The URL can be used to link to this page

Home My WebLink AboutSTOLLE BLK 3 LT 8Stolle Block 3 f #020 - 021 - 20 -� Municipality of Anchorage : ?;} 't�• Development Services Department Building Safety Division On-Site Water and Wastewater Program, 4700 S. Biagaw St. P.O. Box •96650 Anchorage, AK 995196650 Page ` of 3 wvmt.cl.anchorage ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM ANDIOR WELL INSPECTION REPORT Permit Number. 0 0100a;l PID Number. Al Fr; e 5e Wastewater System: ❑ New ❑ Upgrade AAb••• �101 S, ce r-e k `anc%Pr'ac �� 516 ABSORPTION FIELD Phw ♦ M - O IF„D„ M0;,k"0;,k"Ba E I I U O D+ T.„Wr X Stu T,. ch O BM O {h„d O Ooh„' LEGAL DESCRIPTION sn{arhq Tar Dep„homwgn•lrW / D , p ,�, F, lr c 3 Lr /7 sulaMalar / ^ I � p Dsph b VM Edrnn han agY.r 9'.n" ri•M dWh h„r„h pq.• rfyJ C- To..nNp aMp• s«1br FA rh"e •b„r• w" p„N .1. 0"t„qn• -�/7 .a Fr. • FI. Well: New ❑Upgrade &.0 5 „•near.., a� — M FI. j}))� Cb••Ac„an ,rVn1� TrrD•p„: as C••Mb r� J,w Trrw.rp•rrr•• 7`/O P ST%+11)30� F 7 F' ao FI• GA„ A L^P i. DyQ PAM /77/01 slrcwrn L. 6 �L MI•nw v Ott) Dre MrMW —0/ FL ner Vb '7 P„ep$rr' V/A c•••gWV14Aaor•G„M TANK GPM rl. FL SEPARATION DISTANCES Septic ❑ Holding ❑ S.T.E.P. Other. To Septic Absorption Lift Holding Publidndvat M""' ""` . n , �Q �- c w ,,y From Tank Field Station Tank Sewer Line j''/'C / Ce I G QD G., wa t 1 7L.' I3�L , QC -J Mr„�r 14 ` �G U Lane« acaro.nm„w. Sur«. wr„ 00 L ' OO 1t LIFT STATION Lr LM 1 -P.no ri Ir.r r -Puny Ww Ilph •ni„ rrm r ` J n h v Pury MW { EMUrkr Mp«Iron• p„1wm•A W BENCH MARK Louuon rr D•wywn [j T •�- ��T L A• Mr„gn r>1 / 1C)O FI ��1 En9 - S 8 5 ENGINEERING•••'�trd 17034 Eagle River Loop Road, No 2 F Inspections performed by:Eaghv 7F— b, le as: 1 –ZI' 1 �• .....:: n4 7- 01-I- C)1 2 47.. _._ .... • .// :, ._.„ Develdpmejit Services Department Approval 7. .r•` ROCERT G COWll71 I�Q 14�� CE-88.01 1t•s'' Reviewed and approved by: ILj. Date:/S o +li l`�^� L • L:Ziz�►�� PERMIT No. SWO10022 PAGE 2 OF 3 Municipalityof Anchorage DEPARTMENT OF HEATH 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 LOT 8, BLOCK 3, STOLLE S/D P.I.D. No. 020-021-20 LOT 7 �� '� LOT 5 DBLI do DBL2 C01 NEW 1300 GALLON ^ MTI HOPE SEPTIC TANK ` •\ y TBM \ \ SLG ° •,p B srt NEW Sr2 4 BEDROOM 9�T\\T N2 <^y�y A OUSE \ \ \ \ CO2 -TH#3 0. CX TF \� ♦THp1 N LOT 11 GRAVEL DRIVEWAY iC S SCALE: V 40' �- �: ;� t0*x30' TELECOM � ELECTRIC EASEMENT LOT 10 �� \\ LOT 9 �\ y k ROBERT C. COWAN `'c, CE -8801 PERMIT No. SWO10022 PACE 3 of 3 Municipalit 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 LOT 8, BLOCK 3, STOLLE S/D P.I.O. NO. 020-021-20 S S 2 98.3' FINAL GRADE 2" INSULATION NEW 95.0' 1300 GALLON POLYETHYLENE 94.8' SEPTIC TANK Col A B CO2 MT1 CO1 = 92.5' ST1 32.0 19.0 ST2 34.5 22.5 CO2 = 92.2' DBL1 36.5 25.0 FINAL GRADE DBL2 37.5 26.0 C01 90.5 77.5 2" INSULATION MT1 80.5 69.5 CO2 40.0 59.5 C01 = 90.0' EW CO2 = 90.0' MTI = 86.0' N. T. S. r``�rr............: Star NO WATER FOUND l.t � �-�! hr........; 75.0' B.O.H. t r ROBERT C. COWAN 11 en. • 'r L�`.i a ' r I Municipality of Anchorage . DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage. Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Min 7-7- F/() 1- S E DATE PER $LD LEGAL DESCRIPTION:? -07 p o 13LK-3 STQLLIE 1oWnship, Range, Section: Z ti'T; 1 0. 