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Home My WebLink AboutHILLSIDE NORTH #3 BLK 3 LT 3Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON -SITE WASTEWATER INSPECTION REPORT Permit Number: OSP251271 PID Number: 041-031-85 Dwelling: Al Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name Robert & Deborah Cameron PTION FIELD A Trench ❑Wide Trench El Bed El Mound <[EO:]De Site Address 10141 Middlerock Rd, Anchorage, AK 99507 Other Phone Number of Bedrooms Soil Rating Total depth from original grade 907-317-8834 4 D/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original de Gravel depth beneath pipe Ft. Subdivision Block Lot Hillside North #3 3 3 Fill added above original grade Ft. Gr el length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dis ce between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between ches From Tank Field Tank Line FtZ t. Well >100' N/A N/A N/A >25' TANK [N Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1250 Gal. surface water > 100 ' N/A NIA N/A Material Number of compartments Lot Line >5' N/A N/A N/A NA Plastic 2 Foundation > 10' N/A N/A N/A LI TION Manufacturer Capacity Remarks Deep burial Gal. Alarm location Electrica Iled by PIPE MATERIAL House to tank D3034 Tank to D3034 drainfield Installer MacDonald's Pumping Drainfield D3034 CO/MT D3034 Inspector Jared Earls BENCH MARK (Assumed elevation) 100 ft Inspection151 8/22125 Location and description dates: 2 3fd ah Bottom of lowest full log in north east corner of house ON -SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date �rP, •+'� 419 .fir •,. � .A. •• ` Benjarnii Schiller '°fi, •, CE 12592 ,•'w 'r Septic System V Approved Date `7_,�,4-� . 8/27/25 ,� .poop .... • N�� lk ROFESSt4 Note: this approval does not include well permit requirements. (Rev 05/02/18) 17.6' 18.9'10.0' 12.0' 16.2' 7.8' 5.9' 7.8' 13.2' 16.2' 12.0' 15.9'12.0'35.9' 29.0' 30.8' 8 . 8 ' 5.3' RESIDENCE ROOF OVERHANG 14'x14' SHED LEGEND EDGE OF GRAVEL DRIVEWAY UTILITY PEDESTAL DECK PADMOUNTED TRANSFORMER RECORD DATA PER PLAT #90-76 SEPTIC PIPE WELL SEPTIC TANK LID TIMBERLINE SURVEYING AND MAPPING 17035 BARONOFF AVE EAGLE RIVER, AK 99577 907-242-5320 ryan@timberlinealaska.com FILE NO.: 25.168 SCALE: 1" = 40 FEET DATE: 8/27/2025 SHEET: 1 of 1 MOA GRID: SW2143 SCALE: 1" = 40 FEET(11"x17") 40'0' 80' AS-BUILT OF: ADDRESS: 10141 MIDDLEROCK RD, ANCHORAGE, AK LOCATED IN: ANCHORAGE RECORDING DISTRICT LOT 3, BLOCK 3HILLSIDE NORTH SUBD.ADDN. NO. 3, PLAT #90-76 EXISTING WELL Benjamin Schiller CE 12592R E GISTEREDPROFE S S I O N A L E N GINEER 1"=40' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND PERMIT # OSP251271 PID # 041-031-85 HILLSIDE NORTH #3, BLOCK 3 LOT 3 FEET 0 40 80 SEPTIC PLAN 7/29/25 1250-GAL SEPTIC TANK EXISTING TRENCH 2CO 10' UTILIT Y E A S E M E N T 1 0 ' U T I L I T Y E A S E M E N T MI D D L E R O C K R D . WELL AND SEPTIC OUTSIDE OF VIEW PORT NEIGHBORING WELL WELL AND SEPTIC OUTSIDE OF VIEW PORT SEPTIC OUTSIDE OF VIEW PORT 4-BDRM HOME A B A B MH 71.2 SV 73.8 2CO 75.8 71.7 75.4 78.7 MT1 CO1 MT2 CO2 MH SV PROFILE AS-BUILT (NO SCALE) 87.8 82.7 88.5 93.7 FC O MH SV PERMIT # OSP251271 PID # 041-031-85 HILLSIDE NORTH #3 LOT 3 BLOCK 3 1250 GAL SEPTIC TANK 2C O 87.7 Benjamin Schiller CE 12592 R E