HomeMy WebLinkAboutSCENIC MEADOWS BLK 2 LT 2Scenic
Meadows
Block 2
Lot 2
#051-064-81
Municipality of Anchorage ..;. I; .
Development Services Department'""'.
Building Safety Division "
On-Site Water and Wastewater Program, 4700 Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
Page W of 3
www.cl.anchorage.ak.us (907) 343.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL
INSPECTION REPORT
Permit Number: ,-s OOSS PID Number:
No"
ell eIA(IV Wastewater System: ❑Upgrade
Addle" a
2� ABSORPTION FIELD
P"°^• /� _ S LAS NumMr or B•boaM
O JAZHIP rl.nan p
sn.11o. rr.ncn pew p LwWb
.5' p other
LEGAL DESCRIPTION $° R'°"° TWO Depth Nan Mg." gr«r.
BIW Lot. SuodNron. Depth t0 GPD/Fll ./ Ft.
De
Z 2 pa oonom Rom onpinal p .» Grew »pin D llh p»
To M.p. Rik'Ft.
a•a'or' Fa retlw above alp" Clete Gnval Loi Fr
/t FI. 6
FI.
WeII:AtIJW tl ❑ ew ❑ Upgrade Grnilttenan NWmvall F aNanc.wtw..nlikes :
Cleer°weon (Pnrue. A, S. C) Total o A Ft. ' �• Fl
ca
» Ca b Taal ebeapbon wee Pipe Maieno
Ft.
b ID Flt 16V21
DNIr' Dale chilled.
bbc WON' Leval bnenr-
sXAIAZ ,¢J� JeR•v�Lr Dole °rNalledP11 7
17 �O
Y,NtlFl
Pump SVOL C ,* Hrpnl Aoove Grouts. 7
GPM Fl. TANK
FL
SEPARATION DISTANCES
To Septic Absorption Lift
From
Holding ubbdPnvale
Septic ❑ Holding ❑ S.T.E.P. [I Other.
nu dW r
�/
Tank Field Station
Tank Sewer U
, epeUlY
/
— TOO Gal
Wol •�
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_
LI T STATION
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in
inIn
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Pur* rake b N Electnol Inepeceone pwom,w b,
Tito A,
BENCH MARK
loobon rm Deew,_
wnrtl IreekM,
/o o FL
Inspections performed byA1i iff tlkn f_AJ alE
Dates: 1
Engines lamp
0?
40-7
to
Development Services Department Approval.•
�i •o ' 8
Ark
Conditional Approval0
:
��r9ZH x
Date:
qe
W. :'t"
Reviewed and approved by: .t1 Date: /� ' (� - d 7
lTrtJ1 F: 46256 '.te
�'d�ar"0�'"• ••• '' '•:
(Rev 0406)
//
a�LFnVFCJS'�- •"
S -/
Water Key Box
FCO
ST C01
1
2
1
14.5
25
31
20
83
1500 Gallon Se is Tank
5 Bedroom Double C. 's
Home T 0
.C.O. CO1 O—THE
Septic System Construction
Does Not Preclude Adjoining
Lots From Sanitation
Improvements.
NOR THRIM
ENGINEERING
PO Box 770724
Eagle Rl w . Alaska 99377
907.694. 7028
Absorption Trench
C.O.
O� TH #5 (Garness)
Reserve Site
ope
51.
SCENIC MEADOWS S/D
m' * BLOCK 2 LOT 2
SEPTIC SYSTEM
18.6
20
23.5
30
74
V=40'
RECORD
DRAWING
11/30/07 12 of 3
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ILS
_OG — PEF
OLATION TEST
Date Performed: 6/27/07
Comments:
an 6
Performed ByNan±hRj ng. I CERTIFY THAT THIS TEST WAS
Performed In Accordance with All tate/Municipal Guidelines in Effect
ON THIS DATE. DATE, 6/27/07
NORTHRIM
ENGINEERING +`'` smi� TESTHOLE LOG
�r—••s....-....�.j�:....
