HomeMy WebLinkAboutPETERS GATE BLK 1 LT 4Peters Gate
Block 1
Lot 4
#051-541-22
Municipality of Anchorage
\T/ Development Services Department
Building Safety Division
On -Site Water and Wastewater Program, 4700 Bragaw Sl. `
P.O. Box 196650 Anchorage, AK 99519-6650 Page I of�
www.ci anchorage ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number:
PID Number: 0
Name
t' Wastewater System: {New ❑Upgrade
171 "
r't1 'lF'1" u c r �56 ABSORPTION FIELD
Pibaa !%!i !) uroar d Baaodna
'� .} C1 N 4 t(lbwp `t « O SUI/ T « D baa O LI«am O Oub
LdLEGAL DESCRIPTION SodRamq Ta"o°p° h«n«m^• p.aa I�
Brxk I S�OinNan I /' DapmroFWa hdlom hdn p,l IICPDIFIr Grant_
fE�r s C'rci �e wan eowm ab
aaaronFI.
Fu «baa show d�prui(paw Gravel L«q.n
+0.a +rp� 1 FI.
Well:
❑New ❑Upgrade sa""wn —� Nab«dtrba mau xaalwaMtr
Cbssdgal tPnvaN a e r, ._. _.... _. FI.
FI
FI
FI
TANK
Grin Non
Ramnva
❑ Other:
nl�
iarKa aigamona part«mea hy. \
BENCH MARK
t Ir 11 Yuw«a)n
no;,; FI
Inspections performed by: 1U61 S- Birchwood Lp Rd. Dates: 1"3n��11
a o
2 n 630 -()K7
Development Services Department Approval
Conditional Approval Date:
Reviewed and approved by:
IRev (,•Nb)
9— t -, L: :% sL
n • b A.A. S�� riaz
. 14474, ' t '
SEPARATION DISTANCESf
luiSephc
❑ Holding
❑ S.T.E.P.
To
From
septic
Tank
Absorption Litt Holding
Field Station Tank
uhlvpwale 4W.W
sewertlneT
j
ww
1(/.�7�/y�,I 1
' I
JLIFT
Sulr..a w««
'n
L
`
L••
STATION
LN Lab
1
I
6S
�..
,>dy.
Fgnaal'an
•
' / r
G�
-P« W bv" at 'P« em
Grin Non
Ramnva
❑ Other:
nl�
iarKa aigamona part«mea hy. \
BENCH MARK
t Ir 11 Yuw«a)n
no;,; FI
Inspections performed by: 1U61 S- Birchwood Lp Rd. Dates: 1"3n��11
a o
2 n 630 -()K7
Development Services Department Approval
Conditional Approval Date:
Reviewed and approved by:
IRev (,•Nb)
9— t -, L: :% sL
n • b A.A. S�� riaz
. 14474, ' t '
PERMIT AD. SW060050
PACE 2 OF 3
Municipalityof Anchora e
DEPARTMENT OF HEATH 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 LOT 4, BLOCK 1, PETERS GATE S/D P.I.D. NO. 051-541-22
SWO60050
PACE 3 OF 3
UiPDEPARTMENTOFHEALTH ANDHU�AN 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 LOT 4, BLOCK 1, PETERS GATE S/D
ST1
FINAL GRADE
94.6'Z I NEW 1250
GALLON
SEPTIC TANK
FINAL GRA
M'
MT2=89.3'
P.I.D. No. 051-541-22
99.3'
94.4'
CO1=99.2'
'=100.2'
:01=94.3'
:02=94.3'
NO WATER FOUND
83.3' B.O.H.
N. T.S
A
R i 3L %
............r
A. Shalom
s% .. 34574!.
N
' }
AC
FCO
—I
17.5'
1-5@0'ST
18.5
17.0 –
ST2
22.0
22.5 –
DBL1
23.5
24.0 –
DBL2
24.5
24.5 –
C01
30.5
20.0 –
MT1
34.0
18.5
CO2
–
36.5 42.0
MT2
–
28.5 39.5
:01=94.3'
:02=94.3'
NO WATER FOUND
83.3' B.O.H.
