HomeMy WebLinkAboutLAURIE LT 44BLaurie
Lot 44B
#018-092-54
Municipality of Anchorage
Development Services Department `
Building Safety Division
On -Site Water and Wastewater Program, 4700 S. Bragaw St
P.O. Box 196650 Anchorage, AK 99519.6650 Page I/ of
www.d.anchorage.ak.us (907) 343.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: _ 0 6� d 3A PID Number: Of F?— O4'2- —S `f
Wme:
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Wastewater System: New ❑ Upgrade
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ABSORPTION FIELD
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LEGAL DESCRIPTION
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Permit No. SW060032
Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN 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 Description: LOT 448, LAURIE S/D PID No.: 018-092-54
BENCH MARK Ja -4
(M .A00C.
SECONDARY SYSTEM
-- --
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1
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05
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11 1 1 !•41V/t` TEST HOLE S
I I I It
/IT r_jxvCI Ij \ 1 1 • /
I I
1 I 4 A / SINGLE FAMILY RESIDENCE
COCO21 C9f
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1 I I 1 1
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\ 1 I IidT�Y I
\ I I -006 I
MARK A 8 GRND PIPE
ELEV. ELEV
-- \ COt 27.2 5.0 97.6 95.5
i \ CO2 33.0 20.5 96.3 93.8
\ \ TC01 36.0 25.0 96.7
i \ TCO2 42.5 33.6 95.6
\ CO3 62.0 53.2 94.3 92.0
\ \ C04 62.5 53.6 94.3 92.0
\ C05 79.2 90.0 93.7 91.6
MT78.0 66.2 937
\ Ca6 79.0 65.0 93..7 191.6
SCALE: 1"=3b \
0 t�_1. MICHAEL N. ANDEF
w^ I Oc-li _ No. CE 9469
', ..i r a i r .�. .,�.V r.hwi�' ..t Y f. L^Tr d'fM.:'M'.. '.,.. �...*.rY ..
Certf f f eb Orl'Iting Rag
by
Doc CO. dba
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 -TELEPHONE 688-2759
OWNER OF LAND: f41 - IX 444 13
ADDRESS:
LEGAL DESCRIPTION: 1_?4 L4z / /_ 1,,,-r 4�}15
DATE: � J/ 7 L 4
PERMIT NUMBER: L� 61.0 ?ot Date of Issue -L- of.
TAX IDENTIFICATION NUMBER:
Is well located at approved permit location? &-Ye's� U No
Method of Drilling: it rotary U cable tool
Depth of well: �� U
Casing Type STr:;L Wall Thickness # j :5_'� inches
Diameter G inches, depth feet
Liner Type: /J O i%J C
Casing Stickup Above Ground: d • feet
Static Water Level: /J � feet
Recover Rate: 3J gpm
Method of Testing:/
Well Intake Opening Type: b-o)Sen end U open hole
U Screened; Startfeet Stopped feet
- �U Perforations Start feet Stopped feet
l - TJ.�,i C�71 I 15-046
Grout Type: Volume
Depth: from U feet, to T feet
Well Disinfected Upon Completion? Q --Yes U No
Method of Disinfection: C N� o .t . c' so lr%ll
Comments:
BORE HOLE DATA
mm
JD
101! 0�13jel)C0�
..ili./C-C.
.t/
/4/A•�.JO.rt�v i C a r3i3 (r: S
A�zI/,4.J
S -„i. v 0
ZJ,4i, z_
Driller's Name (20 1L. t S L4 4-L 1 004-J
ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality
of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. Matsu Borough:
Department of Environmental Conservation.
MUNICIPALITY OF ANCHORAGE
Development Services Department
Onsite Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Permit Number: SWO60032
Date Issued: Mar 10, 2006
Expiration Date: Mar 10, 2007
Parcel ID: 018-092-54
Legal Description: LAURIE LOT 44B
Design Engineer: 0855 Garness Engineering Group, LTD Site Address: 13801 DAVIS STREET
Owner Name: JASON ALWARD Lot Size: 46200 SO. FT.
