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Home My WebLink AboutROEHL LT 3ARoehl Lot 3A 020-092 -99 %ncv vaivci 10) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221009 PID Number: 020-092-99 Dwelling: 9Z Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name Willard Smith A ORPTION FIELD ❑ D Trench El Wide Trench E] Bed ❑Mound Site Address 5445E 172nd Ave Other Phone Number of Bedrooms Soil RatingTotal depth from original grade 4 D/SFJ Ft. LEGAL DESCRIPTION Depth to pipe invert from original de Gravel depth beneath pipe Ft. Subdivision Block Lot Roehl 3A Fill added above original grade Gr el length Ft. Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dist ce between lines Ft. SEPARATION DISTANCES Tol Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between ches From Tank Field Tank Line Ft' Well 100+ TANK 21 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface WaterI 100+ Greer 1500Gal. Material Number of compartments Lot Line 5+ NA Plastic 2 Foundation 10+ I gATION Manufacturer Capacity Remarks Gal. Alarm location Electri lied by Installer PIPE MATERIAL House to tank Tank to D3034 drainfield D3034 Jr's Drainfield CO/MT Inspector Arcterra Consulting BENCH MARK (Assumed elevation) 100 It ctionLocation Inspdeates: Is' 6/3/22 20 6/3/22 and description 3`° 6/6/22 4'" Roof top corner ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineers Stamp Conditional Approval: Date •''�'"t CF `•�� 1 49 m � '�•�� W f Septic System p Y It�KENNETH UFFUS s �; Approv t� Date _ I� s� CE s + �1+ f'pTy`�.+e• Note: this approval does not include well permit requirements. �41k%k 0� %ncv vaivci 10) AS—BUILT SYSTEM DETAILS/SITE PLAN Permit OSP221009 ROEHL LOT 3A PID# 020-092-99 GPRPG� O DWnNG TROCH 0 3' EILJ1 SECTION UNE I. A -C=117.7' B -C=135.1' N A -D=118,7' B -D=136,1' y A -E=120.4' o B -E=137.8' _ A -F=124.5' o B -F=141.7' Q A-15=127.0' A m B-13=144.2' o r A -H=128.3' N o B -H=145.3' ! a 15M GAL TANG P 'C SCALEi NTS 500 GAL SEPTIC OF• AZ — :,<Q� PREPARED FERI WILLARD & GAIL SMITH 5445 E 172ND AVE *:4 TH ANCHORAGE, AK KE 5 .: FIELD BOOKS compuTED: CE 7 BOUNDAR" N A DRAWN: KSD STMNc. N A CHECKS)' KMD 6 " f ' • ASBUILT: HOLT .DATE: 'sslat�7/5/2, DM FILE: GMD: 3337- AOAD F1'� FILE 'IDB N° 21086 O EXISTING BUILDING 711 a 5� T?Ip 5�5 7� M14S l SCALE, 1' = 40' SCALE: NTS I� W W 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: OSP221009 Work Type: SepticTank Upgrade Tax Code Number: 02009299000 Site Legal Address: KOEH (_ L -T 3 A Site Mailing Address: 5c.j5 F 1'1 Z,ND 'RN E 1 NII�CH Owner: Smith Willard Design Engineer: ARC TERRA CONSULTING INC This permit is for the construction of: Effective Date: Expiration Date ��cnt n"31,11 n !!. llLI) 11'tinent Lot Size in Sq Ft: Total Bedrooms: 1/20/2022 1/20/2023 ❑ 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) 343-79.04 (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: 11 Date: _ Issued By: .t Date: l .2b 0;2.,, ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 020-.092-99 Property owner(s) Willard & Gail Smith Mailing address 5445 E 172nd Ave. Anchorage, AK Site address 5445 E 172nd Ave. Anchorage, AK Legal description (Sub'd., Block & Lot) Roehl Lot 3A Day phone Legal description (Township, Range & Section) Lot Size 90,040 Sq. Ft. Number of Bedrooms _ S APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank ❑x Upgrade 0 Duplex (D) EJ❑ Holding Tank ❑ Renewal Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Dea Duffus (Signature of property owner or authorized agent) Permit/Rush Fees: � '? '� 5 Waiver Fees: Date of Payment: 1/20/26;Z2- Date of Payment: Receipt Number: 06%b l G Receipt Number: Permit No. O SIoa2 1 009' Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221009, Rebecca Carroll, 01/20/22 1250 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221009, Rebecca Carroll, 01/20/22 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~ame DISTANCES --~,~8,,~'(¢,~'" (~J..E')"f,'~ FROM~ SEPTIC ABSORPTION WELL Address TANK FIELD · , FOUNDATION Township, Range, Section AS-BUiLT DIAGRAM (Show location of well, septic system, properly lines, foundation, '~/~ ~U ~ driveway, water bodms, Otc,) Capacity in gallons ~ ~"~2~ ~ /~ ~, .,~'.~ Material No, of Compa~ments II II ~TRENCH ~ BED ~ W. DRAIN ~ OTHER Depth to pipe bottom from Total depth f rom original grade II ~ Fill added above original grade Gravel depth beneath pipe ~ FT ~ FT Gravellength ~0 ~ Grave/width . 'T ~ F' Total ~bsorptio. area ~ SQ FT :~ ~ FT ~mbor of li~es 8oil rat,no ~;/~ Installer ~~-S ' ~ Date Insta~d ~ WELLS ~PRIVATE ~ OTHER fldentifv) Classification (A.B,C) Total DepthFT Ic"~d t° FT ~stailer Date Installed: Scale: ~ ENGINEER'S SEAL I~s Pedormed by: , ~ :' , ,: : I ceflify that this inspmi0n was ped0rmed according t0 all Municipal and State guidelines in effect 0n this date: M U N I (.'] I P A L I T Y 0 F A N C H 0 R A G E Depar, tment o~ Heal{h &. Human Services 8::~!5 L Str~eet, Anchorage, Alaska 9950:1. 345~.~;~7~,{:~ ON-SITE SEWER ~,; SEPTIC TANK &. WELL PERMi'T Per~m.tt Number ~ 880'10,t Date I¢'.~...,u~:,.d,~' = - ~.h.)/c,.." ~ "~ ..../8~:.'1 Engineer' Designed Owner Name: GEORGE [.,LEMANs:, Ownep Address: ],690() GULDEN/IEW DR. ANCHORAGE, AK 99516 Day Phc~ne: ...:,4,.~-6~.88 I::'ar~ c:e ]. I d: 0~.'.::'.0-092-78 t,,.,ot I.,.,egal: Subdivision: ROEHL Lot: 4 Block: Secti;:n: 3 ]"ownship: 11N Range: t...ot. S:i. ze 40477 (sq, ft,, or acres) Max Bedr'-ooms: This Permit~ 4 Total Capacity: SEPTIC TANK: Minimum t{:)t, al septic tank capac:it¥: ].~25~'. ..,. gallons. Each septic tank must have at least 2 compartments,, Depth to top c)f sept:Lc tank(s) < 4,,0 · ~s insulatir~n over. tank(s) feet r equ i r' (..,,,. . WELL: L. og must. be subm:itted tc.~ MunicipaIi'ky of Anchopaqle Depar, tment, of Health and Hl.l~an ~:' ~- ..~4~ vices within 30 days ¢::~f ~m.;~].l comple~ion. INSTALL, PER ENGiNE?.ERS DESIGN, A TRENDH TYPE ABSORPTION SYSTEM,, LENI:i')TH~ 50.0~; GRAVEL. DEPTH: 6.0'; MAXIMUM DEl?TH: :1,(),0~ ., NOTIFY DHHS PRIOR TI] EACH INSPECTION,, THIS PERMI]' IS ISSUED FOR A SINGL, E F¢)MILY RES IDENCI!!!: ONI,,..Y AND EXPIRES ON 12/:].";1/88. ]: CERT]:f:'Y THAT:: :1.~ I am ~'amiliar with tl~e requirements for' on-site .~:~ewers and wells as ~;et ~orth by the Municipality of Anchcmage (MOA) and the State o{ Alaska. ~?.,, I will install the system in accordance with all MOA codes and rmgutations, and in compliance ~,,ith the design criteria of this permit. 3,, I t~ill adher'e to all MOA and State ~)f Alaska requirement~ fer' the set back distanc:es f'r'om any exist:Lng well~ wastewatep disposal system op public ~ewera¢;~e system on this ~:~ any adjacent or neapby lot. 4. I undepstand that this pepmit is valid (op a ma~timum of' 4 bedr~eoms,, I (Owner) GEORGE []LEMANS Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: Township, Range, Section: '-T--/I.Z~ ~.~J :a'~ ~ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS SLOPE WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT ~ DEPTH? p E Depth to Water After ~)~ 4 Monitoring? Dale: SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop +W~o /, ~'-zq-~'~ ~¢?-~'? /~ f~I ,~7--,?/~' PERCOLATION RATE ~*'* ~'""- m~nutes/mcn.~ PERC HOLE DIAMETER TEST RUN BETWEEN ~ . FT AND +7 FT ~7 0, ~" ~ If', PERFORMEDBY: /~--5 , ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 JOB SHEET NO OF CALCULATEDBY /z~, /~J/~'~,~//~ DATE CHECKED BY DATE SCALE ALASKA erlUlRonm6nTAL CONTROL SI RUICtB, InC. [~nclimmq ~ ~nuironmcntal Studies SPECIFICATIONS FOR A TRENCH-TYPE WASTEWATER DISPOSAL SYSTEM - ROEHL SUBDIVISION, LOT 4 1.0 GENERAL 1.! The drawings, sheets ] through 3, shall be a part af this specification. All materials and workmanship shall meet the requirements of the Municipality of Anchorage, Department of Health & Human Services (DHHS), the conditions of the perm]t, and all applicable rules and regulations currently in effect. All elevations and depths are advisory, and are to be verified or modified in the field by the engineer or inspecting agency. 1.4 1.5 It is the responsibility of -the owner or installer to adhere to approved designs for installation, maintain the specified separation distances, and have the appropriate inspections. If the installation is not inspected by an AECS engineer, AECS will not be responsible for the installed system. An engineer at AECS should be consulted prior to construction to determine the number of inspections that will be required and to explain what these inspections will involve. 2.0 SEPTIC TANK 2.1 If there is an existing septic tank, it may be nsed if it meets the capacity requirement for the residence and the approval of the MOA, 2.2 The septic tank shall be a UPC--Approved two-compartment tank, constructed of 12-gauge steel with bitumastic coating and set levet on undisturbed soil. If the Lank is buried at a depth of 4 feet or less, it must be insulated with an overlying layer of 2 inch burial type polystrene rigid board insulation. 2.3 The septic tank and trench shall be a minimum of 100 feet from any private well or body of water, 150 feet from Class C wells, and 200 feet from Class A or B wells, unless otherwise specified. Less than the required separation distance must have prior approval or waiver by ADEC or MOA. 2.4 The septic tank shall be a minimum of 5 feet from the hotme foundation, and a minimum of 5 feet from the absorption area. 2.5 Piping shall be fitted with a mechanical watertight ca]der coupling on the outlet and inlet of the septic tank. Piping shall be 4-inch solid PVC ASTM D3034 or cast iron, sloped a minimum of 1/4 inch per lineal foot. If the piping is buried at a depth of 4 feet or less, must be insulated with an over_lying layer of 2 inch burial type poiystrene rigid board insulation. 2.6 Cleanouts shall be installed as designated and capped with air--tight rain caps (Jim caps or equivalent), and exteaded a minimum of 1 foot above ground level. 2.7 If a lift station is required it shall be a combination lift station septic tank per Anchorage Tank and Welding, Iuc. design. Specifications are attached. 3.0 Absorption Area 3.! The gravel for the trench shall be 0~5 to 2.5 inch, screened rock with less than 3% passing #200 sieve residual. Ail substitutes must have prior DHHS approval. 3.2 The bottom and sides of the excavation shall be raked with the backhoe blade 'to insure that it has not been compacted during excavation. The bottom elevation shall be level. 3.3 Monitor standpipe(s) shall be placed as shown in the drawings, and shall be 4 inch rigid PVC ASTM D3034, or cast iron. The section shown with holes may be 0.5 inch holes drilled on 6--inch centers on opposing sides of the pipe, or a regular section of perforated sewer pipe clamped to a solid section with either a no hub coupling or a solvent joint. A rubber rain cap (Jim cap or equivalent) shai] be installed over the top of 'the pipe. 3~4 The distribution pipe shall be perforated 4 inch rigid PVC with a minimum crush strength of ~500 lbs and shall meet the approval of DHHS for use as drainfield pipe. All distribution pipes shall be laid level. 3.,5 Trenches ]nay be paralleled, but must have a minimum separation distance between tile trenches of 10 feet or 2 times the gravel depth (whichever is greater). 75 feet is the maximum allowed linear length of any trench. If the final grade over the trench is less than 4 feet above gravel, insulation is required, using burial type polystyrene rigid board insulation. There shall be 1 inch of insulation for every foot of soil less than the required 4 feet of cover, but there must be at least 24 inches of soil cover even though insulation is used. The solid pipe extending from the septic tank to the drainfield shall also have 4 feet of cover or an equivalent layer of insulation to prevent freezing of the line. 3.7 If insulation is not necessary, the gravel shall be covered with a layer of nonwoven Geotextile fabric (such as Mirafai, Fibretex 200 grade, Poly Filter X or equivalent). 4.0 INSPECTIONS A minimum of 'two inspections are required for the installation of the trench. The first inspection will be of the open excavation to assure that the system is installed in the proper soil s'trata, correct depth and meet minimum specified design parameters. 4.2 The second inspection will be after placement of the gravel, monitor standpipe and distribution pipe to verify proper installation and position prior to backfill. 4.3 The inspection of the septic tank installation can be incorporated with any one of tile above listed inspections. ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 JOB SHEET.O, / O. ? CALCULATED BY. DATE CHECKED BY DATE SCALE ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue. Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 JOE SHEET NO CALCULATED BY CHECKED BY SCALE OF DATE DATE I j! 0 Date Drilled: 8-12-88 Static Water Level 77 Draw Down N-A feet WELL LOG feet Gallons Per M~nute ' Total Feet of Casi.ng-' 112". _ Type Material Drilled: 0 'feet to 112 Giacial till 1 1 ? f~mt · to bedrock ~ to encountered 1 gpm at 355 ft. continued on to 370 ft. to ta to to to to HEFTY DRILLING 3540 AKULA DRIVE ANCHORAGE, AK 99516 (907) 345-0593 MUNICIPALITY OF A~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION RECEIVED MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMEN'I'AL ENGINEERING DIVISION 925 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE x,~NEW Alan M. Harala 346-2183 [~UPGRADE MAI LING ADDRESS P. 0. Box 10-2063, Anchorage, AK LEGAL DESCRIPTION Lot 3, Roehl Subdivision LOCATION 99510 NOiOFBEDROOMS 5 PERMIT NO. 850544 SectiOn 3~ I Well DISTANCE TO: 1 ~¢1 Manufacturer Greet I Manufacturer ~S~A~C~ ~o: I]70 No of lines I Eenqth of each ine ]' I 65 Top of tile to finish grade 4f~, + Length Width Type of crib Crib diameter DISTANCE TO: iClass Depth P~vate 200 f~. I J.: ...... Buildinq foundation DISTANCE TO: 25 f~. Township llN~ Range 3W Absorption area 5 ft. Dwelling 85 ft. Material steel Width Inside length Dwelling Material Foundation N s 100 ft.+ ~a~e t~t line Total65 le0qthft, of lines ~-~ench w ~tth Material beneath tile 60 ~ inches No. of compartments 2 Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO, 850544 Distance between lines Total effective absorption area 690 s. f. Depth Crib depth Total effective absorption area Building foundation Nearest lot line Driller Syren Bros. PERMIT NO. Distance to lot line 60 ft, ePtic tpnk 50 ft.+ PERMIT NO. 850544 I ffSc~ r p¢i~ n. area(s) OTHER PIPE MATERIALS ASTM D3034 PVC SOIL TEST RATING INSTALLER REMARKS density burial type styrofoam APPROVED DATE LEGAL P,O. SOX 6650 ANCHORAGE, ALASKA 99502-0650 90'7~ 264-4111 TOI~Y KN( MLES DEPARTMENT OF HEALTH & HUMAN SERVICES January 10, 1986 TO: Permit Applicant Subject: Permit # 850544 Lot 3 Roehl Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1985. Permits are issued on a calendar year basis by authority of Municipal Ordinance° A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system the original as-built inspection report(three part form) must be sent to this office for review and approval,and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, Susan E. Oswalt Program Manager On-site Services SEO/lj w enc: Copy of Permit F:'EF:;:I'4 1 T NO .~ DATE [SSLJED: i}EF:'ARTMEIkT ['IF HIEAL. TH AND ENVIRONMIEN"I~AL PROTE:CTION 8.?."5 L. ,S'TREE:-'T, ANCHCIRAGE, AK 9950 1 ~:'.64-4 7::-'.~C) 850544 08/2'7/85 APF::'L t CAN]": A D D R E S S: CONTA[]'T F:'HONE I..,,EGAL DESCRIP: L.OT SZZE~ MAX BED ROOMS: ALAN HARALA P. 0.. B[]X 10-2063 ANCHORAGE, AK 99510 346-2183 StJBD I V I,S I ON: ROEHL !BE{CT' I ON: 3 'T'OWNSI-I I P ." :1, 1N :1.. 14A (SQ. F'T. OR ACF?ES) RANGE ,", 3W BLOCk;: NA I...isted below are the c~pt.~on~-:i avail, able to yc)u :Ln designing yOLtP septic: system,, Choose the option that best {':i.~]s yOLtP site. DEF:']"I4 TO PIPE BOTTOM (FT.) 4.0 4.0 4.0 GRAVEl... DEP]"H (F']".) 5., 5 O. 5 3.5 T'OTAL DEPTH (FT'.) 9.5 4.5 7.5 GRAVEL. WIDT'H (F:"T.) 2.5 22_. () 5.0 GRAVEL. LENG'rH (FT.) 57.0, 43, 0 68.0 GRAVEL. VOLUMIE (CU. YDS.) 3:L.7 35. 1 50.4 ]"ANK SIZE (GALS) 1,500.0 .~.~ 1,500.0 *~ 1,50();0 ** SOIL. R(:YI"ING (SQ.FT. /BR) 125 125 125 · ~-,~ TANI< MUST HAVE AT L. EAST TWO COMPARTME;NTS I c:er'ti{y that: :I.. I am familiar' w:i.'!',.h 'f_he recluicemertts £or' on-site seweps and wells as set £or'th by the Municipality o~' Anchor'age (MOA) and the State o~' Alaska. 2. I w:i. ll ins'Lall t. he sys't:.en~ ~.n accordance wJ.'f..I-'~ all MOA' codes and r'egulatior'~s, and zn comp].zance with the des:~.gn cr'.i, ten.ta o{' this per'mit. 3. I will adhe~-e to all [~I[)A and State of Alaska r[-::qL.t].nements {'on the set back d:~stances ~'r'om any ~r,.,':i. stlng well, ~astewatep d:[sl::H-)sa], sys'[.er~ or pLtl]].zc: seweP, age system on th:i.s or any adjacent of near'by lot. 4. ] und~erstand that this permit is valid £op a ¢l~a),'lf~]Lt£~'i E)~' 5 bedPooms and any enlargemerrl' w~].], r'ec:tuire an add:i.t:i, ona]. per'mit. IF: A I....IFT ,C.~rT'AT ]: ON I~,~ INSTAI...LED IN AN AREA COVERED BY ME~A BLIIL..DING CODES, ]"HE:N (1) AN ELEC]"RICAL. F::'ERMIT AND INSF'EC] IDN MLJST BE OBTAINED; (2) AS-BLIIL..TS W]:L.L IqDT BE AFd='FROVED W:[THOU]' AN EL..ECTRICAL.. INSF:'ECTION REF:'ORT; AND (3) THE EI'.,,EC'TRICAL WORI,;:: MUST' BE DONE BY A L ICEIxlSED [ELECTRICIAN. S;. '[ GNIED ~~ ................................................................................. DATE: ......................................... AF:'y'L. :[ CAt~ ~ARAL..A MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L Street, Anchorage, Alaska 99501 2E~ 4720 SOILS LOG - PERCOLATION TEST [] SOILS LOG [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2, 3- 4- 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19, 20 SLOPE DATE PERFORMED: 7/~'~/~'~'' WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SITE PLAN eft COMMENTS-~.--"~/'~.,~ b.~'~ ~ ~'-'~' J~J~r~.~.~',~ Reading Date Gross Net Depth to Net Time Time Water . Drop S ,'.co /o ,,~, /o ~" / '~ ~-; ,~o ~o ~-~ /~ / ~ ~ ~ ~ ~,~ /~ ~" / ~" PERCOLATION RATE 8, ~ minutes/inch) TEST RUN BETWEEN /~' FT AND /3 ~'~. ET ! CERTIFIED BY: ~ ~- .~~--~ DATE: LOT 3 ~OEtlL SUBDIVIS .;~ Septic system install~ion ~hotos /85 level, Total excavation is 60~ below leach line elevation. 2. Leach lin~ ~,~as qed drair lacement upon 60" of dck. 6 Insulation coverage upon septic tank 7o Leach field insulation coverage Leach field insulation coverage MUNICIPALITY OF ANCHORAGE MEMORANDUM DATE: TO:. May 15, 1989 Department of Economic Development and Planning Zoning and Planning Section FROM: Department of Health and Human Services On-site Services Section SUBJECT: Request for Comments on Subdivisions May 19, 1989 The Environmental Services Division, On-site Services Section, of the Department of Health and Human.Services has r~viewed the following cases and has'these comments: S-8798: Lots 20, 21 Eaglewood Subdivision %4 - Vacation only No objection. S-8802: Lot 3A Roehl Subdivision DHHS has a record of a sewer system and well on each lot. We have no objedtion to the proposed subdivision, but will require that both wells and , sewer systems be, maintained in compliance with Municipal ordinances. S-8804: Lot 35B Bella Vista Subdivision %1 This lot has recently issued a Conditional Health Authority approval which requires either a new well be drilled or a connection made to public water. The Conditional is valid until July 1, 1989. We will require that the Health Authority be satisfied prior to final plat. Susan Oswalt On-site Services SO/ljw of O • Municipality of Anchorage On -Site Water and Wastewater Program 2 ' (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 020-092-99 Expiration Date: -7r ZZ 1. GENERAL INFORMATION Complete legal description Roehl Lot 3A Location (site address) 5445 E 172nd Ave. Anchorage AK Current Property owner(s) Willard & Gail Smith Day phone Mailing address Real Estate Agent 5445 E 172"d Ave. Anchorage AK 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: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Waiver/Variance request for: Received by: 4 Day phone TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ � Z am Date of Payment / —ZC9 ` 0Z Receipt Number 00-K2 e) 1 COSA # 6 - C_ Z ZJ Date: Waiver Fee $ _ Date of Payment Receipt Number Waiver # stance: 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name _KENNETH M. DUFFUS Q Datez/A Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen Oil 41 encroachments, deficiencies or discrepancies exist. �� _y `'11 A:" >e * 4- 9 TTH 6. DSD SIGNATURE ?� KENNETH =P'Il System #1 Approved for ___qbedrooms. I:I� System #2 Approved for bedrooms. rortasto�;•" ,� Disapproved.\� Conditional approval for bedrooms, with the following stipulations: ALIT yn,�r�,_ T F o 0= Arron 9 T "7 - VICES Original Certificate Date:_ mi —2�z� The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska, The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-1a12.doc Legal Description: Roehl Lot 3A If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 7/8/85 Total depth 205 ft Cased to 93 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 11/3/21 Static water level at beginning of test 78.6 ft. Comments B. TANK DATA Age of tank(s) New years Tank type/material Septic/Plastic Measured operating fluid level in septic tank New 10 Standpipes/foundation cleanout per record drawing Date of pumping New Install 6/3/22 D. ABSORPTION FIELD DATA Old Lot 4 System Which system tested (date installed) 7/18/88 ALL standpipes present per record drawing Total measured depth from grade 10 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A —pressurized field New depth 36 in 11 Monitor tubes go to bottom of effective. If not, state Elapsed time 1200 min depth into effective Code -required soil cover over field Final fluid depth 2 in ❑ System presoaked Absorption rate 750+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: Parcel ID: 020-092-99 Structure served by this system Well production at time of test 2.5 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes No Coliform bacteria is Negative Nitrate mg/L 11 Nitrate less than MRL (ND) Arsenic ug/L M Arsenic less than MRL (ND) Collected by Areterra Consulting Date of Sample 10/19/21 IFT STATION ❑ Requl aintenance completed Age of lift station years Lift station material Comments: Adequacy test date 11/8/21 Results Q✓ Pass For 4 bedrooms Fluid depth prior to test 2 in Water added 750 gal COSA Checklist yellow sheet 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 ft Wells on Adjacent Lots: Water Main > 10' Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25'2] Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Anima! Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No ft 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 ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® 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' 0 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 G. ENGINEER'S CERTIFICATION l 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. COSA Checklist yellow sheet ® Yes if No ® Yes if No ft W Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 020-092-99 Expiration Date: 1. GENERAL INFORMATION Complete legal description Roehl Lot 3A Location (site address) 5445 E 172nd Ave. Anchorage, AK x-17 -2- Current Property owner(s) Willard & Gail Smith Day phone Mailing address Real Estate Agent 5445 E 172nd Ave. Anchorage, AK 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: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ WaiverNariance request for: Received by: 4 Day phone TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ ��t/ 2L (J Waiver Fee $ Date of Payment " 2-0 ' 2Z Date of Payment Receipt Number 0 �K (91 C? Receipt Number COSA # (9,sc— 221 0 13 Waiver # istance: 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUTPU_S Date //B% Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future �� o \ \ occupants or can ArcTerra guarantee that no unseen AW encroachments; Ll..nclas ar-discrepancies exist. OF -41 <ti r �Y,1- C) T LI* 6. DSD SIGNATURE System #1 Approved for bedrooms. ` �� T-11. System #2 Approved for bedrooms. q `, /8 z\�� or•�;ssto•'' ' -� Disapproved. Conditional approval for bedrooms, with the following `tt k�pt 66"sPF.q s ct4dw MOVU VV T E R -A N.D m 'ATER z� \ V\J e By:._ J� Original Certificate Date:; / 7% 2C'ZZ The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other _____ COSA blue sheet -10-10-12 doc Legal Description: Roehl Lot 3A Parcel ID: 020-092-99 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 7/8/85 Total depth 205 ft Cased to 93 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 11/3/21 Static water level at beginning of test 78.6 ft. S Qmmen B. TANK DATA Age of tank(s) 35* years Tank type/material Septic/Steel Measured operating fluid level in septic tank 49" Standpipes/foundation cleanout per record drawing Date of pumping * Conditional COSA requested. D. ABSORPTION FIELD DATA Old Lot 4 System Which system tested (date installed) 7/18188 ALL standpipes present per record drawing Total measured depth from grade 10 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A — pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Well production at time of test 2.5 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes M No Coliform bacteria is Negative Nitrate mg/L in Nitrate less than MRL (ND) Arsenic ug/L M Arsenic less than MRL (ND) Collected by Areterra Consulting Date of Sample 10/19/21 IFT STATION ElRequ r aintenance,completed Age of lift station years Lift station material Comments: Adequacy test date 11/8/21 Results Q Pass For 4 bedrooms Fluid depth prior to test 2 in Water added 750 gal New depth 36 in Elapsed time 1200 min Final fluid depth 2 in Absorption rate 750+ gpd Any rejuvenation treatment (past 12 months) 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' Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft 23 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' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Surface Water > 100' ® Yes Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No ft 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 ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water --Maim ,._1.0'-- -.__..._._.._-_ _O Yes- . if No ft _ _ Community_ e!L---?_2oo'.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' Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' ® Yes if No ft Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION / certify that / 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. COSA Checklist yellow sheet DocuSign Envelope ID: C40BEBA3-28A6-4EE7-80BC-98D85C5A66BF ESCROW HOLDBACK AGREEMENT To: Municipality of Anchorage Agreement between: Smith and Greenbaum Property Address: 5445 E 172"d Avenue, Anchorage, AK 99516 File No. 1551344 Amount withheld: $16,228.50 The undersigned parties authorize Stewart Title to escrow funds in the amount of $16,228.50 from the seller For the purpose of: Replace Septic Tank It is the sole responsibility of the undersigned parties to provide invoices to Stewart Title for payment. Upon receipt and with Municipality approval, Stewart Title shall pay invoices for the above-mentioned work. In the event parties are requesting to be reimbursed for invoices they paid out of pocket, Stewart Title will require evidence of paid invoices before any reimbursement is paid. Once work is complete and invoices paid; any excess funds will be refunded to the seller. The undersigned parties hereby jointly and severally indemnify and hold Stewart Title harmless from and against all costs, damages, judgments, attorneys' fees, expenses or obligations of every kind and descriptions which, in good faith, it may incur or suffer in connection with this escrow holdback. Dated: lib >'u �4,2 nz2 Bu er: DocuSigned by: DocuSigned by: _ 06KAI an t ,Alan. 5via, atn,t,In,'A.UaM hd2Bc7&pwnbaum Ns PW8Qfo'Q114Rum Seller(s): Willard C Smith Jr. \ / ZN' L. Smith READ AND APPROVED Y: Munici ' )�-et ch ge January 17, 2022 I1CI I ERRA CONSULTING, INC 20441 Ptarmigan Bid, Eagle River, AK 99577 Office (907) 696-6111, Fax (907) 868-3793 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Conditional COSA - Roehl Lot 3A The owner has requested we proceed forward to obtain a conditional COSA with a septic tank upgrade permit to replace the existing 1500 gallon tank that serves the existing house on the subject lot. The leachfield passed our adequacy on 11/8/21 and field inspection does not show any indication of failure. The property is served by a private well and there are no wells within 100 feet. The septic tank will be replaced with a 1500 gallon tank. The house is currently vacant, and we see no health and safty issues at this time. The adjacent lots are served by public and private wells more than 100 feet from the septic system on this lot. There is no surface water within 100' of the proposed tank. The new system will be outside all protective well radii. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/ FAX 868- 3793. Respectfully submitted, ArcTerra Consulting, Inc. Kenneth M. Duffi Attachments: On -Site Sewer Application Wastewater Absorption System Details/ Site Plan 20441 PTARMIGAN BLVD - EAGLE RIVER, AK 99577-8736 - PH (907) 868-3791 - FAX (907) 868-3793 Septic Tank Advisory Certificate of On -Site Systems Approval #OSC 221013 Subdivision: Roehl Lot 3A Starting at 35 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this p"roperty is 20 years old. Typical replacement costs range from $9,000 to $12,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 -year-old steel tank MAY look like. Mailing Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org '-qELIMINARY PLAT APPLICATION OFFICE U~(~'~ Municipality of Anchorage DEPARTMENT OF COMMUNITY PLANNING REC'D BY P.O. BOX 6650 VERIFY OWN: Anchorage, Alaska 99502-0650 Please fill in the information requested below. Print one letter or number per block. Do not write in the shaded blocks. 0. Case Number (IF KNOWN) 1. Vacation Code 2. New abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOTS 34). 3. Existing abbreviateO legal 0oscription (T~ 2~ ~2W SEC 2 COl 45 OB S~O~I SUB BkK 3 kOI 34) full legal on back pa~e. 4. Petitioner's Name (Last- First) '~ ~,~1~1~1~1. I~1..101~1~1~1 I I I I I I I I II I I It I I I Address [ [ ~ ~ ~ --~k.L ./. ~'-<5 0-C'~ ~:~. City ~-'~ ~/C~U..-~-.~ State Phone No. '~-t ~, -[~,~ ~ %~. Bill Me ~ Z 77 Petitioner's Representative IIitl ' Address ~ Phone No. f~" ° ~f'"~ Bill Me __ 6. Petition Area 7. Proposed 8. Existing 9. Traffic 10. Grid Number 11. Zone Number Number Analysis Zone Acreage Lots Lots I I1 I 111 I I I III IIII 12. Fees '"~'¢'(~ ,~'~t ~' 13.-CommunityCounci, ~e~)l,~'- B. I hereby certify that (I am) (I have been authorized to act for) the owner of the property described above and that I desire to subdivide it in conformance with Chapter 21 of the Anchorage Municipal Code of Ordinances. I understand that payment of the basic subdivision fee is nonrefundable and is to cover the costs associated with processing this application, that it does not assure approval of the subdivision. I also understand that additional fees may be assessed if the Municipality's costs to process this application exceed the basic fee. I further understand that assigned hearing dates are tentative and may be have to postponed by Planning Staff, Platting Board, Planning Commission, or the Assembly dueto administrative reasons. S}gnature 'Agents must .provide written proof or authorization. Date: C. Please check or fill in the followh,g: 1. Comprehensive Plan -- Land Use Classification ~' Residential Commercial Parks/Open Space Transportation Related 2. Comprehensive Plan -- Land Use Intensity Special Study 3. Environmental Factors (if any): a. Wetland 1. Developable 2. Conservation 3. Preservation Marginal Land Commercial/Industrial Public Lands/Institutions Dwelling Units per Acre Alpine/Slope Affected b. Avalanche c. Floodplain d. Seismic Zone (Harding/Lawson) D. Please indicate below if any of these events have occurred in the last three years on the property. Rezoning Case Number Subdivision Case Number Conditional Use Case Number Zoning Variance Case Number Enforcement Action For Building/Land Use Permit For 1~,~,~'~ ~-~2..~'~,,' 0"~ ~"~" ~r ,,~ ~'~,~ Army Corp of Engineers Permit E. Legal description for advertising. Alpine/Slope Affected Industrial Special Study F. Checklist Waiver "- 30 Copies of Plat Reduced Copy of Plat (8Y~ x 11) Certificate to Plat Fee Topo Map 3 Copies Soils Report 4 Copies Aerial Photo Housing Stock Map Zoning Map Water: ' Sewer: x 20-003 Back (4,85j Private Wells Community Well Private Septic Community Sys. Public Utility Public Utility ' Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and 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 FOR A SINGLE FAMILY DWELLING Parcel I.D. 020-092-99 GENERAL INFORMATION Complete legal description Location (site address) COSA # ~, ~D ~---. Expiration Date: Lot 3A, Roehl Subdivision 5445 East 72nd Avenue Anchorage, AK 99516 Current Property owner(s) Rick R. Clemens Mailing address 2230 Mouton Drive Carson City NV 89706 Day phone Lending agency Mailing address Day phone Real Estate Agent Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: Four (4) Day phone 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 pdvate or Class C well and may be reissued with new water sample results. (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, I vedfy that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. DSD ~.~IATURE ~ Approved for ~ Disapproved. Conditional approval for bedrooms. Phone 522-7773 bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev. 11105) X Arsenic Advi.sory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: / (~ ~ ~,~ 7~// Municipality of Anchorage Development Services Department Building Safety Division On-Site. Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type Private Date completed 7/8/85 Total depth 205 ft. Lot 3A, Roehl Subdivision If A, B, or C provide PWSID # Sanitary seal (Y/N) Y Cased to 93 FROM WELL LOG 7/8/85 Date of test Static water level 51 ff. 3 g.p.m. Nitrate N/D mg/L Date of sample! lO/18/11 Bo Well production WATER SAMPLE RESULTS: Coliform o colonies/10OmL Arsenic: N/D ug/I SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Number of Compartments Two Depression over tank (Y/N) ~ Pumper Tank size 1,5oo gal. Foundation cleanout (Y/N) Y Date of pumping No Sludge C. ABSORPTION FIELD DATA Date installed 3/1986 Length 65 ft. Total depth 10 ft. N Parcel ID: 020-092-99 Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 10/21/2011 68.6 ft. 2.5 g.p.m. Collected by: MEA Y Soil rating (g.p.d./ff~ or ft2/bdrm) 125 SF/BDRM Width 4 ff. Eft. absorption area 65o ft2 Monitoring tube Date installed 3/1986 Cleanouts (Y/N) High water alarm (Y/N) Date of adequacy test 10/21/11 Results (Pass/Fail) Pass Fluid depth in absorption field before test 0 in. Water added 655 gal. New depth Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 600 Any rejuvenation treatment(past 12 mo.) (YiN & type) N If yes, give date System type Deep Trench Gravel below pipe 5 Y Depression over field N For 4 bedrooms 0 Y >18 in. in. g.p.d. LIFT STATION Date installed ."Pump on" level at Datum in, E. SEPARATION DISTANCES Size in gallons "Pump off" level at Cycles tested in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot >100' Absorption field on lot >100' Public sewer main N/A Sewer/septic service line >25' Animal containment areas >50' Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? in. On adjacent lots >1oo' On adjacent lots >lOO' Public sewer manholelcleanout Holding tank N/A Manure/~nimal excrete storage areas N/A >100' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation. >5' Property line >5' Water main N/A Water service line >1o' Wells on adjacent lots >lOO' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >1o' Building foundation >1o' Water Service line >1o' Surface water >1oo' Curtain drain None Noted Wells on adjacent lots >lOO' COMMENTS: Absorption field >5' Surface water >1oo' Water main >10' Driveway, parking/vehicle storage >25' 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 Michael E. Anderson, P.E. Date 10/24/2011 COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number z~,,,~ o,~¢' N89° 51' 41"W 300.34' I ~ I~ ~ 6 I-- i~o z , ~¢"~ 3O' I ~ 3oo.~o' s89~ 55, 17-E ~ EAST 172nd AVENUE UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOR CONS~UC~ON OR FOR ESTABLISHING BOUNDARY O~ FENCE LINES. THE SUR~YOR TAKES RESPONSIBILITY FOR THE INI~AL ~ANSACTION ~LY AND ASSUMES RNANCIAL LIABILITY ONLY FOR ~E COST OF THE SURLY. LIS~D DISTANCES PREVAIL O~R SCAMNG. REPROOUC~ON MAY CAU~ ERRORS IN SCALE. ~ ~OT ~.~ SURVEY TYPE ~ r~O. *S-aU~LT SYMBOLS ~ FmNAL SmUC~RE AS-BUILT ~ SET REBAR ~ ~ DRAINAGE ~ ASPHALT ~ PLOT PLAN , . AS-BUILT . . . LOT ~R~Y . , , T~OG~HY O F~ND ERBAR C C O WOOD FENCE ~ CONCRETE ~ AS-BUILT . . . NO CORNERS SET ~ RE~RaRCA~ON AS-~ILT . . NO C~N~S ~T ~ ASSUMED ELEV, ~ ~ ~ METAL FENCE ~ WOOD DECK PLOT PLANS ~ LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OF THE ~UILDER OR OWNER, PRIOR TO ONLY ~OSE IMPRO~MENTS ABOVE GROUND AND ~SIBLE ~LL CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHO~. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRI~WAYS TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DE~RMINE ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW THE EXIS~NCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PEE~NT SOME IMPEDIMENTS FROM BEING SEEN AND LOCA~D. WHICH DO NOT APPEAR ON THE RECORDE0 SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. SURVEY CERTIFICATION .~mmm- Prep o red b y OF Robert E. Johns Jr. & Assoc. ........ · , ............. , ................. ~ee. Professional Land Surveyors .............. ~o.1~ m~ ~litiel, ~1 dimm[m~ ho~ ~m~ ~~~ ANCHORAGE. ALASKA 99504 ~ ~th s:.le: R~. Lot S.[ Re~. ~o~,~o, ~-.~,~ .......... 1" = 60' ho~ perf~ on A~t ~y of ~e~.~ Dote Surve~d: Drown b~ Checked b~ .................... , ......... . 10/20/11 REJaMK ~omn oth~im& ¢ O ~ Dote Drown: Grid: W.O. ~~ 21 ~ ./..~ 10/20/11 3337 11-368 RNAL S~UC~RE AS-BUILT ~ % ¢ ~ ~ I, ")(¢t ~. ~"l, ~-, "l~y )~l¢y t"~t m ~ ~e *' ," ~(--~ Legal Description: ........................ ~¢Z**o' .......... , ~[.~' LOT 3A