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HomeMy WebLinkAboutATELIER #2 BLK 3 LT 6AOnsite File
1"" W
At I io r #2
041 � 031 � 65
5vfl-,W-y a-t,Q "�6 F-OZ- Cosh
Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3
ON -SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP221405 PID Number: 041-031-65
Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade
Name
JACK NICKEL
ABSORPTION FIELD
❑ Deep Trench 0 Wide Trench ❑ Bed ❑ Mound
Site Address
7230 MONTAGNE CIRCLE `ANCHORAGE, AK
❑ Other
Phone
Number of Bedrooms
Soil Rating
depth from original grade
907-250-5022
3
0.8 GPD/SF
JTotal
8.68 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
SEE DWG. Ft.
Gravel depth beneath pipe
4.02 Ft.
Subdivision Block Lot
ATELIER #2; BLOCK 3, LOT 6A
Fill added above original grade
SEE DWG. Ft.
Gravel length
60 Ft.
Township Range Section
Gravel width
5 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
600 Ft2
1
- Ft.
Well
100'+
100'+
-
-
25'+
TANK R Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer Capacity
GREER TANK 1500 Gal.
Surface Water
100'+
100'+
-
-
Material
Number of compartments
Lot Line
1 0'+
1 0'+
-
-
NA
PLASTIC
2
Foundation
1 O'+
1 0'+
-
_
LIFT STATION
Manufacturer
Capacity
Remarks PER CONTRACTOR, OLD TANK WAS DECOMMISSIONED PER UPC
Gal.
WE REQUEST YOU WAIVE THE REQUIREMENT FOR AN UPDATED AS -BUILT SURVEY
Alarm location
Electrical installed by
PIPE MATERIAL House to tank EXISTIN drainfield Tank to
D3034
Installer
A+ HOME SERVICES
Drainfield D3034 Co/MTD3034
Inspector GEG
BENCH MARK (Assumed elevation) 99.16 ft
Inspection1st 5/23/2023 20° 5/25/2023
Location and description
31' 5/25/202 4'" N/A ITOP
OF MANHOLE
ON -SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
,00�oOp��
OF
Conditional Approval: Date
�.... ...........
^
Septic System n'
Approved / v� Date " 2n
..................p
0�� .J f reCE 79 3 Hess: mop
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2
..��3� �g",
Note: this approval does not include well permit requirements.
#AEcC884 4p�000000�
(Kev ub/urria)
PERMPT NUMBER: PARCEL ID NUMBER:
OSP221405 RECORD DRAWING 041-031-65
TH
TOP OF TANK AT INTLET = 95.01
INVERT OF BUNG AT INLET =
ORIGINAL GRADE AT
HIGHEST POINT = 94.46
TOP OF MH = 99.16
98.11-98.38
ST1
2" INSULATION
TOP OF TANK AT OUTLET = 95.00
NEW 1500 GALLON H.D.P.E.
GREER SEPTIC TANK
T
4.02'
T
RELATIVE ELEVATION AT BOTTOM OF T.H. = 77.96
(T.H. DRY ON 5123/2023)
INVERT OF BUNG AT OUTLET = 94.13
FINAL GRADE = 94.46-95.23
TER FABRIC
INVERT OF PIPE = 89.80
OF TRENCH = 85.78
GARNESS EING11NEERING
GROUP, Ltd
ENGINEERING a SALES Q, CONSULTING
3701 E. TUDOR ROAD. SUITE 101 -ANCHORAGE. AK 99507' PHONE (907) 337{,179 -FAX (907) 3363246' WEBSITE: rrnw.gamessengineering.cam
PREPARED FOR:
PHONE NUMBER:
PAGE NUMBER:
JACK NICKEL
907-250-5022
3 OF 3
LEGAL DESCRIPTION:
DRAWN BY:
ATELIER #2; BLOCK 3, LOT 6A
D.J.G.
TYPE OF WORK:
DATE:
SEPTIC TANK PROFILE
5/31/2023
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•PERM!T NUMBER: PARCEL ID NUMBER:
OSP221405 RECORD DRAWING 041-031-65
ATELIER #2; BLOCK 3, LOT 5A
rvn 1 w.7 or.7
CO2 105.7 58.7
MT2 106.4 60.3
NOTE: PIPE LOCATION ARE
SHOWN PER GEG SHOTS
TAKEN WITH LEICA DISTO
S910 LASER DISTANCE
METER. SWING -TIES TO
HOUSE CORNERS WERE
I
T.H.#1
GENERATED IN AUTO AD.
'
MT2
NEW DRAINFIELD
CO
MT1
w
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A
NEW 1500 GALLON GREER TANKLU
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EXISTING DRAINFIELD I
;i
EXISTING 3
BEDROOM HOUSE
.0
\ N /
SCALE:
\ V=40'
5 L I G`R�J9 Ltd
ENGINEERING � SALES Y CONSULTING mzz L11- I' °=
3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK 99507 • PHONE (907) 3376179 • FAX (907) 339J246' WEBSITE:—.ga ,.g(n ing,-.
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
JACK NICKEL 907-250-5022 2 OF 3
LEGAL DESCRIPTION: DRAWN BY:
ATELIER #2; BLOCK 3, LOT 6A D.J.G.
