HomeMy WebLinkAboutEKLUND #1 BLK 3 LT 4Eklund #1
Block 3
Lot 4
#050-531-20
MAY 1 2 qn?i
Municipality of Anchorage
On -Site Water and Wastewater Section ° (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP201123 PID Number: 050-531-20
Dwelling: ❑® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New Upgrade
Name
Peter Drees
A ORPTION FIELD
❑ De Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
4384 Lower Kogru Dr Eagle River
Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
2
/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original gi de
F.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
Eklund #1 3 4
Fill added above original grade
Ft.
Gr 711th
Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Dist ce between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between ches
From
Tank
Field
Tank
Line
Ft2
Ft.
Well>
100'
NA
NA
NA
> 100'
TANK XSeptic ElS.T.E.P. El Holding El Other
Manufacturer
Greer
Capacity
1000 Gal.
Surface Water
> 100'
NA
NA
NA
Material
pastiC
Number of compartments
2
Lot Line
> 10'
NA
NA
NA
NA
Foundation
> 10'
NA
NA
NA
LIF TATION
Manufacturer
Capacity
Gal.
Remarks
Alarm location
Electnc ailed by
PIPE MATERIAL House to tank 3034 Tank to
drainfield 3034
Installer
CMM
Drainfield CO/MT 3034
Inspector Curtis Townsend
BENCH MARK (Assumed elevation) 100 ft
Inspdection 1�1 6/11/2020 6/12/2020
Location and description
2nd
3,' 5/5/21 4111
siding at point A
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval: Date
ii��
OF A
��
�•°°ON'°°°ppppjpe.00000 e
00000000.00
CTo r� Z,
�- °
QFC • • h6o. � 119 •'��`�
Septic System (�°ems°
Approved Date Ofglao)(
.
1ki, PROFESS) �
Note: this approval does not include well permit requirements.
�@,�-��.�,-ate
(Rev 05/02/18) S u1UJi u{ + Ire ' OY Ct CC C J 1 V�p 5� lei I Y Z5 V 6 ;,;,QA % y, p
Se�A�Q -%�a-b10 UIBJ
10,-� -L0 r\,D+ L" 0-n 'p—� uvu,"f y c7
UNDEVELOPED LAND TO
NEIGHBORING SEPTICTHE NORTHEAST X
IS > 10' FROM /
PROPERTY LINE
\ �sF
n l'
T d \
100' ^�
CABIN / `\ARAGE�
DOUBLE CL OUT \� \
1000 GAL SEPTIC TANK.
TANK IS OUTSIDE WELL
RADIUS. TANK MAINTAINS
MINIMUM 5' DISTANCE FROM
DECK SUPPORTS. / \ \ \ \
OFO- HOME \ \ \ \
DOUBLE CLEANOUT NKAT
35% SLOPE/
EXISTING 56' x 60" x 36"-
EFFECTIVE DEPTH TRENCH
UNDEVELOPED LAND TO
THE WEST AND SOUTH
5% SLOP� /
j'X
UNDEVELOPED LAND
SCOPE OF WORK
1. REMOVED EXISTING SEPTIC TANK.
2. PLACED NEW 1,000 GALLON SEPTIC TANK
AND TIED INTO EXISTING ABSORPTION
SYSTEM. THE TANK WAS PROVIDED WITH A
MINIMUM 20" 0 MANWAY RISER SERVING
THE FIRST COMPARTMENT.
3. ALL CONSTRUCTION WAS IN ACCORDANCE
WITH ALL REQUIREMENTS SPECIFIED IN
ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65.
Septic Tank Record Drawing Prepared for �YAto
PETER DREES®.P....""""
