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HomeMy WebLinkAboutJ K LT 46A MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION . 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~AME~ . PHONE ~NEW F nrrtu qq- Oz []UP, R.DE LEGA~D ESCRI P~T6N .... ' ~ ) ' ' -- LOCATION DISTANCE TO: Manufacturer Well area I Dwe~_ lb'~1 Absorption 5 Mate~_~ I F HOMEMADE: Inside length Width Well Dwelling Liq. cai DISTANCE TO: Manufacturer Well DISTANCE TO: No. oflines / LengtholDh%~u~e/ Top of tile to finish grade Length Width Total ,e~.hsf~lines Material beneath tile Depth Material PE ~/I.~ u; No, of compart~ts Liquid depth PERMIT NO. Liquid capacity in gallons Nearest Iot~l~r~ PERMIT NO. Distance between lines Trench ~[Oinches ~TZ inches Total effec.ti_~ve absp~pl~n~area PERMIT N~. -- Type of crib Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest 10t line DISTANCE TO: Driller ' Class Depth Building foundation Sewer line Septic tank DISTANCE TO: Distance to lot line PERMIT NO. Absorpt on area(s) OTHER SOl L TEST RATI N~G ~ LE-R APPROVED 72-013 fRev. 3178) DATE LEGAL PERMIT NO~ FIPF'L Z CFtNT FIECS LOCRT I ON L. EGRL T±5NR±H S8 L46 DEPRRTMENT ~ HERLTH RND EN'v'IRONMENTFIL ~.~OTEE:TION E',25 "L" STREET, RNCHORRGE, RK. 99502 264-4728 ( 8E:0840 ) :12Ft0 [,J. ::::RI:' SU I TE B 9'B50]: ~, b,-:l..~. LOT SIZE '_='.'~9:~'~'~ St..:.!I_IRF':E FEET T~¢PE OF SOIL. RE:SORPTION L-L],"r'STEt"I IS: TRENCH HRXII"iUM NUME:EF.: ElF BE[:,R00t'lS = 4 SOIL RRTING (SQ FT,."BR)= 85 THE RE~S!UIRE[:' SIZE OF THE SOIL RBSORPTION S'T'STEM iS: THE LENGTN DIMENSION IS THE LENGTH (IN FEET:-" OF THE TRENCH OR [:,F.:RiNFIEL[:'. THE [:'EPTH OF R TF.:ENCH OR PIT IS'THE DISTIBNCE E:ETNEEN THE SURFRCE OF' THE GROUN[:' RND TH[-:. E:OTTOM OF THE EXCFI'v'FITION (IN FEET.':'. THERE IS NO SET HID, TH FOR.: TRENCHES. THE GRWv'EL [:,EPTH IS ']'HE MINIMUM DEPTH OF GRR'v'EL E',ETHEEN THE OUTFRLL PIPE RND THE BOTTOM OF' THE EXC:taVRTION ,:.'IN FEET.':,. F-: El L--':." L" ][ BE: E [:, :.- E F ] ]: C: -f R ~'--~ ~-::: S:_; ][ ,.:.:- E. -- :Lt_ ";._: 5 ,~'~ ,.3 F'~ L L. Ex ['-a '.{-::-; PEF.:MIT RF'PLICFINT HFlS THE RESPONSIE:ILIT'T' TO INFOF.:M THIS [:,EPFIF.':TMENT E)LIF.iZNG THE INSTRLLFITION IIqSF'ECTIONS r]F RN'-r' HELLS R[:,JRCENT TO THIS F'F'-"~PEF':T'",-' RNE:, THE NUME',EF.: OF RESI[:,ENF:ES THRT THE 14ELL HILL =,_F..,,E. E:FH"':KFILLING ElF RN"r' S"r'STEM I.dITH3UT FINIAL INSPECTION FIND MFFF._ ,HL B"r' THIS [:'EPIBF..:Tt'iENT 141L.L BE SUE',JEC:T TO PF':OSE ] _ T 1 ON. i'iINIMUM DISTRNCE BETHEEN la WELL RN[:' RN'T' QN-StTE SEWFlGE [:'ISF'OSRL S'T'STEM IS ±00.FEET FQR Ft PF.:'IVFiTE HELL OF-: ±50 TO 200 FEET FF.:OM Fl F'UBLIC HELL [:,EF'EN[:,ING UPON THE T"r'PE OF PUBLIC: HELL HtNIMUM [)ISTFlNC:E FF"]f"I Ft PRI'v'RTE I.,.IFLL TO Fl PRIVFtTE SERVER LINE IS '-25 FEET FIN[:' TO R CCMMUNIT"¢ SEHEF-: LINE IS 75 FEET. ~]THER F.'EFdlIF.'EMENTS MFl"r' FlPF'L? C,F, EF':IEIE:taTIONS RN[:, CONSTF.:UCTIQN [,IFi]RF.tMS RF.:E "FiI~R~iL~-TI~i II'.4'E,~F.'E F'ROF'EF.: INST~-tLLCfTIUN. F" E BE: ~-.1 ][ 'T E..---. ~- ~ BE-: E S [:,, E C: E ['-'] E: E F-: 2E: i .. .. -:c-~. :::: -~: t C:EF.:TIF'-r' THaT i: I Fll'"l FFtMII_IRF.'. NITH THE REQUIREMENTS FOR ON-SITE SE[dERS RND kIELLS RS SET FORTH Bg.' THE MUNIC~IPFlLIT'T' OF FiNCNORRGE. 2: i NILL iNSTRL. L TIdE S'-r'STEM IN FiCCOR[.',RNCE HITH THE CODES. ~.: t UNDERS'f'FIN[:, THRT THE ON-SITE SEt.dER S'T'STEM MFi'T' REQUIRE ENLFlRGEMENT IF ':'FIE RESIDENCE IS REMO[i, ELE[:' TO INCLUDE MORE THFlN 4 BE[:,ROOMS. FiF'F'L I CFINT Fi E C:~4T] CONTROL SERVICE' .INC. 1200 West 33rd Avenu~?