TYPE OF WORK: DATE:
� RECORD DRAWING OF TANK AND DRAINFIELD UPGRADE 5/31/2023
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LICENSE
#AECC884 tee®®®®
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: OSP221405
Work Type: Septic Upgrade
Tax Code Number: 04103165000
Site Legal Address: ATELIER #2 BLK 3 LT 6A G:2142
Site Mailing Address: 7230 MONTAGNE CIR, Anchorage
Owner: HICKEL JOHANNA L & JACK
Design Engineer: GARNESS ENGINEERING GROUP LTD
This permit is for the construction of:
Effective Date
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
cnt
llehartine nt
10/18/2022
10/18/2023
79659
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
Received By:
Issued By:
Date:
Date: D 2
3
MUNMPAUTY OF ANCHORAGE
Development Services DepartmentPhone: 907-343-7904
_r
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 041-031-65
Property owner(s) JACK HICKEL Day phone 907-250-5022
Mailing address 7230 MONTAGNE CIRCLE *ANCHORAGE, AK
Site address 7230 MONTAGNE CIRCLE *ANCHORAGE, AK
Legal description (Sub'd., Block & Lot) ATELIER #2; BLOCK 3, LOT 6A
Legal description (Township, Range & Section)
Lot Size Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field [f Initial ❑
Single Family (SF) El
(w/wo AD U)
Septic Tank [] Upgrade 0
Duplex (D) ❑
Holding Tank ❑ Renewal ElMultiple
Dwellings ❑
Privy ❑
(SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A 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 or authorized agent)
Permit/Rush Fees: 67915- Waiver Fees:
Date of Payment: /0 L12 a Date of Payment:
Receipt Number: og _-03 64 Receipt Number:
Permit No. d 5PQ ,/ t/&5- Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Appllcation.doc
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221405, Deb Wockenfuss, 10/17/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221405, Deb Wockenfuss, 10/17/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221405, Deb Wockenfuss, 10/17/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221405, Deb Wockenfuss, 10/17/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221405, Deb Wockenfuss, 10/17/22
Municipality of Anchorage Page / of_~.._
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: 5 ~/~Do~C~ PID Number: ~/--
Name: M~ ~'~~ WastewaterSystem: ~New ~ Upgrade
Address:
?/W ~n~~ ~r ABSORPTION FIELD
Phone: ~--~ I N°'°fBedr°°ms:~~ ~DeepTrench ~ Shallow Trench B Bed B Mound ~Other
Total Depth from original grade:
LEGAL DESCRIPTION SoilRating: /'~ GPD/Sq. Ft.
Lot: ~ ~ Block~ ~' ~ubdiv~ion:~,~ ~ Depthv~j~ ~t° pipe bottom~,~from_~.~original grade: Ft. Gravel depth beneath pip~,/ Ft.
Township: [ Range: Section: Fill added above original grade: Gravel length:
~ Ft. Ft.
Number of lines: Distance between lines:
WELL: New D Upgrade Gravel width: ~ Ft. / ~ Ft.
Classification (Pri~te, A,B,C):J~t~ ~ Tota~: Ft. Case~ Ft. Total absorptionarea:~,Z. ~ S~.Ft. Pipe material: /
Driller:_ Date D~lled: Static Water Level: Installer: Date installed:~
Yield: / Pump Set at: ~ Casing Height Above Ground:
I~-I~ G~ ~n~n ~. ZO'~ F,. TANK
SEPARATION DISTANCES ~Septic ~ Holding ~ S.T.E.P.
To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons:
From Tank Field Station Tank Sewer Lines A~ ~ ~
, , I Material: ~~ Number of Compa~ments:
Sudace
Water J~'~ ~00 + - - loo'~ LIFT STATION
LOt t , t Size in gallons:~ Manufacturer:
Line ID ~ I0 ~ -- -- I0 *
"Pump on" level at: ~' level at: High water alarm at:
Foundation /0 ~
Cu~ain.~Drain /~0' + /DO'' ~ -- /OO,~ Pum~ I Electrical Inspections pedormed by:
Remarks: ~ ~O ~ ~r ~n ~r~ BENCH MARK
Location and Description:
Assumed Elevation:
/~ n,
~;~:;.. ;ENGINEER'S SEAL ....
Inspections pedormed by: KND ~.o~~ Dates: 1st ~JZSJ?~
Department of Heal~ and Human Ca.ices approval J/~
Reviewed and approved by: ' Date:/~.-~ -~7
72-013 (Rev. 9/91) MOA 25
i AS-BOIl_ 1- SYSIBM DETAILS/SIIEi PLAN Per-mi-L SW960089
IRE GA, BLOCK 3, ATELIER ~S SUSB~VISIBN PIS~041-031 65
~ I BASIS OF
E:
1"
50'
:~ ORIGINAL GRAgE
~ ~ rlL [ER FABRIC~ I
S~--~1500 gal = .
