HomeMy WebLinkAboutPARADISE VALLEY BLK 1 LT 17Paradis
Valley
lock I
Lot 17
¢ 020-424
-37
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program, 4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507 Page of
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: osP1 / C~[I '7 '7 PID Number: 020-424-37
Name:
Hieu and Carol Le Wastewater System: [] New [] Upgrade
Address:
P.O. Box 91059 Anchorage, AK 99509 ABSORPTION FIELD
Phone: Number of Bedrooms:
4 [~ Deep Trench [] Shallow Trench [] Bed [] Mound [] Other:
Soil Rating: Total Depth from original grade:
LEGAL DESCRIPTION .45 GPD/FF 14-14.5 Ft.
Block: Lot: Subdivision: Depth to pipe bottom from odginal grade: Gravel depth beneath pipe:
1 17 Paradise Valley 5.5-6 Ft. 8 Ft
Township: Range: Section: Fill added above odginal grade: Gravel Length:
0-1 Ft. 84 Ft.
Well: [] New [] Upgrade Gravel width: Number of Ii .... Distanca between lines:
3 Ft. 2 >16 Ft.
Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material:
Private 340 Ft. 204 Pt. 1,344 Ft2 ASTM D3034 PVC
Driller: Date Ddlled: Static Water Level: Installer: Date Installed:
Sullivan Water Wells 9/10/10 215 Ft. Tweed Excavating 9/22-23/10
Yield: 6 GPM PumP295Set at: Ft. Casing Height>1.5Ab°ve Ground:Ft. TANK
SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P. [] Other:
T~ To Septic Absorption Lift Holding ~ublicJPrivate Manufacturer: Capacity:
Tank Field Station Tank Sewer Line Ray's Services 1,300 Ga[.
Material: Number of Compartments:
we, >100 >100 N/A N/A >25' HDPE Two (2)
surfacawater >100' >100' N/A N/A ~ /i LIFT STATION
Size: Manufacturer:
Lot Line >5' > 10 N/A N/A Gal
"Pump on" level at: "Pump off" level at: in. High water alarm at:
Foundation >5' >10' N/A N/A in in
Pump Make & Model Electrical Inspections performed by:
Curtain Drain None Noted
R .... ks: BENCH MARK
Location and Description:
Garage Slab.
Assumed Elevation:
100.0 Ft
Inspections performed by: A. Harala Dates: 1st 9/22/10
2® 9/23/10
Development Services Department Approval
Conditional Approval Date:
Reviewed and approvod by: / /¢--'~ ~' Date: /:~,-/~'-//
Permit Number: OSP101177
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904
Page 2 of 3
PID No. 020-424-37
3~.0' B
Sl 42.2'
S2 41.9'44.9'
Fsv I 49'4't 50.9'
C4 54.5' 47.6'
M1 94.7' 89.5'
C6 51.0' 57.7'
M2 92.3 92.8'
18
Existing
Well
Existing
Well
C5
~ TH2
FSV
~T
'~ c4 ALTERNATE SITE:
,\ ..~ Advantex Treatment System
"o. 'd~' with 42' Long x 5' Wide x 8'
'"' Effective Depth Absorption
\ '" ~- Trench.
/ /
/
/
/
?
/
16
LEGEND:
C4 - Cleonout
S1 - Septic Vent
TH - Test Hole
M1 - Monitor Tube
MT - Tank Monitor Tube
FCO- Foundation Cleon Out
FSV - Flow Splitter Valve
PLAN AS-BUILT
SCALE 1" = 30'
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number: OSP101177
Page 3 of 3
PID No. 020-424-37
F
1 lion
Septlc Tank I ~89.5 //
93.5
Finished Grade /
OdginaJ Ground
.......................................................................................... _ .G._e_o_!_ez t i_¥_F_ .a.b_d_c .......................
87.3_ ~, Drainfield Rock
79.3--//
42' (Trench Length)
87.3
SOUTH TRENCH
e4 r,,-
94.5 ~
Finished Grade /
Original Ground
Geotext e Fabdc
88.4- A Drainfield Rock, ~
,~-No 73.5 80.3 --'/
G r°u n. qdj~'~r~
95.8
88.3
I 42' (Trench Length) I
NORTH TRENCH
PROFILE AS-BUILT
No Scale
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522.7773 677.7766 (FAX)
MEMORANDUM
DATE:
October 16, 2011
TO:
Jeff Poet
FROM:
Mike Anderson, P.E.
SUBJECT:
Lot 17, Block 1, Paradise Valley Subdivision
Septic System Permit No. OSP111380
COSA
The area where the septic system absorption trenches were placed on this lot was
virtually flat. We arrived on site after the contractor, Tweed Excavating had placed
the absorption trenches in the location shown on the as built. We were not asked
beforehand whether the trench alignment could be rotated 90 degrees. The septic
system permit requires our inspection of the trenches after they have been
excavated. In this case Tweed Excavating decided to override the design and place
the trenches as shown without prior approval.
The entire absorption area lies within the percolation zone and soil strata. The
septic system design is not affected by rotating the absorption trenches 90 degrees.
Permit
Date Sm
Property
Property
Borehole I
Soil Type,
Hah
Hah
Hah
Hah
Bros
Water Sar
Attentio~
P~ae 9S7~9
158
umber: OSP lollrt Date of Issue 9tat2olo
~d: 9/9/2010 Date Completed: 9/19/2010
Description PARADISE VALLEY Lot 17 Block 1
~wner Name & Address:
Well Log
Parcel Identification Number:
Is well located at approved permit location?
Section: Town:
HIEU LE
5900 GREECE DRIVE ANCHORAGE, AK 99516
Depth Method of Drilling
[ [[
ata:
.'hickness & Water Strata
ag Sfickup
)an W/Cobbles
)an W/Clay
~an W/Cobbles
)an W/Clay
n Bedrock
,lc Results:
Arsenic:
Nitrates
Total Coliform Bacteria
Other bacteria:
From To
0 4
4 109
109 151
151 168
168 192
192 340
coloniesdl00mL
020424370O0
Range:
[] air rotary [] cable tool
CASING LEFT TALL TO ALLOW FOR FINAL
GRAOING
Casing type:
Wall thickness 0.25 inches
Diameter 6 inches Total: 204 feet
Liner type:
Diameter inches Depth: feet
Casing stick-up above ground: 4 feet
Statk Water Level(from top of casing) 215 feet
Pumping Level: feet after
a hours pumping gpm
Recovery Rate 6 gpm
Method of Testing:
Well Intake Opening Type
~ Screened Start __. feet Stopped
~ Perforations Start feet Stopped
Grout Type: I~ntoni~ d~/granular Volume: ~0o
Depth 44 Stare 0 feet Stopped 44
Pump Intake Depth: fee¢
Pump size: HP brand name
WeB disinfected upon Completion? X~ Yes [_~ No
Method of disinfection CHLORINE 50 PPM
Comments:
u~ Weft Driller:
Cole Sullivan
$ull~an W~r Wol~
P.O. Box 670~2
Ch~i~, AK ~7
¢ol/lOOmL (907) 688-2769
The property owner shall provide this log to DSD (onsite) and DNR within 30 days of completion_
feet
Pounds
feet
Permit Number:
Tax Code Number:
Work Type:
On-Site Water & Wastewater System Permit
OSP101177
O2O42437O00
WellSeptic
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Initial
Permit Effective Dates: September 08, 2010 to September 08, 2011
Design Engineer: ANDERSON ENGINEERING
Subdivision: PARADISE VALLEY
Site Legal Address: PARADISE VALLEY BLK 1 LT 17 G:3538
Owner/Address: JOHNSON HEIDI MERRILL TRUST
HEIDI MERRILL JOHNSON/TRUSTEE PO BOX 344 MERIDIAN ID 836800000
Site Mailing Address: 18715 Denmark CIR, Anchorage Lot Size in Sq Ft: 21956
Total Bedrooms: 4
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank N Privy Y Private Well N Water Storage
All construction must be in accordance with: 1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
~'~ Date:
Received By: ~
Issued By: /~.~ /~¢j-¢ ~~~ Date: q~/~//~
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
www.muni.org/onsite
(907) 343-7904
ON-SITE SEWER/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
0~P10117'7
Parcel I.D. 020-424-37
Property owner(s) Hieu T. Le
Mailing address P.O. Box 91059 Anchorage, AK
Site address
Denmark Circle Anchorage, AK
Legal description (Sub'd., Block & Lot) Paradise Valley, Block 1, Lot 17
Legal description (Township, Range & Section)
Lot Size ~ Sq. Ft.
Day phone
Zip Code 99509
.Zip Code 99516
Number of Bedrooms Four (4)
THIS APPLICATION IS FOR (~] all that apply):
Absorption Field []
Septic Tank []
Holding Tank []
Privy []
Private Well []
Water Storage []
THIS APPLICATION IS AN:
Initial []
Upgrade []
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.
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment:
Receipt Number:
(Rev. 11/05)
Waiver Fees:
Date of Payment:
Receipt Number:
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
August 27, 2010
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject:
Lot 17, Block 1, Paradise Valley Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 17, Block 1, Paradise Valley Subdivision intends to construct a new
four-bedroom home on the lot. We are therefore requesting a permit be issued for the
construction of a new well and septic system to accommodate the home. The attached
Site Plan and backup documentation identify the location and configuration of the
proposed well and septic system along with the alternate site. Also identified on the
plans are the existing wells and septic systems on surrounding lots. No conflicts exist
between the proposed well and septic system and wells or septic systems on adjacent
lots. Drainage arrows are shown on the site plan showing the grade and direction of
flow on the lot. The drainage pattern will not be changed as a result of this project.
Two test holes were recently placed on the lot in the area of the absorption trench and
alternate site. The logs indicate the presence of gravel with some silt and sand (GM).
The percolation rate of the soil was determined to be between 20 and 54 minutes per
inch. No groundwater was found during the placement of the test holes and none was
noted during the monitoring period. An application rate of .45 gallons per day per
square foot was used in the design of the absorption system. We are proposing to
place a new 1,250-gallon septic tank and 2-42' long by 3' wide by 8' effective depth
absorption trenches to treat and dispose of the effluent generated in the house. The
elevation of the distribution line in the absorption trenches will be 4' below the surface
and the total depth will be 12'. A minimum of 3' of fill or 2" of insulation and 2' of fill will
be placed over the absorption trench and 4' over the septic tank. A flow splitter valve
will be placed to insure even flow to each trench.
The ground surface on the lot in the area of the septic system slopes to the northwest
at a shallow grade. The new trench will be constructed parallel with the contours of the
Lot 17, Block 1, Paradise Valley Subdivision
August 27, 2010
Page Two
slope as much as possible in conformance with Municipal requirements. The new
septic system will be constructed a minimum of 100' from all wells and any surface
water and 10' the proposed and existing water services in the area.
If the system is constructed in accordance with our design the following statements
apply:
The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
ENGLAND AVENUE
...~y. "..;.~...
AREA MAP
1
PARADISE VALLEY SUBDIVISION
LOT 17, BLOCK 1
21,956 S.F.
ALTERNATE SITE:
Advantex Treatment System \ 2-42' Long x 3' W~de
with 42' Long x 5' Wide x 8' \ x 8' Effective Depth
\ Absorption Trenches
Effective Depth Absorption
Trench.
Proposed
Well
TH2
~.1,250 Gallo
Drivewoy
/
TH1
/
Proposed /
\
S2 k
~S1 \\
\
\
\
\
\
Garage
· Bedroom
Home
\
\
\
\
\
\
\
\
\
\
\
\
\
LEGEND:
CO - Cleonout
SV - Septic Vent
TH - Test Hole
MT - Monitor Tube
FCO - Foundotion Cleon Out
FSV - Flow Splitter Volvo
SITE
PLAN
SCALE 1' = 40'
LOT 17, BLOCK 1, PARADISE VALLEY SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Four Bedroom Home Deep Trench System
Perc. Rate: 30-60 Min./Inch 1,250 Gallon Septic Tank
Application Rate: .45 GPD/SF 8' Drainfield Rock
4 Bedrooms X 150 GPD/.45 GPD/SF (Application Rate) = 1,333.3 SF Absorption Area
1,333.3 SF/16 SF/LF -- 83.3 LF Trench Length
THEREFORE: Construct2~42' Long x 3' Wide x 8' Effective Depth Absorption Trenches at the
Location Shown. Flow Line Elevation in Trench to be 4' Below Original Ground Surface. Total Depth
to be 12' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption
Trench. Maintain 100' Separation from Wells in the Area. Place Flow Splitter Valve to Insure Even
Flow to Each Trench.
Natural
Backfill
Geotextile
-- Fabric
4" Perforated
PVC (Holes Down)
Drainfield Rock
TYPICAL DEEP TRENCH SECTION
~NO ~CA~ ....~..~....~.~,,.
NOTE: Grade Area Over Trench to Drain Away ~;.:"'
M~n~mum 6 Separation From Bedrock. ,.....~. 49th
M~nlmum 4' S~paration From Groundwater. ~ ~'7'""~"'~'~"~
Minimum 100 Separation From Wells n th~ A,~= ~'~"~'~~
. , ~ ...... ~ M[CHAELE. ANDERSON
M,n,mum 100' Separation From Sufiace Water or Streams.- ~,/~ No.
Performed For:
Legal Description:
9-
10-
11-
12-
13-
14-
15-
~7-
~8-
20-
COMMENTS
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507
www.ci.anchoraqe.ak.us
(907) 343-7904
Soils Log - Percolation Test
¥7~¥~t,,~,]~,~ ~/~,~y L~i'7,~a~ Township, Range, Section:
Slope/'
II1[
II1
II1'
WAS GROUND WATER iii
I"1
ENCOUNTERED?
IF YES, AT WHAT DEPTH? ~
Depth to Water After .j
Monitoring?
Site Plan
Reading Date Groes Time Net Time Depth to Water Net Drop
PERCOLA~ON ~TE ~ ' (minu,es~nch) PERC HOLE DIAME~R
~STRUN BE~EEN ~ ~ FT AND ¢-'~ FT
PERFORMED BY: 41~ I "~'~~~ERTIFYTHATTHISTESTWAS
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
Municipality o[ Anchorago
( Development Services Department
Building Safety Divisicn
On-Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507
www.ci.an chora_,gg., ak. u_s,
(907) 345-7904
Soils Log - Percolation Test
Performed For:~..~....~. Date Performed: _~.~"~;';~:~
Legal Description: [",~ ,~'~.%fl'~ ~-~ I Township, Range, Section:
8-
9-
10-
12-
13-
14-
15-
1
17-
18-
19-
Site Plan
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT DEPTH?
L
0
Depth to Water After ~ p
Monitoring? ~ I E
Reading Date Gross Time Net Time Depth to Water Net Drop
t
PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~,. FT AND ~- FT
PERFORMED BY: I ~ ~'~ CERTIFY THAT THIS TESTWAS
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~'~'--~"'~/' I>
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COSA Checklist.docx
COSA Checklist
Legal Description: PARADISE VALLEY BLOCK 1 LOT 17 Parcel ID: 020-424-37
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled 9/10/2010 Total depth 340 ft
Cased to 204 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 24 in.
Date of flow test for COSA 9/11/24
Static water level at beginning of test 214 ft.
Well production at time of test 5 gpm
Water storage tank volume NONE gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 4.77 mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Date 9/11/24
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank 47”
Date of pumping 9/10/24
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 9/23/24
ALL standpipes present per record drawing
Total measured depth from existing grade 13.2 ft (max)
Measured depth to pipe invert from grade 5.1 ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes (MT) go to bottom of effective. (ED)
If not, state depth into effective 7.6 ft (SW Trench)
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Adequacy test date 9/11/24
Results Pass (NE / SW TRENCH)
Fluid depth prior to test 22 / 54* in
Water added 600 gal
New fluid depth 29 / 67 in.
Elapsed time 1440 min
Final fluid depth 20 / 54 in (Add 5” ED missing SW Trench)*
Absorption rate 600 gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 96 in (MOA 8’ ED)
Effective depth used 20 / 59 in
Effective depth (ED) remaining 76 / 37 in
Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots, visual
observations, MOA records & appears approximate with 7.6’ or 92” ED w/ 5” ED missing not measurable in the SW trench.
COSA Checklist.docx
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Engineer’s Printed Name CURTIS HUFFMAN, PE Date 9/27/2024
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
well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting &
09/27/24
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
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 020-424-37
COSA # ~_.~.~C~
Expiration Date:
GENERAL INFORMATION
Complete legal description Lot 17, Block 1, Paradise Valley Subdivision
Location (site address) 18715 Denmark Circle Anchorage, AK 99516
Current Property owner(s) Hieu and Carol Le
Mailing address P.O. Box 91059 Anchorage, AK 99509
Day phone
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS: Four (4)
TYPE OF WATER SUPPLY:
Individual Well []
Individual Water Storage []
Community Class ~ Well []
Public Water System []
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
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 pedod 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,
ordinapces, and regulations in effect at the time of installation.
Name of Firm Anderson Engineering
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
DSD SIGNATURE
'~"" Approved for ~/~
Disapproved.
bedrooms.
Conditional approval for
Phone 522-7773
Date 10/8/2011
bedrooms, with the following stipulations:
Attachments: COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
(Rev. 11/05)
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: /~- / ~ -//
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:
A. WELL DATA
Well type Private
Date completed 9/10/10
Total depth 34o f.
Paradise'Valley Subdivision, Block 1, Lot 17
Date of test
Static water level 215
Well production 6
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL
Arsenic: N/D mg/I
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/HDPE
Parcel ID: 020-424-90
IfA, B, or C provide PWSID # ~
Sanitary seal (Y/N) Y
Cased to
FROM WELL LOG
9/10/10
204 ft.
g.p.m.'
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) >24 in.
AT INSPECTION
g.p.m.
Nitrate 1.21 mg/L
Date of sample: lO/6/2Oll
Collected by: MEA
Date installed 9/22/2011
Tank size 1,300 gal. Number of Compartments Two
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N
Date of pumping New Construction Pumper
C. ABSORPTION FIELD DATA
Date installed 9/22-23/2010 Soil rating (g.p.d./ft~ or ~/bdrm) .45 GPD/SF
Length 84' ft. Width 3' ft.
Total depth 15-16 ft. Elf. absorption area 1,344 ft2 Monitoring tube
Date of adequacy test New Const. Results (Pass/Fail)
Fluid depth in absorption field before test in. Water added
Elapsed Time: ~ min. Final fluid depth
Any rejuvenation treatment (past 12 mo.) (YIN & type)
Cleanouts (Y/N) Y
High water alarm (Y/N) N
System type Deep Trench
Gravel below pipe 8' ff.
Y Depression over field N
For bedrooms
~ gal. New depth in.
in. Absorption rate >= g.p.d.
N If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at ~ in.
Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Size in gallons
"Pump off" level at~
Cycles tested
Septic tank/lift station on lot >100'
Absorption field on lot >100'
Public sewer main N/A
Sewer/septic service line >25'
Animal containment areas >50'
in.
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
in.
On adjacent lots >1oo'
On adjacent lots >1oo'
Public sewer manhole/cleanout
Holding tank N/A
Manure/animal excrete storage areas
N/A
>100'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line >5'
Water main N/A Water service line >10'
Wells on adjacent lots >lOO'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Absorption field >5'
Surface water >loo'
Property line >1o' Building foundation >1o'
Water Service line >1o' Surface water >1oo'
Curtain drain None Noted Wells on adjacent lots >1oo'
COMMENTS:
Water main >1o'
Driveway, parking/vehicle storage >10'
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 Michael E. Anderson, P.E.
Date 10/8/2011
COSA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
(Rev. 11105)
ELEV. C~SSU~EO)
18
-.-.-~;.;.; ;-; i
EXISTING
HOUSE
WELL "
O
\
UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES.
THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY.
LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE.
[] LOT SURVEY SURVEY TYPE
[] FOUNDATION AS-BUILT
] FINAL S~UCTURE AS-BUILT
[] PLOT PLAN . . . AS-BUiLT... LOT SURVEY... TOPOGRAPHY
[] AS-BUILT.. , NO CORNERS SET [] RECER'DFICADON AS-BUILT... NO CORNERS SET
PLOT PLANS & LOT SURVEYS
IT iS THE RESPONSIBILITY OF THE BUILDER OR OWNER. PRIOR TO
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE
TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE
THE- EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
SYMBOLS
E~STING PROP(YD~ED ~ ASPHALT
SET REBAR ~ ~ DRAINAGE
FOUND REBAR O O O WOOD FENCE ~ CONCRETE
ASSUMED ELEV. X X X METAL FENCE ~ WOOD DECK
NOTE:
ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE
SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS,
ETC. ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW
MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED.
ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED.
SURVEY CERTIFICATION
PLOT PLAN
I hereby certify that { hove physically sur~yed
the lot drawn and described hereon, and that I
hove f~nd or esteblished ell of the lot corners
es shown on the plan end to the best of my
knowledge end abilities, oll dimensions ho,,e be~
measured true end con'ect.
FOUNDATION AS-BUILT
I, Robert E. Johns, Jr., hereby certify that I
hove perfor~ned on As--Built surly of the
foendotknn on this lot end thor oll the f
dimensions and info,motion os shown hereon ~.~
ore true and no encroachments exist unless
FINAL STRUCTURE AS-BUILT
Prepared by
Robert E. Johns, Jr~ &
Professionol L(:nd Surveyors
1700 Brink Drive.
ANCHORAGE, ALASKA 99504
ASSOC.
Scale:
1" = 40' Rec. Lot S.F.
Dote Surveyed:10/10/11 Drown ~. REJ
Dote Drown: 10/10/11 ~;~7:3538
Legal Description:
LOT 17 BLOCK 1
PARADISE VALLEY
Rec. Plot File No.
C~eo~ed b,~MK
w.o. 11-340