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HomeMy WebLinkAboutROSEBERRY PARK ESTATES BLK 2 LT 3Roseberry Park Estates Block 2 Lot 3 #050-315-38 Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page / of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: QS Pl 3 /2 3 5 PID Number: _05 ON S39 Dwelling: 1WSingle Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: 14 New ❑ Upgrade Name: E ABSORPTION FIELD Address a &O x _7Z� / Deep Trench E] Shallow Trench ❑ Bed ❑ Mound ❑ Other Phone / 6 Number of Bedrooms Soil Rating w Total depth from original grade .z2?- 41c 1 • OC/ GPD/SF /. J Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Su/f(ivision Block Lot 3.5 Ft. Ft. 1 " f Fill added above original grade p * Gravel length —� Township .Range Section Vi 5 Ft. SZ Ft. I V From Septic Tank I Absorption Field Lift Station Holding Tank Sewer Line Well /'V'1 t Surface Water ,40 �- too Lot Line 4L A _ ,_ Foundation NA Curtain Drain N,h ,V,4 A/,q Ns} Remarks ..._w.._. S,�nfD E,�2 s *- SA�ro ERs' Inspector Oct y7/ G_ q Inspection /L Lit S J. IYw11Vv1 V^LIIIGD VIJIAI RiG UGI - Ft. n area Number of trenches Dist. hetwaon S.T.E.P. 540 S TE EL 2 - on on level at 1pump off level at make and MATERIAL House to tank J, Drainfield ;H MARK (Assumed elevation) t Z3 anddesn!lfl�- --- —. dates: i 2 /2,� /3 3" c COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL ,onditional Approval: Date Inspections V(• draklf!eid r0/3 CO/MT Q `r /'] It 'G )04b Steven' E bar Septic Double CD's 75 63 ST1 68 65 ST2 70 61 CD1 79 82 CD2 94 65 MT 77 77, 5% Slope 1 1 5% Slope � 5 F1 t c _ = 5% Slope RIO :% _ m 4 Bdrm 1 m I �� w15 - w Ditch -U c pa Cut 1 r E I 5% Sl a © 30%New 1250 G e / -- c ti n 8' Drop m �� �� Septic Tank 5% m Double C.O.'s f- Q M 3 5% Slope 7H0 ` rn .� rt r I 5 57 Slope Ditch N ` Cut _ ® 25% Alternate Trenc DropCD /iy 5% Slope No Conflict Off—Pmperty- I � 30 / Eagle River Loop Road ----- - -- :•��.OF A� R❑SEBERRY PARK EST, 1 40' NORTHRIM .y�asm ' . * PLAN ENGINEERING . BLOCK 2, LOT 3 . ao Box 77072+�.... WASTEWATER RECORD LAYOUT Riven 99577 Eagle R7a r 90 7. 694. 7028 �/' �f"T- e; — -� _.___... WELL LOCATION 8/4/14 2 of 3 S u c N L F-- .6 di Y L C5 F- a m aj w m 3 0) CI PCI Ln 41 3 O C, d m U U L N O U 0 0 O L� u s u L Ul L F- 0 O 4' i O W I M 0 F - w CL 0 0 3 0 L d Ol U 3 L 0 4' c 0 f L u ON W 11 C O d d > Ul W W 3 -i \H L�L nOn/ L�L Q � z � w z U ~ z U W u W (4 W �0 n a M a Z O O O Soi W n c ro Zm x i Y it ry as W 0 W W E� cu W e m W W ti m O v W W CO cz PQ W 3 -i \H L�L nOn/ L�L Q � z � w z U ~ z U W u W (4 W �0 n a a Z O O N 0 W n c ro Zm x ri O ZW as W Certified Drilling Log OC CO tltia BILL 8, COLE aP.O.Box 670269, 9 ULLIVANWATER WELLS OWNER OF LAND: Michael Quinn Const. ADDRESS: Bore Hole Data Depth From To LEGAL DESCRIPTION Roseberry Park Est. Blk 2 Lot 3 DATE: 8/15/13 0 4 Casing Stick up PERMIT NUMBER: 131235 DATE OF ISSUE: 8/7/13 TAX IDENTIFICATION NUMBER 05031538000 Is well located at approved permit location: ® Yes ❑ No Method of Drilling: ®air rotary ❑ cable tool Depth of Well: 65ft Casing Type: Steel Wall thickness .250 inches Diameter: 6 inches, depth 65ft Static Water Level: 40 feet Recovery Rate 12 ® gpm ❑ gph Method of Testing Air Well Intake Opening Type: ® open end ❑ open hole ❑Screened Start feet Stopped Grout Type: Bentonite Chips Volume: Depth: from 0 feet, to 20 feet Well Disinfected Upon Completion: ® yes ❑ no Method of Disinfection: Chlorine 50ppm Comments: 4 6 Overburden 