~'~ ~ S~UER RBCK .... ,
(* 49TH~ * q
a D~US
~~~ ~aTa,ii/iS/gGRav.~/30/97 DBA'WING H
~ ORIGINAL GRADE xa c
1500 GAL- ' -,,. _
SEP'I lC ~ - __
~ ~ SEWER ROCK
SCALE: NTS .
PREPARED FEB', I<ND ENGINEERING'
B044] PTARH]iGAN BLVD
MIKE El'CONNER I-'AGLE RIVER, Al<, 99577
7141 MDNTABNE CIRCLE (90'/)696 6111/Fax (90'1)696-8111
ANCHORAGE, AK 99507
SCALE: AS NOTED' sGoso-sl
N0V-26-96 TUE 17:21 PE~K ~NOHOR~GE F~× NO, 907 263 7070 P, 02
1201 Ramona St., 995i5 :..
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cost AL '
, ,.. ,...: , ." ,:.-' ..~',~:;.,**'..'.';71,:.'" ".. ~ ' ' ", ":~;'.':' , ~=~00,00 '
'WRITE ·CHECK PA~ABLE TO ~P~RT P"I~LING w°RK$ FoR ~UM OF .--- , -,.
. ' .. . . ' . . :. . . ~ *':'¢'~. ~ :~ "'"' . ,~ .,
' ,. ;-':" '.. '... ' . :," ' ' '. :'. :.',.':BERNIE C~Ui OF RAMPA~ DRILLIN6 WO ,
..... eec un~, wILL BE ASGE$5~ ~N P~T DUEACCOUN~,
~N~ ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696-8111
September 26, 1997
Mr. Dan Roth
Municipality of Anchorage
Dept. of Health & Human Services
On-Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519-6650
RECEIVED
29 1997
Municipality of Anchorage
Dept. Health & Human Services
Subject: Lot 6A, Block 3, Atelier Subdivision #2 - SW 960089 - Final
Inspection Report
Dear Dan:
Attached is a letter of non-objection from the Department of Public Works for the
section line encroachment on the subject lot.
The well was relocated by the owner due to access problems with the drill rig
and to shorten the water line distance. As the septic system is outside the well
radius there should be no problem with the relocation.
If you have any questions about this application, please call me at 696-6111/FAX
696-8111.
Respectfully submitted,
I1~i~I1~ Eng~ne?dng
c Duffus, P.E.
Mike O'Conner
attachments: Letter of Non-Objection
Mtmicip',flity.
Anchorage
I'.(). Box
Anch(}i'agc, Alaska 99519-66,%0
Tclcpllm~c: (907)~5~-8277
F~x: (907) 561-1057
h tlln//www.ci.anchoragc.ak.us
Rick Mystrom, Mayor
September 9, 1997
Michael R. and Kathleen A. O'Connor
7141 Montagne Circle.
Anchorage, Alaska 99507
Dear Mr. and Mrs. O'Connor:
RE: Septic System Encroachment, Lot 6A, Block 3, Atelier Subdivision #2, Grid 2124
Street Maintenance Right of Way Section has reviewed a request from Mr. and Mrs. O'Conner
for a letter of non-objection to an existing septic system located in the 33' section line easement
on the west side of referenced lot. The as-built survey dated November 15, 1996, submitted with
the request, shows the location of the location. If the 33' section line easement according to Plat
#82-503 is not within the Municipality's jurisdiction, then this letter of non-objection will not be
valid.
Street Maintenance Right of Way Section issues this letter of non-objection with stipulations, and
by using it the petitioner is agreeing to the following:
1. Municipality of Anchorage (MOA) will be held harmless, now and forever, for any damages
or injury to any person as a result of the encroachments.
2. All applicable codes and regulations will be observed and maintained within the easement;
3. This letter of non-objection will in no way preclude MOA from full use and enjoyment of its
rights within any portion of the easement.
4. Additional and extraordinary costs incurred during any future required construction, repair or
reconstruction of MOA improvements to accommodate any or all of the encroachments shall
be paid by the property owner.
This letter of non-objection should be retained in your permanent files. Should you have any
questions, please call me at 343-8246.
Sincerely,
ROW Permit Manager
1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
PoO~ BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PAGE 1 OF
PERMIT NUMBER:SW960089
DESIGN ENGINEER:KND ENGINEERING
OWNER NAME:O'CONNOR MICHAEL R &
OWNER ADDRESS:7141 MONTAGNE CIRCLE
ANCHORAGE, ALASKA 99507
DATE ISSUED: 5/24/96
EXPIRATION DATE: 5/24/97
PARCEL ID:04103165
LEGAL DESCRIPTION:
ATELIER #2 BLK 3 LT
6A
LOT SIZE: 79659 (SQ. FT.)
NUMBER OF BEDROOMS: 5 THIS PERMIT:
5
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
Ao OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
DATE: Y- 24 -
~D ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696-8111
May 10, 1996
Municipality of Anchorage
Dept. of Health & Human Services
On-Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519-6650
Subject: Lot 6A, Block 3, Atelier Subdivision #2 - Sewer and Well Permit
Gentlemen:
Following a request from the owner regarding the proposed development of the
referenced property, we dug two testholes for the proposed system and
replacement field. The results of those tests.are attached.
