HomeMy WebLinkAboutDALE BRIGGS BLK 1 LT 6 N100'Dale Briggs
Block 1
Lot 6 NIOO'
#050-181-01
Municipality of Anchorage
On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP161070 PID Number: 050-181-01
Dwelling: ❑ Single Family (SF) ❑■ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑C New ❑ Upgrade
Name:
Gar & Katherine Henning
ABSORPTION FIELD
❑ Deep Trench A Shallow Trench ❑ Bed ❑ Mound
Address
P.O. Box 770597 Eagle River, AK 99557
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
Six (6)
1.2 GPD/SF
6.8-7 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
2.8-3 Ft.
Gravel depth beneath pipe
4.0 Ft.
Subdivision Block Lot
Dale Briggs 1 6 N100'
Fill added above original grade
1.5-2 Ft.
Gravel length
80 Ft.
Township Range Section
Gravel width
5 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION
DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
800 Fe
2
>10 Ft.
Well
NA
NA
NA
NA
>25'
TANK ❑p Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage Tank
Capacity
1 2,000 Gal.
surface water
>100'
>100'
NA
NA
Material
Steel
Number of compartments
2
Lot Line
>5'
10'
NA
NA
NA
Foundation
>5'
>10'
NA
NA
LIFT STATION
Manufacturer
Capacity
Gal.
Curtain Drain
No ne
Noted
Pump on level at
Pump off level at
High water alarm at
Remarks
in.
in.
in.
Pump make and model
Electrical Inspections performed by
PIPE MATERIAL House to tank D3034 Tank to
drainfield D3034
Installer
Royce Martin
Drainfield D3034 CO/MT D3034
Inspector MEA
BENCH MARK (Assumed elevation) 100.0 ft
Inspection 15' 11/20/16 nd 11/20/16
Location and description
dates: 2
t
Front Deck NE Corner
3rd 4
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
��i�'
:tOF
Conditional Approval: Date
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Municipality of Anchorage Page 3 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number: OSP161070 PID No. 050-181-01
93.7
93.5
U
98.3
UU �
Finished
OG
2" Insulation
2,000 Gallon
Septic Tank
14.3 P94.15
C14
N LOU
98.1
96.5
Finished Grade
Original Grade
Geotextile Fabric
i�
89.71
40' (Trench Length) 82.5
Groundwater @ 85.5'
NORTH TRENCH 5/15/13
U �U
98.0
96.5
Finished Grade
Original Grade
Geotextile Fabric
----------
89.7 Drainfield Rock
89.71
40' (Trench Length) 82.5
Groundwater @ 85.5'
NORTH TRENCH 5/15/13
U �U
98.0
96.5
Finished Grade
Original Grade
Geotextile Fabric
89.51
40' (Trench Length)
82.5
Groundwater @ 85.5'
5/15/13
SOUTH TRENCH
PROFILE AS -BUILT -
No Scale
93.7
93.5
49Th `9
1.1t .1.:::..`.............................' f ``i
MICHAEL E. ANDERSON ;•)Tj,
----------
�/— 89.5 Drainfield Rock
89.51
40' (Trench Length)
82.5
Groundwater @ 85.5'
5/15/13
SOUTH TRENCH
PROFILE AS -BUILT -
No Scale
93.7
93.5
49Th `9
1.1t .1.:::..`.............................' f ``i
MICHAEL E. ANDERSON ;•)Tj,
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650
DEPTH
(feet)
1-
2-
3-
4-
5
6
7
8
9
10-
11
12-
13-
14-
15-
16-
17
18.
19.
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT 6, BLOCK I, DALE BRIGGS SUBDIVISION
PERFORMED FOR: GAR HENNING
DATE: 1012712012 PROJECT No.:
PARCEL ID#- TECHNICIAN: A. HARALA
TEST HOLE 2
a SILTY GRAVEL
WITH SAND
4 GM
a
a
SLOPE
N
11
OQ
SITE PLAN
SEE SITE PLAN
i
WAS GROUND WATER ENCOUNTERED? its
IF YES @ WHAT DEPTH? 1 S
DEPTH OF WATER AFTER MONITORING: I I' O 2%
d DATE OF MONITORING: 5/15/13 P
E
n
BOH @ 14'
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH To
WATER
(INCHES)
NET DROP
(INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
10/27
1
3:13/3:23
10
.25"/8.50"
6.25"
2
3:24/3:34
10
.38"/8.50"
6.12"
3
3:35/3:45
10
.25"/8.5o,,
6.25"
4
3:47/3:57
10
2.50"/8.57
6.07"
5
3:58/4:08
10
2.38"/8.50"
6.12"
6
4:10/4:20
10
2.38°/8.50°
6.12"
PERCOLATION RATE: 1.6 (MIN/INCH) PERC. HOLE DIA. 6�� (INCHES)
TEST RUN BETWEEN: 3.5 FT. and 4.5 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 7/25/17
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number:
OSP161070
Tax Code Number:
05018101000
Work Type:
Septic Renewal
Permit Effective Dates: April 21, 2016 to April 21, 2017
Design Engineer:
ANDERSON ENGINEERING
Subdivision:
DALE BRIGGS
Site Legal Address: DALE BRIGGS BLK 1 LT 6 N100' G:0152
Owner/Address: HENNING GAR M & CATHERINE J
PO BOX 770597 EAGLE RIVER AK 995770597
Site Mailing Address: Lot Size in Sq Ft: 19600
Total Bedrooms: 6
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Issued By
, L
By: Date:
Date:
UNICIPALITY OF ANCHORA �° _
Community Development Department " Ph : 907-343-7904
Development Services Division 07-343-799
On -Site Water & Wastewater Program *11
ON-SITE SEWERMIELL PERMIT APPLICATION
Parcell.D. DSS—/8l-O/D-ao
Property owner(s)r•
Mailing address �p �fb0k
o` s i
-1-) 0 S97 t�(� ve' ,fes
Day phone 7y5 -(. C- /q
gIY77
Site address ('leaf- zmk
Legal description (Sub'd., Block
& Lot) J3 zes $
( L [ A(tJOd
Legal description (Township,
Range & Section)
Lot Size (j&.QQ Sq.
Ft. Number of Bedrooms �o
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
Initial ❑
Single Family (SF) ❑
Septic Tank �]c
Upgrade ❑
(w/wo ADU)
Holding Tank ❑
Renewal
Duplex (D) .s
Privy ❑
Multiple Dwellings ❑
(SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify t1l tthe above information is correct. I further certify that this is in accordance with
owner or authorized
Permit/Rush Fees: C �I 0 1 -60,f C':!V,. Waiver Fees:
Date of Payment:
Receipt Number:
Permit No. 0 J � 1070
Permit App_9-1-12.doo
Date of Payment:
Receipt Number:
Waiver No.
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 FAX
MEMORANDUM
DATE: April 20, 2016
TO: Jay Crewdson
FROM: Mike Anderson, P.E.
SUBJECT: N100', Lot 6, Block 1, Dale Briggs Subdivision
Septic System Permit No. OSP151069
The septic system design for the subject lot was originally designed and permitted in
June of 2015. The permit is now up for renewal. No development has been completed
on this or surrounding lots since the original permit was issued to my knowledge.
Conditions in the area remain the same as described in the original design and permit
application.
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP151069
Tax Code Number: 05018101000
Work Type: Septic Initial
Permit Effective Dates: June 04, 2015 to June 03, 2016
Design Engineer: ANDERSON ENGINEERING
Subdivision: DALE BRIGGS
Site Legal Address: DALE BRIGGS BLK 1 LT 6 N100' G:0152
Owner/Address: HENNING GAR M & CATHERINE J
PO BOX 770597 EAGLE RIVER AK 995770597
Site Mailing Address: Lot Size in Sq Ft: 19600
Total Bedrooms: 6
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Issued By
Municipality of Anchorage
Development Services Division
Onsite Water and Wastewater Program
went IS,
1� P
J
v
H N
N
epartment
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSV161015 COSA#: _ Permit#: OSPIS1069
PID#: 050-18"1
Legal Description: Dale Brings, Block 1, Lot 6 N100'
Engineer: Anderson Engineering
Applicant: Gar & Catherine Henning
Your request for a waiver of the required 10 feet horizontal separation from the _absorption field
to the property line has been approved. The approved separation distance is'6 feet.
This waiverapproval applies to the proposed absorption field only. Any future upgrade to the
on-site wastewater disposal system will require all separation distances be met or another
approval from this department.
The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected
adjacent property.
0 Adjacent properties are not affected by this waiver.
'man ... MEN .... Nam .... owes .... an ... won...won,
Waiver is Granted: X Waiver is not Granted:
Date: Approved by'
Reviewer
............................. a ... .'..... a ...
. -.:....... a....................�
MUNICIPALITY OF
Community Development Department
Development Services Division
On -Site Water & Wastewater Program
Phone: 907-343-7904
Fax: 907-343-7997
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I. D. 050-181-01
Property owner(s) Gar & Catherine Henning Day phone
Mailing address P.O. Box 770597 Eagle River, AK 99557
Site address 17013 Kantishna Drive Eagle River, AK 99557
Legal description (Sub'd., Block & Lot) Dale Briggs, Block 1, Lot 6 N100'
Legal description (Township, Range & Section)
Lot Size 19,600
Sq. Ft.
Number of Bedrooms Six (6)
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(0 all that apply)
Absorption Field
0
Initial 0
Single Family (SF)
El
(w/wo ADU)
Septic Tank
0
Upgrade ❑
Duplex (D)
0
Holding Tank
❑
Renewal ❑
Multiple Dwellings
❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION
INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Lot Line
Distances'6.-S
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 5�1—
Date of Payment: 4f Al1/S
Receipt Number: 6,2Li559 IS
Permit No. 4W 16-1 D (04)
Permit App_9-1-12.doc
Waiver Fees: 021
Date of Payment: L/ /L
Receipt Number: a'5-"% 44
Waiver No. 65V 151015
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 FAX
April 4, 2015
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: N100' Lot 16, Block 1, Dale Briggs Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer
The owner of the North 100' of Lot 6, Block 1, Dale Briggs Subdivision intends to
construct a new six -bedroom duplex on the lot. We are therefore requesting a permit
be issued for the construction of a new septic system to accommodate the structure.
The attached Site Plan and backup documentation identify the location and
configuration of the proposed septic system along with the alternate site. Also identified
on the plans are the existing wells on surrounding lots. The area is served by the
AWWU water system and a new water service will be constructed to this lot No conflicts
exist between the proposed septic system and wells on adjacent lots. Drainage arrows
are shown on the site plan showing the grade and direction of flow on the lot. The
drainage pattern will not be changed as a result of this project.
A test hole was placed on the lot in the area of the absorption trench and alternate site.
The log indicates silty gravel with sand (GM) and some silt in the zone specified for the
absorption trench. The percolation rate of the soil was determined to be 1.7 minutes
per inch. Groundwater was found during the placement of the test hole at 11' below the
surface and remained at that level during the monitoring period which included May 15,
2013. An application rate of 1.2 gallons per day per square foot was used in the design
of the absorption system. We are proposing to place a new 2,000 -gallon septic tank
and 2 - 40' long by 5' wide by 4' effective depth absorption trenches to treat and
dispose of the effluent generated in the duplex. The elevation of the distribution line in
the absorption trench will be 3' below the surface and the total depth will be 7'. A
minimum of 3' of fill or 2" of insulation and 2' of fill will be placed over the absorption
trench and 4' over the septic tank.
The ground surface on the lot in the area of the septic system slopes to the north at
N100' Lot 6, Block 1, Dale Briggs Subdivision
April 4, 2015
Page Two
shallow grades. The new trenches will be constructed parallel with the contours of the
slope as much as possible in conformance with Municipal requirements. The new
septic system will be constructed a minimum of 100' from all wells and any surface
water and 10' the proposed and existing water services in the area.
If the system is constructed in accordance with our design the following statements
apply:
The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
2. The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
3. The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
4. The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
MICHAEL E. ANDERSON
April 6, 2015
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: North 100' Lot 6, Block 1, Dale Briggs Subdivision
Separation Distance Waiver
Absorption Trench to Lot Line
Dear On Site Services Engineer:
The subject lot is only 100' in depth allowing very little area for an on site septic system.
The lot and the surrounding area are served by the AWWU water system however and
no conflicts will result from placement of the absorption trench at 6.3' from the north
property line. Soils in this area percolate at rates less than 5 minutes per inch and little
or no migration of effluent is expected. We therefore request a waiver be issued
allowing the absorption trench system to be constructed 6.3' from the north property
line.
Sincerely,
Michael E. Anderson, P.E.
.' 49th
MICHAEL C ANDERSON
No. CE -4381
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NORTH 100', LOT 6, BLOCK 1
DALE BRIGGS SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS
Six Bedroom Duplex 5' Wide Trench System
Perc. Rate: 1-5 Min./Inch 2,000 Gallon Septic Tank
Application Rate: 12 GPD/SF 4' Drainfield Rock
6 Bedrooms ` 150 GPD/Bedroom = 900 SF Absor tion Area
900 SF/1.2 GPD/SF/5 SF (Width) `.5 (Red. Factor 750 LF Trench Length
THEREFORE: Construct 2-40' Long x 5' Wide x 4' Effective Depth Absorption Trenches.
Flow Line Elevation in Trenches to be 3' Below Original Ground Surface. Total Depth to be
7' Below Existing Ground, Provide 3' Cover Over Absorption Trench and 4' Cover Over
Septic Tank. Place Flow Splitter to Insure Even Flow to Each Trench.
5'
TYPICAL 5' WIDE TRENCH SECTION• iviysm
(NO SCALE) Jev\7E �•• �
NOTE: Grade Area Over Trench to Drain Away. C{i 49th
Minimum 6' Separation From Bedrock. 0- ...:. ......t.......P......
Minimum 4' Separation From Groundwater. 0 y� F!-�-s C.
Minimum 100' Separation From Private Wells in the Area. 00 : MICHAELE ANDERSON
Minimum 100' Separation From Surface Water or Streams No. CE -436,
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650
DEP Ell
(feet)
1 -
2
3
4
5
6
7
8
9
10-
11
12-
13-
1
1
1
1
1
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT 7 BLOCK I, DALE BRIGGS SUBDIVISION
PERFORMED FOR: GAR HENNING
DATE: 10/27/2012 PROJECTNo.:
PARCEL ID#: TECHNICIAN: A. HARALA
OB/OG
TEST HOLE 1
a I SILTY GRAVEL
d 1 WITH SAND
d.
GM
a
� d
d
d .
COMMENTS:
BOH @ 13'
SLOPE
mll
MICHAEL E. ANDERSON
NO. CE -4381
SITE PLAN
SEE SITE PLAN
WAS GROUND WATER ENCOUNTERED? YES
IF YES @ WHAT DEPTH? F
DEPTH OF WATER AFTER MONITORING. I' 2%
DATE. OF MONITORING" 5/15/13
HOLE PRE SOAKED PRIOR TO
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH TO
WATER
(INCHES)
NET DROP
(INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
10/27
1
1:42/1:52
10
.88"714.00"
6.12"
2
1:53/2:03
10
.69"/13.75"
6.06"
3
2:04/2:14
10
7.75^/13.88"
6.13"
4
2:15/2:25
10
7.69"/13.75"
6.07'
5
2:26/2:36
10
.56°/13.63°
6.07'
6
2:37/2:47
10
7.63"/13.63"
6.00"
PERCOLATION RATE: 1.7 (MIN/INCH) PERC. HOLE DIA. K (INCHES)
TEST RUN BETWEEN: 3_5 FT. and 4_5 FT.
TEST PERFORMED BY ANDERSON ENGINEERING. 1, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 4/4/2015
Parcel I.D. 050-181-01
0
o� C
Municipality of Anchorage
On -Site Water and Wastewater Program V6C dA
(907) 343-7904 S F E -r Y 3e
_17
Certificate of On -Site Systems Approval
1
Expiration Date: -'2_0 -) o C7
Complete legal description Dale Briggs, Block 1, Lot 6 N100'
Location (site address)
17022 Monte Road Eagle River, AK 99577
Current Property owner(s)
Mailing address
Real Estate Agent
Day phone
17015 Monte Road Eagle River, AK 99577
2. TYPE OF DWELLING:
❑ Single Family (w/wo ADU)
� Duplex
1771 Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
Individual Well
El
Individual Water Storage
F1
Community Class Well
1771
Public Water System
ED
Day phone
r
Individual
0
Holding Tank
1771
Community
1-1 .
Public Sewer
E-71
Waiver/Variance request for: Distance:
Received by: Date: 71a�1,7
COSA to be released to the engin6e
,'_r unless otherwise requested by the engineer.
COSA Fee $111 -
Date of Payment —712,c t f1
Receipt Number 013
COSA# 05C11_11
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
f•�'��-�t�� li�l��il�l� '�7�+r��C�7fii�TCe7�t-���7
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 Anderson Engineering
Address
P.O. Box 240773 Anchorage, AK 99524
Phone 522-7773
Engineer's Printed Name Michael E. Anderson, P.E.
Date 7/25/2017
OF A4
It a-T-
�°°
° 4.9 fi-i
6. DSD SIGNATURE
• ... °
� �
System #1 Approved for bedrooms
....... ...,.
�� VO,4°Ar,Ur:lzsaN..�
MICHAEL" E, �
System #2 Approved for bedrooms
®��zs381
f
Disapproved
444 pRQF �,p�-
Conditional approval for bedrooms, with the following stipulatlo�i:
lr
�
eN—S _ 7
WATER AND
WASTEWATER c
PReG
�- .7-2_-�
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 engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet—E '- .: c
If more than Iseptic system ksmn the lot:
CDSAChecklist # -of
Structure served bythis system
D[�|�� Briggs, ��|nC� 1 k� �� W1O[Y
Legal OeoorpUnn� ^~ ' ~~''"� ` ^~'`' " ' ' `-~^ ° ' " ' °~
A. WELL DATA - Public Water System
Well type IfA,B.orCprovide PWS |D#____
Date completed Sanitary seal H/N\____
Total depth ft. Cased to ft.
FROM WELL LOG
Date oftest
Static water level ft.
Well production g -p -nn-
VVA[ERSAK4PLE RESULTS:
Coliform co|oniee/100 mL Nitrate
Arsenic ug/L Data of sample:
Well Log HYN)________
Wires properly protected (Y/N)_________
Casing height (above ground) in.
AT INSPECTION
Collected by:
ft.
B.SEPTIC/HOLDI0G TANK DATA
���nt'���t��| 11yJD�O1�
TankTypa/�oteria| `' r^'`"`' ' Date installed ' ''^-"'^'~ ' "
���� � `�
Tank size ' oa| Number ^- C|eanouts(Y7N) '
_--�' _����� . ��`
Foundation cleanout (Y/N)Y Depression over tank (Y/N) N_��_ High water elarm(Y/N)
Date of pumping Plumper New CODst[Uct'DD
Date installed 11/20/17 Soil rating (g.p.dmcor*2 /bdnm) 1.2GPD/SF System type b' Wide
�
��z1O � z1
Length� � '" �� Width� ft. G��|��pi�__ft.
�5
Tota|depth_`,^�_�� E�AOD �obaorptionarea Monitoring Y,Depression K|,._
Date ofadequacy test New Const. Reou|to(Paoa/Fai|) For6bedrooms
Fluid depth inabsorption field before test in. Water added gal. New depth in.
Elapsed Time: _______min. Final fluid depth in. Absorption rate >= g.pd.
�J
Any n�uvenationtreatment
(paot12mV.)(Y/N&typm) '= |fyes, give date________
Q. LIFT STATION
Date installed
"Pump on" level at
Datum
_ Size ingallons __
in. "Pump off" level at
— Cycles tested
in
E. SEPARATION DISTANCES -PUb|iC Water System
WELL ONLOT TO:
Manhole/Access (Y/N)_____
High water alarm level at_____
Meets alarm & circuit requirements?
Septic tank/lift station onlot
Onadjacent lots
Absorption field onlot
Onadjacent lots
Public sewer main
Public sewer manhole/cleanout ____
Sewer /septic service line
Holding tank
Animal containment areas
Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ONLOT TO:
.
�
Building foundation >51�
n Property line >51
/ 10
Water main �,'" Water service line >10'
Wells unadjacent lots >100'
ABSORPTION FIELD ONLOT TO:
' 1M
Property line ��'" Building foundation �^1O'_'`..,____
v
VVaterServioe|ine>10'_`_,^'Su�ocevvatar �'�°1OO
hJOD6�0Ot�� >100'Curtain drain None Noted ` " Wells on adjacent |m�o_`_.~,`,
G. ENGINEER'S CERTIFICATION
/ certify that /have determined through field inspections and
review of Municipal moods that the above smh*mo are in
conformance with MOA C{>S4guidelines /neffect onthis date.
Engineer's Printed Name
Date
Absorption field >51
Surface water >10O'
Water main >10+
DhvaweKpeddng/vehicle storage >1O'
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