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Home My WebLink AboutTHUNDERBIRD HEIGHTS BLK 3 LT 11 ~"~ MUNICIPALITY OF ANCHORAGE f' ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS Absorption area DI,TANCETO: I~e:----- I ~'O Dwe.ing Inside length Width Liq. capacity in gallons Dwelling J ~ {30 IF HOMEMADE: DISTANCE TO: Well Manufacturer Material I Well Foundation/~ Nearest lot Iin~o I DISTANCE TO: ~ ~ inches ,o.o,,,.. / ,..~.~o,.7~, ,ota,,.~,,7~, .,..~,~,~ ,, Top of tile to finish grade .-~ 0 Materiel beneath tile / ~ ti inch~ D=pth Crib depth Total eff~li~ absorption area Length Width Type of crib Crib diameter Well Nearest lot line DISTANCE TO: DISTANCE TO: Building foundation Driller Sewer line I~NEW i--'IUPGRADE PERMIT NO.oc~ / 0 No. of compartments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO. Distance between lines Total e f fective ~_.~or~.tj~r ea PERMIT NO, OTHER PIPE MATERIALS SOl L TEST RATING ' N ST^ ' 'E "E-~,/~/,53. O .,.J REMARKS APPROVED 72-G~3 (Rev. 3/78) DATE LEGAL . . I~IUI--,i 1' 0 1' !~'9~ L t T'.t' OF I:II'-,IC:H"'~Ri:IGE ,'-I ~ . - DEPARTMENT C. HEALTH AND ENVIRONMENTnL i .DTECTION t I]u~G~-/~-~/ · -. ~ %. .' 825 'L' STREET, ANCHORAGE, AK. 99501 /~, , ~ ~ - 264-4720 //~l~v . PERMIT NO ( B10i?6 ) ~. /~ , ~ m,_ --, ~, ~ &-~ APPLICANT CLIFFORD B. SMITH 9480 JADE ST. ~ ~5,~l~24]-7898 UOCn ON OSHnH % --Y ' [Or ll HZS. [OZ SIZE 256 0 SQUARE FEET MHXIMUM NUMBER OF BEDROOMS = F SOIL RATING (SQ FT/BR)= 15~ THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM ID: DEPTH= D LEt~GTH= 7'9 ~RH%~EL DEPTH= :L THE LENGTH DIMENSION ID THE LENGTH (IN FEET) OF THE TRENCH OR DRRINPIELD. THE DEPTH OF A TRENCH OR PIT ID THE DISTANCE BETWEEN THE SURFACE OF THE GROUND RND THE BOTTOM OF THE E~CAYATION (IN FEET) THE TREe'CH ~IDTH IS ~5. ~00 FEET~ THE GRRVEL DEPTH 'ID THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFALL PIPE 8ND THE BOTTOM OF THE EXCAVATION (IN FEET). REi~-~U I RED SEPT I ~ TRN}( ::~ I ZE= ::J-OOO GF:ILLON:s PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY RND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. .... THO (2 > I r~SPEOT I O~'lD HRE REQU I RED ~-.,...,x,-i--l~lG OF ANY SYSTEM WITHOUT FINRL INSPECTION AND APPROVAL BY THIS DEPARTMENT HILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM ID 100 FEET POR A PRIVATE WELL OR 150 TO ~00 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM R PRIVATE HELL TO A PRIVATE SEWER LINE ID 25 FEET RND TO A COMMUNITY SEWER LINE ID 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIHGRAMS ARE AVAILABLE TO INSURE PROPER INSTHLLATION. PERM I T I CERTIFY THAT l: I AFl FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AD SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REOUIRE ENLARGEMENT IF THE RESIDENCE ID REMODELED TO INCLUDE MORE THAN ~ BEDROOMS. S I GNED: ........................................ APPLICANT CLIFFORD B. SMITH V4. 0 Ru~ell Oyster 694-2774 Performed for: Legal Description: O & E ENG,,4EERING & DEVELOI-CLIENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 SOIL LOG Name: /~/2-// -~7-/?/? Mailing Address: ?' ~ * ~ '~/~ ' Earl Ellis 688-2280 Depth (feet) $oll Chire,.'terlsllc~ 0 1 2~ 3~ 4~ 5__ 6__ 7~ 8 9 10 11 12 13 14 15 16__ PLOT PLAN PERC. TEST Ground Water Encountered: Yes.~._..~No If yes, what depth Proposed Installation: seePage Pit Drain Field ~" - ' Comments: ' Performed by: Date' MUNICIPALITY OF ANCHORAGE d��f 3D`r Development Services Department < :�T Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 051-721-22 Certificate of On -Site Systems Approval Expiration Date: Z Gf Legal description THUNDERBIRD HEIGHTS BILK 3 LT 11 Site address 27346 GOSHAWK CT Chugiak AK Current property owner(s) MACK X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: V l By: Original Certificate Date: 9/14/2023 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 Approva"une 2022 M UHMP „ U T Y OF A HCHO" O;= 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. 051-721-22 Complete legal description Lot 11, Block 3, Thunderbird Heights Subdivision Location (site address) 27346 Goshawk Court, Chugiak, Alaska 99567 Current property owner(s) Marvin & Katrina Mack 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone (907) 406-5384 3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units 0 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 11 yr _ See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑■ Wide Trench ❑ Seepage Pit Waiver request for: Distance: Expedited review requested: M 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 $ Waiver Fee $ Date of Payment COSA # CSS C- 7L s Date of Payment Waiver # COSA Application—June 2022 Legal Description: Lot 11, Block 3, Thunderbird Heights Subd Parcel ID: 051-721-22 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 Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L [:]Arsenic less than MRL (ND) Collected by Static water level at beginning of test ft. Date Comments Property is served by a public/community water system (PWSID# 211156), off lot. B. TANK DATA Measured operating fluid level in septic tank Date of pumping 9/12/23 ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 5/20/12 ❑ ALL standpipes present per record drawing Total measured depth from grade 4.5 ft (max) Measured depth to pipe invert from grade 3.5 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) None If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: No Lift Station for this system Adequacy test date 9/11/23 Results ❑ Pass Fluid depth prior to test 0.0 in Water added 710 gal New fluid depth 0.0 in Elapsed time 105 min Final fluid depth 0.0 in Absorption rate 600+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 12 in Effective depth used 0 in Effective depth remaining 12 in 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 5 Community Sewer Manhole/Cleanout > 100' ❑Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' []Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ❑Yes if No ft ❑ Yes if No ft ft If tank or field is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑ Yes if No ft ❑ Yes if No ft K 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 5 ft Surface Water > 100' Yes if No ft Tank to Property Line > 5' ❑i Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' n Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' ■❑ Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' Z Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS 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 P rO a -9 E�9 c ns ever` t lvc Phone (907) 232-1347 Engineer's Printed Name pa_w(, P r o at -d Date COSA Checklist—June 2022 P.O. Box 871347 Wasilia, AK 99687 (907) 357-ENGR (3647) ADEQUACY TEST LOCATION: Lot 11, Block 3, Thunderbird Heights Subdivision APPLICANT: Marvin & Katrina Mack 27346 Goshawk Court Chugiak, Alaska 99567 SEPTIC TANK TYPE/SIZE: Steel/1250 Gallons, per MOA Records ABSORPTION SYSTEM: 5 Wide Shallow Trench, per MOA Records DAILY FLOW: 4 BEDROOMS x 150 GAUBR = 600 Gallons TEST DATA JOB NUMBER: 23-154 DATE OF TEST: 9/11/23 FIELD STAFF: C. Pinard NUMBER OF BEDROOMS: 4 SCUM: 0.0' SLUDGE: 0.0' NEEDS TO BE PUMPED: Yes No XX CURRENTLY IN USE: Yes XX No Time Flow Rate Volume Cumulative Volume Septic Tank Septic Tank Soil Absorption System Comments AM (GPM) (LALs) (GALs) Liquid Level * A Level Monitor Tube 1* A SAS Level Monitor Tube 2* A SAS Level 11:00 6.7 - - 4.0' - 0.0' - 0.0' - Start Flow - Meter 629100 11:15 6.8 101 101 4.0' 0.0' 0.0' 0.0' 0.0' 0.0' 629201 11:30 6.8 102 203 4.0' 0.0' 0.0' 0.0' 0.0' 0.0' 629303 11:45 6.7 102 305 4.0' 0.0' 0.0' 0.0' 0.0' 0.0' 629405 12:00 6.8 101 406 4.0' 0.0' 0.0' 0.0' 0.0' 0.0' 629506 12:15 6.7 102 508 4.0' 0.0' 0.0 0.0' 0.0' 0.0' 629608 12:30 6.7 101 609 4.0' 0.0' 0.0' 0.0' 0.0' 0.0' 629709 12:45 - 101 710 4.0' 0.0' 0.0' 0.0' 0.0' 0.0' Stop Test - 629810 Time I ST CO I SAS MT *ALL MEASUREMENTS IN FT. TEST: PASSED XXX FAILED COMMENTS: System found to be operating satisfactorily. There was no measurable liquid in the SAS MTs prior to, or at any time during the test. Reviewed by: Paul Pinard F Date: 9/11/23 MUNICIPALITY OF