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PRATOR BLK 8 LT 3
Prator Lot 3 Block 8 #017-091-30 ..�t Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On -Site Services Section 825 °L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 Page/ of viww.cLanchorage.ak.us (907) 343-0744 l ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number:S 0001 ct PID Number: C9t4 -091 -`50 Name: j1��O{II IJ�(E Wastewater System: [X New ❑ Upgrade Address' s /1/ ft'qq ABSORPTION FIELD Phone: Number of Bedrooms: "pTrench O Shallow Trench ❑ Bed ❑ Mound ❑ Omer. LEGAL DESCRIPTION Sail Rating: C91 Total Depth from odginal grafi: %/•O GPDIFt' Ft. n: Block Ld+ S ivisioJ V� Depth to pipe Eom from anginal grade: oft Gravel depth bn eeath ppipti- J TV i Jr 0 Ft. O' Ft Township: Range: Section: Fill added above anginal grad : j o Gravel Length: qMlp Ft. ` Well: �.,.,``h ❑ Upgrade � GravelmMh, 2<O Number of lines: ( Distance e-nen lines: Ft. Ft Classification (Private. A. B. C): Total Depth.- r� Cased to 2/9L Total absorption area�' Pipe Material: of1, flNG'I`ei ylTFL Ft Driller Date Drill : e/ Z Static Water Level: Installer, �Pt�Cr �JtJV1lES Date Installed: a0 Y wry- Z7 F Yield. S. O Pump Set at Iu,OW Casing Height Above Ground: Z.O TANK GPM LAA Ft. Ft SEPARATION DISTANCES Aseptic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Holding Public/Prlvat ManufactuQ1rer_ j r Gpacdy From Tank Field Station Tank Sewer Line /^'�C� CaN K.+ l2s O Gal. f t I /00 / �ti0 tt Material. / Number of Ccmpamnenb: Well 00 S �+ 1o01�i— LIFT STATION surface Water trap f ZS + �— Size: Manufacturer, Lot Line SCP Gal. // too i� /� I / "Pump on level at "Pump off' at High walar alarm at Foundation 0tT � in. in Pump Make 1 Eleclncal Inspections performed by Curtain Drain Remmks: BENCH MARK Location and Desoepeon: Z� �� Ai scrod aevabcm loo Ft Engineers Stamp .r ,W & 3:30 M Inspections performed by: rt �eYS 1V 1 Dates: 1s` / egod• t /-eh �p �( < 6 941..1 : CdA . . 2nd /� �. s0 ® ...... 0 Department of Health and Human Services approval p PP �° h11CNAEl N. ANDERSON d �� . c�e�9%a9 X89 Reviewed and approved by: liv� / 1.f/. J �"'t Date: �- - [� o i 'f ° �• w •'• " ��p (Rev. 11/991 ppq FFE A Permit No. SW000194 Page 7 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: LOT 3, BLOCK 8, PRATOR SUBDIVISION PID No.: 017-091-30 n S 89'57'30" W 299.30' �-C,LPTIC FIELD �/ I IC04 \ / I MT I. C05 N .— OOO I v„_�Ol A O i in v 0 � I B � _ U 3 J BENCH MARK =oo J EXISTING WELL — o x 1,250 GALLONJ \ BACKFILLED SEPTIC TANK z SEPTIC TANK �^ \ w \ 1 BACKFILLED CRIB N EXISTING WELL �� 100' RADIUS i N 89'57'30" W 299.19' ASBUILT SCALE: 1"=50' MARK A B CR D. ELEV. PIPE ELEV. C01 87.6 103.3 85.7 82.02 CO2 89.2 106.0 85.72 82.02 TC01 91.0 108.4 86.42 TCO2 97.0 115.5 86.34 CO3 100.4 120.5 85.66 81.62 C04 148.7 196.4 77.94 73.82 C05 161.4 196.8 76.92 73.8 MT 152.5 196.6 78.0 m • .°.`�: coa un FILL 49TH • Rl[P FABRIC � ,!6/a l'�. • e ......... F. y J cw. P • •eer smw ncK / •• MICHA[L iJ. AND,•.RSONO'� •� SEP11C SECV0N 60.0 e01.0r. N.T.S. MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW000194 Legal Description: PRATOR BLK 8 LT 3 Li�0 fav, `7/i Date Issued: Jun 27, 2000 Expiration Date: Jun 27, 2001 Parcel ID: 017-091-30 Design Engineer: 0088 Anderson Construction & Eng'g Site Address: 014600 FERNHILL CIR Owner Name: Dan Neill Lot Size: 49390 SQ. FT. Owner Address: 14600 Fernhill Cir. Total Bedrooms: 4 Permit Bedrooms: 4 Anchorage , AK 99516 - This permit is for the construction of: C Disposal Field M Septic Tank I,] Holding Tank [:] Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: �t/� O P Date: 6— 2 7-oo Michael N. Anderson, P.E. 4640 Shoshoni Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 June 16, 2000 Department of Health and Human Services P.O. Box 6650 Anchorage, Alaska 99519-6650 Re: Lot3 Block 8 Prator Subdivision To Whom it may concern The above property has been sold and a test was performed on the existing crib, which failed due to the full crib. A new test hole was excavated near the old site with no water even after the seven day monitoring period. The perc rate was 6 minutes per inch at elevation -5 feet. The soils are good silty -gravel the full depth of the test hole. The new system will be a deep trench with 8 feet of effective depth. A new tank will be installed outside the 100 foot well radius. The lot is 1.25 acres with the natural slope being to the south-west as the plan shows. None of the surrounding properties will be effected by this new upgrade. If you have any question please call me at 345-3377 Sincerel "-7u Michael Anderson, P.E. DESIGN CRITERIA: 4 BDRM X 150 = 600 GPD SOILS = 600/0.8 = 750 SQ FT REQ'D 750/16 = 47' TRENCH: 12' DEEP 8' EFFECTIVE 2.0' WIDE 47' LONG OVER N 89'57'30" W 299.1 SEPTIC DESIGN PREPARED FOR DAN NEILL LOT 3, BLOCK 8 PRATOR SUBDIVISION PREPARED BY MICHAEL N. ANDERSON, P.E. 4640 SHOSHONI AVE. (907) 345-3377 / FAX (907) 345-1391 SCALE: 1 "=50' JUNE 15, 2000 .FF;e��1�y. �4 T o-1/ t��-° ..�. �f •�/.�°.ease°°• •rv�•i�r ren .0 as°T • , MICHAEL N. ANDERSON .• CE q 9 a, •(, ifr v(J •' ,v tae ......� EXISTING WELL 100' RADIUS S 89'57'30" W 299.30' NEW i `\�\ OSYSTEM I TH#1 I \� � ��C I I I I � of I j �— � w � I u 3 w I I 3 J I I •O J P — M � � M O = o M �� EXISTING SEPTIC o z z , NEW 1,250 GALLON \ TANK TO BE ABANDONED � SEPTIC INK \\\ 4 o Oro 5��� EXISTING CRIB (P TO BE ABANDONED N 89'57'30" W 299.1 SEPTIC DESIGN PREPARED FOR DAN NEILL LOT 3, BLOCK 8 PRATOR SUBDIVISION PREPARED BY MICHAEL N. ANDERSON, P.E. 4640 SHOSHONI AVE. (907) 345-3377 / FAX (907) 345-1391 SCALE: 1 "=50' JUNE 15, 2000 .FF;e��1�y. �4 T o-1/ t��-° ..�. �f •�/.�°.ease°°• •rv�•i�r ren .0 as°T • , MICHAEL N. ANDERSON .• CE q 9 a, •(, ifr v(J •' ,v tae ......� � I I I I I I I I I I I I I I S 89'57'30" W 299.30' NEW SYSTEM � �TH#1 1 -MONIJORING TUBE / i i DOUBLE C.O. TANK C.O. � EXISTING WELL 100' RADIUS i i i i i i i i i i i r EXISTING PIPING I TO BE REUSED I I NEW PIPING I I I I I 1 ISHED NEW 1,250 GALLON ` SEPTIC TANK EXISTING CRIB TO BE ABANDONED W 299. EXISTING HOUSE EXISTING PIPING TO BE ABANDONED EXISTING SEPTIC TANK TO BE ABANDONED SEPTIC DESIGN PREPARED FOR DAN NEILL LOT 3, BLOCK 8 PRATOR SUBDIVISION PREPARED BY MICHAEL N. ANDERSON, P.E. 4640 SHOSHONI AVE. (907) 345-3377 / FAX (907) 345-1391 SCALE: 1 "=30' JUNE 15, 2000 O t� w moi.• 4^ 49-11 r 01- MICHAEL N. ANDERSON i CE 9469 e Municipality of Anchorage e ` DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST a,�(ENGINE r'SSEAWk.t,y� r� l ) 3 MICHAEL N. ANDERSON p(�1 ( PERFORMED FOR: /h'pn I���t' 1 DATE PERFORMED:. ®�� LEGAL DESCRIPTION: S//f� `✓ Township, Range, Section: r -T -7 - SLOPE SITE PLAN DEPTH I I I I I 2 3 4- 67 6- 7 9 WAS GROUND WATER 10 ENCOUNTERED? L4 O S 11 L IF YES, AT WHAT 0 DEPTH? P 12 E Depth to Water After 13 Monitoring? n(Balm (0/t 2 Av 14- 15 16 17 18 1 20 :OMMENTS 0.lvoMO / 9.IC. Reading Date Gross Time Net Depth to Time Water Net Drop n ere re Mira ZM N 21I q m, �1 3' PERCOLATION RATE (minutevinch) PERC HOLE DIAMETER TEST RUN BETWEEN 1//m FT AND S ';' FT PERFORMED BY: �(� a? n 1 e -Ys, pn I CERTIFY THAT THIS TEST WAS PERFORMED IN (R/ -Z/00 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: T 72-008 (Rev. 41851 - GREAI 'R ANCHORAGE AREA BOR, !6H Department of Environmental Quality 3500 Tudor Road Anchorage, Alaska 99507 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME /�lf ,T/�/,��9�MAILING ADDRESS � ���� y/7l � ��/�/ PHONE LOCATION �rZ��/f-/�E/✓fl/'��afLEGAL DESCRIPTION SEPTIC TANK: DISTANCE i NUMBER OF FROM WELLMANUFACTURER Jff� MATERIAL ���'r-/ COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH — LIQUID CAPACITY 12t;2 GALLONS. SEEPAGE PIT: NUMBER OF PITS DIAMETER _=0R WIDTH LENGTH �7 DEPTH LINING MATERIAL%� ( CRIB SIZE: DIAMETER _�L DEPTH DISTANCE FROM: WELL ill-=� //,, /7" TOTAL EFFECTIVE ' BUILDING FOUNDATIONIL_, NEAREST LOT LINE6 ABSORPTION AREA (WALL AREA) / SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE `{�/� CONSTRUCTION iO/�%?ElJL/z% ('AS/ti DEPTH DISTANCE FROM: BUILDING/ NEAREST NEAREST /a SEPTIC C/ SEEPAGE i FOUNDATION, LOT LINE ( C SEWER LINE �� TANK SYSTEM— CESSPOOL YSTEM CESSPOOL OTHER SOURCES APPROVED�DISAPPROVED REMARKS �— DISTANCES: J-- DIAGRAM OF SYSTEM INSTALLED BY: ufL /h, wj PIPE MATERIAL: i LOT SLOPE: P�)/// REMARKS: /,��/c, o�/✓���C�G.�li � �-\-moi L�.�F,�. DATE /, /T7,2Z APPROVED ✓ - G.A.A.B. Form PW -026 GREAT tR ANCHORAGE AREA BOk�UGH DEPARTMENT OF ENVIRONMENTAL QUALITY e 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE, ALASKA 99502 TELEPHONE 279-8686 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT NAME OF APPLICANT av INSTALLATION LOCATION b�.%% LEGAL DESCRIPTION -�A 9 /-cl, INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS COMPLETION DATE ANTICIPATED /- ' /Y � MAI/LING �iADDR 3 PERMIT NO. 2152 PHONE C7 L� PIT'/ DRAIN FIELD , OTHER TO BE INSTALLED BY NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST 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 TYPE E AREA SIZE MINIMUM DISTANCES, REQUIREMENTS i FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT :Z!% , DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK , SEEPAGE PIT DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK �� SEEPAGE PIT / DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK /C� SEEPAGE PIT �[^/ DRAIN FIELD SEPTIC TANK, SEEPAGE PIT /, DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. HEALTH AUTHORITY OR LICENSED DESIGNER TYPE DIAGRAM OF SYSTEM I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGLARLIOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SY TEM IS IN ACCORDANCE WITH SAID CODE.DATE APPLICANT'S SIGNATURE � ! -C' �.Gl�w / :Y,A1L:% n;: �' r;kr:.+,..:.. n....,.. ... 32; F:A:;::t:. ' ANCFiornG::, nF„ns::n s9501 Z J3 Lin k ooM Perr'or,;cd For LT 1C1-�R /,�L-_� _Date Pcrfor cd_�-z LORI DusCripLiOn: uOC :3 'LOCK b(. IV -` This Form hdp Orts a: Was Ground Water Encountered? � s�°d IF Yes, At Fthat Depth Loca-cion SkeYc'h Depth .'6CC . SUli te1`istics r Orgn�tas l + r 3 4 %� caas�s 4o O 3% •� ` lNna11 ►ehsec �oc3csis i V. V% . ° ' IS 9 10 •' Was Ground Water Encountered? � s�°d IF Yes, At Fthat Depth Loca-cion SkeYc'h insCal.Yati o n: Seepage it��_ Dralr, mil QT �..:.Gt 11cpv"I TO �;O'.a0�. Or R. or :r, -,-^r, J � st %erfor med „_A-� Q ,1 c oDJ� �-�131� l`i O.AAS certified B Dzto: + i Date Gross Time Net Tine Dept:: To 20 iNe . Drop r i insCal.Yati o n: Seepage it��_ Dralr, mil QT �..:.Gt 11cpv"I TO �;O'.a0�. Or R. or :r, -,-^r, J � st %erfor med „_A-� Q ,1 c oDJ� �-�131� l`i O.AAS certified B Dzto: cd ai ho Cd 0 Q 2 . . . 