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Home My WebLink AboutCOTTONWOOD HEIGHTS BLK 1 LT 10Cottonwood Heights Block 1 Lot 10 #051-431-23 Municipality of Anchorage Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SCJ 900309 PID Number: Name: V/c To LYrL�' Wastewater System: ❑ New ® Upgrade Address: 00//0 ,-ga0Q ABSORPTION FIELD C 1,,i 7 Y- D o o Phone: No. of Bedrooms: Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: �® / GPD/Sq. . Ft. Lot: 0 Block: / Subdivision: ' Depth to pipe bottom from original grade: Gravel depth beneath pipe i'd7'Odnc/ % Ft. 116— Ft. Township: r' Range: Section: Fill added above original grade: Gravel length: �,.5 Ft. Ft. WELL: El New 13U e Gravel width: Number of lines: Distance between lines: -- 11) , 1/ Ft. Ft. Classification (Private, A,B,C):al Depth: Cased To: Total absorption area: Pipe materia Ft. Ft. 17 50 SQ. Ft. 4-S7/i4 3a 3 1,1Z,—, -/6 Driller: Date Drilled: Static Water Level: Installer: E Date installed: ' t7' 9 81 Ft. %iC Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES R Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: � 1C Capacity in gallons: From Tank Field Station Tank Sewer Lines AAl QQ Cs 7A,,1 Id,50 Well-— /OC74 /00 / o Material: ST�� Number of Compartments: r2 SurfaceLIFT Water 00 / /00 / STATION Lot Size in gallons: Manufacturer: Line 23 /0 Foundation / /o/ "Pump on" level at: off" level at: High water alarm at: CurtainPump LvotJ�l Ma odel Electrical Inspections performed by: Drain I-lalle Remarks: C --&L n.,W C ,s'r S,0 - f BENCH MARK v SC dins <: baa? s/ LcP Location and Description: M Assumed Elevation: /o 0 , ,��(1,e) E • Inspections performed b -& S ENGINEERING tes:1 s E � 8 iage •••• •..•...• •'+' •• ver Loop oe o.••.• Eagle River, Alaska 99577 2nd a 7 A. th.fa 981 140.1 Department of Health and Human Services ap�rval �o�...,..•P �.�,� Reviewed and approved by: J 41' Date: 4'Z-' 72-013 (Rev. 9/91) MOA 25 J PERMIT NO. SW980309 PAGE 2 OF 3 DEPARTMENT uOFiPHEZ ' ANDhHU04N SERVICES ENVIRONMENTAL SERVICES DIVISION P,0, Box 196650 • Anchorage, Alaska 99519-6650 • Telephone) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 10. BLOCK 1. COTTONWOOD HEIGHTS P.I.D. NO. 051-431-23 ~��yy �pO WELL 0 �o 'dJ \\\\s 0 LOT 9 INSULATION N�/ ST2-1 LOT 11 YMT2 2 n NEW TRENCH ;.—=ALT. SITEA THAko1> nua AJ �ro �q 00 FCO &I WELL �,pG s0�res (ABANDONED) 000 O �9 SCALE 1 • = 40' 'CJ r � 'A fwf , / � O� STA05 eh 1457-1OA. Shofqw An PERMIT NO. SW980309 PAGE 3 OF 3 DEPARTMENT uOFipHE4t ' ANDhHURXN SERVICES ENVIRONMENTAL SERVICES DIVISION P.D. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 10. BLOCK 1. COTTONWOOD HEIGHTS P.I.D. No. 051-431-23 e +.� Municipality of Anchorage~ 1w DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST �•• " """"'""" %�" PERFORMED FOR:y l e, -To -t b.- DATE PERFOR` I LEGAL DESCRIPTION: '�0 3 1 Go?'TU,J�,ipoD k IsTownship, Range, Section: SLOPE SITE PLAN kc --s 1 2 < o . 3- 4- 5 45 r 6- 7 7 t 8- 9- 10- 11 9 1011 12 • d 13- 14- 15- 16-6) 3141516 v 71819 17-- 18- 19 20 COMMENTS G-% (0/:5 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water Monitoring) S L A O P E Oate. $ ==Mmm • " PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND 7'57- FT PERFORMED BY: 17034 Eagle River Loop Road No. 204, L-7 t47'°%CERTIFY THAT THIS TEST WAS PERFORMED IN Eagle River, Alaska 99577 /30 / ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW980309 Legal Description: COTTONWOOD HEIGHTS BILK 1 LT 10 Design Engineer:-*- SL. S 'r__�C. \-" a—n Owner Name: VICTOR LYTLE Owner Address: 20110 KABOB STREET CHUGIAK , AK 99567-0000 Date Issued: Aug 18, 1998 Expiration Date: Aug 18, 1999 Parcel ID: 051-431-23 Site Address: 020110 KABOB CIR Lot Size: 54014 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 (24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 8-2748 EN6• C44"LIF-0 0 sr-rrfo MAW 7-ae sE/Tic rq&/< is Of'EpER rp(Aw A,wT.,.yPA.ray. . 7'mr ftanjonam MrAocm wfac yF 4 i'viAt 09.41aFmo wir'N 4' EFFEtpaE A.aD r$- �Lau6. Received By: Issued By: 1 Date: � -/ I- C/8 pry Date: /o S&S� lineeninG August 7, 1998 ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTHAUTHORITY APPROVALSMUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 SEWER & WATER MAIN EXTENSIONS REFERENCE: Lot 10, Block 1, Cottonwood Heights Subdivision SEWER & WATER INSPECTION Request you issue a permit to install an upgrade septic system to serve the four bedroom house on the referenced property. ENGINEERING STUDIES A test hole was excavated and percolation test performed. The approximate location of ANDREPORTS the test hole is located on the attached site plan. At the time of excavation 7/29/98 water was not encountered in the test hole. After WELL INSPECTION seven days of ground water monitoring test hole was found to be dry. & FLOW TEST We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The SITE PLANS construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. ROAD DESIGN Sincerely, SOIL TEST &/Z /" Robert C. Cowan, P.E. RCC/mg PERCOLATION TEST Enclosure STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Z 0 N W a 17034 EAGLE RIVER LOOP ROAD EAGLE RIVER. ALASKA 99577 PHONE# (907)694-2979 FAX# (907)694-1211 KABOB CIRCLE ALL P( WITH I COVER 'm- LOT 10, BLOCK 1 om BY: CHECKED BY: R.D.P-7-TE R.C.C. DESIGN CRITERIA: 4 BDRM = 600 GPD SOILS = 0.8 GPD/SQ FT. 600/0.8 = 750 SOFT. REQ'D. TRENCH CRITERIA: 9 COTTONWOOD HEIGHTS S D DATE: SHEET: 07-07-98 1 1 of 2 10 DEEP 7' EFFECTIVE sEP AR� 2.5' WIDE,/ tijlG 54' LONG LOT 9 NS OF SYSTEM THAN 3.5' OF LOT 11 STRUCTURES, EASEMENTS, OR ENCROACHMENTS SHOWN ON THIS SITE PLAN ARE AS SHOWN ON AN AS -BUILT SURVEY DRAWN BY: DUANE MARK SEWARD IT IS THE RESPONSIBILTY OF THE CONTRACTOR TO VERIFY EASEMENTS, REQUIRED SEPARATION DISTANCES, AND PROPERTY LINES PRIOR TO CONSTRUCTION. NO WELLS WITHIN 200' OF SEPTIC SYSTEM 11[T Co 10' MIN. 0. /i / //T ALT NSULATE UNDER LOT 20 AY Co v Sa PROPOSED TRENCH 41 0 �C �dl 1d� LOT 21 9�J (TO HE ABANDONED) 4( }� ROBERT C. COWAN �! 4. CE . 8801 ES��r !=' CONTRACTOR IS REQUIRED TO I OBTAIN UTIUTY LOCATES PRIOR TO ANY EXCAVATION WORK. SEPTIC AREA R MAY VARY THE SIONS AND DESIGN N THE FIELD. IF TO MEET SITE ,f •y�.••'' '•••, .�9 Ar Municipality of Anchorage '" C), j •' • 'R• DEPARTMENT OF HEALTH & HUMAN SERVICES:�Hwy • w yes• s••••.w•wir••.� 825 "L" Street, Anchorage, Alaska 99502-0650 v,• •• T....•••....� SOILS LOG —PERCOLATION TEST ROBERT C. COWANC. .�, % PERFORMED FOR: t✓'rb12--(/%. 13141 DATE PERFORMEdi `IJj �T"•" d�,, LEGAL DESCRIPTION: t✓ IO 6 J 0,07i'UA)L'IJ,)1, k4Township, Range, Section: SLOPE SITE PLAN 1 / 2 G 3 IU c '� 4 ,J 5- 67 6- 7 8- 9- 10- 11 9 1011 (% 12- 13 2 13 d- 14- . 14 7 Sa � s i yr 15 /. 16 ?D14 17- 18- 19- 20 7181920 COMMENTS WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L O DEPTH? P E Depth to Water �S Monitoring? Date: ==MM� R . PERCOLATION RATEt21'5' (minutes/Inch) PERC HOLE DIAMETER TEST RUN BETWEEN 6 FT AND 7 FT PERFORMED BY: S & S ENGINEERING I CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Eagle River Loop Road No. 204f�ry ACCORDANCE WITH IBa*RtfttNp(►WM((ff§Y aUIDELINES IN EFFECT ON THIS DATE. DATE: a 72-008 (Rev. 4/85) CHUG 1AK, AK 688-3199 WE SERVE V11LI14 411DRILLING C P.O. BDX 670042 — CHUMAK, ALASKA 99667 OWNER OF LAM ... ADDRESS .... 3_2-1.1t ... cetcr. day Akc. 99507 . ........... I ........................ WELL - SFTE.JTLt...13Elk. 1 Cotton. I od iieights Sub, ................. ................. �a .................... . ......... . ..... DATE -STARTED- 72..7 ....................I.......................................... DATE - ENDED .. ....... 7-24-87 t- ...................... - ....... I .................................... KIND OF FORMATION: FROM ................... � FT. TO ..................�. FT. qLuJR� ............... 1. FROM ................... FT. To ..................�. FT. Overburden........... FROM ................... 3 FT. TO .................1. 6 .... FT. rl ... G-... ..ave & Sar d ..................... FROM ................. 16 FT. TO ................. 17, FT. _3oRjder ................... FROM ................. A.Z 17. TO ................32.Fr. ................. Tj. M.-GrAX.e.1 ... &—sa.pe- FROM ................. Fr. TO ................ A4. FT. Boulder............_..... FROM ................. FT. TO 41. FT. Gravel FROM....................... ". TO ......... ...... ................................ FROM ... . ......... FT. TO...._....... FT. Brown Sand ................................ FROM .:...............53 FT. TO ................. Tj. FROM................. 1 1 . TO................ :NFT. Klt.. fi.. G..rave l.... FROM ................. M FT. TO ................ Ag. FT. Boulder.... FROM ........ . ....... 92 FT. TO ..............!P! FT. .U_'a.ser ...Gr.ava.1 MISCL. INFORMATION: -NO war.-anty or no warranties null I PRIQ NAMW ALL ALASKA WASJLLA, AK 376-3199 DEPTH OF WELLJ D3..f,.t .................... . ............. STATIC LEVEL OF WATER FT._?..=t...... DRAW DOWN FT....�5 Aft. GALS. PER HR. KIND OF CASING ... A53 - 25;0 wall A.S.r.-r--! ..................... . ........ I ....................... FROM....................... FT. .... FT...............................- FROM....................... FT. To ........................ FT................................. FROM....................... ". TO -_ . ........... Fr. I.-.._ ....................... FROM....................... FT. TO_ ..................... FT................................. FROM....................... F7. TO ........................ FT................................. FROM....................... FT. To ........................ FT . ................... FROM. ....... FT. TO ................. .. .. .. FT.................. ........ iff FROM............. ......... FT. To ........................ FT . ............ . ..... CD 0 .... D> FROM ....................... FT. TO ......... 5 ............... FT . ................... 90.� .....c'j m FROM....................... FT. To....................... 3: q FT....................S .................... S . .> ... < = FROM ....................... FT. 0 FT...................... C.0 m... 0 CD FROM....................... FT. To ........................ FT ................... � �U r -,f I (*.."*_ 1: F=� " L_ 1 -F 11-e CA K FA r4 C2 VA CA FQ Fl Ci E.-. DEPARTMENT rr HEALTH AND ENVIRONMENTAL �OTECTION 825' STREET, ANCHORAGE, HK. 99°01 . 264-4720 PERMIT NO. ( 810860 ) APPLICANT RICHARD OTTO ST RT BOX 1022 <\ 688-9250 LOCATION UNK LEGAL LOT 10 BLK 1 COTTONWOOD HTS LOT SIZE 43560 SQUARE FEET MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY, SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. ��F:* rwl 1E -T- I FR EE -"E. �I-E C FE r-1 13EE Fl! �� 110*�1_ I CERTIFY THAT 1: I HM 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 THE CODES. SIGNED:______________________________________-_ HPP T RICHARD OTTO B\�l_��__L ___DHTE____�_� NO;/��ISSUED Y?0 GRE." -E-' ANCHORAGE AREA BOP+Ur' i Department of Environmental Quality wn, 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME r u' MAILING ADDRESS 3g2g eruct /tom Ac� PHONE 279 9041 LOCATIONA/��lS/�%�'+ �r�Lr LEGAL DESCRIPTION 6r �� r� (.�nU�WOD�� SEPTIC TANK: DISTANCE NUMBER OF Oyu � Gf� FROM WELL MANUFACTURER MATERIAL COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY loco GALLONS. SEEPAGE PIT: NUMBER OF PITS DIAMETER OR WIDTH _43', LENGTH j/, DEPTH / LINING MATERIAL Oe1( CRIB SIZE: DIAMETER 7r DEPTH 6 DISTANCE FROM: WELL TOTAL EFFECTIVE BUILDING FOUNDATION, NEAREST LOT LINE ABSORPTION AREA (WALL AREA) 3OQ SQ. FT. ADDITIONAL ABSORPTION WELL TYPE BUILDING FOUNDATION _CONSTRUCTION NEAREST LOT LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED DISTANCES: INSTALLED BY: / �. !� • WO�[G S r PIPE MATERIAL: C4tr LOW LOT SLOPE: REMARKS:41 Form No. EQ -031 NEAREST SEWER LINE , REMARKS DATE DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK SYSTEM DIAGRAM OF SYSTEM �E- 4Q roucscla �io�i • y �� APPROV G.A.A.B. ,r _ 1401 LOG OF DR" 1-1 NG by A & L DRILL" IG .COMPANY ,S,t 0� (,A- --------------- DEPTH OF WELL _-----------_------ - OWNER OF LAND ------ .. ........................... - ADDRESS------------------------------------------------- -----_--- ............. ............. STATIC LEVEL OF WATER FT. ---------------------------- WELL SITE ._1. 14.q6< --- wr - - ----- 4, AW DOWN FT. ------_--------- --------------------------------------------- ..................... __.._..--_•--.:....._._............ DATE -STARTED ..... .......... .......................... __ ........... GALS.PER HR . ......... ........ . ............. DATE -ENDED ------ ----- ...... ------------- .......... KIND OF CASING ----- %a-- --- KIND OF FORMATION: MISCL. INFORMATION: DRILLER'S NAME ...................... .......... ........... FROM... --------- FT. TO_2;,.�r FROM.. FT. TO41( ----------- FT ------------------- .... .................... . -------- 04py F T.. R 0 M FT. TO....... ----- FT ................. ............ FROM-? ..... I ........... FT. TO.....- ........ ........................ FROM....../_. .............. FT. TO FROM ---------- t ------------- ..... FT. TO__.._ ............ FT ..................... ..........FT. TO... ---------- M .... ...... -- A** --------FT. TO .....11�t ------FROM------ . FROM..... i------ --- -FT.-../ ------------ FROM.... ................ FT. TO --- �__"J ........ .................... ...... ---- t*v FROM--_!'_ ---------- FT. TO_ Z_'------------ FT_1. .............. FROM ........................ FT. TO ------_--------------- FT ............................... F T..; FROM FT. TO ---------------------_ FT -----------------------_-_--- FROM- --------------------- FT. TO---... .......... ................ ---_--------_-------- FROM-.,)I-.S ......... FT. TO.... S� - ------- FROM ----------------•-------FT. TO ------------- ---------- FT -_-----------_-----------_ MISCL. INFORMATION: DRILLER'S NAME ...................... .......... ........... GREATER ANCHORAGE AREA BOROUGH tl DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 ��N�t[e uM?• SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT NAME OF APPLICANT_ ctl,/t1f�C'` `'�/YyF�•�' MAILING ADDRESS�02-q 5 11C� U I#Wf-h PHONE ^ a�G INSTALLATION LOCATION LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK SEEPAGE PIT TYPE AND SIZE OF FACILITY TO BE SERVED FIELA - , OTHER FINANCED THROUGH t/ TO BE INSTALLED BY SOIL TEST RESULTS / "� �i `r� NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE TYPE 7 / MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT �01 T DRAIN FIELD SEEPAGE AREA SIZE TYPE SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK , SEEPAGE PIT, DRAIN FIELD TO NEAREST LOT LINE. t. WELL TO SEPTIC TANK " SEEPAGE PIT ` ""(f/,.Jj �1 , DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD /f,�' SEPTIC TANK, �, SEEPAGE PIT �= < DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOAGE)AIONS REGARDING INSTALLATION. G.A.A.B. OR ENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER DESCRIBED YSTEM IS IN ACCORDANCE WITH SAID CODE. i DATE ( APPLICANT'S SIGNATURE X-� FORM J. EQ -016 DIAGRAM OF SYSTEM AREA BOROUGH ORI(INANO(E, O. 28-88 AND THAT THE ABOVE 0 & E GEOTECHNICAL & DEVELOPMENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 688-2280 Soils £t Foundations Land Development SOIL LOG Performed for: Name: *\ ), Tel . No. -7-79 Mailing Address: 7A ;N Legal Description: Depth (feet) 0 1 2 3 4 5 6 8 9 10 11 12 Soil Characteristics C_, 3 C` t5 41 tZ5 `z. i Ground Water Encountered: Yes No If yes, what depth_ Proposed Installation: Seepage Pit ✓ Drain Field Comments: ��'s In2-'� �c c�� , ��,^ zy` 3 / x b v N1 0C cam- �; ca c� rn nor) wq� 42 Performed by: �-� ,.,.� �� Date: 0 �'� • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 s . CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-431-23 Expiration Date: 11 -SO -17 1. GENERAL INFORMATION Complete legal description COTTONWOODS HEIGHTS BLOCK 1, LOT 10 Location (site address) 20110 KABOB CIRCLE, CHUGIAK AK 99567 Current Property owner(s) ARROWHEAD PROPERTIES INC. Day phone Mailing address Real Estate Agent P_0 BOX 670263, CHUGIAK AK 99567 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class —Well ❑ Public Water System ❑ WaiverNariance request for: 4 Day phone TYPE OF WASTEWATER DISPOSAL Individual Holding Tank ❑ Community ❑ Public Sewer ❑ Received by:Date: COSA to be released to the engineer, unless (y envise requested by the engineer. COSA Fee $ 5-2-C-0 Date of Payment '&2q-) 7 Receipt Number 009-rop COSA# l�iS� j71 3S�L Waiver Fee $ Date of Payment Receipt Number Waiver # n 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 8/17/17 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. 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, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen OF ALAS encroachments, deficiencies or discrepancies exist. 6. DSD SIGNATURE System #1 Approved for L/ bedrooms. System #2 Approved for bedrooms. Disapproved. 1k, Conditional approval for bedrooms, with the following stipulations: ON-SITE PROGRAM Original Certificate Date: R-� c - t7 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 engineers work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Ewe sheet_10-10.12 d. If more than 1 septic system is on the lot: COSA Checklist # of _ Structure served by this system , Certificate of On -Site Systems Approval Checklist Legal Description: COTTONWOODS HEIGHTS BLOCK 1 LOT 10 Parcel ID: 051.431.23 A. WELL DATA Well type PRVT If A, B, or C provide PWSID # Date completed 712411987 Sanitary seal (Y/N) Y Total depth 103 ft. Cased to 103 ft. FROM WELL LOG Date of test 712411987 Static water level Well production i Well Log (Y/N) Y_ Wires properly protected (Y/N) Y Casing height (above ground) 18+ in. AT INSPECTION 81812017 79 ft. g.p.m. 3.75+ g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 2.61 mg/L Arsenic: ND ug/L Date of sample: 81812017 Collected by: ARCTERRA B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC 1 STEEL Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping 814117 Pumper JRs C. ABSORPTION FIELD DATA Date installed 812711998 Cleanouts (Y/N) Y High water alarm (Y/N) N Date installed 812711998 Soil rating (g.p.d./ftz or ft2/bdrm) 0.8 System type DEEP TRENCH Length 75 ft. Width 2.5 ft. Gravel below pipe 5 ft. Total depth 11_25 ft. (Measured 8/8/17) Eff. absorption area 750 ft2 Monitoring tube Y Depression over field N Date of adequacy test 818117 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 10 in. Water added 600 gal. New depth 12 in. Elapsed Time: 1385 min. Final fluid depth 10 in. Absorption rate >= 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date _ D. LIFT STATION Date installed "Pump on" level at _ in. Datum E. SEPARATION DISTANCES WELL ON LOT TO: Size in gallons "Pump off' level at __ in. Cycles tested Septic tank/lift station on lot 100'+ Absorption field on lot '100'+ Public sewer main 75'* Sewer /septic service line _25'+ Animal containment areas 50'+ SEPTIC/HOLDING TANK ON LOT TO Manhole/Access (Y/N) _ High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout 100'+ IGI Holding tank 100'+_ Manure/animal excrete storage areas 100'+ Building foundation 5'+ Property line 5'+ Water main 10'+ Water service line `5' Absorption field 5'+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line '10'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 1004 Driveway, parking/vehicle storage 104 _ Curtain drain 50'+!N0NE KNOWNI Wells on adjacent lots 100'+ F. COMMENTS 'PER MOA RECORD DOCUMENTS (AS -BUILT 2014 COSA WAIVER ....) 