ANCHORAGE Development Services Department 4 Phone: 907-343-7904 On -Site Water & Wastewater Section ��" Fax: 907-343-7997 Parcel I.D. 051-721-22 Certificate of On -Site Systems Approval Expiration Date: Ma q 19 011 d 1. GENERAL INFORMATION Complete legal description THUNDERBIRD HEIGHTS BILK 3 LT 11 Location (site address) 27346 GOSHAWK Ct, Chugiak AK Current property owner(s) Mailing address Real estate agent KEVIN WIGGINS 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 ❑ Private Septic Fx_1 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑X Public Sewer ❑ Waiver request for: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5,5()/ 11 P. 50 Date of Payment 5 21 a OR O Receipt Number 021060 COSA # D se a o 1 a 00 Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: 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 5-15-20 6. DSDj SIGNATURE J System #1 Approved for 4 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, OF A qy �e�+ o •o a oe•a d �i 4QTH JJJ L • MICHAEL N. ANDERSON �� V- CE - 94 9 PR0T[SSj0\: — with the following stipulatl��o�� J i WASTE=' LATER I f By: VA1q Original Certificate Date: 5 a The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: THUNDERBIRD HEIGHTS BLK 3 LT 11 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments B. TANK DATA Age of tank(s) 9 years Tank type/material SEPTIOSTEE Measured operating fluid level in septic tank 48 ❑■ Standpipes/foundation cleanout per record drawing Date of pumping MAY 1 D. ABSORPTION FIELD DATA SHALLOW TRENCH Which system tested (date installed) 5/2012 ❑E ALL standpipes present per record drawing Total measured depth from grade 4.5 ft (max) Measured depth to pipe invert from grade 3.5 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: 051-721-22 Structure served by this system Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ■❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 5/1/20 Results [DPass For 4 bedrooms Fluid depth prior to test 0 in Water added 600+ gal New depth 0 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate 600+ 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' ❑ Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' ❑ Yes if No ft ❑ Yes if No ft if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑ Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No 5 ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' ❑✓ Yes if No _ Water Main > 10' ✓❑ Yes if No ft Community Wells > 200'✓❑ Yes if No _ Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10'✓❑ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓❑ e �n MCPAEL r4.A&Di : Yes if No ft Private Wells > 100' ❑✓ Yes if No Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' ❑✓ Yes if No Surface Water > 100'✓❑ Yes if No ft F. ENGINEER'S COMMENTS FIELD TO PROPERTY LINE 10' PER THE SURVEY ASBUILT G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review _�.ya�--�®�� of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. e �n MCPAEL r4.A&Di : CE 9 469 .,_ COSA Checklist yellow sheet ft ft ft ft • • ,,,t. Municipality Qpi •F Municipality of Anchorage On-Site Water and Wastewater Program a a.aj 1 (907) 343-7904 $a C T Y CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-721-22 Expiration Date: / 2 -I y I -( 1. GENERAL INFORMATION Complete legal description THUNDERBIRD HEIGHTS BLOCK 3, LOT 11 Location (site address) -27346 GOSHAWK COURT, CHUGIAK,AK 99567 Current Property owner(s) MICHAEL&AMORY SANDERS Day phone Mailing address 27346 GOSHAWK COURT, CHUGIAK, AK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex O Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well 0 Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class A Well ® Public Sewer ❑ Public Water System ❑ WaiverNariance request for: Distance: Received by: Date: 1/f/i V COSA to be released to the engineer,unless othe e requested by the engineer. COSA Fee $ 5,9.4 Waiver Fee $ Date of Payment lf$/i$ Date of Payment Receipt Number &Colalb Receipt Number COSA# 056127603 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 ARCTERRA CONSULTING,INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD.,EAGLE RIVER,AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 12/18/2017 THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore,ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen .�`� encroachments,deficiencies or discrepancies exist. • 'x' 01 A19,1 6. DSD SIGNATURE / * 49 Tr i /� System #1 Approved for / / , � , I bedrooms. ` f % KENNETH M. Dl-'(Jk / System #2 Approved for bedrooms. , saA "'� ��/ a /8I . / Disapproved. n.•Feslo ,� .r \\`11.:11.- Conditional approval for bedrooms, with the following stipulations: _:-„,%':;2 4 �p _sce =z ON No SER =m W S1EwAieR o a W OORp,M - PR 5, Ci- 0,oMEYT SOS\ By: w, (— v, Original Certificate Date: — c7 - / ,7 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. . 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10.10-12.doc If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: THUNDERBIRD HEIGHTS BLOCK 3, LOT 11 Parcel ID: 051.721-22 A. WELL DATA—CLASS A Well type A If A, B, or C provide PWSID# 211156 Well Log (Y/N) Date completed Sanitary seal (Y/N)Y Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height(above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. _ g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic: ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC I STEEL Date installed 8110/2011 Tank size 1250 gal. Number of Compartments 2 Cleanouts(Y/N) Y Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N Date of pumping I l- 1 2- ` 1 Pumper Sa., . C. ABSORPTION FIELD DATA Date installed 5/25/2012 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 System type SHALLOW TRENCH Length 87 ft. Width 5 ft. Gravel below pipe 1 ft. Total depth 4.5 ft. (Measured 12/14/17) Eff. absorption area 500 ft2 Monitoring tube Y Depression over field N Date of adequacy test 12(14/17 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 600 gal. New depth 0 in. Elapsed Time: 1 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) N If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access(Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm &circuit requirements? E. SEPARATION DISTANCES -PUBLIC WATER WELL ON LOT TO: Septic tank/lift station on lot_ On adjacent lots Absorption field on lot On adjacent lots Public sewer main _ Public sewer manhole/cleanout Sewer/septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 200'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation _ 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+(NONE KNOWN) Wells on adjacent lots 200'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. OF 4 Engineer's Printed Name KENNETH M.DUFFUS j `��' `4\'It1 Date 12/18/17 1 *, 9 Ti .? * tKE'M. �7 Q COSA canary sheet_2-6-15.doc 1 ' I g �w/ b � ;L 0 a G/ ' ESSI' ' 41. \ \ \ \\ \ \\ \ �. 0 N Ar- 1, •n II I V N 40 'N V `yZ' 9' N \ �L V` 1 a cS 0`\ \ 0 mQ. \ -0 Co..r. \ \ 0 / \ co J m N r \ f1 0 1 u \ -f,„,.,,,,, \ 7/11 m , �f \ \ cii 2) / 0 > pp I 9 t-C \ • m h \ o p�s,„0 \ 2� ' m A,il- .v ,, 411kr el' ' ...-A ----- ____ _ \ O�c÷ al mN Qvs 0 7• N \ ��Y Z 180. -C1 \ n1 x e� 5$� 'c0 r m� 16•4' $i te Fh r? \ �A 0FF'p 6:6, 4 \ c�F� `o CO-04 ci i \ pF i w g 0 + c4 'D� rrl Z a \ \ / w 0. I • + _ O. /\a, y / / \ O Z Q + m \ \ Z 0 mx / m5 4 , y X/ \ \ \ / • Z 5 \ M u") \ 0 t • Z }� S m \ \ \-_ 0 \ m I \o \ \ ‘ PLOT PLAN AS BUILT X SCALE 1" = 30' GRID NW 1865 Project No. 17-477/A1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone �0000 (907) 522-4625 Fax OFA(\IN Professional Land Surveyors kenOlangsurvey.com _ jonathanOlangsurvey.com Dv s t1. I hereby certify that I hove surveyed the following described propeOA, LOT 11, BLOCK 3, THUNDERBIRD HEIGHTS SUBDIVISION (PLAT 77-226) OO* 4 9� .. * Anchorage Recording District, Alaska, and that the Improvements situated thereon are o 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 Q premises and that there are no roadways, transmission lines or other visible Q?� KEN G. easements on said properly except as indicated hereon. °01‘... (4rt.((� ;• � Dated this the I.)