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Home My WebLink AboutROLLING HILLS VIEW ESTATES BLK 5 LT 5AOnsite File ? EM 3 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191142 PID Number: 050-322-32 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name ALFRED J. ROMASZEWSKI ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 18814 UPPER MC CRARY RD., EAGLE RIVER ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot ROLLING HILLS VIEW EST. 5 5A Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft' Ft. Well 97'+ -- 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCHORAGE TANK Capacity 1000 Gal. Surface Water 100'+ -- Material STEEL Number of compartments 2 Lot Line 10'+ -- NA Foundation 10'+ __ LIFT STATION Manufacturer Capacity Gal. Remarks Existing septic tank decommissioned per code. Deep-burial tank. New tank installed in same hole due Alarm location Electrical installed by to constraints. DWG based on ASB from owner. Installer DEAN CONSTRUCTION PIPE MATERIAL Housetotank 3034 Tank draofeo 3034 Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection1s' 6/5/19 11/12/19 Location and description 2�d 3rd 4'" BOTTOM OF SIDING ON-SITE WATER AND WASTEWATER SECTION APPROVALOF ��►`�'`�� A } �I y Conditional Approval: Date .* � � •; f' C0� SAWN TH :• • Curtis Huffman Septic System Approved - Date 7 d�Zd CE 128991 • c�`� ��F�• 6/30/20 .•��' Aw FdpROfESS14N�- Note: this approval does not include well permit requirements. (Rev 05/02/18) Municipality ®f Anchorage P.O. Box 196650 e 4700 Elmore Road Anchorage. Alaska 99519-6650 ® (907) 343-7904 ® Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Department On -Site Water and Wastewater Section �,vcnt. S * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV201036 COSA#: Permit#:OSP191142 PID#: 050-322-32 Legal Description: Rolling Hills View Estates Block 5 Lot 5A Engineer: First Water Consulting Applicant: Alfred Romaszewski Your request for a waiver of the required 100 feet horizontal separation from the septic tank to the private well has been approved. The approved separation distance is 97.0 feet. In addition, your request for a waiver of the required 5 feet horizontal separation from the septic tank to supports for a deck over 30" tall has been approved. The approved separation distance is 4.0 feet. See engineer's waiver request for justifications. This waiver approval applies to the existing septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ..............................................................................I Waiver is Granted: X Waiver is not Granted: Date: rI' 'T ��•� b.. Approved by: &�� Name of Reviewer WIN ............................................................................I **** VARIAN C E/WAIVER REVIEW **** �?�i 5 FZo-c� � � 5110 5 y 13021 Montego Circle, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com June 30, 2020 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: ROLLING HILLS VIEW ESTATES BLOCK 5, LOT 5A – WAIVERS Per the attached as-built survey by Mark Seward, LS dated March 4, 2020—the septic tank first compartment cleanout was measured at approximately 99.5’ to the subject property’s well with the edge of the tank approximately 98.7’ from the closest well. We are therefore requesting a waiver to 97’ between the referenced well and septic tank be granted at this time. Granting of this waiver is justified in the fact that the tank is 15-20’ down gradient from the existing well and the slopes continue away from the well with no chance of surface effluent reaching the well. The well is on the opposite side of the house and there have been no known issues or influence over the past few decades from the previous existing tank. The edge of the septic tank was measured at 4.1’ to the edge of the deck support. We are therefore requesting a waiver of 4’ between the deck support and septic tank. The granting of this waiver is justified due to the fact that the encroaching support is a corner support with the majority of the deck’s bearing load further away from the tank, there is adequate structural support, the deck does not go over the tank, the tank has been improved with a deep-burial rated tank, there have been no known issues previously and none are anticipated with the granting of this waiver. Granting of these waivers will not impact any of the neighboring properties. Please contact us if you have any questions. Respectfully, Curtis Huffman, P.E. Attachments: As-Built Survey Inspection Report MOA Waiver Fee 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.arglonsite On -Site Wastewater Disposal System Permit Permit Number: OSP191142 Effective Date: 5(212019 -- — Work-Type:--SepticT-ank-Upgrade - -- _. - -� --Expiration Date: - 1--1__11_--1___1_ -5/112020 Tax Code Number: 05032232000 Site Legal Address: ROLLING HILLS VIEW ESTATES BLK 5 LT 5A G:0255 Site Mailing Address: 18814 UPPER MC CRARY RD, Eagle River Owner: ROMASZEWSKI ALFRED J Lot Size in Sq Ft: 53143 Design Engineer: ,ANbER5ot4 C.Ot45RikcTtaN -!- ENGINL.ERING Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (2417). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received B) Issued By: Date: 5Alf j Date: 1 6PIANS MUNICIPALITY OF ANCHORAGE Development Services Department �" Phone: 907-343-7904 On -Site Water & Wastewater Section - ` Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-322-32 Property owner(s) ALFRED J. ROMASZEWSKI Day phone 9072404182 Mailing address PO BOX 770192, EAGLE RIVER, AK 99577 Site address 18814 UPPER McCRARY ROAD, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) ROLLING HILLS VIEW ESTATES B5, L5A Legal description (Township, Range & Section) Lot Size 53143 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: (® all that apply) Absorption Field ❑ Septic Tank Ps Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: TYPE OF DWELLING: Single Family (SF) (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. F1ICS - Brent Western (Signature of property owner or authorized agent) Permit/Rush Fees: 2�7 ff Waiver Fees: Date of Payment: (ota Date of Payment: Receipt Number: (3 30,3 Receipt Number: Permit No. (IJCl 411uZ?_ Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc Michael N. Anderson, P.E. Civil/Structural Engineering and Construction 4661 Natrona Ave. Anchorage, Alaska 99516 Phone 345 -3377 / Fax 345 -1391 Support Services Brent M. Western 907-440-4601 April 28, 2019 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: ROLLING HILLS VIEW ESTATES B5, L5A To whom it may concern: The owner has requested we proceed forward to obtain a septic permit to upgrade the aged septic tank on the subject lot. The proposed upgrade will serve the existing 3- bedroom house. The lot and area is served by a private water and will not impact any of the neighboring properties due to the lot layout. Please contact Brent M. Western or me if you have any questions. Sincerely, Michael N. Anderson, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191142, Rebecca Carroll, 05/02/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191142, Rebecca Carroll, 05/02/19 DEPARTMENT OF HEALTH & ENVIRONMENTAL PRoTECTIoN ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 - SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME/~ IPHONE ~NEW LEGAL DESCRIPTION LOCAT, ON. Well _ I Absorpt~rea ~ DISTANCE TO: ~ Manufacturer ~ ~/~ ~¢ ]Li~in~lons IF HOMEMADE: ,ns~dele.gth ,sTA,o To: Manufacturer Well DISTANCE TO: / ~-Z~0 No. of lines Length~.~eBh li~e ;re finish grade Foundation¢ ~ )f J~nes Width Type of crib Crib diameter NO. OF BEDROO~ W dth Material Nearest lot li~ 2~ til~ ~OO ~_.,~~ inches No. of compar~z Liquid depth __ PERMIT NO, Liquid capacity in gallons PER~T~..)~ 6 (~ Di stun c e I~e~e~ i/~lL Total c ive a~s ti~n area PER~IT NO. Well DISTAN~ DISTANCE TO: Building foundation ng foundation Total effective absorption area Nearest lot line Distance to lot line PERMIT NO. Absorpt on area(s) Septic tank OTHER PIPE MATERIALS s ILTE R IN REMARKS DATE DEF:'RF;YTMENT Iii::' HEF~i....TH FIND ENVIRONMENTFtL PROTECTION 825 L STF,'EET., FINE:t"'tORRE'iE., RK 26 ,,:i--',::i-72 E~ PERH t "I" NO: DRTE ISSUE[:,: FIF:'PL. I CFlNT: Ft[:,D R E'.:i"; S: LEGFlL [:,ESCR I P: ..OT SI;ZEE: h'IFIX BE[:,F;;:OOMS L. OT: 5 BLOCK: 5 F4:Ft1`,K3 E i I.,.I L. tSI'ED BEL. OI.,.I FIF,:E THE OP'T'IOI',i?.'; F:I'v'FtlLFIi:3LE TO YOU 11'.4 [.':,ESIGNING ',r'OLIF;..: SEPTIC S'¢STEM. CIqOO'iT, E THIE OPTION T'HFIT BEST F'ITS '~.'0I..!t:~: SITE. lEE: EE E::, II..,Jl .. E.]::. Fi' F~ DEPT'H TO F:'IPE Ei',OTT'C¢1 <FT. ::, 4. 0 4. 0 4. GI.q'.R'v'EL. [:,EPTF-I <FT. ) 8. 0 0. 5 Z::. 5 TOTRL. [:,EPTH <l:::'T. > i;;!'.. ~...3 .4. 5 7. 5 GRRVEL !.,.!IDTH ,::F'T. ::, 2. 5 :I..7. 0 5. 0 GRWCEL. LE1',iG"Ftq <FT. ::, 2*$. 0 1!:4. 0 4% 0 GF:'.FIVEL VOL..I...tME <CL.I. "r'[:'::']';. ;' 't. 8. :.:] 2:1.. 4 24.. 5 TRNK SIZE ':: (:iit:::tf....'.;;.:, ::' :I.., 000. I;:j :+::+: ::L., 000. 0 ~+::+: i., 000. 0 SO I L RRT I NG ,:: SQ. F'T. ,,"BFq: ) :1.;:-"'5 :L25 :1.25 :+::+: T'f:tNI< MUST' H!:::P,,'E: FIT L..EF:IST Tt.,tC) r2OMF:'RRTME1",t"r's I C:ERTIF'¢ TI...IFIT: ±. I Rl'"l I::FIM:iL. iFIR k!i'T'l:..! THE REQLIiI.:;:EMENTS FOl.:;: ()N-.SITE SE[,.II:i.:RS FI1'.,ID I.,.IELLS FI:-'..'; SE'T' FORTI-..! E:"r' THE MUNIC]:PFlt.!T"r' (::il::' I::INCH[)I:~:I::tGE ,:MOFI) I::t1`',t[) ]"HE: :F:;TFfTE OF 2. I I.,.IILL. !NST'FILL 'T'F'!E: S'T'STEM IN RC.':CORDRNC.:E !.,.!ITH FILL I','tOR CODES RND RE(]-iULFI'TIONS., FIN[:, 11`.,t COHF'L i F!NCIE N Z TH THE DIES I (:iii',! CR I TEl:k:: Z Fl OF TH I ::.:; PERM I T. 2:. t !.4ILL. F![:,HEF.:E TO FILL. MOF! Fll'.,t[:, '.iSTFITE OF' FILFISKFI REQLI]:REMENTS FOR THE SET' BFICK [:,ISTRNC.:ES:; F:I:;;:OH FI1`,I'./ IE;:.:;iSTING I.,.tELI. .... !.,.iFI'..:.FT'Et.,.iRTER [:,ISPOSF;IL S'-r".'5"FEM OR PUBLIC 'f!;Ei.,.tE:.F;i:FIGE S'¢~!;TIEi"! 