HomeMy WebLinkAboutEAGLE RIVER VALLEY RANCHETTES LT 4AEAGLE RIVER VALLEY
RANCHE-TTES
• t t
Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 1
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP251042 PID Number: 05022128000
Dwelling: X Single Family (SF) El with ADU El Duplex (D) n Two Single Family Project: n New nN Upgrade
Name
MCBRIDE
ABSORPTION FIELD
On Deep Trench El Wide Trench n Bed n Mound
Site Address
18848 MAN 0 WAR
F1 Other
Phone
Number of Bedrooms
Soil Rating
depth from original grade
14
1.2 GPD/SF
JTotal
10 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
4 Ft.
Gravel depth beneath pipe
6 Ft.
Subdivision Block Lot
EAGLE RIVER VALLEY RANCHETTES L4A
Fill added above original grade
2.6 (VARIES) Ft.
Gravel length
50 Ft.
Township Range Section
Gravel width
3 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION
DISTANCES
To
Septic
Absorption
Lift Station
Holding 1 Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank Linet2
600 F
Ft..
Well
TANK 9 Septic [:1 S.T.E.P. El Holding El Other
Manufacturer
GREER
Capacity
1250 Gal.
Surface Water
+100
+100 1
Material
Number of compartments
i
Lot Line
+10
+10
NA
POLYETHYLENE
2
Foundation
+10
+10
LIFT STATION
Manufacturer
Capacity
Remarks
Gal.
Alarm location
Electrical installed by
PIPE MATERIAL House to tank 3034 drainfield Tankto 3034
Installer
NORTHERN LIGHTS CONSTRUCTION
Drainfield 3034 CO/MT 3034
Inspector C.13ALZARINI
BENCH MARK (Assumed elevation) 100 ft
Inspectes:tion 5/23/25 5/24/25
da
Location and description
2nd
OF TANK
3rd 5/25/25 4`h 5/26/25
ITOP
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
11
�kkl
C IF A4.,
Conditional Approval: Date
dW t
low
... ...... .
49 TH
0�
Ae
�,o
Septic System
r. ARLES G BALZARIUI
Approved Date
VIC, CE -13854
67,
Not Ahis approval does not include well permit requirements.
AW
OPROFESVO'
I
7/21/2h - -
(Rev 05/02118) 1
CHARLES G BALZARINI
CE-13854R
E
G
I
S TEREDPROFE S S I O N A L E N GINEER
6/9/25
Performed For:
Legal Description:
Depth
Fee
Municipality of Anchorage
Development Services Depart~ent
On-Site Water and Wastewater Section
4 700 Elmore St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
P£(2.C., B p1eio
Soils Log -Percolation Test
-=!1&_8:__~ __ t:.L.)--=.f ___ ~ ______ Date Performed: ____ ).__/)_l/,_1/_#_s ___ _
C.,4-[Jl-£(2.:Jv' £J2-(.//J,.l,,l,~--/ Township, Range, Section:
--=~-~.,,,........-=-:,--::--:--,i7"t'-l't------------------V. AA£ H~TT/3 5 t,.LJ ,-r Slope Site Plan
0
QJE,R~Jt-DLCN 1-_,--
~-f!-~ 2-
3-
~-
~ Svi/SM 4-,. \
p ~ /{ ;\)~
5-<
' '
6-
r-
7-
,..
<'"
8-( '-
9-,
WAS GROUND WATER /JO ENCOUNTERED?
