HomeMy WebLinkAboutALPINE WOODS BLK 6 LT 1Onsite File
Alpine Woods
---------------
Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP191239 I PID Number: 015-234-41
Dwelling: FE-1 Single Family (SF) ❑Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑ Upgrade
Name:
Thomas & Penny Wells Trust
ABSORPTION FIELD
❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
6200 Downey Finch Dr. Anchorage, AK 99516
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
727-3300
5
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
Alpine Woods 6 1
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
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ft
Ft.
Well
>100'
N/A
N/A
N/A
>25'
TANK❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Greer
Capacity
11500 Gal.
Surface Water
>100'
N/A
N/A
N/A
Material
Number of compartments
Lot Line
>5
N/A
N/A
N/A
Plastic
2
NA
Foundation
>10'
N/A
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Curtain Drain
None
Noted
Gal.
Remarks Tank only permit.
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
Insulation was used over tank.
Pump make and model
Electrical Inspections performed by
PIPE MATERIAL House to tank D3034 Tank to
drainfield D3034
Installer
Denali Excavating
Drainfield Existinq CO/MT
Inspector MEA
BENCHMARK (Assumed elevation) 100 ft
InspectionX51 6/17/19 nd
Location and description
dates: 2
aro 4th
Garage slab
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
,011�®1111ttTA4
OF '�Cq®�
Conditional Approval: Date
�'
"'Ar
AW
ri f49th
..... ...u. ..av s...u.. .v v.Ra 10
® t..t.10
e....0.0...................................�
g MICHAEL E. ANDERSON g
AF.� No. CE-4381 ;°AW
Approved Date (� �� jq
0 6/26!19 ��'
11rJ ROFESS®®�`®""�
inspection Keport_a-i--iz.aoc
ALPINE WOODS. BLOCK 6 LOT 1
PERMIT # OSP191239
PID # 015-234-41
ko
WOODEN RETAINING WALL
\
lNGINEERIHG ,
wNimoltollom
i
0 50 100
=. FEET
A B
MT 23.6 19.7
MH
20.4
19.4
SV
18.1
23.3
2CO
14.6
28.1
LEGEND
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT- MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
PERMIT # OSP191239
J*-
EERING
PID # 015-234-41
PROFILE AS -BUILT
(NO SCALE)
1,116,011 LA "oe
ANY PAVING tMOWN Fit KtUN MAY tlt ANNKUX1MAIt UUt IU LALLNNIVt SNUW ANU/UK 1(.t.
12882, FB 165-14
ERFORMED A SURVEY
PERTY
UB.
ALASKA, AND THAT THE
THEREON ARE WITHIN
BLE ENCROACHMENTS
_26 TH DAY OF
HOLT LAND SURVEY/NG
9309 GROVERDR/VE
ANCHORAGE,AK 99507
907.223.8615
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: OSP191239
Work Type: SepticTank Upgrade
Tax Code Number: 01523441000
Site Legal Address: ALPINE WOODS BLK 6 LT 1 G:2738
Site Mailing Address: 6200 DOWNEY FINCH DR, Anchorage
Owner: WELLS THOMAS & PENNY TRUST
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
❑ Disposal Field Z Septic Tank ❑ Holding Tank ❑ Privy
Effective Date
Expiration Date:
,-nenc S.
Z_
i J
De pa rtment
Lot Size in Sq Ft:
Total Bedrooms:
6/17/2019
6/16/2020
44896
❑ 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, seated, and heated to prevent freezing
tI rod N�r1L
Date: l.C/ / / �/ /1�
Date: t 7 11
MUNICIPALITY OF ANCHORAGE
eta f
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. 015-234-41
Property owner(s) Thomas & Penny Wells Trust Day phone
Mailing address 6200 Downey Finch Drive Anchorage, AK 99516
Site address Same
Legal description (Sub'd., Block & Lot) Alpine Woods, Block 6, Lot 1
Legal description (Township, Range & Section)
Lot Size 44,896 Sq. Ft. Number of Bedrooms Five (5)
APPLICATION IS FOR:
APPLICATION IS AN:
(M all that apply)
Absorption Field
❑
Initial ❑
Septic Tank
❑X
Upgrade ❑X
Holding Tank
❑
Renewal ❑
Privy
❑
Private Well
❑
Water Storage
❑
TYPE OF DWELLING:
Single Family (SF) ❑X
(w/wo ADU)
Duplex (D) ❑
Multiple Dwellings ❑
(SF and/or D)
�A
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.
- E_ at'—J-,
(Signature of property owner or authorized agent)
Permit/Rush Fees: 0&0 Waiver Fees:
Date of Payment: (��Lil q Date of Payment:
Receipt Number: Receipt Number:
Permit No. Osp /a / 23 9 Waiver No.
Permit App_.;- :- :'—C
PO BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
June 14, 2019
MOA Development Services Dept, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Alpine Woods, Block 6, Lot 1 – 6200 Downey Finch Drive
Septic System Design
Dear On-Site Services Engineer:
The existing septic tank on Lot 1, Block 6, Alpine Woods Subdivision has outlived its useful life
and must be replaced prior to the issuance of a COSA. We are submitting this permit application
for the replacement of the septic tank. The attached site plan identifies the location of the home as
well as the existing water service line and existing and proposed septic tank site. The new tank
will be placed more than 10’ from the water service on the lot. No conflicts exist between this
proposed system and any other well, water service or septic system, whether on this lot or adjacent
lots.
The new septic tank will be a minimum of 200’ from all wells, 10’ from all water service lines,
100’ from surface water, and more than 5’ from property lines.
Please refer to the attached plan sheet for the septic design. If this design is followed, there will be
no adverse impacts to adjacent properties.
Sincerely,
Michael E. Anderson, P.E.
6-14-19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191239, Rebecca Carroll, 06/17/19
// // // // // //DECOMMISSION EXISTING
1,500 GALLON SEPTIC
TANK PER MOA CODE.
FCO
10050 0
FEET
1"=50'
NOTE:
NO EXISTING WELLS ON SURROUNDING LOTS - PROPERTIES ARE ON
A COMMUNITY WATER SYSTEM. SEPTIC SYSTEM IS MORE THAN 200'
FROM THE COMMUNITY WELL.
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
ALPINE WOODS, BLOCK 6 LOT 1
DOWN
E
Y
FINCH
DRIVE
6/14/19
1
0
'
T
&E EASEMEN
T
WOODEN RETAINING WALL
SHED
5-BDRM HOME
PLACE NEW 1,500 GALLON
SEPTIC TANK w/20" MANWAY.
CONNECT TO EXISTING
ABSORPTION TRENCH.
EXISTING 32' LONG
ABSORTION TRENCH
MH
SV
2CO
NOTE:
SEPTIC TANK MUST BE A MINIMUM OF 10' FROM
THE WATER SERVICE LINE ON THE LOT AND 5'
FROM ANY DECK/STAIR SUPPORTS.
WATER SERVICE LINE.
VERIFY LOCATION PRIOR
TO CONSTRUCTION.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191239, Rebecca Carroll, 06/17/19
ANY PAVING 5HUWN HtRtUN MAY Bt APPRUXSMATt UUt TU tXCt55IVt 5NUW AND/UR iCt.
12882, FB 165-14
ERFORMED A SURVEY
PERTY
UB.
ALASKA, AND THAT THE
THEREON ARE WITHIN
BLE ENCROACHMENTS
_7TH DAY OF
HOLT LAND SURVEYING
600 HIGHVIEW DRIVE
ANCHORAGE,AK 99515
345-5513
i~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME IPHONE
MAILING ADDRESS
LEGAL DESCRIPTION -' ~ '" ....
LOCATION NO. OF BEDROOMS
O_ v DISTANCE TO: ~.a:;~:)~' ,~' I I
I- 2 Manufacturer Material No. of compartments
Liq. capacity in gallons Inside length Width Liquid depth
150D IF HOMEMADE:
~,~ DISTANCE TO: Well Dwelling PERMIT NO.
~0 _ ~ Manufacturer Materia) Liquid capacity in gallons
~ Q :Z: DISTANCE TO: , Well ~. OO + Foundation I ~ Nearest lot line~.~ PERMIT'N~
~' ~ No. oflines , Len§th of e~c~ine Total I en §th c~f.~.nes Trench wid. th Distance between lines
gU , ~6~ ~0 inches
~ ~. Top of tile to finish grade Material beneath tile
0 4- ~Z.O ,~inches Total effective absorption area
.....
Length Width Depth PERMIT NO.
gU
<~ P- Type of crib Crib diameter Crib depth Total effective absorption area
gU Well Building foundation Nearest lot line
r~ DISTANCE TO:
.a Class Depth Driller Distance to lot line PERMIT NO.
gU
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
PIPE MATERIALS ·
02'
·
INSTALLER ,/.L~a~· ~ ~.,.~.
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
DEF AR"IMEIq l :" HEAI_'I"H AND ENV I RONMEN"rAL ROTECT I ON ,
825 L_ STREET, ,ANCHI]~AGE, AK 995()1
;:. 6 4 .- 4 '7,,:. () ' ~ '
[)IM ..... S I ]-E SE~:WER F"ERM I
F"ERM I T NO:
DATE ISSUEI):
850286
06 / 11/85
APPL I CAN'I':
ADDRESS:
CONTACT PHONE:
JOE LO MONACO
4715 I<ERSHNER AVENUE
ANCHORAGE, AK 99501
549-6681
I_EGAL DESCRIP:
LOT SIZE:
LOT LOCATII]N:
MAX BEDROOMS:
SUBDIVISION: ALPINE WOODS
SECTION: 25 'TOWNSHIP:
44896 (SQ.FT. OR ACRES)
Al_PINE WOODS DRIVE
5
LOT: 1 BLOCK: 6
12N RANGE: 3W
Listed below are the options available to you in designing your septic
system., Choose t. he option that best £it.s your site.
'"I'F,~ENCH W. DR(-a~ I I',..I
DEI:::'TH TO PIPE BOTTOM (F'T'.)
GRAVEl.. DEP'T'H (F'T.)
]"OTAL OEP'TH (FT.)
GRAVEL WIDTH (FI'.)
GRAVEL LENGTH (FT.)
GRAV[.EL., VOLUME (CU. YDS. )
TANK SIZE (GALS)
SOIl... RATING (SQ. FT. /BR)
4.0 4.0
6.0 3.5
10.0 , 7.5
2.5 5.0
53.0 68.0
· .:. 1.9 50.4
1,500. C) ** 1,500.0 **
:L25 125
'TANK MUST HAVE AT L. EAST TWO COMPARTMENTS
]: certify that:
1.. I am familiar with the requirements for on-site sewers and wells as set.
~or'th by the Municipality o~ Anchorage (MOA) and the State oF Alaska.
2. I will instal], the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria o~ this permit.
3. I will adhere to all MOA and State oF Alaska requirements ~'or t. he set back
distances Crom any existing well, wastewater disposal system or public
sewerage system on t. his or any' adjacent or nearby lot.
4. I understand that this permit is valid EoT a maximum o~ 5 bedrooms and
any enlargement will. require an additional permit.
IF A LIFT STATION IS INS]"AL. LED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN EL..ECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (~) AS-BUILTS
' ~' ' '" ' ............... ' ' ' '" AND (3) 'T'HE
W.[L..L. NOT EE AFFR~.D WITHOUT AN ELECTRICAL. .[ NSF ECT I ON REFOR],
S]:GNED __~._.~_~._~._.___ ~ ....................... DATE:
AF'PL. ICANT: JOE LO MONACO
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG ,.
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION: *~.~'/~,~'1~- /.,..J,Oi,~¢ ,~/¢x~. ~* ~o/z ,} c~(. Z-,.~
SLOPE
SITE PLAN
/
\/
\/
\/
.-'10
11
12
13
14
15
16
17
18
19
2O
WAS GROUND WATER S
ENCOUNTERED? ~'~'~ L
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
; TEST RUN BETWEEN FT AND FT
COMMENTS~
PER~ORMEDB,,,..cZ::z,--.--t mO~ St-'~r',=,,','--l-- CERT,~,EDB¥~ ~/' -
72-008 (6/79)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
~4
5
6
7
8
9
10
11
12
13
14
15
16
17
PERFORMED BY:
DATE PERFORMED:
SITE PLAN
SLOPE
ENCOUNTERED7 ' ' O
IF YES, AT WHAT
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
'z /z : ~,, ~. Io /' ?? O, ~. e,
~{
/~: /~ / 0 /, ~ ~ , /~
n
PERCOLATION RATE ~ / (minutes/inch)
CERTIFIED BY:
72-008 (6/79)
PERFORMED FOR:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Al#ka 99501 264-4720
SOILS LOG - PERCOLATION TEST
.~c~ ;~,-- DATE PERFORMED:
LOG
[~.PERCOLATION
TEST
SLOPE SITE PLAN
11 ~ ~ / .-;, ~ b WAS GROUND WATER S
ENCOUNTERED? ~ I C.~ L
O
12 P
E
IF YES, AT WHAT
DEPTH?
13
<J'"" e' /' ;, ~<,..-..
Gross Net Depth to Net
Reading Date Time Time Water Drop
" :17 C. Re;d, Jr,
- 2251.E
"":":" . PERCOLATION RATE r
'~ , ,(minutes/inch)
;~,,t -~,,~ S' ' /~ .... , ,. c~,.c .~ty , ,~ $'/.,~Kr~,-- ;,.,~,~ ~, ,'f. .:~,.,r ,r
~, / t'~t~ z~ ; 7 ~ ~--o ~ ~ CEnT~F[ED BY: DATE:~
PEnFOnMED
BY:
MUNICIPALITY F ANCHORAGE
t`,,1,Q
Development Services Department - Phone: 907-343-7904
On -Site Water & Wastewater Section - Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 015-234-41 Expiration Date: V w-) e- 0
1. GENERAL INFORMATION
Complete legal description Alpine Woods, Block 6, Lot 1
Location (site address) 6200 Downey Finch Drive Anchorage, AK
Current property owners) Thomas 8c Penny Wells Day phone
Mailing address 6200 Downey Finch Drive Anchorage, AK 99516
Real estate agent Dave Windsor Day phone 727-3300
2. TYPE OF DWELLING:
E] Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 5
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well ❑ Private Septic
0
Water Storage ❑ Holding Tank
❑
Community Well El Community
❑
Public Water System ❑ Public Sewer
❑
Waiver request for:
Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee 0, 0 o Waiver Fee $
Date of Payment (P(25 sol I Date of Payment
Receipt Number DO �D wL� Receipt Number
COSA # ��Ci�� Waiver #
e*r us V1%41
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 Michael E. Anderson, P.E. Date 6/25/19
6. DSD SIGNATURE
j System #1 Approved for 5
System #2 Approved for
Disapproved
Conditional approval for
bedrooms
bedrooms
_.s'aa®eam
bedrooms, with the following stipulations:
.'affi(((l w",.
By:t6�j, ost"UI-J) ,,, Ilwt ic�e�u�1c� Original Certificate Date: % Z7 1
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 Checkiist blue sheet
Legal Description: Alpine Woods, Block 6, Lot 1
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled
Total depth ft
Cased to ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Comments Community Well, Well Type A, PWSID# 24941
B. TANK DATA
Age of tank(s) New years
Tank type/material Septic/Plastic
Measured operating fluid level in septic tank New
❑ Standpipes/foundation cleanout per record drawing
Date of pumping New Construction
D. ABSORPTION FIELD DATA Deep Trench
Which system tested (date installed) 8/15/85
❑ ALL standpipes present per record drawing
Total measured depth from grade 13.8 ft (max)
Measured depth to pipe invert from grade 5.3 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective 8.5
❑ 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: 015-234-41
Structure served by this system
Well production at time of test 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 ug/L ❑ Arsenic less than MRL (ND)
Collected by
Date of Sample
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 6/4/19
Results ❑✓ Pass For 5 bedrooms
Fluid depth prior to test 0 in
Water added 900 gal
New depth 15 in
Elapsed time 1440 min
Final fluid depth 0 in
Absorption rate >750 gpd
Any rejuvenation treatment (past 12 months) None
If yes, enter date
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Yes
Septic Tank/Lift Station on Lot > 100'
❑ Yes
if No n/a ft
Community Sewer Manhole/Cleanout > 100'
n/a
Absorption Field > 5'
❑✓ Yes
r7 Yes
if No ft
Neighboring Tank > 100' ❑ Yes
if No n/a ft
Private Sewer/Septic Line > 25' ❑ Yes
if No n/a ft
Absorption Field on Lot > 100' ❑ Yes
if No n/a ft
Holding Tank > 100' ❑ Yes
if No n/a ft
Neighboring Absorption Fields > 100'
n/a
Animal Containment > 50' ❑ Yes
if No n/a ft
❑ Yes
if No ft
Community Wells > 200' R Yes if No
Surface Water > 100'✓❑
Community Sewer Main > 75' ❑ Yes
if No n/a ft
Manure/Animal Excreta Storage > 100'
❑ Yes
if No n/a ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' Q Yes if No ft
Property Line > 5'✓❑
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
❑✓ Yes
if No
ft
Private Wells > 100' Q Yes if No ft
Water Main > 10'✓❑
Yes
if No
ft
Community Wells > 200' ❑✓ Yes if No ft
Water Service Line > 10'
✓❑ Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'✓❑
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'✓❑
Yes
if No
ft
Private Wells > 100' Yes if No
Water Service Line > 10'✓❑
Yes
if No
ft
Community Wells > 200' R Yes if No
Surface Water > 100'✓❑
Yes
if No
ft
F. ENGINEER'S COMMENTS
Septic Tank replaced on 6/18.
G. ENGINEER'S CERTIFICATION
I 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
40 e 0.
r
49th `•
,..,r' ....... ............fi.Z.....s..... 0
k.................... .... . m......un..ne .....mss.
MICHAEL E. ANDERSON to
% No. CE -4381
6-26-19 �..•'•��
�p •........... 40,>�5��®
ft
ft
u
,1a9 161 ,� ,
0100
t 4.
• �E9 tri
Municipality of Ancho a e2p17 �* '`°
On-Site Water and Wastewater Prog SUN d 1
(907)343-7904 s a r e.r
6
Certificate of On-Site Systems App o ! 6 a �'
Parcel I.D. 015-234-41 Expiration Date: �._ / (52
1. GENERAL INFORMATION
Complete legal description Alpine Woods, Block 6, Lot 1
Location (site address) 6200 Downey Finch Drive Anchorage, AK 99516
Current Property owner(s) Thomas & Penny Wells Day phone
Mailing address 6200 Downey Finch Drive Anchorage, AK 99516
Real Estate Agent _ Day phone
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: Five
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class A Well Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: tIM et-itDate: 61-7//6--
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ di(e) Waiver Fee $
Date of Payment (Il-1.'- Date of Payment
Receipt Number d %/4 Receipt Number
COSA# O SCS \�,.C� 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 5-31-2017
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6. DSD SIGNATURE d°,°i�p:c1•••,l
System #1 Approved for bedrooms (} MICHAEL AFJDER �
System #2 Approved for bedrooms sr°. c`-qgg) •_```"
Disapproved t, o p •....•.,‘*\.'
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Conditional approval for bedrooms, with the following stipu atibi► =
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By: � t ln.` �l Original Certificate Date: — — ( 7
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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 sheet[ 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: Alpine Woods, Block 6, Lot 1 Parcel ID:015-234-41
A. WELL DATA
Well type A If A, B, or C provide PWSID # 24941 Well Log (YIN)
Date completed Sanitary seal (YIN) Wires properly protected (YIN)
Total depth ft. Cased to ft. Casing height(above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic ug/L Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 8115185
Tank size 1 '500 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N
Date of pumping (-1_I - 20 ( 7 Pumper Around the Clock Pumping
C. ABSORPTION FIELD DATA
Date installed 8/15/85 Soil rating (g.p.d./ft2 or ft2/bdrm) 125 sFIBORM System type Deep Trench
Length 32 ft. Width 3-5 ft. Gravel below pipe 10 ft.
Total depth 14 ft. Eff. absorption area 640 ft' Monitoring tube Y Depression over field N
Date of adequacy test 3/23/17 Results (Pass/Fail) Pass For 5 bedrooms
Fluid depth in absorption field before test 0 in. Water added 755 gal. New depth 18.5 in.
Elapsed Time: 1 ,440 min. Final fluid depth 0 in. Absorption rate >= 750 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 - Community Water
WELL ON LOT TO:
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer/septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line >5 Absorption field
>10' >100'
Water main Water service line >10 Surface water
Wells on adjacent lots >200'
ABSORPTION FIELD ON LOT TO:
>10'Property line Building foundation >1 0 Water main ��0
Water Service line Surface water Driveway, parking/vehicle storage 10
Curtain drain None Noted Wells on adjacent lots >200'
F. COMMENTS
lobvilioi y ii,,
G. ENGINEER'S CERTIFICATION '''''‘:\ 14
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1 certify that l have determined through field inspections and r 0): • . • : 'i'
review of Municipal records that the above systems are in �• 49Th f� .*rD
conformance with MOA COSA guidelines in effect on this date. ,. `• .•;�� •••-/•'�t• L Q,..•
Michael E. Anderson, P.E. o cr.
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Engineer's Printed Name +ICHAEL E. ANDERSON •,,•.t
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Date 6-1-2017 #�sr.,., CE- 4381 .�:�
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COSA brown sheet 10-10-12.doc
