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HomeMy WebLinkAboutNORTH SLOPE #1 BLK 4 LT 8Onsite File AdML Slop Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221293 PID Number: 050-511-28 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New V Upgrade Name Joseph & Jane Quinn ABSORPTION FIELD © Deep Trench ❑Wide Trench ❑Bed El Mound Site Address 30723 Ku parukAve ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 1.2 GPD/SF 8 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2.72 Ft. Gravel depth beneath pipe 5.2g Ft. Subdivision Block Lot North Slope #1 4 8 P Fill added above original grade 0.54-1.80 Ft. Gravel length 40 Ft. Township Range Section Gravel width 3 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line 422 Ftz 1 Ft. Well 100+ 100+ TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1000 Gal. Surface Water 100+ 100+ ( Material Plastic Number of compartments 2 Lot Line 5+ 10+ I NA Foundation` 10.2' 10+ ` TATION Manufacturer Capacity Gal. Remarks Alarm location Electric ' ailed by PIPE MATERIAL House to tank Tank to D3034 drainfield D3034 Installer JR's Drainfield D3034 CO/MT D3034 Inspector Arcterra BENCH MARK (Assumed elevation) 100 ft Inspection 1�Location and description dates: 8/18/22 2nd 8/18/22 3`d 8/19/22 41h 8/22/22 Porch corner ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp +,&..VIS.111,rtllo Conditional Approval: Date * 49 1h '} 00 ■ j. Gas KENN M. S Ar Septic System / , Approved i ✓ Date C/' 12 CE 116 ��+�E` 1 /1 •,++11rixt E Note: this approval does not include well permit requirements. (Rev 05/02/18) AS -BUILT SYSTEM DETAILS/SITE PLAN Permit ❑SP221293 NORTH SLOPE #1 BLOCK 4 LOT 8 PID# 050-511-08 1o, - A -C=12.6' A -H=16.7' B -C=36.1' B -H=37,2' A -D=12.8' A -I=49,0' B -D=36,2' B -I=37,5' A -E=13.3' A -J=51.0' B -E=36,4' B -J=39.0' A -F=15.7' A -K=85,9' B -F=36.9' B -K=77.7' A-13=16.1' A -L=86.2' B -G=37.0' B -L=78.4' W N S 0 A 0 N ,It AdWl OFa A * 9 TH KENNETH �� s - w� EXISTING BUILDING 6 '`D�ivEwgY 9$,8 94.53 or A �1 FINAL GRADE 000 GAL SEPTIC MTER 1000 TANK SHED `.. �l FCO 0 0 M • = :Ml 85,8 SEWER ROCK .85.85 (I 78.8 ani 40' 79,8 'ED aim SCALE: NTS PREPARED FOR: JOSEPH & JANE QUINN 30723 KUPARUK AVE, EAGLE RIVER, AK FIELD BOOKS BOUNDARY: N/A srmNG- N/A As"'T` SALIZ DWG. RLE: AcAD "m FILE COMPUTED: DRAWN: KSD MECKIM: KMD. DATE 9/ B GRID. SE070 " N°'` 22128 y zzs�oo rn N 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: OSP221293 Work Type: Septic Upgrade Tax Code Number: 05051108000 Site Legal Address: NORTH SLOPE #1 BLK 4 LT 8 G:0703 Site Mailing Address: 30723 KUPARUK AVE, Eagle River Owner: QUINN JOSEPH F & JANE K Design Engineer: ARC TERRA CONSULTING INC This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: ent 5' Deiiartment 8/16/2022 8/16/2023 43260 ❑ 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 Special Provisions: • Locate the edge of the existing bed prior toinstallation to confirm that the 10' separation between the tank and field willbe met. Confirm the separation on the record drawing. Received By: Issued By: 3 CO ' I ren n-:dVPd 011n� "�o �DCq'�tan o�C,?