The system will be placed on the west portion of the lot. As indicated on the site
plan there is sufficient grade to maintain a gravity system. A 1500 gallon tank
will be installed in anticipation of a 5 bedroom house being constructed. There is
also sufficient area and grade to maintain a replacement gravity fed field.
As indicated by the site plan drainage arrows, natural drainage is away from this
site and will be maintained after construction. There is no sUrface water within
100' of the proposed installation. There are no curtain drains within 50' of the
proposed installation. No wells exist within 100' of the proposed installation.
If you have any questions about this application, please call me at 696-6111/FAX
696-8111.
Respectfully submitted,
~) Engineering
attachments:
On-Site Well and Sewer Application
Wastewater Absorption System Details
Site Plan
Soils Log/Percolation Test
WASTEWATER i ISPBSAL SYSTFM
LOT 6A, BLOCK 3, ATELIER SUBDIVfSTBN
ND WELL WITHIN 800' OF SYSTEM.
PROPOSED FIELD
RESERVE
~ ND WELL WITHIN 800' DF SYSTEM,
i, Contour in't;ervo[ is 1'.
~, Surf gee w~l'ter weis citon9 Mon't(19ne Cir, during -t;e$'thotes,
tout dls(ippeo, red dur'in9 wo.'ter' monitoring,
PREPARED FOR:
MIKE B'CDNNER
7141 MBNTAGNE CIRCLE
ANCHDRAGE, AK 99507
KND ENGINEERING
20441 PTARMIGAN BLVD
EAGLE RIVER, AK, 99577
(907)696-6111/FAX (907)696-8111
DATE~ 5-10-96 DRAWING #
SCALE~ I' = 100' 9630-S'1
DESIGN DETAILS
WASTEWATER DISPOSAL SYSTEM
LOT GA, BLOCK 3, ATELIER SUBDIVISION
--CONNECT TO PROPOSED HOUSE
Pepmlt
w
J I
UNCLASSIFIED FILL(FROM TRENCH EX)
FILTER FABRIC ~
L 0.5'
1500 GAL --~',,,.-- SEWER ROCK
S,T, ~
53'
BOTTOM OF TRENCH~
7-~ ~-~/-~ //~
BOTTOM OF TEST HOLE 20,0'
BOTTOM OF TEST HOLE PROBED TO 22'
NO WATER OBSERVED
0
C,O, CONNECT TO PROPOSED HOUSE
53'
DESIGN CRITERIA
1, 5 BEDROOMS X 150 GAL/DAY/BEDROOM = 750 GP]]
~. SOILS RATING' a MIN,/INCH = 1,~ GPD/SF(TRENCH)
3. 750 GPD/1,a GPO PER SF = 625 SF
4. 6P5 3F /6'9 x ~ = 5~,08 L (USE 1 TRENCH 53 L)
5, MINIMUM DESIGN SIZE = 53' L x 3' W x 6' D Tmench
6, P' HD INSULATION REQUIRED OVER TANK <4' DF COVER
PREPARED FOR:
MIKE O'CONNER
714l MONTAGNE CIRCLE
ANCHORAGE, AK 99507
KND ENGINEERING
20441 PTARMIGAN BLVD
EAGLE RIVER~ AK, 99577
(907)696-6111/FAX (907)696-8111
DATE~ 5-10-96 DRAWING #
NOT TO SCALE 96030-sa
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
WAS GROUND WATER
ENCOUNTERED?
s
L
IF YES, AT WHAT
DEPTH? /~/'A 0
Depth lo Water After 4,4 ~'/~ PE
Monitoring? Az/fi" Date: ,
..,, ~,oo.?~).
DATE PER FOR~'~; °o_ ~/~¢/~ .c~ ~
Township, Range, Section: ~ __ ~r~
SLOPE SITE PLAN
Reading Date Gross Net Depth to Net
Time Time Water Drop
'~/~
~ ~ :/~ ~ 7~/~ ~/~
~ ~../q z ~ ~
20 E o /4
PERCOLATION RATE 'fi' ~ ~' (m~nutes,qnch) PERC HOLE DIAMETER .__
TEST RUN BETWEEN ~ ~ FT AND fi' ''~ FT
//
ACCORDANCE WITH ALL STATE AND MUNICIP~GUIDELINES IN EFFECT ON THIS DATE,
72-008 (Rev. 4185)
CERTIFY THAT THIS TEST WAS PERFORMED IN
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
4
9
10
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT
E
Depth to Water After ,j,,/ ~../~k~
Monitoring7 /t?pr Date:
13
14
15
Township, Range, Section:
SLOPE SITE PLAN
Gross Net Depth to Net
Reading Date
Time Time Water Drop
o q/~o ~.,o~ - 77~., _
I ' ~:o~ I,~,;~ ,~ ~ ?/~"
z 5,.o/ / ~ 9'¢ ~"
~Z~ 5;,7 I'?Ye ~"
~ 5~q i 7/~ I"
20 Eo/¢'
PERCOLATION RATE / (minutes/tach) PERC HOLE DIAMETER
TEST RUN BETWEEN ~° :~ FT AND 9, ~ FT
//
ACCORDANCE WITH ALL STATE AND MUNICIP IDELINES IN EFFECT ON THIS DATE
72-008 (Rev. 4/85)
CERTIFY THAT THIS TEST WAS PERFORMED IN
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9--
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
so, s
~~ ~ ~/~/~ Township, Range, Section:
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED? ,
S
IF YESo AT WHAT
DEPTH? p
E
Deplh to Water After
Monitoring1 ,
Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RAI.E ~" ~ -~ (m~nutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ '~ Fl' AND ~, 5 FT
~./
ACCORDANCE WITH ALL STATE AND MUNICMGUIDELINES IN EFFECT ON THIS DATE.
72-008 (Rev. 4/85)
CERTIFY THAT]HIS/TEST
WAS PERFORMED IN
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: ~'~
2t_..b Range, Section:
SLOPE
10
11
12
13
14
15
16
17
18
19
20
WAS GROUND WATER
ENCOUNTERED? .
S
IF YES. AT WHAT ,/~,
DEPTH? p
E
Depth to Water After
Monitoring?
SITE PLAN
COMMENTS
Gross Net Depth to Net
Reading Date Time Time Water Drop
5:37 I ~ ~ ' ~
, :,~q I ~ ~
::~1 / 2 V~ I"
:.'VF /, to y: i"
PERCOLATION RATE / (m~nutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN q FT AND . .
~ FT
ACCORDANCE WITH ALL STATE AND MUNICI~L GUIDELINES iN EFFECT ON THIS DATE.
72-008 (Rev. 4/85)
CERTIFY THATtHIS/TEST
WAS PERFORMED IN
unicipality of
Department of Health and Human Services
Tom Fink, 825 "L" Street
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
January 8, 1990
Mari M. Thicks~un & Vernon Collins
1231 Autumn Lane
Anchorage, Alaska 99504
Subject: Lot 6A Block 3 Atelier S/D #2
Permit #890089, PID #041-031-65
The subject permit, issued by this office for a single family
well and/or on-site wastewater system has expired as of December
31, 1989.
Permits are issued on a calendar year basis by authority of the
Municipal Code of Regulations. A new permit must be obtained
from this office for an well and/or on-site wastewater system
not installed by the expiration date.
If you have drilled the well, a well log needs to be sent to
this office for documentation of the installation and to close
the permit.
If a private engineer inspected the installation of the on-site
wastewater system, the original as-built inspection report
(three-part form) must be sent to this office for review,
approval and documentation.
When applying for a new permit, the fees are: $90.00 for an
on-site wastewater permit; $50.00 for a well permit; $140.00 for
a combined on-site wastewater and well permit.
If you have any questions, please call this office at 343-4744.
Sincerely,
John Smith, P.E.
Program Manager
On-site Services
JW/ljm:200
enc: Copy of Permit
"Kids Are Our Future"
I....,:::)'L L,~at.~;la:i.~ '.:Sul::)d:i.¥:i.!!!.:.:i.c:¢'l,-, ~TELIER ~ Lot: 6A Block: :~;
L. c:,'L S :i. ;~ ~'..',, ;2. ,, 5,~.:~ ( ~ ':::1, f 'L ,, o r' ~ c:: r' ~,~, ~ )
['la.~-~ E~r.:.:,(::l i" (::,~::~'l~.~. ~[ 'f' I"'~ :i..~ t:::'(~, r' m :i. C ~', '.~ji 'l"~:~t ,~ ]. Cap ~.(::
'.(:)i::) NO'f' IEXE',tEE:,~:) I"'If:~I',.ILff::'AE;"I"t. JF;,'I.:.!:F;'.!i!; I"lf:~X:t:I"ILJI"I P~[...t...C')NE::;(:) BUF;'.:[~'::q .... DtEF:"TI'"I I:::'E)I::;.: THE:
SI!!!:F"T :[ (::; '!" ¢'~1\I1'~:: ,, THE: IEXC;¢'-IVt..YT]:I',tE') CEiI\ITFd..ICT(3F~: SFICIUL..D EIIE Cd,',tf.../F;.'.IE Eft::'
I::;:IE(:;!LJ :1: i;:;'.IEP'II!!!:NT S Dt..JF;~ ]: I',IE~ TI'"IIE E; X C(.::?v'PFI" ]: (::)lq ,"-.~I",ID :1: N(;3'T'¢d....L..f...'/T ;[ ON C)I::;' "I"H :[ S
.~'31.:i:D,, E;E:D 'T'(::I )3tE :!: NS T¢fl....I....E:D :1:I',1 ~:./CC;CtI::;:;t':)f.q',tC;IE N :1: "fl'"l 1Et",IG ]; NIEEt::~ ' S DE:S :[ [!it'*l,,
"I"1~'1:1: S I:::' E: F;'. PI ]i T :1:!3 F:'QFi'. ¢'.:'~ ~!~ ~31E)::)F;'.E)EIFI !ii!;/F: I::~E!:S :1: Dtili:I',.IE;IE ONI....Y ~ (..~I",ID IE X F:' ]; RES
t::)N :t. 2/:3 :t.