0: . . . . . . c): C\J: C\j Gi q . . . 0: . . . . . . c): C\J: C\j Gi CN rr in . . . . . . . . . . Gi CN c): SI: 0 0 cc):! 0 ojj U i L0 C F- 0 0): U4 PQ ok En En Ln En H c! E, wg I Z I E-1 EF v) . . . . . . . . . . 0 0 ojj U i L0 C F- 0 0): U4 H E-( H c! E, E-4 I E-1 EF v) C) :. z r. C); cil r�: C� cz E4 E4 E-4 E-0 F4 E4 E4 E-4 oN cr,� E-4 H F E EO F E-4 F P E-4 E-4 E E E4 E4 0Gi oNi lr1i HC'<. N:oN:r4 r -I 0 -w w PL4 Pw z MUNICIPALITY OF /ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 017-091-30 1. GENERAL INFORMATION Complete legal description Location (site address) Expiration Date: _�—_ [ —2 d Prator, Block 8, Lot 3 14600 Fernhill Circle, Anchorage Current property owner(s) Mailing address Real estate agent Jason & Janie Dusel Day phone (907) 313--9089 1351 W 70th Ave, Anchorage, AK 99518 Amy Bacon 2. TYPE OF DWELLING: ❑a Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone (907) 947-1401 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Q Private Septic ❑■ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ H )2,5Q C0010 Date of Payment 11 0 Receipt Number. Oq I t.1 q D COSA # DS G 2D I e y Date: Waiver Fee $ Date of Payment Receipt Number Waiver # Distan 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Michael E. Anderson. P.E. Date 11/2/2020 6. DSD IGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: (-w 441,I N41-13, o' ON-s/-FE�= iA/A,. vpj M WASP -1, fiAA4 By: tet.. Original Certificate Date: " Z 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 Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory OtherAdvisory I Other 2 � ���IG � � Si o► COSA Checklist Legal Description: Prator, Block 8, Lot 3 Parcel ID: 017-091-30 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 3/28/72 Total depth 217 ft Cased to 217 ft Al Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) '18 in. Date of flow test for COSA 10/28/20 Static water level at beginning of test 73.4 ft. Comments B. TANK DATA Age of tank(s) 20 years Tank type/material SEPTIC/STEEL Measured operating fluid level in septic tank 50 ❑ Standpipes/foundation cleanout per record drawing Date of pumping Alaska Quality Septic - 10/21/20 D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) 7/1/2000 ❑ ALL standpipes present per record drawing Total measured depth from grade 12 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: Well production at time of test 2.9 gpm Water storage tank volume None gallons Well disinfected for coliform test? ❑ Yes ❑ N ❑ Coliform bacteria is Negative Nitrate 3.99 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by FORGE ENGINEERING Date of Sample 10.21.20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Septic System is gravity flow. Adequacy test date 10/28/20 Results ❑✓ Pass For 4 bedrooms Fluid depth prior to test 30.5 in Water added 600* gal New depth 67 in Elapsed time 1400 min Final fluid depth 38.5 in Absorption rate '600" gpd Any rejuvenation treatment (past 12 months) If yes, enter date *System remained in service during 24 hour test. Estimate additional 150 gallons of water entered system during that time. ,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' ®✓ Yes Community Sewer Manhole/Cleanout > 100' Q