HomeMy WebLinkAboutT15N R1W SEC 8 LT 58T15N RIW
SEC 8
Lot 58 GLO
#051-091-23
Municipality of Anchorage '
j;" .,
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page of
www.cl.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SW040259 PID Number: 051-091-23
Name. Jana & Kirk Gallagher
Wastewater System: [D New ❑ Upgrade
Adidn..a 20624 Sunset Blvd. Chugiak, AK
ABSORPTION FIELD
phone. 907.688-0608 Numbr ar Badrans: 4
0 Deep Trutt❑ Shabw Truth OBed ❑Mand QDdrr
LEGAL DESCRIPTION
aaaRaaq. 1.2
T`WD'°'r°n°3°"�°ra°°
GPDat'
3 Ft.
Black: Ldo GLO Lot 56 swdmrlon:
opa to Plw boon ". wig" grade:
Greer d" wns.m ppa:
2.5 Ft.
NIA Ft
Toemslp. 15N Ran": iW s.won: 8
Fa added above Ong" grade:
creel
1 Ft.
6 Infiltrators or 36 Ft.
Well: 1] New ❑ Upgrade
Gravel ends:
5Infiltrators 15
Nunbsr ar Mus:
Detente between bws:
or Ft,
5
3 F,
ciawksoon IPovar. A a, cp
ToW Daph:
cased a,
T" absaptnn nea:
Pp Marnal:
Private
79 Ft,
79 FT
510 F,.
Infiltrators
Dreer
Hefty Drilling
Date Dread:stat
9/15/04
waw Level:
39
Instab,.
DanBeek/Beek'sContmctirp
Dar alsMYsd:
9/15/04
Ft
v.w.50
Pump snat
76
Gaup Nepht hove Grand:
TANK
GPM
Ft.
2 FL
SEPARATION DISTANCES
E) Septic (]Holding ❑S.T.E.P. ❑Other.
To
Septic
Absorption
LIR
Holding
abilrJPrivata
n°"Z'"".
lr:
From
Tank
Field
Station
Tank
Sewer Lina
Anchorage Tank
1250 Gal.
wall
110'
126'
N/A
N/A
Matnnl:
Steel
Nunbn or carpenmams.
2
satacawnn
>100'
>100'
N/A
N/A
LIFT STATION
ka u»
66'
3'N/A
N/A
.: arw xtwa:
Gm.
Foundation
15'
43'
N/A
N/A
'Pup al Yval ac 'Pwnp aR al: Nqn wow alarm at.
h h
curtain Drain
N/A
N/A
N/A
N/A
Poop Make Ekanw IneoscDons perlomed by
Remnb:
BENCH MARK
Loraaun and Desapuan:
7 -penny nail in tree with flagging
awn:
located off the SW comer of drainfield.
Ft.
100
`,pig°P'""t
.O 0**** t,
Inspections performed by; M. Fisher Dates: 1" 10/14/04
0'
2nd 10/15/04
LL` •...
'%I >� AAnRK 0. ;7.%rFt
Development Services Department Approval
�j s� :• ce -too=8
ao•
Reviewed and approved by: Date:
1t� S1"ONZ,`
t'
Notes: y r
I- Dole of Survey 9/11/03. 10/25/04
2. Ref. Field Book: ANC -02-06. 07 itil5
'tOF
,`(L ••....., ACqPROJECT
Fr1. r 1�
Fnfn
Properly Line f'%(/�� �.9 r�i
Edge of Grovel Rood t?4�, 4 `� �/ `V I j. `
Grovel Driveway �%}•••'/'J;•�• ••••/ / 100
UCE Underground Electrical /, v•,�
S — Sewer Service Lines / Mark A.Stoff d :a,/ j li
IN — Water Service Lines I �.� • �.. i _.', e ;�• �-
Structures 1, �/, 10028 :AZA = i'c 7 J� 4 •,'
Is Wells (Existing & Proposed) �� LA0 • . ' E��'� Ate '
Power Poles X11 pROFESSI60�� f c ✓ :/ �^
O Soils Test Location i1\\\���� its " ' is �
Found Corner Monument -'{.. '. Scoie: 1'.1 Mile L.
Neighbors Well/
\ \ do Septic >200'
_ \ S89'55150'E 279.88'
io 510ft2 Droinfield w/5 Rows of
\ Replacement 6 Infiltrators eo. Buried 3' Deep
Droinfield Site w/2� Blueboord Insulation
15' HDPE Sewerline w/3' I 0
Ground Cover and 2' Insulation J m
HOUSE —C\ In
MIDI_I / C
1=
Neighbors = FCO 76' of 1' HOPE \
Well
00 / B.M. / \ Non -Arctic Waterline
d
^> /1250 Callon Septic Tank / \
N / Buried 3' Deep w/4'
E / Blueboord Insulation
z
p I
o
C3
New Well Location 0 g
i
/
Droinfield \ /
\ Lot S6 \ /
Neighbors Well
do Septic >M.
I 589'56'10'E
279.85'
AN -03-C82
n Sec. Lot S8. S2T.ISN• R.Otw, SM S
_
Ind W8. lAc 66--B.- SN.
?00 DRAM er: ADA I DATE:
RE RADE: COIOMw a.a I We E: "•So' T--
Elev.w95.4
Seasonal High —V i
Ground Water Encountered
at Bft. No Frozen or
Impermeable Layers
Encountered
Foundation Cleonout
15' of 4' SDR it HDPE
Sewer Service Line O 2%
Top of Infiltrators
Elev.w94.4
2w of Blueboord Insulation
Over Entire System
In Elev.-95.1/1250 Gallo "" oftn Infiltrator Drainfield
4' Blueboord Insulation—".'
nsulation Septic Tank 23' of 4' SDR 11 HDPE
Over Septic Tank Effluent Line
Top of Tank Bottom of Field
Elev.-95.25 Out Elev.-94.8 Elev.-93.3
PROFILE
I AN-03-cez I
Ac. Lot 58. Sac. 08. T.1SN. R.01w Sm I SNEET
PUBLIC LAW M-1$1 PROACI
DRANN BY: RDK I DATE: 6/11/0- L
ME NAME. CMOW dwdI SCALE: MTS
3540 AKULA DRIVE
ANCHORAGE, ALASKA 99516
(907) 345-0593•
DFPAItTMENT OF NATURAL RFSOURC:ES
MINING, LAND, WA•rFR HYDROLOGIC SURVEY*
WATER *.vFLL LOG
Dnlline Started: Cn/ •R'/ 1 u: Completed:O9
WylBarottah:
Subdirieior✓USS:
Block
W
Property Owner Name &AddrorY�u ft",��„
4
meridian .-.Township.6N_RanbcjLa._Sation V. �Sif U '/,of Y4 of %of •` 4
LaCN _1•unb•W_..... _.. __NA t2-7OR 12 Elcvwinn: ...
BOMMOLE DATA: (from ground surface) Depth
Drilling method: AAir rotary, 11 Cable tool, Other
'MateaakType,Color &wetness I EMM 1 TQ
Wellvsc:0Public supply,�I.Domestic.0other ..+;•
Depth of he 7`) ft. Casing stickup. S '•
O
Cuing Si:a a.) Thickness 0-%C hxhes •
V� Ut cl n
we:
Casingdianeter. 6 inches Casingdepth 7 q '•. •ft
Ya vee
S
/3
Liner type: Diameter. inches Depth:
Static water (frominp of taLin;; t: _. Ron!/4/�•.
da.l
13
1 $
Pumping level & yield: rect after _homs at'__gpn�
ul
Recovery rate: 5 D rpm Method oftesting
t C_(
s
30
Development method: Duration:
Well intake opening type: O Open end, fJ Open hole '
U a W v
S
n Screened: Start: 76 R. stopped '12 =S
r0L4set= t1pe.<-Ju:.JtjsiirtI Slothnesh Size -.La—
L4
DPerforated4twr: RSiopped 8
Start: R. Stopped ft
Note•...
Grouttypc: o r� a :.Ea Valmne
N as
6 S
1 9
Depth: from Il, to -•— s
v •
pump intake depth: R
Cr
Pump size hp. Rmodname
Was well disinfected upon eomp1lction? ZYcs, ONo
Method of disinfection: C A/o
Driller comments/ disclaimers:
Well Driller Name: n
.
Company Name: HEF OR t ING
Mailing Address: 3540 AKULA DRWE
City.ANCHORAGE State: ALASKA Zip: !39516
Phone Number: t-907• 59
Drillers Signature:
SWC hw raqu(res dW a dpy artko wctl aq i.e w.4 �. M �tac of Meta
*145 drys Fun an, k. (AK stale" 38.05A20. 3LO5.035.
