The URL can be used to link to this page

Home My WebLink AboutT15N R1W SEC 9 LT 61T1 N RIW Lof 61 051 - 104 -16 -~ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Page 1 of On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: OSP111 0 q. C~. P,D Number: 051--1 O. q Name: DOUG SCHMIDT Wastewater System: E] New · Upgrade Address: PO BOX 671562 *CHUGIAK, AK 99567 ABSORPTION FIELD No. of Bedrooms: not~ Ph°ne:(907) 242-2256 3 D Deep Trench n Shallow Trench D Bed [] Mound LEGAL DESCRIPTION ~o,, Rating: Total Depth, .... GPD/Sq. Ft. Ft. 3lock: Lot: Subdivision: Depth to pipe bottom from original grade: Grovel depth~th pipe: 61 - Pt././' rt. Township: 1 5N Range: 1W Section: 9 m, added aba. o~gi,o~ grade: . ~\~ ~ ~ecgth: WELL: [] New [] Upgrade~~ Grovel wldth,~~,~-~y Ft. Number of Il .... Diet .... between lin.,FL Classification (Private, A.B,C): ~ Cased TO:(BEOROCK) Total absorp~ Pipe material: Ft. ¢iilllii~~Driller:.~ Date Drilled:caslng HelghtStatlCAboveWaterGround:Level:rt' '~ NER INSTALL Date installed:8/16/11 ....--- GP. I Pt. rt. TAN K SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P. [] Other* T~.~-'~-.~To Septic Absorption Lift Holding Public/Private Manufacturer: Capoclty in gallons: Tank Field Station Tank S,,,r U,*s PREMIER PLASTIC 1500 Material: Number of compartments: We, 100'+ (_~ - - 25'+ PLASTIC 2 z Surface Water 100'+ ~ - - - LIFT STATION Lot Line 5'+ .... (~) Size in gallons: I Manufacturer:. Foundation 5'+ LLJ _ _ _ 'Pump on' level at: 'Purer alarm at: Curtain Drain - NONE KNOWN . Purnp Ma~col Inspections performed by: I I Remorks: BENCH MARK Location and Description: FRONT DOOR THRESHOLD Assumed Elevation: 98.04 rt. ENGINEER'S SE.~ Inspections performed by: OEO, Ltd. Dates: 1st 8/16/11 2nd - ~ ~.. .......... 3rd - ,~ &~ ~.' ? Development Services Department Approval~.?..;~; vOh.~-¢. "' i'"';CE-Z95'~ '" %% "'. t: Reviewed and approved by: /~:,. -/" ~"~:~' re://- 7 '''// -t,,-*._,~.¢, '"° .... "~ ' '%~,~,~ r o f e s sic ~_..~'~~ '""'"~ AS BUILT DRAWING OSP111099 - 051-104-16 EXISTING L A B 3 BEDROOM HOUSE ST1 8g.88 gg.64 ST2 g.3.~7 102..51 EX)STING ~ELL- DBL1 86.72 97.30 DBL2 87.67 97.93 A DBL3 95.52 103.97 . [,~',,." il DBL4 96.62 104.72 / /" .'[. GWM 87.32 97.21 / 8 \",'.~.7 ~;.i' ~:~'- C01 98.66 105.96,,b~.'"~/ I ";.' ''" '" ''.~.. '~'."" ?-. ~ ,, ..., ..... ...,,... ,,,~,? I" ' . . .~. . ": '" ' .oy /,,.:..':,, ..: , . ...~ / / '. .., . ..' .,, ~. .., . / X..---¢'%...-' '~' : ..- · ' '?. · - · -. · ,.l ~ '-'"~.'"x'-._". :.,.' -.,. ' :.".' "~; '. '.a-' ;' l / ~". ', .7 .,,..N.: '~ ' x./ ../~..':..,.. ~.,.'.%...~ / x.. ../. ~ .,,,:, : .,. .~. . ?/:. ! . ._~.z~ . /' ,,, · . .,, -.. . . .~ ~-~EXlSTING SEWER LINE .;-.:,/ : .-~ . "~ DBLI&2~GWM XISTING DRAINFIELD \ SCALE: I I 1" = 20' "" /'" :'"~!0. GAYNESS ENGINEERING GROUP, Ltd. . i49~1"t"~'" '"...'~?~00~% ................. ' .............. ' ................... .... ,,o, ,,...,,,o. ~. ...,,,. ,o, .,,,,..o~._, ,,, ..,o-, . ,,.o.~. ,,o.,.=-,,,, . ,,,. ,,o,,,.-:,,,,,, . ~,. -.o,,.,...,,,,.,~",,,]'.ii," PREPARED FOR: IPHONE NUMBER: I PAGE NUMBER: DOUG SCHMIDT I 242-2256 I 2 o~- 3 ~:~"'"~'¢~ LEGAL DESCRIPTION: DRAWN BY: T15N, RlW, SECTION 9, LOT 61 PNB ASBUlLT DRAWING 8/18/11 (Rev. 01/05) ,.,~,,,,a. ,,,,,,,,,,.: AS-BUILT DRAWING ,..,,c,~,. ,,:, ,,.,,,,,~ OSP111099 051-104-16 /--FINAL GRADE = 97.a3-97.58 TOP OF TANK / fAT OUTLET = 93.71 ---k / L;_WM/~ ,. r////////sz/// /////////////////~ ~///i~////////~ I I ~ I I NEW 1500 GALLON INVERT OF BUNG "PREMIER PLASTICS" AT INLET = 92.55 ~' SEPTIC TANK I INVERT OF BUNG AT OUTLET = 92.45 A A A__A ~ A GARNESS ENGINEERING GROUP, Ltd. ~.