Loading...
HomeMy WebLinkAboutTANAINA VALLEY LT 19 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221275 PID Number: 011-051-94 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name PIPER MACHAMER ABSORPTION FIELD — EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 6320 TAY CIRCLE, ANCHORAGE, AK 99502 ❑ Other Phone Number o f Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot TANAINA VALLEY 19 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line FtZ Ft. Well 200'+ -- 25'+ TANK N Septic ❑ S.T.E.P. ❑ Holding ❑ Other: Manufacturer GREER Capacity 1250 Gal. Surface Water 100'+-- Material HDPE Number of compartments 2 Lot Line 5'+ __ NA Foundation *5' __ LIFT STATION Manufacturer Capacity Gal. Remarks S.T. INSTALLED IN SAME LOCATION - VERY TIGHT W/ *WAIVERS SEE ATTACHED. Alarm location Electrical installed by Installer MIKE N ANDERSON Tank to PIPE MATERIAL House to tank 3034 draintield 3034 Drainfield 3034 CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspection Ist 8/09/22 2nd 8/10/22 Location and description 31d 8/18/22 4th TOP OF MANHOLE ON-SITE WATER AND WASTEWATER SECTION APPROVAL \ -+ i , .low, -'� l� Conditional Approval: Date .. 11.: Septic System Curtis Huffman. j� Approve / © Date O r �Z / �'•"- C128991 • r� �c�sl ' / • . 8/19/22 AW il�F�pROFESSION�`�'�.. Note: this approval does not include well permit requirements. kmev voiuZi ia/ NEW HDPE TANK INSTALL DESIGN DETAILS SEE MOA FILE W/ EXISTING SITE & 2022 FWC WAIVER LETTER REGARDING EXISTING SEPTIC SYSTEM, FOUNDATION, WATER SERVICE LINE, ETC.... +5.7' EXISTING GRADE - ELEVATED AT S.T. in ASSUMED FOOTER r -i `t ELEVATION \ FROM EXISTING GRADE \�� 1250 -GAL \ SEPTIC TANK \ 6.5'W NEW HDPE TANK BEDDED \ PER MFR REQ. \ BASED ON HOLT ASB, MOA RECORD DOCS, \ So MIKE N. ANDERSON (MNA) - PE STAKES, MOA Fy CONSTRUCTION SITE INSPECTION, MARKINGS & VISUAL OBSERVATIONS. MNA LOCATED & STAKED WATER LINE PRIOR TO CONSTRUCTION & INSPECTIONS. APPROXIMATE WATER LINE \ S� BASED ON THIS & IS ASSUMED 1-2'+'- PER ALL \ TYPICAL UNDERGROUND UTILITY MARKINGS. "T" \ CO USED FOR MAINTENANCE BETWEEN NEW TANK & FIELD. MNA LOCATED BEGINNING OF \ FIELD & TO AVOID ADDITIONAL DISTURBANCE. A \ "T" CO SWEEPS BOTH WAYS FOR MAINTENANCE. \ TANAINA VALLEY LT 19 SUPPORT$SERVICES: PREPARED FOR: ��� OFAZ �� CYNTHIA CARTLEDGE 6320 TAY CIRCLE C ANCHORAGE, AK 99502 �� 9 TH tis Huffman FIRST WATER CONSULTING DATE: 8/19/22 13030 SUES WAY SURVEY: HOLT 2022 CE 128991 ANCHORAGE, AK 99516 907-350-9566 FirstWaterAK©gmail.com SCALE 1" = 5 � s/19/2022 v� " SSI°1o' PID: 0011-051-94 PERMIT: OSP221275 A -C=9.9' B -C=23,8' A -D=13.0' B -D=27,3' A -E=18,0' B -E=32,1' Gy G :VATED WALL. FG SEE ATTACHED LETTER REGARDING WAIVERS TO EXISTING SEPTIC, WATERLINE, FOUNDATION, DRIVE,... ETC DCO "E" IS A "T" CO THAT ALLOWS CLEANING / �qp SNAKING OR JETTING TOWARDS TANK AND SHORTER FIELD. O E TAR OF CO DCO Tiy9 SEPTIC SECTION SCALE, NTS TEL & ELEC ESMT.. TANAINA VALLEY LT 19 SUPPORTIIISERVICES: PREPARED FOR: OF At � 1 CYNTHIA CARTLEDGE & LOUIE WIEGERS rwcs 6320 TAY CIRCLE * 9 TH* ANCHORAGE, AK 99502 FIRST WATER CONSULTING DATE: 8/18/22 ` rtes Huffman , / 13030 SUES WAY SURVEY: HOLT2022 CE 128991 w DRAWN: FWCS '4 AO ANCHORAGE, AK 99516 SCALE: 1" = 30' 8/18/2022,er \FESSIOII�' 907-350-9566 FirstWaterAK@gmail.com \`__� Municipality of Anchorage "` s l _ )ejla amen[ P.O. Box 196650 e 4700 Elmore Road Anchorage, Alaska 99519-6650 s (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV221061 COSA#:OSC221412 Permit#: PID#: 011-051-94 Legal Description: TANAINA VALLEY LT 19 Engineer: First Water Consulting Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the waterline has been approved. The approved separation distance is 8.0 feet. In addition, the tank is approved to be 4' from the field. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date: 0/32)0/0- -Z- Approved by:ke4�Lx Name of Review **** VARIAN C E/WAIVER REVIEW **** tx FIrst Water C O N S U L T I N G " >. ,.E,a 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com August 19, 2022 Municipalities of Anchorage On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: TANAINA VALLEY LOT 19 - VARIOUS WAIVERS Due to very limited site constraints (field, foundation, elevations, water service line,...), the existing tank was removed, properly decommissioned and the new HDPE tank installed in the same location. Given the justification below, we respectfully request a 5' new tank to foundation, 4' from existing trench to new tank and 8' from existing field to water service line waivers be granted at this time. Granting of these waivers will not impact any of the neighboring properties. The original, old tank was in the same location and from the foundation for the past 35 years without any known issues or adverse impacts, the improved new tank is made of higher quality HDPE material with proper bedding and would appear to have minimum if any impact on the foundation and the compacted sandy soils. A "T" cleanout was installed as shown to prevent any disturbance to the existing short 62' long septic field & site, the field was not impacted during excavation and to allow maintenance to the new tank and existing field. The existing field is located along the paved driveway, under an elevated blocked retaining wall and has had no known issues for the past 35 years. The tank upgrade was installed in the best and logical location per the site, per MOA on-site construction inspection and excavation. The site and service waterline were marked prior to construction and appears the existing field may be within 8-10' of the existing field / septic system, but MOA documents (IR & COSAs) show required separations. Granting of all of these waivers is justified since the existing system has been in operation since 1987 with no known issues or ill effects to the adjacent or subject property and it is anticipated that the existing septic system will not impact the neighboring property. Sincerely, Curtis Huffman, P.E. FFS[ W6 �,,„„l11 �R (Iti6 ti ICES n'i 1'?P>! a e LG NlIIH6 ST98-£ZZ ZOS66 XV`39VdOHJNV 3AIY0 Y3AOa0 60£6 9NIA3AHnS ONV7 170H 85-9ZZ Z05h ee0e 1S17917V 30.(VO H1 tr S/Hl VYSV7V:79 &01-1JNV I V 031 d0 0310N NVH1 Y314101S/X3 S1N3WH0V0Y0N3 3791SIA ON ONd S3N17AIY3d0Yd 3H1 N/Hl/M 3YV NO3b'3H1 031 b'nt/S S1N34V3AOY&W/ 379/SUl 31-111 VI -11 ONb' 'VVSV7V 10/&1S/O JN1GH0J-7Y3DVY0HJNV 9175,(377VA VN/VNVI 61107 AlY3dOY& 039210S30.9N1M077033H1 30 A711YnS bO3PVYOdY3d-7A VI/1VHl.