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HomeMy WebLinkAboutPROSPECT HEIGHTS #5 BLK 2 LT 1Onsite File Am A A ow Prospec TO 3� Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231012 PID Number: 015-135-09 Dwelling: n Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name DAVID LESSENS ABSORPTION FIELD Site Address ❑ Deep Trench ❑ Wide Trench ❑ Bed ound 10333 SCHUSS DRIVE *ANCHORAGE, AK EJ Other Phone Number of Bedrooms Soil Rating Total depth original grade 1-734-274-1660 5 GPD/SFI Ft. LEGAL DESCRIPTION Depth to pipe invert from original �;<. Gravel depth beneath pipe Subdivision Block Lot PROSPECT HEIGHTS #5; BLOCK 2, LOT 1 Ft. Fill added above original gr Gravel length Township Range Section _ Ft. Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Holding Sewer Total orption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line Ft2 Ft. Well 100'+ zory TANK [9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other PIPE MATERIAL House to tank D3034 Tank to D3034 Installer drainfield NORTHERN EXCAVATION Drainfield D303VEXISTINc CO/MT D3034 Inspector GEG BENCH MARK (Assumed elevation) 100.00 ft Inspdeact sn 15' 6/20/2023 2�a - Location and description 3rd _ 4' _ BOTTOM OF VERTICAL TRIM AT SW CORNER OF HOUSE ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp OF ap6o�0 conditional Approval: Date Qo ��• / . 95,0 Septic System y A. Garness.= PP ���Gf% �Date % QO 9 CE 795 c G A roved Note: this approva oes not include well permit requirements. 4 ( prOf eSS'O0°p #AECC88��Opp'O�� (Rev 05/02/18) + Manufacturer TANK Capacity 1500 Gal. Surface Water 1001+GREER Material HDPE Number of compartments 2 Lot Line 51+ NA Foundation 10'+zoel LIFT STATION Manufacturer Capacity Gal. Remarks PER CONTRACTOR - OLD TANK DECOMMISSIONED PER UPC WE REQUEST THAT THE DEPARTMENT WAIVE THE REQUIREMENT FOR AN UPDATED SURVEY Alarm location Electrical installed by PIPE MATERIAL House to tank D3034 Tank to D3034 Installer drainfield NORTHERN EXCAVATION Drainfield D303VEXISTINc CO/MT D3034 Inspector GEG BENCH MARK (Assumed elevation) 100.00 ft Inspdeact sn 15' 6/20/2023 2�a - Location and description 3rd _ 4' _ BOTTOM OF VERTICAL TRIM AT SW CORNER OF HOUSE ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp OF ap6o�0 conditional Approval: Date Qo ��• / . 95,0 Septic System y A. Garness.= PP ���Gf% �Date % QO 9 CE 795 c G A roved Note: this approva oes not include well permit requirements. 4 ( prOf eSS'O0°p #AECC88��Opp'O�� (Rev 05/02/18) } LRMIT NUMBER: PARCEL ID NUMBER: OSP231012 RECORD DRAWING 015-135-09 i >ll� PROSPECT HEIGHTS; #5; BLOCK 2, LOT 2 MH 25.8 44.5 7 STI 30.2 48.6 Cj DBL3 36.7 54.8/- DBL4 37.9 55.9 vVI DOTE: IPE LOCATIONS ARE SHOWN PER GEG SHOTS i TAKEN WITH LEICA DISTO S910 LASER DISTANCE / METER. SWING -TIES TO HOUSE CORNERS WERE GENERATED IN ALIT D. r N I EXISTING HOUSE W I NEW 1500 GALLON HDPE GREER TANK >I CONTRACTOR UTILIZED THE EXISTING DOUBLE FCO •;, :' ; :�'-i O CLEANOUTS AFTER THE OLD TANK W , I— I •! . O 'L • c \ 4 t:'•� «. 10'T & E EASEMENT PROSPECT HEIGHTS #2; BLOCK 8, LOT 1 = 40' 1 Ltd u ENGINEERING > SALES -� CONSULTING 3701E TUDOR ROAD, SUITE 107 ANCHORAGE, AK995D7 -PHONE (907)337-6179 -FAX (907)338-3246 -WESSITE: v,Nw,garnessengE enng.cam PREPARED FOR: PHONE NUMBER: PAGE NUMBER: KELLY LESSENS 1-734-274-1660 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: PROSPECT HEIGHTS #5; BLOCK 2, LOT 1 D.J.G. TYPE OF WORK: DATE: ASEPTIC TANK RECORD DRAWINGS 6/26/2023 P_-_RMIT NUMBER: OSPSP231012 RECORD DRAWING TOP OF MANHOLE = 99.90 /--FINAL GRADE = 99,82-99.68 MH1 TOP OF TANK AT INTLET = 93.73 —\ 0 Im I ( /— TOP OF TANK AT OUTLET = 93.73 INVERT OF BUNG AT INLET = NEW 1500 GALLON GREER SEPTIC TANK PARCEL ID NUMBER: 015-135-09 INVERT OF BUNG AT OUTLET = 92.80 ENGINEERING o SALES z, CONSULTING ' 3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, AK 99507' PHONE (907) 337-6179' FAX (907) 338.3246' WEBSITE:-,g.mess"09i0e,,in0_com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: KELLY LESSENS 1-734-274-1660 3 OF 3 LEGAL DESCRIPTION: DRAWN BY: PROSPECT HEIGHTS #5; BLOCK 2, LOT 1 D.J.G. TYPE OF WORK: DATE: ",_ SEPTIC TANK PROFILE 6/26/2023 •irr.ZG mess„ w m E-79 3AW AV LICENSE Illitlya #AECC884 MUNICIPALITY OF ANCHORAGE �»cnt On -Site Water & Wastewater Programtio� s, PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite' "NCH ORP�'� t)epai-tment On -Site Wastewater Disposal System Permit Permit Number: OSP231012 Effective Date: 2/22/2023 Work Type: SepticTank Upgrade Expiration Date: 2/22/2024 Tax Code Number: 01513509000 Site Legal Address: PROSPECT HEIGHTS #5 BLK 2 LT 1 G:2540 Site Mailing Address: 10333 SCHUSS DR, Anchorage Owner: LESSENS DAVID M & KELLY J S Lot Size in Sq Ft: 95243 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 5 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 may: .L55tte t T Issued By: Date: Date: MUNMPAUTY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-135-09 Property owner(s) Kelly Lessens Mailing address 10333 Schuss Drive *Anchorage, AK Site address 10333 Schuss Drive *Anchorage, AK Legal description (Sub'd., Block & Lot) Prospect Heights #5; Block 2, Lot 1 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 5 Day phone 1-734-274-1660 APPLICATION IS FOR: (® all that apply) Absorption Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: Initial Upgrade Renewal ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: TYPE OF DWELLING: Single Family (SF) 0 (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) 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: 02r� 5 -- Date of Payment: Zag Receipt Number: OqL306 Permit No. Z2 31 D 1 2 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231012, Deb Wockenfuss, 02/22/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231012, Deb Wockenfuss, 02/22/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231012, Deb Wockenfuss, 02/22/23 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ;¢:~uJ q (~O"Z.5{~ PID Number: OI3' .- I~- - O~ Name: 'T~t~ ~ ~p Wastewater System: ~ New D Upgrade *d~r~,~: ~-~ ABSORPTION FIELD iNc. ~ Deep Trench B Shallow Trench g Bed B Mound ~ Other of Bedrooms: LEGAL DESCRIPTION So, Rating: O. C GPD/Sq. Ft. Total Depth fro~%ri~nal grade: Lot: Block: Subd[v~ion: I ~ ¢~¢~T 1~'6~'~ ,epthtopipebo~om~originafgrade: Gravel depthbe Ft. ~h pipe Ft.: Township: J Range: Section: Fill added above original grade: Gravel length: WE LL: ' ~ New ~ U pg rede Gravel width: Number of lines: Distance be~een lines: Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: ~ Date Drilled: Static Water Level: Installer: Driller~j~ 0~1~L1¢6 IO--{"'J4 ~ Ft. ~I~CA[O + ~t% Date installed: Pump Set at: Casing Height Above Ground: Yield: ~ GPM~ ~t. Z ~t, TANK SEPARATION DISTANCES ~Septic ~ Holding U S.T.E.P. To Septic Absorption Lift Holding =ublic/Pdvate Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~~ ~ ~Q Number of Compa~ments: Su~ace ~ ~ Water ~ ~O¢t+ -- LIFT STATION LineL°t ~O t ~ ~oi~ ~ ~ ~ Size in gallons:~ Manufacturer: Foundation ~ ~ ~ i~ "Pump on,, level at: J"~ Cu~ainDrain ~oN~ ~N~ J ~ , ~ Pu~ectrical Inspections pedormed by: Remarks: BENCH MARK Location and Description:  Assumed Elevation: 17034 Eagle River Loop ~a~, · '~ ~ ~ ROBERT C, COW~,~ Department of Health and Human ~e~ces approval ~,"~:~' .... .'.? Reviewed and approved by: Date: /- 7-~ '~ ' ' '~' 72-013 (Rev. 9/91) MOA 25 Permit No. SW960256 2 2 Page . of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description:LOT 1, BLOCK 2, PROSPECT HEIGHTS S/D #5 PIDNo.: 015-155-09 ~ ~ I ~ SBk2 39.0' 57.0' /X / I ~ CO1 53.0' 69.0' ~, C02 12(L5' 129.0' GRAVEL DRIV~/~NEW TRENCH ~T2 11~,.5' 125.0' ' C01 ~ 95.2' i C02 p 93.?~ 1500 GAl 72.5' ~.O.H. 72-O13 A (Rev. 9/91) MOA 25 ,. -, L 907S6J845J PARKWAY ATRIUM BUILG JO1P02 OCT 11 '96 16:10 STATE OF ALASKA ~C~D DEPARTMENT OF NATU,AL RESOURCES DIVISION OF MINING & WATER MGMT · - " ~;: ',' ,',,,,'. ............ ,,. .... ~. -.:.. ~. - ,, J ,.. I ... LOCAT'ON/SK~CH: WELL O~ER: ' · ' ' ' D~pth of hole;~ft BOREHOLE DATA: Depth O~p~h of casing' ft ~/ / Type and Color From To ~ ~ DEP~0 STATIC WATER ~. ,~ be,ow ~top of casing ~ ground METHOD OF DRILLING:~;'air rotary [~ cable tool [] other USE OF WELt.;..~dornestic [] irrigation [~ monitor [] public supply [] other CASING STICK-uP: ft. Diam; __~.__in. to Casing type: ~ .~in. to ~ WELL INTAKE OPENIN(~ TYPE: [~] open end [~ screened [] perforated .~-open hole Depths of openings; to ft RECE NOV 1 1996 Dept. Health & Human Servi( SCREEN TYPE: .. Diam: in. Slot/Mesh Size: Length: ft GRAVEL PACK TYPE: Volume used: Depth to top: GROUT TYPE; Volume; Depth: from ..... fi to ft DEVELOPMENT Duration: PUMPING LEVEL AND YIELD: · ~.... hrs pumping ~ gpm PUMP INTAKE DEPTH: ft Horsepower: WELL DISINFECTED UPON COMPLETION7 ~-'VE~ [] NO CONTRACTOR INFORMATION: REMARKS: _~'~ .~"~'~ ~_..~;_ ~/.~ PLEASE MAIL WHITE COPY OF LOG TO: Signature of A~thori~ed Respre~nt~ive ~ ..,.,.,,- DNRIDIVISION OF MINING & WATER MGMT 3601 C St, Suite 800 ANCHORAGE AK 99S03-5536 Phone (907}269-8639, Fax (907J562.1384 PERMIT NUMBER:SW960256 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:ONEY JOHN ANTHONY & RITA GAE OWNER ADDRESS:8000 ONEY CIR ANCHORAGE, AK 99516 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE \ %O,f¥X DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ~~D ANCHORAGE, ALASKA 99519-6650 ~ 't~% ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT %~k[.~[b DATE ISSUED: 8/20/96 EXPIRATION DATE: 8/20/97 PARCEL ID:01513509 LEGAL DESCRIPTION: PROSPECT HEIGHTS #5 BLK 2 LT 1 LOT SIZE: 95243 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST 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 (iSAACS0) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS D DATE: / ROBERTC. COWAN, P.E. ROBERT A. SHAFER, P.E. August 8, 1996 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 1, Block 2, Prospect Heights S/D %5 Request you issue a permit to drill a well and install a septic system to serve the proposed five bedroom house on the referenced property. A test hole was excavated and percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation no water was encountered in the test hole and after seven day ground water monitoring, the monitoring tube was found to be dry. This property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, please contact us. Sincerely, ~C'. Cowan, P.E. RCC/gk Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSION~ SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN ROBERTC. COWAN, RE. ROBERTA. SHAFER, RE. October 5, 1996 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 1, Block 2, Prospect Heights S/D # 5 Attached is a revised design for the referenced property to be installed per permit # SW960256. Request a waiver to 35 feet between the proposed trench and the slope exceeding 25%. Also attached in an additional test hole soils log. Please advise immediately if there are any concerns or questions as this is expected to be installed any day now. Sincerely, Robert C. Cowan, P.E. RCC/gk Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 8~ALE SITEE PLAN DESIGN SCHUSS DRIVE 10' T. & E. ESMT. ZO'~ .d o I Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street. Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: z--cT / Bzo¢~' LEGAL DESCRIPTION: /0~oSP/z-c 7- /Y-~I~,.VT- $ ~:-3-- Township. Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14- 15 16 17 18' 19-__ 20- COMMENTS ~.O.W. SLOPE WAS GROUND WATER ENCOUNTERED? ~/O L IF YES, AT WHAT ~ O DEPTH? p E fleplh lo Waler After Monilori,g? 0~.-'~ Dale: /O SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop ~/~-~-I,v~ ~.'.;. ~ _ ~ ,/e,, _ '~ ' 3 / 3 ~ ,v ~l '/~ " '1~ " ~ : ~ ~ I ~ '~ " ~/)~ " '. ,,, PERCOLATION RATE ,. / ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN '-~ FT AND ~ FT 17034 Eagle River Loop Road No. PERFORMED BY: l[a~Je River, Alaska y~.~l~ /Z;-~ ~ - '~ 7 - CERTJFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ) O / I; / c~ (~ 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ..,~ ~" JJ/J LEGAL DESCRIPTION: Township, Range, Section: DATE PERFORME'I~'~"5-''~'3 ~--"Z-~' ' Jl~,~'" 1 5 8 9 10 11 12 13 14 15 16 17, 18- 19- 20 COMMEN'rS L) 3 ~ 1~/~='t~ SLOPE SITE PLAN ~)/I,J ~ y ~ f J~C~ ~" WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT ~) DEPTH? o p E Depth to Water Afte~ Reading Date Gross Net Depth to Net Time Time Water Drop I~ I%~ 7~ I~ ~G~ I~ 9, I" ~G ~ l ~ ~ 9" I" PERCOLATION RATE J['~ {minutes/inch) PERC HOLE DIAMETER 8 TEST RUN BETWEEN ~ FT AND G ~ FT PERFORMED BY; C O ~95 '~" ~'~--~ ~,, S I /~l (-1~'I' (,~ ~ (..,50 ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 015-135-09 Expiration Date: 1. GENERAL INFORMATION: Complete legal description Prospect Heights #5; Block 2, Lot 1 Location (site address) 10333 Schuss Drive *Anchorage, AK 99507 Current Property owner(s) Matthew Pawlak Day phone 907-575-0953 Mailing address Real Estate Agent 10333 Schuss Drive *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: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5 5 o/ b Date of Payment ) % ' zz� Receipt Number OO 703 G COSA# OSC,�-?,131.5 Date: Waiver Fee $ Date of Payment Receipt Number, Waiver # 6. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineerinq Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: Z In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the systemis on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. ~ #AECC884 6. DSD SIGNATURE System #1 Approved for bedrooms``ll�llttto ((((ff(4( System #2 Approved for Disapproved Conditional approval for bedrooms y���i/i gOW SITE bedrooms, with the followirig stipulg6TAN D rn WAST_' oz JG �_ Original Certificate Date: — .5 Z © 2 - The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Ad�vris,o,�ry. Well Flow Advisory Other _-�' �(`'-�-t� COSA blue sheet_10-10-12.dcc A44 -rd — Legal Description: Prospect Heights #5; Block 2, Lot 1 Parcel ID: 415-135-09 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 'aeras Total depth 325 ft Cased to 89 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA $�10�2 Static water level at beginning of test 88.8 ft. Comments B. TANK DATA Age of tank(s) 26 years Tank type/material Measured operating fluid level in septic tank 49 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 5/10/22 D. ABSORPTION FIELD DATA Well production at time of