HomeMy WebLinkAboutRABBIT CREEK VIEW & HEIGHTS BLK 4H LT 19A1/24/2020
Municipality of Anchorage
On-Site Water and Wastewater Section • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP251416 PID Number: 020-551-33
Dwelling: Single Family (SF) with ADU Duplex (D) Two Single Family Project: New Upgrade
Name
DAVIDSON DEAN ABSORPTION FIELD
Site Address
7841 BYRON DRIVE, Anchorage
Deep Trench Wide Trench Bed Mound
Other
Phone
Number of Bedrooms
3
Soil Rating Total depth from original grade
0.45 GPD/SF 3.5 Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision
RABBIT CREEK VIEW & HEIGHTS
Block
4H
Lot
19A 3 Ft. 0.5 Ft.
Fill added above original grade Gravel length
Township
Range
Section
VARIES 2.29’ – 5’ Ft. 200 Ft.
Gravel width Beds: Number of Lines Distance between lines
SEPARATION DISTANCES 5 Ft. Ft.
From
To Septic
Tank
Absorption
Field Lift Station Holding
Tank
Sewer
Line
Total absorption area Number of trenches Dist. between trenches
1000 Ft2 4 6 Ft.
Well -- 100’+ 25’+ TANK Septic S.T.E.P. Holding Other
Manufacturer Capacity
Surface Water -- 100’+
NA
EXISTING Gal.
Material Number of compartments
Lot Line -- 10’+
Foundation -- 10’+ LIFT STATION
Manufacturer
Capacity
Gal. Remarks Fields insulated & well – tank waiver requested.
Alarm location Electrical installed by
Installer BEEK’S CONTRACTING INC PIPE MATERIAL House to tank Tank to
drainfield 3034
Drainfield 3034 CO/MT 3034
Inspector FWC BENCH MARK (Assumed elevation) 100 ft
Inspection
dates: 1st 12/5/2025 2nd 12/6/25 Location and description
3rd 12/5/25 4th 12/6/25… TOP OF DOWNSTAIRS SLAB
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Conditional Approval: Date
Septic System
Approved -
____________________________ Date
Note: this approval does not include well permit requirements.
(Rev 05/02/18)
12/16/25
FIRST WATER CONSULTING
RABBIT CREEK VW & HTS B4H, L19A
PID: 020-551-33
PERMIT: OSP251416
TH25-1
FIRST WATER CONSULTING
PID: 020-551-33 PERMIT: OSP251416
RABBIT CREEK VW & HTS B4H, L19A
TH25-1
Permit Number:OSP251416
Tax Code Number:02055133000
Work Type:Septic Upgrade
Effective Date:
Design Engineer:
Site Legal Address:RABBIT CREEK VIEW & HEIGHTS BLK 4H LT 19A G:3340
Owner:DAVIDSON DEAN
Site Mailing Address:7841 BYRON DR, Anchorage
Lot Size in Sq Ft:19964
Total Bedrooms:3
This permit is for the construction of:
Disposal Field Septic Tank Holding Tank Privy
Non-Public
Water 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. Coodinate with On-Site staff regarding preferred method.
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
11/26/2025
11/26/2026
FIRST WATER CONSULTING
Expiration Date:
þ ¨¨¨¨¨
Issued To:
Issued By:
Date:
Date:
11/26/2025
11/26/2025
FIRST WATER CONSULTING
Isatou B Njie
MUNICIPALITY OF ANCHORAGE
On-Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On-Site Wastewater Disposal System Permit
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
!
!!
November 25, 2025
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC SYSTEM UPGRADE PERMIT
LEGAL: RABBIT CREEK VIEW & HEIGHTS BLOCK 4H, LOT 19A
The property owner has requested we obtain a permit to upgrade the failed septic field of the above
referenced lot. We propose to remove any biomat material, add MOA sand to maintain elevations to the
existing 2 trenches, reinstall these 2 trenches along with 2 new trenches to serve the existing 3-bedroom
residence.
The design is based on the recent test hole conducted in November 2025 & the existing test hole
conducted by Steve Pannone, PE in October 2014. No groundwater was observed at test hole excavation
of TH25-1 but was monitored at 10.5’ a week later. However, the 2014 test hole monitored groundwater
that October at 7.5’ and this monitored observation has been used in the design.
