HomeMy WebLinkAboutRIVERVIEW ESTATES BLK 9 LT 3AR 0 0
iverview
Estates
Block 9
Lot 3A
#050 � 801 � 19
•
Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 2
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP161022 PIO Number: 050-801-19
Dwelling: [' Single Family (SF) ❑ Duplex (D) [' Multiple(SF and/or D) Project: ❑■ New ❑ Upgrade
Name:
SHANE WHITE ABSORPTION FIELD
Address ❑ DeepTrench
El Shallow Trench ❑ Bed ❑ Mound
❑ Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
4 1.2 GPD/SF 9.0 Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot 3.0 Ft._6.0 Ft.
RIVERVIEW ESTATES BLK 9, LOT 3A Fill added above original grade Gravel length
Township Range Section 1.0 Ft. 42' Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES 2.0 Ft Ft.
To: Septic Absorption Holding Sewer Total absorption area Number of trenches Dist.between trenches
Tank Field Lift Station Tank Line z
From 504 Ft 1.0 Ft
Well 100'+ 100'+ 50'+ TANK ❑Q Septic 0 S.T EP. 0 Holding 0 Other
Manufacturer Capacity
Surface water 100'+ 100'+ AN C H TANK 1250 Gal
Material Number of compartments
Lot Line 10'+ 10'+ STEEL 2.0
l NA
Foundation 10'+ 10'+ LIFT STATION
Manufacturer Capacity
Curtain Drain 1IUN UN Gal.
Pump on level at Pump off level at High water alarm at
Remarks
in. in. in
Pump make and model Electrical Inspections performed by
Installer PIPE MATERIAL House to tank 3034 drainfieldTankto 3034
NORTHERN EXCAVATION Drainfield 3034 CO/MT 3034
Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 109.6 ft
Inspection t'' 10/13/16 2 d 10/13/16 Location and description
da3"' 4th GARAGE SLAB
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Eng
� -g'._eir �tp
Conditional Approval: Date �?••'' ••'r• ri1
iir, 4,
-- :•4 TH '
*' :* ?,
• MICHAEL N. ANDL QN:Zt-s
. e,vi• CE-9469
`'
s. .
Approved CA.-„ _ ` Date.-C;2-s--(7 +tl,P•�l'FE :-
SSI3��n\.:V• s''
Inspection Report_9.1.12.doc
•
Permit No. OSP161022 Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH 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 Description: RIVERVIEW ESTATES BLK 9, LOT 3A PID No.: 050-801-19
MARK A I B
i
TC01 50 32 I
MT1 5347
C04 58 1 83
10' DRAINAGE EASEMENT
_ IS' , ,
mo \-
1, OLD EPTIC L`� 50' SLOPE SETK
1 / YV �\ f \ N
-....,
__ __
, ,
I • CO3 C62
\ f lO4 - -- dam TCO1
�T2~ M /TGO2- — -- __ —
BENCH, GARAGE' SLAB j 1-- O N / fH#2 `
i B \ \ SECONDARY
<A
NN.,
11 ,I 1 \,,, \
„, ,,,..
0
/ I
1 / I \
1 / t \.
/ / /
/ ,
/ / I // ASBUILT
I i _ SCRLE: 1"=50'
FCO TC01 CO1 CO2 CO3 MT MT rC04
y!!-- lj 100 *,",%,,,
1 c TCO2 , eh
1.1 � 1 „ O.6 FINAL coRAE /Q1 .�(4 J. .
/INSULATION =SW ICKST/ .0. �� .. • ...............-4,p'•
ORC / 7
7-MIER FABRIC 1.0 a
a '49 TH �, >/
1,250 CALLON CM/SM
96 2 STEEL TANK (� , .9. % •
•
91 \
92.2..-/ \9?.2 '•MICHAEL N. ANDERSON: i
92 01� No. CE 99469 •
• Bff
SEPTIC SECTION 62 ••\ ..3�T 47
t.Ry .''in
Xiff ://76-7,4=.
• Development Services Department
•
•JrBuilding Safety Division ,ti
��.
. �n-Site Water dr Wastewater Program `,
4700 Elmore Road -14�,
Mark Be ieh P.O.Box 196650 Anchorage,AK 99507 r.l.1 Sl
SA ITV
Mayor www.mumorg/onsite
(907)343-7904
os/a/b/ z 2_ /well Log
Permit Number:#SW Date of Issue:2 /� Parcel Identification Number:G" � °//7
Date Started:49.4e/k, Date Completed:i��T1 (e Is well located at roved
Legal Description: _ PP permit location? Yes ❑ No
rr��i�'l//��r.�'` ms's tstr�.. tar ,3rf rz'G/c y
Property Owner Name&Address: 7>pGy ��4,,75 ff!%1-7e.�S—
/G' >"j; 4'"////x—GG='45E' /i9/'`/G"
Borehole Data: Depth(ft) Method of Drilling
Soil Type,Thickness&Water Strata From To ( air rotary ❑cable tool
Casing type: a1 R5313
S1/ ,iia 0 3 Wall Thickness: .,,ZcQnches
Co ,s,1 1.--$4,4_ c 3 .?� Diameter: inches Depth: /j8' feet
Liner Type:40.0rvs—
Asee440.� Gor.e...eC , _.2.4 )r Diameter: inches Depth: feet
4"iritX.. 7( "el- Casing stickup above ground: .T feet
`+ +4 L.nrr iive owe � ,)� //.e Static water level(from ground level):/no feet
JW s� t Pum in level:Lt«
0444 .may 4041%,ti L. //.2 //c— P t; 'feet after
/� / hours pumping fZ,gpm
ceior Q•f4✓eC //1`^ /4. Recovery Rate: gpm
//k Method of Testing: /3•01-
/ft, /, Well Intake Opening Type:
0 Open End E Open Hole
0 Screened Start feet Stopped feet
❑Perforations Start feet Stopped feet
Grout Type:44as7'L Volume:(qsaj
All Depth: Start feet Stopped feet
Pump:Intake Depth feet
Pump size hp Brand Name
Well Disinfected Upon Com letion? Yea No
Method of Disinfection: G '� /ye
Comments: 7-41:47--e--715"
Well Driller: �V li a?2x a": 4" f
Water S ple Results: /'`rf
. ,..f57 it,,Cy /re-/ 7
Arsenic: N 9ug/L 1/�4 re `'� iz..
Nitrates: -07 mg/L 5�
Total Coliform Bacteria: INQpolonies/100mL
Other Bacteria: col/100mL /2 Z
—
Attention: The well driller shall provide a well log to DSD within 30 days of completion.
Pump1ft :atton Lag
Well Drilling Permit Number:SW 6/5; // 2-47 Date of Issue:
Parcel Identification Number: "T-1W-j7
Legal Description Property Owner Name£Address:
A9/1-
f/dY
Th
Pump Installation Date:
Pump Intake Depth Below Top of Wel Casing: //chat
Pump Manufacturer's Name:
Pomp Mode': 314' 73
Pump Size hp
Mess Adapter Burial Depth: feet
Mess Adapter Manufacturer's Name:
Mien Adapter Installer:
Well Disinfected Upon CompletIon?Pbes 0 No,
Method of DIstafeetIon:
Comments:
Pump Installer Nantes 61/Y4.. ,9/l /.„,/
S
,_9413 •
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
On -Site Water & Wastewater 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: OSP161022
Tax Code Number: 05080119000
Work Type: WellSeptic Initial
Permit Effective Dates: March 08, 2016 to March 08, 2017
Design Engineer: ANDERSON CONSTRUCTION & ENGIN
Subdivision: RIVERVIEW ESTATES
Site Legal Address:
OwnerlAddress:
Site Mailing Address:
RIVERVIEW ESTATES BLK 9 LT 3A G:0358
WHITE SHANE R & HOLLY
21365 BARBARA FALLS DR EAGLE RIVER AK 995770000
This permit is for the construction of:
Y Disposal Field Y SepticTank
Lot Size in Sq Ft:
Total Bedrooms:
N Holding Tank N Privy y Private Well N Water Storage
43182
4
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.
Receivec
Issued B,
111UNICIPALITY OF ANCHORAGE
im
Community Development Department Phone: 907-343-7904
Development Services Division Fa
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 0 =�-O — !&ej �j�
Property owner(s) 4t. r� C Day phone
Mailing address
Site address
Legal description (Sub'd., Block & Lot) �2t V Ir 11 V 6(
Legal description (Township, Range & Section)
Lot Size 11 271'�� 2--- Sq. Ft. Number of Bedrooms
APPLICATION IS FOR:
(E all that apply)
Absorption Field
(w/wo ADU)
Septic Tank
Upgrade F-1
Holding Tank
F-1
Privy
Multiple Dwellings
Private Well
Water Storage
F-1
APPLICATION IS AN: TYPE OF DWELLING:
Initial 1Z
Single Family (SF)
(w/wo ADU)
Upgrade F-1
Duplex (D)
Renewal F-1
Multiple Dwellings
F-1
(SF and/or D)
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
re ot property owner or autrionzecl agent)
Permit/Rush Fees: A;' b 4 �- 11 X�_
Date of Payment: Z-A<//('-
ReceiptNumber: 4" -0- 6 A N-41
Permit No. e I'G I u12 -
PermitApp__'-: :.,c;
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
Michael N. Anderson, P.E.
Civil/Structural Engineering & Construction
4661 Natrona Ave
Anchorage, Alaska 99516
Phone 727-8864
Fax 345-1391
Feb.10,2016
Municipality of Anchorage
Department of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Re: Riverview Estates Blk 9 Lot 3A
To Whom it may concern:
Ibis is a request for anew septic and well permit on the above referenced lot. Two test holes were
excavated and found silty/sandy gravels with no water. The pere rate was 3 minutes with no
water observed during the excavation or after the 7 day monitoring period. A deep trench system
has been designed with an application rate of 1.2 gallon/sFday.
The slope is semi -flat at the site but has a 35 percent slope running from the east to west over 50
feet from the test hole, see site plan. This new system will not impact the surrounding properties
or limit their future development.
If you have any question please call me at 345-3377
Sincerely AVA-t
Michael N. Anderson, P.E.
DESIGN CRITERIA -
4 BDRIVI X 150 = 600 GPD
SOILS = 600/1.2 = 500 GPD
500 GA/1 2 = 42'
(1)
TRENCH
9.0'
DEEP
6.0'
EFFECTIVE
2.0'
WIDE
42'
LONG
EXISTING
OUIFHOUSE---��T�\ I
r
4/0
x
kSE
1.0
18
(TH#1) (TH#2)
MOUND OVER
RADE
FILTER FABRIC
"0 PIPE
�—SEWER ROCK
SHOULDER OF
35% SLOPE
PROPOSED
DRAINAGE FIELD
SED W
Y00
�SE
WELL
Septic Design Prepared for
SHANE WHITE
RIVERVIEW ESTATES, BLOCK 9, LOT 3A
Eagle River, Alaska
Michael N. Anderson, P.E. DATE:
4601 NATRONA AVE DRAWN:
ANCHORAGE, ALASKA 99516
(907) 727-8864 / FAX: (907) 345-1391 SCALE:
2/5/2016
DJR
1"=100'
ORG 1.0
GM/SM
ORG I
GM/SM —3.0
—9.01
MOUND OVER
RADE
FILTER FABRIC
"0 PIPE
�—SEWER ROCK
SHOULDER OF
35% SLOPE
PROPOSED
DRAINAGE FIELD
SED W
Y00
�SE
WELL
Septic Design Prepared for
SHANE WHITE
RIVERVIEW ESTATES, BLOCK 9, LOT 3A
Eagle River, Alaska
Michael N. Anderson, P.E. DATE:
4601 NATRONA AVE DRAWN:
ANCHORAGE, ALASKA 99516
(907) 727-8864 / FAX: (907) 345-1391 SCALE:
2/5/2016
DJR
1"=100'
APPROX. LOCATION OF
OUrHOUSE
J�k .
PROPOSED
'DRAINAGE FIELD
61 . N
1�
e PROPOSED
-5 5- %0
SLOPE OVER aN
421t I�NEW 1,250 GALLON
/ SEPTIC TANK
Septic Design Prepared for
SHANE WHITE
PROPOSED 4
BEDROOM
RIVERVIEW ESTATES, BLOCK 9, LOT 3A
Eagle River, Alaska
Michael N. Anderson., P.E. DATE:
4601 NATRONA AVE DRAWN:
ANCHORAGE, ALASKA 99516
(907) 727-8864 / FAX: (907) 345-1391 SCALE:
\ITH#2
2/5/2016
DJR
1 11=50'
ROPERTY LINE
49 4.
No.
102
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507
www.ci.anchQraqe.ak.0
(907) 343-7904
Soils Log - Percolation Test
*'*49TH
..... .............
...........
F,10- MICHAEL N. NDERS N 'Q1
CE -
Performed For: 4 In 0 W\ 'r- W L' L C_" i Date Performed:
Legal Description: t V't V %A v IIA) P_ 4 � (Z, tv �_ T�cv�Zhqlip, Range, Section:
c2iD slope
o \)- I I
4-
'7
t
5-
6-
7 -
#0 Vol
COMMENTS
0
Reading
Date
WAS GROUND WATER
9-
Depth to Water
ENCOUNTERED9 /�j
10-
IFYES,ATWHAT DEPTH?
11-
Depth to Water After
Monitoring? -ELit—,
12-
Date: A7
13-
#0 Vol
COMMENTS
0
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
PERCOLATION RATE e.�� (minuteslinch) PERC HOLE DIAMETER t"o
TEST R4N BETWEEN FT AND FT
tv" 4 -Vo 4, l,' � 4 1-7
PERFORMED BY: 1,AlqA I CERTIFY THAT TH IS TE7F�VtS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: I;,-
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507
www.gI.aaghoraoe.ak.0
(907) 343-7904
Soils Log - Percolation Test
Performed For: . 4 In # In -- yj � I L C_.� t Date Park
Legal Description: fi k %"t V V1 ? W F__ 4 l' (21 0/ to I 'Ilp, Rang Section:
44- 2-- � �
Ok)-cl ?
(; IVIAIM ''
t4 I r r�'
1'�4 & LT v
1
I
WAS GROUND WATER
ENCOUNTERED? /-to
a
IF YES, AT WHAT DEPTH? L
Depth to Water After 0
Monitoring? 0frw 'E
Date: 46!h 115—
EM
b
Reading
Date
. . . . . .
. . . . . .
Depth to Water
Net Drop
. . . . . . . . . . . . .
P,%-. MICHAEL N. ANDERSON
.*n�
CE -9469
4__
b
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
PERCOLATION RATE jr,� (minutesanch) PERC HOLE DIAMETER 61
TEST RUN BETWEEN FT AND __tf_FT
A I
PERFORMED BY: t'414"t' - I CERTIFY THAT THIS TEST W
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
AND THAT NO FNCROACHhiENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE TK EXISTENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI—
vISTON PLAT. UNDER NO CIRCUMSTANCES SHOUILD
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND
ARY LINES.
CIS.
/,OF
SCALEt
-WIWI%
`�W At
DATEt
40T
..... ......
FBr jr
40 IS - S 8
I Ir
DRAWNs
COSA# a5CQ6106;*-g 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: `Z lllk46
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
in accordance with the guidelines and regulations established by the Municipality of Anchorage and
industry practices. The reported results describe the condition of the system/s on the date/s of the
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or
encroachments may exist that were not identified during the evaluation. The operational life of all wells
and septic systems depend upon a variety of variables, including but not limited to, soil conditions,
groundwater levels (that may fluctuate during the year), quality of construction (materials and
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of
the well or septic system. GEG makes no representation whether an alternative well or septic system
can be installed on the property in the event either of the current systems fail to perform adequately in
the future. The content of this report is for the sole benefit of the person/party that retained GEG to
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
6. DSD SIGNATURE
System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the following
o O F
WE
...... .. ...
re Gar ss:
1��'Profession� o
#AECC884
`TY tOFf'(f rfff,,
ON-SITE
�pulatioftTER AND
WASTEV ATER
S�'
y: 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
Septic System Advisory
Well Flow Advisory
q -
Nitrate Advisory 3�=
Arsenic Advisory
Other
'L: ,•'U
01
Legal Description: RIVERVIEW ESTATES; BLOCK 9, LOT 3A Parcel ID: 050-801-19
If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 218/16
Total depth 196 ft
Cased to 118 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 1/29/20
Static water level at beginning of test 83.8 ft.
Comments
B. TANK DATA
Age of tank(s) 3 years
Tank type/material SEPTI=TEE
Measured operating fluid level in septic tank
48"
❑ Standpipes/foundation cleanout per record drawing
Date of pumping o� rJ� �y
D. ABSORPTION FIELD DATA *AT MONITORING TUBE
Which system tested (date installed) 10/13/16
,ALL standpipes present per record drawing
Total measured depth from grade *10.8 ft (max)
Measured depth to pipe invert from grade 4.4+ ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
Al Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced N/A gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Well production at time of test 6.2+ gpm
Water storage tank volume N/A gallons
Well disinfected for coliform test? ❑ Yes ❑ N
'Coliform bacteria is Negative
Nitrate D• 95Smg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date of Sample 1129/20
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments: N/A
Adequacy test date 1129120
Results QPass For 4 bedrooms
Fluid depth prior to test 21 in
Water added 817 gal
New depth 44 in
Elapsed time, 120 min
Final fluid depth 34 in
Absorption rate 600+ gpd
Any rejuvenation treatment (past 12 months) NONE
If yes, enter date N/A
Is
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'
Q✓
Yes
Community Sewer Manhole/Cleanout > 100'
❑✓ Yes
if No
ft✓/
Yes
if No ft
Neighboring Tank > 100' ❑✓ Yes
if No
ft
Private Sewer/Septic Line > 25' ✓0 Yes
if No ft
Absorption Field on Lot > 100' 0✓ Yes
if No
ft
Holding Tank > 100' ❑✓ Yes
if No ft
Neighboring Absorption Fields > 100'
❑✓ Yes if No ft
Water Main > 10'
Animal Containment > 50' Yes
if No ft
✓❑ Yes
if No
ft
Yes if No ft
Water Service Line > 10'
✓l
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway
Community Sewer Main > 75' ✓❑ Yes
if No
ft
E] Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
Q✓
Yes
if No
ft
Surface Water > 100'
Yes if No ft
Property Line > 5'
✓]
Yes
if No
ft
Wells on Adjacent Lots:
0
Absorption Field > 5'
❑✓
Yes
if No
ft
Private Wells > 100'
❑✓ Yes if No ft
Water Main > 10'
✓]
Yes
if No
ft
Community Wells > 200'✓❑
Yes if No ft
Water Service Line > 10'
✓l
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'
0
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
0
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
0
Yes
if No
ft
Private Wells > 100' Yes if No ft
Water Service Line > 10'
0
Yes
if No
ft
Community Wells > 200' 0✓ Yes if No ft
Surface Water > 100'✓❑
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that 1 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.
COSA Checklist yellow sheet
.:.. .. . ..................
. .... ...........
�O e y '�Garriess.
CE -793 p
p� Oda �..:z•\'��
0fessl0r o
#AECC884
•
• N GE �ti
Municipality of Anchorage
On-Site Water and Wastewater Program
(907) 343-7904
S A f [T Y Y
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 050-801-19 Expiration Date: g- -I 7
1. GENERAL INFORMATION
Complete legal description RIVERVIEW ESTATES S/D BLOCK 9, LOT 3A
Location (site address) FALL WATER CIR, ANCHORAGE,AK 99516
Current Property owner(s) SHANE WHITE Day phone
Mailing address
Real Estate Agent Day phone
G € 789
2. TYPE OF DWELLING: o>>�
® Single Family (w/wo ADU)
❑ Duplex 4//4Y
❑ 4 Multiple Dwellings (Single Family and/or Duplex) x0/7
3. NUMBER OF BEDROOMS: 4 O ' 8 L 9 `'
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 ❑
Waiver/Variance request for: Distance:
Received by: `61/4 Date: 512 q(q.