:t: E; E: I::;'. "I" :1: F;'Y TH¢'.,'/t" I~
~'c:,r"t:.h by 'l:..he t%u"l:i.c::i.l::ia:.'~].:i.'L¥ ¢:)~' Ir:~r~c;l'-i(::~r,a:.~.~;:je (Id1::)¢:1) and the S'La.'.l:.e (::~.1'
2, ]: M:i.:l.:i. :i.r"~!!!d:..a.;I.]. 'Lhe ![i~y~.~'t:.em :i.r"~ ac:c:c:.~r'd,.'~!d"~c:e t,.,¢.~.'l:.l"'~ a:l.;I, l"'lE'h'::', (::c:~,de'.,!i.; ¢=',.r"~d
a.r"~d :i,n c:c:,mp :!. :i.,?,u-~c:e ~,.,.,:i..l:.h 'f..he (::le~.i~.:i.,(;:]t"i L'::r' .'i.'t.:.er' ;i.~.4. ,::)(f 'l:.l"t :i.,.'5 I:~,er't¥t.i.'t:..
::i!;,, :I.' ~.~,~:i.:[]. a~..c:ll"~'..:.)r'e 't:,,:::~ a].:t, t"lEh:':~ and 13't:.,';?cLe ~f (..~:l.,'~'¢~s~d,;:,.':'..'~ r'equ.:i.r-em~:..~r"d'..:.,':.~ f(::)r' 't'..he
~:.'I, :i..'.[Fl'..~;~.r"~c::~:)'..;~ I: r' c)m a:',.r'ly e~.;: :i. ~!~Ft'.. :i. r"~g t,,,~e ]. :1.., ~,'~8~...'ii'l'..e~t.~:.:-:,r' ct :i. ~!.~l:)C;:d[ih?..',. ]. !~}/'~i~'l:.efl'~ c:~r' pu.l:::, ]. :i. c:
:t: u.r'l(:,~er'.:.i~.'(:.,:,:H'"~d 'LI"'~.~'~.'!:. 't:.t'"~:i.:!~, per'rrt:i.'L :i.r..{!. '.,.,'a ]. ¢. (::l ~"c:,r' a m.,:,~:...,':i, mt..tm c~,':.' 5 bedr'(:::.,cm'~.~i~.,,
~ ;1. !~(:;~ t..tl"'t (::l ,?:.;, f, ~iiF(:.,.'¢~,.l"),[::} 't'..h.;';';'ct'.. 'Lb(.:9 (;:: .:'3. [.L~ ~'..'~ ,:::: :i. t.¥ ,:3 {' 't..h6:.~. 'l'..,.'::)'t.i.':',. :t. ~ii.:.y!i~;t. eift :i. ~ L""J bed r'
,:a. ny er'!:l..~'~r'gl{:-:.m'~er'~'l:. ~.,¢:[:1.:t. r'e,::.lLi:i.i"e a. rt adc:l:i.'L:i.c)r'ia]. 12er'm:i.'t ....
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CE - 3589
Flattop Technical Servic,
14530 Echo Street
/..oT 7A
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S IT~ PLA N
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l..ocAr/oN.,f'
,,tl- P p' l~ o X t lUl A T l~
Flattop Technical Service
14530 Echo Street
Anchorage, Alaska 995]~
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PLA N V/~ W t"= ~o'-o"
ELEVATION
LOT 6~/~, 8I-OCH ~
ATELIER ..q /D
5 ~ P 'T'I C .5 Y~ T~ Fl D E'-,c / d
t15
Flattop Technical Services
14530 Echo Street
~chorc~qe, ~.laska 9951~
Lot 6A, Block 3, Atelier S/D #2
Septic System Design Notes and Specifications
1. The design of the soil absorption system is, based on a visual soil rating of
150 square feet per bedroom. This requires a total bed area of 1125 square feet
for the proposed 5 bedroom residence. This is to be achieved by a soil absorption
bed with horizontal dimensions of 30' by 38' and a total gravel thickness of 12",
with the bottom of the gravel at an elevation of 12.5 feet below the ground
elevation in the vicinity of test hole #4.
2. The configuration of the system shall be as shown on the plans, except
that minor modifications may be allowed or required by the engineer conducting
the inspections. The finished ground surface shall be graded to drain away from
the site.
3. Installation shall be by an excavator approved by tl~e Municipal Health
Department, and all construction practices and material specifications shall be in
conformance with Municipal requirements.
4. Three inspections will be required: (1) initial stakeout, (2) after the bed is
excavated, but before placement of sewer gravel, and (3) after the gravel is placed,
the septic tank installed, and pipe connected, but before final backfill.
Flattop Technical Services 77. fl. q~: ~ 14530 Echo Street
orage, Alaska 99516 Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
2
3
4
$?
5
6
7
~'t7
10
~2
14
17
18
19
2O
Co
Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED? ~'~
s
L
IF YES, AT WHAT O
DEPTH? p
Depth to Water Alter
Monitoring? Date: ~'/!~/~
SITE PLAN
A
Reading Date Gross Net Depth to Net
Time Time Water Drop
i~" ?r~,e~r ,5'/II ~ :5'~ ,,t~ - ~ 7 v~ _
I~:~ ~y '/~
(minutes/inch) PERC HOLE DIAMETER
~-:
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.
72-008 (Rev. 4/85)
CERTIFY THAT THIS TEST WAS PERFORMED IN
DATE: "~///~'/~::~
Flattop Technical Services
14530 Echo Street
oraqe, Alaska 99516
PERFORMED FOR:
LEGAL DESCmPT~ON:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED? . j~
~t,.~¢¢e ,,:( ft,~c~ t/~,.~¢,,,4 s~
IF YES, AT WHAT 0
DEPTH? p
E
Oepth to Water Alter ~--/~;~/~:~
Monitoring? gale:
SITE PLAN
A
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE
__ (minutes/inch) PERC HOLE DIAMETER
~ ~L, ~'a TEST RUN BETWEEN __ FT AND __
COMMENTS ~'l~_O /'[~¢1t~' ~'~.~¢ /a.¢~//¢o~
FT
PERFORMED BY:
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.
72-008 (Rev. 4/85)
CERTIFY THAT THIS TEST WAS PERFORMED IN
DATE:
Flattop Technical Service~. ~. :~ 3 14530 Echo Street ·
Orage, Alaska 99518 Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
$
9
10
12
13
15
16
17
18
19
2O
COMMENTS 7~, ~ ~( ~,, ~'
_._/fi .... '.'7" · I
'"
MOORE /_ ~
Township, Range, Section:
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT O
DEPTH? p
Deplh to Waler Alter
Monitoring? Date:
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE
__ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FTAND ~FT
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.
72-008 (Rev. 4/85)
CERTIFY THAT THIS TEST WAS PERFORMED IN
DATE: '~/~'{:~/'~,~
Flattop Technical Services
14530 Echo Street
~orage, Alaska 99516
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
1
2
3
4
5
6
7
8
9
10
11
12~
13
14
15
16
17
18
19
2O
.9om~ Gl, ~1~
Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED? N
s
IF YES, AT WHAT OL
DEPTH? p
Depth lo Water Alter 6,"~ r' ~ ~t
Monitoring? Date:
SITE PLAN
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLAT,ON R^TE
'"r:/¢'~, ,,~Y TEST RUN BETWEEN __
COMMENTS ~'~,.z.~¢~
__ (minutes/inch) PERC HOLE DIAMETER
FT AND __ FT
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE,
72-008 (Rev. 4/85)
CERTIFY THAT THIS TEST WAS PERFORMED IN
DATE:
~lattop Technical Services
14530 Echo Street
~nchoraqe,
Alaska
99511~unicipa~ity- of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION: ~',~f ~"/~ 8lk.,,~ ,4fcft~'~'
Township, Range, Section:
SLOPE , SITE PLAN
9
~"' [,~',,'1 WAS GROUND WATER
10 '~ P ~q~'t~,," G/t~'( ENCOUNTERED? N
11 ~cr,
IF YES, AT WHAT
~' ~ DEPTH?
Depth Io Water After
13 ~, ~, ~onitoring~ Date:
s
L
O
P
E
,(
14
15
16
17
18
19
2O
COMMENTS
Reading Date Gross Net Depth to Net
Time Time Water Drop
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES iN EFFECT ON THIS DATE.
PERCOLATION RATE __ (m~nutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FTAND __FT
CERTIFY THAT THIS TEST WAS PERFORMED IN
DATE:
72-008 (Rev. 4/85)
!
/,,
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
COMM4TS
PERFORMED BY:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
72.008 (6/79)
,Su
WAS GROUND WATER
ENCOUNTERED?
SLOPE
,"tO
SOILS LOG
PERCOLATION
TEST
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date
Time Time Water Drop
~ 7-Z3 5":08 ..E' ' ~
Z 5:~3 5 ,5B
~ . 5'.z:~ 5 , "~' ,~o
5 ', r~Fm' 5:z8 5 , ~-0
b / ,, 5:~'~ 3 ,,f0 ,10
7 / 5~:~8 5 ,30
6/' ', 5:,.f~ 5- , ~0
Et " fO' ..5 ', '¢o ..... ,
PERCOLATION RATI L¢~, ~ \ .(minutes/inch)
TEST RUN BETWEEf ~,~, 5 AND I~ FT
CERTIFIED BY:
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOl LS LOG
PERCOLATION
TEST
SLOPE SITE PLAN
.E.FORMEO.¥:
!
72-008 (6/79)
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date
Time Time I'~ ;1~ · Water Drop
+~z) ,5',~ i 3:z~, O. /.7Z. -.~
2. '~:6'0 lo I .GZ.
,5 ~/.oo ~0 I. 77 , O~
i.73
u w,'3p ~o 1.78
'7+/4z° q.'5'9 -~ 3 .,~zs"
PERCOLATION RATE
T/~ BETWEEN '",~,N D
CERTIFIED BY:
Jtes/inch)
MUNICIPALITY OF ANCHORAGE
:s
Development Services DepartmentPhone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 041-031-65
1. GENERAL INFORMATION
Complete legal description Atelier #2 133 L6A
Location (site address) 7230 Montagne Circle
Current property owner(s)
Mailing address
Shawn O'Conner
Expiration Date: `)2ol
u
Day phone
Real estate agent Day phone
2. TYPE OF DWELLING:
E] Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
it
Private Septic
0
Water Storage
❑
Holding Tank
❑
Community Well
❑
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 $ 5 5 b Waiver Fee $
Date of Payment 5 ? 7 1 Date of Payment
Receipt Number �qJr Receipt Number
COSA # OS C 1 I 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.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA
COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time
of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on
the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not
guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot
provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole
benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly
recommends buyers hire their own engineer to evaluate this report.
Name of Firm Pannone Engineering Services Phone (907) 745-8200
Address P.O. Box 1807 Palmer, AK 99645
Engineer's Printed Name Steven R. Pannone P.E.
6. DSD SIGNATURE
VJ System #1 Approved for 13 bedroorns
System #2 Approved for bedrooms
Disapproved
Date
.... ... ....
' ...
Stever f. Pannone
Conditional approval for bedrooms, with the following stipulations:
X VIbso r,p4- ayN '1% �70% uSq_jet f�r-ry & S ►�� z,
on
v N_CAI
� � r
v
o
W p, OGhp,
J Q �
ENT
J
B Ltd"Vi 'JJ�JJ��pM II��J�G\,\�-,
, '���1)11' khN
y ate Date:
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
Septic System Advisory
Well Flow Advisory
COSA Checklist blue sheet
Nitrate Advisory
Arsenic Advisory
Other MeR a R,= &&,lsD ng X
CJ
Legal Description: Atelier #2 133 L6A
If more than 1 septic system on lot: COSA Checklist # 1 of 1
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 11121111996
Total depth 84 ft
Cased to 84 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 16 in.
Date of flow test for COSA '!2'202'
Static water level at beginning of test 53.2 ft.
Comments
B. TANK DATA
Age of tank(s) 25 years
Tank type/material
Measured operating fluid level in septic tank
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 5 - 2-
D. ABSORPTION FIELD DATA Deep Trench
Parcel ID: 041-031-65
Structure served by this system 1
Well production at time of test 4.5 gpm
Water storage tank volume NA gallons
Well di infected for coliform test? El Yes �o
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:
Which system tested (date installed) 81996
Adequacy test date 51121202'
❑ ALL standpipes present per record drawing
Results QPass For 5** bedrooms
Total measured depth from grade 12.5 ft (max)
Fluid depth prior to test 40 in
Measured depth to pipe invert from grade 6.2 ft (min)
Water added 750 gal
❑ N/A — pressurized field
76
New depth in
❑ Monitor tubes go to bottom of effective. If not, state
1440
Elapsed time min
depth into effective
RNCode-requiredsoil cover over field
Final fluid depth 40 in
RE System presoaked
Absorption rate 750 gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months)
date of test)
Gallons introduced 1500* gallons
If yes, enter date
Comments/Deficiencies: 'Saturated field "System is designed for a 5 bedroom
house, house is listed at 3 bedrooms
COSA Checklist yellow sheet
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'
®✓
Yes
Community Sewer Manhole/Cleanout > 100'
✓� Yes
if No
ft
M Yes
if No
Neighboring Tank > 100' 0 Yes
if No
ft
Private Sewer/Septic Line > 25' [D Yes
if No
Absorption Field on Lot > 100' 0 Yes
if No
ft
Holding Tank > 100' El Yes
if No
Neighboring Absorption Fields > 100'
Yes if No
Water Main > 10'
Animal Containment > 50' FV] Yes
if No
0 Yes
if No
ft
Yes if No _
Water Service Line > 10'
0
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway comment below
Community Sewer Main > 75' E] Yes
if No
ft
[Z] Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
®✓
Yes
if No
ft
Surface Water > 100'
[Zl Yes if No .
Property Line > 5'
0
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
0
Yes
if No
ft
Private Wells > 100'✓0
Yes if No
Water Main > 10'
0
Yes
if No
ft
Community Wells > 200'
Yes if No _
Water Service Line > 10'
0
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' El Yes if No ft If absorption field is under driveway comment below
Property Line > 10'
0
Yes
if No
ft
Wells on Adjacent Lots.-
ots:Water
WaterMain > 10'✓(]
Yes
if No
ft
Private Wells > 100'
Water Service Line > 10'
Yes
if No
ft
Community Wells > 200'
Surface Water > 100'
0
Yes
if No
ft
F. ENGINEER'S COMMENTS
Absorption Field is 70% used, ODeratina in its last 30% of its life.
G. ENGINEER'S CERTIFICATION
I certify that / 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
ft
ft
ft
ft
ft
ft
ft
ft
❑✓ Yes if No ft
0 Yes if No ft
>tevein R. Pannone
i r CE 8149v
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904
On‐Site Water and Wastewater Section Fax: 343‐7997
www.muni.org/onsite
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org
Septic Tank Advisory
Certificate of On‐Site Systems Approval # OSC211291
Subdivision: Atelier #2 Block:3, Lot: 6A
The septic tank for this property is 25 years old. The average life for a steel septic
tank is 20 years. Typical replacement costs range from $7,000 to $11,000.
This advisory must be attached to all copies of the subject Certificate of On‐Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
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