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HomeMy WebLinkAboutEARL RAY BLK 3 LT 36Onsite File Earl Ray Block 3 Lot 36 #051-113-18 Charles A.Leet June 6, 2022 MUNICIPALITY OF ANCHORAGE Department Development Services De p p ! �'� Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 05111318 Property owner(s) Michael & Carol Gershel Mailing address 23919 Ski Road, Chugiak, AK 99567 Site address 23919 Ski Rd Day phone Legal description (Sub'd., Block & Lot) Earl Ray Block 3, Lot 36 Legal description (Township, Range & Section) Lot Size 72310 Sq. Ft. Number of Bedrooms 3+1 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field 0 Initial] Septic Tank ❑ Upgrade) Holding Tank ❑ Renewal ❑ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Single Family (SF) El (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: -59 S Waiver Fees: Date of Payment: S h ib 0,2,2 Date of Payment: Receipt Number: X 24 770 Receipt Number: Permit No. 0.SPZZI I _� g 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 OSP221135, Rebecca Carroll, 06/03/22 Charles A.Leet Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221135, Rebecca Carroll, 06/03/22 Charles A.Leet Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221135, Rebecca Carroll, 06/03/22 Charles A.Leet Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221135, Rebecca Carroll, 06/03/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221135, Rebecca Carroll, 06/03/22 kRGv uJ1U4110) Municipality of Anchorage. - On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201328 PID Number: 051-113-18 Dwelling: P1 Single Family (SF) ❑ with ADU .❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name Roy Kennedy r5OR;PTION FIELD Trench El Wide Trench ❑ Bed ound Site Address 23919 Ski Road Other Phone Number of Bedrooms Soil Rating grade 3 /SF 17rotal,d;�original Ft. LEGAL DESCRIPTION Depth to pipe invert from original a Gravel depth beneath pipe Ft. Subdivision Block Lot Earl Ray 3 ,36 Fill added above originai gr Ft, W length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dista between lines Ft. SEPARATION DISTANCES To Septic Absorption Station Holding Sewer Total orption area Number of trenches Dist. between tr hes From Tank Field. Tank Line Ftz Well 100, {{Lift I TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water 1001+ j Greer 1250 Gal. Material Number of compartments Lot Line 51+ NA Plastic 2 Foundation 101.t TATION —.00000 Manufacture Capacify Remarks Gal. Alarm location �� Electn ed by . Installer PIPE MATERIAL House to tank Tank to D3034 drainfield D3034 Northern Excovation Drainfield CO/MT D3034 Inspector Arcterra Consulting BENCH MARK (Assumed elevation) 100 ft Inspection�� Location and description dates: 9/3/20 2nd 9/3/20 3'd 41h North East building corner ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp I. 0*119KA41111 Conditional Approval: Dater %L . y .t~IElll . , l t iIC MCE Septic System Approved �i�..., _ Date Note: this approval does not k6lude well permit requirements.' kRGv uJ1U4110) AS -BUILT SYSTEM DETAILS/SITE PLAN Permit ❑SP201328 EARL RAY BLOCK 3 LOT 36 P I D # 051-113-18 _'A -C=60.95' B -C=55.25' A -D=65.18' B -D=59.53' �+ A -E-68.94' �, B -E=62.75' a A -F=69.62' W B -F=63.43' d A -G=72,86' B -G=65.96' A -I=57.73' v B -I=52.00' A -H=57.07' B -H=5128' B ny w z� GARAGE � WELL 5 C3 5 55 w v' zzy zzd �.. O 0 JUL.- r12 0 GAL TIC ;r / I TANK EL N -gap- lidw � r■ OF 4Z R / 1 PREPARED F❑R: Aw ROY KENNEDY 23919 SKI ROAD g • yr ; L� TH * 1 CHUGIAK, AK KKMNETfi FIELD BOOKS CDMPUTPD: to �� BDUNDARYi N A DRANK: KSD G 7116 i... { • �� f.� ! f - %ti• STA KING:N A CHECKED: KMQ a` • ' �V" ASBUILT: DATE:9/14/2 ' E'SSI f DUG. Fl<E GRID: NW1360 ACAD FILE: FILE .:DB Na. 20124 ww rasa GAL SANK SCALE: 1' = 40' 1 SCALE: NTS 1 fl�,��le11111 W, r* A K. 99577— s 9577— Anchorage Tank Page: 1 Pick Ticket 2723 Rampart Dr Anchorage, AK 99501 Order Number: 0004465 Phone: 907-272-3543 Fax: 907-277-3715 Customer Number: NOR0013 www.anchoragetank.com Order Date: 9/2/2020 Salesperson: Sold To: Ship To: Northern Excavation & Const. Northern Excavation job site PO Box 672178 23919 Ski Road Chugiak, AK 99567 Chugiak, AK 99567 Confirm To: Customer P.O. Ship VIA F. 0. B. Terms verbal Jon Due On Receipt Description Unit Ordered Shipped Received COUPLING, SEPTIC, 4 X 4 7 EACH 1.000 SEPTIC, COUPLING 5 X 4.5 EACH 2.000 BUTYL TAPE EACH 2.000 RISER 4ft, 4" Insulation EACH 1.000 MA320 GLUE PACKET EACH 2.000 RISER/TANK ADAPTER, 24" ABS EACH 1.000 PolySeptic 1250G 102Lx78Wx68H EACH 1.000 Serial Number 1250 Gallon Poly Tank w/Parts EACH 1.000 poly tank riser adaptor alum EACH 1.000 z w LEGEND: w LOT 23 (C)=CALCULATED DATA w (M)=MEASURED DATA o (R)=RECORD DATA PER PLAT BLOCK 'J ohu=OVERHEAD UTILITIES NAT.=NATURAL Z) TYP.=TYPICAL 319.48 (R) 318.86(C) MENj S81°083 ------ { \ 10' U (IL►TY EASE SATELITE o 10' —0 EASEMENT_ DISH { r 0 3 Co CD 0 Ln O w 0 rn N P� Go 0 LOT 36 r� 3 1 /4 ," BRASS 72310 S.F. CAP UNI/10 UTILITY POLE TOWER (TYP) —��MANHOLE 0 CONCRETE WALK 4" PLASTIC PIPE TYP. GARAGE a 58'f z N NAT GAS V it `'� 24.3 +. •� � \ 5/8" REBAR4 (TYP) { { { I WELL / 100' RADIUS L 4 r� 00 coco d- d- �w LOQ LO 00 00 00 zz 1"=50' NOTES: 1. EXCEPTING FOR GROSS NEGLIGENCE, THE LIABILITY FOR THIS SURVEY SHALL NOT EXCEED THE COST OF PREPARING THIS SURVEY. 2. THIS SURVEY REPRESENTS VISIBLE IMPROVEMENTS & CONDITIONS ON THE DATE OF SURVEY. 3. THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY & IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. 4. THIS SURVEY PERFORMED FOR ESTATE OF ROY KENNEDY, IT SHOULD ONLY BE USED FOR A SINGLE PROPERTY TRANSACTION. EXCLUSION NOTE: IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. F o oy 49TH o °* RR:0000000eo°000°0000°00000°o +eRobert J. Farmer "moo r�°°, 10615—S P o ROFESSINNAL �P - y -7-o AS—BU FARMER SURVEYING 9131 E. FRONTAGE RD. PALMER, ALASKA 99645 PH: (907)745-0222 bob@farmersurveying.com www.farmersurveying.com W0: 20-00264 PAGE: 1 of 1 SCALE: 1 " = 50' FB: 20-05 FILE: 2000264AS I HEREBY CERTIFY THAT A MORTGAGE INSPECTION WAS PERFORMED UNDER MY DIRECTION ON THE FOLLOWING DESCRIBED PROPERTY: EARL RAY SUBDIVISION, BLOCK 3, LOT 36, PLAT No. 64-78, ANCHORAGE RECORDING DISTRICT, ALASKA. SURVEYED ON THE 4th OF SEPTEMBER, 2020. ©2020 MUNICIPALITY OF ANCHORAGE Ort -Site Water & Wastewater Program PO Box. 196650 4700 Elmore Road Anchorage, Alaska 99619.6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://M"muni.orglonete On -Site Wastewater Disposal System Permit Permit Number: OSP201328 Work Type: SepticTank Upgrade Tax Code Number: 05111318000 Site Legal Address: EARL RAY BLK 3 LT 36 G:1360 Site Mailing Address: 23919 SKI RD, Chugiak Owner: KENNEDY ROY D & SUE ESTATE OF Design Engineer: ARC TERRA CONSULTING INC This permit is for the construction of: Effective Date: Expiration Date: �suenr J ~ Department Lot Size in Sq Ft: Total Bedrooms: 8/24/2020 8124/2021 72310 O Disposal Field 10 Septic Tank ❑ Holding Tank CI Privy ❑ Private Well © Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: 1. If there is no existing foundation cleanout (located 1 - 4 ft outside the foundation), one shall be installed or a double cleanout shall be installed upstream the septic tank. 2. The end ofthe drainfield closest to the septic tank shall be field located to verify minimum 5 it separation to the tank. A cleanout should be installed at the end of the drainfield closest to the tank. 3 Received By: 1LDate: 5 4 l�d�C7 Issued By Date: `« ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-113-18 Property owner(s) Roy Kennedy Mailing address 23919 Ski Road, Chuaiak, AK Day phone Site address 23919 Ski Road Chuaiak AK Legal description (Sub'd., Block & Lot) Earl Ray Block 3 Lot 36 Legal description (Township, Range & Section) Lot Size 72,310 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (w/wo AD U) Septic Tank 0 Upgrade 0 Duplex (D) El Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Dea Duffus (Signature of property owner or authorized agent) Permit/Rush Fees: t 16M 5 CSU l b - 19) Waiver Fees: Date of Payment: Receipt Number: 0"733` GI Permit No. 0 Se Z0 I 3 29 Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201328, Rebecca Carroll, 08/24/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201328, Rebecca Carroll, 08/24/20 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVtRONk~ENTAL PROTECTION ENVIRONIVIENTAL ENGH~EERfNG D~VIS~ON 825 L Street - Anchorage, Alaska 99501 Telephone 284-4720 ON-SITE SEWAGE DISPOSAl. SYSTEM AND/OF~ WELL INSPECTION ~EPORT TPHONE E~ UPGRADE MAILIN~ ADDRES,~-~-I "~ LEGAL D~CRIPTIO~ ~ '~ ~~ell ~ [Absorption area ~ /Dwelling f PERMIt. O ........ ~ ~ioga ons - -- -- Inside lengt~--~{'~-- ~ - L'q~'d depZ~~ ~ ~-~t'~' I IF HOMEMADE' - --] Liquid capacity in gallons ~ ~ ~~;-- ~ion ~ [~es . tL~;:d~ir)~ Totall~,~gthofHnes lTrenc{%~Jth ~D,staaceb~t~e/n~,nes P ~ [ Top o¢{~le to finish grade . Matefia beneath tile Total ef~c~-~bsorptlon area ~ '~ ~ I P~MIT NO. Length DISTANCE TO: DISTANCE TO: Crib diameter Well Crib depth Building foundation Depth Driller Building foundation Sewer line OTHER PIPE MATERIAL-~ . SO,L TEST R EMAR KS APPROVED/) 72-013 (R'~, 3/78) -- ' t T otal effec~tive abs;rpdon area Nearest lot line Distance to lot line IPERMIT NO, Septic t~kn k .[ A b~s o r~ til o n ~a rea (s) DATE LEGAL DEPFIRTMENT (? HEFIL"f'H FIN[) ',F.::25 "L S"I"F.'.EE:T., FII'-,I[.'.HORFtE~E., FIk'.'. 264.d. 7;.:.ZO C) F4 .... ::E:; ]ET' Ei: .'::.5 E: ~r,4 E.Z E:: F:" E: F:'~: ~"~ Z T' 1t.4 E'E !L. L. F'::~ "EEEEi45" Fl P F:' 1._ ]: C l:~ t",l T [ Iii:Fl1" ]: r: LE(:.~FIL. L ]:5 B ]: EFfRL RFI'¢ :,,,'[. E;"['FtR I:,i:0UTE r: ..,., ,' 2.4 :~'~1:5156'? E :::' 'E.' """:2 ~;I;:E:; , LOT SIZE 4:jOF'E'~ 'S(;:it.IFRE FEET T'Q:'E OF :i:.;": IL FI[::':: '"F'F'TIOI",I =,~ :,] EJ't IS: TPF'I'.I"H ["t!:~X]:i"ILif't f",ILIr'tBER OF [!.[.L. kLLII ........ ]: c-ii kP ~i',l.~ ':':}T.! FT,,"E~R:: .... :1.~.. ]"I-.tE RE[::!!...t IRE[:, S I ZE (]F' 'T'HE ':::: l L. FE '5 ] RF'TI ON .:., r .:,. t:.f'1 ]: S ' 'T'HE !,...E?.,tEiT!-4 DZt"iENS]:Ot',! IS THE LENGTH ,.'.'IN FEET> OF THE TRENCFI OR E, RFIii",F'IEL. D. THE DEPT,~-I OF P, TF.'.ENCH OR PI'l" IS THE D ISTFINC:E BE'Tf,.IE[EN THE ::::;UF.".FF!CE OF THE E~t:;:OIJND I:."¢4D THE E:OTTOH OF "FHE E',:.:',CFi',,,'FI'f'ZON ,:::[i",l FEET). THERE tS NO :'f;ET kI;[DTH FOR "I'RE:NC:HES. THE [3F:'.FI',.,'EL DEF'TH :[S THE FIZNi'FIIJM [:,EPTH OF 6RFI',,,'EL E:ETI.,EEN THE Ou"rF:fiLL PIPE: FIND THE BOTTOf'I OF "[HE E',=.:,'CF¢,,,'FI'T'ZON (IN FEET). i::'ERI?I I T I'- r F L I CFIN]" HFE; '1'HE [, ~: :,F . N.:, .[ E, ~. L ]. f t TO :[ i'.,IFORFi TH :[ S [. EF Hk] i' IE.t' I r [:,LtF.: I t.42 THE :[ t'.E;TFILLEI'): .. 4 :[ ?-,)EE, F'EC]' ! ONS OF F1N'¢ !.,.!ELL:E; FiD..:rFICENT T ] TH t S pr4, '" PEPT'¥' FIf'-,I[:, THE .:,El;.., E. NLIt'IE~E:R Ot::' RESIE:,ENC:ES THFff "FHE I.,.IEL.L ktILL ' ..... ~',,": ....,. ff,,~ ..... EEE:KF']:L.L. ZNG OF FIN'.r' S'¢S]'Et"I t?I:[.TH:..T FINIAL..T.I'4,:.:.::PECTI'ON FINE:, [l[-f 'F-: ....HL [,t THIE; [':,E:F'FIf;'TI'"!ENT t.,.t I 1.J... EE: 'E [: TEE ] T TO Pt:~:OE;ECIjT FI!t",tlMLli"I D):STFINCE: 13ETI.'.IEEN R I,.IELL R["D I:::IN"r' ON--SITE SEWR6E D:[SF:'OSFIL SYSTEM J. EEi FEE'[' F'OR FI PRt?RTE k!ELL. OR 158 TO 208 FEET FROM R F'UBLZC f.,.IELL DEPEN[)]'.NG UPON ]"HE ]"?F'E OF PUBLIC 1.4ELL. FIlNIIdUF't I)I. STRNCE F'ROM R PRIVffl"E klELL TO R PRIVRTE SEI.'.IER LINE :IS 25 FEET RND TO FI COFIi'"ILJNiTY SEI.,.IEf',~: LINE IS 75 FEET. HELL L..OC~S F~RE REQLt ); RE[:, FINE:, ~'ILIST BE RETURNEE:' TO THE E:,EPFIRTHENT klZTHtN ]:0 OF THE [,.EL.I.. COHF'LET]:ON. OTHER RE[;]IJIREF'IENTE; Fifty RPPL?. SPECZFICRTZONS F4NE:, C:ONSTRLIC]"~OI",I [:'ZFIGRFII¥1S F4RE FI',,,'Ft I L. FECE TO ): NSI.JF:E PROPER :[ NSfF~L. LRT Z ON. ! E:ERTIF'? THFIT Z: I RM F'FIFIILtRR k!]:TH THE REQUIREI¥!Et',IT:E; F'OR OF,F. SZTE SEFIERS FIND I.,.IEt:_S RS SET FORTH B? "fie f,'tUNICZP~L.]:T*¢' OF RNCHC)RRGE. 2: :[ [,~ILL. tNSTI:::tL.L THE SYSTEM IN F~CCORDFiNE:E [4ITH "rile CODES. ]:: t UNDERSTRND THFIT THE ON--S:[TE SEI.4ER S'¢S"['Ef'I MR'¢ RD])UIRE ENLFREiEf'IENT IF THE RES IE)ENCE IS F:Et¥tO[)ELED TO ];NCLLIDE MORE THRt'.~ ::~: 8EDROOf'tS. , ~F F L ] ..... .,I f F'ETEF: L E:,EF'F, IF:TI'IENI- ('T HEr:iL_T!'! Fff-.~[:' E:H',,,'tF:3N'tF't-,!TF'ff.. F' F'ERHI T NCL ( ,.. S 1 LoT r'F'E OF '%OIL_ FI~:SOF:F'TI()N c,~z,T[:. 1 , [:3: [--' -I ' I 4 ..... /0 L.__ E( f-4,3i 3 - t-4 ': .... ~ ,--r-. ""..:, ,'-. ,., ..."--I.:: .... l'3. f:~; I::::' l'-l-t: : ~ THF~ I_EHCiTt't [:'[HEH'.SI f)U I:Z, '['FIE LE. HGTH ,'( IN FEE f) CIF' 'TH[: TI;':[;HC:H OF: C,F:F~I HF' [E~!. [' TjF:CtlJIt[:, [:IN[)THE ECTTfIF1 Cfi: THE' E;>:iC:fl'v'RT'ION (IN FEE:T) THEF'E ['.5 HO SET [,J[[:,t-H F:OF: T'F:ENCHE~ THE ,'iFR','i3.. DE?TH IS -[HE PIINII'ILIp1 [:,EF'TH OF: GR:FO,,'[{t. [?,¢:TI.ff[E.H file OLITF'f~L/ F'IF:'E ~'F~:TF~[I..RTIOfl II4:~;F'~TE:TIOHf~ OF- t~f~'~" NEt. LS Fff)JtaC:ENT TO THIS t-'-_F-Et~, ~ F¢4C, II.IE:EF: OF FiE'{;IIt, EHC:IE~ rHFtT file NEtL t.IILL SEFt'v'E. tC. KF'It_t_ING OF F:lf't'r' z, Tz, IFZtl H['THCHJT F'[fIi~[._ fN';F'EC:TtOH ¢4N[:' Fff:'F'E:O'v'F~L [:,~ ;F:'F~F:]f' ' Eh~- "- l,lil L E:E qt I[: TE'C:T .............. TI]I flIf'ILIPI [:,I:~Ii'CtCE E:ETHE~N Fi i,]ELL FbJF', I'll-I-'::; ~;E'.IF~i]E C,I'EF'O::~i:kL '-'" - r.::. FEET FOF: F~ F'F4:[',,,'Ft]E HELl. '2re .]_5C~ f'O ~:~(:.~ :-EEl Ft;:OPi R F:'I.[jI_[I'": I.IHLI. ttlf'lUf'l [,[:~:IF'tfICE F'F?'dl t':1 F'F:I',,,'i'~I'( [,IEL_t. ['0 F! F:'~tI'v'F]TE[ '::;[~I,H'.:F: ! f~4t~:I'; 2'; FEET t~ (.OP1PUf~[1-'¢ '~qEFtEf;: L. IHE IS, ?L; FILET ~[:~ I-.({F: F-:EO~.IIF:[~PIENT'5 r'IFV¢ FtF'F'L.Y '.~;F'F..CIFI(:F4T~ON~:; RN[:' Ci]r4':_:; 'F;'tlC'TION [)T[~GFiF~P'; I::'[~E:l'4:l'l I 1' t~:~ ;: :: F :::' [ t-::[2E:~E; 12,[ T T'TI:j~:I-ttz:[TEf:;;: ~: ::'t .- FE!F;'~ T F:Y ff::TH E','T' Ttff~ I'lllNICtF'~LIIY Cfi: I I, lZt. I.. [H:LiTFti. L TItE ?¢'~;T[~:H IH RCC:OF:E:'F~NCE I,I~I'H [Hi: '_~IE:,EHCE I':, F'[ i'1()DEL. EC" TO [fiC[_LIE:,E PICffi:E '['HF~N ]~: tqt'[:'[ i C:rff4'f . ~ \, 6__ 7__ 8__ 9__ 11__ 13__ O&E ENG,NEERING & DEVELOFMENT Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2260 CO. 6"~"4t"2~7 4°'"'°r Performed ,o,: Name: Legal Description: ~ Depth (feet) Soil Characteristics PERC. TEST 14__ 16__ Ground Water Encountered: Yes.__ Proposed Installation: Seepage Pit Comments: Nb J"lf yes, what depth Drain Field_ ~ AG..-. E_:d4 ^_ Municipality of Anchorage H` On -Site Water and Wastewater Program T (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL, Parcel I.D. 051-113-18 1. GENERAL INFORMATION Complete legal description Earl Ray Block 3 Lot 36 Location (site address) 23919 Ski Road, Chugiak, AK Expiration Date:. e C 151 Q1 � d Current Property owher(s) Roy Kennedy Day phone Mailing address 23919 Ski Road, Chugiak, AK Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo'ADU) {' ` r-� F-1DuplexH!. .� ❑ Multiple `Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ® Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class Well ❑ Public Sewer ❑ Public Water System ❑ Waiver/Variance request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 9 l' _G0 V � � a`a � 5 WCRLkver Fee /$ _ Date of Payment L-aloD `� I 0�0 Date of Payment Receipt Number Q 14 7 y G Receipt Number COSA# 0_5GWJLI `f y 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 ARCTERRA CONSULTING INC. Phone 696-6111 Address 20447: PTARMIGAN BLVD., EAGLE RIVER, AI< 99577 Engineer's Printed Name KENNETH M. DUFFUS Date �A-) Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. 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, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that ho unseen �'OF�� encroachments, deficiencies or discrepancies exist. Alf 6. DSD SIGNATURE ` KENNETH M. e US V System #1 Approved for bedrooms. t,s System #2 Approved for bedrooms. �1kFo ���Lss1Q�1 Disapproved. Conditional approval for bedrooms, with the following stipulations: (OtFAA z;4 (((((��r(( ON-SITE G� YAIoTER AND= WASTRv�'ATER o J PROGK 1'1)1)))))M) ",. By: Original Certificate Pate:I f J b 0,2 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 X Septic System Advisory Well Flow Advisory COSA blue sheet_10-10-12.dx Nitrate Advisory Arsenic Advisory Other X COSA Checklist Legal Description: Earl Ray Block 3 Lot 36 Parcel ID: 051-113-18 If more than I septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Adequacy test date 8/6/20 Well log is filed with Onsite (or attached) Well production at time of test 5.6 gpm Date drilled 10113/80* Water storage tank volume gallons Total depth 128* ft Well disinfected for coliform test? ❑ Yes ® No Cased to 128* ft ® Coliform bacteria is Negative ® Sanitary seal is functioning correctly Nitrate 9.46 mg/L E] Nitrate less -than -MRL (ND) - ® Wires are properly protected Arsenic ug/L ® Arsenic less than MRL (ND) Casing height (above ground) 24 in. Collected by Areterra Consulting Date of flow test for COSA 815120 Date of Sample 815120 Static water level at beginning of test 99 ft. Any rejuvenation treatment (past 12 months) Comments *See attached well to If yes, enter date B. TANK DATA Age of tank(s) 913120 years Tank type/material Septic/Plastic Measured operating fluid level in septic tank ® Standpipes/foundation cleanout per record drawing Date of pumping New D. ABSORPTION FIELD DATA C. LIFT STATION El Required maintenance completed Age of lift station years Lift station material Comments: Which system tested (date installed) 10127188 Adequacy test date 8/6/20 ® ALL standpipes present per record drawing Results Q Pass For 3 bedrooms Total measured depth from grade 9.4 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 3.4 ft (min) Water added 450 gal ❑ NIA — pressurized field New depth 14 in ® Monitor tubes go to bottom of effective. If not, state- 60 depth into effective Elapsed time min Code -required soil cover over field Final fluid depth 0 in ® System presoaked Absorption rate 450* gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) g Gallons introduced 2000 gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet 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' 0 Yes if No Community Sewer Manhole/Cleanout > 100' If absorption field is under driveway comment below Property Line > 10' Yes if No ft Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 2621 Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Animal Containment ? 50' 0 Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft [✓] Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water> 100' ® Yes if No ft Property tine > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Yes if No ft Private Wells > 100' [i/] Yes if No l ft Water Main > 10' ® Yes if No fit Community Wells > 200' Yes if No ft Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No ft Wells on Adjacent Lots.- ots:Water WaterMain > 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 ft Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that 1 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 JH M.. CE .71 MUNICIPALITY OF ANCHORAGE    DEVELOPMENT SERVICES DEPARTMENT    907‐343‐7904  On‐Site Water and Wastewater Section                                                                                           Fax: 343‐ 7997  www.muni.org/onsite         Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org      Nitrate Advisory   Certificate of On‐Site Systems Approval # OSC201494  Subdivision: Earl Ray, Block: 3, Lot: 36  A  water  sample  revealed  a  nitrate  concentration  of  9.46  milligrams  per  liter  (mg/L).  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.  Since nitrates are known to slowly increase,  we recommend you monitor the water quality.  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.                            DATE RECEIVED INSPECTION APPOINTMENTS :~,, TIME TIME .,~ TIME DATE DATE ., /~ /~ DATE INSPECTO~ INSPECTO~ MUNICIPALITY OF ANCHORAGE DEPT. OF iC/AL'1'H & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~RONMENTAI" P?O'I ~CTiON'  825 L Street- Anchorage, Alaska 99501 ENVl RONMENTAL SANITATION DIVISION ~EOUEST FO~ APPROVAL OF INDIVIDUAL WATE~ AND SEWE~ FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. P~OPE~TY Q~NE~ PHONE MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE ~:'~ ~) ~ PHONE 2, BUYER MAILINGADDBESS 3. LENDING INSTITUTION . PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION .~-/R LET LOCATI ON ! 6, 'TYPE OF RESIDENCE ~ SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER SUPPLY INDIVIDUAL* COMMUNIffY [] PUBLIC UTILITY NUMBER OF~BEDROOMS [] One E~] Four [~] Other~ [] Two [] Five ~ Three [] Six * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM iNDiViDUAL/ON.SiTE.~ [] PUBLIC UTILITY /~'/g"C(~7 YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-O10 (Rev. 6/79) '~ l -~.~.~ THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ~] SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OFBEDROOMS ~] ONE [] THREE [] FIVE [] TWO [] FOUR [] SiX [] OTHER 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3, SEWAGE DISPOSAL SYSTEM ~INDIVIDUAL/ON -SITE F~ PUBLIC UTILITY Connection Verified []Septic Tank or ~HoldingTank Size: /~.,..'. .... If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line PERMIT NUMBER DEPTR OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING MANUFACTURER MATERIAL Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line 5. COMMENTS b-~"~,PP ROV ED FOR ',~ . BEDROOMS CONDITIONAL APPROVAL (letter must accomP/~y c~rtificate) DISAPPROVED ," DATE 72-010 (Rev. 6/79) 825 "L" STREET ANCHORAGE, AI._ASKA 99501 (907) 264-4111 GEORGE M, SULLIVAN, MAYOR DEPARTMENTOF IIEALTH AND ENVIRONMENTAL PRO"E'ECTION November 14,. 1980 Luther C. Dancer 411 East 45th Avenue Anchorage, Alaska 99503 Subject: Lot 36 Block 3 Earl Ray Subdivision Approval for your individual sewer and water facilities cannot be granted until the following items have been completed: ~x) ( ) ( ) A well log submitted to this department for our review. The top of the well casing sealed with a sanitary seal so that it is water tight. The depression or pit around the well casing needs to be filled with impervious type soil so that it slopes away from the well casing. The well casing extended twelve(12) inches above ground level. The water facilities were not turned on at the time of the inspection. Please call this department to reschedule an appointment for the water sample. ( ) ( ) ( ) The water analysis report be delivered to this office from Chem Lab, 5633 B Street, for our review. Expose the well for our inspection to determine proper construction, also to insure minimum distance requirements are met between your well and sewer system. The septic tank pumped with a receipt submitted to this department. Luther C. Dancer November 14, 1980 Page Two ( ) ( ) The septic tank pumped with a receipt submitted to this deparment. The total nuimber of gallons pumped need to be on the receipt to verify the size of the tank. This will need to be verified by a registered engineer prior to submittal. Expose the septic tank manhole to verify its existance. This will need to be reinspected by this department~ Locate and expose the standpipe to the seepage pit for our inspection. This is to insure the minimum distance requirements are met between your well and sewer system. A four'(4) inch cast iron cleanout needs to be installed to the septic tank and/or leaching area. An adequacy test be performed on the existing leaching area. This test will determine if the system is adequate according to Naqionat Standards. A listing of private fiz~s performing the test is enclosed. This report needs to be submitted to this department for our review. ( ) Your permit for the installation of an on-site sewer system has expired as of December 31~ 19 We have not received the as-builts of the installation in this office. If a private engineer inspected the system~ please send us the report for our files and review. ( ) Your application shows the number of bedrooms exceeds the number the sewer system was originally designed for. An upgrade will be required° Prior to any upgrade~ a permit needs to be issued from this department. Please notify this department for a reinspection when the noted descrepancies have been corrected~ If there are any further questions, please call this department at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: Lomas and Nettleton 4449 Business Park Boulevard 99503