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 COSAuidelines in effect on this date. g � rO�';RO - OF -I Engineer's Printed Name KENNETH M. DUFFUS'l Date 811712017� COSA canary sheet_2-6-15.doc - _- P KFVK . iI .3 7118 rssl Parcel I.D. CERTIFICATE OF ON-SITE SYSTEMS APPROVAL —431-23 1. GENERAL INFORMATION Complete legal description Location (site address) Expiration Date: COTTONWOOD HEIGHTS BLOCK 1 LOT 10 20110 KABOB CIRCLE *CHUGIAK AK 99567 Current Property owner(s) MORGAN & DEBBIE ANDERSON Day phone Mailing address Real Estate Agent 20110 KABOB CIRCLE *CHUGIAK. AK 99567 2. TYPE OF DWELLING: ■ Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: Day phone 317-0613 TYPE OF WASTEWATER DISPOSAL: Individual Well ® Municipality of Anchorage 0 Individual Water Storage ❑ On -Site Water & Wastewater Program z - (907) 343-7904 ❑ CERTIFICATE OF ON-SITE SYSTEMS APPROVAL —431-23 1. GENERAL INFORMATION Complete legal description Location (site address) Expiration Date: COTTONWOOD HEIGHTS BLOCK 1 LOT 10 20110 KABOB CIRCLE *CHUGIAK AK 99567 Current Property owner(s) MORGAN & DEBBIE ANDERSON Day phone Mailing address Real Estate Agent 20110 KABOB CIRCLE *CHUGIAK. AK 99567 2. TYPE OF DWELLING: ■ Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: Day phone 317-0613 TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Received by: COSA to be released tb the requested by the engineer. COSA Fee $ 521(o r Date of Payment /0! 2-pq Receipt Number COSA# 0,t Z Distance: — Date: Waiver Fee $ Z 1'5 / Date of Payment Receipt Number /��[�i�G Waiver # 0:5//' % 7 1 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. i further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Ohl Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the oaob�`.�IOO� system under the conditions encountered at the time of the test, and separation o O F �';/ 4pp distances measured to readily identifiable features. The operational life of all wells and OP.`�.. _ Li ,wU4po septic systems depend on the local soils condition, groundwater levels that may O G d V n fluctuate during the year, and the water usage of the family being served by the system. ��.' f' + �'� V These conditions are outside the control of the evaluator of the system. Satisfactory test YS- � 4 T OD results do not guarantee future performance of the system, nor do they guarantee that Q there are no hidden defects or encroachments. GEG, LTD, can therefore not provideI i a any warranty or future estimate of how long the system will continue to meet the 7 j/ r 0 operational requirements of the ADEC or MOA DSD. The contentof this reportis for oaJ0fpey A_Gorness; Q the sole benefit of the owner listed above. Any reliance upon cruse of this report by any Q f �i CE -795 other person or party is not authorized, nor will if confer any legal right whatsoever. 04 sp y .e°O a IA— 6. DSD SIGNATURE 41e0 rof'� essioe, f cz� System #1 Approved for bedrooms. System #2 Approved for bedrooms. (� OF AlUC,, Disapproved. Conditional approval for bedrooms, with the following stipulations: WATER AND'` _ ..,A -r vVATER (D By— - Original Certificate Date: r ') The Muni rpalit" or Anchor ge Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for offers or omissions in the professional engineer's work. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory ,Pa +un,) f Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: COTTONWOOD HEIGHTS; BLOCK 1, LOT 10 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 7/24/1987 Sanitary seal (Y/N) YES Total depth 103 ft. Cased to 103 ft. FROM WELL LOG Date of test 7/24/1987 Static water level 74 Well production 40 —9 P.M. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 1.98 mg./L. Parcel ID: 051-431-23 Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 9/19/2014 81 ft. 5.68 g.p.m. Collected by: GEG. Ltd. Arsenic: ND ug./L. Date of sample: 2, 23/ 014 & 10/6/14 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 08/27/1998 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N)YES Depression over tank (Y- /N) NO High water alarm (Y/N) N/A Date of pumping Of1301// g Pumper J C. ABSORPTION FIELD DATA `BELOW EXISTING GRADE Date installed 8/27/1998 Soil rating (g.p.d./ft`or /bdrm 0.8 System type TRENCH Length 75 ft. Width 2.5 ft. Gravel below pipe 5 ft. Total depth *11.33 ft. Eff. absorption area 750 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 9/19/2014 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 23 in. Water added 91-0 gal. New depth 24 in. Elapsed Time: 11 120 min. Final fluid depth 23 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date - D. LIFT STATION Date installed "Pump on" level at in. E. SEPARATION DISTANCES Size in gallons Manhole/Access "Pump off" level'nom High water alarm level Cycles tested Meets alar & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO **SEE AS—BUILT