~~-TH~ ...................................... ~ ....... ':]'1',' :,~: CONSULTANTS & aENERAL CONTRACTORS ~t'''' :'' '?' 1701 E. 1UDOR ROAD, SUII~ 101 ANCHORAGE, AK 99507 · PHONE (907);557-6179 · FAX (907)558-5246 * WEBSITE: wwe.gamessengineerlng.com PaEPAaED FOa: I PHONE NUMBER: I PAgE NUUSEa: DOUG SCHMIDT [ 242-2256 [ 5 0F 3 .,~,...a_ .~-~:.,,:.-,-,o.: ' ' ~,,..w..¥: \'%.~'"'~' T~5N, a'~W, SECTON 9, LOT S~ PNB PROFILE DRAWING 8/18/1 1 Permit Number: OSP111099 Tax Code Number: 05110416000 Work Type: Septic Permit Effective Dates: June 14, 2011 On-Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Upgrade to June 13, 2012 Design Engineer: GARNESS ENGINEERING GROUP LTD Subdivision: T15N R1W SEC 9 Site Legal Address: T15N R1WSEC 9 LT 61 G:1358 Owner/Address: SCHMIDT DOUGLAS J & RONNIE L PO BOX 671362 CHUGIAK AK 995671362 DeI artment Site Mailing Address: 22115 AURORA BOREALIS RD, Chugiak Lot Size in Sq Ft: 88862 Total Bedrooms: 3 This permit is for the construction of: N Disposal Field Y SepticTank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Date: Date: ~/'?"~'~//~ MUNICIPALITY OF ANCHOraGE ,.,= .... p ....... Se!wices Parcel I.D. Property owner(s) DOUG SCHIvIIDT Mailing address PO BOX 671362, On-Site SewerAfVeH Permit Appiicstion For A Single Family Dweiiing 0~1- IOH- CHUGIAK, AK 99567 Day phone 242-2236 Site address 22115 AURORA BOREALIS ROAD, CHUGIAK, AK Legal description (Sub'd, Block & Lot ) LOT 61 Legal description (Township, Section & Range) T15N, RlW, SECTION 9 Lot Size Sq. Ft. Number of Bedrooms 5 THIS APPLICATION IS FOR: ( [] all that apply) Absorption Field [] Septic Tank [] Holding Tank [] Privy [] Private Vv'ell [] Water Storage [] THIS APPLICATION IS AN: Initial [] Upgrade [] EXPEDITED Renewal [] THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: N./A I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS LN,o,,~EER,,,IG ~R,~,~P,. ~.t,~'~. Perr~[t/~.L!sh Fees: Date of Pay'merit: Receipt Number: Permit No. O~i© ,/Vai,,,~r Fees: Receipt Number: waiver No. (Rev. o~/~) June 10, 2011 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 Elmore Rd. P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Ref: Proposed Septic Tank Upgrade for T15N, R1W, Section 9, Lot 61 To whom it may concern: The existing 3 bedroom house is served private and septic system. The septic system consists of a 1000 gallon septic tank and a trench type drainfieldo The septic tank is collapsing and is need of replacement. The owner is requesting the existing tank be replaced with a 1300 gallon Premier plastic tank. We are requesting an expedited permit for this installation. During our recent site visit we also checked the sump at the end of the drainfield and found it to be dw. The owner is requesting to perform an owner install. The owner is having a local operator who is a friend, Richard "Tweed" Schafer, operate the backhoe for the excavation of tank. The owner will be onsite during the entire installation to make sure tank is level, tank is backfilled/bedded adequately, and to make piping connections. Gamess Engineering will be performing the inspection and documentation of the tank upgrade. We are unaware of a~ny adverse impacts this installation would have on adjacent wells or septic systems. If you ha,~e any questions, please contact us at 337-6179. Thank you for your / assistance. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.corn T!SN, R!W, SECTION 9, LOT 51 iI ii ii T15N, RIW, SECTION g, LOT 62 ~ / / SERVED BY PRIVATE WELL / / AND SEPTIC. NO CONCERNS. / /// I ~ '-- I [ 3 BEDROObl ~ ~ ,.,(~ - ~I J %~¢ ¢~ ~' FEXISTIN6 SEPTIC TANK (TO BE REP~OED:1 __~q ~ __ ~ I N~ ~o~ J ~ ~ ~ % __~ ..~ ...... , ........ TI~N ~. -0 .- . , ~ ' -- ~ ~ ~ ~ ~ ~ ~ ' ~ NO ~NCROACHMENT CONCERNS I I ~ ~,. ~~,, ~---_ ~ I ~' ~';:;' ~, ~,C.~,. '2' .,--.. ~. .~;~:.' DOUG SCHMtDT ~ 242-2258 ~ t OF 2 ~.~.sc.,,o,: j~.,**.: "0%,?¢. T15N, RIW, SECTION 9, LOT 61 J.L.M. ~PE OF WORK: SiTE P~N FOR SEPTIC TANK UPGRADE 8/10/2011 HOUSE XlSTING SEWER LINE . ~ . ,~ /----INSTALL DOUBLE CLEANOUTS /'~.'. i '; ' // ,?/---_2' / EXISTING 1000 GALLON SEPTIC TANK TO / BE REP~CED WTH 1300 GALLON PREMIER / P~TIC TANK, EXISTING TANK TO BE / ~XISTING DRAINFIELD REMO~D ~D TAKEN TO ~NDFILL,~ ....... C, OEASULTAHTS & GEHE~L CO~'~T~,ACTC~S ::x::::: ': :: .: :: .::.:: ::::,: ~70t E. ~JDO~ R~. EU~ I0~ ' A~CHOA~. ~ 99507 * PHONE (907)357-6179 PREPARED FOR: ~PHONE NUMBER: ~ PAGE NUMBER: DOUG SCHMiDT j 242-2256 LEGAL DESCRIPTION: T15N, RIW, SECTION 9, LOT TYPE OF WORK: i DESIGN OF SEPTIC TANK UPGRADE Rev. 01105) 20F2 DRAWN BY: DATE: 6/10/2011 SCALE: 1"=20' 6-14-11;1~:14AM; ;5622502 June 14, 2011 To Whom It May Concern: My name is Douglas J. Schmidt, owner of a home located at 22115 Aurora Borealis Road in Chugiak, Alaska. I am going to be doing a homeowner installation of a new septic tank for our property. I will be doing the install and have experience operating heavy equipment from formal United States Army training as a Heavy Equipment Operator from 1984 - 1988. I also have rented multiple types of equipment over the years for work on the above mentioned property, thus maintaining my heavy equipment operating experience. I will be borrowing the necessary equipment from a friend of mine, Tweed, who in addition will be helping me with the installation through advice and expertise. There will be no money exchanged for his help on any part of this project; I simply need his input and experience with the installation. If you have any questions, please feel free to contact me at home, 907-688-1136 or my cell 907-242-2236. Any help in this matter is greatly appreciated. Sincerely, , - Douglas J. Schmidt P.O. Box 671362 22115 Aurora Borealis Road Chugiak, Alaska 99567 /1UNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE .~"NEW LEGAL DESCRIPTION L' 6t NO, OF BEDROOMS Well I Absorp~°~ Dwelling DISTANCE TO: ~ ~ Material, No. of compartments ~ Z Manufacturer Liq, capaciW in gallons Inside length Liquid depth ~ IF HOMEMADE: Well Dwelling PERMIT NO. O Z ~ Manufacturer ~ ~ ~aterial Liquid capacity in gallons Q Well Foundation Nearest lot line PERMIT NO. ~--~m DISTANCE TO: ~O~ ,engthofline~.~ Trench~i~ Distance between lines ~ Z No. of lines Length of each lin~ Total ~ inches Tu ,~effective ~or~o~ ~, Top of tile to finish grade ~1 ~tl Material beneath tile ~ ~ inches PERMITNO. Length Width Depth ~ ~ ~ TOtal o{fectiue absorption area ~ ~ Type of crib Crib d otc Crib depth ~ Well ~ Building foundation Nearest lot line ~ DISTANCE TO'. ~ · Class Depth 3B/ler Distance to lot line PERMIT NO. ~ DISTANCE TO: Buildingfoundation Sewerline ~ Septictank Absorption area(s) PIPE MATERIALS SOIL TEST RATING INSTAELER · .. LEGAL APPR ~ ~ ~-013 (Rev. 3/78) MLJ~'~ I C I ~ DEPARTMENT Gr' I]N--.':.~J I TE F'ERMIT NO, ( 7~052~ ) RF'PL. I CRNT ~' 3CATI OH , EQAL ~u~ERT E. S~COT~ AURORA RD L61 _,9 Ti5N RIW / hc_BLTFI RND ENVIRZmNMENTAL F,vJ,~CTION / STREET., RNCHORRGE., BK. ~.