HomeMy WebLinkAboutT15N R1W SEC 18 LT 198ATISN RIW
· 18
Lot 198A
#051-252-85
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: OSP121062
Tax Code Number: 05123285000
Work Type: WellSeptic Initial
Permit Effective Dates: April 27, 2012 to Apd127, 2013
Design Engineer: BOWLUS JEREMIAH & KIMBERLY
Subdivision: T15N RIW SEC 18
Site Legal Address: T15N R1W SEC 18 LT 198A G:1054
Owner/Address: BOWLUS JEREMIAH & KIMBERLY
24320 HEARTHSTONE DR CHUGIAK AK 995676282
Site Mailing Address: 18600 MINK CREEK DR, Chugiak
Lot Size in Sq Ft: 54789
Total Bedrooms: 3
Department
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 du ring freezing weather must either:.
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Special Provisions: Seven day groundwater monitoring has not been completed. Prior to .
completion of the seven day groundwater monitoring, the contractor may proceed at his own risk.:
The monitoring results shall be submitted with the final inspection report or sooner.
Date:
Date: ~/.~ ~,~..~
MUNICIPALITY OF ANCHORAGE
Community Development Department
Development Services Division
On-Site Water & Wastewater Program
Phone:907-343-7904
Fax:907-343-7997
Mayor Dan Sullivan
ON-SITE SEWERNVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 05t-232-~
Property owner(s): Troy Davis Homes, Inc. Day phone:
Mailing address: 165 E. Parks Highway, Wasilla, AK 99654
Site address: Mink Creek Drive
Legal description (Sub'd., Block & Lot): BLM Lot '198A, Section 18, TtSN, RtW
Legal description (Township, Range & Section)
Lot Size: t.26 Acres Number of Bedrooms: Three (3)
357-9394
THIS APPLICATION IS FOR:
([~ all that apply)
Absorption Field X
Septic Tank X
Holding Tank []
Privy []
Private Well X
Water Storage []
THIS APPLICATION IS AN:
Initial X
Upgrade []
Renewal []
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/Rush Fees: ~
Date of Payment:
Receipt Number:
Permit NO. ~'-'~PI~
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
C:\Users~AndEng\Desktop\Mike\T15N BLM 198\Permit Application Lot 198A.docC:\Users~AndEng\Desktop\Mike\T15N BLM
198\Permit Application Lot 19SA.doc
April 26, 2012
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Su~e~:
BLM Lot 198A, Section 18, T15N, R1W
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of BLM Lot 198A intends to construct a new three-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 septic system
along with the alternate site. No existing wells are closer than 100' from the proposed
septic system. 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.
The test holes placed on the tract in the area of the absorption trench and alternate site
indicated clean sand (SM/SP/SW) material with some silt. The percolation rate of the
soil was determined to be less than 1 minute per inch, More than 50% of the soil
particles pass the No. 4 sieve and a sand liner is not required. No groundwater was
found during the placement of the test holes and none was noted during the monitoring
period. An application rate of 1.0 gallons per day per square foot was used in the
design of the absorption system. We are proposing to place a new 1,000-gallon septic
tank and a 45' long by 5' wide by 4' 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 7'. 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 ground surface on the lot in the area of the absorption trench slopes from the
northwest to the southeast at a grade of 2% to 5%. The new trench will be constructed
parallel with the contours of the slope as much as possible in conformance with
BLM Lot 198A, Section 18, TI5N, RIW
April 26, 2012
Page Two
Municipal requirements. The new septic system will be constructed a minimum of 100'
from all wells and any surface water and 10' from 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.
Michael E. Anderson, P.E.
