HomeMy WebLinkAboutCARR LT 3ACarr
Lot 3A
#015-163-78
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: OSP221408
Work Type: Septic Upgrade
Tax Code Number: 01516378000
Site Legal Address: CARR LT 3A G:2640
Site Mailing Address: 11561 HILLSIDE DR, Anchorage
Owner: LYONS BENJAMIN & EVA
Design Engineer: NORTH RIM ENGINEERING
This permit is for the construction of:
Effective Date:
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
cnt
v
Departine nt
11/4/2022
11/4/2023
53005
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
5
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:
• Due to the high possibility that there is a field in the area of the proposed field, prior to construction, check
for any existing field.
n
wed -&y: �[ SSc,te(A fU �nGii'oeer i o Date:
Issued By: Date:
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTICM/ELL PERMIT APPLICATION
Parcel I.D. 01516378000
Property owner(s) LYONS BENJAMIN Day phone 240-2474
Mailina address 11561 HILLSIDE DR
Site address Same
Legal description (Sub'd., Block & Lot) CARRLT 3A
Legal description (Township, Range & Section)
Lot Size 53,005 Sq. Ft. Number of Bedrooms 5
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(® all that apply)
Absorption Field 0 Initial
❑
Single Family (SF) 0
(w/wo ADU)
Septic Tank 0 Upgrade
FX 1
Duplex (D) ❑
Holding Tank ElRenewal
ElMultiple
Dwellings ❑
Privy ❑
(SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
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: �7 Q6—
Waiver Fees:
Date of Payment: t'O ��� �i
Date of Payment:
Receipt Number:(a_)
Receipt Number:
Permit No. 0619 oc91009
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client ForrnsTermit Application.doc
SteveEng.com Carr Lot 3A
SPECIFICATIONS & DESIGN GUIDELINES
Wastewater System Sizing: This is an existing 5-bedroom, single family home. The
septic system is failing. The owner wants to upgrade the system to a Category III
Advantex. A design is submitted for a new trench & new Advantex w/Lift Station. The
neighboring lots are developed as indicated in the drawing; this upgrade will not impact
neighbor lots. Groundwater was recently monitored @ 6 depth. A 4 deep trench will be
excavated. The easements are located on the drawing and are not encroached upon. A
Category III application rate of 3 GPD/FT². Trench Length = 250 FT²/2 x 2 = 63 . No
bedrock was encountered. Old holding tank will be decommissioned per UPC. Advanced
system allows 2 separation to groundwater.
Specification Requirements: All components and work must comply with the
Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water
Regulations and Wastewater Regulations.
Connect New Trench To Advantex/Lift Station, steel, anti-floatation. Watertight
couplings, inlet & outlet. 2500 gallons w/ 2 AX-20 pods.
5 minimum between the tank and trench. 10 to property lines.
3 of cover is required for trench or add insulation board.
Solid pipe must be set on well compacted, stable soil
4 of cover or insulation is required for tank; an equivalent of 1 insulation for 1 foot
soil cover. Tank & solid pipe must be set on well compacted, stable soil.
4 diameter cleanouts with airtight caps are required 1 to 4 from foundation wall,
prior to any 90 degree bend in 4 inch line, in each tank compartment, and two
adjacent opposing cleanouts between the tank and the absorption field, not more than
10 from the tank positioned to provide cleanout access towards the tank and towards
the absorption field.
All cleanouts must extend to at least ground level.
In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron.
Trench to be placed level, minimum of 2 to groundwater, 6 to bedrock.
Drain rock to be ½ inch to 2 inch screened. Drain rock to be distributed uniformly.
Force main to be 1.25 Schedule 40 PVC or equal.
Distribution pipe to be 1.25 Schedule 40 PVC w/ 1/8 orifice @ 24 on-center.
Silt barrier (filter fabric) to be installed above the drain rock
Smeared trench sides must be raked or scarified before drain rock placement
Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789,
ABS ASTM D2661, PVC Schedule 40.
Sewer Service Line is minimum 2% slope
Septic Tank to be pumped every two years or when required
Insulation board shall be extruded direct burial polystyrene (Dow Styrofm HI/equal)
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221408, Deb Wockenfuss, 11/04/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221408, Deb Wockenfuss, 11/04/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221408, Deb Wockenfuss, 11/04/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221408, Deb Wockenfuss, 11/04/22
ANCHORAGE
1
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this. -29r' Day of &+669v' of 20_2- Z , by and between
C' ire L.h, V V's , herein the "OWNER," 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
located at (legal description)
Carr Lot 3A
2. Maintenance, Repairs and Alterations.
(Owner is required to read, understand and initial each section)
Throughout 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 s 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).
L, Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rev. 05/18/2018) Page 1 of 3
$ L Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
L Owner acknowledges that the fine for failing to maintain and 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
AWWTS. The Municipality will give at least 24-hour notice.
9 L, Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
�a L^ 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.
`99L... Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Terms. 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. Nonvvaiver. 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
heOwner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Law. 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. Severahility. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05/18/2018) Page 2 of 3
OWNER:
By: _� (signature) Date: Iv �&2. Z
Sev\ (print name)
STATE OF ALASKA )
) ss.
THIRD JUDICIAL DISTRICT }
The foregoing instrument was acknowledged before me thisaT—day of 0Abail"
NO A Y PUBMIn FOR ALASKA
My Commission expires: 9 3{ ,2Dd-3
MUNICIPALITY:
By: G{/� (signature)
(print name)
NOTARY PUBLIC
REGINALD ALSTON
STATE OF ALASKA
Date: Z zZ
Title:
(rev. 05/18/2018) Page 3 of 3
' Municipality of Anchorage Page of
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: Sl)t•/ Q g 0 y �D PID Number: 0y5 — f4'3 —7&
Name
System: ❑ New Upgrade
&-.&I.,Wastewater
Addre63: 7E
0
ABSORPTION FIELD
C-o 1 0
Phone:
No. of Bedrooms:
O Deep Trench ❑ Shallow Trench O Bed O Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating.
Total Depth from original grade
PD/ Ft.
Lot: Bleck: Subdivision:
Oapth to pipe bottom from original grade:
Gravel depth beneath pipe
3 C
FI
Ft
Township:
Range:
Section:
Fill added above original grade:
Gravel length:
F .
Ft
WELL' ❑New ❑Upgrade
Gravel width:
Number of lines:
DManca Dentin liner
Ft.
Ft
Classification (Private. A,B.C):
Total Depth:
Cased To:
Total absorption area:
Pipe material:
Ft.
FL
FI.
Driller;
Date Drilled:
Sore weer level:
installer.
Dale installed,
— 20 0A
\
Ft.
D IEFA N82—F�
Yield:�i
Pump sel at:
Casmg holghl Above Ground:
TANK
Y GPM
Ft.
FI.
SEPARATION DISTANCES
❑Septid olding OS.T.E.P.
To
Septic
Absorption
Lin
Holing
ubucrPristo
Manufacturer. TAN�
Capacity In Ions:
From From
Tank
Feld
Station
Tank
SawrLlMs
1 .
y
Wall-
130
3p
Material: STI t�
r
Number of Con, Iartments:
Surface
t t o
LIFT STATION
Water
Lot
Size In gallons:
Manufacturer.
Line
3f7
"Pump on" level at:
'Pump " level at:
High water alarm at:
Foundation
O
CurtainPump
NIt7
Make &Model
Elac - al Inspections performed by:
Drain
BENCH MARK
Remarks:
I Q
OIC S a
t/ CL [1YW�C
Location and Description:
Qr Elsr
/�,,
��
Assumed Elevation: / a
-ENGrNEER'S SEAL
c
Inspections performed by. Dates: 1st
2nd
a
Department of Health and Human Services approval+J'
''•:,,, • `'
.,,
-7-
Reviewed and approved by: Date: /2 O
,
72-013 IA" 9191) MOA 25
�I
G
I LOT 2
I �
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I`
) �I LOT 34 � ~
I
I
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I ILOT !A
I
I
�CJAC TANK FILLED WITH CONCRETE
00 GAL HOLDING TANK ....'
V\
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LOT 10 '\ \
I LOT 5 i
:e 49th
VEN SPURKLAND
No. CE -222
I I
III < LOT
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,♦ J
0
50 0 50 100 150 200 250 .700
?. SCALE., 1' = 100 FT.
IUUHLIV WKUKKLANU 1'.L. LOT 3 CARR SID SEPTIC SYSTEM AS BUUILT
103 W 157H. AVENUE DOUGLAS NESS DATE. SEPT.. 1, 2000
(NCH. AK. 99501
(907) 779-3916 11 11561 HILLSIDE DRIVE SHEET. 1/3 GRID. 2640
PERMIT a S V990420 PID N 015-163-78 CAR0003I.DV6
RAIN CAP TYPII
6' PUMP ACCES
r /
r.
1' X 10' CONDUIT
1' GAL VANIZED L B.
4—FT BURY BACKFILL
WITH DIRECT BURIAL VIRE
SAND AND GRAVEL TO ALARM PANEL
90.4 90.2 1' PVC CONDUIT
LiJ HIGH VAT£R ALARM ■
MERCURY SVITCH FL '4T
18'
— 75.5'
II
17'
S TANDARD 4000 GAL, HOL DING TANK
OF
ANCHORAGE TANK
.••PSE .........., b
�0 NO SCALE
49th
SPURKLAND
CE -2225
BCNCH MARK. GARAGE SLAB
ASSUMED ELEV. 100.00 Fl.
11LJBBLN SPUf2KLANU P.E. I I LOT 3 CARR SID I I SEPTIC SYSTEM DESIGN I
6751 W. DIMOND BLVD. DOUGLAS NESS DATE
ANCH. AK. 99502-3904 SEPT. 1, 2000
.m" �eo_gnot 11561 HILLSIDE DRIVE SHEET. 3/3 GRID: 27J6
SY19900420 PID 015-163-78 CAR00033.DVIG
MUNICIPALITY OF ANCHORAGE
Department or Health and Human Services
On -Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Permit Number: SW990420
Legal Description: CARR LT 3A
Date Issued: Nov 24, 1999
Expiration Date: Nov 23, 2000
Parcel ID: 015-163-78
Design Engineer. 0007 Tobben Spurkland, PE Site Address: 011561 HILLSIDE DR
Owner Name: Douglas Ness Lot Size: 53005 SQ. FT.
Owner Address: 1400 W Benson Blvd, #150 Total Bedrooms: 5 Permit Bedrooms: 5
Anchorage . AK 00000 -
This permit is for the construction of:
❑ Disposal Field ❑ Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date: Z -.s
Date: � 2
T.SPURKLAND P.E.
203 W 15th. Avenue, Suite 203
ANCHORAGE, ALASKA 99501
(907)279-3916
Fax (907)-276-6013
SEPTIC SYSTEM DESIGN
LOT 3 CARR SID
DOUGLAS NESS
Municipality of Anchorage
Department of Health and Social Services
825 L Street
Anchorage, Alaska 99501
October 29, 1999
We are submitting an application for the upgrade of the septic system for this lot. The submittal
consists of three (3) drawings showing the present improvements on the lot and the adjoining
properties, (sheet 1/3), the proposed improvements of the lot, of which only the septic system is
subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil
logs and percolation tests of applicable testholes are also enclosed. The septic system design is
based on the following :
Ground Water at 3 feet
Soil Not Suitable for Soil Absorption
USE HOLDING TANK
Number of Bedrooms 5
Minimum size holding tank
2000 + 500( 5-3) = 2000 + 1000 = 3000 gal
USE 4000 GAL Based on pumping capacity of 3500 gal per load
Ground water at 3 feet. Up lift on tank when empty:
4000 x 8.35 = 33,400 Ib
Weight of 4 feet of gravel back fill
125 x 6 x 4 x 17 = 51,000 lb
Safety Factor against Flotation: 51000/33400-1.53 OK
The installation of this holding tank will not prevent development of adjacent lots. .
The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff
will not result from this installation.
a
0
0
H
J
I
I
I I
II I I
II LOT 1
I
� \ \ � �. LOT IA
I LOT 3A
I I �
1 LOT 10 �1� LOTS
1 1 1 1 \ LOT 4 I
I I
OF
I I
.�P(E.......• ��y� \
c. ,. % �♦i
49th -I I
ri iD 3EN SPURKLAND•.�
No. CE -2225 ° : 50 0 50 100 150 200 250 300
%�a` •. _.•`cam
SCALE; 1' = 100 FT,
03IUMILNP1 31-UKALAIVU AVENUE
P.L. I I L 0 T 3 CARR SID I I SEPTIC SYSTEM DESIGN
ANC . K. 9 AVENUE DOUGLAS NESS DATE. • OCT. 30.1999
(NCH. AK. 99501 11561 HILLSIDE DRIVE SHEET. 1/3 GRID: 2640
(907) 179-3916 �
PERMIT # SV990XXX PID # YY CAR00031.DVG
I
I �
—
I A - tix
x
I I k
I I
I I
1 I I 100 FT. MINIMUM
1 I k
II I CLEAN OUT
I I
1 I I 4000 GAL. HOLDING TANK O
o .
