The URL can be used to link to this page

Home My WebLink AboutTANAINA HILLS LT 5Tanaina Hills Lot 5 #011-051-06 Permit Number:OSP261160 Tax Code Number:01105106000 Work Type:Septic Upgrade Effective Date: Design Engineer: Site Legal Address:TANAINA HILLS LT 5 G:2123 Owner:CROSBY RICHARD S & SHAREEN R Site Mailing Address:6232 Tanaina DR, Anchorage Lot Size in Sq Ft:111956 Total Bedrooms:4 This permit is for the construction of: Disposal Field Septic Tank Holding Tank Privy Non-Public Water Well Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Coodinate with On-Site staff regarding preferred method. 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing 6/15/2026 6/15/2027 GARNESS ENGINEERING GROUP LTD Special Provisions: An additional test hole is required to be done prior to the construction of the septic field. Construction may proceed at your own risk before the 7 day water monitoring is complete. Please submit stamped and signed results with the As-built Inspection Report. If the results require a design change, construction of the system will stop pending On-Site review and approval Expiration Date: þ þ ¨¨¨¨ Issued To: Issued By: Date: Date: 6/15/2026 6/15/2026 GARNESS ENGINEERING GROUP LTD Isatou B Njie MUNICIPALITY OF ANCHORAGE On-Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On-Site Wastewater Disposal System Permit MUNICIPALITY -0 PANCHORAGE �.�." �5'.:r..s^"`^...�,�£Y�'•,x,�.",._,,...v.-�?�_r_.SPr�L:.,',".�;�'�'i.�::�S»'_�'°'"'�^�""' �� Ph.�.^,..: "c.i']�.. x�,�d�"d:'.°".vi;:�•6'S�'".��'f'�-�+u e::.S� Development Services Department Phone: 907-343-7904- 01--site 07-343-79Q4Or-•Site Water & Wastewater Section ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 011-051-06 Property owner(s) RICHARD CROSBY Day phone 907-277-1098 Mailing address 6234 TANAINA DRIVE, ANCHORAGE, AK Site address 6234 TANAINA DRIVE, ANCHORAGE, AK Legal description TANAINA HILLS; LOT 5 Number of Bedrooms LT Engineering Firm GARNESS ENGINEERING GROUP, LTD. Building Permit Number APPLICATION IS FOR: (® all that apply) Upgrade Absorption Field Renewal Septic Tank Holding Tank ❑ Privy ❑ Well ❑ Not Applicable 7 APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Permit/Rush Fees: Date of Payment: �� 2 I oel o �6 Permit No. F' C", (; (/ lV Waiver Fees: Date of Payment: Waiver No. Distance: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP261160, Isatou Njie, 06/15/26 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP261160, Isatou Njie, 06/15/26 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP261160, Isatou Njie, 06/15/26 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP261160, Isatou Njie, 06/15/26 ATL Material fest Report Client: Garness Engineering Group Ltd. 3701 East Tudor Rd. Anchorage, AK, 99507 Project: 261934 Tanaina Hills t4 410 kw t L o -r 5 Alaska Testlab - Anchorage 1020 W International Airport Rd Anchorage, AK 99518 Phone: 907-205-1987 Fax: 907-782-4409 info@ialaskatestlab.com Report No: MAT:26-2482-S01 Issue No: 1 CC' Jody Maus The results presented in this repon rotor. solely to the he tasted below. No ponion of this report Maria Kampsen may be reproduced, except in full, without the prier written approval of FUaska Testlab or th. agenry. Reviewed By: Cindy Zickefoose, P.E. Title: Materials Engineer Date: 6/5/2026 Sample Details Particle Size Distribution Sample ID 26-2482-S01 Method: ASTM D6913 Client Sample ID Lot 5 1 Oft to 12ft Drying By: Oven Date Tested: 6/4/2026 Tested By: Ardella Hopman Sieve Size % Passing Limits 3in 100 tin 100 1 M, in 100 lin 100 3/in 100 Other Test Results '�2in 100 3/8in 100 Description Method Result Limits No.4 99.2 No.10 97 Group Code ASTM D2487 SM Group Name Silty sand No.20 91 Liquid Limit 0 No.40 77 Plasticity Index 0 No.60 55 Gravel (%) 1 No.100 33 Sand (%) 83 No.200 16 Fines (%) 16 Method ASTM D6913 A Preparation Method Oven Dry Composite Sieving? Yes Separating Sieve(s) No. 4 Cu ASTM D2487 Cc Chart Diameter 100 60 '20 5 2 600 200 100 50 100 90 80 70 t 60 50 t9 40 o 30 20 10 ° . Slsvc sits :i' 1 U2" 1k' 94 410 #2a 440 #100 2' 1' 3!8' ftW #200 Comments No Plasticity Index Test Performed Soil Classification of Fines (4200) in Sieve Analyses Assumed Unless Verified by Additional Testing =orm No: 18909, Report No: MAT:28-2482-S01 02000-2026 QESTLa6 6y SpertraQESTcom Pana 1 of 1 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG PERCOLATION TEST (ENGINEKS SEAL) �i 4, n � - PERFORMED FOR: DATE PERFORMED: 5 LEGAL DESCRIPTION: 1-07— 1&t5 Township, Range, Section: "rl z- j 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMM PERFORMED BY: ( CERTIFY THAT THIS TEST WAS PERFORMED IN _J U // r ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: sr I'' 72-008 (Rev. 4,851 Register 255, October 2025 ENVIRONMENTAL CONSERVATION (f) A conventional soil absorption system must (1) include a distribution medium meeting specifications and criteria publicly identified by the department under 18 AAC 72.070 or alternate specifications presented to and approved by the department; the distribution medium must provide adequate void space and be, as measured from the springline of the distribution pipe or height of chambers, (A) a minimum of 12 inches thick for a bed or shallow -trench type system; (B) greater than four feet deep but not more than 12 feet deep for a deep - trench type system; (C) not more than two feet deeper than the bottom of the distribution tank for a seepage -pit type system; and system; (D) at least 18 inches but not more than four feet deep for a 5 -wide type (2) be installed in an area where the original ground surface slope is (A) less than or equal to 25 percent for a shallow -trench, deep -trench, or 5 - wide type absorption field; or (B) less than or equal to 10 percent for a bed or seepage -pit type absorption field; (3) have the minimum absorption area, calculated from the wastewater application rates in the following table, which corresponds to the soil texture, Unified Soil Classification System, or percolation rate, whichever is most conservative; soils must be classified by digging a test hole or pit within 25 feet of the perimeter of the proposed absorption field and to a minimum of six feet below the estimated bottom of the absorption; WASTEWATER APPLICATION RATES Application Application Percolation Soil Texture Application Rate in gpd/sf ate in gpd atea Unified Soil ate in or design forws design flows o minutes/inch) Classification) f/bedroom flows 2 2,500 gpd 2,500 d Faster than 1 Gravel (GW/GP) Not Suitable Not Suitable Not Suitable 1 — 5 Gravel (GW/GP) 125 1.2 0.79-0.98 1-15 edium to coarse sand 150 1.0.67-0.89 SW/SP Register 255, October 2025 ENVIRONMENTAL CONSERVATION 6-15 ine sand or loamy sand 190 0.8 0.61-0.74 SP -SM 16-30 Sandy loam, silty gravel 250 0.6 0.52-0.61 (GM), silty sand SM 31 — 60° Loam, silt loam, silt (ML) 335 0.45 0.25-0.52 61 — 120d Silty clay loam, clay loam' Not Suitabled Not Suitabled of Suitabled a. Soils classified as silty sand (SM), silty gravel (GM), or silt (ML) must have a percolation test conducted; percolation tests must be performed in accordance with either a method publicly identified by EPA or the department as acceptable, or by an alternate method that has been presented by a registered engineer and approved by the department; a certified installer may perform the percolation test for systems installed under the certified installer's certification; Soils classified as clay (CL or CH), organic silt or clay (OL), or peat (PT) require an engineer design and prior department approval. b. Soils classified as gravel (GW or GP) for which a percolation test has not been conducted or a percolation test result is faster than one minute per inch may still be used if a shallow trench or bed system is installed with a two -foot sand liner below the distribution media and if application rates used are at least 1.0 gpd/sf or 150 sf/bedroom; sand must meet the specifications publicly identified by the department under 18 AAC 72.070; the department may waive the sand liner