HomeMy WebLinkAboutMOUNTAINSIDE VILLAGE BLK 2 LT 3Mountainside
Vi'811age
Block 2
Lot 3
#020-172-11
Municipality of Anchorage
On-Site Water and Wastewater Section • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP231208 PID Number: 020-172-11
Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade
Name
MICHELLE TURNER & CARL JOHNSON
ABSORPTION FIELD - EXISTING
❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
17800 STEAMBOAT DRIVE, ANCHORAGE
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
MOUNTAINSIDE VILLAGE 2 3
Fill added above original grade
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 absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ft'
Ft.
Well
100'+
--
25'+
TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
GREER
Capacity
1500 Gal.
surface water
100'+
--
Material
HDPE
Number of compartments
2
Lot Line
10'+
__
NA
Foundation
10'+
LIFT STATION
Manufacturer
Capacity
Gal.
Remarks
Alarm location
Electrical installed by
Installer JRS
PIPE MATERIAL House to tank 3034Tank to 3034
drainfield
Drainfield CO/MT 3034
Inspector FWCS
BENCH MARK (Assumed elevation) 100 ft
Inspection 1' 9/1/23 2nd 9/1/23
Location and description
3rd 4th
TOP OF MH
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
:41�k
Conditional Approval: Date
��TI . •Z__
�Septic
Curtis Huffman • ,
Syste
Approve Ynt
CE128991Dat•9/5123 • ���Note:
this approval does not include well permit require
1SS\0
7 UDNL/l0)
PID:020-172-11 PERMIT:OSP231208
FIRST WATER CONSULTING
MOUNTAINSIDE VILLAGE B2, L3
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: OSP231208
Work Type: SepticTank Upgrade
Tax Code Number: 02017211000
Site Legal Address: MOUNTAINSIDE VILLAGE BLK 2 LT 3 G:3439
Site Mailing Address: 17800 STEAMBOAT DR, Anchorage
Owner: TURNER MICHELLE T &
Design Engineer: FIRST WATER CONSULTING
This permit is for the construction of:
Effective Date:
Expiration Date:
i�1 an t
�0 roc .,;: P S`
U r.
O
Department
Lot Size in Sq Ft:
Total Bedrooms:
8/14/2023
8/13/2024
55000
❑ 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: S �� D 7-0 LJ C,
Issued By:
Date:
Date: `7 2t i 3 .
E
MUH CO P'\'LIITY 0 /\ HCH0�i� GL:
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 02 0-172-11
Property owner(s) Carl Johnson & Michelle Turner Day phone
Mailing address 17800 Steamboat Drive Anchorage, Alaska 99516
Site address 17800 Steamboat Drive Anchorage, Alaska 99516
Legal description (Sub'd., Block & Lot) Mountainside Village Block 2 Lot 3
Legal description (Township, Range & Section)
Lot Size 55,000 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(N all that apply)
Absorption Field ❑ Initial ❑
Single Family (SF)
Septic Tank Q Upgrade Q
(w/wo ADU)
Holding Tank ElRenewal ElDuplex
(D) El
❑
Multiple Dwellings E]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: Z — Waiver Fees:
/ f >Z-3Date of Payment:
Date of Payment:
Receipt Number: Receipt Number:
Permit No. IWO Waiver No.
G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
!
!!
July 25, 2023
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC TANK UPGRADE PERMIT
LEGAL: MOUNTAINSIDE VILLAGE BLOCK 2, LOT 3
The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic
tank on the above referenced lot. We propose to install a 1500-gallon HDPE tank per the
attached design to serve the existing 4-bedroom residence. The 1500-gallon HDPE tank to be
installed allows for future consideration or flexibility. No groundwater was noted in the MOA
on-site file, but if groundwater is encountered during installation an epoxy coated steel septic
tank may be required. The lot and area are served by private water. The design will not impact
any of the neighboring properties. Please contact us if you have any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231208, Curtis Townsend, 08/14/23
FIRST WATER CONSULTING
NO WELLS WITHIN
100' OF PROPOSED
SEPTIC TANK
MOUNTAINSIDE VILLAGE B2, L3
DESIGN DETAILS:
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231208, Curtis Townsend, 08/14/23
10' UTILITY
EASEMENTS
li
Lot 3
Lot 4
Lot 3
55,000 S.F.
A�
I ar
f
i
1 ,
48.2'
O-
1
4.0.'x14.5'
MANHOLE` BALCONY- A
WELL
SEPTIC
PIPES
FIRE PIT
/ S
I l '
WIRE FENCE
6'
1 30.0' I
I I
I �
S
00'49'00"E
15.40'
\
�rn
'(
4
00
11
0o
o
j v
f
a
1
�
` r
/
44
h
16.3'x24.3'
2 STORY
GALLERY
S 11'22'00"E
3.5'x8.1' DECK 39.01`'
� 1
1
10' UTILITY
EASEMENTS
Lot 4
Lot 2
I \
I I
PLOT PLAN=_ AS BUILT_ _X SCALE _1 5' _ GRID _ SW 3439Project No. 23=45Z/A1 __
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, inc. (907) 522-6476 Phone
kenOlangsurvey.com
Professional Land Surveyor s jonothanOlangsurvey.com .s OF AL kl
travisOlongsurvey.com P'��! ' ' ' • -1
I hereby certify that I have surveyed the following described property:
LOT 3, BLOCK 2, MOUNTAINSIDE VILLAGE SUBDIVISION (PLAT No. 79-177)
Anchorage Recording District, Alaska, and that the improvements situated thereon are
within the property lines and do not encroach onto the property adjacent thereto, that
no improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible
easements on said property except as indicated hereon.
Dated this the __'_'= Day oft'"t�4r�__,_'?`___, at Anchorage, Alaska
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat.
r
>
!Gj •'
48TH •9 I
*. .*
KENNETH G. LANG
0 5242 i
ll P QFf5514N���•��
State of Alaska AECC963
►�o�.n..kalt-,,sib U; l�ao�e �3- a L- 3
AAAROW PUMP & WEA[ SERVICE, LLC UHOMO U(CIE
P.O. Box 110496
Anchorage, AK 99511 NO. 9486
Office: (907) 346-9355 • Fax (907) 333.8976
Eagle River: (907) 622-9335
CUSTOMER
_ r`/i/vG �/✓ice✓ _ _'''�K.---
L
JOB SITTE,! —I
INVOICE GATE
l /1 /
WELL OEPTIIeWL
-�
f
CHI-CMNATED
PUMP DEPTH /
SALESPERSON
QU NTITY
DESCRIPTION
PRICE
;' < i'=C_-7z/fin_.
-j�AMOUNT
—yam ✓ _.Jt`L7. L�'?J..: S'L �4�J_��`!/C.C�_a-.> �./ Es/ (G
- �_J� __
_'_`_`_..
�
�._
-- _
{/ > S ; � S �e /r,� . 1"a« r r✓��i cam-
LABOR
HOURS
RATE
AMOUNT
TOTAL MATERIAL
TOTAL LABOR
WORK ORDERED BY
DATE COMP.
TOTAL
LABOR
PAY THIS AMOUNT 3Z o
Thank You
SIGNATURE
(1 Hereby Acknowledge the Satisfactory Completion of the Above Described Work and agree that if above work is not paid for in 90 days I agree to allow Aarow
Pump & Well Service, L.L.C. the right to remove unpaid for equipment and charge for labor already performed & labor to remove unpaid for equipment)
TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE.
SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS.
MUNICIPALITY OF ANCHORAGE
® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
\\ 82.5 LStreet - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND WELL INSPECTION REPORT
NAME PHONE NEW
_ L� %>•-]C�'i�?..=�"��1 1-C.-r11._t2C._ ---- ------ ----- �96 e ❑ UPGRADE
MAILING ADDRESS
'� ~ V r� q W �5 -
LEGAL DESCRIPTION
� l
LOCATION
NO. OF 6EDROOMS J'
DISTANCE TO:
Well Absorption_zrea
p, i� �'
Dwelling /
JV &L1
PERMIT NO.
810 riq
h Z
Manufacturer
MaterialC
No. of compartments
Li rapacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
L
O 0 z
DIS E TO: Well e lint'
PERMIT NO.
-__--
2 O E Q
anufacturei erial
Liqu aVacity In gallons
Well
DISTANCE TO: ��yr
Found atign Nearest lot line
A1�7- f��
PERMIT NO.
'R- 1`0
O
��
No. of lines Vim each line
LJ��{7_
_
Total length o lines Trench width
�–inches
Distance between lines
-/
Top of the to finish gradde
Material beneat the
e.yL n e
Total effective ab oiption ar n
W
Length Width
Depth
PERMIT NO.
–
Q Ip
Type of crib
–
Crib diameter
Crib de
Total effective a ption area
0. a
W
—
W
N
DISTANCE TO:
Well
Building foundation
N t lot line
J
Class Z
Depth
Driller
Distance to lot line
PERMIT NO.
J
7 r lij
_
W
DISTANCE TO:
Building foundation
Sewer line
Septic tank _
Absorption area (s) –
OTHER
nM. C)
PIPE MATERIALS
G "o � ry `7 - � d 0
r°
SOIL TEST RATING
V
INSTALLER
//++
�r47fw�U-
REMARKS
1
—
101
I
_
APPROVEDDATE
y�
�C4yl
�jLEGAL
TYPE OF SOIL HRPTION SYSTEM ITRENCH
MHXIMUM NUMBER OF BEDROOMS � 4 SOIL RHTING (SQ 225
THE REQUIRED SIZE OF THE SOIL IRB SORPTION SYSTEM IS�
�Q���� �� ��������� �
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFlELD�
THE DEPTH OF R TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFHCE OF THE
GROUND HND THE BOTTOM OF THE EXCHVHTION (I.1 FEET)
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRHYEL DEPTH IS THE MlNIMUM DEPTH OF OUTFALL PIPE
HND THE BOTTOM OF THE EXCHVHTION (IN FEET)
A �.... ����
PERMIT HPPLICHNT HHS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURING THE
INSTHLLHTION INSPECTIONS OF MAY WELLS HDJHCENT TO THIS PROPERTY HND THE
NUMBER OF RESIDENCES THHT THE WELL WILL SERVE.
fl:::')I P -A ��R.- F, E 1C. If-"' F. ��^~
BHCKFILLING OF HNY SYSTEM WITHOUT FINHL INSPECTION HND HPPROVHL GY THIS
DEPHRTMENT NILL BE SUBJ�CT TO PROSECUTION.
MINIMUM DISTHNCE BETWEEN H WELL HND HNY �N~SITE SEWHGE DI�POSHL SYSTEM IS
100 FEET FOR H PRIVHTE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTHNCE FROM 8 PRlVHTE WELL TO H PRIVHTE SENER LINE IS 25 FEET HND
TO HCOMMUNITYR�SEWERELINEDISU75 FEET|TURNED TO THE DEpHRTMENT WITHIN ]0 DHYS
WELL LOGS M�� �UIx u
OF THE HELL COMPLETION
OTHER REQUIREMENTS MAY HPPLY. SPECIFICHTIONS HND CONSTPUCTION DIHGRHMS HRE
HVHILHBLE TO INSURE PROPER INSTAt- LHTION-
W K IT: 1-1 X - V FEE Fo, Y 0, �E�E �'-1 F..", LH.. E.-,3 AL
I CERTIFY THAT
1� I HM FHMILIHR WITH THE REQUIREMENTS FOR Or-4--S-IFF:SEWERS HND WELLS HS SET
FORTH BY THE MUNICIPHLITY OF HNCHORHGE
2 I WILL INSTALL THE SYSTEM IN HCCORDHNCE WITH THE CODES.
]` I UNDERSTHND THRT THE ON�SITE SE�ER SYSTE� MHY REQUIRE ENLHRGEMENT IF THE
R SIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS
HPPLICHNT JHMES HITCHCOCK
/
DHTE
ISSUED BY�L������������
DEPHRTME/�/ / M� �
^
ENVIRONMENTHi ,�OTECTION
/M
STREET/
fill CHORHGE,
264~4720
:'I������
HPPLICHNT
JHMES HITCHCOC
PHLMER
99645 ]76~5�59
LOCHTION
STEHMBOHT DR �
LOT SIZE
55000 SQUHRE FEE.T
LEGHL
L] B2 MOUNTHIN SIDE VILLHGE
TYPE OF SOIL HRPTION SYSTEM ITRENCH
MHXIMUM NUMBER OF BEDROOMS � 4 SOIL RHTING (SQ 225
THE REQUIRED SIZE OF THE SOIL IRB SORPTION SYSTEM IS�
�Q���� �� ��������� �
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFlELD�
THE DEPTH OF R TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFHCE OF THE
GROUND HND THE BOTTOM OF THE EXCHVHTION (I.1 FEET)
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRHYEL DEPTH IS THE MlNIMUM DEPTH OF OUTFALL PIPE
HND THE BOTTOM OF THE EXCHVHTION (IN FEET)
A �.... ����
PERMIT HPPLICHNT HHS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURING THE
INSTHLLHTION INSPECTIONS OF MAY WELLS HDJHCENT TO THIS PROPERTY HND THE
NUMBER OF RESIDENCES THHT THE WELL WILL SERVE.
fl:::')I P -A ��R.- F, E 1C. If-"' F. ��^~
BHCKFILLING OF HNY SYSTEM WITHOUT FINHL INSPECTION HND HPPROVHL GY THIS
DEPHRTMENT NILL BE SUBJ�CT TO PROSECUTION.
MINIMUM DISTHNCE BETWEEN H WELL HND HNY �N~SITE SEWHGE DI�POSHL SYSTEM IS
100 FEET FOR H PRIVHTE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTHNCE FROM 8 PRlVHTE WELL TO H PRIVHTE SENER LINE IS 25 FEET HND
TO HCOMMUNITYR�SEWERELINEDISU75 FEET|TURNED TO THE DEpHRTMENT WITHIN ]0 DHYS
WELL LOGS M�� �UIx u
OF THE HELL COMPLETION
OTHER REQUIREMENTS MAY HPPLY. SPECIFICHTIONS HND CONSTPUCTION DIHGRHMS HRE
HVHILHBLE TO INSURE PROPER INSTAt- LHTION-
W K IT: 1-1 X - V FEE Fo, Y 0, �E�E �'-1 F..", LH.. E.-,3 AL
I CERTIFY THAT
1� I HM FHMILIHR WITH THE REQUIREMENTS FOR Or-4--S-IFF:SEWERS HND WELLS HS SET
FORTH BY THE MUNICIPHLITY OF HNCHORHGE
2 I WILL INSTALL THE SYSTEM IN HCCORDHNCE WITH THE CODES.
]` I UNDERSTHND THRT THE ON�SITE SE�ER SYSTE� MHY REQUIRE ENLHRGEMENT IF THE
R SIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS
HPPLICHNT JHMES HITCHCOCK
/
DHTE
ISSUED BY�L������������
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Mi
Alaska ' cl-As la PI ( ) 7U 1551 �f ''
loot 907 2 (7eietopiee 907)2/1-5742
4040 "B' Street Anchorage, Alaska 99503
October 21 , 1980
W. O. #A19551 or PNC HORPIGE
Grid: 3439 ti;UrnIrPury
Co
ENJ1kGNN�Er;1,-:,
Mr. Dar] Rogers J' 6 i)
SRA Box
Anchorage,
Anchorage,A AK 99507 8
Subject: percolation Tests
Mountainside Village
Gentlemen:
Lot 3
We have completed percolation tests on Block oLot 51 Mountainside
Block 2, Lots 1, 2, 3, 4; and Block 3,
Village Subdivision.
'Pest holes were drilled by Denali Drilling, :Enc. using a
continuous flight auger mounted on a Nodwell carrier.
r1YTest
hole logging and percolation tests were performed by
Latch and Mr. T. Barber, Alaska Testlab geologists, and
Mr. M-3. Holum, DOWL engineer.
After the hole wase drilled, a 3/4" slotted PVC pipe was in-
serted in the hole to maintain an open hole. The hole was
fi:l.l.ed with waterheand holeeft wasoreiill}ed w�th�l water`. The water
following day,
level was recorded at 10 ritiin1te evelsA were'
betweenn3 andt7 feet.
During the tests, the water
below ground surface.
The minimum percolation rates were observed during the last
10 minute interval.. We suggest that on-site waste disposal
systems be designed as follows:
Percolation Recommended
Rate Absorption Area
(rni.nutes/inch) Per. Bedroom (sf)
8.0
150
Block 1 a Lot.
3
2.86
100
Block 2 LO
120.0
225
j.,ot
2
20.0
225
Lot
3
2 86
100
Lo t
4
125
131oCk 3 - 1,0t
5
5.0
9
Page
Absorption trenches are suitable for all tested lots. The
recommended absorption rate per bedroom is based on criteria
in the "Manual of Septic Tank Practice", U.S. Department of
Health, Education, and Welfare.
A well in the Keno Hills Subdivision is located 104 feet
from the test hole at Block 1, Lot 3. The drainage system
should not be placed within 100 feet of -this well.
The water table was observed at 14 feet below ground surface
at Block 2, Lot 2. Drainage trenches should remain six feet
above this :Level.
We recommend the absorption trenches be inspected prior to
installing the system since the tests are based on a 6 inch
diameter test hole. Trench conditions will provide a more
extensive picture of subsurface conditions. If trench
conditions differ significantly from"the test hole condi-
tions, the trench length may be changed to improve system
performance.
The following items are attached:
Test Hole
Logs
Figures
1-6
Test Hole
Locations
Figure
7
Standard
Explanatory Information
Sheets
1-3
We trust this report meets your present needs. If we can be
of further service, please feel free to contact us.
MJH:rb
Enclosures
APPROVED
W? ,, . 0 ac Lam'
Melvin R. Nichols, P.E.
Laboratory Manager
Very truly yours,
ALASKA TESTLAB
Mark J. Holum
OF A44t tp
pJ::' •, O'.•' Awlem •�`. Y �o�
17.7
...r
»..t.. &,Joe ..............
••i
Melvin R. Nichols 4W
46., No. 4113•E ,•'
AW
(t� reg'•••.....•
1n dV.4f'Ow"1.°4 ��
t3 t. o 1< 2 .- r,c t
Mouritain3ide VI -LI -age
DeL)th in Feet
Front To
0.0` 1.0'
1.0' - 2.0'
2A' _. 1 6- 0'
Date: 10/16/80
i.ogged By: O.M. Hatch
W.O. 4A19551
Soil Descri ti On
[frown
Peat
(Pt),
moist,
soft.
Brown
Sandy
Silt
(ML),
moist, stiff, NP.
Brown Silty Sandy Cravel (GM) with occasional
cobbles anal boulders, moist=, medium dense,
subrounded particles to 29"+.
Bottom of Test ifole: 16.0'
1!"rost. Tine: None Observed
Free Ywater None Observed
L,cvel
Type Of
Unified Soil
Depth
Sample
Classification
----_ ----
Saw,pI e
— ---
Grab
GM
2
10. U'
Grab
GM
GM
3
15.0'
Grab
to Sheets
1-3 for unified Soil.
-i-cation
Classif
Rem,rk,
Refer
I
explanation.
A
`CALASKA MUUMUU COnTROL SMIUS, InC.
5
Cngmeerinq & Cnuironmenlal $ludies
P. 0. Box 240668
Anchorage, AK 99524-0668
(907) 279-5553 FAX (907) 276-8706
June 19, 1990
Department of Health & Human Services MUNICIPALITY OF ANCHORAGE
Municipality of Anchorage DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
825 I, Street, Fifth Floor
Anchorage, Al( 99,301 ,
ATTN: John Smith `tl��3
RECEIVED
PPI: Lot 3, Block 2, Mountainside Village
PID# 020-172--11
Dear Mr. Smith:
On September 11, 1989, 1 performed an adequacy gest on the
septic system for this house. For 3 hours water was
introduced into the system at 3.7 gpm. Except for an
initial rise of 0.71 feet for the first 100 gallons, there
was no further rise. Upon stopping flow, the system level
dropped rapidly. The system was adequate for at least a 4
bedroom house.
When the system
home. However,
existing owner
existing system
LCR/sr
was built, i.t was
the house was only
were to enlarge the
would be adequate.
built for a 4 bedroom
a 3 bedroom. If the
house to 4 bedrooms, the
Sincerely yours,
Leroy P.eid, Jr
PhD, PE, DEE
41cIa%�e' M&86
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel 1. D. 020-172-11-000
Expiration Date:
Legal description MOUNTAINSIDE VILLAGE BLK 2 LT 3
Site address 17800 STEAMBOAT DR Anchorage AK 99516
12/14/2023
Current property owner(s) TURNER MICHELLE T &JOHNSON CARL H
X The On-site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
Original Certificate Date: 9/14/2023
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 Approval_June 2022
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 020-1
Complete legal description MOUNTAINSIDE VILLAGE BLOCK 2 LOT 3
Location (site address). 17800 STEAMBOAT_ DRIVE ANCHORAGE, AK 99516
Current property owner(s) DAVID & LADONNA MAPSTON LIVING TRUST Day phone
2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS
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 NEW - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ 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 $
S 5
3U
Waiver Fee $
Date of Payment13�z3
Date of Payment
COSA # 0 S C
Waiver #
COSA Application 2022.doc
COSA Checklist copy.docx
COSA Checklist
Legal Description: MOUNTAINSIDE VILLAGE BLOCK 2 LOT 3 Parcel ID: 020-172-11
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 *Unknown Total depth **85 ft
Cased to **26 ft *Bedrock at 18’
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 24 in.
Date of flow test for COSA 7/5/23
Static water level at beginning of test 24 ft.
Well production at time of test 6+ gpm
Water storage tank volume NA gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 3.73 mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Date 7/27/2023
Comments MO FILE: *Per Dotten Drilling docs dated 3/29/1982. **Per AWPS invoice notes.
B. TANK DATA
Measured operating fluid level in septic tank NA
Date of pumping NEW TANK
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 8/26/81
ALL standpipes present per record drawing
Total measured depth from grade 10.1 ft (max)
Measured depth to pipe invert from grade 3.8 ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes (MT) go to bottom of effective. (ED)
If not, state depth into effective 6.3 ft
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) N
If yes, enter date
Adequacy test date 7/5/23
Results Pass
Fluid depth prior to test 3 in
Water added 600 gal
New fluid depth 11 in
Elapsed time 300 min
Final fluid depth 0 in
Absorption rate 600 gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 96 in (MOA 8’ ED)
Effective depth used 20 in (Missing ED + Final Fluid Depth)
Effective depth (ED) remaining 76 in
Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots &
appears approximately 1.7’ ED is missing.
COSA Checklist copy.docx
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’
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
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
Tank to Property Line > 5’ Yes if No ft
Field to 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
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
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 FIRST WATER CONSULTING Phone 907-350-9566
Engineer’s Printed Name CURTIS HUFFMAN, PE Date 9/5/23
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
well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting &
9/5/23
Municipality of Anchorage °F -
On -Site Water & Wastewater Program
(907) 343-7904
ISS�Unc-e—
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 020-172-11 Expiration Date: 7- _a — ( 3
1. GENERAL INFORMATION
Complete legal description MOUNTAINSIDE VILLAGE S/D; BLOCK 2 LOT 3
Location (site address) 17800 STEAMBOAT DRIVE *ANCHORAGE, AK 99516
Current Property owner(s) KEVIN & CATHERINE STANGE Day phone 230-4069
Mailing address 17800 STEAMBOAT DRIVE *ANCHORAGE. AK 99516
Real Estate Agent RICK JARVIS W/ REMAX Day phone 276-2761
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
4
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $_ _ _ __ _ Waiver Fee $
Date of Payment
Receipt Number
COSA# Sro I a / 2 -7�
Date of Payment
Receipt Number
Waiver #
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
❑
Individual Holding tank
❑
❑
Community On-site
❑
❑
Public Sewer
❑
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $_ _ _ __ _ Waiver Fee $
Date of Payment
Receipt Number
COSA# Sro I a / 2 -7�
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, t 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. 1 further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineers Comments:
In conducting this evaluation, GEG, LtD_ attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, 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 the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
6. DSD SIGNATURE
System #1 Approved for 4 bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
Phone 337-6179
Date 12 2B 11z
bedrooms, with the following stipulations:
ON-SITE
WATER AND
WASTEWATER
PROGRAM
The Municipality or Anchorage Develop, emt 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. ATTCHMENTS:
COSA Checklist
Septic System Advisory
y Nitrate Advisory
Arsenic Advisory
Well Flow Advisory Other
By:
c
(Rev.
Original Certificate Date: 1- 2-___ _L 3_
If more than 1 septic system is on the lot:
COSA Checklist # of
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: MOUNTAINSIDE VILLAGE S/D; BLOCK 2, LOT 3 Parcel ID: 020-172-11
A. WELL DATA *PER DOTTEN DRILLING LETTER DATED 3/29/82.
**BEDROCK
Well type PRIVATE If A, B, or C provide PWSID# N A Well Log (Y/N) YES
Date completed 3/29/82 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth *45+ ft. Cased to ** ft.
FROM WELL LOG
Date of test *3/29/82
Static water level *20 ft.
Casing height (above ground) 12+ in.
AT INSPECTION
4/26/12
10 ft.
Well production *10 g.p.m. 5.4+ g.p.m.
WATER SAMPLE RESULTS:
Coliform QD colonies/100 ml. Nitrate 3 dmg./L. Collected by: GFG. Ltd.
Arsenic: NO ug./L. Dateofsample: 12/10/12
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 8/26/81
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A
Date of pumping 4/26/12 Pumper ONE STOP SERVICES
C. ABSORPTION FIELD DATA *BELOW EXISTING GRAnE
Date installed 8/26/81 Soil rating (g.p.d./Wor /bdrm 225 System type TRENCH
Length 58 ft. Width UNSPECIFIED ft. Gravel below pipe 8 ft.
Total depth *1 1.8 ft. Eff. absorption area 928 ft2 Monitoring tube **YES Depression over field NO
Date of adequacy test ***4/27/12 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 42 in. Water added 755 gal. New depth 54 in.
Elapsed Time: 120 min. Final fluid depth 47 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date —
**SUMP ONLY EXTENDS 6.25' BELOW INVERT OF DRAINPIPE. TOTAL DEPTH AND LIQUID LEVELS CALCULATED.
***HOUSE WAS VACANT AT TIME OF TEST. DRAINFIELD PRE—SOAKED ON 4/26/12 WITH 2000 GALLONS.
D. LIFT STATION
Date installed Size in gallons Manhole/Access(YIN)
"Pump on" level at in. "Pump offlevel High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot *95,+ On adjacent lots 100'+
Absorption field on lot 100 + On adjacent lots
Public sewer main N/A
Sewer /septic service line 25'+
Animal containment areas 50'+
Public sewer manhole/cleanout
Holding tank N/A
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field **5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
1. **PER 1981 INSPECTION REPORT,
G. ENGINEER'S CERTIFICATION
i certrfy that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date It2/2,11 /12
(Rev. 11105)
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99519-6650
x(907) 343-79k.us
04 N"
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 020-172-11 COSA#
1. GENERAL INFORMATION Expiration Date: /0 -2 L5) ` /,
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
MOUNTAINSIDE VILLAGE S/D; BLOCK 2, LOT 3
17800 STEAMBOAT DRIVE * ANCHORAGE, AK * 99516
KEVIN & CATHERINE STANGE Day phone 907-230-4069
17800 STEAMBOAT DRIVE * ANCHORAGE, AK * 99516
Day phone
Real Estate Agent RICK JARVIS W/ REMAX Day phone 276-2761
Mailing address 110 W. 38TH AVENUE, #100 * ANCHORAGE, AK * 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water. System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, t 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. 1 further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNERS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. the operational life of all wells and
septic systems depend on the local soils condition, 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 the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will It confer any legal right whatsoever.
5. DSD SIGNATURE
_1Z Approved for _A__ bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Phone
337-6179
Date O z
y
AGarness:
PCE-793 �o
OpfP
a
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
ON-SITE
WATER AND
WASTEWATER
PROGRAM
By: o ! – Original Certificate Date:/—
(Rev. it/0 )
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: MOUNTAINSIDE VILLAGE S/D; BLOCK 2, LOT 3 Parcel ID: 020-172-11
A. WELL DATA *PER DOT -FEN DRILLING LETTER DATED 3/29/82
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES
Date completed 3/29/1982 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth *45'+ ft. Cased to **BEDROCK Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test *3/29/1982 4/26/2012
Static water level *20 ft. 10 g.
Well production *10 g.p.m. 5.4+ g.p.m.
WATER SAMPLE RESULTS:
Coliform n colonies/100 ml. Nitrates' _q1 mg./L. Collected by: GEG, Ltd.
Arsenic: k O ug./L. Date of sample: 4/27/2012
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Tank size 1250 gal. Number of Compartments 2
Date installed 8/26/1981
Cleanouts (YIN)
HOW
Foundation cleanout (Y/N)
YES
Depression over tank (YIN)NE
High water alarm (YIN) N/A
Date of pumping 4/26/2012
Pumper
ONE STOP SERVICES
C. ABSORPTION FIELD DATA
Date installed 8/26/1981 Soil rating (g.p.d./ft2or /bdrm 225 System type TRENCH
Length 58 ft. Width UNSPECIFIED ft. Gravel below pipe 8 ft.
Total depth *11.8 ft. Eff. absorption area 928 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test **4/27/2012 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 42 in. Water added 755 gal. New depth 54 in.
Elapsed Time: 1 EO min. Final fluid depth 47 in. Absorption rate >= 600+ g,p,d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date —
*SUMP ONLY EXTENDS 6.25' BELOW INVERT OF DRAINPIPE. TOTAL DEPTH AND LIQUID LEVELS CALCULATED.
**HOUSE WAS VACANT AT TIME OF TEST. DRAINFIELD PRE—SOAKED ON 4/26/2012 WITH 2000 GALLONS.
D. LIFT STATION
Date installed Size in gallons Manhole/Access(YM)
"Pump on" level at in. "Pump ofr level High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot *95'+ On adjacent lots 100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer /septic service line 25'+
On adjacent lots
Public sewer manhole/cleanout N/A
Holding tank
Animal containment areas 50'+ Manuretanimal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field **5'
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/v chicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots -2 —()V+
F. COMMENTS
1. **PER 1981
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and p 4 .•�,r
review of Municipal records that the above systems are in
conformance with MOA COSH guidelines in effect on this
date. a.... .f. ...Go ness;'
Engineer's Printed Name JEFFREY A. GARNESS �� ,j CE— m�
Date U- 30 Ila d�n'zaP l-
COSA Fee $ '-f'Zo
Date of Payment/
Receipt Number
(Rev. 71105)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage arvE
Community Development Department
Development Services Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 121272
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 2, Lot 3 of
Mountainside Village subdivision. This inspection revealed a nitrate
concentration of 5.41 milligrams per liter (mg/L) was reported for the
property's well water sample. The Environmental Protection Agency (EPA)
has established a maximum contaminant level (MCL) of 10.0 mg/L for
public drinking water systems. While private wells are not subject to this
regulation, EPA standards are based on existing health information and can
therefore be used to gauge the relative quality of water from private wells.
Please see the attached "Nitrate Fact Sheet" for important information
regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
FROM :Alpine Drilling FAX NO. :907 345 0202 May.22 2012 12:02PM P3
AAROW PUMP & WEU SERVICE, LLC p�]dQo plc'[
P.O. Box 110496
i Anchorage, AK 99511 No. 9372
Office: (907) 346 9355 •Fax (907) 333-8976 / _fnL et�
Eagle River: (907) 622-9335 (�
CUSTOMER
-ZZI AEO S''u �Qv�
L �Po.;'- X30 - x'06
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JOB SITE
rz
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INVOiICE DATE/
WELL DEPTH/
SWL /
CHLORINATED
PUMP DEPTH /
SAL PERSON
W,...:: .....'
..,.>, .. '..:.„#.a^...,..':.
..: ...DEBORIPTION ..:
•.
1.
'70,
LABOR
HOURS
RATE
AMOUNT
TOTAL MATERIAL
avow/
iI'
�S
�.
Q
TOTAL LABOR
WORK ORDERED BY
DATE COMP.
TOTAL
LABOR
PAY THIS AMOUNT
3311
"ThankYou
SIGNATURE
(I Hereby Acknowledge the Satisfactory Completion of the Above Described Work and agree that if above work is not paid for in 90 days I agree to allow Aarow
"Pump & Well Service, L.L.C. me right to remove unpaid for equipment and charge for labor already performed & labor to remove unpaid for equipment).
TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE.
S.
SERVICE CHARGE AT RATE OF 15% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS,
I
ASBUILT
SEIJA:cD IF.
AEP.EBY CERTIFY THAT 1 HAVE SURVEYED THE
SCALE.
FO -LOWING DESCRIBED PROPERTY-
_
rwrvif�rii✓� �itr sva «'� fir: z
DATE.
AND THAT NO ENCROA:HMENTS EXIST 6XEEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE DOSTENCE OF ANY
GRID,
EASEMENTS, COVENANTS, OR RESTRICTIONS
3t39
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLA?. UNDER NO CIRCUMSTANCES SHOE➢ R
F8:
ANY DATA HEREON BE USED FOR CONSrRUCTIDN
OF FENCE �.lNES, OR FOR ESTABLISHING BOUND-
ARY LINES.
�f
L,^.NII
Y
0
_nM I,
P.1
U
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICESD
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel 1. D. # a _.d— I"T 2 - I I \r HAA #� .2 L��21 I-
1. GENERAL INFORMATION
Complete legal description I -o i✓ 3 P,K
Location (site address or directions) )78D D Ste,„ '�ag� -D-rt yQ_
k`ciuL,'\ o2ZR (o(o!�
Property owner S74 — Day phone (
Mailing address —
1786 g9yt& 3y S- 3!740
Lending agency .1 )e � ��+� Day phone
Mailing address
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: V
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
Day phone
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
h. 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 a21
�. 11
1
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm l D 6/0e y av r kZak df �E Phone !V q- 311 b
Address c�d 3 ie f >� �*,;Za 6
Engineer's signature V —
6. DHHS SIGNATURE
Approved fore=�' bedrooms.
Disapproved.
Conditional approval for
Additional Comments
Date It J23 IQ 7-
bedrooms, with the following stipulations:
By. L1 , ,, (J=� -C Date�—
IIITIr
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev, 1/91) Back MOA 421
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST 19
L3
Legal Description: _/8K,2 r��7ilw�aivt�iCL� V+ U Parcel I.D.
A. WELL DATA
Well type If A, B, or C, attach ADEC letter. ADEC water system number r)/A'
/.29/6 Driller_ D64eti
Log present (Y/N) _L Date completed —
it
Total depth _ _�� Cased to _�'a�� Casing height— �
Sanitary seal (Y/N) �� Wires properly protected (Y/N)
—
FROM WELL LOG AT INSPECTION
Date of test
M
Static water level
1 D
Well flow g.p.m. ate—_ g.p.m. f�n
° �'"� 0
Pump level _ — --� —
C) rva
"-
co O
SEPARATION DISTANCES FROM WELL TO:
Iiv ucw '`eelg9 n adjacent lots } z �
9�°w
� ®O2
Septic/holding tank on lot ,�
Absorption field on lot — ' /00 ; On adjacent lots I Z�
N ()
�'� Nlld\
Public sewer main Public sewer manhole/cleanout
Sewer service line moi- _Petroleum tank P,__
WATER SAMPLE RESULTS:
Of
Coliform Nitrate —� Other bacteria
i i
� _,;� 4�e t4�
Date of sample: _
0F Collected by:
—
B. SEPTIC/HOLDING; TANK DATA
Date installed 7'i��J Tank size 1,9 ,5 L) Compartments S � Z'
Cleanouts (Y/N) Foundation cleanout (Y/N) Depression (Y/N) N
High water alarm (Y/N) r� Alarm tested (Y/N) N�A
/ I
Date of pumping Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Wells) on lot IF On adjacent lots i 12 U Foundation
/b
To property line ,>' 6V Absorption field Water main/service line i J O
Surface water/drainage — N� ! C
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION 1 ll�
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
Manufacturer
Manhole/Access (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
D. ABSORPTION FIELD DATA
On adjacent lots
"Pump off" level at
Cycles tested
Surface water _
Date installed Soil rating System type I Ae4,t e�li
Length Width. Gravel thickness 16 Total depth 1 i
Total absorption area 9z g Cleanouts present (Y/N) 1�
Depression over field (Y/N) Date of adequacy testi f t -2,0 1 Z_
Results (pass/fail) for /
bedrooms
Peroxide treatment (past 12 months) (Y/N) >' 7 If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot % 10-0 On adjacent lots �� / Z 0 Property line 1 2�
To building foundation o ± To existing or abandoned system on lot r�/A
On adjacent lots > !! 2-v Cutbank N-0 41 e_ Water main/service line ,'Z_ �
Surface water �P-11Drivewayarkin /vehI t ''Z
Curtain drain �6 o
E. ENGINEER'S CERTIFICATION
i
, p g s e s orage area
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature v! p 1 /�
Engineer's Name i �� Qy J Dv Y- t� its
Date It "�-3� aZ
HAA Fee $ Z 20
Waiver Fe � $
Date of Payment 2- _� ��
Receipt Number 2 z
72-026 (Rev. 3/91) Back MOA 21
e.
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
• T Department of Health & Human Services 14}1
DIVISION OF ENVIRONMENTAL SERVICES —�
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D.#—LS — 1~ 1 1 \ HAAff i=`t���? --
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
—! -3 45'�9oc ,k�.a� lc� 5� %_34J S//
Location (addre'ss or diredtions)
r
(b) Property'oWnbr &V T1 `"�'��� Telephone: (home) Business
Mailing'Ad'dress
r
(c) Lending Institution ` Telephone —
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to the following address: (or check here/K if hold for pick up.)
List contact person and day phone number below:
C £-S G„ , / / ,E
2. TYPE OF RESIDENCE:
Single-FamilyX Number of bedrooms -3
3. WATER SUPPLY
Individual Well X Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site P Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025 (Rev. 7/88) Page 1 of 2
Z to Z abed
8Oe6 (9912 ADU) 9ZO-U
�aom s,jaauibue leuolssaload ay} ui
suolsslwo jo saoaaa aol alglsuodsaa lou si abeaoyouy to 4l!led pun" ayl -panssi si aleollpeo e aaolaq elep az (leue io
suoiloadsui Ion puoo lou op SHHO to saaAoldwd -sluawailnbei alels pue leaapal uieliao /lsiles oliepio ui suoilnlllsui
bulpual ilayl pue sawoq to saasegoind of /selinoo e se slyl scop SHHO ayl 'e�seIy to alelS ayl ul paaalsl60a
jeauibua Ieuolssaloid Iuapuadapui ue Aq anoge 9 ydwBeied U uaAIb suoileluesaidai ayl uodn Aluo paseq paleoilpao
lenoaddy Al!joglny ylleaH sanssi (SHHO) saolAaaS uewnH pue ylleaH;o luawlieda0 a6eaoyouy to Al!ledlolunA ayl
MOUL NdO
lenoaddy euoll!puoO to swaal
leuoll!puoO panoiddesi0 % panoaddy
ale Aq swooapaq - aol panoaddy
TdAOadd`d SHHO •9
rQP
0 to
1' • •i 1.
• '� 'Omli
. ... rrr►rr• •rrrrr• •j
At
_I� i� oleo
990 — z )'— -,5 -7 0), r ov ssaippy
SSS 5-/oGZ� auoydalal �2 577 Wald loaWeN
-uolloadsul slgl to alep ayl uo loa;la ui suolleln5ei pue 'seoueulpio 'sepoo alelS
pue ledlolunW !le yl!m eouelldwoo ui sl walsls lesodslp aaleMalsum ao/pue Alddns aalenn alls-uo ayl 'uolloadsul
pue uolle61ls9nu1 AW wool pue sal!} abeaoyouy to Al!ledlolunW ayl wool paulelgo uollewaolul ayl uo paseq
legl AJ!JGA Jaylin; I -ulaaay poleolpul ainlonals to ad j pue swooapaq;o aagwnu ayl aol alenbape pue leuollounl
'ejes sl walsAs lesodslp aalumalsem ao/pue llddns aalem al!s-uo ayl leyl smogs lenoiddy Al!aoylny ylleaH
dill to u01le61lsanu1 AW leyl /+l!JaA I 'molaq uMoys alep uollep!!eA ayl to se pue olaaay pail;le leas (w !q pal;paao sy
NO11` YYHOdNl aNd ViVG `HOdd3S 3l1d `S1S3J. `SNO1103dSN1 JNId1AOHd Wdld JNIa33NION3 '9
MUNICIPALITY OF ANCHORAGE (MOA)
WT..thority Approval (HAA)
LITY OlF At I�IfD��IST - FEBRUARY 1984
OF HEALTkI. & 343-4744
ENVIRONMENTAL PROTtCTION
Legal Description:
A. WELL DATA RE "'' E `V E D
Well Classification s -v If A, B, C, D.E.C. Approved (Y/N)
Well Log Present6A Date Completed YAC 2 Yield
Total Depth 0 Cased to Depth of Grouting 0At1 Jua"Ji
GL J e Fr r_G4a
Static Water Level Pump Set At
Casing Height Above Ground —_
Electrical Wiring in Conduit&)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line —/"
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Sanitary Seal on Casinq#)N)
Depression Around Wellhead (Y11P
` 5- ; On Adjoining Lots /to
/ ; On Adjoining Lots i /00�
To Nearest Public Sewer Cleanout/Manhole
Date �`/� !7
Water Sample Test Results At Al
Comments /1%a/v� a /r «+• a/I�a��c;/
B. SEPTIC/HOLDING TANK DATA
Date Installed V__ z__Size _ e No. of Compartments
Standpipes 6,)N)
Air -tight Caps 6yN)
Foundation Cleanout &N)
Depression over Tank (Yf)) Date Last Pumped
Purnping/Maintenance Contact on File (Y/N) A)A ; for
Holding Tank High -Water Alarm (Y/N) � Temporary Holding Tank Permit (Y/N)/fl
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water Supply Well__ To Building Foundation
To Property Laine
i
To Water Main/Service Line
To Stream, Pond;' Lake or Major Drainage Course
Comments
L,
To Disposal Field
72-026 (Rev.,7/88) From Page 1 of 2
7
L�
15'�
/S/
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata/ S �Z Type of System Design �� 5
Date Installed _� (` Length of Field 51;? /
Width of Field &0 _ N Depth of Field
Gravel Bed Thickness
Square Feet of Absortion Area
Depression over Field (Y�9
Results of Last Adequacy Test k
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well / E q
To Building Foundation
Statndpipes Present K -?N)
Date of Last Adequacy Test
FA
To Property Line
To Existing or Abandoned System on
Lot On Adjoining Lots '21
To Water Main/Service Line To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course /E>n
To Driveway, Parking Area, or Vehicle Storage Area /0-/
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level. at
Tested for
Meets MOA Electrical Cod /N)
Comments
Dimensions
Manhole�ess (Y/N)
'*Check Permitted Bedroom Rating Against HAA Request"
I certify that I have checke
inspection.
Signed
Company
Date ;L
MOA No.
Pump Off' Level at
Vent (Y/N)
A.)
Pumping Cycles during Adequacy Test.
or c(/l/o/�nformed to all MOA and HAA guidelinesJin e O�•b1p`Qd�a�te of this
0.
1_/Y/1
° HH •• GaY
��A%4 9T
�••• •••••°• M
61'% Seal
s° °° . • °° •e.•.
Receipt No. u L
/—�
Date of Payment
Amount: $
Receipt No. _
Waiver Fee: $
Date of Payment
72-026 (Rev. 7/88) Back Page 2 of 2
ROY C. RFID. • E
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l,: t ENWROOK TAL ENOINEERINO DIVIiION
Attel�l'1tsM. MUM iii g Tddokw 7iii71r
x M L .
,.,. WELL INSPECTION REPOIRP
ON•�7'E SEWAGE DI$POI;AI.31fS'VE ANDS
;,� ,�,
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010. OF BEDROOMS
1} rcfl L' C4 r'
tirvl
SIC1'its �`;w
P&L .a com"rt,mm"
Inid�knyth.. Vwdth
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Municipality ®f Anchorage
Department of Health and Human Services dhh5
825 "L" Street
Tom Fink,
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
September 26, 1989
Lee Reid, P.E.
Alaska Environmental Control
Services, Inc.
PO Box 240668
Anchorage, Alaska 99524-0668
Subject: Waiver Request for Lot 3 Block 2 Mountainside Village
Waiver Request #WR890051, PID #020-172-11, HA890368
Dear Mr. Reid:
Your request for waiver of the required 100 foot separation of
a septic system to a private well has been approved. The
approved separation distance is 95 feet.
This waiver approval applies to the existing septic system to
well separation only. Any future upgrade to either will
require all separation distances be met or another approval
from this department.
Sincerely, -
Daniel J. Roth
Civil Engineer
On-site Services
DJR/ljw#6
ALASKA RuinoWnTAL COMROL SMUS, MC.
engineerinq & Enuironmentol Studies
L -L 2 �'l L)C-)5(q
P. 0. Box 240668
Anchorage, AK 99524-0668
(907) 279-5553
September 13, :1989
Municipality of Anchorage
Department of Health & Human Services
825 L Street, 5th Floor
Anchorage, AK 99501
3
RG: Block 'e, Lot -2-, Mountainside Village
On September 11, 1989, while I was performing art adequacy
test on the subject house, I noted that the well that had
been installed after the sewer system had been built, was
not 100 feet from the septic tank, but only a distance of 95
feet. It is over 100 feet from the on-site system, and
there are no other systems around upon which it would
infringe. The septic tank was installed in 1981, so it
should be in good condition. Although the septic tank is at
a higher elevation than the well, the drainage from the
septic tank would probably he to the west instead of to the
east toward the well. The house and well are on a ridge
that runs roughly northeast --southwest.
There is no really good well log on the files. It was
drilled by Dotten Drilling, and shows rock at 18 feet,
static water level at the time of drilling was 20, but on
the day of testing the static water level was 13 feet below
ground, and the drawdown stopped at 28 feet. Since this is
,4 „1 /rerj w?) av F ii ir-* anrh S®�om� n�n_t cg
a relatively high area that is well drained, there does not
appear to be a problem with the water table. The
bacteriological counts for the well were zero, and the
nitrates were 1.8 mg/1 which is well below 10. The soils in
the test are rated at 225 sq ft per bedroom and with a brown
silty GM (medium (tense). In my professional opinion, I
believe the issuance of a waiver of 5 feet from the 100
required from the well would not create a health hazard.
Please issue the waiver to this effect.
LCR/sr
_
APPLIC NT FILLS OUT UPPER HA[ ONLY
Properly Owner
- ; .. / ... ( ((-.—--
Phone --
Date
Date
Date
Mailing Address
- , �^ Zip Code
Inspector
Buyer
_
- -
Address
_ Zip Code
Lending Institution
- -- -. _ _- F- --
Phone
r
DEPT. OF
ENVIRONM NTAL,BROTECTION
Address
—•=-1 Zip Code
;x,19 f� '� s�-• �
Realty Co.& Agent
Phone
Address
Zip Code
Legal Description
'CONDITIONS OF APPROVAL
( ) DISAPPROVED
Street Location
( OCOTIO
NROVAL'DATe�
BY:S1!
Type of Residence
7C Single Family
- -
❑ Multiple Family
No. of Bedrooms_
,` Other
—
--- ---
Water Supply
---
-- -- ---— — ---
�[7' Individual
^
- ,
� , -
ATTACH WELL LOG. A well to
weg is required for all wells drilled since June 1975.
❑ Community
-; -
For wells drilled prior to that date, give well depth (attach log if available).
❑ Public Utility
Sewer Disposal
P'Individual
Year Individual Installed:
Ll Public Utility
When Connected to Public Utility:
❑ Holding Tank
--
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
1
Time
Time
Time
- --
Time
Date
Date
Date
Date
e_� 1�
Inspector
Inspector
Inspector
Inspector
Field Notes:
!�, (y� , pJ.%`�
�,� b
MUNICIPALITY OP ANCHORAGE
HEALTH i
r
DEPT. OF
ENVIRONM NTAL,BROTECTION
iU �,�o � , � c^ l� 1 ' � �� - � �
;x,19 f� '� s�-• �
RECEIVED
( ) APPROVED BEDROOMS
'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( OCOTIO
NROVAL'DATe�
BY:S1!
Solis Rating
Z S_ 1yG�G�c,�
Date Sewer Installed
Well To Absorption Area ✓B-%'�
p
Well Log Received
G�
�!
Well to Tank
q�eptic
Tank Size j