HomeMy WebLinkAboutFOREST VIEW HEIGHTS LT 1 & 2Forest View
H
ights
Lot ! &2
#014-141-86
Municipality of Anchorage Page 1 of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: .qwqyn174 PIDNumber: · 0141 41 28
..m.: Wastewater System: [] New [~pgrade
Mayo T. Wells
^ddt--: ABSORPTION FIELD
3338 E. 72nd Avenue
Phone: 344-1089 tN°'°f Bedrooms:6 ~p Trench [] Shallow Trench [] Bed [] Mound [] Other
Total Depth from original grfldg:
LEGAL DESCRIPTION So,,R.t,ng: //2-- ~,~,~.Ft. ' //.~ '
~T/I~ ~r~. ~. i ~,. , ~ ~t.
Townahip: I Range: I ~ctlon: Fill edd~ i~ve original grade: Gravel length:
~ Ft. ~, D Et
I
I
WELL: ~. D New D Upgrade Gravel width: Num.rof lines: Di~~:
~ ' Ft. ~ ~ Ft.
Clarification (Pr~ate, A,B,C): Total Depth: ~ To: To~l abao~tlon ama: PI~ material: ~T~
Ft. Ft. ~7~ SO. ~.
SEPARATION DISTANCES ~.,,c s Holding 0 S.T.E.P.
TO Septic Ab~tl~ L~ Holding ~t~ Manufacturer: CapaclW tn gallons:
Weir I~ ~ I ~%. O ~ ~ ~, Mate~ Num~r~of Compa.men~:
su,,~,w~,~ >~' >/o~' ~ ~ >~' LIFT STATION
Line ~ / / ~. pi S~*,n gallons: Manufacturer:
Cu~ain
Drain ~¢ ~ 'mP M~ I Electri~l Ins'cti°ns ~°~ed bY:
BENCH MARK
Remarks: ~xis~i~9 sep[ic sys[em vas
crushed, backfilled and aban- c~(t~ <,,~
doned in place. ~ ~.
A~umed Elevation:
ENGINEER'S SEAL
Inspections pedormed by: ~' Dates: 1st ~//~
2nd 7/,7/~ ~ ,'~"---"':- .....
Depadment of Hea~ and Human Se~ices approval
'/ ~ Date: ~
Reviewe ana app ovea by J
Permit No. SW970174 Pege 2 of 3
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O, Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description:
Lot 1, Forest View Heiqhts PIDNo.: 01414128
SP1 Septic Pump, ~ompa~tment 1
SP2 " " 2
C Clean Out
MT Monitor Tube
Permit No. SW970174 Page 3 of 3
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: Lot 1. Forest View }{eights
PID No.: 01414128
I"=
PAGE 1 OF 1
MUNICIPALITY OF kNCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW970174
DESIGN ENGINEER:ANDERSON ENGINEERING
OWNER NkME:WELLS MAYO T
OWNER ADDRESS:3338 E 72ND AVE
ANCHORAGE, ALASKA 99507
DATE ISSUED: 7/08/97
EXPIRATION DATE: 7/08/98
PARCEL ID:01414128
LEGAL DESCRIPTION:
FOREST VIEW HEIGHTS LT 1
LOT SIZE: 8349 (SQ. FT.)
NUMBER OF BEDROOMS: 6 THIS PERMIT: 6
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND i5.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80) .
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SA_ME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY: ~t~. ~__~
DATE:
DATE:
Rick Mystrom,
Mayor
Mtmicipality of Anchorage
Department of Health and Human Services
$25 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
July 9, 1997
Michael E. Anderson, P.E.
Anderson Engineering
PO Box 240773
Anchorage, Alaska 99524
Subject: Waiver Request for Lots 1, 2, 3 Forest View Heights Subdivision
Waiver Request #WR970028 , PID #041-141-28, SW970174
Dear Mr. Anderson:
Your request for a waiver of the required 10 foot separation
between an on-site wastewater disposal system and a lot line has
been approved. The waived distance is 2 feet from the trench to the
south property lined.
This approval applies to the existing on-site wastewater disposal
system lot line separation only. Any future upgrade to the on-site
wastewater disposal system will require all separations be met or
another approval from this department.
If there any further questions or concerns regarding this waiver,
please call our office at 343-4744.
Sincerely,
Daniel J. Roth
On-site Services
ljw #7
Wells
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR# WR970028 PID~ 041-141-28 HA#
Date Received: June 19~ t997
Legal Description: Lots 1~2~3m Forest View HeiKhts
Engineer: Michael E. Anderson, P.E., ANderson En~ineerin~
PO Box 240773, Anchorage, Alaska 99524
Applicant: Mayo T. Wells
Permit
Waiver Requested:
line.
Lot line waiver of 2 foot from the trench to the south property
Criteria: 1. Geology: Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
Special Conditions:
e
3. Other:
Waiver is Granted: ~ Waiver is NOT Granted:
List Conditions or Reasons for above: ~ ~.;~.~z~ ~,~-~~
Date: 7-¢-~7 By:
Rec ~: 02929(9949) Amount: $ 115.00
Name of Reviewer
Date Paid: 6-19-97
June 19, 1997
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject:
MUNICIPALITy OF ANCHORAGE
ENVIRONMENTAL ,SERvICEs DIVISION
dUN 79 1997
RECEIVED
Lots 1, 2, and 3, Forest View Heights Subdivision
Septic System Upgrade
Lot Line W~Jver ~equest
Dear On Site Services Engineer:
The attached Site Plan shows the location of the proposed septic system
to be constructed on the subject lot to replace the failing absorption crib.
Very little area is available for the new system because of the location of
the well on the property. We are therefore requesting a waiver to place
the trench within 2' of the lot line.
No easements exist along the property line where the new trench will be
constructed. In addition, no development falls within 30' of the adjoining
property to the south. The septic system can be constructed to maintain
100' separation from all wells in the area only if the lot line waiver is
granted.
Please let me know if you have additional questions.
Sincerely,
Michael E. Anderson, P.E.
LOTS 1, 2, 3, FOREST VIEW HTS.
2,000 GALLON
SEPTIC TANK
75' LONG X 5' WIDE X 4/
EFFECTIVE DEPTH TRENCH
SITE PLAN
SCALE 1" = 30'
NOTE: EXISTING TANK AND CRIB TO BE PUMPED, CRUSHED, FILLED WITH
SAND AND ABANDONED IN PLACE.
June 19, 1997
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject:
Lots 1, 2, and 3, Forest View Heights Subdivision
Septic System Design
Impacts to Adjacent Properties
Dear On Site Services Engineer:
We hereby apply for a permit to construct a new septic system on Lots 1,
2, and 3, Forest View Heights Subdivision. The existing absorption crib is
near failure and the tank is currently located within the protective radius
of the well. Both the crib and the tank will be pumped, crushed and
backfilled with sand prior to abandonment. The attached Site Plan shows
the location of the new septic tank and trench. Due to the size of the lot
and the placement of the well the only area available for the new
absorption trench is within 2' of the lot line. A lot line separation
distance waiver is therefore required and attached to this package.
Testholes performed on the property revealed clean poorly graded sands
which percolated at 3 minutes per inch. We have designed the absorption
trenches for an absorption rate of 1.2 gallons per day per square foot.
Total depth of the system will be 12'. No groundwater was encountered
during excavation for the testholes nor was any noted during the
monitoring period.
The surface of the lot slopes from south to north at a very gently grade of
approximately 1%. The surface of the ground in the area of the absorption
trench is fairly flat.
/
If the system is constructed as designed the following statements can be
made:
The system, if constructed as designed, will have no adverse impact
on the wells in the area or those to be constructed in the future.
Lots 1, 2, and 3, Forest View Heights Subdivision
June 19, 1997
Page Two
o
The system, if constructed as designed, will have no adverse impact
on existing septic systems in the area or those to be constructed in
the future.
The system, if constructed as designed, will have no adverse
impact- on reserved space, either surface or subsurface, on any lots
located in the area.
The system, if constructed as designed, will have no adverse impact
on drainage patterns in the area. The current drainage pattern will
be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
LOTS 1, 2, 3, FOREST VIEW HTS.
2,000 GALLON
SEPTIC TANK
e-, , · ' ,. 75' LONG X 5' WIDE X 4'
~.. , .,. , \
~, ~ r.~,~,?,:;. ;: ,;, EFFECTIVE DEPTH TRENCH
,~,. ~::,~.-, .,~ 'E PLAN
SCALE 1" = 30'
NOTE: EXISTING TANK AND CRIB TO BE PUMPED, CRUSHED, FILLED WITH
SAND AND ABANDONED IN PLACE,
LOTS 1, 2, 3, FOREST VIEW HEIGHTS
SUBDIVISION,
DESIGN FACTORS:
Six Bedroom Home
Perc. Rate: ~3 Min./Inch
Application Rate: 1.2 GPD/SF
SYSTEM REQUIREMENTS:
Wide Trench Systen~
2,000 Gallon Septic Tank
4' Drainfleld Rock
6 Bedrooms X 150 GPD / 1.2 GPDISF = 750 SF of Absorption Area
750 SF/5 LF (Trench Bottom) X .5 (Red. Factor) = 75 LF Trench Length
Therefore: Construct a 5' Wide Absorption Trench With One Lateral 75'
in Length. Distribution Pipe in Trench Placed at 8.0' Below the Original
Ground Surface.
NOTE:
TYPICAL WIDE TRENCH SECTION
(NO SCALE)
Grade Area Over Trench to Drain Away. ~~~'
Maintain 4' Vertical Separation From Ground Water.
Muni~,lpaiity of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION: Lots 1-3 t
Mayo Wells
1
2,
3-
7
10
13-
14-
18-
Forest,View
Heights Subd.
Township, Range, Section:
SLOPE
/
WAS GROUND WATER
ENCOUNTERED?
IV
SITE PI. AN F~.,,
IF YES, AT WHAT ~ 0
Grins Net {~p[h to Net
R#dln~ Da~e Time Time Water Omi=
PERCOLATION RATE
(mJnute~nch) PERC HOLE DIAMETER
COMMENTS
TEST RUN B~ETWEEN __, FT AND __. FT
72-008 (Rev, 4/85)
PERFORMED FOR:
LEGAL DESCRIPTION: Lots
10
11
12
13 ~ ~'""'~'~ '¢'-
16-
17-
18-
19-
Munictl~iil~ ol Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 'L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
Mayo Wells
Forest, View Township, Range, Section:
Heights Subd. SLOPE
WAS GROUND WATER
ENCOUNTERED?
$
DEPTH? P
PERCOLATION RATE ~'~ (mmute~mcfl) PERC HOLE DIAMETER
TF~T RUN BETWEEN ~7.~ FT AND ._~.~ FT
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE
72-008 {Rev. 4/~)
GRr~TER ANCHORAGE AREA BOROUmH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
SEPTIC TANK:
MAILING
ADDRESS
LEGAL DESCRIPTION
PHONE/d J:?
DISTANCE FROM WELL
J
LIQUID CAPACITY Jo. z- ~:' GALLONS.
~ NUMBER OF
MATERIAL c ',.-.- ',.-' ~-~'~'..~---'~:'~- COMPARTMENTS
INSIDE LENGTH ~ INSIDE WIDTH '~-
LIQUID
DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS
LINING MATFRIAI,.~' ~'-~'
NEAREST LOT LINE__
OdTSIDE DIAMETER ~ OR WIDTH ~' ']-
(- ~ ~ /'""~ Y"-) DISTANCE FROM WELL // .,.~2~. '/
~OTAL EFFECTIVE ABSORPTION AREA {WALL AREA)
, LENGTH ~'...~2 , DEPTH
, BUILDING FOUNDATION-",/~ ''~
/'7~ ~ ~ SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL ~
NUMBER OF L1NES
A BSORf)TIO N AREA
E~['PTH: TOP OF TILE TO FINISH GRADE
- "~, FOUNDATION ..-"/"'"~' NEARE
S(~. FT. LENGIH.~ EACH LINE
DEPIH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH
OF L I ixJ.EB~- ---.,,
.--" IN. TOTAL EFFECTIVE
IN. ABOVE TILE
DISTANCE FROM
WELL: TYPE/--'..~',~'z~=~? , DEPi'H ./."z' .A'''z ,BUILDING FOUNDATION
NEAREST ~ SEPTIC jr.,.~z~/ SEEPAGE
LOT LINE .- ,z ' ~-' , SEWER LINE , lANK , SYSTEM
...~? ~ WATER ~.,~
SAMPLE ·
-/'"'~': , CESSPOOL
DIAGRAM OF SYSTEM
, NEAREST
OTHER
, SOURCES
DISTANCES:
r_ - ' '//> /~' APPROVED ~ ' ' ' ~ %
HEALTH AUTHORIIY
GAAB-HD-2
GREATEF
327 Eagle St.
NCHORAGE AREA r )ROUGH
HEALTH DEPARTMENT
Anchorage, Alaska 99501 279-2511
Case No. ~
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
; ~//"~ MAILING ADDRESS ,J'- '-, ' . ,, PHONE NO .... ,'. " '
- ,.~'~' LOCATION OF INSTALLATION
NAME OF APPLICANT,,~;~''
RESIDENCE AOBRESS~" '
LEGAL DESCRIPTION ,:
APPLICATION TO INSTALL: SEPTIC TANK, ,":,:-
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PERCOLATION TEST RESULTS
, SEEPAGE PIT.
, DRAIN FIELD
TO BE INSTALLED BY i'
ANTICIPATED DATE OF COMPLETION
, OTHER
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS
AS DESCRIBED BELOW.
· SEPTIC TANK SIZE
DISTANCES:
, PERMIT TO INSTALL A
SIZE OF UNIT TO BE SERVED
TYPE SEEPAGE AREA
DIAGRAM OF SYSTEM
TYPE
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
DATE~ :,_ , - APPLICANTS SIGNATURE .~. ~"..).~ z , ... ~'~ /_
MUMUPAUTY 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. 014-141-86
1. GENERAL INFORMATION
Expiration Date: J— I L - 26 2 :7
Complete legal description Forest View Heights Lot 1+2
Location (site address) 3338 E 72nd Avenue
Current property owners) Terry Lammers
Mailing address
Real estate agent
2. TYPE OF DWELLING:
El Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 6
Day phone
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
Q
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 $ 5 50
Date of Payment i b D-�
Receipt Number 03 f 31 G
COSA# 05G22J26
Waiver Fee $
Date of Payment
Receipt Number
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.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA
COSA guidelines and regulations. The reported results describe 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 soil condition, ground water 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 this system. All systems eventually fail and satisfactory test results do not
guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot
provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole
benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly
recommends buyers hire their own engineer to evaluate this report.
Name of Firm Pannone Engineering Services
Phone (907) 745-8200
Address P.O. Box 1807 Palmer, AK 99645
Engineer's Printed Name Steven R. Pannone P.E. Date
OF F A ``
DSD SIGNATURE ' TH ....
anno
.
System #1 Approved for � bedrooms � Steven R. • re•
onno
r,
CE 8149
System #2 Approved for bedrooms�`�sl
Disapproved
Conditional approval for bedrooms, with the following stipulations:
WQPOTY pF�r��ii
44, Ali
nA, tion'.
oAT
ER
c,
m pATE;q 5. m
- Ji�IiJTSERVICES,.��`�\
BOriginal Certificate Dater Z
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
COSA Checklist blue sheet
Nitrate Advisory
Arsenic Advisory
Other 110
V�
Legal Description: Forest View Heights Lots 1+2 Parcel ID: 614-141-86
If more than 1 septic system on tot: COSA Checklist # 1 of 1 Structure served by this system 1
A. WELL DATA
_1 Well log is filed with Onsite (or attached)
Date drilled PNE 19i<
Total depth 45+ ft
Cased to 45+ ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 16.5 in.
Date of flow test for COSA 05/13122
Static water level at beginning of test 44.2 ft.
Comments Unknown Well Depth
B. TANK DATA
Age of tank(s) 7"5`97 years
Tank type/material SEPTIC.WEE
Measured operating fluid level in septic tank $"
❑ Standpipes/foundation cleanout per record drawing
Date of pumping
D. ABSORPTION FIELD DATA Deep Trench
Which system tested (date installed) 7116197
❑ ALL standpipes present per record drawing
Total measured depth from grade 11.9 ft (max)
Measured depth to pipe invert from grade 8 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective 3.7',4.25'
❑ Code -required soil cover over field
❑ System presoaked _-
(Required if vacant f eater than�3l�d s prior to
date of test)
Gallons intro uced �+� �4:allons
Comments/Defi iencies:
COSA Checklist yellow sheet
Well production at time of test 4.36 gpm
Water storage tank volume NSA gallons
Well disinfected for coliform test? ❑ Yes [QNo
Coliform bacteria is Negative
Nitrate � W % mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L pisisenic less than MRL (ND)
Collected by FL S
Date of Sample 05/13/22 ,
C. LIFT STATION'
❑ Required maintenance completed
Age of lift station NSA years
Lift station material
Comments:
Adequacy test date 05/13/22
Results Q Pass For 6 bedrooms
Fluid depth 0 in
Wat added O gal
New depth in
Elapsed time 43 min
Final fluid depth 0 in
Absorption rate 900 gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
0
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' Fv-1 Yes
if No ft
Absorption Field on Lot > 100' [] Yes
if No
ft
Holding Tank > 100' Q Yes
if No ft
Neighboring Absorption Fields > 100'
M Yes if No ft
Water Main > 10'
Animal Containment > 50' 0✓ Yes
if No ft
0 Yes
if No
ft
M Yes if No ft
Water Service Line > 10'
[]
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is,under driveway
Community Sewer Main > 75' Q Yes
if No
ft
0✓ Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
0
Yes
if No
ft
Surface Water > 100'
Yes if No ft
Property Line > 5'
El
Yes
if No
ft
Wells on Adjacent Lots:
ft
Absorption Field > 5'
[✓
Yes
if No
ft
Private Wells > 100'
M Yes if No ft
Water Main > 10'
Q
Yes
if No
ft
Community Wells > 200'
M Yes if No ft
Water Service Line > 10'
[]
Yes
if No
ft
If septic tank is,under driveway
comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
Il Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
❑ Yes
if No 2*
ft
Wells on Adjacent Lots:
Water Main > 10'
0 Yes
if No
ft
Private Wells >100'
_ ❑Yes if No ft
Water Service Line > 10'
Q Yes
if No
ft
Community Wells > 200' ❑ Yes if No ft
Surface Water > 100'
0 Yes
if No
ft
F. ENGINEER'S COMMENTS
* SEE EXISTING LOT WAIVERS ON FILE
G. ENGINEER'S CERTIFICATION
l certify that / 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.
z,
COSA Checklist yellow sheet
OF AL;k k
��.• � — .via
Steven .P,. •75aniionc-
CE 8149 c�o
Septic 'Tank Advisory
Certificate of On -Site Systems Approval #OSC221264
Subdivision: Forest View Heights Lot 1 & 2
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this COSA / property is 25 years old. A leaking septic tank may be a source of contamination to
the aquifer. Typical replacement costs range from $10,000 to $15,000
This advisory must be attached to all copies of the subject Certificate of On -Site Systems
Approval.
This is an example of a 16 -year-old septic tank in failure and should be replaced.
Ma�lmg Address P C1 Box 196650 *Anchorage, Alaska 99519 6650 *www muni org
Municipality of Anchorage
On-Site Water & Wastewater Program
CERTIFICATE OF ON-SITE SYSTEHS APPROVAL
Parcel l.D 014-141-86
1. GENERAL INFORMATION
Expiration Date:
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
FOREST VIEW HEIGHTS LOT 1 ~ ~
3338 EAST 72ND *ANCHORAGE, AK 99507
GARY &: PAMELA DEPUE
Day phone
3338 EAST 72ND *ANCHORAGE, AK 99507
JOHN COLLINGE W/ PRUDENTIAL
Day phone
2. TYPE OF DWELLING:
· Single Family (w/wo ADU)
[] Duplex
[] Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
6
4. TYPE OF WATER SUPPLY:
Individual Well ·
Individual Water Storage []
Community Class Well []
Public Water System []
TYPE OF WASTEWATER DISPOSAL:
Individual On-site ·
Individual Holding tank []
Community On-site []
Public Sewer []
Received by: /'~.¢'
COSA to be released to the engineer, unless et hen,vise requested by the engiaeer,
COSA Fee $
Date of Payment
Receipt Number
COSA ~ ~l
Waiver Fee $
Date of Payment
Receipt Number
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 bedreoms 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 GARNESS ENGINEERING GROUP, Ltd.
Phone 537-6179
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Date
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 & 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 perfonDance 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 sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
6. DSD SIGNATURE
Y System #1 Approved for
System #2 Approved for
Disapproved.
Conditional approval for __
bedrooms.
bedrooms.
bedrooms, with the following stipulations:
ON-SiTE
WATER AND
The Municipality or Anchorage Develop,emt Services Division (DSD) issues Ceflificates of On-Site Systems Approval (COSA) based only
upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the Slate of Alaska.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineeFs work.
7. ATTCHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
(Rev 1155)
Nitrate Advisory
Arsenic Advisory
Other ?,,~
Original Certi~Jc~[e
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:
A. WELL DATA
Well type PRIVATE
FOREST VIEW HEIGHTS LOT 1 ~ ~--
Parcel ID:
*INSPECTED BY APWS-SEE PRIOR COSA
IfA, I~, or C provide PWSID# N/A Well Log (Y/N)
014-141-86
NO
Date completed PRE 1974 Sanitary seal (Y/N) YES
Total depth *45+ ft. Cased to *45+ ft.
FROM WELL LOG
Date of test NO WELL LOG
Static water level J ft.
Well production ,,,-/ g.p.m
WATER SAMPLE RESULTS:
Coliform ¢-~ colonies/100 mi. NitrateO"~O(ffmg.lL.
Ar'senic:/kJ O ug./L. Date of sample: 1/9/1,3
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Tank size 2000 gal. Numberof Compartments 2
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO
Date of pumping 7/20/12 Pumper
C. ABSORPTION FIELD DATA [*BELOW EXISTING GRADE]
Date installed 7/16-17/97 Soil rating (g.p,d./ft2or~ 1.2
Length 67 ft. Width 5 ff.
Total depth '12,50 ff. Eft. absorption area 670 ft~ Monitoring tube YES
Date of adequacy test 1/8/13 Results (Pass/Fail) PASS
Fluid depth in absorption field before test 21 in. Water added 1970ga1.
Elapsed Time: 980 min. Final fluid depth 20 in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
1/8/13
44 ft.
9.73 g.p.m.
Collected by: GEG. Ltd,
Date installed 7/16-17/97
Cleanouts (Y/N) YES
High water alarm (Y/N) N/A
ONE STOP SERVICES
Absorption rate >=
YES
12+ .in.
System type TRENCH
Gravel below pipe 4.2 .ft.
Depression over field NO
For 6 bedrooms
New depth 29 in.
900+ g.p.d.
If yes, give date -
D. LIFT STATION
Date installed Size in gallons ~ ~
"Pump on" level at ~ High water a arm level at ~n.
~ ~ Cycles tested. Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
100'+
Septic tank/lift station on lot
Absorption field on lot 100'+
Public sewer main 75'+
Sewer/septic service line 25%
Animal containment areas 50%
On adjacent lots. 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout 100'+
Holding tank N/A
Manure/animal excreta sforege areas
100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Properbj line 5'+
Water main N/A Water service line. 10'+
Wells on adjacent lots 100%
Absorption field 5'+
Surface water 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Properly line *2' Building foundation 10%
Water service line 10% Surface water 100%
Curtain drain NONE KNOWN Wells on adjacent lots. 100'+
Water main N/A
Driveway, parking/vehicle storage 10'+
F. COMMENTS
WR#970028
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 CO,SA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date t (-Z i J l~)
(Rev. 11/05)
/~f ~-_~ ~' -'-- ~ ~ -'~'""'-cSPRUCE- _STREET
"~ :'...'."' . ~/ ,
..' ~ <' ..
~' ~ ~'~ '~ ~
65. :4' . . I ~2.
Parcel I.D.
CERTIFICATE
FOR A
014-141-2
1. GENERAL INFORMATION
Municipality of AnchoraGe
Development Services Depsrtment
Building Safety Division
On-Site Water & Wastewater Program
4700 E!more Read
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
OF ON-SITE SYSTEHS
SINGLE FAHILY
APPROVAL
DWELLING
Expiration Date: -? ~ //~ '-//
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
FOREST VIEW HEIGHTS LOT 1
.3538 EAST 72ND *ANCHORAGE, AK 99507
MAYO WELLS
5338 EAST 72ND
Day phone
*ANCHORAGE, AK 99507
Day phone
c/o
AGENT
KIMBERLY ANDERSON W/ DYNAMIC Day phone
5111 "C" STREET *ANCHORAGE, AK 9950,3
529-1151
Unless otherWise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 6
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well · Individual On-site ·
Individual Water Storage [] Individual Holding tank []
Community Class__Well [] Community On-site []
Public Water System [] Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of 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.
STATEMENT OF ~NSPECT!ON BY ENG!NEER
As certified by. my seal affixed hereto and as of the validation date shown below, I ........ v~,,y L,,a,~ ..... ,, ~,
investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
~" ..... ~,5~t' ~ '~he o,,-s,..e- ;' water SUDD!V and/or wastewater H¢o~o,l ovef,~m ie ./~ ) safe, ~,,nctinna/ an~ adequate
for the number of bedrooms and type of structure,,,,~¢.~,¢"¢;~f~ herein. I fu,ffher vefi~/ that based on the
u noil~uOt~ o~u~eo ~,,, ~ M~,,,cwa,,y o~ ~,,~ho,~se and ~m my,,;""o~*~°*~",, ~.,s~.,~,, and inspection, ..*~. ~
on-site water supply and/or wastewater disposal system is(are) in compfiance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installaSon.
Name of Firm GARNESS ENGINEERING GROUP, Ltd.
Address 5701 E. TUDOR ROAD, SUITE 101 * 'ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Phone
Date
557-6t79
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 & 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 sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
DSD SIGNATURE
/
'\,,,~ Approved for (~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
~,JS,~, uhec~tu~
Septic System Advisory
Well Flow Adviso~
Nitrate Advisor),
(Rev. 11105)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:.~_ - / ~ ~//~
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS
Legal Description:
FOREST VIEW HEIGHTS LOT 1
APPROVAL CHEGKLIST
Parcel ID: 01 4-1 41 -,245¢ ~ ¢o
WELL DATA
Well type PRIVATE
Date completed PRE
Total depth *45+ ft.
*INSPECTED BY APWS-SEE ATTACHED RECEIPT.
If A, B, or C provide PWSID# N/A
1974 Sanitary seal (Y/N). YES
Cased to *45+ ft.
FROM WELL LOG
NO WELL LOG
Well Log (Y/N) NO
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi.
Arsenic: ND ug./L.
SEPTIC/HOLDING TANK DATA
Wires properly protected (Y/N) YES
g.p.m.
Casing height (above ground) 12+ in.
Foundation cleanout (Y/N) YES
Date of pumping 3/31/11
ABSORPTION FIELD DATA
Date installed 7/'16-17/'97
Length 67 .ft.
Nitrate 0.252 mg./L.
Date of sample: 5/50/11
Tank Type/Material SEPTIC/STEEL
Tank size 2000 gal. Number of Compartments 2
Depression over tank (Y/N) NO
Pumper
I'BELOW EXISTING GRADEI
Soil rating (g.p.d./ft2o~ 1.2
Width 5 ft.
AT INSPECTION
3/3o/11
45
Date installed 7/16-17/97
Cleanouts (Y/N) YES
High water alarm (Y/N) YES
MCDONALD'S PUMPING
Total depth '11.96 ft. Eft. absorption area 670 ft2 Monitoring tube YES
Date of adequacy test *'3/31/11 Results (Pass/Fail) PASS
Fluid depth in absorption field before test DRY in. Water added 2560ga1.
Elapsed Time: 418 min. Final fluid depth DRY in. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN
**PRE-SOAK ON 3/30/11 WITH 2080 GALLONS OF
Depression over field NO
For 6 bedrooms
New depth 14.5 in.
9OO+ g.p.d.
If yes, give date -
WATER.
System type TRENCH
Gravel below pipe 4.2
Collected by: GEG, Ltd.
8.73 g.p.m.
D. LIFT STATION
Date installed
"Pump on" level at__
Size in gallons Manhole/Access ~ ~
in. "Pump off" levef_~t~. High water alarm level at
in.
E. SEPARATION DISTANCES
Cycles tested.
Meets alarm & circuit requirements~
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot 100'+
Public sewer main 75'+
Sewer/septic service line 25'+
Animal containment areas. 50%
100'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout
Holding tank N/A
Manure/animal excrete storage areas
100'+
100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line. 5'+
Water main N/A Water service line 10'+
Wells on adjacent lots 100'+
Absorption field
Surface water
5'+
100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line *2'+ Bud ng foundat on. 10'+
Water service line 10'+ Surface water 100'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
Water main N/A
Driveway, parking/vehicle storage
10'+
F. COMMENTS
WR#970028
G. ENGINEER'S CERTIFICATION
! 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,
Engineer's Prinlted r~ame JEFFREY A. GARNESS
Date
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
Aa ow Pump & Well S svice, LLC
P.O. Box 110496
Anchorage, AK 99511
CUSTOMER JOB SiTE
- - -- '-- t(_,)i"'j ~ V'~.
QUANTITY DESCRIPTION PRICE AMOUNT
.h-' ~* r-- / / . . --f
..... ,'- ' ,. -, ~ ., . l, .,n, ,~ C r
LABOR HOURS RATE AMOUNT TOTAL MATERIAL
TOTAL LABOR
!WORK ORDERED BYI DATE COMP. ' ......
; ! LABOR " I
'~'
T,,h~nk
S G, MI-U, ,~_
(i Hereby Acknowledge the Satisfactory Completion of the Above Described Work and agree that if above work is not paid for in 90 days I agree to allow Aarow
Pump~. We[! Se:n,iCe:. ..... , .........:: n the right to remove unpaid ~,.r .... ~t~'1~','~'~l~m4~ll''"l'~'' _~nd, charge for labor already pedormed _,~, labor to remove unpaid for equipment.)
TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE.
SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS.
East 72nd AVENUE
Lot 20
/
Lot 1~
Lot 18
Lot 17
USE EASEMENT
GRANTED .,~ORIL 30, 2008
USE EASEMENT J
GRANTED OCTOBER 7,
'-"::'~J' ':'/:::'~' "".' ~:.~:. :.-:-.'~' '-"':'~ ~:~ - ~ I '
. . .~. ': .~ --" .... ... - ~.. ~
..-: .:'.. :; :.-,: :---,..: :Lot
~'-t.:'"'--.'-/-X ..... .' -.: --.-, ....~,7~s ,.f..~.-. ~'.'.'+..,1
m-:':'..~ ~:~-~-...-::-.-..: .--:.. '::~...X
: ".~.. %. ~6 . -= . ' -~ ~'E' ';- ' :-+
12.g '' '- .. ........ "--' ~w~ ~.-..
: ~*' ~3~.58' ,~ "'"~ .... ." '1
: ~ ~ '~.. -"" o ':
'~V xL Lot 2 ~.. ~. r
I
s 89'58'30"E 133.58'
/
~1 ~ 80'58'30~ 133.58' I
J ~uw ~m~ Lot 4 J = 33.00' _ J
I I -]
I
I I ,
/
/
/
/
/
PLOT PLAN
AS BUILT X SCALE 1" = 30' GRID SW 2134 Project No. 11-035
La n g (907) 522-6476
Registered Land Surveyors (907) 522-4625
ken~langsurvey.com / Jonafhan~langsurvey. com
& Associates, inc. 115oo Oaryl Avenue, Anchorage, Alaska 99515-3049
Phone
Fax
I hereby certify that I have surveyed the fallowing described properly:
LOTS 1, 2 & 3, FOREST VIEW HEIGHTS SUB, (Plat 63-44)
Anchoroge Recording District, Alaska, and fhaf the Improvements slfuafed thereon are
wlfhln the properly lines and do not encroach onto the properly adjacent thereto, fhaf
no Improvements on the properly lylng adjacent thereto encroach on the surveyed
premises and fhaf there are no roadways, fronsmlssion lines or other visible
easements on said property except as indlcafed hereon.
Datsd this the ~Z+h Day of ~,~., , '~t.\ , af Anchorage, Alaeka
It Is the responelbillly of the owner fo determine the existence of any easements,
covenants, or restrictions whlch do not appear on the recorded subdivision plat.