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EAGLE CREST #1 TR A LT 23
MUNICIPALITY OF ANCHORAGE Development Services Departmentj Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-303-28 Legal description EAGLE CREST #1 TR A LT 23 Site address 19510 TH I RD ST Expiration Date: 5/2/2025 Current property owner(s) GALLEGOS ESTEBAN RAUL &ALIVIAH X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By: Original Certificate Date: 7/16/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA ApprovaIjune 2022 WN4101MV MINI ON W-1 Development Services Department On -Site Water & Wastewater Section Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 050-303-28 Complete legal description EAGLE CREST #1 TRACT A, LOT 23 Location (site address) 19510 THIRD STREET, EAGLE RIVER, AK 99577 Current property owner(s) ESTEBAN & ALIVIAH GALLEGOS _ Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: Z Private Well ❑ Private Well serving 2 dwelling units F-1 Private Well serving 3+ dwelling units ❑ Community Well or Public r_1 Water Storage 4. TYPE OF WASTEWATER DISPOSAL: Z Private Septic F-1 Private Septic serving 2 dwelling units F Holding Tank F Community Septic or Public Sewer 5. SEPTIC TANK: Z Steel E] Plastic F-1 Concrete M Fiberglass Age 6 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: F] AWWTS ❑ Bed E] Deep Trench H Wide Trench El Seepage Pit Waiver request for: Expedited review requested: Z Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee Date of Payment COSA # Z"y Waiver Fee $ Date of Payment Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: EAGLE CREST #1 TRACT A LOT 23 Parcel ID: 050-303-28 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 1977 Total depth 292 ft Cased to 291 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 5/2/24 Static water level at beginning of test 284 ft. Well production at time of test 5.5 gpm Water storage tank volume NONE gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 2.35 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 5/2/2024 Comments B. TANK DATA Measured operating fluid level in septic tank 49” Date of pumping 5/2/2024 Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) NEW SYSTEM ALL standpipes present per record drawing Total measured depth from grade 7.29 ft (max) Measured depth to pipe invert from grade 3.13 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective (ED). If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date NEW SYSTEM Results Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS – NEW SYSTEM – NOT TESTED Effective depth (per record drawings) 48 in (MOA 4’ ED) Effective depth used 0 in Effective depth (ED) remaining 48 in Comments/Deficiencies: Approximate total measured depths from existing grade. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No *0 ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS *1977 FIELD OFF PROPERTY IN ROW WITH PREVIOUS ROW PERMIT ISSUANCE & ANY LETTER OF NONOBJECTIONS – SEE MOA FILE. G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 7/12/24 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 7/12/24 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP241118 PID Number: 050-303-28 Dwelling: Z Single Family (SF) ❑ with ADU F-1 Duplex (D) R Two Single Family Project: El New Z Upgrade Name ESTEBAN & ALIVIAH GALLEGOS ABSORPTION FIELD F-1 Deep Trench Z Wide Trench M Bed n Mound Site Address 19510 THIRD STREET, EAGLE RIVER El Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 1.2 GPD/SFI 6.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2.5 Ft. Gravel depth beneath pipe 4 Ft. Subdivision Block Lot EAGLE CREST #1 TRACT A 23 Fill added above original grade VARIES 0.79 - 0.63 Ft. Gravel length 50 Ft. Township Range Section Gravel width 5Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 500 Ft' 1 -- Ft. Well 100'+ 25'+ TANK 2 Septic [:1 S.T.E.P. ❑ Holding El Other Manufacturer EXISTING Capacity Gal. Surface Water 100'+ Material Number of compartments Lot Line 10'+ NA Foundation 10'+ LIFT STATION Manufacturer Capacity Gal. Remarks Alarm location Electrical installed by PIPE MATERIAL House totank Tank to drainfield 3034 Installer JRS Drainfield 3034 CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspdatesection 1" 6/26/2024 md 6/27/24 Location and description : 2 3'd 6/28/24 4" 7/2/24 ITOP OF MTA BOX ON POLE ON-SITE WATER AND WASTEWATER SECTION APPROVAL n 0_0 ,dew OF A Conditional Approval: Date Aw 7H .... ... . ...... Septic System Curtis Huffman Approv Date 63 CE 128991 7/12/24 Note: this apprWal� does not include well permit requirements. (Rev 05/02/18) PID:050-303-28 PERMIT:OSP241118 FIRST WATER CONSULTING EAGLE CREST #1 TRACT A LOT 23 3RD STREET , W 0 GRAVEL I S 89'56'00"E 132.00' 100 PROTECTIVE WELL RADIUS. — M. U6 WELLS 2.0' CANT 4.0' x 10.0' WOODSHED 1.9' xJAN ^' 30.9' 37.3' o 11.0'N 1 STORY RESIDENCE N N WITH DAYLIGHT N BASEMENT / 10.2' x 10.2' SHED 68.2' z 38.8'O k �2.0' x 18.3' CANT SEPTIC 0' PIPES Lot 24 Lot 22 w Lot 23 17,820 s.f. / cn O O C C 10' UTILITY EASEMENTS N 89'56'00"W 132.00' — — — — � I Lot 37 I Lot 38 I Lot 39 PLOT PLAN ___ AS BUILT _X_ SCALE _ 1__= 30=_ GRID NW _0_5_5Project No. ----L2±–Q14 _&3---- P.O. Box 210005 Lang & Associates, i n C Anchorage, Alaska 99521-0005 000O� 0 F (907) 522-6476 6� Professional Land Surveyors kenOlangsurvey.com o jonothanOlangsurvey.com 1 hereby certify that I have surveyed the following described property: Q� n LOT 23, TRACT A, FIRST ADDITION TO THE EAGLE CREST SUBDIVISION (Plat No. 63-70) O �+go T �4Anchorage Recording District, Alaska, and that the Improvements situated thereon are """ within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach onthe surveyed premises and that there are no roadways, transmission lines or other visible H C. LANG �Q O easements on said property except as indicated hereon. s�'•�,�- � JLy 2 � ni k� 'J � /� �' LS -9944. Dated this the Da of �- I Z_ ��f; at Anchorage, Alaska 4 F� o p o Day -------------- 4�OR�FESSIONAL moo It is the responsibility of the owner to determine the existence of any easements, �Opppoo� covenants, or restrictions which do not appear on the recorded subdivision plat. State of Alaska AECC963 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 hftp://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241118 Work Type: Septic Upgrade Tax Code Number: 05030328000 Site Legal Address: EAGLE CREST #1 TR A LT 23 G:0055 Site Mailing Address: 19510 THIRD ST, Eagle River Owner: GALLEGOS ESTEBAN RAUL & Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Q Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 6/12/2024 6/12/2025 17820 ❑ Private Well ❑ 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 Received By: S �n 17'`' FCC Issued By: 0, L Date: Date: 2 ti L 4 ON -SITE SEPTICMELL PERMIT APPLICATION Parcel I. D. 050-303-28 Property owner(s) ESTEBAN & ALIVIAH GALLEGOS Day phone Mailing address 19510 THIRD STREET, EAGLE RIVER, AK 99577 Site address 19510 THIRD STREET, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) EAGLE CREST #1 TRACT A LOT 23 Legal description (Township, Range & Section) Lot Size 17,820 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (E] all that apply) Absorption Field Fx_1 Initial ❑ Single Family (SF) ADU) Septic Tank E] Upgrade 0(w/wo Duplex El (D) Holding Tank ❑ Renewal ❑ Multiple Dwellings El Privy El (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) _91— Permit/Rush Fees: Waiver Fees: Date of Payment: Date of Payment: Receipt Number- Receipt Number: Permit No. Waiver No. GAIDevelopment Services\Building Safety\On Site Water and WastewaterTorms\Client FormsTermit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com ! !! June 3, 2024 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: EAGLE CREST #1 TRACT A LOT 23 The property owner has requested we obtain a permit to upgrade the failed septic system of the above referenced lot. We propose to install one shallow trench and connect to the newer tank to serve the existing 4-bedroom residence. The design is based on the recent test hole conducted on May 24, 2024. Groundwater was observed at test hole excavation at 11’ and 10.7’ at monitoring. The proposed trench will be installed towards the toe of the slope per the design. The slopes are approximately 15-20% at the proposed upgrade location, but quickly level out. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241118, Curtis Townsend, 06/12/24 FIRST WATER CONSULTING EAGLE CREST #1 TRACT A LOT 23 DESIGN CALCS: NO WELLS WITHIN 100' OF PROPOSED SEPTIC SYSTEM. MUST STAKE THE PROPERTY LINE & EASEMENT PRIOR TO CONST. NO SLOPES >25% WITHIN 50' OF PROPOSED FIELD. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241118, Curtis Townsend, 06/12/24 FIRST WATER CONSULTING DESIGN DETAILS: EAGLE CREST #1 TRACT A LOT 23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241118, Curtis Townsend, 06/12/24 3030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 firstwaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL : EAGLE CREST #1 TRACT A, LOT 23 PERFORMED BY: FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 6/3/2024 DEPTH FEET OG SOILS 1 ORG/OL 2 3 4 5 6 GM/gp-sp 7 8 9 10 11 12 13 14 15 BOH 16 17 18 19 20 Reading Date Gross Time Net Time Depth to Water Net Drop 5/24/24 10 min 6” 5 1/16” “ 6” 5 0/16” “ 6” 4 15/16” “ 6” 4 15/16” “ 6” 4 15/16” “ 6” 4 15/16” PERCOLATION RATE 2 (MIN / INCH) TEST RUN BEWTWEEN 4 & 5 FT PERC HOLE DIAMETER 6” PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH. GROUND WATER ENCOUNTERED: YES IF YES, AT WHAT DEPTH: 11’ DEPTH TO WATER AT MONITORING: 10.7’ DATE: 5/30/24 TESTHOLE # 24-1 DATE PERFORMED: 5/24/2024 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION PERFORMED FOR: ESTEBAN & ALIVIAH GALLEGOS 6/3/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241118, Curtis Townsend, 06/12/24 Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP 1$1079 PID Number: 050-303-28 Dwelling: ❑Q Single Family (SF) ❑ Duplex(D) ❑ Multiple (SF and/or D) Project: ❑ New Q Upgrade Name: WILLIAM REICHMAN ABSORPTION FIELD Address ❑ Deep Trench CI Shallow Trench ❑ Bed ❑ Mound ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot Ft. Ft. EAGLE CREST#1 TR A LT 23 Fill added above original grade Gravel length Township Range Section Ft. Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Lift Station Tank Line Ft2 Ft. , Well 100'+ 50'+ TANK ❑l Septic 0 S.T.E.P. 0 Holding 0 Other Manufacturer Capacity Surface Water 100'+ ANCH TANK 1250 Gal. Material Number of compartments Lot Line 10'+ STEEL 2.0 NA Foundation 10' LIFT STATION Manufacturer Capacity Curtain Drain UN Gal. Remarks TANK REPLACED PER CONDITIONAL Pump on level at Pump off level at High water alarm at COSA in. in. in. Pump make and model Electrical Inspections performed by ,PIPE MATERIAL House to tank 3034Tank to 3034 Installer drainfield MIKE N ANDERSON Drainfield CO/MT Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 100 ft Inspection 1" 7-14-18Location and description dates: 2"` 3,<, 4th GARAGE APRON SLAB, SOUTH CORNER COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp .`,1/4 , OFA`,9,11 Conditional Approval: Date %y`Q•••• •••5,�i11i • 9 - - l% ' 49TH •:fir 1ti /1 •�.•MICHAEL N. ANDERSON /a •r �•. CE-94p9 .'4`14,e Approve ` — (:x-4( L Date 7-- I 6/-le 1 , ...., 1/?• •. 1�. �• .�C.5",.r l> PRof€SSIA.%4 Inspection Report_9-1-12.doc ``,v��~~ r Permit No. OSP171079 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: EAGLE CREST #1 TR A LT 23 PID No.: 050-303-28 \ / / MARK 8 A TCO1------ 13 26 \ ----; \— / CO1 9 25 - \ / TCO2 19 26 \ / CO2 23 25 \ \ / / y --- — \ / \ — — 1 / 1 / \ 1 1 // 11 /� \\ 11 �� 1 OLD/TANK DECO11,tISSIONED PER UP y/ 1 / 1 p \\ // 1 1 I t N 1 w® / DRNEWAY I // / I� �7 I I / I f',-, '.t,., .:V L . A I // L I r -- ---= 141 r r / / / CO2/If 03 1 / /� 02 11 1 / �1 1 /\_———J,I NEW 12'50 STEEL TANK / / \ / / \ / / \ / / \ / / \ / // EXISTING WELL \\ / / \ / / 7 N — _ ASBUILT . . SCALE: 1"=30' COI TCOI rCO2 COa **\\\�Vi,I TCO2 1 I� X44 Ur ,/ 14/ ���I lull 1 5 4 9"H y #./ y i.aw uuWM nr 0 ��l 0 SSO CALL / • �� • • ..MICHAEL N. ANDERSON:.' * - No. CE 9469 SEPTIC SECTION .. **" �\p\ ��� N.T.S. *, ��\ ,4 . i 3RD ST� TTT ....N\ O 0 0 N 89'56'00" W 132.00 WELL U 23.3 IN I. .. 2 I: so I37.5 LAJ TWO STORY N - WOOD FRAME N o HOME .. o 0 0 O O O di di W O OO O . 5 b O ciiz S 89'56'00" E. 132.00 GRAPHIC SCALE: 1 Inch = 30 Feet 1515 6I0 No property corners were found or set during Bobby F. Burnett this survey. House placement is based on an 2941 Carriage Drive As—built survey dated 3/25/2005 by Seward & Anchorage, Alaska 99507 Associates Land Surveying. Improvements from previous survey have been Re—Certified during (907) 250-5541 this survey, and are as shown. ���.`` Date Scale Legal Description i � T\ 7/10/2018 1" = 30' P Air ��. OF .i.`.. Grid AS-BUILT Lot 23 TRACT A ,��� �'� 1� NW 0554 EAGLE CREST SUBDIVISION di* • * . Drawn by Field Book ADDITION #1 / . �`� BFB ASB-2018 PLAT # P-558 I herebycertifythat the property described hereon has been surveyed j cti P P y ` BOBBY F. BURNETT .p Air by me, or at my direction, and that the improvements situated thereon ` N I 5-5464 are within the property lines and do not overlap or encroach on the 7.4-/s 64 / property lying adjacent thereto unless otherwise shown. That no improvements on the property lying adjacent thereto encroach on the • • • • Air premises in question and that there are no roadways, transmission \ '�SSION�^ti Airl lines or other easements on said property except as shown. �`_�� err/// ,�.