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HomeMy WebLinkAboutT15N R1E SEC 1 S2NW4NE4SW4T15N R1E Sec. 1 52 NW4 NE4 SW4 #057-061-05 trcev uoiuti iu/ Municipality of Anchorage On -Site Water and Wastewater Section e (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP141412 PID Number: 057-061-05 Dwelling: t❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: 0 New ❑ Upgrade Name DAKOTA KELLER ABSORPTION FIELD X Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 4 1.2 GPD/SF JTotal 8.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.0 Ft. Gravel depth beneath pipe 5.0 Ft. Subdivision Block Lot Fill added above original grade 1 -+. Ft. Gravel length 51 Ft. Township Range Section T1 5N R1 E SEC 1 S2 NW4 NE4 SW4 Gravel width 2.0 Ft. Beds: Number of Lines 0 Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 510 FF 1 Ft. Well 1001+ 100'+ 50'+ TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCH TANK Capacity 1500 Gal. Surface Water 100'+ 100'+ Material Number of compartments Lot Line 10'+ 10'+ NA STEEL 2 Foundation 10'+ 101+ LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034Tank to 3034 drainfield Installer MIKE N ANDERSON, P.E. Drainfield 3034 CO/MT 3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 102.6 ft Inspdection 1s` 9-15-17 9-15-17 Location and description Zed GARAGE SLAB 3rd 4th ON-SITE WATER AND WASTEWATER SECTION APPROVAL �gme?S;aTp Conditional Approval: Date �°� l•' e`��eoee e°o•i ��e.° ---f-_ .. eoeeo eo....°o ,,4 MICHAEL N. ANDERSON Septic System / �i��%a°°° c�E]9 69 °.\y ��Q9�® Approve ( w(`��G'-tet_ Date 2^(o-2o2c� <.`:/'�e•°,��' Note: this approval does not include well permit requirements. trcev uoiuti iu/ Permit No. OSP141412 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: T15N R1 E SEC 1 S2 NW4 NE4 SW4 MARK A 8 C01 Tcol 28 55 45 TCO2 65 _9R 65 CO2 68 69 C04 56 88 C05 87 70 MT1 56 88 I BENCH, GARAGE SLAB I 1 1 1 \ NEW WELL zr� \ A \ \ C01 TC01 MT1,1 �� 2`04 C0 CO3 \ I� • Cb5 \ TH#1 RESERVE TRENCH ASBUILT SCALE: 1"=50' PID No.: 057-061-05 TCO2 rCO2lr CO3 coo {/-Cos I / C 02 I I �MT / ®®••� OF DO FlNSH GRADE / C�•' �,.�(/,{�� •�' ®® /—FILTER FABRIC .0 ORD 1 49 !H— ................. H 9 ,.500 ..... ........................ GALLONSTEEL a 7 sn 7 SP .,!............................. TANK TANK 42. : MICHAEL N. ANDERSON: 7* 9 9 No. CE 469 � SEPTIC SECTION 84 ® a;l� ZQ•.••� • 0 N.T.S. DRY. MAY 20P/ ®® • • ®. Certified Drilling log IR DOC CO dba BILL COLE ��►ULLIVAN WATER WELLS ellP.O. Box 670269, Chugiak, AK 99567 688-2759 OWNER OF LAND: Dakota Keller ADDRESS: PO Box 770788 Eagle River, AK 99577 Bore Hole Data Depth From To LEGAL DESCRIPTION T15N RIE Sec 1 S2NW4NE4SW4 DATE: 9-30-14 0 2 Casing Stickup PERMIT NUMBER: OSP141412 DATE OF ISSUE: 9-26-14 TAX IDENTIFICATION NUMBER 05706105000 Is well located at approved permit location: ®Yes ❑No Method of Drilling: ®air rotary ❑cable tool Depth of Well: 244 feet Casing Type: steel Wall thickness .025 inches Diameter: 6 inches, depth 244 feet Liner type none Static Water Level: 112 feet Recovery Rate 2 ® gpm ❑ gph Method of Testing air Well Intake Opening Type: ® open end ❑open hole ❑ Screened Start feet Stopped ® Perforations Start 117 feet Stopped 125 Grout Type: bentonite Volume: 50 lbs Depth: from 4 feet, to 44 feet Well Disinfected Upon Completion: ®yes ❑ no Method of Disinfection: Chlorine 50 PPM Comments: 2 4 Overburden 4 30 Sand and Silt 30 42 Sand and Gravel 42 50 Sand 50 120 Sand and Gravel with Boulders 120 128 Silty Sand, Gravel, and Clay w/ water 128 138 Sand and Silt 138 244 Clay and Gravel 'WATER QUALITY TES-ONG Coliform C011100ML Nitrates UmIL Arsenic uQ1L 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 Eagle River, AK 99577 Mntts a s11 .j r' (907) 688-2510 (907) 243-2282 • Well Drilling Permit Number: osp181217 Parcel Identification Number: 05066114000 Date Of Issue: 7/26/2018 Legal Description mountain valley est #1 B5 L11 Property Owner Name Address: Keller Construction Lot: 11 36784 Eklutna Lake Road Block: 5 Chugiak AK 99567 Pump Installaion Date: Pump Intake Depth Below Top of Well Casing: Pump Manufacturer's Name Pump Model: Pump Size: Pitless Adapter Burial Depth: Pitless Adapter Manufacturer's Name Pitless Adapter Installer: Well Disinfected Upon Completion? Method of Disinfection: Comments: Pump Installer Name: Arctic Pump & Well, Inc. Wednesday=, Februail� S, 2020 5/29/2019 110 Franklin 5Y 10SDQP-1.5HP-3RC 1.5 HP 10 B-10 u/k Yes Chlorine 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: OSP141412 Tax Code Number: 05706105000 Work Type: WellSeptic None Permit Effective Dates: September 26, 2014 to September 26, 2015 Design Engineer: ANDERSON CONSTRUCTION & ENG'G Subdivision: T1 5N R1 SEC 1 Site Legal Address: T1 5N R1 SEC 1 S2NW4NE4SW4 G:1410 Owner/Address: KELLER GLEN B & MARY E PO BOX 770788 EAGLE RIVER AK 995770788 Site Mailing Address: This permit is for the construction of: Lot Size in Sq Ft: 217800 Total Bedrooms: �� PmC %2 17 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 E Issued By: ate: 2 ate: MUNICIPALITY OF ANCHORAGE Community Development Department Development Services Division On-Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATIO~ Parcel I.D. (~"'~ -0~' -- ¢~"'" Property owner(s) .~'f ('~vl Mailing address Site address Phone: 907-343-7904 Fax: 907-343-7997 Day phone Legal description (Sub'd., Block & Lot) ~r"-!~-~_,,~;..i.1~,-~,~- ~--~-~.~ ~ ~ Ly ~ Legal description (Township, Range & Section) ~ ~'~ ~ Lot Size ~ ~/~¢¢ Sq. Ft. Number of Bedro~s ~.~ (~ all t~at apply) Absorption Field ¢ Initial ~ Single Family (SF) (w/wo ADU) Septic Tank ~ Upgrade ~ Duplex (D) Holding Tank ~ Renewal ~ Multiple Dwellings Privy ~ ~ (SF and/or D) Private Well ~ / ~~U" ~~ Water Storage ~ ~ 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 ~ (~ ? ~'~'/~' f ~ 7 O,~aiver Fees' Date ofPayment: I ~(~ ~((~ O~ateofPay~ Receipt Number: I ~ ~ Receipt Number: Permit No. O5¢~ J~ I~ Waiver No. ·Michael N. Anderson, P.E. Civil/Structural Engineering & Construction 4661 Natrona Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 Sept 23 , 2014 Municipalities of Anchorage Departments of Health and ~uman Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Legal: New Septic system and well permit T15N, R1E, Sec 1, S2, NW4, NE4, SW4 To Whom it may concern: This letter is a request for a 4 bedroom septic and well permit on the above referenced lot. The test hole was completed in May and showed loose silty sand for the entire 16 foot depth with no water during the excavation or after the 7 day monitoring period. The perc was measured at 3 minutes per inch therefore a deep trench has been designed. The lot slopes gently to the south at about 5 to 10 percent with no slopes greater than 25 percent within i00 feet. This new system will not impact any of our neighboring wells or septic systems due to vacant land surrounding the site, see the site layout. Please call me if you have any questions. DESIGN CRITERIA: I .~-MOUND OVER ('F4t~1) ~ --~/--GRADE 4 BDRM X 150 = 600 GPD ORO SOILS = 600/1.2 = 500 GPD 1.o_ ~ ~.....~--F.I.L.T~R FABRIC 500 GA/10 -- 50' -3.0- ~ 2.----4'¢ PIPE (1) TRENCH sP ~SEWER ROCK 9.0' DEEP I ,DE I I 50' LONG 16_ SEPTIC FIELD SECTION /--,, ¼%', PROPOSED WELL ~"~*~ I" /t ~ ~ T35N R 1 ~' ~{~ff" EXISTING N~[4N[~,SW4 & i~E4NW 4 ~ FOUNDATION ~ T15N ElK $EC1 T15N R1£ SEC1 T15N ElK $ECl S2NE4NE4SW4 NW4W=SW4 & NW4NW4NE4SW4 PROPOSED/ ~ ~ X-- EXISIINO HOUS£ ~1 DRAINAGE RELD~ ~_PROPERTY UNE ~.. \ T15N ElK SEC$ SE4NE4SW4 / / Septic Design Prepored for DAKOTA KELLER T15N T1E SEC 1 S2NW4NE4SW4 Anchorage, Alaska . ~ .................. ~..,.,. M~¢hael N. Anderson, P.E. ~A*E:@/25/2014 ~,~.... ~.~:~. MICHAEL N. ANDERSONi/~' 4601 N^TEON^ AVE D~WN: D JR ~.....~[~[[~ .....~ ANCHO~GE, A~ 99516 (90~ 345-3377/F~: (907) 345-1391 SCALE: 1 "=500' T15N R1E SEC1 PROPOSED WELL / " I WELL .' :'". '.:' :'. BEDROOM I/ ":~ HOUSE --% /~ ~---'~ ~PROPOSED 1,250 [CO -~ ~LLON SEPTIC TANK ~SN ~lE SEC~ ~PROPER~ UNE Septic Design Prepored for T15N T1E SEC 1 S2NW4NE4SW4 Anchorage, Alaska ............... (907) 345-3377 / F~: (907) 345-1391 SCALE: Legal Description: 'rl~-,,,~ , ~-~1 ~ ~'t ~.,~ / Township, Range, Section: 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 19- 20- Municipality of Anchorage Development Services Department Building Safety Division On-Site Water4700 Elmore Roadand Wastewater Program P.O. Box 196650 Anchorage, AK 99507 (907) 343-7904 Soils Log - Percolation Test COMMENTS Slope Site Plan WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT DEPTH? L O Depth to Water After . t p Monitoring? ~ E Reading Date Gross Time Net Time Depth to Water Net Drop ~/~,~ ~/,',~ /o~,'.~ ' '1 I / ~,* PERCOLATION RATE ~"~ ~"~ (minutes~nch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND ~4~ FT PERFORMED BY: ,jk~ J/l~ ~. I CERTIFY THAT THIS TEqT WA/~ PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: MUNICIPALITY OF ANCHORAGE 0"11Y..., 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. 057-061-05-000 Expiration Date: Legal description T1 5N R1 E SEC 1 S2NW4NE4SW4 Site address 36778 EKLUTNA LAKE RD Chugiak AK 99567 Current property owner(s) SHERWOOD SHANE & LINDSAY 5/21/2024 X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: 0 Original Certificate Date: 12/29/2023 (This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY OF ANCHORAGE Development Services Department -7 Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 057-061-05 Complete legal description T1 5N R1 E Section 1 S2 NW4 NE4 SW4 Location (site address) 3,6778 Eklutna Lake Road, Chu iak, AK 99567 Current property owner(s) Shane & Lindsay Sherwood Day phone (262) 994-2201 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: X Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑Q Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑■ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 6 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑■ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑■ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ ':�' '� 0 Waiver Fee $ Date of Payment COSA # O S 9 Date of Payment Waiver # COSA Application—June 2022 3.55 Forge Engineering 12/11/23 N/A N/A N/A Benjamin Schiller, P.E.12/27/23 (907) 522-7773 I MUNICIPALITY OF ANCHORAGE Development Services Department k�s, h'Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 057-061-05 1. GENERAL INFORMATION Expiration Date; 1 I JIA 7, � 0 o Complete legal description T1 5N R1 E SEC 1 S2 NW4 NE4 SW4 Location (site address) 36778 EKLUTNA LAKE RD EKLUTNA, AK Current property owner(s) DAKOTA KELLER Day phone Mailing address PO BOX 770788 EAGLE RIVER Real estate agent 2. TYPE OF DWELLING: Fx_1 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well [] Private Septic 0 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 $_55D 1� 0 Date of Payment 131)OAI Receipt Number 00 3 2 9 5 COSA #05C 21 l 6c� 7 Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm MIKE N ANDERSON, P.E. phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 12-2-21 3 �{3--8_9 By. Original Certificate Date: I a 7,202 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 blue sheet 6. DSD SIGNATURE '�.___ r <�'�. f'' '• . 4 �! System #1 Approved for bedrooms , .. , , . System #2 Approved for bedrooms. < «ICi1 i/: id, A:�'_RSC:1 ." ��� 4E- Disapproved Conditional approval for bedrooms, with the following stipular; - .a.. 3 �{3--8_9 By. Original Certificate Date: I a 7,202 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 blue sheet COSA Checklist Legal Description: T15N RIE SEC 1 S2 NW4 NE4 SW4 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA H Well log is filed with Onsite (or attached) Date drilled 9/3/14 Total depth 244 ft Cased to 244'+ ft Q Sanitary seal is functioning correctly Q Wires are properly protected Casing height (above ground) 30"+ in. Date of flow test for COSA 11/521 Static water level at beginning of test 110 ft. Comments B. TANK DATA Age of tank(s) 5 years Tank type/material �=Wl Measured operating fluid level in septic tank 48_� ❑ Standpipes/foundation cleanout per record drawing Date of pumping 11/5/21 D. ABSORPTION FIELD DATA Which system tested (date installed) 9/15/17 H ALL standpipes present per record drawing Total measured depth from grade 8.0 ft (max) Measured depth to pipe invert from grade - 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 0 gallons COSA Checklist yellow sheet Parcel ID: 057-061-05 Structure served by this system Well production at time of test 2+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes No X Coliform bacteria is Negative Nitrate 1.52 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L fi❑ Arsenic less than MRL (ND) Collected by MNA Date of Sample 11/521 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material _ Comments: Adequacy test date 1115/21 Results Q✓ Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 600 gal New depth 0 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate 600+ gpd Any rejuvenation treatment (past 12 months) 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' Community Sewer Manhole/Cleanout > 100' v❑ Yes if No — ft ❑✓ Yes if No _ ft Neighboring Tank > 100' 2✓ Yes if No — ft Private Sewer/Septic Line > 25' E✓ Yes if No _ ft Absorption Field on Lot > 100' El Yes if No — ft Holding Tank > 100' 21 Yes if No ft Neighboring Absorption Fields > 100' v❑ Yes if No _ ft Animal Containment > 50' Ov Yes — if No ft — Community Sewer Main > 75' ✓Q Yes if No — ft Manure/Animal Excreta Storage > 100' Qd 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' EJ Yes if No_ ft Property Line > 5' Yes if No — ft Wells on Adjacent Lots: Absorption Field > 5' Yes if No — It Private Wells > 100' Yes if No _ ft Water Main > 10'❑ Yes if No — ft Community Wells > 200'✓Q Yes if No _ It Water Service Line > 10' v❑ 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' ED Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' El 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' v❑ Yes if No ft F. ENGINEER'S COMMENTS --1r= " G. ENGINEER'S CERTIFICATION d `" I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with `' g 9 T MOA COSA guidelines in effect on this date. �NG! /, • • MICHFcC' h F �L -�� rzi-, 7 COSA Checklist yellow sheet MUNICIPALITY OF ANCHORAGE Development Services Department K On -Site Water & Wastewater Section Certificate of On -Site Systems Approval Parcel I.D. 057-061-05 1. GENERAL INFORMATION Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: -5- -e -2C92.C) Complete legal description T1 5N R1 E SEC 1 S2 NW4 NE4 SW4 Location (site address) EKLUTNA, AK Current property owner(s) DAKOTA KELLER Day phone Mailing address PO BOX 770788 EAGLE RIVER Real estate agent Day phone Q� 1 2 3 S. 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) Qo ❑ Duplex d ❑ Multiple Dwellings (Single Family and/or Duplex) _CD CP � 3. NUMBER OF BEDROOMS: 4 Baa 19,9 s 7£ z L Wd 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic El Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Dista Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment 9M616,26 Date of Payment Receipt Number go'T's 2 Receipt Number COSA# 1632 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 Engineer's Printed Name MIKE N ANDERSON, P.E. Date 2-15-20 O A,� 6. DSD SIGNATURE ° ° .. ° . ° ...... ° . ° °.