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HomeMy WebLinkAboutSPRING FOREST BLK 1 LT 3Spring Forest Block 1 Lot 3 #015-321-07 Vo1W1 1 I/w JAN 2 2013 Inspection Report-9-1-12POC Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP121379 PID Number: 015-321-07 Dwelling: ❑Q Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New *Upgrade Name: DOUGLAS BOYCE ABSORPTION FIELD El Deep Trench El Shallow Trench El Bed ❑ Mound Address 5820 WEST TREE DR., ANCHORAGE, AK Other Phone Number of Bedrooms Soil Rating Total depth from original grade 5 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot SPRING FOREST 1 3 Fill added above original grade Ft.Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Flz Ft. Well >200' TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCHORAGE TANK Capacity 1500 Gal. Surface Water >100' Material Number of compartments Lot Line >5' STEEL 2 NA Foundation >5' LIFT STATION Manufacturer Capacity Curtain Drain 1 >50' Gal. Remarks EXISTING SEPTIC TANK ABANDONED Pump on level at in. Pump off level at in. High water alarm at in. PER MOA REQUIREMENTS Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Installer DEAN CONSTRUCTION Drainfield CO/MT Inspector LARS SPURKLAND BENCH MARK (Assumed elevation)100 ft Inspection 1� 11/2/12Location and description dates: 2 ° 3`tl a" DECK DOOR JAM COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL . FjQg oe� AS"T,, %V......... 11 Conditional Approval: Date s ' .... `.. SPUAKLAND:'�-_ / 11}�_F0 0 Approved Date -- Inspection Report-9-1-12POC I I / FOREST S/D I I SpR1N G / BLOCK LOT 2 CIO / I LOT 3 I LOT < 5 BDRM j SF.R. SPRINGCLAFORESWAT SUBDIVISION SERVED PWSID 121356ITER SYSTEM I I / I I / NYSTAC[£0 NEW 1500 GALLON STEEL SEPTIC I I CONNECTED TO ORAIN FIELD Septic' SW NG TIESA B Are a I ABANDONED EXISTING I ST. CO. C 31.0' SEPTIC TANK PER MOA I / I S.T. G0. D OBLC.O.E 39.0' 21.0' CODE RfOIIIRfMfNTS f0.5 — -- ——--------- 10' SCREEN EASE -10' -Thf -EASE - - - - - - - - ----- ---- - - - - - - - - - - — — — — OWALLEY ROAD NOT£.• THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER 25 0 25 50 75 100 125 150 DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE APPROXIMATE. SCALE., 1' = 50 FT FOUNDATION CLEANOUT CONNECTED TO 1500 GALLON SEPTIC TANK EXIST DRAINFI£LD BENCH MARK ASSUMED ELEVATION 100 FEET SPURKLANV ENGINEERING 203 W 15TH. AVENUE SPRING FOREST BLK 1 LT 3 RECORD DRAWING ANCH. AK. 99501 DOUG 80YC£ DATE: DEC. 12, 2012 (907) 279-3918 11 5810 WEST TREE DR. ANCHORAGE AK 99507 SHEET. 1/1 GRID: SW2538 I PERMIT # 0SP121379 PID # 015-321-07 SPRINGFORESTBIL3.DWG On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP121379 Tax Code Number: 01532107000 Work Type: Septic Upgrade Permit Effective Dates: October 26, 2012 to October 26, 2013 Design Engineer: SPURKLAND ENGINEERING Subdivision: SPRING FOREST Site Legal Address: SPRING FOREST BILK 1 LT 3 G:2538 Owner/Address: BOYCE DOUGLAS A & ELLEN B 5820 WEST TREE DR ANCHORAGE AK 995166707 Site Mailing Address: 5820 WEST TREE DR, Anchorage This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank Lot Size in Sq Ft: 35918 Total Bedrooms: 5 N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-321-07 Property owner(s) Doug Boyce Day phone 561-1434 Mailing address 5820 West Tree Dr., Anchorage, AK 99507 Site address Same Legal description (Sub'd., Block & Lot) Spring Forest Block 1 Lot 3 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑ (w/wo ADU) Septic Tank ❑x Upgrade ElDuplex (D) F]Holding Tank ElRenewal 11Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Emergency Tank Replacement Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. owner or Permit/Rush Fees: oiOU Waiver Fees: _ Date of Payment: (OI I Q 112. Cek`!a� Date of Payment: Receipt Number: ni[�55b G