HomeMy WebLinkAboutSIEFKER #3 LT 7Def ker #3
Lot 70
#015-281-37
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 I of 'L
www.cLanchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: �uw/cp 0 1 PID Number:
Name
Rofiarf S¢n�e�
Wastewater System: ❑ New ® Upgrade
Aeneas.
P. o. 00 it 6VYOa� Fe%v-4ankr 99708
ABSORPTION FIELD
Pndu �/ ` 14 m d Benad.s:
I urs - 60 1 Q 3
IRDaao rw o SnallO Trench O Bae 0 Mand a 0"w
LEGAL DESCRIPTION
SOI Rating
1.7
TOM Depnft= or9ulppde.
GPDIFft
10. Ft.
Blodk LotPp. / aelche,- $upeLmf_J wn. �+
Trst ec7� 46 /r2
DepUl p ndtdn hard ,cul
3 S Ft. a�
Geta CeP nOa wd.91
�Fl
7d 0,P: Range. sedan:
FaaddedaCo..l.g"Wade
Gravel L.rWN
0. S Ft.
3 L Fl.
Well: E ❑ Upgrade
wST ❑ New
GravN w,dn.
^
Nuna.rdl.re.
Dnlraa enwsan Inas
FI
FI
Cpsvncauon lPmins.A B. C):
Tdal D.pm:
Cased b'
TdY.o.dpron raa
Ppe MdarW F �ld herF
Ft.
FL
�,/
l �� FIs
0— O v Ncm
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Dale Dnw..
Sola WMer La
"AW
Data antallb.
Ft.
:+" r'
1019 ioc
Yu
Pump SM N.
ca.,np Hag"Aow. Gourd
TANK
GPM
FL
Ft
SEPARATION DISTANCES
® Septic ❑ Holding ❑ S.T.E.P. ❑ Other.
To
Septic
Absorption
Litt
Holding
lubllePrivate
•d"•'
aP.ulY
From
Tank
Field
Station
Tank
Sewer Line
kn cA &Lri6ze ?"p74
10CV"
wall
106
jig,
>
MaIxW /
NVrip.r of campan ..
s ~K. water
!CC r
> too'
-
-
LIFT STATION
Let Llrw
13 r
19,
—
_
WI
Found~
2 f t
3 Y r
—
Perp err rw n
'Pump olr I.vH n.
Wpn wstar alga M.
n
F
N.
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_
—
Puny Moxa a Moeal
Etectmal er.p.oaon. partdm.d M.
R.maAa
Pro v ow nem rJec.cle.! AP
BENCH MARK
Locatan.a Da.apaan.
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o,ne� < /lac. /UorOFL
Psr oval 02rolper6ea.La4o/no�! t�adP,
Engineers Stamp
Inspections performed by: Tanch S✓c Dates: 1"_101910&-
2nd 10 /9 /off
� � OF Azo, p
Development Services Department Approval
1,�; ••"......•.g,"�`
Conditional Approval Date:
yL 49TH
...........::......... 1
THEODORE F. ALOORE�j
V
Revii 06 6r iwed and approved by: • �. V Date: - 0 - C
,V-0-- CE -3589 p` A
4ajyi •.fir+/D6� dad'
PERMIT NO: SW060315
PAGE 2OF2
PID NO: 015-281-37
�OF.A(`�h6
SWING TIES:f;'
? •'• + �0
vfr
FROM:
COR. "A"
COR. "B'
a.:..................:...
ef
FDN. C.O. "C"
11
29.$
:
S.T. C.O. "D"
24'
36'
THEOOOPE F. )ADORE
�{.' ••, CE - 339 "� N
S.T. C.O."E"
29.5'
39'
4.
DBL. C.O."F"33'
41'`�'�JE>»••;.
`E'y
TR. M.T. "G"
67'
66'
TR. C.O. "H"
67'
65.5'
NEW 1000 -GALLON
SEPTIC TANK —
NEW 32 -FOOT LONG
SOIL ABS. TRENCH -
w. 6.9' EFF. GRAVEL
T.H.
;
DRIVE
"G..
---------------------------------------E
TBM
T SOIL COVER
100'
PLAN VIEW
SCALE: 1" = 30'
4' SOIL COVER
„
„
ELEV. 86.1'
PROFILE VIEW
NOT TO SCALE
BOTTOM T.H. #1
ELEV. 77.8'
M.T. DRY
TRACT 7D
SIEFKER SID #3
IN
11000 -GALLON 93.4V.
SEPTIC TANK
rI )
IL
ql
MUNICIPALITY OF ANCHORAGE _Si
Development Services Department
On -Silo Water 6 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904 \
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Sep 26, 2006
Expiration Date: Sep 26, 2007
Permit Number: SWO60315 Parcel ID: 015-281-37
Legal Description: SIEFKER #3 LT 7D
Design Engineer: 0019 FLATTOP TECHNICAL SERVICES Site Address: 012240 JEROME ST
Owner Name: ROBERT SENNER Lot Size: 49546 SO. FT.
Owner Address: PO BOX 84400 Total Bedrooms: 4 Permit Bedrooms: 4
FAIRBANKS , TX 99708-0000
This permit is for the construction of:
❑✓ Disposal Field ❑✓ Septic Tank E] Holding Tank ❑ Privy E] Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3_ The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Date: 9 X26 /O6'
Issued By: Lk /41 An,,/, ,� Date: C1 zr 06
Municipality of Anchorage
Development Services Department
Building Safety Division
• a�
i 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. too S - 2 81 — 3 7
Propertyowner(s) Rub rf _(enefl. Day phone y5*X'-6e410
Mailing address P -o• Vox &40y&&. F�s-S ah N4 h -k Zip Code 9974',5
Site address 12 2-y0 'Te -d~ S'� Zip Code
Legal description (Sub'd, Block & Lot) ir�cF 7 0, S'#'sF k.— W-3 S i -n
Legal description (Township, Section & Range)
Lot Size 4c�.,54(P Sq. Ft.
THIS APPLICATION IS FOR (®all that apply)
Absorption Field
M
Septic Tank
10
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
Number of Bedrooms 'y
THIS APPLICATION IS AN:
Initial
❑
Upgrade
10
Renewal
❑
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.
,Z
(Signature of property owner or authorized agent)
Permit/Rush Fees: Y 60 -`2 Waiver Fees:
Date of Payment: 9 y "// 2.0a if Date of Payment:
Receipt Number: Receipt Number:
(Rev. 11105)
i-:
FLATTOP TEG HNICAL SERVIOrl
4,;,,,::M
CIVIL S ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION d ANALYSIS
TED MOORE, P.E. 14530 ECHO CANYON ROAD
PHJFAX: (907)345-1355 ANCHORAGE, AK 99516
E -Mail: tgmoore@gci.net September 14, 2006
M.O.A. DSD
P.O. Box 19-6650
Anchorage, AK 99519
Dear Sirs:
The purpose of this letter is to provide the required design narrative in support of our application
for a permit to upgrade the wastewater disposal facilities on Tract 7D of Siefker #3 S/D. Soils logs, perc
test results, a site plan, design drawings and specifications are enclosed for your review.
The proposed system will be constructed in the vicinity of test hole # 1. As can be seen from the
soil log, the native material between 2 and 19.5 feet below ground level is a fine silty sand with a
measured perc rate of 2 minutes per inch. Using the soil application rate of 1.2 gpd/sq. ft. specified in
the wastewater ordinance, this 4 -bedroom residence requires a total absorption area of (4 x 150)/1.2 =
500 square feet. The proposed 40 -foot long trench design with 7 feet of effective gravel has a total
absorption area of 560 square feet.
The topography of the lot in the area of proposed construction slopes gently down towards the
south and west at approximately 6%.
The proposed project will have no significant impact on present or future water supply and
wastewater disposal systems serving adjacent properties, nor will it have any significant impact on
reserved space -surface and subsurface, or on drainage. A site for a similarly configured replacement
system is shown on the site plan.
Please give me a call at 345-1355 if you have any questions on this submittal.
Sincerely,
1�wte o.
Ted Moore, P.E.
TRACT782
TRACT 8B
d R 100' r
-----------------------------------------------
{- INSTALL NEW 1250 -GALLON SEPTIC TANK n
-
TRACT8C
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TRACT 7D, SIEFKER SID 83
,y . j.
Jw m ';
SEPTIC SYSTEM UPGRADE
, 49 *0
SITE PLAN
"/
'"
FLATTOP TECHNICAL SERVICES
1INCH =5C FEET
/ p :� THEODORE F. MOORE
!�
14530 EC110 CANYON ROAD
DRAWN BY TFM
�:
CE -3589 ; �cAr
ANCIIORAGE, ALASKA 99516
SEPTEMBER, 2006
�
w pr
HRS ��%I ,
%
,`\'a;►e8s1D �`
NOTE: THIS IS NOT A SURVEYED PLAT.
��
ALL LOCATIONS SHOWN ARE APPROXIMATE.
C.O.
CONSTRUCT NEW 40 -FOOT LONG INSTALL NEW
SOIL ABSORPTION TRENCH W. 1250 -GALLON
7.0' EFF. GRAVEL UNDER DIST. PIPE SEPTIC TANK
4" DIA.
4" DIA. F-810 PERF. PIPE--\ D-3034
NEW4"DIA. FROM NEW
F
40 D-3034 DN. C.O./
M.T. DBI
C.O.
PLAN VIEW
SCALE: 1" = 10'
MONITOR TUBE
CLEANOUT
MOUND BACKFILL 6"
CROSS—SECTION "A" - "Alo
SCALE: I" = 5'
ORIGINAL GROUND
FABRIC OF AtRt
/—FILTER c G, ,
11
4- DIA. F-810 PERF. PIPE f4
7.5 7
1/2"- 2 1/2"SEWER GRAVEL ......... . .......
THEODORE F. MOORE
%f
CE -3569 Ir Ar
BOTTOM OF EXCAVATION
CROSS—SECTION "A" - "Alo
SCALE: I" = 5'
i TEST HOLE # 1
FLATTOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION:_ Tract7D,.Siefker.SID#3
DATE PERFORMED: September 5, 2006
PERFORMED FOR: Wendy Rousalis 8 Robert Senner _ _--
DEPTH
(feet)
1-
2-
3-
4-
5-
6-
7-
8
-
3-
4-
5-
67-8
9'
10--
11 -
12
011-
12 1 13
14-
15-
16-
117-
18-
19-
20
415-
1617-
18-
19
20
COMMENTS:
ML Fine sandy silt fill material
Pt.
SM Reddish sandy loam
SM Fine silty sand
Dry, uniform consistency
Cakey near bottom of test hole
B.H.
e is ,�- • �, ,,, (_t .� �.. � s
i . •'.
/J C
J�r ...`..�:F :7,Q
• i'..0 )CRc F. ADORE j 1•T
Cc -3529 {
••.�(06•� x'04
��.•� tee+
SITE PLAN_____
TRACT 7D
SIEFKER SID #3
N
f ----- �-7
Depth to Groundwater Date
No Grouridwater —, -9/5/06--
Moriitortube dry.—+9112M
Date
Reading
Clods Net Time Percometer
Time (minutes) Reading
Net Drop
(inches)
— —t
--
9/5 _
—]2" Presoak
2712
-
12" Resoak_
_
271/2 —rt—
—2-:01-:50
-- -23
Add water 8 start
#1
water
_ 3/8 —1-----_
2:06:50 _5 _—_;_19 3/8
07 20
T 4 ---_-_-
_Add
_2 _-�_ 233/8
#2
2:12:20_5-19 5/8._ *
2;12:50 - _ _ 23 318 —
—2:17:50_ 5 _ 19 3r4
-33/4-
1
_ 3 5/8
-Add water
#3
PERCOLATION RATE -2— (minutesfinch) PERC HOLE DIAMETER 6"
TEST RUN BETWEEN -6.5 — FT AND_-7,0_Ff
PERFORMED BY FLATTOP TECHNICAL SERVICES. 1�� i •atv —CE RTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 9 / / y / OC
rFYattop 7ecfinicafSemices
14530 Echo Can
yon RP9Anchomge, AX99516
None (907) 34S -135S
Tract 71), Sielker S/D #3
12240 Jerome Street
Wastewater disposal system upgrade
Specifications
1.0 General:
1.1 The scope of the project consists of abandoning an existing log crib seepage pit and
installation of a new 1250 -gallon septic tank that discharges into a new 40 -foot long soil absorption
trench containing a total of 7.5 feet of sewer gravel.
1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor
deviations from these drawings may be allowed or required by the engineer conducting the inspections.
All construction procedures and material specifications shall conform to Municipal and State
requirements. All separation distances shall be in conformance with Municipal requirements, unless
specifically waived.
1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work
around any buried utilities.
1.4 Unless agreed otherwise, the contractor shall be responsible for any tree clearing and
grubbing necessary to complete the project. Prior to the start of excavation, the contractor shall cut
down and remove the branches of all trees larger than 6 inches in diameter and neatly stack these trees
outside the construction area.
1.5 The contractor shall provide adequate cover material and rough grading over all system
components to ensure that proper drainage is achieved after settlement and that there are no residual
depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas.
1.6 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading
after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the
construction.
2.0 Septic Tank:
2.1 The existing log crib seepage pit which shall not be retained in service must be properly
abandoned by thoroughly pumping, removing the top and backfilling with soil.
2.2 The new 1250 -gallon, 2 compartment septic tank shall be Municipally approved and shall be
set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and
a 4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial
type, rigid insulation.
2.3 All pipe connections to the tank shall be equipped with waterproof mechanical couplings.
The waste line from the residence to the septic tank shall have a minimum slope of 1/4"' per foot, and
the waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" per
foot. A cleanout shall be installed I - 4 feet from the building foundation, and a double cleanout shall be
installed within 5 feet downstream of the septic tank.
3.0 Soil absorption system:
3.1 The soil absorption system shall be constructed by excavating a 40 -foot long trench to a
depth of 11.0 feet. The long axis of the excavation shall parallel an existing contour
3.2 The bottom of the excavation shall be level. Any compacted or smeared surfaces shall be
raked to allow proper infiltration.
3.3 A total of 7.5 feet of approved sewer gravel shall be placed in the bottom of the excavation
with the perforated distribution pipes laid level such that the pipe inverts are no less than 7.0 feet above
the bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3%
passing the #200 sieve.
3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown
on the design drawings. The portion of the monitor tube extending through the sewer gravel shall be
perforated.
3.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel. A
minimum of 3 feet of soil cover is to be placed over the filter fabric.
3.6 The top surface of the cover material shall be raised a minimum of 6 inches higher than the
surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill
slopes shall be no steeper than 3:1.
3.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to
have the site finish graded after the backfill material has stabilized, and for placement of adequate
topsoil and seed to promote rapid revegetation of all areas disturbed by the construction.
4.0 Inspections:
4.1 A total of4 engineering inspections will be required during the course of the project: (1)
initial stakeout with the contractor to establish the location of the system and to discuss the plans,
specifications and construction procedures, (2) after the native material has been excavated to expose the
infiltrative surface to ensure that it is level and at the right elevation, and conforms with the soil test
information, (3) after the sewer gravel is in place and the distribution pipes have been laid and connected
up to the septic tank, but prior to placement of insulation or filter fabric, and (4) after rough backfill and
grading is complete. The septic tank requires one inspection after it is set level and the piping
connected, but prior to backfill. This inspection maybe incorporated with any of the above inspections.
4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far
in advance to ensure the availability of the engineer.
Parcel I.D. 015-281-37
Municipality of Anchorage a
On -Site Water and Wastewater Program
(907)343-7904 skrerr
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Complete legal description Siefker #3, Lot 7D
Location (site address) 12240 Jerome St. 99516
Current Property owner(s) M W Lewis
Mailing address
Real Estate Agent
12240 Jerome St.
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Expiration Date: 7 ZG
Day phone
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual
Fxl
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for:
Distance:
Received by:
L41,1,
Date:
x 416
COSA to be released to the engineer, unless otherwise
requested by the engineer.
COSA Fee $ �iQ D
Date of Payment g1/Z�/13 _Cho
Receipt Number 061 Dq G
COSA# Li L I -� It3CA
Waiver Fee $
Date of Payment
Receipt Number
Waiver .#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Pannone Engineering Services LLC
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone
6. DSD SIGNATURE
f/ System #1 Approved for 3 bedrooms
System #2 Approved for _ bedrooms
Disapproved
Phone (907)272-8218
Date 4/15/13
Conditional approval for bedrooms, with the following stipulations:
By:/ Original Certificate Date: Z6
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
COSA blue sheatf 1, c
If more than 1 septic system is on the lot:
COSA Checklist # of
Structure served by this system i
Certificate of On -Site Systems Approval Checklist
Legal Description: Slefker #3, Lot 7D
A. WELL DATA
Well type Private If A, B, or C provide PWSID # _
Before 2006 � " I c1 �lv
Date completed Sanitary seal (Y/N) Y
Total depth
%f�*ft. 33—+ Cased to UNK ft.
"'�j�j FROM WELL LOG
Date of test
Static water level ft.
Well production g.p.m.
WATER SAMPLE RESULTS:
Coliform Neg colonies/100 mL Nitrate 0.193 mg/L
Arsenic 0.540 ug/L Date of sample: 4/10/13
B. SEPTIC/HOLDING TANK DATA
Parcel ID: 015-281-37
Well Log (Y/N) N
Wires properly protected (YIN) Y
Casing height (above ground) 24 in.
AT INSPECTION
4/12/13
33 ft
3.7
Collected by: PES
Tank Type/Material Septic/Steel Date installed 10/9/06
Tank size 1,000 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping C 1 0/ I a Pumper )� S c A C S RA nri ,..n e,- V
C. ABSORPTION FIELD DATA
Date installed 10/9/06 Soil rating (g.p.d.W or ftz/bdrm) 1.2 GPD/SF System type Deep Trench
Length 32 ft. Width 2.5 ft. Gravel below pipe 6.9 ft.
Total depth 10.4 ft. Eff. absorption area 441 ftz Monitoring tube Y Depression over field N
Date of adequacy test 4/12/13 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 510 gal. New depth 33 in.
Elapsed Time: 190 min. Final fluid depth 0 in. Absorption rate >= 450+ g,p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date
IFT STATION
Date installedaze lec7 lions
"Pump on" level at in. "Pump off" level at
Datum Cycles tested _
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100+
Absorption field on lot 100+
Public sewer main 75+
Manhole/Access (YIN)
er alarm level at in.
Meets alarm & circuit
On adjacent lots 100+
On adjacent lots 100+
Public sewer manhole/cleanout 100+
Sewer /septic service line 25+ Holding tank 100+
Animal containment areas 100+ Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+
Water main 10+ Water service line 10+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOTTO:
Property line 10+ Building foundation 10+
Water Service line 10+ Surface water 100+
Curtain drain 50+ Wells on adjacent lots 100+
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 in effect on this date.
Engineer's Printed Name Steven R. Pannone
Date 4/15/13
COSA brown sheet 10-10.12.doc
Absorption field 5+
Surface water 100+
Water main 10+
Driveway, parking/vehicle storage11 0+
Municipality 8f Anchorage
-..\J Development Services Department � °<
Building Safety Division
Onsite Water and Wastewater Program , A ; r
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.orglonsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL-.
FOR A SINGLE FAMILY DWELLING N
Parcel I.D. O!S - Z61 - 3 7 COSA #
Expiration Date: w - .2 1 -_b_7
1. GENERAL INFORMATION
Complete legal description 01, 7 op S re Fkrr C/o -93?
Location(s ite address) f2 -z -'YO Tero�we SF.
Current Property owners) Wte PIX Reuralcr k'401rtrt StOA« Day phone (9 0-7) ' rx- -6o to
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
P o, Box i9y yoo Farr Laekr _ Ak 9f ft7o6
Al'arke, W-4 Day phone
Bill
B,wllle, Dynan„c
Pfo4.
Day phone 3'Y6 -l916
3N1
�C"Sf
*4AcAor o�
hot 946033111
Unless otherwise requested, COSA will be held by DSD for pickup. Pl eaxc cot I ! J3,11
S &when Cot!} ;.jr r`ea cey !oma /�, e k- l-
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
Individual On-site
Individual Holding Tank
❑
Community On-site
❑
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. DSO also Issues COSAs upon request to homeowners. Certificates of Onsite Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional 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 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 F/af-lOi 7-ie,4n:eaF/ S..e.c, Phone S yr- 13Ss-
Address_/NS30 &C40 faAyo+ !i/, i4nc40moa? A -k 95+5/6
Engineer's Printed Name ',o Afe down F. Ma ore Date _ /'Y 1 -+ca --c4, 2-0'407
5. DSD SIGNATURE
_(/ Approved for _3 bedrooms.
Disapproved.• I . I 1
TIK=1 F. MOORE
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 v/� !� Original Certificate Date: 3 - %L _ 0-7
(Rev. HAs(
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.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: � r r o c f 7D S'r a Fk er S /0 VO3 ParcelID: Orf' - z 6 t- 3 T
A. WELL DATA
Well type X1[4'
Date completed JQ 6IC
If A, B, or C provide PWSID #
Sanitary seal (Y/N)
Total depth 71 t ft. Cased to 7 3 * I.
FROM WELL LOG
Date of test .
Static water level
Well production
ft.
9.p -m.
WATER SAMPLE RESULTS:
. , i
Coliform _colonies/100 mL Nitrate o.2vt mg/L
Arsenic: < 5- ppb date of sample: Y / t 6107
B. SEPTIC/HOLDING TANK DATA
Tank TypelMaterial SeAfrc. /SFei/
Tank size 14#400 gal. Number of Compartments 2
Well Log (Y/N) N
Wires properly protected (Y/N) Y
Casing height (above ground) 18+ in.
AT INSPECTION
Io/to/off
31 ft.
g.p.m.
Other bacteria _(_colonies/100 mL
Collected by: Pho f/� Teob $ ✓e
Date installed to / 9 / oti
Cleanouts (YIN) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) _fit High water alarm (YIN) N -A .
Date of pumping N. A. L MtwA Pumper N. A. _—
C. ABSORPTION FIELD DATA
Date installedlot Od Soil rating (g.p.d.lft2 or its/bdrm) I. System type T�t*c4
06%
Length 3 2 ft. Width 2.S ft. Gravel below pipe 6.9 ft.
Total depth W. IV ft. Eff. absorption area 1111 fe Monitoring tube i Depression over field N
Date of adequacy test IJ. A. ( N cw) Results (Pass/Fail) P For 3 bedrooms
Fluid depth in absorption field before test 4 in. Water added Q gal. New depth_ in.
Elapsed Time: 11_ min. Final fluid depth Q in. Absorption rate >= '/S6 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date P. A.
D. LIFT STATION N• A.
Date installed
'Pump on' level at _ in.
Datum
E. SEPARATION DISTANCES
Size in gallons
'Pump off" level at _ in.
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot. 16d'
Absorption field on lot ! 1 9 r
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots > 1000
On adjacent lots > 100
in.
Public sewer main N• A. Public sewer manhole/cleanout N.q,
Sewer /septic service line 2t' Holding tank V. 4 -
Animal containment areas M. A. Manure/animal excrete storage areas N• A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 21'
Property line 13
Absorption field
><
Water main N• A,
Water service line 7 ra'
Surface water _ >
1001
Wells on adjacent lots > 1CV
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 19, Building foundation 3 W Water main N• A_
Water Service line fO' Surface water > 100' Driveway, parking/vehicle storage 1 so'
Curtain drain None Spin Wells on adjacent lots > I tav
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 in effect on this date.
Engineer's Printed Name Tei to choex F. f efcp +
COSA Fee $ O 212- . f
Date of Payment'
Receipt Number
(Rev. 11105) ,
Waivdr Fee $
Date of Payment
Receipt Number
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SCS ReE#
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All Dates/Times are Alaska Standard Time
Client Name
Flattop Technical Srv.
Printed Date?ime
03/15/2007 16:24
Project Name/p
Flattop Tech
Collected Date/rime
02/28/2007 15:00
Client Sample ID
L 7 Siefker SID N3
Received Date/time
02/28/2007 15:57
Matrix
Drinking Rater
Technical Director
Stephen C. Ede
PN SID
0
Sample Remarks:
Parameter Results PQL
Metals by ICP/MS
Arsenic ND 5.00
Waters Department
Total Nitmtc/Nitritc-N 0.241 0.100
Microbiology Laboratory
Total Coliform 100. No Coli
Allowable Prep Analysis
Units Method ContainerhD Limits Date Date Init
ug/L
EP200.8
C
(<10)
03/07/07 0309107
TK
mg/L
EPA 353.2
D
(<10)
02,2&07
1DS
coUl00mL SM2092220 A (<i) 02,2&07 DPT