Po Box 770724 — L
£0910 Plv . Alaska 99377
907'694.7026 ' GEOTECHNICAL
T. H. 6
6/27/07 1--
Performed For: Mike Quinn
Legal Description: Scenic Meadows
Subdivision, Block 2,
Lot 2
DEPTH
(FEET)
Organic TA
Location:
See
Record
Drawing
2
- ::Q: <-:
GP
Sandy Gravel
4
wF
7
_
Groundwater? No
Depth
--
8
-
Water Depth
9
-
After Monitorin
.None
Date:
10
-
# Date Gross Time Net Time De th
Net Dro
11 -
1 6/27
0
--
4'
--
12
-
2 6/27
10
10 mi
9'
5'
13 -
3 6/27
11
--
4'
_-
14 -
4 6/27
21
10 mi
9'
5'
15 -
5 6/27
22
--
4-
16 -
6 6/27
32
10 mi
9'
5'
17 -
18 -
19 -
20 -
21 -
Percolation Rate 2
Test Run Between 5'
Min./Inch
d
Perc
Hole Diameter 6'
Comments:
an 6
Performed ByNan±hRj ng. I CERTIFY THAT THIS TEST WAS
Performed In Accordance with All tate/Municipal Guidelines in Effect
ON THIS DATE. DATE, 6/27/07
NORTHRIM
ENGINEERING +`'` smi� TESTHOLE LOG
�r—••s....-....�.j�:....
Po Box 770724 — L
£0910 Plv . Alaska 99377
907'694.7026 ' GEOTECHNICAL
T. H. 6
6/27/07 1--
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
Permit Number: SW070055
Legal Description: SCENIC MEADOWS BLOCK 2 LOT 2
Design Engineer: 0838 NORTH RIM ENGINEERING
Owner Name: MIKE QUINN
Owner Address: PO BOX 772641
EAGLE RIVER. AK 99577 -
up-Tjo-?
I L O� `�l5
�� A
Date Issued: May 08, 2007
Expiration Date: May 07, 2008
Parcel ID: 051-064-81
Site Address: NHN BLUE SKIES DRIVE
Lot Size: 40519 SO. FT.
Total Bedrooms: 5 Permit Bedrooms: 5
This permit is for the construction of.
Q✓ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Private Well
❑ ❑Water Storage
All construction must be In accordance with:
1. The attached approved design.
2. All requirements specked 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:
Issued By.
Date: S— �i 07
Date: S i o1
Municipality of Anchorage
Development Services Department
Building Safety Division
—% On -Site Water and Wastewater Program
4700Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
ON-SITE SEPTICIWELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. D51- 0,1LI -%I
Property owner(s) /W I / Day phone 0i (11 MIr
Mailing address Po 7 zcur /��s /c- /�r°c✓ Zip Code 7577
N
Site address
Legal description (Sub'd, Block & Lot)
Legal description (Township, Section & Range)
Lot Size q01 tJ 1 q Sq. Ft.
THIS APPLICATION IS FOR (®all that apply):
Absorption Field
a
Septic Tank
1B
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
Code �??S l i
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 Dwelling and is in accordance with applicable Municipal Codes.
;� � �i �4 4r KG G_%JL n.L
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment:
n ' Waiver Fees: _
3 SI Uv Date of Payment:
Receipt Number. `i 5� Receipt Number:
(Rev. I V05)
bTkGINEERING
NorthRim Engineering
PO Box 770724
Eagle River, AK 99577
907.694-7028
March 6, 2007
MOA On -Site Water & Wastewater Program
4700 Bragaw St
Anchorage, AK 99519
RE: Scenic Meadows S/D, Block 2, Lot 2
A lot is being developed. The soil test was conducted during subdivision approval. The
design is based on this test hole. If conditions are found to be different during
construction, a design change will be submitted. Public water serves the subdivision.
Previous test holes in the area have been over 50% sand. This will be verified during
construction.
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
Design Enclosures
bTFINEERING
Scenic Meadows S/D, Lot 2, Block 2
SPECIFICATION'S & DESIGN GUIDELINES
Wastewater System Sizing: This is a new 5 -bedroom, single family home. This is a new
subdivision and most of the neighboring lots are not yet developed. The subdivision test
hole is being used for soil design basis & groundwater monitor. These lots are large and
are 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/FP with 0.5
reduction factor for utilizing a 5' wide trench. Trench Length = 750 FT=/5'x .5 reduction
factor = 62.5'; 1 line @ 63'. No bedrock was encountered or groundwater was
encountered in the soil test. Soil will be verified to be at least 50% sand.
Specification Requirements: All components and work must comply with the Municipality
of Anchorage Specifications (AMC) & 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 V to 4' from foundation wall, prior
to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing
cleanouts 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 cleanouts 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 1/2 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.
• Insulation board to be extruded direct burial polystyrene (Dow Styrofoam ill or equal)
DESIGN NOTES:
1. Total Depth of Trench is 8'.
Terrain Slopes South.
2. Sewer Service Line minimum 2% slope.
3. Test Hole By Others.
L
4. Lots Served by Public Water System.
Wat r Key Bc
Driveway
5 Bedr
Home
"-j1500 Gallon Septic Tank
M.T.
C.O.'s— ,Absorption Trench
STH #5 (Garness)
Reserve Site
Septic System Construction
Does Not Preclude Adjoining oPe /
Lots From Sanitation 5�
Improvements.
,` I, c 40'
-'t� .... SCENIC MEADOWS S/D
NORTHRIM ZAP •
ENGINEERING * 49m'• •••• * 'BLOCK 2 LOT 2 iPLAN
PO Box 770724 .....:•b: '---------_..---._...-------------------.-._._-_ .LAYOUT
Eagle River. Alaska 99577 a -m •' d�
907.694.7028 - SEPTIC SYSTEM Data/6/07 11 of 4
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Goodall, Joe P.
From: Goodall, Joe P.
Sent: Monday, May 07, 2007 7:27 AM
To: 'NorthRimEng@aol.com'
Subject: RE: Scenic Meadows B2 L2
NORTHRIM ENGINEERING:
SUBJECT: SCENIC MEADOWS BI -2 LT2
ENGINEER NEEDS TO SUBMIT ORIGINAL DESIGN PAPER WORK TO ONSITE PROGRAM FOR PRIOR TO REVIEW.
THANKS, ONSITE PROGRAM MUNICIPALITY OF ANCHORAGE
Joe Goodall
Civil Engineer II
4700 Bragaw St
(ph)907-343-7908
—Original Original Message --
From: NorthRimEng@aol.com [mailto:NorthRimEng@aol.com]
Sent: Friday, May 04, 2007 2:28 PM
To: Goodall, Joe P.
Subject: Scenic Meadows B2 L2
Joe,
We perked the lower layer. It is an excellent sand, with low silt. Data attached. This perk test coincides with GEG Test
Hole #5. The original design will function with this soil. Please Issue approval.
Thanks -Steve
Steve Eng, PE, PH
NorthRim Eng.
907.694.7028
See what's free at AQI„_@4rn.
5/8/2007
S❑ILS LOG - PERC❑LATI❑N TEST
II f i I Date Performed) 5/3/07
IINEERING
Performed For: Mike Quinn
Legal Description: Scenic Meadows Subdivision, Block 2, Lot 2
DEPTH
(FEET)
1 -
2 -
3 -
4 -
5 -
6 -
7 -
8 -
9 -
10 -
11 -
12 -
13 -
14 -
15 -
16 -
17 -
18 -
19 -
20 -
Organic
GP
Sandy Gravel
SP
T.H. Location+ See Attached Design
Groundwater? No
Depth
Sand Water Depth
w/ Gravel AP+or Mnnl+nrinn.NnnP ilntPt
#
Date
Gross Time
Net Time
Depth
Net Drop
1
5/3
0
--
23'
--
2
5/3
9
9 min
29'
6-
3
5/3
30
--
23'
--
4
5/3
39
9 min
29'
6'
5
5/3
70
--
23'
--
6
5/3
79
9 min
29'
6'
21 - Percolation Rate 1.5 min./inch Perc Hole Diameter 6'
Test Run Between 8' and 9'
Commentsi PrP�nakPd MnrP hnn R07 tnnd
Performed By NnrthRim Fng, I CERTIFY THAT THIS TEST WAS
Performed in Accordance with All State/Municlpal Guidelines In Effect
ON THIS DATE. DATEt 5/3/07
CF
NORTHRIM9m .:*
TESTH❑LE LOG
T. H. 1
ENGINEERING
PO Box 770724••...... 5,•' e
Eagle River. Alaska 99377 o[e
�•......•
907.694.7028
GEOTECHNICAL•�
T.
5/3/07
1 of 2
_50
OF
N. ... qS,f-
GARNESS ENOINEERING GROUP. Ltd.
r••
0
SOIL LOC;
LEGAL OMCMPTION:_ gum DRi
SttMAMOK M PM tar T,
PERFORM® IOR: QUM Cbk%"WCT,ON
DATi_ .ha�ma
7963 './�
sib
DRokwcs
Lw
3
CP TO
MIN %///i.
w CP/SP
... POORLY CRADCO
S ORAVELS A NO
:ZT
• BAWD r/ LMTLC
tuVOW:,6
OR NO FNES
7
e
0
'�as
TD CM/SM
to SM
TT
S0.TY 34-40534-405AAD
oRAvcL'e �,
12 SRT �tAnvREs
13—
T.
,s
Te
t7
ii�iiiM
IS
19
PERCOLATION RATE <1 (MIN.1wCH) PERC. HOLE DLA. �
6 (*V-P aS)
]EST RUN YETWEEN 3A FT. AND �^FT.
20
A FOLA HOUR PRC30AA( WAS 1FRFORMCD. S YES ONO
SOILS LOGGED IVY7 1AAUS PERCOLATION TEST PCRFOWD DY:
NICK F&V3TUMAN
COMMNTS: IOTS A. 5. a. k 7.
SHOUW BF CMAGEO So THAT SNOW UMT Vll{�NOT L
PD"RMEP By CEC. Ltd. L JUTM A. CIRNE.HAT S, comfy TTMS WAS
oww Ot ACCORDANCE
CIPAL
WfTH ALL STATE AND MUMCUIDELNES IN EFFECT ON THIS DATE: —4'
:
r••
0
'�as
Goodall, Joe P.
From: NorthRimEng@aol.com
Sent: Thursday, March 29, 2007 3:03 PM
To: Goodall, Joe P.
Subject: SCENIC MEADOWS BLOCK 2 LOT 2
Joe,
Thanks for the call on the test hole. I spoke w/Mike Quinn. He asked if we can do a test hole/perk at construction to verify the
submitted test hole. This has been allowed in the past.
Thanks -Steve
Steve Eng, PE, PH
NorthRim Eng.
694-7028
See whafs free at BOL com.
CAhed SfeVt A8CvT r)ejzr,''r Dlrsfy4,
Sc j4 &an,IJ wc2k k04 ,tcs•j %pole
4/2/2007
5 Tc.OF wfK 7CI 1J ch r? Ar
,
prz V ov'f
Goodall, Joe P.
From: NorthRimEng@aol.com
Sent: Thursday, March 29, 200710:21 AM
To: Goodall, Joe P.
Subject: SCENIC MEADOWS BLOCK 2 LOT 2
Joe,
I have attached the test hole location given to me by Mike Quinn. I am unable to verify due to heavy
snow. Yes to your 2nd question. If you will not accept the test hole 1 will notify Mike Quinn &
request another.
Thanks -Steve Eng
Legal description: -$CELJICINEADOMSBLOCK-2 10-2
The attached paperwork has been reviewed and Is being returned for the following reasons:
1. -PLEASE GIVE INFORMATION TO VERIFY THE TESTHOLE SUBMITTED IS CORRECT TESTHOLE FOR
LOT?
2. -BOTTOM OF PROPOSED ABSORPTION FIELD, ACCORDING TO THE TESTHOLE PROVIDED IS IN A
SOIL STRATA THAT WAS NOT PERKED?
Name of reviewer. JOE
See what's free at AOL com.
-31 z,7 l,l c, 2:1 o p,... —
3/29/2007
Date: March 12, 2007
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Municipality of Anchorage
-. Development Services Department
Building Safety Division
Onsite Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
ON-SITE SEWERIWELL SUBMITTAL COMMENT SHEET
To: NORTH RIM ENGINEERING
Legal description: SCENIC MEADOWS BLOCK 2 LOT 2
The attached paperwork has been reviewed and is being returned for the following reasons:
1. -PLEASE GIVE INFORMATION TO VERIFY THE TESTHOLE SUBMITTED IS CORRECT TESTHOLE FOR LOT?
2. -BOTTOM OF PROPOSED ABSORPTION FIELD, ACCORDING TO THE TESTHOLE PROVIDED IS IN A SOIL
STRATA THAT WAS NOT PERKED?
Name of reviewer. JOE
Date: April 2, 2007
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ek.us
(907)343-7904
ON-SITE SEWERIWELL SUBMITTAL COMMENT SHEET
To: NORTH RIM ENGINEERING
Legal description: SCENIC MEADOWS BLOCK 2 LOT 2
The attached paperwork has been reviewed and is being returned for the following reasons:
1. -PLEASE GIVE INFORMATION TO VERIFY THE TESTHOLE SUBMITTED IS CORRECT TESTHOLE FOR LOT?
2. -BOTTOM OF PROPOSED ABSORPTION FIELD, ACCORDING TO THE TESTHOLE PROVIDED IS IN A SOIL
STRATA THAT WAS NOT PERKED?
Name of reviewer. JOE
Date: March 12, 2007
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
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. 051-064-81
1. GENERAL INFORMATION
Expiration Date: q �Z'ZCiZZ
Complete legal description SCENIC MEADOWS BLK 2 LT 2
Location (site address) 23260 BLUE SKIES CIR, EAGLE RIVER AK
Current property owner(s)
Mailing address
Real estate agent
JOEL & LAURA GILBERT Day phone
12110 BUSINESS BLVD STE 6 PMB 422, Eagle River
2. TYPE OF DWELLING:
E] Single Family (w/wo ADU)
❑ Duplex
❑ -Multiple Dwellings (Single Family and/or Duplex)
2. NUMBER OF BEDROOMS: 5
4. TYPE OF WATER -SUPPLY:
Private Well ❑
Water Storage ❑
Community Well El
Public Water System []
Waiver request for:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Day phone
TYPE OF WASTEWATER DISPOSAL:
Private Septic
F
Holding Tank
❑
Community
❑
Public Sewer
❑
Date:
Distance:
Date of Payment
Date of Payment
Receipt Number 0 2 5 3 9 rl Receipt Number
COSA # OS Ca 0 1 s 2 S Waiver #
5. STATEMENT OF INSPECTION 8Y 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 MIKE N ANDERSON, P.E. Phone 727-8864
Address 4661 NATRONA AVE ANCH AK
Engineer's Printed Name MIKE N ANDERSON, P.E. Date 9-15-20
6. DSD SIGNATURE
System #1 Approved for 5 bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms,
Y '4.9 T H
d ' I
ld �;•• MICHAEL N. ANDERSCN10
CE�r46
with the following stipulationsN 1 0 ESS�d��
.`
MATER A
J P � �I ATER
J�1JJ j1 q8, fir
Original Certificate Date: "G
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 Checklist biue sheet
COSA Checklist
Legal Description: SCENIC MEADOWS BLK 2 LT 2
Parcel ID: 051-064-81
If more than 1 septic system on lot: COSA Checklist * of Structure served by this system
WELL DATA �-� Ky tJ
❑ We a °s filed with Onsite (or attached)
Date drilled
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 Comm. Water
B. TANK DATA
Age of tank(s) 13 years
Tank type/material *
Measured operating fluid level in septic tank 48
M Standpipes/foundation cleanout per record drawing
Date of pumping 9/2/20
D. ABSORPTION FIELD DATA
Which system tested (date installed) 8117107
9 ALL standpipes present per record drawing
Total measured depth from grade $ ft (max)
Measured depth to pipe invert from grade 4—ft (min)
❑ NPA – pressurized field
0 Monitor tubes go to bottom of effective. If not, state
depth into effective
Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced 0 gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes Q No
❑ Coliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic_ 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: * steel septic tank
Adequacy test date 9/2/20
Results E Pass For 5 bedrooms
Fluid depth prior to test 18 in
Water added 750+ gal
New depth 27 in
Elapsed time 1440 min
Final fluid depth 18 in
Absorption rate 750+ gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Q
Septic Tank/Lift Station on Lot > 100'
if No
ft
Community Sewer Manhole/Cleanout > 100'
❑ Yes
if No
ft
r7I Yes
if No ft
Neighboring Tank > 100' j] 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'
ft
Community Wells > 200' Q Yes if No ft
Animal Containment > 50' ❑ Yes
if No ft
❑ Yes
if No
ft
Community Sewer Main > 75' [1 Yes
if No
ft
Manure/Animal Excreta Storage > 100'
❑ Yes
if No
ft
From Septic/Holding Tank on Lot to: (Please
enter distances if less than required)
Building Foundations > 10' ❑ Yes
if No
*51+ ft
Surface Water> 100' Q Yes
if No ft
Property Line > 5' Q Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5' Q✓ Yes
if No
ft
Private Wells > 100' Q✓ Yes
if No ft
Water Main > 10' Yes
if No
ft
Community Wells> 200' Q✓ Yes
if No ft
Water Service Line > 10' Q 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'
Q
Yes
if No
ft
If absorption field is under driveway comment below
Property Line> 10'
Q
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
[✓j
Yes
if No
ft
Private Wells > 100' 0 Yes if No ft
Water Service Line > 10'
�z�
Yes
if No
ft
Community Wells > 200' Q Yes if No ft
Surface Water > 100'
Yes
if No
ft
F. ENGINEER'S COMMENTS
* ALLOWED ON THE LAST COSA DUE TO EXISTING CODE
OF A
G. ENGINEERS CERTIFICATION
0-'A � 0 - • r
OW
!certify that 1 have determined through field inspections and review,*
4 q TM • �!
•. ,-. r
of Municipal records that the above systems are in conformance with
�'• • • = • • • • • • ...... ••...
MOA COSA guidelines in effect on this date.,
•NGt
�° • +_ r -N- AND( SON ; Cr f
4�l
�z�
COSA Checklist yellow sheet
Municipality of Anchorage 6
• Development Services Department 12�ft���e,= °a-<
Building Safety Division Gtr
On -Site Water and 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
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 5I -1X riy - � I COSA # 02 UA55
Expiration Date:
1. GENERAL INFORMATION
Complete legal description nCEnrfc
44gaackjc
3�L1 BZ L2
Location (site address2znd) Af?Lf/F
a/4("4 -,f 13 ewe
Current Property owner(s)1L] t K
E Q ujlA lAe Day phone S?,4e— L//rSS
Mailing address PO 9OX
'7']
Zi�rC//
Lending agency
Day phone
Mailing address
Real Estate Agent U -C'—
4ze)re
w- Day phone l9(/- 1-rS
Mailing Address F�X
r4
F !� Jle/l/e?e-
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
S
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 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 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 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
Address
Engineer's Printed Name 7;'rEt/F F.�/'
5. DSD SIGNATURE
_L� Approved for _ r bedrooms.
Disapproved.
Phone K' 9y 7azda
Date // 3G
e OF Qt Zn.
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 Engineers Report
Other
By:Original Certificate Date:
(Rev., IMS)
..17! vrw.�eve...iv•
• C
$reran W. Eng
� W�
4.r 6255
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineers Report
Other
By:Original Certificate Date:
(Rev., IMS)
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water & Wastewater Program :
4700 Bragaw Street
P.O. Box 196850
Anchorage, AK 99519.6650
www.muni.org/onstte
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: _SCE00- M&446i:w,4 S/J 92 Z Z Parcel ID:
A. WELL DATA 41 JW cJ
Well type _ iJorC e PWSID # Well Log (YM)
Date completed (YM) Wires properly protectedTotal depth ft. ft. Casing height (above nd) in.
FROM AT INSPECTION
Date of test
Static water level ft. ft.
Well production g.p.m.r=00wbaderia
g.p.m.
WATER SAMPLE ULTS:
Coliform onies/100 mL Nitrate mg/L colonies/100 mL
Arsenic: mg/I Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/MaterialA4kwff-4MX '%mac/!G�$ .�L Date Installed
Tank size ISOO gal. Number of Compartments _� Cieanouts (Y/N)
Foundation deanout (YM) Depression over tank (YIN)
—AL_ High water alarm (YM) N
Date of pumping A66 AJ Pumper
C. ABSORPTION FIELD DATA
Date krstalled Jf Soil rating (g.p.d /ftz ocR=abdrm) � System type _�E/✓!� -5
Length i5r4l ft. Width _S ft. Gravel below pipe ft.
Total depth ft. Eff. absorption area Aufe Monitoring lube _)�_ Depression over field
Date of adequacy test A&".,)_ Results (Pass/Fail)
For S- 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.) (YM & type) If yes, give date
D. LIFT STATION
Date installed
'Pump ori level at tn.
Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES
Septi/staflon n onAbsotoPubliSewee line _Animt areas
Size in gallons Manhole/Access (Y/N
'Pump otr level at _ in. High water ala evel at in.
Cycles tested Meek al & circuit requirements?
9M W ELL ON LOTTO: fj W W V
On adjacent lots
On adjacent lots
Public sewer
Holding tank
excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Budding foundation S r �' Property line�a ,'f Absorption field
r r
Water main 1,!!5)f Water service line 16 Surface water / CIO 1,e—
Wells
rWells on adjacent lots Q rfi
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Properly line A9 r Building foundation r� Water main /r7 r+
r /
Water Service line /C rt Surface water 166 Driveway. parking/vehicle storage Z 0
Curtain drain —
F. COMMENTS
G. ENGINEER'S CERTIFICATION
r
Wells on adjacent lots f 60 s
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
Date- 3 d 0 7
COSA Fee $ 67 _�O
Date of Payment d
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
..:...CMI ..............:..
p••N�.IT.............
Ssv`n W. Eng
PE 6256aw
ASBUILT
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
SCALE
FOLLOWING DESCRIBED PROPERTY:
s�Esvi� �E�°Co�vr tis?cor - �! z .
AND THAT NO F.NCROACHMEI&S_ EXIST EXCEPT
OATE,
AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE TK EXISTENCE OF ANY
GRID:
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
H�viy6o
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
FB:
ANY DATA HFOR CONSTRCTION
USDESTABLISHING
0 FENCE LINES,NOR FORBE
BOUND-
ARY LINES.
DRAWN:
s'*�wqkwa'4
OF A C'
Duen. Me,4 Uwed ji
LS -6 18
may'' •�//.9,���
Date: 12/5/07
To: Jeff Poet
140A On -Site Services
MEMO
Steve Eng, PE, PH
(907) 694-7028 tel
NorthRimEng@aol.com
Subject: Scenic Meadows SID, Block 2, Lot 2
Comment Sheet
Jeff,
Number of Pages: 1
This is in reply to the 12/4/07 Comment Sheet:
1. The new test hole on the record drawing is 60 feet from the design test hole. The terrain
between the two test holes is at the same elevation. A percolation test was conducted and the
soil was visually analyzed and found to be consistent with previous test hole; soil results
included with record drawings. A telephone conversation was conducted with Joe Goodall on
6/21/07; he was in favor of altering the trench location. This was done to minimize loss of
trees on the lot.
2.
We can pay an additional fee if you feel it is necessary.
The window sill closest to the septic system was used for bench mark.
a� 4
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.cl.anchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET
To: Steve Ena
Legal description: Scenic Meadows Block 2 Lot 2
SPennit SC.O.S.A. ❑Inspection Report
The attached paperwork has been reviewed and is being returned for the following reasons:
1. System moved from permitted site. Need test hole 6 feet below bottom of trench with 7 day water monitoring.
2. Additional engineering fee required.
3. Which window sill was used for bench mark 1
Name of reviewer: Jeff
Date: December 4, 2007
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK