HomeMy WebLinkAboutSCENIC MEADOWS BLK 2 LT 3Scenic
Meadows
Block 2
Lot 3
#051-064-82
�t 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: :57VL0 6 00Pd PID Number: 051-0ol - d ;)
E vin/
Wastewater System: New ❑ Upgrade
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ABSORPTION FIELD
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LEGAL DESCRIPTION
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Inspections performed by: � /Ci15. Dates: 1 /
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Development Services Department Approval
•° �'M1 ¢� ':'� L'•
Conditional Approval Date:
•° """" "�
stovon W.
�' f••n PE 6456
Reviewed and approved by: %/'� • Date: �' _ 0
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Septic System Construction
Does Not Preclude Adjoining
Lots From Sanitation
Improvements.
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DESIGN NOTES: 11
1. Total Depth of Trench is 8'.
Terrain Slopes South.
F.C.D.
A
14.5
B
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S.T. C.❑.1
16
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119
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88
1500 Gallon
Double C.O.'s
DCO
o —
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2. Sewer Service Line minimum 2% slope:
3. Test Hole By Others.
4. Lots Served by Public Water System.
NORTHRIM ;�
ENGINEERING
172.!7 Dear Pow Cirol
Eagle River. Alaska 99377
907.694.7028
Tank
02 Absor tion Trench
C.O.
STH #6 (Gar ss)
/Reserve Site
oPe
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SCENIC MEADOWS S/D
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LOT 3
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` I MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: May 11, 2006
Expiration Date: May 11, 2007
Permit Number: SWO60088ly-- eq tc o. —s 4 4-T ¢ Parcel ID: 051-064-WFa-
Legal Description:
Design Engineer: 0838 NORTH RIM ENGINEERING Site Address: NHN HOMESTEAD ROAD
Owner Name: MIKE QUINN Lot Size: 332324 SQ. FT.
Owner Address: PO BOX 772641 Total Bedrooms: 5 Permit Bedrooms: 5
EAGLE RIVER, AK 99577 -
This permit is for the construction of:
❑v Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be In accordance with:
1. The attached approved design.
2. All requirements specified In Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
-THIS PERMIT IS FOR THE PROPOSED SCENIC MEADOWS SID BLOCK LOT/ 3
Received By:
Issued By.
Date:
Date: • • 1-
MUNICIPALITY OF ANCHORAGE
Dovelopment Services Department
Orf-StteWater d Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 995196650
(907) 343-7904
ON•StTE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: May 11, 2006
Expiration Date: May 11, 2007
Permit Number. SWO60088 geeAlic f444oerS Qt 1 trb Parcel ID: 051-064-61
Legal Description
Design Engineer. 0838 NORTH RIM ENGINEERING
Owner Name: MIKEOUINN
Owner Address: PO BOX 772641
EAGLE RIVER . AK 99577 -
Site Address: NHN HOMESTEAD ROAD
Lot Size: 332324 SO. FT.
Total Bedrooms: S Permit Bedrooms: 5
This permit is for the construction of.
❑✓ Disposal Field [Z] Septic Tank ❑ Holding Tank ❑ Privy
A8 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 (1 SAA072 ) and Drinking Water Regulations (18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide noffication by tatting
(907)343-79U (24 hours). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface sell 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.
5. The following special provisions.
THIS PERMIT IS FOR THE PROPOSED SCENIC MEADOWS SID BLOCK 1 LOT 6
Received By.
Date: /( & C
Issued By.Date: S 4- /4
Municipality of Anchorage
Development Services Department *!A='.
Bu)IdingSafety Division :S•:
On -Site Water and Wastewater Program , r
4700 Bragaw Street
P.O. Box 196650 11
Anchorage. AK 99519.6650 1 � Z S-4-
www.muni.orgronsite _
(90T) 343-7004
ON-SITE SEPTIC/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. _ 66-1-dL-ti'C01 -
Property
Mailing
phone e71^u94a-
Code ??S'2_7
Site address Zip Code
Legal description (Sub'd. Block & Lot) S e rn t r, -
Legal
, -
Legal description (Township. Section & Range)
Lot Size mot aSq. F
THIS APPLICATION IS FOR (®all that apply):
Absorption Field
Septic Tank
Holding Tank
❑
Privy
❑
Private Wen
❑
Water Storage
❑
Number of Bedrooms 6 -
THIS APPLICATION IS AN:
Initial ,1'=
Upgrade ❑
Renewal ❑
1 certify that the above information is correct. 1 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
PermltlRushFees: giro '0D
Date of Payment 31isbxa
Recelpt Number. r
(Ray.1110)
16
Waiver Fees:
Date of Payment:
Recelpt Number:
ENGINEERING
NorthRim Engineering
17237 Bear Pow Circle
Eagle River. AK 99577
907-694.7028
March 13, 2006
MOA On -Site Water& Wastewater Program
4700 Bragaw St
Anchorage, AK 99519
RE: Scenic Meadows S/D, Block 1, Lot 6
A lot is being developed.7he soil test was conducted during subdivision approval. The
design is based on this test hole. If conditions are found to be dif crcnt during
construction, a design change will be submitted. Public water serves the subdivision.
The neighboring lots are under construction. This site should not negatively impact any
of the other area lots. The lot slopes to the south and is relatively flat.
Please review the wastewater system design for the single family home. I have included
design plans & specs, design guidelines, & soil tests. If there is need for additional
information or clarification please give me a call.
Sincerely,
Steve Eng, PE, I'll 4
Dcsign Enclosures
ENGtNEERtNG Scenic Meadows SID, Lot 6, Block 1
SPECIFICATIONS & DESIGN' GUIDELINES
Wastewater System Sizing: Ibis is a new 5 -bedroom, single family home. This is a new
subdivision and most of the neighboring lots arc not yet developed. The subdivision test
hole is being used for soil design basis & groundwater monitor. These lots are large and
arc served by public water. No adverse impacts are expected from development. No
conflicts to the other lots will take place by this septic system construction. The
neighboring lots easements are located on the drawing and are not encroached upon. Soil
tests revealed sandy soil with gravel. An application rate of 1.2 GPD/FT2 with 0.5
reduction factor for utilizing a 5' wide trench. Trench Length a 750 FT'/5'x .5 reduction
factor a 62.5';1 line @ 63'. No bedrock was encountered or groundwater was
encountered in the soil test.
Specification Requirements: All components and work must comply with the Municipality
of Anchorage Specifications (AbtC) & State of Alaska Drinking Water Regulations and
Wastewater Regulations.
• Two compartment, 1500 gallon septic tank. Watertight couplings on inlet & outlet.
• 5' minimum between the tank and bed. 10' to property lines.
• 3' of cover or insulation is required for trench; an equivalent of 1" insulation for each foot
soil cover.
• Tank & solid pipe must be set on well compacted, stable soil.
• 4 inch diameter cleanouts with airtight caps are required 1' to 4' from foundation wall, prior
to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing
cleanouu between the tank and the absorption field, not more than 10' from the tank
positioned to provide cleanout access towards the tank and towards the absorption field.
• All eleanouts must extend to at least ground level.
• In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron.
• Trench to be placed level, minimum of 4' to groundwater, 6' to bedrock from drain -rock.
• Drain rock to be % inch to 2 % inch screened. Drain rock to be distributed uniformly
throughout the trench.
• Perforated pipe to be installed level with perforations down.
• Silt barrier (filter fabric) to be installed above the drain rock.
• Smeared trench sides must be raked or scarified before drain rock placement.
• Backfill over drain rock must not be less than 36".
• The finish grade must be mounded to promote drainage over the trench.
• Insulation must be placed over any pipe Installed under driveways or parking areas.
• Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS
ASTM D2661,
• Sewer Service Line is minimum 2% slope.
• Septic Tank to be pumped every two years or when required.
0 Insulation board to be extruded direct burial polystyrene (Dow Styrofoam FIl or equal)
/ Water Key Box
5 Bdrn
Home
Driveway
.C.O.
DESIGN NOTES:
1. Total Depth of Trench is 8'.
Terrain Slopes South.
Septic System Construction
Does Not Preclude Adjoining
Lots From Sanitation
Improvements.
1500 Gallon ptic Tank
`Double C.O.'s
2. Sewer Service Line minimum 2% slope'
3. Test Hole By Others.
4. Lots Served by Public Water System.
NORTHR/M
ENGINEERING
• 172J7 &*or pow Circle
Coyle RMr. Alaska 99777
907.694.7028
0
Trench
TH #6 <Garh
/Reserve Site
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6
SCENIC MEADOWS S/D
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MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051-064-82
Legal description Scenic Meadows Block 2 lot 3
Site address 23280 Blue skies Circle, Anchorage AK
Current property owner(s) Pena
Expiration Date:
07-27-24
X The On-site system(s) is/are approved for 5 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
\ti-- Original Certificate Date:_y
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA ApprovaLJune 2022
MUNICIPALITY OF ANCHORAGE
0
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051-064-82
1. GENERAL INFORMATION
Expiration Date: 7- 21-20 Z ll
Complete legal description SCENIC MEADOWS BLOCK 2 LOT 3
Location (site address) 23280 BLUE SKIES CIRCLE, CHUGIAK, AK 99567
Current property owner(s) TERRY & CARMEL PENA Day phone
Mailing address
Real estate agent
PO BOX 771401, EAGLE RIVER, AK 99577 1401
2. TYPE OF DWELLING:
Z Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
5
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
❑
Private Septic
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
®
Public Sewer
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 5-550
Date of Payment 17b9l X02
Receipt Number �, T `� aq D
COSA # OS(a a 13 8
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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Address 13030 SUES WAY, ANCHORAGE AK 99516
Engineer's Printed Name CURTIS HUFFMAN, PE Date 7/29/22
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. 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 in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. 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 L�Q
well and septic system. Therefore, any estimate of how long a system will function satisfactory %�Q; • • • !-}
for current or future occupants or guarantee that no unseen encroachments, deficiencies or j g.' •;� �l
discrepancies exist can be given by First Water Consulting & U.5 *' 9 TH �•* (�
.. ......
6. DSD SIGNATURE •Curtis• • •_
• Huffman
System #1 Approved for _� bedrooms t♦���F49 ., CE 128991 .����,/
System #2 Approved for bedrooms �i1,Fo 80F SS1
Disapproved
Conditional approval for bedrooms, with the following stipulations:
B Original Certificate Date:E— / ^ 2_2
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 engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
Legal Description: SCENIC MEADOWS BLOCK 2 LOT 3 Parcel ID: 051-064-82
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA — PUBLIC WATER
log is filed with Onsite (or attached)
Date driffb
Total depth _ft
Cased to _ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) _in.
Date of flow test for COSA
Static water level at beginning of test _ft.
Comments
B. TANK DATA
Age of tank(s) 16 years
Tank type/material SEPTIC / STEEL
Measured operating fluid level in septic tank 48"
® Standpipes/foundation cleanout per record drawing
Date of pumping 7/27/22
D. ABSORPTION FIELD DATA
Structure served by this system
Well production at time of test _gpm
Water storage tank volume_ gallons
Well disinfected for coliform test? ❑ Yes ❑ Nc
❑ Coliform bacteria is Negative
Nitrate _mg/L ❑ Nitrate less than MRL (ND)
ug/L ❑ Arsenic less than MRL (ND)
Collected by=
Date of Sample
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material
Comments:
Which system tested (date installed) 5/19/06 Adequacy test date 7/27/22
® ALL standpipes present per record drawing Results E Pass For 5 bedrooms
Total measured depth from grade 8_9 ft (max) Fluid depth prior to test 16 in
Measured depth to pipe invert from grade 4_8 ft (min) Water added 750 gal
❑ N/A — pressurized field
New depth 26 in
® Monitor tubes go to bottom of effective. If not, state Elapsed time 1440 min
depth into effective MOA IR SHOWS 4'ED
®.Code -required soil cover over field
Final fluid depth 16 in
❑ System presoaked Absorption rate 750 gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N
date of test) If yes, enter date
Gallons introduced gallons
Comments/Deficiencies: MT/CO AT GRADE. SYSTEM OPERATING IN THE LOWER HALF OF THE 41ED.
L_�
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 ft
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' ❑ Yes
if No ft
Absorption Field on Lot > 100' ❑ Yes
if No
ft
Holding Tank > 100' ❑ Yes
if No ft
Neighboring Absorption Fields > 100'
Surface Water > 100'
® Yes
Animal Containment > 50' ❑ Yes
if No ft
❑ Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ❑Yes
_
if No
ft
r] 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:
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'
® Yes
if No
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
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
*MET MOA STANDARDS AT TIME OF INSTALLATION.
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.
.• 7H
Curtis Huffman
•
CE128991
�klkF� ROHWONW AGOW
Municipality of Anchorage
• -� Development Services Department •'•"""
Building Safety Division ea
_ On -Site Water and Wastewater Program '
4700 Bragaw Street '"' C '
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. -0144 -92- COSA #()(Dn Xi jh
Expiration Date: f O -31-07
1. GENERAL INFORMATION
Complete legal description 41:;;-(1 j5Aff0 4,40c -k- 07- g,
Location (site address).4308d gLdr SA/E,S AQ(1jrF
Current Property owner(s) /LI //=F_ to 0110cx l Day phone 4 Pct -L/1 sS
Mailing address PO &A 772e'y'1 7, e5zfa-- 12fyrA
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Day phone
65d cJ11L/A1' Day phone 4zV e11- r
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: S
3. TYPE OF WATER SUPPLY:
Individual Welt
❑
Individual Water Storage
❑
Community Class Well
❑
Public Water System
0
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
121 -
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of 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, 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
Address
Engineers Printed Name5"— EAG
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Phone 6 %!l= po Zz'
Date o r
4: ..... 4,p �A
Steven W. Eng
6256 : '� m
C F9
tZeF�oriorEs
"``�.�"
ts. ..
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date: 10_ _,3/-0(0
(Rev. 11105)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519.6650
www.muni.orglonsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: 5C-en((C. --VL44Cx-J_S BLOCK- Z Gar 3 Parcel
A. WELL DATA fPU8 C_—,4..JwU
Date
com
Wefl type —
pleted
Total depth ft.
Date of test
Static water level
If A, B, or C provide SID #—
Sanitary seal M)
Cased to ft.
FROM WELL LOG
Well production _
WATER SAMPLE RESUL/
Coliform --- cdogt�
Arsenic: m
ft.
g.p.m.
mL Nitrate mg1L
Date of sample: —
B. SEP IC(HOLDING TANK DATA
TankType/Materiai /Irc� if Ti�7C((tllsrrerL
Tank size SDa gal. Number of Compartments Z
Well Log (Y/N)
Wires properly protected M)
Casing height (a round) In.
AT INSPECTION
Foundation cleanout (YlN) Depression over lank (YIN) _AL
Date of pumping ALI _ f4.J Pumper
C. ABSORPTION FIELD DATA
Date Installed 11AIA Soil rating (g.p.dJfe or ftzlbdrm)
Length ft. Width S ft.
Total depth — I— ft. Eff. absorption area 6S0 fe
g.p.m.
Z�fT« : r, • 11
M
Date installed _.S//906
Cleanouls (Y/N)
High water alarm (YIN) /V
system type 7;?/6'r C-ff
Gravel below pipe �=/ ft.
Monitoring tube __)L Depression over field
Date of adequacy test AI Results (Pass/Fail)
Fluid depth in absorption field before test — in. Water added— gal.
Elapsed Time: — min. Final fluid depth — in. Absorption rate >=
For — bedrooms
New depth— in.
Any rejuvenation treatment (past 12 mo.) (YM & type) If yes, give date
RM
D. UFT STATION
Date installed Size in gallons Manhole/Aocess (YM)
'Pump ori level at in. 'Pump ofP el at _ in. High water al ei at in.
Datum Cyc s ted Meets ala circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCE$ FROM WELL ON LOT TO: /w�L I C b.1/FTi�r2
Septic tankilift station o k
Absorption field on I _
Public sewer m
Sewer /se service line
Animal tamment areas
On adjacent lots
On adjacent lots
Holding tank
storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation S'I' Property line /Q ,+� Absorption field -/
Water main / 0 t"f Water service line '� Surface water /00 ('-
Wells on adjacent lots ZOO `t
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
r �
Property line / ~ Building foundation �D r` Water main
Water Service line I o r f Surface water /,,,-5 0 f Driveway, parkirW"hicle storage /O t
Curtain drain Wells on adjacent lots 00 •�
F. COMMENTS
^ti�.�'41•�t
G. ENGINEER'S CERTIFICATION %.P: '•.•,, .j !
1 certify that I have determined through field Inspections and p ' r C.
review of Municipal records that the above systems are in ✓ t',
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name �, s re base <'
Date Z Or 34041 v .... .
COSA Fee $ 59-5o
Date of Payment W 1121a,
Receipt Number 09-4143
(Rev. 11105)
Waiver Fee $
Date of Payment
Receipt Number
�srif • cb
�:J7.07
qs 11
•
ee
J�TC v
M
♦ w
e
z \
t
a
v.
e /
I
0►l�
ASBUILT SEWARD & ASSOCIATES LAND SURVEYING 69
I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE:
FOLLOWING DESCRIBED PROPERTY OF At �!
rc�vi� c9�o�'Sa�'�or3.am-z DATE
AND THAT NO ENCROACHMENTS EX`ST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE ;; ;'q TM '' #
OWNER TO DETERMINE TH•:. EXISTENCE OF ANY GRID y •••-
EASEMENTS, COVENANTS, OR RESTRICTIONS ••••
WHICH DO NOT APPEAR ON THE RECORDED SUBDI- 0'
S•
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FBS I
•Duan* Mork ward
'•, l5- 918 ' ��a
ANY DATA HEREON BE USED FOR CONSTRUCTION ���yBi� �t ° �ca�i
OFFENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
.d�'f