HomeMy WebLinkAboutT13N R3W SEC 13 LT 38 W2NE4NE4SW4NW4NE4T13N R3W
W2 NE4 NE4 SW4 NW4 NE4
Lot 3 8
006�043�06
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
PermitNumber: OSP111029 PID Number: 006-04-306
Name: James A. Clinton
Wastewater System: E] New W] Upgrade
Address:
8036 Peck Avenue Anchorage, AK 99504
ABSORPTION FIELD
Phone: Number of Bedrooms:
0 Deep Trench J6 Shallow Trench 0 Bed El Mound El Other:
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original grade:
.8 GPD/FF
9.5 Ft.
Block: Lot: Subdivision:
38
Depth to pipe bottom from original grade:
Gravel depth beneath pipe:
5.5 Ft.
4.0 Ft.
Township: 13N Range: 3W Section: 13
Fill added above original grade:
Gravel Length:
0-.5 Ft.
20 Ft.
Well: El New El Upgrade
Gravel width:
Number of lines
Distance between lines
5 Ft
I
- Ft.
Classification (Private, A, B, C):
Total Depth:
Cased to:
Total absorption area:
Pipe Material:
AWWIJ
Ft.
Ft.
200 Ft2
ASTM D3034 PVC
Driller:
Date Drilled:
Static Water Level:
Installer
Date Installed
Ft.
Pomraning Excavation
3/24-25/2011
Yield:
Pump Set at:
Casing Height Above Ground:
TANK
GPM�
Ft.
Ft.
SEPARATION DISTANCES
V] Septic El Holding Ej S.T.E.P. El Other:
T 0
0
Septic
Absorption
Lift
Holding
lublic/Private
Manufacturer,
Capacity:
Fr..
Tank
Field
Station
Tank
Sewer Line
Anchorage Tank
1,000 Gal.
Material:
Number of Compartments:
well
N/A
N/A
N/A
N/A
>25'
Steel
Two
Surface Water
>100'
>100'
N/A
N/A
LIFT STATION
Size:
Manufacturer
Lot Line
>51
>10'
N/A
N/A
V
Gal.
"Pump on" level at:
"Pump off" level at:
High water alarm at
Foundation
>5'
>10'
N/A
N/A
in.
in
in.
Pump Make & Model
Electrical Inspections performed by:
Curtain Drain
None
Noted
Remarks
Existing Cesspool Decomissioned in Accordance With
BENCH MARK
Location and Description:
Municipal Code.
Finished Floor.
Assumed Elevation
100-00 Ft
tgile
,4t< I's t
A. Harala st 3/24/2011
Inspections performed by: Dates:
'W �\
nd
- #
2 3/24/2011
yff
Development Services Department Approval
4 9.m*
0
Conditional Approval Date:
MICHAa L ANXIMON Q-- A0
C..;
0
-4381 7;�;
0 Ar
Reviewed -
Ll
and approved Date
(Re, 04/06)
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
Permit Number: OSP111029 4700 Elmore Road Anchorage, AK 99519-6655 - 343-7904
1 PECK AVE
VA
0
A I B q
S1 19. 3.5'
S2 24.9- 8.5-
C4 3 3. 1V" #17. 0' Ci
C5 1 52 6137 0' M
M1 1 47.4'1 31.8'
LOT 39
............
49th
.......................
:3
ERSON
.MICHAEL E. WD-...
*- No, CE -4381
-zy -
P
N 90'00'00"E w 75.00'
afl0
33' BLM Ei
EASEMENT 01
v
ASPHALT
DRIVEWAY'
GARAGE
One Bedroom
Home
17CO \ le
S11
S
C4
Mi
TH1 6 im
C5
—WOODEN FENCE---'
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P
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0 LOT 38
Cn
Page 2 of 3
PID No. 006-043-06
LEGEND
S1 - Septic Vent
C4 - Clean Out
M2 - Monitor Tube
FCO - Foundation Clean Out
TH - Test Hole
N 90*00'00"W 75.00'
NOTE:
N 180', W75', LOT 38 Existing Cesspool.
Abandon In Accordance
T1,3N, R3W, SECTION 13 ith Municipal Code.
13,500 S.F.
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: OSP1 11029
Page 3 of 3
PID No. 006-043-06
Ln
Q
�i�bli I
No Groundwater
49th
........... a .....................
MICHAEL E. ANDERSON
PROFILE AS -BUILT No, CE -4381
No Scale
............
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ztkl;�_.*060001414 ##,
Municipality of Anchorage :��Y _.GINEER'ASM0'
XN
Development Services Department
Building Safety Division -49M 0
so* .0
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On -Site Water and Wastewater Program "Or"
*0 0* 66a "...4
4700 Elmore Road 0 .0
P.O. Box 196650 Anchorage, AK 99507 MXHAEL L ANDMtWN 0
www.ci.anchorg_qiL.ak.qs
% 4381 4;
(907) 343-7904
AW
Soils Log - Percolation Test to, rRi%00�-�
Az
Performed For: Date Performed:. 3
Legal Description: r 13, Township, Range, Section:
Slope Ste Plan
1 it I I I I
Depth I &"
2
3-
4-
'15-
16-
17-
18-
19-
20 -
COMMENTS
I A.Awt
me"< AV*
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT DEPTH? L
Depth to Water After P
Monitoring?, E
D 3
ate: =
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
17
.1,414f
Is -
1� "(4v
3 c, M14
11
1"_�
6.4f
30
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TESTRUNEIETWEEN FT AND FT
PERFORMED BY: CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
On -Site Wastewater Disposal System Permit
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
Permit Number: OSPI 11029
Tax Code Number: 00604306000
Work Type: Septic Upgrade
Permit Effective Dates: March 16, 2011 to March 15, 2012
Design Engineer: ANDERSON ENGINEERING
Subdivision: T1 3N R3W SEC 13
Site Legal Address: T13N R3W SEC 13 LT 38 W2NE4NE4SW4NW4NE4 G:1241
Owner/Address: CLINTON JAMES A
8036 PECK AVE ANCHORAGE AK 995041420
Site Mailing Address: 8026 PECK AVE, Anchorage Lot Size in Sq Ft:
Total Bedrooms:
This permit is for the construction of:
11977
Y Disposal Field Y Septic Tank N Holding Tank N Privy N 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 (1 8AAC72) and Drinking Water Regulations (1 8AAC80).
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.
Special Provisions:
The disposal field was designed with assumed soil and water table properties gained from
inspection of a cesspool on the property. The Engineer shall complete a soil analysis and
percolation test in accordance with the code prior to construction of the septic field. If the results
require a design change, system construction shall stop pending On -Site review and approval.
Please submit sealed soils and percolation test results with the As -built Inspection Report.
Received By:
Issued By:
Pate: 3/(7 /11
Date: 3
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
Mayor Dan Sullivan
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 0010 - 0q5_ 041
Property owner(s) J_ArAG S CL4 tJ T-0 AJ _ Day phone '70 3 — 0 -7 78
Mailing address 8c)36 -Fe-c4i- kjac-�ov: .4*juAoaA6e7,, 9 s-vj
Site address <A�r� W -
Legal description (Sub'd., Block & Lot)
Legal description (Township, Range & Section) 3�-), S C --r— 13, t.,Dr 3'8
Lot Size fi, 0)'17 Sq. Ft. Number of Bedrooms 0o-)6 Wz4 6'q tJG4SW4f-)0`+
C_ .1
tJ G: 14
THIS APPLICATION IS FOR:
(N all that apply)
Absorption Field X
Septic Tank
54
Holding Tank
0
Privy
El
Private Well
0
Water Storage
F-1
THIS APPLICATION IS AN:
Initial
El
Upgrade
K
Renewal
El
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
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.
A
(Signature of property owner or authorized agent)
fp Rush Fees:
nw
Date of Payment:
i
Receipt Number:
P e r m i t N o. C"',
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GABui1ding\0n SiteTormsUient FormsTermit App_01 041 1.doc (Rev. 1 /11)
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
March 15, 2011
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 Elmore Road
Anchorage, AK 99519-6650
Subject: N 180', W 75', Lot 38, Section 13, T1 3N, R3W
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The existing absorption system on the subject lot consists of a cesspool and must be
upgraded prior to the sale of the residence. We are therefore requesting a permit be
issued for the upgrade of the septic system to accommodate the one -bedroom home
on the lot. The attached Site Plan and backup documentation identify the location and
configuration of the existing and proposed septic system. The existing cesspool will be
abandoned in place and decommissioned in accordance with Municipal code. A new
1,000 gallon septic tank will then be installed on the lot along with a new absorption
trench. The subdivision is served by the AWWU water system and no conflicts exist
between the proposed septic system and any wells or water services on adjacent lots.
