HomeMy WebLinkAboutGREAT LAND ESTATES #3 BLK 3 LT 7Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION
Li L is di
Permit Number: OSP211479 PID Number: 051-1-'3-40.,,
A 1,2022
Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade
Name
EARL ROEMER
ABSORPTION FIELD
® Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
19931 M E_T_WAY_, CJLUG1AK
_
❑-tither
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
1.2 GPD/SF
10 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
3 Ft.
Gravel depth beneath pipe
7 Ft.
Subdivision Block Lot
GREAT LAND ESTATES #3 3 7
Fill added above original grade
VARIES 0.8'— 1.3 Ft.
Gravel length
36 Ft.
Township Range Section
Gravel width
2 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
504 Ft2
1
NA Ft.
Well
__
100'+
25'+
TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
EXISTING
Capacity
Gal.
Surface Water
--
100'+
Material
Number of compartments
Lot Line
--
10'+
NA
Foundation
__
10'+
LIFT STATION
Manufacturer
Capacity
Gal.
Remarks ADJ.jlYELL ON LOT 8 WAS DECOMMISSIONED
PREVIOULSY BY MOA CIR. UPGRADE ON QUIET WAY
Alarm location
Electrical installed by
Installer NORTHERN EXCAVATION
PIPE MATERIAL House to tank 3034 Tank to 3034
drainfield
Drainfield 3034 CO/MT 3034
Inspector FWC
BENCH MARK (Assumed elevation) 100 ft
Inspeection 1s` 7/14/22 2nd 7/14/22
Location and description
3`d 8/3/22 4t'
CONCRETE WALKWAY HOUSE
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Ilk
• " "
Conditional Approval: Date
�wP"��.'•'' • �'�, f��
r
/meg.• •:9���
......- ....•..
P ••. • •••• ••••••••••/
Septic System
Ap
Curtis Huffman
��
Date r"?_zproved -
9'
� c�• CE 128991
Gdj '•
7/28/2022••'•��„�
Note: his approval does not include well permit requirements.
kcv vaivu io/
PID: 051-133-40 PERMIT: OSP211479
CO 5.4'x26.0' CANT
10.5'x26.0' DECK a
LO n
STORAGE UNDER DECK
----------
-.-
0 0 - ------ A5
QUIET WAY c� 70.1.1
CC)
O
cp-4
vco
TH21-1 ,r as /
NO WELLS W/IN
100' OF PERMITTED
SEPTIC UPGRADE - MOA
DECOMMISSIONED ADJ WELL N
QUITE WAY WHEN IMPROVED.
A -C=42.2'
B -C=54.5'
A -D=30.9'
B -D=26.4'
A -E=30.2'
B -E=26,9'
A -F=63,9'
B -F=60.2'
A -G=65,2'
B-6=60.8'
FCO DCO
55 Go
EXISTING
1,250 -GALLON
PLASTIC
SEPTIC TANK
1910
VCosyFO
G
XISTING
ON
UND NFIELD
EXISTING 1250—GAL
SUNSET PLASTIC
S.T. VERIFIED
AT CONST.
:0 COTMT
/-FINAL GRADE j 97.31
/- FILTER FABRIC
0 93.50
8650J SEWER ROCK TED
SEPTIC SECTION
SCALE, NTS
GREAT LAND ESTATES #3 B3 L7
PREPARED FOR:
EARL L ROEMER
19931 QUIET WAY
CHUGIAK, AK 99567
FIRST WATER CONSULTING
13030 SUES WAY
ANCHORAGE, AK 99516
907-350-9566 f irstwaterAK@gm oil. com
DATE: 7/28/2022
SURVEY: KGL
DRAWN: FWCS
SCALE: 1" = 30'
DRIVE
96.50
/ WORIG. GRADE
1.0 ORG/01-
SP-SM/GP
SAND INCREASING
W/ DEPTH
DRY 7/14/22
DRY 11/24/21
60.50
BOH
7/28/2022
9*i;< go S; U - 5:3 0
5. =r r- ,
CL 3 0 0 V�
CT
CD :r
0
<
(D CD
0 (A ;u W
,1-0 = o 3 7�
0 CD :1 0 .0 1c,
:3
0, C")
ELL
0 Or
4; a 5:3
0
m 0 "0 CD
=r
r(A
0mo.�onvm
0 M
0 _30 2,q- rn
0o I rn*tom 0 >
a CL B.'a, 2, (D
V CD *,
.0 CDo
0 -1 0. 1 2-
3 = cl c 3'
S* 1^Icl
0 CD
3 —1 =
0, F=mo—z
0 0 — 0' E; 3 9 C.
0 D
0 x 0 0
0
fi
-a 3 CL
0-0 0 (D
0L 0 0 0, -1
--vo
C
0 -1 Z 0
c 0nrno
0
Er o
CL 3
> < 0 d 0a
D to 00
m S SC&I
3 0 0
F.:3 to o
Q-0 3
.
o
Cl
> -1
CD
Ov, C R i Zz: v
> P,
o in
0 65 Ln
z N)
c n
\9
Lq
e7, Z:
CA
0
0.
I--
o
11
rl
N)
C
r -n (A
i
O
�J
z
m
0 (A
Ni
m
m
z
z
m
z
0
m
/
------------
-----------
-m
m
--
00
N
Z
M8
m
KC
rri
z
EA
ca
x
-
Ov, C R i Zz: v
> P,
o in
0 65 Ln
z N)
c n
\9
Lq
e7, Z:
CA
0
0.
I--
-f-
11
rl
N)
C
r -n (A
00, R=50-06
CF)
\9
C
oic�
(n
I--
M OD11
rn
11
rl
N)
r -n (A
i
O
CA
N).
0 (A
Ni
m
o
z
m
m
N
CF)
I
I
E51
\9
C
oic�
(n
I--
M OD11
rn
11
rl
N)
r -n (A
i
O
CA
N).
0 (A
C�
m
I
I
E51
0
- --- ----------
MUNICIPALITY OF ANCHORAGE
Orr -S Ite Water a vwa stewater PrN rani
PD Boa 116650 4 750 Elmore %ad
Anchorage. A UsNip 9951 M550 Phone: (907) 3.4 7944 Fax: (907) 3A3-71997
h ttpjf wmu . m u n i _o rgron V 1 e
On -Site Wastewater Disposal System Permit
Pe rmit N u mbar; OSP211479
Work Type, Septic Upgrade
Tax Code Narn b!r: 05113340000
SIte Legal Address: GREAT LANE) ESTATES 03 BLK 3 LT 7 G1260
Slips Mail Ing Address; 19931 QUIET WAY, Chugiak
Owner: ROEk4ER PARL L
design Engineer: FIRST WATER CONSULTING
This permit is for the constrtjotldn of:
Effective Date=
Itxpiration Bate
L34 Size In Sg Ft;
Total Bedroom 5-
1211)2121
12M2022
122839
D Disposal Field ❑ Seplic Tank ❑ Hold Ing Tank ❑ Privy ❑ Private VNelk Mater 5forago
All construction shall be in accordance with,
1. The atteChed appmed design.
2. All r-equfrements specified m Anchorage Municipal code ChaparE, 15,55 and 15.65 and the Nate of Alasko
Wastewater Disposal Rcqulelion & (18AAC 72) and Ddn king Water Regulelion s (18AA 80)
3. The wastewater ride requires inspectbDns during the installabon- The engineer shall notify the Dove lopment
Services Deparlmeni per AMC 15-65- Provide notification by .Iling (907) 343-7904 (2417)-
4- From Dctober 15 to Aprll 15, a subsurFace sofl absorption system under oorisxruntlon duririg freezing weather
shall be either:
a- Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freazing
Special FrvvIsions; Lvcat:5 the abandoned well on Lot 8 prior to construction. If the proposed trench is less
"than 100' from the well. a change order or waiver Is required.
Received 3y:
�r
Issued By:
Date-. 120 Q 1
Date:
4
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 051-133-40
Property owner(s) EARL L. ROEMER Day phone
Mailing address 19931 QUIET WAY, CHUGIAK, AK 99567
Site address 19931 QUIET WAY, CHUGIAK, AK 99567
Legal description (Sub'd., Block & Lot) GREAT LAND EST. #3 B3, L7
Legal description (Township, Range & Section)
Lot Size 122,839 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN:
(® all that apply)
TYPE OF DWELLING:
Absorption Field E] Initial ❑
Single Family (SF) n
Septic Tank ❑ Upgrade X
pg
(w/wo ADU)
Holding Tank ❑ Renewal ❑
Duplex (D) ❑
Privy ❑
Multiple Dwellings ❑
(SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: $ 59 5 Waiver Fees:
Date of Payment:1 2 2 2021 Date of Payment:
: _
Receipt Number: (o 12, 2 ( O Receipt Number:
Permit No. OS PL ( / y 7 9 Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Clie nt Forms\Permit Application.doc
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
November 24, 2021
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC SYSTEM UPGRADE PERMIT
LEGAL: GREAT LAND ESTATES #3 BLOCK 3, LOT 7
The property owner has requested we obtain a permit to upgrade the failed septic system of the
above referenced lot. We propose to install one deep trench and connect to the existing 1250-
gallon plastic tank to serve the existing 3-bedroom residence. The design is based on the recent
test hole conducted on November 17, 2021. No groundwater was observed at test hole
excavation or monitoring.
The slopes are moderate at 5-10% at the proposed upgrade location. The lot and area are served
by private water. Per MOA record documents, the adjacent Lot 8 shows an abandoned dry well
in the N property corner of Lot 8. We could not locate this well and it appears to be
decommissioned. If it has not, the dry well should have been decommissioned since the well that
serves Lot 8 is in the NE corner of Lot 8. The design will not impact any of the neighboring
properties. Please contact us if you have any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211479, Deb Wockenfuss, 12/01/21
FIRST WATER CONSULTING
GREAT LAND ESTATES #3 B3, L7
DESIGN CALCS:
NO WELLS W/IN
100' OF PROPOSED
SEPTIC UPGRADE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211479, Deb Wockenfuss, 12/01/21
FIRST WATER CONSULTING
GREAT LAND ESTATES #3 B3, L7
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211479, Deb Wockenfuss, 12/01/21
4661
13030 Sues Way - Anchorage, Alaska 99516
Tel. 907-350-9566 firstwaterAK@gmail.com
SOILS LOG - PERCOLATION TEST
LEGAL : GREAT LAND EST. #3 B3, L7
PERFORMED BY: FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT
ON THIS DATE. DATE: 11/24/2021
DEPTH
FEET OG
SOILS
1
ORG/OL
2
3
4
5
6
SP-sm/gp
7
8
9
10
Sand increasing
w/ depth
11
12
13
14
15
16
17
BOH
18
19
20
Reading Date Gross
Time
Net
Time
Depth to
Water
Net Drop
11/17/21 10 min 6 5 12/16
6 5 13/16
6 5 11/16
6 5 10/16
6 5 10/16
6 5 9/16
PERCOLATION RATE 2 (MIN / INCH)
TEST RUN BEWTWEEN 4 & 5 FT
PERC HOLE DIAMETER 6
PRE-SOAKED PRIOR TO TEST & ALL READINGS TO
THE 1/16TH.
GROUND WATER ENCOUNTERED: NO
IF YES, AT WHAT DEPTH: NA
DEPTH TO WATER AT MONITORING: DRY
DATE: 11/24/2021
TESTHOLE # 21-1 DATE PERFORMED: 11/17/2021
SEE SITE PLAN FOR SLOPE & LOCATION
COMMENTS:
VERIFY GROUNDWATER MT
AT TIME OF CONSTRUCTION
PERFORMED FOR: EARL L. ROEMER
11/24/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211479, Deb Wockenfuss, 12/01/21
3
U
0
O
0
O
Y
N
a`cm
J O
M
O
PA ,VA
OO'. HI
•� �J: 4 oa
J
I
�0�0
c
Q
Q
I�a4Em
O Xu
O
U
0
O
0
O
Y
N
a`cm
E
mL
c
Q
o
I�a4Em
O Xu
O
V
0-
o
mo
01
mm�m
`o
Ea
co
> 1� N
�IQy�O
0O)
00 N
C
O
O N
Z�OilI
inc
t^ =VCOL
0
Oa
D
o....°«
a0N0 o
wN
On rO 0
OZ0 TL
O
O O C C
O 0
00 0
U'
vvY n
aH m m
0'JI
's
C 0
CE
dmam0cc
�gE
S`'I
mo
of
U V1
OM a 0 0 coo
I
mm
E
9ZeL`0
i«
L
I
c
0
\+-
I
CZ«m O�
0
w
N L
O I« 0 0O3�y
0 a
\
Q
(j)
V)0 w-0 vvi
JI
ma
N
-+ - N
:E, N
zi
o
so°
p
mWyo T00
100
\
•�
> C l
\
xi
U
NOno 0
0
C�
\\
Q
jZQp OLX
00L
?
J
ig`on`o
m
(n
0W
wN
Q
Q
o�^Nmm°a
_toc—m�I
T$
`oMc�o
Ip��({
O
a
"•(n
wO0
V)
mm�am�o
aZI
Q)
U m m>O N
N
~ N
J
CL
V�
�`^ oz0 C
w
m C
O
mo.amm
O c
«o
0
L
m L `E E m
L
m
N m
CL
J
L a3 oc aom
o
sc
GRE'--ER ANCHORAGE AREA BOF"UGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING ADDRESS ~;~'~Y'"~ ./'~'?C~ C ~/~' PHONE ,-~.~¥~'-'~/"~ ','~'~
LEGAL DESCR,PT.O. L ? ~ 9 E2..~.~7 X.,?,~,.¥' £~',,,~,",,. .
SEPTIC TANK:
DISTANCE , ,,~, ~-~ . . ,y/~,/~C~ //,,~ , , NUMBER OF ,~,
FROM WELL /~'~. MANUFACTURER /~"$'~ MATERIAL ~'~'~' ~'~ COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH __LIQUID CAPACITY /~-~-~ GALLONS.
SEEPAGE Pit:
NUMBER OF PITS ~1 DIAMETER __
L'N,NG MATER,A [ CR, S,ZE:
BUILDING FOUNDATION ~ ~ NEAREST LOT LINE__
OR WIDTH ,-~ ,
DIAMETER __
ADDITIONAL ABSORPTION
LENGTH~4 DEPTH /~
.DEPTH Y DISTANCE FROM: WELL
TOTAL EFFECTIVE d
ABSORPTION AREA (WALL AREA) ~/
SQ. FT.
WELL:
T PE 1 CONStRUCT,ON
BUILDING F NEAREST
FOUNDATION LOT LINE
CESSPOOL
OTHER SOURCES
NEAREST ~//; ~ SEPTIC
SEWER LINE /'~ TANK__
APPROVED DISAPPROVED REMARKS
DISTANCE FROM:
SEEPAGE
SYSTEM
DISTANCES:/~ TM 4'~ /~ / ~
PIPE MATERIAl. (~_~/'~,~"7~ ~t~
LOT SLOPE:
REMARKS:
DIAGRAM OF SYSTEM
PERMIT NO.
[.':,EF'FiF~:TPtEIqT "-~ HERL. TH Rtq[::, EIq',/I ROIqME1'4'TF:IL ?'"~;;:O"l"[i[E:"l" 101'.,i
25::[.6 E.
F:IPI::'L t E:l::ttq'T'
LOC:FFI" I O i",1
TOM BOI.'.IN
L7 B.'.'~: L]iREF:IT LFIIq[:,
8543 PECI<
LOT SIZE: J.~:~Z~E~E~O SL.":.PJF:II:;:E FEET
T"r'PE OF SOIl.. I::IE:SOF.:BTION S"FSTE:M IS.;: TRENC'H
MF~::.,:iI'"IIJM i",iUMF3ER Ot::' 8E[:,F4:OOMS = 4 SOIL RRTII",IG (.S;Q FT,.'"E',R)= 5'5
THE RE6:!i...IIRE[:, SIZE OF THE S~;OIL.. RE:SORPTION S'¢STEM IS;
[::, [S.Z F" "'ti'- lt-.-li ....... :::L ::J_. iL_. FZ II'ql i]i --r b-tt == ;'2 :~E: ,3 IF~: if:..--~ ',,,' IE.C; IL._.
THIE L[:.i'.,iGTFI DIMENSION IS THE LENGTH (:.(1'4 FEET) OF THE TRENCH OE'. [:,RRI1'.~FIEL[:,.
THE [:,EP'T'H liP': F:I 'T'RE1'.4CI:4 OR PIT I~; THE [:,ISTRNC:E E:ETP.!EEN ]'HE '.SJF4."FI::I'-:E OF THE
EiF.:OLIND F:IN[:, TF!E BOTTOM OF THE EXCR',,,'I:~"f'ION (IN FEET).
THERE ]:::"i; NO SET I.,.!II.':,]"H FOF..' TRENCHES.
THE ~P.-,EL [:,EPTH I5; THE MINIMLIM DEF'TH OF uF.'.H,EL. BETP.!EEN THE OUTFFIL. L. F'IPE
~1'.,t1::.', THE BOTTOI'4 OF THE E::<CFI',,,'F:ITION (IN FEET::,.
,.. ,,-. -.
E:i:~E:KFIL. LING I_-IF FiN'.rI --.,~-':T~:.1'I 1.4tTHCIUT FINf~L INSPEL-:TII31"~ RN[:' HI-FF. ,ML. THI':'-::
[:,EF'RRTP1ENT WILL L::E SLIE,'Ji.:.'CT TO PF.'.OSECLITION.
MtNIMUH [:,ISTFINI.'.':E; BETWEEN R I.,.IELL R1",ID RN"r' ON-SiTE SEI4f:IGF [:,ISF'Cr'i;F/I._ S'¢STEM I?,
±~:_."it;:!; FEE'f' FOR la PRI',/RTE I.,.IELL OR 2'.'~El FEET FOE: Fi PUBLIC P~ELL..
SPEC: I F:'I C:RT :1: ONS FIN[> CONSTRLICT I ON [:, I F~GRRI"tL-: RRE R',,,'FI I I._RBLE TO I NSLll;:'.E' PROF'ER
:i: NS;T~LL. FIT I ON.
It::::' F2:: ~::;: iI"."~ ][ "Y' ",,/Ftl IL_ % If.'::, F L, 6 _ C] f-4t ~; ".'~.." E F: F-." F.::' F;: Cu ~"-1! Z :[-E.; :E:."; bi] IE
I C:ERTIF'"r' '¥'HRT
:I..: i FIi',I F'F:IMILIFtl;~: P-~ITH THE REI:;:fl_IIRE:MENTS FEd-q: iZiN-SITE SEF.!E:RS FIN::, I.,.IELI...::;; F4'_::; SET
FORTH B'.r' ]"HE MU1'.,I I C I PFIL. I-i"'-r' (:il::' FtI'-,ICHOFi:RGE.
;:2: I NILL INSTFILL THE SYSTEM IN RCCORDRNE:E WITH THE CODES.
'-' "- ....... F'E::~ IRE ENL. Fii:;.:L":JEMEI'.,IT IF THE
]i:' t UNE:,ERSTFIN[) ]'I-IRT THE CIN-SITE SE!-,.IER .:-r.:']EII MI::'I'T' .-
F.:ESI[:,ENE:E I'.'S I;~:EI'"IODELED "FO :i:NC:LU[:,E PtORE THFtN 4 E:EI}ROOMS.
E; i GNE[:,:
,=,-'~:' ._ t C"" " B .'-' I.,.IN
GED, ~CHNICAL E~ DEVEL'_~PMENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster
6952774
Soils E~ Foundations
Performed for:
Legal Description:
SOIL LOG
Mailing Address: $~;~'_~ ~, ~'~-~
Depth (feet)
Soil Characteristlc~
Earl Ellis
688-2280
Land Development
Tel, No. ~
Ground W~ter Encountered: Yes
Proposed Installation: Seepage Pit
Comments:
Perfomed bv: ~ ....
No
~If yes, what depth
Drain Field ~
,J
Date:
PENINSULA
ENGINEERING
January 15, 1982
Merle Hatch
NHN Quiet Way
Anchorage, Alaska
RE: Adequacy Test
Lot 7, Block 3, Greatland Estates #3
Dear Mr. Hatch:
As per your request, I have performed an adequacy test on the absorp-
tion sewage system for the above lot.
The system consists of a septic tank (1250 gals. approx.) and approx-
imately 25-30 feet of drainfield with all standpipe installed in
accordance with city standards.
The system was tested in accordance with the Municipality of Anchorage
recommended test procedures for a 3 bedroom home. 495 gallons
were added the first day which resulted in a significant increase
in the water level at the end of the trench due to two things.
First, the application rate of 16.5 gpm was higher than normal
and the system had been sitting inactive for a good period before
the test. There was no significant drop in the water level in
the trench after 24 hours, however, the second application of 495
gallons was accepted with only minimal increase in trench water
level.
After a 20 minute rest period the system recovered to the initial
starting level indicating that it is functioning adequately in
the upper area.
In conclusion, after reviewing the test results as tabulated (see
attachment), it appears that the system will function adequat.e~x~a~
as is if properly maintained by regular annual pumping. ~' ~i~
2820 "C" Street, Suite ~3. Anchoraae, A~aska
PENINSULA
ENGINEERING
AI) EQUACY TEST
C] lent:
Addross:
I,ega 1:
Sy$ I:em:
Merle Hatch
NHN Quiet Court
Lot 7, Block 3, Greatland Estates #3
Seepage System Adequacy Test
L/14/81
T 1 HI'; (mi n )
0
~tart
20 nun
30
I H.:I)'I'II
SEi"I'IC TANK
36"
36"
37"
38"
39"
41.5"
43"
44"
44"
44"
,o. rain
20 rain
30 m i n
50 in t it
I~EI"I'II
S~P:. #1~
4'
4'
8'
8'
8'
WAT I,;I,l AI)I)I,:I)
RAT 1';
0
0
0
16.5
t6.5
16.5
TOTAl. WATF, R
AI)I~I,;I) (8al)
0
0
165
33O
495
8'2"
.8'2"
8'2"
8'0"
0
16.5
16,5
16.5
0
165
330
495
( er ifie ' '
I FOHFEALTH &
~Y ~NVIRONMENTAL pRO rECTIO~
DOC Co. dba
SULLIVAN WATER WELLS
OWNER OF LAND
ADDRESS , .' ~ ·
DEPTH OF WELL / :') ~'? ~"
STATIC LEVEL OF WATER FT. "f'-: ~
LEGAL DESCRIPTION c:~ ? ;:. ~ ~' i"
DATE - Started ./,, · i Ended
PERMIT NUMBER
DRAW DOWN FT.
GALS. PER HR 'i~ ,:~;' d)
KIND OF CASING ~, ::: ,?A?
KIND OF FORMATION:
From Ft. to ,/ Ft.
From ;' Ft. to / ~; ,,, Ft.
From /:) Ft. to ? ,:2 Ft.
From -~ Ft. to ~ ~f Ft.
From__Ft. to__Ft.
From ~ .Ft to fi~ ./ ,Ft.
From.__ Ft. to
From ', ? Ft. to?c!
From__Ft. to__Ft,
From ' ~' Ft. to </'?~ Ft.
From Ft. to Ft.
From J'( Ft. to t :~/ Ft
From Ft. to__Ft
From__Ft. to__Ft
From__Ft. to___Ft.
From__Ft. to Ft.
From Ft. to Ft
From__
From__
From
From--
From
From
From
From __
From__
From
From
From
From_
From
From
Ft. to__Ft.
Ft. to Ft.
Ft. to Ft
Ft. to Ft
Ft. to Ft.
Ft. to Ft
Ft. to Et
Ft. to__Ft.
Ft. to__Ft.
Ft. to Ft
Ft. to Ft.
Ft; to Ft,
Ft. to.__Ft.
Ft. to Ft,
Ft. to Ft.
Ft. to Ft.
Ft. to Ft.
MISCL. INFORMATION:
DRII,I,ER'g NAME
~F'F'L. i CFiNT
LOCRTiON
!...EFT S Z
FItNiHUi',? E:,ISTFii',!CE BE'i"!.,.!EE:P,i Fl NE!._L FIN[) RF,?¢ ON-S.'['.i"E SEi.,.!F:!GE [)tSF'O:/..'..RL :?./STEI"'t t5;
::LCtC'~ FEET FOR R F'Ri'v',"fi"FE b.IEELL OR iSEi TO 200 FEE:T FROM FI F:'LiE:L~iC: !I,.E:LL f)iEF:'EEN[>ING
LiPON ]'FIE T'¢PE OF PUE:,LZC HEL. L.
M:[NIMUM DISTI:'~NCE FF:C;I"i Ft F'RI'v'RTE !.4E'LL TO Fi F'RIVFITE SEi.,tE.'F:: LI!',IE ]:rE; 25 FEE'T Fit"..![:,
"i'0 i::! COi'dlfii...iF:!~T¥ SEWER L~'t'-,!E IS 75 FEET.
i.,.!ELL LOGS FLRE RE'%:!UIRED R.N[:, MUST BE F..'ETURNE:[:, TO THE DEF'F!RTMENT !,.!tTH!N 5B3 DFI¥'S
CiF THE i.,!ELL COI'IF'LE]"iON.
OTHE;F..'. RE(;!UZI;E:EI',iEi'.,FFS Mfr.-/ RF:'F'L¥. SPECZF!CFiTIO!'-,iS FIND CONSTRUCTION DIF!GRI:'-'!NS F:!RE
RVRZL. RBLE TO ZNSURE PROPE-:F.: ZiqSTF!LLRT];ON.
! CERT I F"-/ THFIT
.:'..' ]: fall"l F:'FiI"'I:ELiFIP ..... 14l'!*bl THE F-:E(I::!i. JI.i.;.:E]','t[.-ZI'.,ITS F'()E: -'~.J- ':'~"lr[:.,_., '*" .'-- - '~.- ~;~Et.'IlEF]:S faf",!['''l ,... I-'-tEL..L.S FI'."E; SEE'T'
FORTH ~"' THP' h'li.l'.~::;:T.,r:'F'.tl ;.~'rb, -il;: ,'::-d',!'":bi'"F.'~::laE
' ,.!I ....*" ' ..... "
...... ~,. r~.: rhL,._ THE S'./STEi"I Ii'q RC:CORE:,Ri'.,!CE N I TH THE
5; 'J: :'2i'.~EE::
:IF:Pi.. ]' - ¢:Ii'-IT_ MERL ! i',! ~= .......
.iSSUE[:,,.,?. .......... . ............... L..'~'.''"--~ .......... Z. ./ .....
{killing
by
A&-L DRILLING COMPANY
BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE 694-2588
OWNER OF LAND
ADDRESS
DATE-Started ~/o~c>/-Z~ Ended 7/,<F'/7~ GALS. PER HR
PERMIT NUMBER 7~ ~ / ~> KIND OF CASING
DEPTH OF WELL
STATIC LEVEL OF WATER FT.
KIND OF.F6~M,A. TION:,.. -~,
From '''y-.- Et, to ~a~')O~, '~?,t~:-:k~/5~a~O -~' ~'dqt~/, w'/~OoaVZ)¢~ From
From c.~.~ Et to ~O "Ft~ '//~'" From~
From ,'~ 0 Et, to_ 3~ Et:' ~'~0 From__
From 3~-~ Ft. to -~ Ft.~ CL~ ~-~<~dO~4 From~
From '5~ Ft. to Ft. '"' From
From -[d) Et. to /~' Et, ~/,3~ ]~Oq~d'~g From
From / ~{'~Ft. to
From / ~C Ft. to_ g~; Ft. ~e~/C ..... ~d~,. '~/'/c.")" ,'-~r.cYFrom
r~om ~2;~ 9~ .Ft. to g 7~ Ft. ~/~?'~2~O /O ¢/~/~ F~om~
From ~)-'7~ Ft. to '~00 Ft. /~t~D From
From ,~6~ Ft. to ~ / ~ Ft. /~-o<~/E~"} From
From ,~/~' Ft. to ~OcG° Ft /qL~/D From
From <}OC.~ Ft. to ¥~ ~ ~ Ft. ~'~-.T'~[~ ~19 ~'(~ P/~ Froin
From <}1 ~kFt' to %-bC~Ft. ,~Od/<) From
From Ft. to Ft. From
From Ft. to Ft. From
From Ft. to Ft From
Ft. to Ft.
l~t. to Ft
Ft. to Ft
Ft. to Ft.
Ft. to Ft.
Ft. to Ft
Ft. to Ft
Ft. to Ft
Ft. to Ft
Ft. to Ft
Ft. to Ft.
Ft. to Ft.
Ft. to Ft.
Ft. to___.Ft.
Ft. to Ft.
Ft. to Ft.
Ft. to Ft.
MISCL. INFORMATION:
/ 7-o
:~/' <..'./hrh..; 4>
DRILLER'S NAME
[:,EF'FIRTMENT ' ' NERLTN FIND EIb, IF. _Nf~Et4 filL. 'ir:rrEr_':TION
25:t):3 E. FU[:,OR RD.., RNCHORRGE., FIK. 9::,:587'
2'76-222::1.
( 7:E4i8 )
TOH EISWEN 854]: F'E.
QLI I E"f' HFIY
1_7 E:2: GF.:EFI]" L_FII'.,ID ES;TRTE$
LOT SIZE:
:1...';:50C~0 SL-]UFIRE F:'EET
MINIMUH DISTRNCE BETHEEN A WELL AN[:, ANY ON-SITE SEWFIGE DISPO':'.-.';RL. S'.?S'f'EH I':T..;
iL;'~E-i FEET FOR A PRIVFITE 14ELL OR 2,9~3 FEET FOR FI PUBLIE: WELl_.
WELl.. LOGS RRE REE!UIRED RND MUST BE RETURNED TO THE DEPRRTHEN'f' HITHIN .]]:E:~ DFI'?'S
OF THE WELl._ COHPLETION.
SPECIFICATIONS FiND CONSTF,'.UC]']:ON DIRGRAI'"IS ARE AVRILFIDLE TO INSURE PROPER
I NS'T'RLL FFI" I ON.
I CERTIF~r' THRT
'1_: I FIM FRMILIFtR WITH ]'HE REE!UIREMENTS FOR ON-SITE SEWERS FIN[) WELL. S RS SET
FORTH 8b' ]'NE MI.JN.ICIPRLiT"r' OF RNCHORFIGE.
2: I WILL INSTRLL THE S'¢STEM IN RCCORDRNCE WITH THE CODES.
S, 6NEg. :~2'~ ,.~ ~~¢.- ~ ...........................
APPLZCRNT TOM BOWEN
Z 2~;SLIE[::, B'¢_._. ,: ...... L__E:,RTE:
Certificate of On -Site Systems Approval
Parcel I.D. 051-133-40
1. GENERAL INFORMATION
Expiration Date:
Complete legal description _GREAT LAND ESTATES #3 BLOCK 3, LOT 7
Location (site address) 19931 QUIET WAY, CHUGIAK, AK 99567
Current property owner(s) EARL L. ROEMER Day phone
Mailing address
Real estate agent
19931 QUIET WAY, CHUGIAK, AK 99567
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
®
Private Septic
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ h (rn — 2 Q 0
Date of Payment f/J2/ 1
Receipt Number
COSA# (!SC, Z11 6Qq
Date:
Waiver Fee $
Date of Payment
Receipt Number,
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 FIRST WATER CONSULTING Phone 907-350-9566
Address 13030 SUES WAY, ANCHORAGE, AK 99516
Engineer's Printed Name CURTIS HUFFMAN, PE Date 8/3/2022
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the ^moi
well and septic system. Therefore, any estimate of how long a system will function satisfactory /��P•' • !�
for current or future occupants or guarantee that no unseen encroachments, deficiencies or g.' •:� (�
discrepancies exist can be given by First Water Consulting &TH
FWfS *'
.. .........
6. DSD SIGNATURE �.. Curtis Huffman_
System #1 Approved for bedrooms ��t F��s •• CE 128991 :k-
System #2 Approved for bedrooms �i�OPROFESSIQ?�
Disapproved
Conditional approval for bedrooms, with the following stipulations:
By: 7r__Original Certificate Date:
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
Legal Description: GREAT LAND ESTATES #3 BLOCK 3 LOT 7 Parcel ID: 051-133-40
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
® Well log is filed with Onsite (or attached)
Date drilled 7/1982
Total depth 101 ft
Cased to 95 ft
® Sanitary seal is functioning correctly
® Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 11/4/2021
Static water level at beginning of test 49 ft.
Comments
B. TANK DATA
Age of tank(s) 45 years
Tank type/material PLASTIC
Measured operating fluid level in septic tank 49"
® Standpipes/foundation cleanout per record drawing
Date of pumping 11/3/2021
D. ABSORPTION FIELD DATA — NEW FIELD
Which system tested (date installed) NEW
® ALL standpipes present per record drawing
Total measured depth from grade 11.3 ft (max)
Measured depth to pipe invert from grade 4.3 ft (min)
❑ N/A — pressurized field
® Monitor tubes go to bottom of effective. If not, state
depth into effective
Structure served by this system
Well production at time of test 4+ gpm
Water storage tank volume 300 gallons
---- ------ -- --- -- --
Well disinfected for coliform test? ❑ Yes ® No
® Coliform bacteria is Negative
Nitrate 1.47 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ® Arsenic less than MRL (ND)
Collected by EWES
Zi �71 7 -
Date of Sample 11/18/2021
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material
Comments:
Adequacy test date NEW 4BR FIELD
Results E Pass For bedrooms
Fluid depth prior to test in
Water added gal
New depth in
Elapsed time min
® Code -required soil cover over field Final fluid depth in
❑ System presoaked Absorption rate gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N
date of test) If yes, enter date
Gallons introduced gallons
Comments/Deficiencies: MT/CO AT GRADE. Fly"
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
® Yes if No ft
Surface Water > 100'
Septic Tank/Lift Station on Lot > 100'
® Yes if No ft
Wells on Adjacent Lots:
Community Sewer Manhole/Cleanout > 100'
® Yes if No ft
Private Wells > 100'
® Yes
if No
ft
® Yes
if No
ft
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes
if No
ft
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No
ft
Neighboring Absorption Fields > 100'Animal
Containment > 50' ®_Yes_.-
if._No
ft_-________
Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ®Yes
if No
ft
® Yes
if No
ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
® Yes if No ft
Surface Water > 100'
Property Line > 5'
® Yes if No ft
Wells on Adjacent Lots:
Absorption Field > 5'
® Yes if No ft
Private Wells > 100'
Water Main > 10'
® Yes if No ft
Community Wells > 200'
® Yes if No ft
® Yes if No ft
® Yes if No ft
Water Service Line > 10' IN 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'
® Yes
if No
ft
Private Wells > 100' ® Yes if No _ ft
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that l have determined through field inspections and review „®.,�Q+, •' • ' •°.� ��
of Municipal records that the above systems are in conformance �f1"'�? •''�'
with MOA COSA guidelines in effect on this date.
• ' Curtis Huffman
CE 128991 .• 4w i
'�F� $(3/22
�k� • . •�F�c`'.m
PROFiWQ0.
NNI) 1-T 10 N A L
MUNICIPALITY ALITY ®F ANCHORAGE
11
o'l
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. 051-133-40
1. GENERAL INFORMATION
Expiration Date: I f tanc41 11, a0�2 2—
Complete
Complete legal description GREAT LAND ESTATES #3 BLOCK 3, LOT 7
Location (site address) 19931 QUIET WAY, CHUGIAK, AK 99567
Current property owner(s) EARL L. ROEMER Day phone
Mailing address
Real estate agent
19931 QUIET WAY, CHUGIAK, AK 99567
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
®
Private Septic
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee s 5.6 d + 4 2 � 0 Waiver Fee $
Date of Payment 1 a' (' a 0 2
Receipt Number O ( (o ()2 9--
COSA# OSC 21 1 �9
Date of Payment
Receipt Number
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 FIRST WATER CONSULTING Phone 907-350-9566
Address 13030 SUES WAY, ANCHORAGE, AK 99516
Engineer's Printed Name CURTIS HUFFMAN PE Date 12/3/2021
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting & fWCS .
6. DSD SIGNATURE
System #1 Approved for
System #2 Approved for
Disapproved
Conditional approval for
_LrvS4a`(`
bedrooms
bedrooms
7H •,
•
. •........::::
j . ' . Curtis Huffman
9 CE 128991 . %!c�`�r
`I bedrooms, with the following stipulations:
S O r o n („ I 4-o 6e. CD n�:f Ie-4ed b
t)t.Lri e 0 20 2 2-
,
Z pN-SITE
v Z W PJ EK FND
o1
pR4GF•.AM
s<�
5
Ob,�NT SER��G�`��,;
By: Original Certificate Date:
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
Legal Description: GREAT LAND ESTATES #3 BLOCK 3, LOT 7 Parcel ID: 051-133-40
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)
Date drilled 7/1982
Total depth 101 ft
Cased to 95 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 11/4/2021
Static water level at beginning of test 49 ft.
Well production at time of test 4+ gpm
Water storage tank volume 300 gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 1.47 mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date of Sample 11/18/2021
Comments
B. TANK DATA
Age of tank(s) 45 years
Tank type/material PLASTIC
Measured operating fluid level in septic tank 49”
Standpipes/foundation cleanout per record drawing
Date of pumping 11/3/2021
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA – NEW FIELD PENDING
Which system tested (date installed) NA
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
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
Adequacy test date NEW FIELD PENDING
Results Pass For bedrooms
Fluid depth prior to test in
Water added gal
New depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Comments/Deficiencies:
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 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
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No ft
Property Line > 5’ Yes if No
ft
Absorption Field > 5’ 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 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
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
If absorption field is under driveway comment below
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No
F. ENGINEER’S COMMENTS
G. ENGINEER’S CERTIFICATION
I 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.
12/3/21
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
December 3, 2021
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: CONDITIONAL COSA
LEGAL: GREAT LAND ESTATES #3 BLOCK 3, LOT 7
PHYSICAL: 19931 QUIET WAY, CHUGIAK, AK 99567
The pending permitted 4-bedroom septic field upgrade has been impeded due to winter
conditions and other factors. We are therefore requesting a Conditional COSA at this time and
will proceed with the upgrade once conditions allow. The system has been working for the
occupants and granting of this Conditional COSA will not impact any of the neighboring
properties or pose a public health risk. Attached are 2 bids and escrow letter from title for the
pending installation. Please contact us if you have any questions.
Sincerely,
Curtis Huffman, P.E.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
Lot 7; Block 3; Greatland Estates Subdivision ~3
Location (site address or directions) 19931 Ouietway
Property owner
Mailing address
Lending agency
Mailing address
Conrad and Myrl Necrason
Day phone
Tenants - Tim and Deanna Paqe - ~88-0580
CITY MORTGAGE Day phone
Eagle River, Alaska/ATTENTION: Don Pressor
Agent Carol Bennett/FORTUNE PROPERTIEs
Address 3000 A Street, Anchoraqe, Alaska 99503
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3 "',
TYPE OF WATER sUpPLY:
Individual well xxx
Community well
Public water
NOTE:
Day phone 562-7653
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
NOTE:
72-025 (Rev, 1/91} Front MOA ~21
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 further verify that based on the information obtained from
the Municipality of Arichorage flies 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 s & s ENGINEERING
17034 Eagle Ri,vel' LOOp F, oad No. 2~, Phone
Address ~,agJe River, Alaska 99577
Engineer's signature
DHHS SIGNATURE
Approved for
Disapproved.
bedrooms,
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
Date
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 order to 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 engineeds work.
72-025 (Rev. 1/91) Back MOACY21
Legal Description: I/'7 I~'~
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
~~ ~ ~¢¢'~ Parcel I.D.
A. WELL DATA
Log present~/N)
Total depth
Sanitary seald~)
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed '7/~'Z. Driller ~t
Cased to [ ~ Casing height \ Jr'
Wires properly protected~N) ~'~/M,,~,,~- ..........
~N~I~NMI~NTAL'SERVICEs
AT INSPECTION ·
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
g.p.m.
OCT 5 ? 199;
RECEIVED
g.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
WATER SAMPLE RESULTS:
Coliform ~;> d-'c~-~/~'l ¢o~--t¢ Nitrate
Date of sample: ~c~r
On adjacent lots \
; On adjacent lots ~ ~ I..~-
Public sewer manhole/cleanout t~ ~--~
Petroleum tank "~
Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed "7 '" \~1 -~"7 ~, Tank size /~' ~-C;> Compartments ~'"
Cleanouts(.C~/N). - '~/ Foundation cleanout CC/N) ~ Depression (Y/~;)
High water alarm (Y/N) ~ Alarm tested (Y/N)
Date of pumping
Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot t~ ~ ~_lt----~ On adjacent lots \ ~ ~
To property line ~ ,~.~ ~-4 ~. c~ t
Surface water/drainage
Absorption field
Foundation
Water main/service line
72-026 (Rev. 7/91) Front CONTINUED 'ON BACK PAGE
C. LIFT STATION
Date in. led
Size in gal~
Vent (Y/N)
High water alarm level
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Manufacturer
Manhole/Access (Y/N)
Well on lot
"Pump on-b-'NHeveJ~ "Pump off" level at
~~-'~0 y~bl e s~t est e._d~__ _
Surface water
On adjacent tots
D. ABSORPTION FIELD DATA
Date installed '~ ~ [~--'~('~' Soil rating
Length "~ ~,' Width
Total absorption area
Depression over field (Y/~Cj~
Results (pass/fail)
Peroxide treatment (past 12 months)
Gravel thickness ~
Cleanouts present ~:~N)
Date of adequacy test
for ~
~ If yes, give date
System type
f
Total depth
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellon lot ~t~ On adjacent lots
To building foundation ,¢¢t'~/ --- To existing or abandoned system on lot
On adjacent lots
Surface water
Curtain drain h-~t~
E. ENGINEER'S CERTIFICATION
Driveway, parking/vehicle storage area
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect ¢~r4~e~of this inspection.
S & S ENGINEERING
Signature 17034 Eaole Ri~er k~p Road
- .
Eagle River, Alaska 99577
Engineer's Name
Date ~ ~ ~1
HAA Fee $ /*',~/2, ~
Date of Payment
Receipt Number ~r~'~/~¢ ~---" ~"'¢'~"-~'
Waiver Fee: $
Date of Payment
Receipt Number
Time ~ Time
Date Date
Inspectur Inspector
Inspector
Comments
Conditional Approval
Date Sewer Installed Permit No. Septic Tank Size
,~_,_~ ~ Holding Tank Size
Soils Rating Well To Absorption Area Well Log Received
Well to Tank
APPLICANT FILLS OUT LOWER HALF ONLY
Property Owner ~ ~~
Mailing Address ~,~.~,~-jO,x~,~O0, ~-~tJ~ ..~.'~,~
Buyer ,~ ~~ i~:
Lending Institution ~~
Address
Realty Co. & Agent ~ ~-~ ~ ?~~
Legal Description LO~ ~ , ~{0~ ~ '~~
StreetLo~Uon ;~ ~{ ~ ~). ~g I.
Typ[pf Residence
~ingle Family
~ Multiple Family No. of Bedrooms
~ Other
Phone
Phone
Phone
Water ,Supply
)~,Jndividual
'~] Community
[] Public Utility
Sewage Disposal
.~ffndividual
[] Public Utility
[] Holding Tank
ATTACH WELL LOG. A well log is required for all wells drilled since June
1975. For wells drilled prior to that date, give well depth (attach log if
available.)
Year Individual Installed:
When Connected to Public Utility:
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
APPLIC'-' I'I: FILLS OUT UPPER HAL ...... ONLY
Property Owner /~'~-'~'--1 >/4'; ~ ~ ~ Phone
Mailing Addre~ ~ Code
Address Zip Code
Lending Institution Phone
Address Zip Code
Realty Co. & Agent Phone
Address Zip Code
Street
Locati~
Ty~ of Resi~nce
~ Single Family
~~ Multiple Family No. of Bedroo~. ~
~ Other
W~ Supply
Individual A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975.
Community For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utility
Se~ Disposal
~ Individual Year Individual Installed:
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes:
(~) APPROVED BEDROOMS_~ 'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ') CONDITIONAL APPROVal'
Soils Rating Well TO Absorption Area Well Log Received
Date' Se77-~1t~ Well to Tank Septic Tank Size
