HomeMy WebLinkAboutOUR MOUNTAIN BLK 2 LT 7Our Mountain lock Lot 7 051-111 -59 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 Page of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: OSP101138 PID Number: 051-111-59 Name: Dennis E. Figon Wastewater System: [] New [] Upgrade Address: P.O. Box 671492 Chugiak, AK 99567 ABSORPTION FIELD Phone: Number of Bedrooms: 4 r-I Deep Trench [] Shallow Trench [] Bed [] Mound [] Other: Soil Rating: Total Depth from original grade: LEGAL DESCRIPTION GPD~Ft2 Ft. Block: 2 Lot: 7 Subdivision: Depth to pipe bottom from odginal grade: Gravel depth beneath pipe: Our Mountain Ft. Ft. Township: Range: Section: Fill added above odginal grade: Gravel Length: Ft. Ft. Well: [] New [] Upgrade G~vel width: Ft. Number of lines: Distance between lines:Ft. Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material: Existing Ft. Ft, Ft2 Driller: Date Drilled: Static Water Level: Installer: Date Installed: Ft. Royce Martin 8/11/10 Yield: GPM PumpSetat: Ft. CasingHeightAb°veGr°und:Ft, TANK SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P. [] Other: T~ To Septic Absorption Lift Holding 3ublic/PrivateManufacturer: ' Capacity: From Tank Field Station Tank Sewer Line Anchorage Tank 1,500 Gak Material: Number of Compartments: we, >100' >100' N/A N/A >25' Steel Two (2) Surface WaterLot Line >5'>100' >100'>10' N/AN/A N/AN/A~ size: Gal.Manufacturer:LIFT STATION "Pump on" level at: "Pump off" level at: High water alarm at: Foundation >5' > 10' N/A N/A in, in. in. Pump Make & Model Electrical Inspections performed by: Curtain Drain None Noted Remarks: Existing Septic Tank Pumped, Crushed and Backfilled. BENCH MARK Location and Description: Septic Tank Only and Two Post Tank Cleanouts Placed Garage Slab. Assumed Elevation: Under this Permit. 100.0 Ft. Inspections performed by: A. Harala Dates: 1st 8-11-10 2® 8-11-10 Development Services Department Approval Conditional Approval Date: Reviewed and approved by: .' '.,,- / t,*, : (j/t_ _5" Permit Number: OSP101138 Page 2 of 3 PID No.: 051-111-59 Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT 4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904 Lot 4 CE] 0 0 Lot 5 Z S2 16.5 19,5 Existing 33' Long x 2.5' Wide x 5' Effective Depth Absorption Trench to Remain in Service. SI Existing Septic Tank Pumped, Crushed and Backfilled. SHEDS~'~ 65.00' S 89'59'11"W Trocf 2 Lot 8 Lof 7 £xistino Well CIRCLE Four Bedroom Lof 6 LEGEND Sl - Septic Vent C1 CIeon Out M1 - Monitor Tube TH -- Test Hole PLAN AS- UILT SCALE 1' = 50' Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT 4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904 On-Site Wastewater Disposal System or Well Inspection Report Permit Number: OSP101138 Page 3 of 3 PID No. 051-111~59 !1 '3'6J' ~epticTank I ~3'42 // Tank Only Replaced Under This Permit. Existing Tank Pumped, Crushed and Backfilled on Site. PROFILE AS-BUILT No Scale Permit Number: Tax Code Number: Work Type: On-Site Wastewater Disposal System Permit OSP101138 05111159000 Septic MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 EImore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Upgrade Permit Effective Dates: August 06, 2010 to Design Engineer: ANDERSON ENGINEERING Subdivision: OUR MOUNTAIN Site Legal Address: OUR MOUNTAIN BLK 2 LT 7 G:1361 Owner/Address: FIGON DENNIS E PO BOX 671492 CHUGIAK AK 995671492 August06,2011 Site Mailing Address: 20617 EDWARD CIR, Chugiak Lot Size in Sq Ft: 44219 Total Bedrooms: 4 This permit is for the construction of: N Disposal Field Y SepticTank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Date: Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 995i 9-6650 www. muni.org/onsite (907) 343-7904 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-111-59 Property owner(s). Dennis Figon Mailing address P.O. Box 671492 Chugiak, AK Site address 20617 Edward Circle Chugiak, AK Legal description (Sub'd., Block & Lot) Lot 7, Block 2, Our Mountain Legal description (Township, Range & Section) Lot Size 44,219 Sq. Ft. Day phone .Zip Code 99567 .Zip Code 99567 Number of Bedrooms THIS APPLICATION IS FOR ([~ all that apply): Absorption Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage [] THIS APPLICATION IS AN: Initial [] Upgrade [] Renewal [] I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: ~ 3 '"" ~-' Waiver Fees: Date of Payment: ~ ' ~ ~] - t Q Date of Payment: Receipt Number: ~ ~_~ / -~-~ ~ ,~ Receipt Number: (Rev. 11/05) ANDERSON ENGINEERING P.O; BOX 240773 ANCHORAG E, AK 99524 522-7773 522~6779 July 29, 2010 Municipality of Anchorage Development Services Department On-Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 7, Block 2, Our Mountain Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The septic tank on Lot 7, Block 2, Our Mountain Subdivision is failing and must be replaced. We are proposing to replace the tank with a new 1,500-gallon steel septic tank to serve the four-bedroom home on the lot. The existing absorption trench will remain in place for reuse. We are therefore requesting a permit be issued for the construction of a new septic tank on the lot. The attached Site Plan and backup documentation identify the location and configuration of the existing septic system and the location of the new tank. Also identified on the plans is the existing well on the lot. The new tank will be placed more than 100' from the well on this lot and those in the area. The existing tank on the lot will be properly disposed on the property. The drainage patterns will be maintained after construction. The ground surface on the lot is basically flat in the area of the new tank and in all other areas. The new septic tank will be constructed near the location of the existing tank and as parallel with the slope of the land as possible in conformance with Municipal requirements. If the tank is constructed in accordance with our design the following statements apply: The tank, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. The tank, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. Lot 7, Block 2, Our Mountain July 29, 2010 Page 2 of 2 The tank, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. The tank, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments 2 9 8 AREA M AP SCALE 1" = 100' I 4 5 OUR MOUNTAIN SUBDIVISION LOT 7, BLOCK 2 44-,219 S.F. Existing Well Pump, Crush and Abandon Existing Tank in Place. Place New 1,500 Gollon Septic Tank, and 2 Post Tank Cleanouts. Existing AbsorptionTrench 35' Lonq x 2.5' Wide x 5' EfFective Depth NOTE: Place Foundation Cleanout if Necessary. Max. Burial Depth of Tank is 4'. 