HomeMy WebLinkAboutBYERS LT 17AByers
Lot 17A
#090 - 041 - 47
(Rev 05/02)
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE
WASTEWATER INSPECTION REPORT
Permit Number: OSP251066
PID Number: 090-041-47
Dwelling: X Single Family (SF)
❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New R Upgrade
Name
385 INDIAN TRUST
A RPTION FIELD
❑ De Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
385 Indian Rd, Indian,
AK 99540
Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from originalg e Gravel depth beneath pipe
F . Ft.
Subdivision
Block Lot
Byers
17A
Fill added above original grade Gr length
Ft. Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Dista between lines
Ft.
SEPARATION
DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dr he
Dist. between ts
From
Tank
Field
Tank
Line
Ftl
t.
Well
>100'
N/A
N/A
N/A
>25
TANK R Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Greer
Capacity
1250 Gal.
Surface Water
> 100'
N/A
N/A
NIA
Material
Plastic
Number of compartments
2
NA
Lot Line
>5,
N/A
N/A
N/A
Foundation
>1o,
N/A
N/A
N/A
L STATION
Manufactur
Capacity
Gal.
Remarks Deep burial tank
Alarm location
Electric ed by
PIPE MATERIAL House to tank D3034Tank to D3034
drainfield
Installer
Northern Excavation
Drainfield N/A CO/MT NSA
Inspector Jared Earls
BENCH MARK (Assumed elevation) 100 ft
Inspection 1s' 4/7/25
Location and description
dates:
2 nd
Tank manhole cover
3rd
4th
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Ln�
Conditional Approval:
Date
w .���
f
~
_Ben'
)arrunSchiller
CE 12592 •
�'
Septic System
Approved
Date
ec
�r'Aise AMW
• 4/24/25 • �V
pOFESStfl,
,Nlk
ote: this approval does not include well permit require , ents.,�,��-o
(Rev 05/02)
NEW 1250 GALLON TANK
Benjamin Schiller
CE 12592R
E
GISTEREDPROFE S S I O N A L E N GINEER
1"=50'
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
BYERS SUBDIVISION, LOT 17A
FEET
0 50 100
IN
D
I
A
N
R
O
A
D
SEPTIC PLAN
3/24/25
WELL
4-BDRM HO
M
E
LOT 17A
UN
D
E
V
E
L
O
P
E
D
UNDEVELOPED
A
B
MH
2CO
DV
A B
FCO 15.5
MH 68.0
SV1 73.0
2CO 75.0
DV 77.0
16.4
72.0
76.0
77.5
79.0
PROFILE AS-BUILT
(NO SCALE)
95.5
90.0
95.8
99.8
FC
O
MH
SV
PERMIT # OSP251066 PID # 090-041-47
PROPERTY LEGAL DESCRIPTION
1250 GAL
SEPTIC TANK
2C
O
95.3
Benjamin Schiller
CE 12592
R
E
GISTEREDPROFE S S I O N A L E N GINEER
4/24/25
100.0
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP251066
Work Type: SepticTank Upgrade
Tax Code Number: 09004147000
Site Legal Address: BYERS LT 17A GA455
Site Mailing Address: 385 INDIAN RD, Indian
Owner: 385 INDIAN TRUST
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Effective Date:
Expiration Date
Lot Size in Sq Ft:
Total Bedrooms:
UcpartIn 11t
3/25/2025
3/25/2026
62382
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: ` r �' r 6 L Date:
Issued By: Date:
4
� \J)
CPALIT ANCHORAGE � Y
Development Services Department ) Phone: 907-343-7904
On -Site Water & Wastewater Section
ON -SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 090-041-47
Property owner(s) 385 Indian Trust Day phone
Mailing address 10200 Nigh Road, Anchorage, AK 99515
Site address 385 Indian Road
Legal description
Byers, Lot 17A
Number of Bedrooms 4
Engineering Firm Forge Engineering
Building Permit Number
Not Applicable
APPLICATION IS FOR: APPLICATION IS AN:
(® all that apply)
Absorption Field
❑ Initial ❑
Septic Tank
0 Upgrade 0
Holding Tank
❑ Renewal ❑
Privy
❑
Well
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Permit/Rush Fees: _ k6r') Waiver Fees:
Date of Payment:
Permit No. 05P2 �51066
Date of Payment:
Waiver No.
Distance:
March 24, 2025
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Byers Lot 17A – 385 Indian Road
Septic tank replacement
Dear On-Site Services Engineer:
The owner of the above lot intends to replace their aging septic tank. The attached site plan
identifies the location of the home existing well, septic system, and current tank. No conflicts exist
between this proposed system and any other well or septic system, whether on this lot or adjacent
lots.
Wells on this and adjacent lots are shown. The new tank will be a minimum of 100’ from all wells
and surface water, and more than 5’ away from the trench. We have noted the existing diverter
valve and have specified that the new tank tie in to that valve.
Please refer to the attached septic plan. If this design is followed, there will be no adverse impacts
to adjacent properties.
Sincerely,
Benjamin Schiller, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251066, Curtis Townsend, 03/25/25
NEW 1250 GALLON TANK
Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER
1"=50'
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
BYERS SUBDIVISION, LOT 17A
FEET
0 50 100
IN
D
I
A
N
RO
A
D
SEPTIC PLAN
3/24/25
WELL
4-BDRM HOME
LOT 17A
EXISTING SEPTIC TANK
DECOMMISSION PER UPC OR
EXCAVATE AND REMOVE TIE IN TO EXISTING
DIVERTER VALVE
UN
DE
V
E
L
O
PE
D
UNDEVELOPED
WELL >100' FROM PROPERTY LINE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251066, Curtis Townsend, 03/25/25
m
a
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50, B'L•M.
