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HomeMy WebLinkAboutT12N R3W SEC 22 LT 14 E3N2 PTN Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211392 PID Number: 015-141-07 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project:./❑ New ❑ Upgrade Name Linda Hopps ABSORPTION FIELD © Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 4440 O'Malley Rd. ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 6 1.2 GPD/SF 11.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 5 Ft. Gravel depth beneath pipe 6.5 Ft. Subdivision Block Lot E3 N2 PTN 14 Fill added above original grade 1.31-5.63 Ft. Gravel length 58 Ft. Township Range Section 12 3 22 Gravel width 3 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding g � Sewer I Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 754 Ft z 1 Ft. Well ( 1001+ I 1001+ 25'+ TANK 91 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer/Greer Capacity 1000/1250 Gal, Surface Water` 100'+ I 1001+ Material Number of compartments Lot Line I 51+ I 101+ NA Plastic/Plastic 2/2 FoundationI 10'+ 10'+ LIFT STATION 14tan turer Capacity Remarks Two tanks installed connecting to one 58' Gal. trench. Old tanks removed and disposed off site. Alarm location stalled by Old trench abandoned in place, Old crib decommissioned Installer PIPE MATERIAL House to tankTank to D3034 drainfield D3034 Northern Excavation Drainfield D3034 CO/MT D3034 Inspector Areterra Consulting BENCH MARK (Assumed elevation) 100 ft Inspection f�Location dates: 11/4/21 2nd 11/5/21 and description 3`° 11/9/21 41e 11/13/21 of skirt siding on NE trailer corner ---,Top ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp % "14114 I" + Conditional Approval: Date •��P°" i . 9TH � r ' tic System NNETH 0Se cK itis AF Approved Q-Z�Z Approved wp Wac K Date � � - 'E :cE 4 FESSN 40 Note: this approval does not include well permit requirements, � aa� k1Acv uulvel 10) AS—BUILT SYSTEM DETAILS/SITE PLAN Permit ❑SP211392 T12N R3W SEC 22 LOT 14 E3 N2 PTN PID# 015-141-07 wallI 1 1/2 Story Frame House Chain link fence G -I=45.6' H -I=21.7' G -J=49.5' H -J=18.2' G -K=52,8' H -K=15.9' G -L=54.1' H -L=14.7' OF AL 4S� TH s: CE -71 AW z -AW F'ESSIa��`L Ret. wall G -M=68,2' H -M=10.8' G -N=73.8' H -N=15.2' G -❑=88.9' H -❑=27.8' G -P=90.4' H -P=28,4' G -Q=86,9' H -Q=30.9' G -R=88.3' H -R=48,7' G -S=89.6' H -S=49,5' S I Story— Trailer oa FDIlMTM Chimney- -M himney- PREPARED FOR: LINDA H❑PPS 4440 ❑'MALLEY RD. ANCHORAGE, AK 99507 FIELD BOOKS BOUNDARY: N lA sTmNG- N /AA AsaU:f.T: WALAK DWG. FlLE: AcAD "'E' FILE N COMPUTED: DRAY' KSD CHEacev: KMD DATE, 1/27 GMD: SW262 JOB Nn.: 21048 Shed SCALE: 1' = 50' PAGE 1 OF 21 WASTEWATER DISPOSAL SYSTEM DETAILS/AS-BUILT T12N R3W SEC 22 LOT 14 E3 N2 PTN PID# 015-141-07 liff-MM, ww i .. 2 WWWu dd IC TANK 2 SEPTIC SCALE: NTS AMP, OF AZ PREPARED FDR. LINDA HOPPS TH 4440 O'MALLEY RD. 9 ak ANCHORAGE, AK 99507 FIELD BOOKS KENNE S compuTED: CE— 11 BOUND ARY* N —A mAwN: KSQ STMNG-CHE cKm: N/A KIVID Assu'LT- WALAKA DATF-* 11/27 Nl- b'ESSIO DM FILE: MD: SW262' ACRD nLF- FILE " No" 21048 58.0 TH#2 BOH0-9.5-0--�> lln'm m C®NSUI,TING, INC -' 20441 Ptarmigan, Eagle River,AK 9977 rp�n ho- r? Office (907) 696-6111, Fax (907) 868-3793 ' Cq Ak. f'JS7%8�0 SOILS PERCOLATION TEST ,%. t OF ' lf, l r Ae it T F1 /' " Performed for: Linda HO,ppDate Performed:_ 11/09/2021 Project:__Tl2.N R3. W Sec 22 Lot 14 E3;N ________ PERC #2_._„ !___ TEST HOLE # TH 21-2 Depth (Feet) SEE ATTACHED SITE PLAN oRG 0'- o.s' FOR HOLE LOCATION - PERC BENCH # 1 @2' GM with rocks 3"-6" B.O.H. 19' Was Ground water encountered? NO What depth? Depth to water after monitoring? 