HomeMy WebLinkAboutNORTH SLOPE #2 BLK 4 LT 12Permit ~
Applicant:
825
Street, Anchorage, AK.
264-4720
I certify that:
(!) I am familiar with the requirements for on-site Sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will 'install the system in accordance with codes.
(3) I u~e~stand that the on-site sewer system may require enlargement if
the( reSide?ce is r~ff~led to include more tha~ 3 bedroomS._
swP/o24(1/s1)
Legal Description: Z~ /~ ~/~ $ , Lot Size:
Type of Soil Absorption System ~s:
Seepage Bed: Holding Tank:
Trench: Drainfield:
Maximum Number of Bedrooms: _ Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is: '
GRAVEL DEPTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minim~ depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
~ ~ REQUIRED SEPTIC(]~LDI~) TANK SIZE = /~ GALLONS
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the nu~er
of residences that the well will serve.
Backfilling of any system without final inspection and approval by this departmen~
will be subject to prosecution.
Minim~ distance between a well and any on-site sewage disposal system is 100 fee'
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minim~ distance from a private well to a private sewer line
is 25 fee~ and ~oa co--unity sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * HANDWRITTEN PERMIT
WELL AND/OR ON-SITE SEWER PERMIT
C{.,r~U$7~''- , , Mailing Address: $~ ~A~?~,~,'
~ Phone Number: ~-3Y~6
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. . Municipality of Anchora• - a 9 10 77
szt.0On-Site Water and Wastewater Progra ` �2A K. u 1 a
(907)343-7904 • k 5i ETV
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2017 S
Certificate of On-Site Systems 'p•royal •
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Parcel I.D. 050-581-24 Expiratio •: -• , g
1. GENERAL INFORMATION
Complete legal description North Slope #2, Block 4, Lot 12
Location (site address) 30750 Sagwon Avenue Eagle River, AK
Current Property owner(s) Richard Marson Day phone 947-2801
Mailing address 30750 Sagwon Avenue Eagle River, AK 99577
Real Estate Agent Day phone
2. TYPE OF DWELLING:
E Single Family (w/wo ADU)
E Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: Four
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well E1 Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: O/l,Pkteiti ,(') f 1 . Date: 4 6/1
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ !, Waiver Fee $
Date of Payment \1 111 Date of Payment
Receipt Number 01-t_Cik uG Receipt Number
COSA# C6C- f 1 `-( 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 Anderson Engineering Phone 522-7773
Address PO Box 240773, Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 5/31/17
of A
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6. DSD SIGNATURE :* , 49TH �'\ • *
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C� 01•7771.// ••• fiat` • .•J' • •
System #1 Approved for t bedrooms • -
System #2 Approved for bedrooms
^,:11CH SEL E. AND�Rsor.•:��
CE-4337 . �
Disapprovede•,S�slrr7••• ��
OF FSS10°a:"F
Conditional approval for bedrooms, with the following stiptullrtlgn ',Y
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UN-SITE
WATER A1\1n
WASTEWATER
PROGRAM
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By: S ' Original Certificate Date: 2
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 sheeti. '• .. c
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: North Slope #2, Block 4, Lot 12 Parcel ID: 050-581-24
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (YIN) Y
Date completed 4/16/02 Sanitary seal (YIN) Y Wires properly protected (Y/N) Y
Total depth 197 ft. Cased to 196 ft. Casing height(above ground) >18 in.
FROM WELL LOG AT INSPECTION
Date of test 4/16/02 4/21/17
Static water level 74 ft. 122.4 ft.
Well production 6 g.p.m. 3'9 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate .608 mg/L
Arsenic NDug/L Date of sample: 3/31/17 Collected by: Anderson Engineering
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/SteelDate installed 5/22/02
Tank size 1 ,250 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout(YIN) Y Depression over tank(Y/N) N High water alarm (Y/N) Y
Date of pumping 7/16/2016Pumper JRs Pumping
C. ABSORPTION FIELD DATA
Date installed 5/23/02 Soil rating (g.p.d./ft2 or ft'/bdrm) 1.2 GPD/SF System type 5' Wide
Length 2 @ 45 ft. Width 5 ft. Gravel below pipe 2 ft.
Total depth 5 ft. Eff. absorption area 642 ft' Monitoring tube Y Depression over field N
Date of adequacy test 4/21/17 Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added 601 gal. New depth 0 in.
Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 600 g.p.d.
N
Any rejuvenation treatment(past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
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 >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 >25' Holding tank >75'
>50' >100'
Animal containment areas Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5 Property line >5 Absorption field >5
>100'
Water main >10' Water service line X10' Surface water
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
>10' '
Property line Building foundation >1 Water main >1
Water Service line >1 Surface water >��� Driveway, parking/vehicle storage >10'
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
G. ENGINEER'S CERTIFICATION .s+lli1►'+ Wtl1t1
I certify that l have determined through field inspections and a A.:'� ;•............4 c,,, ,®•
review of Municipal records that the above systems are in �;•• 4- 5,
conformance with MOA COSA guidelines in effect on this date. ' �,L 1 N ;i�v wrap
Engineer's Printed Name
Michael E. Anderson, P.E. .... �•-•9•- •• �'
5/31/2017 e" •' .• 0
Date 0 .MICHAEL E. ANDERSON :,. L
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COSA brown sheet 10-10-12.doc
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ASBUILT SEWARD & ASSOCIATES LAND SURVEYING 694-0829
I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE:
.4. 5/e1" ,p�vaRA�
FOLLOWING DESCRIBED PROPERTY: � OF At ,
AfP:,.vvif,=-- .s«fes sr��,p 14f,'W 2 G�j ! DATE: X�' Xi
S' 4
AND THAT NO ENCROACHMENTS EXIS1TEXCEPT AS /.,77,406-6- ••' d •.4-- 1
INDICATED. IT IS THE RESPONSIBILITY OF THE i t' • �'f� r
OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: M'-• •- ' •"" •'
EASEMENTS, COVENANTS, OR RESTRICTIONS S -755-7G r4-v-'- -
WHICH DO NOT APPEAR ON THE RECORDED SUBDI- •Is '• Dv en. Mark Sawerd . n` 0
VISION PLAT. UNDER NO CIRCUMSTANCES SHODU) FB' 1 _ CS-6918 '`ar
ANY DATA HEREON BE USED FOR CONSTRUCTION �!� � # SJR#
OF FENCE LINES, OR FOR ESTABLISHING BOUND- 3� � #-•'..
ARY LINES.
DRAWN:
Alt,«. ►„.'