P UgLIAY &
EA SEMEMTLITy
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N 79 50' 381,
W 285.77
SINGLE FAMILY
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THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY
Nn SHANE A. HOLT DO CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND I5
Jp LS-6914 NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES.
EASEMENTS OF RECORD, OTHER THAN TH05E APPEARING ON THE RECORD PLAT, ARE NOT SHOWN
HEREON (UNLESS INDICATE[))
4A�o fes s iona\6o NOTE: FEN ELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE
400��000 PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE.
AS -BUILT SURVEY 1" = 40'
NO CORNERS SET THIS DATE
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
LOT 17 A, BYERS SUB. ( PLAT 81-301)
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
EXIST OTHER THAN NOTED.
DATED AT ANCHORAGE,ALASKA THIS 29TH DAY OF
_SEPTEMBER , 2017.
HOLT LAND SURVEYIN6
9309 &ROVER DRIVE
ANCHORAGE,AK 99507
345-5513
Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 Page 1 or 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP171264 PID Number: 090-04147
Dwelling: ❑■ Single Family (SF) ❑ Duplex(D) ❑ Multiple (SF and/or D) Project: ❑ New 0 Upgrade
Name:
Nathen & Elizabeth Ellis ABSORPTION FIELD
Address ❑ Deep Trench ❑■ Shallow Trench ❑ Bed ❑ Mound
385 Indian Rd, Indian, AK 99540 ❑ Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
4 1.2 GPD/SF 5.5 Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot 1.5 Ft. 4.0 Ft.
Byers 17A Fill added above original grade Gravel length
Township Range Section 1.0 Ft. 60.0 Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES 5.0 Ft., Ft.
To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches
From Tank Field Tank Line 600 Ft2 Ft.
Well - >100' - — - TANK ❑Septic ❑S T.E.P ❑ Holding ❑Other
Manufacturer Capacity
Surface Water - >100' - - Gal.
Material Number of compartments
Lot Line - 10' - -
NA
Foundation - >10' - - LIFT STATION
Manufacturer Capacity
Curtain Drain None Noted Gal.
Remarks Pump on level at Pump off level at High water alarm at
in. in. in.
Pump make and model Electrical Inspections performed by
PIPE MATERIAL House to tank D3034Tank to D3034
Installer drainfield
Isaac's Excavation Drainfield D3034 CO/MT D3034
Inspector B Schiller/ J Millette BENCH MARK (Assumed elevation) 100 ft
Inspection Location and description
dates: 1st 9/22/17 2nd 9123117
3rd 4,d Nail in tree by drainfield
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Eritg 1eue
.4: t- ° q r,is
Conditional Approval: Datec. `..�,#
...,* . .� •
•
o .L� J
d
i 'f '•. C.11 1 +
♦� 1. • o
Approved i^r— Date /(�-7___V-( QI. 0.
, . .* oo
Inspection Report_9-1-12.doc
BYERS SUB, LOT 17A
PERMIT # OSP171264 PID # 090-041-07
US SURVEY 3200
-=20ICEA___Ej.,S-EMETNNTN
LOT 14A
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LOT 17A '\ —
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50' EL" EASEMENT / 2C0 A 70.0 75.0
ITH 11-,,L44 eas P�s�rc
EMENT DV 72.3 77.5
2C0 112.0 79.1
•
C01 155.8 134.2
MT1 157.3 136.0
/ CO2 148.6 144.8
MT2 145.9 141.1
/ US SURVEY 3200 - - ____ _._/
i LOT 21
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QF \ LEGEND
j/ i�P� AC,gs�'l�r MT-MONITORING TUBE
;#-*: , . ar DV-FLOW DIVERTER VALVE
r • •• •••• •• 0 2C0-DOUBLE CLEANOUT
Ir
..�... ...... ...% CO-CLEANOUT Benja iS Schiller : Al
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l PROFESSIONP = = M FEET
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BYERS SUB, LOT 17A
PERMIT # OSP171264 PID # 090-041-07
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT: 343-7904
4700 ELMORE RD, ANCHORAGE, AK 99519-6655
WASTEWATER DISPOSAL SYSTEM OR WELL INSPECTION REPORT
OIL-. / 98.6 FINAL GRADE fp
U_�_ / / 97.6 ORIGINAL GRADE 2_ U_
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f INSULATION
_ .. ._ ..
96.1 DRAINFIELD ROCK 96.1
92.1 92.1
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GROUNDWATER @ 87.1
9/4/17
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Ben'. in Schiller /�
PROFINEAS BUILT o �,•. 'FL 12592 ...$.
ir1142017 ..;e,
OSppROFE ,
MUNICIPALITY OF ANCHORAGE
• \\ On-Site Water&Wastewater Program .S
a PO Box 196650 4700 Elmore Road
' Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
http:/fwww.muni.org/onsite a t
1)(1)artm int
'V O R PGS
On-Site Wastewater Disposal System Permit
Permit Number: OSP171264 Effective Date: 9/20/2017
Work Type: Septic Upgrade Expiration Date: 9/20/2018
Tax Code Number: 09004147000
Site Legal Address: BYERS LT 17A G:4455
Site Mailing Address: 385 INDIAN RD, Indian
Owner: ELLIS NATHEN J & ELIZABETH A Lot Size in Sq Ft: 62382
Design Engineer: FORGE ENGINEERING Total Bedrooms: 4
This permit is for the construction of:
Q Disposal Field 0 Septic Tank 0 Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: ► Date: Q 1
Issued By: ' ot. ( ayoi)..9 Date: M
MUNICIPALITY OF ANCHORAGE
I`
s
_
c■
Community Development Department .46,.. r/ Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On-Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 090-041-47
Property owner(s) Nathen & Elizabeth Ellis Day phone 351-6.6. 36 _
Mailing address 385 Indian Rd, Indian, AK, 99540
Site address 385 Indian Rd
Legal description (Sub'd., Block & Lot) Byers Sub, Lot 17A
Legal description (Township. Range & Section)
Lot Size 62,382 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(LI all that apply)
Absorption Field IXI Initial I I Single Family (SF) n
(w/wo ADU)
Septic Tank ❑ Upgrade X
Duplex (D)
Holding Tank ❑ Renewal
Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE 1 WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
kAi
(Signature of . .perty owner or authorized agent)
Permit/Rush Fees: ° 69 Waiver Fees:
Date of Payment: 1/1 11Date of Payment:
Receipt Number: 0 1 Cri 3 C Receipt Number:
Permit No. O5 11 1 2-b Li Waiver No.
Permit App_.;-:•._.,.C:
FORGE ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
September 19, 2017
Municipality of Anchorage, On-Site Water& Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Byers Sub, Lot 17A
Septic system design and permit application
Dear On-Site Services Engineer:
The owner of the above lot has an existing 4-bedroom home on the property, but the absorption
bed has failed. We are submitting this permit application for the construction of a new absorption
trench for the septic system. The attached site plan identifies the location of the home, well,
septic tank, and existing absorption bed, as well as the proposed absorption trench location and
alternate site. No conflicts exist between this proposed system and any wells, whether on this lot
or adjacent lots. Drainage arrows are shown on the site plan showing the grade and direction of
flow. The drainage pattern in general will not be changed by the construction.
The test holes placed on the lot indicate sandy gravel with silt. No bedrock was found down to
13'. Some water seepage was observed at 8', but the water level stabilized at 10.5' after the 7-
day monitoring period. The percolation rate was determined to be under 5 min/in. An application
rate of 1.2 gpd/sf was used in the design of the absorption system. We are proposing to place a
new absorption trench 5' wide x 50' long x 4' effective depth. The elevation of the distribution
line will be 1.5' below the surface for a total depth of 5.5'. Soil will be mounded 1' above the
trench. A minimum of 2"of insulation and 2' of fill will be placed over the absorption trench and
4' over the septic tank.
The existing septic tank appears to be intact and in reasonable condition. Our design is to dig up
the line after the septic tank and install a double cleanout along with a bull run valve into the
existing line. The new line will connect to this valve, allowing the homeowner to switch back to
the original bed as desired, after it has recovered sufficiently. This will extend the life of both
septic beds.
The ground surface on the lot slopes moderately on the site, mostly 10-15%. Only in the far
northwest corner of the lot are there steeper slopes, where the ground has been flattened for the
house pad. The slopes do not exceed 25% anywhere near the areas of the septic system. The new
trench will be constructed parallel to the slope as much as possible. It will be a minimum of 100'
from all wells and surface water, and more than 5' away from the septic tank. The alternate site
is located more than 20' away.
If the system is constructed as designed, it will have no adverse impact:
• On the wells in the area or those to be constructed in the future.
• On existing septic systems in the area or those to be constructed in the future.
• On reserve space, either surface or subsurface, on any lots located in the area.
• On drainage patterns in the area. The current drainage pattern will be maintained.
t.
l•` j 4 e
Sincerely, m, � =".4 r
::1I 0
Benjamin Schiller, PE e •fir- J — •
1
1_ us SURVEY 3200
:20I. � L0T14A�6 �EMENT�
N BYERS 8UBOM ON ��
c ''
7/ NbC) LOT iIA�_ \
a`/ c��o� EXISTING 1000—GAL
/ N \ SEPTIC TANK
4-BDRM HOME
t <0()/9 / 1
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I ` EXISTING WELL / /
/ s N
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���P 100' WELL RADIUS `�� 4/1,"�'
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NEW DOUBLE
1 TH#10 / CLEANOUT AND BULL
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50' LONG x 5' WIDE, 4'
1 _ EFFECTIVE DEPTH
- E�C ABSORPTION TRENCH
1----
'-'-' BL EA ES MEN /
UTILITY MF-ASEMENTIC 1- 5.-L
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SITE
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US SURVEY 3200
LOT 21
NOTE:
_ „����xx, NO SLOPES>25%WITHIN 50'OR SURFACE
iir OF 48�i,� SWATER YSTEM WITHIN 100'OF THE PROPOSED SEPTIC
i* TH -1, !#1
••• i•r.
NO CONFLICTS WITH WELLS OR SEPTIC LEGEND
•' ""'/ SYSTEMS ON ADJACENT LOTS
Benja•'�Schiller ' MT MONITORING TUBE
r,PF••• •AE 12592 .•"`�/� 0 50 100
j• $ept9 p17 •,• FCO-FOUNDATION CLEANOUT
I`�;F�PR0FESS10NP�,4 FEET
TH TEST HOLE
ANk.N.��` 1"=50' CO-CLEANOUT
BYERS SUBDIVISION LOT 17A
DESIGN FACTORS: SYSTEM REQUIREMENTS:
600 GPD PEAK FLOW 5' WIDE TRENCH SYSTEM
PERK RATE: 2 MIN/IN 1000-GAL SEPTIC TANK (EXISTING)
APPLICATION RATE: 1.2 GPD/SF
600 GPD / 1.2 GPD/SF /5' WIDE * 0.5 REDUCTION= 50 LF TRENCH
THEREFORE: CONSTRUCT AN ABSORPTION TRENCH 50' LONG x 5' WIDE x 4' EFFECTIVE
DEPTH. FLOW LINE ELEVATION IN TRENCHES TO BE 1.5' BELOW ORIGINAL GROUND
SURFACE. TOTAL DEPTH TO BE 5.5 BELOW EXISTING GROUND. PROVIDE 3' COVER OR 2'
COVER AND 2" INSULATION OVER ABSORPTION TRENCHES AND 4' COVER OVER SEPTIC
TANK.
