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HomeMy WebLinkAboutJENNIFERS LT 2BJennl'*f ers Lot 2B #051-045-04 Municipality of Anchorage Development Services Department • Building Safety Division ' • • • Onsite Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page 1 of 2 www.G.anchorage.ek.us (907) 343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SW06OZ74 PID Number. 051.045-04 "•"e AND AUTUMN SEVERSON Wastewater System: ® New ❑ Upgrade Ad0 CHUMAKABSORPTION FIELD Pna» Nu mw a eebaem 1399 4 O D"P Tnrxh ® ShOW Trerrh O BW O MO.W 0 oaw sa n.uoa Tar Dean "M spot w"e LEGAL DESCRIPTION 1 GPD*? 4.3 Ft. el r Lot Depth W Pwe 1xXIM tram atawi n� tiles e.ah a«w"t P" 2B JENNIFERS LOT 28 0.7 Ft. 3.3 Ft TOW" Rmae seanh Fa eeeea Gist L«pm 15N 1W 4 2.5 Ft. 74 Ft. Well: ® New ❑ Upgrade Greer wah Nu a Inge 1 Direae ao+�Fn nue' 5 Ft. Ft clsno n, ip"e, P, e. C) Tar Depth' Ce"C to Tar 2bWrPtan «ee 600 FPO M~0 ASTM 3034 PRNATE 64 Ft. 64 Ft Ft' Drax COLE SULLIVAN Doe Drdw SuppW«« Leer, 812412006 30 Ft matt!«' ARCTIC MOUNTAIN DEV. Doe nrrue 8015/2006 raw P"'"Ps«r C""'aH&gPt ° Gtana TANK 12 DPM 56 Ft. 2 Ft SEPARATION DISTANCES 0 Septic ❑ Holding ❑ S.T.E.P. ❑ Other. To From Septic Tank Absorption Field Lift Station Holding Tank ub[wJPrtvate sewer Line ep"'r ANCHORAGE TANK a ly 1250 Gr Mo«w NumPK a GOA Wm W" +100' +100' — — +25' STEEL 2 +100' +100' — — LIFT STATION swof"Wr« La tea +5' +10' — — e NO LIFT Gr ]ChIK +5' +10 — — •Faro m• Nvr r •Faro ar Nw r Nph wrK rKm r Faneran n n In. Pump MMe a MPOat E� ntPePnP,a P«tamvd ar Ctnrh Dov,— R~* BENCH MARK 7 FILTER SAND BELOW SEWER ROCK Lx era Dew~ TRENCH SIDE WALL MORE THAN 51% SAND BY VISUAL TOP OF FOUNDATION FLASHING INSPECTION, DURING INSTALLATION. 102.7 Ft E ' Inspections performed by: CHARLES BALZARINI Dates: 1' 812512006 4.F...A• �q 2ne 812512006 Development Services Department Approval Conditional Approval Date: i CHRI3TPHERRWOOD DF- 0 Reviewed and approved by: �t t� Date: 9 �bFFiava DIN O4 ) Permit No. SW060274 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: JENIFERS LOT 26 SWING nes FAWN LANE C 1 17.5' 13.7' D 1 47 1 66 N 89'52'37"W 164.99' 15' TELECOMMUNICATIONS AND ELECTRIC EASEMENT o 0 I WELL Ica -0 h B 0)O O 1 ASF N I) LOT 2B MT -1 ,FILL 1250 GI IC TANK TRENCH V ASSUMED ELEVATION • 102.7' ORIGINAL GROUND LEVEL AT, 99.3\ MT -2 / \ TH-1 TANKI ,; «• o • o • • 0 95.3 Na' .V.T. 1,500 GAL +a"'— �'Rr 96.5 ;�.?Lt.Et{ fANb:;`:. 93.1 83. 9�. 98.6 BOTTOM OF T.H. 051-045-04 SCALE 1'-40' DEER PARK LOT 6 S�C :7AREA e 5/8/2007 ENGINEER'S SEAL o4000Op�O G_ OF•At ......................... CHPoSTOPHER R. NOW '�,'f•� CE -10387 5'X RESERVE / O CLEANOUT AREA --___w/ -� WELL • MONITOR TUBE ELEVATIONS (NOT TO SCALE) MT -1 ,FILL 1250 GI IC TANK TRENCH V ASSUMED ELEVATION • 102.7' ORIGINAL GROUND LEVEL AT, 99.3\ MT -2 / \ TH-1 TANKI ,; «• o • o • • 0 95.3 Na' .V.T. 1,500 GAL +a"'— �'Rr 96.5 ;�.?Lt.Et{ fANb:;`:. 93.1 83. 9�. 98.6 BOTTOM OF T.H. 051-045-04 SCALE 1'-40' DEER PARK LOT 6 S�C :7AREA e 5/8/2007 ENGINEER'S SEAL o4000Op�O G_ OF•At ......................... CHPoSTOPHER R. NOW '�,'f•� CE -10387 05/08/2007 16:41 6882259 SLLLIVAN PAGE 01/01 Certifieb Drilling tog by ow co. am SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99587 •TELEPHONE 688.2759 OWNER OF LAND: &(rZ4Mfw) k &8gA nl `Sz'e ADDRESS: LEGAL DESCRIPTION: yt;J/Jjr'6& Lc / DATE:1[�Fi PERMIT N BER: Wiz_ Date of Issue -05 TAX IDENTIFICATION NUMBER: v--�,jr_ .�Y— Is well located M approved permit location? f3.Ya& [l No Method of Drilling: deirt615ry Cl cable tool Depth of well: 4�.4 Casing Type S FAL-Walt Thickness' Inches Diameter inches, depth feet Luer type: n3:�.J� Casing $tickup Above Ground. �• feet Static Water Level: .A feet Recover Rate: /2. gpm Method of Testing: !1 uC Well Intake Opening Type: b46en end 0 Open hole O Screened; Startfeet Stopped feet O Perforations Start f 1tj�tQ�ped feet Grout Type: 4 -d --'>J" r f Vbl ne Depth: from feet, to a? O feet Well Disinfected Upon Completion? &< O No Method of Disinfection: _ CAZL�-4rd 3-D Mfl Comments: C. � J.4•�d jb�e S•�F.,,A w16��Jr'� Driller's Name_Cr,rI44; ,S II-c•.l+}...i 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. Development Services Department Building Safety Division s g On -Site Water & Wastewater Program SAG < 4700 Bragaw Street i P.O. Box 196650 } r Mark Begich Anchorage, A K 99519-6650 s a E r r Mayor vAmmuni.org/onsite (907)343-7904 Pump Installation L® Well Drilling Permit Number: �'w D (, D Date of Issue: - Parcel Identification Number: (2-5.1 `Ooo Legal Description Block Lot Property Owner Name & Address: �—e r? Y? 13 S-hator? d /9vlvmn S'eve-sOP? �LJ 970 )awn tare, chvemk, 0 Pump Installation Date: NQV - D� Pump Intake Depth Below Top of Well Casing: 9_1b feet Pump Manufacturer's Name rZ n f � 10K L L 124 Pump Model: 4FiOS DE3D ) Pump Size Yf4_1 hp Pitless Adapter Burial Depth: /(5 feet Pitless Adapter Manufacturer's Name: N* Pitless Adapter Installer: 44A Well Disinfected Upon Com le 'on? >( Y s ❑ No Method of Disinfection: 6,b t%`)c? Comments: Pump Installer Name: We S l e<k 1 oi n ia1 en Company: Li ie_H , %7 �6 MrI s e. 5 Mailing Address: % Eox 77/2-36 City: State: 4k- zip: Attention: The pump installer shall provide a pump installation log to DSD within 30 days of pump installation. S89' 56' 05' E 164.90' 4. THIS SURVEY WAS PREPARED IN ACCORDANCE WITH THE ASPLS MORTGAGE SURVEY STANDARDS. This survey is a representation of the conditions that were found of the date of :survey. This document does not constitute a boundary survey and is subject to any inaccuracies thot a subsequent boundary survey may disclose. The information contained on this drawing shot] not be used to establish any fence, structure, or other improvements. Unless gross negligence is discovered, the liability extent of the preporer shall be limited to the amount of fees collected for services in preparation of this product. CERTIFICATE OF SURVEY I HEREBY CERTIFY THAT I HAVE PERFORMED AN AS -BUILT SURVEY OF OF THE FOUNDATION ON THIS LOT AND THAT ALL THE DIMENSIONS AND INFORMATION SHOWN HEREON ARE TRUE AND NO ENCROACHMENTS EXIST UNLESS SHOWN OTHERWISE. 1�a2q, 2c07 al Jennie/A: NV 6471-5 2i FF SIDNNL lito DATE OF SURVEY: 03/11/071 NAME OF SURVEYOR: DRAWN BY: GDJ GERALD D. JENNINGS P.O. BOX 670729 PHONE: 688-0728 CHUGIAK, ALASKA 99567 FINAL STRUCTURE AS -BUILT LOT 2B, JENNIFER'S SUBDIVISION CONTAINING 49469.8 SO. FT. NW 1/4, SECTION 4, T 15 N, R 1 W. S.M., AK. PLAT NO. 2005-184, ANCHORAGE RECORDING DISTRICT SCALE: I CHECKED: GRID NO. 1" = 50' NW in N89" 52' 37'W 165.00' cu 0 �-) FAWN LANE - - 0 M FAWN LANE o (U 164.99' 15' T&E ESMT Cl) ao o+ WDRIVEWAY N Cu 8' LOT 6, B-1nsM casing] DEER PARK EST. U.1p0'Buried Elec w r7 k H + m U i n o0'4 +/^1�, 1r1 W r LL Z oo W E2 4 , Clean out N W a Q W frl / 0 � N , !!2 NOTE: a CQ 1. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTANCE OF ANY EASEMENI COVENANTS, OR RESTRICTIONS NOT SHOWN 0 THE SUBDIVISION PLAT. 2. ALL MONUMENTS SHOWN ARE EXISTING AS DESCRIBED ON THE PLAT OF RECORD. 3. THIS SURVEY WAS PREPARED FOR SHAWN & AUTUMN SEVERSON. S89' 56' 05' E 164.90' 4. THIS SURVEY WAS PREPARED IN ACCORDANCE WITH THE ASPLS MORTGAGE SURVEY STANDARDS. This survey is a representation of the conditions that were found of the date of :survey. This document does not constitute a boundary survey and is subject to any inaccuracies thot a subsequent boundary survey may disclose. The information contained on this drawing shot] not be used to establish any fence, structure, or other improvements. Unless gross negligence is discovered, the liability extent of the preporer shall be limited to the amount of fees collected for services in preparation of this product. CERTIFICATE OF SURVEY I HEREBY CERTIFY THAT I HAVE PERFORMED AN AS -BUILT SURVEY OF OF THE FOUNDATION ON THIS LOT AND THAT ALL THE DIMENSIONS AND INFORMATION SHOWN HEREON ARE TRUE AND NO ENCROACHMENTS EXIST UNLESS SHOWN OTHERWISE. 1�a2q, 2c07 al Jennie/A: NV 6471-5 2i FF SIDNNL lito DATE OF SURVEY: 03/11/071 NAME OF SURVEYOR: DRAWN BY: GDJ GERALD D. JENNINGS P.O. BOX 670729 PHONE: 688-0728 CHUGIAK, ALASKA 99567 FINAL STRUCTURE AS -BUILT LOT 2B, JENNIFER'S SUBDIVISION CONTAINING 49469.8 SO. FT. NW 1/4, SECTION 4, T 15 N, R 1 W. S.M., AK. PLAT NO. 2005-184, ANCHORAGE RECORDING DISTRICT SCALE: I CHECKED: GRID NO. 1" = 50' NW MUNICIPALITY OF ANCHORAGE Development Services Department Onsite Water & 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 Date Issued: Aug 21, 2006 Expiration Date: Aug 21, 2007 Permit Number: SW060274 Parcel ID: 051-045-04 Legal Description: JENNIFERS LOT 2B Design Engineer: 0848 EAGLE RIVER ENGINEERING SEI Site Address: NHN FAWN LANE Owner Name: AUTUMN & SHAWN SEVERSON Lot Size: 49470 SO. FT. Owner Address: PO BOX 672023 Total Bedrooms: 4 Permit Bedrooms: 4 CHUGIAK , AK 99567 - This permit is for the construction of: ❑✓ Disposal Field 0 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 Alaska Wastewater Disposal Regulations ( IBAAC72 ) 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 .4111' Date: Date: 0i Z r ' i Municipality of Anchorage ,, e•, .� Development Services Department Building Safety Division On -Site Water and Wastewater Program , . , C T . 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907)343-7904 ON-SITE SEPTIC/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 651�0 45 -04 % Property owner(s)rnrWel £�JIM'" t ✓-tn'er Day phone r� Mailing address PO- &,)- Oa -3 C11L16 i Qk- A K Zip Code`56� FPdy Zip Code `15 6I� Site address N 1-iil� a� Legal description (Sub'd, Block & Lot) 2 i -ICf r- _T Legal description (Township, Section & Range) -% I y AI SEC 4 e' I k�2 Lot Size (49 4 j0 Sq. Ft. Number of Bedrooms THIS APPLICATION IS FOR (®all that apply): THIS APPLICATION IS AN: Absorption Field ❑ 011' Initial Upgrade ❑ Septic Tank ❑ Renewal ❑ Holding Tank. Privy ❑ Private Well Water Storage ❑ I certify that the above information is correct. I further certify that this application Single Family D ing and is i accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: �� ' + �S Waiver Fees: Date of Payment: bI 5I o Date of Payment: Receipt Number: u�1G Receipt Number: (Rev. 11105) is being made for a Eagle River Engineering Christopher R. Wood, P.E. 10421 VFW RD. Suite 201 Eagle River, AK 99577 August 15, 2006 Dan Roth Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Jennifers Lot 2B Narrative & Permit Application Services (9o7) 694-5195 t II (9o7) 694-3297 fait Dear Mr. Roth: i I Eagle River Engineering Services (FRES) was contracted to design a new septic system'and well at the above referenced property. A test hole was conducted by S & S Engineering in July of 2005 for the purposes of the lot subdivision. ERES checked the monitor tube for water in August 2006 and found the monitor tube to be dry. The proposed 4 bedroom septic system and well will have very limited impact onadjacent properties for the following reasons: 1. 2. 3. 4. 5. The surrounding lots are all large, so this lot and neighboring lots have I oom for septic systems and alternate sites Immediate neighboring septic systems and reserve sites are all +30' distance if not shown on site plan, and no private (or community) wells within 200' of the proposed septic system unless shown on the site plan. This permit is for a septic system and well only Drainage will not be affected and is not a major consideration in our design. Slopes are less than 5% in the area of, and adjacent to the proposed leachfield and reserve site. t2003w6-076SEPTICNARRATI V E Installation of the septic system and well on this lot, to our best available adversely affect the septic systems or reserve areas on adjacent lots. If you have any questions please call our office at 6945195. Sincerely, EAGLE RIVER ENGINEE�RfING SER ICES Christopher R. Wood, P.E. Principal I 0003\06-076SEPTICNARRATI VE will not LOT 1 '\ DEDICATED TO RIGHT Or\\WAY N 89'52'37"W 164.99' \\,\ IV TELECOMMUNICATIONS AND ELECTRIC EASEMENT � ________________ _______ } +200' SEPTIC+30' I \\ 1 1 I PROPOSED 1 I -- _Q EW WELL 100• WELL RADIUS I I , I 1 I 1 I 1 1 \ WELL+200' I \ �— pp / HOUSEaa SED / / INSTALL /I S ALL NEW NEW 1250 CAL i SNX70' TRENCH SEPTIC TANS i� 5 152% LOT 2B ® 110 W MIN BY SBSX I X30' �' �I so ® — TEST HOLE — — — • — MONITOR TUBE — o — SEWER CLEAN OUT _ ¢ — WELL I WELL+200' sEPnc+3o' 100' MELL RADIUS I I �i_ \\� DEER PARK LOT 6 SEPT, C ARE//y I RESERVE V) SEPTIC ARE S 89'56'05"E 164.90' :7 EASEMENT PROPOSED LEACH FIELD 1. NO KNOWN SURFACE WATER +100'. EXISTING LEACH FIELD 2. NO SEPTICS WITHIN 30' UNLESS NOTED DRIVEWAY 1 3. NO WELLS WITHIN 200' UNLESS'NOTED WELL/SEPTIC LEGAL: JENNIFERS LOT 28 OWNER: AUTUMN AND SHAWN SITE PLAN SEVERSON INTRACTOR: UNKNOWN B# 06-076 1 DATE: 8/15/ 000 SCALE 1 "=50' 1 A EAGLE RIVER ENGINEERING SERVICES 10421 VFW RD. SUITE#201 EAGLE RIVER, AK. 99577 t. (907) 694-5195 FAX.(907) 694-3297 OF '47444 .CHRISTOPHER R. WOOD. CE -10387 ' � 1 X:R�Ess10N►y'�� FILL TO BE ADDED WELL SEPTIC SITE PLAN LEGAL:I JENNIFERS LOT 28 OWNER: AUTUMN AND SHAWN SEVERSON CONTRACTOR: UNKNOWN JOB 06-076 1 DATE: 8/15/200d SCALE: NTS A' EAGLE RIVER ENGINEERING SERVICES 10421 VFW RD. SUITE##201 I„ EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) 694-3297 a OF A. .VY.VY• V.' J.......... .CHRISTOPHER R. WOOD.- CE-10387 OODCE-10387 ' k 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 fait I. 1 SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: Jennifers Lot 2B i October 27, 2005 A. i GENERAL 1. The well and septic plan is for a 4 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 Health 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. 1 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 I. 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 ft., with 2 ft. minimum. 2. Septic Tank shall be a minimum of 1,250 gallon tank of MOA approved construction, insulated, or plcace with 4' of soil cover, min. C. F DRAINFIELD 1. The drainfield is to be placed as shown on the site plan. Contractor shall take extreme care ensure that 10'separtation distance is maintained between the house and leachficld, and from the lot line.l 2. Two feet of filter sand shall be installed below 3' of sewer rock 3. The bottom of the drainfield excavation shall be level, plus or minus 1.5", prior to placing filter sand. 4. The top of the filter sand layer shall be level, plus or minus 1.5", prior to placing sewer rock. 5. The total depth of the drainfield excavation shall not exceed 7 R. at any point in relation to natural ground surface, prior to placement of the sand layer. 6. The drainfield gravel shall be covered with typar fabric material. 7. Soil or a combination of soil and extruded board insulation to at depth of 3' or equivalent is to be placed over theleachfield. S. The area over the drainfield is to be finish graded or mounded to prevent ponding of surface water runoff. I 9. The septic tank and Icachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. \\Ercs\DOCS\WPDOCS\2006\06-076drainficid. spcc.doc Eagle River Engineering Services Christopher R. Wood, P.E. RECOMMENDED LEACHFIELD DIMENSIONS TOTAL DEPTH= 7' GRAVEL DEPTH = 3' under pipe, 2" over pipe (3.5' total) FILTER SAND LAYER= 2' DRAINFIELD LENGTH =70' DRAINFIELD WIDTH= S SOUIRATING = 1.2 GPD/fe /1.0 for filter layer BEDROOM CAPACITY= 4 total SEPTIC TANK — 1250 gallons min. Twenty-four (24) hours notice required for all inspections spec.doc EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska "fin (907) 694-5195 ERES Project No.: 06-076 Calculated By: CB Date: 08/10/2006 Legal: JENNIFERS LOT 28 SINGLE FAMILY 4 BEDROOM RESIDENCE TEST HOLE 1& 2 Shallow Trench Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = 600 gallons Percolation rate = 1 minutes per Inch Wastewater application rate = 1 gallons per day per square foot Required absorption area = 600 square feet Trench width (W) = 5 feet Gravel depth (D) = 3 feet Required length = Shallow trench factor • Required absorption area / W Shallow trench factor = (W + 2) / (W + 1 +2 D) 0 To 5 4-V t> Shallow trench factor= 0.58 -7-0 5•d To Total Excavation Depth = � feet Required length = 70 feet CHRISTOPHER R CE:IM M v� �Oh'f t:L PM08/102006 t�zro-eauo a7••r0 7A, Ct'AI II'CCR IIVU 7bf b74 lGll Y.r).S�tl.� Y A 4 PERFORMED FOP t LEGAL DESCRIPI DErtH /. 4 s ;k• G O� 7 �. 9 ..G, 17 is 19 20 ROBERT C. COWAN. P.E. ROBERTA. SHAFE11, PE. CPALENGINEERS (Wn594-2979 FAX (907) 1194.1211 s�i�ry s.P�uO (svll� DATE Range. Section: WAS GROUND WATER�(1 _ ENCOUNTERED? IF YES, AT WHAT 15 15"1 mo i. w so.ny Den"� ER6-5 DR'a' �d�o7 oG 9qw to waar N lAn"?-!!Lr* Mr pale: - I.0 i �4N-T—sH'1 Tio H ROBW Q COWAN "CE -8801 71 )v s- Not Na ReaCinp Dat. TMna T ma W n• o DroO b CQA.N7 ,• atie I N Wko I I ' PERCOLATION RATE [.��. Im1•wla imh) FERC HOLE DIAMETER , TEST RUN BETWEEN J.— FT AND --OL FT Cprmncn Ia - I i �; S�ifsrlFEiAU4G 1 CCR? IFV THAT T.NJ Tf.}TwA1 ►LR.owr�o �N PEPfOpMEO BV: " F / Ds c��tr_Ay_t,.�ep1I�6VIpELINES IN IFFEGT DN TMSDATL OAT: e ACCORDANCE YAT--MwMOr+'a^�'•' TOTAL P.03 ¢�f H4i Municipality of Anchorage • i� 9 On -Site Water and Wastewater Program (907) 343-7904 * Y Certificate of On -Site Systems Approval Parcel I.D.OS1 —c9q5 —©c4 Expiration Date: `� I 1. GENERAL INFORMATION _ 1 Complete legal. description r I,ocation (site address)a 147e:FAc,/,✓ ~ SFI�AI+ AVVv l 116'12 504/ n'Propetyown Day phone Mailing addreas .. 41970 f�N tAri 2- a.. Real EState Agent �+' Day phone F. 2. TYPE 4F PYVELLING: (� 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 for:— Received or:RecG TYPE OF WASTEWATER DISPOSAL: X1 Individual .ZI ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer ❑ COSA to be releled'to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 46WO Waiver Fee $ _ Date of Payment g`010 Date of Payment Receipt Number 614WL) Receipt Number COSA # c5c «O ° 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 -t M Address 3cr6ao l Rc./DNO& F7,4V Ave - Engineer's Printed Name 6F61126c5 64L7,ArAT t 6. DSD SIGNATURE System #1 Approved for -L bedrooms System #2 Approved for bedrooms Disapproved Phone xy -5558 Date OF moi; •.� . ..... .. ............. Charles G. Balzatinl -.%V.% Conditional approval for bedrooms, with the following stipulations: OFA \NN P' AND By: jinn �d/�F/ Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers 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: 7 boT p'-6 Parcel ID:051-Qq5^011' A. WELL DATA Well type P y�� If A, B or C Drovide PWS ID # Well Log &N) yds Date completed Sanitary seal 5 N) YF5 Wires properly protected(O/N) S Total depth �1641' ft. Cased to kA --ft. Casing height (above ground) in. FROM WELL LOG Date of test Static water level i"� ft. Well production V' 9 -P.M. WATER SAMPLE RESULTS: Coliform V�ts colonies1100 mL Nitrate �• mg/L Arsenic A% D ug/L Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SAnZi Tank size b5o gal. Number of Compartments AT INSPECTION 3Idw;lQu C�4 ft. 4L4 g.p.m. Collected by: i'+M Pfj bI-NOFR�&)& Date installed $Yoe©o to Cleanouts(V?N) YF 5 Foundation cleanout (VN) %X5 Depression over tank (Y®/ / High water alarm (YQ A42 Date of pumping 31� J f foVG Pumper ks /^'1 PPL J& C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ftZ or Ahdtm) 1 • System type 7PC4CH Length Width 5 ft. Gravel below pipe �.3 ft. Total dept Eff. absorption area �l ftZ Monitoring tube Depression over field Date of adequacy test i Results as /Fail) I r For _q_ bedrooms Fluid depth 1n'absorption field before test e7 in. Water added'6g2e gal. New depth in. Elapsed Time: min. Final fluid depth ® in. Absorption rate >= 600 9•p•d. Any rejuvenaiion,treatment (past 12 mo.) (Y& type) ► wVe WOW-" If yes, give date N/�} D. LIFT STATION MV t r f Date installed Size in gallons "Pump on" level at in. "Pump off' level at= Datum Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: , { (C)a Septic tank/lift station on lot Absorption field on lot t 60 / { o Public sewer main Sewer/septic service line Animal containment areas SEPTIC/HOLDING TANK ON LOT TO a Manhole/Access (Y/N) in. High water alarm level at Meets alarm & circuit requirements? _ On adjacent lots 4 ( 00 On adjacent lots lOp i Public sewer manhole/cleanout 4-/09 Holding tank .4(00' Manure/animal excrete storage areas f f0� Building foundation 4 S Property line IS Absorption field Water main f Water service line 4 Surface water f (cn Wells on adjacent lots 4 00 ABSORPTION FIELD ON LOT TO Property line f (0 Building foundation ^fid Water main + fo i Water Service line t0 Surface water •f (Fhb Driveway, parking/vehicle storage Curtain drain '+'v Wells on adjacent lots 4 109 in. F. COMMENTS AA9 yT5rofZy ®r` FAZZzr4,1& ® Ar-r:-CLc,4�•T� /4Rc iii �'N'i AFS A/�tis��T2�-� r'�=r�7" /-1-7704E P)C TX-5r*V6. G. ENGINEER'S CERTIFICATION OF �E•.....acq�e ! certify that l have determined through field inspections and `P• ' Sjr review of Municipal records that the above systems are inAV conformance with MOA COSA guidelines in effect on this date. V Engineer's Printed Name i... •. �jpR Charles Balzarini Date �I �S��Dl b �0 s; .,-13g/��4 0419Fo���• r_, ,.�a� �1`q oFfC�,nN ►�• COSA canary sheet_2-6-15.doc V -I f— 3-13M cN -� 3 Q 3 L - .se 192 E8'662 i + m 00'0£ a 'C7 0 t� N Lal rl =r w iu U7 �+- �co Z h 6.1� elf ,0E N 41 0 c cS m ZA cr z i' Ld J + 3 .89 ,ti0 -00 S 433Q00..._.__ MS9i In w� � t -li X -1' lJ�O U tl G N Off' U Z 4 O U 100,00C 31,I0 190 .00 S 100'0EE - 9NIdV39 3❑ SISbg Qu C!'), ul co, > ' o Z Cl C)d �nz zl-x ?DC7}0 C5 t� Wim. Q� ✓� W Z Z Z FIr X mo �-�-- N0 z) {�- Q ¢Z.Lr) of Wg O W W.OS Q 0 Cl) O0_u HOZ wQ ca0 ui� F— Ld¢4-Z W I Y LIP t-- �d w N 0 Q �' � d' `�. w z�wwn tt�Z w ,.y_� � W H— 1. 4w Z U)� ¢D �C -tV 0 j-7 <C p. 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