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HomeMy WebLinkAboutHILLSIDE PARK PUD LT 35Onsite 9% :- - - $`��\� y <\ Domm » » � 2 m . - kRev 05i02ri 8) Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191335 PID Number: 015-122-55 Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑■ Upgrade Name Andrew & Carmen Romerdahl ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 7041 Crooked Tree Dr. Anchorage, AK ❑ Other Phone Numbe r of Bedrooms Soil Rating Total depth from original grade 907-441-6134 4 EXISTING GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Hillside Park PUD 35 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well N/A N/A N/A N/A >25' TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Greer 1250 Gal. Surface Water >1 N/A N/A N/A Material Number of compartments Lot Line >5' N/A N/A N/A NA Plastic 2 Foundation >1 0' >10' N/A N/A LIFT STATION Manufacturer Capacity 1 RemarksGal. Tank only permit. Alarm location Electrical installed by PIPE MATERIAL House to tank D3034 Tank to drainfield D3034 Installer Wilco Contractors Drainfield D3034 CO/MTD3034 Inspector J. Mlllette BENCH MARK (Assumed elevation) 100 ft Inspection 15` 2/27/20 Location and description r ntl Threshold of back door. 3 4,h ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp OF..... Conditional Approval: Date ®® ®.` ..• o 5 49th 0......., ............ .... ..I.....0 ®................................................0 ;•MICHAEL E. ANDERSON AF Septic System® Approved Date lfol,?0�20 ♦ % No. CE-4381 ,� ��� ®A®�F�;'••3/3/20 ,••••''F�� .•,.,• Note: this approval does not include well permit requirements. ®� pROs+• ®i O., FESS��NP kRev 05i02ri 8) HILLSIDE PARK PUD, LOT 35 PERMIT # OSP191335 LOT 34 P I D # 015-122-55 EXISTING ABSORPTION TRENCH TO REMAIN IN SERVICE. LOT 35 \ PORTION OF LANDSCAPE \ \ RETAINING WALL REMOVED FOR \ INSTALLATION OF NEW TANK. NEW 1,250 GALL SEPTIC \ PATIO TANK w/20" MAN AY \ 2Co \ svl •MT1 \ \ MH1\-�Co \ \ © \ LOT 36 \ 4-BDRM HOME \ O \'40 NOTE: Q WATER SERVICE LINE IS MORE THAN 10' FROM/CONC & WOOD RET. WALLS ALL COMPONENTS OF THE SEPTIC SYSTEM. ENGINEERING GE PLAN AS -BUILT 0 50 100 FEET 1 "=50' A B -28. MH1 30.1 17.3 SV1 33.24 21.0 2CO 35.5 23.2 MT1 31.4 21.6 INKVy\ls'l CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE HILLSIDE PARK PUD, LOT 35 PERMIT # OSP191335 PID # 015-122-55 PROFILE AS -BUILT (NO SCALE) ��� AS -BUILT SURVEY 1" =20' NOTE: NO EASEMENTS APPEAR ON THIS LOT ON THE RECORD PLAT. THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINE5. EASEMENTS OF RECORD, OTHER THAN TH05E APPEARING ON THE RECORD PLAT, ARE NOT SHOWN HEREON ( UNLE55 INDICATED) NOTE: FENCELINE5 THAT MAY APPEAR ON THI5 DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCE55IVE SNOW AND/OR ICE. NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 35, HILLSIDE PARK P.U.D. SUB.( PLAT 79-263) ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS _4 TH DAY OF _MARCH , 2020 13555, FB 182-25, 203-19 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 345-5513 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box ' 96650 4700 Elmore Roar Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax (907) 343-7997 http://Www.muni.arg/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP191335 Work Type: SepticTank Upgrade Tax Code Number: 01512255000 Site Legal Address: HILLSIDE PARK PUD LT 35 G.2539 Site Mailing Address: 7041 CROOKED TREE DR, Anchorage Owner: ROMERDAHL ANDREW J & CARMEN M Design Engineer: FORGE ENGINEERING This permit is for the construction of: ❑ Disposal f=ield Cif Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date: � n 1 epartrilent Lot Size in Sq Ft: Total Bedrooms: 8/8/2019 8/7/2020 31344 ❑ 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 Received By: e Date: Issued By: Date. f 4 Ep Ims MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-122-55 Property owner(s) Andrew and Carmen Romerdahl Day phone 907-441-6134 Mailing address 2343 N. 6.1 st Street Seattle, WA 98103 Site address 7041 Crooked Tree Drive Anchorage, AK Legal description (Sub'd., Block & Lot) Hillside Park PUD, Lot 35 Legal description (Township, Range & Section) Lot Size 31,344 Sq. Ft. Number of Bedrooms Four (4) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 Septic Tank Q Upgrade pg � (w/wo ADU) Holding Tank ❑ Renewal ❑ Duplex (D) El Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 1P Date of Payment: d2I Receipt Number: _ 622353 D Permit No. 6 S p l9/J3 cJ Permit App_.:-:• Waiver Fees: Date of Payment: Receipt Number: _ Waiver No. PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) August 1, 2019 MOA Development Services Department On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Hillside Park PUD, Lot 35 – 7041 Crooked Tree Drive Septic System Design Dear On-Site Services Engineer: The existing septic tank on the subject lot has outlived its useful life and must be replaced prior to the issuance of a COSA. We are submitting this permit application for the replacement of the septic tank. The attached site plan identifies the location of the home and the existing and proposed septic tank site. No conflicts exist between this proposed system and any other well or septic system on adjacent lots. The subdivision is served by a community water system. The new septic tank will be a minimum of 200’ from the well serving the subdivision and 100’ from surface water. The tank will be 10’ from the house foundation and 5’ from deck and stair supports. Please refer to the attached plan sheet for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Michael E. Anderson, P.E. 8-1-19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191335, Rebecca Carroll, 08/08/19 FCO 10050 0 FEET 1"=50' 4-BDRM HOME NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM NO EXISTING WELLS - PROPERTIES ARE ON A COMMUNITY WATER SYSTEM. NO EASEMENTS APPEAR ON THIS LOT ON THE RECORD PLAT. CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND HILLSIDE PARK PUD, LOT 35 SLOPES > 25% SLOPES > 46%CROOKED TREE D R I V E 8/1/19 SHED PATIO CONC & WOOD RET. WALLS DECOMMISSION EXISTING SEPTIC TANK PER M.O.A. CODE. EXISTING ABSORPTION TRENCH TO REMAIN IN SERVICE. PLACE NEW 1,250 GALLON SEPTIC TANK w/20" MANWAY A MINIMUM OF 10' FROM BUILDING FOUNDATION AND 5' FROM DECK/STAIR SUPPORTS. PLACE NEW FOUNDATION CLEAN OUT. CO MH 2CO SV NOTE: WATER SERVICE LINE IS MORE THAN 10' FROM ALL COMPONENTS OF THE SEPTIC SYSTEM. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191335, Rebecca Carroll, 08/08/19 {~ MUNICIPALITY OF ANCHORAGE , DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION.REPORT NAME IP.,HONE I~NEW LOCATION ~ ~ NO, OF BEDROOMS Well ~g Absor~o~area k ~ Manufacturer ~ k Liq. capacity in Inside length Width Liquid depth /~,~ IF HOMEMADE: ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. ~Z O ~ ~ Manufacturer Material Liquid capacity in gallons Wellp Foundat,o~ ~ DISTANCE TO: ~: ¢ ~'' ~ w~ Distance b~/~ lines ~ [ No. of lines / Lengt c~ li¢,e Total length of~ines Trench ~// inches ' ~ ~ Top of tile to finish grad~ --1 Material beneath tile~ 0 inches Total~6sorption area Length Width Depth PERMIT NO. ~ Type of crib Crib diameter Crib depth Total effective absorption area m -- Well Building foundation Nearest lot line ~ DISTANCE TO: M Class Depth Driller Distance to lot line PERMIT NO. m Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS SOIL TEST RATINGM REMARKS '~NICIPALITY OF ANCHORAGE ~l Department °x Health and Environmental ~rotection 825 L Street, Anchorage, AK. 99501 264-4720 * * * HANDWRITTEN PERMIT * * * ~ ON-SITE SEWER PERMIT Applicant: Location: Legal Description Mailing Address: Phone NUmber: Type of Soil Absorption System Is: Lot Size: Trench: ,/_ Drainfield: Seepage Bed, Holding Tank,~//~ Maximum Number of Bedrooms: . H Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is: DEPTH I%.~-/~.LENGTH , .. GRAVEL DEPTH ~-' zon is The length dimens' the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(~Q]_D]~n) TANK SIZE = /~5~3) GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjaCent to this property and the number of residences that the well will serve. *** * * * TWO(2) INSPECTIONS ARE REQUIRED Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days Of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * *'* PERMIT EXPIRES DECEMBER ~1~ 1 9 8 1 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in aCcordance with codes. (3) I understand that the on-site sewer system may require enlargement if the res~nce is remodeled to include more that 3 bedrooms. Signe~: _ Issued by: Applicant Date: SWP/024(1/81) )< TYF'E OF SOIL [IE,_-,UF. FTI_N SYSTEM I--.. TREN_.H I "' -'-'..'- ':' = 4 _.JIL F..MTIN.~ ,:'Sf! FT,'BR..- MFfXIM_M N_MBEF. OF E,E[.,F.'.UOM_, ~]- "' ~ ...... '- THE REQUIRE[:, SIZE OF' THE ch'lIL HBz, OF..PTI .N SYSTEM I:,. [)EPFtR"F'MEN'[ [' HEALTH FIN[:, ENVIRONMENTAL ~ ::F['ECTION :.:.:25 "L'" STREET., FINIS'H!_?.AGE., AH::. 99.:,0i - '' r .... BOX 2tB7 I-3NCHORFtGE ~o-~.~*~] 27'4-1754 I-IFFLI ._.HN I M,."'C BUILDERS L 0 ¢: Fi T I 0 N LEGF~L LOT '~'= ~ '-" - .......... _.._, HILL_IDE PARK =,,.'D L. OT SIZE 4'~:F~F~O q':., FIRE FEET 1 -5 J . THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF '[HE TRENCH OR DRBINF'IEL. D. THE [:,EPTH OF FI TRENCH OR PIT IS THE DISTANCE 8ETI,.IEEN THE SURFACE OF THE GROUN[:, AND ]"HE BOTTOM OF THE E'.~.",CAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRFtVEL DEPTH IS THE MINIMUM [:,EPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AN[:, THE BOTTOM OF THE EXCAVATION (IN FEET). I HI=, DEPFIRTMENT [:,IJRING THE REzFLN_IBILI]~ TO INFORM ' "- F'ERMIT RF'F'LICFINT HAS THE ' '-"- '=* "" - ' ,: ...... '="'-" ~: [HI-, rr~.r=~.~ RN[:' THE ~N_,]HLL~T~ON IN:FEbT~BN-, OF ANY WELLS ADJACENT 'FB" "= ~'~" ......'~" , -~ .,-.i~ ~,~ ,~. ,~,,~ * NUMBER OF RE_,~[.EN_.E_, THAT THE WELL W~LL _ER,E. 1- ~--~ g--~ ":' "-:" ~ '- ' .... . .=. .... ][ ~-~:.PE~.] I - '-' FIRE ,*- ,,- ' "' "'-' 'C, BY EFIZ:KFILLIN3 OF FINY =¥=,TE.M WITHOLIT FINAL INSPECTION AND HFFR.,AL THIS DEP~R. TMENT WILL _,E '~IIB.TERT TO F~U:,EbLTILN. MINIMUM DISTANCE BETWEEN A WELL. AND ANY ON-SITE SEWAGE DISPOS~]L SYSTEM IS 100 FEE]" FOR A PRIVF~TE WELL OR 150 TO 200 FEET FROM A PUBLIC I.,.IELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET RN[:, TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY FIPPLY. SPECIFICATIONS AND CONSTR. UCTION D!RGRAMS ARE AYFIILFIBLE TO INSURE PROF'ER INSTALLATION. I CERTIFY THAT i: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. '.2.:': I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]:: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS, S I GNED: BPF'LICANT M,,'C E, JIL[.,EI~_, V4, 0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-222~ SOILS LOG - PERCOLATION TEST SOILS LOG [] PERCOLATION TEST -- ,¢~,,~,~,~ ,,,,¢~/~_~ SLOPE 4 7 8 9- SITE PLAN 10- 11 12 --~-13 14 15 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net , ..Qeazh to Net Reading Date Time Time ~.'~ ~a~, Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN ,. FTAND , FT COMMENTS ~'~. ~" -.-~,~'~ ¢~,~ .,,,~._~t'~,C~j~c~f,,,""¢~,~ ~J~___.~ ~ ~~ ~~~~ Art MUNICIPALITY OF ANCHORAGE Ar Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 015-122-55 Certificate of On -Site Systems Approval Expiration Date: 2 -2-1-20 Z-1 1. GENERAL INFORMATION Complete legal description Hillside Park PUD, Lot 35 Location (site address) 7041 Crooked Tree Drive Current property owner(s) Andrew & Carmen Romerdahl Day phone 907-441-6134 Mailing address 2343 N 61st Street, Seattle, WA 98103 Real estate agent Stuart Greene Day phone 907-782-7276 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well 0 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 $ SSO Date of Payment &/,? /a0a6 Receipt Number 0,? Q oOD COSA# 08Cololo'�3 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone 907-522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage AK 99503 Engineer's Printed Name Michael E. Anderson, P.E. Date 3/9/2020 oaos ocSszo>3®oa OF P 49th ••• •'000 6. DSD SIGNATURE o' j c'� 'S �, ................................................ System #1 Approved for bedrooms off, : MICHAEL E. ANDERSON J' NoCE-4381 �,�'� System #2 Approved for bedrooms ©p �F'••..