HomeMy WebLinkAboutT12N R3W SEC 15 LT 59 LESS S25'TI 2N R3W
Sec 15
Lot 59 Less
525'
#015-052-31
•
Municipality of Anchorage l: •" '
~"
Development Services Department
Building Safety Divbton
'— On-Site Water and Wastewater Program, 4700 Bragaw St.
P.O. Box 196650 Anchorage, AK 99514-6650 Page of
www.d.anchorege.ak.us (907) 3437904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. Swo7-4-4PIDNumber.
015-052-31
Nrtw
Leon
Wastewater System: [I New aUpgrade
n
qS C-Aelson
ABSORPTION FIELD I
Ph"
Rlnmar a Ba0Oan1.
.1__ - _ Tmrn O Shat. Tm Cl Baa O Mand I O ouw
LEGAL DESCRIPTION
add RM.Q
O-W
TOW Daptb ban wqr Vada
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GPDIFtL
Ft.
B1,M UAL B.em aan.
51
Dapdt b P" bOtwn ban M7W V6
Gruel dam banlMh pos
I a
3Ft.
Ft
70.ww. Range
12N 3W
sdJ
IS
Fdacheda wq.W Vad
O-I
Gramal LWM, (06l
O
Ft.
FI.
Well:L ❑ New ❑ Upgrade
ixi ST,'
GravM anMrt
2
1Mmtrabrw
I
DwK. bata..n area
i -
n
Fl.
Ft
Ctnado (Fiesta, . CX
W
7oown
Caged W
TOM M»wn ares. %0IN.bwagladL
P W
tL I �t
l.,1
FL
Ft
T VC 5, e1
l O
oder
DMa peas
W
Sa Wr aLa.M
kw
A+-
h
%O
FL
O O
YOWL
Pulp 5M M,
Curq 11«Va Above Grauta
TANK
GPM/
FL
FL
SEPARATION DISTANCES
❑ Septic ❑ Holding KS.T.E.P. I ❑ Other.
To
Fiom
I Septic
Tank
Absorption
Field
LM
Station
Holding
Tank
a
Sewerlkle
1a' --r
sh ra 1
1250
Wall
1001+
1001+
loo +
N A
251+
MMS
1«mb«a�wnattarda2
ee
BtMadwMa.
,D,
N,0,
Al. 0.
9. o.
LIFT STATION
Ld Lir
ID'+
101+
104-
/V/A
as 1250 GM
At%,:-�ctrccle, Tank
Fwndatan
1
% +
r 1
70 }
[ ..1
SO +
4A
A
'Pimp on Ml M.
-2S
'Puny OR' Y w
N� wM« Mrm M
1 -2Z'I,.
.G h
yy b.
h
cw'"o..
/V A
I LVA
/A
/V/A
N
Mra s MtodM
(fit u
Erctrcr bapectaaa perks eea W a
RrnMbl 3 Ful Fo indjltel
et Lve Ti k
BENCH MARK
Ldcamn and oda,.
QoHorn 5j"Std
'A -',0,
Man
I� 10O FL
1
`
Inspections performed by: Lia Snu rlk 3010 Dates: 1' 8/10,106
Engineer's
6 Q0r,
Q<gS;111
Development Services
2nd
Department Approval
P�(E.�F
g: 4 y ��
Conditional Approval
Date:
i 49TH �w
Lias E.'SPUF CLAYD
�y.
(o6
Reviewed and approved by:(//%3`/?�
Date: - -O
Lba. 0406'
'V
D
b
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LOT 54
VALENT
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— — — — — — — — — — —
1 \1
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LOT 59 A R I
Well
WSTAUED fOW A1W CO. I I
LEVEL
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AAWDOAED DZWG tDwcefTf nen
TANK PCR CODE RCOLIRENENIS
LOT 62A
VALENT
T 12 N R 3 W
SEC15
Z5 0 e5 50 75 LAT 125 150
SCALEt 1' = 50 FT.
WSTAW J-4WDR00Y rpqc swu
1250 CAL SUP TANK �
WDTN 2 fTCT
DL'PTN 11fm I
ROCK d fm
CDVCR J FU7 (INN)
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SPURKLAND
ISPURKLAND ENGINEERINGI I SHEET. 2 T12N R3W SEC 15 LOT 59 I I SEPAC SYSTEM ASBUILT ITE:
203 W 157H. AVENUE LEDNA DAVIDSON DAAUGUST 14, 1006
ANC11. AK. 99501 3 GRID: 2436
lomt �Ta_ To f K 9511 CARLSON ROAD � .
PERMIT k SVO60247 PID # 015-052-31 T12NR3VS15L592.DVG
C 91.0 100.5
I
D 96.5' 106.5
1
f f07.5 0&0
I
C 27.0 J9.0
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WSTAUED fOW A1W CO. I I
LEVEL
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AAWDOAED DZWG tDwcefTf nen
TANK PCR CODE RCOLIRENENIS
LOT 62A
VALENT
T 12 N R 3 W
SEC15
Z5 0 e5 50 75 LAT 125 150
SCALEt 1' = 50 FT.
WSTAW J-4WDR00Y rpqc swu
1250 CAL SUP TANK �
WDTN 2 fTCT
DL'PTN 11fm I
ROCK d fm
CDVCR J FU7 (INN)
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SPURKLAND
ISPURKLAND ENGINEERINGI I SHEET. 2 T12N R3W SEC 15 LOT 59 I I SEPAC SYSTEM ASBUILT ITE:
203 W 157H. AVENUE LEDNA DAVIDSON DAAUGUST 14, 1006
ANC11. AK. 99501 3 GRID: 2436
lomt �Ta_ To f K 9511 CARLSON ROAD � .
PERMIT k SVO60247 PID # 015-052-31 T12NR3VS15L592.DVG
Standard Trench:
2'
Vide
60'
Long
11'
Beep
8'
Sewer rock
3'
Cover
NO SCALE
EL£V.= 98.0"
Silt Barrier
ELEV.= 90.0'
8.0 ft of Septic Rock
Effective
--Oodo 0
O 1250 gal STEP. tank
C
0
a
V
c
1250 gat. S.T.E.P.
ELEV.='40:0' M, L.5,
BENCH MARK BOTTOM SIDING NE
ASSUMED ELEVATION 100 FEET
V
HOUSE I
SPURKLAND LNUINLLRINV SEPTIC SYSTEM ASBUILT
203 W15th Ave T12N RLEO SEC DS LOT 59
Anchorage Ak 99501 LEONA DAVIDSON DATE AUGUST 14, 2006
��a_�.� 9511 CIRLSON ROAD SHEETi 3/3 GRID, 2436
I PERMIT / SWO60247 PARCEL ID / 015-052-51 T12NR3WS15L593.DWG
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Aug 08, 2006
Expiration Date: Aug 08, 2007
Permit Number: SWO60247 Parcel ID: 015-052-31
Legal Description: T12N R31N SEC 15 LT 59 LESS S25'
Design Engineer: 0007 SPURKLAND ENGINEERING Site Address: 009541 CARLSON RD
Owner Name: LEONA DAVIDSON Lot Size: 39220 SO. FT. i
Owner Address: 9511 CARLSON Total Bedrooms: 3 Permit Bedrooms: 3
ANCHORAGE. AK 99507-4323
i
i
This permit is for the construction of:
❑✓ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
I
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specked in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). i
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling �,
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing veeather
must be either: A. Open and closed on the same day. I
B. Covered, sealed, and heated to prevent freezing. i
I
Received By:
Issued By. ���
Date:
Date: 'o
I
Municipality of Anchorage
.� Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
ON-SITE SEPTIC/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 1)15'b59'91
Property owner(s) -Leona. NJ Soy. Day phone
Mailing
M
Site address Sarv1P— Zip Code
I
Code 99516
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Legal description (Sub'd, Block & Lot) "fl2N R3 W Se(. IS Lo} S9 (£SS SQ -6
Legal description (Township, Section &Range) i
Lot Size Sq. Ft.
THIS APPLICATION IS FOR (®all that apply):
Absorption Field
E9
Septic Tank
25
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
I
Number of Bedrooms
I
I
i
i
THIS APPLICATION IS AN:
Initial ❑
Upgrade i 9
Renewal I ❑
I
certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
I
Permit/Rush Fees: N Waiver Fees:
Date of Payment: p I (/04 Date of Payment:
Receipt Number. bN 0 q1 Receipt Number:
(Rev. 11105)
SPUTNumd EIM&Oefing
Environmental Consulting and Design
Municipality of Anchorage
Development Services Department
On Site Water and Wastewater Program
47110 South Ilragaw Street
Anchorage, Alaska 99519
Subject:
SEPTIC SYSTEM DESIGN
T12N R3W SEC 15 LOT 59
Septic Permit
T12N R3W SEC 15 Lot 59
August 1, 2006
Ladies and Gentlemen:
i
1 am writing to request a permit for the construction of a new septic system for this property. The proposed system will
serve a 3 -bedroom single-family residence. The existing septic system was installed in 1979 and is no longer functioning
adequately. There is an existing well on the property.
Solls: A testhole were excavated on July 17, 2006. See the attached soil logs. Ground water was monitored for July
17'" through August 1', 2006. No ground water was detected during this monitoring period.
Surface Water: There are no surface waters within 100 feet of the proposed septic system.
Topography: The topography in the area of the septic system is level.
The installation of this septic system will not prevent wells and septic systems from being installed on the adjacent
lou. There are natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system
will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this
installation.
If you have any questions or concerns, please contact me at 279=3916.
Sincerely,
Lars Spurkland, P.E.
Civil Engineer
i
203 West 15r� Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (907) 276-6013, SpurklandEng@gci.net
r p spwHaimd EIM0001MO IMU
Environmental Consulting and Design
SEPTIC SYSTEM DESIGN
T12N R3W SEC 15 LOT 59
Municipality of Anchorage
Development Services Department
On Site Water and Wastewater Program
4700 South Bragaw Street
August 1, 2006
Anchorage, Alaska 99519
We are submitting an application for the upgrade of the septic system for this lot. The submittal consists of three (3)
drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed
improvements of the lot, of which only the septic system is subject to this permit application, (sheet 2/3), and a schematic
of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable testhole are also enclosed. The septic
system design is based on the following: !
Ground Water Depth> 17 Feet.
Soil Rating. From Testhole 7/18/06.
30 mintin z 0.60 gal per sq.tVday
No. of Bedrooms 3
Required Area per Bedroom: 1501.6 =250 sq.fL
Total area required: 250 x 3 = 750 sqft
USE STANDARD SEPTIC TANK W/ DEEP TRENCH
Bottom Rock At 11 feet
Top Rock At 3 feet
Rock Depth 8 feet
Total Bed Length 750 /16 - 46.8 feet
USE 60 FEET
SYSTEM CONFIGURATION
TOTAL LENGTH
60 FT
TOTAL WIDTH
2 FT
TOTAL DEPTH
11 FT
ROCK DEPTH
8FT
COVER
3 FT (MIN)
203 West 15`h Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (907) 276-6013, SpurklandEng@gei.net I
--� I-- -- I�$eptic5'---
nArea \\
I
LOT 50 I III LOT 1
LOT 54 I I LOT 2
I I vaawr I ® — —
�------
f95THA
l a LOT 59 r - - - LOT 3 - -
LOT 55 I � r
Z 0 I ;3 I LOT 4
I I
LOT58 LOT 62A I LOT 61A
— — — I varnvr I
T12N R3 W SEC15
50 0 50 r00 150 Rw
SCALE, 1' = 100 FT.
BEN SPURKLAND P.E. T1211
f W 151H. AVENUE
H AK. 99501
7)279 16
WT ASV060XXX PID 9
LEONA DAWDSON
9511 CARLSON ROAD
4L.° W49th *-%,%*
ups
SEPTIC SYSTEM DESIGN
DATE. AUGUST 1, 1006
SHEET. 1/3 j CRID. 1436
T12NR3VS15L591.DVG
0
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LOT 54 I ;I
VAMT I I
it
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— — — — — — — — — — —
I
LOT 59 !I
A@AADON Ex/sW WKH PER COVE t I
Well
1 it
wAu TDLANmnom ca I
�d
LOT 62A
VALENT
LEM iI
I
AaAAAWw pasym aawcxErE I
TANK PER CODE REOUNMENN
--
I
T12N R3 W SEC15
L- - - - - - - - -
4 49th If^�
WS SPU RKLAND
No. CE -11300
_ ..�' i- o tom'•••:
25 0 25 50 75 107 125 150 041 '^uklialt$SlzX71"r•
SCALES 1' = 50 FT,
203 W S7H. AEN P.E. T12N R3W SEC 15 LOT 59 SEPTIC SYSTEM DESIGN
103 W 15TH AVENUE •
ANCH. AK. 99501 LEONA DAVIDSON DATE.AUGUST 1, 2006
907 279-3916 11 9511 CARLSON ROAD SHEET. 2/3 j GRID.1s36
PERMIT # PID # T12NR3VS15L592.DVG
(I
06TALL T-"" SE PC 15 VU
10W GAL STEEL TAW !
— — lD0= 6d r— — _
WTH 2 RET
DEPTH !!fE[T
rill;
ROCK Q TILT
COnN 3 M7 (MN)
I I
I
T12N R3 W SEC15
L- - - - - - - - -
4 49th If^�
WS SPU RKLAND
No. CE -11300
_ ..�' i- o tom'•••:
25 0 25 50 75 107 125 150 041 '^uklialt$SlzX71"r•
SCALES 1' = 50 FT,
203 W S7H. AEN P.E. T12N R3W SEC 15 LOT 59 SEPTIC SYSTEM DESIGN
103 W 15TH AVENUE •
ANCH. AK. 99501 LEONA DAVIDSON DATE.AUGUST 1, 2006
907 279-3916 11 9511 CARLSON ROAD SHEET. 2/3 j GRID.1s36
PERMIT # PID # T12NR3VS15L592.DVG
Standard Trench,
2'
Vide
60'
Long
11'
Deep
8'
Serer rock
3'
Cover
NO SCALE
Sit t Bo
8.0 Ft of Septic Rock
Effective
O O
O
0 1000 gal Septic tank
c
a
v
a
.4
C
Monitor
rl0An.,,,+C
NO SCALE
1000 gat septic tank
b
3
ITUBBEN SPURKLAND P.E. 11 T12N R3N' SEC 15 LOT 59 I I SEPTIC SYSTEM DESIGN I
203 orage Ave LEONA DA DATE
Anchornge Ak 99501 AUGUST 1, ?006
279_mj'; 9511 CAR1SON RAID SHEETo 3/3 GRID, 2436
PERMIT / SWO60OXX PARCEL ID / T12NR3WSl5L593.DW0
Municipality of Anchorage � 1%a
Development Services Department y
Building Safety Division :49
y�r On -Site Water and Wastewater Program 10
11 • • • j
4710 South Bragaw SL .0
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.enchoraae.ek.us
(907) 343-7904
Soils Log - Percolation Test II\FOF
Performed For. Lecn7, V4,,.A sen Date Perfc
Legal Description: T l2 At Raw Sec IS LOT Si Township. Range, Section:
Depth
Silt w/
50"Tz sp,�
13-
14-
15-
16-
17--
18-1
3-14-
15-16-
17-
18- Bp•N,
19 -
WAS GROUND NATER • /
ENCOUNTERED? do
8
IF YES, AT NMAT DEPTH? L
Depthlo Weter After D
P
Monitorkv? E
Date: 01 0 (o
-t.-
-1/)9
Reading
Date
Gross Time
Net Time
Depth to Water
( Net Drop
TEST RUN BETWEEN
-411(6106
9tt(o p*1
0 w,,n
TIS 11b"
!
11
4:46 P"I
30,„;,
;31/6 11
It
Slab jtm
60 m:n
Sill(."
I 111
�' Ill1o'
It
S! L16 M
0
I
I
I
PERFORMED PERFORMED IN IN k A L STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATEIS Te lI WLD
PERCOLATION RATE
40
(nWK&M& cn)
PERC HOLE DIAMETER (p
TEST RUN BETWEEN
Lf
FT AND
FT
;;11
COMMENTS Prt- 5O?.k
o�. IU:SS Arn
,�j
I
PERFORMED PERFORMED IN IN k A L STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATEIS Te lI WLD
MUNICIPALITY OF ANCHORAGE
® DEPARTMENT OF HEALTH & ENVIRONMENTAL
PROTE=CTION
ENVIRONMENTAL ENGINEERING
DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264.4720
\
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR
WELL INSPECTION
REPORT
NAME `---
----
PHONE ❑ NEW
UPGRADE
MAILING ADDRESS47
LEGF/9}L DESCRIPTION ''7'' �y �) �% 1
hQ /l / l;c M 1'�, 3 bi
LOCATION
Well Absorptio rea
) ``<�
Dwelling
NO, OF BEDROOMS
PERM N
"7
D DISTANCE TO:
_y
h Z Manufacturer
�'" D
No, of compartments
01 Liq. capacity in gallons IF HOMEMADE: Insidelength
Width
Liquid depth
6 114DISTANCE TO: Well Dwelling
PERMIT NO.
Z
2 h
—
__
Manufacturer
_
Material
Liquid capacity in gallons
D
w=
®�
DISTANCE TO:
Wellr �/
l� -�'
Foundation
Nearest lot line
—L�7`
PERMIT NO
nLS
°1 a U
PZee
No. of lines I_en9th o,� t line
�g
Total lenge lines
dj
Trench width
inches_
Distance bet ei Ines
cc b
Cl
Top of tile to finish grade/
Material beneath the
inches
Total effe ti e a jgprptt
Length
Width
Depth
PERMIT no.
w
Qf-
wE
Type of crib
Crib diameter
Crib depth
Total effective absorption area
w
N
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
W
�
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
7-m .D _
—
SOIL
INSTAL
I C,r
!Ai
{
{�
REMARKS
r%
DATE LEGAL
rA,7PSVEZDJ���n
72-013 (Rev. 3/78)
vv I(1141 1 10 if OIL_F 1-"d" CA V�7 FIVAK" F Qklolwll� y
/ l
|
DEPARTMENT OF HEAL TI AND ENV IR0NMENTHL FkOTECTION� `
^/ J 825 'L' STREET/ ANCHORAGE, OK 99501
y» Vl1^/� 264-4720
11
U--���T-Q A& R171`KEE F? FoEyF!Uql[-F
PERMIT NO. ( 790507 ) &U !}/»'7. |�
RPPLICHNT LEOMH DAVIDSON 3511 CHRLSON RC
LOCOTlON
LEG0L 159 S15 T12N R]W SM LOT SIZE 55450 Slump FFFr
�
/����
� �°
TYPE OF SOlL HBSOR8TION SYSTEM IS: TRENCH >, |
MAXIMUM NUMBER OF BEDROOMS - I SOIL RATING (SQ FT/BR)- 1 0
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
PERMIT DPPLlCHNT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTRLLHTlON INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
--- �1!--U(iin �-::�' T FJA3lF&EFf; F JI: f�-q Q Q FRUEUKA If FRETKA ---
O8CKFlLLlNG OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN H WELL HND RHY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR H PRIVATE WELL, OR
150 TO 208 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION D[HGPRMn ARE
H;RILH8LE TO INSURE PROPER lNST8LLHTl0N.
F m 0 77 VA? 11- E 1. 0- IFE X 4 Do, I ly E? tn Ex LE co EE rl EQ Em F1 20 YL .
I CERTIFY THA -1
1: l HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS
FOKTH RY THE MUNICIPALITY OF HNCHORHqE.
2: [ WILL INSTALL TUE SYSTEM IN ACCORDANCE WITH THE CODES.
]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS.
SIGNED�__�_�\���m.�~�_-�� _--_----------
HPPLICONT LEONR DAVIDSON
ISSUED BY -'%Z-_ -
���RDT
ENLARGEMENT IF THE
;I2
K SOILS LOG
\�
MUNICIPALITY OF ANCHORAGE
\ DEPARTMENTOF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
Pouch 6050, Anchorage, Alaska 99602 270-2221
SOILS LOG -- PERCOLATION TEST
11 WAS GROUND WATER S
�� F le ENCOUNTERED? LO
q /
12 E
I Ur� IF YES, AT WHAT d_
DEPTH? .
13
14 +---'�"� J,
15
16
17
18
19
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
20
PERCOLATION RATE
TESL- RUN BETWEEN
COMMENTS
PERFORMED BY:
CERTIFIED
FT AND m— FT
72-008(78) /3S Ja V ' -�-o /0
T
_ DATE:
?,
-1-t
L, 5,
-\ Municipality of Anchorage
-.1 Development Services Department
Building Safety Division
Onsite Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519te
ww907) 3 3-79 nsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL I "
FOR A SINGLE FAMILY DWELLING
Parcel I.D: ' 015-657 -31 COSA# fko p38f
Expiration Date: — 1(0-106
1..' GENERAL INFORMATION
Complete legal description 'TI1 W 11W S(C K Loo• S9 Less 9.25 r
Location (site address) 9511
Current Property owners) Leon—A. Dh%4 5ov% Day phone
Mailing address `toll L:MISnn Anchnf44P . /AK -1-1
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will
be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3_
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Onsite Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer -registered in the State of Naska.—Certificates of Onsite Systems Approval are required for the transfer -of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with ;valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. 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
Address
Engineer's Printed Name
5. DSD SIGNATURE
t/ Approved for 3 bedrooms.
Disapproved.
Phone 275-Mi(e
Date 14 10 6
��•s) OF A49 1 1
4, 9'14'
T 9 i
LASSE�URKLAI
111 J} �11,��SCS
I1\�giOFESSION�=
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
X Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's I
Other
By: a 0 �//� u%• / aC/1 Original Certificate Date:—
(Rw. 11105)
Municipality of Anchorage
• "` Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
- Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Ta At R3W 56(. 33 Le+ S9 Parcel ID: 015- 067
A. WELL DATA
Well type If A, B, or C provide PWSID # = Well Log (YIN)
Date completed Aft aWWn Sanitary seal (Y/N) Wires properly protected (YIN)
Total depth 2_�tt. Cased to Lft. Casing height (above ground) II Z in.
FROM WELL LOG
Date of test N r%60W' %
Static water level NnhnoW^ ft.
11
Well production LAY% � AUXA- n g.p.m.
WATER SAMPLE RESULTS:
Coliform _—Kcolonies/100 mL Nitrate Oma• 11(0 mg/L
Arsenic: A0 ppb date of sample: � *oG
AT INSPECTION
g /O Ofe
I b0 ft.
'>7;9P1 -n_ g.p.m.
Other bacteria X colonies/100 mL
Collected by:
1-3..
B. SEPTIC/HOLDING TANK DATA
TankType/Material Ana MAS-{
34A_ IsfetI
Date Installed 61,0/0(0
Tank size: 1,250 gal. Number of Compartments Z
Cleanouts (Y/N) I
Foundation cleanout (Y/N) y Depression over lank (YIN)
i
High water alarm (Y/N) i1
Date of pumping at V" Pumper —
C. ABSORPTION FIELD DATA
Date installed 8 to L Soil rating (g.p.d./ft2 or ftZ/bdrm) b.60 System type Deep lren(v-%
Length Gd ft. Width 2 ft.
Gravel below pipe ft.
Total depth 4 ft. Eff. absorption area _Jf?Z Monitoring
tube %Depression over field
Date of adequacy test NevJ Results (Pass/Fail)
For — bedrooms
Fluid depth in absorption field before test — in. Water added= gal. New depth= in.
Elapsed Time: � min. Final fluid depth = in.
Absorption rate >= , I g.p.d.
. /
I
/V
Any rejuvenation treatment (past 12 mo.) (YIN & type) B
�_
If yes, give date
D. LIFT STATION
Date installed g l Oti.
'Pump on' level at 25 in.
Datum TDD Tank
E. SEPARATION DISTANCES
Size in gallons 12 -SO Manhole/Access (Y/N) Y
'Pump off level at qq t in. High water alarm level at Z 2 1 in.
Cycles tested _ Woe W Meets alarm & circuit requirements? Y
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot (00 r4 -
Absorption field on lot 1O6 +
Public sewer main tiI A
r
Sewer /septic service line Z5 +
r
Animal containment areas SO *
On adjacent lots 100 11 -
On adjacent lots too r 1"
Public sewer manhole/cleanout A
Holding tank N/A
t
Manure/animal excrete storage areas 100 i
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
�
Building foundation ID r + Property line 10 t Absorption field S r4
Water main N t Water service line 2 5 + Surface water N. 0.
r
Wells on adjacent lots IDp f
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line to r + Building foundation t0 t+ Water main ,V A
t r
Water Service line -Z5 •+ Surface water /V. 0, Driveway, parking/vehicle storage 10 +
Curtain drain N,0 s Wells on adjacent lots t001 +
F. COMMENTS
G. ENGINEER'S CERTIFICATION P�E•OFA�46% 1
���9'i
1 certify that I have determined through field inspections and i h• �itLiP?.��1�j.-
review of Municipal records that the above systems are in 49TH
conformance with MOA COSA guidelines in effect on this date. 0
Engineer's Printed Name L d(`S Spu�1
Date 44kto
COSA Fee $ D Waiver Fee $
Date of Payment $'� `��QfC Date of Payment
Receipt Number 8q-7& Receipt Number
(Rev. 11/05)
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FINAL STRUCTURE AS -B UILT
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❑ LOT SVRvEr SURVEY
TYPE
SYMBOLS
❑ FRUIDATKeT AS -611T
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PLOT PLANS t LOT SURVEYS 'COIF:
IT IS THE RESPONSIBILITY OF THE BUILDER OR CW+ER. PRIOR TO ONLY 1'HO'r IMPROVFWWTT) ABOVE OROIIND AND VI:<le'.E N1LL e
CONSTRUCTION. TO VERIFY PROPOSED BUILDING: GRADE RFLATIVE SHOWN. FENCES WEU R. SEPTIC CLEANOUT$. SIDEWAII(S. DRIVEWAY'.
TO FINISHLU GNAOL AND UTILITY CONNLCIIVNS ANS TO ULIENMINE ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONI.Y. SNO'
THE EXISTENCE_ OF ANY EASEMENTS. COVENANTS ON NESTRICOONS I MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATE[
�UNrER NO CIRCUMSTANCES STANCES SNOUI.T' A•! A 011!LT FE USED FOR CCF!STRUCT.DF: OR FOR F.STABUSIRNO BOUNDARY OR FENCE LINES.
THE SURVEYOR TAKES RESPONSIBILITY FOR THE INI4AL TRANSACTON ONLY AND ASSIMF.S FINANCIAL LIABILITY ONLY FOR THE COST Or THE SURVEY.
LISTED DISTANCES FREVAII, OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE.