HomeMy WebLinkAboutSPENDLOVE VIEW HEIGHTS BLK 3 LT 908.1 /
/7
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 �t6,
ON-SITE WASTEWATER INSPECTION REPORT
OSP211176 MAY I � 20
Permit Number: PID Number: 021-021-17
Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: 0 New ❑ Upgrade
Name
Kathryn Rose
ABSORPTION FIELD
❑ Deep Trench 0 Wide Trench ❑ Bed ❑ Mound
Site Address
13381 Spendlove Dr, Anchorage, AK 99516
❑ Other
Phone
907-982-4044
Number of Bedrooms
3
Soil Rating
Total depth from original grade
2.0 GPD/SFJ
5.5 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
3.5 FL
Gravel depth beneath pipe
2.0 Ft.
Subdivision Block Lot
Spendlove View Heights 3 9
Fill added above original grade
0.7
Gravel length
33
Township Range Section
Ft.
Ft.
Gravel width
5.0 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
235.7 Ft2
1
Ft.
Well
>50'
>50'
N/A
N/A
>25
TANK ❑ Septic ❑ S.T.E.P. ❑ Holding Q Other
Manufacturer
Orenco / Advantex
Capacity
1500 Gal.
Surface Water
>50'
>50'
N/A
N/A
Material
Plastic
Number of compartments
2
Lot Line
>5'
>10'
N/A
N/A
NA
Foundation
>1 0'
>10'-
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Remarks
Gal.
Alarm location
Electrical installed by
Installer
PIPE MATERIAL House to tank D3034 Tank to
grainfield D3034
Northern Excavation
Drainfield D3034 CO/MTD3034
Inspector J. Millette
BENCH MARK (Assumed elevation) 100 ft
Inspdection X51 8/16/21 Zed 9/$/21
Location and description
aro 4th
Bottom of siding on garage
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
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Conditional Approval: Date
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Note: this approval does not include well permit requirements.
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SPENDLOVE VIEW HEIGHTS SUB, BLOCK 3 LOT 9
PERMIT # OSP211176
96.1
PID # 021-021-17
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"P""rYo� 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
` tFj http://www.muni.org/onsite
Cin -Site Wastewater Disposal System Permit
Permit Number: OSP211176
Work Type: Septic Upgrade
Effective Date
Expiration Date
Tax Code Number: 02102117000
Site Legal Address: SPENDLOVE VIEW HEIGHTS BLK 3 LT 9 G:2942
Site Mailing Address: 13381 SPENDLOVE DR, Anchorage
Owner: ROSE KATHRYN J 50% &
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Q N MR.
DeI)a rtment
6/2/2021
6/2/2022
Lot Size in Sq Ft: 52561
Total Bedrooms: 3
Q Disposal Field P 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
Received By: Veronica Pope Date: 06/02/21
Issued By: fit/ Date
MUMMPALITY OF
i
Community Development Department
Development Services Division
On -Site Water & Wastewater Program
Phone: 907-343-7904
Fax: 907-343-7997
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel 1. D. 021-021-17
Property owner(s) Kathryn Rose / Allison Little
Mailing address PO Box 2632, Palmer, AK 99645
Day phone 947-1110
Site address 13381 Spendlove Drive
Legal description (Sub'd., Block & Lot) Spendlove View Heights Sub, Block 3 Lot 9
Legal description (Township, Range & Section)
Lot Size 52,561 Sq. Ft. Number of Bedrooms
3
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field ❑x Initial ❑
Single Family (SF) IN
(w/wo ADU)
Septic Tank ❑x Upgrade ❑X
Duplex (D) ElHolding
Tank ❑ Renewal ElMultiple
Dwellings ❑
Privy ❑
(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: t,99 5
Date of Payment: -5 26 Z02 1
Receipt Number: 0100 `% 2-b
Permit No. 03 F �2 l 1 17'
Permit App__- ::' .. c
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
May 25, 2021
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
5/25/21
Subject: Spendlove View Heights, Block 3 Lot 9 – Spendlove Dr
Septic system design
Dear On-Site Services Engineer:
The owner of the above lot would like to build a new 3-bedroom home, so we are submitting this
permit application for the construction of a new septic system. The lot has an existing well that the
owner intends to use but the existing crib and tank have been abandoned. The exact location of the
abandoned septic is unknown. Due to the amount of available space, we are proposing a Category
III system. The attached site plan identifies the location of the home as well as the proposed septic
location and alternate site. No conflicts exist between this proposed system and any other well or
septic system, whether on this lot or adjacent lots.
The ground surface on the lot slopes towards the southwest between 25-35%. The new septic
system will be located towards the west side of the lot on slopes between 20-30%. There are no
slopes greater than 46% within 50 feet downslope of either the primary or alternate site. The
current design meets all steep slope provisions as stated in 15.65.210.B.4 of the MOA Wastewater
Code. Contour lines are shown on the site plan showing the grade and direction of flow.
Stormwater drainage will not impact this septic system. The new trench will be constructed parallel
to the slope as much as possible.
Well radii that conflict with this property are shown. The new system will be greater than 50’ from
all wells and surface water, and more than 5’ away from the septic tank. The alternate site is located
more than 6’ away from the primary site.
Please refer to the attached test hole log and plan and profile pages for the septic design. If this
design is followed, there will be no adverse impacts to adjacent properties. Sincerely,
Benjamin Schiller, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211176, Deb Wockenfuss, 06/02/21
SPENDLOVE VIEW HEIGHTS SUB, BLOCK 3 LOT 9
TYPICAL TRENCH SECTION
(NO SCALE)
NOTES:
1. GRADE AREA OVER TRENCH TO DRAIN AWAY
2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2'
WITH 2" OF INSULATION
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY
Benjamin Schiller
CE 12592R
EGISTEREDPROFE S S I O N ALENGINEER4" PERFORATED PVC
(HOLES DOWN)
DRAINFIELD ROCK
5'
6"
6"
3'
2'
DESIGN FACTORS:SYSTEM REQUIREMENTS:
450 GPD PEAK FLOW
PERK RATE: 53 MIN/IN
APPLICATION RATE: 2.0 GPD/SF
SHALLOW TRENCH SYSTEM
1500-GAL ADVANTEX TANK
BOTTOM OF TRENCH: 5' 6" BELOW GRADE
FLOW LINE ELEVATION: 3' 6" BELOW GRADE
TOP OF TRENCH: 6" ABOVE GRADE
450 GPD / 2.0 GPD/SF /5' WIDE * 0.70 RED FACTOR = 31.3 LF TRENCH REQUIRED (32 LF SPECIFIED)
May 25, 2021
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211176, Deb Wockenfuss, 06/02/21
4661
13030 Sues Way - Anchorage, Alaska 99516
Tel. 907-350-9566 firstwaterAK@gmail.com
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: SPENDLOVE VW. HTS B3, L9
PERFORMED BY: FWCS / FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT
ON THIS DATE. DATE: 5/29/2020
DEPTH
FEET OG
SOILS
1
ORG/OL
2
3
4
GM/ML
5
6
7
8
9
10
11
Moist
12
13
14
15
BOH
16
17
18
19
20
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
5/28/20 30 min 6 9/16
30 min 6 9/16
30 min 6 9/16
PERCOLATION RATE 53 (MIN / INCH)
TEST RUN BEWTWEEN 3 & 4 FT
PERC HOLE DIAMETER 6
PRE-SOAKED PRIOR TO TEST & ALL READINGS TO
THE 1/16TH.
GROUND WATER ENCOUNTERED: NO
IF YES, AT WHAT DEPTH: NA
DEPTH TO WATER AT MONITORING: DRY
DATE: 5/29/2020
TESTHOLE # 20-1 DATE PERFORMED: 5/22/2020
SEE SITE PLAN FOR SLOPE & LOCATION
COMMENTS:
VERIFY GROUNDWATER MT
AT TIME OF CONSTRUCTION
PERFORMED FOR: BRETT OBRAY
5/29/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211176, Deb Wockenfuss, 06/02/21
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this Z Day of Cf of 20L —1., by and between
&7,5c- , herein the "OV4PNER," and the Municipality of
Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code
(AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as Advantex Waste Water Treatment System
located at (legal description)
Spendlove View Heights Sub, Block 3 Lot 9
2. Maintenance, Repairs and Alterations.
(Owner is required to read, understand and initial each section)
AkThroughout the term of this Agreement, the Owner shall enter into a service agreement
with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
It shall be the responsibility of the Owner during the term of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
includes an annual maintenance fee (typically $400 to $600).
Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer`s representative will inspect and make any necessary maintenance,
A repairs or permitted alterations to the system.
/ Owner acknowledges that regular maintenance of an AWujTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfreld
replacement.
Otivner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
ALOwner acknowledges that the fine for failing to maintainand repair an AWWTS may be
assessed in accordance with AMC 14.60.030.
Owner agrees to grant the Municipality reasonable access to test and inspect the
AN WTS. The Municipality will give at least 24-hour notice.
1/
Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS vendor/installer and approved by the Municipality are the governing
guidelines for the construction, maintenance and repair of the Owner's AWWTS.
V/ Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred.
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Lay. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
f P 1, is 11 n 1 -
OWNER:
By:
(signature) Date: 1 Z 2oz i
/�jj l I�jn
(print name)
STATE OF ALASKA )
) ss.
TI -JIRD TUDICIAL DISTRICT )
The foregoing a strument was acknowledged before me this day of
20A,, by
\\`III111III11 f11)Ifff'''
rec L Mc ��9 •,,
NO ARYPUBIk FM
ALASKA r'c,OTAR Y
My Commission expires: U ' 04 2
a
n 1 A " P':
MUNICIPALITY:
By: (signat�_tre)
(prim carne)
UBA-
��•
�.ss/ 9TF OF
O p
res
Date: 4 Z 1
Title:
nr 11 n11, 1n\ r , rn
GP~-c,'rER ANCt-IORAGE AREA BOROI'~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
/
LOCATION
SEPTIC TANK:
°,STANCE E,~O,,,, WELL //0
LIQUID CAPACITY /OLIO
COMPARTMENTS
GALLONS. INSIDE LENGTH INSIDE WIDTH
LIQUID
DEPTH
SEEPAGE SYSTEM: SEEPAGE PlI:
NUMBER OF PITS i OUTSIDE DIAMETER
LINING MATERIAL
NEAREST LOT LINE
OR WIDTH
D~STANCE FROM WELL
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
, LENGTH , DEPTH
BUILDING FOUNDATION ~-~? ,
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
TOTAL LENGTH
FOUNDATION , NEAREST LOT LINE OF LINES
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
WELL: ZYPE ~/~/'/..Z-~ DEPTH ,'~,O~'--'
NEAREST SEPTIC
LOT LINE , SEWER LINE , TANK
DISTANCE FROM .~ 1
· BUILDING FOUNDATION
, SYSIEM
WATER
SAMPLE '~ , NEAREST
.~ OTHER
, CESSPOOL , SOURCES --
DIAGRAM OF SYSTEM
DISTANCES:
:-..~..~ ~?'
DATE
/¥
HEALTH AUTHORITY
GAAB-HD-2
~ROUGH
GREATEI ANCHORAGE AREA
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
Case N o.
APPLICATION TO INSTALL: SEPTIC TANK~,aEEPAGEPIT ~ ,D"AIN FIELD. ~,OTHE"
TO SERVE THE FOLLOWING FACILITY. ~ ~ ' ~'~
~~TEST RESULTS ~A~--', / ANTICIPATED DATE OF d~PLETION BELOW T0 BE FILLED 0~T B~ HEALTH BEPARTME~
AS ,~SCm,E~ BELOW. S~Z~ aCUN~T T0 B~ S~,WD TVP~ .~
_. SEPTIC TANK SIZE ~ TYPE ~~SEEPAGE AREA .4~X 1~ -~ 0 -
BIAB~A~ OF SYSTE~
DISTANCES:
- ' e-'t- Authority-
I certify that I am familiar with tile requh'ements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is itl accordance with said code.
-'c--Z/
September 18~ 1968
Rampart Homes
3222 Com~eroial Drive
Anchorage, Alaska 99500,
SUBJECT: Approval of Sewer-Water
Block ~, Spendiove View Heights Sub.
Gentlemen:
information it can be determined that the system will require
square £eet of seepage area In con~uuction with a 1,000 gallon septic
ta~k.
The seepage area requirement could bast be me~ with a drain tile
field co~sisting of q parallel leach lines each 55 feet lon~ and
placed in-a ~roperly const~u0~ed hsd 8 feet wide--each bed being at
least %§ feet from the ne~t.
Since the ho~e will be served by a deep well you will be required
to rr~et the distance requirements to the se~a~e system as stated in
Borough Ordin~ce No. 28-68. Adequate supplies of ~efe water can be
obtained in this area from deep wells.
Sincerely,
OAVID Ro Lo DUNCAN,
Medical Director
DBH/a~r
David B. He,keens ......... · ......
S~itarien
.MUNICIPALITY F ANCHORAGE
t.�R
Development Services Department 7 Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I. D. 021-021-17
1. GENERAL INFORMATION
Expiration Date: I o JV ! 20? c)
Complete legal description SPENDLOVE VIEW HEIGHTS BLOCK 3, LOT 9
Location (site address) 13381 SPENDLOVE DRIVE, ANCHORAGE, AK 99516
Current property owner(s) BRETT O'BRAY Day phone
Mailing address
Real estate agent
3342 WILEY POST LOOP, ANCHORAGE, AK 99517
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 0
4. TYPE OF WATER SUPPLY:
Private Well
Private Septic
Water Storage
❑
Community Well
❑
Public Water System
❑
Day phone
TYPE OF WASTEWATER DISPOSAL:
Private Septic
❑
Holding Tank
❑
Community
❑
Public Sewer
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 10
Date of Payment 7 ZzLC7
Receipt Number (o O'7 DS y
COSA # 0 SC 261311
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 FIRST WATER CONSULTING Phone 907-350-9566
Address 13030 SUES WAY, ANCHORAGE, AK 99516
Engineer's Printed Name CURTIS HUFFMAN, PE Date 7/3/2020
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. 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 in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject toOF
these various and dynamic characteristics and are outside the control of the evaluator of the : `�,q
well and septic system. Therefore, any estimate of how long a system will function satisfactory ��Q; • • • •zu
.!�
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting & / *: 49
Fwl.S .......
6. DSD SIGNATURE �•
• ' • • Curtis Huffman
System #1 Approved for bedrooms �,�F���;•, CE 128991
l�c�• • ,7/2/20�0•��
System #2 Approved for bedrooms ��1F�PROFESSIoNt'�
Disapproved
Conditional approval for bedrooms, with the following stipulations:
Original Certificate Date: 7- /& r29, c) Z 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
Legal Description: SPENDLOVE VIEW HEIGHTS BLOCK 3 LOT 9 Parcel ID: 021• Zt-17
If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Well production at time of test 1.64 gpm
Date drilled CIRCA 1969
Water storage tank volume NA gallons
Total depth 193 ft
Well disinfected for coliform test? ❑ Yes ® No
Cased to 40'+ ft
® Coliform bacteria is Negative
® Sanitary seal is functioning correctly
Nitrate mg/L ® Nitrate less than MRL (ND)
® Wires are properly protected
Arsenic 83.0 ug/L ❑ Arsenic less than MRL (ND)
Casing height (above ground) 24+ in.
Collected by DAVE HARPER
Date of flow test for COSA 7/2/20
Static water level at beginning of test 14 ft.
Date of Sample
Comments *ALL WELL DATA PER THE ATTACHED
DAVE HARPER REPORT.
B. TANK DATA - NA C. LIFT STATION
Age of tank(s) _ years ❑ Required maintenance completed
Tank type/material Age of lift station years
Measured operating fluid level in septic tank Lift station material
® Standpipes/foundation cleanout per record drawing Comments:
Date of pumping
D. ABSORPTION FIELD DATA - NA
Which system tested (date installed)
❑ ALL standpipes present per record drawing
Total measured depth from grade _ft (max)
Measured depth to pipe invert from grade _ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
Adequacy test date
Results ❑ Pass For bedrooms
Fluid depth prior to test in
Water added gal
New depth _ in
Elapsed time min
❑ Code -required soil cover over field
Final fluid depth in
❑ System presoaked Absorption rate gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months)
date of test) If yes, enter date
Gallons introduced gallons
Comments/Deficiencies: PREVIOUSLY EXISTING SEPTIC SYSTEM DECOMMISSIONED PER CODE.FW�
TESTHOLE CONDUCTED — SEE ATTACHED SOILS / REPORT
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'
® Yes
if No
Community Sewer Manhole/Cleanout > 100'
❑ Yes
if No
NA ft
® Yes
if No
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes
if No
Absorption Field on Lot > 100' ❑ Yes
if No
NA ft
Holding Tank > 100' ® Yes
if No
Neighboring Absorption Fields > 100'
Water Service Line > 10'
® Yes
Animal Containment > 50' ® Yes
if No
® Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ®Yes
if No
ft
® Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required) NA - AT THIS TIME
Building Foundations > 10'
® Yes
if No
ft
Surface Water > 100' ® Yes if No
Property Line > 5'
® Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
® 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 septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required) NA - AT THIS TIME
Building Foundation > 10'
® Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
® Yes
if No
_ ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft
Private Wells > 100' ® Yes if No ft
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
RAW LAND WITH WELL WITH FUTURE ON-SITE WASTEWATER SYSTEM TO BE DETERMINED SEE
ATTACHED LETTER WITH SOILS LOG.
G. ENGINEER'S CERTIFICATIONQn
1 certify that l have determined through field inspections and review ��Q:. • • •����
of Municipal records that the above systems are in conformance �' �j ' •;� ��
with MOA COSA guidelines in effect on this date.
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www.muni.org/onsite
Arsenic Advisory
Certificate of On -Site Systems Approval # OSC201311
Subdivision: Spendlove Heights, Block 3, Lot 9
A water sample revealed an arsenic concentration of 83 micrograms per liter
(ug/L). The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. information on arsenic is available from the On -Site Water and
Wastewater Program website (www.muni.org/onsite) or at 343-7904.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
� � Ma�lirig Address P �O Box 196650 *Anchorage, Alaska 995196650
- - - - - - - - — SPENDLOVE DRIVE - -
, �MLLP,'
0 20' 40'
EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE
RECORDED SUBDIVISION PLAT (68-57) ARE NOT SHOWN HEREON
THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY
AND IS SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT
BOUNDARY SURVEY MAY DISCLOSE.
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I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
LOT 9, BLOCK 3, SPENDLOVE VIEW HEIGHTS
SUBDIVISION
ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT
THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE
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