HomeMy WebLinkAboutT15N R1W SEC 5 LT 106SEPARATION DISTANCES
Municipality of AnchorageDevelopment Services DepartmentBullding
Fromank
eptic
FON
Safety DivisionOnsite
mde rep ..�-
Y/
Water and Wastewater Program, 4700 S. Bragaw SI.P.O.
Box 196650 Anchorage, AK 9951&6650 Page f of 3www.cl.anchorage.ak.us
/�
hJ
(907)343-7904
-SITE
WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number:
3 PID Number:
Now:
Wastewater System: Ig New El Upgrade
A
A
itgSaH t L� ABSORPTION FIELD
Phone: •--a �r ��jt
Numbers Bedrooma:�
❑ Oeap Trench 0 ShallowTrerJi Bed l(Alountl ❑ 0lhec
LEGAL DESCRIPTION Soil Ragng: .Tplel D;p M1lrem odginN gretla:
O/a
Block: Lol:
.106
3ubdivLgon: OeLpl-h � to plp0 bollam ham mlgMN ade: Gravel depth beneath pipe:
R7 '~
Towneldp: Renge: 1:12swim:
:5 Fill added abo dg Npreda;�I 51. Orav6l Lan tlt:
B (li
FI.
Well: ❑ New
GravelAdit Numberol gnea: DIN; ce be Mae:
❑ Upgrade .3
Ft
CI Ace+lan (PrI W. A. B. e):
Yy
ToIN 0mlb: qFt Caned M; /AFI Totelebaprplianaaa; /�I/L Plp LMelerlal: FI
!VI !l/9 ��V
Dail
FP J
r. i
pal OMMd Slags Weler L.M- MNNIer. Dal- Mel°II°d:
�30-03 -,Fl. Ow,wr I l -t D-43
Yield: Pum at
ullbligWA GPM
UdMN lleightAbove Ground:
Ft. a FC TANK
SEPARATION DISTANCES
i [I Septic El Holding O(S.T.E.P. DOther.
Fromank
eptic
AhSorption
Field
Lift Holding uNiGPrlvata
Station Tank Sewer Une
mde rep ..�-
Y/
tenet ly:
1 �®
Gal.
1I L
/�
hJ
/
1Mine'
{
1111
tJ/��p
aWell
`
�M11+LIFT
STATION
t
V�!
�F 1rer:
�,��^
^el.`r �' /r
1� 1•Pumpolrewo.l:.�
High water a1.4^•�
L
_/ t
, 1EledrkN
fiapagrons psrlarmed by:
o�
m Sph
BENCH
BENCH MARK
Gill
1/1n ns�
/
LBr .1/P 11111
i' !l f /�
I 1 nesumjan EleveaR.
nn:
f # S ENGINEERING
Inspections performed by: 17M Boole River Loop R* 4 Ne. s. let.11-3-03 r.
2nd 0 i F }S. ROBERT C. COLY31rf
Developmen ervice ep r `
tmentApproval `� "`�sE -awl
"si
Reviewed and approved b . Date:
%tilt=/?7�°•S`i
ul.
PERMIT No. SW030218
PAGE 2 OF 3
DEPARTMENT OF ANDhHUM9,AN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 106, SECTION 5, T1 5N, R1 W P.I.D. NO. 051-082-26
NEW
50' PATENT ROW RESERVE
i w
ROBERT C. COWAN
CE -?801
-.•I... 4
IL
I.. �
WALL
:.,GRAVEL0RIVE
I.
t
_
100' CREEKI --
SETBACK
!
r
W
I o
0,
I w
i A TBH
100' SETBACK
FCO2I�TO
SURFACE
FCO!
WATER
SC6LE: 1" = 50'
ANK WH 1
0
1
MT \ Ei"r'�t�1
NEW
1 Aff+t1r, 0C_ 4Li
r------�
t ..... . r
ALT. SITE
MT7 STH#!
L_-- -A i2
ROBERT C. COWAN
CE -?801
PERXIT NO. SW03021 8 PAGE 3 OF 3
Municipalit of Anchora e
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 •Anchorage, Alaska 99519-6650 f Telephone: 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 106. SECTION 5. T15N. RiW .l.n. 051888-26
See
Fpw it 0ww-�t =
ST1 ST2
89.4'/ NEW 1250
GALLON S.T.E.P.
SYSTEM
MT1=94.2'
DIST. PIPE=94.8'
INLET
=94.3'
1 OF SAND=92.3'
A
WATER FOUND @ 86.8
84.8' B.O.H.
N. T. S.
ROBERT C. COWAN
CE -.8801
Municipality of Anchorage Page 3 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number: SW030218
PID No. 051-082-26
ExiztiN Ground
98.5`*'
Revegetation Complete
N
92.3
94.8
NOTE: Additional fill was placed over the septic system since it was originally constructed in 2003.
In addtion, the mound has been totally revegetated with heavy growth. No evidence of
erosion is evident. For further details see S&S Engineering Inspection Report dated 10/27105.
PROFILE AS -BUILT -
Scale: V=10'
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
MEMORANDUM
DATE: November 13, 2012
TO: Deb Wockenfuss
FROM: Mike Anderson, P.E.
SUBJECT: T15N R1W Section 5, Lot 106
Septic System Permit No. SW030218
t�Il�Elia �a-
v�A;ver
We have reviewed your comments concerning the subject permit and have made the
following revisions:
1. The electrical inspection of the lift station was recently performed by
Rison Son Electric of Eagle River. Their certification is attached.
2. Electrical Certification by Rising Son Electric is Attached.
3. Additional topsoil and vegetation was placed over the tank during the
past nine years. Sufficient fill is now over the tank.
4. Additional topsoil and vegetation was placed over the absorption field.
A heavy growth of vegetation is now found on the mound. No erosion has
occurred. Sufficient fill is now over the absorption mound.
5. A heavy growth of vegetation if now found on the mound. No erosion is
evident.
6. The property has changed hands. We have inspected the septic
system and verified that it was installed in accordance with Municipal Code.
Sep 18 2012 8:03PM RISING SON ELECTRIC 907-622-6777
September 18, 2012
Anderson Engineering
Attn: Mike.Anderson .
Boo E. Dimond Blvd
Anchorage, AK
FAX #677-7766
Rising Son Electric,,Inc.
14916 Woodland Drive
Eagle River, AK 99577
(907) 622-6777
RE: 21330 Bowery Lane— Chugiak, AK 99567
Dear Mike:
The lift station at the above referenced address has been tested and is in working
order in accordance with NEC and State/Local codes.
Thank you.
Sincerely,
Kell Hornbuckie, Owner
Administrator License Number 1284
Specialty Contractor license Number 27285
Cc: file
page 2
JAN -16-2008 12:36 SRS ENGINEERING 907 694 1211 P.02i02
FROM DENALI MATERIALS PHONE N0. : 9076862103 Aug. 10 2005 21:23PM P2
„y„r
HEFI-Y DRILLING STATF OF ALASKA..
3540 AKULA DRIVE MPARTMNNT OF NATURAL RLSOURMS
MiNIKO, LAND, WATRR lt#'YDROLOGIC SURVE`ll°0
ANCHORAGE, ALASKA 99516 wAr> tt WELL LOG .
". .
(907) 345-0593,
Drilling Starred: l9k-/-l., Compleled:
1I "pot"s'hal; c+WAI w 1114 Iw Kar W II -Slot* Df Alwil
'll45' 4% � I snwxs SS.DSAYO, 38.DSASS,
at.p8Oz0, 4fi,15.010 sad 11K regl,UpglS I l AAC 93.14,).
DEPARTMENT OF NATURAL RESOURCES
Wmirl Land & Water Hydrologi, $urvey
S50 W 71h Ave., Suits 900A
Ah,horagc, AK Mt 3577
TelenhnY,. /01171 HCa_OLao .._. n. w ....« ___ . __ .
within the City of Anc}IcraIII,
, it is required that a copy of the welllog be
sent to the appropriate city affiCe within 60 days and tint another copy of
Ike well log be sear to the welUproperty ownar wifhiq 30 trays
DsItOfIssue: �_ r
Pool Identirl"12 Nun&Cr ftl l F. _ '1 r_
TOTAL P.02
CW orough;
3ubdividonrU55:
Block
Lot
I Property0lvnerNum,&Address: ;' A
t..
M«sdrsa' _....... Township/s.N_.Range.LI82_Section..,S..•.._. ,., t/+of ..... r/sof'Gcft�_Il,+'.
-L.at: ': .� .._Lon W_,,, NAA: jOR P1evsiec: ,.• ` -;" •.
BORWOLEDATA* (from ground surface) Depth
DdWnmethod�irrotary. l'1 Cable tolOther
`Mahrx,ljpe. Color & wetness 1 Erste I a
Well�usc: 0 Publia 2upply,31LDomeatie, ❑ Other.
a '
Depth of hole: DA, Casing stictarp:.. R
Casing ape: �'j�is e/ Thickness r'} ate' ', lechers
Casing diameter: � inches Casiogdepth 0..:,R `. .
aveL •—
Litua• typo _ llixmctac: ,inches DrpthI
Static water !from toll of ra%im,:,l: fi on
•
a p
Pumping level & yield: fcot after ..T_ hours at' . Spin a. .
f:
Recovery fate: Spin. Method of testing
ILr
Cri Y
4
Development inetbod:bl
i
41.1.
S -t
Well intake opening type: Open end, 0 Operabolo
�:lL+�� r
47
J 1
0 Screened; start: R, Stepped
�%
6D
Screen type: slot' it size
o�raV LJ
QPerfotatad;Start: k4opped it
Stan: it, Stopped
Now...
Orota type;his -I Voiume
Depth;fmm it,w.—_ '_ A
plump intake deptle ft
Pump size hp, Brand same:
Was well disirtl upon Completion? AYea, [IN*
Mcftdofdisinfectinell.
Driller comments) duelainsers:
Well Driller Name: If
Company Name: HEFTY p LING
Mailing Address:_ 3�t(u-L pptl X
City: )WCyORAGE State ALASt(A 99516
Phone Number
Drillers Signature:
1I "pot"s'hal; c+WAI w 1114 Iw Kar W II -Slot* Df Alwil
'll45' 4% � I snwxs SS.DSAYO, 38.DSASS,
at.p8Oz0, 4fi,15.010 sad 11K regl,UpglS I l AAC 93.14,).
DEPARTMENT OF NATURAL RESOURCES
Wmirl Land & Water Hydrologi, $urvey
S50 W 71h Ave., Suits 900A
Ah,horagc, AK Mt 3577
TelenhnY,. /01171 HCa_OLao .._. n. w ....« ___ . __ .
within the City of Anc}IcraIII,
, it is required that a copy of the welllog be
sent to the appropriate city affiCe within 60 days and tint another copy of
Ike well log be sear to the welUproperty ownar wifhiq 30 trays
DsItOfIssue: �_ r
Pool Identirl"12 Nun&Cr ftl l F. _ '1 r_
TOTAL P.02
A
r MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ONSITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Permit Number: SW030218
Legal Descriptionfl5N Rt W SEC 5 LT -106
Design Engineer: 0003 S & S Engineering
Owner Name: Mary Kelly
Owner Address: 801 Airport Heights 11452
Anchorage , AK 99508 -
Date Issued: Jun 25, 2003
Expiration Date: Jun 24, 2004
Parcel ID: 051-082-26
Site Address:
Lot Size: 108900 SO. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy
All construction must be in accordance with:
1. The attached approved design.
❑? Private Well ❑ Water Storage
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 catling
(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: K Y Zr e5 3
Issued By: ����/ kJ. �— Date: ( ' 25-03
-\ 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.cl.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. �5 — �a. —oC �D Permit Number SW O 3 0 2 19
(,8g— a►o3
Property owners) Nx7e 5,/f ��� / L-`/ Day phone 717 -4.33
Mailing address (1) 801-- �riPn�T .14;-/C AETS "(4672,"(4672,Mailing address (2) /nn4NG i�-t��' A-G� . /1->•: Zip Code
Legal description (Lot, Block & Sub'd.)
Legal description (Section, Township & Range) { yT to: 6;7766/, fes/ t4' 5M.
Lot Size Acreq.Ft Number of Bedrooms 3
/o gi9oz7
THIS APPLICATION IS FOR:
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.
S & S ENGINEERING
• 334 Eagle River Loop Rad ft
(Signature of property owner or authorized agent)
Manama
Permit Fees: / SS 0- Waiver Fees:
Date of Payment: 10 /.- y 4 z Date of Payment:
Receipt Number: a'1 3 } iReceipt Number:
(Rev. 12100)
S&
NEALTHAUTHOF97Y
APPROVALS
SEWER& WATER
MAINE%TENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
ANDREPORTS
WELLNSPECTION
& RAW TEST
SITE PIANS
ROADDESIGN
SM TEST
PERCOLATION
TEST
STRUCTIA'AL&
MECNANCAL
WSPECTIONS
ONSITE
WASTEWATER
OISPOSALSYSTEM
DESIGN
ROBERT C. COWAN, P.E.
CML ENGINEERS
June 3, 2003 (907)694-2979
FAX(907)694-1211
MUNICIPALITY OF ANCHORAGE
Development Services Department
P.O. Box 196650
Anchorage, AK 99519-6650
REFERENCE: Lot 106; Section 5; T15N; R1 W
This letter is to inform you that a curtain drain was installed on the above referenced
property on November 21, 2002 in accordance with M.0 A. requirements. The drain
was effective immediately, dropping water levels to approximately 8 feet below
grade.
A test hole was excavated upgrade from the curtain drain and ground water was found
to be at a depth of 4 feet while water was at 8 feet on the downgrade side.
After groundwater monitoring on both sides of the curtain drain, it appears to
continue to be effective. Groundwater monitoring on June 3, 2003 found water levels
at 6.5 feet on the downhill side of the curtain drain.
Please grant the requested well and septic installation permit. We do not
anticipate any adverse effect on adjacent properties.
If you require additional information, please contact us.
Sincerely,
'AHL,124,
Robert C. Cowan, P.E.
RCC/ts
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER ALASKA 99577
ICALI11knimm"
k"mAls
SMA s WATEn
beweni WAIEn
"C"C"
tNUMERMstutwes
AN MMRTS
WELLMnct"
IKOWIEST
slikk s
sal test
kncatUln4
ZEST
AlnuctuaL
t1EcR44CA1
Ir•'iPECTICNs
W1s11�
WAa1EwAltfl
1xsPOSALsrs1E11
OEs"
hoStnt t;. cowM.1'E.
hoSEhtA. S1Wtn, t'.E.
civil. tNG H&hs
(907)694-2974
FAx(9o7)b94.1211
October 21, 2002
MUNICIPALITY OF ANCHORAGI:
Development Services Department
P.O. Box 196650
Anchorage, AK 99519
REFERENCE: Lot 106; Section 5; T15N; Rt W; S.M.
It is tequested that you issue A petinit to install A well And a septic system to serve the
proposed 3 bedroom dwelling bit the teferenecd property.
Two test holes were excavated And percolation tests performed. The approximate locations
of the test holes are located on the attached site plan. At the time of excavation 4/16/91,
groundwater was found at 3'. After monitoring, water was found at 2' on 4/23/9 L ,
However, groundwater monitoring was done on 9/20/02 and 10/17/02, with groundwater
found at 3', as indicated on the soils log for Tit #t.
Since 4/91, significant thanges hate been made to the topography of the referenced lot.
Much of the lot has been leveled acid some filling has been done. Additionally, surface
channels no longer exist which probably held ground water on the lot.
We are also proposing a subsurface drain above gradient from the proposed primary and
alternate drainfields to ensure propel drainage. The alternate area drain will be completed
during construction of the alternate Site.
1 roa4 Noht14tAGLt htvth (bbP 3 t1Btt 204 a tAGLt h1Vt1t ALAslv199sn
a
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the adjacent
properties.
If you require additional information, please contact us.
Sincerely,
W24th,
Robert C. Cowan, P.E.
RCC/bjj
With Enclosures
0
DESIGN ISITE-PLAN
a v1 W C,
—=nom
-u A — O —
C
Ln M
a0
m
r-
O
I Oo�.a
oocnu,o
II O II
V
CrJ
AEN
i
1 ..
WOrI
AyW-`
I
pOr^O
Z
<�r1
..
fr7
TI N
o
�J
5
3001 8
I
I
�> -0
c,"mn^
v
�
C7
O
F=
CzJ
m o
:"
/EW0S
r• -I
/ p born rt
N
(I1
D r-
N
D
'-�
O
D
"•"
rl v
1
;D
.TI A
'�
D
0-
m
>
�
v
/
A
O
--
r
/
r-
>
<
m
r>
Z O
XZ
y=
/
O
Ln
., ..
..
W
DO v
ZOy
O
x m 'M
50' PATENT ROW
RESERVE
0 rn
K
zy00
<
y
moN
��
Z
DRAINAGE DITCH
ns
1
Nc
m O
O
�
/
/
a v1 W C,
00
0 -Co
Ln M
a0
m
r-
O
II
II O II
V
AEN
1 ..
WOrI
vi
a
Q�L)-10
I a I
fr7
TI N
o
M'
5
3001 8
I
I
,I
�I N
1
v
�
C7
O
v
N O
r
f*I 0
Co
1 ..
n m
M
Zi
I a I
fr7
I
7c
3001 8
I
I
,I
�I N
1
o
I
�
r
1
�
0-
�
N O
C O
A
y7'.,
mm
* ^
., ..
'
50' PATENT ROW
RESERVE
A V
DRAINAGE DITCH
BOWERY LANE
o a!wo
xp'� n V
OCy
iC0
ti
K K N 0
n
X p A
Ani r
y m A
0 0
,._ O
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR PFti2 F'sj'," DATE PERFORMED:— q to --41A
LEGAL DESCRIPTION:-- 5L'" lol., To%
DEPTH
(2.-(--Aonv f4 t GS
tdc.t-1
(Low, '%'d
I ) 3
lw'A
4 -
5 -
9
G, Vc/u)
10— WAS GROUND WAI
ENCOUNTERED?
11
IF YES, AT WHAT
2 DEPTH?
13
14
e1i '&7 0 2-PePth to Water After
/ Monitoring?
COMMENTS
;tion: -r -t51•\ F,%\ . �C- .5
SITE PLAN
L
0
—P—
E
Date:
Reading
Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
W-- 1^J 6n
7--- r
..to 010
4
r-> C
1C> -
OP
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT
S & 5 ENGINIEEPING
17034 Engle Piv-e--r-L-OOP R"ZI-N-OTIU4—
PERFORMED BY: EnI,-RW,0r,-A(ask A-29577— I
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINZI
72-008 (Rev. 4/85)
CERTIFY THAT THIS TEST WAS PERFORMED IN
FFECT ON THIS DATE. DATE:
• ai�.�IEN EF3i'S, LSE&!•
• ," Municipality of Anchorage ?
DEPARTMENT OF HEALTH d HUMAN SERVICES 4' • y
825 "L" Street, Anchorage, Alaska 99502-0650 p . •• .. A .... ,
..
.
SOILS LOG — PERCOLATION TEST t. a' . No. W7-2;
PERFORMED FOR:L,G_F P r Q.. P gAA ..l DATE PERFORMED:
LEGAL DESCRIPTION: 51 -t -A t c r \Ol s. Township, Range, Section: 'L•lS t� Q,\� � Seg- 5
Q� r— SLOPE � SIT PLAN
It EEr Q'�(I�ftt l•,1G.S 1 1 1 1— I
1
O
Y
3-
4 'o
J
6
6-
7m
8-
91011 9-
10-
11
12-
13-
14-
15-
16-
17-
18-
'91
213141516171819
20
COMMENTS
611
5 rAlq%Aw
WAS GROUND WATER
ENCOUNTERED?
IF VES, AT WHAT —
DEPTH?
Depth to Water After
Monitorings 2- Date:
Reading
Date
Gross Net
Time Time
Depth to
Water
Net
Drop
bl 0
O
S
SS c ..
.3.
Z..
PERCOLATION RATE tS (minutes/inch) PERC HOLE DIAMETER i010
TEST RUN BETWEEN FT AND Z FT
PERFORMED BY; 17034 Eagle River LOOP Road—Are. 2 tZ CERTIFY THAT THIS TEST WAS PERFORMED IN
Eagle River, A as a Ts
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFf ECT ON THIS DATE. DATE:
72-008 (Rev. 4/65) /
• Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904
Parcel I.D. 051-082-26
sa crx
Certificate of On -Site Systems Approval
Expiration Date: 1`3
1. GENERAL INFORMATION
Complete legal description Lot 106, T1 5N, R1 W, Section 5
Location (site address) 21330 Bowery Lane, Chugiak, AK 99567
Current Property owner(s) Fed. Natl. Mort. Assn. Day phone
Mailing address
Real Estate Agent
400 National Way Simi Valley, CA
Elizabeth MacMullen
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: Three
Day phone 775-1812
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual
El
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for:
c-
Received by: -T ( Date: isb (
COSA to be release to the enjine , unless otherwise requested by the engineer.
COSA Fee $'- I0
Date of Payment t t I t'1 I t a (le,
Receipt Number f)t-i14 C) G
COSA # 05c,1 D-1 '5a 3
Waiver Fee $
Date of Payment
Receipt Number
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 Anderson Engineering . Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
6. DSD SIGNATURE
System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the following stipulations:
�yky��l Original Certificate Date:101
of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil, engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions In the professional engineers work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet F - L c
If more than 1 septic system is on the lot:
COSA Checklist # _of _
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: Lot 106, T1 5N, R1 W, Section 5
A. WELL DATA
Well type Private If A, B, or C provide PWSID #
Date completed 9/30/03 Sanitary seal (Y/N) Y
Total depth 60 ft. Cased to 60 ft.