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:I:I�1�•:1:l:l:••I��l.•`r!�f 1:1:1:1:•�t:•:•:•:t:t:t:t,
:+:I:1:1:l���1�1,;�l:�•+I•`I�1:/:/:/:t:1:t:1:/�t:t:t:f:1.
:I:I:I:I:t:1�f���f�+�+:1:/:•:t:t:t:t:1:1:t:t:t:t:1,
5'
4' TO SEASONAL HIGH GROUNDWATER
6' TO BEDROCK OR IMPERMEABLE LAYER
5' WIDE TRENCH SECTION
oF•el •q1'+
(NO SCALE) iP•' ) •�
•
*••
tom 2 %\ k fTea
NOTES: •.11110-..a..
GRADE AREA OVER TRENCH TO DRAIN AWAY
MIN 6' SEPARATION FROM BEDROCK . Be - in Schiller
MIN 4' SEPARATION FROM GROUNDWATER r+��F�,•., A 12592 .•
MIN 100' SEPARATION FROM NEARBY WELLS r��eks:o• .....N..��
MIN 100' SEPARATION FROM SURFACE WATER OR STREAMS �\\�����4
MUNICIPALITY OF ANCHORAGE I 4���\,\NA:v,
DEVELOPMENT SERVICES DEPARTMENT 'P,0 =��+
4700 ELMORE ROAD ANCHORAGE, AK 99519-6650 r*:,milli �� .##1.
SOILS LOG AND PERCOLATION TEST ,, • ,, • ,,
r • Be in Schiller
LEGAL DESCRIPTION: BYERS SUB, LOT 17A �rr��1 o s,po2air 92 •'c`��
PERFORMED FOR: FORGE ENGINEERING '414. °PROFESS100.47
DATE: 8-25-2017 PROJECT No.: \\\\���4
PARCEL ID#: 090-04 1-47 TECHNICIAN: J. MILLET T F Professional Engineers Stamp.
DEPTII TEST HOLE
(feet)
1 SLOPE SITE PLAN
2 SILTY GRAVEL
3r4.;;tt3 ..3,
4 ., iv;X:
5 —R�gf.: �.i SANDY GRAVEL W/ SILT SEE SITE PLAN
t'i 1'y,
Q kr•.+%iT.8
V iZVY7:M
iyix
WAS GROUND WATER ENCOUNTERED:'SEEPING
I 0—M7,510 a.; jy•� IF YES u..WHAT DEPTH? 8
,t'F'M -e-e4.1
1 I— t•~`'���'� � DEPTH OF WATER AFTER MONITORING: 10.5'
� ftgsr; , DATE OF MONITORING:9/4/17
12 :)'int _ ,
.x.rAfi..` t GROSS TIME NET TIME DEPTH TO NET DROP
13 ." `"'`�'' BOH DATE READING WATER
(MINUTES) (MINUTES) (INCHES) (INCHES)
14 8/25 TEST HOLE PRESOAKED PRIOR TO TESTING:
15 I 2:32 0
16— 2 2:44 11:36 6 6
17— 9 3:27 0
18 10 3:40 12:45 6 6
19 II 3:42 0
20 12 3:55 12:44 6 6
PERCOLATION RATE: 2.11 (M1N/INCH) PERC.HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 3 FT. and 4 FT.
COMMENTS: PERK TEST WAS RUN 6 TIMES. INTERMEDIATE RESULTS ARE NOT SHOWN BUT WERE VERY SIMILAR.
.~-. MUNICIPALITY OF ANCHORAGE
D~. aTMEN'I' OF HEALTH AND HUMAN SER' ES
. .~ ,. Environmental Health Division
~. - 825 'L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Nar. a .............. DISTANCES
~'~.?¢~ C, /Eye.s '~._' TI1 ..... S~.PTIC ABSORPTI~t'
WELL
^~,essFROM ~...~.- TANK FIELD
Phone(s) IPermit N0. IND. o~ Bedrooms WELL
~A~ ~sc.,.~o. ' LOT LINE /0
Township. Range. Sectio~
AS-BUiLT ~IAGRAM (Show location o[ well, seplJq system, prope~ty hnes, foundation,
~C ~ ~ !0 ~ ~ t ~ drl~way, waterbo~ies, etc.)
. Manuiactu[c~ Capacity m g~tons
Material No. el Compadmenls
TYPE OF SYSTEM ~
~pm ,O p,pe before Item Total depm item ong,na, 0fade ~
' ~1"' added above orlgl.a' g--de Gravel depth beneath pipe '
~vel' length G~avel wldlh
Tolal absorpl,on area D,stance between lines
Installer Date Installed ~
WELLS
'~lass~ficahon~ ~(A,B,Cl " Total Depth I Cased to '
FT
FI ~ ~-~
REMARKS: ,,,
~t ~/~' ° ..... ~ ' Scal~'~5 ENGINEER'S SEAL
Inspections Pedormed by:
,,. ~a~e: /~ ~ ~ ~
...........................