01`.4 THIS OF:: FIN'./ FIDJFICE1`',!T OR 1`'.tERRB"r' LOT. 4. I U1`-,IDERSTF:Ii',I[:, T'HFIT ]"HIS I::'ERMtT IS ',/F'iLI[:, FOR Fl l'dFt',:.:;II"liJM OF "_::': BEDROOHS FIN['.' F:li"-.!."r' E:NL. FIFb]iEMEhlT N I L.L. REQU I RE RN F:I[:'[:' I T'I OI"4RL. PE:I:'::H I T. IF' Fl LIFT .'.::!;TF!TIEIN IS; I1`',ISTI:::IL.L. ED [t',t. !:::Ii',! FIRER COVERED B"r' MOFI Ei:tJlL.DII"4G CODES., THEN ,::.'.t.. ::, I::!i",! EL. ECTl:;;: i CF:IL.. F:ii']:l:;:H I T FffqE:' i' NSPECT 1' ON MUS]" E:E OBT'FI I NE[:'.; , ':: 2) RS-BU I LTS !-,.fIt....I.... NOT' Eqii.:. I::!PF:'RO'v'EI} NI'I'FiOUT I:~N EL.ECTRiC:RL. INSPECI"ION REPOR]".~ FIND' '::2:) ]"HE EL. EC:TI;'.ICRI_ l.,.tOl:;:'.l< MUST BE F..:,OI",iE 8"¢ I::! L tCENSEC, EL. ECTRIC'IRN. F:IPF'I.... I CI::fN T: F..': E M F-t:"~ I_' // ~ · PERFORMED FOR: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG [] PERCOLATION TEST 2 3 5 6 7 8 9 10 11 ;12 13 17 18 2O COMMENTS SLOPE SITE PLAN tWAS GROUND WATER UNTERED? O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net¢,/,~'- ~'~;; Reading Date Time Time Water Drop PERCOLATION RATE /~/ /~' (minutes/inch) TEST RUN BETWEEN FT AND ~ FT by SULLIVAN WATER WELLS P. O. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 'NER OF LAND 4_~ .~ t3 ..r2~q ~_~-~__~. -~'C~ ,~ / DEPTH OF WELL ~O ~ DRESS ~ ('~ O ~ ~ ~ff~J~ /~ STATe, LEVEL OF WATER FT. _Z O~ GAL DESCRI~IO~ ~ ~z < ~ ~<'"'~ '~t~.J~ ~ ': DRAW DOWN F't. ~TE.Sta,ed~'t~'(? Ended ~-~Y - GA~.PERHR -- .ftc ~iT NUMBER ~D OF FORMATION: am , Ft. t~Ft. ~¢C dff ~ I ~ ~om .... Ft. to Vt / ~ ~ Fr~m_-- tom.~.Ft, to_~Ft. From rom Ft. toad. Ft. From rom .... Ft. to ~ ..Ft. Fromm__ KIND OF CASING From---- Ft. to- From__ .. Ft. to .... Ft. Ft. to Ft~ _ Ft. to___Ft.-- _Ft. to~ ___Ft. Ft. to_ Ft. Ft. to Ft._ .Ft. to .... Ft._ Ft. to~ Ft. ~Ft. to .... Ft. _Ft. to .... Ft.- _Ft. to__Vt. Ft. to--- Ft.- Ft. to Ft.' Ft. to. __Ft. .Ft. to_. Ft~ Ft. toad_Ft. I::,Ei:I:::'F:IF;:"I"HEi'~T O1:= HEI::tL_'T'H F:It",t[:, EZNV Z[ !'~.'.Oi",II'"tEI'.,tTFIL. I:::'I~:C~TECT]: ON ;~!~;~-2~; '" i_ "' :E;TI=-".EE'T., F:II'.,IC:HOI::..ff=IrJE., I:::ll-::: ;;:~;,~'"",q.'~'~',;::O : I:Ii',ICI'-IO'F.:I:tGIE ~."'~;94..-.2:'L:J:::L : EI:tCJi...E Ri'v'EI':.'.' C::~ ['"~ ......... :~;; :[: T' IL~:T. [o.~ E!: I[_ L_ FTM El IF~?.: I~'"dt Z 7'" F:tF'PL. :[ C:I=IhlT: F'I[ [:~:OP'IF:I~;:i!![ZI.,.I'2:;K Z PHONE: FII::,D,':.?.E~::E;:~;: F'O 1:30,':':', EF:ICiLE 1::'. :[ ',,.'El:;::., t:':Ii( LECiI=tL DE'..~;['::I.=...':[F'T]:Oi'.~ :E:UE:D]:',,.'Z~:TON: IROEL :[1'.,!~3 H]:LL.S V.T.E[,.f BLOCK: 5 LOT: L.OT .':7 :t.' :-ZE 0 ~(i) F:'T 'TO[,,~NS;H Z P · RFtt'.,I[3E: ..... :~;EOT ]: 01'.4: ..... :[ C:Et:::T ,T. l::".r' ::L. :[ iaFI F'I=tI'"IZL_Zf:i[:~: I.,.I:[TH "F[IE: .F.:EL:.!L.I.'t:F.:E~.I','IENT:~.~, FOF['. OI'.,t...-:~,ZTE '::'~Et.,.tE~:~: FIND [,]ELL:...-_.; I:1:~ F:'OI'r:.'TH E',~.~,' THI::= flL.tf',I:[,'.'::ZF'i-IL:i:'T".~.' OF' F!F,IC:H(3,r';~!F:I~3E I':'ti",!D THI=2 ~:Tt=I'T'E O1= I:IL.F:I~KFt. ;:T='. Z !.,.iZt....L ZI'-,i:~?FFILJ... THE S~'-rL":~21"EH ].'N F!OCO'~'.[::.'FIi",tOE I,.t:[TH THE COE:,E:==i I=llqE:' HI=IVE la COP? OF' THE C:OE)E ~:T, UP'II'IF:II:~:'-r' FIND D :[ l:::tC"il::::l:::tl'"t F:IT'TI"aCHHENT~; I.,.IH T CH ]: .':?, 'F'FII:[:T OF' TH :[ =::.:, F' EF:d"I Z 7'. :3~,. :[ UND[EF,.'::i~,TFIN[.':' TI"'ttaT THE ON-"'~:[TE ':=;EklE'F.". ~:';'¥':i~,'TEI"I t"1F1'¥' ,~EtT!LIZ~:E EI",IL.I::tI:;::GEHEt',IT :IF THE F-".EE~.':.T. E:,ENC.'E ] !E: Fi:EI'IODELL".::D 'T'O ?~ NOLLtDE t"10,~RE THF:hN q. BEI::'F.':OOH:::':. ,r::'E~'.i"1Z T F:IF'F'L :1: C[:INT i ff':!S; 'T'I"IE: I':.'1:~£;I:::'01",1~7: Z B Z L .T. T"? TO :[ i"~FOI:~:I"I [)EFi:L~Ot'-,!I",IEL DI...II:~: ~[ NI2i THE Z t",t~E;'T'I=ILL.!=IT .T. 0[",I :[ ?~:F'E~:,'.':TT :[ ONe:='"; OF' F~i",I*'~'' [,.IEL..L.~2; I:IDJI=tOENT TO TH ]: '..::: F'F.':OF'EtT:.'T"¥' FINE." THE NUk![~Ef:-'.' Cfi: F:".E"2;]:DENC. E:"!i: THFt"F THE [~.IELL. [q]:L..L :[t: 1=I L...'[F'T ::~,TFtTZON ].':~ .T.N:~TT'I::tLLED., FIN ELEC:TFi:]:C:I:aL I='EF[:FIZT t=INt::' ZI",f':_::F'EOT:[ON FiLf~:;T BE OD"F?t~htEE:,. I"I~ii:""E~LI?,:LT~]; C':f':tNNOT BE FIf':'F'~:O',,.'[Z.F.:' I.,.tZTHOLtT F:llq EL..EOTF.::[OFIL TN"_=,F:'EOT:[ON i~:EPOI'?.T. -f'l'IE EL..E:CTf::::[C:I=IL I.,.IOFi:I'::: I'ILI~!;T E:E DOi',!E E',"~" t:::t LZCEN~"_':ED ELEOTF.".:[O]:FIN. Permit Applicant: Location: Legal Description: Z~ ~ ~" ~/~, ~' ~/~/~ ~///~Lo~ Size: Type of Soil Absorption System Is: Trench: ------- Dz=infie£G: Maximttm Number of Bedrooms: mUNICIPALITY Of ANCHORAGE ,-~ Department Health and Environmentalf 'rotection 825 L Street, Anchorage, AK. 99501 264-4720 WELL ,~!~/O~ OM-SITE SEWE~ PERMIT /~/.. ~l~.~ S~C~Z/r/,' Mailing Address:~'~'-~/~ Phone Number: Gg~'~ Seepage Bed: __ Holdzng Tank: Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is: DEPTH ~----qnENGTH GRAVEL DEPTH WTDTH 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 excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = ~ - GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of-residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 51, 1 9 8 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as (2) (3) signe~: set forth by the Municipality of Anchorage. I will install the system in accordance with codes. I understand that the on-site sewer system may require enlargement if the rests remodeled, to include more tha~b~ms ssued by: SWP/024(1/81) MUNICIPALITY OF ANCHORAGE i Development Services Department �, _j Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050`322-32 Expiration Date: 10-2-2--2--2-- 11. ®-2-2-`Z-2- 1. GENERAL INFORMATION Complete legal description ROLLING HILLS VIEW ESTATES BLK 5 LT 5A Location (site address) 18814 UPPER MC CRARY RD, CHUGIAK AK Current property owner(s) ROMASZEWSKI Day phone Mailing address PO BOX 770192, EAGLE RIVER AK Real estate agent 2. TYPE OF DWELLING: Q Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic 171 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 5-5 (3 3 3 C' Lk Waiver Fee $ Date of Payment -I 5 AO�2 Date of Payment Receipt Number 0 15 q Receipt Number COSA # O S C 2 2 1 3 5� Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 7-2-22 _ �1 OFFtp � 4_�� 6. DSD SIGNATURE ,r 4?L— •, s`� �....... ... ..........gid r� System #1 Approved for 3 bedrooms �• • •....,............... � MICHAEL N.-,NDERSON �� ;-dS stem #2 Approved 1;sX. C - 9169 Disapproved�� l'��d` • t z' Conditional approval for bedrooms, with the following stipulatldt��t�� By: Original Certificate Date: Z2 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: ROLLING HILLS VIEW ESTATES BLK 5 LT 5A If more than 9 septic system on lot: COSA Checklist # of A. WELL DATA ❑■ Well log is filed with Onsite (or attached) Date drilled * 118183 Total depth 500 ft Cased to 32.33 ft X Sanitary seal is functioning correctly ❑■ Wires are properly protected Casing height (above ground) 20 in. Date of flow test for COSA 7[7122 Parcel ID: 050-322-32 Structure served by this system Well production at time of test "1.511.0 gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes No X Coliform bacteria is Negative Nitrate 3.6 -*mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑■ Arsenic less than MRL (ND) Collected by MNA Date of Sample 7/7/22 Static water level at beginning of test 112 ft. Comments "* PROPERTY HAS 2 WELLS 1983 AND UK. ' FLOW PER HEFTY DRILLING 1.5 & 1.0 GMP, BOTH USED Sipe • s res CA 6^4'1 b,K-C4 (O'A4 B. TANK DATA Age of tank(s) """' years Tank type/material 5EV c'5"rE Measured operating fluid level in septic tank 8 0 Standpipes/foundation cleanout per record drawing Date of pumping 7/7/22 D. ABSORPTION FIELD DATA Which system tested (date installed) 5/5/84 ❑■ ALL standpipes present per record drawing Total measured depth from grade 4.5 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A — pressurized field ❑■ Monitor tubes go to bottom of effective. If not, state depth into effective C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 7/7/22 Results Q Pass For 3 bedrooms Fluid depth prior to test 3 in Water added 450+ gal New depth 5 in Elapsed time 1440 min 0 Code -required soil cover over field Final fluid depth 3 in ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test)0 If yes, enter date Gallons introduced gallons Comments/Deficiencies: ALL CLEAN OUT -PIPES PRESENT PER THE INSPECTION REPORT 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' L7✓ *97 Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft M Yes if No ft Neighboring Tank > 100'✓❑ Yes if No ft Private Sewer/Septic Line > 25'M Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' Q Yes if No ft Water Main > 10' Animal Containment > 50' ❑✓ Yes if No ft ✓❑ Yes if No ft ❑✓ Yes if No ft Water Service Line > 10' ❑✓ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main 75' ✓❑ 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' L7✓ Yes if No ft Surface Water > 100' Q✓ Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Q Absorption Field > 5' El Yes if No ft Private Wells > 100' Q Yes if No ft Water Main > 10' 0 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'✓Q 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' Q 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 * SEE WAVIER, ALL CLEAN OUT PIPES PRESENT IN THE BED PER THE INSPECTION REPORT G. ENGINEER'S CERTIFICATION 1 certify that 1 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 49TH • MICHAEL N. ANDERSON . 1, General Information MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL ~ALTH DEPARTMENT OF w~.ALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE Application Date __ f~//0/~__~ (a) L egal~D~e sc ript ionLoT~ ,~'~ /~ L-Kr(include .~-l°t' b%9.¢k,~.~m£.~./.,~/~subdivisi°n'/H/f~L~secti°n" y/~-~,~3t°wnship' range) Location (address or directions) Applicants Name /~- PO/2f/k~6;~.j~.~ Tele~hp~e - Home Business (c) Applicants Address Applicant is (check o_~ne) Lending Institution ~ ; 0wner/builder~--~ ; Buyer ~ ; Other I I (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent ~'~X Telephone ~- ~ Z<~P 0 (f) Mail the HAA to the following address: 2. Type of Residence Single-Family~ Number of Bedrooms 3. Water Supp1z~ Individual Well.~ Multi-Family 3 Other (describe) 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 0nsite Public Comm ity olding Tan Note: If community well system, must have written confirmation from the State DBpartment of Environmental Conservation attesting to the legality and status. [Page 1 of 2] En~ineerin~ Firm Provtdin~ Inspections~ Tes,t,s~ File Search~ Data an_d. ,Informa~f_~on 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 orr-site water supply and/or wastewater disposal system is safe, functional and adeqttate 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 investigatio~ and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, amd regula- tions in effect on the date of this inspection. Name of Firm Telephone Address ~ M .~, ~.,,ta~a~E~L~!.q- DHEP Approval __ kpproved for -~ bedrooms Approved ' Disapprov Te~s of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES ~.ALTH 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 ENGINEERWS WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 ae WELL DATA Well Classificati~ S; /~' If A, B, c~ C, D.E.C. Approved(Y/N) Well Log P~esent ~/~) Date Oumpleted ~//~/8 ~ yield~- , ,. , /, Ground Sanitary Seal on Casing {(~___ Casing Height 'Above ,~ -~2 ~' ElectriCal Wiring in COnduit ~ Depression Around Wellhead Separation Distances ,frc~ Well: To,i SePtic/Holding Tank on Lot / 2 g- ; On Adjoining Lots To' Nearest Edge of AbSorption Field on Lot /~Zt9 ' ; On Adjoining Lots To Nearest Public Sewer Line /~ ~-4 To Nearest Public Sewer Clean°Ut/ManhOle /~l ~ To Nearest Sewer Service Line on Lot Water Sample Collected By ~' ~,! ~' ~-~/'/~ t,~/A; Date Water Sample Test Results ~ ~-~-~kT/~g'~}C Be SEPTIC/~ TANK DATA Date Installed ~-/%~/~ Size /c~.3 No. of Co~ga~t/ments ~ Standpipes ~N) Air'tight Caps ~/N) Foundation Cleanout ~N) Depression over Tank (Y~ Date Last Pun~ped /tJ~-~t~~ Pumping/Maintenance COntract on File (Y/N) ~- ~ for - Holding Tank High-Wate~ Alarm (Y/N) ~(3//~ Temporary Holding Tank Permit (Y/N) Separation Distances f~om Septic~ Tank: ! To Water-Supply Well /~ ! To Building Foundation To P~operty Line /O /7~' To Disposal Field /d) r TO Water Main/Service Line /~//$ To Stream, Pond~ Lake, c~ Major D~ainage Course ~3/A' Co~nts [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption ,Strata Date Installed Width of Field ' ~ / Square Feet of Absorption A~ea Deprsssion over Field (Y'_~ Results of Last Adequacy Test /~T .~'/~/L- Type Of System Desi/gn Length of Field Depth of Field Gravel Bed Thickness ?&D ~ Standpipes P~esent Date, of Last Ad~quacy~ Test Separation Distance from Absc~ption Field: / To ter-SupPly , ' To o rty Line 7Z TO Building F~tion ~; To Existing or ~ndo~d System Lo~ '-]~ P ~2oining ~ts 30 ~ ~ TO wate~ Main/~vi~ Line ]~ To %t~(if ~e~nt) M/~ To St~e~ond~ke/~ ~jo~ ~aina~ C~ ~/D / To ~iveWay, Pa~ki~ ~ea, ~ Vehicle St~a~ ~ea /~ ~ Comments D. LIFT STATION Date Installed Size in Gallons "Pump O~" Level at. High WaterAla_~mLevel at Tested for Electrical Codes(Y/N) Comments Dimensions Manhole/Access (Y/N) "P~ O~" Level at : ./ /,Vent (Y/N) Pu~/ng ~yclg~ ~ing Adequacy Test. /: Meets MOA on the date Of this inspection. KBl/d5/s ** Check Permitted Bedroom Rating A~ainst HAA Request I certify that I have checked, verified, o~ conformed to all MOA HAA Guidelines in effect [Page 2 of 2] 2-15-84