Yes if No ft ✓M Yes if No Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25'✓] Yes if No Absorption Field on Lot > 100' Q✓ Yes if No ft Holding Tank > 100' Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' Yes if No p✓ Yes if No ft if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Q Yes if No ft 0 Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 171 Yes if No ft Surface Water > 100' ft ft ft ft ft Q Yes if No ft Property Line > 5'✓Q ®✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Q Yes if No ft Private Wells > 100'✓0 Yes if No. Water Main > 10'✓0 Yes if No ft Community Wells > 200'✓0 Yes if No, Water Service Line > 10' Q 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' ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓Q Yes if No ft Private Wells > 100' U Yes if No Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' Q✓ Yes if No Surface Water > 100' ✓❑ Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION Q �� 1 certify that I 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. 9th % nuuu ... au.... sur ,uiu e ............ .uuu................... un.y fi MICHAEL E. ANDERSON -1Z No. CE -4381 11/19/20,0`'+4� �C��} COSA Checklist yellow sheet .............+- X44 'OROFESS\ � ft ft ft ft DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section . www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval #OSC 201647 Subdivision: Prator Block 8 Lot 3 907-343-7904 Fax: 343-7997 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 20 years old. Typical replacement costs range from $8,000 to $11,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 -year-old steel tank MAY look like. Mailing Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www mum org Alf UA • Municipality of Anchorage . .. on -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 017-091-30 Expiration Date: — 1 1. GENERAL INFORMATION PratOr Block 8, Lot 3 Complete legal description 14610 Fernhill Circle Anchorage, AK Location (site address) Current Property owner(s) Virginia A. Graham Day phone 14600 Fernhill Circle Anchorage, AK 99516 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Four 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual 171 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaivedVariance request for. Received by: Date: COSA to be released to the engineer, unless otherMse requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number COSA # 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. Name of Firm Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE _Aen_� System #1 _Approved for 1 bedrooms System #2 Approved for bedrooms Disapproved Dafte Conditional approval for bedrooms, with the following stipulations: By:. r Original Certificate Date: The nicl 1 f A41forage 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 OOSA Uue sheet f '. 1, 0 If more than 1 septic system is on the lot: COSA Checklist # Structure served by this. system Certificate of On -Site Systems Approval Checklist Legal Descripfion: Prator Subdivision, Block 8, Lot 3 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 3/28/72 Sanitary seal (Y/N) Y Total depth 270 ft._ Cased to 217 ft. FROM WELL LOG Date of test 3/28/72 Static water level 75 ft. Well production 5 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 3.46 mg/L Arsenic ND ug/L Date of sample: 4/8/15 Parcel ID: 017-091-30 Well Log (YIN) Y Wires property protected (YIN) Y Casing height .