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HomeMy WebLinkAboutSUE TAWN ESTATE #2 BLK 1 LT 2Sue Tawn #2 Block 1 Lot 2 #051-471-24 Municipality of Anchorage Community Development Department Page 1 of 2 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191415 PID Number: 051-471-24 ❑ New 0 Upgrade Name: FREDRICK & DREMA FITZHUGH ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 23346 Creek Rd, Chugiak AK 99567 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot SUE TAWN ESTATES #2 1 2 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 119.9 N/A N/A I N/A N/A TANK ❑p Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1250Gal. Surface water 100+ N/A NA N/A Material Number of compartments Lot Line 36.0 N/A NA I N/A POLY 2 NA Foundation 9.3 N/A NA N/A LIFT STATION Manufacturer Capacity Curtain Drain 50+ N/A NA N/A Gal. Remarks TANK REPLACEMENT ONLY Pump on level at in. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House to tank 3034 Tank to drainfield 3034 JRs Septic Pumping LLC Drainfield CO/MT 3034 Inspector Pannone Engineering Services BENCHMARK (Assumed elevation) 635ft InspectionLocation dates: 1" 09/30/19 2"d 10/01/19 and description 3m 41" NW Corner of House COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp OF AC,Zt Conditional Approval: Date �`G ,,4�,��� Tj .. Steven �. f�annoRe CE 8149 Approve ( Date zp�� „11 . NUJ �.UU6 a JO 33HSL9966 Ad '>ivionHO (RJA3]2JO 9t�� Z Nd-ld 311S Stbt6tdS06;� 'ON 11)483d 6* WM 14.. H9nHZ1i3 VVU3 JG � A016CI16J bZ-ILb-ISO fib(' NMb210 ON 0'1'd ::... �: a� ZI L8 Z# S31d1S3 NM�l1 3nS 109 = ,.t 3ldOs 6lOZ/60/Ol0� IOZ9-9bL L06 XVJ OOZE-SbL LO6) 3NOHd 54966 AV '213W1tld L09t X08 '0'd ONIMd234 Oa0032i 5310N 31V0 SNOISIA321 O�1 3AS ON3 3NONNVd r7 N r d' m 11 i n tO Oi N C? O Q C') <J N N W Q U) tUi �" fN- C) ou O Q \ a \ \ r�00 I O Y Z -j � \ mo c cn o~ o _ i �- I�� ~ Z u �, U7 U N _ ckf_ Z tQ- J D- u Ln N p O r I < �0 0 a 0 \ Ln 0: W W n. J W CD w Q � z Ld LL \�C� 41 F / J W V A V / � a W � U w� w F-- W 4Jw W V) O 0 O ¢ w w w O Z Q LP, co CP3 d o 3 z I I (n0 U uj z zzrm Q U N I- 5 N W (/� t w c)F-O�_� O J W nIL F J I- OT zN0W �� 3 U Z00 V)0¢ QNa— 0 Lf) z�ZU C) L W I I t= W�awv�o�� cLLJ n<mY Z m n OF- d Z I I m = a wOUmF--a Q ' MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska S9n1o'b65n pxoos 984 Fax: (907)343-7997 Permit Number: OSP191415 Work Type SapticTonkUpOrade Tax Code Number: 05147124000 Site Legal Address: SUE TAVVNESTATE #28LK 1LT 2 G:1 160 Site Mailing Address: 2334GCREEK RD, Chugiak Owner: RTZHUGHFRED0CKE&DREk8AE Design Engineer: PANN0NEENGINEERING SERVICES This permit |sfor the construction of: El Disposal Field 2 Septic Tank El Holding Tank 0 Privy Effective Date: Expiration Date: Lot Size in Sq Ft Total Bedrooms: 9/24/201Q 9/23/2020 []Private Well El Water Storage All construction shall beinaccordance 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 15.85.Provide notification bycalling (QU7)343-7QO4(24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall beeither: a. Opened and Closed onthe same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: Issued By: All Date: ~ 4 MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. Oa -051-471-24 Property owner(s) FREDRICK & DREMA FITZHUGH Day phone Mailing address 2346 CREEK RD, CHUGIAK, AK 99567 Site address 2;346 CREEK RD Legal description (Sub'd., Block & Lot) SUE TAWN EST #2 131 L2 Legal description (Township, Range & Section) Lot Size 73,051 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑x (w/wo ADU) Septic Tank 19Upgrade 0 Duplex (D) ❑ Holding Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 92 �J^/ Date of Payment: 9 & 9! i9 Receipt Number: (1q Permit No. (9510191(415- Waiver 9510!91(4%5- Permit App_-'-:- ._.,:c: Waiver Fees: Date of Payment: Receipt Number: Waiver No. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191415, Rebecca Carroll, 09/24/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191415, Rebecca Carroll, 09/24/19 \11-`) MUNICIPALITY OF ANCHORAGE DEPARTMENTOF HEALTH &ENVIRONMENTAL PROTECTION 0* ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME LRNEW ®cin 1-k f) Aah — MO/6^rrl --C9,1 CO')Skrur hen Sn C hen 3'/9 - %('Lb/ ❑ UPGRADE MAILING ADDRESS 11700 Plccry Ave A-nC6vnjca A-lw/c a. 995 r,s LEGAL DESCRIPTION /,O/ L>, Z3//T / Sue "rGuu,7 EcA # LOCATION Chu tuk - I.Age re�-e/'s CPr NO. OF BEDROOMS Al Uy DISTANCE TO: Well i Absorption area Dwelling if PERMIT NO. 0-J'®39P_ u Q Manufacturer 11Material jknrhe 'Tank SIveIf No. of compartments "' wF. >° ti Liq. capacity in gallons IFHOMEMADE: Nf�, Inside length Width Liquid depth 6 DISTANCE TO: - Wall Dwelling PERMIT NO. w2Z = — F Manufacturer Material Liquid capacity in gallons DISTANCE TO: Well f Foundation , - 'Z 6- Nearest lot line e0l PERMIT NO. 8S--®392 O No. of lines Length of each line Total length of lines TxeneH widtly� t Distance between lines f t. NtA, oUb iaelies 3 „U Top of tile to finish grade Material beneath tile - Total effective absorption ar y�f y'r inches 6e,0011' /� Length Width Depth PERMIT NO. w Qf- Type of crib Crib diameter - Crib depth Total effective absorption area w ° w rn Well Building foundation Nearest lot line DISTANCE TO: Class rrlvat e Depth ^� !bo' Driller Distance to lot line PERMIT NO. -039a u/puan "ferWel ?0' H. w DISTANCE TO: Building foundation �U' Sewer line IV, A. Septic tank li'r' Absorption annals) 13,S-' OTHER PIPE MATERIALS ASF&I 0303'1 Sofid 0 zi ?y Aerf SOIL TEST RATING 8S O'/ W bL INSTALLER t� Ilan k iambi * /Vf e✓ Dan's 8 -6ce REMARKS K.0. A7 4* i�—:K &5-- e Zy /rFL(tirrtpn Ul nttrfertvr/ lacvo/�. ®n 210 Cover W/4; n-0--d f.;,- 3 s 1 5 1 ®'a1'®'M'AVA® InScrlurriGh ��' OF maw ,0.. ........., f •* 1 e 9 ..°.°.:�:.:..•1'4d ° .. THEODO.tE F. MOORE B d ��(.• 3589 , .,cwt G l= Ic R t� I`t el I � I APPROVED DATE LEGAL A� ,+f)r01C$$�Oii8\V- �•,,c.-cu-��z* 72-013 (Rev. 3/78) OOC Co. dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 6882759 OWNER OF LAND rtd f ADDRESS / r 4''l j i S '� f� "I � W ` it a V_ LEGAL DESCRIPTION / -> t t,( „n l � , J /---4 DATE - Started f x: ice. Ended PERMIT NUMBER KIND OF FORMATION: DEPTH OF WELL /e;, 'a _ STATICLEVEL OF WATER FT. DRAW DOWN FT. GALS. PER HR �" 0 KIND OF CASING C " s From Ft to Ft is r1 '"A4' i<, From -Ft. to From - Irl Ft. to,!,<. Ft. 5,q -,JO From _4 4 From, Ft. From Ft. to From Ft. to Ft. !"'`I + %: ' - O ri-, o 4 .J a"l 1 From Ft. From Ft. to - Ft. Froin—Ft. Fromf�Ft. to C. Ft.r-/al e A? &� J - 7 .i -. ,- <�5 From From _'t: Ft. toFt. Froin—Ft. From -Ft. Ft. to Ft. From Ft. From! Ft. toi S;�: Ft. 1?,c' - z- From i Ft. to j_ Ft. J' " 7A' o < 'J From Ft. to Ft. From Ft. to Ft >/ r?./,tin+" i'i-DA.43 From Ft. to Ft. From Ft. to Ft. e e_-" - From From /'2 , Ft. to—Z�Ft. /� r" J1'14-veo b C: r tom From Ft. to—Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to - Ft. From Ft. to Ft. MISCL. INFORMATION: .a �7 7'„ 7Fc From From From FL to Ft. Ft. to Ft. Ft. to Ft. Ft. to Ft. Ft. to Ft. From Ft. to Ft. From Ft. to Ft- DRILLER'S NAME ' PERMIT NO: � DATE ISSUED: APPLICANT: � ADDRESS: ) ����CS T 1F" 121 L__ I _T_ N' C3 F� 902b Iq C:, 0 -1 L3 FZ r-% C3 E= - DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ^ 825 L STREET, ANCHORAGE, AK 99501 264-4720 ����1E -F EZ E3 E0 &4 E= FT �zZzk W FE 8 . k-. ���M Jr. _*r � CONTACT PHDNQ 850392 HAND WRITTEN 07/0B/R5 MqNIN-ON CONST, INC 11700 MARY AVE ANCHORAGE, AK 99515 349~1124 LEGAL DESCRTP: SUBDIVISION: SUE TAWN #2 LOT: 2 BLOCK: 1 I SECTION: 15 TOWNSHIP: 15N RANGE: IW � LOT SIZE: 1"68A ASQ,FT" OR ACRES) I certify that: 1" I am familiar with the requirements for on-site sewers and wells as set` forth by the Municipality of Anchorage (MOA) and the State of Alaska" 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit" 3. Swill adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public � sewerage system on this or any adjacent or nearby lot" ` IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT RE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE �ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. 1SIGNED �APPLJCANA MONIN-ON CONST, INC !ISSUED BY DATE: DATE: MUNICIPALITY OF ANCHORAGE DepartmenU.''f Health and-Environment4_/Protection Pouch 6-650, Anchorage, AK 99502 264-4720 On-site Sewer/Water Permit HANDWRITTEN Permit No: Date Issued: Applicant: lmyl'o�5ai /Y Ac Address: 112eo /yAcy Ay4,: e/ /— /" p Legal Description: S/D Ze � 4 Z Lot: Block: Section: —/_ —_ Township:. la A.) Range: Lot Size: 1.41, B (r¢ail!r- Acres) � r L o t Location: �yjQUryjA/AJ AW X t/0 e Max Bedrooms: _ Listed below are the options available to you in designing your septic system. Choose the option that best fits your site. Depth to pipe bottom(ft. Gravel depth (ft.) Total depth (ft.) Gravel width (ft.) Gravel length (ft.) Tank size (gal.) Soil rating (sq. ft./br) TRENCH BED W. DRAIN .3� 20.0 *' Gravel length 75 feet requires multiple runs (not exceeding 75 feet each) ** Tank must have at least two compartments ----------------------------------------------------------------------------- I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage(MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for the maximum number of bedrooms: stated above, and any enlargement or modification will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUDDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DO�NyE� BY A LICENSED ELECTRICIAN. SIGNED: � L /��O�L DATE: % 1-?IB,/j Applicant ISSUED BY DATE: J SWP/024 rev.1/85 "i SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (] PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED LEGAL DESCRIPTION: 13lk l DEPTH p (FEET) I ' ( O✓�ti(110yCnie LV er) 1 J DATE PERFORMED: U 1� z's10s S t« ! tcv/1 -H' a6 f.A .SEC Q SLOPE SITE PLAN 2 g3- 131IL301?tl 3 C -w (Shly6f1v Srl� Sand C�tvvel -ma`y co6hlei 5 B3 q`/BDR[ro F5 -I o6 6-[,v (Sa"dr 7 5 o /ne Co6 'v J4 7/2/0�- 9 wale/ Seep ( Mat, rine 40 e- ©R) 10- P �Srl�(y" Sanaf� s1ome n. Ii 514 ?6CUP/d/ WAS GROUNDWATER V ENCOUNTERED? 12 1[[skte bole IF VES, AT WHAT O fermi %Zolg D,FPTH? 13 C Ptl5lQ .ATO -4-Y 1 Mouniidrn lice art PZYf- S Ief O 2 P E WS H 14 a C //�� `` l��i Reading Date Gross Net Depth to Time Time Water Net Drop 15 •0�''1��V • VAr ••V.� co !• 491— * ; H 16 .....................i... 17 /�� !.' : ........ THEODORE F. MOORE ,• CE -3589 �• � 18- R``Ow . Ny 19- 9 20- 20PERCOLATION PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND COMMENTS � t- PI la o a m RPCO/h/n e� d 6�PO( L �rFT /' 5 u[ kyf '0 ¢e O;rf / UAerr/r7A r L/con hPGtNGAOmJ 65- / y it fe 6l S&A f�B,SA PERFORMED BY: T� Moore �❑I.r�,,�h[��r�+ �X CERTIFIEDBY: 1/ ^L I l°'�+�'•'- DATE: Mo'l4ve[ny p;ye / Clv`O` 7/�?19S- MGtxrlsU!01L /0��2S WerC% /else! 72-008 (6/79) eIJVWJ_ MUNICIPALITY OF ANCHORAGE 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. 051-471-24 1. GENERAL INFORMATION Expiration Date: i r 1 � rZt�Z� Complete legal description Sue Tawn Est #2 131 L2 Location (site address) 23346 Creek Road Current property owner(s) Fredrick & Drema Fitzhugh Day phone Mailing address 23346 Creek Road Chugiak, AK 99567 Real estate agent Day phone 2. TYPE OF DWELLING: Fx� Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Waiver Fee $ 4. TYPE OF WATER SUPPLY: 19/19 TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment 19/19 Date of Payment Receipt Number X3,15,1 26 Receipt Number COSA # 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water 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 system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. 6. DSD SIGNATURE System #1 Approved for LI bedrooms System #2 Approved for bedrooms Disapproved Phone (907) 745-8200 Date III© 0 SOF A�q � even N. onnorae L . CE 8149 < �; 1, ���: ` ['•, -S0', d Conditional approval for bPrlrnoms, with the following stipulations: Original Certificate Date: /(9 -1 & `1 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 Legal Description: Sue Tawn Est #2 B1 L2 Parcel ID: 051-471-24 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 6/85 Total depth 180' ft Cased to 93'6" ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 9/13/19 Static water level at beginning of test 96 ft. Comments B. TANK DATA Age of tank(s) t0""' years Tank type/material Measured operating fluid level in septic tank nla 0 Standpipes/foundation cleanout per record drawing Date of pumping' n/a'' D. ABSORPTION FIELD DATA Bed Which system tested (date installed) 7/8/85 0 ALL standpipes present per record drawing Total measured depth from grade 4 ft (max) Measured depth to pipe invert from grade 3.25 ft (min) ❑ N/A — pressurized field Q Monitor tubes go to bottom of effective. If not, state depth into effective Well production at time of test 4.34 gpm Water storage tank volume n/a gallons Well disinfected for coliform test? ❑ Yes R Nc 0 Coliform bacteria is Negative Nitrate 2.77 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Pannone Engineering Services Date of Sample 9/13/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 9/13/19 Results ❑✓ Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 600 gal New depth 0 in Elapsed time 140 min FE -1 Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate '600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) n/a date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: 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' ICJ Yes if No � Community Sewer Manhole/Cleanout > 100' Q✓ Yes if No ft ❑✓ Yes if No ft Neighboring Tank > 100' F✓ Yes if No ft Private Sewer/Septic Line > 25'[Z] Yes if No ft Absorption Field on Lot > 100' ❑✓ Yes if No ft Holding Tank > 100' R✓ Yes if No ft Neighboring Absorption Fields > 100' Water Main > 10' 0 Animal Containment > 50' 0✓ Yes if No ft ✓0 Yes if No ft Water Service Line > 10' 0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑✓ Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ICJ Yes if No � !VX Surface Water > 100' Q✓ Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' Absorption Field > 5' ❑✓ 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' 0 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' E✓ 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' 0 Yes if No ft Private Wells > 100' Q Yes if No ft Water Service Line > 10' El Yes if No ft Community Wells > 200' R Yes if No ft Surface Water > 100' ✓Lj Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I 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. lf 2(L COSA Checklist yellow sheet CREEK ROAD WEST 220.00 cl� P__ M I Septic vent (typ) Wo Manhole— �o 2.2 OH O 28.00 2�.0 Chimney. O O o z o deck o Greenhouse Storage C9`m LOT 2 2 Story Frame House N with Basement Storage )w well LOT 1 1.201 v Ramp m o - o Well 231 p6 LOT 7 co co — M. LO O N W M O O O O z SCALE: 1 "= 50' LOT 3 AW OF • &.1 t� l �. 0 49th00 •'9 ��� �,•. lizabeth L. Walatko .". 00 �� ��a • • 8036 - LS • • ek,,� REVISED 10-15-19, Added septic vents AS -BUILT NO CORNERS E T S DATE I hereby certify that I have performed a Mortgagee's inspection of the following described property: LOT 2, BLOCK 1, SUE TAWN ESTATE ADDITION No. 2 Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska EASEMENTS OF RECORD, OTHER THAN this 2nd day of October ,2019. THOSE SHOWN ON THE RECORDED FRED WALATKA & ASSOCIATES, L.L.C. PLAT ARE NOT SHOWN HEREON. I Engineers and Surveyors UNLESS OTHERWISE NOTED WM, FB 19-8, pg 14-15 BE 907-248-1666 Municipality of Anchorage Development Services Department \\ Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road `• P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907)343-7904 Iw PAN 'Wr CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D. COSA #_ O Q 0 1717 Expiration Date: 9 1. GENERAL INFORMATION Complete legal description Lot 2; Block 1; Sue Tawn estates Subdivision #2 Location (site address) 23346 Geek Rd. Chugiak, AK Current Property owners) Delores Coates Day phone 668-9327 Mailing address PO Box 670757 Chugiak, AK 99567 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site✓❑ Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of fitle (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, 1 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 S s s Engineering Address 15661 S. Birchwood Loop Rd. Chugiak, AK 99567 Engineer's Printed Name Robert A. Shafer 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Phone 694-2979 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: Gl/. Original Certificate Date: m« nasi Municipality of Anchorage • �` Development Services Department Building Safety Division " -- On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: ��j �` OF"q 1,� L)'f- /rykbO 1ST#P? Parcel ID: A. WELL D Well type IVR& If A. B, or C provide PWSID # = Well LogQN Date completedOS Sanitary seal) Wires property protected jy N) Lr3 Total depth fflQft. Cased to _L7 ft. Casing height (above ground) �g r'in. Date of test Static water level Well production FROM WELL LOG � f35 r ft. WATER SAMPLE RESULTS: X/,0 g.p.m. Coliform Z! colonies/100 mL Nitrate aFkS mg/L Arsenic: �TuglL•• date of sample: W2L Oej AT INSPECTION s1.v'o 1a0 r ft. B15 Other bacteria 0 colonies/100 mL Collected by: s r -J 6A.1��cLc6 uo 5 B. SEPTIC/HOLDING TANK DATA Tank Type/Material '3c_AIT-r-C Date installed %AS Tank size lam gal. Number of Compartments d Cleanout0J) 1 Foundation cleanout (t�Y�N E� Depression over tank MOAQ High water alarm (Y(V 1\ O Date of pumping A, C) PumperJrim t 1p-�I rA-ms C. ABSORPTION FIE i Date installed Soil rating (g.p.d./ftp or t�/bdr �5 System type �b 9„ IaxHfS Length � ft. Width � ft. Gravel below pipe `ft, i Total depth $ ft. Eff. absor tion area �QQ ft2 Monitorin tube s Depression over field Date of adequacy test Result(Pas Fail) For bedrooms to i Fluid depth in absorption field before test 0 in. Water added gal. New depth In. Elapsed Time: min. Final fluid depth Qit in. Absorption rate >= 660-1g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/ lP type) &to If yes, give date D. LIFT STATION N/0 Date installed Size in gallons "Pump on' level at _ in.'P peff ` of Datum Cycles tested _ E. SEPARATION DISTANCES (Y/N) at _ in. High water alarm level at SEPARATION DISTANCES FROM WELL ON LOT TO: r Septic tank/lift station on lot r Absorption field on lot Public sewer main Sewer /septic service line r Animal containment areas 1" 4- Meets alarm 8 circuit requirements? 0 r On adjacent lots /OO On adjacent lots Public sewer manhole/cleanout Holding tank A.) i Manure/animal excrete storage areas /Or) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: I f / Building foundation rJ "t Property line 5 f Absorption field S 1 I � Water main N Water service line Surface water !Le 4 r Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: i Property line /49 t Building foundation Water main i t r r Water Service line /D Surface water /DD Driveway, parking/vehicle storage /O 't- OF Curtain drain A101)6 / tVd(iUVells on adjacent tots fir' F. COMMENTS ,r G. ENGINEER'S CERTIFICATION e 1 certify that I have determine th ugh rield inspections and f' %-Vae review of Municipal record that a above systems re in / * r� T►Poer ti PY conformance with MOA CO X gui Gnus n ff c n thi date. •"' •« •• •�� Engineer's Printed Name 1 P! I �,. "Dat a. •, r '0 Date COSA Fee $ q Waiver Fee $ Date of Payment l 02 Date of Payment Receipt Number 0 �JSaar Receipt Number (Rev. 11/05) M 4/EST zzs.eo r^_._.. .0000 4 .r3c, i` 34' ... '.t .. .. 1. - ------- ---- __23.._ i AS—BUILT I hereby certify that LOT 2 , BLOCK SvE 6Sn4TE ,¢DO'N Na, 7 - Anchorage showas nehereonveyed . I't is me theand responsibility of the owner, to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. Listed distances prevail and scaling should not be attempted to determine unshown dimensions. This survey is not adequate for, nor should it be used for establishing boundary or fence lines. 0 WURnm Mcmtack No. IS SM , MCCLINTOCK LAND SURVEY COMPANY P.O. Box 671089 Chuglak, Alaska 99567 Phone (907) 688.4499 DALE 7-3t-85 DRAWN BY BM JOB No.GRID Ntw//Lc, FIELD BOOK i/5 -7-Z SCALE/."{Sp' 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) j,r,¢ 2� $IFr 1 Sue Tawe # 2 Sub Location (address or directions) CA"ar.u(r 1.iFl-le Pekers CFr (b) Applicant Name 07 `ten /J_Ia rrielephon : Home_�__�� 5' Business -P Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) 2. TYPE OF RESIDENCE Single -Family ® Multi -Family ❑ Other Number of Bedrooms A/ 3. WATER SUPPLY Individual Well 19 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 ]2-025(11/84) 5. _ 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, l 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 i the date of this inspection. Name of Firm f5yci n rNCh4tcal Sermiw Telephone�%/ 7-13aS I Address ) ys30 15d?a SX Date And4or'eye Air 995`/6' 1.J n .®..,,....... ys'.®® .• *:4 TH .......................... THEODORE F. MOORS e e ® Engineer's Seal P••,• CE - 3589•• 6. DHEP APPROVAL Approved for —� bedrooms by Date J `� Approved_ Disapproved Conditional Terms of Conditional Approval 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 zt ; institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or Gry analyzedata before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the f�esstonl l engineer's work. � ' MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 MUNICIPALITY OF ANCHORACB DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION _ P 2 41985 Legal Description: T a F �� 1 1 1 rr% Sete i-awin- $'2 S•ceb - - A. WELL DATA Well Classification Privok If A, B, C, D.E.C. Approved (Y/N) N h Well Log Present (Y/N) - Date Completed i / &C Yield &PH Total Depth 1040- Cased to 931.1 n Depth of Grouting N-4. Static Water Level ei Pump Set At U91+ Casing Height Above Ground !6 Sanitary Seal on Casing (Y/N) Y Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) Al Separation Distances from Well: To Septic/Holding Tank on Lot On Adjoining Lots 7 CCOO r To Nearest Edge of Absorption Field on Lot 1 35 On Adjoining Lots f 35' To Nearest Public Sewer Line N,A. To Nearest Public Sewer Cleanout/Manhole 1414 To Nearest Sewer Service Line on Lot . MA} Water Sample Collected by TSF t ; Date 96/30s - /30Water &([OYJ bGttke�,Lt , diher bezc�eet-a• Water Sample Test Results Were found in u.aFtr srcm��e {tuwssr -/A,y gree hGl" Comments a� concern -{a L?�C B. SEPTIC/HOLDING TANK DATA Date Installed 71819- Size 12,b -Ori No. of Compartments Standpipes (Y/N) Y Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) N Date Last Pumped Ad. ( Hew Cq-A_&c k(") Pumping/Maintenance Contract on File (Y/N) 141/4, ; for Holding Tank High -Water Alarm (Y/N) )I g Temporary Holding Tank Permit (Y/N) N 9• Separation Distances from Septic/Holding Tank: To Water -Supply Well To Property Line ^ 30 To Water Main/Service Line Course Comments Page 1 of 2 72-026(11/84) To Building Foundation 9 . To Disposal Field f To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ErSri I Type of System Design Sha l tow lard Date Installed 21219,5- Length of Field 361 F Width of Field Depth of Field W 8 11 Gravel Bed Thickness 911 Square Feet of Absorption Area K690 Standpipes Present (Y/N) Y Depression over Field (Y/N) N Date of Last Adequacy Test —Mlf- ( N,w C6,tdJ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well 13.4, To Building Foundation Lot N, A. To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments _ D. LIFT STATION Kt4- Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments To Property Line To Existing or Abandoned System on On Adjoining Lots "�Z 50 To Cutbank (if present) Dimensions Manhole/Access(Y/N) — "Pump Off' Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed %mac+[ Date Yl e3/,55 - Company /G1uf7�c�P TeC4 Sevri1c&1 MOA No. 85' X752 Receipt No. _ -t3? P5 -2 3 Date of Payment 9 `� Amount: $ 2) Page 2 of 2 72-026 (11,84) ®�P�E OF A4�s�®' *. 49T" . 0 ............... ................... a THEODORE F. MOORE ; M P*•. CE - 3589 vv cAlf Ilk 6, ®�! a prolessiona� �.,�®a Engineer's Seal