(.111X130A9-7Y914/ 31VO SIH113S SH3NNOO ON ,00 ,.l A.3A&nS-L7In9SV 1.AS3 :7373 v 3731 '3JI YO/ONY NONS 3AISS3JX3 01 3170 31VNIXONddY 38 AYN NO3Y3H N170HS 9NIAYd ANY 'S1N3N3AOYd1JI 7YNOI1I00V NOIJISOd 90 S3N17 A1Y3dOYd 3NNN3130 O1 03S17 38 01 JON 3YV 9NI17YNd" SIHI NO YV3ddY AVN 1VH1 S3NI73JN3d -310N (031VJI(7NI SS37N17 ) NO3Y3H N170HS ION 3YV L 1 V7d 0&0J3)/ 3HI NO 9NIYY3ddV 3SOH1 NVHI Y3H10 `Ob'OJ3Y d0 S1N3N3SV3 'S3NI73JN3d NO IS1N3N3AOYdNI `S3Y171J1791S 7VNOI.LI00Y 9NINOI.IISOd Y03 03S17 38 01 JON SI QNV `S1N3N3SY3 YOI(INV S3N17 107 0311V7d MY S38171J17Y1S 9NI1SIX3 N3311138 SJJI7dNOJ ANY 170HS O1 A77YJIdIJ3dS SNOI1171I1SNI 9NION37 d0 3517 3H1 YO -4 SI NO3Y3H NOIIYNYOdNI 3HI 030/A08d S/ NO/SS/WU3d N311/LM S937N17031/H/HOYd S/S3/18Vd OM/H1 AH'JN/MV80 S/Hl d03S/l ANV :(3AY0S S/Hl j031V03H1 d0 SV OH003Uj0 H3NM0 3H1 YOj 03YVd3Yd 3YV NO3Y3H S1N3iY3YNSV3m CNV V1VCA3AYNS3HI o e1 �yuolssaJ045.7 Q a 6169-S1 2 110H 'V 3NVHS ° a . ..•aye 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: OSP221275 Work Type: SepticTank Upgrade Tax Code Number: 01105194000 Site legal Address: TANAINA VALLEY LT 19 G:2122 Site Mailing Address: 6320 TAY CIR, Anchorage Owner: CARTLEDGE CYNTHIA L & Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: 11,cnr S, i)�Irtrerricnt 7/28/2022 7/28/2023 31301 ❑ Disposal Field 0 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 (2417). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: 1. Locatethe beginning of the field prior to installation to confirm that the 5'separation between the tank and field will be met. Install a cleanout so the field can be located in the future. 2. Locate the water line prior to construction and show the water line location on the record drawing. Received B) Issued By: 7/28/22 Date: Date: 4 MUHUPA LIT Y OF " NCHO RA GE Development Services Department `' r° Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTICIWELL PERMIT APPLICATION Parcel I.D. 011-051-94 Property owner(s) CYNTHIA CART ... & LOUIE WIEGERS Day phone Mailing address 6320 TAY CIRCLE, ANCHORAGE, AK 99502 Site address 6320 TAY CIRCLE, ANCHORAGE, AK 99502 Legal description (Sub'd., Block & Lot) TANAINA VALLEY LOT 19 Legal description (Township, Range & Section) Lot Size 31,301 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank El ❑ Upgrade (D) El Holding Tank ❑ RenewalDuplex ❑ 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. (Signature of'property owner or authorized agent) Permit/Rush Fees: 4'Za 5 Waiver Fees: Date of Payment: 11 1 1 � 0 -� R Date of Payment: Receipt Number: 11'9 19 O Receipt Number: Permit No. O S Paa 10 5 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com July 18, 2022 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: TANAIANA VALLEY LOT 19 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1250-gallon HDPE tank per the attached design to serve the existing 4-bedroom residence. The lot and area are served by public water and the water line will be located prior to septic tank installation. AWWU did not have the connect card, but just the water mainline. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221275, Deb Wockenfuss, 07/28/22 FIRST WATER CONSULTING NO WELLS WITHIN 200' OF PROPOSED SEPTIC TANK TANAINA VALLEY LT 19 DESIGN DETAILS: TAY CIRCLE 10' TEL. ESMT. EXISTING HOUSE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221275, Deb Wockenfuss, 07/28/22 MUNICIPALITY OF ANCHORAGE DE RTMENT OF HEALTH AND HUMAN SER ES Eevironmenlal Health Division 825 "L" Street, ANchorage. Alaska 99502, Telephone 264-4720 :' ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELl. INSPECTION REPORT Nome Address Phone(s) TANKS SEPTIC [] HOLDING l TYPE OF SYSTEM ~,,'rRENCH [] BED [~ W. DRAIN [] OTHER Fill addod above original grade FT FT WELLS PRIVATE "~ OTHER (Identilv) REMARKS: DISTANCES TANK FIELO WELL LOT LINE FOUNDATION ~? z /(~ ,* ~-~---- 4¢ I~unicipal end Slale IJuJdelJlleS ill elfecl ell Ibis dale: scal~: x/*r,5' · Inspections Perlormed by: __ certiJy Ihel this ittspeclJell was pedermed according to all ENGINEER'S SEAL 1:~OI'.4'I','~L:I F'JiC)NIi!i: :', l..i:!'l' ~S :[ Z I!i: :: ,~ 70 C:, C)'.;?~ 0 :)./0;/./(ii) 7 DIiZF:'III 1(:1 F:';I;PE ilIJ) l'J'E)l'*l (J:'J.) (:il::';¢'.iVJ;;l, DE!J;:' It'l (I l'~ ) '1 Ci'l f~l.. Dlri:F:'t'iI (F:"t . ) (:~I::'~('~VI!:L.. t4 :l: !)TI'I (F"I ,, ) ii)l:(['lVli;l... I,.IENi:)'I'I'I (F::'I ,, ) I' (~ HI'::: S ]: Zll; S!::) ]: L. F:;:¢YI' ]; I'dG (!i-~[;! ,, F:'I' ,, /~1:'4 ) 20- COMMENTS Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST {ENGI~ER'S SEAL) SLOPE WAS GROUND WATER ,/~ ENCOUNTERED? IF YES, AT WHAT DEPTH? IJepth to Waler ^[ler SITE PLAN S Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE //~5-,~ (m,nutes/,nch) PERC HOLE DIAMETER __ ],~),~U~ N ~,ET WE E N ¢~"/ FT/AND ~" FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DA'rE. DATE: 72-008 (Rev. 4/85) ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO CA~CU~A~S,,¥__ ~' ,'J"~"/ CHECKED 8Y SCALE / ;~'0 [)ATE PERFORMED FOR: LEGAL DESCRIPTION:~'~ / 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20- Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502~0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: Township, Range, Section: (ENGINEEF~ SLOPE SITE PLAN ENCOUNTERED? S IF YES, AT WHAT ~ DEPTH? p E Deplh [o W~ler Monilori.ll? ~'~"7 Oate: Reading Date Gross Net Depth to Net Time Time Water Drop ¢ ( '~¢-*/"/ /o ¢ .¢.,-.,,¢' ¢') /~.¢-/¢?fo /~/,J ,(.,o - .,/'/ ,/? PERCOLATION RATE -~'~ ~'- (minutes/inch) PERC HOLE DIAMETER .E.FORMED BY: ~ ~ ~/~X I ~ ~-- CERTIFY THAT THIS TEST WAS PE.FORMED I. ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE: ~ 72-008 (Rev. 4/85} 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. 011-051-94 Legal description Tanaina Valley Lot 19 Site address 6320 Tay Circle Anchorage AK Current property owner(s) Louie Wiegers Expiration Date: 823-1--22__�' ,�?-3 1-20 2� <J!�__ X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: � ^ �2 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) islare 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 Approval_June 2022 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907 -343 - On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 011-051-94 Complete legal description TANAINA VALLEY LOT 19 Location (site address) 6320 TAY CIRCLE, ANCHORAGE, AK 99502 Current property owner(s) LOUIE WIEGERS & CYNTHIA CARTLEDGE Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 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 Z Plastic ❑ Concrete ❑ Fiberglass Age 0 - 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 $ Waiver Fee $ Date of Payment 016-IZ 2 COSA# 0sC2Z I y)? Date of Payment Waiver # 05 V ZZ 10 61 COSA Application—July 2022 copy.doc Legal Description: TANAINA VALLEY LOT 19 Parcel ID: 011-051-94 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. (COMMUNITY WELL) WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NA NEW HDPE TANK ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 3/5/1987 ® ALL standpipes present per record drawing Total measured depth from grade 7_3 ft (max) Measured depth to pipe invert from grade 3_2 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 4_2' ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Well production at time of test gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ❑ Nc ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 7/14/22 Results M Pass Fluid depth prior to test 2 in Water added 750 gal New fluid depth 30 in Elapsed time 1020 min Final fluid depth 0 in (WET MOSTLY DRY) Absorption rate 600+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 90 in Effective depth used 50 in Effective depth remaining 14R in Comments/Deficiencies: MT/CO AT GRADE WITH EXISTING BLOCKED RETAINING WALL ETC... F COSA Checklist—July 2022 copy.docx 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' 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' ❑ 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/Animal Excreta Storage > 100' Community Sewer Main > 75' E] 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' ❑ Yes if No *5+ ft Surface Water >' 100 _ ®Yes if No ft Tank to Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ® 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 *8-10 ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *SEE ATTACHED LETTER & WAIVER REQUEST TO EXISTING SEPTIC FOUNDATION WATERLINE... 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 Finn FIRST WATER CONSULTING Phone 907-350-9566 Engineer's Printed Name CURTIS HUFFMAN, PE Date 8119122 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 or NO 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 & FWC5 COSA Checklist—July 2022 copy.docx *: 49 TH ....•:* �.• • Curtis Huffman :4 c�c • CE 128991 %f} • . • 8/19/22 • •� r il;F� PROFESSION QW MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWFLLING Parcel I.D.# ~\ - ~,~\-°'t~-I HAA# 1. GENERAL INFORMATION Complete legal description Lot 19; Tanaina Va~ey Subdivision; Location (site address or directions) 47;¢0 T~y C~'~Y~ Property owner Mailing address Lending agency Mailing address Alexander & Mary Qu6zada 6320 Tay Circle, Anchora~6, Alaska Day phone 248-9195 99502 Day phone Agent Dave Aquino Fortune Properties~Inc. Address 3000 A $t~¢.¢~, Anoh~¢rag¢. Afl- Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: Day phone =_ :,562- 7653 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 If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA ~21 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 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 Address Engineer's signature Phone Date DHHS SIGNATURE Approved for .. '. Disapproved. __ Conditional approval for bedrooms. 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 th is 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. 72-025 (Rev. 1/91) Back MOA ~21 Legal Description: A. WELL DATA Well type A Municipality of Anchorage s^,~ Department of Health &Hurnan Services HEALTH AUTHORITY APPROVAL CHECKLIST ~T ~ ~ ~ %/~ Parcel I.D. ,~ ] ~ '~,'/ If A, B, or C, attach ADEC letter. ADEC water system number ~ Log present(Y/N) Date completed Driller Total depth ____Cased to _ Casing height ~_~ Sanitary seal (Y/N) Wires properly .ErJ:~ect~/N) FROM WELL I. OG.~ AT INSPECTION Date of test ~ ' Static Water level ~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~-oO~ ¥ Absorption field on lot ~,c:~~ ~' ; On adjacent lots ; On adjacent lots Public sewer main Public sewer manhole/cleanout Public sewer service line · WATER SAMPLE RESu~ Coliform ~ Nitrate Date ~e: Collected by: P~etr~eurf'Ft~n k Other bacteria SEPTIC/HOLDING TANK DATA Date installed ~ * ~'-- ~'~ Tank size I'-L.~ o _ Compartments ~. Cleanouts ~N) X/ Foundation cleanout (~;~N) _ %/ Depression (Y~ High water alarm (Y/N) ¢'/~ Alarm tested (Y/N) ~q' J/~ Date of pumping ~. o~ . ~ \ /~r- ¢~¢~d c_. (-~¢z.,J ,C~.S, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot '2.~ c~ To property line /_C~ Surface water/drainage On adjacent lots Absorption field Foundation ~; Water main/service line_~l~-' /~S) ¢ 72-026 (Rev. 3/91) Front MOA 21 CONTINU ED ON BACK PAGE C. LIFT STATION Date installed , ,~,~,O Manufacturer Size in gall~ns"~ Manhole/Access (Y/N) '"~.~r~'i(Y/N ) ' '~.~O5'~ "Pump on" level at ~t ~'~HM iegeht s'~'r ~. t~rli ~ a~l c~o ~~Oy~les tested __ __ /N) ~ATION TO: '~ Well on lot On ad acent I t j o s Surface water D. ABSORPTION FIELD DATA Date installed "~ -'-~ Length ~27--~ Width Total absorption area Depression over field (Y~:) Results ~ail) Soil rating ~-.-'-~'"'~ ~/~¢-- System type Gravel thickness -~, ~' ' Total depth Cleanouts present ~N) Date of adequacy teat ,¢¢ _c~ _ for ~¢z:~ ,o ~-.- d,...~¢ '") bedrooms Peroxide treatment (past 12 months)(Y~) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ¢ c~°~ On adjacent lots If yes, give date ~'~//~ Cutbank Property line __ To existing or abandoned system on lot Water main/service line Driveway, parking/vehicle storage area To building foundation On adjacent lots "'~ Surface water Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name Date 7024 ;;%;Io River Loop Road No, 204 HAA Fee $ //7~) ~ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-028 (Rev. 3/91) Back MOA 21 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES D ws oN OF ENV,RONM .NTAL SERWCES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL /~/~_ ~.,_~,,~ / OF ON-SITE SEWER AND WATER FACILITY 264-47'44 Application Date ¢~,//~ ~,.'~ .~, 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) L0catio.'ih. iad.dress.~ .' . dr'db'(.,., Ctions) (b) ,' Prop~ O~ef"¢~ ~ ~ ~¢~elepho~: Home~ . Business Ma';i;~g-A0dress. ;.,',"~., ~/ ~~~ ~ (d) Real E~tate Compan~nd Agent Address Telephone (e) Mail the HAA to the followino address: or; Check here [], if hold for pick up. List contact person and~ay phone number below. ~- i TYPE OF RES,~ENCE Single-Family..X Number of BeOrooms WATER SUPPLY Individual Well [] Community~ Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite'~ Public [] Community [] Holding Tank [] Note; If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status, Page 1 of 2 72-025 (Rev 81861 rronl '~JOM $,Jeau!Sue leUOjSS@joJd eql u! suo!ssfu~o Jo sJoJJe Joj elq!Suodse] jou s! eSeJoqouv ,~o A~,iled!ojunR eq± 'panss! s! aleo!J!peo e eJojeq elep eZ,~leUe do suo!~oedsu! ~onpuo3 ~,ou op SHHQ jo seeAoIdLU3 'siuet.ueJ!nbeJ e~eis pub leJepaJ u!e~J@o AJs!les oh Jep]o u! suo!lm,!lsu! Ou!pual Jjeqi pub seu~oq Jo sJeseqoJnd o~,,~selJnoo e se s!qj seop SHHQ eq/'e>lSel'¢ Jo alel$ eq~ u! peJa~s!~eJ Jeeu!Sue leUO!SSe,toJd luapuadepu] ue ,~q e^oqe ~ qdeJl~eJBd u! ua^!8 suo!lBlueseJdeJ eqj uodn AlUO pesBq le^oJdd¥ Alpoqjnv qHBaH senss! (SHHQ) sao!^JaS uBu~nH pub q~IBeH NOIJ. fl¥O le^oJddv IeUO!;!!puoo Jo SLUJe/ IBUO!),!puoo peAoJddes!E] p@^oJddv '9 uo :!oB,tie u! suo!lelnSeJ pub 'seoueu!pJo 'sepoo eleiS pub led!o!un~ lie H;HM eouB!ldU~oo u! s! ~elsXs lesods!p JeJBMeiSBM do/puB Xlddns JeI~M 81!S-UO eq~ 'uo!]oedsu! pub UOliBS!]SeAU! ~ mOJI pub Sal!l eDeJoqouv Jo Xl!led!olunR eq] ~oJj peu!B]qo uo!ie~Joju! aq] uo peseq Jeql XJpeA Jeqpn~ I 'u!eJaq pe]eo!pu! eJnionJis ~o edX] pub 9~ooJpeq lo Jeq~nu eql aienbape pub leuoljounJ 'ales s! ~e~sXs leSOdS!p JajeMelSeM Jo/puB Xlddns JaleM 8]!s-uo aq~ ~eql SMOH9 jeAoJddv Xlpoqlnv qjleeH s~qj jo uo!1eB!lsaAui Xm leq~ ~JUeA I 'MOleq UMOqS eiep uo!lep!leA eq~ 1o se pub oleJaq pBx!jiB I~es X~ ~q PeIIiPeo sv NOIZ~BOJNI aNY VLVO 'HOBV3S ~91~ 'SZS3~ 'SNOI~O3dSNI 9NIOIAOBd ~BIJ 9NIB33NION3 'g A. WELL DATA MUNICIPALITY OF ANCHORAGE (MO~-.i MUNICIPALITY OII-I[~[!'~-~b~:~THORITY APPROVAL (HAA) DEPT OF HEALTH & · --~I.F,t~KLIST - FEBRi. ARY 1984 ENV RONMENTAL P~um m..~'~- 264-4720 ~JUi~ 2 6 1987 Le~ Descriptio~ ~ RECEIVED Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorptio~ld on To Nearest Public Sewe. p.t_~ne. Cleanout/Man.~f~ Water Sample~ected by Water Sa~le Test Results / Co_~ents If ~t3, C, D.E.C. Approved ~x~'~N) Date Comnleted ~ Yield Depth of Grou~.g/ ~Sot At ///5~nitary Seal on Casing (Y/N) / Depression Around Wellhead (Y/N) : On Adjoining LOtS : On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date SEPTIC/HOLDING I'ANK DATA Date Installed ~/$/~ 7 Size [ ~' S7.~') No. of Compartments Standpipes(~N) Air-tight Caps'~.¢3'4) Foundation Cleanout ~N) Depression over Tank (Y~ Date Last Pumpea Pumping/Maintenance Contract on File (Y/N) ~ ; for Holding Tank High-Water Alarm (Y/N) ~ _ Temporary Holding Tank Permit ',Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ~ 2_0-0 / To Property Line ,'/// To Water Main/Service Line /,¢ / Course _ /Usc, ~-~ '"'"~'~ '~' ' commenis To Building Foundation To Disposal Field _ To Stream, Pond, Lake, or Major Drainage P~ge 1. of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field ~-~ / Type of System Design Length of Field ~ Depth of Field //. Gravel Bed Thickness -"~' Standpipes Present Date of Last Adequacy Test Square Feet of Absorption Area Depression over Field (Y/C_ " Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well .-~ To Building Foundation /~ Lot A/~ k' · To Property Line ¢ To Existing or Abandoned System on ; On Adjoining Lots ~' ,5-~ ~ To Water Main/Service Line /O'/i¢'~'' To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course ./L/~,,~¢ .4,2~ ~ ¢-, To Driveway, Parking Area, or Vehicle Storage Area ~ / :~ Comments ~' ,5'~-.~.,¢?¢,~¢~- ,??L~d'~'~ )/~¢,~,~_~ ~-~¢.~ ~r-/~e, ~.~ ~-~,--.¢~ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions / Manhole/Ac~ ...~]p-~f f" Level at / Vent (Y/N) Pumping Cycles during Adequacy Test, Meets MOA ./ ** 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 Date Company MOA No, Receipt No. ~ Date of Payment Amount: $ /(~ , Page 2 of 2 72-026 {1 U84)