2- 3- 4- 5- 6- 7- r 3 4567 r � tl .t 10 .D a 12- 13- 2 13 R 14- 15- 16- 17 415 16 17 18- 19- 20- COMMENTS s1920COMMENTS SLOPE DR4Art G �' %4Sr G M �w 51��-) Ingo $ G2av4L W sL I _ C—AAAR.3 ArG v 1.A+L A6c,K wIrµ 'SII -7- 12.0.g. WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? jF ;nA R03ERT C. COWAN DRME;� r�^� ,•a L -V SITE PLAN a .■■■■■■■■■ ■■■■■■.■■■ ■■■■■■■■■■ Reading Date Gross Not Time Time Depth to Water Net Drop R"A 1 U — ' — s5.<, �� a 7i -30 0 It ./1., 3 ,. (� / .. o - 3 - CIO 3N' 3" PERCOLATION RATE (minutevmth) PERC HOLE DIAMETER TEST RUN BETWEEN 3 FT AND ` FT 5 & S ENGINEERING PERFORMED BY: afl a 1Ve f OoP oa o. 204 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WIS4&k;WRrEAhd"t>i 0FJRL GUIDELINES IN EFFECT ON THIS DATE. OATS (0//o / D 72-008 (Rev. 4185) 1 Municipality of Anchorage 9 fGWEER'S µ Development Services Department Building Safety Division +.d On -Site Water and Wastewater Program !-•- 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 9951 M650 ;r" "•" www.ci.anchoraae.ak.us l� ^ \ ROBERT C. COWAN (907) 343.7904 CE • 8801 Soils Log - Percolation Test Performed For. /V9 R 7. r x' R I S E Date Performed: Legal Description: t oT g S Lo c. K 3 S70 ). L IL Township, Range, Section: rEs� Depth (Fet) ~� V Gr'•1 X02 j oo SA•e4 -rtST rrAA44.L pN Y Y . WAS GROUND WATER D ENCOUNTERED? Jj 5 IF YES, AT WHAT DEPTH? L Depth to Water After D P Monitoring? /'r Q E Date: X, rian Reading Date Gross Time Net Time Depth to Water Net Drop p A4•SO 4K Vclh 14 Gec," ro i/ rix „ 3 0 30 Cl y SAV of t t 60 ,�� ., L/ `is C7 !i PERCOLATION RATE to. —1 (mn deskoi PERC HOLE DIAMETER b TEST RUN BETWEEN SFT AND 7 FT COMMENTS PERFORMED BY: 170114 S S ENGINEERING 17024 iagl- River LMR Road No. 204 I CERTIFY THAT THIS TEgT WAS PERFORMED IN AEcagge R"Ekj'JTkk"§"TE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7/ c7 0 i Rick Mystrom Mayor Municipality of Anchorage Department of Health and Human Services 825'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 httpffim .d.achorage.ak.us Permit Number: #SW 010022 Date of Issue: 2-20-2001 Parcel Identification Number: 020-021-20 Date Started: 3-13-01 Date Completed: 3-14-01 Is well located at approved permit location? ® Yes ❑ No Legal Description: Stolle Block 3 Lot 8 Property Owner Name & Address: Matt Friese 5101 Spruce Creek Circle Anchorage, Ak 99516 Borehole Data: Soil Type, Thickness & Water Strata Depth (ft) From To Method of Drilling ® air rotary ❑ cable tool Casing type: steel stick-up 0 2 Wall Thickness:.025 inches gravelly silt 2 14 Diameter: 6 inches Depth: 20 feet Bedrock 14 227 Liner Type: Diameter: inches Depth: feet Casing stickup above ground: 2 feet Static water level (from ground level): 62 feet Pumping level: 227 feet after 2 hours pumping 4 gpm Recovery Rate: 4 gpm Method of Testing: airlift Well Intake Opening Type: ® Open End ® Open Hole ❑ Screened Start feet Stopped feet ❑ Perforations Start feet Stopped feet Grout Type: Bentonite # 8 Volume: I be Depth: Start 0 feet Stopped ± feet Pump: Intake Depth feet Pump size hp Brand Name Well Disinfected Upon Completion? ® Yes ❑ No Method of Disinfection: Clorine Tablets Comments: Well Driller. Alpine Drilling & Enterprises P 0 Box 110496 Anchorage AK 99511 Attention: The well driller