HomeMy WebLinkAboutTERRACE HEIGHTS BLK 1 LT 7 Municipality of AnchoragePage ~- 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
~m~ ~. ~ ~ Wastewater System: o New ~ Upgrade
AOdr~s~Zrl ~¢ '~ ~lq~J ~ ABSORPTION F~ELD
Phone:'l NO o~rooms:~ E] Deep Trench ~ Shallow Trench ~ Bed
Other
LEGAL DESCRIPTION so~,.ati.~: Total Deptt original grade:
GPD/Sq Ft.
Lot .q_ Block: [ Subdivision:¢~ ~ Deplh to pipe bottom from original grade: Gra~th beneath pipe
Township: [Range: ISection: Fiff added above original grade: ~vel length:
Classification Private. AB C): Total Depth: Cased TO: Total absorption area: ~ Pipe material:
Driller: Date Drilled: Static Water Level:Ft. ~--~e¢~lnstaller: C~. Date installed: /
SEPARATION DISTANCES Cs~'¢~o,d~,,~ ~ n S.T.E.P.
Capacfty in gsIIons:
From Tank Field Slat .... Tank Sewer Lines ~ ~ ~( ~t~
Well i¢~/ ~¢~1 ¢~ Material: NU tuber of CompaHments:~
Surface ~
w~t~ = ~ .... ~¢LF ~ LIFT STA'rl
Curtsi,Drai,~ ~ ~x¢~¢ ~ ~ --~ Pump~Electricallnspectionsperformedby:
Remarks: [%%1 ~ ~¢~ BENCH ~ARK
~¢¢~ ~'W" ~ ~ Location and Description:
E~GINEER'S SEAL
Inspections performed by: ~ ~ 1st
Doparlmenl o~ Health and Human Services approval
72-013 (Rev 9/91) MOA 25
Permit No. SW950508 Page 2 of
Municipality of Anchorage
DEPAR'rMENT 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
· . TERRACE HEIGHTS SUBDIVISION 01707511
Legal Description:BLOCK I , ,,-,-~ PID No.:
2
N.T,S.
; ........................ :. AI~RM~]A B .....................
i COt [48~) ]33.5/
:: __ C02151~) I 34.5/
75' ,WELL RADIUS
3000 GAL HOLDING
72-013 A (1/93)
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519.-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW930308
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:ROATH GARY T
OWNER ADDRESS:7941 COX DR
ANCHORAGE, ALASKA 99516
DATE ISSUED: 8/19/93
EXPIRATION DATE: 8/19/94
PARCEL ID:01707311
LEGAL DESCRIPTION: TERRACE HEIGHTS BLK 1 LT 7
LOT SIZE: 20700 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
HOLDING TANK 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 (iSAAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS
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 S~%ME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS
RECEIVED BY:
DATE: ~ // ~/~
DATE: 8-/~- ~
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
August 7, 1993
CIVIL ENGINEERS
(907) 694-2979
PAX 694 1211
Municzpality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
Anchorage, AK 99519-6650
REFERENCE: Terrace Heights Subdivision, Block 1, Lot 7
We request you issue a Dermit to install a 1000 gallon
Holding Tank to serve the three bedroom house on the refer-
enced Droperty.
The existing septic system is in a state of failure due to
the groundwater encroachment.
The encroachment of well radius' on the referenced property
limits the availability of usable square footage for a
conventional septic upgrade. In addition groundwater in the
Spring is at the grounds surface, therefore, restricting the
property to a holding tank.
The integrity of the existing 1250 gallon septic tank is to
be verified. If the integrity of the existing septic tank is
found to be poor, the septic tank is to be pumped, crushed
and abandoned in place and replaced with a 2000 gallon
holding tank. The location of the proposed Holding Tank is
depicted on the attached site plan.
We do not anticipate any adverse effects on neighboring
properties by the installation of the proposed Holding Tank.
If you have any questions, or require additional information
for your review, please contact us.
.- Shafer,
P.E.
RAS/LSU/lsu
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
1" =30'
UPGRADE
SCALE
8
COX DRIVE
0N-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
REFERENCE: Terrace Heights Subdivision, Block 1, Lot 7
GENERAL:
1.
The scope of this project includes the installation of a
1000 gallon Holding Tank to serve the three bedroom
residence located on the referenced property. The
existing 1250 gallon septic tank is to be excavated to
verify the integrity. If of poor integrtiy, the tank is
to be pumped, crushed and abandoned in place and replaced
with a 2000 gallon holding tank.
Construction shall be in accordance with the approved
site plan and design drawings; Department of
Environmental Conservation permit with any special
provisions or conditions; and all applicable State and
Municipal. Wastewater Disposal Regulations.
The contractor shall be responsible for obtaining any
necessary underground utility locates.
Unless specifically agreed otherwise, the property owner
shall be responsible for final grading areas subsequently
depressed from soil settling.