I c~ily thai this inspemion was peflormefl acmrdin9 m all
Municipal and State ~ifl~ in effect on this date: /~ ,- ~- ~&
HeaJth Depa ~ment Approval: ~~~~~
~0
DEF:'ARTI~IENT OF HEALTH AN])
825 L S'I"REET~
F-"NV I R[]NME'NT'AL PR£]TECT I ON
ANCHORAGE, AK 99501
264-4720
F:'ERH I'I NO: 850692
DATE I SS]EL): 10/23/$5
APPL![]ANT: ERNEST C. BYERS
ADDRESS: SR BOX 8862'. INDIAN
INDIAN, Al< 99540
C:ONTACT F:t-'IOI'4E: 276- 1735
LEGAL DESCRIP: SUBDiVISISN~ INDIAN US SURVEY3200 L_OT: ].7 A BI_OCK: NA
SECTIGN: ~) T'OWNSHIP: 10N RANGE: tW
LO-I SIZE: 1.4.:?]';A (SQ.F1. OR ACRES)
MAX BEDROOMS: 4
Listed below ape 'Lhe options available 'Lo you in designing your ,_seotic
system. Choose the optiorl that best ~its youp site.
DEPTH I'O PIPE BOTTOM (FT.)
GRAVEl_: DEPTH (F'T.)
TOTAL DEP]'H (FT.)
GRAVE]- WIDT'H (FT.)
GRAVEL LENGTH (FT.)
GRAVEL VOLUME (CU.YDS.)
TANK SIZE (GALS)
SGII_ RATING (SQ.FT. /BR)
** DEPTFt "ro PIPE BOTTOM <
3.0 .e-x- 4..0 3.0 ~.~.
3.0 0.5' 3.0
6 ~ iD 4.5 6.0
2.5 227.0 5.0
184. () ** 54.0 129., 0 '*'~'
59 ,, 7 54. O 8:5.7
1,250.0 -~.* 1,250.0 *~ 1,250.,0 ~*
2.75 242 275
3.5 FT. REQUIRES IlxhSUL. ATION
¢-',,¢' DEPTH TO F'IPE B[]'T'I'OI~I < 4.0 F'T'. MAY REQUIRE A LIFT STATION
sc-* GRAVEL LENGTH > 75 FT. REQLIIRES MULTIF:'L.E RGNS (NG'T EXCEEDING 75 FT. EACH)
'~"~ TANK MUST HAVE AT LEAST TWO COMF'ARTMEN-I-S
cert:il'y that:
1,. I am familiar with '!:.he req~uirements
for' on-site se:.wer~s and weIls as set
forth by the Mun:icipality of Anchorage (MOA) and the State of Alaska.
2. :¢ will install the system in accordaece wi'Lb all MOA c:odes and regulations~
and in compliance with the design triter'ia of this permit.
3. I will adhere to ail MOA and State o¢ Alaska requirements for' the set back
distances er. om any exis{ing well, wastewater disposal system of public
sewei"age system on 'Lhis or' any adjacent or near, by lot.
4.. I understand 'Lhat 'Lhis permit is valid for a maximum of 4 bedr'eoms and
any enlargement will require an additional permit.
IF A LIF'T S-FA'I-IOIq IS INSTALLED l'N AN ARE'A COVIERED BY MOA BUll-DING CODES,
THE:N (:i.) AN ELECTF4ICAL. F:'ERMI]' AI',ID ]:NSF'ECTION MUST BEE OBTAINED~ (2) AS-BUILTS
WILlL NOT' BE AF'PR[]VED WITHOUT AN ELECTRICAL IhlSPE[:]-iON REPOFYr; AND (3) THE
ELECTF<tCA]_ WORK MUS'I BE :OGNE BY A LI[:;E~:NSED EI.._ECTRICIAN.
M-~ieipafi~ o! A~h~rage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: ~'~.~.~'~,~ ' ~-~'
DATE PERFORMED:
(ENGINEER'S SEAL)
io - L~T'-?,S
LEGAL DESCRIPTION: L{~"~ I~ A ~D.~GQ.~ ..~i;1~_{1 T¢~fTownship, Range, Section:
SLOPE
1
2
3-
4
5
6
7
8
9
10
11
12
13
14
15-
16-
17-
18-
19-
20-
COMMENTS
WAS GROUND WATER
ENCOUNTERED?
SITE PLAN
L
IF YES, AT WHAT ' O
DEPTH? a o P
E
Depth to Waler After. p,A~4 1 ~ _ ~ !
Mofliloriflg? Date:
PERCOLATION RATE '~'%'~(~inutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FTAND__ ~ i~.~ FT
Gross Net Depth to Net
Reading Date
Time Time Water Drop
2o9
zi~
2;7:} ~r) A' t '~ ./9
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFEC~'~N THIS DATE. DATE:
72-008 (Rev. 4/85)
HI:.:'t'.'! .~' CF!i'.,I F
] i'.,iD ii; i::if%1
!.Cl-i ..... .,.~ .
MUNICIPALITY OF ANCHORAGE
Development Services DepartmentPhone: (907)343-7904
On -Site Water & Wastewater Section Fax: (907)343-7997
Certificate of On -Site Systems Approval
Parcel ID 090 -041-47
Legal description BYERS LT 17A
site address 385 INDIAN RD
OSC251141
Expiration Date: 3/24/2026
Current property owner(s) 385 INDIAN TRUST
X The On-site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
Original Certificate Date:
4/28/2025
This -Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
sstem(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage,
Development Service 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 submittal.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
im
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. 090-041-47
Complete legal description Byers Lot 17A
Location (site address) 385 Indian Road , Indian, AK 99540
Current property owner(s) 385 Indian Trust Day phone
2. ON-SITE SYSTEMS SIZED FOR BEDROOMS
3. TYPE OF WATER SUPPLY: * Private Well E] Private Well serving 2 dwelling units
El Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ru-1 Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank M Community Septic or Public Sewer
5. SEPTIC TANK: El Steel E] Plastic n Concrete n Fiberglass
Age NEW _ See advisory if steel older than 20 years
6. ABSORPTION FIELD: F-1 AWWTS R Bed EJ Deep Trench 0 Wide Trench M Seepage Pit
Waiver request for:
Expedited review requested: FN
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 -6 <6'
Date of Payment z
COSA #_
Waiver Fee $
Date of Payment
Waiver #
COSA ApplicationJune2022
Byers Lot 17A 090-041-47
3.4
1979 118 N/A
118
38
3/24/25
84
2017
3/24/25
N/A
3/24/25
225
>600
48
(907) 522-7773
Benjamin Schiller, P.E.
ALUMINUM
CAP
W
O
O
LOT 14
7g050 r38'E285.77,7;TS-
N
_ 532 LOT 17A
SEE 62,382 sq. ft.
BUILDING GRAVEL
DETAIL _ DRIVEWAY
1_�
l4
WELL
x
_ I
x x x FENCE J
�Oo
O x—x—x
0
_O x
Z
x 1 -STORY
//r --FRAME
x BUILDING
31•3' SEPTIC
o
i�) GUY STANDPIPES
�x
SEPTIC.—
MANHOLES' }
rb /
} 0
�P
' M }
11.1' O• ANCHOR
J UTILITY 1
}� POLE
EC.
--x— - 50' B.L.M EASEMENT -E°
�^ P BL/C OT /WY Y & ; OV {go�UTILITY NL E /
/
/ N 79055100„ W91
.00'
LOT 21
GRAVEL
CANT. CANT. DRIVEWAY
io
5.5' C1' 40.5'
2 -STORY o
06 FRAME
HOUSE 9.2'
55.2'
DECK SEPTIC
CANT. STANDPIPE
BUILDING DETAIL
1"=20'
EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE
RECORDED SUBDIVISION PLAT (81-301) ARE NOT SHOWN HEREON.
THIS DOCUMENT DOES NOT CONSTITUTE BOUNDARY SURVEYAND
IS SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT
BOUNDARY SURVEY MAY DISCLOSE.
UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE
USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR
ESTABLISHING PROPERTY BOUNDARIES.
THIS SURVEY REPRESENTS A MORTGAGE LOCATION SURVEY
PREPARED IN ACCORDANCE WITH THE ASPLS MORTGAGE LOCATION
SURVEY STANDARDS.
THIS MORTGAGE LOCATION SURVEY SHOULD ONLY BE USED FOR A SINGLE PROPERTY
TRANSACTION. RE -USE OF THIS DRAWING BY THE ORIGINAL CLIENT OR BY OTHERS, FOR
ADDITIONAL USES ATA LATER DATE WITHOUT EXPRESS CONSENT OF THE SURVEYOR ISA
VIOLATION OF FEDERAL COPYRIGHT LAW. UNLESS GROSS NEGLIGENCE IS DISCOVERED,
THE LIABILITY EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES
COLLECTED FOR SERVICES IN PREPARATION OF THIS PRODUCT.
JOB # 25046B I NO CORNERS SET THIS DATE I SCALE 1" = 50'
REBAR
00,
0 25' 50'
OF gC.,S�JI�/
*: 49 T
...............................
�'• B6 u Saliz : �o
�i 's'• LS -14837
�
OFESSIONP\'Po�`
AS -BUILT
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
LOT 17A, BYERS SUBDIVISION
ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT
THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE
WITHIN THE PROPERTY LINES AND NO VISIBLE
ENCROACHMENTS EXIST EXCEPTAS INDICATED.
DATED THIS 11th DAY OF APRIL, 2025,ATANCHORAGE,
ALASKA.
FIXED HEIGHT, LLC C.O.A.122554
Land Surveying Services WWW.FIXEDHEIGHT.COM
600 W 41 st. Ave, Ste. C, Anchorage, AK 99503 907.290.8949
•
• c:, a y 'D '7, Q.G` 84`
Municipality of Ancho `�
_ _ A - --------
On-Site Water and Wastewater Pro -- n—' '' z
(907) 343-7904 Eli SAFETY
cl OCT 132017
ti
Certificate of On-Site Systems •:
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 Forge Engineering Phone
Address 1399 W. 34th Ave. Suite 203
Engineer's Printed Name Benjamin Schiller Date 1x /15/17
alfetc„t, 917.. 444.
. rN •
6. `/DSD SIGNATURE V
N System #1 Approved for bedrooms $ `o jt
,Q 1 ••�".,
9
System #2 Approved for bedroomsS .• tsf�32 `4
Disapproved 01°-
Conditional approval for bedrooms, with the following stipulations:
•
0- C --k-zRA4 eeAdtl
JkYfv"9p tc.. 2 AltocrU
-r` `( OF,gNCy'.
-`� t-�e ode
Wgcs PNp
STcW 11'0ER
W RGGRp,M '_
F1vT SFRv`G
v�-- Original Certificate Date: f C/ "Ed` /7
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_f
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: Byers Lot 17A Parcel ID: 090-041-47
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (YIN) Y
Date completed 6126179 Sanitary seal (Y/N) Y Wires properly protected (YIN) Y
Total depth 118 ft. Cased to 1 18 ft. Casing height (above ground) 38 in.
FROM WELL LOG AT INSPECTION
Date of test 6/26/79 1016117
Static water level 92 ft. 81 .3 ft.
