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Home My WebLink AboutFIRE LAKE LT 4 TR AOnsite File Fire Lake Lot 4 Tract A #051-332-18 krcev uowu 1 o) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211110 PID Number: 051-332-18 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑® Upgrade Name Sharon & Dennis Anderson ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed Zound Site Address 19170 Fish Hatchery Rd, Eagle River, AK 99577 ❑ Other Phone Number of Bedrooms Soil Rating Total depth fr original grade 242-2227 3 Existing GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Fire Lake Tract A 4 Fill added above original gr Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total a rption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well >1 QQ' N/A N/A N/A >25' TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Greer 1250 Gal. Surface Water > 100' N/A N/A N/A Material Plastic Number of compartments 2 Lot Line >5, N/A N/A N/A NA Foundation >1o, N//A N/A N/ALIFT STATION Manufacturer Capacity Remarks Tank is insulated Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank D3034 Tank to drainfield D3034 Installer JR's Septic Drainfield Existing CO/MTD3034 Inspector J. Millette BENCH MARK (Assumed elevation) 100 ft Inspection 15 5/12/21 Location and description dates: d nd 4" Garage slab 4"' ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp kk Conditional Approval: Date co 49 . . • Benjarrr>chiller �F�; •, Septic System Approved Date 12 X62 CE 12592 .• <<``1 'slF . , 7/15/21 , • pROFESSt4NPP.O.ESSO ):k�, Note: this approval does not include well permit requirements. krcev uowu 1 o) 2CO 1"=50' 3-B D R M H O M E CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND MH PERMIT # OSP211110 PID # 051-332-18 FIRE LAKE SUB, TRACT A, LOT 4 A B MH 39.5 SV 43.5 2CO 45.4 A B 65.6 70.1 72.4 FEET 0 50 100 SHED SHED EXISTING WELL NEW 1250-GAL SEPTIC TANK w/ 20" MANWAY EXISTING SEPTIC TANK REMOVED AND DISPOSED OF PER UPC EXISTING FIELD TO REMAIN IN SERVICE 100' WELL RADIUS SV Benjamin Schiller CE 12592R E GISTEREDPROFE S S I O N A LENGINEERJuly 15, 2021 PLAN AS-BUILT PROFILE AS-BUILT (NO SCALE) 90.9 85.8 91.5 95.5FCOMH SV1250 GAL SEPTIC TANK 2CO90.8 PERMIT # OSP211110 PID # 051-332-18 FIRE LAKE SUB, TRACT A, LOT 4 2" INSULATION Benjamin Schiller CE 12592 R E GISTEREDPROFE S S I O N A LENGINEERJuly 15, 2021 *&v- 3..v' ASSU1L7 h p �V �r- �w pt 3 HERESY CERTIFY THAT I HAVE SURVEYED i FIE SCALE- s I FOLLOWING DESCRIBED PROPER i 3 = � OF A L)�, � fir, s� oy'• s; rte. .� DATE- ..... �� AND THAT NO FN6ROA6HMENTS EAST EXCEPT AS��•' + ___INDICATED. Ii 15 THE RESPONSIBI Li TY OF THE MINER TO DETERMINE THE ME GSTENCE OF ANY eRID: EASngEXTS, COVENANTS., OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUSDI- nuano mirk smward VISION PIAT UNDER WO CIRCUMSTANCES SH4EI1.Pa FB` ANY DATA' HEREON BE USED FOR CONSTRUCTION OF FENCE LINER, OR FOR ESTABLISHING BOUND- DRAWN= �'�n� _ "'ra .0.-rARY LINES. ��S a- �8 r. r� pt 3 HERESY CERTIFY THAT I HAVE SURVEYED i FIE SCALE- s I FOLLOWING DESCRIBED PROPER i 3 = � OF A L)�, � fir, s� oy'• s; rte. .� DATE- ..... �� AND THAT NO FN6ROA6HMENTS EAST EXCEPT AS��•' + ___INDICATED. Ii 15 THE RESPONSIBI Li TY OF THE MINER TO DETERMINE THE ME GSTENCE OF ANY eRID: EASngEXTS, COVENANTS., OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUSDI- nuano mirk smward VISION PIAT UNDER WO CIRCUMSTANCES SH4EI1.Pa FB` ANY DATA' HEREON BE USED FOR CONSTRUCTION OF FENCE LINER, OR FOR ESTABLISHING BOUND- DRAWN= �'�n� _ "'ra .0.-rARY LINES. ��S MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore 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: OSP211110 Work Type: SepticTank Upgrade Tax Code Number: 05133218000 Site Legal Address: FIRE LAKE LT 4 TR A G:0554 Site Mailing Address: 18820 Fish Hatchery RD, Eagle River Owner: ANDERSON DENNIS & SHARON Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date Expiration Date 1 G Y"Y'•3 J C v Ue.partment Lot Size in Sq Ft: Total Bedrooms: 4/26/2021 4/26/2022 108900 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 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: Issued By: Date: ` 2 3 gill I EM, M, Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-332-18 Property owner(s) Sharon & Dennis Anderson Day phone 242-2227 Mailing address 19170 Fish Hatchery Rd, Eagle River, AK 99577 Site address Same Legal description (Sub'd., Block & Lot) Fire Lake Sub, Lot 4 Tract A Legal description (Township, Range & Section) Lot Size 108,900 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank IN Upgrade ❑X Duplex El (D) Holding Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municioal Codes. i (Signature of property owner or authorized agent) Permit/Rush Fees: 2- Z-5 Waiver Fees: Date of Payment: �1 /ZI A2 I Date of Payment: Receipt Number: 03221D Receipt Number: Permit No. 0,519 Z( I I 10 Waiver No. Permit App_:- : ,_..:c April 26, 2021 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 4/26/21 Subject: Fire Lake Sub, Lot 4 Tract A – Fish Hatchery Road Septic tank replacement Dear On-Site Services Engineer: The owner of the above lot has an existing septic tank that has exceeded its 30-year life expectancy. Therefore, we are submitting this permit application for its replacement. The existing septic system was originally designed for a 3-bedroom home but has a 1250-gallon tank, so we are proposing a new 1250-gallon septic tank for this design. The well and existing septic on this lot are shown on the site plan. There are no septic systems or wells on the lots directly adjacent to this one. The tank will be greater than 10’ away from the building’s foundation and at least 5’ away from existing drain field. The existing tank will be pumped and decommissioned per U.P.C. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211110, Deb Wockenfuss, 04/26/21 2CO 1"=50' 3 -BDRM H O M E NOTE: NO SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM. NO WELLS OR SEPTIC SYSTEMS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY. CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND FIRE LAKE SUB, TRACT A, LOT 4 FEET 0 50 100 4/20/21 SHED SHED EXISTING WELL NEW 1250-GAL SEPTIC TANK w/ 20" MANWAY MAINTAIN MIN 5' FROM EXISTING FIELD DECOMMISSION EXISTING SEPTIC TANK PER UPC CHECK TO ENSURE LINE TO FIELD IS FREE OF OBSTRUCTIONS EXISTING FIELD TO REMAIN IN SERVICE 100' WELL RADIUS Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211110, Deb Wockenfuss, 04/26/21 32 DEEHUSON22823€239 95 sevne Wen 46 Piccole che 330 SugAL ASKA ASBUILT SEWARD &ASSOCIATES LAND SURVEYING 694-0829 I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE : FOLLOWING DESCRIBED PROPERTY :1²gd FIRE LAKE 30B ,2014,TRATA AND THAT NO ENCROACHMENTS EXIST EXCEPT AS DATE 1114120 INDICATED .IT IS THE RESPONSIBILITY OF THE STATEOF OWNER TO DETERMINE THE EXISTENCE OF ANY 4974 GRID : EASEMENTS ,GOVENANTS ,OR RESTRICTIONS Home WHICH DO NOT APPEAR ON THE RECORDED SUBDI VISION PLAT .UNDER NO CIRCUMSTANCES SHOULD FB : Duane Merk Soward i5-5918 ANY DATA HEREON BE USED FOR CONSTRUCTION 147-73 OF FENCE LINES ,OR FOR ESTABLISHING BOUND ARY LINES .DRAWN : DO0992 Megastered Surveyou MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE ~NEW MAILING ADDRESS LEGAL DESCRIPTION ~'~ ~ C~ LOCATION NO, OF BEDROOMS Well [ Absorption area DwelHng PERMIT NO. ~ ~Z < Manufacturer ~M C YO~ ~ r~ Materla~ ~ ~ Liq./~n gallons IF HOMEMADE: Inside length Width Liquid depth a ~ ~ Z ~ DISTANCE TO: Well~ Dwelling PERMIT NO. O Z ~ Manufacturer Material Liquid capacity in gallons = Well F°undati°n3 Z ~ Nearest lot lingo I PERMIT NO~ Distance between lines No, of lines ~ Length of~¢each[ine , Total length of~linesl Trench~th/ ~ ~ ~ Top of tile to finish grade Material beneath tile Total effective absorption area Length Width Depth PERMIT NO, ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area m Well Building foundation Nearest lot line m DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. m Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER ~ /~ PiPE MATERIALS - SOIL TEST RATING ]~ ~ ,, REMARKS ~ APP~ Br~c~J. CO.in ) ,~ DATE LEGAL PERMIT N[]: BATE ISSUED: DE.F'ARTMENT OF"" HEAL. TH AND ENVIRONMENT~L F:'ROT~TION B25 L STREET, ANCHORAGE, AK 99501 264---4720 C)N ....... S I 'I-E SEWER 8oUuUJ ENGINEERED DESIGN AF:'PL I CANT': ADDRESS: C[IN"f'ACT PHONE".: Al_. RAMUSSON P 0 BOX 770766 EAGLE RIVER, AK 688-2805 99577 I....EGAL. DESCRIF': SUBDIVISION: FIRE LAKE LOT: 4 BLOCK: A SE[,]TION: 51 TOWNSHIP: 15N RANGE: 1W I..[Yl' !SIZE:: :1.0S900 (SQ.FT. OR ACRES) I cer't, ify that.' ,1,. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska, 2. I will install the system in accordance with all MOA codes and regulatior~s, and in compliance with the design cpiteFia o~ this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back dis.'Lances from any existing well, wastewater disposal system or publ. ic sewerage syst. em on this or any adjacent op nearby lot. IF' A ILIFT' STATION IS INSTALLED IN AN AREA COVERED BY MOA BUlL, DING CODES, THEN (1) AN ELEC]'RICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-GUILTS WILL. NOT BE AF.'PROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE IEI,,,.ECTRICAL. WORK MIJST BE DONE BY A LICENSED ELECTRICIAN; ,:~ 1 bNED APPL..IC~NT~ ~1. ~HUSBON l ,:~SIJED BY -- ". .1. . · · . ~ . . . . ~ ~ ~ ~ ..... ~ TO Septic T~I .. , . / PLAN VIEW ~A /~.5' / · ' ~ 4 ~ -0 . ~ /' .; ~........: · . ......: ..: ......: · · .........:: '......~: '.. :.. ~. ~ ~, I/~- z i~' · ~:. ;....::'...:.;. ::..i'>.;'.' .'. ,: .; .',.. '..".'.'..'.~.'.'. .'. .'. '.' ....... :.:.~ ~.T.S. t .o' I. Oeodt ~,o to dlv~t ~foc~ ~at~r away f~ ~d. BEDROCK ~. T~ ~dr~ Wlllm. 3. I~IH t~ fill rated Of .... ENTERPRISES BED DESIGN Prw~ L~T 4, TRACT A, FIRE LAKE SUB. PLAN VIEW SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST PERFORMED FOR: .~~'~ D Y~ LEGAL DESCRIPTION: SLOPE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20- DATEPEREORMED: 6'5'85 StTE PLAN WAS GROUND WATER ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) FT AND FT , TEST RUN B/ETWEEN -- PERFORMED BY: ,.~,~.A A-.~ CERTIFIEDBY:///~/~"DATE:~¢/~ 72-008 [6/79) SPECIFICATIONS FOR ELEVATED BED ALTERNATIVE WASTEWATER TREATMENT SYSTEM - LOT 4, TRACT A, FIRE LAKE SUBDIVISION 1.0 2.0 3.0 GENERAL 1.1 THE DRAWINGS SHALL BE A PART OF THIS SPECIFICATION. 1.2 ALL MATERIALS AND WORKMANSHIP SHALL MEET THE REQUIRE- MENTS OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRON- MENTAL PROTECTION PERMIT. 1.3 ALL EXCAVATIONS AND DEPTHS ARE ADVISORY AND ARE TO BE VERIFIED OR MODIFIED IN THE FIELD BY THE CONTRACTOR. THE LIFT STATION (NOT USED) SEEPAGE BED 3.1 THE GRAVEL FOR THE BED SHALL BE SCREENED TO THE SIZES INDICATED. 3.2 THE BOTTOM OF THE EXCAVATION SHALL BE RAKED WITH THE BACKHOE BLADE TO ENSURE THAT THE BOTTOM HAS NOT BEEN COMPACTED DURING EXCAVATION. THE BOTTOM ELEVATION SHALL BE PLUS OR MINUS 2". 3.3 THE BED WILL BE EXCAVATED 4.5' BELOW ORIGINAL GRADE. CLEAN SAND WILL REPLACE THE EXCAVATED MATERIAL. 3.4 THE DISTRIBUTION PIPE SHALL BE RIGID PVC, ASTM D-2729, PERFORATED PIPE. THE PIPES SHALL BE LAID LEVEL. 3.5. THE SAND SHALL HAVE AN EFFECTIVE SIZE OF 0.4 TO 0.6 MM AND A UNIFORMITY COEFFICIENT OF NOT MORE THAN 4. 3.6 THE GRAVEL SHALL BE COVERED WITH A LAYER OF UNTREATED BUILDING PAPER OR A NON-WOVEN FABRIC SUCH AS MIRAFAR FIBRETEX 200 GRADE, OR POLY-FILTER X OR EQUAL. 3.7 THE BERM AROUND THE SEEPAGE BED SHALL BE CONSTRUCTED OF PER 2.5 FOOT HORIZONTAl_--- -- 3.8 AN OBSERVATION PIPE~SHALL BE PLACED AS SHOWN IN THE DRAWINGS. IT SHALL BE RIGID PVC, ASTM 3033, D-3034. THE SECTION SHOWN WITH HNOLES MAY BE EITHER DRILLED 0.5" HOLES @ 6 INCH CENTERS ON OPPOSITE SIDES OF THE PIPE OR A REGULAR SECTION OF REGULAR PERFORATED SEWER MAY BE CLAMPED TO THE SOLID SECTION WITH A NO HUB COUPLING OR SOLVENT JOINT. A RUBBER RAIN-CAP (JIMCAP OR EQUAL) SHALL BE PLACED ON THE TOP OF THE PIPE. 3.9 IF INSULATION IS REQUIRED THE INSULATION SHALL BE DOW EXTRUDED BLUE STYROFOAM INSULATION BOARD OF THE THICKNESS SHOWN ON THE DRAWINGS. 3.10 THE TOP AND SIDES OF THE BED SHALL BE PLANTED WITH A WHITE CLOVER AND RED FESCUE MIX OR BLUE GRASS. 3.11 THE SEPTIC TANK OF BED MUST NOT BE CLOSER THAN 100 FEET TO ANY EXISTING WELL OR BODY OF WATER. MUNICIPALITY Development Services Department On -Site Water & Wastewater Section Parcel I.D. 051-332-18 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: IVoy i 2, "zDa2l Complete legal description Fire Lake, Lot 4, Tract A Location (site address) 19170 Fish Hatchery Road Eagle River, AK Current property owner(s) Dennis & Sharon Anderson Day phone (907) 229-0065 Mailing address 19170 Fish Hatchery Road Eagle River, AK 99577 Real estate agent Barbara Crittenden 2. TYPE OF DWELLING: ❑■ Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone (907) 242-2227 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: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ -6-- -t Date of Payment I 30 d Receipt Number. 019956 COSA # 05C_2 I I y 3 5 Date: Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date 7/28/21 <<1_ * co - :49 TH 6. DSD SIGNATURE ..... . .. • .. System #1 Approved for 3 bedrooms �. Benja I in Schiller .4 System #2 Approved for bedrooms CE 12592 7/28/21 Disapproved �� FROFESs10Nt Conditional approval for bedrooms, with the following stipulations: �\s\s �-��Y OF'q �i��i �v v 'moi ON-SITE WATER AND 1i� j��)))SERN . Original Certificate Date: /J-0 a 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 blue sheet COSA Checklist yellow sheet COSA Checklist Legal Description: Parcel ID: If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test?Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample Comments __________________________________________________________________________________ B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA ______________________ Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade 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 Adequacy test date 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) If yes, enter date Comments/Deficiencies: Grade over bed differs slightly from east to west. Fire Lake Sub, Lot 4 Tract A 051-332-18 1 8/8/76 525** *325 22.7 0.343 >12 FORGE ENGINEERING 9/9/20 16 7/13/21 *Well deepened in 1986, additional well log attached **525 gallon bladder tank in crawl space. <1 SEPTIC/PLASTIC N/A ■ Tank installed on 5/12/21 8/28/85 9/9/20 3 3.8 0 *2.6 532 0 ■1440 0 >450 *The majority of the bed has at least or over 3' cover. The system has been in continuous use since installation and no freezing has occured. ✔ 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 if No ft Neighboring Tank > 100’Yes if No ft Absorption Field on Lot > 100’Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’Yes if No ft Holding Tank > 100’Yes if No ft Animal Containment > 50’Yes if No ft Manure/Animal Excreta Storage > 100’ 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 Property Line > 5’Yes if No ft Absorption Field > 5’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’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 Property Line > 10’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft F. ENGINEER’S COMMENTS G. ENGINEER’S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 8/5/21 ✔✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ 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 _-'~/~' GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name/¢_RS~_L't-c-c4~'-j E'AJ-r Telephone: Home .............. Business (~1,¢~I Applicant Address ~P__O,~O ~ ?7 0 ?~,~ ~O~__~J~ E'~/~_~/"¢__ /~_,~ ......... (c) Applicant is (check one): Lending Institution []; Owner/builder~(~; Buyer []; Other [] (explain); (d) Lending Institution Address Telephone (e) Real Estate Company and Agent Address ......................... Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Farnily~ Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Individual Well [~. Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ~. Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from tho State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 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 adequete 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 end/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm COI~I,~IIAJ .~ /O~(~//~?iE'~ /,4.~Telephone _,~.~ /~ (~ /5'/ Date --~ Engineer's Seal DHEP APP~ Approved for Approved bedrooms b~~-~Date __ Disapproved Conditiona~,,~..._~ 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 el Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to sabsfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY '1984 264-4720 Legal Description: FIIZE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION .RECEIVED 4 coc/ A WELL DATA Well Classification Well Log Present (Y/N) P/ZIV~'T~ If A, B, C, D,E.C. Approved (Y/N) Date Completed .~_L,)~- ~.~ /~'7~, Yield 2.~_, 7 / Depth of Grouting ? Pump Set At 7 /, ~ Sanitary Seal on Casing (Y/N) Y Depression Around Wellhead (Y/N) -,/ Total Depth / '7'~ / Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot Y To Nearest Edge of Absorption Field on Lot /0 ~, ! To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments /O4> 4- ; On Adjoining Lots ; On Adjoining Lots / OC~ -/-- TO Nearest Public Sewer Nearest Sewer Service Line on Lot ; Date ~ -- B. SEPTIC/HOLDING TANK DATA Date Installed ~ Size /~- 5~::) No. of Compartments Standpipes (Y/N) '~' Air-tight Caps (Y/N) "~ Foundation Cleanout (Y/N) Depression over Tank (Y/N) ./'~ Date Last Pumped ~.///~ Pumping/Maintenance Contract on File (Y/N),~,/./ /~'/,~I-~) ;for Holding Tank High-Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well / 0¢3 ! To Property Line ~O / To Water Main/Service Line Course Comments AJoAJ -'~''~ To Building Foundation ~ .'~ '/ To Disposal Field ~ / To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C, ABSORPTION FIELD DATA Soils Rating in Absorptipn Strata ~ ~_~~~_yvJ Type of System Design Date Installed ~ /a~...~.., /~_~- Length of Field ,.~ ~ I Width of Field /~ / O, ~' ! Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Depth of Field /! Gravel Bed Thickness ~'o C,,/Z/4 tf£C. Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot 3 ~" I ¥_ TO Water Main/Service Line /O~, / Standpipes Present (Y/N) ~' / Date of Last Adequacy Test . To Property Line ~,C.) / TO Existing or Abandoned System on ; On Adjoining Lots ~ ~ t .t(.' To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments /4J O/~ _i~' LIFT STATION~_O 'T' Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test, Meets MOA Comments ' ** Check Per~tted Bed~/om Bating Against HAA Request ** I certify t h a,/[/~ye, cheG~.~'~~, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Sig ned//,,'Y~/~"//~r" ~1--..-1~.1,, Date Receipt No. ~ ~ % ~ ~ ~ Date of Payment Amount: $ ~ ~ ~ Page 2 of 2 72-026 (11/84) GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C'" Street, Anchorage, Alaska 99503 274-4561 Date Received Time of Inspection ~,~X~S~( //~ ~ ~/~ ~ Date of Inspection _~~ REQUEST FOR APPROVAL OF /~--)Zd/- INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: 3. Legal Description: 4. 5. 6. Phone: Dennis Anderson Phone: Lot 4 Tract A Fire Lake Subdivision Location: Fish Hatchery Road Type of facility to be inspected Well Data: Individual A. Type C. Construction Sewage Disposal System: A. Installed C. Septic Tank: D. Seepage Pit: 1. Size 1. Absorption Area E. Disposal Field: Total length of lines Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank C. Absorption area to nearest lot line No. of bedrooms B. Depth D. Bacterial Analysis B. Installer 2. Manufacturer 2. Material , Absorption area , Other contamination , Absorption area Sewer Lines EQ-034 (1/74) Page 1 of two pages Page 2 cf two pages - Re '~t for Approval of Individual .~r & Water Facilities Legal ~Description Lot 4 Tract -A Fire Lake Subdivision Comments Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and tccurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) SULTL'CTt 8ova~ DispooeA hdotLul Hem, Lot # FiN Leke 8ubdivioieu The Wearer, Imebe~el~ Apea let, eulh HoaXth ~m ~e,ed md ~p~d ~e Ante-