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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
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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
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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 -/~--- ~'
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2
3
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11
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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.