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HomeMy WebLinkAboutHERITAGE PARK BLK 2 LT 19(Rev 05/02/18) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201334 PID Number: 1050-211-61 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: © New ❑ Upgrade Name ]Lynette Bedall A ORPTION FIELD ❑ D Trench ❑ Wide Trench ❑ Bed ound Site Address 19434 Eagle River, AK Other Phone mber of Bedrooms Soil Rating Total depth original grade r3u !SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original Gravel depth beneath pipe Ft. Subdivision Block Lot Heritage Park 2 2 Fill added above original Gr length Ft. Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distbetween lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total orption area Number of trenches Dist. between tr hes From I Tank Field Tank Line FF Well NA TANK 2 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1000 Gal. Surface Water 100+ 1 Material Plastic Number of compartments 2 Lot Line 51 NA ' ATION Foundation 10T I Manufacturer Capacity Gal. Alarm location Elec r Iled by Remarks PIPE MATERIAL House to tank Tank to D3034 drainfield D3034 Installer JR's Septic Drainfield CO/MT D3034 Inspector Arcterra Consulting BENCH MARK (Assumed elevation) 100 ft Inspection n 1 Location and description dates: 9/19/20 2.d 9/19/20 3fd 9/23/20 4'h Top of siding ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineers Stamp +r�r"OF Conditional Approval: Dateti'�,•'" a i T YtiYltidsYliY3 f Yiiiil�liiLi�; tiY€:c�YfuyYa'rc i�tt-0u�sy�r US--ar Septic System u +i CE q1 w Approve r Date ,� 2tJ��f��,.�,,,*,'* ,4�, Note: this approval does not include well permit requirements. R#*� (Rev 05/02/18) A -C=17.25' B -C=32.63' A -D=21.50' B -D=34,62' A -E=23.53' B -E=35.30' A -F=25.06' B -F=35.46' M AS -BUILT SYSTEM DETAILS/SITE PLAN Permit OSP201334 HERITAGE PARK BLOCK 2 LOT 19 PID# 050-211-61 '39 SHED E: .NEW 1000 GAL TANK 3 BEDROOM HOUSE w o �5 rn . O u vv _ C3 li AJill I o —7 r1000 GAL ti EPTIC �- Imog i 4 PREPARED FORT LYNETTE BEDALL 19434 LAURA LEE EAGLE RIVER, AK RELD BOOKS BOUNDARY: N /A STAKING: N /A ASSUILT: DWG. FILE ACRD RE: FILE COMPUTED: DRAWN: KSD CHECKED: Ki D DAA' 10/5/ GRID: N W00! " No' 20183 SCALES 1' = 40' SCALE= NTS gCE1�'�t 4/a I �D r � x > q R, ^i c0 ,P/b NSoL.rII3G • l 6l°j Ffe. RK 99577•'03 ) i ASBU1LT SEWPM & ASSOCIATES LAD SURVEYING b94-082 I HEREBY CERTIFY THAI' I HAVE SURVEYED THE SCA1..E/,1� FOLLOWING DESCRIBED PROPERTY= OF A N, ��' -=",�.�,�,! s✓ G-or�y ..,p.� z - i3A31 - „�: , - .... -11 AND THAT NO ENCROACHP&NTS EXIST ID(CEPT AS ��a� ` � �. , ' ! � '-•''{f `� INDICATED. IT IS THE RESPONSIBILITY OF THE a �";" �'' 1— 1 OWNER TO DETERMINE THE EXISTENCE OF ANY GRIDS R ,. EASEMENTS, COVENANTS, OR RESTRICTIONS '`�=�s-� � < �� WHICH DO NOT ,APPEAR ON THE RECORDED SUBDIe Dana iJtrk ward � VISION FLAT. UNDER NO CIRCiIMSTANCES SHOULD FS` �s �� A'._ LS -6 s ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LIN OR FOR ESTABLISHING BOUND- ARY LINES. DRAWN"�x� MUNICIPALITY OF ANCHORAGE �in�nr On -Site Water &Wastewater Program PO Box 196650 4700Elmore Road 4 Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax (907) 343-7997 ,.z http://www.muni.org/onsite _. 