Loading...
HomeMy WebLinkAboutSOUTH LAKEWOOD HILLS #1 BLK 5 LT 4South Lakewood Hills #1 Block 5 Lot 4 #015-151-31 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: OSP111048 PID Number: 015-513-10 Name: Robert and Jennifer Herzog Wastewater System: ✓❑ New ❑ Upgrade Address: 18750 Danny Drive Eagle River, AK 99577 ABSORPTION FIELD Phone: Number of Bedrooms: Four V Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other: LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: 45 GPD/Fe 12 Ft. Block: 5 Lot: 4 Subdivision: So. Lakewood Hills #1 Depth to pipe bottom from original grade: Gravel depth beneath pipe: 3 Ft, 9 Ft. Township: Range: Section: Fill added above original grade: Gravel Length: .5-2 Ft. 76 Ft. Well: W1 New ❑Upgrade Gravel width: Number of lines: Distance between lines: 3 Ft. 1 -Ft. Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material: Existing 173 Ft. 173 Ft. 1,368 Ftz ASTM D3034 PVC Driller: Date Drilled: Static Water Level: Installer. Date Installed: Alpine Drilling 6/16/11 137 Ft A Plus Home Services 5/26-27/11 Yield: Pump Set at: Casing Height Above Ground: 15 GPM 155 Ft >1.5 Ft. TANK SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Holding ublic/Private Manufacturer. Capacity: From Tank Field Station Tank Sewer Line Anchorage Tank 1,250 Gal, Well >100, >100' >100' N/A >25' Material: Steel Number of Compartments: Two (2) Surface Water >100' >100' >100' N/A LIFT STATION Size: Manufacturer: Lot Line >5' >10' >5' N/A Gal. "Pump on" level at: "Pump off' level at: High water alarm at: Foundation >5' >10' >5' N/A in. in. in. Curtain Drain None Noted Pump Make & Model Electrical Inspections performed by: Remarks: BENCH MARK Location and Description: Back Deck Northeast Corner. Assumed Elevation: 100.00 Ft, performed by: A. Harala Dates: 1s' 5/26/11 QInspections ®� 2nd5/27/11 ,W •`•' ..:. •:S.r Development Services Department Approval T / ' 49-� Conditional Approval Date: "" "' "`° °'°° ""`�"'�'� .............° .....""'+L�2.. .4lo �MIGHAEL 6. Ao7�N. cor ®� CE:0 1 �r �� Ar A• :t ��� AV Reviewed and approved by: Za Date: /r ' �� ®��PROFESSION (Re,. 04/06) L i FE W O bd C H TI -I (n K: C7 r C)7: m I I I I I m cD Z p (D O CD 0 C U) O O O O O O O = C C m O fD 7 C (D C) 0 3 O C AMD8d50N 6MGlNLdB/AC N 00'05'00"W 160.00 10' UTIL. ESMT. / ------------------------- I / I I � I I i I IU, CST AN ��®= Im PJ (n I I O -I v N m O> N v OJ V (T T _I I CI / I o o r r � 0. C mI < I r' Z0 co I <. / 0 I / O I 3� a� I I ; I I � I I c- I � I I I m I I m I I �I ®m I r I I I I I I N UU UJ UU W 1 bU.UU m CD 3 z c 0- m O m 0 00 m 3 0 (D o < vm Q" O � oma 0 Z Vl m m'< ><0 C7 D fDm0 Ul 00 C-0mv 0-)D0 (jn ;u cn --q LK M wz v � O O .A W O AWtea,` O : Q z m O r • :� `+ — — — O N) cn 0, zcwo R,2 W 0 •� ���CN Z t •• L i FE W O bd C H TI -I (n K: C7 r C)7: m I I I I I m cD Z p (D O CD 0 C U) O O O O O O O = C C m O fD 7 C (D C) 0 3 O C AMD8d50N 6MGlNLdB/AC N 00'05'00"W 160.00 10' UTIL. ESMT. / ------------------------- I / I I � I I i I IU, CST AN ��®= Im PJ (n I I O -I v N m O> N v OJ V (T T _I I CI / I o o r r � 0. C mI < I r' Z0 co I <. / 0 I / O I 3� a� I I ; I I � I I c- I � I I I m I I m I I �I ®m I r I I I I I I N UU UJ UU W 1 bU.UU m CD 3 z c 0- m O m 0 00 m 3 0 (D o < vm Q" O � oma 0 Z Vl m m'< ><0 C7 D fDm0 Ul 00 C-0mv 0-)D0 (jn ;u cn --q LK M wz v � O O .A W O z WILDWOOD DRIVE — — m — — — O N) cn 0 W 0 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: OSP111048 U .15 r97.2 90.6 N N M U UU 1,250 Gallon Septic Tank Page 3 of 3 PID No. 015-513-10 LO � U Z&HR: PROFILE AS -BUILT - No Scale .................................... MICHAEL E. ANDERSON r� No. CE -4381 ����pROFFCC\ONP�� 4 ROM :Alpine Drilling FAX NO. :907 345 0202 Oct.19 2011 09:56AM P1 Alpine Drilling & Enterprises Well Log Permit Number: #SWOSP111048 Date of, Issue: 5-9-11 Parcel Identification Number: 07575131000 Date Started: 6-14-11 Date Completed: 6-16-11 Is well located at approved permit location? x Yes ❑ No Legal Description: Property Owner Name & Address: South Lakewood Hills #1 Block 5 Lot 4 Herzog Robert D. & Jennifer J. 18750 Danny Dr. Eagle River Alaska 99577 Borehole Data: Soil Type, Thickness & Water Strata Depth (ft) From To Method of Drilling x air rotary ❑ cable tool Casing type: steel. Stick-up 0 2 Wall Thickness: .250 inches Organics &silt Gravelly silt 2 3 3 31 Diameter: 6 inches Depth: 173 feet Liner Type: Diameter: inches Depth: feet silt 31 79 Casing stickup above ground: 2 feet Static water level (from ground level): 15*1 feet gravelly silt 79 112 gravel 112 135 Pumping level: 173 feet after silt 135 164 1 hours pumping 15 gpm ' silty water sand & gravel 164 173 Recovery Rate: 15 gpm Method of Testis : air li Well Intake Opening Type: x Open End ❑ Open Hole ❑ Screened Start feet Stopped feet Perforations Start feet.,,_Stopped feet Grout Type: Bentonite Volume: 2.fts Depth: Start 0 feet Stopped ? feet Pump: Intake Depth feet Pump size hp Brand Name Well Disinfected Upon Completion? x Yes Lj No Method of Disinfection: chlorine tablets Comments: 1 �L Well Driller: Alpine Drilling & Enterprises PO Box 110496 Anchorage, Alaska 99511 Legal Description Proper caner Tam- Addr ss: 3', G NH °N Pump Installation Date: / Pump Intake Depth Below Top of Well Casing: / feet Pump Manufacturer's Name: �✓r��i Pump Model: Pump Size hp Pitless Adapter Burial Depth: Ct//<' feet Jf%'PPitless Adapter Manufacturer's Name: c_.)/`*- Pitless itless Adapter Installer: /"-- Well Disinfected Upon Completion?0 Yes ❑ No Method of Disinfection: Comments: Pump Installer Name: Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Development Services Department Building Safety Division .: 6E 8 On -Site Water & Wastewater Program x 4700 Elmore Road y d P.O. Box 196650 Mark Begich Anchorage, AK 99507 s A E T Y 9 Mayor www.muni.org/onsite (907)343-7904 Pump Installation Log D5 P I 1104 Well Drilling Permit Number: SW Date of Issue: l Parcel Identification Number 1j L oo® Legal Description Proper caner Tam- Addr ss: 3', G NH °N Pump Installation Date: / Pump Intake Depth Below Top of Well Casing: / feet Pump Manufacturer's Name: �✓r��i Pump Model: Pump Size hp Pitless Adapter Burial Depth: Ct//<' feet Jf%'PPitless Adapter Manufacturer's Name: c_.)/`*- Pitless itless Adapter Installer: /"-- Well Disinfected Upon Completion?0 Yes ❑ No Method of Disinfection: Comments: Pump Installer Name: Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. On -Site Water & Wastewater 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: OSP111048 Tax Code Number: 01515131000 Work Type: WellSeptic Initial Permit Effective Dates: May 09, 2011 to May 08, 2012 Design Engineer: ANDERSON ENGINEERING Subdivision: SOUTH LAKEWOOD HILLS #1 Site Legal Address: SOUTH LAKEWOOD HILLS #1 BLK 5 LT 4 G:2638 Owner/Address: HERZOG ROBERT D & JENNIFER J 18750 DANNY DR EAGLE RIVER AK 995770000 Site Mailing Address: 11110 WILDWOOD DR, Anchorage Lot Size in Sq Ft: 30400 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. Special Provisions: 1. The entire subsurface disposal field and/or alternate is not within a 30 foot radius of a percolation test. The Engineer needs to do an additional percolation test prior to the construction of the septic field. Please submit stamped and signed results with the As -built Inspection Report. If the results require a design change, construction of the system will stop pending On -Site review and approval. AMC 15.65.060.B.3 2. Test hole #2 will be deepened to verify the absence of bedrock or an impermeable layer. Received By: Issued By: Date: Date: S MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 ♦ Program Mayor ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D."fS - �S I - 3i Property owner(s) 120 LSCVZ . "t Tr,4iJ-FC72- d 0Z ZD 6 Day phone Mailing address / %75--o _bA-t,3rJ N rJE ,1L_AL i�� �V��-- 4e- ` 45_77 Site address 11t/o tJ Lh(jDdD PrUvc, N-1.r�c)+t.A& . A4'- `"9516 Legal description (Sub'd., Block & Lot) torq. b'i octt a Scw-m 1Awiicoo 0% s Legal description (Township, Range & Section) Lot Size 30, 400 Sq. Ft. Number of Bedrooms'�'C^0 A- 4) THIS APPLICATION IS FOR: THIS APPLICATION IS AN: (® all that apply) Absorption Field Initial Septic Tank Upgrade ❑ Holding Tank ❑ Renewal ❑ Privy ❑ Private Well Water Storage ❑ 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. (Signature of property owner or authorized agent) Permit/ ush Fees: �7? i Waiver Fees: ate of Payment: Date of Payment: Receipt Number: G-1 Dl. J Permit No. ©5 Tpu a Receipt Number: Waiver No. GABuilding\On Site\Forms\Client FormsTermitApp_010411.doc (Rev. 1/11) ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) May 1, 2011 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 4, Block 5, South Lakewood Hills Subdivision No. 1 Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The owner of Lot 4, Block 5, South Lakewood Hills Subdivision No. 1 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 placed on the lot in the area of the absorption trench and alternate site last November. The logs indicates silty gravel (GM) from 1' below the surface to the bottom of the test hole. The percolation rate of the soil was determined to be 32 and 44 minutes per inch. No groundwater was found during the placement of the test holes and none has been 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 a new 75' long by 3' wide by 9' effective depth absorption trench to treat and dispose of the effluent generated in the house. The elevation of the distribution line in the absorption trench will be 3' 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. The alternate site will include an Advantex Treatment System with a 35' long by 3' wide by 9' effective depth absorption trench. The ground surface on the lot in the area of the septic system slopes slightly to the northwest. The new trench will be constructed parallel with the slope as much as Lot 4, Block 5, South Lakewood Hills No. 1 May 1, 2011 Page Two 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: 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, Michael E. Anderson, P.E. Attachments I MICHIGAN �BCQ\LEVARD\ ' � I I I — _----____—__---___—_--_--_� Ii i I ' i 2 3 I 4 0 I I '—----------------�_� i. — *-----------------------� III , � W v~i I J \\ I 4 0 Z i ExisUng ?� i Well ------------- r--- I I i I 00 \ I I 6 I 1 I I I I \U1 , '; 1 Exis ing ' II Well III i i \ i i I49 � 1 112th AVENUE I � I 1 I I I ' 1 I \ l 0 I I 1 I � I I I I 1 1 ' i I I I I I W, OF ���'14 AV 0D c 49th AREA MAP ;:%: �; .�-_t<;. MICHAEL E. ANDERSONAV ;Ar SCALE 1' = 100' •��: NO. CE-4381 AV ••���� ��FESS14��i♦ ♦• I I I I I F�cieting Well I I Well i 11\ 11 i i it it \ \ I 1 1 --- f I I / I I Septic I I lVe7 , 1 I i Proposed Well I , I I II I I I f , I II Existi ng�_----- I Well I I I I I I , Existing i I Well I i I II O O pZ z Q D S W rn ID p M Z CD aa (1) V �(D CcDN CD O- Ul D '4 cr o m r O CD v � rt O S 7 J CD Cn m O p` S a0 N nn•n5'nn"w 1 Fn nn' 10' UTIL. ESMT. / N., cF ��•�m H V O O pZ z Q D S W rn ID p M Z CD aa (1) V �(D CcDN CD O- Ul D '4 cr o m r O CD v � rt O S 7 J CD Cn m O p` S a0 N nn•n5'nn"w 1 Fn nn' N UU Ub UU W 1 6U.UU a w W O WILDWOOD DRIVE co 6 O O fTl • • F- 0 0 w^ 0 0- 41 -41 O O C) i (n f— Z 0 F— n F- C,Tl -T-1 10' UTIL. ESMT. / r--------------------------- I �x(A> / (q Na I I�/ o o�x = ;rte mmW; I < m w �� Ro � ex j Icli I � Tm / /�. � I a I 0IU) Q O I� CD I CD o O 7 rt 2 /ice_ J cel 3CDop a� `D W I c I c C rt x J I r,l LI po� I I o S CD I I 05 mac, I 1 ° I 0 cn 0 c I Jia=<�o m Cli I I / a 0 Asn I �cn z L ----J CD �o � o p x x I CA C CA I aoO_<� cn 0 :3 CD CD D I o �CD n I CD o i 0 < 02--o0 —0 I o m I I � I N UU Ub UU W 1 6U.UU a w W O WILDWOOD DRIVE co 6 O O fTl • • F- 0 0 w^ 0 0- 41 -41 O O C) i (n f— Z 0 F— n F- C,Tl -T-1 LOT 4, BLOCK 5, SOUTH LAKEWOOD HILLS SUBDIVISION NO. 1 DESIGN FACTORS: SYSTEM REQUIREMENTS: Four Bedroom Home Deep Trench System Perc. Rate: 31-60 Min./Inch 1,250 Gallon Septic Tank Application Rate: .45 GPD/SF 9' Drainfield Rock 4 Bedrooms X 150 GPD/.45 GPD/SF (Application Rate) = 1,333.3 SF Absorption Area 1,333.3 SF/18 SF/LF = 74.05 LF Trench Length THEREFORE: Construct a 75' Long x 3' Wide x 9' Effective Depth Absorption Trenches at the Location Shown. Flow Line Elevation in Trench to be 3' 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. .o 3' Drainfield Rock TYPICAL DEEP TRENCH SECTION (NO SCALE) .•�E OF,... •1.4 NOTE: Grade Area Over Trench to Drain Away. : . ,............ ,..::... Minimum 4' Separation From Groundwater. s yI . (, t............................................ Minimum 100' Separation From Wells in the Area. #. A , MICHAEL E.ANDERSON Minimum 100' Separation From Surface Water or Streams. �i%n NO. CE -4381 ••••��� FESS. ... Natural Backfill 2'6" Geotextile Fabric 6" O 4" Perforated PVC (Holes Down) .o 3' Drainfield Rock TYPICAL DEEP TRENCH SECTION (NO SCALE) .•�E OF,... •1.4 NOTE: Grade Area Over Trench to Drain Away. : . ,............ ,..::... Minimum 4' Separation From Groundwater. s yI . (, t............................................ Minimum 100' Separation From Wells in the Area. #. A , MICHAEL E.ANDERSON Minimum 100' Separation From Surface Water or Streams. �i%n NO. CE -4381 ••••��� FESS. ... 1- 2- 5- 9- 10- 11- 12- 13- 15- 16- 17- 18- 19 - q WAS GROUND WATER Net Time ENCOUNTERED? Net Drop Municipality of Anchorage IF YES, AT WHAT DEPTH? Development Services Department • G? •• •'.�� Building Safety Division *A 4918 � • � C� �r On -Site Water and Wastewater Program 4700 Elmore Road • �•• ••• .••. . ....;... f:; 0 P.O. Box 196650 Anchorage, AK 99507 ................................... MICHAEL E ANDERSON es www.ci-anchorage.ak.us (907) 343-7904 �" ACC j+ % IE - 4381 ." 4`" sc 16 4V� (minutesfinch) Soils Log - Percolation Test o P_5poFr'ssio�a` �•® Performed For. Date Performedi g04 'ZO Legal QascriptionSouth t 1 O Lakeyv6iid_:Hills-:Subd.,L4, BIk.5-.- anger Section:-- r Fe �1 Site Plan 1- 2- 5- 9- 10- 11- 12- 13- 15- 16- 17- 18- 19 - q WAS GROUND WATER Net Time ENCOUNTERED? Net Drop IF YES, AT WHAT DEPTH? L Depth to Water After Monitoring?�L(1ii O 1 E Date: a7 Reading PERCOLATION RATE TEST RUN BETWEEN —COMMENTS-Perc_cavity was presoaked-.__-_- _ Date Gross Time Net Time Depth to Water Net Drop 14, 16 4V� (minutesfinch) PERC HOLE DIAMETER of FT AND, fi FT PERFORMED BY: A. Harala .24R I k,,: C ' {-CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCWITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 5 -Z- Depth (Feet) 9- Municipality of Anchorage Development Services Department Building Safety Division w �,r On -Site Water and Wastewater Program L 11- I 4700 Elmore Road O �P ••� P.O. Box 196650 Anchorage, AK 99507 AjCr E mm w.ci.anchorage.ak.us Date: (907) 343-7904 1¢So Soils Log - Percolation Test Performed For. Date _egal v _ption:. _South Lakewood _Hills Subd.,L4, BLk 5 ` Range, -Se Vil.-J— Slope_ - : I I I I I Depth (Feet) 9- WAS GROUND WATER ENCOUNTERED? - t — j[-V�---S 10- IF YES, AT WHAT DEPTH? L 11- Depth to Water After O �P ••� Monftoring? AjCr E 12- Date: 319 �evoa�.�a� 9 v t OF INEE S" ®.' 49TH . •...• r..r. ...... 00 ...� .......... ............ ®� .MICHAEL E. ANDERSON CE - 4381 �IrF��.•11-19-cp •••4��0 ••....•• formed] Site Plan 0 13- 14- 'f Reading Gt Date Gross Time Net Time Depth to Water Net Drop 157 111110 I 14 ••� 1� �� _ 16; (0 319 1¢So 17- 7-18- 18- 19- 1-)* , it 3 n, b 4 PERCOLATION RATE PERC HOLE DIAMETER l� (minutes/inch) TEST RUN BETWEEN. FT AND - FT -COMMENTS-Pere cavity was presoaked--- --- PERFORMED -BY: A. Harala y itil � - i ay -d' -I CERTIFY THAT THIS TEST_ WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: Z -- it a4. • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval F Parcel I.D. 015-151-31 Expiration Date: I ! 7 " I 1. GENERAL INFORMATION Complete legal description 11110 Wildwood Drive Anchorage, AK 99516 Location (site address) South Lakewood Hills #1, Block 5, Lot 4 Current Property owner(s) Robert & Jennifer Herzog Day phone Mailing address 11110 Wildwood Drive Anchorage, AK 99516 Real Estate Agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Four Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual 2 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: VV V� 1 . ..--:711 Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ COO. W Waiver Fee $ Date of Payment 3&3 Date of Payment Receipt Number 6I -,(`t4 Receipt Number COSA# LIS cl3NO Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Phone 522-7773 Date 8/22/2013 s4; 49TH aA 6. DSD SIGNATURE p...............R... .. _System #1 Approved for bedrooms / n� o MICHAn�k it{» asow� ,0 %• CE -4381 System #2 Approved for _ bedrooms rf : Disapproved �PROfE5510�po►O Conditional approval for bedrooms, with the following stipul�TE?��� By. Original Certificate Date: 3 Th unicipalily ofA6chorage 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 Uue sheet r :. c If more than 1 septic system is on the lot: COSA Checklist # _of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: South Lakewood Hills #1, Block 5, Lot 4 A. WELL DATA Parcel ID: 015-151-31 Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 6/16/11 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 173 ft. Cased to 173 ft. Casing height (above ground) >18 in. Date of test FROM WELL LOG 6/16/11 Static water level 137 ft. Well production 15 9 p -m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate '594 mg/L Arsenic N/D ug/L Date of sample: 8/2/13 AT INSPECTION 8/21/13 133 ft 2.2 g.p.m. Collected by: Anderson Eng. B. SEPTIC/HOLDING TANK DATA an Type/Material Septic/Steel Date installed 5/26/11 Tank size 1,250 gal. Number of Compartments 2 Cleanouts (YIN) Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) Date of pumping 8/22113 Pumper Isaac's Pumping C. ABSORPTION FIELD DATA Y N Date installed 5/27/11 Soil rating (g.p.d./ft2 or ft2/bdrm) .45 GPD/SF System type Deep Trench Length 76 ft. Width 2'5 ft. Gravel below pipe 9 ft. Total depth 12-14 ft. Eff. absorption area 1,368 ft2 Monitoring tube Y Depression over field N Date of adequacy test 8/21/2013 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 23 in. Water added 600 gal. New depth 25 in. Elapsed Time: 60 min. Final fluid depth 23 in. Absorption rate >= 600 9 p d Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at in Datum E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot _ Absorption Feld on lot Public sewer main N/A Sewer /septic service line _ Size in gallons "Pump offlevel at Cycles tested _ >100' >1 00' >25' Animal containment areas >50 SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5 Property line >5 Water main N/A Water service line Manhole/Access (Y/N) in. High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots >100' On adjacent lots >100' Public sewer manhole/cleanout N/A N/A Holding tank Manure/animal excrete storage areas >100' Absorption field >5' > 10' Surface water >100' Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line >10, Building foundation >10' Water Service line >25 Surfacewater >100' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. Date 8/22/2013 COSA brown sheet 1 D-10-12.doc Water main N/A Driveway, parking/vehicle storage >10' Municipality of Anchorage Development Services Department Building Safety Division "" x Q x C On -Site Water and Wastewater Program 11 ` TpY 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D. COSA# O`3C.kk�quh Expiration Date: / 2-- 1. GENERAL INFORMATION Complete legal description Lot 4, Block 5, South Lakewood Hills Subdivision No. 1 Location (site address) 11110 Wildwood Drive Anchorage, AK 99516 Current Property owner(s) Robert and Jennifer Herzog Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 18750 Danny Drive Eagle River, AK 99577 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER AF BEDROOMS: Four 3. TYPE OF WATER SUPPLY: Individual Well ✓❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone Day phone 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 period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 5. DSD SIGNATURE _Approved for bedrooms. Disapproved. Phone 522-7773 Date 10/19/2011 IL 0 w A� �` t AW AIF AN �; •'�- fe 49 ,# 00 . i i .r.....•.� 10 7 ••NH.... .. ��N����N��.pp.��..�/..��.N.� JO .ANIC AEA L PMD.1-40 e J, CE *X4381 ,W •0 a .. �� A �1 01* 41W PROFESS�4i1♦4 h1, 1"N� Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory - ON-SITE y � WATI•'P1 A\111 • •.}. STEWATER PROGRAM 4 i,f•r�C►Yt J Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: G'� �` Original Certificate Date: d 2_5_ f r (Rev. 11/05) Municipality of Anchorage u. OpF '' rcS • Development Services Department:, _. Building Safety Division On -Site Water & Wastewater Program $ . `' Y 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: Lot 4, Block 5, South Lakewood Hills Subdivision No. 1 Parcel ID: 015-513-10 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 6/16/11 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 173 ft. Cased to 173 ft. Casing height (above ground) >18 in. FROM WELL LOG AT INSPECTION Date of test Static water level 6/16/11 137 ft. Well production WATER SAMPLE RESULTS: 15 9.p -m. Coliform 0 colonies/100 mL Nitrate •74 mg/L Arsenic: N/D ug/I Date of sample: 10/9/2011 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,250 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping New Construction Pumper C. ABSORPTION FIELD DATA ft. Collected by: M. Anderson Date installed 5/26/11 Cleanouts(Y/N) High water alarm (Y/N) Y N Date installed 5/27/11 Soil rating (g.p.d./ft2 or ft2/bdrm) .45 GPD/SF System type Deep Trench Length 76 ft. Width 3 ft. Gravel below pipe 9 ft. Total depth 12-14 ft. Eff. absorption area 1,368 ft2 Monitoring tube Y Depression over field N Date of adequacy test New construction Results (Pass/Fail) For 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.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off' level at _ Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line >100' >25' >100' Manhole/Access (Y/N) in. High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots >100' On adjacent lots >100' N/A Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas >50' Manure/animal excrete storage areas >100' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5' Absorption field >5' Water main N/A Water service line >10' Surface water >100' Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water main N/A Water Service line >10' Surface water >100' Driveway, parking/vehicle storage >25' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS: oF A , G. ENGINEER'S CERTIFICATION�.'••.*..J�f-�,e 1. I certify that 1 have determined through field inspections and AO *' 49-M review of Municipal records that the above systems are in �1• • • N• N 1111111.11•, %r"•�c�,f�� conformance with MOA COSA guidelines in effect on this date. �••••'a„s�+s•••••••;••• Engineer's Printed Name Michael E. Anderson, P.E. ,I f.• C' 81 �: ,4N AW � AW +®��'•••••'•� Date 10/19/2011 FfSS10�� Ana COSA Fee $ Waiver Fee $ Date of Payment (D 13-0 / �1 Date of Payment `► �1 Receipt Number"�y Receipt Number (Rev. 11 /05) SGS SGS Ref.# 1114958001 Client Name Anderson Engineering Project Name/# Lot 4 Block 5 So Lakewood Hill Client Sample ID Lot 4 Block 5 So Lakewood Hill Matrix Drinking Water Printed Date/Time 10/14/2011 9:05 Collected Date/Time 10/09/2011 10:30 Received Date/Time 10/10/2011 9:00 Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS EP200.8 Arsenic ND 5.00 Waters Department NRB Total Nitrate/Nitrite-N 0.740 0.100 Microbiology Laboratory (<10) E. Coli Negative I Total Coliform Negative I ug/L EP200.8 C (<10) 10/11/11 10/12/11 NRB mg/L SM20 4500NO3-F B (<10) 10/10/11 AYC 100mL SM20 9223B A 100mL SM20 9223B A 10/10/11 DLC 10/10/11 DLC PLAT NO. P-611 SOUTH LAKEWOOD HILLS, FI RST LOT 4, BLOCK 5 30,400 S.F. S 890591nn11F i an nn' 5' UTIL. ESMT. ---------------------------------------- I I I I O N I r � ADDITION 54.0' ---------------- i • 48.0' I q GRAVEL DRIVE • 6.0' EXISTING I Q I BUILDING 8.0' td o a 6.0' 3.01 SEPTIC SYSTEM CANT M J I q`- IIII • • • cn DECK 60o p 13.0' A. O 9.0' a C OVERE D13.2' 5.N CHPOR I I I I I I t I I I I L- - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - -- � OADi A1AAi1P v vv YV VV L IJV.VV LEGEND 0 FOUND 5/811 REBAR • FOUND 3/4" IRON PIPE 0 FOUND 5/8" REBAR WITH YELLOW PLASTIC CAP STAMPED "LS -6091 " S -BU I LT GASTALDI LAND SURVEYING, LLC JEFF A. GASTALDI, R.L.S. 2000 E. DOWLING RD., SUITE 8 ANCHORAGE, ALASKA 99507 PHONE 248-5454 I GRID ATE 2638 110/10/2011 1 F.B. JOB NO. 11-04 1 SLS145 I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DEPICTED ABOVE AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT 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. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. ANCHORAGE RECORDING DISTRICT, ALASKA NOTE: NO CORNERS SET THIS DATE. WELL 9 1 11=30' `+�P •OF•, q4of SI r e Jeffery A. Gastaldi : AV e LS -6091 • • J •�"0' ...e••••••ayJt •