s
10-
11-
IF YES, AT WHAT DEPTH? A/A L
0 Depth to Water After tv A p
Monitoring? E
12-Date: (VI{"
13-
14-Reading Date Gross Time Net Time Depth to Water Net Drop
15-l )/).'1/;;S (l:7;,~ (). 0 ,. 0;,,
16-:).. ll:u 5 l D" ~ -lr(/b~ ii-~,11:
17-' !(: u 4 r 0 ~ ()" 0
18-4-tl : s y tnr ({ _ t~b,. ll.-'Y/1/'
19-s l\~ ~4 F)' o~ 0~
20-\-;>.: () L-\ -Lt -\'/lC t.1 -11// (,.., r✓i l (J r
PERCOLATION RA TE _i_◄ __ f __ (minutes/inch) PERC HOLE DIAMETER G //
TEST RUN BETWEEN
coMMENTs f efffd-Wl'[;;-:J l-4 Hw~ -~~
FT
PERFORMED BY: I ~RTIFY THAT THIS res·r WAS
ALL STATE ANO MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE -2 ) tf..-/))
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: OSP251042
Work Type: Septic Upgrade
Effective Date:
Expiration Date:
Tax Code Number: 05022128000
Site Legal Address: EAGLE RIVER VALLEY RANCHETTES LT 4A G:0054
Site Mailing Address: 18848 MAN O WAR RD, Eagle River
Owner: MCBRIDE GLORIA A
Design Engineer: C&M ENGINEERING SERVICES
This permit is for the construction of:
2 Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy
�11�71(
I)ei� rtt'ttc.•�tC
4/1 /2025
4/1 /2026
Lot Size in Sq Ft: 17955
Total Bedrooms: 4
❑ 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:
The Engineer is required to do an additional percolation test and groundwater study prior to construction of the
septic field. Please submit stamped and signed results with the As -built Inspection Report. If the results require
a design change, construction of the system will stop pending On -Site review and approval.
Received By: - Date:
Issued By: Date: 1 �'
ON -SITE SEPTIC/WELL PERMIT APPLICATION
Parcell.D. 050 'Z21 2-9
Property owner(s) MCBRIDE
Mailing address
Site address 18848 MAN 0 WAR RD
Day phone
Legal description EAGLE RIVER VALLEY RANCHETTES LT 4A
Number of Bedrooms 4
Engineering Firm C&M ENGINEERING
Building Permit Number
Not Applicable �
APPLICATION IS FOR: APPLICATION IS AN:
(N all that apply)
Absorption Field
El Initial El
Septic Tank
F I Upgrade R
Holding Tank
El Renewal ❑
Privy
❑
Well
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
Permit/Rush Fees: Waiver Fees:
Date of Payment: 3 1Z -Z- 0 2� Date of Payment:
Permit No. Waiver No.
C&M ENGINEERING SERVICES
Ph: 907-854-5558
Municipality of Anchorage
Onsite Water & Wastewater Program
4700 Elmore Rd Anchorage, Ak 99507
RE: Proposed Septic System for EAGLE RIVER VALLEY RANCHETTES LOT 4A
Dear Reviewer,
The above referenced property is currently served by an older failing septic system.
Our review of available documentation and field investigation show that this project will not adversely
impact any nearby Wells, Wastewater disposal systems, replacement disposal sites, or drainage flowing
onto and off of the subject property.
As shown on the plan, the tank and field will be greater than 10’ from the house foundation.
The tank will be of MOA approved construction.
The tank and field shall be covered with a minimum of 2” moa approved insulation and 3’ of cover or a
minimum of 4’ of cover without insulation.
The design is based on the testhole logged by us in 2024. We will perform a field perc at the far end of
the field during construction.
Upon completion of the installation, a record drawing will be submitted showing the location of the new
tank, leach field, well, and other applicable features.
Following replacement of the septic, we will be seeking a COSA.
Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854-
5558 or by email cgbalzarini@gmail.com with any questions or concerns.