10 Gauge Tank Required for Deeper Burial. Four Bedroom Home LEGEND SV - Septic Vent CO Cleon Out MT - Monitor Tube TH - Test Hole SITE PLAN SCALE 1" = 50' ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 7, BLOCK 2, OUR MOUNTAIN SUBDIVISION GENERAL: The scope of this project includes the pumping, crushing and backfilling of the existing septic tank on the property and the procurement and placement of a new 1,500-gallon septic tank and two post tank cleanouts at the location shown on the Site Plan. Work also includes the placement of a foundation cleanout, if necessary and connection of the new tank into the existing post absorption trench. The new septic tank must be placed a minimum of 100' from the existing well on the lot and 100' from all private wells and any surface water in the area. A minimum of 4' of cover is required over the septic tank. The foundation cleanout must be replaced if one is not found on the property. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. The Contractor must also verify the location of wells in the area and assure that the separation distances are met. o Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. Contractors installing wastewater disposal systems must be certified by the Municipal Development Services Department Building Safety Division On-Site Water and Wastewater Program for system installations. Owners installing their own systems must receive prior approval from the On-Site Water and Wastewater Program before beginning system installation. SEPTIC TANK INSTALLATION A new 1,500-gallon septic tank must be procured from an approved source and installed at the location shown. The maximum depth of bury for the 1,500 gallon tank is 4'. 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. Lot 7, Block 2, Our Mountain July 29, 2010 Page 2 of 3 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: - EXISTING ABSORPTION TRENCH TO REMAIN IN SERVICE 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trench to drain away. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. All pockets of unacceptable materials must be removed and replaced. Lot 7, Block 2, Our Mountain July 29, 2010 Page 3 of 3 MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as-built of the completed system. ]i MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTIECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAl. SYSTEM AND/OR WELL INSPECTION REPORT MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS ~ M ~ / 3 W~i] / Absorption area Dwelling PERMIT NO. ~- D Manufacturer Material No. of compartments /~ ~F HOMe. DE: ~ ~ Well Dwelling PERMIT NO. DISTANCE TO: ~ ~ ~ Manufacturer M~teriat Liquid capacitv in gallons ~ No. oflines / Length of each li~ ~ / Total lengthoflines ~ '~3 ~ ~ inches ~ ~ ~ Top of the to finish grade -- M~terJ~l beneath tile - Total effective ~bsorpti~ are~ Length Width Depth PERMIT NO. ~ DISTANCE TO: ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST ~ATING ~, ur ~! ~ / -- .... , x ',"-, ~. 2225~ ,~ // ..... DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION APPROVED DATE LEGAL 72-013 (Rev 3/7R) !i'q! iL...~ ih,,J! ]ii: Ci: ::i[: iF::" IF::::~ ii..... ]I:: -Ii"' %"" C::)I IF:" tF:::~ tt'",~ ~Z:: !1'""~ C) I1::;;?: IF:Il [::,E:[::'Fif;i:THE:r,tT O1:::' I--IEFI!..TH FII'.,I[) E:NVII:;.:.'Oi'.,IHEi:i'.,I'FFII_ ',!!~25 !... ZTRKE]"., Fih,ICl-.IOf;i:l::l(:!iE., 1::1[::: 2 6 4- 4. 7 ;Z El I:::'EF:H ]: 'T' I'.,IO: C,f:iTE ]: i~};St. JED: FII'::'I:::'L :[ CI::IN T: F! [:' [:' F:: E :!!i; ~!;: COI",ITI:::IC T F'HOi",IE L..I!!:Gf::IL Df!i2ii;Cl~: I F' I.... O"1" S 12: E':: l'"l F:I::'~: lii~EI)!:;;:O O M S: :'J-::+: TFtI",II< MU:i!i;T I'"ll::l',,,'l!ii: I:::I'T' [....