0 1 elSartnlettc On -Site WasteWater Disposal System Permit Permit Number: OSP201334 Effective Date: 8/26/2020 Work Type: SepticTank Upgrade Expiration Date: 8/26/2021 Tax Code Number: 05021161000 Site Legal Address: HERITAGE PARK BILK 2 LT 19 G:0055 Site Mailing Address: 19434 LAURA LEE CIR, Eagle River Owner: BEDELL REN E & LYNETTE D Lot Size in Sq Ft: 23631 Design Engineer: ARC TERRA CONSULTING INC Total Bedrooms: 3 This permit is for the construction of: 0 Disposal Field El Septic Tank ❑ Holding Tank ❑ Privy ® Private Well O 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 (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. 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 i Dater Date: J Q,(p6 o{� Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201334, Rebecca Carroll, 08/26/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201334, Rebecca Carroll, 08/26/20  ~ ' 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 PHONE 2l []~ NEW NAME MAILING ADDRESS LEGAL DESCRIPTION. - LOCATION NO. OF BEDROOMS PERMIT NO. Well Absorption area DwelHng ~{ ~ Manufacturer ~ ~ Material~.~ (~ _~ No. of~c~partments kiq. ~apacitg in ~all~n~ Inside length ~idth kiquid depth tO¢~ IF HOME'DE: ~ ~ DISTANCE TO: Weg Dwelling PERMIT NO. O Z < Manufacturer Material Liquid capacity in gallons ~.~ DISTANCE TO: Well ~/a Founda~n¢,. Nearestlotlin. ~¢/ PERMIT~zc~NO. ~ ~ ~ No. of lines~,. Length of each line~ I~. Total length of lines ~D~I, Trench width/~ ~(%nches Distance between lin. N/A ~ ~ ~ Top of tile to finish grade~ ( Material beneath tile ~2 i~ch.s To~~~ Length Width Depth PERMIT NO. ( ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller i ~ Distance to lot line PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TQ: OTHER PIPE MATERIALS SOl L TEST RATING - ~ ~ ~ ~(0 BOYD JAY ~ROWNFI~LD e ~ ,,!UN g 0 !( 72-013 (Rev. 3/78) F'ERMI T NO. ~-lUJtr. It I L: I" 'HL i 1-"¢ C~F R~qL--:H [:'EPFIRTMENT L~/ HEBLTH FIN[:, ENV!RONMENTBL q-~'~JOTECT!ON 8~5 "L" STREET., BNCHORBGE, BK. 99.50~ ~4-47~0 C"f-~---S I TE __.E[qER: F'ER:I"I I T ( 82:0285 ) RF'F'L I CRNT LOCRT i ON LEGRL DE',,,'C:ON ENT. I NC. .~ .... · _4ii OLD SEWRRD HH"r'. LOT "19. BU( ~ HEF. TIIf.~E PFIRK =,LIB LOT SIZE 9.99999. S6!URRE FEET T"r'F'E OF SOIL RBSrIF.:PTII-IN S"r'STEI"I IS: TRENC:H Y'IR~-,iIf'IUM NLIME:EF.'. OF BEDRr, C~MS = _.-:'. SOIL RRTING (S~;! FT,-."BF'.)= '='.~ -g' "-~F' f IS THE REL;!UiRED SIZE OF THE SOiL RBSORPTION _'r-,~_ . : [:.EF'TH-- t£~ L Ei'-~,_] TH = ~::2 C~ F-: R %-' E L [:.EF"TH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINF!ELD. THE DEPTH OF ~ TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SLIRFRCE OF THE GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OLITFRLL PIPE BND THE BOTTOM OF THE EXCRVRTION (IN FEET). F-:Eg!Li I F-:E[:. SEF'T Z C: TRFIF.' L:; I ZE= 1~_--~ C~ ~--~ ,]RILLE~f-tIS - ' I" ~ '- '1-1 '- ' T¥ PERMIT HFFLI..PI~T HRS THE F..Ez, F_r4z, IE, ILI TO INFORM THIS [:,EPRRTMENT DLIF-:ING THE iNSTRLLRTION INSF'EE:TIONS OF RN'-r' HELLS R[:,JRCENT TO THIS PROPERT'"r' RN[:, TFIE NUMBER OF RESIDEN~'Z:ES THRT THE WELL WILL SER",,'E. TLqC, .:] 2 ::. I f-.[SF'EC:T ~ Fff'-,IS RF-:E F-:Eg!IU l- F..:E[:. - ' ' '-"- THIS BRE:KFILLING AF RN'-r' S"r'""';TEM WITHOUT FINRL INSPECTION RNE:' HFFRU,,'RL DEPRRTMENT HILL BE SUB..Er:T Tr~ PRriSECUTtON. MINIMUM DISTRNCE BETWEEN R WELL 8ND RN9 ON-SITE SEWRGE DISPOSRL SMSTEM IS 100 FEET FOR R PRIVRTE WELL OR t50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE T9PE OF PUBLIC HELL. MINIMUM DISTRNCE FROM R PRIVRTE HELL TO R PRIVRTE SEHER LINE IS 25 FEET RND TO R COMMUNIT9 SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MRV RPPL¥. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. I CERTIFY THRT iL: I FIM FR~'IILIFIR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FiND WELLS Fi'_-] SET FORTH B'¢ THE MUNICIPRLIT'¢ OF FtNCHORFiGE 2: I WILL INSTFILL THE SYSTEM IN FiCCORDFINCE HITH THE CODES. ]:: I UNDERSTFiND THFIT THE ON-SITE SEWER SYSTEM MR'¢ REQUIRE ENLRRGEMENT IF THE PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 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 SOIl S LOG PERCOLATION TEST - 0 v'e_ r roo~er~ DATE PERFORMED: ,Z~ --I ~.._- (~'~ SLOPE SITE PLAN WAS GROUND WATER ~1~ S ENCOUNTERED? ~ ~ (-.~ L O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop x~. PERCOLATION RATE (minutes/inch) TEST HUN BETWEEN FT AND -- FT PERFORMED BY: 72-008 (6/79) M-unici ality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel 1. D. 050-211-61 1. GENERAL INFORMATION Complete legal description Heritage Park Block 2 Lot 19 Expiration Date: 9 1 Z — Z c? ZZ Location (site address) 19434 Laura Lee Circle, Eagle River AK Current Property owner(s) Ren and Lynette Bedell Day phone Mailing address Real Estate Agent 19434 Laura Lee Circle, Eagle River, AK 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class _ Well Public Water System WaiverNariance request for: Received by: Day phone 3 TYPE OF WASTEWATER DISPOSAL: Individual ❑ Holding Tank ❑ ❑ Community ❑. ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer, Date: COSA Fee $ I 1 a' 50 ((n� I�- 1 °I) Waiver Fee $ Date of Payment 10 13J �O � O Receipt Number N9 91 G COSA# 0SC201560 Date of Payment Receipt Number Waiver # sta n ce: 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 ARCTERRA CONSULTING, INC. Phone 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AI< 99577 Engineer's Printed Name KENNETI3 M. DUFFUS Date /G /g/20 Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the. year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside. the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of hour long a system will function satisfactory for current or future �.► �\ occupants or can ArcTerra guarantee that no unseen '�.{Or izit encroachments, deficiencies or discrepancies exist. rrrti�'9 ,oi J 4 Ti_I 6. DSD SIGNATURE .---- System #1 Approved for bedrooms. +� �� `��'r'`h1 711 ° `'s System #2 Approved for bedrooms. �?�o d R`,•� p %T S. Jo .� Disapproved. Conditional approval for bedrooms, with the following stipulations: N -SITE �, �`1ATER,r TER zo �� GRAS pR0 �JJ J�>>JJI))))11111��1 Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Nue she -et 10-10-12.doo Legal Description: Heritage Parlc Blocic 2 Lot 19 Parcel ID: 050-211-61 If more than 1 septic system on lot: COSA Checklist ## of Structure served by this system 1 A. WELL DATA PUBLIC WATER ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functio correctly ❑ Wires are proper otected Casing height ove ground} in. Date of test for COSA S water level at beginning of test Comments ft. B. TANK DATA 9/19/20 Age of tank(s) �'ew years Tank type/material Septic/Plastic Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA Which system tested (date installed) 6/30/83 ALL standpipes present per record drawing Total measured depth from grade 10.75 ft (max) Measured depth to pipe invert from grade 4.75 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) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Well production at time of test gpm ddv Water storage tank volume gallon Well disinfected for coliform test? es No ❑ Coliform bacteria is Negati Nitrate mg/L itrate less than MRL (ND) Arsenic ❑ Arsenic less than MRL (ND) Collected of Sample C. LIFT STATION NA ❑ Required maintenancm Age of lift station years Lift station m0fe0orial Adequacy test date 8/12/20 Results ®Pass For 3 bedrooms Fluid depth prior to test 50 in Water added 450 gal New depth 56 in Elapsed time 10 min Final fluid depth 50 in Absorption rate 450+ -.gpd Any rejuvenation treatment (past 12 months) If yes, enter date 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 Community Sewer Manhole/Cleanout > ft ❑ Yes if No ft s if No ft Neighboring Tank> 100' ❑ Yes if No ft Private S is Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > Yes if No ft Animal Containment > 50' ❑ Yes if No ft Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' ® Yes Manure/Animal Excreta Storage > 100' ft nity Sewer Main > 75' F1 Yes if No ft ❑ 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' Yes if No - ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Yes Absorption Field > 5' ® Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' Yes if No ft 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 if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS Field is operating in the top 1' of the 6' effective depth and at 84% capacity / life expectancy. G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet • • Municipality of Anchorage • 8G `, V:> O On-Site Water and Wastewater Program (907) 343-7904 �Ti CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 050-211-61 Expiration Date: 6 — 7 `1 E 1. GENERAL INFORMATION Complete legal description HERITAGE PARK BLOCK 2, LOT 19 Location (site address) 19434 LAURA LEE CIRCLE, EAGLE RIVER,AK 99577 Current Property owner(s) TIMOTHY&CHRISTINE GARBE Day phone Mailing address 19434 LAURA LEE CIRCLE, EAGLE RIVER,AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ❑ Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class _Well ❑ Public Sewer ❑ Public Water System Waiver/Variance request for: Distance: Received by: Date: 7ir COSA to be released to the engineer,unles o herwise requested by the engineer. COSA Fee $ 626, Waiver Fee $ Date of Payment q78,07 Date of Payment Receipt Number OA `) Receipt Number COSA# Q (—/f�' 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. Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD.,EAGLE RIVER,AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 9/812017 THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore,ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments,deficiencies or discrepancies exist. OF AI 4 Ar 2c•CN, {7 + k-'4. T1-1* 6. DSD SIGNATURE System #1 Approved for 3 bedrooms. 4 KEiNNEIH f. D• System #2 Approved for bedrooms. _ 7L Seo " "A. Disapproved. \ '~Fijlo. \‘6:411b-r nditional approval for bedrooms, with the following stipulations: 1 l 5 SI t cet-VeAele --OZ{te. A9‘ ,y9exAA- .v�. r ON o 7.3 E o PRVATERIysr q�Q Are ooGiA R M ��= • SFRVIC `�� By: Original Certificate Date: Cf! 13-11 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory ' • • Septic System Advisory Arsenic Advisory , Well Flow Advisory Other " COSA blue sheet 10-10.12.doc If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system _ Certificate of On-Site Systems Approval Checklist Legal Description: HERITAGE PARK BLOCK 2, LOT 19 Parcel ID: 050-211.61 A. WELL DATA — PUBLIC WATER Well type If A, B, or C provide PWSID # Well Log (Y/N) Date completed Sanitary seal (Y/N)Y Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. _ g.p.m. WATER SAMPLE RESULTS Coliform colonies/100 mL Nitrate mg/L Arsenic: ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 6/3011983 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 9/1117 _ Pumper JRS C. ABSORPTION FIELD DATA Date installed 6/30/1983 Soil rating (g.p.d./ft2 or ft2/bdrm) 85 System type DEEP TRENCH Length 22 _ ft. Width 4 ft. Gravel below pipe 6 ft. Total depth 10.75 ft. (Measured 9/7/17) Eff. absorption area 264 ft2 Monitoring tube Y Depression over field N Date of adequacy test 9/7/2017 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 60 in. Water added 450 gal. New depth 62 in. Elapsed Time: 10 min. Final fluid depth 60 in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at in. "Pump off' level at __ in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES - PUBLIC WATER WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/septic service line Holding tank _ Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 200'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ _ Surface water 100'+ Driveway,parking/vehicle storage 10'+ Curtain drain 50'+{NONE KNOWN)_ Wells on adjacent lots 200'+ - F. COMMENTS Per visual observations and pumping,septic tank appears to be operating at normal levels. The field is operating in the top 1'of the 6' effective depth and at 84%capacity/life expectancy.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. OF ill 4.S` Engineer's Printed Name KENNETH M.DUFFUS /f-. Date 91812017 y r' tKENNETH x ' COSA canary sheet_2-6-15.doc s '' 1f A`' L..¢~~ IVlUNICIPALITY OF ANCHORAGE ".~ DEPARTMENT OF HEALTH AND ENVIRONIVIENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SiTE SEWER AND WATER FACILITY 264-4720 Application Date /~'/// GENERAL INFORMATION (~) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~;)O/ ~/'~Telephone: Home Business Applicant Address. ~ (c) Applicant is (check one): Lending Institution ~; Owner/builder ~; Buyer ~; Other ~plain); (d) Lending Institution ~ /~ UF~2C Telephone Address (e) Real Estate Company and Agent Telephone % ~'~ {ff.~.-.O~¢~ Mail the HAA to the roi}owing aOdress: (f) TYPE OF RESIDENCE Single-Family J~Multi-Family Number of Bedrooms Other WATER SUPPLY Individual Well [] Community [] PubliC [g/' Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DI~SPOSAL Onsite [~ i 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. 72-025 (11/84) Page 1 of 2 the date of this inspection. Name of Firm ~--~ ~~/~rjAJ ~ >'~' O~- Date /g -/[~ ~,~ ENGINEERING FIRIVi PROVIDING~INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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 e,ephone I '-g f 5' 1 Date Approved for ,,,- bedrooms b Approved. X Disapproved ConditionaF Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval c(~rtificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy.to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 72-025 (11184) WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) r. NViP. ONM~,'~ ....... HEALTH AUTHORITY APPROVAL (HAA) . ..[Q.~CO, CHECKLIST - FEBRUARY 1984 -~ ! '~' z~, ~,,,,,, . 264-4720 . ,... ~-~ Legat De~.,c~jption' ~'0i~' WeAl Classification ~1~)~ If A, B, C, D.E.C. Approved (Y/N) Date Completed Yield h resent (Y/N) Cased to Depth of Grouting Static Water Le~-- Pump Set At Casing He~'gh~;,~e Gr~Ou~d~_~--- __ Sanitary'Se~asing (Y/N) __ Electrical Wi ir ng in Conduit (Y/N~"-,~...~...~ De.~si~n Around Wellhead (Y/N) . Separation Distances from Well: '~'"'-~_...~..~_~ To Septic/Holding Tank on Lot . .~..~,_.~,n Adjoining Lots __ To Nearest Edge of Absorption Field on ~..~' ; On A'~dj~ots -- To Nearest Public Sewer Line / To Nearest Public Cleanout/Manhole~,,, .~J To Nearest Sewer Service Line on E~t~.~_.~..~.~.~ Collected by ' Date Water Sample ~ ~..,,. , -..~.~. Water Sample Test Re~s Comments,~'// '~'~ B. SEPTIC/HOLDING TANK DATA Date Installed'-JU/V~- -~O¢~'Size /D(/O NO. of Compartments Standpipes (Y/N) ""r' Air-tight Caps (Y/N) T Foundation Cleanout (Y/N) Depression over Tank {Y/N) /kC Date Last Pumped Pumping/Maintenance Contract on File (Y/N) /~J//~ ;for Holding Tank High-Water Alarm (Y/N) //~/~P1~' Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank;~ TO water-Supply Well ~ To Property Line ~ / To Water Main/Service Line Y / To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~ ~" -~;~*F//f~.~ Type of System Design "~"'¢~--~' Date Installed Jdldg ,~0 {[-¢<J~"~ Length of Field Width of Field (1/'?//! / O / Depth of Field Gravel Bed Thickness Square Feet of Absorption Area ~-~;~ Standpipes Present (Y/N) Y Depression over Field (Y/N) N Date of Last Adequacy Test Results of Last Adequacy Test ,/V/,/~ Separation Distance from Absorption Field: , To Water-Supply Well //~b To Property Line // Z ! To Building Foundation ~'~ '~ To Existing or Abandoned System on Lot /L~/]' ; On Adjoining Lots ~/_..20 To Water Main/Service Line ,A"//,/Ir' To Cutb. ank (if present) ,/~J/,~ To Stream/Pond/Lake/or Major Drainage Course /~/,~ To Driveway, Parking Area, or Vehicle Storage Area ¢~) / Comments LIFT STATION Size in Gallons - *%.- ''Pump On" Level at ~-.~ High Water Alarm Level at Tested for Electrical Codes (Y/N~J._~~'''''~ Dimensions Manhole/Access (Y/N) r/~/' ~ "Pu m p~veha~-- ~ Vent (Y/N) ~-~_..~P. umping~ Cycles during Adequacy Test. Meets MOA ** Check Pe ed Bed m Rating Against HAA Request ** I certify that I~h~c/e. checkCdLverified, or conformed to all M CA and HAA guidelines in effect on the date of this inspection. I111//1~ . ~ Si ned ////'//[/g-¢// ~*.---- --Dale Compan/ ~¢ ~C-/~ J~d::(-~,,,~ ~ Receipt No. ,_~....~ ~,,~.~c.~ Date of Payment *~, ~¢f ~':'/'';' %~'*~ ¢4 Engineer's Seal Amount; $ Page 2 of 2 72-026 (11,84) MUNICIPALITY OF ANCHORAGE DMSION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date. ~'~F~ ~ include l~t, ~lock, suJ~division, section, tc~vnship, range) (a) Legal Des~cript~on~(/__/~ ~.~ -- //~p...~/A~.~/~i//~z~ ~/ Location (add~esw or dire~,g~ions) /~o ~c~ /~_~. CL. ~ ~ (o) ~lioant is (che~ o~) Lending Institution ~ ~ o~n~r/~uildeS~ ~uyer ~ ~ Other ~ (explain)~ (d) Lending Institution Telephone (e) Multi-Family 2. ~3f]~ of Residence Single-Family ~ Number of Bedrocks O~er (des~i~) 3. Water Supply Individual Well~--~ .Community~ Public~ Note: If c~¥,~nity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Is the well adequate for the number of bedrocms specified in this HAA '(Y/N) 4. Sewage Disposal .Onsite~ Public ~--~ Co~',~nity ~ Holding Tank ~-~ Is the/kwastewater disposal system adequate fc~ the number of b~drocr~s (Y/N) [Page 1 of 2] 2-15-84 .5. E~gineering Firm Providing Inspections, Tests, Data and Information I c~rtify that .I~ha~-~ ~.~cked, verified, or conformed to all MOA HAA Guidelines in Na~e of ~i~/'' Telephone ~'~'~ e 7e~'~ Address ( ENGINEER SEAL) 6. DHEP Approval. Approve d for Approved ~ ~ bedrocms Disapproved ~ Conditional~--~ Te_=ms of Conditional Approval ~ne Municipality of Anchorage Department of Health and Enviror~ronta! P~otection does not guarantee the continued satisfactory [2erformance cf the water supply and/ct the wastewater disposal system. This approval indicates that, as of tho validatio~ d~te shown above, based on the data and information furnished b/ an ec~ineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func~ tional fo~ tb~ numbe= of badrccm~ and t~ype of structure indicated. ( DHEP SEAr.) 7. Mail the HAA to the following address: KB2/d5/s [Page 2 of 2] 2-15- 8,':t. ae MUNICIPalITY OF ANCHORAGE ( MOA ) HEALT~ AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well Classification Well Log P=esent (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absoz~ption Field on Lot To Nearest Public Sem~r Line C leanout/Manhole Water Sample Collected By Water Sample Test Results If~ B, Date Completed c~ C, D.E.C. Approve ) Yield Depth of Grouting. Pump Set At Sanitary Seal on Casing (Y_/N) Depression Around Wellhead (Y/N____L__) ; On' Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date C~ments SEPTIC/~ TANK DATA Date Installed '~f/J 5 ~ Size /O~ Air-tight Caps ~ Standpipes ~ (~d) Date Last~Pumped Depressidn over Tank Pumping/Maintenance Contract on File (Y/N) L.-~;-for Holding Tank High-Water Alarm (Y/N) ~-~f~-~rary Holding Tank Permit (Y/N) Separation Distances f~om Septic/Holding Tank: To Water-Supply We 11 (~ To j//'J{~/b'/T-&// . Building Foundation /~ / To Property Line ~ / / To Disposal Field ~ / To Water Main/Service Line ~q~{3 d'~//~ To Stream~ Pond, Lake, c~ Major Drainage No. of Ccmpartments ~ Foundation Cleanout ~ [Page 1 of 2] 2~15~84 Ce De ABSORPTION FIELD DATA Soils Rating in Absorption St~ata ~- Type of System Design Date Installed ~/~(/~/ ~_-~ Length of Field 2 - .~-;//.,.~ . .~',j)v~.A~~ f~)~Gravel Bed Thickness Square Feet of Absorpt'lon A~'ea/~ ,D ~ ~ Standpipes P~esent (_~/~.) Depression ove~ Field (~_)) Date of Last Adsquacy Test Results of Last Adequacy Test /~J Separation Distance from Abso~ption Field: To ~te~-Supply Well ~O/~/U/ To Building Foundation ~ ~ / Lot /~/~3~~ ; On Adjoiping To Wate~ Main/Service Line~d3~ To operty To Existing or Abandoned System cn Lots To Cutbank(if present) /~//~ To Stream/Pond/Lake/c~ Majo~ D~ainage Course To ~iveway, Pa~kin~ ~ea, ~ Vehicle Sto~a~ ~ea LI~ STATI~ Date Installed Size inGallons "Pump On" Level at High Water Alarm Level at Tested fo~ Din~nsions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Electrical Codes(Y/N) Con~nts Meets MOA ** Check Pe=mitted Bedroom Rating ~3ainst HAA l%equest I certify tha~t/~ave checked, ~erified, or conforn~d to all MOA HAA Guidelines in effect on the date~f t~i~l~/~ction. Sig~ed.~____ '- ' Date"9' /~ ~/ ~~~.~_ ~.i [Page 2 of 2] ,.~ ........ ~/] 2-15-84