HomeMy WebLinkAboutMELINDA VIEW ESTATES LT 7Onsite File
Melinda View
Estates
Lot 7
#017-092-44
Municipality of AnchorageZJ Ems,
On -Site Water and Wastewater Section • (907) 343-7904 Pa N- - j of.3
ON-SITE WASTEWATER INSPECTION REPORT �0�4
Permit Number: OSP211459 PID Number: 017-092-44
Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade
Name
C/O ARM SEPTIC SERVICES
ABSORPTION FIELD
❑ Deep Trench ❑ Wide Trench ❑ Bed ound
❑ Other
Site Address
14501 JOANNE CIRCLE *ANCHORAGE, AK
Phone
907-688-9433
[Number of Bedrooms
Soil Rating
GPD/SF1
Total depth original grade
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from origin:,�<t.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
MELINDA VIEW ESTATES; LOT 7
Fill added above original gr a
Ft.
Gravel length
Ft.
Township Range Section
_
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION
DISTANCES
To
From
Septic
Tank
Absorption
Field
Lift Station
Holding
Tank
Sewer
Line
Total orption area
Ftz
Number of trenches
Dist. between trenches
Ft.
Well
100'.+.
TANK [i Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
INFILTRATOR
Capacity
1060 Gal.
Surface Water
100'+I
I
Material
Number of compartments
Lot Line
51.+
NA
HDPE
2
Foundation
10,+
LIFT STATION
Manufacturer
Capacity
Remarks OLD TANK
DECOMMISSIONED
PER UPC PER
CONTRACTOR
I
Gal.
location ��� IElectrical installed by
PIPE MATERIAL House to tank D3034 Tank to D3034
Installer drainrield
ARM SEPTIC SERVICES Drainfield EXISTING CO/MTD3034
Inspector GEG AND MOA BENCH MARK (Assumed elevation) 101.97 ft
Inspection d1s` 11/4/2021 2nd - Location and description
3`d _ 4d' _ TOP OF MH
ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's S amp
0060
Conditional Approval: Date
0
Septic System
Approved Date
Note: this approval does not include well permit requirements.
(Rev 05/02/18)
•. • ' �. `S`�4i
ooh,`
.....
./ .
�.......
.J
..'....... .........
f; ey A. arness;*
oU
Q 9.
CE —7 53
P,0 f e s °o
Siond
#AECC88444_,
PERMIT NUMBER: PARCEL ID NUMBER:
OSP211459 RECORD DRAWING 017-092-44
A I B
DBL1 44.7 56.0
DBL2
45.1
55.5
MH
45.6
54.5
STI -
-50.7—
58.7
DBL3
54.6
61.9
DBI -4
55.5
62.6
NOTE: PIPE LOCATIONS ARE
SHOWN PER GEG SHOTS TAKEN
WITH LEICA DISTO 8910 LASER
DISTANCE METER. SWING -TIES
To HOUSE CORNERS WERE
GENERATED IN AUTOCAD
10' TEL & ELECTRICAL EASEMENT
ILLI
CL
0
i
w
w
z
mw zw
z
LU
(o Lu
to
6
w
3 -BEDROOM
w ;t
w
HOUSE
-i
LU ci
0�
-6
1`-
ui
-iw b
I
NEW IM 1060 INFILTRATOR
I
SEPTIC TANK
w
02
1p
T2
MHl
TI MT1
0 EXISTING DRAINFIELD WITH NEW CLEANOUT
`VDBL3&4
INSTALLED AT BOTH ENDS AND NEW MT
AT
SOUTHWEST END (MT2 WAS EXISTING)
ED
DBL1&2
—>1
10' TEL & ELECTRICAL EASEMENT
MELINDA
VIEW; LOT 6
"ARNESS EN"INEERINg' '"ROUP, Ltd
ENGINEERING - SALES- C0NSULTING
3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, AK99507' PHONE (907)337-6179- FAX (907)33a -3246 - WEBSITE: w .game ngineenng.com
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
C/O ARM SEPTIC SERVICES 907-688-9433 2 OF 3
LEGAL DESCRIPTION: DRAWN BY:
MELINDA VIEW ESTATES; LOT 7 D.J.G.
TYPE OF WORK: DATE:
SEPTIC TANK RECORD DRAWINGS 11/12/2021
= 40'
4W ......
0
........... .......................0
0
0
....................
effrey A. Garness tz7o
## CE -7953 AV
1 2, 41P
P. -
LICENSE 4- R6FE
#AECC884 0 It, 1% TUA lak
PERMIT NUMBER: RECORD D RAW I N G PARCEL ID NUMBER:
OSP211459 017-092-44
TOP OF TANK
AT INLET = 98.71
INVERT OF BUNG
AT INLET = 98.16
TOP OF MANHOLE = 101.97
MH i ST1
2" INSULATION PER
CONTRACTOR
IM -1060 2 -COMPARTMENT
INFILTRATOR SEPTIC TANN
FINAL GRADE = 101.92-102.03
ITPI
utd
ENGINEERING- SALES,, CONSULTING ,,.
3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 -PHONE (907) 337-6179' FAX (907) 338.3246' WEBSITE: v .garnessenginee ng,c
PREPARED FOR: HONE NUMBER: PAGE NUMBER:
P
C/O ARM SEPTIC SERVICES 907-688-9433 3 OF 3
LEGAL DESCRIPTION: DRAWN BY:
MELINDA VIEW ESTATES; LOT 7 D.J.G.
TYPE OF WORK: DATE:
i,,, SEPTIC SYSTEM RECORD DRAWINGS 11/11/2021
— TOP OF TANK
AT OUTLET = 98.79
INVERT OF BUNG
AT OUTLET = 98.06
'iiiTlTdTiiTiI12YR[.'f ii[li1r SI
1 Jf rey A. Gayness ; 4:
LICENC7-71
"`\S\`
#AECC864 i
Lot 7
Melinda View Estates Sub.
49,630 Sq. Ft. +/-
14501 Joanne Circle
2 Story Wood Frame House
With Attached 1 Car Garage
E T T
S
W
TTE
LOT 6LOT 8 10.4
18.428.636.628.4
8.26.1
12.06.21.3
6.0
10
0
'
W
E
L
L
R
A
D
I
U
S 10' TEL. & ELEC. EASEMENT10' TEL. & ELEC. EASEMENT10' TEL. & ELEC. EASEMENT10' TEL. & ELEC. EASEMENT20' R.O.W. EASEMENT
10' TEL. & ELEC. EASEMENT
N90° 00' 00"W 300.69'N0° 03' 59"W 165.00'N90° 00' 00"E 300.88'S0° 00' 00"E 165.00'
12.0
119.663.0
EDGE OF GRAVEL
℄ JOANNE CIRCLE30'R.O.W.GRAVEL DRIVEWAY30'R.O.W.PICKETT STREET
SSSSSSSSSSCSS
S
SS
SS
SS
8.1PROFESSIONAL SEAL
Date:Frontier Surveys, LLC Project No:
650 W. 58th Ave. Suite E Anchorage, Alaska 99518
As-Built Survey of:
www.frontiersurveys.com
Frontier Surveys, LLC
I, Pierre Stragier, hereby certify that this Mortgage Inspection Survey was performed by me, or
under my direct supervision on
Plat:Grid:Ordered By:
907.460.1686 - info@frontiersurveys.com
This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and
conditions at the time of the survey. This document does not constitute a boundary survey and is subject to any
inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to determine the
existence of any easements, covenants, or restriction which do no appear on the record plat. Under no circumstances
should this document be used for construction or for establishing a boundary or fence line.
November 17th, 2021.
Legend:
Scale 1" = 50'
Deck
Septic
Fence
S
Lot 7 Melinda View Estates Subdivision
General Notes:
1. This document is created for the purpose of a single property transaction and is subject to Federal Copyright Laws.
2. Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey.
3. All measurements/setbacks are to the visual/apparent building footprint.
4. All dimensions to property lines are plus/minus 0.1ft.
ARM Septic (Mariah Campbell)
21-832 11/17/2021
84-293 3038
E
T
W
Elec. Pedestal
Water Well
Tel. Pedestal x
STA T E O F ALA
S
K
A49 TH
ROYEVRUSDNALLANOISSEFORP
DERE
T
S
IGER Pierre M. Stragier
NO. LS-9812
11/17/2021
Satellite SC Septic Tank Riser Cover
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP211459
Work Type: SepticTank Upgrade
Tax Code Number: 01709244000
Site Legal Address: MELINDA VIEW ESTATES LT 7 G:3038
Site Mailing Address: 14501 JOANNE CIR, Anchorage
Owner: HOSKINS RICHARD E
Design Engineer: GARNESS ENGINEERING GROUP LTD
This permit is for the construction of:
Effective Date:
Expiration Date
Ment �,
�0
r_
:J n
Department
Lot Size in Sq Ft:
Total Bedrooms:
10/28/2021
10/28/2022
49630
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (I8AAC72) and Drinking Water Regulations (I8AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received
Issued By:
Date: )— � -- 0
Date: X09
NIUNICIPALITY OF ANCHORAGE
Development Senjices Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 017-092-44
Property owner(s) RICHARD HOSKING - C/O ARM SEPTIC SERVICES Day phone 907-688-9433
Mailing address 14501 JOANNE CIRCE *ANCHORAGE, AK
Site address 14501 JOANNE CIRCLE *ANCHORAGE, AK
Legal description (Sub'd., Block & Lot) MELINDA VIEW ESTATES; LOT 7
Legal description (Township,. Range & Section)
Lot Size Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(® all that apply)
Absorption Field ❑ Initial ❑
Single Family (SF) 0
Septic Tank El Upgrade Q
(w/wo AD U)
Holding Tank ElRenewal ❑
Duplex (D) E]
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 Municipal Codes.
(Signature of property owner or aujlorized agen`.r }'
�J
Permit/Rush Fees: 2 Z Waiver Fees:
Date of Payment: /0 Date of Payment:
Receipt Number: 000"76 Receipt Number:
Permit No. OS f 21 I y 59 Waiver No.
GADevelopment Services\Building Safety\On Site Water and WastewaterTormsUient FormsTermit Application.doc
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211459, Rebecca Carroll, 10/28/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211459, Rebecca Carroll, 10/28/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211459, Rebecca Carroll, 10/28/21
Scale 1" = 50'
LOT8
Frontier Surveys, LLC Project No: 21-765
Ordered By: ARM Septic (Mariah Campbell)
I
Date: 10/18/2021
Plat: 84-293 1 Grid: 3038
f
PICKETI-STREETd
as
a
Nil° 03' 59"W 155.00'
_ 20'R.O.W. EASEMENT _
10' TEL. & ELEC. EASEMENT T �e
x
xw w
? i Lot 7 f
" Melinda View Estates Sub. >< w
49,630 Sq, Ft. +/- w w
14501 Joanne Circle € j
2 Story Wood Frame Nouse uO as
a i With Attached 1 Car Garage w
F. F�
� 9a.4x
e r o 12.0 LOT 6
9.3 x� ;r f
s.0 �I
IC
a
I�
wl
0
q�lO
O
Z
\
s
SO* 00'00"E 965.00• /
— – – – �- – C JOANNE CIRCLE — –
LT\ Tel. Pedestal –x– Fence! Satellite
Z_E, Elec. Pedestal ® Deck
_S; Septic ;W; Water Well
EDGE OF GRAVEL
General Notes: 0 25 50 100
1. This document is created for the purpose of a single property transaction and is subject to Federal Copyright Laws.
2. Excepting for gross negligence, the liability for this survey shall not exceed the cast of preparing this survey. Scale In Feet3. All measurements/setbacks are to the visuallapparent building footprint,
4. All dimensions to property lines are plus/minus 0.1ft.
`tttttt��►1j11
OF ALQ`.rtool
9►
4 H
•
..............
f i Poe M. St tkr .. =
N .LY 17
r,I►� ••-. 1 011 9120 2 1
I
fill t 1400 ss ofo& •�='
PROFESSIONAL SEAL
This survey complies with the AS PLS Mortgage Location Standards. The survey represents visible improvements and
conditions at the time of the survey. This document does not constitute a boundary survey and is subject to any
inaccuracies that a subsequent boundary survey may reveal. €t is the res ponsi b llity of the Owner to determine the
existence of any easements. covenants, or restriction which do no appear on the record plat. Under no circumstances
should this document be used for construction or for establishing a boundary or fence line.
I As -Built Survey of.• 1
IJ Lot 7 Melinda View Estates Subdivision 1
I, Pierre 5tragier, hereby certify that this Mortgage Inspection Survey was performed by me, or
under my direct supervision on October 13th, 2021.
Frontier Surveys, LLC FRONTIER*
650 W. 58th Ave. Suite E Anchorage, Alaska 99518 1LxVB g•
907.460.1685 - info@frontiersurveys.com
www.frontiersurveys.com
NAME
,~ / 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
EHONE
D £ u,',:.,' ~ r~/~ ~,,,~' -c- r3~..?- eOl~
MAILING ADDRESS
LEGAL DESCRIPTION
[~NEW
[~UPGRADE
Lo'¢ 7
LOCATION
OFt=
dz
~2~'~3[I.~ ~ ~ N O J'~ ~ . Absorption are
Well
DISTANCE TO: ~O~ ~
Manufacturer ~0/40~ ~ ~
Liq.,capacity in gallons I ............. Inside length
DISTANCE TO: We Dwelling
Dw~,lling
Width
NO. OF BEDROOMS
Fo~cJ~tion
J'-'lfO POS E. L~
Liquid depth
PERMIT NO,
Nearest lot line
Manufacturer Material Liquid capacity in gallons
DISTANCE TO:
Total lengt~o~i~es
Well
No. of lines ~ Length of
I
Top of tile to finish grade
Trench wi,~ I '.r~.~h::
Material beneath tile
Distance between lines
Total e~e~/¢(~rption area
Length
Type of crib
Width
Crib diameter
Depth
Crib depth
PERMIT NO.
Total effective absorption area
Well Building foundation Nearest lot line
DISTANCE TO:
Class. ~(~--~J 1-' ¢ ~'~J Depth Driller Distance to lot line PERMIT NO.
Building foundation Sewer line Septic tank Absorption area(s)
DISTANCE TO:
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
F~
REMARKS
DATE
LEGAL
L?
72-013 (Rev. 3/78)
Date Drilled:
~Static WaterLevel
fee t
WELL LOG
~t 7 Blkl
Meltnda View
Gallons Per Minute .... 11
Draw Down M/6 feet
Type ,Material Drilled:
0 feet to
Total Feet of uasing ~@
1~1 foci to 7fi flrv3r rl.~y
7R feet to lOg"Bedro~
Hefty Drilling
S.R,A. Box 1553 H
Anchorage,Alaska
99507
MUNICIPALITY OF ANCI-tOR, A~E
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
MAY 1 8 1988
RECEIVED
PERMIT
DATE
lhql Ib~ ih,41 ][ C]: ]E F=" *~ IL.. ][ 'T' "*,:¢' ~]]l F- Ez~ ~k,Jl ~[.-; iF.-I~ C~, IF-~:: ~gz~ ED lEE
DEPAIRTMENT OF HIEAL..'TH AND ~::*l *R,F~, ....~ '",-r-c-O"T ,,,-
......... ~ ...... :~ ~,_ F,~d]c..,F..C,l,,
8~::~. I ...... TI~E,:] , ..
. A,,I ..... )RAGE.. ,7~,,., ...
AF'PI._ I CANT
ADDREGS:
I CONTACT F'HONE
LEGAL. DIE !.:~ C R I F:' ,",
LOT SIZE:
MAX BEDROOMS:
,FEJES DEVELOF'EMENT
P.O,,BOX 112009
ANCHORAGE, Al< 99511
349-8011
SL!BDIVISION: ItlEL_INDA VIEW ES'I'ATES, LOT: '7
SECTION= 55 TOWNSHIP: 12hl RANGE: 3W
49630 (SD.FT. OR ACRES)
BL(]CK = NA
I_isted below a~'e tl'fe C)p'kions available 'ko you i.n des:i, gr~:i, ng your septic
system. Clnoose *kine Option 'Lhat best Fits yOLH' si{e.
DEPTH TO PIF'E BOTTOM (FmT'.)
GRAVEL DEF:'TH (F'T,,)
TOTAL DEPTH (FT.)
· GRAVEL WIDTH (F'T,,)
.GRAVEL LENGTH (FT.)
GRAVEL VOI_UME (CU. YDS,,
TANK SIZE (GALS)
SOIL RA'TING (SQ,,FT. /BR.
3 0
6 0
2 5
50 0
:[6 3
000 0 -*.*.
~.~ DEF'TH ]'0 F'IPE BOT'T'OM < :::'].5 FT. REDUtI~[_~.' :':'~q INSUL. AT!ON
ee'~- DEF:'TH 'TO F'IF'E Boa"TOM < 4.0 Fa" ~' '-~
, ,'IA, REDUIRE A L:[F]" ~,aArlO,.° .... .~
· .~-~.-~ TANK MUST I..-IAVEE AT LEAST ,TWO COMF'AR]"ME:NTS
I c:: e r' t i ,~' y. 'L h a t:
1. I am Familiap ~J. tln '~Ine r'equi'cements {'os* on..-s:i.'Le se~,~er's; and ~e].].s as s~..~t
forth by the Municipa].i'Ly of Anchorag~. . <MOA) and th~ "*'*c: ,. a L e:, .... o~' Alaska.
I ~ailI install, the system in .......... ~- '~ '
ac. co~ u~nc.~, t4if,h an 1 MOA ......
am-sd in compIiance with the. H..-4 .*
...... 6s=,,.gr~ cr'iteria of this pet-miT
.:,.· I will adhere to a].l. MOA and State QF A].aska requirements for' '..f"' .... set back
di~'kaln(:ss [t"[)lTi any exis'king **.;~tI, ~aste;~ma. tep disposal, syste~]l on pubIic
sewepage system on.this om" a~]y adjac:en'k or near'by
4. I undens'kand 'Lha'.. 'Lhis per'mit Js van. id for' .a M*~.XJ. MLt~
: any enlar'gement wiI]. r. equ:i, pe an addi'Lionat per'mi{.
IF A LIFT STATIOhl ].o It.L. IAJ_,=D llq AREA CO~,_.t~,_.D BY MOA ~:,H"
TFIEN (1) AN EL. EC'f'F~ICAL. F'EF~MIT AND I,,Ic~F,:C]ION' ~' c* ':*' ' MUST BE (]BTAINED:
WI ...... h!OT BE .A,, ROV~_D WITI...IOLJT AN ~'' ¢ .... r,
i ELEECTRICA!.] WORK/tdUST/ BE DONE BY A' LICENSEED EL. EC]"Is?ICIAN.
SOILS
LOG
MUNICIPALITy OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PRoTEcTION [] PERCOLATION,
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
l~[,'~J~ ~/~¢~ Loft- ?. ~rl'f I
SLOPE SITE PLAN
1
2
3
4
5
6
7
8
9
10
11
12
13
c ~_~_tl~'
WAS GROUND WATER L,~,~_.J~ SL
ENCOUNTERED?
IF YES. AT WHAT
DEPTH?
i~l'e~din g ..~ Gross Net Depth to Net
Date Time Time Water Drop
.
14
15
16
17
18
19
20-
COMMENTS .~O(( '~,t~ ',,.~
PERFORMED BY:
//72-008 (6/79)
PERCOLATION RATE
TEST RUN BETWEEN
blO/~ ['-('- ~ c/' cD"~ ~-/ CERTIFIED BY:
(minutes/inch)
FT AND ~ FT
r.~_-'('-e d ~
ALASKA
eFIU -=OFImerITAL COFHROL
December 21, 1984
$1~I~UI~'S, Ill(:.
Department of Health and
Environmental Protection
825 L Street
Anchorage, Alaska 99501
Subject: On-Site Sewage Disposal and/or Well Inspection
Report
During 1984, a number of septic systems have been installed and
inspected, prior to the establishment of the foundation(s). AECS has
contacted (or attempted to contact) the applicants concerning the
installation of foundation clean-out and pipe from the foundation to
the septic tank inlet. In many cases, congtruction will not resume
till in the spring; therefore~ precluding any further inspections.
Since the end of the year is near, with the expiration of permits,
AECS is forwarding the inspection reports without a foundation
cleanouts to ycur office. We understand that this will not eliminate
this situation; nonetheless~ the reports reflect the actual inspected
installation at this time. We recom~mand you accept these as is. The
Health Authority, site evaluation for these properties can confirm the
installation ef the cleanout. Conditional approval, based on required
installation in the spring~ may be required during the interim. ~'~\
this office can be of further assistance, please contact us at .~'
If
56!-5040. //'~.V\
Sincerely,
~.~ ~ont~omer¢
Supervisor,
Environmental Department
Approved By:
/,Z, UN!CIPAL!TY DEPT.
R EC E I',;~:= O
Parcel I.D. 017-092-44
�E 8
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904 5A .FET„Y
t'
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION:
Expiration Date: 6 —Z-3 -Z02-2
Complete legal description MELINDA VIEW ESTATES; LOT 7
Location (site address) 14501 Joanne Circle *Anchorage
Current Property owner(s) Richard Hoskins Day phone 345-0001
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class_Well
❑
Community
El
Water System
❑
Public Sewer
❑
WaiverNadance request for: Distance:
Received by: Date.
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 59 O .
Date of Payment 3/--, 322
Receipt Number_ O SZCl2 G
COSA# O3C-2Z/109
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
cf-
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.
Name of Firm: Gamess Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507
Engineer's Printed Name: Jeffrev A. Garness Date: 3 )2,3 1-22-
In
22
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
in accordance with the guidelines and regulations established by the Municipality of Anchorage and
industry practices. The reported results describe the condition of the system/s on the date/s of the G C)F 1 ��
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or
encroachments may exist that were not identified during the evaluation_ The operational life of all wells �\` �•' �� I�I
and septic systems depend upon a variety of variables, including but not limited to, soil conditions, . T...
groundwater levels (that may fluctuate during the year), quality of construction (materials and
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and G' y'
are outside the control of GLIS. Satisfactory test results do not guarantee future performance of the 'J -
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of • • • • • . •
the well or septic system. GEG makes no representation whether an alternative well or septic system{) f lr y f,
.
can be installed on the property in the event either of the current systems fail to perform adequately in '!� •. 'E- 795.
the future. The content of this report is for the sole benefit of the person/party that retained GEG to s c'O
perform the evaluation. Reliance upon the information provided in this report by any other person or ��1 e^e'" F�c�
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right , oiass+cn�a;�
6. DSD IGNATURE
System #1 Approved for -Z bedrooms
System #2 Approved for
Disapproved
Conditional approval for
bedrooms
bedrooms, with the
\`QvIIk(k TY(OF `#AECC884
0A1
WAT rr_
WT_AS ,:, , ,1,1 ni
� g %igns'
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 Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
Legal Description: MELINDA VIEW ESTATES; LOT 7
Parcel ID: 017-092-44
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 7126185
Total depth 109 ft
Cased to 80 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 12+ in.
Date of flow test for COSA 10/14/21
Static water level at beginning of test 51.1 ft.
Comments
B. TANK DATA
Age of tank(s) NEW years
Tank type/material SEPTIC/PLASTIC
Measured operating fluid level in septic tank NEW
❑ Standpipes/foundation cleanout per record drawing
Date of pumping
D. ABSORPTION FIELD DATA SHALLOW TRENCH
Which system tested (date installed) ""5184
NO ALL standpipes present per record drawing
Total measured depth from grade 7.2 ft (max)
Measured depth to pipe invert from grade 3.95 ft (min)
❑ N/A — pressurized field
Well production at time of test 5.6+ gpm
Water storage tank volume gallons
Well 'sinfected for coliform test? ❑ Yes ❑ No
Coliform bacteria is Negative
Nitrate m /L
g [D'f4itrate less than MRL (ND)
Arsenic ug/L W -Arsenic less than MRL (ND)
Collected by GEG, LTD.
Date of Sample 2/25122
C. LIFT STATION
❑ Required maintenance completed
Age of lift station ye
Lift station material
Adequacy test date 1011412'
Results [✓] Pass For 3 bedrooms
Fluid depth prior to test *24 in
Water added 606 gal
ElMonitor tubes go to bottom of effective. If not, state
New depth -Gy in
depth into effective 2.V -Z9,'
Elapsed time 120 min
❑ Code -required soil cover over field
Final fluid depth *26 in
❑ System presoaked
Absorption rate 450+ gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months) W 0
date of test)
Gallons introduced N/A gallons
If yes, enter date 13 kA
Comments/Deficiencies: 'EAST MT EXTENDS 2.01' BELOW INVERT- MEASURED 24' FLUID DEPTH ON 2125122
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'
Community Sewer Manhole/Cleanout > 100'
0 Yes
if No
ft
2] Yes
if No
ft
Neighboring Tank > 100'
El Yes
if No
ft
Private Sewer/Septic Line > 25'E] Yes
if No
ft
Absorption Field on Lot > 100'
P-1 Yes
if No
ft
Holding Tank > 100' [✓ Yes
if No
ft
Neighboring Absorption Fields
> 100'
Animal Containment > 50' Yes
if No
ft
M Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75'
Q Yes
if No
ft
n Yes
if No
ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
Yes
if No
ft
Surface Water > 100' Q Yes
if No
ft
Property Line > 5'
[] Yes
if No
ft
Wells on Adjacent Lots:
._ Absorption Field > 5'
Yes .
if No
f#_.
.,-...,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'
Q Yes
if No
ft
If septic tank is under driveway comment
below
Prom Absorption t:Ut
Building Foundation > 10'
to. (mease
Q Yes
MIMI diStance-5
if No
it
ft
less than mquhed)
If absorption field is under driveway comment below
Property Line > 10'
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
Yes
if No
ft
Private Wells > 100' [] Yes
if No
ft
Water Service Line > 10'
P11 Yes
if No
ft
Community Wells > 200' 2 Yes
if No
ft
Surface Water > 100'
0 Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
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.
COSA Checklist yellow sheet
OF
... 4 .... . ._ .
of y Gorn ss;
Q 9 C-79 3
44 fP� "2 .1.2�1)
d_rofessior�oo
#AECC884
91)
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
Lot 7; M~inda View Estates
Location (site address or directions)
14501Joanne?¢ircle
Property owner
Mailing address
Lending agency
Mailing address
Anchorage, AK 99516
Paul and Bonnie Lucca
14501Joann Circle Anchoraqe,
Day phone 349-4453 fw) Bonni6
AK 99516
Day phone
Agent Frank Irwin/REMAX OF ANCHORAGE
Address 2600 Cordova Suite 100 Anchorage¢ AK
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3
TYPE OF WATER SUPPLY:
Individual well XXX
Community well
Public water
NOTE:
Day phone 257-0154
99503
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site XX× __
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 inves~Lgation 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.
S & S ENGINEERING
Name of Firm 17034 Ea~le River Loo~ Road No.~¢"~ ' Phone
Eagle River, Alaska 9~577~
Address ~'"'?
Engineer's signature --
DHHS SIGNATURE
~,' Approved for ~"~/.) bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an 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 order to 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
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. Well Data
/Y/~"L.J/L/L.,~ V'/g/,J -~5F,~/'~,~Parcel I.D.
If A, B, or C, attach ADEC letter. ADEC water system number
'"'~~ted ~7/~--~/~-j~''- Driller H~?7-'Y
Cased to cO0 t Casing height
Wires properly protected ~.~N)
Well type ¢/'?-II/i~'T-~
Log present ~tN)
Total depth
Sanitary seal (~N)
FROM WELL LOG AT INSPECTION
Static water level
Well flow
Pump level1 U~
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot /00 ¢'f' ; On adjacent 10ts
Absorption field on lot /(?-)C/_ ; On adjacent lots /Co r~-
Public sewer main JOOJ. J -~'- J~/Z~3'~-/J ublic sewer manhole/cleanout
Sewer service line ~'~' ~Y- Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate (__~,/O ,~u~,,/..~ Other bacteria Collected by: ~' Y'-~--~
B. SEPTIC,~,CLD:;.'=' TANK DATA
Date installed ////-~'!
Cleanouts~N)
High water alarm (Y/~
Date of pumping ~/,.~
Tank size /000 ~'~L_ Compartments
Foundation cleanout(~N) <'/'"~'-~ Depression (Y~
Alarm tested (Y/N)
Pumper /~,/:I/~C '~
SEPARATION DISTANCES FROM SEPTIC/; ;OLD;NC, TANK TO:
Well(s) on lot /~d_~/-/-'- On adjacent lots
To property line /O-'~ Absorption field ·
Surface water/drainage /(~(/% ~
72-026 (3/93)* Front
/
Foundation
Water main/service line
CONTINUED ON BACK PAGE
C. LIFT STATION
Vent (Y/N)
"Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N) ,~
SEPARATION DIST,~46E~ROM LIFT STATION TO:
On lots
adjacent
D. ABSORPTION FIELD DATA
Date installed I I/1:/
Length 4~'~/ Width
Total absorption area
Manufacturer
Manhole/~
.~'~Cycles teste'~ "dPump off" Level at
System type
Soil rating (GPD/FF)
Gravel thickness
Cleanout present(~N)
Date of adequacy test ///~ ~,~ Results/(p~ail)
Water level in absorption field before test ¢~
Peroxide treatment (past 12 months) (Y/N) /4./8,/~2~ ,//~:¢~,j/LJ If yes, give date /U/'//~
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot /:~)_~
To building foundation
On adjacent lots
Surface water
Curtain drain ./,J~f, Jd'
E. ENGINEER S CERTIFICATION
Total depth
Depression over field (Y/~
for ~>(~?'-~/¢-~--~-) Bedrooms
After test
On adjacent lots /"¢O ~7z- Propertyline ._,.~/¢
To existing or abandoned system on lot /~-~/~
Cutbank /q./O/.-~L~ t~'c--~cT'J~-Water main/service line
Driveway, parking/vehicle storage area ---% ~'/
I certify that I have checked, verified, or conformed to afl MOA and HAA guidelines in ef~ect,,en;th~..date of this inspection.
Engineer's .E~r,J~r~ee ~,iver,
HAA Fee $ ,~D~P
Date of Payment /?'
Receipt Number ,~-
Waiver Fee $
Date of Payment
Receipt Number
72-026 (3/93)* Back
Applicati'on Date
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
MUNICIPALITY OF ANCHORAGE :
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES' ' ' '
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~::~ ~
OF ON-SITE SEWER AND W~TER FACILITY
264-4744 ' ';
(b) . Property Owner '-'~L-~/'~r"-
Mailing Address' ' · ''~
(d) Real Es~&tS'd;;Pa~:¢'and Agent
Telephone: Home
Telephone
Business
Address
Telephone
(e) Mail the HAA to the followina address: or: Check here L~, if hold for pick up.
List'contact eerson and day. phone number below. ---
2. TYPE OF RESIDENCE
Number· of Bedrooms -~ ...... - ..... :" ........ : ............... - .........~;,' ~ .........
WATER SUPPLY -] ~'
Individual Well'~ Community [] Public [] - :
Note: I(community well system, must have written conf rrnat on from.the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite~ Public [] Community [] Holding Tank []
Note: If community well system must have written confirmation from the State Department of Environ mental Conservation
attesting to the legality and status. -
Page 1 of 2 72-025 (Rev 81861 Front
'HJO~ s,JeauCua
~euo!ssajoJ~ eql u! suo!ss!uJo JO sJoJJa .101 alq!suoasaJ lou si aSmoqouv jo Al!ledlo!un~ aql 'panss! si e~eo!J!~Jeo e e]qeq
eiep ez~leue JO su o!loadsu! lonpuo3 ]au aa 8HHQ jo saaXoldtUa 's~uatuaJmba] ale,s pue leJapaj u!el~aa XJs!les al JaDJO
u~ suo!lnl!lsu! 8u!pual ]!aqi pue sakuoq jo sJaseqo~na o] Xsapno3 e se s!ql saop SHHQ aq± 'eHSelV ~o ale,S aq~ u! pe~els!aaJ
Jaau~Sua ]euo!ssajoJd luapuadapu! ue Aq a^oqe ~ qde~Smed J. ua^!8 suo!]e~uasaJdaJ aqi uodn ~lUO paseq
le^oJddv Xlpoqln¥ qlleaH sanss! (SHHQ) sao!^JaS ueuJnH pue qlleaH jo iuetupedaQ aaeJoqouv jo Xiiled!o~un~
NOliR¥O
~eAoJddv leUO!l!puoc) Jo SLUJal
euo!],!puo0 oa^oJddBs!a ~ 3aAOJfldv
mJ!J jo otUeN
~{ O~ auoqdalaL ~'Q~ 'uolloadsu! s!ql to olep oql
ua DaJJ9 u[ suol~elnfoJ puu 'soaueu{p]o 'sapoo o]~lS pu~ le8~o[un~ lie ql~ aoUe~ld~oo u~ s! ~o]sXs lesOds~p
Jo/pu~ Xlddns Jole~ al[s-ua oq] 'uq]oadsu~ pue uoqefiqsaA~ Xm moji pu~ SOl[J aOeJOqaUV jo Alq~d~o~un~ oql moji
pau}~qo uo[l~m~oju} oql ua poseq leq] ~}~JaA Joq~nj I 'u}aJaq palgo~pu~ ~Jnlon]~s ~0 odAl pu~ smooJpaq jo ~oqmnu oql
alenbape pub leUqlounj 'ales si malsAs lesod~¢ JS~BMelSBM Jo)puB Xlddns Ja~BM 8~!?~0 Oql leq~ 9MOqS leAoJddv Xl!Joqlnv
qlleeH siqi ~o uo!~e6!~SeAU! Xm leql XJpaA I '~olaq UMOqS e~ep uo!le~!leA e'ql ]o se pue olaJeq pax!l~e leas ~ Xq pe!jfpao sV
WELL DATA
Well Classification
CHECKLIST - FEBRUARY 1984
Legal Description: ~'~
If A, B, C, D.E.C. Approved (Y/N)
Well Log Present'N) Date Completed ~ ~..f~-~.~' Yield
Total Depth ~"~ ~'
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
Depth of Grouting
Pump Set At /0~¢, ,/,j,/~
Sanitary Seal on Casing~N)
Depression Around Wellhead (Y~
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
/'¢-O '¢¢ ; On Adjoining Lots
./~ '¢ ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on
SEPTIC/HOLDING TANK DATA
Date Installed /,]'/-5'~'¢ Size
Standpipes (~N) Air-tight C a p s ~_~,//~N )
Depression over Tank (Y(&I~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
!
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course
No. of Compartments
Foundation Cleanout (Y~)
Date Last Pumped ¢-~;2-*- r~'~*'
,,~/,/+' ;for 4//4,
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field /ge /
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed //-
Width of Field
Square Feet of Absorption Area
Depression over Field (Y~)~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot /J//~
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Type of System Design
Length of Field
Depth of Field
/
Gravel Bed Thickness
Standpipes Prese nt~X~'q)
Date of Last Adequacy Test
To Property Line .3 /
To Existing or Abandoned System on
; On Adjoining Lots /O
To Cutbank (if present)
D. LIFT STATION
~ /,r.~//J/ Dimensions
Manhole/Access (Y/N)
~.~.
"Pump On" Level at ~ "Pump Off" Level at
High Water Alarm Level at -'""~-,..~_ Vent (Y/N) _
Tested for ____ ~ Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N) ~
Comments ~-~.
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I h.,~v:¢/~ ec,~d, verif~d, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ~.~2~.~' //~,~ Date
Company /z~~-¢ MOA No.
Receipt No.
Date of Payment
Page 2 of 2
72-026 (1 i/84)