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HomeMy WebLinkAboutSPRING FOREST BLK 1 LT 2Spring Forest Lot 2 Block 1 #015-321-06 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 1 of 3 www.ei.anchorage.ak.us (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW990163 PID Number: 015-321-06 _ Name: Wastewater System: ® New ❑ Upgrade Address: 04SCeveland Ave, Suite 201, 99507 s_ ABSORPTION FIELD— Phone: Number ofBedrooms: (907) 0 Deep Trench EI Shallow Trench ❑ Bed ❑ Mound ❑ Other: LEGAL DESCRIPTION Soil Rating Total Depth from original grade. 0.6 GPD/Ft' 12.5 Ft. Block: Lot Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: 1 2 — Spring Forest 4-5_5 Ft. 7.0 Ft. Township: Range: Section Fill added above original grade: Gravel Lenglh: 0 Ft. 72 Ft. Well: ❑ New ❑ Upgrade Gravel width: Number of lines: Distance between lines: 3.0 Ft, 1 Ft. Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: -C Pipe Material: A_ Ft. Ft. 1008 Ft' F810/3034 Driller: Date Drilled Static Water Laval: Installer. Date Installed: Ft. Ha meier Const._ 12/30/1999 Yield: Pump Set at: Casing Height Above Ground: TANK -- GPM Ft. Ft. _ SEPARATION DISTANCES ® septic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Public/Private Manufacturer: Capacity: From Tank Field Station Sewer Line Anch Tank 1250Ga1. N /A Material: _ Number of Compartments: Well Steel 2 Surface Water 100+ 100+ rHog _ LIFT STATION 24• 10.5 Size: Manufacturer: Lot Line N/A Gal. 11 14 'Pump on" level at: _ "Pump off' loyal at: High ureter alarm at: Foundation In. in. 100+ 100+ _ Pump Make 6 Model Electrical Inspections performed by: Curtain Drain Remarks: a � � -� BENCH MARK Location and Description: Deck on South Side of House --- ----- Assumed Elevation: 200.0 Ft. Engineer's Stamp Inspections performed by: Pannone Eng. Svc Dates: let :L2/30/199 Awl, wA'v,n 2nd 12/30/1.99 rwuror.+ .urv.n..... •..c smvan R. Pennons Department of Health and Human Services approval c 4 Reviewed approved by: Date:I �I " CI CE-149 w and _ Ota,. 11,99) �I�a PRO,ES$lbeta�{ln.' PERMIT NO, SW990163 AS -BUILT WASTEWATER ABSORPTION SYSTEM LOT2, BLOCK ]. SPRING FOREST S/D NOTES, 15 SUBDI ISION IS SERVED BY 99,61-1 COMMUNITY WATER SYSTEM. 2) NO WE LS WITHIN 100 FEET. 3) INSTALLED CLEAN -OUTS AT EACH END OF THE TRENCH & DOUBLE C.O... AFTER THE TANK. 4) INSTALLED A MONITOR TUBE IN TRENCH, / FULL DEPTH, / 98.5 In v o - W In w fyw o� 0 �o J J Z w H 3z Z � 49TM P.I.D. NO, 015-321-06 ?a3 C] l S I ll� q U 111.01-�1 / PRIMARY TRI y--�72' x Tx 3' MT t yzj i ...15./�� RESERVE TRENCH 72'xTx3' w CO A B FC 23.1 12.4 Tl 16,1 16.3 T2 14.1 23.4 DC 15.0 29.1 Cl 16.9 32.4 MT 44.7 66.4 C2 91.2 1041 DESIGN, PERC RATE, 28 MIN/IN, 250 SF/BR 100 SF REQUIRED DEEP TRENCH, 7' EFFECTIVE, �+ SINGLE TRENCH 72 LF U. 1008 SF TOTAL PREPARED FOR, Panno ._'�A r John Hagiaeler Construction 8149 � 2204 Cleveland Ave, Suite 201 Anchorage, AK 99507 (907) 243-6789 PANNONE ENG, SVC P. O, BOX 102954 ANCHORAGE, ALASKA 99510 272-8218 Phone & Fax NTE, 1-2-00 AS -BUILT :ALE, 1'=6n' __ PERMIT N0, SW990163 AS—BUILT DETAILS PS,D, N0 015-321-06 WASTEWATER ABSORPTION SYSTEM �� LOT2, BLOCK 1 SPRING FOREST S/D O al N m 1nONV313 -�)! 41 a I � u a f } 1 U d I L_y U u z d i 39n1 N011NON 7 a� w m a ne L c H o a L CL 11 Ll p w u CAnj w Ld F_nZ F - Z$i 5 Xsiq�ltt{?34 r� ff E] 91 E] 1n0NV310 e. ni c —7 z a 100Ntl31:1 x n elq p f J E m LnONV3l0 o ,y In m 1nONV310 j f ca CI\Work\2-1SPRNG,dwg 1nONV3l0�vni� ov�P( •• q�io�♦ °M ...... ��OF �.••�••� ♦♦♦ N0I1tl0Nn0j I �. AVtL d 49TH txf ♦♦ ..... P..... ... .°...................4..... """" o PREPARED FOR, PANNONE .ENG, SVC, Steven R. R. Pannone: n �♦ No. CE 8149 "� i John Hagneler Construction P, O, BOX 102954 ♦ �.r� 2204 Cleveland Ave, Suite 201AnchANCHORAGE, ALASKA 99510 ♦olt���' i (907) 243-67B9 679999507 DATE4 1020 8, 272-8218 FAX ____ OT❑ SCAl AS-BUILT 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 Initial ° -Av --9 "ply Date Issued: Jun 30, 1999 Expiration Date: Jun 29, 2000 Permit Number: SW990163 Parcel ID: 015-321-06 Legal Description: SPRING FOREST BLK 1 I -T 2 Design Engineer: 0062 Pannone Engineering Services Site Address: 005810 WEST TREE DIR Owner Name: John Hagmeier Lot Size: 40235 SQ. FT. Owner Address: 2204 Cleveland Drive Total Bedrooms: 4 Permit Bedrooms: 4 anchorage , AK 99517 - This permit is for the construction of: ❑✓ Disposal Field [] Septic Tank ❑ 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: Date: `G/ Steven R. Pannone, P. E. P.O. Box 142025 Consulting Engineer Anchorage, Alaska, 99514 (907) 272-8218 (907)272-8218 Fax -1, 1999 Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 2, Block 1Spring Forest Subdivision, Septic System Permit Request Gentlemen: My firm was contacted to design and install a new septic system for the referenced lot. We conducted a field investigation to locate existing wells and septic system before designing the proposed system. Two test holes were excavated on Jima, 8, 1999 for the system design. No ground water or bedrock was encountered in either testhole. The lot is approximately 40,235 square feet in size. Lot 2 slopes to the north at a rate of approximately 5 to 20 percent with rolling hits throughout the lot. The proposed drain -field installation will be located in the southern portion of the lot on a relatively flat area. Double clean -outs will be installed after the tank. The proposed location is greater than 100 feet away from any wells. The proposed system will be greater than 10 feet from the water service lines. This lot is served from a Class A public water sourse, located greater than 200 feet from the proposed installation The proposed installation will not affect the future development of the surrounding or existing lots. See the attached design. Please contact me at 272-8218 or 227-3522 if you have any questions about the proposed installation. Sincerely, S�R. P" ant!0_11—e?. E_ Attachments: C.\ W ORK\2- I SPRINGFORRST.001 DOC 3f►vem W Rnnumw 1c.• 8ii49� PERMIT NOT SW DESIGN P.I.D. NOT WASTEWATER ABSORPTION SYSTEM LOT2, BLOCK 1 SPRING FOREST S/D NOTE, ."`-... qq� ,J 0��'i. SERVE BY �'y, 1) SUBDIVISION IS C13MMUNITY WATER SYSTEM P) NO WELLS WITHIN WON EEL '9) INSTALL CLEAN -OUTS + END OF THE TRENCH & 110 T EACH BLE CA. AFTER THE TANK. :g 4) INSTALL A MONITOR TU E IN rRENCH, rQF FULL DEPTH. - jE: FF J SH9759`50'E - fF � (tl � �- J TO :Tr' ✓/`` qr�'�a�' Y i ,�r�'.. � 100, G 0. .5@91111031W N891 13'49'E: /� U�� r;+ x", ROP❑ E�4 BR . - HOUSE /•n y-1090 'IF -- .. W 111 ;109 1250 g y ( F.. b1 SIEPTIC T NK nfy Ld No`p w 'n o �/ i V�'` Imo' -"-L' ♦♦i PRIMARY TRENC�i `ara c� yc L) K �/ 72'x7'x3' ii ♦ A�U o' .3 = RESERVE TRENCH v, 72'x7'x3' fl [ j 101.323 Mchvr Es Ik a _10' &'>e¢aMp Enrol _.. _. _101 Tele 4 Sec Esnt 1 O'MALLEY ROAD �'B7 e4�y9 B3'3B3 (:T\Work\3MTTER,DWG ........................... _..... .......... x•14 DESIGNi PERC RATET 28 MIN/INT 250 SF/BR 100 SF REQUIRED DEEP TRENCH, 7' EFFECTIVE, �� ,.•' • SINGLE TRENCH 72 LF O {t r TH 1008 SF TOTAL �p o ... I.Steven R. Pannonei ip PREPARED FOR, PANNONE ENG. SVC Ar No. CE 8149 John Ha meler Constr•uctlon 9 201 P. O. BOX 102954 ;•`�� •• Cleveland Ave, Suite Anchorage, AK 99507 ANCHORAGE, ALASKA 99510 �a I 272-8218 Phone & Fax ...�,.• • � ••��'U�T (907) 243-6789 iE$9`��d�� DATET 6-15-99 DESIGN -- --SCALE 11 - PERMIT NOI SW DESIGN DETAILS P11), ND WASTEWATER ABSORPTION SYSTEM LOT2, BLOCK 1 SPRING FOREST S/D 1nONtl3l] C n a 1" a n c;< I !' N ' o. I U a - sl z I L 3Hn1 NO1lNON a W A CI - m m W. Z �E Uj I LIJ >. zi;r(ji?sS�f Li ol rh 1nONtl3lOC ne ft - CL z a a a intm3io C _ x E 1nONV313-T C F ❑ g J E o •� N Lr)a) 1nCINV313 I I I F CI\Work\2-1SPRNG,dw0 1nONU a �, •. AV NoavaNnoj jo 49M ':Stevan R. Pannone.' PREPARED FOR: PANNONE ENG. SVC, �A s, No. CE 8149 ° A John Hagmeler Construrtlon P. O, BOX 102954 ., 2fObC6 ,.• ° '��� 2204 Cleve, tan 99507 Ave, Suite 201 ANCHORAGE, ALASKA 99510 ��18 �®�� C907) 243-67(39 274-0308, 272-8218 FAX 4��� DATEI 6-14-99 DESIGN --- ---- NOT TO SCAT — Municipality of Anchorage 0* DEPARTMENT- OF HEALTH & HUMAN SERVICES 825 "L•• Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: O Ah ML3 LLQ DATq'.P.ERF LEGAL DESCRIPTION:T'2tWk� Ftb? Wnship, Range, Section: •`- IFEE- 1 � 2 3 N1 L 4- 5 6 7 A t/ 8 SM 9 V Ysor ri L -e -s SST Sit-cY SA00 -« �NNaY e f -a SLOPE Steven R. Panama CE•QlbS O�y`%� _ +PB,hY,Yf$iie SITE PLAN 10 WAS GROUND WATER ENCOUNTERED? __•/�—_ 11 S IF YES, AT WHAT L DEPTH? 12 E Depth to Water Aft 13 674- Monitoring? - L, T Dale: _ av-- 14 15 16- 17 ,s 1s _ la.t1 �1i�1/i�. Reading Date Gross Time Net Time Depth vn- Water Net Drop Ili Lk _ 30 t uW 5 "ie P14 20 PERCOLATION RATE 6 r�� lul (mmutesnnch) PERC HOLE DIAMETER TEST RUN BETWEEN _ FT AND FT COMMENTS -11 LA22i s ICL�Q PERFORMED BY: . S--�n/19 6W(N .lam. t� I � CERTIFY T/HAT THIS � TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:6L' 72-008 (Rev. 4/85) Certificate of On -Site Systems Approval Parcel I.D. 015-321-06 Legal description Spring Forest Block 1 Lot 2 Site address 5810 West Tree Dr, Anchorage Current property owner(s) Schell Expiration Date: 9-6-2023 X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By z iL Original Certificate Date: [ rAC 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 X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY OF ANCHORAGE Development Services Department a 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. 015-321-06 Complete legal description SPRING FOREST; BLOCK 1, LOT 2 Location (site address) 5810 West Tree Drive *Anchorage Current property owner(s) John & Cheryl Schell Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units Q Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: Q Private Septic ❑ Private Septic serving 2 dwelling units 5. SEPTIC TANK: X Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 23 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed X Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Distance: Expedited review requested: ❑ 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 $_ 4 b Date of Payment 01 It COSA# 05G221L15 Waiver Fee $ Date of Payment Waiver # COSA Applicatlan_June 2022 a Legal Description: SPRING FOREST; BLOCK 1, LOT 2 Parcel ID: 015-321-06 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) Date of flow test for COSA Static water leve4,et'l5e—ginning of test ft. B. TANK DATA Measured operating fluid level in septic tank 48° Date of pumping ! o ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Well production at time of test gpm Water storage tank volume ons Well disinfected for ' m test? ❑ Yes ❑ No ❑ Co acteria is Negative mg/L Arsenic ug/L Collected by Date ❑ Nitrate less than MRL (ND) ❑ Arsenic less than MRL (ND) C. LIFT STATION ❑ Required maintenance completed :Age of lift station ye station ma ents: Which system tested (date installed) 12/30/99 Adequacy test date 9/6/22 ❑ ALL standpipes present per record drawing Results ❑ Pass Total measured depth from grade 12.75 ft (max) Fluid depth prior to test 49 in Measured depth to pipe invert from grade 5.75 ft (min) Water added 611 gal ❑ N/A — pressurized field. New fluid depth 61 in ❑ Per record drawings, field is insulated. Elapsed time 120 min ❑ Monitor tubes go to bottom of effective. Final fluid depth 55 in If not, state depth into effective 5-91' Absorption rate 600+ gpd ❑ 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) NONE If yes, enter date N/A Comments/Deficiencies: COSA Checklist June 2022 FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 84 in Effective depth used 68 in Effective depth remaining 16 in 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 Community Sewer Manhole/Cleanout > 100' ❑Yes if No ft ❑ Yes if N Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic _ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft Ing Tank > 100' ❑Yes if No ft Neighboring Absorption Fields > 10 ' if No ft Animal Containment > 50' ❑ Yes if No ft Yes if No ft ft If tank or field is under driveway comment below Manure/Animal Excreta Storage > 100' unity Sewer Main > 75' ❑ Yes if No ft ❑ Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Fields) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *51+ ft Surface Water > 100' 0 Yes if No ft Tank to Property Line > 5' Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' Q Yes if No ft Private Wells > 100' F' Yes if No ft Water Main > 10' ❑Q Yes if No ft Community Wells > 200' ❑■ Yes if No ft Water Service Line > 10' Z Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *MET CODE AT TIME OF INSTALL LINED POND IN AREA OF DRAINFIELD (SEE ATTACHED PHOTO) 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 Garness Engineering Group, LTD. (GEG) Phone Engineer's Printed Name Jeffrey A. Garness Date _ In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. COSA Checklist June 2022 907-337-6179 OF A T. V r J ­�E: 'v "' /:'• CE -70 53 3Vl�Q rP9...%f 0 LICENSE4��a P� ° f e s sion�o #AECC884 ppOc� % Septic Tank Advisory Certificate of On -Site Systems Approval #OSC 221457 Subdivision: Spring Forest Block 1 lot 2 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks The septic tank for this COSA / property is 23 years old. A leaking septic tank may be a source of contamination to the aquifer. Typical replacement costs range from $10,000 to $15,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of a 16 -year-old septic tank in failure and should be replaced. ,Mailing Address F O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org 07 r � z <c iN�v n voyo�li-'tn�mcl_iv OnCZ 0 A _n b" r .Q: _ p ,. s W z�HoCD maa� a a33�o�mmva.�=$r �9ss�m5'a�'d_ asst 17 (D m MTA Rwd N fi CD z 'o N O Cca m c § bP; _R r 4 69402 IJ CD E cr: ,o _. 26470 -sa O o=_ _ SLPOZ �mrty SL40Z� o w ; cn _v CD 9L40Z _ " mast on IJL a r-4lmo 07 r � z <c iN�v n voyo�li-'tn�mcl_iv OnCZ 0 A _n b" N'm 2 v �me5Q�`t �s �_�Sen S��sgT �i$t7 cs)at�)m op 'D � fj W z�HoCD maa� a a33�o�mmva.