(above ground) >12 in. AT. INSPECTION 4/17/,./5- 71 ft 3 g.p.m. Collected by: J. Anderson B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 5/15/14 Tank size 1,500 gal Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (Y/N) N Dateofpumping iz1�3/T Pumper Northland Pumping C. ABSORPTION FIELD DATA Date installed 7/1 /00 Soil rating (g.p.d./ftZ or fe1bdrm) '8 GPD System type Deep Trench Length 50 ft. Width 2 ft. Gravel below pipe 8 ft. Total depth 11 ft. Eff. absorption area 800 fe Monitoring tube Y Depression over field N Date of adequacy test 4/17/15 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth In absorption field before test 73 in. Water added 780 gal. New depth 90 in. Elapsed Time: 1,440 min. Final fluid depth 69 In. Absorption rate >= 600 g p d Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION OF,g4 0® Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES a"' T • f�(jC...... °: d.N t .bgo.o. WELL ON LOT TO: O MICHAEL E. ANDERSON :�Is I,` CE.43SI-81 °� a Septic tank/lift station on lot >100' On adjacent lots >100' >100' Absorption field on lot On adjacent lots >100' 1 Public sewer main >75' Public sewer manhole/cleanout >100' Sewer /septic service line >25' Holding tank >75' Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5' Absorption field >5 Water main >10' Water service line >10, Surface water >100' Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water main >10' Water Service line >10' . Surface water >100' Driveway, parkingtvehicle storage >10' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS G. ENGINEER'S CERTIFICATION+'►����®®�� OF,g4 0® I certify that t have determined through field inspections and in A®s,�w 4W -( ,•• •° I 1® •' °° review of Municipal records that the above systems are e,r X40 conformance with MOA COSA guidelines in effect on this date. tlGgt _', ,0. Engineer's Printed Name Michael E. Anderson; P.E. a"' T • f�(jC...... °: d.N t .bgo.o. I Date 58715 - O MICHAEL E. ANDERSON :�Is I,` CE.43SI-81 °� a . ��� �• COSA brown sheet 10-10-12.doc � W r • i I; �r • a u A .i •• �..�rr�.� moi. __. II � - t� Y N O(P OGIE lealm ---------- 3w .mow— 3w RESERVER RAW. IMMT. m N 3IL,r �p �7 lip N W'a3'00"E 146AW 6Q ... FERNHILL CIR » r v(A tw C= coOD oz k� Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On -Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage. ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FORA SINGLE FAMILY DWELLING Parcel I.D. C:)(% -- OR t - -6 o HAA# Expiration Date: 1. GENERAL INFORMATION Complete legal description __. L o 3 f pr/4 vf- Location (site address or directions) l-/-/ &G' Current Property owner(s) Y, w6 L r r Mailing address Lending agency Mailing address Real Estate Age Mailing Address Day phone_ c/ 0/S Day phone Day phone Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 4 TYPE OF WASTEWATER DISPOSAL: Xr Individual On-site] ❑ Individual Holding Tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Department of Health and Human Services (DHHS) 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 on-site wastewater disposal and/or water supply system. DHHS 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. 72.025 Rev. 01 00)' 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 Health Authority Approval Guidelines for the Health Authority Approval application show 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 M%rllae( P.l J�aLevhrn w.F, Phone '�3 Address 4(, k 0 -, . 0 , Engineer's Printed Name 'M( r 6. DHHS SIGNATURE !/' Approved for — J-� bedrooms. Disapproved. Conditional approval for Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory bedrooms, with the following stipulations. Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: _� Expiration Date: l O -5-325 Rev 01 00C Reissue Date: Municipality of Anchorage U C E I V • Department of Health and Human Services ED Division of Environmental Services On -Site Services Section 825 "L" Street Room 502 JUL 0b 2000 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us MUNICIPALITY OF ANCHORAGE (907) 343-4744 �!"ONMENTAL SERVICES DIVI1— HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: `e a O ?ta {mor A. WELL DATA Well type r' G/ If A, B, or C provide PWSID # Date completed ' Z Sanitary seal — 14— Total depth 2t%- ft Cased to 2,t+ ft FROM WELL LOG Date of test 3 z Z Static water level -7,5 It OI ? -09 Parcel I.D.: Well Log e 5 Wires properly protected Ye- Casing G Casing height (above ground) 2`t in. AT INSPECTION 7300 S 0'= ft Well production 7o 9 -p.m S• 0 9 -p.m WATER SAMPLE RESULTS: Coliform O colonies/100 ml Nitrate ;2. 7r mg/I Other bacteria O colonies/100 ml Date of sample: 7 3 0 a Collected by: MA(� • Ott B. SEPTIC/HOLDING TANK DATA Tank Type/Material S -( e Date installed 7/1/00 Tank size ('4sa gal Number of Compartments '2— Cleanouts y Foundation cleanoutDepression over tank T( High water alarm / cr 40"M1 Date of pumping (A tw Pumper C. ABSORPTION -FIELD DATA Date installed ) / vv Soil rating (g.p.d./ft2 or ft2/bdrm) System type D ea t ir+v(c (7 , Length J3'0 ft Width Z ft Gravel below pipe `r�.O ft Total depth _LL_ft Effective absorption area %= ft2 Monitoring tube Y Depression over field Date of adequacy test � Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test �' in Water added / gala New depth in. Elapsed Time: �_ min Final fluid depth in Absorption rate >= e' g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) eLO If yes, give date 72-026 (Rev. 01/00)' D. LIFT STATION Date installed Size i s "Pump on level at In "Pump off' level at in Datu Cycles tested E. SEPARATION DISTANCES Manhole/Access High water alarm level at in Meets alarm & circuit requirements_ SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot rno 1 On adjacent lots /00 Absorption field on lot /Mo (4- On adjacent lots / 00 f f Public sewer main Public sewer manhole/cleanout T/ Sewer /septic service line t Do 14- Holding tank t!0 SEPARATION DISTANCES FROM SEPTIC/, TANK ON LOT TO: Building foundation So I + Property line - 'o f �- Absorption field . Water main Water service line coo l''- Surface water _ Drainage I (go t 4'• Wells on adjacent lots too 14 - SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Z-cz F Building foundation /yy 1} Water main /'r, 50 /¢ U 4 Water Service line /oo 1+ Surface water r00 ( r` Driveway, parking/vehicle storage_ / a o Curtain drain N 1A Wells on adjacent lots io o t?L F. COMMENTS G. ENGINEER'S CERTIFICATION A. V-. ' q.S Qp I certify that I have determined through field inspections and review of Municipal records that the above systems are in • • • • 0 conformance with MOA HAA guidelines in effect on this date. �• , .... / / I / VO MICHAEL N. ANDERSON Engineer's Printed Name MtTkae\/l"I.V40el 1� f^ ce 9 39 DatePR�SC,'��l HAA Fee $ c�©D • Waiver Fee $ Date of Payment ©7— ©� ° `� Date of Payment Receipt Number ©yl,� 3�( d 7 t�-L' ` Receipt Number 72-026 (Rev. 01/00)'