X24 46.is.am od AK rcp"kws 11 AAC 93.140),
DEPARTMENT OF NATURAL RESOURCES
Mlata& Lad & Water Nydrabcic Survey
554 W 7th Ave., Suite 900A
Aaetmn N AK 99S8l-3ST7
Telepkaae ('907) 2694639 and FAX (907) 562-1384
Within the City of Anchorage, it is required that a copy of the well In be
sent to the appropriate city office within 60 days and that another copy of
the well log be sent to the we1L'pmpert owner within 30 days.
Pemdt Number.�i1.1�
Date orIssuc: -i 1142_1
Parol Identification Number. j= � 1 -'Cztl_
Is well located st approved permit location? a Yes oro No
P4c" �110� k JV Oorc�
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
ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET
To: Alaska Native Tribal Health Consortium
Legal description: T15N. R1W. Section 8. GLO Lot 58
The attached paperwork has been reviewed and is being returned for the following reasons:
❑ Original signature or stamp missing on
❑ Calculation error in design. _
❑ Additional soils information needed. _
❑ Water monitoring results inadequate.
❑ Discrepancy in information submitted.
❑ Topographic information missing or Inadequate.
® Incomplete; missing bed width length depth to pipe bottom from original grade and
distances between lines.
❑ Additional adequacy test information needed.
❑ Water sample unacceptable. _
❑ Measured/proposed distances/dimensions missing.
❑ Locations of all soils, percolation and water monitoring tests not shown. _
® Absorption field too deep for soils information submitted. Permitted maximum depth 3 feet:
installed total depth 4 feet.
❑ Well log required.
❑ Omission In narrative. _
® Insufficient fill over tank or field. The finished orode over a subsurface dicnacal field nate+ he
Name of reviewer. Julie Makelo. P.E.
Date: 4/1/2005
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
• MUNICIPALITY OFANCHORAGE
Development Services Department
Onsite Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Permit Number. SW040259
Legal Description: T15N Rt W SEC 8 LOT SS
Design Engineer: 0858 MARK STAFFORD
Owner Name: JANA & KIRK GALLAGHER
Owner Address: 20624 SUNSET BLVD
CHUGIAK , AK 99567 -
Date Issued: Jul 12, 2004
Expiration Date: Jul 12, 2005
Parcel ID: 051-091-23
Site Address: 20624 SUNSET BLVD
Lot Size: 108900 SO. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
M Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy Q Private Well ❑ 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.
Date:
Issued By: 4Fn Date: T
\ Municipality of Anchorage
• 1- Development Services Department �?
Building Safety Division t
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.orglonsite
(907) 343-7904
ON-SITE SEWERIWELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 05109123-000 Permit Number SW
OW3 !K
Property owner(s) Jana & Kirk Gallagher Day phone 6884S66—
Mailing address (1
Mailing address
Code 99567
Legal description (Lot, Block & Sub'd.) GLO Lot 58
Legal description (Section, Township & Range) Sec. 08, T. 15 N., R. 01 W. 1,
Lot Size 2.5ac 108900s Acres/Sq.Ft. Number of Bedrooms X
THIS APPLICATION IS FOR:
Sewer Only ❑ Well Only ❑
Sewer and Well 0 Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
1 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.
of property owner or authbfhed agent)
Permit Fees: 06.60 Waiver Fees:
Date of Payment: _q j1p Date of Payment:
Receipt Number. .5gig3 -RM Receipt Number.
(Rev. 72/00)
SKA NqT
ALASKA NATIVE TRIBAL HEALTII CONSORTIUM
e �V M Division of Environmental 1901 South Bragaw Street, Suite 200
Health and Engineering Anchorage, Alaska 99508-3440
Telephone: 907-729-3600
y� Facsimile: 907-729-4090
�rEt�SO
gLT11 co
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
PO Box196650
Anchorage, AK 99519-6650
Re: GLO Lot 58, T.15N.,R.01 W.,Sec.08,SM
Permit Application and Narrative
Dear Sirs:
Kirk and Jana Gallagher, the owners of this property, are constructing a new three
bedroom home and have applied to the ANTHC, DEHE Scattered Sites Program for the
installation of their well and septic systems. The proposed well and septic system at the
above property will have very limited impact on adjacent properties for the following
reasons:
1. The nearest well is located 130' West of the drainfield. The wells and septics on
the lots to the North & South are >200' from the proposed well and septic on lot
58.
2. The soils for the absorption system are good (GW).
3. Drainage slopes gently (<5%) to the North and is not a major design
consideration.
4. There is no surface water within 500' of the property.
5. There is plenty room for a replacement system.
If you have any questions please feel free to contact this office at 729-3600.
.0� • OF • q1 41+, Sincerely,
y �
49Tiy Jt1 i. 1/i� �.
MARK A. STAFFO Mark Stafford,P.E.
cE.lcoza .�
AFFO•'......• Esti
141*Rorls :��
N4
T
ALASKA NATIVE TRIBAL HEALTH CONSORTIUM
Environmental Health & Engineering
1901 South Bragaw Street
Anchorage, Alaska 99508
1-907-729-3500
1-800-560-8637
Septic Desian Calculations Jana Gallagher Home Site
Physical Address: 20624 Sunset Blvd. Chugiak, AK 99567
Legal Description: GLO Lot 58, Sec. 08, T.15N.,R.01 W., SM
Parcel I D#: 05109123-000
Home Phone: (907)6884365
Date of Test Hole: 6!1/04
Number of bedrooms
= 4
Water use at 150 gallons/bedroom/day
= 600 gallons
Percolation rate
= 1.5 minutes per inch
Wastewater application rate
= 1.2 gallons per day per ft2
Required absorption area
= 500 ft
Recommended absorption area
= 510ft2
Bed configuration
= 5 x 6 Infiltrators
Bed width @ 34•/Infiltrator x 5
= 14.17ft
Bed length @ 6ft/Infiltrator x 6
= 36ft .
Total excavation depth
= 3.Oft
Separation distance to seasonal high water
= 4ft
Infiltrator cover depth
= 3ft soils W2in Blueboard insulation
k� ..OF•.gZq/
,low * • 49TH
Mark A.Staffai�j W
F•• 10028�-�
v
1 9Fp'•......••• 'a
1
Notes: .r
%r y✓ 4 - �. y J S
1. Dote of Survey 9/11/03
2. Ref. Field Book: ANC -02-06 ��OF \ f f TMIg "x't °,r" • r , ?� . " �':
,\�•�,..... q� If `IPROJECT
LEffm
Property Line `;' 49ni (�V ••••�,y -01
Edge of Grovel Rood k / le '
Grovel Driveway •••• ••
Underground Electrical „„,•„,• „00•/
LICE /?• /� r r i,}`r;
S Sewer Service Lines / Mark A.Stof
W Water Service Lines I • �. i
Structures I� fes. 10028 l`y`
® Wells (Existing do Proposed) F ••E'1'�'� i �`1 3
Power Poles I �� ,�OOFESS10N1' �� r
Soils Test Location �����;” .' �K+ity Mop i�Yy
t, Found Corner Monument
Neighbors Well /
\ de Septic >200•
_ \ S89.55.50'E 279.88'
74 1
Proposed Septic System:
\ Replacement 2311 of 4• Sewer Service Line
CN Droinfield Site
\ 1250 Callon Septic Tank
\ 510ftit Bed Type Grainfield p
\ W/5 Rows of 6 Infiltrotors eo.• \
m
1 / HOUSE —�\ U)
Rion nn* C
-�
Neighbors
Proposed 76' (n Well Z
of 1• of HOPE
/ 36.00 �\ Arctic Waterline
/ I
co
_ I ca I
Proposed New 0 g
/ 1 Well Location I
Droinfield \ /
0 \ /
\ Lot 58 \
VA
\ Neighbors Well
I dE Septic >200•
I S89.56'10'E
TRIBAL HEALTH CONSORTIUM Nomes�le: z no GoBogner AN -03-C82
DEPARTMENT OWater and Septic Service
ENVI YEN J HEALTH Sec. Lot 58. SeC.08• T.15N. R.OI W. SM sNEEr
AND ENGINEERING "t -C .A+ 06-nl PQ . CT1901 SOL� _
"C"OMG[. ALASKA. !0! DEMI OwAw Br. Adl DAR: e/Ilro. r
60l 32e-3600 rxE NAME: GWbMw e.- SCALE: 1'-560 TolAI S LETS
W.
Natural Soil Bockfill
48'
Seasonal 'High —Q—
Ground Water Encountered
at 8ft. No Frozen or
Impermeable Layers
Encountered
Foundation Cleonout 2' of Blueboord Insulation
23' of 4' SDR 11 HDPE rOver Entire System
Sewer Service Line O 2R z /
1250 Callon
Septic Tank
PROFILE
N
Infiltrator Droinfield
16' of 4' SDR 11 HDPE
Effluent Line
Lot 58. Sec. 08. 7.15N. R.01W SM
DRAM Or. AN I DATE: 0/17/0 -
ME N"C. j2H29ha e.a I SCALE: NTS
M-D3-ce2
OF 44 It
Municipality of Anchorage �• GINEER'S • f
Development Services Department : 49TH ••9 �I
Building Safety Division
a1 Onsite Water and Wastewater Program 0 0
4700 South Bragaw SL 0,k A.Slofl••d •; W i
P.O. Boz 196650 Armchorage, AK 995196650
www.munl.orglonsite�'i •, 10028 ?`" �•
(907) 3417904 ,I.rrFe_•._ . • :1.v
Soils Log - Percolation Test I •f ���;►iEssl°���.
Performed For. Jana Gallagher Date Performed: 6/7104
Legal Description: GLO Lot 58 Township, Range, Sectio,: T.15N.,R.01 W.,Sec.08
(6h7)
Aecw>a 6 /,,-ry syNa
w/ eoea�-Es
t
(e7 0
5 /1fl1.I
WAS GROUND WATER
Date
ENCOUNTERED?
Yes
Depth to Water
8
IF YES, AT WHAT DEPTH?
9.L
Depthto Water After
O
Monitoring?
8- E
Date: 6/24/04
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
Soak
6/7/04
1
3:53pm
2"
2
3:58
5min
5 3/8"
3 3/8"
3
3:59
2"
4
4:09
10min
81/2"
61/2"
5
4:10
2-
6
4:20
10min
81/2"
61/2"
PERCOLATION RATE 1_'J (mYwrrhrA) PERC HOLE DIAMETER b
TESTRUN9ETWEEN 3 rr AND 4_5 FT
COMMENTS TPet hole #1 for Original & repfg .p��y%tpm locatsonS
PERFORMED BY: Gary Brown I CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
Municipality of Anchorage •
On-Site Water and Wastewater Program `)
id c. (907) 343-7904
r.
z mall .
S F f is 7 Y
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-091-23 Expiration Date: ) ( 3 -1
1. GENERAL INFORMATION
Complete legal description T15N R1W Section 8 Lot 58
Location (site address) 20624 Sunset Blvd
Current Property owner(s) Moore Day phone 223-1769
Mailing address Same
Real Estate Agent Owner Da • one 223-1769
7
2. TYPE OF DWELLING: � �
® Single Family (w/wo ADU) ° JUL4 • `� .l? A
❑ Duplex . 3
❑ Multiple Dwellings (Single Family and/or Duplex) c<< ��
Asst
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual EZ
Individual Water Storage ❑ Holding Tank ❑
Community Class C Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
Receivedbye}- Date: l /3 / 7
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 52-4,, Date:
Date of Payment -7/(9(o f I I Date of Payment
Receipt Number oil 01 . Receipt Number
COSA# 0SC 11 1313 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 NorthRim Engineering Phone 694-7028
Address PO Box 770724,Eagle River
Engineer's Printed Name Steve Eng Date 7/25/2017 •-
Of At nt•••. .•.. Af
may{'/"� • ••
I i `tr, •• ��
6. DSD SIGNATURE " ��
-* ?49 = ;'
System #1 Approved for L( bedrooms. y� �
L( °471771:14754:11,...."S
c<` : Steven W. Eng •;444
System #2 Approved for bedrooms. A�,'•• PE 625 :
Disapproved. �t0''9Fp� � ����
Conditic3hal appro\Pal for bedrooms, with the following stipulations'
i n
ON—SITE
WATER AND
c t \NA,STEWATER
c.
'G- PROGRAM
`1 C{.
Original Certificate Date: c ' -�" ) 7
The Municipality of Anchorage Devlopment Services Division(DSD)Issues Certificates of On-Site Systems Approval(COSA)based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska.The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet_9-1-12.doc
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Cerrtuf tate of On-Bute Systems ApprovaD CheckD st
Legal Description: T!SA/ �eL- g Lai- 5'8 Parcel ID:2Sf Q J J Z 3
A. WELL DATA
Well type 1 If A, B, or C provide PWSID# Well Log (YIN) Y
Date completed //r-5.l0 1 Sanitary seal (Y/N) sy
Wires properly protected (Y/N) '7.'
Total7 ? ft. Cased to ft.71 Casing height (above above ground) 2 in.
depth p
FROM WELL LOG AT INSPECTION
Date of test 7/1i/o ( _ 7//i' 7
Static water level 3? ft. 3c". 5 ft.
Well production 5 D g.p.m. /ia -f- g.p.m.
WATER SAMPLE RESULTS:
Coliform r) colonies/100 mL Nitrate I. S m•/L
Arsenic /0 ug/L Date of sample: ef / Collected by: A,r (Zr �;)
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material S Er'r77C / S I FFL. Date installed ?///5/09/
Tank size/ZSDgal. Number of Compartments Z Cleanouts (Y/N) i
Foundation cleanout (Y/N) Depression- over tank (YIN) _A/_ High water alarm (Y/N) .
Date of pumping 7//7 // 7Pumper l2 I .S
C. ABSORPTIONFIELDDATA
Date installed {/f 5/0‘,/Soil rating (g.p.d./ft2 or ft2/hdrm)_ l 2 System type 8. /D
Length 3 C ft. Width /5 _ ft. Gravel below pipe-Lel -4/7tfdit.
Total depth T ft. Eff. absorption area S/ ft2 Monitoring tube �/ Depression over field /V
Date of adequacy test 7/(87/7 Results (Pass/Fail) P 1 For c/ bedrooms
Fluid depth in absorption field before test (3 in. Water added 225' gal. New depth / in,
Elapsed Time: 3 0 min. Final fluid depth 0 in. Absorption rate >_ 6-00 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION /SJR
Date installed Size in gallons Manhole/Access (YIN)
"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 le,d 7` On adjacent lots lOa f
Absorption field on lot /o G �t On adjacent lots /5 ' t
Public sewer main le D (7` Public sewer manhole/cleanout . /0 a =if-
Sewer/septic service line S 'f'• Holding tank /i' 7 '74-
Animal containment areas 5-0 Ct Manure/animal excrete storage areas �Qc) IL-
-SEPTIC/HOLDING TANK ON LOT TO:
Building foundation S 'r Property line .�'f Absorption field
Water main /4 eWater service line / 14 Surface water /'OQ 6 "f-
1
Wells on adjacent lots o 'f
ABSORPTION FIELD ON LOT TO:
Property line //e, '1- Building foundation /4 ''` Water main /6r f•'
Water Service line l Q Surface water (0 0 ("I- Driveway, parking/vehicle storage /d #
Curtain drain LIAM-. Wells on adjacent lots /Oa /1--
F.
•&F. COMMENTS
4-Q %o r / f 1f AJ
G. ENGINEER'S CERTIFICATION • � ,; Aim ,
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. `,;i
Engineer's Printed Name S7 t 6 EAla •••
7
Date 7/057/ '•'-
COSA yellow sheet_2-6-15.doc
4 Lot 36 Lot 35 I Lot 34
N 90'00'00'E 329.97'
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141.5'
m 53.2 ;a
Lot 1A "' 53.2" N
SEPTIC V
Z PIPES 1 STORY J GRAVEL o C
0 o RESIDENCE DRIVEWAY I Ro Z
o o 6, 1'x 10.2' WELL I $ Lot 59
COVERED ENTRY
c o Lot 58 o m
Lot 5 108.900 s.f. I o v
50' R.O.W. RESERVES
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WEEPING BIRCH
N 90'00'00-W 329.93'
AVENUE
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F
Lot 64A Lot 63 ( Lot 62
Koehler Subd.
PLOT PLAN AS BUILT X SCALE 1" = 100' GRID NW 1357 Project No. 17-232/A1
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates , inc .
(907) 522-6476 Phone �OpO
(907) 522-4625 Fax 'OF A LIN
Professional Land Surveyors kenolangsurvey.com (� ,.........,Q ��
jonathanOlangsurvey.com s kih
I hereby certify that I hove surveyed the following described property: •k
BLM LOT 58, SECTION 8. T15N. R1W. SEWARD MERIDIAN, ALASKA *: Q STM / } . * O�
Anchorage Recording District, Alaska, and that the improvements situated thereon are Q
within the property lines and do not encroach onto the property adjacent thereto, that �,), .. 0
no improvements on the property lying adjacent thereto encroach on the surveyed •. KENNETH G. LANG
premises and that there are no roadways, transmission lines or other visible
p ` Q
easements on said property except as indicated hereon. Q
O�•••.L5-520 .••• �QO
Dated this the Day of . at Anchorage, Alaska ,o
04 'PO ssloNAt-'14
It is the responsibility of the owner to determine the existence of any easements. �D�OOOo""
covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963