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Home My WebLink AboutCLEARVIEW LT 15(Rev 05/02/18) Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP21110 PID Number: 015-242-54 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name TIMOTHY & DEBORAH MAUDSLEY ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 11620 SNOWLINE CIR ❑ other Phone Number of Bedrooms Soil Rating depth from original grade 5 1.2 GPD/SF JTotal 8.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.0 Ft. Gravel depth beneath pipe 5 Ft. Subdivision Block Lot CLEARVIEW LT 15 Fill added above original grade 1'+ Ft. Gravel length 13 Ft. Township Range Section Gravel width 2.0 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES Toy Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank I I Line 130 Ft2 Ft. Well } , 1 �� oor i 5Or + TANK I'] Septic ❑ S.T.E.P. E3 Holding El Other Manufacturer Capacity GREER TANK 1500 Gal. Surface Water + 10�, ,� ��r} ! Material PLASTIC Number of compartments 2 + Lot Line 10'+ 1 10'+ I NA Foundation j 10�+ 10�+ LIFT STATION Manufacturer Capacity Gal. Remarks Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 drainfield Tank to 3034 Installer MIKE N ANDERSON, P.E. Drainfield 3034 CO/MT3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 110.5 ft Inspection15' 5/14/21 5/14/21 Location and description ection 2 na GARAGE SLAB 3ttl 4` ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Ci' ski Conditional Approval: Date .r',+at. ,L�:•'' • �t'' `� u_�; J 8 Septic Syste MICHAEL N. ANDLRSGN w 5 ZSR � ( . CE 9 69 r� Approv ( Date ,��Z7 71. Note: this approval does not include well permit requirements. (Rev 05/02/18) Permit No. OSP211110 Page 2 of 2 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: CLEARVIEW LT 15 PID No.: 015-242-54 MARK A B FCO TC01 33 40 TCO2 40 43 C01 41 44 CO2 42 45 CO3 58110 MT 40 99 CO3- / SMT l Ili V° I SCALE: '"T'\ e® �F q ®® ArAV La AV ......µ ..M.. i....f..........0- :MICHAEL N. ANDERSON. -_L No. CE 94(50 L m MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Eimore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211120 Work Type: Septic Upgrade Tax Code Number: 01524254000 Site Legal Address: CLEARVIEW LT 15 G:2740 Site Mailing Address: 11620 SNOWLINE CIR, Anchorage Owner: MAUDSLEY TIMOTHY B & DEBORAH S Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sol Ft: Total Bedrooms: nlenr a r� v. opal-ClttenT 5/11/2021 5111/2022 58834 Q 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 15.55. 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 Received By: Date: Issued By: 1p Date: MUNICIPALITY F ANCHORAGE Development Services Department fes,, 3 Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I. D. 015-242-54 Property owner(s) TIM & DEB MAUDSLEY Mailing address 11620 SNOWLINE CIR, ANCH AK Site address SAME Day phone Legal description (Sub'd., Block & Lot) CLEARVIEW LT 15 Legal description (Township, Range & Section) Lot Size 58,834 Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: (® all that apply) Absorption Field x❑ Septic Tank 0 Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: TYPE OF DWELLING: Initial ❑ Single Family (SF) Q Upgrade (w/wo ADU) � Duplex (D) ❑ Renewal ❑ Multiple Dwellings ❑ (SF and/or D) 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. (Signature of property owner or authorized agent) Permit/Rush Fees: 4 59 5 + � 35'l �ILaiver Fees: _ Date of Payment: 14 -2-q "2-( 5 X7121 Date of Payment: Receipt Number: ()2q1;_76( 011 GGVI Receipt Number: Permit No. 0S 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 OSP211120, Rebecca Carroll, 05111/2 May 8, 2021 Municipalities of Anchorage On -Site Water and Waste Water Section 4700 Elmore Rd Anchorage, Alaska Phone 343-7904 Re: Septic Permit Legal: CLEARVIEW LT 15 To Whom it may concern: This is a request for a new 5 bedroom septic permit upgrade on the above referenced lot. The current system is a 4 -bedroom system and is functioning well but the new owner wants a 5 -bedroom system. The existing 4 -bedroom system was tested and found to be in very good condition, with no measured effluent in the system after flooding the system with 600 gallons. We are proposing to extend the existing field 13 feet to the north (see the site plan) for the additional area required for the 5 -bedroom requirement. From the test hole #1 data the soils appear to be excellent with no water observed at 14 feet. The new 1500 gallon plastic tank will also be replaced at this time. This new system will not impact any of the surrounding neighbors. Sincerely Z�; Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 On-site Water and Wastewater DESIGN CRITERIA: , RE &GMBRVWwua o (TH#1) _ OS 19120, Rebecca Caa'oll, 05 1 BDRM X 150 = 150 GPD 1.0 ORG 1 SOILS = 150/1.2 = 125 GPD 2.0 SILT FILTER FABRIC _ 125 GA/10 - 13' -3.0t4"O PIPE (1)TRENCH EWER ROCK 8.0' DEEP sM 5.0' EFFECTIVE -8.0 2.0' WIDE 12 p 13' LONG 14 SEPTIC FIELD SECTION e ® ® �s 1 J P H Q ' 3 W S I /® /-FROSTLINE GT- I— I I I ` PROPERTY LINE I v EXISTING SEPTIC Sour F� 4 EXISTING HOUSE i I a I i I EXISTING WELL 100' RADIUS \ e e e \ Septic Design Prepared for 0 TIMOTHY & DEBORAH MAUDSLEY CLEARVIEW, LOT 15 AV ® :• ®®� Anchorage, Alaska of 49 TH .....:.........................:....® ® Michael er DATE: �. :MICHAEL N. ANDERSON; No 5/2/2021 ® 4601 NATRONA AVE DRAWN: ®G� DJR ®®®®�.4 E21469 ANCHORAGE, ALASKA 99516 SCALE: 1 "=200' ®®�4 (907) 727-8864 /FAX: (907) 345-1391 I ®\® ®®® siter and Wastew< / CLARVIEW \ �/ 1 oT 1 s \ D FOR CODE CCS PROPERTY LINE � r 19120, Rebecca Carroll, CLEARVIEW LOT 17w�MT-� -- ,n 1 ! f _-- - CLEARVIEW RESERVE AREA,\ ��Oe —� J E�)STING �' LOT 12 25X2X5, APPL i �� i HO SE RATE 3 GPD/SQ �i ! ! CLASS IISYSTEM, � �, Co \ / EXISTING �DOC `I � v/ � \\ DRAINAGE FIELD NEW 1500 GALLON l i PLASTIC TANK W/ 20" RISER ZO 1 L1vO WELL \�c� \ �\ �LU \ Obi I 2' CONTOURS TYP. 1 \ 1 L RVIE t // ® APPROX. 15 j NO UNE CIRCLE- CLOSEST IRCLE- CLOSESTSECTION� i OF CREEK TO THE i NEW TANK > THAN`T�� 100' \ II\ CLEARVIEW LOT 14 / G� � EXISTING WELL 100' RADIUS PROPERTY LINE —� ~ Septic Design Prepared for®®®®®®®® TIMOTHY & DEBORAH MAUDSLEY ®®®�P�� OF CLEARVIEW, LOT 15 ® �L 49 TH •' ®� Anchorage, Alaska®.....::........................::.....� O 0 Anderson,�.� ;MICHAEL N. ANDERSON:' Michael ®®® DATE: 5/2/2021 No. CE 9469Aw 4601 NATRONA AVE DRAWN: DJR ANCHORAGE, ALASKA 99516 (907) 727-8864 / FAX: (907) 345-1391 SCALE: 1 "=50' Municipality of Anchorage Page I of 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: PID Number: Name: ,'~bl~..~. 'lccvv~-~. Wastewater System: ~ New ~ Upgrade Address: ~~ ~~ ~ ~ff~ ABSORPTION FIELD Phone: ~No. of Bedrooms: ~Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other LEGAL DESCRIPTION so, Rating: Total Depth from original grade: J,~ GPD/Sq. Ft. Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe ~oT I~- - ~~[~ ~ ~t. ~ ~. Township:~~ Rang~ ~]~ Section:~~ Fill added above originalj ~ grade:~ Ft. Gravel length: ~ ~ Ft. ~,~'ew D Upgrade Gravel ~: ~¢~ Number of lines:,IDistance ~tw~n lines: WELL: ~ Ft. I I ~ Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Date~rilled: Static Water Level: Installer: Date in~talled:. Driller: H--~ ~/~/~ Yield: Pump Set at: ] ~sing Height Above Ground: TANK ~ GPM ~. ~ Ft.I ~ Ft. SEPARATION DISTANCES ~eptic ~ Holding ~ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank SewerLines ~. ~ ~ ~ O Material: Number of Compa~ments: Surface ~ 130 - -- - LIFT STATION Water Lot Size in gallons: ~ Manufacturer: Line ~O ~0 ~ ~ I Foundation J ~ ~ ~ ~ "Pump on" level at: "Pump off" level at: High water alarm at: Cu~ain ~ ~ ~ ~ Pump Make & Model ~ Electrical Inspections pedormed by: Drain I Remarks: BENCH MARK Location and Description: I Assumed Elevation: ENGI~'6 Inspections performed by: ~ Dates: 1st 8~./f ~ k~~~ .... ' '~ ...... " ' (. ~*.~ , .-- Department of Health and Human Services approval ~,:,.~ %.,.. ~ev,owodandapprovod~y: .~~ ~~ Date: ~~ 72-013 (1/91) MOA 25 i / ~~r~ot· ~1 I 25 0 25 50 75 100 125 150 SCALD I' = 50 FE TB~EN SPURKLAND P,E, LOK I% CLE~NVIEV S/~ ~ sEP~Ic srs~ ~s~UILl eoa w ~TU, ~VE~U~ ANCH, AK, 99501 SEC 24, TI2N R2~ D~TD AUG, 28 1992 (~nT~ p7~-~mq JAMES A~LES SHEET, 2/~ GRID, 2740 Moni tor Stondord Trench 3' Wide 50' Long lO' Deep 5' Sewer rock 3' Cover NO SCALE Cleon Out 140 ~ 5 £t o£ Septic Rock TOBBEN SPURKLAND P,E, 803 W15th Ave Anchorcge Ak 99501 -~]iCleon guf O0 0 0 0 I250 gol Septic tank //Cleonoufs --~ Monitor ~ 8.5,7 __/ 1250 gal septic tank NO SCALE 3OTTOM OF TESTHOLE ELEV, 69,0 TOM GARAGE FLOOR SLA3B ASSUMED ELEV, 100,00 LO[ 15 CLEAI VIEk/ SECTION 24 TI£N R3~/ JAMES ,4£LES SEPTIC SYSTEM ASBUILT DATE, AUG 2g i992 SHEET, 3/3 GRID, 2740 IlVl-I'y I~rlll=Llrl~t iflC. P.O. t~ox 110378 · 10330 Old Seward Highway (907) 349.8535 ANCHORAGE, ALASKA 99511 DRILLING, LOG Well Owner.. Jim Ables · Use ofWel! Domest±c Location (address of: Township, Range, Section, if known; or distance main road Lot 15 Clearview Subdivfsion Size of castn~._~J~__Depth of Hole Static water level ~ ft. t~ ~creen ( ); Perforated ( Describe screen or perforatiov 50 feet Cased to 50 feet ~below) land surface. Finish of well (check one) NONE Well pumping test aL3~ galli~hs peJ~ o! drawdown from static level. Date of completion Depth in fe;~ fr-om ............ ground surface 0 TO__2____ 2 TO 8 25 .... 25 .... TO 38 38' TO 42 42 TO 55 55__TO 77 77 TO - (minute) for---~----_hour~ with 100% Note: Well Dzj Grouted WELL LOG Give ddiatIs of formations penetrated, size of material, color and hardnes~ open end ( X ); Bedrock TO, .TO --.TO ... :USTOMER PAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW920154 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:ABLES JAMES T & CINDY K OWNER ADDRESS:3529 W. FORTYSECOND AVE. APT. A ANCHORAGE, AK 99517 1 OF DATE ISSUED: 6/25/92 EXPIRATION DATE: 6/25/93 PARCEL ID:01524254 LEGAL DESCRIPTION: CLEARVIEW LT 15 1 LOT SIZE: 58834 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD / 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 (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: DATE: DATE: LOT 205W15th. Avenue, Suite206 ANCHORAGE, ALASKA 99501 (907) ~,9 Jlo SEPTIC SYSTEM DESIGN 15 CLEARVIEW S/D JAMES ABLE$ No Gr-ound Water- c)r- Imper"vious I...ayer' to 14 ft. Use Standar-d TF'eI"IEH F;:equired Area per" Bedr"oom: 1",){.t f~) b e r" 0 f ~'~': f:.:-? d r' (:3 0 i'fl 4 L..er'~(;}!th c::,.f Tr"er"~ch 4 ).~' 1.25 /1() := 5() SYSTEM CDNF 1' GURAT I DN STANDARD TRENCH TOTAL LEN6TH TOTAL WIDTH TOTAL DEPTH ROCK DEPTH COVER SEPTIC TANK 50 FT. 3 FT. B FT. 5 FT. 3 FT. 1250 GAL. The in~i.'t:a].lat:Lon (::,f thi?; we].], and seF.,t:Lc system v-~ill not impact a(::ljac:(;:~r'~t ]. o't'.s,, "Fha:, ~,~t,:~.:,:L ] 1 ocat fi. c:)n (::: c:,rm~ ~ or ms 't:o 't.'.he si ti. nD of t'.l-~E, e::-~ :t ~.t::i. ~")c~ c,.~el :t s i r': the a.r"ea. ~ ~tznd ~.,Ji t 1 not !:::,r-e,,,er-~t the a.d 'j a(:(~nt :Lot (:::,~.Jr']er s fi: r'gm dE?vel, op:i. r"~(}] these:, ]. (::)t s (::)r" F'ep]. ac:: :~. "~(}..I thE, ex i s'[: ing Th,:..:.:, l::)r"op :.',~.;~:?':I SE, pt i (::: ~:;',.,,~F.'(:erJ'm :i. s ]. oc::a'i:.E,d r;'](:::,r'~.-:' '[:l"','ar'~ ]. C,O f ~:.:,E~". f rmom thE, ,::::r"(~,el.:: (::,n !:.h~::, '.-.'K),,.~'i::I'] west f:),:::)~"-'i:'[(::)r'~ (:)f the loi:.. ]--Ir''l~.{':' pr"(:)t::)(::.':~i~ed !~;E'p'L:i. (::: sy'.-?E:(~,m w:i. 1 i not c:l"',ange 'Lhe gE, r'~E, ral .:_:~). c:,pE, i:he areF~.. J::'OFidiFIg a.. r~ (::l /' (::) r" cc:,rl(:F?r')tl".:t.it'.i (In r"~?su], t fr-(::)m thi s :i. r',,stal 1 ,~'i:.:i. ~:::,~'~. p q ,, 1 LOF I4 '- 50 0 50 I00 150 ~0~ ~50 SOO _-- SCALE: 1' = 100 FE TU39EN SPURKLAN3 P,E, LOT 15 CLEARVIE~ S/B SEPTIC SYSTE. 3ESIGN ~03 ~ ~5TH, AVENUE 3ATE, JUNE 2~ ANCH, AK, 9950~ ~EC ~4, r]~N ~3~ (~7) ~79-39~6 JANE~ A~LE~ SHEET, 1/3 GR]3, ~740 ' i ~ ~ 4-BEIRBDM DWELLING, o__/-% / x 'V: ,,:'~ ~ ~ '.:..'...'...'. -, :', ...:::. / ,,;,., x I '~ '.%. ,:~ ..... . , ~" ~ SCAL& l' = 50 FE TO39EN SPURKLAND P.E. LQT 15 CLEARVIEW S/~ % SEPTIC SYSTEN ~03 ~ 1STH. AVENUE ANCN. AK. 9950t 2EC ~ TJ~N ~3V 9ATE, JUNE ~ (907) 879-39]6 JA~E~ A~LE~ SHEET, ~/3 GRI3, ~74~ Nonltor 3' 5(7' Long 5' Sewer rock 3' Cover I40 5 Pt o£ Septic Rock Cleon 1250 gel Septic tonk ND SCALE Cleonouts / 4' Topsoil Monitor Exist, Ground 4' Min Cover 1250 gol, septic tonk ND SCALE SPURKL~ND P,E, ~03 ~15th Ave Anchor,se ~k 99501 LOT i5 CLEA£VIE / SECTIDN 24 T12N £3~/ JAMES AJBLES SEPTIC SYSTEM DESIGN DATE, JUNE 2~ 19~2 SHEET, 3/3 GRID, 2740 Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST (ENGINEER'S SEAL) PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 DATE PERFORMED: ~'l 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Lo{: 15 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Township, Range, Section: T~.~ i~-~/t SLOPE SITE PLAN Depth Io Water Alter Monitoring? _'~ ~- ~/ ,~at ,/ ~.~ j.,~_~ Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE 1-~" (minutes/inch} PERC HOLE DIAMETER TEST RUN BETWEEN --~ FT AND ''~ Y~- FT COMMENTS ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST (ENGINEER'S SEAL) DATE PERFORMED: Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ~ ENCOUNTERED? ~ S L IF YES, AT WHAT O DEPTH? p E Depth to Water A,~,~..~ t~//~'/ Monitoring? Date: - Gross Net Depth to Net Reading Date Time Time Water Drop I 1 ~! ~1~ .~/,/ PERCOLATION RATE / -/..¢ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~' FT AND '~' 7~' FT COMMENTS PERFORMED BY: "~"~ f~ I '~ ,.f5 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. 72-008 (Rev. 4/85) CERTIFY ,'l-~d~T THIS TEST WAS PERFORMED In DATE: "[-~ ~"~ ~, ~ ~ ~ 20~ W15?H. AVE, SUITE 206 ANCHORAGE, ALASKA 99501 SPECIFICATIONS FOR SEPTIC SYSTEM INSTALLATION LOT 15 CLEARVIEW SEC 24 T12N RSW 1.O GENERAL .tr'~spect: th,:i.:~:, pr'oj((-?ct,, 't"h6~ Engineer rr[u~i', b(~.:., r"~?J:::c]gr'~:Lz~:~xl by '['.h~:;(, Muni c:i pal i ty o.f: Anchorage ~ :0epat"tf~x~.~r'~t o.~:: Hea:[ 'l:h anc:t I--Ju~'fwan S e r v :i. c: ¢ ~s, :i..::!!;Contractor :i.~. t:l'"~t? !:; ~.:~(- r" ~:s c, n cdr' ~.~:,nt:it'.¥ h:i.r't:x:l l::)y -l:,l-'~p. Owner t,'.:¢ i n'~;t-:~,]. ! th i ss proj ec'l.:. -Fh(.::¢ Contractor ¢'r~u¢:: [:,~? r'a:::o~gir"~ :i z ~.:x:i by the f"'i,,..ti"'~ i c i ,,c, ali t:y .of ,4ncl'x:¥a,;:]~:;, ,~ l)el::',ar't:me:rit. (::,-i: l--ha! t.l"~ arid H u. m a ri S ~'~ r v :i ,:::: (~:~..-:ii. ,, :[, 5 Al :t. fYia't:i:~,r':i, a:l. s~; ar".,d ~,x;,rl.::riiari?~-h:i. p .'.i~.hal :I. rr~eet', the reqLt:i. ,,'flel"it??, c)-t:: '(]h(-~:? MLtn:i. (::::i. pa;[ i ty c,f Ar'~cl'-,,orag(.:,~ ~, 0el:)ar'k:.¢ent of Heal th al"ic:t HLtrix~',r'l S.,.:.'~-r'v:i.c~,~;i;., '!'.'.f~.(~ c:~:::,r'~d:it:i.c)ris ,;:ff 't:.h~. pt:.:,ri'r~:i.t~ ar',,d a].]. api:3].icrai::::].e i'-LI].e'.(5 arid r~.?gu].at:ic~ns C: Ll l" l" l.:;-:' rl i: ]. y iri :I.. 6 Al ]. ~.~;.',,':::ava't:'.:i c:.,n r:l~:~,l.':J't:.,~"t:~ ,'..'.¢,~'-? adv:i, s~, t::) r" ";,,.-' ,~ ar'~r.:t ar'{~.~: 't:c) I:::,{~, vel'":i~::J.e,:J and ~'ray I::)~:(-:, fl'i(:x:Jii::iecJ J.r"~ the ~;:Le:i(:J by 't:h~:a Engineer. :L, '7 It :i.s t:he r~-:.:-:-'¥:,c~r"~¢.:Lt::,:il it'...,,.' of th~:...', Owner of '?.h~.::, Contractor · t:c., a,::.~her(.:e to::, '.h..he a,[:,pr-(.3vecJ c:te,:~.ign~ to ver"if¥ 'i:.l-~at the Sl:)ec:i .... f :i. E, cl ..-'~;[.?parat:i. c:,r'~ cii st:an[::i:.:,~; a.*"'~-:, m~:~:,t ,~ and t. hat ti"i~:-:~, rE, CfL'.:i. r',:.:-:.:,d ~,. I~ '-:~il::) CC: t :;~ ctr'i s al-'" £-? p E'K t(: c)r ffi(-.?d. ]. ,, ~:ii 'l'he::, Contractor o; Lf'-,,,,.:.:~, Owner ~Aa:l. :1. r'E, por"t'.', to thE, Engi- neer any E,l:::,~i~.~-,~" ,.,,{-:~-:,c:l cond:i, t:i. c~n wh:i. c:h ~,.x::)ul d put 'U.h~:;. ~[~-~t:::,'t:. i ~::: ~;;Y~,:;'~:'.(.;-:'¢[~ in v:i.c~la'b:[on cfi: 8'l:.a't:~:4, or Mun:i. cipa]. 2.0 SEPTIC TANK 2.:i I-i: t,her'(6~, :i.'.-.'ii. an e>.': i :.:.;;t: :[ ric_:I sept:i.(::: t:anl.::~ :i.t may be Lused if i t: mee'[:~, the capac:i .t::y r~:aqui rem(~:ent: for' the res:i, c!(.~n(::e,, 'T'he toni:: :~;t"iat :1. i::~:~ :i. r,~¥~t.x::t [-:<:I by the~e Engi neer ,, and :i. t.~ watiar' · t:ightness arid str'uctura~ int~:agr'ity sha~ I:,e yet'if led. 2, 2 A I'-'~e~,,~ :~i. el::)t:i .'::: tanl.:: :-::,hal 1 be c)r"~(.:~, fal:)ri c::at'.ect Anchorage Tank and Welding or' l:)y Greet Tank The sep'~::i.c: tank shal 1 I::,e a UF'C;.-apprc)ved t[,,J(:).....c:ompartment 't-.anl.::~ constructed of :!.2 gau(~]e~ c)r better~ si. eel w:i. th b:i. tu mastic: cc:~at:[ng,, ]"he tank shall t:)e se'L: level on undisturbed s c) :i. i . "l"h e '~" ' ,"' ~' ,... ..... :t,~-:. sha]. ]. be cove~' ed wi th the equ:i, va).ent ,"~.f ~:our · feet c:).l: s(:)il. · ~:: e e'?. 2,4 'l"l"~e seF:,t:}.c tank sha].l be a minimum o~: :1.()0 feet +rom any s~er'ving a single res:[dence; !0() .~eet ~r(:)m any body · Fee'[: .f:rom C].ass "C" wells, arid 200 'f:eet 't:r'om Class A C].ass B we].ls,, 2.5 Al. I p:i. pe c:l::,nnect i (:::,ns '~':.(::) '['.he:, tank shal 1 be mec:hani (:::al. v.~a'l.':.el'"t i gi"tt (::al. der C(::)L.',p 1 :i~ r-I{i~l...:e~,, Cji ear-~(::~uts shal 1 l:)e :[ r-i:sta]. 1 ecl as d(-:-s:i, gr'~ated and ',::apl::,ecl w:i. th a:i r-'.--t:i, ght rai n c:aps. C1 ean .... c:,ut:s shal ]. ;:.:-:.,xtencl a mini mum (3~: !2 .i r-i(::hes above '~::inal grour-~d el. eva',','/:i, c)n ,, Prc)v:i s:i. c)ns sha]. 1 be made f c)r 1 andsc:ap :i. ng and imp (::)r t a t :i (:)n :i. f t (:)p sc:) i 1., 2.,6 LiYt stat:i, on shall, be as rnar"~uYactur'ed by Anchorage Tank and Welding ABSORPTION FIELD :i. nc:h screened roc:k~ with less than 3% i:)ass:ing t..he No. 200 ~-"~f f ,:.:act ive gr"a:[ n si. z e l::,etween l',.lo. -'.-].C:, :-::.J. ,.'-:.)ye? at'-id !',~(], :[ [:~] ~,:[ eve. UnJ.-,-(::)r~'~/:i 'l:'.,? c::~ .(~:.,, ~ 1 (. [ (?:.:,r]t '.:.F,?,,~'..'~l 1 !]~.':.".. ]. (:':-:,si~.si~. tt'"~,~?~;'"~ .4, Not :~1 ~ ~. 1 [::, .......... 5% by we:i.c~,ht ........ ~ , ass the l'-.!c,,, 2c)("., , . , , [-~:) I I J F'81 (). F:.'or pr' es J.]:,, .3 -~:J---':i. n(::h r.:)er~(::)r~'~te(::l .r.)J. i::)(:-:i, sha]. ]. i")e ,~c ....... ;. ~/.LU""(.:a ,'::l:l.:.:.~tr:ihu'l"'[(:~l]~ ....... ,~:'~'[ ..... ,!:)e '.sha].i lie [~c:l']edL.',].e 40 F:~V(]: or ~ ......... Sol :i. ,:::i 4-:i. ncl'",, t::':i, pe shal I be E:asi:.t I ton ¢::,r" ASTM D3()34, 3. '::; Mort J. 'l.':.,::.~r s'l::ancil:) i !:)e'~:~ sha]. 1 be i ns':a] 1. ed as showr~, 'l"h at sc,,c::t:i. ~:)r'~ c,-{- the p:i. pe .t::)er'~etrat. i I"'~;t the gravel sba]. ]. be per,:c, ..... r"ated~ either by ,::JrJ. lling 0.5" ho].es c]r'~, 6-:i. nc:h (::er',,'~.:ers or by jc:,:i, n:i. r"~;:l ~::~ sec:~:'.i (:::,r'~ c)¥ F:' (~ii: :). C) i::,({{~,r Fc)r"a'~:ec:~ l:::,i 1 e ~,':.(::? a sc)]. :[ c:l s[~-:,cti (::)r'~ c:~'f: p i p ~:,. 3,, 6 ('}'e(::riz:(~::;::..;ti ].e '..~l"'~al ]. be Miraf:i. :[40. 3. 7 Zl: nsu] at i (:::,r'~ shal 1 be ~.? .'..[ '[': r ..t cl (.:.a (::l d i l,- e (:: 'i:: bLu"'i ail. p,::)i yst',/rene. :r),:::)w Clnem:i. c:a! St,;.'rc.,-~:i:::,am HI 4(). 3,, 8 Tcu:::,so:L ]. shal :1. 13e a m:i. ~-:tt.u'-e c:)'{: 4C)-6,:}% organi (:: matt. er 4.0 INSTALLATION 4.~ I Lc, cate al 1 · ~:uturE~ drivewa'?'E.~ e::.~ist:Lng or proposed water wells, water ways~ sur-~ace and su ponclE.~ and a:L1 other -facilities requir:i.r~g Sel:)ar-at~c~n d~s .... t anc::es fr"om the pr'oposE, d Engineer (:;¢4: any obser'vE, d I::)oss:~ p:, r" o t: 6:, c ~,: :i. v i-:, (::l :i. s 't: a n c ,~;:? .% ~ r o m w E, ]. 1 s a n (::1 w a t:. e r" I.-.~ o c:l i E,'.=.i~. E.:.'.-d:al:; ]. :i. sh an el evati or'; benc:hrr~a.l~k. "rl.~:i. s BI;'I dent i ~: i ab ]. ;:/~, ~ st'.ab 1 ~:.:, and per'mar'~er~t. An e].evati(:)r-~ c:,.-,~: :!.00 can I:)e assigned. sin a ]. ;I. t:) [.:? a r" b i t r a r" y 4.4 lns'l:al i t. he t'.ank as '.=.¢'~c:,wr'~ or"~ '~'.he dr'aw:i, ngs. Rc¢cor"c:l th6~.:, :Lr'~;I. et and outl et el evati c:~ns o.f the 't:anl.::,, Ta. nk shal 1 [)~ n'i ~?i(::E~(:J (::,r'~ t..tr"~c:J'~ st'.u.r'J]eEJ Rat: 4 VE:, S(:)i ]. 4,..'..5 liii:).,' c::ava't:e t'.he al:)sc, r'pt i on ~: i et d ,, Beat:tom of e;,'c:avat i shal :1 be ]. eVE:,], and scar' :i. ~: i ~.)c:l. I.F si dE)wal ]. s smear's ~ tl"~E'y E. hall atso I:)e scar':i.'fied, Record elevation o'~: beginning ¢'r~:i. ddl E', ant! endu-.~.." -I:.r-ench. Rpr' ......... r",r'd. .., E,i eva'd: i c,n (::)~ each c:c)rnE, r- and center p(]i nt o.f I:::,ed ,, [}OI]'EFtZI"-L.C:'(' i on equi [:)merit shal 1 t.. [, e r" a t e (::) nt: h E, ~:' I (::, c) r ('", +t h E.) Ee x (::: ,=~ v ~:~ ,.. i o n. A n y rr~ a t E' r' i a ]. I::~ a c t e d I:, y 't:'. h e o p ........ ~' " ~.~l' a,..&or'~ o')f- the (::or~stru(::J-ic)n equipment sha].l remc, v(::,d ar'~d r"epl aced ~..,~i th t.tr'~c::ompac:t:ecl rr~ateri al. s. 4,6 F'l. ace the re, ok t(:) the deptln speci,~ied. Do riot cantami--'- hatE, roc:k wi'l:h na't:iv(a mater'iaiE; o?' spoils ~:rom t:hE' (:: i ,:::)n ,, Level the rock sur'-fac:e ('+ .... t") be-fore J. nstallLng I::) E, r' ~ (:::, r' ,~ t'. ~:::~(::! ~::) :i. !::) ~'. 4. 7 Ins'!:.a]. ]. 'l:'.he di st'.r':i. I::)t..d:'.J. (::)r'~ p:i. pe. F:ecc, r'(::i t.h[a r.a. ii. evati on c.,.f eac:h ioil"~'i:'. For r~res:~:..ur'e ~.','d:em sol vent b,.eld tine 4.8 Cover' t:h,~:~.:, di str':i, bLd'.'.i c:)r'~, pi pe wi t.h r",.::,ck ~ and ex(::a,..'at'.ic.~n with geote.'.-(t:i.].e be-fdr'e bac:k~:J, llJ. ng J r'~ st..t ]. a t J. c:)r'~ ~ :i..f r'" e c:l L.t i r' e c:l. c c, v e r 't: h ~:=:, a n d :) 1 ac i n g -'.'.l-,, c? R,?c::or'cJ tl'",'E, ,z :i. ni shed grot..tr'~d i.?l evat::i. (::)t'"~ a't:: the beg mi dcll .e and (..-:.:,nd o-f: '[:rench. Record the -f t i c) r",' .a t'. E- ~'i (:: I] c:: oI" r'i E'i"" a r'i [::[ a t' t: h e m :i. (::i !:) {:} :i. r"~ t o-f t h n n i r",, ~:j ,, e I e v a ..... 4,, 1.':} i:'urrtJ. E.h a copy o~,; .~i:t. 1 surve,/ i'~c3't:;~..~.~: to l::he Engineer-. 5.0 INSPECTIONS i r'~.spec:t:i (::.,r"~ w:i. i 1 be to 1 ay c:,L.d: t:he :L r'~s'L:al 1 at i on wi th the pr-cq3er di s~;'t:ar'~c::es .From 'El'~e w~s~l i i(:)ca'Ei(:)n and t. he creek. The:, se:,c:c)ncl i nsl::~(:ec:'lti (::~r'~ wi i 1 bi~ o¥ the c:,p~:~n ex(:::¢ava~:::i.c)r'~, At: -Eh:i. ~ti i]'),]-}~ 'Lh({.:, sc:~i ]L c:c~r"~d~ t:i (:~n~s v-el 1 ;L be oi::,ser'ved and (::ompar-ed 'bbc clc:,s:i gn CaE;~i:.t..Hfq::)t.i Ol"iE;., (Sr'oL.tr]d t.,JE~Lc::¢r- c:c)lqd:J, t;:i. or'Js~ oF' o.F I::,(:,.:,dr'oc:l.:: ~,.¢i ~ ]. b(a s'(.a~nclpip~.:~.~., ,:.l:i.s't:r-ib,,..t~:ior~ pip:i, ng ~ '!:,.'anl-:: (s) and o't':.he:.r- gr'ave]. ~ c-. o Frei:) (3 ..... "f'h~.;;,1 as'i: i r"~s~¥:~.:.;.,c:'~: :i. or",, wi ! 1 !::~e a,z 'l::er' c:omp i e'l: i c.'.,n c)~: the wc:,r' l-::. r-"::r'~',/ cie4:iciei'-,,c:ie'.,s ~,¢:i.].1 be ;'",o't':ed ancl 'l.:he Contractor nc4:i-Fied. ~ii~t.tc:h (..!e-,'-:i,.'::ieric:i,:es :sh.:.'..~ll f.;e c:c~r'rec:t:ed w,i'[':hir-, 'tsen (Jays. 5.2 Al 1 el er.::'t::r":i, c:ai work r"e:,CfL',.i res ~;..'.i'l:.her' ar-,, MOA el. ec:'l:.r'i c:al i F~'..51:) ec:'k., i c',n (]r' c:er-'(: J. -F i ca'l:: i cH-'~ i::,y an ]. i c: er't~.~e('t el e(::'(:.r' i c: i an. Su. bm:i. t'. pr"oc)-F o.f: :i. ,'"'~.Sl::)ec:t :i. c:)r'~ c:,r' c:e:r't: i ¥ i cat'. :i. c:)r'~ 'f:.c., t.h(.:a Engi neet. 5, :3 Sul:.:,mi t. ~:::a1::.a]. c:,g cJa~a o.F a! 1 mec:l'~ar-'~i ~::a:l. (aqt.til:)mer'~t:, '.:5,,.,"-'t. Ncxl:::i.-f:¥, Engineer at 1,'_-'~:,as't. 24 I"~C:,Ltr"s~; :i.r'i acJvance of r';J.r~g any ~,¢or"k, begi r",, - Rush MUNICIPALITY OF ANCHORAGE Development Services Department b Phone: 907-343-7904 Ort -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel 1. D. 015-242-54 1. GENERAL INFORMATION Complete legal description CLEARVIEW LT 15 Expiration Date: IF 2.---C_—/ Location (site address) 11620 SNOWLINE CIR. ANCH AK Current property owner(s) Mailing address Real estate agent TIM & DEB MAUDSLEY same 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic El 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 $_5.50 330 Date of Payment Receipt Number D :g b' `l00 C0SA#_DSG2112�1'-� 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 MIKE N ANDERSON, P.E. Phone.727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 6-25-26 -rja.�•.•••.• "1 i 49TH • 6. DSD SIGNATURE � �....t•• 1. 1 • System #1 Approved for 5 bedrooms- . MICHAEL N. A!:DLB..°)Fi 46 System #2 Approved for bedrooms Disapproved Conditional a pproval for bedrooms, with the following stipulations: .u1.44. (((f((((C-,, vv/ -\I cm /ANN J 'l%�� rSEF\J ,,,;: 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 COSA Checklist bL;e sheet Legal Description: CLEARVIEW LT 15 if more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 6126192 Total depth 77 ft Cased to 50 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 24°+ in. Date of flow test for COSA 5/6/21 Static water level at beginning of test 22 ft. Comments B. TANK DATA Age of tank(S) NEW years Tank type/material Measured operating fluid level in septic tank NEW ❑ Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA Which system tested (date installed) 5/6/21 ❑ ALL standpipes present per record drawing Total measured depth from grade 8 ft (max) Measured depth to pipe invert from grade 3.0 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 015-242-54 Structure served by this system Well production at time of test 5+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 2.28 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by MNA Date of Sample 5/6/21 , C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 'S16/z1 Results QPass For 4 bedrooms Fluid depth prior to test 0 in Water added 600+ gal New depth 0 in Elapsed time 1440 min ❑ Code -required soil cover over field Final fluid depth u in ❑ System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) _ date of test) Gallons introduced 0 gallons If yes, enter date Comments/Deficiencies: ' exiting field tested for 4 bedrooms, (1) bedroom 13' added to make for total of 5 bedrooms. 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' ❑✓ Yes Community Sewer Manhole/Cleanout > 100' QQ Yes if No ft [�]✓ Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' Yes if No ft Absorption Field on Lot > 100' P� Yes if No ft Holding Tank > 100' 2 Yes if No ft Neighboring Absorption Fields > 100' Yes if No ft Water Main > 10' Animal Containment > 50' 0✓ Yes if No ft F/-1 Yes if No ft Yes if No ft Water Service Line > 10' Community Sewer Main > 75' �✓ Yes if No ft Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below n 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 Line > 5' ✓M Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Q Yes if No ft Private Wells > 100'✓Q Yes if No ft Water Main > 10' ✓Q Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' R/I 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: Water Main > 10'✓] Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' F71 Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' ✓0 Yes if No ft F. ENGINEER'S COMMENTS I 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 -A1 �J'...ER , MICHTCi`A!. ANDLRSChI•;;�" CE -945 iffyr.•.•. .�? ��. s 000000 00 �� -F.-A. V o49 IH* QPM SHANEA-HOLT m0 P`�A LS -8914 a o4 �`vU sional o `ti4�000� CONATOAIAAiIVFENADNISEOAC—EO AND LOTUTi ESA.NECNT� SLYtNTS,AN IS CO.vftrCtS BETtYELY Ea;STING STk'JCTU^.ES AND PLATTED LOT L!NfSAM1'D/OFEASEMENlS; Arlp IS EASEMENTS DF RECORD, U1I INOADDNOSEALSTRUCTURES, THE COM£IJTS,. AEEN(ET SHO. EASEMENTS DF IN OOLDER INAII THOSE APPFM1RIflG ON tNERECORDPtAi, AAE NOi5HO1Vlt Hf REOftIUN(E551NDKATEDt NOTEr fENCEt1NF5THATMaYMP£ARONTIIISORAlvrNO ARFNOTTOBE USED SO DETERMNE P.ADPEA; YLINESON I -E- AYBtAP VA TE AN -G SHOWN I+EREON.MAYB£APPROXI:'IATEOUf TO EXCESSIVE SNOW at1DICAICE . R ASSUTIL75URVEY I"=40' I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT15, CLE4R'VI,&VSUB ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VIS iBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS E%IST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS IITH DAY OF Mai 2021 HOLTLANDSURVEYI.VG 9309 GROVER DRIVE ANCHORAGE.AK 99507 `15012,, F6212-54,713-25 3455513 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING . 1, GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Day phone Day phone Agent Address Day phone 76 2---' "5/o & Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: /'"/ TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC lng to the legality and status of system. z TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site 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 #21 o 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 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 _ [ ~ Address ~ Engineer's signature Phone Date DHHS SIGNATURE ~' Approved for ~ Disapproved. Conditional approval for bedrooms. bed rooms, with the following stipulations: By: Additional Comments / Date The Municipality of Anchorage Department of Health · -luman Services (DHHS) issues Health Authority Approval Certificates based only upon the representatl~,'~s 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 satis~ 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. 72-025(Rev. 1/91) Back MOAI¢21 Legal Description: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division MUhlIC~P4ALITY OF ANCHO 825"L" Street, Room 502 · Anchorage, Alaska 99501· (907)E 4~i~ENTAL Health Authority Approval Checklist LoT' 15 c-E~hP-~l ~ ~ ParcelI.D.: RECEIVED A. WELL DATA Well type ~ Log present (Y/N) Total depth Sanitary. seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number y Date completed ~/~-b//,q2--- Cased to ~) Casing height (above ground) 7 Wires properly protected fi/N) Date of test Static water level Well production FROM WELL LOG AT INSPECTION lq: g.p.m. WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate /e L//,~ Other bacteria .~ Collected by: 'Y-~--- ~-~ B. SEPTIC/HOLDING TANK DATA Date installed ~///zv/c~ g-- Tank size Foundation cleanout (Y/N) / Date of Pumping ~/]/t~ /qff C. ABSORPTION FIELD DATA Date installed Length ~(~p Width ~.~ Effective absorption area Date of adequacy test &/~/~- Fluid depth in absorption field before test (in.); Fluid depth ¢~.~ Minutes later: Peroxide treatment (past 12 months) (Y/N) }~)_~c~ Number of Compartments ~ Cleanouts(Y/N) Depression (Y/N) ~ High water alarm (Y/N) Soil rating (g.p.d./ft2 or ft2Podrm) /o ,~ System type Gravel thickness below pipe _~ Total depth ~--~ Monitoring Tube present(Y/N) ~ Results (Pass/Fail) '~ d Immediately after 3'e~O gal. water added (in.): (in.) Absorption rate = ,¢x,~ /~ g.p.d. If yes, give date Depression over field (Y/N) For Z?ff bedrooms Do LIFF STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* "Pump off' level at* High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line /v2-,-5- ' On adjacent lots /,_~L~ ; On adjacent lots D~/,z~, Public sewer manhole/cleanout 3/Or..~ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 1 ~ Property line 7 ~) Absorption field Water main/service line ~ CD Surface water/drainage 12. o Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Surface water Curtain drain Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots 50-/' Fo ENGINEER'S CERTIFICATION , .... I certify that I have determined thrufield inspections and review of Municipal re~Ords that the above systems are in conformance with MOA HAA guidelines in effect on this date. Date HAA Fee $ Date of Payment ReceiPt Number Waiver Fee $ Date of Payment Receipt Number Rev. 8/95 OSS: haa.wk.doc Matrix Cli®nc Name Ordered By Projeoc Name Droject# PW~ID CT&E Environmental Services Inc. Laboratory Division ~ ' Laboratory Analysis Report 95.3713-1 L15 CLEARVIEW TO'BEN EDURKLAIND, D.E. UA WORK Ordar 17606 Prin%e~ Da~e 09/ol/@5 ~ 15:38 hr~. c~lle¢~ed Da~¢ 05/$1/95 ~ 0~:$0 hr~. Received Da%e 08/31/~5 ~ 10:30 hfs. Technical Director STEP~E~ C, EDE Sample Remarks: SAMPLE COLLECTED OC Allowable Ex~. Anal Parame=er Results Qual Units Method Llmit~ Date Da=e Ini~ Nitra~-N 1~42 %~%~/L EPA 353.2 10. 0B/31/95 C"MR See Special I;%struct~ons Above UA - UnaVailable See Sample Remarks ;%bore NA - NO= ~alyzed Undetected, Reported value is ~he practical quantification limit. LT - L$~ Than Secondary dilution. GT - Srea~er Than 200 W, Potter' Drive, Anchorage, AK 99518-1 605 --Tel. (907) 562-234,3 Fax: (907) 561-5301 ENVIRONMENTAL FACIt..ITIE$ IN ALASKA, CALIFORNIA. FLORIDA, ILLI,',,JOIS, MARYLAND, M CHIGAN, MISSOURi, NI~W JERSEY, OHIO, WEST VIRGiNiA T.SPURKLAND P.E. WEST 15TH. AVENUE SUITE 203 ANCHORAGE, ALASKA 99502-3904 (907) 279-3916 Fax (907)-276-6013 RESIDENTIAL WELL INSPECTION RECEIVED SEP ,5 1995 lvtuJ uc~pal~ty ol Anchorage Dept, Health & Human Services LEGAL: LOCATION: OWNER: Lot 15, Clearview S/D 11620 Snowline Cir. James Ables TYPE OF WELL: Private, Single Family WELL LOG AVAILABLE: Yes INSTALLATION REQUIREMENTS MET: Yes WAIVERS GRANTED: None Required WELL YIELD FROM WELL LOG: 35 Gallons per Minute PUMP YIELD FROM TEST: 6.5 Gallons per Minute DATE OF INSPECTION: August 31, 1995 TEST PROCEDURE: Well was pumped at a constant rate while the drawdown was monitored with an acoustic probe. At the beginning of the test water level was found at less than 24 feet below top of casing. At a pumping rate of 6.5 gallons per minute the water level dropped to 25 feet after 15 minutes of pumping. A total of 510 gallons were pumped. TEST FOR E.COLI AND TOTAL NITROGEN: Water was tested for E.Coli and total nitrogen on August 1, 1995 E.Coli 0. Other Bacteria 0 Total Nitrogen 1.42 mg/l. Max. allowable Total Nitrogen 10 mg/l. No Bacteria Allowed TEST RESULTS: This well meets the requirements of the Municipality of Anchorage. THIS WELL WILL PRODUCE MORE THAN 3 GALLONS PER MINUTE FOR MORE THAN FOUR HOURS The Municipal requirement for well flow is 150 gallons of water per bedroom per day. This well exceed this requirement. The assessment of the condition of the well applies only to the conditions as of the day tested. The flow rate may change due to subsurface conditions that may not be observed from the surface, and changes in the land use and other factors that may impact the aquifer feeding the well. 203 WEST 15TH. AVENUE SUITE 203 ANCHORAGE, ALASKA 99502-3904 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOCATION: OWNER: Lot 15, Clearview S/D 11620 Snowline Cir James Ables RESIDENCE: WELL: SEPTIC SYSTEM: 4-Bedroom Single Family On Site Single Family FROM MUNICIPAL RECORDS: 4 Bedroom System TANK: Anchorage Tank, 1250 Gal. 2 Comr>art~7 ABSORPTION SYSTEM: Trench..:.,.~.'~" ABSORPTION AREA: 500 Sq. Ft. SOIL RATING: 125 sq. Ft per bedroom INSTALLATION DATE: August 20, 1992 WAIVERS GRANTED: None Required DATE OF LAST PUMPING: Anchorage Cesspool September 1, 1995 DATE OF TEST: August 31, 1995 ~' '" :~ TEST PROCEDURE: System was inspected and measured. Tank was found with four feet of cover and with a liquid level of 49 inches. Trench clean out was found 3 feet deep and dry. Monitor was 8.5 feet deep with no liquid. 500 gallons of clean water was added to the trench while the water level in the tank and trench were monitored. The level in the tank did not change and no water was observed at the far end of the trench. TEST RESULT: This system meets the code requirements of the Health and Social Services Department of the Municipality of Anchorage. NOTE The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long this system will function satisfactory for current or future occupants. All septic systems ultimately fail. Some systems last 15-20 years, others fail after less than 5 years.