HomeMy WebLinkAboutLAKE HILL ACRES LT 10Loke Hill Ac
Lot 10
#051-052-41
Municipality of Anchorage
Development Services Department
Building Safety Division.-2;~:'-'"
On-Site Water & Wastewater Program, 4700 South Bragaw SL
P.O. BUx lg6650 Anchorage, AK 99519-6650~.. ~"
www.ci.anchomge.ak.us (go7) 343-7g04 Po;e I of
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Numbe~ SW0102§,~ PID Number:. 051--052--41
eROOK ST~LTNER Wastewater System: [] New · Upgrade
N°me:RUTH OGONOWSKI c/o w// RFMAX OF-
Addre#:
~66oo CE~RnrLD ~R. · EAGLE ~R. ~ e~?7 ABSORPTION FIELD
Phone: No. of Bedrooms:
6~4---4200 3 rlD#p Trench l$hollow Tm~ch 13Bed t3Uound rtOther
LEGAL DESGRIPTION '" '~' "~ ~" "' ~
0.6 ~o/s~ ~
10 LAKE HILL ACRES 2.~ - 3.0 rL 1.0+
- - - 0.5 - 1.5 rL 100' (2
WELL: [] New ri Upgrade .5 rt 2
.~. ~ rt .575 s~ rt D-3034/ F-810
r~ CALKINS CONSTRUCTION 7/27-31/2001
SEPARATION DISTANCES -~pu= =~ol~n~ =S.T.~e.
StuUon Tank GREER 1000
W~, 100°+ ~ 00°+- - 25'+ STEEL 2
s.,o:. ~o~.~ ~oo'+ ~oo'+ - - - LIFT STATION
~emorks: THE ~ SEPT1C TANK WAS ABANDONED BENCH MARK
PER U.P.C. BoTroM OF SIDING AT POINT
Inspections performed by:. AWWC, INC. Dates: 1st 7/27/2001 " ........... a'" ~"'"I ......
2nd 7/27-31/01 ~ /~./~..~
........... : ....
Department of Health ancl/~;luma.n Services approval ~h,,~ ... ...
R~vlewed and approved b ate: ~' ~7-~ ! -~-~ ~ ~.=.
~'~; AS BUILT DRAWING
SW01025;5 - 051-052-41
A B C
~ - ~.~ ~.o Iii t~ X / ~~s~,,~
~ - ~'~ ~'" I1~ JII ~ ,
~ ~% ~ ~I~INO ~REE
~1~, /I/ % ~.~. .ous~
% .%2-.
D~. ,¢ ~u~ ,~ ~,/' % '::.;'~'".;~;'.-',
~ ~ or .~ s~c t~~ x :~:~2~;'~:;
~MBLER ROAD
~.~ ............... ~/~/2oo~
~~ WATEE & ~STEWATEE ~z.~.~. '
6~l~r~e~E.~gS~e~l~31~f?geF~O7~4Z~ 1~ = ~0~ ~ ......................
~ ~o~ RUTH OGONOWSKI PHONE NUMBS: P~E
C/O BKOOK STILTNER w/ REMAX OF E.R. 694-4200 2 OF 5
~KE HI~ ACRES SUBDIVISION; LOT 10
AS-BUILT DRAWING FOR SEPTIC UPGRADE
""'~""""~: AS BUILT DRAWING "~'°
SW01025;5 ~ 051-052-41
r- F1NAL GRADE
ST1 /g8'83 (AVG') L fINSULATION
TOP OF TANK A'r~ = = //--TOP OF TAJ~K AT
INVERT OF' BUNG SEPTIC TANK ~NVO~ or BUNG AT
~ TREN--'~'~ lEAST TRENCHI
~ /-- FINAL CRN~ -/ /--ORIClNAL GRAD[
/ $4.75-95.49 - g4.47-g4.97
,- 94..'7-94.87
IN~ERI' O~ P1PE-- 90.97
Z.T.O. '¢'.?' ~t'] ~ ".~
ALASKA WATER & WASTEWATER~ 4
CONSULTANTS, INC. ·
c/o BROOK STILTNER W/ REMAX OF E.R. 694-4200 ~ OF ~
~KE HI~ ACRES SUBDIVISION; LOT 10 ~h~e' .... ~ .....