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ (pi t '1 1g�— Hid (S Waiver Fee $
Date of Payment vI - /I1 k 10211 Date of Payment
Receipt Number 212211 Receipt Number
COSA# OS t I IA "1G1 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 05/23/17
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6. DS SIGNATURE r;, rr,;c'{.Ft r;. <.ar;;;: ,, : '
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System #1 Approved for bedrooms. E�}�r;';,,5� 2/ ::
System #2 Approved for bedrooms.• �.
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Conditional approval for bedrooms, with the following,stipulations:
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BY `'-.. --""`w \ Original Certificate Date: s Z 3—. .
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 10-10-12.tloc
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: RIVERVIEW ESTATES S/1) BLOCK 9, LOT 3A Parcel ID: 050-8111-19
A. WELL DATA
Well type Private If A. B, or C provide PWSID# Well Log (YIN) Y
Date completed 10/1412016 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
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Total depth 196 ft. Cased to SSS ft. Casing height (above ground) 24"+
FROM WELL LOG AT INSPECTION
Date of test 10114/2016
Static water level 100 ft ft.
Well production 12 g p.m g.p.m
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 0 mg/L
Arsenic. ND ug/L Date of sample 412712017 Collected by Wheaton Water Wells
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC 1 STEEL Date installed 10-6-16
Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) Y
Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping NEW Pumper NEW
C. ABSORPTION FIELD DATA— 1985 SYSTEM TESTED
Date installed 10-6-16 Soil rating g.p.d./ft2 .r ft`/bdrm) 1.2 System type DEEP TRENCH
Length 42 ft. Width 2 ft. Gravel below pipe 6.0 ft.
Total depth 11 ft. Eff. absorption area 504+ ft2 Monitoring tube Y Depression over field N
Date of adequacy test NEW Results (Pass/Fail) NEW For 4 bedrooms
Fluid depth in absorption field before test NEW in. Water added NEW gal New depth NEW in
Elapsed Time: _ NEW min. Final fluid depth NEW in. Absorption rate >= NEW g p.d
Any rejuvenation treatment (past 12 mo.) (Y/N & type) UNKNOWN If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y!N)
"Pump on" level at in. "Pump off' level at in.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 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main 75'+ Public sewer manhole/cleanout 100'+
Sewer/septic service line 50'+ Holding tank NA
Animal containment areas 100'+ Manure/animal excrete storage areas 100'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 10'+ Property line 10'+ Absorption field 5'+
Water main 100'+ 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 50'+(None Known) Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION �
'� Q I certify that l have determined through field inspections and 0„0-04,y•-:.•* '...`4-a,,
review of Municipal records that the above systems are in h.• •.� it
conformance with MOA COSA guidelines in effect on this date. *:•49 T H r�, -r; !,
Engineer's Printed Name MIKE N. ANDERSON, PE /.
MICHAEL N. A\D L ON :. .
Date 0512312017 ¢+�,f,.
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PLOT PLAN — AS BUILT K SCALE 1- a 50. GRID SW 0358 Project No. 16-289/85
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, inc. (907) 522-6476 Phone o
(907) 522-4625 Fax a4
Professional Land Surveyors kenOlangsurvey.com �� .. t.,q�Q
JonothanOlangsurvey.com OP .6\11t1
I hereby certify that I have surveyed the following described properly: �:' H -..'f-Op
LOT 3A, BLOCK 9, RIVERVIEW ESTATES SUBDIVISION (PLAT 93-164) $* : 491
Anchorage Recording District, Alasko, and that the Improvements situated thereon are Q
within the property lines and do not encroach onto the property adjacent thereto, that -
no Improvements on the property lying adjacent thereto encroach on the surveyed I��
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premises and that there are no roadways, transmission lines or other visible KEN G
easements on sold properly except as Indicated hereon. Oj). �.{15 �
Dated this the - - Day of OkYi-1L- , , , at Anchorage, Alaska '�j r -520 .- �
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It Is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963