Drainage arrows are shown indicating the current drainage patterns. The drainage
patterns will be maintained after construction.
We are proposing to place a test hole prior to construction of the new absorption
trench. A recent inspection of the cesspool indicated no standing water. We are
confident the groundwater table in the area is very deep and the subsurface soils will
absorb water rapidly. We have designed the new trench to be within the 30' radius of
the proposed test hole and have used an application rate of .8 gallons per date per
square foot. We are proposing to place a 20' long trench by 5'wide with a 4' effective
depth. The total depth of the system will be 7'6" with the distribution line at 3'6" below
the existing surface. The test hole will be placed to a depth of 15'with water monitoring
to continue to verify the absence of groundwater. If field conditions are found to be
different than assumed the work will immediately stop and a redesign will be presented
for review and approval.
N 180', W 75', Lot 38, T13N, R3W
March 15,2011
Page Two
The ground surface on the lot slopes slightly to the south in the area of the absorption
trench. The trench will be placed parallel to the contours of the ground as much as
possible and in conformance with design criteria. A minimum of 100'will be maintained
between all components of the septic system and any surface water in the area.
If the system is constructed in accordance with our design the following statements
apply:
1. 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.
2. 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.
3. 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.
4. 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,
E Qt'—�
Michael E. Anderson, P.E.
Attachments
N 180', W75', LOT
38
T1 3N, RM, SECTION
13
13,500 S.F.
PECK AVE
N 90*00'00"E 75.00'
33' BLM
EASEMENT
((D
ASPHALT
DRIVEWAY'
GARAGE
One Bedroom
0
Home
00
FCO
z
0
1,000 Gallon
q
Septic Tank - SV
0
. SV
:n
0
C3
LOT 39
0
0
CO(2)
b
0
LOT 38
a
rn
C 0 C
U
16 MT
TH
H
z
U-
20' Long . 5- Vid a
z
x V Effecttives Depth
U -j
0
Absorption Trench
0
LEGEND
NOTE:
CO — Clean Out
0
Subdivision Served by AWWU
MT — Monitor Tube
M
z
Water System. No Conflicts with
FC0 Foundation Clean Out
_q
Adjacent Septic Systems.
TH Test Hole
M
z
0
Place Test Hole Prior to
M
Construction of Septic System.
Verify Parameters used in
Existing Cesspool.
System Design.
Abandon in Accordance
with Municipal Code.
N 90*00'00'W 75.00'
'A
LOT 38
49th
. . ..... ...... .... . ..... ..
0 ................................................
PLAN VIEW
MICHAEL E. ANDERSON
A No. CE -4381
SCALE 1' 30'
N 1801 1
SECTION
DESIGN FACTORS:
One Bedroom Home
Perc. Rate: 6-15 Min./Inch
Application Rate: .8 GPD/SF
W 75 1 7 LOT 38
13; T13N, R3W
SYSTEM REQUIREMENTS:
5'Wide Trench System
1,000 Gallon Septic Tank
4' Drainfield Rock
1 Bedroom X 150 GPD/.8 GPD/SF (Application Rate) = 187.5 SF Absorption Area
187.5/5 SF/LF-.5 (Red. Factor) = 18.75 LF Trench Length
THEREFORE: Construct a 20' Long x 5'Wide x 4' Effective Depth Absorption Trench at the
Location Shown. Flow Line Elevation in Trench to be 3'6" Below Original Ground Surface. Total Depth
to be 7'6" Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption
Trench. Maintain 10' Separation from Water Service Lines in the Area. Maintain 100' From Any
Surface Water in the Area.
9 "1
410"
Natural
Backfill
Geotextile
Fabric
0 4" Perforated
PVC (Holes Down)
51
Drainfield Rock
TVDI("'Al rV XAIMC: -rDC:klt---U OCY-1-11-ir-iki
NOTE
(NO SCALE)
Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 4' Separation From Groundwater.
Minimum 100' Separation From Wells in the Area.
Minimum 100' Separation From Surface Water or Streams.
