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HomeMy WebLinkAboutEKLUND #1 BLK 7 LT 1Eklund #1 Block 7 Lot 1 #050-541-16 Municipality of Anchorage, '" Development Services Department / Building Safety Division Onsite Water and Wastewater Program, 47DO Bragaw St. P.O. Boz 196650 Anchorage, AK 99519-6650 Page t of 2 www.ci.snchorage.sk.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SWO50212 PID Number. 050-541-16 R«' LAMERE Wastewater System: ® New ❑ Upgrade MAIN GOAT DRIVE �aam: ABSORPTION FIELD Ptmr.. Nun bW of eebooeu: O Deep Trwr/t ®SMdar Trwdt O Bao O Mann 000W LEGAL DESCRIPTION a°'"rng Tar Depth hdm mqw pede 0.6 GPD/FO 3/3 Ft. 11 c Let $ubdmemn Depen b p" bman hon onVW pede Gre"rd.phbw pye 7 1 EKLUNDM 0.910.7 Ft. 111.3 Ft Twmhm'. Renee. Bedmm Fa added a wgp ped* GraLwgth "r 14N IF:5.714 Ft. 46152 Ft. Well: New Upgrade G, "i1 w0tl1 5 Ww ;i 2 D«wme brwean Nn 15 Ft. FL CleWufKrmn (Pmre. A 6. Ck Tam Daps Ceud b'. Tot* abnrpmn eree Poe Mrenr PRIVATE 280 Ft. 1 80 FL 594 Fe ASTM -3034 D~ Do* DMW Smmwrw Le"r-. MrMl.f One kwawl BILL SULLIVAN 7/25/2005 202 FL MARTIN CONSTRUCTION 911312005 Y" Pump sr r Gwna 'GM'nd TANK 6 GPM 275 Ft. 2 2 FL SEPARATION DISTANCES 0 Septic ❑ Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption LM Holding umciprivate Ww. r From Tank Field Station Tank Sewer Line ANCHORAGE TANK 1000 cr w.a +100' +100' — — +251 Mr«m STEEL Narow a Gmmrhnwee 2 &rleoe wrw +100' +100' — — LIFT STATION La L.» +5' +10' — — sq. NO LIFT Ge, oda« +5' +10' — — Puny I0 N"el N 'Puma ar level r Hgh wrw Yarm M FouMrmn :, 1... In M r. +50' +50' — — Para MYe a Moor Elechmr n.padbaw WM W Cuter Drrrl Renwk. 1'-3' OF WOODCHIPS OVER TOP OF DRAINFIELD. BENCH MARK Locum end a.cwm `,; TOP OF SONOTUBE AT,DECK CORNER «n»d N"eum. 116.6 FL En i Inspections performed by: ERES Dates: 1M 911212005 ! '(�« QF, 54 2nd 9/13!2005 "t,.'` qs`F�► Development Services Department Approval •>' Conditional Approval Date:- �„�, CNRJSTOPHER R WOOD CIE= Reviewed and approved by: Date: (R." owe)ESStotJAti Permit No. SW050212 Page 2 of 2 Municipality of Anchorage DEVELOPMENT SERVICES DEPARTMENT ON—SITE WATER & WASTEWATER PROGRAM 4700 SOUTH BRAGAW STREET P.O. BOX 196650, ANCHORAGE, AK 99519-6650 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: EKLUND#1 LOT1 BLOCK? 050-541-16 I 1 C "I 41-V' i 1 _D 7" 74.Y WELL I = 1 0701 9U' i v0= amus I 1od I N ' N 1 v HOUSE IN, h W 1 GB.RAVEL • // SCALE 10-50' >r 1 •DRIVE, FI L, � F I GATAN / I _ � pl t '- i "•2 X48 OR NFlELD L 0 T 1 I I 3 1 '%52' R• NFlEU) I C' iV I r 1 o I 3 1 z I - X QrEs o I P 10, U NU7N37150nYU o — SEIPMow Y E1S4M4, � - WELL A r S9NOTLIBE AT DECK C NER • - MONITOR TUBE G014 TR ASUMED ELEVATION • 116.6' ELEVATIONS 1/8/2008 (NOT TO SCALE) ORIGINAL GROUND ENGINEER'S SEAL ORIGINAL GROUND LEVEL AT11 0.0 ooOF �0��4 0.5' Flll LEVEL AT, 104.1 o Q MT -1 MT -4 TH-1 •``..•••' ......!S FILL I FILL p��P'• •'•: 3.2' 107.6 6.3 Y AR 99.3 4.4 D *)' '4 �* INSULATION �.... � / x-99.3 G �S� TANK o.: • o • o : ' o .0 94.0 Y.... ........ 1000 GAL o� V GRA L o 03. 0 1.3' GRAN ELo l70 �'•, CHRISTOPHER R. 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BOX 670272, CHUGIAK, ALASKA 99567 *TELEPHONE 688-2759 OWNER OF LAND: A03dol-i C+'tr'f C<I-r ADDRESS: LEGAL DESCRIPTION: EKI.JJJQ 4-1 / SU047, jgge 7 4...