HomeMy WebLinkAboutROSEBERRY RIDGE ESTATES #1 BLK 2 LT 6Roseberry Ridge
Estates #1
Block 2
Lot 6
#050-315-21
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
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP131188
PID Number: 050-315-21 ❑ New El Upgrade
Name:
Karl Spohn
ABSORPTION FIELD
✓❑ Deep Trench E] Shallow Trench E] Bed []Mound
Address
5321 Tudor Top Circle Anchorage, AK 99507
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
6GPD1SF
7-8 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
1-2 Ft.
Gravel depth beneath pipe
6 Ft.
Subdivision
Block - Lot
Roseberry Ridge Estates #1
2 6
Fill added above original grade
0-2 Ft.
Gravel length
84 Ft.
Township Range Section
Gravel width
3Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
ine
1,008 Ftp
TWO
>12Ft.
Well
>100'
>100'
N/A
25'
TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage Tank
,25OGal.Material
#Holdingwer
Surface water
>100'
>100'
N/A
Number oLot
Line
>5'
>10'
N/A
SteelTwo
NA
Foundation
>5'
>10'
N/A
N/A
LIFT STATION
Manufacturer
C
Curtain Drain
None
Noted
Gal.
Mn..i
Remarks
Pump on level at
in.
Pump off level at
iin.Pump
rm at
make and model
Electrical rmed by
Installer
PIPEMATERIAL House to tank D3034 Tank to D3034
drainfleltl
Red Dog Excavation
Draingeld HDPE COIMT D3034
Inspector AH
BENCHMARK (Assumed elevation) 100.Oft
Inspection
dates: 8/17113 2�d 8/18/13
Location and description
p
3'° 8/20/13 4'h
Lower Level Concrete Slab.
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
.:n
��.QF •A���t
Conditional Approval:
DateAV
i �P:•�; ••,5���
♦ `�, .• .4981 .� tea`'.:
Approved
/
�E `.
AOf[SS.tY4
Municipality of Anchorage Page 2 of 3
DEVEOPMENT SERVICES DEPARTMENT
Permit Number: OSP131188 700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
PID No. 050-315-21
NJ Four Bedroom 0 Well
FSV Home
2', co
Alternate
30' Long x 3' Wide
x 6' Effective Depth cs Ml c' COWREe
Absorption Trench 12 ENTRY
w/Advontex Treatment
System. '
TREES
TREES
ROSEBERRY
RIDGE ESTATES
ADDITION NO. 1
\ PLAT NO. 2005-121
LOT 6
BLOCK 2
132,549 SO. FT.
�3 3.04 AC.
n T
u tin @f fq�.y,
ryh S1'p 2 TREES
SlgP
fq
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LOT 2A M
BLOCK 2 �G'jy 4aQ4r
PLAT N0.
2006-138 N
m LEGEND T
C
FCO - Foundation Clean Out /�C<
SV — Septic VentTH Test
F n
.•�E OF 44tty CO — CleanHole Out
"'•��. FSV — Flow Splitter Valve a'
MT — Monitor Tube TRACT C
'• 49th • a 2CO — Double Clean Out
. .. .:..0
r MICHAEL E.CEN 381SON • �_ PLAN AS BUILT
1 p�� N0. CE -0381 ��
,• Iii PpnZry lc'�P�.�•• SCALE 1" = 80'
A B -
S1 19.5' 22.7'
S2 26.3' 19.8'
C4 29.2' 36.5'
C5 55.2' 30.9'
Mi 30.2' 35.8'
FSV 38.2' 21.4-
C6 49.6 47.9
C7 82.6' 643'
M2 1 52.6-1 49.2
TRACT B
ROSEBERRY
RIDGE ESTATES
s
5j3s
ADDITION NO. 1
LOT 5
BLOCK 2
f yo
PLAT NO. 2005-121
PLAT N0.
i4 ;
-__
TRACT'&,.
2005-23
TREES I/ \,�.
NJ Four Bedroom 0 Well
FSV Home
2', co
Alternate
30' Long x 3' Wide
x 6' Effective Depth cs Ml c' COWREe
Absorption Trench 12 ENTRY
w/Advontex Treatment
System. '
TREES
TREES
ROSEBERRY
RIDGE ESTATES
ADDITION NO. 1
\ PLAT NO. 2005-121
LOT 6
BLOCK 2
132,549 SO. FT.
�3 3.04 AC.
n T
u tin @f fq�.y,
ryh S1'p 2 TREES
SlgP
fq
Sf�fN
��GNp
LOT 2A M
BLOCK 2 �G'jy 4aQ4r
PLAT N0.
2006-138 N
m LEGEND T
C
FCO - Foundation Clean Out /�C<
SV — Septic VentTH Test
F n
.•�E OF 44tty CO — CleanHole Out
"'•��. FSV — Flow Splitter Valve a'
MT — Monitor Tube TRACT C
'• 49th • a 2CO — Double Clean Out
. .. .:..0
r MICHAEL E.CEN 381SON • �_ PLAN AS BUILT
1 p�� N0. CE -0381 ��
,• Iii PpnZry lc'�P�.�•• SCALE 1" = 80'
A B -
S1 19.5' 22.7'
S2 26.3' 19.8'
C4 29.2' 36.5'
C5 55.2' 30.9'
Mi 30.2' 35.8'
FSV 38.2' 21.4-
C6 49.6 47.9
C7 82.6' 643'
M2 1 52.6-1 49.2
TRACT B
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Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
Page 3 of 3
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number: OSP131188 PID No. 050-315-21
83.7
U
91
1=— 84.7
N `92.6 >
y U U LL
1,250 Gallon
Septic Tank
Drainfield Rock
86.7
77.8
66.7 EAST TRENCH
No Gmmdw ter �p
U �U
PROFILE AS -BUILT
No Scale
83.8
79.3
49th/!�V°
................
Vlri. f ..
; :- MICHAEL E. ANDERSON -
Certified Drilling; Loi
DOC Co dba
BILL S. tALIVAN WATER WELLS
4P.O. Box 670269, Chugiak, AK 99567 688-2759
OWNER OF LAND: RDesign —David Brownfield — Karl
Spohn
ADDRESS:
LEGAL DESCRIPTION Roseberry Ridge Est. #1 BLK 2 Lot 6
DATE: 9/6/13
PERMIT NUMBER: 131188 DATE OF ISSUE: 7/17/13
TAX IDENTIFICATION NUMBER 05031521000
Is well located at approved permit location: N Yes ❑ No
Method of Drilling: Nair rotary ❑ cable tool
Depth of Well: 360ft
Casing Type: steel Wall thickness ,250 inches
Diameter: 6 inches, depth 44ft feet
Liner type none
Static Water Level: 73 feet
Recovery Rate 36 ❑ gpm N gph
Method of Testing air
Well Intake Opening Type: ❑ open end N open hole
❑ Screened Start feet Stopped
❑ Perforations Start feet Stopped
Grout Type: Bentonite grout Volume:
Depth: from 0 feet, to 40 feet
Well Disinfected Upon Completion: N yes ❑ no
Method of Disinfection: Chlorine 50 ppm
Comments:
Bore Hole Data
Depth
From To
0
2
2
4
4
12
12
120
120
217
217
265
265
312
312
325
325
346
346
352
352
360
Casing stickup
overburden
Bedrock broken
Bedrock gray
Bedrock hard green
Bedrock gray
Bedrock green
Bedrock yellow
Bedrock gray
Bedrock gray quartz seams wet
Bedrock gray
Drillers Name: Cole Sullivan
ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority.
Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation.
Matsu Borough: Department of Environmental Conservation.
Development Services Department
Building Safety Division
On-Site Water &Wastewater Program 4F`
4700 Elmore Road
P.O. Bax 196650 z
Mark Begich Anchorage, AK 99507
Mayor www muni:oro/onsite
(907) 343-7904
Pump Installation Log
Well Drilling Permit Number: SW 131186 Date ofIss u e: 7",7113
Parcel Identification Number: 05031521000
Legal Description
Roseberry Ridge Estates #1 Block 2, Lot 6
Installation Date: 216/14
Pump Intake Depth Below Top of Well Casing: 346
I Pump Manufacturer's Name: Goulds
Pump Model: 10GS15412CL 230W3W
Pump Size 1 1/2 hp
Pitless Adapter Burial Depth: n!a feet
Pitless Adapter Manufacturer's Name: n/a
Pitless Adapter Installer: We
Well Disinfected Upon Completion? ® Yes 0 No
Method of Disinfection:
Comments:
Pump Installer Name: Aarew Pump a Well Service, LLC
PO Box 110496
Anchorage, AK 99511-0496
feet
Property Owner Name & Address:
RDesign - David Brownfield - Karl Sphon
3611 Midvale Circle
Anchorage, AK 99507
Attention. The pump installer shall provide a pump installation lob to the DSD within 30 days of pump installation.
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-
11
1
1
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION:
PERFORMED FOR: _
DATE: 6/'
PARCEL ID#:
OB/OG
PROJECT No.:
TECHNICIAN:
TEST HOLE 1
GM
Silty Gravel
�:•
SLOPE
WAS GROUND WATER ENCOUNTERED?
IF YES @ WHAT DEPTH? L
DEPTH OF WATER AFTER MONITORING: None
DATE OF MONITORING: 6/2I/I3 E
No. 1
SITE PLAN
SEE SITE PLAN e
i
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH To
WATER
(INCHES)
NET DROP
(INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
6/5/13
1
12:00
6.5"
2
12:30
30
7.75"
1.25'
3
12:31
6.25"
4
1:01
30
7.25"
1.00"
5
1:03
6.5"
6
1:33
30
7,5^
1.00"
PERCOLATION RATE:: 30 (MINANCH) PERC. HOLE DIA. 10 (INCHES)
TEST RUN BETWEEN: 4 FT. and 5 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST HOLE DEEPENED TO ISS TO VERIFY LACK OF BEDROCK AND GROUNDWATER.
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: 7/6/13
On -Site Water & Wastewater System Permit
Permit Number: OSP131188
Tax Code Number: 05031521000
Work Type: WellSeptic
Permit Effective Dates: July 17, 2013
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
to July 17, 2014
Design Engineer: ANDERSON ENGINEERING
Subdivision: ROSEBERRY RIDGE ESTATES #1
Site Legal Address: ROSEBERRY RIDGE ESTATES #1 BLK 2 LT 6 G:0155
Owner/Address: SPOHN KARL MATTHEW
5321 TUDOR TOP CIRCLE ANCHORAGE AK 995071631
Site Mailing Address: Lot Size in Sq Ft: 132549
Total Bedrooms: 4
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank N Privy Y Private Well N Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Receive
Issued
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 050-315-21
Property owner(s) Karl M. Spohn Day phone
Mailing address 5321 Tudor Top Circle Anchorage, AK 99507
Site address Mount Magnificent Circle Eagle River, AK 99577
Legal description (Sub'd., Block & Lot) Roseberry Ridge Estates #1, Block 2, Lot 6
Legal description (Township, Range & Section)
Lot Size 132,549 Sq. Ft. Number of Bedrooms Four (4)
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(® all that apply)
Absorption Field 0 Initial Fx_1 Single Family (SF)
0
(w/wo ADU)
Septic Tank 0 Upgrade F]Duplex (D)
F-1Holding
Tank ❑ Renewal El
Multiple Dwellings
❑
Privy ❑ (SF and/or D)
Private Well Fx�
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE 1 WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 5 )U_ 0"-00 Waiver Fees: _
Date of Payment: t/ ( �b Date of Payment:
Receipt Number: 0(t 5-5tG% Receipt Number:
Permit No. met 3lt8l' Waiver No.
Permit App_9-1-12.doc
July 6, 2013
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 6, Block 2, Roseberry Ridge Estates Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer
The owner of Lot 6, Block 2, Roseberry Ridge Estates Subdivision, Addition No. 1
intends to construct a new four-bedroom home on the lot. We are therefore requesting
a permit be issued for the construction of a new well and septic system to
accommodate the home. The attached Site Plan and backup documentation identify
the location and configuration of the proposed well and septic system along with the
alternate site. No existing wells or septic systems are closer than 100' from the
proposed septic system. The property to the north and the east is Tract A of Roseberry
Ridge Estates Addition No. 1. It is currently undeveloped. Topographic contour lines
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 lot in the area of the absorption trench and alternate site
indicated silty gravel (GM) material with some sand. The percolation rate of the soil
was determined to be 30 minutes per inch. No groundwater was found during the
placement of the test holes and none was noted during the monitoring period. The
entire trench and alternate site will be placed within 30' of the two test holes. An
application rate of .6 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 2 —
42' long by 3' wide by 6' effective depth absorption trenches to treat and dispose of the
effluent generated in the house. The elevation of the distribution line in the absorption
trenches will be 2' below the surface and the total depth will be 8'. 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. A flow splitter valve will be placed to assure even flow to each trench.
The ground surface on the lot in the area of the absorption trench slopes to the west at
Lot 6, Block 2, Roseberry Ridge Estates No. 1
July 6, 2013
Page Two
approximately 15% to 25%.. The new trenches will be constructed parallel with the
contours of the slope as much as possible in conformance with Municipal requirements.
The new septic system will be constructed a minimum of 100' from all wells and any
surface water and 10' 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, /f
Michael E. Anderson, P:E.
Attachments.
MICHAEL E. ANDERSON
No. CE -4381
ROSEBERRY RIDGE ESTATES
ADDITION NO. 1
LOT 6, BLOCK 2
132,549 S.F.
TRACT A
VACANT
Alternate Site
30' Long x 3' Wide
x 6' Effective Depth
Absorption Trench
w/Advantex Treatment
System.
LESSEN
FCO — Foundation Clean Out
SV — Septic Vent
TH — Test Hole
CO — Clean Out
FSV — Flow Splitter Valve
MT — Monitor Tube
NOTE:
No Conflicts Between the Well
Radius and Adjacent Septic
Systems. All Adjacent Lots are
Currently Vacant.
TRACT A
VACANT
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LOT 6, BLOCK 2, ROSEBERRY
RIDGE ESTATES SUBDIVISION
ADDITION NO. 1
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Four Bedroom House
Perc. Rate: 30 Min./Inch
Application Rate: .6 GPD/SF
Deep Trench System
1,250 Gallon Septic Tank
6' Drainfield Rock
4 Bedrooms X 150 GPD/.6 GPD/SF (Application Rate) = 1,000 SF Absorption Area
1,000 SF/12 SF/ LF Abs. Area = 83.3 LF Trench Length
THEREFORE: Construct a 2 New 42' Long x 3' Wide x 6' Effective Depth Absorption Trenches.
Flow Line Elevation in Trench to be 2.0' Below Original Ground Surface. Total Depth to be
8.0' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption
Trench. Place Flow Splitter Valve to Insure Even Flow to Each Trench.
Natural
Backfill
1'6"
Geotextile
Fabric
6" 4" Perforated
PVC (Holes Down)
6'0" I 1 '> ---- — Drainfield Rock
i
3'
i
TYPICAL DEEP TRENCH SECTION �,...•�.�,
(NO SCALE) ......... gC ,
NOTE: Grade Area Over Trench to Drain Away. : 4
■
Minimum 6' Separation From Bedrock. 49th
•.....:...............
Minimum 4' Separation From Groundwater. i )
s ............... -Minimum 100' Separation From Wells in the Area. �� 3 MICHAEL E.ANDERSON
Minimum 100' Separation From Surface Water or Streams: �et�+, No. DE -4381
E
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-
11
12-
13-
14-
15-
16-
17-
18-
19-
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION:
PERFORMED FOR: _
DATE: 6/•
PARCEL ID#:
OB/OG
1� PROJECT No.:
TECHNICIAN: JB
TEST HOLE 1
GM
Silty Gravel
SLOPE
1
Professional Ent7neess St D:
SITE PLAN
SEE SITE PLAN
WAS GROUND WATER ENCOUNTERED?
IND
IF YES a WHAT DEPTH?
NET TIME
(MINUTES)
DEPTH To
WATER
(INCHES)
DEPTH OF WATER AFTER MONITORING:
None Q
TEST HOLE PRESOAKED PRIOR TO TESTING:
DATE OF MONITORING:
6/21/13 tC
12:00
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH To
WATER
(INCHES)
NET DROP
(INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
6/5/13
1
12:00
6.5"
2
12:30
30
7.75"
1.25'
3
12:31
6.25"
4
1:01
30
7.25"
1.00"
5
1:03
6.5"
6
1:33
30
7.5"
1.00"
PERCOLATION RATE: 30 (MIN/INCH) PERC. HOLE DIA. 10 (INCHES)
TEST RUN BETWEEN: 4 FT. and 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: 7/6/13
Munic
On -Site
ility of
�r and Wastewater Program
(907)343-7904
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
660-315-2-1
Expiration Date: z 0
Complete legal description Roseberry Ridge Estates #1, Block 2, Lot 6
Location (site address)V�2'511% Mount Magnificent Drive, Eagle River, AK 99557
Current Property owner(s) Karl Spohn
Day phone
Mailing address 5321 Tudor Top Circle Anchorage, AK 99507
Real Estate Agent Day phone
2. TYPE OF DWELLING:
fkr
0 Single Family (w/wo ADU) S UB f T T A
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex) JUN 2 7 2014
3. NUMBER OF BEDROOMS: Four
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
IX
Individual
0
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public :Nater System
❑
Public Sewer
❑
WaiverNariance request for A 111
Distance:
Received by:
Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ iO l adv H lft j&As A — t
Date of Payment -X'
Receipt Number oatlbTCA
COSA# OX-�`�►ZRZ
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.
Name of Firm Anderson Engineering Phone
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
6. DSD SIGNATURE �
System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for
522-7773
bedrooms, with the following
By: Original Certificate Date:_
The4. , 1pal y o r chorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet L . 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: Roseberry Ridge Est. Sub., Block 2, Lot 6
A. WELL DATA
Parcel ID: 050-315-21
Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y
Date completed 7/17/13 Sanitary seal (Y/N) Y W res properly protected (Y/N) Y
Total depth 360 ft. Cased to 44 ft. Casing height (above ground) >18 in.
FROM WELL LOG AT INSPECTION
Date of test 9/6/13
Static water level 73 ft.
Well production 36 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate •919 mg/L
Arsenic ND ug/L Date of sample: 6/20/14
B. SEPTIC/HOLDING TANK DATA
ft.
Collected by: J. Anderson
Tank Type/Material Septic/Steel Date installed 2/28/14
Tank size 1,250 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)
Date of pumping New Pumper Construction
C. ABSORPTION FIELD DATA
21
Date installed 8/17/14 Soil rating (g.p.d./ft2 or ft2/bdrm) •6 GPD System type Deep Trench
Length 84 ft. Width 3 ft. Gravel below pipe 6 ft.
Total depth 9 ft. Eff. absorption area 1,008 ft, 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
Datum
in.
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot _
Absorption field on lot
Public sewer main N/A
>25'
>50'
Size in gallons
"Pump off" level at in.
Cycles tested
>100'
>100'
Sewer /septic service line.
Animal containment areas
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots >100'
On adjacent lots >1 00'
Public sewer manhole/cleanout N/A
Holding tank N/A
Manure/animal excrete storage areas >100'
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation > Property line >5
Water main > 0 Water service line >10'
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
Property line >10, Building foundation >10'
Water Service line > Surface water >100'
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that i have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Michael E. Anderson, P.E.
Date 6127/14
COSA brown sheet 10-10-12.doc
Absorption field >5
Surface water >100'
Water main > 10'
Driveway, parking/vehicle storage >10'
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