requirement in a manner set out in 18 AAC 72.540. c. Soils with percolation rates slower than 30 minutes per inch are unsuitable for seepage pits. d. Soils with percolation rates slower than 60 minutes per inch require an engineer design and prior department approval; soils with percolation rates slower than 120 minutes per inch are considered impermeable. e. Soils without expandable clays or soil types not listed in this table require an engineer design and prior department approval. (4) have filter fabric placed over the distribution media before backfill that meets the specifications publicly identified by the department under 18 AAC 72.070; (5) have an effluent distribution piping system that is laid level; and the layout must be consistent with specifications and methods publicly identified by the department as acceptable for the type of absorption field; (6) have a vertical monitor tube, at least four inches in diameter, that is perforated within the distribution media and transitioned to solid pipe extended to at least one foot above the ground surface and capped; monitor tubes must be installed (A) in opposite corners of a bed type absorption field; (B) at the end of each leg of a trench or 5 -wide type absorption field; or (C) for seepage pits with a single monitor tube, as a solid pipe only attached to the distribution tank; and 50 GEG, Ltd., Year 2022 GARNESS ENGINEERING GROUP, Ltd ENGINEERING SALES CONSULTING Standard Construction Specifications for a Well &/or Onsite Wastewater Disposal System Serving a Single -Family Home or Duplex within the Municipality ofAnchorage SECTION I -DISCLOSURE STATEMENT. Garness Engineering Group, Ltd is a dealer for Anua International, LLC products in the State of Alaska. This dealership includes their Quanics AerocellTM wastewater treatment systems. When a Quanics Category II or Category III system is specified in the drawings and/or specifications, the contractor may substitute an alternate MOA Category II or Category III approved system, such as a BioCycleTM system, Orenco AdvantexTM system, Intermittent Dosing Sand Filter (IDSF), or any other MOA approved technology. Prior to making a substitution, the contractor will need to notify the engineer so that the design can be modified and a change -order to the permit issued by the DSD for the substitution. Additional engineering charges may apply. SECTION II - PROPERTYLEGAL DESCRIPTION & NUMBER OF BEDROOMS Legal Description: TANAINA HILLS; LOT 5 Number of Bedrooms: 4 SECTION III - DEFINITIONS 1. Property owner or homeowner: The legal property owner or his/her appointed representative (not GEG, Ltd.). 2. Engineer: Professional engineer hired to inspect the well and/or septic system installation. 3. Contractor: The company hired to install the septic system. If the property owner installs the system (owner install) then he/she would also be the "contractor" for the purpose of these specifications. 4. Well Driller: The person or company hired to drill the well. 5. MOA &/or DSD: Municipality of Anchorage, Development Services Department, Onsite Water & Wastewater Program. SECTION IV - RESPONSIBILITIES Property Owner Responsibilities: Page 1 of 8 FINAL 3/4/2022 2' CANT./ROOF OVERHANG TYP. 28.8' 34 .0' 8.0' 17 . 0'36.8' 14 . 5' 24.0' 12. 0' 1 4 . 4 '16.0' 12 . 5' RESIDENCE COOP LEGEND EDGE OF GRAVEL DRIVEWAY FENCE EDGE OF ASPHALT RECORD DATA PER PLAT #65-83 SEPTIC PIPE WELL DECK TIMBERLINE SURVEYING AND MAPPING 17035 BARONOFF AVE EAGLE RIVER, AK 99577 907-242-5320 ryan@timberlinealaska.com FILE NO.: 26.079 SCALE: 1" = 50 FEET DATE: 5/22/2026 SHEET: 1 of 1 MOA GRID: SW2123 SCALE: 1" = 50 FEET(11"x17") 50'0' 100' AS-BUILT OF: ADDRESS: 6234 TANAINA DR, ANCHORAGE, AK LOCATED IN: ANCHORAGE RECORDING DISTRICT LOT 5TANAINA HILLS SUBD.PLAT #65-83 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE C' RTMENT OF HEALTH AND HUMAN SER ES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name A'oe_ /r/Qa jJi if or-, /tvj. 1). DISTANCES TO FOOM SEPTIC TANK ABSORPTION FIELD WELL Atltlreea -- A --- 6 2 3=l i';n ,t n,_ 0:J_ f.