���Sti roc, U2U,/�9 -J A C Date: Date:Z2- MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel 1. D. 050-511-08 Property owner(s) Joseph & Jane Quinn Day phone Mailing address 30723 Kuparuk Ave. Eagle River, AK Site address 30723 Kuparuk Ave. Eagle River, AK Legal description (Sub'd., Block & Lot) North Slope #1 Block 4 Lot 8 Legal description (Township, Range & Section) Lot Size 43,260 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field X❑ Initial ❑ Single Family (SF) IN (w/wo AD U) Septic Tank N]Upgrade X❑ (D) El Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Dea Duffus (Signature of property owner or authorized agent) Permit/Rush Fees: �4 .59 5 Date of Payment: 7./,2 5/-�o 2 2 Receipt Number: 0 8 b 3 76Q Permit No. 05P,921 a 9 3 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc August 17, 2022 ARC TERRA CONSULTING, INC 20441 Ptarmigan Blvd, Eagle River, AK 99577 Office (907) 696-61 l I, Fax (907) 868-3793 Municipality of Anchorage Development Services Department On - Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519=6650 Subject: OSP221293- Change Order Request - NORTH SLOPE #I SLK 4 LOT 8 On August '17, 2022, the excavator started groundwork for the installation of the a roved leachfield. Initial excavation ex osed the existin 7 drainage bed in a different location than shown on the recorLYinformati�n use for this permit. The record information indicates the 1984 system consists of a 30'x 45' bed which is closer to the existing building structures. We have also located indication of the existing curtain drain further northeast than originally shown. With this new information we are requesting permission to re -locate the approved design further away (northeast) of the edge othe slope while maintaining the required distance from the curtain drain and its possible outfall location. We do not expect there to be any adverse effects to the existing: well or this septic system operations in the existing location. If you have any questions, please contact me at 696-6111 /FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. Ken Duffus, P.E. Attachment: On -Site Septic System Upgrade Change Order 20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221293, Deb Wockenfuss, 08/16/22 Co & I WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLAN NORTH SLOPE #1 BLOCK 4 LOT 8 PID# 050-511-08 %4A, DJSTALL NEV ID00 �� GAL TANG SHE. l'NN_ 0 GARAGE. a EXISTING ' ; • BUILDING 4• � .DRIVEi✓AY..- y:,'' n% TANG E REMOVED CURE a/ J � FLAG PROPERTY LINES DESIGN DETAILS WELL RADII & EASEMENTS 3 BDRM X 150 GPD = 450 GPD PRIOR TO C❑NSTRUCTI❑N 450 GPD/1.2 GPD PER SQ. FT.= 375 SQ. FT (375 / 2')/(5' ED) = 37.5 FT. TRENCH USE 1 TRENCHi 38' (L) X 2' (W) X 5' (D) Total depth of system Is 8' Max from original grade. Total depth of gravel below distrlbutlon pipe Is 5' . Scale: 1'= 40' PUBLIC VITHIN 200' OF o NOTES: PROPOSED SYSTEM. n ND PRIVATE WELLS WITHIN DF PROPOSED SYSTEM EXCEPT ASS NOTED. 1. INSTALL 1000 GAL. TANK & INSULATE TANK IF <4' COVER, NO 200' O E�XCEPTHIN 2, INSULATE TRENCH WITH 2' HD BURIAL FOAM IF < 3' OF FILL. u PROPOSED WELL NOTEDF o MIN, 2 FILL WITH INSULATION, >3' COVER NO INSUL REQ, 3. TANK TO HAVE MIN. 20' MANWAY RISER PER CODE. 1 4. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INT❑ SEPTIC TANK, 5. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT L ��' WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC... PREPARED FOR: JOSEPH & JANE QUINN 30723 KUPARUK AVE. EAGLE RIVER, AK RELD BOOKS BOUNDARY' N /A SiAWNG N/A ASBUILT: _ DWG. FILE: ACRD FILE FILE COMPUTED: DRAWN: KSD CHECKED: KMD DATE - 8 17 ) SID: SE07C " No.: 22128 PAGE 1 OF 1 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221293, Deb Wockenfuss, 08/16/22 CERTIFICATE OF OWNER 1P1-7 , the under- signed, hereby certify that to my knowledge, no easements, covenants, or restrictions legally exist on this property which I have not revealed to the surveyor of this tract, namely Lot 8, Block 4, North Slope Subdivision, Addition Ido. 1. - DATE SURVEYED: 29 JAN 1984 DRAWN BY: BRK SCALE: I"= 50 ft. 0 i0' 25 50' 75 100 150' NoRTI! 546PC .54119DIV131o1V A01770nl NO, I LtSU17'E0 !N: se w, sec 3z, T/iYN, RIE .3GrJ4rF.0 M"IDIAIV CERTIFICATE OF PROFESSIONAL LAND SURVEYOR I hereby certify that an asbuilt survey of Lot 8, Block 4, North Slope Sub- division, Addition No. 1, Anchorage Recording District, Alaska, has been made by me or under my direct supervision; that improvements are situated as shown hereon and that no visible easements exist except as indicated hereon. Encroachments: NONE Dated at Anchorage, Alaska, this 3Aap day of FEa-Z'4'Cy , 1984. TIM PEARIA PROFESSIONAL LAND SURVEYOR 2055 CAMPBELL PLACE ANCHORAGE, ALASKA 99507 c -u io 1nrv. v/iol C1. 6).'�57/r%�� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 0* ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME Q /UO r PHONE 2 ,) NEW 37 UPGRADE MAILING ADORE�i S LEGAL DESCRIPTI.ON o ri A SI o LOCATION S—A by-/ � ��`/ �lver UY— e, / NO. OF BEDROOMS /d v Y DISTANCE TO: Well 0 L d Absorption area / Dwellin 01 ! 1 PE IT NO r , J �. F- z Manufacturer e Material No. of compar ments LU > (e �eI a. Liq. capa ity iry�a[Ions � U(J IF HOMEMADE: Inside length Width Liquid depth _j 0= z DISTANCE TO: Well Dwelling PERMIT NO. z H Manufacturer Material Liquid capacity in gallons = DISTANCE TO: Well O / F ndati ' Nearest lot line 1 �y /t PEWIT NO W �. (/ e LL z F z w No f lines Length of ep�h�e otall41 %h j Ijnes `T' T�epQV width / —f J 7C 0 iuclzce Distance between lines (7 Q � ¢ Top of tile to finish grade / Material beneath the Totaleffective ab prption area inches 35 0 f w Length Width Depth PERMIT NO. 0 < H CL LU Type of crib Crib diameter Crib depth Total effective absorption area U) DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. J W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER u Q g PJ PIPE MATERIALS C 3 SOIL TEST RATIN % `- T. QC o 0 INSTAL ER skA�� REMARKS , I (i Cl- O -F' a±C2 r 9 Of 0 A10 -to I I 'I-,, U n G �s Gr 110A �Z, 4bo 3f 6 �' /3' '� t e. 1 ? APPROVED DATE LEGAL 4� c -u io 1nrv. v/iol C1. 6).'�57/r%�� 2E;d--,::l. 72Et : F:fi'-,tCHOF.'.'FIGE PERH:[ 'i" NO. FIF'F'L]TCF~NT: ._TO::'5-,EF'H FIND 5'FINE F:E::,[::,F?.E~'-'g: :.-.-:,RF~ [::0::.:; ::i..~!~;2 F! N C., FII-::: 995 !'..5 L. EGFIL. 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":.:" - '" :: =: ;-"': '"' R'::: "': "' ' -: ::" ::THO t]:Oh!F'FIRTI"IEI",T,!- TRt",II<:::' ~\ O "FF¢',II':" '-":; '[ -'::" F' = '1, .c'~¢:'~l:I GFILLEIN% '-.--".%, ..~.~= E..Z C" ~,T..:" LE :~:E;; :E E~'i Ih,ti k!t[:'TH := J.:E. 'Z~ FT. \ ¢ 5 f? ~ ~"_ !L? "*' ICl ~'" LENGTH = ~':L:.':. I..':l FT. ti TOTFIL DEF'TH := 5. ~Z'~ FT. x~ ¢-J """ ~ f. .ar,,r',,,,=L E:'EF'TH = E"l. 5FT. -'"""~' '"' ',,,'Fd...UHE ::::: ;.::hE;. 7' Cf...I. "r'[:'~.;. TFtNk: :5 Z ZE: = %, .." F:l*;'~. E'i GFtL. LON:5 ':: THO :':OHF'F F.'THENT TFiNI<:::' kill)TH = ?;. ~ FT. LENGTH = E;:.::":. lZiFT. TOTFiL i:::,EF'TH := 7'. IZ~ FT. GF:Fi:,,,'EZL. [:,EF'TH = 2... IZi FT. GF:Fi',,,'EL VOLL1HE = ,::l.(t. :~',::lJ. "r'E:,~;. 'i"Fli",ti'::: S;ZZE: = i., E'iE'uL~h ~iFI .3FtLLON9 ,::"i'HO C'..'i'I'F'Ft~'THEHT Tt'ai',h~:::::' Z :::EF.'T.T.F"r: YPIFiT: ':.i... :'[ FtH FFtH:[I.....~FtR H]:TIq THE REE.!Lt:[F:EHENT5 FOF.': r'.:N--'~ZTE 5E!-,.!ER:5 FOR'i"Fi E.F/ THE I"ILIN]:L.,~F. LiT L3F Fit",iCHORFtGE FINI)THE L:TFf't"E OF FtL..FI'.."~;k:Ft. 2. Z F.!:[L.I .... N..':,FPL. L TFIE .:,',,':TEl1 ]:N FIZ:Ff:'F.'E'FINE:E I.,J~[TH THE CODES RN[::, HFt',,,'E F?E"ET","Et) R __.:OF'"," OF' THE CODE ::'5.,UHHRI:;.:"r' FiND E:,:[F!GF.:I~H FITTFICHHENT2"; H.H_.T.E:H F'EF.:H .T.T. ::, ~' .:,TE., t 2.. .T. LiND'ER:.:..;TFli",ti:::' "f'HFFt" THE EIt",F"'S ]: TE '_:,E!...iEF;-': '-' "- '-~"' · F:E:.E;:[DEi",~F:E .'i:t~; F.:EHODE.:LEI) 'l'Z~ :i:NE:LLIDE I'"i'"~'~:E 'f'HFIN 2 E~EE:,F.':L-n3H5. F'ERH ri: 'F F~F'F'L ]: CFtI",IT FIR:::.:; 'THE F.:E:~;F'ON:5 ]: E', .T L. :[ T'?' "D:~ ']: i",IF'ORH F'E:F::%ONNEL L':,IJF.'. '[ NG _ _ _ ~ ~ ~ru T"rF'II"~E:, THE.'t:NtSTFILt...F:tT.I:ON :[H'.F,F'E::.:"f':[E¢4'-:5 FIF FIN"r' HELl ':, RI":,..'rFiCENT TO THE ?qLfHE',E':F.: OF F.'.ES:[E:,Ei'-,E:E:E; T.HFFI" T!--IE: HE'LL i,t]:L.L :SEF.,E. :i:F' F~ L.]:FT :ii;"l'l::l"F~.:,t'.,i ]:E; ]:i'-,i[STFtLLED., fin ELECTF:.T. CF~L F'EF:I'"tZT FINE:, :[H'SF'E'L:'TZON HIJ"_:;T E~E OE~TFt~t',IEE:,. FI!.:,.:-.Efl...I]:LT:T.', "'l::ll'.,ihfOT ErE F:IF'F'F.:O',/ED P.i:i:THE~UT Fli'.,i tEL.ECTF.'.ZCFIL. :!:H'_:;,F'ECT]:ON F:EF'OF::T. THE ELECTR]:Z:FIL t.4OF:I<: HI..EST BE [', .:' t'-,tEX D"r' I:::1 L.T.'..:EN'SEr::, EL. EF:"f'R: :[ L: :[ FIN. E:,FITE: ::LL,- 1._ ,. ,:,-'. Department~ .f Health and Environmenta ?rotection 825 L Street, Anchorage, AK. ~9501 264-4720 * * * HANDWRITTEN PERMIT * * * Permit ~ ~ ~ ON-SITE SEWER PERMIT , ~ ,J~ U~ ~~Mailing Address: ~R~ ~Z~ /~- Applicant:~)~~ ~ Location: L Phone Number: ~ ~ 7--c~~' Legal Description: ~-~t~' ~ ~/" t~ _~'~/~ ~ ~ Sige: Type of Soil Absorption System Is: Trench: Drainfield: Seepage Bed: ~//~'~ Holding Tank: Maximum Number of Bedrooms: \..~ Soil Rating(sq.ft/br) The Required Siz¢~of the Soil Absorption System Is: DEPTH LENGTH 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(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE : /~C~ GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31~ 1 9 * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more Signe~:Ap~l-~ca~!~(~ / % ' ~~~ Issued bY: that ~/~edr°°ms' SWP/024(1/81) ' O & E ENGrNEERING & DEVELOYMENT'CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG 688-2280 Performed for: Name: LegalDescription: ~'r ~/ ~ZZ:~.~4 ~,/~-~'r~.1%~.~/°~''-) 1~,~2,~,,0~"~/~,~/:'~/- / Depth (feet) Soil CharacteriStics 6__ 7__ 8__ 9__ 10__ 11__ 12__ PLOT PLAN 13 14__ 15__ 16__ Ground Water Encountered: Yes Proposed Installation: Seepage Pit.__ Comments: No Y If yes, what depth Drain Field ~ PERC. TEST 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 Parcel I.D. 050-511-08 Legal description North Slope #1 Block 4 Lot 8 Site address 30723 Kuparuk Ave. Eagle River Current property owner(s) Quinn Expiration Date: 12-14-22 X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or advisories: bedrooms, with the following stipulations: Original Certificate Date: 9-14-22 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 Arsenic Advisory Other COSA Approval June 2022 --------------- 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. 