GISTEREDPROFE S S I O N A L E N GINEER 8/29/25 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: OSP251271 Work Type: SepticTank Upgrade Tax Code Number: 04103185000 Site Legal Address: HILLSIDE NORTH #3 BLK 3 LT 3 G:2143 Site Mailing Address: 10141 MIDDLEROCK RD, Anchorage Owner: CAMERON ROBERT SCOTT & Design Engineer: FORGE ENGINEERING This permit is for the construction of: ❑ Disposal Field R1 Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date: Lot Size in Sq Ft Total Bedrooms: 8/12/2025 8/12/2026 93202 ❑ 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 Receiv Issued Date: 8/12/2025 Date: 8/12/2025 4 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 041-031-85 Property owner(s) Robert & Deborah Cameron Day phone Mailing address 10141 Middlerock Rd, Anchorage, AK 99507 Site address 10141 Middlerock Rd, Anchorage, AK 99507 Legal description Hillside North #3 Block 3 Lot 3 Number of Bedrooms 4 Engineering Firm Forge Engineering Building Permit Number Not Applicable FE -1 APPLICATION IS FOR: APPLICATION IS AN: (M all that apply) Absorption Field ❑ Initial ❑ Septic Tank F -I Upgrade Holding Tank ❑ Renewal ❑ Privy ❑ Well ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Permit/Rush Fees: K_00 Date of Payment: -7/,V) k _ Permit No. 6,SP9,Tj17 Waiver Fees: Date of Payment: Waiver No. Distance: August 8, 2025 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Hillside North #3, Block 3 Lot 3 – 10141 Middlerock Rd Septic system design Dear On-Site Services Engineer: The owner of the above lot has a 4-bedroom home on the property, with a 32-year-old steel septic tank, so we are submitting this permit application for the installation of a new tank. The attached site plan identifies the location of the home as well as the proposed septic tank replacement location. The leach field has passed a septic test so it will be reused. The old 1250 gallon tank will be removed and replaced by a new one. Please refer to the attached plan page 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 OSP251271, Ben Cogger, 08/12/25 EXISTING WELL Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER 1"=40' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND HILLSIDE NORTH #3, BLOCK 3 LOT 3 FEET 0 40 80 SEPTIC PLAN 7/29/25 NEW 1250-GAL TANK TO REPLACE EXISTING SEPTIC TANK EXISTING 1250-GAL STEEL TANK TO BE REMOVED EXISTING TRENCH TO REMAIN IN SERVICE 2CO 1 0' UTI L I TY EASEMEN T 1 0 ' U T I L I T Y E A S E M E N T MI D D L E R O C K R D . WELL AND SEPTIC OUTSIDE OF VIEW PORT NEIGHBORING WELL WELL AND SEPTIC OUTSIDE OF VIEW PORT SEPTIC OUTSIDE OF VIEW PORT 4-BDRM HOME Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251271, Ben Cogger, 08/12/25 17.6' 18.9'10.0' 12.0' 16.2' 7.8' 5.9' 7.8' 13.2' 16.2' 12.0' 15.9'12.0' 35.9' 29.0' 30.8' 8 . 8 ' 5.3' RES I DEN C E ROOF OVERHANG 14'x14' SHED LEGEND EDGE OF GRAVEL DRIVEWAY UTILITY PEDESTAL DECK PADMOUNTED TRANSFORMER RECORD DATA PER PLAT #90-76 SEPTIC PIPE WELL TIMBERLINE SURVEYING AND MAPPING 17035 BARONOFF AVE EAGLE RIVER, AK 99577 907-242-5320 ryan@timberlinealaska.com FILE NO.: 25.168 SCALE: 1" = 40 FEET DATE: 7/22/2025 SHEET: 1 of 1 MOA GRID: SW2143 SCALE: 1" = 40 FEET (11"x17") 40'0'80' AS-BUILT OF: ADDRESS: 10141 MIDDLEROCK RD, ANCHORAGE, AK LOCATED IN: ANCHORAGE RECORDING DISTRICT LOT 3, BLOCK 3 HILLSIDE NORTH SUBD. ADDN. NO. 3, PLAT #90-76 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251271, Ben Cogger, 08/12/25 Mayor Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 wmmuni.oro/onsite (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW Parcel Identification Number: Date of Issue: _ Legal Description Property Owner Name & Address: G /V 6 R 7 sco 4+ cA "'ja rrd.a- %0151 / I19±,QPj-*Rock Pump Installation Date: Pump Intake Depth Below Top of Well Casing:tl0 feet Pump Manufacturer's Name: -r;zap �c...r� Pump Model: (? S / C, Pump Size :k hp Pitless Adapter Burial Depth: / O feet Pitless Adapter Manufacturer's Name: 1"04R7-jra Jo ^f Pitless Adapter Installer: to /+ Well Disinfected Upon Completion? 9Yes j No C/u Method of Disinfection: V✓L-+ op Q� Comments: Pump Installer Name: din (� � 333o 7& Alc-Aorc.y, Ak- ggSlp, Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. 0 3�5' K C t. C IV C V Municipality of Anchorage Page of Z r OCT 2 2 1993 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION MuniciPali ty,q t ,%ragg ept. Health &Int a Qrv1 50 Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: I i I -)I� 12-, C) J.., 0 L 1 — PID Number: Name: Scoff Caere, Wastewater System: New ❑ Upgrade Address: Z35 —47 9"1 -#-203 995 ABSORPTION FIELD Phone: / 276-2$63 No. of Bedrooms: y gDeep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: /.2--GPD/Sq. Ft. Total Depth from original grade: / P7' Lot: Block: Subdivi ion: - 3 illsie� N3 Depth to pipe bottom from original grade: �f. 5 Gravel depth beneath pi 5 Ft. • Ft. Township: Range: Section: Fill addedaboveoriginal rade: Gravel length: _5q,- % WELL: New ❑ Upgrade Gravel width: Z• Number of lines: ' Distant=between lines: Ft. Ft. Classification (Private, A,B,C): fIV Total Depth: ZZ Cased To: IZO Total absorption area: Pipe material: PVC Ft. Ft. Soo SD. Ft. Driller: 'Al ine, Drillin Date Drilled: G/16/9Z Static Water Level: //Z Installer: Date installed: /O�y193 5 Ft. Yield:Pubrnp AlefZns ►led Set at: Nor 1 Casing Height Above Ground: Z S Juurf%�ro�/�C *"TANK GPM 1r6Qjfd Ft. • Ft. SEPARATION DISTANCES gSeptic ❑ Holding ❑ S.T.E.P. To From Septic Absorption Lift Holding Public/Private Manufacturer: �f AMM Capacity in gallons: .y C 12 0 Tank Field Station Tank Sewer Lines (mak Well I�+ �'^lnf V, //w IN1A N/A (VIA Material: slim/ 7T Number of Compartments: 2 Surfac Watere Nov 141./. Y/ AA LIFT STATION Lot/ Line .J 50 I / p IVI,+ VI, IV/A /VIA Size in gallons: Manufacturer: Foundation 5 I CN/^ •i!•r/ /'( "Pump on" level at: "Pump off" level at: High water alarm at: Curtain Drain Nov. �� IVIA /►, /�I AI Pump Make & Model Electrical Inspections performed by: — Remarks: BENCH MARK Location and Description Assumed Elevation: ENGINEER'S SEAL IF VS Inspections performed by. o{a�fcans�t `` Dates: 1st 2nd 000* Department of Healt d Hum S ices approval Reviewed and approved b Date: 14"�►a�.��.�►s �� }: �' :v �a9a : °°"Ar 72-013 (Rev. 9/91) MOA 25 Permit No. Page 2 of 2— Municipality Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: L-'+ 3, hill5ic% Ay4h #3 s1D co co con �r n Sur�act: RR n A=1 one 16.4 Fm doh- I 40g,> L 83.7' $4 DRWE cos SK PID No.: W No4x : No 4i4asf Wells or scflc Sy4ev'r w1��n ZCO o� 5154,-m, G"A,er sE!' 79 _ _ o �' No wa+u — — ! l6� Cxis�t'nq we II �o� L;r� AtQrox. !pp' — /oo` EIN . ce.M., I L0+ L�ne A(I"' $p' �Ro4�S£D � BDRM 1oo'R _4 56 4 af.e col A61 W1ZE Z ° Co C.02. o � o Sfl M1 1250 G.I. -A k ENGINEER'S SEAL col 5', $0'i Luf Line � 5T7'!z ?�' l3d, 400 Agtrex. 150' �'•�3F` A(�# Got 7L' t3o' C3 '3; 3n Cosi 0v 1 t), RECEIVEDAlwl e(+"'•,. ...... a, `r's !2*. 135 OCT 2 21993 r IlAR18 ti A �°; `•.° C,E -1393 �•' I =3D Municipality of Anchorage .• Dept. Health & Human Services 4®' �`"" 0 72-013 A (2/91) MOA 25 �+ �Q (� BOROUGH 1SjgBS BD VIS xNi > LOT BLOCK fl� a. '� DIRECTIONS: MEASURING POINT: ® top of casing E]ground surface E]other: STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF GEOLOGICAL AND GEOPHYSICAL SURVEYS WATER WELL RECORD SECTION QTRS TOWNSHIP RANGE MERIDIAN E]N 1:1 E Ms I F1 WELL OWNER: WELL DEPTH: ,� DATE OF COMPLETION: Depth of hole : � c+� y ft Depth of casing:/,;RC) ft�- BOREHOLE DATA: Depth STATIC WATER LEVEL: / f ft. Date e O Material type and color From To METHOD OF DRILLING: ;Llair rotary ❑cable tool ❑other: 11 e USE OF WELL: �° domestic []irrigation []monitor ❑ public supply other: E ` CASING: Stick-up .__. ft. Diam: h;;(� in q WELL INTAKE: 'Q open end ❑ screened perforated ]open hole Depths of openings: . to - ft f 2(0. SCREEN TYPE::" Diam• in Slot/Mesh Size: "-, .Length: ft Set Between and ft' " GRAVEL PACK TYPE: Volume used: ''-,..- Depth to top: GROUT TYPE "-- Volume: Depth: from ft-rto--i _. ft r r DEVELOPMENT METHOD: e'G�t- Duration:F. ef��R q ca REMARKS: PUMPING LEVEL AND YIELD: t? ft after �hrs pumping gpm PUMP INTAKE DEPTH: ft Horsepower: Date Pump Installed - - CONTRACTOR INFORMATION: WATER CHEMISTRY SAMPLE TAKEN? ❑ yes Q no F I /I ;t� " . • Well disinfected upon completion? es no RegiAered Business Name PLEASE. MAIL WHITE COPY OF LOG WITHIN 45 DAYS TO: Signature of Authorized Representative Date DGGS PO BOX 77-2116 EAGLE RIVER, AK. 99577 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650` ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930373 DATE ISSUED: 9/17/93 DESIGN-ENGINEER:POLARCONSULT EXPIRATION DATE: 9/17/94 OWNER NAME:CAMERON SCOTT & DEBORAH A OWNER ADDRESS:235 E. 9TH AVE., SUITE 203 ANCHORAGE, AK 99501 PARCEL ID:04103185 LEGAL DESCRIPTION: HILLSIDE NORTH 43 BLK 3 LT 3 LOT SIZE: 93202 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. RECEIVED B ISSUED BY: DATE: 411 13 DATE: / polar'consult alaska, inc. ENGINEERS • SURVEYORS • ENERGY CONSULTANTS September 14, 1993 DHHS, Environmental Services, On-site Services P.O. Box 196650 Anchorage, Alaska 99519 Attn: Permit Review Officer Re: Design and Construction Approval for On-site Sewer System at Lot 3, Hillside North Addn #3 S/D. Dear Sir or Madam: Please accept the following design for review and permitting. The proposed system does not affect the current use of the adjacent properties and will have minimum future impact. Based on the site investigation, the property appears suitable for the installation of the on-site waste water disposal system provided MOA grading requirement can be met. Due to the unfortunate location of the on-site well, the proposed septic system location is near a slope which averages close to 25%. As shown on the attahed approximate topographic survey, some fill will be needed to cut the slope below 25% for a minimum distance of 50 feet from the absorption trench. 1f you have any questions, please give me a call. POLARCONSULT Attachments: On-site Sewer/Well Permit Application Site Plan, Sheet 1 of 6 Topographic Survey (Approximate), Sheet 2 of 6 System Design Calculations, Section, Sheet 3 of 6 Percolation Test, Sheet 4 of 6 Percolation Test, Sheet 5 of 6 Sieve Analysis Results for TH1, Sheet 6 of 6 $320 Check for Permit Fee 1503 WEST 33RD AVENUE • SUITE 310 • ANCHORAGE, ALASKA 99503 PHONE (907) 258-2420 0 TELEFAX (907) 258-2419 polarconsult alaska, Inc. a 1503 West 33rd Avenue - Suite 310 ANCHORAGE, ALASKA 99503 (907) 258-2420 Fax (907) 258.2419 JOB LoT 901 /1kxvf 4`3 %s�/D SHEET NO. I OF "� l CALCULATED BYE/"/� DATE CHECKED BY DATE v � �wei,l Yev'� •p fi 1577 NL -I :_ _. CID ....... ......_ ....... .. . ... ....4.. ..... ... ..... ____...... ......-...... .......'...Lj _...... - __._.__ _._ _ ..o ...... . _... ..... .� _. TH o m x ........ !vv K . CQ .. .... - Co ._.:.. _l_.. ......_. __.._ ...._.. _ ...... _. __.... 5tf _ a5oGal. ... _. Tal k No..T SYsT&n• wJu c_tRyE /1d -0N G CQN TD V K5. NOTE: PROMIED StTfl WILL N07 AGF c .i�DTACENT PR�Pfri�5 hr✓D w1tL F{AvE H�N�MvM LFG£Nf ,.... _ GtiT R� 17��fr'c'f IC" 14-ge"rq Well PRODUCT204I ISingb SAems) 2051(Padded) (�7® Inc.. Groton. Nass. 01471 To Order PHONE TOLLIHEE 144225-M polarconsult alaska, inc. 1503 West 33rd Avenue - Suite 310 ANCHORAGE, ALASKA 99503 (907) 258.2420 Fax (907) 258-2419 ,OS 40-r S. /VoA -ff-3 15/V SHEETNO.- OF 3 CALCULATED BY MK DATE CHECKED BY DATE SCALE 1-0 '/I... /T� IM .......... ....... .... . ......... ........... 6 polarconsult alaska, inc. 1503 West 33rd Avenue • Suite 310 ANCHORAGE, ALASKA 99503 (907) 258.2420 Fax (907) 258-2419 JOB Z-0-/ 5 f//lS%a2 //oy4 SHEET NO. 3 OF CALCULATED BY J - DATE q� 3 i93 CHECKED BY DATE VF -IV—I` 1IM. muwn. We Uirn.ioUmerrnancrvurncciw4— Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED FOR: SCO-ff CGm2fn't DATE PERFORMED: LEGAL 16 17 18 19 20 COMMENTS) 6J2 gr0JV5l S 43 Township, Range, Section: SLOPE SITE PLAN 9TH tutuutE v AUMAN CE - 1393 4 WAS GROUND WATER / ENCOUNTERED? 0 PERCOLATION RATE U' f (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 5 FT AND —�2_FT 1i`41"t'S SoiA sarc PERFORMED BY: �� 1Q fcr7i r tI�T I y' r -' CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. q/�f/% 3 72-008 (Rev. 4/85) (FEET) 1 D 2 4 ' 5- - �T 6 " 7 r J� 8� 9 J 10 ° G � 11 - o 12 ` o 13 n 14 15 16 17 18 19 20 COMMENTS) 6J2 gr0JV5l S 43 Township, Range, Section: SLOPE SITE PLAN 9TH tutuutE v AUMAN CE - 1393 4 WAS GROUND WATER / ENCOUNTERED? 0 PERCOLATION RATE U' f (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 5 FT AND —�2_FT 1i`41"t'S SoiA sarc PERFORMED BY: �� 1Q fcr7i r tI�T I y' r -' CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. q/�f/% 3 72-008 (Rev. 4/85) �'� , &SEAtt9i1#* e +- Municipality of Anchorage*�'•9�0* DEPARTMENT OF HEALTH & HUMAN SERVICES • • •••• ••••••N 825 ••L•• Street, Anchorage, Alaska 99502-0650 rr " •...••.'Z/�.i SOILS LOG — PERCOLATION TEST : ItAlt� Al93 ' � ••, a- 1843 ,.•, PERFORMED FOR: SCoe CgwVro-yt �►� // II oL 2 DATE PERFORMED: Zd 3 LEGAL DESCRIPTION: , % �/S 4(�,tt - Township, Range, Section: 1 i (FEET) I O 2 3 4 L� 57 6 6 = 7 8 9- i 10 11 O 12 13 14 J 15 16 17 18 19 20 COMMENTS 7/y AZ SLOPE WAS GROUND WATER n/ ENCOUNTERED? NO mom mm ■■■mum®■■■ ■■■■■■■■■■ ■■■■■■ME ■■■■ ■■■■■■■■■■ PERCOLATION RATE (' (O 1,C (Minutes/inch) PERC HOLE DIAMETER 10 TEST RUN BETWEEN FT AND 6 FT PERFORMED BY: PC) A(6MSu/7 ^ `�f^3 CERTIFY THAT THISTESTWAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 9�4i/j 3 72-008 (Rev. 4/85) roro.rnmo-�nwnm mn..1e n.�iemmewnn.mn-e...Gf_.>n— ... ...,...,,,.,,.0 .... .... ....... . 31V0 Asa3M03H0 61VZ-BSZ Q06) XBj OUT -89Z Q06) 31v0 As a31VinOltlO £0566 WSVIV '3JV80HONV OTE apnS . anuanV pa££ }SaM £09T maul `e4sele jInsuowelod F GRAIN SIZE ANALYSIS (ASTM D422) PROJECT NAME: NOT AVAILABLE PROJECT NO.: 5072 CLIENT: POLARCONSULT BOREHOLEILOCATION: 100 SAMPLE NO.: 93-S-3 DEPTH: 0.37 DATE TESTED: 9/11/93 TESTED BY: RJPC REVIEWED BY: DESCRIPTION: Well graded sand with gravel EBA Engineering Inc. Phone (907) 561-4085 907 East Dowiing Road Suite 27 Anchorage, Alaska 995}8 Fax: (907) 56f-707} 01CUC AIJAI YSiC TEST SIEVE SIZE DIAMETER mm) TOTAL% PASSING 6' 152.4 2.6 4' 100 D30. 3' 762 0.37 2' 50.8 100 1' 25.4 96 3/4' 19 92 1/Y 12.7 80 3/8" 9.5 72 # 4 4.75 52 #10 2 35 02D 0.85 19 #40 0.425 11 #60 025 8 #100 0.15 5 #200 0.075 2.6 100.0 90.0 80.0 70.0 60.0 %RNER BY 50.0 wmtfr 40.0 30.0 20.0 10.0 0.0 100 DATE PRINTED 9/11193 •.vwe��uGTG� TCCT ELAPSED DIAMETER TOTAL % TIME mm PASSING 0 0.5 1 2 4 8 15 30 60 250 1440 GRAIN SIZE DISTRIBUTION U.S. STANDARD SIEVE OPENINGS .. ... #29 un un #100 #200 %GRAVEL: 47.9 % SAND: 49.5 % SILT/CLAY: 2.6 D60- 6.61 D30. 1.66 D10. 0.37 Cu. 17.9 Co- 1.1 M.C.= 5.7% USC: SW FC: %.02 mm 10 1 0.1 0.01 0.001 GRAIN SIZE IN MILLIMETERS GRAVEL Ig&un I SILT AND CLAY REVS)93 / MUNICIPALITY OF ANCHORAGE Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Parcel ID 041-031-85 Certificate of On -Site Systems Approval OSC251393 Expiration Date: Legal description HILLSIDE NORTH #3 BLK 3 LT 3 Site address 10141 MIDDLEROCK RD Current property owner(s) CAMERON ROBERT SCOTT & X The On -site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or conditions: By: 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 Service 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 submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other Development Services Department On -Site Water & Wastewater Section MARCUS MCLAUGHLIN Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 041-031-85 Complete legal description Hillside North #3 Block 3 Lot 3 Location (site address) 10141 Middlerock Road, Anchorage, AK 99515 Current property owner(s) Robert & Deborah Cameron 2. ON -SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 907-317-8834 3. TYPE OF WATER SUPPLY: FEJ Private Well serving # 1 dwelling units ❑ Other Non-public well as regulated by MOA E] Water Storage M Community Well or Public 4. TYPE OF WASTEWATER DISPOSAL: MR Private Septic R Private Septic serving 2 dwelling units F Holding Tank F Community Septic or Public Sewer 5. SEPTIC TANK: R Steel RN Plastic R Concrete R Fiberglass Age New - See advisory if steel or fiberglass older than 20 years 6. ABSORPTION FIELD: EJ AWWTS Fj Bed FO-1 Deep Trench F-1 Wide Trench El Seepage Pit Waiver request for: Distance: Expedited review requested: F 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 $ 1; SO Date of Payment 2/;_ lg,5 COSA # QS C 2-51 35 3 Waiver Fee $ Date of Payment Waiver # COSA Appliration—Ap2025.doc COSA Checklist Legal Description: Hillside North #3 Block 3 Lot 3 Parcel ID: 041 - 031 - 85 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 A. WELL DATA R Well log is filed with Onsite (or attached) Date drilled 6/18/92 Total depth 224 ft Cased to 120 ft ❑■ Sanitary seal is functioning correctly 0 Wires are properly protected Casing height (above ground) 36 in. Date of flow test for COSA 7/7/2025 Static water level at beginning of test 116 ft Comments B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NEW tenance completed, if AWWTS Comments: D. DISPOSAL FIELD DATA Which system tested (date installed) 1993 Al ALL standpipes present per record drawing Total measured depth from grade 11.5 ft (max) Measured depth to pipe invert from grade 7.0 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. OR Monitor tubes go to bottom of effective. If not, state depth into effective naked required if (Requlrouse vacant or field not used for more than 30 days pn date of test) Gallons introduced ---.gallons date Any rejuvenation treatment (past 12 mon s� If yes, enter date Comments/Deficiencies: Well production at time of test 3.0 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑Q Nc X Coliform bacteria is Negative Nitrate 3.00 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L M Arsenic less than MRL (ND) Collected by Forge Engineering Date 7/7/25 T STATION ❑ Require tj Age of lift station Lift station material Comments: nance completed Adequacy test date 7/7/25 Results II Pass Fluid depth prior to test 18 in Water added 780 gal New fluid depth 23 in Elapsed time 1440 min Final fluid depth 18 in Absorption rate >600 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 54 Effective depth used 18 in Effective depth remaining 36 in in COSA Checklist_May2025.docx E. SEPARATION DISTANCES From Well on Lot to: (Please enter distances if less than required) Septic Tank/Lift Station on Lot > 100' El Yes if No ft Neighboring Tank > 100' R Yes if No ft Disposal Field on Lot > 100' 0 Yes if No ft Neighboring Disposal Fields > 100' M Yes if No ft Sewer Line/Main > 100' n Yes if No ft Sewer Manhole/Cleanout > 100' 0 Yes if No ft Sewer Service/Septic Line > 25' n Yes if No ft Holding Tank > 100' El Yes if No ft Animal Containment > 50' 0 Yes if No ft Manure/Animal Excreta Storage > 100' 0 Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Disposal Field(s) on Lot to: (Please enter distances if less than required) Tank to Foundation > 10' no Yes if No ft Surface Water > 100' Yes if No ft Field to Foundation > 10' E Yes if No ft Wells on Adjacent Lots: Tank to Property Line > 5' 0o Yes if No ft Wells > 100' no Yes if No ft Field to Property Line > 10' E Yes if No ft Community Wells > 200' no Yes if No ft Water Main/Service Line > 10' n 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 Forge Engineering Engineer's Printed Name Benjamin Schiller, P.E. Phone (907) 522-7773 Date 8/28/25 ,q TH . . < ........ Benja in Schiller VIP )i PROFESSO,, COSA Checklist_May2025.docx