HomeMy WebLinkAboutDENALY BLK 1 LT 17Densly
Block 1
Lot 17
#067-041-23
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program, 4700 Bragaw St
P.O. Boz 196650 Anchorage, AK 99519-6650 Page/ of .3
www ci.anchorage ak us (907) 3417904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: S 00 7J0 PID Number: % —iL
"e"". / r A /�
V
Wastewater System: New EIUpgrade
Aotrass
lre0LF
ABSORPTION FIELD
Pna" _� / Numb. a Beaocros
Dsap Tranrfl O SMnow T.1.1, E3 Bea O MaaN O Olney
LEGAL DESCRIPTION
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I-
Ft.
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Fal aeoea sows or'g"W grow
Gravy Length.
it.
6 FI.
Well: New ❑ Upgrade
G"wah
s
Number d1 s
D,vrWe whv.M Ines
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pt 341.3
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TANK
GPM
Ft. Ft
SEPARATION DISTANCES
t;beptic ❑ Holding ❑ S.T.E.P. ❑ Other.
To
septic
Absorption
Lift
Holding
lublictPrivale
°CWbf
1p°e"y
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Tank
Field
Station
Tank
Sewer Line
—
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Inspections performed by: rttf Dates: 1" 4S
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Development Services Department Approval 7/s aS
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o` J'•'• PE 6.
Reviewed and approved by: Date: 3' 3 0- O (o
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ar Izvo)
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T.H.21
A
B
59
13
52
16
41
22
39.5
23.5
29.5
A98
53
101.5
Double C.O.'s
rptlon Trench
DESIGN NOTES:
1. Total Depth of Trench is 7.5'.
Terrain slopes southwest.
2. Sewer Service Line minimum 2% slope.
3. Trench is Minimum 10' from Lot Line.
4. Lots Served by Private Water Wells.
6
Seo"
oy
Y
.C.O.
eserve�it — \
c.6.�rM.T
2000 Gallon Septic Tan
GP Soil Perked ® 4 Min/Inc n 6/6/05
Septic System Construction
Does Not Preclude Adjoining
Lots From Sanitation
Improvements.
NOR THRIM
ENGINEERING
117237 Beor Pow Circle
Eagle River, Alaska 99377
907.694.7028
Water
CHECK SEPARAT 8N
PRIOR TO DRI INC
WELL
1' = 40'
1 AS -BUILT
DENALY S/D PLAN VIEW
LAYOUT
1 LOT 17, BLOCK 1� ---
3/20/06 12 of 3
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SOILS
LOG - PERC❑LATI❑N TEST
I k`' I� Date Performed: 6/6/05
[Nq NEERING
Performed For. Steve Wakeland
Legal Description: Denaly S/D, Lot 17, Block 1
1 -
2 -
3 -
4 -
5 -
6 -
7 -
8 -
9 -
10 -
11 -
12 -
13 -
14 -
15 -
16 -
17 -
18 -
19 -
20 -
21 -
DEPTH
(FEET)
Organic
CJ
GP
:. Gravel
<Q:•�. w/Sand
Slope < 10%
Groundwater? No
Depth
Water Depth
After Monitorino. Dater
#
Date
Gross Time
Net Time
Depth
Net Drop
1
6/6
0
--
4'
--
2
6/6
4
4 min.
5'
1'
3
6/6
8
--
3'
--
4
6/6
12
4 min.
4'
1'
5
6/6
14
--
3'
--
6
6/6
18
4 min.
4'
1'
Percolation Rate 4 min./inch Perc Hole Diameter 6'
Test Run Between 3' and 4'
Commentst Pre-Sanked
Performed By NnrthRim Eng, I S
Performed in Accordance with All
ON THIS DATE, DATE: 6/6/06
NOR THRIM
j ENGINEERING
j 17237 Bear Pow Circle
Eagle River, Alaska 99577
907-694-7028
.-------- -- - -
cc+
CERTIFY THAT THIS TEST WAS
State/Municipal Guidelines in Effect
DENALY S/D
GE❑TECHNICAL T,H.
2
LOT 17
-�
BLOCK 1
6/6/06 1
M -W Drilling, Inc.
•P.O. Box 110378*Anchorc9e, AK 99511♦
•907-345-4000 • 907-345-3287 Fax•
Job No.: 05-127 Parcel No.: 067-041-23 Permit No. SW050078
Groundwater WeU As -Built & Lot'
• Well Owner: Wakeland, Steve ♦ Use of Well:
♦ Legal Description: Denaly Subdivision, Block 1, Lot 17
Construction
Domestic
• Hole Depth: 84' ♦ Casing Size: 6" ♦ Cased To: 83.12' ♦ Material. A 53 Steel
♦ Drill Alerhod. Air Rotary—
Perf.
♦ Well Completion- Open end X Screen _ Perforated Method.
♦Sereen/Perforatio ndes erlprion: None
♦Grout!Voles: (6 %i ) Sacks- No. 8 bentonite granules
• Notes:
• Well Development., Method. Air surge Nores:
♦Static water level (SIVL) 21' (above) (below) top of easing (TOC).
♦ Wellyield rest at 7 gallons per minute (GR11)/geJl ns-perheur( I) for 20 hours
Willi 100% of drawdown (DD) from static level (SWL).
♦Alerhod• Submersiblepump
♦ Date of completion: 23 July 2005 ♦ Pump Install.
Well Lot+
Depth in feet from
top orcasin .
Details of formations
penetrated, size of material, color and hardness.
0
TO
2.5
Casing stickup__—_
2.5
TO
5
Fill
5
TO
55
Gravel:_cobbley
i 55
TO
79
Siltygravel: clayey
i 79
TO
84
Water sand and gravel
TO
TO
-
_
-
TO
TO
TO
- -_TO
TO
_-_
._
_
_.._
WAYNE`1cT.VTE-.j-TBERG
President, -M-W Drilling; Ina
TO
_.
.-.. -- -NQWA Certified Contractor - _
TO
Certificate Nos:meq-/v{��o
TO
Contractors License No. 1006
TO
MUNICIPALITY OF ANCHORAGE
Development Services Department
Onsite Water 6 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: SWO50078
Date Issued: Apr 12, 2005
Expiration Date: Apr 12, 2006
Parcel ID: 067-041-23
Legal Description; DENALY SUBDIVISION BLOCK 1 LOT 17
Design Engineer: 0838 North Rim Engineering Site Address: 7044 KULCHAY CIRCLE
Owner Name: STEVE WAKELAND Lot Size: 42163 SO. FT.
Owner Address: 7044 KULCHAY CIRCLE Total Bedrooms: 6 Permit Bedrooms: 6
EAGLE RIVER. A 99577 -
This permit is for the construction of.,
❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy 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. I R 1 Date: dide<
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/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 1%4— an - C9,P) Permit Number SW
Property owner(s) Day phone!ay Z4 -C/
Mailing address / 90c%J Rt7-Ri PoeoJr Zip Code nS 77
Site address
Code
Legal description (Lot, Block & Sd9d.) JY4//4L2� S /A 467- /7
Legal description (Section, Township & Range)
Lot Size da, 6_13 Acre
THIS APPLICATION IS FOR:
Number of Bedrooms
Sewer Only ❑ Well Only ❑
Sewer and Well Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
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
Permit/Rush Fees:
Date of Payment:
authorized agent)
Waiver Fees:
Date of Payment:
Receipt Number.10�E�T— Receipt Number:
(Rev. 09/04)
W, NEERII NNG—
Northitim Engineering
17237 Bear Paw Circle
Eagle River, AK 99577
907-694.7028
April 9, 2005
MOA On -Site Water & Wastewater Program
4700 Bragaw St
Anchorage, AK 99519
RE: Septic System Design; Denaly S/D, Lot 17, Block 1
A well & septic system permit are submitted for your review. This is a vacant lot which is
being developed in an established neighborhood. Nearby lots utilize conventional septic
systems. This will also utilize a conventional septic system for the single family, 6 -
bedroom home. The soils report from the subdivision investigation was used as a basis for
design; another soil test with percolation test will be conducted prior to construction,
within the proposed septic system site. The drainage slopes from front to back toward
Eagle River.
Please review the wastewater system design for the single family home. I have included
design plans & specs, design guidelines, & soil tests. If there is need for additional
information or clarification please give me a call.
Sincere)
St
eve Eng, P H
Design Enclosures
t
I�P�I.NEERI� NSG DENALY S/D, Lot 17, Block 1
SPECIFICATIONS & DESIGN GUIDELINES
Wastewater System Sizing: This is a single family home projected at 6 bedrooms. This
requires a 2000 gallon septic tank. This lot is almost about I acre in size, as are
neighboring lots. Most of the neighborhood lots have been developed. No adverse impacts
are expected from developing this lot. The proposed water well is located on the drawing
as are the neighboring wastewater systems & water wells. The lot slopes from front to
back, the water level located at the front. No conflicts to any neighbor lots is anticipated.
The soil test from the subdivision investigation is being used for design; a sandy soil with
an excellent percolation rate. We will confirm the presence of this soil prior to
construction by another percolation test. An application rate of 1.2 GPD/FT2 with 0.5
reduction factor for utilizing a 5' wide trench was utilized.
Specification Requirements: All components and work must comply with the
Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water
Regulations and Wastewater Regulations.
• Two compartment, 2000 gallon septic tank.
• Watertight couplings on inlet & outlet.
• 5 foot minimum between the tank and bed. 10 foot to property lines.
• 3 feet of cover or insulation is required for trench; an equivalent of I" insulation for each foot
soil cover.
• Tank & solid pipe must be set on well compacta!, stable soil.
• 4 inch diameter cleanouts with airtight caps are required 1 to 4 feet from foundation wall, prior
to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing
cleanouts between the tank and the absorption field, not more than 10 feet from the tank
positioned to provide cleanout access towards the tank and towards the absorption field.
• All cicanouts 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 feet to groundwater, 6 feet to bedrock from drain -
rock.
• Drain rock to be'/� inch to 2 '/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.
• Backfill over drain rock must not be less than 36".
• The finish grade must be mounded to promote drainage over the 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 M or equal)
Septic System Construction
Does Not Preclude Adjoining
Lots From Sanitation
Improvements.
.N'
1
T.H.21]
F.]
Double C.O.'s
Trench
Perc Test Prior To
DESIGN NOTES:
1. Total Depth of Trench is 7.5'.
Terrain slopes southwest.
2. Sewer Service Line minimum 2% slope.
3. Trench is Minimum 10' from Lot Line.
4. Lots Served by Private Water Wells.
� F tigr
6
8Pa"o
of
2000 Galion Septic
To Confirm Soil Type
Water Well/
CHECK SEPARA
PRIOR TO DRIL
WELL
I' = 40'
or
NORTHRIM h�� .
DENALY S/D
ENGINEERING
PLAN VIEW
17237 &*or Pow crn,.
LAY❑UT
£ople RI~. A/oako 99377 1� a �y=�
907.694.7028 '�
LOT 17, BLOCK 1
aisios 1 of 4
WEL 6
\ \ PROPOSED %�'
\ *1SEPTIC AREA �
\ \ 5-10% Slope
\
\ SEPT
\ \ AREA
\
\
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i�F. OF .4 1
NORTHRIM y4" '
ENGINEERIN�G/'
DENALY S/D
LOT 17, BLOCK 1
AREA
17237 Boor Pow C,o
£op/o Rhoor,Ald0a 99577 .• a -as •.• e��
LAYOUT
Z/!{
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SEPTIC SYSTEM DESIGN
•-
4/11/05 ,• eo
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li ND ENGINEERING r t
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
SOILS PERCOLATION TEST
Performed for. F. Robert Bell & Associates Date Performed: 4/23%ZI��""-
Project'. Lot 21B McIntyre TEST HOLE# 99-21B
Depth
1-
2-
3-
4-
5-
6-
7-
8-
9-
10-
11-
12-
13-
14-
15-
16-
17-
18-
19-
20 -
SEE ATTACHED SITE PLAN
Org—soft, brown, moist FOR HOLE LOCATION
CP — Med dense, gray to brown
silty, gravelly sand
W/ cobbles, moist
SP — med dense, gray, slightly
silty, gravelly sand
W/ cobbles, moist
B.O.H.
HOLE PRESOAKED PRIOR
TO PERCOLATION TEST
Was Groundwater encountered? NO What depth? N/A
Depth to water after monitoring? DRY Date? 5/15/99
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
1
4/27/99
1:00
-
9"
-
2
1:10
10 min
1 4/16"
712/16"
3
•
1:11
-
9"
-
4
1:21
10 min
12/16"'
714/16"
5
•
1:22
-
9"
-
6
132
10 min
1 2/16"
714/16"
7
•
133
-
9"
-
8
1:43
10 min
1"
8"
9
1:44
-
9"
-
10
1:54
10 min
1"
8"
11
1:5.5
-
9"
-
12
2..05
10 mm
1"
8"
•
Water
Added
Percolation Rate 1.2 (min/in) Perc Hole Diameter 6"
Test Run Between 4 feet and r feet
I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in
effect on this date.
MUNICIPALITY OF ANCHORAGE
o
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. 067-041-23
Legal description DENALY BLK
Site address 7044 Kulchay Cir
1 LT 17
Current property owner(s) Swanson Brian
Expiration Date: �Z
X The On-site system(s) is/are approved for 6 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
0
Original Certificate Date: 3/7/2023
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 X Well Flow Advisory
Absorption Field AdvisoryNitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA Approvaijune 2022
MUNICIPALITY -OF
Development Services Departments
On -Site Water & Wastewater Section
Phone: 907-343-7904
Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 06704123000
Complete legal description DENALYBLK 1 LT 17
Location (site address) 7044 KULCHAY CIR
Current property owner(s) SWANSON BRIAN
2. ON-SITE SYSTEMS SIZED FOR 6 BEDROOMS
Day phone 529-4660
3. TYPE OF WATER SUPPLY: ❑i 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: ❑i Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ■❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age 18 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench X Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
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 $ 556 Waiver Fee $
Date of Payment 13 /ao Date of Payment
COSA # Q S (!� 'M r 0 (4107 Waiver #
G41 -I61)
COSA Application June 2022
COSA Checklist
Legal Description: DENALYBLK 1 LT 17 Parcel ID: 06704123000
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _
A. WELL DATA
0 Well log is filed with Onsite (or attached)
Date drilled 7/23/05 Total depth 84 ft
Cased to 83.12 ft
0 Sanitary seal is functioning correctly
0 Wires are properly protected
Casing height (above ground) 24 in.
Date of flow test for COSA 1/26/23
Static water level at beginning of test 23 ft.
Comments
B. TANK DATA
Measured operating fluid level in septic tank 50
Date of pumping 2/3/23
❑ Required maintenance completed, if AWWTS
Comments: Steel, 18 yrs
D. ABSORPTION FIELD DATA
Which system tested (date installed) 7/5/05
Q ALL standpipes present per record drawing
Total measured depth from grade 10 ft (max)
Measured depth to pipe invert from grade 6 ft (min)
❑ N/A — pressurized field.
❑ Per record drawings, field is insulated.
0 Monitor tubes go to bottom of effective.
If not, state depth into effective
❑ Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Comments/Deficienci
COSA Checklist June 2022
Well production at time of test 7 gpm
Water storage tank volume0 gallons
Well disinfected for coliform test? ❑ Yes ❑■ No
0 Coliform bacteria is Negative
Nitrate mg/L ❑■ Nitrate less than MRL (ND)
Arsenic ug/L ❑■ Arsenic less than MRL (ND)
Collected by NRimEng
Date 1/26/23
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 1/26/23
Results Q Pass
Fluid depth prior to test 12
Water added 900 gal
New fluid depth 18 in
Elapsed time 60 min
Final fluid depth 12 in
in
Absorption rate 900 gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 48
Effective depth used 12 in
Effective depth remaining 36 in
in
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100'
■0 Yes if No ft ❑■ Yes if No
Neighboring Tank > 100' R■ Yes if No ft Private Sewer/Septic Line > 25' *Yes if No
Absorption Field on Lot > 100' ❑■ Yes if No ft Holding Tank > 100' ❑■ Yes if No
Neighboring Absorption Fields > 100' Animal Containment > 50' ■❑ Yes if No
ft
ft
ft
ft
■0 Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' W Yes if No ft M Yes if No ft
❑ N/A— Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
■❑
Yes
if No
ft
Surface Water > 100'■❑
Yes if No _
Tank to Property Line > 5'■❑
Yes
if No
ft
Wells on Adjacent Lots:
Field to Property Line > 10'
■❑
Yes
if No
ft
Private Wells > 100'
❑■ Yes if No _
Water Main > 10'
❑■
Yes
if No
ft
Community Wells > 200'
Fm -]Yes if No_
Water Service Line > 10'
❑■
Yes
if No
ft
If tank or field is under driveway comment below
F. ENGINEER'S COMMENTS
li
ft
ft
G. CERTIFICATION & STATENJENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm NorthRim Engineering
Engineer's Printcd Name Steve Eng
COSA Checklist June 2022
Phone 694-7028
Date 3/3/23
+P�� of Al No
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c Steve Eng 0
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15' T&EJ \ L,
EASEMENT
Lot 18
Q
g
ASPHALT,., I COVERED DECK WELL `
ORNEWAY X60 2.0CANT
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(0, 4.2' PORCH A� \
�;�0'1 s' �' Ssa, ' 1.0'x10.0' CANT rF�r/L
� � •� oF� 43• RFS 208 � l
2.0' CANT t h of
\ �� • �� O f 36II, � ryOry.
2.0'x17.3'
CANT
4ry\/ � SS• Lot 16 �
� ,gS�y SEPTIC PIPES
� \ ?S. Lo 63 7
F.
20' GAS EASEMENT
PLOT PLAN AS BUILT X SCALE 1" = 50 GRID SW 0363 Pro'ect No.
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, inc. (907) 522-6476 Phone o0pp4
(907) 522-4625 Fax
�o OF A 0Q4
Professional Land Surveyors kenolangsurvey.com
jonothanOlangsurvey.com
I hereby certify that I have surveyed the following described property: 0 49TH
LOT 17, BLOCK 1. DENALY SUBDIVISION (PLAT No. 2000-12) Q, . , • :........ ... ..............4
Anchorage Recording District, Alaska, and that the Im rovements situated thereon are 0
within the property Imes and do not encroach onto the property adjacent thereto, that h
no improvements on the property lying adjacent thereto encroach on the surveyed VA's ' KENNETH G LAN ¢ Q
premises and that there are no roadways, transmission lines or other visible V
s+ t °O
easements on said property except as indicated hereon. 'r
Q�4Foo�Q' .LS -520.• oy�
Dated this the �i� Day of 1'f�l:' ___ _�'aL` at Anchorage, Alaskav�4oROF �p
ZSSION4 b
It is the responsibility of the owner to determine the existence of any easements, �����oQa�
covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963
Municipality of Anchorage
-� Development Services Department
Building Safety Division
On -Site Water and Wastewater Program s A r
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519.6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. tyQr4—oul-a3 COSA#
Expiration Date: _� — 3 O —'O
1. GENERAL INFORMATION
Complete legal description
Location (site address) 7OW (2 /.2CGE
Current Property owner(s) 'S 7-F 4(�EI�1 t !� Day phone
Mailing address
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 6
3. TYPE OF WATER SUPPLY:
Individual Well
93
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
�]
Individual Holding Tank
❑
Community On-site
❑
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 Onsite 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 Onsite 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 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 Anchorage is not responsible for errors or omissions in the professional engineers 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 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.
Nameofi
Address
Firm ♦
1
• /i
ZN
Engineer's Printed Name STEAfE FA l 4 Date 34204—oc
5. DSD SIGNATURE
_(G' Approved for C3 bedrooms.
Disapproved.
OF 4L `el
Sieren W .q••
rE 6
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Az lii� Original Certificate Date: '3– 3 O – O
(Ftw. 11AS)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196850
Anchorage. AK 995196850
www.muni.orglonsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Wen type - F— If A, B, or C provide PWSID # _ Well Log (YM) _Y
Date completed _7144 CS Sanitary sea[ (YM) 4 Wires properly protected (YM)
Total depth �_ft. Cased to L3. ILft. / Casing height (above ground) In.
FROM WELL LOG AT INSPECTION
Date of test
Static water level 2 ft. ft.
Well production % g.p.m. 9—
p.m-WATER SAMPLE RESULTS:
Coliform coloniesl100 mL Nitrate C. /O mgIL<M9L Other bacteria Q colonies/100 mL
Arsenic: -eMft Date of sample: fZI-4-916C Collected by
B. SEPTIVHOLDING TANK DATA
Tank Type/Material AA/6&eX (}J�S'r� Date installed ]�S�
Tank size 2060 gal. Number of Compartments 2 Cieanouts (YM)
Foundation cleanout (YM) Depression over tank (YM) �� High water alarm (Y/N) /t/
Date of pumping /VE(iJ Pumper
C. ABSORPTION FIELD DATA
Date Installed ZLSL6'f Son rating (g.p.dR or f !A;d= System type %P'rA(C/f
Length X ft. Width -5 ft. Gravel below pipe _ _ ft.
Total depth /, J Itr Eff. absorption area �ff Monitoring tube Depression over field Al
Date of adequacy test R5�4 Results (Pass/Fan) For --C— bedrooms
Fluid depth in absorption field before test _ in. Water added_ gal. New depth_ in.
Elapsed Time: _ min. Final fluid depth _ in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM 8 type) If yes, give date
D. LIFT STATION
Date installed I Size In gallons I Manhole/Access (Y/N)
'Pump on' level at in. 'Pump ofP level at in. High water alZraquil
ain.
Datum Cycles tested Meets alarmements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot /&40 I# -
Absorption field on lot _/d O it
Public sewer main _ IV14
Sewer /septic service line 1 os-
Animal
SAnimal containment areas /VOit/E
On adjacent lots /DO 14'
On adjacent lots /d O rf
Public sewer manholaideanout i9
Holding tank — _ N��
Manure/animal excrete storage areas AfO,, 97
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation S Property line /O r4' Absorption field S J
Water main eV:f! Water service line /O { Surface water IQ O r�
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line /6 �� Building foundation O Water main
Water Service line �D ,f Surface water /DO �r- Driveway, parking/vehide storage 10 lr`
Curtain drain Wells on adjacent lots /OG 1'f
F. COMMENTS
G. ENGINEER'S CERTIFICATION
P�.• �� •.;r�- gyp;
I certify that I have determined through field inspections and
review of Municipal records that the above systems
are in
•• °r;
conformance with MOA COSH guidelines in effect on this
date.
r, ,, ; • ' •• •• ... • .. �+
Engineer's Printed Name STEVE FN t;
_
6�� �•., ' rtz
•, . �.�
Date
�ei
COSA Fee $ 5 5
Waiver Fee $
Date of Payment3 a j l D
TH_�t
Date of Pa yment
Receipt Number f a Y
Receipt Number
(Rev. I IM5)
LOT 18
00, 1•
LOM DECK
UITO DECK-
\ N4
FSA \
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2�
mo �
cyq
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1
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\ �` X20' GAS EASEMENT
16
PLOT PLAN _ AS BUILT X SCALE —!L-- 50' GRID —2L-363 Project No. 05-086
Lan & Associates, Inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049
9 907) 522-6476 Phone
Registered Land Surveyors 907) 522-4625 Fax OF A�
k9langle0alaska.net / jclangle0alaska.net 1` ..............
w
I hereby certify that I have surveyed the following described property. .. f'
LOT 17, BLOCKI. DENALY SUBDIVISION (PLAT 2000-12)�' 4914 9*
Anchorage Recording District. Alaska, and that the improvements situated thereon are N!!.:........... ........
within the property lines and do not encroach onto tit property adjacent thereto, that
no Improvements on the property lying adjacent thereto encroach on the surveyed •••• ►,•„
premises and that there are no roadways, transmission linea or other visible KENNETH C.
easements on said property except as Indicated hereon.
/Y�(�, LS;5202
Dated this the 14tf4 Day of I.A&94M 'LoofA . at Anchorage, Alaska
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat.