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FIRE LAKE LT 3 TR I1
Fire Loke Tract I- Lo1- 3 #051 Municipality of Anchorage.7'i:? '*'X: Development Services Depadment · - ~: Building Safety Division ,,~/ On-Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of v~/w. ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW020445 PID Number: 051-333-39 Name: WastewaterSystem: [] New [] Upgrade Chris Scott Address: 18612 Fish Hatchery Rd.. Eaale River. AK 99567 ABSORPTION FIELD Phone: Number of Bedrooms: R~R.~ 3 I-I DeepTrench ~ ShaltowTranch D Bed [] Mound I'10lhec. ~oll Rating: TOb31 Depth from original gt'ade: LEGAL DESCRIPTION 1.2 cPO~' 6.0 ,,. Tract 1.1 3 * FIRE LAKE 2.7 r,. 3.3 ,,. 3.23 rt. 75 Well: [] New [] Upg~ ora,~,edth: 5 rt. Numbe~oflines=l Distance between line$:NA ~,. Private/ r,. r~ 380+ ~ D3034 & SCH40 D~i#ee: ~ ~)~ 'TDale D~'flled: Static Water Level: Installer: Date Installed: ~ ,~ RPC-Richard Person 11121/02 v.~: I P~'"P se,,t: C..,.,..~A~.,. c~o~ed: TAN K SEPARATION DISTANCES [] septic I-I Holding [] $.T.E.P, r-I Other:. T~ Septic Absorption Lilt Holding Public/P~vate Manufactu~e~: Tank CapacitY;1 Tank Field Station Tank Se~er UneAnchorage 250 ~a~. w., 100'+ 100'+ 100'+ NA 25'.; Steel 2 s.,~owa., 100'+ 100'+ 100'+ NA ~ / LIFT STATION 1250 c~. Orenco 5'+ 10'+ 5'+ NA Pump on .vel at: , Pump off level at: I Hmgh warm alarm 42" ~.. 44" ~,. ~, 48" NA NA NA Curta;n Drain Franklin 244504011 r. 1/2 HP Rising Son Elect. · none known BENCH MARK New tank Insulated - Old tank abandoned Bottom of siding t00 ;t. Engineer s Stamp --.'~d OF AL' .".'%" ~ InsPections performed by: KND En.qineerin.q, Inc. Dates: 1st. 11121102 ~w !R~t,I'. ~ '.. 2"" 11122102 ~ Reviewed and approved by: ,.. :~'"~ Date: 2./, ~-/.~J' AS-BUILT SYSTEM DETAILS/SITE PLAN Per-mil; SWOaO445 FIRE LAKE TRACT I-1, LBT 3 PID# 05i-333-39 SCALE~ 1' = 50' A-F= 115.3 ~, ~;: .':7.,;.~2%i:..'2 .~.2~.:5,':~'.:~ ~ $ ~.~..' & "..~ ~. CHRIS SCBTT 1BG1E FISH HATCHERY EAGLE RIVER, AK. 99577 (907) 696-E956 ~ou.u~. JOHNNSON ~'~: VBG ST~C~ O~C~: KMD 20441 PTARMIGAN BLY~). ~. a~ 1,/7/o;~ EAGLE RIVER, AK 99577-8736 14 W5 5 4 [: :::::::::::::::::::::::::::::::::::::::::::::::::::::================================================================ ¢::':::::':' 3!~/1"~1 ~Lg/ENGINEERING, INC. ~ ~: ~' ~? L 20441 PTA~GAN BL~. EAGLE ~R, AK 995~-8736 C ~ ~~.. ~ SOILS PERCOLATION TES2 '~~:~-- ~etfo~ for: Chris Stoli te Perform: Project: Fire Lake Lot 3, Tract I-1 TEST HOLE # PERC 2002-2 Depth (Feet) ORG/ML - back red silty overburden w/org. SEE ATTACHED SITE PLAN FOR HOLE LOCATION 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- SP- med dense, gray, w/trace of silt BOTTOM OF TRENCH Was Ground water encountered? NO What depth? NA Depth to water after monitoring? NA Date? NA Reading Date Gross Net Depth to Net Time Time Water Drop 1 11/21/02 1:00 6" 2 1:10 10rain 212/16" 4 14/16" 3 * 1:11 6" 4 1:21 10min 214/16" 413/16" 5 * 1'.~ 6" 6 1'.32 10 rain 2 15/16" 4 10/16" 7 * 1:33 6" 8 1:43 10 rain 3" 4 10/16" 9 * 1:44 6" 10 1:54 10 min 2 15/16" 4 9/16" 11 * 1:55 6" 12 2:05 10 rain 3" 4 10/16" · Water Added 20- HOLE PRESOAKED PRIOR TO TEST Percolation Rate 2.16 (min/in) Perc Hole Diameter 6" I Test Run Between 6 feet and 7 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Munidpal guidelines in effect on this date. Dec 05 02 09:47a ~ichard & Lillian Person 907-688-4678 p.1 Post-E' brand fax transmittal memo 7671 I ~ of pages · December 3. 2002 RE: Fire l~tke Tract I-1 Lot 3 186]2 Fish Hatchery. Rd. Eagle River, AK 99577 Ownen Tim & Chris Scott To Whom It May Concern: As per the Municipality of Anchorage (MOA) requirements: I have insured that the electrical portion of the new lift station for the above described property is installed as per all National Electrical Code 0q'EC), MOA, and the manufacturer's requirements. Kc, via S. Hombuclde, owner Ri.~ing,Yon Electric, Inc. Electrical Administrator License #1284 Specially Contractor License #27285 C:~My Documcal,~l~-'trical laspt-c'L;on Lct~t'.doc 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 SOILS PERCOLATION TEST Performed for:. ]ennifer Hulsey Date Performed: Project: Fire Lake Lot 3~ Tract K-1 TEST HOLE # 2001-01 17- 18- Depth (Feet) ORG/SM- brown overburden frost, moist SP - w/gravel and cobbles to dry, mod. firm density B.O.H. SEE A'I'rACHED SITE PLAN FOR HOLE LOCATION Was Ground water encountered? NO Depth to water after monitoring? NO What depth? NA Date? 4/28/01 Reading Date Gross Net Depth to Net Time Time Water Drop 1 Z2 * Water Add~ 19- 20- Percolation Rate__ (rain/in) Perc Hole Diameter Test Run Between feet and feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on 'this date. MUNICIPALITY OF ANCHORAGE Development Sen~ices Department On-Site Water & Wastewater Program 4700 South Bragaw Street P,O, Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Nov 04, 2002 Expiration Date: Nov 04, 2003 Permit Number: SW020445 Legal Description: FIRE LAKE LT 3 TR I1 Design Engineer: 0070 KND Engineering Owner Name: Chris Scoff Owner Address: 18612 FISH HATCHERY ROAD EAGLE RIVER, AK 99577-9208 Parcel ID: 051-333-39 Site Address: 018612 FISH HATCHERY RD Lot Size: 44686 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received B~ Issued By: ~ Date: Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWEPJVVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Permit Number Property owner(s) Chris Scott Day phone Mailing address (1) 1861~ Fish Hatchery Rd.: Eagle River: AK 99S77 'Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd) Fire Lake Tract !-1: Lot 3 Legal description (Section, Township & Range) Lot Size q~/, ~;~' THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Acres/~ Number of Bedrooms 3 [] Well Only I--i Water Storage [] Jacuzzi [] Water Softening Unit I certify, that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) ! Permit Fees: Date of Payment: Receipt Number: (Rev. 12/00) Waiver Fees: .~/',.~ "" Date of Payment: [O//~4/O'7- Receipt Number: ~_"7,~'/,~ 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 October 26, 2002 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Septic Upgrade - Fire Lake Tract I-l, Lot 3 Gentlemen: The owner has requested'we proceed forward to obtain a septic permit on the subject lot. On October 15, 2002 one testhole was performed for the proposed system. The results of this test are attached. The general slope of this lot is from south to north at a grade of approximately 1-5%, with greater slopes (20%+) on the southern portion of the lot. We have designed our system utilizing the existing testhole that was excavated for the 3-bedroom house. The lot is served by an individual well, located on the northern portion of the lot. We propose to install one 5' wide shallow trench. Water was encountered during the excavation at 10', and the tube was dry at monitoring. There are no public or private wells within 200' of our proposed system location except as noted. With this application, we are requesting a lot-line waiver to 8'. Granting of this waiver will not adversely effect the adjacent property, which has an existing septic field within 30'+/- from the proposed upgrade. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, ]1~}~]11~ Engineering, Inc. Attachments: On-Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test WELL K -iA DISPBSAL SYSTEM DETAILS/SITE PLAN' WASTEWATER FIRE LAKE TRACT I-1, LOT 3 ! / / / / J-2~ , K-1 DESIGN DETAILS 3 BDRM X 150 GPO = 450 OPD · · · 18618 FISH HATCHERY RD, EAGLE RIVER, AK. 99577 (907) 696-8956 F1E].D BOOKS ~ ,.,. ~ ~ 02076,D~ 1-8 450 GPB/1.8 GPO PER SQ, FT, (8.5 MIN/IN,)= 375 SQ, FT (375/5'(;/)) X .58(RF) (3.0' GRAVEL) = 43,5 FT. TRENCH USE I TRENCH - 44 (L) X 5' (;/) X 3,O'(D) To~c~( dep%h oF system Is 6.0' ?rOM original grade. Tot~t clep*h o? gr~vel below dls~rlbu*lon plpe Is 3.0' . NOTES' 1, USE 1850 GAL S,T,E.P, TANK, INSULATE IF <4' OF COVER, 8. INSULATE TRENCHES ;/ITH 8' HB BURIAL FOAM. CONTRACTOR ;/ILL ENSURE MINIMUM 8% SLOPE INTO SEPTIC TANK. ADDITIONAL FILL ;/ILL BE ADDED OVER SYSTEM TO ACHIEVE MIN, 3' COVER IF REQUIRED, CONTRACTOR ;/,/ILL ENSURE ALL SEPARATIONS TD ADJACENT ;/ELLS, SEPTICS, LOT LINES, FDUNDATIDNS AND ALL OTHER SETBACKS. /24/02 NW554 02076 Scc~[e, 1'= 100' PAGE 1 DF 8 ]~~ ENGINEERING 20441 PTARMIGAN BLVD. EAGLE R~VER, AK 99577-8736 ~:.:.:.:....:...~:...~~~:.:..........:.:.:.x...~~.........~:.:.:.:.:~:.:.:~:{.}:....:.:~:.:~:.:.:...~:.:.:....:.S.} } S.X.S {.}:.:.:.} } X.} S.:.} St WASTEWATER DISPBSAL SYSTEM FIRE LAKE TRACT I-1, LBT 3 l~r~l-~l ~ I DETAILS EX~S'~NG TANK TO BE ABANDONED G SYSTEM MT 34' / / / / / PROPOSED 1250 GAL STF:~ / / / / / PROPOSJED D][VERTER VALVE TO FF.,E~ OLD SYSTEM I 1 PREPARE]:} FDRI CHRIS SCOTT 1B618 FISH HATCHERY RI), EAGLE RIVER, AK, 99577 (907) 696-8956 FIELD BOOKS ~ ~u"°"~',,)QHNNSON ~"~"": VBG sT~,e c~ KMD ASBMLT; DWC.. FIL~ A:,e r,.e 02076.DWG 10/24/02 NW554 02076 Sco.[e~ 1'= 20' PAGE 8 DF 8 ]~I~) ENGINEERING 2044! PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 Performed for: Project: Depth (Feet) 1. 11. I 13- 14- 15- 16- 17- 18- 19- 20- Chris Scott Date Performed: 10/15/02 Fire Lake Lot 3, Tract I-1 TEST HOLE # 2002-1 ORG/ML - back red silty overburden w/org. SEE ATTACHED SITE PLAN FOR HOLE LOCATION Was Ground water encountered? YES What depth? 10' Depth to water after monitoring? NO Date? 10/22/02 SW -med dense, gray, w/trace of silt seeps SM B.O.H. Reading Date Gross Net Depth to Net Time Time Water Drop 1 10/15/2 1:00 7" 2 1:10 10 rain 2 12/16" 4 4/16" 3 * 1:11 7" 4 1:21 10 min 2 14/16" 4 2/16" 5 * 1:22 - 7" 6 1:32 10 min 2 15/16" 4 1/16" 7 * 1:33 - 7" 8 1:43 10 rain 3" 4" 9 * 1:44 - 7" 10 1:54 10 min 2 15/16" 4 1/16" 11 * 1:55 7" 12 2:05 10 rain 3" 4" · Water Added HOLE PRESOAKED PRIOR TO TEST Percolation Rate 2.5 (rain/in) Perc Hole Diameter Test Run Between 3 feet and 4 feet 6## I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. Municipality of Anchorage Development Services Department i Building Safety Division On-Sit~e Water and Wastewater Program i 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 ~ww.ci.anchorage.ak.us ~ (9O7) 343-7904 Waiver Review Worksheet WI~: WR020084 PID~: P$1-333-39 Date Received: 10/29102, Legal Description: Fire Lake Tract I-1 Lot 3 Engineer. Kenneth M. Duffus. PE KND ~nflineerlna Applicant: Chds Scott Permit~: ,AYS,.-' O2. Oq- f.~ Waiver Requested: 8 feet from absomtlon field to lot line Criteria: Geology i Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Omdient E. Horizontal Separation ~ Total: Waiver is Granted: ,~' i Waiver is not Granted: List Conditions or Reasons for above: ~'~- ~b'~_.-/~l/~&;~' Ij /.~/rE~q OF Name of Reviewer Rec~; 27616 Amount: $160.00 Date Paid: 10129102 Municipality Anchorage Build mg SafcB' D1v1slOll P.O. Box 196650 * 4700 S. Bmgaw Strcct Anchorage, Alaska 99519-6650 * (907) 3413-8301 h ttp://www.cl.mmhoragc.ak.us Department of Public Works 11/4/2002 Kenneth M. Duffus, PE KND Engineering, Ine 20441 Ptmmigna Blvd. Eagle River, Alaska 99577-8736 Subject: Waiver Request for Fire Lake Subdivision Tract I-1 Lot 3 Waiver Request #WR020084 Parcel ID #051-333-39 Wastewater System Upgrade Permit Number SW020445 Dear Mr. Duffus: Your request for a waiver of the required 10 feet horizontal separation from the absorption field to property line has been approved. The approved separation distance is 8.0 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Daniel J. Roth Civil Engineer On-Site Water & Wastewater Program K~% MUNICIPALITY OF ANCHORAGE ~ ~--~'~j~] DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ilkS. ,'] ENVIRONMENTAL ENG, NEERING DIVISION ~.~// 825L Street- Anchorage, Alaska 99501 Telephone264-4720 ~ /--)ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ~//~ ~ IPHONE ~,[~EW DISTANCE TO: Absorption a r21~) Manufacturer Liq. cap~ IF HOMEMADE: Inside length Well Dwelling DISTANCE TO: Manufacturer DISTANCE TO: We,, Le n gt~q.c~n~..~ No. of lines ~ Top of tile to finish grade ~' Length Width Foundation.~(~ /. Mate~al be~leath ti~e .... Depth NO. OF BEDROOMS Dwelling~ Materi~~ Width Material N eares.~,.~n ~ P E R M I.T-~ O. No. of c:~.~_:rtments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO.~/ /[/~1~ inches Distance b ? i..es inch os Total ef f~5~ rption a rea IPERMIT NO, Type of crib Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATER I%~, ~( SOl L TEST RAT~ ¢ INSTALLER REMARKS 72-013 (Rev. 3/78) !....0 C:FFF 111 OBI F:' LO'T' T'~"F:'Ei: OF:' 'E;O :[ L f::l[~:~;(::l[~:l:::"!" I CIN :~;'-r':E;'T'EH I :~;: [::'1:;~:1:::! '.[ F~F' ;[ ELD THE: F,;:EC&.I I [RE:C' :~; Z 2:E: OF T'HE :~;O :[ L FIE::E;Cff~:F'T ;[ ON '.E','~':~'T'EH ! '~;: THE: t....EN(iFI"I"! [::' :1: F'lE:fq:i~: :1: 0t",I :[ f.:; THE L..E:I",IC'Fi"FI ':: I Iq FEET ::' OF:' THE: "FFi:EI",IC:H [)Fit [::'1:;'::1:::11NF:' ]: Ei:LI:). "I"HE~ DEi:F"I"t'"I OF::' !::t TF;~:E:NC:H CIF~'. 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PERFORMED FOR: LEGAL DESCRIPTION: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 1 2 ~4 7 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG [] PERCOLATION TEST DATE PERFORMED: 7~-~ ~/ SLOPE SITE PLAN 10 11 12 13, 14 15 16 17 18 19 20 COMMENTS PERFORMED BY: 72-008 (6/79) ~,,,,~.,~ · WAS GROUND WATER ~J ~ ENCOUNTERED? 0 -- /~. / ~,~ . IFYES, ATWHAT ~ /Y f/. / DEPTH? // No. 1457-E Gross Net Depth to Net Reading Date Time Time Water Drop / PERCOLATION RATE //~ (minutes/inch} TEST RUN BETWEEN FT AND __ FT by DOC Co, dba SULLIVAN WATER WELLS P.O. BOX 272, CHUGIAK, ALASKA 99567 ~1 TELEPHONE688-2759 OWNER OF LAND _~, ,~' ADDRESS , LEGAL DESCRIPTION DATE- Started PERMIT NUMBER DEl'TH OF WELL STATIC LEVEL OF WATER I)RAW DOWN FT. '"/:; GALS. PER HR __ KIND OF CASING KIND OF FORMATION: From___/2 Ft. to ,.:)-, Ft, From,,-O _._Ft. to. / ,'?', Ft. From /,? _Ft. to~Ft. From ,:'~ o/ _Ft. to From .?~: _'~ Ft. to Fromm/ Ft. to From.~.Ft. to ..... Ft._ From___ Ft. to .... Ft From__Ft. From___Ft. Io___Ft, __ From ___Ft. to___Ft. From Ft. lo____Ft. From._ Ft. lo____.Ft. From ..... Ft. to__ .Ft. From Ft. to___ Ft.__ From Ft. to Ft. From _Ft. to Ft From ..... Ft. to From Ft. to ........ Ft Frmn ....... Ft. to From ....... Ft. to From Ft. to From _ _Ft. to ...... Ft ...................... From_ ._ Ft. lo .... Ft .......................... From _Ft, to Frmn Ft. to ....... Ft ............................ From ...... Ft. to ......... FI ........................... From ...... Ft. to ..... Ft ................ Fmm. = ..... Ft. to ...... Ft, From___ Ft. to .... Ft ...................................... From .... Ft. to .......... Fl From FL to__ Ft From ....... Ft. to .......... Ft From ..... Ft. to ......... Ft ............................ MISCL. INFORMATION: NAME df' / ~L ............ DRILLER'S .......... ___ 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. 051-333-39 1. GENERAL INFORMATION Expiration Date: 3 _a 3 — ZOZI Complete legal description FIRE LAKE LT 3 TR 11 Location (site address) 18612 Fish Hatchery Rd Eagle River Current property owner(s) CLAFLIN BRUCE & SANDRA Day phone Mailing address Real estate agent 34768 Chesapeake Drive Union City CA 94587 2. TYPE OF DWELLING: 0 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 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 $ `� a e 5 0 %f) U I - 1 `I Waiver Fee $ Date of Payment ���ZZ�2('� Date of Payment Receipt Number n7i��f 1 -0 Receipt Number COSA # 0,S C),b f(� S c� 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 907.406.1058 Address 19162 Mountain Rd Chugiak AK 99567 Engineer's Printed Name Curtis Townsend, PE Date 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms' Disapproved Conditional approval for bedrooms, with the following stipulations: Original Certificate Date: 12-23 - F-0 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: FIRE LAKE LT 3 TR 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 1981 Total depth 96 ft Cased to 96 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12 in. Date of flow test for COSA 7/9/2020 Static water level at beginning of test 21 ft. Comments B. TANK DATA Age of tank(s) 18 years Tank type/material STEP Steel Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping 12/16/2020 D. ABSORPTION FIELD DATA Which system tested (date installed) 1981 ❑ ALL standpipes present per record drawing Total measured depth from grade 8 ft (max) Measured depth to pipe invert from grade 5 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 051-333-39 Structure served by this system _ Well production at time of test 4.3 gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ N ❑ Coliform bacteria is Negative Nitrate 1.73 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Curtis Townsend Date of Sample 12148020 C. LIFT STATION Q Required maintenance completed Age of lift station 18 years Lift station material steel Comments: Adequacy test date 7/9/2020 Results ❑✓ Pass For 3 bedrooms Fluid depth prior to test 6.75 in Water added 451 gal New depth 17 in Elapsed time 1440 min ❑® Code -required soil cover over field Final fluid depth 9 in ❑ System presoaked Absorption rate ' 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: Diverter valve is switched to 1981 field. 2002 field has 37" of water in both MTs. COSA Checklist yellow sheet 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' rV-1 Yes Community Sewer Manhole/Cleanout > 100' Q✓ Yes if No ft Q Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25'171 Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' M Yes if No ft Neighboring Absorption Fields > 100' Yes if No ft Water Main > 10' Animal Containment > 50' F/� Yes if No ft M Yes if No ft Q Yes if No ft Water Service Line > 10' ED Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' 0 Yes if No ft R Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' rV-1 Yes if No ft Surface Water> 100' Yes if No ft Property Line > 5' E] Yes if No ft Wells on Adjacent Lots: 0 Absorption Field > 5' 0 Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' ❑✓ Yes if No ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' ED 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' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' R1 Yes if No ft Community Wells > 200' P Yes if No ft Surface Water> 100' 0 Yes if No ft F. ENGINEER'S COMMENTS All septic standpipes present per 2003 inspection report. 2019 survey didn't capture everything during winter. 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. COSA Checklist yellow sheet Lift Station/Pump Vault Maintenance Log 7 Owner Street Address4 / -,-2 Septic Tank: -Sludge level inches -Pumping: requir '6q ;e no -Pumping completed �a�. es no Lift station: -Pump basket cleaned e no -Effluent filter cleaned -Control floats cleanede no *Proper float settings confirmed Q&no no -Operation satisfactory no Alarm Svstem: -Dedicated electrical alarm circuit _ *Audible and visual alarm inside dwelli ,8 no -Alarm system operati n sats not satisfactory Manhole Riser -Ground water intrusion at riser to tank connecti -Ground water intrusion around pipe penetrations e n -Weep hole functi al " e no -Manhole lid: Functiona a no Insulatno Properly Secur no Other -All manufacturer required inspections and maintenance completed yes no Comments: Qualified Maintenance Provider: Technician Date of maintenancej2 Company 'j f 421 Signature __ Date) 2, 20 < w 0 < m3: LD w r Z 0 < w W WWF CR w C, w Cl) w cf) x mti NU) Lu m LL wZ C, <w0- c, N F- z < W W z < W co 0 C) Z) C) X/ 0 lllls� ''' : \5\- m erf — cn cn F- UJ >< z K W -j W U- \N '27B.5Z 0 C6 a- cl > 0 E Z W -J F-- LL 0 Bool,0311 < < w W � T 0 C) F- D x > w (n obw < C) Uj o 02 a- 0 YF- Y LU EL 0 Z 0 = ED U) C) 00) r_oOf w 0 w 2 cr w 5 iz < rn C) (D w (D W 2i w 0 w W � LLf 06 z m 3: 0-1 < -i :E U- C) Ln < m < w 20' 0 W 0 o z 0 M: > 00 w W :3 C/) (6 ct� co w 7: 0 P 0 0 T z Z X Lo c1r) § U) >- w w w (o 0 co _j (D - 011, LU —1 -i F- 0 >- w w WI- z 0 C) OAU 0 < D 0 :t 0 > z F- LLJ Elf w WO 0:� - w CO C� LL LO Z < < ro. 0. 09,00 0 z LLJ 3� 0 P W C) U) U5 < m 0 1: C/) Z U) 0 w w > 0 0- Z w 0 D U) oc_- U) < w 0 0 2: F- W LL O zl- X, Y 0¢ F- � U) z 0 w < 0 uj w w 0 (PZ w F-: 0 < w z = �- F- W F- < F- >- - Z W < LL 0 X F- Z — LU < C,'o) < C) o z 0 Z 0-1 C6 0 . < -J Z 0 D > 0 z 1: < w i W D U- D F- IL m < 00 W L) IL U) 4 w 0 D� z p 0 o u -0 m 0 F - w xx >< > N < W > Co w 0 r-) -i a: () C) C) UQ U) z U) Cl) W LI) < 0 W < z w z U) �- vi 0 - o R; M fn 0 F - w - rr_ F- W w -Y\ 0 00. Z :D 0 > D F- F- 0 U) d C) Z 0 cr LO �F < ca 0 m < L) (.) w ML, of 0 (j) z < 0 Fn w <2 < F� D� Or- F- 0- 0 00! z >- W 00 - F- W 0 -------- --------------- - ----- --- 0,z -j 0 1z < 3: < :E 0 cf �- �- > , m Z C) :DZZ z C) z w 3: p 0� Li- w - OU :) w W 5 -, U) U) Of > 0 Q!: �- z z Ft z w w 0 D w U) Z) �- 0 w 0 Of C) o 0 LL b S 00001'50" W 206.68' w o U) > o N 2' z C) W 0 0 U) < Z 0 F<- ui F- 0 04 � CC 0U0 w 0 z W w CO W U) W Z w 0 i w z 0z X F- < m w D M0 U - 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 GENERAL INFORMATION (a) Application Date January 2, 1987 Legal Description (include lot, block, subdivision, section, township, range) Lot I-l; Section Lot 3; Firelake Subdivision (b) Location (address or directions) 18612 Fish HatcheL'~; Road Applicant Name Tim and Christina Sc~te~phone: Home Applicant Address 688-2956 Business (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer K-I; Other [] (explain); (d) Lending Institution Commonwealth Western MortqaqeTelephone Address Anchoraqe, Alaska (e) Real Estate Company and Agent Jack White Realty/Mary Ann Scott Address Eaqle River, Alaska Telephone 694-5500 (f) ~[~he HAAtothefollowingaddress: S & S Engineering 17034 Eagle River Loop Road, Suite 204 Eagle River, Alaska 99577 Ordered by Mary Ann Scott TYPE OF RESIDENCE Single-Family [] Multi-Family [] Number of Bedrooms ,q Other 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. SEWAGE DISPOSAL Onsite [] Public [] Community [] 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 72-025 (11/84) ENGINEERING FIRM PROVIDII ,NSPECTIONS, TESTS, FILE SEARCH, D, , 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 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 Firm S & S ENGINEERING Address 17034 E_~-.!e ph~,~,- I o.~,~ ~,~1 Date Eagle River, Alaska 99577 Telephone DHEP APPROVAL Approved for edrooms X2. Approved /'"'-"- Disapproved Conditional Date Terms of Conditional Approval CAUTION The Muncipaiity 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 omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) ANC~_OI>,M~NlClPALITY OF ANCHORAGE (MOA) ~AL~LTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ~ Well Classification Well Log Present~;~) Total Depth ~' Static Water Level Casing Height Above Ground Electrical Wiring in Conduit Separation Distances from Well: To Septic/,I,,~ldlh{j Tank on Lot If A, B, C, D.E.C. Approved (Y/N) '"---'" Date Completed '~ /"~ I Yield Depth of Grouting ~ Pump Set At ~ Sanitary Seal on Casing (~:;~N) Depression Around Wellhead (Y~[]) ; On Adjoining Lots Cased to ~ I,~ / t To Nearest Edge of Absorption Field on, Lot ~,'c::,c:~ ; On Adjoining Lots To Nearest Public Sewer Line ,IA / ~ To Nearest Public Sewer Cleanout/Manhole I'~/~' To Nearest Sewer Service Line on Lot Water Sample Collected by '~' ~. ~ ~::::l,.-Y=~t~,.% _(~>z.--t~,...~,~ ; Date Water Sample Test Results ~ ~ ~ ~ Comments ~' Ar ~ ~,.~.~.. ~--'t~,..~ ~ ~.~c~ B. SEPTIC/N~BR~IG TANK DATA Date Installed Standpipesd~/N) Air-tight Capsd~/N) Depression over Tank (Y/~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/l=leld~g Tank: To Water-Supply Well ~ t To Property Line ~i;;;;, To Water Main/Service Line Course ~ t2~ ~ Comments ~C~~ ~ "~ Size ~ No. of Compartments Foundation Cleanout~N) //~ Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) To Building Foundatio~ ~::~' To Disposal Field ~ ~ To Stream, Pond, Lake, or Major Drainage 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/~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field ~'"~r Depth of Field Gravel Bed Thickness "~ Standpipes Present ~'N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots '~c> w .y_ J To Cutbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test, Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all ~OA and HAA guidelines in effect on the date of this inspection. Signed S & S ENGINEEKI~ / Cq 9-~4~ E_-g!_- P~,~,' LQop Road No. 204 MOA REagle River, Alaska 99577 eceipt No. Date of Payment £ I Amount: $ /Od.) .~0 (-J ' Page 2 of 2 72-026 (11/84) MHNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES WAIVER REVIEW WORKSHEET ENGINEER: S & S ENGINEERING 17034 Eng'&' Rl~er Loop~-~-Ne. 204 Eagle River, Alaska 99577 CRITERIA: 1) Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation 2) Special Conditions: Po ir~ts: ~/~-- O 3) ! ¥ WAIVER IS: granted, with co~ditions listed below: not granted for reasons listed below: DATE: BY: NAME fi unicipa itYof Anchorage P.O. ~,3X 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TON Y KNO WLES. MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES January 19, 1987 Robert A. Shafer, P.E. S&S Engineering SRB 196X Eagle River, Alaska 99577 Subject: Lot I-1 Lot 3 Fire Lake Subdivision Waiver Request WR87-008 Dear Mr. Shafer: Your request for a waiver of the 100 foot separation required between the well and septic tank on the subject property has been granted. This distance has been waived to 90 feet. This waiver is valid for the existing septic system only. Upgrades or enlargements of the system must meet applicable separation requirements. Sincerely, Stephen S. Morris Civil Engineer On-site Services S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 ROBERTA, SHAFER January 13, 1987 CIVIL ENGINEER 694-2979 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage Department of Health and Human Services 825 L Street Anchorage, Alaska 99501 ATTENTION: Steve Morris RECEIVED REFERENCE: Lot I-l; Section Lot 3; Firelake Subdivision Dear Steve, Request you approve the attached Health Authority Application and grant a waiver to the horizontal separation distances between the private well and the septic tank located on this property. The horizontal separation distance is 90 feet and was approved under a waiver to 85 feet on Municipal permit 0811110 dated October 15, 1981. In addition to the information required for the Health Authority Approval we are including the following documents: A. Plot plan B. Nitrate water analysis C. Work sheet showing the results of the risk analysis performed by us. The following additional information is also provided: The installer of the on-site wastewater disposal system (Charles Bart, Contractor) is a highly respected excavator in this area. He has always used water tight couplings. Every job which we have ever inspected for this excavator has been letter perfect, manicured almost to perfection and we feel safe in assuming that water tight couplings have been used in this case. Since this waiver is from the septic tank only we feel it is unlikely that sewage would ever seep from this tank. With the system less than six years old and with the house only occupied parttime during this period the sewage load is considered minimal. The ground slope is generally flat with a driveway and house foundation between the well and the septic tank which detour over the ground contamination in the event of septic tank failure and subsequent surfacing of sewage. page two Lot I-l; Section Lot 3~ Firelake Subdivision January 13, 1987 A fair amount of vegetation exists between the septic tank and the well which would induce transpiration of water carrying contaminants. Other considerations are: Ao Permit issued by Municipality of Anchorage on October 15, 198]. approved a waiver of 85 feet. B. The on-site inspection performed on October 29, 1981 approved a horizontal distance of 90 feet. C. A Health Authority Approval was issued by the MOA on January 29, 1982. It is our opinion that the horizontal separation distances prescribed by 18AAC72.021 are not required in this case and that bacterialogical pollution is not possible. If we may~ of further service, please contact us. 0~ ~ DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE ~ . I- 1 INSPECTOR I N$,PECTOR MUNICIPALITY OF ANCHORAGE ~~'~' DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts oll page 1. Incomplete requests will not be processed. Please allow ten (I0) davs for processing. 1. PROPERTY OWNER PHONE PROPERTY RESIDENT (If differen{ from above) PHONE suYE.__ MAILING A[3DR ESS I PHONE MAIrlI~G ADDRESS _ · _ ~4~ ~ # ~ ~V~ 4.' R~ L~rO-R/~G ENT - PHONE LEGAL DES STREET LOCATI~)N - ,~ ,~ ,~ - I B. 'TYPE OF RESIDENCE ~ NUMBER OF~BEDROOMS [] One [] Four ~L~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY ~' Three [] Six 7. WATER SUPPLY ' INDIVIDUAL* * ATTACH WELL LOG, A well log is required for all wells drilled COMMUNITY since June 1975, For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) [] Other 8,SEWAGE DISPOSAL SYSTEM I~ INDIVIDUAL/ON-SITE** /fY/ [] PUBLIC UTILITY 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 NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED [--]PUBLIC UTI LITY Connection Verified INSTALLER []Septi. c Taj31~or I'-I Holding Tank Size: /<~)~--~~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTUR'ER TOTAL ABSORPTION AREA MATERIAL 4. DISTANOESwELL TO: Septic/Holding Tank IAbsorption Area [Sewer Line I Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS [~ APPROVED FOR .~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY 72-010 (Rev. 6/79) Municipality of Anchorage • •--1111 On-Site Water and Wastewater Program _t _ (907) 343-7904 Illi n . 1' _ r V CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-333-39 Expiration Date: X0 -26 -.1 1. GENERAL INFORMATION Complete legal description Fire Lake Lot 3 Tract I1 Location (site address) 18612 Fish Hatchery Road, Eagle River, AK Current Property owner(s) Scott Day phone 865-6472 Mailing address same Real Estate Agent KW Day phone 85c, � Sy 3V 0 77 2. TYPE OF DWELLING: RUSH! ''� ® Single Family (w/wo ADU) a JUL 1 9 Z018 ❑ Duplex 4. ❑ Multiple Dwellings (Single Family and/or Duplex) t hw X01 6 8 L95 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual El Individual Water Storage ❑ Holding Tank ❑ Community Class C Well ❑ Community ❑ Public Water System 0 Public Sewer 0 F I L(0.wa ►ce.(►er WHUclMS .Welbcf 19-( 9 CacrOct.FJ cies Received by: GY �� Date: 7 2_3---(2s- Home �o COSA to be released to the engineer, unless otherwise requested by the engineer. 6t PVLL,p COSA Fee $ 4-i't.top Date: Date of Payment 1- <<g Date of Payment Receipt Number (461) Receipt Number COSA# 05 C 111352 Waiver# +le 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 NorthRim Engineering Phone 694-7028 Address PO Box 770724,Eagle River Engineer's Printed Name Steve Eng Date 7118/2018 <.. 6. DSD SIGNATURE '~ > ,..� tj System #1 Approved for � bedrooms. � System #2 Approved for bedrooms. <s v . r�8 Disapproved. `'•••:?/t cf%.P.P•4D yh t?0 FE-SS10 ,E`�� v Conditional approval for bedrooms, with the following stipulatidiis. ,,,a4, ;°-' OF ON-SITE WATER AND WASTEWATER PROGRAM U ", By: Original Certificate Date: 72d The Municipality of Anchorage Devlopment 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_9-1-12.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:F(/ - - 1,../1-w E L3 / >K--rl C7 27 Parcel ID: 6, !—3s3— 5? A. WELL DATA (� Well type 1 If A, B, or C provide PWSID# Well Log (YIN) y Date completed 9/1/ Sanitary seal (Y/N) Wires properly protected (Y/N) y / q‘ ft. Casingheight (above ground) Z in. Total depth �6 ft. Cased to / g FROM WELL LOG AT INSPECTION Date of test �/ '/ �Vd4 9l Static water level O ft. ��• ! ft. Well production 47&Q0 g.p.4 g.p.m. WATER SAMPLE RESULTS: Coliform d colonies/100 mL Nitrate ZOSmg/L Arsenic ,'V/ ug/L Date of sample: 46-7.q/icr Collected by: /' //e- - ,5f t q B. SEPTIC/HOLDING TANK DATA Tank Type/Material S/,�/ L' Date installed it/276 Tank size/256 gal. N mber of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (Y/N) Depression over tank (YIN) A High water alarm (YIN) y / 1/Date of pumping -572- 7 U Pumper T g j C. ABSORPTION FIELD DATA /SQ /0 i 9/F/ /' ' Date installed/(/Z// Z., Soil rating (g.p.d./ft2 or ft2/bdrm) /2S System type lr'e,.<L(/j Length S7 ft. Width 5 2 ft. Gravel below pipe 3 3 ft. p- 310 Total depth O ft. Eff. absorption area tf SO ft2 Monitoring tube / Depression over field Date of adequacy test / Zp/l Results lts (Pass/Fail) P For 3 bedrooms rooms Fluid depth in absorption field before test in. Water added z'�6 gal. New depth z O in. Elapsed Time: -30 min. Final fluid depth 2 in. Absorption rate >= 17-5-6' g.p.d. Any rejuvenation treatment (past 12 mo.) (YIIN & type) v,//'� If yes, give date D. LIFT STATION Date installed /(/ -//°Z Size in gallons /Z 50 Manhole/Access (Y/N) �/ / "Pump on" level at Lill in. "Pump off' level at lif a in. High water alarm level at ig in. Datum 17L�n.-1 Cycles tested -3 Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot /0 o fi On adjacent lots / 0 0 'f` Absorption field on lot /0 o /-fr On adjacent lots /CD0 (f Public sewer main /0 0 I Public sewer manhole/cleanout (do (t Sewer/septic service line Z5'4- Holding tank /d0 (-F— Animal containment areas 5 D Manure/animal excrete storage areas / 0 O (f SEPTIC/HOLDING TANK ON LOT TO: 1 / Building foundation /6 Property line 5 -f— Absorption field 5- -F- i Water main /0 -r Water service line /6 "Surface water /616 1--- Wells on adjacent lots /J 0 11' ABSORPTION FIELD ON LOT TO: Property line i ‘1.- Building foundation /a Water main /a f Water Service line �� 6f. Surface water /Q6 ('t`� Driveway, parking/vehicle storage CJ Curtain drain 6/!\/(i Wells on adjacent lots /d0 4-- F. COMMENTS Nr---__:40 Lto- f(45:4,4 F./974/54 Q((/ iQ7- VA-L✓F ,5tA) trc X64 QLA f/�"tL — Pr.51.,5.1',-.d G. ENGINEER'S CERTIFICATION -- : `r! f' •'k+ , r I certify that I have determined through field inspections and r•: review of Municipal records that the above systems are in a ,, conformance with MOA COSA guidelines in effect on this date. � r^i•• , Engineer's Prin ed N me �///V' /� by ( Date 7 Ila / & ,, 7/icf//�.o•° � y ,; COSA yellow sheet_2-6-15.doc MUNICIPALITY OF ANCHORAGE • Development Services Department�� '� t Fax; 9007 On-Site Writer&Wastewater Section Phone;9343-7904 n� 7.343-7997 Lift Station/Pump Vault Malwitenance Log Street Address %b(i/>/. t/ � i/�TC. ;Ami septic Tank: �0Azo1 -Sludge level rY inches 'Pumping: required Yes (no "Pumping oompleted nq *Pump basket cleaned nq "Effluent fitter cleaned s no Aiv/✓ - •Control floats cleaned gas_no •Proper float settings confirmed 10,,:A_ ryX 'Operation satisfactory,A7es rti4 grm $yatgrn: 'Dedicated electrical alarm circuit no -Audible and visual alarm Inside dwelling ing ry'o� nQ *Alarm system operation (Ihsta� not caticfiz.:_ , Miaenhoje Riser -Ground water intrusion at riser to t+nk e;•nneutten yek_69) -Ground water Intrusion around pipe penetrations as._ tt4 'Weep hole functional SLS •Menhola lid: Functional r` R 110 InsulateiiQ _no. Properly Secured'xi* no Other I •All manufacturer required Inspections end maintenance completed , c1 no CQmmgllts; i>7 • • • i alif d aigignajce providert • Technician .L7 c bate of mei►ttenence 7//L//-- Company ,),;C 8�netune�, _f Date —` ah:ulinya/rick.{n: P V.a`3i>x '1140'Nnr•hui.t,ic.Atar,ka 1.110q-1•0,0 •..vw4,4,t tis Nrg, NO0'01'50"E 206.68 \ D • \ \x> v' V�J{ v •\ to \71/494‘ .ti ORAL \/N CO \,<" a sr \Po N S0 `,p c,P} \ • c.P '.Ncsilf \) N co- e I __. co zo LA tD W CT m I CI co 0 a) „ 2t.7t W2 ��� �• OF AI. N08Q1p3 \' \ �# � HOBBY F. BIJRNEITp BobbyF. Burnett GRAPHIC SCALE: 1 Inch = 40 Feet CURVE CHART �,. LS-54154 arriage Drive 1 7-// '�J Anchorage, Alaska 99507 �� NO DELTA RADIUS LENGTH 1, (907) 350-5541 20 0 20 40 80 10 89'53'49" 100.00 71.53 ����: Date Scale Legal Description 7/11,2018 1' = 40 I hereby certify that the property described hereon has been surveyed Lot 1-1 by me, or at my direction, and that the improvements situated thereon Grid are within the property lines and do not overlap or encroach on the NW 0554 AS-BUILT property lying adjacent thereto unless otherwise shown. That no FIRE LAKE SUBDIVISION improvements on the property lying adjacent thereto encroach on the ` Drawn by Field Book PLAT # 74-233 premi,,es in question and that there are no roadways, transmission \` BFB ASB-2018 lines or other easements on said property except as shown. //