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Home My WebLink AboutWOOLEVER BLK 1 LT 1Woolver Block 1 Lot 1 #017-411-12 Municipality of Anchorage On-Site Water and Wastewater.Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP 191102 PID Number: 017-411-12 Dwelling: ❑■ Single Family (SF) El with ADU El Duplex (D) ❑ Two Single Family Project: El New ❑ Upgrade Name BILL MCDONALD ABSORPTION FIELD Site Address ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mo -• 12400 TOILSOME HILL DR ❑ Other Phone Number of Bedrooms Soil Rating Total depth from . •.Inal grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade avel depth beneath pipe Subdivision Block Lot Ft. Ft. WOOLEVER BLK 1 LT 1 Fill added above original grad= Gravel length Township Range Section Ft. Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Lift Station Holding Sewer Total a• • ption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well 100'+ 501+ TANK ❑p Septic ❑S.T.E.P. ❑Holding ❑ Other I Manufacturer Capacity Surface water 1004 GREER TANK 1000 Gal. Material Number of compartments Lot Line 10'+ NA PLASTIC 2.0 Foundation 10'+ LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034Tank to 3034 Installer drainfield MIKE N ANDERSON, P.E. Drainfield 3034 Co/MT3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) ft Inspection s 2nd 151 4/13/19 4/13/19 Location and description 3" 4th ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineers Stamp ..-4c. OF <l/ �1 . r....., n Ile Conditional Approval: Date 01-4.;\....� '•.`,'-'Qr ': .49TH '�.� o ,fri, p� •� t� �•�• MICHAEL N. ANDERSCN .7,1:k' Septic System = L _2� a �ejV��,•..W. C -94 9 :;;" Approve �... Date ( 0 k,'t' ••..? .f.*A,' ).;'., >t ��QfLcct�;`,\ "-m Note: this approval does not include well permit requirements. OO�vv�.-.--,, (Rev 05/02/18) Permit No. OSP191102 Page 2 of 2 Municipality of Anchorage 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 Legal Description: WOOLEVER BLK 1 LT 1 PID No.: 017-411-12 MARK A B CO1 10 11 ——— 0O2 30 46 1 TC01 32 49 TCO2 40 55 I CO3 44 58 4� ' N NT 43 59 I ,/ \ C04 44 59 \ / \ / \ �/ BENCH • I \\ I / ya 1 1 1 1 DRIVEWAY: 1 I I I • o WELL I 1 I 1 �, 1 1 / 1 1\ CO * �` \ �: / 1 \ / \ • / \ 02 / / CO3 dTC01 1-002 // CO3 MT1 N 1 V I NEW-1000-.PLASTIC TANK_ - --- 30 N89'59'30"W 118.68 6.5 1 OT 2 I ASBUILT SCALE: 1"=50' COE Tco CO2 coS I .��\\\\111 • i Tcos i i • X44 % OF ,1 ,41 -I NI■ •••.v �' .�11 _ IMV : 49 TFI • v♦0 .friAlL. 1.000 CHION / PLASTIC CRIER TNN / / .A,�I.MICHAEL N. ANDERSON!L i O• .. No. E 469 {.• = SEPTIC SECTION /��U� (( N.T.S. ♦',1�1 ESS\U,— ••• MUNICIPALITY OF ANCHORAGE DE iTMENT OF HEALTH AND HUMAN SER E Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL, SYSTEM AND/OR WELL. INSPECTION REPORT -- ---- NaNa11e DISTANCES FROM TU SEPTIC TANK ABSORPTION FIELD WELL Address -- WELL _ — Phone(s) —ti'fS— _-/f3 Perma No S S -o55 �_— Pio. of Bedrooms LOT LINE -- /0 cores LEGALDESCM!'nen _ bo —I / Block / Subdivision IA) le v(r FOUNDATION -- —� -- 'township. Range. Section .� ! A/ / .�. .�-i.f % AS -BUILT DIAGRAM (Show location of well. septic system. property Ines, foundation. driveway. water bodies, etc.) TANKS ❑ SEPTIC ❑ HOLDING Manoladwer Capacity in gallons Material No. of Companmenls --- TYPE OF SYSTEM U — ly:,1 RENCH ,, ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe fiction Iron, -total depth Irony original grade original a J rade FT FT.lf - Is,LtG. / :a �. 4. 6 �n n r / FII added above ongmzl grade FT Gravel depth beneath pipe FT FT _ Gravel wider- FT _ T oel abso,pron area 644- FT _ Distance between Ines .K/ A FT - -- --- - - _sQ Number of hoes Son rel,ngPipe C' SQ FT ntatenal 3a>3'�l -- - - -- - - - - -- Installer - Date/Installed WELLS S ---- ❑ PRIVATE ❑ OTHER fidentitvl Till kcal (A. B. C) - --- -- Installe, Total Depth Cased to FT FT Date la5talled. -- - -- �REMARKS: E_)(eAA"zt r-- �,..y/(1c •(r�,';K ,fir sl,,;,., ;f �.,r,.r .r'frrl /%i'l.a�J. �'U, 1 ✓' C(S'I"fr l ae� e"JI H, //b Pllt cd!+1 « Oje — — Scale: NTj Inspections Performed by. Date—_--____ inspection was perionlmd accortliny to all ENGINEER'S SERI. 'ejr-,�K_ 't'U /i,', cr- ,r 'i1«l z:'I •,. �) _/;��c�r I . ._---a cellily Ihal Iris G7ulde'llines Municipal and Slat in effect an this date: /c'—� I Health Department Approval:/ I i - Date:W 12-013 (3/85) I� I k.1 IV 1 1: 10 3: to> go U.. 1: -1 Vv' t2f I= ��9- 1[3IF4:! g!!11 C-"3p� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 025 i, STREET, ANCHORAGE, AK 99501 264-4720 43 R%A- $13 ]z Q ITZ Q Is: 09 E'--' ��4 :11: -11 ` PERMIT NO: B50563 DATE ISSUED: 09/04/85 APPLICANT: SARADB-L ARD ADDRESS: 12400 TOILSOME ROAD ANCHORAGE, AK 99516 CONTACT PHONE: 345-7518 LEGAL DESCRlP: SUBDIVISION: WOOLEVER LOT: 1 SECTION: 25 TOWNSHIP: 12N ^RANGE: 3W LOT SIZE: 1.25A (GQ^FT. OR ACRES) MAX BEDROOMS: 3 BLOCK: J. Listed below are the options available to you in designing your septic system" Choose the option that best fits you, site. �A ,..I I= f JEU EE 13 h0��P-111 DEPTH TO PIPE BOTTOM (FT^)4"o 4"0 GRAVEL DEPTH (FT") '0 Ir 0^5 3"5 TOTAL DEPTH (FT^)III � Ord&�^ 4^5 7"5 ° GRAVEL WIDTH (FT.) 5 22"0 5"0 GRAVELLENGTH (FT . ) ^�� ,. 0 '��" �p�� 42 0 ^ 69 0 " URAVEL VOLUME (CU^YDS.) 31"5 34.3 51.2 TANK SIZE (GALS) 1,000"0 ** 1,000"0 ** 1,000,0 ** SOIL RATING (SQ,FT./BR) 212 205 212 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) 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 dipiances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot" 4. I understand that this permit is valid [or a maximum of 3 bedrooms and any enlargement will require an additignal 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-8UILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE DY A LICENSED ELECTRICIAN" SIGNRD APPLICANT: SARADELL ARD DAT0 DAN: y� / ....... ...... PERMIT ND: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: LEGAL DESCRIP: LOT SIZE: MAX BEDROOMS: 1101 LJ FA 3: CA 3: F> 04 L. 1 - If- "v' (13107 04 PJ CA 1-4 C3 FT r% C3�� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 025 L STREET, ANCHORAGE, AK 99501 264^4720 I �::: 0 1 14.�:1 T' �L.-S F:� If" F:j, F"Z 1w 11 1.� 850363, 09/04/85 GAR8DELL,ARD 12400 TOILSOME ROAD ANCHORAGE, AK 99516 345-751B SUBDIVISION: WOVLEVER SECTION: 25 TOWNSHIP: 12N 1.25A (SQ^FT. OR ACRES) 3 LOTx 1 BLOCK: 1\ RANGE: 3W Listed below are the options available to you in designing your septic , system" Choose the option that best [its your site. DEPTH TO PIPE BOTTOM (FT.) olm/ GRAVEL DEPTH (FT.), 0^5/ / TOTAL DEPTH (FT.) 5~�� q GRAVEL WIDTH (FT.) �^2'/~ / GRAVEL LENGTH (FT.) z.*L GRAVEL VOLUME (CU,YDS,) ~/ TANK SIZE (GALS) SOIL RATING (SQ"FT"/BR) ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS � I certify that: 1" I am familiar with the requirements for on -mite sewers and wells as set Forth by the Municipality of Anchorage (MOA) 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 disposal system or public sewerage system on this or any adjacent or nearby lot" 4. I understand that this permit is valid for a maximum of 3 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-RUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND /3> THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIBNED DAT[�: ... ..... ... ~-_._. APPLIC8NT� SARADELL ARD � ISSUED BY ,4 DATE: q/� R0 R. P 01 3: CT A] FA 04 1. :K Q- Ne C3 F� 02% InI CT 1-4 E3 RAI Sh 4 ED Q.] ^ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 ��----- �3; AL -F 11E: 1-3 IFE RMJ ��R" 0 1: - 0 PERMIT NO: 850563 DATE ISSUED: 09/04/85 APPLICANT: SARADELL ARD � | '� ADDRESS: 1001 12400 TOILSOME ROAD � ANCHORAGE, AK 99516 CONTACT PHONE: 345~7518 LEGAL DE5CRIP: SUBDIVISION: WOOLEVER LOT: 1 BLUCK: 1 SECTION: 25 TOWNSHIP: 12N RANGE: 3W LOT SIZE: 1,25A (SQ.FT" DR ACRES) MAX BEDROOMS: 3 Listed below are the options available to you in designing your septic system. ` Choose the option that best [its your site" VA� � DE�PT�fTOPIPE BOTTOM (FT.) 4� GRAVEL DEPTH (FT.) 0 TOTAL DEPTH (FT.) GRAVEL WIDTH (FT,) / � WK GRAVEL LENGTH (FT.) � ) GRAVEL VOLUME (CU^YDS.) TANK SIZE (GALS) I 5iSDIi RATING (SQ"FT"/BR} `� ** TANK MUST HAVE AT LEAST TWO /- COMPARTMENTS I certify tha 1" I am familiar With the requirements for on-site sewera and wells as set forth by the Municipality of Anchorage (MOA) 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 mot hack distances from any existing wel1v wastewater disposal system or public sewerage system on this or any adjacent or nearby lot" 4. I understand that this permit is valid for a maximum of 3 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 I AND CD THE ELECJRICAL WORK MUST BE DONE BY A LIC CT�RICIAN. ---�``� ^�/��x�/� �z^~l^'c°v �a. SIGNED DATE: _... ..... .... ..... ___ ___`............. ...... ______ � APPLICANT: SARADELL ARD 14 / SyA ISSUED 8Y/1 ^ DATE: ^----t�-----------��-------^----~--^-^ ----~-- ------ v Municipality of Anchorage C*2) DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: farce, "1G (/'C DATE PERFORMED:_ g`19 CM_ 5-- LEGAL DESCRIPTION: Ll > t Wovletj"'c Township, Range, Section: 19/I// 3id� �,�- ;2!!i-- r7PTIR,j SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10 12 13 14 15 16 17 18 19 20 n MMENTS pall ' MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION Nov 2 61985 Ezf-C�1\1 D WAS GROUND WATER ENCOUNTERED? JLIK 'px�ec"�� IF YES, AT WHAT I6, / DEPTH? / 8S n &cL4p-e X 2 Depth to Water Alter 44 Moriloring7 tti u06" 0 l // �Pc/WGt�. S L O P E Date: Reading Date Gross Time Net Time Depth to Net Water Drop f l{ 0� 7a { t l{ 0 = /• FY PERCOLATION RATE /�' G2 (minutes/inch) PF_RC HOLE DIAMETER _ T TEST RUN BETWEEN ��FT AND 6,0 F f /I -1-11q124' r-.' I c c -i Sala PERFORMED BY: -D I � CERTIFY THAT THIS TESTI WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ;2-% -61 S 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: •-Xxu•Gl k&.2 DATE PERFORMED:l�S�— 4J��S'� LEGAL DESCRIPTION 5'e-rrr !AIA FILL P+ AEA'r SA& 6 511 .T 6wt 51(-T�sANd`Y 6��/ U" �Vvl G, / U�1�C rWLK e -N ' a'!j o2DS 61/M Af 8 '/ J6?c0"'e5 4hO — aPiTIfW- dwJl'j-. Gok/ems Township, Range, Section: WAS GROUND WATER ENCOUNTERED? Au yer 0-r; 6a l ` / IF YES, AT WHAT l-�(• 8035! y�t DEPTH? 6-JObck ((!0"1µo&+ Depth to Water Altar 1" 441", C46—Fc) Monitoring? COMMENTS —1 r / Date: l ■ ■■■ VIE ■ ONE Reading Date Gross Time Net Time Depth to Water Net Drop fi U •,� ,70 3 � f u3.36 70 lf 3.'36 •t Ido 5'% _2L t 3 : : s� ro 7a I l4 fi O 3-% y=a6 1,Jam/ r� PERCOLATION RATE-[1,2-� (minutes/inch) PERC HOLE DIAMETER _� TEST RUN BETWEEN -7.7:0 FT AND PERFORMED By I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) GAAN -HDI GR 'TER ANCHORAGE AREA BOR01 ,I !_.ARTMENT OF ENVIRONMENTAL QUAL1. 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 _ INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING NAME Ml Coke VC--__J(y71.-,,_-__ ADDRESS—_.1 /-vC`�11.%1 - --PHONE — _ LOCATION��_ rzl, 1U_a/ F'r.( __ LEGAL DESCRIPTION -,-/,LC-- K�)J /` SEPTIC TANK: _ c� , G NUMBER OF DISTANCE FROM WELL--ACTOo.SC MATERIAL l'-ii/K�K SfZ-'�-�. - CL'!!'-U!M- COMPARTMENTS_�— al LIQUID LIQUID CAPACITY—") jr) _GALLONS. INSIDE LENGTH INSIDE WIDTH- - DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS .—� —OUTSIDE DIAMETER_ —OR WIDTH,_,_ , , LENGTH 26 DEPTH �o _, LINING MATERIAL - -Z TL--�N'7� EC/A/0,S_ . DISTANCE FROM WELL _Py_W/�__ /A�� BUILDING FOUNDATION �I/�-�t2�j NEAREST LOT LINE— 4q' '/39 _-- TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. TILE DRAIN FIELD: DISTANCE FROM NUMBER OF ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE FOUNDATION_ , NEAREST LINES SQ. FT. LENGTH OF EACH LINE TRENCH WIDTH TOTAL LENGTH OF LINES_ IN. TOTAL EFFECTIVE DEPTH OF FILTER MATERIAL BENEATH TILE —IN. ABOVE TILE WELL:DISTANCE TYPE /ff) DEPTH /f) //- FROM ,BUILDING FOUNDATION._._ ----SAMPLE---, WATER NEAREST NEAREST SEPTIC SEEPAGE OTHER LOT LINE , SEWER LINE__ TANK_ , SYSTEM__— CESSPOOL , SOURCES__ DISTANCES: Am/, fuw! 256 by NIIPONAIL ItNy OAST I P.G N i -NeOlu,lTC o,pr />JSi ll+ -GE -1T 3�� I)Avc DIAGRAM OF SYSTEM uk 0 - __ Il�'-OIY�si,=0 VJ trU ,S7fu /CO 1 ,3 Ixta ry>cl m ?_-..+. F ^a'-- li6tlSf: GNI CF' ri, ,e h fr// llLd)S li'-U Irl i>N PiT -ts' lfi'-0 Nbi76` 1 If'G Il Oasf INV DATE / itCG LU, /f) //- APPROVED A't% - G.A.A.B. m GRE/A, ER ANCHORAGE AREA BOR,UGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO._-__.� 3500 TU pCR ROAD F'ODCH Cs. fi5O A A'4CHORAGE. ALASKA 99502 // GSA r,;jr".", 2/9.0506 �/ SEWAGE (DISPOSAL SYSTEM - APPLICATION AND PERMIT NAME OF APPLICANT _ �IL��-a�G=-I+--- MAILING ADDRESS INSTALLATION LOCATION LEGAL DESCRIPTION PHONE INSTALLATION OF: SEPTIC TANK ry$� SEEPAGE PIT—__ __. DRAIN FIELD —, OTHER 'TYPE AND SIZE OF FACILITY TO BE SERVED - TO BE INSTALLED BY -- J t1 \ SOIL 'TEST RESULTS � �3 ,reit /^'I NOTE, THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED PFRMIT VALID ONF YEAR _ FINAL INSPECTION, 24 HOUR NOTICE: REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE OV(/ TYPED-toR1-JDy--r0f1CrRt SEEPAGE AREA SIZE - TYPE 4:�)/YGRE7f- MINIMUM DISTANCES, REQUIREMENTS DIAGRAM OF SYSTEM 5 ft, FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT 20 ft• -, DRAIN FIELD - 1.0 ft' SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK�_i �!—. SEEPAGE PIT 2V ftn DRAIN FIELD In ft, TO NEAREST LOT LINE. [ / WELL TO SEPTIC TANKp SEEPAGE PIT DRAIN FIELD /Ltd ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK v ft, SEEPAGE PIT _10 f t • _. DRAIN FIELD 10 ft. —_. l SEPTIC TANK, 25 ft-, SEEPAGE PIT 100 ft- . DRAIN FIELD 50 ft. . TO RIVER. LAKE, STREAM. 