HomeMy WebLinkAboutSCIMITAR #1 BLK 1 LT 7Scimitar #1
Block 1
Lot 7
#051-132-02
f
*7A
Municipality of Anchorage
Development Services Department
Buildinn•SiteWaterandWaste aterProgaDivislm�4700 BragawSt.P.O. Boz 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us (907) 343.7904 Page of
TER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: PID N
_ j(�� p� 7D51
N„r R061_ umber. 17fa
,2T Q a Wastewater System: ❑ New
�'•+• pgrade
Pnorr U'
Z/0a c1l ucAeff ifr2/G 40RIVCc ABSORPTION FIELD
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LEGAL DESCRIPTION Sal R,tuq
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aka / La s mewn / GPDFr'
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TownuuG 7` � � Sean bmegn PP.
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y •nan
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GPM Ft GC OS oI33
FL TANK
SEPARATION DISTANCES Septic ❑ Holding
To Septic Absorption ❑ S.T.E.P. ❑ Other.
Fran Tank Holding ubuUPn a •a«« A
Field Station Tank Sower Line 'PeG1y /T� ZSO Gal
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BENCH MARK
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Engstiv'g,-J�TP
R G OF
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Inspections performed by: Its, C.)
�Z�pS r Ej STN r aw• '. y' e )
Dates: 1q
r ,.
2n°0 Gr
Development Services Department Approval r
Reviewed andapprovedli r, steYen W. �3
b : d s••. FE 6ZIS
Y �,�.
RN I_901 p1. , 0 .. - n ^- Date: _qap/xu., �� `, •.`
'Alf-
Test Hole—
New 1250 Ga o
ISeptic Tan
ew F.C.O.
Existing Tan
Decom issionecl
ull Run e, /
V0JVe C to ���
DESIGN NOTES:
1. Total Depth of Trench is 8' fry
surface. Terrain slopes toward a north.
2. Sewer Service Line minim 2% slope.
3. Trench is Minimum 'f0' from Lot Line.
14. Lots Served by
I /
to Water Wells.
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F.C.D.
A
26.4
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29,7
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S.T.C.❑.2
25
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25.2
24
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26.3
27
C.O./MT
87.5
102
NORTHRIM �P�� SCIMITAR S/D I AS -BUILT
ENG/NEER/NG '.aemBL❑CK 1, LOT 7 LOT PLAN
i 77237 Bear Paw Circle
Eagle River, Alaska 99577 V= $�� _—
907.694.7028 •'••....•• j
DETAIL LAYOUT �.:------�„E7. '
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MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water d Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Permit Number: SWO50347
Legal Description: SCIMITAR #1 BLK 1 LT 7
Design Engineer: 0838 North Rim Engineering
Owner Name: ROBERT & SANDY JOHNSON
Owner Address: 20344 CHUGACH PARK DRIVE
CHUGIAK . AK 99567-6345
Upgrade
Date Issued: Sep 15, 2005
Expiration Date: Sep 15, 2006
Parcel ID: 051-132-02
Site Address: 020344 CHUGACH PARK DR
Lot Size: 141904 SO. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
MV Disposal Field 0 Septic Tank F-1HoldingTank ❑ Privy E] 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 By,.
Issued By:
Date: % Zo OJ
Date: 4
14,
Municipality of Anchorage
�<
... Development Services Department
Building Safety Division
On -Site Water and Wastewater Program s .....
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 05/- /32 -02 Permit Number SW
Property owner(s)
o r /-,` nd� �•• Day phone 6�8-0325
Mailing address Z03yy 6A?(VIZ Zip Code 77 Y?
Site address Zip Code
Legal description (Lot, Block & Sub'd.) S[' riot/Tf%r/ �-
oCf—( 'LQ 7'
Legal description (Section, Township & Range)
Lot Size 41 �� U A es/Sq.Ft. Number of Bedrooms [1
THIS APPLICATION IS FOR:
�_J Well Only
Sewer Only ❑
Water Storage
Sewer and Well
❑ / El
Sewer Upgrade
THIS PROPERTY CONTAINS:
H ❑ Jacuzzi 13ot Tub
Swimming Pool ❑ Water Softening Unit El
Therapy Pool ❑
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 a orized agent)
Permit/Rush Fees: (�D • Waiver Fees:
Date of Payment: 9 Date of Payment:
Receipt Number: �✓? �(!O ��1 _ Receipt Number:
(Rev. 09104)
bT1-�IM
ENGINEERING
NorthRim Engineering
17237 Bear Paw Circle
Eagle River, AK 99577
907-694-7028
September 7, 2005
MOA On -Site Water & Wastewater Program
4700 Bragaw St
Anchorage, AK 99519
RE: Septic System Design, Scimitar #I, Block 1, Lot 7
The septic system has failed on the subject property. The owners wish to replace
immediately. The soil test was excellent.
This is a large lot. Most of the neighboring lots are developed. This site should not
negatively impact any of the other area lots. The slope is relatively flat at about 5%.
Please review the wastewater system design for the single family home. I have included
design plans & specs, design guidelines, & soil tests. If there is need for additional
information or clarification please give me a call.
Sincerely,
v�tJ.'
e Eng, PE, i
Design Enclosures
�NOIUERING_ Scimitar #1S/D, Block 1, Lot 7
SPECIFICATIONS & DESIGN GUIDF.I,INFS
AVnstewnter System Sizing: This is an existing single family home @ 4 bedrooms. The existing
system is in a failure mode and is 28 years old. The septic system will be replaced. This requires
a new 1250 gallon septic tank. The lot is very large at about 3 acres. Neighboring lots are also
large. Most of the neighborhood lots have been developed. Separation will be maintained to the
existing water well. No adverse impacts are expected from developing this lot. The proposed
septic system is located on the drawing as are the neighboring wastewater systems & water
wells. The lot is relatively flat and with a small slope. No conflicts to any neighbor lots is
anticipated. One soil test was conducted. A sandy soil with an excellent percolation rate. An
application rate of 1.0 GPD/FP is being utilized. The old septic tank will be properly
abandoned. The old absorption trench will be connected via a "Bull Run' valve.
Specifieation Requirements: All components and work must comply with the Municipality of
Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater
Regulations.
• Two compartment, 1250 gallon septic tank.
• Watertight couplings on inlet & outlet.
• 5 foot minimum between the tank and bed. 10 foot to property lines.
• 3 feet of cover or insulation is required for trench; an equivalent of 1" insulation for each foot soil
cover.
• Tank & solid pipe must be set on well compacted, stable soil. prior to an
• 4 inch diameter cleanouts with airtight caps are required 1 to 4 feet from foundation wall, p y
90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts
between the tank and the absorption field, not more than 10 feet from the tank positioned to provide
cleanout access towards the tank and towards the absorption field.
• All cleanouts must extend to at least ground level.
• In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron.
• Trench to be placed level, minimum of 4 feet to groundwater, 6 feet to bedrock from drain -rock.
• Drain rock to be''/) inch to 2'/i inch screened. Drain rock to be distributed uniformly throughout the
trench.
• Perforated pipe to be installed level with perforations down.
• Silt barrier (filter fabric) to be installed above the drain rock.
• Smeared trench sides must be raked or scarified before drain rock placement.
• Backfill over drain rock must not be less than 36".
• The finish grade must be mounded to promote drainage over the trench.
• Insulation must be placed over any pipe installed under driveways or parking areas.
• Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM
D2661,
• Sewer Service Line is minimum 2% slope.
• Septic Tank to be pumped every two years or when required.
• Insulation board to be extruded direct burial polystyrene (Dow Styrofoam 111 or equal)
• The existing septic tank will be abandoned; the septic tank will be pumped, crushed, and filled with
sand/gravel or removed and properly disposed of. "Bull Run" valve to old absorption trench.
Septic System Construction
Does Not Preclude Adjoining
Lots From Sanitation
Improvements.
DESIGN NOTES:
1. Total Depth of Trench is 8' from
surface. Terrain slopes toward the north.
2. Sewer Service Line minimum 2% slope.
3. Trench is Minimum 10' from Lot Line.
4. Lots Served by Private Water Wells. 1
NORTHRIM
ENGINEERING
17237 Bear Paw Clroli
Eagle River, Alaska 9937:
907.694.7026
SCIMITAR S/D
BLOCK 1, LOT 7
WASTEWATER LAYOUT
LOT PLAN
V = 100'
We: --- -- -EET.
9/6/05 �1 of S _
I Test Hole—
New1250 Ga o
ISeptic Tan
I
I 1 _,7
Existing Sep
System --
ull Run
Valve (Connect to exit Ing tie(d)
/
I
I /
I
RIO
e w F,C.G.
/ DESIGN NOTES:
I 1. Total Depth of Trench is 8' from
Isurface. Terrain slopes toward the north.
/ 2. Sewer Service Line minimum 2% slope.
I/ 3. Trench is Minimum 10' from Lot Line.
I 4. Lots Served by Private Water Wells.
:s� a SCIMITAR S/D
NORTHRIM
ENGINEERING `• BLOCK 1, LOT 7
li—
77237 Bear Paw CfrWe ••Fe7M
Eagle River. Alaska 99377 ••
907.694.7018 a'w i DETAIL LAYOUT
LOT PLAN
r = 50' ----
Date; _ — EET:
9/6/05 2 of 5
Septic System Construction
Does Not Preclude Adjoining
Lots From Sanitation
Improvements.
DESIGN NOTES:
1. Total Depth of Trench is 8' from
surface. Terrain slopes toward the north.
2. Sewer Service Line minimum 2% slope.
3. Trench is Minimum 10' from Lot Line.
4. Lots Served by Private Water Wells.
SE9.3903f1 10278! (!S 7)9)
_) 1 1019'5900'• 157A IO9-179))
I Test Hole I I
New 1250 Ga o I
Septic Tan
I I I I
I I N99.5901'W-2-0-5 5
I. WELL
^ I Pw F.C.O.
I�'
x(sting Sep
y /
S sten
ulI Run
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NORTHRIM
ENGINEERING
17257 Bear Pow Circ ' •• a 9n,''
Eogie Ri.er, Alaska 99377 t • ••
907.694.7028
t i
SEPIIC w
Jo
SCIMITAR S/D S/D PLAN
BLOCK 11 LOT 7
SUBDIVISION LAYOUT w9/6/0s Na of s_'
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OG - PERCOLATION TES
Date Performed, 8/30/05
Performed For, Robert & Sandy Johnson
Legal Description, Scimitar W. Block 1 Lot 7
T.H. Location, See Attached Design
Groundwater?
DEPTH
(FEET)
Depth
organic
1 -
•,`
Water
Depth
4 -
Monitorin .None
GM
5 -
'' _..
Silty Gravel
6
- :'"
w/ Sand
7
9/6
0
8
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10
9/6
2
2 min
5'
2'
3
9/6
5
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- ' �'.::�.
Dense
4
9/6
7
14
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2'
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19
-
T.H. Location, See Attached Design
Groundwater?
No
Depth
--
Water
Depth
After
Monitorin .None
Date, 9/6_ /_
#
Date Gross Time
Net Time De
th
Net I
1
9/6
0
2
9/6
2
2 min
5'
2'
3
9/6
5
-3.
4
9/6
7
2 min
5-
2'
5
9/6
10
--
r-
air,
12
2 min
5'
2,
20 -
21 - Percolation Rate 1 min./inch
Perc Hole Diameter
Test Run Between 3' and4'
Comments, I
Performed By ni^r+bRi� Erng•
Performed in Accordance with All Sta
ON THIS DATE. DATE, 9/6/05OF
_
6'
CERTIFY THAT THIS Tt5 i why
/Municipal Guidelines in Effect
I NORTHRIMP
••.
I TESTHOLE LOG
ENGINERINGE
117237 Beor Pow Clrcle
s�.+p
'.Eagle Rl"r. Alaska 99577 a;",°'• ; GEOTECHNICAL
907.694.7078
T. H. 1
I�a:et
9/6/05 lof 1
MUNICIPALITY OF ANCHORAGE
A
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
\�
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
+� t r` �jy,.�.. .—_. PHON�fE ..�._.__ NEW
�.7�3 EJ UPGRADE
MAILING ADDRESS
F' C)ACr I ��►L)z�
LEGAL DESCRIPTION
r14
_-La
LOCATION NO. OF BEDROOMS
1OLI 6a
_
Well A sorption area Dwelling
U Y
PERMIT NO.
DISTANCE TO: � � (� � ^'
— — -1,.Q— .— _ V2_0
f- z
N
Manufacturer
Material
No, of compartments
N
Liq. capacity in yallons
IF HOMEMADE:
Inside length
Width
Liquid depth
0 Y
DISTANCE TO: Well Dwelling
PERMIT NO.
JUZ
m `-� I-
Manufacturer Material
Liquid capacity in gallons
2
i.� Z
Well
DISTANCE TO: > �1�
No, of lines Length of each line, jl
Foundation Nearest lot line.
7 I
Total length of linesttI Trench width
PERMIT NO.
�z C) (�
Distance between lines
L3 3 inches
<m
o„ F
Top of rile to finish grade
beneath the
Total effective abso;ption area
❑
.;
.. _ inches
/006 4=4W V
Length
Width
��
Depth -
PERMIT NO.
w
a. f-
as
Type of crib
Crib diameter
Crib depth
Total effective absorption area
N
DISTANCE TO -
�
Well
�
Building foundation
Nearest lot line
_j
Class
Depth
Driller
Distance to lot line
NO.
_I
wDISTANCE
TO:
Building foundation
Sewer line
JPFIT
Septic tank
ption area(s)
OTHER
i
-
PIPE MATERIALS )
�/ c
SOILTEST RATING
12 l�
--
INSTALLER
Yc6ya-io(%�-
- t�
REMARKS
F-14
i
APPROVED DATE
LEGAL
'����
DEPHRTME�T � HEHLTH HND ENYIRONMEMTHL . .OTECTION
STREET, HNCHORHGE, AK 99501
264�4720
TYPE OF SOIL HBSORPTION SYSTEM IS� TRENCH
MHXIMUM NUMBER OF BEDROOMS � ] S�IL RHTING (SQ FT/BR)� 250
THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM Mi
MEMO"! L- �� �����lF�� is" Ss
1711-1 1 ii �": . , �� ��� ����
PERMIT HPPLICHNT HHS THE RESPONSIRILITY TO INFORM THI5 DEPHQTMENT DURING THE
INSTHLLHTION INSPECTIUNS OF MAY WELLS HDJHCEHT TO THIS PROPERTY HHD THE
NUMBER OF RESIDENCES THRT THE NEL. WILL SERVE
11'.
-JP �- -���� ���
~~~~-~LLING OF HNY SYSTEM 11THOUT FINHL INSPECTIGN HND HPPROVHL BY THIS
it �MEOFF HILL BE SUBJECT TO PROSECUTIDN.
MINIMUM DISTHNCE BETWEEN H NEL. HND HNY ON-SITE SBkHGE DISPOSAL SYS TEMNISNG
100 FEET FOR H PRIYATE NELL OR 150 TO 200 FEET FROM A PURLIC WELL UL�� y�
UPON THE TYPE OF PUBLIC uELL|T� WELL TO H pRIyHTE SEWER LINE IS 25 FEET HND
MINIMUM DISTHNCE FROM H PRiYM
TO H COMMUNITYSEWERLINEIS 75SFEET�ICRTIgNS HND CONSTRUCTION �IHG�HMS HRE
OTHER REQUIREREN!S MAY WFIN ,���.
HVHILHBLE TO INSURE PROPER INSTHLLHTION.
������ �-���0� ���M����� SAW... �43 5!.
I
H� � y|1�|
CERTIFYATHHTHR WITH THE REQUIREMENTS FOR ON~SITE SEWERS 9ND NELLS �S SET
1� I
FORTH BY THE MUNICIPHLITY OF HNCHORHGE.
2 I NILL
F1 L. THE SYSTEM IN HCCORDHNCE WITH THE CODESEN[HRGEMENT lF THE
]' I UNDERSTFAM) TINT THE ON-SITE SEWER SYSTEM MRY REQUIRE
R�SIDENCE IS REMODELED TO INCLUDE MORE TION I BEDROOMS
~�`------04 3
~�
�_~-�...
����C 3. F-- 171 Q X W �� PA IC..- 11-41 Fit ���� '
DEP8RTMENT i HEf-11.,11 MID ENVIRON1-1 ENTFi L. ]TE:CTICW-4
^
825 /L/ STREET HN�HORH�E HK 99501 l
/ /
264-4720
L_ 97-1 P-11 �A .1 -_F` :5 ETE 1"I Q IFT: ��E Fr1T
PERMIT NO� ( 810]94 )
lPPLICANT ROBERT G JOHNSON PO BOX ]81 E R c\�`�ll 694�9521
� � ./
.00RTION ER_
.EGHL L7B1 UNIT 1 SCIMITHR LOT SIZE 140000 SQUARE FEET
PYPE OF SOIL HBSORPTICIN SYSTEM IS: TRENCH
1HMMuM NUMBEIR OF MIDR1.1011s - ] SOIL RATING (SO 250
FHE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS:
����911=
:.L. 4zil L.- FEE VA -U H -A �!5 ��IF-1 IEi-E, L_ ���������
C. _
THE:
LEMGTH
DIMENSION 113
THE LR.113TH (IN FUT) OF THE TRENCH
OR DRHINFIELD.
THE
DEPTH OF
H TRENCH
OR PIT IS THE DISTANCE BETWEEN THE SURFACE
OF THE
GROUND HND
THE GOTTOM
OF THE EXCHVHTION (IN FEET).
THERE IS NO
SET WIDTH
FOR TRENCHES.
THE
GR.FiVEL
DEPTH IS THIE
MINIMUM DEPTH OF GRH, -'EL BETWEEN THE
OUTFHLL PIPE
HND
THF: BOTTOM OF THE
EXCHVHTION (IN FEET).
-A:
1 C.- -Y- FOT thl K ���E.,E �CE, C.,_4
L.. Q. CH VJI "'b"
ORMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURING THE
INANTHLLHTION INSPECTIONS OF AI,TY WELLS HDJACENT TO THIS PROPERTY HND THE
1�M�ER OF RESIDENCES THHT THE WELL WILL SERVE.
�P.4 8_11 ��2': 1, ��AT IT"::" IC.:- 'T I C. -I P-A:E_-. �Fi,',, Fit ENE GLl ll� 1 1 Fit E7�
3H�KFILLING OF ANY SYSTEM WITHOUT F7INRL INSPECTION HND RPPROVHL BY THIS
)EPHRTMENT WILL BE SUBJECT TO PROSECUTION.
1INIMUM DISTRNCE BETWEEN H NELL HND ANY ON~SITE SEWHGE DISPOSAL SYSTEM IS
100 FE[HT FOR H PRIVHTE WELL OR 150 TO 200 FEET FROM H WE.LL �EPENDING
]PON THE TYPE OF PUBLIC WELL
1INIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVHTE SEWER LINE IS 25 FEET HND
TO H COMMUNITY SEWER LINE IS 75 FEET.
�ELL LOGS FIFE REQUIRED HND MUST BE RETURNED TO THE DEPHRTMENT WITHIN ]0 DHYS
]F THE WELL COMPLETION.
]THER MAY HPPIM SPECIFICATIONS RNC, CONSTRUCTION DIAGRAMS ARE
TCi INSURE PROPER INSTHLLHTION.
FmV.E::F`.,P.AP. 1: M MKO"', 1 too K Q ERE r"l E3 Q IT.". �ST W
[ CERTIFY
1: I HM FHMILIHR WITH THE REQUIREMENTS FOR ON -..SITE SEWERS HND WELLS HS SET
WRIT BY THE MUNICIPALITY OF HNCHORHGE.
2: I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH THE CODES
I: I UNDERSTHND THAT THE SEWER SYSTEM MHY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODE ED RE THHN ] BEDROOMS
~~.~�~��~_�
ISSUED BY~~_L������-� DHTE^._��_`��-L��.�__ V40
/
January 4, 1982
Robert G. Johnson
P.O. Box 381
Eagle River, AK 99577
I
i
I
Permit �- 810394
Subject-: L 7 B 1 Unit 1 Scimitar
A permit issued by this department for a well and/or sewer
system has expired as of December 31, 1981.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log should be sent to
this department to document the installation date.
If an engineer inspected the installation of the on-site
sewer system, please have them send us the as-builts for our
files.
If there are any further questions, please call this office
at 264-4720.
Sincerely,
Les N. Buchholz
Program Manager�-
Sewer and Plater Program
Enclosure: Copy of Permit
rz. /4 r r.v.
® & E ENG AEERING & LEVEL®I 10ENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster
694-2774 SOIL LOG
/��c> 1', /1 7- �l 61111 !S 0 Al —Tel. N0
Performed for: Name:---
Mailing Address: ,
Legal Description: Z o / 'Z [. °er � 0A/ / 7- 55a Z,�/ / 7-19 fie-
Depth (feet)
Soil Characteristics
0 -
1 5/L 7-
2 2
3
4
sr
5
6 -
i 7
1i S
10
1'I
12
13
14S
15 -- 4
IIol
���uuLia�/d-S %m
Earl Ellis
688-2280
PLOT PLAN
tido �c �ac,an.
PEEK. TEST
Ground Water Encountered: Yes No If yes, what depth—/%4
v�
Proposed Installation: Seepage Pit Drain Field --
C
I
Performed by:
y kOFESSIO'�
!.Jl.- DAIYrY OF ANCHORAGE
,,Ep'I. of HEALTH &
EN`I;tC)NI kENTAL PROTEC ION
61987
J to
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p O O 8 ® O ® O O O O O
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V
Municipality of Anchorage •
On-Site Water and Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL �J
-�rl I
Parcel I,D. 051-132-02 Expiration Date:
1. GENERAL INFORMATION
Complete legal description Scimitar #1 Block 1 Lot 7
Location (site address) 20344 Chugach Park Drive
Current Property owner(s) Johnson Day phone 529-4660
Mailing address Same
Real Estate Agent Keira Dreher Group Da • one 529-4660
‹..36 1 8 9 ,,,
Riffeet
2. TYPE OF DWELLING:
® Single Family (wlwo ADU) JUN 21 261/
❑ Duplex
A
❑ Multiple Dwellings (Single Family and/or Duplex) s.
o' 68L9`^
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class C Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
Received by: Date: 7/7//
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ 4)2-4.0 Date:
Date of Payment (O 1 ) 1 Date of Payment
Receipt Number 0 ca-74(o Receipt Number
COSA# G11 125D 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 NorthRim Engineering Phone 694-7028
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng Date 6/21/2017
Off. AtoPtZ
4• • y
6. DSD SIGNATUREc •
ry `' ' :tet •
System #1 Approved for `1 bedrooms. °� `' ' • ;4
System #2 Approved for bedrooms.
b tr Steven Vr'.
-Eng
Disapproved. % cPE ° 56 •�Giprd'
Conditional approval for bedrooms, with the following stipu�`Ati i°thFESS"
k-Nti- ,y0
ON SITE
WATER AND
WASTEWATER
t PROGRAM
4-17- I`.f `.
By: L.11.. Original Certificate Date: [ '-7 _-1
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: C/ ArreffZ [ $f I. 7 Parcel ID: QS7/3202
A. WELL DATA
Well type T If A, B, or C provide PWSID# Well Log (Y/N)
Date completed ////370 Z Sanitary seal (YIN) y Wires properly protected (Y/N) /y
Total depth.3O1 ft. Cased to 7 5 ft. Casing height (above ground) 2 y in.
FROM WELL LOG AT INSPECTION
Date of test. ///341z CAI/17
Static water level ft. l P" /. 5 ft.
Well production g.p.m. 571- g.p.m.
WATER SAMPLE RESULTS:
Coliform v colonies/100 mL Nitrate 1. 1/ mg/L
Arsenic 1k b ug/L Date of sample: ,61.?/(/7 Collected by: Al (2, wt-1 -
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material .SE177C_/S r.tL Date installed /CV,VOS
Tank size/250 gal. Number of Compartments Z Cleanouts (Y/N)
Foundation cleanout(Y/N) Depression over tank (YIN) /v High water alarm (Y/N) ( /V
Date of pumping 2‘ Pumper -��r.� ( 7 ��t4(�-efJ
C. ABSORPTION FIELD DATA
ecp
Date installed /Q//..OS Soil rating (g.p.d./t2 or ft2/bdrm) l System type Tfe
Length 7C ft. Width 3 ft. Gravel below pipe T ft.
Total depth 7 ft. Eff. absorption area(Ce ft2 Monitoring tube Depression over field/1/
Date of adequacy test C/ (/17 Results (Pass/Fail) P" For 17 bedrooms
Fluid depth in absorption field before test in. Water added ‘00 gal. New depth /Z in.
Elapsed Time: S G min. Final fluid depth in. Absorption rate >= Cad g.p.d.
Any rejuvenation treatment(past 12 mo.) (Y/N &type)No If yes, give date
D. LIFT STATION A./4
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
WELL ON LOT TO:
Septic tank/lift station on lot / '6"i' On adjacent lots /Od 474'
Absorption field on lot (60 't On adjacent lots /06 ,t
Public sewer main /.6 ft Public sewer manhole/cleanout /D'G`t
i
Sewer/septic service line Holding tank /a 6 1-
Animal containment areas 5-6 (e. Manure/animal excrete storage areas/o6 f
SEPTIC/HOLDING TANK ON LOT TO:
� lf
Building foundation J5 i Property line /Q' f Absorption field ,5-'f
Water main /G (f' Water service line /6 f Surface water /00(f
Wells on adjacent lots 46 f
ABSORPTION FIELD ON LOT TO:
(
Property line /l6 "e Building foundation /0 t Water main /
Water Service line /Q' ''f Surface water /00 (-f Driveway, parking/vehicle storage Z O
Curtain drain 50 i Wells on adjacent lots (60 r1
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that t have determined through field inspections and
review of Municipal records that the above systems are in 6�•�,
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name C
Date c/a/// 7
C12111
COSA yellow sheet_2-6-15.doc
LOT 12Co cr'°" I
TI4LGT 9 v.)S69°59'00'E 235.97 S89`59'00'E 332.11 WHALEY AVE. 1
44
` T `-1 —— —` :•
NY uTh_fr EASEMENT I f
"� — r _______ _--- - -- el `ft
�- Tom— to
0 30 I
tl
` sib+n'"'rO LOT 7 $ d
110-1 / .o�'�" g d
141,964 sl.
2 3.258 sc. o
g z
cn S.
N
wre •ryhed S89°59'00'E 266.55 I 1 -- ! 30
,"giro .t- ° ° 11 IS
' iti
115 d� Ig
'.,,,- 31 6
/tt IZ
... CO- / \ LOT 6
,as 1-
/// N
/ \
o KO I-
3 / \
Q
5 // LOT 5 LEGEND
O •- // (` • Fond 3'Aluminum Cap Monument
b Z Q / ,at • Fours!71.7 Brass Cap Mo 1 Mw4
I- b / \yry's o Found 5!6'Rabat eel Yelice Ptae&Gap
z
vs Z / �a
• Fpxs1 WE Regia
W // \ 0 Set Yr Reba
F- i 4
I-
CO
./,‘./F/ o
T.
cn
Z O /.:CA LOT 4 `.ti�\�kAS-BUILT ANO CORNERS SET THIS DATE
J „,:so-
�� '� 4 t nanbr e«rN Mr i new perror'red a MatyTagaat inavailal.
5 /As _ OF.4 1k i
Q / r.t�• ',• •.- S 1 dtbe lolaw�q o«a,rw:;x -, t �i3OCX
o
/cc / ;* 4Q9'rH 1�
/ C./l •• Anchorage Raradmg Prec Aske,eM atilt H
1 / / `� ��+�/ Improvements situated thenen ere.W*1 t*pOdery Ines
/ ` / Fred Walaika j and oo not overlap or encroach or the proper,"lying
/l � atllace n thereto,that no mcro.emeres on re winery M'9
// , ` It�� No 3255-S ! * cant Moat°encroach o ens menses n a.esedn and
that Mere are no'oadesys,transmission%nee or other
1 / 1y' I ltll S! nide easernans on said pmKrry except as Mricit01
/ LOT 3 !fie d u c.e;d 1t, ss +�=v'
/ o SCALE aII� ,�`.N.�•7`- ODM at Arrtfierene.Alaska
/ ,>� Its 27nd _ day o MAY .2039
EASEMENTS Of RECORD.OTHER TNAN FRED WALATIU&ASSOCIATES
• a THOSE SHOWN ON THE RECORDED •
PLAT ARE NOT SHOWN HEREON. FB 09-3. pg 37-4C BE (907445-Me) Engineers and Suwls,rs
MUNICIPALITY OF ANCHORAGE -—"
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL P'Ra- iclns
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date February 4, 1988
1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 7; Block 1; Scimitar #3 _
Location (address or directions)
(b) Property Owner Alaska Housing Telephone: Home Business
Mailing Address
FHA - Centrust Telephone
(c) Lending Institution P
Mailing Address
(d) Real Estate Company and Agent JACK WHITE COMPANY/Laurie Crowder
Address 10928 Eagle River Road, Eagle River, Alaska
Telephone 694-5500
(e) Mail the HAA to the following address: or: Check here 2;� if hold for pick up.
List contact person and day phone number below.
S & S ENGINEERING/694-2979
17034 Eagle River Loop Road, Suite 20-3
Eagle River, Alaska 99577
2. TYPE OF RESIDENCE
Single -Family
Number of Bedrooms 3
3. WATER SUPPLY
Individual Well 12 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 (Rev a,ae) From
5. 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 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
Telephone
Address — S & S ENGINEERING
17034 Eagle River Loop Road No, 244
Date _ Eagle-114ye+;4
.J _o
�r rs y
6. DHHS APPROVAL
Approved for bedrooms by Dated
Approved b Disapproved Conditional
Terms of Conditional Approval
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
certificates based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in
order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or 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 (Rov B/W Bqck
MUNICIPALITY OF ANCHORAGE (MOA)
~UNICIPALIT¥ OF ANQ.~.~i.H AUTHORITY APPROVAL (HAA)
ENVIRONMENTAL SERVICEs DIVISI~CKLIST - FEBRUARY 1984
264-4744
B .1 8 ],988
Legal Description:
RECEIVED
WELL DATA
Well Classification
Well Log Present ~N)
Total Depth ~ (.2L/ /_ Cased to
Static Water Level _ /~ ~
Casing Height Above Ground
Electrical Wiring in Conduit (..~/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
-~-~. ~ If A, B, C, D.E.C. Approved (Y/N)
Date Completed //-. ~' - ~.:~ 7._ Yield
~- ~- ~ Depth of Grouting
L_//' Pump Set At
,-~ P_ '¢ Sanitary Seal on Casin (~N)
Depression Around Wellhead (Y~)
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line /'J//~'
Cleanout/Manhole Id/A
Water Sample Collected by ~.% 4--~% ~7~/-.t L~l ~ I-~-"~ ~./c.
Water Sample Test Results _/_.f~z;¢¢.~¢"o ~ // ./~'~')TQ~ ~.-,..,t
Comments ~ t^)~z~_OL ~C'-L.-D~,¢ '~qrC/'Z~oY'6-~4~
/ ~¢' / '¢ ; On Adjoining Lots
/ccd/¢ ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
;Date _
B. SEPTIC/HOLDING TANK DATA
Date Installed / 62 ~ 7._.~ -~.~ Size [ dp o No. of Compartments
Standpipes (~N) Air-tight Caps f~N). Foundation Cleanout (~.N)
Depression over Tank (Y~ Date Last Pumped -"~--
Pumping/Maintenance Contract on File (Y/N) h...{/ ~,, ; for
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Netdi~g Tank:
/c~c~ /4-
/
Comments
Temporary Holding Tank Permit (Y/N)
To Building Foundation '~ ~
To Disposal Field ~ ~
To Stream, Pond, Lake, or Major Drainage
Page 1 of 2
72-026 IRev 8'861 Fron~
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata g5 4232 'Type of System Design `M
Date Installed Length of Field
Z
�r
Width of Field 3 Depth of Field
Gravel Bed Thickness T
Square Feet of Absorption Area 3zL'_� Standpipes Present (&N)
Depression over Field (Y/6f�
Date of Last Adequacy Test
Results of Last Adequacy Test �`- � sr-,r,-�;-O-q r 171 � ��� ung
Separation Distance from Absorption Field:
To Water -Supply Well oD
To Building Foundation
Lot ),I / (_
r
To Water Main/Service Line r " -r
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date Installed
Size in Gallons
To Property Line
; On Adjoining Lots
r -f
To Existing or Abandoned System on
2;�'-)-
To Cutbank (if present)
r,Jl/-v
Dimensions
Manhole/Access (Y/N)
14,4
"Pump On" Level at .Pump Off' Level at
Vent (Y/N)
High Water Alarm Level at )� —
— Pumping Cycles during Adequacy Test. Meets MOA
Tested for
Electrical Codes (Y/N)
Comments
** 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.
5 a S ENGINEERING
Signed _f7034_Eagte-Rivert00V-R0a I %4 _
Company'r • g a le River Alaska 99577 MOA No.
Receipt No. 16o Z o012—
Date
U12—Date of Payment
ineers'Seal
r}
Amount: $
Page 2 of 2 I"
72-026 (Rev 8'86) Rack 7 f f
C,61 13 Z
CHEMICAL & GEOLOGICAL LABORATORIES Of ALASKA, INC.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562.2343
FEDERAL TAX ID N 92-0040440
ANALYSIS REPORT BY SAMPLE for Work Order # 5180
Date Report Printed: FEB 16 88 8 14:07
Client Sample ID:LT 7 BLK 1 SCIMITAR #3
PWSID :UA
Collected FEB 11 88 8 14:50 hrs.
Received FEB 12 88 9 16:45 hrs.
Preserved with :ICE
Analysis Completed :FEB 15 88
Laboratory Supervisor :STEPHEN C. EDE
Released By : Sd C'_ r4ec--�
Client Name : S & S ENGINEERING
Client Acct : SNSENGP
P.O.# NONE RECD
Req #
Ordered By : R, SCHAEFER
Send Reports to:
1)S & S ENGINEERING
2)
Special
Instruct:
Chemlab Ref #: 9099 Lab Smpl ID: I
Parameter Tested
NITRATE -N
Sample ROUTINE SAMPLE
Remarks: COLLECTED BY J.P.M.
Matrix: Water
Result/Units
00.10) mg/I
Allowable
Method Limits
EPA 353.2 10
1 Tests Performed # See Special Instructions --Above UA=Unavailable
ND= None Detected na See Sample Remarks Above
NA= Not Analyzed LT=Less Than, GT=Greater Than
S,j e�t e
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
o� TELEPHONE (907) 562-2343 5633 B Street
Anchorage, Alaska 99518
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
TO BE COMPLETED BY LABORATORY
❑ PUBLIC WATER SYSTEM I.D.#
[W PRIVATE WATER SYSTEM
Analysis shows this Water SAMPLE to be:
Satisfactory
❑ Unsatisfactory
Marne S & S ENGINEERING Phone No.
Ea-,
iagle
❑ Sample too long in transit; sample should
_
Mailing Address Eagle �a, a. 20�
Rive r Alaska
not be over 30 hours old at examination
, 99571, -
to indicate reliable results. Please send
new sample via special delivery mail.
Received
City State Zip Code
rnDate
SAMPLE DATE: l
Ly L
Mo. Day Year
Time Received
SAMPLE TYPE:
Analytical Method: Membrane Filter
❑ Routine
❑ Check Sample (for routine sample
with lab ref. no. ) ❑ Treated Water
El Special Purpose El Untreated Water
No. of colonies/100 ml.
SAMPLE Time Collected
NO. LOCATION Collected By
Lab Ref. No. Result* Analyst
2 1 S c- r ,-,. < < ZdO
uj
3
m
4
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BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS Membrane Filter: Direct CountCoilform/100ml
BEFORE Verification: LTB BGB
COLLECTING SAMPLE Final Membrane Flit r Resu _ Coflform1100ml
Reported By _ �'"-� Date_ 0,1
/
Time: _ _ a.m.
TNTC = Too Numberous To Count
OB = Other Bacteria ['ART I OF 2 REMAINDER TO FOLLOV!