Contractors installing wastewater disposal systems must
be certified by the Municipal Health Department for
system installations. Owners installing their own
systems must also receive prior approval from the
Municipal Health Department.
HOLDING TANK INSTALLATION:
A holding tank is to be constructed by a certified
wastewater holding tank manufacturer. Construction shall
include a 6" cleanout for pumping access and watertight
manholes.
o
The holding tank shall be sufficiently bedded to prevent
settling or shifting of the tank.
3. Ail standpipes on the holding tank shall extend a minimum
of 12 inches above final grade.
Page Two
Terrace Heights
August 7, 1993
Subdivision, Block 1, Lot 7
Holding tanks installed with less than 4 ft. of cover
shall be insulated.
The holding tank shall be equipped with a high water
alarm which registers both visually and audibly inside
the dwelling. The alarm shall be positioned to allow at
least 450 gallons of storage after the alarm has been
activated.
Final grading over the holding tank shall be such that a
positive slope exists away from the holding tank.
MINIMUM MATERIAL SPECIFICATIONS:
Any septic tank
constructed by
manufacturer·
proposed for installation must be
a Municipally approved septic tank
The following
septic system
Anchorage:
pipe materials are approved for use in
installations in the Municipality of
_Type of Pip~
Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type of pipe other than listed above must be
approved by the inspecting engineer.
Insulation shall be at least 2" thick extruded direct
burial polystyrene (Dow Chemical Company Styrofoam HI or
equal).
Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal)·
Page Three
Terrace Heights
August 7, 1993
Subdivision,
Block 1, Lot 7
INSPECTIONS:
Typically there will be a minimum of three (3) inspections
required during the installation of the wastewater disposal
system. These inspections will occur as follows:
The first inspection must be conducted after the
excavation of ditches, pits, trenches, or beds and
before the installation of any gravel. A septic
tank may be set in place, but may not be backfilled
before this inspection.
o
The second inspection must be conducted after the
placement of the silt barrier, gravel, distribution
lines, standpipes, cleanouts, and insulation, but
before the placement of any other backfill.
o
The final inspection is to occur upon final grading
of the property.
Often there will be more than these 3 inspections required.
Especially with the installation of multiple trenches, sand
filters, pressurized distribution systems, etc. Thus, the
inspecting engineer is to be contacted at least 24 hours prior
to the start of construction. If necessary, a pre-
construction meeting will take place on-site.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Tel0phone 204-4720
ON-SI~T E .SEWAG_ E DIS~PO~S _AL SYSTEM AND/OR ~:LL INSPECTION REPORT ~/7~
LEGAL DESCRIPTION
LOCATION
Manufacturer
Dwelling
Mater'
DISTANCE TO: ] Well ID ~_ ' I Absorptionarea PER MITNO.~.~O~7 .~
No. of compartr~s
Well
IF ROMEMADE: DwellinglnSide length
No. Of lines / Length of~.gl~in,
Liquid depth
PERMIT NO.
Manufacturer Material
Foundation Nearest tot ~.in,p~- ~' PERMIT NO,
DIS ~ANCE TO:
Distance between IMes
Total length~_.~L~of in~;
Material beneath tile
Top of tile to finish grade ~L/
!
Width
Length
Depth
Type of crib Crib diamet0r Crib depth
Building foundation
DISTANCE TO:
Class Depth Dritler
Buildin9 foundation Sewer line
DISTANCE TO:
OTHER
Liquid capacity in gallons
Total effective gbsorption area
PIPE MATERIALS
REMARKS
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
DEPFIR'FMENT HEAl_TH FIND EN',,,':[RONI'qE:NTFIL ,~'X]TEC:T ION
=ii=25 '"L" STREET, FINE:HORFIE~E., FIK. 995E~Z
264. -,., 4. 720
< :Bl. OT'SJ.. )
RPF'I.."TCFINT GER"r' T. ROETH 7047 LL INDEN DRI"/E
LOCffl" Z ON COX DR I",¢E -'
I E.f..F FI_.E x, lJE, LOT _.,I¢_E
'I""¢PE OF SO:EL I SORF']./IOF, '-'"':'" 1S.:
.:, T ;., I El 1 TRENCH
MFI%IMIJM NLIMBER OF: E:E[:,ROOMS =: }~:
24.3:-8:1.98
2:'L000 SQLIRRE FEE].'
SOIl.. RRTING ,::SO FT/E:R>= 225
THE REQUIREI) .'.:.i;I;~E OF THE SOIL F:IBSORPTIC~N 'SYE;]"EEM I'.S:
THE LENGTH DIME:NSI[)N IS ].'HE L. ENGTH (:IN FEET> OF' THE ].'REENC:H OR £,RRINFIEI_D.
THE [:,EPTH OF FI TRENC:H OR PIT IS TFIE D ZSTFII'.,ICE BETI4EEI,,I THE SURFRC"T:: OF:' THE
GROUND FINE'., THE BOTTOM OF THE E'?:',CFI',/FIT"TON (IN FEET>.
THERE _TS; NO SET I.,.I_TD-f'H F'Of4: TRENE:HES.
THEE GRF-¥,,,'EL E:,EPTH _TS THE PI _T N _T MIJM DEF:'TH OF' GRFIVEL. BETHIEEN THE OLFrFFILL I::'"TF'E
FIND THE E~OTTOM OF THE E::..','CR',/FFf'_TCIN ,:; IN FEEET::,.
PERM I T FIF'F'L. I CF:II'.,I'I" HFIS THE RESPON:'S I E,' t I. I -f"T' TO I NF:'ORM TH I S C, EPFIRTMEi'.~].' I>LIR I NG 'tHE
~ I'.~STF:IL.L.f::I].'I OI'.,! I I'.,IS;PEC]"I ONS OF: Ri",l"r' I.,.I[£LLS FI[:'JRC:ENT TO ]''PI I'.~; PROF'ERT"? Ri"4[:' -r'HE
NUMBfSF;: OF' I;?.ES"TDENC:ES; THR].' THE HELL I-,.IILL SER',,,'E.
E:RCKF' ILL 1NG OF: RN'T' S'./S].'EM H I"FHOUT F I NFIL I N'.:.-';PECT I ON RN[:, FIPF'ROVF~L E','¢ TH I ~;
[:,EF'RR].'MEN].' NII.,.L E:E SUE:JECT TO PRCIL~ECIJ'f'ION.
MINIMIJM [:,I';'~TRNCE BE].'HEEN FI HEEL.L. FIND, RNY OI',I-SITE SEP.IRGE [.',ISF'OSRI_ S"r'STEM IS
:I..OE~ FEET FOR FI PRI',,,'FITE HELL OR 150 'FI) ~:~00 FEET FROf"I FI F'LIE:I..IC HEL. L [:,EF'ENB, II'-,IG
UPOI'.,I ]"HE TYPE OF PI]BL"TC HELL.
h'III',IIMUM [>ISTFINCE FROM FI PRIVR'T'E HELL Ti] FI F'I:;;:I',,,'F:ITE 2';EI-,.IER LINE I'.:-; 25 FEET I:::ll'.,l[:,
'TO E:I COMMUNIT'T' ':".;EHER LINE: I5; 7'5 FEET.
MEL. L. L.OG'.:~; FIRE F4:E:g!LIIRE[:, E::Ii'.,ID MU::ST BE RE]"URNE'[:, ].'O THE DEPFIRTMEi',I"I' HI]"HIi'q 30 DE:I'¢2~;
CIF THE HELL COMF'LJ:~:TICIN.
O'THER REQUIF:'.EMIEN].'::S MFI"r' FIPF'I_"r'. SF'ECIFICFI].'IONS f:ll",lD CONS].'I?.UC:TION I::,IRGF.'.Rh!S E:II:;:'.E
FI",,'R I LFIE':LE '].O INSURE F'f;:OPEF.': I N':'.';TFIE_L.FIT _T ON.
:1: C:ERTIF"? 'FfflFF'F
!.,IELI ....... ]~ _, P. E
::l,: _T FIM r:RMIL:EFIF:~ 1.4ITH THE REQUII~EMENTS F'OR .~'1 ,._TIE_ :SEI,,IEI~:S FINE> - ;' :'::' '~ ....
F:'OF~TH B'T' THE MLIN"TC_TPFILITY
2: _T ,t,I:I:LL "TN~TFILL THE SVS].'EM IN Fp::OOF?.g, FINE::E I,,,I"TTH ]'FIE,:. CODES,
- -: ":' '-" "= ' ':'" f{'.EQIJ I Pi'.E ENI_FIRGEMEN].' I F 'THE
Z~:: "T /.IN[:,ERSTFIN[:, "I"HF:IT THE L/,I =,.[TE SEHE;R ::,T_,].EII f'lFl'¢
RESIDENCE IS REMC~E:,ELEL:" TCI INCLUDE MORE 'T'HFIIq 3: E:EDROOMS.
IjJ~ ~
CON
:RE~LllR~t~ ~,}ZE OF qHE E~tJb MEIz~kFllCit'~
Il[gl Or ~EE. JDENC:ES 'IHFO' ]H~ HELL N]LL
:l~ H~LL CLIIFLEllON.
January 5, 1978
Lucius Ferguson
Box 41166
Anchorage, Alaska
99509
Subject: Lot 7 Block 1 Terrace ~teights Subdivision
Permit ~77629
A permit issued by this department for well and/or sewer
system has expired.
Pe~uits are issued on a calendar year basis~ as stated on
the permit, by authority of Municipal ordinance°
If you have drilled the well, a well log should be sent
to this department 'to document the installation date°
If there are any furth(~r questions, please contact this
office at 264-4720.
Sincerely,
Health and Environmental Protection
Sewer and Water Section
!kli E: IL. li ..... f=, NI [:,
PE]E:I.,'IITNO. ( '77E;2'.~ )
laPPL I C:FINT
L. OCFff I ON
L.E GI::II._
LIJL..[U.... I EI~.I~IJ..,U1`I
00 ',:':', DI.R
I..7 B:[ TERRRCE I.'I6TS
[."EI':'RRTP'IENT OF HERLTH R1`''ID E1`',I',/IROhlMEH"I.'FIL~ F'ROTECTIOH
2 ? -9 -' ,.'F-:'.~i::U..
'B ,='~, 't.'1.:1..6 ""'::'"" .......
L,.],~~0 ']. 8 4 S Ii:Hi I.:II.;;.E
'I~¥PE OF SOIL RBSORBTION S"r'STEM IS: TF, tENCH
f'II::~XII'"IUM NUMBER OF BEDROOMS = ii:
SOIL RFIT (:S~;! FT/BR)=. 225
THE RE~UIRED SIZE OF THE SOIL flBSORPTION S¥STEt
[:. lie F:' '-It'- H .~= ::L 2! I_ E~- INI (3 -T FI == 4- :'.a- (~ E: I
[:. IE IF:' ]-
THE LEN[Ff'H DIMENSION IS THE LEN(~TH (II',,1
THE DEPTH OF FI TRENCI-4 OR PIT' IS THE
Ei,ROUHD F:li'.,l[:) THE BOTTOi',I OF THE .,'CFI'¢RTION
THEI;'.E I5 NO SET 'I4IDTI...I FO'I;.'. TREN
THE GRF:IYEL DEPTH IS THE HINIMU
fiND 'I'I,-IE BOTfOI'~ OF '['HE EXC:FIVI,¥1' I £ ,:; I N
TRENCH OR DRFIINFIE!...I}.
1`.,1 THE SURF¥1CE OF THE
RVEL ET!,'IEEN THE OUTFFILL F'IPE
I:I PRCKR(~iE PLRNT
FOL. I..O!.41 NO CONDITIONS
· :L. EITHER R C:L. RS:
H CONTINLIO'IJS
I,C~REEEI,'IENT IS
FtE:SORPT I ON
~E INSTALLED
[TTEE"S OPTION SUBJECT TO THE
I OR II RPF'ROVE _R1`.,IT i'"lR"r' BE INSTRLLE[).
IIHTENRNCE REIE¥'IEN]" IS RE(;!I..)IREI). IF: FI D1RI1"'ITEi"'IflNCEE
KEPT "r'OtJ I"IR'¢ BE RE.E:.!I.JIRED TO ENL. RRGE THE SOIL
i"1 RND?OR "r'O I"1R¥ BE SUB.)'EOT TO F'ROSEE;UTION.
......... 'T II..li C~ ,:-.': ;:2 )
[~:AC:KFILLINO OF RNY SYSTEi',I.
I)EPARTPEN]" !,.!ILl._ BE '.=.;UELfEC:T
INSPECTION RND FIF'F'I';:OVI'::II.~ B"r' THIS
FIINIMUM DISTFIN(;E 8E*f}'IEEN I:1 !.,.lEI),,. RF,ID I=li"'iY ON-"SI'I"E SEI.4RGE DISI:'OSRL S'.r'STEI'"I IS
::L00 FEET E)R 8 F'RIVR'I'E 'I,'IELL OR 20.9 FEET FO[;,'. FI F'IJBLIC
'I4ELL I_..O(~S FIRE RE6!tJIRED Fli',l[.~ I"I[JST BE RETURNED TO THE DIEF'RRTHENT 'I,'IITHII''I 2;0 DFI'¢S
OF' THE 'I,'IELL E:OI"IPLETION.
(:)['PIER RE~DUIREf4ENTS i"lR'f flPPL.'¢. SPECIFIORTIONS RND COI"'IS]"RUCTION DIFtGI,;.'.RI"IS RRE
fl',/FIILFI[?,LE 1"0 INSURE PROI'='ER INS"FflLLRTION.
I C:ERTIF"r' THFIT
i: I FIl"l Ffli','II,I...IFF,'. I.,.!ITH THE I;?.E6...!UIREi"ENTS I ..~F.. O1`,1 _I liE. JJ.,IE,L_
FOFI'}t B~ THE I','IIJ1'.'IIC.T.I,:'FIL.]:T"r' O1,': FI1'.,It]HOF. H::IC:iE.
2: I !,'IILL' INSTflL. L THE S'¢STEI~I IN t%;(]OF,'DFI1`.'ICE 'I4ITH THE CODES.
