00 097.8 i U101 � , �� I SCALES NTS J Air''cS Az 6. 1 PREPARED FOR: CTE R Jo �� ' STEVEN & LORI BECKER �, _[� �, ' �. — �7 2221 ANTHEM PLACE 44(;1• ill �� a��, `o '* .49 9 T• 1 i Chugiak, AK 99567 �I._I� 907-688-5483 ." 12' / KENNETH ,,v S / FIELD BOOKS COMPUTED: ; 1 OD + C: r� Wa BOUNDARY:NA DRAWN, BMW z �'��, . STMW4 NA a1Ea(ED: KMD % �` " j , �' G/s r� \1 ' Q � / AST: JLS DATE 6/5/17 i ��^���� 0ed o '`CESS DW FIE: GRID' c! c� ,_ G i1 Ilk �� NW1562 F9, pis �� `oP `_ ACRD FILE' FILE JOB No.: 15-166 SFR, 99577-8�}6 / , 30' 25' LOT 1 I / trji e N81'0/' ow 00.,W 120,00' 1 1 i WELL® .4.1 1-, l LOT 8 N CO I M1 GRAVEL to I o/w N 1 O 89.0' Cn 24.0' V. 73 rn gO 1 O � M ea. /m SEPTIC I Z 1 100.4' 24.0' SYSTEM co / • \ Z w i 1 1 LOT 2 30.0' BLK C 0' on A 3; N X S 0 o D --1 o 0 0z cDO d G7 N M 11.0' ISI N I GREENHOUSE $HED 30 0' 93 J cc I 16.01°' !3;I U o U 138.4' `] N89'58'10"E 195.41' x—x—x_x--x--x—x 1 1x / LOT 3 / / ANCHORAGE RECORDING DISTRICT,ALASKA ASBUILT OF: LAKE HILL ACRES SUBD. SIXTH ADD. © =FND REBAR LOT 2 BLOCK C PLAT 71-355 ,gg�"`` SURVEY CERTIFICATE:I,John L.Schuller,Have conducted a �+� OF A-co, �1, tiO 41, 0�L physical survey of this property as shown on this drawing and that the _/ ��,.••'' �� �' 'op `(46..,Sr. �� improvements situated hereon are within the property lines and no f 4 I,��1i *...,7,4,7 enchroachments exist other than noted.Under no circumstance should � xany information on this drawing be used for construction of fences, f* " a 4 c�r structures,improvements,or for establishing boundary lines. / / i_ ( ( / U a ' ', EXCLUSION NOTES:It is the owners responsibility to determine / ' n the existence of any easements,covenants,or restrictions which �`�. ' HN L. SCHULLER: L. / do not appear on the recorded subdivision plat. a� LS-10409 �m� : .,,,,�._,�,r. WORK ORDER RIMER: Doh If^a , f • �J�0' 1831 Talkeetna Street NOV 4, 2015 1'=30' \\XX 0 p �a i Anchorage, Alaska 99508 15—046 ""B'"• oEa®°n aim w�eae: °D0KfrAoe ,` Air � o f e$slono, �4+ (907) 227-1455 office ,ILS NW1562 150303 \N�`��� (907) 274-4992 fax On -Site Water and/or Wastewater System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP151179 Tax Code Number: 05112256000 Work Type: SepticTank Upgrade Permit Effective Dates: June 16, 2015 to June 15, 2016 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: LAKE HILL ACRES #6 Site Legal Address: LAKE HILL ACRES #6 BILK CLT 2 G:1562 Owner/Address: BECKER STEVEN J & LORI J 22221 ANTHEM PL CHUGIAKAK 995675714 Site Mailing Address: 22221 ANTHEM PL, Chugiak This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy All construction must be in accordance with: Lot Size in Sq Ft: 34997 Total Bedrooms: 3 N Private Well N Water Storage 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 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 By: Issued By: Date: Date: �� � ._,,99 - MUNICIPALITY OF ANCHORAGE � ar Community Development Department Development Services Division On -Site Water & Wastewater Program 89 1� a ,JUN 1 1 ..D15 Phone: 907 Fax: 907 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-122-56 Property owner(s) Steven & Lori Becker Mailing address 22221 Anthem Place, Chugiak, AK 99567 Site address 22221 Anthem Place Day phone Legal description (Sub'd., Block & Lot) Lake Hill Acres #6, Block C, Lot 2 Legal description (Township, Range & Section) Lot Size 34,997 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑x (w/wo ADU) Septic Tank ❑X Upgrade ❑X Duplex ElHolding (D) Tank ❑ Renewal FJMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. of property owner or authorized agent) Permit/Rush Fees: a15/� Waiver Fees: Date of Payment: (a 1151 IT Date of Payment: Receipt Number: 6"l 6001 Receipt Number: Permit No. 0SPt6 [not Waiver No. Permit App_„-:. ::...:c. Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steveCoDpaneneak.com June 12, 2015 Subject: Lake Hill Acres #6, Block C, Lot 2 Emergency Tank Replace Permit Request Design Narrative This is a design narrative for a permit to install an upgrade 10008 Septic Tank to be issued for this property. The existing tank has collapsed placing the house out of service. The proposed systems will serve an existing three (3) bedroom house. Currently the lot is developed. The proposed system will utilize a replacement 1000g septic tank that will be connected to the existing drain field. This lot and the surrounding lots are served by private wells. There are no wells within 100 feet of this system. 1. Upgrade Tank Design. a. See Sheet 1 of the design package. 2. Surface Water: There is no surface water within 100 feet of the proposed septic tank. The proposed septic tank upgrade will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: The existing topography slopes from the east to the west at approximately 2% in the area of the septic system. There are no steep slopes within 50' of the proposed drain field. The proposed drain field will maintain 50' separation all steep slopes. The proposed installation will not affect the future development of the surrounding or existing lots. There are no surrounding wells within 100 feet of the proposed septic location. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 ' /M� nA—�M\ � 1 1 WELL (E) J \ x 2 U � I 1 1 WELL 2;% 4_ .4 1o00g SEPTIC TANK (E) \ DECOMMISSION PER CODE AND INSTALL 10008 SEPTIC TANK (P) WITH DOUBLE CLEAN OUT BEFORE AND AFTER TANK {y 38R INOUS()E E 1 ` 2% VERIFY CONDITION OF DRAIN FIELD (E) NOTES: i PANNONE ENG SVC, LLC EMERGENCY TANK REPLACE P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 LAKE HILL ACRES #6, BLOCK C, LOT 2 STEVEN & LORI BECKER 22221 ANTHEM PLACE PLAN CHUGIAK, AK 99567 6/12/2015 ��� �9I' Scale ti: 4 TH 0" 1"=50' .... ... .. pJ ... P.I.D. NO �y�,-,� 051-122-56 Steven R. Pannone PERMIT N0. P CE 8149 .�Q,� Ospxxxxxx Ilo o SS. o -.01Sheet 1op t r, \ _ MUNICIPALITY OF ANCHORAGE - DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street • Anchorage, Alaska 99501 Telephone 204-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME (✓ L PHONE j EW OUPGRADE MAILINGADDRESS LEGAL DESCRIPTI N l G RicL 6 . LOCATION � / / // e/ t�''� '1V/ NO. OF BEDROOMS `I Well ,�— Absorption r (L Dwelling C PER DISTANCE TO: /%6 L ` CrZI Manufacturer "� „ / Ma ,r)is No. of compartments �7 Width Liquid depth F�Oxz_ Liq. i i gallons IF HOMEMADE: Inside length DISTANCE TO: Well welling PERMIT NO. Manufacturer Material Liquid capacity in gallons 0W w= DISTANCE TO: ell Foundation Nearest lot line PERMIT NO. LL Z No. of lines Length of a ine tal length of Imes Trench width Distance between Imes f 2 w I inches H Tap finish Material beneath the Total effective absorption area of the to grade p inches Length/ ( Width /� v Depth Qi� PER T . w t v�Iamel Z R Type of crib Crib diameter Crib depth I Total effective absorption area W w DISTANCE TO: Welln � c L �j Builds tpyn6tit�. js Nearest lot line 6- L -. Class `SL]wttA �/ Driller Distance to lot linePERMIT NO. w DISTANCE TO: Building foundation Seer line w Septic tank Absorption areas)3 OTHER PIPE MATERIALS SOIL TEST RATING O A,ff !J �_ _ p p �J INSTALLER (� S �CA r t REMARKS S' A ..•rte :L.I re b o _ tw a -y �s p• r � Robert \.•^'fit � •/.1.. 4 d: APV VED DATE LEGAL ANG'/.Jc=�iC/NG— . 0 3 (Rev. 3/78) t'FUt-F I C I~HL_ I -rke IC►F t�ltaCF �iF RGE /% v DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE, AJ:. 9`1501 2264-4720 4JEL_L_ nt_IL> CDt•J—S ITE SEWER: PERM I T PERMIT NO. ( 810240 ) APPLICANT FLORENCE K. WILLIAMS P.O. BOX 42 CHUGIAK 688-3183 LOCATION ANTHEM PLACE LEGAL LOT 2 B C LAKE HILL ACRES # LOT SIZE 34907 SQUARE FEET 5E£F(Jb£ TYPE OF SOIL ABSORPTION SYSTEM IS: D ELD MAXIMUM NUMBER. OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: 1 0 DEPTH= , ' 1rx O•0.6- E>EF"TH= ioOI THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IPJ FEET). -C? T 1 1---I'E THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). F`EQU I F2ED> 'SEPT I C _rn"K 'S I ZE= 10Eyti-1gD 13FiLL—QN!7 PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DUPING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER. OF RESIDENCES THAT THE WELL WILL SERVE. --- TFJC3 