N. T.S
A
R i 3L %
............r
A. Shalom
s% .. 34574!.
N
' }
ASBUILT
8
v
uunwu. b1 r 1"
I HEREBY CERTIFY THAT 1 HAVE SURVEYED THE
SCALE'V~
FOLLOWING DESCRIBED PROPERTY'
�` y-6
�i•'r+-tG.�.t/Ye? torfij
AND THAT NO FNCROA fjMENTS EXIST EXCEPT AS
DATE+
INDICATED. IT IS THE RESPONSIBILITY OF THE
Qie o1 -
OWNER TO DETERMINE THE EXISTENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED
GRID'
SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
FB'
ANY DATA HEREON BE USED FOR CONSTRUCTION
OFFENCE LINES,
OR FOR ESTABLISHING BOUND-
ARY LINES.
DRAWN+
.t
'bd u u 'l
..wwqal%
�+E OF, At
r� � H
UbAKAh G1V t'Al
Certif ieb �rffllng iog
_by
CO. dba
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUCIAK, ALASKA 99567 -TELEPHONE 688.2759
OWNER OF LAND:��
ADDRESS:
LEGAL DESCRIPTION: -&Z-02,< S 4 rx
DATE:_ L �d 2 f
PERMIT NUMBER: 0(C4 S O Date of Issue _ GS f
TAX IDENTIFICATION NUMBER: U S/ _ Sy/ _ 1);z
Is well located at approved permit location? Q."s- ❑ No
Method of Drilling: Notary O cable tool
Depth of well. S'O
Casing Type LE Wall Thickness .a -.1S 4 inches
it
Diameter 00
depth d `� _ feel
Liner Type: �� 7 Vy/ �' e-1 6 r, /
Casing Stickup Above Ground: 02
� feet
Static Water Level: loot
Recover Rate: 12 Spm
Method of Testing: —A e
Well Intake Opening Type: O open end O open hole
O Screened; Startfeet Slopped feet
O Perforations Startfeet S
CHj �y feet
Grout Type: �:.uTa•`"r` Volume
Depth: from — (_ _ feet to feet
Well Disinfected Upon Completion? kKe's O No
Method of Disinfection: C OWL. ,r,: Sr) r
rj
Comments:
ATTENTION: It Is the responsibility of the property owner to submit a copy of the well tog to the proper authority. Municipality
Of Anchorage: DOpartment of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough:
Department of Environmental Conservation.
tvj UUJ
70:6941211
tulle
:11+fJ!
tid-lug
•
a g.
804"1
Pump ht If$ttofl LogWeR DAlrt ehoe6nt xa /3-� o 7ofterhms77�7 Abe.TL4'.r,�Z &
?Ina
amu.
bhoodam mrWAD*ftwi, rr M y« o No
CALL FOR BERME
-ad^mw wmn sy m swim
ARROW PUMP & WEq SERVICES LLC
CNORA06 LRM WLIS
(1071 JI6gfE0 "OLE AP44�•�
1Ve0 S;/,vi%ems
A'sd"Is&bHpwi�iale46.�/p►MJ!•tl.a
P.1
wnnnn a.ar rna
..r.L Development Services Department
>rr Building Safety Division
On -Site Water d Wastewater Program
4700 Bragaw Street
Mark 6apich P.O. Box 196650
Mo Anchorogc, AK 99519.6650
wnw mun: �
(907)343.7904
Pump Installation Log
Well Drilling Permit Number: SW_ Date of Issue: _
Parcel Identification Number;
Legal Description Property Owner Name &Address:
Lr ti p p� $ 2 K t2
CC'71f X02 o. -ST
GHoc/ FW PrK SG'1
Pump Installation Date: ci�2 G�07
Pump Intake Depth Below Top of Well Casing: feet e j -?o
Pump MAnufactuurer�rsName: &VV 14 ) 0 (,.1 /0 t f 1Z -
Pump Model: Gef AAl me 1'e00t,4',e4 /.&d oe r7t.7d.&..p
Pump Size hp I
Pitless Adapter Durlal Depth: feet /0
PitlessAdspterManufacturerNName: AM
Pltless Adapter Installer: 00A )� R R D w
Well Disinfected Upon Completion? [ryes D No
Method of Disinfection:
Comments:
Pump Installer Name: ANCHORAGE WELL S PUMP SERVICE, INC
330 EAST 76TH AVE. ANCHORAGE, ALASKA 99518
(907)243-0740 - FAX:(907)243-0742
E-MAfL:.PUMPMBnjim@att.net
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
MUNICIPALITY OF ANCHORAGE
Development Services Department
Onsite Water 6 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ONSITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Permit Number: SW060050
Legal Description: PETERS GATE BLOCK 1 LOT 4
Design Engineer: 0003 S & S Engineering
Owner Name: JOEL BARKER
Owner Address: 12226 WEST SKYLINE DRIVE
EAGLE RIVER. AK 99557-
Date Issued: Apr 05, 2006
Expiration Date: Apr 05, 2007
ParcelID: 051-541-22
Site Address: 19711 THORNTON STREET
Lot Size: 55321 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit Is for the construction of.
❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ PrivyPrivate 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 catling
(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.
5. The following special provisions.
IF ARTESIAN WATER WELL: NO PERSON SHALL ALLOW THE WASTE OF WATER BY FREE-FLOWING
WELLS, WETHER BY SURFACE DISCHARGE OR INTO THE LOWER STRATA UNDERGROUND, WITHOUT
PUTTING IT INTO BENEFICIAL USE. FLOW SHALL BE SEALED TO THE SATISFACTION OF THE
DEVELOPMENT SERVICES DEPARTMENT.
Received By:
Date:
Issued By
kild Date:
Parcel I.
Property
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site
/ Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.orgfonsile
(907)343-7904
ON-SITE SEPTIC/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
owner(s) JOG I g r6r Day phone pIO—S'Y3'5,SyI
Mailing address I;aa6 LJeSf1Sky li/ne D1ci 9�Zip Code 9957%
Site address iQ�//Tlyr✓170r? 5T/Ge I / Zip Code
/
Legal description (Sub'd, Block & Lot) Zdf �f Q�� K IF P�'s Gct
fel-.5 5/D
Legal description (Township, Section & Range)
Lot Size 553a1 Sq. Ft.
THIS APPLICATION IS FOR (®all that apply):
Absorption Field
(�
Septic Tank
❑
Holding Tank
❑
Privy
❑
Private Well
Water Storage
❑
Number of Bedrooms —T
THIS APPLICATION IS AN:
Initial
(�
Upgrade
❑
Renewal
❑
certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with a jl jigqWatldetrW*Ql Codes.
EagleRiver Loop Road EtO.
IN
Eagle
Eayla River, Alaska 99577.
(Signature of property owner or authorized agent)
PermiURush Fees: 0 -;' f —V- _ Waiver Fees:
Date of Payment: s. 3 ) W ' - ' Date of Payment:
Receipt Number: D /j Receipt Number:
(Rev. 11/05)
S&
March 29, 2006
ROBERTC.COWAN. P.E.
ROBERTA. SHAFER, P.E.
CML ENGINEERS
(907) 6942979
FAX(907)694-1211
""T11fM0fTf
APPROVALS MUNICIPALITY OF ANCHORAGE
Development Services Department
P.O. Box 196650
Anchorage, AK 99519
SEWER& WATER
MHN EXTENSIONS
REFERENCE: Lot 4, Block 1, Peters Gate Subdivision
SEVVER&WA,CTTION ER It is requested that you issue a permit to install a new septic system to serve the
proposed four bedroom dwelling on the referenced property.
A test hole was excavated and a percolation test performed. The approximate location of
A DREPOWS s the test hole is located on the attached site plan. At the time of excavation 5/17/05, ground
water was not found. Alter monitoring, no ground water was found.
MUINSKWe do not anticipate any adverse effects on neighboring wells, septic systems, reserve
lFWWrEST Cf ON areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the adjacent
properties.
SITE ^""' If you require additional information, please contact us.
Sincerely,
ROAD DESIGN
Robert C. Cowan, P.b.
SOLTEST RCC/bjj
Enclosure
PERCOLATION
TEST
STRUCTwAL &
MECNMACIL
mKcnow
ONSITE
WASTEWATER
OISKULSYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER ALASKA 99577
1 " = 40' DESIGN SITE -PLAN
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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 ek us
(907) 343-7904
Performed For:
Legal Description:
Depth
Soils Log - Percolation Test
VC -TT -r, Dal
1 I'tt-� I • �,t7� 6- Township, Range, Section:
ci..s
-o ew�►�S
3
4- r • Q wLLI 4¢J406�
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12-'•t o,
13-
14-
4f
15- i •o
1s- ;D•.;.
17-
18-
1s-
20 -
COMMENTS
WAS GROUND WATER .•..1�
ENCOUNTERED? d
S
IF YES. AT WHAT DEPTH? L
�- T14t• r Ce 4i $y�.�1 Depth to Water After v
" Monitoring? - E
Tllitkj WIeLL 4211D6()\ Dater
(aeAv6L- komf
el
rian
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
5 z5 aS
Z, 'V14 Al
_
31,
.J
0
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Zo
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5f M
10
DFRCM ernu on.c
1 n 1
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30
16 s/a
125/ „
- -- ------ - • �w o•• •,.�„vq rt MU MULE DIAMETER 129,
TEST RUN BETWEEN — X; FT d FT
PERFORMED BY:
PERFORMED IN ACCORDANCE WITH ALL STATE AND
CERTIFY THAT THIS TEST WAS
IN EFFECT ON THIS DATE. DATE:
S&
ROBERTC. COWAN, P.E.
ROBERTA. SHAFER P.E.
CMLENGINEERS
(907) 6942979
FAX (907) 6941211
E&T`H A.ffH0FM
ON-SITE WASTEWATER DISPOSAL SYSTEM
APP M&S
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
SEWER& WATER
AWNOMNSION5
REFERENCE: Lot 4, Block 1, Peters Gate Subdivision
March 29, 2006
SEWER&WATER
MPECTION
GENERAL:
1. The scope of this project includes the installation of a new 1300 gallon septic
tank and a septic trench to serve the proposed four bedroom residence located
ANDRE sruaEs
on the referenced property.
2. Construction shall be in accordance with the approved site plan and design
drawings, Municipal permit with any special provisions or conditions, and all
WEU rsPEDrIDN
&FWWTEST
applicable State and Municipal Wastewater Disposal Regulations.
3. The contractor shall be responsible for obtaining any necessary underground
utility locates.
SITE PINS
4. Unless specifically agreed otherwise, the property owner shall be responsible
ROADOESIGN
for final grading areas subsequently depressed from soil settling.
5. Contractors installing wastewater disposal systems must be certified by the
Municipal Health Department for system installations. Owners installing their
own systems must also receive prior approval from the Municipal Health
NEST
Department.
RT�"TIGN
P
SEPTIC TANK INSTALLATION:
I. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
STRUCTURAL&
WCHANIM
INSPECTIONS
2. The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
ONSITE
WASTEWATER
DISPOSALSYSTEAI
DESIGN
17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER ALASKA 99577
Page 2
Lot 4, Block 1, Peters Gate Subdivision
March 29, 2006
3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade.
4. Septic tanks installed with less than 4 ft. of cover shall be insulated.
5. A foundation cleanout shall be installed one to four feet from the building foundation. In
the line between the tank and the leachf eld there shall be two adjacent cleanouts (unless
an effluent pumping system exists within the septic tank). These cleanouts shall be
located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line,
shall be to clean toward the leachfield. The second cleanout shall be to clean toward the
septic tank.
6. Final grading over the septic tank shall be such that a positive slope exists away from the
septic tank.
ABSORPTION TRENCII/DRAINFIELD INSTALLATION:
1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the
excavation shall be within 2 inches of level. If the sidewalls of the excavation become
smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock)
placement.
2. Once the gravel is installed, the distribution pipe is to be installed level with the
perforations faced downward. Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
3. A silt barrier must be installed between the final gravel layer and the native soil backfill.
Ensure the silt barrier covers the entire gravel surface before placing backfill.
4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations
shown on the design, and extend a minimum of 12 inches above final grade. The portion
of the monitoring tube extending through the gravel shall be perforated from the bottom of
the trench to the invert of the distribution pipe. This is equivalent to the effective depth of
the gravel as noted on the design.
5. Backfill over the final gravel layer must not be less than twenty-four (24) inches.
Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The
finish grade over the trench must be mounded to prevent the formation of a depression
after settling.
Page 9
Lot 4, Block 1, Peters Gate 3ubdivlsion
March 29, 2006
MINIMUM MATERIAL SPECIFICATIONS:
1. Any septic tank proposed for installation must be constructed by a Municipal approved
septic tank manufacturer.
2. The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
TwcofPipe Perforated Solid
Cast Iron
Yes
Yes
ASTM D3034 (PVC)
Yes
Yes
ASTM F810 (HDPE)
Yes
No
ASTM D2662 (ABS)
Yes
Yes
Use of a type of pipe other than listed above must be approved by the inspecting engineer.
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical
Company Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or
equal).
5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed
between the final leachfield gravel layer and the native soil backfill.
6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3%
passing the #200 sieve.
7. When sand is being used as a filter material, its gradation specifications must conform to
current M.O.A. or D.E.C. requirements, which ever requirement applies.
Page 4
Lot 4, Block I. Peters Gate Subdivision
March 29, 2006
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the installation of the
wastewater disposal system. These inspections will occur as follows:
1. The first inspection must be conducted after the excavation of ditches, pits,
trenches, or beds and before the installation of any gravel. A septic tank may be
set in place, but may not be backfilled before this inspection.
2. The second inspection must be conducted after the placement of the silt barrier,
gravel, distribution lines, standpipes, cleanouts, and insulation, but before the
placement of any other backfill.
3. The final inspection is to occur upon final grading of the property.
Often there will be more than these 3 inspections required. Especially with the installation of
multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer
is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -
construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or
control in any way the contractors activities.
The owner shall contract with the contractor to perform the work outlined in these specifications
and plans and in accordance with the attached M.O.A. permit. There will be no contractual
arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be
the owner's representative and will inspect the work as stated above to document the contractors
activities. Final acceptance of the contractors work rests with the owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or omissions of the
contractor or any other persons performing work on this project or the failure of the contractor to
carry out the work in accordance with these construction documents. S & S Engineering's
inspecting engineer will not be responsible for the construction means, methods, techniques,
sequence, procedures or the safety precautions incident to this project.
CONTRACTOR / INSTALLER
Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-541-22
1. GENERAL INFORMATION
Complete legal description Peters Gate Block 1 Lot 4
Location (site address) 19767 Sue Thornton St
Expiration Date: I (, 23 '1 `�
A
Current Property owner Barker Day phone 244-1930
Mailing address Same
Real Esfafe Agent Cindy Wilson Day phone 244-1930
2. TYPE OF DWELLING:
® 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 C Well
Public Water System
Received by:
IN
TYPE OF WASTEWATER DISPOSAL:
®
Individual
❑
Holding Tank
❑
❑
Community
❑
❑
Public Sewer
❑
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 15Z(0• X
Date of Payment g l I !, r0P
Ii
Receipt Number 0 � 14�I'`T D
COSA# QS0It01M
Date of Payment
Receipt Number
Waiver #
/C
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 Date &46/,20],6
6. DSD SIGNATURE
4 System #1 Approved for bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following
Stan W. ling /.
