HomeMy WebLinkAboutT15N R1W SEC 8 LT 35Onsite File T15N R1W Section 8 Lot 35 #051-091-22 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211203 PID Number: 051-091-22 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New Upgrade Name Troy Davis Homes INC A ORPTION FIELD ElD Trench El Wide Trench El Bed El Mound Site Address 1689 S Knik Goose Bay Rd #400, Wasilla, AK 99654 Other Phone (907) 357-9394 Number o f Bedrooms 4 Soil Rating Total depth from original grade Existing D/SFJ Ft. LEGAL DESCRIPTION Depth to pipe invert from original de Gravel depth beneath pipe F . Ft. Subdivision Block Lot 35 Fill added above original grade Gr I length Ft. Ft. Township Range Section 15N 1W $ Gravel width Ft. Beds: Number of Lines Dista a between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between tr hes From Tank Field Tank Line Ftz t Well >100' > 100' N/A N/A >25 TANK Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Infiltrator Capacity 1530 Gal. Surface Water >1 >100' N/A N/A Material Plastic Number of compartments 2 Lot Line >5' >10' N/A N/A NA Foundation >10' >10' N/A N/A LIFT STATION Manufacturer Capacity Remarks Tank -only permit Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank D3034 drainfield Tank to D3034 Precision General Contracting Drainfield Existing CO/MTD3034 Inspector J. Millette BENCH MARK (Assumed elevation) 100 ft Inspection 1St 6/9/21 Location and description dates: 2 nd 'tnh Bottom of siding 3i° 4 ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp OF A Conditional Approval: Date ,law�Q'! • ' ' , cA,� 4TH ........... Septic System % �•, Benjam(rLSchiller �� <`' • CE 122 -^— /.� �ZDZZ Approve �� Dat• 4 /s/2z ����slF�. , . llki pROFESSIONP�� Note: this approval does not include well permit requirements. 1RCV VJ/VL/ 10) T1 5N R1 W SECTION S, LOT 35 PERMIT # OSP211203 50' ROADWAY & UTILITY RESERVAT/IONS i ( EXISTING TANK REMOVED I & DISPOSED OF PER UPC 2C01 PID #051-091-22 � � I l� f EXISTING WELL w/ 1 00'RADIUS F i �— ABSORPTION FIELDS TO REMAIN IN SERVICE EN GI NC B R1 NG _4 49 TM 0 .... .......... Benja i Schiller CEz2 415/2022 i�®a_ PROFE5S100P .®. LOT 35 50' ROADWAY & UTILITY RESERVATIONS PLAN AS -BUILT 0 50 100 FEET 111=50' A B 2CO1 74.5 80.1 MH 78.8 83.1 SV 88.1 90.4 2CO2 93.4 94.2 LEGEND CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE T1 5N R1 SECTION 8, LOT 35 PERMIT # OSP211203 PID #051-091-22 eNciHeeaiNc (NO SCALE) _ATI ON ALLER ..:. . •'...'.? . 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Ut co 2 l'022 M„ O2,Z0.00 N W c0 CD ,CL -OCC 3,ZO.00 s e®n18 ASNns W m 0 o ` 111.0' D wW m10 a zn PP. Cm b M iw a \ N �t LM ,CL -OCC 3,ZO.00 s e®n18 ASNns W m 0 D a zn Cm b M 2.3' LM > (1 � r 0 X. 0 x o zz VMP 6/8/21 ['01UNICIPALITY 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 APPLICATIONf Parcel I.D. 051-091-22 Property owner(s) Anthony P Losey Day phone 229-8749 Mailing address 20726 Sunset Blvd, Chugiak, AK, 99567 Site address Same Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) T1 5N R1 W Sec 8, Lot 35 Lot Size 108,900 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank Upgrade FX-1Duplex ❑ (D) Holding Tank ❑ Renewal ❑ Multiple Dwellings El ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. t � (Signature of property owner or authorized agent) Permit/Rush Fees: P`USl- Date of Payment: ao� Receipt Number: oE Permit No. osp X 1 1 2 0 3 Permit App__-: ,_..:c: Waiver Fees: Date of Payment: Receipt Number: Waiver No. June 7, 2021 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 6/7/21 Subject: T15N R1W SEC 8, Lot 35 – Sunset Blvd Septic system design Dear On-Site Services Engineer: The owner of the above lot has a septic tank that has reached the end of its expected life, so we are submitting this permit application for its replacement. The attached site plan identifies the location of the home as well as the wells and septic location. No conflicts exist between this proposed system and any other well or septic system, whether on this lot or adjacent lots. The new tank will be a minimum of 100’ from all wells and surface water, and more than 5’ away from the absorption fields. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211203, Rebecca Carroll, 06/08/21 FCO 1"=50'4-BDRM HOMENOTE: NO SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND T15N R1W SECTION 8, LOT 35 SUNSET BLVD.FEET 0 50 100 6/7/21 50' ROADWAY & UTILITY RESERVATIONS 50' ROADWAY & UTILITY RESERVATIONS ABSORPTION FIELDS TO REMAIN IN SERVICE REMOVE EXISTING TANK & DISPOSE OF PER UPC CO 2CO NEW 1250-GAL SEPTIC TANK w/ 20" MANWAY EXISTING WELL 100' WELL RADIUS Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211203, Rebecca Carroll, 06/08/21 w M J 330.1 a) U') J 00 U7 J 1 P b0�; X44 oc�`�• LO v) �D� �O•. C) -):z N 4pa o Q �: •w �.• Q2p a 4p Sa : . REGI o cn I I I O �40000�� z O Q m o O Y m o O L E m 0 o: O a a Ja IL I U I SUNSET BLVD. C O m m o — — maw E m 0- m Co. S 00'02'E 330.13' 185.1 o - E a N nl > n N T N w b a ° a m �3 -Iavmmrn I roOtc �cm� a m, 31 — I I z 0 �NN0Q>`� 0 JZI w ON tmc N 6 O CV 3 l / a o r 0.0 c lsi I 0 ^rnrnyc O2, oim "%90 �goo I .OM° a oI � caE � 03gdz>am= v1 Hm wm rom OL o (� 0FZ -w0oo mm II N cO� L 11IV13CI 3SnoH + r7 33S o w M J 330.1 a) U') J 00 U7 J 1 P b0�; X44 oc�`�• LO v) �D� �O•. C) -):z N 4pa o Q �: •w �.• Q2p a 4p Sa : . REGI o cn = O �40000�� z O Q m o O Y m o O L E m 0 o: O a Ja IL L O O C O m m I maw E m 0- m Co. c o m o - E a N nl > n N T N w b a ° me �3 -Iavmmrn I roOtc �cm� a m, 31 — I I z 0 �NN0Q>`� 0 JZI w ON tmc N +�C m O CV 3 l o n LO c° a o r 0.0 c ae 0 I 0 ^rnrnyc O2, oim _ N �goo .OM° a oI � caE � 03gdz>am= v1 Hm OL o (� 0FZ -w0oo mm II N cO� L 9wE~ o + 20 p—NL I me >c� �I � oaoon°0 I EO �W 0y3jt 00 U ] and Ijj J N VI Z N w 3° m Or; y I 0-0 w -0° ° cm cTc y `m Ya 'm cv0Z C.)C:mN Z OL O QV x C M JI JV a m .°O O m > > toaor Q C) LFm rl >.2 00+-c«a rl S o Z W O +y_ � t y 0 0 `m y d U O m mcc > y y 0 1 y w JN fO EtO0,2 m N U Y d�Oa °rym LO msLEEm mz � a czomo o > O O U) am 0 =0 Xd' w a Municipality of Anchorage Page ~¢- _of _~" DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~"~ ~ C~ ~ ~-~' PID Number: ~ ~ ~ '~ ~'~ ~'"":~ A L.~ ;~d[,S ~ Wastewater System: D New ~Upgrade ~ddress:ZOT~ ~.SC~ ~¢ ¢~ J ABSORPTION FIELD , v I e .T,eno, ~ShailowTrench ~Bed BMound ~Othe, LEGAL DESCRIPTI O N Soil Rabn9: Tola~ Depth from original~/grade: /. 7- ~s Block: Subdlv~ion: Lo(: Township: Range: [ ~' Section: WELL: [] New [] Upgrade,............-- From Well- Sudace Water Lot Line Foundation Cudain Drain Remarks: ¢r.,5 bc~,~ · Gravel depth benealh pipe £ SEPARATION DISTANCES To Absorplion Field Fill added above origin! ride: - /,~? Number of fines: Distance belween liras: ~'~ R. 2-- /:~ Ft Total absor~ion ar.~ I Pipe material: ~) :~ ~ ~// TANK ¢~,,Se pt ic [3 Holding T.E.P. Manufacturer: Capacity in gallons: Number of Compartments: I00 .+ LIFT SI'ATION Size in gallons: Manufacturer: "Pump on*' level at: High water alarm at: Electrical Inspections performed by: BENCH MARK \ Inspections performed by' ~[) ~¢3a~.~¢_~_ Dates ls~,¢~_ '- ~ ~ Depart.ent of .ea,~ an? HLtman Services Reviewed and approved by' ~~ ~- Date'/~-~-r Location and Description: Assumed Elevation: ENGINEER'S SEAL AS-BUILT SYSTEM DETAILS/SITE PLAN swssosss LBT 35, SECTIBN 8, T]SN, RlW, SEWARD MERIDIAN PID~051-.091-~ m EX~STING FIE_I} TB BE RETAINED FINAL GRADE A-E=145,0' ~ EANK J SEWER RBCK , ~.~,, B B:176,0' I~ T~ENCH 1 B-F=156.7' ~ aSR ~ TRENCH a I t PREPARED FBR: ~ CN--~I8 eOUNO,~Y: SEWARD DRA~: K~O MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Sfreet, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 ¢O7) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Sep 25, 1998 Expiration Date: Sep 25, 1999 Permit Number: 8W980386 Legal r)escription: T15N R1W SEC 8 LT 35 Design Engineer: 0070 KND Engineering Owner Name: John & Lennie Davis Owner Address: 20726 Sunset Dr, Chugiak, AK 99567- Parcel ID: 051-091-22 Site Address: 020726 SUNSET BLVD Lot Size: 108900 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. Frem 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. 5. The following special provisions. Total depth of system to be 6 feet or less. Date: Date:_ EAGLE PdVER, AK 99577-8736 (907)696-6n1/FAX (907)696-8111 September 21, 1998 Municipality of Anchorage Dept. of Health & Human Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: Upgrade Sewer Permit - Lot 35, Section 8, T15N, RIW S.M. Gentlemen: At the request of the owners, on September 14, 1998, we excavated one testhole for the subject property to upgrade the existing system which we identified as in failure after our inspection. We installed a monitoring tube with our testhole. The results of this test and water monitoring are attached. We propose to install a 5' wide shallow trench while retaining the existing field for use in the future. The testhole registered water at 10" from BOH upon monitoring. Our proposed system is designed with a minimum of 4' of separation above the ground water. We do not anticipate additional fill being needed over the system. This lot is relatively fiat and slopes to the northeast away from the wells and the house at approximately 2-4%. There are no public or private wells within 100' of our proposed system location except as noted. 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, ]I,{}1~[ ~ Engineering attachments: On-Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Tests WELL & WASTEWATBR DISPOSAL SYSTEM DETAILS/SITE PLAh LET 35, SECTU]N 8, T15N, Ri~/, SEWARD MERIDIAN D MT EXISTING FI LD 1-U 9E RETAINED o WE ¥/ PRIMARY SYST SPLITTER T 35 o WELL DESIGN DETAILS 4 DORM X 150 GPD- 600 GPO 600 GPO/l.2 GPO PER SQ. FT. - 500 SQ. FT <500/(5')) X O.70(RF) (2.0' GRAVEL) = 70 Fl'. TRENCH USE 2 TRENCHES 35'(L) X 5'(W) X 2'<D) Tot(il depth DE system is 7.0' ?rom origino. L gPo. de. Toto. I depth oF 9revel betow distribution pipe is 2.0' . NBTES~ 1. INSULATE TRENCHES V/[TN 2' HD BURIAL FOAM.. 2. CONTRACTOR WILL ENSURE MAXIMUM 2X SLOPE INTO SEPTIC TANK. 3. ADDITIBNAL FILL V/ILL DE ADDED BVER SYSTEM TB ACHIEVL 4, CONTRACTOR TO EXCAVATE TANK AND VERIFY INTEGRITY, REPLACE IF REQUIRE[ 5, INSULATE TANK IF <4' COVER. PREPARED FBR~ JONN & LENNIE DAVIS 20726 SUNSET DRIVE Sco,/e: 1',= 50' CHUGIAK, AK 99567 (907)688-2324 SHEET i/2 F,ELD BOOKS COMPUTSD: l.~ ]~ ~[~ ENGINEERING 80UNOAR¥: SEWARD: DRAI',,~: KMD STAKING: SEWARD CHECKED: KMD P~0441 PTARMIGAN BLVD. EAGLE RIVER, AK 995??-8?36 AS~U.~: SEWARD DATE: 9/21 /98 D~c r,m oR,o: NWl 5~ ACCO r,,E: 98119.DW0 ~0, ~o.: 98119 [9071696-6111/=AX [907~696-8ill WASTEWATER DISPOSAL SYSTEM DETAILS LOT 35, SECTION 8, T15N, R]W, SE~/ARB MERIDIAN / EX]~ST]_NG FI-LD TB MT P~~~ PRIMARY SYSTEb a~ ~ PREPARES FOR~ . CHUGiAK, AK 99567 c~-Tn~ ~ ~ ~o~o~: .~: ENGINEERING ~-~ SEWARD KMD _ ~OassiOS~V ~ ~'~': SEWARD o,,e 9/2~/98 ~~ ~vm ,,L~: cmo: NW1357 20441 PTARMIGAN BLVD. ,,.....-~....?..~.{.q ....... ~ ....... ~........~ ~:AGLE RIWR, AK 99577-8736 ~~~'..._. ~ , ~'~~.-....~.~.~ SOILS LOG- PERCOLATION TEST ~;~"'~Z%!15~' Performed for: %1o ~ ~ L~)t ~ ~ 5 ...... Date l erR.'med: _~_ Legal Description: ~ ~ ~ ~ T~ ~ ~ { ~_ TEST HOLE ~_ SEE ATTACHED SITE PLAN FOR HOLE LOCATION 3- 4- 5- 6- 7- 8- 9- /0- 11 12 13- 15 [7- 18 20 Was Ground water encountered? ~7 . What depth? /Z Depth to water after monitoring? /_/,_~" [)att. Reading Date Gross Net Depth to Net Time Time Water Dro. p~ 7 '~ ~ '33 -- ~" /~ ~.'~ /~,,,~ /.~ ../ f . MUNICIPALITY OF ANCHORAGE 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE ~EWAGE DISPOSAL SYSTEM AND/OR WELl.. INSPECTION REPORT ~me _ .2n~ ~gvlS ~ DISTANCES Address '~1~__ SEPTIC ABSORPTION ~.0.~30~ /~0~0~ ~c~or~,~qqSJq TANK FIELD WELL Township, Flange, Seclion ~ ~riveway, water bodies, etc} ~ SEPTIC TYPE OF SYSTEM U] TRENCH ~ BED D W, DRAIN original grade /~.0 FT ~ FT ~ (~ FT WELLS _ ' ~ ce~ily that Ih~ Jasper[on was pedormed according Io all 72-013 (3/85) ,iI[]N D(- V .I. (,d IM'l(Jl'~(,ibl:;; , :l: NS"I (~tl .I.. PE:F:i: IENE) ]: I~IIEE:I::~;i J(Z)IEB I [')N ,, NEiT' I I::;'Y DI'IH.r~ t ....... I ~ I/. ~ ..... 'I"D I:::,(,~I.,.FI' I: N iiI:::'E'I", T, T "IN,, I I.'.1 ]. ,:~ I:::'lii:l::i~l~l I T :1: ,::~ ~'' I SI,~iI.IIE[) I:::OR 'rHIE lie X ,[ ,;:~ I ,I I IF.~ Zl. , I:,I)l I I( III S~ALE PERFORMED FOR: LEGAL DESCRIPTION:~.~ 07_ 3 -/~--- ~' o~. 2 3 4 5- 6- 7- 8- 9- 10- 11 12 13 14 15 16 17 18 19 20 Municipality of Anchorage ~f/~ DEPARTMI!NT OF HEALTH & HUMAN SERVICES ~ 825 "L" ,Street, Anchorage, Alaska 99502-0650 . SOILS LOG -- PERCOLATION iEST v~-.~/~', ¢~, Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUm-ERED? IF YES, AT WHAT f~ SL DEPTH? . ( O'~ pO E SUNSET LANE Depth to Y/aler Aller ' Moniloriflg? /O O~te: "~ ~ ~ ~ PERCOLATION RATE ~".~mmutes/inch) PERC HOLE DIAMETER Reading Date Gross Net Depth to Net Time Time Water Drop COMMENTS _ S ~'~}C;'~Ec~I~ !7034 Eagle River Loop Road No. 204 EagLe River, Alaska 99577 ~/ / PERFORMED BY: __ 7--/."" ¢%~ ~/ CERTIFY THAT THIS TEST WAS ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDE~CT ON THiS DATE. DATE:, PERFORMED IN DOC Co, dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 ,, TELEPHONE 688.2759 OWNER OF LAND ADDRESS LEGAL DESCRIPTION DATE - Started PERMIT NUMBER DEPTH OF ¥~ELL :~gO -7 Ended ~/':~ (. STATIC LEVEL OF WATER I:'I' d.: ,' -~ DRAW DOWN IrT. GALS. PER HR / KIND OF CASING '- / KIND OF FORMATION: From :'/ Ft. to ~V __Ft. From ' Ft. to '"' Ft, From '--t' Ft. to" '; Ft From .~ ' Ft. to ::,-:' Ft. From Ft. to ~ :-' .... ) __Ft, From ,',~ Ft. to ~ ~ Ft. FromS~__t :, Ft. to(-1 -] Ft. From-'i '7 Ft. to,¢~.='~ From :;~ [ Ft. to ( :~Ft. From: ~2 Ft. to [~ Ft. From~/ , Ft. to" __Ft. From_ __Ft, to__Ft From Ft. to____Ft. From__ Ft. to Ft. From Ft. to Ft. From Ft. to.____Ft. From Ft. to __Ft, From.__ Ft. to Ft Frmn__ Ft. to Ft 52 .~ d g,: ,.: '5 Froln Irt. to Ft. From__ Fl, to Ft,_ From __Ft. to- Ft From FI. Io G h' From Ft. to Fl From Ft. to Ft. /) C/ Fron Ft. to FL From Ft. ~o From ~_Ft. ~o~_ FI From Ft, to Ft From F . to_~ ~' From~ Ft. to_ Ft From Fi. to SE~t. 2 1997 ~,..MunicJp~i.~y ul A~cho~a From Ft. to_ _Ft M1SCL. INFORMATION: (- , ?,, ~ , ,'-)'.> ,- ~ - ,.,, DRILLER S NAME ___, - ~'/ ..... PAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW960251 DESIGN ENGINEER: OWNER NAME:DAVIS JON A & LINNIE L OWNER ADDRESS:P.O. BOX 140806 ANCHORAGE, AK. 99514 DATE ISSUED: 8/13/96 ]EXPIRATION DATE: PARCEL ID:05109122 LEGAL DESCRIPTION: T15N R1W SEC 8 LT 35 LOT SIZE: 108900 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: WELL 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. 1 OF 8/13/97 SPECIAL PROVISIONS: RECEIVED BY: SCAL.E 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 Parcel I.D. 051 -091-22 1. GENERAL INFORMATION Expiration Date: 7 - I 2-©z_ Complete legal description T15 N R1 W SEC 8 Lot 35 Location (site address) 20726 Sunset Blvd, ChUgiak, AK 99567 Current property owner(s) Troy Davis Homes Inc Day phone (907) 357-9394 Mailing address 1689 S Knik Goose Bay Rd #400, Wasilla, AK 99654 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: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑■ Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. Date of Payment Waiver Fee $ Date of Payment Receipt Number 0 X19 3 �) Receipt Number COSA # 0 S C jV i `A 3 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering (M.J.) Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date 4/13/22 Idw 4s -*r 6. DSD SIGNATURE •�• System #1 Approved for bedrooms '. • Benjar%,,Schiller / System #2 Approved for bedrooms }jc��jF 4E132292 Disapproved llk%,\`E`SSSO' Conditional approval for bedrooms, with the following stipulations: VV/-% t L- "">»)))))»>.),,. By: I � Original Certificate Date: _ / 3 . Z O 2? 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 Checklist blue sheet Legal Description: T1 5N R1 W SEC 8 Lot 35 If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ®❑ Well log is filed with Onsite (or attached) Date drilled Aug 1996 Parcel ID: 051-091-22 of Structure served by this system Well production at time of test *1.0 gpm Water storage tank volume N/A gallons Total depth 84 ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to >40 ft 9 Coliform bacteria is Negative 0 Sanitary seal is functioning correctly Nitrate mg/L 0 Nitrate less than MRL (ND) RN Wires are properly protected Arsenic ug/L ®❑ Arsenic less than MRL (ND) Casing height (above ground) 18+ in. Collected by Alaska Water Laboratories Date of flow test for COSA 5/25/21 Date of Sample 3/23/22 Static water level at beginning of test *17 ft. Comments *Well flow rate and static level provided by Wheaton Wells B. TANK DATA Age of tank(s) <1 years Tank.type/material Septic/Plastic Measured operating fluid level in septic tank New * 0 Standpipes/foundation cleanout per record drawing Date of pumping Tank installed 6/9/21 D. ABSORPTION FIELD DATA Shallow Trench Which system tested (date installed) 10/2/98 FE1 ALL standpipes present per record drawing Total measured depth from grade **8.2/7.4 ft (max) Measured depth to pipe invert from grade **6.2/5.4 ft (min) ❑ N/A — pressurized field n Monitor tubes go to bottom of effective. If not, state depth into effective 0 Code -required soil cover over field ❑Q System presoaked (Required if vacant for greater than 30 days prior to date of test) >of ATION aintenance completed ation years Lift station material Comments: Adequacy test date 4/21/21 Results R/ Pass For 4 bedrooms Fluid depth prior to test 0/0 in Water added 1000 gal New depth 6/6 in Elapsed time 1440 min Final fluid depth 0/0 in Absorption rate >600 gpd Any rejuvenation treatment (past 12 months) Gallons introduced 2000 gallons If yes, enter date Comments/Deficiencies: *Double cleanout installed in front of septic tank. **East/west trenches. COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Building Foundation > 10'[]✓ Septic Tank/Lift Station on Lot > 100' if No ft Community Sewer Manhole/Cleanout > 100' 0✓ Yes if No ft ❑✓ Yes if No ft Neighboring Tank > 100' R Yes if No ft Private Sewer/Septic Line > 25' F Yes if No ft Absorption Field on Lot > 100' [71 Yes if No ft Holding Tank > 100' R✓ Yes if No ft Neighboring Absorption Fields > 100' ft If septic tank is under driveway comment below Animal Containment >' 50' R✓ Yes if No ft ❑✓ Yes if No ft ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' M✓ Yes if No ft rVJ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' M✓ Yes if No ft Surface Water > 100' U Yes if No ft Property Line > 5'✓Q Building Foundation > 10'[]✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Property Line,->. 10' Yes if No ft Private Wells > 100' F✓ Yes if No ft ..Water. Majn_>_ 1(1'._._ .. r✓I Yes. if No ft _ Community Wells > 200' .. f✓1 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' 171 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' 0 Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Surface Water > 100'✓0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review co ' •:S� ¢� of Municipal records that the above systems are in conformance with 49TH ' MOA COSA guidelines in effect on this date. ' • ' ' ' `" ' ' ' ' Benjan% chiller 1� ' CE 12592 w� � �i �Jj� 4/13/22 pROFESSION�- COSA Checklist yellow sheet PROFEa'`®��' Municipality of Anchorage Community Development Department On -Site Water and Wastewater Program 4700 Elmore St. a P.O. Box 196650 Anchorage, AK 99519-6650 a http://www.muni.org/onsite a (907) 343-7904 Legal Address: Subdivision q 111 11 q III, Block Lot T 15 �1 R_ I V\[ _ Section_ _ Lot _30 On-site Water & Wastewater Program certified contractor performing the well Name: ?6V-1°Av W I �l Com any: Signature: Well decommissioning date Cj + 2-2 Method of decommissioning: AMC 1 5.55.060L1 a. ® b. ❑ C. ❑ Location: Use the space below to provide a drawing of the property showing the following items; a North arrow Decommissioned well, a Other water weiis on the property, - a Two separate swing -tie distances for each well shown on the drawing, Note: The swing -tie distances shall be measured from either permanent structures or the property corners. K1( and MUNICIPALITY OF ANCHORAGE DL:PARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY [:)WELLING 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner ~k~ ~ L~ ¢, ,~ ~t 5 Day phone Mailing address 2o7Z~ ~-/ Lending agency Day phone Mailing address. Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: Day phone TYPE OF WATER SUPPLY: Individual well Comrnunity well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. 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. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown bdow, 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 fur[her 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 KND Engineering 20441 F~a~mlgan I~lvd, Phone /~ -~/// Address Eagle River, AK 99577-8726 Engineer's signature ~ -~_.~''-'-~ Date /~..~'/;¢~ DHHS SIGNATURE ./~ Approved for ¢ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: AdditionalComments 5~ /¢ff/~d~'£D ~.,~'~ff w,~z_~ 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. Municipality of Anchorage 0C~ DEPARTMENT C)F HEALTH & HUMAN SERVICES ,~,~,~l,.,~,.u~ , :,n/IRONMENIAL SL~VI~N Environmental Seduces Division 825 L Street, Room 502 * Anchorage, Alaska 99501 * (907) 343-4744 Health Authority Approval Checklist Legal Description: L0~' ~ ~® r~ -[-/~'/~ ~,~1 !~/ ~Y~ Parcel I.D.: ~ ~ ( - O~/-~ ~_. A. WELl. DATA Well type ~ ;~ ~ If A, B, or C, attach ADEC letter. ADFC w~tter system nurnber Total depth.fl ,/ge'-/ u) ~./~ Cased to ~PC.) [ u)~l I Cas ng he ght (above ground) 'D Sanitary seal (Y/N) y Y ~,-,~ _ Wires properly protected (Y/N) _ FROM WELl_ LOG Date of test Static water level ~_.,q Well production WATL=R SAMPLE RE:SUETS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed. /o,/~ i//;~? Tank size Foundation cleanout (Y/N) 'Y _ Date of Pumping --~_7~___ C. ABSORPTION FIELD DATA Nitrate _ [. 9:5 Collected by: AT INSPE(~TiON / Z,~-O Number of Compartments ~-- Cleanouts (Y/N)_ Y' High water alarm (Y/N) Depression (Y/N) 4 Pumper._--~ ~ 7~c,¢ bedrooms Date installed, q/5o~ /0/~/~'<~ Soilrating (g.p.d./ft~orfF/bdrrn) /..Z.- Len tF~-~t-'') 3-~.?' Width ~/ ~- Gravel thickness below pipe ~ -~,~ Total depth__~t Effective absorption area ~ ~ ~ Monitoring Tube present ~)_ Y Depression over field (Y/N) Date of adequacy test ~~(Pass/Fail) i F~ Fluid depth in abso~)ti~~ test (in.); .__ Immediately a~l. water added (in.): Fluid depth __~(ins) Minutes later: A~ rate = _ .g.p.d. Peroxide tr~past t 2 months) ~/N) ~~ If ~es, give date 72-026 (Rev. 3/96)* L,FT STAT,O. Date installed J Size in gallons Manhole/Access (Y/N) '...~Pump.on" level at* ",.--'~Pump off" level at* High water alarm level at* _,//'~/' Datum . ~ Cycles t'ested . ,--"/"~ ~ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot AbsorptiOn field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation /(~ ~ Property line /~ ~' Absorption field Water main/service line ~-~ ~F Surface water/drainage ,,/~ ~/~ Wells on adjacent lots SEPARATION DISTANCE FROMABSORPTION FIELD ON LOTTO: Property line //_~ ~h Building foundation /O ~ Water main/service line Surface water //D (~) r._~ I~riveway, parking/vehicle storage area. /~) Curtain drain / (_~(D ~ ~ Wells on adjacent lots / ~) ~ ' ~ F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal recor?=,~a~ ~ ~stems are in conformance with MOA H~ guidelines in effect on this date. ~ ~ .. ~ .. ~ ~. H~Fee $ ~ ~ ' ~ Waiver Fees Date of Payment ,/S r/~ ~ Date of Payment Receipt Number ~tV~ /:~.? Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE MEMORANDUM WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL During a re_eh= Health Authority Approval on-site inspection and test of tl!e potable water supply well on Lot Block '- of T/f~/~;~/;Sf.~ Subdivision, the well's productivity was determined to be ,4~ gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a-- ~ bedroom residence is ,~Z gallons per minute. Although the subject well currently ~ this minimum requirement~ al! parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-cri'tical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies ~f the subject Health Authority Approval.