C 2 ] PECT I OFdS F-iF:zE F;-*EG!U I F<EG• --- SACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT I -JILL BE SUBJECT TO PROSECUTION. MIPJIMUM DISTANCE BETWEEN A WELL AND ANY ON—SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE I -JELL OR 150 TO 200 FEET FROM A PUBLIC 4JELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MIPJIMUM DISTANCE FROM R PRIVATE WELL TO A PRIVATE SEWER. LINE IS 25 FEET AND TO A COMMUNITY SEWER. LINE IS 75 FEET. 14ELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE I -JELL COMPLETION. OTHER, REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PEF?M I T EXP' I FZES 01ECEMF3EF` = 1r :I_ S I CERTIFY THAT 1: I AM FAMILIAR. WITH THE REQUIREMENTS FOR ON—SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. �C 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON—SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE J RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. �$_�6 8�—c1,or�¢ lam, OCC.,/CA SIGNED:( ---- jPKI��T FLOP..EtJCE F:. WILLIAMS N°i^� Sysia.,',s a Lte��.be _ _-_DATE_:'1 �� _ -- - G D - O. ISSUED B Sdf V4. 0 Nc�t: \ as ww• ►u !°;.clrs. J_NSulf}TJ �;..,e,:;o s ►6 For 36 a ,titi.. vv. +j, A p of p po . ��Q U 1 R�� �s+p.o tYIJST HFiut_ Fr / ' n SOILS LOG PERFORMED MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG — PERCOLATION TEST LEGAL DESCRIPTION: G i / PEP (F: ELI D/'�/CC i9! G S! t_ T 1 / 2 f/ -S/ Z— -7- l3 ° ' �%dLLsi 1 le l'G� e,ccaor�Flc'i 4_ D` o LA 23 f}ICG- 0 A4 5 1 S/r/ — 12S - 7 2S r 5 -0� c' r 7 D �✓ y -E �e 0 10 pn/ 67 [/ 11 D / / / WAS GROUNDWATER ENCOUNTERED? 12 13 15 Date --- Gross Time - -- Net Time 16- Net Drop ■ENFAMENNEM ■ERREAME A 17 ri ■■■E,AOMME■ t1 a* y � 19 F. 19 C NOMMMENEME ■■EMNOMMON' ■■.NNE.■■■ �1 1i 20 A( RobeA A. Sho/v f 4 :� No. 1457•: �4 r"ii ;:'.,�F• - r PERCOLATION RATE / �V /�'�- (minutes/inch) IF YES, AT WHAT DEPTH? DATE PERFORMED: UL/L S/ e \A -%'Lk �-c. 6 -y Add SLOPE ■■■■ENINE■■ Date --- Gross Time - -- Net Time Depth to Water Net Drop ■ENFAMENNEM ■ERREAME ■■■E,AOMME■ t1 NNOMENEMEN NOMMMENEME ■■EMNOMMON' ■■.NNE.■■■ ■M.■■,,.■■ EMMUNNEENE NEEMENEWER MENMENNEEN ■■■■.■■■■ Reading Date --- Gross Time - -- Net Time Depth to Water Net Drop t1 TEST RUN BETWEEN FT AND FT r-� PERFORMED BY:S V'•S F.nn^nt.,l-I,s�,r CERTIFIED r 72-008 (6/79) L r Time Time ae Date Date Date cS Inspector Inspector Inspector Comments . /f Q if Conditional ApprovalLV , MUNICIPALITY OF ANCHORAGE ENVII. Ile 1 .0 0 1952 fz RECEIVED Date Sewer Installed Permit No. Septic Tank Size 6c,+- 81 Holding Tank Size Solls Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner FLOKENUL RAi 1,11LETIM,Phone P. 0. BOX 42, Chugiak, Alaska Mailing Address , Buyer MARK XNV VIANE 5MI111-� P. 0. BOX 4-1847, Anchoi•age,�Alaska Address Lending Institution ;jArJUNAL PARKWAY BRANCH, NORTHERN LIGHTS BLVD. ANCHORAGE. E!hone 6-6300 Address 5305 E. Realty Co. d Agent - P. 0. BOX 279;"Chugiak,; Alaska n 88-3 999 Address ,. , ells Legal Description -LUT Z9 5 , ANTHEM STREET Street Location 1, TyXeofResldence single Family ! 0 Single Family 3 O Multiple Family No. of Bedrooms / 0 Other Water]6upply , f ❑ Individual - ATTACH WELL LOG. A well log Is required for all wells drllledatlnce June 0 Community ""- For welWrllied Ddor to that date, give well depth (attach log If 0 Pub,tc Utilityavailable. UD VV �i e�C LL Sewage Disposal - X1 individual Year Individual Installed: _, 1981 0 Public Utility-^--:, , When Connected to Public Utility' ' 0 Holding Tank - NOTE. THE INSPECTION FEE MUST ACCOMPANY CACH REQUEST BEFORE PROCESSING CAN BE INITIATED. October 8, 1982 tds. Florence Kay Williams P. O. Box 22 Chugiak, Alaska 99567 Subject: Lot 2, Block C Lake Hill Acres Dear its. Villiams: Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: • A well log submitted to this office for our files and review. ° The top of the well casing sealed with a sanitary seal so that it is water tight. ° The water analysis report needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. Please notify this Department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt Associate Environmental Specialist RP.4 • • c mo! Municipality of Anchorage =11V,C'zY1 let); On-Site Water and Wastewater Program 4 si;11:H i (907) 343-7904 SA cry CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-122-56 Expiration Date: l f g'-`17 1. GENERAL INFORMATION Complete legal description LAKE HILL ACRES#6 BLOCK C LOT 2 Location (site address) 2221 ANTHEM PLACE, CHUGIAK,AK 99567 Current Property owner(s) STEVEN &LORI BECKER Day phone Mailing address 2221 ANTHEM PLACE, CHUGIAK,AK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) El Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ® Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class Well ❑ Public Sewer ❑ Public Water System ❑ WaiverNariance request for: Distance: Received by: (7e//7 COSA to be r�ea.2:: :'..----- �d to engineer, unless otherwise requested by the engineer. COSA Fee $ 5-21 Waiver Fee $ Date of Payment W5-1! " Date of Payment Receipt Number 02oz) Receipt Number COSA# 05C1 log 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 ARCTERRA CONSULTING,INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD.,EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 6/5/2017 THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface,changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen ++�\ encroachments,deficiencies or discrepancies exist. (sy.) OFA 4 � * L�• TII * � 6. DSD SIGNATURE Waft System #1 Approved for 3 bedrooms. + KEN1:7•Pcyffirr,of . System #2 Approved for bedrooms. + s 7116 +`�/ Disapproved. Conditional approval for bedrooms, with the following stipulations: • D WATER AND 111'- ' WASTEWATER z r H- OGKAM UQ By: ( tn.t.. ` " Original Certificate Date: f 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 blue sheet 10.10-12.doc 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: LAKE HILL ACRES#6 BLOCK C LOT 2 Parcel ID: 051.122.56 A. WELL DATA— PER MOA RECORDS Well type PRVT If A, B, or C provide PWSID # Well Log (Y/N) N Date completed Unknown Sanitary seal (YIN) Y Wires properly protected (YIN) Y Total depth _65 ft. Cased to 60 ft. Casing height(above ground) 24+ in. FROM WELL LOG AT INSPECTION Date of test -- 6!212017 Static water level ft. 12 ft. Well production g.p m. 4.44+ g.p m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 4.0 mg/L Arsenic: __ND ug/L Date of sample: 5/22117 Collected by: ARCTERRA B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC I STEEL Date installed 719/2015 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) N Date of pumping 6/2/17 Pumper JRs C. ABSORPTION FIELD DATA Date installed 1011981 Soil rating (g.p d./ft2 or ft2/bdrm) 125 System type BED Length 36 ft. Width 16 ft. Gravel below pipe 0.5 ft. Total depth 3 ft. (Measured 6/2/17) Eff absorption area 576 ft2 Monitoring tube Y Depression over field N Date of adequacy test 6/2/17 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 800 gal. New depth 3 in. Elapsed Time: 1 min. Final fluid depth 0 in. Absorption rate >= 450 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/Access (YIN) "Pump on" level at in. "Pump off" level at in. High water alarm level at in. Datum Cycles tested Meets alarm &circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 1001+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 100'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 5-10'+(PER MOA RECORDS) Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage O'+/- Curtain drain 50'+(NONE KNOWN) Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION t 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. OF AZ . A ' Engineer's Printed Name KENNETH M.DUFFUS 1- Date 615117 *149TH ajllikbh 4(11.11- at COSA canary sheet_2-6-15.doc Ikk ,s lot .cS— --c. Municipality of Anchorage -� Development Services Department •��'= Building Safety Division ` ' _ On -Site Water and Wastewater Program 3 • ..• 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. 051-/2Z- Se HAA# 0")07X1 I Expiration Date: 9- 1/-0-:? 1. GENERAL INFORMATION Complete legal description 4,j9= Z Location (site address or directions) , Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address L072 . S[GcKG Day phone Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 19 Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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 Address Engineer's Printed Name 5776VE 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Phone 69'54-70x,' Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: a�� /z/ r Original Certificate Date: (0-11-03 (R". 01103) Municipality of Anchorage 0 • -�° Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Boz 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:4-fA-AWIZ o;'GREs *° C.' ,C oTo7, 13LOCk 0 Parcel ID:0S/-/22-51 A. WELL DATA Well type L If A, B, or C provide PWSID # _ Well Log (YIN) Date completed ( ^i7 Sanitary seal (YIN) Wires properly protected (YIN) 7V � Total depth 6g ft. Cased to ft. Casing height (above ground) 43 in. FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Arsenic: L_ mg./i. B. SEPTIC/HOLDING TANK DATA Tank Type/Material S TEe'e, it. Nitrate 4.O3 mg./l. Date of sample: S /0 03 AT INSPECTION '5-h o /03 ft. g.p.m. Other bacteria a colonies/100 ml. Collected by: -Abe--d , Ed Date installed 1014H Tank size /060 gal. Number of Compartments Z Cleanouts (YIN) _ Foundation cleanout (Y/N),rJ.� Depression over tank (YIN) N High water alarm (Y/N)�� Date of pumping S Z1 03 Pumper .�_/l S 110,2&A/e, C. ABSORPTION FIELD DATA Date installed /o Soil rating (g.p.d.lfl? or fl?/bdrm) JZX Length 3e ft. Width /-s ft. System type BEb Gravel below pipe 6. 5 ft. Total depth 3 ft. Eff. absorption area 57e flZ Monitoring tube _Y___ Depression over field _A1 Date of adequacy test -S 194Y Results (Pass/Fail) PA U For 3 bedrooms Fluid depth in absorption field before test 4 in. Water added SOO gal. New depth a in. Elapsed Time2� min. Final Fluid depth 0 in. Absorption rate >= -'5-00 -t- g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) A) If yes, give date D. LIFT STATION /,//# Date installed "Pump on" level at_ in. Datum E. SEPARATION DISTANCES Size in gallons "Pump off" level at _ in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot /3 Manhole/Access (Y/N) High water alarm level at in. Meets alarm 8 circuit requirements? On adjacent lots /Da 'r Absorption field on lot 1.2s On adjacent lots /001' Public sewer main W/1 Public sewer manhole/cleanout .t1 4 Sewer /septic service line 13 C/ Holding tank lyll-f SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5 Property line 24 il- Absorption field s r Water main K/L/i Water service line /,0 �r Surface water /100 'Y - Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /D t` Building foundation- /br Water main N/A Water Service line /O't Surface water. /Oar/o'.• Driveway, parking/vehicle storage Curtain drain Af 4 Wells on adjacent lots /04; t F. COMMENTS 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 HAA guidelines in effect on this date. Engineer's/Printed Name Date �f3�o3 HAA Fee S 2�,, S Date of Payment X01' ,^ (i Receipt Number �Y L (Rev. 12101) Waiver Fee $ Date of Payment Receipt Number JRs Pumping PO Box 773415 Eagle River, AK 99577 (907) 694-6454, invoice BILL TO JOB SITE Remax of Eagle River Laura Hamilton 16600 Centerfield Dr 22221 Anthem Place Eagle River, AK 99577 Chugiak, AK 99567 Invoice Number. 9908 Invoice Date 27 -May -200 Order Num: 9908 Serviced: 21 -May -2003 Manifest P.O. Number. Job Description: 1000g/ 21 min Quant ServiceType Tax I x2 Workers 1 Septic Service Under 2k $115.00 No No Subtotal NonTaxed: $115.00 Subtotal Taxed: $0.00 @ % Tax. $0.00 Subtotal: $115.00 Less Payment: $0.00 Please Pay: $115.00 Payment Terms: Net 30 A color T I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE, H FOLLOWING DESCRIBED PROPERTY: -3G , DATE: AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY GRID - EASEMENTS, COVENANTS, OR RESTRICTIONS Hwif�z WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB` ye/e ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. DRAB f yi OF A �! } Vr.••• LS -45919 ,t �' 29