test'20+gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes . No no Coliform bacteria is Negative Nitrate )--1-(mg/L ❑ Nitrate less than .MRL (ND) Arsenic ug/L WArsenic less than MRL (ND) Collected by GEG; Ltd. Date of.Sample si�oi22._ C. LIFT STATION ❑ Required maintenance completed Age of lift station year Lift station material Which system tested (date installed) 1995 Adequacy test date 6/10/22 ❑ ALL standpipes present per record drawing Results [✓ Pass For 5 bedrooms Total measured depth from grade 14.5 ft (max) Fluid depth prior to test 35 in Measured depth to pipe invert from grade 4.4 ft (min) Water added 835 gal ❑ N/A — pressurized field New depth 49 in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 185 min depth into effective 43 On Code -required soil cover over field Final fluid depth in 754+ ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test) Gallons introduced La gallons ifes enter. date n/a . y ' Comments/Deficiencies: COSA Checklist yellow sheet H 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' Community Sewer Manhole/Cleanout > 100' �✓ Yes if No ft 17V Yes if No ft Neighboring Tank > 100' [l Yes if No ft Private > SeweriSe tic Line 25' P _ ❑Yes if No ft Absorption Field on Lot > 100' [D Yes — if No ft Holding Tank > 100 r ' ❑ Yes if No ft Neighboring Absorption Fields > 100' R Animal Containment > 50' Q Yes if No _ ft Yes if No ft Community Sewer Main > 75' �jr Yes if No ft Manure/Animal Excreta Storage > 100' — ✓[] Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes ` if No *5+ ft Surface Water 100' > _ Q Yes if No ft Property Line > 5' Yes Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Yes if No ft Private Wells > 100' P✓ Yes if No ft Water Main > 10' Cj Yes if No ft Community Wells > 200' [] Yes if No ft Water Service Line > 10' 0 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' ElYes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells >❑ 100' r _ Yes, if No f# Water Service Line > 10' Yes if No ft Community Wells > 200' [J Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS *Met code at time of installation G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with T, MOA COSA guidelines in effect on this date. 4 T :.� CASA Checklist yellow sheet V ar.......... p .J Garnes E-795). � O r a #aEccsaa MOR DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval #OSC 221315 Subdivision: Prospect Heights #5 Block 2 lot 1 907-343-7904 Fax: 343-7997 Starting at 20 years of age the MOA issues Advisory's for steel septictanks The septic tank for this COSA / property is 26 years old. A leaking septic tank may be a source of contamination to the aquifer. Typical replacement costs range from $10,000 to $15,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of a 16 -year-old septic tank in failure and should be replaced. r,PLf AJS MUNICIPALITY OF ANCHORAGE i Development Services DepartmentPhone: 907-343-7904 On -Site Water & Wastewater Section �"—� Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-135-09 1. GENERAL INFORMATION Expiration Date: 6p 1 11e) zV 2D Complete legal description PROSPECT HEIGHTS #5 BLOCK 2, LOT 1 Location (site address) 10333 SCHUSS DRIVE, ANCHORAGE, AK 99507 Current property owner(s) PAMELA J. MASSEY Day phone Mailing address Real estate agent 10333 SCHUSS DRIVE, ANCHORAGE, AK 99507 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 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 $ 6"0 Date of Payment 3Jl3la.aa0 Receipt Number 3613 L61 COSA # ao 1085' 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 3/3/2020 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 & Fk s 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved _49 1H Curtis Huffman / �¢ �'c�G; •.• CE 128991 • �`i �� is1F�• • .3/3/2,02,0• •��s ��. l,`FOPROHSSIONa -� Conditional approval for bedrooms, with the following stipulate .,►lllfi l a"', Original 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 se &'c 4 y_-_4 age Legal Description: PROSPECT HEIGHTS #5 BLOCK 2 LOT 1 Parcel ID: 015-135-09 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 10/6/1996 Total depth 326 ft Cased to 89 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA 2/26/2020 Static water level at beginning of test 97 ft. Well production at time of test 2.1 gpm Comments B. TANK DATA Age of tank(s) 23.5 years Tank type/material SEPTIC / STEEL Measured operating fluid level in septic tank 50" ® Standpipes/foundation cleanout per record drawing Date of pumping 2/26/2020 D. ABSORPTION FIELD DATA Which system tested (date installed) 10/18/1996 ® ALL standpipes present per record drawing Total measured depth from grade 14.8 ft (max) Measured depth to pipe invert from grade 6_3 ft (min) ❑ N/A — pressurized field Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® Nc ® Coliform bacteria is Negative Nitrate 5.83 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by FWi;S Date of Sample 2/26/2020 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 2/26/2020 Results Z Pass For 4 bedrooms Fluid depth prior to test 29 in Water added 760 gal New depth 40 in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 1320 min depth into effective 8.5' +/- INTO THE 9' ED ® Code -required soil cover over field Final fluid depth 28 in ❑ System presoaked Absorption rate 600+ 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 Comments/Deficiencies: As noted above — all pipes present per IR. Fes; 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 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 ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No ® Yes if No ft ft If septic tank is under driveway comment below 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: ® Yes 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 _ 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 G. ENGINEER'S CERTIFICATION l certify that l 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. Aw iT-i •, ..• .. .......... . Curtis Huffman G,•.• CE 128991 •�c`�i �AV �k0\w-p OFESS ON��F•� ft ft ft ft ft ft ft ft .G s E 3 0 m E @ � � � # . ��\ IJ 7n Septic Tank Advisory Certificate of On -Site Systems Approval #OSC OSC201085 Subdivision: Prospect Heights #5 Blk 2 Lot 1 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 23.5 years old. Typical replacement costs range from $8,000 to $11,000. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. `" � � � Mailing Adtlress P O� Box 196650 *Anchorage, Alaska 99519 6650 *www mun orCr MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 On -Site wafer and wastewater Section: Fax: 343-7997 www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC201085 Subdivision: Prospect Heights #5 BLK 2 Lot 1 A water sample revealed a nitrate concentration of 5.83 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. B. — y > ,y ge, Alaska 9 r � .. sow*mak. s.: Mailing Address P O 3Box196650 *Anciora9519 6650'www morn org Y  MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description LeT- / Location (site address or directions) · t ",'~ ~ -, -~ ]' ....... - .. Day phone Mad~ng address,..,'.,3. ~ ~- o ;Lending agency 'Madm9 address '} - .., .?: .:~' A~nt