HomeMy WebLinkAboutFALLING WATER BLK 2 LT 5Falling Wate
Block
Lot 5
#050-772-06
Municipality of Anch0rage Page ~ of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: _.~,,J~l ,~-o'z t ~. PID Number: o5'0 -'"7-/~ - oG
Name:
~¢ ~ ~ k'~v~ Wastewater System: ~ New ~ Upgrade
Address:
~.o. ~,~ '~o~z [~ ~,~ ~ ~ ABSORPTION FIELD
~Phone: ~ ~ ~O No. of~drooms: ~ Deep Trench '~ShallowTrench ~Bed ~Mound ~Other
Total Depth from original grade:
LEGAL DESCRIPTION so,,.~,~: ~'Z ~s~.~. 6 ~
Lot: ~ BIock:~ ~l~Subdiv~i°n: [~ ~t[ Depth to pips bottom~.from~original grade: Ft. Gravel depth beneath~. ~ pipe Ft.
Township: Range: ~ Section: Fill added above original grade: Gravel length:
~ ~~ ~ 0 - ~ Ft. ~ ~ Ft.
Number of lines: Distance between lines:
WELL: ~ New ~ Upgrade Gravel width: ~ Ft. I '~ Ft.
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: A~
~ ~ ~ Ft. ~ Et, ~'~ SO. Ft. / FSIO
Driller: Date Drilled: Static Water Level: installer: Date installed:
Pump Set at: Casing Height Above Ground:
Yield: ~ GPM ~ ~- F,. Z' ~ "'. TANK
SEPARATION DISTANCES ~ Septic D Holding ~ S.T.E.P.
To Septic Absorption Lift Holding =ublic/PrivateManufacturer: Capacity in gallons:
From Tank Field Station Tank SewerLines kNc~oc~ T~ ~oo o
Well' iOet ~ leoI ~ ~ .~ ~.~ Material: ~.~ Number of Compa~ments:~
SuHace .~ ~
Water i~~ ~o,~+ -- LIFT STATION
Lot Size in gallons: Manufacturer: ~
Line ~O1~ ~O~ ~ ~
Foundation ~l ~t -- __ -- "Pump on" le~~mp off" level at: I H~gh water alarm at:
Cu~ainDrain '-- ~O~ ~0[ ~ P~ode[ Electrtcallnspectionspedormedby:
Remarks: p,'~o ~,~ ~ ~,~,,.~ H~,~; ~ BENCH MARK
Location and Description:
I Assumed Elevation:
Inspections pedormed by: 17~ ~1. n:., Loo~ ~, ~.~: 1 st w - ~- q~
Department of mealt~nd Hu~e~ices approval ~, ~',-
Reviewed and approved b Date: Z
72-013 (Rev. 9/91) MOA 25
2
Permit No. . of
SW950216 2
Page
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description:
LOT 5, BLOCK 2, FALLING WATER S/D
PID No.: 050-772-06
ST1
ST2
WELL'
3 BDRM
HOUSE
\
TRENCHJ
/
1000 GAL.
96,4'
96.3'
\
\
72-013 A (Rev. 9/91) MOA 25
C01 = 91.~
C02 91,~
MT1 = 87.E
·
N( WATER FOUND
1.3' B,O.H.
ROBERT C.
CE -8801
hy
OOC CO. dba
SULLIVAN WATER WELLS
P.O. BOX 670212, CHUQIAK, ALASKA gg567 · TELEPHONE 688-2759
ADImESS.~ ,~W '"/7/o~03 6 ~ ST.~TICLEVELOFW~TERF'r.
LEGAL DESCRI~ION ~ g ~&~ ~ ~--~ ~r~ ;0 ~
DATE-Started Ended ~/~ ~ GALS, PER "R
/
PE~IT NUMBER KIND OF CAS~NG
KIND OF FORMATION:
From
From ~
From~ ~
From,-
From
From__
From ........
From__F!
Dom Ft. to
Ffom~Ft. to
From. FL la
F~om ._Ft. to
Ftom.~Ft. to
From Ft,
- Ft. to~. Ft.
. Ft. to(oFt.
. Ft. to ~::~" Ft.
. .. Ft. toTq FI.
Ft, Io~. Fl.
Ft'. to ._Ft.
.Ft. io , , _Fi
.... Ft. to Ft
Ft
,Ft.
Ft.__~
Ft
._Ft.
Ft.__
From__FI. tO ..... Ft
From Fr. to____ Ft.
From__Fi to
From,,--,.~.~-Ft. to.-- Ft.
. _ clLLV u,.,o ,.__
OC, TF,o,~.4.~gC~ vt to ,vt
Mun'.c:O~
~.* ~eaR~
F~om.~Ft. to Ft.
From__Ft. to Ft
M1SCL. INFORM ATION:
Rick Mystrom,
Mayor
Mtmicipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
August 13, 1996
Wayne E Kuykendall
PO Box 771203
Eagle River, Alaska
99577
Subject: Lot 5 Block 2FallingWater Subdivision
Permit #SW950216, PID #050-772-06
The subject permit, issued August 11, 1995 by this office for a
single family well and/or on-site wastewater system, has
expired as of August 11, 1996.
A new permit must be obtained from this office for a well
and/or on-site wastewater system NOT installed by the
expiration date.
If you have drilled the well, a well log must be sent to
this office for documentation of the installation and to
close the permit.
If a licensed Professional Engineer has inspected the
installation of the on-site wastewater system, the original
as-built inspection report must be sent to this office for
review, approval and documentation. All inspection reports
must be submitted within 30 days of construction completion.
When applying for a new permit, the fees are: $320.00 for an
on-site wastewater permit; $120.00 for a well permit and
$440.00 for a combined on-site wastewater and well permit.
If you have any questions, please call this office at 343-4744.
Sin~rely, fi
J~e~s Cross, P.m.
Program Manager
On-site Services
enc: Copy of Permit
cc: S & S Engineering
ROBERT C. COWAN, P.E.
ROBERT A. SHAFER, RE.
Date:
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
HEALTH AUTHORITY
APPROVALS
SE'~NER & WATER
MAIN EXTENSIONS
SEWER&WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAO DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DESIGN
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
RECEIVED
JUL 29 1996
Municipality of Anchorage
Dept. Health & Human Services
REFERENCE:
The septic inspections for the referenced property were
performed on 7-~%-96 and 7-z~-9~ · Prior to submitting
the On-site Wastewater Disposal System and/or Well Inspection
Report we are waiting for the ~4~ ~.,~,R to be
completed.
If we may be of further service please contact us.
Sincerely,
Robert C. Cowan, P.E.
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519 6650
PAGE 1 OF 1
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT ~_~.Q~
PERMIT NUMBER:SW950216 DATE ISSUED: 8/11/95
DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE: 8/11/96
OWNER NAME:KUYKENDALL WAYNE E & JANET L
OWNER ADDRESS:P.O. BOX 20112
EAGLE RIVER, AK 99567
PARCEL ID:05077206
LEGAL DESCRIPTION:
FALLING WATER BLK
2 LT 5
LOT SIZE: 118623 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AACS0) .
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
DATE:
DATE:
ROBERT C. COWAN, RE.
ROBERTA. SHAFER, RE.
July 25, 1995
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL iNSPECTiON
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
W/~STEWATER
DISPOSAL SYSTEM
DESIGN
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK 99519
REFERENCE: Lot 5; Block 2; Falling Water Subdivision
Request ~/o~ issue a. perm, Lt to ~ ame, t.Z and insta,~ a. 6eptd. c 6~6te~
to 6e.~ru./.ee. t/re p~roposed ,tJp~ee. bedroom hou.6e on .t~
p~op~.
A test hole was excavated and a percolation test performed. The
approximate location of the test hole is located on the attached site
plan.
At the time of excavation no water was encountered and after seven day
ground water monitoring, the monitoring tube was found to be dry.
This property has enough area for a future septic upgrade which can be
seen on the attached site plan. We do not anticipate any adverse
effects on n~ighboring wells, septic systems or drainage patterns by
the installation of the. proposed septic system.
There are, no points of contamination within the proposed we2Z radius
which can be seen on the attached site plan.
If you require additional information, please contact us.
Sincerely,
Robert C. Cowan, P.E.
RCC/gk
Enclosure
17034 NORTH EAGLE RIVER LOOP · SUITE 204 ° EAGLE RIVER, ALASKA 99577
Z
. 1" = 60' SITE PLAN DESIGN
O~~ {~ x,
,~ _ v ~/// ~o ~/ ~,~
~ ~ ~ ~ ~ ~ ~ '~
~ 15' UTLITY EASEMENT
N ~ , '~' ( ,.z /-'
: F/X? ~D/ .... -,.~ ...... :, '" ":>'-
~,~-, ~ .¢."t: ..... : UNSUBDIVIDED ' '
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10-
11
12
13-
14-
15-
16-
17
18
19
20
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502~0650
SOILS LOG -- PERCOLATION TEST
gATE PER FoRM~_
Township, Range, Section:
' ~k~[~ SLOPE SITE PLAN
WAS GROUND WATER ~
ENCOUNTERED? ~' 0
S
IF YES, AT WHAT ~1 L
DEPTH? . j~, pO
E
Depth Io Waler After
Monitoring?
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE ~ (mmutes/~nch) PERC HOLE DIAMETER
TEST RUN BETWEEN L,~ FT AND ~ FT
COMMENTS
PERFORMED BY: S & S ENGINEERING
17034 Eagle River LOOl~ Road No. ~04 ¢/~t~l lfi~ '::' ''~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH/JJlJ~J~,J~J~,IlJtI~II~J,~I~UIDELINES IN EFFECT ON THIS DATE. DATE: ~"-~ ~ ~"~'~-
72-008 (Rev. 4/85)
ROBERTC. COWAN, RE.
ROBERT A. SHAFER, RE.
HEALTH AUTHORITY
APPROVALS
SEWER&WATER
MAIN D(TENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE pLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ONSITE
WA~TEWATER
DISPOSAL SYSTEM
DESIGN
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
REFERENCE: Lot 5, Block 2, Falling Water S/D
July 25, 1995
GENERAL:
1.
Se
The scope of this project includes the installation of
a 1000 gallon septic tank and a five foot wide
drainfield to serve the proposed three bedroom
residence for the referenced property.
Construction shall be in accordance with the approved
site plan and design drawings, Municipal permit with
any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal
Regulations.
The contractor shall be responsible for obtaining any
necessary underground utility locates.
Unless specifically agreed otherwise, the property
owner shall be responsible for final grading areas
subsequently depressed from soil settling. On all
leachfield mound systems, the property owner shall be
responsible for ensuring a satisfactory vegetation
growth over the mounded area.
Contractors installing wastewater disposal systems
must be certified by the Municipal Health Department
for system installations. Owners installing their own
systems must also receive prior approval from the
Municipal Health Department.
SEPTIC TANK INST~L?.ATION:
A septic tank is to be constructed by a certified
septic tank manufacturer. Construction shall include
two 4" cleanouts for pumping access.
e
The septic tank shall be sufficiently bedded to
prevent settling or shifting of the tank.
Ail standpipes on the septic tank shall extend a
minimum of 12 inches above final grade.
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
Page Two
Lot 5, Block 2, Falling Water S/D
July 25, 1995
e
De
Septic tanks installed with less than 4 ft. of cover shall
be insulated.
A foundation cleanout shall be installed one to four feet
from the building foundation. In the line between the tank
and the leachfield there shall be two adjacent cleanouts
(unless an effluent pumping system exists within the septic
tank). These cleanouts shall be located on undisturbed
soil not more than 10 ft. from the tank. The first
cleanout, in line, shall be to clean toward the leachfield.
The second cleanout shall be to clean toward the septic
tank.
Final grading over the septic tank shall be such that a
positive slope exists away from the septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
Excavate the proposed trench to the dimensions shown on the
design. The bottom of the excavation shall be within 2
inches of level. If the sidewalls of the excavation become
smeared, they must be raked or scratched (ruffed-up) before
gravel (sewer rock) placement.
Once the gravel is installed, the distribution pipe is to
be installed level with the perforations faced downward.
Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
e
A silt barrier must be installed between the final gravel
layer and the native soil backfill. Ensure the silt
barrier covers the entire gravel surface before placing
backfill.
Monitor tubes shall be of four (4) inch diameter,
installed approximately in the locations shown on the
design, and extend a minimum of 12 inches above final
grade. The portion of the monitoring tube extending
through the gravel shall be perforated from the bottom of
the trench to the invert of the distribution pipe. This is
equivalent to the effective depth of the gravel as noted on
the design.
0
Backfill over the final gravel layer must not be less than
twenty-four (24) inches. Insulation must be installed when
the backfill depth is less than thirty-six (36) inches.
The finish grade over the trench must be mounded to prevent
the formation of a depression after settling.
Page Three
Lot 5, Block 2, Falling Water S/D
July 25, 1995
MINIMUM MATERIAL SPECIFICATIONS:
Any septic tank proposed for installation must be
constructed by a Municipally approved septic tank
manufacturer.
e
The following pipe materials are approved for use in septic
system installations in the Municipality of Anchorage:
Type of Pipe
Perforated Solid
Cast Iron
ASTM D3034 (PVC)
ASTM F810 (HDPE)
ASTM D2662 (ABS)
Yes Yes
Yes Yes
Yes No
Yes Yes
Use of a type of pipe other than listed above must be
approved by the inspecting engineer.
3e
Insulation shall be at least 2" thick extruded direct
burial polystyrene (Dow Chemical Company Styrofoam HI or
equal).
e
Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
De
A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N,
or equal) must be installed between the final leachfield
gravel layer and the native soil backfill.
o
Ail leachfield gravel (sewer rock) shall be 0.5"-2.5"
screened gravel with less than 3% passing the #200 sieve.
When sand is being used as a filter material, its gradation
specifications must conform to current M.O.A. or D.E.C.
requirements.
Page Four
Lot 5, Block 2, Falling Water S/D
July 25, 1995
INSPECTIONS:
Typically there will be a minimum of three (3) inspections
required during the installation of the wastewater disposal
system. These inspections will occur as follows:
The first inspection must be conducted after the
excavation of ditches, pits, trenches, or beds and
before the installation of any gravel. A septic tank
may be set in place, but may not be backfilled before
this inspection.
0
The second inspection must be conducted after the
placement of the silt barrier, gravel, distribution
lines, standpipes, cleanouts, and insulation, but
before the placement of any other backfill.
e
The final inspection is to occur upon final grading of
the property.
Often there will be more than these 3 inspections required.
Especially with the installation of multiple trenches, sand
filters, pressurized distribution systems, etc. Thus, the
inspecting engineer is to be contacted at least 24 hours prior
to the start of construction. If necessary, a pre-construction
meeting will take place on-site. The inspecting engineer will
not coordinate, direct or control in any way the contractors
activities.
The owner shall contract with the contractor to perform the work
outlined in these specifications and plans and in accordance
with the attached M.O.A. permit. There will be no contractual
arrangement existing between the contractor and
S & S Engineering. S & S Engineering shall be the owner's
representative and will inspect the work as stated above to
document the contractors activities. Final acceptance of the
contractors work rests with the owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to
others for acts or omissions of the contractor or any other
persons performing work on this project or the failure of the
contractor to carry out the work in accordance with these
construction documents. S & S Engineering's inspecting engineer
will not be responsible for the construction means, methods,
techniques, sequence, procedures or the safety precautions
incident to this project.
CONTRACTOR/OWNER
08/11/~99§ 12:22
90769~1211
S AND S ENGINEERING
.-'"' )~D¥SJ.3S )t33~tD ,001- ""~-.
~ a]alAIClgl'lSNl'l
/N3~3~¥3 Xll]J. rl
PAGE 02
~OlS3a NV14 311~ ,09 = ,~
MUNICIPALITY OF ANCHORAGE
Development Services Department ;x Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 050-772-06
1. GENERAL INFORMATION
Complete legal description FALLING WATER BLOCK 2, LOT 5
Expiration Date: lOr C -Z
Location (site address) 3141 MISTY MOUNTAIN ROAD, EAGLE RIVER, AK 99577
Current property owner(s) ESTATE OF TIMOTHY GRIFFITH Day phone
Mailing address
Real estate agent
5611 88TH STREET COURT EN, PUYALLUP, WA 98371
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
®
Private Septic
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 550f I Waiver Fee $
Date of Payment a 3 a ba 1 Date of Payment
Receipt Number. 3 Receipt Number
COSA # OSC211059 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 FIRST WATER CONSULTING Phone 907-350-9566
Address 13030 SUES WAY, ANCHORAGE AK 99516
Engineer's Printed Name CURTIS HUFFMAN, PE Date 2/18/21
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 z <0
well and septic system. Therefore, any estimate of how long a system will function satisfactory ���Q; • • •
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting & FWCS ' *' � TH • .. • :* �r!
�. .
6. DSD SIGNATURE ' • • • . • • • �;
• Curtis Huffman /
System #1 Approved for bedrooms CE 128991
System #2 Approved for bedrooms 1i`,Fo ROFESST a��4�
Disapproved
Conditional approval for bedrooms, with the following stipul�i\gAW(l(((((r
yOF;r,�,
O
"'VICES U\*"'
By Original Certificate Date: z
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
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Other I o,w{C 44 vi i
Legal Description: FALLING WATER BLOCK 2, LOT 5 Parcel ID: 050-772-06
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
® Well log is filed with Onsite (or attached)
Date drilled 8/1995
Total depth 81 ft
Structure served by this system
Water storage tank volume NA gallons
Well disinfected for coliform test? ❑ Yes ® No
® Coliform bacteria is Negative
Cased to 81 ft Nitrate 0.767 mg/L ❑ Nitrate less than MRL (ND)
® Sanitary seal is functioning correctly Arsenic ug/L ® Arsenic less than MRL (ND)
® Wires are properly protected
WES
Casing height (above ground) 18+ in. Collected by.
Date of flow test for COSA 2/17/2021
Static water level at beginning of test 13 ft. Date of Sample 2/17/21
Well production at time of test *4+ gpm
Comments *Repetitive cycles (water drew down quickly & recovered quickly) Pump appears to be set at 36'
from TOC. May consider storage tank water system for peak demand / continuous use due to shallow well
B. TANK DATA
Age of tank(s) 25 years
Tank type/material SEPTIC / STEEL
Measured operating fluid level in septic tank 49"
® Standpipes/foundation cleanout per record drawing
Date of pumping 2/10/21
D. ABSORPTION FIELD DATA
Which system tested (date installed) 7/23/1996
® ALL standpipes present per record drawing
Total measured depth from grade 8.9 ft (max)
Measured depth to pipe invert from grade 5.4 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 2000 gallons
Comments/Deficiencies:
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material
Comments:
Adequacy test date 2/17/2021
Results ® Pass For 3 bedrooms
Fluid depth prior to test 0 in
Water added 600 gal
New depth 0 in
Elapsed time <1 min
Final fluid depth 0 in
Absorption rate 450+ gpd
Any rejuvenation treatment (past 12 months) N
If yes, enter date
FRES
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
if No
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'
if No
ft
Animal Containment > 50' ® Yes
if No
® Yes
if No
ft
ft
If septic tank is under driveway comment below
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ® Yes
if No
ft
® Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
® Yes
if No
ft
Surface Water > 100'
® Yes if No
Property Line > 5'
® Yes
if No
ft
Wells on Adjacent Lots:
® Yes
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'
® 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
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
-low OF A
i 0
I certify that I have determined through field inspections and review ��,�Q.: •' • • • , •��1�$j
of Municipal records that the above systems are in conformance �. •:� (�
with MOA COSA guidelines in effect on this date.
�r
.. .. .... ..........�
P Curtis Huffman
G',, •. CE 128991 .•� ��
4FO PROFESSION�`�ti•�,�
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Septic 'Tank Advisory
Certificate of On -Site Systems Approval # OSC211059
Subdivision: Falling Water Block:2, Lot: 5
The septic tank for this property is 25 years old. The average life for a steel septic
tank is 20 years. Typical replacement costs range from $7,000 to $11,000.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
Munic,pahty of Anchorage
Development Services Department/
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
w~w.ci.anchorage.ak.us
(907) 343-7904
C_,ERTIFICATE OF HEALTH AUTHORITY APPIROVAL
FOR A SINGLE FAHILY DWELLING
Parcel I.D. 050-772-06
1. GENERAL INFORMATION
Expiration Date:
Complete legaldescription FALLING WATER SUBDIVISION; LOT 5, BLOCK 2
Location (site address or directions) .3141 MISTY MOUNTAIN ROAD * EAGLE RIVER, AK 99577
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
JANET KUYKENDALL Day phone 696-3640
P.O. BOX 771203 · EAGLE RIVER, AK 99577
Day phone
AUDREY MASON w/ REMAX E.R. Day phone 694--4200
16600 CENTERFIELD DRIVE * EAGLE RIVER, AK 99577
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well [] Individual On-site []
Individual Water Storage [] Individual Holding tank []
Community Class Well [] Community On-site []
Public Water System [] Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAP,) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date cf i~sue for properties served by a pdvate or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid
water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
Note:Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, or pder
to closing for the engineering sen/ices provided.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified b~ my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Health Authority 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 vefify that based on the
information obtained from the Municipality of Anchorage fi/es and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with ali applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
NameofFirm ALASKA WATER & WASTE'WATER CONSULTANTS, INC. Phone ,337-6179
Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE. AK 99504
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Date
Engineer's Comments:
In conducting this evaluation, AKWWC. Inc. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test. and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee futura performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. AKWWC, Inc. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or pariy is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
~ Approved for ~ bedrooms.
Disapproved.
Conditional approval for
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
bedrooms, with the tllowing stipulations:
~.~ -' 0N-SITE
~ .' W~TI::R AND
· ~ : WASTEWATER
-- · PROP-P~,~
--'
Manitenance Agreements
Supplemental Engineer's Reort
Other
Odginal Certificate Date: J /-- ~ '
Municipality of Anchorage
Development Services Department
8ufldin9 ~atety ~
On.Site Water & Wastewater Program
4~00 Sou~ 8ragaw St,
P,O. Bo~ 196650 ~. AK 99519-6650
(9o )
Legal Description:
A, WELL DATA
Welt type P~.^T~
Date completed
Total del:ih 81
HEALTH AUTHORITY APPROVAL CHECKLIST
FALUNG WATER S/D; LOT §, BLOCK 2 Parcel ID: 050-772-06
8/1995
fl.
Date of test
Static Water lav~l 0
Well production 25
WATER SAMPLE RESULTS:
Coliform. O colonies/100 mt.
Amenic: N/A mgJL.
SEPTIC/HOLDING TANK DATA
If A, B, or C provide PWSID~ .N/A
Sanltmy seal (Y/N) YES
Cased to 81 ft.
FROM WELL LOG
8/1995
g.p,m.
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
10/25/2002
26 fl.
4.6+ g.p.m.
YES
YES
24+ in.
Nitrate ~mg./L. Other bacteria ,i~ colonies/100 mi.
Date of sampla:10/28/2002 Coltectedby: AKWWC, INC.
Tank Type/Material STEEL
Tank size 1000 gat. Number of compartments 2
Foundation deanout (Y/N) YES. Depmsston over tank (Y/N) NO
Date of pumping 10/19/2002 Pumper
I*B(LOW [~xiSTING GRAO~
Soil rating ~r ft~'edrm) 1.2
Width 5 fi.
Date installad 7/23/1996
Claanouta(Y/N) YES
H~hwateralam~(Y/N) N/A
JR'S PUMPING
· a.a~ ff. Eft. absorption am'; ~37,5 fl' ' Monitoring tube..?ES
Date of adequacy test 10/25/2002 Results(Pass/Fall) PASS
Rula depth in absorption field before test 0 in. Water added 620 gal.
Elapsed Teme: < 1 min. Final fluid depth 0
Any rejuvenation lreatmem (past 12 mo.) (Y/N & type)
ADSORPTION FIELD DATA
Date installed ?/2,V~Sga
Length 41 ff.
Total depth
System type SHALLOW TRENCH
Gravel below pipe 3.5 ft.
DepreSSion over field NO
For 3 bedrooms
New depth 4 in.
Absorption rate >~ 450+ g.p.d.
NONE KNOWN If yes, give date
Fe
UFT STATION
Date installed
'Pump on' level at ' in.
Datum
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot100' +
Absorption field on lot 100'+
Public sewer main N/A
Sewer/septic service line 2§%
Size r~ gallons
'Pump off' lev~_l ot
Cycles tasted
Manhole/A~ (Y/ri)
in. High water alarm level at in.
Meets alarm & circuit requirements?.
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manholelcteanout
Holding lank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+
Water main N/A Water sewice line 10'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+
Water service line 10% Sudace water 100'+
Curtain drain NONE KNOWN Wells on edjacent lota 100'+
COMMENTS
G. ENGINEER'S CERTIFICATION
I cerafy that I have determined through field inspections and
rm4ew of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed. Name
Date
JEFFREY A. GARNESS
N/A
.=Fse$ -3 /5 s'
~ Waiver Fee $
Date of Payment
Receipt Number
(~. 12ml)
Absorption field 5'+
Surface water 100' +
Water main N/A
Driveway, perking/veblcte storage
2-9f b I Receipt Number
10'+
10/29/0'~
DATE
RECERTIF~A~ON 57-18
AS BULT 44-47
PLOT PLAN 53-01
FLD. BK
NOTES: Easements not appearing on record subdlvhlor
plat are not shown unless description of easement Is
provided by client. Il is Ihs responsibility al the owns
or Builder, I~rlor to construction, to verify proposed
Building grade relative to finish Grade end utilities
connections, and to determine the existence of any
sQsements, covenants, or restrlcllons which do not
appear on the recorded subdivision plat.
Elevations based on assumed datum unless otherwise
indicated, ~nd bearings and distances me record dar,
ngineeri
--..,.... J°.
4' p~
; C/L MISTY MOUNTAIN /
/
/
TRANS,
&
UTLI~
UNSUBDIVIDED
I/d 0
117.0
~A
POST
70.3
oKe~.
0o
136.5
· /.
5 .//./
\;