Well production 3 g.p.m. 3'25 g p m
WATER SAMPLE RESULTS:
Coliform Nr) colonies/100 mL Nitrate Si S' mg/L
Arsenic ND ug/L Date of sample: 10/9/17 Collected by: Forge Eng.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Steel Date installed 10/08/86
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (YIN) Y Depression over tanktar (Y/N) N High water alarm (Y/N) N
Date of pumping g/ )/( 7 Pumper .&/ke c to1.1lYy9(i?li( _
C. ABSORPTION FIELD DATA
Date installed 9/2117 Soil rating (g.p.d./ft2 or ft2/bdrm) 12 GPD/SF. System type 5-Wide
Length 60.0 ft. Width 5.0 ft. Gravel below pipe 4.0 ft.
Total depth 6.5 ft. Eff. absorption area 600 ft2 Monitoring tube Y Depression over field N
Date of adequacy test New Const 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 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 >100On adjacent lots >100'
>1Absorption field on lot 00' On adjacent lots 100'
Public sewer main X75' Public sewer manhole/cleanout 100'
Sewer/septic service line X25' Holding tank X75'
Animal containment areas >50' Manure/animal excrete storage areas >100'
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5 Property line ]�j 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 1 Building foundation >10 Water main 10
Water Service line Surface water 100 Driveway, parking/vehicle storage >10'
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
G. ENGINEER'S CERTIFICATION VOA V411t
l certify that I have determined through field inspections and _".9F.•a •l�s.
review of Municipal records that the above systems are in 0 �,A . ..1-I�
conformance with MOA COSA guidelines in effect on this date. s : 49 Tyr rpt p lot
Engineer's Printed Name
Benjamin Schiller ••• ''„
st
Date 10/15/17 % IL++ . J Sc 7 "' ,
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COSA brown sheet 10-10-12.doc
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AS-BUILT SURVEY 1" = 40'
..cggO�O1 NO CORN!HS SI-I I HIS DA IF
v 710 I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
v Q-'.. �
.4F1,4137."
O TH /\ -.`*0� LOT T17 A, BHE YERSGSUB. (IPLAT BED P801-301)
ERTY
� � : 49
Q � ril /1/44694 - ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
0 0 . a 0 THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
O SHANE A.HOLT..' 44t.D CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS:AND IS THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
LS-6914 ,;O
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES.IMPROVEMENTS,OR FENCELInES, EXIST OTHER THAN NOTED.
440 e0. •• .••• 0 Op EASEMENTS OF RECORD,OTHER THAN THOSE APPEARING ON THE RECORD PLAT,ARE NOT SHOWN DATED AT ANCHORAGE,ALASKA THIS 29TH DAY OF
� DICA TED)
II OJesslona‘ .c " NOTE: FHEREON ENCELIP. SUNLESS N THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE SEPTEMBER , 2017.
ODO�OOQ4 PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. HOLT LAND SURVEYING
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. 9309 GROVER DRIVE
ANCHORAGE,AK 9950
345-5513
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 090-041-47
GENERAL INFORMATION
Complete legal description
Location (site address)
Lot 17A, Byers Subdivision
385 Indian Road
Expiration Date: / O "..2 ',,~--,- ?/
Current Property owner(s) Ernest C. Byers
Mailing address P.O. Box 1156 Talkeetna, AK 99676
Day phone 350-8324
Lending agency
Day phone
Mailing address
. ..R~ai'Estate Agent
'~"-' Mailing AddreSs
Unless °thentcise requested, COSA will be held by DSD for pickup.
2. NUMBEROF BEDROOMS: Four (4)
Day phone
TYPE OF wATER SUPPLY:
Individual Well []
Individual Water Storage []
Community Class __ Well []
Public Water System []
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding Tank []
Community On-site []
Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Anderson Engineering
Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
DSD SIGNATURE
~"'~ Approved for
Disapproved.
bedrooms.
Conditional approval for
bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: 7 - ,~, ~'- - / /
(Rev. 11/05)
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www. muni.orglonsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description:
A. WELL DATA
Bo
Lot 17A, Byers Subdivision
Parcel ID:. 090-041-47
Well type Pdvate
Date completed 7/25/1979
Total depth ll8 f.
Date of test
Static water level 92
Well production 4
IfA, B, or C provide PWSID # ....
Sanitary seal (Y/N) Y....
Cased to 118 f.
FROM WELL LOG
7/25/79
g.p.m.
WATER SAMPLE RESULTS:
Coliform e colonies/100 mL
Arsenic: N/D ug/I
SEPTIC/HOLDING TANK DATA
Tank TypelMatedal Septic/Stee~ '
Tank size ~,250 gal.
Foundation cleanout (Y/N)
Date of pumping 7/13/11
ABSORPTION FIELD DATA.
Date installed 10/8/86
Length 54 ft.
Total depth 5-7 ft.
Nitrate .999 mglL
Date of sample: 6/30/11
Number of Compartments Two
Y Depression over tank (Y/N) ~
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
5/25/11
77.6 ft.
1.45 g.p.m.
~Y
Collected by: M. Anderson
Date installed
Cleanouts (Y/N)
N High water alarm (Y/N)
Pumper McDonald's Pumping Service
10/8/86
Y
'Soil rating (g.p.d./~ or ~/bdrm) 242 SF/BDRM
Width 28 ft.
Eft. absorption area 1,5~2 ~ Monitoring tube
Y
>18 in.
System type Shallow Bed
Gravel below pip~ .5 ft.
Y Depression over field N
Date of adequacy test 5/25/2011 Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test 4 in. Water added 611 gal. New depth
Elapsed Time: ~,440 min. Final fluid depth 4 in. Absorption rate >'- 600
Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date
in.
g.p.d.