4384 Lower Kogru Drive Eagle River, Alaska 99577
n 49TH
EKLUND #1 BLOCK 3 LOT 4 , { ;:
OSP201123 ........... "�
0............`...�......................... jo
DATE. 5/7/2021 -A-' URTIS TOrVNSEND;'
EKLUTI�A ENGINEERING, SLC ®®� : No. GE WNS
'19162 MOUNTAIN ROAD DRAWN: CLT 0 � ''. 5 ( �
CHUGIAK, ALASKA 99567 SCALE: 1" = 40' 4' �
(907) 406-1058®®®®®®
PID: 050-531-20 SHEET 2 OF 3
MARK
A
B
DC011DCO2
11'-10"
15'-2"
SVl
13'-6"
17'-8"
SV2
16'-11 "
22'-1 "
DCOJIDC04
17'-11"
24'-0"
OQ w J o
SOU O QD 14-0
BM IS BOTTOM OF SIDING AT POINT A, ASSUME 100' ELEVATION
EXISTING 56' x 60" x 36"
EFFECTIVE DEPTH TRENCH
Septic Tank Record Drawing Prepared for
PETER DREES
4384 Lower Kogru Drive Eagle River, Alaska 99577
EKLUND #1 BLOCK 3 LOT 4
OSP201123
EKLUTNA ENGINEERING, LLC DATE: 5/7/2021
19162 MOUNTAIN ROAD DRAWN: CLT
CHUGIAK, ALASKA 99567 SCALE: 1 1/2" = 12'
(907) 406-1058
PID: 050-531-20 SHEET 3 OF 3
Till 4®®
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MUNICIPALITY OF ANCHORAGE
C
t
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTICMELL PERMIT APPLICATION
Parcel I.D. 050-531-20
Property owner(s) PETER DREES
Mailing address 4384. Lower Kogru Drive
Day phone 907.529.8672
Eagle River AK 99577
Site address 4384 Lower Kogru Drive Eagle River AK 99577
Legal description (Sub'd., Block & Lot) EKCUND #1 BLOCK 3 LOT 4
Legal description (Township, Range & Section).
Lot Size 56,799 Sq. Ft. Number of Bedrooms �3
APPLICATION IS FOR:
(N all that apply)
Absorption Field ❑
Septic Tank
❑
Holding Tank
❑
Privy
❑,
Private Well
❑
Water Storage
❑
APPLICATION IS AN:
Initial
❑
Upgrade
0
Renewal
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
TYPE,OF DWELLING:
r
Single Fa (SF) 0
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 Mtxticipal Codes.
Zo Z
(Signature o pr perty owner or authorized 'agent /
Permit/Rush Fees: I dog -7,5- Waiver Fees:
Date of Payment: 5/!4 126,2() Date of Payment:
Receipt Number'. 65023D Receipt Number'
Permit No. 6 5 1 9 0 1123 Waiver No.
GADevelopment Services\Building SaferyAOn Site Water and WastewatefformsUlent FormsTemiitApplication.doc
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201123, Deb Wockenfuss, 05/26/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201123, Deb Wockenfuss, 05/26/20
® DOC CO dba
BILL 8c COLE
ULLIVAN WATER WELLS
lf—IF
P.O. Box 670269, Chugiak, AK 99567 688-2759
www.suilivanwaterwells.com
Well Drilling Permit Number: SW Date of Issue
Parcel Identification Number: 050— 53 ,
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
MUNICIPALITY OF ANCHORAGE
w 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
NAME
T
PHONEV9
NEW
❑ UPGRADE
MAI LING ADDRESS
LEGAL DE CRIPTION
LOCATION
ai4 f'N oe� f�9 UE f�lEN/
NO. OF BEDROOMS
L) Y
DISTANCE TO:
Well
p®
Absorption area
/
Dwelling / /
1
PERMIT NO
pry.
0
a2
Lu
Manufacturer
R'6'cil�
Material �-�^E,
SCC
No. of compartments
L
Liq. capacity in gallons
/000
1 IF HOMEMADE:
Inside length
Width
Liquid depth
xDISTANCE
TO:
Well
Dwelling
PERMIT NO.
Manufacturer
Material
Liquid capacity in gallons
0
J =
W71
DISTANCE TO:
Well j
/�°� •�
Foundation ,
•
Nearest lot lin
/ems,
PERMIT NO.�j+
Cl
Lu U. Z
F Z w
No. of lines/
Length of eachline/
Total length of linen
56
Trench width
&C inches
Distance between Hes
¢ F
0
Top of tile to finish grade y2 t
J
Material beneath tile
inches
Total effective absorption area
co
w
Length
Width
Depth
PERMIT NO..
Type of crib
Crib diameter
Crib depth
Total effective absorption area
w•�-
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
Lu
Class �I vq/�
Depth /�/
Driller `ri
Distance to lotli/ne
//� J /
PERMIT NO.81520191
GC
DISTANCE TO:
Building found�ip�
Sewer line )
/
Septic tank loo
Absorption��s)
OTHER 41AC qyY e,
PIPE MATERIALS
A /ice C>3
SOI L TEST RATI NG
/ g `—
INSTALLER +
E'
REMARKS
GRAIlZ ,TT
ro
�A(
e
PROVED /
Y
DATE LEGAL
����
by
DOC Co. aba
SULLIVAN WATER WELLS
P.O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759
OWNER OF LAND.f
ADDRESS :. t s ' < a :;,1,4 A-
LEGAL DESCRIPTION
DATE, - Started �+ � .2 J 6I .a Ended
PERMIT NUMBER
DEPTH OF WELL
r
STATIC LEVEL OF WATER FT.
DRAW DOWN FT.
GALS. PER HR 'qd o
KIND OF CASING (A c
KIND OF FORMATION:
Ft. to
Ft.
From
Ft. to
Ft.
From
ter
Ft. tFt.
Gt.Frr fat
��" `�
From
Ft. to
Ft._
From
..1
Ft. to Ft.
S14 f Y
i� f 44'Fµ''
From
Ft. to -
Ft.:
From
Ft. to Ft.
-'
From
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FromA
Ft. to ;' Ft.
",Of A
X'4 Id
From
Ft. to-Ft-
oFt-From
From
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nae?
5, tic
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F
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to
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-
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to
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Ft.
MISCL. INFORMATION:
DRILLER'S NAME _
THE I R.ED " ZE CjF THE 51" L. ABS OF.,F,TION S TE -P-1 I S
F*-",, 'T- 9-111 9..... E-�, P. -A C— "I II -A -41- -4. tf71F--P' F-'! %/ EA-_ V1
1. 1
TFIE LENLYTH DIMENSIO11-j T, ""�A 11
'FHE L.EI9G*TFi f.'IN Ff-.E-r) OF- 'THE TRIEr-40-1 OR CjI I -4F I ELD.
T? -IE. DEPTH OF' A TREPICH OR PIT IS TFIE DI.,.--,'TANCE BIE114EE: N THE SURF!"ICE OF, THE
GIRC)UND AND T'I--!E 80117011 OF 'THF.E., EXCFNATIOhI (IN F'EET).
iE —F 1;--" E-- r-4 ll ' H 11.4 1 V 1-4 1 Cl &—:;) ff.D F— E: r = "'T-..
'T €E GRAVEL DEPTH 'THE NJININUM DEPTH OF* QRA',:'EL BET!,.IEFN T'Hf,..K (:)U'TF-FlU F--, pE
FINC, THE BOTTOM OP' "ll"FIE E:;-,CFjVA'TIOt.,I r.."IN FEET"j.
F`E'C."!LJ 1F -!.EX> E'. IF=o V *1 C -I- 1::l r-4 Ve,-
.1 . L
JG "',"HE
PEF�.'Nlf APPLICAPIT HAS 'THE TO INFC�IRM THIS DEPFIF`---
IP-,I1-','TAI-LATIw-,i II`-JSPEC-TION..:, OF Ar -4Y WELLS ADJACEY-AT TO 'THIS PROPE!,.;
OF RES.IDENCES THAT THE WfE[ L 1.41L.L., SERIvIE.
BACKFILLING OF- ANY SYSTEM WITHOUT FINA[ INSPEC"IrlOrl AND APPRC%,4.-
DEPAP',--'TIvIEj,-JT F:.?:ELLBE sue-JECT TO PROSECLIT' ION.
0111.'N TteUy.l [)TS'f'j:'-'jr�jCE BETI-4ED-4 A WELL W -4D ANY SEWACiE DISPOSF-L SYSTETI IS
.L. J. 4:.-
1.00 FEET FOR A PRIVATE WIF."'LL OR :150 TO 200 FEET FRf ire! A F,l 1 E.1, I It," 14IEE-N—L. DEPENC.sING
CW PUBLIC lb-IEL.L..
JPO? -4 'THE TYPEE I
IDIS*T'FfN(":r--':' FROMI A PR I VATE WEL.A... 'TO A PRIVA"TE S-1—WER LINE.:" "P-5 Z11 FEE -IT
.1 = -
'TO A C:OI`eINUI`-,IIT-r' SEWER i Il%,IE
WELLL.OGS ARE F-EEC)LURED APID MIUST EtEE: RETUR14ED TO TI--lE Df".F,AR-IMEI%I'T b -1:1: T? --`:O DFIW"'
OF' THE kIELL
.- : I. PE"IFICATIONS AND DIAGRAMS ARE
()THER REC!U' RlEr-10-,ITS MAY A F-1. T.
"N.) PROPER IN.S-TALLATION.
l F,? EE- F 0
CERT'IF*l? THA'!
1: 1 AM F'At--lIL..J:PR THE F'O)'T: ON--S.I.TE Wl:':R�-- Al'41) WE! LS AS '_"ET
F'ORTFIH BY THE NUP-41C.:IPAL IT,. -I OF' A0-,ICHORFilGE,
r_j,_ C -- 1 1.1 -, 1- .:U,
2: 1 WILL- ll` -1 -:TALL THE SYSTEM IN FiCU ' iFDAWP' i., TH THF..- C -CF—""
1) - .: THAT
3 T ,IatTE 'S-Y,:-�TEM MAI -1 REOLJIFE EINLARGUIENT IF:. -11"
N —E.'.".'-,'IDEhICE IS RE11101.)EL-Ell") TO IhIC1. E MORE THAP4
I , UD . 11) 1
Fr 1.N
4--irl
IS�..UED B' DATE
325 'L--"
(DIE...._ T1 Cit.,!
STRE [::-r.,
Fil�-JCHORAGE,.,
19K.. 9 5�: 1.
F.+..0 F -E. L.. !I Fl Ir --J CA
CH P -A
1 _1...F -z-
".-S, E- gt I E: IE °;` F:: E -..-- F
PERMIT
820:171
v
APF,l ICANT
-301-Irl H01SKI W.,
pr X
L OC
.'ATT
J.—Ecif"L. 1-4
83 EKLUND
`-i7QJFiRE FEET
P" F,E OF' SOIL
ABSORPJ'IOP-J SYSTEM
IS: FDRATNFIELD
11W-'�'.[ MIUMI NUMBER ("IF. BEJ)RllDCJrlS =-
":
I r SIG .-TR)::;;;
SOIL. F-,A-rirli3
:LZ::
THE I R.ED " ZE CjF THE 51" L. ABS OF.,F,TION S TE -P-1 I S
F*-",, 'T- 9-111 9..... E-�, P. -A C— "I II -A -41- -4. tf71F--P' F-'! %/ EA-_ V1
1. 1
TFIE LENLYTH DIMENSIO11-j T, ""�A 11
'FHE L.EI9G*TFi f.'IN Ff-.E-r) OF- 'THE TRIEr-40-1 OR CjI I -4F I ELD.
T? -IE. DEPTH OF' A TREPICH OR PIT IS TFIE DI.,.--,'TANCE BIE114EE: N THE SURF!"ICE OF, THE
GIRC)UND AND T'I--!E 80117011 OF 'THF.E., EXCFNATIOhI (IN F'EET).
iE —F 1;--" E-- r-4 ll ' H 11.4 1 V 1-4 1 Cl &—:;) ff.D F— E: r = "'T-..
'T €E GRAVEL DEPTH 'THE NJININUM DEPTH OF* QRA',:'EL BET!,.IEFN T'Hf,..K (:)U'TF-FlU F--, pE
FINC, THE BOTTOM OP' "ll"FIE E:;-,CFjVA'TIOt.,I r.."IN FEET"j.
F`E'C."!LJ 1F -!.EX> E'. IF=o V *1 C -I- 1::l r-4 Ve,-
.1 . L
JG "',"HE
PEF�.'Nlf APPLICAPIT HAS 'THE TO INFC�IRM THIS DEPFIF`---
IP-,I1-','TAI-LATIw-,i II`-JSPEC-TION..:, OF Ar -4Y WELLS ADJACEY-AT TO 'THIS PROPE!,.;
OF RES.IDENCES THAT THE WfE[ L 1.41L.L., SERIvIE.
BACKFILLING OF- ANY SYSTEM WITHOUT FINA[ INSPEC"IrlOrl AND APPRC%,4.-
DEPAP',--'TIvIEj,-JT F:.?:ELLBE sue-JECT TO PROSECLIT' ION.
0111.'N TteUy.l [)TS'f'j:'-'jr�jCE BETI-4ED-4 A WELL W -4D ANY SEWACiE DISPOSF-L SYSTETI IS
.L. J. 4:.-
1.00 FEET FOR A PRIVATE WIF."'LL OR :150 TO 200 FEET FRf ire! A F,l 1 E.1, I It," 14IEE-N—L. DEPENC.sING
CW PUBLIC lb-IEL.L..
JPO? -4 'THE TYPEE I
IDIS*T'FfN(":r--':' FROMI A PR I VATE WEL.A... 'TO A PRIVA"TE S-1—WER LINE.:" "P-5 Z11 FEE -IT
.1 = -
'TO A C:OI`eINUI`-,IIT-r' SEWER i Il%,IE
WELLL.OGS ARE F-EEC)LURED APID MIUST EtEE: RETUR14ED TO TI--lE Df".F,AR-IMEI%I'T b -1:1: T? --`:O DFIW"'
OF' THE kIELL
.- : I. PE"IFICATIONS AND DIAGRAMS ARE
()THER REC!U' RlEr-10-,ITS MAY A F-1. T.
"N.) PROPER IN.S-TALLATION.
l F,? EE- F 0
CERT'IF*l? THA'!
1: 1 AM F'At--lIL..J:PR THE F'O)'T: ON--S.I.TE Wl:':R�-- Al'41) WE! LS AS '_"ET
F'ORTFIH BY THE NUP-41C.:IPAL IT,. -I OF' A0-,ICHORFilGE,
r_j,_ C -- 1 1.1 -, 1- .:U,
2: 1 WILL- ll` -1 -:TALL THE SYSTEM IN FiCU ' iFDAWP' i., TH THF..- C -CF—""
1) - .: THAT
3 T ,IatTE 'S-Y,:-�TEM MAI -1 REOLJIFE EINLARGUIENT IF:. -11"
N —E.'.".'-,'IDEhICE IS RE11101.)EL-Ell") TO IhIC1. E MORE THAP4
I , UD . 11) 1
Fr 1.N
4--irl
IS�..UED B' DATE
r
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
625 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FORj DU rG A('40/'L
EGAL DESCRIPTION' 61K.3
L
Date
Gross
Time
14-
4
Depth to
Water
Net
Drop
'lr
DEPTH
'
\MFEET1^
1
I
16-
16
to
Leroy
2
B8
-3
®�FESSOK ,
18
4-
i
20
54 5
�^
'
a
10 0 1"
11 WAS GROUND WATER
ENCOUNTERED?
12
IF YES, AT WHAT
13 Or A' DEPTH?
COMMENTS
PERFORMED BY: Oc'(5 t 'r I" (';)
72-008 (6/79)
SOI LS LOG
O PERCOLATION
TEST
DATE PERFORMED: /0
SITE PLAN
H
n,.
w2 R ing
Date
Gross
Time
14-
4
Depth to
Water
Net
Drop
'lr
15-
15
16-
16
Leroy
S•atl No. 2251 r •`,c>„,,
a
17
B8
®�FESSOK ,
18
19
20
COMMENTS
PERFORMED BY: Oc'(5 t 'r I" (';)
72-008 (6/79)
SOI LS LOG
O PERCOLATION
TEST
DATE PERFORMED: /0
SITE PLAN
H
n,.
w2 R ing
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
'lr
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN �•FT AND aY. FT;
CERTIFIED BY' —ice— DATE:/—q—
o
dd J
a I
`o T
Municipality of Anchorage � *�.
Development Services DepartmentBuilding Safety DivisionOn-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 050-531-20 COSA# 0SC•I'2 1133
Expiration Date: �/ 2
1. GENERAL INFORMATION
Complete legal description Lot 4. Bk 3. Eklund -i�F p
Location (site address) 4384 Lower Kogru Drive, Eagle River, Alaska 99577
Current Property owner(s)
Mailing address
Lending agency
Mailing address
& Onalee Gries Dayphone(907) 696-2118
4384 Lower Kogru Drive, Eagle River, Alaska 99577
Day phone
Real Estate Agent Owen Strong N Prudential Dayphone(907) 351-4368
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual On-site
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT 'OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
NameofFirm Pinard Engineering Phone(907) 357-3647
Address PO Box 871347 Wasilla, Alaska 99687
Engineer's Printed Name Paul E. Pinard, P.E.
`0004**VC-0 Bibi♦
Pau3 E. Pinard
5. DSD SIGNATURE
✓ Approved for �3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: _-Z Original Certificate Date: J� !Z
(Rev. 11105)
Municipality of Anchorage 4 °`
• Development Services Department °
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lot 4 Bk 3, Eklund Subd, Addn.#1 ParcelID050-531-20
A. WELL DATA
Well type Pv+
Date completed 12 20/82
Total depth 140 ft.
Date of test
Static water level
Well production
If A, B, or C provide PWSID #
Sanitary seal (Y/N) Y
Cased to 4D+ ft.
FROM WELL LOG
12/20/82
WATER SAMPLE RESULTS:
13 ft.
7
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 12+ in.
AT INSPECTION
4/18/12
16.8
ft.
9.p -m. 5.1 g.p.m.
Coliform —colonies/100 mL Nitrate Q__1_5_?mg/L
Arsenic: ND ug/L date of sample: /. /19/12
B. SEPTIC/HOLDING TANK DATA
Other bacteria o colonies/100 mL
Collected byPinard Engineering
Tank Type/Material Septic/Steel Date installed 5/83
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) NA
Date of pumping 8/24/11 Pumper JRs Pumping
C. ABSORPTION FIELD DATA
Date installed 5/83 Soil rating 9)e or ftZ/bdrm) 125 System type 5 Wide
Length 56 ft. Width 5 ft. Gravel below pipe 3 ft.
Total depth 6 ft. Eff. absorption areajI)p- ftZMonitoring tube Y Depression over field N
Date of adequacy test 4/18/12 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added920 gal. New depth 0 in.
Elapsed Time: 180 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) None Knots$ If yes, give date
D. LIFT STATION NA
Date installed
"Pump on" level at —in.
Datum
E. SEPARATION DISTANCES
Size in gallons
"Pump off" level at _in.
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 1001+
Absorption field on lot 1001+
Public sewer main NA
Sewer /septic service line 251+
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots 1001+
On adjacent lots 1001+
Public sewer manhole/cleanout NA
Holding tank 1001+
Animal containment areas 501+ Manure/animal excrete storage areas 100' +
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 10'+ Absorption field 5'+
Water main 251+ Water service line 101+ Surface water 100' +
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 101+ Building foundation 10'+ Water main 251+
Water Service line 10' + Surface water 100'+ Driveway, parking/vehicle storage 25' +
Curtain drain None Shown Wells on adjacent lots 100' +
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review, of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Paul E. Pinard, P. E.
Date 4/30/12
COSA Fee $ `"Ii L"1O
Date of Payment T /3o'�a,, 11 t✓k 14 c),-)-14
Receipt Number J5 aa0'1
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
in.
MUNICIPALITY OF ANCHORAGE
• '� DEPARTMENT OF HEALTH & HUMAN SERVICEStV'
Division of Environmental Services i��� � /��
On -Site Services Section `/r!'
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 050-531-20 HAA # I� /� C) 2%`/
-'. - I.
1. GENERAL INFORMATION
Lot 4j ,Block,.3,`.Eklund SID � 1
Complete legal description
Location (site address or directions)
4384 Lower Kogru
Property owner Jonh Hosking Day phone 694-7039
Mailing address Po Box 771665, Eagle River, AK 99577
Lending agency Day phone
Mailing address
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well xxx
Community well
Public water
Day phone
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site. XXX
Holding tank
Community on-site f
Public sewer.
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 N21
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 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 furtherverify 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 5 & 5 £Pi"?"IEERING Phone 6 `� ' �`�-7 `7
1703... averLoop
Road Nu -204
Address
Engineer's signature ?"X4/ C /," - � Date 3/q r ,� 9
6. DHHS SIGNATURE
�//Approved for __RLEL bedrooms.
Disapproved.
Conditional approval for
Additional Comments
By: C
rlr �• 9 ROBERT C. COWAN j �Q
1�1o�sf CE - 8801 •r���w�i
bedrooms, with the following stipulations:
Date -S./9,99-
The
`/9, /
The Municipality of 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's work.
72-028(Rm. 1/81) Back MOA a21
RECEIVED
Municipality.of Anchorage MAR 09 1999 ,
DEPARTMENT OF HEALTH & HUMAN SERVICiCIPALITYOFANCHO
Environmental Services Division ENVIRONMENTALSERVICEsD1
9
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
Health Authority Approval Checklist
Legal Description: LCL fib- 1 1-J�d� Ir� Parcel I.D.: 6)6-6�3/ �d
A. WELL DATAo
Well'type D Q WA4r.- If A, B, or C, attach ADEC letter. ADEC water system number
i
Log present 6/N) Date completed /d 1,?2
i
Total depth /`% 9 Cased to 7b Casing height (above ground) %
�I n {
Sanitary seal &N) —1-4- Wires properly protected ON)
FROM WELL LOG AT INSPECTION
Date of test 1 Z/sv 3,7 -99
Static water level
Well production 7,n g;p.m. 9•p•m-
WATER SAMPLE RESULTS:
Coliform Nitrate 0,a78 Other bacteria
Date of sample: a %g Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed -83 Tank size !ODl, Number of Compartments Cleanouts ON)
4—
Foundation cleanout (9/N) Depression (Y& n� High water alarm W4N)-
Date of Pumping a'i9 . Pumper -+e �ClGtip/�y
C. ABSORPTION FIELD DATA /n
Date `installed_ " S"-$0 Soil rating, (g.p.d./W or ft?/bdrm) YAs D�- System lype F�
Length Sb Width S Gravel thickness below pipe 3 Total depth
Effective absorption area 78zi Monitoring Tube present dw-4- Depression over field (Y60 �J
Date of adequacy test Results (Fail) For' bedrooms`
Fluid depth in absorption field before test (in.); Immediately afterr°2f gal. water added (in.): 6
Fluid depth 0 (ins) Minutes later: Absorption rate g.p.d.
Peroxide treatment (past 12 months) (YQ r) ° (/ JQc o.J If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
"Pump on" level at* _ "Pump off' level at*
*Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot 1 Da VIA� On adjacent lots
Absorption field on lot I u On adjacent lots 1 oo w
Public sewer main o— Public sewer manhole/cleanout
Sewer /septic service line ZS I k Lift station �I A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation ' + Property line 10 o4- Absorption field S t f
Water main/service line /o ' Surface water/drainage /°D t Wells on adjacent lots 106 l�
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line /o e P Building foundation lfl !� Water main/service line /6 r
t� -l—
Surface water /Q ° Driveway, parking/vehicle storage area
Curtain drain /� Wells on adjacent lots J.0 0 4-
F.
F. ENGINEER'S CERTIFICATION
,�yso^s--o.� r�tti
I certify that I have determined thru field inspections. and review of Municipal recorasa t h ba+�`�S ems are
in conformance with MO HAA g ' lin701zv
ffect on this date. ��rC ,• °`°' ' '�^;
Signature 9�.. •�
Engineer's Name Q,r3,e �� g ("
C oma. ;,.
t+ Zs RQBE'Rl` + ,
Date 3�`�Z%`� la��,: CE -
8801
Y
HAA Fee $ of D c Waiver Fee $ _
Date of Payment ! % / Date of Payment _
Receipt Number T 7 Receipt Number
72-026 (Rev. 3/96)*
- '
APPLI(-'NT FILLS OUT UPPER HACK ONLY
Property Owner6
y r�
Phone
Mailing Address
<^
Zip Code
TIM,
Buyer
Date
Date
Address G9
D
Zip Code
Lending Institution �-M6
Aq t'� y�
f�
Phone
Field Notes:.AU
Zip Code
n,C/51 -�'2/O
Address
DEPT. OF HEALTH &
H
ENVIRONMENTAL PROTECTION
W `
Realty Co. &Agent
Phone
Address
Zip Code
Legal Description
DATE
Street Location
,��'
Type of ence
Date Sewer Installed
Well To Absorption A
Family
Septic Tank Size
❑ Multiple Family No. of Bedrooms -
Well to Tank - b
El Other
Water S
ATTACH WELL LOG. A well log is required for atl wells drilled since June 1975.
ndividual
For wells drilled prior to that date, give well depth.(attach log.if-available).
❑ Community
❑ Public Utility
Sewer Di a
¢�
ndividual
Year Individual Installed:—
❑ Public Utility
When Connected to Public Utility:
❑ Holding Tank
NOTE: THE
INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
- n i
Vz,�iA.�
Time
Time
Time
TIM,
Date
Date
Date
D
Inspector
Inspector
Inspector
Inspector
� �.
Field Notes:.AU
MUNICIPALITY OFANCHORAGE
DEPT. OF HEALTH &
H
ENVIRONMENTAL PROTECTION
W `
() APPROVED BEDROOMS `CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
a
DATE
BY:
Soils Rating
Date Sewer Installed
Well To Absorption A
Well Log Received
Septic Tank Size
Well to Tank - b