Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
HomeMy WebLinkAboutHIGHLAND HILLS #2 BLK 2 LT 7Hilond Hills
Block
Lot 7
#050-382-38
Municipality of Anchorage
On-Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP201208 PID Number: 050-382-38
Dwelling: X Single Family (SF) El with ADU 1771 Duplex (D) El Two Single Family Project: FI New NO] Upgrade
Name
O'NEIL THOMAS & PATRICIA
ABSORPTION FIELD
1771 Deep Trench F-I Wide Trench FE11 Bed E] Mound
Site Address
5823 Hiland Rd Eagle River
El Other
Phone
Number of Bedrooms
Soil Rating
depth from original grade
1 3
0.5 GPD/SF
JTotal
+3.6 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
+4.1 Ft.
Gravel depth beneath pipe
0.5 Ft.
Subdivision Block Lot
HIGHLAND HILLS #2 2 7
Fill added above original grade
7.6 Ft.
_Gravel
Gravel length
45 Ft.
Township Range Section
width
20 Ft.
Beds: Number of Lines
5
Distance between lines
4 Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
on
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
900 FI?
Ft.
Well
NA
>100'
NA
NA
TANK 0 Septic 0 S.T.E.P. El Holding El Other
Manu�
f�t
Capacity
Surface Water
NA
>100'
NA
NA
Gal,
Material
Number of compartments
Lot Line
NA
>10
NA
NA
NA
Foundation
NA
>10'
NA
NA
LIFT STATION
Manufacturer
acity
Remarks 2' of MOA filter sand below septic rock
Gal.
MASS Type I [A ERS below filter sand, thickness varies
Alarm location
Electrical installe
PIPE MATERIAL House totank Tank to 3034
drainfield
Installer
homeowner
Drainfield 3034 CO/MT3034
Inspector Curtis Townsend
BENCH MARK (Assumed elevation) 100 ft
Inspdates:ection 1st 7/17/2020 7/22/2020
�d
Location and description
2
3`d 7/23/2Qj '4 1h 7/27/206
nail in tree near bed construction
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval: Date
- -
;:Fat-- - -
TH
......n.........
rbsq- T .s
Date 7-
No. CE11 04 4",
Septic System
Approved Date
PROF
Note: this approval does not include well permit requirements.
kF\"-v !01
T Lot 8B
NEIGHBORING WELL IS >
100' FROM PROPERTY
LINE
THE SEPTIC TANK IS ON A
BENCH LOCATED HIGHER
THAN THE PROPOSED
SEPTIC FIELD
I
G
v�
ABANDONED 58' L x 30"
W x 48" TRENCH
I A N
1500 GAL STEEL SEPTIC
TANK INSTALLED 2017
a
FCO UNDER
DECK
DESIGN PARAMETERS
BEDROOM: 3 (450 gpd)
SOIL RATING: 300 SF/BR
AREA REQUIRED: 900 S.F
SYSTEM TYPE: BED
20' X 45' YIELDS 900 SF
xW 1
C�
to O
Tn
0
0
100'
NEIGHBORING SEPTI
IS > 10' FROM
PROPERTY LINE
EXTENT OF AREA FLATTENED
BY HOMEOWNER TO
ACCOMMODATE A
GREENHOUSE AND GARDEN
100'
20' L x 45' W x 6"
EFFECTIVE DEPTH BED.
BM MONITOR TUBES IN TWO
CORNERS, AND CLEAN OUTS
AT EACH END OF THE
PERFORATED PIPES
NEIGHBORING SEPTI
IS > 10' FROM a
FLAT PROPERTY LINE /
TOE OF MOUND
GAR AGE
SCOPE OF WORK
1. BASED ON A PERCOLATION TEST PERFORMED IN JUNE
2020, A 20' x 45' BED WAS CONSTRUCTED.
2. THIS BED IS WIDER THAN 15'. SPECIAL CONSIDERATION WAS
GIVEN DURING CONSTRUCTION TO ENSURE THE BOTTOM OF
THE BED WAS NOT TRAVELED ON BY EQUIPMENT TO AVOID
COMPACTING RECEIVING SOILS.
3. ALL CONSTRUCTION WAS IN ACCORDANCE WITH ALL
REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE
CHAPTERS 15.55 AND 15.65.
5eptic As Built Drawings Prepared for
PATRICIA AND THOMAS O'NEIL
5823 Hiland Road Eagle River, Alaska 99577
HIGHLAND HILLS UNIT 2 BLOCK 2 LOT 7
EKLUTNA ENGINEERING, LLC
19162 MOUNTAIN ROAD
CHUCIAK, ALASKA 99567
(907) 355-9820
OSP201208
DATE: 7/29/2020
DRAWN: CLT
SCALE: 1" = 50'
PID: 050-382-38 SHEET 2 OF 3
ONCE VEGETATION WAS
CLEARED FOR THIS PROJECT,
THE TEST HOLE LOCATION
\
WAS MORE ACCURATELY
DETERMINED IN RELATION TO
THE BED
r
D
r
W
NEIGHBORING SEPTIC
AREA >10' FROM
PROPERTY LINE
NEIGHBORING
X
WELL RADIUS
r�
0
SCOPE OF WORK
1. BASED ON A PERCOLATION TEST PERFORMED IN JUNE
2020, A 20' x 45' BED WAS CONSTRUCTED.
2. THIS BED IS WIDER THAN 15'. SPECIAL CONSIDERATION WAS
GIVEN DURING CONSTRUCTION TO ENSURE THE BOTTOM OF
THE BED WAS NOT TRAVELED ON BY EQUIPMENT TO AVOID
COMPACTING RECEIVING SOILS.
3. ALL CONSTRUCTION WAS IN ACCORDANCE WITH ALL
REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE
CHAPTERS 15.55 AND 15.65.
5eptic As Built Drawings Prepared for
PATRICIA AND THOMAS O'NEIL
5823 Hiland Road Eagle River, Alaska 99577
HIGHLAND HILLS UNIT 2 BLOCK 2 LOT 7
EKLUTNA ENGINEERING, LLC
19162 MOUNTAIN ROAD
CHUCIAK, ALASKA 99567
(907) 355-9820
OSP201208
DATE: 7/29/2020
DRAWN: CLT
SCALE: 1" = 50'
PID: 050-382-38 SHEET 2 OF 3
CONNECT TO EXISTIN(
SEPTIC TANK
ORI(
MARK
A
B
MT1
74'-6"
50'-0"
MT2
108'-10"
88'-8"
C01
91'-6"
66'-5"
CO2
94'-5"
76'-5"
)P OF FINISHED GRADE 104.6', TO
\INTMN 3' MINIMUM COVER OVER BED.
DE SLOPES MINIMUM OF 3:1. THE
?EA HAS BEEN TOPSOILED AND
-EDED
PE INVERT 101.1'
DTTOM OF SEPTIC ROCK 100.6'
LAYER OF MOA APPROVED
_TER SAND, BOTTOM OF SAND
98.6'
.L ORGANIC MATERIAL WAS
=MOVED TO EXPOSE
3SORBING SOILS THEN ERS
_L WAS IMPORTED.
ST HOLE ELEVATION 96.2'
---- ADJUSTED WATER LEVEL 95.5'
27 JUNE 2020 WATER LEVEL 94.5'
BOTTOM OF TEST HOLE ELEVATION 92.1'
TEST HOLE DUG JUNE 18, 2020
WATER LEVEL MONITORED TILL JUNE 27, 2020
SCOPE OF WORK:
1. PRIOR TO CONSTRUCTION A TEMPORARY BENCHMARK WAS ESTABLISHED. THE
BENCHMARK IS A NAIL IN THE SIDE OF A TREE NEAR THE BED CONSTRUCTION
SITE. THIS BM WAS USED TO ESTABLISH ELEVATIONS FOR THE PROJECT. ORIGINAL
GRADE ELEVATION WAS ESTABLISHED AT THE SITE OF THE TEST HOLE. THIS
BENCHMARK WAS NOT DISTURBED THROUGHOUT THE LIFE OF THE PROJECT.
2, ALL SURFACE ORGANIC MATERIAL WAS REMOVED UNDER THE BED AREA, AS WELL
AS THE EXTENTS OF THE MOUND OUT TO THE TOE OF MOUND AS SHOWN ON
SHEET 2.