'2:: I . NDEF.:ISTflND TI.-IFIT "('PIE L 1'',1 _., I f E SE!,.IER = ¢=, I Ell i"lFl"r' RE6!LI I RE EI".!IJUiREiEi"IENT
RESII]:'ENCE IS [~'.EI.qODEI_E[:' TO INCLUDE 1.40RE THflI"'I Z4 BEDROOi"IS.
v F:IF'I,:'I..I'FIHT L :'Il. lq
'r ,:::¢:~ H=T', DU/.2'''~%~-~ ~- - U2"~ ............... [: HTI:: ........... ]
I I': 'I,'t'IE
i.~U~iCIPALITY OF ~ '" =
Legal Description
0
6
8
10
16
18
2O
SOILS I,OG
PE RCOLkTIOM f~EST
77 -21
Lucius Ferguson Date Performed
Lot 7, Block 1, Terrace Heights Subdivision
8/2/77
Black organics w/silt
Dense, blue-gray, silty gravel w/some clay lenses
GM-GC) and cobbles to six inches
2
225 ft~ /bdrm.
Total Depth = 15 feet
No water table encountered
AVERAGE ABSORPTION AREA FROM SOILS LOG = 225 ft.2/bd~n.
[)ate Net Time Net Drop Perc Rate
8/2/77 30 min. 3.0 in. 10.0 min./in.
30 min. 2.25 in. 13.3 min./in.
30 min.. 1.875 in. 16.0 min./in.
30 min. 1.625 in.
Percolation P. ate
30 min.
1.625 in.
18.5 minute s/in.
18.5 min./in.
18.5 min./in.
- ~ CH/LMPION DRII,LING COMPANY.~._.
_ Y-F"]'~''~'-'r''''- ..... ~ ................................ ~. INC.
po #JS
MUNICIPALITY OF ANCHORAGE
Development Services Department t Phone: 907-343-7904
On-Site Water& Wastewater Section Fax: 907-343-7997
Certificate of On-Site Systems Approval '� (� (j
Parcel I.D. 017-074-22 Expiration Date: "-o !'
1. GENERAL INFORMATION
Complete legal description Terrace Heights B1 L7
Location (site address) 7941 Cox Drive
Current property owner(s) Tad Sumner Day phone
Mailing address Same
Real estate agent Day phone
2. TYPE OF DWELLING:
O Single Family(w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well 0 Private Septic ❑
Water Storage ❑ Holding Tank El
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.
COSA Fee $ 550 Waiver Fee $
Date of Payment 6/1ch(3 Date of Payment
Receipt Number Receipt Number
COSA# QSCl4 //lea 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.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA
COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the
time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems
depend on the local soil condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by
the system. These conditions are outside the control of the evaluator of this system.All systems eventually fail and satisfactory test results
do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments.Therefore
we cannot provide any warranty for future performance,nor can we estimate remaining life of the system.The content of this report is for the
sole benefit of the owner listed above.
Name of Firm Pannone Engineering Services Phone (907) 745-8200
Address P.O. Box 1807 Palmer, AK 99645
Engineer's Printed Name Steven R. Pannone P.E. Date f'1.9'!7/ ./?
itiAtetr
6. DSD SIGNATURE •••
X, System #1 Approved for J bedrooms —Maven •t•anriae
System #2 Approved for bedrooms •••• CE 8149,
•Disapproved I ,
Conditional approval for bedrooms, with the following\G`it�,QPa- /4
tra( (//��
`�� \ tiilit %
ON_SITE o'er
1I TER A
WRSTEI,y ND "'
RTE
%04 PROGRAM R�0`
'ii)) SERVICS,d��•��
.l
c____‘42,L. (
g
By: k ( Original Certificate Date: l
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
COSA Checklist
Legal Description: Terrace Heights B1 L7 Parcel ID: 017-074-22
If more than 1 septic system on lot: COSA Checklist# of Structure served by this system 1
A. WELL DATA
❑Well log is filed with Onsite (or attached) Well production at time of test 3.45 gpm
Date drilled 1981 Water storage tank volume n/a gallons
Total depth 155 ft Well disinfected for coliform test? ❑Yes 0 No
Cased to uk ft El Coliform bacteria is Negative
0 Sanitary seal is functioning correctly Nitrate 4.00 mg/L ❑ Nitrate less than MRL (ND)
M Wires are properly protected Arsenic ug/L JI Arsenic less than MRL(ND)
Casing height(above ground) 18 in. Collected by PES
Date of flow test for COSA '2'20'9 Date of Sample 5r2/2019
Static water level at beginning of test 135.3 ft.
