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Home My WebLink AboutALPINE VILLAGE BLK 2 LT 17GAAB-HD- I GRraTER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY GALLONS. MATERIAL ~-~'2~_~ INSIDE LENGTH NUMBER OF / COMPA RTMF~NTS INSIDE WIDTH ' DEPTH__ SEEPAGE SYSTEM: NUMBER OF PITS / LINING MATERIAL NEAREST LOT LINE ~- ! SEEPAGE PIT: OUTSIDE DIAMETER OR WIDTH DISTANCE FROM WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ? BUILDING FOUNDATION~'''~0 ,~ ,~ SQ. FT, TILE DRAIN FIELD: TOTAL LENGTH NUMBER /o/'LI~.~S_~/'""D~STAN / TRENCH WI~.__...,..~......_,~,~/~IN. TOTAL EFFECTIVE ABSORPTION AREgS~Z~. SQ. FT. LENGTH OF EACH LINE, DEPTH: TOP OF TILE TO FINISH GRADE TYPE ¢~,,~ .... '-', DEPTH NEAREST LOT LINE I"/ SEWER LINE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE DISTANCE FROM WATER ~ BUILDING FOUNDATION /':'"'~' SAMPLE , NEAREST SEPTIC ¢¢ '/ SEEPAGE/. ~ f OTHER , TANK SYSTEM /~']~' , CESSPOOL '"'"-- SOURCES__ DISTANCES: DIAGRAM OF SYSTEM ,! DATE ~ ' - ' V-H~.'~LTH AUTHORITY GAAB.HD~2' GREATET 327 Eagle St. · NCHORAGE AREA HEALTH DEPARTMENT Anchorage, Alaska 99501 )ROUGH 279.2511 Case No. SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPL'CANT/,~2~'~ RESIDENCE ADDRESS'"~¢r~ ~" ~';":f/,,(' LEGAL DESCRIPTION ~ /~/ ~Z~ APPLICATION TO INSTALL: SEPTIC TANK L_~" , SEEPAGE PIT TOSERVETHE FOLLOWING FACILITY ~ ~~- ~~ FINANCED THROUGH .~~ ~ TEST RESULTS ~ ~ MAILING ADDRESS~'7. ~' '~,' '~-~' · PHONE LOCATION OF INSTALLATION~"~Z '~''~' ~ Z.,,~:'-. , DRAIN FIELD , OTHER c'~ TO BE INSTALLED By_ ~'~---'~1~' ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS . ' ~'~-/~" , PERMIT TO INSTALL A . AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED .SEPTICTANKSIZE~ ~ TYPE~~. , SEEPAGE AREA DIAGRAM OF SYSTEM DISTANCES: ; HEALTH AUTHORITY OR LICENSED DESIGNER I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. 44~'; APPLICANTS Sl G NATU R E,.t.~'~ DATE ~ ~ ,- -.. ~ . REATER ANCHORAGE AEEA BOROUGtt HEALTt{ DEPAETMENT 327 EAGLE STREET ANCHORAGE~ ALA.,KA 99501. CASE P~for, med For A.~z' / ~'~r-.~;~. Le,'a] Deser~ptzon: Lot This Farm Repot:ts a: So~ls Log Depth Feet 3-- Was Ground 'dater Er,.:countered?__~.~.~ If Yes, A~ k'~aZ Depzh.~.~ Location Sketch Net Time Net Drop , op .... e,~ ,m.:..a~..,~......~, See)~age P~% l---~ Dra~n F].e!d Data Cevtifled By: ,~.. Date: Certificate of On -Site Systems Approval Parcel I.D. 014-132-35 1. GENERAL INFORMATION Expiration Date: Complete legal description Alpine Village Sub, Block 2 Lot 17 Location (site address) 7217 Bern St, Anchorage, AK 99507 Current property owner(s) Mailing address Karl Green & Aileen Cannon Day phone _ 8213 San Mateo St, N Las Vegas, lise Bennet Real estate agent M y 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone (907)317-6621 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic ❑ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer no Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ a Waiver Fee $ Date of Payment L9 Ooh 2 Date of Payment Receipt Number 0 7 S 3 Receipt Number COSA #_ 03 C a-? 3 3 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. (M.J.) Date 1/26/22 OF Alq�>t�1 • ..:. 6. DSD SIGNATURE System #1 Approved for 4bedrooms :` ' 'i' 'r . • • • • • • • BenjamlrvSchiller System #2 Approved for bedrooms ��% CE 12592 R�� 1 ` Tp 1 /26/22• - Disapproved 11�, ROFESSIO� Conditional approval for bedrooms, with the following stipulations: WAST'�v'ATER z= J�'- J�p J�\ By Original Certificate Date: 2� — Z Z 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 Checklist blue sheet COSA Checklist Legal Description: Alpine Village Sub, Block 2 Lot 17 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ®❑ Well log is filed with Onsite (or attached) Date drilled 8/16/2013 Total depth 81 ft Cased to 81 ft ❑® Sanitary seal is functioning correctly FE -1 Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 1/19/21 Static water level at beginning of test 28 ft. Comments K DATA Age of tank years Tank type/material Measured operating fluid level Itic ❑ Standpipes/foundation cleanout per Date of pumping tank re2't�r�j drawing BSORPTION FIELD DATA Which Sys tested (date installed) ❑ ALL standpipes ent per record drawing Total measured depth from g ft (max) Measured depth to pipe invert from gra ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 014-132-35 Structure served by this system Well production at time of test 5.1 + gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic 9.43 ug/L ❑ Arsenic less than MRL (ND) Collected by Forge Engineering Date of Sample 1/19/22 T STATION ❑ Require intenance completed Age of lift station ears Lift station material Comments: Adequacy test date Results ❑ Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Fina 'd depth in Absorption ra gpd Any rejuvenation treatm ast 12 months) If yes, enter date 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' n�a if No Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft M Yes if No Neighboring Tank > 100' E] Yes if No ft Private Sewer/Septic Line > 25' M Yes if No Absorption Field on Lot> 100' ❑ Yes if No n/a ft Holding Tank > 100' ❑✓ Yes if No Neighboring Absorption Fields > 100' Surface Water > 100' ❑ Yes Animal Containment > 50' 0 Yes if No 0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑✓ Yes if No ft 0 Yes if No Tank on Lot to: (Please enter distances if less than required) Building Foundations—>> Property Line > 5' Absorption Field > 5' Water Main > 10' Water Service Line > 10' Yes if No ft ❑ Yes if - -o ft ❑ Yes if No ft _❑ Yes.. if No ft ❑ Yes if No ft Surface Water > 100' ❑ Yes if No Wells on Adjacent Lots: ft ft ft ft V ft PTells >j 100' ❑ Yes if No ft Community Wells es if > 20 YNo ft If septic tank is under driveway comment below Fr sorption Field on Lot to: (Please enter distances if less than required) Building Foundation > ,� Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if ft Wells on Adjacent Lots: Water Main > 10' ❑ Yes if No ft Wells > 100' ❑ Yes if No Water Service Line > 10' ❑ Yes if No ft Community Wells > Yes if No Surface Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS Lot is served by public sewer system. G. ENGINEER'S CERTIFICATION 1 certify that I 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 � ®FA i 49 Al Benjarri Schiller �¢ �F� • . • C E 12592 • �`v�r 1/26/22® Aw PROFESSO ft ft