~Suite B ANCHORAGE, ALASKA 99503 Phone 276-1361 SHEET NO. CHECKED BY DATE SCALE ... ~.., ...... ~/ .., ~, ~,~ ~~:i~,~ ~~ ...... i. ': i .?/:~/~:s :. ': :~ ~ ~ ~.~.,.~.."~'~'.~"'~,, = 2.._, ~:' FT. W~ __ ~~ ...... ~,. ..... a, ~.~.~..,,~ = L,'. G F'T ...... ~:"~ .... ' ~ F'T. ?uTHI .... ,_1 I = LENGTH = 44.,~ ''" f:'T. , ...... t .......... ,-,,~f, Z,~ , ,,_.,...,_,,...,_.., ,,~_.~ ~.,, , ,, ......... ~ .... ~,t~.. ,.-.~--~, ~ -~ Department~ ~ Health and Envlronmenta~ /rotectlon ~ ~i~ ,~ 825 ~ Street, Anchorage, AK. ~3~9501 264-4720 ~~~tOf~ * * * HANDWRITTEN PERMIT * * * Permit WELL AND~ ON-SITE SEWER PERMIT Location: Phone Number: ~ ~- ~F~A- Legal Description: ~ 7~/~ ~ 7~ ~/~/ ~Lot Size: ~/~ -~ Type of Soil Absorption System Is: Trench: ~/Drainfield: Seepage Bed: __ Holding Tank: ~ Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) /~~ The Required Size of th~'~i~i-~]P_~6~~S~stem .Is~'~_~ ]~ · ; ~ ........... ~ .... ~ ~' ~ J~¥l ~'~' DEPTH LENGTH ~~ GRAVEE':-DEPTH ~,~( WIDTH' ~'~'~[y~}h:i'i The length dimension is the length(in fee~) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). · * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~9~) GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. · * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection.and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply.. Specifications and construction diagrams are available to insure proper installation. · * * PERMIT EXPIRES DECEMBER 31, 1 9 $ 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand tha~the on-site sewer system may require enlargement if th~.~es/~~~ed to include mor~ bedrooms. SWP/024(1/81) /~ SOILS LOG MUNICIPALITY OF ANCHORAGE [] PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST 825 L. Street, Anchorage, Alaska 99901 264-4720 SOILS LOG- PERCOLATION TEST DATE PERPORMED: ~ l[~m~ ~ z,, &3 SLOPE SITE PLAN 10 11 12 13 14 15 -- 16 17 18- 19.- 20- COMMENTS PERFORMEDBY: WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? ~o ~ ~o E Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN CERTIFIED BY: (minutes/inch) FT AND ~ FT 72-008 {6/79) MUNICIPALITY OF ANCFIORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 82:5 L. Street, Anchorage, Alaska 99901 264.4720 SOILS LOG - PERCOLATIQN TEST SOILS LOG PERCOLATION PERFORMED FOR: LEGAL DESCRIPTION* 2 3 SLOPE 10 11 13. 14 15 16 17 18 19 20 COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, ATWHAT DEPTH? Reading Date PERCOLATION RATE TEST RUN BETWEEN Time Net Time FT ID Net Drop (minutes/inch) P T © APPLK ,.NT FILL~5 UU I, UHHI:M HAL Proper~yOwner ~,~,~.4,.,/,/ i~,, 6-~,i/~/.~/./-- Phone N~ailing Address /O ,/~/J'~' ~) ~) :~> ~//67 //_."'/<-~ ~,'-/_~]' Zip Code Buye.~ Address Zip Code Phone Lendinglnstitution ~, /A' ~'~ t"l ~. Address ,/,~'.~ ? ,'-~/, .;~,' ,/ /' ~./ /~ ./-~' Zip Code -/ Phone Realty Co. & Agent Address ~'"'1~'--''"~ Zip Code Type of Resi~nce ~ngle Family g Multiple Family No. of Bedrooms ~ Other Water Supply ~ndividual A~ACH WELL LOG. A well log is required for all wells drilled since .June 1975. ~ Community For wells drilled prior to that date, give well depth (attach log if available). g Public Utility Sewer Disposal ~ndividual Year Individual Installed: ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESStNG CAN BE INITIATED. Inspector Inspector Inspector Inspector Field Notes: Note: T15N R1W Section 8 Lot 46 - Randy Gilbert #831055  is an expired permit, we have received no MUNICIPALITY O~ ANCHORAG5 DEPT. OF HEALTH ~',. installation as-builts in this office to da~i~,ONM-_NT^L Paperwork is under the metes/bounds. ~1~ c~ ' '~ I (? ) APPROVED BEDROOMS ~~ ~ ' ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' . / / DATE / ~ g 5- // Soils Rating Date ~wer Installed Weir To Absorption Area Well Log Received Well to Tank Septic T~k Size 72-023 (3182) January 23, 1984 Randeli K. Gilbert P. O. Box 773467 Eagle River, AK 99577 Subject: Lot 46A, JK Subdivision or ~.15.