Sincerely,
Charles Balzarini, PE
3/5/25
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251042, Curtis Townsend, 04/01/25
Residence: EAGLE RIVER VALLEY RANCHETTES LOT 4A
number of bedrooms 4 br
Water usage/bedroom 150 gpd/br
Water Usage 600 gpd
system type: Conventional
type: Deep Trench
Application Rate
1.2
gpd/sqft
required absorption area 500 sqft
trench width (W) 2 ft
MIN gravel depth (D) 6 ft
Min Required Length: 42 ft
Groundwater Depth: dry
Testhole Depth: 16 ft
Max Excavation: 10 ft
Calc By: CGB Date: 3/1/2025
C&M ENGINEERING SERVICES
907-854-5558
Septic Design Calculations
RESIDENCE/LOT INFO
DRAINFIELD
REFER TO PLANS FOR DETAILS OF CONSTRUCTION
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251042, Curtis Townsend, 04/01/25
CHARLES G BALZARINI
CE-13854REGISTEREDPROFESSIONALENGINEER
3/1/25
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251042, Curtis Townsend, 04/01/25
Municipality of Anchorage · ·-1.....~-Oevelopment Services Department : ·
On-Site Water and Wastewater Section , ,
4 700 Elmore St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
04 · ~ -(907) 343-79 . .I
l
l
·
TH A I ~ ·· C · ·-,P·
.J I.~ ··.l~l/lft ··· ·· ~-·
·
Soils Log - Percolation Test t · · ·
Performed For: S ...... !....:H..:::.4..!..:G-0:.......!...:(1/-----'rt'1c,~::::::...:::P:_jl.._:.J'_f)..:.__£_
_
_
_
_
_
_
_
Date Performed:_\ _
_
- - = - . . . . L . - - - - -
Legal Description: _CA&....;...;.:::...U _ _~_Ji_v_~_P---._I/._J'.1-~UJ;.-'""_'/ _
_
_
_
Township, Range, Section: _ _ _ _ _ _ _ _ _ _
f<.AtvC If c r it -5 l-or 4-ff___,_s-.:lop,_e~___,
0
1-
2-
3-
4-
5-
6-
7-
8-
9-
10-
11-
12-
13-
14-
15-
16-
17-
18-
19-
20 -
Depth
(Feet}
I""\.,,/
~
I
- r
r
c..
' r
r .
I!. -,,
,.
....
( ~
(-( '-
(
<
((
,
oV[(l...-
i3vP..;)f)J
srt:rt
£M
roe~ j
Sw/5vvi
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT DEPTH?
/JO s
L
,~1
(g)
Site Plan
~t: Ao
\-le ~c
-
-
-
0 1 --~ -1 ---1 --~ l----+ -~ ---+ --4 --+ -----,
pDepth to Water After
Monitoring?E l--~ -l---+ -~ l----+ -~ ---+ --4 --+ -----,
Date:
Reading Date Gross Time Net Time Depth to Water Net Drop
ll!lt/)-Cf
( l~o.5 O
:
o
~
,0 r>0,,,,.
\I '. I l{tJ :· oC,G-°!fb )
-
<J;/t,
-;..
\l ~l S C): (
)
0
() .,.
o
<
.
I~ 2-4 0 , 1 0 '1 ~ - {Jj/J:,
I 5- 0/f~
I I'. ~5 t) 'oo, () ,,0 -,
J {: ?4 o: oi ~-O /l1 o ..5 -- 0({,<
PERCOLATION RA TE Lti (minutes/Inch) PERC HOLE DIAMETER I,,t
-
TEST RUN BETWEEN 5 FT AND lo FT
COMMENTS 1£21 7ffZ:f.!,,2.MCI':::> b
~
/
k&H7T "~&\DY/4$ 7i<@w..L.
Llifi: K ToP:::- 6c, I <;ttJ tM A ),
PERFORMED BY: C { '3 Al2,A(}....;».;:_ I C
I
b l+1ci#J:<V)_ CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: It/ ll/N
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251042, Curtis Townsend, 04/01/25
LOT 5B
MAN O WAR �D
C �1
O
BASIS OF BEARINGS: (S 89.59'15" E 133.00') 128.85'MEAS.
L:;; T 4 B
ASPLS MORTGAGE LOCATION SURVEY NOTES:
NO TITLE REPORT WAS PERFORMED FOR THIS SURVEY, EASEMENTS SHOWN PER THE
RECORD PLAT. THERE MAY BE ADDITIONAL EASEMENTS NOT SHOWN HEREON. THIS
MORTGAGE LOCATION SURVEY HAS BEEN PREPARED IN ACCORDANCE WITH ASPLS
MORTGAGE LOCATION SURVEY STANDARDS. IT IS A REPRESENTATION OF THE
CONDITIONS THAT WERE FOUND AT THE TIME OF THE SURVEY. THIS SURVEY DOES
NOT CONSTITUTE A BOUNDARY SURVEY AND IS SUBJECT TO ANY INACCURACIES THAT
A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. THE INFORMATION CONTAINED IN
THIS DRAWING SHALL NOT BE USED TO ESTABLISH ANY FENCE, STRUCTURE, OR
OTHER IMPROVEMENTS. UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE LIABILITY
EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES COLLECTED
FOR SERVICES IN PREPARATION OF THIS PRODUCT.