+k. Day of 7:::> ,•••,..-.,??�� , at Anchorage, Alaska ,o,p-520? • gQQQ��p___ .. ; ��O gpNA1.�o�a' it is the responsibility of the owner to determine the existence of any easements, DOpp0"ft'• covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot. block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name '~V,'~A~,J*,.I~' /~, ~ ~ Telephone', Home Business (c) Applicant is (check one): Lending Institution ~; Owner/builder D; Buyer D; Other ~ (explain); (d) Lending Institution Address (e) Real Estate Company andAgent Address Telephone (1) Mail the HAA ,o the~o~i~.lNG______ SE B~ 96X ~GLE RIVER~AK 995~ Telephone TYPE OF RESIDENCE Single-Family ~' Multi-Family Number of Bedrooms Other WATER SUPPLY Individual Well D Community I'-I Public ~ Note: If community well system, must have written confirmation Irom Ihe State Department o! Environ mental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite,,'~ Public I"] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Deparlment of Environmental Conservation attesting to the legality and status. Page 1 of 2 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this HeaRh Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate Ior 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. S & $ ENGINEERING Name of Firm Telephone SR B 196X Address EAGL-E'RIVER, AK 9957~' Date MAY I 4 1986 Approved for E'~'~'L-(',t--' bedrooms by '~ s~--~ Approved ~..~"~ Disapproved Conditional/~ Terms of Conditiondl Approval Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered 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 requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or bmissions in the professional engineer's work. Page 2 of 2 MI'~ PAUTY Or- ,~J~,J,~U~PALITY OF ANCHORAGE (MO? UTHOmTY PP.OWL ~~ ~HECKLIST - FEBRUARY Legal De~riptio~ L RECEIVED WELL DATA Well Classification ~'-w.~"z~t C Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lo, t ~o .o ~ '~' To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments '~ ~' ~ ~ ~ If A. B, C, D.E.C. Approve~/N~' Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots "~c~c~ ~ ~- ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date SEPTIC/HOLDING TANK DATA Date Installed ~"~ ''~ Standpipes~l/N) Air-tight Caps~N) Depression over Tank Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm {Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well TO Property Line I ~ ~*' .' · To Water ~,.',;:,;-,,'~ervice Line Size ~ c3(~,~ No. of Compartments 7- Foundation Cleanout ~ Date Last Pumped 7"/" ~ ~- /"//'~- ; for -- Temporary Holding Tank Permit (Y/N) Cours~ To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA ' ' Soils Rating in Absorption Strata Date Installed "~"~ ~' ~' Width of Field ~ Square Feet of Absorption Area c/ Depression over Field ('~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~*,3~ I,,..- To Building Foundation // ~' '¥ Lot To Water Main/G~.,~.ice Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Depth of Field ,.~ Gravel Bed Thickness Standpipes Present~N,f Date of Last Adequacy Test Type of System Design Length of Field ~ · To Property Line To Existing or Abandoned System ; On Adjoining Lots TO Cutbank (if present) '/~'"/~- on Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed $ & S ENGINEERING Date NAY SRB 196X Company MOA No. EAGLE RIVER, AK 99577 Receipt No. ,~ C[ Date of Payment ~'-- 't ~ - Amount: $ Page 2 of 2 72-026 (11,84) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date g/~' "~'/~::~)- 1. GENERAL INFORMATION (a) Legal Description (include lot. block, subdivisi~3n, section,, town,ship, ra, nge) Location (address or direc[ions) {b) Applicant Name~~e ~ / Telephone' Home Busings ~ ~ ~ Applicant Addre~ ~IW~ (C) Applicant is (check one): Lend,ng lnst,tutio. O;Ow.er/builderD;Buyer~;Othe~ (explain); ~/~ (d) Lending Institution Address (e) Real Estate Company and Agent Address Tf~l~,phone (f) ,-~qa~ the HAA to the following address: TYPE OF RESIDENCE Single-Family,,~. Multi-Family [] Number of Bedrooms - ''~ Other Telephone WATER SUPPLY Individual Well FI Community [] Public,,,~ Note: If co m munity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite,~ Public[] Community[] Holding Tank [] Note: If corn munity well system, must have written confirmation from the State Department of Environment~]l Conservation attesting to the legality and status. Page I of 2 72,025 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND iNFORMATION ·" 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 shows that the on-site water supply and/or wastewater disposal system is sate, 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 Firm ~ ~ ~' ~CI[qG'~ Telephone Date . A~proved fo~"- ~,~'¢ ~ bedrooms b ~. ~/). Date ^pproved '; Disa p " * Con ' ona Terms of 'Cohdition,~ Approval ~, ~lt.~\\ ." CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based ~olefy upon the representations given in paragraph 5 above by an independent professional engineer registered 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 requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is Issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 WELL DATA Well Classification/~"~ ~'~, ! ~' Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot _ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 2~ ~720 Leg~al/Descript i,p n:/,~'/'/ 7h t~t ~.'1~.,.~/ ,.(1' I! A. B, C, D.E.C. Approved Date Completed Yield Depth of Grouting Pump ~ot At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ~.. (:~,.o ~ ~Z. c.-'"'"" ; On Adjoining Lots ~ r ~. ~/- c"~, On Adjoining Lots '2. ~-~43 ~ '~. To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Inst ailed (,~,~;/,~ / Standpipes~N) Depression over Tank (Y~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank.~'' To Water-Supply Well Z. ~3:)O ¢'- To Property Line / To Water Main/Service Line Course Size Air-tight Caps~N) No. of Compartments Foundation Cleanout (Y~ Date Last Pumped ~/' / gl- ;for "~'/~'~' Temporary Holding Tank Permit (Y/N) To Building Foundation ~' To Disposal Field TO Stream, Pond, Lake. or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ,.~-~ ;~ ~'-- ~ / Width of Field ~'- · Square Feet of Absorption Area Depression over Field (Y~ Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes PresentON) Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot A~ To Water ~/Sen/ice Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at · [ I -~Pumping Cycles during Adequacy Test. Meets MOA Check Permitted Bedroom Rating Against HAA Request I certi fy that I have checked, verified, or conformed to all MOA a/0d HAA guidelines in effect on the date of lhis inspection, Signed~ & E~GINEEI~N{~ Date ~RB 1~ ' ' ~ MOA No. . PN. Receipt N~m--'--~l~ Date of Payment ~ Amount: $ ~-~-~ ... YIME DATE INSPECTOR .,7 D~, .~RqCEIVED INSPECTION APFOINTMENTS TIME TIME DATE DATE MUNICIPALITY OF ANCHORAGE DEPAR~ENT OF H~LTH & ENVIRONME~AL PROTECTIO~EpT. ENVIRONMENTAL S~ITATION DIVISION Tde~ ~7~ '2. BUYER MAILING ADDRESS PHONE MAILING ADDRE~S PHONE PHONE ~ LEG~EECRIFTION~ ST, E E T,LOCA.I.~i O~N ~' E, TYPE OF RESIDENCE SINGLE FAMILY MULTIPLE FAMILY 7. WATER &%IPPLY [] INDIVIDUAL· COMMUNITY PUBLIC UTILITY -8, SEWAGE DISPOSAL SYSTEM '~-~NDIVI DUAL/ON-SITE ** / [] PUBLIC UTILITY NUMBER OF BEOflOOM~ I--I One [] Four [] Other [] Two [] Five ~ Throe [] Six · ATTACH WELL LOG. A well IO9 is required for all wells drilled since June 1975. For wells drilled prior to that date, give wetl depth (ettach Io9 if aveilebte.) / ? S / YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NU~ER OF BEDROOMS I-'1 SINGLE FAMILY I'-I MULTIPLE FAMILY I-'1 ONE [~] THREE 1-~ FIVE [] TWO [~] FOUR [] SiX 2. WATER SUPPLY PERMIT NUMBER [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or [] Holding Tank Size: give dimensions: TYPE OF TANK PERMIT NUMBER DATE INSTALLED INSTALLER If Tank is homemade SOILS RATING MANUFACTURER TO?AL A~SORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank IAb~orption Area Line 5. COMMENTS I-'] OTHER Lot Line ~"'~'APPROVED FOR ~ . BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [--I DISAPPROVED 72010 (Rev. 6/79)