HomeMy WebLinkAboutT15N R1W SEC 18 LT 206Onsite File
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Municipality of Anchorage
On -Site Water and Wastewater Section . (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP191311 PID Number: 051-232-44
Dwelling: E Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New EM Upgrade
Name
Carrissa and Andrew Thomas
ABSORPTION FIELD
❑ Dee Trench ❑ Bed ❑ Mound
p Wide Trench
Site Address
19037 Spruce Crest Dr Chugiak
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
2
0.675 GPD/SF
3.5-3.9 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
1.5 - 1.9 Ft
Gravel depth beneath pipe
2 Ft.
Subdivision Block Lot
206
Fill added above original grade
1.6-2.0 Ft.
Gravel length
64 Ft.
Township Range Section
15N 1W 18
Gravel width
5
Beds: Number of Lines
Distance between lines
SEPARATION
DISTANCES
Ft.
Ft.
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
4.57 Ft2
1
Ft.
Well
>100'
>100'
NA
NA
> 100'
TANK A Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Greer
Capacity
1000 Gal.
Surface Water
>100'
>100'
NA
NA
Material
Number of compartments
Lot Line
>10'
>10'
NA
NA
NA
plastic
2
Foundation
>10'
>10'
NA
NA
rLLT—S&TATION
Manufacturer
Capacity
Remarks
Gal.
Alarm location
Electrica i to ed by
Installer
PIPE MATERIAL House to tank D3034 Tank to D3034
drainfield
JRs Excavating
Drainfield D3034 CO/MTD3034
Inspector Curtis Townsend, PE
BENCH MARK (Assumed elevation) 100 ft
Inspdection 1'' 9/7/19 2nd 9/9/19
Location and description
31d 9/10/19 4119/21/19
door threshold
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval: Date
oF
o 49
.A6000000: ...........
.
Septic System
CCDa�tezaz;i�
Approved Date 2Z
�
���Jl •.M1'o. CE 11 �
OFESSI
Note: this approval d 4snot
ot include well permit requirements.
®®�W
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WELL 100'/ SEPTIC
RADIUS / MINK CREEK L 0 T B AREA 30'+ 28'
LL 100 -
SCOPE 0PWORK
1. LEFT EXISTING HOLDING TANK, TIED IN
NEW TANK AND FIELD WITH DIVERTER 5% Ti - 64'M S
VALVE. _
2. PLACED NEW 1,000 GALLON SEPTIC TANK TH 3 1 16'
AND NEW 64' LONG X 60" WIDE X 2'
EFFECTIVE DEPTH ABSORPTION TRENCH.
THE TANK WAS PROVIDED WITH MIN 20"0 NEW 64' x x S PTIC
MANWAY RISER SERVING FIRST ED TRENCH A TI 30'+
COMPARTMENT AND A MONITORING TUBE.
MAXIMUM EXCAVATION DEPTH WAS 3.5'. W LL 100'+
3. ALL CONSTRUCTION WAS IN ACCORDANCE Y 22%
WITH ALL REQUIREMENTS SPECIFIED IN j
ANCHORAGE
55 MUNICIPAL CODE CHAPTERS / o
N / N
O p
J J
NEW DOUBLE
CLEANOUTS / SEPTIC
AREA
OtV�RTER
/ VALVVE, 1000 GAL 22%
/
/ 2,000 GAL \ \ TANK/ FCO HOLDING TANK
S,
f — 2 B
100 L -J \` OUS
o ,
BY
�y O
I 7%
O I ` W —I— W
OHI -��- — OHU
►—-----
\ UTILITY EASEMENT
DESIGN PARAMETERS SPR CE CREST DRIVE
PRIMARY SEP11C SYSTEM
NO. BEDROOM: 2 (300 gpd)
TANK SIZE: 1000 G
SOIL RATING: 0.675 GPD/SF
AREA REQUIRED: 444 S.F.
SYSTEM TYPE: WIDE TRENCH
64' X 60" X 2' EFFECTIVE DEPTH, 3' COVER. SWING 77ES ON PAGE 2
Septic Record Drawing Prepared for �
Carrissa and Andrew Thomas ��'�E 0F, q °o®
19037 Spruce Crest Drive, Chugiak Alaska 99567 AV �?:•° S�y��®e
TI 5N R1 W Section 18 Lot 206 A 49TH
OSP 191311 ®.....::.... ...........................o
i............................................ v
EKLUTNA ENGINEERING, LLC DATE: 7/28/2021 0.8, CURTIS TOWNSEND.*
19162 MOUNTAIN ROAD
DRAWN: CLT #G' '- No. CE 1 .904 -* IVAF
CHUGIAK, ALASKA 99567 SCALE: 1" = 50' ®®® r ..
(907) 355-9820 ®��A�S;1®®®®
PID: 051-232-44 SHEET 2 OF 3
MARK
A
B
C
FCO
25'-7"
4'-0"
SV1
21'-9"
13'-8"
Q
U
SV2
23'--5"
18'-3"
m
DCO 1
23'-9"
19'-4"
DCO 2
24'-2"
20t -l"
OO
DIVER TER
24'-8"
20=9"
MT1
173 =0"
168'-0"
MT2
198'-0"185'-0"
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OV
F-
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QN
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~ Z
¢
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OO
1,000 G
PLASTIC TANK
2' INSULATION PLACED OVER TANK
N
8
SMI I NEW &V x V ED x 5' WADE TRENCH
THf4 GROUNDWATER WAS AT 59' IN JULY 2019
Septic Record Drawing Prepared for
Carrissa and Andrew Thomas
19037 Spruce Crest Drive, Chugiak Alaska 99567
T1 5N R1 W Section 18 Lot 206
OSP 191311
EKLUTNA ENGINEERING, LLC I DATE: 7/28/2021
19162 MOUNTAIN ROAD DRAWN: CLT
CHUGIAK, ALASKA 99567 SCALE: 1" = 10'
(907) 355-9820
PID: 051-232-44 SHEET 3 OF 3
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/,,..A MUNICIPALITY OF ANCHORAGE • »e«t
On-Site Water&Wastewater Program 0NR^07S;
/ . ; PO Box 196650 4700 Elmore Road
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 ;
r' http:llwww muni.org/onsite
Department
CNONAOE
On-Site Wastewater Disposal System Permit
Permit Number: OSP191311 Effective Date: 8/7/2019
Work Type: Septic Upgrade Expiration Date: 8/6/2020
Tax Code Number: 05123244000
Site Legal Address: T15N R1W SEC 18 LT 206 G:1054
Site Mailing Address: 19037 SPRUCE CREST DR, Chugiak
Owner: THOMAS CARRISSA THOMAS & Lot Size in Sq Ft: 98010
Design Engineer: EKLUTNA ENGINEERING, LLC* Total Bedrooms: 2
This permit is for the construction of:
21 Disposal Field 1 Septic Tank ❑ Holding Tank 0 Privy 0 Private Well 0 Water Storage
All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
?1
Received By: ✓ Date: •
Issued By: Ad- Date: U
EPtimlut
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water& Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 051-232-44
Property owner(s) Andrew and Carrissa Thomas Day phone (? 15)2?I- 14561
Mailing address 19037 Spruce Crest Drive Chugiak AK 99567
Site address same
Legal description (Sub'd., Block & Lot) T15N R1W SEC 18 Lot 206
Legal description (Township, Range & Section)
Lot Size 98,010 Sq. Ft. Number of Bedrooms 2
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(0 all that apply)
Absorption Field 0 Initial ❑ Single Family (SF) 0
(w/wo ADU)
Septic Tank Upgrade Duplex (D) ❑
Holding Tank ❑ Renewal ❑
Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that t{.ce above information is correct. I further certify that this is in accordance with
applicable NtuniTipal Codes.