D. UFT STATION
Date installed.
"Pump on' level at in.
Datum
E. SEPARATION DISTANCES
Size in gallons
"Pump off" level at
Cycles tested
in.
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
in.
SEPARATION DISTANCES FROM 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'
On adjacent lots >100'
On adjacent lots >100'
Public sewer manhole/cleanout
Holding tank N/A
Manure/animal excrete storage areas
N/A
>100'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line >5' Absorption field
Water main NIA Water service line >1o' Surface water >1oo'
Walls on adjacent lots >1o0'
Property line >10'
Water Service line >1/o'
Curtain drain None Noted
F. COMMENTS:
Building foundation >1o'
Surface water >1o0'
Walls on adjacent lots >1o0'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Water main >1o'
Driveway, parking/vehicle storage
>25'
review of Munici~l ~s that the above sy~e~ am in
~n~an~ ~h ~ CO~ gui~in~ in e~ on this date.
Engi~(s Pd~ ~e ~ E. ~d~, P.E.
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11105)
Waiver Fee $
Date of Payment
Receipt Number
· TI~E II/FOR.~TIOII IIERE.I~# IIFOR TIlE USE OF LE~ING
ffi EASE~NTS ~ 18 NOT:TO BE ~ Fffi
~DITI~AL STRUC~E$ ~' FENCELISE8
aye. perfomed
Ile~ordln~.Dlstrlct
ar. M 'r~f, aY'i
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CE , ,CA E O ,NSPECT,O HEALTH ^ THOR,TY APPROVAL
264-4720
Application Date
GENERAL INFORMATION
(a)
(b)
(c)
Location'(address or direction~!,;~..
ApplicantNa~e' ~ ~[~ Telephone:Home ~Z~/q Business
Applicant is (check one): Lending institution ~; Owner/builder~; Buyer ~; Other ~ (explain);
(d) Lending Institution A//,~
Address
(e) Real Estate Company and Agent
Address ¢'~Z'~
Telephone //~//~
(f) Mail the HAA to the following address:
Telephone
TYPE OF RESIDENCE
Single-FamilyJ~ Multi-Family []
Number of Bedrooms ~
Other
WATER SUPPLY
Individual Well'l~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status. , i , ~.
SEWAGE DISPOSAL
Onsite.~ Public [] Community[] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page I of 2 72-025 (11/84)
, 5.
ENGINEER NG FIRM PROV D E. ,NSPECTIONS, TESTS, FILE SEARCH, D~. ~ AND INFORMATION
AS certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or waste~ater disposal system is 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 flies and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection. ,~,
Name of Firm "~-~'~ / ./~'r Telephone
Address /.,~!~)~'_) ~.~/ .~,_'~'//~///~ "~ /~//~r~-/~ ~-/~
Date
DHEP APPROVAL
Approved for ~ bedrooms by
Approved ~-/'~ Disapproved
Terms of Conditional Approval
Conditional
CAUTION
The MuncipaJity of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
HEALTH AuTHoRITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4720
Legal Description: L / 7,~ ~{~;~/~,.~-,~,/~(-/~'V
R/2u
WELL DATJ~~'~
Date Completed
If A, B, C, D.E.C. Approved (Y/N)
Well Classification
We~l Log Present
Total Depth /I~;~'
Static Water Level ~//2.
Casing Height Above Ground
Electrical Wiring in Conduit CH)
Separation Distances from Well:
To Septic/Holding Tank on Lot /(~)O.-~' /
To Nearest Edge of Absorption Field on Lot /' 0~) r
~/~-~,/7.~ '""- Yield
Depth of Grouting
Pump set At
Sanitary Seal on Casing ~/N)
Depression Around Wellhead (Y(~
; On Adjoining Lots
; On Adjoining Lots
I '
To Nearest Public Sewer Line /V//./~' To Nearest Public Sewer
Cleanout/Manhole A/.//~ To Nearest Sewer Service Line on Lot
-,.
Water Sample Collected by ~, ~/~ ; Date / ~ ~
Water Sample Test Results ~ ~-~ ~¢~ ~ ~
Comments '~~ ~n ~ ~~ ~/~ F~ ~/~ ~/~/~
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes ~N)
Depression over Tank (Y/~
Pumping/Maintenance Contract on File (Y/N)
/.,
Holding Tank High-Water Alarm (Y/N) /~//./~ Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
TO Water-Supply Well / 0,/').._~-' ' ~'d '
Size /Z'~-O No. of Compartments
Air-tight Caps (~N) Foundation Cleanout~///~,~/N)
Date Last Pumped
;for
TO Properly Line /0 z"7~'
TO Water Maih/Service Line /~//,~
Course /Oo "¢-
To Building Foundation
To Disposal Field /~
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72 026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorptio~2~ta
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/~)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
TO Water-Supply Well
Type of System Design
Length of Field
Depth of Field ~,,
Gravel Bed Thickness
Standpipes Present ~'N)
Date of Last Adequacy Test
To Property Line
To Building Foundation
Lot /~'/~
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area. or Vehicle Storage Area
To Existing or Abandoned System on
; On Adjoining Lots ,~)--uO /'-2/~
To Cutbank (if present) /V'/,,~
comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions ~
Manhole/Access (Y/N) J
"Pump Off" Level at _ ~
V /N) _ __ _
uringAdequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request
I certify that I h a~e/~/?~ed,~verif, j, ed. or conformed to all MOA,and HAA guidelines in effect on the date of this inspection.
Signed I~~ Date
Date Of Payment /~ 5:~
Amount: $
72-026 (11/84)
