HomeMy WebLinkAboutSAND LAKE #2 BLK 4 LT 37� '6 kg
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Municipality of Anchorage
Community Development Department Page 1 of 2
On-Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907)343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP181385 PID Number: 011-135-16 E New ❑✓ Upgrade
Name
Donald Cogger ABSORPTION FIELD
Address 0 Deep Trench Shallow Trench
❑ Bed 1:::] Mound
8222 Seacliff Street ❑ Other
Phone Number of Bedrooms Soil Rating Total depth from original • -de
3 GPD/SF Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gra - depth beneath pipe
Subdivision Block Lot t. Ft.
Sand Lake #2 4 37 Fill added above original grade Gravel length
Township Range Section Ft. Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES Ft. Ft.
To Septic Absorption Holding Sewer Total a..•rption area Number of trenches Dist.between trenches
From Tank Field i Lift Station Tank Line Ft2 Ft.
Well 115.5 Existing 1 N/A N/A Existin TANK p Septic 0 S.T.E.P. ❑Holding ❑Other
Manufacturer Capacity
Surface Water 100+ I Existing N/A N/A Greer Tank 1000Ga1.
I Material Number of compartments
I
Lot Line 8.6 1 Existing N/A N/A Steel 2
NA
Foundation 7.0 Existing N/A N/A LIFT STATION
Manufacturer Capacity
Curtain Drain 50+ Existing N/A N/A : Gal.
I
Remarks Pump on level at Pump off lev- : High water alarm at
Tank replace only.
n. in. in.
Pump make ..• model Electrical Inspections performed by
PIPE MATERIAL House to tank Tank to
3034
Installer drainfield 3034
Issacs Excavating Drainfield CO/MT 3034
Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 100.0ft
Inspection 151 11/6/2018 �a Location and description
dates: 2 11/7/2018
aro 41' House FF
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp
Conditional Approval: Date �',OF A�'QSl{4
.titeven,..I5annorte'%
7,1;" 8149
Approved (- Date 9 .R7-t ,k •
� ,q�p p P�
Inspection Report_1-1-12.doc
A B -'
EC 1.8 ��
Ti 7.3 24.9 f j' / `� _
T2 15.0 27.6 r rtil*`*** _..._)l .
DCO 18.0 29.1 I- ** r'
C1(E) 22.9 37.1 ! ` ``'
14 39 '4,+�
TRUEICRTH SCALE : 1"=30
-____ / 1 (4(
I
•
WELL (E)/
INSTALLED NEW 1000. SEPTIC TANK M M --------
W/ DCO AFTER N,
DRAIN FIELD (E) ' • 1
i REMOVED 1000. SEPTIC/
5 PER MOA CODE 38
___*./ ______ . .
i w\3 37
X09: COMMUNITY WELL RADIUS_I- W iy
�— w W r B ` -
/ \
Q I 3 BDR. SFD
�`,r• 5.8 7.0 iy
/� � � � DRIVEWAY �,
V C1(t)\ A \ aa)i
1 0 1 FC !y L
-- — 4.5 1 s16 T7� • \ U' �N
�SEPTIc \ T2 i 115.5 W �� w W
AREA 7 DCO 3�
N 1n
W W
\ W I Ocr ry a
U P { W
O (n
WELL (E)
\ 1 ________
3.
18 I 35 \ i
z
woo 0
m= ti z Z
6 ?a FF; 100 \ I
8c1LI o- i
-- 98.4 —
3'S CRAWL SPACE ABBREVIATIONS
^'`RIc101NSUTATI'0= I TH TEST HOLE
93'9 NEW laoo X90. ;h \ \ (P) PROPOSED
SEPTIC TANK /RN" \ - �� (E) EXISTING
/Q`' \ \ CO CLEAN OUT NO.
/0� \ MT MONITOR TUBE NO.
./yo>� \ 11/ TYP TYPICAL
1
NOTES: PANNONE ENG SVC, LLCDote
RECORD DRAWING P.O. BOX 102954 ANCHORAGE, AK 99510 i 11/13/15
e.".PHONE (907) 272-8218 FAX (907) 272-8211 ". 4•-:..- 9• Sco1e
- *I..• ;., i/\ ,%*: 1„ = 30'
• P.I.D. NO
SAND LAKE #2 B4 L37 ,,,•• 011-135-16
DONALD COGGER •' even•�.•�ann0►i9 PERMIT NO.
DRAWN ACP CE 8149 OSP181385
8222 SEACLIFF STREET
SITE PLAN ANCHORAGE, AK ••t;; y Sheet
2 OF 2
MUNICIPALITY OF ANCHORAGE
On -Site Woter& Wastewater Program
PDBox 19665 4700Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
Permit Number: DSP181385
Work Type: SapUoTmnkUpgnade
Tex Code Number: 01113510000
Site Legal Address: SAND LAKE #28LK 4 L 37 G:2224
Site Mailing Address: 8222SEACL|FFST, Anchorage
Owner: COGGERDONALD D&
Design Engineer: pANNONEENGINEERING SERVICES
This permit iafor the construction of:
Lot Size in Sq Ft:
1UC25/2U18
1O/25/201S
[] Disposal Field 2 Septic Tank [] Holding Tank [] Privy [] Private Well DWater Storage
All construction shall bminaccordance 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 (18AAC8O)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.G5.Provide notification bycalling (Q07)343-7SO4(24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall baeither:
a. Opened and Closed onthe same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: Data: 1 11
|eauad By: Date: / 6) ,9 ;,5 L 0
9
MUNICIPALITY OF ANCHORAGE
Community Development Department 4 . '� 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. 011-135-16
Property owner(s) Donald Cogger Day phone
Mailing address PO BOX 110818
Site address 8222 Seacliff Street 0-ke-
Legal description (Sub'd., Block & Lot) Sand Jac #2 B4 L37
Legal description (Township, Range & Section)
Lot Size 6,750 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN: TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial ❑ Single Family (SF) ❑X
Septic Tank
❑X
(w/wo ADU)
Upgrade M
Duplex (D) El
❑
RenewalTank
Renewal El
Privy
❑
Multiple Dwellings ❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Dis tance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
ignature of property owner or authorized agent)
Permit/Rush Fees: oR 15 -
Date of Payment: a /,2,3 1/'9
Receipt Number: 0, ! &'46
Permit No. Q'Spi 2 3 ,
Permit App_,- :- :_.-'c
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181385, Rebecca Carroll, 10/25/18
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181385, Rebecca Carroll, 10/25/18
�; MUNICIPALITY OF ANCHORAGE
72-013
® DEPARTMENT OF HEALTH & ENVIRONMENTAL. PROTECTION
I ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
PHONE
NEW
P
D()0G LA S GA NT
x702-,2020 j
I ❑UPGRADE
MAILING ADDRESS
R
LEGAL DESCRIPTION
Lei f 37 K SANA kAr
LOCATION
2noPE SiflLL L '1=
NO. OF BEDROOMS
3
DISTANCE TO:
Well ' /10 Absorption are
Dwelling
-78
PERMIT NO.
20,Z,7
i Q
Manufacturer A L
Material
No, of compartments
wF
h
Liq. capacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
Y
DISTANCE TO:
Well
Dwelling
PERMIT NO.
JUZ
= z F
Manufacturer
Material
Liquid capacity in gallons
TO:
ILFoundation
�
Nearest lot line
0J
PERMIT NO.DISTANCE
FLenj_
LL Z
No. of lines
of eac I�e
Total length of ®s
Trench width
Distance between lines
P Z w
inches
FTop
rile io finish
Material beneath tile
Total
of grade '
/ �(
effective ab sor tion area
p
y
inches
Length
Width
Depth
PERMIT NO.
w
Q F
Type of crib
Crib diameter
Crib depth
Total effective absorption area
as
LU
Lu
Well
Building foundation
Nearest lot line
DISTANCE TO:
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
W
3:DISTANCE
T0:
Building foundation
Sewer line -
Septic tank
Absorption areas)
OTHER
PIPE MATERIALS
CAST E ?t 2 F
SOIL TEST RATING
INSTALLER
`I
SELF
1
REMARKS
i,o L
VjIFL-L D/5rANCL
VkDANCE 6tvLt' B
*;49TH ' •:��
...............
JUNE 25, 1971
t-.
APPROVED DATE LEGAL
-
SAN kA L/L:—:-
72-013 (Rev. 3178r
goW.][W"r" W V Ulf VA AM 0=01 fll:�11 !E":
' ' DEPHRTMENT OF HEHLTH HND ENVIRQNMENTHL-PROTECTION
^ 825 'L/ STREET. HNCHORHGE. HK99501
~ 264�4720
,ill �LP"E L.- 1 10 ED CP US --- 15 1 V K �E.E. i,A, P.O'Hi. F�*-;-" ��E RO;? tal 1: -Y
PERMIT NO ( 820217 >
HPPLICHNT DOUGLHS GSLLHNT BX 4-1-1. 09 272�220�
LOCATION WAND LK
LEGHL LT 3'7 BLK 4 5 --ANI) LHKE S/D LOT SIZE 7500 SQUHRE FEET
TYPE OF SOIL IO�N SYSTEM IS: DRHMFIELD
MHXIMUM NUMBER OF BEDROOMS SOIL RHTING (SQ FT/BR)85
THE REQUIRED
S12EE OF THE
SOILHBSORPTI SYSTEM
IS�
BHCKFILLING OF HNY SYSTEM
WITHOUT FINHL INSPECTION
HND HPPROVHL
BY THIS
REQUIREMENTS
/
TO PROSECUTION
FORTH BY THE
/
������
MINIMUM DISTHNCE BETWEEN
�� ��������=
��
�� �������
��
SYSTEM
������
�� =~
�
��v ��
THE
LENGTH
DIMENSION
IS THE LENGTH (IN FEET)
OF
THE TRENCH
OR DRHINFIELD
THE
DEPTH
OF H TRENCH
OR PIT IS THE DISTANCE
BETWEEN
THE SURFHCE
OF THE
GROUND
AND
THE BOTTOM
OF THE EXCHVTIOG (IN
FEET).
WELL LOGS FIRE REQUI�ED
8ND MUST BE RETURNED TO
THE �EPHRTMENT WITHIN
�0
1 it! Ell YA 00
1-1 WA 1: Ell W P-4 1 m E
D CE
��E . . ..�^
THE
GRAVEL.
DEPTH IS THE
MINIMUM DEPTH OF GRAVEL.
HND CONSTRUCTION
BETWEEN THE
OUTFHLL PIPE
HND
THE BOTTOM OF THE
EXCHVHTION (IN FEET).
1-11EATIR.0 I FOOKE, ��to, W :1 jc-.7 ���4 WK -0 �M low &;,_*� F-�� E.-- 11.- 125 v!�
PERMIT HPPLICHWT HHS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTHLLHTION INSPECTIONS OF HNY WELLS HDJHCENT TO THIS PROPERTY HND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERYE
7 y ns 1:1 s":
1:0015101"JED07, IRE
I? Fit K NO: �11E to-,t��
BHCKFILLING OF HNY SYSTEM
WITHOUT FINHL INSPECTION
HND HPPROVHL
BY THIS
REQUIREMENTS
DEPHRTMENT WILL BE SUBJECT
TO PROSECUTION
FORTH BY THE
OF
MINIMUM DISTHNCE BETWEEN
H WELL AND ANY ON-SITE
SENHGE DISPOSRL
SYSTEM
IS
100 FEET FOR H PRIVHTE
WELL OR 150 TQ 200 FEET
FROM H PUBLIC WELL
DEPENDING
HE
UPON THE TYPE OF PUBLIC
WELL
SYSTEM
MHY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMOD���D
MINIMUM DISTHNCE FROM
H PRIVATE WE -:1 L TO H PRIVHTE
SEWER LINE IS
25 FEET
HND
TO H COMMUMITY SEWER LINE
I� 75 FEET
WELL LOGS FIRE REQUI�ED
8ND MUST BE RETURNED TO
THE �EPHRTMENT WITHIN
�0
DHYS
OF THE WELL 1,-'OMPLETIO1%L
OTHER MAY
HPPLX
HND CONSTRUCTION
DIHGRHMS
HRE
HYHILHBLE TO INSURE PROPER INSTHLLHTI/
�EHE ��1 "11- K V Hoo, 1 F -T FE: win �K ID -E-OI 1-11 EO"Ir o.--t:Ot U --
I CERTIFY THHT
1: I HM FHMILIHR WITH
THE
REQUIREMENTS
FOR
ON-SITE SEWERS HND WELLS HS SET
FORTH BY THE
OF
RNCHORHGE.
2: I WILL INSTHLL THE
SYSTEM
IN HCCORDRNCE
HIITH THE CODES
n I UNDERSTHND THAT
HE
ON~SITE
SEWER
SYSTEM
MHY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMOD���D
TO
INCLUDE MORE
THHN
] BEDROOMS
SIGNED als
ISSUED B __�--�..... ........_DHTE�_.e���������� Y40
V v �J
OS6 IE SOILS LOG
MUNICIPALITY OF ANCHORA ' `
• DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
825 L. Street, Anchorage, Alaska 99501 264.4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: _rLLr-monj 17owCS DATE PERFORMED:_
LEGAL DESCRIPTION: LOT S-7 17 KY SAND k A k k• No 2
SLOPE SITE PLAN
SILT SND
1
LOAM
2 M 1.._
3 ♦• SV(/_�11
4
. • '• � C�CctN Sa.�loQ � �,r.
6 ,
is
8 � =
9
10
11
12
13
N�>o-r'o " d F:
N o }a a V%At W.11
y, c ua a,+L4✓
• WAS GROUND WATER
k "4S �« ENCOUNTERED?
:AI s
IF YES, AT WHAT
`� 10 �� Q ® DEPTH?
F �
14
^1.
.
t
Net
Time
�A
ego"
• ••�+t
15
� ,k
19m
!
16
.p•
,10,
2225-E
17
+101
J NE 25, 1971 101
18
••� ,.
8• ....• �
l,ONAL
19
20
COMM E
PPPPn PAArn PV•
S
Q L
O
P
E
Reading
Date
Gross -
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE
(minutes/inch)
xSOILS LOG
0
MUNICIPALITY OF ANCHORAUMCIPALITY OF ANCHORAGE
• ae DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
ENVIn J, !,. ;0 r TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST �` i\` ��4
PERFORMED FOR: � �rA46PIi 80W14 -S D Tf��RPO�MEf� —D '/(O'®
LEGAL DESCRIPTION: � ® I 7 I i� {4 AND I,
SIL ® SLOPE
1 ! OAr H
2 M l_.
s • e.
6
8
10
11
12
3
Date
O� A�'q
14
`';S°
•9TH ••••9 d�9
15
*:
16
•• .
. ..,.... "s N
2225-E
17
X80 .
JNE25,1971 a
.�N .
19
20
COMMENTS
PERFORMED BY:
72-008 (6/79)
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
AkLr No P.
SITE PLAN
�} S
'1t O L
O
P
E
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE
(minutes/inch)
APPLY AT FILL5 Vu s urrr-rn nr+u.. w"65-
Property Owner
Zip Code
Mailing Address CJ L
Buyer
Zip Code
Address
Lending Institution &J `ci �)_ �y�
C 7 Zip Code
Address
Realty Co. & Agent
Zip Code
Address
Legal Description / j / 2-7
Street Location S` 4, 11 1-' l( _
ype of Residence
Single Family
❑ Multiple Family No. of Bedrooms
❑ Other
Phone
Phone
Phone
7Water Supply ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
❑- Individual - For wells drilled prior to that date, give well depth (attach log if available).
Community
❑ Public Utility
wer Disposal
Individual �
� �`�" �'`n Year When Connectedual ld to Public Utility:
❑ Public Utility
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Inv„�......_
FPT.
Field Notes: 4i DC` - TION
ENVIRON! a... .;o
C_ c,. 5.
CUT 14 1982
RECEIVED
( -Z-�-APPROVED BEDROOMS
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
DATE 1
r UU
BY: /t W
Soils Rating
(3182)
Date Sewer Installed I Well To Absorption Area
V iq1-- Well to Tank
`CONDITIONS OF APPROVAL
Well Log Received
Septic Tank Size
Time
Time
Time
Time
fYl\
Date
Date
Date
Date
l0 -'`nn _
Inspector
Inspector
Inspector
Inspector
r
Inv„�......_
FPT.
Field Notes: 4i DC` - TION
ENVIRON! a... .;o
C_ c,. 5.
CUT 14 1982
RECEIVED
( -Z-�-APPROVED BEDROOMS
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
DATE 1
r UU
BY: /t W
Soils Rating
(3182)
Date Sewer Installed I Well To Absorption Area
V iq1-- Well to Tank
`CONDITIONS OF APPROVAL
Well Log Received
Septic Tank Size
CONSTRUCTION AND OPERATION CERTIFICATE
ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION .
PUBLIC WATER SYSTEM
APPROVAL TO CONSTRUCT
Plans for the construction of 9AIM L /1 K E- yf �p i1sT �� 7 LQ s
2-2-11d 6L1G V2 + P E'l 9 O � �5 t� public water system located
in _11 1VC 140 V VAC C Alaska, submitted in accordance with 18 AAC 80.100
by DO (A & C rA L L ),t PU! have been reviewed and are
I approved.
❑ conditionally approved (see attached conditions).
zaa��-'P�
TITLE DATE
If construction has not started within two years of the approval date, this certificate is void and new
plans and specifications must be submitted for review and approval before construction.
APPROVED CHANGE ORDERS
Change (contract order no. Approved by Date
or descriptive reference)
The "APPROVAL TO OPERATE" section must be completed before any water is made available to
the public.
APPROVAL TO OPERATE
The construction of the /4)[12 orf} �(= S�1j L C> % f% Lo 7_c? i public
water system was completed on (date). The system is hereby
granted interim approval to operate for 90 days following the cpmpletion date.
r
DATE
As -built plans submitted during the interim approval period, or an inspection by the Department has
confirmed the system was constructed according to the approved plans. The system is hereby granted
final approval to operate.
j/—
By
TITLE
DATE
E017 LAWS
•;t Municipality of Anchorage
On-Site Water and Wastewater Program <
(907)343-7904
Certificate of On-Site Systems Approval
Parcel I.D. 011-135-16 Expiration Date: ^a 1 q
1. GENERAL INFORMATION
Complete legal description Sand Lake #2 B4 L37
Location (site address) 8222 Seacliff Street
Current Property owner(s) Donald Cogger & Sue Harley Day phone
Mailing address 1387 Hankins Rd N, Twin Falls , ID 83301
Real Estate Agent Day phone
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well 111 Individual ❑
Individual Water Storage ❑ Holding Tank ❑
Community Class C-- Well Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: Date:
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ 52( Waiver Fee $
Date of Payment (1(21 111 Date of Payment
Receipt Number 024 Receipt Number
COSA# 05C11 ((.08 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.
Name of Firm Pannone Engineering Services LLC Phone (907) 745-8200
Address P.O. Box 1807, Palmer AK. 99645 �/
Engineer's Printed Name Steven R Pannone Date /L2 L
6. DSD SIGNATURE 0 `��i
System #1 Approved for 3 bedrooms ���.; STEVEN R. PANNONE
�••• CE-8149 ••�_,
System#2 Approved for bedrooms ��`f✓��O• •.•'��s5
Disapproved +•1I r#ik. OFEss0'-4�
Conditional approval for bedrooms, with the following stipulations:
\ vl'�%
1
ON-SITE m
WATER AND
c3 WASTEWATER o
L�, PROGRAM o
9,o �
4/T SER\)\&5')
By: 1 t� (`— Original Certificate Date: S
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 V
!
Well Flow Advisory Other '
COSA blue sheet f .
If more than 1 septic system is on the lot:
COSA Checklist# 1 of I
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: Sand Lake #2 B4 L37 Parcel ID:011-135-16
A. WELL DATA
Well type community class C If A, B,or C provide PWSID# Well Log(YIN) N
Date completed Sanitary seal (Y/N) Wires properly protected(Y/N)
Total depth ft. Cased to ft. Casing height(above ground) in.
FROM WELL LOG AT INSPECTION
Date of test N/A N/A
Static water level N/A ft. N/A ft.
Well production N/A g,p,m. N/A g p m
WATER SAMPLE RESULTS:
Coliform Neg colonies/100 mL Nitrate ND mg/L
Arsenic 24.0 ug/L Date of sample: 1 1/1/18 Collected by: PES
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic / Steel Date installed 11/6/2018
Tank size 1000 gal. Number of Compartments 2 Cleanouts(Y/N) Y
Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm(Y/N) N/A
Date of pumping New Pumper
C. ABSORPTION FIELD DATA
Date installed 1982 Soil rating (g.p.d./ft2 z 85 Wide Trench
or ft/bdrm) System type
Length 40 ft. Width 5 ft. Gravel below pipe 1 .5 ft.
Total depth 6 ft. Eff. absorption area 256 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 11/1/18 Results(Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 0 in.
Elapsed Time: 130 min. Final fluid depth 0 in. Absorption rate >= 450 g p d
None Known
Any rejuvenation treatment(past 12 mo.)(Y/N&type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access(Y/N)
"Pump on"level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot N/A On adjacent lots N/A
Absorption field on lot N/A On adjacent lots N/A
Public sewer main N/A Public sewer manhole/cleanout N/A
Sewer/septic service line N/A Holding tank N/A
Animal containment areas N/A Manure/animal excrete storage areas N/A
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 7 + Property line + Absorption field 5'+
Water main 101+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100 +
ABSORPTION FIELD ON LOT TO:
11
Property line 10 + Building foundation 10+ Water main 10 +
�+ '-I
Water Service line 5 Surface water 0 Driveway,parking/vehicle storage 0+
Curtain drain 50'+ Wells on adjacent lots 100 +
F. COMMENTS
Drain field presoaked with 2000 gallons
G. ENGINEER'S CERTIFICATION ��`�`~`��
r c °F a�qskk
I certify that I have determined through field inspections and 0.eir�• , .. •�..
review of Municipal records that the above systems are in p'"*:4 /\ -.*y
conformance with MOA COSA guidelines in effect on this date. 0 "'NOW.,
Engineer's Printed Name Steven Pannone •
i� ':Stev�. ISo,e• /
/emel 9,6&.....,, CE-8149 j
Date G / .. ,
ki4 \oFEsN.`o 4,�
COSA canary sheet_2-6-15.doc
8479Q
LOT 38
LOT 15 I 30EAST 135.00
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th —Wood fence W
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048.0 48.0 54.1 00
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Asphalt Gravel driveway Lf) LLI.
LOT 16 =LO
fdeick N Story Frame House v =
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p COe48.0 LOT 37 p w
° Septic vent(typ)
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�_ Chain link fence of
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EAST 135.00
LOT 17 30
LOT 36
AS-BUILT NO CORNERS SET THIS OATS
.. •••\\.t t hereoy certify that I have performed a Mortgagee's inspection
OF A' o'the following described property:_LOT 37,..BLOCK 4.
' ` C.-•• • • • •.qS �� SAND LAKE SUBDIVISION Na2
A.A,. i I
/*• !}9th * '17 k,/.,,
Anchorage Recording District,Alaska.and that the
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improvements situated thereon are within the property lines
/ - / and do not overlap or encroach on the prof/arty Iying
/ adjacent thereto.that no improvements on the property lying
II 3A .Elizabeth L. Walatko: i adjacent thereto encroach on the premises in question and
i `e-•• 80.16 - LS ••Q� that there are no roadways,transmission lines or other
, fqf•• •• yJ visible easements on said properly except as indicated
° �a�� hereon,
SCALE: 1 20' ! `l'O�css owe ` Dated at Anchorage,Alaska
EASEMENTS OF RECORD.OTHER THAN ,\N\‘"%.'" this ..16th____ day of November.2018.
THOSE SHOWN ON THE RECORDED FRED WALATKA&ASSOCIATES.L.L.C.
PEAT ARE NOT SHOWN HEREON. Engineers and Surveyors
UNLESS OTHERWISE NOTED WSS. FB 18-8. pg 53 BE gpW-248-1666
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 907-343-7904
On-Site Water and Wastewater Section r ; Fax: 343-7997
www.muni.org/onsite
Arsenic Advisory
Certificate of On-Site Systems Approval # 0SC1816O8
Subdivision: Sand Lake #2 ,Block, 4 Lot 37
A water sample revealed an arsenic concentration of 24 micrograms per liter (ug/L).
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. information on arsenic is available from the On-Site Water and
Wastewater Program website (www.muni.org/onsite) or at 343-7904.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
Mailing Address:P.O.Box 196650*Anchorage,Alaska 99519-6650*www.muni.org