Lb ( 2
(Signature of property owner or authorized agent)
Permit/Rush Fees: 5ciS Waiver Fees:
Date of Payment: /Iii I� Date of Payment:
Receipt Number: o 9-Q'Q D Receipt Number:
Permit No. O5P)64 1.31 / Waiver No.
Gs\Development Services\Building Safety\On Site Water and WastewateriForms\Client Forms!Permit Application.doc
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191311, Deb Wockenfuss, 08/07/19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191311, Deb Wockenfuss, 08/07/19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191311, Deb Wockenfuss, 08/07/19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191311, Deb Wockenfuss, 08/07/19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191311, Deb Wockenfuss, 08/07/19
NOTES:
1. () RECORD DIMENSIONS PER BLM
PLAT OF TOWNSHIP 15 NORTH,
RANGE 1 WEST, SEWARD MERIDIAN
ALASKA DEPENDANT RESURVEY AND
SUBDIVISION OF SECTIONS 18 & 19.
RECORD DISTANCES SHOWN IN
CHAINS. 1 CHAIN = 66 FEET.
2. UTILITIES OTHER THAN THOSE
SHOWN MAY EXIST.
3. THIS SURVEY DOES NOT
CONSTITUTE A BOUNDARY SURVEY
AND IS SUBJECT TO ANY
INACCURACIES THAT A SUBSEQUENT
BOUNDARY SURVEY MAY DISCLOSE.
UNDER NO CIRCUMSTANCES SHOULD
ANY DATA SHOWN BE USED TO
ESTABLISH ANY FENCE, STRUCTURE
OR ANY OTHER IMPROVEMENTS.
LOT 205-C
4. ALL VISIBLE ABOVE GROUND
FEATURES OF THE EXISTING SEPTIC LOT 205-B
SYSTEM WERE LOCATED AT THE
TIME OF SURVEY AND ARE SHOWN
HEREON.
ASBUILT - NO CORNERS SET THIS DATE
I HEREBY CERTIFY THAT I HAVE PERFORMED
A SURVEY OF
GOVERNMENT LOT 206, TOWNSHIP 15 NORTH,
RANGE 1 WEST, SEWARD MERIDIAN ALASKA
DEPENDANT RESURVEY AND SUBDIVISION OF
SECTIONS 18 & 19,
AND THAT THE IMPROVEMENTS AS DEPICTED
HEREON EXIST AS SHOWN IN RELATION TO
THE PROPERTY LINES. EASEMENTS OF
RECORD ARE NOT SHOWN HEREON UNLESS
OTHERWISE NOTED.
DATE: 7/18/2019 I FB: 2019-2 I
I GRID: NW 1054 DRAWN: DMR
SCALE: 1" = 80' 1 FILE: 19-035AB
MINK CREEK
L 0 T B SUBDIVISION
(S 89'59' E) 328.88' (4.983)
8 I O
GO VERNMEN T L 0 T
206 o O
N
p� N
OTli
C9
of
N
3 -STORY
3 FRAME
0
HOUSE
3'
24.
Z 217.5'± SHED
_F-1
L -J
i S 2 - 83.1'±--
11 `� GRAVEL
cwj I DRIVEAY
-- X -oma,
33' PUBLIC USE EASEMENT -
BK. 963, PG. 362 SPRUCE' CREST DRIVE
(S 89'59' E) 328.88' (4.983)
LEGEND
O
S )
(
_ i _
��P� ��� A`�1�� �WJ
� C ' •'9 ��
*: 48TH n
/ �.... * LT
. W
Y Da na:�-
. Rumfelt
�F9 . . LS 13322 • .S��J �/
04 Fpp
11�ROFfSSIONA� �P`� L
FOUND REBAR
SEPTIC VENT
WELL
TEST HOLE
TELEPHONE PEDESTAL
rn
h
cq
of
N
n
LOT C
LOT 207
LOT 208
0
SCALE 1" = 80'
LIGHT POLE D
GUY WIRE L/A\V E N D E R
POWER POLE// \\SURVEY & MAPPING
=� 2890 S. BARNYARD CIR., WASILLA, AK 99654
OVERHEAD UTILITY DAYNA RUMFELT (907)301-5177
Municipality of Anchorage ,.:;~:
Development Services Department
Building Safety Division '~.~-, ~'~'
On-Site Water and Wastewater Program. 4700 Bragaw
P.O. Box 196650 Anchorage. AK 99519-6650 Page
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: ~'~ O 00 3 4) ;t. PID Number: ~)
"'""' Sco~t'~ ~ ~,.~.~1. ~'~,A"~,.~_~ WastewaterSystem: [-]New F-IUpgrade
'2'Z."~3C) ~..e,~z. ~'~\\ '['x, iZ.. ~ ABSORPTION FIELD
Ptx~e
LEGAL DESCRIPTION s~, ,,~,,~ '~
Wel~ ~ New ~ Upgrade ~"'~' ~,.
o~ Pu~"rt.j~~
~, TANK
SEPARATION DISTANCES D Septic ~ Holding DS.T. EP.
Tank F~ld Station Tank ~rLine ~ ~~ ~
:,
BENCH MARK
Inspe~ionspedormed~mNEE.iNG Dates: 1" fl~Z}ob Eh' ·
17~ E~Ie RI~r L~ Rad, No- ~ 2~ q[~3 JO~
Deve~h~~S~e pa ~me .t Approval
Co d tio, A,p,ow
PERMIT NO. ~
P~cE 2 oF 2
Munieil~alit¥ of Anchorage
DEVELOPMENT SERVICES DEPARTMENT
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650e Anchorage, Alaska 99519-6650 e Telephone: $45-4744
On-Site Wasfewater Disposal System and/or Well Inspectlon Report
LEC.~J_ LOT 206, Section 18, TISN, RIW, S.M. PJ.D. NO. 051--232--44
o L'XlST~NG B£D
..............
................. ,~
55' PUBUC US~ EASEMENT
SPRUCE CREST DRIVE
FINAL GRADE~ 100.4'
g6.0' NEW 2000 GALLON
A ~ HOLDING TANK
FCO 1.0' 55.0'
HT1 26.5' 24.0'
H T2 27.5' 22.0'
HT5 50.0' 20.5'
Sep 28 06 11:43a KING'S REAL ESTATE
Sco~t and Kim Wa~kins
c/o Bonnie King- King Real
22?00 Lake II[Il Dr.
Chuglak, AK 99567
September 15, 2006
Lo~ 206; Section ] ~; TISN; RIW
19037 Sprac¢ Cma
907-688-2275 p.2
As our IeUer da~ed Sep~"rnber 1 I, 20~ s~, we ~ve a~lied for a ~t to
i~[I a s~c ho[~ ~ ~o ~ ~ f~l~ [~chHeld system ~ ~e abo~
~fe~nc~ p~. Since ~t d~, ~e ~ed ~ des~ to ~cludo a di~er valve.
~s wi~ give ~e e~s~g f~l~ I~field ~ o~o~ Io ~ cut ~d ~ssibly
~, ~ ~ler be ~Ic~ ~ck into so.icc.
~c MOA ~s ~pwvcd ~ ~il for ~c holding ~h ~ a ~vc~r ~l~c ~
~ pw~scd.
If you have q~s~ons ~g~n~ ~y of~c a~ve i~o~fion, pI~ fccl ~cc W
c~l.
Sincerely.
I~O O~Fn" C ccrwJ, N, p.F..
TOT;~L P.O~
Sep 28 06 11:43a
KING'S REAL ESTATE
Richard Pc'son Co~tzuc~on
24120 Ramblers Rd.
~AK ~567
907-688-2275
p.1
INVOICE
9,'23/~06 221
~ Ref BID #:
Sep 28 06 11:43a KING'S REAL ESTATE 907-688-2275 p.3
September 27, 2006
(9<37) ~,~'~
FAX(9(T~ ~(.1211
Scott mad Kim Wa,,kir~
e/o Bonnie ICing - King Real Estate
72.'/00 Lake Hill Dr..
Chugi~k, AK 99567
Lot 206; Section 15; TI 5N; RIW
1903'/Spruce Crcs~
Dear Mr. and Mrs. Wa~kins,
The septic holding lank ~ be~ ir~alled to serve thc above referencccl property
as designed and perraln~d September 14, 2006. A divertcr valve waz in~alled
accorCl~g to thc design, but ,~'c do not gvarantcc the httcgrity of the old septic tank or
future vizb~li~ of the ieachfield. We recommend verifying the in~grity of the old sop'dc
tank and thc absorption of ibc septic field before thc divcrter valve is cvcr switched b~:k
to the old system from the new holding tank.
If you have ques6ons regarding any of thc above infomaation* ~lease feel f=e to
call.
Sinc~rcly,
o d', cZ
· Cowan, P.E.
RCC/~
17034 NORTH EAG~.E ~VlLR L.~OP - $0~'C2~4 ,, EAGT.E R.%'E/% N.,&SICA 9~577
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Sep 14, 2006
Expiration Date: Sep 14, 2007
Permit Number: SW060302
Legal Description: T15N R1W SEC 18 ET 206
Design Engineer: 0003 S & S Engineering
Owner Name: SCOTT & KlM WATKINS
Owner Address: 19037 SPRUCE CREST DRIVE
ANCHORAGE, AK 99510-0000
Parcel ID: 051-232-44
Site Address: 019037 SPRUCE CREST, DR
Lot Size: 98010 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field' [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage
mi construction must be in accordance with:
1. The attached approved design.
2. /UI requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of A~aska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). I
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 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:., Date: ~'/ ~.1 ~'
~ Date: ~/I~/o(~
Issued alt:. ~ ~
Municipality of Anchorage'
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
ON-SITE SEPTIC/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
Prope~y ownerCs) ~-~
Mailing address
Site address IqO~7 57r~ d,~'/'O~';Ve
Legal description (Sub'd, Block & Lot) ._~O'J"
Legal description (Township, Section & Range) .~¢~';o~'1 I~. "~'-~'/~J 0-~"~'~
Lot Size q~.~ ~)/0 Sq. Ft. Number of Bedrooms
Day phone g~'- 3 ~' q~
Zip Code
Zip Code
THIS APPLICATION IS FOR (~]all that apply):
Absorption Field
Septic Tank
Holding Tank
Privy
Private Well
Water Storage
THIS APPLICATION IS AN:
Initial
Upgrade
Renewal
Single Family~elling an.n.n.~d isin accordance with applicable Municipal Codes.
(Signature of proper~ owner or authorized agent)
I certify that the above information is correct. I further certify that this application is bein~
Permit/Rush Fees:
Date of Payment:
.ecei t .umber:
(Rev. 11/05)
Waiver Fees:
Date of Payment:
Receipt Number:
made for a
'T~-~,~ Soils Log
Legal Descriplion:
Municipality of Anchorage
Development Services Departmen!
Building Safely Division
On-Site Waler and Wastewater Program
4700 South Bragaw SI.
P.O. Box 196650 Anchorage, AK 99519-6650
www cl anchoraqe ak,us
(907) 343-7904
- Percolation Test DalePe
Sile Plan
,I
/
/
/
/
WAS GROUND WATER
IF YES, AT WNAT DEPTH? ~' I.
Monlt0Hng? ~ PE
Reading Dale Gross Time Nel Time De~)lh ID WaterNel Df Dp
~,~... ~/~/~, $:~ c> 5%" c~
' ~ ~ ~'1." 'A"
~'.~ ~ ~7~' o
PERCOLATION RATE ~.{.~_ ~ ~ ~.u~e.aeeh) PERC HOt. E OLa, MEIER ~
TEST RUN EETWEEN ~ FT AND '~ FT
4-
5-
6-
7-
8~
9-
11-
13-
14-
18-
20.
COMMENTS
PERFORMED BY: I CERTIFY THAT THIS i'EST WAS
PERFORMED tN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON Tills DATE. DATE:
Legal Description:
2-
3-
4-
o
7.
8-
9-
20-
COMMENTS
Municipality of Anchorage
Development Services Department
Building Safely Division
On-Sile Walef and Waslewaler Program
4700 South Brogaw SI.
P.O. Box 196650 Anchorage, AK 99519-6650
www.cl.anchoracie ak.us
(907) 343-7904
Soils Log - Percolation Test
Dale Performed:
Slope
WAS GROUND WATER
IF YES. AT WIIAT DEPTH? ~ L
0
Monllo~lng? E
Township, Range, Section: I
Sile Plan I
I
Reading Dale Gross Time Nel Time De~)lh 1o Waler Nel Drop
PERCOLATION R~TE ~,X~Ch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT
PERFORMED BY: I CERTIFY TtlAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAl. GUIDELINES IN EFFECT ON Tills DATE. DATE:
September 8, 2006
ROBERT C. COWAN. P.E..
CI~L ENGINEERS
(907) 694-2979
FAX (90'7) 694-1211
MUNqCIPALTTY OF ANCHORAGE
Development Services Department
P.O. Box 196650
Anchorage, AK 99519
REFERENCE: Lot 206, Section 18, T15N, RI W, S.M.
It is requested that you issue a permit to install a nexv steel holding tank to serve the
existing three bedroom d~velling on the referenced property. Impermeable soils were
encountered at 2 feet; therefore, 6 feet ofseparatlon is not possible.
A test hole was excavated and a pemolation test performed. The approximate !ocation of
the test hole is located on the attached site plan. At the time of excavation 9/i/06, ground
water was not found. After monitoring, ground water was found at 8.5 feet. [
We do not anticipate any adverse effects on neighboring wells, septic system, s, reserve
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the adjacent
properties.
If you require~l information, please contact us.
Enclosure
17034 NORTH EAGLE RNER LOOP · $UffE 204 · EAGLE RNER, ALASKA 99577
ROBERT C. COWAN, P.E.,,
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRAt=I'ICES
and
MATERIAL SPECIFICATIONS
CML ENGINEERS
(907) 694-2979
FAX (907) 694-1211
REFERENCE: Lot 206, Section 18, TISN, R1W, S.M.
September 8, 2006
GEI~RAL:
1. The scope of this project includes upgrading the existing system with the
installation of a 2000 gallon holding tank to serve the existing three bedroom
residence located on the referenced property.
2. Construction shall be in accordance with the approved site pla~ and design
drawings, Municipal permit with any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal Regulations.
3. The contractor shall be responsible for obtaining any necessary ~ndergroun~l
utility locates.
4. Unless specifically agreed otherwise, the property owner shall b~e responsible
for final grading areas subsequently depressed from soil settling.
5. Contractors installing wastewater disposal systems must be certified by the
Municipal Development Services Department or ADEC if required, for system
installations. Owners installing their own systems must also receive ~fior approval
from the respective agency.
