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SKY HARBOR ESTATES #2 LT 4
Sky Harbor Estates #2 Lot 4 #015-282-40 Municipality of Anchorage ; Ir? Development Services Department: Building Safety Division On -Site Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page ! of 3 www ci.anchorage.ak.us (907) 343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: PID Number. Ha%tt/gark Aild,V IG Wastewater System: ❑ New ❑ Upgrade II / 0 995/6 ABSORPTI IELD Plw» �� ' /��/ Numoar a Bstrooms � O Deep Tr..0 Cl Snenoar Trengr as p MOW ❑ o1w LEGAL DESCRIPTION WRating Twill Depthporal paw GPDiFI' FI. Blatt La S txl-.: n 7 I }rf/ Depen to ppone Dkm pnpw Grade Grey aqn at \ FI. Ft Ta nsn,p Rupe Is,,lm 7i`) Fa mklmlrmp ew9rml paw Gr. FI. ;N FI. Well: ❑ New ❑Upgrade Cr"wal umbar of inns D»laxe 1)4 . 1. 6 Fi C�a;spcntm IPmna AB I, TdN Dapn Caned to Tar Anon ar P.pe;Vtm"m LLQ FI FY Dfdl.r Ona SInK Wafer L.vN MMI»r DateYw/elf FI �% i V Ya.d amp Sal n Canna H.. Grwb TANK GPM FI. SEPARATION DISTANCES (Septic []Holding ❑ S.T.E P. ❑ Other. To Septic Absorption Lift Holding ItibliciPrivate tlVw From Tank Field Station Tank Sewer Line ` ` 'pNo Gal Well ' •�, -�^ Tr Marn,W N a ConpannwMa ✓` Sulaco wear 100 I�'t LIFT STATION Lo L"37 r 37' s. .a�ar Fandnron I I L um 'Pp W. NvN al 'Pump d HIP.1. Yarm al n. Pwnp Maks Elaar,W nnPacaons WM by Cwtan Dion nQ o R.m s' 106� �e owAB BENCH MARK 0& � Lowl»nw D.SUWI,m � c.aa r awn rl - yl 5; 6 01 Ce i c e.of -Cor �4 eeme ft QW pin100FL ,1 / Inspections performed by: kof 6 ry owl Dates: 1 E r )' EN4L 2d-7/ /// to Development Services Department Approval! Conditional Approval Date: 6 y ` ROSERT C. COWAN V eg,: CE -8801 mate: tit',)`'%.._.. .•..00 +11tj f`•,��`�'��"�` Reviewed and approved by: I -� - 06 (Re "%) PERMIT PACE 2 OF 3 Municipalityof Anchora e DEPARTMENT OF HEATH 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 LOT 4, SKY HARBOR ESTATES #2 P.I.D. No. 0Ii-;k-Bz—y0 LOT 3 w w PSPN zV Qi '^7 FCO B 3EXISTING BEDR O�Jy ETRENCH rrr NOUSE TI CO T2 A DBL1 h DBL2 TBM NEW 1000 GALLON SEPTIC TANK SCALE: V 40' 100' WELL RADIUS ENC>rUP ' OF Ri> LOT 5 Vo p, ROBERT C. COWAN +yc�; CE -8801 41 It ,�Vi:�zv�z "� PERMIT NO. PACE 3 OF 3 Municipalit of Anchora e 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 LECAL LOT 4, SKY HARBOR ESTATES #2 P.I.D. NO. 01S- —3 E'1 —hHO ST1 S 98.4' FINAL GRADE 3.0 ST1 29.0 94 2' ST2 NEW 1000 94.0' DBL1 29.0 GALLON DBL2 30.5 SEPTIC TANK `4 ROBERT G COWAN `�cf+.` CE -8801 Jz.-e <„ r ,l�h t�ittii*r�r~~ A B FCO 38.0 3.0 ST1 29.0 18.5 ST2 27.0 25.0 DBL1 29.0 27.0 DBL2 30.5 27.5 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water Q Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Aug 04, 2006 Expiration Date: Aug 04, 2007 Permit Number: SWO60239 Parcel ID: 015-282-40 Legal Description: SKY HARBOR ESTATES #2 LT 4 Design Engineer: 0003 S & S Engineering Site Address: Owner Name: MARK MACHKOVICH Lot Size: 27600 SO. FT. Owner Address: 11740 CANGE ST Total Bedrooms: 3 Permit Bedrooms: 3 ANCHORAGE. AK 99516-2027 This permit is for the construction of: ❑ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: ✓" L Date: Date: 0 " I/ — d Municipality of Anchorage i.\ Development Services Department Building Safety Division Onsite Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEPTIC/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 0 / S— — a 5f 2 – W 0 Property owner(s) N'764< M -4 C H k0 yr cN Day phone 3 S`f ` 4'5``- C Mailing address 1/ 7 'Yo C_AltvG.e S% - ANCtl Zip Code Site address 1 r Zip Code 59S'(6 Legal description (Sub'd, Block & Lot) 1, o T Sky f/RR8« $S?A7L S ;;V2_ Legal description (Township, Section & Range) Lot Size Sq. Ft. THIS APPLICATION IS FOR (Nall that apply): Absorption Field ❑ Septic Tank ONLY A Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms 3 it:14[81i41RQ►IRIX A Initial ❑ Upgrade Renewal ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable �n�cipal Codes. S 3 5 Eagle E INca 17034 Eagle River Looe Road No. 204 ✓�✓ Eaate River, Alaska 99577 (Signature of property owner or authorized agent) Permit/Rush Fees Date of Payment: Receipt Number: (Rev. 11/05) H6 D. •� gl,/O6 0V 9070 Waiver Fees: Date of Payment: Receipt Number: MUNICIPALITY OF ANCHORAGE 4 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 NAME PHONE �T1EW l„"F-O� ft:i- -CH OUPGRADE MAILING ADDRESS \71 4 LEGAL DESCRIPTION / mss (. 444 LOCATION �,�;, NO.OF BE. OOMS -� U DISTANCE TO: Well kzso � 1 - Absorpti n area - Dwelling P/ (15 PERMIT NO. g �y — y F -ZZ Manufacturer ��}� ._ - N Material No. of compartments w Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth �- DISTANCE TO: Well Dwelling PERMIT NO. Z N Manufacturer Material Liquid capacity in gallons m O _j i DISTANCE TO: Well Foundation , Nearest lot line PERMIT NO. _ {,+ J u.Z No. of lines Length of line Total len th f lines Trench, widgth Distance bet�wleen ✓✓i`�nes Z W i )each L / �•Inches K ~ ¢ h Top of tile to fish�rade Material beneath tile 7 rr erptioi area T1o1al effctive abso E7 cJ ! inches J`Z Length Width Depth PERMIT NO. w C7 Q F• Type of crib Crib diameter Crib depth Total effective absorption area w �'- w N Well Building foundation Nearest lot line DISTANCE TO: w w ��Class .� Depth Driller Distance to lot line PERMIT N Lu Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE MATERIALSTF SOIL TEST RATING` INSTALLER M , 4 ,N�- f REMARKS • 1c� -e''��'� `- �l f'1 p� vvv°av°a 1 �j' •7i ata C,j f i------------------ v vv vv •°°•° °°v novo°• THOM•A. FISCIIE • h CE -6793 : a; Q��� •° na 133 - Ri' PPROVED DATELEGAL .�� A -ss s�S L MTx>N' 72-013 (Rev. 3/78) W I # ' I wl 1.1141 X fit 31 00" ell i.. X "WAS f2p V- elAxUcl H - I u 1150 A U� 0 9�E DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTIDN � 825 L STREET' ANCHORAGE, AK 99501 syste�. Choose the option that best: fits your site" 264~4720 ..... ..... ~�__,' F:::;;;!�� 11M_10 X 5.5 6,0 GRAVEL DEPTH <FT,) ��Tr: �-.A: 9 PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONG: 850016 01/17/84 M^A.M CONTRACTING 12721 TANADA ANCHORAGE, AK 99515 345-4456 � LEGAL DESCRIP: SUBDIVISION: SKY HARBOR EST" LOT: 4 BLOCK: NA SECTION: 21 TOWNSHIP: 12N RANGE: 3W LOT SIZE: 37900 (SQ"FT" OR ACRES) MAX BEDROOMS: 3 Listec/ below are the options available to you in designing your sepLic syste�. Choose the option that best: fits your site" ..... ..... ~�__,' F:::;;;!�� DEPTH TO PIPE B8TTOM (FT.) /t"0 5.5 6,0 GRAVEL DEPTH <FT,) B"0 0.5 2.0 TOTAL DEPTH (FT,) 12^0 6.0 8.0 GRAVEL WIDTH <FT.) 2.5 14.0 5.0 GRAVEL LENGTH (FT.) 18"0 28"0 36.0 GRAVEL VOLUME ( 14.2 14"6 16^7 *CU"YDS.) TANK SIZE (GALS) 1,000.0 ** 1,000,0 ** 1�000.0 *� SOIL RATING (SQ^FT"/BR) 95 85 85 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certi�y that: �amiliar with the requirements Ior on~site sewers and wells as set forth by the Municipality oK Anchorage (MOA) and the State o[ Alaska. 2^ I will install the system in accordance with all MOA codes and regulationq and in compliance with the design criteriu o0f' this permit. 3" I will adhere to all MOA and State o� Al requirements Vor the set back distances 11,c)m any existing well, wasteNater disposal s1,stem or public sewerage system on this or any adjacent or nearby lot. ' 4, I understand that this permit is valid for a maximum pf 3 bedrooms and any enlargement will require an additional permit" IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MO�\ BUILDING CODES� (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS~BUILTS ,THEN WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELEC�RICAI MUST BE DONE BY A LICENSED ELECTRICIAN" SIGNED APPLICANT: M A ISSUED BY ��� DATE: LOCATION OF WELL (Please complete .either to, Ib or Ic.) la. Borough Subdivision Lot Block '� Ib. 1/4 qt re. At ct��Sk Harbor 4 �� Ha Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS Second Addition Street Address and Arca of Well Location !2. WELL LOG htotorlal Type WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological a Geophysical Surveys Drilling Pormit No, _ A.D.L. No. Section No. Township N((6111I Range Er®�MarlAlan 5�' 3. OWNER OF WELL: Mr. Marl: Machkovich Address: 12721 Tanada Loop Anchorage, Ak. 99515 Feel Below Surface Top Bottom Hardpan 75 12.0 Gravel small water 120 127 ��. _5_, T Gravel water �— 195 200 I 4. WELL DEPTH (final) !f. DATE OF COMPLETION 6. G Cable tool �:Rtolory © Driven 0 Due Auger OJolted Gored L.,J Of her p7. 1)SEX{ Darnaotic 0 Public Supply Industry [_] Irrigatior Recharge Commerical 0 Toot Well (] Other. B. CASING: O Thrnadod Welded diem. --6.— In. to2_{jQ_ ft. Depth Weight _,__Z, tbs./ (I. diom,._,.-___In. to, _-^ ft. Depth Stickup__ _,_ 11. 9, FINISH OF WELL: Typo SIOI/Meth Sol between ��. IL and ft. Backfilling ,•_--e,_„ Gravel prick 10 STATIC WATER LEVEL:__96_-_}1� :l_214-L� 0 Above or PRVtow land eurfoco Dale Equipment used: lh II. PUMPING LEVEL below land surface and YIELD - 41, ofinr hre. pumping q.p, m. ^" ft, altor�- hre, pumping 12.GROU'i ING Wait Grouted; Yee D No Material: C] Neat Cement Othsrt 13. PUMP: _-(if available) it Length or Drop Pipe ft. capacity ��--g. p.m. D Subm. © Jet D Contrilical Other 14. REMARKS: Production of 30 GPM }1 - _-- IG. WATER WELL COIJ'i F'A^TORS C,_r RTIFIC TION: N : - IJ V/a—la_r Temparalura f I This well was Cr:I;LC under my jufisd1�11on and Ihis repefi is true to tht' bebl of my Rno"Iedge Ona behat; Magnuson Drilli Z AA 5385__ _ Ro pistoroa Business Name fo n!racl Li; ensa Number Address: Signod i Form 02-WWR (II/el) Authorized lReprosonlalivo Du 1 e ---- Copy Distribution: WHITE-Stato DGGS, PINK-Drillor, CANAnY-CVNemer �E B '-� Municipality of Anchorage On -Site Water and Wastewater Program - (907) 343-7904 s a E T Y Certificate of On -Site Systems Approval Parcel I.D. 015-282-40 Expiration Date: 1. GENERAL INFORMATION: Complete legal description SKY HARBOR ESTATES #2• LOT 4 Location (site address) 11740 Cange Street *Anchorage 99516 Current Property owner(s) Imke Maring Day phone 360-0144 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for. Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $_.5.5 0 Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number COSA # 0 S( Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. 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 Date: 31 -),3 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 The reported results describe the condition of the systems on the dates of the 0 F practices. evaluation. Separation distances to identifiable features. Hidden defects G were measured readily or encroachments may exist that were not identified during the evaluation. The operational life of all wells C\� r. and septic systems depend upon a variety of variables, including but not limited to, soil conditions, I / �� � T /r �'):' groundwater levels that may fluctuate Burin the ear g ( y g year), quality of construction (materials and ! ✓ u 1 Q }TH! I I , workmanship), and the water usage of the family utilizing the s stemis. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of they systems; therefore, GEG makes no warranty -(express or implied) regarding the future performance of w tf-=7 .; the well or septic system. GEG makes no representation whether an alternative well or septic system tai' '•,etfrey�A. Gorness: , 'f)� can be installed on the property in the event either of the current systems fail to perform adequately in yJ ' the future. The content of this report is for the sole benefit of the person/party that retained GEG to •.4 �l 2 F4 a p �l Fr perform the evaluation. Reliance upon the information provided in this report by any other person or is it legal party (including subsequent property purchasers) not authorized, nor will confer any right whatsoever. #A CC'884 6. DSD IGNATURE System #1 Approved for 3 bedrooms System #2 Approved for bedrooms ``\\`V \G�pPLITY Disapproved Conditional approval for bedrooms, with the followirQipularn trortit� ATF < wgsT.. qno LnGA ERVICES y: "�-�- f J Original Certificate Date: 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 �' Legal Description: SKY HARBOR ESTATES #2; LOT 4 Parcel ID: 015-282-40 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 6124185 Total depth 200 ft Cased to 200 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 3/2/22 Static water level at beginning of test 113.2 ft Comments Well production at time of test 3.1 + gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes M Nc ❑ Coliform bacteria is Negative Nitrate mg/L ME Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 3/2/22 B. TANK DATA C. LIFT STATION Age of tank(s) 16 years ❑ Required maintenance com Tank type/material 5EP' �` Age of lift station y Measured operating fluid level in septic tank 50" >stationmateri❑ Standpipes/foundation cleanout per record drawing Date of pumping 3/4/22 D. ABSORPTION FIELD DATA TRENCH Which system tested (date installed) 5/1/85 Adequacy test date 3/2/22 ❑ ALL standpipes present per record drawing Results F-1 Pass For 3 bedrooms Total measured depth from grade 11.41 ft (max) Fluid depth prior to test 40 in Measured depth to pipe invert from grade 5.41 ft (min) Water added 601 gal ❑ N/A — pressurized field °60 New depth in ❑ Monitor tubes go to bottom of effective. If not, state 120 depth into effective 5.0' Elapsed time min P ❑ Code -required soil cover over field Final fluid depth 49.75 in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) Gallons introduced N/A gallons If yes, enter date N/A Comments/Deficiencies: 'SYSTEM FULL COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' Q Yes if No ft [71 Yes if No ft Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25' M Yes if No ft Absorption Field on Lot > 100' R Yes if No ft Holding Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' Yes if No ft E1 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' E]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' QQ Yes if No ft Property Line > 5' Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Yes if No ft Private Wells > 100' 0✓ Yes if No ft Water Main > 10' Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' M Yes if No ft Community Wells > 200' 0 Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS *MET CODE AT TIME OF INSTALL G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet OF A L�°�1 'co 49TH y; ............................ Jeffrey A. Gorness, �9 CE -7953 4�Rd Pio f es sionpocti #AECC88d E Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-28240 COSA 1. GENERAL INFORMATION Expiration Date: Complete legal description Lot 4, Sky Harbor Estates #2 Location (site address) 17740 Cange St. Anchorage, AK 99516 Current Property owner(s) Mark Machkovich Day phone 345-4456 Mailing address same Lending agency Day phone Mailing address Real Estate Agent Mailing Address Day phone Unless olhefW SO requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System❑ ❑ ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank ❑ Community On-site 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. OSD 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 sample results. (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 welts 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 seat affixed hereto and as of the validation date shown below. I verify that mhisnvestiapplggation. based on procedures outlined in the Certificate of On -Site Systems App rovalshows 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 Iicablenspection. the Mun cipai and Stateecodesr supply and/or wastewater disposal system is(are) in compliance with all app ordinances, and regulations in effect at the time of installation. Name of Firm s a s Englneedng Address 15661 S. Birchwood Loop Rd. C�glak.g67 �-el o Engineer's Printed Nam % i 5. DSD SIGNATURE Approved for _3___ bedrooms. Phone 694-2979 Dat Disapproved. Conditional approval for bedrooms, with the to stipulations: Attachments: �S_ Arsenic Advisory COSA Checklist Septic System Advisory Maintenance Agreements Supplemental Engineer's Report Well Flow Advisory Nitrate Advisory Other By: Original Certificate Date: (R� 11M) Municipality of Anchorage Development Services Department Building Safety Division Onsite Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 015-282-40 COSA# jX 05g) Expiration Date: "We]t:t47_111IRftlelf lT.11L91i1 Complete legal description Lot 4: Sky Harbor Eatates 82 Location (site address) 11740 Canr.e St. Anchorage. AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Clark ttachkovich same Unless otherwise requested, COSA will be held by DSO for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone 345-4456 Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site]X Individual Holding Tank ❑ Community On-site ❑ 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 Onsite 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 sample results. (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, I verify that my investigation, based on procedures outlined In the Certificate of Onsite 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 S & S Engineering Phone 694-2979 Address17034 N. Eagle River Loop Ste. 204 Eagle River, Ah 99577 Engineer's Printed Name I(OBE.4; C, Co.."f Date 5 �r A c LOU 5. DSD SIGNATURE 9 ROBERT C. COWAN —lG pp �_ 7 CE • 8301 ' Approved for bedrooms. �1�'srti•., ,.•• Disapproved. s. Conditional approval for bedrooms, with the following stipulations: - Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other_ By: /JZ i�Original Certificate Date: (Rw 1105( Municipality of Anchorage Development Services Department Building Safety Divfsion On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsfte (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST 'rt1�r Legal Description: LO T- it Src y NAABr R E 5 -r4 i & f .O Z Parcel ID:O /S-- Z 9X -Yo A. WELL DATA Well type i' R#-14 re If A, B, or C provide PWSID # Date completed 6 J7 A r Sanitary seal 6M) _Lf r Total depth 2±-O—ft. Cased to 2 d) ft. FROM WELL LOG Date of test al y V 3 - Static water level °) SO ft. Well production 30 9— p.m-WATER SAMPLE RESULTS: Coliform &2k colonies/100 mL Arsenic: N 0 mg/i B. SEPTICIHOLDING TANK DATA Well Log &N) YF s Wires properly protected ON) YE l Casing height (above ground) ) a. 4 in AT INSPECTION G /13 /° L O Y Nitrate 0.0.0 mg/L Other bacteria 4a colonies/100 mL Date of sample: Collected by S & S ENGINEERING17M Esvie R1 knot, oad Na 204 Engle RWw, Alaska 99377 Tank Type/Material 5 T6 ri- L Tank size 1000 gal. Number of Compartments a Date installed C/a -'7/0,y Cleanouts `VN) YF 1' Foundation cleanout O/N) Y1 f Depression over tank (Y119 /� c'c' High water alarm (Y& Date of pumping -7 /° G Pumper f A, - r r 4 ,LY P V M P a A S C. ABSORPTION FIELD DATA Date installed s'/l Soil rating (g.p.d.R o /bdrm 9 S— System type 'T A c r C -H Length 2 6 ft. Width 'DL. S- ft. Gravel below pipe 19 ft. Total depth L ft. Eff. absorption area Z!JX-ft Monitoring tube Y-45 Depression over field / O Date of adequacy test 6 // 3 O L Results as ail) AW For 3 bedrooms Fluid depth in absorption field before test 99 in. Water added gal. New dept47)Lin. Elapsed Time:3co min. Final fluid depth 't S- in. Absorption rate >= 7st7 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) /J ° ^ E' 'r^'0 w I/ If yes, give date — D. LIFT STATION Date Installed Size in gallons "Pump on' level at _ in. "P pvi Datum Cycles tested _ E. SEPARATION DISTANCES (YIN) at _ in. High water alarm level at SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot /0 c -t Absorption field on lot /00 r'> Public sewer main Sewer /septic service line Animal containment areas S� f Meets alarm & circuit requirements? On adjacent lots On adjacent lots / 0 0 �f Public sewer manhole/cleanout N / A Holding tank A/ 14 r Manure/animal excrete storage areas /m d t SEPARATION DISTANCES FROM SEPTICA-IOLDING TANK ON LOT TO: I / Building foundation 11 Property line 3-7 Absorption field S f Surface water 140 f r Water main N /,4 Water service line %� f Wells on adjacent lots 10 0 �- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: I r Property line 37 Building foundation j a Water main 1J /A Water Service line 10 r4 Surface water / 0 0 r� Driveway, parkinghrehide storage 40 t r Curtain draini`'O&E {C.+ar✓ Wells on adjacent lots F. COMMENTS G OF G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and j"G1�r review of Municipal records that the above systems are in /j • [ conformance with MOA COSA guidelines in effect on this date. A A woewrTAWeeweN Engineer's Printed Name �04EA; C. Co N 4.✓ yf't` CE aeltAl Date COSA Fee $ S-130.6,0 Date of Payment 1-tl/ 106 Receipt Number y #0 70 (Rev. 1IMS) Waiver Fee $ Date of Payment Receipt Number in. ■ k n � 00'M M QJ -0.N OM A&g,.00N m pPJI ------------- -----------gym&e %m.\ k� V) Cl) / zofki7 §� \ R f 2 I �£®®°2 § k& ^ q ( K B -� 7(� ��� T�©c' £V) < P O t-« £fie §�[o|f2 ec § k ]� E "�§ §+L IkZZ J|§■2■# k I[c cc \`=C^k1 §7 k/k/kƒ/ § |§§ }� }k§ /. — - - CD t moHKeo 2 ff§ $$t■0-■ &Z -m k2 E(2It||�=� ©&«tea&���~ /(kflgi)$kk2 G 2 . ui 00'M M QJ -0.N OM A&g,.00N m pPJI ------------- -----------gym&e %m.\ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) CA -T- S 7 HjOr7�Ce 5 Location (address or directions) ► 6 (b) Applicant Name f 1 1 09:-h� �\+eFe#one: Home Z45— !�'Qness S �M Applicant Address I 1 -7 4 O C AIACy E�-- 12-Nt�-t.sClizMaT;S-' (c) Applicant is (check one): I -ending Institutior3; Owner/builder ❑ ; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: / 'A 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 13 3. WATER SUPPLY Telephone Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11,84) I it 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION A 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 �' � ��+Fc'f'<`Z_ ��.iC�f'_ %ephone �� _ / e Addre Date +►L'��-��� A Ar 04 � ,• (j 9TH B•• ;••� • u•'• • • • 5 Engineer's Seal B •• THOM A. FISCHER 0 fie,'.• CE - 6793 fe 10 DHEP APPROVAL OD j Approved for L 1.' bedrooms by� Date Approved Disapproved Conditional Terms of Conditional Approval �r CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) N MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MO^1 HEALTH AUTHORITY APPROVAL (HAA) ,JAN 2 1 CHECKLIST - FEBRUARY 1984 264-4720 (� C �C Legal Descriptio"I n: 4- �\��`( t� �ELaolds�_��jt� A. WELL DATA Well Classification ��J�s'- If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) ` ,__ Date Completed 3�_AiNE W 19�7 Yield Total Depth Cased to Z'�� Depth of Grouting N«N� Static Water Level %6� Pump Set At —) Casing Height Above Ground �Z1 Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) ` <S Depression Around Wellhead (Y/N) Sao Separation Distances from Well: , To Septic/Holding Tank on Lot 1� '� ; On Adjoining Lots}' / To Nearest Edge of Absorption Field on Lot On Adjoining Lots (�© To Nearest Public Sewer Line 0 / To Nearest Public Sewer 1 Cleanout/Manhole W To Nearest Sewer Service Line on Lot Water Sample Collected by Date 4 Ogg Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed 1 %S Size ) O No. of Compartments ___4_ Standpipes (Y/N) YICS Air -tight Caps (Y/N)' Foundation Cleanout (Y/N) Depression over Tank (Y/N) Nb Date Last Pumped Pumping/Maintenance Contract on File (Y/N) 0 ; for N Holding Tank High -Water Alarm (Y/N) N Pr _ Temporary Holding Tank Permit (Y/N) __ 'J Separation Distances from Septic/Holding Tank: To Water -Supply Well To Building Foundation To Property Line To Disposal Field 1 To Water Main/Service Line 2 —F' To Stream, Pond, Lake, or Major Drainage Course T�'-(W�r Comments _—ngP73ic S. "f &rt-cv% 1►�ilYfur�c, rv, C' l f�'lv . Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA r^17�wcc11 Soils Rating in Absorption Strata Type of System Design J[W 4 'V, Date Installed f /��Length of Field ' / 3�'� Depth of Field Width of Field --�/ % ZiJ Gravel Bed Thickness Square Feet of Absorption Area Z„ Standpipes Present (Y/N) Depression over Field (Y/N)Date of Last Adequacy Test iy Results of Last Adequacy Test Separation Distance from Absorption Field: 2�i To Water -Supply Well tD I -t_ To Property Line ,.L/ To Existing or Abandoned System on To Building Foundation — � � Lot N1 / Ar ; On Adjoining Lots tc5x=� To Water Main/Service Line Z SI "— To Cutbank (if present) -� To Stream/Pond/Lake/or Major Drainage Course�f + To Driveway, Parking Area, or Vehicle Storage Area Comments iP D. LIFT STATION Date Installed — Size in Gallons — ,,Pump On" Level at High Water Alarm L Tested for —� Electrical Co¢4s (Y/N) Dimensions Manhole/Access (Y/N) ,,Pump Off' Level Ven141f/N) ping Cycles during Adequacy Test. Meets MOA It ** Check Permitted Bedroom Rating Against HAA Request I certify that I hav checked, ve ified or onformed to alf Nl A and HAA guidelines in effect on the date of this inspection. Signed ,�_-_ Date Company t a�1t rrt> JewciY Ctb"S-JKMOA No. — Receipt No.��� Date of Payment D� Amount: $ o`) Page 2 of 2 72-026 (11/84) r IF Shat i 9; ri�l'rrs" � � fe �_ rytl