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HomeMy WebLinkAboutSKYLINE VIEW LT 2Onsite File Wo U�, AV Aff Municipality of Anchorage On-Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221216 PID Number: 051-192-05 Dwelling: OR Single Family (SF) El with ADU rj Duplex (D) R Two Single Family Project: R New FO-1 Upgrade Name Vern and Doris Stevenson ABSO.RPTION FIELD ❑ De Trench Fj Wide Trench n Bed F] Mound Site Address 19405 Wildwood Dr Chugiak Other Phone Number of Bedrooms Soil Rating1 depth from original grade 3 /SF ITotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original de Gravel depth beneath pipe Ft. Subdivision Block Lot Skyline View 2 Fill added above original grade Ft. Gr el length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dist ce between lines Ft. SEPARATION DISTANCES To! Septic I Absorption Lift Station Holding Sewer S Total absorption area Number of trenches Dist. between lm�'Ches From Tank I Field T i Tank Line F t2 t. Well >100.1 TANK [9 Septic [I S.T.E.P. El Holding [I Other Manufacturer Greer Capacity 1000 Gal, Surface Water>1 00, Material plastic Number of compartments 2 Lot Line >1 0, . ...... .... NA Foundation i 9' LIFT STATION a rer Capacity Gal. i Remarks 2" insulation provided over inlet pipe Alarm location al installed by PIPE MATERIAL House to tank 3034 drainfield Tankto 3034 Installer JRs Septic Drainfield CO/MT 3034 Inspector Curtis Townsend BENCH MARK (Assumed elevation) 100 ft Inspection is' 7/27/2022 8/3/2022 dates: Location and description 2m 3rd 4h___-_-_- concrete stair landing ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date OF Ak- ...4 . 7 -'W'* "49 1H .... . ................ Ar ....... ... t "Mift- �j'% No CE IIIW4 Septic 1��tsjtgD2_­__ Approved 1 Date Note: this approval does not include well permit requirements. krucv uzmuz/ 10) (PI n > > > CD > --i m ell) T1 rzmn—or-oFn -E �< rri r- ri U) rl M -i > 0 > m C.a ;Z3 z '-z > es > ;u r-1 0 -, - T, — m -:-z > > — x 0 > 7- x Z > f7l n 0 % m 71 -Z > C, x 0 Cf) >Z " 4 CP tp, o -ID T z > 7 E5 C- rT I 71 UD -- - , � `rTtCejp-j > ,tri 73 "� u U)6 i -u Cf) r > 0 �/) -- C (71, C', --i Z M > f— F— U) r Z M CD m 0 m OC) Cf) -u z CA cf)0 2� > f:�a- z < cn 0 0 o rQ M < n C) N) n co 0 M 0 Rwlr�ISMMMU 4_11 Z M CD < M o --i m m 7u -Ti x z CA cf)0 2� > f:�a- z < 0 0 z o M < 0 M C- Cl) 0 M 0 > < 21 m M Z iv cf) 0 CO QD Z cri 0*) 4 Rwlr�ISMMMU ✓ m ----- 0 ----- 0> i Mm 0 V 0- lz 0 m VV P.,hl;, 11— F—t Z M m --i m m 7u -Ti x 0 m , I F,) Zm 0 n =1 Z C) ;:a > < m 0 M 0 M v m M m C) 0 M- m > W. m 0 < C) m ✓ m ----- 0 ----- 0> i Mm 0 V 0- lz 0 m VV P.,hl;, 11— F—t 0 0 0 0 AV AV Air a . - ;T;, t-- -0 -4 : 4-1 o M Z Z AF A, 410. YA IL nCOa0 N3 cn U) r m 0 m CC) Ol Cf) -u 0N) n raj 0 0 AV AV Air a . - ;T;, t-- -0 -4 : 4-1 10 loo Z Z AF A, 410. YA IL 0 0 N3 raj �P� OF A �,9��p4 x..49 TH*'* SHANE A. HOLT .' P� LS -6914 o` e �4aA .-- . cJ_o jessIonaY THESURVEYDATA AND MEASUREMENTS HEREON ARE PREPARED FOR THE OWNER OF RECORD AS OF THE DATE OF THIS SURVEY. ANYUSE OF THIS DRAWING BY THIRD PARTIES IS PROHIBITED UNLESS WRITTEN PERMISSION IS PROVIDED. THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOGI ANY CONFLICTS BETNEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELIN£S- £ASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOW HEREON ( UNLESS INDICATED) NOTE= FENCELINES THAT MAY APPEAR ON THIS