%oc " 1,0, MUNICIPALITY OF ANCHORAGE maentOn-Site Water&Wastewater ProgramPO Box 196650 4700 Elmore Road • f i Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 http://www.muni.org/onsite N7)-110 I) •� ;irtni •nt On-Site Wastewater Disposal System Permit Permit Number: OSP181079 Effective Date: 5/4/2018 Work Type: SepticTank Upgrade Expiration Date: 5/4/2019 Tax Code Number: 05030328000 Site Legal Address: EAGLE CREST#1 TR A LT 23 G:0055 Site Mailing Address: 19510 THIRD ST, Eagle River Owner: REICHMAN WILLIAM C Lot Size in Sq Ft: 17820 Design Engineer: ANDERSON ENGINEERING Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field El Septic Tank 0 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 Received By: Date: c7 . 7 PtAxe 00.30c4 Issued By: Date: • if • MUNICIPALITY OF ANCHORRMIst Development Services Department04 On-Site Water & Wastewater Section F 97 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-303-28 Property owner(s) WILLIAM REICHMAN Day phone Mailing address Site address 19510 THIRD STREET, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) EAGLE CREST#1, TRACT A, LT 23 Legal description (Township, Range & Section) Lot Size 17,820 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (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 the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. I (Signature of prop-rty owner or authorized agent) Permit/Rush Fees: 43114"' Waiver Fees: Date of Payment: 57108 Date of Payment: Receipt Number: 2,pAct 4 O Ckio o J. Receipt Number: Permit No. 65P/$10943 Waiver No. G:1Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc May 1, 2018 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Septic tank replacement with Conditional COSA Legal: EAGLE CREST#1, TRACT A, LT 13 To Whom it may concern: This is a request for a conditional COSA and tank excavation permit to replace the existing septic tank ASAP. The tank was installed in 1977 and needs to be replaced. We are also submitting for a conditional COSA due to the time limit for the title closing. This replacement tank will not impact any of the neighboring properties due to the lot layout or pose any health or safety risks by waiting a couple of weeks. Please call me if you have any questions. Sincerely`,,,e Mike Anderson, P.E. 4661 Natrona Ave. Anch,Ak 99516 727-8864 O WELL 2' CANT 23.3 pI DECK � STREET J W Q 0 N 89 °56' 00" W 1 TWO STORY WOOD FRAME HOME CANT 0 X'_100' WELL RAD) IN ------ — — — — — — — — — — — — — — — — — — — — — — — — — -------- 10' ------ 10' UTILITY EASEMENT S 89°56'00" E. 132.00 Bobby E Burnett 2941'Carriage Drive Anchorage, Alaska 99507 (907) 350-5541 Date Scale 7/10/2018 1'= 30' Grid AS -BUILT GRAPHIC SCALE: I Inch = 30 Feet 15 0 15 30 60 No property corners were found or set during this survey. House placement is based on an As—built survey dated 3/25/2005 by Seward & Associates Land Surveying. Improvements from previous survey have been Re—Certified during this survey, and are as shown. Legal Description Lot 23 1 TRACT A NVV 0554 EAGLE CREST SUBDIVISION :Drawn by Field Book ADDITION #1 BFB ASB -20'18 PLAT # P-558 I hereby certify that the property described hereon has been surveyed by me, or at my direction, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto unless otherwise shown. That no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other easements on said property except as shown. FERHIT NO. l,llJ~-.I I C I F'FIL I T"r' CIF FI~-I~__-HOF-.'FI,SE DEPARTr'IEHT OF HEALTH 8ND EHVIRONHENTAL F'ROTECTION 25t6 E. TUDOR RD. ~ RNCHORAGE, RK. ~9507 276-2221 I~E'LL F~. ~-~b~--S I ]-E ~-~-EI.~EF-: P E~-."~'~ I -l- < ??052: ) ,~ APF'LICBNT NED SEVERSON 80X 152 CITATION ROAD EAGLE RI 694.--~',~:74 LOCATIOH C~:~blVIkW ~ Z:~:D AVE LEGAL TRACT "A" LOT 23 E~GLECREST SU LOT SIZE 23E~OC~ S~I_IARE FEET TYPE 0F SOIL 8E',SORDTION _,%_TEH IS: TRENCH MRXIMUM NUME'.ER OF E:EDROOMS = 4 SOIL RRTING THE REI]UIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: 2 ~] R FI'-.-" E L [:.EPTH= ':' [:.EF"TH= :1.2 LE~-~]TH= ":-c .... ---- THE LENGTH DIMEHSICIN IS THE-LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEF'TH OF A TRENCH OR PIT IS THE DISTBNCE 8ETNEE[I THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOE'. TRENCHES. THE GRAVEL DEPTH IS THE I'IINIMUH DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE 8ND THE BOTTOM OF THE EXCAVATION (IN FEET). I~i:E,]-! IJ I F-:ED SEPT I C T[-JC, ( 2 ) I f~~SF'E,]T I C~f4S ~F:E ' J:~.:EQI_I I RE[:' BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND AF'F'RO',."AL E:Y THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. HINIr,1uM DISTANCE 8ETI,IEEH A WELL 8ND ANY O~-SITE SEWRGE DISPOSAL SYSTEM IS 1E*~} FEET FOR A F'RIYATE WELL OR 2~.