shall provide a well log to the property owner within 30 days of completion and the property n,mw nr fl,n ,vnll AAIIw al,ell nrnvi,in s ,vnll Inn In It,n riw t nr L "w, A. {i„mon Cnn,ira< ,v:1h:n An dove of nmm�lnrinn IIEALMAUTI[ TV MM MALS smndwA¢n MW"TENSKMJS SEWUMWATEn HSPECIM ENOWERNOSTUDES ANDnEPOtNs WELLHSPECTM &FLOW IESt SNEMAM tIDADDESIMI SD& tEST MICOlAUM 1ES1 StnUCIunAL4 LIECIWSCAL INSPECTIONS ONSITE WASIEwAnn OISPOSALSISIEIA DESK7! MG Date: %//q/0 / lfunicipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 nODEnT C. COWAN. P.E. nOnEnTA. SI IArEn. P.E. CIVIL ENGINEEM (907)694-2979 rAx(907)694.1211 REFERENCE: 1-07- $ Bi -o C K 3 5 T 0 L t- E 5 /o The septic in pections for the referenced property were performed on 7 ZL0/ and S - Prior to submitting the On-site Wastewater Disposal System and/or Well Inspection Report we are waiting for theS�Rvtiy to be completed. If we may be of further service please contact us. Sincerely, lglel� Robert C. Cowan, P.E. 17034 Nom l EAGLE mVEn LOOP • SUITE 204 • EAGLE MVEn. ALASKA 99577 Llmra;OA t®— q 13L -DC -K3 STOt_lf. 5'ld To: SSS From: Matthew Frlese Paw 8941211 Pages: 1 Phone: Data: 12/28/2001 Re: Septic Install CC: 0 Urgent 0 For Review 0 Please Comment 0 Please Reply 0 Please Recycle To Whom It May Concern: I am an owns @safer sad Lin fbm"'a with the requh=9n %/ mit atlota for hoWling a wptic ryst m as weS o how to operate the equlpment necessary to complete the Vm*L Suxcrly DWM 10 'd LLOWL06 H08f1H0 1S1168 30IS111H Ab 52:60 IIS 1002-62-030 P w / MUNICIPALITY OF ANCHORAGE Development Services Department Onsite Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 7,7 -al ONSITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Date Issued: Feb 20, 2001 Expiration Date: Feb 20, 2002 Permit Number: SWO10022 Parcel ID: 020-021-20 Legal Description: $TOLLE SUBDIVISION,, BLOCK AOT 8 - Design Engineer: 0003 S & S Engineering Site Address: 5101 SPRUCE CREEK CIRCLE Owner Name: MATT FRIESE Lot Size: 42112 SO. FT. Owner Address: 5101 SPRUCE CREEK CIRCLE Total Bedrooms: 3 Permit Bedrooms: 3 ANCHORAGE. AK 99516 - This permit is for the construction of: Disposal Field r✓ Septic Tank ❑ Holding Tank F*� Privy 0 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. �5. The following special provisions. PRIOR TO CONSTRUCTION OF THE PROPOSED WASTEWATER SYSTEM THE ENGINEER SHALL PERFORM AN ADDITIONAL SOILS TEST/GROUND WATER MONITOR IN THE VACINITY OF THE REPLACEMENT °,WASTEWATER DISPOSAL SITE. 2 - 2 %-O/ —SEE Fk(IIVEER'S 1?EL0CP?1O/V Of7NE Lr)?rE-R wECl- D4 TTP 2-26-0J Received By: Issued By: 2. Date: a -)-'0 — '0 I 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 SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 020-021-20 - Permit Number SWO/0022 Property owner(sDay phone 3q q --300,?o Mailing address (1) I V I d0rUCo= Mailing address (2) A✓I Gho/Act2 IL g01516 Zip Code Legal description (Lot, Block & Sub'd.) Legal description (Secti Township & Range) Lot Size Acresq.Ft. Number of Bedrooms 3 THIS APPLICAT(ON/IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well 0 Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ 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. r2_ S & S ENGINEERING (Signature of property owner or authorized agent) Eagle River, Alaska 