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Home My WebLink AboutMILLPLACE ESTATES LT 1Onsite File M 0 a a a illplace EsTate,7,, a 01mmI12 PID# 54 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221391 PID Number: 015-1t2-54 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New [C Upgrade Name Paul & Theresa Kvernplassen ABSORPTION FIELD ■❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 4220 E 104th Ave, Anchorage, AK 99507 ❑ Other Phone 907-229-8800 Number of Bedrooms 5 Soil Rating JTotal depth from original grade 0.8 GPD/SF 10.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.5 Ft. Gravel depth beneath pipe 6.5 Ft. Subdivision Block Lot Millplace Estate 1 Fill added above original grade 0.0 Ft. Gravel length 75.0 Ft. Township Range Section Gravel width 3.0 . Ft. Beds: Number of Lines N/A Distance between lines N/A Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 975 Ft2 1 N/A Ft. Well >100' >100' N/A N/A >25 TANK Fm] Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1500 Gal. Surface Water >100' >100' 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 LI TION Manufacturer Capacity Remarks Gal. Alarm location Electrics Iled by Installer PIPE MATERIAL House to tank D3034 drainfield Tank to D3034 A+ Home Services Drainfield D3034 CO/MTD3034 Inspector L.Tidwell BENCH MARK (Assumed elevation) 100 ft Inspdection 151 10/5/22 10/6/22 Location and description 2�d 3'd 10/6/22 4m Bottom Of Siding ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date ��Q�. •`4t4fi�1� d* 4TH r Benjam'ja,Schiller /r ¢� ��; • CE 12592 �,'srF�• •ion/22 , •�� Se tIC S Ste p Y Approved Date ' (� G L Note: this approval does not include well permit requirements.PROFESSIO��` kr cv vaivu 10) MILLPLACE ESTATES, LOT 1 PERMIT # OSP221391 P I D # 015-112-54 EAST 104TH AVE', WELL > 100' FROM PROPERTY LINE A-1 _. -- ---- ---- -- LFI 75' LONG x 3' WIDE, mT2 CO2 360 -6-.5'-EFEECTIVE DEPTH ABSORPTION.. zz EXISTING TRENCH TH#1 !GARAGE! - 01 2C01 v vi 355 CO2 H 15.0 m 0* ry _T 1500 -GAL SEPTIC TANK W/ 20" MANWAY Lu 350 fLOT 1 Lij IQ SHED AJ 355 WELL > 100' FROM PROPERTY LINE A B CTE I ENGINEERING PLAN AS -BUILT 0 50 100 ilm ow hm FEET 111=50' 2C0I 13.9 42'1 MH1 15.0 A3.7 svi 18.5 i 48.9 2CO2 20.6,/ 50.0 DV1 21.2 C01 59.4 _50.Q I -MT1 59.8 88.2 CO2 90.3 85.4 MT2 1 89.5 842 LEGEND CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE MILLPLACE ESTATES, LOT 1 PERMIT # OSP221391 PID # 015-112-54 oF- � o r- 95.4 ORIGINAL & FINAL GRADE 91 9 DRAINFIELD ROCK 91.9 85.4 85.4 75' NO GROUNDWATER 9/15/22 _ -79.4 F - 't9 IN � Ben PROFILE AS -BUILT %+ ja Schiller A�`�c ••. CE 12592 (� �sTF�• Ioni22 ENGINEER•F��o ING (NO SCALE) i FpP'•••'' �, �le_ ROFESSIONP ,m -+s � � N bD ;7 §C - n o Ul rn z g m N'RIz v 0 — W rn to o o o T - _ r- i F N &c°c �r-o r rN O to v CO z rrnnz�vo0qZ�= 0 Dmm�° NM--00� A n C Z r.