[ii:l::t:!!i;"l' 't"1.,.IO I CE:Fi:T I I:::'"r' T'HI:::I"F: t. I FIM F'FiI'"IIL. I I::'d:;:: I.,.IITH THE I:;i:i_::QUIRE:MENT::L:; FO,q: OI",i'~"SI"I"E :SEt.,.IE,q::!i; FIN[) NliJ:L..I....S I':IS :~.i;IET I=OF.:"r'H E',"r' ]l...llE i"ILII',IIC:!:F:'I:':IL. IT'¢ OF' I::INE:HEIt:;i:F:IGL~: (MEII::'I) I:::11'.,1[;:, THE STi::ITE OF I:::IL. FISKFI. ;:?:. t I.,.IIL..L..I iq?I'r:ll_L 'T'HIE Z'.r'iT'FIEH I1'.,I I:::ICCOI:;.:[:,I:::II'.,ICIE I.,.lll"H I::11_1... MOt::I CO[:,E~; I::IN[:, F~'.E:GIJL. I:::ITIOI'.,I'.:5., F:hNI) :I: N COMI::'I... I I::ii'.,!CE .b.I I 'f'H "lq--.l!i~: !::,l:Z:ii; I GI'.,I CFi: I 'T'ER I I::1 O1::' TH I :ii; F'EI?H I T. :% I I.,.I]:L.L i::l[:,l..lI!ii:t:;~;lii: TO I:::II...L. HOI:::I I::1i'.,1[:, '.::;I'Frl'IZ OF:' i:::lL..Ft:ili;k:l::'t I:;;'.E(;:!UII:;i:E:Mlii:NTS F:'OFi: 'T'HIE :SET [:, I :!i;TFtNCiE:!; I::Ror,'l i::1i'.,1'¢ E:;:.:: I ST :!: NG .[,JE]_~ ..... .klr::r/?rEl-,.ll::lTEt~,~: [::, I'.E;PO!¢I::II_ ':-i.:;V:i;TEH OP. F:'LII31_ I C :~i;IEI.,If!!:RF:IGIE :i~.;"r".~:i;"t"l!~.l"l OH THIS OF;: FIN"r' Fff)..:rFiE:IEI'.,fT OF: I'.,IEFir;;:EW I....OT. 4.. I I..tl'.,l[)l:i~:l:;.!'.!!;Tl'::lhl[:, 'f'HFiT "FH :i: i~.; I:::'ERM I '1" I S ',,,'I.::iL. I 1) F'Of;i: !::i t','IF:i:~.:; I I',llJl'q OF:' ~: 13E:[:,FiiOOM:.'S I::11'.,1[:, I::ll",l"r' IEIqI...FIF%qiEME]',IT 1.41L.I.... F..'EQI..I I Fi'.IE FIN F:II)Ii:, :1: T ~ OI",IFIL.. F'E:RM 11'. 1t' I::' I::l I.... I FT S"f'FI'T I ON I :E; I hli!;TAl....l_EI) ): N FIN F:ff;;:IEI:::I COVEF;;:E:[:, B"r' MOFI 131...I THE".I",I ':: :!..':" FIN EL.I:'i:C'TR Z CF:IL F:'EI:;;:H ~ ']" F:INI) I I",ISF:'ECT I ON MU:E;'T DE OEFf'FI I r.,iED.~ ,:: ;.'.?. ::, I::l'.':i;-.EflJ :[ L.]"'..::i; Id I L..I_i'.,IOT E:E I:::IF'F::'I;tOVEI:::, I.,.I I "r'HOIJT I:::iJ'.,J EL.IECTF:'. i Cf:IL :[ I",ISP!i!:CT 1!1 ON REF'OF';::T.; F:If',IL":' ,:: ]: ::, THE: E!...ECTI::;: t C:I::IL t.,.IOt:;;':l< MUST E',!Z I:::'ONi.E E',"/ I::'1 I....1: Clii~.l',l:i!i;[i~:l.::' EL. lii;CTf;;: I C I Fli",l. :~; :[ ':!i f','E:t:::' ...~.... ~~____ .............................................. l:::']::l ]~E FtF'f::'L.. Z CI:::INT: I<OE:HL..[!::I~: COi'.,ISI"r~:LICT :1: Oi'.,I [] ~©ILS LOG PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 lO 11 12 13 14 15 16 17 18 19 20.- COMMENTS MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SLOPE WAS GROUND WATER ENCOUNTERED? [] PERCOLATION TEST E IF YES, ATWHAT DEPTH? SITE PLAN PERCOLATION RATE (minutes/inch) i TEST RUN BETWEEN /' AND FT Gross Net Depth to Net Reading Date Time -lime Water O~op CERTIPIED MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PFIONE '~NEW f-,' ~. ~,~-~ ~' ~'-~-'/~ Y- El UPGRADE MAI LING ADDRESS C~ LEGAL DESCRIPTION &..p 7 LOCATION L C/~,"~ ,~- R Weg ! ~' ILiq. capacity in gallons IF HOMEMADE ~ DISTANCE TO: ~ell ~ Manufacturer -- o I IWe]l ~ / ~ST~C~TO: / ~ ~ ~ [ No. of line~ ~Zength of each Hne -z~ / / h ~ ~ Top of tile to finish grad~ ~ ~ ~rib diamete~ ~ DISTANCE TO: ~ Well ~ IClass ' Depth -. ~ ~ I ~,~ ~. Building foundation - IDISTANCE TO: ~mm ~ NO. OF BE©ROOMS Absorption area Dwelling PERMIT NO. Material No. of compartments Inside length W dth Liquid depth Dwelling PERMIT NO. Material Nearest lot line Trench w dt ~ OTHER PIPE MATERIALS SOIL TEST PA-rING INSTALLER REMARKS Foundation Liquid capacity in gallons PERMIT NO. Total length of lines Distance between lines inches Material beneath tile Total effective absorption area inches Depth PERMIT NO. Crib depth Building foundation Sewer line Total effective absorption area Nearest lot line o lot line PERMIT NO. Absorptio~area(sl APPROVED DATE LEGAL Lr 7 by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 OWNER OF LAND ADDRESS ; LEGAL DESCRIPTION DATE - Started ' :; Ended PERMIT NUMBER DEPTH OF WELL STATIC LEVEL OF WATER FT. DRAW DOWN FT. GALS. PER HR : KIND OF CASING KIND OF FORMATION: From Ft. to , 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. 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 From Ft. to Ft. From Ft. to Ft From Ft. to From Ft. to From Ft. to From Ft. to _ From __ _ Fl. to From Ft. to From Ft. to From Ft. to From Ft. to From Ft. to. From Ft. to From Ft. to From Ft. to_ From Ft. to From Ft. to From Ft. to From Ft. to_. Ft. Ft Ft. Ft MUNICIPALITY OF ANCHORAGE Ft DEPT. OF HFAL. Z~=~ ENVIRONMENTAL PROTEcTIoN Ft Ft. AU(} 6 1.984 F,. REC LIVED Ft Ft Ft Ft, _Ft, Ft Ft, Ft. Ft MISCL. INFORMATION: DRILLER'S NAME _ MUNICIPALITYF Development Services Department €� On -Site Water & Wastewater Section Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-111-59 Expiration Date: 1. GENERAL INFORMATION Complete legal description OUR MOUNTAIN BLOCK 2 Location (site address) 20617 EDWARD CIRCLE, CHUGIAK, AK 99567 Current property owner(s) THOMAS M. CRAIG Mailing address Real estate agent 20617 EDWARD CIRCLE, CHUGIAK, AK 99567 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone Day phone 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic 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. COSA Fee $ 550 Date of Payment Receipt Number 3 1 COSA # 05C 211 7 1 Date: Waiver Fee $ Date of Payment Receipt Number 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 FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 12/13/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to OF these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory ��P• for rent discre ancies exist can be iven b First Water Consulting & oachments, deficiencies or j g••• TH curor future occupants or guarantee that no unseen enFgn � / • • • •� •—• • • • • • • ••• • • jl • • • • • • •' 6. DSD SIGNATURE • ' • Curtis Huffman j System #1 Approved for bedrooms CE 128991 •.`�r� 2113121 System #2 Approved for bedrooms liliFOPR FESSIONP��a� Disapproved Conditional approval for bedrooms, with the following stipulations: 1TY(Of Vo -SITE WATER4 IN i p,� rt WAST= TATE r F'A o foo M JJ�� T SERVIGES� `,�\ r � r B Original Certificate Date: 17— I S Z 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 Legal Description: OUR MOUNTAIN BLOCK 2, LOT 7 Parcel ID: 051-111-59 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _ A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 3/1984 Total depth 117 ft Cased to 112 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA 12/02/2021 Static water level at beginning of test 86 ft. Comments B. TANK DATA Age of tanks) 11 years Tank type/material SEPTIC / STEEL Measured operating fluid level in septic tank 48" ® Standpipes/foundation cleanout per record drawing Date of pumping 11/30/21 D. ABSORPTION FIELD DATA Which system tested (date installed) 1984-7/2014 ® ALL standpipes present per record drawing Total measured depth from grade 9.2 ft (max) Measured depth to pipe invert from grade 4.2 ft (min) ❑ N/A – pressurized field ® Monitor tubes go to bottom of effective. If not, state Well