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HomeMy WebLinkAboutMAXWELL LT 2xw 11
Lot 2
#018-281-26
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program, 4700 Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page of
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: OSP111304 PID Number: 018-281-26
Name:
James Seccombe
Wastewater System: ❑ New © Upgrade
Address:
14841 Loc Loman Lane Anchorage, AK 99516
ABSORPTION FIELD
Phone: Number of Bedrooms:
748-2886 4
17 Deep Trench El Shallow Trench ❑Bed [I Mound ❑Other
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original grade
.8 GPD/Ft'
12-13 Ft.
Block: Lot:2 Subdivision:
Maxwell
Depth to pipe bottom from original grade:
Gravel depth beneath pipe:
4-5 Ft.
8 Ft.
Township: Range: Section:
Fill added above original grade:
Gravel Length:
0-1 Ft.
47 Ft.
Well: ❑ New ❑ Upgrade
Gravel width:
Number of lines:
Distance between lines:
3 Ft
1
- Ft.
Classification (Private, A, B, C):
Total Depth:
Cased to:
Total absorption area:
Pipe Material:
Existing
Ft
Ft
752 Ft'
ASTM D3034 PVC
Driller:
Date Drilled:
Static Water Level:
Installer:
Date Installed:
Ft.
Wilco
10/27-28/2011
Yield:
Pump Set at:
Casing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION DISTANCES
® Septic ❑ Holding ❑ S.T.E.P. ❑ Other:
To
Septic
Absorption
Lift
Holding
ublidPrivate
Manufacturer:
Capacity:
From
Tank
Field
Station
Tank
Sewer Line
Anchorage Tank
1,250 Gal.
Well
>100,
>100'
N/A
N/A
>25'
Material:
Steel
Number of Compartments:
Two
Surface Water
>100'
>100'
N/A
N/A
LIFT STATION
Size:
Manufacturer:
Lot Line
>51
>10'
N/AIN/A
Gal.
"Pump on" level at:
"Pump off' level at:
High water alarm at:
Foundation
>5'
>10'
N/A
in.
in.
in.
Curtain Drain
None
Noted
Pump Make & Model
Electrical Inspections performed by:
Remarks:
Flow Diverter Valve Placed. Existing Trench Connected For
BENCH MARK
Location and Description:
Future Use. Existing Septic Tank Decommissioned in
Garage Slab
Assumed Elevation:
Accordance with Municipal Code.
100.00 Ft.
eoF
Inspections performed by: M. Anderson Dates: 1st 10/28/2011
��.•^p�,
'm.` fir••' `' � �
2nd 10/28/2011
AW
Development Services Department Approval
� *; 49� *;
Conditional Approval Date:
ys'rrr• q•• �• •y•�• ••r••.•a
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®� �•NUCUa 8 ANDMSON •,94K
CE -4381 •.'��`6
Reviewed and approved by: f�� !.J.� Date: /,;2 _ S 'l
ROF
®sgP I:SSyd�q
(Rev. 04/06)
i
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: OSP111304
LO
U �
98.8 fl
93.8 L
85.8
99.5 >
N n U) ch
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Original &
Finished
Grade
1,250 Gallon
Septic Tank
X4.2 94.0
/99.5
Finished Grade .(
Page 3 of 3
PID No. 018-281-26
ind----------------
Geotextile Fabric
Drainfield Rock
47'(Trench Length)
PROFILE AS -BUILT -
No Scale
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97
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93.8
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No Groundwater
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ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 FAX
December 7, 2011
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Lot 2, Maxwell Subdivision
Separation Distance Waiver
Absorption Trench to Lot Line
Dear On Site Services Engineer:
A second absorption system was recently placed on Lot 2, Maxwell Subdivision. It was
not possible to maintain 16' separation from the existing absorption trench and still have
the required 10' separation from a short section of the lot line. The trench is less than
10' from the lot line for a distance of X The trench does not impact the property to
the northwest as the absorption trench on this lot is more than 75' away from the new
trench allowing sufficient room for an upgrade. We recommend a waiver be issued
allowing the trench to remain 5' from the northwest property line.
Sincerely,
"'" i
Michael E. Anderson, P.E.
��� •�1
••• P�E
OF
..............
49th _
n ;•MICHAEL E• ANDERSON �
•• NO. CE -4381 •'
41
,♦♦�444. R0F ESS\ NPi��••
Mun-icipality of Anchorage
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Division
On -Site Water and Wastewater Program
* * * * VARIANCE/WAIVER REVIEW
Waiver#: osp11349
PID#: 018-281-26
COSA#: osc111473 Permit#: osp111304
Legal Description: Maxell Lot 2
Engineer: Anderson Engineering
Applicant: James Seccombe
�1ent
�O `Sr
A r
t)epar tIII ent
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 5.0 feet.
This waiver approval applies to the existing 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.
❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
® Notarized letter(s) of nonobjection have been received from the owner(s) of the affected
adjacent property.
❑ Adjacent properties are not affected by this waiver.
............................................... ■ ............................. ■ ■
Waiver is Granted: X
Date:
Waiver is not Granted:
Approved by:
Name of Reviewer
...............................................................................
Rec#: 08327G Amount: $200.00 Date Paid: 12/7/11
**** VARIAN C E/WAIVER REVIEW ****
Municipality of Anchorage
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 0 (907) 343-7904 • Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Division
On -Site Water and Wastewater Program
* * * * VARIANCEIWAIVER REVIEW
Waiver#: osp11349
PID#: 018-281-26
COSA#: osc111473 Permit#: osp111304
Legal Description: Maxell Lot 2
Engineer: Anderson Engineering
Applicant: James Seccombe
n,enr S'
a �
Department
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 5.0 feet.
This waiver approval applies to the existing 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.
❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
® Notarized letter(s) of nonobjection have been received from the owner(s) of the affected
adjacent property.
❑ Adjacent properties are not affected by this waiver.
...............................................................................
Waiver is Granted: X
Date:
Waiver is not Granted:
Approved by:
Name of Reviewer
...............................................................................
Rec#: 08327G Amount: $200.00 Date Paid: 12/7/11
**** VARIAN C E/WAIVER REVIEW ****
To: Joseph Pennebaker, Affected Property Owner Adjacent to Lot 2, Maxwell
Subdivision
Subject: Waiver Notification
To Whom It May Concern:
The Municipality of Anchorage On-site Water & Wastewater Program (On-site)
regulates private drinking water wells and septic systems for single family
residences in accordance with Anchorage Municipal Code (AMC) Chapters 15.55
and 15.65. The Chapters include minimum separation distance requirements for
private drinking water wells and septic systems. The requirements represent a
conservative approach to protecting public health. Occasionally, the construction
or upgrade of a property's well or septic system cannot be accomplished without
reducing the code required separation distances. In these situations, a waiver to
the required separation distance may be approved if an Alaska licensed civil
engineer can successfully show that the public health will be maintained.
The code requires an absorption trench to be located a minimum of 10 feet from
any lot line. The subject property owner's engineer has formally requested a
waiver be granted to allow the absorption trench to be 5 feet from the lot line
located on Lot 1, Maxwell Subdivision. On-site has reviewed the engineer's
request and supporting documents, and is satisfied that the public health will be
maintained with the reduced separation distance. A waiver approving the
requested separation distance will be issued in accordance with the code.
AMC 15.65.140 requires all adjacent property owners be notified seven (7) days
prior to issuing a separation distance waiver. This letter and a copy of the have
been sent to you in accordance with this requirement.
I have read the above and have no objection to granting the waiver allowing
the absorption trench to be within 5' of my property line.
NOTARY .�
:. pugLlC r ,
Date:
ao—
Notary Certification:
ash l . �e L1v� e LCA55'
vim- i �1
r
vv - e�
On -Site Wastewater Disposal System Permit
:S'
MUNICIPALITY OF ANCHORAGE
Development Services Department'
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP111304
Tax Code Number: 01828126000
Work Type: Septic Upgrade
Permit Effective Dates: October 25, 2011 to October 24, 2012
Design Engineer: ANDERSON ENGINEERING
Subdivision: MAXWELL
Site Legal Address: MAXWELL LT 2 G:3135
Owner/Address: SECCOMBE JAMES C III &
PAMELA S 14841 LOC LOMAN LN ANCHORAGE AK 995164030
Site Mailing Address: 14841 LOC LOMAN LN, Anchorage Lot Size in Sq Ft: 47507
Total Bedrooms: 4
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Special Provisions: Prior To Construction: The test hole shall be deepened to 18 feet to verify the
absence of bedrock. Submit results with the final inspection report.
Received By:
I 2_-i_ - -"l1
Issued B L jDate:
:
By i f
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
Mayor Dan Sullivan
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D.: 018-281-26
Property owner(s): James & Pamela Seccombe Day phone: 748-2886
Mailing address: 14841 Loc Loman Lane Anchorage, AK 99516
Site address: Same
Legal description (Sub'd., Block & Lot): Maxwell Subdivision, Lot 2
Legal description (Township, Range & Section)
Lot Size: 47,507 Sq. Ft. Number of Bedrooms: Four (4)
THIS APPLICATION IS FOR:
THIS APPLICATION IS AN:
(® all that apply)
Initial E]Absorption
Field
X
Septic Tank
X
Upgrade X
Holding Tank
❑
Renewal ❑
Privy
❑
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
yy�(f ctc'�
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)
rmi ush Fees: 7
a e of Payment: iv
Receipt Number: v��1 Cry
Permit No.
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
C:\Users\And Eng\Desktop\Mike\Maxwell\Permit Application.docC:\Users\AndEng\Desktop\Mike\Maxwell\Permit Application.doc
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
October 19, 2011
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 Elmore Road
Anchorage, AK 99519-6650
Subject: Lot 2, Maxwell Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The existing absorption system on the subject lot has failed and must be upgraded.
We are therefore requesting a permit be issued for the upgrade of the septic system to
accommodate the four-bedroom home on the lot. The attached Site Plan and backup
documentation identify the location and configuration of the existing and proposed
septic system. The existing 1,250 Gallon Septic Tank will decommissioned in
accordance with Municipal Code and replaced with a new tank. The existing absorption
trench will be left intact and tied to the new system with a flow diverter valve. Also
identified on the plans are the locations of the existing well on this and adjacent lots and
adjacent septic systems. No conflicts exist between the proposed septic system and
the wells on this or adjacent lots. Protective radii are shown to the adjacent wells.
Drainage arrows are shown indicating the current drainage patterns. The drainage
patterns will be maintained after construction.
The test hole placed on the lot indicated silty gravel (GM) to the bottom of the test hole.
The percolation rate was determined to be less than 15 minutes per inch. We have
designed the new trench with an application rate of .8 gallons per date per square foot.
We are proposing to place a 47' long trench by 3' wide with a 8' effective depth. The
total depth of the system will be 12' with the distribution line at 4' below the existing
surface. The test hole will be deepened to 18' to verify the absence of bedrock. The
well on the lot was drilled to 150' with no bedrock present. If conditions are found to be
different than anticipated a change order will be submitted with a new design for the
trench.
The ground surface on the lot slopes slightly to the southwest in the area of the
Lot 2, Maxwell
October 19, 2011
Page Two
absorption trench. The trench will be placed parallel to the contours of the ground as
much as possible and in conformance with design criteria. A minimum of 100' will be
maintained between all components of the septic system and the proposed well and
from any surface water in the area.
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
in the area or those to be constructed in the future.
2. 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.
3. 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.
4. 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
PROFESS\ON=��.
W
z
Q
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2006-171 /�-----�\
MAXWELL SUBDIVISION ,�'
LOT 2
47,507 S.F.
N 90'00'00"E 135.00'
v 0 :
O Existing Well
O
M CN
O
Li F.
N �
N
0
z
ur Bedr
/ Home
NOTE
w
0
0
N
O
O
z
f
Existing Well g
I
1 x
\ x
\ LOT 1
O\
h^O
47' Long x 3' Wide
x 8' Effective Depth
Absorption Trench yr
® r
Np?ion ExistiAbso
Trench
N 89'59'35"E 299.72'
No Areas of Excessive
Slope or Surface Water
are Within 100' of Any
Part of the New Septic
System.
of SCOPE OF WORK
Decommission Existing Septic Tank in
Accordance with Municipal Code.
Place New 1,250 Gallon Septic Tank.
ry/ Place Two Post Tank Cleanouts and
! Flow Diverter Valve. Construct 47'
Long x 3' Wide x 8' Effective Depth
Absorption Trench. Tie in Existing
Trench for Future Use.
SITE PLAN
SCALE 1" = 50'
LEGEND
SV —
Septic Vent
CO —
Clean Out
MT —
Monitor Tube
TH —
Test Hole
FDV
— Flow Diverter
Valve
LOT 2, MAXWELL SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Four Bedroom Home Deep Trench System
Perc. Rate: 6-15 Min./Inch 1,250 Gallon Septic Tank - Replace Existing
Application Rate: .8 GPD/SF 8' Drainfield Rock
4 Bedrooms * 150 GPD/Bedroom = 600 GPD Design Volume
600 GPD/.8 GPD/SF/16 SF/LF = 46.875 LF Trench Length
THEREFORE: Construct a 47' Long x 3' Wide x 8' Effective Depth Absorption Trench.
Flow Line Elevation in Trench to be 4' Below Original Ground Surface. Total Depth to be
12' Below Existing Ground. Provide 3' Cover Over Absorption Trench and 4' Cover Over
Septic Tank. Place Flow Diverter Valve and Connect Existing Absorption Trench for Future Use.
3'
TYPICAL DEEP TRENCH SECTION
(NO SCALE)
NOTE: Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 4' Separation From Groundwater.
Minimum 100' Separation From Private Wells in the Area.
Minimum 100' Separation From Surface Water or Streams.
49th
.........................�...�..�
MICHAEL E. ANDERSON
�j :
S O No CE -4381
,•••����. �FESS��Pi
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650
DEPTH
(feet)
1-
2-
3-
4-
5-
6-
7-
8-
9-
10-
11
12-
13-
14-
15-
16-
17-
18-
19 -
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT 2, MAXWELL
PERFORMED FOR: JAMES SECCOMBE
DATE: 10/15/2011 PROJECT No.:
PARCEL ID#: TECHNICIAN: M. ANDERSON
TEST HOLE A
lj f
a SILTY GRAVEL
d WITH SAND
GM
a
0
SLOPE
N
o°
a
49th
......................
MICHAEL E. ANDERSON : IQ
ff' NO. CE -4381
,•��ti. ROFESS�••i
SITE PLAN
SEE SITE PLAN
x
U
a WAS GROUND WATER ENCOUNTERED? NO
IF YES @ WHAT DEPTH? S
DEPTH OF WATER AFTER MONITORING: NONE O 2%
a DATE OF MONITORING: 10/19/2011 P
E
a
a
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH To
WATER
(INCHES)
NET DROP
(INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
10/1
1
1:24
2.00"
2
1:54
30
4.25"
2.25"
3
1:55
2.13"
4
2:25
30
4.25"
2.12"
5
2:26
2.25"
6
2:56
30
4.38"
2.13"
PERCOLATION RATE: 14 (MIN/INCH) PERC. HOLE DIA. 811
(INCHES)
TEST RUN BETWEEN: 4.5 FT. and 5.5 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST. SOILS VERIFICATION SAME AS GARNESS TEST HOLE.
TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 1011712011
{° \ SO( OG
• VbNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION � PERCOLATION
• $25 L. Sire". Anehorago. Alaska 99501 264.4720 TEST
SOILS LOG - PERCOLATION TEST
mw 5x85 -0V
�0
PERFORMED FOR: DATE PERFORMED:_SJL� �.
LEGAL DESCRIPTION:
MA.
1
. .
z • s C -4p -5P
3 •_+0 jWs$;4.1 broom
i
4
5 •.
6-
7 7
..
.= n
8
9
10
11 WAS GROUND WATER
ENCOUNTERED?
l7
IF YES. AT WHAT
DEPTH?
13
PERCOLATION RATE .:• •••:a;.(jnlwiwit/inch)
14
-
-
15
OF AX11
•a.•i•A.•
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K •... ••
17
mmmmm�
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SITE
.■■■■.■■■■
! m.-m..■m•,
■ONES-mmum■
■ ■ ■■ ■ ■■ ■ ■ ■
==mm
PERCOLATION RATE .:• •••:a;.(jnlwiwit/inch)
-
-
•FT••�
mmmm
•a.•i•A.•
mmmmm�
mmmmm�
mmmm��
mmmmm
.•� �; • I•• .0.: .
PERCOLATION RATE .:• •••:a;.(jnlwiwit/inch)
TEST RUN BETWEEN fT ANq—
•FT••�
L
• t- Lam' ��
•a.•i•A.•
PERFORMED BY:l� ' f �Jj�]OJy CERTIFIED BY.: •DATE: '
72-008
!,+ or: Y'
r
LOCATION OF WELL (Please complete either laj lb or IC.)
�. WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological a Geophysical Surveys
Drilling Permit No.
A.D.L. No.
1/44tr•• Section No. 70.4•hipN13 pool* Ecl Meridian
la. eafough -Subdivision Lot Block F.f—of—of-
Anch kltaxvel2I
1 3 13 WE]
DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS
E-31
S. OWNER OF WELLS
)tail Rcese
Address: SRA Box S49nL
81+01/ LoJc---- Lane
Street Address and Area of well Location
A^(tAs!
Fast Bator
z. WELL Los eel 0 1
4. WENEPT,!(finall
((jj
S.�ATE Of COMPLETIINN7
Q�
Material Type Top Bottom
gravel -hard rocky 0 25
6. C] Cable tool 'win Rotary O Driven C] Dug
❑ Auger Qdetled p eared p other:
sandy -hard little gravel rocl y 2
silty sant:-cobble: 45 85
7.USEX5 Domestic 0 Public Supply ❑ todu•Ity
C) (rrigarlon 0 Reeherge p commerical
D Taut Wali O Other=
gravely hard ,and 85 98
tight gravel seepage 98 118
1001 seepage
B. CASING: 0 Threaded YG Welded
did., 6 1.. to150 tt. Depth weight 1_�_ �_% Ibsps.
diom. In. la ff. Depth Sllckup It.
11.5— 1 1 4 _gpm
hard silty clay deriented gra el 11Z 134
gravel Mandy 11gpm 1120 134 137
9. FINISH OF WELL:
gra & boulders T3 1
pan
Type: Diameter+
Slot/Meeh SI:e: L•nglh:
Sat between ft. and ft.
Backfilling Gravel pock
role harC W.11 ionsusii?—Uifti,
1120 7 C111`1
ArG1i0e•4G
CE4T. OF'R,.
10. STATIC WATER LEVEL: / / fl. 7 12
Above or R Seto. land surface Dote
Equipment used:
n [�i
N
11 . PUMPING LEVEL below land surface end YIELD
ft. efter hrs. pumping 9
`
�
g.p,+n•
It at-*, kit puwp:og t 0 0
tr.sleouTlr.a 10.11 glevito Q ves n%*
Materiel: o Nttt 6em.nt O Other:
• I
• I
1.3. PUMP: (it available) HP
Length of Drop Pipe It. copocity
D subm. 0401 0 centrifical O Other
14. REMARKS:
16. WATER WELL CONTRACTORS CERTIFICATION:
IS. Water Temperature a OF 0 C
This well was drilled under my jurisdiction and this report Is time 10 Inc best
of my knowledge and belief;
tlacka Note-1'lell-Verne c Drilling & Tit
�3�2?N
Registered Business Nome Conlr Lle ns• `7
Ad4re►s:1 2241 1lvion, SRA Box 1560 Anchorage, ��YaM�tu l y `
signed, l
Dots: 7- Z3 - k 3
Authorized Representative
Form 02-WWR (11/e1) Copy Ditlribution: WHITE -State DOGS. PINK -Driller. CANARY-Cusfemsr
C
4
C
s
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 2, MAXWELL SUBDIVISION
GENERAL:
The scope of this project includes the decommissioning of the existing
1,250 -gallon septic tank on the lot in accordance with Municipal Code and
replacement with a new 1,250 -gallon steel septic tank. Work also includes
the construction of a new 47' long X 3' wide X 8' effective depth absorption
trench at the location also shown on the Site Plan. The distribution line in the
trench will be placed at 4' below the existing ground surface. Total depth of
the trench will be 12' below the existing ground surface. The new absorption
trench and septic tank must be placed a minimum of 100' from all private
wells and any surface water in the area and 10' from the water service line on
the lot. A minimum of 3' of cover is required over the absorption trench and
4' of cover over the septic tank. A flow diverter valve must be placed and the
existing absorption trench tied in for possible future use.
2. Construction shall be in accordance with the approved site plan, design
drawings, Municipal Permit with any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal Regulations.
3. The Contractor shall be responsible for obtaining all underground utility
locates and for the layout of the septic system and verification of the location
of all lot lines. The Contractor must also verify the location of wells in the
area and assure that the separation distances are met.
4. Unless specifically agreed otherwise, the contractor shall be responsible for
final grading areas subsequently depressed from soil settling. Property
owner shall be responsible for revegetation of affected areas unless
specifically agreed otherwise.
5. Contractors installing wastewater
Municipal Building Safety Division
for system installations. Owners
prior approval from the On -Site
beginning system installation.
SEPTIC TANK INSTALLATION
disposal systems must be certified by the
On -Site Water and Wastewater Program
installing their own systems must receive
Water and Wastewater Program. before
A new 1,250 -gallon septic tank must be procured from an approved source
and installed at the location shown.
Lot 2, Maxwell
October 19, 2011
Page 2 of 3
2. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
3. The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
4. All standpipes on the septic tank shall extend a minimum of 12 inches above
final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial
insulation.
6. A foundation cleanout shall be installed one to four feet from the building
foundation. Two cleanouts are required between the tank and the drainfield.
7. Final grading over the tank shall be such that a positive slope exists away
from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown on the design.
The bottom of the trench shall be within 2" of level.
2. Distribution piping must be placed level with perforations down atop a level
bed of drainfield rock. Rock should then be placed over the pipe to provide a
minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between the drainfield rock
and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the locations shown on
the design. The portion below the distribution line must be perforated.
5. Contractor shall verify the septic tank and drainfield are a minimum 100' away
from any private water wells in the area, 150' from a Class "C" Well or 200'
from any community well.
6. Direct bury insulation must be placed over the distribution system if less than
3' of backfill depth is available. Finish grade over the trench must be
mounded to prevent settlement or depressions.
7. Grade area surrounding the absorption trench to drain away.
8. A minimum 2' of accepting soil is required below the drainfield rock for a 5'
wide trench. All pockets of unacceptable materials must be removed and
replaced.
Lot 2, Maxwell
October 19, 2011
Page 3 of 3
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a municipally approved septic tank
manufacturer.
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and
solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662
or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow
Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Fernco, or equal).
5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed
between the final drain rock layer and the native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the
#200 sieve.
INSPECTIONS:
Municipal Ordinance requires a minimum of two inspections. These inspections
must be conducted under the supervision of a professional engineer registered
in the State of Alaska. The first inspection must be conducted after the
excavation of trenches, beds or pits and before the installation of any gravel. A
septic tank may be set in place, but may not be backfilled.
The second inspection must be conducted after the placement of the geotextile
fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No
backfill should be in place at the time of inspection.
Contractor shall provide a copy of all field survey layout and construction notes
for use in preparing the certified as -built of the completed system.
1
n MUNICIPALITY OF ANCHORAGE ("N
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street • Anchorage, Alaska 99501 Telephone 264-4720
ONSITE
SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION
REPORT
NAME
PHONE
W NEW
r
PIi ✓I
tefe
271x27/
❑UPGRADE
MAILING ADDRESS
d
-06-4
r
LEGAL DESCRIPTION
tot 2 fllocA'
LL
61 I'10)1tyell u lJL�iv7'l %On
LOCATION
loc lom d„
Or
NO. OF BEDROOMS
DISTANCE TO:
Well
nO%L ih
Absorpbonarea 0
6
Dwelling
6.T
PERMIT NO6302'77Ole
Manufacturer
Material MaterialS�PP/
No. of compartments 2
LLiq,cap
cityiallons
IF HOMEMADE:
Inside length
Width
Liquid depth
DISTANCE TO:Well
Dwelling
PERMIT NO.
Manufacturer
Material
Liquid capacity in gallons
a
-0
DISTANCE TO:
WellL
Foundation
2 2 S
Nearest lot line n 7
PERMIT NO
/
h C! h
7
02
J LL Z
No. of lines
l
Length of each line
Total length of lines A
Trench widt
JO
Distance between linpy
F: Z W
Z
inches
CC
a
Top of tile to finish gradeTotal
if,— V
Material beneath tile
72inche,
effective absor tion area
674 02
Length
Width
Depth
PERMIT NO.
W
<I—
Type of crib
Crib diameter
Crib depth
Total effective absorption
area
wd
to
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
W
i
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area (s)
OTHER
Lrf
PIPE MATERIALS c C �
N
V
SOIL TEST RATING
15-0 ft z
r
r
INSTALLER r 11 [ Q
Ex P63-072
Q e
veLos
REMARKS
Lehi,le
Icc ai7'oh reguired n
J
I
;
VAE
i If Ilev One/ rrh A r
APPROVED
DATE LEGAL
-10-83 Lai 2 block $ &1 ke
72-013 1Rev. 3/78)
MUr4I C I FAL I TY OF= ArdCHC1Fz�RGE
DEPARTMENT 0F. HEALTH AND ENVIRONMENTAL �FOTECTION
_ 825 '( `STREET. ANCHORAGE. AK. 95 1
► 264-4720
44ELL Ar4E> Oro—SITE SEWEFZ F='EFRM I T
PERMIT NO. C 830297 >
APPLICANT J.NEIL REESE SPA BOX 1508-A ANCH. 271-5276
LOCATION
LEGAL LOT 2 MAXWELL SUB LOT SIZE 999999 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING CSO FT/BP,)= 283
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
E>E:FsTH= 11. 5 LErJGTH= S1 C3FRnVE1L ©EF}TH= -7. 5
THE LENGTH DIMENSION
THE DEPTH OF A TRENCH
GROUND AND THE BOTTOM
THERE IS NO SET WIDTH
THE GRAVEL DEPTH IS TI
AND THE BOTTOM OF THE
IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD.
OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
OF THE EXCAVATION CIN FEET).
FOR TRENCHES.
AE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
EXCAVATION CIN FEET).
FZE:QU I FRES SEF}T I C TF hINK SIZE= 1250 GALL-(D"S;
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
--- TWO C 2] I r-JSF}EGT I C31r-4S AFZE FZEGEU I FZED>
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F}EFRM I T EZXF} I FRES ©EC3Er1ES'EFZ :3:1.. 1Eo82:
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
1: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
SIGNE[
ISSUE[
V4. 0
SOI( OG
MbNICIPALITY OF ANCHORAGE I
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION O PERCOLATION
825 L. Sires. Anchor"., Alnka 99501 2643720 TEST
SOILS LOG — PERCOLATION TEST
4mw 5r 83-00-1
PERFORMED FOR: f tlm] U!Z ri[[ -[� A�n DATE PERFORMED: (O.`7 fg$
LEGAL DESCRIPTION: ,/'T�► s�,t ��IS>� l.Q,}'p� S1[ 72PN x
( 1
r� SLOPE SITE PLAN
—t— 11 1 1 1 1 -
1
2 � or P -5P s ed
oe n
4-'
; 3
10 -.06
6
7
8 C71�1
9
10
i l WAS GROUND WATER
ENCOUNTERED)
12
IF YES, AT WHAT
13 DEPTH?
14
is r OF Akq�1I
P, ,..•......., S,� �I
16 co e
Ir_fY H i�
Roid,
l roy ,
s•• - . 2251•E
19
i PROFESS\.! �
in
==mmm�i
-_____
______i
m_____
-_____
m__m__
.•i C' i �i.r �
l' PERCOLATION RATE /.•,•••'a�.(InInill Rfinch)
TEST RUN BETWEEN ' •�fT AN •'F7•••
COMMENTS i_L ;�!1'. c_ / •,,,•t••
V•�
PERFORMED BY:-�Potnaf 1[LIIFir1oA CERTIFIED BV•.' DATE: _
72-006 (6/79) �•f,i�:JJi�•'\'�'�
n n 6 SOILS LOG ;
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PK PERCOLATION
(I TEST
� 825 L. Street, Anchorage, Alaska 99501 2644720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: 1 ' zi I -SP. 1 DATE PERFORMED: L41 �1 3
1 IIAf/�`,
LEGAL DESCRIPTION: �� II 5uhdiyi-siov� 1 t Lo� F—
eP H OL
1
L.
2 brou3n=Uh�ra}ed
pluShc, stl�
3
4
Date
Gross
TimeTime
Net
Depth to
Water
5
+HZO
N�21Ik3
io
ML rey Silt �eLo
716
r 10
vets
s
No
10.43
10
.(0
, oy
8-
0:43
l02
9-
s1011
lo' 43
10
Ioe5
10-
1u�53
11
1
i-f7
12-
21314
�5
2o
13-
.1111
+Hzt]
14-
I1'. o3
: t'S
t 0
Ito11
.I2
. oy
15
15
16
17-
71819
18-
19
20
SITE PLAN
WAS GROUND WATER ^1 L
ENCOUNTERED? IV O
P
IF YES, AT WHAT — E
DEPTH?