� y� h !: a ) �r S WELL % f ) Q Phoneed Permit No. No. of Retlrooms LOT LINE LEGAL DESCRIPTION Lol Block Subtlrvisron 'Tang%nn FOUNDATION u9 r Township, Range. Section ( / 1� AS -BUILT DIAGRAM (Show location of well. driveway, water bodies, etc.) septic systemproperty lines. Whorl TANKS O_SEPTIC ❑ HOLDING Manulaclmer Capacity in gallons J Material No. of Compartments zI rrI In7 77W TYPE OF SYSTEM j R TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe boltom from original grade yam. ' FT Total depth Irom original grade /3 FT -- 7I It L Fill added above original grade, FT Gravel depth beneath pipe _ �% FT Gravel length _ } FT Gravel width .3 FT _ Total absorption area n S46 SQ 'TJ Distance between lines AIA FT Number o1 Imes Soil rating 3 SQ FT Pipe material Installer Date Installed WELLS ❑ PRIVATE ❑ OTHER (Identifv) QassiT,caF0 -A. B. CI Total Depth FT Cased to FT Irrstalle Date Installed. REMARKS: l-�-J scale: Inspections erlormed by. ENGINEER S SEAL Date. '10 - ry- inspection was perlormed according to all I — cetlily that this Municipal and Shale guidelines in ¢Ilett on this dale: _ %p — % y .X Health Department Approval: ' �t� � Date. I'' yr_ 72-013 (3/85) 10 1 J I YJ 3: t: 1 1: F" 04 0 . :1'-T, Cli 11 = INN 1� -1 C]I F-;'! e!::"h EEV, F -E DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 025 L STREET, ANCHORAGE, AK 99501 264-4720 17111�10 2: Q- U; PERMIT NO: 850503 DATE ISSUED: 08/14/85 APPLICANT: RODMAN WILSON, M.D. ADDRESS: 6234 TANAIN0 DRIVE ANCHORAGE, AK 99502 CONTACT PHONE: 264^4622 to Q 0A EE Q ��HOT �:1: -1 LEGAL DESCRIP: SUBDIVISION: TANAINA HILLS LOT: 5 BLOCK: NA SECTION: 4 TOWNSHIP: 12N RANGE: 4W LOT SIZE: 2"74A (SQ"FT. OR ACRES) ' LOT LOCATION: 6234 TANAINA DRIVE MAX BEDROOMS: 4 Listed below are the options available to you in designing your septic system" Choose the option that best fits your site., ' �F�� A� DEPTH TO PIPE BOTTOM (FT.) 4.0 4"8 4^0 GRAVEL DEPTH (FT.) 9.0 0"5 3"5 TOTAL DEPTH (FT") 13.0 4"5 7^5 GRAVEL WIDTH (FT.) 2,5 24"0 5"0 GRAVEL LENGTH (FT.) 41.0 46.0 79"0 ** GRAVEL VOLUME (CU"YDS.) 36"1 40.9 58"6 TANK SIZE (GALS) 1/250"0 ** 1,250.0 ** 1,250^0 ** SOIL RATING (SQ"FT"/BR) 183 1% 103 ** GRAVEL LENGTH > 75 FT, REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH) ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS --~--~----�-^---~^^~^-^----~~`-~~'----�r- I certify that: A. I am familiar with the requirements for On-site sewers and wells as set forth by the Municipality of Anchorage (MDA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit" 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposalsystem or public sewerage system on this or any adjacent or nearby lot" 4. I understand that this permit is valid for a maximum of 4 bedrooms/and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS^BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN" SIGNED DATE: /// ��`�'��`~��~��~-��~`~��— - -, ��`�..........~��..... APPLICANT: RODMAN WILSON, M.D. ISSUED BY DATE: PERFORMED FOR: Dk LEGAL DESCRIPTION: LO.7- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST (ENGINEER'S SEAL) I wr�s��l b-5 bs DATE PERFORMED: /Y'/ j 7 Ar14 *t3 Township, Range, Section: 'T/ 2 N A" 5t C SLOPE T WAS GROUND WATER ,/O ENCOUNTERED? /V IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? Date: E Reading Date Gross Time zz Net Time Depth to Water Net Drop 4 0 8- -8 Io Z' 0 /o 66 r / /o S Lo /l l /0 /u,J If rw iw PERCOLATION RATE�/'L N L�mmutesimch) P RC HOLE DIAMETER 5/ TEST RUN QETWEEN 4 FT AND il S FT COMMENTS /o.a. ��,.w / r ruv /a.i-i•/OVA-11 PERFORMED BY: CERTI4FY/ THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4,85) ON REPORT ON-SITE SEWAGE DISPOSAL Name_Rod_ W.il5oAl Mailing AddresstTMAIL GtV Ph.# Location,al P p �n `Y~Y 66f S !/fiS%�!�`�f LfIet gue Le Description SEPTIC TANK: Distance from well Material�O��E%E Number of compartments__I_ Liquid capacity_ gallons. Inside lengtj)'Z/ Inside width 3'10 Liquid depth 60�� SEEPAGE SYSTEM: Seepage Pit: Number of pits 2 Outside diameter �%eG or width—, length__, depth ` �y2� _, lining material IMCDistance from well //0 , building foundation ,nearest lot line Total effective absorption area (wall area) sq, ft. TILE_DRAIN FIELD; Distance from well , foundation_, nearest lot line— Total length of lines Number of lines Distance between lines Trench width in. Total effective absorption area sq. ft. Length ofe` ach line Depth: Top of tile to finish grade Depth of filter material beneath the in. Above tile WELL: T ype yL+ depthp64 ,distance from building foundation �/e�e, nearest lot line, nearest sewer line, septic tank > seepage system /rd , cesspool , other. sources DISTANCES: A to 'g7 b'9' A/Za 6 A't', T DATE: V 1 SEWAGE DISPOSAL SYSTEM - APPLICATION 6 PERMIT � Name of ApplicantZL/LhA/4 /5,d//4.Q• Mailing Address _ Ph. -�-7']-61711 Residence Address,, j 'V ur'' Location of Installation .� Legal Description y r}/` J1`.SLP�i Application to Install: Septic tank, Seepage pit✓ Drain field ,Other To Serve the Following Facility ,y 1/�C7 % C-r4m;&I P r -S Liyi v r p Financed Through To be Installed by Percolation Test Results Anticipated Date of Completion _ r', -O --G g BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT This is to serve as , permit to install a as described below. Size of unit to be served — Septic tank size_ Type Seepage Area - yp T e .--.., ...,......,_ .. -.... DISTANCES: -iC4ealth Aut or. ty I certify that I am family"" w7.th the requirements Of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. Municipality of Anchorage --1 Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 011 - 05.1 - OS COSA # HA oa o(3a g Expiration Date: :Z-.2,3 —0 C1 1. GENERAL INFORMATION Complete legal description J.of S, Tanaurn Me/G S /.b Location (site address) S2 3Y Tcen crena Drive Current Propertyowner(s) be4orc4A Fen k Day phone Yo 6S -o:LES- Mailing address Lending agency Mailing address Real Estate Agent. Mailing Address _627Y '7;qMe2#na Drive., %lntho. A -49c 9QS0Z Day phone fFrrvcA ►}einroeh, Prwdenheil Dayphone 3Y9-'73?7 3861 Cenkrno,nf Dr. A.ncAor! rg Ak 99SO-7 Unless otherwise requested, COSA will be held by DSD for pickup. P 1 eeveo Cal/ R evx/for @ 3 YQ -733.7 2. NUMBER OF BEDROOMS: t/ coke" CaIA rt'r.cry {or peck -sr 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well JKI Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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 sample results. (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 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. Name of Firm Ftuhfep 7_611741ca/ Slf"«ti Phone 3 VS- ► 34S Address JNS3o Ec-4e minyan Rol.,i A -k 99Sy/ Engineer's Printed Name 71" eoxeore F. m&c ee Date V1151 -LOOP 5. DSD SIGNATURE !/ Approved for ___�L bedrooms. Disapproved. rV7 As � Y J . y.( .......... Y.�• .:... fff , TH;;pCOS9 r. Af70CE a /iyt 1 Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: "f ' Z 3- o ci (R... 11105) Municipality of Anchorage Development Services Department � Building Safety Division ��••• ••• 1:1 -- ' On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Q,I'r, TanCron a flit 14 r1b Parcel ID: Of -0-7-1-06 A. WELL DATA Well type Date completed 19 8 Total depth o• ft. Date of test _ Static water level _ Well production If A. B, or C provide PWSID # Sanitary seal (YIN) 'r Cased to?YO ft. FROM WELL LOG ft. g.p.m. WATER SAMPLE RESULTS: Coliform _0_colonies/100 mL Nitrate 40- f mg/L Arsenic: <-,r ppb date of sample: 09 B. SEPTIC/HOLDING TANK DATA TankType/Material Senf4c ISI -eel Well Log (YIN) Wires properly protected (YIN) _r Casing height (above ground) 12 t in. AT INSPECTION y/8/ Z&O9 16 3 e. 9 -t g.p.m. Other bacteria 0 colonies/100 mL Collected by: 7_eC4 Date installed 10 / I y / sr Tank size 12J'0 gal. Number of Compartments 2_ Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (YIN) _V(� High water alarm (YIN) N. A.. Date of pumping!