FROM WELL LOG
Date of test 9/30/03
Static water level 7 ft.
Well production Unknown 9 -P.M.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate N/D mg/L
Arsenic 9.94 ug/L Date of sample: 8/9/12
B. SEPTIC/HOLDING TANK DATA
Parcel 1D: 051-082-26
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) >18 in.
AT INSPECTION
8/9/2012
26.6 ft.
3.2 g.p.m.
Collected by: MEA
Tank Type/Material STEP/Steel Date installed 11/10/03
Tank size 1,250 gal. Number of Compartments 3 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N)
Date of pumping 9/11/12 Pumper Sanitary Pumpers
C. ABSORPTION FIELD DATA
rn
Date installed 11/10/03 Soil rating (g.p.d./ft2 or ftZ/bdrm) .7 GPD System type Raised Bed
Length 48 ft. Width 15 ft. Gravel below pipe .5 ft.
Total depth 1 ** ft. Eff. absorption area 720 ft, Monitoring tube Y Depression over field N
Date of adequacy test 8/9/12 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 768 gal. New depth 0 in.
Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 450 g p d
Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date
D. LIFT STATION
Date installed 11/10/03 Size in gallons 250 Manhole/Access (Y/N) Y
"Pump on" level at 42 in. "Pump off' level at 32 in. High water alarm level at 44 in.
Datum Bottom of Tank Cycles tested 3 Meets alarm & circuit requirements? Y
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot >100' On adjacent lots >100'
>100' On adjacent lots >100'
Absorption field on lot j
Public sewer main N/A Public sewer manhole/cleanout N/A
Sewer /septic service line >25' Holding tank N/A
Animal containment areas >50' Manure/animal excrete storage areas >100'
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5, Property line >51 Absorption field >51
Water main >10, Water service line >10' Surface water >100'
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
Property line >10, Building foundation >10' Water main >10'
Water Service line >10 Surfacewater >100' Driveway, parking/vehicle storage >10'
Curtain drain None Noted Wells on adjacent lots > 100'
F. COMMENTS
**Top of Mound is 4' to 6' Above Original Ground. Revegetation is Complete
No Erosion of the Mound Slopes was Noted.
G. ENGINEER'S CERTIFICATION
I certify that 1 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.
Engineer's Printed Name Michael E. Anderson, P.E.
Date 11/10/2012
COSA brown sheet 10-10-12.doc
LOT 105
0
\ N
WELL
I
100.0'
PROTECTIVE WELL RADIUS
50' 131-M ROAD & UTILITY EASEMENT
— — — — — —
LOT 106
2.5 ACRES
FOOT
BRIDGE
GRAVEL
DRIVEWAY
4.1
3° ..
'DECK'
CANT.
4.7'x 20.7' 30.2 .
CANT. 7....
4.6'40.9'
SEPTIC 30.1
GARAGE
M
LOT 121
PLOT PLAN _ AS BUILT X SCALE 1' = 40' GRID NW1457 Project No. 12-201A1
Lang & Associates, inc 11500 Daryl Avenue, Anchorage, Alaska 99515-3049
(907) 522-6476 Phone
Registered Land Surveyors (907) 522-4625 Fax
ken®langsurvey.com / jonothan®langsurvey.com o QF
0
��........... 4q 04
I hereby certify that I have surveyed the following described properly: O� '' s OO
LOT 106, T15N, R1W, SEC 5, S.M. `Q 0
Anchorage Recording District, Alaska, and that the Improvements situated thereon are to, fihat
within the property lines and do not encroach onto the
Property P P rty adjacent there """""""' (" Q
no improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visibleti �X...
easements on said property except as indicated hereon. QO ii KENNNEETH QG. IIGC..�ogr0
Dated this the �u Day of �sc>> uen? ( ?iii at Anchorage, Alaska o�4 �� •.!tl z(CO2 •.: yJDaO
It is the responsibility of the owner to determine the existence of any easements,
h-< 43
e?4'
covenants, or restrictions which do not appear an the recorded subdivision plat. oD000o��'
i
I
I
I
0
0
m
D
0
F$
C
7
K
M
z
Cal
En
O
4
0
M
O
m
J
r
N
t0
YYY
Z
V
m