050-511-08 Complete legal description North Slope #1 Block 4 Lot 8 Location (site address) 30723 Kuparuk Ave. Eagle River, AK Current property owner(s) Joseph & Jane Quinn Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: © Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel © Plastic ❑ Concrete ❑ Fiberglass Age 0 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed © Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ 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 $ SRU — Waiver Fee $ Date of Payment qh 62- o4�3a� Date of Payment COSA # n5G Z'�_ 11452 Waiver # COSA Application—June 2022 XqZ Legal Description: North Slope #1 Block 4 Lot 8 Parcel ID: 050-511-08 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ❑✓ Well log is filed with Onsite (or attached) Date drilled 12/20/15—Total depth 125 ft Cased to 125 ft ✓❑ Sanitary seal is functioning correctly ✓❑ Wires are properly protected Casing height (above ground) 35 in. Date of flow test for COSA 5/9/22 Static water level at beginning of test 92 ft. Comments B. TANK DATA Measured operating fluid level in septic tank New Date of pumping New tank installed 8/18/22 ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 8/1.9/22 F/I ALL standpipes present per record drawing Total measured depth from grade 9.8 ft (max) Measured depth to pipe invert from grade 3.26 ft (min) ❑ N/A — pressurized field. 0 Per record drawings, field is insulated. ./❑ 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 Comments/Deficiencies: COSA Checklist June 2022 Well production at time of test 5.1 gpm Water storage tank volume - gallons Well disinfected for coliform test? ❑ Yes W N ❑✓ Coliform bacteria is Negative Nitrate 0.683 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ✓❑ Arsenic less than MRL (ND) Collected by Areterra Consulting Date 5/9/22 STATION ❑ Require�enance completed Age of lift station e `� rys Lift station material Comments; Adequacy test date New Results ❑ Pass Fluid depth prior to test _ Water added gal New fluid depth in Elapsed time min Final fluid depth in 2 Absorption rate gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) in Effective depth used in Effective depth remaining 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' J❑ Yes if No Community Sewer Manhole/Cleanout > 100' 0 Yes if No ! ft ® Yes if No It Neighboring Tank > 100' ✓❑ Yes if No ft Private Sewer/Septic Line > 25' ✓❑ Yes if No It Absorption Field on Lot > 100' ❑✓ Yes if No ft Holding Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' 0 Yes if No ft Q Yes if No ft ft If tank or field is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ©Yes if No ft ❑✓ 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' J❑ Yes if No ft Surface Water > 100' n Yes if No ft Tank to Property Line > 5' n Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' J❑ Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' ✓❑ Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' El 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 f=irm Arcterra Consulting Phone (907)-696-6111 Engineer's Printed Name Kenneth Duffus Date 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 cannot 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. COSA Checklist June 2022 ~._~.. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 8 Block 4 North Slope Subdivision #1 - T14N R1E Section 32 Location (address or directions) Kapanuk Street (b) Property Owner Joseph Quinn Telephone: Home 688-2831 Mailing Address 2434 Eagle River Road, Eagle River, Alaska (c) Lending Institution Telephone Mailing Address Business 99577 (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the followin(~ address: or: Check here E], if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family []× Number of Bedrooms three(3) WATER SUPPLY Individual Well~X Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite [~xxPublic [] 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 1 of 2 72-025 fRev 8/86~ Front EN~GINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA 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 wastewater 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 files 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. NameofFirm A.E.C...q, Thc Telephone 561-$04.0 Address 1200 West 33 Avenue, Suite B Anchorage, Alaska 99503 Date Engineer's Seal This department has received written confirmation of the pumping of the septic tank. This now meets with the Conditional Approval of March 6, 1987. Therefore, this property now meets with Municipal standards. DHHS APPROVAL Approved for three (3) bedrooms by Approved XXX,%Y_Y. XXXXXXX Disapproved Conditional Terms of Conditional Approval Date March 25, 1987 CAUTION The Municipality of Anchorage Department of Health and Human Services fDHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS 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 72-025 fRev 8/86) Back MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date ~'~.'~ /z'~r- ~' g'~.~ GENERAL INFORMATION (MuSSI:"~"~-COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location.(~ddr6ss or directi~d'~),'=; ·" (b) Prosody Owner s%~'~' . ,. Mailing Address - (c) Lend,n§ Insbtubon · . ." ..... Mailing .~ddr. ess "..'. (d) Real Estate Company and Agent Telephone: Home 6¢~F~----.~'~''%~? Business Telephone Address Telephone (e) Mail the HAA to the followina address: or: Check here J~. if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family~ Number of Bedrooms ,7 WATER SUPPLY Individual Well,~] Community [] P~blic [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 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 1 of 2 72-025 fRev 8/86) Fronl ,5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA 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 wastewater 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 files 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 ~. ~"-~-- Address / Date Telephone DHHS APPROVAL Approved for "~'~'~'~$)bedrooms by ~0.~ ~. '~..~.~ Approved Disapproved Conditional Terms of Conditional Approval Date CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements, Employees of DHHS 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 72-025 fRev 8/861 Back MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: p-~'~,'/o ~'/~- WELL DATA Well Classification /¢~? ~'¢ Well Log Present~'~N) Total Depth ~7 5'~- Cased to Static Water Level Casing Height Above Ground '~' (" / Electrical Wiring in ConduitS/N) Separation Distances from Well: To Septic/Holding Tank on Lot /Z ~'- If A, B, C, D.E.C. Approved (Y/N) Date Completed /,/J~//~ ~ Yield Depth of Grouting "v~J/~ Pump Set At ,~. rp ,'-- Sanitary Seal on Casing~'~N) Depression Around Wellhead (Y~) ; On Adjoining Lots ~>/'¢ o / To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole ,A~"~/,~, Water Sample Collected by /O-~ / ; On Adjoining Lots ~./o To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date ~,-~ '7/-~ Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~--~?~"-~/ Size /¢ ¢ (') No. of Compartments Standpipes d~N) Air-tight Caps~N) Foundation Cleanou~N) Depression over Tank (Y/~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) /~///t ; for Holding Tank High-Water Alarm (Y/N) ~.~.7/.~ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well / 'Z_~ / To Property Line /"Z-O / To Water Main/Se[yic¢ Line ? To Building Foundation ~' / To Disposal Field ~_.2..¢ / To Stream, Pond, Lake, or Major Drainage Course Page 1 of 2 72-026(1~/84~ C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~- ~ 7 r-- ~ ~ Width of Field ~ ?, Type of System Design Length of Field ,,...,~ ~;, ('~" ......~'~*~'('~ Depth of Field ~" Gravel Bed Thickness /~Z~- Square Feet of Absorption Area /.~,-L.,.~7~ z Standpipes Present f~N) Depression over Field (Y(¢~ Date of Last Adequacy Test Results of Last Adequacy Test /'~- ;'~'~'~-"/. Separation Distance from Absorption Field: / To Water-Supply Well /E:~. ~ To Property Line --~'5~- / To Building Foundation ';Fr-~ TO Existing or Abandoned System on Lot /t )¢.,t~ '~ ¢~ '~ o'~ /'~. ; On Adjoining Lots /'~'~,4.~ .t..~_~/- , To Water Mair~iService Line /t%r/','~ To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course /b, To Driveway, Parking Area, or Vehicle Storage Area ,'~-'~" 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/Acces~,~/N) ~ Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have.0~ecke~J, verifie, d,,Cr conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ¢'~~/ Date Company v~'/~-s~' ~ MOA NO. ENVIRO~ENTAL SERViCEs Page 2 of 2 Receipt No, Date of Payment Amount: $ 72-026 (11/84) RECEIVED MUNICIPALITY OF ANCHORAGE DMSION OF ENVIRONMENTAL HEALS'H DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Legal Description (include lot, block, subdivision, section, township, range) (a) Location (add~ess or directions) (b) Applicants Narre -~ o%~ p~t C~u =~;~ Applicants AddFess ~b3W ~1~ ~zu~ (c) Applicant is (che~ o~) ~nding Institution Su~r ~ ; ~her ~ (e~lain); (d) ~nding Institution ~o~ %~%q&$ Ad.ess f~ ~ ~- ~0~ ~ (e) ~al Estate ~. & ~ent g~ Telephone Owner/builder Telephone ~_,7 2. -/96-J Address Telephone 2o Type of t~esidenoe Single-Family Numbe~ of Bedrooms 3. Water Suppl~ Multi-Family Other (describe) Individual Well ~ C~a¥~,nity ~-~ Public ~-~ Note: If ccrm~nity w~ll system, ~st ~ ~it~n ~nf~tion ~ ~e State ~p~nt of ~viro~ntal Con~rvation attesting to t~ legality ~d status. Is ~e ~11 ade~ate foF the n~r of ~ s~cified in this ~ ~) 4. ~e Dis~al Onsite ~ ~blic ~. ~r~nity ~ Holdin~ Ta~ ~[ dis~sal system adequate f~ ~e ~ of ~ ~) Is t~ ~stewateF 2-15-84 5. Engir~cring Firm P~oviding Inspections, Tests, Data and Information 6. DHEP Approval Approved for Appr ov~d ~-~ I certify that I have checked, verified, on conformed to all MOA HAA Guidelines in effect ' ' ' Signed °~fj~----__ Date -. ~t~ ~ ~ ~te ~sap~o~d~ ~ndit ional ~ Terms of Conditional ApP~oval The Municipality of Anchorage Dapa~tment of Health and Environmental Protection does not guarantee the continued satisfactory performance of the water supply and/or the wastewater disposal system. This approval indicates that, as of the validation date shown above, based on the data and information furnished by an engineer registered in the State of Alaskat the water supply and wastewater disposal system is safe and func- tional for the number of beclrcc~s and type of structure indicated° (DHEP SEAL) 7. MailPthe HAA to the following address: KB2/d5/s [Page 2 of ~2] Be WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH ALrlMORITY APPROVAL (FAA) CHECKLIST - FEBRUARY 1984 Well Classification I Well Log P~esent .(,'~N) Total Depth q~ Cased to Static Water Level \~ ~ Pump Set At Casing Height Above Ground ~, Elect]zical Wiring in Conduit (Y~ Separation Distances from Well: To Septic/Holding Tank on Lot \ MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION.' MA",' '1 8 1984 RECEIVED' )a 1.pesc_~ip tion.: If A, B, c~ C, D.E.C. Approved(Y/N) Date Completed I ~1 ~1 ~ ~ Yield 7C4%),f~L Depth of Grouting ~-- Sanitat~y Seal on Casing (Y~ Depression A~ound Wellhead ~/N) ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot 103 ~t, ; On Adjoining Lots CTI ~0~-~__ To Nearest Public Sewer Line ~ To Nearest Public Sewer Cleanout/Manhole -~ To Nearest Sewer Service Line on Lot ~ Wate~ Salrple Collected By ~b~A ~C)~-Y% ; Date ~1 j~ ~ ~ ~ Water S afg0~ei-~ Te,s-t-- ~ s u 1 ,t.s ~ ~Ti-~ ~-TS-6L~O p~l ' ,~ ~ SEPTIC/HOLDING TANK DATA ...................................... Date Installed ~-~- Standpipes ~FN) Depression over Tank Size \0(~0 .(:~(:L[ NO. of Co,~a~t/t~nts ~__ Ai~-tight ~ps ~) Foundation Cleanout ~) ~te ~st P~d ~ P~ing~intenan~ ~n~a~ ~ File (Y~) ~ ; for ~ Holding Ta~ High-Wate~ ~a~ (Y~) ~ ~a=y Holding Tank Pe~t (Y~) ~p~ation Distance ~ ~ptic~olding Tank: To Water-Supply Well TO Property Line TO Water Main/Se_-vice Li~ ~/'~ Co~ To Building Foundation To Disposal Field 2 To Stream, Pond~ Lake, c~ Major D~ainage Comments [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~ ~ ~/~ Type of System Design ~,i'6~,3 '~-~'~ Date Installed ~_~'~-~ q 0.Deng.hh of Fie'ld ~c% .~x~, Square Feet of Absorption A~ea Depression over Field Y~N) Results of Last Adequacy Test Depth of Field ~ Gravel Bed Thickness J~2.%7- Standpipes P~esent ~Y~N) Date of Last /~d~quacy Test Separation Distance from Absorption Field: To ~ater-Supply Well ~0-~ To P~operty Line To Building Foundation '~2~ To Existing or Abandoned System cn Lot ~ /~ ; On! Adjoining Lots ~ T To Water Main/Service Line ~/.~ To Cutbank(if present) To Stream/Pond/Lake/o~ Major D~ainage Course /~ /f~ To D~iveway, Parking A~ea, o~ Vehicle Sto~age A~ea ~'~0 ~-~ Date Installed Size in Gallons "Pump On" Level at High Water Ala~-m Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA Con~nts ...... ** Check Permitted Bed~ccm Rating Against HAA Request I certlfy that/J~ha~ve ch~e~ed, verlfled, or confc~red to all MOA HAA ~Gi~; ~%~ effe t on the ~ theirs~ lns~eqt~c~ ~% ,, ~O0o-~ ~ [Pa~ 2 of 2] 2-15-84 ALASKA fllUIRORmI~FITAL COI1TROL $1~RUICE!$, Inc. I~nqin~¢rin~ ~ ~uironm~ntal $1udie~ NAME COMPANY CONTACT REPORT ADDRESS / ~'~ /~L ~-~ /L/~K/-4 ~:O~C ~',1 PHONE NO.# SUBSECT OF CONTACT .OR PRO3ECT NAME OF. PERSON MAKING CONTACT SYNOPSIS OF CONTACT- .C~,~& o~ c:~-~~,~Y., ~:~-~ H/~ m. ALASKA eiIOIROIqmeFITAL CONTROL $1 I 'rJjCI S, IFIC. I~n~lJneerJn,:I & ~nuir'onmentr~l $1uJies June 4, 1984 Department of Health and Environmental Protection 825 L Street Anchorage, Alaska 99501 Attention: Keith Bandt Re: Lot 8, Block 4, North Slope #1 Dear Mr. Bandt: I visited Lot 8, Block 4, North Slope #1 on May 31, 1984, at approximately 7:00 p.m., I observed the electrical wiring to the well p~np was secured properly, the sanitary seal was tight and soil has been mounded up around the well head. However, the landscaping and drainage problems over the system and tank have not been resolved. I recoranend removal of only the well portion of the conditional Health Authority Approval for the Certificate issued May 18, 1984. If you have any questions, please let me know. RG/caj Approv~ Sincerely, Ronald ~. Golden Environmental Engineer MUNICIPALITY OF ANCHORAGI] DEPT, OF HEALTH & 5NVI~ONM~NTAI- PROTECTION, RECEIVED. 1200 ~J~:st 33rcl Auenue, Suite [~ · Anchora§¢, AI,sk, 99503 ~, (907) 276-1361