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SHORT LT 216B
Onsite File :�11.1�11i1 kRCv UJ/UL/ 1 O) Municipality of Anchorage On-Site Water and Wastewater Section - (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221443 PID Number: 018-331-29 Dwelling: V Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name Clemens Family Trust A ORPTION FIELD ❑ De Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 3735 Dora Ave. Other Phone Number of Bedrooms Soil RatingTotal depth from original grade 3 /SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original de F Gravel depth beneath pipe . Ft. Subdivision Block Lot Short 216 B Fill added above original grade Ft. W I length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dista a between lines Ft. SEPARATION DISTANCES To Septic I Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between tr ches From Tank Field Tank Line Ft2 Well 1001+ 25'+ TANK © Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water 100'+ Greer 1000 Gal. Material Number of compartments Lot Line 101+ NA Plastic 2 Foundation 101+ I TATION Manufacturer Capacity Remarks Tank insulated Gal. Alarm location ctra tailed by Eleto Installer PIPE MATERIAL House to tank Tank ld D3034 drainfield D3034 A+ Drainfield CO/MT D3034 Inspector Areterra Consulting BENCH MARK (Assumed elevation) 100 ft Inspection , dates: 3/9/23 2nd 3/9/23 Location and description 3'd 3/10/23 4th SE corner of house, bottom of roof ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineers Stamp Conditional Approval: Date .•••E•ODYF -•4��P ♦♦♦♦♦ 49311. *'�♦ Septic Syste �� KENNETHUFFUS/4 w ApprovedL�Date L/ 2 1♦�� CE 7 11 6�-or *♦*, a� � .. Note: this approva es not include well permit requirements. f�,,'pE ��i+•� kRCv UJ/UL/ 1 O) ■►+rr,r rrs�lr�l>r rzr-•� r� 1r► ttl�r A—C=35.6' B—C=45.0' A—D=37.7' B—D=48.6' A—E=37.3' B—E=50.6' A—F=36.3' B—F=52.0' AS—BUILT SYSTEM DETAILS/SITE PLAN Permit ❑SP221443 SHORT LOT 216B PID# 018-331-15 WELL I I I D I I z r � � D / 1 I M rrn NEV 'o' TANK TNSTAL;Li➢ C E 0 GRAVEL DRIVEWAY e 3' PATENT RESERVATION FOR R.O.W. & UTILITIES v SCALE, NTS AW OF ALS fi�... PREPARED FOR: CLEMENS FAMILY TRUST f3735 D❑RA AVE. * :4. TH * ANCHORAGE, AK KENi3E'F�I M. us FIELD BOOKS COMPUTED: C —7i �� . BOUNDARY: N A DRAWN: KS❑ �w STAKING CHECIQEDD: ����...'�yti N A KM❑ AseuILT: LANG DATE: 3/27i ■h]E9S DWG. FILE: GRID: SW313 waw AcAD FILE: FILE 10B "°'` 22168 PATENT RESERVATION FOR R.O.W. & UTILITIES I SCALE, 1' = 40' SCALE, NTS MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221443 Work Type: SepticTank Upgrade Tax Code Number: 01833129000 Site Legal Address: SHORT LT 216B G:3135 Site Mailing Address: 3735 DORA AVE, Anchorage Owner: CLEMENS FAMILY TRUST Design Engineer: ARC TERRA CONSULTING INC This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: »ent Department 11/23/2022 11/23/2023 40370 ❑ Disposal Field CI Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: • The missing trench standpipes are to be located and repaired prior to COSA approval. G! I Reeeived : j_ 55UeJ -f o Arc / e ora Issued By: Date: Date: 3 MUNICIPALITY OF ANCHORAGE Development Services Department% Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 018-331-29 Property owner(s) Clemens Family Trust Day phone Mailing address 3735 Dora Ave. Site address 3735 Dora Ave. Anchorage. AK Legal description (Sub'd., Block & Lot) Short Lot 216B Legal description (Township, Range & Section) Lot Size 40,370 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑K AD U) Septic Tank Upgrade X(w/wo Duplex (D) ElHolding Tank ElRenewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Dea Duffus (Signature of property owner or authorized agent) Permit/Rush Fees: A 9 5 - Date of Payment: lo%L%1ota- Receipt Number: d I Permit No. o SP'�Zg/443 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Farms\Client FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221443, Deb Wockenfuss, 11/23/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221443, Deb Wockenfuss, 11/23/22 10' T&E EASEM Lot 216A WIRE FENCE 10.1'.14.1' E 3' PATENT RESERVATION FOR R.O.W. & UTILITIES Lot 196 48.7' GRAVEL` Lot 21613 40,370 S.F. /Q WELL) x8.0'.5.0' WOOD SHED 3.7'0.6' DECK F-2.0' CANT 2 STORY RESIDENCE o'.s.0'J PER SEPTIC GRAVEL r PIPES DRIVEWAY N 89'51'18"W 118.72' DORA AVENUE I I I I .. 