Address Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~' TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: lng to the legafity and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank -- Community on-site Public sewer If community well system, provide written confirmation from State ADEC attest- NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91} Front MOA#21 STATEME, NT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date Shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, fUnctional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information Obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/Or wastewater diSposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this insPection. Eagle River, Alaska 9f~577 Address ~/2 Engineer's signature . _. .. Date APproved for Disapproved. Conditional approval for bedrooms· bedrooms, with the following stipulations: Additional Comments By: %·. · .:the Municipality'~ Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval. Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements· Employees of DHHS do not conduct inSpections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer'sWork. MUNICIPALITY OF ANCHORAGI~ ENVIRONMENTAL $SRVICES DIVISION Municipality of Anchorage FEB DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division P~ J~ C 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description: A. WELL DATA I.D.: Well type 10~.~,,/¢¥-r ~- Log present (~N) Total depth Sanitary seal (~/N) If A, B, or C, attach ADEC letter. ADEC water system number iO .~ ~ ~ ~ Casing height (above ground) Wires properly protected(~,~q) Date of test Static water level Well production WATER SAMPLE RESULTS: Date completed t Cased to ~ ¢J FROM WELL LOG g.p.m. AT INSPECTION g.p.m. 3.3( Collected by: Other bacteria Coliform C, Nitrate Date of sample: ~g-/~/q ? ~ ;~/$~/~i '7 B. SEPTIC/HOLDING TANK DATA Date installed Tanksize J~'oO Number of Compartments Z Cleanouts '~e,,¢ Depression (Y,~) /~ High water alarm (Y/~ Pumper Soil rating ~r fF/bdrm) O~ (~ System type ~ Gravel thickness below pipe ~ 1. Total depth Monitoring Tube present ~:~t4) ~---.~' Depression over field (Y,~ /~¢ Results (Pass/Fail) For bedrooms Foundation cleanout (~N) Date of'CJt~'mPing :: "~ C. ABSORPT ON FIELD DATA..-: Date installed j ~ *- J~6 Length::, ~ I Width Effective absorption area Date of adequacy test Immediately after '---gal. water added (in.): Absorption rate = "--'--- g.p.d. If yes, give date Fluid depth in absorption field before test (in.); ~luid depth -- (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N)~. High wa~ - - - On adjacent lots _ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot _ ~ oo ~ ~' _ "Pump off" level at* _ Absorption field on lot Public sewer main _ Sewer/septic service ne ~-~' It~ Lift station _ SEPARATION DISTANCES FROM SEPTiC/HOLDING TANK ON LOT TO: ~ .~ Absorption field_ ioo~W On adjacent lots _ Public sewer manhole/cleanout _ Foundat on 'Zi Property line Water main/service line 1(2!+- Surface water/drainage _J ~o t~f _ Wells on adjacent lots ~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~°~ Building foundation _ M° ~-~+ Water main/service line % Surface water I ~ o 4- Driveway, parking/vehicle storage area _ Curtain drain _ ~ .//N Wells on adjacent lots _ F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records in conformance ~ith.~vfQA HAA gujdelines in effect on this date. i ~ · Signature_ /',/'~Z/'~-~' ~ Engineer's Name ,/~8 ~¢~ 7- ~--~ Date HAA Fee $ ~"0, ~ Rece,ptNumber_ ') Waiver Fee $ Date of Payment Receipt Number _ ?¢-n¢6 fRev. 3/96~*