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CHAMBERS LT 81A
I ooo Municipality of Anchorage . On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201441 PID Number: 051-231-69 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name GARY & SHIRLEY KOSTO ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ® Bed ❑ Mound Site Address 22514 CHAMBER LANE, CHUGIAK ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 3 0.7 GPD/SF JTotal 3.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3 Ft. Gravel depth beneath pipe 0.5 Ft. Subdivision Block Lot CHAMBERS 81A Fill added above original grade VARIES 0.78-0.81 +/- Ft. Gravel length 43 Ft. Township Range Section Gravel width 15 Ft. Beds: Number of Lines 3 Distance between lines 5 Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 645 FtZ Ft. Well 100'-1- 100'+ 25'+ TANK ❑ Septic ® S.T.E.P. ❑ Holding ® Other Manufacturer GREER Capacity 1250 Gal. Surface Water 100'+ 100'+ Material HDPE Number of compartments 2 Lot Line 10'+ *6'+ NA Foundation 10'+ 10'+ LIFT STATION Manufacturer ORENCO Capacity 1250 Gal. Remarks Original system decommissioned per code. *Waiver. Alarm location INSIDE NE ROOM Electrical installed by DRS ELECTRIC PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Installer ,JRg Drainfield 3034 CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspection 15' 11/23/20 god 11/24/2020 Location and description 3`d 11/25/20 4`h ISHED — BOTTOM OF SIDING ON-SITE WATER AND WASTEWATER SECTION APPROVAL q0_1���� ..••OF AQ Conditional Approval: DateAV ' •:�,if.�� *: 49 h+ .....�:* ter, r�JJ �.• Curtis Huffman• • Aeptic roveystem ! Pp Date � Z''1" z� r� `��is••, CE 128991 •.. ���� �� lF� .,11/30/2020 ��� FOPROFESSIONP, �-� Note: this approval does not include well permit requirements. (Rev uwuz/18) PID: 051-103-35 PERMIT: OSP2I01441 00 co CHAMBER LANE - (NORTHSHORE IVE) S89"59'29"E \155.00' WELL PAVED D/W / Ln REMAINS N t TH2O-1 00 co CHAMBER LANE - (NORTHSHORE IVE) S89"59'29"E \155.00' WELL PAVED D/W / 15'' REMAINS M1 TH2O-1 WELL, PL, CREEK BANK MT & BLM RES. ALL STAKED AT CONST. LOT 8 2 A 34.8' 21.5' "3.7.6 0 EXISTING 38 HOUSE d- p-) 42.3' A -C=23,7' B -C=16.6' A -D=26.8' B -D=12.5' A -E=61.3' B -E=23.0' A -F=68.0' B -F=30.7' A -G=42.5' B -G=30,4' A -H=30.6' B -H=21,8' w ESMT BLM RESERVATION 6M a D �4r NEW 1250—GAL HDPE STEP & BED • 0 w U� In CHAMBERS LOT 81A GARY & SHIRLEY KOSTO 22514 CHAMBER LANE CHUGIAK, AK 99567 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 firstwaterAK©gmail.com H2O -1 )RG/OL )RY 10/14/20 bul'FUN I@bLKVIULti: �`S� OF AL4� '9 TIi 0 0 DATE: 11/30/2020 "is Huffman SURVEY: JLS r s CE 128991 DRAWN: FWCS 11 /30/202WSCALE: 1" = 30' PESSi00-, ,Phllr� MUNICIPALITY OF ANGHORAGE On -Site Water & Wastewater Program PC Box 1 NC -.Vi 4700 Elm -oro Road A Anchorage, Alaeka 99519-0050- Phone: (907) 343-79-N Fax: (907) 343-7.9-07 LA eps. i; bn L, Li t On -Site Wastewater DisposalSystem. Permit Permit Nurnb,er: OSF'201441' Effeotive Date, 10(30.12020 Work Type. Septic Upgrade Expfritinn Date-: 10,3012021 Tax Co -de Number: 0511033500D Site Legal Address, CHAMBERS LT 313 0.1368 Site Mailing Address: 22514 CHAMBER LN, ChuglaR Ownen KOSTO GARYR& SHIRLEYA Lot Sizei n Sq Ft-- 494-77 Design Engineer: FIRSTIVATER CONSULTING Total Bedrooms: 3 This permit is for the construction of; 2 Disposal Field Z Septic Tank 13 Holding Tank 11 Prnivy D Private Vkfell El Water Storage All construction shall be in accordance with: I.. The amacbed. approved design.. 2. All requiremenis specilied In Anchorage Municipal code Chapters 15.55 and 15-65 and the State of A1a3R;_; I/Vastowater Disposal Regulations (18AAC72) and Drina lng Vialer Regulations (1 81AAC-80) I The wastewater code requfras. inspections during the installation, The engineer shall notihy the Develo- nient ;p Services Department per AlAC 15-65- Provide notification by caking (907) 343-7904 (2417). 4. Frorn October 16 to Apdl 15, asubsur-jao-e soil absorption systern under construction dung freezing weather shall be either: P. Opened and Closed on the same day. or b. Covered, scaled, and healed to prevent freezing P/,/&, W_4cl De_s�9rl AanY'4 -ro colveo-ho'y"J - ItI771zo Renelved By: 6 Issued By- J1114 Z�� 1013012020 Date, Date: Firs[ Waler G 0 N S U L T I N G "'k 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com November 30, 2020 Municipalities of Anchorage On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: OSP201441- CHAMBERS LOT 81A — LOT LINE WAIVER Per the permitted design, all setbacks, easements and property line were staked prior to construction. Due to sloughing, loose soils it appears the field may have been installed a little closer than 7' to the property line and we are therefore requesting modification of the issued 7' waiver be amended to 6' for field to property line be granted. Granting of this waiver is justified since no negative effect on the adjacent property is anticipated. The location will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, 09A6L-/� Curtis Huffman, P.E. C D ,4e- I Municipality of Anchorage �� Uep:niment P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 ® Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV201080 COSA#: PID#: 051-103-35 Legal Description: Chambers Lt 81A Engineer: First Water Consulting Permit#: OSP201441 Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is. -TO feet. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. ■ ■ .................. t . ■ ■ ...................... ■ ■ ............................. ■ t Waiver is Granted: X Waiver is not Granted: Date: Zb Approved by:&Z fit/ Name of Revie **** VARIANCE/WAIVER REVIEW **** �Jrsl Water �R G D N S U LT I N G a- V11"T, - c A rt i <- .. _ , ..t0 V, P u 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com November 16, 2020 Municipalities of Anchorage On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: OSP201441— CHANGE ORDER WITH LOT LINE WAIVER LEGAL: CHAMBERS LOT 81A It was determined at excavation that an Advantex FAP tank is not applicable and no AX -20 pods are available for sometime. We are therefore are submitting this design change that will decommission / remove the existing crib and install a conventional pressurized bed per the attached design. The proposed 3 -bedroom design is based on the recently conducted test hole and upon the adjacent Lot 81B1 MOA record soils and groundwater data (GW soils to 15' with no groundwater observed). No groundwater was observed at excavation or monitoring. Slopes are flat at the proposed upgrade location and there are no excessive slopes within 50' of the proposed trench. The lot and area are served by private and community water as noted on the design. We also request a 7' field to lot line waiver with this design and have attached the appropriate fee. Granting of this waiver is justified since no negative effect on the adjacent property is anticipated. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, (�A� L/%, -- Curtis Huffman, P.E. F I I I W El", F'WASIEk1EA .:f .', P P G..i AFI A. NINA MUNICIPALITY :p { idea Development Services Department On -Site Water & Wastewater Section Parcel I.D. 051-103-35 ON-SITE SEPTIC/WELL PERMIT APPLICATION Phone: 907-343-7904 Fax: 907-343-7997 Property owner(s) GARY & SHIRLEY KOSTO Day phone 9072292545 Mailing address PO BOX 3648, HOMER, AK 99603 Site address 22514 CHAMBER LANE, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) CHAMBERS LOT 81A Legal description (Township, Range & Section) Lot Size 49,477 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Fx_1 Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank El Upgrade El (D) ❑ Holding Tank ❑ Renewal ElDuplex 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. (Signature of property owner or authorized agent) Permit/Rush Fees: c{ 14 6.257 CaL/1 D Date of Payment: / 0Z16Z o Receipt Number: 216171 Permit No. Waiver Fees: Date of Payment: Receipt Number: Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc DESIGN DETAILS: 3 BDRM X 150 GPD = 450 GPD 450 GPD/0.7 GPD/SF. = 643 SF SAS 643 SF / 15'W = 43 FT. BED USE 1 BED - 43' (L) X 15' (W) X 0,5'(ED) TOTAL DEPTH FROM ORIGINAL GRADE, -3.5' NOTES: REMOVE EXISTING CRIB / BIOMATTED MATERIAL INSTALL TYPE II ERS AS NEEDED OR MOA SAND FOLLOWED BY 2'+ MOA SAND BETWEEN 5.5'-3.5' PRIOR TO ADDING 0.5' SEWER ROCK. — — — — — — — — — — — WELLS TO THE — — — — — — — O \ O Z NORTH ARE 200'+ b In FROM PROPOSED — — � — SEPTIC SYSTEM. — — — in o N CHAMBER LANE I M S89 59'29"E 155.00' U1 n� 15' UTILITY ESMT FLAT EXISTING m -D 5 REMAIN ELM RESERVATION CRIB REMOVED k BAWILLED m W/ ERS $ Y WELL PAVED PAVED STAID: 100• MT 1, b MOA SAND CREEK TOP ANN RAT srAl¢ R% o rrn 1.5 -15' GW SOILS APPROX. v SETBACK w ° LM + NO GRND, WTR, ®WELL MT \SHED B. z1 s. c �s DECOMMISSION ON BLoacs �TT� D WELLS TO THE NNEW ST ARE 100'+ EX�STIN 5 HDPE TEP Z FR PROPOSED w 3BR HOV W SEP SYSTEM. ^ � 423' CJ 2020 50• K (r ( i DECKBAQANC —2ozD u• MUNi6XV ` EC„yr \ 3 CHAMBERS LOT 81A PREPARED FOR: 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 PETERS CREEK LOT 81A S89 59'30"E 175.12' FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 firstwaterAK@gmail.com SUPPORT$SERVICES: ®®®® ')F AL`�� � c� 9TH* 0 DATE: 11/16/2020 ` rtis Huffman a SURVEY: JLS 2020 �, CE 128991 DRAWN: FWCS 11/16/2020e or SCALE: 1 " = 60' 'r�?OFEss10l0 o 1 d - O \ O Z CHAMBERS LOT 81A PREPARED FOR: 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 PETERS CREEK LOT 81A S89 59'30"E 175.12' FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 firstwaterAK@gmail.com SUPPORT$SERVICES: ®®®® ')F AL`�� � c� 9TH* 0 DATE: 11/16/2020 ` rtis Huffman a SURVEY: JLS 2020 �, CE 128991 DRAWN: FWCS 11/16/2020e or SCALE: 1 " = 60' 'r�?OFEss10l0 GOA HOLE SPACING1 114 LF 1 1/4" PVC WITH 3/16" HOLES @ 3.8' SPACING (TYP) DESIGN CRITERIA: DECOMMISSION EXISITING SEPTIC TANK / CRIB & INSTALL NEW 1500—GAL STEP HDPE TANK. MAINTAIN 10'+ FROM FOUNDATION, 100'+ TO PRIVATE WELLS & SURFACE WATER, & 5' TO FIELD WITH 4' OF COVER OR INSULATION. INSTALL 43' LONG BED PER DESIGN DETAILS / NOTES. INSTALL PER AMC 15.65, 15.55, & MASS ... TANK BEDDING, SEPARATIONS, MATERIALS, LO cel I r� S89°59'29"E TH2O-1 5' REMAIN[ — STAKE— M WELL PAVED FLAT D/W STAKE 100' 00 CREEK TOP BANK & WELL SETBACK i FLAT , 34.8'U 0 EXISTING � w 3gR HO US _ 42.3' 0 CHAMBER LANE 155.00' 15' UTILITY ESMT FLAT VF BLM RESERVATION FLAT u� O O^LAT STAKE PL/ '---J \SHED DECOMMISSION ON BLOCKS EXISTING ST & INSTALL NEW 1250—GAL HDPE STEP 2020 56; CREEK SET8q ACK — — MAIN1NgNCEREEK' _ ESA4T _ 1979 25 CREEK _ - - MAINTENANCE ESMT — 2020 TOP SURFACE Wq ER 58ANK \ eF1 EXISTING CRIB REMOVED & BACKFILLED W/ERS &2' MOA SAND cn O M O I r M z 0 w -P i Ui CHAMBERS LOT 81A SUPPORT ®SERVICES:�® ® GARY & SHIRLEY KOSTO ®��� OF A 22514 CHAMBER LANE CHUGIAK, AK 99567 ke 9 TH r FIRST WATER CONSULTING DATE: 11/16/2020 0 �, rtis Huffman �4 13030 SUES WAY SURVEY: JLS 2020 c�A CE 128991 ,� Alf ANCHORAGE, AK 99516 DRAWN: FWCS ` 11/16/2020��'® 907-350-9566 firstwaterAK@gmail.com SCALE: 1' =3&*All �� 4661 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350 -9566 firstwaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: CHAMBERS LOT 81A PERFORMED BY: FWCS / FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 10/15/2020 DEPTH FEET OG SOILS 1 ORG/OL 2 3 4 GW/SW 5 6 7 8 9 10 11 12 13 BOH 14 15 16 17 18 19 20 Reading Date Gross Time Net Time Depth to Water Net Drop 10/5/20 2 min 6 6 2 min 6 6 2 min 6 6 2 min 6 6 2 min 6 6 2 min 6 6 PERCOLATION RATE <1 (MIN / INCH) TEST RUN BEWTWEEN 3 & 4 FT PERC HOLE DIAMETER 6 PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH. GROUND WATER ENCOUNTERED: NO IF YES, AT WHAT DEPTH: NA DEPTH TO WATER AT MONITORING: DRY DATE: 10/14/2020 TESTHOLE # 20-1 DATE PERFORMED: 10/5/2020 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: RAPID PERCOLATING SOILS SAND FILTER VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION PERFORMED FOR: GARY KOSTO 10/15/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201441, Deb Wockenfuss, 10/30/20 0 LCA t CHAMBER LANE (NORTHSHORE DRIVE) N S89'59'29"E ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: - = FND BRASS CAP MONUMENT CHAMBERS SUBDIVISION FND 518" REBAR LOT 81 A PLAT 79-67 , SL RVEF l✓RTIFICATE. 1, Johnj ohn L. Schuller, Have conducted a �, � . • . , O F ... y LAIVD h sical curve of this ro ert as shown on this drawin and that the • . �� ,S Pe� improvements situated hereon are within the property lines and no • , enchroachments exist other than noted. Under no circumstance should /•.' 49TH any information on this drawing be used for construction of fences, . :....... .... . ..... ....:. °..��j structures, improvements, or for establishingboundary lines. A0 � EXCLUSION NOTES: It is the owners res onsibility to determine FA ....... �...'".. , ..... , .....:..� .� Q1� p J •.JOHN L. SCHULLER.• o � the existence of any easements, covenants, or restrictions which �. -�, • .4 •m LS -10408 �' ® •- . do not appear on the recorded subdivision plat. e . • *�--� ••M6q"` ,� • • . , . • �� / 1831 Talkeetna Street WORK ORDER NUMBER: DATE: SCALE: E-MAIL�a ,,. j�,., Anchorage, Alaska 99508 SEPT 16, 2020 1 =40 A� a� ,,�, DRAWN BY: CHECKED BY GRID NUMBER: BOOK/PAGE: kl O f 40 {�, �• �r (907) 227--1455 office 2 7Q JLS NW1359 200213 �® sia��• (907) 274-4992 f ax /~. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT 1PHONE / ~'NEW MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDrOOm8 DISTANCE TO: I Well tO0 I Ab,orptio..~ea [~ Dwelling PERMIT NO. ~ ~ Mate~ ~o. of comoart~nts ~ ~ Manufacturer ~ ~ ikiq' caTci~ '~a~ns IF "OM~mD~: Inside length -- Width -- Liquid depth om:.c -- ~ ~anufacture~ / Materiat~ ~ kiquid ~=~ No.~ines ~th_~ line To~H~g~ i~ ~Z ~Trench width / ~a~ebetween ~ines ~ ~ To~ of tile to finish grad~ Material bene~tile Total effective absorption area ~Q inches Length Width Depth PERMIT NO. ~ t~ / o /o ~ooo~ ~< ~ *vpe of ~ri~ Crib diameter--~: ~ Crib depth~ Total effective ~sormion ~re~ ~ ~ DISTANCE TO: Well [ 00 Building foun~ti~- O Nearest lot 'ine~ ~ Cla~ _ ~ . .~ Depth Driller Distance to lot line PERMIT NO. Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS R EMAR KS I ~ ~ ' ~ ~ APPROVED DATE LEGAL 72-013 (R 3/78) L, J::: i,;jp.!j .... LOT S:I.R C:HRHE:EF.'.S :E;I_IB 'THE O ~t E GEO. ECHNICAL ~ DEVEL.~PMENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russ~ell Oyster Ear/Ellis 694-2774 SOIL LOG r388-2280 Soils Et Foundations Land Development Performed for: Legal Description: ~/~z- ~//~ ~. ~'~ /.~A// ~/~ .~.,~'. Depth (feet) Sotl Characteristics Name: ~'//R/.~' Z~¢ v~'~J 'Tel. No.~ Natllng Address: o 1 2 3 4 5 ?z,~7- 7 8 10 ll 12L 14, 16 Ground Water Encountered: Yes Proposed Installation: Seepage Pit Co~ents: No f If yes, what depth Drain Field Perfomed by: Date: ~-Steven A. Johnson Box 76 ~hugiak, Alaska 99567 Phone: 688-3085 Soils Log Percolation Test Perfo~ed for Legal Description Test Pit Location Chris C. Brown Date 8/12/?a Lot 81, Section 9, T 15 N, R1W SM 157' W and 60' S NE Corner 8 10 _ 12 14 - 16 GW GW 0'- 1.5' red brown silty sandy gravel w/organics (GM) 225 ft2/bdrm 1.5'- 10.0' clean well graded sandy gravel with cobbles to four inches (GW) 110 ft2/bdrm 10.0'- 11.0' 11.0'- 15.0' silty ~ine sand (SM) 250 ft2/bdrm clean well graded sandy gravel with cobbles to eight inches (GW) 100 ft2/bdrm no water table encountered Total depth this test 1.5 feet AVERAGE ABSORPTION AREA REQUIRED FROM SOILS LOG = 1 28 ft. 2/bdrm. NET TITLE (Min.) NET DROP (In.) PERC RA~~/in) Percolation rate ~_~/i n~ h Signed by DOC Co. dba SULLI"N WATER WELLS P.O. BOX 272, CHUG IAK, ALASKA 99567 • TELEPHONE 688-2759 OWNER OF LAND ADDRESS LEGAL DESCRIPTION DATE - Started PERMIT NUMBER Ended DEPTH OF WELL STATIC LEVEL OF WATER FT. DRAW DOWN FT. GALS. PER HR KIND OF CASING KIND OF FORMATION: From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft From Ft. to Ft. From Ft. to Ft From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft MISIS%C/L. INFORMATION: � U y 02 3 0 /, ,�o j �? / A _7�1 Us /fS DRILLER'S NAME MUNICIPALITY OF ANCHORAGE o�Q4, Development Services Department p p Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-103-35 Legal description CHAMBERS LT 81A Site address 22514 Chamber Lane Chugiak Current property owner(s) Daniel Blair Expiration Date: ZI'Zo Z 3 X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 2A�-�2__3 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA ApprovMjune 2022 MUNICIPALITY OF ANCHORAGE ,� Development Services DepartmentI Phone: 907-343-7904 On -Site Water & Wastewater Section V Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051- 103 _ 3 S Complete legal description Chambers Lot 81 A Location (site address) 22514 Chamber Lane, Chugiak, AK Current property owner(s) Daniel Blair 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: © Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: © Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel © Plastic ❑ Concrete ❑ Fiberglass Age 3 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS V Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Date of Payment �` a �`�93, COSA # 1036 0 914 Ll 26 Waiver Fee $ Date of Payment Waiver # COSA Application—June 2022 Legal Description: Chambers Lot 81A Parcel ID: 051-103-35 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _ A. WELL DATA ✓❑ Well log is filed with Onsite (or attached) Date drilled 10/17/1979Total depth 80 ft Cased to 40+ ft ❑✓ Sanitary seal is functioning correctly R Wires are properly protected Casing height (above ground) 12 in. Date of flow test for COSA 2/14/23 Static water level at beginning of test 41 ft. Comments B. TANK DATA Measured operating fluid level in septic tank 42" Date of pumping 2/22/23 ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 11/24/20 Z ALL standpipes present per record drawing Total measured depth from grade 4.5 ft (max) Measured depth to pipe invert from grade ft (min) ✓❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 Well production at time of test 5 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes W N 2 Coliform bacteria is Negative Nitrate 0.365 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L [J. Arsenic less than MRL (ND) Collected by Arcterra Consulting Date 2/14/23 C. LIFT STATION 91 Required maintenance completed Age of lift station 3 years Lift station material Plastic Comments: Adequacy test date 2/14/23 Results 0 Pass Fluid depth prior to test 0 in Water added 482 gal New fluid depth 0 in Elapsed time 10 min Final Fluid depth 0 in Absorption rate 450+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 in Effective depth used 0 in Effective depth remaining 6 in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ✓❑ Yes if No ft ✓❑ Yes if No Neighboring Tank > 100' ✓❑ Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No Absorption Field on Lot > 100' ❑✓ Yes if No ft Holding Tank > 100' 0 Yes if No Neighboring Absorption Fields > 100' ✓❑ Yes if No ft Community Sewer Main > 75' ✓❑ Yes if No ft ft ft ft Animal Containment > 50' JQ Yes if No ft Manure/Animal Excreta Storage > 100' Q Yes if No ft ❑ N/A —Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' 0 Yes if No ft Tank to Property Line > 5' © Yes if No ft Field to Property Line > 10' ❑ Yes if No 6x ft Water Main > 10'✓[] Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft F. ENGINEER'S COMMENTS x Waiver OSV201080 Approved 11/17/20 Wells on Adjacent Lots: Private Wells > 100'✓❑ Yes if No Community Wells > 200' Q Yes if No If tank or field is under driveway comment below ft ft G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Areterra Consulting Phone (907)-696-6111 Engineer's Printed Name Kenneth Duffus Date -061..e r, 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 now 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 no unseen encroachments, deficiencies or discrepancies exist. COSA Checklist June 2022 LJ lJ Gl ` iM C � P L•7 t1 U LI LI O ANCHORAGE o "4t, .y Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-103-35 1. GENERAL INFORMATION Complete legal description CHAMBERS LOT 81A Expiration Date: 3- l —a Oz� Location (site address) 22514 CHAMBER LANE, CHUGIAK, AK 99567 Current property owner(s) GARY & SHIRLEY KOSTO Day phone Mailing address Real estate agent PO BOX 3648. HOMER. AK 99603 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSAFee $ �1O (60yl.b "I�' Date of Payment �( - S 0 _ Z p Receipt Number l l oo,31 COSA# OSCE d 16 b-0 Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907.350-9566 Address 13030 SUES WAY. ANCHORAGE. AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 11125/2020 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the i •� ` well and septic system. Therefore, any estimate of how long a system will function satisfactory i�g�P: • • .. :1•,9 }� for current or future occupants or guarantee that no unseen encroachments, deficiencies or / J discrepancies exist can be given by First Water Consulting & FW CS *' TM .....•.* rr . �. ... ... V�.~.'.- 6. DSD SIGNATURE Curtis Huffman System #1 Approved for bedrooms CE 128991 .�Aw� System #2 Approved for bedrooms �FOPOF SS10NP \\ ESS�� Disapproved Conditional approval for bedrooms, with the follR�\pta�i�Sr O q o c �:� '0 ; J r r� J 1 4411- M ? M Original Certificate Date: 1-2--- q ` 2-02 0 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 Legal Description: CHAMBERS LOT 81A Parcel ID: 051-103-35 If more than 1 septic system on lot: COSA Checklist # _of A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 10/17/1979 Total depth 80 ft Structure served by this system _ Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Cased to 40+ ft Nitrate 0.343 mg/L ❑ Nitrate less than MRL (ND) ® Sanitary seal is functioning correctly Arsenic ug/L ® Arsenic less than MRL (ND) ® Wires are properly protected FK -S Casing height (above ground) 12+ in. Collected by Z Date of flow test for COSA 9/17/2020 Static water level at beginning of test 48 ft. Date of Sample 10/28/2020 Well production at time of test 5+ gpm Comments Only 1' draw down during test. B. TANK DATA Age of tank(s) NEW TANK years Tank type/material STEP / HDPE Measured operating fluid level in septic tank ® Standpipes/foundation cleanout per record drawing Date of pumping * D. ABSORPTION FIELD DATA Which system tested (date installed) NEW SYSTEM ® ALL standpipes present per record drawing Total measured depth from grade 4.3 ft (max) Measured depth to pipe invert from grade _ft (min) ® N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective ® Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: C. LIFT STATION ® Required maintenance completed Age of lift station NEW years Lift station material Comments: *NEW TANK & FEILD Adequacy test date NEW SYSTEM Results ❑ Pass For bedrooms Fluid depth prior to test _ in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) N If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No ft ® Yes if No ft ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if 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 Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' ® Yes if No ft 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' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No *6+ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No —ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *WAIVER. G. ENGINEER'S CERTIFICATION , 14W :-Oz i I certify that l have determined through field inspections and review��Q_:•' •��`�� of Municipal records that the above systems are in conformance g ' •:'� �¢ with MOA COSA guidelines in effect on this date. :. , i%0 .. • ,': • Curtis Huffman �� ?'�'•. CE 128991 �w J ,)/30/ 00200 \\ A �� OFEW ®. ,05 '02 ,5Z NO3°54'50"W M 4- Q N co F -- O 1 ,fi/-66Z U rn Y W LL.J (n m w Lv a M,,x,-vp.00 J 0p U)_ w -_n o .0 a N O C W 0 0'' X) 0 nJ N: N m [� �N3Q„N O� N ,cyb OTt,: o •3 � -0- t,: 49 ca to 1 o Pia w o tiA� it c Yb o y= a�� a-y=R.- o - o, � I C aJ L) OO .O > O Q t.. /xL3. f0 0 0 z i o Q V >, n ci cr3 a o 3 N a W MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264.4720 Application Date Mmrmh 25: lqRR GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 81 A Chambers S/D (b) Location (address or directions) Northshore Drive Applicant Name Shirley Kosto Applicant Address Telephone: Home 688-3550 Business (c) Applicant is (check one): Lending Institution [] · Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution Western Mortqaqe Address Anchorage (e) Real Estate Company and Agent Address Telephone 563-5150 Telephone (f) Mail the HAA to the following address: SRB 196x Eagle .':liver, 2.. TYPE OF RESIDENCE Single-Family [] Multi-Family [] Other Number of Bedrooms (3) Three WATER SUPPLY Individual Welt I~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite [] Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72-025 {11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND'INFORMATION , As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the Son-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 Date SRB 196x Eagle Rivm', Alaska 9957/' Telephone Approved for (c~.) bedrooms b c_~ ; Approved ~/ Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY '1984 264-4720 Legal Description: MUNICIPALITY OF ANCHORAG~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION APR RECEIVED WELL DATA Well Classification '--~ ~ '~~ If A, B. C, D.E.C. Approved (Y/N) Well Log Present ~) Date Completed /9//'~/7 ~ Yield Total Depth ~)(-~) ~ '~ ~1 Cased to Static Water Level Casing Height Above Ground __ Electrical Wiring in Conduit Separation Distances from Well: To Septic/Holding Tank on Lot _ Depth of Grouting ~ Pump Set At ~2~"~', ~'/' / Sanitary Seal on Casing ~,zN'~ Depression Around Wellhea(~'d~ 'J ~ ~ ~ ' On Adjoining Lots To Nearest Edge of Absorption Field on t~ot ~ ~ ~ ~ ~ ' On Adjoining Lots To Nearest Public Sewer Line I,J~/~.~ To Nearest Public Sewer Cleanout/Manhole '~ To Nearest Sewer Service Line on Lot Water Sample Collected by ~) ~ ~ ~ ~ ~ N~C--~__~- I !~ ~ ' Date ~-7__-"] -¢ ~ Water Sample Test Results ~.~-~-~ ~ ¢:~---¢_~-~r-'~ ~ Comments B. SEPTIC/HOLDING TANK DATA Date Installed Stand pipes ~¢~/,N~ Air-tight Caps Depression over Tank,¢¢~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well J ~ c~ ' To Property Line /c~ To Water-MamCService Line ,,~) ~ ~'' ~"'~ ~- ~:~ ~ Size ~ ~o ~ No. of Compartments Foundation Cleanout 4~/.N~ /,Date Last Pumped 'for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field Course To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026t11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed S'-'%~ ~ cd ~ (~::~(.~ Width of Field Square Feet of Absorption Area Depression over Field ¢¢~ Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present ~1~4N~ Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~ o ,.~ ~ ~ To Building Foundation .~,~ ~ 4- Lot ~'41A.-- To Water .Ma~/Service Line '~'~ ~ ~'- To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line ~ t,~- To Existing or Abandoned System on · On Adjoining Lots ~'o ~ "~ To Cutbank (if prese~.~ ~ Comments D. LIFT STATION Date Installed Dimensions Size in Gallons "Pump On" Level at d I High Water Alarm Level at Tested for Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** to all MOA and HAA guidelines in effect on the date of this inspection. . certify that I have checked, verified, or conformed Signed $ & 5 ~'~lirmerin~ Date Company SRB 19&v MOA No. Receipt No. E.I..~iv~".,~,~j[~,~ Date of Payment .,z//.~ .~..4~(¢ Amount: $ (~. ~--o...~;~ Page 2 of 2 72-026 (11/84) ~ DATE RECEIVED INSPECTION APPOI NTM ENTS TIME i TIME TIME DATE DATE DATE INSPECTOR INSPECTOR I N 8 P ECTOI~.. MUNI(~'~E ANCHORAGE DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PROTECTION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street-A,chorage, Alaska 99501 OCT 6 1981 ENVIRONMENTAL SANITATION DI VISION Telephone 264-4720 R E C E I V E D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be proceed. Please allow ten (10) days for processing. 1. PROPERTY OWNER ~ [ PHONE PHONE MAI LI MA~U.G ~s 4. REALTOR/AGEnT - I PHONE M~NG ADDRESS 5. LEGAL DESCRIPTION STREEI I-oc'y/'oN , 6. TYP~ ~IESIDENCE INGLE FAMILY [] MULTIPLE FAMILY NUMBER OF(BEDROOMS [] One [] Four [] Other [] Two [] Five ~Three [] Six WA'r~ 5U.PLY [~ INDIVIDUAL* I I 'COMMUNITY [] PUBLIC UTILITY * 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 '~ IN DIVI DUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY [] ONE [] TWO NUMBER OF BEDROOMS [] THREE [] FIVE [] FOUR [] SIX [] OTHER 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTI LITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or [] Holding Tank Size: If Tank is homemade give dimensions: PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line Septic/Holding Tank 1Absorption Area ISewer Line Nearest Lot Line 5. COMMENTS DATE [[~'~PPROV ED FOR '~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED BY~')Q ~,~ 72-010 (Rev. 6/79) m. DATE RECEIVED INSPECTION APPOINTMENTS ':' TIME ~ ~ /~A~ ,/~./'~ TIME TIME DATE DATE DATE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT~:~N[. OF H~ALTit & 825 L Street- Anchorage, Alaska 99501 ENVIRONMENTAL F,;,:Oi'ECTIOI'4 ENVIRONMENTAL SANITATION DIVISION 3gL 1 ? 1080 lelephone 254-4'120 DIRECTIONS: Complete all parts on pa§e 1. Incomplete request~ will not be proce.~ed. Please allow ten (10} days for processin§. PROPERTY OWNER PHONE MAILING ADDRESS PROPERTY R ESI DENT (If different from above) PHONE 2. BUYER , PHONE MAI LING ADDRESS 3. LENDING INSTITUTION I PHONE I MAILING ADDRESS 4. REALTOR/AGENT I PHONE I MAI LING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four [] SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY ~ Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LITY * 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 UTI Li=FY ~ co 0' 'o¢2c''~ YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6179) t"~. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVI DUAL/ON -SITE [--I PUBLIC UTILITY Connection Verified I-qSeptic Tank or [] Holding Tank Size: [ © '~'-) If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line NUMBER OFBEDROOMS [] ONE [] THREE [] TWO [] FOUR PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING MANUFACTURER MATERIAL [] FIVE [] SlX [] OTHER Septic/Holding Tank 1Absorption Area lSewer Line Nearest Lot Line 5. COMMENTS DATE ~[~APPROVED FOR ._~ BEDROOMS [] CONDITION'AL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 6/79) -~' DATE RECEIVED .' INSPECTION APPOINTMENTS ~J~.L~J-L~4 · TIME ·' TIME TIME DATE DATE DATE NIUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HC. ALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~NVIRONMENTAL F%OTECTION 825 L Street - Anchorage, Alaska 99501 DEC :t 1979 ENVIRONMENTAL SANITATION DIVISION Telephone 264~720-~ REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER DIRECTIONS: Complete all parts on page 1. Incomplete requ~ will not be proce~ed. Please allow ten (10) days for processing. PROPERTY RESIDENT (If different from above) / ~ ' PHONE PHONE 2. BUYER~ 3. LENDINGINST~U[ION J PHONE 4. REALTOR/AGENT PHONE MAI LING ADDRESS ~TREET LOCATION 6. TYPE OF RESIDENCE ~SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER SUPPLY ~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LITY 8. SEWAGE DI,~POSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY NUMBER OF~BEDROOMS [] One [] 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 we~t depth (attach log if available.) /~7 / L('C~ '~'~Z/,//~,'¢~ , YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or []Holding Tank Size: If Tank is homemade give dimensions: NUMBER OFBEDROOMS [] ONE [] THREE [] TWO [] FOUR PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED [] FIVE [] SIX [] OTHER PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line Septic/Holding Tank IAbsorption Area Sewer Line INearest Lot Line 5. COMMENTS DATE [~PROV ED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must/~npany certificate) 72-010 (Rev- 6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION Environmental Health Division CASE REVIEW WORKSHEET CASE NUMBER: S-8191 DATE RECEIVED: June 7, 1985 JCOMMENTS DUE BY: June 28, 1985 SUBDIVISION OR PROJECT TITLE: Lots 80A & 8lB-1 Chambers Subdivision ( ) PUBLIC WATER AVAILABLE ( ) PUBLIC SEWER AVAILABLE ( ) COMMUNITY WATER AVAILABLE COMMENTS: "' ~? :~'~ '"' ' ...... ~ .... 71-014 (Rev. 5/83) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION Environmental Health Division CASE REVIEW WORKSHEET CASE NUMBER: S-7683 DATE RECEIVED: I COMMENTS DUE BY: May 29,1984 I June 22, 1984 SUBDIVISION OR PROJECT TITLE: Chambers Subdivision, Lot 8lB Vacation only ( ) PUBLIC WATER AVAILABLE ( ) PUBLIC SEWER AVAILABLE ( ) COMMUNITY WATER AVAILABLE COMMENTS: 71-014 (Rev. 5/83) CASE NUMBER S-4979 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PLA~rTING OR PLANNING AND ZONING CASE I~IEW / PETITION FOR REZONING SPECIAL EXCEPTION ' VACATION · REGUBDIVISlON DATERECEIVED'. COMMENT TO PLANNING BY Oct 20 '78 COMMENTS: OF Barnard Engineerin§ for Preliminary Plat of Lot 8lA & 8lB a subdivision of S~rtionLo.t 8]_located within the NE 1/4 Section 9 Township 15N R1W, S.M. Ak containing 2.5 acres. FOR MEETING OF NOV 1 '78 of Cases~~ / ENVIRONMENTAL SANITA'~ION: "'.~, PUBLIC WATER NOT AVAILABLE ./ ENVIRONMENTAL ENGINEERING: ~'.'A.,,,..,/ /¥" +; ~"/:, ".. ~.',~', ,.' 71-014 (9/76) ARNARD E ERING I--1 DESIGN 203 WEST I STH AVENUE ENERGY __ PRODUCT I--] CONSTRUCTION ~-} RESOURCE DEVELOPMENT · ANCHORAGE, ALASKA 9950! · TELEPHONE 907-274-5235 Department of Environmental Health Municipality of Anchorage 825 L Street Anchorage, Alaska 99501 Re: Lots 8lA and 8lB Platting Case S-4979 Att: Mr. John Lind Dear Sirs: Submitted herewith are copies of the revised plat showing flood plain information, a proposed well and septic tank location and lot dimensions which make the existing septic tank legal. A copy of the soils log for Lot 8lA is also included. If there should be other requirements please let us know. Sincerely yours Earl R. garffard Encl: 2 DATE: TO: FROM: SUBJECT: Ntu ipality of Anchor e MEMORANDUM November 17, 1978 Jerry Weaver - Planning Dept. John W. Lynn - Environmental Engineering - DHEP Case #S4979 File No.: PB3 Regarding Case #S-4979: Septic tanks and Well Locations are well out of the Flood Plain. John W. Lynn Environmental Engineering JWL:lmp 91-010 (4/76) w~ o ~ ,',,/2 \ Y_~l-bY.. ('93~ dou. J ,'I,L'6~'C ('031:1 IAtqB) 3,,O0,gOoO , t,./. '66Z I / /