At time of design, it was found that the existing septic tank is approximately 95.5’ from the referenced
well. The immediate area does not have a high nitrates and the attached CAN water samples show nitrates
at 0.637 mg/L. The referenced well is significantly up gradient from the septic tank, there have been no
known issues and the area well logs indicted a confining, protective layer of silt. For these reasons, a
waiver is justified, but at this current time a waiver is not requested till after the integrity of the tank is
verified at construction – please see design note. Also, it was found that the well appears to be in the
Byron Drive ROW. A different surveyor is verifying and if need be, the owner will contact MOA ROW
to resolve. This issue does not affect the issuance of the septic upgrade permit.
The slopes are 17-22% at the proposed upgrade location. 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
OSP251416, Isatou Njie, 11/26/25
3030 Sues Way - Anchorage, Alaska 99516
Tel. 907-350-9566 firstwaterAK@gmail.com
SOILS LOG - PERCOLATION TEST
LEGAL : RABBIT CREEK VIEW & HEIGHTS BLOCK 4H, LOT 19A
PERFORMED BY: FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 11/12/2025.
DEPTH
FEET OG
SOILS
1
2
ORG/OL-FILL
3
4
5
6
GM/ml
7
8
9
10
11
12
13
14
15
BOH
16
17
18
19
20
Reading Date Gross
Time
Net Time Depth to
Water
Net Drop
11/06/25 30 min 6” 13 /16”
“ 6” 13 /16”
“ 6” 13 /16”
PERCOLATION RATE 37 (MIN / INCH)
TEST RUN BEWTWEEN 4 & 5 FT
PERC HOLE DIAMETER 6”
PRE-SOAKED PRIOR TO TEST & ALL READINGS TO
THE 1/16TH.
GROUND WATER ENCOUNTERED: NO
IF YES, AT WHAT DEPTH: YES
DEPTH TO WATER AT MONITORING: 10.5’
DATE: 11/12/2025
TESTHOLE # 25-1 DATE PERFORMED: 11/05/25
SEE SITE PLAN FOR SLOPE & LOCATION
COMMENTS:
Pannone 10/22/2014 TH-1 monitored groundwater at 7.5’
VERIFY GROUNDWATER MT
AT TIME OF CONSTRUCTION
PERFORMED FOR: DEAN DAVIDSON
11/12/25
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251416, Isatou Njie, 11/26/25
FIRST WATER CONSULTING
RABBIT CREEK VW & HTS B4H, L19A
DESIGN CALCS:
NO SLOPES >25% WITHIN 50'
OF PROPOSED FIELD.
STAKE PROPERTY LINES,
WELL RADII, ESMTS,
OR OTHER SEPARATIONS...
PRIOR TO CONST.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251416, Isatou Njie, 11/26/25
FIRST WATER CONSULTING
NO WELLS WITHIN
100' OF PROPOSED
SEPTIC FIELDS.
DESIGN DETAILS:
RABBIT CREEK VW & HTS B4H, L19A
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251416, Isatou Njie, 11/26/25
MUNICIPALITY OF ANCHORAGE
DE 1TMENT OF HEALTH AND HUMAN SER' iS
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Aurora Contractors
2901 Rose, Anchorage Alaska 99516
Phonets}
561-6611 850110 3
LEGAL DESCRIP~rlON
Lot [- Bio TSubd,vls~on
19 ~ ~ '~
I Rabbit CK Hei§h~s
i1N ~'
TANKS
F,~ SEPTIC [~ HOLDING
Greer 1000 Gallons
Ma,e.~,,Steel
TYPE OF SYSTEI~I
~'FRENCH [] BED [] W. DRAIN [] OTHER
3.5 FT 7.5
i FT 3.5
14.8
)z-~'J~O(,.-~t" J~o SO FI 10 FT
2J 445 SO FT 3034 PVC
~,urora Contractor 7-19-85
WI=LL$
~ PRIVATE [] OTHER (Identifv)
C~assd,cat,on iA ~.C, ~otai ~u(~H] ] Cased to
C I:T 180 FT
;4[,; ~rilling 6-14-85
REMARKS:
DISTANCES
SEPTIC
TANK
WELL
LOT LINE
FOUNDATION
105 ft
22.5 'Ft
2~. 7 ft
ABSORPTION
FIELD WELL
104 'Ft
10 ft 2.5 ft
40.8 ft 30.2 ft
AS-BUILT DIAGRAM tShow Iocahol] of well. septic system, properly hr/es, foundation.
