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Home My WebLink AboutPETERS GATE BLK 3 LT 3A Peters Gate Block 3 Lot 3A #051-551-17 Municipality of Anchorage Page I of Z DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: sW`I 70031 PID Number: 0 51 -- 551 — opi Name: '� 40� ,(0' p,SAA 2G1 Cos Tclr�•c o J Wastewater System: 7 New ❑ Upgrade Address: ABSORPTION FIELD 190X 41,004f!; Phone: No. of Bedrooms: O Deep Trench O Shallow Trench I( Bed O Mound O Other LEGAL DESCRIPTION toll Rating: (t0r1. F1vr" 0•7 Total Depth from original grade: * 91 + Z, SANTO FI'T&A, GPD/Sq. Ft. Lot: Block: Subdivision: 3 Pwrecs 6,yrE Depth to pipe bottom from original grade: 6.91 Ft. Gravel depth beneath pipe O.5 1 Ft. Township: Range: Section: "� Fill added agove original grade: —3 Gravel length: 5 *' ..�. �.. 1 Ft. Ft. WELL: I& New ❑ Upgrade Gravel width: 1 1Z Number of lines: 3 Distance between lines: /f, Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: —1 Pipe material: Ai71M� 0' l� fit I doer ,5 019 Ft. Cq Ft. SO. Ft. Driller:Date Drilled: Static Water Level: Installer: Date installed: 8 .:�vw-IvAO cJAT.aUi64 3110 138 Ft. Yield: • (,GPM I Pump Set at: U • K • Ft. Casing Height Above Ground: 2;11 Ft. TANK I SEPARATION DISTANCES I$ Septic O Holding O S.T.E.P. To Septic Absorption Lift Holding Public/Private Manu acturer: Capacity in gallons: From Tank Field Station Tank' Sewer Lines Well- (oo + 10(. 1 zs �f Material: STEEL Number of Compartments: 2 SurfaceLIFT Water la+ 100%i STATION LotSize y in gallons: Manufacturer: Line 20 101 "" — " Foundation gS.I.f C5�-F +^ •-•.• --- "Pump on" level at: "P " level at: High water alarm at: Curtain + Y Pump M odel Electrical Inspections performed by: Drain (V r h Remarks: Z.' SAflin tV69— 6,61LOO BENCH MARK 161woG•P0E Sr—C At•r-riwCC 2:o S164E Location and Description: TlroM tc 9f0/4G Aldr►ufS%S OF SAuo XWO. Ar Poll -11 a A" .Assumed Elevation: .aFt 'S /Q ereN•eeee•e4n• ! A .... ..e ....:�.»...:..,..,.� MGtt Q ,n� INEERING 6 4 PIO — 1 -moi � Inspections performed by: .Mit 4III—] �iynr I nop Road. NE}M: 1st � e ...- ...,...... ��t--.....-. ...eee� e ROBERT C. COWAN y Alaska 9957 1£agls Rlvor, 2nd B -z-97 �` CE _ asol ,•`�`�',,�' 14 _q1 3t� Department of Health and Human Se ices approval— ; , : ,;.�.�' 6��ate:/2-2-77 Reviewed and approved by: 2 - (Rev. 9/91) MOA 25 PERMIT NO. SW970031 PAGE 2 OF 2 ` MunicipaUt of Anchora e DEPARTMENT OIC �If�A�H AND HURAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,O, Box 196650 *Anchorage, Alaska 99519-6650 • TIlehone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR MEL INSPECTION REPORT LEGAL LOT 3, BLOCK 3, PETERS GATE SUBDIVISION P.I.D. NO. 051-551-04 01 & MTI = 100.0' CO2 & M = 101.8' MALCOLM DRIVE FINAL GRADE MT 2 COS CO2 MT1 10' UTILITY EASEMENT ----A -------------- ----- - - - - - A B C STl 44.5 89.5 ST2 50.5 9-5 - a 2 SANDV4' DB 97.0 - SECTION NE ESMT. DBL2 54.5 97.5 - 001 58.5 103.5 - 93TI 57.0 95.5 pCO2 105.0 - 93 MT2 108.0' I 114.0 -------------------- ----- ----- ♦84.4' r -NO WATER FOUND -, coal 1 2 82.4' B.O.H. Al THi i NEW BED I I � I FINAL GRADE � J I I j STI ST2 NEW 1000 GAL. i 99.7' SEPTIC TANK MTtIL X01 2 o ALT. SITE w NEW a 94.0' 1000 GAL 93.8' q SEPTIC I I TANK I I WELL B Co L _ J c , PROPOSED A 3 BDRM HOUSE E� DECK ff•• •••h•%,'ir�+1 j ROBERT C. COWAN �. %CE -8801 `• SCALE 1" = 40' �` `' . .' �•� •- 07 746 4721 t 1 n. r 1 H ,o. r. �• r'� . P. E. A �. MARK. HANSEN P.L. i,nn.0 ,u,g Cng;nr.rr, Toting l,aborgtnry P.01 N(:l'): LU\ i1A F'r�1,A1ER. r IASK4 Q9h43 o07) 74;+-1731 r,4� (go -,'I746,4721 May 15, 1997 project 9711 Quality $and and Gravel p U. Box 14156 powner, AK 99645 Subject $i;�v6 Arr.alys,s of Fi er Sand Gentlemen S! F, or the $ampi8 taken 5114/9T ..the following IS it""..� E:�e ar a vs S ,A pass; -,g % Required for'ADEC Filter cSand Group A Group B #4 100 85-100 85- 100 410 ifs 60-90 #20 - r 25 �d - a: o 15 #100 ,�', p-5 0.5 Maxil1'1Ur11 r;. Ct, Caeffic.�e.� t of Un'fa "a'tY 2 J 1 Maximum Maximum r�rl'10.lrll ��$�Ina Pne 5��•'` 41 and r@t2'n8d 1 lie 5elliplp�,pni0r«�S to bcch C,rou� A ar'd C,rcu�� B �pecificat�aris. do not hes+tate to call 4` VO'al have erly' Guest Ons /Mark Har -,Se- AT ` `rb l5ritting ire by DOC Co. dba SULLI"N WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759 OWNER OF LAND E t (J R'�j Ic,._, DEPTH OF 1vCLL 6z c) ADDRESS _ STATIC LLVEL OF NY %TUR F T. 4L� LEGAL DESCRIPTION 4 oTC K 3�`� �'�DR �' D04ti'N FT. DATE - Started _ Ended GALS. PER HR PERMIT NUMBER KIND OF CASING KIND OF FORMATION: From- a Ft. to0� Ft.QoccIA)6 TTi<gc)A From —.Ft. to_—__ -_Ft. From--01—Ft. to--4q—Ft... From . Ft. to _ Ft. From � Ft. to�Ft. TA*-J4I ol<4JG L From --Ft. to__ Ft. f.r• r I / Froz,+%-�-3�- Ft. t0—a4Ft. (��- ii-e4`fi'Froin---Fl.. Fro�—F_Ft. to ------ .Ft.�___._.—_..___--__.�-_,_=,.s-.- From _D � .__Ft.to__ 1 y2 -Ft.y�/`f��- From _Ft. A rA C��+rX From y J Ft. to�Ft. `1 4T 4 +4Jt=_�From Ft. to— Ft. —_ Frorn46:d--:Ft. to'7r Ft. �641Q a C K dl-4C/G Fromt Ft. to _._-_ Ft. , -- ..-T From___-l!rFt. to -710 Ft. 694RDCK 6+PFrom______Ft. to____—Ft.-�_ FL 0,111 (9) 1) Ft. to_.�s Ft.__ m Ft. to_ --From a�-� Ft. to??��Ft. /�� '�/�r4�T �(�0% �5 � �-�0�-`-4.r Fr m Ft. to_ Ft. From --_'_LFt. to—? -(M. Aa& CK— y�&Q_fj From— Ft. to. --_Ft. From .J_Z !._Ft. to 0 Ft.C��C.t% �`� 3 �F� Ft. to Ft. From 4 &D Ft. to �'F't. ��d �� /G �} �� Front Ft. to ----.—Ft TN Frot;t—b_ Ft. to--��(� .�_F1. �+ 6, �� o111— Ft. to-__ o-----Ftt --"'- - - From`(_S2_ Ft, to dt Ft._ 3 Ce'From Ft. to -- Ft. From Ft. toFt. --___Ft. From— µ�ma�i�ptBAce*w. From ----.—Ft. to ---Ft, From --------Ft. to _ eaItt� MISCL. INFORMATION: S&S� lineeninG HEALT14 AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN Date: Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 o REFERENCE: LoT ROBERT C. COWAN, P.E. ROBERT A. SHAFER, P.E. CIVIL ENGINEERS (907)694-2979 FAX (907) 694-1211 RECEIVED AUG 12 1997 Municipality of Anchorage Dept. Health & Human Services The septic inspections for the referenced property were performed on ;9 / ZS -1 and,��' Prior to submitting the On-site Wastewater Disposal System nd/or Well Inspection Report we are waiting for the n- &4"r 5AFF-a �to be completed. ase If we may be of further service please contact us. Sincerely, Robert C. Cowan, P.E. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 a Sn 1 \ I ta__�) PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW970031 DATE ISSUED: 3/10/97 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES EXPIRATION DATE: 3/10/98 OWNER NAME:JOHANNES GARY A & CAROLEE A OWNER ADDRESS:3841 REFLECTION ROAD ANCHORAGE, ALASKA 99504-4394 PARCEL ID:05155104 LEGAL DESCRIPTION: PETERS GATE BLK 3 LT 3 LOT SIZE: 55321 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THE SAND USED IN THE FILTER LAYER MUST BE A CLEAN COARSE SAND WITH 4% OR LESS PASSING THE #100 SIEVE AND 20 OR LESS PASSING THE #200 SIEVE. A SIEVE ANALYSIS MUST BE PROVIDED ON THE SAND USED 0 TAINED ROM AN APPROVED SOURCE. f RECEIVED BY: fi/1-y^�� DATE: 3,_ ( ' ISSUED BY: * DATE: Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax February 12, 1997 Jim Cross, P.E. Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Peters Gate Lot 3, Block 3 Narrative & Permit Application Dear Mr. Cross: The proposed well and septic system will have very limited impact on adjacent properties for the following reasons: 1. The surrounding lots are large, allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, due to absorption capacity. 4. Drainage will not be affected and is not a major consideration in our design. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. \1997\96 -084A -NAR. DOC R Nl QPAUTY or fNV1 NM� ENTAt SEPVICEs C),oN FEB f VIS1 VE MALCELM DRIVE- RIVE NO NO WELL1 +Ioo' w ----160.00----- ---- ---- N 89°57'47" W 10' UTILITY EASEMENT 33' SECTION LINE EASEMENT d DOG /� �L �— 33' SECTION LINE EASEMENT --KENNEL// -4/ -- — N m u IV\ ---------- f'l iT) T® 12X54' v Fq BED rq v VACANT LET 2 LOT PQeJs� MO 1000 GAL 3 SEPTIC 3 TANK C:) lf� o L(7 PRHOUSE � LOCAOP TION C) PROP (4 WELL SITE (/7 L T 1 LOT 4 BED DETAIL OW SEPTIC raw'' of LOT 3 2 4' 4' z ENCRpACHMENT 160,00 N 89°57'47' W ® — TEST HOLE TRACT I • — MONITOR TUBE o — SEWER CLEANOUT 0 — WELL NO SURFACE WATER — EASEMENT NO KNOWN CURTAIN DRAINS — PROPOSED LEACHFIELD — EXISTING LEACHFIELD WELL_ SEPTIC SITE PLAN ��.•OF ��P ••S��l�, 00 :49TH• •. �j �, '•, LOUIS A. BUTERA 4 �,�iPJ •.�• CE-6736�_= LEGAL: PETERS GATE LOT 3, BLK 3 OWNER: VARNER CONTRACTOR: N/A JOB 96-084 DATE: L2/12/971 SCALE 1" = 60' EAGLE RIVER ENGINEERING SERVICES AP. 0. Box 773294 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) 694-3297 Al pROFESSIONP� �•_ ��"`��•� `o "(ENGIf E x' "a Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES ' •• ",;� •A 5 825 "L" Street, Anchorage, Alaska 99502-0650 W Louis A• Suterz- SOILS LOG — PERCOLATION TEST �w °+ �t`-arae,' a' PERFORMED FOR: 1114A/(/Ex GATE PERFORMED: LEGAL DESCRIPTION:_GwTc (..r3 AMSC 3 Township, Range, Section: Tlr.,y '?/(,f/ Sic /y DEPTH SLOPE SITE PLAN (FEET)' -�� 1 / I 2 �' T 3 4 _ - - SM Net Depth to Net Time Water Drop 6- —; " n k44 /� 7 7 ■NNE 0 EN'©E ENIME ■■I.■ i®N N,OE uE�N 87aNl 14-1 2' Yv" 9- /65l.' IV "r -3 '04** I. EMO 10- 101112 7 ' 76" 11- 12- 13- 1314 14- 4 , 15- 16 17 10 rra .' gC 7-h' 18- 19 20 COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Y -f S L l 7 ' 1365 E Depth to Water After , Monitoring? 1 7 Q6S Dale: Reading Date Gross Time Net Depth to Net Time Water Drop NOON —; " n k44 /� 7'- e f 77*eta.►/. ■NNE 0 EN'©E ENIME ■■I.■ i®N N,OE uE�N 9 L7-96 14-1 2' Yv" NONE /65l.' IV "r -3 '04** I. EMO s R.'ed 7 ' 76" WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Y -f S L l 7 ' 1365 E Depth to Water After , Monitoring? 1 7 Q6S Dale: Reading Date Gross Time Net Depth to Net Time Water Drop —; " n k44 /� 7'- e f 77*eta.►/. l 9 L7-96 14-1 2' Yv" /65l.' IV "r -3 '04** I. s R.'ed 7 ' 76" PERCOLATION RATE �' (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND ? FT PERFORMED BY: /% f I /��✓ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: — / c% ,! 72-008 (Rev. 4/85) M EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 694-5195 ERES Project No.: 96-084 Calculated By: LB Date: 10/4/96 Legal: PETERS GATE LOT 3 BLK 3 Single Family 3 Bedroom Dwelling Bed Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = Percolation rate = Wastewater application rate = Required absorption area = Bed width (W) = Gravel depth (D) = TEST HOLE 450 gallons 0.5 minutes per inch 0.7 gallons per day per square foot 643 square feet 12 feet 1 feet Required length = Required absorption area / Bed width Required length = 643 / 12 Required length = 54 feet Total Excavation Depth = 8.0 feet 2' FILTER SAND TO BE USED UNDER SEWER ROCK. oo��.°F••q��soo 49 TH ................ ........I ...................... LDUIS A. BUTERA: •, CE -6736 �G �� pROFESS10NPo� Eagle River Engineering S Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: Peters Gate Lot 3, Blk 3 02/12/97 A. GENERAL 1. The well & septic plan is for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is recommended that the inspecting engineer locate the leachfield position and the location of any easements. B. SEPTIC TANK 1. The septic tank shall be an MOA approved, 1,000 gallon septic tank. C. BED 1. The bed is to be located as shown on the site plan. 2. The bottom of the bed shall be level, plus or minus 1.5". 3. A 2' thick filter sand layer shall be required below the leachfield gravel. Material shall be an MOA approved filter sand. 4. The total depth below ground surface of the septic gravel layer is not to exceed 10' at any point minimum depth is 4' below ground surface. 5. The effluent lines in the bed shall be laid level within 0.03'. 6. The bed gravel is to be covered with typar fabric material. 7. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the bed. Mounded side slopes not to exceed 3:1. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: BENCHMARK = 100.00 ASSUMED DATUM, NE LOT CORNER BOTTOM OF GRAVEL LAYER = 91.057 5' BELOW GRADE' (dependent on house slab FF elev.) BOTTOM OF T FILTER SAND LAYER = 89.05/ T BELOW GRADE SAND FILTER THICKNESS = T of ADEC approved material GRAVEL THICKNESS = 6" under pipe, 2" over pipe BED LENGTH= 54' BED WIDTH= 12' SOIL RATING = 0.7 GPD/SF BEDROOM CAPACITY = 3 SEPTIC TANK = 1,000 gallons minimum Twenty-four (24) hours notice required for all inspections. \1997\96-084a-spc.doc MUNICIPALITY F ANCHORAGE 0 :rl'v 4 ^i�x Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-551-17 1. GENERAL INFORMATION Complete legal description PETERS GATE Expiration Date: _7- 1`3 BLK 3 LT 3A Location (site address) 24920 Malcolm Dr Chugiak AK Current property owner(s) SHUMAN CECIL & CATHERINE Mailing address PO Box 671441 Chugiak Real estate agent Keira Dreher 2. TYPE OF DWELLING: 0 Single Family (wICAD�U) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone AK 99567 Day phone 907.529.4660 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic Z 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 $ 55 0 Waiver Fee $ Date of Payment Date of Payment Receipt Number 0 00 `�� Receipt Number COSA # Q S C a 1 1(�, Z 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 Eklutna Engineering, LLC Phone 907.406.1058 Address 19162 Mountain Rd Chugiak AK 99567 Engineer's Printed Name Curtis Townsend, PE Date Z�/5/2, 6. DSD SIGNATURE System #1 Approved for 3 bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms OF At. ° a° °Curtis L. ovmsend �' - Lo 2/ • �¢� /f ho. E Ca• ,Cy,y bedrooms, with the following stipulations: l`o(((Kil(((q(( �I g CN -SITE �y �oVVtj I C NANll �H- 63 WASTE v';qTER_ z Jm PROGRA Jy)))1))�11 ��11� Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Advisory Other 1 c L ct et P Ao&i u o r Legal Description: PETERS GATE BLK 3 LT 3A If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1997 Total depth 500 ft Cased to 64 ft 0 Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) ' 18 in. Date of flow test for COSA 3130/2021 Static water level at beginning of test 63 ft. Comments B. TANK DATA Age of tank(s) 24 years Tank type/material septic Steef Measured operating fluid level in septic tank 51 ❑ Standpipes/foundation cleanout per record drawing Date of pumping June 22, 2020 D. ABSORPTION FIELD DATA Which system tested (date installed) 1997 ❑ ALL standpipes present per record drawing Total measured depth from grade 8.6 ft (max) Measured depth to pipe invert from grade 8.1 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Parcel ID: 051-551-17 of Structure served by this system Well production at time of test 3.4 gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ No Al Coliform bacteria is Negative Nitrate 2.37 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Curtis Townsend Date of Sample 3130/2021 C. LIFT STATION ❑ Required maintenance complete Age of lift station y Lift station material Comment Adequacy test date W3012021 Results Q Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 533 gal New depth 0 in Elapsed time 0 min Final fluid depth 0 in Absorption rate >450 gpd Any rejuvenation treatment (past 12 months) no Gallons introduced gallons If yes, enter date Comments/Deficiencies: measurements taken at northeast monitor tube. Verified all standpipes present per record drawing. 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' Q Yes Community Sewer Manhole/Cleanout > 100' ❑✓ Yes if No ft jam✓ Yes if No Neighboring Tank > 100' �✓ Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' R1 Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' M Yes if No 0 Yes if No ft if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' F/� Yes if No ft F� Yes if No ft ft ft ft ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' El Yes if No ft Surface Water > 100' ® Yes if No ft Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' F71 Yes if No ft Private Wells > 100' Q Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' ✓� Yes if No ft Water Service Line > 10' E✓ 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' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' F71 Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓� Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' E✓ Yes if No ft Community Wells > 200' P11 Yes if No Surface Water > 100' El Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet co oo o 0,,< Dab/3 Z62(:�` ido. i190t .��` ft ft O => v = ::r-tCD D /rte CD y m + Q U1 *0Q =O n m O- r j- n rn W O O 0 C m S C N� --to W� �n N W CD D O0 m> 0 CD 41 n. CA m O 'O m —.0CD 0-3 m OJ :7L U) j O C m 0 0 O'< CD M I aQ, m to W 7 O I ti= n o a N -+ S O O N S pnyO s-mim (n M ID A (D `< N C O -t En U) V/ - I) O SO O � C m 0 >C) C 0. =1 -� =�n�N�m O i CD o o X-ri Q no i O Q OO in = nes '^ n o I �� o aim V/ (D m I y 'h � �n 0 i n 3 I O C 0 O O v CD A N OC o m j o W Z 0.-«Z3 (D't m =•, y, I O u -O O < . a msm � m Q�0 m � x1 � _m:.Z(00 � 0 Vi C) Eft 3 O y n. n m Oo CD I TS 't N m N n. n.O '3Cm p �. m O n O' O t0 t0 C ( Cl Q m S O Q'n -�+O O C Ove- n O Ut L" 0_fl 3 �U3 NCD N n W m D n :3l< I C 3 + O) -A,� (n m rn � > 'W s CD v1�NJ< d 3 On N C p th O) j m "1 SO � O C -_ � (D 0-a m3-Vm (� m O a n A X O = A O O O D CD C) n to to 3 S W fl a ° n - o 4ovaopp� D y 000a Z' V o m � c) (o � z' j •. 0 cainPA(CO z 121 pyo z co cn N (J� D n m Cf) Cn m D (n m m Z --I N ON N 00'06'38°E 170.44' ) N 00'06'38°E •174.73' D0 mn I ' XO Zy tINo, c0 g o m m z I N N x J {z f N XO p T pp V I rl 0 N 160.2' 1�/ �' r o 1-4 n 7 36.2' Z I W rl cn ? o w qS -yi X p o{ 3.2' O I ( i \ X 13.5' � m m y F� rr N ro F _ 135.0' _ 13.5' � z a Dm I cn m 9.2 0 0 I DS nD Nm� O Nf�*1 co Wco \ O N n / � 23.8 x N 0 ® o ! --- =— SIERRA ESA ca >En m CIRCLE -ur � C I co m rn -1 m N z z n m � I 0 ( m 1p — S 00'04'44"W 344.95' mJ II m u, K: o p i �z i 0 o d m MUNICIPALITY DEVELOPMENT SERVICES DEPARTMENT #i On -Site Water and Wastewater Section www.muni.org/onsite Septic 'Tank Advisory Certificate of On -Site Systems Approval #OSC 211162 Subdivision: Peters Gate B 3 Lot 3A 907-343-7904 Fax: 343-7997 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 24 years old. Typical replacement costs range from $8,000 to $11,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. t � k Mailing Address � O Box 196650. Anc{�orage Alaska 99519 6650 wWw mum org Municipality of Anchorage • Development Services Department Building Safety Division On-Site Water and Wastewater Program s �, 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 _ CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-551-04 HAA# N/ 0301 6 3 .. 4Expiration Date: 7 1. ,-dENERAL INFORMATION Complete legal description Lot 3; Block 3; Peter's Gate Subdivision Location (site address or directions) 24920 Malcom 'Current Property owners) Joel Varner Day phone 688-•7468 Mailing address PO Box 671836 Chugiak, AK 99567 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address_ Unless otherwise requested, HAA wig be held by DSD for pickup. 'n„_ It /xy A 3 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: . Individual Well Individual On-site Individual Water Storage Cl 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 frcm 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 cf Anchcrage 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(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S &'S Engineering Phone 694-2979 Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577 Engineer's Printed Name Robert C. Cowan Date '1/,, 16 3 5. DSD SIGNATURE 1� Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments • ON-SITE • d�� • WATERANU :11n. waSTFWATER �r,nnnnnA Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By; /,r/ Original Certificate Date: - •� �'� 3 (Rev. 01,102) Municipality of Anchorage •�, Development Services Department Building Safety Division` On-Sfte Water & Wastewater Program '" "` 4700 South Bragaw St P.O. Box 195650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L -o i 3 4L4r,K 3 PfTfR i C.4T4- s/0 Parcel ID: 0 S-/ -J-1 1 -o i A. WELL DATA Well type t,�'v 4 r *_ If A, B, or C provide PWSID # Date completed _3 7 Sanitary seal &)Y 4 S Total depth SO 0 ft. Cased to 6H . Sft FROM WELL LOG Date of test Static water level 1 _34 ft. Well production ILL O.P.M. WATER SAMPLE RESULTS: Coliform colonies1100 mi. Nitrate. q_mg!I. Arsenic: A. Date of sample: 1403 4 B. SEPTICIHOLDING TANK DATA Tank Type/Material 5 kA P 4- L Well Logo/N) _ y-5 J Wires properly protected ( f�N) _ '1 i Casing height (above ground) ? %+ in. AT INSPECTION j)-7/0 3 _— 01 ft. 3 Other bacteria a coionies/100 ml. Collected M 8 ENGINEERING boRls-95-0-WERFORM. 404 eagle River, Alaska 99577 Date installed q&/--'-/17 Tank size 100 O gal. 'Number of Compartments ,2_ Cleanouts&N) Yw 1 Foundation cleanout &N) `1LI Depression over tank (Ya N 0 High water alarm (Y/® 740 Date of pumping G/0Z Pumper s AN 1 r,4 AY C. ABSORPTION FIELD DATA Date installed ��a/g Soil rating 6�or fe/bdrm) 0 7 System type Length Spy ft. Width 1 7- ft Gravel below pipe 0.3- ft. Total depth G •j`" ft. Eff. absorption area ftp Monitoring tube YtJ Depression over field N 0 Date of adequacy test 3/17/0:) Results: w ail) As -sl For 3 bedrooms Fluid depth in absorption field before test O in. Water added$ gal. New depth�S_ in. Elapsed Time: 110 min. Final fluid depth v in. Absorption rate >= 41 Jr 0 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) K+^''k K i✓owA/ If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at _ in. "Pump ofr level at, in. Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot J d 0 r� Absorption field on lot IV (, Public sewer main tj 14 - Sewer 4 - Sewer /septic service line r4 - Manhole/Aocess (Y/N) at Meets alarm & circuit requirements? in. On adjacent lots On adjacent lots{ - Public sewer manhole/cleanout N 14 _ Holding tank N 14 _ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: _ t I Building foundation y 3 ± Property line 10 Absorption field r 4 Water main 9'l I -A_ Water service line /0 �-� Surface water _ I oo 4 _. Wells on adjacent lots J00 -� SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: 'N /q Property line J 0 Building foundation S"s Water main Water Service line J0 4 Surfacewater 10 0 IJ.- r- Driveway, parking/vehide storage r Curtain drain NoNh, K•ww✓ Wells on adjacent lots /010 It F. COMMENTS G. ENGINEER'S CERTIFICATION; f .R/rl I certify that 1 have determined through field inspections and ` review of Municipal records that the above systems are in .• . F conformance with MOA HAA guidelines in effect on this date. fl, 41° f ti QED C • Engineer's Printed Name R /a / T C. @ wq � tt ;� �-...... Date( HAA Fee $ Waiver Fee $ Date of Payment _ to b Date of. Payment Receipt Number '3qOb Receipt Number (Rev. 12/01) Wo MALCOLM DRIVE 0 uodi S 89°57'45'E 160.00 (R) W ixy S 89042'07'E 158.75' (M) o� �c Q m ----------------------- 10' UTILITY EASEMENT -- --- \ 3E v 0 '.nw SECTION LINE EASEMENT En N A O 8 O 0 tm N N =� CD v U v y 8O N N �c 2Yuo O •712.4' L N — 49.7 9 EXISTING HOUSE a S 31.3' 214' p A O m / / yy ri U DCX 36.0 W o 1a.r m 0 —' m zo 0y rrn m� N $ 8� TRACT I r Fri O m A D A W a °' z 00 o rn m w w m c CD G) W w a (REC) c� uodi ixy o� �c Q m N 0o � C, vo ^w moo b 9 SOSrA \ 3E 0 '.nw •" b a 06 d \ m N _ ._ c r MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICo� Ekv(c�s r�ivlsic( Division of Environmental Services On -Site Services Section �4V �� P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 RECEIVED CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # C S"I — a `f v HAA # Q Q 0 -S S 1. GENERAL INFORMATION Complete legal description Lot 3; Block 3; Peters Gate Subdivision Location (site address or directions) NHN Malcolm Drive Chugiak, AK 'Property owner M2C1 Construction/Leroy Alderman Day phone 688-3403 Mailing address P.O. Box 670045 Chugiak, AK 99567 Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Phone q y - >c/, q Z 17034 Eagle River Loop Road o. 204 Address Eagle RiTer, Alas4z99577`; Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for Additional Comments By: bedrooms. WTIC Date /i �/br/-77 bedrooms, with the following stipulations: Date/2.