~ R1W, Sec. Lot 46 Approval for the individual sewer and water facilities cannot be granted until the ~oltowing items have been completed: The permit for the installation of the on-site sewer system will expire December 31, 19U3. We have not received the as-builts of the installation in this office. If a private engineer inspected tile syste.~, please send us the report ~or our ~iles and review° Please notify this Department Cot a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this oCfice at 264-4720. Sincerely, Cory Willis, Acting Sewer & Water Program ~4anager CWtO1/ej/E1 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 05109331 1. GENERAL INFORMATION Complete legal description J KLT 46A Location (site address) 20236 J -K LN Current property owner(s) ZARAGOZA EVAN Mailing address Expiration Date: q-2-4 - 2— z. Day phone 486-0829 Real estate agent Day phone 2. TYPE OF DWELLING: [K] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distan Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5550 Date of Payment �3 zy, Receipt Number D 554 Lib COSA# bSCa-�l _�09 Date: 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 NorthRim Eng. Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 6/22/22 ♦♦7,Vq1ok �* :49LH� ••�1 6. DSD SIGNATURE _ System #1 Approved for bedrooms f stere �, System #2 Approved for bedrooms ♦��-szss� Disapproved Conditional approval for bedrooms, with the following stipulations: NLITY 0110 �r�r oN s FR q11j G) �o ROG6 q TFR z Z F By: Original Certificate Date: _z 'Z The Municipality of Anchorage Development Services Division (DSD) issues Certificates of Onsite 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 aetkdlst blue Octel COSA Checklist Legal Description: J KLT 46A Parcel ID: 05109331 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 11121/83 Total depth 81 ft Cased to 81 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 36 in. Date of flow test for COSA 6/1/22 Static water level at beginning of test 39 ft. Comments B. TANK DATA Age of tank(s) 19 years Tank type/material Sptcstl Measured operating fluid level in septic tank 5011 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 5/31/22 D. ABSORPTION FIELD DATA 9/83 Which system tested (date installed) 9/83 ❑ ALL standpipes present per record drawing Total measured depth from grade 10 ft (max) Measured depth to pipe invert from grade 4—ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective " ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Well production at time of test 8+ gpm Water storage tank volume0 gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 1,85 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by NRim Eng. Date of Sample 6/7/22 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 6/1122 Results F1 Pass For 3 bedrooms Fluid depth prior to test 24 in Water added 450 gal New depth 30 in Elapsed time 30 min Final fluid depth 24 in Absorption rate 450 gpd Any rejuvenation treatment (past 12 months) no If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Yes Septic Tank/Lift Station on Lot > 100' it If absorption field is under driveway comment below Community Sewer Manhole/Cleanout > 100' D ✓ Yes if No ft My Yes if No ft Neighboring Tank > 100' D Yes if No ft Private Sewer/Septic Line > 25' D Yes if No ft Absorption Field on Lot > 100' D Yes if No ft Holding Tank > 100' D Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' D Yes if No ft Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No ft D Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 1:1 Yes if No 5+ ft Surface Water> 100' D Yes if No ft Property Line > 5' El Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' El Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10* D Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' D 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 it If absorption field is under driveway comment below Property Line > 10' D 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' D Yes if No ft Community Wells > 200' D Yes if No ft Surface Water> 100' Yes if No ft F. ENGINEER'S 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 COSA guidelines in effect on this date. COSA Checklist yellow sheet MUNICIPALITY OF ANCHORAGE o~ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ?~ DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~j~)-7-/'}-~'-~c~--~---- OF ON-SITE SEWER AND WATER FACILITY 264-472O GENERAL INFORMATION (a) (b) (c) Application Date April 23~ 1987 Legal Description (include lot, block, subdivision, section, township, range) I,OT 46A~ .T-f{ SIfRDTVTSION: T15N: RIW; SECTION 8 Location (address or directions) .T-K LANE,, OPP SOIITW BTRCHWOOD LOOP: IN CHUGIAK ALASKA Applicant Name Tz3RT~, ¢,ROkrPRR Telephone: Home P./a Business Applicant Address 10928 Of,r) C,T,EN'M HTP, HWA¥: EAGLE RTVER: AK 99577 Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [~X[(explain); RRAT ,rD(hR 694-5500 (d) (e) . (f) Lending Institution ¢', iv[_ A_ P, Telephone 562-2181 Address 701 W. rRfr~R~ ~ITTq$': 107~ ANCHORAP, R AT,ASKA 99503 Real Estate Company and Agent .TAP. f{ WR'Tq~R RRAT,rpY - fDRTR P, ROWDAR Address 10928 OT_,D Of,RAIKT T-TTO. TaWA¥, ~A~T,R RT~FRR, AT,AgMA 99577 Telephone 694-5500 Mail the HAA to the following address: FOR PTCK]--TP _.my ~_.~.GT,R pT~_FRR RNG~RTNG gRR~R,g TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms q; Other WATER SUPPLY Individual Well [~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite[~ Public [] Community [] Holding Tank [] . ' Note: Il community well system, must have written confirmat!on from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72-025 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ___~GLE RIVER ENGINE~NG SERVICES_ Telephone -- 694-~9~ Address P O BOX 2 4 ~_GTL~ t~!FV'BR ALAS~ Date /7~./~/7///~ ~ DHEP APPROVAL Approved for bedrooms by Approved t~ Disapproved Conditional Terms of Conditional Approval Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 ~ MUNICIPALITY OF ANCHORAGE (M Oi: ANCHOI~G~J''TH AUTHORITY APPROVAL (HAA) i,~.uN~C~pALt'~ ...... ,-'~ DiViS[~-IECKLIST - FEBRUARY 1984 ENVi~,O~,MSH~AL 5'ct~'~ ~,~-~ 264~4720 APR2 7't987 Legal Description: /'/~ WELL.ATA RE C E IV rr.D Well Classification /~:~'~ t t~.~ 7~.~' Well Log Present (Y/N) -" Total Depth ~/ Cased to If A, B, C, D.E.C. Approved (Y/N) /7,/./'4 Date Completed ?/~1 ~.~ ~ Yield ~-~'*~- d~/~'m 7'.~¢ ¢/~=?z*~ o¢/ / Depth of Grouting /t/,./~ Static Water Level .z./¢ /.,¢~/¢,~, ,¢z,¢~ ~.,¢ Casing Height Above Ground 3 -~-/' Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot /~/ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line /V//~ Pump Set At x¢~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots / ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole Water Sample Collected by Water Sample Test Results To Nearest Sewer Service Line on Lot ~v~ / ~ ~- ; Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~/,E ~ StandPipes (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: To Water-Supply Well /~/ / To Property Line /-//J ? To Water Main/Service Line Course Size ./,¢¢~..,c~/. No. of Compartments Air-tight Caps (Y/N) 'Y' Foundation Cleanout (Y/N) Date Last Pumped ?,/~c ~ ~.~//~ 'for Temporary Holding Tank Permit (Y/N) 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 ./¢;¢) ¢/"~,.4~ Type of System Design Date Installed ~/~--~ Length of Field ,=~ ,-~' / Width of Field ~ / Depth of Field ./gP / Gravel Bed Thickness ~' / Square Feet of Absorption Area ~¢~ 4z~ Standpipes Present (Y/N) Depression over Field (Y/N) cA} Date of Last Adequacy Test '~//~-~/,¢' Results of Last Adequacy Test ~/~-j' ;~-/-~-,.~ .,,,¢¢/~j-~ ,.-z-.~'--/~ )¢_~/~ ~ Separation Distance from Absorption Field: To Water-Supply Well /~'""""~ / To Property Line /~/O / To Building Foundation /~- / To Existing or Abandoned System on Lot ..d//'¢~ ; On Adjoining Lots ¢' z'¢ / To Water Main/Service Line ~'/~ / To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ¢/~ / Comments LIFT STATION Date Installed Size 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 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection, Signed .- .... ~;;~-~"~'~ Date .~'//.~ ~/,/~' '~ Company ~/~/¢ ~z~'-F MOA No, Receipt No, Date of Payment Amount: $ Eagle River Engineering Services P. O. Box 773294 Eagle River, AK 99577 694-5195 Page 2 of 2 72-026 (11/84) Municipality of Anchorage • On-Site Water and Wastewater Program en,,�E s c _t c_ (907) 343-7904 Lid l e s F r e r v CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-093-31 Expiration Date: 1. GENERAL INFORMATION Complete legal description J K Lot 46A Location (site address) 20236 J-K Lane Current Property owner(s) Pospeck Day phone 830-3228 Mailing address Same Real Estate Agent Carmi Day phone 830-3228 l:36 " 970 2. TYPE OF DWELLING: `� 'f` '' ', , ,'r_ ® Single Family (w/wo ADU) Q MAR i. 6 ZU18 ❑ Duplex Q ❑ Multiple Dwellings (Single Family and/or Duplex) ti 401 6 8 L 9 9.14 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage 0 Holding Tank 0 Community Class C Well 0 Community 0 Public Water System 0 Public Sewer 0 Received by: __,, ----.5T— Date: -3/22P, COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 5 .._.(e, Date: Date of Payment .2)I 19 l I Date of Payment Receipt Number Oct"E 1 Receipt Number COSA# MC—'g\CA 3 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 3/18/2018 • 6. DSD SIGNATURE System #1 Approved for 3 bedrooms. • System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: `y4t; A 1A ERAS 14/As rEWA E P 0GRAM R �� • �vT.c~RVtf;f•c� • (( E ---i'j �"�' Original Certificate Date: 3 ._ZZ—(�S The Municipality of Anchorage Devlopment 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 9-1-12.doc If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On Site Systems Approval Checklist Legal Description: -I ('C L07 CIZZ/} Parcel ID: 4 51- 0 ?3-3/ A. WELL DATA Well type P If. A, B, or C provide PWSID# Well Log (Y/N) y Date completed //2f/(1)3 Sanitary seal (Y/N) ( Wires properly protected (YIN) \,/ / Total depth S/ ft. Cased to trY ft. Casing height (above ground) 3C in. FROM WELL LOG AT INSPECTION?SP Date of test. /f,2/!/P3 ` z3//i Static water level `f' ° ft. 0. ‘ ft. Well production 4( g.p.m. GF-71-- g.p.m. WATER SAMPLE RESULTS: Coliform Q colonies/100 mL Nitrate 4 zi 7 mg/L Arsenic Ad ug/L Date of sam le: 3/2/7 t Collected by: /v/z,'"L 4-7 p B. SEPTIC/HOLDING TANK DATA / . Tank Type/Material .