HOLDING TANK INSTALLATION:
1. A holding tank is to be constructed by a certified wastewater holding tank
manufacturer. Construction shall include a 6" cleanout for pumping access,
'and water-tight manholes.
2. The holding tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
3. All standpipes on the holding tank shall extend a minimum of 12
final grade.
17034 NORTH EAGLE RIVER LOOP * SUITE 204 ' EAGLE RNER, ALASKA 99577
nchcs above
Page 2
Lot 206, Section 18, T15N, R1W, $.M.
September ~, 2006
4. Holding tanks installed with less than 4 ft. of cover shall be insulated.
5. The holding tank shall be equipped with a high-water alarm which registers both 4sually and
audibly inside the dwelling. The alarm shall be positioned to allow at least 150 gallons of
storage per bedroom or a minimum of 300 gallons after the alarm has been activate~l.
/
6. Final grading over the holding tank shall be such that a positive slope exists aw~ay from the
holding tank.
7. On areas of high ground water, sufficient weight shall be installed on the tank to prevent
flotation.
MLNIMLrSI I~IATERIAL SPECIFICATIONS:
1. Any holding tank proposed for installation must be constructed by a Municipally/approved
holding tank manufacturer. [
2. The following pipe materials are approved for use in septic system installaItions in the
Municipality of Anchorage:
Type of Pipe Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 0tDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type of pipe other than listed above must be approved by the inspecting
Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical
Company Styrofoam HI or equal).
Tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco or equal).
~age 3
206, Sec~lon 18~ ~15~, E~l~, $.~.
Sepbez~be= 8, 2005
INSPECTIONS:
Typically there will be a minimum of two (2) inspections required during the installation of the wastewater
disposal system. These inspections will occur as follows:
1. The first inspection must be conducted after the tank has been set; lines, cleanouts,
standpipes and insulation are in place; and prior to backfilling.
2. The final inspection is to occur upon final grading of the property.
The inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a
pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or
control in any way the contractor's activities. 1
The owner shall contract with the contractor to perform the work outlined in these specificatio, ns and p aris
and in accordance with thc attached M.O.A. permit. There will be no contractual arrangement existing
between the contractor and S & S Engineering. S & S Engineering shall be the owner's repre,~entative and
will inspect the work as stated above to document the conWactors activities. Final acceptance of the
contractors work rests with the owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or omissions of the,contractor or
any other persons performing work on this project or the failure of the contractor to carry out the work in
accordance with these construction documents. S & S Engineering's inspecting enginee! will not be
responsible for the construction means, methods, techniques, sequence, procedures or the safety
precautions incident to this project.
CONTRACTOR / OWNER
/ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
i ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL DESCRI~ION ~
~' Manufacturer~
, ~ Well DwelHng PERMIT NO.
~Z DISTANCE TO: ~ / ~ ....
~ Well Foundation Nearest lot tine PERMIT NO.
~ No. ofl:nes Length ofeachl~e~ To~~l length of lines Trench width inches Distance between tines
~ ~ Top of tile to finish grade ~ - Total effective absorption area
Length ~__Z / Width ~O ¢ Depth / / PERMITNO.
~ Type of cri~ Crib diamete~ Crib depth ""~ Total effective absorption area~
~ 31ass Depth Driller Distance to lot line PERMIT NO.
~ Building foundation Sewer line Septic tan~ Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS
INSTA LER i I ,
REMA~S ~ ~
(Rev. 3/78)
Applicant:
Department
Location:
Legal Description: ~/~ ~
Type of Soil Absorption System Is:
Trench: Drainfield:
Maximum Number of Bedrooms: ~
HUNICIPALITY 0P ANCHORAGE
Health and Environmental rotection
825 L Street, Anchorage, AK. 99501
264-4720
* * * HANDWRITTEN PERMIT * * *
~.~W'~, ON-SITE SEWER P.ERMIT
~i"~, ~,,m,,,,,~ 7~ Mailing AoQress:
~ Phone Number:
/II
Size:
/
Seepage Bed: ~,--~Holding Tank:
Soil Rating(sq.ft/br)
The~d_~Si~z.~ of the. Soil AJD~rption System Is:
DEPTH ~,~) . LENGTH GRAVEL DEPTH WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval
will be subject to prosecution.
by this department
Minimum distance between a well and any on-site sewage disposal system is 100 fee'
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 8 1 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes. ·
I understand that the on-site sewer system may require~e~largement if
(3) the~resi~ence i~ remodeled to include mor t~3 bedrDo~s. ~z
' ~ ' Date: ~'~--~( ' ' __
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
(:::~,~-~II Cf
3
13
14
15
16
17
18
19
2O
[] PERCOLATION
TEST
WASGROUNDWATER
ENCOUNTERED?
DATE PERPORMED 6
SLOPE SITE PLAN
/I
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN FT AND -- FT
COMMENTS
PERFORMED BY:
72-008 (6/79)
~ ~ . iNSPECTION APPOINTMENTS · L DA,. REOE'IVE'D
A E
~ i~/J , ENVIRoNMENTA~ SANITATION DIVISION SE P 2 ~ 3981
DI RECTIONSI C~mp[ete al/ parts ol~ page 1, Incomplete feques~ will not be ~o~ased. Please all'ow' ten' (1 O) days for
MAILING ADDRESS
~6P'~RTYRES DENT (If different f~om ebove .... ' .... PHONE
USG Lot 206~ Secbion 18~ T15N RlW SM ~
2 BU~ER H N
Sam Kyu Lim &Una' Lim
3 ~ENDING INSTITUTION PHONE
......... ~ ' "' ' PHONE
'4' REALTOR/AGENT
MA L N~ADDRESS
INDIVIDUAL*
orilled
II
INDIVIDUAL/ON.SITE** -- 1981 .YEAR
PUBL/I
~/79)
unicipa ty- '.
Anchmx e
September 25, 1981
Eklutna Inc.
% John Parker
Totem Realty
Post Office Box 911
Eagle River, Alaska
99577
Subject: T15N R1W Section 18 Lot 206
Approval for the individual sewer and waLer facJli[ies
cannot be granted until the following items have been
completed:
l )
(2)
The water analysis report needs to be submitted ho
this office from the Chem Lab, 5633 B Street, for
our review.
The top of the well casing needs to be sealed so that
it is water tight.
(3)
Exposed wires to the well head are in violation of the
Municipal codes and need to be placed in conduit. This
will need to be reinspected by this office.
If there are any further questions, please call this office
at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
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. 051-232-44
1. GENERAL INFORMATION
Expiration Date: 10 " I q ^ 2-2,
Complete legal description T1 5N, R1 W, SEC 18, LOT 206
Location (site address) 19037 SPRUCE CREST DR, CHUGIAK AK
Current property owner(s) WARE
Mailing address SAME
Real estate agent
2. TYPE OF DWELLING:
C] Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 2
4. TYPE OF WATER SUPPLY:
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL
_Private Well____,_._._
❑ ._.__._.___._____private -.Septic--...--- ___[j
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 othenMse requested by the engineer.
Date:
COSA Fee $ 5 50 3 3 0waiver Fee $
Date of Payment 7 7 Date of Payment
Receipt Number 00 ;27 7 Receipt Number
COSA # 0 S C)LD-1 3� H Waiver #
Distance:
S. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864
Address 4661 NATRONA AVE ANCH AK
Engineer's Printed Name MIKE N ANDERSON, P.E. Date 7-2-22
6. DSD SIGNATURE
System #1 Approved for :Z bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms,
OE
r *'
49TH
P�- J
MICHAEL N..-,\DERS0N
c •. CE/ -'94469 • '�``'%
IV9P
with the following stipulat Bp®�,S-dQo�►
g WATER AND �"
FAr SERv\0
BYOriginal Certificate Date: 7—
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description: TI 5N, R1 W, SEC 18, LT 206 Parcel ID: 051-232-44
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
Total depth ft
Cased to ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 20 in.
Date of flow test for COSA 6/29122
Static water level at beginning of test 43 ft.
Comments
Well production at time of test 3+ gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate - mg/L Q Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by MNA
Date of Sample
6/29/22
B. TANK DATA
C. LIFT STATION
Age of tank(s) .3 -years
❑ Required maintenance completed
Tank type/material 6ew"�k<. / N�aS�' G
Age of lift station years
i�r
Measured operating fluid level in septic tank .5 b
Lift station material
Q Standpipes/foundation cleanout per record drawing
Comments:
Date of pumping 6129/22
D. ABSORPTION FIELD DATA
Which system tested (date installed) Q -
5!29122
Adequacy test date
❑ ALL standpipes present per record drawing
Results EJ Pass For 2 bedrooms
Total measured depth from grade 5.515.5 ft (max)
Fluid depth prior to test DRY in
Measured depth to pipe invert from grade 3.5/3:5 ft (min)
Water added 300+ gal
❑ N/A- pressurized field
0
no Monitor tubes go to bottom of effective. If not, state
New depth in
Elapsed time 1440
depth into effective
min
❑ Code -required soil cover over field
Final fluid depth 0 in
❑ System presoaked
Absorption rate 300 gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months)
date of test)
Gallons introduced 0 gallons
If yes, enter date
Comments/Deficiencies: HOLD TANK NOT TESTED
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Q
Septic Tank/Lift Station on Lot > 100'
if No
ft
Community Sewer Manhole/Cleanout > 100'
✓[�(' Yes
if No
ft
✓, Yes
if No ft
Neighboring Tank > 100' 0 Yes
if No
ft
Private Sewer/Septic Line > 25' E] Yes
if No ft
Absorption Field on Lot> 100' ❑✓ Yes
if No
ft
Holding Tank> 100' [✓] Yes
if No ft
Neighboring Absorption Fields > 100'
ft
Community Wells > 200' Q Yes if No ft
Animal Containment > 50' F✓ Yes
if No ft
R1 Yes
if No
ft
F. ENGINEER'S COMMENTS
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' El 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' El Yes
if No ft
Property Line > 5' Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5' Q Yes
if No
ft
Private Wells > 100' ED Yes
-if No ft
Water Main > 10' Q Yes
if No
ft
Community Wells > 200' Q Yes
if No ft
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'
Q
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'
Q
Yes
if No
ft
Community Wells > 200' Q Yes if No ft
Surface Water > 100'
Q
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that 1 have determined through held inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
® �: •;S�}fid
49TH
zH
..•�I 'e-+ .......•�
• MtHg
IEL N. c
1 �•+ . NDERSMN • QL- /0
vJ . CE- 9469 ?r ' ;` 010
MUNICIPALITY OF ANCHORAGE
Development Services Department (
r")
Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On-Site Systems Approval
Parcel I.D. 051-232-44 Expiration Date: ? S G
i
1. GENERAL INFORMATION
Complete legal description T15N R1 W Sec 18 LT 206
Location (site address) 19037 Spruce Crest Drive
Current property owner(s) Lee Day phone 244-1930
Mailing address
Real estate agent Cindy Wilson Day phone 244-,, „ 0
2. TYPE OF DWELLING: `\' roil ei
0 Single Family (w/wo ADU) a Arc( 4, d X1)19 3
l I Duplex
Multiple Dwellings (Single Family and/or Duplex) Vic, �s
o[ ss � gc
3. NUMBER OF BEDROOMS: 3 �``
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well H Private Septic ❑
Water Storage Holding Tank 0
Community Well II Community ❑
Public Water System n Public Sewer ❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 556 Waiver Fee $
Date of Payment Le124/t9 Date of Payment
Receipt Number Q Ia3ab Receipt Number
nI
COSA# SClq/1310 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 NorthRim Eng. Phone 694-7028
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng Date 4/26/19
:a3
GeV FS A
O� Y
6. DSD SIGNATURE 7."j
System #1 Approved for __ bedrooms
Y PP . .
System #2 Approved for bedroomsV72‘tr
Disapproved . .
Conditional approval for bedrooms, with the following stipulations:
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 blue sheet
COSA Checklist
Legal Description: T15N R1W Sec 18 LT 206 Parcel ID: 051-232-44
If more than 1 septic system on lot: COSA Checklist# of Structure served by this system
A. WELL DATA
❑ Well log is filed with Onsite (or attached) Well production at time of test 3+ gpm
Date drilled Water storage tank volume 0 gallons
Total depth ft Well disinfected for coliform test? ❑ Yes • No
Cased to ft • Coliform bacteria is Negative
• Sanitary seal is functioning correctly Nitrate mg/L Nitrate less than MRL (ND)
■❑ Wires are properly protected Arsenic ug/L ■❑ Arsenic less than MRL (ND)
Casing height (above ground) 18 in. Collected by NRim Eng
Date of flow test for COSA 4"2/19 Date of Sample 3/12/19
Static water level at beginning of test 37 ft.
Comments
B. TANK DATA C. LIFT STATION
Age of tank9/23/06
years
(s) ❑ Required maintenance completed
Tank type/material Steel Age of lift station years
Measured operating fluid level in septic tank Lift station material I
• Standpipes/foundation cleanout per record drawing Comments:
Date of pumping
D. ABSORPTION FIELD DATA
Which system tested (date installed) Adequacy test date
❑ ALL standpipes present per record drawing Results Pass For bedrooms
Total measured depth from grade ft (max) Fluid depth prior to test in
Measured depth to pipe invert from grade ft(min) Water added gal
❑ N/A— pressurized field
New depth in
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective 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)
date of test)
Gallons introduced gallons If yes, enter date
Comments/Deficiencies:
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100'
❑Yes if No ft 0 Yes if No ft
Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft
Absorption Field on Lot > 100' E Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment > 50' 0 Yes if No ft
❑✓ Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' 0 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' ❑✓ Yes if No ft
Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots:
Absorption Field > 5' [' Yes if No ft Private Wells > 100' ✓❑ Yes if No ft
Water Main > 10' 0 Yes if No ft Community Wells > 200' 0 Yes if No ft
Water Service Line > 10' [' 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 ft
Surface Water > 100' ❑ Yes if No ft
F. ENGINEER'S COMMENTS
/-/�L 4 'A!- 7-47'W /7 /o P//SAD 7-6 ie___.o .
,_5/5/377c-- 7 Al k, 17.e,1161(/l
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. . �
t-(//04f
COSA Checklist yellow sheet
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SBUILT :Ewan h ASSOC IAT:S LANG sr' .v yI ,"; -( r. • ,
I HE:PE8v CERT,FY THAT I HAVE SJR'VEYEU THE SC'A` ICr �,�' �;`��;�
FCS.-L0 Wi NG D�;5CR I BED PROPERTY: I._ 4.T., OF A E ►
} '0.4146:4,'/122.7-e 7YAv4/ DATE. �—' .1174%Q .-._. . _ `c*4
AND 'ISA' N D Fw 4CHMEI'TS EXIST EXCEPT AS :e":".44.0 •A\ .- -, � '`- t
Ir:DFC.I?ZD IT :S THE RESPONSIBILITY OF THE .....:4:i'4'.� `z" ti '.
JM•NE'9 TO D .1 tr4MINE T H-. E:OSTEIIFC= OF ANY RID! r•
_..:. .
E4SEMENTS. COVENANTS, OA PVTRICTIoNS ,.v ..'troy f �! ,-
WmICH DC NOT APPEAS ON THE RECORDED SU80I• �«-. ••••► :,•••a t
Y:S I ON P1. . UNDER H 0 CIRCWIeSTANCES S��D F& +%C.. a
&NY DATA HEREON BE USED FOR CONSTRUCTION /rl- ' * •,. '•
It,,'. ice •' r
h. CCaItC 1 I.•C!' Peel trrr, rrT•n. 1r.n..w ww....w .+ �
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEHS APPROVAL
FOR A SINGLE FAHILY DWELLING
Parcel I.D. 051-232-44
1. GENERAL INFORMATION
Expiration Date:
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
T15N, RlW, SEC 18, LOT 206
19057 SPRUCE CREST DRIVE * CHUGIAK, AK * 99567
KERRI DAVIS Day phone 250-9722
19057 SPRUCE cREsT DRIVE * CHUGIAK, AK * 99567
Day phone
ANN ROBERTS W/ PRUDENTIAL' Day phone 689-6464
16655 CENTERFIELD DRIVE * EAGLE RIVER, AK * 99577
Unless otherwise requested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS: 5
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well · h~dividual On-site ·
Individual Water Storage [] Individual Holding tank []
Community Class Well [] Community On-site []
Public Water System [] Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems
Approval are valid for 90 days from the date of issue for propertieS served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As cerfified by my seal a~xed hereto and as of the vafidation date shown below, I yetiS, that my
investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this appfication,
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 GARNESS ENGINEERING GROUP, Ltd.
Address 5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
'Engineer's Printed Name JEFFREY A.' GARNESS, P.E.
Phone
Date
557-6179
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious e. ngineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are. outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
DSD SIGNATURE
Approved for _)
Disapproved.
Conditional approval for
bedrooms.
..... ~ ; PROGRAM :. S
bedrooms, with the following st~pu~auons:-~ <2 'o ,' ,6'"'~'
.... '
'</YYJ)))) ) ) } } )
Attachments: COSA Checklist
Septic System Advisory
Well Flow Advisory
(Rev. "11/05) // '
Arsenic Advisory.
Maintenance Agreements
Supplemental Engineer's Report
Other
/'L~ 0~'~' Original Certifi ca te Date:
Municipality of Anchorage
Development Sentices Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
CHECKLIST
Legal Description: T15N, RlW, SEC 18, LOT 206 Parcel ID: 05125244
A. WELL DATA *PER (;EG INSPECTION. **PER ARCTIC PUMP AND WELL INSPECTION. SEE ATTACHED.
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) NO
Date completed UNK Sanitary seal (Y/N). YES Wires properly protected (Y/N) YES
Total depth *76+ ft. Cased to **40+ ft. Casing height (above ground) 12+
in.
FROM'WELL LOG AT INSPECTION
Date of test 9/50/2010
Static water level __..~-~"'v'~ ff. 54 ff.
Well production ~ g.p.m. 2.25 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi.
Arsenic: ND ug,/L,
Nitrate O. 105 mg./L. Other bacteria
Date of sample: 9/15/2010 Collected by:
0 colonies/lO0 mi.
GE(; Ltd.
SEPTIC/HOLDING TANK DATA
HOLDIN'(; TANK/STEEL
Tank Type/Material SEPTIC/STEEL
2000
Tank size 1250 gal. Number of Compartments 2
NO
Foundation cleanout (Y/N) YES r Depression over tank (Y/N) NO
9/22.-2.5/2006
Date installed 9/1/1981
YES
Cleanouts (Y/N) YES
Highwater alarm (Y/N) N~/
Date of pumping 9/17/2010 Pum per JR'S PUMPIN(;
C=
[*BELOW EXISTING GRADEI
Soil rating (g.p.d./ft2o~ 85
Width 20 ft.
ABSORPTION FIELD DATA
Date installed 9/'1/'198!
Length 26 ft.
Total depth *5.25 ft. Eft. absorption area 520 ft2 Monitoring tube YES
Date of adequacy test 9/.30/2010 Results (Pass/Fail) PASS
Fluid depth in absorption field before test DRY in. Water added 450 gal.
Elapsed Time: 0 min. Final fluid depth DRY in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
System type BED
Gravel below pipe 1 ft.
Depression over field NO
For 5 bedrooms
New depth DRY in.
450+ g.p.d.
If yes, give date -
Absorption rate >=
NONE KNOWN
D. LIFT STATION
Date installed
"Pump on" level at
in.
Size in gallons Manhole/Access ~ ~
"Pump off" leve~aL~ High water alarm level at .in.
Cycles tested, Meets alarm & circuit requirements?
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
100'+
Septic tank/lift station On lot
Absorption field on lot 100'+
PubliC sewer main N/A
Sewer/septic service line 25'+
Animal containment areas. 50'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout
Holding tank 75'+
Manure/animal excrete storage areas
N/A
100'+
Em
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation
Water main
Wells oa adjacent lots
SEPTIC
5'+/5'+ Property line 5'+/5'+ Absorption field
N/A Water service line '10'+/'10'+ Surface water
100'+/75'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+
10'+
Water service line
Curtain drain NONE
COMMENTS
*PER PREVIOUS C,O.S.A.
KNOWN
Building foundation. 10'+
Surface water 100'+
Wells on adjacent lots 100'+
TANK/HOLDING TANK
5'+/5'+
100'+/100'+
Water main N/A
Driveway, parking/vehicle storage 10'+
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~
Engineer's Printed Name JEFFREY A. GARNESS
Date
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
SGS ReL# 1104846001
Client Name GarnessEngineering Group, Ltd Printed Date/Time 09/27/2010 8:13
Project Name/# T15N,R1V,SECI 8,L206 Collected Date/Time 09/15/2010 11:20
Client Sample ID T15N,R1V,SECI 8,L206 Received Date/Time 09/15/2010 12:33
Matrix Drinking Water Technical Director Stephen C. Ede
Sample Remarks:
4500NO3 - Nitrate/Nitrite - MS recovery is outside of QC criteria. Refer to LCS for accuracy requirements.
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic ND 5.00 ug/L EP200.8' C (<10) 09/21/10 09/23/10 KDC
Waters Department
Total Nitrate/Nitrite-N 0.105 0.100 mg/L SM20 4500NO3-F B (<10) 09/16/10 AYC
Microbiology Laboratory
E. Coli Negative 1 100mL SM20 9223B A 09/15/10 DLC
TotalColiform Negative 1 100mL SM20 9223B A 09/15/10 DLC
Page 1 of 1
Andrew Gray
From:
Sent:
To:
Cc:
apw@gci.net on behalf of Jim Sullivan [apw@gci.net]
Tuesday, October 05, 2010 6:50 PM
Andrew Gray
kldavis@mtaonline.net
Subject: 19037 Spruce Crest
Andrew
On 10-5-2010 I Inspected the well on this property
S-50 pitless adapter 10'
Static 32'
Casing 40'+ With no perforations
Moa seal and conduit in new condition
Thanks
Jim Sullivan, CPI
Arctic Pump & Well, Inc.
PO Box 770197
Eagle River, AK 99577
(907) 688-2510
(907) 258-2510
(907) 745-2510
10/13/2010
10712/~010 08:~1
PAGE
JRs Pumping
PO Box 773415
E~gl¢ R. ivcr, AK 99577
(907) 694-6454
Kerri Deines Job Description:
19037 Spruce Crest P.O. Number:
Chuglak, AK 99567 Terms:
(907) 688-4955 Salesrep;
Map Book:
Andrew- Garness
19037 Spruce Crest Drive
1500g
Service Agreement
Chugiak, AK 99567
(907)688-3640
Additional Location Comments:
Gray home w/green roof - home
looks like a skyscraper
#'s are on a sign post @ end of dw
Septic @ back of home
Service Type Qty
Septic Serv 1000K 1
Number: 032047
Order Date: 16-Sep-2010
Service Date: 17-Sep-2010 12:00
Technician: Dan
Net 30 Tax %: 0
Dawn-Dawn Job Type: Repeat
Map Grid: 49
BJrchwood Loop Road
Job Comments; iE~t' Servi'ce '11/06/2009' 1500g
tank level normal
back flushed 1 time
clean outs good
..............................................
Diagram: ~t~gr0m~\16303.bmp Gallons Planned:
/ ® c/o
ground ~
level w/
Price Each Tax?
$185.00 No
1500
Gal. Actual:
Hose Length: 2.5
Double Tank: [] ~
Pump System: ~
Baffles Inlet: ~ _
Baffles Outlet: r'q ~
Extension Actual
$185.00
NonTaxable Total Taxable Total Tax Total Grand Total
Estimated Charges: ,$185.00 $0.00 $0.00 $155.00
Actual Charges; ___ _ ~
Customer agrees to the terms end conditions shown. THIS IS A BINDING AGREEMENT,
fSignatu .r~n~Cu~tomer Representative // ~ Date . /
For your ad~led (~onvenience wa aooept; AYmeri~n Express, Dioover, Visa and Master Card payments over the pholle.
After 30 Days ¢¢coun! ~v~ be turned over to OOLLEOTION$. ,$30.00 For NSF Ohccks Returned.
10: E~ FROM
6940850
~0:3383~q6
ASBUILT
I HEREBY CERTIFY THAT ~ HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY,
AND THAT' NO ENCROACHMENTS EXIST EXCEPT 'AS
INDICATED. IT IS THE RESPONSH31LITY OF THE
OWNER TO DETERMINE TH,?. EXISTENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT, UNDER NO CIRCUMSTANCES SHOULD
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINE~, OR FOR ESTABLISHING BOUND-
ARY LINES.
SEWARD & ASSOCIATES LAND SURVEYTNG
DATE.
GRID.'
694-082
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 190650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
-r'arc~lq.D. 051-232-44
GENERAL INFORMATION
Complete legal description
COSA #
Expiration Date:
Lot 206: Section 18: T15N:
Location (site address) 190~7 Spry, ce Crest Dr. Chu~tak. ^~: 99~;67
Current Property owner(s) Scott &Kim t{atktns
Dayphone688-3640
Mailing address
Lending agency
Day phone
Mailing address
Real Estate Agent
Bonnie KtnR
Dayphone 688-2276
Mailing Address
Un/ess otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class ~
Public Water System
Well
[]
[]
[]
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank ~]
Community On-site [-]
Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
~ngineerTeglsteredlrrthe-State-of ¢Jaska;-Certificates-of On--Site-Systems-Approval areTequlrod forthelransfer'of
title (except between spouses) for properties served by a single-family an-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify 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 flies 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.
NameofFirm S & S En~ineerinR
Address 17034 N. EaRle River Loop Ste. 204 Eagle
Engineer's Pdnted Name.
$. DSD SIGNATURE
~ Approved for ~
Disapproved.
Conditional approval for
bedrooms.
Phone 694-2979
River, AK 99577
Date ~7/D ?/o ~
z ........
bedrooms, ~th the follo~ng stipulations:
Additional Comments
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate -Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: ~ -- ~',',',',',',',',',~- ~ - O ~
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Westewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
LegalDescription:~.g)T' ;}.Q(~ <~.~.~'/o~ I~' 7')5"~,,/ ~lc~/ ParcellD: 0~/
Bo
WELL DATA
Well type ~n,~
Date completed ~/[K
Total depth 7 I,~'7 ft.
Date of test
Static water level
Well production
IfA, B, orC provide PWSID # -
Sanitary seal ~/N)
Casedto /~0-~ ft.
FROM WELL LOG
t/ g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL
Arsenic: ~' ~ mg/I
Nitrate Oot.cl,. mg/L
Date of sample:
SEPTIC/HOLDING TAHK DATA
Tank Type,~aterial ~ 0 ~ DJ ~v/,. / ~ ~' E- ~. L
Tank size ;~O~ O gal. Number of Compartments
Foundation cleanout(~N) Y'~ )' Depression over tank
Dateofpumping' /J[A - ,.'e..~: Pumper '"""
we, Log (Y~) ~, o
Wires propedy protected{~l'~) 'Y~ J'
Casing height (above ground) I~ -/. in.
AT INSPECTION
~q ft.
3,5- gp.m.
Other bacteria O colonies/100 mL
Collected by: S & s wu~.tt~==o! _uC-
17034 E~gle RIwr ~ R~d No. ~
E~le Ri~r, Ala~ ~
Date instali~ ~/*~/0 ~
H~h water alarm~) ~ ~ ~
ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./ft= or ft=/bdrm) ~type
Length ft. Width ~ Gravel below pipe ft.
Total depth ft. Eft. absorption area ~Monitoring tube Depression over field
Date of adequacy test .,~~lts (Pess/Fail) For bedrooms
Fluid depth in absorption ~ test in. Water added gal. New depth in.
Elapsed Time: ~' Final fluiddeP_th in. Absorption rate >= g.p.d.
Any reju~ment (past 12 mo.) (YiN & type) If yes, give date
Do
LIFT STATION
Date installed
'Pump on' level at
Datum
Size in gallons
E. SEPARATION DISTANCES
in.
Absorption field on lot
Public sewer main
Sewer/septic service line
Animal containment areas
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
/do ~-/
On adjacent lets / o ~ ~-~
On adjacent lots /.~
Public sewer manhole/cleanout ~'/~
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTI~TANK ON LOT TO:
Building foundation I o ~ Property line ,~ 0 ~-~ Absorption field ~, ~4
Water main /d / 4 Water service line /o ~t- Surface water I ~ ~ ~'"/
Wells on adjacent lots /Do 4-
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Water Service line
Curtain drain
F. COMMENTS
Building foundation ~ --
~ D 'nveway, patldng/vehicte storage
Wells on adjacent lots
G. ENGINEER'S CERTIFICATION
....
review of Municipal records that the above systems am in ~'~'.~"~'~"'-:"."';'
Engineer's Printed Name ~*L~,A.~' C. C0~u,~,-.' ~>~, .c.=,-,~0! ..,:.:.,,~
,~_, o/.x-, /. ~ et r,.~.- ..... "C" -~'
COSA Fee $.
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
....
" ' I hereby ce~ that [ ~ave SU~ the foHow~g
: "." ' Anchorage R~i~g Pre.d. Alaska. and that ~e ~mve-
I
. ..........: ~. ~ ~ , · merits situat~ the~on am within the pm~y ~e~ and ~o not
~, ... :. '- ;. (..r'.,~ ~ overlap or encroach on the pm~y lying adjacept the~to, that
......... - · --~ - on the p~m~s ~ question and that ~e~ am no ~adways.
~ - . . .:~ ~,. . ~ans~s~n lines or other vis~le ea~ments on sal~ pm~y
~~~ ~cept as indicated he,on. '.
. ~ ~ '~='~ ' ~ ~ ~ Dated af EaRle ~ver. Alaska
Municipality of Anchorage
Development Servtces D l $iHment
Building Safety Division
On-Silo Water and Waslewa~er Program
4700 Soulh 13ragaw SL
P.O. Box 196650 Anchorage, AK g95fg-6650
www.ct.anchorage.ek.us
(907) 3,{3-7g04
CERTIFICATE OF HEALTH AUTHORITY , PPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D._ D,~'/-,~. °/,/4/
1. G,ENE~AL.INFORMATION
.,(~.ompl.ele legaldescrption Lot 206;
· ocahon (s~te address or direcbons)
Expiration Date:
Sec 18; T15N; R1W; SM
19037 Spruce Crest
-,'Current Property owner(~),
. Mailing address
Lending agency
Mailing address
Sam l;dm
PO 'RnY--~t:g~;477
Dayphone ~RR-?617
Day phone.
Real Estate Agent ¥,',,, g Vien~tng Day phone -563 -5500
MailingAd. dress 3201 C Street Ste'200 Anehorage~ A£ 99502
Un/ess o'/,erw,se requested, HAA wi/l be held by DSD for pickup. ~/~'Z ~ f /,. /, z.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Slorage
Community Class. Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site [~
~ Individual, Holding tank
Commumty On-site ~]
[] Public Sewer []
The Municipality of Anchorage Development Sen/Ices Depadmen! (DSD) Issues Certificales of Health Authorily
Approval (I-IAA) based only upon the representations given In paragraph 5 by an Independent professional civil
engineer registered in Ihe Slale of Alaska. Certificates of Heallh Aulhority Approval are required for the transfer of
lille (except between spouses) for properties served by a single family on-site wastewa[er disposal and/or wa~er
supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Aulhori[y Approval are
va~id for 90 days from the date of issue for properties sen/ed by a private or Class C well and may be reissued with
new water sample results less than 30 days old. (Certiflcales may be reissued for a period of up Io one year with
valid water samples.) Certi~c%tes are valid ~'or one year for properties sen/ed 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
englneer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as ol' Ihe validation da{e shown below, I verify Ihat my Inves{Iga{ion,
based on procedures outlined In the Health Au~horRy Approval Guidelines for this application, shows that the
on-site water supp y and/or wastewater d sposal SySlerrl Is(are) safe, functional and adequate for the number of
bedrooms and type of structure Indicaled herein. I ~'uHher Var ry Iha~ based on the Informa on obtained from the
Municipality of Anchorage files and from my InvestlgaUon and Inspection, the on-site water supply end/or
wastewa~er disposal system Is(are) In compliance With all applicable Municipal and State codes, ordinances,
and regulations In effect at the time of InstallaUon.
NameofFirm S & $ En.~ineerin,~ Phone 694-2979
Address 17034 N E~?I~, ~v~r T,nnp ~ '}OA ~!~ River, AK 99577
Engineer's Print. ed Name Robert C. Cow~n Date $'-/:z
5. DSD SIGNATURE 'd,,~./~... CE-8801
~ Approved for '~ bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Commenls
Attachments:
HAA Checklist
Septic Sys{em Advisory
Well Flow Advisory
X
Maintenance Agreements
SUpplemental Engineer's Report
Other
Original Certificate Date: ._'5~- ~ q - ~, /
Municipality of Anchorage
Development Services Department
Building Safety Dlvlsio~
On-Site Water & Wastewater Program
4700 South Bregew St.
P.O. Box 196650 Anchorage, AK 99519-6650
va~v.ci.anchorage.ak.us
(907) 343-7g04
HEALTH AUTHORITY APPROVAL CHECKLIST
L.ge~ O.~p,on: Lot- 2.~, 5~/~.; 7-/q~/.: .~ / ~..'~/ Pa.=~,D: ~ ~'/- -?- ~-- ?~
A. WELL DATA
Date completed L~/d I~
ToW dap., ;>/¢'"/..
If A. B, or C provide PWSlD # ""
cas,< te_ p_T.. 18+.
FROM WELLLOG
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:"
Coliform C) colonias/100 mi.
Date of ,ample: ~*/'~/~)~'"
B. SEPTIC/HOLDING TANK DATA
g.p.m.
Well Log (Y/N)
Wlres pmperiy protected
Casing height (above ground)
AT INSPECTION
~6"
5' ~ a.p.m.
Nitmta ~' ~'mg./1. Other bacteria. ~) colonies/100 mi.
Tm;k',ize'/~4~ gaL' Number of Compertments
Foundation ciearlout (Y/N) F Depression over tank
Date of pumping '~'/~"~/~'"" Pumper
C. ABSORPTION FIELD DA~'A
Date installed ~__~
/
/
C~eanouts (Y/N) ~/
High water alarm (Y/N)
Date installed ~. Soilrating (g.p.d./ft~o~/~'
Length *' ~./. ff. Wklth ~:~O ft.
Fluid depth in absorption field before test/ -- ~in. Water added'~S'/gal.
Elapsed Time: .~:::min. Final fiuid depth ~ in. Absm'ptio~ rate >=
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
System type ~
Gravel below pipe ~ ' ft.
Depression over field ,~
For :;~ bedrooms
New depth_~in.
4~'~ g.p.d.
If yes. give date
UFT STATION ,/~//~'/~
Date installed /
"Pump on" level,/~ in.
Datum
Size in gallons
'Pump off' level at in.
Cycles tested
Manhole/Access (Y/N)
High water alarm level at.
Meets alawn & circuit requirements?
in.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tanldll.~ on lot
Absorption field on lot
Public sewer main /.,~/
~S~'we-~r/septic service line / O(~ ! w.-- Holding tank
SEPARATION DISTANCES FROM SEPTIC/NO.,,.LDlflr~'TANK ON LOT TO:
Building foundation ~' /'+' Property line ~' /'~ Absorption field
/
Water main /"//~ Water service line /C) ~ Surface water
Wells on adjacent lots ~/~) /
On adjacent lots /
On adjacent lots /0 0 / '+'
Public sewer manhole/deanout ~//~q'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line I O .4- Building foondat~on ( O 4- Water main J~'
/
Water Service line /0 ~ Surface water ('~)~) ~ D~my, parking/vehicle storage
CUr tain d rain/V~/V.~'-- ~//r/~/JWells on adjacent 'ote /2~/'~'
/D /,-
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
revfew of Municipal mcon~$ that the above systems are/n
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name .__~__.~6
Date
CE
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12/00)
Waiver Fee $
Date of Payment
Receipt Number
205C
205B
LOT B,.' MINK' SUBD.
N 89'57'30'V/ (R£C. 75-247)
206
PO~ 0
~3' PUBLIC USE EASEMENT BK 953., PG 3.62
S 89°56°00'E 3.28.88' (R)
SPRUCE CREST DRIVE
103.5' +_
85.4' +_
2O7
208
5.,'10xOZ i
DATE
NOTES: Easements
plal are not shown
provided by clienl.
or builder, prior to
building grade
connections, and to
easements, 'c ?_v.'e nan
appear on the recor
Elevations based on
indicaled, and bearlr
LE(
LOT 20G,.
SEC. 18, TI5N,
PLAT NO.
BLM