HomeMy WebLinkAboutSKYLINE VIEW LT 4Skyline View
Lot 4
#051-192-03
Municipality of Anchorage
On-Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP211400 PID Number: 051-192-03
Dwelling: K Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑Q Upgrade
Name
SCOTT SMOTHERMON
AORPTION FIELD
❑ De Trench ElWide Trench EJ Bed ound
Site Address
19313 WILDWOOD DRIVE, CHUGIAK, AK 99567
Other
Phone
Number of Bedrooms
Soil Rating
Total depth fr original grade
301-7085
3
/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original a
Gravel depth beneath pipe
Subdivision Block Lot
SKLYLINE VIEW - 4
Ft.
Fill added above original gr
Ft.
G I length
Ft.
Township Range Section
- -
Gravel width
Ft.
Beds: Number of Lines
Dist between lines
Ft.
SEPARATION
DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total a orption area
Number of trenches
Dist. between t ches
From
Tank
Field
Tank
Line
Ft'
-
-
Well
*80'+
EXIST.
_
-
25'+
TANK M Septic ❑ S.T.E.P. ElHolding ❑ Other
Manufacturer Capacity
GREER TANK 1000 Gal.
Surface Water
100'+
EXIST.
_
_
Material
Number of compartments
Lot Line
5'+
EXIST.
-
-
NA
PLASTIC
2
Foundation
10'+
EXIST.
_
_
L TION
1
Manufacturer Capacity
Remarks *WAIVER GRANTED - SEE WAIVER # OSV211075
Gal.
Alarm location Electn i alled by
Installer
PIPE MATERIAL House to tank D3034 Tankto
D3034
ARM SEPTIC SERIVCES
Drainfield EXISTING COIMTD3034
Inspector GEG CONSULTANT, JODY MAUS
BENCH MARK (Assumed elevation) 100.00 ft
Inspection ection 1s` 11/23/21 -
Location and description
nd
2
aro - 4,„ _
BOTTOM OF SIDING AT POINT "A"
ONSITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
00600. �
Conditional Approval: Date
oo ��- ' "' t • �s��o
° 49� f
D
J "rey'ess.* °p
Q CE-7953
Septic System
Approved - w — Date
444��P ' • J, s�� t.� p,. c''���pi0
Note: this approval does not include well permit requirements.AEccaa°��40pooto��o
% wv vwvu iof
PERMIT NUMBER:c PARCEL ID NUMBER:
OSP211400 RECORD DRAWING 051-192-03
A I B
I
I
I
I
FCO 6.T 2.1' PERP
MH
26.6'
47.0'
ST1
31.0'
50.8'
DBL1
32.8'
52.4'
DBL2
33.8'
53.3'
C01
39.9'
58.T
CO2
69.
79.0'
MTI
67.3'
77.6'
NOTE: PIPE LOCATIONS ARE
i SHOWN PER FRONTIER
/ SURVEY'S 12/6/2021 AS -BUILT
/ SURVEY. SWING -TIES TO
HOUSE CORNERS WERE
GENERATED IN AUTOCAD.
/ I
\
1
\
\\\ EXISTING DRAINFIELD
INSTALLED CLEANOUT (CO1) \\ (SEE PAGE 3 OF 3
\ FOR ELEVATIONS)—
AT BEGINNING OF TRENCH \
INSTALLED DOUBLE
CLEANOUTS (DBL1 & DBL2)
NEW 1000 -GALLON GREER �\
PLASTIC SEPTIC T_AN_K
W
a
ENGINEERING o SALES o CONSULTING:
--•
PREPARED FOR:
PHONE NUMBER:
/
PAGE NUMBER:
SCOTT & CHRISTINE SMOTHERMON
301-7085
CK
PROJECT/LEGAL DESCRIPTION:
•/
// •
SKYLINE VIEW; LOT 4
J.L.M.
-
DATE:
RECORD DRAWING OF SEPTIC SYSTEM UPGRADE
QA.
`
/
Y'
j j
• `t
.T: •~, ..r
'•3 •.a
.� �
Baa• -.
!
1"=30'
------
1 �
INSTALLED
FOUNDATION
CLEANOUT (FC(
00T
'3_5fD
f'OI
'—INSTALLED NEW
\ CLEANOUT (CO2)
\\ AND MONITORING
\\ TUBE(MT1).
NOTE: OLD SEPTIC TANK WAS
DECOMMISSIONED PER UPC
PER THE CONTRACTOR.
WELL
AV
:
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,/� rpm peurey A. varness ;o ij mr
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CE -7953 = _®
LICENSE 8® ESS S
#AECC884 ViTIA
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ENGINEERING o SALES o CONSULTING:
3701 E. TUDOR ROAD, SUITE 101 "ANCHORAGE, ALASKA -PHONE (907) 337.6179 • WEBSITE: www.gameswngineodng.com
PREPARED FOR:
PHONE NUMBER:
PAGE NUMBER:
SCOTT & CHRISTINE SMOTHERMON
301-7085
2 OF 3
PROJECT/LEGAL DESCRIPTION:
DRAWN BY:
SKYLINE VIEW; LOT 4
J.L.M.
TYPE OF WORK:
DATE:
RECORD DRAWING OF SEPTIC SYSTEM UPGRADE
12/15/2021
AV
:
.H .......... ......................
,/� rpm peurey A. varness ;o ij mr
®® G;
CE -7953 = _®
LICENSE 8® ESS S
#AECC884 ViTIA
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,/� rpm peurey A. varness ;o ij mr
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CE -7953 = _®
LICENSE 8® ESS S
#AECC884 ViTIA
PARCEL ID NUMBER:
PERMIT NUMBER: RECORD DRAWING I N
OSP211400
V 051-192-03
TOP OF MANHOLE FINAL GRADE sr1
(MH1) = 97.06 = 96.79-96.94
MH1
TOP OF TANK @
INLET = 91.62 TOP OF TANK @
OUTLET = 91.61
INVERT OF BUNG @
INLET = 90.94 INVERT OF BUNG @
OUTLET = 90.78
NEW 1000-GALLON
GREER PLASTIC
SEPTIC TANK
EXISTING GRADE = 96.03
C01
MTi CO2
NEW 2" STEEL MONITORING
TUBE WITH TOIP SECTION
SLEEVED IN 4" SOLID PVC PIPE
EXISTING 4" PERFORATED 4' OF STANDING LIQUID IN CO2 DURING 12/13/2021 SEPTIC
DISTRIBUTION LINE. 1.13' ADEQUACY TEST. DISTRIBUTION LINE WAS JETTED DURING
FROM NEW ELEVATION DIFFERENCE FROM CONSTRUCTION BY ARM SEPTIC SERVICES. NO CHANGE IN
sEPrlcL, (QUID LEVEL DURING 12/1312021 SEPTIC Y TES
ADEQUACY TES
WEST END TO EAST END S �.---` Y
rtiNK ► D
INVERT OF
DIST. LINE r
ON WEST
END ,.s s _ ..•_.v
CLEANOUT
= 89.09
BOTTOM OF NEW 2' STEEL MONITORINGINVERT OF
TUBE = 83.32. MONITORING TUBE DRY ON DIST. LINE
11/18/2021.4.64' TO 5.77' OF EFFECTIVE ON EAST
ELEVATION OF EXISTING DRAINFIELD WITH NEW MONITORING TUBE (MT1) END
(FOR INFORMATIONAL PURPOSE ONLY) CL8T96 T
z
11
.. = ... ..... =v
.. 4. .. ...............