3' PATENT RESERVATION FOR R.O.W. & UTILITIES z r- I O Nn a I OD o � M D N Z ba J I ,q Z M I I I ASEPTIC PIPES I NOTE: DUE TO SNOW & ICE COVER, SOME SURFACE LEVEL L=31.51' I FEATURES ARE APPROXIMATE. R=20.00'1 I I PLOT PLAN ___ AS BUILT _X SCALE _1" =50_– GRID _ SW 3135__ Project No. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone 000000 O (907) 522-4625 Fax 4 Professional Land Surveyors ken9langsurvey.com o/ 9 ionathanO(anasurvev.com O� .• O A `. S 0 I hereby certify that I have surveyed the following described property: LOT 216B, SHORT SUBDIVISION (PLAT No. 2004-8) Anchorage Recording District, Alaska, and that the Improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said properly except as Indicated hereon. Dated this the 1)_ Za___ Day ofNINe�w\C�utti–, _1_�L_�_, at Anchorage, Alaska •.• KE•LA G ...o �9F. '••,LS -5202.••' Seo 40nRoFESSIONA\- Uo It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 MunicipalitY of Anchorage Page 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: ~t, Jq~O ffql PID Number: ~'/~'-~ II, S- Na~ne:' , Wastewater System: ~New [] Upgrade Address; ABSORPTION FIELD ~,hc.~ ~ No. of B~rooms: ~CHO~i ~ ~/~ ~ DeepTrench ~ Shallow Trench ~ Bed ~ Mound ~ Other LEGAL DESCRIPTION S°""~t~n": ~,~GPD/Sq. Ft.T°talOepthfr°m°riginalgrade~I Lot: ~ Subdiv~ion: Depth to pipe bosom from original grade: Gravel depth beneath pipe ' S~ction: Township: Range;~ ~ ~ Fill added above original grede: Gravel length: WELL: ~ New ~ Upgrade Gravelwidth: ~ Ft. Number of lines:~ 0islance be~eenlines:/~ Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: ~/O Driller: Date Drilled: ;tatic Water Level: Installer: Date installed: Yield: GPM PumpSetat: Ft. CasingHe[ghtAboveGroundFt. TANK SEPARATION DISTANCES ~eptic ~ Holding Q S.T.E.P. To Septic Absorption Lift Holding =ublic/Private Manufacturer: Capacity in gallons: From Tank Field StMion Tank Sewer Lines ~C~O~ ~ sua~c~ ,~ ' LIFT STATION Water /OO /oo ~ Foundation ~G'/~'~ ,. "Pump on" level at: ~t: IHigh water alarm at: Drain Remarks: BENCH MARK Location and Description: Assumed Elevation: ENGINEER'S SEAL 17034 Eagle River Lo~ Road, No 2~ ~ *'- ~ Inspections performed by: ~.,1, glve~. Alaeka ~5~ Dates: 1st c-7- ~4~,~,~:~-;~ Department of Hea~uman Se~ices approval ~~~;~ 72-O13 (Rev. 9/91) MOA 25 Permit. No. SW930491 Page 2 of 2 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 Wastewster Disposal System and/or Well Inspection Report Legal Descripti~.2N' R3W, SEC.$$, LOT 216 PIDNo.: 01833115 CO1 NEW 1000 GAL SEPTIC TANK 201 B5.0 29.£ 302 ~6.5 35.£ 303 B6.5 36.£ 304 ~5.0 86.C ~05 ~12.5 37.£ ?,06 ~2.0 37,£ C07 E8.0 55.C ~Off~ v28'~0' '&gX; C09 ,~4.5 61.C CO10 ~14.0 63.£ ~Oii 50.0 75.[ MT1 ~6.5 53.[ MT2 B4.5 61.£ MT8 ~19.5 75.£ NEW 1000 G~L. SEPTIC TANI~ SCALE t' = 40' 72-013 A (1/93) CO~i 3 BDRM HOUSE B GRADE C05 89.2~ FROM C07 MT1 C09 MT3 ~6,6 · 80.6'! NO WATER FOUND COl: 86.6~/~ OF FOUNDATION~ @ SOUTHEAST HOUSE CORNER N No. 1457-f 08/20/2003 ~4:52 I' 3453287 M W ])RILLING, lNG PAGE 82 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PAGE 1 OF 1 5 f PERMIT NUMBER:SW930491 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:SHORT JAMES L & IRIS J OWNER ADDRESS:5535 N. STAR STREET ANCHORAGE, AK 99518 DATE ISSUED:il/23/93 EXPIRATION DATE:il~23~94 PARCEL ID:01833115 LEGAL DESCRIPTION: T12N R3W SEC 33 LT 216 LOT SIZE: 108900 (SQ. FT.) NUMBER OF BEDROOMS: 3~ THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWIN~ SPECIAL PROVISIONS. SPECIAL PROVISIONS: DUE TO THE FACT THAT THE DESIGN OF THIS MULTIPLE TRENCH SYSTEM IS BASED ON THE PREMISE THAT EACH TRENCH WILL HANDLE ONE-THIRD OF THE SEPTIC TANK EFFLUENT, A PRESSURE DI~TRIB- SYSTEM FLOW DIVERTEd,SPLITTER DEVIOE UST BE OS D. ROBERT SHAPER, P.E. ROGER SHAFER, P.E. November 17, 1993 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECT[ON & FLOW TEST SITE PLANS ROAO DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS Municipality of Anchorage DEPARTMENT OF HEAL TH AND HUMAN SERVICES 825 'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 216, Section 33, T12N, R3W, SM, AK Request you issue a permit to drill a well and install a septic system to serve the proposed three bedroom house on the referenced property. Test holes were excavated and percolation tests performed. The approximate location of the test holes are located on the attached site plan. The monitoring tubes within the test holes have been checked and found to be dry. This property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information for your review, please contact us. RAS/LSU/Isu ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP ° SUITE 204 · EAGLE RIVER, ALASKA 99577 Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: 1 3 4 5 7 g 12 13- 15- 16- 17- 18- 19 2O DATE PER F(] :',; ' '(ENGIN~EER.~S SEAL) Township, Range, Section: WAS GROUND WATER tTMII~(~ ENCOUNTERED? S L IF YES, AT WHAT ~' O DEPTH? P E Depth to Wat~ir After -- Dele: '"'/~"~1' Monitoring? \ ,.~? SLOPE SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop :~ IO ~' ~'1~" V~" PERCOLATION RATE ~::~0 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN --~/--- FT AND ,-~ FT COMMENTS $ & ENGINEERING ///~~CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED BYITC=,; 72-008 (Rev. 4~85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: l~)-~ (-~/6! ~¢-~,'~;T'J,~-/~? ~j~JT°wnship' Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? pO E Depth Io W~terJl~r ~/ Moni{orino?,~_~__..7~_ DaLe: Gross Net Depth to Net Reading Date Time Time Water Drop 3 4 5- 6 7 8 9 10 11 12 13 14 15 16 17 18 19- 20- PERCOLATION RATE c~'~ {minutes/inch) PERC HOLE DIAMETER (~ ~ TEST RUN BETWEEN ~ AND L'/ FT PERFORMED B' '0~Z.g,e ~{ver {Do, "Da, NO. 2~ I ~~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE~:~': :::;;:?;:;~rCIPAL GUIDEL]NE~;F~;F~T ON TTON THIS DATE. DATE: 72-008 (Rev. 4/85) ~ MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 018-331-29 Expiration Date: 5/30/23 Legal description SHORT LT 216B Site address 3735 DORA AVE Current property owner(s) CLEMENS FAMILY TRUST The On-site system(s) is/are approved for bedroom X Conditional approval for 3 bedrooms, with the following s ipulations: A l( conc�Ch Comments or advisories: To receive an unconditional COSA: 1. The driveway over the field is to be permanently blocked to traffic. 2. Standpipes are to be located and repaired. 3. An as -built survey to be submitted showing the new tank and repaired standpipes. By: G(/ Original Certificate Date: 4/7/23 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY OF ANCHORAGE C�_ Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 018-331-$ 2Q Complete legal description Short Lot 216B Location (site address) 3735 Dora Ave. Anchorage, AK Current property owner(s) Clemens Family Trust Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑✓ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass Age New - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed Z Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. cond t!hlona COSA Fee $_5 2 Q0 Waiver Fee $ Date of Payment 3 Zy /4'2_ 3 Date of Payment COSA # () S G 210 6 3 Waiver # COSA Application—June 2022 Legal Description: _ COSA Checklist Short Lot 216B Parcel ID: 018-331-15 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA A Well log is filed with Onsite (or attached) Date drilled 4/3/94 _Total depth 117 ft Cased to 117 ft ❑✓ Sanitary seal is functioning correctly V Wires are properly protected Casing height (above ground) 32 in. Date of flow test for COSA 10/13/22 Static water level at beginning of test 52 ft. Comments B. TANK DATA Measured operating fluid level in septic tank New Date of pumping New Install ❑ Required maintenance completed, if AWWTS Comments - D. ABSORPTION FIELD DATA Which system tested (date installed) 5/7/94 ❑✓ ALL standpipes present per record drawing Total measured depth from grade 10.75 ft (max) Measured depth to pipe invert from grade 5.75 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ✓❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 Well production at time of test 8.5 gpm Water storage tank volume *A gallons Well disinfected for coliform test? ❑ Yes ❑✓ No ✓❑ Coliform bacteria is Negative Nitratemg/L 2Nitrate less than MRL (ND) Arsenic ug/L 21 Arsenic less than MRL (ND) Collected by Areterra Conaulting Date 2/6/23 C. IFT STATION ❑ Require tF Age of lift station Lift station material Comments: ce completed Adequacy test date 10/13/22 Results[Z] Pass Fluid depth prior to test 15 in Water added 450 gal New fluid depth 25 in Elapsed time 10 min Final fluid depth 15 in Absorption rate 450+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 60 Effective depth used 15 in Effective depth remaining 45 in in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ✓❑ Yes if No ft ❑✓ Yes if No ft Neighboring Tank > 100' ✓❑ Yes if No ft Private Sewer/Septic Line > 25'�/❑ Yes if No ft Absorption Field on Lot > 100' ❑Q Yes if No ft Holding Tank > 100'✓❑ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ❑J Yes if No ft Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Fv� Yes if No ft Z] Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100'✓❑ Yes if No Tank to Property Line > 5' ✓❑ Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ✓❑ Yes if No ft Private Wells > 100' Yes if No Water Main > 10' ❑✓ Yes if No ft Community Wells > 200' © Yes if No Water Service Line > 10' ✓❑ Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS ft ft ft G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Arcterra Consulting Phone (907)-696-6111. Engineer's Printed Name Kenneth Duffus Date 5P Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. ♦��"'�����i The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year A �J ;+ and the water usage of the family being served by the system. The operational life of all well and septic r systems are subject to these various and dynamic characteristics and are outside the control of the evaluator 49-W r• of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will 0 -- function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. KENYE M. FU5 /X CE 711� ; AV COSA Checklist June 2022 �,�+��atE�RM�*��4+ 10' T&E EASEM Lot 216A WIRE FENCE Lot 196 S 89'49'1 0 N a O' AB ;;1[24.8- S ` W AB 48.7' ' GRAVEL-' Lot 2166 40,370 S.F. P WELL) 8.0'x5.0' WOOD SHED 3.7'x DECK 1 r2.0' CANT 10.1'x14.1' SHED u 2 STORY 3s�• Z m RESIDENCE 0 25.8' 20.7 0 23.4' Z, N0 O 9• a] 4.0'x3.0' I 0 PORCH I rMANHOLE I CURB- "f O 10 3' PATENT RESERVATION FOR R.O.W. & UTILITIES J 0 — M GRAVEL DRIVEWAY 1 N 89'51'18•W 118. DORA AVENUE 3' PATENT RESERVATION FOR R.O.W. & UTILITIES i r- 0 N 0 �,-SEPTIC PIPES F NOTE: DUE TO SNOW & ICE COVER, SOME SURFACE LEVEL L=31.51' 1 FEATURES ARE APPROXIMATE. R=20.00' 1 I PLOT PLAN --_ AS BUILT _X— SCALE _1"_= 50__ GRID _ SW 3135__ Project No. Lang & Associates, inc. 11500 Daryl Avenue, Anchorage, Alaska (907) 522-6476 Phone 99515-3049 907 522-4625 Fax oo QO F O4� Professional Land Surveyors kenOlongsurvey.com Q jonathan9langsurvey.com_ O��•' A '•St�B. I hereby certify that I have surveyed the following described ProPertY ^' O� . LOT 2168, SHORT SUBDIVISION (PLAT No. 2004-8) o � 49T.H •— •. Anchorage Recording District, Alaska, and that the improvements situated thereon are . .. . . within the property lines and do not encroach onto the property adjacent thereto, that a no improvements on the property lying adjacent thereto encroach on the surveyed ... KENNET .LA .:. premises and that there are no roadways, transmission lines or other visible easements on said properly except as indicated hereon. Q sr '•.�13��'L� �'� gJOG Dated this the ---- Day of-------------- at Anchorage, Alaska 04 OA ,po ----. -FESSIONAL o It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. �,'RcTERR� ARC TERRA CONSULTING, INC % 20441 Ptarmigan Blvd, Eagle River, AK 99577 Office (907) 696-6111, Fax (907) 868-3793 )osP -ba June 13, 2023 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: COSA Approval and Release -Short Lot 216E On April 7, 2023, a Conditional COSA was issued with 3 conditions to be resolved as follows: 1 The driveway over the field is to be permanently blocked to traffic. 2 Standpipes are to be located and repaired. 3 An as -built survey to be submitted showing the new tank and repaired standpipes. The conditions of approval have all been met and we have attached the new a - built survey from Lan & Associates for your records and review. The driveway is permanently blocked with concrete curb stops anchored with rebar between the house and the nearest septic standpipe and all standpipes have been found and repaired. Please process the final approval of the COSA so the Title Company holding the escrow funds from the sale transaction can move forward with closing this transaction. Respectfully submitted, ArcTerra Consulting, Inc. uffus, P.E. Attachment Lang Asbuilt survey dated 5 / 31 / 23 20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793 �RC'TE RRA ¢ ARC TERRA - CONSULTING, INC 2044,1 Ptarmigan Blvd, Eagle River, AK 99577 Office (907) 696-6111, Fax (907) 868-3793 April 5, 2023 Municipality of Anchorage Development Services Department On --Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Conditional COSA Approval -Short Lot 216B On March 9, 2023, a new septic tank was installed under permit OSP221443, and the property is now in the final phase of purchase. The latest as -built survey does not show all the septic pipes for the existing leachfield. The leachfield did meet the adequacy test criteria for the COSA. There is a concern that part of the leachfield may be under the gravel driveway used to access to the shop building behind the residence. Due to the snow levels, it is not currently feasible to locate the end of the 25 -foot trench in question and extend the pipes above grade. We propose to block the driveway with concrete curb stops anchored with rebar between the house and the nearest septic area until May 30, 2023, by which time we will be able to locate the end of the trench and determine any fCLrther actions needed to protect the trench from traffic crossing it. We do not expect there to be any adverse effects to the existing wells in the area or this septic system operations in the existing location. If you have any questions, please contact me at 696--6111 /FAX 868-3793 Respectfully submitted, ArcTerra Cansulti , Inc. Kenneth . D fus, P.E. Attachment On -Site System As -built 20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793 '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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 018-331-15 '1.. GENERAL INFORMATION 'i COmplete legal desCription HAA# 03 o /I Expiration Date: Lot 2161 Section 33; T12N;'R3W Location (site address or directions) Current Property' ~wner(s) B e th 'Mailing address Lefiding agency 2008 3735 Dora Ave, Anchorage Short Dayphone 360-733-6649 "C' St. Bellinghaa," ..:, WA 98225 Day phone Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. ' NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: ' Individual Well 'Individual Water Storage Community Class . Well Public Water System Day phone TYPE OF wASTEWATER DISPOSAL: Individual On-site ~ Individual Holding tank [] 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 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title'(except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a pdvate or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a pedod 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. '£ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchofage,.AK 99519-6650. www.ci.anchorag'e.ak, us (907) 343-7904 CERTiFiCATE OF HEALTH AUTHORITY APPROVAL P'OR/A ,.%INGEE FAMILY L)WELLING - Parcel I.D. 018-331-15 1. GENERAL INFORMATION Complete legal description L o t Location (site address or directions) Expiration Date: __/_~ - ,,~2_- .(~ 3 216; Section 33; T12N; R3W 3735 Dora Ave. Anchorage___ Current Property owner(s) · Mailing address Lending agency Maiiing address Real Estate Agent Mailing Address Beth Short 2008 'C' St. ___ Day phone _360-733-664_9_ gel 1 i pgha~= ' W.A_._gJ~.~25 Day Phone Day phone Unless othe,,wise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 = TYPE OF WATER SUPPLY: · Individual Well ~: Individual Water Storage [] Community Class __ Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individua~ On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Deparl:ment (DSD) Issues Certificates of Health Authority Approva~ (HAA) based only upon the representations given in paragraph 4 by an independent professionai civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a pdvate or Class C well and may be reissued with new water sample results. (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 ornissions 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 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. NamcofFirm S & 'S F, ngi-neering Address 17034 N. Eagle River Loop Ste. Engineer's Printed Name Robert C. Cowan ~,io,~= 69~-2979 204 ,Eagle River, AK 99577 Date ...... bedrooms, with the folloWing stipulations: DSD SIGNATURE ~ Approved for -~ bedrooms. Disapproved. ' Conditional approval for Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory, X Maintenance Agreements Supplemental. Engineer's Report Other Original Certificate Date: (Rev. 01/02) MUn ality.of An.chorage' ,..., :,...., icip ......... ... . : Development Services Department -r-..-.-.,,. .... . . , ....... ..,:';, ;, .:;~ Building Safety.Divisio0.. ,',,: ..... ~ .. 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'"~' ': :' lota de~th :q '~"a ':}':"'E" ,u~omtion am,~ ~o ~ Uonitorin~ tub~ .~[J Depression Over field ~ O "? ' '. · For '3 .: ,:'.~'? . : . ,,' . '.:.. . ... ~- ~'~ h y.s. ~ive Any rejuvenation tre~tment (past12 mo.) (YIN & type) ~0~ ~,~d ' ~ .' ,'.' .,, ,F.~ :: .~.~,~' -,.~.-. ~-.';,~ .... ' ~ - ' D. LIFT STATION .'-. Datum . ' ...... ycles tested. " . :' .:; MeMs alarm & circ~Jit requirements? ',. · ..=..;. ;. " Public Sewer'main ',X/ / ~1' . Public sevcer manhole/cleanout "'. ~'/"ff' ' ' '. "' SEPARATION ' ~' - K,"' b~ adjacent lots' F. ·COMMENTS ' '1. '"' I cedify that I have det, rmined through field inspections a d #% Y ' ~':.~,'~. '"..'~_. ~ · review of Municipal records that the above syslems are in '~? '.,:~ ""~'~' ~.?~' ~. Date of Payment ~ .~ Date of Payment Receipt Number 0 '~.0 3/--/3" ,/? _.~'""- Receiot Number -~ William D. '~leming, hereby certify that I have performed a ~,~.~1 I, As-Built survey of the structure on this lot and that all the -dimensions and information as shown hereon are true and that :encroachments exist unless shown otherwise.