HomeMy WebLinkAboutSTUCKAGAIN HEIGHTS #2 BLK 1 LT 5Stuckagain
Heights #2
Lot 5
Block 1
#041-021-34
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On -Site Services Section 825 °L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650 Page of
www.ci.anchorage.ak.us (907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SbJ9g0/03 PID Number: OVI-02/-35/
Name: nn /
K D � /u rc�l9n r
Wastewater System: )9 New ❑Upgrade
Address: �n
1201 Turre C'r. 7�/ /TN�, 99S/S
ABSORPTION FIELD
Phone: Number of Bedrooms:
y
v
Deep TrenU ❑Shallow Trench ❑Bed ❑ Mountl C] Other.
LEGAL DESCRIPTION
Soil Rating:
2—GPD/Ft,
Total Depth from original grade:
/0, 03`— 9,99 Ft.
Block: Lot: Subdivision: q
S A. 0L
Depth to pipe bottom from original grade:
r_
Gravel depth beneath pipe:
slyck4Q n
•BOG • 57 Ft.
FI.
Township: Range: Section:
Fill added above original g!de:
Ft.
Gravel Length:
-36 Ft.
Well:
XNew Upgrade
Gravel wdlh:
2
Number of lines:
/
Distancebehveen lines:
I
FI.
F(.
Classification (Private. A. B. C):
PYrVat k
Total Depth: /
12—r t
Cased to:
it
Total absorption area:
5eD Ft'
Pipe Materfal: .D 3a 3 y
7
ic 9/0
Dnller:� /Rt'_ �r�ll
ll,,``AAtt ✓1
DateODdlled^
7 LJ
Static Water le
UQ Ft
Installer ���Qn�Cs
Date Installed: 1d 99
Yield: Pump Set at Casing Height Above Ground:
iG
TANK
GPM 6 FI. .7— Ft.
SEPARATION DISTANCES
Xseptic ❑ Holding ❑ S.T.E.P. ❑ Other.
To
Septic
Absorption
Lift
Holding
Public(Pdvate
Manufacturer: /
�H/�
Capacity:
lZs�
From
Tank
Field
Station
Tank
Sewer Line
/(JJ OrQ
Gal.
Materia
Number of Compartments:
Well
to
(.
e
G—
Surface Water
/p�'+-
X44 rt
—
—
LIFT STATION
/D
/�
�
Size: -
Man acturer.
Lot tine
><'
>`
Gal,
/0%
m11A
�—
'Pump on' level at:
'Pump ofr
High water alarm at:
Foundation
in.
Curtain Drain
Electrical Inspections performed by.
Remarks: /
rrt G/�
BENCH MARK
Location and Description: L
Assumed Devation:
Ft.
Engineer's Stamp
�h5%hff/ii7S
Inspections performed by: U Dates: let /d a7 9g0°
.2nd /d 2 7111
Department of Health and Human Services approve
® u Kenneth
®�urF
Reviewed and approved by: �%�� �i �f/ , �o Date: Jr 'OO
a,o CE�7116/�0°°,
(Rcv. 11199)
��(.®®
AS—BUILT SYSTEM DETAILS/SITE PLAN Permit SW990183
STUCKAGAIN HTS, #2, S/D, LOT 5, BLOCK 1 PID#041-021-34
IB.0 AV ID DRTv 3 5.00'
P IMARY SYSTEM
co
s eo' TH #9 —
o , MT
WE
Arco • 0 1250 T1 co RES RVE SYSTEM
B co
2 M
4
o�
TH 97-1
O LUT
'so
.00
315.82'
F9 C \l
J("3�lt �'\\ N 80'11'13' E
61.7 tiT� \
"WELL L-6 SCALE- = 50'
A—C=117.7'
FIELD BOOKS
COMPUTED:
BounOAav: ALDS °PAWN:
KMD
B—C=128.2'
w
AseuILT: GASTALDI °ATE-
4/26
DWG. FILE: GRID:
2541
A—D=126.2'
99054
Vu
104.3 FINISHED GRADE
107,2
B—D=136,6'
f
K
ER PFHRIC
V0.PIES
A—E=135,5'
AT
B—E=145,0'
1SEPTICL
99.32
99,37
I
A—F=135.0'
v TANK
SEWER ROCK
3.3.
B—F=150.5'
99.97 99.75
91.95_
91.95
—_n_` -- PREPARED FOR 3G'
oP\\ SCALE NTS 85.50 eox
/�.........f 1
,Of ROB 1 ROB MERCHANT
*1201 SURREY #1
<a TH * #j ANCHORAGE, AKR 99515
....................... ..................... .......AV
�1 KENNETH M. S:�
CE 711 ,: �yq /
G/
pROF'ESSIO'o —
FIELD BOOKS
COMPUTED:
BounOAav: ALDS °PAWN:
KMD
GASTALDI CHECKED:
KMD
AseuILT: GASTALDI °ATE-
4/26
DWG. FILE: GRID:
2541
ACAD FILE: JOB No.:
99054.DWG
99054
RI
JLkLAI J U) ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
®SOF 4
ENGINEERING
°.
20441 PTARMIGAN BLVD. neo gft
EAGLE RIVER, AK 99577-8736
Kenneth M, Duff,° Qt
CE 7176 mss°
SOILS PERCOLATION TEST
Performed for: Rob Merchant Date Performed: 1b .�vq
Project: Stuckagain Hts#2, BIk 1, Lt 5 TEST HOLE # 99-1
Depth
1-
2-
3-
4-
5-
6-
7-
8-
9-
10-
it-
12-
13-
14-
15-
16-
17-
18-
19-
20-
SNI/Org. — soft, brown, moist
SW —brn/gray, gravelly sand
ML — fine sand, silt increasing
w/ density, platelets at
bottom
I x71_.`_!
HOLE PRESOAKED
PRIOR TO TEST
SEE ATTACHED SITE PLAN
FOR HOLE LOCATION
Was Ground water encountered? NO What depth? N/A
Depth to water after monitoring? DRY Date? N/A
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
1
10/26/99
4:00
9"
-
2
4:10
5 min
3 4/16"
5 12/16"
3
*
4:11
9"
-
4
4:21
5min
310/16"
56/16"
5
*
4:22
9"
6
4:32
5 min
3 13/16"
5 3/16"
7
4:33
9"
-
8
4:43
5 min
315/16"
51/16"
9
4:44
9"
-
10
4:54
5 min
4"
5"
11
*
4:55
9"
-
12
5:05
5 min
4"
5"
*
Water
Added
Percolation Rate 1 (m n/in) Perc Hole Diameter 6"
Test Run Between 5.5 feet and 6.5 feet
I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in
effect on this date.
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
Rick Mystrom hitp://www.ci.anchorage.ak.us
Mayor
Permit Number: #SW 990183 Date of Issue: 7-9-99 Parcel Identification Number: 041-021-34
Date Started: 7- ,5-99 Date Completed: 7-16-99 Is well located at approved permit location? ® Yes ❑ No
Legal Descriptiop: Stuckagain Hghts #281k 1 lot 5
Property Owner Name & Address: Robert Merchant
1201 Surrey Circle
Anchorage, Ak 99515
Borehole Data:
Soil Type, Thickness & Water Strata
Depth (ft)
From To
Method of Drilling ® air rotary ❑ cable tool
Casing type: steel
Stick up
0
2
Wall Thickness: .025 inches
Organic & silt
2
5
Diameter: 6 inches Depth: 117 feet
gravelly silt
5
19
Liner Type:
gravel
silty sandy grave129
gravelly silt
19
29
67
29
67
gg
Diameter: inches Depth: feet
Casing stickup above ground: 2 feet
Static water level (from ground level): 85 feet
Pumping level: 124 feet after
silty sandy gravel h2o
99
101
2 hoursg —gPn um i 20 m
P P
sandy silt
101
115
Recovery Rate: 20 gpm
weathered rock H2O
115
124
Method of Testing: airlift
Well Intake Opening Type:
❑ Open End ® Open Hole
❑ Screened Start feet Stopped feet
❑ Perforations Start feet Stopped feet
Grout Type: bentonite Volume: 1 bag
Depth: Start 0 feet Stopped feet
Primp: Tntake Depth feet
Pump size hp Brand Name
Well Disinfected Upon Completion? ® Yes ❑ No
Method of Disinfection:
Comments:
v E®
Well Driller: Alpine DrillingEnterprises
RCC
P.O8ox
{AUG 6 1999
Anchorage, AK 99511
Municipality Hman Ser9ces
Dept. Health &u
