HomeMy WebLinkAboutDEER PARK #1 BLK 1 LT 8r Park
Block
Lot 8
#051-042-59
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP231032
PID Number: 051-042-59
Dwelling: ® Single Family (SF)
❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade
Name
MATTHEW J O'CONNOR
ABSORPTION FIELD - EXISTING
❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
22709 OAK KNOLL DRIVE, CHUGIAK, AK
_T
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision
Block Lot
DEER PARK #1
1 8
Fill added above original grade
Ft.
Gravel length
Ft.
Township Range
Section
Gravel width
Ft'
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
FtZ
Ft.
Well
100'+
__
25'+
TANK ® Septic ® S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Capacity
Surface Water
100'+
--
GREER
1500 Gal.
Material
Number of compartments
Lot Line
51+
__
NA
HDPE
2
Foundation
101+
__
LIFT STATION
Manufacturer
GREER / ORENCO
Capacity
1500 Gal.
Remarks
Alarm location
BACK ROOM / WALL
Electrical installed by
DRS
Installer JRS
PIPE MATERIAL House to tank 3034 Tank to 3034
drainfield
Drainfield CO/MT 3034
Inspector FWCS
BENCH MARK (Assumed elevation) 100 ft
Inspection 1s' 4/5/2023Location
dates:
2"d 4/6/2023
and description
3rd
4`h
BOTTOM OF SIDING
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Conditional
A4.
Approval:
Date®�Q'1`.'•
• • •..���
•7H •� ���
.. .....�..
Septic System
••,•• •••• ••••••••••
Approved
�� �•,. Curtis Huffman
-
0
y /
Date y ( z0
.:
F CE 128991
2
iC�'f'1 • . 4/12/2023. •<c.�.
pROFESSOXkV
�
Note: this approval does not include well permit requirements.
1`�1�,��-�a,"�-
PID:051-042-59 PERMIT:OSP231032
FIRST WATER CONSULTING
DEER PARK #1 BLOCK 1, LOT 8
MUNICIPALITY OF ANCHORAGE 'ocnr
On -Site Water & Wastewater Program NOV
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite "Ilil
Department
On -Site Wastewater Disposal System Permit
Permit Number: OSP231032 Effective Date: 3/16/2023
Work Type: SepticTank Upgrade Expiration Date: 3/15/2024
Tax Code Number: 05104259000
Site Legal Address: DEER PARK #1 BLK 1 LT 8 G:1558
Site Mailing Address: 22709 OAK KNOLL DR, Chugiak
Owner: O'CONNOR MATTHEW J Lot Size in Sq Ft: 43560
Design Engineer: FIRST WATER CONSULTING Total Bedrooms: 3
This permit is for the construction of:
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions:
• Locate the beginning of the field prior to installation to confirm that the 5' separation between the tank and
field will be met. Install a cleanout or monitor tube so the field can be located in the future.
eived�� _3
�SSt terj +C) ►� Date:
Issued
Date: 3� 7�
Development Services Department 1 Phone: 907-343-7904
On -Site Water & Wastewater Section - Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 051-042-59
Property owner(s) MATTHEW O'CONNOR Day phone
Mailinq address 22709 OAK KNOLL DRIVE, CHUGIAK, AK 99567
Site address 22709 OAK KNOLL DRIVE, CHUGIAK, AK 99567
Legal description (Sub'd., Block & Lot) DEER PARK #1 BLOCK 1, LOT 8
Legal description (Township, Range & Section)
Lot Size 43,560 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
F-1
InitialEl
Single Family (SF) El
(w/wo ADU)
Septic Tank
El
Upgrade Q
Duplex (D) ❑
Holding Tank
❑
Renewal ❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: ;2 26 Waiver Fees:
Date of Payment:3115 , 6 A 3 Date of Payment:
Receipt Number: OY Receipt Number:
Permit No. CSP9 3116 3, Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
!
!!
March 13, 2023
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC TANK UPGRADE PERMIT
LEGAL: DEER PARK #1 BLOCK1, LOT 8
The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic
tank on the above referenced lot. We propose to install a 1000-gallon HDPE tank per the
attached design to serve the existing 3 -bedroom residence. We may recommend a 1500-gallon
HDPE tank be installed for future consideration or flexibility.
There is a current septic tank to existing foundation waiver with no observed conflicting issues
for 40 years and the tank upgrade will attempt to be installed 10’ from foundation or as far as
possible to maintain elevations at excavation installation. The new septic tank will be installed
outside the soil bearing prism. As normal, the MOA will be notified and able to be on site for the
septic tank upgrade construction inspection. If needed and subsequently noted on the inspection
report (IR), an appropriate wavier will be requested and as previously stated the new tank will be
outside the existing foundation soil bearing prism.
Separation to the proposed septic tank and existing field of 5’ will be verified at construction and
a new field cleanout will be installed at the start of the trench and noted on the design. Also, the
property is served by a private class ‘C’ shared well located on Deer Park #4 B2, L3.
No groundwater was noted in the MOA on-site file, but if groundwater is encountered during
installation an epoxy coated steel septic tank may be required. The lot and area are served by
private water. The design will not impact any of the neighboring properties. Please contact us if
you have any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231032, Deb Wockenfuss, 03/16/23
FIRST WATER CONSULTING
NO WELLS WITHIN
100' OF PROPOSED
SEPTIC TANK
DEER PARK #1 BLOCK 1, LOT 8
DESIGN DETAILS:
SEPTIC TANK DESIGN
BASED ON MOA DATA
& DIGITIZED SURVEY.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231032, Deb Wockenfuss, 03/16/23
~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 2644720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
PHONE I [~[ EW
X2/. -,sZ"A . I:/;'./,-/-/cs t []U,ORA.E
NAME
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
in gallons IF HOMEMADE: Inside le~nglh Width
DISTANCE TO:
Well Dwelling
Well
DISTANCE TO:
No. of line.~
Top of tile to finis~grade
Length Width
Total length of lines
Material beneath tile
Depth
Material /~,~ !
Nearest lot line
Trench width
NO. OF BEDROOMS
PEHMI NO.
Liquid__depth
PERMIT NO.
Liquid capacity in gallons
PERMIT N .
Distance between lines
PERMIT NO.
Type of crib Crib diameter
Well
DISTANCE TO:
DISTANCE TO:
Crib depth
Building foundation
Total ef recline absorption area
Nearest lot line
Driller , lot line
Sewer line t' Septic tank
Absorption area(s)
OTHER
PIPEMATERIALS
$OI L T EST RATING
14,'7
INSTALLER
REMARKS
APPHOVED
DATE LEGAL
[',EF'RRTNEHT ' HERLTH RN[:, Ef. IVIF.'ONMENT~'_' ~:O~:EL. TION/_¢~{~
'.g25 "L'. ~TF:EET, RHE:HORRGE, RK. -9~501 .
264-4720
I-!ELL RI'-.I[:, C~I'-J.--S ! TE SEI-IEF: PERt1 z T
RF'F'LICRNT HL~T CONSTF:LICTION ALALSK7~ 289 H DIHOND ~502
LOCFiT ~ OH
LEGRL L8 BI DEER PARK SUB LOT Cf~F
MR'XIHUH NUHErER OF DE[:,ROOMS = 3 SOIL RRTIN~J ,.SO FT,"BR>=
/
THE REQUIRED SIZE OF THE ~OIL RB~ORPTZOf.t SYSTEM
~,EF'T~=~ ~ LEt-~TH= G~:~%-'~L ~.EF"TH--
THE LEHGTH E~IMEN~ION ~ THE LEMGTH (IN FEET) OF THE T~.ENCH OR ~;,R~NF~ELD.
THE DEPTH OF ~ TRENCH OR PIT ~S THE DISTANCE E'ETHEEH THE ~URFFtCE OF THE
GF'.OUHD ~HD THE BOTTOH OF THE EXE:~'./~TIOH (IN FEET).
THE Tff:E~-~CH Iq · B, TH · ~ ~. ~:~ FEET.
THE GR~'...'EL DEPTH ~ THE MINIHUH DEPTH OF GR~VEL ~ET]4EEP~ THE OUTF~LL P~PE
~HD THE BOTTOH OF THE EXCaVaTiON (~H FEET).
F:E~;:I I l- F:ED- SEPT 1- C TRI'-.II--.-: _'S. T ZE :;LC~¢~C4 ~-iRLLC~I'4S
PERMIT RPF'LICRNT HRS THE F:ESF'ONSIE:ILITY TO INFORH THIS DEF'RRTHENT DURING THE
IN'=-TRLLRTION It-ISPECTIOflS OF RN'¢ 14ELLS R[:,JRCENT TO THIS F'ROPERTY RND THE
f.I_F:E:ER OF E:ESI[:,ENCES THRT THE HELL HILL SERVE.
TI..IC~ ,.': 2 .-" T I'-.ISF'EOT 1. ¢~!'-.IS RF:E REt_--.!IJ T RE[:,
E'RC:Y;F~LL[HG r'~F RN'¢ _,~=,TEtl HITHOUT F~NRL [NSF'ECT~OH RNb RF'PROVRL E:Y THIS
DEFRF:TF~ENT NILL BE SLIB.fECT TO PF:OSECUTIOM.
hIZNII,1UH D~STRNCE BETHEEN A HELL RND RNY OH-~ITE SEHRGE DISPOSAL SYSTEM IS
!00 FEET FOR A F'RIVRTE HELL OF: ~.50 TO 200 FEET FROH R PUE:LIC: HELL DEPENC, ING
dF'Ofl THE T~'PE OF PUBLIC HELL
M]HIHUH DISTRNCE FROF1 R F'R~VRTE NELL TO R PRIVATE SEI.!ER LINE IS 25 FEET RND
TE, F~ COr,tHUN~TY SEI4ER LINE IS 75 FEET.
HELL LOGS RRE REQUIRED, RMD HUST BE RETURNED TO THE DEPRRTHENT HITHIN .30 DRYS
OF THE HELL COHFLETION.
OTHER F:EOUIREHENTS I'1R'¢ RPPLY. SPEC~F~CRTIONS RND CONSTRUCTION D[RGRRr,IS RRE
F~'...'R[L. RE:LE TO INSURE F'F.'OPEF'. INSTRLLATIOf. I.
F'EF:I-1 ! T E:~--'. F· 1. F:ES E:,ECEI'-IE.'ER _-~'--I .. :::[~:~:2
I CERTIF"r' THFtT
1: I Ri"1 FRHILIRR HITH THE REOUIREt'?ENTS FOF: ON-SITE SEHERS F'Ii"~D HELLS RS SET
FORTH BY THE HUHICIPRLITM OF RNCHORRGE.
2: I HILL iNSTFILL THE SYSTEM If',! RCCOF:DFINCE FILTH THE CODES
=': I UN[:'EF:STPzSI.~ THFIT THE ON-SITE SENER S~r'STEP! i"]R'¥' F:E6!UIF:E Ef',!LF~F:GEHEI"IT IF THE
F:ESIE,ENCE//Z~-y:f.!E~;LED~,T~/~.~ r.y.E THRN 3: E. EDROOt. IS.
APF'LIC:RHT HURT~CONZ. TF;-d~TION ALRSKR IN,~. . ../~f_.)~ ,,¢--.,/6x4_,~%
PERFORMED FOil:_
L E G A L 'D E SCRip Ti ON:__~_.,*') ~
§
6
7
8
9
l0
ll
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF IIEALTI! AND ENVIRONMENTAL PROTECTION
SOILS LOG - PERCOLATION TEST
/_?~'c..-,- /. ,:..,.~ .I " .'.
/4.., t- ,"" '
£NTS__
SLOPE
WAS (~IIOUN[) WATEI!
PEIqCOL,~TION IIATE __
TEST RUN DETWEEN
SOILS LOG
PERCOLATION
TEST
SITE PLAN
FT AND __ _FT
./
DATE:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
925 L. Street, Anchorage, Al&ski 99501 2644720
SOILS LOG - PERCOLATION TEST
I-I SOILS LOG
I-1 PERCOLATION
TEST
PERFORMED FOR: /~e' f
SLOPE
4-
5-
6-
7
8
9
10
12
13
14
15
16
19 -'*'
WAS GROUND WATER
ENCOUNTERED?
IF YES. AT WHAT
DEPTH?
DATE PERFORMED:
SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
20-
PERCOLATION RATE I 4~, ~
COMMENTS /f'~'~'~"5'/,~-~ 4~ ~ ~~ ~ ~,~.~
PERFORMED BY:~
72-008 (6/79)
(minutes/inch)
L.- 58
L: 7B
(
, T~
LABORATORY
' [ STS
G
hanical. Analyses C
H
D
35.6
8.1
28.8
5.0
10-
I,/,.., Olli. SI PIT 5
[OuII'MI t~l. CA]*l:..fg_(0C Backhoe
I:LEV^llON~xi_s_~. GroundDATE 9/19/81
· Dark Brown PEAT,PT,moist,w/fibrous
__ Brown-Orange SILTY SAND,SH organics
moist,w/gravel & roots
Secondary Pit dug to 3.0'
Percolation hole duo to 4.0'
Percol t'on r f*4 ' e ' ch .
F-2, moist, w/random cobbles
__ Grey SILT, NL
wet, soft to medium soft
Grey S~NDY GRAVEL, GW, ~FS
so,~ sloughing in this strata.
I$.
TOTAL DEPTII OF TEST PIT - 16.0'
No Free water observed.
No fl'ee water observed on 10/5/81
LOG OF TEST PIT 6.,..
'F
D
B
13.1
q
3.1
4,5 5-
IO-
15-
I C)UIPI,',ENI..CASE 880C Backhoe
(I.[v^lIO;,' Exist. GroundOA?E 9/19/81
Brown PEAT, PT', w/fibrous organics
Reddish P, rown SILTY GRAVELLY SAND, SN
moist, w/roots
~rown SA~IDY GRAVEL,~, ~iFS
loose, w/random cobbles
SILTY, denseGRAVELLY SAND , ~,~-2.
__ IdaLer seeping in slowly at 8.0'
during excavaLion.
Free waLer observed L~ 10.0' on
·10/5/81
Free waL~r observed (~ 11.5' on
9/22/81
Pe,'colation rate of 1 minute/inch
TOTAL DEPTII OF TEST PIT - 15.0'
Secondary pie (lug to 2.5'
Percolation hole'dug t6
J IYI
.ils Laboralory ~nd GeotechnicaJ Engineering
,,o. 8l-]19.30 App,. JML
LOG OF TEST PITS 5 & 6
QUADP, A EIIGII~EERING
DEERE I'AR}'. SU~DIVISIOII
PLATE
5'
LABORATORY
TESTS
· chan~cal Analyses A
A
21.7
8.2
10.6
LOC, OF TEST"P[T '""'~
EQU~PMENr_C^SLP~0C fla~kho~
ELEVATION Exist. Ground.DATE.g/19/81
--'I]~1[TT'FTIIITOu$ u~un~l~, ~l
Brownish Orange SILTY GRAVELLY SAND,SM
moist, soft
Secondary pit dug to 3.2'
Percolationhole dug to 4.3'
Percolation rate of ]2 minutes/inch
Grey SILTY SANDY GRAVEL, GM, F-!
moist, dense to very dense, w/random
cobbles.
I0-
.F
B
A
17.9
8.1
8.3
15-
I0-
I$-
TOTAL DEPTII OF PIT - 15.0'
No free water observed.
LOG OF TEST'"P~TL~?
EQUIPMENI._.CJ~5[ 880C Backhoe' '
ELEVATION_I~.jSt., GroundDATE g/lC/8!
J'B'R-O-OS--OR~-A[~I-CS, P i
-- Brownish Orange SILTY GRAVELLY SAND,SH
moist, soft
Seconda,-y pit dug to 3.0'
Percolation hole dug to 4.0'
Percolation rate oF 5 minutes/inch
Grey SILTY SANDY GRAVEL, GN, F-1
moist, very <lense, w/random cobbles
Free wa~er observed @ 11.75 on 10/5
__ Free water observed 0 11.5' g/22/81
ater sdeping in at 12.Or during
excavation.
-- TOTAL DEPTII OF PIT - 15.0'
J M ASSOCIATES
ails Laboratory and Oeotechnical Engineering
· no._ 81-119.30
Appr... JNL Dore lO/2/tql
LOG OF TEST PITS 7 & 8
QUADRA ENGINEERING
DEERE PARK SUBDIVISION
PLATE
" AL/~SKA ENVIRONMEN
".,,,' '. CONTROL SERVICES,/INC.
· 1220 West 25th Avenue
.,:~ v.-i'.,~:.. ANCHORAGE. ALASKA 99503
Certificate of On -Site Systems Approval
Parcel I.D. 051-042-59
Legal description DEER PARK #1 BLK 1 LT 8
Site address 22709 Oak Knoll Dr Chugiak
Current property owner(s) Matthew O'Connor
Expiration Date: 2
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for
Comments or advisories:
bedrooms, with the following stipulations:
Original Certificate Date: 4/19/2023
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA Approval_June 2022
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-34377904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 051-042-59
Complete legal description DEER PARK #1 BLOCK 1, LOT 8
Location (site address) 22709 OAK KNOLL DRIVE, CHUGIAK, AK 99567
Current property owner(s) MATTHEW J O'CONNOR Day phone
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units
® Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass
Age NA — NEW STEP -See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS [—]Bed ❑ Deep Trench ® Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ -5 -S O Waiver Fee $
Date of Payment Date of Payment
COSA # 0_15C2_2)J09 Waiver #
COSA Application 2022.doc
COSA Checklist copy.docx
COSA Checklist
Legal Description: DEER PARK #1 BLOCK 1, LOT 8 Parcel ID: 051-042-59
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA - PRIVATE SHARED WELL OFF PROPERTY - DEER PARK #1 B2, L3
Well log is filed with Onsite (or attached)
Date drilled Total depth ft
Cased to ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Well production at time of test gpm
Water storage tank volume NA gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic 7.80 ug/L Arsenic less than MRL (ND)
Collected by Date 3/10/2023
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank NA
Date of pumping NA – NEW STEP TANK
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 10/5/1982
ALL standpipes present per record drawing
Total measured depth from grade 7.1 ft (max)
Measured depth to pipe invert from grade *4.8 ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes go to bottom of effective. (ED)
If not, state depth into effective 2.2’ INTO THE 3’ED
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Adequacy test date 3/10/2023
Results Pass
Fluid depth prior to test 6 in (Fluid depth)
Water added 630 gal
New fluid depth 15 in
Elapsed time 1200 min
Final fluid depth 6 in
Absorption rate 450 gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 36 in
Effective depth used 15 in (Fluid Depth + any missing ED)
Effective depth remaining 12 in (ED – Sewer rock)
Effective depth missing 9 in (Assumed per shots)
Comments/Deficiencies: Approximate total measured depths from existing grade & ED per elevation measured shots. *Per
visual observations of lateral into sump. Terralift treatment in 2015 & per MOA docs and visual observations at recent tank
installation soils seem to be adequate to consider another absorption field treatment in the future if needed.
COSA Checklist copy.docx
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No * ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No 2.5 ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
New STEP tank is 10’ from existing foundation and 5’+ to existing field. *MOA waiver & approval of existing
field to property line & foundation in MOA file.
G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Engineer’s Printed Name CURTIS HUFFMAN, PE Date 4/12/2023
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 or NO 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 &
4/12/23
NOTES:
1) DUE TO SNOW & ICE COVER, SOME SURFACE LEVEL
FEATURES ARE APPROXIMATE.
2) THIS LOT IS SERVED BY A PRIVATE WATER WELL ON LOT 3.
(Doc. No. 1983-070677-0)
25.0'
Lot 9
S 89'57'45"E 264.51'
COOP
ANQ; 2 MANHOLES
N W SEPTIC PIPES
WOODEN FENCE /
--10' UTILITY EASEMENT
I
Lot 7
PIPES
Lot 8
43,560 S.F.
FENCE
FENCE
WOODEN
T
PLOT PLAN ___ AS BUILT _X_ SCALE __1" = 49_— GRID __NW 1558-- Project No.
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
907 522-6476 Phone
Lang Associates, n C+ • kenOlangsurvey.com��\\X
Professional Land Surveyors jonathanOlangsurvey.com ?t OF Aqkk\
travisOlongsurvey.com i�Q' s,L ,
I hereby certify that I have surveyed the following described property:
LOT 8, BLOCK 1, DEER PARK — ADDITION No. 1 (PLAT No. 82-133) *; 49TH *�0
Anchorage Recording District, Alaska, and that the improvements situated thereon are
within the property lines and do not encroach onto the property adjacent thereto, that 0,
no improvements on the property lying adjacent thereto encroach on the surveyed • • • • • • • • • • • • /
premises and that there are no roadways, transmission lines or other visible
easements on said property except as Indicated hereon. I+9csf, o /
. KENNETH G. ANG
202
Dated this the --LLL-- Day of __ Y`_1c— ------- _ ` _, at Anchorage, Alaska ,� F9FOp 1
ll AOFFSSIONAL�a
It is the responsibility of the owner to determine the existence of any easements, ��
covenants, or restrictions which do not appear on the recorded subdivision plat. State of Alaska AECC963
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Complete legal description
Location (site address) ~
Current Pro'perty owner(s)~
COSA # _(~ ~---J/
Expiration Date:
Mailing address
Lending agency
Mailing address
Real Estate Agent
Day phone
Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS: _~
3. TYPE OF WATER 'SUPPLY:
Individual Well
Individual Water Storage
Community Class ~ Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding Tank
Community On-site
Public' Sewer
[]
[]
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
',. engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of
.... title (except between spouses) for properties served by a single-family on-site wastewater disposal anS/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer'S work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my. investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Engineer's Printed Name ~'['-/-~'J'~-- ~-f~' Date
DSD SIGNATURE
\/ Approved for ~
Disapproved.
Conditional approval for
bedrooms. '~:,.'
bedrooms, with tho following
By:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
(Rev. 11105)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
//~,,'/--~_ ,~Original Certificate Date: ~/- ~ -//
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343'7904
CER'I FICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Well ~pe '~ IfA, B~°vide PWSID g
Date complet~ ~nita~ seal (WN)
Total depth __ ff. ~ Cased_to ~. in.
~ROM WELL LOG
Date of test ~
We~u~i~ g.p.m.
WATER SAMPLE RESULTS:
Coliform ~ ~lonies/100 mL' Nitrate ~ m~
Well Log (Y/N)
Wires properly pro'N)
Casing height, h~ove ground)
AT
g.p.m.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material
Tank size/~ac, gal. Number of Compartments
Foundation deanout (Y/N) __~
Date of pumPing ~/S//!
C, ABSORPTION FIELD DATA
Date installed ./to/t~
Length ~/~_~" ff.
~_.
Depression over tank (Y/N)
Pumper
Soil rating (g.p.d./ft2 or ~/bdrm)/~' '~
Width 5' ft.
Date installed / ~)/~ 2.-
Cleanouts (Y/N) ~
High water alarm (Y/N) /%,"
System type 7'-~'~,~r'_ ~.
Gravel below pipe ~
Total depth .7,. 'ft. :~ Eft. absorption area '~~ ~ Monitoring tube ~ Depression over field /c/
Date of adequacy tes~ (/~/ Results (Pass/Fail) P/f~ J~ For -~ bedrooms
Fluid depth in absorption field before test ~ in. wate~ added~ gal. New depth o in.
Elapsed Time:~~ min ' .... ~inal fluid depth ~ in. Absorption rate >= ~ O ~ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
LIFT STATION
Date installed
"Pump on" level ayin.
Datum
Size in gallons
"Pump off" level at~
Cycles tested
in.
Manhole/A/~ (Y/N)
High w~r alarm level at
Meets alarm & circuit requirements?
in.
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift,station on lot /
Absorption field on lot ~
Public sewer mai~~
Sewer ~I~C service !ine
An:~ containment areas
On adjacent lots ~
On adjacent lots / "
Public sewer/~ole/clear~out
Holdin~ _ ~ ~.
Ma~,ur'e/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation
Water main ~/'/~
Wells on adjacent lots
Property line /~;:)/'/~- Absorption field ,~"-
Water service line / o r~- Surface water
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line /~ /"F- Building foundation /~/~' Water main
Water Service line 2 ~' ~'t'
Curtain drain _/f_~,/*,,,~
COMMENTS
Surface water / ~ 0 ~-~" Driveway, parking/vehicle storage
Wells on adjacent lots / ~'0 f~'-
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.
Engineer's Printed Name ~'7''~J*/~- ~'~J ~"
Date ~7/~I~//[~
COSA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
(Rev. 4/10)
,N
EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON.
A$-'~1,111.1' NO CORNERS SET THIS DATE
I hereby certify that I have pezfformed a Mortagee's in-
spection of the following described property:
Anchorage Recording Precinct, Alaska, and that the improve-
ments situated thereon are within the property lines and do
not overlap or encroach on the property lying adjacent there:
to, that no improvements on property lying adjacent thereto
encroach on the premises in question and that there are no
roadways, transmission lines or other visible easements on
said property except as indicated hereon. '
Dated at Anchorage, Alaska
thi.~,~" ~_~/4 day of ,~--~.~-?~.,,./~2,,:, ,~' 19~
FRED WALATKA & ASSOCIATES
,~- .... Engineers and Surveyors
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section 825 'L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-4744
Parcel I.D. 051-042-5q
1, GENERAL INFORMATION
Complete legal description ~,ot
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Expiration Date:
8, Block 1, Deer Park Addition #1
22707 Oak Knoll Drive Drive
243-4732
Day phone
Location (site address or directions)
Current Propertyowner(s) Ed & Linda Price
Mailing address ~ ~ ~ ~ ~ ~ ~
Lending agency
Day phone
Mailing address
Real Estate Agent Prudential Vista/Rae Hall Day phone 689-6464
Mailing Address 3.6635 Centerfield Dr., Eagle River~ AK 99577
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class C
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
[] Individual Holding Tank []
[] Community On-site []
[] Public Sewer []
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of
Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent
professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are
required for the transfer of title (except between spouses) on properties served by a single family on-site
wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners.
Certificates of Health Authority Approval are valid for 90 days from the date of issue !or properties served by
a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates
are valid for one year for properties served by Class A or B wells or a public water system. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 01J00)'
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 Health Authority Approval Guidelines for the Health Authority Approval
application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation.
S & S ENGINEERING
17034 Eagle River Loop Road No. 2~4
Eagle River, Alaska 99577
Name of Firm
Address
Engineer's Printed Name Robert. C. Cowan
Se
DHHS SIGNATURE
J.-"'" Approved for _'~ bedrooms.
Disapproved.
Conditional approval for
Phone.,
Date
...,~.~ ~ OF
bedrooms, with the following stipulations.
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Expiration Date: ~-'- ~ ~-0 0
Original Certificate Date: /'/- ~ O -~ O
Reissue Date:
72-025 (Rev. 01/00)°
Municipality of Anchorage
Department of Health and Human Servicl~ E
Division of Environmental Services !~. C E I ¥ E
On-Site Services Section 825'L' Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us ~OV
(907) 343-4744
MUNICIPALITY OF ANCHORAGE
HEALTH AUTHORITY APPROVAL CHECI'~NMENTAL SEI~VICES 01VlSl0N
Legal Description: Lrr
A, WELL DATA
Parcel I.D.: (~' I "'
Well type/"~'~~,¢ C ,, A, B, or C provide PWSID # '
Date compleied Sanitary seal _ ~ Wires properly protected
Total depth ~ _ ft Cased to __ tt ~ Casing height (above g[ound) in.
Date of test FROM WEL---~..~IIC)~ J '
AT
INSPECTION
Static water level ,,/it ft
Well production J g.p.m g.p.m
WATER SA ULTS:
Coliform J O colonies/100 mi Nitrate O. ~ mg/I Other bacteria 42 colonies/100 mi
Date~3~f sample: I ~ ! ~ I / o c~ Collected by: s & $ ENGINEERING
SEPTIC/HOLDING TANK DATA 17034 E,gle River Loop Road No. 204
Ta, nkType/Material ~'dl'l-lC. '~'~('~' ~ E'gteRlvor'Ala'k'9<~$77
Dateinstalled 10"16'~" Tanksize {b"L,"c) gal Number of Compartments ~
CleanoutsF('~, Foundation cleanout Depression over tank /VOi High water alarm
iDate of pumping [ ~ ~ Pumper
ABSORPTION FIELD DATA :
Dateinstalled (O .~,' Soilrating ( rit2/bdrm) ~,/,,~1~ Syste ,m type I E-.-'~J¢-.-~
Length /,¢,~ It Width .~" ft Gravel belowpipe ~ ft
T°tal depth i~[ It Effective absorption area ~"J~) fF Monitoring tube "//~ Depression over field /V'~
Date of adequacy test Results Fail) ~4 For ',~ bedrooms
Fluid depth i0 absorption field beforetest .~ in Water added~l gal. Newdepth t 0 in.
Elapsed'lime: ~D min Final fluid depth ~,~ in Absorption rate >=~d~c~'~g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) ~t¢~/p /~.N[~,'t,] If yes. give date
72,02~ I Rev.
D. LIFT STATION
"Pump on" level at ~."'~in 'Pump off" level at
Datum ...." Cycles tested
SEPARATION DISTANCES ~,Tc,,~-~,~ ~_~ e,..,
Manhole/Access
in High water alarm level at __ in
Meets alarm & circuit requirements
Absorption field onlo~'''''''''''~
Publi~n
S. ew~r/septic service line
SEPARATION DISTANCES FROM WELL ON~ TO:
Septic tankAift station on lot ~ On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation
Water main "J
Drainage ~-//~,
Property line ~'/..z-
Water service line /'~ ~
Wells on adjacent lots /~'-,~ L~
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line / ~ ~ Building foundation /(~ ~ Water main
Water Service line /~'/,.¢- Surface water / ~ /-~
Curtain drain ~,~4- ~Vrw~ Wells on adja~:ent lots /~"/? ~-.
F. COMMENTS " '
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name /~0/~
Date ///3-'$/~ o
Absorption field
Surface water
,,via
Driveway, parking/vehicle storage
HAA Fee $ ~
Date of Payment
Receipt Number ~,~J~ ~'-,~
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 01/00)*
"' - ': ? ~ :.." .' ,,~ . ' ';, - MUN CIPALIT~f. OF ANCHORAGE
;' : ,; (~i~ ' DEPARTMENT OF HEALT,H & HUMAN S. ERVICES '. '
' ';'*:- "' "q',': i': ~.'~__~'- ./. '"'-"i!: Divisk~n 'of Envlr6~'er~'tai Services"
"*, *". . .. ,..-..,~ ,~ ..-: ~On-SiteServices Sectlo
: :; :.l~.u. HOX 196650 ;Anchorage, Amska ~:99519-665u
' ~.i CERTIF CATE OF HEALTH AUTHOR TY ,
· ."1'-.~,* .... ? !.: .... ': ": ............ APPROVAL FOR A SINGLE FAMILY DWELLING· ** ' -
:.~; : ~ .... ,,.._.; ,., , 05-/-'0 -5T9 .", ;-,.: .'..'-..,.~..~. ~: .... ~.-. ,I,IC~c~/-,Cl~z,~.~ --
'.iX''' '-' ' ~°mplete -e. ga-I descripti°n LOtZi-:StO. al,}!P,.ee"'~.~.~-~';$a~div'~tOn'/' ..... ~' ~
;'*i~ . , Locatmn (s~te address or d~rect~ons) _ ____ . ___ * - ._ _ - · :-.-
· ~. -.
-ax phone ,~ ...... ~: .~
· NOTE: *; If community wastewate...system, provide written confirmation from State ADEC
~ ~r[llleo Dy ITIV seal afl, v,.,. ~....A. - - ............. .-.
'"ves~ga~,onofthlsHealthAuth0~;,,'^' ..... :.-,.. ::
.--u~ur wasmwater disposal system Is Saf,a' ~.;--,..-:-. ' "-.-?:.
and type of structb~-e Iner i '.-i "a' a. 9a _oequate
the Mun/c pa i~ ~ A,,-~:.J:-'".-., "' ~: -:'rm~r*ver ty that ,based on the
su,~,~l .... ,~,-- -:-~=:'" ":'" ~ :?-"' -~' .a~d irom my investigation and
r ' · ' ,-.. .... .¥.~, · .... ~o .~ ~,uillpllance With all
o dmances and r~'~ul~*~,,,,'x'~..'--,~"=:""-.= "' · Munlc
me of F · - & $ ENG NEER NG .......
Phone
.. ~ . ~g;~ ,:.,..~:;;~., 17034 Eagle K~ver ~.O~p ka.'~
',, ' Address- ....... *,-~ ~.~l;.g;;'~'~;;~,'- aa;~-, ...... ~.,...~ ........
· , , . ' . v "~ '.'~ -,,' ...... '..' '~'~ ': ·: .... . .......... ~t~,~'
.. . ..~:.., .., .~ :.- .............. =:.-= ....... .~ ........... ~ .~,,~
.. . ............ -.~....~..... ..... . ., ~: .~..-...,.:,.~.. _: .,-= .. ~. .... . ~- . ta
MunicipalitY,'of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744
Health Authority Approval Checklist
Lcgal Description: ~,,-~'~, Ib~.v---I Df..,~_r- ¢~t-a..--5~ol~l P:,rccl I.D.:
A. WELL DATA
Wcll t.'.pc
Log present (Y/N)
Total depth
Sanitary scal (Y/N)
Dale of test
Static water level ~
W~,~II~s:
-.r'? _ o
Ir A. B. or C. attach ADEC letter. ADEC water system nambcr
Date complcled
Cased lo C~ing height (a
Wires propcrh..~m~cted (Y/N)
FRONt WELL~ AT INSPECTION
g.p.m, g,p.m.
Coliforra
Dalc of samplc: ti-2- t -
SEI'TIC/IIOLDING TANK DATA
Nitrate O, I0 Other bacteria 0
Collcctcd by: __
$ & S ENGINEERING
Eagle River, Alaska 99577
Date installed /O '~'2. Tank size {0o0 Nuraber of Compartments 2- Clcaoouts~',l) _
Founda!i0n cleanout
Date of Pumping
Dcprcssion (Y/'~) ~
Pumper ~'~.(-. IO0~.r,..Lt.
tligh water alam~ (Y~) ~
ABSORFFION FIELD DATA
Date installed lo-~ 2... Soil rating (g.p.d.lfi: or ft:/bdrm)
Lcngth ~,.,.e- tWidth 5'" ~ Gravel thickness below pipe
Effective absorption area 6-6 ~, ~ Monitoring Tube prcsent~q',l) y
Date of adcqua~' test Il- .~ 7- ~.v- Resuhs~ff:ail)
Fluid depth in absorption field bcforc test (in.):
/ 67 T~,~z Systera type '7-'/4,~.~e H
~ ~ Total depth 6,-,V'~
. Depression over field (Y,~ ~
For ~ ~dr~ms
Imm~iatcly aflc~C~o gal. water added (in.): ~2"
Flaid dcpth.~ ~ '* (ins.) Minutes latcr:~ ~50 Absorption rate =
tJa,~.6, t'L~'J ~3f If yes. g~vc date
Peroxide treatment (past 12 momhs) (Y~ .... ' ~ '":" '
z/6..O ,t. g.p.d.
D. LIFT STATION
Date instullcd Size itt gallons
Manhole/Access (Y/N) ~"Pump oft' Icvcl at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Scpticgholding tank on lot
Absorption field ou Iol
Public scwcr main
: On adjacent lots
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation ~q~t Prope~ty linc /o ~ '/' Absorption field
Water main/service line /o w ,t,. Surface water/drainage /o,o t/" Wells on adjaccnl Iota
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation .5'''/
Surface water /OD /4-
Curtain drain '"/~
Water main/sen'ice line /o w 4- ,,;
Drivcv.'ay. parkingA'chiclc storage arcu
~VcIIs on adjacent lots [o"'b t ar Property linc /0 ~ 4-
F. ENGINEER'S CERTIFICATION
I certi~, that I have deterntined thrufield inspections and review of Municipal records that_~{.ems ~re
in co,~,rmance wit/, MOA IL.L-I guide~s in effect on this date. ~ ~
tIAA F= $... ~ ~ t ~ Waivcr FCC $
Rev. 8/95 DSS: haa.~vk.~
STATE OF ALASKA
DEPARTMENT OF ENVIRONMENTAL CONSERVATION
CONSTRUCTION AND OPERATION CERTIFICATE
for
PUBLIC WATER SYSTEMS
*'A. APPROVALTO CONSTRUCT
...~ Plansforthe~t, uudu, vrmodlflcatlonof Z~ ~,~,~ , ,'~/,,,,I ,~ ; Z,.~ r/~ ~/, $,/,;./, / "P~o-' ~rJ= '
,S,,I~,',,:_~:,,.,, publl¢ v~ater system located
&..,
..,,..j. ,.L Z',, ,//
[] approved.
· *, Alaska, submitted In accordance with 18 AAC 80.100
,~'/~.,~a~,~' " have been reviewed and ars
· -~'. . [] conditionally approved (see attached conditions).
If construction has not started wlthln two years of the Ipproval date, this certificate Is void and new plans and
· specifications must be submitted for review and approval before construction.
APPROVED CHANGE ORDERS'
Change ~*~,~-~ ~ ~o. o~ e.,~a;~ ~,,~*~ Approved by
Date
C. APPROVAL TO OPERATE
The "APPROVALTO OPERATE" section must be ccmpleted and signs'3 by the Department before any water
Is made available to the public.
The construction of the ~d~*/-.,~
public
water system was completed on Og.~.. If ~ '~V (date). The system ls hereby
granted Interim approval to operate for 90 days following the completion date.
,r..,..,,.
As-butlt plans submitted ~urlng the Interim approval period, or an Inspection by the Depa~ment, has confl~ed
the system was constructed according to the approved plans. ~e system Is hereby granted final approval to
operate.
MUNICIPALITY OF ANCHORAGE
' DMSION OF E~ArIRO~4ENTAL HEALT~
DEPARDtENT OF HEALTH AND DAriRCXgMENTAL P~l'~-rlON
APPLICATI(~I ~OR HEALTH AUTHORITY APPROVAL CEKTIFICATE
1. General Info~,ation
Application Pate
(a)
[~gal ~scripticn (include lot, block, sub~.ivisicn, secticn, tcwrship, range)
a ~ ~ ~ D:,,,- FI< ~,~, <~ 'T,~'M P,~,,,'
Location (address c~ direction2)
Applicants Address
[c) Applicant is (check one) Lendi~-g Institution
(d) [endi~ Institution
Address
(e) Real Estate Co. & AGent
Address
Telephcne '?~ ~-, -0~7 ~
Owner/builder ~
Te le p hone
Telephom~
2. T~ of ~sidence
Single-Family ~-~
Numbe~ of Bedrocz~
3. %4ater Supply
Individual W~ll ~
0
~,lti-Family ~--~
3
Other (describe)
Note: If w,,,.~nity well system, ~ust have w~itten confirmaticn fr~ the State'
Department of Envirc~'~:mntal Conservatio~ attesting to the legality and status.
Is the well adequate fc~ the r~umber of bedrooms specified in this HAA (Y/N)/
Se wa~e Dispcsal
Onsite ~-~ Public ~--] Cc~Tm/~ity ~ Holdi~.g Tark ~
Is the wastewater disposal systeg adequate f(= the rnm~er of kedro~ns .(Y/N) ~ ~ ),f~ ~
[Page 1 of 2]
2-15-84
5. En.~ineering Firm Providing ]nspecticem~ Tests, Duta and 2nformaticn
I ~rtify that I have checked, ~:ified, c~ c~nfo~,~d to all ~A HAA Ouid~lims in
effect o~ the date of this inspection. ! ~rf,{y {k~ -~¢ ,-T~.~,.._~;...
Telephc~ -~ ~-~ ~ ~ ~1
Address
Date
( ENGIN~ SEAL)
6. DHEP Approva 1
Approved for ---~
Approved _'~. Disap~oved ~-~
Terms of CorzJitio~ml Approval
The Municipality of Anchorage Department of Health a~d Envircr~ntal Protection dces
not guarantee the c~ntinued satisfactc~y I:erfo".-man~e of the water supply and/ct the
waste~ate~ disposal system. This approval indicates that, as cf the velidaticn date
sho~n above, b~sed on the data and information furnished by an ergi~er registered in
the State of Alaska, the w~ter supply and wastewater disposal system is safe a~ func--
tic~ml for the rumber of kedrcc~s and ty~e of structure indicated.
(D~EP SEAL)
7. Mail the HAA to the foll~inG addre~-s:
KB21dSIs
[Page 2 of 2]
2-15-84
ae
MUNICIPALITY OF ANCHORAGE
D£PT. OF HEALTH &
ENVIRONMENTAL PROTECTIO~
Well Classification ~
Well Log Present (Y/N) ~
Total Depth ~l Cased to
Static Water Leal .g~t ~
/JUl
RECEIVED
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Legal Description: ~_ ~ ~ I
If A, B, c~ C, D.E.C. Approved(Y/N) y
Date Cu~leted .~ /~ .~ Yield
~ ~" tr C ~epth of Grouting ~C/a h ~
Casing H~ight Abov~ Ground 2' Sanitary Seal on Casing (Y/N) ~
/~'.~. e. s.l~\~ '
Elect=leal Wi=ing in Conduit (Y/N)/~. ~ ~/ ~. ~ PeL~ession A~ound Wellhead (Y/N)~
Separation Distar~s f~cm Well:
TO Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field 'on Lot
To Nearest Public Sewe~ Line
; On Adjoining Lots /.~'d/+
; On Adjoining Lots ;~ '+
To Nearest Public Sewer
Cleancut/Manhole ~
Wate~ Sample Collected By
Wate: Sample Test Results
To Nearest Sewer Service. Line on Lot
; Date "
B. SEPTIC/~OLDING TANK ~TA
Date Installed I~) /~.,~ Size IdOo No. cf Cu~U,~nts
Standpipes (Y/N) ~ Aid-tight Caps (Y/N) ~ Foundation Cleanout (Y/N)
Depression o~ Ta~]~ (Y/N) ~/ Date Last Pumped < :z ~-S ~ ;~
PumpinG/Mainte~zn~ Contract on File (Y/N) ~/.~ ; fc~
Holdir~ Tank HiGh-Wate~ Alarm (Y/N) /~/~ Temporary Holding Tank Permit (Y/N)
Separation Distan~s f~om Septic/Holding Ta~R:
To Water-Supply Well /~-~ + To Building Foundation
To Property Line
To khter MaiP/Service Line
To Disposal Field ~
To S~-e~, Pond, Lake, c~ Major Drainage
[Page 1 of 2] 2-15-84
C. ABSORi~ION FIELD DATA
Soils Rating in Absorption Strata , /& 7 ~Z~/~ ~fpe of S~m ~sign ~.~ ~
S~e ~et ~ ~s~pti~ ~ea .~6¢ ~ ~ Stan~t~s k-e~nt ,(Y~) ~
Date Installed
Size in Gallons
"Pu~ On" Level at
High Water Alarm Level at
Tested for
Electrical Cedes (Y/N)
C~tz~ents
Dim~ r~ io~.~
Manhole/Access {Y/N)
"Pump Off" Level at
~ %%nt (Y/N)
Pu~ping Cycles Jdu~irg ~equacy Test.
** Check Permitted Bedroom Rating AGairst HAA R~quest **
I certify that I have checked, verified, cr ccnfc~m~d to all MOA HAA Guideli~s in effect
Date
MOA No.
[Page 2 of 2]
2-15-84