~,0i 264-4720 ~L ~[~ SEL.4E~.' F"E Rr-1 I 'T SR BOX 9L~8 uHLI5IAK 6,~,_ ,~:.,=.....I LOT SIZE 168908 SQORRE F'EE:T "~ ' ~ '- IS: TYPE OF SOIL RB_~ORBTION _,Y:,TEM TRENCH MAXIMUM NUIdBER OF BEDROOMS SOIL RATING (SQ FTFBR)= t00 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [:,E:F~"TH~= [Q LENGTH= -~$ [iRR%~EL- DEPTH= '~ THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF' THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUND AND THE BOTTOM OF THE ENCRVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRL.L, PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). REi~,.:!U I RE~-, SEPT I C PERI'4IT flF'PLICRNT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT [,.mlN3 THE INSTRLLRTION INSPECTIONS OF RNY WELLS RD~RCENT TO THZ~ PROPERTY 8ND THE NUMBER OF RE~/DENCE~ THRT THE WELL NZL. L ~ERVE. T'L~O ~ ~. INSPECT I mL~r~ RRE ~E~UQI_I I RE~:E: ; E,~L. KFILLING OF RNY SYSTEM WITHOUT FINRL IN:,PE..TION RND RPPROVRL BY THIS DEF'RR"rMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL RND ANY ON-SITE SEWRGE DISPOSAL SYSTEM IS t00 FEET FOR 8 PRIVATE WELB OR t50 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OE PUBLIC NELL .... Ol"HER REQUIREMENTS MAY APPL~. SPECIFICATIONS 8ND CONSTRUCTION [:,IRGRFtMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERI~I I "~ EXF" I RESZ; DECEr-IBER .-~1~ :~lSr?r9 I CERTIF~r' THAT WELL- Am:, ±: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND ' S EORTH B~ THE MUNICIPALITY OF ANCHORAGE. 2: I WILL IHSTALL THE ~..TEM IN HCCORDRN~E WITH THE CODES. ?' I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MR~ REQUIRE ENLARGEMENT IF' THE: RESIDENCE IS REMODELED TO IHCLUDE MORE THAN ~ BEDROOMS. S I GNED: .__.~-~~- ..................... flPPLICflNT~ROBERT~ E. SCOTT _~~. ~SSUED BY~ ........... DRTE 0 ~t E GEC.. 3HNICAL 8' DEVEL.. Box 90, Davis St,, Eagle River, Alaska 99577 694-2774 or 688-2280 R~$sel! Oyster 694-2774 S0 I,I- LOG Soils ~ Foundations Performed for: Name: Natltng Address: ¢~(~, Legal Description: Za'z' ~ /i ..~'~'. Depth (feet) MENT CO. Eat/Ellis 6~-2280 Land Development Tel. No. ~'~ 7-/,.~-w'r ,~'/~, Sot1 Characteristics 0 3 , 4 5 6 8 9 10 11~ ,,~,, 12, 15 16 Ground Water Encountered: Yes Proposed Installation: Seepage Pit , Comments: No z~ If yes, what depth Drain Field Date: 08 ,sL0dY OF "HCC=0 ,, G 177 r; Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approva Parcel I.D. 051-104-16-000 Legal description T1 5N R1 W SEC 9 LT 61 Expiration Date: Site address 22115 AURORA BOREALIS RD Chugiak AK 99567 Current property owner(s) SCHMIDT DOUGLAS J & RONNIE L 12/8/2023 X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: CL�_By:1% Original Certificate Date: 9/8/2023 is 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 Absorption Field Advisory Tank Age Advisory Other X Well Flow Advisory Nitrate Advisory Arsenic Advisory COSA ApprovaIjune 2022 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION ua�*xIN 3 Parcel I.D. 051-104-16 Complete legal description T15N R1W SEC 9 LOT 61 Location (site address) 22115 AURORA BOREALIS ROAD, CHUGIAK, AK 99567 Current property owner(s) DOUGLAS & RONNIE SCHMIDT Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 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 12 - 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 $ -550 Date of Payment COSA # t50- C 23 I? 26 Waiver Fee $ Date of Payment Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: T15N R1W SEC 9 LOT 61 Parcel ID: 051-104-16 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 UNKNOWN Total depth UNKNOWN ft Cased to UNKNOWN – 40+ MOA RECORDS ft Sanitary seal is functioning correctly Wires are properly protected* Casing height (above ground) 18 in. Date of flow test for COSA 8/22/2023 Static water level at beginning of test 37 ft. Well production at time of test 4+ gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 2.67 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 8/22/23 Comments *Well inside attached structure to the house. B. TANK DATA Measured operating fluid level in septic tank 48” Date of pumping 8/22/23 Required maintenance completed, if AWWTS Comments: 1300-gal Premier Plastic Tank C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 7/3/1978 ALL standpipes present per record drawing Total measured depth from grade 9.3 ft (max) Measured depth to pipe invert from grade 4.8 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 3.3’ 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 Adequacy test date 8/22/23 Results Pass Fluid depth prior to test 0 in (1” at 100 gallons added) Water added 1000 gal New fluid depth 5 in Elapsed time 15 min Final fluid depth 0 in (8” ED missing) Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 48 in (MOA 4’ ED) Effective depth used 8 in (Missing ED + Final Fluid Depth) Effective depth (ED) remaining 40 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots & appears approximately 0.7’ ED is missing. 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’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ 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 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 Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS 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 8/28/23 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 & 8/28/23 Dayna M. Rumfelt R E GISTEREDPROFESSIO N A L L A N D S URVEYORNo. LS 13322 NORTH0 40 ' 80 ' SCALE: 1" = 40' 9/1/23 -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. # _("~\ - \G;L\- \\o 1, GENERAL INFORMATION Complete legal description B£M Lot 61~ Sec., 9; T15N, RIW, S., M. Location (site address or directions) 22115 Aurora Bor~:C. As Road Property owner Mailing address Bob & Linda Sco,¢¢t Day phone Lending agency Mailing address Day phone Agent Sharon Minsch RE/MAX OF EAGLE RIVER Day phone 694-4200 Address ~4~bO Oo.~2'oAf,ioP. d Driu¢~ E~gl~ Riv&r. A~ 99577 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: '~ TYPE OF WATER SUPPLY: Individual well XX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: XX 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(Rev 1/91) Front MOA#21 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 ~ ,~, ~ ENGINEERING Phone 17034 Eagle River Loop Road No. 204 E=.~[c ~!"e'", AIn~lea 99S77 Address Engineer's signature DHHS SIGNATURE //~ Approved for ,./'~;' bedrooms. Disapproved. Date Conditional approval for bedrooms, with the following stipulations: Additional Comments Date 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 order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 fRev 1/91) Back MOA #2~ Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type ~'~J ~--~ Log present (Y/~) Total depth L) tz--- Sanitary seal (~N) If A, B, or C, attach ADEC letter. ADEC water system number A Date completed ~ ~ Driller Cased to ~ ~ 4-' Casing height Wires properly protected~/N) FROM WELL LOG AT INSPECTION Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line 'Z.~" / Date of test ..-.'/ ~ '~' ,-'~{ 7..-- ~ ~: Static water level ~ '~ ~ ~ ' ~ ~ Well flow / g.p.m. ~',O+ t"~ ~ ~ Igll~m. ~ Pump level f.)/Z- .~ ~_~ ~ > SfiPARATION DISTANCES PROM WELL TO: ~ ~ o ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~:) ~ '~["¢,~v~ Nitrate Date of sample: ~ '~ O - ~2.... B. SEPTIC/HOLDING TANK DATA Date installed ~7¢ ~ -"7 ~ Cleanouts {~'/N ) ~/ High water alarm (Y/~) Date of Pumping 1,,¢ Collected by: Other bacteria ,,~J'O,,"J~ $ & $ ENGINEERIN~ 17034 Eagle River Loop Road No. 204 E~gle River, Alaska 99577 Tank size I OO~ Compartments Foundation cleanout ~/N) ')/ Depression (Y~_/_~ ,,~ J"[ Alarm tested (Y/N) "U'~ /[~"7~-'~ [ Pumper ,..~"'.-~. ~.~F~¢~c~ I..- Well(s) on lot To property line t~ Surface water/drainage SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: ~ 00 I-P' On adjacent lots ~ oo Absorption field ~'~ ~o Foundation Water main/service line ~o 72 026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) High water alarm level Meets MOA elec~ SEPARATI.~)N-O~TANCE FROM LIFT STATION TO: ,~T~on lot On adjacent lots ~ste~i at Surface water D. ABSORPTION FIELD DATA Date installed "~" ''~ ~"~ ~ Length ~ Width ~'~? Total absorption area "'~'~ '~ Depression over field (Y/~ ~ ResU ItS ~/fail) ~;'~J: ,5 Peroxide treatment (past 12 months) (Yl~l.l.l.~) / Soil rating ~c~o Gravel thickness '~r~ Cleanouts present(~N) Date of adequacy test. for ~'['~¢Z-~ ~-"/~= ~/~, If yes, give date _ System type '1'"¢,6~¢-I.~ Total depth bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain E. ENGINEER'$.CERTIFICAT On adjacent lots I z~o ['~ Propertyline I c, \ O ~ ~'- To existing or abandoned system on lot ,'J' L~, Cutbank ~"~' I ,~- Water main/service line 'IL;)~''~ Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in, this inspection. Signature Engineer's Name Date S & S ENGINEERING 17034 Eagle River Leop Rosd Eagl· River, Alaska 99577 HAA Fee $ Date of Payment Receipt Number ~. 0'¢~':'¢ .~> 72-026 (Rev, 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ANALYSIS RESULTS for INVOICE t 57291 Chemlab Ref.N 92.4334 Sample t S Matrix: FAX:(907) 561-5301 Client Sample ID ; BLM LOT 61 BEC 9 T1SN RIW PWSlD ; UA Collected : ~ hts. Received : AUG 20 92 ~ 14:00 h~s. Client ~ame :S & S ENGINEERING Client Acct :SNSENGP Req$ : Ordered 2¥ :R. S~E~R PO! :NONE RECEIVED Analysis Completed : AUG 21 92 Send Reports to: 1)S ~ S ENGINEERINO Parameter Results Units Method Allowable Limits NITRATE-N 1.4 ~g/1 EPA 353.2 Sample ROUTINE SAMPLE COLLECTED BY: UA. Remarks: 1 Tests Performed ' See Special Instructions Above UA-Unavailable ND- None Detected '* See Sample Remarka kboYe NA- Not Analyzed LT-Less Than, GT-Greate~ Than ~SGS Member of the SGS Oroup (Soci~t~ G~n~rale de Surveillance) GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 TIME: REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES FOR 1. APPROVAL REQUESTED ADDRESS'. PHONE: 2. PROPERTY OWNER: 3. LEGAL DESCRIPTION: 4. TYPE FACILITY TO BE NUMBER OF BEDROOMS: WELL DATA: A. TYPE B. DEPTH C. SIZE INSPECTED: PHONE: ¢ D. CONSTRUCTION E. BACTERIAL ANALYSIS SEWAGE DISPOSAL SYSTEM: A. SEPTIC TANK (IF HOMEMADE, SHOW DIAGRAM ON BACK) ~ . 5 1 ZE ~ // 3. MANUFACTURER 4. INSTALLER APPROVAL REQUEST .... SEWER & WATER FACILITIE PAGE TWO SEEPAGE PIT - <~""~' 1. SIZE 2. LINING C. DISPOSAL FIELD 1. NUMBER OF LINES 2. TOTAL LENGTH 7. REQUIRED A. B. C. D. E. o MEASUREMENTS £ WELL TO SEWER LINE WELL TO PROPERTY LINE p O'. WELL TO OTHER POSSIBLE CONTAMINATION F. FOUNDATION TO SEPTIC TANK G. FOUNDATION TO SEEPAGE PIT .... H. SEEPAGE PIT TO PROPERTY LINE APPROVED: DATE: APPROVAL VALID FOR ONE YEAR GREATER ANCHORAGE AREA DISAPPROVED: DATE: FROM DATE SIGNED. BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY