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Home My WebLink AboutFISCHER BLK 1 LT 3A3Fischer 5/D Block 1 Lot 3A3 #015-292-16 \ f \ MUNICIPALITY OF ANCHORAGE I DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION •� 825 L Street - Anchorage, Alaska 99501 Telephone 2644720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME S F— y� PHONE CX NEW �� 3 _2 p ❑UPGRADE MAILING ADDRESS N 3 LEGAL DESCRIPTION 3 V S LOCATION pE-L / NO. OF BEDR OMS G c�— DISTANCE TO: Well Absorption area T— I Dwelling PERMIT NO. _ DY 3 O w H Manufacturer _ Material No. of compartm;nts _ �E Q Liq, capacity in gallons IF HOMEMADE: Inside length Width Liquid depth TO: Well Dwelling PERMIT NO. —10ZDISTANCE S?H Manufacturer Material Liquid capacity in gallons 0 W = DISTANCE TO: Well Foundation Nearest lot line PERMIT fj0. 3 .0 LL ZNo. ? of lin s Length of a ch ine Total leng f ines Trench width Distance between lines f ¢ inches F- Top of tile to finish grade Material beneath tile _ Total effective a¢s92on area O inches �,'/J W Length Width Depth PERMIT NO. /7 d f- W 1 Type of crib Crib diameter Crib depth Total effective absorption area UJ DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. J W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS 303L/ L GI2 c SOIL TEST RATING 8 4 7 INSTALLER REMARKS r w 0.. ..... . •a•e SACO N 2225;E,W /•n�' 52 971 APPHOV ED r- r D TE LEGAL 4�6`rL lLor 3 A 3 r/ICW,E re- t• 11_1 r-4 11z: I ,Fy=.�' A L I T' -r i F n t -d C H� F.- n G E DEPARTMENT i \HEALTH AND ENVIRONMENTAL OTECTION 825 'L STREET, ANCHORAGE, AK 44501 264-4720 WELL Fit-4C� 11r-4 : I TE E14E=F F ' FEE FZ trt I T PE41IT NO. ( £:20351 ) APPLICANT DAVID OR SHARON HEPRELL 4440 ABBOTT RD 344-2816 LOCATION DEL CIRCLE LEGAL L3A3 61 FISCHER SID LOT SIZE 10840 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING CSP FT/BR)= 107 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C�EFITH= a LE"ln—r"= 4i GF (ik•EL C'tiEP'TH= 4. THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DP.AINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). REG!L_1 I REC�SEF'T I C TFit�F� '� I �E= 1^ ;rte LifiLLQt-.IS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY 14ELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- TL•!O t=:�? I tJ5~F=EE CT I C -1r4 � nF_E F:EG?LI I F:ER: E] --- BACrFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. 14ELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER.. REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER. INSTALLATION. F"EF:rl I T aXF� I F?E= C�ECEMEEF.' - 1: 15422 I CERTIFY THAT 1: I AM FAMILIAR. WITH THE REQUIREMENTS FOR ON-SITE SEWERS AMD WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I I -JILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED APPLICANT DAVID OR SHARON HERRELL ISSUED B4'�'tL'/G--------- DATE _Z/Z?/E-L ---- V4. 0 r ' .. _ _' r•PJt4 L L F"J iL_ I T'1' I:1':-= t-ft�l-i1' -tt;-a=f�_3 LTJ ;�: i r I:s' !•ta7t _ 1'N sir'7u �7f.' 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TiJ_�'4 H txLL Ftihr :ir4ti' m-�:-tTc sr -m r.F_ ti[•& rs)i_ Sr5R=111 is 109 .=11£11 FOR )i PRI+•') -m' H`:oj_ iv^ 150 TO 2AG FrEI FPOrl P-Njjy_It: I.nLL Uir�sJ'IvtF1G coif rw rYFF cr Ft}ct_tt:• !,io {_ 'unit, i•ii;itiYi_--t:�rk R :'R£'; r.: !<u— TO ,A ?StiKitrr +vtr 1'_[P 15 t � r P, t1' r)I•f"nJPt i i'G` •�t:ri L f 4111_ t� ?9 �F} t. •'' ±tTrl LLlsi> )E1t �v+AIMV% )7?'![s MW C:"i ;R:Z_n RI'k-`L TI, n3E ice: r?F rt'r_±Ir tri tsttN tip rnfir: +�• 17#= Lks j_ s y3tt�l1 r tri±t . , _ 1'r1)ri� i rr?%Jtnit:�itr5 )•k�Y' t•�F? 1: ;.'-�CtFtr;trTtl,rf: 11}).11, r�,?)t�r;3!_0.',rtu)4 utra'url*rt..i.�F`i R'Jri tr_tT4_;7_ TO [ mml-w PRa:- ,? un ux-L r r t r71[ ` i t: PFIFY MIT I.