Loading...
HomeMy WebLinkAboutPROSPECT HEIGHTS #1 BLK 3 LT 4C+ ei 3 �i n Im Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP241008 PID Number: 015-092-04 Dwelling: ❑® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑® Upgrade Name Duane Threlkeld PTION FIELD A<EE:11 D Trench ❑ Wide Trench El Bed ❑Mound Site Address 9250 Buddy Werner Drive Other Phone Number of Bedrooms Soil Rating Total depth from original grade Four(4) EXISTING /SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original de Gravel depth beneath pipe Subdivision Block Lot Prospect Heights #1 3 4 Fill addedFt. above original grade !�h Township Range Section Ft. Ft. Gravel width Ft. Beds: Number of Lines Dist a en lines betwe Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between ches From Tank Field Tank Line Ft2 Well >100' >� 00' N/A N/A >25' TANK [ESeptic ElS.T.E.P. ElHolding [:1Other Manufacturer Greer Capacity 1,250 Gal. Surface Water >100' >100' N/A N/A Material Plastic Number of compartments Two(2) Lot Line >5' >10' N/A N/A NA Foundation >10' >10' N/A N/A ATION Manufacturer Capacity Remarks Gal. Elects i alled by Alarm location Installer PIPE MATERIAL House to tank D3034 drainfield Tank to D3034 Northern Excavation Drainfield D3034 CO/MTD3034 Inspector M. Jakubisin BENCH MARK (Assumed elevation) 100 ft Inspection1st 3/4/24 dates: 2 nd Location and description 3`d 4�' th Bottom of siding @ NE wall ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp OF Conditional Approval: Date NW.... ,qs�l� .•AAGWPI d TH BenjamL Schiller �V ���l Septic System i�� Date i LC/ / •� CE 12592 .-0 3/15/24Approved J. Note: this klkF,PROFESSIONP�'4`� approval does not include well permit requirem d nts. ������®�® Benjamin Schiller CE 12592R E GISTEREDPROFE S S I O N A L E N GINEER 1"=50' APPROX. LOCATION OF EXISTING TRENCH REMAINING IN SERVICE CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT DV - DIVERTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND SHEDS PERMIT # OSP241008 PID # 015-092-04 PROSPECT HEIGHTS #1, BLOCK 3 LOT 4 A B CO1 20.1 CO2 24.2 MH 26.9 A B SV 29.4 2CO 31.4 MT 52.4 CO3 53.5 16.0 21.5 34.5 39.3 41.8 62.3 63.7FEET 0 50 100 BUDDY WERN E R D R I V E 4- B D R M H O M E PLAN AS-BUILT 3/15/24 10' UTILITY EASEMENT 2CO EXISTING WELL NEW 1250-GAL SEPTIC TANK MT CO3 REPAIRED TRENCH PIPES SV MH CO2 CO1BM PROFILE AS-BUILT (NO SCALE) 95.4 90.3 96.1 100.1 CO 1 MH SV PERMIT # OSP241008 PID # 015-092-04 PROSPECT HEIGHTS #1, BLOCK 3 LOT 4 2C O 95.2 Benjamin Schiller CE 12592 R E GISTEREDPROFE S S I O N A L E N GINEER 3/15/24 CO 2 1250 GAL SEPTIC TANK 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: OSP241008 Work Type: Septic Upgrade Tax Code Number: 01509204000 Site Legal Address: PROSPECT HEIGHTS #1 BLK 3 LT 4 G:2441 Site Mailing Address: 9250 BUDDY WERNER DR, Anchorage Owner: THRELKELD DUANE L & Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 1 /31 /2024 1 /30/2025 81457 ✓Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ 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 Special Provisions: A test hole is required prior to construction of the absorption field, in the location shown on the site plan, to confirm minimum separation to impermeable soil and seasonal high groundwater, as well as percolation rate. Construction may proceed at your own risk prior to 7-day groundwater monitoring. If results require a design change, construction shall stop pending approval of a change order. Please submit results with the inspection report (or change order, if required). Received By: 1 S,3 �'�� -�0 F Co� C, r Issued By: Date: Date: 1 Z 3 % Z MUNICIPALITY OF ANCHORAGE Community Development Department `� Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON -SITE SEWER/WELL PERMIT APPLICATION Parcel I. D. 015-092-04 Property owner(s) Duane Threlkeld Day phone Mailing address 9250 Buddy Werner Drive, Anchorage, AK 99507 Site address 9250 Buddy Werner Drive, Anchorage, AK 99507 Legal description (Sub'd., Block & Lot) Prospect Heights #1 Block 3 Lot 4 Legal description (Township, Range & Section) Lot Size 81,457 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field �. Initial ❑ Single Family (SF) ❑X Septic Tank ❑X Upgrade ❑X (w/wo ADU) Holding Tank ❑ Renewal ❑ Duplex (D) ❑ Privy ❑ Multiple Dwellings ❑ (SF and/or D) ---_-------- Private Well El ----- - -- ------- Water Storage ❑ 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. (5lgnature of property owner or authorized agent) Permit/Rush Fees: -Z. Z,S Waiver Fees: Date of Payment: %//,gAq Date of Payment: Receipt Number: O ,560 / 0 Receipt Number: Permit No. 05102-9 1 DD5 Waiver No. Permit App__- ;-.,:c January 30, 2024 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Prospect Heights #1 Block 3 Lot 4 – 9250 Buddy Werner Drive Septic System Replacement Dear On-Site Services Engineer: The owner of the above lot has a marginal septic system, so we are submitting this permit application for its replacement. The attached site plan identifies the location of the home as well as the wells and septic location. The new system will also be designed for 4-bedrooms. To save the client time and costs, we have designed the system using test hole records on this and surrounding properties, while specifying that a new test hole and perk test must be done at the time of construction. The following table details the information that we found on these properties, all in the Prospect Heights #1 Subdivision (Block 3): Property Soils Depth Groundwater Percolation rate Lot 4 ML/SM, GP 15’ None 150 SF/BDRM (Visual) Lot 3 SM, SW 15’ None 1.45 min/in SW 17’ None 2.4 min/in GW/SW 13’ None 85 SF/BDRM (Visual) Lot 5A GM 18’ None 2.7 min/in We have designed the trench to be 9’ total depth using an application rate of 1.2 GPD/SF. We request that this be approved for the permit, with the provision of the new test hole. The slopes on the property run downhill to the west, between 10-15% in general, and get steeper close to the west property line. There are no slopes greater than 47% within 50’ of the proposed location of the new trench. Stormwater runoff will not have any adverse effect on the trench. The new septic system will be a minimum of 100’ from all wells and surface water. Please refer to the attached plan and profile for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241008, Curtis Townsend, 01/31/24 Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER 1"=50' APPROX. LOCATION OF EXISTING TRENCH TO REMAIN IN SERVICE CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT DV - DIVERTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND SHEDS MT PROSPECT HEIGHTS #1, BLOCK 3 LOT 4 FEET 0 50 100 NEW FCO BUDDY WERN E R D R I V E 4- B D R M H O M E SEPTIC PLAN 1/17/24 10-15% CO 10' UTILITY EASEMENT NEW 2CO EXISTING WELL NEW 1250-GAL SEPTIC TANK ENSURE 100' SEPARATION FROM WELL DECOMMISSION EXISTING SEPTIC TANK NEW TRENCH 3' WIDE x 42' LONG 6' EFFECTIVE DEPTH MIN 12' SEPARATION FROM EXISTING TRENCH DIVERTER VALVE MT CO 10-15% 10-15% PROPOSED TEST HOLE PRIOR TO INSTALLATION Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241008, Curtis Townsend, 01/31/24 TYPICAL TRENCH SECTION (NO SCALE) NOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER 4" PERFORATED PVC (HOLES DOWN) DRAINFIELD ROCK 3' 6" 2'-6" 6' DESIGN FACTORS:SYSTEM REQUIREMENTS: 600 GPD PEAK FLOW PERK RATE: 1-5 MIN/IN APPLICATION RATE: 1.2 GPD/SF DEEP TRENCH SYSTEM 1250-GAL SEPTIC TANK BOTTOM OF TRENCH: 9' BELOW GRADE FLOW LINE ELEVATION: 3' BELOW GRADE 600 GPD / 1.2 GPD/SF / 6' DEEP / 2 SIDES = 41.7 LF TRENCH REQUIRED (42 LF SPECIFIED) GEOTEXTILE FABRIC 6" 8/22/23 PROVIDE ADDITIONAL FILL TO ACCOUNT FOR SETTLEMENT PROSPECT HEIGHTS #1, BLOCK 3 LOT 4 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241008, Curtis Townsend, 01/31/24 HOUSE DETAIL SHED Scale: 1 "=30' /�. 12.0' 7.9' x 9.2' 4.0' a ?So BALCONY WITH 3.5' DECK BELOW ry E 2 STORY^h RESIDENCE WITH WALKOUT BASEMENT Lot 5A Ls Go N 3 0 0 0 0 0 VA 16.7' x 1 1.0' "- COVERED BALCONY 16.T x 8.1' DECK BELOW 5.8' x 4.3'— CONCRETE PAD Lot 4 81,457 s.f. NOTE: DUE TO SNOW & ICE COVER, SOME SURFACE LEVEL FEATURES ARE APPROXIMATE. WOOD SHED >R 9 N 89'56'28" E 338.03' UTILITY EASEMENTS O SEPTIC PIPES N N Lot 3 0 o � o F / 1) -,"°NSF r---�ASPHALT -OAVEI A ENT 100' PROTECTIVE WELL S 89' 56' 16" W 67.85' R,63 00� o �ER�AER DR I VE_— -- PLOT PLAN AS BUILT X SCALE 1" = 60' GRID SW 2441 Project No. 24-010/A1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone 4Q�ppp�� (907) 522-4625 Fax Q !94�Q Professional Land Surveyors kenolangsurvey.com 0 F q �' jonathanOlangsurvey.com ryonOlangsurvey.com oa��Q •. �V4 49TH I hereby certify that I have surveyed the following described properly: •� 0 LOT 4, BLOCK 3, PROSPECT HEIGHTS SUBDIVISION (PLAT No. 67--23) Anchorage Recording District, Alaska, and that the improvements situated thereon are %io within the property lines and do not encroach onto the property adjacent thereto, that; KENNEi`H G. L4Nno improvements on the property lying adjacent thereto encroach on the suryed Gpremises and that there are no roadways, transmission lines or other visible �� Z(3oJ�-A- easements on said property except as indicated hereon. V ��'•.-5202• 'Oy�p10 '4 at Anchorage, Alaska Dated this the - Day of ��� £'•'�}� `' "� . 9 �p°O�sslOw►+-`�� It is the responsibility of the owner to determine the existence of any easements, AECC963 covenants, or restrictions which do not appear on the recorded subdivision plat. HOUSE DETAIL Scale: 1"=30' 7.9' K BALCONY 3.5' DECK o� M OD N O O 0 a a .. 5.8' x 4.3' - CONCRETE PAD N 89'56'28" E 338.03' m SHED N SHED P 9 �y. 10' UTILITY EASEMENTS SEPTIC PIPES ANHOLE / SF F / s SF ASPHALT' PAVEMENT �+ R�63 .00' S 89'56'16" W 67.85' 1, �ER� -R DRIVE__ NOTE: DUE TO SNOW & ICE COVER, SOME SURFACE LEVEL FEATURES ARE APPROXIMATE. PLOT PLAN AS BUILT -2L -SCALE 1" = 60' GRID SW 2441 Project No. 24-010/A1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone (907) 522-4625 Fax 44�QF Professional Land Surveyors kenOlangsurvey.com ov� • .. ,9s�� jonothanOlongsurvey.com G ryan0lang3urvey.com 2-..KENNETH I hereby certify that I have surveyed the following described property rTH LOT 4, BLOCK 3, PROSPECT HEIGHTS SUBDIVISION 0 l ( P1bi Ho( Anchorage Recording District, Alaska, and that the improvements a tua ed thereon arowithin the property lines and do not encroach onto the property adjacent thereto, that %.�o G. �no Improvements on the property lying adjacent thereto encroach on the surveyedr I promises and that there are no roadways, transmission lines or other visible easements on said property except as Indicated hereon. �ON�A Dated this the (4� Day of __jam �� at Anchorage, Alaska kc?�lotrA�- Q �44��Qo It Is the responsibility of the owner to determine the existence of any easements, AECC963 covenants, or restrictions which do not appear on the recorded subdivision plot. t��� •y� It'��� ` +� Development Services Department Building Safety Division =a=�' On -Site Water & Wastewater Program rr: i .ir 4700 Bragaw Street F.O. Box 196650 Mark Begich Anchorage, AK 99519-6650 Mayor www muni.oro/ons to (907)343-7904 Pump Installation Log Well Drilling Permit Number: SWAA Date of Issue: N A Parcel Identification Number:— Ml- CA -WO Legal Description Pros H C t 6tts Mu.s,13LU k,5, Y"" - 9 L&4 Property Owner Name & Address: Val e� ie,11 te, 25 C) 6 LX & Yy bVe ruler Dr. A"6v� AV-L)()5n Pump Installation Date: 02.26.2 map Pump Intake Depth Below Top of Well Casing: l � feet Pump Manufacturer's Name: Aitromo �r Pump Alodel: T5-45 Pump Size L hp Pitless Adapter Burial Depth: l feet Pitless Adapter Manufactuer(,(,AVMWA _sName: 1r Pitless Adapter Installer: U'VIbLOW 1% N 'L' Well Disinfected Upon Completion?es ❑ No Method of Disinfection: q -ralbl ir!fi Comments: Pump Installer Name: M _ W DRILLING INC. P.O. BOX 110378 ANCHORAGE, ALASKA 99511 LM Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION o ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME Sc"_.1-.a C- h kG C- Ate. 1 PHONE 3 41y'-a9rl I 'EW ❑ UPGRADE MAI LING ADDRESS &3.3 Es S1�$'f" ✓� LEGAL DESCRIPTION L - LOCATION 6'8� W2r ��^. NO. OF BEDROOMS ,(� t%er 'k/ U DISTANCE TO: Well NG ,A Absorption area ° Dwelling ,/ p f A PERMIT NO. c' 3 Wf ©.�� y Manufacturer /j1) i Material No. of compartments wQ �Y G:7 0 K N F Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth pJ�y DISTANCE Well Dwel' g P MIT NO. 0 z Manufact r Maiai Liquid capaci m gallons F w= DISTANCE TO: WellFoundatio pT ��' /fit/ Nearest lot I�e b f' PERMIT NO. IOJ c� J u. z No. of lines Length of each line Total length of lines ° Trench width Distance between lines �'-------- Z w r �Ullel ° �' '--�� inches ~ F• Top of the to finish grade o Material beneath rile Total ffective absorption area O �/ -mss R S Length Width Depth PERMIT NO. w C7 a F Type o ib Cri ameter Cribdepth Total effective absor n area wa W Well Building ndation Nearest to e DISTANCE T Class y Depth Driller Distance to lot line PERMIT NO. W Building foundation Sewer line Septic tank Absorption area(s) DISTANCE T0: OTHER n4 PIPEMATERIALS �- IJ WLP SOIL TEST RATING �t /'S -0S �/ �,�ir n, s rw INSTALLER 5'ctiac�i/e �`xc . REMARKS s �r 0 N l 0 APPROVED �/ DAT/EJ LEGAL I c. I F,*!_!Wi=t 3 DEF.`ARTNENT 0. -iEALTH AND EN• V I R+ �N•aN°1EhITAL € .)TECT I ONd �yVl t `:TREE f, ANCHORAGE, AK. :-?==,eri: � U :Y'f� 4--•'•r;'20 Ao .t� UCt/ � 7'd l PERMIT NO. 810527, ) 7 APPLICANT SCHAk_HL.E E„C; 6?:_ E. 81 AVE. LOC,ATION PROSPECT HEIGHT LEGAL L4 E:_<: PROSPECT HEIGHT LOT SIZE 84500 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM I S : TRENCH MAXIMUM NUMBER )_)F BEDROOMS_ SOIL RATING O FT'/BR)= 150 McZ�Lnf4/� THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM I S : c; _ J� � 1 THE LENGTH D I MEN•_ I' ON•d IS THE LENGTH I t+l FEET) OF THE TRENCH OR L: RA I NF I ELD. THE DEPTH OF A TRENCH )_1R. PIT 15 THE. DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE 0XCAVATION �IN FEET:. THERE IS NO SET WIDTH FOR TRENCHES. 'THE GRAVEL DEPTH 15 THE MINIMUM DEPTH OF 13RA EL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXC:A%,ATION (IN FEET) PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THF_' INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS, PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. __(._ g =-9 e_n a-: fes=° > 7 P-4 ° F=4 E=_ �__= _T_ 1 V=® fi -A == Ez� ETa E^ F--;' EF_ 1D 9_9 1 p E _ CH E AC:K€= I l_L I NG OF ANY SYSTEM WITHOUT FINAL INSPEC:TION AND APPROVAL B',' THIS DEPARTMENT WILL BE SUBJECT 'TO PROSECUTION. M I N I N M DISTANCE BETWEEN.! A WELL AND ANY ON—SITE SEWAGE DISPOSAL SYSTEM I :100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC: WELL DEPENDING G UPON THE TYPE OF PUBLIC: WELL.. -=. MINIMUM GI'=TAN+lCE FROM A PRIVATE WELL TO A PRIVATE S=EWER LINE IS 25 FEET AND 1-0 A COMMUNITY SEWER LINE I C 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND COt-FITRUCT•ION•d DIAGRAMS ARE AVAILABLE TO INSURE PROPER IN•?STALLATION. I CERTIFY THAT :1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON --SITE SEWERS AND WELLS, AS SET FORTH B'•'e•' THE MUNICIPALITY OF ANCHORAGE. : I WILL INSTALL THE SYSTEM IN A�:CORDAN•dC:E WITH THE CODES. I I_Jt4DERSTt=AN D THAT THE ON—SITE SEWER 'SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE REMODELED TC1 INC -1.1-11:1E MORE THAN � BEDROOMS-_ ,F.LIi . tdl" S,C:HAC:HLE E,�<i)=: p j % V4. i >> x SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION EJ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: 09 C NAA 1C7 t L•}�E`� G !\� —DATE PERFORMED: J— I — O 1 ''i LEGAL DESCRIPTION: LOT b 1I'. -6 TPOS T eG HEI H I SLOPE SITE PLAN PE Pc 1 1 e — I FINE SAND ISltri y SAND 3 4 MLISM 5 6 ©dp IPooR L`( G Q.AD E D s ti0�+.-t+.tlsU� o�-� nCu ,ra 10 0 11 ~ & &IqsV� WAS GROUND WATER d ©ENCOUNTERED? ENCOUNTERED? O C 12 IF YES, AT WHAT b DEPTH? 131- I 3, I KA 14 • SM 15 16- - - mit 17 •49T_U*>Ar 18 .. 0000• 00• 04 •:0. 0000 .. •b• 19 o. 2225-E *4r UNE 25a 1971 4t. 20 �, ;•,• •.••��i � ` �`� 0000. • �G .� i k\ ONAL COMMENTS 7 INJO O P E Reading Date Gross Time Net Time Depth to Water Net , Drop PERCOLATION RATE TEST RUN BETWEEN FT AND (minutes/inch) — FT PERFORMED BY: 7T9w&19 `µCC CERTIFIED BY: /" DATE: J? I t� H H H H H H H H H H H H O O O O O O O O O O ® O Ln iV i rn U rn un Ln •. i� Ln H H H H per] H H l7 ' 47 47 f W a ro ro c 11 D 0 Hti (D P b x x d c� w c� ' w a � :rte• � a � ;` O rn cn O m r vC EcGn xt :E� r7 v it JD O O ® O O ® ® O ® ® ® O :w r• :o C :� C rt n m cD rt x rt inn ;o r r r n rD Er ' i w v rn v,'• Lq Lq rn -r- o wH o, :4' io h A H H H H H H H H H H H H O O O O O O O O O O ® O Ln iV i rn U rn un Ln •. i� Ln H H H H per] H H l7 ' 47 47 f W a ro ro c 11 D 0 H H Hti (D P b x x d c� w c� ' w a � :rte• � a � ;` O rn cn :rt m r vC EcGn xt :E� r7 v it JD lD : (D :b :w :w r• :o C :� C rt n m cD rt x rt inn ;o r r r n rD H H Hti N w b x d t4 a C � a � ;` O rn y m r vC EcGn xt :E� r7 v it JD lD : (D :b CO :� rt m :(D rt inn ;o Er i w p x h A » IC � p � � •rrn oil M o r _x L4 r r z Cs � � H ® r p ib H vu � :y Eo � ;rt ;fD n i� :Ln :a icD W N oa f+ N i t� 110 .Time Time e Date Date Date 4� Inspector Inspector Inspector Comments Conditional Approval Date Sewer Installed Permit No. Septic Tank Size Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY _ Property Owner =1011, 77 75 Phone Mailing Address G/{;;/L?/ml ' Buyer Address Lending Institution �, 7 Phone t Address Realty Co. & Agent Phone Address Legal Description f -V 7 IV E'4077T Street Location t3ur��y c.!//;l�/JJd/? P/Z11%/� TypResidence C9 Single Family /V ❑ Multiple Family No. of Bedrooms ❑ Other WatgVSupply tl Individual ATTACH WELL LOG. A well log is required for all wells drilled since June ❑ Community 1975. For wells drilled prior to that date, give well depth (attach log if ❑ Public Utility available. SewQpe Disposal Y9 Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. MUNICIPALITY OF ANCHORAGE Development Services Department pPhone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-092-04-000 Expiration Date: 1/16/2025 Legal description PROSPECT HEIGHTS #1 BLK 3 LT 4 Site address 9250 BUDDY WERNER DR Anchoraqe AK 99507 Current property owner(s) THRELKELD DUANE L ESTATE OF &DOYLE VALERIE D ESTATE OF XThe On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: New field was not installed because the engineer found the old field was dry and passed the adequacy testing. Original Certificate Date: 3/19/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services 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 work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approvdjune 2022 PrWHUPAUTYOF-- HCHORAGE Development Services Department o� Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-092-04 Complete legal description Prospect Heights #1 B3 L4 Location (Site address) 9250 Buddy Werner Drive, Anchorage, AK 99507 Current property owner(s) Valerie Doyle & Duane Threlkeld Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: 9 Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel Q Plastic ❑ Concrete ❑ Fiberglass Age < 1 yr - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: 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 Waiver Fee $ Date of Payment 1, �+ Date of Payment COSA # �S G Z ` Q ,! 1 0 Waiver # COSA Application—June 2022 4.73 Forge Engineering 1/16/24 N/A Benjamin Schiller, P.E.3/15/24 (907) 522-7773