4" CAST IR011 BI HPTIC PIPE El ill AIRT1 1A: :I: CAPS 14 1ST/111 L._ level � CAST IRON IB70 UNDISTURBED SOIL 4 15' :I11lIY.U: ( NINIBUx , 6 I r.qui red bhmevpr Iine crosses vnJcr Jrivexoy. ;NT CRIB II�r1itU;f'�IT. AAOBEU tp SKFIIL'r, B. (CRIB 4' KININUN ABOVE NATER TABLE) CO NS I L!R dREl: DELI SS S1LPA61 Pit FICAVATIO11 BASED ON 5011. TEST. NousE UST `POII, Ir.iG ux: nlGnmr.cn --) SOIL ;\ Grade: 2' -per 1W' or 1/4' p r fent except lo' p"e,idu tank A tha. sfo.Id not exceed 2i. 6' per 100 on flat Terrain. 4 MEN CAST IR0N SIPHON PIPE %SEEPAGE PIT `CRIB GRAVEL BACKFILL zIl xlxlnwr `✓.__ ._..__ GEAPESS LOT I.IIIE I CERTIFY THAT I AM FAMILIAR WITH THE REOUIREME:NTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 2888 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE��/-J ' -t APPLICANT'S SIGNATURE L ell,i"a!1 (RIA i1411:[TS-_ CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF---'-'-""' II: x'1.1 NOAL EXCAVATION 5 FEET INTO UNDISTURBED SOIL. III-Ti?:"r.= CO. 10 I'I T- 100' NO SLBLR LJCE- 10 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT }; !I (_NOL IE FITTED WITH AIRTIGHT REMOVABLE CAPS. Tn I'Ir- 120' 1 40 GRAVEL BACKFILL nn'_en' 0m.r An I200 SCrLR L ICL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. I]IPL I.C. 1 200' 011 U' 41 ! Ir.F '/� .411 SrINPCE Or HEALTH AUTHORITY' Al I'll IIoil OR LICENSED DESIGNER L ;NT CRIB II�r1itU;f'�IT. AAOBEU tp SKFIIL'r, B. (CRIB 4' KININUN ABOVE NATER TABLE) CO NS I L!R dREl: DELI SS S1LPA61 Pit FICAVATIO11 BASED ON 5011. TEST. NousE UST `POII, Ir.iG ux: nlGnmr.cn --) SOIL ;\ Grade: 2' -per 1W' or 1/4' p r fent except lo' p"e,idu tank A tha. sfo.Id not exceed 2i. 6' per 100 on flat Terrain. 4 MEN CAST IR0N SIPHON PIPE %SEEPAGE PIT `CRIB GRAVEL BACKFILL zIl xlxlnwr `✓.__ ._..__ GEAPESS LOT I.IIIE I CERTIFY THAT I AM FAMILIAR WITH THE REOUIREME:NTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 2888 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE��/-J ' -t APPLICANT'S SIGNATURE L GRetaTE.R ANCHORAGE AREA BOROUG'atel DEP); MENT OF ENVIRONMENTAL QUA, ,'Y CASE N 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 Performed For Jim woolever Date Performed 6/13/72 Legal Description: Lot i Block 1 Subdiision woolever �— This Form Reports Soils Log erco at7on est Depth Feet Soil Characteristics 2 Brownclayey silt 4 ® Brown silty sandy fine gravel (GM) with gray silty sand and sandy silt 6 seamer inter -bedded Was Ground Water Encountered? No If Yes, At What Depth? --- rroposea installation: Seepage Pit_ Drain Field Depth Of Inlet Depth To Bottom Of Pit ?-r Trenc-h - COMMENTS: 250 Sq_ Ft. of drainage area is required per bedroom. ormed ByCerlisle "—agc der Date: O F �� E�IQ Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 017-411-12-000 Legal description WOOLEVER BLK 1 LT 1 Expiration Date: 2/14/2024 Site address 12400 TOILSOME HILL DR Anchorage AK 99516 Current property owner(s) COWAN JUSTIN & JENNIFER X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 11 /14/2023 This 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 Approvdjune 2022 MUNICIPALITY OF /ANCHORAGE Development Services Departments : Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 01741112000 Complete legal description WOOLEVER BLK 1 LT 1 Location (site address) 12400 TOILSOME HILL DR Current property owner(s) COWAN 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: I■❑ 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: X Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ■❑ Plastic ❑ Concrete ❑ Fiberglass Age 4 - See advisory if steel older than 20 year's 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed X 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 $ 5.5U Waiver Fee $ Date of Payment I Date of Payment COSA # 0-5C—;;—>I `i 0,� Waiver # COSA Application—June 2022 COSA Checklist_June 2022 COSA Checklist Legal Description: Parcel ID: 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 Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank Date of pumping Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective 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) If yes, enter date Adequacy test date Results Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) in Effective depth used in Effective depth remaining in Comments/Deficiencies: COSA Checklist_June 2022 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 Phone Engineer’s Printed Name Date C&M ENGINEERING CHARLES BALZARINI, PE 10/18/23 Ru5H _ pktolgeLu0 MUNICIPALITY OF ANCHORAGE 1.----._..._........ Development Services Department :) Phone: 907-343-7904 __ On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On-Site Systems Approval Parcel I.D. 017-411-12 Expiration Date: 7-2 5 —I 1. GENERAL INFORMATION Complete legal description WOOLEVER BLK 1 LT 1 Location (site address) 12400 TOILSOME HILL DRIVE Current property owner(s) BILL MCDONALD Day phone Mailing address SAME Real estate agent Day phone 678g7o 2. TYPE OF DWELLING: 45 ,, 0 Single Family (w/wo ADU) ati � � ❑ Duplex APR 2 o 2019 ❑ Multiple Dwellings (Single Family and/or Duplex) ' A:' `` 3. NUMBER OF BEDROOMS: 3 0i4 L 9 s�� 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: /1/1\14—r Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ so 1330 "g 8O Waiver Fee $ Date of Payment ( 21./bq Date of Payment Receipt Number ei6# /6796//0275. Receipt Number COSA# 40. 19//g5 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER • As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On-Site staff may visit the site to verify the information submitted. Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 4-27-19 49TH 1 ,� Ad 6. DSD SIGNATURE P System #1 Approved for 3 bedrooms / • MICHAEL N. ANDLRSCN ;4 `-%'•• CE- 46cf •• %i System #2 Approved for bedrooms +‘j `` ��• Z2 ��y ee Disapproved �‘‘,4 FESSIO'A Conditional approval for bedrooms, with the following stipulations: \G\Pp�l.1TY pF�frir ON, tit SITS G,, 11/4,97-6.1,.1-14/0 R, P/YO �9 4T ER JJ �\ . (6/7— Original Certificate Date: 1-( Z '1 I 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: WOOLEVER BLK 1 LT 1 Parcel ID: 017-411-12 If more than 1 septic system on lot: COSA Checklist# of Structure served by this system A. WELL DATA [' Well log is filed with Onsite (or attached) Well production at time of test 4+ gpm Date drilled 7-26-1972 Water storage tank volume 0 gallons Total depth 135 ft Well disinfected for coliform test? ❑ Yes ❑■ No Cased to 20 ft ❑■ Coliform bacteria is Negative ❑■ Sanitary seal is functioning correctly Nitrate mg/L m Nitrate less than MRL (ND) ❑■ Wires are properly protected Arsenic ug/L ® Arsenic less than MRL (ND) Casing height(above ground) 12 in. Collected by MNA Date of flow test for COSA 4/15119 Date of Sample Static water level at beginning of test 15.2 ft. Comments B. TANK DATA C. LIFT STATION Age of tank(s) 2019 years ❑ Required maintenance completed Tank type/material PLASTIC Age of lift station years Measured operating fluid level in septic tank NEW Lift station material ❑■ Standpipes/foundation cleanout per record drawing Comments: Date of pumping NEW TANK D. ABSORPTION FIELD DATA Which system tested (date installed) 9/25/85 Adequacy test date 4-15-19 ❑■ ALL standpipes present per record drawing Results ID Pass For 3 bedrooms Total measured depth from grade 10 ft(max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 3 ft(min) Water added 500+ gal ❑ N/A— pressurized field New depth 0 in ❑■ Monitor tubes go to bottom of effective. If not, state Elapsed time 1440 min depth into effective ❑l Code-required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 500+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) UN date of test) Gallons introduced 500+ gallons If yes, enter date Comments/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' 0 Yes if No ft 0 Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot> 100' 0 Yes if No ft Holding Tank > 100' El Yes if No ft Neighboring Absorption Fields > 100' Animal Containment> 50' El Yes if No ft 0 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' El Yes if No ft Surface Water> 100' E✓ Yes if No ft Property Line > 5' El Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' El Yes if No ft Private Wells > 100' 0 Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ✓❑ Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓0 Yes if No ft Private Wells > 100' D✓ Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' E✓ Yes if No ft Surface Water> 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION , g�•of Az 'AI kt I certify that I have determined through field inspections and review j y••• �� •••9af of Municipal records that the above systems are in conformance with *: 49TH -N ; ,'/ MOA COSA guidelines in effect on this date. % s S' i . • i T�• MICFAEL�N. ANDERSON ; ;4• r� ,.. .. 79,9 COSA Checklist yellow sheet �i`�\ 'tom~~ • 8334N UPPER HUFFMAN ROAD coq. co M co N89°58'00"W 118.68 30 16.5 10' UTILITY EASEMENT . • I- Lri co W 9 "- W a F- � C— 2 co LOT 1 Z W 3 a' `r > CV N: CP N o o J � p _ _ `° O O Q W CD 0 0 2 Z oO 2.0 o z SCALE: 1"= 30' awA,, I- 1 0 co °' 35.5 o O o Z o Cleanou m o O cl+ p� v4 0 0 .Q �k cv 41. `G.0 2.0 01 deck aeck%' 0 0 00 0 O \Septic vent(typ) cli ' 0 • 30 t I N89°59'30"W 118.68 16.5 ( LOT 2 RECERTIFIED 4-17-2019 ✓ -(...) RECERTIFIED 2-23-2015 AS-BUILT NO CORNERS SET THIS DATE `�\\\� O(= � ' I hereby certify that I have performed a Mortgagee's inspection =�"` • • . .A��S is of the following described property: LOT_11 BLOCK 1. WOOLEVER SUBDIVISION sem'• t - 49 th •••'•*,/ Anchorage Recording Precinct,Alaska.and that the ro r• / improvements situated thereon are within the property lines s- �• and do not overlap or encroach on the property lying �s adjacent thereto. that no improvements on the property lying /, .Elizabeth L. Wolotko • ,o / adjacent thereto encroach on the premises in Question and • ��F •• 8036 - LS ,� that there are no roadways.transmission lines or other • ' ',0 • . ',.‘p"' visible easements on said property except as indicated Is DROF • •�r — hereon. I ' fSSI0NA1 ` Dated at Anchorage.Alaska EASEMENTS OF RECORD, OTHER THAN 1 ‘14%•.%' this 10th day of October .2008 THOSE SHOWN ON THE RECORDED 47- II - ICI PLAT ARE NOT SHOWN HEREON Fb 08-8, pg 68-69 FRED ers and A v ASSOCIATES.L.L.C. UNLESS OTHERWISE NOTED. Fb 19-2. pg 50 I Engineers and Surveyors BE 907-248-1666 , • _ Municipality of Anchorage =A �+ -- On -Site Water and Wastewater Program 907 343-7904 Parcel I.D 017-411-12 Certificate of On -Site Systems Approval / Expiration Date: 1. GENERAL INFORMATION Complete legal description 12400 Toilsome Hill Drive Anchorage, AK 99516 Location (site address) Woolever, Block 1, Lot 1 Current Property owner(s) Glen Parker Day phone 782-6215 Mailing address 12400 Toilsome Hill Drive Anchorage, AK 99516 Real Estate Agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Three Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well i] Individual i] Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for:. Received by: yY 'f— C'�—c��/i Date: COSA to be released to the engineer, unless otherwise requested by the engineer. 3 COSA Fee $\� /C�u Waiver Fee $ Date of Payment /C! Date of Payment Receipt Number U� C� Receipt Number ) COSA 4 SC sig 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. Anderson Engineering Phone 522-7773 Name of Firm A 9 g A.I.J.--- P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE ---? System #1 Approved for bedrooms System #2 Approved for _ bedrooms Disapproved Conditional approval for Date 3/9/15 bedrooms, with the following CE -4381 12 PFnrrcc�nNt`�' �� Certificate Date: // —E l% he' 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 Septic System Advisory Well Flow Advisory COSA blue sheet_I Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the. lot: COSA Checklist # _of _ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: WOOlever, Block 1, Lot 1 A. WELL DATA Well type Private Date completed 7/26/72 Total depth 1358ft. Date of test Static water level Well production If A, B, or C provide PWSID # Sanitary seal (Y/N) Y Cased to 20 ft. FROM WELL LOG 7/26/72 Parcel ID: 017-411-12 Well Log (YIN) Y Wires properly protected (Y/N) Y Casing height (above ground) >12 in. AT INSPECTION 2/10/15 Unknown ft. 142 ft Unknown g p m 6.0 g p:m WATER SAMPLE RESULTS Coliform 0 colonies/100 mL Nitrate 1.30 mg/L Arsenic ND ug/L Date of sample: 2/6/15 Collected by: Anderson Engrg. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,000 gal. Number of Compartments Y N Date installed 7/10/72 Cleanouts (Y/N) Y Foundation cleanout (Y/N) _ Depression over tank (YIN) _ High water alarm (Y/N) Date of pumping 11/21/14 Pumper McDonald's Pumping m C. ABSORPTION FIELD DATA Date installed 9/25/85 Soil rating (g.p.d./ftZ or fe/bdrm) 205 SFIBDRM System type Deep Trench Length 46 ft. Width. 4 ft. Gravel below pipe 7 ft. Total depth 10 ft. Eff. absorption area 644 ftZ Monitoring tube Y Depression over field N Date of adequacy test 2/10/15 Results (Pass/Fail) Pass For �-lfedrooms Fluid depth in absorption field before test 0 in. Water added 1,070 gal. New depth 2.5 in. Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 600 g p d Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D LIFT STATION No Add On Manhole - Gravity Flow to Absorption Trench. Date installed "Pump on" level at Datum Size in gallons in. "Pump off" level at _ Cycles tested Manhole/Access (Y/N) in. High water alarm level at Meets alarm 8 circuit requirements? in. E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot >50'* On adjacent lots >1 00' Absorption field on lot >100' On adjacent lots >100' Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line >25' Holding tank N/A Animal containment areas 250' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5' Water main >10, Water service line >10' Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water Service line >10' Surfacewater >100' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS *Septic Tank Installed before 1973. G. ENGINEER'S CERTIFICATION I certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. Date 3/9/2015 COSA brown sheet -1 0-10-1 2.doc Absorption field >5' Surface water >100' Water main N/A Driveway, parkingNehicle storage >10, 1 IASL E. ANDERSON :�ffi CE -4381 ate® ••..... PROFESSlO-W t\��t�� Municipality of Anchorage --1 Development Services Department� � �`� Building Safety Division ��• _ On -Site Water & Wastewater Program 4700 Bragaw Street SN P.O. Box 196650 �& Anchorage, AK 9951"650 650 / ww907) 3.3-790 site fit) (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL y� FOR A SINGLE FAMILY DWELLING Parcel I.D. 015 - (d 11- 12: COSA 03 1. GENERAL INFORMATION Expiration Date: �b d Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address WOOLEVER• BLOCK 1 LOT 1 12400 TOILSOME HILL DR • ANCHORAGE AK ' 99516 SARADELL ARD Day phone 272-1032 12400 TOILSOME HILL DR • ANCHORAGE AK • 99516 Day phone KEVIN SIGAFOSS W/ PRUDENTIAL Day phone 244-3212 3801 CENTERFIELD DR #200 • ANCHORAGE AK • 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 0 ❑ 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 samples. (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 thaty investigation, based on procedures outlined in the Certificate of On -Site Systems Approval G1idelin8s for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functionI and 044uwo for the number of bedrooms and type of structure indicated herein. I further verify that based on the"^ ri information obtained from the Municipality ofAnchorage files and from my investigation and inspection, ttie f 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 GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineers Printed Name JEFFREY A. GARNESS, P.E. Engineers Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines d Regulations. The reported results described 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 soils condition, groundwater 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 the system. Satisfactory lost results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE _�,� Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the Attachments: COSA Checklist Septic System Advisory Well Flow Advisory 337-6179 Date ID 1 C/o 8 �'NNk( 0 C •• ON-SITE ...�fii pultdV6�i AND WAST WATER DDOrRAM )11)W J� Arsenic Advisory Maintenance Agreements Supplemental Engineers Report Nit to Adviso Other By: a " (R" MOS) Original Certificate Date: AOK la Municipality of Anchorage " • -tel Development Services Department Building Safety Division: 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: WOOLEVER; BLOCK 1, LOT 1 ParcelID: A. WELL DATA Well type PRIVATE If A. B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 7/26/1972 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 135 ft. Cased to 20(BEDROCK) ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 7/26/1972 9/25/2008 Static water level UNKNOWN ft, 14 ft. Well production UNKNOWN g,p,m, 4.4 g,p,m, WATER SAMPLE RESULTS: Coliform C_ colonies/100 ml. NitrateDJ—'�-mg./L. Other bacteria colonies/100 ml. Arsenic: iVn ug./L. Date of sample: 9/25/2008 Collected by: GEG Ltd. B. SEPTICIHOLDING TANK DATA *IN THE HOUSE. SEE ATTACHED DRAWING Tank Type/Material SEPTIC/STEEL Date installed 7/10/1972 Tank size 1000 gal. Number of Compartments 1 Cleanouts (YIN) YES Foundation cleanout (YIN) *YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping 9/22/2008 Pumper MCDONALDS PUMPING C. ABSORPTION FIELD DATA •BELOW EXISTING GRADE TO BOTTOM of SUMP Date installed 9/25/1985 Soil rating (g.p.d./ft o /bdr 205 System type TRENCH Length 46 ft. Width 4 ft. Gravel below pipe 7 ft. Total depth +9.91 ft. Eff. absorption area 644 ft' Monitoring tube "YES Depression over field NO Date of adequacy test "9/25/2008 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test"O in. Water added 473 gal. New depth"'25 in. Elapsed Time: 135 min. Final fluid depth"""6tn.: Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date **SUMP ONLY EXTENDS 25" BELOW INVERT *"AT INVERT OF DRAINPIPE "••19" BELOW INVERT D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off" level a .. High water alarm level at Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot •50'+ On adjacent lots 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION %J1 I certify that I have determined through field inspections and ,i ! 1 01B.. •. YJ review of Municipal records that the above systems are in Q.•••••• .. '•.•""• conformance with MOA COSA guidelines in effect on this date. 0..... e s•ei r Ass,: Engineer's Printed Name JEFFREY A. GARNESS Qo I E— Date ..o��'� COSA Fee S Waiver Fee $ Date of Payment Receipt Number (Rev. 11105) Date of Payment Receipt Number SGS RecN 1085266001 Client Name Garncss Enginccring Group, Ltd. ProjectName/N L1,B1 Woolcvcr Client Sample ID L1,B1 Woolcvcr Matrix Drinking Walcr PWSID 0 Printed Datefrime 10/062008 16:19 Collected Datefrime 09252008 8:55 Received Datefrime 09252008 13:22 Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis parameter Results PQL Units McIMd Container ID Limits Date Date [nit Metals by ICP/MS Arsenic ND 5.00 ug/L CP200.8 C (<10) 09/30/08 10/01/08 NRB Waters Department Total Nitmtc/Nitritc-N 2.15 0.100 mg/L SM204500NO3-F B WO) 10/01/08 1DZ Microbiology Laboratory Colony Count 0 coV100mL SM209222B A (<200) 0925/08 DLC Total Coliform 0 coVI00mL SM209222B A (<I) 0925/08 DLC Fecal Coliform 0 coVIOOmL SM209222B A (<1) 0925/08 DLC 5.744 9 • ` M -W DRILLING, Inc. ` • - • P. O. Box 4-1728 • 2811 Dawson ' A C 99:::i-1::. ANCHORAGE. ALASKA 99599 DRILLING LOG Well Owner sA l e dzo OAJ( Ilse of Well Location (address of: Township, Range Sec if known; .or distance main road wed W/fes• W Size of casing Depth of Hole -M -5 ---.feet Cased to nO feet H/ —/q9 `f 32 / • .2 - Static water levet ft. (above) (below) land surface. Finish of well (check one) open end ( Z ); Screen ( ); Perforated ( ).. Describe screen or perforation Well pumping test at_'2_gallons per (hour) • (minute) for -1 --hours with Yaod/o tt of drawdown from static level. Date of completion al. !�& u WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness O 10 ,G V.OVCI Over bu.d an TO ' 10 f DS �� rocK: Grey Si ItSiont Rr9; 11; to TO . H ; . rrocturee. -TO— OTOTOTO TO- To- To- 77 To- OTOTOTOTO To- To- TO- To! TO TO TO TO jLqs /685 �■ 07/20/2008 04:29 ■ i ■ 907-348-8931 .C/�-a c�sePJ PAGE 01 4/ o/p V Wim- o`4� 4L rT 6Al?,1-11 In UPPER HUFFMAN ROAD _ I N69 -58-00"W 118.66 3016.5 10' UTILITY EASEMENT I I 30 2.0 to T LOT 1 N09°59'30"W 116.60 LOT 2 API Res rn�TE Lecrt\ON or, ZN� SASS T0.=NLN• _D VpoN MOq k'ep 0334N SCALE: 1"= 30' I I ' 6 I � AS -BUILT NO CORNERSISET I I IIS DAI E I hereby certify that I have performed a Mortgagees Inspoci P'(�.. • • • • . ��Q� I of Ore following descrtbed property:IILOT 1. BLOCK 1. DIVISIbN 49 T it • 1r I Ancholege Recording Precinct. Alas a, and that Ore D Improvements sltuated thereon are t•Mthin the property Ones cQ (ey'k • . "!: PY.7. .' yr and do not overlap or encroach on I(ie propeny lykg "I". Fred Walalka. • / adjacent thereto, that no Inprbvermks on the property lyin / adjacent thereto onc�rbaclh on the primises in question and No. 3255-S ghat there are no roadways; Iransmlision Ines or other 't�f%i • 10S vistble on Bahl ny m%eept as IhJlcotoJ \\ �`ESS10W�— I\\\\\�� Dated al Anchorage, Alaska, L"ASLM -NTS OF RECORD• OTIIER TtIAN OJs 10th day of October 2000 71105E SI IOWN ON THE RECORDED pp PI AT AUG G tarvr 4MAmd ucoc^y Fb 00-0, pg 00-eg FRED W/1LATI(A 6 ASSOCIATE 7 X1.0 Il\/ \µ \ el rt i N09°59'30"W 116.60 LOT 2 API Res rn�TE Lecrt\ON or, ZN� SASS T0.=NLN• _D VpoN MOq k'ep 0334N SCALE: 1"= 30' I I ' 6 I � AS -BUILT NO CORNERSISET I I IIS DAI E I hereby certify that I have performed a Mortgagees Inspoci P'(�.. • • • • . ��Q� I of Ore following descrtbed property:IILOT 1. BLOCK 1. DIVISIbN 49 T it • 1r I Ancholege Recording Precinct. Alas a, and that Ore D Improvements sltuated thereon are t•Mthin the property Ones cQ (ey'k • . "!: PY.7. .' yr and do not overlap or encroach on I(ie propeny lykg "I". Fred Walalka. • / adjacent thereto, that no Inprbvermks on the property lyin / adjacent thereto onc�rbaclh on the primises in question and No. 3255-S ghat there are no roadways; Iransmlision Ines or other 't�f%i • 10S vistble on Bahl ny m%eept as IhJlcotoJ \\ �`ESS10W�— I\\\\\�� Dated al Anchorage, Alaska, L"ASLM -NTS OF RECORD• OTIIER TtIAN OJs 10th day of October 2000 71105E SI IOWN ON THE RECORDED pp PI AT AUG G tarvr 4MAmd ucoc^y Fb 00-0, pg 00-eg FRED W/1LATI(A 6 ASSOCIATE 7