HomeMy WebLinkAboutSCENIC MEADOWS BLK 1 LT 2Scenic
Meadows
Block
Lot 2
1
#051-064-78
i
Municipality of Anchorage r .
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program, 4700 Bragaw St.
P.O. Box 196650 Anchorage. AK 99519.6650 Page/ of ,3
www.ci.anchorage.sk.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. r% Ci / ! 3 PID Number: OS/- 0
Name
^haea. Wastewater System: Palew ❑Upgrade
Q�
Pnaro e_,Q�,f— ABSORPTION FIELD
_
9 9Ss NunM of ittro F 41
aap Trargt Cl sneiaw Trerrli O Baa O MatnE O Omar
LEGAL DESCRIPTION R•t'ng Tan Da to eaea.ann Pena
Bionr. la' SrEaweron: Gpowt, Ft
apt .
F otr
Dn W pa w"M eom ar'gn qra Graw1 Mean;wZhpipe
T~io. /e'Ur� Gw1.f
P Rype SMion'. FAOJo ,bo Fr. Ft
er'ar'y vba � Gravy L.npm.
Ft. S3 Ft.
Welt:4r V New pgrade Ga ywgn. Num» abpe D,uencewwantrse
CMwmutan (Pinna, A 9. Tay Depm.. caFt. Ft
OnDni
Tay weapuan rea: ^� Pwe ' !enn
FI. FI J Fe Q
Draw . 11K Wm -Lava F
� /�//� One nataieG
Y�nO. FJ /VfJ(%/(� LV1J (/ Q
Pump Sat n Lasing Ita�gtn Foove Gravyt
GPM Ft' Fl TANK
SEPARATION DISTANCES 15ISeptic 0 Holding
To Septic Absorption Lift ❑ S.T.E.P. ❑Other.
1P Holding ubiiUP Line
From Tank Field Station Tank Sewer Line �� �•' ewuqr
wMaiw.n Gy
en
� -� NunWar a Lo'ro+nmeme.
LIFT STATION
La Lina G' �• f O ./, •� ^ �•. a;au«
G
Fpagaaon /1 / 'Perp on'Nvyn
Q 'Pump orf Wv N -2n wnM a m 11.
in n
Cutnn Drrn —• Pump Maes d ei Ebanrai h.
nWa�one pwramM Oy'
Remane
BENCH MARK
Louoon nq Dasa�puan.
Inspections performed by: V Dates: 1"7 7 G(
2o' o�
Development Services Department Approval
Conditional Approval Date:
Reviewed and approved by: J Date: /0-23-06
1Rw wroer
FL
Septic System! Construction
Does Not Preclude Adjoining
Lots From Sanitation
Improvements,)
SvoP\51•
DESIGN NOTES:
1. Total Depth of Trench is 8'.
Terrain Slopes South.
2. Sewer Service Line minimum 2% slope
3. See Lot Line Waiver.
4. Lots Served by Public Water System.
- B
F.C.O A 16.4
S.T. .0.1 9 24.5 Driveway
S.T.C. .2 51.5 31
D.C.O. 8 42
C.O. 54 56.5 50 GallonSe is k
C.O. 77 S7 F.C.O
M.T. 57 56 Double C. .'s
4 Berm STC01
Home STCO2
/ H.2
02
CO1
MT
/T.H.1
Absorption Trench
Reserve Site
— — Water Key Box
_ --
NORTHRIM SCENIC MEADOWS S/D 1 40
ENGINEERING ,... ;WASTEWATER
17257 8vor Paw Circle _
................. .. _
Eogle River. Alaska 99577q ; - ! - --------- A S -BUILT
907.694.7028 BLOCK 1 LOT 2 �.:-
- - 10/13/06 22 3
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MUNICIPALITY OF ANCHORAGE
Development Services Department
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 PERMIT
Initial
Date Issued: Jun 14, 2006
1
Expiration Date: Jun 14, 2007
Permit Number: SWO60153 Parcel ID: 051-064-79
Legal Description: SCENIC MEADOWS BLOCK 1 LOT'4—
Design Engineer: 0838 NORTH RIM ENGINEERING Site Address: 23247 BLUE SKIES LANE
Owner Name: MIKE QUINN Lot Size: 40035 SO. FT.
Owner Address: PO BOX 772641 Total Bedrooms: 4 Permit Bedrooms: 4
EAGLE RIVER. AK 99577 -
This permit is for the construction of:
Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ 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 iaska
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
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By.
Date: I b
Date:
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.orglonsile
(907) 343-7904
ON-SITE SEPTIC)WELL PERMIT APPLICK
FOR A SINGLE FAMILY DWELLING
Parcel I.D. J151 -010q-"
Property owner(s)y %' ( `l'G �' L.)/Ax Day
n..
Mailing
Site address
Legal description (Sub'd, Block & Lot)
Legal description (Township, Section & Range)
Lot Size 40, D3 Sq. Ft.
THIS APPLICATION IS FOR (®ail that apply):
Absorption Field
f'
Septic Tank
Holding Tank
Privy
Private Well
El
Water Storage
Number of Bedrooms
i
Zip Code
Code
_V 1A fes/ kfr L
THIS APPLICATION IS AN'
Initial
Upgrade
Renewal
I certify that the above information is correct. 1 further certify that this application is being
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or aut ed age
Permit/Rush Fees: 'f- Waiver Fees:
Date of Payment: Jam^ 2- G- O G Date of Payment:
Receipt Number: C D Receipt Number:
(Rev. 11/05)
made
for a
ENINEERIN� GL—
Norfhitim Engineering
17237 Bear Paw circle
Eagle River, AK 99577
907-694-7028
May 24, 2006
MOA On -Site Water & Wastewater Program
4700 Bragaw St
Anchorage, AK 99519
RE: Scenic meadows SID, Block 1, LotX Z
A lot is being developed. Two soil tests revealed excellent soil & no groundwater. Public
water serves the subdivision.
The neighboring subdivision lots are vacant or under construction by the same builder.
This site should not negatively impact any of the other area lots. The lot slopes to the
south and is relatively flat.
Please review the wastewater system design for the single family home. I have included
design plans & specs, design guidelines, & soil tests. If there is need for additional
information or clarification please give me a call.
Sincerel
Steve Eng, PE, PH
Design Enclosures
bTF,�IM
ENGINEERING Scenic Meadows S/D, Lot 2, Block I
SPECIFICATIONS & UF,SIGN GUIDFLINF.S
Wastewater System Sizing: This is a new 4 -bedroom, single family home. This is a new
subdivision and most of the neighboring lots are not yet developed. These lots are large
and are served by public water. No adverse impacts are expected from development. No
conflicts to the other lots will take place by this septic system construction. The
easements are located on the drawing and are not encroached upon. Soil tests revealed)
sandy soil with low silt. An application rate of 1.2 GPD/FT` with 0.5 reduction factor for
utilizing a 5' wide trench. Trench Length = 500 FT=/5'x .5 reduction factor = 50'; 1 line
@ -50'. No bedrock was encountered or groundwater was encountered.
Specification Requirements: All components and work must comply with the
Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water
Regulations and Wastewater Regulations.
• Two compartment, 1250 gallon septic tank. Watertight couplings on inlet & outlet.
• 5' minimum between the tank and bed. 10' to property lines.
• 3' of cover or insulation is required for trench; an equivalent of I" insulation for each
foot soil cover.
• Tank & solid pipe must be set on well compacted, stable soil.
• 4 inch diameter cleanouts with airtight caps are required 1' to 4' from foundation
wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two
adjacent opposing cleanouts between the tank and the absorption field, not more than
10' from the tank positioned to provide cleanout access towards the tank and towards
the absorption field.
• All cleanouts must extend to at least ground level.
• In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron.
• Trench to be placed level, minimum of 4' to groundwater, 6' to bedrock from drain -
rock.
• rich screened. Drain rock to be distributed uniformly
Drain rock to be 1/2 inch to 2'/2 i
throughout the trench.
• Perforated pipe to be installed level with perforations down.
• Silt barrier (filter fabric) to be installed above the drain rock.
• Smeared trench sides must be raked or scarified before drain rock placement.
• Backfill over drain rock must not be less than 36".
• The finish grade must be mounded to promote drainage over the trench.
• Insulation must be placed over any pipe installed under driveways or parking areas.
• Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM 17789,
ABS ASTM D2661,
• Sewer Service Line is minimum 2% slope.
• Septic Tank to be pumped every two years or when required.
• Insulation board to be extruded direct burial polystyrene (Dow Styrofoam Ill/equal)
Septic System Construction
Does Not Preclude Adjoining
Lots From Sanitation
Improvements.
SvoP\
NORTHRIM
ENGINEERING .. •
17237 bear Pow Circle sw+q
Eagle River. Alaska 99577 a�u� :.•s
907.694.7028
DESIGN NOTES:
1. Total Depth of Trench is
Terrain Slopes South.
8'.
2. Sewer Service Line minimum 2% slope
3.
See
Lot Line
Waiver.
4.
Lots
Served
by Public Water System.
Driveway
50 Gallon Sel
F.C.O. Do ble
4 Bdrm
Home
.H.2
i]
AG bsorption Trench '
Reserve Site Water Key Box
----- — -- - -- i V = 40'
ISCENIC MEADOWS S/D ,WASTEWATER
— LAYOUT
5/2�
BLOCK 1 LOT 2 Dow. 4/06 {1�oT'f 4
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S❑ILS LOG - PERC❑LATI❑N TEST
RiN,
�I'�_ Date Performedi 5/12/06
NEERING
Performed For: Mike Quinn
Legal Description: Scenic Meadows Subdivision, Block 1,
Comments: CERTIFY THAT THIS (TEST WAS
Performed BYNan±hRiM—F-ng. I
Performed in Accordance with All State/Municipal Guidelines in Effect
ON THIS DATE. DATE: 5/12/06 _— -- -
�P.�f:
NORTHRIM * y9m TESTH❑LE LOG IT. H. 1
ENGINEERING I _
17237 Beor Pow Clrcle
Eagle Rfw , Alaska 99577ate!•: • '`
907.694.702A �•'•••••• - GEOTECHNICAL 5/12/06
DEPTH
(FEET)
T.H. Location
See Attached Design
Organic
SP
Sand
3 -
;•::'CI'
w/ Gravel
4 -
r:
6
-
Groundwater? No
7
_
Depth --
.;`
Water Depth
8
_
After Monitorin .None
Date:
5/15&19/06
9
_
Date Gross Time Net Time
De th 1 Net pj
10
5/12 0
--
-Dro
5�
2 5/12 12
12 mi
11' 6'
12-
3 5/12 30
--
13
- ::° :":
4 5/12 42
12 mi
. 11' 6'
14
-
5 5/12 60
--
5• � --
15
-
6 5/12 72
12 mi
11' 6
16
-
17
-
18
-
19
-
20
-
Percolation Rate 2 roih
Perc
Hole Diameter 6_
21
_
Test
Run Between 4' and 5'
Comments: CERTIFY THAT THIS (TEST WAS
Performed BYNan±hRiM—F-ng. I
Performed in Accordance with All State/Municipal Guidelines in Effect
ON THIS DATE. DATE: 5/12/06 _— -- -
�P.�f:
NORTHRIM * y9m TESTH❑LE LOG IT. H. 1
ENGINEERING I _
17237 Beor Pow Clrcle
Eagle Rfw , Alaska 99577ate!•: • '`
907.694.702A �•'•••••• - GEOTECHNICAL 5/12/06
SOILS LOG - PERCOLATION TEST
qE6TINEERING Fu�� Date Performed: 5/12/06
Performed For, Mike Quinn
Legal Description Scenic Meadows Subdivision, Block 1, Lo -
DEPTH
(FEET) T.H. Location See Attached
Groundwaterl No
Depth --
Water Depth
After Monitorin ,
# Date JGross Time
1 15/12 1 0
3 5/12 30
organic
*5/ 60
SP
2-:'p:::.::.
'.`'
Sand
3 -
w/ Gravel
4 _
r.:
5 -
"•
6 -
7 -
8
9 -
10 -
11 -
12 -
13
-
14
-
15
-
16
-
17
-
18
-
19
-
Groundwaterl No
Depth --
Water Depth
After Monitorin ,
# Date JGross Time
1 15/12 1 0
3 5/12 30
42
*5/ 60
72
Date,
Net Tim
12
12
3'
9'
3'
9'
3'
Design
6'
6'
6'
20-
21 - Percolation Rate 2 min./inch Perc Hole Diameter 6_
Test Run Between !and 5'
Comments, —thI
Performed By ��orRim-g
�n
Performed in Accordance with Al
' CERTIFY THAT THIS TEST WAS
ate/Municipal Guideline in Effect
ON THIS DATE. DATE, 5/12/06 .--
I
NORTHRIM
ENGINEERING
17237 Bear Paw Circle
Eagle River, 99577
a o�
907.694.94.70 7028
t
TESTHOLE LOG T. H. 2
i
GEOTECHNICAL °'" ..
- _- --_-1� 5/12/06_ 2 -of 2_-i
M UMC PAUTY OF ANCHORAGE
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. 051-064-78 Expiration Date: 7,21 "2-3
1. GENERAL INFORMATION
Complete legal description SCENIC MEADOWS BLOCK 1, LOT 2
Location (site address) 23285 BLUE SKIES CIRCLE, CHUGIAK, AK 99567
Current property owner(s) PAUL & JENNIFER NIGHTINGALE
Mailing address
Real estate agent
Day phone
23285 BLUE SKIES CIRCLE, CHUGIAK, AK 99567
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:
Private Well
❑
Private Septic
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 $ 550
Date of Payment %4Z6�i I
Receipt Number 7Z6Z2Z
COSA # 0 SC 211 y 2 9
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 FIRST WATER CONSULTING Phone 907-350.9566
Address 13030 SUES WAY, ANCHORAGE, AK 99516
Engineer's Printed Name CURTIS HUFFMAN, PE Date 7/2212021
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the\\
system and maintenance. The operational life of all well and septic systems are subject to e '04 �5���
these various and dynamic characteristics and are outside the control of the evaluator of the �Q
well and septic system. Therefore, any estimate of how long a system will function satisfactory g�Q: • • • �,9 ���
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
TRL
discrepancies exist can be given by First Water Consulting & FWfS ' ... •'* �r
.... ......::-
6. DSD SIGNATURECurtis Huffman
System #1 Approved for bedrooms �%f. .CE 128991 *010-1
F�F.7,122/x9
�
System #2 Approved for bedrooms ll� pROFESSO
Disapproved
Conditional approval for bedrooms, with the following stipulations:
- VVH 1 CR h1V V _
WASTEVATEERRHKUuRAM
o
J /
By: J Original Certificate Date: �"- 2 2-1
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.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
Legal Description: SCENIC MEADOWS BLOCK 1, LOT 2
If more than 1 septic system on lot: COSA Checklist # _of
A. WELL DATA — PUBLIC WATER
❑ Well log is filed with Onsite (or attached)
Date drilled
Total depth _ft
Cased to ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) _in.
Date of flow test for COSA
Static water level at beginning of test _ft.
Comments
B. TANK DATA
Age of tank(s) 15 years
Tank type/material SEPTIC / STEEL
Measured operating fluid level in septic tank 48"
® Standpipes/foundation cleanout per record drawing
Date of pumping 7/21/2021/
D. ABSORPTION FIELD DATA
Which system tested (date installed) 7/11/2006
® ALL standpipes present per record drawing
Total measured depth from grade 7.3 ft (max)
Measured depth to pipe invert from grade 3_3 ft (min)
❑ N/A — pressurized field
® Monitor tubes go to bottom of effective. If not, state
depth into effective
Parcel ID: 051-064-78
Structure served by this system _
Well production at time of test _gpm
Water storage tank volume_ gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate _mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by_
Date of Sample
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material
Comments:
Adequacy test date 7/21/2021
Results M Pass For 4 bedrooms
Fluid depth prior to test 32 in
Water added 620 gal
New depth 41 in
Elapsed time 1260 min
depth 32 in
dep
®Code -required soil cover over field Final fluid❑ System presoaked Absorption rate 600 gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N
date of test) If yes, enter date
Gallons introduced gallons FWD'S
Comments/Deficiencies: FIELD OPERATING IN THE TOP ONE-THIRD OF THE 4' ED.::,.
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
® Yes
if No
Community Sewer Manhole/Cleanout > 100'
❑ Yes
if No
ft
❑ Yes
if No
Neighboring Tank > 100' ❑ Yes
if No
ft
Private Sewer/Septic Line > 25' ❑ Yes
if No
Absorption Field on Lot > 100' ❑ Yes
if No
ft
Holding Tank > 100' ❑ Yes
if No
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' ❑ Yes
if No
❑ Yes
if No
ft
ft
If septic tank is under driveway comment below
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ❑ Yes
if No
ft
❑ Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
® Yes
if No
ft
Surface Water > 100'
® Yes if No _
Property Line > 5'
® Yes
if No
ft
Wells on Adjacent Lots:
® Yes
Absorption Field > 5'
® Yes
if No
ft
Private Wells > 100'
® Yes if No _
Water Main > 10'
® Yes
if No
ft
Community Wells > 200'
® Yes if No _
Water Service Line > 10'
® Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
® Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
® Yes
if No
_ ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft
Private Wells > 100' ® Yes if No ft
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATIONAMAI
I certify that l have determined through field inspections and review ®� ,�Q.: •' 1 •:��
of Municipal records that the above systems are in conformance *J ' •:� ��
with MOA COSA guidelines in effect on this date. : . TH
.... ....�..�..
���• �.. Curtis Huffman
VIP, FFD
CE 4/ J91•�����
Irl .712 4/2 •��.�
PROFESSO -W
ft
ft
ft
ft
ft
ft
ft
ft
• rt Municipality of Anchorage
On -Site Water and Wastewater Program 2 _
(907)343-7904 s r
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-064-78
1. GENERAL INFORMATION
Expiration T -M
n Date: = %� v
Complete legal description SCENIC MEADOWS S/D, BILK 1, LOT 2
Location (site address) 23285 Blue Sky Circle, Chuaiak AK 99567
Current Property owner(s) Bret Hamilton Day phone
Mailing address
Real Estate Agent
23285 Blue Skv Circle, CHnaiak AK 99567
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: Dictanra-
unless otherwise requested by the engineer.
COSA Fee $_ n(a Waiver Fee $ _
Date of Payment gI`Z 61. Date of Payment
Receipt Number oi+rJ?Jts �--- Receipt Number
COSA # 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 MIKE N ANDERSON, P.E. Phone 727-8864
Address 4661 NATRONA AVE.
Engineer's Printed Name MIKE N ANDERSON, PE Date 08/8/16
6. DSD SIGNATURE
System #1 Approved for bedrooms
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
)11
♦d s o V
i
.<" ^
MICHAEL N. ANDERSCN•a (v -°C3
'. IICS� 9,469
ReoS®®4�
bedrooms, with the following stipulations:
Original Certificate Date: —f
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
COSH 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: SCENIC MEADOWS SID, BLK 1, LOT 2 Parcel ID: 051-064-78
A. WELL DATA AWWU Water Service
Well type
Date completed
Total depth _ft.
Date of test
Static water level
Well production
If A, B, or C provide PWSID # _ Well Log (YIN)
Sanitary seal (YIN)
Cased to _ft.
FROM WELL LOG
WATER SAMPLE RESULTS:
ft.
g.p.m.
Wires properly protected (YIN)
Casing height (above ground) _
Coliform colonies/100 mL Nitrate mg/L
Arsenic: ug/L Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material
Tank size 1250 gal.
Foundation cleanout (YIN) Y
Number of Compartments 2
AT INSPECTION
ft.
Collected by:
Date installed 7.11-06
Cleanouts (YIN) Y.
Depression over tank (YIN) _N_ High water alarm (YIN)
Date of pumping 8-9:16 Pumper Quality Pumping
C. ABSORPTION FIELD DATA
Date installed, 7-111-06'.: ..So.11 rating (g.p.d./ft2 or ftz/bdrm) 1.2 System type 5 Wide
Length 53 ft,• Width 5 ft. Gravel below pipe 4 ft.
Total depth '7 5 ' ft. off:, bsorption area 530 ft2 Monitoring tube v Depression over field N
Date o(ade�udGytest•.$ fig 6 Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in 66sorption field before test 19 in. Water added 600+
p p gal. New depth 27 in.
Elapsed Time: 60 min. Final fluid depth 23 in. Absorption rate >=_600+_g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) unknown If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at in.
Datum
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot _
Absorption field on lot
Public sewer main
Size in gallons Manhole/Access (Y/N)
"Pump off" level at in.High water alarm level at _ in.
Cycles tested Meets alarm & circuit requirements?
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Sewer /septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+ Absorption field 10+
Water main 10+ Water service line 10+ Surface water 100+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+ Water main 10+
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+
Curtain drain unknown Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I 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, PC
Date 081812016
COSA canary sheet_2-6-15.doc
OF At
.l
............
MICHAEL N. ANDERSON .-Ce,
yC 169
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water 8 Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 0.5-1- O Cc L/- �Z,R COSA# 0 Cl O Z % 0
1. GENERAL INFORMATION Expiration Date: - c� - ! - / 0
Complete legal description SCENIC MEADOWS, BLOCK 1. LOT 2
Location (site address) 23285 BLUE SKIES CIRCLE • CHUGIAK. AK 99567
Current Property owner(s) PAUL DEVAUGHN Day phone
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
23285 BLUE SKIES CIRCLE " CHUGIAK. AK 99567
Day phone
Effl
BARBARA CRITTENDEN w/PRUDENTIAL Day phone 242-2227
16635 CENTERFIELD DRIVE * EAGLE RIVER, AK 99577
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
0
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
0
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of We (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. 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. 1 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 GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines d Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
Ouctuato during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party Is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for _ bedrooms.
Disapproved.
Phone
337-6179
Date Q /t z/69
MONaftemm
iJfrey A. arnessr,
CE -7953 `FG
Conditional approval for bedrooms, with the fllowing stipulations:
POFA!V
r
ONSITE•'�Gi's
WATER AND
WASTEWATER
PROGRAM'
Attachments:
COSA Checklist Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By: '
I Original Certificate Date:
(R" 11105(
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water 8 Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description:
SCENIC MEADOWS, BLOCK
1, LOT 2
Parcel lD:CSI'eCy-78
A. WELL DATA
PUBLIC
WATER
Well type
Date completed
Total depth ft.
Date of test
Static water level
Well production
If A. B. or C provide PWSID# _
Sanitary seal (Y/N)_
Cased to ft.
FROM WELL LOG
WATER SAMPLE RES
Coliform colonies/100 ml.
enic: ug./L.
B. SEPTIC/HOLDING TANK DATA
Nitrate mg./L.
Well Log
Wires properly protected
Casing height (abgwt-r(
AT
g.p.m.
Other bacteria , colonies/100 ml.
Date of sample: Collected by:
Tank Type/Material SEPTIC/STEEL Date installed 7/11/06
Tank size '1250 gal, Number of Compartments 3 Cleanouts (Y/NYES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) QNO High water alarm (Y/N) N/A
Date of pumping $ 1/ U_ Pumper y� 1 �n T�� g.�
C. ABSORPTION FIELD DATA ow xISTING GRAD
Date Installed 7/11/06 Soil rating (g.p.d./ft'o /bdr 1.2 System type TRENCH
Length 53 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth •7.33 ft. Eff. absorption area 530 ft' Monitoring tube YES Depression over field NO
Date of adequacy lest 8/3/2009Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before lest155 In. Water added 930 gal. New depth26 in.
Elapsed Time: 1100 min. Final fluid depth15 in. Absorption rate >= 600+ g,p,d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date -
D. LIFT STATION
Date installed Size in gallons Manhole/Acces=evel
'Pump on" level at in. "Pump off level High water alarin.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tanknift station on lot
Absorption field on lot
Public sewer main
Sewer /septic servic
PUBLIC WATER
On adjacent
On
Public sewer manhole/cleanout
Holding tank
Artirr containment areas Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+'
Water main 10'+ Water service line -K 10'+ Surface water 100'+1
Wells on adjacent lots 100'+ PVT & 200'+ PUBLIC
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water service line * 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+ PVr & 200'+ PUBLIC
F. COMMENTS
ilE Qom- Sr6.r>: 6.1Cr1 Q• E. waSTEwa`�•s°� /it-gu'�+'
G. ENGINEER'S CERTIFICATION
I certify that I 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.
Engineers Printed Name JEFFREY A. GARNESS
Date (a /126 ci
COSA Fee e !I ti O
Date of Payment (2 0�
Receipt Number 0 L� 7So —
(Rev. 11105)
Waiver Fee $
Date of Payment
Receipt Number
r
Municipality of Anchorage /oAr//06.
• Development Services DepartmentV 6• ''`• +i
� Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw, Street s • .
P.O. Box 196650
Anchorage, AK 99519-6650
www.munl.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
�1, FORR/pASINGLE FAMILY DWELLING ?�
Parcell.D. �.�1-Qrny 7d COSA# 1llo�Cj��
1. GENERAL INFORMATION Expiration Date: - 3 -12 Z
Complete legal description SC n- jfF,q/1 ( $Ld lC
Location (site address) c23a, 5 , 02f `Tf j r `
Current Property owner(s) A41
'6' (IJLIVW
Day phone/ 9SS
Mailing address PO
Rbc 7 724q/ Fi4CLE ,�ryE�
Lending agency
Day phone
Mailing address
Real Estate Agent
el Ls a't
Day phone 6901- tr/9SS
Mailing Address. IPE14fi¢,
pF
EgG�t= !2/tlE(2
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
Individual Water Storage❑
Individual Holding tank ❑
Community Class Well
❑
Community On-site ❑
Public Water System
1EP
Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Onsite Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. 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
Address
Engineer's Printed Name
Phone 611/-70ZJ0
Date zwOf
�-• .. aLZ
'g*Gf.4C 6
o: CF ..........Aa.0. 1-
V
5. DSD SIGNATURE
�C Approved for bedrooms.
stere, W Eng
PE 6256
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
t�((t, urrrrr�
�OF
z
� ry0
TE
ON-SITE 0
Additional Comments
;WASTEWATER . c
pliblir
/VZ?a ENTSO-
_
Attachments:
COSA Checklist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By:
(Rev. 7105)
Original Certificate Date: - 3 - Oto
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196850
Anchorage, AK 99519-6650
www.muni.org/0nske
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: t/C M46 antic R/Q^/L / LaTZ. Parcel ID: O5-1- G -%g
A. WELL DATA pugc.fc r,.JAr!Fk
Well type _ If AX, or C provide PWSID #_ Well Log (Y/N�
Date completed,_,
Total depth ft.
Date of test
Static water leel
Well production
WATER SAMPLE RESULTS:
Coliform colonies/100
Arsenic: _ mgA /
B. SEPTIC/HOLDING TANK DAI
' Sanitaryseal (YIN)_
Cased to ft.
WELL LOG
ft.
g.p.m.
Nitrate mg1L
Date of sample: _
Tank Type/Material4C {co l.�4C 6 Ta&t& /S rcGX
Tank size /ZSa gal. Number of Compartments _el_
Wires properly pro*ed (Y/N)
Casing height
AT
ground) in.
in
g.p.m.
Other bacteria lonies/100 mL
Collected by.
Date installed 7Z✓0 g
Cleanouts (Y/N) y
Foundation cleanout (YIN) 4- Depression over tank (Y/N) -A High water alarm (Y/N) iV
Date of pumping Xe si Pumper
C. ABSORPTION FIELD DATA
Date installed 7
Z1,J6 Soil rating (g.pAJ112 or ft=/bdrm) /a System type WreAje H
Length.3 ft. Width S ft. Gravel below pipe 09' ft.
Total depth _-L ft. EN. absorption area153-0ft2 Monitoring tube Depression over field ^I
Date of adequacy testA(Y1 rJ Results (Pass/Fail) For, bedrooms
Fluid depth in absorption field before test _ in. Water added_ gal. New depth_ in.
Elapsed Time: _ min. Final fluid depth _ in. Absorption rate >= g.p.d,
Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date
D. LIFT STATION
Date installed ize in gallons Manhole/Acres Y/N)
"Pump on' level at _in "Pump off" level at _ in. High water arm level at
Datum Cycles tested Mee larm & circuit requirements?
E. SEPARATION DISTANCES r /�
SEPARATION DISTANCES FROM WELL ON LOT TO: post-
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer /septic serv' line _
Animal contain ant areas
On adjacent lots
On adjacent lots
Public sewer
Holding tank
Manurelanimal oi(crete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation _ Property line /W- Absorption field J`—
in.
Water main /'Q r'F Water service line /G rf Surface water
r
Wells on adjacent lots26 d r
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
� �� Water main
Property line /T /� Building foundation �_
r �
Water Service line Surface water ��Q f' Driveway, parkinglvehicle storage D r
Curtain drain ' I Wells on adjacent lots 200 •*
F. COMMENTS
I u«.:�� 9'd1
G. ENGINEER'S CERTIFICATION 1WF .•' • S ��
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in Joe
conformance with MOA COSA guidelines in effect on this date. ,,,,...
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Engineer's Printed Name f f�[ QQ+ rl•.• PE 6256 : v:
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Date ��3,0�/1 �r'�CFLS�k�1•'
11100000101
COSA Fee $ 7 � Waiver Fee $
Date of Paymentfr Date of Payment
Receipt Number �a�E (� Receipt Number
(Rev. 11/05)
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ASSUILT SENARD & ASSOCIATES LAND SURVEYING 69
1 HEREBY CERTIFY THAT I HAVE SURVEYED THE
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FOLLOWING DESCRIBED PROPERTY:
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OF �e�
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DATE:
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AND THAT NO FNCROACNTS EXIST EXCEPT AS
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INDICATED. IT IS THE RESPONSIBILITY OF THE
GRID:
OWNER TO DETERMINE THS EXISTENCE OF ANY
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EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
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VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
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ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
DRAWN:
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