LEGEND
( ) RECORD DATA PER PLAT #63-129A
o FOUND 1 /2" REBAR, NO CAP
o FOUND 5/8" REBAR, NO CAP
EDGE OF ASPHALT
o P POWER POLE
& SEPTIC PIPE
FA DECK
0 CONCRETE
OF
0' 20' 40' 0i�Q� • ;gS`'�li�
SCALE: 1" = 20 FEET % * ••49 / . , , • •• .
••. Johnson;
WINTER SURVEY NOTE: +/- 6INCHES OF Ryan G�+ •, No. 192159
SNOW ON -SITE AT TIME OF SURVEY. ONLY c%,,-
11/6/202,4.•�VISIBLE IMPROVEMENTS SHOWN HEREON�Skl ' � \y
AS -BUILT OF:
LOT 5D
LOT 1 LOT 2
IIC�]II�J�7
GAAB-HD_,. R".. "IER ANCHORAGE AREA LF — 4
WEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING fF'x
NAME _'r &L,
= ADDRESS ; PHONE
LOCATIONXL DESCRIPTION"�
SEPTIC TANK: I
DISTANCE FROM W
LIQUID CAPACITY f? GALLONS
SEEPAGE SYSTEM:
SEEPAGE PIT:
f'
` NUMBER OF
\TERIAL f COMPARTMENTS
CIc ID
INSIDE LENGTH INSIDE WIDTH DePTH.
NUMBER OF PITS —OUTSIDE DIAMETER OR WIDTH Z Z ,LENGTH ` DEPTHS,
LINING MATERIAL ( 1 C` DISTANCE FROM WELL �` BUILDING FOUNDATION
NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.
TILE DRAIN FIELD:
TOTAL LENGTH
DISTANCE FROM WELL
FOUNDATION NEAREST LOT LINE
OF LINES
NUMBER OF LINES
DISTANCE BETWEEN LINES TRENCH WIDTH
IN. TOTAL EFFECTIVE
ABSORPTION AREA
SQ. FT.
LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH
GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
WELL: C-
e 7
DISTANCE FROM
WATER
TYPE
DEPTH
BUILDING FOUNDATION.
SAMPLE NEAREST
NEAREST
SEPTIC SEEPAGE
OTHER
LOT LINE
SEWER LINE
, TANK SYSTEM
CESSPOOL , SOURCES
DIAGRAM OF SYSTEM
DISTANCES:
f
-
DATE
,., .:-
� .^
,�-APPROVED
��
,__HEA1TH
AUTHORITY d*
15�_')
NAME OF APPLICANT. 0 Ade A0 J;. MAILING ADDRESS PHONE NO.,
RESIDENCE ADDRESS LOCATION OF INSTALLATION em
LEGAL DESCRIPTION 19 6a 46 L ,I, ()O�Cz4 AIJt4--d_j4=-�
APPLICATION TO INSTALL: SEPTIC TANK , SEEPAG� PIT , D RAN FIELD—, OTHER
TO SERVE THE FOLLOWING FACI,�ITY 9 1 /b& a4,,6zV-?n - Z
FINANCED THROUGH TO BE INSTALLED BY
PERCOLATION TEST RESULTS ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT -(,,- ML -11A ral
THIS IS TO SERVE AS Q, PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED.
MOO YPE Ad -SEEPAGE AREA C49 )-9
SEPTIC TANK SIZE �/ - DIAGRAM OF SYSTEM
TYPE
0
Health Authority
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
DATELA 6% APPLICANTS SIGNATURE q P2�
0
1'77 7 1 11
F',
GAAB-HD-2GREATEh -tNCHORAGE AREA
Atb'UGH
case
HEALTH DEPARTMENT
i -
oul
"
327 Eagle St. Anchorage, Alaska 99501
279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
15�_')
NAME OF APPLICANT. 0 Ade A0 J;. MAILING ADDRESS PHONE NO.,
RESIDENCE ADDRESS LOCATION OF INSTALLATION em
LEGAL DESCRIPTION 19 6a 46 L ,I, ()O�Cz4 AIJt4--d_j4=-�
APPLICATION TO INSTALL: SEPTIC TANK , SEEPAG� PIT , D RAN FIELD—, OTHER
TO SERVE THE FOLLOWING FACI,�ITY 9 1 /b& a4,,6zV-?n - Z
FINANCED THROUGH TO BE INSTALLED BY
PERCOLATION TEST RESULTS ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT -(,,- ML -11A ral
THIS IS TO SERVE AS Q, PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED.