___S /7YG/ S T 5.4.- Date installed 7f' //10..? Tank size /2 SOgal. _ Number of Compartments 2- Cleanouts (Y/N) X Foundation cleanout(Y/N) Depression over tank (Y/N) Al High water alarm (YIN) A Date of pumping /2/i / / 7 Pumper T/Z f C. ABSORPTIO 4 ELD DATA Date installed Soil rating (g.p.d./ft2 or ft2/bdrm)I /G 6 System type 7-r-e.t.c Length 2-5 ft. Width 3 ft. Gravel below pipe C ft. Total depth `0 ft. Eff. absorption area Jaaft2 Monitoring tube y Depression over field At/ Date of adequacy test Z/z3frr Results (Pass/Fail) P For 3 bedrooms Fluid depth in absorption field before test /'( in. Water added 5-O gal. New depth AP' in. Elapsed Time: 3 G min. Final fluid depth l47/ in. Absorption rate >_ �-.5'.'o 4 g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) vA1(C-- If yes, give date D. LIFT STATION ^/ Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot /o 7 , On adjacent lots /O'Q r. Absorption field on lot /6 6 'f On adjacent lots /06 '(- Public sewer main /6 G 'F Public sewer manhole/cleanout Sewer/septic service line 25 'f Holding tank /0G `-(- Animal containment areas fi Manure/animal excrete storage areas /G'O'r.i4 SEPTIC/HOLDING TANK ON LOT TO: • Building foundation ,Property line 6 '' Absorption field S -F- r � Water main �G 7` Water service line . /O ?` Surface water /O Wells on adjacent lots /60'x"" ABSORPTION FIELD ON LOT TO: r Property line 7G '" Building foundation /v �'`- Water main l0 (4" Water Service line /0 r Surface water / a 0 ''e Driveway, parking/vehicle storage G *- Curtain drain v41 if-- Wells on adjacent lots /o o rf F. COMMENTS • G. ENGINEER'S CERTIFICATION ,[b�o g���wl �•'` •°a`•e a ^I I certify that I have determined through field inspections and •.tP;•° **%Y...4:47% .`r.¢ review of Municipal records that the above systems are in ��o' ••,q d j conformance with MOA COSA guidelines in effect on this date. ®* = '� g! Engineer's Printed N me �, �• - • `cam , M1: ,104,1 � �� / /� �xn'G'�' Steven W. Eng 4; Date 4 ( 8 % •° p- 6255 fv • COSA yellow sheet_2-6-15.doc J-K LANE 84701 _ - 0 0 co co N89°44'00"E 165.88 H i 20'T & E Easement : I �3' BLM Easement o Well col Gravel Ml driveway , l 4..0 - o co 5.4 - 16.0 coM 1 Story o deck � Frame • 120 House `8. 22.0 0 •eck N Z "' . -Septic vents d0 O 20.0 . N no W .1.; co co 1 i Wire fence M CV Lot 46B IV ' NCO o Lot 45 Co hed O N Z Co LOT 46A t 1 Lot 48 Lot 47B I N89°48'36"E 154.00 I Lot 47A I AS-BUILT NO CORNERS SET THIS DATE %. �' I hereby certify that I have performed a Mortgagee's inspection OF • Aj of the following described property: LOT 46A. g Note: Griveway location is ..7,...‘' F'• • • • ;9S •a J K SUBDIVISION approximate due to ' ' '� snow and ice. CO• 49th �, ••;7 /\ .,, // Anchorage Recording Precinct,Alaska,and that the •• ••• improvements situated thereon are within the property lines and do not overlap or encroach on the property lying CI-614.- ,o0 adjacent thereto,that no ovements on he / Fred• Wal o tk a ,o / adjacent thereto encroach onr the premisest in questionproperty yandg / `% • 1. i that there are no roadways,transmission lines or other ,�`P,s,••• 3255 - S •.•��� — visible easements on said property except as indicated SCALE: 1"= 50' Op • . • • • • • Poo 41, hereon. 1 RorESSIONAL Dated at Anchorage,Alaska EASEMENTS OF RECORD,OTHER THAN 1\N.V•�' this 6th day of MARCH ,2018. THOSE SHOWN ON THE RECORDED FRED WALATKA&ASSOCIATES PLAT ARE NOT SHOWN HEREON. Engineers and Surveyors UNLESS OTHERWISE NOTED FB 18-3, pg 1 BE 907-248-1666