�=$r �9ss�m5'a�'d_ asst 17 (D m N fi CD z 'o N O Cca m c § 0 Parcel LD, 015-321-06 Municipality of Anchorage ^ On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Expiration Date: i 0-2q - ( 7 1. GENERAL INFORMATION Complete legal description Spring Forest, Block 1, Lot 2 Location (Site address) 5810 West Tree Drive Anchorage, AK 99507 Current Property owner(s) Diane Stefan Family Trust 5810 West Tree Drive Anchorage, AK 99507 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: Fxj Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Four Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Il Individual Water Storage ❑ Holding Tank ❑ Community Class A Well Il Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: uisrance: Received by: 10"40. /V Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ S'z Q Waiver Fee $ Date of Payment l�y Date of Payment Receipt Number 03y��� Receipt Number COSA# �SG/lc/S/� 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 Address 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 Phone 522-7773 Date 11/14/2016 Conditional approval for bedrooms, with the followinc By. ` Original Certificate Date: The Municipality of Anchorage Development Services Div ion (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 Stale of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet ! .: c If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Legal Description: Spying Forest, Block 1, Lot 2 Parcel ID: 015-321-06 A. WELL DATA Well type Class A If A, B, or C provide PWSID # 213564 Well Log-(Y/N) Date completed Sanitary seal (Y/N) Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level Well production _ _ WATER .SAMPLE _RESU g.p.m. g.p.m. Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L . Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA l Uv Septic/Q.0 T' K gac--A 12/30/1999 Sw 901,0/ s 3 Tank Type/Material _ Date installed Tank size 1,250 gal Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout,(Y/N) Y Date of pumping 10/24/2016 C. ABSORPTION FIELD DATA Depression over tank (Y/N) N High water alarm (Y/N) — Pumper Around the Clock Pumping 7 Date installed 12/30/99 Soil rating (g.p.d./ft2 or ft2/bdrm) •0 GPD/SF System type Deep Trench Length 72 ft. Width 3 ft. Gravel below pipe 7 ft. Total depth 11.5 ft. Eff. absorption area 1,008 ft2 Monitoring tube Y Depression over field N Date of adequacy test 11 /2/16 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 37.5 in. Water added 633 gal. New depth 57 in. Elapsed Time: 1,440 min. Final fluid depth 37.5 in. Absorption rate , 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &.type) N If yes, give date D. LIFT STATION 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 & circuit requirements? E. SEPARATION DISTANCES Class A Well. No Well on Lot. WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer /septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5' Water main >10' Water service line >10' Wells on adjacent lots >200' ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water Service line >10 Surface water >100' Curtain drain >50' Wells on adjacent lots >200' F. COMMENTS Absorption field >5' Surface water >100' Water main >10' Driveway, parking/vehicle storage G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and �� P•° �,5 review of Municipal records that the above systems are in ^° ®°. tee° conformance with MOA COSA guidelines in effect on this date. � � e 49t Engineer's Printed Name Michael E. Anderson, P.E. MICHAEL E. A ®� gE. ANDERSON Date 11/14/2016 °ee% No CE -4381 Jt ty-1 COSA brown sheet 10-10-12.doc 111=40' 8' A.C. B TRAIL 83-7 SPRING FOREST SUBDIVISION LOT 26 2B SOCK 1 FINAL STRUCTURE AS -BUILT GASTALDI LAND SURVEYING JEFF A. GASTALDI, R.L.S. 4726 WEST 88TH AVENUE ANCHORAGE, ALASKA 99502 PHONE 248-5454 GRID I DATE 2538 1/13/2000 F.B. I JOB NO. 99-15 SFS21 20' DRAINAGE ESMT. I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DEPICTED ABOVE AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDNISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. ANCHORAGE RECORDING DISTRICT, ALASKA NOTE: NO CORNERS SET THIS DATE. VcVT) MUNICIPALITY OF ANCHORAGE DEPARTMENT f E HEALTH e HUntalMAN SERVICES Division onoviro 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 l.D.# C>1—o6 HAA If L-Iq 1. GENERAL INFORMATION Complete legal description 1-0T 71 93e.eck I Sp2(n� �o2azS-r S`b Location (site address or directions) — Sd /C w c3ST �rzls ra �z,vr3 Property owner �:ko0N LU1,tar+uc-an_ cn, Day phone `2 K �-6 4 Mailing address,CL,04ecAAjvb Ava Lending agency. Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be field for pickup. 2. NUMBER OF BEDROOMS: 1� _ 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1191) F10M MOA X21 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm TA(J&)ova Q -NG• SV c Phone Z�2$zfg Address , 6v OL 4 4�5l 0 Engineer's signature Date Z/ZAon 6. DHHS SIGNATURE Approved for bedrooms. 0 Disapproved. Conditional approval for Additional Comments bedrooms, with the following stipulations: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/911 Buck MOA #21 RECEIVED Municipality of Anchorage JAN 0,7I 2000 DEPARTMENT OF HEALTH & HUMAN SERVICE$Aumuvn.Itr UF ANCH C* -D Environmental Services Division "tKU4NTALURVICE 82.5 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: 4 Z L[� ( SG'2wt'.'F&aGsz 51 Parcel I.D.: (> (6-- 2l— C5 6 A. WELL DATA Well type __ If A, B, or C, attach ADEC letter. ADEC water system number Log present(Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production WATER SAMPLE REESSUJL Coliform Date completed Cased to FROM WELL LOG 25)""s ple: B. SEPTIC/HOLDING TANK DATA Nitrate Casing height (above ground) Wires properly protected (Y/N)_ Collected by: AT INSP Other bacteria g.p.m. Date installed P2 Tank size /'ZSc5 Number of Compartments'- Cleanouts (Y/N)_ i Foundation cleanout (Y/N) _ Depression (Y/N) A% _ High water alarm (Y/N) Date of Pumping i &�✓_ Pumper_ C. ABSORPTION FIELD DATA Date installed (e 130 199 Soil rating (g.p.d./ftz or ft2/bdrm) _ ©. 6 System type V) -r Length g 72 _Width 3Gravel thickness below pipe _ �" Total depth /!— 176- Effective 26_Effective absorption area/0-0 �_ Monitoring Tube present (Y/N) Depression over field (Y/N) _A,-' Date of adequacy test _✓v 'W Results (Pass/Fail) Ind aS _ For _ Y bedrooms Fluid depth in absorption field before test (in.); '— Immediately after= gal. water added (in.): Fluid depth — (ins) Minutes later:Absorption rate = _g,p,d. Peroxide treatment (past 12 months) (Y/N) -- 72-026 (Rev. 3/96)" If yes, give date D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm le _ —y es tested E. SEPARATION DISTANCES Size in gallons level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main service line On adjacent lots Pump off' level at* Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation / ✓l Property line z K Absorption field �D Water main/service line z6t Surface water/drainage 10c)t Wells on adjacent lots 'Dom SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line <m ;C Building foundation / y Water main/service line Surface water /eo `r Driveway, parking/vehicle storage area Curtain drain my T Wells on adjacent lots F. ENGINEER'S CERTIFICATION 1 certify that I have determined thru field inspections and review of Municipal recordsp,<6hbbo� ems are «. in conformance with MOA HAA guidelines in effect on this date. +'44;• "� /►"•,;�S�e. Signature max.. bh k' 't •� uwwur"Ipuoy . Engineer's Name STZoJt?- -) Q�•AN�uONr3 • •14•Na.1p.a4 g I T.Siaven Pannone Date 1 / 0. CE -£1149 + _ /`z!®® c_ HAA Fee $ �D 0 • Waiver Fee $ Date of Payment (7;�9^/ ©� y�� Date of Payment Receipt Number �� ! –' �3 �Receipt Number 72-026 (Rev. 3/96)*