°. System #1 Approved for 4 bedrooms ........... Q^^° ° ��•• MICHAEL N. ANDERSEN :':Z'— System �System #2 Approved for bedrooms CE -9(.69 � Disapproved X�0�®S�Q���� Conditional approval for bedrooms, with the following stipulations. B 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 COSA Checklist blue sheet COSA Checklist Legal Description: T15N R1 E SEC 1 S2 NW4 NE4 SW4 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 9/3114 Total depth 244 ft Cased to 244'+ ft 0 Sanitary seal is functioning correctly 0 Wires are properly protected Casing height (above ground) 30°+ in. Date of flow test for COSA NEW Static water level at beginning of test 112 ft. Comments B. TANK DATA Age of tank(s) NEW years Tank type/material STEEL Measured operating fluid level in septic tank NEW 0 Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA NEW SYSTEM �- Which system tested (date installed) NEW 0 ALL standpipes present per record drawing Total measured depth from grade 8.0 ft (max) Measured depth to pipe invert from grade 3.0 ft (min) ❑ N/A — pressurized field 0 Monitor tubes go to bottom of effective. If not, state depth into effective 0 Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 0 gallons Comments/Deficiencies: NEW HOUSE AND ON -SITE SYSTEMS COSA Checklist yellow sheet Parcel ID: 057-061-05 Structure served by this system Well production at time of test 2+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes X No 9 Coliform bacteria is Negative Nitrate 0.543 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L *Arsenic less than MRL (ND) Collected by MNA Date of Sample 10/14/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date NEW Results Q✓ Pass For 4 bedrooms Fluid depth prior to test 0 in Water added NEW gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) 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 Community Sewer Manhole/Cleanout > 100' Q Yes if No ft Q Yes if No Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' ❑✓ Yes if No Absorption Field on Lot > 100' [Z] Yes if No ft Holding Tank > 100' ❑✓ Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' 0 Yes if No F71 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' MYes if No ft 0 Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' P/1 Yes if No ft Surface Water > 100' ft ft ft ft ft El Yes if No ft Property Line > 5' ✓❑ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' F� Yes if No ft Private Wells > 100' 0 Yes if No. Water Main > 10' 0 Yes if No ft Community Wells > 200' ✓❑ Yes if No. Water Service Line > 10' F-11 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' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' El Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' El Yes if No ft Community Wells > 200' Yes if No Surface Water > 100' F-11 Yes if No ft F. ENGINEER'S 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. COSA Checklist yellow sheet . a �mamoo noom� mm a. aoa�pa f T" CE -9 c;9 mti a� •aaaQa• aVx ft ft ft ft 00 N W Q 0 0 b Q A SE 1/4, NE 1/4, SW 1/4 WELL 8-100' PR( 2.0'x12.3' CANT PLOT PLAN AS BUILT X SCALE 1" = 100' GRID NW 1410 Project No. 16-3821&1 , 2.0'x11.7' CANT 3 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 E Lang & Associates, i n C (907) 522-6476 Phone 36.3- (907) o OF q L�opp \ BALCONY M (907) 522-4625 Fox �4 2 STORY Professional Land Surveyors ken®langsurvey.com `�� ,q 4 N RESIDENCE jonothan®longsurvey.com �oP S �Onn I hereby certify that I have surveyed the following described property:Q0� V \ 72.5 S 1/2, NW 1/4, NE 1/4, SW 1/4, SECTION 1, T15N, R1E, S.M., ALASKA � ,�': 49TH � � 2.0'x14.0' CANT Anchorage Recording District, Alaska, and that the Improvements situated thereon are """ """ within the properly lines and do not encroach onto the property adjacent thereto, that \ SEPTIC no improvements on the property lying adjacent thereto encroach on the surveyed �hh.. ' KENNETH....LAN ... premises and that there are no roadways, transmission lines or other visible V �, o �-- --- easements on sold property except as indicated hereon. �� )Rj�Q 8.1'x9.8' 1-4 -ikl r �)--.h-2%U.2.•'• 11 SHED Dated this the Day of �� i�`�' �G at Anchorage, Alaska �QR� v0p Q3SlONA� �© It is the responsibility of the owner to determine the existence of any easements, ��0��`�d" SPTIC P PES covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 HOUSE DETAIL SCALE: 1"=50'