Comments
B. TANK DATA C. LIFT STATION
Age of tank(s) 25 years ❑ Required maintenance completed
Tank type/material SteelAge of lift station years
tIt)ldin
Measured operating fluid level in<se{�tie� ank 6" Lift station material
0 Standpipes/foundation cleanout per record drawing Comments:
Date of pumping 5/10/19
D. ABSORPTION FIELD DATA n/a holding tank
Which system tested (date installed) Adequacy test date
❑ALL standpipes present per record drawing Results ❑Pass For bedrooms
Total measured depth from grade ft(max) Fluid depth prior to test in
Measured depth to pipe invert from grade ft(min) Water added gal
❑ N/A—pressurized field New depth in
❑ Monitor tubes go to bottom of effective. If not,state Elapsed time min
depth into effective
0 Code-required soil cover over field Final fluid depth in
❑ System presoaked Absorption rate gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months)
date of test) If yes, enter date
Gallons introduced gallons
Com ments/Deficiencies:
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout> 100'
El Yes if No ft IT Yes if No ft
Neighboring Tank > 100' E✓ Yes if No ft Private Sewer/Septic Line>25' El Yes if No ft
Absorption Field on Lot> 100' LEI Yes if No ft Holding Tank> 100' 0 Yes if No ft
Neighboring Absorption Fields> 100' Animal Containment> 50' 0 Yes if No ft
--rj Yes if No ft
Manure/Animal Excreta Storage> 100'
Community Sewer Main > 75' 0 Yes if No ft 0 Yes if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations> 10' p✓ Yes if No ft Surface Water> 100' ❑✓ Yes if No ft
Property Line> 5' 0 Yes if No ft Wells on Adjacent Lots:
Absorption Field > 5' 0 Yes if No ft Private Wells > 100' p✓ Yes if No ft
Water Main > 10' 0 Yes if No ft Community Wells>200' 0 Yes if No ft
Water Service Line> 10' p✓ 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' 0 Yes if No ft If absorption field is under driveway comment below
Property Line> 10' Q✓ Yes if No ft Wells on Adjacent Lots:
Water Main > 10' ✓l Yes if No ft Private Wells > 100' D Yes if No ft
Water Service Line> 10' 0 Yes if No ft Community Wells> 200' 0 Yes if No ft
Surface Water> 100' ✓❑ Yes if No ft
F. ENGINEER'S COMMENTS
S Oar e —t—A,,le- -i r-cs¢g tio�,Ai ct 'r,v 1c tag A•0---0dNEAQ
"---P•ExZC crYt- 7T
G. ENGINEER'S CERTIFICATION -m'� O .At; ,;1
I certify that I have determined through field inspections and review .0.eco. 9
of Municipal records that the above systems are in conformanc with ,4 '�.' 9 TF:I_ �., ��
MOA COSA guidelines in effect on this date. / • f �,•�,
SIR,'<.;,,.;; ••. cj...,�
COSA Checklist yellow sheet
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--------__-.-.----_-•-•-•--^•�•-.�. I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
MOT 7,BLOCK t TERRACE'HcK('HTS 5Ud
THE [NiORNAlf OM NE RE0T1 IS TOR TIC USE Of LENDING INSTITUTIONS SPECIFICALLY TO SHOT/ANT ANCHORAGE RECORDING DISTRICT,ALASKA, AND THAT TI-E
CONELICTS BET.. EXISTING STRUCTURES AMD PLATTED LOT LINES ANO/OR EA SEMEN'S; AND IS VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
NOT fl)BI TIRED fOR POSITIONING ADDITIONAL STRUCTURES, INPROVENCNTS, OR rENECLINES. THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
EASEMENTS OF RECORD,OTNEN THAN THOSE APPEAR:4G ON TMC RECORD PLAT , ARC NOT 10001, EXIST OTHER TURA NOTED.
HEREON I UNLESS INDICATED) DATED AT ANCHORAGE,ALASKA THIS '�T� DAY OF
NOTE: •ENCELIMES THAT PAY APREA1 ON THIS BRAVING ARE NOT ID BE USED TO METEORIC FRAY . 2.019
PROPERTY LINES OR POSITION ADDITIONAL IRPROVENENT S.
ANT PAVIH4 SNOYO MEREON OAR DE APPROXIRATE DUE TO EXCESSIVE SNOV*ROTOR ICC.
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Parcel I.D.
Municipality o.f Anchorage
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw Street
'P.O. Box 196650 Anchorage, AK 99519-6650
wWW. ci.anChorage.ak.us (907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
__0 17.07r~.~1~7'''7''
Expiration Date:
1. GENERAL INFORMATION -
Complete legal description Lot 7 Block 1 Terrace Hei hts S/D
Location (site address or directions) 7941 Cox Drive Anchora e AK 995;16
Current Property owner(s) _ Skip Garrett ,
Day phone .,345-8790
Mailing 'address
Lending agency
Mailing address
7941 Cox Drive Anchora e AK 99516
Day phone
Real Estate Agent _Careen Muir ~ Dynamic Properties Day phone ~727-2289
Mailing Address 3111 C Street Ste. 100 Anchora e AK 99503
Unless otherwise requested, HAA Will be held by DHHS for pickup. HAA picked up by:
2.- NUMBER OF BEDROOMS: ~3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[~ Individual On-site
r'~ Individual-Holding-tank' [~-
[] Community On-site J--I
l-'l Public Sewer J--I
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) on properties served by a single family ~n-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to home owners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. 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.
(Rev. 11/°~)
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 th'e Health Authority Approval Guidelines for 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 applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation.
Name of Firm- Pannone En.q. Svc.
Address P.O. Box 102954, Anch, AK 99510
Phone 272-8218
Engineer's Printed Name Steven R. Pannone, P.E. Date
thinest, ~d s~parat~on di~t~ce~ me~ured to readily identifiable features. ~e operational life of all
we~s aha sepuc s~te~ aetna on the local soil condition. ~ound water I.~.~ ,~., .... n,.~, .... '
during the year, ~d the water usage of the f~ly being se~ bv the s~t~%~'~7 ~'~;,";~7~.~ ~
oo.not gu~te~ :~ peno~ce of~e system, nor do they ~ar~tee ~at there ~e no hidden defects ~~
°r encroachments, ee~ c~ therefore not pro,de ~y w~ty for fu~re perforce nor give ~y
~s.~ h~w Ion~the s~em wdl continue to meet ~e o~rational requirem~ts of the ADEC or
sv~ ~. ~ ne coment or-this re~a is for the sole benefit of*g ....... ~:~-~ -~ ......
. . .~ vw~s~t ~t~wu uvove. ~y rell~ upon
°r, u~e °f~'s repo~ bY ~Y other person or p~ ]s not au~o~ nor will it co.er ~y legal .ght
E
'~ Approve~ for '~ bedrooms.
Disapprove~.
~on~ition~l ~pprowl for'. ~e~moms, wit~ t~e following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Adviso'ry
Well Flow Advisory
X
Expiration Date:
(Rev. ! f/99)
~. 0N- . ~:
~ ' WASTEWATER :
' '~ ' ~J] t '~ ~ I ~ - .~ ~ ·
Maintenance Agreements
Supplemental Engineer's Repod
Other , ·
'Or!ginal Certificate Date:
Reissue Date:
Municipality .of Anchorage
DevelOpment. Services Department
'Building Safety DiviSion
On-Site Wate~ and Wastewater Program'
4700 South Bragaw Street.
P.O. BOX 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907} 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 7 Bk I Terrace Hts
A. WELL DATA
'Parcel I.D.: 017.073.11
Well type P
Date completed_
Total depth 15._!.~.~_5 ft
Date of test '
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform .. 0 colonies/100 mi
Date of sample: 4/21/2004
If A, B, or C provide PWSID #.
Sanitary seal Y
Cased to. 40+ ft
FROM WELL LOG
.~ Well Log N
Wires properly protected Y
Casing height (above ground) 20 .in.
AT INSPECTION
412112004
139 ft
2.34 [j.p.m
Nitrate .2.31 mg/I
Collected by:. Laura Pannone
Other bacteria 2 colonies/100 mi
B., SEPTIC/HOLDiNG T4NK.D. ATA , ~ ~'¢--D3~?r--.-To-~ ~'~:tll.~ ~c[ ,~ I
- Ta.nk Type/M. ater'~al , AnchoraRe Tank Steel , ·
Date'i'n' ''~L~:"j~'~I ' ; '~rl~SC) ' , .
Clean°'~uts~ ~ ~.~2Uoni~n cleanout Y ~_~...5°'Dc~Ssi°n over~ank ~ High'rater a' arf~ Y'~
Date of pumping '4/2b/2004 .~ Pump~e~_lsaacs - . ~
C. ABSORPTION FIELD DATA
inst--' '~ Soil rating (g.p.d./ft~ or ft~/bdrm) ~' System tYPe .
Date
Length_. ft ~, ,~dth~ ~ ft,* ' GravelbeloWpipe~ ft
Total dept~., ft Effective a~a. ~ Monitoring tube ~Depression over field
Date of a~e~uTy test__.. R, esl~m8.~. For bedrooms
Fluid dept_h ,n absorption fi.old before te~t_ .[ \ ,n' '~~ded.. gal. ~NeW depth in.
Elapsed lime: _.0 rain Final fluid depth, in ~../,': Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo~) (y/N & type) If yes, give date
(Rev. 11/99)
LIFT STATION
Date installed
"P'ump on" level
Datum
Cycleste~ed~_ . !'' '
Manhole/Access
in". High water alarm level at ~ in
Meets alarm & circuit requirements?
SEPARATION DISTANCES
...... ,
SEPARATION DISTANCE~; FROM'WELL ON LOT TO:
Septic tank/lift station on IotJ/~103~ ' On adjacent Iots'~00+
Absorption field on lot ~l~ . adjacent lots 100+
Public sewer main 100+. Public sewer manhole/clean0u't 100+
Sewer/septic service line 25'+ Holding tank 122
SEPARATION DIS'['ANCE, S FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundatio~¢ ' Prope~y line
Water main ' 10'+ Water se~ice line 10'+ -. ' Sudace water
Draina 75'+ Wells on adjacent rots
SEPARATI~ANCE FROM ABSORPTION FIELD ON LOTTO: -
Properly line ~ ~uilding foundation ~ . . Water main ....
Water Se~ice line . ~ater. '~ _ ' 'Driveway, parking/vehicle'storage
Curtain drain !' ] Wells on ~ent lots
I cedify that ! have determined through field inspections and ~ .
review of Municipal records that the above systems are in .. ~----~-~
conformance with MOA HAA guidelines in effect on this date; ' ~"~7; ...........
Engineer's Printed Name Steven R. Pennons, P.E. '~.~
Waiver Fee $
Date of ,payment
Recei~)t Number
HAA Fee $
Date'of Payment
Receipt Number
(Rev. 11/99)
8Z~'U
?-~-C~.o.H.
S~o 5~'oo" ~-
Io' Ut'/I.
~ we II
S ago 54.' oo" z:
87, BI
AS-BUILT
NO CORNERS SET THIS DATE
EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ONTHE RECORDED
PLAT ARE NOT SHOWN HEREON.
F'W
I hereby certify that I have performed, a M9rtgagee:§ inspection
ol the following described proper.fy:/_- c, '/' "7, ~//< I
Anchorage Recording Precinct, Alaska, and that the
improvements situated thereon are within t.he. property lines and
do not overlap or encroach on tho, property lying adjacent
thereto, that no improvements On Property lying adjacent thereto
encroach on the premises in questiOn:andlthat there are no
roadways, transmission lines or Other Visible'easements on said
property except las indicated hereon.
Dated at A_n~horage, Alaska ~
:this--'~ ':~ dayof:/L.~r
: FRED WALzATKA & ASSOCIATES
(907) 248-1666 Engineers and Surveyors
MUNICIPALITYOFANCHORAGE "'
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, # 01 707311
1, GENERAL INFORMATION
Complete legal description
Terrace Heights Subdivision, Block 1, Lot 7
Location (site address or directions) 7941 Cox Drive
Property owner
Mailing address
Gary To Roath
Same as Above
Day phone
99516
Lending agency
Mailing address
Day phone .'
Agent
Address
Day phon~
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Un/ess otherwise requested, HAA will be held for pickup.
3
NOTE:
Individual well ×xx
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-.
lng to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site
Holding tank XXX
Community on-site
Public sewer
If community wa~tewater system, provide written confirmation from State ADEC
attesting to the I¢gality and status of system.
72-025 (Rev. 1/91) Front MOA #21
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Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Descriptio ¢-(2-¢:~:-~ { Parcel I.D. ~ I '"-~',¢'"~
A. Well Data
Well typ~ ~ ~ If A, B, or C, attach ADEC letter. ADEC water system number
Log present (~~v Date completed / ~ / Driller
Total depth Cased to ~ /~ Casing height
Sanitary seal~. )
Date of test
Static water level
Well flow
Pump level1
FROM WELL LOG
~ g.p.m.
Wires properly protecte~, )
AT INSPECTION
i
?,;
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main h-~/t~:~ .
Sewer service line
WATER SAMPLE RESULTS:
Coliform ~'~//0¢ ~
Date of sample: ///dS>
Nitrate
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
g~'~-~ /'¢/~'/'~ Other bacteria ~-~/¢/&~° ~
Collected by: ~ ~ /-~. '~"h-[' E-1 ¢
B.-~B~I=I=~HOLDING TANK DATA
Date installed [ ~- I ~ -~'¢~' Tank size ¢2~:'~-P ~ PC------Compadments
Cleanout (~N) "'-/, i...j. Foundation cleano t~N)- ~ ~_ Depression (Y~_~
Highwater'alarm~N)t' -~ ~'"~ Alarmteste (~N) ~
of pumping ,///~Oy':?' z/{_ Pumper ( ~ /~1 t~t_~ ~
Date
,-4
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
We (s) on ct I '~-'7-~ On adjacent lots , '~]r¢~ d-
To property line _ ,~,bsor~tion field
Surface water/drainage
Foundation
Water main/service line
72-026 (3/93). Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
Meets MOA electrical codes (Y/N)
D. ABSO ~T~lO~ FIELD DATA
Date installed f"-J / ~ .
Length Width
Total absorption area
Date of adequacy test
Manufacturer
"Pump on" level at / "Pump off" Level at
,,--'"'"'"""'-Cycles tested
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
SEPARATIOh~ DISTANCE FROM AB~TIPTION FIELD TO:
Well on lot /On adjacent lots
To building foundation
On adjacent lots ,
Surface water
Curtain drain / ~
Soil rating (GPD/Ft2)
.Gravel thickne.~
Cleanout present (Y%
Results (pas. a.a.a~ail)
Surface water
~System type
Total depth
Depression over field (Y/N)
for
After test
Bedrooms
If yes, give date
Property line
To existing or abandoned system on lot
Cutbank Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, ¢r-eonf¢rmed to all MOA and HAA guideflnes in effect o,,n the a of this inspection.
Engineer's
HAA Fee $ ¢'¢~O
Date of Payment
Receipt Number
Waiver Fee
Date of Payment
Receipt Number
72-026 (3/93)' Back