/ /1012,00 9 Pumper A -t IA-,oe Serve c ,, C. ABSORPTION FIELD DATA Date installed D I S Soil rating (g.p.d./ft2 or ftZ/bdrm) 163 17' System type Trrrc h r3D?,; Length K 7 ft. Width 3 ft. Gravel below pipe 9 ft. Total depth 13 ft. Eff. absorption area 6�_f? Monitoring tube 7 Depression over field " Date of adequacy test 'y / 6/ 09 Results (Pass/Fail) Pat/ For Y bedrooms Fluid depth in absorption field before test -32r4 in. Water added (2{ gal. New depth'��. Elapsed Time:' -7 min. Final fluid depthYo3/vin. Absorption rate >= 6 GO g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N& type) Nu n C kn c wn If yes, give date N • /� D. LIFT STATION N. A. Date installed "Pump on' level at_ in. Datum E. SEPARATION DISTANCES Size in gallons 'Pump off" level at —In. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot IIB' Absorption field on tot 130' Manhole/Access (YIN) High water alarm level at Meets alarm 8 circuit requirements? On adjacent lots > 100 1 On adjacent lots > 1001 Public sewer main ti -A. Public sewer manhole/cleanout M. A Sewer /septic service line > 2d"' Holding tank N • A., Animal containment areas N. A. Manure/animal excrete storage areas N• A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation K I' Property line ZS,_O' Absorption field > 6' Water main > too' Water service line > 100Surface water > too, ,Wells on adjacent lots > t00 ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: in. Property line > 10' Building foundation 7 �' Water main >1001 Water Service line > 100' Surface water > 160' Driveway, parking/vehicle storage Curtain drain NvnL0 Se.o^ Wells on adjacent lots >!GG' F. COMMENTS SV-4ef" pre–Soaked Prrtsr la Srrrt r.A,d� mer el or teA4it9 G.' ENGINEER'S CERTIFICATION •" f;0 •, s+,,,, I that 1 have determined through field inspections and1�rCtTH 11.1 ,•; i, certify 'review of Municipal records that the above systems are in �...' ...............:•..q) conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Ti7eod02' f-• t'-rcovr CL -31,39 ' ,t '47 Date-' 9 r.:• ., COSA Fee $ L190 Dateof Payment ��02 f Receipt Number Ud �%g r (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number 1 R•ee.0W 9•12-9!ilk I .lt-BUIL!' SDRYaT i I hereby seriL4 that I have surveyed the 17021os_18 dssaribed property LOT 3, SABADLA Kl=3 SUED. regi namy IQ sated as she, as •, an ut tie — i Cars a a,n o roadways, tbensa ars IQ sated a s!»m on this plot, and that t2an w no nadsgs, transsSssloa lines er other visible essomonts on said property •aoept a indicated hereon. Dated at Anahoraga. Alaska, this 0th day of Jan. 1969. Cf144L 9r _ C4,Ev ,L1 i n is a ca, eglacsre'3'6ng1n•:r iP�tY'""`tt�8h •fa i'.. r•'+•yt4 Is Fred tAAssociate toginaers v.ors 3107 29th Avantn 0 ��ett•eqo.E Anchorage, Alssis 904e- ..1.•Q.�'y SCS ReO Client Name Project Name/b Client Sample ID Matrix Sample Remarks: 14 1091339001 Flattop Technical Srv. Lot S,Tanaina [fills Lot S,Tanaina [fills Drinking Water Printed Date/Time Collected Date/Time Received Date/1'ime Technical Director 04/17/2009 13:02 04/062009 11:50 04/062009 12:10 Stephen C. Fade Allowable Prep Analysis Parameter Results PQL Unit: Method Container ID Limits Date Date Init Metals by ICP/MS Hardness asCaCO3 ND 5.00 mviL SM20234011 C 04/08/09 04/09/09 NRB Waters Department Total NitratcNitritc-N ND O.IOC mg,L SM204500NO3-F 13 04/09/09 JD7, Private Individual Analysis Aluminum ND 20.0 ug'L. E1200.8 C 04/08'09 04,'09'09 NRI3 Antimony ND 1.00 ug/I. E1200.8 C (<6) 04/08/09 04'09,'09 NRB Arsenic ND 5.00 ug/l. E1200.8 C (<IO) 04/08/09 04/09.109 NRB Barium ND 3.00 ug'I. EP200.8 C (<2000) 04/08/09 04/09/09 NRB Cadmium ND 0.50C ug/l., E1200.8 C (<5) 04/08/09 04/09'09 N1113 Calcium ND 500 ug/l, EP200.8 C 04/08,'09 04109/09 NRB Chromium ND 2.00 ug/L EP200.8 C (<I00) 04/08/09 04/09/09 NRB Copper 9.76 1.00 ug'I. E1200.8 C (<1300) 04/08/09 04/09'09 N1111 Iron ND 250 ug'I. E1200.8 C (<300) 04/08/09 04/09•'09 NIM Lead 0.398 0.20C ug'L EI1200.8 C (<15) 04/08,'09 04/09109 NRB Magnesium ND 50.0 ug'l. ENOO.8 C 04/08/09 04'09/09 NRB Manganese 2.90 1.00 ug/l. E1200.8 C (<50) 04/08/09 04'09'09 NRB Chloride 7.14 O.IOC mg 1, EPA 300.0 D (<250) 04/15/09 04/15/09 JIM Fluoride ND O.IOC mgL EPA 300.0 D (<2) 04/15/09 04/15.'09 1D7. Selenium ND 5.00 ug![, E11200.8 C (<50) 04/08/09 04/09:09 NRB Sodium 116000 2500 ugli. E1200.8 C (<250000) 04/08109 04/09,09 NRR Silver ND L(q ug/l. ENOO.8 C (<100) 04/08/09 04109'09 NRB Sulfate 8.62 O.IOC mg 1, EPA 300.0 D (<250) 04/15/09 04115109 1D7 Thallium ND 1.00 ug'L ENOO.8 C (Q) 04/08109 04/09/09 NRB Zinc ND 5.00 ug'I. E1200.8 C (<5()00) 04/08/09 04/09.'09 NRB M SCS Ref.# Client name Project Name/# Client Sample 11) Matrix 1091339001 Flattop Technical Srv. Lot S,Tanaina Flills Lot S,Tanaina }tills Drinking Water Printed Daterrime Collected Date/'fime Received Datefrime Technical Director 04/172009 13:02 04/062009 11:50 04/062009 12:10 Stephen C. tide Allowable Prep Analysis Parameter Results PQL Unit: %I:shod Container ID Limits Date Date Init Private Individual Analysis , Total Dissolved Solids 309 10.0 mgt 1. SM20 2540C D (<500) 04-'07/09 RJT Nickel ND 2.00 ug'L EP200.8 C (<I00) 04/08'09 04/09/09 NRB 11CO3 Alkalinity 285 10.0 mpL SM20 2320B D 04'13.'09 WAW Conductivity 505 1.00 umhnfiCm SM20251011 D 04/06/09 RJ7 pit 7.20 0.10C pl I u dis SM20 4500-11 D D (6.5-8.5) 04,'06'09 RJT Alkalinity 285 10.0 mg, 1. SM20 232011 D 01/13/09 WAW Colony Count 0 coli 10 hnL SM20 922211 A 01%06'09 KAR Total Colifonn 0 coV10)ml. SM209222B A (<I) 01/06/09 KAR Fecal Coliform 0 coV10)mL SM20 9222B A 04'06/09 KAR S -.34, MUNICIPALITY .s4- MUNICIPALITY 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. # n\ It - C)Z,\ - n, -rvY_-� HAA # i % -) b Z� LI 1. GENERAL INFORMATION _ Complete legal description Z_0-" 51 Location (site address or directions) 62H Thain 0. HI'lls Drive - Property owner. �R- RoDMA/V WILSON Day phone Z�'3-55$3 Mailing address 6231 /angih0. Dr, 27502- Lending agency e_maax Qr ,, e_S .Tkic Day phone 276- 276 Mailing address 2600 Cayyoo . , � 9503 Agent &e''"' Cro`^/ lee Day phone 25,7-01711 Address 2600 Cpf'Ay0. , 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: / � 3. TYPE OF WATER SUPPLY: Individual well i 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 X 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(Rov.1/91) Front MOAM21 uJOp-A QS -A P('L A 1_ _ Q\ - Ip 'r T)() V V-OGflrl Lan vow w0ji (i6n ,9u)seo aL •welgAG 1;o sn;e;s pue Aple6a; a(a; o; Bullsa;;e 03(ly a;e;S woa; uoilewjyuoo uell;am epino.rd 'wejsAs ja;ema;seM A;iunwwoo J; :310N jamas ollgnd a;!s-uo Al!unwwo0 luel 6ulploH X al!s-uo lenpinlpui :IVSOdSIO 831afM31SVM dO 3dAl 'b wets (s {o sn;e;s pue At 6a; ay; o; 5ui -;sa;;e 034b' a;elS woa; uoi;ewaf;uoo ua;;uM apino.rd 'wa;sAG II m Apunwwoo;; :310N jolum ollgnd Ilam Allunwwo0 X Ilam lenpinlpui :Alddns d31VM d0 3dA1 '£ :SWOOUa39 d0 b39wnN 'Z •dn)joid jo{ pray q;;im VVH 'pelsonbai asimaay;o ssa;un IZQ 6 6 ronTJOD 00 9Z ssajPPV Z auoyd (ea a'r,o-AD (,yv-LD lua6V sMppe6ullieW 91—Z -9Zz auoyd !ep �y Sa, XVW?� , louabe Bu!pual ZOS—oulbu� h £Z q ssaappe Bu!I1eW SSSS —�fi2 auoyd Aea No r7l/v\ N Qo Q jaumo Ajjadojd an r.,C Srir -vui u� h�Z % (suolloejlp jo ssajppe alis) uolleool *V U I NA07 uol;duosap le6al alaldwo0 / II NOIIVWUOdNllVa3N30 '4 ! T# VVH - #'0'I laojed EJNIl13M0 AIIWVd 310NIS V HOd lVAOUddV AlIHOHinV H1lV3H d0 31VOIdil830 � U� q� 0999-64966 e>IseIV'a6ejoy0uV 099961Xo9'O'd 2(�2 uoiloaS S901AIGS 01!13 -UO 1 IL � seolmag leluawuajlAu310 uolslAla S3OIAd3S NVNnH'8 H1lV3H JO lN3V4idVd3a 3EJVHOHONVJOAlilVdIOINnvq ® Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: G oT 5 ,V.Mk42 TAnai na 05 Parcel I.D. A. Well Data Well type 7n VQ1ti If A, B, or C, attach ADEC letter. ADEC water system number IVIA /l/ 96 ' Log present (Y/N) D Date completed I S Driller Total depth 20 y Cased to unknawr. Casing Sanitary seal (Y/N) Y Wires properly protected (Y/N). SEPARATION DISTANCES FROM WELL TO: uki kn cwn height Y 12 AT INSPECTION 7/3//MUNICIPALITY OI-NMt-PIUI�,1ISI r , MONMENTAI. SERVICES [)IVISIQN )57' oc 1 -I 1993 2,8 g.p.m. N i80' RECE..IVED Septic/holding tank on lot 115 ; On adjacent lots r Absorption field on lot I Z. -J ; On adjacent lots Public sewer main N14 Public sewer manhole/cl Sewer service line N/A Petroleum tank �L WATER SAMPLE RESULTS: Coliform 0 / Nitrate < 0.05 Date of sample: 9/3 /93 Collected by: > /00 > /00 1 N Other bacteria 111,4- r,9.rW Ko Ra NIA/ B. SEPTIC/HOLDING TANK DATA Date installed gf2y185 Tank size 12-50 &q/ Compartments Z Cleanouts (Y/N) T Foundation cleanout (Y/N) y Depression (Y/N) High water alarm (Y/N) /V/11 / Alarm tested (Y/N) NIA Date of pumping 7123 / 9 2 Pumper ZS 0.a c 'S SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: r 1 i Well(s) on lot 1 1 5 On adjacent lots /c�0 —Foundation (3 2 r IVIA To property line > 10 Absorption field Water main/service line Surface water/drainage A 72-026(3193)• Front CONTINUED ON BACK PAGE FROM WELL LOG Date of test Unknawo_ Static water level �%nkhawrn Well flow (AknaW+1 g.p.m, Pump levels (%n knawn SEPARATION DISTANCES FROM WELL TO: uki kn cwn height Y 12 AT INSPECTION 7/3//MUNICIPALITY OI-NMt-PIUI�,1ISI r , MONMENTAI. SERVICES [)IVISIQN )57' oc 1 -I 1993 2,8 g.p.m. N i80' RECE..IVED Septic/holding tank on lot 115 ; On adjacent lots r Absorption field on lot I Z. -J ; On adjacent lots Public sewer main N14 Public sewer manhole/cl Sewer service line N/A Petroleum tank �L WATER SAMPLE RESULTS: Coliform 0 / Nitrate < 0.05 Date of sample: 9/3 /93 Collected by: > /00 > /00 1 N Other bacteria 111,4- r,9.rW Ko Ra NIA/ B. SEPTIC/HOLDING TANK DATA Date installed gf2y185 Tank size 12-50 &q/ Compartments Z Cleanouts (Y/N) T Foundation cleanout (Y/N) y Depression (Y/N) High water alarm (Y/N) /V/11 / Alarm tested (Y/N) NIA Date of pumping 7123 / 9 2 Pumper ZS 0.a c 'S SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: r 1 i Well(s) on lot 1 1 5 On adjacent lots /c�0 —Foundation (3 2 r IVIA To property line > 10 Absorption field Water main/service line Surface water/drainage A 72-026(3193)• Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed NA Manufacturer Size in gallons Manhole/Access (Y/N) Vent(Y/N) --- High water alarm level "Pump on" level Meets MOA electrical codes (Y/N) — SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots -- "Pump off" Level at Cycles tested water Date Date installed 812-2-185 Soil rating (GPD/Ft2) O. 8 System type %r � (DW) Length 'q7' Width 3 r Gravel thickness % / Total depth �3 r Total absorption area 8 y6FT 2 Cleanout present (Y/N) r� _Depression over field (Y/N) _ �/ Date of adequacy test 913(/8 3 Results (pass/fail) II /T S for 7 Bedrooms n u Water level in absorption field before test S (AF1'Ele F/LUNG)�fter test z1Q (NPRoK, 3 0 99 (li„CJ� Peroxide treatment (past 12 months) (Y/N) N If yes, give date 111A SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I ) 5 On adjacent lots > /00 Property line r To building foundation 75 To existing or abandoned system on lot _ On adjacent lots W A Cutbank AM Water main/service line_ Surface water NZA Driveway, parking/vehicle storage area 501 Curtain drain /N E. ENGINEER'S CERTIFICATION >l0 ' >/0' NA l certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. l`\294 °mon nco an 4 Signature Engineer's Name Earle /IUSmQY1 M6eeveo°oo``o°:oo°°au d` 3 tr/1RiE V. Ae3MA9I Date 917193 G' CE -1393 HAA Fee $ 'go 0 Date of Payment /(% w 9-3 Receipt Number �2 S- =3 L0 6 92- "Pump L 72026 (3/93)' Rack Waiver Fee $ Date of Payment Receipt Number NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 907-456-3116 2505 FAIRBANKS ST. ANCHORAGE, ALASKA 99503 907-277-8378 PolarConsult 1503 W 33rd Avenue Anchorage AK 99503 Attn: - Our Lab #: F12793O Location/Project: - Your Sample ID: /p23NTanainal Sample Matrix: Water Y�t� Comments: Method Parameter ------------------- EPA 353.3 Nitrate -N Reported By: Patricia A. Woody Senior Chemist Units ------------ mg/l Report Date: 09/13/93 Date Arrived: 09/07/93 Date Sampled: 09/03/93 Time Sampled: 1300 Collected By: MK MDL = Method Detection Limit * Flag Definitions B = Below Regulatory Min. H = Above Regulatory Max. Date Date Results * MDL Prepared Analyzed <MDL 0.05 09/11/93