Receipt Number: Permit No. OSP12 ) 3llI Waiver No. Permit App_9-1-12.doc &,-Ak SparNand Environmental Consulting and Design October 19, 2012 Municipality of Anchorage Development Services Department Building Services Division On-site Water and Wastewater Program 4700 Elmore Road Anchorage, AK 99519-6650 Subject: SEPTIC TANK PERMIT APPLICATION Spring Forest Block I Lot 3 Ladies and Gentlemen: We are submitting an application to upgrade the septic tank for this lot. The existing septic tank serving the above referenced property has been compromised and the owner would like to replace it. The submittal consists of one (1) drawing showing the present improvements on the lot and the proposed improvements of the lot, of which only the septic tank is subject to this permit application. The installation of this septic tank will not prevent wells and septic systems from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses within 100 feet of the proposed septic tank location. The proposed septic tank will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. If you have any questions or are in need of additional information please contact me at 279-3916. Sincerely, Lars Spurkland, P.E. 203 West 15`a Avenue Suite 202, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (907) 276-6013, SpurklandEng@gci.net 1 1 .110' FOREST S/D S pRING F / I I LOCK 1 I I B LOT ? Lo I I I \� / LOT 3... I LOT 4 0 o I _I ti I SPe - O 5 BDRM S.F.R.RING FCLASSOREST SUBDIVISKM SERVED 1 yl PWSN) 213564TER SYSIfM ('^I I / I / INSTALL NEW 1500 GALLON STEEL SEPTIC I CONNECT TO DRAIN FIELD Septic. Area I / I SEPT�TANK PER MOA CODE REOUIREMENTS I/ - - - - - - - - - - - - - - - - - -- - - - - - - - - 10 SCREEN EASE — — — — — — — — — — — — — — — — — —� — 10' T&E £ASE — — — — — — OWALLEY ROAD NOTE • THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC LOCATIONS TAKEN FROM ON -SIT£ WATER AND WASTE WATER 25 0 25 50 75 100 125 150 DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE APPROXIMATE. SCALE, 1' = 50 FT DOUBLE CLEAN �— 3 FEET COVER ^ FOUNDATIDN CLEANOUT CONNECT TU 1500 GALLON SEPTIC TANK EXIST DRAINFI£LD IS03 W 1KU L.NlVENUEIn(i I I SPRING FOREST BLK 1 LT 3 I I SEPTIC SYSTEM DESIGN I 203 W 15TH. AVENUE ANCH. AK. 99501 DOUG BOYCE DATE. OCT 19, 2012 (907) 279-3916 5820 WEST TREE DR, ANCHORAGE AK 99507 SHEET • VI GRID:SW2538 Municipality of Anchorage Page / of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 O Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: �� �ys/ PID Number: 0�.�;-.3 OZ /0 Name: Wastewater System: L�New ❑Upgrade Address: ABSORPTION FIELD Phone: UC7 c No. of Bedrooms: [a Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Sell Rating: /� Total Depth from original grade: (/ ' GPD/Sq. Ft. /7-10 Lot: 3 Block: / Subdivision: ifrom original grade: Depth to pipe bottom' _ Gravel d�grpth beneath pipe Township:/ z / /1/ Range: 3 Section: / Fill added above original grade: Gravel length: 0 Ft. d Ft. WELL: /I/,t1 ❑ New ❑ Upgrade Gravel depth, kN oT .j Number of lines: Distance between lines: ' Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: l% Pipe material: FL FL 4'-Yd SQ. Ft. /Y %•'/ n O Driller: Date Drilled: Static Water Level: Installer: Date installed: / Yield: Pump Set at: Casing Height Above Ground: O/G � TAN K GPM Ft. Ft. SEPARATION DISTANCES Optic ❑Holding ❑S.T.E.P. To Soplic Absorption Lill Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sower linos ��/ ylJ2/j /; E 7+ /,�! „��a c'J (_2 Well7 Material: Number of Compartments: surface. Water /✓X /V// � /✓/ 7�J1. /,4f LIFT STATION Lot 3 /�, /�1i'' //9 %�� Size in gallons: Manufacturer: Line Foundation p Ll 7 1719 �t "Pump on" level at: 7ump off" level at: High water alarm at: Curtain ,. /!moi /' 1 Pump Make & Model Electrical Inspections performed by: Drain Remarks: SeediNd�,/„ ,r l { BENCH MARK / uY� Location and Description: Assumed Elevation: 7— ENGIN€Eli'S�$�AL < OF r � »r (' f .......... Inspections by: 7 Dates: 1st— performed 2nd /o pz ...,.F.- ......':. H an SZD s approval Department of Heal77,� �F �,� v'S�� Reviewed and approved by: _ l ate: 72-013 (7/91) MOA 25 Permit No, 92-0459 Municipality of Anchorage Page 2 of 2 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 0 Telephone 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report DI nnv 1 coDIK10 cnDrcT CI IDnlvlclnXI nlrzo-Im -ea al UesCrIDLIOn: -- ---- _. ....._ _..--• ---_..._. .. YIU NO,: 2" HI POLYSTYRENE INSULATION EL. 99.8 PHE :...............: NK EL. 95.72 MONITORIN TUBE TRENCH EL. 87.5 DRIVEWAY PROFILE .�/ / / NTS... .......................... WATER LINE ........................................................ ....../.. .//.. 20' DRAINAGE EASEMENT TABLE OF REFERENCE DISTANCES / / ! POINT DISTANCE TO INVERT REMARKS / A I B ELEVATION 1 28.3 5.8 CO ( 2 31.7 12.5 97.17 STCO 3 38.5 21.3 96.91 STCO 4 39.9 22.8 CO 3' : WIDE TRENCH A 5 30.2 26.3 95.73 CO EXISTING 6 53.5 42.6 95.71 CO HOUSE 7 77.3 63.7 MT �i 5 2 9 8 110.0 92.8 95.70 CO MONITORING TUBE - � 1 .'♦v♦O A*/� 4 f �jl SEPTIC TANK ♦ P� :...nnu..,': ♦ D� T. H. 3 s •.••. r} 01 T.H.2 - - . E .49th AN te r/�i... �0 ..............:.. r.. . .../. . . ................... ....... STANLEY BRUST ••F�r � ✓' ••. NO, CE -966 .•' �, 0 •�I�N•V V PLAN ♦ :SCALE: 1"=60' 44,IpROFESS �♦ PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON—SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW920178 DATE ISSUED: 7/10/92 DESIGN ENGINEER:BRUST AND ASSOCIATES c�i_7 EXPIRATION DATE: 7/10/93 OWNER NAME:FORSYTHE GRANT H & OWNER ADDRESS:5820 WEST TREE DR ANCHORAGE, AK 99516 2— t( A / �l 2 ��- e? 2�f C rL-_( PARCEL ID:01532107 . LEGAL DESCRIPTION: SPRING FOREST BLK 1 LT 3 LOT SIZE: 35918 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THE SEPTIC SYSTEM MUST BE INSTALLED IN ACCORDANCE WITH THE APPROVED ENGINEERIS DESIGN DATED 7/6/92. /, RECEIVED BY: ( /�v°��`- /t 4)l �_�,�,-,-<_: DATE:7� " y �v 7 /�, ISSUED BY: z"USG �2 DATE: ,/ �;L BRUST & ASSOCIATES Engineers - Planners - Surveyors 1610 Dimond Drive Anchorage, Alaska 99507 (907) 562-7878 July 6, 1992 Municipality of Anchorage Department of Health and Human Services On-site Services 825 "L" Street Anchorage, Alaska RE: Lot 3, Block 1, Spring Forest Subd. This letter and attachments is to accompany a permit application for an on- site waste disposal system at Lot 3, Block 1, Spring Forest Subdivision. The following are attached. 1. Drawing of proposed on-site systems, and separation distances. 2. Soils logs and percolation test results. 3. Trench design calculations. 4. Compliance letter from ADEC on Spring Forest public water supply. 5. Applicable portion of plat for Spring Forest Subdivision. This subdivision is served by a Class A well which is not within 200' of the proposed on-site system. Development of the adjacent properties will not be adversely impacted by construction of the proposed system as distances to adjacent features are in compliance with applicable requirements. The closest feature that could be affected is the proposed water line, which is about 40' from the closest point of the proposed original system. Slopes on this lot are moderate. Drainage is to the drainage easement to the north. Both the replacement and the original system trenches fitted within the 30' radius circles around the test holes. It is recommended that a permit for the on-site system be issued. Sincerely, j� Stanley Brust, P.E. cc: Spring Forest, Inc. OF '* 49YW N0. 986-.... 1 E 64 S ' GIST �k O/ONN� C�� � JOS NO. BY -/ SHEET DATECHPK-13 OFZ vp i i I..- ... .. .... J_ 1. J - - --------- 74 ' 7o 4' vp i i I..- ... .. .... J_ 1. J I i� I� OF A AV 4 J.- ?,,1 0No. .98d 4�0 ..'GI TE I._ -b ST I& Associ, ENGINEER - PLANNERS - -01 -DF lo QNDt A N,','C RAPM _E, IALASK Av ).Rs - - --------- I i� I� OF A AV 4 J.- ?,,1 0No. .98d 4�0 ..'GI TE I._ -b ST I& Associ, ENGINEER - PLANNERS - -01 -DF lo QNDt A N,','C RAPM _E, IALASK Av ).Rs I I I / I / I / I / / I / I � I I I I I I I I I I I I /I ml \ —T- 49th •°°e_ STANLEY BRUST " No, CE -986 °°°°••r............ ©®�OFESS�1 t®a�® DRANM BY; D. B. CHECKED BY; S. B._ DATE; 7/6/92 SCALE; 1"-100' JOB NUMBER; 92-10 \ y \T T,Q FF r c —LOT 2 6T/3/ LOT 4 DRAINAGE EASEMENT BICYCLE PATH PRPOSED I �— I I WATER LINE a a� I I L PROPOSED I\AV �\ 0.0. I I TRENCHL ,T1 U (\11, _J c.a I !� T.H.11 I A-30' RADIUS I T H \ (TYR) I I \ / PRDPOSED REPLACEMENT TRENCH I I 4 -- — G.4. 7_7 10' SUVEENINC EASEIAENT ID' DiC. Y TELE E SORE NT — — — — — — — — — — — 1 MqLLY ROAD —� -A------- T V\ / PLAN NOTES: 1, TRENCH IS 79' LONG FOR A 5 BEDROOM DWELLING. 2. SEPTIC TANK CAPACITY IS 1500 GALLONS. 3. ALL MATERIALS TO CONFORM TO MOA REQUIREMENTS. 4. FINAL ELEVATIONS TO BE SET IN THE FIELD. 13RUST & ASSOCIATES ENGINEERS—PLANNERS—SURVEYORS 1610 DIMOND DRIVE (907)562-7878 ANCHORAGE, ALASKA 99507 G — FILL f MF SILT HARRIER z 0 //_,�'/_ L- PERFORATED �— PIPE co �PTIC ROCK TYPICAL TRENCH CROSS SECTION N.T.S SEPTIC SYSTEM LAYOUT LOT 3, BLOCK 1 '" 1 SPRING FOREST SUBDIVISION of 1 Municipality of Anchorage t DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: �,Pr /, o74 LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 I— .a r t 6/kms -s: COMMENTS wf \ . ........ AA ry * 14 9,* .49,x; TJX . E ....., .. DAT PERFORMED: i FoIzCsT z;-4/0> 7-/ Township, Range, Section SLOPE SITE PLAN S GROUND WATER 'OUNTERED7 /V S /ES, AT WHAT L 0 'TH? p E to Water Aller O oring? gale: ® N�- aCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN� FT ANDFT /I/ %UAl. !_r /,,A4 /a�o //.°% � 94 /3.3 PERFORMED BY: I C �n 7 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) 0 PERFORMED LEGAL DESCRIPTI DEPTH (FEET) pT 2 — 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19- 20- COMMENTS 920 COMMENTS (ENLS7R Municipality of Anchorage•..e..,, DEPARTMENT OF HEALTH & HUMAN SERVICES lie 825 "L" Street, Anchorage, Alaska 99502-0650 f th ' t\ " ..' • . 986..E O SOILS LOG — PERCOLATION TEST p''A p, 'e{,„;� V ••GIST'S --- F �. DATE PERFORMED: `��`Q;��,"��c+• Wownship, Range, Section: --•—•--- --- SLOPE SITE PLAN s// / 5A,� of' WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water Alter Monitoring? A104 S L — 0 P E Date: 1 _ 'Ilk v Reading Date Gross Net Time Time Depth to Water Net Drop a'33 o G'y '•,r o:54t o a 7 4. 3 G v PERCOLATION RATE � (minutes/incch) PERC HOLE DIAMETER TEST RUN BETWEEN ••' FT AND `•� FT PERFORMED BY: S� 1.� f -w s7 I S_ L' o—ewS CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) PERFORMED LEGAL DESCRIPTI DEPTH _ (FEET) 1 2 3 4 5 6 7 8 9 10• 11 12 13 14- 15- 16- 17 4151617 18 19 20 7��/- Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST G.5,z-, � / 4X -A r �'/ DATE PE ORME . 49Th D� �...:..' ..... F, 10 • !1 rtA 'd986.I-Aff nship, Range, Section: `z���� Y y SLOPE SI E PLAN WAS GROUND WATER ENCOUNTERED? O fjv�n J �Y ,r � IF YES, AT WHAT 0 DEPTH? E Depth to Water Alter Moellering? A1* Dale: �� MA PERCOLATION RATE _•�� (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEENFT AND COMMENTS /y7�f �A=� r,�I—S /0 -:• S": c/rf' 7! c'a-rc'`,_../ rrtiti o /mss > a.- it S G'' PERFORMED BY: /> CERTIFY „THAT p/TeF}IS TEST W�. AdS /PERFORMED i IN1 -- S� ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: - / // 7lf-Z,- 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE 0: Development Services Department's Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval 6� l Parcel I.D. 015-321-07-000 Expiration Date: Legal description SPRING FOREST BLK 1 LT 3 Site address 5820 WEST TREE DR Anchorage AK 99507 Current property owner(s) BOYCE DOUGLAS A & ELLEN BREVOCABLE TRUST 50% EA X The On-site system(s) is/are approved for 5 bedrooms Conditional approval for Comments or advisories: 1I bedrooms, with the following stipulations: Original Certificate Date: 8/28/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval June 2022 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-321-07 Complete legal description Spring Forest Block 1 Lot 3 Location (site address) 5820 West Tree Dr. Current property owner(s) Douglas & Ellen Boyce Day phone 2. ON-SITE SYSTEMS SIZED FOR 5 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units © Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: N Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: © Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 11 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed V Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 5� Waiver Fee $ Date of Payment gzl�,lg_3 Date of Payment COSA # 0 SG2312q '-7 Waiver # COSA Application—June 2022 Legal Description: COSA Checklist Spring Forest Block 1 Lot 3 Parcel ID: 01.7-3 21-07 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system LL DATA ❑ Well log i � with Onsite (or attached) Date drilled I depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments B. TANK DATA Measured operating fluid level in septic tank 49" Date of pumping 6/2/23 ❑ Required maintenance completed, if AWWTS Comments D. ABSORPTION FIELD DATA Which system tested (date installed) 9/10/42 ✓❑ ALL standpipes present per record drawing Total measured depth from grade 12 ft (max) Measured depth to pipe invert from grade 3.8 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑✓ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies COSA Checklist June 2022 Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative trate mg/L ❑Nitrate less than MRL (ND) Arsenic ug/L E] Arsenic less than MRL (ND) Collected by Date STATION ❑ Require zt( Age of lift station . Lift station material Comments: nce completed Adequacy tesl date 8/12/23 Results Q Pass Fluid depth prior to test 32 in Water added 750 gal New fluid depth 32 in Elapsed time 10 min Final fluid depth 32 in Absorption rate 750+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) Effective depth used 32 in Effective depth remaining 64 in 96 in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ❑ Yes if No ft ❑ Yes if No ft ft If tank or field is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑ Yes if No ft ❑ Yes if No ft Z N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No 5+* ft Surface Water > 100'❑ Yes if No _ Tank to Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑✓ Yes if No ft Private Wells > 100'✓❑ Yes if No _ Water Main > 10' F/❑ Yes if No ft Community Wells > 200' © Yes if No _ Water Service Line > 10' ❑✓ Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *Met code at time of install ft ft ft G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Arcterra Consulting Phone (907)-696-6111 Engineer's Printed Name Kenneth Duffus Date 8 /� Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. do The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The �� �� OF 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 i f7 and the water usage of the family being served by the system. The operational life of all well and septicAp w 49 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 cannot give any estimate of how long a system will 01 Al function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. �A i CNN� A k&FUS CE 7115 COSA Checklist -June 2022 11�����i 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 Parcel I.D. # r 3 N 1 - o-7 HAA # 1. GENERAL INFORMATION Complete legal description Lot 3 • 8tock 1, SnnCng Fon.e,6 t Subdivision Location (site address or directions) 5820 G)ezt Tkee, VkiVe, Anchona,ge., AK Property owner Bntien Reel.? Day phone 346-8283 Mailing address CIO RAL Inspect -.on S ny'0A 901 ('(21jq)1'gAA nk7aP RPuri S111to 9nn CarLmelr IN 46032 Lending agency _ Day phone Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS' 5 3. TYPE OF WATER SUPPLY: Individual well Community well XXX Public Cvater Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1191) 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 furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Phone 6 g y ' a y' 17034 Eagle River Loop Read No. 204 Address Eaule River, .Alaska 99577 ::f2 Engineer's signature 6. DHHS SIGNATURE ' Approved for J Disapproved. Conditional approval for Additional CgmmentS By: bedrooms, atm Date /l(/a.a/ 9S` RS OF A :o ROBERT C. COWAN�i ,C ce -aaol r bedrooms, with the following stipulations: Date /2 -/3 - `/S 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 orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rw. 1/91) Back MOA #21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 91 PYY Health Authority Approval Checklist Legal Description: Loi :3 R L i< 1 S PR,� G Fo/i l s r S1b Parcel I.D.: 07 -S ' 3 e / — ° IV A. WELL DATA (� Well type c H ^"' ' If A, B, or C, attach ADEC letter. ADEC water system number O Log present (Y/N) Date completed� �m Total depth Cased to Sanitary seal (Y/N) W FROM WELL LOG Date of test Static water level Well production _ g.p.m. WATER SAMPLE LILTS: Coliform Nitrate D;irc of sample: Collected by: B.(SEPTI OLDING TANK DATA Casing height vc ground) reoperly protected (Y/N) AT INSPECTION Other bacteria Date installed �'o Z Tank size 1 S "U Number of Compartments -2 _ Cleanouts o/N) yes Foundation cleinout 01N) Y f 3 Date of Pumping C1 Ii, 19.5— Pumper C. ABSORPTION FIELD DATA Depression (Y/& ^�� High water alarm (YA ^ U 1 944 C S• Date installed`i /r0l °' l Soil rating g.p.d./f 2 or ft'`/bdrm) 0 _ System type" E 2 ° r44, ` N r , Length �0 Width Gravel thickness below pipe g Total depth to Effective absorption area I as d Monitoring Tube present(O/N) VC3 Depression over field (Y/6) /'0 Date of adequacy test It / 3.1 `) S Results ((assl ail) �� S S For S— bedrooms Fluid depth in absorption field before test (in.); I `/ Immediately afterloi Ogal. water added (in.): / 7 Fluid depth I 'I • S' (ins.) Minutes later: - W Absorption rate = _ '7 S() + g. p. d. Peroxide treatment (past 12 months) (Y/N) N/�'t k," -Al If yes, give date D. LIFT STATION Date installed Manhole/Access (YM) High water alarm level at* Cycles t E. SEPARATION DISTANCES Size in gallons *Damm "Pump off' level at* SEPARATION DISTANCES FROM WELL ON LOT TO: /v 14 ` C -0/4t Septi holding tank on lot : On adjacent lots Absorption field on lot ; On adjacent to Public sewer main Sewer sewer manhole/cleanout Lift station SEPARATION DISTANCES FRO SEPTI~CyHOLDING TANK ON LOT TO: Building foundation S �+ Property line /f Absorption field_ Water main/service line 10 ,* Surface water/drainage 104 f Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO Building foundation / o Water main/service line , Surface water 1 6 ° Y Driveway, parking/vehicle storage area Curtain drain n a,, t k Nuw iv Wells on adjacent lots 0 ° / .4- Property line S l a o J 4- 30 F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of1funicipal in conformance ivith M )A HfLI guidelines in effect on this date. Signature Engineer's Name /0013-9-47- 6. Cp r✓ q�✓ Date It 6-a / ,-I j` Aw HAA Fee $ km z � Waiver Fee $ Date of Payment !� �Sf _ Date of Payment Receipt Number T r�J ( -q17 Receipt Number Rev. 8/95 OSS: haa.wk.doc r are