HomeMy WebLinkAboutLAKE O THE HILLS EAST BLK 1 LT 4-ane, � i IIs_
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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
hftp://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP251139
Work Type: Septic Upgrade
Tax Code Number: 01533304000
Site Legal Address: LAKE O THEHILLS EAST BLK 1 LT 4 G:2639
Site Mailing Address: 11101 MOUNTAIN LAKE DR, Anchorage
Owner: MAGILL CHRISTINA BRAY KENNY &
Design Engineer: GARNESS ENGINEERING GROUP LTD
This permit is for the construction of:
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy
Effective Date:
Expiration Date:
5/13/2025
5/13/2026
Lot Size in Sq Ft: 20000
Total Bedrooms:
❑ 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 (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
Received By: / - C> C_ C-2 Date:
Issued By: Date: %'�
MUNICIPALITY OF ANCHORAGE
Development Services Department j Phone: 907-343-7904
On -Site Water & Wastewater Section
ON -SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 015-333-04
Property owner(s) ANDREW MAGILL Day phone 314-283-2377
Mailing I address 11101 MOUNTAIN LAKE DRIVE, ANCHORAGE, AK —
Site address 11101 MOUNTAIN LAKE DRIVE, ANCHORAGE, AK
Legal description
LAKE 0 THE HILLS EAST; BLOCK-1, LOT 4
Number of Bedrooms 3 (SEPTIC SIZED FOR 4)
Engineering Firm GARNESS ENGINEERING GROUP, LTD.
Building Permit Number
Not Applicable A
APPLICATION IS FOR: APPLICATION IS AN:
(E all that apply)
Absorption Field
0 Initial ❑
Septic Tank
E Upgrade
Holding Tank
D Renewal El
Privy
0
Well
0
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
Permit/Rush Fees: )5,w Waiver Fees:
Date of Payment:. aj,� T Date of Payment:
Permit No. (OSPPS_113q Waiver No.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251139, Curtis Townsend, 05/13/25
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251139, Curtis Townsend, 05/13/25
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251139, Curtis Townsend, 05/13/25
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251139, Curtis Townsend, 05/13/25
1U1'tIl. PilA l f �' O ANC�'l<��RAG i'.
ADVANCED
ilIA1NT NANCE AND R PAIR AGRt,ENJ1 NT
1'illS +tAlN1 t=NAIN! <.;F AND REPAIR AGREEMENT, herein the "AGRC;EIv[ENT" made and
_1j o
entered into has ��f dtis (_ Day of l �,��f 20 �, by and between
a herein the OWNER," and the Municipality of
Ancix�raiie. herein the "MUNICIPALITY", in accordance 4vith Anchorage Municipal Code
(AN1 40 15.65,365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
Advanced Wastewater Treatment Systems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as t�cvti tCS �eroC�� t
located at (legal description) .
2. i1"iaintenance. Repairs and Alterations.
(Owner is required to read; understand and initial each section)
!it
Throughout the term of this Agreement, the Owner shall enter into a service agreement
with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
I accordance with the equipment's approval for operation in the Municipality.
% It shall be the responsibility of the Owner during the term of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
includes an annual maintenance fee (typically $400 to $600).
F
r' Owner agrees that only maintenance and repair personnel approved by the k1unicipality
or the manufacturer's representative will inspect and make any necessary maintenance,
/ repairs or permitted alterations to the system.
i ¢ Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sexvage backup and costly repairs or drainfield
replacement.
(rev. 05/18/2018) 1131-e 1 of3
LI
{lN\ncr acknitwlcdgcs that the AItnticipalil�' ratty request records of•niaintenance and
(�;tirs ('rom file nuutufacturcr's representative or maintenance provider.
Chi ncr acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance with ;AI\'IC: 14.60.030.
a (:
ONrner agrees to grant the Municipality reasonable access to test and inspect the
\\\`\\'1'S. The Municipality will give at least 24-bout notice.
`k Owncr agrees that any sale or transfer of* title of the property will not occur without a new
Certificate of On -Site Systems Approval.
'r Owner agrees that the AWWTS installation and maintenance requirements as provided
by the A\V WTS vendor/installer and approved by the Municipality are the governing
Luidelines for the construction, maintenance and repair of the Owner's AWWTS.
�j r; r Owner agrees to maintain remote monitoring of the AWWTS as required by the
A\\"WTS approval,
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred.
4- Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
b. .Jurisdiction: Choice of Latin. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of tile
parties under this Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
t.t e of3
Date:
la u 1,C)
----- -- --- ---
-int name)
s K,
ss.
THIRD JUDICIAL DISTRICT
The fk1rC(-,0Hb-1 ills �l ment was acknowledged before me thisq— day of
20 Z5. by
Avo- n1l t-3oc-)J "Off al Seal"
NOTAR'r ALASKA PUBLIC FOR Notary Public
N Commission expires:. 63 Ck A, VVOOd
_cn
Y1Lj..NjCIRAL1TY:
B (signature)
'
C, V MTW -71 S / (print name)
Date. S 3 -Z ,-
Title: C, I V( L- G
I f i_, W, t) / 1 %/2.0 1 %) lllil,,e 3 k)C3
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
PHONE
❑v'NEW
�p
❑ UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
L lAllG of j)),L LS f5A r
LOCATION
NO. OF BEDROOMS
Z220LIIV7_41� ,GA/CE: _IteJ✓/,
3
Uy
Well
DISTANCE TO: �'
Absorption area/
9�
Dwelling
No //J
PERMIT NO .
� !'3_5
PZ
wF
Manufacturer /� //++
l>G�J�Ei�
Material
jib/-'�...cy
No- of compartme
y
Liq. capacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
y
DISTANCE TO:
Well
Dwelling
PERMIT NO.
-JQZ
2 Z <
Manufacturer
Material
Liquid capacity in gallons
o
DISTANCE TO:
Well
Foundation
Nearest lot line
PERMIT NO. /
w=
J LLz
No. of lines
Length of each line /
Total length of lines /
Trench wid
*0
Distance between lines
Zw
!'
-
inches
F
Top finish
Material beneath tilee,
Total effective abs rption.area
o
of tile to grade /
96
C
inches
y
Length
Width
Depth
PERMIT NO-
L
a
Q F-
Type of crib
Crib diameter
Crib depth
Total effective absorption area
WCL CL
WWell
N
Building foundation
Nearest lot line
DISTANCE TO:
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
W
i:
Building foundation
Sewer line
Septic tank
Absorption area(s)
DISTANCE TO:
Peke- 5-PV816 OTHER
PIPE MATERIALS—
ATE IAL
SO[ L TEST RATING
SO[
1
31 z
INSTALLER
r-WTo.0 cxc 4vas
-h.
REMARKS
(� vL %
6/
jpD
Oil
lV'94I 0" e
r
Iz—
1
APPROVED DATE LEGAL
��
Af'I�)L �' lake /7/ /I$' EO, S 7- A
72-013 (Rev. 3/78)
I I 16_6 r-4 I /_: 1 1—" 6"11.-_ -1" / --a' 80 a- a—a a --A a__ a � ' a - a e a i r . vv
DEPARTMEN•dT ; HEALTH AND EI''d`5``IRON• MEN•dTAL,,'.'OTECTION
825 'L'" STREET: ANCHORAGE, AK. ti_a_���_il I
264-4720
PERMIT NO. 830135 :>
APPLICANT KENNETH P B STEDT -GSH BOX 1566 99502 563-3012
LOCATION LOCATE SIS WITHIN 10 OF T. H. 4
LEGAL L4BI LAKE 0 THE HILLS EAST LOT SIDE _�:?�_�_ ? SQUARE FEET
TYPE OF SOIL ABSORPTION•d SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS _ _ SOIL RATING SQ FT/BR) = 155
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
C-aF=F='T"= ::L:JL L_E—=r-4f__j _F t= -^* /:3F:'''Fla F=1_ E E= F:: -T- VA o`
THE LENGTH DIMEN•dSION•d IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAIN•dFIELD.
THE DEPTH OF A TRENCH OR FIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND D AND THE BOTTOM M OF THE EXCAVATION (IN FEET'.
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL F'IF'E
AND THE BOTTOM OF THE EXCAVATION (IN FEET').
Fes_ EE CA 6.—/ I F=, F= C--E:F=° T � /� T 1 / 8° � F==- � � � = � §D -C-10 C 6=1 iL C P-4 u—='
,
PERMIT APPLICANT HAS 'THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION IN SPECTION•dS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDEN•dCES, THAT THE WELL WILL SERVE.
— — — -T- L--1 {_{
■:- 2 --a 1N
`_ F- E—= 0 -T- I {_/"!F. F=l FP' E_
Fr_ F=" { ! 641 I F._ F= F
BACKFILLING OF
ANY
SYSTEM
WITHOUT FINAL INSPECTION AND
APPROVAL BY THIS
DEPARTMENT WILL
BE
SUBJECT
TO PROSECUTION.
MIN•dIMUM DISTANCE BETWEEN A WELL AND ANY ON—SITE SEWAGE DI_,POSAL SYSTEM IS
100 FEET FOR. H PRIVATE WELL OR 1501 TO 200 FEET FROM H PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MIN•dIMUM DISTANCE FROM A PRIMATE WELL TO A PRIVATE _EWER LINE IS ',=:U FEET AND
T� � A COMMUNITY SEWER LINE I 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION GSI AGRAMS AF:E
AVAILABLE TO INSURE URE PROPER INSTALLATION.
F=���_3�� ! �o �F✓" F':ate/� �9���� _:J_ e-0-=;eE._:
I CERTIFY THAT
1: I AN FAMILIAR WITH THE REQUIREMENTS FOR ON—SITE =EWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
I WILL IN+ISTALL THE SYSTEM IN•d ACCORDANCE WITH THE CODES.
3: I UNDERSTAND D THAT THE ON—SITE SEWER SYSTEM MAY REQ?HIRE ENLARGEMENT IF THE
RESIDENCE IS REMOG LEC: TO IN•dCLUDE MORE THAN 3 BEDROOMS
IGN•dED : ---—=��d�; _ -------------------
APPLICANT
----------------
APPLICAN•dT KF 4ETH P BYSTEDT
ISSUED BY
ATP __ V4. 0
I
it
H
I
PROJECT_
CLIENT H.T. Newton ELEV. TOP OF MOLE 817.0
W. ®. 0716 DATE February 6, 1981
0
1
2
3
4
5
6
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8
9
10
12-
13-
14-
15-
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21
21314151617-
1819202]
22-
23-
24-
25-
Organic
z232425
UI%JitllIN a SCHESEN a KORYNTA u HUETTL
2515 A STREET
ANCHORAGE, AK. S9,903 276-4245
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25
Or anic Material
Moist, Brown, Silty Sandy Gravel, GM
Some Cobbleff
Grab Sample /2.7 % Pusr�:�y Zoo
Moist, Brown, Gravelly Sand, SW
Bottom of Hole
No Water Table
Perculation Rate 9.2 min/inch
Time Dept-h_to Water.
8:32 6'10"
8:42 7'i"
8:52 713'1
9:02 7'4-3/4"
9:12 7'6"
9:22 7`7"
9:32 7'8"
UI%JitllIN a SCHESEN a KORYNTA u HUETTL
2515 A STREET
ANCHORAGE, AK. S9,903 276-4245
X
2
3
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7
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MT. LAK
p_ 1, N G, PAvEMENT
PV MT, Pv NT
a Io4 b LL.Io
\ N 8g, S-1 I I' 15 3. 4' Pt
,
10¢.0 �' 10� 1✓LECT. ES I'I'
1-. SIN �`
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��oQ°�L'�� PrdposE� 2•Y2 STOf�i DWELLING,T H 3 ?3� ��� Q ,��•
�SErS NOTE i ° GARAGF- SL14'G EL. 102.5
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N 6��•S`�8. a
C _o„
HOTF, MoViVE EKOSION ptioTEcTloN .......
_ 6N 51•pQF. ��"TWi=Lhl WEST slt�E
of HOUSE iNNO WF-ST ?17-0p. LIH E � (�
�b�p
�L`- rtoLe 1 3 P-L.95.-15 / r
1AKE SHoICF �i' EL 91.2 LAKEsuKfi•
• /NOTE I
TH. 5 � TH 44 .ARS SoIL TV-
SOILS KrzpoRT 53-( USK M t
I HEREBY CERTIFY THAT I HAVE SURVEYED THE HEREON DESCRIBED
PROPERTY AND PROPOSE TO LOCATE IMPROVEMENTS AS INDICATED
AND THAT -THERE ARE NO EXISTING IMPROVEMENTS, ROADWAYS,
TRANSMISSION LINES OR OTHER VISIBLE EASEMENTS ON THE
PROPERTY EXCEPT AS INDICATED HEREON.
LE
.AT, _LAK t) K,
E�CISTIt-IG PAVF-ME=NT
P\/NT.
- �L.loo•0- . _
N SR° 57 I I�. 153.4' Pl-.`18,2 GRouND i
10' i✓ I_EGT. ES 1` -I -T
65
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. < j oo .. po lccN 53 T /
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i�
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5 d
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LL
CD -0 10-0,
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R. TE TI oN
\N FIST sIVE
pito p . L.I w E '
SL, 9 5.-1 S
LAKE. 5 H 0 K E "-->i
����°
�L91.2 LAK65uRF.
• NoT� V
TH 3 �TFi $ ::ARS SOIL TEST HOLES . )✓Rol,4 OrugiHAL
$OIL$ : KE PORT 53 f U S K M V TEb 2. - G
E SURVEYED THE HEREON DESCRIBED
CATE IMPROVEMENTS AS INDICATED
ING IMPROVEMENTS, ROADWAYS,
R VISIBLE EASEMENTS ON THE
rm urorn►,
®ba
=-I,
APPLK SVT FILLS OUT UPPER HAI � ONLY
Time
Owner
tb7
FPhone,
Mailing Address
Zip Code
%L7%('Pre^erty
Buyer
Inspector
Inspector
On C
Address
Zip Code
Field otes:DEPT.
Lending Institution
,
Phone
Address /0/
A) 1', 1. L) Zip Code 1 ` S') 3
� -0061 ,l
Realty Co. & Agent
1
Phone
( ) APPROVED BEDROOMS
/�} p, CONDITIONS OF APPROVA
l �A- 6j\M7@_. � { V-' J V"Q.A_J�'
( )DISAPPROVED
( ) CONDITIONAL APPROVAL`S
Address
Zip Code
((��-',�c�������
��t��1_v9XC'Y �\�tiZJ%- VV"C_�J�.C�`f'"`��
Legal DescriptionZGCf
k L07
Street Location
1/1/0- V )C",
Type of Residence
Date Sewer Installed
Al Single Family
Well Log Received
Septic Tank Size 7 S C>
O Multiple Family No. of Bedrooms
L� 593
❑ Other
Water Supply
❑ Individual
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
0Community
For wells drilled prior to that date, give well depth (attach log
if available).
❑ Public Utility
Sewer Disposal
A Individual
nstalled:
Year Individual Installed:-
❑ Public Utility
71
When Connected to Public Utility:
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
U IZL A i 1'1 /` QP P V
1 2
Time
Time
Time
Time
Date
Date
Date
.�
Date Lx
Inspector
Inspector
Inspector
Inspector
(�
t__t- _JL�i�-
OF ANCHORAGE
Field otes:DEPT.
OF HEALTH &
ENVIRONMENTAL PROTECTION
1
RECEIVED
( ) APPROVED BEDROOMS
/�} p, CONDITIONS OF APPROVA
l �A- 6j\M7@_. � { V-' J V"Q.A_J�'
( )DISAPPROVED
( ) CONDITIONAL APPROVAL`S
0-9-
DATE-�11( ,Sc�J'�
((��-',�c�������
��t��1_v9XC'Y �\�tiZJ%- VV"C_�J�.C�`f'"`��
l�0 —�
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well Log Received
Septic Tank Size 7 S C>
L� 593
Well to Tank
72023 f3/82)
)
A01.4+v
Municipality of Anchorage -
On -Site Water & Wastewater Program
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 015-333-04 Expiration Dater
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
LAKE O THE HILLS EAST SID; BLOCK 1, LOT 4
11101 MOUNTAIN LAKE DRIVE, ANCHORAGE, AK, 99516
KENNETH BYSTEDT Day phone
10121 EVERGEEN WAY, STE 25-626, EVERETT, WA, 98203
CIO AGENT
Real Estate Agent JULIE ERICKSON W/ REMAX/DYNAMIC Day phone 242-9282
2. TYPE OF DWELLING:
Single Family (w/wo ADU) g '�
❑Y6�¢ ":
Duplex
❑ Multiple Dwellings (Single Family and/or Duplex) JUL D 6 2DM
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class_!-�_Well
Public Water System
waiverfvariance request for.
3
TYPE OF WASTEWATER DISPOSAL
Individual On-site N
❑ Individual Holding tank ❑
N Community On-site ❑
❑ Public Sewer ❑
r ,
Received by: !fi' Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Distance:
COSA Fee $ Waiver Fee $ ^t��
Date of Payment Date of Payment
—
Receipt Number 6�)G" Receipt Number bbl I
COSA # (/ il. ! T 1 J1 `I Waiver # . L ! `7,1 2 \
b. 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
GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 `ANCHORAGE, AK, 99507
Engineer's Printed Name
Engineers Comments:
JEFFREY A. GARNESS, P.E.
In conducting this evaluation, GEG, Lfo attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines 8 Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the wafer usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sale benefit of the owner listed above Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
6. DSD SIGNATURE a
System #1 Approved for ✓ bedrooms.
M
System #2 Approved for bedrooms.
Disapproved.
Phone
337-6179
Date /`t
Conditional approval for _ bedrooms, with the following stipulations:
OF
Off! -SITE
WATER A11O
Original Certificate Date: 7 — % � A '
The 06`nic0aX2!✓ p orage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the represenatations 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. ATTCHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
to_ am19n91
Nitrate Advisory
Arsenic Advisory
Other
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:
A. WELL DATA
Well typecOMMUNIY
Date completed
Total depth ft.
Date of test
Static water level
LAKE O THE HILLS EAST S/D; BLOCK 1, LOT
If(aA B, or C provide PWSID# 213603
Sanitary seal (Y/N)
Cased to ft.
FROM WELL LOG
Parcel ID: 015-333-04
Well Log (Y/N)-
Wires properly protected
Casing height (abo rc
AT
ft.
Well production / g.p.m. g.p.m.
WATER SAMPLE
n.
Coliform colonies/100 ml. Nitrate mg./L. Collected by:
Afg-enic: ug./L. Date of sample:
B. SEPTIC/HOLDING TANK DATA *INSIDE BASEMENT.
Tank Type/Material SEPTIC/STEEL Date installed 4/5/1983
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) *YES Depression over tank (Y/N) NO High water alarm (Y/N) NIA
Date of pumping % / Pumper ISAACS PUMPING
C. ABSORPTION FIELD DATA -BELOW EXISTING GRADE
Date installed 4/5/1983 Soil rating (g.p.d./ftor /bdr) 155 System type TRENCH
Length 34 ft. Width 3.33 ft. Gravel below pipe 8 ft.
Total depth *14.25 ft. Eff. absorption area 544 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test **7/2/2014 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 66 in. Water added 600 gal. New def th"�60 in.
Elapsed Time: 120 min. Final fluid depth 68 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date
**HOUSE WAS VACANT AT TIME OF TEST. DRAINFIELD WAS PRE-SOAKED WITH 2010 GALLONS ON 7/1/2014. AN
ADDITIONAL 1010 GALLONS WERE INTRODUCED TO THE DRAINFIELD ON 7/2/2014 PRIOR TO THE ADEQUACY TEST
NOTE: MT ONLY EXTENDS 73" BELOW INVERT. TOTAL DEPTH AND LIQUID LEVELS ARE THE CALCULATED ABSOLUTE
LEVELS BASED UPON THE INVERT OF THE DRAINPIPE AS THE VERTICAL DATUM. ***16" BELOW INVERT.
D. LIFT STATION
Date installed
"Pump on" level at in.
Size in gallons
"Pump off"level at
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on
Public sewer main
Manhole/Access (Y/N)_
warmt
Meets alarm & circuit requirements?
CK0Pn 111RUMMUM
On adjacent lot:
On adjacent lots
manhole/cleanout
Sewer /septic service line Holding tank
containment areas Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Building foundation 51+ Property line 5'+
Water main 10'+ Water service line 10'+
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Water service line
10'+
Curtain drain NONE KNOWN
F. COMMENTS
G. ENGINEER'S CERTIFICATION
Absorption field 5'+
Surface water 1004
Building foundation 10'+ Water main 10'+
Surface water 100'+ Driveway, parking/vehicle storage 1'+
Wells on adjacent lots 200'+
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.
Engineer's Printed Name JEFFREY A. GARNESS
Date
(Rev. 10112112)
MOUNTAIN LAKE DRIVE
OF A VA�DO�o
N 'SHANE A. HOLT ma
1 F LS -691 4, QO
THE INFORMATION HEREON I5 FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS: AND I5
NOT TO BE USED FOR POSITIONING A DDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINE5.
EASEMENTS OF RECORD, OTHER THAN TH05E APPEARING ON THE RECORD PLAT , ARE NOT SHOWN
HEREON( UNLESS INDICATED)
NOTE: FENCELINE5 THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE.
AS -BUILT SURVEY V =30'
NO CORNERS SET THIS DATE
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
LOT 4, BLOCK 1, LAKE 0 THE HILLS EAST
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
EXIST OTHER THAN NOTED.
DATED AT ANCHORAGE,ALASKA THIS _15T DAY OF
_JULY , 2014.
HOLT LAND SURVEYING
600 HIGHVIEW DRIVE
12596, 167-3 ANCHORAGE,AK 99515
345-5513
O V03/99 12:17 FAX 90725.@74.30 DEC MOW VA001
ALASKA DEPARTMENT OF ENVIRONWNTAL CONSERVATION
DIVISION OF ENVIROPAWTAL HEALTH
DRINKING WATER AND WASTEWATER PROGRAM
5% CORDOVA STREET
ANCHORAGE, ALASKA 99501
TELEpgONE; (907) 269-7517
Fit (907) 269-7650
338-32 f�t2. "`�c►�,~
DATE: 9-1'06 Pages including cover sheet:
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