SURVEY Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ (**ASSUMED) On adjacent lots 100'+ Public sewer main N/A Sewer /septic service line 25'+ Animal containment areas 50'+ Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption Water main N/A Water service line ***5'(APPx) Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line • **10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS ***SEE ATTACHED WAIVER REQUEST. DOUBLE C/0'S AFTER TANK HAD 1.5 INCHES OF STANDING WATER IN THEM. G. ENGINEER'S CERTIFICATION I cerfify 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 10 1 7-1.)1 N (Rev. 11105) \� o P ASBUILT SEWARD & ASSOCIATES LAND SURVEYING 694-0829 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE: FOLLOWING DESCRIBED PROPERTY:OF At y�Gei�s r . zario �'/ DATE AND THAT NO ENCROACHMEPifS EXIST EXCEPT AS 7��6 .v .• ✓r A s4 INDICATED. IT IS THE RESPONSIBILITY OF THE i OWNER TO DETERMINE THE EXISTENCE OF ANY GRID:"^• ^••••••. EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI-•w's 4 Duene Mark Sear / VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: ! •. LS- c� Ar ANY DATA HEREON BE USED FOR CONSTRUCTIONAl ✓��'�,, OF FENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN L y ARY LINES. .a GARNESS ENGINEERING GROUP, Ltd - - CIVIL & ENVIRONMENTAL ENGINEERS=Qwlx , October 20, 2014 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Rd. P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Ref: Cottonwood Heights; Block 1, Lot 10 — Request for COSA and Water Line Waiver Request To whom it may concern GEG completed a septic and well test on the referenced property. During the testing process, it was observed that an encroachment might exist between the septic system and the water line supplying the house. As a result, the homeowners hired One Stop Services to locate the water line. After the first locate was completed, a discrepancy in the water line location took place due to a weak signal. One Stop Services then returned to the property and after acquiring a stronger signal on the water line, confirmed that an encroachment issue existed between the water line and the septic system (see attached photo). It appears that the separation between the septic tank and the water line is approximately 5.5', and the separation distance between the second double cleanout and the water line is approximately 4.4' (the sewer line is most likely closer). It should be noted that per the 2009 Uniform Plumbing Code, the required separation distance from an "On-site domestic water service line to a septic tank" is "5 feet", and the required separation distance from an "On-site domestic water service line" to a building sewer line is "1 foot". it is unlikely that the water and sewer line cross each other. These encroachments have existed for over 15 years and based upon the water sample results, there is no health concerns. With this in mind, we request at this time that your department grant a waiver for a separation distance of V from the water service line to the sewer service line, and 5' from the water service line to the septic tank. If you have aWy questions, please contact Jeff Garness at (907) 317-9433. P.E., M.S. NOTE: Attached is a photo ofthe water line locates in proximity to the septic tank and double cleanows. 3701 E. Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garressengineering.com Municipality of Anchorage al P.O. Box 196650 0 4700 Elmore RoadAnchorage Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 Department v, http://www.muni.orn/Onsite Development Services Division On -Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW **** Waiver#: 141477 COSA#:141552 Permit#: PID#:051-431-23 Legal Description: Cottenwood Heights B-1 L-10 Engineer: Garness Engineering Group Applicant: Morgan & Debbie Anderson Your request for a waiver of the required 10 feet horizontal separation from the septic tank to the water service line has been approved. The approved separation distance is 5 feet. Also approved is 1 foot separation distance water service line to sewer service line. This waiver approval applies to the existing only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. ............................................................................... Waiver is Granted: X Waiver is not Granted: Date: / O - y) tf — I y Approved by: cc/,22 eviewer ............................................ .. . .�......................... Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program , •4700 South Bragaw St. . P.O.'Box 196650 Anchorage, AK 99519-6650 , www.ci.enchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY, APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.051-431-23 HAAtrt�b�o7 3 Expiration Date: C.. GENERAL INFORMATION �. .. Complete legal description 'Lot 10 Block 1 Cottonwood Heights _ -Location(siteadd ressordirections) 20110 Kabob StrPP t•.'..Current Property owner(s) Mark & Ann Roberts Day phone 696-4598: Mailing address 20110 Kabob Street' Chugiak -AK 99567; `t �''='•�: :.: ' ' ' Lending agency Day phone Mailing address Real Estate Agent Prudential/Gary Gearhart Day phone 689-6502 Mailing Address 16635 Centerfield Dr., Eagle River AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well n Individual Water Storage ❑ Community Class Well. ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sevier ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates 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, 1 verify that my investigation, based.on procedures outlined in the Health Authority'Approvai 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. `' S & S ENGINEERING) 1 Name of Firm 17034 Eagle Rivep 1 cap Rsed Ne, 204 Phone G`f XC) 7 7 Address Eagle River, Alaska 99577 Engineer's Printed Name Robert C. Cowan, p_F- Date -7 `) o/ '?jGINEE t 5.. DSD SIGNATURE ROEEAT G COWAN CE•8801 Approved for _� bedrooms. rt e;. ; Disapproved. Conditional approval for bedrooms, with the following stipulations:' ' , I yr i'ik, J • ON-SITE lA)ATFRAn(n WASTEWATER Additional Comments ; I�JJ/l' rC T Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Welt Flow Advisory Other By: ZI Original Certificate Date: -7--2 3—OL (Rev. 1200) Municipality of Anchorage ' Development Services Department Building Safety Division :. ■,. ° On.Site Water & Wastewater Program 4700 South Bregaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.d.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Parcel ID: 061 134---Z-5 Legal Description:(.4/ , A. WELL DATA Well type 'Pal's VAif A, B, or C provide PWSID # = Well Log (YM) Date completed Z /8� Sanitary seal (Y1N))(4i;r Wires property protected // RR t' Total depth ft. Cased to �fl• Casing height (above ground) min• FROM WELL LOG AT INSPECTION Date of test— O Static water level Well production 4o g•p•m• 3 g.p.m. WATER SAMPLE RESULTS: Coliform O .�colo�niies/1�000, ml. Nitrate •3 - m9-1• ahs bads colonies/100 ml. Date of sample: — Collected by: S`} G i,-SiJ G in/ e:r=m/ f46 - B. SEPTICIHOLDINd TANK DATA Tank Type/MaterialGn^"' / � DateinslaNed 0) Tank size L!M1 � gaL .. I Number of Compartments �/ Cleanouts (Y/N) Depression over tank (YIN) � O High water alarm (Y/N) N Foundation cleanout (YM) _ Date of pumping Z Pumper J R'S c. ABSORPTION FIELD DATA �� fi�tt� Date Installed Cpl //7 / ./ g Soil rating (9.p.d./fl' or fF/bdrmc-0 System type lG i • s ft. Gravel below pipe Length �ft• Width Total depth Liz ft. Eff. absorption areaMonitoring tube � Depression over field fl N Date of adequacy test � ( Results (Pass/Fail) BmFor-4--bedrooms Fluid depth In absorption field before test SL in. Water added _LIS gal. New depth IG in. Elapsed Time: 8 o min. Final fluid depth 0 in. Absorption rate >= 400 g p•d• NO N *- k New,✓ If esgive date Any rejuvenator treatment (past 12 mo.) (YM &type) Y, 9 D. LIFT STATION Date installed _ 'Pump on" level; Datum / Size in gallons Manhole/Access (YM) in. "Pump ofr level at _ in. E. SEPARATION DISTANCES Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankliMitation on lot / CV (- Absorption field on lot /00 r+ Public sewer main r SP/ffr-/sepdc service line ZS 4 - High water alarm level at in. Meets alarm b circuit requirements? On adjacent lots /00 /-A- On adjacent lots / C>0 it Public sewer manhole/cleanout /V ,4 Holding tank n/ /Ar SEPARATION DISTANCES FROM SEPTIC HOLOING`TANK ON LOT TO: r I Building foundation 5 +' Property line _J f- Absorption field 45;7 Lf - Water main N Water service line } Surface water / 00 �r- Wells on adjacent lots /00 f SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r Properly line /0 . 101Building foundation 0 Y'- Watermain N is � / r Water Service line //0 Surface water / 00 �- Driveway. paftvl chide storage Curtain drain N4j & �Lf Al Wells on adjacent lots /00 ;d, F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and y, review of Municipal records that the above systems are in 8801 ril conformance with MOA HAA guidelines lo effect on this date. RaAe�r Engineer's Printed Name C' . + 7 ` 7�✓A.✓ Co% �C ' Date _ � A /p CE- / HAA Fee S 300. 04 Date of Payment 71/01 o / Receipt Number 0 0 tea 17 (Rev. 12100) Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE AiL • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 051-431-23 1. GENERAL INFORMATION A. y5v� HAA # I+ A- ' � Complete legal description Lot 10, Block 1, Cottonwood Heights S/D Location (site address or directions) victor Lytle Property owner Mailing address Day phone Lending agency Day phone Mailing address Agent Raney Hardman/Remax of Eagle River -Day phone 694-4200 Address -16600 Centerfield Dr.,Suite 201, Eagle River, AK -99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 - 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of thiknspection. Name of Firm 17034 Eagle River Loop Road Address C_,.1_ Engineer's signature 6. DHHS SIGNATURE Approved for FOUR bedrooms. Disapproved. Conditional approval for Phone � ej — Date 4 bedrooms, with the following stipulations: Additional Comments Th 1.5 1-5 a. re, 1 ssyc- 0 7C IVA A -tt c/ 90 2.52. joaGa,a5e- grC'V10US 15Svri WA -5 7CaV 3 OtkkoaM-c ditet C, Y' or By: Date 9--1 (--1k The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev.1/91) Back MOA #21 D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 100 �k On adjacent lots Absorption field on lot \00 On adjacent lots Public sewer main ?� Public sewer manhole/cleanout 1k Sewer /septic service line Z S Lift station Ips SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation fe r Property line 1 r Absorption field Ifl i� Water main/service line l a Jt- Surface water/drainage /06 Wells on adjacent lots I+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line D Building foundation I Water main/service line /0 Surface water 1 o Driveway, parking/vehicle storage area '(a f Curtain drain N !� Wells on adjacent lots F. ENGINEER'S CERTIFICATION f��1 /certify that/ have determined thr `field nspectio and review of Municipal recordsAW b9rie ms are in conformance with MOA H gu in eff, t on this date. '��""'• �4 Signature '� �,�� • t 7034E a Rive bad No. 204 Engineer's Na mg •y�•�,� "" ""•� Date / f�;• . t -e•• X® AMbn HAA Fee $_�%3� Waiver Fee $ Date of Payment <? / Date of Payment Receipt Number Receipt Number 72-026 (Rev. 3/96)* Parcel I.D. # 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 051-431-23 HAA # _LC) 1. GENERAL INFORMATION Complete legal description Lot 10, Block 1, Cottonwood Heights S/D Location (site address or directions) 20110 Kabob Street Af, , Property owner Ai ntar. Lyt-1 e Day phone Mailing address Lending agency Day phone Mailing address Agent Raney Hardman/Remax Eagle River Day phone 694-4200 Address16600 Centerfield Drive, Suite 201, Eagle River, AK 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 � 3. TYPE OF WATER SUPPLY: Individual well xxx Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xxx Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA *21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date g is inspection. Name of Firm Address 17034 Eagle River Eagle River, Alas Engineer's signature 6. DHHS SIGNATURE Approved for i�� bedrooms. Disapproved. Conditional approval for Additional Comments By: at - Phone 6�Y' 2'l 7 f" Date I A % v9' if 4 A ahric � � ' ;•y�. 1457-f � s bedrooms, with the following stipulations: /10 Date 7 ' ' 70 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 engineers work. 72-M (Rev. 1/91) Back MOA #21 DATE FEC€IVED INSPECTION APPOINTMENTS -TIME - TIME — TIME A01A r P DATE DATE DATE 21 -.�- Clls INSPECTOR e INSPPTOR INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITYOF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTICIMPT C- HE 825 L Street -Anchorage, Alaska 89501 ENVIR Ir. t;,A. ENVIRONMENTAL SANITATION DIVISION SEP 2 ? 1982 Telephone 264--4720 j REGUEST FOR APPROVAL. OF INDIVIDUAL WATER AND SAfiGUIILIEle+S DIRECTIONS: Complete all parts on page 1. Incomplete requests will nat be processed. Please allow ten (10) days for processing. 1 PROPERTY OWNER\ PHONE MAILING ADDRESS PROPERTY RESIDENT (11 different from above) PHONE 2. BUYERPHttiO,,NE yy Cf MAILING ADDRESS 3. LENDIN^G\ INSTITUTION{�(� PHONE ea k!& 1 kkC lk o_ -a+Zss MAILING ADDRESS ' qq SCS 3 4. REALTOR/AGENTPHO Lp p ser2 NE FZot YEt�v�e� M1y\P r ' 17`� 0'1 E., �e ►u' i� -00 - i MAILING ADD SS _ P D - - �\ �►vef- `3aS �l i 5. LEGAL DESCRIPTION crwo>n,A_1©0 � SIAb STREETLOCATION 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS I�1 0 One ❑ Four ❑ Other SINGLE FAMILY M Two ❑ Five ❑ MULTIPLE -FAMILY ❑ Three ❑ Six 7. WATER SUPPLY >k INDIVIDUAL* "ATTACH WELL LOG. A well log �®r red for all wells rifled COMMUNITY; since June 1975. For wells drille that date, give it PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-StTE"" ITS YEAR ON-SITE SYSTEM WAS INSTALLED. C� PUBLIC UTILITY NOTE: THE INSPECTION FE ^STAC MPANY EACH RE r ST BEFORE P 0.� m_ NG CAN B NITIArTED. I 72-0120 ( V. 6179) 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS D ONE El THREE ED FIVE ED OTHER EJ SINGLE FAMILY EJ MULTIPLE FAMILY 1-1 TWO ED FOUR 0 six 2. WATER SUPPLY 1-1 INDIVIDUAL DEPTH OF WELL EJ COMMUNITY DATE DRILLED EJ PUBLIC UTILITY Connection Verified—.__ LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER EJINDIVIDUAL/ON -SITE 1__jPUBLIC UTILITY _DATE INST—A (e Connection Verified INSTALLER ElSeptic Tank or [---.]Holding Tank Sizc: If Tank is homemade 4ING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption AreaNearest Lot Line Line WELL TO: Absu,,:-ptton Area to nearest Lot Line ----rer 5. COMMENTS E-] APPROVED FOR BEDROOMS 0 CONDITIONAL APPROVAL (letter MUSt accompany certificate) DISAPPROVED DAZE 0Y 72-010 (Rev. 6/79)