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: N 180', W75, LOT 38, SECTION 13, T13N, R3W
GENERAL:
The scope of this project includes the procurement and placement of a new
1,000 -gallon septic tank at the location shown on the Site Plan. Work also
includes the construction of a new 20' long X 5' wide X 4' effective depth
absorption trench at the location also shown on the Site Plan. The
distribution line in the trench will be placed at 3'6" below the existing ground
surface. Total depth of the trench will be 7'6" below the existing ground
surface. The new absorption trench and septic tank must be placed a
minimum of 100' from all surface water in the area and 10' from the water
service line on this and adjacent lots. A minimum of 3' of cover is required
over the absorption trench and 4' of cover over the septic tank. The existing
cesspool on the lot must be abandoned in accordance with Municipal code.
2. Construction shall be in accordance with the approved site plan, design
drawings, Municipal Permit with any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal Regulations.
3. The Contractor shall be responsible for obtaining all underground utility
locates and for the layout of the septic system and verification of the location
of all lot lines. The Contractor must also verify the location of wells in the
area and assure that the separation distances are met.
4. Unless specifically agreed otherwise, the contractor shall be responsible for
final grading areas subsequently depressed from soil settling. Property
owner shall be responsible for revegetation of affected areas unless
specifically agreed otherwise.
5. Contractors installing wastewater
Municipal Building Safety Division
for system installations. Owners
prior approval from the On -Site
beginning system installation.
SEPTIC TANK INSTALLATION
disposal systems must be certified by the
On -Site Water and Wastewater Program
installing their own systems must receive
Water and Wastewater Program. before
A new 1,000 -gallon septic tank must be procured from an approved source
and installed at the location shown. The tank must be designed and
constructed for a maximum burial depth of 8'.
N 180', W75', LOT 38, SECTION 13, T13N, R3W
March 15, 2011
Page 2 of 3
2. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
3. The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
4. All standpipes on the septic tank shall extend a minimum of 12 inches above
final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial
insulation.
6. A foundation cleanout shall be installed one to four feet from the building
foundation. Two cleanouts are required between the tank and the drainfield.
7. Final grading over the tank shall be such that a positive slope exists away
from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown on the design.
The bottom of the trench shall be within 2" of level.
2. Distribution piping must be placed level with perforations down atop a level
bed of drainfield rock. Rock should then be placed over the pipe to provide a
minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between the drainfield rock
and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the locations shown on
the design. The portion below the distribution line must be perforated.
5. Contractor shall verify the septic tank and drainfield are a minimum 100' away
from any private water wells in the area, 150' from a Class "C" Well or 200'
from any community well.
6. Direct bury insulation must be placed over the distribution system if less than
3' of backfill depth is available. Finish grade over the trench must be
mounded to prevent settlement or depressions.
7. Grade area surrounding the absorption trench to drain away.
8. A minimum 2' of accepting soil is required below the drainfield rock for a 5'
wide trench. All pockets of unacceptable materials must be removed and
replaced.
N 180', W75', LOT 38, SECTION 13, TUN, R3W
March 15, 2011
Page 3 of 3
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a municipally approved septic tank
manufacturer.
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and
solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662
or A. B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow
Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Fernco, or equal).
5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed
between the final drain rock layer and the native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the
#200 sieve.
INSPECTIONS:
Municipal Ordinance requires a minimum of two inspections. These inspections
must be conducted under the supervision of a professional engineer registered
in the State of Alaska. The first inspection must be conducted after the
excavation of trenches, beds or pits and before the installation of any gravel. A
septic tank may be set in place, but may not be backfilled.
The second inspection must be conducted after the placement of the geotextile
fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No
backfill should be in place at the time of inspection.
Contractor shall provide a copy of all field survey layout and construction notes
for use in preparing the certified as -built of the completed system.
Parcel I.D. 006-043-06
1-:_1 �90
Municipality of Anchjf- goG o4: ZU16
On -Site Water and Wastewater Pro r
(907) 343-7904 C. S A F E T Y
e c.
A
z
Certificate of On -Site Systems
Expiration Date:. 1 �7
1. GENERAL INFORMATION
Complete legal description T1 3N R3W SEC 13 Lot 38 W2NE4NE4SW4NW4NE4
Location (site address) 8036 Peck Avenue Anchorage, AK 99504
Current Property owneqs) Wayne & Mary Stacks Day phone 242-0241
Mailing address 8036 Peck Avenue Anchorage, AK 99504
Real Estate Agent
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
Duplex
Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
One
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual
FX
Individual Water Storage
Holding Tank
F
Community Class Well
Community
F
Public Water System
El
Public Sewer
F-1
Waiver/Varlance request for..
Received by: lza� &2&44& Date:
COSA to be released to the engineer, unless otdrwijrequested by the engineer.
COSA Fee
Date of Payment
Receipt Number 0 7�9 67
COSA# 05C
�&�3qo
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my sea] 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 ls(are) in compliance with all applicable Municipal and State codes,
ordinances, 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.
6. DSD SIGNATURE
System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved
Phone 522-7773
Conditional approval for bedrooms, with the following stipulations:
Original Certificate Date:
By:
N
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 sheelj - '., c
If more than I septic system is on the lot:
COSA Checklist ft —of
Structure served by this system _
Certificate of On -Site Systems Approval Checklist
Legal Description: T13N R3W SEC 13 Lot 38 W2NE4NE4'W4NW4NE4 Parcel ID:006-043-006
A. WELL DATA
Well type If A, 13, or C provide PWSID
Date completed Sanitary seal (Y/N)
Total depth ft. Casedto ft.
FROM WELL LOG
Date of test
Static water level ft.
Well production
WATER SAMPLE RESULTS:
Coliform colonles/1 00 mL Nitrate
Arsenic — ug/L Date of sample:
261=1
mg/L
Well Log (YIN)
Wires properly protected (Y/N)
Casing height (above ground) _in.
AT INSPECTION
Collected by:
g.p.m.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 3/24/2011
Tanksize 1,000 cial. Number of Compartments 2 Cleanouts (Y/N)
Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N)
Date of pumping 8/5/2016 Pumper Around the Clock Pumping
C. ABSORPTION FIELD DATA
Y
N
Date installed 3/24-25111 Soil rating (g.p.d./ft2 or if/bdrm) '8 GPD/SF System type 5' Wide
Length _ 20 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth 9,5 ft. Eff. absorption area 200 fl� Monitoring tube Y Depression over field N
Date of adequacy test 7/15/16 Results (Pass/Fail) Pass For bedrooms
Fluid depth in absorption field before test 0 in. Water added- 600 gal. New depth_ 8 _ in.
Elapsed Time- 23 min. Final fluid depth 0 in. Absorption rate >= 50 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at
Datum
— Size in gallons Manhole/Access (Y/N)
in. "Pump off" level at_in. High water alarm level
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer Iseptic service line
Animal containment areas
Cycles tested
Meets alarm & circuit requirements?
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
Manurelanimal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >51 Property line >5'
Water main >1 01 Water service line >10,
Wells on adjacent lots >100,
ABSORPTION FIELD ON LOT TO:
Property line >10, Building foundation >10,
Water Service line >10, Surfacewater >100,
Curtain drain None Noted Wells on adjacent lots >1 00'
F. COMMENTS
Lot is served by AWWU Water System.
G. ENGINEER'S CERTIFICATION
/ 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 8/4/2016
COSA brown sheet-10-10-12.doc
Absorption field >51
Surface water > 1001.
Water main >1 01
Driveway, parking/vehicle storage >I 0,
in
0
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program S A F E T V
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. 006-04-306
1. GENERAL INFORMATION
COSA# OSC, M C)9
Expiration Date:
Complete legal description T13N R3W SEC 13 Lot 38 W2NE4NE4SW4NW4NE4
Location (site address) 8036 Peck Avenue Anchorage, AK 99504
Current Property owner(s) James A. Clinton
Mailing address
Lending agency
Mailing address
Real Estate Agent
8036 Peck Avenue Anchorage, AK 99504
Day phone
Day phone
Day phone
Mailing Address
Unless otherwise requested, COSA will
be held by DSD
forpickup.
2. NUMBER OF BEDROOMS:
One (1)
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
z
Individual Water Storage
Individual Holding Tank
El
Community Class Well
El
Community On-site
El
Public Water System
M
Public Sewer
1:1
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
" "" I
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based ort. proceq,,ures outlined in the Certificate of On -Site Systems Approval Guidelines for this aeRlication,
shows that the oh-pte water supply and/or wastewater disposal system is (are) safe, functional and,19dequate
for the number of bedrooms and type of structure indicated herein. I further verify that based ori'the information
obtained fr8m 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 ar�d Siate�bqcfe%
ordinances, 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.
Phone 522-7773
00'
4 Ot At'llIt
AW
0.
00
TO AMCMAEL IL NMRWN 00
-14 - "" AV
5. DSD SIGNATURE -;b CE �- 4381 AV
3 AW
44;"
__�Z Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with thcs following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
VMSTEWATER E.
PROGRAIMI
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Nitrate Advisory Other
B n.,LVO
(Rev. 11/05)
Original Certificate Date:.
S,
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program S A C T V
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEms APPROVAL CHECKLIST
Legal Description: T12NR3WSEC13Lot38W2NE4NE4SW4NW4NE4
A. WELL DATA
Well type _ If A, B, or C provide PWSID #
Date completed Sanitary seal (Y/N)
Total depth ft. Cased to ft.
FROM WELL LOG
Date of test
Static water level
ft.
Well production 9 -P.M.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic: _ ug/I Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Tank size 1,000 gal. Number of Compartments TWO
Foundation cleanout (Y/N) Y Depression over tank (Y/N)
Date of pumping New Construcfion Pumper
C. ABSORPTION FIELD DATA
Date installed 3/24-25/2011 Soilrating (g.p.d./ft2orfl?/bdrm).jGPD/SF System type 5! Wide Trench
Length 20 fte Width 5 ft. Gravel below pipe 4 ft.
Total depth 9.5 ft. Eff. absorption area 200 ft2 Monitoring tube Y Depression over field N
Date of adequacy test New Const. Results (Pass/Fail) For. bedrooms
Fluid depth in absorption field before test in. Water addecl_ gal. New depth n.
Elapsed Time: min. Final fluid depth in. . Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
Parcel ID: 006-04-306
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground) _in.
AT INSPECTION
9.13 -m -
Other bacteria colonies/1 00 mL
Collected by:
Date installed 3124/2011
Cleanouts (Y/N) Y
N High water alarm (Y/N) N
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at in. "Pump ofr level at in.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot N/A
Absorption field on lot N/A
Public sewer main N/A
Manhole/Access (Y/N)
High water alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots N/A
On adjacent lots N/A
Public sewer manhole/cleanout
N/A
Sewer /septic serviceline N/A Holding tank N
Animal containment areas N/A Manure/animal excrete storage areas N//A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5, Property line >5' Absorption field >5'
Water main >10' Water service line >10' Surface water >100'
Wells on adjacent lots >100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >101 Building foundation >10' Water main >10'
Water Service line >19 Surface water. >1W Driveway, parking/Vehicle storage >26
Curtain drain None Noted Wells on adjacent lots >100-
F. COMMENTS: Lot is Served by AWWU Water System.
G. ENGINEER'S CERTIFICATION AW
AW
*** 492J
certify that / 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.
Michael E. Anderson, P.E. 4381
Engineer's Printed Name 0 N, A
*- / I 0-rAJ
000009
Date 4/27/2010
- aSSITMO
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
PECK AVE
N g(rOO'00"E 75.00'
Ui
LO
ASPHALT
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C.4
20' W I
GARAGE -
00
0
C�"
12.3' x 20.1' DECK
CLEANOUTS
EASEMENT
1 —STORY
RESIDENCE
6
OD
.01
kd
0,
LOT 38
0' x 8.0' SHED
--�L7.8'
x 8.0' LEAN TO
*LOT 38
13,500 s.f.
FENCE
LOT 39
*A DEEDED PORTION OF LOT 38
LOT 38 SEE DESCRIP11ON BELOW
PLOT PLAN AS BUILT X SCALE 1 30' GRID . SW 1241 _ Project No. 11 —032ZLcl
Lang & Associates, inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049
(907) 522-6476 Phone
Registered Land Surveyors (907) 522-4625 Fox
1=0 OF Akkl
kglangIsOalaska.not / jclangisOalaska.not 'r, ...
I hereby certify that I have surveyed the following described property:
N116Y. W75 LOT 38, SEC 13, T1.3N, R3W, S.M.
Anchorage Recording District, Alaska, and that the Improvements situated thereon are
within the property lines and do not encroach onto the property adjacent thereto, that
no Improvements on the property lying adjacent thereto encroach on the surveyed
promises and that there are no roadways, transmission lines or other visible
easements on sold property except as Indicated hereon.
Dated this the VV+) Day of ZW . at Anchorage, Alaska
If Is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat.
49-T±1
. ...........
KENNETH LANG
LS, 5202
J
VX
low.