Attachments
199
201
187
202
197B
AREA NAP
SCALE 1' = 100'
187 188B
186
~j~9.57,]9,,~ J~ MINK CREEK DRIVE
20.00
1.26 ACRES
gO3
gO1 gO~
~OTE~
~/ I '*.~*~ New Septic System. LEGEND
BLM LOT 198A, SECTION 18, T15N, R1W
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Three Bedroom Home 5' Wide Trench System
Perc. Rate: <1 Min./Inch 1,000 Gallon Septic Tank
Application Rate: 1.0 GPD/SF 4' Drainfield Rock
3 Bedrooms X 1.50 GPD/1.0 GPD/SF(Application Rate) = 450 SF Absorption Area
450 SF/5 SF/LF .5 (Red. Factor) = 45 LF Trench Length
THEREFORE: Construct a 45' Long x 5' Wide x 4' Effective Depth Aborption Trench at the
Location Shown. Flow Line Elevation in Trench to be 3' Below Original Ground Surface. Total Depth
to be 7' Below Existing Ground. Provide 3' of Cover Over Trench and 4' Over Tank or Provide
2" of Insulation and 2' of Cover. Maintain 10' Separation From Water Services in the Area.
Backfill
Geotextile
-- Fabric
4" Perforated
~. o----- -- PVC (Holes Down)
-- Drainfield Rock
TYPICAL DEEP TRENCH SECTION
(NO SCALE)
NOTE: Grade Area Over Trench to Drain Away. ~'.~ / .... ~ "-~ ~-~
Minimum 6 Separation From Bedrock. e,,,,:;,,~,,,,,~,,,,.~,..,,~,.~ ........ ~.,,,,~
Minimum 4' Separation From Groundwater. .~
Minimum 100' Separation From Private Wells in the Area. ~'~'?"'~['~"~;~"?~'~
Minimum 100' Separation From Su~a~ Water or Streams. ~ '
, ~
Minimum 10 Separat on From Water Se~ ~ L ne
&700
[VluNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
BRAGAW STREET ANCHORAGE, AK 99519-,5650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: BLI"4 LOT 102.
PERFORMED FOR: TROY DAVIS HOMES, INC.
DATE: Z+/25/2012 PROJECT No.:
PARCEL ID#:
DEPTH
(fee0
1
2
3
4--
5
6
7
8
9 --
11
20-
OB/OG
SILTY SAND
WITH GRAVEL
SN
B0H @ 13'
TECHNICIAN:
WAS GROUND WATER ENCOLrNTERED?
IF YES ~ WHAT DEPTH?___
DEPTH OF WATER AFTER MONITORING:
MEA
SLOPE
NO
NONE
DATE OF MONITOPdNG- /~/27/201~
SiTE PLAN
SEE SITE PLAN
I DEPTH TO
DATE READING GROSS TINE NET TINE WATER NET DROF
(HINUTES) (HINUTES) (INCHES) (INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTIN0:
4/26 ] ]]:10 .38"
2 11:20 10 Dry >10"
3 11:21 .50"
4 11:31 10 Dry >10"
5 11:32 .38"
6 11:42 10 Dry >10"
PERCOLATION RATE: <l (MIN/INCH) PERC. HOLE DIA. 6" CrNCHES)
TEST RUN BETWEEN: 3.5 FT. and 4.5 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE:
4700
DEPTH
(feet)
1
2--
3
4--
6--
7--
8--
9--
11
20¸
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
BRAGAW STREET ANCHORAGE, AK 99519-,5650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: BLI'I LOT 102
PERFORMED FOR: TROY DAVIS HOMES. INC.
DATE: L/25/2012 PROJECT No.:
PARCEL ID#: TECHNICIAN:
I TEST HOLE 4 I
OB/OG
SILTY SAND
WITH GRAVEL
SN
BOH @ 15'
MEA
SLOPE
SITE PLAN
SEE SITE PLAN
WAS GROUND WATER ENCOUNTERED? NO
DEPTH OF WATER AFTER MoI~qTOPdNG: NONE
DEPTH TO
DATE READING GROSS TIME NET TINE WATER NET DROP
(MINUTES) (MINUTES) (INCHES) (INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
4/26 1 11:55 .25"
2 12:05 10 Dry >10"
3 12:06 .38"
4 12:16 10 Dry >10"
5 12:17 .38"
6 12:27 10 Dry >10"
PERCOLATION RATE: <1 (IvIIN/INCH) PERC. HOLE DIA. 6" .(INCHES)
TEST RUN BETWEEN:. 3.5 FT. and 4.5 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIFLE GUIDELINES IN EFFECT ON THIS
DATE: L/27112
Municipality ~ Anchorage
Depa~ment OT ~ea~tn ~ ~uman ~e~s
825 L Strut, Anchorage, AK 99502~0 5~,, CE.4381 ,.*~
SOILS LOG - PERCO~TION TEST
Pe~o~ For: Gas~ldi Land Su~eyieg Date P~orm~:
Legal Description: BLM Lot 189
OGIOL
GP
SP
GP/SP
Bottom of
Hole
SLOPE
1
11
12
13
14
15
16
18
19
Was Groundwater
Encountered? No S
If Yes, What Depth? L
Depth to Water O
After Monitoring None P
Date: 5110/01 E
SITE PLAN
87'
2%
~25% 2%
Reading Date Gross Net Depth To Net
Time Time Water Drop
1 7-May 12:22 .75"
2 12:32 10 Dry 7.5"
3 12:33 .625"
4 12:43 10 D~J 7.625"
5 12:34 .75"
6 12:44 10 Dry 7.5"
Perc. Rate: 1.3 Min./Inch Perc. Hole Diameter: 6"
Test Run Between 2 Ft. and 3 Ft.
Comments: Percolation Cavity Presoaked Prior to Testing.
Performed By: ~ I, E~l~a~D~,~ Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 5110101
Dep~Hment of H~lth & Hum3n Se~,ces
825 L S~et, Ancho~ge, AK 99502~
SOILS LOG- PEECO~TION TEST
Ped~m~ For: Gastaldi Land Su~eying Date Pe~orm~:
L~al Des~iption: BLM Lot 189
SLOPE SITE
OG/OL
GP
57'
11
12
13
14
15
16
17
18
19
GP/SP
Was Groundwater
Encountered? No
if Yes, What Depth?
Depth to Water
After Monitoring None
Date: 5/10/01
2%
Bottom of
Hole
Reading Date Gross Net Depth To Net
Time Time Water Drop
1 7-May 2:17 .5"
2 2:22 5 Dry 6.5"
3 2:23 .5"
4 2:28 5 Dry 6.5"
5 2:29 .5"
6 2:34 5 Dry 6.5"
Perc. Rate: >1 Min./Inch Perc. Hole Diameter: 6"
Test Run Between 4 Ft. and 5 Ft.
Comments: Percolation Cavity Presoaked Prior to Testing.
Performed By: ~ l, MJ~J~.AD~E Cert~ That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 5/10101
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: BLM LOT 198A, SECTION 15, T15N, R1W
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 45' long by 5' wide by 4' effective depth
absorption trench also at the location shown on the plan. The distribution line
in the trench will be placed at 3.0' below the existing ground surface. Total
depth of the trench will be 7.0' below the existing ground surface. The new
absorption trench must be placed a minimum of 100' from all wells in the area
and 100' from any surface water in the area. The septic system must also be
a minimum of 10' from the water service line on the lot. A minimum of 3' of
cover is required over the absorption trench and 4' of cover over the septic
tank.
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.
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,
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.
o
Contractors installing wastewater disposal systems must be certified by the
Municipal Department of Building Safety On-Site Water and Wastewater
Program for system installations. Owners installing their own systems must
receive prior approval from the On-Site Water and Wastewater Program
before beginning system installation.
SEPTIC TANK INSTALLATION
1. A new 1,000 gallon septic tank must be procured from an approved source
and installed at the location shown.
2. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
BLM Lot 198A, Section 18, T15N, R1W
April 22, 2012
Page 2 of 3
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 budal
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 drainfleld shall be constructed to the dimensions shown on the design.
The bottom of the trench shall be within 2" of level.
Distribution piping must be placed level with perforations down atop a level
bed of drainfleld 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.
Contractor shall vedfy 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.
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.
A minimum 2' of accepting soil is required below the drainfield rock for
absorption trenches. All pockets of unacceptable materials must be removed
and replaced.
MATERIAL SPECIFICATIONS:
BLM Lot 198A, Section 18, T15N, R1W
April 22, 2012
Page 3 of 3
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.
U M�P AU T El OF
Development Services Department -
On -Site Water & Wastewater Section
Parcel I.D. 051-232-85
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Complete legal description T15N R1W SEC 18 LOT 198A
Location (site address) 18600 MINK CREEK DRIVE, CHUG
Phone: 907-343-7904
Fax: 907-343-7997
Expiration Date: R_Z9- L!_
AK 99567
Current property owner(s) DAVID & JULIE JOHNSON Day phone
Mailing address 18600 MINK CREEK DRIVE, CHUGIAK, AK 99567
Real estate agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
Private Well
Private Septic
Water Storage
❑
Community Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Private Septic
Holding Tank
❑
Community
❑
Public Sewer
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 5 ,Sv
Date of Payment a - 0" f
Receipt Number % 3'Z
COSA # DSC -Z 113 L -I 6
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm FIRST WATER CONSULTING Phone 907.350-9566
Address 13030 SUES WAY, ANCHORAGE, AK 99516
Engineer's Printed Name CURTIS HUFFMAN, PE
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 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 & FWH
DSD SIGNATURE
System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved
Date 6/2212021
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.... .........
Curtis Huffman
�"q • CE 128991
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Conditional approval for bedrooms, with the following stipulations:
�t�ctrrrrrr
ON—SITE
ATFR AA(fl m
I^^- Original Certificate Date: / .- Zg—Z
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
11 Ali 111��
�l:
Legal Description: T15N R1W SEC 18 LOT 198A Parcel ID: 051-232-85
If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _
A. WELL DATA
® Well log is filed with Onsite (or attached)
Date drilled 5/2/2012
Total depth 104 ft
Cased to 104 ft
® Sanitary seal is functioning correctly
® Wires are properly protected
Casing height (above ground) 24+ in.
Date of flow test for COSA 6/17/2021
Static water level at beginning of test 49 ft.
Well production at time of test 4.5 gpm
Comments
B. TANK DATA
Age of tank(s) 9 years
Tank type/material SEPTIC / STEEL
Measured operating fluid level in septic tank 48"
® Standpipes/foundation cleanout per record drawing
Date of pumping 6/17/2021
D. ABSORPTION FIELD DATA
Which system tested (date installed) 5/1/2012
® ALL standpipes present per record drawing
Total measured depth from grade 8 ft (max)
Measured depth to pipe invert from grade 3.9 ft (min)
❑ N/A — pressurized field
Water storage tank volume NA gallons
Well disinfected for coliform test? ❑ Yes ® No
® Coliform bacteria is Negative
Nitrate mg/L ® Nitrate less than MRL (ND)
Arsenic 6.02 ug/L ❑ Arsenic less than MRL (ND)
Collected by FWD;
Date of Sample 6/17/2021
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material
Comments:
Adequacy test date 6/17/2021
Results ® Pass For 3 bedrooms
Fluid depth prior to test 24 in
Water added 480 gal
New depth 27 in
® Monitor tubes go to bottom of effective. If not, state
depth into effective Elapsed time 40 min
® Code -required soil cover over field Final fluid depth 24 in
❑ System presoaked Absorption rate 450 gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N
date of test)
Gallons introduced gallons If yes, enter date
Comments/Deficiencies:
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
❑ Yes
if No *5+
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
® Yes
if No
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes
if No
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' Yes
if No
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' ® Yes
if No
® Yes
if No
ft
ft
If septic tank is under driveway comment below
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ® Yes
if No
ft
® Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
❑ Yes
if No *5+
ft
Surface Water > 100'
® Yes if No _
Property Line > 5'
® Yes
if No
ft
Wells on Adjacent Lots:
® Yes
Absorption Field > 5'
® Yes
if No
ft
Private Wells > 100'
® Yes if No _
Water Main > 10'
® Yes
if No
ft
Community Wells > 200'
® Yes if No _
Water Service Line > 10'
® Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
® Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
® Yes
if No
_ ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft
Private Wells > 100' ® Yes if No —ft
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
*PER CODE AT INSTALL.
G. ENGINEER'S CERTIFICATION
l certify that 1 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.
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• Municipality of Anchorage
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On-Site Water and Wastewater Program .. JUL. �< R
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(907) 343-7904 ev
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Certificate of On-Site Systems Approval °` L g
Parcel I.D. 051 -232-85 Expiration Date:
1. GENERAL INFORMATION
Complete legal description T15N R1 W Sec 18 Lot 198A
Location (site address) 18600 Mink Creek Drive
Current Property owner(s) Jeremiah & Kimberly Bowlus Day phone
Mailing address 24320 Hearthstone Drive Chugiak, AK 99567
Real Estate Agent Day phone
2. TYPE OF DWELLING:
[] Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Individual 0
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
1
Received b} .(5`�t� Date: ),,I
COSA to be released to the engineer, un e otherwise requeste b the engineer.
COSA Fee $ Waiver Fee $
Date of Payment -71W(11 Date of Payment
Receipt Number 06?6(1 Receipt Number
COSA# Y?C1,1 13-26 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 Ori-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater
disposal system is (are)sale, 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 installatiQrp , •
In conducting a ri'adequcy.test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations:The reported results describe the performance of the system under the conditions encountered at the time of the test,
and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil
condition,ground water levels that may fluctuate during the year, and the water usage of the family being served by the system.These conditions
are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system, nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date 7/26/2017
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6. DSD SIGNATURE r• ���'�•
System #1 Approved for bedrooms • '%Steven H. Pannone.. f
-Vs% CE-8149 .•,-i
System #2 Approved for bedrooms
Disapproved >> FNOfESS\O �
Conditional approval for bedrooms, with the following stipulations:
ON-SITE
'WA l ER AND f
WAS-Mt/m.1-r, E
T PROGRAM
•By: � Original Certificate Date: 0— I 1 l
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 bi.,e sheet 4
If more than 1 septic system is on the lot:
COSA Checklist# 1 of 1
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: T15N R1I/1/ Sec 18 Lot 198A Parcel ID 051-232-85
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y
Date completed 5/2/2012 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 104 ft Cased to 104 ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 5/2/2012 7/5/2017
Static water level 48 ft. 48 ft.
Well production 8 g.p.m 4.3 g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate ND mg/L
Arsenic ND ug/L Date of sample 7/5/2017 Collected by PES
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 5/1/2012
Tank size 1 000 gal. Number of Compartments 2 Cleanouts (YIN) Y
Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (Y/N) N/A
Date of pumping 6/29/2017 Pumper JR's Pumping
C. ABSORPTION FIELD DATA
Date installed 5/1/2012 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 GPD/SF System type Shallow Trench
Length 50 ft Width 5 ft Gravel below pipe 4 ft
Total depth 7 5 ft Eff absorption area 500 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 7/5/2017 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in Water added 455 gal. New depth 4 in
Elapsed Time 1440 min. Final fluid depth 0 in. Absorption rate >- 450+ g.p.d.
N
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100+ On adjacent lots 100+
Absorption field on lot 100+ On adjacent lots 100+
Public sewer main 75+ Public sewer manhole/cleanout 100+
Sewer/septic service line 25+ Holding tank 100+
Animal containment areas 50+ Manure/animal excrete storage areas 100+
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+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+ Water main 10+
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
Survey on file.
G. ENGINEER'S CERTIFICATION OF AL.•4 1��!
I certify that I have determined through field inspections and y'�A. _�� 9'I
review of Municipal records that the above systems are in `*,• ,L N •
conformance with MOA COSA guidelines in effect on this date. - *• • MP 9: 0
�_ •
Steven Pannone1;116. 6•1;%',44
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Engineer's Printed Name1;116. 6•1;%',44�. '��nnone
7126/2017 is CE-8149•
Date �'�'�
COSA canary sheet_2-6-15.doc