• 'i Fitt : ,1141LI)iR W±r71 r!.rjncr.)J[�r'tl=t1' t5 J°I)^. rja�nl r; • mic, Lt:7 t s Rs =mac'T :- :=11)111',♦ > Y t'#: i'YVr1r:lF^l_IrY r?r :iTJr�rJ3r 2. i.u[tr_ [ItSVII-L 1"7 in irr:.oxewvb turn tl*- to-Kvzj [ t.Pll>cici rtirdn t ; t!l F i : D. ut4 -'; t TE S!_'r,#=..R 7'11 S tr_n t•rri :• :' Qij i %;% ff�trta>'X t5->?J!e_L£t TO Mrj1 1 '•y,_ tare" Mitt 4 £•t:r1) uVri. L,��R IJ/y -_� I7J._ ]w11^d [` .. �G c 4 tI;.- - v • +� .1-• µ.11.l � , i. .. .. � �.'1 1�-.l1'. s. Yom. 'ir•,� .�(T r / !— SOILS LOG MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF �\ANCHORAGEr'T C° I -r'1.- + -. DEPARTMENT OF HEALTH AND ENVIRONMENTALPRTG'TIOSE O! PERCOLATION O ►7J�/ 825 L A, TEST Street, Anchorage, Alaska 89501 264.4J20� n SOILS LOG -PERCOLATION TESTI �t 4 152 RECEIVED _ �7 p PERFORMED FOR: DAVID 44 E22Ep1 L 1' DATE PERFORMED:_.&' Z2.8 2 LEGAL DESCRIPTION: LOT 5A7% S Lo G w— I SGt�I F_ !2. SIo 1x11111'11 LOAM 2 6 VMR•%! C0AUE 3 c o GIQ.gvC LI R.Ookfoej' j 4- 0 0 5 5 ",•.:: FINE S4ND • • -' s 7 CJ o 0-M d ; ev UULL Q2ADE ssa SANDICa'L 1a ee ROLE 15 - 9- OF q�gsl�• 9� 17 20 1_ COMMENTS_ L i K.4. WASGROUND WATER S ENCOUNTERED? -o L O P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop 0 0 12 • • 13 6 BOTT 0 64 o F 1a ROLE 15 - OF q�gsl�• 9� 17 18 /... ��e'• .. .... N 2225-E 19 1U E 25,197L 20 1_ COMMENTS_ L i K.4. WASGROUND WATER S ENCOUNTERED? -o L O P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) %� TEST RUN BiTWEEN T—AT AND F� ,/ w • w PERFORMED BY: CERTIFIED BY: T / qTE; .� . ZZ•!i L. 72-008 (6/79) ENKINS WELL DRILLING P.O. BOX 3.112 ECB `./ ANCHORAGE, AK 99501 - PHONE 3411-3192 DRILLERS WELL LOG CUSTOMER LOCATIO,ySZoa S'r-l�ti SIZE DEPTHZ9s^CASING DEPTH -L-96-GROUTING DEPTH YIELD _17_� STATIC WATER LEVEL 7S-0 HOW TESTED ?/ti PU4P INSTALLED —Lz�a TYPE FOR'IATIONS ENCOUNTERED AND APPROPRIATE DEPTHS / TO eT Gz. cr To G _ TO /zee /zo TO j8 TO Z -A!5' TO r`/ 4i C 60 ✓ 4^�a . Z TO �f �4dt G !t/a �v A ✓ TO TO TO TO TO //T Time APPLIC —NT ILS OUT UPPER HAl' )ONLY Time Property OwnerU i Date Phone Mailing Addle as 1 1 lI� �frj r !ll ��)I In for Fie d Notes: — ZIP Code ,TU ✓ Buyer JIlp' Pir' hese ( ) APPROVED BEDROOMS Address (.ill DISAPPROVED ZIP Code Lending Institution / it l tr 1 1, - r •:rzi-7. Phone Address . Date Sewer Installed Zip Code Well Log Received e? Realty Co. d Agent n ,^pl/� _t� / 1 rl ,/ nG ! 'l / Septic Tank Size i Phoned Address Zip Code Jp' Legal Description I J,�I Yyf��ff- l iv ria. D Street Lod IJ 1 iatlon e Type o Residence Single Family ❑ Multiple Family No. of Bedrooms ❑ Other Water,Supply Indlviduat ❑ Community L LOG. A well log Is required for all wells drilled since June 1975. ACH illd FF ❑ Public Utility wells prior to that date, give well depth (attach log It available). Sewefaposal OD Individual Year Individual Installed: ❑ Public Utility ❑ Holding Tank When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. //T Time Time Time Tlm�'71 Date Date Date Dat 4— — Inspector Inspector Inspector In for Fie d Notes: 6lycoTr�� W Eck ( ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL (.ill DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE r •:rzi-7. BY: i� Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received e? mm� orae, Well to Tank Septic Tank Size i Q,'�' /1 -u -f%, 1` i� February lu, 1964 David A. anti Sharon L. Herrell SRA 17180 Anchorage, AK 99507 Subject: Lot 3A3, Block 1, Fischer Subdivision Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: o Expose the well for our inspection to determine proper construction, also to insure minimum distance requirements are met between the well and sewer system. ° Locate and expose the cleanout to the seepage pit and/or leaching area for our inspection. This is to insure the minimum distance requirements are met between the well and sewer system. Please notify this Department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, Jim Roberts Associate Environmental Specialist JR38/ej/E1 cc: First National Bank Polar Realty Jerry Duval / APPLICNT FILLS OUT UPPER HAL ONLY Property Owner h11 •� U! rlJ ��%P! U 1 Phone Mailing Address Date n ,n Q 21p Code I .216% Buyer ff Date Inspector Address �� •/ Zip Code Lending Institution rj A��' I n G� F' /r ,�(1 /GSC. L4 '�jC,OQ� Phone Address '1 I l ��'t'Y ✓ Zip Code MUNICIPALITY OF ANCHORAGE Realty Co. d Agent Phone Address i•: i• 1 5 1982 Zip Code RECEIVED Legal Description 1D� 2 jj/) /j fob, /l L (J f� ch- July l Street Location ( I CONDITIONAL APPROVAL' Type o Residence Single Family B ❑ Multiple Family No. of Bedrooms Date Sewer Installed • ❑ Other Well Log Received Water upplY Indidual. 1 L (.,1.,n -n9 CC_L� a I 1 bet et Septic Tank Size ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. Community E7 Public Utility For wells drllled prior to that date• give well depth (attach log if available). Sew" Isposal Individual Year Individual Installed: 0 Public Utility ❑ Holding Tank L/,S�J • 9 -,m -s2 • When Connected to Public Utility: g!jj NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RECUEST BEFORE PROCESSING CAN BE INITIATED. - . '�'lU r• n n tii..1� Time Time Time Time 11 nLt-A<AyU P Date Date Date ff Date Inspector Inspector Inspector Inspector '1 I l ��'t'Y Field Notes: MUNICIPALITY OF ANCHORAGE ENVIR Jt C.'..f .. A- :..0, ECTION i•: i• 1 5 1982 RECEIVED BEDROOMS 'CONDITIONS OF APPROVAL (tAPPROVED ) DISAPPROVED ( I CONDITIONAL APPROVAL' DATE B Soils Rating Date Sewer Installed • Well To Absorption Area Well Log Received Well to Tank Septic Tank Size • -� Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-292-16 Expiration Date: ;z -3 1. GENERAL INFORMATION Complete legal description FISCHER S/D, BLK 1, LOT 3A3 Location (site address) 5100 SELDON CIR, ANCHORAGE, AK 99516 Current Property owner(s) Steve Rudd Day phone Mailing address Real Estate Agent 5100 SHELDON CIR, ANCHORAGE, AK 99516 2. TYPE OF DWELLING: ® 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: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for:_Property line waiver Distance _4' Received by: /*�' Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 52 Date of Payment Is-/ / 6 Receipt Number 20_212_G) COSA# l9SC(61ZR� Waiver Fee $ Date of Payment Receipt Number Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER M 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 MIKE N ANDERSON P E Phone 727-8864 Address 4661 NATRONA AVE. Engineer's Printed Name MIKE N ANDERSON PE Date 11/1/16 DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.Coc 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: FISCHER S/D, BLK 1, LOT 3A3 Parcel ID: 015-292-16 ri�riR��l7_`/1 Well type Private If A, B, or C provide PWSID # Date completed 1218182 Sanitary seal (Y/N) Y Total depth 295 ft. Cased to 288 ft. FROM WELL LOG Date of test 1218182 Static water level 250 ft. Well production 7.8 g. p. m. WATER SAMPLE RESULTS: Well Log (Y/N) Wires properly protected (Y/N) Y Casing height (above ground) 18 AT INSPECTION 612712016 247 ft. 5+ g. p. M. Coliform NEG colonies/100 mL Nitrate 2.70 mg/L Arsenic: ND ug/L Date of sample: 1 012112 01 6 Collected by: Mike N. Anderson B. SEPTICIHOLDING TANK DATA Tank Type/Material SEPTIC 1 STEEL Date installed 9116182 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 71912016 Pumper Alaska Quality pumping C. ABSORPTION -FIELD DATA — 1985 SYSTEM TESTED Date installed 9116182: Soil rating (g.p.d./ft2 or ftZ/bdrm) 85 System type DEEP TRENCH Length 48 ft.- Width 3 ft. Gravel below pipe 4.5 ft. Total depth 9_6 ft. f Eff; absorption area 432 ft' Monitoring tube Y Depression over field N Date of adequacy test 312612016 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in -absorption field before test 0 in. Water added 600+ gal. New depth 14 in. Elapsed Time: .180' min. Final fluid depth 0 in. Absorption rate >= 600+ g. p. d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) UNKNOWN If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons Manhole/Access (Y/N) in. "Pump off' level at in.High water alarm level at Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT T0: Septic tank/lift station on lot 1001+ Absorption field on lot 100'+ Public sewer main 75'+ Sewer /septic service line 50'+ Animal containment areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: In. On adjacent lots 100'+ On adjacent lots 1001+ Public sewer manhole/cleanout 100'+ Holding tank 100' Manure/animal excrete storage areas 1001+ Building foundation 10+' Property line 504 Absorption field 104 Water main 100'+ Water service line 50'+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line4'+* Building foundation 5'+ Water main Water Service line 25'+ Surface water 1001+ Driveway, parking/vehicle storage 10'+ Curtain drain 100'+ (None Known) Wells on adjacent lots 100'+ F. COMMENTS new survey shows leach field is less than 5' from PL therefore waiver required per the 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. Engineer's Printed Name MIKE N. ANDERSON. PE Date 07/1512016 COSA canary sheet_2-6-15.doc TH*•,• d •.....:..`.d�� 0 �•9 •• iM]CHAEL N. ANDERSON CE -9469 e • Municipality of Anchorage On -Site Water and Wastewater Program g (907) 343-7904 u5 CERTIFICATE OF ON-SITE SYSTEMS APPROU�ry JUL 1 5 2016 Parcel I.D. 015-292-16 Expiration Date: 1. GENERAL INFORMATION Complete legal description FISCHER S/D, BLI< 1, LOT 3A3 Location (site address) 5100 SELDON CIR ANCHORAGE, AK 99516 Current Property owner(s) Steve Rudd Day phone Mailing address Real Estate Agent 2. TYPE OF DWELLING:' 5100 SHELDON CIR ANCHORAGE AK 99516 ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for:_Property line waiver Distance: 4' Received by: A -A, Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ �_Z (P Date of Payment 7 % Receipt Number 02(fa a& COSA# l qjz Waiver Fee $ 2- /JJ - Date of Payment :zh S /lo Receipt Number aQ Waiver #(1SVv�lalU?a .P, 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 MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE. Engineer's Printed Name MIKE N ANDERSON, PE Date 07/15/16 6. DSD SIGNATURE Disapproved. MICHAEL N. ANDERSON C 94 :.� QF,2 �y�e Conditional approval for bedrooms, with the following stipulations:, la Original Certificate Date: 1—�� The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12,doc System #1 Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. MICHAEL N. ANDERSON C 94 :.� QF,2 �y�e Conditional approval for bedrooms, with the following stipulations:, la Original Certificate Date: 1—�� The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12,doc If more than 1 septic system is on the lot: COSA Checklist # _of _ Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: FISCHER S/D, BLK 1, LOT 3A3 Parcel ID: 015-292-16 A. WELL DATA Well type Private Date completed 1218182 Total depth 295 ft. Date of test Static water level Well production If A. B, or C provide PWS ID # _ Sanitary seal (Y/N) Y Cased to 288 ft. FROM WELL LOG 1218182 250 ft. 7.8 9.10 -m - WATER SAMPLE RESULTS: Well Log (YIN) Wires properly protected (Y/N) Y Casing height (above ground) 18 AT INSPECTION 612712016 247 ft. 5+ g.p.m. Coliform NEG colonies/100 mL Nitrate Z'3 mg/l_ Arsenic: ND ug/L Date of sample: 612712016 Collected by: Mike N. Anderson B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC I STEEL Date installed 9116182 Tank size 1250. gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation' cleanout (YIN) Y Depretsion over tank (YIN) N ' High water alarn' '(Y/N) N Date of pumping 71912016 Pumper Alaska Quality oumoinc C. ABSORPTION FIELD DATA —1985 SYSTEM TESTED Date installed 9116182 Soil rating (g.p.d./ft2 o ft2/bdr 5 System type DEEP TRENCH Length 48 ft. Width 3 ft. Gravel below pipe 4.5 ft. Total depth 9_6 ft. Eff. absorption area 432 ft2 Monitoring tube Y Depression over field N Date of adequacy test 312612016 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 600+ gal. New depth 14 in. Elapsed Time: 180 min. Final fluid depth 0 in. Absorption rate >= 600+ g. p. d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) UNKNOWN If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons Manhole/Access (YIN) in. "Pump off' level at in.High water alarm level at _ in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main 75'+ Sewer /septic service line 50'+ Animal containment areas 1004 SEPTIC/HOLDING TANK ON LOT TO: On adjacent lots 100'+ On adjacent lots 1004 Public sewer manhole/cleanout 100'+ Holding tank 100' Manure/animal excrete storage areas 100'+ Building foundation 10+' Property line 504 Absorption field 10'+ Water main 1004 Water service line 50'+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 4'+* Building foundation WA7t Water main .Mlb /OB Water Service line 25'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 100'+(None Known) Wells on adjacent lots 100'+ F. COMMENTS Gm q, eo. fora% L 4 onty is eip ,qlL .u«n y. �+ rnF attGC,�/fir new survey shows leach field is less than 5' from PL therefore waiver required per the MOA. orOF l �a�t G. ENGINEER'S CERTIFICATION 1p��•• • A; s r OW 47 I certify that 1 have determined through field inspections and to,�•;PP�a review of Municipal records that the above systems are in j •„ 49TH k �� conformance with MOA COSA guidelines in effect on this date. Z. a ..: Engineer's Printed Name MIKE N. ANDERSON. PE/ ,�0. '• MICHAEL N. ANDERSON : 1�1 r t!f ss•� CE! 9469 Date 07115/2016 11 r4>9- o Wrfp . -�`oa.' COSA canary sheet_2-6-15.doc LOT 3A4 sxro �1 3 30 96 / O[Cv. R. mnlry e.", AVO SINGLE FAMILY FRAME HOUSE N 89 55' 10" W 75.00 THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS: AND I5 NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES. IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD OR OTHER RIGHTS OF WAY, OR ANY ENTITY NOT ON THE RECORD PUT ARE NOT SHOWN HEREON, UNLESS NOTED. NOTE: FENCELINE5 THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. SELDON CIRCLE a LOT 3 A 2 49 TH '.� e SHANE A. HOLT " LS -6914 4� AS -BUILT SURVEY 1" = 20' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLONING DESCRIBED PROPERTY LOT 3 A 3, BLOCK 1, FISCHER SUB. ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS _IST DAY OF _JULY , 2016. HOLTLAND SURVEYING 9309 GROVER DRIVE ANCHORAGEAK 9M7 July 15, 2016 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Lot line waiver Legal: Fischer S/D, Blk 1, Lot 3A3 To Whom it may concern: This is a request for a lot line waiver on the above referenced tot. The original MOA documents state the system is 5 feet from the west property tine but new survey show it at/feet. Therefore we are requesting a waiver. 3 This waiver will not impact any of the neighboring properties due to the tot layout. Please call me if you have any questions. SincerelyA)� Mike Anderson, P.E. 4661 Natrona Ave. Anch, Ak 99516 Municipality of Anchorage