----- -- - - -- - - - - --
NPUMP
ABANDON EXISTING SEPTIC TANK IN PLACE
AND CLEAN, FILL WITH LEAN CONCRETE
i-
....i.....49t.....«....«.... ...�
0
i......1» .. ...............«..........
= TDB $N SPURKLAND
i
�1� fes•.,• No. CE -2225 r•.'•��
I
4.�OFESSVN'. ���
SCALE., I' = 50 FT.
[08dLN 5PUHKLAND P.L.SEPTIC SYSTEM DESIGN
203 V/ 15TH. AVENUE LOQ' L��kK SID
ANCH. AK. 99501 DOUGLAS NESS DATE: OCT. 30,1999
(907) 279-3916 11 11561 HILLSIDE DRIVE SHEET. • 2/3 GRID: 2640
PERMIT R SV990XXX PID H YY CAR00031.DVC
4—FT BURY
RAIN CAP T
6' PUMP AC
BACKFILL
WITH
SAND AND GRAVEL
I' X 10' CONDUIT
I' GALVANIZED LB.
DIRECT BURIAL WIRE
TO ALARM PANEL
---F 1' PVCLu CUNDU/
HIGH WATER ALARM /
MERCURY SWITCH FL AT
18'
75.5'
17'
STANDARD 4000 GAL, HOLDING TANK
P��. ..•...,, ♦♦♦♦ ANCHORAGE TANK
ri7,e
♦j NO SCALE
s 49th lr st
It EN $PURKLAND j
No. CE -2225 t �
B£NCH MARK.
ASSUMED ELEV. 100.00 £T.
ITOBBEN SPURKLAND F.E. I I LOT 3 CARR SID I I SEPTIC SYSTEM DESIGN
6751 W.. 9950 BLVD. DOUGLAS NESS DATE: OCT. 30,1999
ANCH. AK. 99502-3904
<gn7> Peo_cnoc 11561 HILLSIDE DRIVE SHEET: 3/3 GRID: 27J6
�SI'/990XXX PID YY CAR000JJ.DV/GI/990XXX PID YY CAR000JJ.DVIG I
PERFORMED
LEGAL DESCR
1
2
N- 3
7-
4
5
6
7
8
9
10
11
12
13
14
15
16
17
16
19
Munl:lEaflly of Anchorage
DEPARTMENT OF -IEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
das�-0- Sold-liez
LL.141 � r�vC
f3 UAA--
FH vi -
Ile -4..'P&4t-cr
i-
r,, ea• •1
'z 6) '.{ENGINEER'S SEAL)':',
• � � :.. �
.............
T.
DATE PERFORMED: ' RIEcI99 '
Township, Range, Section:
IF YES, AT WHAT
OePTH7
Oe;..h to Water Atter
Irvilorinp7
JITt PLAN
mmmmmmmmmm
■■■■■■■■■■
20 -{
IL.— JI PERCOLATION PATE (m,nulevmcn) PERC HOLE DIAMETER
TLST RUN BETWEEN FT AND FT
DISCLAIMER• Groundwater rnnditinne indirated are fnr the datPe shown only.
Past and future presence i.nd/or depth of grolndwater can not be predicted
from these o s,ecv tions.
PERFORMED BY: — �- ___ 1 1 . _ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUI: ELINES IN EFFECT ON THIS DMF. DATE: - to -2-q " Tr
72.008 (Rev. 4/85)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAl. PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
,, I 825 L Street- Anchnrage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE [] NEW
MAILINO~DDRESS
LEGAL DESCRIPTION
I Well I Absorption area D~lling PERMIT
Manufacturer Material No. of compartments
Liq. capacity in gallons IF HOME.DE: Inside length Width Liquid depth
~O ~ DISTANCE TO: Well Dwelling PERMIT NO.
O z ~ Manufacturer Material Liquid ca.city in ~llons
~ Well Poundation Nearest lot hne P~RMIT NO.
~ ~ DISTANCE TO:
O~ ~ Top o~ hie to finish grade ~ ~ ~a~eria} beneath tile . ~ inch~ TotaJ ef~i~ ~/abs°~t~°n area
m Well Building f~ndafion Nearest lot line
~ DISTANCE TO:
~ Building foundation Se~r line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER , ~ ~
PIPE MATERIA~ ~rg~Z
APPHOVED DATE LEGAL
PERMIT NO.
HUN I C: I PAL I T¥ OF I:INCHURI=IGE
-~' DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 'L' STREET, ANCHORAGE, AK. ~501
264-4720
ON--~ I TE ~EI~ER PERM I m
( 800085 )
APPLICANT
LOCATION
LEGAL
DAN P. HUC~RBRY
HILLSIDE DR.
TYPE Of SOIL ABSORPTION SYSTEM
~610 HAZEN,
IS: DRRINFIELD
ANCH.
LOT SIZE
~49-5264
5~560 SQUARE FEET
MAXIMUM NUMBER Of BEDROOMS = 4
SOIL RATING
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
DEPTH=
DEPTH= ::~
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THE TRE~4CH WIDTH I~; 5. ~0~ FEET.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM Of THE EXCAVATION (IN FEET).
REQU I RED :~EPT I ¢ TAt4K S I ZE= '1250 Gi:ILLO~I$
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 NELL WILL SERVE.
------ Tt~lO ( 2 ) I NSPEC:T I O~,lS liRe REQU I RED
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
190 FEET FOR A PRIVATE WELL OR t50 TO 200 FEET FROM R PUBLIC NELL DEPENDING
UPON THE TYPE OF PUBLIC NELL.
MINIMUM DISTANCE FROM R PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO R COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
I CERTIFY THAT
l: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS 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.
~IGNED: ~~ '
ISSUED B~_~___ DR 'E-~/-~t~-~- V4.~
.RE
REID ENVIRONMENTAL ENGINEERING
SRA BOX $584R
ANCHORAGE, ALASKA 99507
SF'ECiFTCATIC. NS?-!b 7- <AE:AY (907) 344.-1205
PACE
1.0 GEN:E~AL
1.1 The drawings, sheets i thru 4 sh,~il be a Pert of this
specification.
1.2 All materials end work~anshi~ shall mee'C the approval
of the AnchoraGe De~t of Health ant Environmental
Protection ~ermi'to
Z.O LiFT STATIO~
2.1 ~11 eIec~rzcal fittings end connections in the lift
station sh~ll mee~ NE~ ~eouirene~ts for a' water
tight se~viceo
2o~ There shall be e hish level alarm set e~ the level
of the existin~ soil Pipe fro~ the septic ta~ko The
buzzer sh~ll be located in a weather tight enclosure
adjacent or inside the e~istin~ electrical entrance
near the
2o3 The sump Pu~,P shall be capable of delivering 1~ GP~
at a hemd of 20 feet.
2,4 The sump P~,P small be s~sPended not less than &
inches off the bottom of the lift station with a
chain or n~lon line.
~.5 The ~4' Pipe for the lift station shall have a
water ti~hb sealed bottom.
2o& The to~ ca~ shall be rain tioht mhd securel~
fasteneO with screws,
~.? All Penetration of the lift station Pipe shmll be
water tishto
3.0 SEEPAGE BED ·
3,1 The ~ravel for the bed shall be screened to the
sizes inoiceted0
3,2 The sand shall have an.e'rfeo%ive size of 0.4 TO
M~, and m uniform, itu coefficient of not more then
3.3 A one foot cle~ seal shell be installed or, the
sloped sides, of the excavation° It shall be well
con, Packed+
3.4 The bottom, of the cxc~vation shell be raked with the
bacEhce blade to ir, sure tha~ the botto~ hms not
conPacted d~in~ the excavetior,, The bottom
elevation shall be + or -
3,5 The 1' distribution Pipes sh~ll be rioid PVC or
Pol~eth~ler, eo Holes, 1/4 ' in diameter end spaced at
~4' cen~ers shell be Orilled ~lor,~ the Pieeso The
hemdor Pipes sh~ll not be drilled,
3,& A heat trace line shall be run alor,~ the side of the
distributzon Pi~e~ next to the drive, ThetaPe shall
be taped to the sides of the PiPe,The tape shell be
Chemelex, 4ATV1, or eeuelo Retino is 4 Wefts Pea
foot at 1leV.
MUNICIPALITY OF ANCIIORAGE
lle~''''''%, and Environmental Prote"'Ron
Fourth Floor West
825 L Street
Anchorage, Alaska 99501
279-2511, x 224, 225
LOCAT,ON LEGAL
SEPTIC TANK:
DISTANCE
FROMWrLL !Oo
INSIDE LENGTH
COMPARTME~S
INSIDE WIDTH ~ LIQUID DEPTH ~ LIQUID CAPAClTY%~OGALLONS.
TILE DRAIN FIELD:-'~'''~tl~-~u'¢-~
DISTANCE FROM WELL ~ ~O FOUNDATION NEAREST LOT ~ OF LINE
~ ~ DISTANCE BETWEEN LIt;ES ~/~ TRENCH WIDTH ~IN. TOTAL EFFECTIVE
ADSORPTION AREA ~0 ~ SQ. FT. LEITH OF EACH Lira/
~t DEPTtl OF FILTER
DEPTIt: TOP Or TILE TO FINISH GRADE MATERIAL BENEATH TILE /0~IN. ABOVE TILE ~ I~.
SEEPAGE PIT:
DIAMETER OR WIDTH
Log Crib Rings/cRIB SIZE: DIAMETER
BUILDING FOUNDATION NEAREST LOT LINE
LENGTH DEPTH
DEPTH__ DISTANCE FROM: WELL
TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA)
SQ. FT.
Well ~-
Class:it~. Depth:
Well Di-~nce To: Lo~ Line
Bldg: 10I~ Sewer Line:
Pipe Materials:CI~L~k~~
~ of Bedrooms:
Installer: ~0~ q
Remarks: ~':'7~1
DATE c;h'-\~-'T"t APPROVED .
Well Log
~,o~o~..~~.. ~..~.~.....~..~,.~...~~. ~.<~.,
'Da~.e completed......~.~..~.~. ;.. ~...~?.z ./...~..ff.~... ................... .................................
~:P~h of we11...,...~.~..~.~ .......... : ........................................................
s~,~ o~ ~ .~...~. ...................................
D~e ~o ,~e~.'~~ ...... ~-~..~ ..........
)~t~ce to water while p~plng...,~....~ ...................... ~t rate
o~ ..... ~.~ ......................... ~uo~ p~ ho~.
I ~rom { tO
Driller
DELTA DRILLING COMPANY
HrFl I [.nN1
I_I:I[:A T ) 13N
H1 .... :,ILL DRIVF
L.--~ _.rtf~K
.... IIL KHTINJ <S~ FT/F;R)= J.,-...,
,'1: RE[~LIIRE[) _I,:'.E I],- TIqlE '_g;llIL ~F;S;3RPTION=,'r=,TErl'-'"- ' IS:
'IHC LENGTH [)IHEN'SI£1N IS; TH~ LENGTH (IN FEET) OF THE TRENCH CiE: DRHIN~-IEI.D.
THF: DEPTH i-~F' ~ IR'ENCH OR PI1 IS THE DISTANCE E:ETNEEN TFliZ SURFACE OF THE
';H;{~'E ~!, NFl SKT WIDIH FFI;¢ IR'.FNCH~{S
lHE G;'F~VEL D~F'TH IS TH;Z IIINIHiIH DEPTH OF GRAVEL BETWEEN THE OUIFAL. I.. PIPE
~ND IHE BOITOH OF 'TH;: E)3CFI'dATICiN (IN FEET).
F' t:; I:: I (: i:i 13 I_-~ F' I_ Fi l'-J 1" I:I F' T
Ft PIRC:I.3--iGE F'LFINI' MFi',' E',E ]II%TFII.LI--_D FIT THE F'ERi'IITIEE'S OPTIClhl Si_.IF;JEC1 TO 1HE
FOLI_[Y,.,I I Ni_-i Ii:I:IN[) I T ] CINS:
t. Ell'tlf{R F~ CI_FI-'5..S I Ol;~ Il NSF I:IPi:'RO',,,'E[') F'I_I-tNT
g CFINTINUFiI.rF_, Ht~INTENi~N;;:E FtGK'EEHEN~ IS; RE~U[RED. IF ~ HFtINTENFtNCE
RGRF[EIIIEI-'I IS hh:iT t-~EF'I' C:IIp~'REi',!I YOU HFt',' BE REiS)IIIRE[:, TO ENLARGE 1HE SOIl_
AF:SI]F<PTION SYSTEI'I FiNF)/13&T YOU I. tFIY lie SI_IB._IEC1 lO PROSECUTION.
IIINIHLI;'I E)ISI'ANCE DETNEEN FI IqELL gNO ~N',' ON-SITE SEHI~GE DISPOSAl_ SYSTEIi IS
I~o FEET FFli~ F* F'RIVFtTE NELl_ OR 2~A FEET FCIR A PI_IE;LIC NELL.
L.J~LI_ LOGS GR~ REQUIRED ~NO HI.IST F;E R'ETLIRNED TO TH~ DEPARTMENT NITHIN 3A DRYS
I]F TIi[{ N;:LL F:gHPI.~ETII-IN
OTHI{N ~'Ei~IIIg'FHENFS ~1~'~' ~PPI_Y. '$F'ECIF]CFITIONS FIND CONSTEJ. JCTION D~FIGE'~M'5 ~R'F
AVF~II HF-N_E TEl INSIIRf: PROPER INSTFfl._I.ATION
i ;ERTIF',' THAT
:]: [ tim FII, 111.IHF, NIlH THE REFJLITRFFlhENTS FFI,~ ON-SITE c.
F-O~?IH B'¢ T[hE I.lilMICIPALITY OF ANT;HDA'AGF
~' I IIFKJFRSTANF) TH$1T TH~ ON-SIIE SFWER SY'STEH HAY RECJI.JIRE ENL~'GEMENT IF T~I,~
RESI[,ENgE IS REIIOOEI.ED TO INCII.D~ I'IOI{:E THI~N 4
MATERIALS TESTING · QUALITY CONTROL
SOILS ENGINEERING
2204 ClevelonCl
P.O. Bo~ 10-1126
Ancho~ege~ Al(. 99511
277-
710 Third Ave
P.O.. Box 2540
Fairbanks. AK. 99707
452-1267 · 456-51=...5
Hole N o.
Location
TRENCH ~1 Sheet 1 of 4 ;
W.O. No. 80-1326
Operator
Date 23 April 1980
see plot plan
.Top Elevation Unknown
Client Mr. Dan Huckaby
Project Residence on Hillside Dr.
Depth Classification Sample Legend
Feet System Data
C,R,~.Y ~TT,TY CLAY Grovel
BROWN GRAVEI.L¥ SAND Sand
lB0 SF per Bedroom
BOTTOM OF TRENCH
Cloy
0rgonic
Content
. .........
22.~ ~j~ James R, Ping,ad ;. ~ Frost
H01e No. TRENCH ~ 2
Location
see plot plan
.Top Elevation Unknown
2204 Cleveland ,~ve.
P.O. Box 10-1126
Anchorage, AK. 99511
277 - 0251
710 Third Ave.
RO. Box 2540
Fo[~bonki, AK 99707
452-1267'456'5155
Sheet 2 of 4
W.O. No. 80-1326
Operator t~_ ~;~,,~ic~
Date 23 April 1980
Client Mr. Dan Huckab¥
Project R~dence ,,n !!i!!side Dr-,
Depth
Feet
I.
2.
..
12.
13.-
14.-
15.
16.
17..
18.
19.
20..
21.
22.
23.
24.
25.
26.
Classification
System
Sample
Data
BROWN PEAT
GRAY SILTY CLAY
BROWN GRAVELLY SA~D
BOTTOM OF TRENCH
NOT ACCEPTABLE FOR SEPTIC
SYSTEM
Legend
Gravel
Sond
Silt
Clay
Organic
Content
Peat
V,'6t e r
MATERIALS TESTING · QUALITY CONTROL
SOILS ENGINEERING
2204 Cleveland ,~ve.
P.O. 8ox 10-1126
Anchorage, AK. 99511
277- Ct'S1
710 Third Ave
P.O Box 2540
Fairbanks, AK 99707
452-1267-456-5155
Hole N o.
Location
Trench ~3 Sheet 3 of 4
~0. No. 80-1326
Operolor R.
Date 23 April 1980
'Rem ~lnf ~lnm
· ,'Fop Elevation Unknown
Client Mr. Dan Huckab¥
Project Residence on Hillside Dr.
Depth Classification Sample Legend
Feet System Dote
2.
5 Black Peat
Grovel
· ?o
Bottom of Trench
Clay
NOT ACCEPTABLE FOR SEPTIC
SYSTEM Organic
Content
,.%
MATERIALS IF_STING · QUALIIY CONTROL
,SOILS ENGINEERING
T-ITT,T.~ TBE DR'TVIFt
T
TRENCH 3
TRENCH 2 /~
CLEAN-OUT FOR SEPTIC TANK
NOT DR, A}~I TO SCALE
SHEET 4 OF 4
Performed For Dan Huckabay
Lenal qescrintion: Lot 3 Block
This form Renorts Soils Lon yes
2204 Cleveland Anchorage, Alaska 99503
Date Performed 6/13/77
Subdivision Carr
Percolation Test
Tenth
Feet Soil Characteristics
4--
6--
10--
12'--
14--.
16--
18
20
Peat (some surface water)
Grey Sandy Silt
Brow~ Sandy Gravel
Bottom o: Test hOle
Was Ground Water Encountered?.No
I¢ Yes, At what Denth?
i-.-J I J i~ t I ~ I
I. Readinq Date Grnss Time Net Time Depth to H20 /let Dron
i
I
I ·
Percolatinn Rate fiinute
Prnrosed Installation: Seenaae Pit Drain Field
Deoth of Inlet Denth To Bottom Of Pit Or Trench
CAU!'ENTS: 125 sq F~'~ldrainaqe area required per bedroom from -5 to 12 feet.
Test PerformedBY~ Data Certified B~CONSTRUCTION TEST
~ - David Paul ~ Date: 6/13/77
MUNICIPALITY OF ANCHORAGE
,1
Development Services Department `r ` ') Phone: 907-343-7904
On -Site Water & Wastewater Section �- Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I. D. 015-163-78
1. GENERAL INFORMATION
Complete legal description
Location (site address)
CARR LT 3A
11561 Hillside Dr
Expiration Date: ��/2.d
Current property owner(s) SECRETARY OF VETERANS AFF Day phone 240-2474
Mailing address
Real estate agent
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF' BEDROOMS: 5
4. TYPE OF WATER SUPPLY:
Private Well 0
Water Storage . ❑
Community Well ❑
Public Water System ❑
Waiver request for:
Received by:
Day phone
578970
`/
�
'�'U V 12 2019 a
0z69L9�h
w
TYPE OF WASTEWATER DISPOSAL:
_ Private Septic
❑
Holding Tank
0
Community
❑
Public Sewer
❑
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $ 5_56 Waiver Fee $
Date of Payment 11 113 IN Date of Payment
Receipt Number 031 dab Receipt Number
COSA # 0 q 15Q3 Waiver #
Distance:
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 NorthRim Eng. Phone 694-7028
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng Date 11/12/19
k'a
6. DSD SIGNATURE n ��
+ C:�
System #1 Approved for .5 bedrooms
W
System #2 Approved for bedrooms `` , steYc:,
S
O
Y pp Gia" PE
v
Disapproved ��� O o
Conditional approval for bedrooms, with the following stipulations''`
.�ttlll(tttttt�,,
WASTEWATER z�
� PROGRAM \fig
)))))111
By:Original Certificate Date:
, 4-4The Municipality of A orage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations gi n 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
Septic System Advisory
Well Flow Advisory
COSA Checklist blue sheet
X Nitrate Advisory, .
Arsenic Advisory '
Other
Legal Description: CARR LT3A
If more than1septic system onlot: 'C0SAChecklist #of
A. WELL QATA
RE Well log is filed with Onsite (or
8112/77OabadhUad
Parcel ID: O15-163-78
Structure served bythis system
Well production at time of test 8+ .pm
Water storage tank volume 0 gallons
Total depth 66 ft Well disinfected for coliform test? E] Yes XNo
Cased to 06 ft XColiform bacteria koNegative
FE -1 Sanitary seal is functioning correctly Nitrate 0-8 mg/L F-1 Nitrate less than MRL (NO)
Wires are properly protected /\raenicug/L XArsenic less than MRL (ND)
Casing height (above ground) 36 in. Collected by NRi[nEnQ
Date nfflow test for CC)G& 1118«9 Date ofSample 1012V
Static water level mtbeginning oftest 12 ft,
Comments Well artesian- K4QA records indicate as artesian. Not artesian -flowing during test.
B. TANK DATA
81 -of years
Tanktype/mohaho| HT/steel "
Measured operating fluid level inseptic tank 52
01Standpipes/foundation cleanout per record drawing
Date of pumping 1117Y19
D. ABSORPTION FIELD DATA
Which system tested (date ___
MALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth topipe invert from grade _ft (min)
El N/A — pressurized field
F-1 Monitor tubes @ntnbottom ofeffective. Ifnot, state
depth into effective
_____
F-1Code-required soil cover over field
MSystem presoaked
(Required ifvacant for greater than 3Udays prior ho
date of
Gallons introduced gaUnno
Comments/Deficiencies:
COSA Checklist yellow sheet
C. LIFT STATION
F1Required maintenance completed
Age oflift station ____years
Lift station mohaha|
Adequacy test date
Results F—lPaaaFor bedrooms
Fluid depth prior to � in
'
Water added,
_gal
New depth in
Elapsed time __rnin
Final fluid depth in
Absorption rate gpd
Any rejuvenationtreatment (past 12months)
If yes, enter date
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
0
Yes
Community Sewer Manhole/Cleanout > 100'
C j,�„ Yes
if No
ft
M 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' 21 Yes
if No
ft
Holding Tank > 100' Yes
if No ft
Neighboring Absorption Fields > 100'
�M
Yes
if No
Animal Containment > 50' Yes
if No ft
Yes
if No
ft
Manure/Animal Excreta. Storage > 100'
Community Sewer Main > 75' [Z] Yes
if No
ft
M Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' FV_1 Yes if No ft Surface Water> 100' ;D Yes if No ft
Property Line > 5'
0
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
7
Yes
if No
ft
Private Wells > 100' F-71 Yes if No ft
Water Main > 10'
❑ Yes
Yes
if No
ft
Community Wells > 200' Q Yes if No ft
Water Service Line > 10'
Yes
if No
ft
if septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' 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'
Water Service Line > 10'
❑ Yes
if No
ft Community Wells > 200'
Surface Water> 100'
❑ Yes
if No
ft
F. ENGINEER'S COMMENTS
Holding Tank Alarm Confirmed By A+. Tank is Holding Tank -Steel.
e7-. E
G. ENGINEER'S CERTIFICATION
1 certify that 1 have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOR COSA guidelines in effect on this date.
COSA Checklist yellow sheet
Yes if No ft
❑ Yes if No ft
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program /
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650 I Q�
www.muni.org/onsite
(907)343.7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. O% ` 7 9 COSA# 0 9 0 Z
1. GENERAL INFORMATION Expiration Date: _� - R — / 0
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
CARR LOT 3A
11561 HILLSIDE DR. 'ANCHORAGE. AK
DOUG
& FLORA
NESS
Day phone C/O AGENT
Community On-site
❑
Public Sewer
11561
HILLSIDE
DR. *ANCHORAGE. AK
Day phone
MICHELLE DROEGE W/ PRUDENTIAL Day phone
230-3372
3801 CENTERPOINT DR. #200 *ANCHORAGE, AK 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 5
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage ❑
Community Class Well ❑
Public Water System ❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
❑
Individual Holding tank
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered In the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems
Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 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. 1 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 Finn GARNESS ENGINEERING GROUP, Ltd. Phone
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines d Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory lest
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the ownerlisted above. Any reliance upon or use of this report by any
other person or party Is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for 1-5— bedrooms.
Disapproved.
Conditional approval for
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Date
bedrooms, with the fllowing stipulations:
f/ Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report'
Other
337-6179
= ••.ON-SITE • :
WATER AND
WASTEWATER :
PROGRAM
By: (lw. / ""6-e� Original Certificate Date:
(Rn. 11105)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343.7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: CARR LOT 3A Parcel ID: O ljf�- / 61':5 - 78
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 8/12/77 Sanitary seal (Y/N) YES
Total depth 66 ft. Cased to 66 ft.
FROM WELL LOG
Date of test 6/12/77
Static water level ARTESIAN ft,
Well production 8 .. -g•p.m.
WATER SAMPLE RESULTS:
Well Log (Y/N) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 12+ in.
AT INSPECTION
4/28/09
ARTESIAN ft,
2.19 g.p.m.
Coliform 0 colonies/100 ml. Nitrateod 3mg./L. Other bacteria 0 colonies/100 mi.
Arsenic:�5_ug./L. Date of sample: 1/29/2010 Collected by: GEG Ltd.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL/HOLDING TANK Date installed 8/20/2000
Tank size 4000 gal. Number of Compartments ? Cleanouts (Y/N) YES
Foundation cleanout (YIN) YES Depression over tank (Y/N) NO High water alarm (Y/N) YES
Date of pumping AS REO'D Pumper ISAACS PUMPING
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./feor ft'/bdrm)_ System type
Length ft. Width ft.
Total depth ft. EH. absorption area_ ft' Monitoring It
Date of adequacy test
Results
Gravel below
over field
For bedrooms
Fluid depth in absorption field before m-! in. Water added _gal. New depth _in.
Elapsed Time: . • Final fluid depth _ in. Absorption rate >= g.p.d.
Iuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date -
"HOUSE HAS BEEN VACANT SINCE APRIL 2007.
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N
'Pump on" level at in. 'Pump off" level High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot N/A On adjacent lots 100'+
Absorption field on lot N/A On adjacent lots 100'+
Public sewer main N/A
Sewer /septic service line 25'+
Animal containment areas 50'+
Public sewer manhole/cleanout N/A
Holding tank 75'+
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 100+ Surface water 100'+
Wells on adjacent lots 75'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Water service line
F. COMMENTS
G. ENGINEER'S CERTIFICATION
Building foundation Water
Surface water
on adjacent lots
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date z / /to
COSA Fee S C
Date of Payment ,1A. >
Receipt Number 0 6 % Y'
(Rev. 1 troy)
Waiver Fee $
storage
Date of Payment
Receipt Number
Municipality of Anchorage _- F
I -tel Development Services Department4 4.
l Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsiteonsite
(907)343-7904
'CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-10-7?) COSA# Qq O217 /
1. GENERAL INFORMATION Expiration Date: f d - / G - �
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
CARR LOT 3A
11561 HILLSIDE DR. *ANCHORAGE. AK
DOUG do FLORA NESS Day phone C/O AGENT
11561 HILLSIDE DR. *ANCHORAGE. AK
Day phone
MICHAEL DROEGE W/ PRUDENTIAL Day phone
230-3372
3801 CENTERPOINT DR. #200 *ANCHORAGE, AK 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 5
3. TYPE OF WATER SUPPLY:
Individual Well
❑
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
❑
Individual Holding tank
0
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered In the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF 114SPECTION 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 riles 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 Finn GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SURE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineers Comments:
in conducting this evaluation, GEG, LID. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily Identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
_1� Approved for bedrooms.
Disapproved.
Phone 337-6179
Date -I 1 0ci
:. ..............
.J fry ess;
CE-79;jJb�
P9.cgo�
Conditional approval for bedrooms, with the flowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
t/
Arsenic Advisory
Maintenance Agreements
Supplemental Engineers Report
Nitrate Advisory I `Other
By: f—
tae.. nmst
a4��tttttllrrr ri
OF4, ,
QP '
S� yo' _
ON-SITE •'•��;
WATER AND
WASTEWATER
PROGRAM '
Original Certificate Date: 7— n - 0 1
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.orglonsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: CARR LOT 3A
Parcel ID: O 1S C 3- 7 S
A. WELL DATA
Well type MATE If A. B, or C provide PWSID# N/A
Well Log (YIN) YES
Date completed 8/12/77 Sanitary seal (Y/N) YES
Wires properly protected (Y/N) YES
Total depth 66 ft. Cased to 66 ft.
Casing height (above ground) 12+ in.
FROM WELL LOG
AT INSPECTION
Date of lest 8/12/77
4/28/09
Static water level ARTESIAN ft,
ARTESIAN _ft.
Well production 89.p.m.
2.19 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate 0.124 mg./L.
Other bacteria 0 colonies/100 ml.
Arsenic: 0 ug./L. Date of sample: 4/27/09 Collected by: GEG Ltd.
B. SEPTIC/HOLDING TANK DATA
Tank TypelMaterial STEEL/HOLDING TANK
Date installed 8/20/2000
Tank size 4000 gal. Number of Compartments 1
Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (YIN) NO
High water alarm (Y/N) YES
Date of pumping Pumper
ISAACS PUMPING
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./ft'or ft'/bdrm)_
System type _
Length ft. Width ft.
Gravel below i r� ft.
Total depth ft. EH. absorption area_ ft' Monitoring
tube' Depression over field
Date of adequacy test Results P all)
For—bedrooms
Fluid depth in absorption field before _ in. Water added gal. New depth _in.
Elapsed Time:Final fluid depth _ in.
Absorption rate >= g.p.d.
uvenation treatment (past 12 mo.) (YIN & type) NONE
KNOWN If yes, give date —
**HOUSE HAS BEEN VACANT SINCE APRIL 2007.
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at in. "Pump oft"
E. SEPARATION DISTANCES
Manhole/Access
water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot N/A
Absorption field on lot N/A
Public sewer main N/A
Sewer /septic service line 25'+
Animal containment areas 50'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank 75'+
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 50+ Absorption field 5'+
Water main N/A Water service line
10'+ Surface water 100'+
Wells on adjacent lots 75'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line Building foundation Water
Water service line Surface water
on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date -7.1106-1
COSA Fee $ ��9D .
Date of Payment o
Receipt Number 16 3 a 93
(Rev. 11/05)
Waiver Fee S
storage
Date of Payment
Receipt Number
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~ PLEASE HAKE ALL CONTAC~HRU REALTOR: ELLIOT LAWSON AT~K I~tITE C~O...~.(2.77-1553)
'~'~ Send all correspond~ to abo've agent also .... MANY ~NKSII!
~S L SWm - A~or~, ~
ENVIRONMENTAL ENGINEERING DIVISION
1. pRO~R~Y~NER I PHONE
Dan ;. & 3amte A. Huckabay I 349-5264
MAILINGADDRESS S~ SOX 257~::; Anchotase, AK 99507
~OPERTY RESIDENT (If dif ferent from ~o~) PHONE
~. &Nts. Hatvtn Sp~uak none a~ this t~e
~ BUYER ~t~t~ [~O ~ PHONE
Mr. & Mrs. Marvin Sprunk %-%~-:
MAILING ADDRESS
S~ Box'~2572~ Anchorage, AK 99507
Alaska National Bank of the North ~%~ ~ 27~4581
MAILING ADDRE~
('~, ~EALTOR/AGENT
,L,NG ADDRESS
3301 C Street, Anchorage, AK 99503
Jack White Co. (ATTN: ELLIOT LAWSON)
PHONE
277-1553
3201 C Street, Anchorage, AK 99503
E. LEGAL DUCAI~TION
Lot 3, Carr Subdivision
STREET LOCATION Hillside Drive (East side of Hillside)...approx. ½ mile south of
Q'~4,11o_v Road. Home is beautiful redwood sided structure aoorox. 200'
e. TYPE OF RESIDENCE NUMBER OF BEDROOMS ~ Hil3
[] One J~ Four~~ [] Other
~ SINGLE FAMILY f--I Two ~-~
I~1 MULTIPLE FAMILY [] Three
7. WATER SUPPLY
INDIVIDUAL*
COMMUNITY
[] PUBLIC UTILITY
8. SEWAGE DIS -Fi~-&L SYS~TEM
INDIVIDUAL/ON-SITE**
PUBLIC UTI LITY
ACH WELL LOG. A well Io~ is requi'red for all wells drilled
since June 1975. For wells drilled prior to that date, g'~ hell ,
depth (attach log if available.) ~ L.~- t~::~'~ '"J~l.~J '~'
'elf i'ndivldual/(~n-site, give installation date ~1~"[---~4 ~ ~ ~"~
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
off
;ide Dx
72.010(3/78)
· .' THIS SIDE-FOR OFF'ICIAL USE ONLY
DATE RECEIVED '.
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
iNSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[--I SINGLE FAMILY [-I ONE I--I THREE I-'1 FIVE [] OTHER
I-'1 MULTIPLE FAMILY [] TWO [] FOUR [] SIX
2. WATER SUPPLY PERMIT NUMBER ~ .
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY '
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE iNSTALLED
[]PUBLIC UTILITY ~--~ -[
Connection Verified
INSTALLER
[]Septic Tank or [] Holding Tank
Size: I ~,:~"O If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
-
Absorption Area to nearest Lot Line
-
[~ONDITIONAL APPROVAL (letter must acp6ml~ny certificate)
LEGAL DESCRIPTION ~. ,
72-010 IRev. 3/78)
-~ ,..,I~IUNICIPALITY OF ANCHOR ..... ~ ~ /o/~L
~//~-~], . DEPARTMEN' iF HEALTH AND ENVIRONMENT,r--! ROTECTION ,.~,:~.~ ·
; C~%,~I ~ Time
Date ~-~Q~ ~D~ Date ~(D-~-qQ Date
Insp [30,/% Insp ~~ Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request: Security National Bank % Chris Anderson
Mailing Address~ 880 H Street, 99501 Phone: 276-6800/18
Property Owner:
Mailing Address:
Robert/Lanore Carr
Phone:
3. Legal Description:
4: Single Family Residence: (~
Multiple Family Residence: (
Lot 3 Carr Subdivision ',
....
Number of ~e~roo~ns:
) Number of Bedrooms:
Well System:
Permit #
Construction
Individual well ( ~ Community/Public System ( )
Depth of Well Well Log on File
Bacterial Analysis
Sewage Disposal System: On-site System ~x) Public Utility ( )
Permit ~ Installed ~ ~ ~ Installer ~uc~ ( ~,
Septic Tank Size .~ ~GC~ Manufacturer ~
Absorption Area
Soils Rate ~ ~ ~-- Material
7. Distances: Well to Septic Tank to Absorption Area
to Sewer Line Nearest Lot line Absorption Arca
to Nearest Lot Line
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO VA ' FHA
2. Property Owner: Robert and Lahore Cart ~.n t:[tle
Mailing Address:
3. Name of Buyer: Dan and Jamf. e Ruckabav
Mailing Address: 411 1~. &Sth ~'~] An~-horn_~e:Alc
99504
4. Name of Lending Institution: ~,~,-,,r.l~-? Nnr'lnnnl R,~nk
Mailing Address: Pm,o~ 7-777 An~.ln~rn?.~: AI~ Phone:
99510
CONV. XXX
5. Name of Realtor or Agent:
Mailing Address:
6. Legal Description:
Location:
Lot 3 Carr S/D
I,]l~t11~tde Drive
Day Phone:
Day Phone:
27&-7282
** (Contact)
7. Type of Facility to be 16~pe~ed: ~/F'
8. WaterSupp .' , :
Type of Supply: Public Utility
o
No. Bdrms. .S
Individual
Phone:
If Individual, number of dwellings presently served One
If Individu~il, depth of well, - '
Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation
Individual (on-site) XXX
Chris, there has to be a $25.00 check enclosed with each request
the fee schedule went into effect May 24, 1977. See attached
fee schedule. This must accompany the request before we can
sta=t processing.
Thank you. Laura, 264-4720
Chris Anderson 9-8-77 ~
72-003(3/76)
Pa~q"'Two
Department of IIealth and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 3 Carr Subdivision
Affadavit Attached: '( ) Letter Attached: ( )
Disapproved: ~__~-~-- %, '~' ~ ..... ,, _' Date:~
~epartment Worksheet:
October 30, 1978
Dan IIuckaby
411 East 45th Avenue 31
Anchorage, Alaska 99503
SubJect~ Overflowing Sewage - Lot 3 Cart Subdivision
This is a follow-up of our phone conversation, Monday, October 30,
1978, at 9:00 a.m. In regard to overfl=~ing sewage on the property
currently owned by you.
On October 17, 1978 at 1:30 p.m., eight(8) ounces of soluble liquid
red dye was dropped into a four(4) inch cleanout of the septic tank
to ascertain entry location of sewage into roadway drainage ditches.
An initial check October 26, 1978, at 3:45 p.m. to the property r
revealed penetration of dye was present around the septic sump.
A further check of soils test previously taken showes two(2) feet
of surface peat. Surface water obviously is being absorbed near
the septic sump. Although, changing water table may be cause of
the in~_--usion.
I may suggest diverting surface water to street culvert and prevent
absorption at sump, or an additional soils test be taken near the
sump to check against the =xisting test to ascertain water table.
However, the tank m~st temporarily be used as a holding tank and
pumped as needed. The septic pipe nust be blanked by a cover at
the outlet side of the tank until intrusion of surface water is s
stopped.
If there are any further questions, please contact this office at
264-4720 or at ~e above address.
Thank you for your cooperation in this matter.
Sincerely,
Hank Allers
Principal ~nvironmental Control Officer
m%/ljw