HomeMy WebLinkAboutGRAVITY HILL ESTATES LT 1B
GRAVITY HILL
ESTATES
Block
Lot 1B
#015-242-99
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP231393 PID Number: 015-242-99
Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ■❑ New ❑ Upgrade
Name
Adrian Ramos
ABSORPTION FIELD
El Deep Trench 9Wide Trench F-1 Bed El Mound
Site Address
12255 Aurora View Circle
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
6
2 GPD/SF
0.0 / 0.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
+0.5/+0.5 Ft_
Gravel depth beneath pipe
0.5 / 0,5 Ft.
Subdivision Block Lot
Gravity Hill Estates 1 B
Fill added above original grade
3.6/4.0 Ft.
Gravel length
45 / 45 Ft.
Township Range Section
Gravel width
5/5 Ft.
Beds: Number of Lines
N/A
Distance between lines
N/A Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
2
Dist. between trenches
From
Tank
Field
Tank
Line
450 Ft2
>6 Ft.
Well
>50'
>50'
>50'
N/A
>25
TANK ❑ Septic ❑ S.T.E.P. ❑ Holding 0 Other
Manufacturer
Anchorage / Advantex
Capacity
3000 Gal.
Surface Water
>50'
>50'
>50'
N/A
Material
Steel
Number of compartments
2
Lot Line
>5'
>5'
>5'
N/A
NA
Foundation
> 10'
> 10'
> 10'
N/A
LIFT STATION
Manufacturer
Orenco
Capacity
250 Gal.
Remarks Trenches listed east / west
Alarm location
North vide UI Garage
Electrical installed by
vvlrllly` up AK Electric':
PIPE MATERIAL House to tank D3034 Tank to D3034
drainfield
Installer Red Do M
gasonr y
Drainfield D3034 CO/MT D3034
Inspector M. Jakubisin & J. Opheim
BENCH MARK (Assumed elevation) 100 ft
Inspection 1- 10/16/24 10/21/24
Location and description
dates: 2nd
tthh
Garage Door Threshold
3rd 4
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
OF
Conditional Approval: Date
�
,W�Q�.
* �TH 9t+�
�jj Benjamin Schiller
I FFG
Septic System'.
Approved Date
CE 12592 ��
�� 'srF • , 12/18/24
Note: this approval does not include well permit requirements.
trcev uo/uzri a/
r
L
ALTERNATE SITE
Benjamin Schiller
CE 12592
R
E
G
ISTEREDPROFE S S I O N A L E N GINEER
1"=50'
(2)X45' LONG x 5' WIDE, 0.5'
EFFECTIVE DEPTH ABSORPTION
TRENCHES WITH 1' SAND LAYER
3000-GAL
ADVANTEX TANK
w/ (2) AX20 PODS
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
PV - PUMP VAULT
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
SPURKLAND TH
PERMIT # OSP231393 PID # 015-242-99
GRAVITY HILL ESTATES, LOT 1B
A B
FCO 15.3
MH1 23.2
POD 1 26.1
A B
POD 2 29.7
MH2 33.2
PV 41.3
MT1 67.3
25.1
24.7
25.9
26.7
27.1
29.0
38.4
FEET
0 50 100
FCO
AU
R
O
R
A
V
I
E
W
C
I
R
C
L
E
6-BDRM HOME
PLAN AS-BUILT
2/10/25
TH#2
10' T&E/DRAINAGE EASEMENTS
15' INGRESS / EGRESS /
GAS EASEMENTS
10' T&E EASEMENT
PV
MT1MT3
MT2MT4
NEW WELL
w/ 50' RADIUS
TH#1
MH1
POD 1
POD 2MH2
MT2 96.780.1
MT3 75.343.2
MT4 104.883.5
10
'
T
&
E
/
D
R
A
I
N
A
G
E
E
A
S
E
M
E
N
T
10.2
8.5
BM
PROFILE AS-BUILT
(NO SCALE)
PERMIT # OSP231393 PID # 015-242-99
GRAVITY HILL ESTATES, LOT 1B
Benjamin Schiller
CE 12592
R
E
GISTEREDPROFE S S I O N A L E N GINEER
12/18/24
AX-20 POD AND
MANHOLES
AX-20 POD AND
MANHOLES
FC
O
MH
1
MH
2
3000 GAL
SEPTIC TANK96.7
91.2
101.5
97.5
97.8 FINISH GRADE
45'
MOA APPROVED SAND
MT
1
TH
#
1
GROUNDWATER @ 91.2 11/1/23
94.294.7
81.7
94.2
94.7
MT
2
2" INSULATION
93.2
94.2 ORIGINAL GRADE
EAST TRENCH
96.2 FINISH GRADE
45'
MOA APPROVED SAND
MT
3
TH
#
1
GROUNDWATER @ 89.2 11/1/23
92.292.7
79.7
92.2
92.7
MT
4
2" INSULATION
91.2
92.2 ORIGINAL GRADE
WEST TRENCH
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
OSP231393
Well Drilling Permit Number:
Parcel Identification Number: 015 -242- 99
Date of Issue:
12 18 23
Legal Description Block Lot Property Owner Name & Address:
Gravity Hill Estates LT 1 B G:2740 1 B Adrian Ramos
NHN Aurora View Cir.