3. ENGINEERED RECEIVING SOILS (ERS) WAS IMPORTED TILL THE ELEVATION OF THE
BOTTOM OF SEWER ROCK WAS REACHED. ERS WAS MASS TYPE II OR II—A.
4. SEWER ROCK AND PERFORATED PIPE WAS LAID LEVEL. THE BOTTOM OF SEWER
ROCK IS 5.1' ABOVE THE WATER ELEVATION AFTER THE CONCLUSION OF THE 7
DAY WATER STUDY.
5. FILL TO A DEPTH OF 3' ABOVE SEWER ROCK WAS PROVIDED. SIDE SLOPES ARE A
MINIMUM OF 1:3. TOPSOIL COVER HAS BEEN SPREAD AND GRASS SEEDING WAS
DISTRIBUTED TO PROVIDE VEGETATION.
Septic As Built Drowings Prepared for
PATRICIA AND THOMAS O'NEIL
5823 Hiland Road Eagle River, Alaska 99577
HIGHLAND HILLS UNIT 2 BLOCK 2 LOT 7
EKLUTNA ENGINEERING, LLC
19162 MOUNTAIN ROAD
CHUGIAK, ALASKA 99567
(907) 355-9820
OSP201208
DATE: 7/29/2020
DRAWN: CLT
SCALE: 3" = 1'
PID: 050-382-38 SHEET 3 OF 3
OF q�� �♦1
49T" ♦10
„
CURTISTOWNSEND.-ff
1
No. E 1 904 i
•
♦♦iww� Z9l �?:
ΔSURVEYOR'S CERTIFICATE
MUNICIPALIry OF ANCHORAGE
On-Site Water & Wastewater prograrr
PO Bor 196650 4700 Etmore RoadAnchorege, Arasl(' 99919-66q0 phone: (907) 94e"7904 Fax: (907) g43-7gs7
http:/1www. runi,org/onsite
On-$ite \Alastewater Disposal System permit
Permit Number: OSp20120g
Work Type: Septic Upgrade
Tax Code Number: 0503829S000
site Legal Address; HTGHLAND H|LLS #2 BLK 2 LT z G:0s58
Site hllailing Address: SB23 HILAND RD, Eagle River
Owner: O'NEIL THOMAS E & pATRtCtA
Design Engineer: HKLUTNA HNGINEERING, LLC-
This permit is for the construcfion of:
M Disposar Fierd H septic Tank fl Hording Tank E erivy
Received By:
E Private Wetl fl Water $torage
n^1^.udtu.
n ^+^.ud(9,
Effective Date:
Expiration Date:
Lot Size ln So Ft:
Total Bedrooms:
7t16{2020
7/16/2021
928'19
All construction shall be in accordance with:
4. From October 15 to April 15, a subsurface soil absorp
shail be elther:
a. Opened and Closed on the same day, or
. b Covered, sealed, and heated to prevent freezing
special Provisions: since ihe groundwatermonitoring tube is less than 5 ft from the proposed drainfield, it shallbe removed at the time of drainfield construction in ordir to not create " "onorit to-troundwater. please takethis into account when establishing the benchmark.
.t , ,: . '-it:: .'7'.: :''
uf z.u,
7
eparnlle n t
lssued By:
Municipality ®f Anchorage
P.O. Box 196650 ® 4700 Elmore Road
Anchorage, Alaska 99519-6650 e (907) 343-7904 a Fax (907) 343-7997
http://www.muni.org/Onsite
Development'Services Department
On -Site Water and Wastewater Section
\�\Cllf
^ i/V H
Department
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#: OSV201040 COSA#: Permit#:OSP201208
PID#: 050-382-38
Legal Description: Highland Hills #2 Block 2 Lot 7
Engineer: Eklutna Engineering
Applicant: Thomas & Patricia O'Neil
Your request for a waiver of the required Category III Nitrogen -reducing system for an ERS
design has been approved. See engineer's waiver request for justifications.
This waiver approval applies to the proposed absorption field only. Any future upgrade to the
on-site wastewater disposal system will require all code requirements be met or another approval
from this department.
............................................... ■ ............................. ■ t
Waiver is Granted: X Waiver is not Granted:
Date: 1 b Approved by:
'Name of Reviewer
......................................'........................................ t
**** VARIAN C E/WAIVER REVIEW ****
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 050-382-38-000
Property owner(s) O'NEIL THOMAS E & PATRICIA
Mailing address PO Box 773174 Eagle River AK 99577
Site address 5823 Hiland Rd Eagle River AK
Day phone
Legal description (Sub'd., Block & Lot) HIGHLAND HILLS #2 BLK 2 LT 7
Legal description (Township, Range & Section)
Lot Size 92,819 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(N all that apply)
Absorption Field 0 Initial ❑
Single'F SF) 0
Septic Tank ElUpgrade 0
(/wo ADU
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 Gde,§. ;
(Signature of properVowner or authorized agent)
Permit/Rush Fees:
Date of Payment: 30 2620
Receipt Number: 00 33 &b -
Permit No. C S P_ 01009
2, W2, z-,
Waiver Fees: 1� 81, 1 5 _
Date of Payment: 7 ZO 20
Receipt Number: 0'7%59 72,
Waiver No. 0S V Z0.'( 0 y 0
G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201208, Rebecca Carroll, 07/16/20
Name: Eklutna Engineering Lab ID#: M200392
Mailing Address: 15162 Mountain Rd Date Sampled: 05/12/2020
Chugiak, AK 99657 Time Sampled: 1430
Legal Description: Highland Hills #2 B2 L7 Sampled By: CLT
Date Received: 05/13/2020
Sample Site Location: Inside Bathroom Sink Time Received: 1041
Health Guard I
Parameter Method Result Unit MRL MCL Date
Total Coliforms Colilert
(SM 9223B) A --- --- --- 05/14/2020
E. coli Colilert
(SM 9223B) A --- --- --- 05/14/2020
Total
Nitrate/Nitrite – N
TNTplus 835/836
(Hach 10206) 1.84 mg/L 0.200 10.0 05/15/2020
Arsenic Arsenic by ASV
EPA 7063 6.565 µg/L 1.000 10 05/13/2020
Method Reporting Limit (MRL): the lowest concentration that can be reported reliably
Maximum Contaminant Level (MCL): highest acceptable level in public water systems as set by EPA
mg/L: milligrams per liter; 1/1000th of a gram
µg/L: micrograms per liter; 1/1,000,000th of a gram Absent (A): none of this type of bacteria was detected
Present (P): one or more bacterial cells of this type were detected
Results Reported By:
_____________________________
Patience Lynch
Laboratory Analyst
Reviewed By:
9131 E Frontage Rd, Ste 15
Palmer, AK 99645
(907)745-3005
matsutestlab.office@gmail.com
Signature:
Email:
Lynne Hill (May 20, 2020 16:29 AKDT)
Lynne Hill
matsutestlab.office@gmail.com
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201208, Rebecca Carroll, 07/16/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201208, Rebecca Carroll, 07/16/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201208, Rebecca Carroll, 07/16/20
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org
Septic System Owner-installer Agreement
The On-site Water and Wastewater Section (On-site) may issue an approval for a homeowner
to perform work on an on-site wastewater disposal system to serve that individual's owner-
occupied, single-family or duplex home if the homeowner meets and agrees to the following
requirements:
1. The property owner and excavation equipment operator may perform work on no more
than one owner-installation project in a 12-month period.
2. Owner’s projected active involvement with the installation:
_______________________________________________________________________
_______________________________________________________________________
3. The name of the excavation equipment operator: ________________________________
4. I agree that there will be no monetary compensation for installation services rendered.
5. The name of the inspecting engineer: _________________________________________
6. I agree to discuss the following items with the inspecting engineer:
a. Permit design criteria and specifications.
b. Inspection requirements set forth in AMC 15.65.070.
c. Advance notice given to the On-site Water & Wastewater Section for all required
municipal inspections (AMC 15.65.070A).
7. I agree to have the project-specific On-site Wastewater Disposal System Permit available
at the construction site for the duration of all related work.
8. I agree that if the system is an advanced wastewater treatment system (AWWTS), I will
obtain additional installation instructions and approval from the equipment distributor.
As owner of (legal description) ________________________________________________
I agree that the information above is true and accurate.
Owner’s printed name: _________________________
Owner’s signature: _________________________ Date: ________________
Complete installation of the septic bed as required by the MOA permit.
Thomas O'Neil
Curtis Townsend
TEO
07/17/20
12:42 PM AKDT
dotloop verified
TEO
07/17/20
12:42 PM AKDT
dotloop verified
TEO
07/17/20
12:42 PM AKDT
dotloop verified
HIGHLAND HILLS #2 BLK 2 LT 7
Thomas O'Neil
07/17/2020dotloop verified
07/17/20 12:42 PM
AKDT
Thomas E O'Neil
dotloop signature verification: dtlp.us/6WZF-xDrm-D3cE
30' i 30' 1 :_ ii r :::?, r=r 4. i:,,.
1 20' I —20' WIDE
S 890 39 07" W 202.42' I j SKI TRAIL
l EASEMENT
1 10' WI
I
\ \ I UTILI
\ I EASEM
I
i ` I
I
\ O LOT 7
SEPTIC
h q PIPES
X s
0 0 @ ��G
�� d)
C -*)I cp,
O IIm,
PP 1,,\
1jE\
2Z
-50.0�l GAS RAMPMETELE W00(TE��' 24BoGARAGE —
36 3'x28.2�
N n I \\ ® I
I � I
I I
� a 1
m
I
a M II CAR
I I
I i I O SHE
20 L.�_ 20' WIDE m
I i DEPT. OF - '
—ll— I HIGHWAYS -
II EASEMENT _
I I I
o I I
W I I
I I I
� I I
I I
� 1 I
I
I I N 890 34 ' 50 " E 2
30' I 30 I
11
7 Al
SURVEYOR'S CERTIFICATE
I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY AS
DESCRIBED ON THIS EXHIBIT 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 ON THE SURVEYED PREMISES AND THAT
THERE ARE NO ROADWAYS, TRANSMISSION LINES, OR OTHER
VISIBLE EASEMENTS ON SAID PROPERTY EXCEPT AS INDICATED
HEREON.
DATED THIS THE �� DAY OF
AT ANCHORAGE, ALASKA.
li i I
DE —eJIO I NOTE: DIMENSIONS SHOWN ARE ALASKA
II
3/.97'
TY ; ; II STATE
PLANE COORDINATE SYSTEM,
ENT 1 I NAD83,
ZONE 4, GRID BEARINGS AND
DISTANCES.
LOT 7, BLOCK 2
II 'i A II
li
HIGHLAND HILLS SUBDIVISION
(3,I
''I 111 I'I
UNIT NO.
Ili 1 I
°°°
1 I
PREPARED BY:
li ,
GRID:
tloning
�`"
Ill ; I
1 I
7'—I, I
— ervloss Ino.
-_
DRAWN BY:
CHECKED BY:
2603 Blueberry Road
L. LAMAS
L VAUGHAN
Anchorage, Alaska 99503
DATE DRAWN:
, I
907-569-2000 PHONE
,
AN -TO I� 1 I
5/1/2020
D SHED
X 12' II '; II
LEGEND
,
PRIMARY MON. RECOVERED
_---91.7 �� I ; 1 II
• REBAR RECOVERED
WELL
0 SEPTIC PIPE
P -- OVERHEAD POWER LINE
CULVERT
PORT -
;/;
OF
20' WIDE 20
I ,;
G3
SKI TRAIL i
'
I
'I rr$ °
j *�48- *�I
EASEMENT I';
/ °°8°°°
iiio
LINDSEY S. VAUGHAN o o
LS -12318
0
AVgJ-
,1
10' WIDE —�IIIO 1
UTILITY 11 i
II ��A °�� Aw
R01
0FESsIONAL
EASEMENT
I Aw
I
I
I
I
I
IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE
EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
N0. REVISION DESCRIPTION
BY
I DATE
AS -BUILT
LOT 7, BLOCK 2
HIGHLAND HILLS SUBDIVISION
UNIT NO.
2
PLAT NO. 74-14 - ANCHORAGE RECORDING DISTRICT
PREPARED BY:
SCALE:
GRID:
I" = 60'
ER SW0558
AA
CTLORA1. l-OSITIONING SERVICES mc.
DRAWN BY:
CHECKED BY:
2603 Blueberry Road
L. LAMAS
L VAUGHAN
Anchorage, Alaska 99503
DATE DRAWN:
SURVEY WE
907-569-2000 PHONE
5/29/2020
5/1/2020
907-569-2002 FAX
JOB NO:
SHEET:
S20501
I OF I
Municipality of Anchorage 7307 -
On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP-171127 PID Number: 050-382-38
Dwelling: ❑■ Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑■ Upgrade
Name:
Thomas and Patricia O'Neil
A ORPTION FIELD
ED Dee Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
5823 Hiland Road, Eagle River 99577
Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
9076225823
3
D/sF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original de
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
Highland Hills 2 2 7
Fill added above original grade
Ft.
G lel length
Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Dis ce between lines
Ft.
SEPARATION
DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between nches
From
Tank
Field
Tank
Line
Ft'
t.
Well
100+
-
_
_
_
TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Greer Tank 11500
Capacity
Gal.
Surface Water
100+
-
-
_
Material
Steel
Number of compartments
2
Lot Line
5+
-
-
-
NA
Foundation
5+
_
-
_
L STATION
Manufactu
Capacity
Curtain Drain
None
Known
Gal.
RemarksTank Replacement only
Pump on level at
in.
Pump evel at
in.
High water alarm at
in.
Pump make and model
Electrical Inspectio erformed by
PIPE MATERIAL House to tank Tank to D3034
drainfield
Installer
Territory North
Drainfield CO/MT
Inspector Luke Randall, P.E.
BENCHMARK (Assumed elevation) 100.00 ft
Inspection 1't 6/30/17
Location and description
2
Middle Deck Pier Support between points A&B
s� 4th
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
Conditional Approval: Date
OF 44-44
.`�
49TH
�••f-•
.............................,....
'• Lucas M. Randall
Approved Date `!� �0l
`' ��• CE 12595
�' s
Inspection Report_9-1-12.doc „,;�,°'
PERMIT NO: OSP171127 LOT 813
PARCEL ID: 050-382-38
n
Q
O
ry
z
J
r — — — — • — — • — — • — — .— — • — — • — — . _
I PROPERTY LINE NOTE:
1. ALL REQUIRED SEPARATION DISTANCES
FOR THE NEW SEPTIC TANK WILL BE FIELD
VERIFIED AND ENFORCED AS PER MUNI
REQUIRMENTS.
DESC
A
B
FCO
8.8'
18.7'
COt
27.7'
34.5'
Ti
30.5'
37.1'
T2
40.5'
46.9'
DBL1
42.6'48.8'
DBL2
44.0'
50.3'
DBL 2
DBL 1
T2
Ti
/
I ,
I PROPERTY LINE
1
I
I
I
I I
I
i
I
l
1 \
I \
\
I \
i LOT 12
\ FCO NOTE: LOT 7
h �1. POINT A AND B ARE THE OUTSIDE North
{ \ \ \I CENTER OF THE OVERHANG COLUMN
SUPPORTS
A EXISTING 3 BEDROOM HOME I
7 1 I \EXISTING GARAGE LOT 13
�! WELL 1 ♦!'`�F.......
AV .
i*�..4�1 *it
I
{ I \ I 00 .......:.... .........
I...
{ 0,�'� :
Luca, M. Randall ; ��
1 595 Aw
AV
Aw
RO ESS
10' T&E EASEMENT '
\ 1 7• I
100' RADIUS FOR WELL DISTANCE 1
l EDGE OF DRIVEWAY
DETERMINATION (TYP.) I
THOMAS AND PATRICIA O'NEIL SCALE: 1"= 40'
AS -BUILT RECORD LOT 7, HIGHLAND HILLS 2, BLK2
SEPTIC TANK REPLACEMENT
LMRJ SHEET
LMR w
MA 1
9/19/17
PERMIT NO: OSPI7112-7
TOP OF TANK AT INLET
012.68 —
2" R1610 INSULATION
INVERT OF BUNG
AT INLET
62.05
NOTE:
1. ELEVATION BASED ON TBH -
PECK PIER = 100.00
PARGEL ID: 050-552-38
FINISHED &RADE
Q6. -Io
TOP OF TANK AT OUTLET
012.52
__It---- -------------------------------------------
NEN 1500 OALLONINVERT OF BUNG
STEEL T/ AT INLET
I \_ ql.bq
THOMAS AND PATRICIA O'NEIL
PREPARED LMR
SHEET
AS -BUILT RECORD
LOT 7, HIGHLAND HILLS 2, BLK 2
REVIEWED MA
SEPTIC TANK REPLACEMENT
DATE
7/11/17
MUNICIPALITY OF ANCHORAGE �„t
On-Site Water& Wastewater Program
PQ Box 196650 2.700 Elmore Road
., Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
httpalwww.muni.org/onsite
cpartrnent
On-Site Wastewater Disposal System Permit
Permit Number: OSP171127 Effective Date: 6/19/2017
Work Type: SepticTank Upgrade Expiration Date: 6/19/2018
Tax Code Number: 05038238000
Site Legal Address: HIGHLAND HILLS #2 BLK 2 LT 7 G:0558
Site Mailing Address: 5823 HILAND RD, Eagle River
Owner: O'NEIL THOMAS E & PATRICIA Lot Size in Sq Ft: 92819
Design Engineer: Total Bedrooms: 3
This permit is for the construction of:
❑ Disposal Field E Septic Tank ❑ Holding Tank 0 Privy 0 Private Well 0 Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72)and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: Date:
Issued By: "'e�',(��i (2.'L&'( Date: ►o t 7
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On-Site Water& Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 050-382-38
Property owner(s) Thomas and Patricia O'Neil Day phone 9076225823
Mailing address PO Box 773174, Eagle River AK 99577
Site address 5823 Hiland Road, Eagle River 99577
Legal description (Sub'd., Block & Lot) Lot 7, Block 2, Highland Hills#2
Legal description (Township, Range & Section)
Lot Size 92819 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
( all that apply)
Absorption Field ❑ Initial ❑ Single Family (SF) ❑X
(w/wo ADU)
Septic Tank ❑X Upgrade ❑X
Duplex (D) ❑
Holding Tank ❑ Renewal ❑
Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: S9/5.190 Waiver Fees:
Date of Payment: (0110/0 Date of Payment:
Receipt Number: 035378 Receipt Number:
Permit No. OSP I Waiver No.
Permit App_ • • : ..
LOT 8S /
I /
. - - . - - - - - . - - • - - • - - • - - • — � Ir,
/
I/ PROPERTYLINE NOTE: 1 r
I.ALL REQUIRED SEPARATION DISTANCES 1 /
FOR THE NEW SEPTIC TANK HILL BE FIELD 1 r
I
I
VERIFIED AND ENFORCED AS PER MUNI
REQUIRMENTS. I PROPERTY LINE
I I/11—
I\
I
I1 GOlMT
1
l
. \ • 1 ,
\ 1 `1
\ 1 ,
1
� \ \ 1
n0� � \ ,
IYEXISTING CLEANOUT 4 START OF 1
\ ••
\ ABSORPTION FIELD
Q I INSTALL DOUBLE CLEANOUT 1 `♦
Z I \ \ I NEIN 1,500 GALLON TANK `
J \\ \ ; LOT 12
= I \ SEPTIC LINE LOT -1
1
\\ \ i• - -
\ FOUNDATION CO 1
—
\.-_ \— —_, 1 North
r 1444k
•
N\ I
II��OII
I
// \ EXISTING 3 BEDROOM HOMEI II
•
A 1 S
1 I
//
1 `•
l I
/ \EXISTING GARAGE
/ �T 15
I
l
r .� I
r •
f I HELL 111 *• 4 TH7 * 0
I I I / /
7
\ \ 004 .V¢e: oo .....00
` ; f,013;4 Lucks M. Randall ��
• _..
11 1 I 10'Ta E EASEMENT /a O AOFES` �-+
I'
• IDOT ROH LINE / /
•
I (20'EASEMENT FROM PROPERTY LINE) ,
•
/ 1
i /
`•
I I r / 1
/
1 I /
•
1 — /
1
N — /
/..„/\ - 1
•
100'RADIUS FOR NELL DISTANCE
'` DETERMINATION(TYPE
1 ---.. EDGE OF DRIVEHAY 1
I \ --.------------
PREPARED
LIAR SHEE-
THOMAS AND PATRICIA O'NEIL SCALE: 1"=40'
REVIE LAR
SITE PLAN
LOT 7, HIGHLAND HILLS 2, BLK 2 REVIEWED MA
SEPTIC TANK REPLACEMENT DATE:
6/6/17
NOTE:
I. NEW SEPTIC TANK TO CONFORM WITH ALL REQUIREMENTS
WITHIN CHAPTER 15,SECTION 15.65.050 SEPTIC TANKS AS
WELL AS DEC STANDARDS.
2. IF SEPTIC TANK 15 NOT INSTALLED AT LEAST 4' BELOW THE
EXISTING SURFACE DUE TO EXISTING CONDITION
CHALLENGES, INSULATION WILL BE PROVIDED BY THE
INSTALLER AS PER MUNI REQUIREMENTS.
3. EXISTING TANK SHALL BE DEMO'D AND DISPOSED PER MUNI
REQUIREMENTS.
4. A DOUBLE CLEANOUT WILL BE REQUIRED BETWEEN THE TANK
AND THE ABSORPTION FIELD.
4'MIN(SEE •TE 2
I - ASSUMED EXISTING GROUND
SURFACE
TO EXISTING
ABSORPTION FIELD
NEW 1500 GALLON
STEEL TANK
TO HOUSE
elSEPTIC SYSTEM
PLAN VIEW
ft �•QF •ALSk1
o*• 49 TH *-57 r,/
•
%9�••• Lucas M. Randall ,5:
1j6� CE 1 595 .•• ``�
i
- \ -11%,,
4 -;.:`,.,.
THOMAS AND PATRICIA O'NEIL PREPARED LMR SHEET
LOT 7, HIGHLAND HILLS 2, BLK 2 REVLMR
PLAN VIEW REVIEWED MA
SEPTIC TANK REPLACEMENT DATE
6/6/17
! MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPI=CTION REPORT
'~AME
PHONE
LEGAL DESCRIPTION ~/[ ~/17~ ,~/~ .
~CATION NE. OF BEDROOMS
Well Absorption area / Dwelling PERMIT NO.
~ Manufacturer ~ Material~/
~ ~ No. of compartments
Liq. capacity in gallons Inside length Width Liquid depth
DISTANCE TO: ~ell Dwelring PERMIT NO.
Manufacturer Material Liquid capacity in gallons
Nearest lot line.~ PERMIT NO.
~ DISTANCE TO: /~¢ ~
~Z Nc. of lines Length of eaoh line ,/ Totallength~jne, Trench width DistancebetweeoHne,
~. ~ Top of tile to finish grade / Material beneath tile
~ ~ ~inches Total effective~ ~"-oabs°rpti°a
Length Width Depth PERMIT NO.
~ Type of crib Crib diameter Crib depth Total effective absorption area
DISTANCE TO: Well Building foundation Nearest lot line
~ Class ~ ~ Depth Driller Distance to lot line PERMITNO.
~ DISTANCE TO: Building foundation Sewer line Septic tank
Absorption Crea(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
APPROVED DATE LEGAL
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geologicel Et Geophysicol Surveys
Z WELL. LOG
Material Type
..... UFCOu-~i~ersy sand,
---- .Slack rock
..... O~e.y .L. uck 7,~r-L-im
seams, water
~MUNiC~PAI
DEPT
ENVIRONt
OF HEALTP
~ENTAL PRO'
IS. WAI'ER WELL CONTRACTOR'S CERTIFICATION:
Section Na.
&
'E~qTOlq~
Drilling Permit No.
A.D.L. No.
$. OWNER OF W~LL: ~lr. earl Disotell
Add~o~,: SR Box 9385
Ea~,le River, Ak
,i. WEL.~,EPTH: (Hnol)~ ft. 5. DUE OF_ CSM~LET~~,_ ~-
6. ~Ceblo tool E~Otary C]Driven ~ Dug
7. USE;~ Oomgllic 0 Public Supply [~ industry
~ Irrigoflon ~ Recherge ~ Comm~ricel
~ TO~ Well ~ Othor:
CASING: {'~ Threaded '~ werded
9. FINISH OF WELL;
Typo: Olomoler:
SIot/Maeh Size: Lenglh:
Sot between ft. O~d ft
13ack filling G r <r,'e I pock
Equipmonl used:
II. PUMPING LEVEL below lend surface and YIELD
-- ft. alter bro. pumping g.p.m.
I~'.GROUTING Well Grouted: [] YOl [] No
Malorlol: [] Neet Cement L~ Other:
13. PUMP: (if available) HP
Length of Drop Pipe fl. capacity g p.m
[] su~. [] do~ [] Con,r.~:o, [] O,~or
[4 RE MA~K ~ r~ ~
_.rD ucvzon of 20 G]2H
15. Wafer Tomporalure .... o [] F [] C
This well wes drilled under my jurisdiction and Ihis report is true Io the bee! el my knowledge and belief;
Ma~nuson Drilling AA 5385
~.0 Box '770504 Eagle River~ Ak 99577
1984 _
F:'IERkt ]: ']" NO:
D~'I"E: I!3SLJlED u
rq P F-'I... I CrqN T :',
C[] NT ~E',"I" F:'H [:)lxll!!~ ,",
DIEF~Iq E; [)1\t ,S 'T' I::~ U [.:' T I Q I',1
SIR
t::.f.~(.'.~l...l:: I",. ]. VI::.I"~, Al .... "~ '?,..~77
69z1.'"'c? 11 '7
H I GH LAN D v(pv
SIE[:"r' ]: []1,,1: 28 'I"[]NI",ISI.-I I F:'," J.."IN
2. ()¢'.I (!3(;!,, FrT, [.)1:::: ,~'~C;F(E:S)
'T' IF:;¢ lEE I1"*.11
!:)IEF:'"FH 't"C) F::' 3: F:'[~: E',O'I""I"CIt'I (l::r'l'' ,, ) Zl. ,, 0
GFd.'iVIEL. )Z_)E:F:'TH (1::"1".) 4. ,,
"I"C)'I'~,L. DIEF::"I"I'I (I::'T ,, ) E! ,, 0
C'Fff:;:hVIEL.. I/'J]:DTI'I (F:"I",,) 2..
(3F;~f. iV[...-.I... L.JiZI\I[.iTH (F::"T,) F:~"? ,, 0
[:~I:::~VliF. L.. VE)L..Ut¥Ili!:: (CU ,, Yi)S ,, ) 2~!; ,,
'l"~l',ll< !3]: ZIE (GIM...!3) 1 ~, (X)(),, C) .~..~
SOIl... I::~¢FI*ING (~3[i),, F:I". /BR) :LfSC)
'>~'¢,' TrqNl< i'ILI!iFI'' I'-I~.~VIE AT L. IEAF::;T '1"1,4[:) COI,IF'ART'MEixI'T'S
II,,..~ .... :11], iF::;;::. ~::::'ll % II"ql
::~ ,, '5
7.5
~:~ ,, 0
4?. 0
1, .. 0()(). 0 .~..~.
15 ()
For,'Lh by Ch[~ kluniEil:~a].i.Ly of' ¢~nc:hor'age (Iq[]f./) and 'Lbs:, Si:.a'Le
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
,,~"(' SOILS LOG
[] PERCOLATION
TEST
SLOPE
SITE PLAN
o. 2225-E
JUNE,,'% 197!
A O.O.NDWATER
ENCOUNTERED?
IF YES, ATWHAT
DEPTH?
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PEt:f~OLA~PION RATE /~(~¢' ~d~/r~ (minute~/hrch)
TEST RUN BETWEEN FT AND FT
CERTIFIED BY: i~
DATE:
72-008 (6/79)
MUNICIPALITY OF ANCHORAGE
0
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. 050-382-38
Legal description Highland Hills #2 Block 2 Lot 7
Site address 5823 Hiland Rd, Eagle River
Current property owner(s) Richardson
Expiration Date: 1-18-2023
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for
Comments or advisories:
bedrooms, with the following stipulations:
p
By: L. i Original Certificate Date:/ 2ZZ
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA Approval_June 2022
MUHMPA U7Y OGSHC HO R „ OCA
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 050-382-38
Complete legal description HIGHLAND HILLS #2 BLOCK 2, LOT 7
Location (site address) 5823 HILAND ROAD, EAGLE RIVER, AK 99577
Current property owner(s) ALEC D. RICHARDSON Day phone
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age 5 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ® Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
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 $ 55z Waiver Fee $
Date of Payment lo I& lea
COSA # OSS i L1q 3
c�
9- 5)3U_i L/
Date of Payment
Waiver #
COSA Application 2022.doc
Legal Description: HIGHLAND HILLS #2 BLOCK 2 LOT 7 Parcel ID: 050-382-38
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 1984 Total depth 86 ft
Cased to 29 ft (INTO BEDROCK)
® Sanitary seal is functioning correctly
® Wires are properly protected
Casing height (above ground) 18 in.
Date of flow test for COSA 9/20/2022
Static water level at beginning of test 15 ft.
Well production at time of test 6.2 gpm
Comments
B. TANK DATA
Measured operating fluid level in septic tank 50"
Date of pumping 9/28/2022 i
❑ Required maintenance completed, if AWWTS
Comments: 2017 SEPTIC TANK INSTALLED
D. ABSORPTION FIELD DATA
Which system tested (date installed) 7/2020
® ALL standpipes present per record drawing
Total measured depth from grade 4 ft (max)
Measured depth to pipe invert from grade 3_6 ft (min)
❑ N/A — pressurized field.
❑ Per record drawings, field is insulated.
® Monitor tubes go to bottom of effective.
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
Water storage tank volume NA gallons
Well disinfected for coliform test? ❑ Yes ® No
® Coliform bacteria is Negative
Nitrate 2.22 mg/L ❑ Nitrate less than MRL (ND)
Arsenic 9.02 ug/L ❑ Arsenic less than MRL (ND)
Collected by F
wrs
Date 9/20/22
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 9/20/22
Results E Pass
Fluid depth prior to test 0 in (DRY)
Water added 530 gal
New fluid depth 0 in
Elapsed time <5 min
Final fluid depth 0. in
Absorption rate 450 gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 6 in
Effective depth used 0 in
Effective depth remaining 6 in
Comments/Deficiencies: 2020 SEPTIC FIELD INSTALLED. NO KNOWN FROST ISSUES.
COSA Checklist 2022.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'
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
® Yes
if No
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes
if No
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No
Neighboring Absorption Fields > 100'
Animal Containment > 50' ® Yes
if No
® Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ®Yes
if No
ft
® Yes
if No
❑ 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 Surface Water > 100' ® Yes if No
Tank to Property Line > 5' ® Yes if No ft
Field to Property Line > 10' ® Yes if No ft
Water Main > 10' ® Yes if No ft
Water Service Line > 10' ® Yes if No ft
F. ENGINEER'S COMMENTS
Wells on Adjacent Lots:
Private Wells > 100' ® Yes if No
Community Wells > 200' ® Yes if No
If tank or field is under driveway comment below
ft
ft
ft
ft
ft
ft
ft
ft
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 10/07122
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 & fWGS
COSA Checklist 2022.docx
,�'°!Lq� li
/AW'1&
*: 49 TM ....•:*
�j• '. - Curtis Huffman
(� �'�'•• CE 128991
�%fl'A- . 10/07/22, •F���•�
l�lFOPROFESWO
U!)Vi
MUNICIPALITY OF ANCHORAGE
Development Services Department- Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 050-382-38
1. GENERAL INFORMATION
Expiration Date: ©j sa , a Cu) C
Complete legal description HIGHLAND HILLS #2 B LK 2 LT 7
Location (site address) 5823 Hiland Rd Eagle River AK
Current property owner(s) O'NEIL THOMAS E & PATRICIA Day phone
Mailing address
Real estate agent
PO Box 773174 Eagle River AK 99577
2. TYPE OF DWELLING:
0 Single Family ( w AD
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
0
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 $ 2-10 (_0 U 10
Waiver Fee $
Date of Payment
Date of Payment
Receipt Number
Receipt Number
COSA # ()5G20/3'0_L
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 Eklutna Engineering, LLC Phone 907.355.9820
Address 19162 Mountain Rd Chugiak AK 99567
Engineer's Printed Name Curtis Townsend, PE Date�<- -''ZCI
_a
7H
6. DSD SIGNATURE""""":::
E ate` .
System #1 Approved for bedrooms : oa 2
iy No. CE 11984. a
System #2 Approved for bedrooms ���assioNa�
Disapproved
Conditional approval for bedrooms, with the following stipulations:
OFq�,tlri,�
WATER AND
WASTEEVt'ATER
...i .inn.-. r•- ♦ e
By:���✓ l�'�i�,Q�� Original inal Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
COSA Checklist
Legal Description: HIGHLAND HILLS 92 BLK 2 LT 7
If more than 1 septic system on lot. COSA Checklist # of
A. WELL DATA
■❑ Well log is filed with Onsite (or attached)
Date drilled 1984
Total depth 86 ft
Cased to 29 ft
lA❑ Sanitary seal is functioning correctly
■❑ Wires are properly protected
Casing height (above ground) +12 in.
Date of flow test for COSA 5"21202°
Static water level at beginning of test 19.5 ft.
Comments bedrock starts at 28' depth in well casing
B. TANK DATA
Age of tank(s) 3 years
Tank type/material septic Steel
Measured operating fluid level in septic tank
50"
■❑ Standpipes/foundation cleanout per record drawing
Date of pumping 10 Jul 2020
D. ABSORPTION FIELD DATA
Which system tested (date installed) 7/2020
❑■ ALL standpipes present per record drawing
Total measured depth from grade 4.0 ft (max)
Measured depth to pipe invert from grade 3.5 ft (min)
❑ NIA — pressurized field
❑Q Monitor tubes go to bottom of effective. If not, state
depth into effective
❑ Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comm ents/Deficiencles: new bed installed July 2020
COSA Checklist yellow sheet
Parcel ID: 050-382-38
Structure served by this system
Well production at time of test 5.4 gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes 0 No
0 Coliform bacteria is Negative
Nitrate 1.84 mg/L ❑ Nitrate less than MRL (ND)
Arsenic 6.565 ug/L ❑ Arsenic less than MRL (ND)
Collected by Curtis Townsend
Date of Sample 511212°20
C. LIFT STATION
❑ Required maintenance compl
Age of lift station y
Lift station materia
Comment
Adequacy test date
Results ❑ Pass For bedrooms
Fluid depth prior to test in
Water added gal
New depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
Any rejuvenation treatment (past 12 months)
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'
EJ
Yes
Community Sewer Manhole/Cleanout > 100'
❑Q Yes
if No
ft
0 Yes
if No
Neighboring Tank > 100' ❑✓ Yes
if No
ft
Private Sewer/Septic Line > 25' ❑Q Yes
if No
Absorption Field on Lot? 100' ❑Q Yes
if No
ft
Holding Tank? 100' Yes
if No
Neighboring Absorption Fields > 100'
Yes
if No
Animal Containment? 50' Yes
if No
❑Q Yes
if No
ft
if No
ft
F. ENGINEER'S COMMENTS
Manure/Animal Excreta Storage > 100'
Community Sewer Main? 75' ❑Q Yes
if No
ft
Z Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ❑Q Yes if No ft Surface Water > 100'
Property Line > 5' ❑Q Yes if No ft Wells on Adjacent Lots:
Absorption Field > 5' 0 Yes if No ft Private Wells > 100'
ft
ft
ft
ft
ft
Q Yes if No ft
0 Yes if No ft
Water Main > 10' Q Yes if No ft Community Wells > 200' ❑✓ Yes if No ft
Water Service Line > 10'[]✓ Yes if No ft if septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
EJ
Yes
if No
ft
If absorption field is under driveway comment below
Property Line a 10'
❑Q
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'
❑✓
Yes
if No
ft
Community Wells > 200' Yes if No ft
Surface Water > 100'Q❑
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that 1 have determined through field inspections and review
of Municipal records that the above systems are in conform,,
MOA COSA guidelines in effect on this date. �pF k,Ak �
COSA Checklist yellow sheet
ENGINEER`S
STAMP
*:'49 aL
*.
.... .. ...........
.
�Alp
I •' Rata
.C
pROFES
M,—
ENGINEER`S
STAMP
Municipality of Anchorage
Development Services Dej3aHment
Building Safely Division
On-Sile Waler and Waslewa~er Program
4700 South Bragaw St,
P,O, Box 196650 Anchorage, AK 995t9-6050
www.cl.anchorage,ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
ParcelI.D. 050-382-38
1, GENERAL'INFORMATION
C~mplele, legal descripUon Ln r 7;
Location (site address or directions) 5823 Hilafld ' Road
~bn:entPropertyowne~'({)' Tom & Judy CraiR
Expiration Dale:
Rln~ ?' ~41nnd Rilln ~?
Day phone
Mailing address
Lending agency
Day phone
Mailing address
Real Estale Agent
Kathy Geraci / Greatland
Day phone 694-9125
Mailing Address 11/,11 ~31d ~lPnn g'vy F~,l~, g~vor, A~( qq577
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Wa[er Slorage
Community Class ~
Public Waler System
Well
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding lank
Communily On-site
Public Sewer
The Municipality of Anchorage Development Services Departmenl (DSD) Issues Certil~cates of Health Authorily
Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil
engineer registered In Ihe State of Alaska. CerUficales of Health Authority Approval are required for the Iransfer of
lille (excepl between spouses) for propedies served by a single family on-site wastewa[er disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Cedificeles of Health Authorily Approval are
valid for 90 days from Ihe date el' issue for propedies served by a private or Class C well and may be reissued with
new waler sample results less Ihan 30 days old. (Cedi[icales may be reissued for a period of up Io one year wilh
valid water samples.) Cerlific~[es 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 o~' Ihe validation date shown below, I verify that my Investigation,
based on procedures outlined In Ihe Health Authority ^ppmval Guidelines for this application, shows that the
on-site water supply and/or wastewaler disposal system Is(are) safe, functional and adequale for the number of
bedrooms and type of struclure Indicated herein. I furUter verify fha{ based on the Information obtained I'rom 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 o[ installation..
NameofFirm S & S En~ineer~n_~
AddresslT034 N. Ea~le River Loop Ste.
Engineer's Printed Name Robert C. Cowan
DSD SIGNATURE
~ Approved for 3
Disapproved.
Conditional approval for
Phone 694-2979
204 EaRle River, AK 99577
Dale ~ [ 5/0 7.
bedrooms. ,~ ~.~ ...... .' ~- ~
bedrooms, with the following slipulations:
Additional Comments
Altachments:
HAA Checklist
Septic Sys{em Advisory
Well Flow Advisory
X
Maintenance Agreements
SUpplemental Engineer's Report
Other
Original Cediricate Date:
Municipality of Anchorage ~
Development Services Department ~ '°
Building ,Safety DIv~ion ' °
On-Site Water & Wastewate~ Program ~
4700 Sou~ Sragaw St,
P,O. Box 196650 Anchorage, AK 99519-6850
www.ci.anchorage,ak.us
(9O7) 3437904
HEAL:H AUTHORITY. ~PROVAL CHECKLIST
Well type ~ If A, S, or C provide P~ID # '""
Datecompleted?~*/4~ Sonltanjseal(Y/N)~V~
To,*, d,p,~ ~,',. c~ fo ~'~ ..
FROM WELL LO(}
Date of test
Static water level
Log (Y/N)
Wires properly protected (Y/N)
Casing hetght (above ground)
AT INSPECTION
Well production ~ g.p.m. ~' } g.p.m.
WATER SAMPLE RESULTS:
Coliform ~) colonies/lO0 rnl.
Nitrate ~.~/mg./1. Other bacteria / colonies/100 mL
c~*~: ~t ~;
e. SEPTIC/I'iO.I.DIN~.TANK DATA
Tank Type/M~teriai '~{~}o'rr¢.,
/
Tank size ~ gal. Number of Comparlments
Foundation cieanout (Y/N) ~ Depression over tank (Y/N)
". Date of pumping ~//~2"/0'~: Pumper
C. ABSORPTION FIELD DATA
Date instelled
Cleanouts (Y/N) "~
High water alarm (Y/N)
Date i~stalted~ Soil rating (g.p.dJftz or ft=fodrm)/~) System type '~(~--~,J~,
Length ~5'~ ~ f~ w.~th '~ ft. (~revel below pipe 4 ft.
Total depth ~ ft.
Eft. absorption area '¢~ Monitoring tube
Fluid depth in absorption--/field before test 0 in. Wate~ added~gaL
Elapsed Time: ~ min. Final fluid depth ~*in. Absorption rate >= '~'~ g.p.d.
Any rejuvenation treathlant (past 12 mo.) (Y/N & type) /%/If yes, give date
Depression over field ~
For. ~ bedrooms
D. LIFT STATION
Date installed
'Pump on" level at/ in.
/
Datum
E. SEPARATION DISTANCES
Size in gallons
"Pump olr levol at ..
Cycles tested
Manhole/Access (Y/N)
· in. High water alarm level at in.
Meets alarm & circuit mqalmments?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankal,~on on lot
Absorption field on lot
Public sewer main
S/,~septic sewice line
On adjacent lots . /C~ %'
On adjacent lots ~/~ /' ~
Public sewer manhole/ctsanout /V///¢~'
Holding tank /V'//]--
SEPARATION DISTANCES FROM SEPTIC/H~J~I~"G TANK ON LOT TO:
Building foundation ~ ~'/-
Property line ~'._.___~ Absorption field ~"
Water main /~//~(" Water sen~ce line /(9 ~'- Surface water
/
Wells on adjacent lots /'O0
Property line
Water Sewice line
Curtain drain
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation [O /'/'' Water main /U'//~-
Surface water /4~/.e' Driveway, park~hide storage
Wells on adjacent lots //0/~ ~
F. COMMENTS
I certify that I have determined through field ~n~pectlons and
/o
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12~oo)
0 25-o&-f- ~
Waiver Fee $
Date of Payment
Receipt Number
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
1. GENERAL INFORMATION
Complete legal description
Lot 7; Block 2~ Highland Hllls #2
Location (site address or directions)
Property owner' Pam6Za Page
Mailing address P.O. Bo;c 771843
Hiland Road
Eaqle Rive% AK
Eagle River,
Day phone
AK 99577
694-6685
Lending agency
Mailing address
Agent Eva Loken / REMA× PROPERTIES
Address 16600 Cer~:erfigld Drive Su.,L~e 201
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3 ~
TYPE OF WATER SUPPLY:
Individual well XXX
Community well
Public water
NOTE:
Day phone
Day phone 694-4200
Eagle River, AK 99577
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
'rYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
XXX
If community wastewater system, provide wriften confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Ftonl MOA ¢lgl
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 inves~i~gation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm Phone ~;~ ~'¢~ ~ ~ 7 ~'
Address
Engineer's signature
DHHS SIGNATURE
/~ Approved for ~/¢-~-~ ~,? bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
By:
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 anatyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72~)25 (Rev. 1/91) Back MOA#21
Legal Description:
A, Well Data
Municipality cf Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Well type ~7¢._~q ~-¥_ .If A, B, or C, attach ADEC letter, ADEC water system number
Log present ~7N) ..~ Date completed d'l ~'~ ~ ~'~ Driller ~-"~A~ ~O~ ~,..~
Total depth % Lc' Cased to "2--~1 ' ~-~, ¢--. Casing height ~/-~
Sanitary seal ¢~/N) ',./ Wires properly protected (~/N) b/
AT INSPECTION
Date of test
Static water level
Well flow
Pump level1
FROM WELL LOG
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot \~:> ~
Absorption field on lot , \ ~ ~ \ .b-
Public sewer main ~ l Z:~
Sewer service line '~/.--~ \~
g.p,m.
MUNICIPALITY OF AN(;H~.)RAGE
ENVIRONMENTAl- SERVICES DIVISION
Rt!CEIVED
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform (~ Nitrate
Date of sample: "7 -- ?.. ~z~ . oi :~
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed \
Cleanouts t~'N)
High water alarm
Date of pumping
Other bacteria
S & S ENGINEERING
]~'u;~,~ [~agie River L~p ~oa6
Eagle River, Alaska 99577
Tank size ~, ~ ~ O Compartments
Fou ndation cleanout (~)q) k/ Depression (Y('~
Alarm tested (Y/h~)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot \, ©c> ~ ¥ On adjacent lots \ ~ ~ k .b Foundation
To property line \ ~o I & Absorption field. / / i Water main/service line
Surface water/drainage ~, ~ o
72-026 (3/93)° Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons.
Vent (Y/N).
"Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N) ~
SEPARATION DIS~ STATION TO:
~ On adjacent lots
Manufacturer
Manhole/Access (Y/N)
.~]8~ tested
Su dace water
D. ABSORPTION FIELD DATA
Date installed l ~ ~z~
Length ~ ~ ~ Width
Total absorption area /J¢(~ ~'~, ,Cleanout present ~N)
Date of adequacy test '~ -- '?.--'1 ---~%
Results~;ffail)
Soil rating (GPD/FF) /~o ~l~-- System type
'~o'" Gravel thickness 4 t Total depth
k~/ Depression over field (Y~
~',~-~ % for ~ Bedrooms
Water level in absorption field before test -1~ ~)"~ After test
Peroxide treatment (past 12 months) (Y~.)~ ~ t'z'~°v'/~ if yes, give date
SEPARATION DISTANCE' FROM ABSORPTION FIELD TO:
Well on lot V ©o
To building foundation
On adjacent lots ~,~
Surface water
Curtain drain
On adjacent lots ! D~ ~ ~ Property line
) To existing or abandoned system on lot
Cutbank ~/~, Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
have checked,
I certify that l ~
Signature ~~, ~N?
Engineer's .... '
Loop [~ad No. 204
99,577 /
Date /~t'te Fqv~;r' Ai~'d'a ~//2-' ~//~'~''~
or conformed to all MOA and HAA guidelines in ~ff..,e..c, ~;
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # t'-'%~ - ")_~ ,. _~L - ~O-~b ,°_~ NAA# l-/~--'~ ~ ~
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
Location (address or directions)
(b) Property owner _'~l
Mailing Address
(c) Lending Institution /~ ///4
Mailing Address _,/~J
(d) Real Estate Company and Agent
Address
Telephone /~
(e)
Telephone: (home)
Telephone
Business
Mail the HAA to the following address: (or check here I'q, if hold for pick up.)
List contact person and day phone number below:
_ ]/
TYPE OF RESIDENCE
ily'l~
Single-Faro Number of bedrooms
WATER SUPPLY
Individual Well~ Community [] Public []
Note:If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
SEWAGE DISPOSAL
On-site,~ Public [3 Community E] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev. 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of thevalidationdateshown below, Iverifythat my investigation of th is
Health Authority Approvat shows that the on-site water supply and/or wastewater d'isposal 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 this inspection.
Name of F rm Telephone Z- /
Address J~C'C' ~ ~,~c,~,-/ ~_Oc,.G ~,'~ ~.~. ~'.~/)~
Date Z//~///~¢
Engineer's Seal
6. DHHS APPROVAL '
Approved for -,'~ bedrooms by
Approved ~(~ Disapproved
Terms of Conditional Approval
Date
Conditional
The MunicipalityofAnchorageDepartmentof Health and Human Services(DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5abovebyan 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 DHHSdo not conduct inspections
or analyze data before a certificate is issued. The MunicipalityofAnchorageisnot responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88) Back Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST- FEBRUARY 1984
343-4744
Legal Description: L~
A. WELL DATA
Well Classification '~]¢~///~c'TL(L
Well Log Present (Y/N) Y' Date Completed
Total Depth ~/,~ ~ Cased to~'¢] ' -~-
Static Water Level '::Ct:- ~ '
Casing Height Above Ground ~ ~
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot ] l(~ '
To Nearest Edge of Absorption Field on Lot
If A, B, C, D.E.C. Approved (Y/N)
Depth of Grouting ~k~
Pump Set At ~(',-~ '
Sanitary Seal on Casing (Y/N) ~Y/
Depression Around Wellhead (Y/N)
; On Adjoining Lots ~ /~(~
; On Adjoining Lots '~'/Z(? ~
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
Comments ~-~r- (~]~, ,~,Z¢.~
J~, ]~[ To Nearest Public Sewer Cleanout/Manhole
;Date ~ /i(; /~ '~,
B. SEPTIC/HOLDING TANK DATA
Date Installed (]/,,¢f"zf Size
I '
Standpipes (Y/N) ~' Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
/(~('-2~-).~(No. of Compartments
)/' Foundation Cleanout (Y/N) ¥/'
Date Last Pumped
;for ~i
Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well //C')t
To Property Line -:~.~
To Water Main/Service Line /(])(_.2 ¢
To Stream, Pond, Lake or Major Drainage Course
To Building Foundation
To Disposal Field ..~'~
Comments
72-026 (Rev. 7/88) Fronl Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Abso(ption Strata
Date Installed
Width of Field
Square Feet of Absortion Area
Depression over Field (Y/N) ~.