production at time of test 6 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate mg/L ® Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by FW Date of Sample 12/3/21 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 12/2/21 Results 0 Pass For 5 bedrooms Fluid depth prior to test 0 in Water added 750 gal New depth 0 in depth into effective Elapsed time <1 min ® fluid depth 0 in Code -required soil cover over field Final— ❑ System presoaked Absorption rate 750 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: FWC; 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' ® Yes if No ft Wells on Adjacent Lots: Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes _ if No ft ®Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ft ft ft ft ft ® Yes if No ft Property Line > 5 ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells >' 100 _ ®Yes if No Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes Property Line > 10' ® Yes Water Main > 10' ® Yes Water Service Line > 10' ® Yes Surface Water > 100' ® Yes F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION if No ft If absorption field is under driveway comment below if No _ ft Wells on Adjacent Lots: if No ft Private Wells > 100' ® Yes if No ft if No ft Community Wells > 200' ® Yes if No if No ft I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. OF A ,kk 7H • ,� ...... ..........� • • Curtis Huffman ;t� CE 128991 .•,�`ir;v' �E,�`•d,2/10/;1•'��� l pROFESSO:.� ft ft 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 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Our Mountain S/D, Block 2, Lot 7 COSA # C ~)(~ Expiration Date: Location (site address) 20617 Edward Circle, Chugiak, Alaska Current Property owner(s) Dennis Figon Mailing address Lending agency Mailing address Real Estate Agent Audrey Mason of ReMax of Eagle River Mailing Address 11525 Old Glenn Hwy., Eagle River, AK 99577 Unless otherwise requested, COSA will be held by DSM for pickup. NUMBER OFBEDROOMS: 3 Day phone 748-3867 Day phone Day phone 622-3344 TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class __ Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding Tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSM) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSM also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of 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 Douglas T. Kenley, P.E. Address 9806 E. Northstar Circle, Palmer, AK 99645 Engineer's Printed Name Douglas T. Kenley DSD SIGNATURE ~J Approved for ..~ Disapproved. Conditional approval for bedrooms. Phone (907) 746-1073 bedrooms, with the following stipulations: Attachments: CQSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory .://::.,, (Rev. 11105) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: (~ - / ~ '-// Municipality of Anchorage Development Services Department Building Safety Division On-Site'Water & Wastawater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Our Mountain S/O, aa~ck 2, Lot 7 A. _WE_U- DAT~ " Well type p,va~ Data completed .3/~9a4 Total depth 117 f. If A, B, or C provide PWSID # Sanitary seal (Y/N) Y Cased to ll2 ft. ,Parcel ID:. 051-111-59 Well Log (Y/N) Y Wires properly protected (Y/N) Casing height (above ground) 34 Y in. Data of test Static water level FROM WELL LOG AT INSPECTION 7/24111 Well production 3000 g.p.m. WATER SAMPLE RESULTS: Coliform Negatlvecoionies/100 mL Nitrate ND mg/L Arsenic: . ,N~ Og/L date of sample: 7/24.1 3.9 g.p.m. co,e~ed ~y: F. Kenley SEPTIC/HOLDING TANK DATA : Sepac/Steel .... - Tank Type/Mata~l ~ : TanksiZe ls°°;.