HomeMy WebLinkAboutBRUIN PARK BLK 4 LT 25Bruin Park
block 4
Lot 25
#016-101 -15
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP 231176 PID Number: 016-101-15
Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑9 Upgrade
Name
Dianne McKinney
ABSORPTION FIELD
Deep Trench ❑Wide Trench E] Bed ❑Mound
Site Address
11100 Polar Drive
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
907-223-8004
3
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
Bruin Park 4 25
Fill added above original grade
Ft.
Gravel length
Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION
DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ft2
Ft.
Well
>100'
N/A
N/A
N/A
>25
TANK I] Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Greer
Capacity
1000 Gal.
Surface Water
> 100'
N/A
N/A
N/A
Material
Plastic
Number of compartments
2
Lot Line
>rj'
N/A
N/A
N/A
NA
Foundation
>1o,
N/A
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Remarks Tank only replaced under this permit
Gal.
Alarm location
Electrical installed by
PIPE MATERIAL House to tank D3034 drainfield Tank to
D3034
Installer
Hiland Excavation
Drainfield -- CO/MTD3034
Inspector B Schiller
BENCH MARK (Assumed elevation) 100 ft
Inspection 151 6/28/2023
Location and description
dates: 2
r m th
Bottom siding at bldg corner
3 4
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval: Date
Septic Syste
Approved Date
N e: this approval does not include well permit require ents.
(Kev ub/ul/1 7
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Benjamin Schiller
CE 12592R
E
GISTEREDPROFES S I O N A L E N GINEER
1"=30'
EXISTING WELL
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
DV - DIVERTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
2CO
PERMIT # OSP231176 PID # 016-101-15
BRUIN PARK, BLACK 4 LOT 25
A B
MH 35.0
SV 35.3
A
B
2CO 34.8
19.0
20.5
20.5
FEET
0 30 60
FCO
PO
L
A
R
D
R
I
V
E
3-BDRM HOME
SEPTIC RECORD DRAWING
6/26/23
DV
CO
CO
CO
MT
MT
NEW 1000 GAL SEPTIC TANK
DECK SUPPORT
CO1
CO1 33.016.7
BENCHMARK:
BOT SIDING AT CORNER
PROFILE RECORD DRAWING
(NO SCALE)
92.3
88.0
92.9
98.6
FC
O
MH
SV
1000 GAL
SEPTIC TANK
2C
O
92.1
Benjamin Schiller
CE 12592
R
E
GISTEREDPROFES S I O N A L E N GINEER
9/7/22
BRUIN PARK, BLACK 4 LOT 25
PERMIT # OSP231176 PID # 016-101-15
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: OSP231176
Work Type: SepticTank Upgrade
Tax Code Number: 01610115000
Site Legal Address: BRUIN PARK BLK 4 LT 25 G:2633
Site Mailing Address: 11100 POLAR DR, Anchorage
Owner: MCKINNEY DIANNE M
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy
Effective Date:
Expiration Date
Lot Size in Sq Ft:
Total Bedrooms:
4
D-eparttnent
6/27/2023
6/26/2024
19800
❑ 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
C �
Received By: 15 V) '►�� G Date:
!�2- 3
Issued By: �^�- � Date: '� Z
3
MUNICIPALITY F ANCHORAGE
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 live
Parcel I.D. 016-101-15
Property owner(s) Dianne McKinney Day phone 907-223-8004
Mailinq address 11100 Polar Drive, Anchorage, AK 99516
Site address 11100 Polar Drive
Legal description (Sub'd., Block & Lot) Bruin Park, Block 4 Lot 25
Legal description (Township, Range & Section)
Lot Size 19,800 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(M all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF) ❑X
(w/wo ADU)
Septic Tank
NUpgrade
❑X
El
(D)
Holding Tank
❑
Renewal El.Duplex
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
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.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 3V D Waiver Fees:
Date of Payment:
Receipt Number:
Permit No. 0 S Z 3 !
Permit
Date of Payment:
Receipt Number:
ffy0h1�'iR93
June 27, 2023
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Bruin Park, Block 4 Lot 25
Septic Tank Replacement
Dear On-Site Services Engineer:
The owner of the above lot has a septic tank that has reached its end of useful life, so we are
submitting this permit application for its replacement. The attached site plan identifies the location
of the home as well as the wells and septic location. No conflicts exist between this proposed
system and any other wells or septic system, whether on this lot or adjacent lots. We are replacing
the septic tank with the same size designed for 3 bedrooms.
Due to the tight space on the lot, the septic tank will need to go in the space between the existing
deck (and the enclosed portion of the deck labeled the ‘sun room’) and the trench. The portion of
the deck labeled ‘sun room’ is under 30” high, while the grade drops below the rest of the deck.
Careful placement should allow the tank to maintain 5’ from the existing field as well as adjacent
deck supports for the higher deck.
The new septic tank will be a minimum of 100’ from all wells and surface water. Please refer to
the attached plan 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
OSP231176, Curtis Townsend, 06/27/23
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Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER
1"=30'
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
2CO
BRUIN PARK, BLACK 4 LOT 25
FEET
0 30 60
FCO
PO
L
A
R
D
R
I
V
E
3-BDRM HOME
SEPTIC PLAN
6/26/23
DV
CO
CO
CO
MT
MT
EXISTING TRENCHES
TO REMAIN IN SERVICE
DECOMMISSION EXISTING
TANK PER UPC
NEW 1000 GAL SEPTIC TANK
MAINTAIN 5' SEPARATION
FROM EXISTING TRENCH AND
DECK SUPPORT
"SUN ROOM" DECK < 30"
ABOVE GRADE
DECK SUPPORT
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231176, Curtis Townsend, 06/27/23
MRV U.MUze ini
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE
WASTEWATER INSPECTION REPORT
Permit Number: OSP221175
PID Number: 01610115
Dwelling: A Single Family (SF)
❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade
Name
LAPELLA PETER
ABSORPTION FIELD
❑ Deep Trench X Wide Trench ❑ Bed ❑ Mound
Site Address
11100 POLAR DR
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
312-7602
3
1.2 GPD/SF
6'-7' Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original gradeGravel
2- 3 Ft
depth beneath pipe
4 Ft.
Subdivision
Block Lot
BRUIN PARKBLK 4 LT 25
Fill added above original grade
0 - 1 Ft.+
Gravel length
38 Ft.
Township Range Section
Gravel width
5 Ft_
Beds: Number of Lines
-
Distance between lines
- Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
j Tank
Field
Tank Line
380 Ft=
1
-
Ft.
Welll
na
1 00�
na
na 100'
TANK E3 Septic E]S.T.E.P. [:1 Holding [I Other
Manufacturer
existing tank
Capacity
Gal.
Surface water
na
1100 '+
na
na
Material
Number of compartments
Lot Line na
1'+
na
na NA
na
Foundation na
10'+
na
LIFT STATION
Manufacturer
Capacity
Remarks Trench Addition, existing tank
Gal.
remains
Alarm location
Electrical installed by
Installer
PIPE MATERIAL House to tank existing Tank to D3034
g drainfleld
Leif Weisner Highland Excavation LLC
Drainfield D3034 COMITD3034
Inspector NorthRim Eng.
BENCH MARK (Assumed elevation) 100 It
Inspdecct sn 1:: 6/13/22
2`6/14/22
Location and description
3'tl 6/15/22
4"1
Deck
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval:
DateOF
1v 4
:� •� ``t
or -9
* THTO
Septic System
Approved f Date 2 W Z
fM131 !
I' szss Q:
4���a
d
4�1
Note: this approv I
es not include well permit requirements.
G/21/2
MRV U.MUze ini
NOR THR/M
ENGINEERING
SteveEng. com
PO Box 770724
Eagle River. Alaska 99577
907.694.7028
me FIND ► 0 'i'
BLOCK 4 LOT 25
WASTEWATER
UPGRADE SEPTIC
1" = 40'
RECORD
LAYOUT
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6/21/22 2 of 3
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8252X
N33047"30"W 265.73 (R) -�� NOTE:
N33047'02"W 265.79 (M) Plat record bearings and
3� distances do not achieve
mathematical closure. This
boundary is computed from
Lot 24 � 0 L--., -� monuments found on adjacent
Op3 \Z� lots 22, 23, and 24.
0 co O �o°a� Well
LO co
O c o
N N Gj� Q"�0.00 t i LEGEND
00
00Ib (R) Record
(M) Measured
o (C) Computed
CO Missing F 23.3
`Ourvey Y
c o'n SN Asphaltto to
Z Z v \1 N
ae N 1 Story ,_ J
deck 4.t Frame o
CI House. j �0%%
\
shed v . F12.0 12.7 C15O X OF A %6
cn 00QJ AW : ,QS O
�- P.
2p, Septic vent (typ) o N Ret. !t 1!
14.30 N ^ 15.3 wallOf I ow (/)-* 49th ••�' t
20.7 m 2g r •.
\ ` Sun room• • 00
00
5'7
r5b. Lot 25 /4 1� •. f izabeth L� Walatka•. �
�0>, 7 ` ��F • . 8036 - LS • • tee'
AM
do 0
� S?O1„ Railroad ties "?0"CSSI014AL
Shed s
V�je'�t9(9 �C%92� RECERTIFIED 6-16-22
98 0 RECERTIFIED 4-29-22
?o AS -BUILT NO CORNERS SET THIS DATE
Lot 22 Y/% / / 1 hereby certify that I have performed a Mortgagee's inspection
\ in accordance with ASPLS Standards of the following
/ described property: LOT 25 BLOCK 4
/ BRUIN PARK SUBDIVISION, FIRST ADDITION
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.
SCALE: V= 40' Dated at Anchorage, Alaska
FB 22-1, pg 32 this 24th day of December , 2003.
THOSE SHOWNN ON THE RECORDED
EASEMENTS RECORD, OTHER THAN FB 21-8, pg 57-58 FRED WALATKA & ASSOCIATES, L.L.C.
PLAT ARE NOT SHOWN HEREON Recert 1-04-10, 8-22-14 BEEngineers and Surveyors
UNLESS OTHERWISE NOTED. Recert file 12-26-03 907-248-1666
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.
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: OSP221175
Work Type: Septic Upgrade
Tax Code Number: 01610115000
Site Legal Address: BRUIN PARK BLK 4 LT 25 G:2633
Site Mailing Address: 11100 POLAR DR, Anchorage
Owner: LAPELLA PETER V & DONNA I
Design Engineer: NORTH RIM ENGINEERING
This permit is for the construction of:
Effective Date:
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
..�»cnr S�
0
3,1
llehartrnent
6/8/2022
6/8/2023
19800
Q Disposal Field ❑ 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
Received By:Date: 6/8/22
Issued By: Date: ��
3
ta) mmmty of Anchorage
(�, Mun
^ F
/5x
P.O. Box 196650 0 4700 Elmore Road
Anchorage, Alaska 99519-6650 (907) 343-7904 0 Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Department
On -Site Water and Wastewater Section
Waiver#: OSV221036 COSA#: Permit#:OSP221175
PID#: 016-101-15
Legal Description: Bruin Park Block 4 Lot 25
Engineer: North Rim Engineering
Applicant: Peter Lapella
Your request for a waiver of the required 10 feet horizontal separation from the absorption field
to the property line has been approved. The approved separation distance is 1.0 feet. See
engineer's waiver request for justifications.
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.
■oeao■maa■ae®■senano�eaooeeaeamoaa■eaaonoeommmo■■m®naammae®®®®eaa®®aen®aaoaeae�
Waiver is Granted: X Waiver is not Granted:
Date: 7 X0-2 Approved by: ! `x (�
(?VUZ,0_y_
Name of Reviewer
■■■an®®■■o■m®■a®■®■a®■ssae�mma■am®®®®®■o®■a®■a®■■aa�eao®ea®me®®®®®om®a®mmae®a®�
**7k* I ikil-*fir
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. 01610115
Property owner(s) LAPELLA PETER
Mailing address 11100 POLAR DR
Site address same
Day phone 312-7602
Legal description (Sub'd., Block & Lot) BRUIN PARKBLK 4 LT 25
Legal description (Township, Range & Section)
Lot Size 19,800 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
Q
Initial ❑
Single Family (SF) El
(w/wo ADU)
Septic Tank
❑
Upgrade El
❑
(D)
Holding Tank
El
Renewal ❑
Renewal
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
re-Lci -�oj2 r-, 9 et- -1,j UIa Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal C
(Signature of property owner or authorized agent)
Permit/Rush Fees: 595 Waiver Fees: Qa 5
Date of Payment:
Receipt Number: 33h
Permit No. 05 PZ 2 l 17 5
Date of Payment:
Receipt Number: (15so ��d,za� cosrl�
Waiver No. 0S, V a `d, 10
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
T RUM
FEZINEERING
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221175, Rebecca Carroll, 06/08/22
SteveEng.com Bruin Park B4 L25
SPECIFICATIONS & DESIGN GUIDELINES
Wastewater System Sizing: The existing septic tank will continue use; deck posts are
not over tank. A new trench will be constructed parallel to the existing trench, connect
the old trench via Diverter Valve. This is a tight space & requires precise measurements.
Lot line waiver to I' requested due to limited area. A well is located directly south; a note
on Plan sheet requires measurement to this well prior to construction. No other
wells/septics impacted by lot line waiver. No adverse impacts are expected from trench
addition. No easements are present on the lot. The slope is indicated in the area of the
septic system. No conflicts to neighbor properties. An application rate of 1.2 GPD/FT2.
Trench Length = 375 FT2/5'x 0.5 = 38' trench, 4' effective.
Specification Requirements: All components and work must comply with the
Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water
Regulations and Wastewater Regulations.
• 3' of cover or insulation is required for trench; an equivalent of 1 " insulation for l'
foot soil cover. Tank & solid pipe must be set on well compacted, stable soil.
• 10' minimum between the tank trench, tank to house. 10' to property lines,
• 4" diameter cleanouts with airtight caps are required 1 ' to 4' from foundation wall,
prior to any 90 degree bend in 4 inch line, in 2nd tank compartment, and two adjacent
opposing cleanouts between the tank and the absorption field, not more than 10' from
the tank positioned to provide cleanout access towards the tank and towards the
absorption field. Manhole Riser required in 1St tank compartment.
• All cleanouts must extend to at least ground level.
• In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron.
• Trench to be placed level, minimum of 4' to groundwater, 6' to bedrock from drain -
rock.
• Drain rock to be 1/2 inch to 2 inch screened. Drain rock to be distributed uniformly
throughout the trench.
• Perforated pipe to be installed level with perforations down.
• Silt barrier (filter fabric) to be installed above the drain rock.
• Smeared trench sides must be raked or scarified before drain rock placement.
• The finish grade must be mounded to promote drainage away from trench.
• Insulation must be placed over any pipe installed under driveways or parking areas.
• Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789,
ABS ASTM D2661,
• Sewer Service Line is minimum 2% slope.
• Septic Tank to be pumped every two years or when required.
• Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal)
* 4 TH
1, Steve Eng �W
CE -6856 ga2i
h 6/8/22 `=
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221175, Rebecca Carroll, 06/08/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221175, Rebecca Carroll, 06/08/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221175, Rebecca Carroll, 06/08/22
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Municipality of Anchorage
.,. DEVEOpMENT SERVICES DEPARTMENT Page 2 of 3
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number: SW030173 PID No. 016-101-15
Well
C5
Alternate
Site
=droom
A B
S1 17.3 12.4
S2 22.8 14.1
C4 33.1 31.0
M1 47.0 24.2
C5 41.2 21.9
PLAN
AS-BUILT
SCALE 1' = 40'
Lot 25, Block 4
Bruin Pork Subdivision
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number: SW030173
Page 3 of 3
PID No. 016-101-15
-- 93.5
I
])rnlnFletd Rock
38' (Trench Leng%h)
.I
80,5
PROFILE AS-BUILT
Scale: 1' = 10'
nt By: McGee Industries Inc.;
907 345 1553;
Jan-12-04 4:43PM;
M-W Drilling, Znc.
· P.O. Box l10378+AnchOragg, AK 99511~
· 907-345-4(X)0,907°345-*3287 Fax t
Job No.: 03-167 Project No.:
Permit No.
SW 03030173
Page 1/1
.~roUndwater Well As-Bullt
Well Owner: '1 revithick, Eric & Bobbi
· L~alDe~crlptlon: Brain Park Subdivision~ Block 4, Lot 25
11100 Polar Drive; Anchorage,' AlaaJca
Use of l~ett:
Domestic
Cons0'ucfi01~
6" + Ca, ed To:
160.53'
· WeE Completion- Open end X Screen I'er~otat~t
*$creen/ Petf orrttion description: No~ .~
· Grout Note~: (1) Sack- No. 8 bentonite granules
· IVote$:
· Material: A 53 Steel
Per/.
Method:
* WelIDevdo~: · Method: . Air surge IVme~: :
· .s~ae wa~er.te~(swr) .... 9~.~ (.~n~ (t~.o.w) tot, ofc~,tn.g
... with 100% '~f~Jitw~tbwn (DD) frd~i'M~ie'le~el'~Wl,).'
· . eMet~etL. Air lift ................. : ...
Date of ~ontpletlo'n:
· '09 July 2003 ....... +Pu~ In~tb/l:
WeU Log :
Depth in feet from .. - ..... n ,.
top of easing. Details of formations penetratedt ~'tze of mnt.c~"i.qlt color.~nd hardn_~s_=
0 TO 3 Casing stJckup - -
3 TO 6 Fill
6...TO 25 Siltyclay: gravelly : ·
25 TO 50 Clay: dense
"50 TO ...55 Gravelly ia~d: siltY, clayey, ~p ! "
55 TO 61 Gravelly sand: wet (wouldn't clean ~p- sil~!) " _ .....
61_.....T_O_ 110 Silty gravel: clayey, dry .......
110 TO 125 Clay.: dense ..
125 TO 135 Silty, gravelly, clay: wet
135 TO 161 Sandy gravel: water-bearing ·
TO ................. :
TO__,......... ".¥" " ' :' . ' "','. ........ ',".' . : '.'., . ' " . '. . ,":~. '),¢~"
TO '.:' ...... . .... .;" ..... :",. · .. ,,.
....... TO." . "':'"".. ""': ', ~-'L' '~ .'"' .. . . .' .~..? ..,,........ .
TO
Certifl~to No'g. 814 & 973
/'C- SO°
~ Z C, Z,X
.~.c'-,.- :, '~ '~'
· . .w: .'.~ .~
=;~" ,~'...', ,, ,
~SEMENT8 OF RECORD, OTHER THAN
THOSE SHOWN ON THE REOO~DED
P~T ARE NOT SHOWN HEREON.
AS-BUILT
NO CORNERS SET. THIS DATE
I hereby certify that '1 have performed a. Morlgagee's inspection
of the following described property: .. '-. ~ 'r' ~..~.~
Anchorage Recording Precinct, Alaska, and that the
improvements situated thereon are within the property lines and
do not overlap or encroach on the property ly!ng adjacent
thereto, Ihat no improvements on 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 ~---~A day of J2,~4:£/.A ~',R '20" ~
FRED WALATKA & ASSOCIATES
(907) 248-1666 Engineers and Surveyors
MUN/CIPALITY OF ANCHORA GE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Date Issued: Jun 06, 2003
Expiration Date: Jun 05, 2004
Permit Number: SW030173 Parcel ID: 016-101-15
Legal Description: [-BRUINPARKSUBDIVISION" [~,Oe,_~¢,_ t-[ ' ~O~' c~-'?
Design Engineer: 0014 Anderson Engineering Site Address: 11100 POLAR DRIVE
Owner Name: ERIC TREVITHICK Lot Size: 19800 SQ. FT.
Owner Address: 6200 LAKE OTIS BLVD STE 202 Total Bedrooms: 3 Permit Bedrooms: 3
ANCHORAGE, AK 99507-
This permit is for the construction of:
r~ Disposal Field r~ septic Tank
Holding Tank r-~ Privy r~ Private Well r~ Water Storage
All construction must 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By~~
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Permit Number SWO~OI
Property owner(s) Eric Trey_it:hick Day phone _D_~O
Mailing address (1)~2QO_Lake_Ot, i~D_~ulcwar~,_.~ui~,~_202._~nchora~c, AK. 99507
Mailing address (2) Zip Code
Legal description (Lot, Block & Sub'd.) _LoX,_2.5~_DJo~k ,~; Bruin ?ar_~,_Ezu~,z:iJvision
Legal description (Section, Township & Range)
~_~..1,~cres/Sq. Ft. Number of Bedrooms Three (D_)
Lot
Size
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Well Only []
Water Storage r-]
["-] Jacuzzi
[-I Water Softening Unit
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees:
Date of Payment:
Receipt Number: ,~'b 3~( !
(Rev. 12/00)
Waiver Fees:
Date of Payment:
Receipt Number:
522-7773 ,-.~i~,., · '! ,,,, 522-6779 (FAX)',
May 29,2003
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject:
Lot 25, Block 4, Bruin Park Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 25, Block 4, Bruin Park Subdivision intends to construct a new three-
bedroom home on the lot. We are therefore requesting a permit be issued for the
construction of a new well and septic system to serve the home. The attached Site Plan
and backup documentation identify the location and configuration of the new septic
system and alternate site and the parameters used in the design. Also identified on the
plans are the location of the proposed well, test holes and the wells and septic systems
on the surrounding lots. Drainage arrows and spot elevations are Shown indicating the
current drainage patterns. The drainage patterns will be maintained after construction.
The test holes placed near the location of the proposed absorption trench and alternate
site indicated clean sand with some gravel and varying amounts of silt and percolation
rates apProximating 2 to 5 minutes per inch. Ground water was found at 12' below
the surface during placement of the test holes and and remained at that elevation
during the monitoring period. We are therefore proposing to place a 1,000-gallon septic
tank and a 38' long x 5' wide x 4' effective depth absorption trench. The distribution
pipe will be placed 3' below the existing surface and the total depth will be 7' to assure
a separation distance of at least 4' from ground water. Sufficient fill will be placed over
the septic tank and absorption trench to prevent freezing.
The ground surface on the lot slopes as shown on the site plan from east to west at
varying slopes. The absorption trench will be constructed at the back of the lot parallel
with the slope as much as possible in conformance with Municipal requirements. All
components of the new septic system will be constructed a minimum of 100' from any
surface water and 100' from the well on this and adjacent lots.
If the system is constructed in accordance with our design the following statements
apply:
1.. The system, if constructed as designed, will have no adverse impact on the wells
Lot 25, Block 4, Bruin Park
May 29, 2003
Page Two
in the area or those to be constructed in the future.
The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
2
23
0
EAST
110th
Ave
194.23
22
25
lA
(96-57)
17020
WEST 175.20
21
3
4
121.94
71.84
9
7
6
8
5
186.1,,7
AREA MAP
10X25
Pwr Line Emit
25
5
10X25
p~ Une Eimt
MICHAEL E. ANDERSON
NO. CE-4381
27
165.88
26
de
Absor
hree !