~C1 FEET FOR. A PUBLIC WELL WELL LOGS ARE REQUIRED AND HUST BE RETURNED TO THE DEPARTMENT WITHIN ]::C~ DAYS OF THE WELL COMPLETION SF'ECIFICATIONS A~iD CONSTRUCTIOli DIBGE'.RMS 8R.E AVAILABLE TO INSURE PR. OF'ER I NSTALLAT IO~L F'EF-:I,1 I T ',.."RLI [".., FE~F-: ¢"~1'-.I E "t"EFIF:: FF-:~]I~-I I SSLIE I CERTIFY THAT 1: I ~M FAHILIAR WITH THE RE~2UIREMEHTS FOR ON-SITE SE[4ERS AND WELLS AS SET FORTH BY THE MUNICIF'8LITY OF. 8NCHOR~OE. 2: I WILL INSTALL THE SYSTEM IH 8CCORD~HCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEHER SYSTEM HAY REQUIRE ENL8E'.GEMENT IF THE R. ESIDENCE IS REMODELED TO INCLUDE MORE THB~; 4 BEDROOMS. MUNICIPALITY F ANCHORAGE CO 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. 050-303-28 1. GENERAL INFORMATION Complete legal description Location (site address) Expiration Date: 'Z —I — z©Z( EAGLE CREST #1 TR A LT 23 19510 THIRD STREET, EAGLE RIVER AK Current property owner(s) Mailing address Real estate agent DAVID & SHARON WELCH SAME 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well FX -1 Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ q(2. 5-0 (Covlb- 1 Date of Payment 11 /,5/.2 0 2 0 Receipt Number 00 �5 �o COSA # 0 S C �2 0 I b09 Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On-Site staff may visit the site to verify the information submitted. Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 11-2-20 ° Owl 6. DSD SIGNATURE l 49TH d''-`� System #1 Approved for 4 bedrooms -X— MICHAEL I'J MICHA! ' �:• • ..• . < EL 4. A\DLRSC:J•^_ r System #2 Approved for bedrooms /t CE- 94?� 9 Disapproved ¢�� Fq�'•. t��� Conditional approval for bedrooms, with the following stipulations:k-f �v����-.,► ``llllt,ll YOP trfrrr��'�i -SITE WASTLWATE _ J O J�o G R A M �z �-z-, lG� i `A'� Original Certificate Date: 0 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: EAGLE CREST #1 TR A LT 23 if more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1977 Total depth 295 ft Cased to 40'+ ft ❑ Sanitary seal is functioning correctly IN Wires are properly protected Casing height (above ground) 14 in. Date of flow test for COSA 10127/20 Static water level at beginning of test 255 ft. Comments B. TANK DATA Age of tank(s) 2Q18 years Tank type/material Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping steel septic tank installed D. ABSORPTION FIELD DATA Which system tested (date installed) 1977 ❑ ALL standpipes present per record drawing Total measured depth from grade 11.3 ft (max) Measured depth to pipe invert from grade 3.3 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 0 gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 050-303-28 Structure served by this system Well production at time of test 5+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 1.03 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by MNA Date of Sample C. LIFT STATION 10/28120 ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 10/27/20 Results ❑✓ Pass For 4 bedrooms Fluid depth prior to test 8 in Water added 500+ gal New depth 13 in Elapsed time 1440 min Final fluid depth 8 in Absorption rate 000+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑✓ Yes Community Sewer Manhole/Cleanout > 100' r, Yes if No ft ❑✓ Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' F,71 Yes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' [D Yes if No ft Neighboring Absorption Fields > 100' F,71 Yes if No ft Water Main > 10' Animal Containment > 50' E✓ Yes if No ft Yes if No ft Q Yes if No ft Water Service Line > 10' 0 Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' d Yes if No ft Q 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' P/1 Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Q Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' F,71 Yes if No ft Water Main > 10' F71 Yes if No ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' 0 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' �, �. ^� , •, ✓" t # r Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' [✓ Yes if No ft Water Service Line > 10' F,71 Yes if No ft Community Wells > 200' R Yes if No ft Surface Water > 100' ✓[.l Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review {s ,� ,1 of Municipal records that the above systems are in conformance with in this date. �, �. ^� , •, ✓" t # r MOA COSA guidelines effect on ,N o . , • o E • • • . °•, �AI�hAct N. ANDERSCtJ• CE -9469 .'