-r i DATE: 7 -z S �,> Sr PERMIT NUMBER: 6213d/1 Date of Issue-. - % -c= TAX IDENTIFICATION NUMBER: Is well located at approved permit location? CPYLIt O No Method of Drilling: 4'3i rotary otary O cable tool Depth of well: a Y- 0 Casing TypeS Z'L7� Wall Thickness inches Diameter 1 inches, depth �� feet Liner Type: 0-00-J - Casing Stickup Above Ground: feet Static Water Level: tR Z)A feet Recover Rate: (C> gpm Method of Testing: 141IL Well Intake Opening Type: O open end 4aUpen hole O Screened; Start feet Stopped feet O Perforations Startfggt Stopped feet Grout Type: Xf.Jif Volume / W' 4 S. Depth: from U feet. to `' feet Well Disinfected Upon Completion? (ales 0 No Method of Disinfection: -J= S J >�f Comments: CAi. 6 r; ,c..,c..J/.) rz S..4.41 -r Driller's Name _ /3...,c.f 'C -LR. 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. q1,z Q ►ytoo bns MUNICIPALITY OF ANCHORAGE 1 p Development Services Department l 0 On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial 1'r� Date Issued: Jul 08, 2005 Expiration Date: Jul 08, 2006 Permit Number: SWO50212 Parcel ID: 050-541-16 Legal Description: EKLUND #1 SUBDIVISION BLOCK 7 LOT 1 Design Engineer: 0848 Eagle River Engineering Services Site Address: NHN MOUNTAIN GOAT DRIVE Owner Name: ROBBIN LAMERE Lot Size: 46626 SO. FT. Owner Address: 4451 UPPER KOGRU Total Bedrooms: 2 Permit Bedrooms: 2 EAGLE RIVER. AK 99577 - This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy Q Private Well ❑ 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By. 1-/_ ao-r"ll Date: 7 OcKCJ Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON—SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 050 -!rg i — 16 Permit Number SW Property owners) P'011;yl LC mpa rE Day phone Mailing address (1) �iv5/ er koor-"� E a,_� a ZyM Ak- 9457,7 -1774 3 a�kagaddress (2) �tJ �,k'(�1.�7R11� 6(LL� Vt, Zip Cade 1:eget-description (Lot, Block & Sub'd.) L 11 8 7__ E k Lnd 4k 1 Legal description (Section, Township & Range) Lot Size 4160 6.2 6 Acres q.Ft. THISAPPLICATION IS FOR: Number of Bedrooms 21 Sewer Only ❑ Well Only ❑ Sewer and Well Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 1 certify that the above information s correct. I further certify that this application is being made for a Single Famllyopwelling an 's in cordance with applicable Municipal Codes. ca - (Signature of property owner or authorized agent) Permit Fees: clbo 4 / 7i Waiver Fees: Date of Payment: 7C7 Z tj Date of Payment: Receipt Number: 62• Receipt Number: (Rev. 12/00) Eagle River Engineering Services Christopher R. Wood, P.E. 10421 VFW Road Suite 201 (907) 694-5195 tel Eagle River, AK 99577 (907) 694-3297 fax June 29, 2005 Dan Roth Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Eklund #I Lot 1 Block 7 Narrative & Permit Application Dcar Mr. Roth: The proposed well and septic system will have very limited impact on adjacent properties for the following reasons: 1. The surrounding lots are large, or undeveloped, allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance, and wells +100'. 3. This permit is for a new well and 2 bedroom septic system. 4. Drainage will not be affected and is not a major consideration in our design. This is a 1 acre parcel, surrounded by undeveloped land on 3 sides. Impact on neighboring wells, septic systems, or reserve areas is negligible. If you have any questions please call our office at 694-5195. Sincerely, EAGLE RIVER ENGINEERING SERVICES (h4ristophcr R. Wood, E. Principal \2003\05-018SErncNAwurtvE If \ M 89.52'20" E VACANT 222.38 1 I I »o• lu' PROPOSED WELL 00 N 2 I \ Lot 1 N I ROPOSED / HOME / .� ISSEESPPTICCo ANK, N IN 1•\: 1 / / ry. ' VACANT. j�K• •\ �.� Lot 2 3 � I 0 STALL c l NEW V M.2 J INXSO' ORNNFILEDS 1\ ;Op Rj R N O 8 1 1 \ Z 1 Ip• • . 41 1 M,/ TWO S'XSO' e\ EPLACEMENT SITES O\ co rop St8R \ 10. Un_ ® — TEST HOLE N 73• uTyFA • — MONITOR TUBE 50" Ovr _ ` 0 _ SELLER CLEAN OUT MOON — EASEMENT TAIiy '44'98 — — — — PROPOSED LEACH FIELD COAT OEXISTING RIS ©— DRIVEWAY LEACH FIELD 1. NO SURFACE WATER +100'. 2. NO KNOWN CURTAIN DRAINS 3. NO WELLS OR SEPTIC WITHIN 200' OTHER THAN SHOWN ON LOT 2 WELL/SEPTIC SITE PLAN OF LEGAL: EKLUND 1 LOT1 BLOCK 7 �•�� OF OWNER: ROBBIN LAMERE `P.. 5�1# CONTRACTOR: UNKNOWN 0* JOB 05-018WS DATE: 07/08/05 1 SCALE 1"=50' i 0 CHRISTOPHER •. WOOS. EACLE RIVER ENGINEERING SERVICES ♦ � Wr CE -10387 P.O. Box 773294 EACLE RIVER, AK. 99577 �hO (907) 694-5195 FAX: (907) 694-3297 1k%',.:;�:•�•'� Eagle River Engineering Services Christopher R. Wood, P.E. 10421 VFW Rd. Suite 201 (907) 694-5195 tel Eagle River. AK 99577 (907) 694-3297 fax SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: Eklund #1 Lot 1 Block 4 - May 31, 2005 A. GENERAL 1. The well and septic plan is for a 2 bedroom single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of I Iealth and State Department of Environmental Conservation requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. Any remaining open test hole excavations shall be filled and monitor tube removed. B. SEPTIC TANK 1. The sewer piping from the house shall be 4" PVC 3034 laid at 2% grade maximum — 1% minimum and insulated with 2" of burial foam if shallower than 3 fl., with 2 R. minimum. 2. Septic Tank shall be a minimum of 1,000 gallon tank of MOA approved construction, insulated, or place with 4' of soil cover, min. C. DRAINFIELD 1. The drainfield is to be placed as shown on the site plan. Contractor shall take extreme care ensure that I O'separtation distance is maintained between trenches. 2. The bottom of the drainfield excavation shall be level, plus or minus 1.5", prior to placing gravel. 3. The total depth of the drainfield excavation shall not exceed 2 R. at any point in relation to natural ground surface. 4. One and a half feet of sewer rock shall be placed over the native GM soil as follows: One foot below the distribution pipe, 4" along side the distribution pipe, and 2" over the pipe. The drainfield sewer rockl shall be covered with typar fabric material. 5. Soil or a combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. 6. The area over the drainfield is to be finish graded or mounded to prevent ponding of surface water runoff. 7. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. \\Eros\docs\W PDOCS\2005\05-018drsinfietd- spcc.doc Eagle River Engineering Services Christopher R. Wood, P.E. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = 2' maximum GRAVEL DEPTH = 1.0' under pipe, 2" over pipe (1.5' total) DRAINFIELD LENGTH = 100' total DRAINFIELD WIDTH = 5' SOIL RATING= 0.6 GPD/ft= BEDROOM CAPACITY= 2 total SEPTIC TANK = 1000 gallons min. Twenty-four (24) hours notice required for all inspections. \\Eves\d0c3\WPD0CS\2005\05.018drainficid- spcc.doe EAGLE RIVER ENGINEERING SERVICES 10421 VFW RD Suite 201 Eagle River, Alaska 99577 (907) 694-5195 ERES Project No.: 05.018 Calculated By. CW Date: 6/29/2005 Legal: Eklund #1 L1 B7 TEST HOLE 1 6 2 Single Family 2 Bedroom Dwelling Shallow Trench Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = 300 gallons Percolation rate = 19 minutes per Inch Wastewater application rate - 0.8 gallons per day per square foot Required absorption area - 500 square feet Trench width (W) = 5 feet Gravel depth (D) = 1 feet Required length - Shallow trench factor • Required absorption area / W Shallow trench factor = (W + 2) / (W + 1 +2 D) Shallow trench factor = 0.88 Total Excavation Depth = 2.0 feet Required length = 88 feet 05-018_2brdrainfieldCalc 1:34 PM6129/2005 Municipality of Anchorage Development Services Department Building Safety Division • On -Site Water and Wastewater Program 4700 South Bragaw, SL P.O. Bax 196650 Anchorage, AK 9951"650 1,W--cl.anchoraoe ak us 7)343-7904 Performed For. Legal Description: Depth 1 11711 ll ole ti x Soils Log - Percolation Test III a'r, iere Date Performed: r _Ekl,AA,) fl I Loll (/l(X. F % Township, Range, Section: TION R I t, SrC. sa 1_ "( 02G.�P11L5, Wovb w 3- [ GM 5s1I TA 8- 9- WAS GROUND WATER yes ENCOUNTERED] 10- •7 r S g61TOla1OG t101- IF YES, AT WHAT DEPTH? 7.0 L 11- Depth to Water AfterD MonhorIna? 6-V E E 12 O Dates W 13- 14• 15• 16- 17- 18- 19- 2D - Reading Date Gross Tune Net Time Depth to Water Net Drop 4 Y -Js ' 10,14 8� O N ��' H•N 1 - •%N' c PERCOLATION RATE I -J $ pneur.ehe>t 1 PERC HOLE DIAMETER (? ' COMMENTS - TEST RUN BETWEEN 7 FT AND FT 1n ((�) PERFORMED BY: Ctiatf,ks P., r*.' I PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. TH DATE; T� Municipality of Anchorage Development Services Department Building Safety Division • +1 On-site Water and Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 995198650 r VrWw.d.anchoraae ak u• (907) 343.7904 Performed For, Legal Description: Depth `I F>+ Hoff f3 I ��ff ff Soils Log - Percolation Test I�Qp61rl La,MC�e Date Performed:.5/al/c" Ekl1A#1'1t1l b,11 %Int -k7 Townahip,Range, Section: J 1uN RIE, Sf.C.3a 1.r 4Xj 0RhgNTCSf- FS1- C)YA - 5 7-1I 1-R 6'M-1 STI.Tl 8K 9_ Dale Gross Time Net Time WAS GROUND WATER yes ENCOUNTERED? IF YES, AT N4NTDEPTH7 �a.0 � L 11- O Depth to Water Agar Monitoring? O 7-'L E 12-I 1 Date:5/31105 13- 17- 18- 19 - Reading Dale Gross Time Net Time Depth to Water Net Drop y-4,s�r---- O 35V —I p 'I 11Y L17 J MIn•17 1_Z._,r... r. '...41 tR O COMMENTS TEST RUN BETWEEN SFT AND FT PERFORMEDBY: Cho%les PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. ATE: TS Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: EAGLE RIVER ENGINEERING Legal description: EKLUND #1 BLOCK 7 LOT 1 The attached paperwork has been reviewed and is being returned for the following reasons: ❑ Original signature or stamp missing on _ ❑ Calculation error in design. _ ❑ Additional soils information needed. ❑ Water monitoring results inadequate. ❑ Discrepancy in information submitted. ❑ Topographic information missing or inadequate. _ ❑ Incomplete; missing _ ❑ Incomplete; missing _ ❑ Additional adequacy test information needed. _ ❑ Water sample unacceptable. _ ❑ Measured/proposed distances/dimensions missing. _ ❑ Locations of all soils, percolation and water monitoring tests not shown. _ ❑ Proposed system too deep for soils information submitted. ❑ Well log required. ❑ Omission in narrative. ❑ Insufficient fill over tank or field._ ® Other. -SITE PLAN SHOWS PROPOSED TRENCH IS TOO CLOSE TO TOP OF CUT BANK OR SLOPE GREATER THAN 25%. TRENCH NEEDS TO MAINTAIN 50 FOOT SETBACK FROM SLOPE GREATER THAN 25%. OR 35 FOOT HORIZONTAL SEPARATION USING INSTRUCTIONS ON ATTACHED MEMO DATED APRIL 7.2004. r -NEED AN ENGINEERS STATEMENT THAT THE BOTTOM OF ABSORBTION FIELD WILL MAINTAIN 6 FOOT VERTICAL SEPARATION FROM IMPERMEABLE LAYER OR A LAYER WITH A PERC RATE GREATER THAN 60 MINIIN. Name of reviewer: JOE GOODALL Date: 7/1/2005 Please supply the necessary information and re -submit your request. DATE: April 7, 2004 MUNICIPALITY OF ANCHORAGE Building Safety Division MEMORANDUM TO: On - Site Services Program FRs oss, P.E. ger, On -Site Water Wastewater Program SUBJ: Slope setbacks from >25% In situations where slope conditions will not allow a wastewater disposal field to be located 50 feet horizontally up gradient from a change in slope to greater than 25%, as required In AMC 15.65.060.A.1.b the following requirements apply. (As allowed by AMC 15.65.030.G) 1. A point shall be determined two and one half feet above the Invert of the distribution piping of the septic field at the tie s oses poen o t e s ope greater than 25%. 2. A line shall be drawn from this point and perpendicular to the distribution piping at a down slope of 25% In the direction towards the slope greater than 25%. 3. The Intersection of this hypothetical line and the actual slope shall be a minimum of 35 feet horizontally from the point established in #1. 4. This 35 foot horizontal separation shall be the minimum allowed between a disposal field and a slope of greater than 25%. If a property has a wastewater disposal system that was constructed prior to 1986 and the absorption field encroaches a change In slope greater than 25%, an upgrade of the failed system may be approved in the same location if the following applies: 1. No other location exists on the property to construct an upgrade drain field with proper separations. 2. The engineer field verifies that no effluent ever surfaced on the slope surface. 3. The engineer maximizes the separation from the field to the slope as much as possible. 'OK k S • Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval Parcel I.D. 05�) - JLI - 16 1. GENERAL INFORMATION 2. Complete legal description E,-Lvn/j) 1-1 Expiration Date: 2Co " % 13 LCZ;K 7 L -o 7 Location, (sif6 address): . - 068 O-AJT[t-�— CurrEnt Pr perty dw ier(s)* .Mailing, addre$s . L�6� 9�it uji�� Real 'Estatp;Agent Y #� TYPE`OF`tJWELLING. [ Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System WaiverNariance request Received by: 1169 Day phone 70i -,l �-6E6 Day phone TYPE OF WASTEWATER DISPOSAL: ® Individual -9 ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. Date: —5z6 4 COSA Fee $ e I S " I Waiver Fee $ Date of Payment Date of Payment Receipt Number d-nooU Receipt Number / COSA # ®� (p 0 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 C�tGv! �v�Tnr ci Ar(, Phone�1o7`$Su 5558 Address �95fria?F /DkoE B,9Y Engineer's Printed Name CjE&ZtZ2 5 Date 04130 lb �E OF m mo,i�•• j..°'° ;rte°o .......4 g o� 6. DSD SIGNATURE to ° Vpl....................,: L System #1 Approved for Z bedrooms h3rte§, ini n. .. �alzar System #2 Approved for _bedrooms ®�sT�•, CE -1 3/85,m Disapproved dRill ^Fp",90F ssil GJ��pe�p�C �. Conditional approval for bedrooms, with the following stipulations. BY , (=-cJ2 Original Certificate Date: 5 '2 �—kc� The Municipality of Anchorage Development Services Division (DSD) issues Certificates of Cn-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 r - : 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: E kcc.vvp tj I MACK 7 L.dT-t Parcel ID: OSO-iul A. WELL DATA Well type If A, B, or C provide PWSID # Well Log (ON) 5 Date completedpp 1/95/05 Sanitary seat ON)5 Wires properly protected PN) Total depth � OV ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level oqo; �sLft. " $. Well production; JE5 ✓- ell g.p.m. _ 9 -P.M. WATER SAMPLE RESULTS Coliform /Vio'+Tool n�ies/100 mL Nitrate A/D mg/L Arsenic AID ug/L Date of sample: 93 /od /dot L collected by: 'JEK CA (30t TkiVt 2 B. SEPTIC/HOLDING TANK: DATA Tank Type/Material �tt�T �r S l=L Date installed Tank size lid gal Number of Compartments 2 Cleanouts (:RN) IAS Foundation cleanout6?N) Depression over tank (Y@) A High water alarm (YAM NO. r1-1fi/ Date of pumping Pumper C. ABSORPTION FIELD DATA �OW,f%vC� Date installecL JSoil rating (.p.d./ft t ii) ©v,6 System type T'A>,T Lengt .r Width 5 / ft. Gravel below pipe �, ' ft. Tat�►�d0pthi aorption area fl? Monitoring tube Depression over field tj0 Datft![fbdequacyfesf ,✓ �rG Results as /Fail) Forbedrooms �, ... Flu% pIk1f `9b2sotp8*}ltlfd retest Jo_in. Water added 0 gal. New depthm-6— in. Elapsed'Time: min;�Final fluid depth �7 in. Absorption rate >= OO g.p.d. Any rejuve}%tigp (past 12 mo.) (YO& type) 1✓ONf-KIVW°1 If yes, give date N/ D. LIFT STATION (vyf L;c{ Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at _ in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested ' Meets alarm & circuit requirements? t E. SEPARATION DISTANCES WELL ON LOT TO: Septic tankllift station on tot Alv! On adjacent lots E Absorption field on lot # t49i . On adjacent lots 4(00° Public sewer main A 6tw' Public sewer manhole/cleanout 4W., Sewer /septic service line Holding tank -Ew Animal containment areas E� Manure/animal excrete storage areas k{� SEPTIC/HOLDING TANK ON LOTTO: i Building foundation ti Property line S� Absorption field- S Water main Water service line �'� Surfacewater Wells on adjacent lots f© ABSORPTION .PIELD ON LOT TO: Property line Building foundation4to Water main -t LO Water Service line t" Surface water -1 (60 � Driveway, parking/vehicle storage S � Curtain drain %� Wells on adjacent lots F. COMMENTS t�rt4t 4J-+ `rS UpAf/ nr@Y ClVCI i7'i� �C n�ri G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in i '•f .�j_ conformance with MOA COSA guidelines in effect on this date. t- ` `4 i $ yr 10 Engineer's Printed Name (f>KAfZG.ES 5AL,ML&��I'" q.i Date 00 /1, a V0 I R.• C BS G. •Orin `•Q�i-nav•�""'• s',rrr+ COSA yellow sheet_2-6-15.doc - -