MOO YPE Ad -SEEPAGE AREA C49 )-9
SEPTIC TANK SIZE �/ - DIAGRAM OF SYSTEM
TYPE
0
Health Authority
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
DATELA 6% APPLICANTS SIGNATURE q P2�
0
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
OSC251326
Parcel ID 050 -221-28 Expiration Date
5/26/2026
Legal description EAGLE RIVER VALLEY RANCHETTES LT 4A
Site address 18848 MAN O WAR RD
Current property owner(s) MCBRIDE GLORIA A
X The On-site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
No comments
By:
Original Certificate Date:
8/22/2025
This Certif' to of On -Site Systems Approval (COSA) is intended to demonstrate the subject
syste is/are in substantial compliance with municipal code. The Municipality of Anchorage,
Dev opment 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
NIPPON
A
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 050 221 28
Complete legal description Eagle River Valley Ranchettes Lot 4A
Location (site address)
Current property owner(s) McBride
2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS
Day phone
3. TYPE OF WATER SUPPLY: Fj Private Well ❑ Private Well serving 2 dwelling units
El Private Well serving 3+ dwelling units F* Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: nN Private Septic n Private Septic serving 2 dwelling units
[I Holding Tank R Community Septic or Public Sewer
5. SEPTIC TANK: [_1 Steel nN Plastic n Concrete F-1 Fiberglass
Age 0 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: R AWWTS R Bed R Deep Trench RE Wide Trench R Seepage Pit
Waiver request for:
Expedited review requested: F-1
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 .31 S� Date of Payment
COSA # 11) _1D � ;z Ct Waiver #
COSA Application—June 2022
COSA Checklist_May2025.docx
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.DISPOSAL 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_May2025.docx
E. SEPARATION DISTANCES
From Well on Lot to: (Please enter distances if less than required)
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Disposal Field on Lot > 100’ Yes if No ft
Neighboring Disposal Fields > 100’
Yes if No ft
Sewer Line/Main > 100’ Yes if No ft
Sewer Manhole/Cleanout > 100’
Yes if No ft
Sewer Service/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 Disposal Field(s) on Lot to: (Please enter distances if less than required)
Tank to Foundation > 10’ Yes if No ft
Field to Foundation > 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/Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
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
5.
3
'
11.6'
5.
3
'
12.4'
26
.
2
'
72.1'
26
.
2
'
25.6'
4.0
'
11.3'4.0'
5.4'
2.0' CANT.
TWO STORY RESIDENCE
GA
S
EL
E
C
.
12'x16'
SHED
8'x12'
SHED
COVERED STORAGE
RETAINING
W
A
L
L
LEGEND
FOUND 1/2" REBAR, NO CAP
DECK
CONCRETE
POWER POLE
EDGE OF ASPHALT
RECORD DATA PER PLAT #63-129A
SEPTIC PIPE
SEPTIC TANK LID
FOUND 5/8" REBAR, NO CAP
TIMBERLINE SURVEYING AND MAPPING
17035 BARONOFF AVE
EAGLE RIVER, AK 99577
907-242-5320
ryan@timberlinealaska.com
FILE NO.: 24.222
SCALE: 1" = 20 FEET
DATE: 6/3/2025
SHEET: 1 of 1
MOA GRID: NW0054
SCALE: 1" = 20 FEET(11"x17")
20'0' 40'
AS-BUILT OF:
ADDRESS: 18848 MAN O WAR RD, EAGLE RIVER, AK
LOCATED IN: ANCHORAGE RECORDING DISTRICT
LOT 4AEAGLE RIVER VALLEY RANCHETTESPLAT #63-129A