99577 Permit Fees: Date of Payment: Receipt Number: (Rev. 12100) Waiver Fees: Date of Payment: Receipt Number: February 12, 2001 ROBERT C. COWAN P.E. CML ENGINEEt1S (907)694-2979 FAX(907)694.1211 f HDR" MUNICIPALITY OF ANCHORAGE APPRgVAlAP WWAL S Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 SEWER& WATER MAINUTENSIORS REFERENCE: Lot 8, Block 3, Stolle S/D SEWER & WATER INSPECTS It is requested that you issue a permit to install a well and a septic system to serve the proposed three bedroom dwelling on the referenced property. A test hole was excavated, and a percolation test performed. The approximate location of roFIEPOR,cs"°E5 the test hole is located on the attached site plan. At the time of excavation, 5/12/00, water was not found. After ground water monitoring, the tube was dry. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve n LOW` TEST f ON areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. SITE PLANS If you require additional information, please contact us. Sincerely, ROAD DESIGN % -1Wh Robert C. Cowan, P.E. SOIL TEST RCC/bjj Enclosure PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 u C n 1" = 40' DESIGN N SITE—PLAN b a b o .ryi St7A,r tr Oto io Om m O m Ot =C! ` O am Cox / > u C n v N g b a b o .ryi �7 w A p m Z Md'4LJCAZA s,s0 LL,ist) r Ta/' 4lot i D n / ZNO/ 01 v Municipality of Anchorage . DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: M); r Y )= R 1 ESE DATE PER o LEGAL DESCRIPTION: LO 13 L K 3 S 7d LL'i''S/TOWnship, Range, Section: oEl� SLOPE SITE PLAN 3- 4 ^+. 6 C'J 7 8 h 9 ,Q 10 y 11 12 13 14 15 16 17 18 19 O2(n.FNI G S' SM 51L r B InL v4e7 F.M4 7f4.0 6sh/fir I✓ LAALI, A.."t ,44 R0 c. It S 1 ^/ SILr , 5A-0 4 6AAV4 L_ WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? Q _rY Date: 20 IL_ JI PERCOLATION RATE � I (minutevinch) PERC HOLE DIAMETER 6 1 TEST RUN BETWEEN FTAND S` FT COMMENTS V i �- a" -°-A• Ming, %,.; n fr7N n S & S ENGINEERING PERFORMED BY:I a- of 'I� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WIEfa JIBLI vAnzhIN*mL9RWAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 'rh xla0 72-008(Rev. 9i85) or t l`c!1t�Lxa-jl :4r,MINLID=r. t .inw- sGd1P 2 �7iivi lb-IritT1!l0!rpMfi ttiilU :l,r,�=;•r..J;J��X.Ir',J�111E7•fii�7iu �.X�y%-%'..CJ _. '��' �''�'fid.T+iiT.•T7!�IiGrjilci'.�ir��?::CC,.Yl!t��t•�r :tr:;r;rirstl�.rrtr. #.�F3 iTTiC�Ar�y!i(•T�o rrrdi%;MadiWO �iTJ7l�,ti7r�?CIiLrZJh,Id f�TSia L' r 4 -J1il•,1i�i� L•%i•L'�i7'f ��lGt�7iiil'�?I7i4rY�a.Li� -"r'r►r�-�y��t"�.�a�'�.Uyty��"..`p.-71;t�'�lwi!'•�� py��v X77 Ci'i"l..iClrllLi�'� Il - C�.U.."_.-ilaITj. r ,'•.�;"�.�e.7�Clr�`��.11►i11F�i�tCrik� Ill~•Nk.ICSritz�ii�I�ti7�t�F'>�1'ia w,. Zitl.' ;Mr.�yclu J}� iJw3tJJi��I�'t1C! � L a'i Municipality of Anchorage Development Services Department Building Safety Division On -Site Water 8 Wastewater Program + 4700 Bragaw Street P.O. Box 196650 % y Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. WD�n3/" aU COSA# 0f)n'5A6 1. GENERAL INFORMATION Expiration Date: 1-26-0 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address STOLLE SUBDIVISION: BLOCK 3. LOT 8. 