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HomeMy WebLinkAboutCOLONIAL PARK BLK 3 LT 7 N2Colonial Park Block 3 Lot 7N2 #050 - 301 - 24 Municipality of Anchorage On-Site Water and Wastewater Section - (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP251280 PID Number: 050-301-24 Dwelling: E Single Family (SF) r_1 with ADU n Duplex (D) n Two Single Family Project: El New 0 Upgrade Name JENNIFER E HOELDT ABSORPTION FIELD - EXISTING n Deep Trench 171 Wide Trench [:] Bed FI Mound Site Address 19732 SECOND STREET, EAGLE RIVER El Other Phone Bedrooms Soil Rating depth from original grade 3 GPD/SF ITotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot COLONIAL PARK 3 7 N2 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches Lift Station Tank Tank Line From Field F t2 Ft. + Well 100'25'- TANK 0 Septic [:1 S.T.E.P, El Holding El Other Manufacturer GREER Capacity 1500 Gal. Sur-face Water 100,+11 Material HDPE Number of compartments 2 Lot LineNA Foundation 10'+ LIFT STATION Manufacturer Capacity Gal. Remarks Deep-burial septic tank. Alarm location Electrical installed by Tank to PIPE MATERIAL Housetotank 39,34-.... installer MARTIN CONSTRUCTION COMPANY drainfieId_3,03­4_,­­_­ Drainfield CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspection Is' 5/12/20nd 5/13/20 Location and description dates: 2 3rd 4" TOP OF MH ON-SITE WATER AND WASTEWATER SECTION APPROVAL OF AGA, Conditional Approval: Date . TH . ... ........ . . -49 .... .... . ......... Septic System Approved Dat VF* Curtis Huffman CE 12 , " i�, !8991 'ASW 4�Z Zthis does include .10/ 15/25. aw 4W PROFEW6 `... approval not well permit require ents. ► (Rev 05/07) PID:050-301-24 PERMIT:OSP251280 FIRST WATER CONSULTING COLONIAL PARK BLOCK 3, LOT 7 N2 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP251280 Work Type: SepticTank Upgrade Tax Code Number: 05030124000 Site Legal Address: COLONIAL PARK BLK 3 LT 7 N2 G:0055 Site Mailing Address: 19732 SECOND ST, Eagle River Owner: HOELDT JENNIFER E Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: ❑ Disposal Field R1 Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 8/8/2025 8/8/2026 17820 ❑ Private Well ❑ Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued to FWCS Date: 8/8/2025 Issued By:1 ( '�g _'— Date: 8/8/2025 3 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-301-24 Property owner(s) JENNIFER E HOELDT Mailing address PO BOX 301 ANIAK, AK 99557 Day phone Site address 19732 SECOND STREET, EAGLE RIVER, AK 99577 Legal description COLONIAL PARK BLOCK 3, LOT 7 N2 Number of Bedrooms 3 Engineering Firm FIRST WATER CONSULTING Building Permit Number Not Applicable RE APPLICATION IS FOR: APPLICATION IS AN: (M all that apply) Disposal Field El Initial ❑ Septic Tank El Upgrade Holding Tank 0 Renewal D Privy R Well D Water Storage M THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Permit/Rush Fees: �22�i Date of Payment: �_/Mf Permit No. 072.512V May 2025 Waiver Fees: Date of Payment: Waiver No. Distance: 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / FirstWaterAK@gmail.com ! !! July 25, 2025 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: COLONIAL PARK BLOCK 3, LOT 7 N2 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1000-gallon deep-burial HDPE tank per the attached design to serve the existing 3 -bedroom residence. A 1500-gallon septic tank may be considered for current functionality and future consideration or flexibility. Groundwater was not noted in the MOA on-site file and is not anticipated to affect the septic tank installation. If groundwater is encountered during installation that may affect this septic tank upgrade, an epoxy coated steel septic tank or other action may be required. The lot and area are served by private & public water and any encroaching wells, easements, … must be staked prior to construction. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251280, Ben Cogger, 08/08/25 FIRST WATER CONSULTING COLONIAL PARK BLOCK 3, LOT 7 N2 DESIGN DETAILS: NO WELLS WITHIN 100' OF PROPOSED SEPTIC TANK Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251280, Ben Cogger, 08/08/25 Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page / of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: SYS7-E/0 0C 0M6A)Pf7OID Number: 050 - 341-2ci Dwelling: 0 Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New WUpgrade Name: ABSORPTION FIELD DOCUA4Ji5A1T�F,1OA1 El Deep Trench El Shallow Trench El Bed [I Mound Address 9 %3Z 2 Na 5 TWEET Other PhoneNumber 6'G3- 190- 556 of Bedrooms 3 Soil Rating SFIa p /$O I Total depth from original grade laFt. �versF LEGAL DESCRIPTION Depth to pipe invert from original grade Ft IGravel depth beneath pipe 6 Ft. Subdivision Block Lott? / !1 G GL Q/J/e Z- i� �z Fill added above original grade --" FL Gravel length — Ft. /* � ,4-g `3 / Township Range Section Gravel width 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 Ftr Ft. Well /00 f NA / /V A r a� TANK Septic ❑ S.T.E.P. El Holding El Other Manufactkkpw,' _ _ Capacity �G � � - ©G 6 Surface Water �d,.f /OQ ;�. �q r /�, l_J Gal. Material Number of compartments /� Lot Line /Q /0i� Af-f— /*A 1�l NA Foundation /0 / /Q C f ,V.4 x1¢ LIFT STATION Manufacturer Capacity Curtain Drain �v// �N� �,4 4/4 Gal. Remarks Sy STF_iY1 � � G �M�i4770 Pump on level at in. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by .__.._ PIPE MATERIAL Housetotank �T�ankto /� t �1C 1��/` d (�)adA—ow4 Drainfield CO/MT Inspector BENCH MARK (Assumed elevation) IeL k Inspection a dates: � 2"" Location and description o'P /e-- Q K 3m 4m COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Epglhe si p <, Conditional Approval: Date vj �geaa� ece x �q �s� uP 9f�� Approved /it/ Date Y Z6 /,6 4 3z W4 inspection Kepon_u.1_U.aoc i I 6'2 N 1/2 Lot 8 L4 N O O — — ----arc A I o \ 2nd STREET ma. 0 S 89'56'00"E 132.00' N N 1/2 Lot 7 ------ 17,820 s.f. WELL f /-1.9'08.2' CANT r'N RFsip sr� OAYL�CFNC z4.o. HT 1 �FCk 10.1'x12.1' SHE WOODEN FENCE )RCH u / /-1.9'x23.7' CANT O / 50.4' q o N 1/2 Lot 6 h , m L4 0 / 10' UTILITY EASEMENTS S 1/2 Lot 8 I S 1/2 Lot 7 S 1/2 Lot S PLOT PLAN AS BUILT X SCALE 1" = 40' GRID NW 55 Project No. 16-094/A7 Lang & Associates, Inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 (907) 522-6476 Phone oQ�o4pp� Registered Land Surveyors (907) 522-4625 Fax _olQl OF.A (p04 kenOlangsurvey.com / jonothanOlangsurvey.com per``• " " • QS�o I hereby certify that I have surveyed the following described property: NORTH 1/2 OF LOT 7, BLOCK 3, COLONIAL PARK SUBDIVISION (PLAT P-688) 49TH �* Anchorage Recording District, Alaska, and that the Improvements situated thereon are Q....:...... ........... within the property lines and do not encroach onto the property adjacent thereto, that Q no Improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible z KE ET G r easements on sold property except as Indicated hereon. �ooc 1 ° Dated this the Da of hr',..i -t QP ' •.A L520 JOS y at Anchorage, Alaska p4�Q 1.,',,,,• deo It Is the responsibility of the owner to determine the existence of any easements, �4pR0�ssi°Nnua4 covenants, or restrictions which do not appear on the recorded subdivision plat. DDOp�o� ..... ( j =,3 § rn Z . ) too \ m - / `© s \ / $ § 0� . w 3 » ± 2 D }CD � ( j %\ § & m {2 m - , & s ro $ } )\ \ FID )\ f AD = 2Q- ° $ } ® $ ) i �i L i }CD � ( j %\ § & /{ } ® 2 & s ro ro ro m M } \w } OD / } n &a mg / ? ? R Apr 011603:32p Richard Woodsy, 603-3626003 P Q 94X 190M . 2921 WTERWOHAL AMM ROAD • ANCHORAGE. ALAwA 996i94Ne TELEPHONE 243-2466 I Customer's j Order No, Date Name Address __ �:_ •�a L_; #F '_.. .-, � awc er i.sH cnn riunae ! ou.cGr. �pxe xt'ra oam'our �— . ALL Claims and renamed goods MUST be aocompanled by this bill PAST DUE ACCOUNTS SUBJECT TO 1" WNWHIR CHAMN PER MONTH. A-13090 asedtr PA Department of Environ mental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER ~'~l~,J~. q'C~c'G-b,-. MATERIAl ~-~'~",1 INSIDE WIDTH LIQUID DEPTH NUMBER Of COMPARTMENTS LIQUID CAPACITY /~ GALLONS. SEEPAGE PIT: NUMBER OF PITS LINING MATERIAL BUILDING FOUNDATION 3Or, DIAMETER ~'~,1 OR WIDTH LENGTH DEPTN CRIB 51ZE~ DIAMETER''~z DEPTH DISTANCE FROM: WELL NEAREST LOT LINE ~-I I TOTAL EFFECTIVE ABSORPTION AReA (WALL AREA) /~/~ ADDITIONAL ABSORPTION WEU: TYPE BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION NEAREST LOT LINE OTHER SOURCES DISAPPROVED _ DEPTH DISTANCE FROM: NEAREST SEPTIC SEEPAGE SEWER LINE TANK_ SYSTEM_ REMARKS DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: EO-031 GReaTEr ANChORAge AREa BOROUgh DEPARTMENT OF ENVIRONMENTAL QUALITY 3530 'C" STREET ANCHORAGE, ALASKA 99503 PERMIT NO SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION LOCATION \ TYPE AND SIZE OF FACILITY tO BE SERVED~~ . ~ . OTHER NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY sYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK ~ SEEPAGE PIT ~t~/) / , DRAIN FIELD SEEPAGE PIT ALSO CON~DER AREA WELLS. SEEPAGE PIT ! /~ . DRAIN FIELD GRAVEL BACKFILl. CONFORM TO E~OROUGH REGULATIONS REGARDING INSTALLATION. AREA SIZE TYPE DIAGRAM OF SYSTEM CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH O~DINANCE NO. 2E.68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAIl:} CODE. GREATER ANCHORAGE AREA BOROI]b"~I Department of Environmental Quality 3330 "C" Street Anchorage, Alaska 99503 ~ ~ SOILS I,OG -- PEROI,ATION TEST Performed for ~:_}"C~ ~C)~_~ /-)DateiPerformed Legal This form reports: Soils log '~ Percolation Lest Depth Feet 3- 4- 5- 6- 10- 11 - 12- Was ground water encountered? If yes, at what depth? Reading Da te '~ercolation rate -Proposed installa~i-~n~ Depth of Inlet COMMENTS: Gross Time Net Time Depth to Water Net Drop minute. Seepage Pit Drain Field Depth to bottom of pit or trencil F6'FFo ¥d' Certified By: __ Eq-040 6/74) Date: MUNICIPALITY OF ANCHORAGE Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Certificate of On -Site Systems Approval OSC251474 Parcel ID 050 -301-24 Expiration Date: 7/14/2025 Legal description COLONIAL PARK BLK 3 LT 7 N2 site address 19732 SECOND ST Current property owner(s) HOELDT JENNIFER E X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or conditions: bedrooms, with the following stipulations: Original Certificate Date: 10/17/2025 This C ificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject sys m(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, velopment Service Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other U C 2. 0 3. T' 't. I I F I. WI VV^%J I L-VVr% 9 1— IN VI %JU %.#%WP%J6.. t=J I I IV QLG %.JWfJU %I " I I IV CIL711 v�'FLJ%o 'r. IV I I lu � r Vv� I III IU MI IIty F� Holding Tank M Community Septic or Public Sewer 6. SEPTIC TANK: M Steel F Plastic M Concrete M Fiberglass AgeNEW _See advisory if steel or fiberglass older than 20 years 6. ABSORPTION FIELD: ❑AWWTS ❑Bed MDeep Trench MWide Trench FOSeepage Pit Waiver request for: Distance: Expedited review requested: M By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ T Waiver Fee $ Date of Payment i t1 -7 Date of Payment COSA'# 05c?s Waiver # COSA ApplicatiorLApr2025,doe COSA Checklist_May2025 copy 2.docx COSA Checklist Legal Description: COLONIAL PARK B3, L7 N2 Parcel ID: 050-301-24 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled *UNK Total depth *UNK ft Cased to *UNK ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 07/14/2025 Static water level at beginning of test 285 ft. Well production at time of test 3.5 gpm Water storage tank volume NONE gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 2.70 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 7/14/2025 Comments *Per MOA docs date drilled is circa 1974 with total depth & casing to 327’. B. TANK DATA Measured operating fluid level in septic tank NA Date of pumping NEW TANK Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. DISPOSAL FIELD DATA Which system tested (date installed) 10/06/1974 ALL standpipes present per record drawing Total measured depth from grade 9.7 ft (max) Measured depth to pipe invert from grade *5.4 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective 4.3’ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 7/17/2025 Results Pass Fluid depth prior to test 37 in Water added 600 gal New fluid depth 46 in Elapsed time 1440 min Final fluid depth 37 in Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 72 in (MOA 6’ ED) Effective depth used 57 in (Missing ED + Final Fluid Depth) Effective depth remaining 15 in Comments/Deficiencies: Total measured depths from existing grade. *Approximate invert at crib. ED per elevation measured shots & appears approximately w/ 1.7’ or 20” of ED unmeasurable / missing. COSA Checklist_May2025 copy 2.docx E. SEPARATION DISTANCES From Well on Lot to: (Please enter distances if less than required) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Disposal Field on Lot > 100’ Yes if No ft Neighboring Disposal Fields > 100’ Yes if No ft Sewer Line/Main > 100’ Yes if No ft Sewer Manhole/Cleanout > 100’ Yes if No ft Sewer Service/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Disposal Field(s) on Lot to: (Please enter distances if less than required) Tank to Foundation > 10’ Yes if No ft Field to Foundation > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main/Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 10/15/2025 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 these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 10/15/25 3.8' x 8.1' I I I I / I / 2nd STREET N 1/2 Lot 17,820 s.f. 7 WELL 1.9'x18.2' CANT L/ PORCH 1-1.9'x23.7' CANT 1 Sd7 50.4' . N Resp TORi, N 1/2 Lot 8�q o� CHT s W/ c N 1/2 Lot 6 21.5' pe Mr ti M SEPTIC MANHOLE q8,a N z \ o 0 o \ 00 PIPESC Zn \ / 10.1'x12.1' SHED 10' UTILITY EASEMENTS i V— — — — — j N �9•ss ao' W 13z.00' WOODEN FENCE r S 1/2 Lot 8 S 1/2 Lot 7 S 1/2 Lot 6 I I I I I I NOTES: GROUND LEVEL IMPROVEMENTS SHOWN ARE APPROXIMATE. DATE OF SURVEY: 14 OCTOBER 2025 PLOT PLAN AS BUILT X SCALE 1" = 40' GRID NW 55 — Project No. J25-139/Al 0005 Lang &Associates, enc. 'A' 21-0005 age, Allaska 99521-0005 � �O�V1 (907) 522-6476 .o= p FA °opa Professional Land Surveyors survey®langsurvey.com o ��• •-... _ ...q �,pn I hereby certify that I have surveyed the following described property: NORTH 1/2 OF LOT 7, BLOCK 3, COLONIAL PARK SUBDIVISION (PLAT P -688): 9T A, Anchorage Recording District, Alaska, and that the Improvements situated thereon are . .... "•" ' 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 . . . . ; . . . . . . /. . . premises and that there are no roadways, transmission lines or other visible O j° C. LANG o easements on said� /properly except as Indicated hereon. Dated this the / rI Da of oc TOhJ FIZ2� ` O� ' •LS -9944. Day — at Anchorage, Alaska 044pR°�sslor+n� `yap 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. State of Alaska AECC963 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 050-301-24 1. GENERAL INFORMATION Expiration Date: 7 --2 Co — l ,� Complete legal description Colonial Park Block 3 Lot 7N2 Location (site address) 19732 Second Street Current Property owner(s) Wood Day phone 603-490-5506 Mailing address 180 Main Street, Atkinson NH 03811 Real Estate Agent Kathi Olmstead Day phone 694-5050 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class C Well Public Water System 3 TYPE OF WASTEWATER DISPOSAL: ® Individual 71 ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer ❑ Received by: 7 ! 5 Date: COSA to be released to the engineer, unless otherwise requested by the engineer. 11111111110 COSA Fee $ fj O� ' Date: Date of Payment q m 6 a_N_ Receipt Number t>bgci �J ,J COSA # C?SGI to f 12-2 Date of Payment Receipt Num Waiver S. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and.from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng 6. DSD SIGNATURE 77 System #1 Approved for J bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. Date - 4/18/2016 ... I bedrooms, with the following stipulations: By:`=WE Original Certificate Date: The Municipality of Anchorage Devlopment Services Division (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 9-1-12.doo 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: C a /a r. I &rk 133 1-7 4/z- Parcel ID: 4 !/- 301- A. WELL DATA Well type 10 If A, B, or C provide PWS ID # Well tog (Y/N)_ Date completed / 91 Sanitary seal (Y/N) ��. [ Wires properly protected (YIN) Total depth3!?2f% Cased to 127ft. Casing height (above ground) Af in. FROM WELL LOG AT INSPECTION Dae of test e Static water level ft: Z 8* 7 ft. Well production r g.p.m. g -I g:p.m. WATER SAMPLE RESULTS: Coliform _-9--colonies/100 mL Nitrate Z q'? mg/L Arsenic N� ug/L Date of sample: �� /` Collected by: "/'E" 4', B. SEPTICIHOLDING TANK DATA // Tank TypelMaterial SEPI G / .S TEFL Date installed Tank size Jp04 gal. Number of Compartments Z Cleanouts (Y/N) Y Foundation cleanout (Y/N) Depression over tank (Y/N) High water alarm (YIN) A/— Date of pumping 4allJ $ Pumper-: r 7 PV —,&—p C. ABSORPTION FIELD DATA Date installed 24�k&41 Soil ratingd./ft? Z or ft/bdrm (g.p. ) aG� � System type Length _ 23 ft. Width 20 ft. Gravel below pipe ft. Total depth _ ft. Eff. absorption area YLIZ-fe Monitoring tube 4 Depression over field Date of adequacy test 0 /6 Results (Pass/Fail) _ For _3_ bedrooms- Fluid depth in absorption field before test O in. Water added2 5'0 o gal. New depth in. Elapsed Time: min. V min. Final fluid, depth in, Absorption Yate >= S g.p.d. " Any rejuvenation treatment (past 12 mo.) (Y/N &type) _ &,g If yes, give date D. LIFT STATION NSG} 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 A, WELL ON LOT TO; Septic tank/lift station on lot /Cl « On adjacent lots /&f/7- Absorption &fQAbsorption field on lot On adjacent lots /D f k l Public sewer main 0 0 ��. Public sewer manhole/cleanout /OO `F Sewer /septic service line r+ Holding tank Animal containment areas J �� Manure/animal excrete storage areas/ d �f SEPTIC/HOLDING TANK ON LOT TO: Building foundation i f Property line Al Absorption field 5 °` Water main AT f Water service line &1 Surface water X40 h" Wells on adjacent lots 00 ABSORPTION FIELD ON LOTTO: Property line Z r� Building foundation 164 Water main Water Service line , Surface water -'�-Driveway,, parkingNehicle-storage----- Curtain drain U>%/V- Wells on adjacent lots Afa La/- F. COMMENTS G ENGINEER'S CERTIFICATION ����►®1�� ! certify fhat I have determined through field inspections and aR� ,.•••° °,°�e`,j �e review of Municipal records that the above systems are,• in°�7 t conformance with MOA COSA guidelines in effect on this date. gt 4 FIs ., D► Engineers Printed Name g Date ®n W. Eng COSA yellow sheet_2-6-15.doc.. - - N 1/2 Lot 8 S so i 89'56'00"E 132.00' N 1/2 Lot 7 ------ 17,820 s.f. WELL 1 1,9 x18.2' CANT / PORCH N /--1.9'x23.7' CANT o OAY GNT 0� W 2<.0• SEPTIC PIPES 10.1'02.1' SHED — — — ---- &T 90.4' q N 1/2 Lot 6 / u / 0 / 0 j—UTILITY EA EASEMENTS WOODEN FENCE S 1/2 Lot 8 I S 1/2 Lot 7 I S 1/2 Lot 6 PLOT PLAN AS BUILT X SCALE --!L= 40' GRID 55 Project No. 16-094/At Lang & Associates, Inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 (907) 522-6476 Phone oQF 4 Registered Land Surveyors (907) 522-4625 Fax oCa�� Ate` pQ ken*langsurvsy.cam / jonathanOlangsurvsy.com P`, .A..`N5 I hereby certify that I have surveyed the following described property: NORTH 1/2 OF LOT 7, BLOCK 3, COLONIAL PARK SUBDIYtSION (PLAT P-688) a . 491H , Anchorage Recording District, Alaska, and that the Improvements situated thereon are ............ within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the properly lying adjacent thereto encroach on the surveyed. ET G . premises and that there are no roadways, transmission lines or other visible KE r� easements on said property except as Indicated hereon. Q a t� .' Dated this the ��' Day of C .iL a 1 p at Anchorage, Alaska p'•0-520Z.•e*yos�p � If is the responsibility of the owner to determine the existence of any easements, OpOp��" covenants, or restrictions which do not appear on the retarded subdivision plat.