HomeMy WebLinkAboutWARD LT 5Ward
Lot 5
#011-122-84
Inspection Repolt-1-1-12.doc
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 • hftp://www.muni.org/onsite - (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP131106
PID Number: 011-122-84 ❑� New ❑ Upgrade
Name:
Merit Homes LLC
ABSORPTION FIELD
R] Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
1920 W. Dimond, Suite F Anchorage, AK 99515
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
334-9233
5
1.0GPD/SF
10 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
4 FL
Gravel depth beneath pipe
6-OFt.
Subdivision
Block Lot
Ward
5
Fill added above original grade
4-5 Ft
Gravel length
64 Ft
Township Range Section
Gravel width
3Ft
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Lift Station
Tank
Line
768 Fe
1
Ft
Well
N/A
N/A
N/A
N/A
N/A
TANK a Septic S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage Tank
Capacity
I 1,50OGal.
Surface Water
>100'
>100'
N/A
N/A
Material
Steel
Number of compartments
Two
Lot Line
>5'
>10'
N/A
N/A
NA
Foundation
>5'
>10'
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Curtain Drain
None
Noted
Gal.
Remarks
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
Pump make and model
Electrical Inspections performed by
Municipality of Anchorage
Installer
PIPE MATERIAL House to tank D3034 Tank to
drainfield D3034
Red Dog Excavating
Drainfield F810 CO/MT D3034
Inspector MEA
BENCH MARK (Assumed elevation) 100.Oft
Inspection,e
1 6/17/13
6/17/13
Location and description
dates:
3r° 6/18/13
2w
4'"
Lower Level Concrete Floor.
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
.OFA4k
4L gSti�go
Conditional Approval:
Date
,Q��'-....
O
:�04
4'TH . *#i
00
...r«r«�..•
�n rb 101ABI. F ANDERSON 0
W
s✓ S CE - 4381so Y
Approve
Date 3 ` l
�it;tie 000* E
`oma®•
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Inspection Repolt-1-1-12.doc
Municipality of Anchorage Page 2 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904
Permit Number: OSP131106 PID No. 011-122-84
PENNY ROSE
CIRCLE
LEGEND
FCO
— Foundation Clean Out
C4 —
Clean Out
M1 —
Monitor Tube
TH —
Test Hole
SV —
Septic Vent
PLAT NO. 2006-13
WARD SUBDIVISION
LOT 5
41,238 S.F.
f=rM01i119MI
SCALE 1' = 40'
Municipality of Anchorage Page 3 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number: OSP131106
PID No. 011-122-84
i�
Finished G.d.
ar.a
92.8
nshng a e
Geotextile Fabric
88.9
grainfield Rock
.77--
82.9—/82.9
74.8 64' (Trench Length)
No Groundwater
5-31-13
PROFILE AS -BUILT
No Scale
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT 5, WARD SUBDIVISION
PERFORMED FOR: MERIT HOMES LLC
DATE: 6/17/2013 PROJECT No.:
PARCELID#: TECHNICIAN: A. HARALA
DEPTH
TEST HOLE 11
(feet)
NET TIME
(MINUTES)
1
NET DROP
(INCHES)
OB/OG SLOP[
2
1
9:15/9:25
10
.50"/9.50"
9.00"
2
SILTY SAND
10
3
9.00"
WITH GRAVEL
9:37/9:47
10
.63"/9.50"
8.87"
SM/SP
4
4
10
.75"/9.75"
9.00"
5
9:59/10:09
10
.75"/9.63"
8.87"
6
6
10:10/10:20
BOH @ 6'
.63"/9.50"
7
8
9
° 49th
�h
V✓l.r-+-�.-o--es � lir-dL
R'; M[C"AEL E- ANDERSON ? 4
SITE PLAN
SEE SITE PLAN
i
10 WAS GROUND WATER ENCAUNCERED? No
IF YES @ WHAT DEPTH?
DEPTH OF WATER AFTER MONITORING: - 2%
1 1 DATE OF MONITORING: P
1
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEWPTH TO
ATER
(INCHES)
NET DROP
(INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
6/17
1
9:15/9:25
10
.50"/9.50"
9.00"
2
9:26/9:36
10
.75"/9.75"
9.00"
3
9:37/9:47
10
.63"/9.50"
8.87"
4
9:48/9:58
10
.75"/9.75"
9.00"
5
9:59/10:09
10
.75"/9.63"
8.87"
6
10:10/10:20
10
.63"/9.50"
8.87"
PERCOLATION RATE: 1_13 (MINANCH) PERC. HOLE DIA. 6f� (INCHES)
TEST RUN BETWEEN: 6 FT. and 7 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST. PERCOLATION TEST ONLY.
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: 3/5/2014
MEMORANDUM
DATE: March 5, 2014
TO: Reviewer
FROM: Mike Anderson, P.E.
SUBJECT: Lot 5, Ward Subdivision
Septic System Permit No. OSP131106
The excavator graded the lot nearly flat prior to the construction of the absorption
trenches. He then placed the alignment of the trenches slightly different than on the
permitted plan. Jeff was onsite during the initital inspection and verbally approved the
placement and alignment of the trenches. The placement of the trenches is in
compliance with the original permit.
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: OSP131106
Tax Code Number: 01112284000
Work Type: Septic
Permit Effective Dates: June 03, 2013 to June 03, 2014
Design Engineer: ANDERSON ENGINEERING
Subdivision: WARD
Site Legal Address: WARD LT 5 G:2222
Owner/Address: PETERSEN KENNETH C & GLADYS M
1301 ROSEHILL BLVD SCHENECTADY NY 123092525
Site Mailing Address: Lot Size in Sq Ft: 41238
Total Bedrooms: 5
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 prevent freezing.
Received
Issued By
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division QD Fax: 907-343-7997
On -Site Water & Wastewater Program
Parcel I.D.
ON-SITE SEWER/WELL PERMIT APPLICATION
011-122-84
Property owner(s) Kenneth & Gladys Petersen Day phone
Mailing address 1301 Rosehill Boulevard Schenectady, NY 12309
Site address Penny Rose Circle Anchorage, AK
Legal description (Sub'd., Block & Lot) Ward, Lot 5
Legal description (Township, Range & Section)
Lot Size 41,238 Sq. Ft. Number of Bedrooms Five (5)
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field ❑X Initial ER
Single Family (SF)
[Z
(w/wo ADU)
Septic Tank ❑X 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:
Dis tance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
owner or authorized
Permit/Rush Fees: 536, W Waiver Fees:
Date of Payment: �.'�9A Date of Payment:
Receipt Number: )tacit) Receipt Number:
Permit No. OQJI0I3 Waiver No.
Permit App_: S:L,:c.:
May 24, 2012
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 5, Ward Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 5, Ward Subdivision intends to construct a new five -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 served by the AWWU
water system. 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 to 1.5 minutes per inch. No groundwater was
found during the placement of the test holes and none was noted during the monitoring
period. An application rate of 1.0 gallons per day per square foot was used in the
design of the absorption system to allow for the sandy material and the fast percolation
rate. We are proposing to place a new 1,500 -gallon septic tank and a 63' long by 3'
wide by 6' 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 10'. 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 to the
northeast at a grade approximating 7%. The new trench will be constructed parallel
with the contours of the slope as much as possible in conformance with Municipal
Lot 5, Ward Subdivision
May 24, 2012
Page Two
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:
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
MICHAEL E. ANDERSON
No. CE -4381
Hanks Subdivision
Lot 2
40,262
sq.ft.
VACANT
Let 3
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rn Lot 1
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w
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--4
m sq.ft.
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Hanks Subdivision
Lot 2
40,262
sq.ft.
VACANT
Let 3
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S00'13'36"E
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Im
49.97'
1m
114.01'
134.00'
1
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--------249.83'----
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NNY
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- — ROSE
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S89'51'10"W 329.76' o
CIRCLE
--249—
_ 113_95'
—"'—
134.00-----------
-
C2
S0013'36"E
-
-
I
50.03'
15'
Gas Esmt
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10'
T&E Esmt
Drainages \ \
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Esmt
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Lot 9 o
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Lot 8
u
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Lot 7
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40,155
N
40,250
0
42,134
a
sq.ft.
n'
sq.ft.
N
sq.ft. \\
m
L4
I
10' T&E Esmt—,,
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10' Utility Esmt
------
133.99'----
-
-'134.00''---
-------------
223.06'-----
50'
Ratcliff'ie Subdivision
1 3
2 1
AREA PLAN
SCALE 1" = 100'
wt s
zC-z
Lot 4
1
Lot 6I\
45,681 0 1.1
sq.ft. a I�
NIN
Io
0
49th
�'; MICHAEL E. ANDERSON �ypi
'fii •.. No. CE -4381 r�.c.
1
PLAT NO. 2006-13
WARD SUBDIVISION
LOT 5
41,238 S.F.
0, I? p101 R�
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;LLEVATION72 NGS DBASEDATUM (0 235
SITE PLAN
SCALE 1' = 40'
63 ,Lon x, 3' Wide
tTre
15' GAS ESMT.
Absorption ch
A`9
c0
240' Xr---,
\
239. 9'
-
Water
site
1 Service
Alternate
~� I
EL.
G. SLAB
= 240.0
L —
240.5'
Tank
PENNY ROSE
A.C.1 DRIVE 1
Fc0
1500 e tic
CIRCLE
I
Five Bedroom
sv sv 2co
240, xLII
Home
hN
r
1
239.2'
/
co ®to
Z--
x zaa.s'
LEGEND
FCO — Foundation Clean Out
CO — Clean Out
S
62�g
MT — Monitor Tube
�9F
TH — Test Hole
SV — Septic Vent
26�
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;LLEVATION72 NGS DBASEDATUM (0 235
SITE PLAN
SCALE 1' = 40'
LOT 5, WARD SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Five Bedroom Home Deep Trench System
Perc. Rate: < 1 Min./Inch 1,500 Gallon Septic Tank
Application Rate: 1.0 GPD/SF 6' Drainfield Rock
5 Bedrooms X 150 GPD/1.0 GPD/SF (Application Rate) = 750 SF Absorption Area
750 SF/12 SF/LF = 62.5 LF Trench Length
THEREFORE: Construct a 63' Long x 3' Wide x 6' Effective Depth Aborption Trench at the
Location Shown. Flow Line Elevation in Trench to be 4' Below Original Ground Surface. Total Depth
to be 10' 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.
Natural
Backfill
3'6"
Geotextile
Z'14 Fabric
6„ 4" Perforated
PVC (Holes Down)
6'0" 1 I �— Drainfield Rock
3'
TYPICAL DEEP TRENCH SECTION
(NO SCALE)
NOTE: Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 4' Separation From Groundwater.
Minimum 100' Separation From Private Wells in the Area.
Minimum 100' Separation From Surface Water or Streams.
Minimum 10' Separation From Water Service Line.
Municipality of Anchorage
Development Services Department
Building Safety Division
• On -Site Water and Wastewater Program
4700 South Bragaw St.
P,O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Performed For:
Legal Description:
Depth
h� l
(Feet
491H
20 -WCHAEL P ANDERSON
6 •. CE -4381 .•�t'a
gb_949 A^ 6. .*0 ����a
00111S Log - Percalatian Test
lqmrr 4uAl. Lf -'s Date Performed:
- .�-- s4,jmkQ Township, Range, Section: _
1-
Date
Gross Time
o(,
2-
Net Drop
P ✓ 9�/
brY)
t�tn�
3-
,. i
1649�3
f2Cr
4_
(p �
7-
8-
10-
11
14-
15-
16-
17-
491H
4 -15-
16-
17-
COMMENTS
5� L'.AS GROUNDWATER A—
riNCOUNTERED?
e
Fa1,� IYXGI AT WHAT DEPTH?
0
Depth to Water After �% P
119 k t �ry Monitoring? ' • c�� E
Date: S' 31 1 3
Site Plan
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
,. i
1649�3
f2Cr
fL.f®t
(p �
17 �o�f -�S
STs
12f�f
S �
PERCOLATION RATE G f -o Iminuws(inah) PERU HULL UTAMt I to )
TEST RUN BETWEEN FT AND 5r FT
PERFORMED BY: Al�-— I CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCdRDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
Municipality of Anchorage
6
Development Services Department
00
i
Building Safety Division
00`
0 y-, On -Site Water and Wastewater Program
4700 South Bragaw St.
o
0
P.O. Box 196650 Anchorage, AK 99519-6650
iP
www ci anchorage. ak. us
p+j Gn E
07) 343-7904
SO'!T14,?
Soils Log 90Percolation Test
��o
lZ 3lA•
Performed For: AVZ4 7- AW Date Performed:
Legal Description: T- Township, Range, Section:
_
Depth nCs
(Feet)
1-
2 of
4-
5 C tej
6- �t'a
7-
8-
9-
10-
11-
12-
13-
14-
15-
16-
17-
18-
19-
COMMENTS
5t
WAS GROUND WATER
6
ENCOUNTERED?
/V 0
Depth to Water
s
IF YES, AT WHAT DEPTH?
L
e
Depth to Water After
iP
Monitoring?
p+j Gn E
Date:
SO'!T14,?
491,
�,. MICHAEL E. ANDERSON
GE - 4361
4BilOROe EssoO
oue
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
s
(7;(7 ',vo
��o
lZ 3lA•
f? •2F:€7
7 f
f7'1'5 -S
20
s
PERCOLATION RATE Ta. - / (minmeynch) rtnc MULt uwdmt i to
TEST RUN BETWEEN 5 FT AND Lo FT
PERFORMED BY: /' ti I CERTIFYTHATTHIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
MUNICIPALITY OF ANCHORAGE
�®
Development Services Department .:,/ Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 011-122-84
1. GENERAL INFORMATION
Complete legal description WARD LT 5
Expiration Date:0 5 d CQa
Location (site address) 6963 PENNY ROSE CIR ANCH, AK
Current property owner(s)
Mailing address
Real estate agent
CLIFFORD & JENNIFER JOHNSON
SAME
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
Day phone
3: NUMBER'OF BEDROOMS:
5
4. -TYPE OF WATER SUPPLY:'
TYPE OF WASTEWATER DISPOSAL:
Private Well
[]
Private Septic
IX
Wbter Storage
❑
Holding Tank
❑
Community Well
❑
Community
[]
Public Water System
❑X
Public Sewer
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless othervnse requested by the engineer.
COSA Fee $ 1 FJO (LD I 5 Waiver Fee $
Date of Payment to 13 %0 02 0 Date of Payment
Receipt Number 0 13 4 t $ Receipt Number
COSA# 0scaDI51 I 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 MIKE N ANDERSON, P.E. Phone 727-8864
Address 4661 NATRONA AVE ANCH AK
Engineers Printed Name MIKE N ANDERSON, P.E. Date 10-4-20
S. DSD SIGNATURE
System #1 Approved for 5 bedrooms
System #2 Approved for _ bedrooms
Disapproved
4 j ,�
P
I ;a: MICHAEL N• ANDEPaCN °C- P'
)°CE 9
4
r9f
Conditional approval for bedrooms, with the following stipulations:
By; fi4 n 0 6a Original Certificate Date: 10 ,2 a2 oa v
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 chocWisl bfuo sheet
COSA Checklist
Legal Description: WARD LT 5
If more than 1 septic system on lot: COSA Checklist # _of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled
Total depth ft
Cased to ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Comments
B. TANK DATA
Age of tank(s) 7 years
Tank type/material
Measured operating fluid level in septic tank 48
0 Standpipes/foundation cleanout per record drawing
Date of pumping 10/5/20
D. ABSORPTION FIELD DATA
Which system tested (date installed) 6/17/13
X ALL standpipes present per record drawing
Total measured depth from grade 14.5 ft (max)
Measured depth to pipe invert from grade 8.5 ft (min)
❑ N/A —pressurized field
Monitor tubes go to bottom of effective. If not, state
depth into effective
ParcellD: 011-122-84
Structure served by this system
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes N No
❑ Coliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by _
Date of Sample
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material _
Comments:
Adequacy test date 10/5/20
Results [DPass For 5 bedrooms
Fluid depth prior to test 0/1'� in
Water added 750+ gal
New depth 4/6 in
Elapsed time 1440 min
* Code -required soil cover over field Final fluid depth 1/� in
❑ System presoaked Absorption rate 750+ gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months)
date of test) If yes, enter date
Gallons introduced gallons
Comments/Deficiencies: ' MT at each end of the trench
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'
v❑
Yes
Community Sewer Manhole/Cleanout > 100'
_ ft
❑ 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
It
Neighboring Absorption Fields > 100'
if No
_ ft
Animal Containment > 50' ❑ Yes
if No
ft
❑ 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 _
ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
v❑
Yes
if No
_ ft
Surface Water > 100'
Yes if No_ ft
Property Line > 5'
❑v
Yes
if No
_ ft
Wells on Adjacent Lots:
Absorption Field > 5'
if No _
Yes
if No
_ ft
Private Wells > 100'
❑✓ Yes if No _ ft
Water Main > 10'
ft
Yes
if No
_ ft
Community Wells > 200'
0 Yes if No _ ft
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'
v❑
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'✓❑
Yes
if No _
ft
Private Wells > 100' ❑v Yes if No _ It
Water Service Line > 10'❑
Yes
if No _
ft
Community Wells > 200' ❑v Yes if No ft
Surface Water > 100'✓❑
Yes
if No _
ft
F. ENGINEER'S 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.
COSA Checklist yellow sheet
t .. °. ' t
�•T MICHA€L N. ANDrRJCN•,
CE 9469
�O\ a'r•�►
Parcel I.D. 011-122-84
Municipality of Anchorage a
On -Site Water and Wastewater Program 9
(907)343-7904 cserer
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Complete legal description Ward, Lot 5
2.
Expiration Date: S
Location (site address) 6963 Penny Rose Circle Anchorage, AK
Current Property owner(s) Merit Homes LLC Day phone 334-9233
Mailing address 1920 W. Dimond, Suite F Anchorage, AK 99515
Real Estate Agent Day phone
S U is illi i 1 'y
TYPE OF DWELLING: L
(] Single Family (w/wo ADU) MAR 5 2014 I
❑ Duplex
P .7 p
❑ Multiple Dwellings (Single Family and/or Duplex) I & , '" if i
3. NUMBER OF BEDROOMS: Five
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Pi Hir Wntar 53vctam
n
Waiver/Variance
Received by: t Date:
COSA to be released�to the engineer, unless otherMse requested by the engineer.
COSA Fee $ Mpg •o V 4 q 1 .w Gush Waiver Fee $
Date of Payment 3� `J �1 y Date of Payment
Receipt Number 61!1 l / Receipt Number
COSA # __ 0,y,1 ,A 10 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 !slate) 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
Phone 522-7773
Engineer's Printed Name Michael E.
Anderson, P.E.
Date 3/4/2014
...9 T H ! \�
6. DSD SIGNATURE
rr, �6® "` ° PP .
System #1 Approved for
s bedrooms
aaP
System #2 Approved for
bedrooms
y -
�.
Disapproved
°cam �rFESSI
Conditional approval for
bedrooms, with the following stipulations:'°
:_
Original Certificate Date: �S
l ii7
The Vqgiolpality of Anchorage Development Services Division (DSD) issues Certilicates 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.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet t -- 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: Ward, Lot 5
A. WELL DATA AWWU Water System
Well type If A, B, or C provide PWSID #
Date completed Sanitary seal (Y/N)
Total depth fL Cased to ft.
FROM WELL LOG
Date of test
Static water level ft.
Well production g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic ug/L Date of sample:
B. SEPTICIHOLDING TANK DATA
Parcel ID: 011-122-84
Well Log (YIN)
Wires properly protected (Y/N)
Casing height (above ground) in.
AT INSPECTION
Collected by:
ft.
16
Tank Type/Material Septic/Steel Dateinstalled 6/17/13
Tank size 1,500 gal. Number of Compartments 2 Cleanouts (YIN) Y
Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (Y/N)
Date of pumping New Const. Pumper
C. ABSORPTION FIELD DATA
N
Date installed 6117/13 Soil rating (g.p.d./ft' or ftz/bdrm) 1.0 GPD/SF System type Deep Trench
Length 64 ft. Width 3 ft. Gravel below pipe 6 ft.
Total depth 14.5 ft. Eff. absorption area 768 fe Monitoring tube Y Depression over field N
Date of adequacy test New Const. Results (Pass/Fall) 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.) (YIN & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at in. "Pump off' level at in.
Datum Cycles tested
E. SEPARATION DISTANCES
WELL ON LOT TO:
Manhole/Access(Y/N)
High water alarm level at
Meets alar & circuit requirements?
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'
Water main Water service line >10
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
Property line >10' Building foundation >10'
Water Service line >10' Surface water >100'
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
Lot is Served by AWWU Water System.
G. ENGINEER'S CERTIFICATION
I 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 3/4/2014
COSA brown sheet_10-10-12.doo
Absorption field >5'
Surface water >100'
Water main N/A
Driveway, parking/vehiclestorage 0,
® IN RR .
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dee ..s .............. 6
6 m : E. ANDERSON
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in.
15' GAS ESMT
PENNY ROSE
CIRCLE
1 11=40'
PIAT NO. 2006-13
Il/A P711 Poi 1r%r\ii
GASTALDI LAND
SURVEYING, LLC
JEFF A. GASTALDI, R.L.S.
2000 E. DOWLING RD., SUITE 8
ANCHORAGE, ALASKA 99507
PHONE 248-5454
GRID DATE
SW2222 2/12/2014
F.B. JOB N0.
14-07 WARDS
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
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: Jeffery A. Gastaldt . oAIF
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