HomeMy WebLinkAboutT12N R3W SEC 27 LT 41A-1GRE,/ .... R ANCHORAGE AREA BOP Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME_HAIDA I-tlP~_ OF AIF-MA,LING ADDRESS 210~) 4' ACCe pA, PHONE Z-/-l---/g~l¢ LOCATION j~ A/~/~O0~) (~D ' LEGALDESCRIPTION__'F/2'IVj ~SK/j ¢qEC, z_7/ LOFfllA SEPTIC TANK: DISTANCE FROM WELL P/~)P, MANUFACTURER ~-A~'(~' ~-~'L- MATERIAL INSIDE LENGTH /~c)~)Z~INSIDE WIDTH -- _LIQUID DEPTH. NUMBER DE ~ ~-J~, ~ L~ COMPARTMENTS LIQUID CAPACITY j 2- 5 ~ GALLONS. SEEPAGE PIT: NUMBER OF PITS__ / DIAMETER -- _OR WIDTH J~7, LINING MATERIAL ~_ O/~AF~;L- CRIB SIZE: [DIAMETER BUILDING FOUNDATION 2-O¢~, NEAREST LOT LINE 2.~ / ADDITIONAL ABSORPTION ~/ LENGTH ll7, DEPTH ~ APPRo×. DEPTH ~(~ DISTANCE FROM: WELL /o~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~:~)(~ SQ. FT. WELL: IPROPO3 I~J) TYPE PR BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUC'rlON NEAREST LOT LINE OTHER SOURCES __ DISAPPROVED NEAREST SEWER LINE REMARKS. DEPTH DISTANCE FROM: SEPTIC SF-EPAGE TANK SYSTEM DISTANCES: INSTALLED BY: PIPE MATERIAL: A-N/) 'T/TA N LOT SLOPE: REMARKS: ~/~AVE L DIAGRAM OF SYSTEM G.A.A.B, GREATE, R ANCHORAGB AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TE:LEPHONE 274-4561 PERMIT NO, SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION OF; SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH soil TEST .esuE~s COMPLETION DATE A~TICIPATED NOTE: THIS PERMIT I-~t NOT VALID WITHOUT 5OIL TEST FOUNDATION TO SEPTIC TANK TO NEAREST LOT LINE. WELL TO sePtIO TANK __ l~>(') / DRAIN FIELD ,/ ~l~? WATER MAIN TO SEPTIC TANK /~<-- DRA]~ FIELD SEPTIC TANK,. ~ ~ / , SEEPAGE PIT ~D ~ TO RIVER, LAKE, STREAM. SEEPAGE PIt /(/0 ~) ALSO CONSIDER AREA WELLS. , SEEPAGE PIT . , DRAIN FIELD ~'~-(~) CAST ]RON ]N'FO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATrON 5 FEET INTO UNDISTURBED SOIl.. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC. TANK AND SEEPAGE PIT FITTED WITH Al RTIGHT REMOVABLE CAPS TYPE DIAGRAM OF SYSTEM I CERTIFY THAT [ AM FAMIIJAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-6B AN~ THAT THE ABOVE D ESCRIBED/~¢~}SYSTEM/ IS ]N AC CORDANCE~/~ ~'-~¢ WITH SAID CODE. X ~¢~ (~ /~ Date /~;)1~ // / ~APPLICANTIS SIGNATURE I o o Civil Enginaars 229 EAS~ olst. AVE. - P.O. BOX 6087 - ANGHORAGr.-, ,~LASKA 99503 TELEPHONE 907--279-0483 TELEX 090--35419 Geologists Land Surveyors JAMES W. ROONEY, P. E. JAMES H. WELLMAN, P.E. RALPH R. MIGLtACCIO April 25, 1973 R & M No. 36603 Ha{da Hide of Alaska 2100 4 Acre Drive Anchorage, Alaska 99504 Re: Test Hole and So~ Log Report ~or Sa~ta~ System ~t 4~ T 12 N R3W Section 27 S.M. Dear 1VIr. Novellh We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject site. This investi- gation was performed in accordance with your request o~ April 20, 1973, and those procedures outlined in a letter dated September 13, 1971 by 1VLr, Roll Strickland of the Greater Anchorage Area Borough Department of Environmental Quality. A single test hole was put down within the Lot 41 A area for the purpose o~ denning general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with a tractor-mounted backhoe and the test hole was extended to a total depth of 14 feet below ground surface. The ~inal log prepared {or the test hole has been included in Drawing A-01. Ground water was not encountered in the test hole. We appreciate bein~ g~ven this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, ENGINEERING & GEOLOGICAL CONSULTAlk~TS · ~/ James W, Rooney Partner JWR:wb ANCHORAGE FAIRBANKS JUNEAU T.H -I 4 - 20-75 ORGANICS O.O~ GRAVELLY SAND WITH SOME COBBLES, TRACE ORGANICS GRAVELLY SAND WITH SOME COBBLES AND SILT (SP-SM) No Water Table Note : Hole excavated with tractor mounted 15.0' T.D. backhoe. Engineering ~ Geological ConsuJtant-J ____A~c.o~*o~ ~^,.~s ALASKA J~N~AU DATE Jr-24-75 JSC~L~ I" = 2' JDWN BY G.A.W. Haida Hide of Aloskm Property LOG OF TEST HOLE Anchorage Alaska GREA'TbR ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL, QUALITY 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE, ALASKA 99502 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT NSTALLATION CE: SEPTIC TANK ~ SEEPAGE PIT ~ , DRAIN FIELD TYPE AND SIZE CE FACILITY TO ~E SERVED ~ ~///~ ~/~/~;/~ ~[¢1 ) ¢ F[NANCE~ THROUGH -- ~, TO ~E INSTALLED BY , OTHER NOTE: Tl'lJ~ PERMIT IS NOT VALID WITHOUT SOIL TE$'r FINAL INSPECTION= 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION, ~p[~ SEEPAGE AREA SIZE TYPE DIAGRAM OF SYSTEM MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO sePtiC TANK FOUNDATION TO SEEPAGE PIT DRAIN FIELD - , DRAIN F[ELD /~,~ / SEEPAGE PIT ALSO CONSIDER AREA WELLS , SEEPAGE PIT , DRAIN FIELD EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE Pit FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL ~AGE AREA GREATbR ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT LECAL DESCRIPTION //¢~ /// ~g~ ,)7 '~' J ~./~ ~)~U ~'l~' X OTHER _ INSTALLATION OF: SEPT[C 'rANK /~ SEEPAGE PIT BRAIN FIELD ~ TYPe aND SIZE Of FACILITY 1'O Be SERVED {j~'~.,/~: ¢~/ t~K~'~/~ ~':~ '~.~4,t / SOil TEST RESULTS ¢ NOI'E~ T~HI~ ~!lE;R~4 T lB_ NOT FINAL IN~BPECTIONJ 2~4 HOUR NOTICE REQUIRED. BACI(FILLING OF AI~IY SYSTEM WITHOUT FINAL INSPEC~TION BY TH~ HEALTH DEPARTMENT AUTHORITY WILL, BE ~UBJECT TO PROSECUTION. SIZE -- MINIMUM DISTANCES, REQUIREMENTS DIAGRAM Of ~YSTEM FOUNDATION TO SEPTIC TANK~' SEPTIC TA~K TO SEEPAGE Pit WALL ~0' SEPTIC TANK, - ~''/ , SEEPAGE Pit /O1~, DRAIN FIELD - FITTED WITH Al R~~.~S. Mr. William PoLter Allchori~J~, ~Tli~ska 99B02 Sewer I n.q t, al 1 at~ on ,, T12i,I, R3H, ,,,I,. on June 3, 1L~T1 you obtained a p(~rm'it frum this O[. syst~;qn to be installed, at ~bc ahow~ location. P'loasr: advi:~.~ i;h'is llr:t,artmant iF Che systm"~ has bn~'n installed or iF you w'lsil your perrotC l~u'[~t valid In our f i '1 e s, [ ,~vi rom,e,, ~.=, 1 .qnecialis~ st FROM: DEPARTMENT: INITIATED BY: TO: DEPARTMENT: RECEIVER: FOR INFORMAIION ONLY FOR IMMEDIATE ACTION : FOR YOUR CONSIDERATION Gl'HER GREATER ANCHORAGE AREA DATE OF MEMO: DATE ANSWER REQUESTED: REQUESTED ACTION SCHEDULE PREPARE BACK-UP INFORMATION CALL ME BEFORE YOU ANSWER NEED YOUR RECOMMENDATION SIGNATURE [}anuary 2, 1973 William Pott(:r [$ox 10177 Anchorage, Alaska 99502 Subject: Installation of an on-site sewa~le systei~, Lot 41/~ Secl;'lon 27, 'F12N, R3,,/., S.M. Dear Plr. Potter: On Flay 9, 1972 a permit for ac on-slCe seNvage system ~.~as issued ~o you fop the subject sewage sysCe(~. In r(:viewing our 'Files, we find that no f'inal inspect:ion u~ Lhc sys&~:,~ ~,~s been pro perty. Since tile permi(: 'is still ou'~s~arl,:lin], wa ',l(,t~]C like furl;h~:r informal, Ion on ~he s~a~us of its cons~;ruc~iun. IF i~ nas not: Imlc~in(~ it un~il a 1,s~er date or riddin¥ our Files oF 'it iF y~u have abandoned thc project. IF Ltle sysCem hc~s b~]en tnsLa'lled you are z,,,, which states, "?lo sepi;ic tank, draini~i~'l,~, se~q~L~}e i)i~ or c~:sspool shall be backfilled wiCi~oui; the pc-riiissiun of In an effort to correct ~he situation, i;his office will allow you fifteen (15) days from rocoipt of this letter ~o send or br'in~ pertil~ent data about the sewer system Lo our' oFf'icc. This 'in'For~,;aLion should inclu<le receipts For backfillil~,j, sep'[,ic i;,~nk, brib, perc- ulation tests, excavation work. e~c., along wit;h a detailed drawin~i of t!'~ system. !lo erfurt to comply with l~orou!lh re!lulat'ions a c t i o I~. Please direct any questions you may have t;o this u'Ffice, l'hank yOlJ for yo~Jr cooperation. Si ncerely, Deborah A. lSarr ~:nvironmen~al Control Off~cor II mb DEPT. 0," l~/"Ig.~l & MUNICIPALITY OF ANCHORAGE EHVIP, Oi',I(, ENT ~L i' ,;.CTION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 RECEIV. REQLJEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DI ~ECTIONS: Complete all earls on page 1. Incomnlete ramiests will not be processed, Please allow ten (10) days for processing, · PRO ERTYOWNER..~-. -~OPERTY RESIDENT Jif different from abavel ~'. BUYER PHONE PHONE AILING ADDRESS 3 LEN, pING INSfJTUTI~.~ JF~ONE pHONE LEGAL DEScRiPTIoN STREET LOCAT ON . n 6. TYPE OF FIESIOENCE NUMBER OF BEDRGOMS E] One [] Four E] SINGLE FAMILY E3 ./.~o [] Five [~ MULTIPLE FAMILY C-~ Three [] Six Other____ 7, WATER S..UPPE~' [E~ iNDIVIDUAL~' [] COMMUNITY tZ] PUBLIC UTI EITY ATTACH WELL LOG. A wall Icg is required for all wells drilled since June 1975, Fo'r wells drilled prior to that date, give well deptl~ (~ttach Icg if availa61a,) 8, SEWAGE DISPOSAL SYSTEM  ..LN DIVI DUAL/ON-SITE*~' PUBLIC UTILITY If mdlv!dual/on-s te, give installation date__ _. b~4hk~De~tlnc n t. ~ NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFDRE PROCESSING CAN BE INITIATED· THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED " INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS; 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX 2. WATER SUPPLY PERMIT NUMBER [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] I NDIVI DUAL/ON -SITE DATE INSTALLED [22]PUBLIC UTILITY Connection Verified [~]Septic Tank or []Holding Tank Size: I~.~.~t3 .If Tank s homemade SOILS RATING give dimensions; TYPEOFTANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Lin8 Nearest Lot Line Absorption Area to nearest Lot Line .. COMMENTS [] APPROVED FOR __ . BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) ~ DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, A~aska 99501 REQUEST FOFI APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES ENVIRONMENTAL ENGINEERING DIVI SION Telephone 264-4720 DIRECTIONS: Complete all parts on page 1. Inoomplete requests will not be proco$/~ed. Please allow ten (10) davs for processing. ~UN~ A~ ~ ~ -- 2, BUYER / --' ~ PH~E ~ ~ m ~HONE TYPE! OF RESIDENCE NUMBER OF BEDROOMS SINGLEF~VIILY MULTI PLE FAMILY [] One [] Four  . Two [] Five Three E~ Six Other WATER SUPPLY  NDIVIDUAL*<:~ff,~'~) j~, * ATTACH WELL LOG. A well log is requ~red for al wells drilled . COMMUNITY ~ .~'x'/. , s~nce June 1975. For wells drilled orior to that date, ~. va well [] PUBLIC UTI LITY g~/~'~Z~-~/ :leoth (attach og if available,) SEWAGE DISPOSAL SYSTEM /~ ~7,.~  I NDIVI DUAL/ON-SITE** *' If individual/on-site, give installation date ,. 1~.~ ~* svsterr is over two [2) years old an a~equacy [esi is required PUB LIC UTI LITY ov this Department, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST ]EFOR E PROCESSING CAN BE INITIATED. 72-010~3/71]) t?~.~.~ THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME --- TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [~ FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SiX 2. WATER SUPPLY PERMIT NUMBER E]] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBEF~ ' [~]INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified. INSTALLER Sizo: I ~,~-~ If Tank is homemade SOILS RATING give dimensions: TOTAL ABSORPTION AREA MATERIAL WELL TO: 5. COMMENTS / [] APPROVED FOR BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) ~ DISAPPROVED 72-010 (Rev. 3/78) l. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received April 5, Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Conv. Alaska Statebank 1976 310 East Northern Lights Blvd. Phone: Samuel Hartman Phone: De Armound Road 279-7637 ext 36 276-5676 3. Legal Description: Lot. 4lA Govt Lot 41 Section 27 5"12N R3W 4. Location: ]De Armoun Road 5. Type of facility to be inspected 6. Well Data: Individual A. Type _m/C~~ Single Family No. of bedrooms B. Depth Sewage Disposal System: A. Installed _ C. Septic Tank: D. Seepage Pit: E. Disposal Field: Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank l. Size 1. Absorption Area Total length of lines D. Bacterial Analysis On-site system ~~, B. Instal]er 2. Manufacturer , Absorption area , Other contamination 2. Material , Absorption area C. Absorption area to nearest lot line __ , Sewer Lines 2 EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Re, st for Approval of Individual ! er & Water Facilities legal Description Lot 4lA Govt Lot 41 Section 27 T12N R3W Comments Approved~~ Disapproved Date ~'o,~ 1 Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) April 1, 1976 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C' Street, Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRC) VA 2. ProperLy Owner: HARTMAN, Sameul W. FHA CONV XXX Mailing Address: 3. Name of Buyer: NELSON, Arthur J. Day Phone 276-5676 Mailing Address: 4. Name of Lending Institution: Alaska Stateb~nk Mailing Address: 310 E. Northern Lights 5. Name of Realtor or Agent: N/A 4433 Business Park BlwJ. Day Phone 272-~537 Blvd. Phone 279-7637 ext. 36 Mailing Address: Phone Legal Description: Lot 41 "A" of Government Lot 41, Sec 27 T1BN HSW, 5M Location: qoinq East on BeArmoun past Elmore Rd, and 5helburn Road~ .lust before 132 Ave. on right hand ~¢ side. Mile 1.6 DeArmoun 7. Type of Facility to be inspected: 8. Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility If Individual, date of installation Road single family duelling No. Bdrms. 2 Individual XXX XXX Individual (on-site) EQ-037 (1/74) AREA OROU N j~~'rC" Street,~fchora9e, Alaska 99503 274-4561 ~/ Date Received March 23, 1976 ~.,. ~ lime of Inspection /'~/) ~c~ Date of Inspection REQUEST FOR APPROVAL OF ~. INDIVIDUAL SEWER & WATER FACILITIES FOR Co~lv. l. Approval requested by: -]~z~-f~--Na-t-io~a-t--J2~sv~oJc--of _~t~oac-ag.~ ~ ~.~ )/~. Ma~]lng AddPess: .... off ........ ~ Phone: 279-4481 2. PPopePty 0w~eP: Samuel Hartman Phone: 276-5676 Mailing AddPess: Mile 1.6 De Armoun Road[ 3. Legal DescP~ption: Lot 4lA Resub Govt Lot 41 Section 27 T12n R3W, S.M. 4. L0sati0~: Mile 1.6 De armoun Road ~ A/&~ ~~)3~L):/~,M'/'~'~J~--~ ' 5. Type of facility to be inspected Single Family No. of bedroom~ 3 6. ~ell ~a~a: Individual ~. Type 8. ~epth 2dO' C. Construction D. Bacterial Ana!ysis 7. Sewage Disposal System: On-site system. A. Installed_ ~974 B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: I. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area , Sewer Lines , Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Re st for Approval of Individual ar & Water Facilities .Legal Description Lot 4lA Resub Govt Lot 41 Section 27 T12n R3W, S.M. Approved Approval Valid for one year from date sign ~9_~x/ Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and 'these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) ANCI ~()RAQE, ALASKA 99502 ~9()/) 279 25tl April 16, 1979 Arthur J. Nelson % Phil Kravs Polor Realty 101 East International Airport Anchorage, Alaska 99502 Road Subject: T12N R3W Section 27 Lot 4lA Approval for the individual sewer and water facilities will not be granted until the following items have been completed: (1) The Water analysis report be delivered to this office from Chem Lab, 5633 B Street, for our review. (2) Expose the standpipes to the septic tank and to the leaching area so that we can measure the distances to the well to insure the minimum distance requirements are met. Notify this department for a re-inspection when descrepancies have been corrected. If there are any further questions, please contact this office at 264-4720. Sincerely, Robert C. Pratt, R.A. Associate Specialist RCP/ljw cc: Alaska Pacific Bank 101 East Benson Boulevard 99503 MUMCM UTT OFANCHORAGE Development Services Department -Y Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I. D. 018-092-70 1. GENERAL INFORMATION Complete legal description T12N R3W SEC 27 LOT 41A-1 Expiration Date: J - % ' Z 0 Z Z__. Location (site address) 4904 DE ARMOUN ROAD, ANCHORAGE, AK 99516 Current property owner(s) CHRIS & BEVERLY BEHEIM Day phone Mailing address Real estate agent 6910 CATINE CIRCLE, ANCHORAGE, AK 99507 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Private Well Private Septic Water Storage ❑ Community Well ❑ Public Water System ❑ Waiver request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ S Date of Payment g Q Receipt Number COSA # 0S G 211517 Day phone TYPE OF WASTEWATER DISPOSAL: Private Septic Holding Tank ❑ Community ❑ Public Sewer ❑ Date: Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 8/25/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FWfS 6. DSD SIGNATURE System #1 Approved for -_'3 bedrooms System #2 Approved for bedrooms Disapproved 0,* *:49TM *r� • • Curtis Huffman • • .:.. 4$ 29% CE 128991 ,• c`�/� P 8/25/21. �,� ll ROFESSIONP Conditional approval for bedrooms, with the following stipulations: JI1�FNT SE , U"r yMb)ll��1rtificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: T12N R3W SEC 27 LOT 41A-1 Parcel ID: 018-092-70 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _ A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled CIRCA 1973 Total depth 240 ft (PER MOA RECORD DOCS) Cased to UNKNOWN ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 6/25/2021 Static water level at beginning of test 127 ft. Well production at time of test 3+ gpm Comments B. TANK DATA Age of tank(s) 5 years Tank type/material SEPTIC / STEEL Measured operating fluid level in septic tank 50" ® Standpipes/foundation cleanout per record drawing Date of pumping 6/25/2021 D. ABSORPTION FIELD DATA Which system tested (date installed) 8/17/2016 ® ALL standpipes present per record drawing Total measured depth from grade 12 ft (max) Measured depth to pipe invert from grade 6 ft (min) ❑ N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® Nc 0 Coliform bacteria is Negative Nitrate 1.17 mg/L E]Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by FW'E:. Date of Sample 8/11/2021 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 6/25/2021 Results Z Pass For 3 bedrooms Fluid depth prior to test 61 in Water added 450 gal New depth 71 in Elapsed time 1440 min ® Code -required soil cover over field Final fluid depth 61 in ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallonsFwrs If yes, enter date Comments/Deficiencies: FIELD IS OPERATING IN THE TOP 1' OF THE 6' ED: 83% SATURATED E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) ® Yes if No Septic Tank/Lift Station on Lot > 100' Surface Water > 100' ® Yes if No ft Property Line > 5' Community Sewer Manhole/Cleanout > 100' if No ❑ Yes if No *83+ ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No *84+ ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ft ® Yes if No ft _ Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® 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' ® Yes if No _ ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No *1+ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *MOA WAIVERS ISSUED PREVIOUSLY. G. ENGINEER'S CERTIFICATION l 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. Awl r,. ..............� jj Curtis Huffman / �r� �'F� •.. CE 128991��r/ -.8Z ©EssiQA�` =A0dew 11 TT 11 h Z v N O I- CL J J N A D1 Ln a� C O LL LA M rn fa. 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N dzo �i N LU 2 C / :aLL $c �' • O uE . rnSN /�/ 6 OO - o i w N LnIr ZNQ aj a r %! !l CD1�cVMV W Q zS° \ I coff � � I � I mss � I I _ tOd.M £G9 'J ° sso W �o �I W Q Q caw I I / Q LU CO o. w / �, UliW O � w 00 c0 U C :.2 N O rte, YY fiY 1- (L)m N E F� > ° M _ _ -_.._.- .. _. ✓ U -Ia O Ll- N N O N a y E t/Z o C. d c.Onai p m �LO..'2 c O_ N N O N G m O m` T N aria 0_ 00 m��a O ya)ou n9 N om CL) Qm cc cm a I S O 3 �_�o C N J O O L .N O QO J (n c dmU 9 � N c - > L ca Ln o o- Z; M o rn T� NN- Tc o 0 CL U m O O cV m O y O C E M L Y Um 'O�Tc a) ,nE L N E N ..-. O m O cu maw° E E a� �n I Y ) oNZo`2 N 'Jo C Q)LL lry t1 o L N Q -2 O O C cu: ++ cn0 ==oma u 0 U acE C3 f > N o w a N N a; LL °o $ h m D 3 o a E -a ti� N > Ln o a>i m ( +\ % guc Emaci �, `^ N S °O o �cuo tII Cn L° cc`0 c 0 T Z N- a Ln Q L "II 000 � 'rc _ +-+ L. 00 �--� c u v TLC a) vy�= rj Ln > Ti Lnao o) c If ZomU� d v E �, t $ I D o p_TI Nw c v- o a oda NaC.)15 00 +' a� o 0�3 o v o- c c :c o m 'x 0 ^ O CL c L Ln o O O N N N F- U G dl N Q _) _ 7 L1 LO O1 'S $ ~ .N fc a o ® mc 0 ON yi o� n w o� _~ s �l J Li v w�� O2�%/ w m c m oc v. � Ln C7 H ,o :2 CL /LL; p/ � m i Z w / _ Ln i O N /p. N dzo �i N LU 2 C / :aLL $c �' • O uE . rnSN /�/ 6 OO - o i w N LnIr ZNQ aj a r %! !l CD1�cVMV MUNICIPALITY OF ANCHORAGE o 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. 018-092-70 1. GENERAL INFORMATION Complete legal description T12N R3W SEC 27 LOT 41A-1 Expiration Date: (4:5, ^ 7- 2- 02-2- Complete 22- Location (site address) 4904 DE ARMOUN ROAD, ANCHORAGE, AK 99516 Current property owner(s) CHRIS & BEVERLY BEHEIM Day phone Mailing address Real estate agent 6910 CATINE CIRCLE, ANCHORAGE, AK 99507 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: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $^ m 0 Date of Payment g�z�i� ZQZ Receipt Number Z-27�I COSA # OC' 2_0 ) —1 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 3/3/22 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of -• :? e' construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to %�Q'•' • • • !� , these various and dynamic characteristics and are outside the control of the evaluator of the fig.'• ':� �� well and septic system. Therefore, any estimate of how long a system will function satisfactory .. • ••: * rI for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting • • & FRGS ' • • , , , .. , . ,. • " Curtis Huffmanj 6. DSD SIGNATURECE 123 3/22 ��l;F©PROFESS �P1?'� System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: I d� -4wC" � f� t P b S c)!%��r Qv� �' �� e Id )'s �cc(rrrr \°\8a � d o aNd J � -14O BOriginal Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist Legal Description: T12N R3W SEC 27 LOT 41A-1 If more than 1 septic system on lot: COSA Checklist # _of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled CIRCA 1973 Total depth 240 ft (PER MOA RECORD DOCS) Cased to UNKNOWN ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 6/25/2021 Static water level at beginning of test 127 ft. Well production at time of test 3+ gpm Comments B. TANK DATA Age of tank(s) 5 years Tank type/material SEPTIC / STEEL Measured. operating fluid level in septic tank 50" ® Standpipes/foundation cleanout per record drawing Date of pumping 6/25/2021 D. ABSORPTION FIELD DATA Which system tested (date installed) 8/17/2016 ® ALL standpipes present per record drawing Total measured depth from grade 12 ft (max) Measured depth to pipe invert from grade 6 ft (min) ❑ N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 018-092-70 Structure served by this system _ Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate 1.55 mg/L E]Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by ME Date of Sample 8/11/2021 & 2/22/22 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 6/25/2021 Results 0 Pass For 3 bedrooms Fluid depth prior to test 61 in Water added 450 gal New depth 71 in Elapsed time 1440 min ® Code -required soil cover over field Final fluid depth 61 in ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date Wcs Comments/Deficiencies: FIELD IS OPERATING IN THE TOP V OF THE WED: 83% SATURATED Q � E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' ❑ Yes if No *83+ ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ❑ Yes if No *84+ ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Water Service Line > 10' ® Yes Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No _ Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No _ Water Main > 10' ® Yes. if No ft Community Wells > 200' ® Yes if No _ Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line ,> 10' ❑ Yes if No *1+ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *MOA WAIVERS ISSUED PREVIOUSLY. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. or— ape .... ........ .. .... ......... Curtis Huffman i 'ZIP CE 128991 �c�� OFis ft ft ft ft ft ft ft ft