DRANING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOW HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNO/V AND/OR ICE. AS-BU/LT SURVEY f"=30' NO CORNERS SET THIS DATE l HEREBY CERTIFY THAT / HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY ACRE LOT2SKYLINE VIEWEST.4TES (PLAT P- 08) ANCHORAGERECORDING DISTRICT, ALASKA, AND THAT THE VISIBLEIMPROVEMENTSS/TUATED THEREON AREWITHIN THEPROPERTYLINESAND NO VISIBLEENCROACHMENTS EXIST OTHER THAN NOTED. DATED ATANCHORAGE,ALASKA THIS 1 -'Ty DAYOF AUCLIST -2022 1552 i25-26 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 223-8615 MUNICIPALITY OF ANCHORAGE On-Site Water & Wastewater Program PO Box ',|96650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone; (907)343-7904 Fax: (907) 343-7997 httpr//wwu muni. org/on site Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: Date: Date: l)af trn en r On-Site Wastewater Disposal System Permit Permit Number: O5P221216 Work Type: SepticTank Upgrade Tax Code Number: 05119205000" Site Legal Address: SKYLINE VIEW LT 2 G:1159 Site Mailing Address: 19405 WILDWOOD DR, Chugiak Owner: STEVENSON VERNON R & DORRIS A Design Engineer: EKLUTNA ENGINEERING, LLC* This permit is forthe construction of: fl Disposal Field EI Septic Tank E Hotding Tank [J privy ! PrivateWell E 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 (18A C72) and Drinking Water Regulations (18AACSO) 3. The wastewater code requires inspections during the installation. The engineer shall notifi7 the Development Services Depaftment 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 ',|, Special Provisions: ' Deck supports within 5' of the proposed tank are to be removed and replaced with supportS that are deeper than the bottom of the tank. ' The engineer is to indicate on the Record Drawing the location and depth of the supports replaced. 6129t2022 612912023 43560 3 Received By: MUNICIPALITY OF ANCHORAGE Development Services Department epartment ._.. � phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-192-05 Property owner(s) STEVENSON VERNON & DORRIS Mailing address PO BOX 671935 CHUGIAK, AK 99567 1935 Site address 19405 WILDWOOD DR Legal description (Sub'd., Block & Lot) SKYLINE VIEW Legal description (Township, Range & Section) Lot Size 43,560 Sq. Ft. Number of Bedrooms 3 LT 2 Day phone APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (M all that apply) Receipt Number: Absorption Field ❑ Initial ❑ Single Family (SF) Q Septic Tank Q Upgrade [Q (wlGvoA`D ' ) Holding Tank ElRenewal ❑ Duplex (D) ❑ Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Munigjjal Codes. (Signature of prdpeffy owner or authorized agent) Permit/Rush Fees: Date of Payment: ( ab,)_� Waiver Fees: Date of Payment: Receipt Number: 00 3 2 3b Receipt Number: Permit No. Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Eklutna Engineering, LLC curtistownse nd @gma il.com June 21,2022 Subject: Skyline View Lot 2 Upgrade Septic System Permit Request Narrative osP 22t2L6 This is a design narrative for a permit to upgrade the septic system at this property. The proposed system will serve a three bedroom house. The existing tank and field are 39 years old. The existing septic tank will be removed and disposed of. The existing trench was tested in May 2022 and found to be adequate. lt will not be replaced at this time. L. Soils. A test hole was previously dug to a depth of L4' and no groundwater was encountered. Soils are gravels and silts. Wells. This lot is served by a private well. This well was tested for nitrates in May 2O22.The concentration of nitrates is 9.1-2 mg/1. The well has a sanitary cap and the electrical wires are protected. The well is greater than L00' from the septic field and tank. The tank will be greater than l-0' away from the water line. Neighboring wells are all greater than 100' from the proposed system. Neighboring Wastewater systems. lmmediate neighboring septic systems are all +30' distant. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 5. Topography: The area where this tank will be installed has a slope of less than L%. The proposed installation will not affect the future development of this or the surrounding lots. Sincerely, Curtis L. Townsend, P.E. 2. 3. 4. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221216, Deb Wockenfuss, 06/29/22 f-oH== 6- =zoa,.>62Y'o >6 -,2 H ;3I=--l-v'ffR GX:\^---l!!--.r-*i=7n"-tr;-#tsi5f?.,::3us+?D=-Yift932*o==t?i!64q;-'':a;=2>z 3;s=UE-El=t=i,E=v722e>!;"23":F-z SAEHFb=?[A- EH=ff>-,Idq3-PdHdE=#3df<'Y*'i6o_8-.iFtU)^ioFPb<Ec)o-9>,r9FtLhLJfi-?z--'<_|.r)+oJCO trJozrlA;-et<AJ>r-1 OUM=f,oOot!-oh<'otrJv)Ldmo<o+usl asnclqnJqcr,lj'l.-_t L-o_fa"t6LrJl'l LF-O<(rc)o-9>,r3EU-hLlJl|t^^ Zi "-jfI/ Lr-lIOl<IMO(0NNN(Laof.-@lr)-O)z-aOcu.9i!I'trn FrYbY F(trJI(D'6r=F @=trta-s-3 ttCl>' OgLU: ooz=* 2E-;E zPtr=tlJ>)roOto)NFhNA;id6rr-X(JttO-S!F(otuIUTaro9No)5IJ-i= E EFo o atL' oc)\ (o-\xo-U=Ai.)=Fxo-trJ-C' O|r),Urr )Z t-tLr=;Jz=rLLl><LLtrtil Lrl FL!ELJJm>oIOIr\JIOz.ftlrll;F-^(-Z?,r,a) o')OEorZ-z4nl,t=\ZrA<-x=<=7 6-co= ^-2v1-) a-| .r/i,^toYFr\a'-Jnlrlo/,o,-Uv Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221216, Deb Wockenfuss, 06/29/22 brco c)z.xLllM^LO'IxI^L!a-\|.'\M)L!9)z--LVinLrlv't,>< LLLiJ t!2-l,xQM7\)TSt-3-mo..(,uaFEff! v-Yrzdi=(/)so_o>-. -6=<555q>ft rLdLr-l<l^OmF(,.)rf)lno Nvlrc tt8nocInoNVI-tc )NV_tlno NV:lc)NVIaUoO(nYtZo_<--.., Fo l,J7Eol--UZ3OO_z-F6oIL Z-5aF,a=<>#Ll v92XY+,^=9-,n6=-'<=8,o28>^ Ao=<o9gE*9..*f,'''r5dz5^n-(nm<aatrl F:<oYE- YZO<O<3O <LJ(TLdLdUJLIIo0(-)orlzor_)<z..<L-JI_OA-<-Jo_lf+N6J'bNFtuLIJTU)t()oINO)I-=58fr5eoa (L(oNNN(L.U)o1'-(otoZEO<u* 9it 9,f;rF FJYbU I- OJi(D'oa.5a=tr)@-!_Att't);oi.urE oaz-32Ei:-3 Zpt=UJ>)roosP=Oz.ftlrli:iD-z?6a)O)OEO>Z- .z4wLLr=X!=< =z --9F>VY--) l-| ../\,^LOYx- --) ;-I rI o)/: o,-Uv Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221216, Deb Wockenfuss, 06/29/22 EEE5EEs q?Pio3<6(u) ,oo'r t2 stsvg(vl) ,st'il1. i$.00, loooo N )JoU(d) ,oo'zEt (d) ,€oz€lIN:llrt:tsv:t lsn f,n€nd ,€€.fFDF h (\I FoJ lrl E.(J (u).oo'z€l (d),8,:l€l 9-=2i=!!- Iso6Jo I g: o -o F! E o o'tln Fof! o(D z o s u" or- --b 5 Bd lf)m =: ro FoJ lrl E.(J (u) ,oo'zf (d) ,fr'92 (n)/ll"gt,loooo N fi,to"@ N(u) ,oo''92 fAIUO OOOIAC-]l,tl OE--EP633EEEE3i9!E!s=5<E 56 0756 ocE G El:GI c0 3 EDF o I .!9-c!!c o aE I5c a 9 c'oE€oE!!Ea0Ec- IoI o E5Eocod C E a Foz ElcEErc)!e RE51 3:g? i-gti ;::; eHE-U'2o9:ool =@ si> 5E Hi FJfo@;F Fo J (u) .oo't ll. stsv€(n) ,81'llL ,T,OO, loooo N ,z'El (u) .oo-zg | (d) lNilESrf lsn JtTlfld ,€€ \ o U6-9-i=2r lil E _E> o .c''€ HILl Jl),i;l't I T I Ix It^t>t:rO lo) IRI'+u trl @+ o)o z. ro FoJ t_d E.() =^d.o- 3Bi\ ct- ra,m o|rt o6 z I ats o o'rOro Fof) {Dro z (\J FoJ IJJ tE, 6. ot- E* MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING * DIVISION 825 L Street - Anchorage, Alaska 99501 L Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE SEW �> —..