�> m O =ao00 X z C c �o;jNrrnn0M 0 0M;ufn0rn A M 0 z�x��,�mQ�Pv� A rn ;o v_ z ommn ome0— m ��tntn - 'n 0 nm m � �z Z C 0 w_ moE; g0 0 C Cz ov�nZ9r zo zo ''�A—zr Oy NM'Ozr�D00 M rn �D�o O� m ELMORE ROAD O N 00010'00"W 220.00' — — — — — — — — — — — — — — — — — — — — — r ----— ———————— — — — — —— -- A.C. PAVING 0 OD ((A r-4 C) " rn fn D X m181 =`f�I C -0 (4 I W 1 s c� m vm I co ® A Y 03 �4b OD as I m U) oma, as C2 �� I o r i 77.6' I r i 33' o ' o I co < `®s' CA q 4 00 c I m I z 26.1' I � I W I I co " N — — — — — — — — — — — — — — — — — — — — — — — — I 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 hftp://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221391 Work Type: Septic Upgrade Tax Code Number: 01511254000 Site Legal Address: MILLPLACE ESTATES LT 1 G:2536 Site Mailing Address: 4220 E 104TH AVE, Anchorage Owner: KVERNPLASSEN PAUL & THERESA L Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: trent d l Uepai,tnlent 63996 Q Disposal Field Q 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: Issued By: Date: Date: 2 51 ZO 2 Z 5 M U iHMPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-112-54 Property owner(s) Paul & Theresa Kvernplassen Day phone Mailing address 4220 E 104th Ave, Anchorage, AK 99507 Site address 4220 E 104th Ave Legal description (Sub'd., Block & Lot) Millplace Estates Lot 1 Legal description (Township, Range & Section) Lot Size 63,996 Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (M all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) ❑X Septic Tank ® Upgrade ❑X (w/wo ADU) (D) El Holding Tank ❑ RenewalDuplex ❑ Multiple 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: 15-01 b Date of Payment: % 21AZ 22 Receipt Number: a 9 p Permit No. 0.1264 Permit App_:;- : :_-C Waiver Fees: Date of Payment: Receipt Number: Waiver No. September 24, 2022 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Millplace Estates Lot 1 – 4220 E 104th Ave Septic system design Dear On-Site Services Engineer: The owner of the above lot has a septic that has failed, so we are submitting this permit application for the construction of a new septic system. The attached site plan identifies the location of the home as well as the existing well and septic system. 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 mildly on the lot, generally to the southwest. Contours 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. Wells on this and adjacent lots are shown. The new s ystem will be a minimum of 100’ from all wells and surface water, and more than 5’ away from the septic tank. Please refer to the attached test hole logs, 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 OSP221391, Curtis Townsend, 09/29/22 Benjamin Schiller CE 12592R EGISTEREDPROFES S I O N ALENGINEER 1"=50' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND CO TH#1 MILLPLACE ESTATES, LOT 1 FEET 0 50 100 2CO NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. 355 9/7/22 4- B D R M H O M E EAST 104TH AVE ELMORE RDSHED GARAGE 10' UTIL EASEMENT15' T&E EASEMENT10' UTIL EASEMENTWELL > 100' FROM PROPERTY LINE WELL > 100' FROM PROPERTY LINE 360 350 355 NEW 1500-GAL SEPTIC TANK W/ 20" MANWAY DECOMMISSION EXISTING TANK PER UPC CO MT MT NEW 3' WIDE SEPTIC TRENCH 75' LONG x 6.5' EFFECTIVE DEPTH MIN 13' SEPARATION FROM EXISTING TRENCH INSTALL FLOW DIVERTER VALVE AND CONNECT TO EXISTING TRENCH VERIFY EXISTING FOUNDATION CLEANOUT EXISTING TRENCH 17.2 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221391, Curtis Townsend, 09/29/22 MILLPLACE ESTATES, LOT 1 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 EGISTEREDPROFES S I O N ALENGINEER4" PERFORATED PVC (HOLES DOWN) DRAINFIELD ROCK 3' 6" 3'-6" 6'-6" DESIGN FACTORS:SYSTEM REQUIREMENTS: 750 GPD PEAK FLOW PERK RATE: 6 MIN/IN APPLICATION RATE: 0.8 GPD/SF DEEP TRENCH SYSTEM 1500-GAL SEPTIC TANK BOTTOM OF TRENCH: 10.0' BELOW GRADE FLOW LINE ELEVATION: 3.5' BELOW GRADE TOP OF TRENCH: 0.5' ABOVE GRADE MAX DEPTH FOR SEPARATION TO GROUNDWATER OR IMPERMEABLE LAYER: 10.0' 750 GPD / 0.8 GPD/SF / 6.5' EFFECTIVE / 2 = 72.1 LF TRENCH REQ'D (75 LF SPEC'D) GEOTEXTILE FABRIC 9/10/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221391, Curtis Townsend, 09/29/22 LEGAL DESCRIPTION: PERFORMED FOR: DATE: PARCEL ID#: SOILS LOG AND PERCOLATION TEST 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 DEPTH (feet) TEST HOLE 1 DATE READING START TIME NET TIME (minutes) DEPTH to WATER NET DROP PERCOLATION RATE: (MIN/INCH) (inches)(inches) DATE OF MONITORING WAS WATER ENCOUNTERED? DEPTH TO WATER AFTER MONITORING IF YES @ WHAT DEPTH? 6.0 9/8/22 1 2 3 GM (SILTY SANDY GRAVEL) Professional Engineers Stamp: NO MILLPLACE ESTATES LOT 1 9/8/2022 015-112-54 PAUL KVERNPLASSEN 3:05 0 3:38 4:09 2' OB 30 Benjamin Schiller CE 12592R EGISTEREDPROFES S I O N ALENGINEER9/24/22 PERC TEST LOCATION TECHNICIAN: L TIDWELL 5 12 16 - NONE 9/15/22 COMMENTS: 6" DIAMETER TEST HOLE PRESOAKED PRIOR TO TESTING SITE PLAN 5 12 16 USCS SOIL CLASSIFICATION WAS VISUALLY DETERMINED 030 5 0 16 5 0 16 030 4 15 16 4 15 16 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221391, Curtis Townsend, 09/29/22 .00'OZZ M,,00.gOoOO N g U) w to � v O L'9Z e I° I o` JV 41 I y !O V ! m U) It) N_ t� VJ LLJ U) W O O w LLJU O L.iJ I U _P, ~ .— 0— J W M m .00'OZZ M,,00.gOoOO N g U) w to � v O L'9Z e I° I o` JV 41 I .00'OZ6 MIIOO.O LoOO N O OVON 38OW13 _ n N 0 P z 06 J N :D m WO�ogQo O Z V M w O Z O W 0 $= O W F- cn w =mOOZW U ~ >�W (nom to 25W �—WcoC)0 WOW Cf) O OXU-pUlZ U M mw �I W T 6x mw x m = W 0 W U O W W= W O CL- �i W W W0m W �O VOC9 0 Z mU W Z O Zm(= O .. ww6iEW5W,��, Mo vz W = 0 U N 7 0 Q Z aW 1=aU�DZW 00 0 in _ � � 0) N N O J < \ Z z W to a 0D o — 0 �o N W w 0 � � O LO of �=a � D W p U p m N Op C9 N y C) w I _P, ~ .— I W M m I .00'OZ6 MIIOO.O LoOO N O OVON 38OW13 _ n N 0 P z 06 J N :D m WO�ogQo O Z V M w O Z O W 0 $= O W F- cn w =mOOZW U ~ >�W (nom to 25W �—WcoC)0 WOW Cf) O OXU-pUlZ U M mw �I W T 6x mw x m = W 0 W U O W W= W O CL- �i W W W0m W �O VOC9 0 Z mU W Z O Zm(= O .. ww6iEW5W,��, Mo vz W = 0 U N 7 0 Q Z aW 1=aU�DZW 00 0 in _ � � 0) N N O J < \ Z z W to a 0D o — 0 �o N W w 0 � � O LO of �=a � D W p U p m N Op C9 N w _P, ~ .— W M m w C'4 N � I H00 0 �O N ONIAdd .00'OZ6 MIIOO.O LoOO N O OVON 38OW13 _ n N 0 P z 06 J N :D m WO�ogQo O Z V M w O Z O W 0 $= O W F- cn w =mOOZW U ~ >�W (nom to 25W �—WcoC)0 WOW Cf) O OXU-pUlZ U M mw �I W T 6x mw x m = W 0 W U O W W= W O CL- �i W W W0m W �O VOC9 0 Z mU W Z O Zm(= O .. ww6iEW5W,��, Mo vz W = 0 U N 7 0 Q Z aW 1=aU�DZW 00 0 in _ � � 0) N N O J < \ Z z W to a 0D o — 0 �o N W w 0 � � O LO of �=a � D W p U p m N Op C9 N MunicipaLity of Anchorage Page \ DEPAR-rMENT OF HEALTH AN[) HUMAN SERVICES ENVlFtONMENTAL SERVICES DIVISION P.O. Box 196650 · Anohorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Nt~,/k.b)).,' ,~J,c. I21.~::::~U.~_.,,~J Wastewater System: ~-New ~.[~ Upgrade LEGAL DESCRIPTION Sol, Rating: ~), ~ GPD/Sq Ft Tolal Depth from original Lei: Depth Io pip0 bo/tom from OP i I 9rede: Gravel del)th beneath WELL: D New D Upgrade Gravelwidth '~ Ft ~ ~ ~ Ft Class alien (Private, A,8,C) TOI~I Depth: Cased TO: Total absorpbon area: Pipe material: ~ SEPARATION DISTANCES ~Septic ~ Holding ~ S.T.E P su~o~ ~ LIFT STATION FouRdation ~ ~ ~ ~ 'Pump oh"level at: 'Pump off"~ r alarm at: Remarks: b~ ~¢~ BENCH MARK Assumed Elevation: Department of Health ~ s approval ~¢?,~.. Reviewed and approved by: Date: ~ 72 013 (Rev 9/91 ) MOA 25 Page ~ of ~ Municipality of Anchorage DEPARTMENT OF HEAl. TH AN[) 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 N 72 013 A (Rev 9/91) MOA 25 O~tober 21, 1991 ROBERT SHAFER. P.E. ROGER SHAFER, P E. CIVIL ENGINEERS (907) 694-2979 FAX 694 1211 HEALI'H AUTHORITY APPROVALS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD D~SIGN SOIL [EST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: SEPTIC INSPECTION REPORTS: OCT 2 2 1931 OepL Hsu'.ith ~.;," . ~e W NE ~,SW ~, SEC. 6, TI4N, RIW, S.M. Lot 3, Bear Park Subdivision; Lot 6, Block 4, So~th Fork West Subdivision; Lot 16A, Sec. 15, TI~N, R3W, S.M. Lot 29, Hillside Park Subdivision; Lot 6, Block 8, Trails End Subdivision; Lot 3, Block I, Gat~vay To The Park Subdivision; Over t~s sw~mer we have performed inspections on the installation of septic syst~s located on the above referenced properties. All of these systems w~re installed in a satisfa~ory manner and in accordance with the permits issued by your office. However, to date these r~nain virtu~y undeveloped ~oropo~£ties without foundations installed. Once foundations are inst~led we wil~ complied i~pe~ion reports with swing ties tied into the corners of the house. The appropriate elevation data can then be tied i~o a prop~ benc~,~ark. Therefore, complied septic inspe~on report~ for these properti~ are forthcoming~ If you have any questions or comment~ please co,ct us. Sincerely, ROGER J. SHAFER, P.E. RdS/gm cc: REFERENCED PROPERTY OWNERS PAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW910096 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:KVERNPLASSEN PAUL H & OWNER ADDRESS:P. O. BOX 231302 ANCHORAGE, ALASKA PARCEL ID:01511241 DATE ISSUED: 5/13/91 .~EXPIRATION [)ATE: 99523-1302 LEGAL DESCRIPTION: T12N R3W SEC 15 LT 16A 1 OF 5/13/92 LOT SIZE: 91279 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS ]PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: THE ATTACHED APPROVED DESIGN. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AN[) 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0). THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: 1. VERIFY NO~TCK TO 15'~DURING INSPECTION. _ ISSUED BY: ,~--~ ~-~b'd DATE: ~'-- /~'-~ DATE: ~-1~-9I ~a~ lO, 1991 ROBERTSHAFER, P.E. ROGER SHAFER CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 16A; Sec. 15, TI2N, R3W, S.M. PERMIT REQUEST NARRATIVE From the Mu~cipal fil~s i~ appears there may have been a 1000 gallon septic tank i~stalled on the property as a holding tank. T~ tank ~ to be located and prop~Lly abandoned. There is a well log on file for the existing wet~. We have proposed ~he instal~on of a 1250 gallon septic tank and 112 ft. long seepage trench with 4.5 ft. of gravel. The area proposed for the septic syst~ is consiste~with the septic location on neighboring properties. The lot is relatively flat. We anticipate no adverse effects eighboring propcrti~. ROAD DESIGN A. SHAFER, P.E. ~m SOILTEST PERCOLATION TEST S'rRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION:_ 1 2 3 4 7 9 10 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS DATE '<"~ Township, Range, Section: '~ SLOPE WAS GROUND WATER ENCOUNTERED? SITE PLAN S L IF YES, ATWHAT O DEPTH? p E geplh to Waler Afl~"~ ,/ Monitoring7 ~-"T-'~ gato: ~ { o -~ \ / Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE ~'~' (mmuteszmch) PERC HOLE DIAMETER lEST RUN BETWEEN FTAND__L~ FT PERFORMED BY: ' ' ,~.,. ~¢,~kyy I ~ ~ _ CERTIFY THAT THIS TEST WAS PERFORMED IN ""~' ¢~ I ~,~,' ~"~"~..L~E~E R'S SEAL) (~) DEPARTMENT OF HEALTH& HUMAN SERVICES ~ 025 "L" Street, Anchorage, A,aska 00502'0650 8OIL8 LOG -- PERCOLATION TEST /~~ ......... LEGALOESCRIP'rlON:. ~ ~ ~ Township, Range, Section:~ SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20- Depth to Wal~ MonltodnO? S L 0 P E Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE ""~ .'~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~--,~---~'r AND ~'~ FT COMMENTS Y / ' AOOORDANCE WlTH ALL STATE AND MUNIClPAL GUIDd~FECT ON THIS DATE. DATE; '/¢ ' uoySD~o~d I~us~uOa!AuZ pu~ '0gLP-P9E ~P · pa~idx~ s~q Ig~LL~ q.T ~L6I ~gAapnu~p Ill:, ,~..i .I I ~l,! :::,'l. It i ii;% I'iII; i E;l',il;ilil ii;:, ); 1'1t ;I;',i:!i; ;[ Of'ii ;I; q; Fl-ii!: i ~:;l'.iiE:i'l I' I ,:] :1; i',l I:::li:l!; t ;:, Ell::: -i I'IE '¥1:;;:i;i'-,IC:H ~:)i:;i: BI;i:l::i ii i',iF :!: li!i.ii) '11'11} I;:,l~l:::'tli O1::' I:::1 I'l::i:iiiZl'.,l(;;:iil Eli:;;: I::'];I ;l:ii; -li'IE; t;:,;IZ:.E;I'I:::It..tl;;:I;; lidill.,tE;ti;l',t Fl'ti ::-;I. 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Oiiiil)l~:ii;. 7::: ii' i.INI)i;I;i::ii-II::lhll;:, ii'lll:iif i'f'lI:iZ iiZiiH":iiiii I~Z iiii;tiZii'ltii;f'~: :i;'/:ii;-Iti:{l'l i'i1:::¢¢ I:;:l:;ii;iit~ii;l::iil-; liiJ".i! I:::ll::iil;;iilii;l'lt'.;i".tl iii::: 'liIF{ I:;i:li::!;ii;l:,l};HE:lE ii ;; I';;:ii;l'lOI)iiit E;I;:, ]O GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-456! SEWAGE DISPOSAL SYSTEM -- APPLI¢...ATION AND PERMIT PERMIT NAME OF APPLICANT Milton Lott INSTALLATION LOCATION. Abbott Loop off MAILING ADDRESS of O' Malley PHONE 349-2491 LEGAL DESCRIPTION. T12N R3W Section 15 Lot 16A INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS COMPLETION DATE ANTICIPATED · SEEPAGE PIT ., DRAIN FIELD -, OTHER TO BE INSTALLED BY NOTE~ THIS PERMIT IS NOT VALID WITHOUT BOIL s~XC¢]4~¢¢~!, 000 qallon~pe MINIMUM DISTANCES, REOUIREMENTB FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL -- SEPTIC TANK __. SEEPAGE PIT TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FJELD SEPTIC TANK, ., SEEPAge PIT TO RIVER, LAKE. STREAM. · DRAIN FIELD SEEPAGE PIT ALSO CONSIDER AREA WELLS. · SEEPAGE P]T SEEPAGE AREA SIZE CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROS.¢~ING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCh DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE Pit FITTED WItH AIRTiGhT REMOVABLE CAPS. GRAVEL BACKFILl. CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. TYPe I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE WATER WELL LOG FOSS DRILLING 1336 Ir~ra Street Anchorage, Alaska 99501 USE 0~' WEL~_~_~3__ .... SIZE OF CASING.~__DEPTH OF HOL ~T. CASED TO. /,,,7 ~ ' FT. STATIC WATER LEVEL_.~L~.~?T. YIEL~)_~GAL.PER.MIN. WITH_~~ FEET OF D~WDOWN. REMARKS ...... _____t O~ RESIDENCE; 277,7162 OFFiCC'; ;2.72.0619 CIVIL i~NOINI-'~RINO ANO LAND I~URVE:YINO ~107 29'tH AVE~NUE: · ANC. HORAOE, AI.A~,I(A 99503 December 5, 1972 C, roator Anchorage A::ea BoMo~gh Depo~tment of Envioz~mental Quality 3500 Tudor Road lmchore~o, Alaska &ttn: Roll Striokl~nd Gentlemen: On November 27, 1972, this firm oonduoted a soils invosti~ation on the proposed Loft Subdivision. 'l~o results below the top soil ~ve as follows: '~ ri~I ,",.fl ~rom 1.0' to 13.0"was a cle~, po?fly ~aded, medi~ s~d (SP) ~[ ~.~2 from 1.0~ to 6.0' was silty s~d wzth a trace of ~I ~3 f~om 1.0~ to 6.0~ was ~.avely~ cease o~d ~f) . ' from 6.0~ to 12.)~ was the s~e as ~ TH .//2 The holes awe located on the accomp~g test hole map. Those holes we=e dug on Lot 1, ~d it is o~ opinion that TH #1 is representative of the majority of the lo~ which is 2~ aores ~ ~ea. No water table was fo~d. With this ~m mind, seepage pit sewsce disposal could be ~,ooompolished with a minim~ ~ea of 150 squ~e feet per bedroom.~ '. On ~ho p~oposed Lot 2, the=e are p:~esently two systems operating;' so. we did no~ pe=fo~ ~ e~lo=ation ~ this ~ea. ' Respec~tfulIy Submit%ed~ P~ed Walatka, P. E. 4¢ I I I I I I 297.80' 93~48§ ~,f. 93,,485 J.f, 289.89' MUHMPA\U TY (OF A, HCHOPRA2 GE Development Services Department = Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I. D. 015-112-54 Legal description Millplace Estates Lot 1 Site address 4220 E 104th Anchorage Alaska —_ Expiration Date:1-'4-0--Z2 D 2D�� Current property owner(s) Paul 71 Theresa Kvernplassen X The On-site system(s) is/are approved for 5 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: BY:zz; Original Certificate Date: L_ This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA ApprovaLJune 2022 MUNICIPALITY OF ANCHORAGE ,9 Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-112-54 Complete legal description Millplace Est, Lot 1 Location (site address) 4220 E 104th Ave, Anchorage, AK 99507 Current property owner(s) Paul & Theresa KvernplasSen Day phone (907) 229-8800 2. ON-SITE SYSTEMS SIZED FOR 5- BEDROOMS 3. TYPE OF WATER SUPPLY: ❑■ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age < 1 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 1$ Waiver Fee $ Date of Payment W %(C)1r 6,2� Date of Payment COSA # 6 S _`Ll R 7?' Waiver # COSA Application—June 2022 COSA Checklist Legal Description: Millplace Estates, Lot 1 Parcel ID: 015-112-54 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA OR Well log is filed with Onsite (or attached) Date drilled 9/14/76 Total depth 175 ft Cased to 175 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 8/24/22 Static water level at beginning of test 130 ft Comments B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NEW ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) NEW ❑ ALL standpipes present per record drawing Total measured depth from grade 10 ft (max) Measured depth to pipe invert from grade 3.5 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. IN Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced N/A gallons N/A date Any rejuvenation treatment (past 12 months) N/A If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 Well production at time of test 4.3 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 3.01 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Forge Engineering Date 8/24/22 C. LIFT STATION ired maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date NEW Results Fol Pass Wkuid depth prior to test in Wat\tim gal New in Elapmin Finain Absorption rate gpd FIELD STATUS — POS RE Effective depth (per recorrawings) in Effective depth used i Effective depth remaining E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' 0 Yes if No Community Sewer Manhole/Cleanout > 100' DYes if No ft Yes if No ft Neighboring Tank > 100' ❑® Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ❑ Yes if No ft Q Yes if No ft ft If tank or field is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No ft ❑ Yes if No ft ❑ N/A - Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' F Yes if No ft Tank to Property Line > 5' n Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' Q Yes if No ft Private Wells > 100' FO -1 Yes if No ft Water Main > 10' n Yes if No ft Community Wells > 200' n Yes if No ft Water Service Line > 10' no Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Forge Engineering Engineer's Printed Name COSA Checklist—June 2022 Benjamin Schiller, P.E. Phone (907) 522-7773 Date 10/7/22 low 4N� 49 TH ...r ... Benjan chiller i FFG' . • CE 12592 �� islF�• . 00/00/00 .4P�,� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of E-'nvironmental Services On-Site Services Section P.Q. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORI'f'Y APPROVAL FOR A SINGLE FAMILY DWELLING Parcel i.D. GFNERAL INFORMATION Complete legal description Lot i~A; Sec, 15; T12N: R3W; SM Location (site address or directions) Ancbnrmg~ 4220 East 104th. Anchoraqe¢ Alaska 99516 Property owner Mailing address _ Lending agency ~3] Kv~rnpla~,~en Day phone hm~,349~9838-- mb. 244-8228 P.O--Box 2~!~O2 Aaehe~a§er-Alask~ ~=~ ~ Day phone Mailing address Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTF: 4 Individual well xxx Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: _X.X× _ If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 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 of this Health Authority Approval application 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 investi_gation 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 S &~Jd~N~fNEERING ,A, dd ross 12'034 IEa~le River Engineer s signature DHHS SIGNATURE .~/" Approved for '~-~-~(~-: bedrooms. DisapprOved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS 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. 724)25 (Re',', 1/g~) BSCk MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: l.o~' /(of) ~-[¢~-JJ- Tl?,fil 1~3~J &,~,ParcelI.D. ¢/ ~-¢ // ~' ~ c// A, Well Data Well type Log present~d~) _ Total depth _/'~ Sanitary seal ~J) If A, B, or C, attach ADEC letter. ADEC water system number_ ,'f.-/////~ Date completed ~[l"~/~/[~ Driller f;'o£5 Cased to __ ! '~- f Casing height / Wires properly protected~Y~) FROM WELL LOG Date of test 1//'~/'~ Static water level J ~'~ ! Well flow __ r,~, ~'- g.p.m. Pump level1 (-~K AT INSPECTION ', On adjacent lots /O~ · On adjacent ots Public sewer manhole/cleanout Petroleum tank SEPARATION DISTANCES FROM WELL TO: Septic/he~tank on lot ~/~- Absorption field on lot /(~30 f'~ Public sewer main _ ¢-~' ~'- Sewer service line ~' WATER SAMPLE RESULTS: Coliform Date of sample: /(~/~/¢ ,~ B, SEPTIC/HOLDING TANK DATA Date installed Cleanouts~(~N) High water alarm (Y/~) Nitrate_ Collected by: _ Other bacteria ../L/o/-J(::'~ S & 5 ~NGiH[-:~t:tlNG Tank size _/p..¢O Foundation cleanout(~) ~'/f:~. ~ Alarm tested (Y/N) _ Compartments Depression Date of pumping /~'M ¢°~£'/"~uf~71°AJ - Pumper SEPARATION DISTANCES FROM SEPTIC/H~ TANK TO: Well(s) on lot t/dp~ r'.¢~ On adjacent lots _ 'I'o property line /~ /nc- Absorption field _ Surface water/drainage _/(-~--) 72-026 (3/93)* Front Foundation /0 ~/~ Water main/service line /0 ¢/- CONTINUED ON BACK PAGE C. LIFT STATION /UC, rdE~ /2~'~E:/./T- Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level ~'~ Cycles tested Meets MOA electrical co~ Manufacturer Manhole~ ' Pump off' Level at Surface water D, ABSORPTION FIELD DATA Date installed ~/~_C-/¢-% Soil rating (GPD/FF) Length //~ ¢ Width ..~ r Gravel thickness Total absorption area /O,~','~ ~ Cleanout present'N) Dat~0~dequacy test ~E¢ ~ ~ Results~/fail) ~ for wa[er level in absorption field before test ~l~ After test Peroxide treatment (past 12 months) (Y/N) ~),~¢ ~X/~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellonlot_ /~f~ Onadjacentlots /¢~ f~ Propedyline To building foundation _ /O f~ To existing or abandoned system on On adjacent lots ~ Cutbank ~O~ ~J~~ Water main/se~ice line Sudace water /~O /~ .Driveway, parking/vehicle storage area Cu~ain drain ~O~ ~ ~ System type '7-/~£/,CH ~-/ Total depth /O' Depression over field (Y/~ .~-~ Bedrooms E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or confQc¢~d to all MOA and HAA guidelines in effect,~,,°n-the,~,~ date,, of this inspection. .? Signature ,,-/ ,/-,.~.-~,...-~ Engineer's 170~4'~:acj[~'~er Loop Road NO. 204 Name Date Eagle Ri~laslca ~957ZO~ //'~ //~,/Z ~.¢ HAA Fee $~'~00 ~ ~ ' Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)· Back Date of Payment Receipt Number