0'0" Date 11 /9/21 (Depth beloNv grade) Reading Date Gross Time --filet-- Time Depth to Water Net Drop 1 2 3 4 6 7 8 9 10 11 12 * Water Added Percolation Rate (min/in) Perc Hole Diameter_ Test Run Between feet and feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. 0 0 C0 C) o Q C:) O Z J Q N N c 0 U O 07 M Of Z N OWALLEY ROAD 8495W POB S89°57'00"E 1 Ret LlN2lOH xAsphalt wall� �-'-- 16.068.0 - 1 112 Story Frame ,n N House r"'i 48.0 30.00 Chain link fence (typ) 0 O M O O O rA c0° L7.OH M X 20.0 Ret. wall T12N R3W Section 22 Lot 14 Portion E 1/3 N 1/2 25' ROW acquisition per State of Alaska DOT & PF Alaska Project HPRM-MGS-STP-05121(5) Shed t l l ,3 tlC� f ° °° s ! Septic vent tr{ �° 1 (typ) I cam,.._ , 2i_f e ° 1 Story Frame Trailer Shed CMmney 720 tl N89057'00"W 100.00 T12N R3W Section 22 Lot 14 Portion S 1/2 & W 30' EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON FB 21-7, pg 31 UNLESS OTHERWISE NOTED. FB 21-3, pg 8-11 LEGAL DESCRIPTION: Commencing at the section corner common to sections 15, 16, 21 and 22 In T12N R3W, S.M., AK thence S89°57'E 860 feet; thence S00°03'E 50 feet to the True Point of Beginning; thence S89°57'E 130 feet; thence S00°03'E 280 feet; thence N89°57'W 100 feet; thence N00°03'W 160 feet; thence N89°57'W 30 feet; thence N00°03'W 120 feet to the to the true point of beginning; Records of the Anchorage Recording District, Third Judicial District, State of C:) Alaska; EXCEPTING THEREFROM the North 25 feet. 0 LO LO N W T12N R3W Section 22 o Government Lot 15 O 0 .,►*,,®® `A U) �� , of • A<; q 0 th � • 49 t 00 00 #4�,'. Elizabeth L. Walatka : o �a .� 8036 - LS • oaf® �P • . ` °i O ®®F o o f �Aw 0,1�Esslow& SCALE: V= 50' � `®``®®�►~' RECERTIFIED AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection in accordance with ASPLS Standards of the following described property: T12N R3W SECTION 22 LOT 14 E1/3 N1/2, PTN (Book 449 pq 372) See description above Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 10th day of MAY 2021. FRED WALATKA & ASSOCIATES, L.L.C. BE907-248-1666 Engineers and Surveyors This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. 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: OSP211392 Work Type: Septic Upgrade Tax Code Number: 01514107000 Site Legal Address: T12N R3W SEC 22 LT 14 E31\12 PTN G:2636 Site Mailing Address: 4440 O'MALLEY RD, APT B, Anchorage Owner: HOPPS EASY LODE TRUST Design Engineer: ARC TERRA CONSULTING INC This permit is for the construction of: Effective Date: Expiration Date �l»cnt u r, r Depai- tin ent Lot Size in Sq Ft: Total Bedrooms: 10/13/2021 10/13/2022 28821 Q Disposal Field Z 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 Special Provisions: A test hole is required prior to construction of the absorption field, in the location shown on the site plan, to confirm minimum separation to impermeables. If results require a design change, construction shall stop pending approval of a change order. Please submit results with the inspection report (or change order, if required). Received By: Date: Issued By: Date: Z MUNICIPALITY OF ANCHORAGE r P- Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTICIWELL PERMIT APPLICATION Parcel I. D. 015-141-07 Property owner(s) Linda Hopps Day phone Mailing address 4440 O'Malley Rd, Anchorage, AK 99507 Site address 4440 O'Malley Rd, Anchorage, AK 99507 Legal description (Sub'd., Block & Lot) Lot 14:� :�-2- Legal Legal description (Township, Range & Section) T12N R3w Sec 22 Lot Size 28,821 Sq. Ft. Number of Bedrooms 6 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Initial ❑ Single Family (SF) ❑ (w/wo AD U) Septic Tank ® Upgrade Duplex (D) ❑ Holding Tank ElRenewal El 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: A 5 9 5 Date of Payment:QT L4? Receipt Number: 00667 & Permit No. cS PZ 1139 2 Waiver Fees: Date of Payment: Receipt Number: 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 OSP211392, Deb Wockenfuss, 10/13/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211392, Deb Wockenfuss, 10/13/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211392, Deb Wockenfuss, 10/13/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211392, Deb Wockenfuss, 10/13/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211392, Deb Wockenfuss, 10/13/21 ti 6 m fZ' O J Q I OWALLEY ROAD 8495W 25' ROW acquisition per State of Alaska r POB DOT & PF Alaska Project HPRM-MGSSTP-05121(5) �4C7ll.fW1G • 7.1 I7}'1 RetrWe" wag Asphalt a Ll 16.0 68.is O 1 112 Story FramI O N House 48.0 � zr� 7.5 OH 20.0 Ret wall a` Septic vents CD T12N R3W Section 22 q Lot 14 Portion E 1/3 N 1/2 in N I N89�57'00" sped Cheln link fence (typ) 0 0 0 0 � 1 Story Frame Trailer T12N R3W Section 22 Lot 14 Portion S 1/2 & W 30' A IT Shed -n 100.00 EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON UNLESS OTHERWISE NOTED. FB 21-3, pg 8-11 LU 0 0 Cf) 0 0 0 rn LEGAL DESCRIPTION: Commencing at the section comer common to sections 15, 16, 21 and 22 In T12N R3W, S.M., AK thence S89°57'E 860 feet; thence S00°0TE 50 feet to the True Point of Beginning; thence S89°5TE 22W feet #& ice N'3—.S7W 100f'eet,- thence N00°03'W 160 feet; thence N89°57'W 30 feet; thence N00°03'W 120 feet to the to the true point of beginning; Records of the Anchorage Recording District, Third Judicial District, State of Alaska; EXCEPTING THEREFROM the North 25 feet. T12N R3W Section 22 Government Lot 15 BE A� �S wP fflw '49th �j 00A-_..& Z. 00 00 00 ... .: �+ lizabeth L. Walatka ; s 'sN 8036 - LS SCALE: V= 50' AS -BUILT NO CORNERS SET THIS DATE I L Yrnrah r rp td e S n�!fLM-_ _ Oda " " ¢ inG in accordance with ASPLS Standards of the following described property: T12N R3W_ SECTION 22 _LCT 1.4 E113 N112, PTN (Book 449 pg 372) See description above Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent'thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 10th day of MAY 2021. FRED WALATKA & ASSOCIATES, L.L.C. Engineers and Surveyors 907-248-1666 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other Improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence Is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. CC oe O O M O a O zr� T12N R3W Section 22 Lot 14 Portion S 1/2 & W 30' A IT Shed -n 100.00 EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON UNLESS OTHERWISE NOTED. FB 21-3, pg 8-11 LU 0 0 Cf) 0 0 0 rn LEGAL DESCRIPTION: Commencing at the section comer common to sections 15, 16, 21 and 22 In T12N R3W, S.M., AK thence S89°57'E 860 feet; thence S00°0TE 50 feet to the True Point of Beginning; thence S89°5TE 22W feet #& ice N'3—.S7W 100f'eet,- thence N00°03'W 160 feet; thence N89°57'W 30 feet; thence N00°03'W 120 feet to the to the true point of beginning; Records of the Anchorage Recording District, Third Judicial District, State of Alaska; EXCEPTING THEREFROM the North 25 feet. T12N R3W Section 22 Government Lot 15 BE A� �S wP fflw '49th �j 00A-_..& Z. 00 00 00 ... .: �+ lizabeth L. Walatka ; s 'sN 8036 - LS SCALE: V= 50' AS -BUILT NO CORNERS SET THIS DATE I L Yrnrah r rp td e S n�!fLM-_ _ Oda " " ¢ inG in accordance with ASPLS Standards of the following described property: T12N R3W_ SECTION 22 _LCT 1.4 E113 N112, PTN (Book 449 pg 372) See description above Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent'thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 10th day of MAY 2021. FRED WALATKA & ASSOCIATES, L.L.C. Engineers and Surveyors 907-248-1666 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other Improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence Is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. ,C~ATER ANCHORAGE AREA BORr--~GH HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 9950! 279.251 N? 835 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME /'~.RNJ~I~O /7/~,o/c~ MAILING o~.~ · . ADDRESS ~r~r, . LOCATION ~ .~/,/~-~ ~A~ ~'..,.e~ ///~' ,41-~W/4~..~,'~/4~'' LEGAL DESCRIPTION,~._~_~/ SEPTIC TANK: PHONE NUMBER OF DISTANCE FROM WELL / MATERIAL COMPARTMENTS ~- LIQUID LIQUID CAPACITY ~'~ .~'~ GALLONS, INSIDE LENGTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PiTS J OUTSIDE DIAMETER OR WIDTH J 5~ , LENGTH / ~), DEPTH LINING MAIERIA[ ~'/~I/~.~ "/~)/V~I~ . DISTANCE FROM WELL /~O'~t'- , BUILDING FOUNDATION NEAREST LOT LINE u~' "7~ ~r/~'~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) U~/~~) SQ. FT, TILE DRAIN FIELD: DISTANCE FRO W[U~'~'~ NUMBER OF LINES ABSORPTION AREA __, UNDATION. , NEAREST LOT LINE ~OL~iN ES SQ, F~ L[N~NE DEPTH: TOP OF TILE TO FINISH GRADE LINES WELL: LOT LINE TYPE O,/J,//'~'/) DEPTH /g~, ~,~0 /~ ~/~ NEAREST -- SEPTIC SEWER LINE _ TANK DISTANCE FROM WATER BUILDING FOUNDATION [ ~,-~' . SAMPLE / ~'0'+ SEEPAGE / ~Oi.j- SYSTEM CESSPOOL · NEAREST OTHER -- , SOURCES DISTANCES: DATE DIAGRAM OF SYSTEM NAME Of APPLICANT ~-~ GREAFEr ANCHORAGE AREA BoRouGH SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT INSTALLATION LOCATION PHONE INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED fINANCED THROUGH LEGAL DESCRIPTION .o,E 'NST^L'E"d' NOTE: THI~p~RMIT IS NOT VALID WITHOUT ~OIL FINAL INSPECTION: 2:4 HOUR NOTICE REQUIRED. RAGKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENTS DIAGRAM OF SYSTEM FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PiT , DRAIN fIELD SEPTIC TANK , SEEPAGE PIT -, DRAIN fIELD TO NEAREST LOT LINE. / WELL TO SePTiC TANK ~/~ DRAIN FIELD SEEPAGE PIT ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK ?-- SEEPAGE P]T SEPTIC TANK, ., seePAge PiT /~)/~J ., DRAIN fIELD . CAST IRON INTO AND OUT Of SEPTIC TANK AND INTO CRIB CROSSING 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 I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE D E S C R IB,.E D S Y S t E M ISIN~ ~7/a C C O R D a N C e Wit H S AID G O D E, ['ql CAS[ 99501 ~ I Gm The sediment con~aots in this area were errat! with some erratcl bodie~ .of sand and silt sized .. )articles. ~!as Gpoun0 Watop Encounter-ed? NO Reading /,oc tti sn Sketch Depth Tc GRATER ANCHORAGE AREA 80ROUG'~ DEPf ~qENT OF ENVIRONMENTAL QUALm, 3500 TUDOR ROAD ANCHORAGE; ALASKA 99502 CASE # Performed For ~vbt% ~,:~.~,~t.r: Date Performed ~c> .- Legal Description: Lot t~_Blo6k ~St~b~iqri-~i~orr ~ z~' ~F~ This Form Reports Soils--log 7q percolatio~ Test Depth Feet Soil Characteristics Was Ground Water Encountered? If Yes, At What Depth? Reading Date Gross Time Net Time Depth to H20 Net Drop o .... ~*~^. nate Minute Proposed Installation: Seepage Pit Drain Field Depth Of Inlet Depth To Bottom Of Pit Or Trench Test PerfOrmed BY.,l~~ Data C~rtifi~d By. Date: • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 s a F T Y CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. _0.15-141-07 Expiration Date: `20 27- 1. GENERAL INFORMATION Complete legal description T12N R3W Sec 22 Lot 14 E3N2 PTN Location (site address) 4440 O'Malley Anchorage, AK Current Property owner(s) Linda Hopps Day phone Mailing address 4440.O'Malley Anchorage, AK Real Estate Agent _ _ Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class _ Well ❑ Public Water System ❑ WaiverNariance request for: N TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 2 Waiver Fee $ Date of Payment �- . Z — Z2. Date of Payment Receipt Number l% �'j^'O j Receipt Number COSA # - 0-!!5-C 221175 Waiver # stance: 5. STATEMENT OF INSPECTION BY ENGINEER 6. 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 _ Date _ 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 �0. OI,' ,I encroachments, deficiencies or discrepancies exist. '��= �011 ),TH DSD SIGNATURE " , ' " System #1 Approved for bedrooms_ f "�, IceNNI� M.�wi us I 16,�- 10( System #2 Approved for bedrooms. Y bedrooms, with the followil lations: hp T5,7 `z�3 � _ g - nN-SITE WATER AND �o _AST_ T-��;._ --pROGFAM co :Z1 J � 0 Disapproved. Conditional approval for BY Original Certificate Dater -ZO2 -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 10-1Q-12.doc Legal Description: T12N R3W See 22 Lot 14 E3N2 PTN If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled _ .UNK .__. Total depth UNK ft Cased to UNK ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 30 in. Date of flow test for COSA 4/15/22 Static water level at beginning of test 234 ft. Comments B. TANK DATA Age of tank(s). New years Tank type/material,S tie!1'lasfic X2 Measured operating fluid leve:' ,n septic: teink New Standpipes/foundation GIQEirlout per,rec:ord drawing Date of pumping 2 newer.tanks installed 11/4/22 D. ABSORPTION FIELD DATA Which system tested (date installed) 11/9/21 ALL standpipes present per record drawing Total measured depth from grade 17.13 ft (max) Measured depth to pipe invert from grade .6.31 ft (min) ❑ N/A — pressurized field 10 Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 015-141-07 of Structure served by this system Well production at time of test 2-8 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes No 11 Coliform bacteria is Negative Nitrate 4.80 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L IN Arsenic less than MRL (ND) Collected by Areterra Consulting Date of Sample 4/15/22 C. LIFT STATION ired maintenance completed Age of lift sfa years Lift station material a Comments.- Adequacy omments: Adequacy test date New Results ry Pass For 6 bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) ® Yes if No Septic Tank/Lift Station on Lot > 100' Wells on Adjacent Lots: Community Sewer Manhole/Cleanout > 100' ® Yes ® 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' Building Foundation > 110" Yes Animal Containment > 50' ® Yes if No ft ® Yes if No ft ft . Wells on Adjacent. Lats: Water. Main >10' .Yes if No, • Manure/Animal Excreta Storage > 100' Private Wells > 100'> ®Yes if No ft 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 Yes ' if No ft 'a AL,U.. ., N Community � ells - 20v V 'F �j Yes i, 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 > 110" Yes if No ft. If absorption' field is under driveway.comment below Prpperty. Line-> 10' Yes if No ft . Wells on Adjacent. Lats: 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 I certify that l 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