(nth, d VIAa
Reading
Date
Gross
TimeTime
Net
Depth to
Water
Net
Drop
+HZO
N�21Ik3
io
1�
716
r 10
33
No
10.43
10
.(0
, oy
0:43
l02
+1ln2()
lo' 43
10
Ioe5
03S
1u�53
1
i-f7
'\
Il)
�5
2o
11:03
.1111
+Hzt]
I1'. o3
: t'S
t 0
Ito11
.I2
. oy
+HZO 5*6. i3 43 IU 133 . oy
PERCOLATION RATE '� (minuteslincfil
TEST RUN BETWEEN . — 6 FT AND FT
PERFORMED BY: C YiQ ii iI e -!;I 6Y -\50t1 CERTIFIED
72008 (6/79)
DATE: � — � �'
n WATER WELL RECORD
STATE OF ALASKA
.- DEPARTMENT OF NATURAL RESOURES
I Division of Geological a Geophysical Surveys
Drilling permit No.
LOCATION OF WELL (Plea.* complete either Is, Ib 0r Ic.) A.D.L. No.
Io. Borough Subdivides LotBI*Ck In. y4 afte. Section No. To.nsnipNO Range E❑ Meridian
1
Ai faxwell 2—af—of—ef— a w❑
1c. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL:
• Pfeil Rcesc
Address: SRA Box SY10L
fYeq/ Let.10 t ^ L4"c-
Street Address end Area .f Well Location A/a L14 eY 4
2. WELL LOG
Fest B•Iow
Set
Sae•
4. WE; }6EPT" (final)
77u
3.•..QATE OF COMPLETIgf�
(
Material Type
Top Bottom
gravel -hard rocky
0 25 1
6, ❑cable tool dinflotary ❑Driven C] Dug
❑Auger ❑Jolted ❑Bared ❑other:
candy -hard little rravel rocly
2
silty sand -cobbles
45 85
7.USE`(] Domestic ❑ Public Supply ❑ Induslry
❑ litigation ❑ Recharge ❑ commerical
❑ Test Wait ❑ other:
grave 1y hard sand
85 98
tight gravel seepage
98 118
1001 seepage
s. CASING: ❑ Th1r�ea/d�ed Ya Welded
did., 6 n. to ft. Depth Weight —42me./ft,
diom, In. to_ ft. Depth SNckep It.
11 —11 4_gpm
hard silty clay demented gral
el 1 T9 134
sandy 1+gpM 1120
134 137
gravel
9. FINISH OF WELL:
y'
Type:[' Diameter:
///
Slot/Mesh sl:•: Length:
set between ft. and It.
Backfilling Graaf pats
and pan & boulders
13 1
ro):n ar i chews
+ ( >
I120 9 GYI'1
AKCHO"ko
h
CEPT. Of
Olk
10. STATIC WATER LEVEL: /h/ fl. 7 12 gz
ENVIRON "
❑ Above or R Belo. land surface Oct*
L }yG J
Equipment used: t/,L.1
{� [
11 . PUMPING LEVEL below fond surface god YIELD
n. ever pumping 9 9 I m.
_n...
it ane. _ft's eump:wp_tpm
IE.6ROUTINa 0.11 ars.ba ❑Yo ref.
Mesial: Onset Cement C]Olher:
. 1' _ I
l
Is. PUMP: (if available) HP
Length of Drop Pipe ft. capacity 0. p. m.
❑ Subm. ❑ Jet ❑ centrifieal O Other
14.REMARKS:
16. WATER WELL CONTRACTOR'S CERTIFICATION:
15. Wafer Temperature _a ❑ F ❑ C
This call was drilled Under my )uilsglcllon and this report It true to toe best of my knowledge and ballet;
Alaska Nor:-C/oll-Vern's Drilling & Ent nn3 7
Registered Business Nom•Contr LIc n1.
Addrae:12241 Avion, SRA Box 1560 Anchorage, RYasfca j
signed:% Date'
Authortr'.. pr*sentallre
Form 02•WWR(11/8I) Copy Dielri0ution: WHITE'Btate DGGS. PINK-0r1IIer. CANARY'Catgmu
n
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES 0 � 4f
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date 0-0. % F
1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
!_ n 7- 2 /fax 11 .s/-( -C.0 _r 3'f. Ted
Location (address or directions)
lLlS `II I- Cc,Lcwre,rt
(b) Property Owner r►^J!4"-n � X9[ C Telephone: Home I ;- �� Si z Business
Mailing Address Y�
(c) Lending Institution
Mailing
Telephone
(d) Real Estate Company and Agent 'rn t UL'M
Address S'4 010 0CLA3 Z1 0-r 2910-7
0 -7
(e)
Telephone
Mail the HAA to the following address: or: Check here if hold for pick up.
List contact person and day phone number below.
2.7 4 -31 L2
2. TYPE OF RESIDENCE
Single -Family,
Number of Bedrooms
3. WATER SUPPLY
Individual Well Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite Public ❑ Community ❑ Holding Tank [7
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 Ina, e -e61 Flom
roue rsere •+ar sco-te i )o Z abed
•NLom siaaul6ua
leuolssa)ad ayi ul suolsslwo Lo sioua zol elglsuodsal lou sl 86e%0yauy )o Apledlolunyy ay1 panssl sl aleolllUao a a%olaq
elep azAleue jo suoiloadsul,onpuoo lou op SHHO )o saaAoldw3 •sivawaimbai alels pue leLapal uieuao Alslles of iapjo
ul suollnl 1sul 6ulpual ilayl pue sawo14)o sLaseyoLnd of Asaynoo a se siyl saop SHHO 8141 •e�lsely to alelS 8141 ul paialsl6al
La3ul6ua leuolssalad luapuadapul up Aq anoge S ydeAcied ul uaAi6 suopeluasa%da1 8141 uodn Aluo paseq saleoy!Uao
lenaddy Al!joyiny yyeaH sanss! (SHHO) saolAiaS uewnH pue ylleaFl )o luawUedaO e6eLo14ouy )o Al!ledlolunyy ey1
NOunVo
lenaddy Ieuo!l!PuoO )o swial
leuolilpuo0 panwddnici --�— panaddy
�_ ale0ZPV 1 7P7Aq swoapaq Jo) panaddy
1VAOtlddV SHHO '9
r"- TL61 'S'31'
3 SZZZ ' r
leas s,i9aul6u3
\. `
ale0
kosl"Cl f7I p ssaLppV
' b auoydalal wily )o aweN
• u0113a Sul slyi )o alep ayi
uo loal)a ul suolleln6al pue •saoueulpLo'sapoo olelS pue ledlolunyy lie Llpm eouelldwoo ul sl walsAs lesodslp jalemalsem
jo/pue Alddns %alem ails-uo ayi 'uolioadsul pue uope6psanul Aw wal pue sal!) o6eLoyouV )o Ailledlolunyy ayi wo11
paulelgo uollewjolul ayi uo paseq leyl Apm jayvn) I •ulaja14 paleolpul oinloruls )o adAl pue swoapaq )o iagwnu eyi iol
alenbape pue leuoliounl'ales Si walsAs lesodslp lalemaisem Lo/pue Alddns La1em ells-uo ayi ie141 SM04S lenaddy Aluoyiny
41leaH s!yl to u01ie6lts9nul Aw leyi A)IIaA I'molaq UMOyS alep uollepgeA 8,41 10 se pue olaiay poxllle leas Aw Aq paipliao sy
NOIIVWHOyNi CNV V1VC'HOtlV3S 3liy'S1S31'SN01103dSNi ONIOIAOtld WHid E)Nltl33NIJN3 'S
• Municipality of Anchorage V �PG a fo
On -Site Water and Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 018-281-26
1. GENERAL INFORMATION
Complete legal description Maxwell Lot 2
Expiration Date: 3- 1-7- Zd 22—
Location (site address) 14841 Loc Loman Ln, Anchorage. AK 99516 __
Current Property owner(s) Michael Jolin & Marie Kathiio ___. Day phone
Mailing address
Real Estate Agent
14841 Loc Loman Ln, Anchorage AK 99516
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Individual Well
N
Individual Water Storage
❑
Community Class _ Well
❑
Public Water System
❑
WaiverNariance request for:
Received by:
4
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual
Holding Tank
❑
Community
❑
Public Sewer
❑
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $ 5 5 O Waiver Fee $ _
Date of Payment Date of Payment
Receipt Number 0 9 '?5 8 Receipt Number
COSA # OS C a 11'7 1 Y Waiver #
istance:
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 ARCTERRA CONSULTING, INC. Phone 696-6111
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date % 1 -
Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition
of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface
conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate
during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are
subject to these various and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen OF 14 \
encroachments, deficiencies or discrepancies exist.
6. DSD SIGNATURE
System #1 Approved for bedrooms.
System #2 Approved for bedrooms.
Disapproved.
KENNETH �: J�iI�FUS 0(
% 711In—
—`
\� ,s
Conditional approval for _ bedrooms, with the following stipulations:
0
J
J
NLITY p_'76i__
i
By: Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineers work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 10-10-12.doc
COSA Checklist
Legal Description: Maxwell Lot 2 Parcel ID: 018-281-26
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled 7/23/83
Total depth 150 ft
Cased to 150 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 30 in.
Date of flow test for COSA 12/15/21
Static water level at beginning of test 104 ft.
Comments
B. TANK DATA
Age of tank(s) 10 years
Tank type/material Septic/Steel
Measured operating fluid level in septic tank 49"
Standpipes/foundation cleanout per record drawing
Date of pumping 11/8/21
D. ABSORPTION FIELD DATA
Well production at time of test 4.5 gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes Nc
Coliform bacteria is Negative
Nitrate 3.52 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Areterra Consulting
Date of Sample 12/7/21
C. LIFT STATION
ired maintenance completed
Age of lift std years
Lift station material`
Comments:
Which system tested (date installed) 10/28/11
Adequacy test date 12/15/21
ALL standpipes present per record drawing
Results ❑✓ Pass For 4 bedrooms
Total measured depth from grade 12-13 ft (max)
Fluid depth prior to test 61 in
Measured depth to pipe invert from grade 4-5 ft (min)
Water added 600 gal
❑ N/A — pressurized field
New depth 69 in
Monitor tubes go to bottom of effective. If not, state
Elapsed time 300 min
depth into effective
Code -required soil cover over field
Final fluid depth 61 in
❑ System presoaked
Absorption rate 600+ gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months)
date of test)
Gallons introduced gallons
If yes, enter date
Comments/Deficiencies:
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'
❑ Yes
if No 5+*
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
® Yes
if No ft
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25'5Z Yes
if No ft
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No ft
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' ® Yes
if No ft
® Yes
if No
ft
ft
If septic tank is under driveway
comment below
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ® Yes
if No
ft
® Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
❑ Yes
if No 5+*
ft
Surface Water > 100'
® Yes if No ft
Property Line > 5'
® Yes
if No
ft
Wells on Adjacent Lots:
® Yes
Absorption Field > 5'
® Yes
if No
ft
Private Wells > 100'
® Yes if No ft
Water Main > 10'
Yes
if No
ft
Community Wells > 200'
'Yes if No ft
Water Service Line > 10'
® 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 5**
ft
If absorption field is under driveway comment below
Property Line > 10'
❑ Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft
Private Wells > 100' ® Yes if No ft
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No ft
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
*Tank 5'+ from foundation meet code at time of install. ** Waiver OSP11349 granted 12/7/11
G. ENGINEER'S CERTIFICATION
I certify that l 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
OF PhCH W'%0VA ;
Mut.11G1PE� P,,SERVlOES MUNICIPALITY OF ANCHORAGE (MOA)
E�lRO HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984.
2644744
Legal Description: Le> T 4Z r )I A y W O LL
RGI. SEG 3� . T_ , aL.1 jz3Ur/
A. WELL DATA
Well Classification ' 1Z ES It A. B, C, D.E.C. Approved (Y/N) N�iAr
Well Log Present (Y/N) y - Date Completed 7'4 3 • R'3 Yield 1 per.
Total Depth f 50 Cased to Depth of Grouting NON C
Static Water Level (13 Pump Set At •FSoTTo H
•
Casing Height Above Ground sv0 Sanitary Seal on Casing (Y/N) y
Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N)
Separation Distances from Well
To Septic/Holding Tank on Lot (C Q ; On Adjoining Lots ) 10 f
To Nearest Edge of Absorption Field on Lot 110 * ; On Adjoining Lots f no t
To Nearest Public Sewer Line N oNE To Nearest Public Sewer
Cleanout/Manhole No rvE To Nearest Sewer Service Line on Lot % �C
Water Sample Collected by 7-S ; Date %ZZ
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed w r 3 Size _1.2' O No. of Compartments T 1& o
Standpipes (Y/N) T It/o Air -tight Caps (Y/N) y Foundation Cleanout (Y/N) N
Depression over Tank (Y/N) N Date Last Pumped 1 L/l f 7 /64acS
Pumping/Maintenance Contract on File (Y/N) N/A ; for fY1A
Holding Tank High -Water Alarm (Y/N) WA Temporary Holding Tank Permit (Y/N) NZA
Separation Distances from Septic/Holding Tank
To Water -Supply Well ( O 2 To Building Foundation h
To Property Line 96 f To Disposal Field S
To Water Main/Service Line > iV To Stream, Pond, Lake, or Major Drainage
Course KoN4
Comments
Pagel of 2
77-M fRov 8 861 Front
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 0 Type of System Design 'Le EW#
Date Installed g 3 Length of Field 15.S
Width o1 Field 30 Depth of Field --
Gravel Bed Thickness
Square Feet of Absorption Area Standpipes Present (Y/N)N
- IAC
Depression over Field (Y/N) N Date of Last Adequacy Test —111h 7
Results of Last Adequacy Test _ "-s
tz-e �y✓ > /rOerflS
Separation Distance from Absorption Field:
To Water -Supply Well f
To Property Line 93
To Building Foundation
To Existing or Abandoned System on
Lot No N L
; On Adjoining Lots 1
To Water Main/Service Line / o
To Cutbank (if present) NO NE"
To Stream/Pond/Lake%or Major Drainage Course --
No NL '
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION • NO n/C'
Date Installed
Dimensions
Size in Gallons
Manhole/Access (Y/N)
"Pump On" Level at
"Pump Off' Level at
High Water Alarm Level at
Vent (Y/N)
Tested for
Pumping Cycles during Adequacy Test Meets MOA
Electrical Codes (Y/N)
Comments
•' Check Permitted Bedroom Rating Against HAA Request •'
Icertify that Ihave conformed to all
MOAand HAA guidelines in effect on the date of this inspection.
�c+hecked•verified,o
Signed Date
Date
Company MOA No.
Receipt No. o%0 O - O O S^
�F �tX�1
Date of Payment
d
i .� •y r
Amount: $ xd d
x"; 4c,_7r+Engineer's Seal
11
f
2225-E ...Q
Page 2 of 2
i.' nE 25. 1971 •:4�/
72.026 (Rev 81161 Bark
E ti
• n n n �N �' o n n 203 W. 15th AVE "C SUITE 203
y G LLQAD9 [PQF ANCHORAGE, ALASKA 99501
CONSULTING ENGINEER TELEPHONE: 19071 279-3916
RESIDENTIAL WELL INSPECTION
LEGAL: Lot 2, Maxwell
LOCATION: . 14841 LocLoman Lane
OWNER: ChemExce. Relocation
TYPE OF WELL: Residential, Single Family
WELL LOG AVAILABLE: Yes
INSTALLATION REQUIREMENTS MET:Yes
WELL YIELD FROM WELL LOG:
PUMP YIELD FROM TEST:
DATE OF INSPECTION:
_ ��� _tea •,o
�t.T
..........
r
9 Gallons Per Minute
6 Gallons Per Minute
December 14, 1987
TEST PROCEDURE: Well was pumped at a constant rate while the
draw down was monitored with an acoustic
probe. At the beginning of the test water level was found at 113
feet below top of casing. At a pumping rate of 6 gallons per
minute the water level dropped to 120 feet after 30 minutes of
pumping and remained at that level for the remainder of the test,
70 minutes. A total of 1000 gallons were pumped. The well
recovery was instantaneous.
TEST FOR E.COLI AND TOTAL NITROGEN: Water was tested for E.Coli
and total nitrates on December 15, 1987.
E.Coli 0. Total Nitrates 0.53 mg/1.
.Max. allowable Total Nitrates 10 mg/1.
TEST RESULTS: This well meets the requirements of the
Municipality of Anchorage.
THIS WELL WILL PRODUCE MORE THAN 3 GALLONS PER MINUTE FOR MORE
THAN FOUR HOURS
The Municipal requirement for well flow is 150 gallons of water
per bedroom per day. This well exceed this requirement. The
assessment of the condition of the well applies only to the
conditions as of the day tested. The flow rate may change due to
sub surface conditions that may not be observed from the surface,
and changes in the land use and other factors that may impact the
aquifer feeding the well.
40 203 W 15th AVE "C" SUITE
3
ANCHORAGE. ALASKA 99501
CONSULTING ENGINEER TELEPHONE: 19071 279-3916
SEPTIC SYSTEM ADEQUACY TEST
LEGAL: Lot 2, Maxwell .'�„�;.••"� �:;�;� i�
LOCATION: 14841 LOCLoman Lane * 49TH^ •••
OWNER: ChemExec. Relocation
rr :•)UNE ZS 25-
RESIDENCE: Single Family, Four Bedrooms P')
WELL: On Site `lila'^
SEPTIC SYSTEM: FROM MUNICIPAL RECORDS:
TANK:Greer Steel, 1250 Gal. Two Comp.
ABSORPTION SYSTEM: Trench
ABSORPTION AREA: 624 sq. ft.
SOIL RATING: 150
INSTALLATION DATE: October 1983
DATE OF LAST PUMPING: December 14, 1987. Isaacs Pumping
DATE OF TEST: December 16, 1987
TEST PROCEDURE: System was inspected and measured on Dec. 11,
1987. Tank was found with two feet of'cover
and 48 inches of liquid. Trench sump was 11 feet deep and had 6
inches of liquid. 150 gallons of water was added to the trench.
At this time hose and meter silted up and test was discontinued.
On December 14, 1000 gallons were added to the sump. When water
depth was checked it was discovered that the sump had been filled
with gravel and no water depth could be measured. On December 16,
the sump was excavated and replaced. A clean out was also
installed. Then 650 gallons was added—This caused a 12 inch rise
in the water depth. 15 hours later the water depth had returned
to the level prior to the test.
TEST RESULT: This system meets the code requirements of
the Health and Social Services
Department of the Municipality of Anchorage.
NOTE The operational life of all septic systems depends on the
local soil conditions, ground water levels that mayfluctuate
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 this septic system. We can therefore not give any
estimate of how long this system will function satisfactory for
current or future occupants.
APPLI(-`NT FILLS OUT UPPER HA^ ONLY
Prope(ty Owear
Time
Phone
Time
%%/
Mailing Address fY
Zip Code y —
Buyer
CXAQfLrS�{t r
Address
Zip Code
Lending Institution 5
�_ /A +
Phone
y
Inspector
Address
Zip Code
Realty Co. A Allem
Phone
Address
Zip Code
n
Legal Description (y[WL.eY S
Z
Street Location
Type of Residence
'
Single Family
LIN;; _I
❑ Multiple Family No. of Bedrooms_
❑ Other
W ater Supply
Individual
H WELL LOG. A well lop Is required for all wells drilled Since June 1975.
[Falls
❑ Community
drilled prior to that date, give well depth (attach lop If available(.
❑ Public Utility
RECEIVED.
Sewer Disposal
{r_Indlvidual
Year Individual Installed: !�
❑ Public Utility
When Connected to Public Utility:
❑ Holding Tank
( APPROVED BEDROOMS
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time II
CXAQfLrS�{t r
Date
Date
Date
Date,,
Inspector
Inspector
Inspector
Inspector
Field Notes:
Z N
LIN;; _I
dK `
RECEIVED.
1,% 1-- C .o
. 6.4zo
( APPROVED BEDROOMS
-CONDITIONS
OF APPROVAL
( ) DISAPPROVED
"-1
( ) CONDIT NAL
PPROVAL'
DATE
D
BY:04
Solis Rating
Date Sewer Installed
Well To Absorption Area. /d
Well Lop Received Q Cdr
G �1 O — 83
Well to Tank
Septic Tank Size I -, Sp
rxaxz even A E C 5
ALASKA RUIROWnTAL COnTROL SCRUICCS, InC.
Engineerinq S Enuironmental Studics
PERCOLATION TEST DATA SHEET
CLIENT Neil DATE Ll1 X83
ADDRESS
ZIP CODE Clg66 l
LEGAL LOCATION MflXwPlk 60bdlVl5iOn Tl_0+ Z
TOTAL DEPTH OF HOLE ft.
ZONE TESTED
ft TO ft
READING P
CLOCK TIME
NET TIME
DEPTH TO
DATUM
NET DROP
RATE (min/in)
+H2.0
qi1
9:31
10 rn,r1.
;:�,0
oy
+ I+,O
4;32
10 min.
1, 1V
.00
41147-
9'.52
V0 YY1i e1.
o52.
10vy1l11.
x;.-13
�2
+ R20
loos.
10:13
10 mi n
ins
.,)3
1 .00
Ill: ty
IU rn I n.
FINAL PERCOLATION RATE O (min/in)
PERFORMED BY e-jay'1SbYI
1200 West 33rd Auenue. Suha'.F• AP&Mge. Aioska 99503 • (907) 276.1361
Municipality of Anchorage
Development Services Department -
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road IYY
P.O. Box 196650 Anchorage, AK 99519.66
www.ci.anchorage.akus
(907) 343-7904 Pi —ICJ s
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I. D. 018-281-26 COSA# -fes
1. GENERAL INFORMATION Expiration Date:
Complete legal description MAXWELL LOT 2
Location (site address) 14841 LOC LOMAN LANE *ANCHORAGE, AK 99516
Current Property owner(s) WEICHERT RELOCATION RESOURCES. INC.Day phone
Mailing address
Lending agency Day phone
Mailing address
Real Estate Agent NIEL THOMAS W/COLDWELL BANKER Day phone 868-2750
Mailing address
Unless otherwise requested, COSA will be held by DSD for pickup.
2: NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
kfdividual Well
Individual On-site
Individual Water Storage
ElIndividual
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, 1 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. t further verify that based on the
information obtained from the Municipality of Anchorage fifes 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 GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 4141
Engineer's Comments:
In conducting this evaluation, GEG, Lit). attempted to provide a thorough,
ADEC MOA
aoOF �0��0
conscientious engineering analysis of the system in accordance with and
The described the of the
- O
-- - - - DSD Guidelines -&-Regulations, reported results performance
the time of the test, and separation
P' S�4Qi
- system under the conditions encountered at
features. The life wells and
p
9 H '•.i'*
distances measured to readily identifiable operational of all
O
septic systems depend on the local soils condition, groundwater levels that may
(7• ... .. • . • • • • • • .. • . • . • ... • •
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
Q •. ff ey Gar ess:
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
i-7 m i
QQ" ' . CE
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
00"dprlofessio�°a
0004000��
the sof& 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.
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
By:
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
NJ
ON-SITE
WATER AND
WASTEWATER
Original Certificate Date: -)
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
CERTIFICATE OF ON—SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: MAXWELL LOT 2 Parcel ID: 018-281-25
A. WELL DATA *WELL TEST PERFORMED BY MICHAEL E. ANDERSON, P.E.
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 7/23/83 Sanitary seal (Y/N) YES
Total depth 150 ft. Cased to 150 ft.
FROM WELL LOG
Date of test 7/23/83
Static water level 1 u 1 ft.
Well production 9 —9 P.M.
WATER SAMPLE RESULTS:
Well Log (Y/N) YES
Wires properly protected (Y/N) YES
Casing height (above ground) >18 in.
AT INSPECTION
*10/31/2011
*95.8 ft.
*4.6 g.p.m.
Coliform n colonies/100 ml. Nitraten 958 _mg./L. Collected by: GEG, Ltd.
Arsenic: Nn ug./L. Dateofsample: 4/6/12 PULLED BY GEG
*NEW SEPTIC INSTALLED BY WILCO CONTRACTOR'S &
B. SEPTIC/HOLDING TANK DATA INSPECTED BY MICHAEL E. ANDERSON, P.E.
Tank Type/Material SEPTIC/STEEL Date installed 10/27/2011
Tank size 1250 gal. Number of Compartments E 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
NEW
C. ABSORPTION FIELD DATA
Pumper.
Date installed 10/28/2011 Soil rating (g.p.d./Wor � 0.8 System type DEEP TRENCH
Length 47 ft. Width 3 ft. Gravel below pipe 8 ft.
Total depth 12-13 ft. Eff. absorption area 752 ft' Monitoring tube YES Depression over field NO
Date of adequacy test NEW Results (Pass/Fail) NEW For 4 bedrooms
Fluid depth in absorption field before test in. Water added =gal. New depth in.
Elapsed Time: = min. Final fluid depth in. Absorption rate >= Sno+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NnNF If yes, give date
D. LIFT STATION
Date installed
Size in gallons
Manhole/Access (Y/N
"Pump on" level at in.
"Pump off" level
High water alarm level at in.
Datum
Cycles tested
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
100'+
On adjacent lots 100'+
Absorption field on lot
100'+
On adjacent lots 100'+
Public sewer main
N/A
Public sewer manhole/cleanout N/A
Sewer /septic service line
25'+
Holding tank N/A
Animal containment areas
NONE
Manure/animal excrete storage areas NONE
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+
Property line
5'+ Absorption field 5'+
Water main N/A
Water service line
10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ***5'+ Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 25'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS YeCA4uJF— 01= SNc-'J
***SEE LOT LINE WAIVER Loc-��5�cr—
G. ENGINEER'S CERTIFICATION G OF..
certify that t have determined through field inspections and^- Y ��
review of Municipal records that the above systems am in """' "' . .. "" """""
conformance with MOA COSA guidelines in effect on this
date.
Qa � ��.J ff A. me sr
Engineer's Printed Ime JEFFREY A. GARNESS 9 79 3 dp
Date, I2 Odd P,e ' Lr,Cr7�.F2'�caoo
�� aprof e SSIOM1°o
��40000�a
COSA Fee
Date of Pa,
Waiver Fee $
Date of Paym
Receipt Number Receipt Number
(Rev. 1 1105)
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Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Progra
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
Parcel I.D. 018-261-26 COSA # C_ ( �
Expiration Date: _3
1. GENERAL INFORMATION
Complete legal description Lot 2, Maxwell Subdivision
Location (site address) 14841 Loc Loman Lane Anchorage, AK 99516
Current Property owner(s) James Seccombe Day phone
Mailing address 14841 Loc Loman Lane Anchorage, AK 99516
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
�,Mailiag Address
. °Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
Four (4)
3. TYPE bF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
individual Well
✓❑
Individual On-site
✓❑
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 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 engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 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
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
5. DSD SIGNATURE
—G1 Approved for bedrooms.
Disapproved.
Phone 522-7773
Date 12/8/2011
AV
AW•
MI4JAEL E. pHpStSON.
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CE -4381 �- v
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
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' = PRQGRAM
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"0'PENT SE�6��� '.
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date:
61"XI 91"
(Rev. 11105)
Municipality of Anchorage
�• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lot 2, Maxwell Subdivision
A. WELL DATA
Well type Private If A, B, or C provide PWSID #
Date completed 7/23/83 Sanitary seal (Y/N) Y
Total depth 150 ft. Cased to 150 ft.
Date of test
FROM WELL LOG
7/23/83
Static water level 101
Well production 9
WATER SAMPLE RESULTS:
ft.
Parcel ID: 018-281-26
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) >18 in.
AT INSPECTION
10/31/2011
95.8 ft.
g.p.m. 4.6 g.p.m.
Coliform 0 colonies/100 mL Nitrate 1.56 mg/L
Arsenic: N/D ug/I Date of sample: 10/27/11
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Tank size 1,250 gal. Number of Compartments Two
Foundation cleanout (Y/N) Y Depression over tank (Y/N)
Date of pumping New Construction Pumper
C. ABSORPTION FIELD DATA
Collected by: MEA
Date installed 10/27/2011
Cleanouts(Y/N) Y
N High water alarm (Y/N) N
Date installed 10/28/2011 Soil rating (g.p.d./f:2 or ftz/bdrm) •8 GPD/SF System type Deep Trench
Length 47 ft. Width 3 ft. Gravel below pipe 8 ft.
Total depth 12-13 ft. Eff. absorption area 752 ft2 Monitoring tube Y Depression over field N
Date of adequacy test New construction Results (Pass/Fail) For 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.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at in.
Size in gallons
"Pump off" level at in.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot >100'
Absorption field on lot >100'
Public sewer main N/A
Sewer /septic service line >25'
Animal containment areas None
Manhole/Access (Y/N) _
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots >100'
On adjacent lots >100'
Public sewer manhole/cleanout N/A
Holding tank
N/A
Manure/animal excrete storage areas None
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line >5' Absorption field >5'
Water main N/A Water service line >10' Surface water >100'
Wells on adjacent lots >100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 5"•" Building foundation >10' Water main
>10'
Water Service line >10 Surface water >100 Driveway, parking/vehicle storage >25'
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS: ""' See Lot Line Waiver,
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G. ENGINEER'S CERTIFICATION
A2�0 •�• .•••J'T��o
I certthat I have determined through field inspections and
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49sd*ify
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review of Municipal records that the above systems are in
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conformance with MOA COSA guidelines in effect on this date.
�'• '••
Engineer's Printed Name Michael E. Anderson, P.E.
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Date 12/8/2011
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COSA
COSA Fee $ — tA�alrc�O_ Waiver Fee $
Date of Payment 1 al I I Date of Payment
Receipt Number. G Receipt Number
(Rev. 11 /05)
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