ENGINEERING SALES CONSULTING_:=r
3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE. ALASKA" PHONE (907) 337-6179 • WEBSITE. www.gamessengineering.com
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PREPARED FOR:
PHONE NUMBER:
PAGE NUMBER.
SCOTT & CHRISTINE SMOTHERMON
301-7085
3 OF 3
' CE 7953
P / �\AV
PROJECT/LEGAL DESCRIPTION:
PRAWN By:
SKYLINE VIEW; LOT 4
J.L.M.
�l®� p'p•..........,••�'y(.�P�l ®�
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��
TYPE OF WORK:
DATE:
RECORD DRAWING OF SEPTIC SYSTEM UPGRADE
12/15/2021
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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://w .muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP211400
Work Type: SepticTank Upgrade
Tax Code Number: 05119203000
Site Legal Address: SKYLINE VIEW LT 4 GA 159
Site Mailing Address: 19313 WILDWOOD DR, Chugiak
Owner: SMOTHERMON SCOTT A
Design Engineer: GARNESS ENGINEERING GROUP LTD
This permit is for the construction of:
Effective Date:
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
p, Cnr
9641 1 0'.
Duparuncllt
9/30/2021
9/30/2022
43560
❑ Disposal Field 0 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:
Issued By:
1,
Date: "i
Date: Z 1
Municipality of Anchorage
Urp;n•tmenr
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907) 343-7904 o Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Division
On -Site Water and Wastewater Program
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#: OSV211075 COSA#: Permit#:OSP211400
PID#: 051-192-03
Legal Description: Skyline View Lt 4
Engineer: Garness Engineering Group
Your request for a waiver of the required 100 feet horizontal separation from the septic tank to the
private well has been approved. The approved separation distance is 80.0 feet.
This waiver approval applies to the proposed septic tank only. Any future upgrade to the on-site
wastewater disposal system will require all separation distances be met or another approval from
this department.
............................................... ■ ............................. ■ 1
Waiver is Granted: X Waiver is not Granted:
Date: 2 Approved by: (tet/
Name of RevieWcV
M n M 0 0 0 0 M M 0 0 0 0 0 0 n M
**** VARIANCE/WAIVER REVIEW ****
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 I.D. 051-192-03
Property owner(s) SCOTT & CHRISTINA SMOTHERMON Day phone 301-7085
Mailing address 19313 WILDWOOD DRIVE, CHUGIAK, AK 99567
Site address 19313 WILDWOOD DRIVE, CHUGIAK, AK 99567
Legal description (Sub'd., Block & Lot) SKYLINE VIEW; LOT 4
Legal description (Township, Range & Section)
Lot Size Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(Z all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF) 0
Septic Tank
0
Upgrade 0
(w/wo ADU)
Holding Tank
ElRenewal
❑
Duplex (D) E]
El
Multiple
Multiple Dwellings ElPrivy
and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
WELL TO NEW SEPTIC TANK Distance: 80'
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
C)
(Signature of property owner or au orized age
Permit/Rush Fees: 02 2 5 Waiver Fees:�/
Date of Payment: Z 71Z 1 Date of Payment:
Receipt Number: 6-37536 Receipt Number:
Permit No. �O-S PZ I / yn0 Waiver No.
G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211400, Deb Wockenfuss, 09/30/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211400, Deb Wockenfuss, 09/30/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211400, Deb Wockenfuss, 09/30/21
PROPOSED FINISHED FLOCK
ETEY. (ASSUMED)
ON FILE AT MOA ONSITE DEPARTMENT
PROPOSED SUMNO CORNEA
AdIED)
ELEV. (ASSUMED)
ZCNINO OtSTRICT
FRONT DVILD HO SETBACK
PCE BUADNG SMACK
REAR BUILDINO SEMokO
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330.00' S89` 59' OWE
W
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65A
EXISTING
W
HOUSE
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330.00' S89' 59' 00"E
! 30'
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5
UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES.
THE SURVEYOR TAKES
RESPONSIBIUTY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST
OF THE
SURVEY.
LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE.
LOT SURVEY
SURVEY TYPE
SYMBOLS
taro
ASPHALT
FOUNDATION AS -BUILT
SET REBAR
• DRAINAGE
CONCRETE
❑FINAL STRUCTURE AS -BUILT
0 FOUND REBAR 8-9-9' WOOD FENCE
❑ PLOT PLAN ... AS -BUILT ...
LOT SURVEY ... TOPOCRAPHY
OOIl ASSUMED ELEV. -R--X 10 METAL FENCE
�-7� �►
1L LG.1
WOOD DECK
PLOT PLANS & LOT SURVEYS
IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE
TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE
THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT_
SURVEY CERTIFICATION
PLOT PLAN AOF ++�+
I hmoby aertrry that T haw PI•y"y o—oyW
the `ot &." and debut" twom, and that I
haw, round ar MWITehad d of ETN lot _mrIt
4a .Norn m It. Plan and to the b..t of my ,
Mo.loa" and dose ; aQ on alms hM ban Ar h : •��{{ ♦ •�'�'j.'+����j{
.same" VO4 orw trotted. !
FOUNDATION AS -BUILT
I. RoW E. Mhrl& t., herby CWi fy that I
how W01mw m Aa—*At w y of the
roundotion m thb rot and Bat do tha �
dirr ow. oed efamotlm w bo.n l,_i
, "1-4 ,o .na aadwNmt...iot -a—
.oMYY1►e-
FINAL STRUCTURE AS -BUILT
I. Rterert r Johm k., herby o.H%fy Mot I
ho.a Priormeo m a-aat o— y
aL..ctva m thla lot
and Mot oR 1!a
almenllor:e and Womlotlal ae .am hRwn
ora ;rr. Ora ne -V od—t. aaH aNe.a
eha.n �k+arw.e.
�' •R08ERT • S.,JR_
, 411_ -S
14a rOfessionO t+,�10
NOTE:
ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WALL BE
SHOWN. FENCES. WELLS, SEPTIC CL.EANOUTS. SIDEWALKS, DRIVEWAYS,
ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONLY. SNOW
MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED.
ALL DISTANCES ARE: RECORD UNLESS OTHERWISE NOTED.
Prepared by
Robert E. Johns, Jr. & Assoc.
Professional Land Surveyors
1700 Brink DrIm
ANCHORAGE, ALASKA 99504
Scale: 11I + 50' Rec. Lot S,F. Rec. Plat File No.
Date surveyed: 10104!13 Drawn by RE. Checked b,MK
Date Drawn_ 10/05113 Grid- -NW1159 W -D- 13-51
Lot 4
SKYLINE VIEW
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF
HEALTH & ENVIRONMENTAL
PROTECTION
ENVIRONMENTAL. ENGINEERING
DIVISION
825 L Street - Anchorage, Alaska 99501
Telephone 264.4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR
WELL INSPECTION
REPORT
NAME
PH//gQN//E`` ElNEW
XUPGRADE
one
MAILING ADDRESS
LEGAL DESCRIPTION
Z
0//�;lri
'
CSIr 16Z/^Je
LOCATION
14
NO. OF BEDROOMS
%
.i Sr'
DIS TANCE TO:
L- {✓y"
Absor it t anp.l
(-'
Dwelling ,.•-
f"
PERMIT NO,
.----a--eO---
U
eX
Q
Man u facturer�. � ` /lJ �
M�'al
No. of compartments
W I.-
�� /
N
Liq. c 1city in callons
�"�i a�
IF HOMEMADE:
Inside length
Width
Liquid depth
® X
DISTANCE TO:
Well
Dwelling �«
PERMIT NO.
0 Z
Manufacturer -
Material
Liquid capacity in gallons
Well /�j /4,
Foundation %�- -
Neares of 141
PE I VO
z
S
DISTANCE TO:
/ �!Q _
/
[�
C_ �y
W u. U
No. of lines
h li Length o �e
g �•CJL�
Total lei tJ�,of ne
Trenc Idth l/
Distance b weer�li/�es y�
inches
/✓ `/ �-
p.
Top of tile to f" fish grads j
M7 rjal bene t Tile ' �p
/
inches
Total effectiygay�spr�}tio rea
L<LS7.FG7Gi
Length Width
eptII
PERMIT NO.
w
C7
a. M
Type of crib
Crib eters
Crib depth
Total effective absorption area
Uj
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
Class �7
[2
Deyth?` C
Driller
Distance to lot line
PERMIT NO.
J
.i
W
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area (s)
OTHER
-
PIPE MATERIALS
L\
SOIL TEST RATINGp'7
C
e
INSTALLER
< / 7 Z - X, �' ,
tri
/y�/
y
REMARKS
N
-
tt
IP in
6F
ANCHUK
V3/
ENVI
I.,F.
.v E
d
-® ��aFFS5I0NAo
l
APPtED DATE LEGAL
^: a
t:i<.
10 IQ_ 0 chi A: & � 1: `MR.. 31^3- lay ��� 4410 A A FRIM 0 A Ey �
DEPHRTMENT HEll LTH HND ENVIRONMENTHL .ROTECTION
S25 /L' STREET. HNCHORHGE, RK99501
264-4720
6'm FEE 150 U Q Q lot 001 W3 KT: FIN IRE FQ 9 0 T�
PERMIT NO ( O2026] ) ~
m� �
HPPLICHNT F�RN CHHNDONNET �Q `���
LOCHTIDN PETERS CREEK
LEGHL L.4 SKYLINE VIEW LOT SIZE 20000 SQUHRE FEET
TYPE OF SOIL HBSORPT1ON SYSTEM IS: TRENCH
MHXIMUM NUMBER OF BEDROOMS � ] SOIL RHTING (SQ FT/BR)z 150
THE REQUIRED SIZE OF MET SOIL HBSQRPTION SYSTEM IS�
Kim EYE M W 1-1 " :1. KEN �M M CA 7'1qA.=� ?s WW ����E� ���� �-
THE LENGTH DIMENSION IS THE LENGTH (IH FEET) OF THE TRENCH OR DRHIHFIELD
THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE 8ETWEEN THE SURFHCE OF THE
GROUND HND THE BOTTOM OF THE �XCHVHTIOH (IN FEET)
TH�RE IS NO SET WIDTH FOR TRENCHES.
THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFHLL PIPE
HND THE BOTTOM OF THE EXCHVHTION (IN FEET)
PERMlT HPPLICHNT HHS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURIHG THE
IHSTHLLHTION INSPECTI0HS CO: HNY WELLS HDJHCENT TO THIS PROPERTY HND THE
NUM8ER OP RESIDENCES THHT THE WELL WILL SERVE
� - 9- 0"j kip �_,:%, "h(: 011 F"N EYE C: W X CA 1 0 101 101 PC Q Flo EYE W T.j X Ell WRE Co ~~—
BMKFILLINQ OF MY SYSTEM WITHOUT FINHL lNSPECTEON GND HPPROVHL U":Y THIS
DEPHRTMEHT WILL BE SU8JECT TO PROSECUTION.
MIHIMUM DISTHNCE BETWEEN H WELL HND HNY OIiiJSITE SENHGE DISPUSHL SYSTEM IS
100 FEET FOR H PRIVHTE WELL OR 150 TO 200 FEET FROM H PUBLIC NEL... DEP2N�IHG
UPON THE TYPE OF PU8LIC WELL
MINIMUM DISTHNCE FROM H PRIYHTE WELL TO H PRIVATE SEWER LINE IS 25 FEET 8ND
TO A COMMUNITY SEWER LINE IS 75 FEET.
OTCLR REG'!WREMENTS MHY FICHTIONS HND DIAGRAMS HRE
HVHILHBLE TO INSURE PROPER INSTHLLHTION-
MEE FT M 1' F F.'
I CERTIFY THAT
1: I HM FAMILIAR NITH THE REQUIREMENTS FOR GO~SITE SEWERS HND WELLS AS SET
FORTH BY THE MUNICIPHLITY OF HNCHORHGE.
2: I WILL INSTALL THE 5YSTEM IN HCCORDAHCE WITH TH2 CODES.
]: I THAT THE OH—SITE SEWER SYSTEM MHY REQUIRE ENLHRGEMMT IF THE
RESIE)ENCE IS REMODELED TO lNCLUDE MORE THHN ] 8EDROOMS
SIGNED�_
X SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 2644720
\� SOILS LOG — PERCOLATION TEST
PERFORMED FOR: 7" r'll- ilo6/✓/Vc r( [/,n(��/' 3`J �� J DATE PERFORMED:_Nt4t4 e .�a /4cg2
i
LEGAL DESCRIPTION: L-21 ,.-If— 'E(„/ &4 J
br Fq—q7H SLOPE SITE PLAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
lJ I ( vot i n �fatkeA C fPV P,l S
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Robort A. Sha r : 'c
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Reading
WAS GROUND WATERS
Gross
Time
Net
Time
ENCOUNTERED?
Y L
O
IF YES, AT WHAT
"Cn V
DEPTH?
Oa
Robort A. Sha r : 'c
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Reading
Date
Gross
Time
Net
Time
Depth to
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Net
Drop
Oa
00
PERCOLATION RATE_ Zyjh (minutes/inch)
T"
TEST RUN BETWEEN FT AND FT
A �
PERFORMED BY: CERTIFIED
72-008 (6/79)
DATE: --
G� eV
• Municipality of Anchorage
V Fs,
On -Site Water and Wastewater Program _
(907) 343-7904 5'a F E`TyY
Certificate of On -Site Systems Approval
Parcel I.D. 051-192-03
1. GENERAL INFORMATION:
Complete legal description SKYLINE VIEW; LOT 4
Expiration Date: Z-2,1 w
Location (site address) 19313 WILDOWOOD DRIVE, CHUGIAK, AK 99567
Current Property owner(s) SCOTT SMOTHERMON Day phone 907-301-7085
Mailing address
Real Estate Agent
19313 WILDOWOOD DRIVE, CHUGIAK, AK 99567
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for. Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $ 5 O Waiver Fee $
Date of Payment f 2 /�2 2021 Date of Payment
Receipt Number 03249 (7 Receipt Number
COSA # O S C 21172'7 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: Gamess Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101 -Anchorage, Alaska 99507 /
Engineer's Printed Name: Jeffrey A. Garness Date: ?-v',If
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
in accordance with the guidelines and regulations established by the Municipality of Anchorage and
industry practices. The reported results describe the condition of the system/s on the date/s of the
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or
encroachments may exist that were not identified during the evaluation. The operational life of all wells
and septic systems depend upon a variety of variables, including but not limited to, soil conditions,
groundwater levels (that may fluctuate during the year), quality of construction (materials and
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of
the well or septic system. GEG makes no representation whether an alternative well or septic system
can be installed on the property in the event either of the current systems fail to perform adequately in
the future. The content of this report is for the sole benefit of the personiparty that retained GEG to
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
6. DSD SIGNATURE
System #1 Approved for -J bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the
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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 _ Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA We 3heot_10.10-12.doc
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B �• Original Certificate Date: Z — z
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 _ Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA We 3heot_10.10-12.doc
Legal Description: SKYLINE VIEW; LOT 4
If more than 1 septic system on lot: COSA Checklist # 1 of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled "1963
Total depth **128 ft
Cased to **40+ ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 8/18121
Static water level at beginning of test 84.4 ft.
Comments *1963 CIRCA (PER 2016 COSA
B. TANK DATA
Parcel ID: 051-192-03
Structure served by this system I
Well production at time of test 1.1 + ppm
Water storage tank volume N/A gallons
Well disinfected for coliform test? ❑ Yes ❑ No
olfform bacteria is Negative
Nitrate` �' (v mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L Drsenic less than MRL (ND)
Collected by GEG,LTD.
Date of Sample 12/14/21
**PER MOA RECORDS AND 2016 COSA
Age of tank(S) NEW years
Tank type/material PLASTIC
Measured operating fluid level in septic tank NEW
❑ Standpipes/foundation cleanout per record drawing
Date of pumping NEW
D. ABSORPTION FIELD DATA DEEP TRENCH
Which system tested (date installed) 511982
❑ ALL standpipes present per record drawing
Total measured depth from grade *12.7 ft (max)
Measured depth to pipe invert from grade '7.0+1 -ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective *4.6-5.8'
IFT STATION
Regwr aintenance completed
Age of lift station ye
::"**�
Lift station material)
Comments -
Adequacy
Adequacy test date 1ti1"21
Results Cj✓ Pass For 3 bedrooms
Fluid depth prior to test 3.5 in
Water added "500 gal
New depth 22.5 in
Elapsed time 97 min
❑ Code -required soil cover over field Final fluid depth 3.5 in
❑ System presoaked Absorption rate 450+ gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE
date of test)
Gallons introduced 't2OOfl gallons If yes, enter date
Comments/Deficiencies: `SEE ATTACHED RECORD DRAWING SHOWING INFORMATIONAL ELEVATIONS ON EXISTING TRENCH.
"TIM EKLUND WITH MOA ONSITE DEPARTMENT APPROVED PRESOAK AND ADEQAUCY TEST PERFORMED ON SAME DAY PER
PHONE CONVERSTION WITH GEG CONSULTANT, JODY MAUS ON 12/13/2021. THERE WAS 4" OF STANDING LIQUID IN CO2 PRIOR
TO TEST. LIQUID DEPTH IN CO2 REMAINED THE SAME DURING PRESOAKISEPTIC ADEQUACY TEST AND C01 WAS DRY
THROUGHOUT THE TEST. PER ARM SEPTIC SERVICES, THE DISTRIBUITON LINE WAS JETTED DURING THE INSTALLATION OF
THE NEW CO'S AND MT.
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
[D Yes
*$0+
Community Sewer Manhole/Cleanout > 100'
❑ Yes
if No
ft
Q Yes
if No ft
Neighboring Tank > 100' 0 Yes
if No
ft
Private Sewer/Septic Line > 25' [] Yes
if No ft
Absorption Field on Lot > 100' ❑ Yes
if No
**90} ft
Holding Tank > 100' Yes
if No ft
Neighboring Absorption Fields > 100'
Surface Water > 100'
0 Yes
Animal Containment > 50' Yes
if No ft
Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' Yes
if No
ft
n Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' R Yes if No ft Surface Water > 100' B Yes if No ft
Property Line > 5'
[D Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
0 Yes
if No
ft
Private Wells > 100' EI Yes if No ft
Water Main > 10'
Yes
if No
ft
Comr"rdhity Wells > 200' El Yes if No ft
Water Service Line > 10'
Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
Q Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
❑ Yes
if No
**5+ ft
Wells on Adjacent Lots:
Water Main > 10'
[] Yes
if No
ft
Private Wells > 100' Yes if No ft
Water Service Line > 10'
Yes
if No
ft
Community Wells > 200' El Yes if No ft
Surface Water > 100'
0 Yes
if No
ft
F. ENGINEER'S COMMENTS
*SEE WAIVER# OSV211075. **SEE WAIVER# OSP131374
G. ENGINEER'S CERTIFICATION
1 certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
,Jfft y Ga ness.
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Nitrate Advisory
Certificate of On -Site Systems Approval # OSC 211727
Subdivision:
A water sample revealed a nitrate concentration of.9.63 milligrams per liter (mg/Q.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Recommending annual testing. If Nitrates go over 10.0
milligrams per liter further investigation regarding perforations noted at 64.4'
may need to be investigated.
Please see the attached "Nitrate Fact Sheet" for important information regarding
n itrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
Parcel 1.13
o<�
Municipalityof Anchorage
On -Site Water and Wastewater Program
(907) 343-7904 e
5n-erx
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
-192-03
1. GENERAL INFORMATION
Complete legal description SKYLINE VIEW LOT 4
Expiration Date: (9 — / b —
Location (site address) 19313 WILDWOOD DRIVE CHUGIAK AK 99567
Current Property owner(s) DANIEL E. FRICK Day phone
Mailing address
Real Estate Agent
19313 WILDWOOD DRIVE CHUGIAK AK 99567
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class _Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for: Distance:
COSA to be released to the engineer,
COSA Fee $
Date of Payment �,�
_
Receipt Number h�-t43-q s
COSA# 05CB t Ib42
requested by the engineer.
Waiver Fee $ _
Date of Payment
Receipt Number_
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 2/18/16
Engineers 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.
Of' A \
I-4
�r cS�
4 Tt1c
5. DSD SIGNATURE s�
�,- _—
-7
System #1 Approved for bedrooms.
KENNETH nl. -bus C
a ; 4 ,
System #2 Approved for bedrooms.
1 ` /
rR
eesstoNh� i
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Original Certificate Date: z ���� / Co
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 engineers work.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet_10-10-12.dw
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: SKYLINE VIEW LOT 4 Parcel ID: 051.192A3
A. WELL DATA
Well type PRVT If A, B, or C provide PWSID # _
Date completed 1963 CIRCA Sanitary seal (Y/N) Y
Total depth (Per MOA docs) 128 ft. Cased to 40+ ft.