By: �—_I ^^ �� Original Certificate Date: - 23
The Municipality of Anchorage 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 sheat 9-i-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: P€rFl?S C*2Z B/
Get' ParcelID:Cf.5f*W22
A. WELL DATA
Well type If A, B, or C provide PWSID #
Well Log (YIN) �
�
Date completed. Z Q6 Sanitary seal (Y/N)
1Wires properly protected (YIN) '
7-
Total depth ft.-. Cased to ft.
Casing height (above ground) Xer in.
FROM WELL LOG
Date of test ZZ
AT INSPECTION
2
Static water level ft:
Well production sZ g.p:m.
3t g.p.m.
WATER SA LE RESULTS:
Coliform B colonies/100 mL Nitrate 9 &(7Cmg/L
Arsenic N� ug/L Date of sample: 6
Collected by: Zt1;er +,
w . B. SEPTIC/HOLDING TANK DATA
_._ Tank Type/Materials
Date installed Ei
Tank size /254 gal. Number of'Coropartments z
Cleanouts (YIN)
Foundation cleanout (YIN)Depression over tank (YIN) High water alarm (YIN) Al
Date of pumping 0,1146,r_ . Pumper S
UKt
C. ABSORPTION FIELD DATA
Date installed /�O/(Lls Soil rating g.p.d./ftZ r f?/bdrm)
r r—
b�Ep
102 System types511Cff
Length_ „ 11. Width 3
ft.. Gravel below pipe S ft.
.n
Total depth ft absorption area Qd fe Monitoring tube Depression over field
Date of.adequac test ..y Results (Pass/Fain
'
_ For bedrooms
Fluid depth in abscrrption fel before test a 'in. Water added 2 e66 gal. New depthl,:E:, in.
Elapsed Tirhe dQ rrll�i. Final fluid depth _ 0 in.
Absorption rate >= 4!5-Lilgaf g.p.d.
Any rejuvenation treatm&nt (past 12 mo.) (YIN & type) /V If yes, give date
D. LIFT STATION AIA
Date installed Size in gallons
"Pump on" level at in. "Pump off" level at in.
Manhole/Access (Y/N)
High water alarm level at in.
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot _T d U t� On adjacent lots
Absorption field on lot /!fQ On adjacent lots
Public sewer main �QQ f Public sewer manhole/cleanout JQO rF
Sewer/septic service line ZS t Holding tank /041*
Animal containment areas 50 �'f Manure/animal excrete storage areas,/O( &
SEPTIC/HOLDING TANK ON LOT TO:
2 rF
Building foundationJ� 'f" Property line 4- Absorption field 5
Water main Water service line . Surface water /00'*
Wells on adjacent lots
ABSORPTION FIELD ON LOT TO:
Property line l� �4- . Building foundation Water main
Water Service line, Surface water Z!U f Driveway, parking/vehicle storage /D 'f
Curtain drain �,,_ Wells on adjacent lotsZaa
f
F. COMMENTS
G. ENGINEER'S CERTIFICATION
/-certify that l 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 chaste.
Engineer's Printed Name
Date
COSA yellow sheet 2-6-15.doc
M
se.v w. ¢fe
,F9pR0FESSIO��`,.
r�
ASBUI LT
U
A
0
,YJ uu4
In 0l F/ -FE
w/�AV�a�isH s�cd®
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
SCALE,
FOLLOWING DESCRIBED PROPEHTYI
y01
N •' THAT 6' FNCR6�? lory
AND THAT NO FNCROAC'�IMENTS EXIST
DATEIQ�
XIjj EXCEPT A$
INDICATED. IT IS THE RESPONSIDILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR DN THE RECORDED
GRID,
SUBDI•
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
FB'
ANY DATA HEREON BE USED FOR CONSTRUCTION
OFFENCE LINES,
OR FOR ESTABLISHING BOUND-
ARY LINES.
DHA��