Attention: The weti l4ersha11proui&& well log to the property owner within 30 days of completion and the property
nu,nar nr tha wan dxili,r eha11 AJa u,aii Ina to fiha runt n# i-iaoifih 2 iiiunan Carvirae uAthin r(1 (Invc nF rmm�latinn
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On -Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
/v _ 27 - 9v lsf
A0 ; ¢o y n -t
ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Permit Number: SW990183
Legal Description:
STUCKAGAIN HEIGHTS #2 BLK 1 LT 5
Design Engineer:
0070 KND Engineering
Owner Name:
Robert Merchant
Owner Address:
1201 Surrey Circle
Anchorage , AK 99515-4230
Date Issued: Jul 09, 1999
Expiration Date: Jul 08, 2000
Parcel ID: 041-021-34
Site Address:
Lot Size: 47522 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ 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 engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Receiv Date:
Issued By: Z Date: 7— q— ��_
N D ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696-8111
July 4,1999
Municipality of Anchorage
Dept. of Health & Human Services
On -Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519-6650
Subject: New sewer/well permit — Stuckagain Hts S/D #2, Block 1, Lot 5
Gentlemen:
On March 20, 1997, we excavated two testholes for the subject property. The results
of these tests and water monitoring are attached.
We propose to install a 2' wide deep trench. There was no water monitored during
our excavation or after water monitoring. Although the percolation test indicated
that the soils percolate greater than 1 minute per inch the fine sand layer located at
11 feet we believe will provide sufficient filtration of the effluent. Additional fill
will be placed over the system to provide a minimum of 3' of cover when complete.
This lot slopes from east to west at approximately 10-15%, which is away from the
proposed house, and any surrounding wells.
We propose to drill the well east of the house and septic area. There are no public or
private wells within 100' of our proposed system location. There is neither surface
water within 100' nor any known curtain drains within 50'. We do not expect that
there will be any adverse effect on adjacent lots by the development of this system.
If you have any questions, please contact me at 696-6111/FAX 696-8111.
Respectfully submitted,
Engineering
Kenneth M. Duffus,
attachments: On -Site Well and Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/ Percolation Test
ELL' & WASTEWATER DISPOSAL SYSTEM DETAILS/SITE PLA
STUCKAGAIN HTS, #2, S/D, LOT 5, BLOCK 1
maul A
NO PUBLIC WELLS WITHIN 200OF
PROPOSED SYSTEM.
NO PRIVATE WELLS WITHIN 200' OF
PROPOSED SYSTEM EXCEPT AS NOTED.
NO SEPTIC SYSTEMS WITHIN 200' OF
PROPOSED WELL EXCEPT AS NOTED.
LOT 4
Idw Ar
���� of AL4 \,
® *e�49Tx
KED �r Mn 1,,Z:
CE 7711
�e
A�FEss1oP�.H►
ram
TN q9]�
.ARDPMED WELL
LOT 5
wELLLOT 6
BL❑
SEPTIC
LOT 7
V
1
\
LOT IB
_ at
\
1
^, 1
1
1
\
on 1
1
1
1\
\
\
'1 1
1
1
1 11
1 11
1 se
171,
DESIGN DETAILS
4 BDRM X 150 GPD = 600 GPD
600 GPD/1.2 GPD PER SO. FT. (I F MIN/IN.)= 500 SQ. FT
500/(2'(W)) X 7'(D) (7.0' GRAVEL) = 35.8 FT, TRENCH
USE 1 TRENCH - 36(L) X 2' (W) X 7'(D)
Total depth of systen is 10.0' from original grade.
Total depth of gravel below distribution pipe is 7.0'
NOTES
1. USE 1250 GALLON SEP71C TANK. INSULATE TANK IF <4' COVER.
2. INSULATE TRENCHES WITH 2" HD BURIAL FOAM.
3. CONTRACTOR WILL ENSURE MAXIMUM 27. SLOPE INTO SEPTIC TANK,
4. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT
WELLS & SEPTICS. T '
ar hew late �o Ile,"I /
PREPARED FOR dI� �jcroc/C. �rt ��8(Fl
RUB MERCHANT
AI Scale: 1`= 100'
ANCHORAGE, AK
PAGE 1 OF 2
FIELD BOOKS
C MPUTEDI
MNI AJ)ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
BOUNIYARY: R. JOHNS ORAYIN: KMD
STAKING: R. JOHNS CHEPPED: KMD
ASBULT: R. JOHNS pATe: 7 4 99
DWG, FILE:
GRID:
2043
[�
907 696-6111 FAX (907 696-8111
ACRD FILE: 99054.DWG JOB v': 99054
WASTEWATER DISP❑SAL SYSTEM DETAILS
STUCKAGAIN HTS, #2, S/D, LOT 5, BLOCK i
10-150
I
®���� of AZA
*49TH* *$a
EFNN Ull M.
�C`E-77111 �y4
V7/�/ LAG~®
ROFESSIDT`P� d
1 7--)
PREPARED FOR
ROB MERCHANT
ANCHORAGE, AK
FIELD BOOKS
COMPUTeD:
SOUNDAav: ALDS
DRAA1V:
KMD
STAKING: ALDS
CHECKED:
KMD
AsemLr. ALDS
DATE,
7/3/9
011t. Ene
Gam:
2541
ACAo EaE: 99053.DWG
JOB N°'
99053
SER
Scale: 1'= 20'
PAGE 2 OF 2
LE11 J LTJ ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
11
F) W,
Municipality of Anchorage ®*�.•"�¢��Tyt
t DEPARTMENT OF HEALTH 8 HUMAN SERVICES •••• ••• •••
825 "L" Street, Anchorage, Alaska 99502-0650 ,,,••G .s!
SOILS LOG — PERCOLATION TEST/ I 4 Y.enne t1 M. 01 '11,
CE 7116
LEGAL DESCRIPTION
DEPTH
(FEET)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20.
COMMENTS _
0/r 7 C/
0
�'ou/Se .Santry �i�'a✓e�
b -I -n cobblcsJf-o0 8"
P/C. Zoe .
WAS GROUND WATER
ENCOUNTERED?
SLOPE
S
L
/ IF YES, AT WHAT O
F1' )7 . $G hG DEPTH? ��f� P
M L E
Course, Sandy
Depth to Water After
Monitoring? Date:
PLAN
W2
.-- ---
Gross
PERFORMED FOR: CM M
CD V)Y LL +Df
S
DATE PERFC
L/ _ h
_ _ I I1
-'A 9
YZ U/ I
Tn.n,hfn Rannp gPrfinn'
LEGAL DESCRIPTION
DEPTH
(FEET)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20.
COMMENTS _
0/r 7 C/
0
�'ou/Se .Santry �i�'a✓e�
b -I -n cobblcsJf-o0 8"
P/C. Zoe .
WAS GROUND WATER
ENCOUNTERED?
SLOPE
S
L
/ IF YES, AT WHAT O
F1' )7 . $G hG DEPTH? ��f� P
M L E
Course, Sandy
Depth to Water After
Monitoring? Date:
PLAN
W2
.-- ---
Gross
PERCOLATION RATE (mmutes/mChh)) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND (0 FT
PERFORMED BY: I Kennr-L Yl �J�Y! CERTIFY THAT THIS -TEST WASPERFORMEDIN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE.
72008 fRe, 4/85)
)P7
n
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN E
825 "L" Street, Anchorage, Alaska 9950
SOILS LOG — PERCOLATION
PERFORMED FOR: CM )VIII''
Ci>04-LL'
2r5V DATEPERFORMAQ
2-
LEGAL DESCRIPTION:SkUCKQIn
0.4
LT
IS Djh j Township, Range, Section:
-rg-aL
DEPTH
LO S SLOPE
SITE PLAN
I
(FEET)
Or, rW i c,
2-
3
5
�'✓I?Gv��IGSU'�v8n
7-
PrG. Goy .
8-
9-
910
10-
WAS GROUND WATER
O
ENCOUNTERED?
11
S
IF YES, AT WHAT L
A O
A
12
DEPTH? n E
E
13
Depth to Water After
Monitoring? Dale: -:5,"7
14 � —I— 1$o H
15
16
17
18
19
X
20 u
PERCOLATION RATE (minutesnnch) PERC HOLE DIAMETER 62
TEST RUN BETWEEN FT AND 4P FT
COMMENTS -
PERFORMED BY. X-NI11 I Kevinr.l. k14S&5 CERTIFY THAT THIS TEST WAS PERFORMED M
,ORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE
\ ar\
F7
BURNING BUSH DRIVE
S9*48'47"E 117.83
1 30' 30'
1 *0 40D
LOT 5
BLK 1
Li
> 00
ry • SEPTIC
PIPE
t yp)
0
n
(Y
0
< 0
LO 0
r4') 00
•
\ T-
00
WELL
PAVED •
D/W
3
9 7'
58.0'
A,
O
C"
17
5�
ANCHORAGE RECORDING DISTRICT, ALASKA 4� =FNT) AI TMTNT TM MONI TMENT
AS -BUILT OF: Q = FND 5/8" REBAR
STUCKAGAIN HEIGHTS ADD Not
LOT 5 BLOCK I PLAT 80-101
Sul?
L A
SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a Aw A • 0• F
physical survey of this property as shown on this drawing and that the '0W
improvements situated hereon are within the property lines and no
10
enchroachments exist other than noted. Under no circumstance should o', 49TH
any information on this drawing be used for construction of fences, A0 .A':Zz % z
.......... . ...... C') a'
structures, improvements, or for establishing boundary lines.
FAFVAZ................ ................EXCLUSION NOTES: It is the owners responsibility to determine A da -,J HN L. SCHULLER: 0
__N_ the existence of any easements, covenants, or restrictions which qj � �f
do not appear on the recorded subdivision plat. Oi �; LS-10408 0;0,
4 831 Talkeetna Street
DATE: SCALE; E—MAIL: Anchorage, Alaska 99508
WORK ORDER NUMBER: JUNE 1, 2024 1 " =40' schuflerakftmafl.com ,2.0d.
DRA*4 B CHECKM BY: GMD NUMBER., 8001</PAGE: essiono\ (907) 227-1455 office
24-051 A•*P"
'I JLS SW2043 240202®\ (907) 274-4992 fax
Y,
Parcel I.D. 041-021-34
Certificate of On -Site Systems Approval
Expiration Dater Z,
Legal description STUCKAGAIN HEIGHTS #2 BILK 1 LT 5
Site address 9825 NEARPOINT DR Anchorage AK
Current property owner(s) HARNESS
X The On -site system(s) is/are approved for 4 bedrooms
Conditional approval for
Comments or advisories:
bedrooms, with the following stipulations:
Original Certificate Date: 6/17/2024
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 X Arsenic Advisory
Other
COSA Approval June 2022
1. GENERAL INFORMATION
Parcel I.D. 041-021-34
Complete legal description STUCKAGAIN HEIGHTS #2 BLOCK 1 LOT 5
Location (site address) 9825 NEARPOINT DRIVE, ANCHORAGE AK 99507
Current property owner(s) EVAN & ELLEN HARNESS Day phone
2. ON -SITE SYSTEMS SIZED FOR 4 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: ® Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age 25 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ® 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 $ Waiver Fee $
Date of Payment 3
COSA # 05C 2H 116 7
Date of Payment
Waiver #
COSA Application.doc
COSA Checklist
Legal Description: STUCKAGAIN HEIGHTS #2 BLOCK 1 LOT 5 Parcel ID: 041-021-34
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system
A. WELL DATA
® Well log is filed with Onsite (or attached)
Date drilled 7/16/1999 Total depth 124 ft
Cased to 117 ft
® Sanitary seal is functioning correctly
® Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 5/20/2024
Static water level at beginning of test 90 ft.
Comments
B. TANK DATA
Measured operating fluid level in septic tank 49"
Date of pumping 5/20/24
❑ Required maintenance completed, if AWWTS
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed)10/27/1999
® ALL standpipes present per record drawing
Total measured depth from existing grade 14 ft (max)
Measured depth to pipe invert from grade 5_1 ft (min)
❑ N/A — pressurized field.
❑ Per record drawings, field is insulated.
® Monitor tubes (MT) go to bottom of effective. (ED)
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) N
If yes, enter date
Well production at time of test 4.2 gpm
Water storage tank volume NONE gallons
Well disinfected for coliform test? ❑ Yes ® No
® Coliform bacteria is Negative
Nitrate 4.89 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ® Arsenic less than MRL (ND)
Collected byFwrs
Date 4/25/2024
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 5/20/24
Results E Pass
Fluid depth prior to test 4 in
Water added 600 gal
New fluid depth 7 in
Elapsed time <20 min
Final fluid depth 4 in
Absorption rate 600 and
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 88 in (MOA TT ED)
Effective depth used 4 in (Final Fluid Depth)
Effective depth (ED) remaining 84 in
Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots &
appears approximate.
COSA Checklist.docx
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' 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' Animal Containment > 50' ® Yes if No ft
® Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ® Yes if No ft ® Yes if No ft
❑ 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 ft Surface Water > 100' ® Yes if No ft
Tank to Property Line > 5'
® Yes if No ft
Field to Property Line > 10'
® Yes if No ft
Water Main > 10'
® Yes if No ft
Water Service Line > 10'
® Yes if No ft
F. ENGINEER'S COMMENTS
Wells on Adjacent Lots:
Private Wells > 100'
Community Wells > 200'
® Yes if No ft
® Yes if No ft
If tank or field is under driveway comment below
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 FIRST WATER CONSULTING Phone 907-350-9566
Engineer's Printed Name CURTIS HUFFMAN PE Date 6/11/2024
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. 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 in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. 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, any or NO estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting & FWrS
o1`C4q�1
/// � ► TM *�
• • ♦ . • • . . . . . . .
• Curtis Huffman /
��jF •,• CE 1289916/11/24 �.•c/
AW
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COSA Checklist.docx
MUNICIPALITY _
DEVELOPMENT SERVICES E?EPAPTMI CST j '� 907-343-7904
On -Site Water and Wastewater sectionNX, Fax. 343-7997
ww,w.muni.org/onsite \
Septic Tank Advisory
Certificate of On -Site Systems Approval # OSC241167
Subdivision: STUCKAGAIN HEIGHTS #2 Block:2, Lot: 5
The septic tank for this property is 25 years old. The average life of an asphalt
coated steel septic tank is 20 years. Typical replacement costs are $10,000 or more,
not including engineering, surveying or MOA permitting fees.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
Municipality of Anchorage
004Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
470South St. []i
P.O. Box 196655 0 Anchorage,
AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 041-021-34 HAA# 03o u%O
1. GENERAL INFORMATION
Expiration Date: .Z ' C 3
Complete legal description STUCKAGAIN HEIGHTS SUBDIVISION #2: LOT 5, BLOCK 1
Location (site address or directions) 9825 NEARPOINT DRIVE * ANCHORAGE, AK * 99507
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
ROB k DELORIS MERCHANT Day phone 529-4844
9825 NEARPOINT DRIVE * ANCHORAGE, AK * 99507
Day phone
MARIANNE GRANT W/ PRUDENTIAL JACK WHITE Day phone
762-3168
3201 "C" STREET, SUITE 200 * ANCHORAGE, AK * 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well
0
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
0
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid
water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. 1 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, AKWWC, inc. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & 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 identirrable 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 water 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. AKW WC, Inc. 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 sole 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.
5. DSD SIGNATURE
ZApproved for L� bedrooms.
Disapproved.
337-6179
Dater) b I L10-?
Conditional approval for bedrooms, with the fllowing stipulations:
NOTE: The well for this nronerty meets existing Srare an11 Mnnicinal Codes. There
are nitrates present. It is suggested that periodic testing be performed to insure
the wells continued suitability. Current nitrate concentration is 6.30 mg/1. EPA
n^"nant mann is 10.0 m2/1. More information on nitrates is available
from the On—Site Services Program, at 343-7904.
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Manitenance Agreements
Supplemental Engineer's Reort
Other
By: Original Certificate Date:
(Rev.12101)
-a--9-o3
Municipality of Anchorage
Development Services Department *A9
Building Safety Division
O"Ite Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.d.anchorage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: STUCKAGAIN HEIGHTS SUBDIVISION #2: LOT 5. BLOCK 1 Parcel ID: 041-021-34
A. WELL DATA
Well type PRIVATE If A, B. or C provide PWSID# N/A
Date completed 7/9Z 1999 Sanitary seal (Y/N) YES
Total depth1124fL Cased to 117 ft.
FROM WELL LOG
Date of test 7/9/999
Static water level 85 ft.
Well production 20 g.p.m.
WATER SAMPLE RESULTS:
Coliform n_ colonies/100 mi. Nitrate &.5 mg./L.
Well Log (Y/N) YES
Wires property protected (Y/N) YES
Casing height (above ground) 24 in.
AT INSPECTION
9/9/2003
92 ft.
4.6 g.p.m.
Other bacterta 0 colonies/100 ml.
Arsenic _.N/A mg./L.Date of sample: 9L9/2003 Collected by: AKWWC, INC.
S. SEPTIC/HOLDING TANK DATA
. Tank Type/Material STEEL Date installed 10f 27/
Tank size 1250 gal. Number of Compartments 2 Cleanouts (YM) YES
Foundation cleanout (Y/N) M Depression over tank (YM) NO High water alarm (Y/N) N/A
Date of pumping 9/9/2003 Pumper CHUGACH PUMPING
C. ABSORPTION FIELD DATA 10BELOW ExISnN0 G E
Date installed 10/27/1999 Soil rating p.d. r fI1bdnn) 1.22 System type DEEP TRENCH
Length 36 ft. Width 2 R Gravel below pipe 7.3 ft.
Total depth•_„ 11 ft. Eff, absorption area 500+ ft2 Monitoring tube YES Depression over field NO
Data of adequacy fast 9[9/2003 Results (Pass/Fatl)Pte, tFor 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added 861 gal. New depth 4 in.
Elapsed Time:t 7 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date —
D. LIFT STATION
Date installed
"Pump on" level at in.
Datum
E. SEPARATION DISTANCES
Size in gallons
High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?,
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 1000+
Absorption field on lot 100'+
Public sewer main N/A
Sewer /septic service line '8'
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line t0'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 1001+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. 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 HAA guidelines in effect on this date.
Engineer's Printed me JEFFREY A. GARNESS
Date —T hN3
HAA Fee $ � 1.7 • Waiver Fee $
Date of Payment °L'e'as Date of Payment
Receipt Number � r L 17 C Receipt Number
(Rev. 1?101)
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44.
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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. # "w- ev- 3//�-
HAA # O01 W b
1. GENERAL INFORMATION
Complete legal description SfuC/�agg>n ft�S• Z7 311, LS
Location (site address or directions)'
Property owner0� Merc�iGn Day phone
Mailing address �o�OI SUr C'ir: 79V 4nckora�a , 4A- VS75
Lending agency Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well X
Community well :
Public water
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 �—
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(Ra,1/91) Front MOA1121
5.
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed, hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm �k'N� �y ihYtrih9 Phone (907) (n9G-la//l
Address fIK 99,r77
Engineer's signatur r Date
6. DHHS SIGNATURE �8�® PRO.....
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
/.'X r The yP11 f— -rb' r meet2 exlstlngSt,te and MunIcipal CA
There are nitrates present. It is suggested that periodic testing be
performed to insure the wells continued suitability.. Current nitrate
concentration is 5.66 mg/1. EPA maximum concentration is 10.0 mg/1.
Mo"re-information on nitrates is available from the On-site Services Program,
BI•HIS, 343 4444.
By: �%�i /—E Date
ItITIC
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.
]2-0251Rev. Ustl Back MOAk l
RECEIVEu
Municipality of Anchorage APR 28 �00�
DEPARTMENT OF HEALTH & HUMAN SMWQQ ,98r or ANCHo&ACE
Environmental Services Division"A('NMENTALSERVIcFe nnm 6
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
Health Authority Approval Checklist
Legal Description: SNC R�`/H A41S• W2- 1, /?/,,GS Parcel LD.: X/ -421-3Z/
v
A. WELL DATA
Well type Pt' /'Va 16 If A, B, or C, attach ADEC letter. ADEC water system number
Log present_(Y/N)
Total depth
Sanitary seal(Y/N)
Date of test
Static water level
Well production
V Date completed 67125Z79i7
/a L/ / Cased to //7 Casing height (above ground)
Y Wires properly protected (Y/N)
FROM WELL LOG
67/2 s /99
8$ �
WATER SAMPLE RESULTS:
Coliform
0
AT INSPECTION
2/
g.p:m. g.p.m.
Nitrate S && Other bacteria
Date of sample: OY1,4//2'900 Collected by: 'eIVA Z9i4eeiih9
B. SEPTIC/HOLDING TANK DATA
Date installed /d a7 99 Tank size%Number of Compartments 2 Cleanouts (Y/N)�
Foundation cleanout (Y/N) Y Depression (Y/N) Al High water alarm (Y/N)
Date of Pumping
C. ABSORPTION FIELD DATA
Pumper
Date installed /D 7 %9 Soil ratingg.p.d./ft or ft2/bdrm) /, 2- System type . CCA T'e"e4
Length 3�Width / Gravel thickness below pipe 73' Total depth //I). e3 '
Effective absorption area SDO &-F Monitoring Tube present (Y/N)—�L Depression over field (Y/N) t/
Date of adequacy test
Results (Pass/Fail)
Fluid depth in absorption field before test (in.);
Fluid depth
(past 12 months) (Y/N)
72-026 (Rev. 3/96)`
Absorption rate =
For
gal. water added (in.):
If yes, give date
D. LIFT STATION
Date installed
Manhole/Access (Y/N) "Pump on" lev
High water alarm level at* Datum
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
r�
Size in gallons
"Pump off" level at*
/-1-
Septic/holding tank on lot /Oa On adjacent lots /vv
r
Absorption field on lot M i� On adjacent lots /Qd
Public sewer main &A Public sewer manhole/cleanout A/fF
Sewer /septic service line '25- r � Lift station /VA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation /D /� Property line /d /� Absorption field
Water main/service line M /'f Surface water/drainage %06 /s Wells on adjacent lots /Ods f
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
/
Property line �6 r� Building foundation 1,414 Water main/service line /d
Surface water Driveway, parking/vehicle storage area
Curtain drain /D b Wells on adjacent lots
F. ENGINEER'S CERTIFICATION
A
i certify that I have determined thru field inspections and review of Municipal re o .i a oaf Items are
in conformance with MOA HAA guidelines in effect on this date. AV Gj ; •°°•• �� ��
Signat
_.. •���. °HOC° b�i_S y�e e
Engineer's Name
Date 'y
HAA Fee $ Cl 1
Date of Payment
Receipt Number G
72-026 (Rev. 3/96)*
01M
Waiver Fee $
Date of Payment
Receipt Number
Kenneth M. Duffus
CE 711A