HoMe
1o000 Oc
,~,.~. Septic: To. nk
SITE
PLAN
SCALE 1" = 40'
Lot 25, Block 4
Bruin Pork Subdivision
LOT 25, BLOCK-4, BRUIN PARK SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Three Bedroom House 5' W~e Trench System
Pert. Rate: 1 -'5 Min./Inch 1,000 Gallon Septic Tank
Application Rate: 1.2 GPD/SF 4' Drainf'~ld Rock
3 BedrOOms X 150 GPD/1.2 GPD/SF (Applicaticin Rate) = 375 SF Absorption Area
· 375 SF/5 LF (Width)" .5 (Red. Factor) =-37.5 LF Trench Length
THEREFORE: Construct a 38' Long x 5' Wide x 4'-Effective Depth Absorption Trench.
Flow Line Elevation in Trench to be 3' Below Original Ground Surface.. Total Depth to be
7' Below Existing Ground. Maintain 100' Separation From Well on Lot. Place 2' of Direct
Bury Insulation and 2' of Fill Over Absorption Trench or Provide' Minimum 3' of Cover to
Prevent Freezing.
16-
4~0.
Natural
Backfill
\ O
Geotextile
Fab ric
4" Perforated
PVC (Holes Down)
Drainfield Rock
ST
TYPICAL 5' WID~oEs TRENCH SECTION ~__..~.-.,,,,,
' <~,,, .' '~ ............ ~.'l'
.o~.. !! ! ' .' ....?!ii~'. ......... '"'"ii:::~i',. '.
PROJECT #:
PERFORMED FOR:
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT/ON-SITE WATER AND WASTEWATER PROGRAM
6,700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
Eric Trevitheck
DATE PERFORMED:
5/19/2003
LEGAL DESCRIPTION:
Lot 25, Block &, Bruin Park Subdivision
5 .
.' ~,. '.-'; ..::'
12 ."
.:.. ,. -.: [.,
1.3 ' "':",""=
17--
18,
TEST HOLE
PT/OG
1 SLOPE
Silty Sand
Some Gravel - SW
WAS GROUNDWATER
ENCOUNTERED?
IF YES, WHAT DEPTH?
DEPTH OF WATER
AFTER MONITORING:
DATE:
........ ·
..............
SITE PLAN
Yes
12'
12'
5~26~2003
S
READING DATE GROSS NET DEPTH OF NET
TIME TIME WATER DROP
Start 5120103 /,:40 10.63"
1 5:10 30 0 10.63"
Recharge 5:11 10.5"
2 5:/,1 30 0" 10.5"
Recharge 5:/,2 10.5"
3 6:12 30 0" 10.5"
PERC RATE: ~l MIN./INCH PERC. HOLE DIAMETER: 6"
TEST RUN BETWEEN 6.5 FT. AND '/.5 FT,
COMMENTS:
Test Hole Pre Soaked Prior to Test·
TEST PERFORMED BY: NRA
I, MICHAEL E. ANDERSON, CERTIFY THAT TH~S TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 5/26/2003
PROJECT #:
PERFORMED FOR:
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT/ON-SITE WATER AND WASTEWATER PROGRAM
/,700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
Eric Trevitheck
DATE PERFORMED:
5/19/2003
LEGAL DESCRIPTION:
Lot 25, Block/+, Bruin Park Subdivision
I
2
5m
6.
7"
8.,
9.
I0 .
II
12--
13,
15.
17
18
TEST HOLE #
PT/OG
SLOPE
Silty Sand
Some Gravel - SW
WAS GROUNDWATER
ENCOUNTERED?
IF YES, WHAT DEPTH?
DEPTH OF WATER
AFTER MONITORING:
.,~,~,?..~,~ ~ .. DATE:
.............
' ~ .n% No. C[-~3B1 ..' ~
SITE PLAN
No S
None
5/2612003
READING DATE GROSS NET DEPTH OF NET
TIME TIME WATER DROP
Start 5/20/03 z,:/.2 11.5"
1 5:12 30 1.75" 9.75"
Recharge 5:13 11.'/5"
2 5:/.3 30 2" 9.75"
Recharge 5:z,?. 12"
3 6:1L 30 2.25" 9.7~;"
PERC RATE: . ~ MIN./INCH PERC. HOLE DIAMETER: 6"
TEST RUN BETWEEN /+ FT. AND 5 FT.
COMMENTS:
Test Hole Pre Soaked Prior fo Test.
TEST PERFORMED BY: MEA
I, MICHAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 5/2612003
~e~nt By: McGee'Industries Inc.;
May 28, 2003
On-Site Water and WastCWater
Municipality of Aachotage
4700 South Bragaw
Anchorage, AK99519
RE:
Lot 25, BlOck 4, tilmin Pa
11100 Polar DHve, Anch~
Dear On-Site Staff,
This ]citer is lo inform you
the lot listed above. The design am
spoken w~th him about my inteatic
have ycar~ of conStruction and exc
supervisor and co-installer of thc ir
with septic systems
~Id' excavatio~
other words, I'm not hiring ,~ subc¢
owner install that will ultimate]y b~
your efforts in working with m= pC
Sincerely,
Eric Trcvithick
907 345 1553;
~ay-2a-03 12:04Pgl;-'
S~bdivision
ag~, Ak.
!
~ha~ I plan on doing an owner install septic system for
! inipections will be done'by M~e Anderson. I have
ns ti~ do the install, and he has agreed to comply. I
lva,tion ,~'xpcricn¢¢. I will be onsite at all times as both
· te~n. My help will also be skilled and oxpc'xiencaxl
..Tl~:~y are also f~,o. ily members who an: unpaid. In
,ntrimor to install the system. This Will truly be an
,' approved by Mik~ Anderson as Such. I appreciate
rsofiall¥ and the cormllunity as a whole in this matter.
Page
MUNICIPALITYOFANCHORAGE
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. 016-101-15-000
Expiration Date:
Legal description BRUIN PARK BLK 4 LT 25
Site address 11100 POLAR DR Anchorage AK 99516
Current property owner(s) MCKINNEY DIANNE M
10/5/2023
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
M
Original Certificate Date: 7/5/2023
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 Services 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 work.
ATTACHMENTS:
COSA Checklist
Absorption Field Advisory
Tank Age Advisory
Other
X Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
COSA Approvaljune 2022
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 Application /Z ve,
.4
1. GENERAL INFORMATION
Parcel I.D. 016-101-15
Complete legal description Bruin Park Block 4 Lot 25
Location (site address) 11100 Polar Drive, Anchorage, AK 99516
Current property. owner(s) Dianne McKinney Day phone (907) 223-8004
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY: X 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: X Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel X Plastic ❑ Concrete ❑ Fiberglass
Age <1 yr - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ■❑ 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 $ 1� 90 Waiver Fee $
Date of Payment Z Date of Payment
COSA # 2 (2- 2 Waiver #
COSA Application—June 2022
Bruin Park Block 4 Lot 25 016-101-15
3.2
7/9/03 161 N/A
160.53'
18+
6/20/23 Forge Engineering
51 6/7/23
N/A
New Installation
8.0
4.0
N/A N/A
N/A
6/20/23
0
660
18
1440
0
> 450
48
0
48
Benjamin Schiller, P.E.6/28/23
1*
Waiver OSV221036*
(907) 522-7773
09
N N
o�
U') L0
0 0
LID LC)
ZZ
N33047"30"W 265.73 (R) f�
N33047'02"W 265.79 (M)
30
Lot 24 "o t�� Pipe missing from
survey, visually
!�Q' per' �� e� located
4 TIV
�O
0
Q)
q?,C§3 0 f
shed
23.3
f o
N N
� n
'7
8.0
a0 N 1 Story
deck 4.(j Frame
o House.
X12.0
2O, Septic vent (typ)
14.3
cov
\ .14
� 0
20.706
\
oil °o Manhole
� m
Well
o '
Cr I
O)
Asphalt VM
jV I11 W
8252X
NOTE:
Plat record bearings and
distances do not achieve
mathematical closure. This
boundary is computed from
monuments found on adjacent
lots 22, 23, and 24.
LEGEND
(R) Record
(M) Measured
(C) Computed
x \ J J I
co
12.7 r, P<<c.
oo Q S
N Ret. 11 it
5.3 wall a' ai O 0 . 49th
Lot 25
S,>,
S2o Ste, \ o''/„ Railroad ties
0,, OO, \
(9'� 7a shed
r2�j \61 X 92
3�9�2�0 �x�
Lot 22 J
76 / 0 00 `� 00
#4 9 lizabeth L. Walatka :',a /
krl • 8036 - LS •§7k/ �
AM
/ RaFESsIONA\
%'t xx �
/ RECERTIFIED 7-01-23
3o 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: LOT 25 BLOCK 4.
BRUIN PARK SUBDIVISION, FIRST ADDITION
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.
��FB 23-2, pg 19 Dated at Anchorage, Alaska
SCALE: 1 = 40 Recert 4-29-22, 6-16-22 this 24th day of December , 2003.
FB 22-1, pg 32
EASEMENTS OF RECORD, OTHER THAN FB 21-8, pg 57-58 FRED WALATKA & ASSOCIATES, L.L.C.
THOSE SHOWN ON THE RECORDED Recert 1-04-10, 8-22-14 Engineers and Surveyors
PLAT ARE NOT SHOWN HEREON BE 907-248-1666
UNLESS OTHERWISE NOTED. Recert file 12-26-03
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
Development Services Department P P Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 01610115
1. GENERAL INFORMATION
Expiration Date:6(/2-q 17-Z
Complete legal description BRUIN. PARKBLK 4 LT 25
Location (site address) 11100 POLAR DR
Current property owner(s) LAPELLA PETER
Mailing address
Real estate agent
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone 312-7602
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
El
Private Septic
0
Water Storage
❑
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 $ 5,150
Date of Payment 5 / y ) o
Receipt Number o 32 3 Lf b�
Waiver Fee $
Date of Payment
Receipt Number
COSA# Waiver #
COSA Checklist
Legal Description: BRUIN PARKBLK 4 LT 25
If more than 1 septic system on lot: COSA Checklist #
A. WELL DATA
❑■ Well log is filed with Onsite (or attached)
Date drilled 7/9/03
Total depth 161 ft
Cased to 161 ft
❑■ Sanitary seal is functioning correctly
❑■ Wires are properly protected
Casing height (above ground) 24 in.
Date of flow test for COSA 5/5/22
Static water level at beginning of test 56 ft.
Comments
B. TANK DATA
Age of tank(s) 19 years
Tank type/material Sptcstl
Measured operating fluid level in septic tank
❑■ Standpipes/foundation cleanout per record drawing
Date of pumping 5/9/22
D. ABSORPTION FIELD DATA 6/15/22
Which system tested (date installed) new
❑■ ALL standpipes present per record drawing
Total measured depth from grade 6-7 ft (max)
Measured depth to pipe invert from grade 2-3 ft (min)
❑ N/A — pressurized field
❑■ Monitor tubes go to bottom of effective. If not, state
depth into effective
of
Parcel ID: 01610115
Structure served by this system
Well production at time of test 5+ gpm
Water storage tank volume0 gallons
Well disinfected for coliform test? ❑ Yes ❑■ No
❑R Coliform bacteria is Negative
Nitrate mg/L ❑■ Nitrate less than MRL (ND)
Arsenic ug/L ❑■ Arsenic less than MRL (ND)
Collected by NRim Eng.
Date of Sample 5/5/22
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date new
Results ❑✓ Pass For 3
Fluid depth prior to test _
Water added gal
New depth in
Elapsed time min
bedrooms
in
❑E 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) n0
date of test)
Gallons introduced gallons If yes, enter date
Comments/Deficiencies: Deck supports not over tank/field.
COSA Checklist yellow sheet
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'
Q
Yes
Community Sewer Manhole/Cleanout > 100'
Yes
if No
ft
0 Yes
if No
Neighboring Tank > 100' Yes
if No
ft
Private Sewer/Septic Line > 25' 0 Yes
if No
Absorption Field on Lot > 100' Yes
if No
ft
Holding Tank > 100' El Yes
if No
Neighboring Absorption Fields > 100'
Animal Containment > 50' 0 Yes
if No
Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' Yes
if No
ft
E] Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ❑ Yes if No 7+ ft Surface Water > 100'
ft
ft
ft
ft
ft
0 Yes if No ft
Property Line > 5'
Q
Yes
if No ft
Wells on Adjacent Lots:
Absorption Field > 5'
Q
Yes
if No ft
Private Wells > 100' ❑✓ Yes if No.
Water Main > 10'
Community Wells > 200'
Yes
if No ft
Community Wells > 200' ❑✓ Yes if No.
Water Service Line > 10'
Q
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' 0 Yes if No ft If absorption field is under driveway comment below
Property Line > 10'
❑ Yes
if No 1+ ft
Wells on Adjacent Lots:
Water Main > 10'
El Yes
if No ft
Private Wells > 100'
Water Service Line > 10'
El Yes
if No ft
Community Wells > 200'
Surface Water > 100'
El Yes
if No ft
F. ENGINEER'S COMMENTS
Lot line waiver
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
ft
0 Yes if No ft
El Yes if No ft
++++SOF 41
s* .49L� �Ir
,Steve Eng
CE -6256_
21%2'�
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 NorthRim Eng. Phone 694-7028
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng Date 4/30/22
: 449 -Bi* �r
6. DSD SIGNATURE s
sbv. pp•r.
iC System #1 Approved for 3 bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the following stipulations:
By: Original Certificate Date: -6Z
The Municipality of Anchr e Development Services Division (DSD) issues Certificates of Onsite Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the Stale 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
COSH Checklist blue sheet
Municipality of Anchorage
• '�� Development Services Department .
Building Safety Division €
Sn [Tv
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904 v -
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 016-101-15 COSA# 1000c2 S
1. GENERAL INFORMATION Expiration Date:
Complete legal description BRUIN PARK S/D; BLOCK 4, LOT 25
Location. (site address) 11100 POLAR DRIVE * ANCHORAGE, AK * 99516
Current Property owner(s) PHILLIP FIELDS Day phone
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
11100 POLAR DRIVE * ANCHORAGE, AK * 99516
Day phone
947-5223
MARY COX W/ REMAX Day phone 257-0165
110 W. 38TH AVENUE, #100 * ANCHORAGE, AK * 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3-
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
0
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, l 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. l 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
Address
GARNESS ENGINEERING GROUP, Ltd.
3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the .
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
DSD SIGNATURE
V Approved for bedrooms.
Disapproved.
Phone 337-6179
Date
Conditional approval for bedrooms, with the fllowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Nitrate Advisory Other
By:
(Rev. 11/05)
..,,...,.,...J , m"
WASTEWATER :
PROGRAM
•
••.11
St=N'C}j�l
Original Certificate Date: -�_) 3 _/ a
Municipality of Anchorage -0
m Deve[opme t Sem gees Department
Building Safety Division
On -Site Water & VVastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: BRUIN PARK S/D; BLOCK 4, LOT 25 Parcel ID:',
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N A Well Log (Y/N) YES
Date completed 7/9/2003 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth 161 ft. Cased to 160.53 ft. Casing height (above ground) 24+ in.
FROM WELL LOG AT INSPECTION
Date of test 7/9/2003 1/4/2010
Static water level 98 ft. 58 ft.
Well production 10+ g.p.m. 4.1 g.p.m.
WATER SAMPLE RESULTS:
0 colonies/100 ml. Nitrate 0.1 m
Coliform g•/L. Other bacteria 0 colonies/100 ml.
Arsenic: N/A ug./L. Date of sample: 1/4/2010 Collected by: GEG Ltd.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 6/13/2003
Tank size
1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping 5/27/2009 Pumper AROUND THE CLOCK PUMPING
C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE
Date installed 6/13/2003 Soil rating p.d./ r ftZ/bdrm) 1.2 System type 5—WIDE TRENCH
Length 38 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth *7.5+ ft. Eff. absorption area 380 ftz Monitoring tube YES Depression over field NO
Date of adequacy test 1/4/2006 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test DRY in. Water added 450 gal. New depth DRY in.
Elapsed Time: 0 min. Final fluid depth DRY in. Absorption rate >= 450+ g.p•d•
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date —
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at in. "Pump off' level .
Cycles teste
Manhole/Access (Y.
High water alarm level at in.
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent
Absorption field on lot 100'+
Public sewer main N/A
On adjacent lots
100'+
*100'+
Public sewer manhole/cleanout N/A
Sewer /septic service line 25+ Holding tank N/A
Animal containment areas 50'+ Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorotion field
Water main N/A Water service line
Wells on adjacent lots 100'+
10'+ Surface water
100'+
5'+
100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
*SEE ATTACHED LETTER.
�o60�t`
G. ENGINEER'S CERTIFICATION o �F
off. 1,
certify that / have determined through field inspections and * g f
review of Municipal records that the above systems are in p
conformance with MOA COSA guidelines in effect on this
�.
date. O Jeffry ` Garne s:
Engineer's Printed Name JEFFREY A. GARNESS Qo9, •, E-7
jj 4's 11 •cG
Date �1 �Bu �fOed 9�•+'�Fo°o
I o
Pr0f essio��a
e
COSA Fees / —� Waiver Fee $
Date of Paymento� �qv i O Date of Payment
Receipt Number Q <� c� I :7 Receipt Number
(Rev. 11/05)
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS.
February 1, 2010
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650,
Anchorage, Ak 99519-6650
(907)343-7904
Ref: Separation Distance for Bruin Park Subdivision; Lot 25, Block 4,
To whom it may concern:
The existing well was installed in August 2003. According to the inspection report, dated 6/13/2003, the
well maintained 100'+ separations from all septic systems in the adjacent area. During our inspections, no
functional standpipes could be found for the septic system on Bruin Park Block 5, Lot IA. The
separation distance could not be verified without extensive locating or possibly excavation. We cannot
verify that this septic system does, or does not, encroach on the subject well. A recent water sample
indicates no bacteria present and 0.1 mg/L of nitrates. In light of this, we request you accept an assumed
distance of 100'+ from the well on Lot 25, to the septic system on Lot IA.
If you have any qupst,1, please contact us at 337-6179. Thank you for your assistance.
Cm rely,
t
mm,ey ?
Presidentf
4
3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com
Municipality of Anchorage
Development Services Department
Building Safety Division
~ On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343-7904
CERTiFiCATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel J.D. 016-101-i5
Expiration Date: ,~'-"" ~ "" O ~
1. GENERAL INFORMATION
Completelegal description Lot 25, Block 4, Bruin Park Subdivision
'" L6C~tion'(site:'address or directions). Polar Drive at East 110th Avenue
Current Property owner(s) ,Eric Trevithick Day phone 345-1400
Mailing address 6200 Lake Otis Parkway, Suite 202 Anchorage, AK 99507.
Lending agency
Mailing address
Day phone
Real Estate Agent
Mailing Address
· ?n'le'ss otherwise requested, HAA wi//be held by DsD forpickup.
2, ,',NUMBER OF BEDROOMS: Three (~)
3. TYPE OF WATER SUPPLY:.
IndividUal Well : []
"' '"Individual Water st0mge []
Community Clas{s - Well []
Public Water System []
Day phone
'rYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding tank []
Community On-site []
Public Sewer []
I
The Municipality Of Anchorage Developn~ent Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system.' DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid for one year for properties served by Class A or B. wells or a public water system. The
Municipality of An.chorage is not responsible for errors or omissions in the professional engineer's work.
4. 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 Health Authority 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 Anderson Engineering Phone 522-7773
Address P.O. Box 240773, Anchorage, AK. 99524
Engineer's Printed Name Michael E. Anderson Date 2/2/0.4
®®'+acct'®®.
®®•�� OF ; h4
,. �' ®®
N 49th.
.,r.....:.A... :........... ........4:...4
J_Vj*.MICNAEE E. ANDERSON ; -'
5. DSD SIGNATURE ,®c °: No. CE -4381
Approved for bedrooms. ®®®® •...4.............
••�..
%.
Disapproved. "11l®* +
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
v ! Y�nvl�rrn��..�� •
PRC�GF�AM = =
off• .•�-,�
T/TIIT)►►''
Attachments:
HAA Checklist X Maintenance Agreements
.Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: Original Certificate Date: - " C 7
(Rev. 01/02)
M
D IoPme' Services Department .
' '~ ':; ~ BUii~ling Safety Division :: .. .
. , :. On-Site Water & Wastewater Program
' [~; Ii! ' P.O.'Box 196650 AnChorage, AK 99519-6650
..... ,HEALTH AUTHORITY APPROVAE.' CHECKLIST'
Legal Description: Lot 25, BI0ck 4,: Bruin Park Sub'divisiOn .:. :~ " Parcel ID: 016-101.15
Well, type Private .~ If A! B, or C provide PWSID # .
Date completed 719/2003 '. '*' !*.,San tary seal (Y/N) Y. : . W res properly protected (Y/N) Y
Total'dePt,h' 161 ff.. ~ '!! i'~Casedto !1160.5 ft." :". '-
Cohform=iO colomes/lOOm:' ,!, N~trate tNon'ma/I , ,' '{:, ' Otherbactera ~0 colones/lOOml
Tank s~ze I~ gal. ',; ~ : Number of Compartments 2
Foundation cleanout (Y/N) Y- ,'? ' l,,Depress~on over tank (Y/N) N , :, Hlgh water alarm (Y/N) N
ABSORPTION FIELD DATA ,l, I, ,~ , , : ......
Date installed 61'1312003. .: Sofl!rabng (g.p:dJft= or. ft=/bdrm) 1,2 GPDISF .' :Systbm type 5' Wide Trench '
Total depth, '7.5 ft. Eft. absorpbon area 380 ft~ :: Monitoring tube Y - Depression over f eld N ·
Date of adequacy test , ,I ,1,, , ': , Results (Pass/Fad), ,t , , , ' , .For , bedrooms
ElapsedT~me: . mn.' ~ F~nalfluddepth :1,'.:. ~n. : . :' ;Absorpton'rate >= '. ' god
Anyrejuvenat~ontreatment(past;12mo)(Y/N'&'type) N '; ::~,; '~: ,.. : i:!;ifves,.aiVedate
D. LIFT STATION
Date installed
"Pump on" level at
Datum
Size in gallons
in. "Pump off' level at in
Cycles tested
E. SEPARATION DISTANCES
CI -1A O/1 T1lll.l fIIC`TICER C \ ON LOT Tc) -
Septic tank/lift station on lot >100'
Absorption field on lot >100'
Manhole/Access (Y/N) _
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots >100'
On adjacent lots >100'
Public sewer main NIA Public sewer manhole/cleanout NIA
Sewer /septic service line >25' Holding tank NIA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line >5' Absorption field >5'
Water main >10' Water service line >10' Surface water >100'
Wells on adjacent lots >100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10' Building foundation >10' Water main >10'
Water Service line >10' Surface water >100' Driveway, parking/vehicle storage >5'
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
O"
G. ENGINEER'S CERTIFICATION
in.
1 certify that I have determined through field inspections andAN
'��
review of Municipal records that the above systems are in �.....: 49th
conformance with MOA HAA guidelines in effect on this date. ......
..........�.�...tom-�
�'; MICHAEL E. ANDERSON
Engineer's Printed Name Michael E. Anderson, P.E. ��� % No. CE-4381'
ArAV
Date 212!04 441, 411 SS
HAA Fee $ `4 5 C Waiver Fee $
Date of Payment`'2 2 - Date of Payment
t
Receipt Number +1 R Receipt Number
(Rev. 12/00) ~