<.VF;_s 1(� 6%4—Z`3%5 ❑UPGRADE MAILING ADDRESS P. ®' max_ to) IqK(< ' S -C(" - LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS 13 Well Absorption area / Dwelling / PERMIT NO. DISTANCE TO: /G d� U _Y I-_ Q Manufacturer �a 12-.�i MatgfLayl��� No. of compartments LU ti c� 1 Cs Z. rn Liq. c acityingallons (( p IF HOMEMADE: Inside length Width Liq uid depth X DISTANCE T0: Well Dwelling PERMIT NO. 0Z O Z Q Manufacturer _ Material Liquid capacity in gallons DISTANCE TO: Well / Foundt3-� atio !.- Nearest lot line,, / PERMIT NO. �, S r Z No. of lines / Length of ea�b,line( q Total length lines,, Trench widt Distance between lines h! F. u 0 inches 7a cut` tinches Top of tile to finish grade Material beneath tile Total effective absorption area Length Width Depth PERMIT NO. w (7 F- Type of crib Crib diameter Crib depth Total effective absorption area OQ. LU LU Well Building foundation Nearest lot line DISTANCE TO: ClasspegtIt Driller Distance to lot line PERMIT NO. LU i� I DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER c REMARKS r e- au _P n�nnrc��oQ,yt�4 t LT o, s' eri ec• n ,a � Al - ''obert A. Sh❑for t4e Y " No. f457.E r R , c t,c APPROVED:` r DATWECE PI 69i-, 72-013 (Rev. 3/78) % / MUNICIPALITY OF ANCHORAGE Department 'f Health and Environmenta Protection 825 Street, Anchorage, AK. >9501 264-4720 # HANDWRITTEN PERMIT Permit # ELL AND/OR ON-SITE SEWER PERMIT Applicant:<. '(%P/�i/�U Mailing Address:1 Aoy A-577 Location: Phone Number: l Legal Description: LG ��/I �P ���� `f� Lot Size: Type of Soil Absorption Sys em Is: Trench: Drainfield: _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms:_ Soil Rating(sq.ft/br)�� �r The Required Size of the Soil Absorption System Is: DEPTH LENGTH G� GRAVEL DEPTH WIDTH 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(Z) 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 feel 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 31, 1 9 u 3 es I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enla em t if the residence is remod led to include more th t 3 drooms Signed: Issued by: Applicant Date: SWP/024(1/81) XSOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION t( s �1� TEST i 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST /12 opo cn QnnGn tinct l (�/��� j/i /'/ DATE PERFORMED: / y �J LEGAL DESCRIPTION: //0- /`'SLOPE ho 1 SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS y WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT S// Z'/, r% DEPTH? �U P F,R•� �1�3 _r; L� S L O P E M Reading Date Gross Time Net Time Depth to Water Net Drop fel , PERCOLATION RATE /M (minutes/inch) TEST RUN BETWEEN -- FT AND - FT 72-008 (6/79) DEPHRTMEHT HEHLTH HN� ENVIRONMENTRL �OTECTION STR2E[/ HHCHORHGE/ HK995G1 264'4720 PERMIT NO ( 82025� ) HPPLICHNT KHTIE PHILLIPS LOCRTION LEGRL L2 �KYLINE VIEW S/D BOX 164 EHGLE RIYER HK LOT SIZ� ]0008 SQUHRE F��T MIHIMUM DISTHNCE BETNEEN H WELL HND HNY OH~SITE SEWH�E DISPOSHL SYSTEM IS 100 F�ET FOR H PRIVHT� HELL OR 15G TU 20G FEET FROM H PUBLIC NELL DEPENDING UPOM THE TYPE OF PUBLIC NELL MINIMUM DISTHNCE FR0M H PRIVHTE WELL TO H PRIVHTE SEWER LIHE lS 25 FEET HMD TO H COMMUMITY SENER LI�E IS 73 FEET HELL LOGS HRE REQUIRED HN� MUST BE RETURNED TO THE DEPSRTMENT WITHIN ]0 DHYS OF THE WELL COMPLET{ON OTHER REQUIREMENTS MHY RPPLY SPECIFIC8TIONS HND CONSTRUCTION DIHGRHMS HRE HVHILHBLE TO INSURE PROPER INSTHLLHTION ��- .111. �l��� I CERTIFY THHT i� I HM FHMILIRR WITH THE REQUIREM�Nl�S FOR ON�SITE SEWERS HND WELLS HS SET FORTH BY THE 11NICIPHLITY OF HNCHORHG� 2� I WILL I��THLL THE����EM IN HCCORDHNCE H�TH THE CODES ISSUED BY S __- ~_.~DHTE.~~~^ ' v Trrjtfirb l5rillingj'arvaig by DOC Co. dba SULLMN WATER WELLS P.O. BOX 272, CHUG IAK, ALASKA 99567 • TELEPHONE 688-2759 OWNER OF LAND ADDRESS LEGAL DESCRIPTION - DATF. -Started _ Ended PERMIT NUMBER KIND OF FORMATION: From Ft. to` Ft. From From Ft. to 'f - Ft. _' ` Ft. to From Ft: to Ft. Ft. From ' Ft. to Ft. From From Ft, to Ft. Ft. to From Ft. to -LL-' Ft.. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to IdFt. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. MISCL. INFORMATION: DEPTH OF WELL STATIC LEVEL OF WATER FT. DRAW DOWN FT. GALS. PER HR r KIND OF CASING Froin—Ft. to— Ft From Ft. to_ Ft From Ft. to Ft. From Ft. to Ft From —Ft. to Ft From Ft. to Ft. From Ft. to—Ft.— Froin—Ft. oFt.FromFt. to'�, PNG From_ Kol.�10-F ` � Ftp, t From �J, I t�" F Ft. ',. t . From Ftr fo, �ti t. (� From Ft. toc From Rjl',_ Ft. From Ft. to Ft. From Ft. to Ft. From - Ft. to Ft. From Ft. to Ft. DRILLER'S NAME Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: Tobben Spurklond Legal description: Skyline View Lot 2 The attached paperwork has been reviewed and is being returned for the following reasons: ❑ Original signature or stamp missing on _ ❑ Calculation error in design. _ ❑ Additional soils information needed. _ ❑ Water monitoring results inadequate. _ ❑ Discrepancy in information submitted. _ ❑ Topographic information missing or inadequate. _ ❑ Incomplete; missing ❑ Incomplete; missing _ ❑ Additional adequacy test information needed. ® Water sample unacceptable. Allowable Nitrate is 10. ❑ Measured/proposed distances/dimensions missing. _ ❑ Locations of all soils, percolation and water monitoring tests not shown. _ ❑ Proposed system too deep for soils information submitted. ❑ Well log required. _ ❑ Omission in narrative. _ ❑ Insufficient fill over tank or field._ ❑ Other. Name of reviewer: Jeff Poet Date: 10-28-02 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK Certificate of On -Site Systems Approval Parcel I.D. 051-192-05 Legal description Skyline View lot 2 Site address 19405 Wildwood Dr Chugiak Current property owner(s) Vernon Stevenson Expiration Date: 11-26-22 X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By: 1.-.._- Original Certificate Date: This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist Absorption Field Advisory Tank Age Advisory Other X Well Flow Advisory Nitrate Advisory Arsenic Advisory COSA Approval_June 2022 ��1�UMCPAUTY OF AHCHORQGE Development Services DepartmentPhone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I. D. 051-192-05 Complete legal description SKYLINE VIEW LT 2 Location (site address) 19405 WILDWOOD DR Chugiak Current property owner(s) STEVENSON VERNON & DORRIS Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel Jfl Plastic ❑ Concrete ❑ Fiberglass Age <1 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ®❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Waiver Fee $ Date of Payment 11-6 ZZ Date of Payment COSA # 05G 22I y 09 Waiver # COSA Application_ June 2022 Legal Description: SKYLINE VIEW LT 2 Parcel ID: 051-192-05 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test 7.8 gPm Date drilled 1982 Total depth 81 ft Water storage tank volume 0 gallons Cased to $1 ft Well disinfected for coliform test? ❑ Yes ❑ N ❑ Sanitary seal is functioning correctly ❑ Coliform bacteria is Negative ❑ Wires are properly protected Nitrate 9.12 mg/L ❑ Nitrate less than MRL (ND) Casing height (above ground) '24 in. Arsenic ug/L ❑ Arsenic less than MRL (ND) Date of flow test for COSA 5/25/2022 Collected by Curtis Townsend Static water level at beginning of test 63 ft. Date 5/25/2022 Comments verified that well has a sanitary seal and electrical wires are protected B. TANK DATA Measured operating fluid level in septic tank _ Date of pumping tank installed July 2022 ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 1983 ❑ ALL standpipes present per record drawing Total measured depth from grade 9.8 ft (max) Measured depth to pipe invert from grade 4.83 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) no If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 STATION ❑ Require aintenance completed Age of lift station years Lift station material Comments: Adequacy test date 5/25/2022 Results ❑ Pass Fluid depth prior to test 49 in Water added 467 gal New fluid depth 58 in Elapsed time 1417 min Final fluid depth 45 in Absorption rate ' 450 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 60 in Effective depth used 45 in Effective depth remaining 15 in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No 9 Community Sewer Manhole/Cleanout > 100' Q Yes if No ft Fal Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' [-1 Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No ft Yes if No ft ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft ❑ Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No 9 ft Surface Water > 100' Q Yes if No ft Tank to Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' Ful Yes if No ft Private Wells > 100' 0 Yes if No ft Water Main > 10' no Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' Pn� Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Finn Ek, & 0_/VA C /�'J 6 (Ak fzz,(Z'l Phone 907.406.1058 Engineer's Printed Name 1./ U .-'f1, Date 15�Z COSA Checklist June 2022 �F • " . ce 11 'x^ •' • ,,' hc�sTn. _ • , ... • •_aa�.�.v ENGINEER'S R Nitrate Advisory Certificate of On -Site Systems Approval # OSC 221409 Subdivision: Skyline View Lot 2 A water sample revealed a nitrate concentration of 9.12 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Mailing Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Mailing Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org / Municipality of Anchorage ! • �1 Development Services Department :• \ Building Safety Division On -Site Water and Wastewater Program 4700 South Bracaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchcrage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. _� CJ �— jQ)_-0t5- HAA#, Q,12 Expiration Date: 1. GENERAL INFORMATION Complete legal description Lccation (site address or directions) 101 4 v0 5 W; kd , , o �_ Current Property owner(s) Steve Lt j K a� Day phone _ � S3 P — g7.0-5 Mailing address Lending agency Mailing address Real Estate Agent S v n ri et i eo_I L, T— Mailing Address ve gi e izedl e a Unless otherwise requested, HAA will be held by DSD for pickup. C Day phone 7 Day phone�- ��L gg6,c; J 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY:' TYPE OF WASTEWATER DISPOSAL: Individual Well �/ Uv Individual On-site (7� 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 Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(we) safe, functional and adequste 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 Stale codes, ordinances, and regulations in effect at the time of installation. Name of Address Engineer's Printed Name _ n irb rH SRO, I lgl LaC _ Phone _9-7q- 3-01/J6 Date Y.- 1 _ 1 5. DSD SIGNATURE c` ".Ly Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date: JR. 01.02) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L42 2 S k/ A I i&u V t tut' Parcel ID: 051-- Lg2,06 A. WELL DATA Well type Date completed !l -U2- If A, B, or C provide PWSID # NA Sanitary seal (Y/N) Total depth _al_ft. Cased to _81_ft. FROM WELL LOG Date of test Static water level Well production ft. WATER SAMPLE RESULTS: Coliform _o—oolonies/100 ml. Arsenic: ✓ mg.A. B. SEPTICIHOLDING TANK DATA Nitrate Date of sample: to]I40 7 - Tank Tank TypelMaterial�4, S k e c Tank size lovig gal. Number of Compartments Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) 99 n. AT INSPECTION 10/11CL b 6 fL % g.p.m. Other bacteria N -D colonies/100 ml. Collected by: Lars S.p,1 rik la w °� Date installed !-7-83 Cleanouts (Y/N) Foundation cleanout (Y///N) _)L_ Depression over tank (Y/N) --N Hih water alarm (Y/N) U Date of pumping /O(3%ot Pumper SC! &C; K L4 -w le -4 rS C. ABSORPTION FIELD DATA Date installed 7 -7-�i 3 Soil rating (g.p.d./ft= or ft�/bdrm) (L System type I.uw.ic Length '�y ft. Width 215 ft. Gravel below pipe ft. Total depth ft. ER. absorption area .2ugg_f1:2 Monitoring tube -y— Depression over field N Date of adequacy test r ° Results (Pass/Fail) tom' For 3 bedrooms Fluid depth in absorption field before test 3 7 in. Water added Loo gal. New depth in. Elapsed Time: _ min. Final fluid depth 17 in. Absorption rate >= 6 6O �.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) 11-1/ If yes, give date r/ �, r.,+ ! .r.. D. UFT STATION Data installed SIZA n gallons 'Pump on" level at _ in. 'Pump otr level at _ in. High r alarm level at in. Datum Cycles tested eft alarm 8 circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1 t0 0 1 On adjacent lots roc Absorption field on lot 11004 Public sewer main t-4/Al- On adjacent lots /e0 r Public sewer manhole/cleanout N/h Sewer /septic service fine I ;C) t Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO Building foundation 10 Property line qi) Absorption field .6 Water main t-41,,, Water service line % h Surface water 100 t Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ti0 Building foundation 13 Water main NA Water Service line > ;- .5— Surface water, 100+ Driveway. parking/vehide storage 101 Curtain drain Meg eg Wells on adjacent lots 100 f F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and W—tom, review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date.Oft 06 Engineer's Printed Name ( Q %ktN �ny Y V. l aK t \ ,,�� s�ti•. Date QL� 3� ��,; F•OrE55�0�� HAA Fee $ 3 7 Waiver Fee $ Date of Payment IOIy *102Date of Payment Receipt Number a7 9-119--1.+- Receipt Number (Rev. 12/01) F,01 : a • Oct. 23 2nm 01:39F1 P3 4 £C8 a—ec dil .11 'C.ccA FOX W. v V � 4 I� Non V 03 (� f• S• .. 1 � r t �l V C"et a y Y ti h Oct. 23 2nm 01:39F1 P3 4 £C8 a—ec dil .11 'C.ccA (i:atH vis? c Yon r w Al r •� i Bos d M �. �,•"i8;y Gi a Hit 41 W u O� `4 e t t. )t r w Al r 0. .+ 2 •1 � f• S• .. 1 � r t �l V C"et a.: . 1 41 W u O� `4 e t t. )t t -t• lT V, C"et �CC 1 �• i