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HomeMy WebLinkAboutT15N R1W SEC 3 S2NE4SE4 PTNOnsite File
T15N R1W SEC 3
S2NE4SE4 PTN
#051-062-38
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP211444 PID Number: 051-062-38
Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade
Name
Tony DeGange and Emily Davies
ABSORPTION FIELD
E] Deep Trench Wide Trench El Bed Mound
Site Address
21625 Old Glenn Hwy
tt
Phone
Number of Bedrooms
Soil Rating
ITotal depth from original grade
5
0.6 GPD/SF
2.9 - 4.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
1.9-3.0 Ft.
Gravel depth beneath pipe
1 Ft.
Subdivision Block Lot
S2NE4SE4 PTN
Fill added above original grade
0.7-1.3 Ft.
Gravel length
220 Ft.
Township Range Section
T1 5N R1 W SEC 3
Gravel width
5 Ft.
Beds: Number of Lines
Distance between lines
I Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Holding ' Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Lift Station
Tank Line
1264 Ft2
4
6 Ft.
Well
I > OU`
I >'� (}`1s
J0
I V
NA
NA
I V
TANK ED Septic E3S.T.E.P. [I Holding El Other
Manufacturer
greer
Capacity
1500 Gal.
Surface Water
> 100'
> 100'
NA
NA
Material
plastic
Number of compartments
2
Lot Line
>10'
>5.2'
NA
NA
NA
Foundation >1 0'
>100'
NA
i NA
LW -STATION
Manufacture
Capacity
Gal.
I
Remarks
Alarm location
Electrica d by
—
PIPE MATERIAL House to tank 3034 drainfield Tank to
3034
Installer
Whitters Excavating
Drainfield 3034 Co/MT3034
Inspector Curtis Townsend
BENCH MARK (Assumed elevation) 100 ft
Inspection 151 12/7/2021 2nd 12/8/2021
Location and description
dates:
1
bottom of siding point B
3`d 12/9/20C3 4 12/21/26
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval: DateP
�'Nb �-
...:.L.
TSI
— — --
V Uurtis L Townsend' ]
Septic S - stem
%
6
Approve Date 7"
9'• Dme
C
� c`iJ '. No. cE 11-O�t
j44 • • • •;
,�
� . • • ���
�k pROFESSiO� A
���'`��'��
Note: this approval does not include well permit requirements.
(Rev 05/02/18)
RATE:BEDROOM: 5 (750 GPD)
SOIL PERCIOLATION 16 nnpi
APPLICATION RATE: 0.5 GPO/sf
AREA REQUIRED: 1'250 SF
SYSTEM TYPE: WIDE TRENCH
FOUR TRENCHES VWTH LENGTHS OF 55' WERE INSTALLED
220'x 60^ x �' EFFECTIVE DEPTH YIELDS 1.264 sf
WAX|WUkJ DEPTH OF �XCAVAT|(}N WAS 4'
NEW TRENCHES MAINTAINED 0'
SEPARATION FROM OLD TRENCH
GARAGE
6, 0 GAL WATER
STORAGE TANKS
LOCATION
��-
5 BR
THERE ARE NO STEEP DCO
SLOPES VV|TV|N 50' OF THE
PROPOSED FIELD.
SCOP[ OF WORK
MT5
C08 C{]7C[)6CO5
5.2'
�[}C(l //
~
A' CRIB EFFECTIVE DEPTH WAS
5.5' CONCRETE CRIB 0A WAS
CONFIRMED TO BE 6', NO
SEWER ROCK. NEW FIELDS
MAINTAINED 11' SEPARATION.
l DECOMMISSIONED TANK AND CRIB.
2. PLACED NEW 1.500 GALLON TWO—COMPARTMENT SEPTIC TANK
AND TIED INTO NEW ABSORPTION SYSTEM. TANK WAS PROVIDED,
WITH A MINIMUM, 20" 0A RISER SERVING THE FIRST
COMPARTWENT. CONSTRUCTED (4) SEPARATE TRENCHES WITH
LENOTH OF 55' EACH. INSTALLED(3) SPLITTER VALVES.
�ALL CDNSTRUCTlO! WAS IN ACCORDANCE WITH ALL
REQU|REVENTS SPEC|FlEO IN ANCHORAGE MUNICIPAL CODE
CHAPTERS 1-15.55 AND 15.55.
Record Drawing Prepared for
TONY DEGANGE AND EK8y[Y DAV|ES
21625 Old Glenn Highway
'" ChUg'Bk. Alaska 99567
[0 UTkN �N/`/N����/N/� ///`
�-/\/-�///vr1 L/v\�//vc_�_/\//v��, �_/_��
19152 MOUNTAIN ROAD
CHUG|AK` ALASKA 99567
/907\ 406-1058
DATE: 12/22/2021
DRAWN: CLT
SCALE: 1"=3O
PID: 051-002-38 SHEET OF 3
ll�ll[
Municipality ®i Anchorage
C, Ur.partinent
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (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#: OSV211082 COSA#: Permit#:OSP211444
PID#: 051-062-38
Legal Description: T15N R1W SEC 3 S2NE4SE4 PTN
Engineer: Eklutna Engineering
Your request for a waiver of the required 10 feet horizontal separation from th absorption field to
the property line has been approved. The approved separation distance i,, feet.
This waiver approval applies to the proposed 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.
............................................... ■ ............................. ■ 1
Waiver is Granted: X Waiver is not Granted:
Date: /0Z6 Z / Approved by:
Name of Reviewer
..........................................................7.............. 1
**** VARIAN C E/WAIVER REVIEW ****
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.rnuni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP211444
Work Type: Septic Upgrade
Tax Code Number: 05106238000
Site Legal Address: T15N R1 W SEC 3 S2NE4SE4 PTN GA460
Site Mailing Address: 21625 OLD GLENN HWY, Chugiak
Owner: SEBAUGH PERRY D & MARGARET A
Design Engineer: EKLUTNA ENGINEERING, LLC*
This permit is for the construction of:
Q Disposal Field 121 Septic Tank ❑ Holding Tank ❑ Privy
Effective Date:
Expiration Date
Lot Size in Sq Ft:
Total Bedrooms:
v
t]cl�artn3e:ttr
10/26/2021
10/26/2022
108900
❑ Private Well 0 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:
0"010
Locate the edge of the seepage pit to confirm that the 11' separation between the seepage pit and the proposed
trenches will be met.
Received B}
Issued By:
f U Z 2 t
Date: --o
4
Date: A zZ
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 051-062-38
Property owner(s) SEBAUGH PERRY & MARGARET Day phone
Mailinq address 16621 Rivers Edge Ln Eagle River AK 99577
Site address 21625 Old Glenn Hwy Chugiak
Legal description (Sub'd., Block & Lot) T15N R1 W SEC 3 S2NE4SE4 PTN
Legal description (Township, Range & Section)
Lot Size 108,900 Sq. Ft. Number of Bedrooms 5
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(E all that apply)
Absorption Field Fx_1
Initial ❑
Single Family (SF)
(w/wo ADU)
Septic Tank [l
Upgrade x
(D)
EJ
Holding Tank ❑
Renewal ElDuplex
Multiple Dwellings
❑
Privy ❑
(SF and/or D)
Private Well ❑
Water Storage 0
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
F l 1" LJ) j'G
C.0 % t
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 ag
Permit/Rush Fees: 459 5 + 160 Waiver Fees: t) Ayr
Date of Payment: f l/9, z I Date of Payment: Sa,►, P
Receipt Number: 016 5 zo 1) Receipt Number:
Permit No. 0 S P 21 j y `-{ 9 Waiver No. O S V21 [ 0 8 2
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
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On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211444, Deb Wockenfuss, 10/26/21
S nrs cN PARA[,/L rtRS
e> / B[DROol\r' 5 (750 CPD)
SOIL PERCOLATION RATE: 16 mpi
t-o+
J
\)
O
Z.
-l
t-
z_U
aC/
o?
(r"/ npprrcnrioN RATf: o 6 GpDlsf
AREA RtQUIRED: 1,250 Sf
---'-SYSTIN/ TYPE: WIDt TRTNCH
1,250 sf2oMAX|MUIV DTPTH OF EXCAVATION TO BE 4',\"o.\
.A
t'O TXISTING TRINCH IS 2'
ttFtCTlV[ DTPTH x 3' WIDTH x
LINGTH UNKNOWN, 4' COVER
\^
o)
6.0' rI!
T,
CRIB EFFTCTIVE DTPTH IS
5.5,. CONFIRN/ DIIVENSION
OF CRIB BIFORI
CONSTRUCTING NTW TIILD.
(ti
(Jl-
-
I-u
PROPOSTD
WATER STORAGI
TANK LOCATION
"?SLOPT 5%
/---4
\=-__\u,,tr
\- ---=-
THE O-?//
o
THERI ARI NO STttP
SLOPTS WITHIN 50'OT
PROPOSTD FIII D.
\.-"
o_
SCOPT OF WORK1.TXISTING STPTIC TANK IS APPROXIMATILY 1,500 GALLONS IN
CAPACITY CRIB HAS APPROXIMATILY 5.5' TIFECTIVT DEPTH
RTN/OVE TANK AND DECON/MISSION CRIB.
2. P[ACt NtW 1,500 GALLON TWO-CON/PARTMtNT STPTIC TANKAND TIt NTO NtW ABSORPTION SYSTIM. ENSURE NtW TANK IS
OUTSIDT THt lOO'WTLL RADIUS. TANK IS TO BE PROVIDID WITHA IVINIMUN/ 2O'' DIA RISIR STRVING THE FIRST COMPARTN/ENT.
coNSTRUCT (4) SIpARATt TRTNCHES MIN LTNGTH Oa 5+.4',IACH THIS ltLD WtLL RIQUtRt (3) SpLtTTIR VALVIS.AtL CONSTRUCTION TO BE IN ACCORDANCT WITH A-_RIQUIRIMINTS SPEC ITD IN ANCHORAGT MUNICIPAL CODI
CHAPTTRS 15.55 AND 15.65.
3
5 BR HOUSE
Gp"\
{uei
Yr,,-
roNY DEiAriSE?iiB"Eiluy onvrs
21625 Old Glenn Highway Chugiak, Alaska 99567
T15N RlWSEC 3 S2NE4SE4 PTN
osP211444
EKLUTNA ING/NIIRING, LLC
19162 N/OUNTAIN ROAD
CHUGiAK, ALASKA 99567(e07) 406- 1 OsB
DATE: 1012512021
DRAWN: CLT
SCALE: 1" =4O'
PID: 051-062-38 SHEET 1 OF 2
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211444, Deb Wockenfuss, 10/26/21
SOILS LOG _ PERCOLATION TEST
1
2
3
4
5
6
7
8
9
10
11
12
13
14
ORGANICS I
fr(al
Y
I
CONSIDERED IMPERMEABLE
DATE PERFORMED: 9 /27 /2021
WAS GROUND WATER
ENCOUNTERED? NO
DEPTH TO WATER AFTER
MONITORING? NO
DATE:10/4/2021
WATER READINGS ARE TO THE NEAREST 1/16 INCH.
PERCOLATION RATE: 16 |t/lN /INCH
PERC HOLE DIAMETER: 6"
TEST RUN BETWEEN 3 AND 4 FE[I.
PERFORMTD BY: CURTIS TOWNSEND. I, CURTIS TOWNSEND, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATT. DATE: 10/4/2021
NO. DATE CLOCK TIMI
NET
TIME
iMIN.
WATER
LEVEL
READING
1 10 /4 /2021 18 57 /19:27 JO 6" -3 7/8" 2 1/8
z 10 /4 /2021 19: 30 /2O: OO an 6" -+ 1/8" 1 1/8
10 /4 /2021 20:OO /2O:3O 30 6" -4 1/8- 1 7/E
4 10 / 4 /2021 20:30 /21:OO 30 6" -4 1/8- 1 7/8'
Septic Design Prepcred for
TONY DEGANGE AND EMILY DAVIES
21625 Old Glenn Highway Chugiak, Alaska 99567
T15N RlWSEC 3 S2NE4SE4 PTN
osP211444
EKLUTNA INGINItRING, LLC
19162 MOUNTAIN ROAD
CHUGIAK, ALASKA 99567
(eo7) 406 1 0sB
DATE: 1011812021
DRAWN: CLT
SCALE: 1" =40'
PID: 051-062-38 SHEET 2 OF 2 WKg
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211444, Deb Wockenfuss, 10/26/21
,
�o .`
DOLLY
— 41- —/
AVENUE /
/
LEGEND
�S ,
N 89'55'1
G
^� Portion of
AD SJ, N EJ, S EJ
Qry 93,372 S.F.
\ WELL GARAGE
J
0
\OVERHEAD
POWER LINES DECK
R
O O_F
O_e
S 89'57'10"W(R2) 400.
Lot 1
STOCKHAUSEN
R1 = RECORD STOCKHAUSEN SUBDIVISION (PLAT No. P-450)
R2 = RECORD YOSH SUBDIVISION (PLAT No. 2009-64)
C = COMPUTED
15.1"x8.6" SHEOJ
3.0' CANT
—1 STORY RESIDENCE
w/ WALKOUT BSMT.
/ 89.8'
PIPES
X:
N
PLOT PLAN __ AS BUILT _X_ SCALE _1" -_ 60__ GRID _ NW 1460__ Project No.
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, inc. (907) 522-6476 Phone 000��pO�
(907) 522-4625 Fax —� p A �
F X44
Professional Land Surveyors kenolongsurvey.com o 9 Q
jonothanAlongsurvey.com
I hereby certify that I have surveyed the following described property:
Portion of S},NE),SEJ of Section 3, T15N, R1W, SEWARD MERIDIAN, ALASKA
Anchorage Recording District, Alaska, and that the improvements situated thereon are
within the property Imes and do not encroach onto the property adjacent thereto, that
no improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible
easements on said property except as indicated hereon.
Dated this the _ ZqN" _ Day of _ ShLtsr�n.�t°�' ``��'� at Anchorage, Alaska
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat.
49TH SOI
� .
p .t. n.... TH N.. ..
�4�RFo''..LS-5202.•' yJpG
' NOo
40pzR aFES510NA1-
AECC963
MUNICIPALITY OF ANCHORAGE
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. 051-062-38
1. GENERAL INFORMATION
Expiration Date: 3 2--7'2 ©ZZ.
Complete legal description TI 5N R1 W SEC 3 S2NE4SE4 PTN
Location (site address) 21625 Old Glenn Hwy Chugiak
Current property owner(s) T15N R1 W SEC 3 S2NE4SE4 PTN Day phone
Mailing address 21625 Old Glenn Hwy Chugiak
Real estate agent Day phone
2. TYPE OF DWELLING:
El Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex) -
3. NUMBER OF BEDROOMS: 5
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well 0 Private Septic FD
Water Storage IX Holding Tank ❑
Community Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 2 W
Date of Payment r' a
Receipt Number 0�y 1
COSA !7 32
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Eklutna Engineering, LLC Phone 907.406.1058
Address 19162 Mountain Rd Chugiak AK 99567 /
Engineer's Printed Name Curtis Townsend, PE Date
6. DSD SIGNATURE
System #1 Approved for bedrooms
System #2 Approved for
Disapproved
Conditional approval for
bedrooms
49 v
1 Date 1'1'1 L
1
�``O/� tdo. CE 11904;
8���pa��GFES51�t�
S :ku4
bedrooms, with the following stipulations:
\``�`` UTY
� ON_ yo
�VAAT6RAN,) ria
PROG , ATER ��
GJ\\\1
ERV �C
Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description: T15N R1 W SEC 3 S2NE4SE4 PTN
If more than 1 septic system on lot: COSA Checklist # of
Parcel ID: 051-062-38
Structure served by this system
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Well production at time of test 0.1 gpm
Date drilled unk
Water storage tank volume 0 gallons
Total depth unk ft
Well disinfected for coliform test? ❑ Yes ❑ No
Cased to unk ft
❑ Coliform bacteria is Negative
❑ Sanitary seal is functioning correctly
Nitrate 4.01 mg/L ❑ Nitrate less than MRL (ND)
❑ Wires are properly protected
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Casing height (above ground) ' 18 in.
Collected by Curtis Townsend
Date of flow test for COSA 913021
Date of Sample 9"72021
Static water level at beginning of test 55 ft.
Comments 600 gal water storage was installed Dec 2021 after well production was tested
B. TANK DATA
Age of tank(s) < 1 years
Tank type/material septic plastic
Measured operating fluid level in septic tank new
❑ Standpipes/foundation cleanout per record drawing
Date of pumping new
D. ABSORPTION FIELD DATA
Which system tested (date installed) 2021
❑ ALL standpipes present per record drawing
Total measured depth from grade 4.7 ft (max)
Measured depth to pipe invert from grade 3.2 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: new field installed Dec 2021
COSA Checklist yellow sheet
C. LIFT STATION
❑ Required maintenance comp
Age of lift station y .ars'
Lift station material
Com
Adequacy test date
Results ❑✓ Pass For 5 bedrooms
Fluid depth prior to test in
Water added gal
New depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
Any rejuvenation treatment (past 12 months) no
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
Community Sewer Manhole/Cleanout > 100'
dQ Yes
if No
ft
[]✓ Yes
if No ft
Neighboring Tank > 100' 0✓ Yes
if No
ft
Private Sewer/Septic Line > 25' M Yes
if No ft
Absorption Field on Lot > 100' M Yes
if No
ft
Holding Tank > 100' 7✓ Yes
if No ft
Neighboring Absorption Fields > 100'
Yes if No ft
Water Main > 10'
Animal Containment > 50' 0 Yes
if No ft
0 Yes
if No
ft
Yes if No ft
Water Service Line > 10'
❑✓
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway comment below
Community Sewer Main > 75' �✓ Yes
if No
ft
❑d 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'
Q✓ Yes if No ft
Property Line > 5'
111
Yes
if No
ft
Wells on Adjacent Lots:
0
Absorption Field > 5'
Q
Yes
if No
ft
Private Wells > 100'
Yes if No ft
Water Main > 10'
0
Yes
if No
ft
Community Wells > 200'✓0
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'
21
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
❑
Yes
if No >5
ft
Wells on Adjacent Lots:
Water Main > 10'
0
Yes
if No
ft
Private Wells > 100' El Yes if No ft
Water Service Line > 10'
M
Yes
if No
ft
Community Wells > 200' 0 Yes if No ft
Surface Water > 100'
0
Yes
if No
ft
F. ENGINEER'S COMMENTS
OSV211082 allowed for 5' senaratinn frim mmnprty IinP
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.
COSA Checklist yellow sheet
K`•-�
TH
. , curris i : f send
Dale
�� Z',- •to.CE11904 •�t r�
Municipality of Anchorage �s4R
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Water Well Advisory
Certificate of On -Site Systems Approval (COSA) # 211732
During a recent COSA on-site_ _inspection and test of the potable water
supply well T15N R1 W Sec 3 S2NE4SE4PTN, the well's productivity was
determined to be .1 gallons per minute. The minimum well productivity
required by this Department (AMC 15.55) for a 5 -bedroom residence is .52
gallons per minute. All parties concerned are advised that the production
capacity of the well may fluctuate. Restriction of non-critical water uses
such as washing cars and watering lawns and gardens may be required.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
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