HomeMy WebLinkAboutCAMPBELL CANYON LT 6Campbell
Canyon
Lot 6
#041 -01 1 -08
Municipality of Anchorage
Community Development Department Page 1 of 3
On -Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904
ONSITE WASTEWATER INSPECTION REPORT
Permit Number: OSP121346 PID Number: 041-011--419 d g 0 New ❑ Upgrade
Name:
Colony Builders
ABSORPTION FIELD
❑ Deep Trench ❑✓ Shallow Trench ❑ Bed [:]Mound
Address
9420 Vanguard Drive #A Anchorage, AK 99507
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
-8GPD/SF
9.8 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
5.8 Ft.
Gravel depth beneath pipe
4.OFt.
Subdivision Block Lot
Campbell Canyon 6
Fill added above original grade
5-6 Ft.
Gravel length
75 Ft.
Township Range Section
Gravel width
5Ft.
Beds: Number of Lines
Distance between lines
SEPARATION DISTANCE$
Ft.
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
600 Ftp
One
Ft.
well
>200'
>200'
N/A
N/A
>100'
TANK ❑ Septic ❑ S.T.E.P. El Holding ❑ Other
Manufacturer
Anchorage Tank
Capacky
1,250Gal.
Surface water
>100'
>100'
N/A
NIA
Material
Number of compartments
Lot Line
>5'
>10'
N/A
NIA
Steel
Two
NA
Foundation
>5'
>10'
N/A
N/A
LIFT STATION
Manufacturer Capacity
Curtain Drain
None
Noted
Gal.
Remarks Septic Tank is 10 Gauge Steel.
Pump on level at
in.
Pump off level at
n.
High water alarm at
in.
Pump make and model
Electrical Inspections performed by
Installer
PIPEMATERIAL Housetotank D3034 Tankto D3034
drainfeld
Red Dog Excavation
Drainfield HDPE CO/MT D3034
Inspector A. Harala
BENCHMARK (Assumed elevation) 100.0a
Inspectionts,
dates: 12/4/12 2- 12/5/12
Location and description
3`° 5/23/13 41"
Garage Slab.
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
x,44 ...... At �Se1
Conditional Approval: Datear
Mr
ice,•'
• ..N Mf Oee O
,••.. .•• •• ..•• ..
� : MId1A@. E ANDH2SON . 2
c• . W
Approved Date (0—«-/3
f��1�►s��
���''
Insnenfinn Rannrt 1-t _17 nr
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
Permit Number: OSP121346 4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904
A B
444.4' 59.5'
48.2 66.9
75.9 62.1
70.8 79.2
51.0' 93.3'
M2 51.1 91.4
LEGEND
M1 - Monitor Tube
FCO - Foundation Clean Out
TH - Test Hole
Cl - Clean Out
FSV - flow Splitter Valve
M
SHIVALIK DRIVE
n
N 89'5832"E
49.23'
Page 2 of 3
PID NO.: 041-011-08
1
1
1
-- 1
1
1
1 PLAT NO. 2005-118
\ I
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CAMPBELL CANYON
u
zea SUBDIVISION
n e I
ell `) \\Ir 2,07 o S.F.
Four Bedroom
House
TH3 \
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6 \�- ' 0
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M1 ®TH4 \\ �mo "92
I I c aIternate \\N ,Y
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L I 49th
EL
PLAN AS -BUILT E. ANDERSON
�Oc�ICH NO. CE -4381
SCALE V = 50'
ra
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: OSP121346
N �96.5
U) UU
1,250 Gallon
Septic Tank
NOTE: 10 Gauge Septic Tank
Page 3 of 3
PID No. 041-011-08
No Groundwater
No Bedrock
12-4-2012
PROFILE AS -BUILT
No Scale
86.4
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650
DEPTH
(feet)
1 -
2
3
4
5
6
7
8
9
10 -
II
13
14
15
16
17
18
19
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT 6, CAMPBELL CANYON SUBDIVISION
PERFORMED FOR: CRowN POINTE HoMEs
DATE: 12/4/2012 PROJECT No.:
PARCEL ID#: TECHNICIAN: A. HARALA
OB/OG
TEST HOLE 4
b
d
d "
a
SILTY SAND
WITH GRAVEL
d SM
d
SITE FLAN
SEE SITE PLAN
it
WAS GROUND WATER ENCOUNTERED? NO
S
IF YES @ WHAT DEPTH
DEPTH OF WATER AFTER MONITORING: NONE 2%
DATE OF MONITORING' 6/8/2012
a P
E
BOH @ 21'
COMMENTS: TEST HOLE TO VERIFY LACK OF
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH TO
WATER
(INCHES)
NET DROP
(INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
PERCOLATION RATE: (MIN/INCH) PERC. HOLE DIA. INCHES)
TEST RUN BETWEEN: FT. and FT.
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: 6/4/2013
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: OSP121346
Tax Code Number: 04101108000
Work Type: Septic Initial
Permit Effective Dates: October 10, 2012 to October 10, 2013
Design Engineer: ANDERSON ENGINEERING
Subdivision: CAMPBELL CANYON
Site Legal Address: CAMPBELL CANYON LT 6 G:2044
Owner/Address: EGEMO JOE
1639 CYPRESS PT LADY LAKE FL 321592212
Site Mailing Address: Lot Size in Sq Ft: 52780
Total Bedrooms: 4
This permit is for the construction of:
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 (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 Drevent freezing _ -x •_ ..
Special Provisions: Prior to construction, the 200' protective well radius must be staked by a
registered land Surveyor.•.,
Received
Issued By:
MUNICIPALITY OF
Community Development Department
Development Services Division
On -Site Water & Wastewater Program
ANCHORAGE
Phone: 907-343-7904
Fax: 907-343-7997
ON-SITE SEWER/WELL PERMIT APPLICATION
o$
Parcel I.D. 041-011-x
Property owner(s) Joe Egemo Day phone
Mailing address 1639 Cypress Point Lady Lake, FL 32159
Site address Shivalik Drive at Aletha's Mountain Way Anchorage, AK
Legal description (Sub'd., Block & Lot) Campbell Canyon, Lot 6
Legal description (Township, Range & Section)
Lot Size 52,780 Sq. Ft. Number of Bedroomsa`�
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply) -
-
Ab6orption Field 0 '°
Initial 4
Single Family (SF)
0
(w/wo ADU)
Septic Tank '`'
Upgrade ❑
Duplex (D)
❑
Holding Tank ❑
Renewal ❑
Multiple Dwellings
❑
Privy ❑
(SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information
is correct. I further certify that
this is in accordance with
applicable Municipal Codes.
_.OL C.S_ '- t
property owner or
Permit/Rush Fees: S 3o (mi
Date of Payment: Io I SII'a C
Receipt Number.
Permit No. OtA01 al 3`l Ia
Permit Appj.1-12.doc
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
October 3, 2012
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 6, Campbell Canyon Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer
The owner of Lot 6, Campbell Canyon Subdivision intends to construct a new four-
bedroom home on the lot. We are therefore requesting a permit be issued for the
construction of a new septic system to accommodate the home. The subdivision is
currently served by a Class A Water System and no private well is required. The
attached Site Plan and backup documentation identify the location and configuration of
the proposed septic system along with the alternate site. Also identified on the plans
are the existing Class A Well radius and septic systems on surrounding lots. No
conflicts exist between the proposed septic system and the well or septic systems.
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 were placed on the lot in the area of the absorption trench and alternate
site during the subdivision phase. The logs indicate silty gravel with sand (GM). The
percolation rate of the soil was determined to be 6-15 minutes per inch. No
groundwater was found during the placement of the test hole and none was noted
during the monitoring period. Bedrock was located at 14' to 16'. An application rate of
.8 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 75' 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 4' below the
surface and the total depth will be 8'. A minimum of Sof 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 septic system slopes to the northwest.
The new trench will be constructed parallel with the contours of the slope as much as
Lot 6, Campbell Canyon Subdivision
October 3, 2012
Page Two
possible in conformance with Municipal requirements. The new septic system will be
constructed a minimum of 200' from the Class A Well and 100' from 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:
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
�D 49th •�:�
MICHAEL E. ANDERSON
Nn. CE -4381
SHIVALIK DRIVE
i7
M
N 89'58'32"E
49.23'
1
1
1
1092' �
I
\ i septic Area
I
2Io I
n m I
Il LOT 5
Z -11,
N NA
X 1096,
FHousBedroom \\
I � \1108e. X o' u / A.C. DRIVE \
ti
% rco co ®H3\\\\
Call
Septi on
W Z j Septic Tank
z ,Y JS' Long x 5' Wille ® 2
4' 11.. a oopth / o.
Absorption Trench / Atemote
N
site
O G\
._—Wahl Ramer
NOTE:
Prior to Construction the 200'
Protective Well Radius must be
Staked by a Registered Land o ®THI � \
Surveyor. ry I I \\
PLAT NO. 2005-118 \
VACANT a CAMPBELL CANYON SUBDIVISION
o j j 52,780 S.F. \\\ \
z NOTE:
I Subdivision is Served by a Class A
Water System. No Conflicts with
LEGENI Adjacent Septic Systems.
D
MT - Monitor Tube
TH - Test Hole AD
Clean Out AD T. E. EZ ap6,
CO - Clean Out J '' N 5.43'12"E �����,OF 14
..... ....:qC..
VACANT 0
` 49th l V
.............
'MICHAEL E. ANDERSON
No Areas of Excessive Slope or SITE PLAN `•� f No. CE -4381
Surface Water are Within 100' of Any
Part of the New Septic System.
SCALE 1" = 50'
3
LOT 6, CAMPBELL CANYON SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS
Four Bedroom Home 5' Wide Trench System
Perc. Rate: 6-15 Min./Inch 1,250 Gallon Septic Tank
Application Rate: .8 GPD/SF 4' Drainfield Rock
4 Bedrooms * 150 GPD/Bedroom = 600 SF Absorption Area
600 SF/.8 GPD/SF/5 SF/LF*.5 (Red. Factor) = 75 LF Trench Length
THEREFORE: Construct a 75' Long x 5' Wide x 4' Effective Depth Absorption Trench.
Flow Line Elevation in Trench to be 4' Below Original Ground Surface. Total Depth to be
8' Below Existing Ground. Provide 3' Cover Over Absorption Trench and 4' Cover Over
Septic Tank.
5'
TYPICAL 5' WIDE TRENCH SECTION
(NO SCALE)
jrc
NOTE: Grade Area Over Trench to Drain Away. C
Minimum 6' Separation From Bedrock. JO.....
Minimum 4' Separation From Groundwater. sx
Minimum 200' Separation From Class A Well in the Area. �
Minimum 100' Separation From Surface Water or Streams.
MICHAEL E. ANDERSON
1. No. CE438i
0
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT/BUILDING SAFETY DIVISION
ON-SITE WATER AND WASTEWATER PROGRAM
4700 SOUTH BRAGAW ANCHORAGE, AK 99519
SOILS LOG — PERCOLATION TEST
PROJECT #:
PERFORMED FOR: Sovthcentral Timber Development DATE PERFORMED: —5/8!2004
LEGAL DESCRIPTION' Lot 6. Campbell Canvon
TEST HOLE # ?
jOG/OL/PT
NO
S
GH
• i
L
IF YES, WHAT DEPTH?
,•�
Silty Gravel
s
s •ts
14 t Lei.
GM
Bedrock
asional Boulders
- 20'
WAS. GROUNDWATER
ENCO_ 11MERED?
NO
S
DEPTH OF
WATER
NET
DROP
L
IF YES, WHAT DEPTH?
0
DEPTH OF WATER
/�o�l�•
P
AFTER MONITORMG:
S.S'
E
DATE:
S^4r-0y
SITE PLAN
N
See Site Plan
See Site Plan
READING DATE
GROSS
TIME
NET
TIME
DEPTH OF
WATER
NET
DROP
Start S/9/04
8:36
8"
1
9:06
30
S.S'
25-
.5'Rechar
a
Recharge
9:07
r
2
9:37
30
5.75'
2.25'
Recharge
938
8"
3
10:08
30
PERC RATE: 13.3 MIN./INCH FERC. HOLE DIAMETER:
TEST RUN BETWEEN 50 FT. AND 6.0 T.
COMMENTS Test Hale Pre Soaked Prior to Percolation Test.
TEST PERFORMED BY: AH I, tIICHAEL F. ANDERSON. CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 5/13/2004
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT/BUILDING SAFETY DIVISION
ON-SITE WATER AND WASTEWATER PROGRAM
4700 SOUTH BRAGAW ANCHORAGE, AK 99519
SOILS LOG PERCOLATI
PROJECT #: - ON TEST
PERFORMED FOR: SouthcentralTimber Develooment DATE PERFORMED: 5/8/2004
LEGAL DESCRIPTION: Lot 6. Campbell Canyon
TEST HOLE # 2
WAS GROUNDWATER
ENCOUNTERED? NO
IF YES, WHAT DEPTH?
DEPTH OF WATER /�Q `t•
AFTER MONITORING:
DATE:
s
L
0
P
E
SITE PLAN
N
See Site Plan
See Site Plan
READING DATE
GROSS
TIME
NET
TIME
DEPTH OF
WATER
NET
DROP
Start 5/9/04
8:45
8'
1
9:15
30
5.5`
25'
—Recharge
9:16
8•
2
9:46
30
5.75"
2.25'
Recharge
9:47
8'
3
10:17
30
PERC RATE: 13.3 MIN./INCH PERC. HOLE DIAMETER:_V
TEST RUN BETWEEN 50 FT. AND 6.0 T.
COMMENTS: Test Hole Pre Soa6ed Prior to Percolation Test.
TEST PERFORMED BY: AN I, MICHAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDUIINES ON THIS DATE: 5/13/2004
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT/BUILDING SAFETY DIVISION
ON-SITE WATER AND WASTEWATER PROGRAM
4700 SOUTH BRAGAW ANCHORAGE, AK 99519
PROJECT #: SOILS LOG - PERCOLATION TEST
PERFORMED FOR; Soutthrentral Timber Develooment DATE PERFORMED: —5/012004
LEGAL DESCRIPTION: Lot 6. Campbell Canyon
TEST HOLE # 3
OG/DL/PT
7
17,
Poorly Graded Gravel
Medium to Dark Gray
25" - 4' Rocks
GM with ML
Clusters Intermittent
WAS GROUNDWATER
GROSS
TIME
NET
TIME
ENCOUNTERED?
NO
S
10:33
L.
IF YES, WHAT DEPTH?
1 1
O
DEPTH OF WATER
At I It
P
AFTER MONITORING:
1D:44
E
DATE:
2
Recharge
See Site Pian
READING DATE
GROSS
TIME
NET
TIME
DEPTH OF
WATER
NET
DROP
Start 5/9/04
10:33
g-
1 1
10:43
10
Dry
g-
Rechar a
1D:44
g-
2
Recharge
10:54
10:55
10
Dryg+
8-
3
11:05
10
PERC RATE: —125— MIN./INCH PERC. HOLE DIAMETER:. 6"
TEST RLN BETWEEN,—LO—FT. AND. 6.0 T.
COMMENTS: Test Hole Pre Soaked Prior to Percolation Test.
TEST PERFORMED BY: AN LMICHAEL_^` F• A� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 5/13/2004
Municipality of anchorage
On -Site Water and Wastewater Program 4' .r
(907) 343-7904 s <
Certificate of On -Site Systems Approval
Parcel I.D. 041-011-08
1. GENERAL INFORMATION:
Expiration Date:mwulIj Q0 �3
Complete legal description CAMPBELL CANYON: LOT 6
Location (site address) 10608 Aletha's Mountain Way *Anchorage 99507
Current Property owner(s) Michael Faust
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
❑X Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone 717-9193
Day phone
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual
.Individual Water Storage
❑
Holding Tank
❑
Community Class A Well
®
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee J� � Waiver Fee $
Date of Payment 5 Date of Payment
Receipt Number -3:2 G/ Receipt Number
V
COSA # 5C 1 S � 6 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: Garness Engineering Group Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: L II �Z)
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
in accordance with the guidelines and regulations established by the Municipality of Anchorage and
industry practices. The reported results describe the condition of the system/s on the date/s of the
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or `L,.• "'
encroachments may exist that were not identified during the evaluation. The operational life of all wells
and septic systems depend upon a variety of variables, including but not limited to, soil conditions, T,' i
groundwater levels (that may fluctuate during the year), quality of construction (materials and ✓
workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and """"" ... "...... '
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the
.....
�......
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of ��• .. .___,�- - • • • • •:
the well or septic system. GEG makes no representation whether an alternative well or septic system np './ =hrey A. t?ornEss:
can be installed on the property in the event either of the current systems fail to perform adequately in Q'�11 . ' Cr'-} 7 53
the future. The content of this report is for the sole benefit of the person/party that retained GEG to u� s.` �+ t `%1.•'*
perform the evaluation. Reliance upon the information provided in this report by any other person or� ""'
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right � p o`esscn�^_
whatsoever.
#AECC884
6. DSD SIGNATURE
System #1 Approved for _�__ bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms,
OF
(:3 yO.p//ter
Jam' ON-SITE
with the following tl latiWATER AND m
WASToEV,IATER o
PROGRA
J
Original Certificate Date: %91.2-o: i
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist x Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist
Legal Description: CAMPBELL CANYON; LOT 6
Parcel ID: 041-011-08
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) Well production at time of test gpm
Date drilled Water storage tank volume gallons N �,
Total depth ft Well disinfected for coliform test? ❑ Yes -*M
Cased to ft ❑ Coliform bacteria is Negative
❑ Sanitary seal is functioning correctly Nitrate mg/L ❑ Nitrate less than MRL (ND)
❑ Wires are properly protected Arsenic ug/L ❑ Arsenic less than MRL (ND)
Casing height (above ground) in. Collected by
Date of flow test for COSA Date of Sample
Static water level at beginning of test ft.
Comments CLASS "A" PWSID #218642
B. TANK DATA
Age of tank(s) 9 years
Tank type/material SEPTI -TEE
Measured operating fluid level in septic tank
50"
FE -1 Standpipes/foundation cleanout per record drawing
Date of pumping c' �"' /Z/
D. ABSORPTION FIELD DATA TRENCH
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments: N/A
Which system tested (date installed) 12/5/12
Adequacy test date 5/21/21
V ALL standpipes present per record drawing
Results [DPass For 4 bedrooms
Total measured depth from grade 15.5 ft (max)
Fluid depth prior to test 5 in
Measured depth to pipe invert from grade 11 ft (min)
Water added 620 gal
❑ N/A — pressurized field
New depth 17 in
A-1 Monitor tubes go to bottom of effective. If not, state
Elapsed time 120 min
depth into effective
❑■ Code -required soil cover over field
Final fluid depth 10 in
❑ System presoaked
Absorption rate 600+ gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months) NONE
date of test) N/A
Gallons introduced gallons
If yes, enter date N/A
Comments/Deficiencies:
COSA Checklist yellow sheet
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'
0
Yes
Community Sewer Manhole/Cleanout > 100'
❑ Yes
if No
ft
❑ Yes
if No ft
Neighboring Tank > 100' ❑ Yes
if No
ft
Private Sewer/Septic Line > 25' ❑ Yes
if No ft
Absorption Field on Lot > 100' ❑ Yes
if No
ft
Holding Tank > 100' ❑ Yes
if No ft
Neighboring Absorption Fields > 100'
Yes if No ft
Water Main > 10'
Animal Containment > 50' ❑ Yes
if No ft
❑ Yes
if No
ft
✓❑ Yes if No ft
Water Service Line > 10'
0
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway comment below
Community Sewer Main > 75' ❑ Yes
if No
ft
0 Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
0
Yes
if No
ft
Surface Water > 100'
Ul Yes if No ft
Property Line > 5'
❑✓
Yes
if No
ft
Wells on Adjacent Lots:
SHOWN ON AS -BUILT SURVEY. SEE ATTACHED DRAWINGS.
Absorption Field > 5'
❑✓
Yes
if No
ft
Private Wells > 100'✓❑
Yes if No ft
Water Main > 10'
0
Yes
if No
ft
Community Wells > 200'
✓❑ Yes if No ft
Water Service Line > 10'
0
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'
0 Yes if No ft Wells on Adjacent Lots:
Water Main > 10'
0 Yes if No ft Private Wells > 100' ❑✓ Yes if No ft
Water Service Line > 10'
0 Yes if No ft Community Wells > 200' ❑✓ Yes if No ft
Surface Water > 100'
0 Yes if No ft
F. ENGINEER'S COMMENTS
*APPROXIMATELY 200'. CANNOT BE ABSOLTELY CERTAIN WITHOUT WELL
SHOWN ON AS -BUILT SURVEY. SEE ATTACHED DRAWINGS.
G. ENGINEER'S CERTIFICATION o� 0F /� %�Q
........ . -q�,�4
l certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance with p C�
MOA COSA guidelines in effect on this date. .:. -.9-h. ... r ... * ............
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06/0912021 07:02 8686770 APLUS PAGE 01
I/ SSp�IGHT F(U
i, F'rS A FULL)L
H��
i
A+ HO SERVICES INC.
75C 1 E. 140th Avenue
And orage, Alaska 9951.6
345-1890
CUSTOMER
■ ch—a , Faust
`
10608 Ai eflim Mountain My 6+Ue I,,
MWO1 thy. usmc@�gmail.com �
Blockv
Lof .
DESCR(PTION
1 w1D Gallons —N— ;';eptic .each Area Holding Tank
❑ PROBLEM%REA — CALL FOR MORE INFORMATION
❑ NEEDS To 13E DONE AGAIN IN 6 MONTHS I
90 Good Shap,, ❑ Sludge buildup on bottom
❑ Jim cap mlE sing or ❑ Cut standpipe to 1' above ground
needs repla ging
INVOICE # �= N., r
jI
Standpipes V°
❑ Floater on top
❑ Needs Septictrine
�'�of
•
• f,G' 8p
.; Municipality of Anchorage
On-Site Water and Wastewater Program 4
(907) 343-7904 mill
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 041-011-08 Expiration Date: 1 [O `( 7
1. GENERAL INFORMATION
Complete legal description CAMPBELL CANYON LOT 6
Location (site address) 10608 ALETHAS MOUNTAIN WAY,ANCHORAGE, AK 99507
Current Property owner(s) MICHAEL FAUST TRUST Day phone
Mailing address 10608 ALETHAS MOUNTAIN WAY,ANCHORAGE,AK 99507
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: 4
TYPE OF WASTEWATER DISPOSAL:
4. TYPE OF WATER SUPPLY: Individual
Individual Well: ❑ Holding Tank ❑
Individual Water Storage ❑ Community ❑
Community Class A Well ® Public Sewer ❑
Public Water System ❑
WaiverNariance request for: Distance:
Received by: i Lii . Date: ��/17
COSA to be released to the engineer, unless oth- ,1,7
uested by the engineer.
COSA Fee $ JW- Waiver Fee $
Date of Payment gull ll? Date of Payment
Receipt Number 0 GO(IAD Receipt Number
COSA# 666 P11-10.6 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 ARCTERRA CONSULTING, INC. Phone 868-3791
Address 20441 PTARMIGAN BLVD.,EAGLE RIVER,AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 8129/2017
THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED
WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineers Comments: This investigation was completed in compliance with
ADEC and MOA regulations. 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 inland use,
local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the
system. 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, ArcTerra can not give any estimate of how long a system will function
satisfactory for current or future occupants or can ArcTerra guarantee that no unseen
encroachments,deficiencies or discrepancies exist. OF .41,q`Air1
`)4-•
' 4• Tli
6. DSD SIGNATURE
System #1 Approved for Lr bedrooms. F tixti
System #2 Approved for bedrooms. , s'', $ 7 16 ����/
L •c
Disapproved. \ '' Fess OS•\'
Conditional approval for bedrooms, with the following stipu atida0Ik((c((t
„v.\TY OF �'�,1�,
o ,
WATER
o ER A !
ND m
mW
AST
EWAMR
=� PROGRAM I=
/6.›,_SERVtG�s�'
Original Certificate Date: oqi I 1
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 engineers work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory - ' '
Septic System Advisory Arsenic Advisory , , - -
Well Flow Advisory Other
COSA blue sheet 10-10-12.doc . .
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: CAMPBELL CANYON LOT 6 Parcel ID: 041-011-08
A. WELL DATA
Well type A If A, B. or C provide PWSID# 218642 Well Log (Y/N)
Date completed Sanitary seal (YIN)Y Wires properly protected (Y/N)
Total depth ft Cased to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/1 00 mL Nitrate mg/L
Arsenic: _ ug/L Date of sample: Collected by
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 12/4/2013..
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 8/28/17 Pumper A+
C. ABSORPTION FIELD DATA
Date installed 1215!201 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8 System type WIDE TRENCH
Length 75 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth 15.5 ft. (Measured 8/28/17) Eff. absorption area 600 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 8/28/2017 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 3 in. Water added 620 gal. New depth 4.5 in.
Elapsed Time: 10 min. Final fluid depth 3 in. Absorption rate >= 600+ 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 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 -PUBLIC WATER
WELL ON LOT TO:
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer/septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 101+ Surface water 100'+
Wells on adjacent lots 200'+
ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ _ Water main 10'+
Water Service line 10'+ Surface water 100'+ Driveway, parkinglvehicle storage 10'+
Curtain drain 50'+(NONE KNOWN) Wells on adjacent lots 200'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 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. '_s ,OF
Engineer's Printed Name KENNETH M.DUFFUS
Date 8/2912017 4
KENNI rU M. MA fir Al
COSA canary sheet_2-6-15.doc 4 71 6 -
O. Aar
\`_�f
• ® Municipality of Anchorage °
On -Site Water and Wastewater Program s
(907) 343-7904
j VA
a 1
Certificate of On -Site Systems Approval
Parcel LD.
041-011-08
1. GENERAL INFORMATION
Expiration Date: 12- - S ` / _�)_
Complete legal description Campbell Canyon, Lot 6
'Location (site address) 10608 Aletha's Mountain Way
Current Property owner(,,) Colony Builders Inc. Day phone
Mailing address 9420 Vanguary Drive # A Anchorage, AK 99507
Real Estate Agent.
2. TYPE OF DWELLING:
I
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
I1
Individual Water Storage
❑
Holding Tank
❑
Community Class A Well
0
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver/Variance request for:
Distance:
Received by: ,�
w
Date:( sJt(
!
COSA to be release(o thvengineer, unless otherwise requested by the engineer.
COSA Fee $ 0/15411-0 Waiver Fee $
Date of Payment �O %3 Date of Payment
Receipt Number Receipt Number
COSA# /A3Waiver#
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,=tt e 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 Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
6. DSD Sl
System #1 Approved for y' bedrooms
System #2 Approved for bedrooms
Disapproved
Date 6/3/2013
OF A4 400
� -*
lk� 4918
Conditional approval for bedrooms, with the following
1-4381
By: o, d4 Original Certificate Date:_(p
The•ung ali ' 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 forerrors 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 sheet ! :j ,
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: Campbell Canyon, Lot 6
A. WELL DATA
C 218642
Parcel ID: 041-011-08
Well type lass A If A, B, or C provide PWSID # Well Log (Y/N)
Date completed Sanitary seal (YIN) _ Wires properly protected (Y/N)
Total depth ft. Cased to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate
Arsenic ug/L Date of sample:
g.p.m.
ft.
g.p.m.
mg/L
Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 12/4/13
Tank size 1,250 gal. Number of Compartments 2 Cleanouts (Y/N)
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N)
Date of pumping New Const. Pumper
Y
I
C. ABSORPTION FIELD DATA
Date installed 12/5/13 Soil rating (g.p.d./ft2 or ft2/bdrm) •8 GPD/SF System type Wide Trench
Length 75 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth 14-15 ft. Eff. absorption area 600 fe 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 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) If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at in.
Datum
Size in gallons _
"Pump off' level at
Cycles tested
Manhole/Access(YIN)—
in.
anhole/Access(YIN)_in. High water alarm level at
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot N/A On adjacent lots N/A
Absorption field on lot N/A On adjacent lots N/A
Public sewer main N/A Public sewer manhole/cleanout N/A
Sewer /septic service line N/A Holding tank N/A
Animal containment areas N/A Manurelanimal excrete storage areas _
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5 Property line >5'
Water main >10 Water service line >10
Wells on adjacent lots >200'
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 >200'
F. COMMENTS
G. ENGINEER'S CERTIFICATION
/ certify that l 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 6/3/2013
COSA brown sheet 10-10-12.doc
Absorption field >5'
Surface water >100'
Water main N/A
Driveway, parking/vehiclestorage
N/A
in.