Anchorage, AK
Pump Installation Date: 1 -22 -25
370
Pump Intake Depth Below Top of Well Casing:
Grundfos
Pump Manufacturer's Name:
5SQE15-450
Pump Model:
1.5
Pump Size:
hp
ilt,
feet
Pitless Adapter Burial Depth: feet
Campbell 1310 Type
Pitless Adapter Manufacturer's Name:
Red Dog
Pitless Adapter Installer:
Well Disinfected Upon Completion? ® Yes ❑ No
Method of Disinfection: Tabs
Comments:
Dylan Kay
Pump Installer Name:
Hefty Drilling, Inc.
Company:
P.O. Box 112130
Mailing Address:
Anchorage AK 99511
City: State: Zip:
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Well Log
Permit Number: #__________ Date of Issue: ________ Parcel Identification Number: __________________
Date Started: _________ Date Completed: _________ Is well located at approved permit location? Yes No
Legal Description:_________________________________________________________________________
Property Owner Name & Address: _______________________________________
_______________________________________
_______________________________________
Borehole Data: Depth (ft)
Soil Type, Thickness & Water Strata From To
Method of Drilling air rotary cable tool
Casing type: _________
Wall Thickness: inches
Diameter: inches Depth: feet
Liner Type: _________
Diameter: inches Depth: feet
Casing stickup above ground: feet
Static water level (from ground level): feet
Pumping level: feet after
hours pumping gpm
Recovery Rate: gpm
Method of Testing: _________
Well Intake Opening Type:
Open End Open Hole
Screened Start feet Stopped feet
Perforations Start feet Stopped feet
Grout Type: _________ Volume: _________
Depth: _________ Start feet Stopped feet
Well Disinfected Upon Completion? Yes No
Method of Disinfection: Comments:
Well Driller: _____________________________
Company: _____________________________
Mailing Address: _____________________________
Water Sample Results:
Arsenic: _________ ug/L
Nitrates: _________ mg/L
Total Coliform Bacteria:_________ colonies/100mL
Attention: The well driller shall provide a well log to the
On-site Water and Wastewater Section within 30 days of
completion.
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 Water & Wastewater System Permit
Permit Number: OSP231393
Work Type: WellSeptic Initial
Tax Code Number: 01524299000
Site Legal Address: GRAVITY HILL ESTATES LT 1B G:2740
Site Mailing Address:
Owner: RAMOS ADRIAN &
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Effective Date:
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
enr
Uepartnlent
12/18/2023
12/17/2024
50215
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Q Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By:
S5 ��� -i D
Date:
Issued By:
,L
Date:
Z �'� Z 3
n,
V UHF CC PALS TV OF ' H CH00 R\1,, GFEE
Community Development Department ' - Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON -SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 015 -49� Zy2—aq
Property owner(s) Brian Murphy
Mailing address 2421 Redwood St, Anchorage, AK 99508
Day phone
Site address NHN Aurora View Cir, Anchorage, AK 99516
Legal description (Sub'd., Block & Lot) Gravity Hill Estates, Lot 1 B
Legal description (Township, Range & Section)
Lot Size 29,700 Sq. Ft. Number of Bedrooms
6
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field ❑X Initial ❑X
Single Family (SF) ❑X
Septic Tank ❑X Upgrade ❑
(w/wo ADU)
Holding Tank ❑ Renewal ElDuplex
(D) El
Multiple Dwellings ❑
Privy ❑
(SF and/or D)
Private Well ❑X
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
1-
(Signature of property owner or authorized agent)
Permit/Rush Fees:. S2d
Date of Payment: i t /
I
Receipt Number:
Permit No. 0S P2 _13a22
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
Permit App__- :- :' ., c;
November 9, 2023
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Gravity Hill Estates Lot 1B – Aurora View Drive
Septic system design
Dear On-Site Services Engineer:
The owner of the above lot intends to build a 5-bedroom home on the property, with a 1-bedroom
ADU possible in the future, so we are submitting this permit application for the construction of a
new well and septic system. The attached site plan identifies the location of the home as well as
the proposed well, septic location and alternate site.
The ground surface on the lot slopes moderately toward the northwest at around 10-20% There are
no slopes greater than 25% within 50 feet downslope of either the primary or alternate site.
Contours are shown on the site plan showing the grade and direction of flow. Stormwater drainage
will not impact this septic system. The new trench will be constructed parallel to the slope as much
as possible. Wells on this and adjacent lots are shown. No conflicts exist between this proposed
system and any other well or septic system, whether on this lot or adjacent lots. The new system
will be a minimum of 50’ from all wells and surface water, and more than 5’ away from the septic
tank. The alternate site is located more than 6’ away.
Please refer to the attached test hole logs, plan and profile pages for the septic design. If this design
is followed, there will be no adverse impacts to adjacent properties.
Sincerely,
Benjamin Schiller, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231393, Curtis Townsend, 12/18/23
ALTERNATE SITE
Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER
1"=50'
(2)X45' LONG x 5' WIDE, 0.5'
EFFECTIVE DEPTH ABSORPTION
TRENCHES WITH 1' SAND LAYER
3000-GAL
ADVANTEX TANK
w/ (2) AX20 PODS
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
PV - PUMP VAULT
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
SPURKLAND TH
GRAVITY HILL ESTATES, LOT 1B
FEET
0 50 100
FCO
AU
R
O
R
A
V
I
E
W
C
I
R
C
L
E
6-BDRM HOME
1210
SEPTIC PLAN
11/5/23
TH#2
1220
1200
1190
1180
10' T&E/DRAINAGE EASEMENTS
15' INGRESS / EGRESS /
GAS EASEMENTS
10' T&E EASEMENT
PV
MT MT
MT MT
NEW WELL
TH#1
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231393, Curtis Townsend, 12/18/23
GRAVITY HILL ESTATES, LOT 1B
TYPICAL TRENCH SECTION
(NO SCALE)
NOTES:
1. GRADE AREA OVER TRENCH TO DRAIN AWAY
2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2'
WITH 2" OF INSULATION
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY
Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER
DRAINFIELD ROCK
5'
1'
DESIGN FACTORS:SYSTEM REQUIREMENTS:
900 GPD PEAK FLOW
PERK RATE: 26.7 MIN/IN
APPLICATION RATE: 2 GPD/SF (CONSERVATIVE)
5-WIDE TRENCH SYSTEM
3000-GAL ADVANTEX SEPTIC TANK
BOTTOM OF TRENCH: AT GRADE
FLOW LINE ELEVATION: 0.5' ABOVE GRADE
900 GPD / 2 GPD/SF / 5' WIDE * 1.0 RED FACTOR [0.5 DEEP] = 90 LF TRENCH REQ'D (90 LF SPECIFIED)
GEOTEXTILE FABRIC
AND INSULATION
11
4" PVC w/ 10 - 1
8" ORIFICES
SPACED @ 4.5' OC (EACH
TRENCH)
6"
11/5/23
MOA-APPROVED SAND
LAYER AS FILLER
THROUGH ORGANICS
TO RECEIVING SOILS
2'-6"
3:1 SIDE SLOPES
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231393, Curtis Townsend, 12/18/23
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE: PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
DEPTH
(feet)
TEST HOLE 1
DATE READING START TIME NET TIME
(minutes)
DEPTH to
WATER NET DROP
PERCOLATION RATE: (MIN/INCH)
(inches)(inches)
DATE OF MONITORING
WAS WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING
IF YES @ WHAT DEPTH?
26.7
10/25 1
2
3
CLAYEY GM
Professional Engineers Stamp:
YES
GRAVITY HILL ESTATES LOT 1B
10/25/23 015-093-57
ERIC TREVITHICK
2:12 1 0
16
1' OB
30
Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER
PERC TEST LOCATION
TECHNICIAN: M. JAKUBISIN
2 0
16
12'
3'
11/1/23
COMMENTS:
SITE PLAN
1 0/16
USCS SOIL CLASSIFICATION WAS VISUALLY DETERMINED
11/5/23
BOH
1 0
16 2 2
16 1 2/16
1 0
16 2 2
16 1 2/16
30
30
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231393, Curtis Townsend, 12/18/23
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE: PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
DEPTH
(feet)
TEST HOLE 2
DATE READING START TIME NET TIME
(minutes)
DEPTH to
WATER NET DROP
PERCOLATION RATE: (MIN/INCH)
(inches)(inches)
DATE OF MONITORING
WAS WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING
IF YES @ WHAT DEPTH?
CLAYEY GM
Professional Engineers Stamp:
YES
GRAVITY HILL ESTATES LOT 1B
10/25/23 015-093-57
ERIC TREVITHICK
1' OB
Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER
TECHNICIAN: M. JAKUBISIN
SEEPS
COMMENTS:
SITE PLAN
USCS SOIL CLASSIFICATION WAS VISUALLY DETERMINED
11/5/23
BOH
TEST HOLE NOT PERKED, SEEPS THROUGHOUT
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231393, Curtis Townsend, 12/18/23
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM.
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this Day ofr PLdif t PC of 20 yam, by and between
Di�r�6N Maf flwplP# 44, JTf erein the "OWNER," and the Municipality of
Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code
(AMC) 15,65.365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
l . Advanced Wastewater Treatment Systems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as Advantex System
located at (legal description)
Gravity Hill Estates Lot 1 B
2. Maintenance, Repairs and Alterations.
(Owner is required to read, understand and initial each section)
P� Throughout the term of this Agreement, the Owner shall enter into a service agreement
with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
�S It shall be the responsibility of the Owner during the terns of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
includes an annual maintenance fee (typically $400 to $600).
Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rev. 05/18/2018) Page 1 of 3
"' Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
P-
Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance with AMC 14.60.030.
Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS vendor/installer and approved by the Municipality are the governing
guidelines for the construction, maintenance and repair of the Owner's AWWTS.
Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred.
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Mumicipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction; Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severahility. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05/18/2018) Page 2 of 3
(signature:)
OWN
By: Date: I'l 12n
,4NZ'AAJ VMA05 W4,.*��(Printnamc)
JJ
STATE OF ALASKA
MRD JUDICIAL DISTRICT
The foregoing instrument was acknowledged before me this jj day of
20,q±, by _N1t�, ; r, �e,(j &tj C,
1A If I I k
NOTARY I �SKA
My Coniniission 15� In STATE OF ALASKANOTARY PUBUC
L'
cancim Ann Hendrickson
My Commission Expiree
s Sep 25.2W
MUNICIPALITY:
By: — L / L —(signature)
CUO,-M (print name)
(rev. 05! 18/2018)
Date: / 2 ( F/ 2.0 Z,,3
Title: C t v i (- c- -- 4' t r7- k",
Page 3 of 3
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
OSC251046
Parcel ID 015 -242-99 Expiration Date:
Legal description GRAVITY HILL ESTATES LT 1 B
Site address 12255 AURORA VIEW CIR
Current property owner(s) RAMOS ADRIAN &
1/22/2026
X The On-site system(s) is/are approved for 6 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
No comments
By:
Original Certificate Date:
2/13/2025
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage,
Development Service 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 submittal.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
MUNICIPALITY OF
Development Services Department
\
t'
On -Site Water & Wastewater Section
ANCHORAGE Ru-sR
Phone: 907-343-7904
Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 015-242-99
Complete legal description Gravity Hill Estates, Lot 1 B
Location (Site address) 12255 Aurora View Circle, Anchorage, AK, 99516
Current property owner(s) Adrian Ramos Day phone
2. ON-SITE SYSTEMS SIZED FOR 6 BEDROOMS
3. TYPE OF WATER SUPPLY: 0 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: 0 Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: X Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age NEW - See advisory if steel older than 20 years
6. ABSORPTION FIELD: 0 AWWTS ❑ Bed ❑ Deep Trench 0 Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: 0
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 $ 12.0 Waiver Fee $
Date of Payment
COSA# i0.SG Z 5 /0
Date of Payment
Waiver #
COSA Applicalionjune 2022
COSA Checklist_June 2022
COSA Checklist
Legal Description: Parcel ID:
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. 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.
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank
Date of pumping
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed)
ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade 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
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)
If yes, enter date
Adequacy test date
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) in
Effective depth used in
Effective depth remaining in
Comments/Deficiencies:
COSA Checklist_June 2022
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’
Yes if No ft
Neighboring Tank > 100’Yes if No ft
Absorption Field on Lot > 100’Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’Yes if No ft
Holding Tank > 100’Yes if No ft
Animal Containment > 50’Yes if No ft
Manure/Animal Excreta Storage > 100’
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 ft
Tank to Property Line > 5’Yes if No ft
Field to Property Line > 10’ Yes if No ft
Water Main > 10’Yes if No ft
Water Service Line > 10’Yes if No ft
Surface Water > 100’Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’Yes if No ft
Community Wells > 200’Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm Phone
Engineer’s Printed Name Date Benjamin Schiller, P.E.