Owner Address: 7341 WHITE HAWK DRIVE Total Bedrooms: 4 Permit Bedrooms: 4
ANCHORAGE. AK 99507 -
This permit is for the construction of:
Disposal Field Q Septic Tank Holding Tank F] Privy Private Well Water Storage
All construction must be In accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, seated, and heated to prevent freezing.
Received By:
Date: 2_/0./0-r
O
Issued Byl_ntfDate:S
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
ON-SITE SEPTIC/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. DI $-1�Q2-
Propertyowner(s) A(t.rayj Day phone
Mailing address i �u( 100e > 06)e- Zip Code 4 So 7
Site address 13gD1 D2 f/1 �' V Zip Code
Legal description (Sub'd, Block & Lot) / ata, o L y `l Jr':�
Legal description (Township, Section & Range)
Lot SizeY(D'w
THIS APPLICATION IS FOR (®all that apply)
Absorption Field
W
Septic Tank
Holding Tank
❑
Privy
❑
Private Well
Water Storage
❑
Number of Bedrooms
THIS APPLICATION IS AN:
Initial
Upgrade
Renewal
❑
certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelli_g and is in accordance with applicable Municipal Codes.
of property owner or authorized agent)
Permit/Rush Fees:
Waiver Fees:
Date of Payment: -7" L- - O 6 Date of Payment:
Receipt Number:0392-21 eceipt Number:
(Rev. 11105)
GARNESS ENGINEERING GROUP, Ltd.
•.:.�w CONSULTANTS 8 GENERAL CONTRACTORS
February 27, 2006
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650,
Anchorage, Ak 99519-6650
(907)343-7904
Ref: Proposed Well and Septic System for Laurie Subdivision; Lot 44B,
To whom it may concern:
The proposed 4 bedroom house is to be served by a private well and septic system. We are proposing to
install a new 1250 gallon septic tank and a 5 -wide trench type drainfield. Two test holes were excavated
on the property. The drainfield will be designed around the 30 foot radii of these test holes. Comments
regarding the design are summarized as follows:
1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the
percolation test results.
2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications.
3. SURFACE RATERS: There are no surface waters within 100 feet of the proposed septic system.
4. TOPOGRAPHY: As can be seen on the attached design drawing, the average topography around the
proposed drainfield is fairly flat. In short, there are no slope concerns.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems.
If you have anyAuestions, please contact us at 337-6179. Thank you for your assistance.
P.E., M.S.
NOTE: Attached is a site plan drawing, a design drawing, one soil lag, which are all part of the design package for
this septic system. (Contact G.E.G. Ltd. for 7 page construction specification letter.)
3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507
Ph: (907) 337-6179' Far: (907) 338-3246' Website: gamessengineering.com
I
1
T12N, R3W, SEC. 27,
LOT 29,
T12N, R3W, SEC. 27
LOT 28A
I
1
138th
- - - - - - - - ALTERNATE SITE
138th; --ll
II^ I
li�ii TH/2
1 O¢ / \
T12N, R3W, SEC. 27 I\
LOT 45 / \ PROPOSED SEPTIC SYSTEM /
1 v) \ (SEE DESIGN PAGE 2 OF 2) I
LAURIE S/D; LOT 44ALLL---/iii"' D
'------------------ j
- - I - - - - - - - - - - - - - - - - -
I ' 1
I I I
I � I
T12N, R3W, SEC. 27,
LOT 61B,
I I I
I � I
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS
JASON ALWARD
LEGAL pESCRIPTION:
LAURIE SUBDIVISION
: OF WORK:
SITE PL
(,.OY. V IIViI
PHONE NUMBER: PAGE NUMBER:
632-1480 1 OF 2
DRAWN BY:
LOT 44B, C.J.G.
DATE:
)SED WELL AND SEPTIC SYSTEM I 2/27/2C
T12N, R3W, SEC. 27,
LOT 30,
APPROXIMATE
LOCATION
�sEPnc
ARS
T12N, R3W, SEC. 27,
LOT 43,
w
OF BEDROOMS:4
PER DAY (GPD): 600
RON RATE/S: 1.2 B 5 MIN./INCH
D APPLICATION RATE: 1.0
DRAINFIELD SO.FT.: 600
DRAINFIELD DESIGN:
MAXIMUM DEPTH:8 FEET
WIDTH:5 FEET
LENCTHAO FEET
M.O.A. APPROVED SAND FILTER: N/A
EFFECTIVE:4 FEET
REDUCTION FACTOR: N/A
ACTUAL SO.FT.: 600
NOTE: THE CONTRACTOR SHALL
HAVE THE 100' WELL RADIUS
TO THE SOUTH FLAGGED BY A
REGISTERED LAND SURVEYOR
PRIOR TO CONSTRUCTION.
138th
0
LETTER THAT PERTAINS TO THIS DESIGN.
TO OBTAIN A COPY OF THE LETTER
CONTACT CEG. BY PROCEEDING FORWARD
WITH THIS INSTALLATION. THE ENGINEER.
WELL DRILLER. CONTRACTOR AND
PROPERTY OWNER AGREE THAT THEY
HAVE READ THESE SPECIFICATIONS AND
AGREE TO ACCEPT THE TERMS AND
—' �ciEwour
PROPOSE
4 BEDROI
HOUSE
`\ `PROPOSED DRAINFIELD \
\ \ 1
� I
IS
J
GARNESS ENGINEERING GROUP, Ltd. ;?:'
CONSULTANT$iOENERAL CONTRACTORS •••••....... ../.y ........
JAI C T II0,0. AA[ 101 • MGtlIIIL[, MI "W7 • F1dlC (907W7- li • FM ("7)M -M" �OLIL w.P....W�Mawn
PREPARED FOR: PHONE NUMBER: PACE NUMBER:
JASON ALWARD 632-1480 2 OF 2
LEGAL DESCRIPTION: DRAWN BY:
LAURIE SUBDIVISION; LOT 448, 1 C.J.G.
OF WORK:
DESIGN FOR PROPOSED WELL
SYSTEM 1 3/1/2006
Y A ess:'
E-7,953 �Fo
pFo /waeio��V�
ALTERNATE SITE _
T, MTr I
TH/11 I
�I I
II I
U C
IL
i
>
o
/
NOTE: THE CONTRACTOR SHALL
HAVE THE 100' WELL RADIUS
TO THE SOUTH FLAGGED BY A
REGISTERED LAND SURVEYOR
PRIOR TO CONSTRUCTION.
138th
0
LETTER THAT PERTAINS TO THIS DESIGN.
TO OBTAIN A COPY OF THE LETTER
CONTACT CEG. BY PROCEEDING FORWARD
WITH THIS INSTALLATION. THE ENGINEER.
WELL DRILLER. CONTRACTOR AND
PROPERTY OWNER AGREE THAT THEY
HAVE READ THESE SPECIFICATIONS AND
AGREE TO ACCEPT THE TERMS AND
—' �ciEwour
PROPOSE
4 BEDROI
HOUSE
`\ `PROPOSED DRAINFIELD \
\ \ 1
� I
IS
J
GARNESS ENGINEERING GROUP, Ltd. ;?:'
CONSULTANT$iOENERAL CONTRACTORS •••••....... ../.y ........
JAI C T II0,0. AA[ 101 • MGtlIIIL[, MI "W7 • F1dlC (907W7- li • FM ("7)M -M" �OLIL w.P....W�Mawn
PREPARED FOR: PHONE NUMBER: PACE NUMBER:
JASON ALWARD 632-1480 2 OF 2
LEGAL DESCRIPTION: DRAWN BY:
LAURIE SUBDIVISION; LOT 448, 1 C.J.G.
OF WORK:
DESIGN FOR PROPOSED WELL
SYSTEM 1 3/1/2006
Y A ess:'
E-7,953 �Fo
pFo /waeio��V�
no
GARNESS ENGINEERING GROUP, Ltd. ��P 'f0
CONSULTANTS & GENERAL CONTRACTORS Q * �•' •�d
1 OWO. ARE 101• AM]MkM M NEO'!•NI01(: (WW -IN /i%: N -WU JIL ,sn• F,.00m •••••"• •• ••"••• •••••••••••//
SOIL LOG — PERCOLATION TEST .:..
LEGAL DESCRIPTION: LAURIE S D, LOT 448, A ';J Y mess.
PERFORMED FOR: JASON ALWARD DATE. 11/29/200 �'CE —7953
DE
(feet)
aaaa ORG ITEST HOLE 1 00000��
1 a_aaa (PACE 1 OF 2)
tr:
SOIL CLASSIFICATIONS
2
+��'+�: GW =__= ORG TEST HOLE
"�«• LOCATIONS ARE
3N� titer GP ML APPROXIMATE
GM CL
q:�: GC OL
«. GP/SP
.� . •°> a SWMH
5 �N' •• SP CH
«..•: SM 0, OH TMII 4tH/2
•�«,
6 Sc
7— DEPTH TO DATE
GROUNDWATER % `��
N
8 DRY 11/29/200!
DRY 12/6/2005
9
I 100'
10 GM/SM
11
12
13
14
B.O.H.
15
16
17
16
19 PERCOLATION RATE 1.2 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 7.0 FT. AND 7.5 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: N YES ❑ NO
SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: BENNY MAUS
COMMENTS:
PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS E FORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: OIL/( 0
DATE READING CLOCK NET TIME WATER LEVEL NET DROP
TIME (MINUTES) READING (INCHES)
11/30/2005
1
2:20
—
6'
—
2
2:50
30
0'
6'
3
2:50
—
6'
—
4
3:20
30
0'
6'
5
3:20
—
6"
—
6
3:50
30
0'
6'
oQ AC p4
GARNESS
ENGINEERING GROUP,
Ltd.
CONSULTANTS & GENERAL CONTRACTORS
1
101 • NKMOIIKi. NL NE01 • -.1 • FAC M • X14 ,vrrrgMKgmm
...... .. .. ...............V
SOIL LOG — PERCOLATION TEST
LEGAL DESCRIPTION:
LAURIE S D, LOT 44B,
s•
a Omess.,
PERFORMED
FOR: JASON ALWARD DATE. -_11/29/2005
-
CE -753
.,1�/V/9�
�s^0
(r et)
TEST HOLE#11
-
0.0 rofa$ %
40�ao
1
6•
(PACE 2 OF 2)
SOIL CLASSIFICATIONS
2
r,a:.rt:i= GW -- ORG
3
GP ML
GM CL
q
GC OL
. •°. a SW MH
5
•� SM
CH
SEE
SITE PLAN
w
, , ;
6
Q
SC
(PAGE 1 OF 2)
w
7 —
DEPTH
GROUNDWATER DATE
Z
s
O
of 2
1
9
PPGE
Z
SEE
10
O
QDATE
READING CLOCK
NET TIME
WATER LEVEL NET DROP
11
U
TIME
(MINUTES)
READING (INCHES)
12
LL -
11/30/2005 1 -
-
6• -
(n
2 -
<1
0• 6•
13
N
3 -
-
6• -
U
a —
<1
D.
14
15
_J
O
16
(n
17
w
w
18
19
PERCOLATION RATE <1 (MIN./INCH)
PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 3.0 FT. AND 3.5
FT.
20
A FOUR HOUR PRESOAK WAS PERFORMED: [:1 YES ENO
SOILS LOGGED BY:
JODY MAUS PERCOLATION TEST PERFORMED
BY:
BENNY MAUS
COMMENTS:
PERFORMED
BY CEG,
Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS E
FORMED IN ACCORDANCE
WITH ALL STATE AND
MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE:
s•
5
-
-
6•
-
6
-
<1
0•
6•
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS b GENERAL CONTRACTORS
SOIL LOG - PERCOLATION TEST
LEGAL DESCRIPTION:
PERFORMED FOR:
DE
(1°°t)
JASON ALWARD
DRY
DAl
DRY
12/6/2005
2:2D
-
ORG
TEST HOLE
2
1
nada
0'
PAGE 1 OF 2
3
2'�L
:•�
6•
SOIL CLASSIFICATIONS
4
3:20
30
0•
y,s. GW 'z=='7=
ORG
3:20
-
6•
-
6
3:50
":rJ
GP/SP
At:iv GP 111tUtl
ML
CL
111 11119 JIGM
q
t`
GC
OL
. •°.4 SW
MH
5
' SP
CH
: OH
6
SC
7
8
9 -ii n nin GM/SM
10
11
12
13
14
15
16
17
18
DEPTH TO
GROUNDWATER
DATE
DRY
1/29/200
DRY
12/6/2005
2:2D
-
6•
-
TEST HO2AR
LOCATIONSAPPROXIM
THI !o 4:M12
i
� N
1 1 _
1
DATE READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
11/30/2005 1
2:2D
-
6•
-
2
2:50
30
0'
6•
3
2:50
-
6•
-
4
3:20
30
0•
6-
5
3:20
-
6•
-
6
3:50
30
0•
6•
19� PERCOLATION RATE 5 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 5.0 FT. AND 5.5 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: N YES ❑ NO
SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: KENNY MAUS
COMMENTS:
PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WASE FORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: _I L6 0S
�4
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS 6 GENERAL CONTRACTORS * .: * /I.
....... PJ
F"A Sun 10I • Noah[ / - In • & M • Womm i•,r.yvr,lrye*,
SOIL LOG e — PERCOLATION TEST „ „ ,,,,,, •,,,,, 0
LECAL DESCRIPTION: LAURIE S D, LOT 44B, f rey A. omess.
PERFORMED FOR: JASON ALWARD DATE. 11/29/2005 ai CE— 9 3
,mss' • • .l 216,�o.S'��gGv
(feet) TEST HOLE 2 D000����
1 PAGE 2 OF 2
2
N SOIL CLAS SIFlCATIONS
Isc
GW ORG
3 LL_ GP ML
O GM CL
q GC OL
$W MH
5 0 SM . ; off SEE SITE PLAN ON
6 0- (PAGE 1 OF 2)
Z DEPTH GROUNDWATER
6
DATE
O �F 2
1
s Z
O SEE
10
Q
11 U DATE READING CLOCK NET TIME WATER LEVEL NET DROP
LL TIME (MINUTES) READING (INCHES)
12 (n 11/30/2005 1 — 6' —
V)
13
14 U
J
15 O
U)
16 W
17 LLI
(n
16
19 PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 2.0 FT. AND 2.5 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES ENO
SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: BENNY MAUS
COMMENTS:
PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS E FORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 1 ib O
—
2
—
<1
0e
6e
3
—
—
6'
—
5
—
6e
—
6
—
<1
0e
6'
-\ Municipality of Anchorage
Development Services Department *A.
Building Safety Division
Onsite Water and Wastewater Program °
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904.
i r
6 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING rr1� 1�
Parcel l.D. C7l Ss' — o 42- S y COSA # M055
Expiration Date: ro
1. GENERAL INFORMATION
Complete legal description L ae f c c_ Lo 4- e4 Lk 6.
Location (site address) I S byt Dovi s v' A
Current Property owners) Z a s u ri . A 1wv. d Day phone
Mailing address
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will be hold by DSD for pickup.
2. NUMBER OF BEDROOMS: y
3. TYPE OF 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 Onsite Systems
Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil
engineer registered In the State of Alaska. Certificates of Onsite Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also Issues COSAs upon request to homeowners. Certificates of 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 engineers work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation,
based on procedures outlined In the Certificate of Onsite 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
Address
Engineer's Printed Name
5. DSD SIGNATURE
Phone '3N S' •3397
.1.\.VI.Y.W.•...... /
MXHAEI N. ANDERSON;�c •0
-9
j69
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
BY �70Original Certificate Date: 3AV e�olr
(Pe .1 LO5)
Municipality of Anchorage
Development Services Department
Building Safety Division '
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 198050
Anchorage, AK 99519-6850
www.muni.orglonsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: LAtt4 i e. to f 01-1 B. Parcel ID: O( ii^ n9 Z- 54 f
A. WELL DATA
Well type ►^iuo�bG If A. B, or C provide PWSID # Well Log (YM) Y
Date completed S /7/0 (7 Sanitary seal (YM) __Y__ Wires properly protected (YM) Y
Total depth / (� —Pft. Cased to
FROM WELL LOG
Date of test S/r7 l0 6
Static water level 105- ft.
Web production 3 D 9—
p.m-
WATER SAMPLE RESULTS:
Coliform 4—oolonies/100 mL Nitrate d, 21YmglL
Arsenic: -9- mg4 Date of sample: 7/x"'110,9'
B. SEPTICIHOLDING TANK DATA
Tank Type/Material 61 r5z
Tank size (25'0 _ gal. Number of Compartments 7�
Casing height (above ground) L`/ in.
AT INSPECTION
3� i/v 9-
1 v S ft.
f g.p.m.
4.0 Ce"1-"
Other bacteria _V colonies/100 mL
Collected by. ml % f�w.
Date Installed 7/Ze 1O &
Cleanouts (YIN)
Foundation cleanout (YIN) _Y- Depression over tank (Y/N) F_ High water alarm (YM)
Date of pumping Pumper
C. ABSORPTION FIELD DATA
Date installed 7 120tv & Soil rating (g.p.dAe or fe/bdrm) System type S n z
Length V3 ` ft. Width s-, D ft. Gravel below pipe D ft.
Total deptp '7.D ft. EN. absorption area -A&-be ftp Monitoring lube Y Depression over field I_
Date of adequacy test / Results (Pass/Fail) i For _fL bedrooms
Fluid depth in absorption field before test _--' in. Water added ,::�'ga 1. New depth�in.
Elapsed Time: / min. Final fluid depth e-�_ in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at _ in. 'Pump ofr
Datum Cycles (egg
E. SEN5aTION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankfift station on lot / o '
Absorption field on lot /0o, {-
Public sewer main N ��
Sewer /septic service line 1`01)(4 -
Animal
va/'f'Animal containment areas lot) I i -
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots t e o ' 4 -
On adjacent lots 1 n o ' .-
Public sewer manhole/cleanout talA,
Holding tank _ /'I lA t
Manure/animal excrete storage areas 100 r rt,
SEPARATION DISTANCES FROM SEPTIC/H> TANK ON LOT TO:
Building foundation Z O r -I Property line SU 'f Absorption field z7 1
Water main %1114, Water service line Gd�f Surface water /V0 (7t,
Wells on adjacent lots / a r 14�
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line '3 0 '+- Building foundation t/ 0 "(- Water main ,V
Water Service line r a o 4 Surface water [ o v t D' 1�
Driveway, parking/vehicle storage —/
Curtain drain IVA, Wells on adjacent lots t r u r f -
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines /n eflec(on this date.
Engineers Printed Name M, a A A C( A(IlF R T r4 rr,1Date '7l/5--/
0'?-
COSA Fee $
Date of Payment 3 V
Receipt Number ;z T,
(Rev. 11/05)
Date of Payment
AC�s1l+
r *: 49TH
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N. ANDDCRSCN
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Receipt Number L+Dlo ,�"
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