HomeMy WebLinkAboutHILLSIDE PARK PUD LT 31
Municipality of Anchorage Page of_
'" DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~'W ~5'~ ~ 7,~ PID Number:
Name: ~ f~~/~ Wastewater System:D New ~Upgrade
Address: /
~0~0 ~/6~ ~ ~ ~~ ~ ABSORPTION FIELD
No. of Bedr~ms:
Phone: ~7~--~Z ~ ~ Deep Trench ~Shal~owTrench ~Bed ~Mound ~Other
LEGAL DESCRIPTION SoilRating: O*& GPD/Sq. Ft. TotalDepthfromorigina~gra~:/
Lot: ~ / Block:~/~/~ ~ ~-- -- Sub~v~ion: ~ Depth to pipe bottom from original~,~grade: Ft. Gravel depth beneath pipe~,~ Ft.
Township: I Range: I Section: Fill added above original grade: G~v~
WELL:D New ~ Upgrade Gravelwidth: ~/ Number of lines: Distancebe~eenlines:
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:
Driller: ~ Date Drilled:~ Static Water Level:__ Ft. Installer:~~
Yield: Ft. Casing Helght A~ove Grou;~; TANK
SEPARATION DISTANCES ~septic~ Holding ~ S.T.E.P,
To Septic Absorption Lift Holding )ublic/Private Manufacturer: Capacity in gallons:
From Tank Field Station Tank Sewer Lines ~ ~
Material: ~ ~, Number of Compa~ments:
S~,~ce ~ ~ LIFT STATION
Water /0~ ~ /~ ~ ~
Lot ~ Size in gallons: ~ Manufacturer:
Line /~ /~ /~ I+ -- ~ /~ ~ ~
Foundation ~ /~/~ ~ ~ ~ "pump °n" level at: I "Pump °fi" level at: IHigh water alarm at: ~
Cu~ain + ~ ~ ~. ~
Drain ~ / + ~ ~ Pump Make & Model Electrical Inspections reed by:
Remarks: BENCH MARK
Location and Description:
Elevation:
ENGINEER'S SEAL
*' ""
Department of Health~d Hue,~Se~ices approval ~ ¢~' ¢ ~''
Reviewed and approved b .- Date:
AS-3UILT
~/ASTEWATER DISPOSAL SYSTEM
LOT 31, HILLSIDE PARK P,U,D,
LOT 32
P,I,D, 015-31a-34
/
/
SEWER SYSTEH
LBT
3O
SEWER SYSTEN
T,H,
TRACT F-1
A-C=9,94+/-
B-C=14.80+/-
A-D=28.32+/-
B-D=13,18+/-
A-E=89,87+/-
B-E=75,90+/-
A-F=24,31+/-
B-F=23,66+/-
A-G=86.90+/-
B-G=76,56+/-
D-C=18,45+?-
F-C=lG,29+/-
H-G=17,16+/-
PREPARED FBR:
RODNEY & PEGGY LIND
7080 CROOKED TREE DR,
ANCHORAGE, ALASKA 99515
KND ENGINEERING
20441 PTARHIGAN BLVD
EAGLE RIVER, AK, 99577
(907)696-6111/F~x (907)696-8111
AS-BUILT DESIGN DETAILS
WASTEWATER ABSORPTION SYSTEM
LE]T 31, HILLS]DE PARK P.U,D,
P,I,D, 015-312-34
1250 GA
1,67' New Tank
1,58 ~
2,75'
E3
92,07
ORIGINAL GRADE
FILTER
SEWER ROCK
64'
TYPICAL TRENCH SEGNENT
§rd
94.93 inv
Zobel, Z-200 SpLitter
9,83'
94,86 inv
66,7'
No~ce:
1, 90 degnee sweep [occted ct the beglnnln§ oC t:pench,
2, 90 degpee elbows [occl~ed ci~ ~c¼e end oF 1;pent¼,
PREPARED FOR:
ROD & PEGGY LIND
7080 CRBBKED TREE BRIVE
ANCHBRAGE, ALASKA 99515
KND ENGINEERING
20441 PTARHIGAN BLVD
EAGLE RIVER, AK, 99577
(907)696-6111/Fox (907)696-811i
BATE~ i1-6-95 JBRA~/ING #
NTS ] 9547-$2
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE 1 OF
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW950372
DESIGN ENGINEER:KND ENGINEERING
OWNER NAME:LIND RODNEY D & PEGGY R
OWNER ADDRESS:7080 CROOKED TREE DR
ANCHORAGE, AK 99515
DATE ISSUED:il/03/95
EXPIRATION DATE:il/03/96
PARCEL ID:01531234
LEGAL DESCRIPTION:
HILLSIDE PARK PUD LT 31
LOT SIZE: 27490 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION 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 (iSAACS0) .
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AMD CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY:
DATE'
DATE:
· KND ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696-8111
October 27, 1995
Municipality of Anchorage
Dept. of Health & Human Services
On-Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519-6650
Subject: Lot 31, Hillside Park P.U.D.- Sewer upgrade
Gentlemen:
Following an adequacy test in which the existing system failed, we dug two testholes
for the proposed upgrade. The results of those tests are attached.
The upgrade will be placed on the southern portion of the lot. It appears that we
will be able to use a conventional septic tank and gravity flow to both trenches. The
existing septic tank will be abandoned in place and a n~ij~50gall°n tank installed,
Natural drainage is away from this site and will be maintained after construction.
There is no surface water within 100' of the proposed installation. There are no
curtain drains within 50' of the proposed installation. No wells exist within 200' of
the proposed installation.
We are requesting an expedited permit. The owners are being transferred out of
state and must complete the upgrade prior to leaving.
If you have any questions about this application, please call me at 696-6111/FAX 696-
8111.
Respectively submitted,
KennethM. Ddf ,P~.E.
KND Engineering
attachments:
On-Site Well and Sewer Application
Wastewater Absorption System Details
Site Plan
Soils Log/Percolation Test
SITE PLAW
~/ASTE~/ATER DISPOSAL SYSTEM
LBT 31, ~ILLSIDE PARK P,U,D,
P,I,D, 015-312-34
SEWER SYSTEM
~ELLZNG"
o~
NG TRENCH
AND SEPTIC TANK
LOT 30
SEWER SYSTEM
T.H, ~2
TRACT F-1
I, NO WELLS WITHIN 200' OF PROPOSED
INSTALLATION,
2, PUBLIC WATER MAIN IN STREETj SERVICE LINE
TO FRONT DF HOUSE,
3, ENTIRE LOT IS FLAT.
PREPARED FOR:
RODNEY & PEGGY LIND
7080 CROOKED TREE DR,
ANCHORAGE, ALASKA 99515
KND ENGINEERING
20441 PTARMIGAN BLVD
EAGLE RIVER, AK, 99577
(907)696-61il/F~x (907)696-8111
;DESIGN )ETAILS
WASTEWATER ABSFIRPTIBN SYSTEM
LBT 31, HILLSIDE PARK P,U,D,
nd d d
ORIGINAL GRADE
SEWER ROCK
!/
Ld
New T(lnk
DESIGN
l,
8.
3.
4,
5.
6,
7,
8,
9.
lO,
64'
TYPICAL TRENCH SEGMENT
P,I,D, 015-312-34
Permit
T,D. = 5.5'
t
RBD& PEGGY LIND
7080 CROOKED TREE DRIVE
ANCHORAGE, ALASKA 99515
PREPARED F~R:
KND ENGINEERING
20441 PTARMIGAN BLVD
EAGLE RIVER, AK, 99577
(907)696-6111/Fox (907)696-8ill
DATE~ 10-27-95 DRA~/ING #
NT$ 9547-S2
CRITERIA
4 BEDROOMS X 150 GAL/DAY/BEDROOM = 600 GPD
SOILS RATING: 20 MIN,/INCH = APPL. RATE 0,6 GPD/SF
600 GPD/0,6 GPD/SF = 1000 SF
lO00 SF /5 x ,64= 188'L
MIN, DESIGN SIZE = 2 TRENCHES - 64' L x 5' ~/ x e.5' D
2" HD INSULATIBN REQUIRED BVER FIELD <3' DF CBVER
2' HD INSULATIBN REQUIRED BVER TANK <4' BF COVER
CONTRACTOR TB PUMP TANK AND A]BANDBN IN PLACE,
CBNTRACTBR TB VERIFY AND INSURE 2X GRADE FRBM HOUSE,
ANY ASPHALT, CONCRETE BR APPERTANENCES DAMAGED BR
DESTROYED BY THE CDNTRACTOR DURING CDNSTRUCTION SHALL BE
REPLACED ]BY THE CBNTRACTBR AT NO ADDITIONAL COST TB THE B~/NER.
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: ~C~"t~,~'~'% ~,..~1~.5 ~ DATE PERFOR~V
\
LEGAL DESCR,PT,ON: ~.~'/ /r~M_~;,/,),~' P.Z~ /~/~ Township, Range, Section:
4
5
6
9-
10-
11
12
13-
14-
15-
16-
18-
19-
20-
~eFr¼
COMMENTS
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT O
DEPTH? P
E
Depth to Water After h'
Monitoring? J~!~ Date
SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
,~ ~ ,~ -- ~ ~/,t --
-'~ ~,Db~'~
PERCOLATION RATE
TEST RUN ~ETWEE. ~?~-
(minutes/inch) PERC HOLE DIAMETER
FT AND ,.~..jV,¢/' FT
PERFORMED BY: '~..~'C'~ '~.,,b~,,,, 1~3~,'-~'l;:~.J, (.,?, I ~ ~ .... _. CERTIFY THAT THIS TEST WAS PERFORMED IN
AOCORDANCE W,T. ALL STATE AND MUN'C'PAL ~'~'DEL'NES'N E'~N TH'S"^TE- DA~E:
72-008 (Rev. 4/85)
PERFORMED FOR:
LEGAL DESCRIPTION:
(FEET)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15-
16-
18-
19-
20-
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
· 'A- '..~,~ Il
,..'~ ...'.~, "~
~'~"~'~t""~"':'" ~
DATE PERFORME~
Township, Range, Section: t~ ~ ~¢~ :;
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
L
IF YES, AT WHAT .... O
DEPTH? p
Depth to Water After
Monitoring? ',0
E
PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN 7 FT AND ~ FT
COMMENTS
Gross Net Depth to Net
Reading Date Time Time Water Drop
'~ ,s ~* ~/~ ~"
PERFORMED BY: ~,.3't;:> ~ ~ ~ ~-- I -- , .... CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUN,CIPAL GUIDELINES IN EFFEC~i'- N~THISDATE. DATE:
72-008 (Rev. 4/85)
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
4
5
8
9
10
~2
14-
16-
17
20
COMMEN*S
Municipality o! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
/
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT O
DEPTH? p
E
Depth to Water Alter ~
Monitoring? ~ ~ Dale:
Gross Net Depth to Net
Reading Date Time Time Water Drop
¢ 7// ) 7¢4
~ 7~ ¢ .I 7 //~
¢ 7 )C / 7 q~
PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ¢'~/'~ FTAND ~¢~ FT
PERFORMED BY: ¢/*"¢ ~-~¢'/-~ w~ F~ I ~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPA~'GUIDEUNES IN EFFECT ON THIS DATE. DATE: ,/'~¢,,/¢2~,,/¢~
72-008 (Rev. 4185)
PERFORMED FOR:
LEGAL DESCRIPTION:
(FEET)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20-
Municipality o! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT O
DEPTH? P
E
Depth to Water Alter
Monitoring? Date: _
~'1' °.'~°"'~'"'" ....... ~'
DATE PER~R~~
Township, Range, Section: 7~/ ~. _~
SLOPE SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
~ ?~ 3- /,~ /~"
~ qo~ ~ .n ~/,/ W~,
~ ,~"~b, F_2> ~--.
PERCOLATION RATE
TEST RUN BETWEEN
· .. {minutes/inch) PERC HOLE DIAMETER ~ //
FT AND 7 FT
PERFORMED BY:
I CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: J~,//"'~ ~'//~'~'-
72-008 (Rev. 4/85)
MUNICIPALITY OF ANCHORAGE
· DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL DESCRIPTION . /.
oc .,o d2o .
DISTANCE TO: Well ~~ Absorption area
~ ~ Manufacturer ~ Mate~ ~ No. of compartments
Well Dwelling
~OZ~ ~ ~ ~~~ Li~~
O Z ~ Manufacturer
~ Welledm Foundation i~( Nearest lot line PERMIT NO~
~ ~ ~ No. of lines I ,Length o~a~ ,~ne Total len~o,
-- O~( inches Total effec~rption area
~ Top of tile to finish grade ¢ F Material beneath tile ?~ inches
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
m DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
(
AP~ DATE LEGAL
DEPAF..TM~NT (~:-,HEALTH AND ENVIRONMEf-ITAL F~,?ECTION
APPLIC8NT JBK CONST. C:HILKRT CT BOX ~511
LOC:~TION iR~SKED TREE DR.
t_EGAL LOT: :2~: HILL LOT _,X~E _,, eee _~._ .E FE
MM,.:,It'IUM N.IMBER OF BEDRUCMz, = 4 SOIL RATING (SQ FT,"BR)=
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
! [:,EF'T~-~== :]L ;=-: LEI'-~13 T H = 34 :] R A"..-" E L D-,EPTH= 6
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE E~CRVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETHEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE
INSTALLATION INSPECTIONS OF' ANY HELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE HELL WILL SERVE.
............ TI~.I,] (2) I t-~$PEC:TI C~-45 RF~E ~:E~]LIIRE]D,
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL RND ANY ON-SITE SEWRGE DISPOSRL SYSTEM IS
180 FEET FOR R PRIVATE WELL OR ~50 TO 280 FEET FROM A PUBLIC WELL DEPENDING
UPON THE T'¢PE OF PUBLIC HELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS RRE
AVAILABLE TO INSURE PROPER INSTALLATION.
I CERTIF'~.' THAT
'-' .... '-- ON-SITE _,EWERs, AND WELLS AS -,ET
i: I I'"iM F'AMILIRR WITH THE RE~...!LIIREMENT_, FOR ,= c ,=
FORTH BY '['HE MUNICIPALITY OF ANCHORAGE.
2: I HILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
]:: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED 7/0 INCLUDE/~ORE THAN 4 BEDROOMS.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-650, Anchorage, Alaska 99502 276-222~
SOILS LOG - PERCOLATION TEST
I~]~" SOILS LOG.
LEGAL DESCRIPTION:
PERCOLATION
TEST
8
· ':'~ '= 9-
10-
-, 15 -
16-
COMMENTS
SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE ~ Z~P?~7//~minutes/inch)
TESTeR,UN BETWEEL~ ~ F,T~A~D ~ CT
DATE:
• '� Municipality of Anchorage
On -Site Water and Wastewater Program z
(907) 343-7904
Certificate of On -Site Systems Approval
Parcel I.D. 015-312-34
1. GENERAL INFORMATION:
Complete legal description HILLSIDE PARK PUD; LOT 31
Expiration Date: 1P r�eI Z,3
Location (site address) 7080 Crooked Tree Drive *Anchorage
Current
perty owners) --- Jeanne Davis_&._Leo._B.ustud—_—__.Day_phone_720-346
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual
M
Individual Water Storage
❑
Holding Tank
❑
Community Class A Well
®
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver/Variance request for: Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $ 55o Waiver Fee $
Date of Payment 3 ��� Date of Payment
Receipt Number 0 a S 5 3(�J Receipt Number
COSA # 05(-2,) 1293 Waiver #
a
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.
Name of Firm: Gamess Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101- Anchorage Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
in accordance with the guidelines and regulations established by the Municipality of Anchorage and
industry practices. The reported results describe the condition of the system/s on the date/s of the
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or
encroachments may exist that were not identified during the evaluation. The operational life of all wells
and septic systems depend upon a variety of variables, including but not limited to, soil conditions,
groundwater levels (that may fluctuate during the year), quality of construction (materials and
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of
the well or septic system. GEG makes no representation whether an alternative well or septic system
can be installed on the property in the event either of the current systems fail to perform adequately in
the future. The content of this report is for the sole benefit of the person/party that retained GEG to
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
DS IGNATURE
System #1 Approved for bedrooms
System #2 Approved for
Disapproved
Conditional approval for
�t� t -.,*C /1i(
bedrooms
Date: -2-
bedrooms,
bedrooms, with the following
. ....... I.........
U7
CE 7u; ,
�#�ECC88���
siT
O
-- o wq
rn r'
�o PRGG�,-.gT�R
7::�^
CD
;ti JtJfFFRVtCESO\'s
tJ�o l�
Original Certificate Date: S
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_ Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
4-a-&" �Al e Ar) ✓,S corms
44 o •c �C
I
COSA Checklist
Legal Description: HILLSIDE PARK PUD; LOT 31
If more than 1 septic system on lot: COSA Checklist # of
COMMUNITY
A. WELL DATA I WELL
❑ 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 -C - — ----------- -- --
Static wate at beginning of test ft.
B. TANK DATA
Age of tank(s) 27 years
Tank type/material SEPTIC/STEEL
Measured operating fluid level in septic tank 0"
❑� Standpipes/foundation cleanout per record drawing
Date of pumping'
D. ABSORPTION FIELD DATA DUAL TRENCH
Parcel ID: 015-312-34
Structure served by this system
Well production at time of test
:Water storage tank volume gallons
ll disinfected (form test? ❑ Yes ❑ No
C bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by
--Date-ofiSample-------------------- ----
C. LIFT STATION
❑ Required maintenance com
Age of lift station y
Lift station mated
Which system tested (date installed) 11/5195
Adequacy test date 6/1/22
0 ALL standpipes present per record drawing
Results Q Pass For 4 bedrooms
Total measured depth from grade 6.5 ft (max)
Fluid depth prior to test 11 in
Measured depth to pipe invert from grade 3.08 ft (min)
Water added 656 gal
❑ N/A — pressurized field
18
New depth in
❑ Monitor tubes go to bottom of effective. If not, state
125
depth into effective 1.75'-2.08'
Elapsed time min
❑ Code -required soil cover over field
Final fluid depth 15 in
❑ System presoaked
Absorption rate 600+ gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months) NIA
date of test)
Gallons introduced N/A gallons
If yes, enter date
Comments/Deficiencies:'SEEATTACHEDE)MLREGARDING EEZING-TESTED EASTTRENCH ONLY -WEST TRENCH HOLDING XOF LIQUID UPON ARRIVAL AND 3'OF LIQUID AT END OF TESTING
Ei
COSA Checklist yellow sheet
(N
E. SEPARATION DISTANCES
❑ Yes
COMMUNITY —]
*5'+ ft
Surface Water > 100'
Q Yes if No ft
-Property--
WELL
No
--
ft
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Wells on Adjacent Lots:
Septic Tank/Lift Station on Lot > 100'
--- - --- -- ---
Community Sewer Manhole/Cleanout >
Yes
❑ Yes
if No ft
es
if No ft
Neighboring Tank > 100' ❑ Yes
if No ft
Private S eptic Line > 25' ❑ Yes
if No ft
Absorption Field on Lot > 100' ❑ Yes
if No
Holding Tank > 100' ❑ Yes
if No ft
Neighboring Absorption Fields > 1
ft
Animal Containment > 50' ❑ Yes
if No ft
Yes
if No ft
Manure/Animal Excreta Storage > 100'
Co ewer Main > 75' [:1 Yes
if No ft
❑ Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
❑ Yes
if No
*5'+ ft
Surface Water > 100'
Q Yes if No ft
-Property--
— —
No
--
ft
ft
Wells on Adjacent Lots:
- - --— --- - ---
Well—s— on Adjacent Lots:
--- - --- -- ---
Absorption Field > 5'
Yes
if No
ft
Private Wells > 100'
✓el Yes if No ft
Water Main > 10'
Q Yes
if No
ft
Community Wells > 200'
R1 Yes if No ft
Water Service Line > 10'
Q Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
Q
Yes
if No
ft
Private Wells > 100' El Yes if No ft
Water Service Line > 10'
Yes
if No
ft
Community Wells > 200' Yes if No ft
Surface Water > 100'
Q
Yes
if No
ft
F. ENGINEER'S COMMENTS
*MET CODE AT TIME OF INSTALLATION
27 YEAR OLD STEEL SEPTIC TANK IS APPROACHING THE END OF IT'S
USEFUL LIFE.
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and review O
of Municipal records that the above systems are in conformance with0 C� .T��
MOA COSA guidelines in effect on this date. �• . • • • • • 4 . • • • . r7,,
QO
00 9 ��
CE 79 3
0 ' dere • . ' I2 Z' � � c�,oG
COSA Checklist yellow sheet
#AECC884Q �dp�f essi°"°��
Q1 o O f e sOOq
K-
Erik Widger
From: Jeanne Davis <davisbustad@aol.com>
Sent: Wednesday, June 8, 2022 2:56 PM
To: Erik Widger
Subject: Re: 7080 Crooked Tree Drive - 2022 COSA
Attachments: 7080 Crooked Tree dr. as built pg 1 of 3 jpeg; 7080 Crooked Tree Dr. as built pg 2 jpeg;
7080 Crooked Tree Dr as built pg 3 of 3 jpeg
Thank you for getting back to us so quickly. I am attaching what we have from the previous owners that looks like an as
built survey. It was done in 1995. Is this adequate or do we need a new one?
I called ARM Services and they will call me with dates available to do the repairs.
I would like the name of someone to pump. I have used A+ Services in the past. Maybe you have a better referral?
We have lived here since December 1995 and have never had a freezing problem with the septic.
Again, thanks for the great service. Jeanne Davis
Sent_from_my
On Jun 8, 2022, at 11:25 AM, Erik Widger <erik@garnessengineering.com> wrote:
Hello,
In order for us to submit your COSA to the MOA we will need the following items/repairs:
• As -built Survey showing all septic pipe locations
• Pumping for septic tank with receipt newer than 1 year (please let us know if you need a reference for this work)
• The clean-out pipe at the south end west drainfield is filled with dirt/debris and completely nonfunctional. This will
have to be repaired (see attached drawing for location).
For work regarding septic, we recommend ARM Services (688-9433). For work regarding surveying, we recommend
Shane Holt (345-5513) or Walatka & Associates (248-1666). It should also be noted that the drainfield is shy on soil
cover in some areas. If you have not had any freezing in the past related to septic, please email us a brief statement
explaining this. If you have any questions, please give us a call.
Thank you,
Erik D. Widger,
Consultant
Garness Engineering Group, Ltd.
3701 E. Tudor Road, Suite 101
Anchorage, Alaska 99507
Phone: 907-337-6179
Cell: 907-632-7479
Website: www.garnessengineering.com
<image001.jpg>
MUHMPAI U 7 Y OF AVACHORA, GE
DEVELOPMENT SERVICES DEPARTMENT¢
t�
On -Site Water and Wastewater Section
www.muni.org/onsite
Septic Tank advisory
Certificate of On -Site Systems Approval #OSC 221393
Subdivision: Hillside PUD lot 31
907-343-7904
Fax: 343-7997
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks The septic tank for
this COSA / property is 27 years old. A leaking septic tank may be a source of contamination to
the aquifer. Typical replacement costs range from $10,000 to $15,000
This advisory must be attached to all copies of the subject Certificate of On -Site Systems
Approval.
This is an example of a 16 -year-old septic tank in failure and should be replaced.
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org
_ �
-,• .. r
-. .
-}� �- .yin
,n ,^' 3r
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org
--) - -
l :.!.::..,
L)Oq� !
Wx
I
LL- - �I
all W
�•
a,
F G7
o
3 a c v
4�yvt\✓
`�
V {= �
�rJGJ�J �l
L)Oq� !
Wx
I
La40�
o
3 a c v
z
O VI
'C
Lal K 'd 41 2 K
U OC
OSu4
uN�
--i :jt
CN
La l CH(D
u L.0 co
I I :ll
C� QD a �
La_ , r
x mLO
u
L u Cri
G
iQ
Q_ W
In u LO
%� u= z N
Cr)
U .f)
tw Ol Z.
Y
Q
C
� ii •1 q i� � L—
�5
F Z ^�
Ulla(Lj
G (.rai
Co
CF]
Z
�LJ 1j 4i W
G _ ?' �J
<r Z Y-
C
In
3 (or�
Division of Env ronmental Services
On-Site Services Section :- · · 'L'~MEN ~ N
:~: i~,~ i l;i~'i'-'~~ ': · P.O. Box196650 Anchorage, Alaska 99519-6650::
, ~ ' 343-4744
,:~; , :,; ,.,
· cERTIFICATE OF HEALTH AUTHORITY
~: ~ APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.O: # ~//O'-- .~/~-~/-/ HAA# '~-~ ~°~5(~)--~{~)c~
1. GENERAL INFORMATION
Complete legal description
· LocatiOn (,,site address or directions) ----7'~ ~-~'"~;//~':~"'~
~~ .... ·
Pro~ertY"0wner ~/~ ~,~ ~ Day phone
M,ai~ing ad~ess ' ff ~ ~;~S ~ . ~/d.
Leg~ding agency 2' ~ ~y pho
' /~ / ph°~e r
' '"' ": '"'":'? "'" '"'" ' ~ Day
·" . Agent ",'", ~
· . · .:.:.~?--.. ::?:..;t:;;: ...... ; , , :..,: ......... .
, .: ,.,:._ _Address" ~ .~gf/f~/~g ................. ', > :..: ,-
..... ' .... 2- ", N~MaER OF BEDROOMS '~ , , ....... ;¥::~ ,~-.~,., ~ ....
~., :,. 8.-,. :~PE OF WATER ~PPLY ....... ~, ..~ ,e,,, ~, ~ . ,e,. ......... , ....... .,.. .....
"~:~-~"~'~'~:+'g"~'e'"z~e~t~¥:'~?*~;z:~'";~'t'~''' ...... ~"'"":"~'""'"~""' ~ ' '- '- .' '- ' :.'t:.'Zt, -~:~":~'":;~ ;:
. .:...: ..... :.:.. ~:.:-:,,...,.: ,, ........ :::, Indw~duai well .. ,
..- NOTE: If community well system, ~rovide written confirmation from State AD~C attest-
ing to the legality and status of system. .
4. TYPE OF WASTEWATER DISPOSAL: .......... . ...... '"'-
Individual on-site
?:~ ~:.-~.~r ':.:;~' :~:~T~ -:~ :- Holding tank;
::.:, :~.~ ~:~.~ , ...... ~,Commun ty on-site - ~ .... ..... ,, ~:.. ,.~, ,,..,.-.~ z.~. .~,~
..... ;r~ ~', ~' ' L,' 'u ; · , ~'~'~,'.~
';" '""~"~"' ......... Public sewer
'NOTE: .: If community wastewater system, provide written confirmation 'from State,DEC
'~ " a~esting to the legality and status of system. '
72-025 (Rev. 1/91) Front MOA#21
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm KND En;lineerin j Phone
2.0441 Ptarmigan Blvd.
Address Eagle River: AK' ~1~;.'/7.._~?_~_
Engineer's signature ~, /_~'~-~ Date
bedrooms.
6. DHHS SIGNATURE
. ~ Approved.for
~' Con~.itiona.! r.?Ppr0:v~l.:.for ~'"' b~dr0oms, with the following
Additional Comments
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.
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-
Health Authority Approval Checklist
Legal Description: ~////~/~/~-"/~, ZtffgS~. Zo~ :fi/ Parcel I.D.:
A. WELL DATA
Well type
If A, B, or C, attach ADEC letter. ADEC water system nmnber
Log present (Y/N) // Date completed J
Total depth ~//~ Cased to ~Casing height (above ground) ~
Sanitaly seal (Y~~ ~,,~ Wires properly protected ( )y~
FROM WELL LOG
AT INSPECTION
Date of test J J
Static water level ~ ~
Well production ~ g.p.m. ~ g.p.m.
WATER SAMPLE RESULTS:
Coliform J
Date of sample: .~ ~'~
Nitrate J
~~Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed /I/~A~ Tank size /~Y'~) Number ofCompaltments ~ Cleanoats (Y/N)
//
Foundation cleanout (Y/N) 'y Depression (Y/N) t/~/ High water alarm (Y/N)
Date of Pumping g/~ ____ Pumper .///~
C. ABSORPTION FIELD DATA
Date installed l,/~///fl~..~
Length ~ Width
Soil rating (g.p.d./fI2 or ft2/bdrm) a~O System type _~J~./t~/~aY/r~,.SF~
Gravel thiclmess below pipe. ~, ~' Total depth
Effective absorption area /DX/ Monitoring Tube present(Y/N) y Depression over field (Y/N) ~
Date of adequacy test A/t,~ Results (Pass/Fail) ---"- For ~ bedrooms
Fluid depth in absorption field before test (in.); "~ Immediately after ~ gal. water added (in.):
Fhfid depth ~ (ius.) Minutes later: ~ Absorption rate = ~ g.p.d.
Peroxide treatment (past 12 months) (Y/N) /t//-~ If yes, give date -'""-
Do
LIlT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
Size in gallons //~
~"Pump on" level at* ~np off~~
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot .~ ; On adjacent lots ~
Public sewer main ~'~ Publ~m~hole/cleanout
Sew s .cs e
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation ..6- t + Property line /~) ~-P Absorption field
Water main/service line /~) t., Surface water/drainage ./t~dP t 4- Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation /t9 / q- Water main/service line /~9 t ¢.
Surface water /{)O t 4- Driveway, parking/vehicle storage area ff
Curtain drain :~.~) t 4- Wells on adjacent lots ~d)~ t -~ Property line
F. ENGINEER'S CERTIFICATION
I certify that 1 have determined thrufield inspections and review of Municipal record~tJbo:~b~v2~}alems_..~,a,~ are
in con/brmance with MOA H~ guidelines in effect on this date.
Engineer's Name ~..~ ~. b~,
........................................................................................................... ........
HAAFee $ ~, ~ W~verFee$
Date of Payment ///~/~ ~ Date ofP ayment
Receipt Number Receipt Number
Rev. 8/95 OSS: haa.wk.doc
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, r~n¢)
Location (address or directions)
(b) Property Owner t.~'; .J~-~4~ ~ Telephone: Home %~'
Mailing Address 70 o~O (..~--~O ~__o,
(c) Lending Institution ~ ~ ~.~ ~ Telephone
Mailing Address
Business
(d) Real Estate Company and Agent ~'ACV-- ~.' Fi- IT 1~. j '-~.-~'
Address ,-~.,¢-.0 [ C, ~T~ ~
Telephone ~'~ -~ ~ '~ '~ o~
(e) Mail the HAA to the followin~ address: or: Check here~, if hold for pick up.
List contact person and day phone number below.
TYPE OF RESIDENCE
Single-Family ~
Number of Bedrooms
WATER SUPPLY
Individual Well1-1 Community'~ Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite'~ Public [] Community [] Holding Tank []
Note:t~f community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page I of 2 72-025 fRev 8/86~ Front
~-",,
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the 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 / ~.~.,,_~¢'~ .:.~,-~_. Telephone
Address ~'~'~ ~ !~' /~,~ ~
DHHS APPROVAL
^..row.,or
Approved ~ Disapproved Conditional
Date
Terms of Conditional Approval
CAUTION
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.
Page 2 of 2 72-025 fRev 8/86) Back
MUNICIPALITY OF ANCHORAGE (MOA)
cy, O?.p, Gc. HEALTH AUTHORITY APPROVAL (HAA)
· ~-, O~/~' _ ~N~$\O~ CHECKLIST - FEBRUARY 1984
C~L~' ~C~5 ~' 264-4720
~ ~ ~1 Legal Description: ~/-
WELL DATA ~b,C~b,\~J ~l..
Well Classification -
Well Log Present (Y/N)
Total Depth 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
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
If A, B, C, D.E.C. Approved (Y/N)
Date Completed Yield
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
,¢'~C~ '7~ ; On Adjoining Lots
· ~ "J' ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
Pup
Water Sample Collected by
; Date
Water Sample Test Results
Comments
B. SEPTIC/I.I~L-,.i~I~tTANK DATA
Date Installed .'~,1:'7'~ Size
Standpipes (Y/N) ¢-~/~ -~'~ Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
No. of Compartments ¢,ir~ t~.¢
Foundation Cleanout (Y/N)
Date Last Pumped
;for
Temporary Holding Tank Permit (Y/N) ¥'~/& --
To Building Foundation
To Property Line
To Water Main/Service Line
Course
Comments
To Disposal Field . Z~
To Stream, Pond, Lake, or Major Drainage
Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed S~/~' ~
Width of Field
Square Feet of Absorption Area /'/~)
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation !
Lot /~O/~/~?
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Type of System Design
~:;~:) Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line /
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present) r"4'~:~/"~/,~~
LIFT STATION
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 Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or c, ef~formed to ali ~ OA.and HAA guidelines in effect on the date of this inspection.
Signed '"r'~, ~_~_~_~-~4~-~' D at e-// /'~/~/' ~¢)/~' ~'
Company MOA No.
Receipt No. /'/(~
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
Engineer's Seal
CONSULTING ENGINEER
/-'~ 203 W, 15th AVE -C" SUITE 203
ANCHORAGE, ALASKA 99501
TELEPHONE: (907) 279-3916
SEPTIC SYSTEM ADEQUACY TEST
LEGAL:
LOCATION:
OWNER:
RESIDENCE:
WELL:
SEPTIC SYSTEM:
LOT 31, HILLSIDE PARK
7080 CROOKED TREE
W. WITTEN
SINGLE FAMILY, FOUR BEDROOMS
COMMUNITY, CLASS A
FROM MUNICIPAL RECORDS:
TANK: GREER STEEL, TWO COMP. 1250 GAL.
ABSORPTION SYSTEM: TRENCH
ABSORPTION AREA: 408 SQ. FT.
SOIL RATING: 100
INSTALLATION DATE: SEPTEMBER 1980
DATE OF PUMPING: APRIL 9, 1987. ROTO-ROOTER
DATE OF TEST:
APRIL 9, 1987
TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED. TANK WAS FOUND
WITH FIVE FEET OF COVER AND A LIQUID DEPTH OF 51
INCHES. FOUNDATION CLEAN OUT WAS FIVE FEET DEEP, CLEAN AND DRY.
TRENCH CLEANOUT WAS SIX FEET DEEP, CLEAN AND DRY. TRENCH SUMP WAS
8.5 FEET DEEP, DISTRIBUTION PIPE TEE COULD BEE SEEN AT SIX FEET.
' SUMP WAS DRY.
600 GALLONS WAS ADDED TO THE TRENCH CLEANOUT WHILE THE LEVELS IN
TANK AND SUMP WERE MONITORED. NO WATER SHOWED AT SUMP, TANK LEVEL
DID NOT CHANGE. 50 GALLONS OF WATER WAS ADDED TO THE SUMP. THIS
WATER DISAPPEARED IMMEDIATELY.
TEST RESULT:
THIS SYSTEM MEETS THE CODE REQUIREMENTS OF
THE MUNICIPALITY OF ANCHORAGE.
The operational life of all septic systems depends on the local
soil conditions, groundwater levels that may fluctuate during the
year, and the water usage of the family being served by the
system. These conditions are outside the control of the evaluator
of this septic system. We can therefore not give any estimate of
how long the system will continue to meet the operational requi-
rements of the Municipality and State.
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF ~.ALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
I. General Information Application Date I~-/~I ~
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or direction~)
(b) Applicants Name ~-/l~..~l,~ f~Ol,,~ Telephone - Home Business
Applicants Address "70 ~O C-~mm~-~. .... ~-~ ~
(c) Applicant~is (check. one) Lending.Instituti°n ~-~; Owner/b~P~-l~er ~;
Buyer I I ; Other ~-~ (explain), ' '
(d) Lending Institution Telephone
Address
(e) Real Estate Co. & Agent
Address 2O'~ ~-' ~ C) ~
Telephone ~ $ - ] ~ ~ ~
(f) Mail the ~ to the following ~dress:
2. Type of Residence
Single-Family~
Number of Bedrooms
3. Water Suppl~
Individual Well~
Multi-Family~-~
Other (describe)
Community.?~. Fubli~--~
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 hav~written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
[Page 1 of 2]
5. Engineerin~ Firm Providin~ Inspections~ Tests~ File Search~ Data and Information
As certified by my seal affixed hereto and as of the validation date shown below,
verify that my investigation of this Health Authority Approval shows that the on-site
water supply and/or wastewater disposal system is safe, functional and adequate for
the number of bedrooms and type of structure indicated herein. I further verify that,
~ased on the ~nformation 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 regula-
tions in effect on the date of this inspection.
Name of Firm ~--~. ~ Telephone ~7~-~
Address ~-~
Date
DHEP Approval
Approved for ~f.'~ ~) bedrooms
Approved .
Terms of Conditional Approval
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES NRALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. 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.
(DHEP SEAL)
RR4/eJ/D18
[Page 2 of 2]
7-19-84
As
WELL DATA
Well Classification ~~ A
Well Log P~esent (Y/N)
Total Depth Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances f~om Well:
To Septic/Holding Tank on Lot ~&
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
C leanout/Manhole
Water Sample Collected By
Water Sample Test Results
Co~,~,~nts
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Legal Description:
NOll:D3lOad I¥IN3~NO~IAN3
~' Nll¥~N 40 '143(]
If A, B, or C, D.E.C. Approved(Y/N) ON
Date Completed Yield
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression A~ound Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date
SEPTIC/HOLDING TANK DATA
Date Installed ~ B~ Size
Standpipes (.Y/N) O~ ~- Air-tight Caps (Y/N)
No. of Compartments -~ ~/O
Foundation Cleanout (Y/N) ~
Depression ove~ Tank (Y/N> N Date Last Pumped /":]~l-~-~']~-~
Pumping/Maintenance Contract on File (Y/N) ~¢/~ ; for
Holding Tank High-Water Alarm (Y/N) lq/A Temporary Holding Tank Permit (Y/N)
Separation Distances f~om Septic/Holding Tank:
To Water-Supply Well ~ ~ +
To Property Line /
To Water Main/Service Line
Course
Counts
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Receipt #
Date Paid:
Amount: ~-
[Page 1 of 2] 2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~- / ~ 80
Width of Field ~.~
Square Feet of Absorption A~ea
Depression over Field (Y/N)
Results of Last Adequacy Test
loc)
Depth of Field
Gravel Bed Thickness
~/d3~.P Standpipes Present (Y/N)
Date of Last
Type of System Design-~b~C~
Separation Distance from Absorption Field:
To Water-Supply Well ~ ~' To Property Line 7 ~)
To Building Foundation I ~) To Existing or Abandoned System r3n
Lot ~ O/~ ; On Adjoining Lots ~ O ~
To Water Main/Service Line / O ~ To Cutbank(if present) ~/O ~ ~-
To Stream/Pond/Lake/or Majo~ Drainage Course' ~ 0 ~ l~
To Driveway, Parking Area, or Vehicle Storage Area ~
Counts
De
STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes(Y/N)
Dimmnsions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (~/N)
Pumping Cycles du~ing Adequacy Test.
Meets MOA
Con~nts
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA HAAGuidelines in effect
KB1/dL/s
Date
MOA NO.
[Page 2 of 2]
2-15-84
CONSULTING ENGINEER
203 W. 15th AVE "C" SUITE 203
ANCHORAGE, ALASKA 99501
TELEPHONE: (907) 279-3916
PETE JARRET
HERITAGE INVESTMENT
207 E. NORTHERN LIGHTS BLVD.
ANCHORAGE, ALASKA 99503
DECEMBER 5, 1984
SEPTIC SYSTEM ADEQUACY TEST
LEGAL:
LOCATION:
OWNER:
RESIDENCE:
WATER SYSTEM:
SEPTIC SYSTEM:
DATE OF PUMPING:
DATE OF TEST:
TEST PROCEDURE:
LOT 31, HILLSIDE PARK
7080 CROOKED TREE
WILKINSON
FOUR BEDROOMS, SINGLE FAMILY
COMMUNITY
FROM MUNICIPAL RECORDS:
TANK: Greer Steel, 1250 gal. two compartments
ABSORPTION SYSTEM: Trench, 34 feet long,
6 feet of rock
ABSORPTION AREA: 400
SOIL RATING: 100
INSTALLATION DATE: September 1980
11.29.84
12.05.84
Drainfield sump was charged with water at a steady
rate of 9.5 gpm. The water levels in sump and tank
were monitored. Sump level went to 34 inches and
remained at that level throughout the test. The
water level in the tank rose as follows:
Water volume Tank depth
-0- gal 43 1/2"
100 44 1/4
360 47 1/2
600 49 1/2
800 51 1/2
50 1/2
Time 1.00 pm.
Time 5.30 pm
Tobben Spurkland P.E.
Pete Jarret
Lot 31, Hillside park
Dec. 6,1984
Page 2
TEST RESULT:
This system absorbed 100 gallons of
water in less than 4 hours. Extended to a
24 hour period the absorption rate is in
excess of 600 gallons. The Municipal
Code requires an absorption rate of 150
gallons per bedroom per day. This system
meets that requirement.
The operational life of all septic systems
depends on the local soil conditions, groundwa-
ter levels that may fluctuate during the year,
and the water usage of the family being served
by the system. These conditions are outside the
control of the evaluator of this septic system.
We can therefore not give any estimate of how
long the system will continue to meet the
operational requirements of the Municipality
and State.
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA g9501
BILL SHEFFIELD, GOVERNOR
Telephone: (907)
Address:
274-2533
To Whom it May Concern:
According to records on file in this office the NI//JIJ~ /~Cw-~
~/[~ Water System is in compliance-with the State Drinking
Water Regulations
Sincerely,
~ DA'rE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME(.~
DATE DATE DATE
INSPECTOR
INSPECTOR INSPECTOR
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF H2ALTil &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~IRONMENTAL F,-o'r~CTION
) 825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 W ERR~FC..~ [ yl ~Eb_D
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten {10) days for processing.
PHONE
PROPERTY RESIDENT (If differen'~ from above) -- - / PHONE
2, BUYER PHONE
MAI LING ADDRESS
3. LENOINGINSTITUTION , , } PHONE
MAIL NG ADDRESS
.,z) F/4 /r.)4-:- .4-/r
4. REALTOR/AGEnT /~ ' ' ' I PHONE
MAILING ADDRESS
5. LEGAL DESCRIPTION
STREET L--OCATI ON
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
[] One {~ Four
~. SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
[] Other
7. WATER SUPPLY [] INDIVIDUAL*
COMMUNITY
[] PUBLIC UTI LITY
*ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
J~i INDIVIDUAL/ON-SITE** /"~'~'b/',) YEAR ON-SITE SYSTEM WAS
INSTALLED.
[] PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVI DUAL/ON -SITE DATE INSTALLED
I--~ PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic Tank or [] Holding Tank
Size:_ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCESwELL TO: Septlc/H°lding Tank IAbsorpti°n Area Isewer Line iNearest L°t Line
Absorption Area to nearest Lot Line
5. COMMENTS
[;~}~' APPROVED FOR ~T' BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY ~.~