Results of Last Adequacy Test
¢~/¢;.~.¢m Type of System Des'gn '%~CH
Length of Field ~ ~
Depth of Field ~ ~
Gravel Bed Thickness ~' f
~ % Statndpipes Present (Y/N) ~
Date of Last Adequacy Test ~//o,/~'~
/
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well /~?-S~ / To Property Line . ~ r.~
To Building Foundation ~'¢,~-~ To Existing or Abandoned System on
Lot /~,,/~>'~ 'On Adjoining Lots ~./(~)(? t
To Water Main/Service Line /OO ~
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Packing Area, or Vehicle Storage Area
To Cutback (if present)
D. LIFT STATION /~
Date Installed ~, )'t~
Size in Gallons ~
"Pump On" Level at ~
High Water Alarm Level at ~
Tested for '%%
~l;e:r~eMnOtsA Electrical Codes (Y/N)'~
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and
inspection.
Signed
Company
Date
MOA No.
Receipt No
Date of Payment
Amount: $
72-026 (Rev. 7188) Back
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
effect on the date of this
Engineer's Seal
& GEOLOGICAL LABORATORIES OF ALASKA, INC.
FEDERAL TAX ID # 92-0040440
ANALYSIS REPORT BY SAMPLE for Work Order ~ 11670
Date Report Printed: FEE 13 89 @ 15:15
Client Sample ID:I,7, SS, IlIGHLAND HTS
PWSID :UA
Collected FEB l0 89 @ 15:00 hrs.
Received FEB 10 89 @ 16:30 hrs,
Preserved with :AS REQUIRED
Client Name : CORWIN & ASSOC
Client Acct : CORWINP
P,O.$ NONE REC'D
geq ~
Ordered By : J. KRESS
Analysis Completed :FEB 13 89 Send Reports to:
Laboratory SuperTTj~PHEN C. EDE
Released By : ~'.,(~%ta~-' ~___--. 1)CORWIN & ASSOC
Special
Instruct:
Chemlab Roi ~: 4221 Lab Smpl ID: i Matrix: WATER
Allowable
Parameter Tested Result/Units Method Limits
NITRATE-N 1.9 ~/1 EPA 353.2 10
Sample ROUTINE SAMPLE.
Remarks: SAMPLE COLLECTED BY J. KRESS.
I Tests Performed ' See Special Instructions Above UA=Unavailable
ND~ None Detected '* See Sample Remarks Above
NA= Not Analyzed LT-Less Than, GT=Greater Than
bPJNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
J~PPLICATION FOR HE~TH AUTHORITY A~PROVAL CERTIFICATE
1. General Information
Application Date
(a) Legal Description (include lot, block, subdivision,__section, township, rare;e)
Location (address or directions)
-~.,..,, ,~',, -' ~,~_. Telephone - Home Business
Applicants Name..
Applicants Address ~, / .....~ ._~ ,
(c) Appliqant .is (check~ one) Lending Institution
Buyer ~--~ ; Other ~--~ (explain);
/
Address ,;C~ , ,~.: ;~' .~ '~ r-
(e) Real Estate Co. & Agaric ~/~
~--~ ; Owner/builder.S';
Telephone ,~3 J? / /~v D /
Address
(f)
Telephone
Mail the HAA to the following address:
2. Type of Residence
Number of Bedroome ~
3. Water Supply
Individual Well ~ Community ~--~ Public ~--~
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. S,ewa~e Disposal
Onsite ~ Public ~-~ Community C~ Holding Tank ~-]
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
[Page 1 of 2]
Engineering Firm Providin~. Inspections~ Tests~ File Search~ Data and Information
As certified by my seal affixed hereto and as of the validation date shown below, ]
verify that my investigation of this Health Authority Approval 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 theft,
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 regula-
tions in effect on the date of this inspection.
Name of Firm
Address ~ O
pHEP Approval
Approved for~bedrooms
Approved__~__ Disapproved
Terms of Conditional Approval
CAUTION
T"HE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES ~;~.ALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESS--f~-~ ENGINEER REGISTER~iD
IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE~
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANA3~YZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN T~ PROFESSIONAL ENGINEER'S WORK.
RR4/eJ/Di8
[Page 2 of 2]
(DHEP SEAL)
7-19-84
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
!984
WELL DATA Legal Description: Z~'~ 7 //~/~
Well Classification /~/~, ~ ~e If A, B, or C, D.E.C. Approved(Y/N)
Well Log P~esent (Y/N) // Date Completed ~/~/ Yield
Total Depth ¢~E / / Cased to 2'~ '. ~e~¢~/~ Depth of Grouting
Static Water Level '.~.% / Pump Set At ~'6- ~
Casing Height Above Ground ~_z/ ~ Sanitary Seal on Casing (.y/N)..fi/
Electrical Wiring in Conduit (Y/N) ~/ Depression A~ound Wellhead (Y/N) ~/
Separation Distances f~om Well:
To Septic/Holding Tank on Lot /~3 ~- ; On Adjoining Lots. /~3 ~
To Nearest Edge of Absorption Field on Lot /~¢- ; On Adjoining Lots
To Nearest Public Se~a~ Line /Z/~9~t_ To Nearest Public Sewer
Cleanout/Manhole /Z/~¢_ To Nearest Sewer Service Line on Lot
Water Sample Collected By ~/-¢.-T/.ve~¢-,- ; Date
Water Sample Test Pesults -~"~7~z& ~¢-~-¥ t_~~
Conmgnts
B. SEPTIC/HOLDING TANK DATA
Date Installed .~.//~<¢ Size /~ ~/ No. of Cc~pa~tments ~)~
Standpipes (Y/N) .~Y/ Air-tight Caps (Y/N) . ~. Foundation Cleanout (Y/N) ~ .y
Depression over Tank (Y/N) /~/ Date Last Pumped ,'¢/~¢~/
Pumping/Maintenance Contract on File (Y/N) ~ ; for __~-
Holding Tank High-Water Alarm (Y/N).////~ . ~mporary Holding Tank Permit (Y/N)~/¢//~
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
To P~operty Line _z/D
To Water Main/Service Line
C o ur se
To Building Foundation ~-~2/
To Disposal Field II /
To Stream, Pond, Lake, o~ Major Drainage
Coim~nts
Receipt ~
Date Paid:
Amount: /4%~ -oe-
[Page 1 of 2]
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~/~ ~
Width of Field ~> ~
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Type of System Design
Length of Field ~6~ ~
Depth of Field ~ z
Gravel Bed Thickness g/z ~
Standpipes Present .iY/N)
Date of Last Adequacy Test /L//_J-~
Separation Distance from Absorpticn Field:
To Water-Supply Well / W~ / To Property Line /zP /
To Building Foundation /~2~ To Existing or Abandoned System on
Lot /J/P~ ; On Adjoining Lots z~/~n~_ ~w-
To Water Main/Service Line /~P f- To Cutbank(if present) ~_~F
To Stream/Pond/Lake/or Major Drainage Course /L/~-~
To Driveway, Parking Area, or Vehicle Storage Area /~ r
Comments
LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes(Y/N)
Di.wensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I oertify that I have checked, verified, or ccnforn~d to ali. MOA HAA Guidelines in effect
on the date of this ins~ionF A/~
Signed Date /
Company ~ ~ ~ ~/~r A ~ 7~?~. MOA No.
KB1/d5/s
2-15-84