• . •' 3/9/2020 ..••� Disapproved ®© ©orlQ0 FESS\ om®©® Conditional approval for bedrooms, with the following sg�J�tu(il5l/(/ r(r_ /r M a�� QN-SITE V-,% WATER AND Original Certificate Date: OZ —to — 2.0 2-0 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: Hillside park PUD Lot 35 If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments COMMUNITY WELL B. TANK DATA Age of tank(s) `1 years Tank type/material Septic/Plastic Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping New Construction - 2/27/20 D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) 6/25/81 ❑ ALL standpipes present per record drawing Total measured depth from grade 13.4 ft (max) Measured depth to pipe invert from grade 8.4 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective OR Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 2000 gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 015-122-55 of Structure served by this system Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station N/A years Lift station material N/A Comments: Adequacy test date 5/23/19 Results E✓ Pass For 4 bedrooms Fluid depth prior to test 20 in Water added 1120 gal New depth Z1 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate 600+ gpd Any rejuvenation treatment (past 12 months) No 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' El Yes Community Sewer Manhole/Cleanout > 100' r7,/ Yes if No ft 2] Yes if No Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' EZI Yes if No Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' Q Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' Yes if No M Yes if No ft if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' M Yes if No ft 0 Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Fv� Yes if No ft Surface Water > 100' ft ft ft ft ft P Yes if No ft Property Line > 5' El Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Q Yes if No ft Private Wells > 100' 0 Yes if No. Water Main > 10' Q Yes if No ft Community Wells > 200' 0 Yes if No. Water Service Line > 10' 7 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' El Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓� Yes if No ft Private Wells > 100' R✓ Yes if No Water Service Line > 10' FV-] Yes if No ft Community Wells > 200' 0 Yes if No Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION OF I certify that I have determined through field inspections and review ���p;.•°`°"••• ''•..5��� of Municipal records that the above systems are in conformance with y MOA COSA guidelines in effect on this date.' 49th sA..... uutntucuttutpt. u+....... ftuuaae'.. *-.MICHAEL E. ANDERSON ��� �T�� •••° No. 3/10/20 $:•°` �: � COSA Checklist yellow sheet 'OROFESS\C���40' still,,%�®��� ft ft ft ft • • Municipality of Anchorage1,11MTrf G On-Site Water and Wastewater Program (907) 343-7904 5* r T Y CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-122-55 Expiration Date: / 2 - 1 2 1 7 1. GENERAL INFORMATION Complete legal description HILLSIDE PARK PUD LOT 35 Location (site address) 7041 CROOKED TREE DRIVE,ANCHORAGE,AK 99507 Current Property owner(s) ANDREW& CARMEN ROMERDAHL Day phone Mailing address 7041 CROOKED TREE DRIVE, ANCHORAGE,AK 99507 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) El Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ❑ Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class A Well ® Public Sewer ❑ Public Water System ❑ WaiverNariance request for: Distance: Received by: Date: 5=3 )- /7 COSA to be rele ed to engineer,unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment ',I So I l l Date of Payment Receipt Number b"ldkso`{O Receipt Number COSA# 05C-11 12.O 1 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING,INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD.,EAGLE RIVER,AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 4/28/2017 THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen }�� encroachments,deficiencies or discrepancies exist. - O Az f *'4 9 TI I* 6. DSD SIGNATURE • System #1 Approved for bedrooms. �� F KENNETH N, s System #2 Approved for bedrooms. + ,r��9, ,y7 �lA , Disapproved. b •aFs,to., Conditional approval for bedrooms, with the following stipulations: 14 4:1491 A—CAWL (\,, 3 Co yea v- 1 verA gut _.(21=Gel 3q3 - 9' y 6-Nt F Attic, JZ ON-SITE G, WATER AND rn F / WASTEWATER l-' Original Certificate:j�atd:'R4 s�The Municipality of Anchorage Development ServicesDivision (DSD) issues Certificates of On-Site S sempqrY,ab(CPSA)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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-1D-12.dcc 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: HILLSIDE PARK PUD LOT 35 Parcel ID: 015-122-55 A. WELL DATA Well type A If A, B, or C provide PWSID# 210605 Well Log (Y/N) Date completed Sanitary seal (Y/N) Y Wires properly protected (YIN) Total depth ft. Cased to ft. Casing height (above ground) _ in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic: ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 6/1981 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (YIN) N Date of pumping 12/12/2016 Pumper NORTHLAND C. ABSORPTION FIELD DATA Date installed 6/1981 Soil rating (g.p.d./ft2 or ft2/bdrm) 125 System type DEEP TRENCH Length 51 ft. Width 3 ft. Gravel below pipe 5 ft. Total depth 12 ft. (Measured 4/28/17) Eff. absorption area 500 ft2 Monitoring tube Y Depression over field N Date of adequacy test 4128117 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 620 gal. New depth 22 in. Elapsed Time: 10 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N __ If yes, give date D. LIFT STATION Date installed _ Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 200'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 200'+ 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 COSA guidelines in effect on this date. Nk. Engineer's Printed Name KENNETH M.DUFFUS ( Date 4128/17 / * 9 Ti I /\ � -p, KEYNi COSA canary sheet_2-6-15.doc 1 �',. rr„ • iHt • . J; rw // • S,F'i •`0 SINGLE FAMILY • FRAME HOUSE ss- • f� 0 4',•• • S , • DECK • 0:0- ads • • • °� OF '�C°% ooION • _ti�a ��Q p * 49 TH 0 0g 0(2 fi Up,s ti SHANE A. HOLT��4 LS-6914 s 0 Qrofessional • O�j SURVEY ORDERED BY �� AS-BUILT SURVEY * 2E- LAURA HALVERSON NOTE: RENA%PROPERTIES NO CORNERS SET THIS DATE NO EASEMENTS APPEAR ON THIS LOT ON THE RECORD PLAT. I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 35, HILLSIDE PARK P.U.D. SUB. ( PLAT 79-263) ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY EXIST OTHER THAN NOTED. CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS,AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES,IMPROVEMENTS.OR FENCELINES. DATED AT ANCHORAGE,ALASKA THIS _29TH DAY OF EASEMENTS OF RECORD,OTHER THAN THOSE APPEARING ON THE RECORD PLAT,ARE NOT SHOWN APRIL , 2017. HEREON(UNLESS INDICATED) NOTE: FENCELINE5 THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. HOLT LAND SURVEYING ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. 9309 GROVER DRIVE ANCHORAGE,AK 99507 13555, FB 182-25 345-5513 (c) /~MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PRO*i =CTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date , INFORMATION Lejal/~escription (i~t, blo,.c.J~division, section, township, range) Location (address or directions) ' Applicant Nam~---'~-~-x/~ -.~/'~/PA../4.~z~Telephone: Home ~"~ ~-/'~' '-/~'~-~ Business Applicant Address _~.¢z',~¢'.~..~- ~ Applicant is (check one): Lending Institution []; Owner/builder ~['i Buyer []; Other [] (explain); / g Institution Address Telephone (e) Real Estate Company and Agent Address (f) Telephone Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family/~ Multi-Family [] Other Number of Bedrooms ~ WATER SUPPLY Individual Well [] Community,:]/ Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status, 4. SEWAGE DISPOSAL Onsite~]~ Public I-1 Community [] Holding Tank [] Note:/If corn munity well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. 72-025 (11/84) Page I of 2 ENGINEERING FIRM PROVIDIN ,dSPECTIONS, TESTS, FILE SEARCH, DA AND INFORMATION AS certified by my seal affixed hereto and as of the validation date shown below, I verify that my mveshgabon of this Authority Approval shows that the on-site water suppty and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of th~ion. Name of Firm ~' ~'-'~--~-'~- ~/~,,~.S ~ ./'---'~'~>~-/-'-& Telephone ,Z~-~ f~',~ -~'~,..~/ Date .//- -~ Engineer's Seal Approved for ~~beOrooms ~' ate Approved Disapproved Conditi~al ~ Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) Welt Classification ~../~,.;¢'//~---6 '~'¢/ ''~ / If A, B, C, D.E~C..ApproveCN) Well Log Present (.'¢~ Date Com/pleted ~ Total Depth' ~ Cased to ~ Depth of Grouting / Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by MUNICIPALITY OF ANCHORAGE (MOA/ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 NOV 0 5 ~ 264-4720 Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date MJ~IICIPAUTY OF AI~I~OI~GE DEPT. OF HEAltH & F~IVII~NNI~NTAL PROTEC'flClN Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA / Date Installed ~?/~?.? Standpipe~l) ×' Depression over Tank Pumping/Maintenance Contract on File (Y/N) ., / / Holding Tank High-Water Alarm (Y/N) / Separation Distances from Septic/Holding Tank: To Water-Supply Well~//~-'rr ~*/- To Property Line ./"~ /'-~--- To Water Main/Service Line /Grr-~// Course Comments ~<-; *'~-/~ /.;'////'~'''~/' 7''¢~ Size /',.~o'~ No. of Compartments ~:'--~, Air-tight Cap~) Foundation Cleanout~) .d.-~- Date Last Pumped ;,or Temporary Holding Tank Permit (Y/N) ~ __ TO Building Foundation To Disposal Field /,7 To Stream, Pond, Lake, or Major Drainage Page 1 of 2 ABSORPTION FIELD DATA ' L-~f ~ ~.~,.-*~.~/,Type of System Desig Soils Rating in Absorption Strata ,.J.-~- --~-'~'~,/-zz: Dail~ !?$~,alled i',~-~//~.,.z-~_,~/~--~/ .Y Length of Field ,~ ~'~'~,.-" / Width of Field ~; // / // Square Feet of Absorption Area Depression over Field (Y~. Results of Last Adequacy Test Depth of Field //-~ Gravel Bed Thickness / Standpipes Present~l) Date of Last Adequacy Test Separation Distance from ~.~rption Field: TO Water'Supply Well ~ ~/~.,/~.~- .,~,/J~x~='~/~/~ To Property Line //~_j To Building Foundatio/~~_ ..~'d-P / ./ To Existing or Abandoned System on Lot .-'d,/~ ~"~ ; On Adjoining Lots /'~,~'~ //'-/--- To Water Main/Service Line '~ ?'-7/---~ To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course /'~/~ To Driveway, Parking Area, or Vehicle Storage Area ~ Comments ~ /~"~ //Uc-~f)~-'~W,~ / D. LIFT STATION Date Installed Size in Gallons "Pump On" Levet at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that~have checked, verified, or conformed to al! MOA and HAA guidelines in effect on the date of this inspection. Signed ~LIJ~/~ ,~". Date Company.~'~--~,~ --~,,'.~ ~ /-~,-~/-~ MOA No. Receipt No. c-~ ~(~ ~""'/~, Date of Payment I t -~ Amount: $ L.~'.~'~ ~ Page 2 of 2 72-026 (11/84) DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 DATE: PWS I.D.# To Whom it May Concern: According to records on file in this office the Water Regulations Water System is in compliance with the State Drinking Sincerely, MUNICIPALITY OF ANCHORAG2 DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION NOV 0 5 ~ RECEIVED Time ~ ~Time Date Date Date Inspector Inspector Inspect°~_~,. Comments Conditional Approval Date Sewer Installed Permit No. Septic Tank Size ¢~, j .~,.~t ~.~',~ ~-- Holding Tank Size Soils Rating Well ~o Absorption Area Well Log Received I~-- Well to Tank ~~ APPLICANT FILLS OUT LOWER HALF ONLY Property Owner ~-~ [ ~_ ¥~ ~ ~ [~ ~ ~.L~ ~ [~ ' Phone Mailing Address ~0~ ~,~ [[~ ~~ Buyer % ~/~ ~X/~ ~ Address Realty Co. & Agent Phone Address Street Location {j. ~' [ ~ '~':) '~" :~ ~ ~ Typ~ ofcResidence ~Single Family ~ Multiplo Family ~o. o~ ~odrooms ~ Othor Wator Supply D Individual A~ACH WELL LOG. A well Icg is required for all wells drilled since June ~ Community 1975. For wells drilled prior to that date, give well depth (attach log if ~ Public Utilit~ available.) Sewage Disposal ~ Individual Year Individual Installed: ~ Ci ~ ~ ~ Public Utility When Connected to Public Utility:_ ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.