PROFILE AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE
B1/O1/lgSS B0:01 ~BB225~
SULLIVAN
PAGE 01/01
( erlifiel lrilling
SULLIVAN WATER WELLS
P.O. BOX 670272. CHU GIAX. ALAS KA 99567 · TELEPHONE 6~.2759
/qq°
ADDR~5 -~ ~ ~, ~Ot~ -~ ~ ~TATIC LEV~L OF WATER FT.
~GALDES~ION~O~ /b Z4A'~ ~l~ ~ DRAWDOWN~.
' PE~ NUMBER ~ I .· KIND OF CASING
KIND OF FORMATION:
Wrom~wc ~o ~. . ~ ~rom~
F~om Ft. to ~t.~ From
From Ft. to~F/. ~
From /~._<;'F,.,o/~'n..~',~.v~' .F~f~O ·
From Ft. to_ Ft.~
From FL ~ FL /~ ~
Ft. to, Ft.
. Ft. lo Ft,
Ft. to Ft.
FI. IO Ft~
FI. to FI
FI. to Ft.
Ft. lo Ft.
From~Ft. to Ft.
From FL to Ff.
From FI. to Ft.
From Ft. to Ft.
From Ft. to.--.Ft.
From~FL to , .Ft.
'From Ft. to Fl
From Ft. to Ft.
fr6m Ft. to Ft.
From Ft. to , .Fi
From Ft. to.~Ft.
From Ft. to .Ft.
From FI. Io~Ft.
From Ft. to_~Ft._
INFORMATION:
DRILLER'S NAME
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage. AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Jul 18, 2001
Expiration Date: Jul 18, 2002
Permit Number: SW010253
Legal Description: LAKE HELL ACRES LT 10
Design Engineer: 0041 AK Water & Wastewater Consultant
Owner Name: Ruth Ogonowski
Owner Address: 16600 Centeffield Dr,
Eagle River, AK 99577-
Parcel ID: 051-052-41
Site Address: 024219 RAMBLER RD
Lot Size: 32030 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] SepticTank [] 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 DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 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: ~3~~~.=~
Issued By:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bmgaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.cLanchorage.ak, us
(907) 343-?~}4
Parcel I.D.
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Permit Number
Property owner(s)
Mailing address (1)
Mailing address (2)
RUTH OGONOWSKI c/o BROOK STILTNER
16600 CENTERFIELD ORIVF' * FAGLE RIVER. AK
Day phone 694-4200
~pCode 99577
Legal description (Lot, Block& 8ub'd.) LOT 10: tAKE HILL ACRES SUBDIVISION
Number of Bedrooms
Legal description (Section, Township & Range)
Lot Size ._'~_O ~t..~ Acms/Sq. FL
Well Only
Water Storage
THIS APPUCATION IS FOR:
Sewer Only
Sewer and Well
Sower Upgrade
Jacuzzi
Water Softening Unit
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
I certify that the above Information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal codes.
ALASKA WATER &: WASTE'WATER CONSULTANTS, INC.
Permit Fees: ,,~ :~g,~) · CO
Date of Payment: ~'/
Receipt Number:. *7 1 (,c, ~
Waiver Fees:
Date of Payment:
Receipt Number:.
ALASIG WATER & WASTEWATER
' '" ""' CONSULTANTS, INC.
July 4, 2001
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Septic System Upgrade Design for Lot 10, Lake Hill Acres Subdivision
To whom it may concern:
The existing 3 bedroom house is be served by a private well and septic system. The drainfield is
in a state of failure. A test hole was excavated northwest of the existing septic system. The
proposed septic system will be designed around the 30 foot radius of this test hole. We are
proposing that a¢1000 gallon septic tank and a dual five foot wide drainfield be installed.
Comments regarding the proposed design are summarized as follows:
1. SOILS: See the attached log which show the soil classifications, groundwater monitoring,
and the percolation test results. It is our opinion that due to the overall appearance of the soils, an
application rate of 0.8 gallons/day/ft2 should be used.
2. TRENCH DESIGN:
a. Percolation Rate: 8.6 minutes/inch
b. Allowable Application Rate: 0.8 gallons/day/ft2
c. NumberofBedrooms: 3
d. Design Flow: 450 gallons per day
e. Minimum Absorption Area: 563 fta
f. Total Depth: 4.0 feet (max.)
g. Effective Depth: 1.0 feet
h. Width: 5 feet
i. Reduction Factor: 0.87
i. Minimum Length: 100 feet (2 @ 50 feet long each)
j Effective absorption area = 575 fla
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade.
.//. julia. ~i't.~. 6901 Debarr Road, Suite 2B* Anchorage, AK 99504
Ph: (907) 337-6179 Fax: {907) 338-3246 Wcb$ite: akww¢.com
4. TOPOGRAPHY: As can be seen on the attached design, the average topography in the area
of the proposed upgrade is a I to 5 percent running from approximately east to west; in short,
there are no slope concerns. The trenches are to be installed parallel to slope contours.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact us at 337-6179. Thank you for your
assistance.
iarness, P.E., M.S.
NOTE: Attached is a site plan drawing, a design drawing, a soils log, and a 7page construction
speci)qcation letter which are all part of the design package for this septic system.
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
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- A~SI~ ;NWl'ER & ;~STE;%~TER ~ ~p/,[~: ~ :~_~
CONSULTANTS, INC.
RUTH OGONOWSKI 1 OF 2 '~ .....
LOT 10, ~KE HILL ACRES
~E OF WORK:
SITE P~N
I
PROPOSED ORNNREU~. EXC~kVATE TWO m
1 F~ OF C~. W~H~D. S~R / / 1
~,,~K. / /_~ ' .
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I I ~1 ~' IN~ ~W HO~E
I I I I ~
~O~
~N S~ T~K
~O BE ~N~ COMPLY
~BCER ROe (D~EN~ ~.) _~__
NOTE TH[ COHT~CTOR ~UST
~ ~E 100' WE~ ~l] SHOWN
SU~OR PRIOR TO CON~RU~ON
~SI~ ~TER & ~STE~TER ~: 4
CONSULTANTS, IN~.
RUTH OGON0WSKI 2 OF 2
~ D~CRI~ON:
LOT 10, ~E HILL ACRES SUBDIVIS[OH
DESIGN DRAWING FOR SEPTIC SYSTEM UPGRADE
CONSULTANTS. INC.,
)SOIL LOG - PEECO~TION TEST)
PERFORMED FOR:. Rm ~ONOWSKI DAT~
[Pm ° mcs ITEST HOLE
~ GW ~ ORG
i GC OL
..... sw
DEPIH TO ....
GROUNDWATER DAlE
D~ 7/4/01
10
11 DATE RE'lNG CLOCK NET TIHE WATER LEVEL NEI DROP
TIHE (HINGES) RE'lNG (INCHES)
12 6/28/2001 I 5:27 - 6- -
2 5:57 30 2" 4'
15 5 ~:57 - 6' _
4 4:27 30 2 1/2' ~ 1/2'
14 5 4:27 _ 6' -
6 4:57 30 2 1/2' 3 1/2'
15
~6
17
18
19 PERCO~TION ~TE 8.6 (HIN./INCH) PERC. H~E DIA. 6' (INCHES)
20 TEST R~ BETWEEN 3.5 FT. ~D 4.0 FT.
COHHENTS: PERC HOLE W~ PRESOAKED FOR 4+ HOURS PRIOR TO ~.
PERFORMED BY A~ WATER & W~ATER I, JEF~ ~ ~NESS, CER~ ~T ~IS W~ CERFORMED
IN ACCORD~CE W~ ~ ~A~ ~D MUNIClP~ GUIDEUNES IN E~CT ON
Tom Fink,
Mayor
Nlunicipality Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6050
January 8, 1991
F.N.M.A.
PO Box 670272
Chugiak, Alaska
99567
Subject: Lot 10 Lake Hill Acres Subdivision
Permit #900041, PID #051-052-41
The subject permit, issued by this office for a single family
well and/or on-site wastewater system has expired as of December
31, 1990o
A new permit must be obtained from this office for a well and/or
on-site wastewater system not installed by the expiration date.
If you have drilled the well, a well log needs to be sent to
this office for documentation of the installation and to close
the permit.
If a private engineer inspected the installation of the on-site
wastewater system, the original as-built inspection report
(three-part form) must be sent to this office fo~ review,
approval and documentation. All inspection reports must be
submitted within 30 days of construction completion.
When applying for a new permit, the fees are: $90.00 for an
on-site wastewater permit; $50.00 for a well permit; $140.00 for
a combined on-site wastewater and well permit.
If you have any questions
J~n Smit~' P.E-. ~
P~og .r am M~nager '
05-site Services
, please call this office at 343-4744.
JW/ljm:200
enc: Copy of Permit
"Kids Are Our Future"
Fl' E] I::' M ill T'
1,/c:~, y
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al'"d:i J.l"~ E:cu~H::~].J.a.['ic:a, ~,~J.'Lh 'I.1. i"i{.~:~ i:!i.:{.:,~.J.i.:.:jr'i cPJ.'LeP:[a oi: th:i.E.
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,'il.,i u. nd~,mE~'La, rld l:.ha'L 'l:.l"ii~. pE:,P~li:i.'l:.. :}.E. valid {or' a itiai.i:i, mL.u!i fl:ii' ::'.~ [::~,;~,dr.c:iom~i~,
~:.~. ]. ~(:.~ ~.~nc!a.)P ~P:.,::':u"~d 'Lhat. 'Lha~ (:::apac: :L 'Ly (::)f Cf'm) tc:H'.a ]. E~y~[M:.mm'~ :i. ~ :S b('.,)d r' oc.m'~-~ and
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SUITE 205
~ T /~ ANCHORAGE, ALASKA 99515
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONIVIENI'AL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL DESCRIPTION ..... I
LOCATION NO, OF BEDRO
DISTANOETO: IWell ~ Absorptiona:e~/~ Dwelling.,~ '~ ~ PE,MITNO.~.
~~ Ma~~ ,partments ~
~ ~ Width
Liq, IF HOMEMADE:~ Inside length Liquid depth
DISTANCE TO: Well ~ ~ Dwelling PERMIT NO.
Foundation
Length of each
Manufacturer
Material ' Liquid capacity in gallons
Nearest lot line PERMIT NO,
Total length of lines Trench w dth inches Distance between lines
Material beneath tile Total effective absorption area
inches
Well
DISTANCE TO:
No. of lines
Top of tile to finish grade
Ty~.e o.~ff crib Crib diam~eter Total effective absorption area
Well ~/~ Building four Nearest lot line /_~L
DISTANCE TO: ~
Driller Distance to lot line
DISTANCE TO:
PERMIT NO.
Septic tank Absorption area(s)
~UPGRADE
OTHER
PIPE MATERIALS
SOl L TEST~.~c.~RATI NG
REMARKS
LEGAL
MUNICIPALITY OF ANCHORAGE
, ,. , Department,~ Health and Environmenta~?rotection
-' 825 ~ Street, A~chorage, AK. .9501~ ~~
264-4720
Permit # ' - WELL AND~ ON-SITE SEWER PERMIT
/~!:~ Mailing Address ~,O, ~Y ??' /
Applicant: ~/~ ~' ~ :
Location: Phone Number: ~'
Legal Description: L ~ ~/~ /~/~ ~'~'/~%~'~ Lot Size:
Type of Soil Absorption System Is:
Trench: ~ Drainfield: Seepage Bed: __ Holding Tank:
Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) ~Y~
The Required Size of the Soil ~bsorption System Is:~
EPTH
GRAVEL DEPTH WIDTH
The length dimension is 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~H~L~NG) TANK SIZE = /~ 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 conumunity 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 31, 1 9 8 3 * * *
i certify that:
(!) I ara fa~iliar 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 ~ha~ %he on-si~e sewer system may ~equire en!a~e~ent if
the residence is remodeled to include more that/3~b~droo~%. ~ ?
Applicant ~ ~ :,S.,~. ,
Date: ~?~ ~., ,> : ,
SWP/024(1/81)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
~ [] SOILS LOG
/~ PERCOLATION
TEST
1
2
3
4
5
6'
7
8
9
10
11
SLOPE
WAS GROUND WATER //~0 ~
ENCOUNTERED?
O
P
E
IF YES, AT WHAT
DEPTH?
12
13
14-
15-
16-
17-
18-
19'-
20
COMMENTS
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERFORMED
PERCOLATION RATE
TEST RUN BETWEEN
CERTIFIED
(minutes/inch)
Q
0
MUNICIPALITY OF ANCHORAGE
Development Services Department V` j� Phone: 907-343-7904
On -Site Water & Wastewater Section �` Fax: 907-343-7997
Parcel I.D. 051.052-41
Certificate of On -Site Systems Approval
Expiration Date: Ir-6--2—ow
1. GENERAL INFORMATION
Complete legal description LAKE HILL ACRES LOT 10
Location (site address) 24219 RAMBLER ROAD, CHUGIAK, AK 99567
Current property owner(s) SCOTT & CRYSTLE MILBURN Day phone
Mailing address 816 W EVELYN STREET, LEWISTON, MT 59457
Real estate agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Private Well
Water Storage
Community Well
Public Water System
3
TYPE OF WASTEWATER DISPOSAL:
® Private Septic,1
❑ Holding Tankl ❑
❑ Community ! ❑
❑ Public Sewer' El
Waiver request for: Distance:
J.
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ J'`—� - Ll l 2. .,TD Waiver Fee $
Date of Payment &/IP-0 -.;l-6 Date of Payment
Receipt Number 269 A43
COSA# 05C900-0►
COVID-19
25% DISCOUNT APPLIED
Receipt Number
Waiver #
i
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below;:) 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 6/18/2020
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 to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting & Fks
6. DSD SIGNATURE
System #1 Approved for —3-- bedrooms
System #2 Approved for bedrooms
v �
*,
• • .
Curtis Huffman
9 % CE 128991 •��c�+
Disapproved
Conditional approval for bedrooms, with the follow; I ( 4j���
ON-SITE
WATER AND
WASTEVvATERz
PROGRAM
V
Original Certificate, Date:
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: LAKE HILL ACRES LOT 10 Parcel ID: 051-052-41
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)
Date drilled 3/4/1990
Total depth 178 ft
Cased to 178 ft
® Sanitary seal is functioning correctly
® Wires are properly protected
Casing height (above ground) 24+ in.
Date of flow test for COSA 6/18/2020
Static water level at beginning of test 155 ft.
Well production at time of test 3.8+ gpm
Comments
B. TANK DATA
Age of tank(s) 19 years
Tank type/material SEPTIC / STEEL
Measured operating fluid level in septic tank 49.5"
® Standpipes/foundation cleanout per record drawing
Date of pumping 6/17/2020
D. ABSORPTION FIELD DATA
Which system tested (date installed) 8/1983
® ALL standpipes present per record drawing
Total measured depth from grade 5.7 ft (max)
Measured depth to pipe invert from grade 5.2 ft (min)
❑ N/A — pressurized field
® Monitor tubes go to bottom of effective. If not, state
depth into effective
Water storage tank volume NA gallons
Well disinfected for coliform test? ❑ Yes ® No
® Coliform bacteria is Negative
Nitrate 4.65 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ® Arsenic less than MRL (ND)
FWES
Collected by «
Date of Sample 6/18/2020
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material
Comments:
Adequacy test date 6/18/2020
Results Z Pass For 3 bedrooms
Fluid depth prior to test 0 in
Water added 490 gal
New depth 3 in
Elapsed time 1140 min
® Code -required soil cover over field Final fluid depth 0 in
❑ System presoaked Absorption rate 450 gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N
date of test)
Gallons introduced gallons If yes, enter date
Comments/Deficiencies: F
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
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
_ ft
Holding Tank > 100' ® Yes
if No
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' ® Yes
if No
® Yes
if No
ft
ft
If septic tank is under driveway comment below
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)
Building Foundations > 10'
® Yes
if No
ft
Surface Water > 100'
® Yes if No _
Property Line > 5'
® Yes
if No
ft
Wells on Adjacent Lots:
® Yes
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)
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
G. ENGINEER'S CERTIFICATION
I certify that 1 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.
TH
r
•. ......... Curtis Huffman '
��¢ FFG,/•,� CE 128991 •. ����
FQ ROFESS ON1'��.���
ft
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ft
ft
ft
ft
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
GENERAL INFORMATION
(a) Legal Description (include lot, bloc.k, subdivisio~n, section, township, range)
Location (address or directions) '
(c) Applicant is (check one): Lending Institution ~; Owner/build.Buyer ~; Other ~ (explain);
(d) Lending Institution "¢'--)'~ '"'-J ~ Telephone
Address
(e) Real Estate Company and Agent ~2-f /"~_/.~¢~:.~:: //-¢ -¢
Address ~
Telephone
(f) h~et~the iCtAA to the following address:
TYPE OF RESIDENCE
Single-Famil~,. Multi-Family~ []
Number of Bedrooms
Other
WATER SUPPLY
Individual WelJ~ 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
Onsitex Public [] Community [] Holding Tank []
Note: If community well system, must have wr tten confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 {11/84)
-'ENGINEERING FIRM PROVIDING INSPECTIONS, TES
AS certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply 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 this inspection.
Name of Firm Telephone
Address
DHEP APPROVAL b~ '/-~~o~n
Approved for ~ ~L.,hedrooms Date
Approved ~ Disapprd;~ed 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.
Paae 2 of 2
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4720
Legal Description:
iMUNICIPALITY OF ANCHoP, AGE
DEPT, OF HEALTH &
ENVIRONMENTAL PROTECTION
Well Classification
Well Log Present/N)
Total Depth / "~ ~' I
Static Water Level
Casing Height Above Ground __
Electrical Wiring in Conduit4~/N)
Separation Distances from Well:
To Septic/~ loldi,~§ Tank on Lot
Cased to '~c-~t J¢
/
If A, B, C, D.E.C. Approved (Y/N)
Date Completed ~ ~ (~)'¢ ~;;~*;~ Yield
Depth of Grouting - --
Pump Set At L.~. ~,
Sanitary Seal on Casing
Depression Around Wellhead (Y~
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line /0/¢~/
Cleanout/Manhole ~o/~
Water Sample Collected by
Water Sample Test Results
Comments
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on
B. SEPTIC/I,H~Et~'tt~G TANK DATA
Date Installed ~::?'~ ~ ~ ~-~ Size
Standpipes~,N) Air-tight Caps~N)
Depression over Tank (Y~_L(J~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/I-4oldi,~g Tank:
To Water-Supply Well t ~.~
To Property Line j
To Water Mei~/Service Line
Course rC'//~
No. of Compartments
Foundation Cleanout ~/4'N)
Date Last Pumped .~,'2_)~)
; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation I'~
I
To Disposal Field ~
To Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~- ~ "~.~'~
Width of Field '~'-~ '
Square Feet of Absorption Area /¢(z'*¢'.)
Depression over Field (Y/LI~
Results of Last Adequacy Test ~')/~'~
Separation Distance from Absorption Field:
I
To Water-Supply Well ~ t C:-~
To Building Foundation '~--~-~ ~
Lot P/~)
To Water Math/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present.N)
Date of Last Adequacy Test
To Property Line I Cb f -k
To Existing or Abandoned System on
; On Adjoining Lots ~ '4-~ Id
To Cutbank (if present) "")1,% '
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level'at
High Water Alarm Level at
.,.
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ~'-A ~ ~..l~le~l~ Date
Comp, a~,y,..~f¢.8~ ~.¢57~' MOA No,
Receipt No. ' ...... ;"; ......... ~ ~t ~ J~
Date of Payment ~ "q'~ %
Amount: $ Z~- o~
Page 2 of 2
72-026 (11/84)