16110 HONEY BEAR CIRCLE • ANCHORAGE. AK 99516 MATTHEW FRIESE Day phone 529-1841 16110 HONEY BEAR CIRCLE • ANCHORAGE. AK 99516 Day phone Real Estate Agent BRIAN BRODFRICK w/ PR Il DFNTIAI .I.W. Day phone 762-5838 Mailing address 3801 CFNTFRPOINT DR. X1200 * ANCHORAGE. AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 0 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 On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private 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. 4. 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 tiles 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 GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 8 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 future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. 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 solo benorit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will N confer any legal right whatsoever. 5. DSD SIGNATURE Approved for ___Lj— bedrooms. Disapproved. 337-6179 Date i 01 I °i 1Jb Conditional approval for bedrooms, with the flowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineers Reort Other ^��/�rvHltK PROGRAM !11))111 By: / /i//�„� / (/. �/ C Original Certificate Date: lo—a&-06 /Fr t1M1 s Municipality of Anchorage 4, ' Development Services Department Building Safety Division . t On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Baa 190850 Anchorage, AK 99519 -WW www.muni.argfonsfte (907) 3437904 CERTIFICATE OF ON—SITE SYSTEMS APPROVAL CHECKLIST Legal Description: STOLLE SUBDIVISION: BLOCK 3. LOT S. Parcel ID: 6 2 D - E% ?-I - 2 () A. WELL DATA 'CASED TO BEDROCK Wei type SATE If A, B, or C provide PWSID# N/A Date completed 14/2001 Sanitary seal (YM) YES Total depth 227 ft. Cased to •20 It. FROM WELL LOO Date of test 3/14/2001 Static water level 62 ft. Well Log (YIN) YES Wires property protected (Y/N) YES Casing height (above ground) 18 In. AT INSPECTION 10/2/2005 74 ft. Well production 4.0 9 -P.M. 3.8 g.p.m. WATER SAMPLE RESULTS: Cdiform colonies/100 ml. Nitrate I' 43 RVA. other bacteria _J_colonies/100 ml. Arsenic: ND ugiL. Data of sample: 10/2/2006 Collected by: CEG. Ltd. S. SEPTICIHOLDINO TANK DATA Tank Type/Material SEPTIC/PLASTIC Date installed 7/9/2001 Tank sin 1300 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (Y/N) NO High water alarm (YIN) N/A Date of pumping 8/29/2006 Pumper ANCHORAGE CESSPOOL PUMPING C. ABSORPTION FIELD DATA Date Installed 7/912001 Sod rating K.dJi r ft%drm) 0_8 System type TRENCH Length 78 ft. Width 5 ft. Gravel below pipe 4.0 ft. Total depth 06.6 It. Eff. absorption area 780 fe Monitoring tube YES Depression over field NO Date of adequacy test 10/2/2008 Results (Pass/Fal) PASS For 4 bedrooms Fluid depth In absorption field before test 18 In. Water added 620 gal. New depth 25 in. Elapsed Time: 130 min. Final fluid depth 25 In. Absorption rate >- 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (YM &type) NONE KNOWN If yes, give date - D. LIFT STATION Date installed Sirs in gallons "Pump oM level at _in. 'Pump oft Is High water alarm level at Datu Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanklllR station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ Public sewer manhole/clesnout N/A Holding tank N/A Animal containment areas 50'+ Manuretanimal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water----1221+- Wells ater100'+Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property We /0'+ Building foundation 10'+ Water main 10'+ Water service line N/A Surface water 1000+ Driveway, paridnglvehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS 0. ENGINEER'S I certify that 1 have determined through Reld 6aspections and review of Munickpal records that the above systems are in conformance with MOA COSA guldeQnes In effect on this date. Engineer's Printed Name JEFFREY A. CARNESS Date 10/1910b COSA Fee S 4/30, 0 Date of Payment W 1 1 U l (c Receipt Number. 7 3 (Wv. IU05) Walver Fee $ Date of Payment Receipt Number Oct 19 06 09:39a L.�� 0 Kay Cl MM COMPICLIM rloT I,/N 1 ryl AIM 1 M //./, rTI r H•.A •wrr �..I MI r�r wwrrrr wry •r r ra 101/OASON AS -SWT L rw a •�r •� L•R_� � 1 .�� • Y lam—•Y rA—moi /M/L 3rRu0R1AE A'.-SULr 1'.iW • •.M .nom / r /„�..wy•I .nr/r O LOT Fu _ 1 0 MAMASDI W1Ef O rA•L ++•lea/a A►auat PWT MANS 1 LOT SURVEYS o' 907-929-5839 p, LA "S BE/7k = CSR o, 40i4V � a -E rl o./rinred by tt m Tn[ P[SIONS TI 0 M PULDOI OA T IRIOMO MEW roR THE I HMUI AN ME SUntYoN l, TAK4 IK OICTANQS PREvi \72 Robert E. Johns, Jr. do Assoc. Professional land Surveyors ,toe eR•/c aR. AMOaRAOT. A1AtSA 10WA•a L/L Lr. 11•n rw M Na n Lot 8 Block 3 Stolle Sabdivisioa ...� C • SCT PEW � � DRMMAOE ASriIALt O ap/o ROAR wow COMCK,i MM— m A3lUM[O EIlV. i—Ih-! Au A TO OWLV r1OSC WPMOvcNCNT1 Agave ORoU AMD -A"LC "LL SE ATIVER�C EM., ARE NLLIL Mb Y RDO MA LOCA110K OMLDY SNOW TIONS MAY /RLvcNT SOME WrTOVFA•cNTS iROM 0CM4 3QM ANO LOCA,ED. Usm r0R CaMd7PUETKW Q rd, CSTASItSWM EOIINDMY W FE UNU r n v AMO A>a1MES nW MOAL UA3SRY_ONLv rOA TM 006T Or TNC S.RKY. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING .; r arcel I.D. O a 0— O a f— _-� 0 1. GENERAL INFORMATION HAA#�i%� O/OdoS� Expiration Date: /— % S' (7 3 Complete legal description LoT- � BLOGK 3 S70LL£ S/) Location (site address or directions) Municipality of Anchorage --1 Development Services Department Community On-site Building Safety Division Public Sewer On -Site Water and Wastewater Program F 4 t¢ ,T f 4700 South Bragaw St. 3 IVY 3 v 1 v P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ok.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING .; r arcel I.D. O a 0— O a f— _-� 0 1. GENERAL INFORMATION HAA#�i%� O/OdoS� Expiration Date: /— % S' (7 3 Complete legal description LoT- � BLOGK 3 S70LL£ S/) Location (site address or directions) N t4✓ lh.v4-y O_A e C4 AL c_�L ❑ Community On-site ❑ Public Sewer Currenl r'roperty owners) MA r T F 4 t¢ ,T f Day phone 3 IVY 3 v 1 v Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone Day phone Unless otherwise requested, NAA will be held by DSD for pickup. 7. NUMBER OF BEDROOMS: '-I 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Individual On-site Individual Holding lank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered In the Slate 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 of Issue for properties served by a private or Class C well and may be reissued with nPw water sample results less than 30 days aid. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificrates are valid for one year:or properties served by Class A or 8 wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION by ENGINEER As certified by my seal affixed hereto and as 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 turUler 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 Slate codes, ordinances, and regulations In effect at the time of installation. Name of Firm S& S ENGINEERING Phone `� y- a 9 7 9 Address Eagle River, AlasJta 99577 Engineer's Printed Name Date �, C" 1 ?0% ROBERT C. COWAN 5. DSD SIGNATURE CE -&901 Approved for Pp bedrooms. �ttt •,.._.r. ..... !/•• Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date:_ (Pe.. 12"1 Municipality of Anchorage •. • Development Services Department Building Safety Division ` On -Site Water & Wastewater Program 47W South Bragaw St. P.O. Box 106650 Anchorage, AK 99519.6650 www.cl.anchorage.ak.us (907) 343-79W HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Loi $ 9 Lc r- K 3 S To L L 4L SAO parcel ID: O a 0- 0 34 -JL O A. WELL DATA Well type LA 114 A) E if A, B, or C provide PWSID # _ Well Log (9N) YES Date completed 3/ r Sanitary seal &) YE J Wires properly protected 4!'N) YE I Total depth 13 f ft. Cased to �0 ft.A 4 Casing height (above ground) )!g+ In. FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: `1 Coliform --2--colonies/loo ml. Date of sample: ! a / r I / o B. SEPTIC/HOLDINOTANK DATA AT INSPECTION fv� ft. 9 - p.m - Nitrate O. #*7 mgA. Other bacteria O colonies/100 ml. S & 5 E 01111M UNG Collected by: Esyle Rtiwr, Ain" 9!377 Tank Type/Material S At P r, C- H a F E Tank size 13 0 0 gal, Number of Compartments a Foundation cleanout &N) Y#I Depression over tank (Y&L 0 Date of pumping "J/* - N 4- w Pumper Date installed -71-110) Cleanouts 6VN) y E -f High water alarm (YI@ N 0 C. ABSORPTION FIELD DATA SF1gG�ou Date Installed 7/q/O I Soil rating g.p.dJft= ft=/bdrm) Q• 9? System type TA6C.14 Length 7 8 ft. Width S ft. Gravel below pipe 14 ft. Total depth G ft. Eff. absorption area'7 fS 0 fe Monitoring tube Y El Depression over field N 0 Date of adequacy test W14 ' � cw Results (Pass/Fail) Fluid depth in absorption field before test _ in. ater added_ gal. Elapsed Time: _ min. Any rejuvenation tnwUwrll (past 12 mo.) (Y/N & type) in. For If bedrooms New depth_ in. Absorption rate >= g.p.d. If yes, give date D. LIFT STATION Date installed 'Pump on" level at _ in. Datum E. SEPARATION DISTANCES Size in gallons "Pump ofl" � Cvdes tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/liR station on lot 1 3 0 Absorption field on lot 13 Public sewer main ),114 Sewer /septic service line a- n f High water alarm level at Meets alarm & circuit requirements? On adjacent lots / v D f On adjacent lots / 00 �t Public sewer manhole/deanout N 14 Holding tank Al A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation j O Property line i t Absorption field r � Water main N /,q Water service line /O t Surface water 0 0 f Wells on adjacent lots ) o O f SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line i/ (V ' Building foundation 37 / Water main N A Water Service line 1 o t Surface water ) 0 o + Driveway, pa6ingh ehide storage St) + Curtain drainRt�t k&ywN Wells an adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date {�. Engineer's Printed Name r`WAT C, COwq.,1 Date HAA Fee $ 3 00, o " Date of Payment I X / > M /of Receipt Number O 17 7 7 (Rev. 12/00) Waiver Fee $ Date of Payment Receipt Number NS OW,ui GL '13801 ll1,rp .....«••fir; in.