•�1�� COSA Checklist yellow sheet DocuSign Envelope ID: D7ECC100-FE3C-4811-98EF-C7768EF9F812 POST IN A CONSPICUOUS PLACE �tz% e n t ALL WORK MUST BE INSPECTED �Aftwd Field Inspection Request required 2 working days in advance of starting work and 2 working vc days in advance for final inspeciton. Call (907) 343-8206 (voice recorder) for scheduling. f,y Permit is not valid without the call-in and also must include She one -call ticket (utility locate) h number. MUNICIPALITY.OF AN - RIGHT OF WAY DNIsnN D e p a r;t m'e n t 4700 ELMORE ROAD TELEPHONE (907) 343-8240 FAX (907) 343-8250 RIGHT OF WAY- PERMIT__ ., W..1 � R202631 Type: EncrchmntStatus ued Grid NW0055 Date Applied: 11/19/2020-11 e Issued: 11/19/2020 `"'=Issued Bv..:x clauriia ninard Summarized Financial Transactions"LL ` Fee Description,u nti" Amount See reverse for requirements/remarks I have read and understand both sides of this permit. I agree to the terms and conditions; and I certify that all work will comply with federal, state, and municipal codes and regulations and the provisions of this permit. DocuSigned by: Docusigned by: SignaturE�370DBF4699CC440 bin �" 1 Date: 12/1/2020 .. 370DBF4699CC440... DocuSign Envelope ID: D7ECC100-FE3C-4811-98EF-C7768EF9F812 men r F MUNICIPALITY Off' ANCHORAGE �0 S ePS �- a ;. Development Services' Department Right of Way Section Department ENCROACHMENT PERMIT R202631 THIS AGREEMENT, made this 23`d day of November, 2020, by and between DAVID B. WELCH & SHARON L. WELCH and their heirs, administrators, and assigns, hereinafter called "PERMITTEE", and the Municipality of Anchorage, a municipal corporation organized and existing under its Charter and the laws of the State of Alaska, hereinafter called the "PERMITTER"' WITNESSETH: WHEREAS, PERMITTEE is the owner of the following described real property: EAGLE CREST #1, TRACT A, LOT 23, according to the official records thereof, on file in the office of the District Recorder, Anchorage Recording District, Alaska, and; WHEREAS, PERMITTER owns and/or maintains the real property more particularly described as follows: The SIXTY FOOT RIGHT OF WAY OF THIRD STREET, immediately to the north of PERMITTEES property as shown on Plat No. 63-70, on file in the office of the District Recorder, Anchorage Recording District, Alaska, and; WHEREAS, PERMITTEE has placed a sewer standpipe upon the referenced real property which encroaches 6.5 feet upon the PERMITTER'S 60.0 -foot Right of Way. NOW, THEREFORE, it is mutually agreed between the parties hereto that: 1. The PERMITTER, acting through the Director of Development Services Department, hereby grants to the PERMITTEE the privilege of allowing a sewer standpipe which encroaches 6.5 feet upon the PERMITTER'S 60.0 -foot Right of Way, as shown on "Attachment A," included herewith. 2. The PERMITTEE agrees forever to indemnify, defend, save and hold harmless, the Municipality, its officers and employees, from any and all lawsuits, claims or actions brought to any person for or on account of damage to property or injury, disease, illness or death of persons, including all costs and expenses incident thereto, arising wholly or in part from or in connection with the existence of, alterations, maintenance, repair, renewal, reconstruction, operation, use or removal of the encroaching a sewer standpipe as placed upon the PERMITTER'S 60.0 -foot Right of Way. 3. The PERMITTEE shall not assign or transfer any of the rights granted herein to another individual or company without first notifying and securing the approval of the Director of Development Services Department. DocuSign Envelope ID: D7ECC100-FE3C-4811-98EF-C7768EF9F812 4. This Agreement and Permit grants PERMITTEE no interest in PERMITTER'S real property whatsoever, except only the encroachment rights described herein. 5. The PERMITTER reserves the right to revoke this permit upon twenty (20) days written notice to the PERMITTEE. The PERMITTEE agrees upon such notice of revocation, to move said encroachment(s) from the 60.0 -foot Right of Way in which it is placed. Should the PERMITTEE refuse or fail to comply with said written notice, the PERMITTER may, without further notice to the PERMITTEE, remove or cause to be removed the encroachment(s), and the PERMITTEE hereby agrees to reimburse the PERMITTER for all costs incidental to the removal thereof. In addition to the mutual promises heretofore made, the PERMITTEE has paid the PERMITTER a one-time permit application fee of $120.00. The PERMITTER hereby waives the annual fee of $315.00. IN WITNESS WHEREOF, the parties hereto have hereunto set their hands and seal the day and year first hereinabove written. GRANTEE: FS DocuSigned by: LV6V, b xxU�c Cts ��F4 Owner DocuSigned by: 1 77l S laf-- Owner GRANTOR: GRANTOR: MUNICIPALITY OF ANCHORAGE Jack L. Frost, Jr. Right of Way Supervisor November 24, 2020 S E Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 s A P F T CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 050-303-28 Expiration Date: 1. GENERAL INFORMATION Complete legal description _EAGLE CREST #l, TRACT A, LT13 Location (site address) _19510 THIRD STREET, EAGLE RIVER AK Current Property owner(s) _WILLIAM REICHMAN Mailing address SAME Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® _ ` Individual Individual Water Storage ❑ Holding.Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ -5-2 ( - 3 15 Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number COSA #S �� I�Z Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE. Engineer's Printed Name MIKE N ANDERSON, PE Date 7/17/18 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for Disapproved. Conditional approval for bedrooms OF 41, lb ,O e /J 49TH P 4 z 'MICHAEL N. ANDERSCPJ �:�•. CCE -9.4'69/ bedrooms, with the following stipulations: By: t-.., 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 blue sheet -10-10-12 doc Legal Deachption�EAGLE CKE3TI-|.TRACT A. LTZ3 A. WELL DATA Well type Private If A, B. or C provide PVVS|D # Date completed 1gTT Sanitary seal (Y/N)Y Total depth _295 Ift. Cased to4U'+_ft. FROM WELL LOG Date oftest 1977 Static water level 283 ft, Well production UK g.p,m. WATER SAMPLE RESULTS: Ifmore than 1septic system iamnthe lot: C(}SAChecklist # —of ___ Structure served by this system Parcel|D:050-3O3-28 Well Log (Y/N)y Wires properly protected (YYN)y Casing height (above ground) _14"± AT INSPECTION Coliform N _EG colonies/100 mL Nitrate 0.148 mg/L 4-19-2018 285 ft. g,p.m. Arsenic: N D ug/L Date of sample: 3-12-18 Collected by: Mike Anderson B. SEPTIC/HOLDING TANK DATA TenhType/Moteha| STEEL Tank size _1250 _gal. Number ofCompartments 2 Foundation cleanout (Y7N)y Depression over tank (Y/N) W Date of pumping Pumper NEVV______ C. ABSORPTION FIELD DATA — 1985 SYSTEM TESTED Date installed 7-14-18 C|eanouts(YYN) High water alarm (Y/N) Y Date installed 1g77 Soil rating (SF/BEDROOyW)12{i- type DEEP TRENCH Length _35.ft. Width 3.0 ft, Gravel below pipe 8.0 ft. Total depth 11.3 ft. Ef[ absorption area 560 *e Monitoring tube.f Depression over field N Date ofadequacy test Results (Pass/Fail) PASS For 4_bedrooms Fluid depth in absorption field before test 78 in VVabar added 600+ gal. new depth _BT___ in. Elapsed Time: 1350 min. Final fluid depth _77 in. Absorption rote >= _GOO___g.p.d. Any rejuvenation treotment(past12mo.)(Y/N&type) N |fyes, give date_____ D. LIFT STATION Date installed "Pump on" level at Datum in Size in gallons Manhole/Access (Y/N) "Pump off" level at in.High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: 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: Building foundation I A'+ Property line 13'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout 100'+ Holding tank 100'+ Manure/animal excrete storage areas 100'+ Absorption field 100' Water main 100'+ Water service line 5'+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line C9 Building foundation 17 Water Service line 25'+ Surface water 100'+ Curtain drain 50'+ (None Known) Wells on adjacent lots 100'+ F. COMMENTS SEPTIC TANK HAS BEEN REPLACED PER THE CONDITIONAL COSA g� SQ e LeA4K-V'� 60 aJ 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 MIKE N. ANDERSON, PE Date 7117/2018 COSA canary sheet_2-6-15.doc Water main 100'+ Driveway, parking/vehicle storage 21'+ OF 41 • ' ° Fj' o: 49TH ••••• •.• • 6 0 0 0 0 6 0 0 0. 0 0 I� �. �� •� MICHAEL N. ANDERSCN CE - PRO address or directions) - ~9510 5rd St~t .~.. WASTEWATER DISPOSAL:, .' .i.~ ~ ~' ,~ g ..~. ~J~ h~'~ -~1 ~x~ he.to and ~ of ~e vali~tion date sho~ ~,- ¢ - ,-' ' '~'~' ~"' --a ~*~ ~,~,~ ~-d ~ heroin; I ~her~d~ ~at ~ on the info~atlon obtain~ ~om ~ 't 'v' ,, ~ ' (' ' ~e Mun c ~ ~ of An~o~ ~1~ ~d from my In~i~adon a~ ins~io~, .... ~ ~: :~!~ - Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescHption:~.l..Z..-ST,Cr...~, c~h<.,~u.~.~,/Pameli. D' O.~O "50-3 ~.~ A. Well Data Well type 1~.~ d ~c- Log presen~) ~ Total depth .~c~' ' Sanitary seal ~N) FROM WELL LOG Date of test Static water level '~-~ Well flow Pump level1 ~)t/''' If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~, ~"/'J Driller .Cased to ~ o ~ ~' Casing height Wires properly protected~h~l) ~ AT INSPECTION g.p.m. ~"l ?,.-'t'' SEPARATION DISTANCES FROM WELL TO: Septic~,,c!