The URL can be used to link to this page

Home My WebLink AboutROSEBERRY HIGHLANDS LT 6 try Highland Lot 6 #050-315-64 Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page I of, ON-SITE WASTEWATER INSPECTION REPORT Permit Number:QS P/6/ / 175 PID Number: 6 SQ 3 J 5 6 r Dwelling: Single Family(SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project:New ❑ Upgrade Name: 0 0/�`/'7 ABSORPTION FIELD Address ❑ Deep Trench Fs Shallow Trench ❑ Bed ❑ Mound Po 3 ox 7 76z(/ 67. (2. ❑ Other Phone ! Number of Bedrooms Soil Rating Total depth from original grade 2 21 y !r !� Li /, . GPD/SF %' 5 Ft. LEGAL DESCRIPTION Depth to pipe invert from ori yalge Gravel depth beneath pipe Subdivision,c ' �/ �/ / / Block Lot Or 1 //�olT /13 S Fill added above original .rade Ft. Gravel length �q Ft. Township J Range Section a 4- ("!�' -f Ft. 4'Z Ft. Gravel widthBeds:Number of Lines Distance between lines SEPARATION DISTANCES 5 Ft. — Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Tank Line 577 Ftp / _ FL Well /�� /��-t- 2s4 TANK Septic El S.T.E.P. D Holding 0 Other �w ( Manufacturer ,7 �— Capacity Surface Water /DO /QQ f — 4, / HO1 MC6 /�AJk- Material Number of compartments/ 5 a Lot Line /6 ,Q f r� Gal. NA LIFT STATION N4 Foundation C/-�- /D .� ,,J Manufacturer Capacity Curtain Drain 5d t so r Gal. Pump on level at Pump off level at High water alarm at Remarks tAJE'LLS DleiL4 DIVL AJ 12/2,21CA/7a04‘, in. in. in. 1/0 a Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank A Tank to - Installer 1J 3a3y drainfield �`��{ /06 i S4106-1- Drainfield b3CCy/ CO/MT b31.11V Inspector ,t or tt r2l � ,,�Q BENCH MARK (Assumed elevation) / ft Inspection V J " / / Location and description �j dates: 1 673-pc 2� Zr;��b 7—Q ? c6e-Cg 3rd 5/ p?7 4`h • COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL En qolt p OF At �1 Conditional Approval: Date iiiZ�� ..• � '17 ;�$�40 i.:::- ..,,,,,,.., .. ..:: -'-.:^ %S sieven W. Erg f- //[]PE7 Approved \ v Date cp -0 f 7 110p , _ tea ' Inspection Report_9-1-12.doc - AS-BUILT MEASUREMENTS • A B ST1 13 22 ST2 21 14 DCO 30 17 CO 28 59 MT/CO 40 18 Lot 5 Tract 7 /15-20% Slope Lot 4 45-28". Slope R101 Irrigation c,, New 1250 Ga,lon Well t Septic Tank 1111,\ Lot s 112.640 ..t. ..% 1.* Tract 1 Alternate I Ibt Trench Site T H 4 iy�.�C / o 1/5% p Well '100 ' win / Altp• 5-20% Slop - 20-25% Scope Lot 7 Tract 1 � °F ROSEBERRY HIGHLANDS s) * 1 loo NORTHRIM :yP.. . ENGINEERING • Po Box 770724swe LAYUUT Engle River, Alaska 995774 � WASTEWATER RECORD 907. 694. 7028 SEPTIC SYSTEM Dote: 6/8/17 rETOf 3 f Lot 45 - 21 ° 0 Slope R100 0 Irrigation G,p Well ALF New 1250 Gallon ol,% 6 Lot Septic Tank �`Ly� 112, s.f. 6 15% 11110 '1144411111111ilik 1111111111 Tract 1 I 1 'i Alternate 1 1 s'''' o siTrench Site • .�TH4 9 9 9/1/16 No Groundwater O 0,\ , • Well 0 �L`, ' 100 --7,,_ / S '''th'0p Lot 7 20-25% Slope / o / 15-20% Slope e A — :1 ' U' M N S E A B ST1 13 22 ST2 21 14 Z DCO 30 17 CO 28 5' MT/CO • 0 8 Tract 1 �..wM�� . ��°�.' `'` R❑SEBERRY HIGHLANDS 1' = 50' NORTHRIM *~a9m ,,, RECORD ENGINEERING LOT 6 1 Po Box 770724 .a. . t I L A Y❑U T Eagle River, Alaska 99577 6 { r7s WASTEWATER RECORD dav S 907. 694. 7028 `/ SEPTIC SYSTEM 6/14/17 r2ccE, of 3 Foundation Cleanout Elevation @ 94' / Tank Cleanouts Elevation @ 89' Fin ^amide Opposing Cleanouts Between Septic Tank & Trench !Elevation @ 88.5' ,..L.'� i a-To Mid-Point of' Trench 1250 Gallon Steel levation @ 89' 'Anchorage Tank' Elevation @ 88.3' Solid Pipe Monitor Tube Elevation @ 86'-92' l'lnai , CO-ope Slope Original Elev @ 81.5'-87' 0I I____ FilterFabric .�IIII __30 Elevation @ 80' ��Witil � � 4,5 IF:�. Effective Depth 3, X• ipiYA �> Elevation @ 77' _ =I O=e=/=it TH Elevation @ 67,5' —S'0 J 4.4.,iF�**, NORTHRIMA • �,._ Vit, TRENCH END VIEW R❑ SEBERRY HIGHLANDS ENGINEERING 9m� ��. '' Po Box 770724 ji SEPTIC TANK PRDEILE LET 6 Eagle River, Alaska 99577 a 1.907.694.7028 � �1� SEPTIC SYSTEM RECORD "6: /8/17 BY: SE r°": 1• = s ' :3 of 3 6/8/17 I SE Certified Drilling Log DOC CO dba BILL & COLE l'► ULLIVAN WATER WELLS 41.PO. Box 670269,Chugiak,AK 99567 688-2759 OWNER OF LAND: Michael Quinn Bore Hole Data ADDRESS: PO BOX 772641 Eagle River, AK 99577 Depth LEGAL DESCRIPTION Roseberry Highlands Lot 6 From To DATE: January 2017 0 2 Casing Stickup PERMIT NUMBER: 0SP161195 DATE OF ISSUE: 8-22-16 TAX IDENTIFICATION NUMBER 05031564000 2 4 Overburden Is well located at approved permit location: fYes No 4 12 Silty Sand& Gravel w/Cobbles Method of Drilling: ®air rotary ❑cable tool 12 220 Bedrock Gray Depth of Well: 400' 220 312 Bedrock Green Casing Type: Steel Wall thickness .250 inches 312 345 Bedrock Gray w/Quartz Diameter: 6 inches, depth 44 feet Liner type 345 400 Bedrock Gray Static Water Level: 10 feet Recovery Rate 1 gpm I f gph Method of Testing Air Well Intake Opening Type: ri open end ®open hole -- ❑ Screened Start feet Stopped ❑ Perforations Start feet Stopped Grout Type: Bentonite Volume: 50 lbs Depth:from 2 feet, to 42 feet Well Disinfected Upon Completion: ®yes ❑no Method of Disinfection: Chlorine 50 PPM Comments: WATER Q ITY TESTING Conform I e 9 CoI/100mL -Nitrates 3 mg/L Arsenic P uglL Drillers Name: Cole Sullivan 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. DOC CO dba �ULLIVAN.,« a COLE WATER WELLS '� ► P.O. Box 670269,Chugiak,AK 99567 688-2758 www.sullivanwaterwells.com Pump Installation Log Well Drilling Permit Number: SW Date of Issue Parcel Identification Number: Legal Description Property Owner Name &Address Roseberry Highlands Lot 6 Michael Quinn PO BOX 772641 Eagle River, AK 99577 Pump Installation Date: 5-22-17 Pump Intake Depth Below Top of Well Casing: 404 feet Pump manufacturer's Name: Goulds Pump Model: 75810411C Pump Size: 1 hp Pitless Adapter Burial Depth: N/A feet Pitless Adapter Installer: N/A Disinfected Upon Completion? ® yes ❑ no Method of Disinfection: Chlorine 50 PPM Comments: Pitless Manufacturer:N/A Pump Installers Name: Sullivan Water Wells Attention:The pump installer shall provide a pump installation log to the D50 within 30 days of pump installation. Certified Drilling Log 11 DOC CO dbe hiUU°AiJ WATER WELLS ler P.O.Box 670269,Chugiak,AK 99567 666-2759 OWNER OF LAND: Michael Quinn Bore Hole Data ADDRESS: PO BOX 772641 Eagle River,AK 99577 Depth LEGAL DESCRIPTION Roseberry Highlands Lot 6 From To DATE: 10-6-16 0 2 Casing Stickup PERMIT NUMBER: DATE OF ISSUE: TAX IDENTIFICATION NUMBER 2 4 Overburden Is well located at approved permit location:Ekes ❑Na 4 15 Silty Sand &Gravel w/Cobbles Method of Drilling: ®air rotary ❑cable tool 15 20 Soft Bedrock Depth of Well: 420' 20 194 Bedrock Gray Casing Type: Steel wall thickness 2S0 inches 194 329 Bedrock Gray Hard Diameter: 6 inches, depth 44 feet Liner type 329 344 Bedrock Gray Static Water Level: 60 feet 344 362 Bedrock Green Hard Recovery Rate 1 n gpm ® gph 362 420 Bedrock Gray Method of Testing Air Well Intake Opening Type:❑open end ®open hole ❑ Screened Start feet Stopped ri Perforations Start feet Stopped Grout Type: Bentonite Volume: 50 lbs Depth:from 2 feet,to 42 feet Well Disinfected Upon Completion: Zyes LI no Method of Disinfection: Chlorine 50 PPM Comments: WATER Il rItSitl - Colikwm Wolf wOrnni -Nit=tee . t o L Arsenic- ug& Drillers Name: Cole Sullivan 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. 00C co dna iiie !CbLL1fIAN WATER WELLS P.O.Box 670269,Chu9iak,AK 99567 688-2759 www.sullivanwaterwells.com Pump Installation Log Well Drilling Permit Number:SW 05P161195 Date of Issue 8-22-16 Parcel Identification Number: 05031564000 Legal Description Property Owner Name&Address Roseberry Highlands Lot 6 Michael Quinn PO BOX 772641 Eagle River,AK 99577 Pump Installation Date: 5-18-17 Pump Intake Depth Below Top of Well Casing: 390 feet Pump manufacturer's Name: Goulds Pump Model: 5SB10411C Pump Size: 1 hp Pitless Adapter Burial Depth: 10 feet Pitless Adapter Installer: Sanders &Sanders Disinfected Upon Completion? ® yes ❑ no i Method of Disinfection: Chlorine 50 PPM Comments: Pitless Manufacturer:Martinson Pump Installers Name: Sullivan Water Wells Attention:The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. I • 1 Lot 5 .. N • I I 1 ,� Tract 7 / a 65 / — Lot 4 / \\ / / / OO 0, 5 N. '' AIL N. ....,1I f ��►� G� \ ISWELL .O I o \ ,... moi wo b 0 ck U, \ -04y / Lot 6 \ 9 112,640 s.f. , ♦ -$ - tel. : Tract 1 o -�� -- --_ \ a ______ ot h \ Y . 119.5' N 0557'34E $''$�• SEPC ';Icl .13.23' .f PIPES 'N N tiL: \\ �N � Fo,15 I I N \ N 85 37'58"E .1-0.i,�� 71.9-: ` ECSERpp1U WELLJLot 2A \-- - 102.20 ` PROS Nar '4' 442` / sy0pRy 1� / 41V S5 f oLihtil — 5 Lot 7 .. c-..o I o Tract 1 HOUSE DETAIL / SCALE: r=30' / / 24 x / N / T cP I q1)\ my - '0 • 17 Z� 4.0' @ 1O CD .9 23' 2).o PLOT PLAN AS BUILT X SCALE 1' = 60' GRID NW 0155 Project No. 16-281/B5 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 3e3. ry Lang & Associates, nc . (907) 522-6476 Phone ..a,‘, (907) 522-4625 Fax d �`� Professional Land Surveyors kenOlangsurvey.com v` �F.AC `<< Y jonathanOlangsurvey.com ,b,f .... . ''•'9s I hereby certify that I hove surveyed the following described property: P .• 49TH / :17 LOT 6, ROSEBERRY HIGHLANDS (PLAT 2014-58) $, 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 -• KENN G. : premises and that there ore no roadways. transmission lines or other visible a0,\,. s�L(c`t trj easements on said properly except as Indicated hereon. .••.LS-5202.•'' cP Dated this the 6". Day of fie`'( , ?C , at Anchorage, Alaska o� 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 On-Site Water & Wastewater System Permit OSP161195 05031564000 WellSeptic 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: Tax Code Number: Work Type: Permit Effective Dates: August 22, 2016 to Design Engineer: NORTH RIM ENGINEERING Subdivision: ROSEBERRY HIGHLANDS Site Legal Address: ROSEBERRY HIGHLANDS LT Owner/Address: QUINN MICHAEL Initial August 22, 2017 6 G:0155 PO BOX 772641 EAGLE RIVER AK 995772641 Site Mailing Address: Lot Size in Sq Ft: 112640 Total Bedrooms: 4 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy Y 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. Special Provisions: 1. The entire field and alternate is not within a 30' radius of a percolation test. An addition test is to be done prior to construction. Submit results with the Inspection Report. 2. The trench is to be installed parallel to the contours. ate: Date: MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION V JUL Gretchen Stuller Parcel I.D. ~ 5~_,,,) "~ ! 5 - ~' Propertyowner(s~ ./~//~ ~',. ~ O/,,t/',,~' Dayphone ,Z~-~ ~'-¢-~ ~'~' Mailing address rd &~.,~'7 '72 ~'.~,/ Site address /DI"~ v'~ ,~. Lega descr pt on (Sub d., Block & Lot) ~O.5~_~e/~ /7~,~(~=.~,~' . Legal description (Township, Range & Section) Lot Size //2., ~./-/~Sq. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: (~;~] all that apply) Absorption Field ~ Initial Septic Tank Upgrade [] Holding Tank ' [] Renewal [] Privy [] Private Well Water Storage TYPE OF DWELLING: Single Family (SF) (w/wo ADU) Duplex (D). Multiple Dwellings (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. (Signature of property owner o~,,e~thorized agent) Permit/Rush Fees: Date of Payment: Receipt Number: Permit No. oql OD Waiver Fees: Date of Paymenb Receipt Number: Waiver No. Permit App_9-1-12.doc MEMO Steve Eng, PE, PH P.O. Box 770724, Eagle River AK 99577 (907) 694-7028 SteveEngPE~gmail.com Date: 7/12/16 To: MOA On-Site Services Subject: Roseberry Highlands Lot 6 Septic System & Well PermitDesign Number of Pages: This is a new subdivision. Most of the neighbor lots are undeveloped. A new conventional septic system & shallow trench is being utilized. Private water wells serve the area lots- a well permit is requested for the well site. Please review the wastewater system design for the single family home. I have included design plans & specs, design guidelines, & soil tests. If there is need for additional information or clarification please give me a call. Thanks-Steva~ [xL'RT IM ~ E,~?EERING Roseberry Highlands Lot 6 SPECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing: This is a new 4-bedroom, single family home. This is a new subdivision and most of the neighboring lots are not developed. These lots are large and are served by private water wells. No adverse impacts are expected from development. No conflicts to the other lots will take place by this septic system construction. A previous subdivision soil test revealed sandy soil with low silt. The test hole from the subdivision did not cover the entire area for the trench; a perk test will be completed prior to construction. An application rate of 1.2 GPD/FT2 with 0.5 reduction factor for utilizing a 5' wide trench. Trench Length = 500 FT2/5'x .58 reduction factor = 58'; 1 line ~ 58'. No bedrock was encountered. Groundwater separation was maintained. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations. · Two compartment, 1250 gallon septic tm~k. Watertight couplings on inlet & outlet. · 5' minimum between the tank and bed. 10' to property lines. · 3' of cover or insulation is required for trench; an equivalent of 1" insulation for 1' soil cover may be used. 2" Minimum thickness for insulation. · Tm~k & solid pipe must be set on well compacted, stable soil. · 4 inch diameter cleanouts with airtight caps are required 1' to 4' from foundation wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts between the tm~k and the absorption field, not more than 10' from the tank positioned to provide cleanout access towards the tank and towards the absorption field. · All cleanouts must extend to at least ground level. · In solid pipe rinds, ASTM D-3034 may be used in lieu of cast iron. · Trench to be placed level, minLmum of 4' to groundwater, 6' to bedrock from drain-rock. · Drain rock to be ½ inch to 2 ½ inch screened. Drain rock to be distributed uniformly throughout the trench. · Perforated pipe to be installed level with perforations down. · Silt barrier (filter fabric) to be installed above the drain rock. · Smeared trench sides must be raked or scarified before drain rock placement. · The finish grade must be mounded to promote drainage away from trench. · Insulation must be placed over any pipe installed under driveways or parking areas. · Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, · Sewer Service Line is minimmn 2% slope. · Septic Tank to be pumped every two y_e~0~..or when required. · Insulation board to be extruded d~*t~}~m~p0'Iystyrene (Dow Styrofoam HI/equal) is 4.5'. 2% slope. DESIGN NOTES: 1. Total Depth of Trench Terrain Slopes Southwest. 2. Sewer Service Line minimum 3. Privof. e Wot. er Wells. 4. Check Well/Septic Seporation Prior To Construction. 5~ Ploce Trench Porellel To Contours. 6. Additional Perk Test Prior To Construction. Undevetop6 /15-20Y. SR~pe )% S(ope °PeNew 1250 G(lton }t;ic T(xnP 15-207, tope l/ Undeveloped Undeve[o ,ope ~[tern~te Trenc/~e UndeveLoped N OR THRIM ENGINEERING .~0 BOX 770724 ~ogle River, AIo~ko 907. 694. 7028 RBSEDERRY HIGHLANDS LBT 6 WASTEWATER DESIGN SEPTIC SYSTEH 1' = 100' PLAN LAYFIUT 8/18/16 o¢ 3 0 C 0 [/ 01.1 h ~- 0 C u c 0 0 0 [] +~ ~ 0 (3) SOILS LDG - PERCDLATI~N TEST Dale PerCmrmeoh 8/15/07 Per¢ormecl For~ Lee Coy DEPTH (FEET) 14 15 - ~7 - 18 .- Description: Raseloemry HtghtamcIs Lot; 6 (Previously Roseloerry Ridge Hightonds l]rgo, nlc See Loco. i;tom Mc~p SM Silty Sc~nol W/ Gravel Low Silt Cobbles Lot 6) Slope ne6r 25% Groundwcter? Yes Depth 15' Wcter Depth i AF~cer Monitor'ing.,~ Dote, 10/15/07 Do~ce Gross Time Net Time Depth Ne~ Drop 8/I5 0 -- 4, -- 8115 10 -- 4 .... 8/15 ~0 10 mir' 8' 4' 8/15 20 -- 4, -__ 8/15 30 lO Percotation Rate 8.5 min,/Inch Pert Hole Run Between 4' ond 5' Pe,,"{:ormed By~9, I ~ CERTIFY THAT THIS TEST WAS I%,r'formed in Accordonce with Att St(~l;e/Municipot Guidelines in EPCect DN THIS DATE. DAfD 8/15/07 tWOR THf~iM'"~ ' *~"'"'~"~'~ TESTHBLE LDG ~, :~gu~'~ ", · T, H, 4 ENOtNEERtNS .......... .o~.,,0,~, I '~2: GEBTECHNICAL Lo~ 5 ~ 8/15/07 )¢ 5 �� Municipality of Anchorage • On-Site Water and Wastewater Program -t1 j, / (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 050-315-64 Expiration Date: q'^ f 1 7 1. GENERAL INFORMATION Complete legal description Roseberry Highlands Lot 6 Location (site address) Mt Magnificent,Eagle River,AK Current Property owner(s) Quinn Day phone 229-4966 Mailing address same Real Estate Agent Quinn Day phone 229-4966 ,, 2. TYPE OF DWELLING: ti � �- ® Single Family (w/wo ADU) i ❑ Duplex ' ❑ Multiple Dwellings (Single Family and/or Duplex) .1fl - c`4r Q! 6 Lg/art 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class C Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Received by: _ Date: .4/is//7 COSA to be released to the engineer,unless otherwise equested by the engineer. COSA Fee $ 6cf.30 Date: Date of Payment to /61 I R Date of Payment Receipt Number 0002 5G 3-6 Receipt Number COSA# (J C7/ .2.9t3 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 NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 64$r',A(1.7,�� SOF4 4t 6. DSD SIGNATURE System #1 Approved for bedrooms. 4101. ( • .;c► F` Steven Vv.. •ng System #2 Approved for bedrooms. fie s`•. P 6256 a 41 Disapproved. 4 9�o p ��'! Conditional approval for bedrooms, with the following stipulations: ON-SITF 1�. WATER AND r• vv, STEWATER PROGRAM 70 rC_ By: h,.., �^, -� Original Certificate Date: �� — 1 7 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.doc If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate .,f Or Site Systems Approval Checklist Legal Description: _?OJE3 Ry hife/M-64J LOT £ Parcel ID: 052JS/564,/ A. WELL DATA Well type T If A, B, or C provide PWSID# Well Log (YIN) y Date completed 37401/7 Sanitary seal (YIN) / Wires properly protected (Y/N) Total depthyaO ft. Cased to `74-/ ft. Casing height (above ground) Z in. FROM WELL LOG AT INSPECTION Date of test. _ / 7 Static water level to ft. ft. Well production / g.p.m. g.p.m, WATER SAMPLE RESULTS: Coliform d colonies/100 mL Nitrate A/L mg/L Arsenic //b ug/L Date of sample: 5/25/1 7 Collected by: NZ, B. SEPTIC/HOLDING TANK DATA Tank Type/Material Si°T/C�7S7 L Date installed_ cf',2.S7//‘ Tank size /Z5°gal. Number of Compartments 2_ Cleanouts (YIN) Foundation cleanout (YIN) y Depression over tank (Y/N) A/ High water alarm (Y/N) I Date of pumping /tE14.) Pumper C. ABSORPTION FIELD DATA Sffl>i�t.ac,J Date installed S/2 6.1/ Soil rating (g.p.d./ft2 or ft2/bdrm) / . System type 71z c./f Length ft. Width 5 ft. Gravel below pipe ? ft. Total depth dONft. Eff. absorption area SI 7 ft2 Monitoring tube / Depression over field N Date of adequacy test /1.7 (.J Results (Pass/Fail) For 1"{ bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >- g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Am Date installed Size in gallons Manhole/Access (YIN) "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 /670 f On adjacent lots /GG t Absorption field on lot l DG f On adjacent lots /Q G rt Public sewer main /04 "'r Public sewer manhole/cleanout . /6D Sewer/septic service line 2'� Holding tank (C) "1- Animal Animal containment areas 50 Manure/animal excrete storage areas /oa, (7- SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5 t Property line / O (:14 Absorption field '1"-- Water main r/& 1` Water service line / rt Surface water /cm '7,- Wells on adjacent lots /7o ' ABSORPTION FIELD ON LOT TO: Property line l0 'f- Building foundation /C '7- Water main /4 f Water Service line /G t Surface water /OG t Driveway, parking/vehicle storage /id f Curtain drain 50 'f Wells on adjacent lots /QG (14- F. F. COMMENTS • L.ow Pg o-1 cuc/ (19770,0 1 G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections andCSF a review of Municipal records that the above systems are in •°" conformance with MOA COSA guidelines in effect on this date. Ai'3s4k:A=` u Engineer's Printed Name Date 7t7i 7 ' '/8/!? :z. COSA yellow sheet_2-6-15.doc