~~ ~ai. ' ' : '~ · ~ ~,Number of~Comp~d~nents '2 .Foundation cleanout (Y/N) .. ,Y..' ' , Depression over tank (Y/N) ~ .N.., Data of:pumpi.'ng ;.?~..see.~ ~.~.,..rrtment~ Pumper .Date install~ 5/1984' Soil rating (g.p.d./ft= or ft=/bdrm) . !09 Le~lgth/. ':'33 ., fL ~ 2.5 fL Total depth ,8.8 ft. Eft. absorption area 3.27 ft2 Monitoring tube .ft. Data of adequacy test 7/24111 Results (Pass/Fail) Pass Fluid depth in absorption field before test ...0. in. Watar added 545 gal. Elapsed Time: .. 80.. min. Final fluid depth . .... 0 in. Any rejuvenation trea~-~nt (past 12 mo.) (YIN & type) Cleanouts (Y/N) High ~,ater alarm (Y/N) 8/11110 Y N SyStem type Trench Gravel below pipe., . § Y Depressien over field N "'For 3 bedrooms Newdepth. 3 in. Absorption rate >= ..... 45O , g.p.d: N If yes, give date '-' LIFT STATION Date installed "Pump on" level at .... in. SEPARATION DISTANCES SEPARATION DISTANCES FROM ~WELL ON LOT TO: Septic tank/lift station on lot 100+ ff. Absorption fi~id on lot 100+ f. Public sewer main '~ ~fJ'~ Sewer/septic sent~~ Animal containment areas 50+ ft. Size in gallons Manhole/Access (Y/N) _ "Pump off' level at ' - ' =--~ er alarn~ level at Cycles tested Meets alarm & circuit requirements? 100+ ft. On adjacent lots On adjacent lots 100+ f. Public sewer manhole/cleanout, ~ Holding tank N/A Manure/animal excrete storage areas 100+ ft. Building foundation 10+ ft. Surface water 1'00+ ft. Wells on adjacent lois 100+fl. Absorption field Sudace water SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO' Building foundation 5+ it. Property line lo* FT. Water main 10+ ft. Water service line 1 0-1- ft. Wells on adjacent lots 100+ ff. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properbj line 10+ ft. Water-Servise line 10+ ff. Curtain drain None Known 5+ ft. F. COMII~NTS 100+ fl~ Water main 10+ ff. G. ENGINEER'S CERTIFICATION I ~ that I have ~i~ ~h ~ld in~ns and ~'J.~ IM ~ ~_~... mvi~ of Muni~pal ~ th~ ~ of P~nt ~ ~ I Il ~ ~ Payment, R~ Numar 0 ~ ~ ~ ~ ~ Re~i~ Numar ~ev. 4/1~ MUNICIPALITY OF ANCtlORAGq'] DIVISION OF ENVIRONMENTAL HEALTH ~ DEPAR%MENq. OF HEALTH AND ~.~,~ ~.,~O ,.~ ~ ~, ~RO~'~C~ ,~.. APPLICATION FOR HEALTH AUTHORITY APPROV~ CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, Location (address or directions) (b) Applicants Name ,/ ' ,": ., ',,-, Tele~phone - Home Applicants Address (c) Applicant is (check one) Lending Institution Buyer ~'-~ ; Other CCi] (explain); (d) Lending Institution Telephone Address (e) Real Estate Co, & Agent Address Telephone (f) Mail the HAA to the following address: 2. ~e. of Residence S ingle-Fatally Number of Bedrooms 3. Water Individual Other Community r-[.~ Public Note: If community well system, mu.~t have wt-itten confirmation frown the State Department of Enviroz~mental Conservation attesting to the legalit7 a~d statu.~. S__e_.wa~g~e Disposal 0nsite [lZi[ - Public ~[--__~ Community ~7Z! Holding T,,,,k [_~.[]~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and statu~;, [Page 1 of 2] ~:j~leerinj5' Firm Prov_ld_~l.,,l_a.k J~j'~s__pe__ct_ions, Tcc;t~, rii,a Sea~-~J!~z Data a~d i. uifovmation As certified by my seal affixed hereto and as of the validation date shown belew, I verify that my investigation of this Heal. th Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, func. tional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the kkmicipality of galchorage files and from my investlgatiou and inspection, the on-site water suppIy and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regu].a- tions in effect on the date of this inspection. Name of Firm~_~ --~d]____:'. ~'' ' ,': ~.. , Telephoue ' . Address ~ .:._] : DHEP A_pj)r oval Approved for Approved ~_~_ bed rooms Disapproved Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARI~ENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUF, S HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON Tile REPRF, SENT~ ATIONS GIVEN IN PAiLAGIL\Ptl 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEF, R REGISTERED IN TIlE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AN]) THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRe- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA F, EFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ~%NCHORAGE iES NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL F, NGINEER'S WORK° (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7 .--1 9.--8 4 A® WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well Log P~esent (Y/N) .)/ Total Depth // ? ~ Cased to Static Water Level ~ .~ Casing Height Above Ground ~ 4z/~ Electrical Wiring in Conduit (Y/N) j Separation Distances fFcm Well: To Septic/Holding Tank on Lot /o/'b~ To Nearest Edge of Absorption Field on Lot To Nearest Public Se~r Line /~'w~ MUNICIPALI]Y OF ANCHORA~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION' 'AU6 11984 RECEIVED Legal Description: LT~ '~ If A, B, c~ C, D.E.C. Approved(Y/N) Date Completed '~/~ L{ Yield ~pth of G~outin~ ~ ~t At ~z/~ ~- .... ( Sanit~y ~al on Casing (Y~,~' ~ession ~ound ~l~ead Cleancut/Mar~%ole. /~/~z~C_ To Ne~u~est Sewer Service Line on Lot Wate~ Sample Collected By Water Sample Test Results C~a~ents ; On Adjoining Lots /¢© + /5'~, / ; On Adjoining Lots /¢'¢ ''~ TO Nearest Public Sewer B. SEPTIC/HOLDING TANK DATA Date Installed ~-/~ Size /[)oo ~j / No. of CgJ~a~tmsnts Standpipes (Y~) ,~ Ai~-tight Caps (Y~) f/Foundation Cleanout (Y~) ~ession o~ Ta~ (Y~) ~ ~te ~st P~d ~e~ (L~ P~ing~intenan~ Con~a~ ~ File (Y~) ~0~; fo~ ~ /~. Holding Ta~ High-Wate= ~a~ (Y/N) ~ '~=a=y Holding ~ank ~=~t (Y~) ~p~ation Distan~s ~ ~ptie~olding Tank: To Wate=-Supply ~11 /6 ~- To ~ilding Foundation To ~o~=ty Li~ ~ ~' ~-- / To Dis~sal Field~ To Water Main/Service Line .Y To Stream, Pond, Lake, or Major D~ainage Course Comments [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 Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Weter-Supply Well /~o -F- To P~operty Line Date of Last Adequacy Test Type of System Design Length of Field. -~ ~' Depth of Field ..~ z Gravel Bed Thickness ~ o ~z Standpipes P=esent (Y/N) To Building Foundation Lot /P~'~ ; On Adjoining Lots ~o 'Y-- To Water Main/Service Line ~ '~- To Cutbank(if present) To Stream/Pond/Lake/or Major D~ainage Course /~/~ To D~iveway, Pa~king A~ea, or Vehicle Storage Area ~-°~J- To Existing or Abandoned System cn Co~z~nts D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Dim~rsions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Mgets MOA Comments ** ** ~/~. Check Permitted Bed~oomRating Against HAA 9equest I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Co. any / l ', KBl/d5/s Date MOa No. [Page 2 of 2] ~).. JUN[ 25, 197~ 2-15-84