Scale: ~O =- I't
Inspechons Pet~or~.ed by
Date
7-22-85
, /'~¢£~'~ .~Z~L~-~_~ ___~ __ cerlil¥ thai ,his inspeolion was ped0rmed acc0rdi.0 to all
MunicipoI and Slate guideIines in ellecl on this dafe:
Health Department Approval:
72 013 (3/85)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG -- PERCOLATION TEST
[] SOILS LOG
PERCOLATION
TEST
PERFORMED FOR: Lionel Urban
DATE PERFORMED: 4/1_7/85
LEGAL DESCRIPTION: Lot 19 Block 4
1 ~ ?ibrous
..1 1/1 Brown Peat
Pelc Zone
2
3
4
5
6
7
8
9
10
11
12
13 --
14
15
16
17
18
19
2O
COMMENTS
Rabbit Creek Heights
Brown SiltZ Sandy
Gravel (OM)
with occasional cobbles
SLOPE
SITE PLAN
Water Seepage
WASGROUND WATER
ENCOUNTERED? Yes
IF YES, AT WHAT
DEPTH? 131
Reading
Date
Time
6.
~ca±e bu' ,per ;~quare
Net Depth to Net
Time Water Drop
No
24 hfs Satura io Perio Waber
~,.¢/,,..¢; .......;-.,~,.~. ~/~7/U5 0 hrs 1 1/2"
'~ .' L~,~aoi~,,,o~.~ ~ i 4 0 hrs~ 5 1/2" 1/2'
~.--~%,, .... , i¢~ERCOLATION RATE 60 ,mn pe~ ~noh (mmuteshnch)
(~Y'&~:~ TEST RUN BETWEEN , ~ , FT AND ,~ FT /
32~ square feet of drainage area required per bedroom
/
PERFORMEDBY: NPC
CERTIFIED BY: Alaska Test Lab DATE: 4/17/8g
72-008 (6/79)
FV1-W DRILLING, Inc.
P.O. Box 10-378 · 10300 Old Seward Highway
(907) 349-e~3s
ANCHORAGE, ALASKA 99511
85-189
DRILLING LOG
Well Owner A~ror~ C~n~-r~rtL.ion _Use of We]l Dc~m -
Location (address of: Township, Range, Section, if known; or distance main road L19, B4, Rabbit Creek Hts., Anchorage
Size of casing 6" Depth of Hole 180 feet
4"---160-180
Casedto 6"=162.9 feet
Static water level
Screen ( ); Perforated ( X ),
Describe screen or perforation 4" perforated liner,./~0/-/~>0 /
Well pumping test at 2 gallons per (hRRr) (minute) for 4 ' hours with
of drawdown from static level.
30 ft. (~) (below) land surface. Finish of well (check one) open end (
100%
);
Date of completion 20 June 1985
WELL LOG
Depth in feet from ~
ground surface Give details of formations penetrated, size of material, color and hardness
2 TO 6
6 TO
TO
TO
TO_
__TO.
TO_
~TO.
TO
__.TO.
.TO.
____.TO.
,TO.
40
40 53
53 60
60 80
80 100
100 125
125 140
140 180
Clayey Gravel
Coarse 8ravel;cobbl%
Boulder grave].
Cobble. gKa. vel; wet
Tight gravely hard_pan
Cl'ay
Clayey gravel
$Iave]? clay
Grava]y hard?~n; wntmr mm~p~ ~n mmmll grmvml ~rdngmrm
1 -- Cus'rOMER
Development Services Department
On-Site Water & Wastewater Section
Phone: (907)343-7904
Fax: (907)343-7997
MUNICIPALITY OF ANCHORAGE
020 -551-33
RABBIT CREEK VIEW HEIGHTS BLK 4H LT 19A
Expiration Date: Parcel ID
Legal description
Site address 7841 BYRON DR
Current property owner(s) DAVIDSON DEAN
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
No comments
By:Isatou B Njie Original Certificate Date: 12/19/2025
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 Service Department (DSD) issues COSAs based upon representations provided by an
independent professional engineer. The Municipality of Anchorage is not responsible for errors or
omissions in the professional engineer's submittal.
ATTACHMENTS:
COSA Checklist
Absorption Field Advisory
Tank Age Advisory
Other
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Certificate of On-Site Systems Approval
X
OSC251547
10/22/2026
COSA Checklist_May2025 copy.docx
COSA Checklist
Legal Description: RABBIT CREEK VIEW & HEIGHTS BLOCK 4H LOT 19A Parcel ID: 020-551-33
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled 6/20/1985 Total depth 180 ft
Cased to 180 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 36 in.
Date of flow test for COSA 10/22/25
Static water level at beginning of test 38 ft.
Well production at time of test 2 gpm
Water storage tank volume None gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 0.637 mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Date 10/22/25
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank 49"
Date of pumping 12/11/25
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. DISPOSAL FIELD DATA – NEW SYSTEM
Which system tested (date installed) NEW
ALL standpipes present per record drawing
Total measured depth from grade 8.5 ft (max)
Measured depth to pipe invert from grade 5.3 ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes go to bottom of effective.
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Adequacy test date NA - NEW
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 6 in
Effective depth used 0 in
Effective depth remaining 6 in
Comments/Deficiencies:
COSA Checklist_May2025 copy.docx
E. SEPARATION DISTANCES
From Well on Lot to: (Please enter distances if less than required)
Septic Tank/Lift Station on Lot > 100’
Yes if No *95 ft
Neighboring Tank > 100’ Yes if No ft
Disposal Field on Lot > 100’ Yes if No ft
Neighboring Disposal Fields > 100’
Yes if No ft
Sewer Line/Main > 100’ Yes if No ft
Sewer Manhole/Cleanout > 100’
Yes if No ft
Sewer Service/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 Disposal Field(s) on Lot to: (Please enter distances if less than required)
Tank to Foundation > 10’ Yes if No ft
Field to Foundation > 10’ Yes if No ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No ft
Water Main/Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
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
*95’ WELL TO SEPTIC TANK WAIVER REQUESTED WITH THIS SUBMITTAL.
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 12/16/2025
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 &
12/16/25
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
December 16, 2025
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: WELL TO SEPTIC TANK WAIVER
LEGAL: RABBIT CREEK VIEW & HEIGHTS BLOCK 4H, LOT 19A
At time of design, it was found that the existing septic tank is approximately 95.5’ from the referenced
well. The immediate area does not have a high nitrate issue, and the previously submitted CAN water
samples show nitrates at 0.637 mg/L. The referenced well is significantly up gradient from this septic tank
with no chance of effluent from the tank going towards the well, there have been no known issues and the
area well logs indicate a confining protective layer of very tight impervious silt “clay” of the aquifer. For
these reasons, a waiver is justified and request a well to septic tank waiver of 95’ be issued.
Also, the well appears to be in the Byron Drive ROW and this was verified by two different surveyors.
The owner has obtained the attached ROW permit for this encroachment. Please contact us if you have
any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
P.O. Box 196650 ⚫ 4700 Elmore Road
Anchorage, Alaska 99519-6650 ⚫ (907) 343-7904 ⚫ Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Division
On-Site Water and Wastewater Program
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSV251058- COSA#: OSC251547 Permit#: _
PID#:
Legal Description: ABBIT CREEK VIEW & HEIGHTS BLK 4H LT 19A
Engineer: First Water Consulting
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 95.0 feet.
This waiver approval applies to the existing 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.
Waiver is Granted: ____X_______ Waiver is not Granted: ______________
Date: __________________ Approved by: _________________________________
Name of Reviewer
**** VARIANCE/WAIVER REVIEW ****
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.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test,
and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil
condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions
are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone
6. DSD SIGNATURE 2I \ I\1`
XSystem #1 Approved for 3 bedrooms
v System #2 Approved for bedrooms
Disapproved
Conditional approval for 3 bedroon
Date 11/10/2014
iJc,4,t� t?F Al.,q`S''��
.j Seven R.•Pannone
,• CE -8149
AW
Amw
with the following stipulations:
Zrts�2C- ori ne-PR+/jue rd &-oL0,1"V Peru \\�`�� 9Fttrr►rn,f(61,/
z 0 --
A
D
�-S \A
h, CqJ
PROG
YX
FAIr cFR ..�
gy Original Certificate Date: R/�'t� ,9
The unicipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet �
1.
B'IUNICIPALI'f¥ OF ANCf4OEtAGE
DEPARTMENT OF I-tEAt..'i"I-t AND ENVIRO~IIS'IENTAL PROTEC¥1ON
DiVISiON OF ~:;NVlt';IONBIENYAL
CEFiTIFICATE Of-INSPECFION FOR HEAl_TIt AUrFHORITY APPROVAl.
(.)F ON-SITE SEWEI-I AND WA't-ER FACILITY
264-4720
Application Date ._
¢¢ Et',MI.iA ~ ii',]t:'O R t¥1A'fl C'N
Ca) Legal Description (include lot, bloc;l(, subdivision, section, township, range)
Location (address or di~ecbons~
Applica'nt Address ,-' ~ , ~'-
Cc) Applicant is (check o¢~e): Lending institution
Cd) .endinq Institution ~_ _~. ~ __~Z.~. ~;.:;~_;_ ~f~; ' '" Teiophono ............
Address ~- .14)]'. ~.qji~ .
Ce) Real l~staio Company and Agent
'i-eiehhone .................
Cf) Mall the I tAA io the following address:
S~ng!e FamHy,-d Multi Falnily ~1 Othai'
Number of Bedrooms. _
WATi;. R SUPPL'!
h~diviclual We',t lei" ()omrnunity b-] Public
Note: If o()mt rit!l~lty well system, fYit.isi have writter~ coflflrrnatior~ fi'om the Stale [)er)al trnont of E~i r¢~ronrnental Conservation
attesting to the legality and status
Onstte 15 ['ubiic [~1 (;o,~mlunity 17] I-tolcling -[alqk E']
attesting to lhe Iooahty and stat(m
Page I of 2
and i~s ~fi ti ~e va id~ i ol dado 51~owll below, t verliy ti ~at my
on-giro water sHpply arid, or wastewater disposal oysl.,in oo¢ ~, ~dr,~.,:o,,,,, az!d a(x:,:,.,m
. fdes arid from rny iriveslioatlon al~d inspectK)n, tho on..site
CAIJTI
WELL DATA
Well Classification (-'
Well Log Present (Y/N) '~
Total Depth t~C~ Cased to
Static Water Level ~0' ~,E~z..o~ ~.Iv4E:~ ~o1'-~.~¢_~.. _
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
MUNICIPALITY OF ANCHORAGE (MOAJ
HEALTH AUTHORITY APPROVAL (HAA)
CHECI(LIST - FEBRUARY 1984
Legal Description: ~1' I~) ~.-
If A, B, C, D.E.C. Approved (Y/N)
Date Completed ~'~'~ Yield
Depth of Grouting
Pump Set At
~¢~ Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
To Nearest Edge of Absorption Field on Lot _l
To Nearest Public Sewer Line
Cleanout/Manhole ~ To Nearest Sewer Service Line on Lot
Water Sample Collected by ~)~-'f~E-,4 ~-t,-~':~-t~'~=;
__ 40~¢~:)~__; Date
Water Sample 'rest Results
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
Comments
B. SEPTIC/HOLDING TANK DATA
Date installed "~"J~C~tt"¢"~:~--Size ~ No. of Compartments
Standpipes (Y/N) _ y ~ Air-tight Caps (Y/N).
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N) _
Separation Distances from Septic/Holding Tank:
/
,~) Foundation Cleanout (Y/N) Y
Date Last Pumped ~
; for
Temporary Holding Tank Permit (Y/N)
To Water-Supply Well [
To Property Line _-- 1
To Water Main/Service Line
Course ~
To Building Foundation
To Disposal Field (~
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11184)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed '~ ~ ~'~
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test ~ ~/~,
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design __~:)
Length of Field
Depth of Field '7, .~
Gravel Bed Thickness
Standpipes Present (Y/N) ~
Date of Last Adequacy Test N./A- ),3~..)
/
To Property Line 't O
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present)
Comments
D. LIFT STATION
Date Installed -~--~'b~t...h~, ~
Siz6 in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I hav.e check_ed, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
/r/~4~//¢,,~'~'~'-'~' Date- 0¢"~ ~-~ -- --
Signed
Company,~,~/'~/vt('/~'-E,~.~W6.~/~. MOA No. 'ST'i~c~'?'~
Receipt No. _?_b
Date of Payment
Amount: $ ,/A~
Page 2 of 2
72-028 (11/84)
.~-. ' Engineer's Seal
~. ¢ ,, E.K. McMIIlan