FROM WELL LOG
Date of test
Static water level ft.
Well production g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 8.99 mg/L
Arsenic: ND ug/L Date of sample: 2.5-2016
B. SEPTICIHOLDING TANK DATA
Well Log (Y/N) N
Wires properly protected (YIN) Y
Casing height (above ground) 18+ in.
AT INSPECTION
2.5.2016
"I
Collected by: ARCTERRA
Tank Type/Material SEPTIC I STEEL Date installed Unknown— Circa 1963
Tank size 1000 gal. Number of Compartments 1 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y onsideFound.t Depression over tank (Y/N) N High water alarm (YIN) N
Date of pumping 2.5.16 - Pumper
C. ABSORPTION FIELD DATA
Date installed 5.1982 Soil rating (g.p.d./fe or fe/bdrm) 150 System type DEEP TRENCH
Length 40 ft. Width 2.5 ft. Gravel below pipe 6' ft.
Total depth 11.8 ft. (Measured 215/16) Eff. absorption area 480 ft Monitoring tube Y Depression over field N
Date of adequacy test 2/5116 Results (Pass/Fail) PASS For 3 bedrooms
Fluid deplo in a13so&pj19rt fig. id before test 28 in. Water added 820 gal. New depth 44 in.
Elapsed Time: 1020 min. Final fluid depth 29 in. Absorption rate >= 450 g.p.d.
Any rejuvenatibrh treatment (past 12 mo) (Y/N & type) N if yes, give date
D. LIFT STATION
Date installed
"Pump on" level at _ in.
Datum
E. SEPARATION DISTANCES
WELL ON LOT TO:
Size in gallons
"Pump, off' level at _ in.
Cycles tested
Septic tank/lift station on lot 65'+1.(2013 Waiver)
Absorption field on lot 90'+1. (2013 Waiver)
Public sewer main 75'+
Sewer /septic service line 25'+
Animal containment areas 564
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line; 51+
Manhole/Access (Y/N)
High water alarm level at -- in.
Meets alarm & circuit requirements?
On adjacent lots 1001+
On adjacent lots 1001+
Public sewer manhole/cleanout 1001+
Holding tank 100'+
Manure/animal excrete storage areas 1001+
Absorption field 5'+
Water main 101+ Water service line 104Surface water 1004
Wells on adjacent lots 1001+
ABSORPTION FIELD ON LOT TO:
Property tine 5'+l- (2013 Waived Building foundation 10'+ Water main 10'+
Water Service line 101+ Surface water. 1001+ Driveway, parking/vehicle storage 104
Curtain drain 50'+(NONEKNOWN) Wells on adjacent lots 1004
F. COMMENTS
6 -week vacant system surcharged prior to testing Heavy sludge/fluid bottom 2' of monitoring tube System operating in the top half of
the 6' effective depth.
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal reMids that the above systems are in conformance
with MOA COSA guidelines in effect on this date.
Engineer's Printed Name KENNETH M. DUFFUS
Date 2118116
COSA canary sheet 2-6-15.doc
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Municipality of Anchorage
Development Services Department;
:
Building Safety Division s A I
,, °
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC161042
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
4 of Skyline View subdivision. This inspection revealed a nitrate
concentration of 8.99 milligrams per liter (mg/L) was reported for the
property's well water sample. The Environmental Protection Agency (EPA)
has established a maximum contaminant level (MCL) of 10.0 mg/L for
public drinking water systems. While private wells are not subject to this
regulation, EPA standards are based on existing health information and can
therefore be used to gauge the relative quality of water from private wells.
Please see the attached "Nitrate Fact Sheet" for important information
regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
• '� Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-192-03
1. GENERAL INFORMATION
Complete legal description SKYLINE VIEW LOT 4
Expiration Date: 1 - V�, I / �,
Location (site address) 19313 WILDWOOD DRIVE, CHUGIAK AK 99567
Current Property owner(s) DOUGLAS & ANGELA JOHNSON Day phone
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
PO BOX 672492, CHUGIAK AK 99567
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
3
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class _Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver/Variance request for: Field to Property
Line & Well to Field Distance:
5'& 90'
Received by: `mom ' Date:
COSA to be released to th gineer, unless otherwise requested by the engineer.
COSA Fee $ HIC)
Date of Payment
Receipt Number
COSA# OSU�15;Sa
Waiver Fee $ I O jU • co
Date of Payment (C) I to I I a
Receipt Number bS53h
Waiver# OSPC 31YN
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 10/7/13
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 OF, `� J�,
occupants or can ArcTerra guarantee that ie unseen ��Ti�
�,
encroachments, deficiencies or discrepancies exist.Joe
/ ,# 6. DSD SICyNATURE KehneTH NT. HU
FF M
�i// System #1 Approved for _3 bedrooms. r1, 1I6
System #2 Approved for bedrooms. T' ly?orss.= ",-
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
ON-SITE
PROGRAM
i'NT ��0� �•
By: Original Certificate Date: / ) 5�
The 6Zpality nchorage 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.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory_
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 10-10-12.dw
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: SKYLINE VIEW LOT 4 Parcel ID: 051.192.03
A. WELL DATA
Well type PRVT If A, B, or C provide PWSID # _
Date completed 1963 Circa Sanitary seal (Y/N) Y
Total depth (aerMoAdocs1128 ft. Cased to '40+ ft.
FROM WELL LOG
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
FN
Coliform NEG colonies/100 mL Nitrate 7.93 mg/L
Arsenic: ND ug/L Date of sample: 101212013
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC f STEEL
Tank size 1000 gal. Number of Compartments 1
Foundation cleanout (Y/N) r Depression over tank (YIN) N
Date of pumping 1 01212 01 3 Pumper JRs
Well Log (Y/N)
Wires properly protected (Y/N) Y
Casing height (above ground) 18+ in.
AT INSPECTION
1 01212 01 3
ft.
Collected by: ARCTERRA
Date installed Unknown - Circa 1963
Cleanouts (Y/N) Y
High water alarm (Y/N) N
C. ABSORPTION FIELD DATA
Date installed 5.1982 Soil rating (g.p.d./ftz or ftZ/bdrm) 150 System type DEEP TRENCH
Length 40 ft. Width 2.5 ft. Gravel below pipe 6 ft.
Total depth 11.8 ft. (Measured 10/2/13) Eff. absorption area 480 fe Monitoring tube Y Depression over field N
Date of adequacy test 101212013 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 520 gal. New depth 22 in.
Elapsed Time: 65 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
"Pump on" level at —in.
Datum
Size in gallons
"Pump oft"level at —in.
Cycles tested
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot * 65'+/ -
Absorption field on lot * 90'+/ -
Public sewer main 751+
Sewer /septic service line 25'+
Animal containment areas 50'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 54 Property line 54
Manhole/Access (YIN)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout 1004
Holding tank
Manure/animal excrete storage areas 100'+
Absorption field 5'+
Water main 104 Water service line 104 Surface water 100'+
Wells on adjacent lots 100'+
ABSORPTION FIELD ON LOT TO:
Property line * 5'+/- Building foundation 104 Water main
Water Service line 10'+ Surface water. 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 100'+
F. COMMENTS
in.
*See Sullivan's well scoping letter. FCO located inside the foundation Waivers (well -field & field - lot line) requested with this COSA.
Well to septic tank meets separation requirement at time of installation circa 1963
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and review of
determined through field inspections and review of Municipal records that
inspections and review of Municipal records that the above systems are in
Municipal records that the above systems are in conformance with MOA
above systems are in conformance with MOA COSA guidelines in effect on
conformance with MOA COSA guidelines in effect on this date.
COSA guidelines in effect on this date.
on this date.
Engineer's Printed Name KENNETH M. DUFFUS
Date
COSA brown sheet 10-10-12.doc
OF AZ
4c�Tx[, v*
P I4N'NETH M. DLr�}'yny /
y Ott
ro�9 /3 wfiG i
6�F,SSro-a i
%, & � -ft.
Municipality of Anchorage
Ea
Community Development Department
Development Services Division s ` ET
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval 4 131532
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
4 of Skyline View subdivision. This inspection revealed a nitrate
concentration of 7.93 milligrams per liter (mg/L) was reported for the
property's well water sample. The Environmental Protection Agency (EPA)
has established a maximum contaminant level (MCL) of 10.0 mg/L for
public drinking water systems. While private wells are not subject to this
regulation, EPA standards are based on existing health information and can
therefore be used to gauge the relative quality of water from private wells.
Please see the attached "Nitrate Fact Sheet" for important information
regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
,A%NSi LL % COLE OC Cb d6a
� ak, AK 99567
LLIVANgWATER oWELL
TO: Arcterra Consulting Inc.
c/o: Brent Western bmw.kndeng@ak.net
20441 Ptarmigan Blvd
■*M.- Fa1147 1-11.0221 FAV
TERMS
PHONE
907-868-3791
DATE OF ORDER
10/4/2013
ORDER TAKEN BY
CUSTOMER ORDER NO.
❑ DAY WORK ❑ CONTRACT ❑ EXTRA
JOB NAME/NUMBER
JOB LOCATION
19313 Wildwood Dr.
JOB PHONE
STARTING DATE
10/4/2013
CITY. DESCRIPTION OF WORK PRICE AMOUNT
During well inspection with down hole camera, perforations were
discovered at a depth of 64.4 ft. These perforations had water pouring in
continuously with resting static maintaining below perforations at 79.1 ft.
Casing appears to be entact and penetration free aside from perforations.
Non-compliant well cap was replaced with MOA approved sanitary seal.
Thank you,
Cole Sullivan
DATE COMPLETED:
WORK ORDERED BY: Click here to enter text.
PROPORD nnl9im fLCUi
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PROPOSED BUIMRG <OPNW
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UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES.
UA(3flUTY FOR THE COST OF THE SURVEY.
INITIAL TRANSACTION ONLY THE SURVEYOR TAKES RLSSTED (DISTANCES
D
REVAIL OVER SCALING. EPRODUCTIONSMAYSCAUSECIAL
ERRORS IN SCANEY
El LOT SURWY SURVEY TYPE
SYMBOLS
ASPHALT
❑ FOUNDATION AS -BUILT
SET REBAR 7 ;W DRAINAGE
CONCRETE
❑ FINAL STRUCTURE AS -BUILT
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❑ PLOT PLAN ... AS -BUILT ... LOT SURVEY ... TOPOGRAPHY
00 a ASSUMED ELEV. -x--X 19 METAL FENCE ® WOOD DECK
71 AS-8UILT ... NO OWNERS SET M RECEATIRCATON AS -BUILT .. NO CORNERS SET
NOTE:
PLOT PLANS & LOT SURVEYS
IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO
ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE
WELLS, SEPTIC CLEANOUTS. SIDEWALKS, DRIVEWAYS,
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE
TO DETERMINE
SHOWN. FENCES,
ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONLY. SNOW
1 TO FINISHED GRADE AND UTILITY CONNECTIONS AND
OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS
MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED.
NOTED.
THE EXISTENCE
1 WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
ALL DISTANCES ARE RECORD UNLESS OTHERWISE
Prepared by
SURVEY CERTIFICATION
Robert E. Johns, Jr. & Assoc.
.•�E�OF�q�`ty
LOT LANs am T New Iwwxexr rrwPa ♦ P..........
PLOT PLAN �� '• .••. Q ♦
Professional Land Surveyors
Mo --ot aw.n eb Rwer IN.M, me Mol C^� ♦.
new Rome > rtmm.a a m In. lel �R+ "l
1700 Brink Ori.e.
ANCHORAGE, ALASKA 98501
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Scale:
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Date Serve d- 10/04!13
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10/05/13
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Legal OeBcriOtion:
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SKYLINE VIEW
Municipality of Anchorage
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997
httg://www.mu n i.org/Onsite
Development Services Division
On -Site Water and Wastewater Program
nient S
No
UAW i
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Department
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSP131374 COSA#:OSC131532 Permit#:
PID#: 051-192-03
Legal Description: Svline View, Lot 4
Engineer: ArcTerra
Applicant: Douglas & Angela Johnson
Your request for a waiver of the required 10 feet horizontal separation from the absorption field
to the property line has been approved. The approved separation distance is 5.0 feet.
Your request for a waiver of the required 100 feet horizontal separation from the absorption field
to the private well has been approved. The approved separation distance is 90.0 feet.
This waiver approval applies to the existing absorption field only. Any future upgrade to the on-
site wastewater disposal system will require all separation distances be met or another approval
from this department.
® The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected
adjacent property.
❑ Adjacent properties are not affected by this waiver.
...............................................................................
Waiver is Granted: X Waiver is not Granted:
Date: 6 Approved b -P
Name of Reviewer
............................................................................�
Rec#: 055361 Amount: $1,050.00 Date Paid: 10/1012013
**** VARIANCEIWAIVER REVIEW ****
�RcTERRq
�� Al2CT1:12RA
~ $ CONSULTING, INC
31 8 212 E. 51"Ave, Anchorage, AK. 99503
'111 Q Office (907) 868-3791, Fax (907) 868-3793
October 7, 2013
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
RE: SKYLINE VIEW LOT 4 - MULTIPLE WAIVERS
Previous Municipality of Anchorage (MOA) on-site records indicated that separation
distance requirements were met for the referenced property's water and wastewater
systems. However based on the recently completed survey by Robert E. Johns and
review of MOA records, it appears that the absorption filed sump is approximately 7'
from property line and that the absorption field itself is approximately 95' to the well.
We are therefore requesting separation distance waivers of 5' from absorption field to
property line and 90' from well to absorption field be granted.
The distance between the well to septic tank is approximately 65', but meet the 50'
separation requirements at time of installation. This septic and well are located on the
opposite sides of the house and have been in operation for 30-50+ years with no known
adverse effects. Recent water analysis submitted with the COSA is similar to those of the
surrounding area.
We respectfully request that the waivers and the Certificate of On -Site Systems Approval
be granted. If you have any questions or require additional information, please contact
me at 868-3791 / FAX 868-3793.
Respectfully,
ArcTerra Consulting, Inc.
Kenneth M. Duffus, P.E
xeceoseu 1v+�m Hoare
SC+ .PE. P�nOrJ
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UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABUSHINC BOUNDARY OR FENCE LINES.
THE SURVEYOR TAKES RESPONSIBIUTY FOR THE INITIAL TRANSACTION ONLY
AND ASSUMES FINANCIAL UABIUTY ONLY FOR THE COST OF THE SURVEY,
LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE.
LOT SURVEY SURVEY TYPE
SYMBOLS 1F
FOUW)ATKXl AS -BU f
SET REBAR DRAINAGE ASPHALT
❑ ANAL STRUCTURE AS -BUILT
*--*-a WOOD FENCE ....
o FOUND REBAR- CONCRETE
❑ PLOT PUN ... A5 -Boar ... LOT SURVEY ... i0P0NY
DO a ASSUMED ELEV. T(--j(--IE METAL FENCE ® M'000 DECK
AS -BUILT ... MO AS- SET RECERTIFlCATIaN AS -BUILT ... NO C 5 SET
PLOT PLANS & LOT SURVEYS
NOTE;
IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER. PRIOR TO
ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE
CONSTRUCTION. TO VERIFY PROPOSED BUILDING GRADE RELATIVE
TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE
SHOWN. FENCES. WELLS. SEPTIC CLEANOUTS. SIDEWALKS. DRIVEWAYS.
ETC_ ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONLY. SNOW
THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS
MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED.
UNLESS OTHERWISE NOTED.
I WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
ALL DISTANCES ARE RECORD
Prepared by
SURVEY CERTIFICATION
.`.��K�
•
Robert E. Johns, Jr. & Assoc.
PLAN
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Surveyors
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7700 E,BrinkDrive.
ANCHORAGE, ALASKA 99504
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Date sarn>°a: 10/04/13
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Date Drawn: 10/05/13
Grid;
N W 1159
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ROBERT E S. JR•• A
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La al Description:
Legal
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SKYLINE VIEW
MUNICIPALITY OF ANCHORAGE
• �` DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section co
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 4�/ / PZ' O2Z
1. GENERAL INFORMATION
HAA# 1Ar:�l5
Complete legal description Lor .,1
Location (site address or directions)
Property ownerDay phone
Mailing address qpe--257
Lending agency
Mailing address.
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
Day phone
Day phone
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA 421
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 of this Health Authority Approval application 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 7X�
Phone — a 7�
Address &/ev i two x 4-' y� ��� , > �� 99l
Engineer's signature J4. C-1
Date (O - -3 - c)
01
��DCL' S „ISL `' .: •i
'~''moi'• CEi7
6. DHHS SIGNATURE �� $�,• •'.c:•:v
Approved forHI I�E_C bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments Note: The well for this property meets existing
State and Municipal Codes. There are nitrates present. It ss
at a Periodic testing be Performed to insure the wells
cont nued suitab' 'ty N't ate concentration is 5.53 mg/l. EPA
By. t /V fiYwy
� Date /,;2_ 6
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.
72-025 (Rev. 1/91) Back MOA apt
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division RECEIVED
825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
JUN 61996
Municipality of Anchorage
Health Authority Approval Checklist Dept. Health & Human Services
Legal Description:-/&eE Lar �Z lvParcel 1.D.: D�-i i 9z 0S
A. WELL DATA
Well type Q,Z d4T If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Al Date completed l�ousC B`�" � "J ig6,9
Total depth 40vK o w +J Cased to 4,'o F7' Casing height (above ground) .Z'/ "
Sanitary seal (Y/N) Y Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION
Date of test .tJdT 4rJa,c4��E ,ygy zj iqq/
Static water level 71�
Well production g.p.m. 41.0 g.p.m.
WATER SAMPLE RESULTS:
Coliform Nitrate Other bacteria
Date of sample: i99 46 Collected by: XEAJc.E?1"
B. SEPTIC/HOLDING TANK DATA
Date installed zA/AZ Uocu,_Tank size /00,0 G9tNumber of Compartments / Cleanouts (Y/N) Y
Foundation cleanout (Y/1) _/ Depression (Y/N) N high water alarm (Y/N) N1'9
Date of Pumping 7-,4
C. ABSORPTION FIELD DATA
Date installed "919,2-- Soil rating (g.p.d.ftz or ftz Podrm)/11�/
aystem type
Length j/0 Ff Width o Gravel thickness below pipe 7.Z ..v. Total depth 10
Effective absorption area 'YBoF'° 2 Monitoring Tube present(YN Y Depression over field (YIN) N
Date of adequacy test Results (Pass/Fail) ,P.Qrs For 14� bedrooms
s�9
Fluid depth in absorption field before test (in.); 00 % Immediately after` gal. water added (in.): YB ,,A -J
Fluid depth Z 94 (ins.) Minutes later: / /L r- Absorption rate = ,5-0 /
Peroxide treatment (past 12 months) (Y/N) If yes, give date
D. LIFT STATION
Date installed _ Size in gallons _
Manhole/Access (Y/N) "Pump on" level at*
p off level at*_
High water alarm level at* *e m
CyOe s ed
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot 7 q ,cam
On adjacent lots / Op
Absorption field on lot /,V e7,4 -,Z ; On adjacent lots /o p " �f
Public sewer main Public sewer manhole/cleanout
Sewer /septic service line Z -T- Lift station A/,�
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line _ o FfAbsorption field er F71
Water main service line zSt.e;ace water/drainage Wells on adjacent lots ioo
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation _ z 9? 14�z
Property p rtY Line '-s/Water main/service line
Surface water. ILIIOA-e- Driveway, parking/vehicle storage area
Curtain drain .cJo ,,j &F� Wells on adjacent lots i e i 4-7�4
F. ENGINEER'S CERTIFICATION
1 certify that have determined thru freld inspections and review of Municipal records t ovX
in conformance with MOA HAA guidelines in effect on this date. w A yrs are
NR
Signature ��;.•
Av •.f,��
i
� 49 E! ;
Engineer's Name ouG �/ / 6
GTJ / r !\ !�
Date - ? - 9
HAA Fee $ �(/� . �---------------__----------__..
Waiver Fee $ _
Date of Payment ,t!�/��� Date of Payment
Receipt Numbert�3
Receipt Number
Rev. 8/95 OSS: haa.wk.doc 11-11
•..1.?
�S1KENLEv.
GE 8176 L
a
Douglas T. Kenley
Civil Engineer
State of Alaska C.E. 8176
HUSTON.XLS
SEPTIC SYSTEM ADEQUACY TEST
Legal Description .4coedr
Applicant
Date of Test
SYSTEM DATA
Tank Volume zppp ar,4z-
Number of Bedrooms
Absorption system
Number of Bedrooms
Absorption required (1.5 daily flow)
System Passed V-1�
Comments
y ;
74 t
Sysylem Failed,
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Page 1 of Z,
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TEST DATA
TIME
FLOW
VOL.
TANK LEVEL
TUBE LEVEL
COMMENTS
"
2
!
,/
!O
System Passed V-1�
Comments
y ;
74 t
Sysylem Failed,
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Page 1 of Z,
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Douglas T. Kenley
Civil Engineer
State of Alaska C.E. 8178
HUSTON.XLS
SEPTIC SYSTEM ADEQUACY TEST
Legal Description
Applicant , u,fro,L, .4e.�4.SAnJ
Date of Test X;��y
SYSTEM DATA
Tank Volume
Number of Bedrooms
Absorption system
Number of Bedrooms
Absorption required (1.5 daily flow)
/Ve a GQt_
�a p
TIME
FLOW
VOL.
TEST DATA
TANK LEVEL TUBE LEVEL
COMMENTS
/67.
/ y9
la • 2.
/B 6 i9
—
—
/ xx,
.J-—
.d ?mss
/
9y. a
Q !�
2 f✓
System Passed
Comments ^,q
TG
mN ,/rte=prig,
P" o.v uJ6LL,
Sysytem Failed.
Q.t
8 a 1x' /m o , 7 a -e YS
/BPZ �
yx�x - x /9
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i
Paged oma,"
LtE
ME Environmental Services Inc.
Laboratory Division rii�iii��.,ri«i�i�ii®it®iiw�w�„>ri�siiiioi«i►i�
Laboratory Analysis Report
ME Ref,d 962024.962024001
Client Sample ID L4 Skyview Sul..)
114atrix DriiWng Water
Collected Dnte 05/23/96
Technical Director: Stephen C, Ede
Released By
PArameter Results QC PQL Unita Method Allowable Prep Analysis Init
4ual Limits Date bate
Nitrate -N 5.53 0.500 mg/L EPA 353.2 05/29/96 EMB_
Total Coliform 0 0 col/100mL SM18 92220 (DW) 05/23/96 TAV
U - Undetected
LT Less than
GT Greater than
D - Secondary Dilution
J Below the calibration
b
0
200 W. Potter Drive, Anchorage, AK 99518-1605 — Tel: (907) 562.2343 Fax: (907) 561-5301
3180 Peger Road, Fairbanks, AK 99709-6471 — Tel: (907) 474.8656 Fax; (907) 474.9685
ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, "'(0, WEST VIRGA
Time
APPLIC IT
FILLS
OUT UPPER HAL' ")NLY
Property Owner
Time
Date
Phone
Mailing Address_
-
Date
- Zip Code
-
Buyer \ \.. I
, `'V
Address -�..._
----. �.Zip
Code
Lending Institution
Field Notes:
-
Phone
Address
( %r -)APPROVED BEDROOMS
_ Zip Code -1 ;\(.%
-_
Really Co. & Agent
\� ;�;- --.r'. ,.-. , :. `: -
,__ t, `, ,
,..� .--.:.._ \t,\ .� _
Phone
DATE—
ATE
BY:
BY: _ l
Address - I
:\ .,� ;_.i, ,, , :
�...
\ ,, . _ -� Zip Code
Well To Absorption Area /00-
Legal Description
.: \ . /.. ,. \i �.< .. _
.�:
:\ _ .. 14
Well to Tank
Street Location
Type of Residence
M'Single Family
❑ Multiple Family
No. of Bedrooms -
0 Other
Water Supply
U Individual
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
❑ Community
For wells drilled prior to that date, give well.depth (attach log if available).
O Public Utility
-
Sewer Disposal
��1e 244
5' Individual
Year Individual Installed: `-4 '
❑ Public Utility
When Connected to Public Utility:
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
Field Notes:
( %r -)APPROVED BEDROOMS
'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE—
ATE
BY:
BY: _ l
Soils Rating
Date Sewer Installed
Well To Absorption Area /00-
Well Log Received .
Septic Tank Size (�
Well to Tank
rz Uzi NluzI
0
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3500 Tudor Road, Anchorage, Alaska 99507 279-8686
Date Received November 13, 1973
Time of Inspection 2:00 p.m.
Date of Inspection November 19,1973
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Conventional
1, Approval. Requested By: National Bank of A14sK�
Address: P.O. Box 600 Anchorage AK Phone: 272_;544
2. Pr000rty Owner: Chandonnet Fernand L Phone:
3, Legal. Description,
—.Lots 3 & 4, Skyline VieW SUbdivisiQn_
4. Location: Chuqiak
51 Type of Facil-ity to he Inspected: Single FAgt Dwe111�16
Numher o-` Bedrooms: Four (4)
6. Well Data:
A.
Tvne Drilled
B.
Depth 128'
C.
Construction—
D.
Bacterial Analysis Satisfactory
7. Sewage Disposal Svstem:
A. Installed— 10 Years old
C. Septic Tank: 1. Size
8. Installer
2. Manufacturer
D. Seepage Pit: 1. Size 2. Material
E9 Disposal Field: Total Length of Lines
8. Distances:
A. Well To: Septic Tank Absorption Area Sewer Lines
dearest Lot Line Other Contamination
B. Foundation t^ Sentic Tank Absorption Area
C, Absorption Area to Nearest Lot Line »
RagIeEt for Approval. of 1 vidual Sewer & )Nater Facilitie
Page Two
9. Comments: Cannot approve or disapprove sewer system unknown
Lynn Coad, Sanitarian.
Annroved Disapproved Date November 20, 1973
Approval 'valid for One Year From Date Signed
Greater Anchorage Area Aorough, Department of Environmental Quality
DIAGRAM OF SYSTEM.
T cer�,ifv that the information contained In this requ"_M; t0' cJpp.t UV C]A Uv +./c a
and accurate representation of the su`Diect sewer and w@ter facilities located 1"
SIgn("d gate
July 29 1063
Fir.. K, D* Rahman
Ll, 6, Department of Agriculture
reamers' lift" Administration
Paalmer, Alaska
Dear Sir$ Subject: Inspection - water supply
and including sewage disposal, syste"
Jeanrovo Property, Lots I & 4
Skylines View Subdivision Chuglak
At the request of Mr. Jaanrowe, an inspection was made of the above
captioned Installation, Tho water supply aaac3 sew apse disposal system
are bath satis actory, according to ;hate Public Hearth erito•r.iran.
Tile water supply consists of s 1201 drilled well, with a properly sealed
6" steel. casing. The well mets minimum distance requirements in re-
lation to the newag•o disposal mystemO and to property l,ineca.
The individueal septic tank/€seepage Pit Sewaagre disPOS61 cayatena is acrept-
f;hles ftcause of the evident abnorbtion capability of the g*,round at the
seepage pit exuavat4on, a percolation test was not requirod. All com-
p4nanto were satisfactorily located with regard to location, praade,
mraterial, depth etc, The 1400 gel., steel septic flank (L}.L, Seal 'V69061)
is situated 0 feet from the foundation wells, House sewer is 3" copper,
Than septic tank is connected to an 80xB: for crib seepaag;a pit by 32 feOt
of 411 transito Pipe.
Hotta these systems appear to he satisfactory and should operate without
mal -fgnc't ion o
Very truly yours,
John R. Kuhn
District Sanitarian
JR.K i rm
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