6 25 Tight Sand & Gravel w/ Boulder 25 46 Hard Pan 46 59 Tight Sand & Gravel 59 65 Sand Gravel & Water 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. ARCTIC PUMP & WELL INC. Jim Sullivan PO Box 770197 ppm'�pu�mi Eagle River, AK 99577 sUas f 8 (907) 688-2510 (907) 243-2282 Pump Installation Log Well Drilling Permit Number: OSP131235 Parcel Identification Number: 05031538000 Date Of Issue: 8/7/2013 Friday, April 04, 2014 Legal Description Roseberry Park Estates B2 L3 Property Owner Name Address: Quinn Construction Lot: 3 PO BX 772641 Block: 2 Eagle River AK 99577 Pump Installaion Date: 3/27/2014 Pump Intake Depth Below Top of Well Casing: 55 Feet Pump Manufacturer's Name Franklin Pump Model: 10JS05P4-2W230 Pump Size: 1/2 HP Pitless Adapter Burial Depth: 10 Feet Pitless Adapter Manufacturer's Name B-10 Pitless Adapter Installer: u/k Well Disinfected Upon Completion? Yes Method of Disinfection: Chlorine Comments: Pump Installer Name: Arctic Pump & Well, Inc. Friday, April 04, 2014 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: OSP131235 Tax Code Number: 05031538000 Work Type: Welseptic Permit Effective Dates: August 07, 2013 to August 07, 2014 Design Engineer: NORTH RIM ENGINEERING Subdivision: ROSEBERRY PARK ESTATES Site Legal Address: ROSEBERRY PARK ESTATES BILK 2 LT 3 G:0154 Owner/Address: MICHAEL QUINN CONSTRUCTION INC PO BOX 772641 EAGLE RIVER AK 995772641 Site Mailing Address: Lot Size in Sq Ft: 50348 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. Received Issued By By Date: Date: v MUNICIPALITY OF Community Development Department Development Services Division 0* On -Site Water & Wastewater Program ANCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 4'511'315- 3 ff Property owner(s) /Y11 k -e-- rYr Day phone ZZ.7— q `%.-I( Mailing address Site address Legal description (Sub'd., Block & Lot) C Legal description (Township, Range & Section) Lot Size -50 -?q k Sq. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Initial Single Family (SF) (w/wo ADU) Septic Tank Upgrade ❑ Duplex (D). El Holding Tank El Renewal ❑ Dwellings 171 Privy 171 (SF and/or D) (SF Private Well Kb Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: 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) 60 Permit/Rush Fees: Waiver Fees: Date of Payment: �_ Date of Payment: Receipt Number: 063NN_ Receipt Number: Permit No. 6 Waiver No. Permit App_9-1-12.doc TH IZ- ENGINEERING Roseberry Park Estates, Block 2, Lot 3 SPECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing: This is a new 4 -bedroom, single family home. This is a new subdivision and some of the neighboring lots are not yet developed. These lots are large and are served by private water wells. No adverse impacts are expected from development. No conflicts to the other lots will take place by this septic system construction. The easements are located on the drawing and are not encroached upon. A previous subdivision soil test revealed sandy soil with low silt. The test hole from the subdivision has a fast percolation rate, but soil is about 75% sand. An application rate of 1.2 GPD/FTZ with 0.5 reduction factor for utilizing a 5' wide trench. Trench Length = 500 FTI/5'x .5 reduction factor = 50'; 1 line @ 50'. No bedrock was encountered or groundwater was encountered. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations. • Two compartment, 1250 gallon septic tank. Watertight couplings on inlet & outlet. • 5' minimum between the tank and bed. 10' to property lines. • 3' of cover or insulation is required for trench; an equivalent of 1" insulation for each 1 foot soil cover. • Tank & solid pipe must be set on well compacted, stable soil. • 4 inch diameter cleanouts with airtight caps are required F to 4' from foundation wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field, not more than 10' from the tank positioned to provide cleanout access towards the tank and towards the absorption field. • All cleanouts must extend to at least ground level. • In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron. Trench to be placed level, minimum of 4' to groundwater, 6' to bedrock from drain - rock. • Drain rock to be '/Z inch to 2 Y2 inch screened. Drain rock to be distributed uniformly throughout the trench. • Perforated pipe to be installed level with perforations down. • Silt barrier (filter fabric) to be installed above the drain rock. • Smeared trench sides must be raked or scarified before drain rock placement. • Backfill over drain rock must not be less than 36". • The finish grade must be mounded to promote drainage away from trench. • Insulation must be placed over any pipe installed under driveways or parking areas. • Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, • Sewer Service Line is minimum 2% slope. • Septic Tank to be pumped every two years or when required. • Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal) Neighbor Septic DESIGN NOTES: 1. Total Depth of Trench is 7.5'. 2. Sewer Service Line minimum 2% slope. 3. Test Hole From Subdivision. 4. Lots Served by Private Wells. / 5% Slo e \ 5% Slope U Z CD RIO r S 5% lope Q I o m 31 ��\� v CD 4 B rrn House / 1 0 Ditch _ Gut I 5% Slope ® 30% c0 57/. Slope ° 8' Drop INew 1250 Gallon/ o 0 Septic Tank 5•r. Slope Double C.O.'s —� M 5% Slope Ditch cn Cut � c 9 25% CD y Drop (D 5% Slope No Conflict Off— mperty Eagle River Loop Road -��..• • R❑SEBERRY PARK EST NORTHRIM ENGINEERING*i49m BLOCK 2) LOT 3 PLAN ss WASTEWATER DESIGN LAYOUT 90 7. 694. 7028 WELL L❑CATI❑N 8/6/13 z of 3 �� TH IIZM �NLNEERING MEMO Steve Eng, PE, PH (907) 694-7028 tel northrimeng@aol.com Date: 7/25/13 To: MOA On -Site Services Subject: Roseberry Park Estates, Block 2 Lot 3 Number of Pages: S The soil is excellent, similar to most subdivision test holes. The owner is planning for a 4 - bedroom house. Slopes are as depicted on the drawing. Cut -banks exists above the road, but there is adequate separation to the septic system. The nearest neighbor's well/septic is over 200 feet away, except for the lot directly north. Please issue a permit to install the septic system & drill well. If there is need for additional information or clarification please give me a call. Thanks-S`r_s_ -_i W S NN M 4 0} M 7 o v L �- S ~ O C� M c + LLJ iO O c LO �I 1. �I j m CL o U rcl �� O LL L LLJ 3 vL + A a, LLJ U M �L o E::] W OJo� O 4 LA LJ n w rip lJ Li m U\H Q LL W i Q N Vl N / Q i' L al Q a>o Z Y W 0 U W I— U Q a u c� o z o o W H u ° H I— .�-+ _ N 1 3 0, {+ 6 a vi N a W LJ a� v N~ 4� -ate N d U > i' �': wy�1j 4 Y U d i-' 3 O U d a L7 O S wO E a +' f O -- U) QE 0)i'r_+ ., i +� sa'. I dE ~� O W o U LO n O N N al U L_0)S Ea, lob %`b '. f i kA �� LOQ ;40, 4 jOj¢ 3U L J O O E df U }' j L'i C5 �z �( 0 i—�'a�UYE O N a o ai 0 W O a z u L L vai aa° 3.N -1 ~ W a L7 � a,3 d Q0 0.0,30 Z C7 O L� A .-: (U ('M v L6 �O W _j 7 0 i L TI�:�1M ENGINEERING DEPTH (FEET) 1 - , Time Net Time 3 Net Drop 4 11/11 5 -- 6 - -- 7 - Q 8 •• 9 1' 10 - O. 11 - -- 12 - -- 13 4 14 1 rain. 15 1' 5 16 - 1 64 17 - 7.5' 18 - 6 19 - 1 65 20 - 6.5' 21 - Organic Sand w/ Gravel SP/GW S❑ILS LOG - PERCOLATION TEST Performed For, Lee Coy Groundwater Observed: None Depth To Water After Monitoring) None Date of Monitor, 11/23/03 & 5/1/04 # Date lGross Time Net Time D!6* Net Drop 1 11/11 0 -- -- 2 11/11 1 1 Min. 1' 3 11/11 32 -- ' -- 4 11/11 33 1 rain. 6.5' 1' 5 11/11 1 64 -- 7.5' -- 6 11/11 1 65 1 min. 6.5' 1' Percolation Rate, 1.0 min./inch Pre -Soak Seeped Away in Under 10 Minutes Perc Hole Diameter = 6' Test Run Between 3' and 4' Performed in Accordance with All State/Municipal Guidelines in Effect NOR THRIM ENGINEERING 177.77 Eeor Pow Cirels Lo9le Rim,, Alosk* 99577 61146-70 z& Roseberry Park Est. T. H. 1 GEOTECHNICAL Door. 9/05 11 of 29 HJUM, P A UT Y O G CC �O G„ OEE r 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. 650-315-38 1. GENERAL INFORMATION Expiration Date: L l I / i Complete legal description Lot 3, Bk 2, Roseberry Park Estates Location (site address) 11268 Sitka Rose Circle, Eagle River, Alaska 99577 Private Septic Current property owner(s) Russ & Kaci Hall Day phone(207) 420-1836 Holding Tank Mailing address same Real estate agent Traci Barickman/ReMax Frontier Day phone (907) 315-0324 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ci ~ ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic n Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ O o Q - 0O Date of Payment � 11 12DI - p� Receipt Number Cr I Q(.t-14 1 v% COSA# OSCI�135t� Waiver Fee $ Date of Payment Receipt Number .Waiver # J 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 Pinard Engineering Phone (907) 232-1347 Address PO Box 871347, Wasilla, Alaska 99687 Engineer's Printed Name Paul Pinard 6. DSD SIGNATURE --4< System #1 Approved for —�-- bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for Date 7/30/19 1 /r 0 A�i� /IIY�� � bedrooms, with the following .,kitttt (((w"" Mm)) By: `� Original Certificate Date: 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 CASA Checklist blue sheet COSA Checklist Legal Description: _Lot _3, Bk 2, Roseberry Park Estates Parcel ID:050-31 5-38 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 4.0 gpm Date drilled 8/15/13 Water storage tank volume gallons Total depth 65 ft Well disinfected for coliform test? ❑ Yes [] No Cased to 65 ft n Coliform bacteria is Negative ® Sanitary seal is functioning correctly Nitrate4. 719 mg/L ❑ Nitrate less than MRL (ND) ® Wires are properly protected Arsenic ug/L Arsenic less than MRL (ND) Casing height (above ground) 24 in. Collected by Pinard Engineering Date of flow test for COSA 7/29/19 Date of Sample 7/17/19 Static water level at beginning of test37.8 ft. Comments See attached Well Flow Test Data Sheet. Well capable of 4+ gpm. B. TANK DATA Age of tank(s) 6 years Tank type/material Steel Measured operating fluid level in septic tank 4.0' ® Standpipes/foundation cleanout per record drawing Date of pumping 5/3/19 D. ABSORPTION FIELD DATA Which system tested (date installed) 8/23/13 ® ALL standpipes present per record drawing Total measured depth from grade 8.5 ft (max) Measured depth to pipe invert from grade 3. 5 ft (min) ❑ N/A —pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective ® Code -required soil cover over field ® System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 2000 gallons Comments/Deficiencies: COSA Checklist yellow sheet C. LIFT STATION NA ❑ Required maintenance completed Age.of lift station years Lift station material Comments: Pumping Receipt is attached Adequacy test date 7/29/19 Results [EPass For 4 bedrooms Fluid depth prior to test 0 in Water added 720 gal New depth 0 in Elapsed time 180 min Final fluid depth 0 in Absorption rate600+ gpd Any rejuvenation treatment (past 12 months) None If yes, enter date 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 Community Sewer Manhole/Cleanout > 100' ® Yes if No ft F7 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' Surface Water > 100' ® Yes Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Fx� 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' ® Yes if No ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' 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' 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 ft Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that / 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 OF ®*�.� lG;a °a Paul E. Pinard "Ce. CE - 4793 ( 33.0' IroT - 5' SNOW WOODEN FENCE ' STORAGE ` EASEMENT I ( 10.1'x12.2' ENCLOSED PATIO I) LOT 50.348 S.F. 5.0' \ ( 100.0' . `\ EASEMENT _ PROTECTIVE WELL RADIUS -Z WELL �� .. 49,7. 88.7' 3 -2.0'x 10.2' CANT DECK 10'x12.0' S a LOT 4 \ SEPTIC -' CLEANOUT h 1.5'x4.1' CANT. N REiAINING�JALL W Iz p = �� z I SEPTIC w ui CLEANOUT , 2 L _ N 15' TELECOMM. U `EASEMENT m Cil d 7 a i7 ro ` I WOODEN FENCE !/ 7,,,, "TT 30' WALKWAY & DRAINAGE EASEMENT 5.0' f 115' TELECOMM. . `\ EASEMENT 0 1.0' WELL �� .. 49,7. -2.0'x 10.2' CANT LOT 4 5.0' f 115' TELECOMM. EASEMENT 0 1.0' �� .. 49,7. LOT 4 L _ N 89'31'34"W 135.03 \\ TRACT A,--2 BRENDLWOOD SUBDIVISION 1 I Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 r CERTIFICATE OF ON-SITE SYSTEMS APPROVALt Parcel I.D. 050-315-38 1. GENERAL INFORMATION SHi Jt Expiration Date: //- /E-14 Complete legal description Roseberry Park Estates Block 2 Lot 3 Location (site address) It?, (PY Sitka Rose Circle, Eagle River, AK Current Property owner(s) Quinn Day phone 229-4966 Mailing address same Real Estate Agent Cindy Wilson Day phone 244-1930 2. TYPE OF DWELLING: i ® Single Family (w/wo ADU) (+° �i 7! F-1DuplexNU( f d4 ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class C Well Public Water System TYPE OF WASTEWATER DISPOSAL ® Individual ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer ❑ Received by: - ,` V , Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Oso f Date of Payment tgII Receipt Number/B �5S2J� COSA # 0e2q`f,q I?i Date of 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 NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng 6. DSD SIGNATURE System #1 Approved for System #2 Approved for Disapproved. Conditional approval for bedrooms. bedrooms. Date 8/4/2014 Stv x� U ;G 9LeYC• GC i R 11t ro r� `t rn ` 7, (+ *r s bedrooms, with the following stipulations... - By: v Original Certificate Dater! The Municipality of A horage Devlopment 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 9-1-12.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: ROJ'' &Zi ,/°MIK � rT-/ tE-r Parcel ID: 050-3/S >'8 A. WELL DATA Well type _ If A, B, or C provide PWSID # Date completed !S 3 Sanitary seal (Y/N) Total depth j!!C5_ft. Cased to FROM WELL LOG Date of test !3 Static water level ft. Well production 12 g,p,m, WATER SAMPLE RESULTS: Coliform !�Lcolonies/100 mL Nitrate 2,63 mg/L Arsenic Q Z38 ug/L Date of sample:2 B. SEPTIC/HOLDING TANK DATA Tank Type/Material _74o7-1 C / S%ECL Z Well Log (Y/N) Wires properly protected (YIN) V Casing height (above ground) �in. AT INSPECTION WE t.J ft. Collected by: L� Date installed Z3 f3 Tank size i0 gal. Number of Compartments Z Cleanouts (Y/N) Foundation cleanout (YIN) Depression over tank (Y/N) e_ High water alarm (Y/N) AY Date of pumping f Pumper C. ABSORPTION FIELD DATA Date installed O Z 1 Soil rating (g.p.d./ft2 or ftZ/bdrm) Z System type ZEi—SWG(f Length Z ft. Width 5 ft. Gravel below pipe T ft. r7 sf Total depth ft. Eff. absorption area SZ Oftz Monitoring tube Depression over field 2 Date of adequacy test _ Results (Pass/Fail) For _ bedrooms Fluid depth in absorption field before test in. Elapsed Time: - min. Final fluid depth _ Any rejuvenation treatment (past 12 mo.) (Y/N & type) Water added gal. New depth in. _ in. Absorption rate >= g,p,d. If yes, give date D. LIFT STATION Date installed "Pump on" level at _ Datum Size in gallons in. "Pump ofr level at E. SEPARATION DISTANCES Cycles tested WELL ON LOT TO: r Septic tank/lift station on lot BOO T Manhole/Access (YIN)_ in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots 410 r't in. Absorption field on lot 1610 On adjacent lots / O n rt Public sewer main A/A Public sewer manhole/cleanout NM r Sewer /septic service line Z 5 r Holding tank NA rel Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation Jr t Property line 'f Absorption field S +� r era Water main A A Water service line /O Surface water id Q r Wells on adjacent lots /QQ �I- ABSORPTION FIELD ON LOT TO: r Property line �O �� Building foundation t Water main Water Service line �Q �� Surface water �� e� Driveway, parking/vehicle storage 2 S r 't' Curtain drain OYQA) E Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that t 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 S i,FvC: J—=7X.)6- Date COSA brown sheet 10-10-12.doc M] .. i �O.D♦\G9�1 ie•. P.Oaw diO s..' w .... csr< Steven c�a > 4� I LOT 2 �;:Q , 0 5' SNOW STORAGE / EASEMENT 89.12'22'E 182.29' \ I a vO 1,OA \0„ LOT 3 �'•.. 50348 &F, WELL -100.0, \ I 100.0' - -__ 10x101 \ - -- --- PROTE6TIVF.: WELL RADIl15 CANT i r 1 86.7• I 11CCK i t0•x+�.0 -- tir mss t o �- SEPTIC CLEANOUT 'v mcnur. �° • i' t rri \\ i LOT 4 /' / z O ISEPTIC / CLEANOUT - ---- z / i o a �r15' TELECOMM, a EASEMENT J 30' WALKWAY / pRAINAGE F EASEMENT � TRACT A-2 BRENDLWOOD SUBDIVISION t PLOT PLAN AS BUiLT X SCALE 1" 40' GRID NW 154— Project No. L13 --159E7 Daryl Avenue, Anchorage, Lan SC ASSUCIat@S inc. Alaska 99515-3049 (907) 522-6476 Phone (907) Registered Land Surveyors (907) 522-4625 Fax •G�>�'aop�,�p -5�'OF A ken®iangsurvey.com / jonothanCiongsurvey.com �p( �y K'Cr........... rj.l 'i JM1 I hereby certify that i have surveyed the following described property: -'j -"V, LOT 3, BLOCK 2 ROSEBERRY PARK ESTATES (PLAT#2005-155) ��C7: a.9TH Anchorage Recording District, Alaska, and that the improvements situated thereon are the lines do onto the adjacent thereto, that within property and not encroach property the no Improvements on the property lying adjacent thereto encroach on surveyed `� p remisas and that there are no roadways, transmission lines or other visible �''s Q KENNETH 0 tA�r'/ r' easements an said property except as indicated hereon. ,o I QQ� La -5202` _ , '�.�. f.fk , at Anchorage, Alaska Dated this the t.i� .:"` Day of j1.,�i ,�- ���� f,` 1�� 'a 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 plot.