~'~g tank on lot Absorption field on lot \ Public sewer main Sewer sen/ice line ,,~.~.~ ~c:~ ~ '~' ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform (:~ .Nitrate Date of sample: ! ~- - ~ .~"~ ~/' ~, ~, ~ Other bacteria Collected by: --("~/~ ~','~'4~--. B. SEPTIC/H~EBtN~ TANK DATA Date Installed ~ ~3 '/ Tank size 12-~'c:> Comparfments ~- Cleanouts (~N) ~ Foundation cleanout ~1) ~// Depression (Y,~ High water alarm (Y~ ~ Alarm tested (Y/N) ~ I,a' Date of pumping ~'-'~.'& ~ Pumper ~ t~v~ SEPARATION DISTANCES FROM SEPTIC/H4;)LC~';G-TANK TO: Well(s) on lot \ o,:. t J~ On adjacent lots ~ =::,c::, t'~Foundation To property line t ~ ~ ~' Absorption field ~ t ,Water main/service line Surface water/drainage ~ .~, m. 72-e2s (~3}' ~=~t CONTINUED ON BACK PAGE C. UFT STATION Date installed ' ,Manufacturer Size in galIons Manhole/Access (YIN) Vent (YIN) , 'Pump on' level at High water alarm level ..~.~ycles tested Meets MOA electrical cedes (YIN) SEP STATION,TO: ' Onadiac nt,o Su'ace water D. ABSORPTION FIELD DATA Date installed :Total absorption area Date of adequacy test Soil rating (GPD/Ft~) t'/'~'~/g'~- Systemtype ~4.~ Width '~l ~ ' Gravel thickness .5'¢0 ~C,~_. Cleanoatpresent,.~d) y ~ ~..~ 3.x~ .-~ ~ Results ~fail) ~,~ ,Water level in absorption field before test I/~" ,After test 'Peroxide treatment (past 12 months) (Y{~j~ ~ o~.~. ~ o ~J ,.[ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: ~' Total depth Depression over tiald (Y~ for ~ Bedrooms Well on lot To building foundation On adjacent lots Surface water Curtain drain /-~'~ On adjace, nt lo, ts I ~ ~ ~'~ Property line t ~' ~ .I- ' ' '~ To existing or abandoned system on lot Cutbank__ ~ I ~ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I cerb*Fy that. I have...,?~//' checked, /.~verified':~///~ or~coofcn'ned ~ /~ to all MOA . _, and HAA guidelines [' ~J; ,~;"c~' in..'Y.~"..~:';J~' ~/eff~'~a~f .....' .w,~ ............ '"':'"~'.'~ ~ '~¥' ~' '~*-';" ];'~,~ A ,~t.~*~- ".,'~,:' '.,,...~ this ~.~ '~ ,- ~ insl:~c~on...., Date :...... ,) ,..'j-,o-.,: ,.,~o"' ~ 72-~6 (3~3)' Back Waiver Fee $ Date of Payment ~ ~ Receipt Number DEPARTM[ /OF HEALTH AND ENVIRONMEN.~ PROTECTIONL~.,,- 825 L Street, Anchorage. Alaska 99501 264-4720 Date Received: January 27, 1978 %1: Time 1:30 p.m. 92: Time %3: Time Date 1-31-78 Tuesday Date Date Insp Pratt Insp Insp e e Se REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Lending Institution Request: First National Bank of Anchorage Mailing Address: Post Office Box 720 99510 Phone: Property Owner: Ned Severson Mailing Address: Box 152 Citation Road 99577 Phone: 694-9874 Legal Description: Lot 23 Tract A Eagle Crest Subdivision Single Family Residence: ~) Number of Bedrooms: Four Multiple Family Residence: ( ) Number of Bedrooms: Well System: Individual well (x) Community/Public System ( ) Permit # 77053 Depth of Well 295' Well Log on File Construction Bacterial Analysis 6. Sewage Disposal System: ( ) e Permit # 77053 Septic Tank Size Absorption Area. On-site System ~) Public Utility ( ) Installed 1977 Installer R.B. Woods 1,250 gallons Manufacturer Soils Rate Material Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line Dbpartment of Health and Environmental Protec,~z'on..,: 825 L Street, Anchorage, Alaska .99501 264-4720 ~'~ ..... "-- ,quest for Approval of Individual Sewer and 1, Property Owner: ~/ Mailing Address: ~ /~ ~Y~~~. Phone: 2. Name of Buyer: &~R Mailing Address~ Phone: 3. Lending Institutio~: Mailing Address: Phone: e Realtor/Agent: ~ ~~ ~F~ Mailing Address: ~ ~. 7~~ Legal Description: ~ ~.~ Street Location: 3 ~ ~, Phone: Se Single Family Residence: (~) Number of Bedrooms: ~ Multiple Family Residence: ( ) Number of Bedrooms: Water Supply: *Individual Well (~) If Individual Well, well depth ~uz- If community System, name of System Public/Community System ( J Sewage Disposal System: *~n-site System (~) Public System ( ) If On-site System, date of installation: *NOTE: A well log is required on ALL wells drilled since 6/$5. ** If on-site sewer system is over two(2) years old, an adequacy .test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77 ~age 'Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 23 Tyact A Eagle Crest Subdivision Comments: Affadavit Attached: Disapproved :, Letter Attached: Date: ~----/~/~ Date: Department Worksheet: ~ECEIPT FOR CERTIFIED MAIL~O¢ (plus postage) SENT 10 --~V[~-~O ADD~E~f~ONL¥ .................................................. SOd PS Fo-- 'IlO INSURANCE COVERAGE PROVIDED-- Apr. 1971 3800 NOT FOR INTERNATIONAL MAIL (See erie,