-2-— The ate /2 i 2 - /— The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Ith Authority Approval Certificates based only upon the representations given in paragraph 5 above by independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA ®21 Municipality of Anchorage R E C E I V DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division NOV 19 li& 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Municipality of Anchorage Dept. Health & Human Services Health Authority Approval Checklist Legal Description: LeT 3 . BLocy- 3, QETeas 64Ta Parcel I.D.: C'S 1 SSI -01 SVFsD�J1S�on1 A. WELL DATA Well type PIt Wo,?E If A, B, or C, attach ADEC letter. ADEC water system number Log present ON) Y6 Date completed Total depth .500 Cased to t;K t Casing height (above ground) Z Sanitary seal ON) YIE5 Wires properly protected(&N) Date of test Static water level Well production FROM WELL LOG 3 A -1 WATER SAMPLE RESULTS: 13g g.p.m. AT INSPECTION Yes t� g.p.m. Coliform Nitrate t / Other bacteria AOMENEW Date of sample: I ti /I Lf L9-1 Collected by: 13 & S ENGINEERING 17084 Eagle River Loop Road, No. 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Date installed $ 'Z-411 Tank size ►Doo Number of Compartments Z Cleanouts&N) YES Foundation cleanout (eNN) Depression (Ya a High water alarm (YAM rio Date of Pumping Pumper C. ABSORPTION FIELD DATA Date installed 8 ' 2 -Ot-% Soil rating .p.dd or ft2/bdrm) 6 •'7 System type 9150 Length �y, Width i2, Gravel thickness below pipe ©•5� Total depth 4•S�- 8� Effective absorption area 05 Monitoring Tube present JVN) YES Depression over field (Yo lJo Date of adequacy test N EV3 Results (Pass/Fail) For -3 bedrooms Fluid depth in absorption field before test (in.); Immediately after -gal. water added (in.): '— Fluid depth (ins) Minutes later: Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) Ft ur a e, Ci) 72-026 (Rev. 3/96)* 'F SA►JO If yes, give date D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES Size in gallons. "Pump on" level *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: "Pump,1WrrIR\414 fir" , AVIRONMENTAi SERVICES DIVISION NOV 19 1997 RECEIVED Septic/holding tank on lot 1001 On adjacent lots loo 1 f Absorption field on lot 106 On adjacent lots ) oo f Public sewer main 0 /A, Public sewer manhole/cleanout 1 foe Sewer /septic service line ZS Lift station IA01 - SEPARATION DISTANCES FROM SEPTIC401110111111MG TANK ON LOTTO: i Foundation 4S t ± Property line Zp I Absorption field Water main/service line _Surface water/drainage loo14 Wells on adjacent lots too f SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: t I Property line 10 Building foundation 55 i- Water main/service line /o tt Surface water 1001 + Driveway, parking/vehicle storage area S I Curtain drain U oaE k4oJA Wells on adjacent lots 144 % F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal record in conformance with MOA H A. uideli s in effect on this date. ,. yrsC2f• Signature lE Engineer's Name Date Ir/It 117 HAA Fee $ Date of Payment / Receipt Number•/ 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number RCi ERT: -COWAN, f �k- G, • CE -8801 r 7ZS�A �' `• .•rN t •• :, .,v are